Developing a European urban health indicator system: results of EURO-URHIS 1.

Introduction: More than half of the world's population now live in cities, including over 70% in Europe. Cities bring opportunities but can be unhealthy places to live. The poorest urban dwellers live in the worst environments and are at the greatest risk of poor health outcomes. EURO-URHIS 1 set out to compile a cross-EU inventory of member states use of measures of urban health in order to support policymakers and improve public health policy. Following a literature review to define terms and find an appropriate model to guide urban health research, EURO-URHIS Urban Areas in all EU member states except Luxembourg, as well as Croatia, Turkey, Macedonia, Iceland and Norway, were defined and selected in collaboration with project partners. Following piloting of the survey tool, a the EURO-URHIS 45 data collection tool was sent out to contacts in all countries with identified EUA's, asking for data on 45 Urban Health Indicators (UHI) and 10 other indicators. 60 questionnaires were received from 30 countries, giving information on local health indicator availability, definitions and sources. Telephone interviews were also conducted with 14 respondents about their knowledge of sources of urban health data and barriers or problems experienced when collecting the data. Most participants had little problem identifying the sources of data, though some found that data was not always routinely recorded and was held by diverse sources or not at local level. Some participants found the data collection instrument to not be user-friendly and with UHI definitions that were sometimes unclear. However, the work has demonstrated that urban health and its measurement is of major relevance and importance for Public Health across Europe. The current study has constructed an initial system of European UHIs to meet the objectives of the project, but has also clearly demonstrated that further development work is required. The importance and value of examining UHIs has been confirmed, and the scene has been set for further studies on this topic.

Socio-demographic inequalities in overweight and obesity among Lithuanian adults: time trends from 1994 to 2014.

AIM: The aim was to examine trends in socio-demographic differences in the prevalence of overweight and obesity among the Lithuanian adult population from 1994 to 2014. METHODS: The data from 11 postal surveys were analysed. For every survey, a nationally representative random sample aged 20-64 was drawn from the National Population Register. The sample consisted of 3000 individuals in each of the 1994-2008 surveys and 4000 in the last three surveys. Altogether, 8738 men and 11,822 women participated in the surveys. Self-reported weight and height were used to calculate BMI. RESULTS: From 1994 to 2014, the prevalence of overweight and obesity increased in all socio-demographic groups of men, reaching 58.6% and 19.5% respectively. Highly educated men and those living in cities had higher BMI values than lower educated and non-urban inhabitants without substantial changes in the differences in BMI over the study period. In women, the prevalence of overweight decreased from 51.7% to 46%, whereas the prevalence of obesity did not change being 19.2% in 2014. Overweight and obesity were more common among lower educated women and those living in non-urban areas than in the others. Educational inequalities in weight status of women increased due to the decrease of BMI only in women with university education. CONCLUSIONS TIME TRENDS IN BMI WERE MORE PRONOUNCED AMONG LITHUANIAN MEN THAN WOMEN, WHEREAS SOCIO-DEMOGRAPHIC INEQUALITIES WERE GREATER AMONG WOMEN THE STRATEGIES FOR PREVENTION AND CONTROL OF OBESITY SHOULD TARGET ALL MEN AND WOMEN WITH LOWER EDUCATION AND LIVING IN NON-URBAN AREAS OF LITHUANIA.

Trends in major risk factors and mortality from main non-communicable diseases in Lithuania, 1985-2013.

BACKGROUND: This study aimed to assess the trends in the prevalence and levels of risk factors and mortality from main non-communicable diseases in the Lithuanian population aged 45-64 years during 1985 to 2013. METHODS: Data from four general population surveys conducted between 1985 and 2008 were used. All these surveys were carried out in Kaunas city and five randomly selected municipalities of Lithuania. Risk factors measured at each survey included regular smoking, overweight, obesity, arterial hypertension, and high levels of blood lipids. In total, data of 10,719 subjects (4,965 men and 5,754 women) aged 45-64 were analysed. Trends in standardized all-cause mortality and mortality from cardiovascular disease (CVD), coronary heart disease (CHD), and malignant neoplasms were estimated for both sexes by joinpoint regression analysis. RESULTS: In 1985-2013, some favourable trends were observed in the age-standardized mean levels and prevalence of risk factors and mortality from main non-communicable diseases in the Lithuanian middle-aged population. The mean values of blood lipids (with the exception of triglycerides) and the prevalence of dyslipidemias declined. In women, mean levels of systolic blood pressure and body mass index decreased, while in men, the levels of these factors increased. The prevalence of arterial hypertension and obesity increased in men. The proportion of obese women decreased. Smoking prevalence increased in both men and women. From 2007 to 2008, significant downward trends, which were steeper in women than in men, were observed in all-cause, CVD, and CHD mortality. CONCLUSIONS: Despite the favourable changes in some risk factors and mortality rates, the prevalence of risk factors and mortality from main non-communicable diseases in Lithuania are still high. This indicates the importance of the ongoing primary and secondary prevention and optimal treatment of these diseases.

Associations between risk factors in childhood (12-13 years) and adulthood (48-49 years) and subclinical atherosclerosis: the Kaunas Cardiovascular Risk Cohort Study.

BACKGROUND: The data on the childhood determinants of adult cardiovascular disease (CVD) are lacking in populations of Eastern Europe that are characterised by substantially high CVD mortality. From a public health perspective, it is important to identify high-risk individuals as early as possible in order to have the greatest benefit of preventive interventions. The aim of this study was to evaluate the associations of childhood and adulthood traditional risk factors with subclinical atherosclerosis and arterial stiffness in a Lithuanian cohort followed up for 35 years. METHODS: The study cohort consisted of 380 adults aged 48-49 from Kaunas Cardiovascular Risk Cohort study, who were followed up since childhood (12-13 years). The baseline survey (1977) included blood pressure (BP) and anthropometric measurements and sexual maturity scale. In the follow-up survey (2012), BP, anthropometric and lipids measurements, interview about smoking, measurement of carotid intima-media thickness (IMT) and determination of pulse wave velocity (PWV) were performed. Two types of general linear models were applied to test the associations of childhood and adulthood risk factors with IMT and PWV. Model 1 included only childhood variables. In model 2, adulthood variables were added to childhood variables. RESULTS: In linear regression model with childhood variables childhood systolic BP (ß = 0.014; p = 0.016) and BMI (ß = 0.006; p = 0.003) were directly associated with IMT only in women. When adulthood variables were included into regression model, the association between childhood systolic BP and IMT remained significant (ß = 0.013; p = 0.021), while childhood BMI was not associated with IMT (ß = 0.003; p = 0.143). Additionally, association of adult smoking and IMT was found in women (ß = 0.033; p = 0.018). IMT of men was directly related to adult systolic BP (ß = 0.022; p = 0.018) and inversely to HDL cholesterol level (ß = -0.044; p = 0.021). PWV was directly associated only with adult systolic BP in both genders (ß = 0.729 for men and ß = 0.476 for women; p = 0.001). CONCLUSIONS: Sex differences in the associations between childhood and adulthood risk factors and subclinical atherosclerosis were found. The results of the study support efforts to reduce conventional risk factors both in childhood and adulthood for the primary prevention of atherosclerosis.

The effect of tobacco control policy on smoking cessation in relation to gender, age and education in Lithuania, 1994-2010.

BACKGROUND: This study aimed to evaluate the association between tobacco control policies and trends in smoking cessation according to gender, age and educational level in Lithuania in 1994-2010. METHODS: The data were obtained from nine cross-sectional postal surveys conducted biennially within the framework of Finbalt Health Monitor project during 1994-2010. Each survey was based on a nationally representative random sample drawn from the National population register. The sample consisted of 3000 citizens aged 20-64 in 1994-2008 surveys and 4000 in the 2010 survey. In total, 17161 individuals participated in all surveys. The development of tobacco control policy in Lithuania was assessed using the Tobacco Control Scale (TCS). The association of the TCS scores with short-term and long-term quitting according to gender, age and education was examined using logistic regression analysis with control for secular trends. RESULTS: Over the last two decades, a large improvement in the development of tobacco control policy has been achieved in Lithuania. At the same time, this progress was associated with the increase in smoking cessation. A significant increase in both short-term and long-term quit ratios was found among people aged 20-44. An increase by 10 points on the TCS was associated with 17% increase in the odds of short-term quitting and with 15% increase in the odds of long-term quitting. The association between tobacco control policies and long-term quitting was stronger among younger than older people. No differential effect of tobacco control policies on smoking cessation was found in relation to gender and educational level. CONCLUSIONS: The improvement in Lithuanian tobacco control policies was associated with an increase in smoking cessation in long-term perspective. These policies have not only benefitted highly educated groups, but lower educated groups as well. Nonetheless, further development of comprehensive tobacco control policies is needed in order to decrease social inequalities in smoking cessation.

Anthropometric measurements in childhood and prediction of cardiovascular risk factors in adulthood: Kaunas cardiovascular risk cohort study.

BACKGROUND: This study aimed to examine the associations between anthropometric measurements in childhood and adulthood as well as the effect of childhood body mass index (BMI) and skinfold thickness in the prediction of adult cardiovascular risk factors. METHODS: The Study subjects were participants of the Kaunas Cardiovascular Risk Cohort study. They were 12-13 years old at the time of the baseline survey (1977) and 48-49 years old in the 35-year follow-up survey (2012, n = 506). In childhood, height, weight, subscapular and triceps skinfold thickness measurements were taken. In 2012, health examination involved measurements of blood pressure (BP), BMI, waist circumference, glucose, lipids, and high-sensitivity C-reactive protein (CRP) levels. Logistic regression models were fitted to assess the associations of childhood BMI and skinfold thicknesses as well as BMI gain with cardiovascular risk factors in middle age. All logistic regression models were adjusted for sex, physical activity level, alcohol consumption, smoking and family history of obesity. RESULTS: Over 35 years of follow-up, BMI gain was greater in men than in women. Anthropometric measurements in childhood significantly correlated with values measured in adulthood. The highest correlation coefficients were defined for weight and BMI measurements (in girls r = 0.56 and r = 0.51 respectively; in boys r = 0.45 and r = 0.41 respectively, P < 0.001). Mean values of change in BMI were similar in all quintiles of childhood BMI; however, prevalence of adult obesity increased considerably with increasing quintiles. The risk of adult obesity, metabolic syndrome, hyperglycaemia or type 2 diabetes, and elevated level of high-sensitivity CRP increased with a rise in childhood BMI and skinfold thicknesses, irrespectively of BMI gain from childhood to adulthood. No relationship was found between childhood anthropometric measurements and arterial hypertension, raised level of triglycerides or reduced level of HDL cholesterol. Gain in BMI from childhood to adulthood was associated with increased odds of all above-mentioned risk factors independently of childhood BMI. CONCLUSIONS: Risk of metabolic syndrome, hyperglycaemia and diabetes, and elevated high-sensitivity CRP may be affected by childhood BMI and skinfold thickness, while risk of hypertension, raised triglycerides and reduced HDL cholesterol is associated more strongly with BMI gain from childhood to adulthood.

Association between APOE, SCARB1, PPARα polymorphisms and serum lipids in a population of Lithuanian adults.

BACKGROUND: Dyslipidemia is one of several known risk factors for coronary heart disease, a leading cause of death in Lithuania. Blood lipid levels are influenced by multiple genetic and environmental factors. Epidemiological studies demonstrated the impact of nutrition on lipid levels within the Lithuanian population although the role of genetic factors for dyslipidemias has not yet been studied. The objective of this study was to assess the distribution of the APOE, SCARB1, PPARα genotypes in the Lithuanian adult population and to determine the relationship of these genotypes with dyslipidemia. METHODS: A cross-sectional health survey was carried out in a representative random sample of the Lithuanian population aged 25-64 (n=1030). A variety of single-nucleotide polymorphisms (SNPs) of the APOE (rs429358 and rs7412), SCARB1 (rs5888) and PPARα (rs1800206) genes were assessed using real-time polymerase chain reaction. Serum lipids were determined using enzymatic methods. RESULTS/PRINCIPAL FINDINGS: Men and women with the APOE2 genotype had the lowest level of total and low-density lipoprotein cholesterol (LDL-C). Men with the APOE2 genotype had significantly higher levels of triglycerides (TG) than those with the APOE3 genotype. In men, the carriers of the APOE4 genotype had higher odds ratios (OR) of reduced (<1.0 mmol/L) high density lipoprotein cholesterol (HDL-C) levels versus APOE3 carriers (OR=1.98; 95% CI=1.05-3.74). The odds of having elevated (>1.7 mmol/L) TG levels was significantly lower in SCARB1 genotype CT carriers compared to men with the SCARB1 genotype CC (OR=0.50; 95% CI=0.31-0.79). In men, carriers of the PPARα genotype CG had higher OR of elevated TG levels versus carriers of PPARα genotype CC (OR=2.67; 95% CI=1.15-6.16). The odds of having high LDL-C levels were lower in women with the APOE2 genotype as compared to APOE3 genotype carriers (OR=0.35; 95% CI=0.22-0.57). CONCLUSIONS/SIGNIFICANCE: Our data suggest a gender difference in the associations between APOE, SCARB1, PPARα genotypes and lipid levels. In men, the APOE4 genotype and PPARα genotype CG were correlated with an atherogenic lipid profile while the SCARB1 genotype CT had an atheroprotective effect. In women, APOE2 carriers had the lowest odds of high LDL-C.

Time trends in social differences in nutrition habits of a Lithuanian population: 1994-2010.

BACKGROUND: During the post-communist transition period, political, economic, and social changes affected the lifestyles of the Lithuanian population, including their nutritional habits. However, people of lower socio-economic position were more vulnerable to these changes. The aim of the present study was to evaluate the trends in selected food habits of the Lithuanian adult population by their level of education and place of residence from 1994 to 2010. METHODS: The data were obtained from nine biannual cross-sectional postal surveys of Lithuanian health behaviours, beginning in 1994. Each survey used a randomly selected nationally representative sample of 3000 inhabitants aged 20-64 drawn from the population register. In total, 7358 men and 9796 women participated in these surveys. Questions about food consumption were included within all health behaviour questionnaires. RESULTS: During the transition period, use of vegetable oil in cooking and the frequency of consumption of fresh vegetables increased, use of butter on bread decreased, and the proportion of women drinking high-fat milk declined. Lithuanians with higher education reported more frequent use of vegetable oil in cooking as well as daily consumption of fresh vegetables than those with a lower level of education. Consumption of high-fat milk was inversely associated with educational background. In addition, the proportion of persons spreading butter on bread increased with higher education level. The greatest urban-rural difference was observed in high-fat milk consumption. The increase in the use of vegetable oil in cooking, and the reduction of spreading butter on bread was more evident among less educated and rural inhabitants. Meanwhile, a greater proportion of the rural population, compared to urban, reduced their use of butter on bread. Daily consumption of fresh vegetables increased most among highly educated Lithuanians. CONCLUSIONS: The data from our study indicate beneficial dietary changes among the Lithuanian adult population. In general, those with a higher level of education had healthier food habits than those with low education. The educational gradient in analyzed food habits, except the use of vegetable oil, enlarged. A higher proportion of the rural population, compared to urban, reduced their usage of butter on bread. However, consumption of high-fat milk was greatest in the rural population. Our data highlight the need for future food and nutrition policies, as well as health promotion programmes, targeting the whole population, particularly those with lower education and living in rural areas.

Trends and social differences in alcohol consumption during the postcommunist transition in Lithuania.

The aim of the study was to evaluate the trends and social differences in consumption of various types of alcoholic beverages in Lithuania over the postcommunist transition period (1994-2010). The data were obtained from nine nationally representative postal surveys of Lithuanian population aged 20-64 conducted every second year (n = 17154). Prevalence of regular (at least once a week) consumption of beer, wine, or strong alcoholic beverages and the amount of alcohol consumed per week were examined. Regular beer drinking as well as the amounts consumed increased considerably in both genders. The increase in regular consumption of strong alcohol was found among women. Sociodemographic patterning of regular alcohol drinking was more evident in women than in men. In women, young age and high education were associated with frequent regular drinking of wine and beer. Social differences in regular alcohol drinking should be considered in further development of national alcohol control policy in Lithuania.

Sources and reasons for seeking health information by Lithuanian adults.

UNLABELLED: The aim of this study was to assess the attitudes of Lithuanian adults aged 20-64 years toward the reasons for accessing health information and to determine the main health information sources and their relation to sociodemographic factors. MATERIAL AND METHODS: The data for this study were gathered in 2008 within the framework of the International Project Finbalt Health Monitor evaluating health behavior in a Lithuanian adult population. RESULTS: More than half of respondents searched for health information during the last year. Men were 2.7 times more likely to trust friends and family as a health information source compared with women. For each 1-year increase in age, the odds of using friends and family, and the Internet as the main sources of health information decreased, while the odds of using people with the same condition and different means of media increased. Marital status was associated with greater trust in health professionals and the Internet as health information sources. Higher education was positively associated with more frequent reporting courses and lectures, and the Internet as the sources of health information, while those with lower education preferred television and radio. CONCLUSIONS: This study revealed the characteristics of the "risk group" in terms of the sources of health information that people, assigned to it, tend to use, and it is especially important when providing health information.

Diet and dyslipidemias in a Lithuanian rural population aged 25-64: the CINDI survey.

UNLABELLED: The aim of the study was to evaluate the dietary intake of a Lithuanian rural population and to assess the relationship between diet and dyslipidemias. MATERIAL AND METHODS: A cross-sectional health survey was carried out in 5 municipalities of Lithuania in 2007. The random sample was obtained from lists of 25- to 64-year-old inhabitants registered at primary health care centers (n=1739). The food frequency questionnaire and 24-hour recall was used for the evaluation of nutrition habits. The levels of serum lipids were determined using enzymatic methods. Factor analysis was employed in order to reduce the number of food items. The scores of food factors were used in linear regression analysis of associations between nutrition and serum lipid levels. RESULTS: The diet of the study population was very high in fat, especially in saturated fatty acids. The content of cholesterol in the diet of men was higher than recommended. The main sources of fat and protein were meat, milk, and their products. Cereals were the main source of carbohydrates. The major proportion of monosaccharide and disaccharides was derived from confectionary and fruits. The mean serum total cholesterol level was 5.60 mmol/L in men and 5.51 mmol/L in women. CONCLUSIONS: Healthier food patterns were associated with the lower levels of total, low-density lipoprotein cholesterol, and triglyceride.

Diet and serum lipids: changes over socio-economic transition period in Lithuanian rural population.

BACKGROUND: Since regaining of independence in 1990, Lithuania has been undergoing substantial political, economic, and social changes that affected the nutrition habits of population. Dietary changes might have impact on the trends of dietary related risk factors of chronic diseases. The aim of the study was to compare trends in diet and lipid profile of Lithuanian rural population aged 25-64 during two decades of transition period (1987-2007). METHODS: Four cross-sectional surveys were conducted within the framework of the Countrywide Integrated Noncommunicable Diseases Intervention Programme in five regions of Lithuania in 1987, 1993, 1999, and 2007. For each survey, a stratified independent random sample was drawn from the lists of the inhabitants aged 25-64 years registered at the primary health care centres. Altogether 3127 men and 3857 women participated in the surveys. 24-hour recall was used for evaluation of dietary habits. Serum lipids were determined using enzymatic methods. Predicted changes of serum cholesterol were calculated by Keys equation. RESULTS: The percentage of energy from saturated fatty acids has decreased from 18.0 to 15.1 among men and from 17.6 to 14.8 among women over the period of 20 years. The average share of polyunsaturated fatty acids in total energy intake increased from 5.3% to 7.1% among men and from 4.9% to 7.3% among women. The mean intake of cholesterol declined among women. Favourable trends in fatty acids composition were caused by increased use of vegetable oil for cooking and replacement of butter spread with margarine. Since 1987, the mean value of total cholesterol has decreased by 0.6 mmol/l. Total dietary effect accounts for a 0.26 mmol/l (43.3%) decline in serum cholesterol among men and 0.31 mmol/l (50.8%) decline among women. CONCLUSIONS: Improvement in the quality of fat intake was observed in Lithuanian rural population over two decades of transition period. Positive changes in diet, mainly reduction in saturated fatty acids intake, contributed to decline in serum cholesterol level. Strengthening of favourable trends in nutrition habits in Lithuanian population should be one of the most important strategies of cardiovascular diseases prevention.

Associations between depressiveness and psychosocial factors in Lithuanian rural population.

BACKGROUND AND OBJECTIVE: Data from various scientific studies all over the world show that depression is becoming one of the biggest health problems in society. The aim of this study was to evaluate characteristics of depressiveness and its associations with psychosocial factors (stress, social support, suicidal intentions) in Lithuanian adult rural population. MATERIAL AND METHODS: Within the Countrywide Integrated Non-communicable Diseases Intervention (CINDI) program, the survey was carried out in a stratified random sample of population aged 25-64 in 5 rural regions of Lithuania between 2006 and 2007. A total of 1754 participants were examined. RESULTS: About half (43.8%) of respondents experienced high and moderate levels of depressiveness. Women in comparison to men reported higher levels of depressiveness. The likelihood of depressiveness among women was related to older age, lower education, small social network, lower level of social support, higher level of stress, and suicidal intentions. Whereas, the same indicator among men was associated with older age, lower education, being divorced, small social network, having no social support, higher level of stress, and suicidal intentions. CONCLUSIONS: Depressiveness is highly prevalent among Lithuanian rural population with a higher prevalence among women than men. Older persons and persons with lower education of both genders were more likely to be depressed than younger and more educated persons. Absence of social support, high level of stress, and suicidal intentions were related to higher levels of depressiveness in both genders. Depressiveness was more common among women having a small social network and divorced men.

[Characteristics of social support and their associations with depressiveness among Lithuanian adult rural population]. / Lietuvos rajonu suaugusiu gyventoju socialines paramos savitumai ir sasajos su depresiskumu.

BACKGROUND AND OBJECTIVE: Data of recent scientific studies have showed strong associations between person's social environment and physical and mental health. The aim of this study was to evaluate the characteristics of social support and disclose their associations with depressiveness in rural adult population. MATERIAL AND METHODS: In 2006-2007, the survey was carried out in a random sample of population aged 25-64 years in five rural regions of Lithuania within the framework of the international CINDI program. A total of 1754 participants were interviewed using structured questionnaires. The associations between depressiveness and indicators of social support were assessed using logistic regression analysis. RESULTS: About one-third (34.7%) of respondents had little social support in their closest social environment, and 4.5% had no supporting persons at all. A lack of social support was more characteristic of women and less educated persons. The greater likelihood of depressiveness was related to worse indicators of social support: small social network, lack of support, and difficulties in communication with a husband/wife and relatives. Older and less educated women and men and those having poor relationships were more likely of being depressed. Depressiveness among men was also associated with being divorced. CONCLUSIONS: One-third of Lithuanian adult rural population reported a lack of social support. The established associations between social support and depressiveness indicate that the development of social skills is an important resource for mental health improvement.

Female ever-smoking, education, emancipation and economic development in 19 European countries.

Large differences in ever-smoking rates among women are found between countries and socio-economic groups. This study examined the socio-economic inequalities in female ever-smoking rates in 19 European countries, and explored the association between cross-national differences in these inequalities and economic development and women's emancipation. Data on smoking were derived from national health interview surveys from 19 European countries. For each country, age group (25-39, 40-59 and 60+ years), educational level (4 standard levels), and cumulative ever-smoking rates were calculated as the proportion of current and former smokers of the total survey population. A Relative Index of Inequality was estimated for women in the three age groups to measure the magnitude of educational differences. In regression analyses the association of ever-smoking rates of women age 25-39 years with the gross domestic product (GDP) and the Gender Empowerment Measure (GEM) was explored. Less educated women aged 25-39 years were more likely to have ever smoked than more educated women in all countries, except Portugal. In the age groups 40-59 years the educational pattern differed between countries. Women aged 60+ years who were less educated were less likely to have ever smoked in all countries, except Norway and England. The size of inequalities varied considerably between countries and reversed within three age groups. For women 25-39 years, the association of ever-smoking rates with GDP was positive, especially for more educated women. The association of ever-smoking rates with GEM was positive for less educated women, but negative for more educated women. The results are consistent with the idea that economic development and social-cultural processes related to gender empowerment have affected the diffusion of smoking in different ways for more and less educated women.

Association between educational level and vegetable use in nine European countries.

OBJECTIVE: The relationship of socio-economic status and vegetable consumption is examined in nine European countries. The aim is to analyse whether the pattern of socio-economic variation with regard to vegetable consumption is similar in all studied countries with high v. low vegetable availability and affordability, and whether education has an independent effect on vegetable consumption once the effects of other socio-economic factors have been taken into account. DESIGN: The data for the study were obtained from national surveys conducted in Finland, Denmark, Germany, Estonia, Latvia, Lithuania, France, Italy and Spain, in 1998 or later. These surveys included data on the frequency of use of vegetables. Food Balance Sheets indicated that the availability of vegetables was best in the Mediterranean countries. The prices of vegetables were lowest in the Mediterranean countries and Germany. RESULTS: Educational level was positively associated with vegetable consumption in the Nordic and Baltic countries. In the Mediterranean countries, education was not directly associated with the use of vegetables but, after adjusting for place of residence and occupation, it was found that those with a lower educational level consumed vegetables slightly more often. Manual workers consumed vegetables less often than non-manual workers, but otherwise there was no systematic association with occupation. CONCLUSIONS: The Mediterranean countries did not show a positive association between educational level and vegetable consumption. The positive association found in the Northern European countries is linked to the lower availability and affordability of vegetables there and their everyday cooking habits with no long-standing cultural tradition of using vegetables.

[Dietary patterns and their association with lifestyle factors in Lithuanian adult population]. / Lietuvos gyventoju mitybos iprociu ir gyvensenos veiksniu sasajos.

The aim of this study was to determine the association between dietary patterns and others lifestyle factors. In 1998-2004, four cross-sectional surveys were carried out within the FINBALT HEALTH MONITOR project. For every survey, a random sample of 3000 Lithuanians, aged 20-64 years, was taken from the National Population Register. The response rates varied from 61.7% to 74.4%. The study material was collected by mailed questionnaires. The 20 food groups were included into food frequency questionnaire. Factor analysis was employed in order to reduce the number of food items. Four main factors were identified: "Light food," "Sweets," "Heavy food," and "Cereals." They accounted for 46% of total variance in food intake in men and women. The associations between dietary patterns and lifestyle factors were examined by applying logistic regression analysis. Nonsmokers, physical active people, wine drinkers, and men consuming beer were more likely to follow the "Light food" pattern (consumption of fresh vegetables, fruits, chicken, and fish). People having positive values of the "Cereals" pattern smoked and drank alcohol less often and were more physical active than those with negative values of the factor. "Heavy food" factor was associated with daily smoking and drinking of strong alcohol in men and drinking of beer in women. The consumers of strong alcohol and people less physically active in leisure time were more likely to follow "Sweets" pattern. CONCLUSIONS. Nutrition habits were related to lifestyle factors. Men and women who followed the "Cereals" pattern have the healthiest lifestyle.

Evaluation of dental care and the prevalence of tooth decay among middle-aged and elderly population of Kaunas city.

UNLABELLED: The aim of the study was to evaluate the prevalence and the intensity of tooth decay among the middle-aged and elderly population of Kaunas, city, and to assess the need for prostheses as well as the possibilities for oral care. MATERIAL AND METHODS: During 2006-2008, we studied 1,141 inhabitants of Kaunas city; the subjects' age was 45-72 years. Oral evaluation technique proposed by the WHO was used in the investigation. We evaluated the prevalence of tooth decay, and its intensity was evaluated using the DMF-T index. We also evaluated dental prostheses, the need for prosthetics, and asked the subjects how they took care of their oral health. RESULTS: The prevalence of tooth decay among middle-aged and elderly population of Kaunas city was 99.9%. The DMF-T index was 21.01+/-0.3 in the age group of 45-54 years, 23.52+/-0.4 - in the age group of 55-64 years, and 25.63+/-0.3 - in the elderly subjects. Full removable dentures were found in 14.0% of the elderly subjects, while 1.0% of the middle-aged subjects and 1.2% of the elderly subjects required full dentures. 57.7% of the subjects aged 45-54 years, 53.1% of the subjects aged 55-64 years, and 43.4% of the elderly subjects brushed their teeth twice daily. CONCLUSIONS: The intensity of tooth decay in middle-aged and elderly population of Kaunas city significantly increased with age (21.01-25.63). A relationship was found between oral hygiene status and the DMF-T index. In the middle-aged and elderly population of Kaunas city, the intensity of tooth decay was significantly lower (DMF-T 23.04%) among those who brushed their teeth twice daily than among those who brushed their teeth once daily or less frequently (DMF-T 24.01%). Reduction of the prevalence of tooth decay among middle-aged and elderly population of Kaunas city necessitates alterations in people's attitudes towards dental care, implementation of suitable hygiene habits, and creation and implementation of the dental disease prevention program for adults and the elderly, based on the strategy proposed by the World Health Organization.

Corrigendum to "Factors Associated with the Prevalence of Thyroid Nodules and Goiter in Middle-Aged Euthyroid Subjects".

[This corrects the article DOI: 10.1155/2017/8401518.].

Dietary patterns and their association with sociodemographic factors in Lithuanian adult population.

SUMMARY: The aim of the study was to determine the association between dietary patterns and sociodemographic factors using the data of Lithuanian health behavior monitoring. MATERIAL AND METHODS: In 1998-2004, four cross-sectional surveys were carried out within the Finbalt Health Monitor project. For every survey, a random sample of 3000 Lithuanians aged 20-64 years was taken from the National Population Register by mailed questionnaires. The response rates varied from 61.7% to 74.4%. Factor analysis was employed in order to reduce the number of food items. Four main factors were defined: "light food," "sweets," "heavy food," and "cereals" factors. The associations between dietary patterns and sociodemographic factors were examined by applying a logistic regression analysis. RESULTS: Four major factors accounted for 45.9% of the total variance in food intake in men and 46.5% in women. The "sweets" factor was inversely associated with age both in men and women. A strong positive association was found between age and the "cereals" factor. Men and women with a higher level of education were more likely to follow "light food" and "sweets" pattern and less likely "heavy food" if compared with people with a lower level of education. The odds of consuming "light food" were higher in cities than in rural areas. Married men and women were more likely to follow "heavy food" pattern compared to unmarried. CONCLUSION: This study identified four main dietary patterns in Lithuanian population. Dietary patterns of people with a higher level of education and inhabitants of cities are closer to the recommendations on healthy nutrition.