Cross-cultural connections: School climate and equity in Germany, Italy, Latvia, and the United States.

In recent decades, much international research has been carried out on school climate and its relationship with learning, socioemotional, and health outcomes (Berkowitz et al., 2017; La Salle, Rocha-Neves, et al., 2021; Pizmony-Levy et al., 2019). Limited research has been carried out to investigate the relationship between school climate and educational inequalities, with particular reference to the results obtained by minoritized students. This contribution focuses on this issue, and it is organized as follows. First, The International School Climate Collaborative, which led to the cross-cultural adaptation of the Georgia School Climate Survey, is presented with normative data for the use of the survey with secondary school students in four countries: Germany, Italy, Latvia, and the United States (La Salle, Rocha-Neves, et al., 2021). Second, the theme of the relationship between School Climate and Educational Equity is focused on the basis of the most recent scientific literature. Third, the theme of the relationship between School Climate and Educational Equity is focused on comparing four countries: the United States, Germany, Italy, and Latvia. Fourth, the practical implications are investigated, focusing on three possible interventions that could be useful for improving the school climate while promoting equity and valuing cultural differences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A narrative review of alcohol control policies in Latvia between 1990 and 2020.

ISSUES: Latvia has one of the highest alcohol per capita consumption in Europe. This study provides a narrative review of all evidence-based population-level alcohol control policies implemented in Latvia during the past 30 years. APPROACH: A review of country-level alcohol control policies implemented in Latvia between 1990 and 2020 was conducted. The World Health Organization's "best buys" and other recommended interventions for alcohol control were used to guide the search. KEY FINDINGS: Alcohol control policies in Latvia have evolved significantly over the last three decades. The most changes to alcohol control policy occurred in the transitional period between regaining independence in 1991 and joining the European Union in 2004. A number of significant alcohol control policies have been implemented to reduce alcohol availability and affordability, to restrict alcohol marketing and to counter drunk-driving. However, since 2010, when an increasing trend of alcohol consumption was observed, there has been a reluctance to pursue national public health policy actions to reduce alcohol consumption, and few adjustments to legislation to increase alcohol control have been made. IMPLICATIONS: Despite the progress in alcohol control, Latvia still has considerable potential for strengthening alcohol control to reduce the high levels of alcohol consumption. CONCLUSION: Although several alcohol control policies have been established in Latvia, many of the planned activities to limit alcohol intake and related harm have not been executed. Public health goals rather than political and economic incentives should be prioritised to reduce high levels of alcohol consumption in Latvia.

Detection of SARS-CoV-2 RNA in wastewater and importance of population size assessment in smaller cities: An exploratory case study from two municipalities in Latvia.

Wastewater-based epidemiology (WBE) has regained global importance during the COVID-19 pandemic. The mobility of people and other factors, such as precipitation and irregular inflow of industrial wastewater, are complicating the estimation of the disease prevalence through WBE, which is crucial for proper crisis management. These estimations are particularly challenging in urban areas with moderate or low numbers of inhabitants in situations where movement restrictions are not adopted (as in the case of Latvia) because residents of smaller municipalities tend to be more mobile and less strict in following the rules and measures of disease containment. Thus, population movement can influence the outcome of WBE measurements significantly and may not reflect the actual epidemiological situation in the respective area. Here, we demonstrate that by combining the data of detected SARS-CoV-2 RNA copy number, 5-hydroxyindoleacetic acid (5-HIAA) analyses in wastewater and mobile call detail records it was possible to provide an accurate assessment of the COVID-19 epidemiological situation in towns that are small (COVID-19 28-day cumulative incidence r = 0.609 and 35-day cumulative incidence r = 0.89, p < 0.05) and medium-sized towns (COVID-19 21-day cumulative incidence r = 0.997, 28-day cumulative incidence r = 0.98 and 35-day cumulative incidence r = 0.997, p < 0.05). This is the first study demonstrating WBE for monitoring COVID-19 outbreaks in Latvia. We demonstrate that the application of population size estimation measurements such as total 5-HIAA and call detail record data improve the accuracy of the WBE approach.

Assessment of Iodine and Selenium Nutritional Status in Women of Reproductive Age in Latvia.

Background and Objectives: Adequate dietary intake of iodine and selenium is essential during pregnancy. While iodine is vital for maternal thyroid function and fetal development, selenium contributes to the regulation of thyroid function and thyroid autoimmunity. This study aimed to assess the consumption of iodine- and selenium-containing products by women of reproductive age and the iodine and selenium nutritional status of pregnant women in Latvia. Materials and Methods: Population health survey (2010-2018) data were used to characterize dietary habits in women of reproductive age. Additionally, 129 pregnant women in the first trimester were recruited; they completed a questionnaire and were tested for thyroid function, urinary iodine concentration (UIC), and serum selenium and selenoprotein P levels. Results: The use of some dietary sources of iodine (e.g., milk and dairy products) and selenium (e.g., bread) has decreased in recent years. Less than 10% of respondents reported the use of iodized salt. The use of supplements has become more common (reported by almost 50% of respondents in 2018). Dietary habits were similar in pregnant women, but the use of supplements was even higher (almost 70%). Nevertheless, most supplements used in pregnancy had insufficient contents of iodine and selenium. Thyroid function was euthyreotic in all women, but 13.9% of participants had a thyroid peroxidase antibodies (TPO-ab) level above 60 IU/mL. The median UIC (IQR) was 147.2 (90.0-248.1) µg/gCr, and 52.8% of pregnant women had a UIC below 150 µg/gCr. The mean selenium (SD) level was 101.5 (35.6) µg/L; 30.1% of women had a selenium level below 80 µg/L. The median selenoprotein P level was 6.9 (3.1-9.0) mg/L. Conclusions: Iodine nutrition in Latvian population of pregnant women was near the lower limit of adequate and a third of the population had a selenium deficiency. Supplements were frequently used, but most did not contain the recommended amounts of iodine and selenium.

Challenges for Workplace Risk Assessment in Home Offices-Results from a Qualitative Descriptive Study on Working Life during the First Wave of the COVID-19 Pandemic in Latvia.

Epidemiological restrictions due to the COVID-19 pandemic have raised legal and practical questions related to the provision of workplace risk assessment in home offices of teleworkers. The objective of this qualitative study was to analyze practical experience of employers and occupational safety and health experts performing workplace risk assessment in Latvia during the first wave of the COVID-19 pandemic. Our findings suggest that employers have not sufficiently implemented their legal obligations related to workplace risk assessment which can result in an increased number of physical and mental health problems of teleworkers in the short term and in the future. Work from home has shown how different working conditions can be for the same type of work (office work); therefore, the promotion of personalized workplace risk assessment should be encouraged. Even if virtual workplace visits using photos and videos are not the traditional way the workplace risk assessment should be done, it is effective; workers who report that their employers assessed their working conditions report fewer health effects. The experience of workers in participation in workplace risk assessment for telework might change the level and role of worker participation in the management of health and safety hazards at work in general.

How the Labor Market Affects the Self-Perceived Health of Older Workers. The Evidence From Central and Eastern European Countries (CEECs).

Background: The paper aims to analyze the impact of key labor market indicators on the self-assessed health of the population of older workers (aged 55-64). Methods: Authors build the econometric models where the dependent variable is the self-perceived health status (for women and men separately). Explanatory variables are selected key indicators of the labor market, covering unemployment, including long-term, inactivity, or under-employment. The average household income is used to control the effect of wealth. Additionally, the models incorporate the variable describing the proximity of retirement. The research sample consists of nine countries of Central and Eastern Europe: Poland, Czech Republic, Slovakia, Hungary, Lithuania, Latvia, Estonia, Bulgaria, and Romania. Results and Conclusions: The study confirms that in the group of elderly workers, the perceived state of health is influenced by long-term unemployment, inactivity, and, in the case of women, time-related underemployment.

Production losses attributable to suicide deaths in European Union.

BACKGROUND: Suicide is an important public health problem with multidimensional consequences for societies. One of the under-researched areas of suicide consequences are cross-country analyses of production losses associated with these deaths. The aim of this study was to estimate the production losses (indirect cost) of suicide deaths in 28 European Union states (EU-28) in 2015. METHODS: The study used societal perspective and human capital approach to investigate production losses due to suicide mortality at working age. Eurostat's data on the number of deaths was used to identify suicide mortality burden in terms of years of potential productive life lost. Labour and economic indicators were applied to proxy the discounted value of potential economic output lost. A one-way deterministic sensitivity analysis was conducted to test the robustness of the estimates. RESULTS: The production losses attributable to suicide deaths in EU-28 in 2015 were €9.07 billion. The per suicide indirect cost of these deaths was €231,088 for the whole EU-28 population; Luxembourg experienced the highest per suicide burden of €649,148. The per capita production losses of suicides in EU-28 was €17.80 and Ireland experienced the highest per capita burden of €48.57. The losses constituted an economic burden of 0.061% of EU-28's GDP and this share ranged from 0.018% in Cyprus to 0.161% in Latvia. Most of the losses (71-91%) were due to men's deaths. The results of the sensitivity analysis exhibit a large variation of losses; the highest (lowest) cost was identified with no adjustment for lower employment rates among those dying by suicide (adjustment for minimum productivity) and was 92.3% higher (59.7% lower) on average than in the base scenario. CONCLUSION: Public health actions aimed at prevention of suicides might reduce their health burden but also contribute to the economic welfare of European societies.

Financing Healthcare in Central and Eastern European Countries: How Far Are We from Universal Health Coverage?

After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the role of government and households in financing healthcare in eight countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied to collect quantitative data on healthcare expenditures and qualitative data on gaps in universal health coverage. A linear regression analysis was used to analyze a trend in health expenditure over the years 2000-2018. Our results indicate that a high reliance on out-of-pocket payments persists in many EU-8 countries, and only a few countries have shown a significant downward trend over time. The gaps in universal coverage in the EU-8 countries are due to explicit rationing (a limited benefit package, patient cost sharing) and implicit mechanisms (wait times). There is need to increase the role of public financing in CEE countries through budget prioritization, reducing patient co-payments for medical products and medicines, and extending the benefit package for these goods, as well as improving the quality of care.

Long-term changes in microbial water quality indicators in a hydro-power plant reservoir: The role of natural factors and socio-economic changes.

Long-term changes, from 1984 to 2010, in the indicators of microbial pollution (total viable count, coliforms, Escherichia coli, enterococci, and Clostridium perfringens) are analysed in the Riga Hydropower Plant Reservoir, an essential source of drinking water for Riga, the capital of Latvia. Counts in microbial indicators fluctuated seasonally and were related to physicochemical parameters (nitrogen compounds, turbidity, temperature, and pH). The changes in microbial pollution were brought about by two major socio-economic developments. Firstly, Latvia's independence from the USSR in 1991 which facilitated a distinct reduction in most microorganism counts due to a sharp decline in industrial and agricultural production. This resulted in a significant drop in point and nonpoint pollution in the river basin. A further development was Latvia joining the European Union in 2004. The corresponding focus on water management, including wastewater treatment, was a major priority of environmental investment and lead to improvements in microbial water quality.

The assessment of factors associated with patient satisfaction in evaluation of mental health care center.

AIMS: The study was conducted to explore patient satisfaction and to identify factors associated with patient satisfaction with the care in psychiatric wards using Psychiatric Inpatient Patient Experience Questionnaire On-Site (PIPEQ-OS) self-assessment tool. Such studies to detect factors associated with patient satisfaction in mental health care have not yet been conducted in Latvia. METHODS: Cross-sectional study was conducted over 6-month period in 2018. Total amount of 773 mental health care patients were offered to fill in the questionnaire in subacute and acute wards. From them, 419 (54.2%) filled and returned the questionnaire and 354 (45.8%) refused to fill it. Descriptive statistical analysis and factor correlation was done. RESULTS: Response rate was found to be 54.2%. Patients generally showed high satisfaction with received care. However, lower satisfaction rates were found in items related to engagement of relatives and patients in the treatment process, as well as patients were less satisfied with information provided. Statistically significant higher satisfaction was associated with organic mental disorders compared to schizophrenia spectrum disorders, as well as with female gender, older age, being employed or pensioner, being married or divorced. Patient education level did not show significant association with self-assessment scores. CONCLUSION: The study revealed possible directions for improvement in the future in terms of providing information to patients, involvement of relatives and patients in the process of treatment. Further studies with more patients and involvement of other hospitals are required to assess factors associated with the satisfaction to organize care and to plan treatment according to the needs of the patients.

How does Latvia’s health sector contribute to the economy? Health and the economy: a series of country snapshots

Health matters. The health sector is an important and innovative industry, as well as a source of stable employment for many people. Health systems support active and productive populations, reduce inequities and poverty and promote social cohesion. A strong health system makes good economic sense and underpins the overall sustainable development agenda. Countries around the world are grappling with the health, economic and fiscal implications of the COVID-19 pandemic. As they begin to recover from the crisis, difficult decisions will need to be made about how to allocate scarce resources. These snapshots share valuable evidence for policy-makers on how investing in health sectors and health systems helps to achieve national economic objectives.

Assessment of sapropel use for pharmaceutical products according to legislation, pollution parameters, and concentration of biologically active substances.

Development trends need the necessity for wider use of the local resources and available natural materials are one of the priorities around the world. Freshwater sapropel is a common material in the water basement of the lakes, but still not sufficiently explored. The main goal of the project to start detailed and systematic research on the medical properties of sapropel to be obtained in Latvia, promote its scientifically based use in balneology, develop new medical procedures and services, and promote development of new exportable products. The results include the survey, sampling depths, and processing, evaluation of external signs, physical, chemical, and biochemical parameters, and evaluation of microbiological indicators. Active components from the sapropel samples extracted using the alkaline method. Sapropel extracts were characterized by organic carbon content, humic and fulvic acid concentrations, total phenolic content, trace metal and pesticide concentrations, total antioxidant status, and microbiological flora. Summarizing the article's main findings it was concluded that Latvian freshwater sapropel can be used as raw material for obtaining sapropel extract and use it in the preparation of pharmaceuticals and promote the development of new exportable products and services.

Pharmacy in Latvia during the occupation regime of Nazi Germany (1941-1945).

The study covers the period of World War II after shift of occupational powers in Latvia when Soviet occupation was replaced by the occupation regime of Nazi Germany in the summer of 1941 and retained until first half of 1945. Due to this shift gradually Latvia, Lithuania, Estonia and Belarus were merged into a single administrative area and designated as "Ostland". Soviet officials left the pharmaceutical industry, which they had tried to apply to the communist ideology from June 1940 to June 1941 creating confusion and chaos. The renewed Pharmacy Board of Latvia had to deal with the restoration of supervision and a partial return from the communist to the capitalist regime. The research provides an insight to adaptation and development of the pharmaceutical industry in Latvia during Nazi Germany occupation regime, highlighting as essential indicators the administrative operation of Pharmacy Board of Latvia and its cooperation with German authorities, the availability of medicines, process of reprivatisation of pharmacies and changes in the number of pharmaceutical employees. The research issue raised is topical, since it is this period that reflects the industry's ability to adapt and perform work in fundamentally different and severe circumstances, which include both resource deficits and the transition from one regime to another. The collected evidence shows the efforts to stabilize the pharmaceutical industry in many terms. One example was the attemptions to ensure the rational dispensing of medical products to the pharmacies and hospitals, with the greatest degree of austerity, because the supply and consumption of medication was extremely complex issue throughout the war.

Health technology assessment and reimbursement policy for oncology orphan drugs in Central and Eastern Europe.

BACKGROUND: The reimbursement of orphan drugs (OD) is an increasingly important for country policymakers, and still insufficiently understood, especially in Central and Eastern Europe. The aim of this research was to provide a comprehensive description of country-specific health technology assessment (HTA) policies as well as evaluate the percentage of HTA recommendations and reimbursement decisions for oncology OD. In addition, the study was designed to elucidate the impact of reimbursement of these drugs on the public budget and the agreement between HTA recommendations and reimbursement decisions in the analysed countries. A questionnaire survey was used to collect data on the reimbursement status, HTA recommendation, marketing authorisation, and public expenses on reimbursement in 2014, 2015, and 2016 for all oncology drugs with an orphan designation by the European Medicine Agency in 2017 in Bulgaria, Croatia, Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, and Slovakia. The agreement between the HTA recommendation and reimbursement status was assessed using the kappa coefficient. The Pearson's correlation was used to analyse the relationship between gross domestic product (GDP) and GDP per capita and reimbursement expenses. RESULTS: A total of 36 drugs were analysed (25% conditionally approved; 5.56% approved under exceptional circumstances). The share of reimbursed drugs ranged from 11.11% in Latvia to 41.67% in Poland. The highest share of positive recommendations was observed for Bulgaria and Estonia (36.11%), and the lowest, for Latvia (11.11%). The agreement varied from 0.4 for Poland to 1 for Latvia, Hungary, and Slovakia. Expenses were correlated with GDP (0.95 [0.81-0.99]), and not with GDP per capita (0.54 [- 0.136 to 0.873]). Expenses per capita were not correlated with GDP per capita (0.52 [- 0.15 to 0.87]). CONCLUSIONS: In Hungary, Latvia, and Slovakia, a positive recommendation was associated with a reimbursement, and a negative one, with the lack of reimbursement. The reimbursement of oncology OD is associated with a growing burden for public budget, and the expenses are correlated with the total GDP. The highest share of drugs with any recommendation was observed in Poland, and the lowest, in Latvia and Romania. The share of reimbursed drugs was the lowest in Latvia and the highest in Poland.

Determination of Fungi and Multi-Class Mycotoxins in Camelia Sinensis and Herbal Teas and Dietary Exposure Assessment.

In this paper, a study of fungal and multi-mycotoxin contamination in 140 Camellia sinensis and 26 herbal teas marketed in Latvia is discussed. The analysis was performed using two-dimensional liquid chromatography with time-of-flight mass spectrometry (2D-LC-TOF-MS) and MALDI-TOF-MS. In total, 87% of the tea samples tested positive for 32 fungal species belonging to 17 genera, with the total enumeration of moulds ranging between 1.00 × 101 and 9.00 × 104 CFU g-1. Moreover, 42% of the teas (n = 70) were contaminated by 1 to 16 mycotoxins, and 37% of these samples were positive for aflatoxins at concentrations ranging between 0.22 and 41.7 µg kg-1. Deoxynivalenol (DON) and its derivatives co-occurred in 63% of the tea samples, with their summary concentrations reaching 81.1 to 17,360 µg kg-1. Ochratoxin A (OTA), enniatins, and two Alternaria toxins were found in 10-37% of the teas at low concentrations. The dietary exposure assessment based on the assumption of a probable full transfer of determined mycotoxins into infusions indicated that the analysed teas are safe for consumers: the probable maximum daily exposure levels to OTA and the combined DON mycotoxins were only 0.88 to 2.05% and 2.50 to 78.9% of the tolerable daily intake levels.

Sociodemographic, Lifestyle and Medical Factors Associated with Helicobacter Pylori Infection.

BACKGROUND AND AIMS: The prevalence of Helicobacter pylori (H. pylori) infection is higher in developing countries and is often linked to lower socioeconomic status. Few studies have investigated the association between H. pylori and individual level characteristics in Europe, where several countries have a high prevalence of H. pylori infection. The study aimed to identify risk factors for H. pylori infection among adults in a large clinical trial in Latvia. METHODS: 1,855 participants (40-64 years) of the "Multicenter randomized study of H. pylori eradication and pepsinogen testing for prevention of gastric cancer mortality" (GISTAR study) in Latvia tested for H. pylori IgG antibodies were included in a cross-sectional analysis. Sociodemographic, lifestyle and medical factors were compared for participants seropositive (H. pylori+) and seronegative. Mutually adjusted odds ratios (OR) were calculated for H. pylori+ and factors significant in univariate analysis (education, smoking, binge drinking, several dietary habits, history of H. pylori eradication and disease), adjusting for age, gender and income. RESULTS: Of the participants 1,044 (55.4%) were H. pylori seropositive. The infection was associated with current (OR: 1.34, 95%CI: 1.01-1.78) and former (OR: 1.38; 95%CI: 1.03-1.85) smoking, binge drinking (OR: 1.35; 95%CI: 1.03-1.78), having ≥200g dairy daily (OR: 1.37; 95%CI: 1.11-1.69), and very hot food/drinks (OR: 1.32; 95%CI: 1.03-1.69) and inversely with ≥400g vegetables/fruit daily (OR: 0.76; 95%CI: 0.60-0.96), history of H. pylori eradication (OR: 0.57; 95%CI: 0.39-0.84), peptic ulcer (OR: 0.55; 95%CI: 0.38-0.80) and cardiovascular disease (OR: 0.78; 95%CI: 0.61-0.99). CONCLUSIONS: After mutual adjustment, H. pylori seropositivity was associated with lifestyle and in particular dietary factors rather than socioeconomic indicators in contrast to the majority of other studies.

Women's socioeconomic position in ontogeny is associated with improved immune function and lower stress, but not with height.

Immune function, height and resource accumulation comprise important life history traits in humans. Resource availability models arising from life history theory suggest that socioeconomic conditions influence immune function, growth and health status. In this study, we tested whether there are associations between family income during ontogeny, adult height, cortisol level and immune response in women. A hepatitis B vaccine was administered to 66 young Latvian women from different socioeconomic backgrounds, and blood samples were then collected to measure the level of antibodies that the women produced in response to the vaccination. Cortisol levels were measured from plasma samples pre- and post-vaccination. Women from wealthier families had lower cortisol levels, and women from the highest family income group had the highest levels of antibody titers against hepatitis B vaccine. No significant relationships were observed between cortisol level and immune function, nor between family income and height. The results show that income level during ontogeny is associated with the strength of immune response and with psychoneuroendocrine pathways underlying stress perception in early adulthood. The findings indicate that the quality of the developmental niche is associated with the condition-dependent expression of immune function and stress response.

Health assessment of harbour porpoises (PHOCOENA PHOCOENA) from Baltic area of Denmark, Germany, Poland and Latvia.

Harbour porpoise (Phocoena phocoena), the only resident cetacean species of the Baltic Sea is formed of two subpopulations populations, occurring in the western Baltic, Belt Seas and Kattegat and the Baltic Proper, respectively. Harbour porpoises throughout these areas are exposed to a large number of human activities causing direct and indirect effects on individuals, that might also harm this species on a population level. From Latvia, Poland, Germany and Denmark 385 out of 1769 collected dead harbour porpoises were suitable for extensive necropsy. The animals were collected between 1990 and 2015 and were either by-caught or found dead on the coastline. Following necropsies, histopathological, microbiological, virological and parasitological investigations were conducted. Females and males were equally distributed among the 385 animals. Most animals from the different countries were juveniles between 3 months and 3 years old (varying between 46.5 and 100% of 385 animals per country). The respiratory tract had the highest number of morphological lesions, including lungworms in 25 to 58% and pneumonia in 21 to 58% of the investigated animals. Of those with pneumonia 8 to 33% were moderate or severe. The alimentary, hearing, and haematopoietic systems had inflammatory lesions and parasitic infections with limited health impact. 45.5 to 100% of the animals from the different countries were known by-caught individuals, of which 20 to 100% varying between countries had netmarks. Inflammatory lesions, especially in the respiratory tract were found in higher numbers when compared to control populations in areas with less human activities such as arctic waters. The high number of morphological changes in the respiratory tract and of bycatches especially among immature animals before reaching sexual maturity is of serious concern, as well as the low number of adult animals among the material. Data on health status and the causes of death are valuable for management. A next step in this regard will combine data from health and genetic investigations in order to detect differences between the two populations of the Baltic.

Gender Inequalities in Health and Their Effect on the Economic Prosperity Represented by the GDP of Selected Developed Countries-Empirical Study.

The objective is to evaluate the relations between gender health inequalities and economic prosperity in the Organisation for Economic Co-operation and Development (OECD) countries. The groups included health indicators in the specification of men, women and gender inequalities: life expectancy, causes of mortality and avoidable mortality. The variable determining the economic prosperity was represented by the Gross Domestic Product (GDP). The analytical processing included descriptive analysis, analysis of differences and analysis of relationships. The regression analysis was presented as the main output of the research. Most of the significant gender differences in health showed a more positive outcome for women. It is possible to identify a certain relation between gender health inequalities and economic prosperity. If there is some reduction in gender inequalities in health, the economic prosperity will increase. The reduction seems to be more effective on the part of men than women. The output of the cluster analysis showed the relations of indicators evaluating the inequalities and the prosperity. The countries such as Luxembourg, Norway or Switzerland showed very positive outputs, on the other hand, the countries with a potential for the improvement are Lithuania, Latvia or Estonia. Overall, the policies should focus on reducing the inequalities in avoidable mortality as well as reducing the frequent diseases in younger people.

Medical, pharmacy and nursing students in the Baltic countries: interactions with the pharmaceutical and medical device industries.

BACKGROUND: Interactions between pharmaceutical and medical device industries and students can lead to commercial influences on educational messages, with a potential to bias future treatment choice. This is the first study in the Baltic countries describing exposure and attitudes of medical, pharmacy and nursing students towards cooperation with industry. METHODS: A cross-sectional on-line survey of current medical, pharmacy and nursing students (n = 918) in three Baltic countries was carried out. RESULTS: We found that most students participate in events organized or sponsored by industry and accept a range of gifts and benefits. Students in the Baltic countries consider cooperation with industry important; at the same time, most do not feel that they have sufficient training on how to ethically interact with pharmaceutical and medical device companies and believe that these interactions can influence their prescribing or dispensing patterns. There is a tendency to rationalize cooperation with industry by referring to the current economic situation and patient benefits. Pharmacy students have higher rates of participation and they accept gifts and other benefits more often than nursing or medical students; therefore, they are likely to be more vulnerable to potential industry influence. CONCLUSIONS: The findings highlight the need to include topics on ethics and conflicts of interests in cooperation with industry in curriculum of health care students in Baltic countries. Without proper training, students continue to be at risk to industry influence and may develop habits for their further practice differing from evidence-based practice in prescribing and dispensing of medicines, as well as use of medical devices.