Health workforce forecast in the university hospital: evidence from Lithuania.

BACKGROUND: The increasing shortage of staff in healthcare facilities worldwide calls for a human resource planning strategy in order to ensure safe, timely and patient-centred care. The purpose of this paper is to provide an analysis and supply and demand projections of nurses, midwives, and radiographers within the labor market of the largest university hospital in the Baltic States by 2030. METHODS: The staff supply was calculated on the intake and outflow of persons in the labour market annually for various factors. Projections for the demand of nurses, midwives, and radiographers took into account the different needs of the population, categorized by gender and age, for the services offered within the institution. RESULTS: The analysis highlights significant projected shortages in the supply of nurses and radiographers by 2030, while the supply of midwives is expected to meet the demand. The projected supply of nurses in 2030 will be lower than in 2021. Projected nurses demand in 2025 according medium scenario - shortage of 59 nurses, on prospective scenario - of 331 nurses. In 2030 according medium scenario - shortage of 173 nurses on prospective - of 772 nurses. The projected supply of radiographers in 2030 will be higher than in 2021. Projected radiographers demand in prospective scenario which is the most likely in 2025 - shortage of 26 and in 2030 - shortage of 52 radiographers. The projected supply of midwives in 2030 will be higher than in 2021. The variables influencing the increase in the demand for midwives did not exceed the projected supply in the institution, indicating a balanced supply-demand scenario for midwives. CONCLUSIONS: Due to the rising demand for nurse and radiographer services from the aging population, the predicted supply of nurses and radiographers will be insufficient. To ensure the projected demand for nurses in the medium and prospective scenarios, the nurses recruited each year should increase up to 38% in the medium scenario and 69% in the prospective scenario from 2022. In the prospective demand scenario, the recruitment of radiographers should increase three-fold and the recruitment of midwives should be reduced by 30%.

Cardiometabolic Health in Adolescents and Young Adults with Congenital Adrenal Hyperplasia.

Background and objectives: Data on long-term cardiometabolic consequences in patients with congenital adrenal hyperplasia (CAH) are controversial. The aim of our study was to evaluate body mass index (BMI), body composition, blood pressure (BP) and insulin sensitivity in adolescents and young adults with CAH in comparison with healthy controls. Methods: Thirty-two patients with classical CAH (13 males; mean of age 26.0 ± 7.1, years (14.0−37.3) were compared to 32 healthy sex and age-matched controls (13 males; mean of age 28.7 ± 4.6 years (14.1−37.2), p = 0.13). Body composition was evaluated in all subjects with DXA (Hologic Inc., Bedford, MA, USA). Elevated BP was defined as BP > 95th percentile in adolescents, and >140/90 mmHg in adults. Comparisons between the two groups were adjusted for age, gender, pubertal stage and height. An oral glucose tolerance test was performed, and fasting insulin levels were evaluated. Insulin sensitivity was determined using a homeostasis model assessment of insulin resistance index (HOMA-IR). Results: The median BMI was significantly higher in subjects with CAH (1.63 (0.3−2.4) SDS and 0.41 (−0.63−1.19) SDS, respectively, p < 0.001). Visceral adipose tissue (VAT) in grams was significantly higher in CAH females versus control females (467 (231−561) vs. 226 (164−295), p = 0.002). Elevated BP was identified in 34% of CAH patients (nine SW and two SV) and 12.5% (n = 4) of controls (p = 0.038). Impaired fasting glycemia was detected in one SW CAH patient and impaired glucose tolerance in three SV CAH patients; normal glucose tolerance was found in all controls. A strong positive correlation was found between median cumulative hydrocortisone (HC) dose equivalents and LDL-cholesterol and a negative association with lean body mass (r = −0.79, p = 0.036) in females with CAH. BMI, VAT, BP and HOMA-IR were not related to median cumulative HC dose equivalents. Conclusions: CAH patients had higher BMI, VAT and frequency of elevated BP compared to controls. Doses of glucocorticoids were related directly to LDL-cholesterol and inversely to lean body mass in CAH females, but not associated with body composition, insulin sensitivity and BP in the whole cohort of CAH patients.

Assessment of radiographers' competences from the perspectives of radiographers and radiologists: a cross-sectional survey in Lithuania.

BACKGROUND: Assessing radiographers' clinical competence is of major importance in all medical imaging departments, and is a fundamental prerequisite for guaranteeing professional standards in both nursing care and radiography. Despite the fact that self-assessment has been reported to be the most common form of competence evaluation only several studies defining the radiographers' self-assessment of clinical competencies were identified. The aim of the study was to evaluate radiographers' professional competence from the perspectives of radiographers and radiologists by applying the Radiographers' Competence Scale (RCS). METHODS: The study was conducted in university hospitals of Lithuania. We used the original instrument designed by Swedish researchers - the Radiographers' Competence Scale (RCS) consisting of two domains: A "Nurse-initiated care" and B "Technical and radiographic processes". The study involved in all 397 respondents; radiographers (250) and radiologists (147) working in departments of diagnostic radiology. Each competence was evaluated twice - the level on a 10-point scale, and the frequency of practical application on a 6-point scale. RESULTS: The overall level of the radiographers' competence and the frequency of its use in practice were evaluated high or very high by both respondent groups. The radiographers attributed the highest evaluations to such competences as "Encouraging and supporting the patient" and "Collaborating with other radiographers", while the lowest evaluations were attributed to "Guiding the patient's relatives" and "Empowering the patient by involving him/her in the examination and treatment" competences. The radiologists attributed the highest evaluations to such competences as "Collaborating with radiologists" and "Independent carrying out of the radiologist's prescriptions", while the lowest evaluations - to the same competences as the radiographers did. Irrespectively of the work experience and age, the radiographers gave significantly higher ratings to all competences that the radiologists did (p < 0.001). CONCLUSIONS: Both groups of the respondents attributed high or very high evaluations to the competences in both the "Nurse-initiated care" and the "Technical and radiographic processes" domains.

Bone mineral density determinants in adolescents and young adults with congenital adrenal hyperplasia.

Background: The effects of long-term glucocorticoid (GC) treatment on bone mineral density (BMD) in patients with congenital adrenal hyperplasia (CAH) remain controversial. Objectives: This cross-sectional study aimed to evaluate BMD in relation to genotype, growth, vitamin D status, cumulative GC doses, and other relevant factors in youths with CAH. Methods: Thirty-two patients with classical CAH (13 males; mean age 26.0 ± 7.1 years) were compared with 32 healthy controls matched by age and sex. BMD was measured using dual-energy x-ray absorptiometry, and statistical analyses, including the Mann-Whitney U-test and Spearman's correlation coefficient, were performed to evaluate differences and associations. Results: Median whole-body and lumbar BMD Z-scores were similar between CAH patients and controls (p = 0.27 and 0.15, respectively). Low bone density was observed in 12.5% of CAH patients and 18.75% of controls (p = 0.5), and osteoporosis was confirmed in 12.5% of CAH patients and 0% of controls (p = 0.04). BMD did not correlate with cumulative GC doses, estradiol, renin, phosphate, sodium levels, or anthropometric parameters in CAH patients. There was no significant difference in BMD between severe and non-severe genotypes of CAH. However, a positive correlation was found between the whole-body BMD Z-score and growth velocity during infancy (r = 0.776, p = 0.021) in CAH patients. Vitamin D deficiency was noted in 56.25% of CAH patients, although vitamin D levels did not correlate with BMD or genotype. No history of bone fractures was reported among study participants. Conclusions: CAH patients are at risk of developing osteoporosis, but in this study, BMD Z-scores were not associated with cumulative GC doses. The study did not identify an association between genotype and BMD. Poor growth during infancy was linked to decreased BMD in adulthood.

Impact of Nutrient Intake on Body Composition in Very Low-Birth Weight Infants Following Early Progressive Enteral Feeding.

Preterm infants have increased body adiposity at term-equivalent age and risk of adverse metabolic outcomes. The aim of the study was to define how nutrient intake may impact body composition (BC) of very low-birth weight infants fed with early progressive enteral feeding and standard fortification. Eighty-six infants with <1500 g birth weight were included in the BC study and stratified into extremely preterm (EP) and very preterm (VP) groups. Nutrient intake was calculated during the first 28 days and BC assessed by dual X-ray absorptiometry at discharge and by skinfold thickness at 12 months of corrected age (CA). Total nutrient intake did not differ between the groups. EP infants had a higher fat mass percentage at discharge than VP infants (24.8% vs. 19.4%, p < 0.001); lean mass did not differ. None of the nutrients had any impact on BC of EP infants. Protein intake did not result in a higher lean mass in either group; fat intake was a significant predictor of increased fat mass percentage in VP infants at discharge (p = 0.007) and body adiposity at 12 months of CA (p = 0.021). Nutritional needs may depend on gestational age and routine fortification should be used with caution in more mature infants.

Nursing students' attitudes and beliefs towards addressing sexual health: A multicentre study and latent class analysis.

BACKGROUND: To provide competent and respectful sexual health care, a critical and comprehensive assessment of students' attitudes towards sexuality is needed, which implies using reliable and valid questionnaires. AIM: To assess whether the extended version of the Students Attitude Towards Addressing Sexual Health (SA-SH-Ext) provides different, additional information about students' attitudes towards providing sexual healthcare compared to the Sexual Attitude and Beliefs Survey (SABS), to explore SA-SH-Ext potential response patterns through latent class analysis and to assess students' attitudes towards providing sexual healthcare and evaluate the differences in their attitudes to the cultural background and sociodemographic characteristics. DESIGN: Multicentre, descriptive, analytical, comparative, and correlational cross-sectional study at three nursing faculties. PARTICIPANTS: Nursing students n = 514 (Serbia n = 180, Poland n = 150 and Lithuania n = 184). METHODS: A general questionnaire for obtaining sociodemographic data, SA-SH-Ext and SABS were used as students' report measures. RESULTS: One part of the variance of each instrument does not overlap with the other, indicating that these instruments, in addition to the shared variance, provide different, additional information. A solution with three latent classes was found in the domain of responses to the SA-SH-Ext items. The response pattern placed nursing students in the class Comfortable and prepared in some situations, and the SABS score revealed students' moderately positive attitudes towards providing sexual healthcare. Significantly more conservative attitudes were demonstrated by students from Poland, those identifying their religious affiliation as Catholic and females, while first-year students showed more positive attitudes than those in later years of study. CONCLUSIONS: The SA-SH-Ext and SABS enable a reliable and quick assessment of nursing students' comfort and competence in providing sexual healthcare. However, the differences in students' attitudes towards sexuality concerning belonging to a specific group imply a need for curriculum redesign and facilitating students to be more open to communication about sexuality with people with mental illnesses and intellectual and physical disabilities.

Nurse's Role from Medical Students' Perspective during Their Interprofessional Clinical Practice: Evidence from Lithuania.

Background: Attitudes towards interprofessional education are key factors that shape students' behaviour during interprofessional practice. An interprofessional approach to training and practice is "unique", important, and challenging. Interprofessional education allows for a deeper understanding and analysis of problems from perspectives different to those of "us". The aim of the study was to assess medical students' attitudes toward the nurse's role during their interprofessional clinical practice. Methods: This study used a descriptive, correlational design. Results: Lithuanian medical students were statistically significantly more likely to think that the role of a nurse was clear and transparent to other professionals and that nurses exuded a high degree of professionalism, sought a high degree of involvement with the patient, and built deep relationships with the patients. Foreign medical students were statistically significantly more likely to believe that nurses worked more effectively alone than in a team and that they worked with the patients within their own professional field of knowledge rather than referring patients to other professionals. Conclusions: After 6 months of interprofessional training with nurses in the hospital, medical students gain a more clear professional picture of the role of the nurse.

Supply and demand for radiographers in Lithuania: a prognosis for 2012-2030.

BACKGROUND: This is the first ever study on the planning of the supply and demand for radiographers in Lithuania. The aim of this study was to analyze the supply and demand for radiographers in the labor market with respect to their number, structure, and services, and to provide a prognosis for the period of 2012-2030. MATERIALS AND METHODS: Supply was calculated using two scenarios with differing duration of studies, annual student drop-out rates, rates of failure to start working, the annual number of new entrants into the labor market, and emigration rates. Annual mortality rates, the number of first-year students, and retirement rates were evaluated equally in both scenarios. Two projections of the demand for radiographers, based on the population's differing (by age and gender), need for outpatient radiology services, computed tomography, and magnetic resonance scans. Subsequently, the supply and demand scenarios were compared. RESULTS: Evaluation of the perspective supply and demand scenarios - which are the most probable - revealed a gap forming during the analyzed period, the predicted specialist shortage will reach 0.13 full-time equivalents per 10,000 population, and in 2030-0.37 full-time equivalents per 10,000 population. CONCLUSIONS: Considering the changes in education of radiographers, the socio-demographic characteristics of the staff, and the increasing need for radiographers' services, the supply of radiographers during the next two decades will be insufficient. To meet the forecasted demand for radiographers in the perspective scenario, the number of students choosing this specialty from 2013 on should increase by up to 30%.