Psychometric properties and normative data of the Latvian and Russian language versions of the strengths and difficulties questionnaire (SDQ) in the Latvian general adolescent population.

OBJECTIVES: Mental health screening instruments are essential in population health research and clinical practice. The strengths and difficulties questionnaire (SDQ) self-report version has been widely used across the globe to screen for mental health problems in adolescent populations. This study aimed to explore the psychometric properties of the Latvian and Russian language versions of the SDQ in a representative sample of a general population of Latvian adolescents and establish the population-based normative scores. MATERIALS AND METHODS: This analysis was based on data from the international Health Behaviour in School-aged Children study year 2017/2018 Latvian database. The sample comprised 2683 Latvian and 1321 Russian-speaking 11-, 13-, and 15-year-old adolescents. RESULTS: Significant language-based variance was observed in the mean scores of the externalising subscales of the SDQ, with Latvian-speaking adolescents reporting higher levels of conduct problems and hyperactivity. The reliability was satisfactory (ordinal alpha >0.7) only for the prosocial behaviour, emotional, internalising problems, and total difficulties subscales, while conduct, hyperactivity, peer, and externalising problems scales demonstrated lower internal consistency (ordinal alpha 0.5-0.7). Confirmatory factor analysis (CFA) did not support the hypothesised narrow-band five-factor or broad-band three-factor structure of the SDQ. The normative banding scores were calculated for both language variants. CONCLUSIONS: This study suggests that the self-report SDQ must be used cautiously in Latvian adolescents because some SDQ subscales lack reliability. When used in population research, the internalising subscales seem more reliable than the externalising ones. More research is needed regarding the reliability of the SDQ in clinical adolescent populations.

Relationship between Maternal Socioeconomic Factors and Preterm Birth in Latvia.

Background and Objectives: Worldwide, preterm birth (PTB) stands as the primary cause of mortality among children under 5 years old. Socioeconomic factors significantly impact pregnancy outcomes, influencing both maternal well-being and newborn health. Understanding and addressing these socioeconomic factors is essential for developing effective public health interventions and policies aimed at improving pregnancy outcomes. This study aims to analyse the relationship between socioeconomic factors (education level, marital status, place of residence and nationality) and PTB in Latvia, considering mother's health habits, health status, and pregnancy process. Materials and Methods: A cross-sectional study was conducted using data from the Medical Birth Register (MBR) of Latvia about women with singleton pregnancies in 2022 (n = 15,431). Data analysis, involving crosstabs, chi-square tests, and multivariable binary logistic regression, was performed. Adjusted Odds ratios (aOR) with 95% confidence intervals (CI) were estimated. Results: Lower maternal education was statistically significantly associated with increased odds of PTB. Mothers with education levels below secondary education had over two times higher odds of PTB (aOR = 2.07, p < 0.001, CI 1.58-2.70) and those with secondary or vocational secondary education had one and a half times higher odds (aOR = 1.58, p < 0.001, CI 1.33-1.87) after adjusting for other risk factors. Study results also showed the cumulative effect of socioeconomic risk factors on PTB. Additionally, mothers facing two or three socioeconomic risk factors in Latvia exhibited one and a half times higher odds of PTB (aOR = 1.59, p = 0.021). Conclusions: The study highlights the cumulative impact of socioeconomic risk factors on PTB, with higher maternal education demonstrating the highest protective effect against it. This underscores the importance of education in promoting optimal foetal development. Since the influence of socioeconomic factors on PTB is not a widely studied issue in Latvia, further research is needed to improve understanding of this complex topic.

Excess mortality associated with the COVID-19 pandemic in Latvia: a population-level analysis of all-cause and noncommunicable disease deaths in 2020.

BACKGROUND: Age-standardised noncommunicable disease (NCD) mortality and the proportion of the elderly population in Latvia are high, while public health and health care systems are underresourced. The emerging COVID-19 pandemic raised concerns about its detrimental impact on all-cause and noncommunicable disease mortality in Latvia. We estimated the timing and number of excess all-cause and cause-specific deaths in 2020 in Latvia due to COVID-19 and selected noncommunicable diseases. METHODS: A time series analysis of all-cause and cause-specific weekly mortality from COVID-19, circulatory diseases, malignant neoplasms, diabetes mellitus, and chronic lower respiratory diseases from the National Causes of Death Database from 2015 to 2020 was used by applying generalised additive modelling (GAM) and joinpoint regression analysis. RESULTS: Between weeks 14 and 52 (from 1 April to 29 December) of 2020, a total of 3111 excess deaths (95% PI 1339 - 4832) were estimated in Latvia, resulting in 163.77 excess deaths per 100 000. Since September 30, with the outbreak of the second COVID-19 wave, 55% of all excess deaths have occurred. Altogether, COVID-19-related deaths accounted for only 28% of the estimated all-cause excess deaths. A significant increase in excess mortality was estimated for circulatory diseases (68.91 excess deaths per 100 000). Ischemic heart disease and cerebrovascular disease were listed as the underlying cause in almost 60% of COVID-19-contributing deaths. CONCLUSIONS: All-cause mortality and mortality from circulatory diseases significantly increased in Latvia during the first pandemic year. All-cause excess mortality substantially exceeded reported COVID-19-related deaths, implying COVID-19-related mortality during was significantly underestimated. Increasing mortality from circulatory diseases suggests a negative cumulative effect of COVID-19 exposure and reduced access to healthcare services for NCD patients.

A mixed-method study on the provision of remote consultations for non-communicable disease patients during the first wave of the COVID-19 pandemic in Latvia: lessons for the future.

BACKGROUND: The COVID-19 pandemic has challenged the ability of healthcare systems to ensure the continuity of health services for patients with non-communicable diseases (NCDs). The issue of remote consultations has emerged. Before the COVID-19 pandemic, remote consultations were not routinely provided or covered by public health funding in Latvia. This study aimed to describe the dynamics of consultations and the volume of remote consultations provided for patients with particular NCD and explore clinicians' experiences of providing remote consultations during the first wave of the COVID-19 pandemic in Latvia. METHODS: A mixed-method study focusing on the first wave of the COVID-19 pandemic in Latvia in Spring 2020 was conducted. Quantitative data from the National Health Services were analysed to assess the dynamics of consultations for patients with selected NCDs. Qualitative data were collected through 34 semi-structured interviews with general practitioners (GPs) and specialists and were analysed using an inductive thematic analysis. Purposive maximum variation sampling was used for participant selection. RESULTS: During the period with the strongest restrictions of scheduled on-site consultations, a decrease in the total number of consultations was observed for a variety of NCDs. A significant proportion of consultations in this period were provided remotely. GPs provided approximately one-third of cancer-related consultations and almost half of consultations for the other selected conditions remotely. Among specialists, endocrinologists had the highest proportion of remote consultations (up to 72.0%), while urologists had the lowest (16.4%). Thematic analysis of the semi-structured interviews revealed five themes: 1) Adjusting in a time of confusion and fear, 2) Remote consultations: safety versus availability, 3) Sacrifice and loss of privacy, 4) Advantages and disadvantages of communication technologies, and 5) Different form of communication and a health literacy challenge. CONCLUSIONS: During the first wave of the COVID-19 pandemic in Latvia, disruptions to health care services decreased the total number of consultations for patients with NCDs provided by both GPs and specialists. In this period, remote consultations proved to be an important instrument for ensuring the continuity of health care for patients with NCDs, and the necessity to develop a well-designed system for telemedicine in Latvia was highlighted.

Clinical Utility of the Parent-Report Version of the Strengths and Difficulties Questionnaire (SDQ) in Latvian Child and Adolescent Psychiatry Practice.

Background and Objectives: Screening instruments can be crucial in child and adolescent mental healthcare practice by allowing professionals to triage the patient flow in a limited resource setting and help in clinical decision making. Our study aimed to examine whether the Strengths and Difficulties Questionnaire (SDQ), with the application of the original UK-based scoring algorithm, can reliably detect children and adolescents with different mental disorders in a clinical population sample. Materials and Methods: a total of 363 outpatients aged 2 to 17 years from two outpatient child psychiatry centres in Latvia were screened with the parent-report version of the SDQ and assigned clinical psychiatric diagnoses. The ability of the SDQ to predict the clinical diagnosis in major diagnostic groups (emotional, conduct, hyperactivity, and developmental disorders) was assessed. Results: The subscales of the parent-report SDQ showed a significant correlation with the corresponding clinical diagnoses. The sensitivity of the SDQ ranged 65-78%, and the specificity was 57-78%. The discriminative ability of the SDQ, as measured by the diagnostic odds ratio, did not quite reach the level of clinical utility in specialised psychiatric settings. Conclusions: We suggest the SDQ be used in primary healthcare settings, where it can be an essential tool to help family physicians recognise children needing further specialised psychiatric evaluation. There is a need to assess the psychometric properties and validate the SDQ in a larger populational sample in Latvia, determine the population-specific cut-off scores, and reassess the performance of the scale in primary healthcare practice.

Self-reported suicide attempts and exposure to different types of violence and neglect during childhood: Findings from a young adult population survey in Latvia.

AIMS: Suicide rates in Latvia are among the highest in the EU. Among 18-25 year-old young adults, it is the second leading cause of death. This study investigates the prevalence of self-reported suicide attempts in young adults and examines its association with neglect or violence of a physical, emotional or sexual nature. METHODS: A questionnaire was administered to 1259 young adults 18-25 years of age, selected by targeted quota sampling from secondary and vocational schools. RESULTS: The prevalence of self-reported suicide attempts was 6.1%. Physical and emotional adverse experiences showed clear associations with attempted suicide. Although prevalence of reported physical neglect was higher than for physical violence (27.0% versus 16.3%, respectively) the latter posed a higher risk for attempted suicide (OR = 4.0; 95% CI, 2.4-6.6). Conversely, emotional violence had a higher prevalence than emotional neglect (31.5% vs. 23.6%, respectively), but neglect showed a stronger association with attempted suicide (OR = 4.4; 95% CI, 2.6-7.3). CONCLUSIONS THE HIGH OR FOR ATTEMPTED SUICIDE ASSOCIATED WITH EMOTIONAL NEGLECT, TOGETHER WITH FINDINGS THAT EMOTIONAL VIOLENCE HAD THE HIGHEST PREVALENCE, AND THAT EMOTIONAL NEGLECT AND EMOTIONAL VIOLENCE SHOWED THE HIGHEST POPULATION ATTRIBUTABLE RISK FRACTION POPAR% OF 468 AND 404, RESPECTIVELY, SUGGESTED THAT EMOTIONAL FACTORS MERIT SPECIAL ATTENTION IN FURTHER INVESTIGATIONS OF ATTEMPTED SUICIDE AMONG YOUNG ADULTS IN LATVIA THE TARGETED QUOTA SAMPLING METHOD FROM FIVE CITIES REPRESENTING ALL REGIONS OF LATVIA AND 438% OF ITS POPULATION, ENSURE NATIONAL RELEVANCE OF OUR FINDINGS FOR POLICY AND PROGRAM DEVELOPMENT BY LEGISLATIVE, EDUCATIONAL AND PUBLIC HEALTH INSTITUTIONS.

Maternal age-associated congenital anomalies among newborns: a retrospective study in Latvia.

BACKGROUND AND OBJECTIVE: In Latvia, the mean age of women giving birth increased from 27.3 in 2000 to 29.0 years in 2010 during the last 11 years. The aim of this study was to report on major congenital anomalies of newborns at birth by the maternal age and to compare the mean maternal age by different diagnosis subgroups and maternal and neonatal characteristics. MATERIAL AND METHODS: A cross-sectional retrospective study with the data from the Medical Birth Register (2000-2010) was carried out. The live birth prevalence rate was calculated for the subgroups of major congenital anomalies per 10 000 live births by the maternal age. RESULTS: The live birth prevalence rate of major congenital anomalies during the period 2000-2010 was 211.4 per 10 000 live births. The prevalence rate increased depending on the maternal age. Congenital heart defects, limb defects, and urinary system anomalies were the most common anomalies. The study results showed an age-related risk of abdominal wall defects, orofacial clefts, and chromosomal anomalies. There were significantly higher proportions of preterm births, newborns with low birth weight, and complications during pregnancy among mothers aged 35 years and more. CONCLUSIONS: The data on congenital anomalies from the Latvian Medical Birth Register can be used for the assessment of epidemiology of congenital anomalies. The results of this retrospective study showed a decrease in the live birth prevalence rate of major congenital anomalies despite an increase in the mean age of mothers in Latvia.

Adolescent use of social media and associations with sleep patterns across 18 European and North American countries.

OBJECTIVE: Over the past decade, concurrent with increasing social media use (SMU), there has been a shift toward poorer sleep among adolescents in many countries. The purpose of this study was to examine the cross-national associations between adolescent SMU and sleep patterns, by comparing 4 different categories of SMU (nonactive, active, intense, and problematic use). DESIGN, SETTING, AND PARTICIPANTS: Data were from 86,542 adolescents in 18 European and North American countries that participated in the 2017/18 Health Behaviour in School-aged study. MEASUREMENTS: Mixed-effects linear regression models were used to examine cross-national associations between 4 SMU categories and adolescent sleep duration, bedtime and social jetlag derived from self-reported data. RESULTS: For all countries combined, nonactive SMU was associated with longer sleep, earlier bedtimes, and less social jetlag, compared to active SMU, although the differences were minor. By comparison, intense and problematic SMU were associated with less sleep and later bedtimes on both school and nonschool days, and greater social jetlag, compared to active SMU. While findings were relatively consistent between countries, some differences were observed, suggesting that the national and cultural context may be important in interpreting results. CONCLUSIONS: These findings suggest that both intense and problematic SMU are associated with poorer sleep patterns in adolescents across most countries. Further research is needed to identify effective policies, programs, and messaging to promote the healthy use of social media and prevent potential negative impacts on adolescent sleep.

The medicine use and corresponding subjective health complaints among adolescents, a cross-national survey.

BACKGROUND: Medicine use among children and young people is under-researched. Studies that investigated cross-national patterns in adolescents' medicine use practice are rare. This study aims to investigate adolescents' medicine use for corresponding health complaints in Europe and USA. METHODS: Nationally representative samples of adolescents from 19 countries and regions in Europe and USA completed an anonymous, standardised questionnaire as part of the Health Behaviour in School-aged Children 2005/2006 survey. The prevalence of health complaints and medicine use were determined. The influence of the frequency of medicine use, age, gender and country of residence, on the likelihood of medicine use was assessed using multilevel multivariate logistic regression, with separate analyses for boys and girls. RESULTS: Both health complaints and medicine use were common among adolescents. Medicine use was strongly associated with the frequency of health complaints. The prevalence of both medicine use and health complaints was higher among girls than boys. Boys and girls with weekly health complaints were both similarly likely to report elevated rates of medicine use. CONCLUSIONS: The findings indicated that adolescents who report more frequent recurrent health complaints are also more likely to report more frequent medicine use for their health complaints. Adolescent boys with weekly health complaints have the same risk of medicine use as girls with weekly health complaints. The importance of educating school-aged children to interpret their bodily feelings and complaints and to use medicines appropriately is of high priority.

Correlation between driving-related skill and alcohol use in young-adults from six European countries: the TEN-D by Night Project.

BACKGROUND: Only few studies with small experimental samples investigated the impact of psychoactive substances on driving performance. We conducted a multicenter international cross-sectional study to evaluate the correlation between alcohol use and driving-related skill as measured by brake reaction time (RT). METHODS: Before and after the entrance into randomly selected recreational sites from six European countries, all subjects aged 16-35 years, owning a driver license, were asked to compile a structured socio-demographic questionnaire and measure RT (SimuNomad3 driving simulator), breath alcohol concentration (BAC; Drager Alcoltest), and drug use (Oratect III saliva test, only at the exit). Mixed regression modeling was used to evaluate the independent association between RT and alcohol concentration or drug use. RESULTS: Before the entrance into the recreational site, 4534 subjects completed all assessments and composed the final sample. Their mean age was 23.1±4.2 y; 68.3% were males; 54.7% had BAC>0 g/L (assumed alcoholics); 7.5% declared illegal drug assumption (mostly cannabis). After the exit, 3019 also completed the second assessment: 71.7% showed BAC>0 g/L. Controlling for age, gender, educational level, occupation, driver license years, and drug use, BAC was positively associated with RT, achieving significance, however, only when BAC was higher than 0.49 g/L. Significant interaction terms were found between BAC and female gender or drug use, with highest RTs (>1 sec.) recorded among drug users with BAC>or=1 g/L. CONCLUSIONS: This field study confirms previous experimental data on the negative impact of alcohol use on driving-related skill, supporting regulations and educational campaigns aimed at discouraging driving after consumption of psychoactive substances.

Converging or diverging trajectories of mortality under one year of age in the Baltic States: a comparison with the European Union.

BACKGROUND: Information about trends in perinatal and child health inequalities is scarce, especially in the Eastern Europe. We analyzed how mortality under 1 year of age has been changing in the Baltic States and the European Union (EU) over 25 years, and what associations occurred between changes in macroeconomic factors and mortality. METHODS: Data on fetal, neonatal, infant mortality, and macroeconomic factors were extracted from WHO database. Joinpoint regression analysis was performed to analyze time trajectories of mortality over 1990-2014. We also investigated how the changes in health expenditures and Gross Domestic Product (GDP) contributed to the changes in mortality. RESULTS: The reduction of fetal, neonatal and infant mortality in the Baltic countries led to convergence with the EU. In Estonia this process was the fastest, and then the rates tended to diverge. The strongest effect in reduction of neonatal mortality was related to the annual increase in health expenditure and GDP which had occurred in the same year, and a decrease in fetal mortality associated with an increase in health expenditure and GDP in the 4th and 5th year, respectively, following the initial change. CONCLUSIONS: These findings outlined convergences and divergences in mortality under 1 year of age in the Baltic States compared with the patterns of the EU. Our data highlighted a need to define health policy directions aimed at the implementation of effective intervention modalities addressing reduction of risks in prenatal and early life.

A European study on alcohol and drug use among young drivers: the TEND by Night study design and methodology.

BACKGROUND: Young individuals are the age group with the highest risk of car accidents. One of main explanations relies on the use of psychoactive substances (alcohol, illegal and medicinal drugs), which are known to be major risk factors of road accidents, and whose consumption is almost universally more common among younger drivers. Although the correlation between psychoactive substances use and decrease in driving performance has been established in controlled experimental or laboratory settings, few studies were conducted in naturalistic circumstances. The TEND by Night project has been designed to evaluate the relationship between driving performance and psychoactive substances assumption in young drivers enrolled at typical places of consumption. METHODS/DESIGN: The TEND by Night project, endorsed by the European Commission, is a multidisciplinary, multi-centric, cross-sectional study conducted in six European countries (Italy, Belgium/Netherlands, Bulgaria, Spain, Poland and Latvia). The study population consists of 5000 young drivers aged 16-34 years, attending recreational sites during weekend nights. The intervention is based on the portal survey technique and includes several steps at the entrance and exit of selected sites, including the administration of semi-structured questionnaires, breath alcohol test, several drug assumption test, and measurement of the reaction time using a driving simulator. The main outcome is the difference in reaction time between the entrance and exit of the recreation site, and its correlation with psychoactive substances use. As a secondary outcome it will be explored the relationship between reaction time difference and the amount of consumption of each substance. All analyses will be multivariate. DISCUSSION: The project methodology should provide some relevant advantages over traditional survey systems. The main strengths of the study include the large and multicentric sample, the objective measurement of substance assumption (which is typically self-reported), the application of a portal survey technique and the simultaneous evaluation of several psychoactive substances.

Insufficient sleep duration in association with self-reported pain and corresponding medicine use among adolescents: a cross-sectional population-based study in Latvia.

OBJECTIVES: Pain among adolescents is prevalent that may negatively affect adolescents' general well-being of which sleep is an important domain. This study aims to explore the associations between weekly pain and medicine use for relevant pain and insufficient sleep duration among 11-, 13- and 15-year-old adolescents in Latvia by assessing the moderation effect of gender and age. METHODS: Data from the Health Behaviour in School-aged Children Study on 2017/2018 of Latvia (n = 4412; 49.6% boys) were used. Logistic regression was applied to analyse the odds of insufficient sleep (< 7 h) on schooldays and weekends in association with weekly headache, stomach ache or backache and corresponding medicine use when testing the interaction effect of adolescents' gender and age. RESULTS: The experience of weekly pain with or without medicine use significantly increased the odds of insufficient sleep compared to adolescents with pain less than weekly, while controlling for gender and age. The interaction effect of gender and age on the studied associations was not significant. CONCLUSIONS: Weekly pain among adolescents is a significant risk factor for insufficient sleep duration, regardless of adolescents' gender and age.

How Are Adolescents Sleeping? Adolescent Sleep Patterns and Sociodemographic Differences in 24 European and North American Countries.

PURPOSE: Insufficient and poor sleep patterns are common among adolescents worldwide. Up to now, the evidence on adolescent sleep has been mostly informed by country-specific studies that used different measures and age groups, making direct comparisons difficult. Cross-national data on adolescent sleep that could inform nations and international discussions are lacking. We examined the sleep patterns of adolescents across 24 countries and by gender, age, and affluence groups. METHODS: We obtained sleep data on 165,793 adolescents (mean age 13.5 years; 50.5% girls) in 24 European and North American countries from the recent cross-sectional Health Behaviour in School-aged Children surveys (2013-2014 and 2017-2018). For each country, we calculated the age-standardized mean in sleep duration, timing, and consistency and the proportions meeting sleep recommendations on school and nonschool days from self-reported bedtimes and wake times. We conducted stratified analyses by gender, age, and family affluence group. RESULTS: Adolescent sleep patterns varied cross-nationally. The average sleep duration ranged between 7:47 and 9:07 hours on school days and between 9:31 and 10:22 hours on nonschool days, and the proportion of adolescents meeting sleep recommendations ranged between 32% and 86% on school days and between 79% and 92% on nonschool days. Sleep patterns by gender and affluence groups were largely similar, but older adolescents slept less and went to bed later on school days than younger adolescents in all countries. CONCLUSIONS: The sleep patterns of adolescents vary across countries and sociodemographic groups. Insufficient sleep on school days is common in many countries. Public health and policy efforts to promote healthy adolescent sleep are encouraged.

Latvia: Health System Review.

This analysis of the Latvian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. After regaining independence in 1991, Latvia experimented with a social health insurance type system. However, to overcome decentralization and fragmentation of the system, the National Health Service (NHS) was established in 2011 with universal population coverage. More recently, reforms in 2017 proposed the introduction of a Compulsory Health Insurance System, with the objective of increasing revenues for health, which links access to different health care services to the payment of social health insurance contributions. In June 2019 the implementation of this proposal was postponed to 2021. Latvia has recovered from the severe economic recession of 2008, which resulted in the adoption of austerity measures that significantly affected the health care system. The recovery has created fiscal space to focus on policy challenges neglected in the past, especially regarding health. Despite recent increases in spending, the health system remains underfunded and resources have to be allocated wisely. Latvia's health outcomes should be considered within this context of limited health system resources. While life expectancy at birth in Latvia has increased since 2000, reaching 74.9 years in 2017, it remains among the lowest in the EU. Recent reforms have focused on improving access to services in rural/remote areas, increasing funding for health care services, and tougher regulation of tobacco and alcohol. However, a number of longstanding unresolved problems still need to be addressed, including financial sustainability and low public funding, high levels of unmet need, high rates of preventable and treatable mortality, and challenges in both communicable and noncommunicable diseases.

Prevalence of self-reported chronic pain among adolescents: Evidence from 42 countries and regions.

BACKGROUND: Reports of the overall chronic pain prevalence and its associated demographic characteristics among adolescents vary greatly across existing studies. Using internationally comparable data, this study investigates age, sex and country-level effects in the prevalence of chronic single-site and multi-site pain among adolescents during the last six months preceding the survey. METHODS: Data (n = 214,283) from the 2013/2014 Health Behaviour in School-aged Children (HBSC) study were used including nationally representative samples of 11-, 13- and 15-year-olds from general schools in 42 participating countries. Multilevel logistic regression analyses were used. RESULTS: The overall proportion of adolescents reporting chronic weekly pain during the last six months was high (44.2%). On average, in comparison with different specific localized types of single-site pain, the prevalence of multi-site pain was more common varying from 13.2% in Armenia to 33.8% in Israel. Adolescent age and sex were strong predictors for reporting pain, but significantly different demographic patterns were found in the cross-country analyses. The most consistent findings indicate that multi-site pain was more prevalent among girls across all countries and that the prevalence increased with age. CONCLUSIONS: Internationally comparable data suggest that self-reported chronic pain among adolescents is highly prevalent, but different age and sex patterns across countries exist. Adolescents with chronic pain are not a homogenous group. Chronic pain co-occurrence and differences in chronic pain characteristics should be addressed in both clinical and public health practice for effective adolescent chronic pain management and prevention. SIGNIFICANCE: Chronic pain co-occurrence is common during adolescence across countries, the prevalence being among girls and in older age groups. Significant cross-country variations in the chronic pain prevalence and chronic pain patterns among adolescents exist. Significant country differences emerge for specific chronic pain patterns in association with adolescent demographics.

Injury mortality in local communities in Sweden and in the three Baltic States: implications for prevention.

This study provides a comparative time-trend evaluation of injury mortality in local communities in Sweden and the three Baltic States, considering their national socio-political and economic situations and with analysis of local injury prevention structures and activities. Data for the period from 1990 to 2002 were gathered from national statistical offices for the cities of Borås, Tartu, Jelgava and Kaunas and from WHO databases for national level analyses. The death rates for Borås remained relatively stable over the time period, while the Baltic communities had increasing rates until 1994 and seemed to stabilize after 1997. The differences in injury mortality in the studied communities were highest for the 0 - 19 year age group and especially in the 20 - 64 year age group, but not for the 65+ year age group. Local communities in the Baltic States should consider coordinated safety promotion and injury prevention programmes as a complement to national safety promotion framework.

Latvia: health system review

This analysis of the Latvian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. After regaining independence in 1991, Latvia experimented with a social health insurance type system. However, to overcome decentralization and fragmentation of the system, the National Health Service (NHS) was established in 2011 with universal population coverage. More recently, reforms in 2017 proposed the introduction of a Compulsory Health Insurance System, with the objective of increasing revenues for health, which links access to different health care services to the payment of social health insurance contributions. In June 2019 the implementation of this proposal was postponed to 2021. Latvia has recovered from the severe economic recession of 2008, whichresulted in the adoption of austerity measures that significantly affected the health care system. The recovery has created fiscal space to focus on policy challenges neglected in the past, especially regarding health. Despite recent increases in spending, the health system remains underfunded and resources have to be allocated wisely. Latvia’s health outcomes should be considered within this context of limited health system resources. While life expectancy at birth in Latviahas increased since 2000, reaching 74.9 years in 2017, it remains among the lowest in the EU. Recent reforms have focused on improving access to services in rural/remote areas, increasing funding for health care services, and tougher regulation of tobacco and alcohol. However, a number of longstanding unresolved problems still need to be addressed, including financial sustainability and low public funding, high levels of unmet need, high rates of preventable and treatable mortality, and challenges in both communicable and noncommunicable diseases.

Bullying and subjective health among adolescents at schools in Latvia and Lithuania.

OBJECTIVES: To investigate the prevalence of bullying among adolescents in Latvia and Lithuania and to study its association with self-rated health, health complaints, and life satisfaction. METHODS: A total of 3417 students in Latvia and 5626 in Lithuania were surveyed using the Health Behaviour Study among School-aged Children 2001/2002 (HBSC) questionnaire and research protocol. RESULTS: Being a victim, bully, or bully/victim was reported by 30.1% adolescents in Latvia and 52.3% in Lithuania with the highest proportion reporting being a victim. Bullying was associated with poor subjective health and low life satisfaction. CONCLUSIONS: The factors explaining the difference of bullying prevalence between both countries should be studied to develop effective anti-bullying interventions relevant to local conditions.

Latvia: health system summary

This Health System Summary is based on the Latvia: Health System Review (HiT) published in 2019 and relevant reform updates highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org). For this edition, key data have been updated to those available in March 2022 to keep information as current as possible. Health System Summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.