Does the level of burnout differ between occupational groups in Lithuania?

Background: The strain on workers of the healthcare system and education sector increased psychological distress and burnout. This study aimed to distinguish the occupational group that is the most affected by occupational burnout and to reveal the scope of psychosocial risk factors among each occupational group. Methods: This is a cross-sectional study that analyzed burnout syndrome among 1,046 participants of different occupational groups in association with psychosocial work environment factors in Lithuania. The anonymous questionnaire was composed of the standardized Job Content Questionnaire (JCQ), and the Copenhagen Burnout Inventory (CBI). To find out associations between psychosocial work environment factors and burnout dimensions, a multiple logistic regression model using the stepwise method was applied. Results: The burnout levels in all three dimensions (personal, work-related, and client-related burnout) were significantly higher in physicians' and nurses' groups compared with public health professionals, teachers, and managers (p < 0.05). The job demands were associated with the personal burnout subscale for all occupations, except public health specialists - each one-unit increase of this variable significantly increased the probability of personal burnout from 10 to 16%, respectively by the occupation. Co-worker support was found to have a buffering effect for all occupational groups, except managers - and significantly reduced personal burnout for physicians (OR = 0.80), nurses (OR = 0.75), public health specialists (OR = 0.75), and teachers (OR = 0.79). Conclusion: The burnout levels in all three dimensions differed between occupational groups: there were significantly higher in physicians' and nurses' groups compared with public health professionals, teachers, and managers. Considering the occupational preventive measures in the healthcare sector attention should be paid to the reduction of workload and ensuring good relations between co-workers.

Risk of ischemic and hemorrhagic stroke in relation to cold spells in four seasons.

BACKGROUND: Cold winter weather increases the risk of stroke, but the evidence is scarce on whether the risk increases during season-specific cold weather in the other seasons. The objective of our study was to test the hypothesis of an association between personal cold spells and different types of stroke in the season-specific context, and to formally assess effect modification by age and sex. METHODS: We conducted a case-crossover study of all 5396 confirmed 25-64 years old cases with stroke in the city of Kaunas, Lithuania, 2000-2015. We assigned to each case a one-week hazard period and 15 reference periods of the same calendar days of other study years. A personal cold day was defined for each case with a mean temperature below the fifth percentile of the frequency distribution of daily mean temperatures of the hazard and reference periods. Conditional logistic regression was applied to estimate odds ratios (OR) and 95% confidence intervals (95% CI) representing associations between time- and place-specific cold weather and stroke. RESULTS: There were positive associations between cold weather and stroke in Kaunas, with each additional cold day during the week before the stroke increases the risk by 3% (OR 1.03; 95% CI 1.00-1.07). The association was present for ischemic stroke (OR 1.05; 95% CI 1.01-1.09) but not hemorrhagic stroke (OR 0.98; 95% CI 0.91-1.06). In the summer, the risk of stroke increased by 8% (OR 1.08; 95% CI 1.00-1.16) per each additional cold day during the hazard period. Age and sex did not modify the effect. CONCLUSIONS: Our findings show that personal cold spells increase the risk of stroke, and this pertains to ischemic stroke specifically. Most importantly, cold weather in the summer season may be a previously unrecognized determinant of stroke.

Association between Outdoor Air Pollution and Fatal Acute Myocardial Infarction in Lithuania between 2006 and 2015: A Time Series Design.

BACKGROUND: Air pollution has a significant effect on human health and there is a broad body of evidence showing that exposure to air pollution is associated with an increased risk of adverse health effects. The main objective of this study was to assess the association of traffic-related air pollutants with fatal AMI during the ten-year period. METHODS: The study was conducted in Kaunas city, where the WHO MONICA register included a total of 2273 adult cases of fatal AMI cases during the 10-year study period. We focused on the period between 2006 and 2015. The associations between exposure to traffic-related air pollution and the risk of fatal AMI were evaluated by using a multivariate Poisson regression model, RR presented per an increase in IQR. RESULTS: It was found that the risk of fatal AMI was significantly higher in all subjects (RR 1.06; 95% CI 1.00-1.12) and women (RR 1.12; 95% CI 1.02-1.22) when the concentration of PM10 in the ambient air was increased 5-11 days before the onset of AMI, adjusting for NO2 concentration. The effect was stronger during spring in all subjects (RR 1.12; 95% CI 1.03-1.22), in men (RR 1.13; 95% CI 1.01-1.26), in younger-aged (RR 1.15; 95% CI 1.03-1.28), and in winter in women (RR 1.24; 95% CI 1.03-1.50). CONCLUSIONS: Our findings show that ambient air pollution increases the risk of fatal AMI, and this pertains to PM10 specifically.

Relationship between Depressive Symptoms and Weather Conditions.

Background: Weather is a well-known factor worldwide in psychiatric problems such as depression, with the elderly and females being particularly susceptible. The aim of this study was to detect associations between the risk of depressive symptoms (DS) and weather variables. Methods: 6937 participants were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study during 2006−2008. To assess the risk of DS, a multivariate logistic model was created with predictors such as socio-demographic factors, health behaviors, and weather variables. Results: DS were found in 23.4% of the respondents, in 15.6% of males and in 29.9% in females. A higher risk of DS (by 25%) was associated with November−December, a rising wind speed, and relative humidity (RH) < 94% and snowfall during the cold period occurring 2 days before the survey. A higher air temperature (>14.2 °C) predominant during May−September had a protective impact. A higher risk of DS in males was associated with lower atmospheric pressure (<1009 hPa) 2 days before. Females were more sensitive to the monthly variation, snowfall, and RH. Conclusions: The findings of our study suggest that some levels of weather variables have a statistically significant effect on DS.

Association between El Niño-Southern Oscillation events and stroke: a case-crossover study in Kaunas city, Lithuania, 2000-2015.

The aim of this study was to determine the association between the daily number of cases of ischemic stroke (IS) and hemorrhagic stroke (HS) in patients aged 25-64 years and the El Niño-Southern Oscillation (ENSO) events during 2000-2015. As an indicator of the effect of the ENSO, the monthly NIÑO 3.4 index (Equatorial Pacific Sea Surface Temperature) was used. During the 5844-day study period, 5600 cases of stroke (3170 (56.61%) in men and 2430 (43.39%) in women) were analyzed. Of these, 4354 (77.8%) cases were IS, and 1041 (18.6%) cases were HS. In 3496 (62.2%) cases, stroke occurred in the age group of 55-64 years. In the analysis, we used the following categories of the ENSO events: strong La Niña, moderate La Niña, moderate El Niño, and strong El Niño. The effect of the ENSO was examined by using the multivariate Poisson regression adjusting for weather variables. The highest risk of both strokes (BS) was observed on days of strong and moderate La Niña (rate ratio (RR) 1.27, 95% CI 1.13-1.42) and RR = 1.15 (1.07-1.23), respectively), while the risk for IS was the highest on days of moderate El Niño (RR = 1.11(1.02-1.20)). A lower risk for BS was found on days of strong El Niño (RR = 0.77(0.62-0.97)). We found that ENSO events affected the occurrence of BS and IS in all age groups, and the strongest effect was observed among females. The results of this study provide new evidence that ENSO events may affect the risk of stroke, especially the risk of IS.

Association between winter cold spells and acute myocardial infarction in Lithuania 2000-2015.

Acute myocardial infarction (AMI) is a major public health problem. Cold winter weather increases the risk of AMI, but factors influencing susceptibility are poorly known. We conducted an individual-level case-crossover study of the associations between winter cold spells and the risk of AMI, with special focus on survival at 28 days and effect modification by age and sex. All 16,071 adult cases of AMI among the residents of the city of Kaunas in Lithuania in 2000-2015 were included in the study. Cold weather was statistically defined using the 5th percentile of frequency distribution of daily mean temperatures over the winter months. According to conditional logistic regression controlling for time-varying and time-invariant confounders, each additional cold spell day during the week preceding AMI increased the risk of AMI by 5% (95% CI 1-9%). For nonfatal and fatal cases, the risk increase per each additional cold spell day was 5% (95% CI 1-9%) and 6% (95% CI - 2-13%), respectively. The effect estimate was greater for men (OR 1.07, 95% CI 1.02-1.12) than for women (OR 1.02, 95% CI 0.97-1.08), but there was no evidence of effect modification by age. Evidence on factors increasing susceptibility is critical for targeted cold weather planning.

Association between stroke occurrence and changes in atmospheric circulation.

BACKGROUND: The impact of weather on morbidity from stroke has been analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily stroke occurrence may be associated with changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic strokes (ISs) and haemorrhagic strokes (HSs) and the teleconnection pattern. METHODS: The study was performed in Kaunas, Lithuania, from 2000 to 2010. The daily numbers of ISs, subarachnoid haemorrhages (SAHs), and intracerebral haemorrhages (ICHs) were obtained from the Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression and adjusting for the linear trend, month, and other weather variables. RESULTS: During the study period, we analysed 4038 cases (2226 men and 1812 women) of stroke. Of these, 3245 (80.4%) cases were ISs, 533 (13.2%) cases were ICHs, and 260 (6.4%) cases were SAHs. An increased risk of SAH was associated with a change in mean daily atmospheric pressure over 3.9 hPa (RR = 1.49, 95% CI 1.14-1.96), and a stronger El Niño event had a protective effect against SAHs (RR = 0.34, 95% CI 0.16-0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR = 1.13, 95% CI 1.04-1.23). The risk of IS was negatively associated with the Arctic Oscillation index on the same day and on the previous day (RR = 0.97, p < 0.033). During November-March, the risk of HS was associated with a positive North Atlantic Oscillation (NAO) (RR = 1.29, 95% CI 1.03-1.62), and the risk of IS was negatively associated with the NAO index (RR = 0.92, 95% CI 0.85-0.99). CONCLUSIONS: The results of our study provide new evidence that the North Atlantic Oscillation, Arctic Oscillation, East Atlantic/West Russia, and El Niño-Southern Oscillation pattern may affect the risk of stroke. The impact of these teleconnections is not identical for various types of stroke. Emergency services should be aware that specific weather conditions are more likely to prompt calls for more severe strokes.

Associations between Quasi-biennial Oscillation phase, solar wind, geomagnetic activity, and the incidence of acute myocardial infarction.

An increase in the daily rate of acute myocardial infarction (AMI) has been observed during days of geomagnetic storm (GS). However, the analysis of associations between the daily number of AMI and geomagnetic activity (GMA) over longer periods sometimes yields controversial results. The study aimed to detect the complex association between the daily numbers of AMI and weather, the Quasi-biennial Oscillation (QBO) phase, GMA, and solar wind variables. We used data of Kaunas population-based Ischemic Heart Disease Register of residents of Kaunas city (Lithuania) for 2000-2012. The associations between weather and space weather variables and the daily number of AMI were evaluated by applying the multivariate Poisson regression. A higher risk of AMI was positively associated with active-stormy local GMA (rate ratio (RR) = 1.06 (95% CI 1.01-1.10)), solar wind dynamic pressure with a lag of 4 days (RR = 1.02 (1.01-1.04) per 1 nPa increase), and solar wind speed with a lag of 3-7 days (RR = 1.03 (1.01-1.05) per 100 km/s increase). A positive association was found between the west QBO phase and the risk of AMI during winter (RR = 1.08 (1.01-1.16)), and a negative association was observed between them during March-November (RR = 0.93 (0.90-0.97)). The risk of AMI positively associated with the GS due to stream interaction regions with a lag of 0-2 days during the east QBO phase (RR = 1.10, p = 0.046) and was negatively associated with them during the west QBO phase (RR = 0.82, p = 0.024). These results may help understand the population's sensitivity under different weather and space weather conditions. The QBO phase may modify the effect of GS.

The influence of the North Atlantic Oscillation index on arterial blood pressure.

AIM: to detect the complex association between arterial blood pressure (BP) and air temperature, atmospheric pressure, relative humidity, wind speed, and North Atlantic oscillation (NAO) indices. METHODS: Data were obtained from the survey performed in the framework of the international Health, Alcohol and Psychosocial Factors in Eastern Europe study. The number of individuals used in the models or other analysed groups was 7077. The association between environmental variables and SBP and DBP were evaluated by applying the multiple regression analysis, adjusting for health-related and weather variables. RESULTS: More than one-half (58.7%) of the respondents had high BP, and 39.4% of the respondents had taken drugs for high BP during the last 2 weeks. Among the respondents, the mean SBP and DBP were 141.6 ±â€Š22.2 and 90.4 ±â€Š12.5 mmHg, respectively. An increase in SBP was associated with the presence of a lower relative humidity, and a higher wind speed and extreme atmospheric pressure with a lag of 2 days. During the period of spring-autumn, continuous NAO indices on the same day and a positive NAO on the same and on 2 previous days were negatively associated with the SBP value. A positive NAO was associated (P = 0.001) with a decrease in SBP by 1.7 mmHg in all participants, by 2.30 mmHg in physically active participants, and by 3.62 mmHg in the elderly, as compared with a negative NAO. CONCLUSION: These results provided new evidence that the NAO index may be affect the value of SBP and DBP in the elderly during the period of spring-autumn.

Relationship of meteorological factors and acute stroke events in Kaunas (Lithuania) in 2000-2010.

Some researchers have hypothesised that meteorological factors may have an impact on acute cerebrovascular diseases. The aim of this study was to determine an impact of some meteorological factors on occurrence of acute cerebrovascular events in the middle-aged Kaunas population. Kaunas stroke register data were used. Data on meteorological factors for the time period from 2000 to 2010 were obtained from the Lithuanian Hydrometeorological Service Kaunas Meteorological Station. We analysed 4038 cases with stroke. Ischemic strokes composed 80.4% and haemorrhagic strokes-19.6%. According to Poisson regression analysis, significant negative correlation between ischemic, haemorrhagic and all types of stroke and ambient air temperature was found (ß coefficient - 0.007, -0.016, -0.009, p < 0.001, respectively). Results of ARIMA showed that ambient temperature of the day of stroke onset was associated with the occurrence of ischemic, haemorrhagic and all types of stroke: when temperature was lower, the risk of stroke was higher (-0.006, -0.003, -0.009, p < 0.001, respectively). Low temperature on the event day and 1 and 2 days before the event was associated with higher incidence of haemorrhagic stroke in women. Low ambient temperature on the event day increased incidence of haemorrhagic stroke in subjects 55-64 years. High wind speed on the event day was associated with higher incidence of ischemic stroke in older subjects. Meteorological factors may have some impact on the risk of acute cerebrovascular events. Health care providers should focus on preventive measures, which can reduce these risks.

Associations between musculoskeletal pain and work-related factors among public service sector computer workers in Kaunas County, Lithuania.

BACKGROUND: Information technologies in occupational activities have been developing very rapid. Epidemiological studies have shown that musculoskeletal disorders are widely prevalent among employees working with a computer. The aim of this study was to evaluate the prevalence of musculoskeletal pain in various anatomical areas and its associations with individual, ergonomic, and psychosocial factors among computer workers of the public sector in Kaunas County, Lithuania. METHODS: The investigation consisting of two parts - questionnaire study (Nordic Musculoskeletal Questionnaire and Copenhagen Psychosocial Questionnaire) and direct observation (evaluation of work ergonomics using the Rapid Upper Limb Assessment [RULA]) - was carried out in three randomly selected public sector companies of Kaunas County. The representative study sample comprised 513 public service office workers. The prevalence of musculoskeletal pain in five anatomical areas of the body (shoulders, elbows, wrists/hands, as well as upper and low back) was evaluated. RESULTS: The prevalence rates of shoulder, elbow, wrist/hand, upper and low back pain were 50.5 %, 20.3 %, 26.3 %, 44.8 %, and 56.1 %, respectively. Individual factors such as gender, age, computer work experience, and body mass index were found as significant for musculoskeletal pain in various musculoskeletal regions. The respondents reporting pain in shoulder, wrist/hand, upper back, and low back areas had a statistically significantly higher mean RULA score. The duration of working with a computer was found as a significant factor for shoulder pain. High quantitative demands were related to musculoskeletal pain in all investigated anatomical areas expect for the low back; weak social support was a significant predictor for complaints in upper and low back areas. CONCLUSION: This study confirmed associations between musculoskeletal pain and work ergonomics; therefore, preventive measures at the workplace should be directed to the improvement in ergonomic work environment, education, and workload optimization.

Associations of morbidity and mortality from coronary heart disease with heliogeophysical factors.

The aim of this study was to evaluate the associations among morbidity of acute myocardial infarction (AMI) and mortality from ischemic heart disease (IHD) with heliogeophysical factors among the Kaunas population. The study population was stratified into three age categories: 25-54, 55-64, and ≥65 years. In this study, solar flares (SF), solar proton fluences (SPF), and geomagnetic activity (GMA) were employed as heliogeophysical factors and used Poisson regression and two methods of time series modeling (lag and lead). Influence of GMA in different age and sex category is uneven. The mean number of AMI events per day was greatest (23 %) among men aged 25-54 years on the third day and the same sex aged 55-64 years-increased 10 % 2 days before when the GMA intensity was A+S. Both for men and women aged ≥65 years, the highest increase in the mean number of deaths from IHD events per day was observed on the second day when the GMA intensity was A+S-51 and 34 %, respectively. Evaluating the impact of SF of 10(-5) ≤ SF < 10(-4) W/m(2) (M+X) intensity, the mean number of AMI events per day was greatest for 55-64-year-old women and men on the same and second days. Such SF were associated with a 13 and 20 % increase, respectively. Evaluating the impact of large fluence SPF, it was determined that the increase in the mean number of AMI events per day among 25-54-year-old men was greatest (30 %) 1 day, and death from IHD (54 %) was observed among women aged ≥65 years 2 days before the energy of the SPF has increased.

The effect of atmospheric temperature and pressure on the occurrence of acute myocardial infarction in Kaunas.

OBJECTIVE. The aim of the study was to evaluate the impact of meteorological variables (atmospheric temperature and pressure) on the daily occurrence of acute myocardial infarction (AMI). MATERIAL AND METHODS. The study used the daily values of atmospheric temperature and pressure in 2000-2007. The meteorological data were obtained from the Lithuanian Hydrometeorological Service for Kaunas. The relative risks of event occurrence were computed for 5°C atmospheric temperature and for 10-hPa atmospheric pressure variations by means of the Poisson regression model. RESULTS. The occurrence of AMI and atmospheric temperature showed an inverse linear relationship, while the occurrence of AMI and atmospheric pressure, a positive linear relationship. Among the youngest subjects (25-44 years old), no relationships were detected. Contrary, among the subjects aged 45-64 years and those aged 65 years and older, the occurrence of AMI significantly decreased with higher temperature (P=0.001 and P=0.002, respectively). A decrease in atmospheric temperature by 10ºC reduced the risk of AMI by 8.7% in the age groups of 45-64 and 65 years and older and by 19% in the age group of 25 years and older. Among the first AMI cases, the risk increased by 7.5% in the age group of 45-64-year olds and by 6.4% in the age group of 25-64-year olds. The relationship between atmospheric temperature and pressure, and AMI occurrence was found to be linear but inverse. An increase in atmospheric pressure by 10 hPa resulted in an increase in risk by 4% among the subjects aged 65 years and more and by 3% among the subjects aged 25 years and more. CONCLUSIONS. Atmospheric temperature and pressure variations had the greatest effect on middle-aged and aging subjects (starting from 45 years). At younger age, the effect of such factors on the AMI risk was considerably lower.