Out-of-hospital cardiac arrest research progress and challenges in Lithuania.

Aim: To present the evolution of data collection and analysis methods of out-of-hospital cardiac arrest (OHCA) research in Kaunas city, Lithuania, and discuss the challenges encountered. Methods: In late 2016, data collection began with a focus on 2016 data, following the Utstein 2014 template. The Kaunas city emergency medical services (EMS) station, which has a protocol dispatch system, pioneered the use of electronic submissions for the national EMS data collection form, making the research process more efficient. Most OHCA patients were treated in a tertiary university hospital which transitioned to electronic health record system in 2017, improving data accessibility. Throughout data collection significant efforts have been directed towards enhancing process efficiency and simplifying operations. As a result, the expansion of the Excel data table led to the creation of the ''resuscitation registry form' 'in 2018, which became operational in 2020. Results: The collected data were used in several observational studies to identify and better outcomes. Conclusion: Engaging in research on OHCA is difficult and poses many unique challenges owning to the urgency of the condition, complexity of legal and ethical considerations, and implications of any research intervention. The lack of a connection between the EMS and hospital electronic health record systems poses challenges for data collection. Legal and ethical complexities, including mandatory initiation of resuscitation and challenges in obtaining ethical approval, highlight the need for a comprehensive framework. This study aims transition the accumulated expertise into a nationally recognised registry for OHCA.

Effect of high-dose intravenous ascorbic acid on microcirculation and endothelial glycocalyx during sepsis and septic shock: a double-blind, randomized, placebo-controlled study.

Previous studies indicate supplemental vitamin C improves microcirculation and reduces glycocalyx shedding in septic animals. Our randomized, double-blind, placebo-controlled trial aimed to investigate whether a high dose of intravenous ascorbic acid (AA) might improve microcirculation and affect glycocalyx in septic patients. In our study, 23 septic patients were supplemented with a high dose (50 mg/kg every 6 h) of intravenous AA or placebo for 96 h. Sublingual microcirculation was examined using a handheld Cytocam-incident dark field (IDF) video microscope. A sidestream dark field video microscope (SDF), connected to the GlycoCheck software (GlycoCheck ICU®; Maastricht University Medical Center, Maastricht, the Netherlands), was employed to observe glycocalyx. We found a significantly higher proportion of perfused small vessels (PPV) 6 h after the beginning of the trial in the experimental group compared with placebo. As an indicator of glycocalyx thickness, the perfused boundary region was lower in capillaries of the 5-9 µm diameter in the AA group than placebo after the first dose of AA. Our data suggest that high-dose parenteral AA tends to improve microcirculation and glycocalyx in the early period of septic shock. The study was retrospectively registered in the clinicaltrials.gov database on 26/02/2021 (registration number NCT04773717).

AI-Enabled Public Surveillance Cameras for Rapid Emergency Medical Service Activation in Out-of-Hospital Cardiac Arrests.

This study aims to evaluate the potential usefulness of a novel artificial intelligence (AI)-based video processing algorithm for rapidly activating ambulance services (EMS) in unwitnessed out-of-hospital cardiac arrest (OHCA) cases in public places. We hypothesized that AI should activate EMS using public surveillance cameras after detecting a person fallen due to OHCA. We created an AI model based on our experiment performed at the Lithuanian University of Health Sciences, Kaunas, Lithuania, in Spring 2023. Our research highlights the potential benefits of AI-based surveillance cameras for rapidly detecting and activating EMS during cardiac arrests.

Short- and long-term survival after out-of-hospital cardiac arrest in Kaunas (Lithuania) from 2016 to 2018.

BACKGROUND: No studies analysing out-of-hospital cardiac arrest (OHCA) epidemiology and outcomes in Lithuania were published in the last decade. METHODS: We conducted a retrospective analysis of prospectively collected data. The incidence of OHCA and the demographics and outcomes of patients who were treated for OHCA between 1 and 2016 and 31 December 2018 at Kaunas Emergency Medical Service (EMS) were collected and are reported in accordance with the Utstein recommendations. Multivariable logistic regression analysis was used to identify predictors of survival to hospital discharge. RESULTS: In total, 838 OHCA cases of EMS-treated cardiac arrest (CA) were reported (95.8 per 100.000 inhabitants). The median age was 71 (IQR 58-81) years of age, and 66.7% of patients were males. A total of 73.8% of OHCA cases occurred at home, 59.3% were witnessed by a bystander, and 54.5% received bystander cardiopulmonary resuscitation. The median EMS response time was 10 min. Cardiac aetiology was the leading cause of CA (78.8%). The initial rhythm was shockable in 27.6% of all cases. Return of spontaneous circulation at hospital transfer was evident in 24.9% of all cases. The survival to hospital discharge rate was 10.9%, and the 1-year survival rate was 6.9%. The survival to hospital discharge rate in the Utstein comparator group was 36.1%, and the 1-year survival rate was 27.2%. Five factors were associated with improved survival to hospital discharge: shockable rhythm, time from call to arrival at the patient less than 10 min, witnessed OHCA, age < 80 years, and male sex. CONCLUSION: This is the first OHCA study from Lithuania examining OHCA epidemiology and outcomes over a three year period. Routine OHCA data collection and analysis will allow us to track the efficacy of service improvements and should become a standard practice in all Lithuanian regions. TRIAL REGISTRATION: This research was registered in the clinicaltrials.gov database: Identifiers: NCT04784117, Unique Protocol ID: LITOHCA. Brief Title: Out-of-hospital Cardiac Arrest Epidemiology and Outcomes in Kaunas 2016-2021.

Modulation of Endothelial Glycocalyx and Microcirculation in Healthy Young Men during High-Intensity Sprint Interval Cycling-Exercise by Supplementation with Pomegranate Extract. A Randomized Controlled Trial.

The natural components of the pomegranate fruit may provide additional benefits for endothelial function and microcirculation. It was hypothesized that supplementation with pomegranate extract might improve glycocalyx properties and microcirculation during acute high-intensity sprint interval cycling exercise. Eighteen healthy and recreationally active male volunteers 22-28 years of age were recruited randomly to the experimental and control groups. The experimental group was supplemented with pomegranate extract 20 mL (720 mg phenolic compounds) for two weeks. At the beginning and end of the study, the participants completed a high-intensity sprint interval cycling-exercise protocol. The microcirculation flow and density parameters, glycocalyx markers, systemic hemodynamics, lactate, and glucose concentration were evaluated before and after the initial and repeated (after 2 weeks supplementation) exercise bouts. There were no significant differences in the microcirculation or glycocalyx over the course of the study (p < 0.05). The lactate concentration was significantly higher in both groups after the initial and repeated exercise bouts, and were significantly higher in the experimental group compared to the control group after the repeated bout: 13.2 (11.9-14.8) vs. 10.3 (9.3-12.7) mmol/L, p = 0.017. Two weeks of supplementation with pomegranate extract does not influence changes in the microcirculation and glycocalyx during acute high-intensity sprint interval cycling-exercise. Although an unexplained rise in blood lactate concentration was observed.

Quality of life of the family of children with asthma is not related to asthma severity.

The quality of life for the family is an important outcome of childhood asthma. The aim of the study was to describe the quality of life in families who have a child with asthma. The Pediatric Quality of Life Inventory Family Impact Module was completed by the parents of 527 children with asthma. The median overall score was 75.0 (interquartile range 63.9, 87.5). The following factors were independently associated with lower quality of life: additional difficulties such as anxiety and financial hardship (3.81 [2.45, 5.93]), waking with asthma symptoms one or more nights a week (odds ratio 2.53 [1.34, 4.75]), regular use of symptoms reliever medication (2.47 [1.57, 3.87]), and female gender (1.97 [1.27, 3.05]). Lower socioeconomic status of the family and exposure to molds at home doubled the odds for lower quality of life. Physician's diagnosed asthma severity and control were associated with quality of life in univariate, but not multivariate analysis.Conclusion: Multiple factors, several of which are not related to asthma, contribute to the family burden of having a child with asthma. Clinicians should be mindful of the impact of asthma on the child and the family, and consider exploring factors not directly related to childhood asthma. What is Known: • Childhood asthma as a chronic disease impacts the quality of life of the patient, but there is also an impact on the immediate family. • There are relatively few studies exploring the quality of life of parents of a child with asthma; the results are heterogeneous and none has been carried out in an Eastern European country. What is New: • This is the first study to describe caregiver's quality of life in an Eastern European population in the context of childhood asthma. • The quality of life of the family of asthmatic child depends not only on factors related to asthma, but also non-asthma related factors such as poverty which play even more important role.

The self-reported quality of life of Lithuanian children with asthma was comparable to Western populations.

AIM: Quality of life (QoL) has been widely researched among children with asthma in Western countries, but there is a lack of data from eastern Europe, where the prevalence is relatively low, but hospital admission rates are higher. We evaluated the overall level and major determinants of QoL in Lithuanian children aged 5-11 years with asthma. METHODS: This study was carried out in six asthma outpatient clinics in the two largest cities of Lithuania from January 2015 to July 2016. The children's QoL was measured using the Pediatric Quality of Life Inventory (PedsQL) asthma module, which was completed by the child and one parent. RESULTS: We collected questionnaires from 226 children (68% boys) with a mean age of eight (±2) years: 65% had mild asthma, 31% had moderate asthma and 4% had severe asthma. One in 10 had been hospitalised in the preceding 6 months. The mean self-reported QoL score was 74 and the parent-reported QoL score was 73. QoL was associated with asthma severity and control, shortness of breath and the child's general health, but not socioeconomic factors. CONCLUSION: The overall level and major determinants of QoL in children with asthma in Lithuania were comparable with Western populations.

Time Evolution of Sublingual Microcirculatory Changes in Recreational Marathon Runners.

We aimed to evaluate changes in sublingual microcirculation induced by a marathon race. Thirteen healthy male controls and 13 male marathon runners volunteered for the study. We performed sublingual microcirculation, using a Cytocam-IDF device (Braedius Medical, Huizen, Netherlands), and systemic hemodynamic measurements four times: 24 hours prior to their participation in the Kaunas Marathon (distance: 41.2 km), directly after finishing the marathon, 24 hours after the marathon, and one week after the marathon. The marathon runners exhibited a higher functional capillary density (FCD) and total vascular density of small vessels at the first visit compared with the controls. Overall, we did not find any changes in sublingual microcirculation of the marathon runners at any of the other visits. However, in a subgroup of marathon runners with a decreased FCD compared to the subgroup with increased FCD, the subgroup with decreased FCD had shorter running time (190.37 ± 30.2 versus 221.80 ± 23.4 min, p = 0.045), ingested less fluids (907 ± 615 versus 1950 ± 488 mL, p = 0.007) during the race, and lost much more weight (-2.4 ± 1.3 versus -1.0 ± 0.8 kg, p = 0.041). Recreational marathon running is not associated with an alteration of sublingual microcirculation. However, faster running and dehydration may be crucial for further impairing microcirculation.

Are two or four hands needed for elderly female bystanders to achieve the required chest compression depth during dispatcher-assisted CPR: a randomized controlled trial.

BACKGROUND: Rescuers are often unable to achieve the recommended 5-6 cm CC depth. The physical limitations of elderly bystanders may affect the quality of CC; thus, we investigated new strategies to improve CC performance. METHODS: We performed a randomized controlled trial in December 2013. Sixty-eight lay rescuers aged 50-75 were randomized to intervention or control pairs (males and females separately). Each pair performed 8 min of DA-CPR on a manikin connected to a PC. Each participant in every pair took turns performing CCs in cycles of 2 min and switched as advised by the dispatcher. In the middle of every 2-min cycle, the dispatcher asked the participants of the intervention group to perform the Andrew's manoeuvre (to push on the shoulders of the person while he/she performed CCs to achieve deeper CC). Data on the quality of the CCs were analysed for each participant and pair. RESULTS: The CC depth in the intervention group increased by 6.4 mm (p = 0.002) compared to the control group (54.2 vs. 47.8 mm) due to a significant difference in the female group. The CC depth in the female intervention and control groups was 51.5 and 44.9 mm. DISCUSSION: The largest group of out-of-hospital cardiac arrest occurred in males over the age of 60 at home, and accordingly, the most likely witness, if any, is the spouse or family member, most frequently an older woman. There is a growing body of evidence that female rescuers are frequently unable to achieve sufficient CC depth compared to male rescuers. In some instances, the adequate depth of the CCs could only be reached using four hands, with the second pair of hands placed on the shoulders of the rescuer performing CPR. CONCLUSION: Andrew's manoeuvre (four-hands CC) during the simulated DA-CPR significantly improved the performance of elderly female rescuers and helped them to achieve the recommended CC depth.

Microcirculatory effects of L-arginine during acute anaerobic exercise in healthy men: A pilot study.

BACKGROUND/OBJECTIVE: We hypothesized that L-arginine supplementation increases sublingual capillary perfusion during acute anaerobic exercise. METHODS: In a double-blind randomized study, 20 healthy men were randomly assigned to an L-arginine group or a placebo group. Both groups performed a standard 60-second duration BOSCO jumping test. Before the exercise, immediately after, and 30 minutes after exercise, systemic hemodynamic parameters were recorded. Sublingual evaluation of microcirculation using sidestream dark field (SDF) videomicroscopy was also carried out. RESULTS: There were no differences in mean arterial blood pressure and cardiac output between the placebo and L-arginine groups immediately after exercise and at 30 minutes after exercise. Both groups had no changes in the microvascular flow index and proportion of perfused vessels of small vessels over the testing period. We observed significantly higher functional capillary density [14.1 (12.5 - 16.0) vs. 11.7 (10.9 - 12.9) 1/mm, p = 0.021] and total vessel density of small vessels [27.8 (24.4 - 29.2) vs. 23.0 (21.6 - 24.2) mm/mm2, p = 0.041] in the L-arginine group compared with the placebo group immediately after exercise, but after 30 minutes these differences had disappeared. CONCLUSION: Our findings show that supplementation with L-arginine may cause additional effects on the acute anaerobic exercise-induced transient increase in capillary density in the sublingual mucosa of untrained men.

Magical manoeuvre: a 5-s instructor's intervention helps lightweight female rescuers achieve the required chest compression depth.

BACKGROUND: Adequate chest compression (CC) depth is crucial for resuscitation outcomes. Lightweight rescuers, particularly women, are often unable to achieve the required 5-6 cm CC depth. This nonrandomized cohort study investigated new strategies to improve CC performance. OBJECTIVE: To evaluate the effects of a 5-s instructor's intervention on the depth of CCs performed by female rescuers during standard video self-instruction basic life support training. METHODS: Data were prospectively collected from January 2011 to January 2012 from 336 female medical and pharmacy students undergoing cardiopulmonary resuscitation (CPR) training at the Lithuanian University of Health Sciences. During the training process, the instructors performed a simple 5-s intervention (Andrew's manoeuvre) with all of the rescuers in the study group. The instructor pushed 10 times on the shoulders of each trainee while she performed CCs to achieve the maximal required compression depth. Immediately after training, the participants were asked to perform a 6-min basic life support test on a manikin that was connected to a PC with Skill Reporter System software; the quality of the participants' CPR skills was then evaluated. RESULTS: The CC depth in the study group increased by 6.4 mm (P<0.001) compared with the control group (52.9 vs. 46.6 mm). A regression analysis showed that Andrew's manoeuvre increased the depth of the CCs among women by 14.87×(1-0.01×weight) mm. CONCLUSION: A simple 5-s instructor's intervention during the CPR training significantly improved the performance of the female rescuers and helped them achieve the CC depth required by 2010 resuscitation guidelines. Andrew's manoeuvre is most effective among the women with the lowest body weight.

Can lightweight rescuers adequately perform CPR according to 2010 resuscitation guideline requirements?

AIM: To evaluate associations between rescuers' anthropometric characteristics and chest compressions (CC) depth according to 2010 resuscitation guidelines. METHODS: 186 medical and pharmacy students, never trained in basic life support (BLS) before, underwent video self-instruction training. The participants were asked to perform a BLS test on a manikin connected to a PC for 6 min immediately after training, and the quality of the cardiopulmonary resuscitation (CPR) skills was evaluated. RESULTS: Women with body weights less than 56 kg were 6.29 times more likely to produce insufficient CCs than women weighing 56-62.7 kg, and 4.72 times more likely to produce insufficient CCs compared with women weighing more than 62.7 kg. CONCLUSIONS: Lightweight rescuers may have difficulty achieving the full compression depth of 5-6 cm required by new resuscitation guidelines. These rescuers require special attention during CPR training, with an emphasis on correct body positioning and use of body weight for CCs.

[Economic evaluation of nosocomial infections in pediatric intensive care units in Lithuania]. / Hospitalines infekcijos ekonominis ivertinimas vaiku intensyviosios terapijos skyriuose Lietuvoje.

UNLABELLED: The aim of this study was to estimate direct costs related to nosocomial infection in three pediatric intensive care units in Lithuania and to overview the effectiveness of preventive programs of nosocomial infections. MATERIAL AND METHODS: A prospective empirical surveillance study was launched in 3 Lithuanian pediatric intensive care units during the period of January 2005 to December 2007. Using the method of targeted selection, all children aged from 1 month and 18 years, treated in pediatric intensive care units for more than 48 hours, were enrolled into the study. Direct costs of nosocomial infections in pediatric intensive care units were calculated for each patient and each case of nosocomial infection. For calculation of average expenditures per patient-day, data from nosocomial infection registry and from analysis of hospital income for services provided at pediatric intensive care units according to price-list of health care price approved by the order of the Minister of Health of the Republic of Lithuanian (No. V-802, October 27, 2005) were used. According to length of stay, costs of intensive care services, and costs caused by nosocomial infections, all the patients were divided into two groups: those who did and did not acquire an infection. For the evaluation of economic efficiency, the patients were divided into other two groups: pre- and postintervention groups. All economic evaluation was made in national currency (litas). RESULTS: The data of 755 patients were used. Multiple linear regression analysis (R(2)=0.47) revealed a 6.32-day increase (95% CI, 4.32-8.33; P=0.003) in hospital stay in a pediatric intensive care unit if a patient acquired nosocomial infection. Costs related to nosocomial infections for one patient made up 5215.47 litas (95% CI, 3565.00-6874.19). Average costs caused by one nosocomial infection case were 4070.61 litas (95% CI, 2782.44-5365.22). Nosocomial infection prevention programs (interventions) gave a total economical effect of 20046.14 litas. Prevention of one patient from nosocomial infection caused a reduction of 1336.41 litas, and one avoided nosocomial infection case resulted in a 1113.67-litas reduction; cost-to-effect ratio was 1:4. CONCLUSIONS: Total costs related to nosocomial infections in pediatric intensive care units were high. The implementation of nosocomial infection prevention program resulted in a positive economic effect - 1 litas spent for the prevention of nosocomial infections saved 4 litas.

New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010.

Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. We have performed a search in the MEDLINE and the Cochrane databases for randomized controlled trials, meta-analyses, expert reviews from December 2005 to March 2010 using the terms cardiac arrest, basic life support, and advanced life support. The lack of randomized trials during the last 5 years remains the main problem for crucial decisions in cardiopulmonary resuscitation. Current trends in cardiopulmonary resuscitation are toward minimizing the interruptions of chest compressions and improving the quality of cardiopulmonary resuscitation. In addition, attention should be paid to all the parts of chain of survival, which remains essential in improving survival rates.

[Conception of quality of life and health-related quality-of-life investigations in children population]. / Gyvenimo kokybes samprata ir sveikatos nulemtos vaiku gyvenimo kokybes tyrimai.

Assessment of the impact of diseases and their treatment on a patient with chronic disease is especially important. When there is no possibility to recover, patients and their closest relatives have to accept changes in lifestyle, which may vary with time. Health professionals assume that improvements in symptoms show better quality of life of patients. Quality-of-life assessments incorporate not only the impact of illness and treatment on physical functions, but also its effect on lifestyle and emotional well-being. Quality of life deals with a higher order of complexity: the impact of functional impairment on other aspects of life, e.g. the ability of children to go to school or play, and the emotional effect of these restrictions. The aim of this article is to present measurement tools and how to use them and the application of quality-of-life measurement in pediatric medicine. Every investigator has to raise the question to himself/herself, "What is health-related quality of life," and before planning the investigation, answer this question correctly.

The ability of Lithuanian ambulance services to provide first medical aid in trauma cases.

OBJECTIVE: To evaluate the ability of country ambulance services to provide first medical aid in trauma cases. MATERIAL AND METHODS: A survey of chiefs of emergency medicine service was performed in October-November 2005, in which 34 of the 59 institutions (58%) were participating. The questionnaire presented questions concerning physical and human resources, performance values, and system configuration. The study has shown that emergency medicine service operates in radius of 23 km, each team providing service for about 40,000 inhabitants. Taking into consideration distance and average on-scene time values, emergency medicine service is capable to render the first medical aid within so-called "golden hour" in case the accident is reported immediately. The physical resources are not quite complete. Not all the cars are equipped with essential first aid measures. Among more rarely found resources are vacuum pumps, intubation sets, defibrillators, vacuum splints, back immobilization devices, and hammock immobilization devices. There are less mentioned resources than working teams and even more than two times less than emergency cars at all. Two-thirds of the operating emergency medicine services do not provide advanced life support procedures. The evaluation of theoretical/practical ability to provide some important medical procedures used in emergency medical care showed that medical staff quite often fails to perform defibrillation, intubation, and pleural cavity drainage. CONCLUSIONS: Country ambulance service network configuration according to area under service, number of people served, and response frequency comply with the requirement set. The ambulance vehicles lack complete set up as well as some important supplies. Only rarely the staff is skilled enough to perform such advanced life support procedures as intubation, defibrillation, and pleural drainage.

[Passive smoking and respiratory health of children]. / Pasyvus rukymas ir vaiku kvepavimo sutrikimai.

Passive smoking has been shown to be a risk factor for respiratory diseases in children. Some authors reported reduced lung function of children exposed to passive smoking. The purpose of the study was to assess the prevalence of exposure to passive smoking and its relation to respiratory health of Kaunas children. In 1998-2000 a cross-sectional survey was conducted in 20 kindergartens of Kaunas. Survey participants were 594 children (356 boys and 238 girls) aged 6-7 years. Children's parents filled out a questionnaire of the Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution designed on the basis of International Study of Asthma and Allergy in Childhood. Exposure to passive smoking was determined by an answer "everyday" or "sometimes" to the question "How often is your child in surrounding where someone smokes?". The parameters of respiratory function (FVC, FEV1, FEV1/FVC, FEF25, FEF50, FEF75, PEF) were measured with Pony Graphics 3.5. Response rate was 58.6% to 69.2% depending on a kindergarten. More than two fifth of children were exposed to passive smoking at home. Cough that lasted for at least four weeks during the past year was experienced by 24.5% and 16.9% of children with and without exposure to passive smoking (p<0.05). Wheezing in the past was found in 43% and 27% of children in groups compared (p<0.05). There was a significant difference in prevalence of sneezing or a runny/blocked nose when a child did not have a cold among children with and without exposure to passive smoking (46.6% and 36.6%, respectively, p<0.05). FEF25, FEF50, FEF75 and PEF of exposed girls were significantly lower than that of girls not exposed to passive smoking. Multiple regression analysis that included variables such as passive smoking, family history of allergy, smoked mother during pregnancy, gas stove and pets in child's room showed that FEF25 and FEF50 in girls were related to passive smoking. Our data show that more than two fifth of children are exposed to passive smoking which is associated with increased prevalence of chronic cough, wheezing, running nose and sneezing without cold. Passive smoking is also related to decreased lung function, especially for small airway flows.

[Atmosphere air pollution and health of Kaunas children]. / Atmosferos oro tarsos itaka Kauno miesto vaiku sveikatai.

Many studies support the impact of long-term exposure to air pollution on respiratory and allergic symptoms and illnesses. The aim of the study was to assess the prevalence of respiratory and allergic symptoms and illnesses in children living in 4 districts of Kaunas, to estimate the indices of respiratory function and to assess the relationship between mentioned indices and air pollutants such as dust, sulfur dioxide and nitrogen dioxide. A cross-sectional survey included 840 Kaunas children (34 subjects in Senamiestis, 288 in Zaliakalnis, 128 in Petrasiunai and 390 in Silainiai) aged 6-7 years, whose parents filled out the questionnaire and children performed respiratory function test. Response rate varied from 58.6 percent to 69.2 percents depending on district. Questionnaire of International Study of Asthma and Allergy in Childhood (ISAAC) was used. The parameters of respiratory function (FVC, FEV1, FEV1/FVC, MEF25, MEF50, MEF75, PEF) were measured with Pony Graphics 3.5. The data showed that prevalence of respiratory and allergic symptoms and illnesses in children living in 4 districts of Kaunas did not differ significantly. In most of the cases it was similar to that found in Riga and Tallinn. There is a significant relationship between MEF25, MEF50, MEF75, PEF and sex as well as gas for cooking.

Overweight and increased blood pressure in preschool-aged children.

This paper presents the data on height, weight, body mass index, systolic and diastolic blood pressure of 3-7 year old children. A sample of preschoolers (n=1441) was drawn from the kindergartens in Kaunas city (Lithuania). The 5 ( th ), 10 ( th ), 50 ( th ), 90 ( th ) and 95 ( th ) percentiles were estimated for studied variables and the criteria for the overweight and increased blood pressure were calculated. It was shown that body mass index could be used as an indicator of the child's physical development. Its value 14-18 kg/m ( 2 ) indicates an optimal child's growing, value < or = 14 kg/m ( 2 ) - the underweight, value > or =18 kg/m ( 2 ) - the overweight. According to these criteria it was found that 7.4% of 3-7 year old children were underweight, 5.8% overweight. Increased blood pressure (over 90 ( th ) percentile of systolic or/and diastolic blood pressure) had 21.4% of examined children. The prevalence of increased blood pressure was significantly higher in obese than in normal weight children. We conclude that the significant prevalence of childhood overweight and increased blood pressure emerge in preschool aged children. Thus, we recommend investigations of prevention and intervention programs to be used in the preschool setting.