Diagnostic Ability of Structural Transcranial Sonography in Patients with Alzheimer's Disease.

The aim of this study was to assess the diagnostic ability of transcranial sonography (TCS) for the evaluation of the medial temporal lobe (MTL) in Alzheimer's disease (AD). Standard neuropsychological evaluation, TCS and 1.5 T MRI were performed for 20 patients with AD and for 20 age- and sex-matched healthy controls in a prospective manner. Measurements of the size of the third ventricle and heights of the MTL (A) and the choroidal fissure (B) were performed twice on each side by two independent neurosonologists for all participants. On MRI, both conventional and volumetric analyses of the third ventricle and hippocampus were performed. Receiver operating characteristic (ROC) curves analyses were applied. Height of the MTL on TCS had sensitivities of 73.7% (right)/63.2%(left) and specificities of 65% (right)/65-70% (left) Area under a curve (AUC) 75.4-77.2% (right), 60.4-67.8% (left)) for AD. A/B ratio on TCS had sensitivities of 73.7% (right)/57.9% (left) and specificities of 70.0% (right)/55.0% (left) (AUC 73.3% (right), 60.4% (left)) by the experienced neurosonologist, and sensitivities of 78.9% (right and left) and specificities of 60.0% (right)/65.0% (left) (AUC 77.8-80.0%) by the inexperienced neurosonologist for AD. On MRI, linear measurement of the hippocampus and parahippocampal gyrus height had sensitivities of 84.2% (right)/89.5% (left) and specificities of 80.0% (right)/85% (left) (AUC 86.1-92.9%) for AD. Hippocampal volume had sensitivities of 70% (right and left) and specificities of 75% (right)/80% (left) (AUC 77.5-78%) for AD. Atrophy of the right MTL in AD could be detected on TCS with a good diagnostic ability, however MRI performed better on the left.

Retrospective analysis of the impact of anthracycline dose reduction and chemotherapy delays on the outcomes of early breast cancer molecular subtypes.

BACKGROUND: The objective of study was to determine the effect of anthracycline dose reduction and chemotherapy delays on 5-year overall survival in patients with stage I-III breast cancer, to establish the impact of molecular subtypes on the anthracycline modification effects and to analyze reasons for such chemotherapy scheme modifications. METHODS: Medical records of patients with stage I-III breast cancer were reviewed. Inclusion criteria involved stage I- III breast carcinoma; radical surgery performed and 4 courses of AC regimen (doxorubicin and cyclophosphamide), or at least 6 courses of FAC regimen (fluorouracil, doxorubicin and cyclophosphamide) completed; no neoadjuvant chemotherapy applied; no taxane group medications administered; medical records maintain comprehensive data on treatment and follow-up. 5- year overall survival were analyzed using Kaplan-Meier and Cox proportional hazards models. RESULTS: Significant 3.17 times higher death risk at 5 year period in patients who experienced anthracycline dose reduction compared with patients who did not experience any modifications was established (HR = 3.17, 95% CI 1.7-5.9, p < 0.001). Increased death risk in patients who experienced both chemotherapy dose reduction and treatment delays compared with patients who did not experience any modifications was also established (HR = 2.76, 95% CI 1.3-5.6, p < 0.05). 5- year overall survival was affected by anthracycline dose reduction by more than 15% in ER-HER2- group (80% v. 55.6%, p = 0.015), ER + HER2- group (90.7% v. 64.9%, p < 0.01) and ER+/-HER2+ group (100% v. 84.4%, p = 0.019). 5-year overall survival was affected by chemotherapy delays more than 2 cycles in ER-HER2- group (79.2% v. 51.4%, p = 0.002), ER + HER2- group (86.3% v. 58.8%, p = 0.014) and there was no difference in ER+/-HER2+ group. Main reasons for chemotherapy scheme modifications (in decreasing order) were the following: neutropenia, modifications with no objective medical reasons, thrombocytopenia, anaemia, fatigue, infection. CONCLUSIONS: Anthracycline dose reduction in patients with stage I- III breast cancer were associated with higher mortality risk and significantly decreased 5- year absolute survival in all molecular subtypes. Chemotherapy delays alone were not associated with decreased survival only in HER2 positive subtype. The most common reason for dose reduction or chemotherapy delays was neutropenia.

Retrospective analysis of the impact of platinum dose reduction and chemotherapy delays on the outcomes of stage III ovarian cancer patients.

BACKGROUND: Ovarian cancer is a common gynaecological malignancy still remaining a challenge to treat. The objective of this study was to evaluate the impact of platinum dose reduction and chemotherapy delays on progression free survival and overall survival in patients with stage III ovarian cancer and to analyze reasons for such chemotherapy scheme modifications. METHODS: Medical records of patients with FIGO stage III ovarian cancer were reviewed. Inclusion criteria involved FIGO stage III epithelial ovarian carcinoma; cytoreductive surgery performed and 6 courses of platinum-based chemotherapy completed; no neoadjuvant chemotherapy applied; and no history of previous malignancies. Progression free survival and overall survival were analyzed using Kaplan-Meier and Cox proportional hazards models. RESULTS: Significant 3.3 times higher death risk in patients who experienced only chemotherapy delays compared with patients who did not experience any chemotherapy scheme modifications was established (HR = 3.3, 95% Cl: 1.2 - 8.5, p = 0.016). Increased death risk in patients who experienced only chemotherapy delays compared with patients who experienced both chemotherapy delays and platinum dose reduction was also established (HR = 2.3, 95% Cl: 1.1 - 4.8, p = 0.021). Main reasons for chemotherapy scheme modifications (in decreasing order) were the following: neutropenia, modifications with no objective medical reasons, renal disorders, anaemia, poor performance status, gastrointestinal symptoms and neuropathy. Overall survival in patients who experienced chemotherapy scheme modifications with no objective medical reasons was non-inferior than in patients who did not experience any chemotherapy scheme modifications. CONCLUSIONS: Chemotherapy delays in patients with FIGO stage III ovarian cancer caused lower overall survival. The most common reason for chemotherapy scheme modifications was neutropenia.

Physical, behavioural and genetic predictors of adult hypertension: the findings of the Kaunas Cardiovascular Risk Cohort study.

BACKGROUND: The roots of adult hypertension go back to childhood. This study aimed to examine the independent effects of physical, behavioural and genetic factors identified in childhood and mid-adulthood for prediction of adult hypertension. METHODS: The study subjects were participants of the Kaunas Cardiovascular Risk Cohort study started in 1977 (n = 1082, age 12-13 years). In 2012, a total of 507 individuals (63.9% of eligible sample) participated in the 35-year follow-up survey. Health examination involved measurements of blood pressure (BP), anthropometric parameters, and interview about health behaviours. Subjects were genotyped for AGT (M235T), ACE (I/D, rs4340), ADM (rs7129220), and CACNB2 (rs12258967) genes polymorphisms. A genetic risk score was calculated as the sum of the number of risk alleles at each of four single nucleotide polymorphisms. RESULTS: AGT TT genotype male carriers had the highest mean values of systolic BP in childhood. In females, ADM genotype AA was associated with the highest values of systolic and diastolic BP, while CACNB2 genotype CC carriers had the highest values of diastolic BP in childhood. Systolic and diastolic BP in childhood, gain in BMI from childhood to adulthood, and risky alcohol consumption predicted hypertension in middle-aged men. In women, genetic risk score together with diastolic BP in childhood and gain in BMI were significant predictors of adult hypertension. The comparison of four nested logistic regression models showed that the prediction of hypertension improved significantly after the addition of BMI gain. Genetic risk score had a relatively weak effect on the improvement of the model performance in women. CONCLUSIONS: BP in childhood and the gain in BMI from childhood to adulthood were significant predictors of adult hypertension in both genders. Genetic risk score in women and risky alcohol consumption in men were independently related with the risk of adult hypertension.

Association between APOE, SCARB1, PPARα polymorphisms and serum lipids in a population of Lithuanian adults.

BACKGROUND: Dyslipidemia is one of several known risk factors for coronary heart disease, a leading cause of death in Lithuania. Blood lipid levels are influenced by multiple genetic and environmental factors. Epidemiological studies demonstrated the impact of nutrition on lipid levels within the Lithuanian population although the role of genetic factors for dyslipidemias has not yet been studied. The objective of this study was to assess the distribution of the APOE, SCARB1, PPARα genotypes in the Lithuanian adult population and to determine the relationship of these genotypes with dyslipidemia. METHODS: A cross-sectional health survey was carried out in a representative random sample of the Lithuanian population aged 25-64 (n=1030). A variety of single-nucleotide polymorphisms (SNPs) of the APOE (rs429358 and rs7412), SCARB1 (rs5888) and PPARα (rs1800206) genes were assessed using real-time polymerase chain reaction. Serum lipids were determined using enzymatic methods. RESULTS/PRINCIPAL FINDINGS: Men and women with the APOE2 genotype had the lowest level of total and low-density lipoprotein cholesterol (LDL-C). Men with the APOE2 genotype had significantly higher levels of triglycerides (TG) than those with the APOE3 genotype. In men, the carriers of the APOE4 genotype had higher odds ratios (OR) of reduced (<1.0 mmol/L) high density lipoprotein cholesterol (HDL-C) levels versus APOE3 carriers (OR=1.98; 95% CI=1.05-3.74). The odds of having elevated (>1.7 mmol/L) TG levels was significantly lower in SCARB1 genotype CT carriers compared to men with the SCARB1 genotype CC (OR=0.50; 95% CI=0.31-0.79). In men, carriers of the PPARα genotype CG had higher OR of elevated TG levels versus carriers of PPARα genotype CC (OR=2.67; 95% CI=1.15-6.16). The odds of having high LDL-C levels were lower in women with the APOE2 genotype as compared to APOE3 genotype carriers (OR=0.35; 95% CI=0.22-0.57). CONCLUSIONS/SIGNIFICANCE: Our data suggest a gender difference in the associations between APOE, SCARB1, PPARα genotypes and lipid levels. In men, the APOE4 genotype and PPARα genotype CG were correlated with an atherogenic lipid profile while the SCARB1 genotype CT had an atheroprotective effect. In women, APOE2 carriers had the lowest odds of high LDL-C.

Cardiovascular risk factors and cognitive function in middle aged and elderly Lithuanian urban population: results from the HAPIEE study.

BACKGROUND: The purpose of this study was to examine associations between cardiovascular risk factors and cognitive ability in middle aged and elderly Lithuanian urban population. METHODS: Data from the survey performed in the framework of the HAPIEE (Health, Alcohol, Psychosocial Factors in Eastern Europe) study were presented. A random sample of 7,087 individuals aged 45-72 years was screened in 2006-2008. RESULTS: The scores of immediate recall and delayed verbal recall, cognitive speed and attention were significantly lower in men than in women; yet numerical ability scores were higher in men. Significant associations between lowered cognitive functions and previous stroke (in male OR = 2.52; 95% CI = 1.75-3.64; in female OR = 2.45; 95% CI = 1.75, 3.64) as well as ischemic heart disease history (among male OR = 1.28; 95% CI = 1.03-1.60) have been determined. Higher level of physical activity in leisure time (among female OR = 1.32; 95% CI = 1.03-1.69), poor self-rated health (among male OR = 1.57; 95% CI = 1.15-2.14) and poor quality of life (in male OR = 1.67; 95% CI = 1.07-2.61; in female OR = 2.81; 95% CI = 1.92-4.11) were related to lowered cognitive function. CONCLUSIONS: The findings of the study suggest that associations between cardiovascular risk factors and lowered cognitive function among healthy middle-aged and elderly adults strongly depend on gender.

All-cause and cardiovascular mortality risk estimation using different definitions of metabolic syndrome in Lithuanian urban population.

OBJECTIVE: The objective of the study was to assess mortality risk in the subjects with diagnosed metabolic syndrome (MS) using National Cholesterol Educational Program (NCEP-ATPIII), American Heart Association and National Heart Lung and Blood Institute (AHA/NHLBI) International Diabetes Federation (IDF) and Joint Interim Societies (JIS) definitions. METHODS: Two random samples aged 35-64 years were examined in 1992-2002 in the framework within the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study (N=2455). The follow-up was carried out in terms of the end points reached from the baseline health examinations until December 31, 2009. RESULTS: Cox regressions demonstrated that MS defined by IDF and JIS definitions remained the only significant determinants for all-cause mortality (RR=1.48 and RR=1.41; p<0.05) and cardiovascular disease (CVD) mortality in men (RR=1.81 and RR=1.66; p<0.05). In men (without previous CVD) the NCEP-ATPIII definition had increased mortality risk from CVD (RR=1.98; p=0.012), than in men with identified MS by the IDF and the new JIS definition. In women the MS was not associated with risk of mortality from CVD. CONCLUSION: The MS definitions according to the IDF and JIS criteria appear to be a slightly better predictor of all-cause mortality and mortality from CVD; MS according to the NCEP-ATPIII criteria appears to be a better predictor of mortality from CVD in men.

Associations between apolipoprotein E genotype, diet, body mass index, and serum lipids in Lithuanian adult population.

BACKGROUND: Apolipoprotein E (APOE) polymorphism is associated with lipid levels. Some studies have reported that blood lipid response to diet or obesity varies depending on APOE genotypes. The aim of this study was to assess the effect of APOE genotypes, the intake of saturated fatty acids (SFA), and obesity on serum lipid levels in Lithuanian adult population. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional health survey was carried out in five municipalities of Lithuania. The random sample was obtained from lists of 25-64 year-old inhabitants registered at primary health care centres. The data from 996 subjects (416 men and 580 women) were analysed in this study. Two single-nucleotide polymorphisms (rs429358 and rs7412) were assessed using a real-time polymerase chain reaction. 24-hour recall and food frequency questionnaire were used for evaluation of dietary habits. Serum lipids were determined using enzymatic methods. Men and women with the APOE2 genotype had the lowest level of total cholesterol (TC) (p = 0.002 for men, and p = 0.02 for women) and low-density lipoprotein cholesterol (LDL-C) (p<0.001). Multivariate linear regression analysis showed that age, genotype APOE2, SFA intake, and body mass index (BMI) were significant determinants of TC and LDL-C level (with p values ranging from 0.043 to 0.001). Our data did not reveal any statistically significant interactions between APOE genotype and SFA intake or between APOE genotype and BMI regarding TC and LDL-C level (all p>0.05). However, the predictive power of the regression model for LDL-C improved when gene-BMI interaction and gene-BMI interaction plus gene-nutrient interaction were added (p = 0.04 and p = 0.032 for R(2) change, respectively). CONCLUSIONS/SIGNIFICANCE: APOE genotypes, SFA intake, and obesity were found to be associated with blood lipid levels in Lithuanian adult population. Analysis of gene-diet and gene-obesity interactions did not confirm that the effects of diet and obesity on TC and LDL-C level significantly depended on APOE genotype.

Depression predicts perioperative outcomes following coronary artery bypass graft surgery.

OBJECTIVES: To assess preoperative depression in middle-aged men undergoing coronary artery bypass graft surgery (CABG) and to determine if depression is related to perioperative outcomes. DESIGN: One hundred and nine middle-aged male patients were randomly selected and assessed for depression one day before CABG using the Symptom Checklist-90 Revised (SCL-90R). Perioperative outcomes were: (1) postoperative length of hospital stay, (2) the presence of any early complications (at intensive care unit), and (3) the presence of any late complications (at cardiac surgery unit). RESULTS: Twenty-five (23%) patients had a high level of depression. Preoperative depression scores significantly predicted postoperative length of hospital stay (p < 0.001) and the incidence of late perioperative complications (p < 0.05) independently from biomedical and sociodemographic factors. Each increase in depression T score increased the odds of occurrence of late complications by 10% (p = 0.018, CI 95% 1.02-1.19). CONCLUSIONS: Depression is common in middle-aged men undergoing CABG and is an independent predictor of postoperative length of hospital stay and late perioperative complications.

[Impact of p53 protein and HER2 overexpression on survival of patients with stage II breast cancer]. / HER2 receptoriu ir p53 baltymo padidejusios raiskos itaka II stadijos kruties veziu serganciu moteru gyvenimo trukmei.

OBJECTIVE: To assess the prognostic significance and impact of p53 protein and human epidermal growth factor receptor 2 (HER2) overexpression on 5-year survival in young patients with stage II breast cancer (aged less than 50 years). MATERIAL AND METHODS: Material from medical records and archived tumor tissues from 34 young women diagnosed with stage II breast cancer and obtained between 2001 and 2003 was analyzed retrospectively. Twelve (35%) patients died from breast cancer. Using archived tumor tissues, p53 protein and HER2 over-expression was determined immunohistochemically. Using medical records, and adjuvant chemotherapy, adequacy of anthracycline dose, and hormonotherapy administered for the patients were analyzed. RESULTS: p53 protein and HER2 overexpression was documented in 20.6% and 26.4% of women, respectively. Kaplan-Meier survival analysis showed that patients with tumors positive for p53 protein and negative estrogen receptors, and treated with an inadequate dose of anthracyclines died within shorter period after diagnosis (log-rank P=0.016, log-rank P=0.027, log-rank P=0.013, respectively). There were no significant associations between HER2 overexpression and 5-year survival in this population (log-rank P=0.51). Multivariate analysis revealed that an inadequate dose of anthracyclines (P=0.028) was the only independent factor for poor outcome. CONCLUSIONS: p53 protein overexpression, negative estrogen receptors in tissue samples, and inadequate chemotherapy with anthracyclines were associated with reduced overall survival in young women with stage II breast cancer. Inadequate adjuvant therapy with anthracyclines was the only independent prognostic factor.

Psychosocial risk factors for depression during pregnancy.

OBJECTIVE: To assess the prevalence of antenatal depressive disorder in different trimesters and to evaluate the relation of psychosocial risk factors to antenatal depressive disorder. DESIGN: Cohort follow-up. SETTING: University Hospital, Kaunas, Lithuania. SAMPLE: Two hundred and thirty pregnant women consecutively admitted. METHODS: At 12-16 weeks, 22-26 weeks, and 32-36 weeks of pregnancy, participants were screened for depression using the World Health Organization's Composite International Diagnostic Interview Short Form (CIDI-SF). Women who gave at least one positive answer to the CIDI-SF depression-screening question were evaluated for depressive disorder using the non-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP). Psychosocial stressors and two Big Five Personality dimensions, neuroticism and extraversion, were also evaluated. MAIN OUTCOME MEASURES: Prevalence of depressive disorder. RESULTS: The prevalence of the antenatal depressive disorder at 12-16 weeks' gestation was 6.1%, at 22-26 weeks 3.5%, and at 32-36 weeks 4.4%. In the first trimester, a greater prevalence of current depressive disorder was independently associated with unplanned and unwanted pregnancy, high neuroticism, low education, and a previous history of depression; in the second trimester with unplanned and unwanted pregnancy and high neuroticism; in the third trimester with unplanned and unwanted pregnancy, high neuroticism, and the occurrence of psychosocial stressors during the last year. CONCLUSIONS: The highest prevalence of depressive disorders was found in the first trimester, the lowest in mid-pregnancy. Several determinants (unwanted and unplanned pregnancy, high neuroticism) were independent predictors of antenatal depressive disorders throughout whole pregnancy, while other determinants (low education, previous history of depression, the occurrence of psychosocial stressors at the end of pregnancy) were trimester specific.

[Physical and mental health of stroke survivors and their daily activities]. / Persirgusiuju galvos smegenu insultu fizine ir psichine sveikata bei kasdiene veikla.

UNLABELLED: The aim of the study was to compare the quality of life between stroke survivors and controls with respect to their health, daily activities, and emotional status. CONTINGENT AND METHODS OF THE STUDY: The studied group consisted of 508 25-84-year-old inhabitants of Kaunas city who have survived first-onset stroke. The control group consisted of 508 age- and sex-matched randomly selected inhabitants of Kaunas city who had not experienced stroke. The SF-12 Quality of Life Questionnaire was used for the study. Logistic regression was used to compare quality of life with respect to health, daily activities, and emotional status. RESULTS: Only 1.0% of stroke survivors evaluated their health as excellent or very good, compared to 24.4% of the controls (P=0.0005); the respective percentages of those who evaluated their health as poor or fair were 78.9% and 26.4% (P=0.0005). Health significantly limited moderate activities in 35.2% of stroke survivors and 3.5% of controls (P=0.0005). During the last 4 weeks, health status or emotional problems most of the time or a little of the time impeded social activities in 19.3% of stroke survivors and 1.6% of controls (P<0.05). When comparing with respect to age, sex, and diseases (arterial hypertension, myocardial infarction, atrial fibrillation, diabetes mellitus, transient ischemic attack), stroke had the greatest negative effect on social activities (odds ratio, 36.7), caused sadness (odds ratio, 16.0), and significantly limited home activities (odds ratio, 15.5). CONCLUSIONS: Less that one-third (28.2%) of stroke survivors evaluated their health as poor, and 50.7% as fair as compared to 1.8% and 24.6% of controls, respectively. Stroke significantly impaired the subjects' emotional status and limited their daily activities.

[Quality of life in stroke survivors]. / Persirgusiuju galvos smegenu insultu gyvenimo kokybe

UNLABELLED: The aim of the study was to compare the quality of life among stroke survivors and healthy controls and to evaluate the influence of age, sex, and social and demographic factors on the quality of life. Contingent and methods. The case group consisted of 508 inhabitants of Kaunas city who were 25-84 years of age and had experienced their first stroke. The control group consisted of age- and sex-stratified randomly selected 508 stroke-free inhabitants of Kaunas city. The quality of life was evaluated using the SF-12 questionnaire. The study compared the quality of life between stroke survivors and controls in eight domains of quality of life and compared the evaluation of quality of life considering social and demographic features. RESULTS: In the domain of physical and mental health, stroke survivors presented poorer evaluation of their quality of life compared to controls except for the evaluations of mental health in the age groups of 25-34 and 35-44 years. As compared to healthy controls, stroke survivors presented poorer evaluation of their quality of life in all domains except for pain. Only in the control group, females presented poorer evaluation of physical health, whereas no differences in the evaluation of mental health between sexes were found. The evaluation of physical health in both groups worsened with age. Both stroke survivors and controls presented better evaluation of their physical health if they were living not alone, were better educated, and were employed compared to those who were living alone, had poorer education level, and were unemployed. In addition, controls who were currently or previously engaged in mental work evaluated their physical health better. CONCLUSIONS: Stroke survivors presented poorer evaluations of their quality of life in both physical and mental health domains compared to controls. Only in the control group, females evaluated their physical health worse than males did. In both groups studied, poorer evaluation of physical health was associated with older age and lower social and demographic status. Relationship between mental health and subjects' social and demographic status was not statistically significant in either of the studied groups.

[Evaluation of the quality of life in the population of Kaunas city using the SF-12 questionnaire]. / Kauno populiacijos gyvenimo kokybes vertinimas naudojant SF-12 klausimyna.

UNLABELLED: The aim of the study was to evaluate the suitability of the SF-12 questionnaire for the evaluation of the quality of life in 25-84-year-old inhabitants of Kaunas city and to compare quality of life between men and women as well as between socially and demographically different groups. MATERIAL AND METHODS: The study sample consisted of randomly selected inhabitants of Kaunas city, stratified by age and sex. The suitability of the questionnaire for the evaluation of the quality of life in the selected contingent was verified using Cronbach's alpha coefficient. The convergent validity of the questionnaire was assessed by the strength of the linear relationship between the domains of the questionnaire, calculating Pearson's correlation coefficients. We calculated mean ranges of the values of the questionnaire and compared the distribution of values. RESULTS: Cronbach's alpha values indicated a very strong internal consistency of the mental and physical domains of the SF-12 questionnaire (0.87 and 0.88, respectively). Women reported lower quality of life in the domains of mental health and physical health-pain as compared to men. People who were not living alone, with higher level of education, and employed reported better physical and mental health than those living alone, with lower level of education, or unemployed. In addition to that, people who were engaged in mental work during the study or had worked such work before reported better physical and mental health. CONCLUSIONS: The questionnaire SF-12 is suitable for the evaluation of the quality of life in the population of Kaunas city. Women reported lower quality of life in mental health domain than men did. The evaluations of the quality of life worsened with increasing age and lower social and demographic status.

Diverging trends in the incidence and mortality of stroke during the period 1986-2002: a study from the stroke register in Kaunas, Lithuania.

AIMS: The aim of the present study was to explore the longitudinal stroke trends in the middle-aged Lithuanian population. METHODS: All stroke events in the studied population were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients aged 25 to 64 years who experienced a stroke between 1986 and 2002. RESULTS: A flat trend was observed in both the incidence and the attack rates of stroke among men during the 17-year study period, while among women, the incidence of stroke increased by 1.7%/year, and the attack rates by 2.3%/year. The 28-day case fatality and mortality rates of stroke decreased significantly in both sexes. The decline in case fatality explained 100% of the decline in mortality. Among the types of stroke, cerebral infarction contributed most to the decline in the mortality in men. In women, the mortality from cerebral infarction and intracerebral haemorrhage declined similarly to that from all types of strokes. CONCLUSIONS: Findings from our study indicating no positive changes in the incidence of stroke but instead an increase among middle-aged women in Kaunas are disturbing. These results suggest a need for the intensification of appropriate strategies for stroke prevention by the public health officials in Lithuania.

[Survey on drug-related problems in Lithuania's pharmacies]. / Vaistu vartojimo problemu tyrimas Lietuvos vaistinese.

OBJECTIVE: to survey the most common and the most important drug-related problems in Lithuania, to explore their solution and factors influencing it, to formulate recommendations for solving drug-related problems. MATERIAL AND METHODS: Pharmacists from community pharmacies participated in a random survey. They filled in questionnaires about drug-related problems and their solutions. It was the first survey on drug-related problems ever carried out in Lithuania. RESULTS: For the first time, it was found out that in Lithuania pharmacists most commonly encountered drug-related problem--additional drug therapy (52.03% of respondents)--and most rarely encountered drug-related problem--dosage too high (3% of respondents). Pharmacists stated that all categories of drug-related problems were of equal importance. It was established that pharmacists commonly solved drug-related problems associated with noncompliance with instructions (72.5% of respondents) and rarely met the problem when improper drug was selected (39.56% of respondents). CONCLUSION: Patients taking prescription medicines commonly encounter additional drug therapy problem, and patients taking nonprescription medications commonly encounter problems related to noncompliance with instructions.

The validity of post-concussion syndrome in children: a controlled historical cohort study.

The aim of this controlled historical cohort study was to assess the validity of post-concussion syndrome in children. We identified 301 children aged 4-15 years who had sustained an isolated brain concussion, and another group of 301 children who sustained any other mild body injury excluding the head. Parents from both groups filled in standardized questionnaires containing questions about the health condition of the children: headache, neck pain, dizziness, malaise, fatigability, exercise or noise intolerance, irritability, weepiness, sadness, anxiety, nocturnal enuresis, tics, sleep disorders, memory or learning difficulties, hyperactivity, seizures, attention disorder, buzzing in the ears, subjective parental concerns about the child's health condition, and parental concerns about their child having a brain disorder. The severity of the complaints was rated on the Visual Analogue Scale. After the final exclusion, 102 pairs strictly matched by sex, age, and the date of trauma were analyzed. The differences of parental complaints about the health condition of their children between case and control groups were statistically insignificant for all symptoms, except parental concerns about their child having brain damage which were significantly higher in the case group. The likelihood of parental concerns about the possibility of their child having brain damage was 2.7 times higher in the case group. Headache, learning difficulties, and sleep disorders were significant variables predicting the concerns. These results question the validity of the post-concussion syndrome in children.

The prevalence, course and clinical features of post-concussion syndrome in children.

OBJECTIVE: To investigate the clinical features and the prevalence of symptoms of post-concussion syndrome in children with mild traumatic brain injury, and to evaluate their changes over time. MATERIAL AND METHODS: The research involved two groups of 4-16 year-old children: the case group of 301 children who had experienced a single mild traumatic brain injury, and the control group of 301 children who had sustained any other mild body injury without head trauma. Groups were matched according to gender, age, and the date of admission to hospital. In total, 102 matched pairs were analyzed. The period between the date of the trauma and the examination was one to five years (median-27 months). Standardized questionnaires were sent by post to parents from both groups. Parents were asked about the health state as well as symptoms of post-concussion syndrome, their character and frequency. The respondents were inquired about the presence of the symptoms prior to the trauma, shortly after the trauma, and during the last year and the last month before the inquiry. RESULTS: The prevalence of headache, irritability, fears, sleep disorders, learning difficulties, as well as concentration and memory problems did not differ significantly between children with mild traumatic brain injury and the control group when the results of the last year before examination and the last month before the examination were compared. We have investigated how the period of time between the date of the trauma and the date when the questionnaire was filled in influenced the results. The comparison of the questionnaires that were filled a year (but less than two years) after the trauma to those that were filled in 2-5 years after the trauma revealed significant differences in the prevalence of a number of symptoms of the post-concussion syndrome. In children with mild traumatic brain injury, there was a significant decrease in the prevalence of learning difficulties soon after the trauma (p=0.032), headaches before (p=0.026) and soon after the trauma (p=0.01), and irritability the last month before the examination (p=0.043). In children from the control group, there was a significant decrease in the prevalence of concentration problems the last year before examination (p=0.023) and the last month before examination (p=0.036). CONCLUSIONS: More than one year after the trauma, the prevalence of the symptoms of the post-concussion syndrome is not significant higher in children with mild traumatic brain injury, compared to children with other mild body injuries, and is comparable by the changes over time.

Prognosis of risk factors and trends in mortality from external causes among middle-aged men in Lithuania.

AIMS: The aims of this study were to investigate the risk of death and time trends from external causes, and to evaluate the significance of the effects of age, period and birth cohort on suicide mortality among middle-aged men during the period 1971-2000 in Lithuania. METHODS: Random samples of men aged 45-59 years from the Kaunas Rotterdam Intervention Study (conducted in 1972-74) and Study of Multifactorial Prevention of CHD (conducted in 1977-80) were examined (n?=?6,480). The participants of the two surveys were observed until 1 January 2001. Over this time 2,841 men had died, 230 of these from external causes. The Cox proportional hazards model was used to evaluate the risk of death from external causes. Trends in mortality from external causes and average annual changes were based on logarithmic regression analysis. For assessment of the effects of age, period, and birth cohort the Poisson regression model was applied. RESULTS: The risk of mortality from external causes among men was positively related to smoking habits and arterial hypertension and negatively related to education level and total serum cholesterol concentration but there was no association with consumption of alcohol. The risk of suicide mortality was associated with family status and occupation only. Trends in mortality from all external causes showed no significant changes during the period 1971-2000. After adjusting for age and cohort effects, the period effect was statistically significant. CONCLUSION: Prognosis of risk factors for mortality from external causes and period effect on suicide mortality rates will form important parts of future research agendas.

[Time trends in mortality from malignant tumors and lung cancer during the period 1971-2000 and the risk of death in the middle-aged Kaunas men]. / Vidutinio amziaus Kauno vyru mirtingumo nuo piktybiniu naviku pokyciai ir prognostiniai veiksniai (1971-2000 m.).

The aims of this study were: 1. To examine the prevalence of risk factors and the risk of mortality from malignant tumors and lung cancer in 45-59-year-old Kaunas men; 2. To assess time trends during the period 1971-2000 in mortality from malignant tumors and lung cancer in Kaunas men aged 25-64 years. The random samples of Kaunas men aged 45-59 years from the Kaunas Rotterdam Intervention Study (1972-1974) and Study of Multifactorial Prevention of IHD (1977-1980) surveys (n=6446) were examined using the standard epidemiological methods. The participants of the two surveys were followed-up, in terms of the end points reached, from the beginning of each study until January 1, 2001. A multivariate Cox model was used for the analysis. The risk of death from malignant tumors and lung cancer among screened men was directly related to age and smoking habits and inversely related to education, total cholesterol, and body mass index levels. The mortality from malignant tumors and lung cancer among Kaunas men aged 25-64 years has not changed over the period 1971-2000. The mortality from all malignant tumors statistically significantly decreased from 1991 to 2000.