[Assessment of disability-free life expectancy in Lithuania]. / Vidutines tiketinos gyvenimo be negalios trukmes Lietuvoje ivertinimas.

UNLABELLED: THE AIM of the study was to evaluate disability-free life expectancy of Lithuanian males and females in 2001. MATERIAL AND METHODS: The data about the Lithuanian population and the deceased were available from the Statistics Lithuania, while information about the prevalence of disability was obtained from the Population and Housing Census performed in 2001, where the question on the registered disability was included. The method, presented first by Sullivan in 1971, was applied for the assessment of disability-free life expectancy. RESULTS: Disability-free life expectancy of Lithuanian males and females was 60.6 and 70.6 years, respectively, accounting for 91.9% of male and 91.0% of female total life expectancy. At the age of 65, disability-free life expectancy was 6.2 years for males and 11.7 for females (45.8% and 64.9% of total life expectancy for males and females, respectively). Disability-free life expectancy declined more intensively with increasing age, comparing to total life expectancy. Disability-free life expectancy of females exceeded that of males by 10 years, while life expectancy with disability did not differ significantly. CONCLUSION: Monitoring of disability-free life expectancy, based on officially registered disability and mortality statistics, should be used for the assessment of economic and social burden of disability for the society and state.

[Inequalities in life expectancy of Lithuanian males and females and contribution of major causes of death]. / Lietuvos vyru ir moteru vidutines tiketinos gyvenimo trukmes netolygumai bei juos lemiancios mirties priezastys.

UNLABELLED: The aim of this study to assess inequalities in life expectancy of Lithuanian males and females throughout the period of 1990-2006 and to estimate the contribution of major causes of death to inequalities in life expectancy. MATERIAL AND METHODS: Information on deaths was obtained from the Lithuanian Department of Statistics. Life table analysis was carried out. Analysis of components was applied in order to assess the contribution of the major causes of death to the differences in life expectancy of males and females. The joint point regression analysis was used to identify the critical points, wherever a statistically significant change in life expectancy occurred. RESULTS: Two cut points, dividing the trends in life expectancy into three periods of decreasing, increasing, and again decreasing life expectancy, were characteristic of both males and females in 1990-2006. Changes in life expectancy were more pronounced for males in all three periods. Overall change in life expectancy was not statistically significant for males and was increasing by 0.2% annually for females throughout the period of investigation. The greatest number of years in life expectancy was lost due to cardiovascular diseases in both males and females. External causes contributed most to the difference in life expectancy of able-bodied (aged 15-64 years) males and females. Differences in life expectancy of males and females decreased from 12.3 to 11.8 years throughout the period of 1994-2006; however, it remained among highest in Europe. Since 1991, external causes of death have become the major, though decreasing, contributors to inequalities in life expectancy between males and females. In 2006, compared to 1994, contribution of cardiovascular diseases and cancer increased. CONCLUSION: Attempts to reduce demographic and social inequalities in health should become a priority in social and health policy formulation. The criteria for evaluation of the national and regional health and social programs should reflect aspects of equal opportunities in health for males and females.

Sense of coherence and its associations with psychosocial health: results of survey of the unemployed in Kaunas.

OBJECTIVE. To evaluate the associations between sense of coherence and psychosocial health among unemployed adult population. MATERIAL AND METHODS. The data were collected during a cross-sectional study in 2005. There were 429 filled-in questionnaires received (response rate, 53.6%) from unemployed persons registered at the Kaunas Labor Market Office (Lithuania). For the assessment of the sense of coherence, a short 13-item version of the Orientation to Life Questionnaire was used. Long-term unemployment was defined as lasting 12 months or longer. Logistic regression was used to estimate the risk factors having influence on sense of coherence. The risk was evaluated using odds ratio (OR). RESULTS. The mean score for sense of coherence was 56.6+/-11.2 (min, 13; max, 91). Significantly higher sense of coherence was found among the short-term unemployed as compare to the long-term ones. Analysis showed that sense of coherence was significantly higher in males, more educated and less materially deprived groups. The findings indicated that persons with depression, suicide intentions, more intensive alcohol consumption (after the job loss), poor self-reported health, feelings of loneliness and shame, and poor relations with family reported lower sense of coherence. The risk of low sense of coherence was significantly higher for females (OR=2.97) and the long-term unemployed (OR=1.81). Nevertheless, higher education (OR=0.73) and income (OR=0.83) were the factors that significantly improved sense of coherence. CONCLUSIONS. Sense of coherence was low among the unemployed in Kaunas. Sense of coherence was lower among the unemployed with negative psychosocial health characteristics in comparison to the unemployed with positive characteristics.

Inequalities in life expectancy by education and socioeconomic transition in Lithuania.

OBJECTIVE: To present changes in life expectancy of males and females by the level of educational achievement and describe different aspects of inequalities in life expectancy over the decade of socioeconomic transition in Lithuania. MATERIAL AND METHODS: This analysis is based on routine mortality statistics and census data for 1989 and 2001 for the entire country. The study included the population more than 25 years of age. RESULTS: Increasing inequalities in life expectancy by education have occurred due to increasing life expectancy amongst persons with higher educational achievements, and conversely, a declining life expectancy in groups with low levels of education. Cardiovascular diseases were responsible for the greatest number of years lost in life expectancy by all educational categories both in males and females. The numbers of years lost due to cardiovascular diseases decreased in majority of educational categories, particularly in lower secondary educational group. The increase in the years of life expectancy lost was observed due to external causes of death, the higher education being associated with the lower numbers of years lost, especially in females. The greatest impact on the difference in life expectancy between males with university and primary education was caused by external causes both in 1989 and 2001, while the major contribution to the educational differences in life expectancy of females was made by cardiovascular diseases. CONCLUSIONS: Favorable forecast of declining health inequalities by education in Lithuania can hardly be expected in the nearest future. Collective efforts and constructive actions should address the health problems of the least privileged groups in terms of education, as well as promotional efforts directed at young people to complete their education and guarantee of equal opportunities for education.

Clinical cosmobiology: distribution of deaths during 180 months and cosmophysical activity. The Lithuanian study, 1990-2004. The role of cosmic rays.

UNLABELLED: The aim of this study is a next step of our previous, initial, publications--to explore the links between monthly death number (total, and for the major death causes and each gender) with levels of monthly cosmophysical activity in a long-term, big cohort observation. METHODS: Death number during 180 consecutive months from the National Registry of Lithuania for years 1990-2004 were studied. A total of 630,205 deaths were analyzed (333,035 males). For comparison, monthly indices of solar activity, geomagnetic activity, and cosmic ray activity and year and month (1-12) of the study were used. The cosmophysical data were obtained from space research centers in the USA, Russia, and Finland. Statistics. Pearson correlation coefficients (r) and their probabilities (P) between compared parameters were calculated. A multivariate model of prediction was designed. RESULTS: It was a significant correlation between total monthly death number and indices of cosmic ray activity and, inverse, of solar activity; in men stronger than in women. Monthly geomagnetic activity was significantly correlated with traffic accidents, ischemic heart disease/stroke ratio, suicide victim number. Deaths from stroke, noncardiovascular causes, suicide, traffic accidents were related with cosmic ray activity and, inverse, with solar activity. Relationship of ischemic heart disease/stroke ratio to year of observation showed additional evidence for the growing role of stroke in cardiovascular mortality. CONCLUSIONS: Monthly death number is linked to cosmic ray activity, and inverse, to solar activity. Central place of stroke-related deaths in cardiovascular mortality is emerging. Geomagnetic activity, in monthly account, plays a relatively minor role. We presume that forces antagonistic to cosmic ray activity, like solar activity and geomagnetic activity, can prevent some negative biologic effects of cosmic ray.

Prediction of perinatal mortality at an early stage of pregnancy.

AIM: To define the probability of foetal and neonatal death (PFND) in Lithuania by means of the Medical Birth registry. METHODS: The Medical Birth registry for the year 2002 (29,619 pregnancies resulting in delivery) was used, covering social, environmental, health behaviour factors, obstetric history, health status of pregnant women, and delivery. RESULTS: A statistically significant model has been obtained in which 12 out of 45 analysed factors were significant for the risk of perinatal mortality (PM). In the case of previous neonatal pathology, e.g. damage to CNS, the risk of PM (OR 5.2; 95% CI = 2.1-13.3) was similar to the reported manual work or harmful working conditions during pregnancy (OR 4.8; 95% CI = 1.9-12.1 and OR 4.5; 95% CI = 1.3-15.2, respectively). The influence of father's alcohol abuse (OR 2.6; 95% CI = 1.4-4.7) was comparable to that of the stillborns or premature deliveries. The combination of several factors increased PFND significantly: maternal smoking during pregnancy and paternal smoking and alcohol abuse raised PFND to 0.03 (OR 6.8), mother's hard manual work in combination with harmful conditions during pregnancy increased OR more than 10 times (PFND 0.32) as compared with the situation when only one of those factors was present. CONCLUSIONS: The influence of social, environmental, and behavioural factors on the risk of PM was comparable to that of some of the complications during a previous pregnancy. The combination of risk factors significantly increased PFND. Using modelling, the individual prognosis may be presented to every pregnant woman at an early stage of pregnancy to potentially decrease the impact of unfavourable risk factors on PM.

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

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

Social dimensions of mortality from external causes in Lithuania: do education and place of residence matter?

OBJECTIVES: To assess inequalities in mortality from external causes by the level of education and the place of residence during the period of socio-economic transition in Lithuania. METHODS: Information on deaths, place of residence, and the level of education of persons aged 25 and older was derived from the National Database of Lithuania and censuses for 1989 (n=3537) and 2001 (n=4790). RESULTS: Mortality from external causes of Lithuanian urban and rural populations was strongly associated with the level of education. Educational inequalities increased throughout the period of socio-economic transition. In urban areas, mortality among the least educated population was 3.20 times higher in 1989 and 3.37 times higher in 2001, compared to those with university-level education. In rural areas the educational mortality rate ratios reached 3.47 and 4.33, respectively. The greatest educational inequalities were observed in suicide mortality, especially among males. CONCLUSIONS: The results of this study disclosed increasing inequalities in mortality from external causes. Less educated populations, especially in rural areas, should receive particular attention in the development of strategies for the prevention of mortality from external causes.

Duration of unemployment and depression: a cross-sectional survey in Lithuania.

BACKGROUND: In spite of a growing economy, unemployment is still a severe socio-economic problem in Lithuania. Nonetheless, no studies have been performed about the associations between unemployment and mental health in Lithuania. The aim of this study was to evaluate the associations between unemployment duration and depression in Lithuania. METHODS: The data was collected in a cross-sectional study in 2005. There were 429 filled-in questionnaires received (53.6% response rate) from unemployed persons registered with the Kaunas Labour Market Office. The severity of depression symptoms was evaluated using the Beck Depression Inventory (BDI). Logistic regression was used to estimate the risk factors for occurrence of depression. Sex, age, place of residence, marital status, education, income and practiced religion were the independent variables. Long-term unemployment was defined as lasting a duration of 12 months or more. RESULTS: The findings showed that long-term unemployed persons had more episodes of a depressive mood in the past 12 months in comparison with the group of the short-term unemployed. In addition, the BDI score mean was higher among the long-term unemployed compared with the short-term unemployed (10.1 +/- 8.8 and 14.2 +/- 9.5 respectively, p < 0.001). It was estimated that the duration of unemployment and BDI score had a positive correlation (r = 0.1968, p < 0.001). Among the short-term unemployed, the risk of depression increased significantly when the person was female, had an older age and had experienced more episodes of unemployment. Among the long-term unemployed, an older age was the risk factor for development of depression. However, higher education and income were the factors that significantly decreased the risk of developing depression for-short term as well as for long-term unemployed. CONCLUSION: The results indicated that depression is a severe problem in the unemployed population. Depression is more elevated among the long-term unemployed. This leads to arguing for common efforts in providing needed social support and health care to reduce the effects of unemployment on mental health.

Seasonal patterns of suicides over the period of socio-economic transition in Lithuania.

BACKGROUND: In Lithuania, suicides are a grave public health problem, requiring more extensive investigation. The aim of the study was to assess the seasonal variations of suicides in Lithuania throughout the years 1993-2002, describing patterns by gender, age and method of suicide. METHODS: The study material consisted of all registered suicides (n = 16,147) committed throughout 1993-2002 in Lithuania. Smoothed trends were inspected. The seasonal effect was explored using monthly ratio statistics and spectral analysis. RESULTS: Suicides in Lithuania have a distinct annual rhythm with peaks in summer and troughs in December. The December frequencies fell by more than 23% in men and 30% in women, while June peak reached nearly 23% in men and July peak exceeded 29% in women, compare with the average levels, (p < 0.05). Hanging was the most common method of suicide both in men and women comprising up to 90% among all suicides in 1998-2002. Among different methods, only hanging suicides showed significant seasonal variations, especially in men. The seasonal amplitude has decreased over time. CONCLUSION: Substantial seasonal variations in suicides were associated with a high proportion of hanging. Extremely high suicide rates in Lithuania require further extensive studies and urgent preventive programs, taking into account the suggestions of this survey.

Links between accidents and lifestyle factors among Lithuanian schoolchildren.

The aim of the study was to evaluate associations of some lifestyle factors with injuries among schoolchildren. Analysis was performed using data from the survey conducted in 2002 according to the methods of World Health Organization Cross-National Study on Health Behavior in School-Aged Children (HBSC). Using stratified random sampling, the representative sample of 5645 schoolchildren aged 11, 13, and 15 years from 104 schools of Lithuania was drawn and surveyed. Associations between potential risk factors and injuries among schoolchildren were evaluated calculating odds ratio and its 95% confidence intervals. For the evaluation of the impact of explanatory variables on analyzed event, logistic regression analysis was performed. Behavioral, psychological, and social integration factors were associated with the risk to sustain injuries among school-aged children. The impact of these factors varied within subgroups of schoolchildren by grade and sex. The most significant factors were: risk-taking behavior (smoking, alcohol and drug consumption, premature sexual activity), frequent participation in sport activities, involvement in physical fight, longer time spent away from home with friends, experienced bullying, poor self-assessed health and academic achievement, unhappiness, feeling unsafe at school, and high suicidal risk. Analysis failed to identify an expected association between lower socio-economic status and risk for injury. Integrated approach to injury etiology is essential in planning injury prevention and safety promotion activities among schoolchildren, paying particular attention to lifestyle factors, which can have the potential influence on risk to sustain injuries.

Mortality from external causes in Lithuania: looking for critical points in time and place.

AIM: A study was undertaken to analyse trends in mortality from major external causes of death, and to detect urban/rural differences by cut points over the period of socioeconomic transition. METHODS: Information on deaths from major external causes (traffic accidents, suicides, and homicides) for the 1990-2000 period was obtained from Lithuanian Department of Statistics. Mortality rates were age standardized, using the European standard, and analysed, according to (urban/rural) residence and sex. The Jointpoint analysis was used to identify the best-fitting points, wherever a statistically significant change in mortality occurred. RESULTS: The most critical point for external causes of mortality during the period of transition was the year 1994, when an increasing mortality trend reversed to a decreasing one. Mortality from suicides primarily caused these positive changes. Changes in mortality from traffic accidents were not significantly associated with the period under analysis. Numerous less favourable trends in rural areas, including suicide rates, traffic accidents, and homicides, are likely to stratify urban/rural health outcomes in the future. CONCLUSION: Despite a recent decline, mortality from external causes remains at an extremely high level in Lithuania. Future progress requires sustained improvements in prevention, and serious attention to external causes of death in health policy development.

[Methods of suicides in Lithuania and their associations with demographic factors]. / Savizudybiu budai Lietuvoje ir ju rysys su demografiniais veiksniais.

Methods of completed suicides in relation to gender, age and place of residence and their changes in Lithuania during 1993-1997 and 1998-2002 were analyzed in this study. Data on completed suicides (n=16147) was compiled from the computerized database of the Lithuanian Department of Statistics. Hanging was the most common method of completed suicides in Lithuania. Proportion of hanging among the other methods of suicides increased from 87.3% during 1993-1997 till 90.1% during 1998-2002. Proportion of hanging increased most notably among girls aged 10-19. Hanging, as the method of suicide, was more prevalent among males in comparison to females and among rural residents in comparison to the urban population. Proportion of hanging had the increasing tendency with an increase of age. The next most prevalent method of suicide among males was firearm, while among females--poisoning, jumping from the height and drowning. Different types of poisoning were more prevalent among adolescents, particularly among girls, in comparison to the adult population. Poisoning and jumping from the height were more common among urban males and females if compared to the rural population.

[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.