Avoidable mortality in Lithuania.

STUDY OBJECTIVE: The study aimed to analyse avoidable mortality in Lithuania as an index of the quality of health care and to assess trends in avoidable mortality from 1970-90. SETTING AND PARTICIPANTS: All deaths of Lithuanian residents aged between 0 and 64 years between 1970 and 1990 were analysed. MEASUREMENTS AND MAIN RESULTS: Twenty seven per cent of all deaths in this age group were avoidable. Avoidable deaths were grouped into preventable and treatable ones. Treatable causes of death accounted for 54%, and preventable, 46% of avoidable mortality. Time trends showed that general mortality and mortality from avoidable causes of death in this age group were almost stable between 1970 and 1990. Mortality from treatable causes of death fell, while deaths from preventable causes increased. The results in the preventable group were greatly affected by deaths from malignant neoplasms of trachea, bronchus, and lungs. Differences were noted between the sexes in total mortality as well as in avoidable mortality. CONCLUSIONS: Avoidable causes of death are relatively common and, consequently, they are of practical importance for public health and studies of the health care quality in Lithuania. Reorganisation of health care is to be carried out and considerable emphasis will be placed on health education, promotion, and prevention, as primary prevention measures have not been effective thus far.

Time trends in lung-cancer mortality rates among men in Lithuania, 1965-1994.

This study examines time trends in lung-cancer mortality rates among men in Lithuania during the period 1965-1994. Age-standardized mortality rates increased from 32.5 per 100,000 in 1964-1969 to 62.9 per 100,000 in 1990-1994. Regression analysis indicates that net drift (sum of cohort and period slopes) was positive. Cohort effect was dominant in the trend observed. Mortality in cohorts born before 1945 showed an increase. In younger generations, born after 1945, the risk declined in each subsequent cohort. Higher prevalence of cigarettes with filters and lower tar content of cigarettes may be of importance. This analysis suggests that mortality will rise until cohorts born around 1950 reach middle age or old age. After that some stabilization can be expected if other conditions remain unchanged and previous trends continue.

Lung cancer in the USSR: patterns and trends.

Lung cancer in the USSR has become the most frequent type of tumour in males. In females, however, lung cancer rates are far behind rates for cancer of the breast, stomach and cervix. In 1980, lung cancer accounted for about one-fourth of newly diagnosed cancer cases in males and about one-sixth of all cancer cases in both sexes. The incidence of lung cancer is increasing in the USSR. In the five Soviet republics for which time trends have been examined in this paper, increases in lung cancer incidence have been observed in men for all ages, with the exception of the age group 30-39 years. Modest increases in lung cancer are seen in women in the older age groups, while small decreases or stabilization of rates are observed in younger age groups. However, there are two exceptions: statistically significant increases in Georgia for women aged 40-49 years, and an upward trend in Lithuania in urban females born in the years 1932 and 1937, suggesting that these particular groups of women smoke more than other women in the areas for which lung cancer time trends have been analysed. The continued increase in cigarette consumption in this country explains the rising trends in lung cancer and, moreover, leads to the prediction that this increase will continue for another 30-40 years.

An evaluation of laryngeal cancer morbidity time trends in Lithuania.

PURPOSE: To make assessments of the rates of cases of larynx cancer in Lithuania in the years 1978-2001 as well as possible trends of changes in the future. MATERIAL AND METHODS: The data contained in the Lithuanian Cancer Register for the period 1978-2001 about new cases as well as the data compiled by the Lithuanian Department of Statistics on the average number of population of Lithuania within the same period in the same age groups have been used in the course of the study. The data have been standardized by age using direct method, in accordance with the European standard; a regression analysis of larynx cancer case rates was made. RESULTS: After standardization of data for the period 1978-2001, tendencies of increase have been registered both among men and women: in 1978 the case rate per 100,000 population was 10.73 among men and 0.26 among women, in 2001 the corresponding data were 11.6 among men and 0.7 among women. Throughout the period the investigated case rate for men was higher than for women. An increasing average age of men and women suffering from this disease has been noticed: average age for men is annually increasing by 0.1566 years and for women--0.0602 years. The forecast for men in the year 2006 is 13.88 cases per 100,000 population and 0.54 for women. CONCLUSIONS: The increase of larynx cancer case rates is growing more rapidly among women than among men, and also average age of the patients is increasing. The forecast is that in 2006 the case rate will be growing up, and both men and women will get ill at older age.

Meeting patient's expectations in primary care consultations in Lithuania.

OBJECTIVE: Patient satisfaction with health care services is considered an important factor of health care. Although research on patient satisfaction has become standard in Western Europe, in countries such as Lithuania the concept of patient satisfaction is still a relatively new one. This study aimed to investigate how the meeting of patients' expectations is related to increased satisfaction with medical consultation. STUDY DESIGN: The methodology used by Williams et al. in the UK was applied to the Lithuanian health care setting. Forty physicians from 22 primary health care centres attending courses on general practice at Vilnius University were recruited for the study. Every third adult patient coming to a practice during a 5-day period was invited to participate in the study. In all, 609 patients coming to meet their physician regarding health problems were included in the study sample. The patients were asked to complete three standardized questionnaires: the Patient Intentions Questionnaire prior to the consultation, and the Expectations Met Questionnaire and Medical Interview Satisfaction Scale after the consultation. Cronbach's alpha statistic was used for the validation of the questionnaires and principal components analysis was used to determine the factors of patient expectations. RESULTS: The response rate was 78%. ANALYSIS: of 460 sets of questionnaires revealed that satisfaction with medical consultation is higher among patients who have a greater number of expectations met. Physicians' success in meeting different types of patient expectations also had different influences on patient satisfaction. The most important expectations to be met were "understanding and explanation", followed by expectations of "emotional support", while "getting information" was less important. CONCLUSIONS: The most frequently reported expectations on the Patient Intentions Questionnaire were for "getting information" and "understanding and explanation" of the patients' health problem items, and the least mentioned were for emotional support items. Patients with more expectations met were found to have significantly higher scores on the satisfaction index. Satisfaction with the consultation is best predicted by meeting the patient's expectations for understanding and explanation, and for emotional support. Providing desired information to the patient as well as meeting the patient's expectations for diagnostic procedures and treatment is less associated with patient satisfaction.