[Show abstract][Hide abstract] ABSTRACT: Objective:
The main objective of this study was to estimate the annual direct healthcare cost of type 2 diabetes mellitus healthcare and its complications in Lithuanian population.
Material and methods:
The study uses a prevalence-based top-down approach. The random sample of study participants was formed using the database of the National Health Insurance Fund under the Lithuanian Ministry of Health. 762 patients with diabetes mellitus type 2 data were analyzed in this research. The data on healthcare costs was recorded between January 1, 2011 and December 31, 2011.
Ambulatory care cost mean per patients with diabetes mellitus type 2 in 2011 was EUR 156.14 (95% CI, 147.05-165.24). 34.4% patients had at least one hospitalization during the 2011 year. Mean annual cost per patients of hospitalization was EUR 1160.16 (95% CI, 1019.60-1300.73). Covered drugs and diabetes supplies annual direct cost mean per patients was EUR 448.34 (95% CI, 411.14-485.54). The more expensive treatment was with oral and non-insulin injectable hypoglycemic medications (P<0.001). 65.1% participants were diagnosed one or more diabetes-related chronic complications. Average annual cost per person, increased gradually with the numbers of complications from EUR 671.94 (95% CI, 575.03-768.86) in patients without complications to EUR 1588.98 (95% CI, 1052.09-2125.86) in patients with 3 and more complications (P<0.001).
The largest part of direct costs in diabetes mellitus healthcare composes hospital inpatient care and covered drugs expenditures. In our study we observed that the presence of microvascular, macrovascular chronic complication increased the direct cost per patient, compared with patients without complications.
Preview · Article · Dec 2014 · Medicina (Kaunas, Lithuania)
[Show abstract][Hide abstract] ABSTRACT: Objectives To assess the prevalence and correlates of self-reported genital warts (GWs) among women and men aged 18–45 years in the Baltic countries.
Methods In 2011–2013 we performed a cross-sectional survey using a self-administered questionnaire to collect information on the history of clinically diagnosed GWs, sociodemographic characteristics and sexual behaviour. Probability sampling methods were used to invite 16 959 individuals representing the general population, of whom 7760 (45.8%) participated (Estonia: 1967 women, 1221 men; Latvia: 1525 women, 1525 men; Lithuania: 1522 women).
Results The estimated lifetime prevalence of clinically diagnosed GWs in women was 4.6% (95% CI 3.8 to 5.5) in Estonia, 2.9% (95% CI 2.0 to 3.6) in Latvia and 1.5% (95% CI 1.2 to 2.0) in Lithuania. Among men, the corresponding values were 2.8% (95% CI 1.9 to 4.0) in Estonia and 1.9% (95% CI 1.3 to 2.6) in Latvia. The mean age at first episode of clinically diagnosed GW was 24.6 years (95% CI 23.6 to 25.5) for women and 24.5 years (95% CI 22.9 to 26.0) for men. A lifetime history of clinically diagnosed GW was associated with a history of sexually transmitted infections other than GW (adjusted OR (AOR) 3.0, 95% CI 2.1 to 4.3 for women; AOR 5.3, 95% CI 3.0 to 9.2 for men), and a higher number (5+) of lifetime sexual partners (AOR 2.9, 95% CI 1.9 to 4.2 for women; AOR 2.1, 95% CI 1.2 to 3.9 for men). Men living comfortably within their household income had higher odds for GW (AOR 1.9, 95% CI 1.1 to 3.2).
Conclusions Our estimated prevalence of clinically diagnosed GWs was lower than estimates from the general population of other European countries.
Full-text · Article · Aug 2014 · Sexually Transmitted Infections
[Show abstract][Hide abstract] ABSTRACT: The assessment of health-related quality of life (HRQL) in newly diagnosed breast cancer patients is necessary to address predictive factors in supportive clinical practice.
The objectives of this study are to evaluate self-reported HRQL within 1 year after breast cancer diagnosis and to determine important factors associated with self-reported impaired HRQL.
A cross-sectional study was performed in newly diagnosed breast cancer patients. The statistical analysis included descriptive statistics and stepwise logistic regression modeling.
The survey response rate was 67 % (n = 338). Almost 50 % of the studied population was identified as experiencing anxiety. The impaired HRQL domains were emotional functioning and global health status. Severely expressed symptoms included insomnia, fatigue, and financial difficulties. Poor financial situation, comorbidities, unemployment, and lack of psychological counseling were identified as important predictive factors (p < 0.001).
Psychosocial, but not clinical, factors were the prevalent predictive factors in impaired HRQL. Early identification of women that are at risk of poorer HRQL and interventions of psychosocial support following breast cancer diagnosis are recommended.
No preview · Article · Oct 2013 · Supportive Care in Cancer
[Show abstract][Hide abstract] ABSTRACT: This study aimed to ascertain associations between stress coping strategies, socio-demographic factors and depressive symptoms in international students. Specific stress coping strategies and depressive symptoms were assessed in 98 international multicultural students. Stress coping strategies were measured by Coping Orientation of Problem Experience questionnaire. Depressive symptoms were assessed with Zung Self-Rating Depression Scale. It was ascertained that the use of stress coping strategies in international students differs due to their gender and course. Some of the stress coping strategies are indepen dently associated with depressive symptoms in international students.
Full-text · Article · Jul 2013 · Procedia - Social and Behavioral Sciences
[Show abstract][Hide abstract] ABSTRACT: Many of the strategic planning studies worldwide have made recommendations to the policy makers on the steps to be taken in eliminating the perceived shortages of physician workforce or in improving their distribution and retention. Policy makers have also considered various policy interventions to ensure adequate numbers of physicians. This study reviewed the research evidence and health policy decisions taken from 2000 to 2010 in Lithuania and evaluated the chronological links over time between scientific recommendations and policy decisions. From the analysis it would seem that Lithuania's success in retaining physicians between 2000 and 2010 was influenced by the timely implementation of particular research recommendations, such as increased salaries and increased enrolment to physician training programmes. In addition were the health policy interventions such as health sector reform, change in the legal status of medical residents and establishment of professional re-entry programmes. Based on this evidence it is recommended that policy makers in Lithuania as well as in other countries should consider comprehensive and systematic health policy approaches that combine and address various aspects of physician training, retention, geographic mal-distribution and emigration. Implementation of such an inclusive policy however is impossible without the integration of research into strategic decision making in workforce planning and effective health policy interventions.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE. The assessment of breast cancer survival rates and comparison with those of other countries may help to deepen knowledge among decision makers in the health care system and to improve the inequalities in accessibility to early detection and effective treatment. The aim of this study was to evaluate breast cancer survival rates in Kaunas region, Lithuania, and to compare them with those in the selected European countries. MATERIAL AND METHODS. A retrospective study was carried out using medical records and data gathered from the Lithuanian Cancer Registry. A group of 240 patients with primary breast cancer diagnosed in 2008 in Kaunas region was analyzed. All causes of death were included in the analysis. The closing date of follow-up was September 30, 2010. Survival was determined using the life-table method and the Kaplan-Meier method. Cox proportional hazard models were used to estimate the effects of prognostic risk factors on survival. RESULTS. The median age of the patients was 63 years (range, 28-95). The 1-year and 2-year cumulative survival for breast cancer patients in Kaunas region, Lithuania, was 94.2% and 90.1%, respectively. As expected, the survival of patients with diagnosed advanced disease (stage III and IV) was significantly worse than that of patients with stage I (P<0.001) and II (P=0.003) disease. The screening group (aged 50-69 years) showed better survival in comparison with the group older than 69 years. Age, T4 tumor, and distant metastasis were the prognostic factors significantly associated with an increased relative mortality risk of breast cancer. CONCLUSIONS. Compared to the European survival rates, the 1-year and 2-year survival of patients with breast cancer in Lithuania was found to be similar to most European countries.
Full-text · Article · Aug 2012 · Medicina (Kaunas, Lithuania)
[Show abstract][Hide abstract] ABSTRACT: The policy of population-wide human papillomavirus (HPV) vaccination has been debated as the introduction of such a programme in a low-resource country faces the risk of insufficient cost-effectiveness.
To assess the potential healthcare spending changes after the introduction of a HPV16/18 population-wide vaccination programme in Lithuania.
For a cost-effectiveness analysis, we used mathematical simulation and epidemiological data modelling based on a Lithuanian female population. We performed comparative analysis of an annual 12-year-old girls population-wide vaccination programme combined with cervical cancer screening programme compared to the screening programme strategy only.
HPV vaccination would gain an average of 35.6 life years per death avoided or up to 284.8 thousand life years would be gained over 90 years in total. The programme costs would be 2932.58 EUR per life year gained. All costs associated with the introduction of the vaccination programme could be recovered in 48 years. The HPV vaccination programme in Lithuania has the potential to generate up to 40.07 million EUR of economic returns annually compared with the current practice of the cervical screening alone.
In Lithuania the HPV16/18 vaccination programme would be economically effective only in the long term. The investment costs of HPV16/18 vaccination have the potential to be recovered.
Full-text · Article · Jul 2012 · Scandinavian Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: There is a large difference in the prevalence of cervical cancer between European countries. Between European Union countries, cervical cancer is the most prevalent in Lithuania. Currently we have available vaccines for different types of human papillomavirus virus (HPV), but we lack evidence on how the vaccination would be cost-effective in low-resource Eastern European countries like Lithuania.
To create a simulation model for the Lithuanian population; to estimate epidemiological benefits and cost-effectiveness for a HPV16/18 vaccination programme in Lithuania. Study design: For the cost-effectiveness analysis, we used Lithuanian population mathematical simulation and epidemiological data modelling. We performed comparative analysis of annual vaccination programmes of 12-year-old or 15-year-old girls at different vaccine penetration levels. Population: Lithuanian female population at all age groups.
A vaccination programme in Lithuania would gain an average of 35.6 life years per death avoided. Vaccinated girls would experience up to 76.9% overall reduction in incidence of cervical cancers, 80.8% reduction in morbidity and 77.9% reduction in mortality over their lifetime. Cost per life year gained with different vaccine penetration levels would range from 2167.41 Euros to 2999.74 Euros.
HPV vaccination in Lithuania would have a very positive impact on the epidemiological situation and it would be cost-effective at all ranges of vaccine penetration. Vaccination in Lithuania in the long term potentially could be more cost-effective due to avoiding early disease onset and lower accumulation of period costs.
Full-text · Article · Aug 2010 · Scandinavian Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: Breast cancer is the most common cancer among women, comprising about 23% of all cancer types. About 1300 new cases of breast cancer are registered in Lithuania annually. During the last decade, health-related quality of life has become an important part of breast cancer treatment. Pain, fatigue, and sleep disorders are important aspects of health-related quality of life. The aim of the study was to evaluate health-related quality of life (HRQL) among patients with breast cancer in Lithuania. The main tasks were to analyze HRQL in sociodemographic and clinical aspects, and to determine symptoms that have the greatest impact on HRQL .
A cross-sectional study was carried out in four major Lithuanian hospitals. An EORTC QLQ-C30 (version 3) questionnaire with general demographic and medical information was distributed among 318 patients. A total of 284 patients were included in the analysis.
The response rate was 89%. The mean age of patients was 55.9 years (SD, 10.1 years), and the mean time from diagnosis--2.36 years (SD, 3.2 years). A greater part (65%) of the studied women lived in a family or with a partner. Women reported high level of functioning across several standardized HRQOL scales: cognitive functioning, everyday activity, and physical functioning. Fatigue and sleeping disorders were the most commonly indicated symptoms in the symptom scale. Fatigue and pain were the most important factors affecting general HRQOL.
Our results emphasize that the general HRQOL of the studied women is fair, but poorer than that of the corresponding population in other countries. Women living in a family or partnership experienced fewer financial troubles and had higher HRQOL scores across several standardized measures compared to those who were single. Women with late stages of breast cancer felt worse and were less socially active compared to women who were diagnosed with early-stage breast cancer.
Preview · Article · Jan 2010 · Medicina (Kaunas, Lithuania)
[Show abstract][Hide abstract] ABSTRACT: Chronic hepatitis B infection is an important health care problem worldwide. According to the World Health Organization, 10% to 15% of population is infected with hepatitis B virus. Nearly 100 new cases of acute hepatitis B are annually registered in Lithuania, but official statistics covers only 8-25% of all disease incidence. The aim of this study was to evaluate the cost-effectiveness of the treatment of chronic hepatitis B with peginterferon alfa-2a and compare it to treatment with interferon alfa and lamivudine in Lithuania.
A Markov model was used to evaluate long-term cost-effectiveness of the treatment with peginterferon alfa-2a and to compare it with treatment with interferon alfa and lamivudine. Peginterferon alfa-2a was administered by subcutaneous injections at a dosage of 180 μg every week for 48 weeks; interferon alfa, 6 million IU three times a week for 24 weeks; and lamivudine, 100 mg per day from 48 weeks to 5 years for HBeAg-positive chronic hepatitis B and 100 mg per day up to 5 years in HBeAg-negative chronic hepatitis B.
Treatment with peginterferon alfa-2a gained 1.179 life years as compared to 0.658 life years gained with treatment with interferon alfa; incremental costs per incremental life-year gained (LYG) were 51,256.92 Lt (14,845.03 €). Treatment with peginterferon alfa-2a gained 0.545 quality-adjusted life-years (QALYs) with incremental costs per incremental QALY of 48,980.08 Lt (14,185.61 €). Treatment with peginterferon alfa-2a had twice higher cost-effectiveness than treatment with interferon alfa: 50,4167.00 Lt (146,016.85 €) vs. 954,020.08 Lt (276,303.31 €), respectively. Costs for a complete response were also twice lower. Treatment with peginterferon alfa-2a gained 0.757 incremental LYG more compared to lamivudine (48-week course). Comparing incremental cost-effectiveness using peginterferon alfa-2a for treatment, incremental costs per incremental LYG were 41,993.67 Lt (12,162.21 €); additionally there was a gain of 0.792 incremental QALYs, while incremental costs for incremental QALY were 40,096.19 Lt (11,612.66 €). Complete response costs were 83,515.98 Lt (24,187.89 €) less compared to lamivudine (48-week course).
Treatment of chronic hepatitis B prolongs patients' overall survival and quality-adjusted life. Peginterferon alfa-2a was the most effective drug registered in Lithuania for CHB treatment.
Preview · Article · Jan 2010 · Medicina (Kaunas, Lithuania)
[Show abstract][Hide abstract] ABSTRACT: Economic evaluations in health care involve the identification, measurement, valuation, and then comparison of the costs (inputs) and outcomes of treatments or preventive activities. The aim was to analyze the cost-utility of six-month methadone maintenance treatment program in a Lithuanian primary health care setting.
A prospective study design was used. All the information was obtained through the validated questionnaires at the baseline and 3- and 6-month follow-ups. WHOQOL-BREF was used to assess the quality of life; the costs were assessed using the DATCAP methodology from the perspective of a patient and outpatient clinic during follow-up period.
A total of 102 opioid-dependent patients were recruited in the study; 512 follow-up patient-months were obtained. The methadone maintenance treatment has significantly improved physical, psychological, and environmental components of quality of life during follow-up. Total program costs were 61 288.87 EUR. Cost paid by a patient comprised about 31% of total program costs. Cost per quality-adjusted life-month (QALM) for physical domain was 2227.55 EUR; for psychological domain, 1879.50 EUR; for social domain, 5467.64 EUR; and for environmental domain, 4626.47 EUR. Costs per QALM and quality-adjusted life-year (QALY) for total quality of life in the maintenance program were 2864.00 EUR and 34 368.00 EUR, respectively.
Our results showed that 6-month methadone maintenance program was effective in the terms of quality-of-life improvement. Methadone maintenance treatment program was less effective in terms of cost per QALY.
Full-text · Article · Jan 2010 · Medicina (Kaunas, Lithuania)
[Show abstract][Hide abstract] ABSTRACT: Type 1 diabetes mellitus is a slowly progressive autoimmune disease. The genetic background of type 1 diabetes mellitus is polygenic with the major disease locus located in the human leukocytes antigen (HLA) region. High risk and protective alleles, haplotypes, and genotypes have been determined in Lithuanian children with type 1 diabetes mellitus and healthy children.
In this case-control study, 124 children with diabetes (55 males and 69 females; mean age, 9.2±3.9 years) were tested for HLA class II and compared with 78 healthy controls (43 males and 35 females; mean age, 10.8±3.4 years; range, 0-15 years). HLA DRB1, DQA1, and DQB1 alleles were genotyped using a polymerase chain reaction.
T1D risk-associated haplotypes (DR4)-DQA1*0301-DQB1*0302, (DR3)-DQA1*0501-DQB1*0201, and (DR1)-DQA1*0101-04-DQB1*0501 were more prevalent among children with diabetes than controls (50.0%, 41.1%, and 37.9% vs. 10.3%, 5.1%, and 24.4%, P<0.001). The haplotypes (DR4)-DQA1*0301-DQB1*0302 and (DR3)-DQA1*0501-DQB1*0201 increased T1D risk by 8.75 and 12.93 times, respectively (P<0.001). Protective haplotypes (DR2)-DQA1*0102-B1*0602, (DR11/12/13)-DQA1*05-DQB1*0301, and (DR13)-DQA1*0103-DQB1*0603 were significantly more prevalent among controls than children with diabetes (25.6%, 33.3%, 19.2% vs. 0%, 3.2%, 0%; P<0.001). These frequencies are quite similar to those from neighbor countries with varying incidence of type 1 diabetes mellitus.
HLA class II haplotypes associated with type 1 diabetes mellitus positively or negatively were the same in Lithuanian children as in other European Caucasian populations. Differences in incidence and clinical manifestations of type 1 diabetes might be due to different environmental factors and/or lifestyle.
Full-text · Article · Jan 2010 · Medicina (Kaunas, Lithuania)
[Show abstract][Hide abstract] ABSTRACT: The damage of beta cells occurs during the asymptomatic prodromal period called prediabetes before onset of diabetes mellitus. It is characterized by the presence of islet cell autoantibodies (ICAs). The aim of this study was to find out what environmental factors predict ICA seroconversion in healthy schoolchildren in Lithuania.
Sera from 3053 nondiabetic schoolchildren living in Lithuania were investigated for ICAs. ICAs were measured in undiluted sera by indirect immunofluorescence method. All ICA-positive and randomly selected ICA-negative children were invited to participate in the study. Response rate in the families of ICA-positive children was 100% and in ICA-negative-76.5%. Data from 13 ICA-positive and 199 ICA-negative schoolchildren were included in the analysis. Information on the environmental factors was collected via questionnaires.
Proportions of breastfed children were similar in ICA-positive and ICA-negative schoolchildren. Full cow's milk was introduced at one month of age or earlier more often in ICA-positive than ICA-negative schoolchildren (8.3% and 1.1%, respectively; P=0.05). Cereal before 3 months of age was introduced more often in ICA-positive than ICA-negative schoolchildren (7.7% and 0.5%, respectively; P=0.01). The mothers of cases took medicine during pregnancy more often than mothers of controls did (61.5% and 14.1%, respectively; P<0.001). More than half (53.8%) of ICA-positive children lived in homes where family members were smoking indoors, while this was recorded only for 26.6% of controls (P=0.04).
Early introduction of cow's milk and cereal, the intake of medicine during pregnancy, and indoor smoking of family members are risk factors that predict the development of prediabetes among Lithuanian children.
Full-text · Article · Jan 2008 · Medicina (Kaunas, Lithuania)
[Show abstract][Hide abstract] ABSTRACT: The aim of this study is to examine the attitudes of Lithuanian pharmacists towards migration to other countries of the European Union or European Economic Area. Using a questionnaire developed by the Ministry of Social Affairs, Labour and Solidarity of France, surveys were sent to 654 Lithuanian pharmacists (response rate 47.5 per cent). Univariate logistic regression was used to estimate risk factors for intention of pharmacists to go abroad. More than one quarter of Lithuanian pharmacists intended to work in other EU/EEA countries; however this was a definitive decision of only 2.3 per cent. Target destination countries were the United Kingdom, Ireland, Germany, Norway, Sweden and Denmark. The major reasons for leaving were higher salary, better quality of life and better professional opportunities. English language skills significantly increased the potential risk of working abroad by four times. Other significant factors were age less than 30 years, graduation since 1990, urban residence, and friends/family abroad. Even though the study did not find evidence of large-scale migratory flows, it found a significant percentage of Lithuanian pharmacists who intended to migrate. The potential effects of migration ought to be tackled systematically and in a coordinated way, because emigration affects the health system and health workers remaining in the country. In order to observe future trends, the survey should be repeated every two or three years.
Full-text · Article · Apr 2007 · Journal of Ethnic and Migration Studies
[Show abstract][Hide abstract] ABSTRACT: To define the probability of foetal and neonatal death (PFND) in Lithuania by means of the Medical Birth registry.
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.
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.
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.
No preview · Article · Feb 2007 · Scandinavian Journal of Public Health
[Show abstract][Hide abstract] ABSTRACT: The evaluation of quality of life and self-perceived health represents an assessment of the impact of treatment on patient functioning and well-being.
Our aim was to explore the impact of methadone maintenance treatment on quality of life and self-perceived health of opioid-dependent persons in Lithuania.
A total of 102 opioid-dependent patients were recruited in the study. A prospective follow-up study design was used. To assess quality of life, the WHOQOL-BREF 26-item version was used. The impact of methadone maintenance treatment on self-perceived health was assessed by Opiate Treatment Index (OTI).
Following 6 months of methadone maintenance treatment, significant improvements in physical (P=0.004), psychological (P=0.004), and environmental (P=0.048) components of quality of life were observed; no statistically significant improvements were found in social component of quality of life. Study participants reported lower rates of medical morbidity associated with injection (P<0.001), cardiorespiratory (P=0.034), musculoskeletal (P<0.001), neurological (P=0.013), gastrointestinal (P<0.001), and general health (P<0.001).
Methadone maintenance treatment substantially reduces morbidity associated with opioid dependence and improves the quality of life of patients.
Full-text · Article · Jan 2007 · Medicina (Kaunas, Lithuania)
[Show abstract][Hide abstract] ABSTRACT: We compared the prevalence of beta-cell autoantibodies and genetic risk factors in Sweden and Lithuania. Ninety-six patients from Sweden and 96 from Lithuania matched for age and gender (1-15 years old, median age 9.0 years) were included. We analyzed autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA) and the protein tyrosine phosphatase like IA-2 (IA-2A) as well as risk-associated polymorphisms of HLA, insulin and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) genes. The frequency of patients positive for IAA and GADA was higher in Sweden than in Lithuania (p = 0.043 and 0.032). The differences remained even when the patients were matched for HLA, insulin and CTLA-4 risk genotypes. Patients with low levels of IAA had higher levels of HbA1c and ketones at diagnosis. The frequency of the risk haplotype DR4-DQ8 was higher in Swedish than in Lithuanian patients (p = 0.004), as well as the high-risk combination of DR4-DQ8 and DR3-DQ2 haplotypes (p = 0.009). Our results suggest that autoimmune process against insulin and GAD(65) is more common at diagnosis in children in areas with high incidence of type 1 diabetes (T1D), independent of genetic risk markers. Furthermore, the disease in patients with insulin autoantibodies seems to be clinically milder.
No preview · Article · Jul 2006 · Diabetes Research and Clinical Practice
[Show abstract][Hide abstract] ABSTRACT: Economic considerations influence the substance user treatment system. These considerations influence who gets treatment and for how long, as well as determining what services they receive and in what setting. Current medical literature argues that maintenance treatment reduces risk-taking behavior, such as injection drug use and needle sharing. Treatment also reduces the mortality associated with abuse of opiates by injection and can cause decreases in costs incurred by the criminal justice system and social services agencies. This suggests the need for complex economic evaluations of a maintenance treatment to find out the optimum treatment program. This paper describes methods of economic evaluation in health care and reviews the methodology of cost-utility analysis in economic evaluations of methadone maintenance treatment.
No preview · Article · Feb 2006 · Substance Use & Misuse
[Show abstract][Hide abstract] ABSTRACT: To measure the incidence of severe acute maternal morbidity (SAMM) and to find the risk factors that could be useful in trying to predict the development of SAMM.
The data were collected prospectively in 7 maternity units from different Lithuanian regions over a 1-year period. Every woman with a clinical diagnosis of severe preeclampsia, eclampsia, Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome, severe hemorrhage, uterine rupture, or severe sepsis during pregnancy or delivery or until the 42nd day post partum was included after verification of diagnosis by using clinical criteria.
One hundred and six cases of SAMM and one maternal death were identified during the study among 13,399 deliveries (7.91/1000 deliveries 95% CI 6.48-9.56). There were 57 cases of severe preeclampsia, 3 cases of eclampsia, 38 cases of severe hemorrhage, 3 cases of uterine rupture, and 4 cases of severe sepsis. One maternal death occurred due to HELLP syndrome, so the case-fatality ratio for severe morbidity was 0.99%.
The incidence of SAMM and case-fatality rate in Lithuania are similar to those in other European countries. The main risk factors for SAMM were previous peripartum hemorrhage, previous hypertension, previous renal diseases, lack of antenatal care, and dystocia.
No preview · Article · Jan 2006 · International journal of fertility and women's medicine
[Show abstract][Hide abstract] ABSTRACT: When health care reform was started in 1991, the physician workforce in Lithuania was dominated by specialists, and the specialty of family physician (FP) did not exist at all. During fifteen years of Lithuania's independence this specialty evolved rapidly and over 1,900 FPs were trained or retrained. Since 2003, the Lithuanian health care sector has undergone restructuring to optimize the network of health care institutions as well as the delivery of services; specific attention has been paid to the development of services provided by FPs, with more health care services shifted from the hospital level to the primary health care level. In this paper we analyze if an adequate workforce of FPs will be available in the future to take over new emerging tasks.
A computer spreadsheet simulation model was used to project the supply of FPs in 2006-2015. The supply was projected according to three scenarios, which took into account different rates of retirement, migration and drop out from training. In addition different population projections and enrollment numbers in residency programs were also considered. Three requirement scenarios were made using different approaches. In the first scenario we used the requirement estimated by a panel of experts using the Delphi technique. The second scenario was based on the number of visits to FPs in 2003 and took into account the goal to increase the number of visits. The third scenario was based on the determination that one FP should serve no more than 2,000 inhabitants. The three scenarios for the projection of supply were compared with the three requirement scenarios.
The supply of family physicians will be higher in 2015 compared to 2005 according to all projection scenarios. The largest differences in the supply scenarios were caused by different migration rates, enrollment numbers to training programs and the retirement age. The second supply scenario, which took into account 1.1% annual migration rate, stable enrollment to residency programs and later retirement, appears to be the most probable. The first requirement scenario, which was based on the opinion of well-informed key experts in the field, appears to be the best reflection of FP requirements; however none of the supply scenarios considered would satisfy these requirements.
Despite the rapid expansion of the FP workforce during the last fifteen years, ten-year forecasts of supply and requirement indicate that the number of FPs in 2015 will not be sufficient. The annual enrollment in residency training programs should be increased by at least 20% for the next three years. Accurate year-by-year monitoring of the workforce is crucial in order to prevent future shortages and to maintain the desired family physician workforce.
Full-text · Article · Nov 2005 · BMC Family Practice