Aurelijus Veryga

Recent heavy alcohol consumption at death certified as ischaemic heart disease: correcting mortality data from Kaunas (Lithuania).

AIMS To assess the proportion of deaths assigned to ischaemic heart disease (IHD) which in fact were caused by the toxic effects of alcohol, and how this may affect the official statistics of mortality from IHD in Lithuania. METHODS Using the IHD register in Kaunas, Lithuania, and verifying underlying causes of death using standard international methodology, 3061 cases were found in Kaunas city who had died from IHD at age 25-64 during 1993-2007. Out-of-hospital sudden deaths accounted for 2467 cases (81%), including 1498 where forensic autopsy was conducted and post-mortem concentration of alcohol in blood and urine was available. RESULTS In total, 78.4% of all initial IHD diagnoses were verified, while in 8.7% of deaths the underlying cause of death was corrected into an alcohol-related cause and in 12.9% to other diseases. Alcohol was found in about half (50.3%) of out-of-hospital death cases subjected to autopsy. In 18.0% of cases, the alcohol concentration was 3.5% or higher. Alcohol was more likely to be present in winter months and at weekends. CONCLUSION A significant number of alcohol-attributable deaths in Lithuania were misclassified as coronary deaths, accounting for almost one-tenth of officially registered deaths from IHD in ages 25-64. A high prevalence of positive post-mortem blood or urine alcohol tests suggests that the proportion of alcohol-related deaths among out-of-hospital IHD deaths may be actually even higher. A similar situation may be present in some other countries where high levels of alcohol consumption and binge drinking patterns are observed.

Smoking during pregnancy in association with maternal emotional well-being

OBJECTIVE The aim of the study was to investigate psychosocial predictors of smoking during pregnancy. MATERIALS AND METHODS It was a cross-sectional analysis of a prospective birth-cohort study. The participants were 514 mothers of full-term infants. Women completed questionnaires during hospital stay after delivery. Questionnaire included items on sociodemographic characteristics, planning and emotional acceptance of pregnancy, reproductive history, health-related behavior, emotional well-being, and relationships with a partner. RESULTS Smoking during pregnancy was reported by 14.8% of the participants. Prenatal smoking was associated with secondary or lower education, maternal age less than 20 years, childbirth outside of marriage, history of elective abortion, unplanned pregnancy, lack of positive emotional acceptance of pregnancy by mother and father, emotional distress and alcohol consumption during pregnancy. Smoking during pregnancy remained significantly associated with prenatal alcohol consumption, previous elective abortion, and lack of positive emotional acceptance of pregnancy by mother even after adjustment for maternal age, education, and family structure. CONCLUSIONS Results support an idea of complexity of the relationships among smoking, alcohol use, and emotional well-being. Lack of positive emotional acceptance of pregnancy by mother and history of elective abortions can be considered as possible associates of smoking during pregnancy and suggest that strengthening of positive attitudes toward motherhood could add to lower smoking rates among pregnant women.

Burden of smoking in Lithuania: attributable mortality and years of potential life lost

Background High mortality rates from smoking related diseases are a significant public health issue in Lithuania. Study aims to estimate the number of smoking attributable deaths (SADs) and years of potential life lost in Lithuania in 2013. Methods Gender, age and disease specific mortality was calculated by applying the smoking attributable fractions (SAFs) to prevalence estimates of current and former smokers among Lithuanian adults aged ≥35 years that are based on the 2005 Lithuanian Health Interview Survey. Mortality data were obtained from the Institute of Hygiene Health Information Centre. Eight years lag was assumed between smoking rates and subsequent mortality. Sensitivity analysis was used to calculate SAFs applying smoking impact ratio method. Results In 2013, 13.9% of total mortality or 5771 deaths in Lithuania were attributable to smoking (5181 men and 590 women). The two leading causes of SADs were ischaemic heart disease (2861) and lung cancer (1054) that accounted for 67.8% of the smoking attributable mortality. In the same year, smoking accounted for 39 279 years of potential life lost (34 663 years for men and 4615 years for women). Conclusions Smoking causes a considerable mortality burden in Lithuania, killing nine times more males than females. Therefore reduction of smoking prevalence is an urgent public health need, which calls for implementation of effective and comprehensive tobacco control measures consistent with the World Health Organization Framework Convention on Tobacco Control Articles and Protocols and The Tobacco Products Directive.

Building an international public health academic partnership: The Alberta-Lithuania experience

The schools of public health at the University of Alberta and the Lithuanian University of Health Sciences have developed a partnership committed to a variety of collaborations (eg, faculty/student exchanges and joint projects). Our initial efforts have resulted in the initiation of joint projects, important connections between numerous institutions/academics, and planning for future efforts within and beyond the partnership. The positive potential for such partnerships is significant, and a number of strategies for successful implementation are suggested.

Smoking-Attributable Direct Healthcare Expenditure in Lithuania: A Prevalence-Based Annual Cost Approach

Introduction: The estimates of the economic burden of smoking provide the basis for a comprehensive assessment of the overall economic impact and evidence for potential public health policy intervention by the government. The aim of this paper is to estimate the smoking-attributable direct healthcare expenditure covered by the Compulsory Health Insurance Fund (CHIF) in Lithuania in 2013. Methods: A prevalence-based and disease-specific annual cost approach was applied to 25 smoking-related diseases or disease categories. Our analysis included only direct government healthcare expenditure (reimbursed by CHIF), including: smoking-attributable outpatient and inpatient care services, medical rehabilitation, reimbursable and publicly procured pharmaceuticals and medical aids, the emergency medical aid (ambulance) service, nursing, and expensive tests and procedures. The smoking-attributable expenditure on the above-mentioned healthcare services was calculated by multiplying the total annual expenditure by the corresponding smoking attributable fractions (SAFs). Results: The total smoking-attributable government expenditure amounted to €37.4 million in 2013. This represented 3% of the total CHIF budget in 2013. Smoking-attributable expenditure on inpatient care and medical rehabilitation services was two times higher for male smokers, than for female smokers. Conclusions: Smoking imposes a significant preventable financial cost within the budget of the Lithuanian healthcare system. A quantitative estimation of smoking related healthcare costs could provide an incentive for the development of smoking cessation services, with additional attention towards male smokers, as well as an important focus on smoking prevention among children and youths.

Assessing Formation of Evidence Based Tobacco and Alcohol Control Policy in Lithuania: the Retrospective Analysis of Voting of the Members of Parliament

Goal. To develop the instrument for monitoring and assessment of the Members of Parliament (MP) voting patterns on tobacco and alcohol control policy and present main results of the changes in voting indicator (rating) during 2012–2015. Methodology. Analysis was conducted using statistical data of MP voting on the issues of the tobacco and alcohol control policy publicly available on the internet page of the Parliament of the Republic of Lithuania. Final analysis included 57 law amendments voted on between 16th of November, 2012 and 30th of June, 2015, after assessment of their potentially positive or negative impact on public health. The instrument is used to assess individual MPs and political parliamentary factions based on their votes on the issues of tobacco and alcohol control policy. The final rating was based on calculating weight coefficient depending of the MP vote having the potentially positive or negative impact on public health. A sum of each MPs positive and negative votes was then converted into 10 point scoring system, with the worst assessment of 0 and best – 10. Overall assessment of each Parliamentary faction was calculated as an average of the scores of individual faction members. Results. The instrument for assessment of the Republic of Lithuania MPs voting patterns has been developed and implemented for the six Parliamentary sessions during 2012–2016. On average 75 MPs voted per voting round (min. 38; max. 114) through 57 voting rounds included in the final analysis. Out of 146 current and former MPs assessed with this instrument 58 percent received less than 5 points (negative assessment), 27 percent were assessed 5-7 points, 13 percent received 8 points and 2 percent – 9-10 points. The assessment of the Parliamentary factions revealed differences between individual voting pattern and that of a political group to which MP belongs. Highest assessments were received by the Lithuanian Polish Election Action and Lithuanian Homeland Union and Lithuanian Christian Democratic political groups (accordingly 6.3 and 5.9 points). Labour party and Order and Justice political groups received barely positive assessment (accordingly 5.1 and 5.3 point). Negative assessments were received by the Liberal Movement political group (2.3 points), the Lithuanian Socialdemocratic Party political group (4.4 point) and the Mixed parliament political group (4.6 point). Conclusions. Assessment of the MP voting patterns has revealed differences between individual MPs and political factions voting rating, also large differences within factions. Over half of the MPS received negative rating assessments. Non-attendance of the Parliamentary meetings by MPs had a significant impact on their negative rating. Instrument is suitable for monitoring individual MPs and political factions inclination to favour public heath interest.