Dalia Virviciute

The relationship of green space, depressive symptoms and perceived general health in urban population.

Aims:To assess the relationship between green space proximity, use of green space and depressive symptoms and perceived general health among a random sample men and women. Methods: Cross-sectional study of a population-based sample of 6,944 45–72 year old Kaunas city residents. Self-reported questionnaires provided information on sociodemographic variables, health behaviours, depressive symptoms and poor and very poor perceived general health. Residential proximity to green spaces was defined as living less than 300 m, within interval of 300–999 m, and equal or more than 1 km from a park. The use of the park was divided into two categories: no park use or use <4hrs/week and use of the park ≥4 h/week. The study received approval from the Kaunas Regional Research Ethics Committee. Multiple logistic regression assessed the associations controlling for confounding variables. Results: The prevalence of depressive symptoms and poor and or very poor perceived general health was higher in women than in men. The association between the use of the park and residential proximity to the park revealed that women living >300 m from a green space and who used the space ≥4 h/week showed higher odds 1.92 (1.11–3.3) and 1.68 (0.81–3.48) of depressive symptoms and poor and very poor perceived general health as compared to those who used the park <4 hrs/week and residential proximity was >300 m. Conclusions: The results of our study confirmed an association between use of the green space, residential proximity, and depressive symptoms and poor and very poor perceived general health among women only.

Trends in prevalence, awareness, treatment, and control of hypertension, and the risk of mortality among middle-aged Lithuanian urban population in 1983-2009

BackgroundArterial hypertension (AH) is a main risk factor for the risk from cardiovascular (CVD) and stroke mortality. Only few data was published on prevalence, awareness and management of AH in Lithuania. Development of objective approaches to the treatment and control of AH reduces the risk of mortality. The aim of this study was to evaluate time trends, the prevalence, awareness, treatment and control of AH and risk of mortality among Lithuanian urban population aged 45–64 years during the period of 1983–2009.MethodsTime trends of AH and risk of mortality were examined in three MONICA health surveys in 1983, 1986, 1992, and in one health survey according to MONICA protocol in 2002 included randomly recruited of 2,218 men and 2,491 women. AH was defined as systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP of ≥90 mmHg or current use of antihypertensive medication. The main outcome measures were all-cause mortality, mortality from CVD, coronary heart disease (CHD) and stroke. The mean duration of follow-up was 11.8 ± 9.2 years. All survey periods were age standardized to the year 2006 of Kaunas population. The estimates of hazard ratio and 95% confidence interval were based on the multivariate Cox proportional hazards regression.ResultsIn men during 1983–2002 period hypertension prevalence was 52.1–58.7% and did not significantly change whereas in women decreased from 61.0 to 51.0%. There was a significant increase in hypertension awareness among hypertensive men and women (45.0 to 64.4% and 47.7 to 72.3%, respectively) and in treated hypertensives (55.4 to 68.3% in men and 65.6 to 86.2% in women). Adjusted Cox proportional hazard regression analyses revealed a strong dose–response association between blood-pressure level and all-cause, CVD, CHD and stroke-mortality risk in both men and women groups.ConclusionIn Lithuanian urban population the prevalence of hypertension remains high. Despite positive changes in hypertension awareness and treatment, hypertension control remains poor. A strong dose–response association between the level of BP and all-cause, CVD, CHD and stroke mortality risk was indicated.

Trends in suicide in a Lithuanian urban population over the period 1984–2003

BackgroundThroughout the last decade of the twentieth century, Lithuania had the highest suicide rates in Europe among both men and women aged 25–64 years. The rates increased from 1986 until 1995, but later there was a slight decrease. This paper describes the trends in suicide deaths in urban population in Lithuania by gender, dates and suicide method over the period 1984–2003.MethodsData from the regional mortality register were used to analyze suicide deaths among all men and women aged 25–64 years in Kaunas city, Lithuania over the period 1984–2003. Age-standardized death rates per 100,000 persons (using European standard population) were calculated by gender, suicide method and dates. A joinpoint regression method was used to estimate annual percentage changes (EPACs) and to detect points where the trends changed significantly.ResultsThe frequency of death by suicide among males was 48% higher in 1994–2003 than in 1984–1993. The corresponding increase among females was 28%. The most common methods of suicide among men were hanging, strangulation and suffocation (87.4% among all suicide deaths). The proportions of hanging, strangulation and suffocation in males increased by 6.9% – from 83.9% to 89.7% – compared to a 24.2% increase in deaths from handgun, rifle and shotgun firearm discharges and a 216.7% increase in deaths from poisoning with solvents, gases, pesticides and vapors. Among females, the most common methods of suicide were hanging, strangulation and suffocation (68.3% of all suicide deaths). The proportion of hanging deaths among females increased during the time period examined, whereas the proportion of poisonings with solid or liquid substances decreased.ConclusionSuicide rates increased significantly among urban men aged 25–64 years in Lithuania throughout the period 1984–2003, whereas among women an increasing but statistically insignificant trend was observed. There were changes in the suicide methods used by both men and women. Changes in the choice of method may have contributed to the changes in suicide rates.

Health factors and risk of all-cause, cardiovascular, and coronary heart disease mortality: findings from the MONICA and HAPIEE studies in Lithuania.

Aims This study investigated the trends and levels of the prevalence of health factors, and the association of all-cause and cardiovascular (CVD) mortality with healthy levels of combined risk factors among Lithuanian urban population. Methods Data from five general population surveys in Kaunas, Lithuania, conducted between 1983 and 2008 were used. Healthy factors measured at baseline include non-smoking, normal weight, normal arterial blood pressure, normal level of total serum cholesterol, normal physical activity and normal level of fasting glucose. Among 9,209 men and women aged 45–64 (7,648 were free from coronary heart disease (CHD) and stroke at baseline), 1,219 death cases from any cause, 589 deaths from CVD, and 342 deaths from CHD occurred during follow up. Cox proportional hazards regression was used to estimate the association between health factors and mortality from all causes, CVD and CHD. Results Between 1983 and 2008, the proportion of subjects with 6 healthy levels of risk factors was higher in 2006–2008 than in 1983–1984 (0.6% vs. 0.2%; p = 0.09), although there was a significant increase in fasting glucose and a decline in intermediate physical activity. Men and women with normal or intermediate levels of risk factors had significantly lower all-cause, CVD and CHD mortality risk than persons with high levels of risk factors. Subjects with 5–6 healthy factors had hazard ratio (HR) of CVD mortality 0.35 (95% confidence interval (CI) 0.15–0.83) compared to average risk in the whole population. The hazard ratio for CVD mortality risk was significant in men (HR 0.34, 95% CI 0.12–0.97) but not in women (HR 0.38, 95% CI 0.09–1.67). Conclusions An inverse association of most healthy levels of cardiovascular risk factors with risk of all-cause and CVD mortality was observed in this urban population-based cohort. A greater number of cardiovascular health factors were related with significantly lower risk of CVD mortality, particularly among men.

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.

Alcohol consumption and risk of gastric cancer: a cohort study of men in Kaunas, Lithuania, with up to 30 years follow-up

BackgroundGastric cancer is the second most common cause of death from cancer in the world. Epidemiological findings on alcohol use in relation to gastric cancer remain controversial. The aim of this study was to examine the effect of alcohol consumption on the risk of gastric cancer.MethodsThe association between alcohol intake and the risk of gastric cancer was examined in a population-based cohort of 7,150 men in Kaunas, Lithuania, who were enrolled during 1972–1974 or 1976–1980. After up to 30 years of follow-up, 185 gastric cancer cases were identified. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). The attained age was used as a time-scale.ResultsAfter adjustment for smoking, education level and body mass index, the HR of gastric cancer was 2.00 (95% CI: 1.04–3.82) for the highest alcohol consumption frequency (2–7 times per week) compared with occasional drinking (a few times per year) and 1.90 (95% CI: 1.13–3.18) for ≥100.0 g ethanol/week versus 0.1–9.9 g ethanol/week. A stronger effect of alcohol consumption on gastric cancer risk was observed during the second half of the study (1993–2008). In the analysis of gastric cancer risk by alcoholic beverage type, all beverages were included simultaneously in the model. The multivariate HR for men who consumed ≥0.5 litre of wine per occasion (compared with those who consumed <0.5 litre) was 2.95 (95% CI: 1.30–6.68). Higher consumption of beer or vodka was not statistically significantly associated with gastric cancer risk. After adjustment for smoking, education level, body mass index and ethanol, we found no excess risk of gastric cancer in association with total acetaldehyde intake.ConclusionsThis study supports a link between alcohol consumption (primarily from ethanol) and the development of gastric cancer in the Lithuanian population. Although an association with heavy wine consumption was observed, the effect of exposure to acetaldehyde on the development of gastric cancer in this cohort was not confirmed. Further research is needed to provide a more detailed evaluation of alcohol drinking and gastric cancer risk.

Smoking and other risk factors for pancreatic cancer: A cohort study in men in Lithuania

BACKGROUND Cancer of the pancreas is a relatively rare, but highly fatal cancer worldwide. Cigarette smoking has been recognized as an important risk factor, but the relation to other potential determinants is still inconsistent. We investigated the association between different lifestyle, biological and anthropometric factors and the risk of pancreatic cancer in a prospective population-based cohort study from Kaunas, Lithuania. METHODS Our study included 7132 urban men initially free from any diagnosed cancer, followed for up to 30 years. 77 incident cases of pancreatic cancer were identified. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI). RESULTS Compared to never smokers, current smokers had a significantly increased risk of pancreatic cancer, HR was 1.79 (95% CI 1.03-3.09) after adjustment for age, body mass index, education and alcohol consumption. Among smokers, a significant association with higher smoking intensity was shown (≥ 20 cigarettes/day: HR = 2.60; 95% CI 1.42-4.76, P(trend) = 0.046). We also observed a significantly increased risk for ≥ 30 pack-years of smoking (HR = 2.24; 95% CI 1.12-4.49, P(trend) = 0.16) and for age at starting smoking < 18 years (HR = 2.29; 95% CI 1.11-4.70, P(trend) = 0.43) as compared to never smokers. Alcohol consumption, body mass index and total cholesterol level were not significantly associated with pancreatic cancer. CONCLUSIONS Smoking significantly increases pancreatic cancer incidence and its high prevalence in Lithuania may partly explain high incidence of the disease. No convincing evidence was found that alcohol consumption, body mass index or serum cholesterol level were associated with pancreatic cancer risk, although the assessment was limited by the lack of statistical power.

Link between healthy lifestyle and psychological well-being in Lithuanian adults aged 45–72: a cross-sectional study

Objective This study uses a cross-sectional study design to analyse the connection between psychological well-being (PWB) and components of a healthy lifestyle in the Lithuanian population aged 45–72. The purpose of our study is to establish the links between PWB and lifestyle factors such as physical activity, smoking, alcohol consumption and dietary patterns in people above the age of 44. Participants A stratified sample of 10 940 urban citizens aged 45–72 years were randomly selected from the National Population Register. The response rate was 65%. Methods PWB was evaluated by using a Control Autonomy Self-realization and Pleasure (CASP-12) questionnaire. The standard questionnaire included questions regarding the respondents sociodemographic, socioeconomic and social status. The lifestyle questionnaire evaluated behavioural factors as smoking status, alcohol consumption, nutrition habits and physical activity. Objective measurements of cardiovascular disease (CVD) risk factors were taken. Results Adjusted for sociodemographic, socioeconomic, social and biological CVD risk factors, the probability of higher PWB increased for physically active men and women and male former smokers. Higher PWB was directly associated with consumption of fresh vegetables and fruits. Responders who consumed potatoes, meat, boiled vegetables and eggs less frequently than average were more likely to have higher PWB. A direct association was ascertained between PWB and consumption of chicken and fish, as well as an inverse association between PWB and consumption of sweets in women. Conclusions Healthy lifestyle education efforts should focus on increasing physical activity, controlling smoking and improving diversity in healthy food consumption including the consumption of fresh vegetables and fruits, particularly among older adults with lower PWB.

Trends in major risk factors and mortality from main non-communicable diseases in Lithuania, 1985-2013.

BackgroundThis study aimed to assess the trends in the prevalence and levels of risk factors and mortality from main non-communicable diseases in the Lithuanian population aged 45–64 years during 1985 to 2013.MethodsData from four general population surveys conducted between 1985 and 2008 were used. All these surveys were carried out in Kaunas city and five randomly selected municipalities of Lithuania. Risk factors measured at each survey included regular smoking, overweight, obesity, arterial hypertension, and high levels of blood lipids. In total, data of 10,719 subjects (4,965 men and 5,754 women) aged 45–64 were analysed. Trends in standardized all-cause mortality and mortality from cardiovascular disease (CVD), coronary heart disease (CHD), and malignant neoplasms were estimated for both sexes by joinpoint regression analysis.ResultsIn 1985–2013, some favourable trends were observed in the age-standardized mean levels and prevalence of risk factors and mortality from main non-communicable diseases in the Lithuanian middle-aged population. The mean values of blood lipids (with the exception of triglycerides) and the prevalence of dyslipidemias declined. In women, mean levels of systolic blood pressure and body mass index decreased, while in men, the levels of these factors increased. The prevalence of arterial hypertension and obesity increased in men. The proportion of obese women decreased. Smoking prevalence increased in both men and women. From 2007 to 2008, significant downward trends, which were steeper in women than in men, were observed in all-cause, CVD, and CHD mortality.ConclusionsDespite the favourable changes in some risk factors and mortality rates, the prevalence of risk factors and mortality from main non-communicable diseases in Lithuania are still high. This indicates the importance of the ongoing primary and secondary prevention and optimal treatment of these diseases.

Anthropometric trends and the risk of cardiovascular disease mortality in a Lithuanian urban population aged 45–64 years

Aims: To estimate trends in anthropometric indexes from 1992 to 2008 and to evaluate the risk of cardiovascular disease mortality in relation to anthropometric indexes (body mass index, waist circumference, waist:hip ratio, waist:height ratio). Methods: Data from the three surveys (1992–2008) are presented. A random sample of 5147 subjects aged 45–64 years was selected for statistical analysis. During follow-up there were 141 deaths from cardiovascular disease (excluding those with cardiovascular disease at entry). Cox’s regression was used to estimate the associations between anthropometric indexes and cardiovascular disease mortality. Results: During a 17-year period among men, the prevalence of obesity (body mass index ⩾30 kg/m2) increased from 18.4% to 32.1% (p<0.001) and a high level of waist:hip ratio (>0.9) from 59.3% to 72.9% (p<0.001). The risk profile of obesity did not change in women, but prevalence of a high level of waist:hip ratio (>0.85) increased from 25.9% to 41.5% (p<0.001). Multivariable-adjusted Cox’s regression models showed that body mass index, waist circumference, waist:hip ratio, waist:height ratio were associated with cardiovascular disease mortality risk only in men (hazard ratios 1.40, 1.45, 1.49, 1.46 respectively (p<0.01)). Conclusions: Our data indicate that anthropometric measures such as body mass index, waist circumference, waist:hip ratio and waist:height ratio are good indicators of cardiovascular disease mortality risk only in men aged 45–64 years.