Giedrius Vanagas

Does quality of life of prostate cancer patients differ by stage and treatment

Background: The lack of consensus amongst experts delineate how important it is for patients diagnosed with prostate cancer (PCa) to make an informed decision on available treatment options through an objective discussion of the risks and benefits. One of important benefits could be seen as patient’s quality of life (QoL) after treatment. We aimed to assess QoL differences in prostate cancer patients by stage and treatment for a population-based sample. Methods: The cross-sectional PCa patient population-based national level study for a prostate cancer patient population was performed. QoL was investigated with EORTC QLQ-C30. The analysis includes descriptive statistics and evaluation of differences in functional and symptom scales by stage and treatment group by predictors in the model. Results: Response rate was 79.1% (N=514). The highest QoL scores were observed in localised PCa, active surveillance treatment group. The lowest scores were observed in advanced stages, chemotherapy treatment group. Between cancer stages, statistically significant differences were observed only in scales of emotional functioning (p<0.001) and social functioning (p<0.001). Between treatment groups, statistically significant differences were observed in scales of physical functioning (p<0.001), role functioning (p<0.001), emotional functioning (p<0.001), and social functioning (p<0.001). Conclusions: Our study highlighted statistically significant differences in QoL between cancer stages and treatment. Understanding how the QoL changes in relation with the selected treatment option can be important to the urologist and individual patient to have realistic expectations as well as to optimise treatment decisions for the prostate cancer patient when exist several alternatives.

Cost-Utility Analysis of Methadone Maintenance Treatment: A Methodological Approach

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 healthcare and reviews the methodology of cost–utility analysis in economic evaluations of methadone maintenance treatment.

Interaction among general practitioners age and patient load in the prediction of job strain, decision latitude and perception of job demands. A cross-sectional study

BackgroundIt is widely recognized and accepted that job strain adversely impacts the workforce. Individual responses to stressful situations can vary greatly and it has been shown that certain people are more likely to experience high levels of stress in their job than others. Studies highlighted that there can be age differences in job strain perception.MethodsCross-sectional postal survey of 300 Lithuanian general practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the Karasek scale. The analysis included descriptive statistics; logistic regression beta coefficients to find out predictors and interactions between characteristics and predictors.ResultsResponse rate was 66% (N = 197). Logistic regression as significant predictors for job strain assigned – duration of work in primary care; for job demands- age and duration of working in primary care; for decision latitude- age and patient load.The interactions with regard to job strain showed that GPs age and job strain are negatively associated to a low patient load. Lower decision latitude for older GP age is strongly related to higher patient load. Job demands and GP age are slightly positively related at low patient load.ConclusionsLithuanian GPs have high patient load and are at risk of stress, they have high job demands and low decision latitude. Older GPs perceive less strain, lower job demands and higher decision latitude in case of low patient load. Young GPs decision latitude has week association to patient load. Regarding to the changes in patient load younger GPs perceive it more sensitively as changes in job demands.

Cost-effectiveness of 12- and 15-year-old girls’ human papillomavirus 16/18 population-based vaccination programmes in Lithuania:

Background: 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. Objectives: 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. Results: 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 to 2999.74. Conclusions: 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.

Assessment of validity for EuroSCORE risk stratification system

Prognostic scoring helps doctors, patients and their families to weigh the risks and benefits of medical care and clarifies their expectations. Objective We aimed to analyze the risk stratification performance of the EuroSCORE system because of its common use in Lithuania. Design EuroSCORE performance is assessed in terms of sensitivity, specificity, accuracy and area under the receiver operating characteristic (ROC) curve (AUC). Logistic regression is carried out for modeling categorical data and odds ratio calculations of being a non-survivor case for each EuroSCORE risk group. Results The study was completed on 1002 patients. Mean score for EuroSCORE was 4.77±2.8; ROC curve of 0.71; accuracy was 65.5%; 65.4% sensitivity and 67.2% specificity. Conclusions EuroSCORE created a moderately predictive area under the ROC curve for our patient population. Probability of non-survival by logistic regression model for each EuroSCORE risk group is statistically significantly higher compared to the lower risk group. Predictions available from prognostic scoring systems could be useful in decision making when there is uncertainty in whether to carry out surgery or not.

Factors Affecting Electronic Health Information Needs in Primary Care Patients

BACKGROUND Electronic health information is a new concept in the Lithuanian healthcare system. It gives the possibility of obtaining accurate medical information online by quick, convenient, and private access and presents to the patients the opportunity for better-informed decisions on their own health and greater participation in healthcare processes. The aim of this study is to assess the availability of health information for patients and to assess the factors affecting a patients health-related information needs on the Internet. SUBJECTS AND METHODS A cross-sectional study design was used. Self-perceived needs for health-related information and health-related information on the Internet were evaluated by means of a questionnaire. The questionnaires were distributed to the patients during on-site visits to primary care physician. Cumulative numbers of health information searches were calculated. RESULTS The Internet was used by 63.2% of the respondents. Electronic health information search indicated 47.3% were Internet users. Internet users were statistically significantly more satisfied and informed about available electronic health services: registration for physician services (p<0.001), health information portal (p<0.001), electronic health record (p<0.001), clinical investigations (p=0.001), medical consultations (p=0.009), patient health education services (p=0.019), and patient self-help groups. A higher frequency of health information searches on the Internet was more associated with female patients (odds ratio [OR], 3.1; p=0.012), patients having chronic disease (p=0.013), living in couples (OR, 14.8; p=0.031), having e-health service experience (OR, 7.0; p<0.001), daily Internet user (OR, 6.7; p=0.054), and longer duration of Internet use per day (OR, 1.3; p=0.046). CONCLUSIONS The Internet is an important source of health information. Internet users are more satisfied with available health information. Female patients, those having chronic disease, living as couples, and having e-health service experience, and daily Internet users are the most frequent users of health information on the Internet.

Factors affecting health-related quality of life in prostate cancer patients

Abstract Objective. Prostate cancer is the most common cancer among men in Lithuania. Quality of life (QoL) assessment plays a key role in the evaluation and treatment of cancer patients. The aim of this study was to evaluate factors affecting the QoL of patients with prostate cancer in Lithuania. Material and methods. A cross-sectional national-level study was performed. QoL was investigated with the EORTC QLQ-C30 questionnaire. Statistical analysis included descriptive statistics, interrelationship analysis between characteristics and multivariate logistic regression to estimate predictors and odds ratios (ORs) for each of the independent variables in the model. Results. The response rate was 74.8% (N = 486). One-quarter of respondents with prostate cancer indicated high QoL scores. Higher QoL scores were given for prostate cancer patients with lower education level [OR = 3.092, 95% confidence interval (CI) 1.007–9.491, p = 0.049], having lower monthly expenses for treatment (OR = 3.653, CI 1.318–10.128, p = 0.013), disease stage II (by patient conveyance) (OR = 10.053, CI 1.015–99.534, p = 0.048), disease stage I (by medical record) (OR = 2.19E + 08, CI 218514200.17–218514200.17, p < 0.001) and in those with undisclosed disease stage (OR = 9.220, CI 1.251–67.965, p = 0.029). Conclusions. Significant predictors for higher QoL scores were education level, own monthly expenses for treatment and disease stage. Patients with undisclosed disease stage more often had higher QoL scores.

Clinical-Technical Performance and Physician Satisfaction with a Transnational Telephonic ECG System

The effective use of cardiology hospital services could improve patient safety while shortening pre- and in-hospital stay periods using modern transtelephonic technologies and consultations by phone to follow up electrocardiograph (ECG) changes of the patients on a waiting list. The aim of this study was to assess clinical-technical performance and satisfaction with application of an international telephonic ECG system. A transnational telephonic ECG system was established between Lithuania and Germany. A follow-up study design was used to assess clinical-technical performance and user satisfaction with the system. According to inclusion and exclusion criteria, 34 patients were enrolled who transmitted 329 ECGs, of which 14 ECGs showed clinical changes. Of the ECGs sent 254/329 (77%) were of good quality, 9 (3%) were of moderate quality, and 66 (20%) were of bad quality. Among physicians surveyed, 77.6% were satisfied or very satisfied with telemedicine services. A telecardiology service can help to identify patients with urgent problems requiring rapid assessment at the hospital. The service has high acceptance from physicians but needs to be improved in terms of technical performance and patient compliance expectations.

Factors Affecting Relevance of Tele-ECG Systems Application to High Risk for Future Ischemic Heart Disease Events Patients Group

Telecardiology can identify patients with urgent problems requiring rapid assessment at the hospital or even emergency admission. Telemedicine applications in cardiology must identify factors that make the service most beneficial to the patients. The aim of the study was to analyze factors affecting relevance and benefits of telephonic electrocardiography (ECG) consultations. A transnational telephonic ECG system was established between Lithuania and Germany. Using a follow-up study design, clinical performance and beneficial factors for telecardiology were assessed. According to inclusion and exclusion criteria, 34 patients sent 329 ECGs with 14 ECG showing important clinical changes. Of the 329 ECGs only 263 (80%) ECGs were of acceptable quality for clinical interpretation. Most important factors associated with benefits from tele-ECG service were gender, Thrombolysis in Myocardial Infarction (TIMI), Systematic Coronary Risk Evaluation (SCORE) risk stratification, and chest pain in previous month. Tele-ECG service of routine ECGs can be useful in recognition of silent ischemia or arrhythmias, and facilitating diagnosis. However, other factors such as chest pain in the previous month, gender, TIMI, and SCORE risk stratifications are important in planning tele-ECG services.

Evidence-Based Public Health.

Public health decision making can be a complicated process because of the complex nature of inputs and the need for group decision making. Nevertheless, public health research and practice during the last century gained many notable achievements and contributed to the 30-year gain in life expectancy. Despite these accomplishments, a greater attention to evidence-based approaches may be helpful. In its most straightforward definition, evidence-based public health (EBPH) means applying the principles of evidence-based medicine (EBM) to the field of public health [1]. However, the randomized clinical trials—the gold standard in EBM—are not always applicable in investigating public health problems. Key components of a broader definition of EBPH include making decisions on the basis of the best available scientific evidence by using sound data collection and research methods while engaging with the affected community in decision making. An evidence-based approach to public health could potentially have numerous direct and indirect benefits, including access to more and higher-quality information on best practice, a higher likelihood of successful prevention programs and policies, greater workforce productivity, and more efficient use of public and private resources. In this special issue we collect several contributions to the emerging field of evidence-based public health, covering different aspects of the EBPH policy cycle, that is, from evidence generation and evidence synthesis to evidence communication and policy recommendation [2]. We are particularly delighted about the broad geographical coverage and methodological range of the included paper. The utilized methodology ranges from randomized controlled trial (RCT) to simulation studies with observational studies still being the most popular research design. The study titled “Worksite Tobacco Prevention: A Randomized, Controlled Trial of Adoption, Dissemination Strategies, and Aggregated Health-Related Outcomes across Companies” by V. Friedrich et al. conducted an RCT to compare various approaches to worksite tobacco prevention. An instructive finding of this study is that special attention must be paid to the dissemination of findings if adoption of proven public health measure should increase. Similarly, the article “Strong Public Health Recommendations from Weak Evidence? Lessons Learned in Developing Guidance on the Public Health Management of Meningococcal Disease” by G. Hanquet et al. shows the necessity to be transparent about the quality of the underlying evidence when giving policy recommendations. Systematic reviews and meta-analysis are a workhorse of evidence-based medicine and two studies in our special issue demonstrate clearly that this is also the case for evidence-based public health. G. A. Kelley et al. conducted a systematic review titled “Exercise and BMI in Overweight and Obese Children and Adolescents: A Systematic Review and Trial Sequential Meta-Analysis” utilizing a trial sequential meta-analysis approach. This approach combines conventional meta-analysis methodology with meta-analytic sample size considerations; inferences derived from this method may potentially improve reliability of estimates. The systematic review “Sexual Risk Behaviors and HIV Infection among Men Who Have Sex with Men and Women in China: Evidence from a Systematic Review and Meta-Analysis” by H.-Y. Wang et al. sheds light on potential transmission mechanism of HIV/AIDS in China, indicating that more emphasis must be put on prevention measures for men who have sex with men and women. A crucial, but at times overlooked, factor for a successful public health policy is the availability of trained medical staff. In our special issue two articles study this important topic. Interestingly enough, both are from Sub-Saharan Africa, a region that constantly faces the challenge of brain drain, that is, the outmigration of well-trained individuals. The study from Ethiopia titled “The Prevalence of Skilled Birth Attendant Utilization and Its Correlates in North West Ethiopia” by M. Alemayehu and W. Mekonnen looks at the prevalence of skilled birth attendants demonstrating that both social and technical factors must be addressed if this prevalence should be improved in the future. The study titled “Working Atmosphere and Job Satisfaction of Health Care Staff in Kenya: An Exploratory Study” by K. Goetz et al. investigates the factors that influence job satisfaction for health care works in Kenya. Clearly, improving job satisfaction may prove to be a very cost-effective tool in increasing retention rates among health care staff in Africa. The contribution “Intervention Mapping to Adapt Evidence-Based Interventions for Use in Practice: Increasing Mammography among African American Women” by L. Highfield et al. uses the topic of mammography among African American women to demonstrate the use of intervention mapping as a tool for a systematic planning process. Their use of a simplified framework (IM Adapt) allowed adapting and implementing an evidence-based intervention to help underserved African American women to keep appointments for mammography screening. A separate paper titled “Evaluation of the Effectiveness and Implementation of an Adapted Evidence-Based Mammography Intervention for African American Women” by L. Highfield et al. evaluated the effectiveness of the identified intervention and added evidence to the finding that sequentially measuring efficacy and effectiveness of an evidence-based intervention, followed by implementation, may be missing important contextual information. A paper from Croatia titled “Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia” by U. Rodin et al. describes how the national perinatal health audit improved after introducing reporting criteria as recommended by WHO and PERISTAT. This database now allows comparison in perinatal outcome with other countries and targeting areas of improvement in a more evidence-based fashion. The contribution “Health Impacts of Increased Physical Activity from Changes in Transportation Infrastructure: Quantitative Estimates for Three Communities” by T. J. Mansfield and J. M. Gibson utilizes the approach of quantitative health impact assessment to assess the implications of increased physical activity from changes in transportation infrastructure. To this end they use a simulation tool (DYNAMO-HIA) that was specifically developed for such applications. An Australian paper titled “Public Concern about the Sale of High-Caffeine Drinks to Children 12 Years or Younger: An Australian Regulatory Perspective” by C. M. Pollard et al. presents a study connected to the epidemiology of caffeine intake. Usually this is attributed mostly to coffee consumption. However, this paper demonstrates that growing concerns regarding the consumption of caffeinated beverages such as energy drinks by children and adolescents exist in communities in Western Australia, in particular by females and those living with children. These concerns increase with age. The final paper of this special issue titled “Smoke-Free Workplaces Are Associated with Protection from Second-Hand Smoke at Homes in Nigeria: Evidence for Population-Level Decisions” by D. Kaleta et al. aims to support decision making at the population level. These authors find evidence that smoke-free workplaces have the important additional effect of stimulating smoke-free homes in Nigeria and in turn reduce second hand smoking exposure of children. In summary such collection of papers covering different issues relevant to EBPH will provide evidence for decision makers and will contribute to the development of this field.