Žilvinas Padaiga

Longer breastfeeding is an independent protective factor against development of type 1 diabetes mellitus in childhood

Early weaning diet, early introduction of breast milk substitution and cows milk have been shown to increase the risk of type 1 diabetes later in life. It is also shown that older maternal age, maternal education, preeclampsia, prematurity, neonatal illness and neonatal icterus caused by blood group incompatibility, infections and stress might be risk factors for type 1 diabetes. We aimed to determine whether early nutrition is an independent risk factor for diabetes despite other life events.

Severity at onset of childhood type 1 diabetes in countries with high and low incidence of the condition

Severity of Type 1 diabetes mellitus (DM) at presentation was compared between south-east Sweden and Lithuania where incidence of childhood Type 1 diabetes is three times lower than in Sweden. New cases of diabetes at age 0-15 years from August 1995 to March 1999 in south-east Sweden and from August 1996 to August 2000 in Lithuania were included. Symptoms and clinical characteristics at diagnosis were recorded. Data about the close environment were collected using questionnaires. Lithuanian children were diagnosed in a more severe condition, mean pH 7.30 and HbA(1c) 11.5% compared with mean pH 7.36 and HbA(1c) 9.7% in Swedish children (P<0.0001). More Lithuanian than Swedish children were diagnosed in ketoacidosis (pH < or = 7.2, hyperglycaemia and ketonuria), 21.3 versus 7.3% (P<0.0001). Only 4.6% of Swedish children and 1.0% of Lithuanian children had no symptoms (P=0.007). Children in families with at least one first degree relative with diabetes (12.2% in Sweden and 8.4% in Lithuania, NS) had laboratory values at diagnosis closer to normal than sporadic cases in either country. Factors predicting ketoacidosis in Sweden were an unemployed mother and absence of infections in the 6 months before diagnosis. In Lithuania it was younger age and mother with less education. Additional educational activities for doctors are needed in countries with low incidence to reduce prevalence of ketoacidosis at onset.

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.

Direct cost of patients with type 2 diabetes mellitus healthcare and its complications in Lithuania.

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. RESULTS 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). CONCLUSIONS 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.

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.

The cost of newly diagnosed breast cancer in Lithuania, 2011.

BACKGROUND AND OBJECTIVE Although the cost of treating women with breast cancer (BC) is an important component for cost saving and effectiveness in relation to the benefits of BC treatment interventions, there is limited information on the direct cost reported for BC in Lithuania. Therefore the aim of this study was to evaluate annual direct medical cost for newly diagnosed BC in Lithuania in the year 2011. MATERIALS AND METHODS The retrospective incidence-based top-down direct cost analysis was used. From January 1 to December 31, 2011 incident cases of BC (N=1142) registered by the National Health Insurance Fund, the stage determined by Lithuanian Cancer Registry were included in the study. RESULTS The total average direct cost of BC amounted per patient was 2580 (95% CI 2444-2752)EUR in 2011. The main cost driver per BC patients was the inpatient hospital stay, respectively 1655 (95% CI 1478-2334)EUR. The average outpatient cost for one BC patient was 564 (95% CI 547-898)EUR. The dominant proportion of inpatient expenditures was assigned to BC surgery and chemotherapy treatment. The BC direct medical cost increased according to the diagnosed stage of diseases from 2409 (95% CI 2196-2621)EUR in stage 1 to 3688 (95% CI 2703-4672)EUR in stage 4. The direct medical cost was inversely proportional to age. CONCLUSIONS The direct BC medical cost estimates provided by this analysis can be used to determine priorities for the future research on BC treatment interventions.

INDIRECT COSTS OF BREAST CANCER IN LITHUANIA IN 2008

Introduction. The costs of breast cancer constitute a huge economic impact on so ciety. Indirect costs associated with breast cancer present a significant challenge to the health care system as well. This is primarily due to temporary and permanent disability, disability allowances and pensions or premature death. Aim. The objective of this study was to estimate annual indirect costs of breast can cer from a societal perspective in Lithuania for the year 2008. Materials and methods. A survey of 379 women treated in five major Lithuanian hospitals was conducted in the period of October 2008 – March 2009. Economic data concerning sick-leave and disability due to illness was gathered via survey; data on breast cancer mortality was obtained from the Lithuanian Health Information Center. Results and Discussion. Productivity loss due to premature death reached €14.280 million, productivity loss due to morbidity amounted to €27.036 million – the major portion of these costs accounted for a production loss due to permanent disability. Temporary disability allowances and permanent disability pensions were estimated at €6.116 million and €8.550 million, respectively. The paper also highlights the impact of the disease on the whole society and upon survi vors personally. Decreasing the production losses due to breast cancer should be emphasized. Effective treatment strategies should be implemented in order to balance the costs of the disease. Conclusions. Total indirect breast cancer costs, estimated from a societal perspective, reached €55.982 million in 2008 in Lithuania with an average annual amount

Validation of the EFFECT questionnaire for competence-based clinical teaching in residency training in Lithuania

BACKGROUND AND AIM In 2013, all residency programs at the Lithuanian University of Health Sciences were renewed into a competency-based medical education curriculum. To assess the quality of clinical teaching in residency training, we chose the EFFECT (evaluation and feedback for effective clinical teaching) questionnaire designed and validated at the Radboud University Medical Centre in the Netherlands. The aim of this study was to validate the EFFECT questionnaire for quality assessment of clinical teaching in residency training. MATERIALS AND METHODS The research was conducted as an online survey using the questionnaire containing 58 items in 7 domains. The questionnaire was double-translated into Lithuanian. It was sent to 182 residents of 7 residency programs (anesthesiology reanimathology, cardiology, dermatovenerology, emergency medicine, neurology, obstetrics and gynecology, physical medicine and rehabilitation). Overall, 333 questionnaires about 146 clinical teachers were filled in. To determine the item characteristics and internal consistency (Cronbachs α), the item and reliability analyses were performed. Furthermore, confirmatory factor analysis (CFI) was performed using a model for maximum-likelihood estimation. RESULTS Cronbachs α within different domains ranged between 0.91 and 0.97 and was comparable with the original version of the questionnaire. Confirmatory factor analysis demonstrated satisfactory model-fit with CFI of 0.841 and absolute model-fit RMSEA of 0.098. CONCLUSIONS The results suggest that the Lithuanian version of the EFFECT maintains its original validity and may serve as a valid instrument for quality assessment of clinical teaching in competency-based residency training in Lithuania.