Paulauskienė, Justina

Background The rate of aging in Lithuania is faster than the EU average. The number of long-term health problems in older (65+yrs) people increases, posing changes in societal needs. The aim of our study was to identify the most important needs of older people in Lithuania.

Methods Generic qualitative inquiry employed purposeful sampling of stakeholders in Lithuania: policymakers, administration, academia, civil society, health care, social service, public health, organizations of elderly. 43 experts, engaged in online focus groups, generated a list of needs for health, wellbeing, active ageing in elderly; they deliberated to prioritize top 5; scientific team condensed a list of 10 for voting to determine final 5 national needs. Research was done within project “Roadmap to improve the health and well-being of the ageing population in the Baltic Sea Region (AgeFLAG)”, 2020.

Results Top needs identified were: shaping healthy lifestyle habits and motivation for change (72%) / age friendly environment and virtual assistive technologies (72%); person centred care (domiciliary care, residential care and nursing, social activities and etc. depending on the needs and wishes of the older person) (58%); increasing and maintaining physical capacity (56%); intersectoral collaboration and integration of social and health services (53%); establishment of positive public attitudes towards elderly people (50%). All stakeholders indicated that “Establishment of positive public attitudes towards elderly people” is the corner stone of all priorities for action to healthy ageing in Lithuania.

Conclusions The main issue hindering active and healthy ageing in Lithuania - negative image of ageing in the society. Recommendations on the public health actions included promoting intergenerational conversation, reducing stigmas around ageing, strengthening social inclusion, generating age-friendly environments, and creating a safe space for self-realization and development.

Key messages • The main issue hindering active and healthy ageing in Lithuania – negative image of ageing in the society.

• The change in the population requires the transformation of health care and social care systems building age friendly environments in Lithuania.

Temos aktualumas. Lietuvoje moterų sergamumo ir mirtingumo rodikliai nuo gimdos kaklelio vėžio (GKV) yra vieni didžiausių tarp Europos Sąjungos valstybių narių. 2020 metais Lietuvoje diagnozuota 412 naujų GKV atvejų ir 193 mirtys nuo šios ligos. Efektyvios GKV profilaktikos priemonės yra mergaičių vakcinacija nuo didelės onkogeninės rizikos žmogaus papilomos viruso (ŽPV) ir organizuota GKV patikros programa tikslinės amžiaus grupės moterims. Darbo tikslas. Įvertinti moterų, auginančių mergaites, žinias apie gimdos kaklelio vėžį ir jo išvengimo galimybes bei požiūrį į pirminę ir antrinę šio vėžio profilaktiką ir jos priimtinumą. Tyrimo metodai. 2021 metais anoniminės anketinės apklausos metodu internetinėje erdvėje, socialinio tinklo platformoje, apklausa 1016 Lietuvos moterų, auginančių mergaites (0-18 m.). Respondenčių amžiaus vidurkis 32,6 m. (jauniausiai – 19 m., vyriausiai – 50 m.). Klausimyne vertintos moterų žinios apie GKV ir jo rizikos veiksnius; informuotumas apie pirminę ir antrinę GKV profilaktiką, bei ŽPV ir jo sąsajos su GKV. Tyrimas atliktas gavus LSMU Bioetikos centro leidimą. Rezultatai laikyti statistiškai reikšmingais, kai p<0,05. [...].

[...]. Tikslas: Įvertinti metodų, siekiančių padidinti Lietuvos gimdos kaklelio piktybinių navikų patikros programos aprėptį, efektyvumą. Uždaviniai: 1.Įvertinti sisteminio kvietimo metodų poveikį dalyvavimo gimdos kaklelio piktybinių navikų patikros programoje rodikliams ir ikivėžinių pakitimų diagnostikai. 2.Palyginti sisteminio kvietimo metodų efektyvumą skirtingose populiacijose. 3. Įvertinti papildomų kvietimo metodų poveikį dalyvavimo gimdos kaklelio piktybinių navikų patikros programoje rodikliams. 4. Įvertinti nedalyvavimo gimdos kaklelio piktybinių navikų patikros programoje priežastis ir ŽPV savityros testo taikymo priimtinumą. 5. Atlikti skirtingų kvietimo metodų taikymo gimdos kaklelio piktybinių navikų patikros programoje ekonominį kaštų – efektyvumo vertinimą. Darbo mokslinis naujumas Disertaciniame darbe pirmą kartą Lietuvoje įvertintas sisteminio asmeninio kvietimo dviem laiškais (sisteminis asmeninis kvietimo laiškas ir sisteminis asmeninis kvietimo-priminimo laiškas) poveikis GKV patikros programos aprėpties rodikliams, nustatant ikivėžinius pakitimus tikslinės amžiaus grupės moterims, bei atliktas ekonominis kaštų efektyvumo vertinimas. Pirmą kartą vertintas papildomų patikros metodų – kvietimo telefonu ir didelės onkogeninės rizikos ŽPV savityros testų, siųstų į namus, efektyvumas GKV patikros programos aprėpties rodikliams. Skirtingi kvietimo metodai palyginti miesto ir rajono populiacijose. Taip pat pirmą kartą įvertintas ŽPV savityros testo priimtinumas tiriamųjų populiacijoje. [...].

In Lithuania, cytological screening of cervical cancer (CC) is largely opportunistic. Absence of standardized systematic invitation practice might be the reason for low participation rates. The study aimed to assess the cost-effectiveness of systematic invitation approach in CC screening programme from the perspective of a healthcare provider. A decision tree was used to compare an opportunistic invitation by a family doctor, a personal postal invitation letter with appointment time and place, and a personal postal invitation letter with appointment time and place with one reminder letter. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) per one additionally screened woman and per one additional abnormal Pap smear test detected. The ICER of one personal postal invitation letter was €9.67 per one additionally screened woman and €55.21 per one additional abnormal Pap smear test detected in comparison with the current screening practice. The ICER of a personal invitation letter with an additional reminder letter compared to one invitation letter was €13.47 and €86.88 respectively. Conclusions: A personal invitation letter approach is more effective in increasing the participation rate in CC screening and the number of detected abnormal Pap smears; however, it incurs additional expenses compared with current invitation practice.

Background and Objectives: In 2004, Lithuania started the Nationwide Cervical Cancer Screening Programme. However, screening is more opportunistic than population-wide and the programme’s coverage is insu cient. The aim of this study was to assess the e ect of systematic personal invitation on coverage of cervical cancer (CC) screening in urban and rural regions of Lithuania. Materials and Methods: The study was conducted in an urban primary healthcare centre (PHCC) and in a rural PHCC, where prevailing CC screening practice was highly opportunistic. Over the first year, all women aged 25–60 who had not received a Pap smear test within the last three years in urban (n = 1591) and rural (n = 1843) PHCCs received a personal invitation letter to participate in the screening. Over the second year, the reminder letter was sent to the non-attendees (n = 1042 in urban and n = 929 in rural PHCCs). A random sample of women (n = 93), who did not attend for screening after two letters, was contacted by phone in order to identify the barriers of non-attendance. Results: Before the study, only 9.6% of the target population in urban and 14.7% in rural PHCCs participated in CC screening. After the first invitation letter, the participation in CC screening increased up to 24.6% in urban and 30.8% in rural areas (p < 0.001). After the reminder letter, the attendance was 16.4% in urban and 22.2% in rural PHCCs (p < 0.001). The most common barriers for the non-attendance were lack of time, long waiting time for family doctor’s appointment, worries that a Pap test might be unpleasant and preventive gynaecological examination outside of the screening program. Conclusions: A systematic personal invitation with one reminder letter significantly increased the coverage of CC screening and was more e ective in rural regions than in urban regions. The assessed barriers for non-attendance can be used to improve the coverage of screening.

Introduction. In Lithuania, cervical cancer (CC) is the 4th cause of female cancer and 2nd cause of cancer among women aged 15 to 44 years. A well-organized CC screening at the population level every 3 to 5 years can reduce the incidence of CC by 80%. In 2004, Lithuania started a Nationwide Cervical Cancer Screening Programme with a three years screening interval, targeted at women aged 25-60 years, however, screening is more opportunistic than population-wide and its coverage is still insufficient. Research aim. To assess the efficacy of systematic personal invitation model for the cervical cancer screening coverage in the urban (Kaunas) and rural (Prienai) areas. Research methods and organization. The study was carried out in an urban (Kaunas) and a rural (Prienai) primary healthcare centres (PHCC). Before the study women in Kaunas PHCC and in Prienai PHCC were invited to participate in the CC screening by a family doctor. In the first year of the study, all women aged 25-60 not having had Pap smear test within the last 3 years in Kaunas (n=1591) and in Prienai (n=1843) received a personal invitation letter to participate in the screening. In a year, the reminder letter was sent to the non-attendees (n=1042 in Kaunas and n=929 in Prienai). Women, who did not attend for screening after two letters, received a questionnaire aimed at identifying the barriers of non-attendance. Results. Before the study, family doctors invited 35.1% of women in Kaunas PHCC and 17.7% in Prienai PHCC to participate in the CC screening. Only 9.6% of target population in Kaunas and 14.7% in Prienai attended. After the first invitation by letter, the participation rate in CC screening increased up to 24.6% in urban and 30.8% in rural areas (p<0.001). The lowest participation rate was in the youngest age group (25-34 years). The coverage after the reminder letter were also significantly higher in rural than in urban population, 22.2% and 16

Tyrimo tikslas. Įvertinti sisteminio asmeninio kvietimo poveikį moterų dalyvavimui gimdos kaklelio piktybinių navikų prevencijos programoje. Tyrimo metodai. Tyrimas atliktas Lietuvos mokslų universiteto ligoninės Kauno klinikų (toliau - Kauno klinikos) Šeimos medicinos klinikoje. Į tyrimą įtrauktos 3524 tikslinio amžiaus (25-60 metų moterys, per pastaruosius trejus metus nedalyvavusios programoje. Tiriamosios atsitiktinai suskirstytos į eksperimentinę (n=1591) ir kontrolinę (n=1933) grupę. Eksperimentinės grupės moterys gavo I sisteminio asmeninio kvietimo laišką paštu į namus, neatvykusios pasitikrinti - II sisteminio asmeninio kvietimo - priminimo laišką paštu į namus. Kontrolinės grupės tiriamąsias pasitikrinti kvietė jų šeimos gydytojas įprastinio apsilankymo metu, neatvykusios pasitikrinti gavo I sisteminio asmeninio kvietimo laišką paštu į namus. Rezultatai. Po pirmo asmeninio kvietimo - laiško į namus eksperimentinės grupės moterų dalyvavimas programoje padidėjo nuo 9,6 iki 24,3 proc. Kontrolinėje grupėje dalyvavimas nepasikeitė, atitinkamai - 13,4 ir 10,8 proc. Po antro sisteminio kvietimo - priminimo laiško papildomai atvyko pasitikrinti dar 19,2 proc. moterų. Iš viso, taikant sisteminį kvietimo metodą, pasitikrino 34,6 proc. eksperimentinės grupės moterų. Išvados. Siunčiant sistemino asmeninio kvietimo laiškus paštu į namus, reikšmingai didėja moterų dalyvavimas programoje, tačiau jis išlieka nepakankamas, todėl būtina ieškoti papildomų priemonių.

Introduction. Incidence and mortality from cervical cancer in Lithuania is one of the highest among the European Union member states. A well-organised cervical cancer (CC) screening at the population level can reduce the incidence of CC by 80 %. In 2004, Lithuania started a Nationwide Cervical Cancer Screening Programme; however, screening is more opportunistic than population-wide and its coverage is still insufficient. Aim. The aim of the study is to assess the efficacy of systematic invitation system for the uptake of CC screening in the urban (Kaunas) and rural (Prienai) areas. Material and Methods. The study was conducted in an urban and a rural primary healthcare centres (PHCC). Women aged 25–60 registered at the PHCC and not having had Pap test over the last three years were included in the study. All women in Kaunas (n = 1591) and in Prienai (n = 1843) received a personal invitation letter to participate in the screening. In a year, the reminder letter was sent to the non-attendees (n = 848 in Kaunas and n = 1058 in Prienai). Women, who did not attend the screening after two letters, received a questionnaire aimed at identifying the barriers of non-attendance. Results. Before the study, 35.1 % of women in Kaunas PHCC and 17.7 % in Prienai PHCC were invited to participate in the CC screening by a family doctor. Only 9.6 % of the target population in Kaunas and 14.7 % in Prienai participated in the screening. The participation rate in CC screening after the first invitation by letter was 24.3 % in urban and 30.8 % in rural areas (p < 0.001). In both areas the lowest participation rate (18.9 % in urban and 23.1 % in rural areas) was in the youngest age group (25–34 years) (p < 0.05, compared with other age groups). The participation rates after the reminder letter were also significantly higher in rural than in urban population, 30.9 % and 18.8 %, respectively (p < 0.001). Both invitation letters subst[...].

Introduction. In Lithuania, incidence and mortality from cervical cancer is one of the highest among the European Union member states. Well organized cervical camcer screening at the population level can reduce the incidence of cancer by up to 85%. In 2004, Lithuania started the Nationwide Cervical Cancer Screening Program with screening interval of 3 years, targeting women aged 25-60 years. However, screening is more opportunistic than population-wide and coverage is still inadequate. The aim. The aim of the study was to assess the effect of organized cervical cancer screening on attendance of women in Kaunas. Material and methods. The study was conducted in the Department of Family Medicine at the Hospital of Lithuania University of Health Sciences Kaunas Clinics. The family doctors working in the Department were randomly allocated to the experimental or control group. [...].

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.