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Background: Even in mycophilic nations, mushroom foraging and use traditions may vary from region to region, making it part of cultural diversity and a source of traditional knowledge even in modern and changing societies. The main objective of our study was to investigate mushroom foraging and use traditions in major ethno-regions of Lithuania, to record and analyse whether and how biogeographical and ethno-cultural features influence these traditions, what is their biocultural significance, and whether they persist in the face of societal and environmental change. Methods: The study conducted a survey among 106 respondents from eleven administrative units of Lithuania, representing four ethno-regions (Žemaitija, Suvalkija, Dzūkija and Aukštaitija, the latter divided into North and East). The age of the respondents ranged from 32 to 97 years (mean 70 years, median 68 years). Each respondent was asked six questions about mushroom species and mushroom foraging. The interviews were accompanied by 50 photographs of different mushroom species. The similarity between mushroom foragers' preferences in ethno-regions and the sets of mushroom species used for food and medicine was tested using cluster analysis. Clustering was carried out using Sørensen distances and the method of cluster mean linkage method. Results: The number of mushroom species recognised per respondent was quite similar, with the lowest number of mushroom species recognised in Žemaitija and the highest in Eastern Aukštaitija. Species of no economic or other importance were not well recognised in any of the regions. The number of names applied to mushroom species varied from region to region and did not coincide with the popularity of mushrooms among mushroom pickers. The number of mushroom species used for food was also similar between regions, except for Dzūkija, which had the lowest number of species collected. Nine mushroom species were identified by respondents as medicinal mushrooms, the most popular being Amanita muscaria and Inonotus obliquus. When analysing the similarity of mushroom species collected for food and medicine, it was found that ethno-regions clustered into three distinct groups. Two groups depended on the prevailing forest types, while Žemaitija formed a separate cluster defined only by local traditions. Conclusions: The work represents the largest study of ethnomycological tradition in Lithuania, covering major ethno-regions. We have found that ethnomycological knowledge and tradition are not influenced by any long-term historical events, ethnicity or religion, but rather by the prevailing forest types and regional ethno-culture. Knowledge of edible mushrooms is considered to be inherited from the older generation and is conservative regarding the changes in the set of species consumed and mushroom-related gastronomy. This is also reflected in the safety of mushroom consumption, as mushroom poisoning was very rare among the respondents. Economically insignificant mushrooms are not distinguished and overlooked by traditional mushroom pickers who are not a good source of information on rare or otherwise noteworthy species. However, from a biocultural point of view, mushrooms and mushroom-related traditions remain important for linguistic diversity, traditional knowledge systems and their transmission. [ABSTRACT FROM AUTHOR]

Background: Promotion of health literacy is an important goal in the context of promoting whole school health. Physical education teachers are of particular importance in achieving this goal. However, very limited empirical studies have addressed the health literacy of physical education teachers. This research aimed to test the structural validity and reliability of the HLS19-Q12, to measure health literacy among physical education teachers, and to evaluate associations of health literacy with health- and lifestyle-related indicators. Methods: We conducted a cross-sectional study of Lithuanian physical education teachers. The participants completed a self-administered online survey that collected information on socio-demographics and health literacy (HLS19-Q12 for general health literacy and the optional package HLS19-DIGI to measure digital health literacy) as well as health behavior. Results: A total of 332 participants completed the survey. The HLS19-Q12 demonstrated acceptable internal consistency (Cronbach's α of 0.73 and McDonald's ω of 0.75) and satisfactory structural validity (CFI = 0.924, TLI = 0.917, RMSEA = 0.081). Participants had an average score of 85.09 (SD = 17.23) when using the HLS19-Q12, with 19.3% and 48.8% displaying excellent and sufficient levels of health literacy, respectively. Regression analyses revealed that a higher level of health literacy was significantly associated with better health evaluation (β = 0.15, p < 0.01), but no significant association was found with other health behavior and lifestyle indicators. Conclusions: Overall, the results suggest that teachers' general health literacy is relatively high. Our findings highlight the importance of conducting more in-depth studies to pursue the understanding of the whole school teachers' health literacy. [ABSTRACT FROM AUTHOR]

Simple Summary: The quality of life of patients with facial basal cell carcinoma significantly improves after surgery. Nevertheless, it remains inferior to those without the disease. Facial scarring has been identified as a contributing factor to adverse psychosocial changes. In this study, we explore the aesthetic assessment of facial scars within this specific patient group, aiming to uncover potential correlations between the severity of scars and the quality of life. This study comprises two phases as follows: scale validation and pilot with a sample size of 100 patients. The Lithuanian version of the POSAS 2.0 was established after a thorough psychometric evaluation, surpassing acceptable validity thresholds. The pilot phase findings show a notable improvement in scars during the later stages of postoperative recovery, with the initial identification of specific groups that perceive their scars more negatively. Given the observed correlations between the scar assessment and the quality of life, this study highlights the crucial role of addressing the aesthetic satisfaction of patients with surgically treated basal cell carcinoma. Facial basal cell carcinoma (BCC) surgery enhances the quality of life (QoL) but leaves patients with inferior QoL, presumably caused by scarring, emphasizing the need to understand post-surgery aesthetic satisfaction. This study aimed to validate the Lithuanian version of the Patient and Observer Scar Assessment Scale (POSAS) 2.0 and utilise it to identify scar evaluation differences and correlations among POSAS scores and specific aesthetic facial regions, age, gender, surgery types, and short- and long-term QoL. Employing a prospective longitudinal design, 100 patients with facial scars after surgical BCC removal were enrolled. The validation phase confirmed the translated POSAS 2.0 psychometric properties, while the pilot phase used statistical analyses to compare scores among demographic and clinical groups and evaluate correlations between scar assessment and QoL. The findings indicate that the translated Lithuanian version of POSAS 2.0 exhibits good psychometric properties, revealing insights into aesthetic satisfaction with post-surgical facial scars and their impact on QoL. The Lithuanian version of the POSAS 2.0 was established as a valid instrument for measuring post-surgical linear scars. QoL with scar assessment statistically significantly correlates, 6 months after surgery, with worse scores, particularly notable among women, younger patients, and those with tumours in the cheek region. [ABSTRACT FROM AUTHOR]

Background: Studies in recent years have shown a significant increase in problematic internet use. Prolonged internet usage negatively impacts various aspects of adolescents' lifestyles. Methods: The survey was conducted in three Lithuanian cities—Vilnius, Klaipėda, and Molėtai—between October and December of 2023. The survey involved students between the ages of 12 and 16. The participants completed a questionnaire that included questions about wellness and happiness, the Internet Addiction Test (IAT), and the Strengths and Difficulties Questionnaire (SDQ). Our study aimed to investigate problematic internet use among Lithuanian adolescents and its relationships with wellness, happiness, and mental health. Results: This study included 1412 adolescents, with a mean age of 14.41 ± 1.20, with the sample composed of 52.3% boys. Boys indicated that they felt healthier and happier than girls (69.4% vs. 47.4%; 51.4% vs. 29.6%), p < 0.001. A total of 20.8% of students had IAT scores that reflect a normal level of internet usage. For IAT, the average score of girls was statistically significantly higher than that of boys (41.87 ± 12.24 vs. 39.96 ± 12.37), p < 0.001. The IAT score was higher in the group of students who felt less happy and healthy, had more frequent headaches or abdominal pain, and had problems with sleep, p < 0.001. A statistically significant, positive weak correlation was found between students' IAT scores and SDQ internalizing and SDQ externalizing scores (r = 0.366; r = 0.385, p < 0.001). Conclusions: Prolonged internet use is arising as a serious problem among adolescents. Negative feelings, unhappiness, and poor emotion regulation have an association with internet addiction. Also, the female gender may be more associated with possible internet addiction. The results of this study can serve as initial steps toward developing preventive interventions. [ABSTRACT FROM AUTHOR]

Children from vulnerable backgrounds often have insecure attachment or disorganized attachment, which are related to psychological troubles, and such children need interventions to help them heal. The attachment system reorganizes in middle childhood, and other important adults play a considerable role in children's lives. Thus, it is essential to weigh the impact of psychosocial interventions, while the main focus of the intervention is the staff member's direct work with the child through a trusting relationship. The primary purpose of this study is to investigate whether children's attachment security and mental health outcomes change after participating in a trauma-informed, attachment-based, Trust-Based Relational Intervention (TBRI) provided in a daycare center. It was a case-series study involving twelve children aged 8–11 years. The child attachment interview (CAI), CBCL/6-18, TRF/6-18, and clinical interviews for parents and children were used, measuring the change between the TBRI implementation in the daycare center and after one year. For ten participants, we noticed an improvement in mental health; for seven participants, security scales improved; for two participants, their disorganized attachment changed into insecure–dismissing. We have preliminary evidence that vulnerable children may benefit in terms of attachment security and mental health from the trusting relationship that staff build using the TBRI. [ABSTRACT FROM AUTHOR]

Background: Children being left behind (LBC) in their home countries due to parental emigration is a global issue. Research shows that parents' emigration negatively affects children's mental health and well-being. Despite a high number of LBC, there is a dearth of data from Eastern European countries. The present study aims to collect and analyse self-reported data on LBC emotional and behavioural problems and compare children's reports with those of parents/caregivers. Methods: A cross-sectional study was conducted in 24 Lithuanian schools, involving parents/caregivers and their children aged 12 to 17. We employed self-reported measures, including the Achenbach System of Empirically Based Assessment (ASEBA) tools – Child Behaviour Checklist (CBCL 6/18) and Youth Self Report (YSR 11/18), to evaluate the emotional and behavioural problems of the children. These instruments had been translated, standardised, and validated for the Lithuanian population. Data collection took place between January 2022 and April 2023. In addition to descriptive analysis, multivariate regression was used to adjust for various sociodemographic factors. Results: A total of 760 parents/caregivers and 728 of their children participated in the study. LBC exhibited higher total problem scores (57.7; 95% CI 52.0-63.4) compared to non-LBC (47.1; 95% CI 44.7-49.4). These differences were consistent across all YSR 11/18 problem scales. However, no significant differences were observed in CBCL 6/18 scores. Furthermore, LBC self-reported a higher total problem score (57.7; 95% CI 52.0-63.4) compared to their parents/caregivers (24.9; 95% CI 18.9-30.9), and this pattern persisted across all scales. Being female, having school-related problems and having LBC status were associated with higher YSR 11/18 scores in the multivariable regression, while female gender, living in rural areas, school-related problems, and having hobbies were associated with higher CBCL 6/18 scores. Conclusion: This study highlights that LBC report more emotional and behavioural challenges than their non-LBC peers, while parent/caregiver assessments show lower problem scores for LBC. Gender, living environment, school-related issues, and engagement in hobbies have influenced these outcomes. These findings underscore the multifaceted nature of the experiences of LBC and the importance of considering various contextual factors in understanding and addressing their emotional and behavioural well-being. [ABSTRACT FROM AUTHOR]

The Wound‐QoL assesses the impact of chronic wounds on patients' health‐related quality of life (HRQoL). A 17‐item and a shortened 14‐item version are available. The Wound‐QoL‐17 has been validated for multiple languages. For the Wound‐QoL‐14, psychometric properties beyond internal consistency were lacking. We aimed to validate both Wound‐QoL versions for international samples representing a broad range of European countries, including countries for which validation data had yet been pending. Patients with chronic wounds of any aetiology or location were recruited in Austria, Lithuania, the Netherlands, Poland, Slovakia, Spain, Switzerland and Ukraine. Psychometric properties were determined for both Wound‐QoL versions for the overall sample and, if feasible, country‐wise. We included 305 patients (age 68.5 years; 52.8% males). Internal consistency was high in both Wound‐QoL‐17 (Cronbach's α: 0.820–0.933) and Wound‐QoL‐14 (0.779–0.925). Test–retest reliability was moderate to good (intraclass correlation coefficient: 0.618–0.808). For Wound‐QoL‐17 and Wound‐QoL‐14, convergent validity analyses showed highest correlations with global HRQoL rating (r = 0.765; r = 0.751) and DLQI total score (r = 0.684; r = 0.681). Regarding clinical data, correlations were largest with odour (r = −0.371; r = −0.388) and wound size (r = 0.381; r = 0.383). Country‐wise results were similar. Both Wound‐QoL versions are valid to assess HRQoL of patients with chronic wounds. Due to its psychometric properties and brevity, the Wound‐QoL‐14 might be preferrable in clinical practice where time is rare. The availability of various language versions allows for the use of this questionnaire in international studies and in clinical practice when foreign language patients are being treated. [ABSTRACT FROM AUTHOR]

Recent events in Europe, like the COVID-19 pandemic and the 2022 Russo–Ukrainian War (RUW), might have sparked anxiety among adolescents. This study aimed to compare anxiety levels in Lithuanian adolescents post-COVID-19 peak (Study 1, October 2021) and during the onset of the RUW (Study 2, April–June 2022). Data from 459 participants in Study 1 and 6637 in Study 2, aged 11–17, were collected through HBSC pilot and national surveys in Lithuania. Self-reported questionnaires assessed anxiety, social media use, stress, loneliness, self-efficacy, and peer support factors. Analysis was conducted using multivariable logistic regressions. Notably, anxiety prevalence in Lithuanian adolescents showed no significant difference between Study 1 and Study 2, stabilizing around 24%. In 2021, stress (OR = 5.89, 95% CI 3.11–11.17), problematic social media use (OR = 4.58, 95% CI 1.89–10.58), and female gender (OR = 2.87, 95% CI 1.58–5.22) significantly predicted anxiety. By 2022, stress (OR = 3.68, 95% CI 3.14–4.30), loneliness (OR = 2.85, 95% CI 2.43–3.35), and lower self-efficacy (OR = 1.40, 95% CI 1.20–1.60) emerged as important predictors. This study enhances our understanding of adolescent anxiety during crises, emphasizing the urgency of addressing multiple factors to manage and support vulnerable youth. [ABSTRACT FROM AUTHOR]

Persisting high poverty and social exclusion rates remain a key challenge of European welfare states. The socio-economic consequences following the COVID-19 crisis are challenging the protection of social citizenship and social rights of the most vulnerable. We examine the role of the European Union (EU) in supporting the most vulnerable citizens by focusing on the Fund for European Aid to the Most Deprived (FEAD). Our key question is, if and in which ways the EU strengthens social citizenship and social rights through FEAD. We base our analysis on a document analysis of the Regulation, Member States' operational programmes and results of a survey with food aid organizations in Belgium, Lithuania and Portugal. Our findings suggest that FEAD represents a contradictory case of European action in the field of social citizenship and social rights. On the one hand, FEAD is a highly targeted social policy instrument. On the other hand, food aid, as the main provided instrument, is based on charity and not on social rights. Accompanying social inclusion measures could support beneficiaries in the take-up of social rights, but these measures lack clear rules for implementation and monitoring. We conclude that FEAD seems to contribute to the institutionalization of charitable food aid within national welfare systems. [ABSTRACT FROM AUTHOR]

Introduction: The selection of an appropriate PROM is a crucial aspect in assessing outcomes. Questionnaires that have not been designed or validated for a paediatric population are routinely used. Using a questionnaire requires translation, cultural adaptation, and testing the psychometric properties of the translated questionnaire. There is no applicable questionnaire in our country for children with knee-specific conditions in sports orthopaedics. Therefore, this study aims to translate, culturally adapt, and assess the psychometric properties of the Paediatric IKDC (Pedi-IKDC) questionnaire within the Lithuanian paediatric population. Methods: The translation was conducted in accordance with international standards. Patients aged 11–17 years with various knee disorders participated in three surveys and completed the Pedi-IKDC, Lysholm, and PedsQL questionnaires. Interviews with patients following the translation process, in addition to floor and ceiling effects, were used to assess content validity. Cronbach alpha (α) statistics and the intraclass correlation coefficient (ICC) were applied to measure internal consistency and reproducibility, respectively. The standard error of measurement (SEM) and smallest detectable change (SDC) were calculated to assess reliability. Pearson correlations were calculated between Pedi-IKDC and Lysholm PedsQL scores to determine criteria validity. The effect size (ES) and standardised response mean (SRM) were calculated to assess the responsiveness to change. Results: Cronbach's alpha (α) was 0.91 for the total score, 0.75 for symptoms, and 0.92 for the sport/function component. The ICC for overall scores was 0.98, with each question ranging from 0.87 to 0.98. The SEM was 2.97, and the SDC was 8.23. Lysholm and PedsQL physical functioning domain scores had moderate correlations (0.8 > r > 0.5), and the overall PedsQL score had a weak correlation (0.5 > r > 0.2) to the Pedi-IKDC score. The floor and ceiling effects were 3.3% and 1.6%, respectively. The SRM was 1.72 and the ES was 1.98. Conclusions: The Lithuanian Pedi-IKDC version is an appropriate evaluation instrument for assessing outcomes in children with knee disorders. All of the psychometric features produced acceptable results. [ABSTRACT FROM AUTHOR]

Background: Job satisfaction is a key factor for the successful transition of newly graduated nurses (NGNs) and for retaining NGNs in their workplaces. However, there is limited evidence of the relationship between satisfaction regarding the nursing education program and NGNs' job satisfaction in the first year after graduation. Therefore, this study aims to examine the association of the nursing education related factors and NGNs' job satisfaction. Methods: A cross-sectional study design with the utilization of data collected from the same respondents one year earlier as educational factors was applied. The data were collected from NGNs (n = 557) in 10 European countries using an electronic survey between February 2019 and September 2020, and analyzed in detail for four countries (n = 417). Job satisfaction was measured with three questions: satisfaction with current job, quality of care in the workplace, and nursing profession. Nursing education related factors were satisfaction with nursing education program, level of study achievements, nursing as the 1st study choice, intention to stay in nursing, and generic nursing competence. The data were analyzed statistically using logistic regression. Results: Most of the NGNs in the 10 countries were satisfied with their current job (88.3%), the quality of care (86.4%) and nursing profession (83.8%). Finnish, German, Lithuanian and Spanish NGNs' satisfaction with the nursing education program at graduation was statistically significantly associated with their job satisfaction, i.e., satisfaction with their current job, the quality of care, and the nursing profession. Moreover, NGNs who had fairly often or very often intention to stay in nursing at graduation were more satisfied with their current job, with the quality of care, and with the nursing profession compared with NGNs who had never or fairly seldom intention to stay in nursing at graduation. Conclusions: Nursing education plays a significant role in NGNs' job satisfaction one year after graduation, indicating the importance to start career planning already during nursing education. Both nursing education providers and healthcare organizations could plan in close collaboration a transition program for NGNs to ease the transition phase and thus increase the NGNs' job satisfaction and ultimately the high-quality care of the patients. [ABSTRACT FROM AUTHOR]

Introduction: The user expectations and experiences of healthcare services are acknowledged as components of the quality of healthcare evaluations. The aim of the study is to analyse women's experiences and views on childbirth care in Lithuania. Methods: The study used the Babies Born Better (B3) online survey as the data collection instrument. The B3 is an ongoing longitudinal international project, examining the experiences of intrapartum care and developed as part of EU‐funded COST Actions (IS0907 and IS1405). Responses to open‐ended questions about (1) the best things about the care and (2) things in childbirth care worth changing are included in the current analysis. The participants are 373 women who had given birth within 5 years in Lithuania. A deductive coding framework established by the literature review was used to analyse the qualitative data. The framework involves three main categories: (1) the service, (2) the emotional experience and (3) the individually experienced care, each further divided into subcategories. Results: Reflecting the experience and views regarding the service at birthplace women wished empowerment, support for their autonomy and to be actively involved in decisions, the need for privacy, information and counselling, especially about breastfeeding. In terms of emotional experience, women highlighted the importance of comprehensibility/feeling of safety, positive manageability of various situations and possibilities for bonding with the newborn. Individually experienced care was described by feedback on specific characteristics of care providers, such as competence, personality traits, time/availability and encouragement of esteem in women in childbirth. The possibilities of homebirth were also discussed. The findings reflected salutogenic principles. Key Conclusions: The findings suggest that the Lithuanian healthcare system is in a transition from paternalistic attitude‐based practices to a shift towards patient‐oriented care. Implementation of the improvements suggested for women in childbirth care in Lithuania would require some additional services, improved emotional and intrapersonal aspects of care and a more active role for women. Patient/Public Contribution: Patients and the public contributed to this study by spreading information about surveys and research findings through their involvement in service user groups that have an interest in maternity care. Members of the patients' groups and the public were involved in the discussion of the results. [ABSTRACT FROM AUTHOR]

Background: Cultural competencies are known as a multidimensionalconstruct; however, they usually refer to an individual's sensitivity orcultural attitudes, cultural awareness, knowledge, and skills. Aim: The aim of the study was to compare the cultural competences of nurses in Poland and Lithuania based on an adaptation of the Nurse Cultural Competence Scale (NCCS). Design: The design was a comparative cross‐sectional study. Methods: A total of 383 Polish nurses and 184 Lithuanian nurses took part in the study. The questionnaires of the NCCS—Polish version (NCCS‐v.PL) and the NCCS—Lithuanian version (NCCS‐v.L) were used after linguistic adaptation and an evaluation of psychometric properties. Results: As a result of the comparative analysis, a higher general level of cultural competences (based on the NCCS) was found in the Lithuanian group M‐148.09 (SD = 22.85). The results show statistically significant differences among the respondents in the subscale of Nurse Cultural Competence Scale‐Cultural Knowledge (NCCS‐CK; p ˂ 0.001); higher competences of the nurses were found in the Group LT (M = 31.05; SD = 6.75) than in the Group PL (M = 28.82; SD = 7.82). In the group of Polish nurses (Group PL), the intensity of cultural competences was found to increase along with age (NCCS‐v.P r = 0.157, p < 0.05); this, however, was not observed in the Group LT (NCCS‐v.LT, p > 0.05). Conclusions: Both the nurses in Poland and in Lithuania are characterised by an average level of cultural competences. Diversity in the level of cultural competences was found in both groups depending on age, education and work experience. [ABSTRACT FROM AUTHOR]

Background: Worldwide statistics highlight that many adolescents suffer from various types of maltreatment, which often tend to co‐occur in the form of poly‐victimisation. The experience of maltreatment at a young age causes physical and mental health problems, and can also lead to self‐harm and suicide. The aim: To explore the possible impact of maltreatment and poly‐victimisation on adolescent self‐harm and suicide attempts. Participants and settings: In total, 1898 students (15–18 years old) from Lithuanian vocational schools completed the survey (65.5% male). Method: The impact of maltreatment and poly‐victimisation on self‐harm and suicide attempts was tested using multivariable binary logistic regressions. Results: Different maltreatment types were significantly associated to self‐harm (odds ratio from 2.47 to 3.80, p < 0.001) and suicide attempts (odds ratio from 3.15 to 7.58, p < 0.001). The odds ratios for self‐harm and suicide attempt increased as the number of different types of maltreatment experienced increased. A history of experiencing four types of poly‐victimisation increased adolescent risk for self‐harm (OR = 18.57, p < 0.001, 95% CI: 5.77–59.72) and suicide attempts (OR = 45.54, p < 0.001, 95% CI: 14.37–144.28) the most. Conclusion: Adolescents with experience of maltreatment, particularly if poly‐victimised, are at greater risk of engaging in self‐harming and suicidal behaviours. [ABSTRACT FROM AUTHOR]

Background. The problem of the ageing population has resulted in attitudes towards aging in different age groups becoming a subject of increased academic interest. Objectives. To provide comparative characteristics of the prevalence of manifestations of gerontological ageism among university students in five European countries. Material and methods. The sample consisted of university students (n = 2493) aged 18–25 from Belarus (n = 827), Russia (n = 528), Poland (n = 798), Lithuania (n = 223) and Ukraine (n = 117). The prevalence of gerontological ageism among respondents was evaluated according to the Fraboni Ageism Scale. Results. The prevalence and manifestations of gerontological ageism vary depending on the country. The maximum total indicator, displaying the highest overall level of ageism, was noted among Belarusian students, the minimum – in Lithuania (p < 0.05). The final indicators of gerontological ageism were found to be the following: the level of age discrimination and negative emotional attitude towards the elderly was increased in one fifth of the respondents in all five groups. The observation found the level of ageism averaging at 60%, evenly distributed in all groups. The predominant attitudes towards older people were found to be neutral or positive (84.6%). Conclusions. The manifestations of ageism are international in nature and can explain 20% of the total variety of answers characterising the differences in ranked attributes and degree of ageism. The total indicator showed the highest degree of gerontological ageism among students in Belarus, the lowest – among those in Lithuania, with levels of gerontological ageism among students in Russia, Poland and Ukraine distributed in between. [ABSTRACT FROM AUTHOR]

Background: Emergency medical services (EMS) are the first health care contact for the majority of stroke patients. However, there is a lack of data on the current paramedics' hospital-directed feedback and training needs across different health care settings. We aimed to evaluate paramedics' prehospital stroke care knowledge, training needs, and current status of feedback on suspected stroke patients. Methods: We surveyed paramedics from the Vilnius region from September to November 2019 and compared the answers between the city and the district agencies. The questionnaire content included questions on paramedics' demographic characteristics, prehospital stroke care self-assessment, knowledge on stroke mimics, stroke training needs, and the importance of hospital-directed feedback on suspected stroke patients. Results: A total number of 161 paramedics (or 49.4% of all paramedics from our stroke care network) were surveyed, with more district paramedics rating their prehospital stroke care knowledge as inadequate (44.8% (95% confidence interval (CI) 32.8–57.6) vs. 28.1% (95% CI 20.1–27.8), p = 0.028). In addition, more district paramedics indicated a need for additional stroke training (83.1% (95% CI 71.5–90.5) vs. 69.8% (60.0–78.1), p = 0.043). However, respondents reported being the most confident while dealing with stroke (71.3%, 95% CI 63.8–77.7) compared to other time-critical conditions (p < 0.001). Vertigo (60.8%, 95% CI 53.0–68.0), brain tumors (56.3%, 95% CI 48.5–63.8), and seizures (54.4%, 95% CI 46.7–62.0) were indicated as the most common stroke mimics. Only 6.2% (95% CI 3.4–11.1) of respondents received formal feedback on the outcome of suspected stroke patients brought to the emergency department. Conclusions: A high proportion of paramedics self-perceive having inadequate stroke knowledge and an urgent need for further stroke training. The EMS staff indicate receiving insufficient feedback on suspected stroke patients, even though its usefulness is perceived as paramount. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

Sharing mobility solutions changes people's lives in cities; however, such services are not common in remote areas, where the most widespread transport mode is a privately owned car. The main challenge is that the existing transport system fails to meet the population's daily travel needs in such regions. Sharing mobility covers environmental issues, infrastructure development, digitalisation, integration of different transport modes, and people behaviour changes. This study analyses the possibility of expanding the existing urban mobility sharing system in remote tourist areas of Lithuania; for this purpose, a small resort in the central part of Lithuania - Birštonas was selected, and a survey of residents and tourists (visitors) was conducted. Using the survey results of residents and tourists, the needs for Car Sharing (CS) and micro-mobility services are determined. The attitude of municipality, residents, tourists, service providers towards micro mobility and vehicle sharing services is determined. Based on the achieved results, further steps of service development are proposed. The article's main aim is to evaluate the views of various stakeholders on the development of micro mobility and CS systems in remote areas and propose development solutions. [ABSTRACT FROM AUTHOR]

Aim: To investigate the prevalence of burnout, depression, anxiety and stress of Lithuanian midwives. Design: A descriptive, cross‐sectional survey design. Methods: The Work Health and Emotional Wellbeing of Midwives (WHELM) survey instrument developed within the Australian maternity context was adapted and used in this research. The survey collects country‐specific demographic data and incorporates several validated measures including the Copenhagen Burnout Inventory (CBI), Depression, Anxiety and Stress Scale (DASS‐21). Results: Three hundred and thirty‐eight completed surveys were received. Results obtained using a CBI subscale showed that 84.9% experienced personal burnout, 70.1% reported work‐related burnout and 41.1% had client‐related burnout. The results indicate that the midwives reported moderate to extreme levels of depression (16.3%), anxiety (28.4%) and stress (13.9%) symptoms. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate 20 days and 3 months follow-up effectiveness of cardiac rehabilitation (CR) enhanced by resistance/balance training and telephone-support program compared to usual CR care in improving quality of life, clinical course and physical activity behavior. Design: Single-centre randomized controlled trial. Setting: Inpatient CR clinic Subjects: 116 (76.1 ± 6.7 years, 50% male) patients 14.5 ± 5.9 days after valve surgery/intervention were randomized to intervention group (IG, n = 60) or control group (CG, n = 56). Intervention: Additional resistance/balance training (3 days/week) during phase-II CR and telephone-support program during 3-month follow-up. CG patients were provided with usual CR care. Main measures: Short Form 36 Health Survey scales, European Quality of Life 5 Dimensions 3 Level Version QoL index, visual analog scale, clinical course, and physical activity behavior assessed with standardized questionnaires. Results: IG reported statistically significant higher mental component score (48.5 ± 6.91 vs. 40.3 ± 11.21 at the baseline, 50.8 ± 9.76 vs. 42.6 ± 9.82 after 20 days, 49.4 ± 8.45 vs. 40.5 ± 8.9 after 12 weeks follow up), general health (48.6 ± 3.17 vs. 45.0 ± 2.95 at the baseline, 53.6 ± 3.02 vs. 43.8 ± 2.55 after 20 days, 53.2 ± 3.11 vs. 44.2 ± 3.07 after 12 weeks) and role limitations due to emotional problems (48.5 ± 15.2 vs. 27.7 ± 11.5 at the baseline, 72.7 ± 12.6 vs. 30.5 ± 11.2 after 20 days, 66.6 ± 14.2 vs. 36.1 ± 11.2 after 12 weeks) in all three assessments (p < 0.05). CG patients had more documented hospital admissions (4 (8%) vs 10 (25%), p = 0.027), atrial fibrillation paroxysms (3 (6.0%) vs. 10 (35.0%), p = 0.011) and blood pressure swings (13 (26%) vs. 20 (50%), p = 0.019). IG patients chose more different physical activities (1.7 ± 0.7 vs. 1.25 ± 0.63, p = 0.002), spent more time being physical active every day (195.6 ± 78.6 vs. 157.29 ± 78.8, p = 0.002) Conclusions: The addition of resistance/balance exercises and telephone-support program 12 weeks after to the CR could linked to higher physical activity levels and fewer clinical complications but did not lead to a significant improvement in quality of life. [ABSTRACT FROM AUTHOR]

Background Patients with pre-existing conditions and poor health status are vulnerable for adverse health sequalae during the COVID-19 pandemic. We investigated the association of pre-existing medical conditions and self-perceived health status with the risk of mental health complications during the COVID-19 pandemic. Methods In October—December, 2020, 1036 respondents completed online survey that included assessment of pre-existing conditions, self-perceived health status, depressive (Patient Health Questionnaire-8 score ≥ 10), anxiety (Generalized Anxiety Disorders-7 score ≥ 10) and post-traumatic stress (Impact of Events Scale Revised) symptoms, alcohol use (AUDIT), and COVID-19 fear (COVID-19 Fears Questionnaires for Chronic Medical Conditions). Results Study participants were predominantly women (83%), younger than 61 years of age (94%). Thirty-six percent of respondents had a pre-existing condition and 5% considered their health status as bad or very bad. Pre-existing conditions and poor perceived health status were associated with increased risk for moderate to severe depressive and anxiety symptoms, fear of COVID-19 and post-traumatic stress symptoms, independently from respondents' age, gender, living area, smoking status, exercise, alcohol consumption and diet. Conclusions Pre-existing medical conditions and poor perceived health status are associated with increased risk of poor mental health status during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the change in posttraumatic growth (PTG) of women survivors of intimate partner violence (IPV) in Lithuania, in relation to the centrality of traumatic experience, identity exploration, and time after exposure to violence. The longitudinal study sample consisted of 217 women who experienced IPV, recruited from women shelters, social support centers, and through counseling psychologists. In this sample the assessment instruments were administered three times during an 18-month period (at 6-month intervals). The results of the study revealed that PTG significantly increased over time for the women who experienced IPV more recently. Those women who experienced IPV more anciently reported higher PTG levels at the beginning of the study, but significant changes in PTG did not emerge. In addition, higher levels of PTG at the beginning of the study were positively associated with event centrality and identity exploration, meaning that those women who perceived their IPV experience as central to their identity and who explored possible identity choices were more likely to have higher levels of PTG at the beginning of the study. However, neither the centrality of the event nor the identity exploration was important for the change in PTG over the study period. Findings of this study highlighted the importance of the first 2-year period after the violence when the potential for PTG and its increase occurs. Limitations of the study and implications for future research are discussed. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to examine the association between the characteristics of a nursing student's final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries. Design: A longitudinal design with two data collections points (pre‐ and post‐graduate). Methods: The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence. Results: Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found. Conclusion: Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession. Impact: This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses. [ABSTRACT FROM AUTHOR]

Recently, discussion of the potential of health literacy (HL) for health promotion has increased; however, clear evidence illuminating the relationship between adolescents' HL and their physical activity (PA) remains scarce. This study aimed to assess the association between adolescents' HL and leisure time PA. A representative cross‐sectional study was conducted with 2,369 Lithuanian adolescents aged 13–16 years. A self‐reported questionnaire gathered information regarding HL, leisure time PA, and other confounders (gender, age, family affluence and parents' exercise). Descriptive statistics and the probabilities of being physically active were estimated using logistic regression. The results revealed that almost 60% of the participants were not sufficiently physically active. Having moderate or high levels of HL was positively associated with leisure time PA. Additionally, being male, belonging to a more affluent family, and having a father who exercise were significant predictors of adolescents' leisure time PA. This study revealed that moderate and high HL positively related to leisure time PA among Lithuanian adolescents. The study results highlighted the importance of encouraging schoolchildren's PA and including HL promotion in a school curriculum. [ABSTRACT FROM AUTHOR]