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Experts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth.

Abstract Background There are number of studies showing that general practice is one of the most stressful workplace among health care workers. Since Baltic States regained independence in 1990, the reform of the health care system took place in which new role and more responsibilities were allocated to general practitioners' in Lithuania. This study aimed to explore the psychosocial stress level among Lithuanian general practitioner's and examine the relationship between psychosocial stress and work characteristics. Methods The cross-sectional study of 300 Lithuanian General practitioners. Psychosocial stress was investigated with a questionnaire based on the Reeder scale. Job demands were investigated with the R. Karasek scale. The analysis included descriptive statistics; interrelationship analysis between characteristics and multivariate logistic regression to estimate odds ratios for each of the independent variables in the model. Results Response rate 66% (N = 197). Our study highlighted highest prevalence of psychosocial stress among widowed, single and female general practitioners. Lowest prevalence of psychosocial stress was among males and older age general practitioners. Psychosocial stress occurs when job demands are high and job decision latitude is low (χ2 = 18,9; p < 0,01). The multivariate analysis shows that high job demands (OR 4,128; CI 2,102–8,104; p < 0,001), patient load more than 18 patients per day (OR 5,863; CI 1,549–22,188; p < 0,01) and young age of GP's (OR 6,874; CI 1,292–36,582; p < 0,05) can be assigned as significant predictors for psychosocial stress. Conclusion One half of respondents suffering from work related psychosocial stress. High psychological workload demands combined with low decision latitude has the greatest impact to stress caseness among GP's. High job demands, high patient load and young age of GP's can be assigned as significant predictors of psychosocial stress among GP's.

Abstract Background It 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. Methods Cross-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. Results Response 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 GP's 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. Conclusions Lithuanian GP's have high patient load and are at risk of stress, they have high job demands and low decision latitude. Older GP's perceive less strain, lower job demands and higher decision latitude in case of low patient load. Young GP's decision latitude has week association to patient load. Regarding to the changes in patient load younger GP's perceive it more sensitively as changes in job demands.

A capacitive micromachined ultrasound transducer (CMUT) was engineered and functionalized with zeolitic imidazolate framework-8 (ZIF-8) dispersed in a photoresist AZ1512HS (AZ) matrix to function as a gravimetric gas sensor. The sensor response was recorded in the presence of nitrogen, argon, carbon dioxide, and methane gases as well as water, acetylene, a propane/butane mixture, n-hexane, gasoline, and diesel vapors. The photoresist matrix alone was found to have a negligible response to all the gases and vapors, except for water vapor. No visible difference in sensor response was detected when switching from nitrogen to methane gas. However, a strong shift in the sensor resonance frequency was observed when exposed to higher hydrocarbons, ranging from 1 kHz for acetylene to 7.5 kHz for gasoline. Even longer-chain hydrocarbons, specifically kerosene and more so diesel, had a significantly reduced sensor frequency shift compared with gasoline. Sensors functionalized with a thin film of AZ+ZIF-8 demonstrated higher sensitivity in their response to a hydrocarbon molecular mass than without functionalization.

The effect of microchannel height on acoustic streaming velocity and capacitive micromachined ultrasound transducer (CMUT) cell damping was investigated. Microchannels with heights ranging from 0.15 to 1.75 mm were used in experiments, and computational microchannel models with heights varying from 10 to 1800 micrometers were simulated. Both simulated and measured data show local minima and maxima of acoustic streaming efficiency associated with the wavelength of the `bulk acoustic wave excited at 5 MHz frequency. Local minima occur at microchannel heights that are multiples of half the wavelength (150 μm), which are caused by destructive interference between excited and reflected acoustic waves. Therefore, microchannel heights that are not multiples of 150 μm are more favorable for higher acoustic streaming effectiveness since destructive interference decreases the acoustic streaming effectiveness by more than 4 times. On average, the experimental data show slightly higher velocities for smaller microchannels than the simulated data, but the overall observation of higher streaming velocities in larger microchannels is not altered. In additional simulation, at small microchannel heights (10-350 μm), local minima at microchannel heights that are multiples of 150 μm were observed, indicating the interference between excited and reflected waves and causing acoustic damping of comparatively compliant CMUT membranes. Increasing the microchannel height to over 100 μm tends to eliminate the acoustic damping effect as the local minima of the CMUT membrane swing amplitude approach the maximum value of 42 nm, which is the calculated amplitude of the freely swinging membrane under the described conditions. At optimum conditions, an acoustic streaming velocity of over 2 mm/s in a 1.8 mm-high microchannel was achieved.

The trade-off between the functionalization shift of the informative parameters and sensitivity of capacitive micromachined ultrasound transducers (CMUT)-based CO 2 sensors is addressed, and the CMUT surface modification process by thin inkjet-printed polyethyleneimine (PEI) films is optimized. It was shown that by the proper preparation of the active CMUT surface and properly diluted PEI solution, it is possible to minimize the functionalization shift of the resonance frequency and the quality of the resonance and preserve the sensitivity potential. So, after optimization, we demonstrated 23.2 kHz frequency shift readings of the sensor with 16 MHz nominal frequency while in the gas chamber and switching between pure N 2 and CO 2 . After testing the sensors with different PEI film thickness, it was confirmed that a 200 nm average thickness of a PEI film is an optimum, because this is the practical limit of CO 2 absorption depth at given conditions. Additionally, we note that modification of the hydrophilic/hydrophobic properties of the CMUT surface allows changing the nanoscale surface roughness of the printed PEI film and controlling the area resolution of the inkjet functionalization by reducing the diameter of a single dot down to 150 μm by a commercially available printer cartridge.

This review paper discusses the advances of the gravimetric detection devices based on capacitive micromachined ultrasound transducers structure. Principles of gravimetric operation and device modeling are reviewed through the presentation of an analytical, one-dimensional model and finite element modeling. Additionally, the most common fabrication techniques, including sacrificial release and wafer bonding, are discussed for advantages for gravimetric sensing. As functional materials are the most important part of the selective gravimetric sensing, the review of different functional material properties and coating and application methods is necessary. Particularly, absorption and desorption mechanisms of functional materials, like methylated polyethyleneimine, with examples of applications for gas sensing and using immune complexes for specific biomolecules detection are reviewed.

Competing Interests: The editors declare no conflicts of interest.

A gravimetric gas detection device based on surface functionalized Capacitive Micromachined Ultrasound Transducers (CMUTs) was designed, fabricated and tested for detection of carbon dioxide (CO 2 ) and sulfur dioxide (SO 2 ) mixtures in nitrogen. The created measurement setup of continuous data collection, integrated with an in-situ Fourier Transform Infrared (FT-IR) spectroscopy, allows for better understanding of the mechanisms and molecular interactions with the sensing layer (methylated poly(ethylene)imine) and its need of surface functionalization for multiple gas detection. During experimentation with CO 2 gases, weak molecular interactions were observed in spectroscopy data. Linear sensor response to frequency shift was observed with CO 2 concentrations ranging from 0.16 vol % to 1 vol %. Moreover, the Raman and FT-IR spectroscopy data showed much stronger SO 2 and the polymer interactions, molecules were bound by stronger forces and irreversibly changed the polymer film properties. However, the sensor change in resonance frequency in the tested region of 1 vol % to 5 vol % SO 2 showed a linear response. This effect changed not only the device resonance frequency but also affected the magnitude of electroacoustic impedance which was used for differentiating the gas mixture of CO 2 , SO 2 , in dry N 2 .

Background: Mortality rates for acute coronary syndrome (ACS) patients are still very high all over the world. Our study aimed to investigate the impact of ACS treatment on cardiovascular (CV) mortality eight years following ACS., Methods: A retrospective cohort study with a total of 613 patients was used. The data was collected from databases and medical records. An evidence-based treatment (EBT) algorithm was used based on the ESC guidelines. Logistic regression analysis and standardized odds ratios with 95% confidence interval (CI) were used for the risk assessment, with a p level<0.05 considered as significant., Results: The median follow-up time in this study was 7.6 years. During follow-up 48.9% of the patients (n=300) died from CV and 207 (69%) for a relevant reason. For monotherapy ACE inhibitors and β-blockers, and for fixed dose combined drugs ACE inhibitors and diuretics, were most frequently used. EBT was provided to 37.8% of patients. The EBT use (HR 0.541, CI 0.394-0.742, p<0.001) during follow-up period was important for reducing CV mortality in ACS patients., Conclusions: The combined use of EBT significantly improved outcomes. The recurrent myocardial infarction and percutaneous coronary intervention patients were more frequent in EBT and it was beneficial for reducing CV mortality.

Background: It is licely that illness perceptions can explain variations in quality of life of patients with prostate cancer across different treatment methods and stages. Therefore, the aim of this study was to determine if illness perception can explain variations in quality of life of patients with prostate cancer., Material and Methods: The cross-sectional national-level study was carried out. Quality of life was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Visual Analogue Scale. Illness perceptions were measured by the revised Illness Perception Questionnaire., Results: The response rate was 77.1% (N=501). The variation in global quality of life was explained (32.0%) by levels of emotional representation (β=-0.126; P=0.023) and consequences (β=-0.209; P<0.01); physical functioning (27.0%), by consequences (β=-0.203; P<0.01) and chemotherapy (β=-2.911; P=0.007); role functioning (37.0%), by emotional representations (β=-0.198; P<0.01), timeline cyclical (β=-0.209; P=0.014), and stage of the disease (β=-0.779; P=0.007); emotional functioning (43.0%), by emotional representations (β=-0.361; P<0.01) and education level (β=-0.566; P=0.025); cognitive functioning (34.0%), by educational level (β=0.714; P=0.005), emotional representations (β=-0.118; P=0.019), illness coherence (β=-0.167; P=0.030), consequences (β=-0.187; P=0.001), and hormonal therapy (β=-0.778; P=0.049); and social functioning (39.0%), by consequences (β=-0.320; P<0.01) and combined treatment (β=-1.492; P=0.016)., Conclusions: Illness perceptions may be important while investigating quality of life in patients with prostate cancer. It may underlie quality-of-life differences in this group of patients and could inform decision makers about the importance of the provision of psychosocial services to patients with prostate cancer.

Introduction: Chronic heart failure in Baltic Sea Region is responsible for more hospitalisations than all forms of cancer combined and is one of the leading causes of hospitalisations in elderly patients. Frequent hospitalisations, along with other direct and indirect costs, place financial burden on healthcare systems. We aim to test the hypothesis that telemedicine and distance learning applications is superior to the current standard of home care., Methods and Analysis: Prospective parallel group non-randomised open label study in patients with New York Heart Association (NYHA) II-III chronic heart failure will be carried out in six Baltic Sea Region countries. The study is organised into two 6-month follow-up periods. The first 6-month period is based on active implementation of tele-education and/or telemedicine for patients in two groups (active run period) and one standard care group (passive run period). The second 6-month period of observation will be based on standard care model (passive run period) to all three groups. Our proposed practice change is based on translational research with empirically supported interventions brought to practice and aims to find the home care model that is most effective to patient needs., Ethics and Dissemination: This study has been approved by National Bioethics Committee (2011-03-07; Registration No: BE-2-11)., Trial Registration: This study has been registered in Australian New Zealand Clinical Trials Registry (ANZCTR) with registration number ACTRN12611000834954.

Unlabelled: The aim of the study was to evaluate the factors associated with the prevalence and severity of dental caries as well oral hygiene habits among 4- to 6-year-old children in Kaunas (Lithuania) in 2000 and 2010., Material and Methods: A repeated cross-sectional study was carried out to reveal the changes in dental caries prevalence in 2000 and 2010. The study population comprised 4- to 6-year-old children living in Kaunas city and attending kindergartens. The study consisted of two parts: questionnaires on oral health behavior and clinical examination of children's teeth by the World Health Organization methodology., Results: A total of 941 4-6-year-old children were examined in 2000 and 2010. The prevalence of dental caries increased from 85.4% in 2000 to 88.4% in 2010; however, the difference was not significant (P=0.28). A significant increase in the dmf-t index, describing the severity of dental caries, was observed (from 7.42 in 2000 to 12.03 in 2010, P<0.001). The percentage of 4- to 5-year-old girls and 5-year-old boys brushing their teeth regularly decreased in 2010. During the period of the study, a significant change in the accumulation of plaque on children's tooth surfaces was documented (P=0.001)., Conclusions: Comparing 2000 and 2010, no significant difference in the prevalence of dental caries among 4- to 6-year-old children in Kaunas was observed; however, the severity of dental caries differed significantly. A significant decrease in regular toothbrushing skills was documented for 4- and 5-year-old girls and 5-year-old boys. The Silness-Loe oral hygiene index was assessed as satisfactory.

OBJECTIVE. The assessment of breast cancer survival rates and comparison with those of other countries may help to deepen knowledge among decision makers in the health care system and to improve the inequalities in accessibility to early detection and effective treatment. The aim of this study was to evaluate breast cancer survival rates in Kaunas region, Lithuania, and to compare them with those in the selected European countries. MATERIAL AND METHODS. A retrospective study was carried out using medical records and data gathered from the Lithuanian Cancer Registry. A group of 240 patients with primary breast cancer diagnosed in 2008 in Kaunas region was analyzed. All causes of death were included in the analysis. The closing date of follow-up was September 30, 2010. Survival was determined using the life-table method and the Kaplan-Meier method. Cox proportional hazard models were used to estimate the effects of prognostic risk factors on survival. RESULTS. The median age of the patients was 63 years (range, 28-95). The 1-year and 2-year cumulative survival for breast cancer patients in Kaunas region, Lithuania, was 94.2% and 90.1%, respectively. As expected, the survival of patients with diagnosed advanced disease (stage III and IV) was significantly worse than that of patients with stage I (P<0.001) and II (P=0.003) disease. The screening group (aged 50-69 years) showed better survival in comparison with the group older than 69 years. Age, T4 tumor, and distant metastasis were the prognostic factors significantly associated with an increased relative mortality risk of breast cancer. CONCLUSIONS. Compared to the European survival rates, the 1-year and 2-year survival of patients with breast cancer in Lithuania was found to be similar to most European countries.

Background: Chronic hepatitis B infection is an important health care problem worldwide. According to the World Health Organization, 10% to 15% of population is infected with hepatitis B virus. Nearly 100 new cases of acute hepatitis B are annually registered in Lithuania, but official statistics covers only 8-25% of all disease incidence. The aim of this study was to evaluate the cost-effectiveness of the treatment of chronic hepatitis B with peginterferon alfa-2a and compare it to treatment with interferon alfa and lamivudine in Lithuania., Material and Methods: A Markov model was used to evaluate long-term cost-effectiveness of the treatment with peginterferon alfa-2a and to compare it with treatment with interferon alfa and lamivudine. Peginterferon alfa-2a was administered by subcutaneous injections at a dosage of 180 μg every week for 48 weeks; interferon alfa, 6 million IU three times a week for 24 weeks; and lamivudine, 100 mg per day from 48 weeks to 5 years for HBeAg-positive chronic hepatitis B and 100 mg per day up to 5 years in HBeAg-negative chronic hepatitis B., Results: Treatment with peginterferon alfa-2a gained 1.179 life years as compared to 0.658 life years gained with treatment with interferon alfa; incremental costs per incremental life-year gained (LYG) were 51,256.92 Lt (14,845.03 €). Treatment with peginterferon alfa-2a gained 0.545 quality-adjusted life-years (QALYs) with incremental costs per incremental QALY of 48,980.08 Lt (14,185.61 €). Treatment with peginterferon alfa-2a had twice higher cost-effectiveness than treatment with interferon alfa: 50,4167.00 Lt (146,016.85 €) vs. 954,020.08 Lt (276,303.31 €), respectively. Costs for a complete response were also twice lower. Treatment with peginterferon alfa-2a gained 0.757 incremental LYG more compared to lamivudine (48-week course). Comparing incremental cost-effectiveness using peginterferon alfa-2a for treatment, incremental costs per incremental LYG were 41,993.67 Lt (12,162.21 €); additionally there was a gain of 0.792 incremental QALYs, while incremental costs for incremental QALY were 40,096.19 Lt (11,612.66 €). Complete response costs were 83,515.98 Lt (24,187.89 €) less compared to lamivudine (48-week course)., Conclusions: Treatment of chronic hepatitis B prolongs patients' overall survival and quality-adjusted life. Peginterferon alfa-2a was the most effective drug registered in Lithuania for CHB treatment.

Background: Economic evaluations in health care involve the identification, measurement, valuation, and then comparison of the costs (inputs) and outcomes of treatments or preventive activities. The aim was to analyze the cost-utility of six-month methadone maintenance treatment program in a Lithuanian primary health care setting., Methods: A prospective study design was used. All the information was obtained through the validated questionnaires at the baseline and 3- and 6-month follow-ups. WHOQOL-BREF was used to assess the quality of life; the costs were assessed using the DATCAP methodology from the perspective of a patient and outpatient clinic during follow-up period., Results: A total of 102 opioid-dependent patients were recruited in the study; 512 follow-up patient-months were obtained. The methadone maintenance treatment has significantly improved physical, psychological, and environmental components of quality of life during follow-up. Total program costs were 61 288.87 EUR. Cost paid by a patient comprised about 31% of total program costs. Cost per quality-adjusted life-month (QALM) for physical domain was 2227.55 EUR; for psychological domain, 1879.50 EUR; for social domain, 5467.64 EUR; and for environmental domain, 4626.47 EUR. Costs per QALM and quality-adjusted life-year (QALY) for total quality of life in the maintenance program were 2864.00 EUR and 34 368.00 EUR, respectively., Conclusions: Our results showed that 6-month methadone maintenance program was effective in the terms of quality-of-life improvement. Methadone maintenance treatment program was less effective in terms of cost per QALY.

Background: For many years, poor oral hygiene and frequent consumption of sugars is known as key behavioral risk factors for oral diseases, such as dental caries and periodontal disease. Parental attitudes toward children's oral health could be associated with their own oral health skills. We aimed to analyze associations between parental skills and attitudes toward caries development and possibilities to control positive oral health behavior in their children., Material and Methods: A cross-sectional study involved 550 parents of 3- to 4-year-old children. A 40-item questionnaire was developed from the Theory of Planned Behavior, Health Belief Model and the Health Locus of Control model, and parental attitudes toward dental caries in their children were analyzed., Results: A total of 397 filled-in questionnaires were collected; the response rate was 72%. Parents with good own oral hygiene skills significantly more often understood the importance of brushing their children's teeth (chi(2)=29.8; df=1; P<0.001). Study results highlighted also significant differences in importance to prevent tooth decay (chi(2)=3.1; df=1; P=0.051), importance to control sugar snacking (chi(2)=10.6; df=1; P=0.001), and parental perceived seriousness of tooth decay in children (chi(2)=9.2; df=1; P=0.002) comparing parents with poor and good oral hygiene skills. Differences in parental efficacy to control proper toothbrushing and parental efficacy to control sugar snacking in children were not significant comparing both groups., Conclusions: More than half (61%) of the parents have reported appropriate own oral hygiene skills. Parental attitudes toward children's oral health were significantly associated with their own oral health behavior and understanding the importance of development of oral hygiene skills in their children.

Ischemic heart disease in European countries over decades causes up to 55% of all cases of sudden death and also has a high rate of mortality, morbidity, and hospital admission. Patients with such chronic diseases also require intensive home care facilities from community nurses. The aim was to establish international multilingual platform for transtelephonic ECG system as an alternative solution for home care and assess its performance. METHODS. During this pilot study, the international toll-free line between Lithuania and Germany was established, and practical applicability of the tele-ECG device was tested. Transtelephonic ECG system was implemented between Telemedicine Center in Bad Segeberg (Bad Segeberg Clinic, Germany), the Call Center in Kaunas at the Hospital of Kaunas University of Medicine, and a patient residence. RESULTS. Over a 6-month follow-up period, 34 patients were recruited. Following the ECG transmission, 86 teleconsultations were done. During the study, a total of 329 ECGs were sent by the patients; out of them, 14 ECGs were with clinical changes. Technical problems due to insufficient patient training, telecommunication systems, acoustic data transmission, and device itself were reported. Up to 23% of ECGs sent by patients were unreadable and not applicable for further clinical analysis. CONCLUSIONS. Our study showed the potential of telemedicine facilities to overcome the problems of access that makes the technique so potentially useful, but for telemonitoring application at patient homes in a wider population, it needs to be improved in terms of technical performance, transmission and analysis automatization.

Background: The evaluation of quality of life and self-perceived health represents an assessment of the impact of treatment on patient functioning and well-being., Objective: Our aim was to explore the impact of methadone maintenance treatment on quality of life and self-perceived health of opioid-dependent persons in Lithuania., Methods: A total of 102 opioid-dependent patients were recruited in the study. A prospective follow-up study design was used. To assess quality of life, the WHOQOL-BREF 26-item version was used. The impact of methadone maintenance treatment on self-perceived health was assessed by Opiate Treatment Index (OTI)., Results: Following 6 months of methadone maintenance treatment, significant improvements in physical (P=0.004), psychological (P=0.004), and environmental (P=0.048) components of quality of life were observed; no statistically significant improvements were found in social component of quality of life. Study participants reported lower rates of medical morbidity associated with injection (P<0.001), cardiorespiratory (P=0.034), musculoskeletal (P<0.001), neurological (P=0.013), gastrointestinal (P<0.001), and general health (P<0.001)., Conclusions: Methadone maintenance treatment substantially reduces morbidity associated with opioid dependence and improves the quality of life of patients.

Background: Most cardiac surgery risk stratification systems were primarily designed using patient-related factors to predict mortality and postoperative morbidity. Relative mortality rates are higher at cardiac surgery centers which perform surgery on elderly patients. Our aim was to assess the validity of risk stratification systems for our regional population., Material/methods: The study involved 1021 patients. Risk stratification was carried out using the EuroSCORE, Ontario, and QMMI scoring systems. Analysis comparing the scoring systems included sensitivity, specificity, predictive values, and receiver operating characteristics (ROC) curves. Accuracy was assessed using the systems' ability to avoid Type I and Type II errors., Results: Sensitivity and specificity of the QMMI scoring system were 33.3% and 97.2%, of EuroSCORE 20.7% and 96.7%, and of Ontario 21.1% and 94.4%, respectively. The best positive predictive value was for QMMI and EuroSCORE with 75% versus Ontario's 50%. The highest negative predictive value was QMMI's 85.4% versus Ontario's 78.9% and EuroSCORE's 72.0%. The best accuracy showed QMMI scoring with 84.5% versus Ontario's 78.9% and EuroSCORE's 72.2%., Conclusions: All the investigated risk stratification systems were moderately predictive. The QMMI score showed the best predictive characteristics (sensitivity, specificity, and accuracy) for our patient population. The QMMI system had high specificity and accuracy. The EuroSCORE system showed mortality overprediction for our population, associated with high false negative test results and low accuracy. The Ontario risk stratification system often commits Type II errors, associated with a high rate of false positive test results and low accuracy.

Background: It 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., Methods: Cross-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., Results: Response 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 GP's 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., Conclusions: Lithuanian GP's have high patient load and are at risk of stress, they have high job demands and low decision latitude. Older GP's perceive less strain, lower job demands and higher decision latitude in case of low patient load. Young GP's decision latitude has week association to patient load. Regarding to the changes in patient load younger GP's perceive it more sensitively as changes in job demands.

Unlabelled: Methadone maintenance is effective in reducing injection drug use, needle sharing, and the overall mortality associated with opiate abuse. Scientific literature describes that efficiency of methadone maintenance program depends on many factors. Our analysis is based on description of economic research methods and on factors affecting economic efficiency of methadone maintenance., Methods: Computerized Medline data base was searched by key words: "economic evaluation", "cost-effectiveness", "cost-utility", "methadone", "methadone dosage", "ancillary services", "treatment duration". Review and analysis., Results: Methadone maintenance therapy has higher economic efficiency with 80-100 mg per day methadone dose. Doses lower than 40 mg per day are considered as inefficient. Some methadone programs limit treatment to 90 days or less, but such short treatment episodes are not likely to be cost-effective. Ancillary services are more cost-effective at the beginning of methadone maintenance program, than in the later stages of the program. Economic efficiency is higher when program involves more participants, than when more ancillary services are provided. CONCLUSIONS. Effectiveness of Methadone maintenance program affects methadone dosage policy, treatment duration and ancillary services.

Quality of life measurements are increasingly incorporated into trials of pharmaceuticals. This can be applied to a wide range of medical areas including drug-addiction maintenance treatment programs. Maintenance treatment has been demonstrated to be an effective treatment for opioid addiction but still lacks quality of life specific measures to measure the maintenance program effects and until now there have been only few attempts to assess the impact of opioid dependence and its treatment on the drug-addicted patients' quality of life. The aim of this article is to describe quality of life concept, measurement instruments, selection criteria and its applicability in the drug addiction maintenance studies.

Background: General practice is one of the most stressful workplaces among health care workers and is characterized by higher rates of job strain than in reference population. We need to take into account that respondents are influenced by quite similar working conditions and health status differently. Thus this article aimed to review the subjective processes, which make general practitioners more vulnerable to the job strain., Methods: Computerized database Medline was searched. Search included data for 1983-2003. In this review data form many comparative cross-sectional studies found in this database were included. A data collection form was developed, prepared and filled up on reading each article., Results: Collected studies highlighted that age, gender and marital status influence job strain development for general practitioner but were very controversial on how and whom they influence. We found that outcomes of job strain have higher impact for females than for males. We also found data that males have also high rates of job strain working in general practice. The age impact on job strain between females and males increases in older age groups. The rate of job strain is the highest among middle-aged general practitioners and depends on marital status. Married females have the worst health and are most vulnerable to job strain., Conclusions: Magnitude of job strain varies depending on age, gender and marital status of general practitioner. The highest rates of job strain are mostly observed in married females, younger or older general practitioners. Sociodemographic factors contribute to this. The development of job strain, in some extent, can be explained within social context.

Unlabelled: Demographic changes in the society, favorable changes in disease patterns within population cause higher morbidity and higher mortality from cardiovascular diseases and increase need for hospital resource use. It is very important to identify the risk factors, which are responsible for higher health care costs. The objective of this article is to identify risk factors, which are responsible for higher hospital resource use., Methods: Search in web and meta analysis of the electronic-medical articles within journals under review were performed., Results: The main risk factors for higher hospital resource utilization were identified: longer length of stay in the hospital, type of operation, postoperative mortality, postoperative complications and age., Conclusions: The main factors affecting higher hospital resource utilization are following: longer duration of stay in the hospital, advanced type of operation, postoperative mortality, postoperative complications and advanced age. Hospital resource utilization depends on patient anamnesis and quality of care in institution.

Unlabelled: Its is important to predict patients having the highest risk of surgery. Risk stratification systems need to be tested in different surgical populations and whether they are or not appropriate to our population remains unknown., Objective: To test various risk stratification systems for our region population having cardiac surgery in our institution during 2002., Materials and Methods: Between January 1, 2002 and November 1, 2002, all adult patients undergoing heart surgery with cardiopulmonary bypass in our institution were included in the study and scored using the EuroSCORE, Parsonnet, Ontario, and QMMI. Study was completed by 444 patients. We analyzed score systems predicting characteristics by assessing receiver operating characteristics (ROC)., Results: Observed mortality was 25 (5.63%). Mean score for alive and dead patients for EuroSCORE was -7.8+/-3.1 and 10.8+/-3.2, p<0.005; Parsonnet - 14.2+/-11 and 32.5+/-13.8, p<0.0005; Ontario - 3.6+/-2.7 and 6.4+/-3.5, p<0.005; QMMI score - 10.4+/-6.9 and 20.3+/-8.7, p<0.0001. ROC curve analysis for mortality showed best predicting characteristics for the Parsonnet and QMMI, best accuracy for QMMI score - 84.4 %., Conclusions: Most (71.2%) of our investigated patients having heart surgery are at high-risk group for death. All investigated score systems have significance in mortality prediction. Among the investigated score systems, the QMMI score and Ontario score systems yielded the highest predictive value in our patient population. Highest accuracy of prediction patient population showed QMMI score. Our study highlighted over prediction of mortality for Parsonnet score and EuroSCORE systems for our population.