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Objectives: To assess the prevalence and correlates of self-reported genital warts (GWs) among women and men aged 18-45 years in the Baltic countries., Methods: In 2011-2013 we performed a cross-sectional survey using a self-administered questionnaire to collect information on the history of clinically diagnosed GWs, sociodemographic characteristics and sexual behaviour. Probability sampling methods were used to invite 16,959 individuals representing the general population, of whom 7760 (45.8%) participated (Estonia: 1967 women, 1221 men; Latvia: 1525 women, 1525 men; Lithuania: 1522 women)., Results: The estimated lifetime prevalence of clinically diagnosed GWs in women was 4.6% (95% CI 3.8 to 5.5) in Estonia, 2.9% (95% CI 2.0 to 3.6) in Latvia and 1.5% (95% CI 1.2 to 2.0) in Lithuania. Among men, the corresponding values were 2.8% (95% CI 1.9 to 4.0) in Estonia and 1.9% (95% CI 1.3 to 2.6) in Latvia. The mean age at first episode of clinically diagnosed GW was 24.6 years (95% CI 23.6 to 25.5) for women and 24.5 years (95% CI 22.9 to 26.0) for men. A lifetime history of clinically diagnosed GW was associated with a history of sexually transmitted infections other than GW (adjusted OR (AOR) 3.0, 95% CI 2.1 to 4.3 for women; AOR 5.3, 95% CI 3.0 to 9.2 for men), and a higher number (5+) of lifetime sexual partners (AOR 2.9, 95% CI 1.9 to 4.2 for women; AOR 2.1, 95% CI 1.2 to 3.9 for men). Men living comfortably within their household income had higher odds for GW (AOR 1.9, 95% CI 1.1 to 3.2)., Conclusions: Our estimated prevalence of clinically diagnosed GWs was lower than estimates from the general population of other European countries., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: There is a large difference in the prevalence of cervical cancer between European countries. Between European Union countries, cervical cancer is the most prevalent in Lithuania. Currently we have available vaccines for different types of human papillomavirus virus (HPV), but we lack evidence on how the vaccination would be cost-effective in low-resource Eastern European countries like Lithuania., Objectives: To create a simulation model for the Lithuanian population; to estimate epidemiological benefits and cost-effectiveness for a HPV16/18 vaccination programme in Lithuania., Study Design: For the cost-effectiveness analysis, we used Lithuanian population mathematical simulation and epidemiological data modelling. We performed comparative analysis of annual vaccination programmes of 12-year-old or 15-year-old girls at different vaccine penetration levels., Population: Lithuanian female population at all age groups., Results: A vaccination programme in Lithuania would gain an average of 35.6 life years per death avoided. Vaccinated girls would experience up to 76.9% overall reduction in incidence of cervical cancers, 80.8% reduction in morbidity and 77.9% reduction in mortality over their lifetime. Cost per life year gained with different vaccine penetration levels would range from 2167.41 Euros to 2999.74 Euros., Conclusions: HPV vaccination in Lithuania would have a very positive impact on the epidemiological situation and it would be cost-effective at all ranges of vaccine penetration. Vaccination in Lithuania in the long term potentially could be more cost-effective due to avoiding early disease onset and lower accumulation of period costs.

This paper assesses the changes in avoidable mortality in Lithuania in 1991-1999 compared with 1970-1990. Causes of death were disaggregated into causes most amenable to treatment and those amenable to prevention. Trends in age-standardised death rates were calculated. In 1970-1990, avoidable causes of death accounted for 26.3% of all deaths. By 1991-1999 this figure had decreased slightly to 24.6%. At the same time, age-standardised death rates from avoidable causes increased by 8%, from 118.1 per 100000 in 1970-1990 to 127.9 in 1991-1999. Avoidable mortality among men was considerably higher than for women in both periods. There was considerable fluctuation in both treatable and preventable mortality during the 1990s, reflecting diversity in trends in different causes of death. Increases occurred in death rates from tuberculosis, cervical cancer and liver cirrhosis and, immediately after independence, also in hypertensive and cerebrovascular diseases and, among men, lung cancer, followed by subsequent declines. Deaths from chronic rheumatic heart disease, asthma and other respiratory diseases, appendicitis, abdominal hernia, cholelithiasis and maternal mortality consistently declined. In conclusion, avoidable mortality declined as a proportion of total mortality in Lithuania during 1991-1999 compared with 1970-1990. This reflected the combined impact of an initial rise in death rates from treatable and, to a lesser extent, preventable causes, followed by subsequent declines. While this indicates some success in the development of medical care, it emphasises the need for more effective public health policies directed at the major determinants of health.

Diabetes is becoming one of the major public health problems because a great proportion of the healthcare expenditure has been spent on the treatment of its associated morbidity and mortality. Diabetes is also a major cause of premature mortality, stroke, cardiovascular disease, peripheral vascular disease, congenital malformations as well as long- and short-term disability. In addition, persons with diabetic complications have a lower quality of life compared with persons without diabetes. The goal of this paper is to review the studies on the costs of diabetes, to identify the strengths and limitations of currently available diabetes cost studies, and to identify future research areas that will help us to better understand the economic burden of diabetes. The economic burden of diabetes mellitus is enormous in the world. Cost or illness estimates are often cited as an important element in the choices made regarding diabetes care and management. Studying these economic aspects presents several challenges, such as collecting the appropriate epidemiological and cost data, determining the diabetes attributable factors for premature morbidity and mortality, and determining methods to account for premature morality, disability, and reduced quality of life. The cost to care for diabetes puts a tremendous burden on both the patient and the payer. The direct cost of diabetes increased from 1.7 billion US dollars in 1969 to 44.4 billion US dollars in 1997. Several studies over the years have found that indirect costs related to diabetes are higher than direct. Indirect costs during 28 years increased 33 times, from 1.6 billion US dollars in 1969 to 54.1 billion US dollars in 1997. The expenses of one diabetic patient highly vary in different countries: from 13 US dollars in Bangladesh to 11,157 US dollars in USA per one year. Most of diabetes expenditure is used to pay for inpatient services (60-85%); the biggest part of it is incurred because of late diabetes complications (70%). Diabetes accounted to 3-12% of total healthcare expenditure in different countries. In this era of limited resources and escalating costs, it is critical to have an understanding of the economics of diabetes in order to develop and implement sound public health and prevention policies.