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Patient-centered care is considered to be one of the essential pillars of a modern healthcare system. Thus, quality assessment based on patients’ perceptions, views and experiences in their journey through the healthcare system is recognized as one of the key principles for quality improvement initiatives. Measuring patient satisfaction can be confounded by expectations and prior experiences, which can be at least partly overcome by evaluating patient-perceived healthcare quality (PPHQ). Understanding the principal constituents of PPHQ may aid healthcare professionals and decision makers in the healthcare management process and help in creating instruments to meaningfully measure patient feedback. Herein, we aimed to analyze the primary determinants of PPHQ and their interactions, with a focus on patient experiences and healthcare accessibility, using the example of Lithuanian primary healthcare. For this purpose, we conducted a cross-sectional representative telephone survey that included a total of 1033 respondents (48% male) who had encountered primary healthcare during last 3 years. Survey questions consisted of sociodemographic characteristics, patient perceptions of healthcare service provision, patient experiences, self-reported health status and overall PPHQ ranked with a 5-point Likert scale as the primary outcome. The classification-regression tree (CRT) technique was used to analyze the relationship between different explanatory variables and PPHQ, as well as their relative importance and interactions. The majority of respondents (89%) evaluated PPHQ as acceptable or good. CRT analysis identified staff behavior, organizational accessibility and financial accessibility as the most important factors affecting PPHQ. Importantly, the latter factors surpassed the effect of other known PPHQ determinants, such as sociodemographic characteristics or health status. Further analysis has revealed that the relative importance of staff behavior, including understanding, attention and empathy, increased when more problems with organizational accessibility were encountered. In conclusion, our study suggests that PPHQ in primary healthcare may primarily be determined by organizational and financial accessibility and staff behavior, which may also act as an important mediating factor. Keywords: healthcare accessibility; healthcare quality; patient experiences; patient-perceived healthcare quality; primary healthcare.

The aim of this study was to evaluate the prevalence of cardiovascular risk factors in middle-aged Lithuanian women in different body mass index and waist circumference groups.Data selected from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program between 2009 and 2016. This community-based cross-sectional study comprised 53,961 women aged 50-64 years old. We compared the prevalence of arterial hypertension, dyslipidaemia, diabetes mellitus, smoking, and metabolic syndrome in different body mass index (BMI) and waist circumference (WC) groups. The most prevalent cardiometabolic risk factor was dyslipidaemia (91.71%, n = 49,488). The prevalence of arterial hypertension, dyslipidaemia, diabetes mellitus, and metabolic syndrome was greater in those with higher-than-normal BMI and WC. Smoking was the most prevalent in women with low BMI and normal WC (24.00% and 13.17% respectively).The analysis showed that all risk factors, except smoking, were significantly more prevalent in women with higher-than-normal BMI and with increased WC or abdominal obesity. The prevalence of dyslipidaemia was surprisingly high in all BMI and WC groups. Obesity measured by WC was more strongly associated with an adverse metabolic profile.

The aim of the study was to estimate trends and differences in cardiovascular disease (CVD) risk factor prevalence among middle-aged men and women based on the data from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program between 2009 and 2018.A community-based cross-sectional study included men aged 40-54 years and women aged 50-64 years without overt CVD. Nationally representative data comprised 110,370 Lithuanian adults (42.4% men and 57.6% women) examined in the period 2009-2018. Prevalences of major CVD risk factors, such as dyslipidaemia, arterial hypertension, diabetes mellitus, obesity, metabolic syndrome and smoking, were assessed.The study showed a significant drop in the prevalence of dyslipidaemia and TC levels among men (p = 0.030 and p0.001) and no significant change among women (p = 0.594 and p = 0.799). The prevalence of AH significantly decreased in both gender groups (p0.001 in women and p0.001 in men). Obesity rates declined among women while it remained constant among men (p0.001 and p = 0.100 respectively). There was a significant decline among women and a significant increase among men in the prevalence of metabolic syndrome (p0.001 and p = 0.016 respectively). The prevalence of diabetes increased until 2013, after which it started decreasing in the whole group (p = 0.005). The study showed a significant increase in the percentage of smoking women (p0.001), although the number of smoking men remained much higher (about 40%) (p0.001).In our observational study, we have documented a high prevalence of all CVD risk factors in 2009 with a slight decrease during the period in most prevalence rates, except in dyslipidaemia and smoking levels.

Summary Objectives: There is increasing evidence that metabolic syndrome (MetS) may be associated with increased uric acid levels. Previous studies indicate that hyperuricaemia is an independent risk factor for cardiovascular disorders. We sought to determine the association of serum uric acid (SUA) with MetS components and other cardiovascular risk factors among middle aged Lithuanians with MetS. Design and methods: A cross-sectional study was conducted in 2018. A total of 705 subjects aged 40 to 65 years with MetS diagnosed using NCEP ATP III criteria were included. None of the participants had previously diagnosed cardiovascular, cerebrovascular, peripheral artery or end-stage oncological disease. Blood tests and all anthropometric measurements were obtained using standard methods. Subjects were divided into 2 groups: with hyperuricaemia and without hyperuricaemia. Results: Hyperuricaemia was found in 33.3% of subjects. Mean serum uric acid level increased as the number of metabolic factors increased. Participants with hyperuricaemia had abnormal waist circumference (p < 0.001), higher systolic (p = 0.001) and diastolic blood pressure (p = 0.003), higher levels of triglycerides and, lower levels of high-density lipoprotein cholesterol (p < 0.001). Subjects in hyperuricaemia group were more likely to be alcohol users (p = 0.034), to have diabetes (p = 0.02) and higher body mass index (p < 0.001). Their creatinine levels were statistically significantly higher (p < 0.001). Conclusions: Our analysis showed that serum uric acid is associated with MetS and other cardiovascular risk factors. The study found a statistically significant association with the four out of five components of the MetS (excluding plasma glucose) as well as with alcohol consumption, and renal function indicators (creatinine, eGFR).

Summary Objectives: Circulating levels of inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) have been reported to be associated with increased risk of cardiovascular disease (CVD), as well as with metabolic syndrome (MetS). Therefore, our objectives were to investigate the associations between hs-CRP levels and individual MetS components as well as to analyse if hs-CRP levels are linked with the number of MetS components present in middle-aged subjects. Design and methods: A cross-sectional study included 4628 middle-aged MetS subjects from the Lithuanian High Cardiovascular Risk primary prevention programme (LitHiR) from 2011 to 2020. MetS was diagnosed according to the National Cholesterol Education Program ATP III modified criteria. CRP was measured by a validated high-sensitivity assay. A hs-CRP cutpoint of 5 mg/l was used to differentiate high and low hs-CRP groups. Results: The mean value of hs-CRP was 3.23 ± 4.04 mg/l, and significantly increased as the number of components of MetS increased (p < 0.001). The concentration of serum hs-CRP was significantly associated with waist circumference, systolic and diastolic blood pressure, and fasting blood glucose (all p < 0.001). However, no statistically significant associations were found between hs-CRP and serum triglycerides (p = 0.340) or serum high-density lipoprotein cholesterol (p = 0.148). Conclusions: Serum hs-CRP increased progressively with increased waist circumference, blood pressure, fasting blood glucose in middle-aged subjects with MetS. The higher values of hs-CRP were more often present in obese subjects and women. The incremental rise in mean serum hs-CRP level was found with an increasing number of MetS components.

Various comorbidities and multimorbidity frequently occur in chronic obstructive pulmonary disease (COPD), leading to the overload of health care systems and increased mortality. We aimed to assess the impact of COPD on the probability and clustering of comorbidities. The cross-sectional analysis of the nationwide Lithuanian database was performed based on the entries of the codes of chronic diseases. COPD was defined on the code J44.8 entry and six-month consumption of bronchodilators. Descriptive statistics and odds ratios (ORs) for associations and agglomerative hierarchical clustering were carried out. 321,297 patients aged 40–79 years were included; 4834 of them had COPD. A significantly higher prevalence of cardiovascular diseases (CVD), lung cancer, kidney diseases, and the association of COPD with six-fold higher odds of lung cancer (OR 6.66; p < 0.0001), a two-fold of heart failure (OR 2.61; p < 0.0001), and CVD (OR 1.83; p < 0.0001) was found. Six clusters in COPD males and five in females were pointed out, in patients without COPD—five and four clusters accordingly. The most prevalent cardiovascular cluster had no significant difference according to sex or COPD presence, but a different linkage of dyslipidemia was found. The study raises the need to elaborate adjusted multimorbidity case management and screening tools enabling better outcomes.

BACKGROUND: The relationship between longitudinal clinical congestion pattern and heart failure outcome is uncertain. This study was designed to assess the prevalence of congestion over time and to investigate its impact on outcome in chronic heart failure.METHODS: A total of 588 patients with chronic heart failure older than 60 years of age with New York Heart Association (NYHA) functional class >= II from the TIME-CHF study were included. The endpoints for this study were survival and hospitalization-free heart failure survival. Orthopnea, NYHA >= III, paroxysmal nocturnal dyspnea, hepatomegaly, peripheral pitting edema, jugular venous distension, and rales were repeatedly investigated and related to outcomes. These congestion-related signs and symptoms were used to design a 7-item Clinical Congestion Index.RESULTS: Sixty-one percent of patients had a Clinical Congestion Index >= 3 at baseline, which decreased to 18% at month 18. During the median [interquartile range] follow-up of 27.2 [14.3-39.8] months, 17%, 27%, and 47% of patients with baseline Clinical Congestion Index of 0, 1-2, and >= 3 at inclusion, respectively, died (P CONCLUSIONS: The extent of congestion as assessed by means of clinical signs and symptoms decreased over time with intensified treatment, but it remained present or relapsed in a substantial number of patients with heart failure and was associated with poor outcome. This highlights the importance of appropriate decongestion in chronic heart failure. (C) 2019 Elsevier Inc. All rights reserved.

The wide spectrum of COVID-19 symptoms complicates the selection of target groups for screening. We aimed to compare data of children screened for COVID-19 at the pediatric emergency department in Vilnius between different phases throughout 1 year (Phase I: March–May, 2020; Phase II: June–September, 2020; and Phase III: October, 2020–February, 2021) and to evaluate the possible predictors of the disease. SARS-CoV-2 PCR tests were positive for 2.7% of tested children (248/9,238), significantly higher during the Phase III (5.5%) compared with the Phase I (0.6%,p= 0.000) and Phase II (0.3%,p= 0.000). Infants and teenagers (12–17 years) accounted for a larger proportion of COVID-19 patients (24.6 and 26.2%, respectively) compared to other age groups: 1–2 years (18.9%), 3–6 years (14.9%), and 7–11 years (15.3%). There were more COVID-19 cases among children with a known SARS-CoV-2 exposure compared to those who did not declare any contact (18.2 vs. 1.1%,p= 0000). When symptoms were adjusted for age, gender and known exposure to SARS-CoV-2, we found that fever (OR 2.66; 95% CI 1.89–3.81), pharyngitis (OR 1.35; 95% CI 1.01–1.80), headache (OR 1.81; 95% CI 1.09–2.90), and anosmia/ageusia (OR 6.47; 95% CI 1.61–22.47) were the most significant predictors.Conclusion:Although high numbers of testing were maintained throughout the year, the positive test results were significantly higher during the Phase III. Age (

Background and Objectives: Lateral compression injuries of the pelvic ring are most common among young and elderly patients. Of all pelvic ring fracture injuries, the B2.1 type—involving lateral compression of the pelvic ring—is the most common. Despite this, we still have no high-level evidence to consult when choosing between the surgical and non-operative approaches. The purpose of this research was to compare the short-term functional and quality of life outcomes between operatively and non-operatively treated young patients after a B2.1 type pelvic fracture. Materials and Methods: Patients aged 18 to 65 years with pelvic B2.1 type fractures—according to AO/Tile classification—that were hospitalized in a single trauma center between 2016 November and 2019 September were included in the research. Patients were retrospectively divided into two groups regarding their treatment: non-operative and operative. Functional outcomes were evaluated using Majeed score, and SF-36 was used for the evaluation of quality of life. Patients completed these questionnaires twice: first during hospitalization, regarding their pre-traumatic condition (timepoint I), and again 10 weeks after the injury, regarding their current condition (timepoint II). Results: A total of 55 patients (70.6% of whom were female) with type B2.1 pelvic fractures were included in the analysis, with an average age of 37.24 ± 13.78 years. There were 21 (38.18%) patients with high injury severity, and 37 (67.3%) patients were treated operatively versus 18 (32.7%) non-operatively. Between the two timepoints, Majeed score reduced by 34.08 ± 18.95 for operatively and 31.44 ± 14.41 for non-operatively treated patients. For operatively and non-operatively treated patients, the physical component summary (PCS) of the SF-36 questionnaire reduced by 19.45 ± 9.95 and 19.36 ± 7.88, respectively, while the mental component summary (MCS) reduced by 6.38 ± 11.04 and 7.23 ± 10.86, respectively. Conclusions: We observed that operative treatment of B2.1 type pelvic fractures for young patients is not superior to non-operative in the short-term, because the functional outcomes and quality of life are similar in both groups.

BackgroundThe development of metabolic syndrome (MS) augments risk for atherosclerotic cardiovascular disease (CVD), but pathophysiological mechanisms of this relation are still under discussion. Overlapping CVD risk factors make it difficult to assess the importance of individual elements. This study aimed to analyze subclinical atherosclerosis based on arterial structure and function parameters in patients with MS and different triglycerides levels.MethodsPatients (aged 40–65 years) were divided into two groups: patients with MS and with or without hypertriglyceridemia (hTG). Noninvasive assessment of vascular parameters—aortic augmentation index adjusted for heart rate 75 bpm (AIxHR75), pulse wave velocity (PWV), and common carotid artery intima-media thickness (cIMT) were performed.ResultsCarotid-femoral PWV (cfPWV) and carotid-radial PWV (crPWV) were significantly higher in patients with hTG. After adjusting for age, gender, waist circumference, fasting glucose, smoking status, cardiovascular family history and mean arterial pressure, crPWV (OR 1.150; CI 95% 1.04–1.28), cfPWV (OR 1.283; CI 95% 1.14–1.42) and cIMT (OR 1.13; CI 95% 1.02–1.25) were significantly associated with hTG (p ConclusionIncreased triglycerides are independently associated with a cfPWV, crPWV, and cIMT and may modify CVD risk in patients with MS.

Background: Development of metabolic syndrome (MetS) augments risk for atherosclerotic cardiovascular disease (CVD), but pathophysiological mechanisms of this relation are still under discussion. Overlapping CVD risk factors make it difficult to assess the importance of individual elements. This study aimed to analyze subclinical atherosclerosis based on arterial structure and function parameters in patients with MetS and different triglycerides (TG) levels.Methods: Patients (aged 40-65 years) were divided into two groups: patients with MetS and with or without hypertriglyceridemia (hTG). Noninvasive assessment of vascular parameters—aortic augmentation index adjusted for heart rate 75 bpm (AIxHR75), pulse wave velocity (PWV), and common carotid artery intima-media thickness (CCA IMT)—were performed.Results: Carotid-femoral PWV (cfPWV) and carotid-radial PWV (crPWV) were significantly higher in patients with hTG. After adjusting for age, gender, waist circumference, fasting glucose, smoking status, cardiovascular family history and mean arterial pressure, crPWV (OR: 1.150; CI 95%: 1.04-1.28), cfPWV (OR: 1.283; CI 95%: 1.14-1.42) and CCA IMT (OR: 1.13; CI 95%: 1.02-1.25) were significantly associated with hTG (pConclusion: Increased TG are independently associated with a cfPWV, crPWV, and CCA IMT, but not with a higher AIxHR75.

Edita Lycholip,1,2 Ina Thon Aamodt,3,4 Irene Lie,3 Toma Šimbelytė,5 Roma Puronaitė,2,6,7 Hans Hillege,8 Arjen de Vries,8 Imke Kraai,9 Anna Stromberg,10 Tiny Jaarsma,11 Jelena Čelutkienė1,2 1Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; 2Center of Cardiology and Angiology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; 3Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway; 4Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; 5Clinic of Internal Medicine, Centre of Family and Internal Medicine, Vilnius University Santaros Clinics, Vilnius University, Vilnius, Lithuania; 6Centre of Informatics and Development, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania; 7Institute of Mathematics and Informatics, Vilnius University, Vilnius, Lithuania; 8Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 9PRA Health Sciences – Early Development Services, Groningen, the Netherlands; 10Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden; 11Department of Social and Welfare Studies, Linkoping University, Norrkoping, Sweden Introduction: Self-care is an important patient-reported outcome (PRO) for heart failure (HF) patients, which might be affected by disease management and/or telemonitoring (TM). The number of studies reporting the influence of TM on self-care is limited.Aims: This study aimed: to assess whether TM, in addition to information-and-communication-technology (ICT)-guided disease management system (ICT-guided DMS), affects self-care behavior; to evaluate the dynamics of self-care during the study; to investigate factors contributing to self-care changes; and to identify a patient profile that predisposes the patient to improvement in self-care. Methods: In the INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) study, 177 patients were randomized to either ICT-guided DMS or TM+ICT-guided DMS, with a follow-up of 9months. The current analysis included 118 participants (mean age: 69±11.5years; 70% male) who filled the following PRO instruments: the nine-item European Heart Failure Self-care Behaviour scale (EHFScBs), Hospital Anxiety and Depression scale (HADs), and Minnesota Living with HF Questionnaire (MLHFQ). Results: The baseline level of self-care was better in the TM+ICT-guided-DMS group (n=58) compared to ICT-guided-DMS group (n=60, p=0.023). Self-care behavior improved in the ICT-guided-DMS group (p28, or from 17 to 28 with concomitant HADs depression subscale (HADs_D) score ≤8, demonstrated the greatest potential to improve self-care during the study. Conclusion: TM did not have an advantage on self-care improvement. Poor physical aspect of quality of life, lower LVEF, and lower NYHA class were associated with self-care worsening. The greatest self-care improvement may be achieved in those patients who have low or medium initial self-care level in the absence of depression. Keywords: heart failure, self-care, telemonitoring, disease management, patient-reported outcomes

Hypertriglyceridemia (hTG) is 1 of the dyslipidemia manifestations in patients with metabolic syndrome (MetS). However, for several decades, the role of hTG in cardiovascular risk was not well established.The aim of this study was to assess the parameters of the vascular structure and function in patients with MetS and different degree of hTG.Patients (aged 40-65 years) with MetS were divided into 3 groups by triglyceride (TG) levels according to National Cholesterol Education Program Adult Treatment Panel III Guidelines: severe hTG (TG ≥ 500 mg/dL), moderate hTG (TG 200-499 mg/dL), and a control (TG 150 mg/dL) groups. Noninvasive assessment of vascular parameters (aortic augmentation index adjusted for heart rate 75 bpm [AixHR75], pulse wave velocity [PWV], flow-mediated dilatation, and common carotid artery intima-media thickness (IMT)) were performed.Among the 1938 patients analyzed, 1041 had hTG. Moderate hTG was observed in 90.40% (n = 941), whereas severe TG was observed in 9.6% (n = 100) of patients. Overall TG concentration was 231.17 ± 184.23 mg/dL; in severe hTG group, TG concentration was 795.36 ± 368.45 mg/dL, in moderate hTG group 285.20 ± 70.86 mg/dL, and 112.48 ± 24.80 mg/dL in control group. AIxHR75 and IMT were the lowest in the severe hTG group (P .001 for both). Mean arterial pressure, carotid-radial PWV (9.25 ± 1.13 vs 9.24 ± 1.28 vs 8.91 ± 1.28; P .001) as well as carotid-femoral PWV (8.63 ± 1.65 vs 8.75 ± 1.58 vs 8.51 ± 1.6; P = .006) were the higher in hTG groups compared with control. There were no significant differences between groups in flow-mediated dilatation (3.39 ± 2.01 vs 3.26 ± 2.43 vs 3.45 ± 2.61, P = .283).Patients with MetS and severe hTG have lower IMT and AIxHR75 and higher PWV and mean arterial pressure. Many factors could affect arterial parameters, and more research are needed to investigate arterial parameters and hTG connection.

The study objective was to evaluate the midterm outcomes of transventricular mitral valve repair and its association with the initial anatomy of the mitral valve.This nonrandomized observational study included 88 patients (mean age, 60 years; 69% were men) who underwent transventricular mitral valve repair for severe degenerative mitral regurgitation between 2011 and 2017. Mitral valve function was assessed by echocardiography at 1 and 6 months and annually after the procedure. According to the location of mitral valve pathology, all patients were stratified into 4 anatomic types (A, B, C, and D). Results were assessed using Kaplan-Meier method, mixed-effects continuation ratio model, and multivariable Cox regression.Median follow-up of 42 months (interquartile range, 27-55) was complete for 83 patients (94.3%). There were 3 late deaths: 2 cardiac and 1 noncardiac. Recurrent mitral regurgitation greater than 2+ was observed in 29 patients (33%), and 18 patients (20.5%) underwent repeat surgery. Device success was 82% in type A at 6 months and thereafter; 87%, 85%, and 75% at 6, 12, and 36 months in type B, respectively; and 53% at 1 month and 20% at 24 months in type C. Probability of postoperative mitral regurgitation progression was higher in patients with greater preoperative left ventricular end-diastolic diameter, type B pathology, and type C pathology (P lt; .05). Risk factors of mitral regurgitation recurrence included increased left ventricle size (hazard ratio, 1.11; 95% confidence interval, 1.04-1.20; P = .001) and type C pathology (hazard ratio, 5.99; 95% confidence interval, 1.87-19.21; P = .003).Initial acceptable mitral regurgitation reduction after transventricular mitral valve repair of isolated P2 prolapse was possible but found durable in only 82% at 3 years. Higher risk of mitral regurgitation recurrence occurred with complex degenerative pathology.

Background Recent triple-blind sham procedure-controlled study revealed neutral effects of the cardiac shock wave therapy (CSWT) on exercise tolerance and symptoms in patients with stable angina. Current data about the effects of CSWT on global and regional myocardial contractility and perfusion is limited. Hereby we report the results of an imaging sub-study that evaluated the capacity of CSWT to ameliorate myocardial ischemia induced during dobutamine stress echocardiography (DSE) and cardiac single photon emission computed tomography (SPECT). Methods Prospective, randomized, triple-blind, sham procedure-controlled study enrolled 72 adult subjects who complied with defined inclusion criteria. The subjects were assigned to the OMT + CSWT and the OMT + sham procedure study groups with 1:1 ratio. Application of the CSWT covered all segments of the left ventricle. Imaging ischemia tests were performed in 59 study patients: DSE and SPECT before the CSWT treatment and after 6 months, with DSE carried out additionally at 3 months after randomization. Co-primary endpoints of the study were: change in wall motion score index (WMSI), representing the stress-induced impairment of regional myocardial function, and change in summed difference score (SDS), representing the amount of perfusion defect. Results OMT + CSWT and OMT + sham procedure study groups included 30 and 29 patients, respectively. Regional myocardial contractility during DSE significantly improved at 3 months follow-up in OMT + CSWT group compared to baseline as shown by WMSI at stress (1.4 ± 0.4 vs 1.6 ± 0.4, p = 0.001), but not in OMT + sham procedure group (1.5 ± 0.3 vs 1.6 ± 0.4, p = 0.136). The difference in stress DSE results between both study groups disappeared after 6 months. SPECT results demonstrated a significant reduction of inducible ischemia in OMT + CSWT group compared to OMT + sham procedure group at 6 months follow-up (SDS dropped from 5.4 ± 3.7 to 3.6 ± 3.8 vs 6.4 ± 5.9 to 6.2 ± 5 respectively, p = 0.034). Conclusions Cardiac shock wave treatment showed the ability to reduce stress-induced myocardial ischemia, as assessed by wall motion abnormalities and perfusion defects, compared to sham procedure. Trial registration Clinicaltrials.gov (NCT02339454). The trial was registered retrospectively on 12 January 2015.

Background and Objectives: The aim of the study was to evaluate trends in smoking among middle-aged men and women based on the data from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program between 2009 and 2016. Materials and Methods: A community-based cross-sectional study comprised 92373 Lithuanian adults (41.6% men and 58.4% women). We compared the prevalence of smoking, smoking cessation activity and smoking intensity by gender and age groups. Results: There was a statistically significant upward trend in the number of smoking subjects (average annual percent change (AAPC) 2.99%, p &lt, 0.001). The number of smoking male subjects remained much higher than the number of smoking female subjects during the 2009&ndash, 2016 period. The study showed a significant increase in the percentage of smoking quitters in the whole group (AAPC 7.22%, p &lt, 0.001) and among men and women separately. There was no significant change in smoking intensity in groups of male and female smokers separately. Conclusions: The analysis showed that the prevalence of smoking in Lithuania is still increasing due to women smoking despite all the governmental tobacco control efforts to reduce it.

Background. Patients with multimorbidity account for ever-increasing healthcare resource usage and are often summarised as big spenders. Comprehensive analysis of health care resource usage in different age groups in patients with at least two non-communicable diseases is still scarce, limiting the quality of health care management decisions, which are often backed by limited, small-scale database analysis. The health care system in Lithuania is based on mandatory social health insurance and is covered by the National Health Insurance Fund. Based on a national Health Insurance database. The study aimed to explore the distribution, change, and interrelationships of health care costs across the age groups of patients with multimorbidity, suggesting different priorities at different age groups. Method. The study identified all adults with at least one chronic disease when any health care services were used over a three-year period between 2012 and 2014. Further data analysis excluded patients with single chronic conditions and further analysed patients with multimorbidity, accounting for increasing resource usage. The costs of primary, outpatient health care services, hospitalizations, reimbursed and paid out-of-pocket medications were analysed in eight age groups starting at 18 and up to 85 years and over. Results. The study identified a total of 428,430 adults in Lithuania with at least two different chronic diseases from the 32 chronic disease list. Out of the total expenditure within the group, 51.54% of the expenses were consumed for inpatient treatment, 30.90% for reimbursed medications. Across different age groups of patients with multimorbidity in Lithuania, 60% of the total cost is attributed to the age group of 65–84 years. The share in the total spending was the highest in the 75–84 years age group amounting to 29.53% of the overall expenditure, with an increase in hospitalization and a decrease in outpatient services. A decrease in health care expenses per capita in patients with multimorbidity after 85 years of age was observed. Conclusions. The highest proportion of health care expenses in patients with multimorbidity relates to hospitalization and reimbursed medications, increasing with age, but varies through different services. The study identifies the need to personalise the care of patients with multimorbidity in the primary-outpatient setting, aiming to reduce hospitalizations with proactive disease management.

Background. Essential data on the quality of diabetes care needed for the development of National Diabetes Programme in Lithuania are lacking. The aim of the study was to assess the quality of diabetes care compared to the local guidelines in Vilnius, Lithuania. Materials and methods. Retrospective data collection covering the period from 2012 to 2013 was performed in 5 Vilnius outpatient clinics assessing process and outcome indicators in type 1 (T1DM) and type 2 diabetes mellitus (T2DM) subjects. Results. In a sample of 1,719 patients (58.9% women, 92.6% T2DM) the annual HbA1c assessment rate was 88.6%. Glycaemic control was significantly better in T2DM compared to T1DM patients: average HbA1c was 7.0 ± 1.4% vs 9.1 ± 1.8% and HbA1c ≤ 7% in 59 vs 9.4%, respectively (p

Background and objectives: T-cadherin (T-cad) is one of the adiponectin receptors abundantly expressed in the heart and blood vessels. Experimental studies show that T-cad sequesters adiponectin in cardiovascular tissues and is critical for adiponectin-mediated cardio-protection. However, there are no data connecting cardiac T-cad levels with human chronic heart failure (HF). The aim of this study was to assess whether myocardial T-cad concentration is associated with chronic HF severity and whether the T-cad levels in human heart tissue might predict outcomes in patients with non-ischemic dilated cardiomyopathy (NI-DCM). Materials and Methods: 29 patients with chronic NI-DCM and advanced HF were enrolled. Patients underwent regular laboratory investigations, echocardiography, coronary angiography, and right heart catheterization. TNF-&alpha, and IL6 in serum were detected by enzyme-linked immunosorbent assay (ELISA). Additionally, endomyocardial biopsies were obtained, and the levels of T-cad were assessed by ELISA and CD3, CD45Ro, CD68, and CD4- immunohistochemically. Mean pulmonary capillary wedge pressure (PCWP) was used as a marker of HF severity, subdividing patients into two groups: mean PCWP &gt, 19 mmHg vs. mean PCWP &lt, 19 mmHg. Patients were followed-up for 5 years. The study outcome was composite: left ventricular assist device implantation, heart transplantation, or death from cardiovascular causes. Results: T-cad shows an inverse correlation with the mean PCWP (rho = &minus, 0.397, p = 0.037). There is a tendency towards a lower T-cad concentration in patients with more severe HF, as indicated by the mean PCWP &gt, 19 mmHg compared to those with mean PCWP &le, 19 mmHg (p = 0.058). Cardiac T-cad levels correlate negatively with myocardial CD3 cell count (rho = &minus, 0.423, p = 0.028). Conclusions: Univariate Cox regression analysis did not prove T-cad to be an outcome predictor (HR = 1, p = 0.349). However, decreased T-cad levels in human myocardium can be an additional indicator of HF severity. T-cad in human myocardium has an anti-inflammatory role. More studies are needed to extend the role of T-cad in the outcome prediction of patients with NI-DCM.

Background: Dyslipidemia is highly prevalent and is one of the major risk factors for cardiovascular disease in Lithuania. The purpose of this study was to determine the prevalence of severe dyslipidemia in Lithuanian middle aged primary prevention population and to investigate cardiovascular risk profile.& para;& para;Methods: The group of 83,376 people were examined in the Lithuanian High Cardiovascular Risk primary prevention program (LitHiR), during 2009-2015 years. This study recruited middle aged men and women without overt cardiovascular disease. The prevalence of cardiovascular risk factors was compared between severe dyslipidemia group and control group.& para;& para;Results: Severe dyslipidemia was present in 13.5% (11265) of the subjects; 66.6% (7508) were females. The subjects with severe dyslipidemia had significantly higher rates of arterial hypertension (63.5% vs. 44.2%, p < 0.001), diabetes mellitus (16% vs. 8.1%, p < 0,001), abdominal obesity (51% vs. 30.3%, p < 0.001), body mass index (BMI) > 30 (kg/m(2)) (38.8% vs. 24.1%, p < 0.001), metabolic syndrome (47.2% vs. 9.2%, p < 0.001), unbalanced diet (66.5% vs. 53.5%, p < 0. 001), insufficient physical activity (56% vs. 44.2%, p < 0.001), family history of cardiovascular disease (29.7% vs. 22.7%, p < 0.001) in comparison with control group. Subjects without dyslipidemia had significantly higher rates of smoking (26.4% vs. 22.7%, p < 0.001).& para;& para;The prevalence of familial hypercholesterolemia was 0.1%, very high hypertriglyceridemia - 0.2% and familial mixed dyslipidemia - 0.1% of the subjects examined in the LitHiR programme.& para;& para;Conclusions: High prevalence of dyslipidemia remains a major problem in Lithuania. 9 out of 10 people have dyslipidemia, 1 out of 10 - severe dyslipidemia. Severe dyslipidemia is associated with higher frequency of other cardiovascular risk factors.

Background Currently there is no diabetes-specific quality of life (QOL) instrument available in Lithuanian language. We aimed to develop a Lithuanian version of a widely-used individualised instrument - the Audit of Diabetes Dependent Quality of Life questionnaire (ADDQOL-19) and assess the validity and reliability in patients with type 1 and type 2 diabetes mellitus (DM). Methods This study was conducted at the Primary Care and Endocrinology Outpatient Clinics in Vilnius. The ADDQOL was translated from the original English (UK) into Lithuanian using a standardized methodology of forward and back translation. After cognitive “debriefing” the validity and reliability of LT-ADDQOL questionnaire were assessed in a sample of 138 diabetes patients. Cronbach’s alpha coefficient, factor analysis, independent t tests and ANOVA were used. Results There were 106 participants with type 2 and 32 with type 1 DM included in the study with a mean age of 55.5 years (± 14.5) and 56.2% women. The Cronbach’s alpha coefficient was 0.908 and most of items loading values onto one single factor were larger than 0.40 (varied from 0.41 to 0.77), indicating good internal consistency and reliability of instrument. Conclusions We developed the Lithuanian version of ADDQOL-19 which is a valid and reliable instrument to measure impact of diabetes on QOL. It could be further used by clinicians and researchers for comprehensive assessment of QOL in adults with diabetes.

Summary Objectives:The aim of this study was to assess the diagnostic value of exercise stress testing to detect coronary heart disease (CHD) in the group of patients with metabolic syndrome. Design and methods: 2803 patients without prior diagnosis of CHD and identified metabolic syndrome were investigated. Subjects underwent electrocardiogram (ECG) stress testing and, depending on the results, coronary angiography and/or coronary computed tomography angiography to detect hemodynamically significant stenosis. CHD was confirmed, if lumen narrowing ≥ 50% of coronary arteries was found. Results: Exercise stress testing was interpreted as positive in 12% patients (71.7% women and 28.3% men). CHD was diagnosed in 45 patients (1.6%), 23 of them had positive exercise stress testing. ECG stress testing was more frequently positive in patients, who had typical/atypical anginal chest pain, dyspnea and/or non-anginal chest pain, in comparison to asymptomatic patients (16.6% vs 8.9%, p p < 0.001, women 5.3% vs 0.6%, p < 0.001, men respectively 8% vs 0.8%, p < 0.001). Conclusions: Diagnostic value of exercise stress testing for detecting CHD is limited in population with metabolic syndrome. CHD was more prevalent in patients with chest pain or dyspnea than in asymptomatic patients.

Objectives: We aimed to investigate the association between arterial stiffness assessed as cardio-ankle vascular index (CAVI) and cardiovascular (CV) risk factors and CV events in the middle-aged metabolic syndrome (MS) patients. Materials and methods: A follow-up study was carried out in 2106 middle-aged (53.83 6.17 years old, 62% women) MS subjects without overt atherosclerotic disease. Patients were initially recruited in 2009–2011 as participants of the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program and followed up for 3.8 ± 1.7 years for CV events. Thorough cardiometabolic risk assessment was carried out at inclusion. Results: Subjects with higher CAVI had worse lipid and glucose metabolism profile: elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), decreased highdensity lipoprotein cholesterol (HDL-C), higher fasting and oral glucose tolerance test (OGTT) glucose levels (all P &lt, 0.001), and lower fasting insulin (P = 0.021). Greater age (P &lt, 0.001), heart rate (P = 0.016), and mean arterial pressure (P &lt, 0.001) were also associated with higher CAVI. Over the follow-up period, 93 (4.4%) patients developed a cardiovascular event: 55 (2.6%) patients had myocardial infarction and 38 (1.8%) suffered a cerebrovascular event. Fatal CV events comprised 6.5% (n = 6) of all CV events. CAVI was statistically significantly associated with occurrence of myocardial infarction (P = 0.027) and total cardiovascular events (P = 0.045), but not cerebrovascular events (P = 0.65). However, this association was dependent on age and gender.Conclusions: In the middle-aged MS patients, higher CAVI was associated with altered lipid and glucose metabolism, older age, greater heart rate and mean arterial pressure, and worse cardiovascular outcome.

Background: The aim of the present study was to identify specious radiologic and/or physiologic prognostic marker(s), which lead to optimize of the patient follow-up frequency. Methods: Eighty consecutive patients with newly diagnosed pulmonary sarcoidosis. Patients underwent chest radiography, high-resolution computed tomography (HRCT) examination, pulmonary function tests (PFT), bronchoscopy with bronchoalveolar lavage (BAL) and lung biopsy, and bronchoalveolar lavage fluid (BALF) cell examination. Results: The reduction in PFT values seen in radiological sarcoidosis stage III was greater than that seen in stages I and II. The percentage of neutrophils in the lungs was found to increase in stages II and III. PFT indices were correlated negatively with the consolidation and ground glass opacities CT scores, but not with the micronodule or macronodule scores. The rise in the percentage of BALF lymphocytes was associated with the restriction pattern of PFT. The diagnostic value of BALF for sarcoidosis was higher when the typical radiologic patterns of stage I disease were found and that smoking decreased the diagnostic value of CD4/CD8 ratio. Conclusions: This study supports the opinion that the staging of the pulmonary sarcoidosis with chest X-rays is still valuable from the prognostic point of view, because significant correlations between the radiologic stages of sarcoidosis and PFT parameters were found. Chest HRCT was significantly superior to chest X-ray in detecting mediastinal and pulmonary parenchymal changes. However, the prognostic role of HRCT needs to be better investigated evaluating serial examinations. Only consolidation and ground glass scores (neither of which are frequently found in sarcoidosis) hold prognostic value, since these were negatively correlated with PFT parameters.

Introduction Multimorbidity – the coexistence of ≥2 chronic conditions in same individual is usually associated with older age. There is an increase in its prevalence at a much younger age, however with very limited research specifying that. Objective To identify age breaking points for the occurrence of multimorbidity. Methods The study included patients, who used any healthcare services between the 01/01/2012 and 30/06/2014. Patients were divided into two groups – with single chronic condition and with multimorbidity. Age-specific proportion of multimorbidity, rate of primary and outpatient visits, number of hospitalizations and prescribed reimbursed medications between these groups were analyzed. Results The study included 452578 patients, 94.63% of them had more than one chronic condition. The risk increase with every consecutive year for developing multimorbidity was between the age of 28 and 39 years. The age breaking point for the rapid increase in hospitalizations was about 29 years in multimorbidity group. The proportion of patients with multimorbidity using expensive medications starts to increase at the age of 41. Conclusions The risk of acquiring an additional chronic condition rises exponentially from the age of 29 years and platos between the age of 51 and 57. Patients with multimorbidity require increasing amounts of primary healthcare resources, where patients with single chronic condition require decreasing primary care usage, possibly attributed to successful patient empowerment.

Summary Objectives: Metabolic syndrome (MetS) is linked to the development of type 2 diabetes and increased risk of cardiovascular disease (CVD). Physical inactivity is one of the main pathophysiological factors of MetS subjects. The aim of this study was to evaluate if 4-week supervised aerobic training had any impact on anthropometric, metabolic, hemodynamic and arterial wall parameters in MetS subjects. Design and methods: 57 MetS subjects were randomly selected from a Lithuanian High Cardiovascular Risk (LitHiR) national primary prevention programme. Hemodynamic, cardiometabolic risk and arterial wall parameters were evaluated after the 4-week supervised aerobic training. Results: After 4 weeks of aerobic training there was statistically significant decrease in body mass index from 30.58 ± 3.7 to 30.3 ± 3.55 kg/m2 (p = 0.010), waist circumference from 104.24 ± 9.46 to 102.9 ± 9.48 cm (p = 0.003), decrease of LDL cholesterol from 4.21 ± 1.15 to 3.78 ± 1 mmol/l (p = 0.032) and high sensitivity C-reactive protein from 2.01 ± 2.36 to 1.64 ± 1.92 mg/l (p = 0.009), decrease of diastolic blood pressure (BP) from 83.06 ± 10.18 to 80.38 ± 8.98 mmHg (p = 0.015), mean BP from 100.03 ± 10.70 to 97.31 ± 8.88 mmHg (p = 0.027) and aortic stiffness, assessed as carotid-femoral pulse wave velocity, from 8.34 ± 1.26 to 7.91 ± 1.15 m/s (p = 0.034). Conclusions: In subjects with MetS even short-duration (4-week) supervised aerobic exercise training is associated with improvement of some anthropometric, metabolic and hemodynamic parameters as well as the decrease in aortic stiffness. This training modality could be recommended for initiation of physical training and could increase motivation for further physical activity.

Raktiniai žodžiai: cukrinis diabetas, metabolinė kontrolė, ambulatorinė priežiūra, klinikinis auditas. Tikslas. Įvertinti cukriniu diabetu sergančių pacientų, gydomų Vilniaus universiteto ligoninės Santariškių klinikų Šeimos medicinos centre, priežiūrą, palyginti su Lietuvoje galiojančiomis rekomendacijomis. Tyrimo medžiaga ir metodai. Diabetu sergančiųjų, 2011–2012 metais gydytų Šeimos medicinos centre duomenys surinkti retrospektyviai iš elektroninės duomenų bazės ir pacientų ambulatorinių kortelių. Duomenų rinkimo forma sudaryta atsi- žvelgiant į rekomendacijose apibrėžtus parametrus. Vertintos pagrindinės charakteristikos, diabeto komplikacijos, lydinčios ligos bei diabeto priežiūros rodikliai: glikuotas hemoglobinas, rekomenduojami atlikti tyrimai (lipidograma, kreatinino kiekis kraujyje, šlapimo tyrimas, albuminurija), oftalmologo, endokrinologo konsultacijos, pacientų mokymas bei pėdų apžiūra. Rezultatai. Atlikta restrospektyvi 315 pacientų (53 proc. moterų; 90 proc. 2 tipo cukriniu diabetu sergantieji) duomenų analizė. Vidutinis pacientų amžius – 64,4 ± 13,9 metų (sergančių 1 tipo diabetu – 38,2 ± 15,9; 2 tipo diabetu – 67,3 ± 10,2); vidutinė diabeto trukmė – 8,2 ± 8,1 metų (15,6 ± 14,1; 7,4 ± 6,6); kūno masės indeksas – 31,8 ± 5,9 kg/m2 (24,9 ± 4,9; 32,5 ± 5,6); liemens apimtis – 106,1 ± 12,8 cm (94,5 ± 6,4; 107,4 ± 12,7). Vidutinis glikuotas hemoglobinas – 6,9 ± 1,3 proc. (8,1 ± 1,9; 6,7 ± 1,1), tikslinį glikuotą hemoglobiną ( 7 proc.) pasiekusių pacientų dalis – 67 proc. (29; 71). Diabetinė nefropatija, polineuropatija, retinopatija ir angiopatija nustatyta atitinkamai 15,6; 38,4; 19,4 ir 6 proc. pacientų, dažniau – 1 tipo diabetu sergantiesiems. Arterinė hipertenzija, širdies ir kraujagyslių ligos, dislipidemija nustatyta atitinkamai 88,9; 40,6 ir 73,4 proc. pacientų, dažniau 2 tipo diabeto grupėje. Duomenų apie kūno masės indeksą, liemens apimtį, pacientų mokymą trūko atitinkamai 44,2; 74,3 ir 91,4 proc. atvejų. Informacijos apie pėdų apžiūrą, akių dugną, šlapimo tyrimą, albuminuriją, kreatinino kiekį kraujyje, lipidogramą trūko atitinkamai 81,4; 47,6; 64,8; 89,8; 31,1 ir 44,8 proc. atvejų. Esant nepakankamai glikemijos kontrolei, tik 68 proc. pacientų nukreipti į endokrinologo konsultaciją. 2011 ir 2012 metų diabeto priežiūros rodikliai reikšmingai nesiskyrė. Išvados. Klinikinio audito metu nustatyta, jog Vilniaus universiteto ligoninės Santariškių klinikų Šeimos medicinos centre didžiajai daliai diabetu sergančių pacientų pasiekta labai gera glikemijos kontrolė, ypač 2 tipo cukrinio diabeto grupėje. Ta- čiau pacientų mokymas, diabeto komplikacijų ir kardiovaskulinės rizikos veiksnių išaiškinimas, lyginant su galiojančiomis rekomendacijomis, yra nepakankamas. Tyrimo rezultatai nubrėžia gaires diabetu sergančiųjų priežiūros gerinimui centre bei pagrindžia panašių tyrimų poreikį kitose ambulatorinės sveikatos priežiūros įstaigose.