Changes in mortality inequalities in urban and rural populations during 1990-2018: Lithuanian experience

Background and Objectives: Reduction in health inequalities is a highly important task in public health policies worldwide. In Lithuania, inequalities in mortality by place of residence are among the greatest, compared to other European Union (EU) countries. However, studies on inequalities in mortality by place of residence over a long-term period have not been investigated in Lithuania. The aim of this study was to present changes in mortality inequalities in urban and rural populations during 1990–2018. Materials and Methods: Mortality rates from all causes, cardiovascular diseases, cancer, external causes, and gastrointestinal diseases in urban and rural population by sex were calculated per 100,000 populations and were standardized by age. Inequalities in mortality were assessed using rate differences and rate ratio. For the assessment of inequality trends during 1990–2018, the joinpoint regression analysis was applied. Results: Mortality between urban and rural populations varied. In rural areas, mortality lower than that in urban areas was observed only in 1990 among women, in case of mortality from cancer and gastrointestinal diseases (compared with in 2018) (p <0.05). In 2018, mortality from all causes, cardiovascular diseases, and external causes in urban and rural areas was lower than in 1990 in both sexes. However, mortality from gastrointestinal diseases was higher (p <0.05). In 2018, mortality from cancer among both sexes was lower only in urban areas (p <0.05). Mortality inequalities between rural and urban areas decreased statistically significantly only among men from external causes and from all causes (respectively, on average, by 0.52% per year and, on average, by 0.21% per year). Meanwhile, mortality from cardiovascular and gastrointestinal diseases increased in both sexes, and mortality from cancer and all causes of death increased among women. The increase in the inequalities of mortality from gastrointestinal diseases was the most rapid: among men—on average, by 0.69% per year, and among women—on average, by 1.43% per year, p <0.0001. Conclusions: During 1990–2018, the inequalities in mortality by place of residence in Lithuania statistically significantly decreased only among men, in terms of mortality from external causes and from all causes. Therefore, reduction in inequalities in mortality must be the main the health policy challenge in Lithuania

Professional burnout of nurses during the COVID-19 pandemic

COVID-19 pandemijos laikotarpiu bene 60,0 proc. visų sveikatos priežiūros specialistų sudarė slaugytojai. Dirbdami COVID-19 infekcijos aplinkybėmis, slaugytojai patyrė psichologinę įtampą, kuri mažino jų veiklos produktyvumą ir didino klinikinės praktikos klaidų riziką. Tyrimo tikslas. Nustatyti chirurgijos skyrių slaugytojų profesinio perdegimo paplitimą COVID-19 pandemijos laikotarpiu. Metodika. 2021 m. gruodžio – 2022 m. sausio mėnesiais Lietuvos sveikatos mokslų universiteto Kauno klinikose (LSMU KK) anoniminės anketinės apklausos būdu apklausta 113 slaugytojų (atsako dažnis – 86,9 proc.). Hipotezėms apie požymių priklausomybę tikrinti taikyti chi kvadrato (χ²) ir z kriterijai. Skirtumai tarp požymių statistiškai reikšmingi, kai p <0,05. Išvados. Pandemijos metu 54,3 proc. respondentų jautė padidėjusį nerimą, 50,0 proc. slaugytojų jautėsi psichologiškai išsekę, tiek pat respondentų tapo mažiau fiziškai aktyvūs. Pagrindiniai stresoriai pandemijos protrūkio metu darbo aplinkoje buvo baimė užkrėsti artimuosius (30,1 proc.) ir baimė užsikrėsti COVID-19 (21,2 proc.). Nors 31,9 proc. tyrime dalyvavusių slaugytojų patyrė aukštą emocinį išsekimą, tačiau tik 5,3 proc. patyrė aukštą depersonalizaciją. Aukštus asmeninius pandeminio laikotarpio pasiekimus nurodė 74,3 proc. tyrime dalyvavusių slaugytojų. Raktažodžiai: profesinis perdegimas, slaugytojai, COVID-19.The pandemic of COVID-19 is one of the biggest global health disasters of the century and the biggest challenges facing humanity. One of the most important health care workers during the pandemic period are nurses, who make up almost 60.0 % of all healthcare professionals. Faced with the COVID-19 infection nurses experienced psychological stress which eventually led to lower productivity and errors in patient care. The aim of this study is to determine the prevalence of burnout in surgical nursing units during the COVID-19 pandemic. In 2021 December - 2022 January 113 nurses were interviewed (response rate – 86.9 %) during an anonymous survey at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics. The chi-square (χ²) and z criteria were used to test hypotheses about established dependence. Differences between groups are statistically significant when p <0.05. During the study, it was found that during the pandemic, 54.3 % respondents felt increased anxiety, 50.0 % of nurses said they were psychologically exhausted also the same number of respondents became less physically active. The main stressors during the outbreak of the pandemic in the work environment were infecting family members (30.1 %) and fear of contracting COVID-19 (21.2 %). Although 31.9 % of the nurses who participated in the study felt high emotional exhaustion, only 5.3 % experienced high depersonalization and 74.3 % accomplished high personal achievements. Keywords: professional burnout, nurses, COVID-19

Amenable mortality inequalities and their changes by place of residence during 1990-2019: the case of Lithuania

Reikšminiai žodžiai: Mirtingumas; Mirties priežastys; Miestas; Kaimas; Nelygybė; Mortality; Causes of death; Urban and rural population; InequalitiesMethods Information on deaths was obtained from Statistics Lithuania and the Institute of Hygiene. Mortality rates from amenable causes of death by urban and rural among men and women were calculated per 100,000 population and were standardized by age. Inequalities in mortality were assessed using rate differences. For the assessment of the trends of mortality and its inequalities during 1990–2019, joinpoint regression analysis was applied. Results During 1990–2019, amenable mortality of men and women in rural areas was higher compared to urban areas (P <0.05). Changes in men’s and women’s mortality and its inequalities between rural and urban areas were characterized by three cut-off points (P <0.05). However, not all the periods between the cut-off points were characterized by statistically significant changes in mortality. A reduction in amenable mortality was more evident in women, especially those living in rural areas. During 1990–2004 and in 2006, the differences in amenable mortality were greater among rural and urban women than among men. However, during 2013–2019, the differences were smaller (P <0.05). Inequalities of men’s mortality decreased during 1990–2001 and 2005–2012, and inequalities of women’s mortality decreased during 1993–2006, 2006–2017, and 2017–2019 (P <0.05). Inequalities of men’s mortality decreased most rapidly during 2005–2012 (on average, by 10.24% per year), while inequalities of women’s mortality decreased most rapidly during 2017–2019 (on average by 18.32% per year) (P <0.05). Conclusion During 1990–2019, inequalities and a decline of inequalities in amenable mortality among rural and urban men and women were identified in Lithuania. The amenable mortality of the residents of Lithuania remained high, changed unevenly, and no significant sharp decrease was observed. Further reduction of inequalities in amenable mortality between rural and urban inhabitants with a special focus on men remain the health policy challenges in Lithuania

Inequalities in life expectancy by education and its changes in Lithuania during 2001-2014

Background and Objectives: Reduction of health inequalities is a highly important task in public health policies worldwide. In Lithuania, inequalities in life expectancy (LE) by education level are among the greatest, compared to other European countries. However, studies on inequalities in LE by level of education over a long-term period are quite scarce in Lithuania. The aim of the study was to analyze inequalities in life expectancy by education and its changes in Lithuania during 2001–2014. Materials and Methods: Information on deaths (in population aged 30 years) was obtained from Statistics Lithuania. Life expectancy at age 30 (LE30) and 95% confidence intervals (CIs) were calculated using life tables. Inequalities in LE30 were assessed using rate differences. Joinpoint regression analysis was used to assess the trends and inequalities of LE30 during 2001–2014. Results: During 2001–2014, LE30 in males and females with post-secondary education was higher than in those with up-to-secondary education (p <0.05). Among males and females, LE30 increased in both education groups, except for males with up-to-secondary education. Among individuals with post-secondary education, LE30 started increasing earlier and more quickly than in those with up-tosecondary education. Over the analyzed period, greater differences in LE30 between post-secondary and up-to-secondary education groups were found among males. Differences in LE30 due to different educational background were statistically significantly, increasing across the sexes with a more rapid increase for females than for males. During 2001 and 2014, the highest number of years of LE30 lost in both education groups was due to cardiovascular diseases. Conclusions: Throughout the period of 2001–2014, life expectancy in Lithuania in the post-secondary education group was statistically significantly longer and was increasing more rapidly compared to the up-to secondary education group. Inequalities in life expectancy by level of education significantly increased among both males and females

Interrupted time series analyses to assess the impact of alcohol control policy on socioeconomic inequalities in mortality in Lithuania: a study protocol

Introduction: Alcohol use is a major risk factor for mortality. Previous studies suggest that the alcohol-attributable mortality burden is higher in lower socioeconomic strata. This project will test the hypothesis that the 2017 increase of alcohol excise taxes linked to lower all-cause mortality rates in previous analyses will reduce socioeconomic mortality inequalities. Methods and analysis: Data on all causes of deaths will be obtained from Statistics Lithuania. Record linkage will be implemented using personal identifiers combining data from (1) the 2011 whole-population census, (2) death records between 1 March 2011 (census date) and 31 December 2019, and (3) emigration records, for individuals aged 40-70 years. The analyses will be performed separately for all-cause and for alcohol-attributable deaths. Monthly age-standardised mortality rates will be calculated by sex, education and three measures of socioeconomic status (SES). Inequalities in mortality will be assessed using absolute and relative indicators between low and high SES groups. We will perform interrupted time series analyses, and test the impact of the 2017 rise in alcohol excise taxation using generalised additive mixed models. In these models, we will control for secular trends for economic development. Ethics and dissemination: This work is part of project grant 1R01AA028224-01 by the National Institute on Alcohol Abuse and Alcoholism. It has been granted research ethics approval 050/2020 by Centre for Addiction and Mental Health Research Ethics Board on 17 April 2020, renewed on 30 March 2021. The time series of mortality inequalities as well as the statistical code will be made publicly available, allowing other researchers to adapt the proposed method to other jurisdictions