Epidemiology of Lyme Disease in a Highly Endemic European Zone

Background and objective: Lyme disease, also known as Lyme borreliosis (LB), is a tick-borne infectious disease caused by the spirochete bacteria Borrelia. The risk of infection depends on the geographical area, ecological factors, and human behavior. Clinical manifestations of Lyme borreliosis have a wide range, but the most frequent clinical symptom, which is also a diagnostic symptom, is a skin rash called erythema migrans (EM). The disease is very common worldwide. In Lithuania, the disease frequency is 99.9 cases per 100,000 population (Centre for Communicable Diseases and AIDS, Lithuania, 2017). The main aim of this study was to obtain the baseline characteristics of the disease regarding the infected Lithuanian population. Materials and Methods: We analyzed data from the Centre for Communicable Diseases and AIDS about all Lyme disease (A69.2) diagnosed patients over a three-year period (from 2014 to 2016) in Lithuania. Results: In 2014–2016, 7424 (crude incidence rate 85.4) cases with LB were diagnosed in Lithuania. Most of them (4633 (62.4%)) were identified in women. Older people were more likely to suffer from LB. Urban residents were 2.6 times more often affected that those living in villages. Tick bites were primarily observed in high season months, from May to September (90%), with the highest peak in July. There was a higher number of observed tick bites (p = 0.003) in the urban residents. Erythema migrans occurred in 75.6% LB cases, while other symptoms did not exceed a quarter of all LB cases. There were 7353 (99.6%) cases where LB was confirmed via clinical symptoms and/or laboratory tests. Also, 1720 (23.2%) patients were tested for LB immunoglobulins. Conclusions: This study found a high incidence of Lyme disease in Lithuania. We elucidated the baseline characteristics regarding the infected Lithuanian population which may ease medical clinicians’ work on new Lyme diagnoses

Clinical syndromes and epidemiological factors of Lyme disease in Lithuania

Lyme disease is the most common tick-borne infectious disease in Europe. The pathogen is the gram-negative bacterium spirocheta Borrelia burgdorferi (B. burgdorferi). More than 20 genotypes of this bacterium are isolated, four of which are pathogenic to humans and result in the development of LL: B. burgdorferi sensu strictu (B. burgdorferi ss), B. afzelii, B. garinii, B. bavariensis. Each of these genotypes is associated with different clinical manifestations of Lyme disease. B. burgdorferi ss is associated with joint damage, B. afzelii is associated with neurological changes, B. garinii is associated with dermatological damage. The global prevalence of these B. burgdorferi genotypes varies, B. burgdorferii ss is found in North America, but can also be found in Europe, and B. afzelii and B. garinii are prevalent in Europe and Asia. Since the manifestations of the disease are diverse, this disease is faced by doctors of many specialties. Therefore, it is very important to know how the disease manifests itself in our country, to single out individuals of the risk group. This doctoral dissertation provides a detailed overview of Lyme disease factors in Lithuania, includes data on epidemiological disease factors and clinical manifestations of the disease

Laimo ligos klinikiniai sindromai ir epidemiologiniai rodikliai Lietuvoje

Lyme disease is the most common tick-borne infectious disease in Europe. The pathogen is the gram-negative bacterium spirocheta Borrelia burgdorferi (B. burgdorferi). More than 20 genotypes of this bacterium are isolated, four of which are pathogenic to humans and result in the development of LL: B. burgdorferi sensu strictu (B. burgdorferi ss), B. afzelii, B. garinii, B. bavariensis. Each of these genotypes is associated with different clinical manifestations of Lyme disease. B. burgdorferi ss is associated with joint damage, B. afzelii is associated with neurological changes, B. garinii is associated with dermatological damage. The global prevalence of these B. burgdorferi genotypes varies, B. burgdorferii ss is found in North America, but can also be found in Europe, and B. afzelii and B. garinii are prevalent in Europe and Asia. Since the manifestations of the disease are diverse, this disease is faced by doctors of many specialties. Therefore, it is very important to know how the disease manifests itself in our country, to single out individuals of the risk group. This doctoral dissertation provides a detailed overview of Lyme disease factors in Lithuania, includes data on epidemiological disease factors and clinical manifestations of the disease

The influence of assessment and modification of cardiovascular risk on atherosclerosis progression and relation to the markers of arterial wall damage

This paper reviews the 1997−2008 experience gained by the Preventive Cardiology unit since its establishment in the department of Cardiovascular diseases of Vilnius University. We summarize the results of managing 1624 patients with coronary heart disease, 977 subjects with different cardiovascular risk (metabolic syndrome, diabetes, dyslipidaemia, arterial hypertension, healthy controls), evaluated 236 subjects from 67 families in the genetic project. A survey on the lifestyle, risk factors and use of cardioprotective drug therapies in patients with coronary heart disease from 22 European countries has showed major patient management differencies between Lithuania and other countries. The large proportion of patients in Lithuania do not achieve the targets for cardiovascular disease prevention, especially in lipid management. There is still considerable potential in Lithuania to raise standarts of cardiovascular prevention. We analyzed the prevalence of conventional risk factors among our patients with coronary heart disease and showed that they are more common than described in the literature. Our data revealed that 98% of coronary patients had at least one of four conventional risk factors. Two-thirds (66,5%) of younger patients (<55 years) with coronary heart disease had two and more risk factors. We have found statistically significant correlation between atherosclerosis progression rate in the coronary arteries and risk factors: elevated blood pressure, blood glucose, homocystein, lipoprotein (a), low density lipoprotein cholesterol. Central obesity and any type of glycaemic disorder seem to be core components of the metabolic syndrome. Waist cimcumference are significantly correlated with the insuline resistance indexes in our patients. Other findings indicate that the immunological and inflammatory factors (adhesion molecules, cytokines, etc.) are significantly higher in acute coronary group compared with the normal levels in healthy subjects, so those factors could be markers of atherosclerosis and the severity of coronary heart disease. We have analyzed efficacy and safety of different antiatherosclerotic and cardioprotective drugs. Our findings demonstrate that calcium channel blocker improves flow-mediated dilatation in the brachial artery in patients with coronary vasospasm. This improvement was accompanied by the improvement of angina characteristics. There were no allelic variants associated with the susceptibility to atherosclerosis identified in our first genetic study. Further studies are warranted including more families. The first experience with arterial dysfunctional and wall structural markers have shown that carotid intimal-medial thickness, presence of plaques, flow mediated dilatation of brachial artery, aortic stiffness parameters are related to traditional cardiovascular risk factors and can help to predict cardiovascular risk

Evaluation of arterial hypertension control and treatment in daily practice of family physicians

The objective of this study was to evaluate the percentage of patients with primary arterial hypertension treated with antihypertensive drug(s), who achieved target arterial blood pressure (ABP), and to compare the characteristics of patients with controlled and uncontrolled ABP, their current treatment, and treatment modifications. Material and methods. A total of 429 18–80-year-old patients with primary arterial hypertension treated for ≥1 year participated in this study. General practitioners collected data on patients’ demographic and clinical characteristics, current treatment for primary arterial hypertension, and treatment modifications. Results. According to physicians, 45.4% of patients achieved target ABP levels. Adequately controlled ABP was documented more often in the group of low and moderate cardiovascular risk than in high- and very high-risk group (n=141, 62.9% versus n=54, 26.3%; P&lt;0.0001). Based on ABP measurements, 160 (37.3%) patients had ABP of &lt;140/90 mm Hg. The majority of patients were treated with a combination of two (n=153, 35.7%) to three (n=144, 33.6%) antihypertensive drugs. Patients with uncontrolled ABP more frequently than patients with controlled ABP were given combination therapy. Treatment was not modified in 37.8% (n=162) of patients, more commonly in those with controlled ABP. Conclusions. The level of hypertension control in study population was far from optimal, especially in the group of patients at high- and very high-risk where target ABP was lower. Almost 12% of patients with uncontrolled ABP were still undergoing monotherapy, whereas 16% of patients were not recommended any modifications of antihypertensive treatment despite their ABP was not controlled

Slightly intellectual disability students‘ creative expression in technology lessons

Darbe analizuojama nežymų intelekto sutrikimą turinčių mokinių kūrybinė raiška technologijų pamokose. Pasitelkus vizualinius kūrybingumo stimuliavimo metodus technologijų ugdymo procese įgyvendinamas pedagoginis eksperimentas. Tikslas – ištirti nežymų intelekto sutrikimą turinčių mokinių kūrybinės raiškos pokyčius, naudojant vizualinius kūrybingumo stimuliavimo būdus. Tyrimo metodai: mokslinės literatūros ir dokumentų analizė; kokybinis tyrimas – pedagoginis eksperimentas. Nežymų intelekto sutrikimą turinčių mokinių kūrybingumo sampratos ir vizualinių kūrybingumo ugdymo metodų analizė atskleidė, kad šie mokiniai pasižymi specifiniu kūrybingumu. Pirmojo diagnostinio pjūvio duomenų analizė atskleidė, jog nežymų intelekto sutrikimą turinčių mokinių ryškiausias kūrybingumo bruožas - detalumas pasižymi elementų gausa, tačiau pasigendama elementų įvairovės ir jų tarpusavio darnos. Antrojo diagnostinio pjūvio duomenų analizė parodė, kad nežymų intelekto sutrikimą turinčių mokinių kūrybingumo stimuliavimo labiau nuo tikrovės nutolusių objektų vaizdais poveikis ryškiausiai atsiskleidė kūrybiniu detalumu konstrukcinių medžiagų srityje. Trečiojo diagnostinio pjūvio duomenų analize atskleidė, kad kūrybingumo stimuliavimas vizualiniais – patirtiniais metodais ryškiausiai atsiskleidė kūrybiniu sklandumu tekstilės srityje. Remiantis pedagoginio eksperimento rezultatais galima daryti prielaidą, kad kryptingai taikant vizualinius kūrybingumo stimuliavimo metodus galima paskatinti mokinių technologinį kūrybingumą. Minėtų metodų naudojimas didžiausią poveikį turėjo kūrybinio sklandumo raiškai. Didesnį poveikį kūrybingumui plėtoti turėjo stimuliavimas vizualiniais – patirtiniais metodais, o mokinių kūrybingumo plėtrai palankiausia buvo mitybos sritis. Stimuliavimas vizualiniais nuo tikrovės nutolusiais objektais mažiausią poveikį turėjo lankstumo raiškai. Nepalankiausia mokinių kūrybingumo plėtrai elektronikos sritis. Šiame darbe analizuojama vizualinių kūrybingumo stimuliavimo metodų įtaka nežymų intelekto sutrikimą turinčių mokinių kūrybingumo plėtrai galėtų sudominti specialiuosius pedagogus ir technologijų mokytojus, ugdančius specialiųjų poreikių mokinius.The article analyzes the slight intellectual disability students‘ creative expression in technology lessons. With the help of visual creativity stimulation techniques technology in the technology educational process implemented pedagogical experiment. Purpose - to investigate a minor intellectual disability students‘ creative expression changes using visual creativity stimulation techniques. Investigation methods: analysis of scientific literature and documents; qualitative investigation - educational experiment. The slight intellectual disability students‘ creative concepts and visual creativity in education methods analysis revealed that those students with specific creativity. The first section of the diagnostic analysis of the data revealed that a slight intellectual disability students‘ the most notable feature of creativity - is characterized by the abundance of elements of detail, but lacks the elements of diversity and coherence between them. Second section of the diagnostic analysis of the data showed that a slight intellectual disability students‘creative stimulation from reality more distant subjects, the effect most marked during the creative detail in the construction materials range. The third section of the diagnostic analysis of the data revealed that visual stimulation of creativity - most vividly shown during experiential methods of creative fluidity of textiles. According to the teaching of the experiment results suggest that specific stimulation of creativity through visual techniques can stimulate students' technological creativity. Mentioned techniques had the greatest impact on the creative fluency expression. Greater impact on the development of creativity was visual - experiential methods stimulation and the development of students' creativity was favorable nutrition. Visual stimulation from the reality distant objects have a minimal impact on the flexibility expression. Unfavorable development of students' creativity in the electronics field. This paper analyzes the visual creativity stimulation techniques influence on a slight intellectual disability students‘ creative development to interest special educators and technology teachers who teach special needs students.Švietimo akademijaVytauto Didžiojo universiteta

The features of parents involvement in a nurture of children in preschool groups

The subject of a master's work- the features of parents involvement in a nurture of children in preschool groups.Švietimo akademijaVytauto Didžiojo universiteta

Balys sruoga and jurgis savickis: art reform and its recognition

XIX-XX century junctions, and the twentieth century the beginning in Lithuania formed typological literature research, criticism, was to settle the essence of art, originality, problem, and do not dispute. In this context, as one of the most active reformers Lithuanian literature, there Balys Sruoga and Jurgis Savickis. So the goal - to recognize the art criticism of the reform of Sruoga and Savickis creation. 1. The first task of the work - to provide the philosophy of art intuitivism features. 2. The second task of this work - to analyze the literary theories and methods in the understanding of B. Sruoga criticism. 3. The third task - to reveal the art concept of B. Sruoga criticism. 4. The fourth task of working out J. Savickis assessments of his creative; to reveal features of the modern artist's creativity, to explore the J. Savickas creative source of innovation. The work led to the following conclusions. 1. Intuitive philosophy of art, the art world and the intuitive understanding of knowledge in the set, emerged as a reaction to the rationalist and positive ideas institutionalized. These early-oriented – H. Bergson and B. Croce. 2. B. Sruoga highlights the main achievements of the literature of science challenges the substance and the form should be examined analytically, biographical and historical, and only after all of this work can be assessed. Evaluation of a work of art, according to B. Sruoga requires constant spiritual renewal, because the art work is open to various interpretations. Allotting philological, aesthetic, biographical-psychological and cultural-historical approaches Sruoga express their views on the works of the language, style and context reveals the importance of their understanding of the substance and form of unity, the psychological things, the aesthetic value of the determination of the complexity. 3. Works of B. Sruoga divided into the conscious and the unconscious. Himself closer to automatic art. Meanwhile, it is very close to intuitive school. Of the lyric B. Sruoga requires inspiration, the expressions power, a sense of purity, volatility of thought, form and content of the synthesis. But poetry can not be mechanical, the poet must survive. Sruoga thinking is a particularly striking modernity, avant-garde as racionalistic doubt classicist and traditions, individual artistic identity fredom, expression aspect of the routine work of foms requires the rejection of the radical reform of the art. 4. J. Savickas novels crucial in the context of the evaluations and opinions, not only in their speech era, but nowadays. The creator of many books of his literary contemporaries seemed unusually innovative, and confusing. However, Savickas works, however, the context and enthusiastic supporters. One of them - B. Sruoga. Maximum Savickis creative innovation is that the creator of her work, highlighting what is unconscious, irrational, and the will of the uncontrolled mind. Savickas story mode does not meet the objective in the usual classical epic tale tone of the birth of a new Savickis novel form. Savickis prosaic demonstrates a new technique, in rejecting the established Stencil write another novel and creating the world. Savickis play images, perspectives, interest details, and especially style. From the traditional Lithuanian prosaic different and novel topics. It is away from the rural to recent Lithuanian literature world-view and realistic and the romantic literary tradition. Savickis its növelése a new urban, upper-class culture topic. The creator of the Lithuanian literature "bring" modern civilization man - ironic, skeptical, affected gloomy environment, the weak, no higher ideals and unpredictable behavior. It raises new human noveles - marionette motif. Savickis innovative creative origin had a significant impact on the Russian and Polish culture. It is also Savickis identified himself as a painter, very interested in theater

Nežymų intelekto sutrikimą turinčių mokinių kūrybinio originalumo neverbalinės raiškos pokyčiai technologijų pamokose

This article analyzes the slight intellectual disability students‘ creative originality expression in technology lessons. Technological development consists of four areas: textiles, nutrition, construction materials and electronics. The authors organize and implement educational experiment: with the help of information technology in the educational process by technological development areas using visual creativity stimulation techniques. At the beginning and end of the educational experiment conduced diagnostic test sections. Comparing the data obtained by the above-mentioned sections change, showing the visual methods in the educational process of slight intellectual disability students‘ creative expression of originality technology lessons. Informants creative originality is measured by the article’s authors selected seven creative originality of expression evaluation criteria. The research problem: what is a slight intellectual disability students‘ creative originality of expression change in technology lessons using visual methods of education, and technology education in the areas where it occurs the most. The research problem: what is a slight intellectual disability students‘ creative originality expression change in technology lessons using visual methods of education, and technology education in the areas where it occurs the most. Object - slight intellectual disability students‘ creative originality.Purpose – to assess slight intellectual disability students‘creative originality of expression changes in technology lessons using visual education methods. Investigation methods: analysis of scientific literature and documents; qualitative study – educational experiment. The first section of the diagnostic data revealed that a slight intellectual disability students characterized by realistic, distinctive creative originality, which is mostly revealed in objects decoration. It should be noted that there is a necessary condition - the principles of humanism based on the learner and educator relationship. Second section of the diagnostic analysis of the data showed that a stimulation of slight intellectual disability students more creativity from the reality of distant subjects, the originality of creative expression become more liberal, and expression of the mean values generally increase. Noticeable signs of change in objects decoration - from the everyday, real parts toward imaginary, unseen objects. An important fact that a slight intellectual disability students‘created objects unrealistic plot is positive, demonstrating altruism, assistance to the other, efforts for the general welfare, felt empathy. In safe environment for creative expression slight intellectual disability students are enjoying the creative process, expressing his admiration for the work of others, and are encouraged to act themselves and others