Health care accessibility and disparities in medical staff availability in Latvia

The Health care accessibility for inhabitants, especially in rural regions, is related to the problem of the medical staff availability in state and municipal hospitals and ambulatory institutions as well as for General Practitioners. Despite the fact, that there are two state Universities – University of Latvia and Rıga Stradiņš University, as well as colleges, that educate medical staff – there is a lack of human resources in health care institutions in Latvia. The Ministry of Health and municipalities had several initiatives to solve this problem – changes in regulations for Residency students, programme financed by European Funds with obtainable funding in the amount of 10 million euro, as well as different stimuli and programmes from municipalities. The research explores the current situation with staff availability and, basing on interviews and outcomes, analyzes the effectiveness of the available programmes to attract human resources, and predict the impact and outcomes of those activities. The results showed that all the programmes had some fragmented positive impact and partially solve the problem, but those activities will not provide sufficient outcomes and the problem of medical staff availability will still be the urgent topic in future.publishersversionPeer reviewe

The voice of society in healthcare politics in Latvia

It is impossible to imagine contemporary democracy without society participation in the process of developing regulations and implementation of changes that have a significant impact on society. The opinion of the society is represented by social communities, interest groups, and other non-governmental organizations, which unite people with similar views and ideas and serves as a representative of common opinion to government. The principles of good governance demand cooperation and collaboration with society in all phases of developing, implementing and assessing changes in any policy. The article represents the research on evaluation of cooperation and collaboration practice, as well as an assessment of used lobbying strategies and evaluation of their results in Healthcare politics in Latvia. The research is based on in-depth interviews with the representative of main actors presenting the NGO sector, as well as the representatives of the Ministry of Welfare. The research results indicated that actors that operate in Healthcare sector use all of the possible lobbying techniques with various outcomes. The achieved results are dependent on the skills and available resources of Interest groups, on the desire and possibilities to follow good governance principles in state authorities, as well as of the topical issue.publishersversionPeer reviewe

Pulmonary endarterectomy in Latvia : A national experience

Publisher Copyright: © 2019 by the authors. Licensee MDPI, Basel, Switzerland.Background and objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a hemodynamic state characterized by chronic obstruction in pulmonary circulation. The treatment of choice is pulmonary endarterectomy (PEA). The aim of our study was to compile and analyze the data of a small, national center, which has not yet been done in the Baltic states. Materials and methods: The data of Latvian CTEPH registry in timeframe from 1 September 2007 to 31 December 2016 was retrospectively analyzed and all patients who underwent PEA were included. Results: PEA was done for 7 patients. The in-hospital mortality was 14%. The 3-year survival rate was 86%. The procedure restored pulmonary blood pressure to normal values for three of the patients (42%). The remaining four patients (57%) had persistent pulmonary hypertension (mPAP > 30 mmHg), which required continuous therapy. There was a comparable decline in mean mPAP compared to baseline, 53.4 ± 14.4 mmHg to 44.3 ± 30 mmHg, respectively. At 12-month follow-up, there was a significant improvement in functional capacity, as seen by increased 6-min walk test distance and shifts in New York Heart Association functional class. Conclusions: Only 16% of all prevalent Latvian CTEPH patients have underwent PEA in the course of nine years, despite it being the treatment of choice for CTEPH. As PEA and other emerging treatment options, such as balloon pulmonary angioplasty, can only be done in expert centers, numerous organizational, logistical, and economic issues arise for patients of smaller countries, where such centers have not yet been created due to lack of experience and limited amount of patients.publishersversionPeer reviewe

Individualized home-based exercise program for idiopathic pulmonary arterial hypertension patients : A preliminary study

Publisher Copyright: © 2019, ČKS.Background: Exercise-based rehabilitation has been proved as a benefi cial additional non-pharmacological treatment in patients with stable pulmonary arterial hypertension (PAH). Majority of studies include hospital-based supervised programs. To improve patient accessibility to this important intervention and long-term efect the research on home-based programs is warranted. The purpose of our study was to evaluate the adherence, safety, training efects of 12-week individualized home-based exercise program in patients with idiopathic PAH. Methods: This was a prospective pilot uncontrolled interventional study. Six patients with iPAH confi rmed by right-heart catheterization from the Latvian PAH registry were selected. A 12-week exercise program adaptable for each patient's functional state and home environment was created. The program included muscle strength training, respiratory, aerobic exercise and neuro-muscular relaxation techniques, self-control monitoring, weekly phone control and on-site re-assessment by physiotherapist were parts of the program to ensure both individualized adjustments and proper execution, and to maximize clinical safety. The primary outcome measures for training efects were exercise capacity, breathing pattern and quality of life, for adherence days of performance, for safety any event of "alarm sign" indicators during exercising, incomplete recovery, worsening of PH symptoms. Results: The results showed a rather high degree of adherence to the prescribed exercise regimen (in average 92.5%). No adverse events were observed during the course of the program. The results proved the importance of ensuring optimal self-control skills both for objective measures and subjective symptoms. The 6-minute walking test (6MWT) results show that the developed program signifi cantly improves exercise capacity (mean improvement 39 ± 17.5 m). In four participants (66.7%) the minimum clinically important diference (MCID) for 6MWT distance in PAH patients was observed (25-33 m). Signifi cant improvement in chest excursions confi rm changes in breathing pattern suggesting better engagement of diaphragm during breathing after the program. Results did not show signifi cant improvements in either SF-36 survey domain. However, half of the participants reached MCID (11%) after the program at the physical health subscales. Conclusion: The results of this preliminary study prove that the created individualized home-based exercise program is safe, easily followed and allows progression in exercise intensity and improves physical functional state in clinically stable iPAH patients. This study hypothesis supports the need for RCT to continue research and approve the results.publishersversionPeer reviewe

Individually tailored 12-week home-based exercise program improves both physical capacity and sleep quality in patients with pulmonary arterial hypertension

Publisher Copyright: © 2021, ČKS.Background: Most patients with optimal PAH-targeted medical therapy suffer from clinical symptoms, reduced exercise tolerance and have a poor quality of life. The 2019 European Respiratory Society task force statement on physical exercise and rehabilitation in patients with severe, chronic PH suggests that individually adjusted and monitored exercise programs are likely to be safe for PH patients, who are clinically stable on medical therapy. Currently, the development of PAH-specific rehabilitation interventions is still in the research stage. We present the preliminary results of a more extensive study with the aim to show the effectiveness of a 12-week individualized, home-based exercise program in promoting physical capacity, quality of sleep and reducing signs of emotional distress in patients with PAH. Methods: This was a prospective randomized controlled interventional study. 16 PAH patients were included in the analysis. Training group underwent a complex training program, consisting of 12-week individually tailored home-based exercise training, education, self-control measures and tele-rehabilitation components. The program included muscle strength training, respiratory, aerobic exercise and relaxation techniques. Results: A statistically significant mean increase in 6MWT distance was observed for the training group (Δ = 51.7 ± 45.1 m). In six participants (66.7%) from the training group and two patients (28.6%) from the control group, the minimal clinically significant difference for 6MWT distance was observed (25–33 m). IPsubmax test results changed significantly in training group (Δ = 9.8 ± 4.7 cm H20). PSQI values sleep quality improved from poor to good in four (44.5%) patients from training group. HADS sub-scales scores values confirmed clinically important reduction of anxiety symptoms in both groups. Depression symptoms did not show clinically important changes. No adverse events were observed. Conclusion: The studied 12-week individually tailored home-based exercise program is effective in stable PAH patients by improving physical functional capacity, as well as sleep quality. Further studies are required to solidify the methodology of exercise programmes in the field of PAH. These are the preliminary results of ongoing study.publishersversionPeer reviewe

Individually Tailored Remote Physiotherapy Program Improves Participation and Autonomy in Activities of Everyday Life along with Exercise Capacity, Self-Efficacy, and Low-Moderate Physical Activity in Patients with Pulmonary Arterial Hypertension : A Randomized Controlled Study

Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Background and Objectives: Pulmonary arterial hypertension (PAH) is a rare, chronic, pro-gressive, and life-threatening disease; however, the appropriate target medical treatment today allows patients with PAH not only to survive but also to live a relatively normal life. However, patients face the challenge of adapting and maintaining a good quality of life, thus it is important to consider complex interventions related not only to medical treatment. Methods: This was a prospective, ran-domized, controlled, single-blind study. Twenty-one (21) patients diagnosed with PAH were included and randomly assigned to training or control group. All participants continued target medical therapy. Furthermore, TG underwent the individually tailored 12-week remote physiotherapy program. As a primary outcome measurement, the Impact on Participation and Autonomy Questionnaire (IPA) was used. Secondary outcome included aerobic capacity (6MWT), accelerometery and general self-efficacy (GSE). Data were collected at baseline, after 12 weeks and at follow-up 6 months after the beginning of the intervention. Results: A significant difference between the groups was found in the follow-up assessment on three of the four IPA subscales analyzed, AO, RF, and AI. The total IPA score decreased significantly in TG after the program, indicating an improved participation. In addition, in TG a significant increase in 6MWT results, daily time in low-or moderate-intensity physical activities, and GSE was observed. Conclusions: In summary, the individually tailored physiotherapy program inves-tigated added to stable target medical therapy in patients with PAH encourages improvement and prevents possible deterioration of perceived participation of patients in activities of their everyday life in the context of one’s health condition in the long term, along with improved exercise capacity and increased time spent in low-or moderate-intensity physical activities. Future studies are needed to develop and evaluate long-term intervention to support patients living with this rare, chronic, and life-threatening disease.publishersversionPeer reviewe

Choriocarcinoma mimicking chronic thromboembolic pulmonary hypertension

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Glomerular filtration rate as a prognostic factor for long-term mortality after acute pulmonary embolism

Publisher Copyright: © 2019 The Author(s) Published by S. Karger AG, Basel.Background: In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. Objective: To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. Patients/Methods: The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. Results: In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919-0.979; 1-year: HR 0.967, 95% CI 0.943-0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915-0.983; 1-year: HR 0.971, 95% CI 0.945-0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. Conclusion: Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.publishersversionPeer reviewe

Characteristics and survival data from Latvian pulmonary hypertension registry : comparison of prospective pulmonary hypertension registries in Europe

Publisher Copyright: © The Author(s) 2018.Patient registries are a valuable tool in the research of rare conditions such as pulmonary hypertension (PH). We report comprehensive hemodynamic and survival data of 174 patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), included in the prospective Latvian PH registry over a period of > 9 years. In total, 130 adult PAH patients (75%) and 44 adult CTEPH patients (25%) were enrolled. The median follow-up period was 33 months for PAH and 18 months for CTEPH, P = 0.001. Latvian CTEPH patients had significantly higher plasma levels of B-type natriuretic peptide, higher pulmonary vascular resistance, and lower cardiac index than Latvian PAH patients. Calculated incidence of PAH and CTEPH in Latvia in 2016 was 13.7 and 5.1 cases per million inhabitants, calculated prevalence was 45.7 and 15.7 cases per million inhabitants, respectively. Survival rates at one, three, and five years for PAH patients was 88.0%, 73.3%, and 58.1%, and 83.8%, 59.0%, and 44.2% for CTEPH patients, respectively. We compared our study results with data from European adult PH registries. Latvian PAH patients had the fourth lowest and CTEPH patients the lowest one-year survival rate among European adult PH registries. As most PH registries in Europe are small, yet with equivalent patient inclusion criteria, it would be desirable to combine these registries to produce more reliable and high-quality study results.publishersversionPeer reviewe

Individually tailored home-based physiotherapy program makes sustainable improvement in exercise capacity and daily physical activity in patients with pulmonary arterial hypertension

Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study did not receive funding but was financially supported by Pauls Stradins Clinical University Hospital Scientific Institute (provision of IMT devices) and the Latvian Rare Diseases Research Foundation along with Beurer Company (provision of pulse oximeters). Publisher Copyright: © The Author(s), 2022.BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare, chronic, progressive, and life-threatening cardiopulmonary disease. This study investigated the impact of an individually tailored 12 weeks home-based physiotherapy program in PAH patients, with the aim to evaluate change in exercise capacity and daily physical activity level. METHODS: This was an analysis of secondary outcomes from a prospective, randomized, controlled intervention study. Twenty-one participants were recruited from the Latvian PH registry based on inclusion criteria and randomized in a training group (TG) and control group (CG). Both groups continued a medical target therapy, but for TG, the individually tailored home-based physiotherapy program was added including physical exercises, relaxation, self-control, education, and supervision with telehealth elements. Outcomes included a 6-min walk test (6MWT) (m) and daily physical activity based on accelerometry results assessed at baseline, after 12 weeks, and at follow-up 6 months after commencement of intervention. RESULTS: 6MWT distance significantly (p 33 m) increased within TG after 12 weeks (51.8 m, 95% CI = 25.7-77.9 m, Cohen's d = 1.7) and at follow-up (75.5 m, 95% CI = 46.1-104.8 m, Cohen's d = 2.1). A significant difference in 6MWT results between the groups at 12 weeks and follow-up was approved. In TG, low-intensity activities significantly (p < 0.05) increased both after 12 weeks (Cohen's d = 1.6) and at follow-up (Cohen's d = 1.2), moderate-intensity activities significantly (p < 0.05) increased at follow-up (Cohen's d = 1.3), and no significant improvements were present in CG. CONCLUSION: The individually tailored 12 weeks home-based physiotherapy program comprising comprehensive physical exercise training, relaxation, self-control skills training, and education, added to stable medical target therapy and supervised by physiotherapist through telehealth elements, is effective in improving exercise capacity and increasing daily time in low or moderate physical activities 6 months after commencement of the intervention in patients with PAH.publishersversionPeer reviewe