Maternal age-associated congenital anomalies among newborns : A retrospective study in Latvia

Background and Objective: In Latvia, the mean age of women giving birth increased from 27.3 in 2000 to 29.0 years in 2010 during the last 11 years. The aim of this study was to report on major congenital anomalies of newborns at birth by the maternal age and to compare the mean maternal age by different diagnosis subgroups and maternal and neonatal characteristics. Material and Methods: A cross-sectional retrospective study with the data from the Medical Birth Register (2000-2010) was carried out. The live birth prevalence rate was calculated for the subgroups of major congenital anomalies per 10 000 live births by the maternal age. Results: The live birth prevalence rate of major congenital anomalies during the period 2000-2010 was 211.4 per 10 000 live births. The prevalence rate increased depending on the maternal age. Congenital heart defects, limb defects, and urinary system anomalies were the most common anomalies. The study results showed an age-related risk of abdominal wall defects, orofacial clefts, and chromosomal anomalies. There were significantly higher proportions of preterm births, newborns with low birth weight, and complications during pregnancy among mothers aged 35 years and more. Conclusions: The data on congenital anomalies from the Latvian Medical Birth Register can be used for the assessment of epidemiology of congenital anomalies. The results of this retrospective study showed a decrease in the live birth prevalence rate of major congenital anomalies despite an increase in the mean age of mothers in Latvia.publishersversionPeer reviewe

Factors determining competitiveness in healthcare institutions in Latvia - Results of the EKOSOC-LV national research programme

Competitiveness as a factor of a company selling its services in the market is becoming more relevant in the healthcare sector. The number of institutions that offer their services to international patients is growing. Research shows that the development of medical tourism is country-specific. The main objective of this publication is to discover positive and negative factors for engagement in the provision of services to non-residents. The data was obtained from a cross-sectional study in which 86 managers of health care institutions in Latvia completed a questionnaire. A total of 80.2% of health care institutions had provided services to non-resident patients in the previous year while 19.8% did so regularly. Institutions mainly used websites to advertise their services. Only a small number of institutions employed a marketing specialist or had a strategy to attract non-resident patients. Heads of institutions pointed to a number of internal and external barriers in this connection, including lack of staff, low motivation, limited language skills, inadequate infrastructure, insufficient state-level support to promote the export of services, the social environment, and problems in the health system itself. The study revealed areas that need to be improved regarding future policies to attract non-resident patients and to increase global competitiveness.publishersversionPeer reviewe

Association of self-rated health, life satisfaction and mental health difficulties in Latvian adolescents

Mental health difficulties are highly prevalent in adolescent populations, but often unrecognised and untreated. The aim of the study was to investigate self-rated health and life-satisfaction as a possible proxy indicator of mental health difficulties in Latvian adolescents. The study was conducted using data from the international Health Behaviour in School-aged Children (HBSC) study year 2017/2018 database. HBSC in 2017/2018 included a mental health-screening instrument - The Strengths and Difficulties Questionnaire (SDQ), which is a brief behavioural screening questionnaire for 3-16 year olds. SDQ results were classified as abnormal, and indicative of significant mental health difficulties, if 22 points and higher were reached on the SDQ total difficulties score (results above the 90th centile). A binomial logistic regression model was used to explore the link between self-rated health, life-satisfaction and mental health difficulties, adjusting for sociodemographic factors (sex, age, ethnicity and socioeconomic status). The sample consisted of 4412 adolescents age 11, 13 and 15. 2224 (50,4%) were girls. Girls in the sample had 1,33 times higher odds (CI 1,07-1,66) [Office1] of reporting significant mental health difficulties. Adolescents who evaluated their socioeconomic status as low had 2,44 times higher odds (CI 1,62-3,69) of reporting significant mental health difficulties. The results of the regression model indicated that even after controlling for sociodemographic factors, adolescents that did not rate their health as good or excellent had 2,56 times higher odds (CI 2,00-3,29), and adolescents with low life satisfaction (0-6 on a 10 point scale) had 3,06 times higher odds (CI 2,39-3,93) of reporting significant mental health difficulties. Poor self-rated health and life satisfaction are important predictors of significant mental health difficulties in the adolescent population. It is recommended to screen adolescents reporting poor self-rated health and life satisfaction in general medical practice for previously undiagnosed mental health difficulties.publishersversionPeer reviewe

The response of patient organizations to the first phase of the COVID-19 pandemic : A qualitative study in Latvia

Patient organizations have proven to be crucial stakeholders for patient needs in the health system. However, the global health crisis due to the emergence of COVID-19 has affected the routine of organizations. This qualitative study explores the experience of patient organizations in adapting their services to the situation during the first phase of the COVID-19 pandemic in Latvia in Spring-Autumn 2020. Fifteen chairpersons of patient organizations were recruited and interviewed using a semi-structured key informant interview. The interviews were recorded, transcribed, and thematically analyzed with manual thematic coding. Four main themes were identified: information needs on COVID-19; diversification of communication channels and their adjustment to the COVID-19 situation; continuity of routine management of patient organization; support mechanisms for patient organizations in the context of the COVID-19 pandemic. Patient organizations experienced a rapidly changing environment as a result of COVID-19 and have had to react immediately to ensure the provision of the service to the patient community they serve.Peer reviewe

Excess mortality associated with the COVID-19 pandemic in Latvia : a population-level analysis of all-cause and noncommunicable disease deaths in 2020

Funding Information: The study was funded by the National Research Program to mitigate the consequences of COVID-19 within the project “Impact of the COVID-19 pandemic on the health care system and public health in Latvia; strengthening the preparedness of the health sector for future epidemics” (VPP-COVID-2020/1-0011). Publisher Copyright: © 2022, The Author(s).BACKGROUND: Age-standardised noncommunicable disease (NCD) mortality and the proportion of the elderly population in Latvia are high, while public health and health care systems are underresourced. The emerging COVID-19 pandemic raised concerns about its detrimental impact on all-cause and noncommunicable disease mortality in Latvia. We estimated the timing and number of excess all-cause and cause-specific deaths in 2020 in Latvia due to COVID-19 and selected noncommunicable diseases. METHODS: A time series analysis of all-cause and cause-specific weekly mortality from COVID-19, circulatory diseases, malignant neoplasms, diabetes mellitus, and chronic lower respiratory diseases from the National Causes of Death Database from 2015 to 2020 was used by applying generalised additive modelling (GAM) and joinpoint regression analysis. RESULTS: Between weeks 14 and 52 (from 1 April to 29 December) of 2020, a total of 3111 excess deaths (95% PI 1339 - 4832) were estimated in Latvia, resulting in 163.77 excess deaths per 100 000. Since September 30, with the outbreak of the second COVID-19 wave, 55% of all excess deaths have occurred. Altogether, COVID-19-related deaths accounted for only 28% of the estimated all-cause excess deaths. A significant increase in excess mortality was estimated for circulatory diseases (68.91 excess deaths per 100 000). Ischemic heart disease and cerebrovascular disease were listed as the underlying cause in almost 60% of COVID-19-contributing deaths. CONCLUSIONS: All-cause mortality and mortality from circulatory diseases significantly increased in Latvia during the first pandemic year. All-cause excess mortality substantially exceeded reported COVID-19-related deaths, implying COVID-19-related mortality during was significantly underestimated. Increasing mortality from circulatory diseases suggests a negative cumulative effect of COVID-19 exposure and reduced access to healthcare services for NCD patients.publishersversionPeer reviewe

A mixed-method study on the provision of remote consultations for non-communicable disease patients during the first wave of the COVID-19 pandemic in Latvia : lessons for the future

Publisher Copyright: © 2022, The Author(s).Background: The COVID-19 pandemic has challenged the ability of healthcare systems to ensure the continuity of health services for patients with non-communicable diseases (NCDs). The issue of remote consultations has emerged. Before the COVID-19 pandemic, remote consultations were not routinely provided or covered by public health funding in Latvia. This study aimed to describe the dynamics of consultations and the volume of remote consultations provided for patients with particular NCD and explore clinicians' experiences of providing remote consultations during the first wave of the COVID-19 pandemic in Latvia. Methods: A mixed-method study focusing on the first wave of the COVID-19 pandemic in Latvia in Spring 2020 was conducted. Quantitative data from the National Health Services were analysed to assess the dynamics of consultations for patients with selected NCDs. Qualitative data were collected through 34 semi-structured interviews with general practitioners (GPs) and specialists and were analysed using an inductive thematic analysis. Purposive maximum variation sampling was used for participant selection. Results: During the period with the strongest restrictions of scheduled on-site consultations, a decrease in the total number of consultations was observed for a variety of NCDs. A significant proportion of consultations in this period were provided remotely. GPs provided approximately one-third of cancer-related consultations and almost half of consultations for the other selected conditions remotely. Among specialists, endocrinologists had the highest proportion of remote consultations (up to 72.0%), while urologists had the lowest (16.4%). Thematic analysis of the semi-structured interviews revealed five themes: 1) Adjusting in a time of confusion and fear, 2) Remote consultations: safety versus availability, 3) Sacrifice and loss of privacy, 4) Advantages and disadvantages of communication technologies, and 5) Different form of communication and a health literacy challenge. Conclusions: During the first wave of the COVID-19 pandemic in Latvia, disruptions to health care services decreased the total number of consultations for patients with NCDs provided by both GPs and specialists. In this period, remote consultations proved to be an important instrument for ensuring the continuity of health care for patients with NCDs, and the necessity to develop a well-designed system for telemedicine in Latvia was highlighted.publishersversionPeer reviewe

Invasive pneumococcal disease in Latvia in PCV10 vaccination era, 2012-2018

Funding Information: This work was supported by the Hepatologu asociacija. Publisher Copyright: © Copyright © 2021 Savrasova, Krumina, Cupeca, Zeltina, Villerusha, Grope, Viksna, Dimina and Balasegaram.In 2010 in Latvia, invasive pneumococcal disease (IPD) became a cause for concern and vaccination of infants with four doses of 7–valent pneumococcal conjugate vaccine (PCV7) commenced. In 2012, 10–valent pneumococcal conjugate vaccine (PCV10) (three doses at 2, 4, and 12–15 month of age) vaccination was introduced. We described incidence and serotype distribution of IPD in Latvia and investigated serotypes associated with death from IPD based on surveillance data. Adult vaccination against pneumococcal infection is not included in the national immunization program. Laboratory confirmed IPD cases are passively notified to the Center for Disease Prevention and Control of Latvia (CDPC) by laboratories and clinicians. We calculated incidence by age, sex, case fatality, and trend in serotypes by conducting a retrospective population-based cross-sectional study based on national IPD surveillance data. From 2012 to 2018 466 cases of IPD were reported. The highest notified incidence was in 2015 at 4.4/100,000, which fell to 3.9 in 2018. The highest mean annual IPD incidence was in infants (4.8) and in the elderly (6.0). PCV10 vaccine serotypes were the most prevalent in IPD cases up to 2015 with a decreasing trend from 50% (20/40) in 2012 to 19% (14/74) in 2018 (chi2 test for trend of odds = 0.000). PCV23nonPCV13 vaccine serotypes had an increasing trend and rose from 18% (7/40) to 34% (25/74) (chi2 test for trend of odds = 0.000). Non-Vaccine serotypes had an increasing trend and rose from 13% (5/40) to 27% (20/74) (chi2 test for trend of odds = 0.038). Reported total case fatality was 19% (87/466). The highest, at 36% (20/56), was reported in 2013. After adjusting for age, Streptococcus pneumoniae serotype 3 was associated with death from IPD (adjusted OR 2.3 95%CI 1.25–4.12 p 0.007). Surveillance data indicate evidence of serotype replacement with an increasing trend of serotype 19A and PPV23nonPCV13 and Non-Vaccine serotypes. Serotype 3 and age were associated with fatal IPD outcome. Further studies of S. pneumoniae carriage would be useful in providing more evidence to characterize serotypes' circulation.publishersversionPeer reviewe

Education, Special Needs, and Autism in the Baltic States: Policy Mapping in Estonia, Latvia, and Lithuania

The Soviet occupation of the Baltic States followed by joining the United Nations (UN) and European Union make these countries an interesting point of comparison in the development of autism and education policy. This study investigates how policies changed following the transition and how the right and access to education are facilitated for autistic children by performing a path dependence analysis. All Baltic States created new education policies following the transition out of the Soviet era, with their accession to the UN and their appetite to follow internationally available guidance. The right to education for all children in was adopted in all education systems. Education facilities for children with disabilities were implemented in all countries. Afterward, all countries started toward the development of more inclusive systems. Nevertheless, the majority of policies did not specify for autism, yet covered special education needs in general. A development in Latvia should be noted, where various special education needs are outlined in national policy, along with provisions and professional assistance required to address them in mainstream or special classrooms. Ultimately, education policy flourished after the transition. Their development caught up to other European Union countries and they are currently working on implementing inclusive education

Adolescent use of social media and associations with sleep patterns across 18 European and North American countries

Objective: Over the past decade, concurrent with increasing social media use (SMU), there has been a shift toward poorer sleep among adolescents in many countries. The purpose of this study was to examine the cross-national associations between adolescent SMU and sleep patterns, by comparing 4 different categories of SMU (nonactive, active, intense, and problematic use). Design, setting, and participants: Data were from 86,542 adolescents in 18 European and North American countries that participated in the 2017/18 Health Behaviour in School-aged study. Measurements: Mixed-effects linear regression models were used to examine cross-national associations between 4 SMU categories and adolescent sleep duration, bedtime and social jetlag derived from self-reported data. Results: For all countries combined, nonactive SMU was associated with longer sleep, earlier bedtimes, and less social jetlag, compared to active SMU, although the differences were minor. By comparison, intense and problematic SMU were associated with less sleep and later bedtimes on both school and nonschool days, and greater social jetlag, compared to active SMU. While findings were relatively consistent between countries, some differences were observed, suggesting that the national and cultural context may be important in interpreting results. Conclusions: These findings suggest that both intense and problematic SMU are associated with poorer sleep patterns in adolescents across most countries. Further research is needed to identify effective policies, programs, and messaging to promote the healthy use of social media and prevent potential negative impacts on adolescent sleep