Background: Inappropriate use of medications (IUM), in particular inappropriate prescribing and non-adherence to prescribed medications, are important causes of drug-related morbidities (DRMs). They are increasing problems with the ageing populations and the growing burden of chronic conditions. However, research is needed on the association of IUMs with DRMs in outpatient settings and in the general population. Aim: The aim of this thesis is to estimate and analyse the burden of potentially inappropriate prescriptions (PIPs) in the elderly and non-adherence to long-term medications among adults across care settings, and to investigate how IUM is associated to DRMs. Methods: A meta-analysis summarised the previous evidence on the percentage of adverse drug reactions (ADRs) associated to IUM across healthcare settings (Study I). From a cohort in the general population, using medical records and register data, the prevalence of PIPs in the elderly and its association with ADRs were estimated retrospectively (Study II). From the same cohort, the factors associated with refill non-adherence to antihypertensive therapy, considering the use of multiple medications, and the association between non-adherence and sub-therapeutic effects (STEs) were investigated (Study III). A survey assessed the refill behaviour to antihypertensive, lipid lowering and oral antidiabetic medications (undersupply, adequate supply and oversupply), and its association with perceived ADRs and STEs (Study IV). Results: IUM was the cause 52% and 45% of ADRs occurring in adult outpatients and inpatients respectively. Across healthcare settings, 46% of the elderly refilled PIPs over a 6-month period; PIPs were considered the cause of 30% of all ADRs; and the elderly who were prescribed PIPs had increased odds to experience ADRs (OR 2.47, 95% CI 1.65-3.69). In total, 35% was nonadherent to the full multidrug therapy and 13% was non-adherent to any medication (complete non-adherence).  Sociodemographic factors (working age and lower income) were associated with non-adherence to any medication, while clinical factors (use of specialised care, use of multiple medications, and being a new user) with non-adherence to the full multidrug therapy. STEs were associated with non-adherence to any medication a month prior to a healthcare visit (OR 3.27, 95% CI 1.27-8.49), but not with long-term measures of non-adherence. Among survey respondents, 22% of the medications were oversupplied and 12% were undersupplied. Inadequate refill behaviour was not associated with reporting ADRs or STEs (p<0.05). Conclusions: A large proportion of ADRs occurring in hospital is caused by IUM, but more knowledge is needed in other settings. PIPs are common in the elderly general population and associated with ADRs. Therefore decreasing PIPs could contribute towards ADR prevention. Considering the use of multiple medications may help to better understand the factors associated with non-adherence to a multidrug therapy for tailoring the interventions to patient needs. Monitoring the adherence prior to a healthcare visit may facilitate interpreting STEs. Yet, the absence of an association between long-term measures of refill non-adherence with clinical and perceived DRMs suggest the need to enhance the knowledge of this association in clinical practice. In summary, this thesis shows a significant potential for improvements of medication use and outcomes.

Einleitung: L-Carnitin spielt eine zentrale Rolle im Energiestoffwechsel. Da dieser in der Frühlaktation bei Hochleistungskühen besonders beansprucht und z.T. überlastet wird, ergibt sich die Frage, ob durch L-Carnitinsupplementation ein stabilerer Stoffwechsel und damit bessere Leistungen erreicht werden können. Zielstellung: Es wurde geprüft, ob bei Hochleistungskühen mit einer mittleren Milchleistung von 12000 kg/Jahr die orale Supplementation von L Carnitin im peripartalem Zeitraum bei zwei verschiedenen Applikationszeiträumen Stoffwechsel-, Leistungs- und Gesundheitsverbesserung erbringt. Versuchsanordnung: Aus einer Gesamtherde von 322 Kühen wurden 81 Tiere randomisiert auf vier Gruppen aufgeteilt. Zwei dieser Gruppen erhielten L-Carnitin (Supplementationsgruppen) und die anderen zwei Gruppen stellten die Kontrollgruppen (KG 1 n = 14/ KG 2 n = 11) dar. Von den supplementierten Gruppen erhielt Car. 1 (n = 26) von 3 Wochen (Wo.) ante partum (a.p.) bis zur Kalbung über das Futter täglich 5g L Carnitin (Carnipas®). Post partum bekamen die Tiere 1g L Carnitin von der Kalbung bis vier Wo. p.p. Parallel wurden einer zweiten supplementierten Gruppe, Car. 2 (n = 30), täglich 5g L Carnitin 3 Wochen a.p. bis zur Kalbung verabreicht. Klinische und Blutkontrollen erfolgten 28 Tage (d) a.p., drei d p.p, 28 d p.p. sowie 56 d p.p. Es wurden das Gesamtcarnitin (GC, n = 5), das freie Carnitin (FC, n = 5), Carnitinester (CE, n = 5), FFS, BHB, Bilirubin, Glucose, Cholesterol, Harnstoff, TTP, Albumin, CK, AST, Pi, Ca, Fe bei allen Tieren analysiert. Zusätzlich erfolgte die Erfassung der Laktationsleistung, der Milchinhaltsstoffe, der Rastzeit (RZ), der Zwischentragezeit (ZTZ) und der Morbidität. Ergebnisse: Das GC, FC und die CE besitzen in den supplementierten Gruppen Car 1 drei d p.p. höhere Konzentrationen als die Kontrollgruppen, die bei Car. 2 (p < 0,05) im GC und FC auch im weiteren Verlauf beobachtet wurden. Ein deutlicher Konzentrationsabfall aller L-Carnitinfraktionen vier Wo. p.p. wurde in den supplementierten Gruppen beobachtet. In den Kontrollgruppen stiegen sie zur gleichen Zeit nicht einheitlich an. Acht Wochen p.p. sanken die L-Carnitinkonzentrationen im Blut sowohl in den Kontrollgruppen, als auch in der supplementierten Gruppen weiter ab. In allen Gruppen stiegen drei d p.p. die FFS-Konzentrationen an (p < 0,05), das BHB auch in den supplementierten Gruppen, die Glucose- und Cholesterolkonzentration fielen ab (p < 0,05). Vier und 8 Wo. p.p. ließen sich ein Abfallen der FFS- (p < 0,05) und der BHB-Konzentrationen (p < 0,05) erkennen. Die Cholesterol- (p < 0,05) und verzögert auch die Glucosekonzentration stiegen an. Drei d p.p. stiegen die Bilirubinkonzentration (p < 0,05) und die AST-Aktivität (p < 0,05) an, dem ein ebensolcher Abfall (p < 0,05) folgte. Präpartal trat in der supplementierten Gruppen Car. 2 eine höhere Bilirubinkonzentration als in der Kontrollgruppe (p < 0,05) auf, was bei den AST-Aktivitäten zwischen den supplementierten Gruppen postpartal (p < 0,05) der Fall war. Drei d p.p waren niedrigere Konzentrationen des Proteins (p < 0,05), des Albumins (p < 0,05) in Car. 2 und in der Kontrollgruppe sowie des Harnstoffs (p < 0,05) in den Kontrollgruppen zu beobachten. Die CK-Aktivität nahm drei d p.p. zu (p < 0,05), um vier Wo. p.p. wieder abzufallen (p < 0,05). Gleichzeitig war einen Anstieg des Proteins (p < 0,05) und des Albumins in den Kontrollgruppen (p < 0,05), verzögert auch in den supplementierten Gruppen (p < 0,05), messbar. In allen Gruppen waren drei d p.p. niedrigere Ca- (p < 0,05), Fe- (p < 0,05) und Pi- Konzentrationen (p < 0,05) auffällig, die später wieder anstiegen. Im Verlauf war die Ca-Konzentration bei Car. 2 gegenüber der Kontrollgruppe höher (p < 0,05). Die Leistungsparameter differierten weder bei den Milchleistungs-, noch bei den Fruchtbarkeitskennzahlen gesichert. Bezüglich der Morbidität war auffällig, dass das GC und FC bei gesunden Kühen a.p. gegenüber den im Laktationsverlauf erkrankten gesichert höher war (p < 0,05). Schlussfolgerungen: Orale L Carnitinapplikation bei Kühen mit hohem Milchleistungsniveau erbrachte keine Stoffwechsel-, Leistungs- und Morbiditätsunterschiede gegenüber den Kontrollgruppen. Die Ergebnisse entsprechen aber der Hypothese einer gesteigerten ß-Oxidation durch die Carnitinsupplementation mit erhöhten BHB-Konzentrationen als Folge. Post partum gesunde Kühe hatten a.p. signifikant höhere L-Carnitinkonzentrationen als kranke.

Live kidney donors are healthy volunteers who are exposed to major surgical procedure and physical harms with no direct therapeutic benefits. Efforts to minimize their risks and morbidity are therefore of utmost importance. The current thesis describes studies on donor evaluation, surgical procedure and postoperative management of live kidney donors. The overall purpose is to evaluate and possibly improve routines and treatments in order to reduce risks and the overall morbidity of live kidney donors. In Study I, we evaluated the assessment of kidney function during donor evaluation and found that the accuracy of iohexol glomerular filtration rate (GFR) is compromised by large variations in repeated measurements in presumably healthy donors. We proposed that there is a need for improvement of GFR measurements and that the assessment of predonation kidney function should be more comprehensive, involving GFR, laboratory investigations, functional and morphological examinations and sound clinical judgment. In Study II, we addressed the risk of perioperative venous thromboembolism (VTE) and concluded that expanding the standard screening protocol for VTE to include perioperative venous duplex can potentially decrease the VTE-related morbidity. In studies III and IV, we investigated the impact of hand-assisted retroperitoneoscopic (HARS) nephrectomy on donor safety and perioperative morbidity. The HARS nephrectomy uses the hand-assisted approach, which enables immediate manual compression for hemostasis in case of sudden and severe bleeding. Additionally, the pure retroperitoneal access further increases the safety margin of laparoscopic donor nephrectomy by 1) minimizing the risk of intestinal injury, and 2) exposure of the retroperitoneal nerves, making HARS suitable for continuous infusion of local anesthetics (CILA). CILA effectively reduces the need for opioid consumption and has the potential to totally obviate opiate analgesics postoperatively. Consequently, CILA in combination with HARS reduces morphine-related morbidity and promotes postoperative recovery. In accordance with these data, we recommend improvement and modification of the donor evaluation process as well as a broad introduction of HARS nephrectomy in combination with CILA to increase the safety margin for live kidney donors.

Dental caries and periodontal disease are the major causes for tooth loss. While dental caries commonly involve the posterior teeth in both jaws, the teeth most commonly lost due to periodontal problems are the first and second molars in the maxilla. As a consequence, the upper posterior jaw is frequently edentulous. Implant therapy today is a predictable treatment modality for prosthetic reconstruction of edentulous patient. Insufficient amounts of bone, due to atrophy following loss of teeth or due to the presence of the maxillary sinus, can make it impossible to insert implants in the posterior maxilla. During the 1970s and 1980s, Tatum, Boyne and James and Wood and Moore first described maxillary sinus floor augmentation whereby, after the creation of a lateral access point, autologous bone grafts are inserted to increase crestal bone height and to create the necessary conditions for the insertion of implants. This surgical procedure requires a two-stage approach and a double surgical site: first, bone is harvested from a donor site and transplanted to the recipient site; then, after a proper healing period of between 4 to 6 months, the implants are inserted. This kind of bone reconstruction, even if well documented, has its limitations, not least in the creation of two different surgical sites and the consequent increased risk of morbidity. In 2004, Lundgren et al. described a new, simplified technique for the elevation of the sinus floor. The authors showed that by lifting the sinus membrane an empty space was created in which blood clot formations resulted in the establishment of new bone. The implants were placed simultaneously to function as “tent poles”, thus maintaining the sinus membrane in a raised position during the subsequent healing period. An essential prerequisite of this technique is to obtain optimal primary implant stability from the residual bone in the sinus floor. An extremely resorbed maxillary sinus floor, with, for example, less than 2-3 mm of poor quality residual bone, could impair implant insertion. The aims of the present research project were (i) to evaluate the donor site morbidity and the acceptance level of patients when a bone graft is harvested from the anterior iliac crest, (ii) to evaluate implant stability, new bone formation inside the maxillary sinus and marginal bone resorption around the implants in long term follow up when maxillary sinus floor augmentation is performed through sinus membrane elevation and without the addition of any grafting material, (iii) to investigate new bone formation inside the maxillary sinus, in experimental design, using a resorbable space-maker device in order to maintain elevation of the sinus membrane where there is too little bone to insert implants with good primary stability. In Paper I, 70 consecutively treated patients were retrospectively evaluated in terms of postoperative donor site morbidity and donor site complications. With regard to donor site morbidity, 74% of patients were free of pain within 3 weeks, whereas 26% had a prolonged period of pain lasting from a few weeks to several months. For 11% of patients there was still some pain or discomfort 2 years after the grafting surgery. Nevertheless, patients acceptance was high and treatment significantly improved oral function, facial appearance, and recreation/social activities and resulted in an overall improvement in the quality of life of formerly edentulous patients. In Paper I and III, some differently shaped space-making devices were tested on primates (tufted capuchin - Cebus apella) in two experimental models aimed at evaluating whether a two-stage procedure for sinus floor augmentation could benefit from the use of a space-making device to increase the bone volume and enable later implant installation with good primary stability, without the use of any grafting material. An histological examination of the specimens showed that it is possible to obtain bone formation in contact with both the Schneiderian membrane and the device. In most cases the device was displaced. The process of bone formation indicated that this technique is potentially useful for two-stage sinus floor augmentation. The lack of device stability within the sinus requires further improvement in space-makers if predictable bone augmentation is to be achieved. In Paper IV, a total of 84 patients were subjected to 96 membrane elevation procedures and the simultaneous placement of 239 implants. Changes of intra-sinus and marginal bone height in relation to the implants were measured in intraoral radiographs carried out during insertion after 6 months of healing, after 6 months of loading and then annually. Computerised tomography was performed pre-surgically and 6 months post-surgically. Resonance frequency analysis measurements were performed at the time of implant placement, at abutment connection and after 6 months of loading. The implant follow-up period ranged from a minimum of one to a maximum of 6 years after implant loading. All implants were stable after 6 months of healing. A total of three implants were lost during the follow-up period giving a survival rate of 98.7%. Radiography demonstrated an average of 5.3 ± 2.1 mm of intra-sinus new bone formation after 6 months of healing. RFA measurements showed adequate primary stability (implant stability quotient 67.4 ± 6.1) and small changes over time. In conclusion, harvesting bone from the iliac crest could result in temporary donor site morbidity, but in 11% of patients pain or discomfort was still present up to 2 years after surgery. However, patient satisfaction was good despite this slow or incomplete recovery, as showed by the quality of life questionnaire. Maxillary sinus membrane elevation without the use of bone grafts or bone substitutes results in predictable bone formation both in animal design, where the sinus membrane is supported by a resorbable device, and in clinical conditions, where the membrane is kept in the upper position by dental implants. This new bone formation is accompanied by a high implant survival rate of 98.7% over a follow-up period of up to 6 years. Intra-sinus bone formation remained stable in the long-term follow-up. It is suggested that the secluded compartment allowed bone formation in accordance with the principle of guided tissue regeneration. This technique reduces the risks of morbidity related to bone graft harvesting and eliminates the costs of grafting materials.

Darbo tikslas: Išanalizuoti sergamumą oro-lašinėmis infekcijomis Kauno mieste 2002 – 2007 metais ir nustatyti sąsajas tarp sergamumo oro – lašinėmis infekcijomis ir imunoprofilaktikos. Darbo uždaviniai: 1. Įvertinti oro - lašinių infekcijų (tymai, epideminis parotitas, skarlatina, raudonukė, virusinis meningitas, infekcinsu meningokokas, vėjaraupiai) pasiskirstymą įvairiose amžiaus grupėse Kauno mieste 2002-2007 metais. 2. Palyginti sergamumo kai kuriomis oro- lašinėmis infekcijomis kitimą Kauno mieste 2002 – 2007 metais. 3. Nustatyti sąsajas tarp sergamumo oro – lašinėmis infekcijomis ir imunoprofilaktikos. Metodika: Informacija apie sergamumą oro-lašinėmis infekcijomis gauta iš Kauno visuomenės sveikatos centro. Duomenys apie sergamumą oro-lašinėmis infekcijomis paimti iš Kauno visuomenės sveikatos centro kompiuterinės duomenų bazės ULISAS (užkrečiamųjų ligų informacijos ir statistinės apskaitos sistema). Taip pat buvo naudojamasi 2002-2007 metų mėnesinėmis, pusmetinėmis ir metinėmis atskaitomis. Duomenys apdoroti ir išanalizuoti naudojantis statistine programa SPSS 16. Skaičiuotas vidurkis, SD, PI. Duomenys pateikiami absoliučiais skaičiais ir procentais. Buvo skaičiuojami sergamumo rodikliai 10 000 gyventojų. Rezultatai: Sergamumo pagal amžiaus grupes analizė parodė, kad rečiausiai sirgo 13 – 18 metų vaikai, o dažniausiai – 3-6 metų. Susirgimai vėjaraupiais sudaro didžiausią dalį visų oro – lašinių infekcijų - 80,1 proc. (be ūmių virusinių kvėpavimo takų infekcijų ir... [toliau žr. visą tekstą] / Aim of the study. To analyse morbidity of air-born infections in Kaunas city in 2002–2007 and to assess links between morbidity of air-born infections and immunoprophylaxis. Tasks of the study: 1. To assess prevalence of air-born infections (measles, mumps, scarlatina, rubella, viral meningitis, infectious meningococcus, varicella) in various groups of age in 2002–2007 in Kaunas city. 2. To compare trends of some air-born infections in Kaunas city in 2002–2007. 3. To assess links between air-born infections’ morbidity and immunoprophylaxis. Method: Information about morbidity of air-born infections is got from Kaunas Public Health Center. Data of air-born infections’ morbidity is taken from data basis ULISAS (a system of communicable diseases information and statistical accounting). Also, the monthly, half-yearly and annual records of the years 2002–2007 were used. Data was archived and analyzed by using the statistical programme SPSS 16. An average, SD, PI were counted. Results are submitted in total numbers and percents. Morbidity was calculated to 10000 population. Results: The analysis according to the age groups showed, that children of 13–18 years old were ill most rarely and most frequently – children of 13–16 years old. Ailment of chickenpox makes the biggest part of air-born infections – 81 % (without Acute upper airway infections and influenza), ailments of rubella were registered least – 0,2 %. Of 10698 ill cases, 67 diseases (0,63 %) were registered after... [to full text]

Introduction: Domestic research studies focused on the interrelationships between political ideology characteristics inherent in policy decisions and the contributions these political determinants exert over health indicators and outcomes are limited. Given the paucity of research that focuses on political and policy support of health at the county-level, this study sets out to utilize the University of Wisconsin Population Health Institute’s (UWPHI) annual County Health Rankings data and examine them within the context of county-based majority political partisanship and economic measures. Methods: This exploratory ecological study examined differences between independent variables: partisan voting behavior (trichotomized as conservative, moderate, and liberal) and median per capita household income in U.S. dollars (by quartile) on dependent variables related to mortality (years of productive life lost) and morbidity (number of poor mental and physical health days) at the county-level to compare differences in political and ideological underpinnings that may act as influencers on health outcomes. Multiple data sources were combined and matched to all 3,140 counties located in the U.S. Two-way between-subjects ANOVA statistical tests were conducted to determine if there is an effect of partisan voter index category on the three aforementioned dependent variables related to health outcomes, and median per capita income by quartile. Results: There was a statistically significant main interaction between median per capita household income by quartile and partisan voter index category on years of productive life lost, F(6,2789) = 19.3, p < .000, partial η2 = .040. While there were also statistically significant interactions between the independent and dependent variables of poor mental and physical health days, results of those analyses should be interpreted with caution. Pertaining to years of productive life lost, post hoc analyses of significant interactions revealed significant differences at the lower income quartile, but not in the expected direction. The conservative category had statistically significant lower years of productive life lost in comparison to the liberal category (M = -8.21, SE = 1.47, p = .000). Also, there were significant differences detected in the upper quartile suggesting that the liberal category has lower years of productive life lost in comparison to the conservative category (M = 7.06, SE = 1.06, p = .000). Conclusion: Results should be interpreted with caution and suggest more research and methodological refinements are needed, particularly related to categorizing county-level political dynamics.

Tuberculosis (TB) is an airborne infection. Though effective anti-TB drugs have been available for more than 50 years, over one-third of the world’s population is exposed to TB bacterium; deaths due to TB infection occur at high frequency every day worldwide. Today, drug-resistant TB, TB/HIV co-morbidity and poor health infrastructure are major challenges worldwide, particularly in less developed countries. The primary objective of the study was to assess the progress of TB control programs in twenty-two Eastern Mediterranean Region countries toward Millennium Development Goals (MDGs) including implementation of the Directly Observed Treatment, Short-course (DOTS). Also, the study was designed to explore TB/HIV co-morbidity and to assess some factors potentially associated with TB progress in the region. Secondary data, obtained from the World Health Organization, World Bank, and World Resource Institute on line databases were used. Paired samples t-test and bivariate correlation were conducted. Between 1990 and 2005, TB incidence had decreased 9%, TB prevalence had decreased 37% (statistically significant) and TB mortality had decreased 28%; nevertheless, MDG targets were not met. TB/HIV co-morbidity increased in the region especially in HIV-high burden countries. Though DOTS population coverage was increased to 94% in 2005, DOTS new smear-positive case detection rate was 61% (target 70%) and DOTS treatment success was 80% (target 85%). Thus, the 1991 Stop TB Partnership targets were not met. In spite of the progress of TB control programs in the EMR, MDGs and DOTs targets of 2005 were not obtained. Further efforts such as allocation of more resources, strengthening of TB surveillance systems, extension of drug-resistant TB and TB/HIV collaborative programs, and TB research are required to achieve MDGs by 2015 and to fully implement the new Stop TB Strategy in the region.

Darbo tikslas. Įvertinti Klaipėdos m. moksleivių sergamumą profilaktinių sveikatos patikrinimų duomenimis ir moksleivių bei jų tėvų požiūrį į profilaktinių apžiūrų kokybę. Tyrimo metodika. Tyrimui atrinktos šešių Klaipėdos miesto bendrojo lavinimo vidurinių, mokyklų vienuolika 7-tų ir dešimt 10-tų klasių .Moksleivių sergamumas tirtas remiantis 2008 m. profilaktinių patikrinimų ataskaitomis, sudarytomis mokyklų visuomenės sveikatos specialistų pagal sveikatos pažymėjimą (forma Nr.027-1/a). Atlikta atrinktų klasių moksleivių (n=430) ir jų tėvelių (n=341) anoniminė anketinė apklausa. Duomenys analizuoti kompiuterine SPSS 13.0 versijos programos pagalba, lyginant sergamumo ir profilaktinių apžiūrų kokybės kintamuosius pagal c2 kriterijų. Skirtumas statistiškai reikšmingas, kai pasikliovimo lygmuo p<0,05 Rezultatai. Iš 90,2 proc. pasitikrinusiųjų sveikatą mokinių 16 proc. buvo sveiki. Tarp kitų vyravo širdies kraujagyslių, regos, skeleto-raumenų, kvėpavimo ir nervų sistemos sutrikimai. Beveik du trečdaliai (60,7 proc.) mokinių sveikatos patikrinimų kokybę įvertino kaip paviršutiniškai atliekamą sveikatos patikrą. Ne visiems mokiniams buvo matuojamas arterinis kraujo spaudimas, tikrinamas regėjimas, klausa, laikysena, atliekamai kraujo ir šlapimo tyrimai, ne visi tikrino dantis, esant sveikatos sutrikimams ne visiems buvo teikiamos rekomendacijos. 39,5 proc. mokinių savo sveikatą įvertino kaip visiškai sveikas ir 52,3 proc. mokinių - pakankamai sveikas. Į mokyklos visuomenės... [toliau žr. visą tekstą] / Objective. To asses the schoolchildren morbidity of Klaipeda town according to the data of preventive health checkups and the schoolchildren and their parents’ attitude towards the quality of preventative checkups. Methods. Schoolchildren’s morbidity was tested on the basis of 2008 preventative checkup reports, which were performed by the school public health workers (form Nr. 027-1/a). The study was conducted in eleven seventh forms and in ten tenth forms. Schoolchildren (n=430) and their parents (n=341) were asked to fill in an anonymous questionnaire. The data was analyzed using SPSS computer program by comparing the variable of morbidity and the quality of preventative checkups according to c2 criteria. The data difference was considered as statically significant when p<0.05. Results. 90.2 % of schoolchildren checked their health. 16 % out of them were healthy. The rest of the respondents experienced cardio vascular, vision, skeletal-muscular, respiratory and nervous system disorders. About one third (60.7%) of schoolchildren described preventative checkups as very superficial health examination. Not all schoolchildren had their blood pressure checked, their eyes and hearing tested, posture and their teeth examined, blood and urine tests made. Not all schoolchildren receive recommendations in case they have any health disorders. 52.3 % of schoolchildren perceived themselves as quite healthy and 39.5% of schoolchildren regarded themselves as completely healthy and they... [to full text]

Disertacijos tikslas yra įvertinti Kauno m. 25-64 metų gyventojų sergamumo ūminiu miokardo infarktu, medicinos pagalbos ir trumpalaikio bei ilgalaikio išgyvenimo pokyčius 1996 m. bei 2003-2004 m.: išanalizuojant 25-64 metų Kauno m. gyventojų sergamumo ūminiu miokardo infarktu, mirštamumo nuo ūminio miokardo infarkto ir mirtingumo nuo išeminės širdies ligos rodiklių pokyčius 1996-2004 m.; įvertinant medicinos pagalbos apimtį bei ypatumus Kauno m. 25-64 metų gyventojams, ištiktiems ūminio miokardo infarkto, 1996 m. bei 2003-2004 m.; nustatant 25-64 metų Kauno m. gyventojų, ištiktų ūminio miokardo infarkto, trumpalaikį išgyvenimą 1996 m. bei 2003-2004 m.; įvertinant 25-64 metų Kauno m. gyventojų, ištiktų ūminio miokardo infarkto, ilgalaikį išgyvenimą 1996 m. bei 2003-2004 m. / The aim of dissertation is to evaluate the trends in morbidity of acute myocardial infarction, medical care and the short term and long term survival in Kaunas population aged 25-64 years in 1996 and in 2003-2004: to analyze the trends in the rates of morbidity of acute myocardial infarction, lethality from acute myocardial infarction and mortality from ischemic heart disease in Kaunas population aged 25-64 years from 1996 to 2004; to evaluate the extent and peculiarities of medical care provided for Kaunas population aged 25-64 years, who experienced acute myocardial infarction, in 1996 and in 2003-2004; to determine the short term survival after acute myocardial infarction in Kaunas population aged 25-64 years in 1996 and in 2003-2004; to evaluate the long term survival after acute myocardial infarction in Kaunas population aged 25-64 years in 1996 and in 2003-2004.

The urban landscape-heat-health relationship was explored using a model of human thermal comfort (as energy budget) modified to incorporate varying urban landscape. Census Tract-level energy budget was modelled in Toronto during four extreme heat events. Energy budgets (~+80 W m-2) and heat-related ambulance calls (~+10%) increased during heat events and were positively correlated, albeit with some event-to-event fluctuation in relationship strength. Heat-related calls were negatively correlated to canopy cover. “Cooling” design strategies applied to two high-energy budget Census Tracts nearly neutralized (~–25 W m-2) thermal comfort and increased canopy cover (500–600%), resulting in an estimated 40–50% reduction in heat-related ambulance calls. These findings advance current understanding of the urban landscape-heat-health relationship and suggest straightforward design strategies to positively influence urban heat-health. This new high-throughput, Census Tract-level thermal comfort modelling methodology incorporates the complexities of the urban landscape has relevance to landscape architecture, urban design, and public health.