This thesis investigates gender differences in health and how they have changed between 1992 and 2002 among very old people. It explores gender differences in the association between disability and health, and gender differences in care utilization among our oldest old people. The studies are based on nationally representative data of the population in Sweden aged 77 and older (SWEOLD).  Results from Study I showed that women generally had more health problems than men. Analyses of change between 1992 and 2002 showed increased prevalence rates for both sexes, especially women. However, women’s reporting of poor global self-rated health did not increase. There were no gender differences and there was no change over time in activities of daily living (ADL). Several health indicators seem to be developing differently for women and men.  Study II showed that associations between ADL disability and other health indicators changed between 1992 and 2002, with several health problems and functional limitations becoming less disabling over time. This trend was especially true for women, while for men, the findings were mixed.  Study III found no gender differences in physician visits and dental visits, despite women’s worse health and dental status. Marriage was associated with more physician visits for men and dentist visits for women. Results imply that women and unmarried older adults may have unmet health-care needs.  Study IV examined whether the increase in life expectancy at age 65 observed between 1992 and 2002 consisted of years with or without musculoskeletal pain. Results showed that total years without pain decreased for both women and men, but more so for women. Women also had more years with pain added to life.  The results of this thesis suggest an increase of health problems, but not disability, in the oldest Swedish population. However, gender variations in the findings highlight the importance of analyzing health trends separately for women and men. / At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: In press. Paper 3: Manuscript. Paper 4: Submitted.

MIRTINGUMO NUO IŠORINIŲ MIRTIES PRIEŽASČIŲ TRENDAI LIETUVOS MIESTO IR KAIMO KOHORTOSE 1967 - 2006 62 puslapiai, 32 grafikai, 2 lentelės. Raktažodžiai: amžiaus - periodo - kohortos analizė, mirtingumas, trendas, savižudybės, autotransporto įvykiai. Tyrimo tikslas: Nustatyti detalius mirtingumo dinamikos nuo savižudybių ir autotransporto įvykių ypatumus 40 - ies metų laikotarpiu priklausomai nuo lyties ir gyvenamosios vietos. Uždaviniai: Apskaičiuoti pagrindinius dinamikos parametrus - amžių, periodą, kohortas ir nustatyti jų įtaką dinamikos procesui; Išanalizuoti du svarbiausius mirtingumo dinamikos faktorius kiekvienai mirties priežasčiai ir sumodeliuoti šių faktorių poveikio kartu įtaką šiam procesui pagal lytį ir gyvenamąją vietą. Nustatyti, kaip paamžiniai mirtingumo rodikliai kinta kiekviename kohortos penkmetiniame intervale, koks šių kreivių lygis įvairiose kohortose ir kaip tai skiriasi pagal lytį ir gyvenamąją vietą. Metodai: Mirčių duomenys nuo savižudybių ir autotransporto įvykių Lietuvoje nuo 1967 iki 2006 m. buvo sugrupuoti į 17 amžiaus grupių ir 8 penkmetinius periodus. Duomenų analizei panaudotas Poissono regresijos metodas pritaikytas amžiaus - periodo - kohortos modelių efektams atskirti. Rezultatai: Ir moterų ir vyrų kaimo populiacijos mirtingumo nuo savižudybių tendencija buvo ryškiai didėjanti per visą analizuojamą periodą. Miesto moterų populiacijoje mirtingumo rodikliai nuo savižudybių mažėjo, išskyrus didėjančius senyvo amžiaus grupių rodiklius. Miesto... [toliau žr. visą tekstą] / MORTALITY TRENDS FROM EXTERNAL CAUSES AMONG URBAN AND RURAL COHORTS IN LITHUANIA 1967 - 2006 62 pages, 32 graphics, 2 tables. Keywords: age – period – cohort analysis, mortality, trends, suicide, vehicle accidents. Research aim: The aim of this study was to examine particular trends of mortality from suicide and vehicle accidents during 40 years period subject to sex and place of residence. The tasks of the research work were as follows: To calculate basic parameters of mortality trends - age, period and cohorts and detect their influence to the process; To analyze two most important factors to variation for each cause of the death and to simulate this along factors' influence to the procces subject to sex and place of residence. To find out how subsequent mortality rates vary in each cohort quinquennial interval, what is the difference of these curves levels in different cohorts and how they differ between sex and place of residence. Methods: Deaths due to suicides and vehicle accidents in the period from 1967 through 2006 and the corresponding population figures were grouped into 17 age groups and 8 5-year periods. These were fitted to Poisson regression models to assess age, period, and cohort effects. Results: Both women's and men's mortality trends from suicides increased dramatically through analyzed period. Trends of urban women's suicide mortality have decreased, except increasing trends of the elderly. Urban men's population had experienced increasing trends from... [to full text]

Objective: To evaluate trends in the use of antipsychotic drugs in Lithuania between 2003 and 2005 years. Methods: The data on total sales of antipsychotic drugs in all Lithuanian regions over three years (2003-2005) were obtained from IMS Health Inc. Drugs were classified according to the Anatomic Therapeutic Chemical system and use was quantified in terms of defined daily doses. Meta-analysis of observational studies retrieved through systematic search of all available electronic data sources. 1651 abstracts were found and checked. 76 randomised double-blind studies were identified for the met-analysis. Data were calculated by DDD methodology and expressed in DDDs per 1.000 inhabitants per day. The pharmacoeconomic analysis of antipsychotics was performed by cost minimization and reference price methodology. Results: In Lithuania the total antipsychotics consumption increased by 16% over three years (2003-2005) period reaching the value of 5,5 DDD/1000 inhabitants/day. Since 2003 the proportion of use of conventional antipsychotics has increased by 2%, while the use of atypical antipsychotics has increased by 14%. The expenditures of antipsychotics has reached 39 mln Litas (in 2005), of which 48% was costs for atypical antipsychotic agents. Setting the reference price of risperidone (according to the meta-analysis results of effectiveness) for atypical antipsychotics it would be possible to rationalize schizophrenia treatment using 10,68 mln Litas extra money. Conclusions:... [to full text]

The subject of this scientific research is urban artistic lighting, analyzed herein as a means for highlighting the urban and architectural features and aimed at evaluation of aesthetic qualities of the nightscape depending on its illumination. Aesthetic (application and keeping to the beauty criteria) illumination development, contemporary trends and their influences on the nightscape formation is under analysis in the present work. Any psychological, physiological, ecological, economical, different technological and any other aspects are analyzed only in so far as they are related to the field of art criticism. The development analysis covers the entire history of human kind with the main focus being made on the period starting with electricity invention and spread of lighting, i. e. from the second half of the 19th century till nowadays, in foreign, as well as Lithuanian practice. / Darbo mokslinių tyrimų objektas – miestų meninis apšvietimas, kuris nagrinėjamas kaip urbanistikos ir architektūros požymius išryškinanti priemonė, siekiant įvertinti naktinio miestovaizdžio estetines kokybes ir jų priklausymą nuo apšvietimo. Nagrinėjama estetinė (grožio kriterijų taikymas ir laikymasis) apšvietimo raida, šiuolaikinės tendencijos ir įtaka naktinio miestovaizdžio formavimui. Psichologinis, fiziologinis, ekologinis, ekonominis, įvairūs technologiniai ir kiti aspektai nagrinėjami tik tiek, kiek yra susiję su menotyros sritimi. Raidos tyrimas apima visą žmonijos istoriją, tačiau dėmesys telkiamas į laikotarpį nuo elektros apšvietimo išplitimo, t. y. nuo XIX a. pabaigos, iki šių dienų.

Šio tiriamojo darbo tikslas yra suformuluoti inovatyvios pakuotės kaip komunikacijos priemonės kūrimo modelį. Teorinėje darbo dalyje analizuojama pakuotės funkcijos ir elementai, iškeliamos pagrindinės priežastys sąlygojančios pakuotės inovacijų poreikį, aprašomos teorinės pakuotės inovacijų taikymo galimybės ir pateikiamas pakuotės kaip komunikacijos priemonės susiformavimas ir įtaka. Analitinėje darbo dalyje pateikiami ir analizuojami rezultatai tyrimo, atlikto naudojant kiekybinio tyrimo metodą – apklausą, kurios metu buvo siekiama nustatyti, kokią įtaką inovatyvūs pakuotės sprendimai turi prekės ir prekės ženklo suvokimui bei pirkimo elgsenai. Projektinėje darbo dalyje suformuluoti tokie sprendimai: inovatyvios pakuotės kaip komunikacijos priemonės kūrimas turėtų susidėti iš penkių pagrindinių etapų, kurie yra – analizė; pakuotės komunikacijos objekto pasirinkimas; pakuotės tikslo suformulavimas; pakuotės elementų tikslo įgyvendinimui pasirinkimas; pasirinktų elementų panaudojimas remiantis naujausiomis pakuotės tendencijomis. / The aim of this research is to formulate innovative packaging development model which would increase packaging communication effect. The theoretical part of the paper analyzes functions and elements of the package, brings the main reasons leading to packaging innovations, describes the theoretical applications of packaging innovations and highlights the growth of packaging importance and influence as a communication tool. The analytical part of the paper presents and analyzes the results of a study carried out by using quantitative research method - a survey, which was conducted to determine the impact of innovative packaging solutions to shopper‘s brand perception and purchasing behavior. The final part of work suggests following results: innovative packaging as a communication tool should be created based on five steps, which are - analysis, decision making on packaging communication object, decision making on packaging funkctions, choosing packaging elements for functions implementation, adjust the use of chosen elements to newest packaging trends.

Magistro baigiamajame darbe nagrinėjamos Lietuvos ir Europos Sąjungos ekonomikos strateginių nuostatų sąsajos su nacionalinėmis socialinėmis ekonomikos tendencijomis. Pirmajame baigiamojo darbo skyriuje nustatomi teoriniai valstybės dalyvavimo ekonomikoje pagrindai, vertinant Lietuvos pereinamosios ekonomikos ypatumus per šalies Nepriklausomybės laikotarpį. Antroje baigiamojo darbo dalyje nagrinėjama ekonomikos strateginio planavimo metodika, parenkamas scenarijaus metodas, sudaromos baigiamojo darbo tyrimo modelis. Trečioje empirinėje dalyje atliekama Lietuvos ūkio (ekonomikos) raidos iki 2015 m. strategijos analitika, lyginamos 2002 m. formuotos strateginės nuostatos ir jų įgyvendinimas 2012 m. Taip pat analizuojami Strategijos Europa 2020 keliami tikslai, šių tikslų atitikimas Lietuvos socialinėms ekonominėms tendencijoms bei šių tikslų įgyvendinimo logiškumas ir realistiškumas. Ketvirtoje baigiamojo darbo dalyje pateikiamos išvados ir formuojami siūlymai toliau įgyvendinant strategines ekonomikos nuostatas. / The links between national social economics trends and strategic statements of EU and Lithuanian political documents are analyzed in the master thesis work. In the first part of the work, the basics of the role of the State in economics are analyzed considering Lithuania to be a transitional economics. In second part of the master thesis work, the methodic of strategic economic planning is analyzed, the model of the research is constructed and the scenarios method is selected to do empirical research in the third part. In the third part, the results of long term economic strategy till 2015 are investigated and the real socio economic situation is evaluated. The strategic goals of Europa 2020 strategy are identified and its fitness to national socio economic trends is characterized. The logics and realism of set goals are evaluated considering hypothetical picture of Lithuania in 2020. In the fourth part of the master thesis work, the conclusion is drawn and recommendations for forward economic policy are suggested.

Snow surface energy balance was studied along an elevational gradient and under varying forest cover types during the ablation season of 2007 in the Coldstream Basin, Okanagan, British Columbia, Canada. During the snowmelt period, 1-4% of the peak annual snow-water equivalent (SWE) was lost to sublimation in open sites – averaging 0.4 mm d-1. Melt and sublimation rates increased significantly with elevation, and were higher and more variable in the open sites than under forest canopies. Melt rates were driven almost entirely by sensible heat fluxes and exceeded 30 mm d-1 during large-scale advection events. The melt and sublimation processes observed at the snow surface were significantly linked to conditions in the atmospheric boundary layer. From these linkages, a proxy record of historical ablation season energy fluxes for the period 1972-2007 was created. Significant trends towards earlier dates of snowmelt and freshet onset were detected, as was a trend towards increasing ablation-season temperatures at the 850 mb height. Significant correlations between estimated historical ablation-season melt and sublimation and the regionally dominant teleconnection indices were also found. This study significantly advances the understanding of ablation season snow-surface energy exchanges, and the links to the driving atmospheric conditions in the Okanagan Basin.

Large-scale assessment results for schools, school boards/districts, and entire provinces or states are commonly reported as the percentage of students achieving a standard – that is, the percentage of students scoring above the cut score that defines the standard on the assessment scale. Recent research has shown that this method of reporting is sensitive to small changes in the cut score, especially when comparing results across years or between groups. This study extends that work by investigating the effects of reporting group size on the stability of results. For each of ten group sizes, 1000 samples with replacement were drawn from the May 2009 Ontario Grade 6 Assessment of Reading, Writing and Mathematics. The results showed that for small group sizes – analogous to small schools – there is little confidence and that extreme caution must be taken when interpreting differences observed between years or groups.

Large-scale assessment results for schools, school boards/districts, and entire provinces or states are commonly reported as the percentage of students achieving a standard – that is, the percentage of students scoring above the cut score that defines the standard on the assessment scale. Recent research has shown that this method of reporting is sensitive to small changes in the cut score, especially when comparing results across years or between groups. This study extends that work by investigating the effects of reporting group size on the stability of results. For each of ten group sizes, 1000 samples with replacement were drawn from the May 2009 Ontario Grade 6 Assessment of Reading, Writing and Mathematics. The results showed that for small group sizes – analogous to small schools – there is little confidence and that extreme caution must be taken when interpreting differences observed between years or groups.

Doctor of Philosophy / Over the past decade, population-based cancer registry data have been used increasingly worldwide to evaluate and improve the quality of cancer care. The utility of the conclusions from such studies relies heavily on the data quality and the methods used to analyse the data. Interpretation of comparative survival from such data, examining either temporal trends or geographical differences, is generally not easy. The observed differences could be due to methodological and statistical approaches or to real effects. For example, geographical differences in cancer survival could be due to a number of real factors, including access to primary health care, the availability of diagnostic and treatment facilities and the treatment actually given, or to artefact, such as lead-time bias, stage migration, sampling error or measurement error. Likewise, a temporal increase in survival could be the result of earlier diagnosis and improved treatment of cancer; it could also be due to artefact after the introduction of screening programs (adding lead time), changes in the definition of cancer, stage migration or several of these factors, producing both real and artefactual trends. In this thesis, I report methods that I modified and applied, some technical issues in the use of such data, and an analysis of data from the State of New South Wales (NSW), Australia, illustrating their use in evaluating and potentially improving the quality of cancer care, showing how data quality might affect the conclusions of such analyses. This thesis describes studies of comparative survival based on population-based cancer registry data, with three published papers and one accepted manuscript (subject to minor revision). In the first paper, I describe a modified method for estimating spatial variation in cancer survival using empirical Bayes methods (which was published in Cancer Causes and Control 2004). I demonstrate in this paper that the empirical Bayes method is preferable to standard approaches and show how it can be used to identify cancer types where a focus on reducing area differentials in survival might lead to important gains in survival. In the second paper (published in the European Journal of Cancer 2005), I apply this method to a more complete analysis of spatial variation in survival from colorectal cancer in NSW and show that estimates of spatial variation in colorectal cancer can help to identify subgroups of patients for whom better application of treatment guidelines could improve outcome. I also show how estimates of the numbers of lives that could be extended might assist in setting priorities for treatment improvement. In the third paper, I examine time trends in survival from 28 cancers in NSW between 1980 and 1996 (published in the International Journal of Cancer 2006) and conclude that for many cancers, falls in excess deaths in NSW from 1980 to 1996 are unlikely to be attributable to earlier diagnosis or stage migration; thus, advances in cancer treatment have probably contributed to them. In the accepted manuscript, I described an extension of the work reported in the second paper, investigating the accuracy of staging information recorded in the registry database and assessing the impact of error in its measurement on estimates of spatial variation in survival from colorectal cancer. The results indicate that misclassified registry stage can have an important impact on estimates of spatial variation in stage-specific survival from colorectal cancer. Thus, if cancer registry data are to be used effectively in evaluating and improving cancer care, the quality of stage data might have to be improved. Taken together, the four papers show that creative, informed use of population-based cancer registry data, with appropriate statistical methods and acknowledgement of the limitations of the data, can be a valuable tool for evaluating and possibly improving cancer care. Use of these findings to stimulate evaluation of the quality of cancer care should enhance the value of the investment in cancer registries. They should also stimulate improvement in the quality of cancer registry data, particularly that on stage at diagnosis. The methods developed in this thesis may also be used to improve estimation of geographical variation in other count-based health measures when the available data are sparse.