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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.

Table of Contents

Medicina, Volume 47, Issue 5 (May 2011) – 8 articles

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Open AccessArticle
Causes of Refraining From Buying Prescribed Medications Among the Elderly in Kaunas, Lithuania
Medicina 2011, 47(5), 41; https://doi.org/10.3390/medicina47050041 - 31 May 2011
Viewed by 264
Abstract
Background and Objective. Accessibility to medications among the elderly is a source of concern in Lithuania and beyond. However, there are no studies carried out on this topic in Lithuania. Therefore, the aim of this study was to evaluate the causes of refraining [...] Read more.
Background and Objective. Accessibility to medications among the elderly is a source of concern in Lithuania and beyond. However, there are no studies carried out on this topic in Lithuania. Therefore, the aim of this study was to evaluate the causes of refraining from buying prescribed medications among the elderly in Kaunas, Lithuania.
Material and Methods
. The data were collected in a cross-sectional ABUEL study in 2009. A total of 624 filled-in questionnaires (response rate, 48.9%) from the elderly aged 60–84 years living in Kaunas (Lithuania) were received. For evaluation of the impact of explanatory variables on the analyzed event (binary dependent variable), an Enter model of logistic regression was used.
Results. The study showed that 32.7% of the respondents refrained from buying prescribed medications. The most common reasons (respondents could select several options) for this decision were financial problems (48.0%), disappearance of problems (40.7%), and fear of side effects (22.5%). Refraining from buying prescribed medications was positively associated with age (OR, 0.85; 95% CI, 0.74 to 0.99). Higher education was associated with a reduced risk of refraining from buying prescribed medications due to financial problems (OR, 0.49; 95% CI, 0.31 to 0.78) and an increased risk of refraining from buying medications due to the disappearance of health problems (OR, 1.75; 95% CI, 1.15 to 2.68). An opposite association with worries about daily expenses was observed.
Conclusions
. Study has revealed that one-third of the elderly refrained from buying prescribed medica Full article
Open AccessArticle
Galvos smegenų insulto ir mirties rizika po vidinės miego arterijos endarterektomijos
Medicina 2011, 47(5), 42; https://doi.org/10.3390/medicina47050042 - 23 May 2011
Viewed by 306
Abstract
Tyrimo tikslas. Įvertinti galvos smegenų insulto ir mirties dažnį po vidinės miego arterijos endarterektomijos bei rizikos veiksnių ir kraujagyslių chirurgo įgūdžių reikšmę šių komplikacijų atsiradimui.
Tyrimo medžiaga ir metodai
. Vilniaus greitosios pagalbos universitetinėje ligoninėje nuo 1995 iki 2006 m. atlikta 790 [...] Read more.
Tyrimo tikslas. Įvertinti galvos smegenų insulto ir mirties dažnį po vidinės miego arterijos endarterektomijos bei rizikos veiksnių ir kraujagyslių chirurgo įgūdžių reikšmę šių komplikacijų atsiradimui.
Tyrimo medžiaga ir metodai
. Vilniaus greitosios pagalbos universitetinėje ligoninėje nuo 1995 iki 2006 m. atlikta 790 vidinių miego arterijų endarterektomijų. Išankstinėje duomenų bazėje buvo registruojami visų ligonių rizikos veiksniai, neurologinė būklė, gretutinės ligos, radiologiniai ir angiografi niai duomenys, angiochirurgo patirtis, atliktų endarterektomijų skaičius, mirties bei insulto atvejai. Duomenų analizei naudota vienaveiksnė ir daugiaveiksnė logistinė regresija bei ROC kreivės.
Rezultatai
. Tarp 790 endarterektomijų, mirčių užregistruota 2,2 proc., insultu susirgo 2,4 proc. ligonių. Operacijos komplikacijų dažniau radosi sergantiesiems cukriniu diabetu palyginus su nesergančiaisiais šia liga (12 proc. palyginti su 3,4 proc. p<0,001) ir sergantiesiems kitos lokalizacijos insultu (10,7 proc. palyginti su 1,4 proc., p<0,02) lyginant su sergančiaisiais lėtine smegenų išemija. Daugiau radosi komplikacijų, kai ligonius operavo kraujagyslių chirurgas, vidutiniškai atliekantis ne daugiau kaip penkias endarterektomijas per metus palyginus su kraujagyslių chirurgu, kuris padarė šešias ir daugiau endarterektomijų per metus (10,0 proc. palyginus su 4,6 proc., p<0,02). CD (ŠS 3,51; 95 proc. PI 1,60–7,66, p=0,002), kitos lokalizacijos insultas (ŠS 4,14; 95 proc. PI 1,57–10,91, p=0,004) ir mažai operacijų padaręs angiochirurgas (ŠS 0,32; 95 proc. PI 0,13–0,78, p=0,013), daugiaveiksnės logistinės regresijos duomenimis, turėjo didžiausią operacijos mirties ir insulto riziką. ROC kreivių analizė parodė, kad šių trijų parametrų bendra prognostinė vertė – 0,72.
Išvados. Cukrinis diabetas, kitos lokalizacijos insultas ir mažai operacijų padaręs angiochirurgas turėjo didžiausią nepalankios operacijos baigties prognostinę vertę. Full article
Open AccessArticle
Genetic Variation of the Human ACE and ACTN3 Genes and Their Association With Functional Muscle Properties in Lithuanian Elite Athletes
Medicina 2011, 47(5), 40; https://doi.org/10.3390/medicina47050040 - 23 May 2011
Cited by 2 | Viewed by 514
Abstract
Background and Objective. Based on the results of many studies, the angiotensinconverting enzyme (ACE) and the α-actinin-3 (ACTN3) genes are considered strong candidate genes associated with human physical performance. On the other hand, the data regarding the association of [...] Read more.
Background and Objective. Based on the results of many studies, the angiotensinconverting enzyme (ACE) and the α-actinin-3 (ACTN3) genes are considered strong candidate genes associated with human physical performance. On the other hand, the data regarding the association of the ACE I/D and ACTN3 R/X polymorphisms with human physical performance in different populations have been conflicting. The objective of our research was to evaluate the significance of these genetic variants on muscle performance phenotype in Lithuanian athletes.
Material and Methods
. The study involved 193 Lithuanian elite athletes and 250 controls from the general Lithuanian population. Genotyping was performed by polymerase chain reaction and/ or restriction fragment length polymorphism analysis. Anthropometric measurements and muscle strength (grip strength and vertical jump) were measured.
Results
. It was determined that ACE I/I and I/D genotypes were more frequent in the athlete group compared with the general Lithuanian population. The results of grip strength and vertical jum p were better in the athletes with the ACE I/I and ACTN3 X/X genotype compared with the athletes with ACE D/D and ACTN3 R/R, respectively.
Conclusions. The ACE I and ACTN3 X alleles determine speed and power for Lithuanian athletes. In line with other researchers, it can be confirmed that the absence of a functional ACTN3 in fast-twitch muscle fibers is compensated. Lithuanian athletes who are carriers of the ACE I/I and I/D as well as ACTN3 X/X and R/X genotypes have the potential to achieve better results in power-requiring sports; therefore, the analyzed polymorphisms of these genes might be used as the criteria for the sport type selection. Full article
Open AccessArticle
Changes in Antibiotic Resistance Level of Nosocomial Pseudomonas Aeruginosa Isolates in the Largest University Hospital of Lithuania
Medicina 2011, 47(5), 39; https://doi.org/10.3390/medicina47050039 - 23 May 2011
Cited by 3 | Viewed by 281
Abstract
The aim was to estimate changes in the resistance rates of Pseudomonas aeruginosa (P. aeruginosa) strains isolated from patients treated in intensive care units of the largest university hospital.
Materials and Methods
. Isolates were identified with the Phoenix ID [...] Read more.
The aim was to estimate changes in the resistance rates of Pseudomonas aeruginosa (P. aeruginosa) strains isolated from patients treated in intensive care units of the largest university hospital.
Materials and Methods
. Isolates were identified with the Phoenix ID system (Becton Dickinson, USA). The minimum inhibitory concentration (MIC) of ceftazidime, ciprofloxacin, and amikacin were determined by the E-test and evaluated following the recommendations of the Clinical Laboratory Standards Institute.
Results. In 2003, the proportion of P. aeruginosa strains resistant to piperacillin was greatest followed by strains resistant gentamicin and ciprofloxacin. In 2008, the resistance rates markedly changed being the highest to ciprofloxacin. An increase in the resistance rates to ciprofloxacin (+24%, P<0.001) and ceftazidime (+8.3%, P<0.05) was documented. In 2003, there were 66.7% of P. aeruginosa strains sensitive to all antibiotics tested, and this percentage decreased to 47.5% in 2008 (P<0.05). During the study, a significant increase in the median MICs for ciprofloxacin and amikacin was observed (P<0.001); however, no significant change was documented for ceftazidime.
Conclusions
. P. aeruginosa remains an important nosocomial pathogen with relatively high overall resistance to antimicrobial agents, and the resistance level is increasing. Full article
Open AccessArticle
Diagnostic Value of Conventional Visual Evoked Potentials Applied to Patients With Multiple Sclerosis
Medicina 2011, 47(5), 37; https://doi.org/10.3390/medicina47050037 - 23 May 2011
Viewed by 267
Abstract
Objective. The aim of this study was to determine the sensitivity and specificity of this classical technique employed at the Hospital of Lithuanian University of Health Sciences for the patients with multiple sclerosis and to assess its possible correlations with affected neurological [...] Read more.
Objective. The aim of this study was to determine the sensitivity and specificity of this classical technique employed at the Hospital of Lithuanian University of Health Sciences for the patients with multiple sclerosis and to assess its possible correlations with affected neurological systems.
Material and Methods
. Pattern shift visual evoked potentials were recorded in 63 patients with multiple sclerosis, 17 (27%) of whom had a history of optic neuritis, and in 63 control patients with other neurological diseases. The latencies and amplitudes of P100 were measured. In total, 126 patients were referred to the inpatient department of neurology for differential diagnosis of demyelinating disorders between January and December of 2007.
Results
. Abnormalities of visual evoked potentials were observed by 73% more frequently in patients with multiple sclerosis than in control patients (α=0.05, β<0.01). The combined monocular/ interocular test showed a specificity of 90.5% and a sensitivity of 82.5%. The probability of an affection of the pyramidal system was 5 times greater (95% CI, 2.2–11.0; P<0.01) and the probability of the optic pathways involvement was 4.8 times greater (95% CI, 1.9–11.9; P<0.01) in patients with multiple sclerosis than in controls.
Conclusion
. Conventional visual evoked potentials must be reappraised in light of their diagnostic value in multiple sclerosis given their high diagnostic efficiency, relatively easy, short, and cheap implementation, and easy availability in everyday clinical practice. Full article
Open AccessArticle
Research on the Quality of Abdominal Surgical Nursing Care: A Scoping Review
Medicina 2011, 47(5), 35; https://doi.org/10.3390/medicina47050035 - 23 May 2011
Cited by 1 | Viewed by 312
Abstract
Various health care measures have been identified over the years as indicators of health care quality. However, studies evaluating the quality of nursing care among different patient groups are scarce. Patients undergoing abdominal surgery may be a group that has different views, needs, [...] Read more.
Various health care measures have been identified over the years as indicators of health care quality. However, studies evaluating the quality of nursing care among different patient groups are scarce. Patients undergoing abdominal surgery may be a group that has different views, needs, expectations, and evaluation of the quality of nursing care. Literature search was conducted using the following key words in various combinations in the MEDLINE, PsycInfo, CINAHL, and Cochrane databases: quality of nursing, surgical or perioperative, abdominal or abdomen. The studies that focused on the evaluation of surgical nursing care with a study sample of patients undergoing abdominal surgery and nurses taking care of these patients were included in this scoping review. In total, 17 research articles were analyzed. The analysis revealed that the quality of nursing care was usually rated as high according to the perceptions of patients and/or nurses. The following factors associated with the quality of nursing care were identified: nurse staffing, organizational characteristics, patients’ characteristics, nurses’ characteristics, nursing care needs, and nursing documentation. Further research should be focused on the measurement and evaluation of the quality of abdominal surgical nursing care from nurses’, patients’ and their relatives’ perceptions by using nonexperimental and experimental study designs for gaining the knowledge how to improve the quality in practice. Full article
Open AccessArticle
Use of Combined Oral Contraceptives and Headaches
Medicina 2011, 47(5), 36; https://doi.org/10.3390/medicina47050036 - 21 May 2011
Viewed by 314
Abstract
Objective. The study was designed to examine the certain patterns of combined oral contraceptive use in women of childbearing potential and evaluate the relationship between the use of combined oral contraceptives and headaches, bad habits, type of work, and concomitant diseases.
Material
[...] Read more.
Objective. The study was designed to examine the certain patterns of combined oral contraceptive use in women of childbearing potential and evaluate the relationship between the use of combined oral contraceptives and headaches, bad habits, type of work, and concomitant diseases.
Material and Methods
. In total, 194 randomly selected women aged 18 to 40 years who visited a gynecologist for preventive gynecological examination were surveyed. Respondents were categorized as combined oral contraceptive users (n=116; study group) and nonusers (n=78; control group). An anonymous questionnaire developed by the authors of this study and a standardized scale called the Migraine Disability Assessment Scale (MIDAS) were used for the survey.
Results
. A multivariate logistic regression analysis demonstrated a significantly higher prevalence of combined oral contraceptive use in women older than 20 years (odds ratio, 6.0; 95% CI, 2.6–14), better educated women (odds ratio, 5.7; 95% CI, 2.1–15.2), and women reporting a steady sexual partner (odds ratio, 4.0; 95% CI, 1.5–11.0). Relationship between headaches and use of combined oral contraceptives as well as other factors were analyzed in a group of 178 respondents; the rest 16 respondents reported not having headaches at all. The prevalence of reported minimal-tomild and moderate-to-severe impact of headaches on daily activities did not differ significantly between the study and control groups, women with and without bad habits, and white-collar and bluecollar groups (P>0.05). However, women with concomitant diseases significantly more often reported moderate-to-severe impact on daily activities due to headaches (P<0.01). Differences in impact of headaches on daily activities between women using combined oral contraceptives containing 20 or less μg of ethinylestradiol and 30 or more μg of ethinylestradiol did not differ significantly.
Conclusions. The prevalence of combined oral contraceptive use was higher in women older than 20 years, better educated women, and women reporting a steady sexual partner. The impact of headaches on daily activities did not differ significantly between the combined oral contraceptive users and nonusers. Full article
Open AccessArticle
The Impact of Medical Conditions on the Quality of Life of Survivors at Discharge From Intensive Care Unit
Medicina 2011, 47(5), 38; https://doi.org/10.3390/medicina47050038 - 11 May 2011
Cited by 1 | Viewed by 249
Abstract
Background and Objective. Impaired health-related quality of life (HRQOL) is one of the possible outcomes after discharge from an intensive care unit (ICU). Evaluation of patient health status on discharge from the ICU would help identify factors influencing changes in HRQOL after ICU [...] Read more.
Background and Objective. Impaired health-related quality of life (HRQOL) is one of the possible outcomes after discharge from an intensive care unit (ICU). Evaluation of patient health status on discharge from the ICU would help identify factors influencing changes in HRQOL after ICU discharge. The objective of the study was to identify whether health state on discharge from prolonged stay in the ICU has any influence on survivors’ HRQOL 6 months after intensive care.
Material and Methods
. A prospective study of patients with the prolonged length of stay (exceeding 7 days) in the ICU was conducted. The study covered the impact of organ system dysfunction (SOFA score), number of therapeutic interventions (TISS-28 score), and critical illness neuromuscular abnormalities (CINMA) on discharge from the ICU on HRQOL 6 months following ICU discharge.
Results
. In total, 137 patients were included in the study. The SOFA score on the last day in the ICU was 2.91 (SD, 1.57); the TISS-28 score on the last day in the ICU was 21.79 (SD, 4.53). Decreased physical functioning (PF) and role physical (RP) were identified. Circulatory impairment on discharge from the ICU had an impact on decreased PF (P=0.016), role physical (P=0.066), and role emotional (P=0.001). Patients with dysfunction in more than one organ system on ICU discharge had decreased role emotional (P=0.016). Severe CINMA was diagnosed in 18 patients. They had decreased PF (P=0.007) and RP (P=0.019). Patients with the TISS-28 score above or equal to 20 points showed lower HRQOL in the PF domain (P=0.077) and general health (P=0.038).
Conclusions. HRQOL in patients with prolonged stay in the ICU is particularly impaired in the domains of physical functioning and role physical. It is associated with circulatory impairment, CINMA, and greater number of therapeutic interventions on discharge from the ICU. Full article
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