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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 52, Issue 4 (August 2016) , Pages 205-261

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Open AccessArticle
The relationship between pain catastrophizing, kinesiophobia and subjective knee function during rehabilitation following anterior cruciate ligament reconstruction and meniscectomy: A pilot study
Medicina 2016, 52(4), 229-237; https://doi.org/10.1016/j.medici.2016.07.005
Received: 12 June 2015 / Revised: 28 April 2016 / Accepted: 15 July 2016 / Published: 11 August 2016
Cited by 11 | Viewed by 440 | PDF Full-text (403 KB)
Abstract
Background and objective: Psychological responses to the initial injury and rehabilitation might be an important additional determinant of functional level outcomes after knee surgery. The objectives of this study were (1) to measure pain catastrophizing and kinesiophobia levels and (2) determine their association [...] Read more.
Background and objective: Psychological responses to the initial injury and rehabilitation might be an important additional determinant of functional level outcomes after knee surgery. The objectives of this study were (1) to measure pain catastrophizing and kinesiophobia levels and (2) determine their association with self-reported subjective knee function during rehabilitation, following anterior cruciate ligament reconstruction (ACLR) and meniscectomy.
Materials and methods: The study involved 41 participants. The levels of catastrophizing (Pain Catastrophizing Scale [PCS]), kinesiophobia (Tampa Scale of Kinesiophobia [TSK-11]), pain (Numeric Pain Rating Scale [NRS]), and subjective knee function (the Knee Injury and Osteoarthritis Outcome Score [KOOS]) were assessed before and after completion of 14-session rehabilitation program.
Results: The mean level of catastrophizing changed from 5.8 (SD, 0.9) to 4.2 (SD, 0.5) during rehabilitation (P < 0.05). The mean level of kinesiophobia changed from 22.7 (SD, 0.7) to 18.4 (SD, 0.6) (P < 0.05). There was a moderate negative correlation between the PCS and the KOOS pain, function in daily living, knee-related quality of life subscales before and after rehabilitation (P < 0.05). There was a moderate negative correlation between the TSK-11 score and the KOOS function in daily living subscale before and after rehabilitation (P < 0.05).
Conclusions: Pain catastrophizing and kinesiophobia decreased during rehabilitation. A higher pain catastrophizing level correlated with a greater level of knee pain during activities, more difficulties experienced during daily activities before and after rehabilitation. A high level of kinesiophobia correlated with more difficulties experienced in daily activities and poorer knee-related quality of life before and after rehabilitation. Full article
Open AccessArticle
Associations of the quality of life and psychoemotional state with sociodemographic factors in patients with psoriasis
Medicina 2016, 52(4), 238-243; https://doi.org/10.1016/j.medici.2016.07.001
Received: 18 April 2016 / Revised: 5 July 2016 / Accepted: 9 July 2016 / Published: 30 July 2016
Cited by 4 | Viewed by 316 | PDF Full-text (412 KB)
Abstract
Objective: The aim of this study was to evaluate the interrelationships between the quality of life and psycho-emotional, demographic, and clinical factors in patients with psoriasis.
Materials and methods: The study included 18-year-old or older patients with psoriasis recruited from the university hospital [...] Read more.
Objective: The aim of this study was to evaluate the interrelationships between the quality of life and psycho-emotional, demographic, and clinical factors in patients with psoriasis.
Materials and methods: The study included 18-year-old or older patients with psoriasis recruited from the university hospital (n = 385). Their sociodemographic data, Psoriasis Area and Severity Index score and disease duration were assessed. The quality of life was evaluated by using the Dermatology Life Quality Index. Depression and anxiety were assessed using the Hospital Anxiety and Depression scale.
Results: A severe change in the quality of life (DLQI ≥ 10 points) was found by 1.8 times more commonly in females, by 2.7 times more commonly in patients with moderate and severe psoriasis (PASI ≤ 10) than in those with a mild psoriasis (PASI ≤ 10), and by about 2 times more commonly in patients with nail psoriasis than in those without, as well as in patients with psoriasis-related anxiety or depression than in subjects without those symptoms. Anxiety and depression were observed in 37.4% and 23.4% of the patients, respectively. Depression was more frequent in patients older than 55 years than in those <35 years of age. Anxiety was more frequent in females and in the respondents with primary and unfinished secondary education.
Conclusions: One-half of patients with psoriasis, women more often than men, regardless of the severity of the disease, reported a significant change in their quality of life. Patients with psoriasis, especially women and older people (aged more than 55 years), experienced anxiety and symptoms of depression. Full article
Open AccessArticle
Trends and regional inequalities in mortality from stroke in the context of health care reform in Lithuania
Medicina 2016, 52(4), 244-249; https://doi.org/10.1016/j.medici.2016.06.003
Received: 3 June 2015 / Revised: 21 June 2016 / Accepted: 22 June 2016 / Published: 29 July 2016
Cited by 3 | Viewed by 229 | PDF Full-text (790 KB)
Abstract
Background and objective: The objective of the study was to analyze mortality from stroke in Lithuania the context of health care reform with particular interest in urban/rural and regional inequalities. Based on the analysis of trends in mortality, and to detection of breakpoints [...] Read more.
Background and objective: The objective of the study was to analyze mortality from stroke in Lithuania the context of health care reform with particular interest in urban/rural and regional inequalities. Based on the analysis of trends in mortality, and to detection of breakpoints over two decades of socioeconomic transition, it focused on the challenges in stroke care provision.
Materials and methods: The analysis covered the entire country. Information on deaths from 1991 to 2012 was gathered from death certificates held by the Lithuanian Department of Statistics. The joinpoint analysis was used to identify the best-fitting points, wherever a statistically significant change in mortality occurred. Age-standardized mortality rates were calculated for 60 municipalities of Lithuania.
Results: The positive break-points in mortality from stroke were registered in 2007 for females and 2008 for males, when the increasing trends reversed to the declining. More positive changes occurred in urban areas, where stroke mortality is lower compare to rural since 1996. Considerable inequalities were disclosed among administrative regions of Lithuania: ratio between the highest and the lowest rates in different municipalities reached 4.88 for males and 3.35 for females.
Conclusions: There are good reasons to expect the favorable stroke mortality trends observed will follow the same direction in the future. Stroke centers are growing up in their competence while networking is also under the development. The new strategies in stroke care should result not only in the declining mortality rates and numbers of severely handicapped stroke patients, but also in diminishing regional and urban/rural inequalities. Full article
Open AccessArticle
Associations of HLA DRB1 alleles with IgG oligoclonal bands and their influence on multiple sclerosis course and disability status
Medicina 2016, 52(4), 217-222; https://doi.org/10.1016/j.medici.2016.07.004
Received: 3 December 2015 / Revised: 11 July 2016 / Accepted: 13 July 2016 / Published: 28 July 2016
Cited by 2 | Viewed by 258 | PDF Full-text (380 KB)
Abstract
Background and aim: Oligoclonal bands (OCB) may be associated with the genes of HLA complex, which allows to consider the possible interaction of genetic and immunological factors and its importance in the development and progression of multiple sclerosis (MS). The aim of this [...] Read more.
Background and aim: Oligoclonal bands (OCB) may be associated with the genes of HLA complex, which allows to consider the possible interaction of genetic and immunological factors and its importance in the development and progression of multiple sclerosis (MS). The aim of this study was to evaluate the associations between HLA DRB1 alleles and oligoclonal bands (OCBs) in the disease course and disability of multiple sclerosis (MS) patients.
Materials and methods: This was a prospective study of 120 patients with MS. HLA DRB1 alleles were genotyped using the polymerase chain reaction. Matched cerebrospinal fluid (CSF) and plasma samples were analyzed using isoelectric focusing and IgG specific immu- nofixation to test for the presence of intrathecal specific OCB.
Results: HLA DRB1*08 allele was related to a lower degree of disability. Oligoclonal bands were an independent and significant factor that influenced disability status irrespective of HLA DRB1* 04, *07, *08, *13, *15 and *16 alleles. Age at the onset and duration of the disease were independent and significant factors for MS progression in all logistic regression models with each newly added HLA DRB1 allele. HLA DRB1*08 allele was related to 75% lower odds that relapsing remitting (RR) MS will change to a progressive course MS irrespective of the other factors investigated. Detection of OCBs in the CSF was associated with the higher possibility of RR MS progression in all cases, except when the *08 allele was present.
Conclusions: OCBs had an influence on disability status, while HLA DRB1*08 allele was significantly associated with lower possibility that RR MS will change to progressive course MS. Full article
Open AccessCase Report
Bilateral cleft foot: Radiographic and prenatal ultrasound features of two siblings with a review of literature
Medicina 2016, 52(4), 257-261; https://doi.org/10.1016/j.medici.2016.07.003
Received: 26 January 2016 / Revised: 29 May 2016 / Accepted: 12 July 2016 / Published: 26 July 2016
Cited by 1 | Viewed by 220 | PDF Full-text (754 KB)
Abstract
Cleft foot deformity, also known as ectrodactyly, is a rare congenital developmental defect of extremities caused by malformation in continuity of apical ectoderm. The syndrome typically involves malformation or absence of the central rays of the feet and is character- ized by deformities [...] Read more.
Cleft foot deformity, also known as ectrodactyly, is a rare congenital developmental defect of extremities caused by malformation in continuity of apical ectoderm. The syndrome typically involves malformation or absence of the central rays of the feet and is character- ized by deformities like median deep clefts of distal extremities. Routine examination of feet during second-trimester ultrasound (US) may increase the detection rates of foot malformations. Many malformations can be diagnosed with 2-dimensional (2D) US, but 3-dimensional (3D) US also helps better understanding of the foot malformations. In the present study, we report the case of two brothers (a fetus and a 5-year-old) with cleft foot deformity. 2D and 3D second trimester US findings of one case and the foot radiography findings of the other are presented here. Full article
Open AccessArticle
Reliability and validity of the Lithuanian Tinnitus Handicap Inventory
Medicina 2016, 52(4), 223-228; https://doi.org/10.1016/j.medici.2016.07.002
Received: 18 January 2016 / Revised: 1 July 2016 / Accepted: 9 July 2016 / Published: 22 July 2016
Cited by 2 | Viewed by 284 | PDF Full-text (343 KB)
Abstract
Objective: The aim of this study was to determine the reliability and validity of the Lithuanian version of the Tinnitus Handicap Inventory (THI), a self-report measure of perceived tinnitus handicap.
Materials and methods: A cross-sectional psychometric validation study was performed in the University [...] Read more.
Objective: The aim of this study was to determine the reliability and validity of the Lithuanian version of the Tinnitus Handicap Inventory (THI), a self-report measure of perceived tinnitus handicap.
Materials and methods: A cross-sectional psychometric validation study was performed in the University Hospital. A total of 248 subjects reporting chronic tinnitus as their primary complaint or secondary to hearing loss were encluded in the study and filled in the Lithuanian version of THI. For assessment of construct validity a subgroup of 55 participants completed the Lithuanian version of the Hospital Anxiety and Depression Scale as a measure of self-perceived levels of anxiety and depression. Test–retest and internal consistency reliability as well as construct validity were calculated.
Results: The Lithuanian version of the THI and its subscales showed a robust internal consistency reliability (Cronbach's alpha = 0.93) comparable to the original version. Sta- tistically significant correlations were observed between the Lithuanian translation of the THI and the measures of self-perceived levels of anxiety and depression using HADS. Confirmatory factor analysis demonstrated that the three subscales of the THI Lithuanian version corresponded to three different factors, which strongly correlated between themselves.
Conclusions: The results suggest that the Lithuanian version of THI maintains its original validity and may serve as reliable and valid measure of general tinnitus related distress that can be used in a clinical setting to quantify the impact of tinnitus on daily living. Full article
Open AccessArticle
Health care professionals' skills regarding patient safety
Medicina 2016, 52(4), 250-256; https://doi.org/10.1016/j.medici.2016.05.004
Received: 5 October 2015 / Revised: 17 March 2016 / Accepted: 26 May 2016 / Published: 30 June 2016
Viewed by 310 | PDF Full-text (365 KB)
Abstract
Background and objective: The importance of patient safety is growing worldwide, and every day, health care professionals face various challenges in how to provide safe care for their patients. Patient safety skills are one of the main tools to ensure safe practice. This [...] Read more.
Background and objective: The importance of patient safety is growing worldwide, and every day, health care professionals face various challenges in how to provide safe care for their patients. Patient safety skills are one of the main tools to ensure safe practice. This study looks to describe health care professionals' skills regarding patient safety.
Materials and methods: Data were collected using the skill scale of the Patient Safety Attitudes, Skills and Knowledge (PS-ASK) instrument from different health care professionals (n = 1082: physicians, head nurses, nurses and nurse assistants) working in hospitals for adult patients in three regional multi-profile hospitals in the western part of Lithuania.
Results: Overall, the results of this study show that based on their own evaluations, health care professionals were competent regarding their safety skills. In particular, they were competent in the sub-scale areas of error analysis (mean = 3.09) and in avoiding threats to patient safety (mean = 3.31), but only somewhat competent in using decision support technology (mean = 2.00). Demographic and other work related background factors were only slightly associated with these patient safety skills areas. Especially, it was noted that nurse assistants may need more support from managers and colleagues in developing their patient safety skills competence.
Conclusions: This study has served to investigate the general skills of health care professionals in regard to patient safety. It provides new knowledge about the topic in the context of the Baltic countries and can thus be used in the future development of health care services. Full article
Open AccessReview
Determination of death: Metaphysical and biomedical discourse
Medicina 2016, 52(4), 205-210; https://doi.org/10.1016/j.medici.2016.06.002
Received: 19 April 2016 / Revised: 8 June 2016 / Accepted: 19 June 2016 / Published: 30 June 2016
Viewed by 252 | PDF Full-text (360 KB)
Abstract
The prominence of biomedical criteria relying on brain death reduces the impact of metaphysical, anthropological, psychosocial, cultural, religious, and legal aspects disclosing the real value and essence of human life. The aim of this literature review is to discuss metaphysical and biomedical approaches [...] Read more.
The prominence of biomedical criteria relying on brain death reduces the impact of metaphysical, anthropological, psychosocial, cultural, religious, and legal aspects disclosing the real value and essence of human life. The aim of this literature review is to discuss metaphysical and biomedical approaches toward death and their complimentary relationship in the determination of death. A critical appraisal of theoretical and scientific evidence and legal documents supported analytical discourse. In the metaphysical discourse of death, two main questions about what human death is and how to determine the fact of death clearly separate the ontological and epistemological aspects of death. During the 20th century, various understandings of human death distinguished two different approaches toward the human: the human is a subject of activities or a subject of the human being. Extinction of the difference between the entities and the being, emphasized as rational– logical instrumentation, is not sufficient to understand death thoroughly. Biological criteria of death are associated with biological features and irreversible loss of certain cognitive capabilities. Debating on the question ‘‘Does a brain death mean death of a human being?’’ two approaches are considering: the body-centrist and the mind-centrist. By bridging those two alternatives human death appears not only as biomedical, but also as metaphysical phenomenon. It was summarized that a predominance of clinical criteria for determination of death in practice leads to medicalization of death and limits the holistic perspective toward individual's death. Therefore, the balance of metaphysical and biomedical approaches toward death and its determination would decrease the medicalization of the concept of death. Full article
Open AccessArticle
The acute effects of passive heat exposure on arterial stiffness, oxidative stress, and inflammation
Medicina 2016, 52(4), 211-216; https://doi.org/10.1016/j.medici.2016.06.001
Received: 9 May 2015 / Revised: 20 May 2016 / Accepted: 14 June 2016 / Published: 29 June 2016
Cited by 6 | Viewed by 290 | PDF Full-text (460 KB)
Abstract
Background and objective: The aim of the study was to determine the acute effect of passive heat exposure (PHE) on arterial stiffness, oxidative stress (OxS) and inflammatory parameters.
Materials and methods: Subjects were studied in thermoneutral conditions before and after PHE in a [...] Read more.
Background and objective: The aim of the study was to determine the acute effect of passive heat exposure (PHE) on arterial stiffness, oxidative stress (OxS) and inflammatory parameters.
Materials and methods: Subjects were studied in thermoneutral conditions before and after PHE in a climatic chamber. Pulse wave analysis was used for assessment of central hemodynamic and arterial stiffness parameters. Venous blood samples were obtained to measure OxS and inflammatory parameters.
Results: Rectal temperature increased after PHE exposure compared to baseline: 37.01 °C ± 0.19 °C and 36.4 °C ± 0.31 °C, respectively (P < 0.001). There was a 17% (P < 0.05) decrease in large artery elasticity index (from 24.68 ± 5.53 to 20.42 ± 2.65 mL/mmHg*10), which was predicted upon normothermic value (r = −0.878, P < 0.01). However, no significant changes were found in others arterial stiffness parameters. A 30% (P < 0.05) increase occurred in blood IL-6 concentration (from 0.43 ± 0.15 to 0.56 ± 0.23 pg/mL), but OxS parameters remained significantly unchanged.
Conclusions: This study describes for the first time acute PHE effects on arterial stiffness, inflammation and OxS. PHE significantly decreases large artery elasticity index and increases inflammatory IL-6 level. However, further larger investigations are needed for clarifying acute PHE effects on arterial function and biomarkers. Full article
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