Quality assessment of blood pressure measurements in epidemiological surveys. The impact of last digit preference and the proportions of identical duplicate measurements. WHO Monica Project [corrected

In the WHO MONICA Project, cardiovascular risk factor surveys including measurements of arterial blood pressure (BP) were conducted in more than 50 different populations. In the course of a retrospective BP measurement quality assessment effort, two indicators of "prejudiced" blood pressure reading, last digit preference and high proportions of identical results in duplicate measurements, are used in addition to other items to evaluate blood pressure measurement quality. We used fictitious blood pressure distributions and applied to them Last Digit Preference scores and Proportions of Identical Duplicate Measurements actually found in the MONICA surveys. The analysis showed that Last Digit Preference affects predominantly the shape of the BP distribution curve, whereas high Proportions of Identical Duplicate Measurements may cause a shift of the entire BP distribution curve. Although the two items are partly interrelated, a clear distinction between them and their effects is advocated.     

The burden attributable to headache disorders in children and adolescents in Lithuania: estimates from a national schools-based study

BackgroundWe recently showed headache to be common in children (aged 7–11 years) and adolescents (aged 12–17) in Lithuania. Here we provide evidence from the same study of the headache-attributable burden.MethodsFollowing the generic protocol for Lifting The Burden’s global schools-based study, this cross-sectional survey administered self-completed structured questionnaires to pupils within classes in 24 nationally representative schools selected from seven regions of the country. Headache diagnostic questions were based on ICHD-3 beta criteria but for the inclusion of undifferentiated headache (UdH; defined as mild headache with usual duration < 1 h). Burden enquiry was conducted in multiple domains.ResultsQuestionnaires were completed by 2505 pupils (1382 children, 1123 adolescents; participating proportion 67.4%), of whom 1858 reported headache in the preceding year, with mean frequency (±SD) of 3.7 ± 4.5 days/4 weeks and mean duration of 1.6 ± 1.9 h. Mean proportion of time in ictal state, estimated from these, was 0.9% (migraine 1.5%, probable medication-overuse headache [pMOH] 10.9%). Mean intensity on a scale of 1–3 was 1.6 ± 0.6 (mild-to-moderate). Symptomatic medication was consumed on 1.5 ± 2.8 days/4 weeks. Lost school time was 0.5 ± 1.5 days/4 weeks (migraine 0.7 ± 1.5, pMOH 5.0 ± 7.8) based on recall, but about 50% higher for migraine according to actual absences recorded in association with reported headache on the preceding day. More days were reported with limited activity (overall 1.2 ± 2.4, migraine 1.5 ± 2.2, pMOH 8.4 ± 8.5) than lost from school. One in 30 parents (3.3%) missed work at least once in 4 weeks because of their son’s or daughter’s headache. Emotional impact and quality-of-life scores generally reflected other measures of burden, with pMOH causing greatest detriments, followed by migraine and tension-type headache, and UdH least. Burdens were greater in adolescents than children as UdH differentiated into adult headache types.ConclusionsHeadache in children and adolescents in Lithuania is mostly associated with modest symptom burden. However, the consequential burdens, in particular lost school days, are far from negligible for migraine (which is prevalent) and very heavy for pMOH (which, while uncommon in children, becomes four-fold more prevalent in adolescents). These findings are of importance to both health and educational policies in Lithuania.     

Trend in eating habits among Lithuanian school-aged children in context of social inequality: three cross-sectional surveys 2002, 2006 and 2010

Background  

Intermittent monitoring of food intake at the population level is essential for the planning and evaluation of national dietary intervention programs. Social-economic changes in Lithuania have likely affected dietary habits, but only a limited number of temporal studies on food intake trends among young population groups have been published. The aim of this study was to investigate changes in eating habits among Lithuanian school-aged children from 2002 to 2010, and to explore the association of these changes with the respondents' reported socio-economic status (SES).     

Health behavior among Lithuania's adolescents in context of European Union

Aim

To compare health behavior patterns of adolescents in Lithuania with health behavior of adolescents in European Union (EU) in 2001/2002.

Methods

The study was carried out in conformity with the methodology of Health Behavior in School-aged Children: a World Health Organization cross-national study. Three country representative samples of schoolchildren, aged 11, 13, and 15, were surveyed in 25 EU countries and regions in 2001/2002 school year. The study instrument was a standardized questionnaire that included questions on alcohol consumption, smoking, illegal drugs use, physical activity, and other patterns of health behavior. The rate or mean values of the targeted health behavior of Lithuanian students were assessed and compared to those calculated as an average for the EU countries and regions.

Results

We found an early onset of alcohol consumption among Lithuanian boys. Lithuanian boys and girls across all age groups reported being drunk two and more times more often than their peers from other EU member states. Lithuanian 15-year-old boys smoked more often that did their European peers, while girls smoke more rarely. The prevalence of drugs (marihuana group) use among Lithuanian students is relatively low: the prevalence of drug use among 15-year-olds in Lithuania is two times lower than the prevalence in other EU countries and regions (11.2% vs 24.5% for boys and 4.5% vs 18.3% for girls, respectively). Physical activity of Lithuanian adolescents is rather high in comparison with their EU peers, although many students watch television for ≥4 hours a day. Lithuanian students did not eat sweets often, or drank soft drinks (Coca Cola and other), and they ate fruits and had breakfast every school day. With respect to hygienic habits, approximately only one in 3 boys and every second girl brushed their teeth more than once a day.

Conclusions

There are health behavior differences between adolescents in Lithuania and those in other EU countries. The disparities among health behavior of young people in EU countries and regions require Lithuanian and EU health policy to develop initiatives aimed at decreasing health behavior inequalities.Lithuania’s joining the European Union (EU) was the most significant event for the country in 2004 and one of the most important steps in the integration of Lithuania into the international community. In this context, a critical and objective assessment of population health is needed to determine the level of health in Lithuania within the EU context (1).Good health implies longer, healthier, and more productive life, higher quality of life, and better basis for steady economic growth and sustainable development of the country (2). Therefore, investment in the health of youth is doubtlessly a key priority in all EU countries. Early investments in health typically pay off later in life (3).Over the last decades, dramatic social, political, and economic shifts, along with medical and public health interventions, have radically altered the profile of adolescent health around the world. Presently dominant negative social, behavioral, and environmental factors, such as smoking, alcohol consumption, and drugs use, affect young people’s health and are the triggers for chronic non-communicable diseases in the future (4).The Health Behavior in School-aged Children (HBSC) study carried out in Europe and North America showed an early onset of smoking and alcohol use, high consumption of sweets and soft drinks, low consumption of fruits and vegetables, and frequent skipping of breakfast among the adolescents (5). It also showed that most young people did not meet the recommended physical activity guidelines and that many reported spending long hours on doing homework, watching television, and on a computer. The European School Survey Project on Alcohol and Drugs (ESPAD) study showed that cannabis use among youth in most countries was increasing and that the differences in the cannabis use rates between the western European countries and North America were diminishing (6).Many European countries have undergone social and political changes as well as economic transition. Health has suffered most where economies were unable to ensure an adequate income for all, where social systems have collapsed, and where natural resources have been poorly managed, as evidenced by a health gap between the western and eastern parts of the EU region. Reduction in health inequalities, including disparities in health behavior, between the countries and regions is the first target of the “Health for All” initiative (3).Our aim was to compare health behavior patterns of adolescents in Lithuania and those in other EU countries.     

Predicting the dynamics of elevated arterial pressure in 12--13-year-old children of Kaunas and Berlin

The increased arterial blood pressure (BP) variation between 12-13 and 15-16 years of age was examined in 119 schoolchildren of Kaunas and 169 schoolchildren of Berlin. The 90th percentile for systolic and/or diastolic BP was used as a criterion of increased arterial BP. The data were treated by multivariate logistical regression analysis. Independent samples were used to construct and test the model. The reproducibility of increased arterial BP was shown to be affected by physical developmental status as well as baseline systolic and diastolic BP, the influence being more pronounced in girls, as compared to boys. The derived formulas are presented as a nomogram to facilitate their practical application.     

Suicidal tendencies and attitude towards freedom to choose suicide among Lithuanian schoolchildren: results from three cross-sectional studies in 1994, 1998, and 2002

Background  

Suicidal behaviour is increasingly becoming a phenomenon associated with young people and an important public health issue in Lithuania. However, there are very few studies evaluating impact of young peoples' attitudes towards suicide to their suicidal behaviour. A better understanding of the relations among the variables associated with suicidal ideation and threats in the normal population of adolescents may eventually result in a better understanding of the more serious forms of adolescent suicidal behaviour. The aim of the present study was to evaluate prevalence of suicidal tendencies among Lithuanian schoolchildren and to estimate its association with an attitude towards suicide in 1994 – 2002.     

Health behavior inequalities among Lithuanian,Polish and Russian school-aged children in Lithuania

The aim of this study was to compare and get a deeper insight into issues of the health and health behavior inequalities among Lithuanian, Polish and Russian school-aged children in national and international contexts. Investigations were carried out in the framework of Health Behavior in School-aged Children (HBSC) study — a WHO collaborative cross-national survey. Five thousand seven hundred and seventy six randomly selected students aged 11, 13, and 15 years of age answered questionnaires in the classroom in 108 schools located in different regions in Lithuania in March–April of 2006. Questions on perceived health and health related behaviors were addressed to the respondent (response rate was 95 %). 5632 questionnaires were selected for further analysis by the international data center in Bergen. SPSS version 11.5 and multilevel analysis program MLwiN 2.0 was applied for statistical analysis of data. Relatively minor inequalities in health and health behavior were established when comparing different health and health behavior indicators in Lithuanian, Polish and Russian school-aged children in Lithuania. These disparities are lower in comparison with differences, which were established among respondents of HBSC international studies. Odds ratios to have negative self-rated health evaluation were higher in girls of Russian (OR-1.71, p<0.05) and Polish (OR-1.62, p<0.05) nationality. Therefore, Russian and Polish students were tending to have higher odds ratios for perception of happiness (p<0.05). Respondents of Russian nationality have expressed less somatic and psychological complaints. Polish boys (OR=1.38, p<0.05) were tending for higher prevalence of headache, but have expressed fewer complaints for depression (OR=0.65, p<0.05), anxiety (OR=0.71, p<0.05). Chances to be involved in risk taking behaviors (alcohol consumption, smoking, drug use) were lower among Polish and Russian respondents. In schools with Lithuanian language based-schoold, health and health behavior indicators were more negative in Polish and Russian respondents in comparisons with their Lithuanian peers However, Lithuanian students, who were enrolled in Russian and Polish schools, tending to have better perceived health evaluation and better health behavior in comparison with their peers of Polish and Russian nationality. Analysis shows, that Polish and Russian students are integrated well into Lithuanian society and being a member of the minority class is not related to poor health or negative lifestyle. Therefore, with few exceptions universal health promotion programs should be provided to school-aged children of all ethnicities and cultural backgrounds.     

Health-behaviour inequalities among Russian and ethnic majority school-aged children in the Baltic countries

Aims: The main aim of this paper was to investigate whether ethnic heath inequalities exist in self-rated health and risk-taking behaviours (smoking, drunkenness, use of cannabis) between ethnic majority (Estonian, Latvian, Lithuanian) and minority (Russian) population groups of school-aged children in three Baltic countries. Methods: Investigation was carried out in the framework of Health Behaviour in School-aged Children (HBSC) study. Randomly selected students aged 11, 13, and 15 years answered questionnaires in the classroom in 2006. In total, 14,354 questionnaire forms were selected for analysis. Results: Russian boys were more likely (p<0.05) to evaluate their self-rated health positively in schools with Russian teaching language. Odd ratios for current smoking and drunkenness were significantly lower among Russian boys in the schools with Russian language of instruction (p<0.05) in comparison with the reference group. Russian girls did not differ significantly (the exceptions were smoking in Estonia and cannabis use in Latvia) from the majority population girls by self-rated health as well as by the risk of smoking, drunkenness, and use of cannabis. Conclusions: The study found some differences in self-rated health and in risk-taking behaviours between Russian minority and ethnic majority students as well as between students of schools with different language of instruction (majority language vs. Russian) in Estonia, Latvia, and Lithuania. Being a member of minority group was not related with poor self-rated health or involvement in risk-taking behaviours in school-aged children in the Baltic countries.     

Body image and weight control among adolescents in Lithuania, Croatia, and the United States in the context of global obesity

Aim

To compare body image and weight control behavior among adolescents in Lithuania, Croatia, and the United States (US), the countries with striking contrasts in the prevalence of overweight among adolescents.

Method

The study was carried out according to the methodology of the Health Behavior in School-aged Children collaborative survey. Nationally-representative samples of students, aged 13 and 15, were surveyed in Lithuania (3778 respondents), Croatia (2946 respondents), and the US (3546 respondents) in the 2001/2002 school year.

Results

In all three countries, girls perceived themselves as being “too fat” more frequently than boys (37.0% vs 19.7%, P<0.001, z test). The prevalence of this perception increased with age among girls (32.7% vs 41.1%, P<0.001, z test) and decreased among boys (21.4% vs 17.9%, P = 0.005, z test). Lithuanian adolescents were least likely to perceive themselves as “too fat;” this perception was significantly more frequent in Croatia and the US (24.2%, 27.5%, and 34.3%, respectively; P<0.001, χ² test). With the exception of 15-year-old Lithuanian boys, in all respondents the proportion of adolescents with body mass index (BMI) ≥85th percentile who perceived themselves as “too fat” was significantly higher (up to 3.13 times among 15-year-old US girls) than the proportion of adolescents with BMI ≤15th percentile who perceived themselves as “too thin.” The highest proportion of overweight boys and girls on a diet or doing something else to lose weight was found in the US. Boys in Lithuania were most likely to be satisfied with their weight regardless of their weight status.

Conclusion

Perceived body image and weight control behavior differ among adolescents in Lithuania, Croatia, and the US. Cross-cultural, age, and sex influences moderate body image and weight control behavior in underweight and overweight adolescents.The prevalence of overweight and obesity among adolescents is rising rapidly in many countries around the world, including Europe (1). Parallel to the rise in obesity, there is an increase in body dissatisfaction among adolescents (2,3). Previous studies have found that body dissatisfaction is a strong predictor of unhealthy weight control practices (4,5), and restrictive dieting and unhealthy or extreme weight control methods are frequently used by adolescents attempting to achieve an internalized image of ideal body (6). Longitudinal studies have indicated that dieting also predicts weight gain and obesity (7,8). Furthermore, weight control behavior is associated with a wide range of health risk behaviors and psychological problems (9). Thus, frequent weight control associated with poor body image can lead to significant health risks or has potentially serious medical and social consequences.Psychologists define adolescence as a critical period with respect to psychological development of self-image. The association between self-image and mental health is particularly important, since during this period these newly developed cognitive abilities facilitate self-reflection (10,11). Sociocultural theories of body image and empirical research pertinent to them suggest that unrealistic cultural standards of beauty contribute to adolescents’ body dissatisfaction (12). Body dissatisfaction has serious physical and psychological consequences, so further study is needed on cultural and sex differences in these attitudes.Body dissatisfaction problems, which are prevalent in adolescents worldwide, can be incorporated into discussions on perceptions of physical appearance and suggest new hypotheses. Recent international data suggest that of the 34 countries, which conducted the Health Behavior in School-age Children (HBSC) study in 2001/2002, the US had the highest and Lithuania had the lowest prevalence of overweight and obesity in adolescents (13,14).The aim of this article is to compare body image and weight control behavior among adolescents of Lithuania, Croatia, and the US, selected as the countries with different cultural context and a striking contrast in the prevalence of overweight among adolescents. We hypothesize that body weight perceptions among adolescents and weight control behavior pertinent to them differ across countries. Moreover, cross-cultural comparisons may indicate whether the influence of being underweight or overweight on body image and dieting is a universal characteristic of adolescence or if there are cultural, age, or sex influences that moderate this relationship (9).