Browsing by Author "Brigis, Girts"
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Item Birth order and childhood type 1 diabetes risk : A pooled analysis of 31 observational studies(2011-04) Cardwell, Chris R.; Stene, Lars C.; Joner, Geir; Bulsara, Max K.; Cinek, Ondrej; Rosenbauer, Joachim; Ludvigsson, Johnny; Svensson, Jannet; Goldacre, Michael J.; Waldhoer, Thomas; Jarosz-Chobot, Przemystawa; Gimeno, Suely GA; Chuang, Lee Ming; Roberts, Christine L.; Parslow, Roger C.; Wadsworth, Emma JK; Chetwynd, Amanda; Brigis, Girts; Urbonaite, Brone; Šipetić, Sandra; Schober, Edith; Devoti, Gabriele; Ionescu-Tirgoviste, Constantin; de Beaufort, Carine E.; Stoyanov, Denka; Buschard, Karsten; Radon, Katja; Glatthaar, Christopher; Patterson, Chris C.; Department of Public Health and EpidemiologyBackground: The incidence rates of childhood onset type 1 diabetes are almost universally increasing across the globe but the aetiology of the disease remains largely unknown. We investigated whether birth order is associated with the risk of childhood diabetes by performing a pooled analysis of previous studies. Methods: Relevant studies published before January 2010 were identified from MEDLINE, Web of Science and EMBASE. Authors of studies provided individual patient data or conducted pre-specified analyses. Meta-analysis techniques were used to derive combined odds ratios (ORs), before and after adjustment for confounders, and investigate heterogeneity. Results: Data were available for 6 cohort and 25 case-control studies, including 11 955 cases of type 1 diabetes. Overall, there was no evidence of an association prior to adjustment for confounders. After adjustment for maternal age at birth and other confounders, a reduction in the risk of diabetes in second-or later born children became apparent [fully adjusted OR=0.90 95% confidence interval (CI) 0.83-0.98; P=0.02] but this association varied markedly between studies (I2=67%). An a priori subgroup analysis showed that the association was stronger and more consistent in children <5years of age (n=25 studies, maternal age adjusted OR=0.84 95% CI 0.75, 0.93; I2=23%). Conclusion: Although the association varied between studies, there was some evidence of a lower risk of childhood onset type 1 diabetes with increasing birth order, particularly in children aged <5 years. This finding could reflect increased exposure to infections in early life in later born children. Published by Oxford University Press on behalf of the International Epidemiological AssociationItem Breast-feeding and childhood-onset type 1 diabetes : A pooled analysis of individual participant data from 43 observational studies(2012-11) Cardwell, Chris R.; Stene, Lars C.; Ludvigsson, Johnny; Rosenbauer, Joachim; Cinek, Ondrej; Svensson, Jannet; Perez-Bravo, Francisco; Memon, Anjum; Gimeno, Suely G.; Wadsworth, Emma J.K.; Strotmeyer, Elsa S.; Goldacre, Michael J.; Radon, Katja; Chuang, Lee Ming; Parslow, Roger C.; Chetwynd, Amanda; Karavanaki, Kyriaki; Brigis, Girts; Pozzilli, Paolo; Urbonaite, Brone; Schober, Edith; Devoti, Gabriele; Sipetic, Sandra; Joner, Geir; Ionescu-Tirgoviste, Constantin; De Beaufort, Carine E.; Harrild, Kirsten; Benson, Victoria; Savilahti, Erkki; Ponsonby, Anne Louise; Salem, Mona; Rabiei, Samira; Patterson, Chris C.; Department of Public Health and EpidemiologyOBJECTIVE - To investigate if there is a reduced risk of type 1 diabetes in children breastfed or exclusively breastfed by performing a pooled analysis with adjustment for recognized confounders. RESEARCH DESIGN AND METHODS - Relevant studies were identified from literature searches using MEDLINE, Web of Science, and EMBASE. Authors of relevant studies were asked to provide individual participant data or conduct prespecified analyses. Meta-analysis techniques were used to combine odds ratios (ORs) and investigate heterogeneity between studies. RESULTS - Data were available from 43 studies including 9,874 patients with type 1 diabetes. Overall, there was a reduction in the risk of diabetes after exclusive breast-feeding for >2 weeks (20 studies; OR = 0.75, 95% CI 0.64- 0.88), the association after exclusive breast-feeding for >3 months was weaker (30 studies;OR = 0.87, 95%CI 0.75 -1.00), and no association was observed after (nonexclusive) breast-feeding for >2 weeks (28 studies; OR = 0.93, 95% CI 0.81-1.07) or >3 months (29 studies; OR = 0.88, 95% CI 0.78-1.00). These associations were all subject to marked heterogeneity (I 2 = 58, 76, 54, and 68%, respectively). In studies with lower risk of bias, the reduced risk after exclusive breast-feeding for >2 weeks remained (12 studies; OR = 0.86, 95% CI 0.75-0.99), and heterogeneity was reduced (I 2 = 0%). Adjustments for potential confounders altered these estimates very little. CONCLUSIONS - The pooled analysis suggests weak protective associations between exclusive breast-feeding and type 1 diabetes risk. However, these findings are difficult to interpret because of the marked variation in effect and possible biases (particularly recall bias) inherent in the included studies.Item Factors related to good asthma control using different medical adherence scales in Latvian asthma patients : An observational study(2017-12-01) Smits, Dins; Brigis, Girts; Pavare, Jana; Maurina, Baiba; Barengo, Noël Christopher; Sabiedrības veselības un sociālās labklājības fakultāte; Faculty of Medicine; Faculty of PharmacyOne of the main challenges in asthma control is adherence to pharmaceutical treatment. The aim of this study was to test the association between adherence to asthma medication, control and medical beliefs, cognitive and emotional perceptions using three different validated questionnaires. Beliefs about asthma medicine, cognitive and emotional factors were determined in a cross-sectional survey of patients attending outpatient pulmonologist practices in Latvia (n = 352). The validated Beliefs about Medicines Questionnaire and the Brief Illness Perception Questionnaire were used. Adherence to asthma medication was assessed using the Morisky Medication Adherence Scale and two different versions of the Medication Adherence Reporting Scale. Several questions about necessity or concerns related to pharmaceutical treatment were able to predict poor adherence according to the Morisky scale. If the patient felt that without the asthma medication his life would be impossible, his risk to have poor treatment adherence was 46% reduced (odds ratio 0.54; 95% confidence interval 0.33-0.89). Furthermore, asthma patients who were convinced that their health depends on the asthma treatment were less likely to have poor treatment adherence (odds ratio 0.56: 95% confidence interval 0.32-0.97). In case the patient was concerned by the need to constantly use asthma medication or sometimes concerned by long-term effects of asthma medication the odds of poor treatment adherence were 1.96 (95% confidence interval 1.19-3.24) and 2.43 (95% confidence interval 1.45-4.08), respectively. In conclusion, medication beliefs, particularly concerns and necessity of asthma treatment were associated with poor treatment adherence when assessed with the Morisky or 5-item Medication Adherence Reporting Scale.Item Factors related to poor asthma control in Latvian asthma patients between 2013 and 2015(2017-04-03) Smits, Dins; Brigis, Girts; Pavare, Jana; Maurina, Baiba; Barengo, Noël Christopher; Sabiedrības veselības un sociālās labklājības fakultāte; Faculty of Medicine; Faculty of PharmacyObjectives: To investigate whether beliefs about asthma medication, cognitive and emotional factors are related to poor asthma control in a sample of Latvian asthma patients in 2015. Design: Cross-sectional, self-administered survey. Subjects: Three hundred and fifty two asthma patients (mean age 57.5 years) attending outpatient pulmonologist consultations in Riga, Latvia during September 2013 to December 2015. The sample size was calculated to detect a prevalence of poor asthma control of 50% with a margin of error of 5% and a power of 95%. Main outcome measures: The validated Beliefs about Medication Questionnaire (BMQ) and the Brief Illness Perception Questionnaire (brief IPQ) were used. Good asthma control was assessed using the asthma control test (ACT), a validated five-item scale that reliably assesses asthma control over a recall period of four weeks. Logistic regression models were used to predict poor asthma control. Results: Patients who had a good control of asthma medication (OR 0.70; 95% CI 0.61–0.79) or were confident that their asthma medication improves illness (OR 0.84; 95% CI 0.74–0.95) had a reduced risk of poor asthma control. The more symptoms (OR 1.63; 95% CI 1.44–1.84) the asthma patients perceived or the more their illness affects their life, the higher the probability of poor asthma control (OR 1.47; 95% CI 1.31–1.65). Some beliefs of necessity and concerns of asthma medication were also statistically significantly related to poor asthma control. Conclusions: Beliefs of necessity of asthma medication, cognitive and emotional illness perception factors correlate well with poor asthma control in Latvian patients.Item Glutathione reductase is associated with the clinical outcome of septic shock in the patients treated using continuous veno-venous haemofiltration(2021-07-06) Moisejevs, Georgijs; Bormane, Eva; Trumpika, Dace; Baufale, Regina; Busmane, Inara; Voicehovska, Julija; Grigane, Anda; Suba, Olegs; Silova, Alise; Skesters, Andrejs; Lejnieks, Aivars; Gailite, Linda; Brigis, Girts; Department of Internal Diseases; Bioķīmijas zinātniskā laboratorija; Scientific Laboratory of Molecular Genetics; Department of Public Health and EpidemiologyBackground and objectives: At present, there is insufficient evidence to support the use of continuous veno-venous haemofiltration (CVVH) in the early treatment of septic shock. This study focuses on the association between survival and different parameters of oxidative stress (RedOx). Thereby, we evaluated whether RedOx markers are associated with the outcome of septic shock in patients under early-initiated CVVH treatment. Materials and Methods: We conducted a prospective observational study of 65 patients with septic shock who started CVVH within 12 h after hospital admission. Blood samples were taken from each patient prior to the start of CVVH. The following RedOx markers were measured: glutathione peroxidase, glutathione reductase (GR), total antioxidant capacity, superoxide dismutase, nitric oxide, malondialdehyde and 4-hydroxynonenal. The odds ratio (OR) was calculated using binary logistic regression and stepwise multivariable regression. Results: The 65 patients had a median age of 66 years and 39 were male. Based on the outcome, the patients were divided into two groups—non-survivors (n = 29) and survivors (n = 36)—and the levels of RedOx markers were compared between them. Of all the markers, only higher GR activity was found to be significantly associated with the fatal outcome; 100.3 U/L versus 60.5 U/L, OR = 1.027 (95% CI, 1.010–1.044). Following adjustment for the sequential organ failure assessment score and other parameters, GR activity still presented a significant association with the fatal outcome, OR = 1.020 (95% CI, 1.002–1.038). Conclusions: GR activity is associated with in-hospital fatal outcomes among septic shock patients under early-initiated CVVH treatment. Septic shock patients who have a lower GR activity at hospital admission may have a favourable outcome of the early initiation of CVVH.Item Healthcare financing reform in Latvia : Switching from social health insurance to NHS and back?(2014-11-01) Mitenbergs, Uldis; Brigis, Girts; Quentin, Wilm; Department of Public Health and EpidemiologyIn the 1990s, Latvia aimed at introducing Social Health Insurance (SHI) but later changed to a National Health Service (NHS) type system. The NHS is financed from general taxation, provides coverage to the entire population, and pays for a basic service package purchased from independent public and private providers. In November 2013, the Cabinet of Ministers passed a draft Healthcare Financing Law, aiming at increasing public expenditures on health by introducing Compulsory Health Insurance (CHI) and linking entitlement to health services to the payment of income tax. Opponents of the reform argue that linking entitlement to health services to the payment of income tax does not have the potential to increase public expenditures on health but that it can contribute to compromising universal coverage and access to health services of certain population groups. In view of strong opposition, it is unlikely that the law will be adopted before parliamentary elections in October 2014. Nevertheless, the discussion around the law is interesting because of three main reasons: (1) it can illustrate why the concept of SHI remains attractive - not only for Latvia but also for other countries, (2) it shows that a change from NHS to SHI does not imply major institutional reforms, and (3) it demonstrates the potential problems of introducing SHI, i.e. of linking entitlement to health services to the payment of contributions.Item Interbirth interval is associated with childhood type 1 diabetes risk(2012-03) Cardwell, Chris R.; Svensson, Jannet; Waldhoer, Thomas; Ludvigsson, Johnny; Sadauskaite-Kuehne, Vaiva; Roberts, Christine L.; Parslow, Roger C.; Wadsworth, Emma J. K.; Brigis, Girts; Urbonaite, Brone; Schober, Edith; Devoti, Gabriele; Ionescu-Tirgoviste, Constantin; de Beaufort, Carine E.; Soltesz, Gyula; Patterson, Chris C.; Department of Public Health and EpidemiologyShort interbirth interval has been associated with maternal complications and childhood autism and leukemia, possibly due to deficiencies in maternal micronutrients at conception or increased exposure to sibling infections. A possible association between interbirth interval and subsequent risk of childhood type 1 diabetes has not been investigated. A secondary analysis of 14 published observational studies of perinatal risk factors for type 1 diabetes was conducted. Risk estimates of diabetes by category of interbirth interval were calculated for each study. Random effects models were used to calculate pooled odds ratios (ORs) and investigate heterogeneity between studies. Overall, 2,787 children with type 1 diabetes were included. There was a reduction in the risk of childhood type 1 diabetes in children born to mothers after interbirth intervals β3 years compared with longer interbirth intervals (OR 0.82 [95% CI 0.72-0.93]). Adjustments for various potential confounders little altered this estimate. In conclusion, there was evidence of a 20% reduction in the risk of childhood diabetes in children born to mothers after interbirth intervals β3 years.Item Maternal age at birth and childhood type 1 diabetes : A pooled analysis of 30 observational studies(2010-02) Cardwell, Chris R.; Stene, Lars C.; Joner, Geir; Bulsara, Max K.; Cinek, Ondrej; Rosenbauer, Joachim; Ludvigsson, Johnny; Jané, Mireia; Svensson, Jannet; Goldacre, Michael J.; Waldhoer, Thomas; Jarosz-Chobot, Przemysława; Gimeno, Suely G.A.; Chuang, Lee Ming; Parslow, Roger C.; Wadsworth, Emma J.K.; Chetwynd, Amanda; Pozzilli, Paolo; Brigis, Girts; Urbonaite, Brone; Šipetić, Sandra; Schober, Edith; Devoti, Gabriele; Ionescu-Tirgoviste, Constantin; De Beaufort, Carine E.; Stoyanov, Denka; Buschard, Karsten; Patterson, Chris C.; Department of Public Health and EpidemiologyOBJECTIVE - The aim if the study was to investigate whether children born to older mothers have an increased risk of type 1 diabetes by performing a pooled analysis of previous studies using individual patient data to adjust for recognized confounders. RESEARCH DESIGN AND METHODS - Relevant studies published before June 2009 were identified from MEDLINE, Web of Science, and EMBASE. Authors of studies were contacted and asked to provide individual patient data or conduct prespecified analyses. Risk estimates of type 1 diabetes by maternal age were calculated for each study, before and after adjustment for potential confounders. Meta-analysis techniques were used to derive combined odds ratios and to investigate heterogeneity among studies. RESULTS - Data were available for 5 cohort and 25 case-control studies, including 14,724 cases of type 1 diabetes. Overall, there was, on average, a 5% (95% CI 2-9) increase in childhood type 1 diabetes odds per 5-year increase in maternal age (P = 0.006), but there was heterogeneity among studies (heterogeneity I2 = 70%). In studies with a low risk of bias, there was a more marked increase in diabetes odds of 10% per 5-year increase in maternal age. Adjustments for potential confounders little altered these estimates. CONCLUSIONS - There was evidence of a weak but significant linear increase in the risk of childhood type 1 diabetes across the range of maternal ages, but the magnitude of association varied between studies. A very small percentage of the increase in the incidence of childhood type 1 diabetes in recent years could be explained by increases in maternal age.Item The mortality of patients with diabetes mellitus in Latvia 2000-2012(2014) Pildava, Santa; Strele, Ieva; Brigis, Girts; Department of Public Health and EpidemiologyBackground and objective: In Latvia, like in other European countries, the incidence of diabetes mellitus is increasing and so it is important to find out what the trends in the mortality of diabetes mellitus in Latvia are. The aim of this study was to calculate the mortality indicators of diabetes patients in Latvia from 2000 to 2012 and compare mortality among diabetes mellitus patients with mortality among the population of Latvia. Materials and methods: The study was carried out with a quantitative statistical analysis approach. In the study, all the registered patients with diabetes mellitus from 2000 to 2012 were included. Results: Mortality in a population with diabetes decreased statistically significantly from 57.76 per 1000 py in 2000 to 45.33 per 1000 py in 2012. In the general population of Latvia, there were no statistically significant changes; the mortality in 2000 was 13.56 per 1000 py, in 2012 - 14.24 per 1000 py. The age-standardised mortality ratio of the population with diabetes and the population of Latvia decreased from 1.71 (95% CI = 1.62-1.81) in 2000 to 1.23 (95% CI = 1.19-1.27) in 2012. Conclusions: In Latvia the mortality of patients with diabetes exceeds mortality in the general population. Mortality rates are higher for men and older patients, however, compared to mortality in the general population, diabetes increases the risk of death; especially for women and for younger patients. There is a tendency that the mortality indicators of patients with diabetes and mortality indicators in the general population are becoming closer.Item The prevalence of viral hepatitis C in Latvia : A population-based study(2011) Tolmane, Ieva; Rozentale, Baiba; Keiss, Jazeps; Arsa, Frida; Brigis, Girts; Zvaigzne, Aivars; Rīga Stradiņš University; Department of Infectology; Department of Public Health and EpidemiologyBackground and Objective: Chronic viral hepatitis C (VHC) is one of the most discussed infectious diseases worldwide. The number of infected persons worldwide is approximately 170 million, and in Europe, it exceeds 9 million. The aim of this study was to determine the prevalence of antibodies to hepatitis C virus (anti- HCV prevalence) and prevalence of HCV viremia (HCV-RNA prevalence) in Latvia. Material and Methods: A multistage randomized selection was used. A total of 42 primary care physicians (PCPs) were randomly selected from the register of PCPs from different regions of Latvia. From each PCP register, 60 subjects were selected (1651 individuals in total) and invited for the anti-HCV test with a screening method (ELISA). In case of positive results, antibodies were confirmed by the Western blot test, and all these subjects were tested for HCV-RNA by polymerase chain reaction. Results: Of the 1459 subjects tested, 57 were positive for anti-HCV (3.9%; 95% CI 3% to 5%); 35 of them were positive for anti-HCV with a confirmatory test (2.4%; 95% CI, 1.7% to 3.3%): 19 men and 16 women (3.8% and 1.7%, respectively; P=0.011). The results of HCV RNA test were positive in 25 subjects (1.7%; 95% CI, 1.2% to 2.5%): 15 men and 10 women (3% and 1% respectively, P=0.019). Conclusions: The prevalence of anti-HCV and HCV-RNA in Latvia was found to be 2.4% and 1.7%, respectively. The prevalence of anti-HCV and HCV-RNA was higher in men than women.Item Public-private partnership role during the pandemic : A case of COVID-19 testing in the Republic of Latvia 2020(2023-08) Kaļva, Artūrs; Brigis, Girts; Kruks, Sergejs; Šmits, Dins; Department of Public Health and Epidemiology; Komunikācijas fakultāteThe novelty of this research includes public-private partnerships (PPP) in emergency situations, especially during a pandemic, where there are only a few researched topics. The goal of this study is to answer the following research question: What is the role of PPP in achieving quick and effective COVID-19 testing during a new pandemic in a small country? The methods of this paper are based on a case study approach. In the beginning, a related literature review was done (keywords: public-private partnerships in COVID-19, testing of the COVID-19, health systems during the pandemic). The second step contains data collection about COVID19 in Latvia (2020). Finally, an analysis of the case and data was performed with the conclusion in the result. Results: The average number of tests in 2020 was 2355.99 (interval: 4.00–12,091.00) per day and 2141.73 (interval: 7.67–7365.77) per month. The private sector conducted around 95.78% per month to check COVID19 infection. Conclusion: The PPP role of COVID-19 testing during a pandemic in small countries contains extra resources for rapid and previously not established process organization that allows governments and the public sector to pay attention to other important questions. As a result, collaboration can decrease infection prevalence and mortality.