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Browsing by Author "Kivite-Urtane, Anda"

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Anxiety Screening among the General Population of Latvia and Associated Factors
(2022-08-26) Vinogradova, Vineta Viktorija; Kivite-Urtane, Anda; Vrublevska, Jelena; Rancans, Elmars; Department of Psychiatry and Narcology; Institute of Public Health; Department of Public Health and Epidemiology
Background and Objectives: The aim of this study was to determine the point prevalence of at least mild anxiety symptoms and symptoms of generalized anxiety disorder in the Latvian general population, and to analyze the associated factors. Materials and Methods: A computer-assisted face-to-face survey was conducted in 2019–2020 with a multistage stratified probability sample of the Latvian general adult population (n = 2687). Anxiety was assessed using the 7-item Generalized Anxiety Disorder (GAD-7) scale; a score of ≥5 was defined as indicating the presence of mild symptoms of anxiety, and a score of ≥10 as the cutoff for identifying cases of generalized anxiety disorder. The Patient Health Questionnaire 9 (PHQ-9) and MINI International Neuropsychiatric Interview (M.I.N.I.) modules were used for assessing comorbid conditions. Multinomial logistic regression was conducted. Results: The point prevalence of mild anxiety symptoms was 10.9%. The point prevalence of generalized anxiety disorder symptoms was 3.9%. Higher odds of mild anxiety symptoms were detected in respondents of a young age (vs. 65 y.o. and older, aOR 3.1, p < 0.001), unmarried respondents (vs. married/cohabiting, aOR 1.5, p = 0.02), those living in the capital city (aOR 1.6, p = 0.008) or rural areas (aOR 1.5, p = 0.03) (vs. other towns), respondents with poor self-rated health (vs. good, aOR 2.6, p < 0.001), and diagnosed alcohol use disorder (aOR 1.9, p < 0.001), suicidal behavior (aOR 2.4, p < 0.001), and symptoms of depression (aOR 6.4, p < 0.001) (vs. no such conditions). As for symptoms of generalized anxiety disorder, female sex (vs. males, aOR 2.5, p = 0.003), age below 44 years (vs. 65+, aOR 6.2, p = 0.002), average self-rated health (vs. good, aOR 2.6, p = 0.005), and poor self-rated health (vs. good, aOR 5.3, p < 0.001), together with comorbid suicidal behavior (aOR 6.1, p < 0.001) and symptoms of depression (aOR 43.4, p < 0.001) (vs. no such conditions), increased the odds. Conclusions: Young age, poor self-rated health, and comorbid symptoms of depression and suicidal behavior were significant factors associated with symptoms of both mild anxiety and generalized anxiety disorder. Being unmarried, living in the capital city or rural areas, and alcohol use disorder were associated with mild anxiety symptoms alone. Female sex was associated with generalized anxiety disorder symptoms alone.
Comment on "The European response to the WHO call to eliminate cervical cancer as a public health problem"
(2023-08-15) Tisler, Anna; Nygard, Mari; Kivite-Urtane, Anda; Berza, Natalija; Zodzika, Jana; Stankunas, Mindaugas; Baltzer, Nicholas; Pärna, Kersti; Uusküla, Anneli; Institute of Public Health
Comparison of Characteristics and Outcomes of Multisystem Inflammatory Syndrome, Kawasaki Disease and Toxic Shock Syndrome in Children
(2023-03) Klavina, Lizete; Smane, Liene; Kivite-Urtane, Anda; Vasilevska, Lauma; Davidsone, Zane; Smitins, Emils; Gardovska, Dace; Lubaua, Inguna; Roge, Ieva; Pucuka, Zanda; Meiere, Anija; Pavare, Jana; Rīga Stradiņš University; Department of Paediatrics; Institute of Public Health; Department of Public Health and Epidemiology
Background and Objectives: Since the first cases of multisystem inflammatory syndrome in children (MIS-C) in April 2020, the diagnostic challenge has been to recognize this syndrome and to differentiate it from other clinically similar pathologies such as Kawasaki disease (KD) and toxic shock syndrome (TSS). Our objective is to compare clinical signs, laboratory data and instrumental investigations between patients with MIS-C, KD and TSS. Materials and Methods: This retrospective observational study was conducted at the Children’s Clinical University Hospital, Latvia (CCUH). We collected data from all pediatric patients <18 years of age, who met the Centers for Disease Control and Prevention case definition for MIS-C, and who presented to CCUH between December 2020 and December 2021. We also retrospectively reviewed data from inpatient medical records of patients <18 years of age diagnosed as having KD and TSS at CCUH between December 2015 and December 2021. Results: In total, 81 patients were included in this study: 39 (48.1%) with KD, 29 (35.8%) with MIS-C and 13 (16.1%) with TSS. In comparison with TSS and KD, patients with MIS-C more often presented with gastrointestinal symptoms (abdominal pain (p < 0.001), diarrhea (p = 0.003)), shortness of breath (p < 0.02) and headache (p < 0.003). All MIS-C patients had cardiovascular involvement and 93.1% of MIS-C patients fulfilled KD criteria, showing higher prevalence than in other research. Patients with KD had higher prevalence of cervical lymphadenopathy (p < 0.006) and arthralgias (p < 0.001). In comparison with KD and TSS, MIS-C patients had higher levels of ferritin (p < 0.001), fibrinogen (p = 0.04) and cardiac biomarkers, but lower levels of platelets and lymphocytes (p < 0.001). KD patients tended to have lower peak C-reactive protein (CRP) (p < 0.001), but higher levels of platelets. Acute kidney injury was more often observed in TSS patients (p = 0.01). Pathological changes in electrocardiography (ECG) and echocardiography were significantly more often observed in MIS-C patients (p < 0.001). Conclusions: This research shows that MIS-C, KD and TSS have several clinical similarities and additional investigations are required for reaching final diagnosis. All the patients with suspected MIS-C diagnosis should be examined for possible cardiovascular involvement including cardiac biomarkers, ECG and echocardiography.
Effect of Combination of Point-of-Care C-Reactive Protein Testing and General Practitioner Education and Long-Term Effect of Education on Reducing Antibiotic Prescribing for Children Presenting with Acute Infections in General Practice in Latvia : A Randomized Controlled Intervention Study
(2024-09-10) Likopa, Zane; Kivite-Urtane, Anda; Strele, Ieva; Pavare, Jana; Department of Paediatrics; Department of Public Health and Epidemiology; Institute of Public Health; Institute of Occupational Safety and Environmental Health
BACKGROUND: Antibiotics are often overprescribed in children in general practice. We investigated whether the availability of C-reactive protein point-of-care testing (CRP POCT) in daily practice and general practitioner (GP) education reduces antibiotic prescribing for children with acute infections and whether GP education has a long-term effect on antibiotic prescribing. METHODS: This was a randomized controlled intervention study with randomization at the GP practice level. Eligible patients were children aged 1 month to 17 years presenting to general practice with an acute infection. INTERVENTIONS: In the first study period, one GP group received combined interventions (CRP POCT was provided for daily use in combination with a live educational session), while the second GP group continued usual care. During the second study period, the GP groups were switched. During this period, the long-term education effect was evaluated in the GP group, which had previously received both interventions: the CRP POCT was no longer available in their practices in accordance with the study protocol, but education could have a lasting effect. PRIMARY OUTCOME: Antibiotic prescribing at index consultation. RESULTS: GP with combined intervention enrolled 1784 patients, GP with usual care enrolled 886 patients, and GP with long-term education effect enrolled 647 patients. Most of the patients had upper (76.8%) and lower (18.8%) respiratory infections. In total, 29.3% of the study patients received antibiotic prescriptions. Adjusted binary logistic regression analysis showed no differences for the primary outcome between GPs with usual care and GPs with combined intervention (aOR 0.89 (0.74-1.07), p = 0.20), but significantly lower antibiotic prescribing was observed for GPs with long-term education in comparison with GPs with usual care (aOR 0.75 (0.59-0.96), p = 0.02); however, after multilevel analyses, any differences in the antibiotic prescription between intervention groups became non-significant. GPs widely used CRP POCT when it was available in practice (for 69.1% of patients in the combined intervention group), but rarely measured CRP in the laboratory in the usual care group (8.8% (n = 78)) or long-term education group (14.8% (n = 98)). The majority of the tested patients had low CRP levels (below 20 mg/L); despite this, up to 35.4% of them received antibiotic prescriptions. CONCLUSIONS: Our results show that the availability of CRP POCT and educational training for GPs together did not reduce antibiotic prescribing, and one-time education did not have a long-term effect on antibiotic prescribing.
Health-related quality of life and binge eating among adolescent girls with PCOS
(2022-03) Lidaka, Lasma; Lazdane, Gunta; Kivite-Urtane, Anda; Gailite, Linda; Dzivite-Krisane, Iveta; Stokenberga, Ieva; Department of Obstetrics and Gynaecology; Institute of Public Health; Department of Public Health and Epidemiology; Scientific Laboratory of Molecular Genetics
Background: Polycystic ovary syndrome (PCOS) affects 3–8% of adolescents. It is characterized by hyperandrogenism and oligoovulation/anovulation. PCOS has a negative impact on health-related quality of life (HRQoL). However, the extents to which factors influence total HRQoL of adolescents are not known. Adult PCOS patients have a higher incidence of binge eating than the general reproductive-age female population. Limited data on binge eating in adolescents with PCOS are available. Aim of this study was to investigate how PCOS and its associated factors, including binge eating, affect the HRQoL of adolescent girls. Methods: This case-control study recruited 63 adolescent girls 13–18 years of age with PCOS and 66 age-matched healthy controls. The PCOS health-related quality of life questionnaire (PCOSQ) and Binge Eating Scale (BES) were used. Multiple linear regression was executed to establish exact predictors and their effect on total HRQoL. Results: HRQoL was significantly lower in adolescents with PCOS than controls (4.9 (interquartile range (IQR) 1.5) vs. 5.8 (IQR 0.9) points). The lowest scores were found in the body hair and weight domains. BES results were not significantly higher in the PCOS group than in the control group (p = 0.727). The main predictors for total HRQoL were PCOS diagnosis per se (β = –1.002; p < 0.001), BES score (β = –0.27; p = 0.004) and body mass index (BMI) percentile (β = –0.007; p = 0.013). Conclusions: The lower HRQoL in adolescents with PCOS is attributable to the diagnosis of PCOS, BES score and BMI percentile, confirming the importance of tailoring clinical interventions and counselling to address the domains (i.e., symptoms of hirsutism and weight concerns) causing distress and lowering HRQoL. Further implementation research is required to evaluate the impact of targeted interventions on the HRQoL of adolescent girls with PCOS.
Impact of educational training and C-reactive protein point-of-care testing on antibiotic prescribing in rural and urban family physician practices in Latvia : a randomised controlled intervention study
(2022-09-21) Likopa, Zane; Kivite-Urtane, Anda; Silina, Vija; Pavare, Jana; Rīga Stradiņš University; Department of Public Health and Epidemiology; Institute of Public Health; Department of Family Medicine
BACKGROUND: Although self-limiting viral infections are predominant, children with acute infections are often prescribed antibiotics by family physicians. The aim of the study is to evaluate the impact of two interventions, namely C-reactive protein point-of-care testing and educational training, on antibiotic prescribing by family physicians. METHODS: This randomised controlled intervention study included acutely ill children consulted by 80 family physicians from urban and rural practices in Latvia. The family physicians were divided into two groups of 40. The family physicians in the intervention group received both interventions, i.e. C-reactive protein point-of-care testing and educational training, whereas the family physicians in the control group continued to dispense their standard care. The primary outcome measure was the antibiotic prescribing at the index consultation (delayed or immediate prescription) in both study groups. The secondary outcome was CRP testing per study group. Patient- and family physician- related predictors of antibiotic prescribing were analysed as associated independent variables. Practice location effect on the outcomes was specially addressed, similar to other scientific literature. RESULTS: In total, 2039 children with acute infections were enrolled in the study. The most common infections observed were upper and lower respiratory tract infections. Overall, 29.8% (n = 607) of the study population received antibiotic prescription. Our binary logistic regression analysis did not find a statistically significant association between antibiotic prescriptions and the implemented interventions. In the control group of family physicians, a rural location was associated with more frequent antibiotic prescribing and minimal use of CRP testing of venous blood samples. However, in the intervention group of family physicians, a rural location was associated with a higher level of C-reactive protein point-of-care testing. Furthermore, in rural areas, a significant reduction in antibiotic prescribing was observed in the intervention group compared with the control group (29.0% (n = 118) and 37.8% (n = 128), respectively, p = 0.01). CONCLUSION: Our results show that the availabilty of C-reactive protein point-of-care testing and educational training for family physicians did not reduce antibiotic prescribing. Nevertheless, our data indicate that regional variations in antibiotic-prescribing habits exist and the implemented interventions had an effect on family physicians practices in rural areas.
Latvian Primary Care Management of Children with Acute Infections : Antibiotic-Prescribing Habits and Diagnostic Process Prior to Treatment
(2021-08-17) Likopa, Zane; Kivite-Urtane, Anda; Pavare, Jana; Department of Public Health and Epidemiology; Institute of Public Health; Department of Paediatrics
Background and Objectives: Primary care physicians frequently prescribe antibiotics for acutely ill children, even though they usually have self-limiting diseases of viral etiology. The aim of this research was to evaluate the routine antibiotic-prescribing habits of primary care in Latvia, in response to children presenting with infections. Materials and Methods: This cross-sectional study included acutely ill children who consulted eighty family physicians (FP) in Latvia, between November 2019 and May 2020. The data regarding patient demographics, diagnoses treated with antibiotics, the choice of antibiotics and the use of diagnostic tests were collected. Results: The study population comprised 2383 patients aged between one month and 17 years, presenting an acute infection episode, who had a face-to-face consultation with an FP. Overall, 29.2% of these patients received an antibiotic prescription. The diagnoses most often treated with antibiotics were otitis (45.8% of all antibiotic prescriptions), acute bronchitis (25.0%) and the common cold (14.8%). The most commonly prescribed antibiotics were amoxicillin (55.9% of prescriptions), amoxicillin/clavulanate (18.1%) and clarithromycin (11.8%). Diagnostic tests were carried out for 59.6% of children presenting with acute infections and preceded 66.4% of antibiotic prescriptions. Conclusion: Our data revealed that a high level of antibiotic prescribing for self-limiting viral infections in children continues to occur. The underuse of narrow-spectrum antibiotics and suboptimal use of diagnostic tests before treatment decision-making were also identified. To achieve a more rational use of antibiotics in primary care for children with a fever, professionals and parents need to be better educated on this subject, and diagnostic tests should be used more extensively, including the implementation of daily point-of-care testing.
Nationwide study on development and validation of a risk prediction model for CIN3+ and cervical cancer in Estonia
(2024-10-19) Tisler, Anna; Võrk, Andres; Tammemägi, Martin; Ojavee, Sven Erik; Raag, Mait; Šavrova, Aleksandra; Nygård, Mari; Nygård, Jan F; Stankunas, Mindaugas; Kivite-Urtane, Anda; Uusküla, Anneli; Institute of Public Health
Transitioning to an individualized risk-based approach can significantly enhance cervical cancer screening programs. We aimed to derive and internally validate a prediction model for assessing the risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) and cancer in women eligible for screening. This retrospective study utilized data from the Estonian electronic health records, including 517,884 women from the health insurance database and linked health registries. We employed Cox proportional hazard regression, incorporating reproductive and medical history variables (14 covariates), and utilized the least absolute shrinkage and selection operator (LASSO) for variable selection. A 10-fold cross-validation for internal validation of the model was used. The main outcomes were the performance of discrimination and calibration. Over the 8-year follow-up, we identified 1326 women with cervical cancer and 5929 with CIN3+, with absolute risks of 0.3% and 1.1%, respectively. The prediction model for CIN3 + and cervical cancer had good discriminative power and was well calibrated Harrell's C of 0.74 (0.73-0.74) (calibration slope 1.00 (0.97-1.02) and 0.67 (0.66-0.69) (calibration slope 0.92 (0.84-1.00) respectively. A developed model based on nationwide electronic health data showed potential utility for risk stratification to supplement screening efforts. This work was supported through grants number PRG2218 from the Estonian Research Council, and EMP416 from the EEA (European Economic Area) and Norway Grants.
Non-classical congenital adrenal hyperplasia-causing alleles in adolescent girls with pcos and in risk group for pcos development
(2021-05-28) Lidaka, Lasma; Bekere, Laine; Lazdane, Gunta; Dzivite-Krisane, Iveta; Kivite-Urtane, Anda; Gailite, Linda; Faculty of Medicine; Department of Obstetrics and Gynaecology; Institute of Public Health; Department of Public Health and Epidemiology; Scientific Laboratory of Molecular Genetics
Background: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women. Depending on the diagnostic criteria applied, it occurs in up to 16.6% of the general female population. Congenital adrenal hyperplasia includes a group of autosomal recessive disorders, the most common of which is non-classical congenital adrenal hyperplasia (NCAH) caused by mutations in the CYP21A2 gene. PCOS and NCAH have similar clinical manifestations (hyperandrogenemia, i.e., hirsutism, acne, alopecia, and increased androgen levels in the blood) and potential impact on long-term health (infertility, increased risk of type 2 diabetes, and cardiovascular disease. Consequently, it is thought that NCAH mutations in the heterozygous state may play a role in PCOS development and phenotypic expression. Objective: To determine the prevalence of the most common pathogenic alleles of the CYP21A2 gene in adolescents with PCOS and adolescents at risk of PCOS development, and to compare the results with healthy adolescents matched for gynecological age. Methods: A cross-sectional study was conducted with 55 PCOS patients, 23 risk patients (with hyperandrogenism but a normal menstrual cycle), and 49 healthy adolescents. Genetic variations in the CYP21A2 gene were analyzed using a standard Multiplex Ligation-dependent Probe Amplification test (SALSA MLPA Probemix P050-C1 CAH; MRC Holland). Results: No significant differences were found among the three groups regarding the frequency of carriers of NCAH variations in the heterozygous state. It was found that the I172N carrier in the PCOS group had a significantly higher Global Acne Grading Scale score than PCOS patients without this variation (p = 0.038). Within the control group of healthy adolescents, compound heterozygous carriers (IVS2-12A > G and-113G > A) had a significantly higher body mass index than non-carriers (p = 0.036). Conclusion: We found no differences in the incidence of NCAH-causing variations in the heterozygous state in adolescent PCOS patients, risk adolescents (with hirsutism but normal menstruation), and healthy adolescents. Future studies of larger cohorts and rarer pathogenic CYP21A2 gene variations are required.
An overview of cervical cancer epidemiology and prevention in the Baltic States
(2023-01) Kojalo, Una; Tisler, Anna; Parna, Kersti; Kivite-Urtane, Anda; Zodzika, Jana; Stankunas, Mindaugas; Baltzer, Nicholas; Nygard, Mari; Uuskula, Anneli; Institute of Public Health
AIMS: To inform future Baltic States-specific policy analyses, we aimed to provide an overview of cervical cancer epidemiology and existing prevention efforts in Estonia, Latvia and Lithuania. METHODS: A structured desk review: we compiled and summarized data on current prevention strategies, population demography and epidemiology (high risk human papillomavirus (HPV) prevalence and cervical cancer incidence and mortality over time) for each Baltic State by reviewing published literature and official guidelines, performing registry-based analyses using secondary data and having discussions with experts in each country. RESULTS: We observed important similarities in the three Baltic States: high burden of the disease (high incidence and mortality of cervical cancer, changes in TNM (Classification of Malignant Tumors) stage distribution towards later stage at diagnosis), high burden of high-risk HPV in general population and suboptimal implementation of the preventive strategies as low screening and HPV vaccination coverage. CONCLUSIONS: Cervical cancer remains a substantial health problem in the region and the efforts in addressing barriers by implementing a four-step plan for elimination cervical cancer in Europe should be made. This goal is achievable through evidence-based steps in four key areas: vaccination, screening, treatment, and public awareness.
Oxidative stress, depression, and risk of recurrence of stable coronary heart disease
(2021) Ivascenko, Tarass; Voicehovskis, Vladimirs V.; Voicehovska, Julija G.; Skesters, Andrejs; Apsite, Ketija; Grigorjeva, Julija; Kivite-Urtane, Anda; Pahomova, Natalija; Kalejs, Oskars; Rīga Stradiņš University
Aim: The aim of the study was to investigate the relationships between a level of oxidative stress (OS), depression (D) and risk of recurrence of stable coronary heart disease (SCHD). Methods: A retrospective study was conducted on 174 participants, at the age 45+ years: 86 in-patients of the cardiology department with a recurrent SCHD and 88 in-patients of the cardiology department with primary SCHD. The severity of depressive symptoms was assessed using the long 30-item form of Geriatric Depression Scale (GDS), valid Latvian version of GDS-LAT. The blood samples were taken from each patient to measure oxidative stress parameters malondialdehyde (MDA) and glutathione peroxidase (GPx). Results: 83.9% of the sample had high level of MDA. In 72.4% of the sample the GPx level was normal, in 17.8% it was high and in 9.8% low. Slightly more than a half of the patients were experiencing depression (44.3% – mild D and 6.9% – severe D). GPx was found statistically differing between primary and recurrent SCHD (p = 0,003). Patients with both D and high GPx had 10.6 times higher chances of recurrent SHCD compared to those without D and normal GPx (p = patients with present D were experiencing both – high levels of MDA and GPx – more often than responders with no D, but this wasn’t statistically significant [p = 0.51]). Conclusion: In the present study it was found that level of antioxidant (AO) enzyme GPx was significantly higher in depressed patients with recurrent SCHD compared to patients without D and to patients with primary SCHD and patients with both D and high GPx had higher chances of recurrent SCHD compared to those without D and normal GPx. It could be supposed that GPx is a more significant marker of risk of D and recurrence of SCHD. The high level of MDA in most of both (primary and recurrent SCHD) groups patients could evidence that increased OS is a risk factor for CHD in general. Monitoring OS biomarkers seems to be important in the management of SCHD comorbidity with D. Further studies are warranted to confirm these findings.
Prevalence and associated factors of mental disorders in the nationwide primary care population in Latvia : a cross-sectional study
(2020-04-07) Rancans, Elmars; Renemane, Lubova; Kivite-Urtane, Anda; Ziedonis, Douglas; Department of Psychiatry and Narcology; Department of Public Health and Epidemiology
Background: Mental disorders are common amongst patients in primary care. There are no published studies on the prevalence of mental disorders in primary care patients in Latvia. The purpose of the study was to evaluate the current prevalence of mental disorders in the nationwide Latvian primary care population and to study possible associated factors and comorbidity of mental disorders. Methods: A cross-sectional study within the framework of the National Research Program BIOMEDICINE 2014-2017 was performed at 24 primary care settings across Latvia. Adult patients seen over a 1-week time period at each facility were invited to participate in the study. Sociodemographic variables (age, sex, education, employment and marital status, place of residence, and ethnicity) were assessed onsite. A Mini-International Neuropsychiatric Interview assessment was conducted over the telephone within 2 weeks after the visit to the general practitioner (GP). Results: Overall, 1485 individuals completed the interview. The current prevalence of any mental disorder was 37.2% and was significantly greater in women. Mood disorders (18.4%), suicidality (18.6%) and anxiety disorders (15.8%) were the most frequent diagnostic categories. The current prevalence of any mood disorder was associated with being 50-64 years of age, female sex, economically inactive status, divorced or widowed marital status and urban place of residence, whilst any current anxiety disorder was associated with female sex, lower education, and single marital status; however, being of Russian ethnicity and residing in a small city were protective factors. Suicidality was associated with female sex, lower education, unemployment or economically inactive status, being divorced or widowed and residing in a small city. The comorbidity rates between mental disorders varied from 2.9 to 53.3%. Conclusions: High prevalence rates of mental disorders, comorbidity and certain associated socio-demographic factors were found in primary care settings in Latvia. This highlights the importance of screening for depression and anxiety disorders and suicidal risk assessment by GPs. The results are fundamentally important for integrative medicine, monitoring and promotion of mental healthcare at the primary care level, as well as for healthcare policy and development of strategic plans in Latvia.
Self-reported suicidal behaviours and associated factors in the general population of Latvia (2010-2018)
(2023-11) Mieze, Krista; Kivite-Urtane, Anda; Grinberga, Daiga; Velika, Biruta; Pudule, Iveta; Rancans, Elmars; Department of Doctoral Studies; Institute of Public Health; Department of Public Health and Epidemiology; Department of Psychiatry and Narcology
BACKGROUND: Latvia has the second highest suicide rate in the European Union - with a total population age-standardized suicide rate of 16.1 per 100,000 inhabitants. AIMS: We aimed to assess the prevalence of different types of self-reported suicidal behaviours in Latvia and determine the associated sociodemographic and health-related factors. METHODS: This study was based on secondary data obtained from the Health Behaviour Among Latvian Adult Population survey. A representative sample of the general population was used, aged 15 to 64 years in 2010, 2012, 2014; and 15 to 74 years in 2016 and 2018 ( n = 16,084). Respondents were asked to report the occurrence of life weariness, death wishes, suicidal ideation, suicidal plans and suicide attempts during the previous year. We assessed socio-demographics and health-related factors associated with suicidality. We performed univariate analysis and constructed stepwise multivariate logistic regression models. RESULTS: In 2010 to 2018, 15.6% of responders reported some type of suicidal behaviour (95% CI [15.1, 16.2]). Sociodemographic factors - including non-cohabitation status and Latvian nationality - were associated with mild (life-weariness and death wishes) and serious (suicidal ideation, plans to commit suicide, suicide attempts) types of behaviour. Older age was associated with mild suicidal behaviours, whereas lower educational levels were associated with serious suicidal behaviours. Diagnosed depression, self-reported depression, self-reported anxiety, stress, low mood, alcohol intake habits with heavy drinking episodes (less than monthly, monthly and weekly), perceived health as average or below average, disuse of primary health services were associated with mild and serious types of suicidal behaviour. Current smoking status and absenteeism were associated with mild suicidal behaviour types. Self-reported insomnia, having at least two somatic diagnoses, occasional smoking status, absenteeism with 11 or more days in the last year, receiving disability pension were associated with serious suicidal behaviour types. Musculoskeletal diseases exhibited preventive effects. CONCLUSIONS: Our findings indicate that certain groups of individuals might exhibit greater vulnerability to suicidality.
Short- and mid-term outcomes of multisystem inflammatory syndrome in children : a longitudinal prospective single-center cohort study
(2023) Roge, Ieva; Kivite-Urtane, Anda; Smane, Liene; Meiere, Anija; Klavina, Lizete; Barzdina, Elza; Pavare, Jana; Department of Paediatrics; Department of Public Health and Epidemiology
Background: Multisystem inflammatory syndrome in children (MIS-c) emerged during the coronavirus disease 2019 pandemic and is associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the extensively studied clinical manifestation of acute condition, the short- and long-term effects of MIS-c on children's health are unknown. Methods: This was a prospective longitudinal cohort study. Children aged <18 years who met the Centers for Disease Prevention and Control (CDC) diagnostic criteria and who were admitted to the Children's Clinical University Hospital of Latvia (CCUH) between July 1, 2020, and April 15, 2022, were enrolled in the study. An outpatient follow-up program was initiated in July 2020. All children were evaluated at 2 weeks, 2 months (1–3 months), and 6 months (5–7 months) after discharge. The face-to-face interviews comprised four domains as follows: symptom assessment, physical examination, laboratory testing, and cardiological investigation [including electrocardiogram (ECG) and echocardiography (echo)]. Results: Overall, 21 patients with MIS-c were enrolled. The median age of the study group was 6 years. At the 2-week follow-up, almost half of the patients (N = 10, 47.6%) reported exercise intolerance with provoked tiredness. Laboratory tests showed a considerable increase in blood cell count, with a near doubling of leukocyte and neutrophil counts and a tripling of thrombocyte levels. However, a decline in the levels of inflammatory and organ-specific markers was observed. Cardiological investigation showed significant improvement with gradual resolution of the acute-phase pathological findings. Within 2 months, improvement in exercise capacity was observed with 5-fold and 2-fold reductions in physical intolerance (N = 2, 9.5%) and physical activity-induced fatigue (N = 5, 23.8%), respectively. Normalization of all blood cell lines was observed, and cardiological investigation showed no persistent changes. At the 6-month visit, further improvement in the children's exercise capacity was observed, and both laboratory and cardiological investigation showed no pathological changes. Conclusions: Most persistent symptoms were reported within the first 2 weeks after the acute phase, with decreased physical activity tolerance and activity-induced fatigue as the main features. A positive trend was observed at each follow-up visit as the spectrum of the children's complaints decreased. Furthermore, rapid normalization of laboratory markers and cardiac abnormalities was observed.
Suicidality and Its Relation with Physical and Mental Conditions : Results from a Cross-Sectional Study of the Nationwide Primary Care Population Sample in Latvia
(2021-09-01) Renemane, Lubova; Kivite-Urtane, Anda; Rancans, Elmars; Department of Psychiatry and Narcology; Department of Public Health and Epidemiology; Institute of Public Health
Background and Objectives: Physical and mental conditions are important risk factors for suicidality. However, there is no clear understanding of these relationships and the effect of co-occurrence on suicidality. We aimed to investigate the associations between current suicidality and mental disorders, physical conditions, and health-related factors in the nationwide primary care population in Latvia. Materials and Methods: A cross-sectional study was performed within the framework of the National Research Program BIOMEDICINE 2014-2017 at 24 primary care settings across Latvia in 2015. Adult patients were evaluated over one week at each facility. Socio-demographic variables, physical condition, and health-related factors were assessed on-site by trained psychiatrists. Mental disorders and suicidality were determined using the Mini International Neuropsychiatric Interview, and assessments were conducted over the telephone within two weeks after the visit to the general practitioner. Results: Of the 1485 cases, 18.6% reported suicidality. Only current depression, any anxiety disorder, any alcohol use disorder, and physical-mental multimorbidity were significantly associated with suicidality in the multivariate logistic regression analysis. Gastrointestinal diseases were associated with current depression alone (odds ratio (OR) 10.36; 95% confidence interval (CI) 2.34-45.76) and comorbid depression with any anxiety disorder (OR 7.55; 95% CI 2.15-26.49) among persons with current suicidality. Conclusions: Screening for depression, anxiety, and alcohol use disorders regularly among patients with physical illness may be important to help recognise suicidality in primary care that could improve the quality of life of patients and prevent suicides.
Validation of the generalized anxiety disorder scales (GAD-7 and GAD-2) in primary care settings in Latvia
(2022-10-06) Vrublevska, Jelena; Renemane, Lubova; Kivite-Urtane, Anda; Rancans, Elmars; Department of Psychiatry and Narcology; Institute of Public Health
Background: Anxiety disorders are the most prevalent mental disorders in the world and have an important impact on the global burden of disease. Generalized anxiety disorder (GAD) is the most prevalent anxiety disorder encountered in primary care. There are no available validated anxiety screening tools in primary care in Latvia. We aimed to validate both a seven-item and a two-item generalized anxiety disorder scale (GAD-7 and GAD-2) in the Latvian and Russian languages, to detect generalized anxiety disorder (GAD) in primary care settings in Latvia. Methods: During a 1-week period, all patients aged 18 years or older visiting their GP (general practitioners) with any health concern at 24 primary care settings throughout Latvia were invited to complete the GAD-7 in their native language (Latvian or Russian). Criterion validity was assessed against the Mini International Neuropsychiatric Interview (MINI). Results: The study sample included 1,459 participants who completed the GAD-7 and the MINI. The GAD-7 items showed good internal reliability [Cronbach's alpha 0.87 for Latvian version and 0.85 for Russian version (for Latvia) of the GAD-7]. A cut-off score for detecting GAD of 5 or above was estimated for Latvian version of the GAD-7 (sensitivity 75.4%, specificity 68.9%, respectively) and 7 or above for Russian version of the GAD-7 (sensitivity 73.3%, specificity 84.1%, respectively). The internal reliability of the GAD-2 was lower for both languages (Cronbach's alpha 0.75 for Latvian version and 0.68 for Russian version of the GAD-2). A cut-off score of 2 or above was established for both the Latvian, and Russian versions of the GAD-2 (sensitivity 78.9 and 83.3%; specificity 63.7 and 69.1% for the Latvian and Russian versions of the GAD-2, accordingly) for detecting GAD. Conclusions: This is the first study to report criterion validity of the Latvian and Russian (for Latvia) versions of the GAD-7 and GAD-2, assessed in a nationwide study conducted at the primary care level.

Browsing by Author "Kivite-Urtane, Anda"

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