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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they 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.

Medicina, Volume 46, Issue 9 (September 2010) – 10 articles

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Article
Ethical dilemmas concerning decision-making within health care leadership: a systematic literature review
Medicina 2010, 46(9), 595; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46090084 - 14 Sep 2010
Cited by 5 | Viewed by 979
Abstract
The objective was to describe the research methods and research focuses on ethical dilemmas concerning decision-making within health care leadership.
Material and methods
. The search was conducted on Medline and PubMed databases (1998–2008). The systematic review included 21 selected articles. Results. The [...] Read more.
The objective was to describe the research methods and research focuses on ethical dilemmas concerning decision-making within health care leadership.
Material and methods
. The search was conducted on Medline and PubMed databases (1998–2008). The systematic review included 21 selected articles. Results. The ethical dilemmas concerning decision-making within health care leadership are related to three levels: institutional (particular organization), political and local interface (local governmental structure), and national (professional expertise and system). The terms that are used as adequate to the term of “ethical dilemma” are the following: “continuous balancing,” “result of resource allocation,” “gap between professional obligations and possibilities,” “ethically controversial situation,” “concern about interactions,” “ethical difficulty,” “outcome of medical choices,” “concern about society access to health care resources,” “ethically difficult/ challenging situation,” “(the consequence of) ethical concern/ethical issue.” In qualitative studies, a semi-structured interview and qualitative content analysis are the most commonly applied methods; in quantitative studies, questionnaire surveys are employed. In the research literature, there is a lack of specification according to professional qualification of health care professionals concerning ethical dilemmas by decision-making within health care management/administration.
Conclusions.
The research on ethical dilemmas in health care leadership, management, and administration should integrate data about levels at which ethical dilemmas occur and investigate ethical dilemmas as complex phenomena because those are attached to decision-making and specific nuances of health care management/administration. In this article, the presented scientific problem requires extensive scientific discussions and research on ethical dilemmas concerning decision-making within health care leadership at various levels. Full article
Article
The coagulation system changes in patients with chronic heart failure
Medicina 2010, 46(9), 642; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46090091 - 11 Sep 2010
Cited by 21 | Viewed by 521
Abstract
Though heart failure can mainly be caused by systolic or diastolic dysfunction, the impairments of the neurohormonal, immune, and hemostatic systems are observed too. Therefore, it is not easy to determine etiology of the syndrome. Parameters that can be helpful to predict chronic [...] Read more.
Though heart failure can mainly be caused by systolic or diastolic dysfunction, the impairments of the neurohormonal, immune, and hemostatic systems are observed too. Therefore, it is not easy to determine etiology of the syndrome. Parameters that can be helpful to predict chronic heart failure, to evaluate its course and the risk of complications are still being searched. The aim of this article is to review the recent studies in order to find the links between the coagulation system and the development of chronic heart failure. Stress is a key factor for the development of most diseases including chronic heart failure too. Signals of emotional and physical stress via particular structures trigger an increase in concentrations of the following hormones: noradrenaline, renin, angiotensin II, aldosterone, vasopressin. It is proved that it causes the disorders of the coagulation system: an increase in the following factors of plasma coagulation (fibrinogen, VII, VIII, fibrinopeptide A, thrombinantithrombin complex), fibrinolysis (D-dimer), endothelium (interleukin 1, endothelin 1, vascular cell adhesion molecules, endothelial growth factor), platelet activity (von Willebrand factor, intercellular adhesion molecules, platelet factor 4, P-selectin, thromboxane A2, thromboglobulin, CD63P) and cytokines (tumor necrosis factor, interleukin 6) and decrease in E-selectin. The role of particular coagulation factors for the development of chronic heart failure has not been understood yet. Thus, it is necessary to carry out further studies. Full article
Article
Parental cigarette smoking and the risk of congenital heart septal defects
Medicina 2010, 46(9), 635; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46090090 - 11 Sep 2010
Cited by 17 | Viewed by 566
Abstract
The objective of this study was to determine the association between parental cigarette smoking and the risk of congenital heart septal defects in Kaunas infant population in 1995–2005.
Material and methods. An epidemiological case-control study was conducted. The study comprised 261 newborns [...] Read more.
The objective of this study was to determine the association between parental cigarette smoking and the risk of congenital heart septal defects in Kaunas infant population in 1995–2005.
Material and methods. An epidemiological case-control study was conducted. The study comprised 261 newborns with congenital heart septal defects (cases) and 1122 randomly selected newborns without any defects (controls), born in Kaunas city during 1995–2005. Information on potential risk factors of newborns’ health was collected through an interview with parents using standardized questionnaires. Multivariate logistic regression analysis was used to assess the association between parental smoking and septal defects while controlling for possible confounders.
Results
. According to the validated registry, 371 newborns with congenital heart malformations were born in Kaunas city during 1995–2005; 70.3% of cases had ventricular and/or atrial septal defects. After adjustment for possible confounding factors – maternal education, social status, marital status – a statistically significant relationship was observed between parental smoking and congenital heart septal defects. Parental, maternal, and paternal smoking was significantly associated with a 2.27-fold (adjusted OR=2.27; 95% CI, 1.49–3.46), 2.2-fold (adjusted OR=2.20; 95% CI, 1.01–4.79), and 1.45-fold (adjusted OR=1.45; 95% CI, 1.03–2.03) increased risk of defects if compared with nonsmoking parents.
Conclusions.
According to the results of our study, parental smoking was significantly associated with an increased risk of congenital heart septal defects in infants. Full article
Article
Sickness, colleagues’ harassment in teachers’ work and emotional exhaustion
Medicina 2010, 46(9), 628; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46090089 - 11 Sep 2010
Cited by 6 | Viewed by 563
Abstract
The aim of this study was to assess the relationship among colleagues’ harassment, emotional exhaustion, and sickness absence with a sample of teachers.
Material and methods
. The sample consisted of 351 teachers from 8 secondary schools in Kaunas. Instruments used in the [...] Read more.
The aim of this study was to assess the relationship among colleagues’ harassment, emotional exhaustion, and sickness absence with a sample of teachers.
Material and methods
. The sample consisted of 351 teachers from 8 secondary schools in Kaunas. Instruments used in the study included the Work Harassment Scale (WHS) developed by Björkqvist and Österman (1992), the Emotional Exhaustion Scale (the MBI-ES) by Maslach et al. (1996), and a questionnaire of demographic information.
Results
. Data analysis indicated that a higher level of work harassment was related to higher emotional exhaustion. Regression analysis findings indicated that a higher level of emotional exhaustion was related to higher levels of disruption, humiliation, alienation, and indignity. Teachers who observed harassment reported higher levels of emotional exhaustion. Respondents who missed work due to illness reported higher levels of disruption on the WHS.
Conclusions.
The study indicated that work harassment could be an important aspect in teacher’s health. The seriousness of the work harassment phenomenon may be supported by the results showing that teachers who witnessed others being harassed experienced a higher level of emotional exhaustion. The phenomenon appears to be an area that requires additional research. Full article
Case Report
Vehicle-associated closed trauma-induced stroke in a 27-day-old girl
Medicina 2010, 46(9), 624; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46090088 - 11 Sep 2010
Viewed by 414
Abstract
Birth trauma, but not postnatal trauma, has been recognized as a cause of cerebral infarction in newborns. We report a case of cerebral infarction in a 27-day-old girl after a car accident. During the car accident, the child was properly restrained to the [...] Read more.
Birth trauma, but not postnatal trauma, has been recognized as a cause of cerebral infarction in newborns. We report a case of cerebral infarction in a 27-day-old girl after a car accident. During the car accident, the child was properly restrained to the child’s safety seat. The patient was admitted to the hospital for observation because of pronounced irritability. There were no focal neurological symptoms on admission. Twenty-eight hours after the accident, the child developed focal tonic-clonic seizures and mild right-sided hemiparesis. The seizures were successfully treated with phenobarbital at a dose of 30 mg per day. Computed tomography and magnetic resonance imagining performed on the second and third days after the accident, respectively, showed subdural hemorrhage in the occipital regions and cerebral ischemia in the left parieto-occipital region. Control imaging 10 days later showed signs of reperfusion. Persistent child irritability after head trauma is one of the indicating factors for performing an emergency computed tomography scan of the head. Full article
Article
Prevalence of human papillomavirus types in cervical intraepithelial lesions
Medicina 2010, 46(9), 616; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46090087 - 11 Sep 2010
Cited by 8 | Viewed by 437
Abstract
Background. Since the implementation of the cervical cancer screening program in Lithuania in 2004, cervical cancer incidence rates have stabilized during a 4-year period: in 2006 and 2007, 508 and 485 new cases, respectively, were diagnosed. Human papillomavirus (HPV) infection is one [...] Read more.
Background. Since the implementation of the cervical cancer screening program in Lithuania in 2004, cervical cancer incidence rates have stabilized during a 4-year period: in 2006 and 2007, 508 and 485 new cases, respectively, were diagnosed. Human papillomavirus (HPV) infection is one of the main risk factors for cervical cancer and development of intraepithelial lesions. However, not only HPV, but also HPV type, is a very important factor for malignant transformation. Cervical intraepithelial lesions with HPV 16 and 18 more frequently progress to cancer. To date, in Lithuania, studies only on HPV prevalence and risk factors have been carried out, and less attention has been paid to the identification of HPV types. The aim of this study was to identify the most common HPV types in women with various cytological lesions.
Material and methods. A total of 246 women with various cytological lesions (atypical squamous cells of undetermined significance [ASCUS], low-grade squamous intraepithelial lesion [LSIL], and high-grade squamous intraepithelial lesion [HSIL]) were included into the study. All the women were screened for HPV infections followed by HPV typing for types 6, 11, 16, 18, 31, 33, 45, and 59. Polymerase chain reaction was used.
Results. Less than half (45.5%) of women with cytological lesions were infected with HPV. The highest prevalence of HPV was detected in women with HSILs (62.1%) and CIN2 (86.7%). HPV typing revealed that the most frequent type was HPV 16 (64.3%); HPV 18 and HPV 33 accounted for 5.4% and 4.5% of cases, respectively. Based on cytologic diagnosis, HPV 16 was more frequently found in women with HSILs than women with ASCUS (77.8% vs. 50.0%).
Conclusions. The prevalence of HPV infection in women with cytological lesions was 45.5%. The highest prevalence of HPV was detected in women with HSILs (cytologic investigation) and CIN2 (histologic investigation). HPV 16 is the most common type in women with various cervical intraepithelial lesions. Full article
Article
The need and reasons for referrals to specialists among Lithuanian general dentists
Medicina 2010, 46(9), 611; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46090086 - 11 Sep 2010
Cited by 4 | Viewed by 495
Abstract
Objective. To analyze the need for referral to a specialist and to identify the reasons of referrals among Lithuanian general dental practitioners.
Material and methods
. Questionnaires were sent to all 2879 Lithuanian dental practitioners registered on the Lithuanian Dental Chamber license [...] Read more.
Objective. To analyze the need for referral to a specialist and to identify the reasons of referrals among Lithuanian general dental practitioners.
Material and methods
. Questionnaires were sent to all 2879 Lithuanian dental practitioners registered on the Lithuanian Dental Chamber license registry. The questionnaire was made with multiple-choice answers. Respondents were asked to choose only one category of answer that best fitted their clinical attitude. Questions included in the questionnaire concerned general and specific information regarding the need and main reasons for endodontic referral.
Results. Of the 2879 questionnaires mailed, 1532 questionnaires containing useful information were returned. The response rate was 53.2%. Of the 1532 respondents, 1431 were general dental practitioners. Majority (72.1%) of the respondents performed complicated root canal treatment by themselves. Almost half (49.6%) of them would like to refer patients to an endodontist. Two of the reasons, which restricted their decision, were the shortage of endodontists and high cost of the procedures in the specialized clinics. Approximately 19% of the respondents referred patients to an endodontist. The main reasons for referral were fractured instruments (86.6%), dental trauma (83.6%), difficulties in diagnostics (79%) followed by persistent symptoms (78.1%).
Conclusion. The findings of the present study suggest that the need for referral of patients to an endodontist among Lithuanian dental practitioners exists. The main reasons for referrals were complications of endodontic treatment, traumatic injuries, difficulties in diagnostic procedures, and persistent symptoms. Full article
Article
The role of high-grade prostatic intraepithelial neoplasia for biochemical relapse of prostate carcinoma after radical prostatectomy
Medicina 2010, 46(9), 604; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46090085 - 11 Sep 2010
Cited by 3 | Viewed by 544
Abstract
The objective of the study was to evaluate the relationship between high-grade intraepithelial neoplasia diagnosed after radical retropubic prostatectomy and the clinical and pathological characteristics of prostate cancer, and to evaluate the time to biochemical relapse of the disease within the groups of [...] Read more.
The objective of the study was to evaluate the relationship between high-grade intraepithelial neoplasia diagnosed after radical retropubic prostatectomy and the clinical and pathological characteristics of prostate cancer, and to evaluate the time to biochemical relapse of the disease within the groups of high-grade prostatic intraepithelial neoplasia (HGPIN) and non-HGPIN patients.
Material and methods
. Patients, clinically diagnosed with local prostate carcinoma at the Clinic of Urology, Kaunas University of Medicine, during 2003–2007 and treated with radical retropubic prostatectomies, were distributed into two groups according to the HGPIN detected in the postoperative material: HGPIN and non-HGPIN. The two groups were compared in terms of preoperative and postoperative characteristics. The patients who were followed up for at least 12 months were included into the study. The biochemical relapse of prostate cancer was determined if there were two consecutive rises of prostate-specific antigen (PSA) level above 0.2 ng/mL or according to the attending physician’s opinion, there was a need for adjuvant treatment even with onetime rise of PSA level above 0.2 ng/mL.
Results
. There was no significant difference between the HGPIN and non-HGPIN groups in terms of time to biochemical relapse and frequency of biochemical relapses, time before surgery, the timing of the HGPIN diagnosis, age, or PSA level. After radical prostatectomy, patients in the HGPIN group were found to have significantly more often poorer cancer cell differentiation according to the Gleason score (≥7 vs. <7; P=0.001) and higher TNM stage (T3a,b vs. T2a,b,c; P=0.001). Fewer positive resection margins were diagnosed in the HGPIN group (P=0.05). The groups did not differ in terms of the degree of differentiation according to the Gleason score or perineural invasion (P=0.811 and P=0.282, respectively).
Conclusions
. HGPIN was more often associated with the characteristics of the poor prognosis for relapse of prostate cancer: poorer tumor cell differentiation according to the Gleason score and more cases of higher TNM stage. HGPIN did not have any influence on biochemical relapse of the disease during the short-term follow-up. Full article
Article
Voluntary performance
Medicina 2010, 46(9), 581; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46090083 - 11 Sep 2010
Cited by 25 | Viewed by 472
Abstract
Will, purpose, and volition have long been viewed as either causes of behavior or of no direct consequence to behavior. In this essay, volition affects a flexible direct coupling of participant to task, modulating the degrees of freedom for kinematics in action, a [...] Read more.
Will, purpose, and volition have long been viewed as either causes of behavior or of no direct consequence to behavior. In this essay, volition affects a flexible direct coupling of participant to task, modulating the degrees of freedom for kinematics in action, a point of view first introduced in theories of motor coordination. The consequence is an explanation consistent with present knowledge about involuntary and voluntary sources of control in human performance, and also the changes of the body expressed in aging and dynamical disease. Specifically, this view explains how tradeoffs between sources of overly regular versus overly random dynamics change the structure of variability in repeated measurements of voluntary performance. Full article
Article
New insights for adult cardiopulmonary resuscitation. Up-coming resuscitation guidelines 2010
Medicina 2010, 46(9), 571; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina46090082 - 11 Sep 2010
Cited by 2 | Viewed by 445
Abstract
Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. We have performed a search [...] Read more.
Despite advances in cardiac arrest care, the overall survival to hospital discharge remains poor. The objective of this paper was to review the innovations in cardiopulmonary resuscitation that could influence survival or change our understanding about cardiopulmonary resuscitation. We have performed a search in the MEDLINE and the Cochrane databases for randomized controlled trials, meta-analyses, expert reviews from December 2005 to March 2010 using the terms cardiac arrest, basic life support, and advanced life support. The lack of randomized trials during the last 5 years remains the main problem for crucial decisions in cardiopulmonary resuscitation. Current trends in cardiopulmonary resuscitation are toward minimizing the interruptions of chest compressions and improving the quality of cardiopulmonary resuscitation. In addition, attention should be paid to all the parts of chain of survival, which remains essential in improving survival rates. Full article
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