Zielinski, Andrzej; Håkansson, Anders; Jurgutis, Arnoldas; Ovhed, Ingvar; Halling, Anders
Background Lithuanian primary health care (PHC) is undergoing changes from the systems prevalent under the Soviet Union, which ensured free access to specialised health care. Currently four different PHC models work in parallel, which offers the opportunity to study their respective effect on referral rates. Our aim was to investigate whether there were differences in referrals rates from different Lithuanian PHC models in Klaipeda after adjustment for co-morbidity. Methods The population listed with 18 PHC practices serving inhabitants in Klaipeda city and region (250 070 inhabitants). Four PHC models: rural state-owned family medicine practices, urban privately owned family medicine practices, state-owned polyclinics and privately owned polyclinics. Information on listed patients and referrals during 2005 from each PHC practice in Klaipeda was obtained from the Lithuanian State Sickness Fund database. The database records included information on age, gender, PHC model, referrals and ICD 10 diagnoses. The Johns Hopkins ACG Case-Mix system was used to study co-morbidity. Referral rates from different PHC models were studied using Poisson regression models. Results Patients listed with rural state-owned family medicine practices had a significantly lower referral rate to specialised health care than those in the other three PHC models. An increasing co-morbidity level correlated with a higher physician- to self-referral ratio. Conclusion Family medicine practices located in rural-, but not in urban areas had significantly lower referral rates to specialised health care. It could not be established whether this was due to organisation, training of physicians or financing, but suggests there is room for improving primary health care in urban areas. Patient's place of residence and co morbidity level were the most important factors for referral rate. We also found that gatekeeping had an effect on the referral pattern with respect to co-morbidity level, so that those
Zemlys, Petras; Ferrarin, Christian; Umgiesser, Georg; Gulbinskas, Saulius; Bellafiore, Debora
This work is focused on the application of a modelling system to simulate 3-D interaction between the Curonian Lagoon and the Baltic Sea coastal waters and to reflect spatio-temporal dynamics of marine waters in the Curonian Lagoon. The model system is based on the finite element program package SHYFEM which can be used to resolve the hydrodynamic equations in lagoons, coastal seas, estuaries and lakes. The results of a one year 3-D model simulation with real weather and hydrological forcing show that the saline water intrusions from the sea through Klaipeda Strait are gradually decreasing with distance from the sea and become negligible (average annual salinity about 0.5 psu) at a distance of about 20 km to the south of Kiaules Nugara island. Analyses of the simulation results also show this area being highly heterogeneous according to the vertical salinity distribution. While in the deeper Klaipeda Strait (harbour waterway) differences in average salinity between near bottom and surface layers varies in the range 2-2.5 psu, in the rest of the Curonian Lagoon it is less than 0.1 psu. Analyses of the simulation results confirmed the presence of a two-directional flow that from time to time changes to either saline water one-directional flow to the Curonian Lagoon or fresh water one-directional flow to the sea. Two-directional flow duration decreases with a distance from sea entrance in Klaipeda Strait from around 180 days year-1 close to the sea entrance to 50 days year-1 just behind Kiaules Nugara island. One-directional outflow duration is increasing with a distance from the sea entrance from 100 to 225 days year-1. One-directional inflow duration occurs in the range 85-100 days year-1. The analysis of the ratio of buoyancy layer thickness and water depth (hb/H), and the Wedderburn number showed three main flow regimes in the strait identifying the main importance of wind action in the along-strait direction. Absence of wind or cross-strait wind regimes allow the
Anne, Olga; Burskyte, Vilma; Stasiskiene, Zaneta; Balciunas, Arunas
Freight handling in EU ports fell by more than 12 % during the global economic crisis in 2008-2009 after almost a decade of continuous growth. The decrease of freight handling in the Klaipeda seaport, the only port in Lithuania, was 6.7 % and happened due to the dominant outward movement of goods (mainly oil products). The Klaipeda seaport, due to its peculiarity, is the only ice-free port in the northern part of Baltic Sea. The present study explores the environmental impact of Klaipeda seaport activities from 2001 to 2011. Moreover, it compares the environmental effectiveness of environmental protection strategies used in the four biggest companies that, in fact, cover about 88 % of total activities (except general cargo) of the seaport. The first group of targeted companies used an environmental protection strategy to implement an ISO 14001-based environmental management system, and the second group selected to follow environmental management practices without certification. The paper analyses the development of the companies' activities in regard to the change of environmental effectiveness. The paper evaluates the pressure of the economic crisis on the companies' activities and its influence on environmental decisions, with particular interest in the ability of different environmental protection systems to resist and handle the expected performance. The study identified a significant decrease in companies' activities during the crisis period. However, the economic activities and environmental effectiveness demonstrated similar short-term tendencies in regard to the environmental strategy selection but differed in long-term perspective. PMID:25109472
Quintano, J. F.
This paper is a continuation of the research into the astronomical reasons behind prehistoric rock and mobiliary art in the Iberian Peninsula, the first part of which was presented in the previous SEAC Congress celebrated in 2007 in Klaipeda (Lithuania). It proposes that all heavenly objects painted as rock art and on ceramic pieces be given the name of astraliformes [=solar and stellar paintings]. The six astraliformes from the two shelters visited, and the ceramic pieces on which astraliformes appear in the Prehistoric Museum of Granada are presented. Astraliformes appear in schematic art in a sudden manner and on a large scale, and are included in the panel because of their function as a means of regulating and promoting the agrarian cycle.
Stucinskas, Justinas; Robertsson, Otto; Wingstrand, Hans
Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania. Methods The 10-year revision rate for the first 595 primary ScanKnee arthroplasties inserted in Klaipeda, Lithuania, was compared to that for the first 1,280 ScanKnee primary arthroplasties inserted in Sweden. As in the hip replacement study, only patients with osteoarthritis (OA) were included. Primary knee arthroplasties without patellar resurfacing were included, and the endpoint was revision for any reason other than addition of a patellar component. Results We found that the cumulative revision rate was not statistically significantly different between the groups. The revision pattern was different, however, and we observed 24 isolated patellar component additions in Sweden, but none in Klaipeda. Interpretation Contrary to the results of our previous hip arthroplasty study, the cumulative revision rate after total knee arthroplasty was similar in the two groups. This suggests that compared to hip arthroplasty, the outcome of total knee arthroplasty was less dependent on surgical experience. The large difference regarding isolated patellar component additions may be explained by long-term accumulation of severe OA cases in Lithuania. To patients subject to a newly introduced surgical treatment offering great improvement in quality of life, patellofemoral pain may be a minor problem. Furthermore, patellar problems may not have seemed particularly relevant for the surgeons, considering the disability of other patients waiting to be treated. PMID:19297790
Kasprzyk, Idalia; Rodinkova, Victoria; Šaulienė, Ingrida; Ritenberga, Olga; Grinn-Gofron, Agnieszka; Nowak, Malgorzata; Sulborska, Aneta; Kaczmarek, Joanna; Weryszko-Chmielewska, Elzbieta; Bilous, Elena; Jedryczka, Malgorzata
Spores of the genus Alternaria belong to one of the most prevailing constituents of the air in all regions of the world. They form infectious inoculum of numerous plant species as well as severe inhaled allergies. The aim of this study was to compare the biological pollution with Alternaria spores of the air of 12 cities located in central and eastern Europe. The experiment was done in 2010 and it covered the territory of Latvia (LV), Lithuania (LT), Poland (PL) and Ukraine (UA). The spores were counted using an identical method and standard equipment (7-day Lanzoni volumetric sampler) followed by extensive statistical calculations. The timing of the day of maximum concentration changed mainly along the N-S direction and had a positive correlation with latitude. The most important factor determining the increase in Alternaria spore concentration was the temperature, whereas other weather parameters were not related or of low significance. Regardless of geographical location, the first phase of the season (0-0.9 % of Alternaria spores in the air) was the longest (up to 60 days) and the last (97.5 to 99 %) was the shortest (22 days or less). The means of daily concentrations of Alternaria spores ranged from 11 spores m(-3) in Klaipeda (LT, Baltic Sea coast) to 187 in Poznan (west PL, agricultural plain). The threshold value of 80 spores m(-3) that triggers the first allergy symptoms was exceeded in 8 to 86 days (Vinnitsa, UA, temperate continental, forest-steppes region). There were considerable differences between the highest number of spores per cubic metre of air, varying from 139 in the north (Klaipeda, LT) to 2,295 in central west (Poznan, PL). The biological pollution by Alternaria spores in several places of central and eastern Europe was high; the number of days exceeding the threshold value of 300 spores m(-3) connected with serious health problems of atopic people ranged from 0 to 1 on the north (LV, LT) to 29 in central west (Poznan, PL). PMID:25592912
Lujanienė, G; Remeikaitė-Nikienė, N; Garnaga, G; Jokšas, K; Šilobritienė, B; Stankevičius, A; Šemčuk, S; Kulakauskaitė, I
Activities of (137)Cs, (241)Am and (239,240)Pu were analyzed with special emphasis on better understanding of radionuclide transport from land via the Neman River estuaries to the Baltic Sea and behavior in the marine environment. Although activity concentrations of (137)Cs in water samples collected the Baltic Sea were almost 100 times higher as compared to the Curonian Lagoon, its activities in the bottom sediments were found to be comparable. Activity (238)Pu/(239,240)Pu and atom (240)Pu/(239)Pu ratios indicated a different contribution of the Chernobyl-originated Pu to the suspended particulate matter (SPM) and bottom sediments. The largest amount of the Chernobyl-derived Pu was found in the smallest suspended matter particles of 0.2-1 μm in size collected in the Klaipeda Strait in 2011-2012. The decrease of characteristic activity (238)Pu/(239,240)Pu and atom (240)Pu/(239)Pu ratios towards the global fallout ones in surface soil and the corresponding increase of plutonium (Pu) ratios in the suspended particulate matter and bottom sediments have indicated that the Chernobyl-derived Pu, primarily deposited on the soil surface, was washed out and transported to the Baltic Sea. Behavior of (241)Am was found to be similar to that of Pu isotopes. PMID:24144889
Paulauskienė, Tatjana; Jucikė, Indrė
One of the most popular transportation methods of crude oil is water transport, leading to potential spills of these pollutants in the seas and oceans and water areas of ports, during their extraction, transportation, transhipment and use. The growth of the Lithuanian economy and the expansion of competitiveness were hardly imagined without the development of the Klaipeda seaport. However, the intensity of shipping and the increase in cargo loading volumes at specialised terminals are associated with a higher risk of environmental pollution. To achieve a sustainable development of the seaport, it is necessary not only to ensure the prevention of potential water pollution but also, if necessary, to use environmentally friendly technology for pollution management. The work analyses the possibilities related to the collection of oil products from the water surface using natural sorbents (peat, wool, moss and straw) and their composites.The research of absorbed amount of crude oil and diesel fuel spilled on the water surface, while using sorbents and their composites, determined that sorbents' composite straw-peat (composition percentage of straw-peat 25-75 %) absorbs the major amount of both crude oil (60 % of the spilled volume) and diesel fuel (69 % of the spilled volume) comparing to single sorbents and sorbents' composite straw-peat (composition percentage of straw-peat 50-50 %). PMID:25994272
Umgiesser, Georg; Razinkovas-Baziukas, Arturas; Zemlys, Petras; Ertürk, Ali; Mėžinė, Jovita
The spatial pattern of the hydrodynamic circulation of the Curonian lagoon, the largest European coastal lagoon, is still little understood. In absence of automatic current registration data all the existing models relied mostly on such data as water levels leaving high level of uncertainty. Here we present CISOCUR, a new project financed by European Social Fund under the Global Grant measure. The project applies a new methodology that uses the carbon stable isotope (SI) ratio of C12 and C13 that characterize different water sources entering the lagoon and may be altered by internal kinetic processes. Through the tracing of these isotope ratios different water masses can be identified. This gives the possibility to validate several hypotheses of water circulation and validate hydrodynamic models. In particular it will be possible to 1) trace water masses entering the lagoon through the Nemunas and the Klaipeda strait; 2) test the hypothesis of sediment transport mechanisms inside the lagoon; 3) evaluate the importance of physical forcing on the lagoon circulation. The use of a hydrodynamic finite element model, coupled with the SI method, will allow for a realistic description of the transport processes inside the Curonian lagoon. So the main research goal is to apply the stable isotope tracers and a finite element model to determine the circulation patterns in the Curonian lagoon. Here we show how the SI analysis was used to validate the hydrodynamic model on the basis of residence time. The average residence time of the Nemunas waters is estimated through SI data and is then compared with the model data computed through standard algorithms. Seasonal changes of carbon content are taken care of through a preliminary application of a carbon kinetic model. The results are compared to literature data.