Cancer mortality and morbidity among patients with schizophrenia: A hospital-based cohort study, 1992-2020

OBJECTIVE

Due to the inconsistency of the evidence about the cancer risk among patients with schizophrenia, the aim of this study was to analyse cancer mortality and morbidity in patients with schizophrenia treated in a single centre in Lithuania during the study period of 1992-2020.

MATERIALS AND METHODS

A retrospective cohort study was conducted in Vilnius Republican Psychiatric Hospital, the biggest specialised psychiatric hospital in Lithuania, with approximately 5000 hospital admissions annually. The patients' cohort was established by identifying all patients with the diagnosis of schizophrenia (ICD-10 code F20) in the hospital database from 1 January 1992 until 31 December 2017. The cancer cases and cancer deaths in the cohort were identified in the Lithuanian Cancer Register through linkage procedures. The analysis of risk was based on a comparison of observed and expected numbers of cancers and deaths. Expected number of cancer cases were calculated by multiplication of the exact person-years under observation in the cohort by sex, calendar year and a 5-year age-group-specific national incidence and mortality rate. All statistical analyses were carried out using STATA 15 statistical software.

RESULTS

During the follow-up, out of 8553 patients, 673 cases of cancer were diagnosed in both sexes. Statistically significantly lower risk for overall cancer incidence was observed in men (SIR 0.74, 95% CI 0.66-0.83), but not in women (SIR 1.07, 95% CI 0.97-1.18). Statistically significant lower overall cancer mortality risk was observed in men (SMR 0.82, 95% CI 0.70-0.96), while in the women's group, risk of cancer deaths was significantly higher compared to the general population (SMR 1.28, 95% CI 1.11-1.48). We observed lower risk for pancreatic cancer (SIR 0.36, 95% CI 0.14-0.96), non-melanoma skin cancer (SIR 0.54, 95% CI 0.33-0.88) and prostate cancer (SIR 0.69, 95% CI 0.55-0.87) in men and higher risk for malignant neoplasm of liver (SIR 2.58, 95% CI 1.53-4.36) and skin melanoma (SIR 2.03, 95% CI 1.12-3.66) in men and for breast cancer (SIR 1.38, 95% CI 1.14-1.66) and corpus uteri cancer (SIR 1.56, 95% CI 1.18-2.07) in women.

CONCLUSIONS

The current results of our study indicate lower risk of overall cancer incidence and mortality in male patients with schizophrenia, while female patients had a higher mortality risk, alongside variations in the risk of different cancer types. This information is important not only for patients, but for healthcare specialists to develop effective disease-specific preventive interventions and programmes.

The impact of the COVID-19 on the consumption of food supplements in the Lithuanian population

Background

The COVID-19 pandemic affected the dietary changes of the population. The aim - to evaluate the changes in the consumption of food supplements in the Lithuanian population over 1997-2020, and the impact of the COVID-19 pandemic on the consumption of food supplements.

Methods

A representative sample of the Lithuanian adult population was formed by sex, age and the number of residents in each county. A total of 2573 adult respondents were surveyed using questionnaires on their consumption of food supplements and the results were compared to previous studies. SPSS, 20.0 for Windows version was used for the statistical analysis of the data. The reliability of the differences was found by the chi-squared (χ2) test with statistical significance of p ≤ 0.05.

Results

Between 1997 and 2017, food supplements were never taken by an average of 37-47 % of the Lithuanian population. In 2020, the number of never users dropped to 17.6 % and 82.4 % of the Lithuanian population started taking food supplements, mostly to strengthen the body and boost the immune system. The number of daily consumers more than doubled - from 8.9 % in 2017 to 18.6 % in 2020. In recent years the number of consumers of food supplements for 3-4 months per year has doubled and reached 15.5%. The percentage of users for 1-2 months per year (13%) has been almost stable in recent years and only a slight change occurred in the number of occasional users of food supplements - from 30.3% in 2017 up to 34.4 % in 2020.

Conclusions

The COVID-19 pandemic has provoked the consumption of food supplements by the Lithuanian population - the number of users has increased from 59 % to 82.4 %, and the number of daily users doubled to 18.6 %. The population mainly consumes food supplements mainly to strengthen the body and boost the immune system.

Key messages

The COVID-19 pandemic has had a significant impact on the increase of food supplement consumption.

The population mainly consumes food supplements mainly to strengthen the body and boost the immune system.

Differences in consumption of sugar and sweeteners in two neighbor countries: Lithuania and Poland

Background

In connection with attempts to reduce consumption of added sugar, consumption of non-nutritive (or low caloric) sweeteners (NNS) is likely to increse in many countries. In addition to variety of NNS, limited evidence on public health effects related to NNS exist. Thus, it remains important to monitor consumption of added sugar and sweeteners in our societies. As Lithuania and Poland are neighbor countries with similar culture and nutritional habits, the objective of this study was to compare consumption of sweeteners among adults in Lithuania and Poland.

Methods

A representative sample of Lithuanian population of adults aged 18 to 75 years was formed. A total number of 1008 residents from Lithuania participated. Distribution of them by answers about consumption of added sugar and sweeteners was assessed with respect to results of the survey conducted in central part of Poland where a group of 2000 adult respondents was investigated.

Results

Majority of respondents in both countries declared consumption of added sugar: 79.3% and 87.4% of Lithuanian and Polish respondents, respectively (p-value less than 0.05). Apart from sugar, majority of the respondents in Lithuania declared consumption of honey or fructose (respectively, 78.1% and 43.4%), consumption of other sweeteners such as saccharin, stevia, corn syrup, aspartame and sucralose were less prevalent (respectively, 30.9%, 18.2%, 9.5%, 9.0%, 3.4%). In Poland, 41.8% of respondents declared consumption of products containing stevia. Distribution of Poles by answers to the question which sweetener they used most often was 26.6%, 23.6%, 15.6%, 12.3% for stevia, xylitol, aspartame and fructose, respectively. Honey, acesulfame K, thaumatin and other substances were used by a lower percentage of Polish respondents.

Conclusions

Despite cultural similarities consumption of added sugar and sweeteners among adults differed significantly in two neighbor counties: Lithuania and Poland.

Key messages

In comparison to Lithuania, consumption of added sugar, xylitol and natural non-nutritive but intense sweetener stevia was more prevalent in Poland. In comparison to Poland, consumption of added sugar was less prevalent, but non-intense and high in calories sweeteners were more prevalent in Lithuania.

Evaluating knowledge of healthy diet recommendations of Lithuanian adults

Backgroud

Studies show that diet of Lithuanian population does not follow healthy diet recommendations and is related to increased risk of cardiovascular disease. By knowing Lithuanian populations knowledge about the dietary recommendations and in what socio-demographic groups what dietary recommendation knowledge is missing, we could use effective targeted health promotion and prevention programs or provide particular information for those groups.

Methods

Cross-sectional study was conducted in 2019. 1007 residents of Lithuania aged 18-75 were surveyed by anonymous questionnaire. Survey was carried out by using multi-stage stratified random sampling.

Results

Almost half of the respondents (45.5% (95% CI: 45.5; 51.7)) knew how many times a day fruits and vegetables should be consumed. Possession of having this knowledge was significantly associated with female gender (OR = 1.67 (95% CI: 1.29; 2.14)) and higher education (OR = 1.83 (95% CI: 1.41; 2.3)). Only 21.2% (95% CI: 18.7; 23.7) of the respondents knew that bread and grain products should be taken several times a day. More than half of the population knew the recommendations for meat, fish, milk and dairy products 56.7% (95% CI: 53.6; 59.7). Respondents with higher education had a 2.05 times higher chance (OR = 2.05 (95% CI: 1.55; 2.72)) of knowing these recommendations. 39.7% (95% CI: 36.7; 42.8) knew that butter, salt and sweets should be consumed rarely and in small quantities. Having this knowledge was significantly associated with female gender (OR = 1.80 (95% CI: 1.37; 2.34)), higher education (OR = 1.75 (95% CI: 1.32, 2.32)), and living in a bigger city (OR = 1.67 (95) % CI: 1.19; 2.35)).

Conclusions

Lithuanian populations knowledge about the recommendations of healthy nutrition is insufficient, therefore, in order to reduce the morbidity of cardiovascular diseases, it is necessary to provide the population with information on healthy nutrition.

Key messages

The population of Lithuania lacks knowledge about healthy eating recommendations. Although it is necessary to provide all residents of Lithuania with information about health nutrition recommendations, the main focus should be on men and people with lower education.

Well-being of families of people with psychosocial disabilites in context of deinstitutionalization

Background

A large part of disabled people have psychosocial disabilities. Importance of their inclusion is stated in many strategic documents. However, this group of people still faces many barriers in societies. Currently, deinstitutionalization is carried out in Lithuania. Well-being of people with psychosocial disabilities and their family members is affected by this process. Thus, we aimed to assess changes in well-being of family members of people with psychosocial disabilities during deinstitutionalization in Lithuania.

Methods

Data was collected during two stages of deinstitutionalization, in 2016 and 2019. Family members living with people with psychosocial disabilities answered anonymously to questions of Lithuanian psychological well-being scale. Respectively, 334 and 391 adults participated (13.8% of males and 86.2% of females each time). T scores and levels of well-being were calculated and compared according to socio-demographics of respondents and stage of deinstitutionalization.

Results

Generally, distribution of the participants did not differ by level of overall well-being between the stages of deinstitutionalization (p-value more than 0.05). Differently, place of residence, younger age, higher income and employment were associated with higher well-being. In the second phase, rural, younger, employed and full-time employed respondents had higher estimates of overall well-being (p-value less than 0.05). Also, younger and employed population had higher satisfaction with physical health, income, employment and life in Lithuania (p-value less than 0.05). In most counties of Lithuania, overall well-being of family members of people with psychosocial disabilities was in line with the average level.

Conclusions

Although distribution of family members of people with psychosocial disabilities by level of overall well-being had not changed from 2016 to 2019, an increase in well-being among rural, younger, employed and those with higher income was observed.

Key messages

Generally, overal well-being of family members of people with psychosocial disabilities had not changed during the process of deinstitutionalization in Lithuania from 2016 to 2019. Living in rural areas, younger age, higher income and employment were associated with an increase in well-being of family members of people with psychosocial disabilities.

Managing occupational stress: should we consider the sociodemographic groups of health workers?

Background

An essential part of occupational stress management is identifying target groups and developing a wellbeing program that tailors organisational interventions to the specific needs of the target groups. The study aimed to explore whether psychosocial risk determinants and organisational intervention objects differ across employees' groups based on sociodemographic factors in a public healthcare institution.

Methods

Using a cross-sectional study design, paper questionnaires were delivered to all health workers (n = 690) of the Lithuanian primary healthcare institution; the response rate 68%. The questionnaire contained items related to sociodemographic groups (gender, age, job seniority, education, occupational status), 14 psychosocial risk determinants, and 10 organisational intervention objects. Nonparametric tests for comparisons of the groups were used.

Results

The results showed that differences by gender were not statistically significant except for one organisational intervention object. Only 3 organisational intervention objects had mean rank scores differing statistically across age and job seniority groups; 5 objects - across education groups and almost all objects - across occupational groups. Regarding psychosocial risk determinants, one determinant had mean rank scores differing statistically across age and job seniority groups; 4 and 6 determinants - across education and occupational groups respectively. Statistical significance was considered with p-value < 0.05 and 95% confidence interval.

Conclusions

The findings showed that different psychosocial risk determinants and organisational intervention objects were emphasized by different sociodemographic groups of health workers in the institution, but they did not impact groups in the same measure. Therefore, it is crucial to start by determining the risk group's specific needs before developing and implementing stress management programs.

Key messages

The study contributes to bridging the gap between theoretical knowledge and practical solutions in occupational stress management at public primary healthcare settings. The study has proposed a way of diagnosing psychosocial risks and of tailoring interventions to all health workers of the public primary healthcare institution by using a simple and robust tool.

Personal cell phones among children: attitudes of parents of primary school pupils

Background

A large number of primary school children have personal smartphones which enable them to communicate with lots of people and use social networks. However, social networking should not be accessible to primary school pupils due to existing age restrictions. Studies show that cell phones can be used to send offensive or sexual content to children or by them. This might have long-term effects on child's mental health and even provoke suicidal thoughts. While parents are able to control many aspects of children's life, we aimed to disclose parental attitudes towards use of mobile phones among children.

Methods

A total number of 619 parents of primary school children from middle-sized town of Lithuania participated in this study. Parents anonymously expressed their opinion to questions about personal cell phones usage among children. Distribution of participants was assessed according to social and demographic characteristics.

Results

Most of the respondents (79.8%) indicated that use of mobile phones might be harmful to children's health, 56.0% indicated that their children use social networks and every second child was registered by their parents (49.5%). Minority of the respondents (8.1%) thought that children (including children from other families) receive messages from strangers and communicate with them (2.1%). Similarly, very few of the respondents thought that children receive offensive (15.0%) or sexual (4.8%) content. Younger and lower educated parents registered their children to social networks more frequently (p-value less than 0.05). Lower educated parents more frequently indicated that offensive or sexual content can reach children via smartphones (p-value less than 0.05).

Conclusions

Majority of parents of primary school children thought that cell phones might be harmful to children's health but most of them did not pay attention to threats such as communication with strangers or transmission of sexual content.

Key messages

Only minority of parents of primary school children indicated communication with strangers or transmission of sexual content as threats induced by use of smartphones among children. Regardless that lower educated parents indicated awareness of content-related threats to children more frequently they registered their children to social networks more frequently as well.

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

Main sources of information on nutrition of various socio-economic groups

Backgroud

For effective non-communicable disease prevention and health promotion programs, it is very important to know from where the targeted audience gets all the information on nutrition (NI). The shortage of this information lead to the aim of this study - to determine the main sources of NI of various socio-economic groups.

Methods

Cross-sectional study was conducted in 2019. 1007 residents of Lithuania aged 18-75 were surveyed by anonymous questionnaire. Survey was carried out by using multi-stage stratified random sampling. Chi square test was used for the data analysis.

Results

More than half respondents (58.6% (95% CI: 55.5; 61.6)) indicated that one of their main sources of NI is internet, 47.2% (95% CI: 44.1; 50.3) of respondents trusts television and radio. Only one third of residents (36% (95% CI: 33.1; 39.1)) indicated physicians and pharmacists as the main source of NI and only 20.6% (95% CI: 18.2; 23.2) of them received NI from specialized nutrition and health magazines. Younger people were more likely to choose internet as the main source of NI (65,7%, 58%, 54,1% accordingly (p = 0.004)). Internet as the main source of NI was significantly related to residence, education, income and marital status. The number of respondents who identified television as the main source of IN was significantly higher among the rural population (53.2%) and small-town population (52.9%) than among the population of big cities (39.4%) (p < 0.0001). Choosing television as one of main source of NI was significantly related to age, education, income and marital status. 24.3% of women and 16.4% of man indicated that the main source is specialized nutrition and health magazines (p = 0.002).

Conclusions

Best place for spreading NI is internet and television. When trying to target young people the best place is internet and for targeting senior citizens NI is better to carry out by television and radio.

Key messages

Most population gets information about nutrition from internet and television. Most young people gets information about nutrition from internet and most older people gets information from television and radio.

Parity and Risk of Thyroid Cancer: a Population-Based Study in Lithuania

An association between parity and thyroid cancer risk has been investigated in a number of independent studies but yielded contradictory findings. The aim of this study was to explore the association between parity and thyroid cancer risk. The population-based cohort study in Lithuanian was conducted. The study dataset based on the linkages between all records from the 2001 population census, all cancer incidence records from the Lithuanian Cancer Registry, and all death and emigration records from Statistics Lithuania for the period between 6 April 2001 and 31 December 2009. Cox's proportional hazards regression models were used to estimate the hazard ratios (HRs) for parity, age at first birth, number of children, place of residence, education, and age at census. The cohort of 868,105 women was followed for 8.6 years, and 1775 thyroid cancer cases were diagnosed during the study period. The significantly higher thyroid cancer risk was observed among parous women (HR = 1.45, 95% CI: 1.20, 1.75) and in women with 1, 2, and 3 children, after adjusting for the possible confounding effects of relevant demographic variables. The findings of this study are consistent with the hypothesis that parity might be associated with the risk of thyroid cancer in women.

Transfer of innovation on allergic rhinitis and asthma multimorbidity in the elderly (MACVIA-ARIA) - EIP on AHA Twinning Reference Site (GARD research demonstration project)

The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1-year period of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) to follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults.