No abstract

Įvadas. Miunhauzeno sindromas yra fiktyvus sutrikimas, kurį gydytojui itin sunku diagnozuoti ir gydyti. Šioje literatūros apžvalgoje paaiškinami tokios būklės pacientų klinikinio atpažinimo ir gydymo klausimai, pateikiama Miunhauzeno sindromo apibrėžtis. Šios būklės pacientai dažnai elgiasi dramatiškai ir sąmoningai pateikia klaidingus ir (arba) perdėtus simptomus bei informaciją. Jie prašo nuolatinio gydytojų dėmesio, nuolatos kreipiasi į gydytoją (arba į kelis, skirtingų specializacijų gydytojus), prašo nuolat kartoti diagnostinius tyrimus, procedūras, itin nori būti hospitalizuojami ir įrodinėja, kad pagerėjimas dinamikoje yra labai nedidelis arba jo nėra. Gydymo plano laikymasis paprastai nėra teisingas bei adekvatus, o šios būklės pacientai dažnai palieka ligoninę be gydytojo patarimo ar net leidimo. Gydymui parinkti svarbus daugiadalykis požiūris. Tai dažniausiai apima profesinį pirminės sveikatos priežiūros įstaigos gydytojo ir gydytojo psichiatro bendradarbiavimą. Svarbu atvira, palaikanti, nesmerkianti, kantri diskusija su pacientu apie jo būklę, pateikiant aiškų gydymo planą ir tiesą apie Miunchauzeno sindromą. Naudinga ilgalaikė psichoterapija ir nuolatinis paciento stebėjimas. Tikslas − atrinkti ir išanalizuoti ekspertų pateiktą medžiagą apie Miunhauzeno sindromą, jo klinikinį pasireiškimą, diagnostiką bei gydymą. Tyrimo medžiaga ir metodai. Atlikta mokslinių šaltinių paieška, apžvalga bei analizė. Publikacijų paieška atlikta anglų kalba tarptautinėje medicinos duomenų bazėje PubMed, pasitelkiant šiuos raktinius žodžius ir jų derinius: ,,Miunhauzeno sindromas“, ,,sindromas“, ,,klinikinis pasireiškimas“, ,,Miunhauzenas“, ,,diagnostika“. Rezultatai. Taikant teorinės analizės metodus, surastos 66 publikacijos, atitinkančios įtraukimo kriterijus. Kitos 200 publikacijų buvo atmestos, nes neatitiko įtraukimo kriterijų. Išvados. Tikslios Miunhauzeno sindromo priežastys išlieka nežinomos. Dauguma pacientų, sergančių Miunhauzeno sindromu, pabrėžia trauminę vaikystės patirtį (smurtas šeimoje, tėvų nuolatiniai pykčiai ir t.t.). Miunhauzeno sindromas, remiantis iki šiol padarytomis išvadomis, blogai prognozuojamas bei diagnozuojamas, nes pacientai atsisako tinkamo gydymo, t.y. psichoterapijos. Pasirinkusiems psichoterapinį gydymą, šis sutrikimas gali būti visiškai išgydytas.

ObjectiveThe aim of the study was to evaluate smoking habits among Lithuanian adult smokers, according to gender, age and education.MethodsThe study analyses data from the Lithuanian adult population health behavior survey carried out in 2008. The national random sample of 3000 inhabitants aged 20-64 was taken from the National Population Register. The study material was collected through mailed questionnaires covering smoking habits, social status. In 2008 daily smokers were 38,8 % of Lithuanian adult men and 14,9 % of women.ResultsDaily smoking was least common in the oldest age group in both sexes. Indirect educational gradient was found among men. Among women, no association was observed between smoking and educational level.ConclusionsAssessment of inequalities in smoking habits helps to identify subgroups of society that should have a priority of tobacco control policies.

The aim of study was to estimate the relationships among smoking/quitting behavior, having a smoke-free home and a number of social variables, including perceived family pressure to quit, the presence of adult non-smokers and children in the household, and belief in the harmfulness of secondhand smoke. Methods: The study analyses data from Lithuanian adult population health behavior surveys, performed in period of 1994-2008. For every survey the national random sample of 3000 inhabitants aged 20-64 was taken from the National Population Register. The study material was collected through mailed questionnaires covering smoking habits, sociodemographic characteristics. Results: 65 % of current smokers reported living in a home with a total smoking ban, 35% reported having no restrictions on smoking in the home. Report of a recent quit attempt and intention to quit were associated with family preference that the smoker not smoke. Smoke-free homes appear to prolong time to relapse following cessation. Male smokers were more likely than females to report smoke-free homes, and such reports decreased with age. Smokers were nearly 5 times more likely to report smoke-free homes if they lived with a non-smoking adult and child compared to when there was no child or adult nonsmoker in the household, and over 4 times more likely to report a smoke-free home if they believed in the harmfulness of secondhand smoke. Conclusions: Social influences, especially at the family level, motivate smokers to modify smokers´ behavior in ways that would help them quit and stay quit.

Statistical data of recent years evidences that Lithuania is leading in Europe in the suicide rate. Suicide is one of the main causes of death in adolescence. Objective: The goal of the study was to establish the relationship between teenagers' anxiety and depression symptoms and suicidal behavior. Methods: Two groups of teenagers from 14 to 17 took part in the study: the study group (after suicide attempts, N=109) and the control group (no suicide attempts, N=218). Hospital Anxiety and Depression Scale (HADS) was used in evaluating anxiety and depression symptoms. Results: Evaluating adolescents', who attempted suicide, anxiety and depression symptoms according to HADS, no significant differences between genders were determined: anxiety symptoms were determined to 22.8% of girls and 26.9% of boys (χ 2 =3.50, df=2, p=0.2), depression symptoms were determined to 21.1% of girls and 26.9% of boys (χ 2 =1.01, df=2, p=0.6). Evaluating possible impact on teenagers' suicidal behavior, the odds rate was calculated, the chance was determined whether a suicide is possibly attempted. The possibility of suicidal behavior was increased significantly by anxiety and depression symptoms, determined with HADS: 3,9 times more anxiety symptoms (95%, CI 1,6-9,7) and 9,2 times more depression symptoms (95% CI 2,9-29,7) in boys, and in girls, respectively-2,5 times (95%, CI 1,1-5,9) and 7,6 times (95%, CI 2,4-24,8). Conclusions: Anxiety and depression symptoms, according to HADS, may have possible impact on teenagers' suicidal behavior.