Suchergebnisse

Author: Mantas Čekanauskas. Title: Myocardial infarction morbidity, risk factors and survival in working age population in 2005– 2015. Aim: To review data found in scientific literature about myocardial infarction morbidity, risk factors and survival in working age population in 2005–2015. Tasks: To evaluate morbidity of myocardial infarction and its changes in Lithuania and European Union. To summarize etiology, main symptoms and principles of diagnostics. To identify the most significant risk factors for men and women. To evaluate survival, its changes and factors that contribute to it. Method: Search of scientific literature and data was done using PubMed, Lithuanian Academic Electronic Library (eLaBa), Lithuanian Institute of Hygiene and WHO Regional Office for Europe "Health for all" databases. Keywords used in research were: "myocardial infarction" and "young", "young people", "young adults", "young men", "young women", "men", "women", "characteristics", "pathogenesis", "diagnosis", "risk factors", "epidemiology", "morbidity", "survival", "mortality", "in hospital mortality", also "miokardo infarktas", "sergamumas", "išgyvenamumas", "mirštamumas", "rizikos veiksniai", "darbingo amžiaus". Only studies that were made with humans, written in English or Lithuanian and published not earlier than 10 years ago were selected. Articles that analyzed 65 years old and older population as well as younger than 18 years old people and those in which myocardial infarction was not the main analyzed topic were rejected. Additionally, other scientifical articles that corresponded to the topic of this paper were analyzed, prioritizing literature published not earlier than 10 years ago or articles written by Lithuanian authors. Conclusions: The number of hospitalizations due to ischaemic heart disease and myocardial infarction is slowly decreasing in EU (European Union) with the numbers being lowest in southern countries and biggest in Baltic and Scandinavian countries. The numbers in Lithuania remain the highest among all countries in the EU. The morbidity of myocardial infarction in Lithuania increased throughout 2005–2015. The morbidity in men was a few times higher than in women. Men aged 45 to 64 took the highest part among all patients. Myocardial infarction usually occurs as a result of thrombus forming in a coronary artery after a rupture of atheroma. The most common clinical manifestation is chest pain lasting 20 minutes or longer. Diagnosis is made after collecting patient's anamnesis, finding increased Troponin levels in blood serum and making other necessary examinations. The most important risk factors for 18–64 years old people are smoking, dyslipidaemia, diabetes and hypertension. Women experienced their first myocardial infarction later than men. Dyslipidaemia significantly increases the risk for men, while comorbidities for women. In recent years, numbers of hypertension and diabetes have increased among middle-aged, while numbers of smoking have decreased among younger MI patients. Mortality from ischaemic heart disease (including mortality from myocardial infarction) in Lithuania and Europe was decreasing throughout the period, even though in Lithuania it is still higher than the average of EU and is among the highest in the Union. Despite decreasing rates, this tendency is least noticeable among young women. General mortality among working age men decreased averagely -4,7 percent/year., p<0,05, among women -2,0 percent/year, p=0,16, among young men -7,8 percent/year, p<0,05, among young women -1,1 percent/year, p=0,56, among middle-aged men -4,5 percent/year, p<0,05, among middle-aged women -2,3 percent/year, p=0,16 respectively. Young women also got sufficient treatment later and less often than the other groups. The risk of mortality for patients who had experienced MI decreased a few times in 1980–2009. Previous acute heart failure worsened long-term survival for all patients, while additionally previous acute MI, stroke, and obesity was related with lower chances of survival in men, whereas stroke and diabetes in women. Overweight was associated with better prognosis for both men and women.

Author: Mantas Čekanauskas. Title: Myocardial infarction morbidity, risk factors and survival in working age population in 2005– 2015. Aim: To review data found in scientific literature about myocardial infarction morbidity, risk factors and survival in working age population in 2005–2015. Tasks: To evaluate morbidity of myocardial infarction and its changes in Lithuania and European Union. To summarize etiology, main symptoms and principles of diagnostics. To identify the most significant risk factors for men and women. To evaluate survival, its changes and factors that contribute to it. Method: Search of scientific literature and data was done using PubMed, Lithuanian Academic Electronic Library (eLaBa), Lithuanian Institute of Hygiene and WHO Regional Office for Europe "Health for all" databases. Keywords used in research were: "myocardial infarction" and "young", "young people", "young adults", "young men", "young women", "men", "women", "characteristics", "pathogenesis", "diagnosis", "risk factors", "epidemiology", "morbidity", "survival", "mortality", "in hospital mortality", also "miokardo infarktas", "sergamumas", "išgyvenamumas", "mirštamumas", "rizikos veiksniai", "darbingo amžiaus". Only studies that were made with humans, written in English or Lithuanian and published not earlier than 10 years ago were selected. Articles that analyzed 65 years old and older population as well as younger than 18 years old people and those in which myocardial infarction was not the main analyzed topic were rejected. Additionally, other scientifical articles that corresponded to the topic of this paper were analyzed, prioritizing literature published not earlier than 10 years ago or articles written by Lithuanian authors. Conclusions: The number of hospitalizations due to ischaemic heart disease and myocardial infarction is slowly decreasing in EU (European Union) with the numbers being lowest in southern countries and biggest in Baltic and Scandinavian countries. The numbers in Lithuania remain the highest among all countries in the EU. The morbidity of myocardial infarction in Lithuania increased throughout 2005–2015. The morbidity in men was a few times higher than in women. Men aged 45 to 64 took the highest part among all patients. Myocardial infarction usually occurs as a result of thrombus forming in a coronary artery after a rupture of atheroma. The most common clinical manifestation is chest pain lasting 20 minutes or longer. Diagnosis is made after collecting patient's anamnesis, finding increased Troponin levels in blood serum and making other necessary examinations. The most important risk factors for 18–64 years old people are smoking, dyslipidaemia, diabetes and hypertension. Women experienced their first myocardial infarction later than men. Dyslipidaemia significantly increases the risk for men, while comorbidities for women. In recent years, numbers of hypertension and diabetes have increased among middle-aged, while numbers of smoking have decreased among younger MI patients. Mortality from ischaemic heart disease (including mortality from myocardial infarction) in Lithuania and Europe was decreasing throughout the period, even though in Lithuania it is still higher than the average of EU and is among the highest in the Union. Despite decreasing rates, this tendency is least noticeable among young women. General mortality among working age men decreased averagely -4,7 percent/year., p<0,05, among women -2,0 percent/year, p=0,16, among young men -7,8 percent/year, p<0,05, among young women -1,1 percent/year, p=0,56, among middle-aged men -4,5 percent/year, p<0,05, among middle-aged women -2,3 percent/year, p=0,16 respectively. Young women also got sufficient treatment later and less often than the other groups. The risk of mortality for patients who had experienced MI decreased a few times in 1980–2009. Previous acute heart failure worsened long-term survival for all patients, while additionally previous acute MI, stroke, and obesity was related with lower chances of survival in men, whereas stroke and diabetes in women. Overweight was associated with better prognosis for both men and women.

The object of this master thesis is a process of forming new ecological policy and waste management system of collecting, recycling and utilization of municipal waste in Ukraine. The main purpose of the theses is to determine features and problems of the functioning of the waste management system in Ukraine in light of the country's obligations resulted from signing of the Association Agreement between European Union (EU) and Ukraine in 2014. The main objectives of the theses are to research world's best practices in waste management, to analyze recycling processes of the system and waste recycling hierarchy options, to research laws and regulations of the EU and Ukraine in waste management to focus on main principles; to make an analyses of the empirical data received from expert interviews to summarize specifics and problems of the whole waste management system. The following methods were used such as analyses of the scientific literature and statistical data as well as laws and regulations and qualitative methods of analyses of expert interviews with state employee of the ecological body and employees of non-government organizations. The following conclusion was made that current ecological policy of Ukraine in regards with waste management system needs a correction in areas of implementation of European ecological standards. Ukraine is in a state of deep structural reforms under a heavy burden of different ecological problems. Current status of the waste management system and its functioning mechanisms do not allow handling constantly increasing volume of waste to make it economically beneficial and to be effective in ecological sense. Utility tariffs for waste management do not cover a fraction of the cost to collect, transport and recycle waste. Collection of waste products is not well coordinated, the lack of a clear division of areas of responsibility between collectors, carriers and those responsible for recycling leads to their demotivation in the qualitative results of each stage of waste treatment, which as a result leads to a small percentage of secondary material resources extracted from waste. In the regions, the problem of collection leads to unauthorized landfills. There is a communications problem between central government, local authorities and general public, when legislation norms and requirements are adopted and then an understanding comes in that neither conditions nor infrastructure readiness can handle these legislation initiatives. General public is not well informed on basics of the ecological policy which is only done by non-government organizations, which is definitely not enough. Low utility rates for waste disposal do not meet the basic principle of the environmental policy on minimizing landfills disposal volumes. The lack of a unified system of accounting for transported and disposed wastes and criteria may be a reason for obtaining the distorted data necessary for further quality planning. The prevention and minimization of waste generation is not considered at the legislative level as apriority principle of environmental policy in the field of waste management. Lack of funding and worn out infrastructure does not allow implementing new recycling technologies in full. Copy and paste approach of the EU ecological legislation does not help to resolve problems in Ukraine. Cohesion policy and integration practices of the EU and Ukraine require thorough planning and precise implementation with performance indicators. Ecological integration must be executed in a framework of current legislation considering current local conditions and practices, the infrastructure status, recommendations of non-government organizations and donors as well as EU experience in implementing such a policy. During five years since Ukraine signed Association Agreement with the EU and its member-states a significant progress was made in coherence policy of the waste management system; however dynamics of positive changes are quit low. The Government in cooperation with NGOs, donors and general public is in a good position to develop ecological norms and requirements and successfully implement it to create mechanisms of stimulus and rationale for all actors of the waste management system in line with EU policy guidelines. The author believes that the results of the study could give useful guidelines to students, researchers, people involved in governance, legislation, management and public policy and whose, whom personal and professional interests lie in the area of ecology, environmental protection and waste management.

The object of this master thesis is a process of forming new ecological policy and waste management system of collecting, recycling and utilization of municipal waste in Ukraine. The main purpose of the theses is to determine features and problems of the functioning of the waste management system in Ukraine in light of the country's obligations resulted from signing of the Association Agreement between European Union (EU) and Ukraine in 2014. The main objectives of the theses are to research world's best practices in waste management, to analyze recycling processes of the system and waste recycling hierarchy options, to research laws and regulations of the EU and Ukraine in waste management to focus on main principles; to make an analyses of the empirical data received from expert interviews to summarize specifics and problems of the whole waste management system. The following methods were used such as analyses of the scientific literature and statistical data as well as laws and regulations and qualitative methods of analyses of expert interviews with state employee of the ecological body and employees of non-government organizations. The following conclusion was made that current ecological policy of Ukraine in regards with waste management system needs a correction in areas of implementation of European ecological standards. Ukraine is in a state of deep structural reforms under a heavy burden of different ecological problems. Current status of the waste management system and its functioning mechanisms do not allow handling constantly increasing volume of waste to make it economically beneficial and to be effective in ecological sense. Utility tariffs for waste management do not cover a fraction of the cost to collect, transport and recycle waste. Collection of waste products is not well coordinated, the lack of a clear division of areas of responsibility between collectors, carriers and those responsible for recycling leads to their demotivation in the qualitative results of each stage of waste treatment, which as a result leads to a small percentage of secondary material resources extracted from waste. In the regions, the problem of collection leads to unauthorized landfills. There is a communications problem between central government, local authorities and general public, when legislation norms and requirements are adopted and then an understanding comes in that neither conditions nor infrastructure readiness can handle these legislation initiatives. General public is not well informed on basics of the ecological policy which is only done by non-government organizations, which is definitely not enough. Low utility rates for waste disposal do not meet the basic principle of the environmental policy on minimizing landfills disposal volumes. The lack of a unified system of accounting for transported and disposed wastes and criteria may be a reason for obtaining the distorted data necessary for further quality planning. The prevention and minimization of waste generation is not considered at the legislative level as apriority principle of environmental policy in the field of waste management. Lack of funding and worn out infrastructure does not allow implementing new recycling technologies in full. Copy and paste approach of the EU ecological legislation does not help to resolve problems in Ukraine. Cohesion policy and integration practices of the EU and Ukraine require thorough planning and precise implementation with performance indicators. Ecological integration must be executed in a framework of current legislation considering current local conditions and practices, the infrastructure status, recommendations of non-government organizations and donors as well as EU experience in implementing such a policy. During five years since Ukraine signed Association Agreement with the EU and its member-states a significant progress was made in coherence policy of the waste management system; however dynamics of positive changes are quit low. The Government in cooperation with NGOs, donors and general public is in a good position to develop ecological norms and requirements and successfully implement it to create mechanisms of stimulus and rationale for all actors of the waste management system in line with EU policy guidelines. The author believes that the results of the study could give useful guidelines to students, researchers, people involved in governance, legislation, management and public policy and whose, whom personal and professional interests lie in the area of ecology, environmental protection and waste management.