Society Health Welfare

THE 8TH INTERNATIONAL MULTIDISCIPLINARY RESEARCH CONFERENCE

SOCIETY HEALTH WELFARE

ABSTRACTS

24-26 March, 2021 Riga, Latvia

SOCIETY HEALTH WELFARE 2021 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Table of Contents

COVID-19

A double-edged sword – telemedicine for maternal care during COVID-19: ﬁndings from a global mixed methods study of healthcare providers 2 Ms. Anna Galle, Ms. Aline Semaan, Ms. Elise Huysmans, Ms. Constance Audet, Dr. Anteneh Asefa, Dr. Thérèse Delvaux, Prof. Bosede B. Afolabi, Dr. Alison El Ayadi, Prof. Lenka Benova

Access to healthcare during COVID-19 among ageing population in Latvia 3 Dr. Ieva Reine, Dr. Andrejs Ivanovs, Dr. Signe Tomsone

Challenges in implementation of a project on the impact of COVID-19 on sexual and reproductive health in Latvia 4 Prof. Gunta Lazdāne, Prof. Dace Rezeberga, Dr. Ieva Briedite, Dr. Elizabete Pumpure, Ms. Ieva Pitkēviča, Ms. Marta Laura Graviņa, Prof. Anda Ķīvīte-Urtāne, Ms. Darja Mihailova

Comparison of intrinsic capacity factors in older individuals before and during COVID-19 in the context of healthy ageing in Baltic States 5 Ms. Madara Mikelsone, Ms. Diana Baltmane, Dr. Andrejs Ivanovs, Dr. Signe Tomsone

Effects of COVID-19 restrictions on emotional, physical and sexual violence in Latvia 6 Ms. Ieva Pitkēviča, Dr. Ieva Briedite, Ms. Marta Laura Graviņa, Ms. Ināra Kantāne, Prof. Anda Ķīvīte-Urtāne, Prof. Gunta Lazdāne

Ethical and organizational challenges of COVID-19 – view from the medical frontlines in Estonia 7 Dr. Kadi Lubi, Dr. Kadri Simm, Ms. Kaja Lempu, Ms. Angela Eensalu-Lind

Ethics and use of restraints in time of COVID-19 8 Prof. Vladimir Littva, Prof. Soňa Hlinková, Mrs. Anna Králová

Excess mortality in Latvia in association with COVID-19 in 2020 9 Prof. Inese Gobiņa, Mr. Andris Avotiņš, Mrs. Una Kojalo, Dr. Ieva Strēle, Mrs. Santa Pildava, Prof. Ģirts Briģis, Prof. Anita Villeruša

Family physicians’ perspective on risks and beneﬁts of remote patient consultations during the state of emergency due to COVID-19 epidemic in Latvia: qualitative study in primary care 10 Mrs. Mirdza Kursīte, Dr. Inese Stars, Prof. Anita Villeruša, Dr. Lauma Spriņģe

From pandemic to “infodemic”: the spread of COVID-19 information in Latvia 11 Ms. Lāsma Šķestere, Mr. Roberts Darģis

Impact of COVID-19 epidemic on court proceedings in civil cases – legal and psychological aspects 12 Ms. Jolanta Dinsberga

Impact of the ﬁrst wave of COVID-19 on the employment of older people in Latvia, the Baltic States and Europe 13 Dr. Olga Rajevska, Ms. Agnese Reine, Ms. Diana Baltmane

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Incidence of obsessive-compulsive disorder elements during COVID-19 pandemic and its association with alcohol consumption in the general population of Latvia 14 Dr. Anna Kodinceva, Prof. Gunta Lazdāne, Mrs. Eva Petrošina

Indicators of a preventive behaviour of the Latvian population and related factors, during the COVID-19 crisis 15 Mrs. Sanita Surina, Prof. Kristine Martinsone, Ms. Viktorija Perepjolkina, Dr. Jelena Kolesnikova, Prof. Aleksejs Ruža

Inﬂuence of COVID-19 on eating habits of pregnant women in Latvia 16 Prof. Gunta Lazdāne, Prof. Dace Rezeberga, Prof. Laila Meija, Ms. Ināra Kantāne, Dr. Elizabete Pumpure, Ms. Ieva Pitkēviča

Issues and challenges in the Latvian dental care system during COVID-19 pandemic: qualitative study 17 Dr. Ilze Maldupa, Dr. Olga Sļepcova, Dr. Natālija Šilova, Ms. Elizabete Ribalkina, Dr. Inese Stars, Dr. Egita Senakola, Prof. Anda Brinkmane, Prof. Sergio Uribe

Legal restrictions imposed on access to sexual and reproductive health services during the ﬁrst COVID-19 emergency state in Latvia 18 Prof. Solvita Olsena, Prof. Gunta Lazdāne, Prof. Dace Rezeberga, Dr. Ieva Briedite, Prof. Anda Ķīvīte-Urtāne

Limitation of COVID-19: international experience and management strategies 19 Dr. Andrejs Vilks, Dr. Aldona Kipāne

Peculiarities of patient organizations’ communication during the state of emergency in Latvia due to COVID-19 pandemic 20 Dr. Lauma Spriņģe, Mrs. Mirdza Kursīte, Dr. Inese Stars, Prof. Anita Villeruša, Prof. Anda Ķīvīte-Urtāne

Provision of scheduled outpatient consultations for patients with non-communicable diseases during the COVID-19 emergency in spring 2020 in Latvia 21 Dr. Daiga Behmane, Dr. Ieva Strēle, Mrs. Mirdza Kursīte, Prof. Inese Gobiņa, Mrs. Alina Dūdele, Mr. Andris Avotiņš, Prof. Anita Villeruša

Remote work as one of the challenges of the COVID-19 pandemic 22 Mrs. Linda Nātriņa

The differences in mental health reactions to COVID-19 pandemic between men and women in the general population of Latvia 23 Dr. Kamila Kuzmina, Prof. Gunta Lazdāne, Mrs. Eva Petrošina

The emotional impact of paediatric COVID-19 on parents of the affected children: qualitative study 24 Dr. Inese Stars, Dr. Liene Smane, Dr. Zanda Pučuka, Dr. Ieva Roģe, Prof. Jana Pavāre

Women’s sexual health in times of COVID-19 25 Dr. Ieva Briedite, Prof. Anda Ķīvīte-Urtāne, Prof. Gunta Lazdāne, Prof. Dace Rezeberga, Prof. Solvita Olsena, Ms. Ināra Kantāne, Dr. Elizabete Pumpure, Ms. Ieva Pitkēviča, Ms. Marta Laura Graviņa, Ms. Darja Mihailova

World Health Organization as the main international actor in ﬁght against COVID-19 26 Dr. Jānis Grasis, Dr. Karīna Palkova

Health Promotion

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Analysis of dietary habits in Latvian general population in respect to adherence to Mediterranean diet 28 Mrs. Liene Sondore, Mrs. ILze Indriksone-Gromova, Mrs. Ilva Daugule, Mrs. Inese Poļaka, Mr. Sergejs Paršutins, Mrs. Ilona Kojalo, Mr. Mārcis Leja, Mrs. Ineta Jurkevica, Mrs. Daiga Šantare

Analysis of referrals to genetic investigations in children 0–3 months old in Children’s Clinical University Hospital (Riga, Latvia) in year 2019 29 Dr. Jelena Liepa, Dr. Madara Kreile, Dr. Gita Tauriņa, Dr. Ieva Mičule, Dr. Ieva Grinfelde, Dr. Daiga Mūrmane

Association between road safety behaviour and careless health behaviour in Latvian adult population 30 Mrs. Aija Bukova-Zideluna, Prof. Anita Villeruša, Mrs. Iveta Pudule

Beliefs about necessity and admissibility of physical activity during lower back pain episode 31 Dr. Jelizaveta Aleksejeva, Dr. Matīss Mežals, Prof. Inara Logina

Disability and pain catastrophizing in patients with low back pain during COVID-19 pandemy 32 Dr. Zaiga Kalnberza Ribule, Dr. Anna Millere, Prof. Liana Deklava, Prof. Inara Logina, Dr. Anda Nulle, Prof. Inga Millere

Impact of different physical activity on children socialization 33 Prof. Rūta Dadeliene, Mrs. Ineta Daniuliene

Intervention model for health behaviour change: a tool to support practitioners in health promotion intervention development 34 Prof. Inese Gobiņa, Mr. Aigars Miezitis, Mrs. Margarita Apine

Needs and priorities to improve health and well-being of the ageing population in Latvia: ﬁndings from the AgeFLAG project 35 Dr. Signe Tomsone, Ms. Madara Mikelsone, Dr. Andrejs Ivanovs

Physical activity in young people with cystic ﬁbrosis living in Latvia 36 Mrs. Arta Ūdre, Mrs. Dace Bertule, Dr. Elina Aleksejeva

Physical activity, subjective health complaints’ and problematic internet use related psychosocial behavior problems in adolescents 37 Dr. Aija Kļaviņa, Dr. Viktors Veliks, Prof. Juris Porozovs, Mrs. Luize Bebrisa-Fedotova, Mr. Aleksandrs Anis- cenko, Mr. Nageswara Krishnavarapu

Poor self-reported health in association with sleep duration and health complaints among adolescents in Latvia 38 Mrs. Solvita Klavina-Makrecka, Prof. Inese Gobiņa, Mrs. Iveta Pudule, Mrs. Daiga Grīnberga, Mrs. Biruta Velika, Prof. Anita Villeruša

Promotion of health and quality of life 39 Ms. Kalina Racheva

Risk identiﬁcation for cross-sectoral cooperation in health promotion practice 40 Mrs. Elīna Vrobļevska, Prof. Anita Villeruša, Prof. Inese Gobiņa, Dr. Lauma Spriņģe, Ms. Indra Liniņa

The self-assessment tool for cross-sectoral health promotion 41 Dr. Kaija Matinheikki-Kokko, Dr. Arja Liinamo

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Towards integration of dynamic and complex systems in health promotion: addressing the necessity to cooperate 42 Dr. Agnė Slapšinskaitė, Dr. Justina Vaitkevičiūtė, Dr. Monika Grincaitė, Dr. Asta Raskilienė, Mr. Lukas Galkus

Disease Prevention And Screening

Association between preceding mammography results and the breast cancer-screening adherence among the ﬁrst cohort of women enrolled in the organized screening program in Latvia 44 Dr. Dzeina Mezale, Mrs. Una Kojalo, Prof. Inese Gobiņa

Association of self-rated health, life satisfaction and mental health diﬃculties in Latvian adolescents 45 Dr. Nikita Bezborodovs, Dr. Inga Zarde, Mrs. Iveta Pudule, Prof. Anita Villeruša

Awareness and prevalence of HPV vaccinations in Lithuania 46 Ms. Migle Jakineviciute, Mrs. Olga Mesceriakova-Veliuliene, Ms. Ramunė Blankaitė, Mrs. Jurgita Vladickiene, Mr. Domas Sikorskis

Body mass index and waist-to-height ratio as a predictors of metabolic syndrome 47 Dr. Sabīne Rumpe, Dr. Jeļena Daniļenko

Colorectal adenomas in patients under age of 50 48 Dr. Ilona Vilkoite, Dr. Ivars Tolmanis, Dr. Hosams Abu Meri, Dr. Laura Veide, Dr. Vita Skuja, Dr. Linda Mežmale, Dr. Zane Dzērve, Dr. Oskars Bulmanis, Dr. Justīne Māliņa, Prof. Aivars Lejnieks

Colorectal cancer screening attendance inﬂuencing factors and coverage improvement options in general practice 49 Mrs. Līga Virziņa, Mrs. Sigita Petrovska, Dr. Jeļena Daniļenko

Comparison of sensitivity of the traditional score chart and sensitivity of the score chart using low- density cholesterol level as one of the fatal cardiovascular disease risk factors 50 Mrs. Anna Voitkeviča

Differences between women and men knowledge about prophylactic measures at general practice 51 Mrs. Eva Grīnfelde, Mrs. Evita Pundure, Dr. Ilze Skuja

Disease prevention in general practice from patient’s perspective depending on presence of chronic disease 52 Mrs. Evita Pundure, Mrs. Eva Grīnfelde, Dr. Ilze Skuja

Effectiveness of breast cancer screening in women: case of Latvia 53 Dr. Anrijs Djatkovičs

Evaluation of cystic ﬁbrosis newborn screening program in Latvia 54 Dr. Elina Aleksejeva, Dr. Dita Gaidule-Logina, Dr. Madara Kreile, Ms. Jekaterina Isakova, Dr. Dagne Gravele, Dr. Ineta Grantiņa, Dr. Linda Gailīte

Factors determining the decision to participate during breast cancer screening 55 Dr. Kadi Lubi, Ms. Vita Savicka, Prof. Anda Ķīvīte-Urtāne, Ms. Kaire Sildver, Ms. Diana Sokolova, Ms. Silja Mets-Oja

In silico determination of vitamin B12 reference intervals from general patient data accumulated in E. Gulbis Laboratory in Latvia 56 Dr. Didzis Gavars

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Latvian population-based birthweight charts 57 Prof. Natalija Vedmedovska, Dr. Anna Miskova, Prof. Anda Ķīvīte-Urtāne, Dr. Katsiaryna Rimaido, Dr. Baiba Andersone

Parents’ awareness and attitude towards the use of non-invasive dental treatment methods on children 58 Ms. Santa Agate Valaine

Prevalence of anxiety and depression symptoms in adolescents with type 1 diabetes and their parents 59 Mrs. Evija Siliņa

Trends in chromosomal anomalies for live births and prenatal diagnoses in Latvia 60 Mrs. Irisa Zile-Velika, Mrs. Inese Ledina, Dr. Ieva Grinfelde, Ms. Zane Baltane, Dr. Ieva Malniece

Social Determinants Of Health

Changes in mortality inequalities from major causes of death in Lithuania by education 62 Ms. Olga Mesceriakova-Veliuliene, Ms. Ramune Kalediene, Ms. Skirmante Sauliune, Mr. Gvidas Urbonas, Mrs. Renee White, Mr. Zachariah Madaki, Mr. Kelechi Roy Ogbuagu, Mrs. Gerda Kvitko, Mr. Dovydas Švegžda, Mrs. Ujunwa Ekweogu, Mrs. Yasmine Agyemang

Disparities of social trust, subjective wellbeing and health status among 18–50 age-cohort in Lithuania 63 Dr. Rasa Indriliunaite

Individual factors that cause professional burnout syndrome in social workers, employed in community rehabilitation centre for addictive diseases 64 Prof. Vida Gudzinskiene, Ms. Jautre Ramute Sinkuniene, Mr. Andrejus Pozdniakovas

Inequalities in prevalence, incidence and mortality from mental disorders by place of residence and their changes in Lithuania 65 Ms. Deimantė Andriuškevičiūtė, Mr. Saulius Knystautas, Ms. Olga Mesceriakova-Veliuliene

Mortality from melanoma by socio-demographic status and its inequalities between 2001 and 2014: Lithuanian study 66 Ms. Olga Mesceriakova-Veliuliene, Ms. Ramune Kalediene, Ms. Skirmante Sauliune, Mrs. Jurgita Vladickiene, Mrs. Viktorija Vitkute, Mrs. Migle Jakineviciute, Mr. Domas Sikorskis

Mortality from suicides by the level of education and its inequalities: situation in Lithuania during 2001– 2014 67 Ms. Skirmante Sauliune, Ms. Olga Mesceriakova-Veliuliene, Ms. Ramune Kalediene, Mr. Gvidas Urbonas, Mr. Domas Sikorskis

The effect of the concept of individual agency on the estimation of health among different age-cohorts 68 Prof. Vylius Leonavicius

The relationship between fire fighters’ phychosocial risks and physical fitness: evidence based study from Estonia 69 Mrs. Karin Reinhold, Mrs. Marina Järvis, Mrs. Sigrid Kontus, Mrs. Jelena Hartsenko

Use of digital health-care services during the ﬁrst wave of COVID-19 pandemics among ageing population in Latvia 70 Dr. Ieva Reine, Ms. Madara Mikelsone, Dr. Andrejs Ivanovs

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Research Of Risk Factors And Epidemiology Of Diseases

Alcohol use during pregnancy as a risk factor for miscarriage. A pilot study 72 Mr. Vladimirs Naumovs, Prof. Valērija Groma

Drowning associated risk groups in a ﬁve-year time period in Riga and Riga planning region: location and season 73 Ms. Evelīna Stepiņa, Ms. Marta Riekstiņa

Factors associated with primary source of sterile syringes among injecting drug users 74 Ms. Laura Isajeva, Prof. Anda Ķīvīte-Urtāne, Prof. Ģirts Briģis

Risk for developing breast cancer in women: above-normal BMI 75 Dr. Anrijs Djatkovičs

Seasonal variations of 25(OH)D vitamin in Latvia are age and gender-related – implications for testing schedule 76 Dr. Sergey Nikulshin, Dr. Jana Osite, Dr. Stella Lapina, Dr. Anda Krisane, Prof. Iveta Dzivite-Krisane

The associations of short birth intervals with pregnancy outcomes: population-based cohort study 77 Mrs. Irisa Zile-Velika, Mrs. Anija Uibo, Dr. Ieva Strele, Dr. Iveta Gavare

Governance And Financing Of Health Systems

Continuing way of health ﬁnancing policy reform: the case of Latvia 79 Dr. Kārlis Ketners

Health workforce planning in Latvia: comparison of balance between existing supply and demand 80 Ms. Ieva Grike, Prof. Ilze Grope

Using the Workload Indicator of Staﬃng Need (WISN) – method to model the HR requirements and costs of health care services in Kyrgyzstan 81 Prof. Olav Goetz, Mr. Jean-Olivier Schmidt, Mrs. Sandra Blackaby, Mrs. Damira Seksenbaeva, Mrs. Valerie Broch

Person-Centered Health Services And Systems

Chronic disease management in medical institutions in Latvia requires signiﬁcant improvements 83 Mr. Alekss Ūpis, Dr. Daiga Behmane, Mrs. Alina Dūdele

Chronic disease management in primary care in Latvia requires signiﬁcant improvements 84 Dr. Daiga Behmane, Mrs. Alina Dūdele, Prof. Aivars Lejnieks

Concerns and needs of mothers raising children with epilepsy and developmental disabilities in Lithua- nia 85 Dr. Lina Danuseviciene, Dr. Ramunė Jurkuvienė, Dr. Polina Šedienė, Dr. Rūta Butkevičienė

Financing challenges for person-centred healthcare systems 86 Ms. Diana Araja

Headache care and service in Latvia. Challenges, priorities and further perspectives 87 Mrs. Linda Zvaune

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Implementation of medication use review in community pharmacies in Latvia 88 Mrs. Jūlija Pavlovska, Dr. Ieva Salmane-Kuļikovska, Ms. Ieva Rutkovska, Mrs. Dace Ķikute, Ms. Kristine Karklina, Dr. Elita Poplavska

Linking rehabilitation problems and interventions of patients with neuro-oncological disease to the WHO classiﬁcations 89 Mrs. Anete Petersone, Mrs. Agnese Kārkliņa, Dr. Guna Bērziņa

Measuring patient satisfaction: dimensions and approaches 90 Mrs. Olga Veilande

Satisfaction of the full time employed Latvian adult population with general practitioners 91 Mrs. Lāsma Wisper

The perceptions of women with impaired physical mobility about occupational therapy during pregnancy and the postpartum period 92 Ms. Anneliis Aavik, Mrs. Marika Merits, Dr. Kadi Lubi

Measuring And Improving Quality

Comparison of disease prevalence, utilization of health care services and mortality rates in Latvian regions for persons with selected chronical diseases 94 Mrs. Alina Dūdele, Dr. Daiga Behmane, Ms. Jana Lepiksone, Ms. Jolanta Skrule, Mrs. Santa Pildava

Conﬂicts and disputes in the disability determination process: deﬁciencies of expertise or legislation 95 Dr. Galija Kaļinkina, Dr. Irēna Ausma Rudņeva

Factors associated with 30 days mortality and one year mortality after hospitalization with acute myocardial infarction in Latvia 96 Mrs. Alina Dūdele, Prof. Ģirts Briģis, Ms. Lāsma Asare, Ms. Jolanta Skrule, Ms. Jana Lepiksone

Improving quality of ischemic stroke patients requires substantial changes in hospitalization plan and treatment intensiﬁcation in Latvia 97 Mrs. Alina Dūdele, Dr. Daiga Behmane, Mr. Toms Baumanis

Perception of patient safety climate in Latvian nurses: the effect of training 98 Dr. Evija Andzane, Prof. Juris Barzdins, Dr. Lilian Tzivian

Process-management in healthcare – how process-modelling and simulation can help to increase eﬃ- ciency and quality of health care services 99 Prof. Olav Goetz

Regulating nursing practice through the application of standards 100 Prof. Silviya Borisova

The impact of COVID-19 pandemic on the quality of community pharmacy services in Estonia 101 Ms. Hedvig Rass, Mrs. Kadi Lubi, Mrs. Kristiina Sepp, Mrs. Daisy Volmer

The quality in mental health services – data on care for patients with schizophrenia from the community- based mental health clinic “Veldre”, Riga Centre of Psychiatry and Addiction Medicine 102 Mrs. Dina Ozerska, Prof. Māris Taube

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Young sportsmen demonstrate pronounced daily variations of hematological values – are traditional reference ranges compromised? 103 Dr. Sergey Nikulshin, Dr. Iveta Gorel, Dr. Ivita Sela, Dr. Dagne Gravele, Prof. Dace Gardovska, Mrs. Tamara Lopatina, Mr. Vladimirs Nikolajenkovs

Information And Communication Technology For Health

Adoption speed of the COVID-19 smartphone tracing apps and COVID-19 incidence rates – is there a correlation? 105 Ms. Silja Elunurm, Ms. Kristiina Kuldkepp, Ms. Maarja Lember, Dr. Piret Sell, Dr. Elen Vettus

Digitalization of health care system in Pakistan 106 Dr. Eumna Tehseen, Dr. Marina Järvis, Prof. Piia Tint

Ownership of data used in the teaching process of artiﬁcial intelligence 107 Mr. Artūrs Žukovs

Occupational Medicine

Analysis of occupational morbidity in Latvia in comparison with European countries 109 Prof. Maija Eglīte, Dr. Jolanta Cīrule, Dr. Ieva Kalve, Prof. Ivars Vanadzins, Dr. Tija Zvagule

Immunohistochemical expression and localization of MMP-9, MMP-13, e-cadherin and Ki-67 in road pavers’ skin chronically exposed to bitumen products 110 Prof. Venerando Rapisarda

Impact of workplace conﬂicts on sickness presenteeism in Latvia 111 Mrs. Svetlana Lakiša, Dr. Linda Matisane, Prof. Inese Gobiņa, Prof. Ivars Vanadzins

Individual consequences in healthcare workers subjected to straining in relationship with personality proﬁles 112 Dr. Francesca Vella, Prof. Tiziana Ramaci, Prof. Venerando Rapisarda

Investigation on work ability in healthcare workers after breast cancer: preliminary data of a pilot study 113 Prof. Emanuele Cannizzaro

Lack of workplace risk assessment as a predictor of adverse health effects for teleworkers – results from the survey on life with COVID-19 in Latvia 114 Dr. Linda Matisane, Mrs. Linda Paegle, Prof. Ivars Vanadzins, Ms. Asnate Linde

Muscle fatigue for construction workers and plasterers in construction enterprise 115 Prof. Zenija Roja, Prof. Henrijs Kalkis, Dr. Inara Roja

Reasons for low protection of COVID-19 risk group workers – results from the study on working life with COVID-19 in Latvia 116 Dr. Linda Matisane, Mrs. Linda Paegle, Prof. Ivars Vanadzins, Ms. Asnate Linde

Relationships between professional burnout and job demands, resources among industrial workers in Lithuania 117 Dr. Aurelija Stelmokiene, Dr. Loreta Gustainienė, Dr. Kristina Kovalčikienė, Dr. Giedrė Genevičiūtė-Janonė

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Risk assessment of chemical laboratory staff regarding safely fuel sampling 118 Prof. Piia Tint, Prof. Ada Traumann

Situation analysis of occupational health and safety training in the national higher education system in Estonia 119 Prof. Eda Merisalu

Strategic OH&S workforce planning and development in Estonia 120 Prof. Eda Merisalu

The investigation of individual whole-body protective clothing effects on thermal and subjective well- being of physically working medical staff 121 Dr. Jeļena Reste, Mrs. Darja Kaluznaja, Prof. Ivars Vanadzins

The role of macrophage migration inhibitory factor and heme oxygenase-1 in defence of lung subjected to asbestiform ﬁber 122 Dr. Claudia Lombardo, Prof. Sergio Castorina, Prof. Carla Loreto, Prof. Rosario Caltabiano, Prof. Venerando Rapisarda, Prof. Caterina Ledda

Water-soluble sapropel extract gel for external use 123 Dr. Ilona Pavlovska, Ms. Aneka Klavina, Mr. Agris Auce, Prof. Ivars Vanadzins, Ms. Laura Komarovska, Mrs. Linda Paegle

Work-related eye injuries: prevalence, work capacity and risk factors in Latvia 2009–2019 124 Dr. Jeļena Aleksejeva, Dr. Sandra Ausekle

Environmental Health

Association of mortality related with heat waves in Riga from 2009 till 2015 126 Dr. Kerstin Pfeifer, Dr. Daniel Oudin Astrom, Dr. Žanna Martinsone, Mrs. Darja Kaluznaja, Dr. Anna Oudin

Comparison of black and white and colour laser printers’ emitted ﬁne particles’ number and mass concentration 127 Mrs. Linda Paegle, Dr. Žanna Martinsone, Prof. Ivars Vanadzins

Endocrine disrupting chemicals related to metabolic disorders and its inﬂuence 128 Mrs. Irina Pires, Dr. Jeļena Reste

From the shooting gallery to the oﬃce – lead as an occupational risk factor 129 Dr. Inese Mārtiņsone, Ms. Laura Komarovska, Ms. Anita Seile, Ms. Liga Abolkalna, Dr. Linda Matisane

Possible exposure ways of pesticide mixtures in Latvian adults 130 Ms. Lāsma Akūlova, Ms. Laura Komarovska, Ms. Kristiāna Venžega, Dr. Žanna Martinsone, Ms. Anita Seile, Dr. Inese Mārtiņsone, Prof. Ivars Vanadzins

The investigation of air cold temperature short-term effects on all-cause and cause-speciﬁc mortality in Tallinn and Riga 131 Mr. Daniel Oudin Astrom, Mrs. Triin Veber, Dr. Žanna Martinsone, Mrs. Darja Kaluznaja, Dr. Ene Indermitte, Mrs. Anna Oudin, Prof. Hans Orru

Variability in time of volatile organic compounds in work environments 132 Ms. Zane Čerpakovska, Ms. Kristine Sproge, Ms. Aneka Klavina, Dr. Inese Mārtiņsone

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Health And Clinical Psychology

Academic self-eﬃciency and cognitive load for students in distance learning 134 Mrs. Inguna Griskevica

Development and preliminary validation of the Psychological Resilience Scale 135 Ms. Viktorija Perepjolkina, Prof. Kristine Martinsone

Development and psychometric properties of the Self-care Strategies Questionnaire 136 Ms. Viktorija Perepjolkina, Dr. Jelena Kolesnikova, Prof. Aleksejs Ruža, Ms. Aiva Bundzena-Ervika, Prof. Kris- tine Martinsone

Mystical experience has stronger relationships with spiritual intelligence than schizotypal personality traits and psychotic symptoms 137 Ms. Daiga Katrīna Bitēna

Psychological intervention as an aspect of the professional identity of psychologists: Latvian sample 138 Mrs. Elīna Akmane, Prof. Kristīne Mārtinsone, Mrs. Zane Krieke, Mrs. Agnese Kolmane, Prof. Miguel Bernardo Ricou da Costa Macedo, Mrs. Sílvia Marina Amado Cordeiro

Relationship between work-related cognitive reserve and overall cognitive functioning in older women: longitudinal study 139 Ms. Kristīne Šneidere, Dr. Ainars Stepens

Resilience development strategies of the chronically ill: theoretical insight 140 Mrs. Elīna Zelčāne, Prof. Anita Pipere

Sociodemographic factors associated with social distance from children and adolescents with mental illness in the sample of psychology students 141 Ms. Marija Aušraitė, Prof. Kristina Žardeckaitė-Matulaitienė

The relationship between co-dependency, coping strategies and perceived social support of women in relationship with an individual addicted to psychoactive substances 142 Dr. Velga Sudraba, Mrs. Aiva Lāce

The role of social problem solving and emotion regulation skills in predicting psychological resilience 143 Ms. Viktorija Perepjolkina, Dr. Jelena Kolesnikova, Ms. Inese Paiča, Prof. Kristine Martinsone

“Death is the only thing that scares”: the construction of meanings about inﬂuenza vaccination among non-vaccinated people in Estonia (and what role COVID-19 plays) 144 Dr. Kadi Lubi, Ms. Eliisa Metsoja, Ms. Kaie Eha, Ms. Silja Mets-Oja, Ms. Lilian Ruuben

Sustaining Psychological Resilience During Covid-19

Comparison of psychological resilience of different groups of society during COVID-19 pandemic in Latvia146 Ms. Aiva Bundzena-Ervika, Ms. Viktorija Perepjolkina, Prof. Kristine Martinsone

Global pessimism and/or disturbed future: what has philosophy to offer us? 147 Dr. Marija Semjonova-Reinholde

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Perceived changes in the frequency of emotional abuse before and during the ﬁrst wave of COVID-19 pandemic 148 Ms. Kristīne Šneidere, Prof. Sandra Mihailova, Ms. Viktorija Perepjolkina, Dr. Jelena Kolesnikova, Prof. Kristine Martinsone

Possibilities of receptive music therapy for mothers raising children with developmental disorders as a self-help tool for overcoming stress during the COVID-19 pandemic 149 Ms. Jautre Ramute Sinkuniene, Mrs. Jurgita Zalgiryte-Skurdeniene

Psychological resilience in time of COVID-19 crisis: emotion regulation as a protective factor 150 Ms. Inese Paiča, Prof. Kristine Martinsone, Ms. Viktorija Perepjolkina

Socio-psychological proﬁle of Latvian inhabitants who did not comply with the COVID-19 epidemiological requirements 151 Mr. Gatis Upesleja, Dr. Viktorija Perepjolkina

Technology-Supported Social Work

Level of statistical literacy of social work students and the possibility of using available technologies to increase it 153 Dr. Angela Almasiova, Dr. Katarina Kohutova

The role of digital competencies in the professionalism of future social worker 154 Prof. Irene Zemaitaityte, Dr. Raminta Bardauskienė, Dr. Daniele Markovic

Social Services Management: Values And Ethics

Care, dignity and bio power at the end of terminally ill patients life 156 Prof. Jolanta Kuznecoviene

Context of practical experience and education of crisis intervention in social services facilities in Slo- vakia 157 Dr. Sona Srobarova

Demographic challenges and demand for long-term care in Riga municipality 158 Mr. Mārtiņš Moors, Mr. Juris Osis

Evaluation of cooperation between social and health care services for persons with chronic diseases in Latvia 159 Mrs. Alina Dūdele, Dr. Daiga Behmane, Mrs. Lilita Cirule

Nonformal adult education coordinators as developers of educational activities and community interaction 160 Prof. Irene Zemaitaityte, Dr. Alina Petrauskiene

Organizational culture in social services – focus on the workers’ well-being 161 Mrs. Lenka Chlebanova, Prof. Marketa Rusnakova

Responsibility experience for your own life through volunteering 162 Dr. Neringa Kurapkaitiene, Prof. Vida Gudzinskiene

xii RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The level of the legal culture of road users as an indicator of a traﬃc safety 163 Ms. Alina Kalinina, Dr. Vladyslava Batyrgareieva, Ms. Sabriie Shramko

Family And Child Welfare

Animal therapy for children with functional disorders in the process of deinstitutionalisation 165 Mrs. Marika Lotko

Being a father of twins – forming an equal bond with both twins and supporting their individuality 166 Dr. Kristiina Heinonen

Case manager as a leader in providing social support for families and children 167 Dr. Jolanta Pivoriene

Excessive alcohol consumption referring women and their natural recovery process 168 Prof. Marketa Rusnakova

Individual budget model for community based social services for children with disabilities in Latvia: analysis of results of pilot project 169 Mrs. Alina Dūdele, Mrs. Lolita Cibule, Mrs. Gundega Klauza, Dr. Daiga Behmane

Intergenerational solidarity in family: manifestations and inﬂuencing factors 170 Ms. Nadežda Kuļigina, Prof. Signe Dobelniece

Life course scenarios, family events’ sequences and the locus of control in Lithuania 171 Dr. Apolonijus Žilys

Making new lives after exiting care: social orphans in Latvia 172 Mrs. Zoë Kessler, Dr. Ilze Trapenciere

On some implications of COVID-19 on the living conditions of children in families and out-of-family care 173 Ms. Ilze Trapenciere, Ms. Zoë Kessler, Prof. Lolita Vilka

Pandemic causing infection and its impact on family health-related quality of life: quantitative study 174 Dr. Zanda Pucuka, Dr. Ieva Roģe, Dr. Liene Smane, Dr. Iveta Račko, Dr. Lizete Kļaviņa, Ms. Anna Beate Apsite, Dr. Inese Stars, Prof. Anda Ķīvīte-Urtāne, Prof. Jana Pavāre

Policy and legal framework on protecting children’s rights in Latvia and Sri Lanka 175 Ms. Ilze Trapenciere, Ms. Shelomi Perera, Prof. Lolita Vilka

Selected aspects of adaptation of voluntary immigrants to life in Slovakia 176 Dr. Daniele Markovic

Social factors as the catalyst of emigration 177 Dr. Maruta Pranka, Ms. Ginta Elksne, Dr. Ilze Koroļeva

The mental health of the elderly population throughout the COVID-19 pandemic in Latvia: the role of social and support networks 178 Dr. Ilze Koroleva, Mrs. Sigita Sniķere, Mr. Aleksandrs Aleksandrovs, Dr. Ieva Reine, Dr. Andrejs Ivanovs, Mrs. Ilona Gehtmane-Hofmane

xiii RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The process of implementation of children’s rights in healthcare system: challenges and future perspectives 179 Dr. Karīna Palkova

The relations between the elderly parents and adult children during the Covid-19 pandemic 180 Mrs. Romaniia Silinsh, Prof. Nadiia Khopta, Mr. Stepan Khopta, Ms. Anna Martyniuk, Mrs. Ella Mintsys

The Safe School – community framework of multidisciplinary support, protection and social inclusion of children with fetal alcohol spectrum disorders 181 Mr. Dominik Očko, Dr. Oľga Okáľová, Prof. Marketa Rusnakova

The social work practice with vulnerable families, young people and disabled children during the COVID- 19 pandemic in Latvia 182 Ms. Anna Broka, Ms. Hanna Mihailova

Transition from pediatric to adult epilepsy care: patients’ experiences of learning how to manage with epilepsy 183 Mrs. Jurgita Tuitaite, Dr. Polina Šedienė

Violence against children in a close environment: situation in Lithuania 184 Mr. Domas Sikorskis, Mrs. Olga Mesceriakova-Veliuliene, Mrs. Jurgita Vladickiene, Ms. Migle Jakineviciute

Social Work Transformations During Covid-19

Crisis management in the provision of social services during the COVID-19 pandemic 186 Mrs. Anna Višķere, Prof. Lolita Vilka, Prof. Liana Deklava, Ms. Ilze Trapenciere

Differentiation of social services as part of transformative social work practice during COVID-19 187 Ms. Anna Broka

Loneliness of seniors in long-term care institutions and COVID-19 restrictions 188 Dr. Liga Rasnaca, Dr. Mareks Niklass, Ms. Dace Lina

Medical and social work at the time of world pandemic 189 Ms. Katerina Vitanova

Social support provided by non-governmental organisations during COVID-19 190 Mrs. Marika Lotko

Social support for balancing the situation of high-risk families during the COVID-19 pandemic 191 Mrs. Sigita Pulkstene-Bērtiņa, Ms. Ilze Trapenciere, Prof. Lolita Vilka, Ms. Anna Broka

Digital Health Solutions For Rehabilitation

Technologies for healthy and active ageing 193 Dr. Signe Tomsone, Mr. Ilona Zariņa, Mr. Aleksandrs Grjadovojs

Innovations In Rehabilitation Service

Effect of pilates method on the motion functionality of shoulder complex for sedentary workers 195 Ms. Kristiana Jansone, Mx. Anita Gauruča, Dr. Una Veseta

xiv RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Interventions used in acute rehabilitation for patients with neuro-oncological disease: scoping review 196 Mrs. Agnese Kārkliņa, Mrs. Anete Petersone, Dr. Guna Bērziņa

Mindful-based dance movement therapy for depression and anxiety reduction for chronic back pain patients 197 Mrs. Indra Majore-Dūšele, Prof. Vicky (Vassiliki) Karkou, Prof. Inga Millere

Mindful-based dance movement therapy for emotion regulation skills development on patients with chronic low back pain 198 Mrs. Madara Valberga-Porozova, Mrs. Indra Majore-Dūšele, Prof. Inga Millere

Mindfulness-based dance movement therapy for fear-avoidance beliefs reduction in patients with chronic musculoskeletal pain 199 Mrs. Darja Krizska-Popova, Mrs. Indra Majore-Dūšele

Motivation of Rīga Stradiņš University students to choose the study course “Nordic Walking” during COVID-19 200 Prof. Irena Upeniece, Ms. Indra Vīnberga, Ms. Lāsma Reide, Dr. Una Veseta

Physical capacities and performance for rehabilitation specialists wearing protective clothing during the COVID-19 pandemic 201 Mrs. Darta Balcuna, Mr. Rudolfs Ceseiko, Dr. Jeļena Reste, Mrs. Darja Kaluznaja, Prof. Ivars Vanadzins, Prof. Inga Dāboliņa, Mrs. Liene Silina, Mrs. Eva Lapkovska, Mrs. Laura Kalnina, Mrs. Agnese Simsone, Prof. Aivars Vetra

Specialized rehabilitation program for patients with pulmonary hypertension: the experience, prerequisites and the barriers of implementing this service 202 Ms. Eglė Palevičiūtė, Ms. Lina Gumbiene, Ms. Elena Jueviciene, Ms. Toma Simbelyte, Ms. Ieva Lauceviciene, Mr. Aleksandras Laucevicius, Ms. Jurate Barysiene, Ms. Christina Eichstaedt, Ms. Nicola Benjamin, Mr. Ekkehard Gruenig, Ms. Jelena Celutkiene

Nursing

Establishing healthy habits in children of less than three years of age – a challenge for parents 204 Mrs. Diana Grozdeva, Mrs. Katya Eguruze

Ethical and legal norms regulating the right to information and informed consent of patients related to the nurse’s activities 205 Prof. Anna Georgieva, Ms. Stanislava Mavrodinova

Examining the state of practice readiness in three Canadian undergraduate nursing programs 206 Dr. Louela Manankil-Rankin, Dr. Baiba Zarins

Lack of nurses and nosocomial infections in Slovakia 207 Dr. Lukas Kober, Mr. Vladimir Siska

Motor activity of nursing students in the conditions of the COVID-19 pandemic 208 Ms. Nikoleta Popova, Prof. Anna Georgieva, Ms. Vasilena Digalovska

Participation of nurses in laparoscopic and robotic surgery in the Republic of Bulgaria – personal research 209 Mrs. Milena Nankova

xv RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Support of activity of seniors in institutional facilities 210 Mrs. Mária Novysedláková

The nurses’ experience of infection control in their practice 211 Ms. Diana Platace, Dr. Velga Sudraba, Prof. Inga Millere

Midwifery

Expectancies and reality gap about the hospital accommodation and orders among patients in Maternity Hospital 213 Mrs. Ilze Ansule, Prof. Inga Millere, Prof. Anda Ķīvīte-Urtāne

Comprehending Death And Dying At The Time of Covid-19

“Good death” – the circumstances in which it would be best for a person to die. The representative survey of Latvian population 215 Mrs. Diāna Kalniņa

Actual and preferred places of death and forms of burial in Latvia: ﬁndings from the 2020 social survey 216 Dr. Agita Misane, Dr. Ritma Rungule, Dr. Silva Senkane

Construction of meaning in discourses of death in Latvian society 217 Mrs. Ilva Skulte, Mr. Normunds Kozlovs

Latvian version of the DAPR-R – translation and validation of a multidimensional measurement of attitudes toward death 218 Dr. Silva Senkane, Dr. Ritma Rungule

Life-review activities applied in the music therapy-based end-of-life care programs: literature review 219 Ms. Jana Duhovska

Public attitudes toward assisted dying in Latvia 220 Mr. Ivars Neiders, Dr. Silva Senkane

Suicide in general practitioner’s narratives in Latvia 221 Mrs. Edite Pauna

xvi COVID-19 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

A double-edged sword – telemedicine for maternal care during COVID-19: ﬁndings from a global mixed methods study of healthcare providers

1 2 3 3 3 Ms. Anna Galle , Ms. Aline Semaan , Ms. Elise Huysmans , Ms. Constance Audet , Dr. Anteneh Asefa , Dr. Thérèse Delvaux 3, Prof. Bosede B. Afolabi 4, Dr. Alison El Ayadi 5, Prof. Lenka Benova 3

1. International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, 2. Institute of Tropical Medicine, Antwerp, 3. ITG, 4. University of Lagos, 5. Bixby Center for Global Reproductive Health

Objectives The COVID-19 pandemic has led to a rapid and wide implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences of healthcare professionals globally with the provision of telemedicine for maternal and newborn healthcare during the pandemic.

Materials and Methods The second round of a global, online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data was collected between July 5 and September 10, 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19 and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level.

Results Responses from 1060 maternal and newborn health professional were analysed. Telemedicine was used by 58% of health professionals and two ﬁfths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postna-tal care by video/phone, a COVID-19 helpline, and online psychosocial counselling. Challenges reported where technological, ﬁnancial and language barriers, technological illiteracy, lack of nonverbal feedback, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers also emphasized the lower quality of care and risk of increasing the already existing inequalities in access to healthcare.

Conclusions Telemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem diﬃcult to deliver by telemedicine. More research regarding the effectiveness, eﬃcacy, and quality of telemedicine for maternal healthcare in dif-ferent contexts is highly needed before considering long-term adaptations in provision of care away from face to face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and tech-nological inequalities in access to care are urgently needed.

2 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Access to healthcare during COVID-19 among ageing population in Latvia

Dr. Ieva Reine 1, Dr. Andrejs Ivanovs 1, Dr. Signe Tomsone 2 1. Rīga Stradiņš University, 2. Department of Rehabilitation, Rīga Stradiņš University

Objectives Medical staff has worked tirelessly throughout the COVID-19 pandemic to test and treat coronavirus patients. However, the focus on the virus has caused huge disruption to healthcare services resulting in delayed treatment for patients with other serious conditions. Additionally, the reasons for forgoing or abstaining healthcare could also be related to individual decisions.

Materials and Methods We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), where the respondents 50 years and older of the Wave 8, were asked to answer, among other, questions on delayed, postponed or denied healthcare services during the ﬁrst wave of Covid-19 pandemic in Latvia. The study is based on 195 483 valid weighted cases. Pearson’s chi-squared test was performed to assess the association between the variables.

Results Preliminary results show that 14% of the respondents forwent medical treatment. General practitioner or specialist/dentist check-ups were forgone (both 9%) or postponed more commonly (16% respectively 11%). Ap- pointment was denied to 7% of the respondents. We found signiﬁcant gender differences (p < 0.001), but they varied depending on the type of treatment and reason for not receiving it.

Conclusions During the ﬁrst wave of Covid-19 in Latvia, there were few older people that chose themselves or were forced to abstain planned medical treatment or operations, as well as rehabilitation and physiotherapy. However, it is not clear how limited access to the healthcare for other reasons has affected health of ageing population and remains to be studied. The study was performed within the project/agreement No. 1.1.1.2/VIAA/3/19/540 ‘Challenges of ageing in the Baltic Sea region’.

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Challenges in implementation of a project on the impact of COVID-19 on sexual and reproductive health in Latvia

Prof. Gunta Lazdāne 1, Prof. Dace Rezeberga 2, Dr. Ieva Briedite 3, Dr. Elizabete Pumpure 3, Ms. Ieva Pitkēviča 3, Ms. Marta Laura Graviņa 1, Prof. Anda Ķīvīte-Urtāne 3, Ms. Darja Mihailova 4 1. Institute of Public Health, Rīga Stradiņš University, 2. Department of Obstetrics and Gynaecology, Rīga Stradiņš University; Riga Maternity Hospital; Riga East Clinical University Hospital, 3. Rīga Stradiņš University, 4. Faculty of Medicine, Rīga

Stradiņš University

Objectives Sexual and reproductive health (SRH) is a very sensitive topic for many. Population-based household sampling is expensive and in 2020 was impossible because of COVID-19. The aim of the study was to analyze the possibilities of the SRH online survey and qualitative research during COVID-19 restrictions.

Materials and Methods The online survey and qualitative research (in-depth interviews and focus group discussions) were conducted from July to October 2020 as a part of the international multi-country study I-SHARE Survey in the time of COVID- 19 and the state research project “Impact of COVID-19 on health care system and public health in Latvia; ways in preparing health sector for future epidemic” (VPP-COVID-2020/1-0011). Survey was carried out through an online link on the RSU webpage. It was disseminated through different national networks as well as Facebook groups, Twitter and Instagram. Quantitative data were summarized and analyzed using MS Excel and IBM SPSS 26.0.

Results Main challenges in carrying out online survey were: (1) translation of a number of SRH terms of the internationally used questionnaire from English to Latvian and Russian; 2) most of the responders (1173) were women (82.35%), 18-32 years old ones (59%) and those living in the capital city Riga (62%). 3) despite promotion of the study through perinatal centers and other health care institutions and webpages targeting information to pregnant women, only 7.2 % of participating women were pregnant. Several focus group discussions were carried out using the zoom platform. Most of the quantitative and qualitative research results conﬁrmed the same trends, except the results related to the inﬂuence of COVID-19 restrictions on the intimate partners violence.

Conclusions Good promotion of the online survey results in high numbers of participants but does not cover all population groups. One can rely on the results of the online survey if conﬁrmed by qualitative research data.

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Comparison of intrinsic capacity factors in older individuals before and during COVID-19 in the context of healthy ageing in Baltic States

Ms. Madara Mikelsone 1, Ms. Diana Baltmane 1, Dr. Andrejs Ivanovs 1, Dr. Signe Tomsone 2 1. Rīga Stradiņš University, 2. Department of Rehabilitation, Rīga Stradiņš University

Objectives The Covid-19 outbreak in the context of healthy aging is associated with decline in body functional abilities, serious illness and even death in older individuals, regardless of infection with Covid-19. Regular assessment of the ageing process, including intrinsic capacity factors (cognitive, psychological, sensory, locomotion and vitality), provides an opportunity to better understand the individual’s functional abilities and vulnerabilities, especially during outbreak of Covid-19. The objectives of this study – to evaluate and compare intrinsic capacity factors of older individuals before and during Covid-19 outbreak in three Baltic countries.

Materials and Methods Based on the data (2017-2020) from two waves (7 and 8) of the Survey of Health, Ageing and Retirement in Europe (SHARE), an evaluation and comparison (where possible) of the intrinsic capacity factors of older individuals (50 years and older) before and during Covid-19 outbreak was conducted (n=4422, from which Latvia=648, Lithuania=1079, Estonia=2695).

Results Excellent or very good health status before the outbreak reported 35,3% respondents in Latvia, 54,9% in Lithua- nia and 45,3% in Estonia (p<0,001). Worsened health status since outbreak reported 7% respondents in Latvia, 13,8% in Lithuania and 5,9% in Estonia (p<0,001). Feeling of nervousness, depression and loneliness during Covid-19 outbreak increased among all respondents, regardless of nationality and severity of symptoms before outbreak (p<0,001).

Conclusions The results indicate that at this moment respondents are experiencing deterioration in cognitive and psychological health. WHO recommendation for maintaining mental and physical health during Covid-19 is the use of digital technologies (for communication, online workout etc.) in everyday life, but results in Latvia and Lithua- nia indicate that more than 75% of respondents (75+ years) has none or poor computer skills, and 30% of them reported reduced physical activities since Covid-19 outbreak. Therefore, more attention needs to be paid to this part of society to maintain their current functional abilities as long as possible.

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Effects of COVID-19 restrictions on emotional, physical and sexual violence in Latvia

Ms. Ieva Pitkēviča 1, Dr. Ieva Briedite 1, Ms. Marta Laura Graviņa 1, Ms. Ināra Kantāne 1, Prof. Anda Ķīvīte-Urtāne 1, Prof. Gunta Lazdāne 1

1. Institute of Public Health, Rīga Stradiņš University

Objectives Since March 2020 COVID-19 restrictions were implemented in Latvia. The study aimed to understand the effect of COVID-19 restrictions on violence. A cross-sectional online survey was realized from July 26 to September 3. Qualitative research with structured interviews was carried out from September 24 to October 30. This study was a part of the International Sexual Health and Reproductive Health Survey (I-SHARE) realized in Latvia as a component of the National Research Programme project “Impact of COVID-19 on health care system and public health in Latvia; ways in preparing health sector for future epidemics” (Nr. VPP-COVID-2020/1-0011).

Materials and Methods Quantitative data were analyzed using MS Excel and IBM SPSS Statistics 26.0. Qualitative data were coded and analyzed.

Results 966 women, 204 men and 3 persons who did not consider themselves neither men nor women aged 18 to 68 participated in the survey. During COVID-19 restrictions women experienced less emotional violence than before (21.2% (n=162) vs 24.9% (n=195); p<0.001). The same tendency was observed among men: 17% (n=25) in times of COVID-19 restrictions vs 22.6% (n=34) men before; p=0.018. There was no statistical difference between physical and sexual violence before and during COVID-19 restrictions. Oﬃcial reports about violence against women were submitted in 3 cases and none for violence against men. 2.6% (n=8) used the support of non-governmental organizations. The qualitative study showed a different situation. “Sexual violence increased during a pandemic”, “As the state of emergency lengthened, the number of people who approached us doubled”, “Good time for violence to ﬂourish,” was just a few of the statements.

Conclusions Although quantitative data showed a decrease in violence in times of COVID-19 restrictions, qualitative research showed a tendency similar to other European countries. This difference demonstrates the importance of qualitative research when studying sensitive topics such as violence within relationships.

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Ethical and organizational challenges of COVID-19 – view from the medical frontlines in Estonia

Dr. Kadi Lubi 1, Dr. Kadri Simm 2, Ms. Kaja Lempu 3, Ms. Angela Eensalu-Lind 3 1. Health Education Center, Tallinn Health Care College, 2. Institute of Philosophy and Semiotics, University of Tartu, 3. Chair of Nursing, Tallinn Health Care College

Objectives The COVID-19 infectious disease caused by coronavirus SARS-CoV-2 reached to pandemic in March 2020 and ethical dilemmas in the context of clinical decision-making and lack of resources emerged. The objective was to evaluate the impact of the COVID-19 pandemic on the ethical decision-making in clinical emergency situations, to identify the gaps and areas of improvement in terms of acquiring and implementing the knowledge, skills and experiences of ethical decision-making in clinically demanding situation in Estonia.

Materials and Methods A mixed-method approach was used for data collection and analysis. A total of 218 front-line healthcare professionals (doctors, nurses, midwives, and ER technicians) completed an online survey in November 2020. A statistical analysis was performed for closed-end questions while open-ended questions passed qualitative textual content analysis. A total of 8 qualitative in-depth interview were additionally conducted which passed thematic textual analysis.

Results While majority of participants (55%) felt themselves conﬁdent in clinical situations, only 25% felt the same con- ﬁdence in an imaginary situation where there would appear the need to limit healthcare resources. The support in this decision-making was perceived from professional education, colleagues, institutional organization and other factors (e.g. family, experiences, information etc.). Pandemic service- provision was perceived widely different, the biggest concerns were worry about relatives, fast-changing situation, lack of knowledge and resources. COVID-19 has the potential to increase health inequality as patients of other diseases might experience the lack of access to healthcare service. The need to improve theoretical knowledge about medical ethics was highlighted.

Conclusions The COVID-19 pandemic affected the operation of the work of emergency and intensive care units. In dealing with the physical side of the illness, the mental and social inﬂuences of the illness should be taken into the focus. The development of ethical decision-making is based on experiences and more theoretical training is needed.

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Ethics and use of restraints in time of COVID-19

Prof. Vladimir Littva 1, Prof. Soňa Hlinková 1, Mrs. Anna Králová 2

1. Faculty of Health, Catholic University in Ružomberok, 2. Central Military Hospital, Faculty Hospital in Ružomberok

Objectives At present with the occurrence of the COVID-19 pandemic, the question is what measures and the use of restraints are available to society. It is questionable whether everything has to be just legally enforceable, or is there a norm in terms of ethical behavior that should correct our behavior. The contribution is based on survey focused on ethical attitudes to the application of restraints in times of pandemic in a project KEGA no. 007KU-4/2018.

Materials and Methods In our survey we used Acceptation of Restrains in Pandemic Questionnaire – 13 Items (ARPQ13) which we analyzed by statistical program SPSS 22.

Research sample consisted of 132 respondents: 43 (32.6%) men and 89 (67.4%) women. The most represented age category were respondents from 41-60 years - 76 (57.6%). Research was held in 2020 in different health care facilities in Slovakia.

Results An important indicator of attitudes is the mean of individual answers. The higher the mean value (maximum is 5 and minimum 1), the stronger the respondents’ consent to the use of the intervention. Mean for whole set was 3.74 but for individual items ranged from 3.04 to 4.27 which represents pretty good level of acceptance. Men were significantly less inclined to such measures. The younger generation of respondents is significantly less inclined to use coercive measures such as protective mask, quarantine, tests and distance. In terms of residence, there is no significant difference between urban and rural respondents. A significant difference in education was confirmed. Respondents with higher education are more inclined to use coercive measures.This may be related to the awareness of individual age groups.

Conclusions In order to successfully manage any epidemic, it is necessary to realize that society has not only the right but also the obligation to intervene and, if necessary, to restrict certain freedoms of individuals without violating ethical standards.

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Excess mortality in Latvia in association with COVID-19 in 2020

Prof. Inese Gobiņa 1, Mr. Andris Avotiņš 1, Mrs. Una Kojalo 1, Dr. Ieva Strēle 2, Mrs. Santa Pildava 3, Prof. Ģirts Briģis 1, Prof. Anita Villeruša 4 1. Rīga Stradiņš University, 2. Institute of Public Health, Rīga Stradiņš University, 3. Patient Safety and Health Care Quality Improvement Unit, 4. Department of Public Health and Epidemiology, Rīga Stradiņš University

Objectives During the COVID-19 pandemic, the measure of excess mortality is used to assess the pandemic’s total impact on crude mortality. Excess mortality captures not only COVID-19 conﬁrmed death but also undiagnosed or not reported COVID-19 death and death from other causes that are attributable to the overall crisis conditions. The study analyzed the changes in the crude-mortality per 100,000 population in Latvia in 2020 compared to the average mortality rates during the previous ﬁve years, i.e., 2015–2019.

Materials and Methods All-cause monthly and COVID-19 monthly mortality data were obtained from the Causes of Death database from the Centre for Disease Prevention and Control. Excess mortality was calculated using monthly and cumulative monthly mortality differences with P-score. Both monthly excess mortality (differences in mortality rates per month) and cumulative monthly excess mortality (differences in cumulative mortality rates per month) were calculated. Positive excess mortality indicates that the observed mortality is higher than expected. The study was implemented within the State Research Program VPP-COVID-2020/1-0011.

Results The ﬁrst COVID-19 death in Latvia was registered in April 2020. Since May 2020, positive excess mortality in the following months was observed. Excess of cumulative monthly mortality remained negative until November 2020; however, since March, the constant reduction in cumulative monthly differences occurred, and in De- cember, the cumulative monthly excess mortality was positive. In May, June, August, and September, less than 10% of excess mortality was attributed to COVID-19 mortality. In July, 45%, in October, 30%, more than 70% of excess mortality was related to COVID-19 mortality in November and December.

Conclusions Findings of excess mortality suggest the cause-of-death structure should be studied in detail by investigating the trends of cause-speciﬁc mortality rates contributing to all-cause mortality changes in Latvia.

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Family physicians’ perspective on risks and beneﬁts of remote patient consultations during the state of emergency due to COVID-19 epidemic in Latvia: qualitative study in primary care

Mrs. Mirdza Kursīte 1, Dr. Inese Stars 1, Prof. Anita Villeruša 1, Dr. Lauma Spriņģe 1 1. Department of Public Health and Epidemiology, Rīga Stradiņš University; Institute of Public Health, Rīga Stradiņš University

Objectives The study aimed to identify and analyze the risks and beneﬁts of remote patient consultations in primary care from family physicians’ perspective during the emergency due to COVID-19 epidemic in Latvia in Spring 2020.

Materials and Methods Qualitative face-to-face or online, semistructured interviews with 19 family physicians were conducted from September to December 2020. A purposeful maximum variation sampling was used. Interviews were recorded and transcribed. Thematic analysis revealed three themes related to beneﬁts and risks of remote patient consulting. The study was carried out in the frame of the project VPP-COVID-2020/1-0011 of National research programme to lessen the effects of COVID-19.

Results The 1st theme ‘remote consultation as integral part of primary care’ indicated benefits of higher effectiveness and increased autonomy of physicians in deciding on the form of consultation. Identified risks were patients being hesitant to call the doctor and not capable to use more advanced communication technologies. The 2nd theme ‘remote evaluation of patients’ health needs’ emphasized benefits of physicians ability to remotely solve health needs that did not require a visit, in the same time risks of underestimating the seriousness of patient’s health issue was of great concern. The 3rd theme ‘change in the physician-patient relationship’ revealed benefits of increasing patients’ responsibility and involvement, and promoting the potential of patient empowerment. In the same time risk of doctors’ burnout due to stress related to new communication forms and blurred lines between remote consultations and personal life was identified.

Conclusions Findings indicate potential gains of remote consultations by creating more eﬃcient, autonomous and health literacy promoting communication between physician and patient. Managing identiﬁed risks – patient capa- bility to use technologies, physician competence of remote health evaluation and ability to separate work from personal life - are crucial in order to protect both patients’ and physicians’ wellbeing and health.

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From pandemic to “infodemic”: the spread of COVID-19 information in Latvia

Ms. Lāsma Šķestere 1, Mr. Roberts Darģis 2 1. Department of Doctoral Studies, Rīga Stradiņš University, 2. Institute of Mathematics and Computer Science, University of Latvia

Objectives The outbreak of the COVID-19 has led to substantial discussions in traditional media as well as in social networks. The understanding of the diffusion of information can help government oﬃcials to obtain a better understand-ing of public concerns as well as to prevent the rapid spread of misinformation. This article provides analysis of public conversations in Twitter and news online media during the ﬁrst wave outbreak of COVID-19 in Latvia. Using computer-assisted text analysis, we examined the main themes and topical agendas of public discussions.

Materials and Methods The authors compiled more than 46 thousand tweets and 45 thousand news articles related to the COVID-19 during the ﬁrst outbreak of virus. To identify common themes and to describe how the prevalence of these changes took place over time, the researchers manually created the project dictionary. The dictionary included 11 dominant themes, 31 major topics and 160 subtopics and 11 topical agendas. Human and computer coding was combined to explore the patterns of the spread of information and to identify extent to which social media correlates to the agenda of traditional media and vice versa.

Results Results show that the application of computer-aided methods can eﬃciently identify the most important issues of public and media agenda, such as the global nature of pandemic, the response of the government as well as information about disease control measures. Findings illustrate core differences between traditional and social media and provide evidence that to a certain extent the public agenda can alter agendas of traditional media.

Conclusions This research shows the potential of using social media to conduct “infodemic” studies for the public health. The methodology created in research can be used to track information diffusion and to analyse near real-time content, allowing health authorities to respond to public concerns more quickly.

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Impact of COVID-19 epidemic on court proceedings in civil cases – legal and psychological aspects

Ms. Jolanta Dinsberga 1 1. Faculty of Law, Rīga Stradiņš University; College and University of Economics and Culture; College of Business Management

Objectives The year of 2020 will be accentuated in the history of the world and Latvia by spread of the Covid 19 epidemic, which led to countless sicknesses and deaths, rapid development and adoption of regulatory enactments, signiﬁcant restrictions of rights, splitting of society and lowering of psychological stability. Objective: Through the analysis of spread of the Covid 19 epidemic, to reﬂect its impact on court pro-ceedings in civil cases from the viewpoint of legal and psychological aspect, to make conclusions and provide recommendations.

Materials and Methods Used scientiﬁc research methods – descriptive, analytical, inductive and deductive and interpretation of legal norms – historical, grammatical, systemic and teleological.

Results During the emergency situation, courts provide to the maximum extent examination of cases in the written procedure or remotely. If it is not possible, onsite court hearings are held in all the cases related to a signiﬁcant infringement of rights of a person and objective urgency. Unfortunately, the cases regarding establishing right of way are basically postponed, since they are not related either to a signiﬁcant infringement of rights of a person or urgency. However, the lingering examination of cases prevents the owner of the immovable property to enter his/her property. Problems in circulation of documents have also been established. Besides, the persons involved in the proceedings become psychologically unstable.

Conclusions Although a number of regulatory enactments aimed at the protection of the public health and safety interests and effective operation of public and municipal authorities has been adopted in Latvia, it has not led to the desired result in practice. Therefore, when adopting urgent decisions, the legislator must rely also on the recommendations provided by specialists of the relevant sector.

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Impact of the ﬁrst wave of COVID-19 on the employment of older people in Latvia, the Baltic States and Europe

Dr. Olga Rajevska 1, Ms. Agnese Reine 1, Ms. Diana Baltmane 1 1. Rīga Stradiņš University

Objectives The objective of the study was to examine changes in the employment of older people brought about by the ﬁrst wave coronavirus pandemic in Latvia in comparison with other European countries.

Materials and Methods The study is based on the SHARE Wave 8 COVID-19 Survey conducted in June-August 2020 in 26 European countries and Israel via computer-assisted telephone interviews. Questions examined how people aged 50 years and older coped with socioeconomic and health-related impact of COVID-19. The methods of descriptive statistics were applied in order to compare the inﬂuence of the ﬁrst coronavirus wave on employment in older age groups in Latvia and across Europe.

Results In Latvia, 6% of employed or self-employed aged 50+ experienced unemployment, laid off or business closed during the ﬁrst wave of COVID-19, which is one of the lowest rates among all participating countries. The strongest impact was suffered by older workers in France (39%), Greece (36%) and Cyprus (35%). 75% of Latvians continued to work at their usual work place. Meanwhile 10% of participants in Latvia started to work from home; and 9% combined working from home and at the usual work place. Most of the employed experienced neither a reduced nor increased number of working hours.

Conclusions Participation of older age groups in labour market is comparatively high in Latvia and other Baltic States and the COVID-19 (at least, its ﬁrst wave) had relatively mild impact on it. The branches with traditionally high share of workers aged 50+ (education, healthcare, agriculture, administrative services) were least affected by lockdown measures. Although the prevalence of remote work from home in Latvia was lower than the European average, this issue requires more regulation as the existing legislation lacks provisions on remote work and does not therefore ensure protection of workers’ rights and health.

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Incidence of obsessive-compulsive disorder elements during COVID-19 pandemic and its association with alcohol consumption in the general population of Latvia

Dr. Anna Kodinceva 1, Prof. Gunta Lazdāne 2, Mrs. Eva Petrošina 3 1. Rīga Stradiņš University; Riga East Clinical University Hospital, 2. Institute of Public Health, Rīga Stradiņš University, 3. Statistics Unit, Rīga Stradiņš University

Objectives The restrictive measures to prevent COVID-19 infection may cause the development of obsessive-compulsive disorder (OCD), especially washing compulsions and fear of contamination. It is manifested by uncontrollable, repetitive thoughts that could lead to obsession and unhealthy behavior. OCD can be associated with alcohol abuse as it provides temporary relief from the symptoms. The aim of the study is to analyze the incidence of OCD elements during COVID-19 pandemic and its association with alcohol consumption.

Materials and Methods The data was collected by using behavioral cross-sectional online survey that was conducted as a part of international multi-country study I-SHARE (International Sexual Health and Reproductive Health Survey) realized in Latvia as a component of the National Research Programme project “Impact of COVID-19 on health care system and public health in Latvia; ways in preparing health sector for future epidemics” (VPP- COVID-2020/1-0011). Be-sides questions focusing on sexual and reproductive health the survey included 20 questions related to mental health. Data was analyzed by using MS Excel and IBM SPSS 26.0. The results have been deﬁned as statistically signiﬁcant if p<0.05.

Results There were 1173 people involved in the study, mostly women (82.4%), 18-39 y.o. (77%) living in Riga (62%). The following OCD elements were present: 19% experienced obsessive or compulsory hand washing behavior, 27% noted fear of touching items outside the house and 13% had obsessive thoughts about the pandemic. When analyzing the alcohol consumption 13.8% noted that during pandemic it has decreased either a lot or a bit, 15.9% confirmed a bit increased alcohol consumption. None of responders confirmed substantial increase of alcohol use. There was no statistically significant correlation between OCD elements and alcohol consumption.

Conclusions Despite quite high incidence of OCD elements among responders, there was no inﬂuence on alcohol consumption found in the online survey related to sexual and reproductive health during COVID-19 pandemic.

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Indicators of a preventive behaviour of the Latvian population and related factors, during the COVID-19 crisis

Mrs. Sanita Surina 1, Prof. Kristine Martinsone 1, Ms. Viktorija Perepjolkina 2, Dr. Jelena Kolesnikova 1, Prof. Aleksejs Ruža 3 1. Department of Health Psychology and Paedagogy, Rīga Stradiņš University, 2. Faculty of Communication, Rīga Stradiņš University, 3. Department of Psychology, Daugavpils University

Objectives The aim of this study is to examine association of COVID-19 preventive behaviour with trust in COVID-19 information sources, COVID-19 risk perception and fear of COVID-19 in Latvia society.

Materials and Methods A quantitative cross-sectional online survey in a sample of Latvian general population aged 18-74 years has been carried out in the frame of the Latvian National Research Program No.VPP-COVID-2020/1-0011: “Impact of COVID-19 on health care system and public health in Latvia; ways of preparing health sector for future epidemics”

Results The results show that there is signiﬁcant association between COVID-19 preventive behaviour and COVID risk perception (r = .40, p < .001), COVID-19 preventive behaviour and trust in COVID-19 information sources (r = .29, p < .001), COVID-19 preventive behaviour and fear of COVID-19 (r = .42, p < .001), COVID risk perception and fear of COVID-19 (r = .37, p < .001), COVID risk perception and trust in COVID-19 information sources (r = .45, p < .001), fear of COVID-19 and trust in COVID-19 information sources (r = .14, p < .001)

Conclusions The results show, that those Latvian residents, who show higher fear of COVID-19, higher COVID-19 risk perception and have more trust in COVID-19 information sources, are more actively involved in COVID-19 preventive behaviour.

15 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Inﬂuence of COVID-19 on eating habits of pregnant women in Latvia

Prof. Gunta Lazdāne 1, Prof. Dace Rezeberga 2, Prof. Laila Meija 3, Ms. Ināra Kantāne 1, Dr. Elizabete Pumpure 3, Ms. Ieva Pitkēviča 3

1. Institute of Public Health, Rīga Stradiņš University, 2. Department of Obstetrics and Gynaecology, Rīga Stradiņš University; Riga Maternity Hospital; Riga East Clinical University Hospital, 3. Rīga Stradiņš University

Objectives There is contradictory information regarding the inﬂuence of COVID-19 restrictions to the eating habits of pregnant women. Nutrition in pregnancy is of utmost importance for the health of the woman and the fetus during gestation and afterwards. The aim of the study was to analyze the impact of COVID-19 on nutrition during pregnancy

Materials and Methods An online survey was conducted from July to October 2020 as a part of an international multi-country study I-SHARE Survey in the time of COVID-19 and the state research project “Impact of COVID-19 on health care system and public health in Latvia; ways in preparing health sector for future epidemic” (VPP-COVID-2020/1- 0011). Survey was carried out through an online link on the RSU webpage. Data were summarized and analyzed using MS Excel and IBM SPSS 26.0.

Results 1173 Latvian inhabitants participated in the online survey. From 966 women 662 women were of reproductive age and 70 of them were pregnant during the COVID-19 pandemics. Answers related to nutrition during COVID- 19 pandemic were analyzed comparing a group of pregnant women with a group of reproductive age women who were not pregnant. There was no statistical difference between these two groups regarding (1) worries about the amount of food in the household; (2) eating of preferred food by any of the household members; (3) eating of less food; (4) having household food stores ever completely empty and no way of getting more, and (5) increased consumption of foods of low nutritional value. However, women who were not pregnant increased food consumption during COVID-19 in comparison to pregnant women (51.4% vs 37.2%, p<0.05).

Conclusions COVID-19 restrictions inﬂuence the eating habits of many, including pregnant women. When developing the public health recommendations, it is of essential importance to make information regarding nutrition in pregnancy during COVID-19 restrictions available and accessible.

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Issues and challenges in the Latvian dental care system during COVID-19 pandemic: qualitative study

1 1 1 2 3 Dr. Ilze Maldupa , Dr. Olga Sļepcova , Dr. Natālija Šilova , Ms. Elizabete Ribalkina , Dr. Inese Stars , Dr. Egita Senakola 1, Prof. Anda Brinkmane 1, Prof. Sergio Uribe 4 1. Department of Conservative Dentistry and Oral Health, Faculty of Dentistry, Rīga Stradiņš University, 2. Faculty of Dentistry, Rīga Stradiņš University, 3. Rīga Stradiņš University, 4. Bioinformatic Research Unit, Department of Conservative Dentistry and Oral Health, Rīga Stradiņš University

Objectives To explore current issues, problems and challenges of dental caries during the COVID-19 pandemic in Latvia.

Materials and Methods Semi-structured online qualitative interviews were conducted and recorded between October and November 2020. Participants were eight dentists - head of large dental clinics, covering all regions of Latvia and two leaders of professional associations. After transcription of the interviews, thematic analysis was used for data processing. Three specialists combined all codes. Six themes with 13 subtopics emerged. The results were peer-reviewed by another team member. This study is a part of the project VPP-COVID-2020/1-0011.

Results All clinic and association leaders acknowledged that the priority during the state of emergency was the health of personal and patients. Personal protective equipment (PPE), disinfection and other protective measures were introduced timely; currently, there are no problems with their delivery, and dental services continue to be provided in Latvia. The availability and provision of dental services significantly decreased because of existing restrictions during the state of emergency in Latvia. Clinics incurred financial losses, revenues decreased, but expenses for the purchase of PPE increased. The Latvian Dental Association was active and efficient, organized purchase and distribution of PPE, as well as provided recommendations and informed about restrictions that affected the dental service.

Conclusions Dentists and Dental Hygienists perceive that they are more at risk COVID19 infection because they work close to the patient, perform long procedures, and most are aerosol-generating manipulations. At present, all clinics have accumulated PPE, including speciﬁc to work with infected patients. Non-invasive manipulations are perceived as a solution by some respondents, but the main issue for their implementation are the costs and lack of preparation. To promote the use of remote consultations in dentistry, new skills and motivation should be created for dentists and patients.

17 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Legal restrictions imposed on access to sexual and reproductive health services during the ﬁrst COVID-19 emergency state in Latvia

Prof. Solvita Olsena 1, Prof. Gunta Lazdāne 2, Prof. Dace Rezeberga 3, Dr. Ieva Briedite 2, Prof. Anda Ķīvīte-Urtāne 4 1. Faculty of Medicine, University of Latvia, 2. Institute of Public Health, Rīga Stradiņš University, 3. Department of Obstetrics and Gynaecology, Rīga Stradiņš University; Riga Maternity Hospital; Riga East Clinical University Hospital, 4. Department of

Public Health and Epidemiology, Rīga Stradiņš University

Objectives The overall objective of this paper is to characterize legal restrictions that had been posed on sexual and reproductive health care services in Latvia during the Covid-19 restrictions lasting from March 12 to June 9, 2020 as well as to identify major challenges in respect to protection of sexual and reproductive health (SRH) during pandemic.

Materials and Methods Study was a part of the NRP project “Impact of COVID-19 on health care system and public health in Latvia; ways in preparing health sector for future epidemics” (VPP-COVID-2020/1-0011). Legal research was done by combining normative legal research methods with empirical research methods. In doctrinal legal research statutes and regulations had been reviewed. Empirical data were collected by using semi-structured interviews which were analyzed from a legal perspective. The combination of research methods secured the building of a comprehensive picture concerning protection of human rights in SRH.

Results During the emergency state legal restrictions on provision and access to SRH care services were imposed by the Minister of Health and by the health care institutions. Most restrictive period lasted from March 27 to May 12. Emergency services were available as well as the treatment of HIV/AIDS/sexually transmitted infections, prenatal health care services as well as those services provided by general practitioners. Provision of all other SRH services including out-patient and day-care consultations and treatments by gynecologists, urologists, midwifes etc. was legally banned. Restrictions imposed were not issued in line with constitutional requirements particularly in respect to limits on human rights, were lacking scientiﬁc evidence or reasoning in the epidemiological data.

Conclusions Access to SRH services during the ﬁrst wave of Covid-19 in Latvia was diﬃcult due to numerous restrictions often contradicting human rights and existing legal regulations. Legal expert should be part of a team developing the regulations nationally as well as in the health care facilities.

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Limitation of COVID-19: international experience and management strategies

Dr. Andrejs Vilks 1, Dr. Aldona Kipāne 2 1. Rīga Stradiņš University; Riga East Clinical University Hospital, 2. Rīga Stradiņš University

Objectives The aim of the article is to study international experience in the area of limitation of COVID-19 and strategies for overcoming its negative consequences.

Materials and Methods Descriptive, analytical, synthetic and modelling methods, as well as methods of interpretation of legal norms are used in the study. The authors analyse international and national legal regulations in the area of limitation of COVID-19, as well as the results of particular studies in this ﬁeld.

Results The epidemiological, social, economic, legal and other impacts of COVID-19 on modern society are comprehensive and possible long-term. All regions of the world have been affected by the pandemic. Analysing the European experience and experience of other regions in pandemic management it can be concluded that there are three main strategies for limitation of COVID-19. There is a liberal strategy with the lowest restrictive measures for natural and legal persons (Sweden). Most restrictive measures are of an advisory nature. The second one is a repressive strategy in which a number of countries impose regulatory restrictions and there is a speciﬁc liability for their breach. At certain times the activities of people, enterprises and institutions are subject to strict control, curfew and quarantine are possible (Lithuania, Spain, Belgium). The third strategy, conditionally, is a hybrid strategy where a liberal approach can be combined with regulatory restrictive measures (Latvia, Estonia). The movement of people is recorded by video technologies (digital tracking, the installed application “Apturi Covid”), physical and social distance is common.

Conclusions At present it is not possible to draw objective conclusions on the following: Which of the pandemic management strategies is the most effective one? Which of them has prevented high level of human mortality and infection? Which of the strategies has made it possible to maintain a suﬃciently high standard of living?

19 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Peculiarities of patient organizations’ communication during the state of emergency in Latvia due to COVID-19 pandemic

Dr. Lauma Spriņģe 1, Mrs. Mirdza Kursīte 1, Dr. Inese Stars 2, Prof. Anita Villeruša 3, Prof. Anda Ķīvīte-Urtāne 3

1. Department of Public Health and Epidemiology, Rīga Stradiņš University; Institute of Public Health, Rīga Stradiņš University, 2. Rīga Stradiņš University, 3. Department of Public Health and Epidemiology, Rīga Stradiņš University

Objectives Aim of the study was to obtain information about patient organizations chairmen’s experience during state of the emergency due to COVID-19 epidemic in Latvia in Spring 2020.

Materials and Methods Qualitative face-to-face or online, semistructured, in-depth interviews with 7 chairmen of chronic diseases patient organizations were conducted from September to October 2020. Interviews were recorded and transcribed. Thematic analysis was used for data processing. The codes were combined and transformed into themes. In total 10 themes emerged and two of those were related to communication. The study was carried out in frame of the project VPP-COVID-2020/1-0011 of National research programme to lessen the effects of COVID-19.

Results The ﬁrst theme was information search and distribution. During emergency state in Latvia patient organizations actively looked for up-to-date information regarding the health care services availability, COVID-19 risks, and precaution measures for patients with chronic disease that is under the particular patient organizations’ supervision and communicated it with their members and other stakeholders. Speciﬁc COVID-19 risk related informative materials were produced and distributed. The second theme was change of communication channels. Change of communication platform from on site to distance communication was challenging. Before the emergency, many patient organizations had regular meetings with their members, so to ensure communication during emergency diverse e-environment tools were used, mostly, social networks. Also, patient organizations observed increase in demand for telephone consultations that highlighted the need for extra workforce.

Conclusions During emergency due to COVID-19 epidemic in Latvia in Spring 2020 patient organizations experienced increased demand for information and necessity to ensure continuity of communication. Findings could indicate possible patient organizations perception as a reliable source of information and their systematic involvement into health information communication in future could be of value. Change from on site to distance communication channels require digital literacy improvement among patient organization members.

20 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Provision of scheduled outpatient consultations for patients with non-communicable diseases during the COVID-19 emergency in spring 2020 in Latvia

Dr. Daiga Behmane 1, Dr. Ieva Strēle 1, Mrs. Mirdza Kursīte 2, Prof. Inese Gobiņa 2, Mrs. Alina Dūdele 1, Mr. Andris Avotiņš 3, Prof. Anita Villeruša 2 1. Institute of Public Health, Rīga Stradiņš University, 2. Department of Public Health and Epidemiology, Rīga Stradiņš University; Institute of Public Health, Rīga Stradiņš University, 3. Statistics Unit, Rīga Stradiņš University

Objectives The study aimed to assess the changes in provision of the total and remote consultations by family physicians and specialists during scheduled on-site outpatient consulting suspension (except for oncological patients) due to the COVID-19 emergency in Spring 2020. The study was carried out in the frame of the National research programme project VPP-COVID-2020/1-0011.

Materials and Methods Data from the National Health Service for selected non-communicable diseases were analyzed, including diseases with suspended on-site consultations for diabetes (E10; E11), cardiovascular diseases (CVD) (I10; I20-I25; I50), asthma (J44; J45), and oncological diseases with ongoing on-site consultations (breast (C50) and prostate cancer (C61)). Proportionate 2020 weekly consultation volume against 2019 was assessed, and its average for 13th-16th week was calculated, as well as remote consultation proportion out of total.

Results On average, during 13th-16th week the largest decrease of consultation volume was seen for both family physicians and specialists, respectively: 63.1% and 76.6% for diabetes, 74.8% and 29.7% for CVD, 85.3% and 35.1% for asthma, 80.2% and 110.0% for breast cancer, 71.6% and 68.8% for prostate cancer. During 13th-16th week a gradual increase of remote consultation proportion was seen in all groups of diagnosis both for family physicians and specialists, respectively: 47.1% and 85.2% for diabetes, 53.4% and 63.3% for CVD, 44.9% and 67.4% for asthma, 40.5% and 38.9% for breast cancer, 36.4% and 23.9% for prostate cancer at the highest point during the period.

Conclusions A reduction of total consultation volume in 2020 compared with 2019 was observed for all groups of diagnosis and for both family physicians and specialists, including oncological diseases, with one exception – specialists’ consultations for breast cancer patients. On-site consultations partly were replaced with remote consultations, but without the capacity to compensate for the total decrease. Further research is needed on remote consultation implementation as a valuable tool and their sustainable provision.

21 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Remote work as one of the challenges of the COVID-19 pandemic

Mrs. Linda Nātriņa 1 1. Rīga Stradiņš University

Objectives How can the company’s management bord be socially responsible and help in the matter of public health? What legal tools do the company’s management board have to ensure responsible decision-making? What would be considered as effective crisis management in the new circumstances?

Materials and Methods During the preparation of the article there are used analytical, descriptive and induction methods. By using these methods, there are going to be analyzed legal acts, case study and drawn conclusions.

Results The state of emergency declared in Latvia in order to limit the spread of Covid-19 has directly affected employees and employers. Many employees are currently likely to be concerned about their their job security, health and the way they should do their job in this new context. Such changes causes stress for everyone, but it is the company’s management board that determines the internal organization issues and determines working conditions. In order to solve the problems associated with remote work and the organization of it the State Chancellery has issued speciﬁc guidelines, thus expressing the possible pattern of action and indicating that remote work is preferred. However, the ﬁnal decision on this matter lies with the company’s management board. Practice shows that the approach to this issue is very different.

Conclusions Companies that position themselves as socially responsible have been able to ﬁnd a solutions to provide their employees with full-ﬂedged remote work options thus actively engaging in and supporting the concept of public health. The reorganization of the work process was also facilitated by amendments to the Labour law.

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The differences in mental health reactions to COVID-19 pandemic between men and women in the general population of Latvia

Dr. Kamila Kuzmina 1, Prof. Gunta Lazdāne 2, Mrs. Eva Petrošina 3 1. Rīga Stradiņš University, 2. Institute of Public Health, Rīga Stradiņš University, 3. Statistics Unit, Rīga Stradiņš University

Objectives The coronavirus disease (COVID-19) pandemic has taken a toll on the mental health of millions of people around the world. It is known that there is an overall difference between men and women mental reactions to stress. They attempt to manage stress in very different ways and perceive their ability to do so. The aim of this study was to explore the differences in mental health reaction patterns between men and women, residents of Latvia.

Materials and Methods The analysis was done by obtaining data from online survey conducted as a part of international multi-country study I-SHARE. The survey was carried out as a part of the state research project focusing on impact of COVID- 19 on sexual and reproductive health (VPP-COVID-2020/1-0011) and included 20 questions related to mental health. Data was summarized and analyzed using MS Excel and IBM SPSS 26.0. The results have been deﬁned as statistically signiﬁcant if p < 0.05.

Results • 1170 responses were analyzed: 82.6% women and 17.4% men. Women mostly agree with the statement, which reflects an element of obsessive-compulsive disorder (OCD) compared to men (26.7% N=258 vs. 18.5% N=33), and more rarely have a neutral reaction (15% N=147 vs. 22% N=45) p<0.01. Overall, during COVID-19 pandemic women more often show an element of obsessive-compulsive disorder than men do. • Overall women more often agree with a statement which reflects an element of thought disorders (24.6% N=235 vs. 21% N=41), and more rarely have a neutral reaction (20% N=190 vs. 24% N=47). During COVID- 19 pandemic women more often reflect an element of thought disorders than men.

Conclusions In developing public health messages related to COVID-19, it is important to ensure focus on both sexes, with a special emphases to women as women are in a higher risk group in relation to obsessive-compulsive disorders and thought disorders.

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The emotional impact of paediatric COVID-19 on parents of the affected children: qualitative study

Dr. Inese Stars 1, Dr. Liene Smane 2, Dr. Zanda Pučuka 2, Dr. Ieva Roģe 3, Prof. Jana Pavāre 2 1. Rīga Stradiņš University, 2. Rīga Stradiņš University; Children’s Clinical University Hospital, 3. Children’s Clinical University Hospital

Objectives The study provides a more in-depth understanding of the emotional impact of paediatric COVID-19 on parents whose children were diagnosed with SARS-CoV-2 positive. The emotional domain is a critical part of parental and family health-related quality of life.

Materials and Methods This was descriptive qualitative research. The participants (n = 20) enrolled in this research were parents or legal guardians as primary caregivers of children (aged below 19) who have been diagnosed with a laboratory- conﬁrmed case of SARS-CoV-2 infection and living in Latvia. A semi-structured interview method was used to obtain qualitative data. Interviews were transcribed verbatim and analysed manually using inductive thematic analysis.

Results Six themes emerged: 1. Parents’ first reactions to their child’s diagnosis (varied from fright, surprise, confusion, disbelief to more calm reactions). 2. Uncertainty related to COVID-19’s novelty (not knowing the course of the disease led to distress). 3. Emotions associated with child’s health (despair, helplessness (when child’s temperature raised rapidly); panic (when the child needed hospitalization due to severe symptoms); insecurity (because of the absence of specific treatments); fault (for not protecting the child); anger (on those people who infected a child); relief (when the child’s symptoms eased) etc.). 4. “Fact, as a fact” (several parents accepted this situation more pragmatically). 5. “There was something positive about it” (love, trust, optimism, compassion, gratitude, closeness, togetherness was experienced). 6. Other factors influencing emotional impact on parents (psychological fatigue, feeling of imprisonment, and intolerance because of family lockdown etc.).

Conclusions Caring for a child with a COVID-19 can be emotionally challenging for their primary caregivers. Paediatric COVID-19 provoked vivid emotional reactions to parents. A myriad of factors inﬂuencing the emotional impact on parents was identiﬁed.

24 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Women’s sexual health in times of COVID-19

Dr. Ieva Briedite 1, Prof. Anda Ķīvīte-Urtāne 2, Prof. Gunta Lazdāne 1, Prof. Dace Rezeberga 3, Prof. Solvita Olsena 4, Ms. Ināra Kantāne 1, Dr. Elizabete Pumpure 5, Ms. Ieva Pitkēviča 5, Ms. Marta Laura Graviņa 1, Ms. Darja Mihailova 6 1. Institute of Public Health, Rīga Stradiņš University, 2. Department of Public Health and Epidemiology, Rīga Stradiņš University, 3. Department of Obstetrics and Gynaecology, Rīga Stradiņš University; Riga Maternity Hospital; Riga East Clinical University Hospital, 4. Faculty of Medicine, University of Latvia, 5. Rīga Stradiņš University, 6. Faculty of Medicine, Rīga Stradiņš University

Objectives Since on March 11, 2020 WHO declared the novel coronavirus disease pandemic, a signiﬁcant proportion of the world population was either under complete or partial lockdown along with family or even unwanted company. Almost all domains of lives have been affected whilst sexual life through bio-psycho-social factors is not an exception. Aim of the study was to ﬁnd out impact of COVID-19 restrictions on woman’s sexual health.

Materials and Methods Online survey and qualitative research were conducted from July to October 2020 as a part of a multi-country study I-SHARE (International Sexual Health And REproductive Health survey in the time of COVID-19) and the state research project “Impact of COVID-19 on health care system and public health in Latvia; ways in preparing health sector for future epidemics” (VPP-COVID-2020/1-0011). Data were summarized and analysed using MS Excel and IBM SPSS 26.0.

Results 1173 people living in Latvia submitted an online survey - 82.4% women, 17.4% men. Most respondents (37.8%) noted having sexual relations 2 to 3 times a week and for 58.8% frequency of sexual relations did not change. De- crease in sexual satisfaction was observed among women (16.2% vs 24.3% not satisfied), Friedman test, p<0.001. People who did not have children more often were dissatisfied with their sex life (27.2% vs 20.2%), Cramer’s V=0.119, p=0.002. As relationship tension increased, dissatisfaction with sex life increased (Spearman’s correlation, rs=0.207, p<0.001) and sex life frequency decreased (Spearman’s correlation, rs= 0.254, p <0.001). Women who increased alcohol consumption were less satisfied with their sex life (Cramer’s V=0.100, p=0.009). Quanti- tative survey showed decrease of intimate partner violence (Wilcoxon test, p<0.001), while qualitative research discovered significant increase of violence against women.

Conclusions Sexual life was ongoing also during pandemic time, but many aspects of women’s sexual quality of life and relations were inﬂuenced, including increased risks of violence during lockdown.

25 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

World Health Organization as the main international actor in ﬁght against COVID-19

Dr. Jānis Grasis 1, Dr. Karīna Palkova 1 1. Rīga Stradiņš University

Objectives World Health Organization (WHO) was established 7 April 1948 – this is a date when we now every year celebrate as World Health Day. The objectives of this article are to analyze the role and inﬂuence of WHO in ﬁght against COVID 19 virus: efectiveness of governance of WHO, how WHO memberstates overtakes WHO recomendations and what are the main problems for WHO to become even more efective as the main international actor in order to ensure the health of the inhabitants of our planet.

Materials and Methods According to the preamble to the Constitution of WHO, the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political be- lief, economic or social condition. Governments have a responsibility for the health of their peoples which can be fulﬁlled only by the provision of adequate health and social measures. the main stekholders of WHO are: Ministries of Health, government agencies, other government departments at the national level; and also in- ﬂuencers like health partnerships, foundations, intragovernmental and nongovernmental organizations, civil society, media, professional associations, and WHO collaborating centres. As You see the main steakholders are very different with different interests, so it is not so easy to adopt decisions to satisfy all interests. Comparative and analytical research methods are used for this paper.

Results Recently the WHO has got a lot of critics in connection with COVID19, starting from US for failing to make necessary warnings in a timely manner, and for misleading information for countries on use of masks and also making “contradictory statements”.

Conclusions As United Nations agency, WHO can’t function without the goodwill of the governments; the governments must enlarge ﬁnancing of the WHO. We need a multinational institution composed of medical professionals who manage public health in the world.

26 Health Promotion RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Analysis of dietary habits in Latvian general population in respect to adherence to Mediterranean diet

Mrs. Liene Sondore 1, Mrs. ILze Indriksone-Gromova 1, Mrs. Ilva Daugule 1, Mrs. Inese Poļaka 1, Mr. Sergejs Paršutins 1, Mrs. Ilona Kojalo 1, Mr. Mārcis Leja 1, Mrs. Ineta Jurkevica 2, Mrs. Daiga Šantare 1

1. University of Latvia, 2. Rīga Stradiņš University

Objectives To evaluate adherence to the MD in average 40-64 year old Jekabpils population and to analyse socioeconomic factors that are associated with adherence to diet.

Materials and Methods The study was carried out as a sub-study of the “Multicentric randomised study of H.pylori eradication and pepsinogen testing for prevention of gastric cancer mortality (the GISTAR study)”. Participants aged 40-64 years were enrolled (October,2019 - November,2020) in the study centre in Jekabpils. Participants completed a 14 item self-administered MD diet score questionnaire; one score point was assigned for each match. Adherence to MD was evaluated as low (score 0-5), medium (score 6-9) or high (score 10-14). Socioeconomic data were collected within the GISTAR study protocol.

Results In total, 963 participants completed the questionnaire, the ﬁnal sample - 938 individuals, out of them - 283(30%) men. Adherence to MD was evaluated as low in 671(69.7%), medium - 297(29.0%) and high - in 13(1.30%) cases. There was a signiﬁcant difference in adherence between genders: low adherence was reported in 63.20% and 85,20%; medium - in 34.90% and 14.80%; high - in 1.90% and 0.00% of females and males, respectively (p<0.001; χ2 test). No difference in adherence was noted for age and employment, while participants with higher education level showed trend to higher scores for adherence to MD.

Conclusions The adherence to MD in Jekabpils general population is low with higher adherence in women and no association with age or employment.

28 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Analysis of referrals to genetic investigations in children 0–3 months old in Children’s Clinical University Hospital (Riga, Latvia) in year 2019

Dr. Jelena Liepa 1, Dr. Madara Kreile 2, Dr. Gita Tauriņa 3, Dr. Ieva Mičule 3, Dr. Ieva Grinfelde 4, Dr. Daiga Mūrmane 5 1. Rīga Stradiņš University, 2. Clinic of Medical Genetics and Prenatal Diagnosis, Children’s Clinical University Hospital; Scientiﬁc Laboratory of Molecular Genetics, Rīga Stradiņš University, 3. Clinic of Medical Genetics and Prenatal Diagnosis, Children’s Clinical University Hospital, 4. Clinic of Medical Genetics and Prenatal Diagnosis, Children’s Clinical University

Hospital; Rīga Stradiņš University, 5. Children’s Clinical University Hospital; Clinic for Medical Genetics and Prenatal Diagnosis

Objectives Genetic disorders occur in about 2-5% of all live births and cause about 50% of infant deaths in industrialized countries. Children presenting with a severe disease in early childhood represent a population likely enriched for rare genetic diseases. The aim of the study was to investigate the most common causes for referral to a clinical geneticist during ﬁrst 3 months of age and observe the diagnoses.

Materials and Methods This is a retrospective analysis of 1096 medical records of patients consulted by a clinical geneticist in Children’s Clinical university hospital during year 2019. From all the records 101 were selected as appropriate.

Results In 36 cases (35,6%) ﬁrst consultation was made during the ﬁrst week of life. Born prematurely were 31 (30,7%) infants. Apgar score was below 7 in 31 (30,7%) cases. Abnormalities were found prenatally in 36 cases (35,6%). The most common causes for consultation were nervous system diseases – 22,7 %, congenital heart defect - 19,8% and muscle-skeletal abnormalities – 17,8%. In 78 cases (77,2%) the patient’s features were strongly suggestive of a genetic disorder, but in 23 cases (22,7%) the clinical picture was very complicated and the geneticist was invited as one of several consultants. Diagnosis of a genetic disease was made in 15 cases (14,83%), of which 10 were chromosomal abnormalities and 5 (4,9%) were monogenic disorders.

Conclusions Genetic disorders were suspected in many infants but found in a minority. Genetic disorders should be suspected in premature births. Neonates who needed resuscitation in delivery room are suspicious on genetic disorders. Urgent transfers from the perinatal centres to Children hospital are often needed in these cases. The study should be continued with bigger patient count and for a longer time period as diagnostics of rare diseases may take several years.

29 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Association between road safety behaviour and careless health behaviour in Latvian adult population

Mrs. Aija Bukova-Zideluna 1, Prof. Anita Villeruša 1, Mrs. Iveta Pudule 2 1. Department of Public Health and Epidemiology, Rīga Stradiņš University, 2. The Centre for Disease Prevention and Control of Latvia

Objectives The aim of the study was to research the road safety behaviour of the adult population of Latvia in relation to careless health behaviour (smoking, excessive alcohol consumption, no regular health check-ups at the family doctor).

Materials and Methods The data of “Health behaviour among the Latvian adult population” for ﬁve consecutive surveys for the years 2010-2018 were selected for analysis. Questions regarding sociodemographic factors, self-reported use of seat belt in vehicle and other health related behaviour were used to obtain information and analyse results. T-test and logistic regression analyses were conducted to compare outcomes.

Results The prevalence of respondents always wearing a seat belt has increased from 93.5% (N = 1932; 95% CI 92.4 – 94.5) to 95.6% (N = 2272; 95% CI 94.8 – 96.4) in the front seat and from 52.4% (N = 1084; 95% CI 50.3 – 54.4) to 56.3% (N = 1338; 95% CI 54.5 – 58.3) in the rear seat between year 2010 to 2018 (p < 0.0001). Of the 10731 respondents, 30.8% (N = 3309; 95% CI 30.0 – 31.7) were daily smokers, 14.8% (N = 1593; 95% TI 14.2 – 15.5) had excessive alcohol consumption habits, 74.1% (N =7952; 95% CI 73.3 – 74.9) had visited their family doctor last year one or more times. Odds to use seat belt were 2.6 times lower in the front seat and 1.7 times lower in the rear seat for daily smokers, 2.8 and 2.4 times lower for excessive alcohol users, 1.6 and 1.4 times lower for those, who had not visited their family doctor last year, respectively. Multivariate regression analysis showed careless behaviour is an independent factor associated with road safety habits.

Conclusions The relationship between individual road safety habits and careless health behaviour highlights the need to base public health policies and health promotion on an integrated approach.

30 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Beliefs about necessity and admissibility of physical activity during lower back pain episode

Dr. Jelizaveta Aleksejeva 1, Dr. Matīss Mežals 2, Prof. Inara Logina 3 1. University of Latvia, 2. Rīga Stradiņš University, 3. Rīga Stradiņš University; Pauls Stradins Clinical University Hospital

Objectives The aim of the current study was to analyze opinion on activity status during back pain episode.

Materials and Methods A retrospective study was performed through a survey. The questionnaire used in the study contained sociodemographic data, pain characteristics and the Back-Pain Attitudes Questionnaire (Darlow et all, 2014). In this study only questions regarding activity participation while experiencing back pain were selected. The obtained results were compared between healthcare professionals (HCP) and non-HCP. IBM SPSSv23 was applied for the statistical analysis.

Results Two hundred sixty-three respondents were included in the study (mean age 46.9 years, SD ± 14.1), predominantly females (80.6% vs. 19.4%). From all participants, HCP accounted for 36.9% (N=97). Almost all (non-HCP and HCP) participants agreed that it is important to see a HCP if individual has back pain – 91.0% vs. 90.7% (151/166 vs. 88/97). Both analyzed groups (non-HCP and HCP) were unsure or agreed with the statement that in the case of back pain, exercise should be avoided – 59.0% vs. 41.2% (98/166 vs. 40/97). Interestingly that a little bit more part of non-HCP group in comparsison to HCP group agreed that during back pain episode the risks of vigorous exercise outweight the beneﬁts – 65.1% vs. 57.7% (108/166 vs. 56/97). Non-HCP and HCP groups to varying degrees were unsure or disagreed with the statement that if they have back pain, they shouldn’t try to stay active – 46.4% vs. 30.9% (77/166 vs. 30/97).

Conclusions Healtcare professionals’s recommendations has a fairly large impact on patient’s recovery from the back pain episode and until HCP are conﬁdent that avoidance of physical activity and resting is better than being active, patient’s pain and disability episode becomes longer. HCP should be more educated about physical activity signiﬁcance in the recovery from back pain.

31 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Disability and pain catastrophizing in patients with low back pain during COVID-19 pandemy

Dr. Zaiga Kalnberza Ribule 1, Dr. Anna Millere 2, Prof. Liana Deklava 3, Prof. Inara Logina 4, Dr. Anda Nulle 2, Prof. Inga Millere 5 1. National Rehabilitation Centre “Vaivari”; Rīga Stradiņš University, 2. National Rehabilitation Centre “Vaivari”, 3. Rīga Stradiņš University, 4. Rīga Stradiņš University; Pauls Stradins Clinical University Hospital, 5. Rīga Stradiņš University; Riga East Clinical University Hospital

Objectives To examine disability and pain catastrophizing during COVID-19 pandemy among patients with LBP in rehabilitation practice.

Materials and Methods In this study four research tools were used: Demographic questionnaire, Visual analog scale (VAS), The Oswestry Low Back Disability Questionnaire (Fairbanks et al., 1980.), Pain Catastrophizing Scale (Sullivan et.al. 1995). The statistical analysis was performed using SPSS software version 22.0.

Results Totally 74 patients with LBP received rehabilitation for LBP were included in this study during Covid-19 pandemy aged from 40 to 82 years with mean age 59. During Covid-19 pandemy higher LBP intensity was reported by those individuals who were aged between 35 and 56 years old. According to Visual analogue scale mean scores in patients during Covid-19 pandemy were 40 mm which indicates mild pain. According to Oswestry Low Back Pain Disability Questionnaire most of LBP patients during COVID-19 pandemy had minimal disability 60% and moderate disability were 40%. Results showed statistically correlation between disability and pain intensity (p<0.01), catastrophizing (p<0.05), such as rumination and helplessness (p<0.01).

Conclusions The Covid-19 pandemic has strained the importance of biopsychosocial approach to pain management. The decrease of pain services jointly to home lockdown had affected chronic pain management with additional impact on patient’s psychological health. It is necessary to ensure continuity of rehabilitation during pandemy. The obtained results point out the importance of pain catastrophizing in determining disability. It is very important to use results for low back pain management model in rehabilitation practice. However, it is necessary to continue research work to identify all possible aspects of factors that inﬂuence low back pain in multidisciplinary care and cure for better target interventions.

32 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Impact of different physical activity on children socialization

Prof. Rūta Dadeliene 1, Mrs. Ineta Daniuliene 1 1. Vilnius University

Objectives To determine the impact of different physical activities on the socialization of primary school students.

Materials and Methods The research involved 48 primary school students. Subjects were devided into two groups: research group (n = 24) and control group (n = 24). The research group experienced educational physical games and exercises routine and the control group underwent ordinary physical activities. Both groups classes were held twice a week, for 45 minutes, 24 times for each student. The research had two stages: before and after the intervention. Methods used in the study: for the behavior, expression of emotions and communication with peers – Strengths and Diﬃculties Questionnaire; to determine concentration of attention – Digital correction table; to evaluate stress levels during activity – VERIM Lab. ProNet, biofeedback.

Results Applied educational physical games and exercises intervention for the research group had a positive impact for students’ behavior (p=0,001), hyperactivity (p=0,011), communication with peers (p=0,011) and general dif- ﬁculties (p=0,001). There was a statistically signiﬁcant improvement in students’ attention indicators in both research (p=0,001) and control (p=0,036) groups. In the research group stress levels during physical activities decreased, in smallest (p=0,021) and biggest (p=0,037) intensity of activity ‘s.

Conclusions 1. Educational physical games and exercises applied during non-formal education reduced students’ behavior problems, hyperactivity and general student’s diﬃculties, examined normal physical activity’s indicators weren’t affected. 2. Applied extracurricular educational physical activities had greater impact to primary school students’ concentration of attention and stress levels during physical activity’s lowest intensity phase, compared to ordinary activities.

33 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Intervention model for health behaviour change: a tool to support practitioners in health promotion intervention development

Prof. Inese Gobiņa 1, Mr. Aigars Miezitis 2, Mrs. Margarita Apine 2 1. Institute of Public Health, Rīga Stradiņš University, 2. Rīga Stradiņš University

Objectives Health promotion interventions on a local level are often being planned and implemented by practitioners not explicitly trained in health promotion intervention development. This project aimed to develop the intervention model for health behavior change on the individual or group level for supporting practitioners in health promotion.

Materials and Methods The intervention model was developed by the Public Health Institute at Rīga Stradiņš University (Latvia) and tested within the Interreg BaltCityPrevention project (www.baltcityprevention.eu). The model was built upon existing frameworks on health interventions by applying a systematic multi-stage and user-centered approach when developing the model for health promotion practitioners. The model was reviewed and tested by 14 project partners – municipalities, NGOs, SMEs, and universities from the countries of the Baltic Sea Region: Latvia, Lithuania, Estonia, Poland, Finland, and Germany.

Results The intervention model included the planning phase consisting of “explore”, “design “, “operate”, and “test” stages followed by the implementation (“act”) and evaluation (“check”). In the model, both intervention design and development of a logic model were presented to ensure the intervention operates well into the practice. The model provided both conventional and e-tools for user needs assessment and behavioral change that might be selected when planning the intervention. The guidelines and visual e-learning tools were developed to support the health promotion practitioners to use the model. In general, the project partners – health promotion practitioners appreciated the model as a practical tool that can be useful for developing health promotion interventions.

Conclusions Collaboration between universities and local health practitioners can improve health promotion practice by translating academic and evidence-based knowledge into practice.

34 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Needs and priorities to improve health and well-being of the ageing population in Latvia: ﬁndings from the AgeFLAG project

Dr. Signe Tomsone 1, Ms. Madara Mikelsone 2, Dr. Andrejs Ivanovs 2 1. Department of Rehabilitation, Rīga Stradiņš University, 2. Rīga Stradiņš University

Objectives The project “Roadmap to improve the health and well-being of the ageing population in the Baltic Sea Region (AgeFLAG)” seeks to identify the most important issues in relation to active and healthy ageing that countries in the region are facing. The aim of the study was to bring together the most relevant national stakeholders to identify the top ﬁve national needs that should be addressed to improve active and healthy ageing in Latvia.

Materials and Methods In Latvia, the study was implemented in the form of an expert survey which was organized in a four steps- presentation of the most recent national data, mapping of all possible needs, prioritization of needs and iden- tiﬁcation of top ﬁve needs in the country. Representatives from various organizations were approached as experts to participate in the survey, based on publicly available information about the organization’s activities or based on RSU’s previous cooperation experience in implementing various projects related to active and healthy ageing. In total 26 experts completed the survey.

Results The top ﬁve needs priorities named in Latvia were- 1) provision and availability of health and social care, 2) ﬁnancial and social security, 3) sense of security and independence, 4) health promotion and 5) physical and social activities. In addition, needs such as respectful treatment of seniors and digital skills were mentioned.

Conclusions Results from the expert survey in Latvia will be synthesized with the similar data from other countries in the Baltic Sea region in order to support healthy and active ageing policy recommendations for state and public institutions of the countries in the region.

35 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Physical activity in young people with cystic ﬁbrosis living in Latvia

Mrs. Arta Ūdre 1, Mrs. Dace Bertule 1, Dr. Elina Aleksejeva 2 1. Rīga Stradiņš University; Children’s Clinical University Hospital, 2. Department of Paediatrics, Rīga Stradiņš University; Department of Pediatrics, Children’s Clinical University Hospital

Objectives To ﬁnd out the amount of physical activity in young people with cystic ﬁbrosis and research physical activity experience.

Materials and Methods In the quantitative part of the research self-assesment of habitual activity of 13 young people with cystic ﬁbrosis was performed using the questionnaire “Habitual Activity Estimation Scale” (HAES). Participants objective activity measurement was performed by using Maastrichts University developed accelerometer device MOX. Data were analyzed and compared using descriptive and conclusive statistics. In the qualitative part of the research were performed individual semi-structured interviews with four participants about experience of physical activity. Data processing was performed using deductive content analysis.

Results Average time spent in total activity after HAES was 304,3 (+-125,9) min/day, after MOX was 220,3 (+-61,5) min/day. Average amount of moderate physical activity after MOX was 62,1 (+-38,8) min/weekday and 59,1 (+-21,3) min/weekend day. Motives for physical activity in youth living with cystic ﬁbrosis are health improvement, visual image, competences and social inﬂuence. Experience of physical activity is affected by health, personal and environmental factors.

Conclusions Habitual physical activity of participants is sufficient - twelve from thirteen reached World Health Organization recommendations of moderate to vigorous physical activity minutes per week. HAES is useful questionnaire to assess physical activity of youth with cystic fibrosis. The main reason to use HAES could be to assess the changes in activity of persons with cystic fibrosis. Significant aspects of physical activity experience in children and young adults with cystic fibrosis are - improvement in health, visual image, benefits form physical activity, feelings in time and after physical activity, pleasure and knowledge of physical activity, social and environmental aspects. Qualitative results give opportunity to develop instrument to identify and grade factors that affect physical activity in individuals with cystic fibrosis. Facilitation of positive physical activity experience would be the main target of instrument.

36 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Physical activity, subjective health complaints’ and problematic internet use related psychosocial behavior problems in adolescents

Dr. Aija Kļaviņa 1, Dr. Viktors Veliks 2, Prof. Juris Porozovs 2, Mrs. Luize Bebrisa-Fedotova 1, Mr. Aleksandrs Aniscenko 1, Mr. Nageswara Krishnavarapu 1

1. Latvian Academy of Sport Education, 2. University of Latvia

Objectives This study investigated physical activity, subjective health complaints and psychosocial behavior problems related to problematic internet use in adolescents across different regions of Latvia.

Materials and Methods Participants were 570 adolescents (age 11-19 year old) representing different districts of Latvia. A composite score of the Problematic and Risky Internet Use Screening Scale (PRIUSS) contained social, emotional and risky/ impulsive internet use variables. The subjective health complaints explored were somatic and psychological health diﬃculties, while the healthy lifestyle included physical activity, eating habits and screen-based behav- iors. PRIUSS total score was used as dependent variable in multiple analysis of covariance with the four age subgroups (11-12, 13-14, 15-16 and 17-19) and gender as covariates.

Results There were significantly higher scores in somatic health complaints (headache, stomachache, backache, dizzi- ness) and PRIUSS scores for girls than for boys (p <.05). The healthy lifestyle outcomes did not present significant differences across gender subgroups, while these scores were lower than indicated in the WHO physical activity guidelines (2020) (e.g. daily physical activity level was 1.53 – 3.34h /week for boys, 1.84-2.46 h/ week for girls). The subjective health complaints and PRIUSS scores were significantly higher for 15-16 years old girls (p <.05), while such differences were not observed in boys (p >.05). The high PRIUSS scores (≥ 26 ) were significantly related to low level of daily physical activity, high rates of unhealthy eating habits and subjective health com-plaints (p <.000). There were not significant differences in study outcomes across the four regions of Latvia.

Conclusions High PRIUSS score and low physical activity rates are related with more subjective health complaints and unhealthy eating habits. The research was done in the framework of the Latvian Council of Science Fundamental and Applied Research Project Nr. lzp-2019/1-0152 Comprehensive Assessment and Support Program to Reduce Screen Time Related Health Risks in Adolescents.

37 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Poor self-reported health in association with sleep duration and health complaints among adolescents in Latvia

Mrs. Solvita Klavina-Makrecka 1, Prof. Inese Gobiņa 1, Mrs. Iveta Pudule 2, Mrs. Daiga Grīnberga 2, Mrs. Biruta Velika 2, Prof. Anita Villeruša 1 1. Rīga Stradiņš University, 2. The Centre for Disease Prevention and Control of Latvia

Objectives Self-reported health is a feasible and valid indicator of adolescents’ general health, including physical and emotional dimensions. Insufficient sleep and recurrent health complaint may increase the risk of poorer self- reported health in adolescence. The association between poor self-reported health and insufficient sleep, and mediating effect of health complaints among adolescents is not well understood. This study aims to explore the association between poor self-reported health and insufficient sleep duration (on school and non-school days) among 11, 13, 15-years old adolescents in Latvia by assessing moderation effects of age and gender and by considering the mediating effect of health complaints on association between sleep duration and self-reported health.

Materials and Methods Data from the Health Behaviour in School-aged Children Study on 2017/2018 of Latvia (n=4412) were used for statistical analysis. Logistic regression models were calculated to assess the main effects of insuﬃcient sleep duration (<7h) adjusted by gender, age and health complaints (HBSC health complaint sum-score); and interaction effects of gender and age on poor self-reported health.

Results 19.3% reported insufficient sleep duration on schooldays and 4.4%on non-school days. Of those with insufficient sleep duration, 5.8% reported poor self-reported health while this proportion was 2%among those with sufficient sleep. Insufficient sleep duration was associated with increased odds of poor self-reported health on schooldays (OR=3.02;95%CI 2.02-4.49), but not on non-schooldays, regardless of adolescent’s gender, age. The association between insufficient sleep and poor self-reported health changed considerably after adjustment with health complaints (OR=1.58;95%CI 1.03-2.43), however, it still remained significant.

Conclusions Adolescents with insuﬃcient sleep are at increased risk of poor self-reported health on schooldays regardless of their gender and age. Insuﬃcient sleep seems to have strong effect on poor self-reported health that cannot be fully explained by having more health complaints. Further studies are needed to study explanatory mechanisms of the association between sleep duration and self-reported health.

38 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Promotion of health and quality of life

Ms. Kalina Racheva 1 1. Medical University “Prof. Dr. Paraskev Stoyanov” – Varna

Objectives Popularizing health and science, aiming to help people change their way of living. It involves various activities, which strive towards expanding the individual and societal wellbeing. The goal is to save, protect and heal the mental and physical state of a human being. This includes avoiding or removing everyday risks and replacing them with beneﬁcial for the person ingredients for a better health. All of this is possible, when the medical personnel actively spreads out a correct interpretation of health education and are responsible for the proper implementation of the said education.

Materials and Methods Documental method, statistical methods – analyzing information collected from NSI and the European Commis- sion

Results Based on previous years the average life span of Bulgaria has increased, however the cardiovascular diseases are the main reason for passing in the country. The reason for this is the behavioral risk factors. In Bulgaria this is caused by leading an unhealthy lifestyle, supported mainly by alcohol abuse and nicotine addiction. Having said that however, in Bulgaria it is reported that there is great effect in the treatment regarding the prevention of death. The law invokes regulations for smoking in public places, for selling nicotine products to minors and decreased the ads on cigarettes. A project was created with the name “Healthier Children”, which provokes physical ﬁtness and maintaining a balanced diet in schools. 67% of the population report that they are in good-health. Medical facilities and research are growing, as well as the prevention campaigns for different subjects.

Conclusions The major aspect in succeeding in our goal is to provide equal and substantial health maintaining possibilities for keeping a lively and healthy lifestyle. The next big step is to have control over the methods that are responsible for lowering risk factors as well as supplying the public with alternative means for optimal health.

39 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Risk identiﬁcation for cross-sectoral cooperation in health promotion practice

Mrs. Elīna Vrobļevska 1, Prof. Anita Villeruša 2, Prof. Inese Gobiņa 3, Dr. Lauma Spriņģe 4, Ms. Indra Liniņa 3 1. Department of Political Science, Rīga Stradiņš University, 2. Department of Public Health and Epidemiology, Rīga Stradiņš University, 3. Rīga Stradiņš University, 4. Department of Public Health and Epidemiology, Rīga Stradiņš University; Institute of

Public Health, Rīga Stradiņš University

Objectives Cooperation in health promotion is an everyday practice where all the partners can beneﬁt from learning and achieving individual and shared goals for establishing better and healthier patterns in society. During the COVID-19 pandemic, unplanned events can challenge project implementation making it even more crucial to elaborate on a strategy for dealing with unexpected situations by identifying risks of cooperation. This paper aims to present the component of risk identiﬁcation for cross-sectoral cooperation as a part of the Model for cross-sectoral cooperation.

Materials and Methods Within the EU Interreg project, “Urban Labs for Better Health for All in the Baltic Sea Region” (Healthy Boost), the Model for cross-sectoral cooperation was developed for improving the cross-sectoral cooperation for health and wellbeing in nine cities of the Baltic Sea Region. Risk identification as one of the five domains of cross-sectoral cooperation has been developed based on published scientific literature and the results of a self-assessment of cross-sectoral cooperation in the Healthy Boost project partner cities.

Results Risk identiﬁcation focuses on different types of risks that should be considered at different stages of the project. In the project mapping stage, partner assessment, the timing of cooperation, and the identiﬁcation of risk obstacles for cooperation should be considered. In the planning stage, realistic objectives, honest and trustworthy communication among partners are important. The fair distribution of responsibility and projects according to the previously planned activities and strategies should be considered in the implementation stage. In the assessment stage, partners should consider the risks for successful assessment by determining the cooperation indicators and methods to collect those.

Conclusions Risk identiﬁcation is an essential domain of successful cross-sectoral cooperation that should be considered during all stages of the partnership. It allows partners to identify possible obstacles that could hinder the achieve- ment of project objectives at any stage of the project implementation.

40 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The self-assessment tool for cross-sectoral health promotion

Dr. Kaija Matinheikki-Kokko 1, Dr. Arja Liinamo 1 1. Metropolia University of Applied Sciences

Objectives Health promotion environments require cross-sectoral cooperation to enhance and optimize the use of frag- mented resources and to improve coherence in addressing urban health solutions in all sectors. By creating and testing the Model for Cross-Sectoral Co-operation, the Healthy Boost project (“Urban Labs for Better Health for All in the Baltic Sea Region”) aims to enhance cross-sectoral cooperation for urban health and well-being. The Healthy Boost -project also created a self-assessment (SA) tool with concrete focus on health promotion. The core of self-assessment was to enable Healthy Boost’s partner cities from nine Baltic Sea countries to identify their current state of cross-sectoral collaboration and its potential to improve health promotion. The results also provided information used for model development.

Materials and Methods All together 329 staff members from nine cities with different city sectors assessed their cross-sectoral cooperation actions by using the SA questionnaire including 16 Strategic and 27 Operative statements. The city- based analysis of self-assessments will be published anonymously because the pilot did not intend to compare the superiority of the test cities.

Results There were signiﬁcant differences within and between cities according to what extent they engaged in the cross- sectoral cooperation in their strategical work and operative actions related to health and well-being. The biggest strategical challenge was the ability to coordinate cross-sectoral cooperation. In operative actions the lack of common cross-sectoral tools, communication and resources challenged cross-sectoral day-to-day work in health and well-being.

Conclusions Assessment tools and the input of all sectors are needed to establish accountability, increase capacity to address health challenges and to mobilize increased resources for implementing cross-sectoral actions. In the future evidence-based SA-tool and Model produced by Healthy Boost -project will be available guiding cities towards systematic cross-sectoral cooperation for the best of residents’ health and well-being.

41 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Towards integration of dynamic and complex systems in health promotion: addressing the necessity to cooperate

Dr. Agnė Slapšinskaitė 1, Dr. Justina Vaitkevičiūtė 2, Dr. Monika Grincaitė 2, Dr. Asta Raskilienė 3, Mr. Lukas Galkus 2 1. Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences; Department of Sports Medicine, Faculty of Nursing, Medical Academy, Lithuanian University of Health Sciences, 2. Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, 3. Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences; Institute of Biology Systems and Genetic

Research, Lithuanian University of Health Sciences

Objectives To summarize the importance of cooperation for health promotion

Materials and Methods Opinion research paper

Results Health promotion enables people to increase control over their own health. It covers wide range of social and environmental interventions that are designed to benefit and protect individual people‘s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure. Health is containing that dynamic perspective as it can be seen as adaptive state unique to each person. The dynamic perspective of city – several political, economic, social and infrastructural characteristics of city network demonstrates how it interacts and evolves. Complex system is characterized by highly connected network of entities (i.e., physical objects, people, people groups) from which emerges higher order behavior. Complexity itself stands as potential solution that can add coherence and direction to this emerging field in health promotion practice. Main properties that may determine the requirements needed to accomplish realization of “health promotion” functionality in society: interconnections between the system elements follow non-linear dynamics; evolves only when harmony or coherence between its elements is present; organizes its functions on the basis of deterministic chaos; contains fractal levels, and involves an interplay between cooperation and competition. For realization of health promotion cooperation is crucial. Each fractal level (regulatory body (administration in any level of health promotion activity), financial resources, and real institution) needed for realisation of any health promotion initiative. Small change in areas of management, financing or implementation provokes all other components instantaneously to review their capabilities and adapt.

Conclusions It is important to develop, review health promotion activities, and involve partners from different sectors. The development of effective cooperation and partnerships with private sector stands as priority once we take into account the sensitivity of complex system. Interconnectedness is crucial.

42 Disease Prevention And Screening RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Association between preceding mammography results and the breast cancer-screening adherence among the ﬁrst cohort of women enrolled in the organized screening program in Latvia

Dr. Dzeina Mezale 1, Mrs. Una Kojalo 1, Prof. Inese Gobiņa 1 1. Rīga Stradiņš University

Objectives In Latvia, the participation rate in a nationally organized breast cancer screening remains low, but the underlying factors are not studied suﬃciently. The study aimed to investigate the association between the preceding screening results and breast cancer-screening adherence among the cohort of women participating in breast cancer-screening program from 2009 to 2017. The screening mammography results are measured from R1 to R5, where R1 means no changes in breast tissue and R5 – proved malignancy. If the screening result is higher than R3, women are offered to do the post-screening examination to establish the cancer diagnosis; however, if the examination reveals false positive screening results, these women tend to have lower chances to participate in the followings screening rounds.

Materials and Methods A cohort of 140 781 women (aged 50–69) who were enrolled in the breast cancer screening program for the ﬁrst time in Latvia was analysed cross-sectionally for every two years. Result of the screening mammography was measured from R1 to R5. The odds of breast cancer screening adherence in association with the previous mammography results were analysed with a binary logistic regression.

Results In 2009, the proportion of screening results R3-R5 was 18.7%, and it followed to exceed the acceptable level of 5% in the following study years. In every studied year women with previous screening results R2-R5 had lower chances (9%-74%) to be screened for breast cancer than the women with last screening results R1 by adjusting for age.

Conclusions A strong association between the result of the previous screening mammography and future screening adherence rates was found - the more serious the result was, the less likely it was that a woman would undergo repeated screening mammography. The ﬁndings suggest that particular attention should be paid to the mammography description quality in the breast cancer screening program.

44 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Association of self-rated health, life satisfaction and mental health diﬃculties in Latvian adolescents

Dr. Nikita Bezborodovs 1, Dr. Inga Zarde 2, Mrs. Iveta Pudule 3, Prof. Anita Villeruša 4 1. Department of Psychiatry and Narcology, Rīga Stradiņš University; Child Psychiatry Clinic, Children’s Clinical University Hospital, 2. University of Latvia, 3. Research and Health Statistic Department, The Centre for Disease Prevention and Control

of Latvia, 4. Department of Public Health and Epidemiology, Rīga Stradiņš University

Objectives Mental health diﬃculties are highly prevalent in adolescent populations, but often unrecognised and untreated. The aim of the study was to investigate self-rated health and life-satisfaction as a possible proxy indicator of mental health diﬃculties in Latvian adolescents.

Materials and Methods The study was conducted using data from the international Health Behaviour in School-aged Children (HBSC) study year 2017/2018 database. HBSC in 2017/2018 included a mental health-screening instrument - The Strengths and Difficulties Questionnaire (SDQ), which is a brief behavioural screening questionnaire for 3-16 year olds. SDQ results were classified as abnormal, and indicative of significant mental health difficulties, if 22 points and higher were reached on the SDQ total difficulties score (results above the 90th centile). A binomial logistic regression model was used to explore the link between self-rated health, life-satisfaction and mental health difficulties, adjusting for sociodemographic factors (sex, age, ethnicity and socioeconomic status).

Results The sample consisted of 4412 adolescents age 11, 13 and 15. 2224 (50,4%) were girls. Girls in the sample had 1,33 times higher odds (CI 1,07-1,66) [Office1] of reporting significant mental health difficulties. Adolescents who evaluated their socioeconomic status as low had 2,44 times higher odds (CI 1,62-3,69) of reporting signif-icant mental health difficulties. The results of the regression model indicated that even after controlling for sociodemographic factors, adolescents that did not rate their health as good or excellent had 2,56 times higher odds (CI 2,00-3,29), and adolescents with low life satisfaction (0-6 on a 10 point scale) had 3,06 times higher odds (CI 2,39-3,93) of reporting significant mental health difficulties.

Conclusions Poor self-rated health and life satisfaction are important predictors of significant mental health difficulties in the adolescent population. It is recommended to screen adolescents reporting poor self-rated health and life satisfaction in general medical practice for previously undiagnosed mental health difficulties.

45 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Awareness and prevalence of HPV vaccinations in Lithuania

Ms. Migle Jakineviciute 1, Mrs. Olga Mesceriakova-Veliuliene 2, Ms. Ramunė Blankaitė 3, Mrs. Jurgita Vladickiene 4, Mr. Domas Sikorskis 1 1. Master’s Study Programme “Medicine”, Lithuanian University of Health Sciences, 2. Doctoral Study Programme “Public Health”, Lithuanian University of Health Sciences, 3. Vilnius University, 4. Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences

Objectives The aim of the study was to assess the awareness and prevalence of HPV vaccinations in Lithuania.

Materials and Methods Anonymous survey was conducted in February 2019 in Kelmė city, Lithuania. It included 203 women aged 25 to 60 years old. Associations between categorical variables were measured using Chi square test. A statistically signiﬁcant difference was deﬁned when P<0.05. Z criterion was used for evaluating hypothesis of variable dependence.

Results Although 79.8% of the respondents reported that HPV has an impact on the development of cervical cancer and 68% stated that HPV is the main risk factor of cervical cancer, none of them were vaccinated and only 11.8% of their daughters were vaccinated. Only 30% of the respondents were aware of free vaccination for 11 years old girls: 44.4% have obtained this information from their family physician, 34.9% – from the mass media. Overall, 84.2% of the respondents reported the lack of information about HPV vaccination, especially women aged 40–60 years and having lower than the upper secondary education (P<0.05).

Conclusions The participants of the study know that cervical cancer is caused by HPV, however, the lack of information about vaccination can lead to low vaccination levels. As expected, public education and adding HPV vaccine to the national vaccination program for 11 years old girls could enhance the choice for vaccination and likely reduce cervical cancer morbidity in the future.

46 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Body mass index and waist-to-height ratio as a predictors of metabolic syndrome

Dr. Sabīne Rumpe 1, Dr. Jeļena Daniļenko 1 1. Rīga Stradiņš University

Objectives The purpose of this study was to evaluate and compare usefulness of the body mass index (BMI) and waist-to- height ratio (WHtR) in screening for metabolic syndrome (MS).

Materials and Methods A cross-sectional study was conducted in MFD Outpatient hospital “Ilguciems” from October 2017 to March 2018 and continued from October 2020 to December 2020. The patients were asked to complete a questionnaire about their socio-demographic characteristics and lifestyle factors. Patients systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood sugar (FBS), serum triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels were measured. Disease history were studied. Anthropometric measurements (height, weight and WC) were taken. BMI and WHtR were calculated. All statistical analysis was performed in IBM SPSS 23.0. The value of Spearman’s rank correlation coefficient (rS), Pearson correlation coefficient (rP), Pearson’s chi-squared test (X2) and Fisher’s exact test were determined. P value <0.05 was considered to be statistically significant.

Results The study involved 99 patients 47 to 87 years old: 38 (38.4%) men and 61 (61.6%) women. The frequency of MS was 65 (65.7%): 25 (38.5%) men and 40 (61.5%) women. We found a moderate positive statistically sig-nificant relationship between MS and psycho-emotional distress (X2=4.83, p=0.032, Phi=0.221, p=0.032) and a moderate positive statistically significant relationship between smoking and MS (X2=7.90, p=0.014, Cramer’s V=0.283, p=0.014). Study shows a very strong positive statistically significant correlation between MS and WHtR (X2=33.70, p<0.001; Phi=0.583, p<0.001), and a strong positive statistically significant correlation between MS and BMI (X2=12.11, p=0.001, Phi=0.350, p=0.001). We determined a moderate positive statistically significant correlation between serum TG level and both obesity parameters: BMI (rS=0.450, p<0.001), WHtR (rS=0.511, p<0.001).

Conclusions

1. Patients with MS are more likely to experience psycho-emotional distress on a daily basis than patients without MS. 2. Smoking is a signiﬁcant risk factor for MS development. 3. WHtR is superior to BMI for predicting MS.

47 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Colorectal adenomas in patients under age of 50

Dr. Ilona Vilkoite 1, Dr. Ivars Tolmanis 2, Dr. Hosams Abu Meri 3, Dr. Laura Veide 4, Dr. Vita Skuja 5, Dr. Linda Mežmale 6, Dr. Zane Dzērve 7, Dr. Oskars Bulmanis 8, Dr. Justīne Māliņa 4, Prof. Aivars Lejnieks 9 1. Rīga Stradiņš University; Health Center 4; Digestive Diseases Centre GASTRO, 2. Digestive Diseases Centre GASTRO, 3. Health Center 4, 4. Rīga Stradiņš University; Health Center 4, 5. Rīga Stradiņš University; Riga East Clinical University Hospital; Health Center 4, 6. University of Latvia; Riga East Clinical University Hospital, 7. Rīga Stradiņš University, 8. Health Center 4; Riga East Clinical University Hospital, 9. Rīga Stradiņš University; Riga East Clinical University Hospital

Objectives The incidence of colorectal cancer, especially located in distal colorectum, is rising markedly in young patients. Conventional adenomas have been widely recognised as precursors of colorectal cancer. The aim of this study is to investigate the correlation of polyp features and location in patients under age of 50.

Materials and Methods Adult out-patients under the age 50 who received colonoscopy were included in the study from Sep 1 2020 to Nov 30 2020. Clinical data including number, location, size and histopathology of polyps were collected. Polyp detecion rate was calculated as 27,4%. Advanced adenomas were deﬁned as ≥3 adenomas, size ≥10 mm, villous pattern or high grade displasia.

Results In total, 190 patients - 55% female and 45% male patients aged 18 - 49, with the mean age- 47 were enrolled in the study. In total 52 polyps were detected in the studied group, with polyp detection rate of 27,4%. 36 (19% patients) had at least one polyp. 21(11% patients) had 24 conventional adenomas. 17 (71%) of all adenomas were located in left colon. 11 (46%) of all adenomas were detected in patients aged 45-49. The detection rate of advanced adenomas was higher in patients aged 45-49.

Conclusions Among patients under age 50 advanced adenomas were predominantly located in the left colon. Advanced adenomas more often were found in patients aged 45-49. Those results could explain the rising trend of left colon cancer in young adults and update the topicality for colonoscopy screening in this population. Results of this study comply with the results of other studies that suggest a need for screening colonoscopy in age group 45-50.

48 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Colorectal cancer screening attendance inﬂuencing factors and coverage improvement options in general practice

Mrs. Līga Virziņa 1, Mrs. Sigita Petrovska 1, Dr. Jeļena Daniļenko 1 1. Rīga Stradiņš University

Objectives Colorectal cancer is the third most common oncology in Latvia. Finding colorectal cancer in early stages provides the greatest chance for complete recovery. The aim of this study was to ﬁnd out whether patient attendance improves when patients are personally invited to do the test and whether there is a difference between made tests in rural and urban general practitioner (GP) practices.

Materials and Methods The study was conducted in two GP practices in Latvia – one in Madona city, and second - rural area of Gulbene. A study was designed during 2020. We compared data before and after engaging a resident in GP practices: in rural practice since 26.08.2020., in urban practice - 19.10.2020. Analysis of screening attendance was made, based on data from given and executed immunochemical fecal occult blood tests (I-FOBT). We compared factors (age, sex and location) inﬂuencing I-FOBT performance. Microsoft Excel 2012 and IBM SPSS were used for statistical analysis.

Results 633 patients aged 50-74 were the target population for colorectal cancer screening in both GP practices. 137 patients (21,64%) took the I-FOBT (mean age 60,31± 6,55; 56,20% women and 43,80% men), but only 87 (63,50%) patients (mean age 61,10 ± 6,88; 54,02% women and 45,98% men) did it (p>0,05). There is a statistically signiﬁcant difference (p<0,05) between made tests in the rural practice (31 tests or 52,54% of all the given tests) and in the urban practice (56 tests or 71,79% of all). Testing was improved by 49,16% in rural practice and by 30,76% in urban practice after engaging a GP resident.

Conclusions The performance of the test was inﬂuenced by the location of the GP practice, but there was no difference between the patients’ sex or age. Colorectal cancer screening attendance can be greatly improved with the help of GP residents and a more personalized approach.

49 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Comparison of sensitivity of the traditional score chart and sensitivity of the score chart using low-density cholesterol level as one of the fatal cardiovascular disease risk factors

Mrs. Anna Voitkeviča 1 1. Rīga Stradiņš University

Objectives To estimate whether using of LDL level as a variable increases the SCORE chart sensitiveness.

Materials and Methods This retrospective study was conducted at the family doctor’s practice in Riga examining 460 patient’s records corresponding to the SCORE chart criteria. The sensitivity of the traditional SCORE chart was compared with its alternative version. In the alternative SCORE chart, the level of LDL was taken as equal with the level of total cholesterol if the difference between them was two units. Differences in the predicted risk level appeared when the level value differed from each other by more than 2 units. Data processing and analysis was performed using the Microsoft Excel, SPSS, and the Spearman correlation coeﬃcient.

Results The calculated risk level and actual fatal CVD correlation in the next decade in the alternative version of the SCORE chart is slightly stronger than in its traditional version, respectively, 0.13 (p < 0.05) and 0.15 (p < 0.01). Among CVD patients, the traditional SCORE chart identiﬁed increased risk (> 5%) in 41%, however the alternative chart recognized 2% more, namely 43%.

Conclusions Replacing one of variables - total cholesterol with LDL makes the SCORE chart slightly more sensitive. Unfortu- nately, in both versions, the correlation between the risk level of fatal CVD and real CVD events in the next ten years is weak, and more than 50% of patients with fatal CVD in the future remain unidentiﬁed as high-risk patients. However, even small improvements in the sensitivity of this test deserve attention and possible revision of the SCORE chart.

50 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Differences between women and men knowledge about prophylactic measures at general practice

Mrs. Eva Grīnfelde 1, Mrs. Evita Pundure 1, Dr. Ilze Skuja 1 1. Rīga Stradiņš University

Objectives General Practitioner’s(GP’s) one of the main tasks is to provide disease prevention to reduce future illnesses. Doctor and patient teamwork are needed to achieve this goal successfully. To ensure effective disease prevention, it is necessary to know which patients and how should be educated more on this topic.

Materials and Methods After literature review on disease prevention, we created questionnaire for patients to understand if there are differences between women and men attitude and knowledge about prophylactic measures. In this abstract we have analysed seven closed and one opened question from total study. Data were processed using SPSS and NVivo software. Participants were involved from one region, different GP’s. All respondents were divided in two groups according to gender.

Results There were 236 respondents, aged 18–90 (mean age 51), 62%(N=147) were women and 38% (N=89) - men. 10% of women (W) and 19% of men (M) visit GP less than once a year. There was no signiﬁcant difference between genders who have chronic illnesses that requires regular GP consultation (W41%,M35%;p=0.309). We have analysed participant opinion and knowledge about preventive measures. Both groups showed equal knowledge and there was no statistical difference between genders in these measurements - vi-sion test (W82%,M83%;p=0.349), heart auscultation (W95%,M91%;p=0.074), weight and height measurements (W82%,87%;p=0.114), regular medication use (W53%,M42%;p=0.056). But there was statistical difference between genders - women are more knowledgeable about blood pressure measurement (W98%,91%;p=0.048), lung auscultation (W91%,M85%;p=0.017), chest radiograph (W67%,M58%;p=0.001), colorectal cancer screening (W50%,M36%;p=0.002), but men are more aware of healthy eating as preventive measure - 64% included it in prophylaxis while only 57% women did same(p=0.002).

Conclusions Women are more likely to see a GP and are slightly better informed about preventive measures. Almost all respondents believe that these measures are necessary. It is important to educate both sexes more, as many do not know what prophylactic program includes.

51 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Disease prevention in general practice from patient’s perspective depending on presence of chronic disease

Mrs. Evita Pundure 1, Mrs. Eva Grīnfelde 1, Dr. Ilze Skuja 1 1. Rīga Stradiņš University

Objectives Disease prevention is one of the most important General Practitioner’s (GP’s) tasks in Primary care. Currently, it is very important to protect patients from COVID-19, especially those in risk groups. To accomplish qualitative disease prevention, we need doctor’s knowledge and patient’s partnership. To achieve patient’s compliance, we must understand how knowledgeable they are about prophylaxis and we must speak in their language to educate them.

Materials and Methods After literature review and qualitative research on disease prevention, we have developed questionnaire for patients to ﬁnd out their view of prophylaxis. In this topic we chose seven closed and one opened question from whole questionnaire. Data analysis was done using SPSS and NVivo12 software. To analyse data respondents were divided in two groups – with chronic diseases (CDG) and without chronic diseases (WCDG).

Results There were included 236 respondents(147 women, 89 men) from different GP’s lists, living in one region (mean age 51,4±15,9 years). There were 92(38,98%) respondents in CDG and 144(61,02%) - WCDG. There is statistically significant difference between replies about their last preventive examination within last year – 52,08% CDG and 81,53% WCDG (p<0,05). In both groups only small part had prophylaxis as the reason for GP’s appointment(48,61% WCDG and 35,87% CDG), but there was no statistically significant difference(p>0,05). Further results highlighted different reasons for GP’s appointment, there were significant differences between both groups. Analysing opened question about reasons for GP’s appointment without complaints majority of respondents named prophylaxis or health check-up.

Conclusions Patient knowledge about prophylaxis help to achieve disease prevention goals. There must be clearly deﬁned period for every patient to see GP even without complaints. If prophylactic programme is carried out in high quality and timely manner and chronic diseases are well controlled, then in situations as COVID-19 pandemic, we can consult patients remotely more often than without qualitative disease prevention.

52 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Effectiveness of breast cancer screening in women: case of Latvia

Dr. Anrijs Djatkovičs 1 1. University of Latvia

Objectives 1. Assess attendance of women at breast cancer screening in Latvia. 2. Analyse, what impact had introduction of breast cancer screening on the early detection of breast cancer in women in Latvia.

Materials and Methods Statistical data of the Latvian Centre for Disease Prevention and Control (LCDPC) on attendance of women aged between 50-69 at the state-funded breast cancer screening from 2010 to 2019 and statistical data of LCDPC on the stages of breast cancer diagnosed from 2010 to 2017 were used for statistical analysis.

Results From 2010 to 2019, between 130 205 as minimum (2012) and 196 578 as maximum (2010) screening invitations were sent to women. In other research years on average 140 000 invitations were sent annually. Between 2010 and 2019, women attendance ﬂuctuated between 38 148 as minimum (2010), i.e., 19,4% of all sent invitations and 62 455 as maximum (2017), i.e., 44%. From 2017 to 2019, attendance reached its highest rate 44-39% respectively. From 2010 to 2017, the lowest percentage of I, II stage breast cancer was detected in 2011, i.e. 61,7% (741) of all cancer cases, the highest was in 2017, i.e. 67.7% (767). From 2015 to 2017, percentage increased annually from 61,8% (729) to 67.7% (767) respectively. The highest percentage of III, IV stage was detected in 2013, i.e. 33% (348), the lowest in 2017 (314), i.e. 27,7%. From 2015 to 2017, percentage decreased annually from 31,5% (472) to 27,7 (314) respectively.

Conclusions Women attendance at breast cancer screening in Latvia is low, and lags behind the EU recommendations (70- 75% attendance). Screening has shown its effectiveness for the breast cancer early detection. Promotion of attendance can further facilitate early detection of cancer in larger number of women.

53 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Evaluation of cystic ﬁbrosis newborn screening program in Latvia

Dr. Elina Aleksejeva 1, Dr. Dita Gaidule-Logina 2, Dr. Madara Kreile 3, Ms. Jekaterina Isakova 4, Dr. Dagne Gravele 2, Dr. Ineta Grantiņa 1, Dr. Linda Gailīte 4 1. Department of Paediatrics, Rīga Stradiņš University; Department of Pediatrics, Children’s Clinical University Hospital, 2. Children’s Clinical University Hospital, 3. Rīga Stradiņš University; Children’s Clinical University Hospital, 4. Scientiﬁc

Laboratory of Molecular Genetics, Rīga Stradiņš University

Objectives Newborn screening for cystic ﬁbrosis (CFNBS) has revolutionized the diagnosis and early management of this common, inherited disease. CF NBS is performed in 22 European countries although using different strategies. CFNBS has introduced in Latvia in July of 2019 using a strategy that combines the detection of immunoreactive trypsinogen (IRT), sweat test, and DNA analysis for CFTR. The aim of the study is to evaluate CFNBS experience in Latvia.

Materials and Methods Data were gathered and evaluated for CFNBS from July 2019–December 2020. IRT was measured by ﬂuorometric enzyme immunoassay, with a cutoff value of 70 µg/l. In case if the IRT is elevated for the ﬁrst time (IRT1), the IRT level was detected for the second time (IRT2). All infants with elevated IRT2 were selected for a sweat test by Macroduct system and CFTR analysis – started with the detection of p.Phe508del and p.Ser18ArgfsX16 (CFTRdele2,3) variants, followed by Sanger sequencing and MLPA.

Results 27057 neonates underwent CFNBS. Of these 490 (1.8 %) neonates had elevated IRT1, and 85 (0.3%) neonates had elevated IRT2. The sweat test was performed for 80 (94%) infants – there were no one borderline results, in four cases sweat test was positive (>60 mmol/l), 5 (6 %) of cases parents refused from test due to COVID-19 pandemic. Since CFNBS was introduced, CF was confirmed molecularly in four cases (all of them had positive sweat test) with the following genotypes: p.[Phe508del];[Phe508del]) in three cases, and one – p.[ ];[Leu1335Pro]. In five cases the carrier status was confirmed (with normal range sweat test) with genotypes: p.[Phe508del];[=], Ser168Ter p.[Arg553Ter];[=], and p.[Leu138dup];[=].

Conclusions In all individuals who have elevated IRT twice and positive sweat test, the molecular analysis should be done starting with the detection of p.Phe508del and p.Ser18ArgfsX16 (CFTRdele2,3) variants following with CFTR gene sequencing and MLPA analysis.

54 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Factors determining the decision to participate during breast cancer screening

Dr. Kadi Lubi 1, Ms. Vita Savicka 2, Prof. Anda Ķīvīte-Urtāne 3, Ms. Kaire Sildver 4, Ms. Diana Sokolova 1, Ms. Silja Mets-Oja 4 1. Tallinn Health Care College, 2. Faculty of Communication, Rīga Stradiņš University, 3. Department of Public Health and Epidemiology, Rīga Stradiņš University, 4. Health Education Center, Tallinn Health Care College

Objectives Breast cancer is the most common cancer in women. Despite the availability of effective breast cancer screening programs, only six countries in the European Union reach the recommended target rate of 70% screened. Previ- ous research has shown the inﬂuence of existing habits to determine health behaviour, however current health communication campaigns do not address this area and focus rather mainly on the neoliberal individualistic approach promoting individual responsibility. The research aimed to explore the role of different inﬂuenc- ing factors, including the role of existing health behaviour and habits in developing the decision to participate during breast cancer screening.

Materials and Methods The research has used mixed-method approach within the sequential approach where at the ﬁrst stage, 21 in-depth interviews were performed in Estonia and Latvia and additional quantitative data collection was performed in Estonia among 1200 women. Statistical analysis with SPSS was performed

Results The results of qualitative research highlighted that there are three main type of reasons (practical, emotional, and habitual) why women do not attend the screening procedure. The habitual ways of communication with the representatives of medical system might play an integral part of the formulation of the decision and it is note- worthy that habitually formed ways are not only individualistic but may be influenced by cultural and societal traditions. Following data analysis of quantitative data has confirmed the importance of existing Mechanisms of Action (influencing factors) of breast cancer prevention behaviour: perceived benefits and threats as well as self-efficiency and barriers (both are related to habits).

Conclusions Individualistic health communication approach is insuﬃcient, as there are also other (e.g. non-individual) factors inﬂuencing the decision formation in the context of screenings. There is a need to address existing health behaviours and habitual ways of contacts with medical system to create and/or strengthen the understanding of preventive health behaviour.

55 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

In silico determination of vitamin B12 reference intervals from general patient data accumulated in E. Gulbis Laboratory in Latvia

Dr. Didzis Gavars 1 1. E. Gulbja Laboratory

Objectives Determination of reference intervals (RI) from existing patient data can be a cost effective alternative as compared to special research following C28-A3 guidelines [1]. Affordable local RI can enable adaption of RI for different population subgroups like gender, age, ethnicity and geographical region. For B12 most recent local RI was reported in [2]

Materials and Methods Standard clinical laboratory technique and procedures were used for all EGL B12 tests ranging from year 2004 to year 2019. RI was calculated by using mean value and distribution function over the logarithm of B12 value for 201 127 measurements from 125 119 patients. Patients with multiple B12 tests were represented with the mean value as a single date point.

Results The spread of EGL internal reference test results was found to be in order of magnitude less than the spread of the reference test results between different laboratories. B12 distribution of EGL patients was well approxi- mated with Gaussian distribution. Because of the overrepresentation of patients with B12 deﬁcit due to medical and dietary reasons the high B12 value part of the distribution was used for determination of the Gausian distribution parameters and RI. Meta-analysis of RI from the literature show that our “in silico” RI is at the high end of the RI distribution but still within the range of RI’s reported in literature.

Conclusions Credible RI for B12 was established by using in silico analysis of large number of patient data without prese- lecting “healthy” individuals. The method can be extended for other cases where material from predominantly healthy individuals is analyzed.

56 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Latvian population-based birthweight charts

Prof. Natalija Vedmedovska 1, Dr. Anna Miskova 1, Prof. Anda Ķīvīte-Urtāne 2, Dr. Katsiaryna Rimaido 3, Dr. Baiba Andersone 3 1. Rīga Stradiņš University, 2. Department of Public Health and Epidemiology, Rīga Stradiņš University, 3. Riga Maternity Hospital

Objectives Large differences exist in size at birth and rates of impaired fetal growth across the world. Different factors like the environment, genetics, nutrition, and diseases can affect these discrepancies. In clinical practice, various references are often used to assess fetal growth and newborn size across populations. No such population-based birthweight charts exist in Latvia. The aim of the study was to create the local Latvian population birthweight charts that can help to assess fetal growth.

Materials and Methods The mean birth weight of 100 newborns was obtained at deliveries at 40 weeks (40+0 to 40+6) of gestation at Riga Maternity Hospital prospectively (N50) and retrospectively (N50) from August to December 2020. Only cases with accurate pregnancy dating, without any risk factors for fetal growth restriction and gestational diabetes were included.

Results The mean birth weight of newborns at 40 weeks was 3758g (SD ±372,8g or 9,92%). The mean birth weight of girls was 3719 (SD ±318,1 or 8,55%), boys -3806g (SD ±429, or 11.2%), respectively p=0,25. The gender-speciﬁc birthweight percentiles for the Latvian population were constructed based on a Global Reference, proposing by WHO. Z-score for percentiles of normal distribution of in utero fetal growth are -0.674 for 25%, -1.282 for 10%, -1,645 for 5%, -1,881 for 3% and -2,326 for1%.

Conclusions The population-based gender-speciﬁc references increase the identiﬁcation of abnormal newborn size at birth and therefore may better predict adverse perinatal outcomes than the non-customized fetal-weight references.

57 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Parents’ awareness and attitude towards the use of non-invasive dental treatment methods on children

Ms. Santa Agate Valaine 1 1. Academic School of Dental Hygiene, Rīga Stradiņš University

Objectives Dental caries remains a worldwide problem. The prevalence of caries in Latvia is higher than the European average (Maldupa et al., 2020). New approaches are being sought to combat caries, and a non-invasive approach is one of them. To successfully integrate this new approach into the daily life of dentistry, its application must start in early childhood, which is the responsibility of parents. Therefore, the aim of the study is to investigate parents’ awareness and attitudes about the use of various non-invasive methods on children.

Materials and Methods Fifty two parents of 2-6 years old children were interviewed with a 24-item self-constructed questionnaire. Respondents’ awareness and attitude towards three non-invasive methods of caries treatment (ﬂuoride varnish, sealants and silver diamine ﬂuoride solution (SDF)) was investigated. Data analysis was performed with Microsoft Excel. No comparative analysis of parents’ attitude was possible because of low awareness of respondents.

Results Despite the fact that parents themselves felt well informed about non-invasive treatment, the actual knowledge about methods included in the study was extremely low. Most of the respondents (75%) admitted that their children had no experience with any of these preventive methods. The lowest awareness was related to SDF (5,7%), followed by fluoride varnish (9,6%), while parents were relatively better informed about fissure sealants (17,3%). In adverse, 63% of the respondents’ children have had experience with the invasive treatment. Despite the lack of information, most parents would be willing to use these scientifically approved methods to treat their child’s caries, except when SDF would be applied to anterior teeth due to dark discoloration of the teeth.

Conclusions Parental awareness of non-invasive caries treatment methods was very low, and invasive methods are still highly valued. However, the reliable source of parental information affected the level of parental awareness. Therefore, professionals should educate the parents about alternative caries treatment options.

58 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Prevalence of anxiety and depression symptoms in adolescents with type 1 diabetes and their parents

Mrs. Evija Siliņa 1 1. Rīga Stradiņš University

Objectives 1. Identify symptoms of anxiety and depression in children with type 1 diabetes (T1D) and their parents. 2. Detect symptoms of anxiety and depression in somatic healthy children and their parents. 3. Compare the results in the target and control groups.

Materials and Methods The study population has been divided into 2 sub-groups: the target group consisting of adolescents with T1D aged 12-18 and their parents (N = 64), and the control group consisting of somatic healthy adolescents and their parents (N = 36). Anxiety symptoms have been evaluated applying the Generalized Anxiety Disorder 7-item (GAD -7) scale. Depression symptoms have been evaluated using the Patient Health Questionnaire 9 (PHQ - 9) scale. 100 respondents were eligible for screening. The severity of anxiety and depression symptoms has been assessed on a scale of points , interpreting in gradations: “no symptoms; mild symptoms; moderate symptoms and severe symptoms”.

Results Severe, generalised anxiety was detected in 13% adolescents suffering from T1D and 47% of their parents. In contrast, no severe anxiety was detected in the control group by any of the respondents. In adolescents with T1D, 9% of cases experienced symptoms of severe depression, 16% experiencing symptoms of moderate depression. In the control group, no signs of severe depression were seen in children or parents, while signs of moderate depression occurred in 6% of teens. Moderate and severe anxiety and depression symptoms were seen signiﬁcantly more frequently in the study group than in the control group, both in the child and in the parent subgroups.

Conclusions 1. Adolescents with Type 1 diabetes and their parents are more predisposed to anxiety and depression symptoms than somatic healthy children and their parents. 2. Further multiprofessional research is necessary for children with T1D and their families, in order to avoid the development of stress-related mental health disorders.

59 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Trends in chromosomal anomalies for live births and prenatal diagnoses in Latvia

Mrs. Irisa Zile-Velika 1, Mrs. Inese Ledina 2, Dr. Ieva Grinfelde 3, Ms. Zane Baltane 4, Dr. Ieva Malniece 2 1. The Centre for Disease Prevention and Control of Latvia; Rīga Stradiņš University, 2. Children’s Clinical University Hospital, 3. Children’s Clinical University Hospital; Rīga Stradiņš University, 4. The Centre for Disease Prevention and Control of Latvia

Objectives Screening for fetal chromosomal abnormalities is an essential part of antenatal care. It includes non-invasive approaches as well as invasive procedures for the deﬁnitive prenatal diagnosis of disorders. During the last decades, an increasing number of congenital anomalies have been diagnosed before birth by prenatal screening. Down syndrome (DS) is the most common chromosomal aberration detected in prenatal testing. The aim: To describe trends of DS and other chromosomal anomalies (ChA) for live births and antenatal diagnoses in Latvia over the last 10 years.

Materials and Methods Data source was Register of Patients with Particular Diseases, Patients with Congenital anomalies. All live newborns, which were born (2010–2019) and were diagnosed chromosomal anomalies [ICD10: Q90-Q99] (n = 373) and termination of pregnancy for anomalies following prenatal diagnosis (TOPFA) (n = 461) data were included. Live birth (LB) and TOPFA period prevalence of DS and ChA was calculated.

Results The most common chromosomal anomaly is Down syndrom (DS). A total of 177 cases for LB with DS and 281 for TOPFA were included in data analysis. Ten year LB period prevalence with DS was 8.8/10000 (95%CI 7.6-10.2) and TOPHA 13.9/10000 (95%CI 12.4-15.6) (per live and stillbirths). ChA period prevalence for LB was 9.8/10000 (95%CI 8.4-11.2) and 8.9/10000 (95%CI 7.7-10.3) for TOPHA. There are statistically signiﬁcant DS prevalence trends observed over the study period. LB prevalence with DS has shown slight reduction (p<0.05), an average 0.8/10000 contrary to TOPFA – increase an average 2.2/10000 per year (p<0.001). The same situation was with ChA TOPHA increase by 2.0/10000 per year (p<0.001) but not signiﬁcant trends for LB with ChA.

Conclusions Prevalence decrease of LB with DS is the result of improvements in antenatal care and prenatal screening thereby an increasing number of pregnancies are terminated. Pregnant women are given a choice between termination or continuation of pregnancy.

60 Social Determinants Of Health RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Changes in mortality inequalities from major causes of death in Lithuania by education

Ms. Olga Mesceriakova-Veliuliene 1, Ms. Ramune Kalediene 2, Ms. Skirmante Sauliune 2, Mr. Gvidas Urbonas 2, Mrs. Renee White 3, Mr. Zachariah Madaki 2, Mr. Kelechi Roy Ogbuagu 3, Mrs. Gerda Kvitko 2, Mr. Dovydas Švegžda 2, Mrs. Ujunwa Ekweogu 3, Mrs. Yasmine Agyemang 3 1. Doctoral Study Programme “Public Health”, Lithuanian University of Health Sciences, 2. Lithuanian University of Health Sciences, 3. Master’s Study Programme “Applied Public Health”, Lithuanian University of Health Sciences

Objectives The aim of the study is to present changes in mortality inequalities from major causes of death in Lithuania by education in 2001-2014.

Materials and Methods Information on deaths (aged 30+) from cardiovascular diseases, cancer, external causes, and digestion system diseases in 2001-2014 was obtained from Statistic Department of Lithuania.Mortality rates from these causes by the level of education (up to secondary and post-secondary) were calculated by 100000 people per year. In- equalities in mortality were assessed calculating relative risk with 95% conﬁdence intervals. For the assessment of trends in relative risk of mortality during 2001-2014, the Joinpoint regression analysis was applied.

Results Mortality from cardiovascular diseases, cancer, external causes and digestion system diseases among males and females in 2001 and 2014 was signiﬁcantly higher in lower educational group with the exception of female mortality from cancer in 2001. The most considerable decline was observed in mortality from external causes. A major increase was registred in mortality from digestion system diseases (in males with up to secondary educational group by 64.50%, in females – 60.60%; in post-secondary – by 37.28% in males, 17.51% in females). Among males, a major increase in the relative risk was observed in mortality from external causes – from 1.74 in 2001 to 2.89 in 2014 by 3.75% per year on average (p<0.05), and among females from digestion system diseases – from 1.97 to 2.69 by 2.71% per year on average, (p<0.05). The most gradual increase in the relative risk was noted in mortality from cardiovascular diseases – among males from 1.43 to 1.65 by 1.20% per year on average (p<0.05), among females – from 1.51 to 1.69 by 0.93% per year on average (p<0.05).

Conclusions Inequalities in mortality by education from cardiovascular diseases, cancer, external causes, and digestion system diseases increased signiﬁcantly in Lithuania throughout the period of 2001-2014.

62 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Disparities of social trust, subjective wellbeing and health status among 18–50 age-cohort in Lithuania

Dr. Rasa Indriliunaite 1 1. Vytautas Magnus University

Objectives The quality of life surveys nowadays use different indicators of subjective wellbeing of an individual alongside with objective indicators more often. At the individual level, the assessments of subjective wellbeing of an individual are often based on the indicators of the marital status, the state of health, social inclusion, life satisfaction, income and similar indicators (Glatz, Eder 2019). The research shows that indicators of subjective health and social trust are one of the most signiﬁcant components of positive assessments of subjective well- being: healthier people are more productive, socially engaged, and often earn more. Meanwhile, another part of researchers reveal that trust as a social resource as well as emotional wellbeing can also be a signiﬁcant factor for physical health (Kim, Kawachi 2002). The objective of this presentation is to reveal the interrelation of assessments of social trust, subjective health and subjective wellbeing among representatives of different generations in Lithuania.

Materials and Methods The presentation is based on the national study Experiences of (In)Security across Generations in Lithuania: Motives and Opportunities to Choose Life Trajectories which was implemented in 2020. Rich empirical data was collected during it (N=3000) about the most active 18–50 age-cohort which was analysed by using different methods of statistical analysis.

Results The data shows differences in assessments of social trust, subjective health and subjective wellbeing by representatives of different cohorts that are not limited only to the category of age, i.e. differences in assessments are also observed according to other socio-demographic factors such as gender, etc.

Conclusions The differences in assessments can be based on structural factors (the Soviet period, transition, etc.) and experiences undergone during them, which contributed to formation or change of certain values. Assessments are also determined by certain choices made in different stages of a life course that contributed to formation of a certain approach to own life.

63 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Individual factors that cause professional burnout syndrome in social workers, employed in community rehabilitation centre for addictive diseases

Prof. Vida Gudzinskiene 1, Ms. Jautre Ramute Sinkuniene 1, Mr. Andrejus Pozdniakovas 1 1. Mykolas Romeris University

Objectives Research object is individual factors that cause professional burnout syndrome in social workers, employed in community rehabilitation centres for addictive diseases. The aim of the article is to reveal individual factors that cause professional burnout syndrome in social workers, employed in community rehabilitation centre for addictive diseases. Tasks: 1) to provide theoretical assumptions about individual factors that cause professional burnout syndrome; 2) to reveal individual factors that cause professional burnout syndrome in social workers, based on experiences of social workers, employed in community rehabilitation centre for addictive diseases.

Materials and Methods Research methods: academic literature analysis, document analysis, qualitative research type was chosen for the study. In the study, the method of a semi-structured interviews quality (content) analysis, summarizing method was used.

Results Empirical research revealed that individual factors that cause the occurrence of professional burnout syndrome in social workers, employed in community rehabilitation centres for addictive diseases, are related to employees’ feelings of inferiority and an excessive imposition of requirements on themselves (distrust, self-devaluation; feeling of guilt; lack of self-evaluation skills and an excessive imposition of requirements on oneself); to personal qualities (too much: empathy, attachment to clients or doubts about the meaning of work); individual factors related to the environment (having nobody to talk to about problems, inability to change the environment, prolonged stress, narrowing of interests outside work, and forced abandonment of activities that previously preventively helped to combat professional burnout syndrome)

Conclusions Individual factors related to clients (collapse of hopes to help the client and exaggerated responsibility of the social worker for the client’s life). Participants of the research became “inaccessible” to family members, were unable to distance themselves from work stress (worries outside work, obsessive thoughts that hinder dissoci- ation from work, inability to relax, use of free time for work activities); felt a lack of general and professional competencies.

64 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Inequalities in prevalence, incidence and mortality from mental disorders by place of residence and their changes in Lithuania

Ms. Deimantė Andriuškevičiūtė 1, Mr. Saulius Knystautas 1, Ms. Olga Mesceriakova-Veliuliene 2 1. Master’s Study Programme “Medicine”, Lithuanian University of Health Sciences, 2. Doctoral Study Programme “Public Health”, Lithuanian University of Health Sciences

Objectives The aim of the study is to analyze inequalities in prevalence, incidence and mortality from mental disorders by place of residence and their changes in Lithuania in 2001-2019.

Materials and Methods A retrospective review of data (aged 0+) on incidence, prevalence and mortality from mental disease (ICD-10 codes F00-F99) in rural and urban in 2001-2019 was obtained from Hygiene Institute. Inequalities between rural and urban were assessed using a rate ratio. Joinpoint regression analysis was used to assess rates and inequality trends during 2001-2019.

Results In 2001-2019 prevalence of mental illness increased in rural (on average by 4.5% per year, P<0.0001) and urban (by 3.3% per year, P<0.0001) areas. Incidence and mortality of mental illnesses have been unevenly changing furthermore cut points were found in both areas. According to statistical data in 2013, there was a cut point of incidence in urban areas and increased: 2001-2013 on average by 1.9% per year (P<0.001); 2013-2019 - by 6.8% per year (p<0.0001). In urban areas mortality of mental disorders has been irregularly shifting. Moreover, a statistically signiﬁcant cut point was found in 2013. From 2001 to 2013 mortality rate accelerated (by 2.9% per year, P>0.05) and during 2013-2019 (by 26.3% per year, P<0.001). Besides, in rural areas cut point was established in 2015, and mortality of mental illnesses increased: 2001-2015 on average by 5.1% per year (P<0.001); 2015-2019 - by 31.1% per year (P<0.01). During 2001-2019 inequalities in prevalence increased on average by 1.1% (P<0.05) per year. Meanwhile, incidence increased on average 0.5% per year (P<0.01) between rural and urban areas.

Conclusions In 2001-2019 prevalence, incidence, and mortality from mental illnesses have been increased in rural and urban areas. Furthermore, inequalities in prevalence and incidence became progressively greater.

65 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Mortality from melanoma by socio-demographic status and its inequalities between 2001 and 2014: Lithuanian study

Ms. Olga Mesceriakova-Veliuliene 1, Ms. Ramune Kalediene 2, Ms. Skirmante Sauliune 2, Mrs. Jurgita Vladickiene 3, Mrs. Viktorija Vitkute 2, Mrs. Migle Jakineviciute 4, Mr. Domas Sikorskis 4 1. Doctoral Study Programme “Public Health”, Lithuanian University of Health Sciences, 2. Lithuanian University of Health Sciences, 3. Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences, 4. Master’s Study Programme “Medicine”, Lithuanian University of Health Sciences

Objectives The aim of the study – to assess mortality from melanoma by socio-demographic status and its inequalities in Lithuania between 2001 and 2014.

Materials and Methods Individual records from population censuses conducted in 2001 and 2011, National Mortality Register (period of 2001-2014), and Population Register (period of 2001-2014) have been linked using personal identiﬁcation number. Study included those aged 30+. Mortality rates from melanoma by education, marital status, occupation, economic activity and place of residence was calculated per 100,000 person-years and standardized by age. Inequalities in mortality by socio–demographic status were assessed calculating rate ratio with its 95% conﬁdence intervals. For the assessment of trends of mortality and inequalities between 2001 and 2014, the Joinpoint regression analysis was applied.

Results No statistically signiﬁcant changes in melanoma mortality and its inequalities were found in the period of 2001– 2014. In the period of 2001–2014, higher mortality rates of melanoma were observed among the unemployed population, workers and males living in the urban, as compared to the employed, civil servants and males living in rural areas. Mortality among other groups was fairly evenly distributed. During the analysed period, an increasing mortality tendency was observed in all socio–demographic groups of males, except for the group of males with post-secondary education. A decreasing mortality tendency was observed in the groups of working females, females living in rural areas, workers and females of both education groups; whereas among other groups of socio–demographic status of females, an increasing mortality tendency was observed. In all socio– demographic groups of males and females, a decreasing tendency of mortality inequalities was observed, except for the females by place of residence and occupation.

Conclusions Different tendencies have been identiﬁed in socio-demographic inequalities of melanoma mortality in Lithuania in the period of 2001–2014.

66 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Mortality from suicides by the level of education and its inequalities: situation in Lithuania during 2001–2014

Ms. Skirmante Sauliune 1, Ms. Olga Mesceriakova-Veliuliene 2, Ms. Ramune Kalediene 1, Mr. Gvidas Urbonas 1, Mr. Domas Sikorskis 3 1. Lithuanian University of Health Sciences, 2. Doctoral Study Programme “Public Health”, Lithuanian University of Health Sciences, 3. Master’s Study Programme “Medicine”, Lithuanian University of Health Sciences

Objectives To assess mortality from suicides by the level of education and its inequalities in Lithuania during 2001–2014.

Materials and Methods Information on deaths (in population aged ≥30 years) from suicides (ICD codes X60-X84) was obtained from Statistics Lithuania. Mortality rates from these causes were calculated by the level of education per 100,000 person-years and were age-standardized using the European standard. For the assessment of trends of mortality between 2001 and 2014, the Joinpoint regression analysis was applied. Inequalities in mortality were assessed using a relative index of inequalities with its 95% conﬁdence intervals.

Results Mortality of males and females from suicides decreased statistically signiﬁcantly among all education groups with an exception for females in post-secondary non-university and university education groups. A signiﬁcant decrease was observed in mortality among both genders in population with preprimary or no education: among males mortality decreased from 87.9 in 2001 to 33.3/100,000 person-years in 2014 (on average by 12.7% per year (P=0.03)) and among females from 15.3 in 2001 to 2.1/100,000 person-years in 2014 (on average by 13.7% per year (P=0.0005)). A relative index of inequalities among males decreased from 4.4 (95% CI=-1.3-10.1) in 2002 to 1 (95% CI=0.67-1.32) in 2009; while among females - from 2.5 (95% CI=-0.5-5.4) in 2002 to 0.6 (95% CI=0.1-1.2) in 2011. A relative index of inequalities among both genders decreased (among males from 2.3 (95% CI=0.8-3.8) in 2001 to 1.3 (95% CI=0.8-1.9) in 2014; while among females from 1 (95% CI=0.5-1.5) in 2001 to 0.8 (95% CI=0.01-1.6) in 2014).

Conclusions Mortality from suicides by the level of education and its inequalities in Lithuania decreased during 2001–2014.

67 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The effect of the concept of individual agency on the estimation of health among different age-cohorts

Prof. Vylius Leonavicius 1 1. Vytautas Magnus University

Objectives A sudden structural transformation of Lithuanian society has induced new conditions of different age cohorts for choosing self-determination and (in)security experiences. These conditions can be explained by the late modernity theories (R.Inglehart, A.Giddens, U.Beck), which are based on the explanation of the interaction between individual agency and structural or institutional determination. Agency refers to the ability to act or perform an action. In contemporary theory, it hinges on the question of whether individuals can freely and autonomously initiate action, or whether the things they do are in some sense determined by the ways in which their health, life and so on has been constructed. The differencies in the concept of agency show the more individualistic, or more fatalistic attitudes to the health. The presentation invite to discuss about the relation between health concept among different age-cohorts, and, their values attitudes tied to possibilities of agency and age- cohort speciﬁc appropriate of modern society type.

Materials and Methods In study is used the data of representative survey, which was carried out in June-September 2020 in Lithuania. Presentation is built upon rich biographical data set ( a sample of 3000 most active (18-50 old) age-cohort) and used an intra-cohort multivariate statistical analysis.

Results The data shows that different age-cohorts express different attitudes to the possibilities to inﬂuence their individual health and can be treated as belonging to the different type of modern society: materialistic (ﬁrst modernity), or postmaterialistic (late or second modernity). Different age-cohort express different feeling of the state of the subjective health related to the different attitudes to their agency.

Conclusions The concept of the heath of different age-cohorts mostly depends on their understanding of their possibilities to inﬂuence their activities and individual life trajectories. The results could be used to explain the individual behavior during pandemic Covid-19.

68 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The relationship between fire fighters’ phychosocial risks and physical fitness: evidence based study from Estonia

Mrs. Karin Reinhold 1, Mrs. Marina Järvis 2, Mrs. Sigrid Kontus 1, Mrs. Jelena Hartsenko 1 1. Tallinn University of Technology, 2. Tallinn University of Technology; Estonian Entrepreneurship University of Applied Sciences

Objectives The overall aim of the study was to evaluate the psychosocial risks and physical fitness among fire fighters in Estonia.

Materials and Methods The study was conducted in 2018-2020. The study had a mixed-method approach - quantitative study (using COPSOQII questionnaire and tailored questionnaire about physical activities, health behaviour etc) and qualitative study (focus-group semi-structured interviews with fire fighters). The sample size was 400 fire fighters (completed questionnaires). The sample covered 4 regions in Estonia - North, South, East and West.

Results Our results proved that health awareness among fire fighters is high: majority of employees are regularly do- ing sports or physical activities during and after working time, they know how to eat healthy and are aware of the importance of recovering time and sleep during the night. Majority of psychosocial risks are under control and the top management is dealing with this topic systematically. However, some issues have to be emphasized: low influence of work, leadership quality issues and varied justice and respect need to be improved. The correlations between different variables showed that family and worklife imbalance is in correlation with low physical activity and emotional exhaustion. The results from the qualitative study identified several shortcomings in work organization, health and safety management, quality of leadership as well as in reward system. On the other hand, community at work, good social support from colleagues, high role clarity and predictability received high scores in the study. The results also identified different health promotion programms which contribute positively for fire fighters’ healthy behaviour.

Conclusions The findings have implications for health and safety management, health promotion as well as human resource department in order to find more solutions for future activities to support and ensure the high work ability of fire fighters.

69 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Use of digital health-care services during the ﬁrst wave of COVID-19 pandemics among ageing population in Latvia

Dr. Ieva Reine 1, Ms. Madara Mikelsone 1, Dr. Andrejs Ivanovs 1 1. Rīga Stradiņš University

Objectives The objective of the study was to analyse reasons for not using digital technologies among older population to receive health-care services.

Materials and Methods By using information on demographic background variables from the Survey of Health, Ageing and Retirement in Europe (SHARE), the respondents 50+ years were asked to answer additional questions relevant to the Latvian context, like access to digital devices, affordability, knowledge, thus focusing on social and age inequality that might affect different areas of life, including ability to use health-care services remotely. Pearson’s chi-squared test was performed to assess the association between variables on a representative sample consisting of 977 respondents in Latvia.

Results The mean age of the respondents was 69 years (± SD 9.92). The results showed that 593 persons (61%) used digital technologies during the ﬁrst wave of Covid-19 pandemic in Latvia, mostly for communication with family and friends as well as acquisition of information (90%). There were no considerable gender differences as regards the use of digital devices in general (p>0.05), neither their use to receive health care services (36%, p>0.05). Even though there was an overall small proportion of those who had affordability problems (8%), more than twice of women than men responded that it was too expensive (p<0.001). Of all respondents 8% had health-related, e.g. cognitive, limitations to use digital technologies.

Conclusions Even though the ageing population is actively using digital technologies to communicate and search information, considerable improvements and education to encourage to use health-care services, make purchases can still be made. An awareness that almost one of ten older persons can be left out of health-care services due to affordability problems, should be also considered to ensure equal access to basic needs. VPP-COVID-2020/1-0011 “Impact of COVID-19 on health care system and public health in Latvia; ways in preparing health sector for future epidemics”.

70 Research Of Risk Factors And Epidemiology Of Diseases RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Alcohol use during pregnancy as a risk factor for miscarriage. A pilot study

Mr. Vladimirs Naumovs 1, Prof. Valērija Groma 2 1. Department of Postgraduate Studies, Rīga Stradiņš University, 2. Institute of Anatomy and Anthropology, Rīga Stradiņš University

Objectives Consumption of alcohol occurs in different age groups. The modal alcohol consumer is 18 – 29 years old. It is also the modal child-bearing age. 2019 National Survey on Drug Use and Health reports 9.5 and 5.8% of pregnant women consume alcohol and illicit drugs, respectively. There is a range of pathologies correlated to antenatal exposure to alcohol. It is important to understand these pathogenic mechanisms for clinical practice to establish biomarkers that would help evaluate the teratogenic risk of current exposure. The aims of the study are as follows: a) determine alcohol use prevalence among pregnant women; b) determine and compare miscarriage prevalence among pregnancies exposed and unexposed to alcohol.

Materials and Methods Information concerning medical history and pregnancy outcomes are retrieved from the Health Care Monitor- ing datalink (HCMD).

Results The data obtained from HCMD included 584 women; 103 (17.64%) out of them had at least once consumed alcohol during pregnancy. Thirty-eight (7.90%) and 15 (14.56%) pregnancies ended in miscarriage in the unexposed and exposed group, respectively, yielding an OR 1.99 [CI 1.048, 3.768]. Data was further stratiﬁed by age into four groups: <24y.o. (n=112); 25-29 y.o. (n=222); 30-34 y.o. (n=162); 35-39 y.o. (n=88). Among them 20 (17.86%), 42 (18.91%), 30 (18.52%), and 11 (12.50%) women, respectively, have used alcohol at least once during pregnancy. The following odds ratios were derived, when stratiﬁed by age: 1.59 [CI 0.297, 8.537]; 1.08 [CI 0.341, 3.411]; 1.69 [CI 0.499, 5.734]; 1.44 [CI 0.152, 13,616], respectivley.

Conclusions Antenatal alcohol exposure is a relevant problem in Latvia. There is a higher risk of miscarriage for women consuming alcohol during pregnancy. Based on the available relevant international literature risk for miscarriage increases in a dose-dependent manner, however further analysis is required in the Latvian population to determine if this pattern of cause and effect is applicable.

72 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Drowning associated risk groups in a ﬁve-year time period in Riga and Riga planning region: location and season

Ms. Evelīna Stepiņa 1, Ms. Marta Riekstiņa 2 1. Faculty of Medicine, Rīga Stradiņš University, 2. Department of Pathology, Rīga Stradiņš University; Children’s Clinical University Hospital

Objectives Drowning is the 3rd leading cause of unintentional injury of death worldwide. These deaths are often unintentional, classiﬁed as accidents and instantaneous. Yet they are potentially preventable. There are several factors that could be associated with risk groups within our population. Aim of this study is to identify whether drowning place and season determines higher chance an individual will drown.

Materials and Methods A study was carried out involving fatal drowning victim cases from January 1st, 2015 to December 31st, 2019 at the State Centre for Forensic Medical Examination of the Republic of Latvia. All recorded data were analysed using MS Excel and IBM SPSS.

Results In total, 215 victim cases were enclosed in this study. 34,9% of victims drowned in rivers (n=75), from which 66,7% were in Daugava river (n=50). 12,6% drowned in ditches (n=27), 10,2% in lakes (n=22), 9,3% in bathtubs (n=20), 8,4% in sea (n=18), 7,9% in ponds (n=17), 2,8 % in swimming pool (n=6) and 14% in other places (n=30). 45,1% of victims drowned in summer (n=97), 20,5% in autumn (n=44), 14,4% in winter (n=31), 20% in spring (n=43).

In summer and autumn there is 35,1% and 45,5% occurrence in rivers respectively (n=34 and n=20). In winter 29% drown in bathtubs (n=9), in spring 25,6% in ditches (n=11) (p<0,0001). 70,6% of drowning in ponds happen in summer (n=12), 77,8% of drownings in sea happen in summer (n=14) (p<0,0001). Also, the study revealed that 83,3% of drowning accidents in swimming pools happen in autumn (n=5).

Conclusions Swimming in summer and autumn in river, especially Daugava river, determine that these individuals statistically have higher risk to fall into category of drowning victims.

In winter drowning is more often in bathtubs but in spring – ditches. Drowning in swimming pools is more likely in autumn than in any other season.

73 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Factors associated with primary source of sterile syringes among injecting drug users

Ms. Laura Isajeva 1, Prof. Anda Ķīvīte-Urtāne 2, Prof. Ģirts Briģis 3 1. Department of Public Health and Epidemiology, Rīga Stradiņš University; The Centre for Disease Prevention and Control of Latvia, 2. Department of Public Health and Epidemiology, Rīga Stradiņš University, 3. Rīga Stradiņš University

Objectives Latvia has the highest HIV incidence rate in the EU, and injecting drug use is the second main mode of HIV transmission. Needle-syringe exchange program (NSP) is a harm reduction to prevent blood transmitted infections. However, Latvia has insuﬃcient coverage of sterile syringes through NSP, some people who inject drugs (PWID) are not informed about NSP services and availability of NSP services is limited, consequently, it increases injecting risk behaviour and spread of infectious diseases. Aim of the analysis is to identify factors associated with the primary source of sterile syringes among PWID.

Materials and Methods Data from the 11th phase of Drug User’s Cohort Study (2018, Latvia) was used. The research was held by the Centre for Disease Prevention and Control and NGO “DIA+LOGS”. Of the 478 respondents, 431 PWID provided information about the primary source of sterile syringes in the last 30 days. Multiple logistic regression models were adjusted for age, gender, income, duration of injection, the intensity of injection, by using IBM SPSS 24.0 software.

Results There were 92.8% (n = 400/431) PWID obtaining sterile syringes mainly from NSP and 7.2% - at the pharmacy stores (n = 31/431). PWID obtaining syringes from NSP have higher odds of polydrug use (aOR 16.3; 95%CI 2.0-134.9) and injecting at least two times per day (aOR 7.0; 95%CI 1.9-26.0) than PWID obtaining syringes at the pharmacy stores. Clients of NSP services are more likely to use previously used syringes (aOR 6.0; 95%CI 1.1-32.9) and overdose (aOR 3.8; 95%CI 1.1-12.6) than PWID obtaining syringes at the pharmacy stores.

Conclusions PWID obtaining syringes from NSP have higher odds of injecting risk behaviour, which indicates insuﬃcient coverage of sterile syringes and needs to improve the availability of NSP services. Also, pharmacy stores could provide NSP services, like a possibility to utilize syringes and distribute sterile syringes for free.

74 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Risk for developing breast cancer in women: above-normal BMI

Dr. Anrijs Djatkovičs 1 1. University of Latvia

Objectives The aim of this study is to analyse, how BMI and age affects development of breast cancer in women.

Materials and Methods A total of 283 medical history cases of women diagnosed with breast cancer at the Oncology Centre of Latvia in 2010 and in 2017 aged between 30-89 were included in this study. SPSS version 22.0 was used for statistical analysis.

Results From 283 researched breast cancer patients 69% (N=196) had above-normal BMI. Of these, 31% (N=88) were overweight and 38% (N=108) were obese. On the ﬂipside, only 31% (N=85) of patients with normal or below- normal BMI were diagnosed with breast cancer, i.e. 29% (N=82) had normal weight and 1% (N=3) were under- weight. Additionally, more than 70 % of women diagnosed with breast cancer with above-normal BMI were aged between 50-89. Of these, 75% (N=109) were aged between 50-69 and 77% (N=47) were aged between 70-89. Women aged between 30-49 had above-normal BMI in 53 % (N=40) of cases.

Conclusions There is a signiﬁcant link between above-normal BMI and breast cancer development in women. The risk of developing breast cancer increases with age for woman with above-normal BMI. Development of breast cancer in women can be reduced by assuring normal weight, especially in elderly women.

75 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Seasonal variations of 25(OH)D vitamin in Latvia are age and gender-related – implications for testing schedule

Dr. Sergey Nikulshin 1, Dr. Jana Osite 2, Dr. Stella Lapina 2, Dr. Anda Krisane 3, Prof. Iveta Dzivite-Krisane 1 1. Rīga Stradiņš University; Children’s Clinical University Hospital, 2. Central Laboratory, 3. E. Gulbja Laboratory

Objectives Considerable seasonal deviations of 25(OH)D, typical for countries with seasonal climate, are important for proper testing and correction regimens. We present an extensive retrospective analysis of seasonal 25(OH)D status in Latvian population.

Materials and Methods Anonymized test results from two leading Latvian laboratories were assessed – E.Gulbja Laboratory (EGL, 849739 tests, 2012-2019) and Central Laboratory (CL, 410427 tests, 2014-2019). 25(OH)D level, rate of deﬁciency <12 ng/mL, testing date and clients’ age and gender were analyzed by IBM SPSS v25 software (Kolmogorov- Smirnov and Kruskal-Wallis tests).

Results Testing methods and target populations of the laboratories were different, so results are not directly comparable. Still, trends were remarkably similar. In both data sets 25(OH)D level was highest in summer (SU), intermediate in autumn (AU) and lowest in winter (WN)/spring (SP), deficiency rate mirrored the dynamics. Maximal seasonal difference was 3.8 ng/mL of 25(OH)D level and 6.8% of deficiency rate in EGL and, respectively, 4.7 ng/mL and 10.5% in CL, all differences highly significant. Seasonality was more pronounced in men, with WN/SP levels significantly lower than in women and SU levels equal. Variations in both sets were similar in all age groups, except children and adolescents (no gender differences) and elderly women (negligible seasonal variations). Maximal number of tests in both laboratories had been performed in AU (27.6% in EGL and 27.3% in CL), minimal – in SU, this distribution was seen in all age groups.

Conclusions The study that covered a major part of 25(OH)D testing in Latvia demonstrated significant variations, charac- teristic for seasonal climate and diet. These variations were more pronounced in younger people and in men, thus defining target populations for additional correction. Higher testing activity in autumn that probably reflects clients’ preferences, seems to be clinically unfounded.

76 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The associations of short birth intervals with pregnancy outcomes: population-based cohort study

Mrs. Irisa Zile-Velika 1, Mrs. Anija Uibo 2, Dr. Ieva Strele 3, Dr. Iveta Gavare 4 1. The Centre for Disease Prevention and Control of Latvia; Rīga Stradiņš University, 2. Health Inspectorate, Ministry of Health of the Republic of Latvia, 3. Rīga Stradiņš University, 4. The Centre for Disease Prevention and Control of Latvia

Objectives Short interpregnancy interval has been linked to adverse pregnancy outcomes. WHO recommends waiting at least 2 years after a live birth and 6 months after miscarriage or induced termination before conception of another pregnancy. The objective of the study was to assess association of short interpregnancy interval and pregnancy outcomes.

Materials and Methods Data source was Medical Birth Register. A total of 51,109 mothers who gave birth between 1 January 2000 and 31 December 2017 were selected for the study. The analysis include women who have had a single pregnancy in the ﬁrst birth and no stillbirths and abortions in the anamnesis. Interpregnancy interval was deﬁned as the time between the end of pregnancy (delivery date) and the start of the next pregnancy (delivery date of next pregnancy minus gestational age at birth). Adjusted Odds (ORadj) ratio were calculated.

Results Compared with an interpregnancy interval of 18-23 months, intervals shorter than 6-11 and ≤5 months associated with increased odds of preterm births, accordingly ORadj 1.5 (95%CI 1.2-1.9) and ORadj 2.0 (95%CI 1.5-2.6); low birth weight (≤2499g) ORadj 1.6 (95%CI 1.3-2.1) and ORadj 2.1 (95%CI 1.6-2.8). Results of interpregnancy interval 12-17 months showed the same tendency – increased odds of preterm birth (ORadj 1,4 (95%CI 1.2-1.8) and low birth weight (ORadj 1.5 (95%CI 1.2-2.0). Increased odds of death in early antenatal period with shorter interpregnancy interval was observed but not statistically signiﬁcant.Women with a primary education are much more likely to have a shorter interpregnancy intervals than women with a higher education.

Conclusions Mostly adverse pregnancy outcome is seen in women with interpregnancy interval ≤5 months and 6-11 months. These ﬁndings could be used for planning future pregnancies and giving guidance on family planning.

77 Governance And Financing Of Health Systems RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Continuing way of health ﬁnancing policy reform: the case of Latvia

Dr. Kārlis Ketners 1 1. BA School of Business and Finance

Objectives The Latvian health care financing system continues a path to the sustainable financing and improvements of budgetary decision making within budget planning and execution continues to be vital. This study aims to review of the health financing policy application, allocation of financing resources for the health care system in Latvia and to discuss future changes, taking into account the implications of the coronavirus COVID-19 pandemic. The objective of the study is to examine the possible resource allocation decisions and budget policy challenges.

Materials and Methods The research used a combination of the descriptive research, comparative documentary analysis and economic analysis methods and used National Health Service data sources to establish evidence of impact. For investigating the impact on budget policies, the research drew on quantitative data assembled and synthesised by health care provider groups with a view to discerning trends in health care financing. Case study approach allows the identification of procedural or institutional gaps within the financing system.

Results General taxes remains to be the primary source of revenue for ﬁnancing the health care system.Additional re- allocation of the general government budgets is possible medium term solution. Additional elasticity powers for the Ministry of Health to reallocate appropriations are necessary.

Conclusions In Latvia despite various institutional reforms and changes in financing sources done during the past 30 years, the level of total public financing remains approximately the same – 3-4%of GDP. Public spending is low, while out-of-pocket payments are among the highest in Europe. Since 2013 there has been a focus on the financial sustainability of the system. In 2017, parliament passed a law for the introduction of a Compulsory Health Insurance System, with the aim of increasing revenues for health, which postponed to 2022. Budget strategy improvements to achieve high-level priorities, including assessments linked to needs and outcomes and adapt- ing spending review is recommended.

79 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Health workforce planning in Latvia: comparison of balance between existing supply and demand

Ms. Ieva Grike 1, Prof. Ilze Grope 2 1. Master’s Study Programme “Health Management”, Faculty of Public Health and Social Welfare, Rīga Stradiņš University; Faculty of Residency, Rīga Stradiņš University, 2. Faculty of Residency, Rīga Stradiņš University; Children’s Clinical University Hospital

Objectives Limited public funding available to health care in combination with time dedicated to train post-graduate medical specialists are the key issues according to which amount as well as distribution by specialty of post-graduate training places needs to be planned foresightly, wisely and in a complex manner. To use resources in most effective way, supply and demand needs to be balanced very well. The main objective of this thesis was to assess existing demand in Latvia of post-graduate training specialists in comparison with supply policy implemented by Ministry of Health.

Materials and Methods Documents and information analysis were carried out. Demand side was analyzed using Job vacancy platform, maintained by Riga Stradins university Faculty of Residency (RSF). RSF regularly updates Job vacancy platform, surveying and gathering information from 29 medical institutions. Supply side was analyzed through the public policy documents by Ministry of Health and data from post-graduate training admission contest in 2019 and 2020.

Results 1. 365 post-graduate training posts for basic specialties in medical institutions was available in 2020, including 32 posts for gynecologist, obstetrician, 32 posts for internist and 30 posts for anesthetist. 2. In average 200 post-graduate training posts to basic specialties in admission contest was available in 2019 and 2020, including 5 study posts for gynecologist, obstetrician, 18 study posts for internist and 15 study posts for anesthetist. 3. In average 44 undergraduate students in 2019 and 2020 were not able to enter state ﬁnanced post-graduate studies due to lack of available training posts.

Conclusions Demand exceeds existing supply, especially in certain specialties. Supply of post-graduate specialists is insuﬃ- cient. Given the lack of coherent planning of posts of undergraduate and post-graduate studies, bottleneck in supply value chain exists, exacerbating insuﬃcient supply. Existing supply policy needs to be improved. Nevertheless, further studies must be carried out to offer appropriate solutions.

80 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Using the Workload Indicator of Staﬃng Need (WISN) – method to model the HR requirements and costs of health care services in Kyrgyzstan

Prof. Olav Goetz 1, Mr. Jean-Olivier Schmidt 2, Mrs. Sandra Blackaby 2, Mrs. Damira Seksenbaeva 2, Mrs. Valerie Broch 2 1. APOLLON University of Applied Sciences, 2. GIZ German Corporation for International Cooperation GmbH

Objectives Health Care Systems are facing several challenges. The lack of resources, such as health workers, costing and financing are open and urgent questions in Health Care Systems. Tools from HR-Management and Cost- Accounting can help to improve financing of Health Care Services and provide substantial input to further develop Health Care reimbursement systems, such as DRG-Systems. The Workload Indicator of Staffing Need (WISN) – Method, a WHO - HR-Management Tool, can help to support the process of developing good reimbursement systems.

Materials and Methods Based on empirical data and interviews with Health Care professionals from multiple Health Care institutions in Kyrgyzstan the WISN – method was applied to calculate Human Resources in a Perinatal Health Care provider in Bishkek, Kyrgyzstan. Using the HR requirement calculation, the personnel costs were calculated and combined with the material costs, calculated using the DRG-Cost-Matrix of the German DRG-System (G-DRG-Report- Browser). These calculations were compared with the reimbursement of the intervention based up on the national reimbursement system in Kyrgyzstan.

Results The results of the analysis show, that it is possible to calculate the required personnel resources using the WISN- Method. Additionally, WISN can be used to calculate personnel costs, which are the highest share of costs in Health Care institutions. The results also show, that in combination with material costs, e.g. from a DRG – Cost – Matrix, such as the G-DRG-Report Browser, it is possible to calculate the total costs of Health Care services and to use this as a basis for the reimbursement system.

Conclusions It can be concluded that WISN in combination with additional Cost-Accounting systems is a good way how to calculate the total costs for an intervention in an Health Care institution, e.g. hospitals. These tools can help to develop or improve existing reimbursement systems and make ﬁnancing in health care more transparent and eﬃcient.

81 Person-Centered Health Services And Systems RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Chronic disease management in medical institutions in Latvia requires signiﬁcant improvements

Mr. Alekss Ūpis 1, Dr. Daiga Behmane 1, Mrs. Alina Dūdele 1 1. Rīga Stradiņš University

Objectives The objective of this study is to assess chronic disease management in medical institutions in Latvia and to identify aspects for improvement.

Materials and Methods A survey tool was developed based on the Patient-centered medical home assessment (PCMH-A) instrument related to Chronic Care Model (Wagner,2009) for secondary and tertiary care providers. Respondents (N= 34) rated their practice at 4 levels (D, C, B, A) with assigned rates from 0 to 3 (highest level) characterizing the implementation level in 4 areas (33 questions): organization, collaboration outside health care system, currently implemented practice and integration of chronic care components.

Results The management of chronic patients in health care institutions in Latvia is rated at low level: none of the areas exceeded 38% of the highest performance possible. The organization of services for chronic care patients is evaluated at the level of 38%, organization’s collaboration outside health care system at 27.2%, currently implemented practice for patient centered care – 21.95% and integration of chronic care components - 25% level.

Conclusions Chronic disease management in medical institutions requires improvements related to setting clear organizational goals„ collaboration outside the health care system, wider use of clinical information systems, systemic patient clinical monitoring, multidisciplinary approach and support for patient self-care. The development of individual patient care plans and collaboration between primary and secondary care teams is crucial for the success.

83 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Chronic disease management in primary care in Latvia requires signiﬁcant improvements

Dr. Daiga Behmane 1, Mrs. Alina Dūdele 1, Prof. Aivars Lejnieks 2 1. Rīga Stradiņš University, 2. Rīga Stradiņš University; Riga East Clinical University Hospital

Objectives Chronic disease management has become a key priority in Latvia as non-communicable diseases are characterized by relatively high preventable hospitalizations and poor care outcomes. Objective of the study was to assess current situation and identify measures to improve chronic diseases management in primary care.

Materials and Methods A survey based the Patient-centered medical home assessment (PCMH-A instrument was developed. Primary care specialists (N= 87) rated their current practice at 4 levels (D, C, B, A) with assigned rates from 0 to 3 in 5 areas: organization, patient centeredness, availability of services, coordination and medication. Each area was assessed on the basis of points obtained and expressed as a percentage of the sum of the maximum possible points.

Results The study justiﬁes rather low level of management of chronic patient care in GP practices: no element of care exceeds 50% of the highest performance expected. Organization of care is evaluated at the level of 36.85%, patient centeredness at 33.96%, availability and planning of services – 48.19%, care coordination - 45.19% and availability of medication - 38.72 % level. The study identiﬁes measures for the improvement of care management: introduction of individual patient care plans and targeting chronic patients, complete approach to evidence-based clinical algorithms, monitoring of results and data collection and exchange between specialists.

Conclusions Chronic disease management in primary care requires improvements related to care coordination, systemic patient clinical monitoring, multidisciplinary approach and support for patient self-care. The development of individual patient care plans and the development of primary and secondary care teams are recommended as key elements of coordination. The role of GPs and all other stakeholders in the care of chronic patients needs to be deﬁned, including social care and local government responsibilities, and an integration-oriented model of cooperation and support needs to be established.

84 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Concerns and needs of mothers raising children with epilepsy and developmental disabilities in Lithuania

Dr. Lina Danuseviciene 1, Dr. Ramunė Jurkuvienė 1, Dr. Polina Šedienė 1, Dr. Rūta Butkevičienė 1 1. Lithuanian University of Health Sciences

Objectives 1. To explore mothers‘ concerns and needs in raising child with epilepsy and developmental disability. 2. To reveal experiences of support and care assuring children with condition education, health and social care by services providers from mothers point of view.

Materials and Methods A qualitative study was conducted in Lithuania by interviewing 12 mothers raising children with epilepsy and developmental disabilities. Children‘ age varied from 4 to 17 years.

Results The study revealed that besides fulfilling the needs related to child’s health situation and stabilization of seizures, fulfillment of needs related to child’s education and socialization are important. Parents expressed the concern that in most cases they feel left alone with their problems despite the services provided to them by the various systems. Mothers expressed their feeling as it seems that they don‘t live their own life. Such families tend to get isolated instead of integrated into society. Also, children with epilepsy and developmental disability have to navigate through three systems without coordination of services, lack individualization and continuity of care. The system of care lack of attention of services aiming to enhance capacity of children independence. Children with condition attending general schools get into deeper isolation and loneliness as their do not have a chance to find a friend similar to them.

Conclusions Interviews revealed mothers experience of being quite alone taking care of the child. Big need for innovative, systematic and holistic services assuring children education, health and social care that could cover thee gaps in atkind of services families need and how these services should be provided was expressed by mothers. Improvements in community services and programs are needed to ensure the child-and-family-centered, coordinated services, specialized according child‘s health condition and the family as a whole.

85 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Financing challenges for person-centred healthcare systems

Ms. Diana Araja 1 1. Rīga Stradiņš University

Objectives Person-centred healthcare becomes relevant and creates a logical succession in the development process of the healthcare systems. Consequently, the question arises as to the suitability of current healthcare ﬁnancing models for person-centred health care. The aim of this study is to conceptually examine the appropriateness of the current healthcare ﬁnancing concepts for person-centred healthcare.

Materials and Methods To achieve the aim of this study, a Medline scientific search and institutional literature review was carried out. The papers identified were reviewed following the Synthesis Without Meta-analysis (SWiM) methodology, and classified according to the focus of the healthcare financing and organisational models.

Results Literature review results show, that in recent years, there has been an increasing focus on seeing health care financing as an investment, and usually, the concept of investment is associated with the expected return on investment. It should be noted that the indicators most commonly used in healthcare investment valuation, are focused on determining the future benefit of the patient’s current treatment. In these circumstances, financing challenges arise for healthcare of elderly people in the context of a rapidly aging society and increasing life expectancy. This is specifically actual in countries where current seniors’ generation lived and paid taxes peren- nial in a centralised system, without accumulating health insurance entitlements. It could be assumed, that the healthcare financing for this patients’ generation should take into account their past investments in productiv- ity of society and determine the present value of these investments. This approach could be in a contemporary context with person-centred healthcare, but simultaneously would require the introducing of new approaches to healthcare financial management, creating such tools as the personal health accounts and budgets, providing individual care packages and services.

Conclusions Person-centred healthcare requires the person-centred ﬁnancial management and poses new challenges for health ﬁnancing and organisational systems.

86 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Headache care and service in Latvia. Challenges, priorities and further perspectives

Mrs. Linda Zvaune 1 1. Rīga Stradiņš University

Objectives Headache disorders are prevalent and disabling. They are still under-recognized, under-diagnosed and under- treated, despite largely treatable. Health care for headache must be improved through well-organized health services and supported by education at multiple levels. The main aims of this study were to assess the current situation on headache care in Latvia and to identify the urgent needs in headache care in Latvia

Materials and Methods An electronic questionnaire survey of the three main groups involved in headache care -neurologists, general practitioners and patients. The questionnaire covered 7 themes related to headache care: epidemiology, diagnosis and assessment, treatment, human resources, headache impact, and issues.

Results A total of 150 respondents were interviewed (50 patients, 50 family doctors, 50 neurologists). The most unsat- isfied of headache care were patients, rating of 4,5 (from 1-10) and the main obstacle stressing an inadequate availability of appropriate medication due to the financial barrier. A general practitioners major challenge is a poor availability to a headache -specific health care. In turn, neurologists highlight lack of physicians knowledge of headache disorders. There are silent findings in this study that demonstrate unmet needs mentioned above. The most notable to point out is inappropriate headache treatment reported by physicians and the insufficient control over headaches noted by patients.

Conclusions Latvia faces a similar challenge in headache care like elsewhere in the world. The substantial call for action is better education both for professionals and patients. Improvement of availability to appropriate medications is an unmet need to reduce the burden of headaches in Latvia.

87 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Implementation of medication use review in community pharmacies in Latvia

Mrs. Jūlija Pavlovska 1, Dr. Ieva Salmane-Kuļikovska 1, Ms. Ieva Rutkovska 1, Mrs. Dace Ķikute 2, Ms. Kristine Karklina 3, Dr. Elita Poplavska 1 1. Rīga Stradiņš University, 2. Pharmacists Society of Latvia, 3. Benu Pharmacy

Objectives The problem of polypharmacy increases globally and also in Latvia - the number of patients simultaneously using five and more medications grows, contributing to increasing number of problems regarding use of medicines. Medication use review (MUR) is a service offered by pharmacies in a number of different countries. This service involves a pharmacist-patient consultation to improve patients’ knowledge and promote rational use of medicines. A pilot study (2019-2020) in five pharmacies was organized in Latvia – pharmacists underwent a training programme based on methodology by University of Tartu; patients with polypharmacotherapy (five and more medicines) were recruited by General practitioners (GPs) and pharmacists to three subsequent consultations. Aim of the study was to identify necessity, readiness and obstacles of MUR implementation in Latvia.

Materials and Methods The focus group was organized (December 2020) to explore opinions of the pharmacists participating in the pilot study regarding implementation of the study and its results, as well as views regarding introduction of MUR in Latvia – potential gains, obstacles and preconditions. The semi-structured interview was recorded, subsequently transcribed verbatim and answers were coded according to the guidelines of qualitative data processing methodology.

Results The pilot study results were evaluated positively by pharmacists – knowledge of patients and medication adherence improved; communication skills, knowledge and conﬁdence of the pharmacists increased after the pilot study. The main obstacles were lack of time and space for consultations, lack of interest of the GPs, patients’ lack of information about the project, insuﬃcient number of appropriately trained pharmacists.

Conclusions Successful implementation of MUR in Latvia has a potential to contribute to enhanced role and prestige of a pharmacist in health care, time savings of physicians, as well as to better outcomes in patients’ health, as the result of more rational use of medicines.

88 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Linking rehabilitation problems and interventions of patients with neuro-oncological disease to the WHO classiﬁcations

Mrs. Anete Petersone 1, Mrs. Agnese Kārkliņa 1, Dr. Guna Bērziņa 1 1. Rīga Stradiņš University; Riga East Clinical University Hospital

Objectives To systematize rehabilitation problems and interventions identified in the literature for patients with neuro- oncological disease by linking them to the International Classification of Functioning (ICF) and the International Classification of Health Interventions (ICHI).

Materials and Methods Previous scoping review (Interventions used in acute rehabilitation for patients with neuro-oncological disease: a scoping review)identiﬁed 24 problems and 38 unique interventions used in acute rehabilitation for patients with neuro-oncological diseases. The problems were linked to the ICF and interventions – to the ICHI, using principles of the ICF linking rules. Each concept was linked to the most precise ICF or ICHI category.

Results 27 problems were linked to the body function domains and 6 to the activities and participation domains (second level classification). 3 interventions were linked with the ICF in chapter level “activities and participation” (first level classification). One of the problems identified (inpatient nursing care) was not classified according to the ICF. 34 of the interventions were classified in the ICHI classification. 22 of identified interventions are classified into Body Structures and Functions section, 10 - into the Activities and Participation section, 1 in each Environmental and Health-related Behavior sections. Four of identified interventions are not included in the ICHI (virtual reality, mirror therapy, robotic upper extremity training to improve function and cognitive group therapy).

Conclusions According to the problems analyzed in the literature that target interventions, often do not coincide with the purpose of the specific intervention or are too broadly defined and not specific. This report shows that although rehabilitation works with activities and participation, the literature shows that interventions are mostly covering body functions section in the ICHI.

89 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Measuring patient satisfaction: dimensions and approaches

Mrs. Olga Veilande 1 1. Rīga Stradiņš University

Objectives Over the last decade, the concept of the patient satisfaction as an outcome measure has gained importance as healthcare providers. Patient expectations are the anticipated or believed encounters a patient envisions will occur in a healthcare system and can affect patient satisfaction. In order to obtain information on patient satisfaction with the quality of health care services, national level surveys are conducted in Latvia. However, as indicated in the ﬁnal report of the study “On Patient Satisfaction with the Quality of Healthcare Services”, the country has not yet developed uniform criteria according to which such surveys should be conducted. To make valid comparisons of data about patient experience of care of hospitals, similar methodology of measuring patient satisfaction with the medical care should be used, therefore the review of the scientiﬁc literature was made to develop and propose a model to the public hospitals for measuring patient satisfaction.

Materials and Methods The current study is a literature review of scientiﬁc articles and scientiﬁc researches about internationally recognised methodologies of measuring patient satisfaction. Information was analysed and synthesized.

Results The results of the study show that the patient satisfaction encompasses several different dimensions, including: interpersonal manner, technical quality, accessibility/convenience, ﬁnances, eﬃcacy/outcomes, continuity, physical environment, availability and the use of SERVQUAL approach dominates in patient satisfaction and service quality research.

Conclusions Measuring of patient satisfaction is of the multidimensional nature, results of which are good basis for improving quality management of operation of public hospitals. Process quality is as important as clinical quality in predicting patient satisfaction. Creating a positive patient experience is highly relevant in today’s healthcare environment since satisfaction metrics are often linked to payment.

90 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Satisfaction of the full time employed Latvian adult population with general practitioners

Mrs. Lāsma Wisper 1 1. Faculty of Health Science, Kristianstad University

Objectives Satisfaction of primary care is important factor that improve persons trust to primary care and encourage visiting their general practitioners (GP) more often. Therefore it is one of key point to provide society with lasting and continuous medical care. Good access to GPs is even more important to full time employed persons because of limited time resources. However, there is a lack of studies about factors that inﬂuence Latvian full time employed adult population satisfaction with GPs. The aim of the study was to analyse socio economics factors, usage of the health care resources, GP availability and communication inﬂuence to full time employed adult satisfaction with GP in Latvia.

Materials and Methods Quantitative survey study design was used based on data from Health Behaviour among Latvian Adult Pop- ulation 2016 survey (FINBALT). Data from 1864 persons were used for data analysis with SPSS Statistic 25,0.

Results GP opening (contact) hours, way of contacting GP practice, seeing GP in the appointed time, GP characteristics, patient’s self-assessed health condition and visiting GP in last 12 months were factors that affected full time employed person’s satisfaction with GP in Latvia.

Conclusions Targeted measures in stately, praxis and individual level could be introduced to improve full time employed person’s satisfaction with GP and therefore provide each person and society alltogether with lasting and continuous medical care.

91 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The perceptions of women with impaired physical mobility about occupational therapy during pregnancy and the postpartum period

Ms. Anneliis Aavik 1, Mrs. Marika Merits 1, Dr. Kadi Lubi 1 1. Tallinn Health Care College

Objectives Studies among women with physical disabilities show that there is a lack of scientiﬁc information about the support of an occupational therapist to support women with physical disabilities during pregnancy and the postpartum period in Estonia. The aim was to analyze the problems related to the physical and social environment, awareness of the occupational therapist’s service, and opportunities in occupational therapy to support women with impaired physical mobility during pregnancy and the postpartum period.

Materials and Methods For data collection, three semi-structured interviews were conducted which was suﬃcient for data saturation and in accordance with the size of the target group. The interviews followed the interview schedule and data analysis was based on qualitative content analysis. Ethical approval was granted by the Tallinn Medical Ethics Research Committee.

Results Physical access to health services and medical equipment is a major problem that requires solutions to support women with impaired mobility in general, as well as during pregnancy and postpartum. The social attitude towards women with reduced mobility and their motherhood is positive rather than negative. Awareness of the occupational therapist’s service and interventions to support women with reduced mobility during pregnancy and after childbirth is low due to the lack of knowledge about the discipline of occupational therapy and the content and availability of the service.

Conclusions There is a need for increased awareness about occupational therapy and the potential support it could provide to women with impaired physical mobility during pregnancy and the postpartum period. In order to improve the physical and social environment, midwives should also be involved in the information and service provision in supporting women.

92 Measuring And Improving Quality RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Comparison of disease prevalence, utilization of health care services and mortality rates in Latvian regions for persons with selected chronical diseases

Mrs. Alina Dūdele 1, Dr. Daiga Behmane 1, Ms. Jana Lepiksone 2, Ms. Jolanta Skrule 2, Mrs. Santa Pildava 3 1. Rīga Stradiņš University, 2. The Centre for Disease Prevention and Control of Latvia, 3. Patient Safety and Health Care Quality Improvement Unit

Objectives To compare prevalence, utilization of health care services and mortality rates for patient with selected chronical diseases between regions in Latvia.

Materials and Methods Data from health system administrative data bases for selected chronic diseases were analyzed. Mean and range of utilization rates of outpatient services, hospital services and mortality rates by country regions per 10000 inhabitants were assessed.

Results Estimated prevalence of selected chronical diseases varies between regions: for hypertension (I10) it is 1632 (1399-1787) , for diabetes mellitus (E11) it is 446 (399-552), for asthma (J45) it is 269 (221- 329). Number of outpatient visits varies between regions from 602 to 824 for patients with hypertension (I10), from 577 to 1135 for patients with diabetes mellitus (E11) and from 456 to 757 for patients with asthma (J45). Hospitalization rates vary from 28,0 to 61,0 for hypertension (I10), from 7,3 to 12,3 for diabetes mellitus (E11) and from 8,5 to 18,8 for asthma (J45). Mortality rate varies from 33,8 to 57,7 for I10-I25 and 2,63 to 4,37 for diabetes mellitus.

Conclusions Estimated prevalence of selected diseases by regions differs by 15-30%, utilization of health care services differs by 80-280%. Higher utilization of services is not associated with lower mortality rates.

94 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Conﬂicts and disputes in the disability determination process: deﬁciencies of expertise or legislation

Dr. Galija Kaļinkina 1, Dr. Irēna Ausma Rudņeva 1 1. State Medical Commission for the Assessment of Health Condition and Working Ability, Pre-trial Dispute Resolution and Legal Support Department

Objectives Disability is a long-term or permanent very severe, severe or moderate level functional limitation which affects a person’s physical or mental abilities, ability to work, self-care, and integration into society. State Medical Com- mission for the Assessment of Health Condition and Working Ability (SMCAHCWA) performs the examination of predictable disability and disability. Sometimes, person is not satisﬁed with the decision of SMCAHCWA and therefore occurs disputes, which are resolved in court.

Materials and Methods The aim of this retrospective, qualitative research is to evaluate and analyze materials of the expert case and legal proceedings, study and compare the reasons why courts have adopted judgments in favor of persons for the period from 2017 to 2019.

Results From 2017 to 2019, the SMCAHCWA participated in 225 legal proceedings in courts of ﬁrst, appellate and cassa- tion instance and in 19 cases decisions were made in favor of person. The most common reasons for the loss of proceedings, combine shortcomings of the court, the referring doctor, and the medical expert: Referring doctor mistakes: • The referral is not always correct, and the medical documents are not always ﬁlled in accurately • Inconsistencies in medical records Medical expert mistakes: • Is not used opportunity to invite a person for an on-site examination and to hear a person’s complaints related to health problems • No additional documents are required • Improper evaluation of contradictory information • The diagnosis, described in examination does not fully conform functional state of person Court mistakes: • In doubtful cases, the doubt is considered in favor of the person, not in accordance with the law • It is not judged only legal side of dispute, namely, expertise compliance with laws and regulations but also new, additionally obtained information

Conclusions Obtained data indicates deﬁciencies in legal proceedings, examinations and referrals. By correcting mentioned shortcomings, we can expect less proceedings and more legal and fair decision.

95 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Factors associated with 30 days mortality and one year mortality after hospitalization with acute myocardial infarction in Latvia

Mrs. Alina Dūdele 1, Prof. Ģirts Briģis 1, Ms. Lāsma Asare 1, Ms. Jolanta Skrule 2, Ms. Jana Lepiksone 2 1. Rīga Stradiņš University, 2. The Centre for Disease Prevention and Control of Latvia

Objectives To estimate impact of factors such as patients’ comorbidities, age and level of the hospital to 30-day and one year mortality in Latvian hospitals after hospitalization with acute myocardial infarction (AMI).

Materials and Methods Administrative data for 15321 patients admitted to the hospitals with AMI in 2014-2017, data on 30-day mortality and mortality within one year after admission were used to estimate odds ratio associated with age, index of comorbidities (Charlson comorbidity index was used) of patient and level of the hospital. Binary logistic regression models were constructed to estimate impact of every factor and its’ statistical signiﬁcance.

Results Binary logistic regression model identiﬁed that 30-day and one year mortality odds ratio when compared between age groups, comorbidity (Charlson) index groups and hospitals’ level groups are statistically signiﬁcant. 30-day mortality odds ratio when compared age group >80 years with age group <60 years is 8,77 (95% CI: 7,33- 10,50). 30 day mortality odds ratio when compared patients with more than two comorbidity (Charlson index >2) with no comorbidities is 1,90 (95% CI: 1,65-2,19). 30-day mortality odds ratio when compared regional hospitals with university hospitals is 1,37 ((95% CI:1,27-1,52). One year mortality odds ratio when compared between group of patients in age group >80 years with age group <60 years is 9,98 (95% CI: 8,58-11,61).

Conclusions Although main predictors of 30-day and one year mortality after admission to the hospitals with AMI in Latvia remain age of the patient and status of comorbidities, the level of the hospital care provided associated with the level of the hospital is by itself statistically signiﬁcant.

96 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Improving quality of ischemic stroke patients requires substantial changes in hospitalization plan and treatment intensiﬁcation in Latvia

Mrs. Alina Dūdele 1, Dr. Daiga Behmane 1, Mr. Toms Baumanis 1 1. Rīga Stradiņš University

Objectives To investigate causal relationship of stroke mortality in relation to the patient’s treatment site and provided treatment in 2019.

Materials and Methods Administrative data for 3982 major manipulations applied for treatment of stroke patients admitted to hospitals were studied by the treatment site. 30-day mortality rates for hospitals were obtained from the NHS public data base.

Results In total 5077 ischemic stroke patients were admitted to 21 treatment site in 2019, 13,8% of which did not represent stroke unit. Mortality rate in hospitals without stroke unit is 1,38 times higher and is in range from 16,5% to 66,7%, but in hospitals with stroke unit is in range from 16,% to 38,9%. Thrombolysis therapy was administered to 24% of patients admitted to hospitals without stroke unit and 47% in stroke units. Percutaneous translumi- nal angioplasty was administered to 23% of patients and intra-arterial embolization was administered to 11% of patients admitted to stroke units. Ischemic stroke patients admitted to hospitals without stroke units do not receive appropriate treatment and are at higher risk of 30-day mortality.

Conclusions Improving the quality of ischemic stroke treatment and reducing the 30-day mortality rates requires providing treatment only in hospitals with stroke units and the treatment used should be intensiﬁed. The hospitalization plan for stroke patients and treatment guidelines needs to be revised.

97 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Perception of patient safety climate in Latvian nurses: the effect of training

Dr. Evija Andzane 1, Prof. Juris Barzdins 2, Dr. Lilian Tzivian 2 1. Health Inspectorate, Ministry of Health of the Republic of Latvia; University of Latvia, 2. University of Latvia

Objectives Objectives of the current study was to investigate differences between Latvian nurses in assessment of safety climate according to their participation in patient safety training (PST) programs.

Materials and Methods Altogether 321 nurses from different Latvian hospitals were enrolled in the study. We assessed patient safety climate, using a validated Staff Survey for Measuring of Patient Safety (SSMPS) questionnaire. We investigated differences across 4 domains: Teamwork Climate, Safety Climate, Stress Recognition, Job Satisfaction between nurses that did not attended PST at all, those that attended only one lecture, those that attended between 5 to 16 hours, and those attended more than 16 hours of PST using Kruskal-Wallis test. We further investigated differences between nurses that did not participate in PST programs and those that did at least for 16 academic hours in their assessment of domains of SSMPS using Mann-Whitney test.

Results Most of study participants were women (99.4%) working full time (93.1%), 45-49 years old (18.9%), 1.9%-less than 24 years old and 1.9%-older than 65. From all nurses, 102 (31.8%) attended more than 16 hours of PST, and 57 (17.8%) did not attend PST at all. Differences between participants attended different number of hours of PST were in their assessment of Stress Recognition domain (p< 0.01). In those that attended more than 16 hours of PST acknowledgement of how performance is inﬂuenced by stressors (Stress Recognition) were higher (Mean ± standard deviation 3.87 ± 0.75 versus 3.58 ± 0.64, respectively).

Conclusions PST presents positive effect on nurses’ perception of human ability to work safely in stressed conditions if PST is at least 16 hours. Stress, high workload, time limits are usual factors in healthcare, therefore human factors training should be part of PST. Organizational culture and learning system is basis to improve teamwork, safety climate, job satisfaction for patient safety.

98 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Process-management in healthcare – how process-modelling and simulation can help to increase eﬃciency and quality of health care services

Prof. Olav Goetz 1 1. APOLLON University of Applied Sciences

Objectives Health Care Systems are facing several challenges, especially in the time of a pandemic. The lack of resources, such as health workers, but also scarce capacities, such as Operating theatres and Intensive Care Unit beds, are crucial in the process of providing high class Health Care Services. Operations research offers a variety of tools that support the analysis, modelling and evaluation of processes. Especially, Discrete Event Simulation (DES) is a method to support these analyses and helps to support decision making to increase the eﬃciency and quality of Health Care Services.

Materials and Methods Based on empirical data, gathered by observation, interviews, process analysis, time study and data from the hospital information systems, the presentation will analyze how process can be modelled and evaluated in Health Care. By using different stochastic DES models, the treatment process within an Operating Theatre and an Outpatient department will be modelled and simulated.

Results The results of the presented studies show that DES is an appropriate method for representing different processes in Health Care Systems. It is possible to increase the utilization rate of scarce resources, which results in an increasing eﬃciency of the services provided and to decrease the time in the system, as part of a quality parameter in health care service provision.

Conclusions It can be concluded that DES is a powerful tool that can substantially support the areas of process management, thereby helps to reduce costs, increases the eﬃciency of processes and quality in hospitals and in health care systems.

99 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Regulating nursing practice through the application of standards

Prof. Silviya Borisova 1 1. Medical University “Prof. Dr. Paraskev Stoyanov” – Varna

Objectives In accordance with the development of medical science nursing acquires a new dimension in the ﬁeld of health care. Nursing activities are based on rules and norms for good practices based on a comprehensive concept in the standardization of health care. The Nursing in Bulgaria there are authors who explore the quality of nursing cares and the applying of rules for good nursing practice. Unfortunately it has been studied partly and insuﬃcient. In nursing practice researches are being conducted to introduce standards for nursing practice.

Materials and Methods The researches are focused on applying of care standards in professional activities that nurses can act independently. For studying the problem following researches are made: analysis of theories in nursing; opportunities to change current practice; analysis of the laws determining nursing practices; studied attitudes and readiness of nurses to work according to standards; SWOT analysis of nursing practice.

Results Have been identiﬁed attitudes and readiness of nurses in Bulgaria to work with care standards. Expert opinion shows that this approach contributing to the theoretical and practical development of nursing. Theories in nursing are used to generate modern knowledge and guidelines in the development of the nursing profession. We developed criteria to compare the content and results of the applying of theoretical concepts in practice- theory, concept, ﬁeld of applying and assessment. Nursing theories allow different professional approaches to be applied in the nurse’s practice. Allow take action to promote the importance of nursing care and validation of autonomy.

Conclusions Professional standards help to implement safe practices for the patient, to delegate tasks, to register, report and take responsibility for every action taken and patient care provided. The standards of care are outlined as priority in nursing practice in Bulgaria.

100 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The impact of COVID-19 pandemic on the quality of community pharmacy services in Estonia

Ms. Hedvig Rass 1, Mrs. Kadi Lubi 2, Mrs. Kristiina Sepp 1, Mrs. Daisy Volmer 1 1. University of Tartu, 2. Tallinn Health Care College; Rīga Stradiņš University

Objectives Community pharmacy service is an integral part of primary care. During COVID-19 pandemic, pharmacists working alongside with other front-line healthcare professionals had to secure the availability, accessibility, and quality of the service to maintain the health of the population. Evaluate the impact of the COVID-19 pandemic on the organization, quality and provision of community pharmacy services in Estonia.

Materials and Methods 35 qualitative in-depth semi-structured interviews (10 representatives of Estonian governmental institutions and pharmaceutical companies (experts), and 25 pharmacists from different regions of Estonia) were conducted online in April-June 2020. Recorded interviews were transcribed verbatim and thematic textual analysis based on the interview schedule was performed.

Results Pharmacies were able to reorganize service provision based on national situation and governmental instructions to ensure the safety of patients and pharmacists and the availability of the service. National restrictions on the prescribing and dispensing of medicines were generally considered appropriate. As the provision of the primary care service was mostly restricted, then most pharmacies remained open and became an important information- and service-provider. The quality of pharmacy services became more demanding with addition towards COVID-19 speciﬁc healthcare information.

Conclusions The COVID-19 pandemic affected the operation of community pharmacies in Estonia, but nevertheless a high- quality pharmacy service was available to patients throughout the lockdown period in spring and community pharmacists demonstrated their crucial role in primary healthcare. It is important to maintain access to medicines and develop rapid communication pathways with other healthcare providers and governmental institutions in situation of crisis.

101 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The quality in mental health services – data on care for patients with schizophrenia from the community-based mental health clinic “Veldre”, Riga Centre of Psychiatry and Addiction Medicine

Mrs. Dina Ozerska 1, Prof. Māris Taube 2 1. Clinic Veldre; Rīga Centre of Psychiatry and Addiction Medicine, 2. Rīga Stradiņš University; Riga Psychiatry and Narcology Centre

Objectives In Latvia the methodology for qualitative and quantitative evaluation and improvement of the mental health service system is currently under development. Clinic “Veldre” (2012) is one of the only two community – based mental health care centers in Latvia. The quality of clinic “Veldre” has never been assessed before. The aim was to assess the quality of care for patients with schizophrenia of the “Veldre” clinic’s outpatient department.

Materials and Methods The retrospective nonexperimental observational study was performed. The data for the last three years were obtained from the inner information system. The quality indicators were calculated for the patients of the outpatient department (aged 18 – 65 with the diagnosis of schizophrenia spectrum disorder): Percentage of patients rehospitalized to the same psychiatric facility within 30 days after discharge (indicator F 1) Percentage of patients rehospitalized to the same psychiatric facility within a year after discharge (F 2) Percentage of patients received a psychiatry consult within 30 days after discharge (F 3) Frequent rehospitalization rate - percentage of patients readmitted for the in-patient care more than once per year (F 4) Long-stayers rate - percentage of patients spend more then 28 days continuously in the in – patient care (F5) Percentage of patients received care in the day clinic within one year after being discharged from in-patient care for the ﬁrst, second, third time in their life (F 6) Suicide rate within one year following the discharge from in-patient psychiatric care (F 7) Mortality rate (F 8). The results are compared with the corresponding international data.

Results Results of the study can be used to improve the quality of care for people with schizophrenia.

Conclusions Further research is needed to compare the quality of community - based mental health service with the conventional one.

102 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Young sportsmen demonstrate pronounced daily variations of hematological values – are traditional reference ranges compromised?

Dr. Sergey Nikulshin 1, Dr. Iveta Gorel 2, Dr. Ivita Sela 2, Dr. Dagne Gravele 2, Prof. Dace Gardovska 1, Mrs. Tamara Lopatina 2, Mr. Vladimirs Nikolajenkovs 3 1. Rīga Stradiņš University; Children’s Clinical University Hospital, 2. Children’s Clinical University Hospital, 3. Diamedica Ltd.

Objectives Diurnal variations of patients’ laboratory parameters, including clinical blood test (CBT) cause considerable interpretation problems; it is unclear if these variations are physiological or disease-related. Narrowing of daily testing schedule is the accepted solution, still, it’s not always possible in hospital setting and its effectiveness has not been studied.

Materials and Methods 8-17 years old sport school trainees have had CBT regularly performed in Children’s Clinical University Hospital as a part of obligatory yearly checkup; the cohort may be tentatively considered as a healthy model. We analyzed 15068 anonymized CBT tests (Sysmex XN2000) taken between 8.00 and 15.00. IBM SPSS v25 was used for statistical analysis.

Results The study revealed pronounced variations within the 8.00–15.00 interval: WBC varied by 14%, absolute NEU by 27%, LYM by 12%, EO by 20%, MON by 14%, PLT and RBC by 4%. WBC, NEU, LYM and MON increased during the time, EO and RBC decreased and PLT peaked at noon. All differences were highly signiﬁcant in Kruskal-Wallis test. The dynamics were similar in age groups (8-12 and 13-17 years) and in genders.

Conclusions The study demonstrated significant and consistent fluctuations of CBT parameters in healthy children and adolescents at 8-hour interval; 24-hour variations may be even greater. Leukocytes were more variable than platelets and red cells. The findings prove that diurnal changes in patients are not only disease-related, but are at least partly due to normal biological rhythms. These variations in our study were by their size comparable or larger than differences between age groups and genders that are traditionally incorporated in reference ranges, and thus must not be ignored. Sharp and asynchronous dynamics of blood parameters suggest that strict fixing of testing time is not really practical and may be misleading, a more elastic approach to testing schedule and to definition of normal values is necessary.

103 Information And Communication Technology For Health RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Adoption speed of the COVID-19 smartphone tracing apps and COVID-19 incidence rates – is there a correlation?

Ms. Silja Elunurm 1, Ms. Kristiina Kuldkepp 1, Ms. Maarja Lember 2, Dr. Piret Sell 1, Dr. Elen Vettus 2 1. Tallinn University of Technology, 2. Tallinn University of Technology, North Estonia Medical Center

Objectives Recent study shows that if 15% of the population would use a tracing app, it could reduce COVID-19 infections by 8% and deaths by 6%. Current study aimed to identify available COVID-19 smartphone tracing apps and study the correlation between tracing apps download statistics and COVID-19 incidence rates in the European Union and European Free Trade Association countries.

Materials and Methods 31 countries were included and in total 29 tracing apps were identiﬁed. Total download numbers were available for 20 apps. Daily or weekly data was acquired for 16 apps. Data was collected retrospectively (13 March - 30 September 2020) either directly from app developers or public sources. The download numbers were compared with COVID-19 incidents to analyze the correlation.

Results From identiﬁed apps, 28 were functioning tracing apps. There were no tracing apps in Greece, Liechtenstein, Luxembourg, Romania, Slovakia, and Sweden. In Norway, the app was suspended due to privacy risks. Total downloads ranged from 1.0% to 50.5% of the total population. There was no correlation between tracing app downloads and COVID-19 incidences rates, except for Italy [(r)=0.7]. There was a tendency that apps using decentralized privacy-enhancing technologies with Bluetooth had higher total downloads, compared to GPS based tracing apps, with one exception - Iceland.

Conclusions Based on the current study, there was no signiﬁcant correlation between smartphone tracing app adoption speed and COVID-19 incidences, except for Italy. It can be considered that further studies are required to assess how other factors inﬂuence the adoption speed, e.g. governmental leadership and strategic communication, the novelty of the app, the technology used, attitudes and trust towards public e-services. The main limitation of this study was its short duration, as the second wave of the COVID-19 spread is not included, therefore a longitudinal study is required.

105 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Digitalization of health care system in Pakistan

Dr. Eumna Tehseen 1, Dr. Marina Järvis 1, Prof. Piia Tint 1 1. Tallinn University of Technology

Objectives The number of inhabitants in Pakistan is 212 million while the doctor to patient rate is 0.83 physicians per 1000 individuals. Moreover, as many female doctors leave clinical practice due to household and childcare responsibilities, telemedicine initiatives such as eDoctor (SE Software Technologies) and Sehat Kahani (Grocode.io) enable them to conduct their medical practices remotely via online patient consultation through a telehealth platform. According to the World Health Organization, E-health helps health professionals and health consumers to deliver health information through the Internet and telecommunication services. In the UK, Pakistan origin doctors built the telemedicine software to connect to the intensive care unit in Lahore (Pakistan) for Covid-19 treatment. The software allows doctors to talk via video link and exchange copies of case notes as they speak. His aim was to provide a high quality of treatment plan for patients in Pakistan. The aim of the paper is to clarify, that to what extent is the health care system digitalized in Pakistan and what can be done using the experience of the European countries.

Materials and Methods 20 interviews via video link were carried out with health professionals in Pakistan based on the questionnaire to know the depth of knowledge they have regarding digital health and the role of it in improving female health throughout the country.

Results According to DataReportal, in January 2020, Pakistan had 164.9m mobile connections, which makes up 75% of the total population. There were 76.38m internet users.

Conclusions E-health and telemedicine may prove to be critical solutions to overcoming geographical, ﬁnancial, or other barriers for those seeking quality of health care. References: Digital Pakistan - www.sehatkahani.com

106 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Ownership of data used in the teaching process of artiﬁcial intelligence

Mr. Artūrs Žukovs 1 1. Doctoral Study Programme “Law”, Rīga Stradiņš University

Objectives In today’s technologically rapid society, it is important to pay attention to the modernization of the legal framework and, based on the ex ante principle, to provide a legal framework for the prevention of future legal problems. The aim of the research is to identify the dimensions of data, the role of data in the teaching process of artiﬁcial intelligence and data ownership in the stages of the learning process of artiﬁcial intelligence.

Materials and Methods To determine the results the following materials will be analyzed: opinions of the Council of the European Union, the General Data Protection Regulation and case law. An analytical and descriptive method will be used for the research. The analytical method will help to analyze the terms “data”, “ownership”, “artiﬁcial intelligence” and on what principles it is determined, meanwhile, the descriptive method will describe the main ownership principles that would apply to data in the context of artiﬁcial intelligence training.

Results By identifying the dimensions of the data, one can conclude that data today is identifiable as a product. On the other hand, “training” of artificial intelligence is not possible without data, moreover, the larger the amount of data used in the “training” process, the more accurately and faster artificial intelligence can operate.

Conclusions The data used in artificial intelligence, as an object of ownership, in the author’s opinion is vulnerable. The data subject is not provided with the legal tools to benefit from the further use of his data. Under the General Data Protection Regulation, the data subject has the right to monitor his or her data, but the regulation does not prohibit the processor from commercializing legitimately collected data which does not bring any benefit to the data subject himself.

107 Occupational Medicine RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Analysis of occupational morbidity in Latvia in comparison with European countries

Prof. Maija Eglīte 1, Dr. Jolanta Cīrule 2, Dr. Ieva Kalve 1, Prof. Ivars Vanadzins 1, Dr. Tija Zvagule 2 1. Department of Occupational and Environmental Medicine, Rīga Stradiņš University, 2. Centre of Occupational and Radiation Medicine, Pauls Stradins Clinical University Hospital

Objectives Objectives of the study is to analyze occupational morbidity in Latvia during a 23-years period and to compare with occupational morbidity in member countries of the Northern Dimension Partnership in Public Health and Social Well-being (NDPHS).

Materials and Methods The analysis of occupational diseases (OD) and patients revealed for the ﬁrst time during a year according to the data from the Latvian State Registry of Occupational Diseases (OD) for 23 years period 1996 – 2019 was performed. Numbers of new cases of OD and patients were recalculated per 100 000 employees. Data on OD in the NDPHS countries were obtained from EU Prevention Reporting of Work – Related Diseases and OD (2018).

Results The number OD patients and diseases revealed for the first time during a year has been gradually increasing since 1996 until 2019. The number of first – time registered OD patients per 100 000 employees was 11.5 in 1996 and 196.6 in 2019. Number of newly revealed OD patients in 2019 exceeded that of 1996 by 17.0 times, but number of first time registered OD by 29.7 times. There is a wide variation of reported OD in the participating countries. OM rates in 2016 were highest in Latvia, followed by Norway and Finland. The lowest rates were in Russian Federation and Poland. There are a variation in diagnosis of recognized OD. Musculoskeletal diseases is the leading group of diseases followed by diseases of the nervous system and sensory organs, among them, carpal tunnel syndrome and hearing loss.

Conclusions It should be noted that during the last years, occupation morbidity tends to decrease in developed EU countries, while it is still increasing in Latvia.

109 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Immunohistochemical expression and localization of MMP-9, MMP-13, e-cadherin and Ki-67 in road pavers’ skin chronically exposed to bitumen products

Prof. Venerando Rapisarda 1 1. Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania

Objectives Several categories of workers are exposed to agents present in the outdoor environment, among which there are road pavers who are chronically exposed to numerous substances including asphalt fumes. Asphalt, also known as bitumen , is a sticky, black and highly viscous liquid (or semi-solid) form of petroleum oil, contains high levels of polycyclic aromatic hydrocarbons (PAHs) that have several carcinogenic and non- carcinogenic potential. Road pavers skin is chronically exposed to bitumen fumes. To investigate the matrix metalloproteinase (MMP)-9, (MMP)-13, e-cadherin and Ki-67 expressions in road pavers’ skin chronically exposed to bitumen products in order to contribute to a better understanding of the earlier tissue alteration.

Materials and Methods Skin punch biopsies from 16 daily exposed workers and a control group were studied by immunohistochemistry. Morphometric and densitometric analyses were also conducted.

Results Morphological specimen evaluation of skin of road pavers showed epidermal thinning, ﬂattening and loss of intercellular junction with a decreased expression of e-cadherin conﬁned to the basal skin layer, together with MMP-9 and MMP-13 overexpressions in all epidermis layers, vascular structures and adnexa. No immunohistochemical alteration was reported for Ki-67 vs normal skin.

Conclusions Results from this study show that overexpression of MMP-9 and MMP-13 may represent an early response of the ﬁrst human barrier to exposure to bitumen products. Regulation of MMPs could be one of the strategies to prevent primary skin disease.

110 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Impact of workplace conﬂicts on sickness presenteeism in Latvia

Mrs. Svetlana Lakiša 1, Dr. Linda Matisane 1, Prof. Inese Gobiņa 2, Prof. Ivars Vanadzins 1 1. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University, 2. Rīga Stradiņš University

Objectives The study’s objective was to investigate the associations between different types of workplace conﬂicts and self- reported sickness presenteeism using cross-sectional survey data pooled from four periodic national surveys “Work conditions and risks in Latvia” (2006 - 2018). The studied outcome sickness presenteeism was deﬁned as went to work while being ill.

Materials and Methods Computer-assisted personal interviewing method for data collection of randomly selected respondents was used to obtain the sample representative to the working population of Latvia. The study sample (n=6368) consisted of hired workers between 16 and 80 (average 42.9 +/- 12.6), 47.1% males and 52.9% females. The association between workplace conﬂicts and sickness presenteeism was analysed using binomial logistic regression with adjustment for gender, age, education, and survey year. Respondents who were not ill during the last year were a reference group.

Results On average, 11% of respondents noted sickness presenteeism during last year. The odds of presenteeism significantly increased for all types of conflicts, but most significantly with workplace conflicts between managers and workers (OR=2.84, 95% CI 2.36-3.41) which was also the most frequent type of conflicts reported by 53.5% of all respondents. In general, the odds of sickness presenteeism increased twice for those reporting the conflicts between individual workers (OR=2.19, 95% CI 1.86-2.59), conflicts between groups of workers (OR=1.93, 95% CI 1.62-2.30) and conflicts with customers (OR=1.85, 95% CI 1.56-2.19) compared with respondents not reporting the respective types of conflicts.

Conclusions Significant associations between all types of analyzed conflicts and presenteeism show the need to understand the underlying causes for presenteeism to implement targeted and effective preventive measures at the organizational level. Improving managers’ leadership and human resource management skills should be prioritized as the conflicts between managers and workers were reported most often, and the chances of sickness presenteeism associated with this type of conflict increased the most.

111 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Individual consequences in healthcare workers subjected to straining in relationship with personality proﬁles

Dr. Francesca Vella 1, Prof. Tiziana Ramaci 2, Prof. Venerando Rapisarda 1 1. Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, 2. Faculty of Human and Social Sciences, University of Enna “Kore”

Objectives Dysfunctions of work organizations and their subsequent degenerative manifestations is an important topic in the literature, therefore it is diﬃcult to ﬁnd a way amongst clearly vexatious phenomena such as mobbing or bullying and stress situations that are rather related to strategic, environmental, or relational conditions. Straining is an attenuated form of mobbing, in which the continuity of vexatious actions is not driven by a discriminatory intent. The aim of this study was testing the possible moderating role of personality in the relationship between perceptions about straining at work and individual consequences.

Materials and Methods A correlational design research involved 374 healthcare workers (HCWs) from two Italian hospitals. The following questionnaires were administered: Short Negative Acts Questionnaire (S-NAQ), to assess discriminative actions at work); the Italian version of the Big Five Inventory (BFI-10 scale), to assess personality factors; Occu- pational Stress Indicator (OSI), to measure psychological and physical health. Regression analysis and Structural Equation Models (SEM) were computed in order to test the relationships between variables.

Results Perceived straining showed signiﬁcant correlations with both psychological and physical health. Conscientious- ness was inversely proportional to work-related bullying (WB), as agreeableness was to personal bullying (PB). Emotional stability was negatively correlated with all the three component scales of S-NAQ: WB, PB, and social bullying.

Conclusions The results seem to conﬁrm that straining perceptions especially elicit, through emotional stability, psychological consequences. As regards the role of emotional stability in risk perceptions, it seems management has to pay thorough attention to personal factors in organizational perceptions and to straining actions.

112 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Investigation on work ability in healthcare workers after breast cancer: preliminary data of a pilot study

Prof. Emanuele Cannizzaro 1 1. Department of Sciences for Health Promotion and Mother and Child Care “Giuseppe D’Alessandro”, University of Palermo

Objectives Breast cancer (BC) is by far the most common malignancy in women. The median age is 64 years. Disabilities resulting from breast cancer treatment often reduce the quality of daily life and affect working and social life. This study investigated the residual work ability in a cohort of female healthcare workers (HCWs) suffering from BC.

Materials and Methods The study analysed a cohort of female HCW’s operating at a hospital in Southern Italy. Each HCW underwent a medical examination and routine laboratory tests and a questionnaire on the Work Ability Index (WAI).

Results Out of the 663 (100%) HCW’s undergoing health surveillance, 6% (n=40) had been affected by BC; however, only 75% (n=30) agreed to join the study. 23 (77%) worked night shifts. The average number of days of absence from work was 155.8 ±205.4 days in nurses/technicians and 128.2 ±239.7 days for doctors/biologists. The WAI score was very low in 2 (7%) cases; moderate in 9 (30%) cases, good in 7 (23%) cases and excellent in 12 (40%) HCW’s. The nursing/technical staff has lower WAI scores than the other health ﬁgures. Arm/shoulder pain, numbness, limited mobility in the upper limbs and lymphoedema were the main comorbidities reported by HCW’s which affected WAI score.

Conclusions A greater absence from work was observed in nurses and technicians compared to doctors/biologists, also jus- tiﬁed by the different professional risks that see them perform a physically more demanding job, i.e. manual handling of loads. WAI showed lower scores in nurses/technicians than in doctors/biologists. Morbidity in the upper limbs is one of the main complications that can negatively affect any work activity. This seems to affect the return to work, evident in sick leave days and in the ability to perform tasks.

113 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Lack of workplace risk assessment as a predictor of adverse health effects for teleworkers – results from the survey on life with COVID-19 in Latvia

Dr. Linda Matisane 1, Mrs. Linda Paegle 1, Prof. Ivars Vanadzins 1, Ms. Asnate Linde 1 1. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University

Objectives The objective of the study was to identify the level of implementation of workplace risk assessment in case of telework and assess the link between it and health complaints among teleworkers in Latvia during the 1st emergency state in force between 12 March and 9 June, 2020 due to the COVID-19 pandemic.

Materials and Methods Web based survey was used to gather information from respondents – workers. Survey participants were recruited using snowball sampling method and social media advertisements. In total, 1006 employees fully answered the questionnaire between 07.10.2020. and 27.10.2020. The results were analyzed with statistical software IBM SPSS, version 26.

Results Out of 523 teleworking respondents, only 26.4% have mentioned that their employer had checked the working conditions where the worker was teleworking. 31.0% have stated that such assessment had not been done, 42.6% of workers believe there is no need for such activities, therefore it was not provided although legal requirements in Latvia requires that risk assessment for all workplaces must be done already since 2002. The results of the web survey shows that workers who have reported lack of risk assessment more often have health related complaints – e.g. pain longer than 3 days (33.3% with risk assessment versus 51.5% with no risk assessment), sore eyes (31.4% versus 50.0%) and anxiety (24.8% versus 56.8%) (p<0.001 in all cases).

Conclusions Because prevalence of teleworking has dramatically increased during emergency state in Latvia and the employers do not pay suﬃcient attention to the working conditions of telework, increased numbers of occupational musculoskeletal diseases and burnout can be predicted in coming years. In order to reduce this burden, good practice examples implemented in Latvia should be gathered and promoted. In addition, guidelines for labour inspection should be developed in order to cover supervision of all workplaces including teleworking workplaces.

114 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Muscle fatigue for construction workers and plasterers in construction enterprise

Prof. Zenija Roja 1, Prof. Henrijs Kalkis 1, Dr. Inara Roja 2 1. University of Latvia, 2. MFD Healthcare group, Latvian Ergonomics Society

Objectives Injuries and muscle pain affecting the wrists, shoulders, neck and back are common problems for construction workers and are caused by compulsory work postures, repetitive movements and long term standing positions. Aim of this study was to determine the muscle fatigue caused by physical load for construction workers and plasterers in medium size construction enterprise. 60 construction workers and 30 plasterers with chronic pain (for four month or more) in the neck, shoulders, arms, hands and legs were chosen for the research.

Materials and Methods The extended version of Standardised Nordic Musculoskeletal Questionnaire (NMQ-E) was used to assess musculoskeletal problems. Determination of the functional state of skeletal muscles and muscle fatigue was carried out using myotonometric measurements with the MYOTON-3 device.

Results NMQ-E inquiry data showed that construction workers and plasterers most frequently complain on feeling discomfort after the work, particularly, fatigue or muscle pain in the neck, shoulders, arms, hands and legs. Myotonometric measurement results show that construction workers muscle tone at the end of the working week has increased in the shoulder region (m. trapezius - upper part), wrist/hands (m. extensor digitorum; m. ﬂexor carpi radialis). Plasterers muscle tone at the end of the working week increased in the wrist/hands, shoulder region, legs: m. ﬂexor carpi radialis; m. tibilais anterior; m. gastrocnemius. Accordingly 18 (k = 0.65) construction workers can be referred to category III, and 42 (k = 0.78) construction workers – category II. Hence for both reference groups muscles relax partly and results in high muscle fatigue levels.

Conclusions Myotonometric measurements are suitable for objective determination of the fatigue of various muscle groups. During our research low muscle frequencies were not examined, due the MYOTON-3 device doesn’t allow measuring the deep muscles groups. Therefore the investigation will be continued. In this case the electromyogra- phy measurements are necessary.

115 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Reasons for low protection of COVID-19 risk group workers – results from the study on working life with COVID-19 in Latvia

Dr. Linda Matisane 1, Mrs. Linda Paegle 1, Prof. Ivars Vanadzins 1, Ms. Asnate Linde 1 1. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University

Objectives The objective of the study was to investigate reasons for low protection of elderly workers and workers with chronic diseases during the 1st emergency restrictions in Latvia in force between 12 March and 9 June, 2020 due to the COVID-19 pandemic.

Materials and Methods Snowball sampling method and social media advertisements was used to gather information from respondents – workers. In total, 1006 employees fully answered the web – based questionnaire in October, 2020. The results were analyzed with statistical software IBM SPSS, version 26. During 10 focus group discussions 24 occupational health and safety experts and 65 employers from companies of different sizes and regions were interviewed.

Results Only 29.1% of respondents mentioned that their employer had identiﬁed risk groups and taken measures to protect them (17.9% in all cases, 11.2% in some cases). This has been one of the least frequent workplace based restriction measures (most frequent – additional disinfection was mentioned by 94.1%, distance meetings–79.7%, telework– 78.1%, reorganized work processes–76.4%, avoidance of social gathering of workers–74.6%; least frequent control of temperature for workers, visitors–28.4%). Several employers stated that their risk groups included critical workers for business continuity (e.g. key con- trollers in electrical or heat supply). Others had not taken measures because of information lack due to General Data Protection Regulation. Moving workers away from workplace (e.g. back-oﬃce without contact with clients, telework, paid vacations, paid downtime) was the most frequent action to protect such workers.

Conclusions Most employers do not see elderly workers and workers with chronic diseases as risk groups, thus are not implementing measures to protect them. Poor communication and lack of interest of employers to ask their workers if they need special protection is the topic to be addressed also at the national level (like training on identiﬁcation of risk groups, sharing of best practice examples).

116 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Relationships between professional burnout and job demands, resources among industrial workers in Lithuania

Dr. Aurelija Stelmokiene 1, Dr. Loreta Gustainienė 1, Dr. Kristina Kovalčikienė 1, Dr. Giedrė Genevičiūtė-Janonė 1 1. Vytautas Magnus University

Objectives Burnout can negatively impact both workers’ health and safety outcomes in organization (Smith et al., 2020). Safety issues are especially signiﬁcant in industrial sector that is seeking for evidence-based interventions to diminish professional burnout. So, the current study was oriented to identify the main risk and protective factors that predicted professional burnout among industrial workers in Lithuania. Job demands-resources model (Bakker, Demerouti, 2014, 2017) was used to list the main factors that could be related to employees’ physical, emotional and mental exhaustion. It was hypothesized that job demands should be associated with higher professional burnout, and that job resources should reduce the negative impact to strain of employees.

Materials and Methods 249 industrial workers (74 percent males and 23,4 percent females, 2,6 percent did not indicate their gender) and 74 administrative workers (46 percent males and 54 percent females) from one organization ﬁlled up a self-administered questionnaire in a cross-sectional survey. Perceived job demands, resources and professional burnout were measured with COPSOQ II (Copenhagen Psychosocial Questionnaire, National Centre for the Working Environment, 2007) scales.

Results Findings revealed that there were no signiﬁcant differences of level of professional burnout between industrial and administrative workers. Results of linear regression analysis showed that work pace, quantitative demands at work alongside with work-family conﬂict acted as risk factors for the professional burnout among industrial workers. Even bigger possibilities for development (aspect of job resources) predicted their higher professional burnout. However, only emotional requirements predicted professional burnout of administrative workers.

Conclusions Results of the study identiﬁed signiﬁcant risk factors for employees’ physical, emotional and mental exhaustion. Further research should pay attention to additional protective factors for professional burnout, maybe other than job resources.

117 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Risk assessment of chemical laboratory staff regarding safely fuel sampling

Prof. Piia Tint 1, Prof. Ada Traumann 2 1. Tallinn University of Technology, 2. Tallinn University of Applied Sciences

Objectives The aim of the paper is to clarify, how much the workers care about their own safety involved in very dangerous jobs, using theoretical learning (LMRA) and questionnaires with multiple answers to choose the right one.

Materials and Methods 40 interviews (60 questions with four answers everyone) were presented in moodle- environment to the workers of the chemical laboratory. For example: Benzene: the selective answers: 1) the vapours are heavier than air and sustain no hazard to the health; 2) …are heavier and are bad to your health; 39 … are lighter than air and sustain no hazard; 4) benzene does not release vapours).

Results The main per cent of answers was under 40% of 100. Some questions could have several right answers. That kind of learning was very interesting to the workers as the questionnaire was connected with the speciﬁc work situations (climbing on ladders etc.).

Conclusions The learning method with innovative tests could be used also at enterprises, companies in different areas.

118 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Situation analysis of occupational health and safety training in the national higher education system in Estonia

Prof. Eda Merisalu 1 1. Estonian University of Life Sciences

Objectives The aim of this research was to give an overview about OHS training in the Estonian national universities and higher vocational schools, to describe OHS subjects and their volumes by study levels and ﬁelds of education and to assess the need for corrections of OHS training programmes in higher education system in Estonia.

Materials and Methods The data search of OHS curricula and lists of subjects was carried out through websites of Estonian national higher education institutions using diferent keywords as “occupational health”, “occupational safety”, “ergonomics”, “risk assessment”, “risk management”, “risk analysis”, “safety”, “safety training” and „other“ safety topics. The data input and descriptive data analysis were carried out in the MS Excel programme.

Results In total 555 curricula were analysed and only 30% of them contained OHS subjects. The most often the subjects comprised to “other” safety topics were represented (58%), followed by risk tuition, ergonomics, occupational safety and health. The number of OHS subjects was higher in applied higher education and master studies, but they missed in doctoral studies. The most common subject volume was 3 ECTS (1…14 ECTS). The highest number of OHS subjects was represented in the Estonian Academy of Music and Theater and TTK University of Applied Sciences compared to ohter institutions. OHS curricula missed altogether in the Estonian Academy of Arts and Pallas College of Art. Single OHS subjects were observed in the Academy of Internal Affairs and College of Finance curricula. In the other applied higher education institutions to some extent OHS subjects are represented.

Conclusions OHS training in the Estonian higher education system does not meet all practical requirements of working life in terms of both content and scope. OHS teaching must be included into the higher education standard and established in all the levels of higher education system in general.

119 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Strategic OH&S workforce planning and development in Estonia

Prof. Eda Merisalu 1 1. Estonian University of Life Sciences

Objectives The goal of the project was to estimate current situation and needs for the national OHS specialized workforce, analyse teaching programs, competency proﬁles and registries of OHS specialists in Estonia.

Materials and Methods A descriptive analysis of the materials collected in reference to the training standards and educational programs. The multidisciplinary research team of academics, doctors, nurses and experts of professional associations was completed and interviewed. The real and prognostic numbers of OSH specialists were estimated.

Results The analysis on existing teaching programmes and training conditions for OSH specialists showed quite poor situation in Estonia. Since 1997 the regular postgraduate study programme for occupational health physicians (OHP) has established in the University of Tartu. In the Health Board registry there are 109 OHPs have registered. The courses for occupational nurses was established in the beginning of century and 27 of them are registered the Health Board. A two year Master Curricula on ergonomics was established since 1998 in the Es- tonian University of Life Sciences and now 109 of them are graduated. In the Estonian Qualiﬁcations Authority () 24 certiﬁed ergonomists (7th level) are registereds in 2016-2020. Ten years ago a two-year master program for occupational hygienists was established in the Tallinn Technical University (TalTech), but it’s closed in 2015 and 7 graduates in EQA registry. The estimated numbers of different OHS specialities clearly demonstrated the need for 10 times higher numbers of occupational health nurses and occupational hygienists, 5 times more occupational ergonomists, psychologists and physiotherapists in Estonia.

Conclusions The process undertaken and results obtained clearly demonstrate an urgent need for enhancing national capacities in strategic OH&S workforce planning and development in Estonia as proposed in the ILO strategy.

120 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The investigation of individual whole-body protective clothing effects on thermal and subjective well-being of physically working medical staff

Dr. Jeļena Reste 1, Mrs. Darja Kaluznaja 1, Prof. Ivars Vanadzins 1 1. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University

Objectives The aim was to investigate thermal and ergonomic effects of individual whole-body medical protective clothing while performing physically demanding tasks.

Materials and Methods Thermography of the body surface was performed for 9 healthy physically trained persons (mean age 30±3 years) before and after 17-minutes long trials with walking on treadmill at stable pace and gradually increasing inclination by 2% every 3 minutes till 13%. The ﬁrst trial was done in common sportswear simulating work of physiotherapist. The second trial was conducted in whole-body protective clothing recommended and generally available for work with COVID-19 patients. Suﬃcient rest was provided for participants between trials. Thermograms were taken by high resolution medical digital infrared camera ICI ETI 7320 Pro in standing position in underwear. The anterior surface of the right thigh was set as the region of interest, where skin surface mean temperature was measured. Trials were conducted under controlled ambient conditions with mean air temperature being 22.86±0.28ºC and air relative humidity – 46.78±5.12%. The survey of participants was added to get information about subjective comfort.

Results Skin surface mean temperature decreased in trials done in sportswear (23.86±1.26ºC before vs. 23.30±1.37ºC after trial, p<0.01) as it has good air-permeability and allows evaporation. Extensive sweating was observed during trials in protective clothing, but skin surface temperature after trials was signiﬁcantly higher (24.04±1.34ºC, p<0.05). Survey results showed that most of participants experienced discomfort while performing task in protective clothing (excessive friction and sweating around neck, in lower back, inguinal, axillar region, and lower part of calf). All participants would like to improve air-permeability and elasticity of material.

Conclusions In context of COVID-19 pandemic, continuous wearing of whole-body individual protective clothing by medical staff while preforming physically demanding tasks can put them at high risk of overheating and dehydration. The protective clothing made from air-permeable and elastic materials should be recommended.

121 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The role of macrophage migration inhibitory factor and heme oxygenase-1 in defence of lung subjected to asbestiform ﬁber

Dr. Claudia Lombardo 1, Prof. Sergio Castorina 1, Prof. Carla Loreto 2, Prof. Rosario Caltabiano 3, Prof. Venerando Rapisarda 4, Prof. Caterina Ledda 5 1. Department of Medical and Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Anatomy section, University of Catania, 2. Department of Biomedical and Biotechnological Sciences, Anatomy and Histology, University of Catania, 3. Department of Medical and Surgical Sciences and Advanced Technologies “G. F. Ingrassia”, Anatomic Pathology, University of Catania, 4. Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, 5. Department of Clinical and Experimental Medicine, University of Catania

Objectives Fluoro-edenite (FE), an asbestiform fiber, is responsible for many respiratory pathologies: chronic obstructive diseases, pleural plaques, fibrosis, and malignant mesothelioma. Macrophage migration inhibitory factor (MIF) is one of the first cytokines produced in response to lung tissue damage. Heme oxygenase-1 (HO-1) is a protein with protective effects against oxidative stress. It is up regulated by several stimuli including pro-inflammatory cytokines and factors that promote oxidative stress.

Materials and Methods The in vivo model of sheep lungs naturally exposed to FE was studied in order to shed light on the pathophysio- logical events sustaining exposure to fibers,by determining immunohistochemical lung expression of MIF and HO-1. Protein levels expression of HO-1and MIF were also evaluated in human primary lung fibroblasts after exposure to FE fibers in vitro.

Results In exposed sheep lungs, MIF and HO-1 immunoexpression were spread involving the intraparenchymal stroma around bronchioles, interstitium between alveoli, alveolar epithelium and macrophages. High MIF immunoexpression prevails in macrophages. Similar results were obtained in vitro, but signiﬁcantly higher values were only detected for HO-1 at concentrations of 50 and 100 μg/mL of FE ﬁbers.

Conclusions MIF and HO-1 expressions seem to play a role in lung self-protection against uncontrolled chronic inﬂammation, thus opposing the strong link with cancer development, induced by exposure to FE. Further studies will be conducted in order to add more information about the role of MIF and HO-1 in the toxicity FE-induced.

122 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Water-soluble sapropel extract gel for external use

Dr. Ilona Pavlovska 1, Ms. Aneka Klavina 1, Mr. Agris Auce 1, Prof. Ivars Vanadzins 2, Ms. Laura Komarovska 1, Mrs. Linda Paegle 2

1. Laboratory of Hygiene and Occupational Diseases, Rīga Stradiņš University, 2. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University

Objectives The aim is to develop methodology for treatment and diagnostics, veriﬁcation and assessment of therapeutically effects of sapropel on musculoskeletal diseases in a clinical study of sapropel applications for improving lymph and blood circulation in joints.

Materials and Methods The composition of water-soluble sapropel extract gel contains the sapropel extract in a liquid form, sodium salt of carboxymethyl cellulose, glycerol solution, ethanol water solution, structure stabilizer, eucalyptus oil and water. The treatment effects assessed using digital thermography, measurements by dynamometer, goniometer and Nine Hole Peg test, at two points – before the ﬁrst procedure and before the discharge from the hospital. Additionally, the patients will surveyed using questionnaire.

Results Sapropel extract gel and method of preparation are ready and suitable for external use in medicine, skin care and cosmetics. Effects on hand pain analysed using visual analogue scale and Boston Carpal Tunnel Syndrome Questionnaire score. Nine Hole Peg test and measurement of muscle strength and determination of the ampli- tude of hand movements can be applied. Our tests demonstrate the eﬃcacy of sapropel applications for patients with carpal tunnel syndrome and can be achieved only by ten-application course.

Conclusions The resulting gel has skin moisturizing, anti-inflammatory and regeneration-enhancing properties; it can be used in medicine and skincare, as well as for the preparation of other cosmetic products. Musculoskeletal disorders have constantly the highest prevalence of all occupational diseases in Latvia in recent years and they are very prevalent in general population with carpal tunnel being the leading single cause for musculoskeletal disorders. Our tests show that there are beneficial effects of sapropel applications in patients with carpal tunnel syndrome. The research was co-financed by project “Analysis of characteristics of medical sapropel and its usage for medical purposes and elaboration of industrial extraction methods”, No.1.1.1.1/16/A/165.

123 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Work-related eye injuries: prevalence, work capacity and risk factors in Latvia 2009–2019

Dr. Jeļena Aleksejeva 1, Dr. Sandra Ausekle 1 1. Faculty of Residency, Rīga Stradiņš University; The State Medical Commission for the Assessment of Health Condition and Working Ability

Objectives The aim of the study is an analysis of work ability, risk factors and causes for people with work-related eye injuries in 2009 -2019 in Latvia.

Materials and Methods The study includes people with work-related eye injuries who applied to the State Medical Commission for the Assessment of Health Condition and Working Ability for work capacity assessment from 2009-2019.

Results During the period speciﬁed, primary were determined 34 people (average 3,1/year) with eye injuries acquired at work. Results of medical assessment: 11,8% (4) had a grave form of disability and loss of ability to work from 80-100% (average 91,7%, SD +/- 10,4), 2,9% (1) - severe disability and loss of ability to work 70%, 70,6% (24) - moderate disability and loss of ability to work from 25-50% (average 27%, SD +/- 6,9) and 14,7% (5) - a loss of ability to work 10-20% (average 18%, SD +/- 4,5). There were 91% (31) men, 9% (3) – women; 64,7% (22) - in the age group of 20-44 years, 35,3% (14) - in the age group of 45-59 years. The average age was 39 years (min–21, max-59). Work injuries mostly affect one eye – 85,3% (29), but both eyes - 14,7% (5). Classifying the eye injuries by mechanism - 58,8% (20) were perforation, 23,5% (8) – contusion, 11,8% (4) - chemical or thermal eye injuries, 59% (2) - combined injuries, by economic sector - in industry 73,5% (25), in agriculture 14,7% (5), others 11,8% (4).

Conclusions Signiﬁcant loss of functional ability occurred 85,3% of people who had an eye injury at work. As a result of work injury, 11,8% have become blind. Main risk factors: industry worker, a man, aged 20-44. Epidemiological data shows, that 90% of work-related eye injuries are preventable. Improving prevention signiﬁcantly reduces the risk of loss of ability to work and functioning.

124 Environmental Health RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Association of mortality related with heat waves in Riga from 2009 till 2015

Dr. Kerstin Pfeifer 1, Dr. Daniel Oudin Astrom 2, Dr. Žanna Martinsone 3, Mrs. Darja Kaluznaja 3, Dr. Anna Oudin 2 1. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 2. Division of Sustainable Health, Umeå University, 3. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University

Objectives To evaluate associations between heat waves and mortality in Riga during the summer months.

Materials and Methods The ecological study includes mortality and daily temperature data in Riga during 2009 – 2015 period. Daily mean and maximum temperature data for Riga were supplied by the Latvian Environment, Geology and Mete- orology Centre for the ﬁve warmest months of the year (from May to September) with no missing observations for the study period (2009–2015).Daily all-cause mortality data for the same period were provided by the Latvian Register of Causes of Death. The Quasi-Poisson regression was used to show associations between heat waves and all-cause as well as cause-speciﬁc mortality in Riga.

Results There were found association between 10% to 20% increase in the risk of all-cause mortality and heat waves in Riga. Furthermore, during heat waves episodes heat-related mortality increased significantly among age group ≥65 (between 12% and 22%). And cause-specific mortality was found significantly increased (approximately 15% to 26%) in case of cardiovascular mortality. But no significant associations were found between heat waves and respiratory or external causes of mortality. The results of the study are likely to differ from regional areas due to the urban heat island effect, therefore temperatures are likely to be higher in Riga compare to regional areas.

Conclusions Results show short-term associations between heat waves and all-cause as well as cardiovascular mortality in Riga. In general, heat waves play a role as environmental health issue (with climate change processes) and show potential impact to public health in this Baltic region.

126 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Comparison of black and white and colour laser printers’ emitted ﬁne particles’ number and mass concentration

Mrs. Linda Paegle 1, Dr. Žanna Martinsone 1, Prof. Ivars Vanadzins 1 1. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University

Objectives The main objective of this study was to compare emitted number and mass of ﬁne particles (pt) from black and white (b/w) and colour laser printers during the printing process and one hour afterwards.

Materials and Methods Air samples were taken with the particle size spectrometer for real-time ELPI+, Dekati (air ﬂow rate 10 l/min). Day before each test surfaces of the testing room were cleaned. Measurements were taken ~ 0.5 m from the printers: one hour before the test, during printing and one hour after the printing (observing the one-hour break before starting last measurement). There were two types of tests performed on each printer: a 10-page and a 100-page test (with 1 minute pause). The test was completed when 1200 pages were reached or 90 minutes had elapsed. A total of 460-470 pages were printed during the 10-page test, and 1100-1200 pages were printed during the 100-page test using StoraEnso Multicopy 80g/m3 paper for all tests.

Results During the 10-page test 13630 pt/cm3 ﬁne particles for the b/w printer and 19943 pt/cm3 for colour printer were determined. 100-page test produced 9294 pt/cm3from b/w and 8324 pt/cm3from colour printer. One hour after the printing b/w printer emitted 117071 pt/cm3 in 10-page test and 152351 pt/cm3in 100-page test. Colour printer 10-page after test produced 54722 pt/cm3and 122985 pt/cm3 after 100-page test. Detected particle mass was insigniﬁcant: in range of 0.005 to 0.006 mg/m³ for b/w printer and 0.014 to 0.019 mg/m³ for colour printer.

Conclusions The highest number of particles was observed one hour after the end of the printing for both tested printers. Particle mass in mg/m³ was detected in the size range 6nm - 2.5 μm (no particles were detected at range 2.5 to 10μm), the larger mass results presented colour printers.

127 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Endocrine disrupting chemicals related to metabolic disorders and its inﬂuence

Mrs. Irina Pires 1, Dr. Jeļena Reste 2 1. Rīga Stradiņš University, 2. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University

Objectives This literature review is intended to be an analytical overview of Endocrine Disrupting Chemicals and to investigate the most prevalent chemicals that can be involved in the pathogenesis of Metabolic diseases, how they alter the physiologic metabolism and the severity of exposure.

Materials and Methods Overall, 106 articles from databases Pubmed, Science Direct and Clinical Key were reviewed for the purpose of writing this literature review. Initially 180 articles were obtained by the search using the keywords “endocrine disrupting chemical”, “metabolic disrupting chemical”, “obesity”, “diabetes mellitus”, “metabolic syndrome”, “bisphenol A”, “phthalates”, “parabens” and “persistent organic pollutants”.

Results Endocrine Disrupting Chemicals are ubiquitous, and routes of entry into the human body are mainly by inges- tion but also by inhalation and dermal route. In-vitro studies have shown that Endocrine Disrupting Chemi- cals can disrupt energy metabolism, β-cell glucose sensing, and hepatic and skeletal muscle insulin sensitivity. Metabolism disruption occurs through receptor mediated pathways, specifically nuclear receptor mechanism. BPA and Organochlorine pesticides have oestrogenic activity. Phthalates, PBDE, PFASs and Dioxins act through PPARγ modulation. All of these are classified according to their effect as obesogens and diabetogens. Parabens are thought to be obesogens acting through interference with nuclear receptors but are not classified as diabetogens due to lack of evidence.

Conclusions The effects of Endocrine Disrupting Chemicals can cause epigenetic changes, epimutations, that can be trans- generational. These effects and their severity do not only depend on dose but mainly on the period to which the human was exposed to, being of higher vulnerability developmental periods of life.

128 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

From the shooting gallery to the oﬃce – lead as an occupational risk factor

Dr. Inese Mārtiņsone 1, Ms. Laura Komarovska 2, Ms. Anita Seile 1, Ms. Liga Abolkalna 1, Dr. Linda Matisane 3 1. Laboratory of Hygiene and Occupational Diseases, Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University, 2. Laboratory of Hygiene and Occupational Diseases, Rīga Stradiņš University, 3. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University

Objectives Lead (Pb) is known as a powerful toxicant for many centuries. Due to ongoing discussions on Pb toxicity at the EU level, our scientific interest focused on analysis of Pb circulation in an office building with shooting gallery and occupational exposure to Pb of workers in the shooting gallery and regular office rooms with no direct contact to ammunition.

Materials and Methods In order to investigate the level of Pb contamination within the same building, air quality measurements were carried out at 16 points (48 samples) with different work tasks, including shooting gallery, storage room of weapons and oﬃce rooms. Pb concentration was measured by atomic absorption spectrometry. The obtained results were compared with the national occupational exposure limit value, which is 50 µg/m3for Pb.

Results During the shooting process Pb concentration in the breathing zone of the shooter was between 18 and 24 µg/m3. Extraordinary high levels of Pb were observed in the shooting gallery near the shooting target (concentration fluctuated between 2700 and 5400 µg/m3 depending on the distance to the target). In the storage and mainte- nance facilities of weapons and ordnance the measured concentration was between 1.6 and 2.3 µg/m3, in the office rooms - 0.7 and 1.8 µg/m3, with exception for the office of shooting experts where it was 7.9 µg/m3.

Conclusions The results show Pb transmission from shooting gallery to the other premises in the same building resulting in long-term daily exposure of oﬃce workers to low levels of Pb. This transmission might be explained by lack of proper hygienic habits of shooters (washing hands, use personal protective equipment etc.), but it should be further investigated. There is a need for further research also on Pb biomonitoring of all workers not only those directly involved in the shooting activities and their family members.

129 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Possible exposure ways of pesticide mixtures in Latvian adults

Ms. Lāsma Akūlova 1, Ms. Laura Komarovska 1, Ms. Kristiāna Venžega 2, Dr. Žanna Martinsone 3, Ms. Anita Seile 1, Dr. Inese Mārtiņsone 4, Prof. Ivars Vanadzins 3 1. Laboratory of Hygiene and Occupational Diseases, Rīga Stradiņš University, 2. Rīga Stradiņš University, 3. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University, 4. Laboratory of Hygiene and Occupational Diseases, Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University

Objectives Pesticides are substances causing adverse health effects on human bodies. Major sources of exposure include use in households, gardens, consumption of fruits or vegetables and environmental exposure.

Materials and Methods The study group consisted of 45 females and 5 males (n=50), age range 25-62. Surveys were carried out in June, 2020. Several exposure ways were analised: type of crops/vegetables grown nearby, use of own garden, use of pesticides in own gardens, etc. Consumer habits and consumption of organic food in the last 6 months were also evaluated.

Results Most respondents have winter wheat growing nearby (closer than 250m) (78%, N=39), followed by winter rape- seed (62%, N=31) and summer wheat (26%, N=13) all of whom are treated with pesticides. 92% of respondents (N=46) indicated that they own a garden, where most grow vegetables, herbs, fruits for family consumption (78%, N=39). Most of the respondents hadn‘t used any chemicals to treat their gardens in the last 3 days (82%, N=41). Most respondents (48%, N=24) buy vegetables in food markets or supermarkets or grow by themselves, 44% of respondents (N=22) buy products only in supermarkets, but only 8% of all (N=4) consume self-grown products or locally grown products. Most consumers (48%, N=24) buy organic products instead of conventional products, 32% of respondents (N=16) choose only conventional products, but 20% of all respondents (N=10) didn’t know if they consume organic or conventional products.

Conclusions Most studies on health effects of pesticides have focused on occupational exposures people are also exposed to pesticides in our daily lives. This study confirms that living near agricultural fields lead to exposures from aerial spraying. Daily consumer habits may also affect pesticide levels in human body and conventional diets have significantly higher levels of pesticide metabolites in their urine than those consuming organic products. According to HORIZON 2020 Programme „European Human Biomonitoring Initiative” Nr.733032-HBM4EU.

130 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The investigation of air cold temperature short-term effects on all-cause and cause-speciﬁc mortality in Tallinn and Riga

Mr. Daniel Oudin Astrom 1, Mrs. Triin Veber 2, Dr. Žanna Martinsone 3, Mrs. Darja Kaluznaja 3, Dr. Ene Indermitte 2, Mrs. Anna Oudin 1, Prof. Hans Orru 2

1. Division of Sustainable Health, Umeå University, 2. Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, 3. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University

Objectives was to investigate the association of air cold temperatures with all-cause and cause-speciﬁc mortality in Tallinn and Riga.

Materials and Methods Daily air temperature data were acquired from the Estonian Weather Service and the Latvian Environment, Geology and Meteorology Centre for the ﬁve winter months (November - March) for the periods of 1997–2015 (Tallinn, Estonia) and 2009–2015 (Riga, Latvia). Daily all-cause, respiratory (ICD 10 J00–J99), cardiovascular (ICD 10 I00–I99) and external-cause (ICD 10 V00–Y99) mortality data for the previously mentioned periods for Tallinn and Riga were acquired from the Estonian and Latvian Causes of Death Registers. For data statistical analysis were used the Poisson regression, combined with a distributed lag non-linear model considering lag times of up to 21 days.

Results The coldest month was a February (min/mean t−27.3/−6.5◦C in Tallinn, −24.4/−4.9◦C in Riga); and the warmest month was a November (−13.5/0.2◦C, −13.8/2.9◦C). Below temperature 4.0◦C in Tallinn and 4.4◦C in Riga mortality started to increase. The all-cause mortality attributable to non-optimal cold temperatures were 7.4% (95%CI - 3.7–17.5) in Tallinn and 8.3% (95%CI -0.5–16.3) in Riga. Increased mortality associated to cold temperatures was observed in the 75+ years age group (RR=1.64, 95%CI 1.17–2.31), and in cardiovascular mortality (RR=1.83, 95%CI 1.31–2.55) in Tallinn and in <75 years age group (RR=1.58, 95%CI 1.12–2.22) in Riga. No association were found of cold temperatures with respiratory and external-cause mortality.

Conclusions Increased total mortality due to cold temperatures was observed in the 75+ age group, as well as due to cardiovascular mortality in Tallinn and in the below 75 age group in Riga.

131 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Variability in time of volatile organic compounds in work environments

Ms. Zane Čerpakovska 1, Ms. Kristine Sproge 1, Ms. Aneka Klavina 2, Dr. Inese Mārtiņsone 1 1. Laboratory of Hygiene and Occupational Diseases, Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University, 2. Laboratory of Hygiene and Occupational Diseases, Rīga Stradiņš University

Objectives Volatile organic compounds are important constituents of different technological processes. Producers of sol- vents, primers, colours, varnish, and putty need to continuously improve and invent new chemical compositions according to changes in legislation and needs of consumers. The new substances (acrylates, glycol esters, isocyanides) have different effects on human body than the usual ones (toluene, styrene, xylene etc.). Many industries choose water-based products containing “new” substances in their work processes. These products are more environmentally friendly due to lower emissions of volatile organic compounds. But are these substances properly assessed as to the chemical risk to the health of the workers?

Materials and Methods In order to investigate the changes in the workplace air pollution by chemical composition, the laboratory measurement database for time period from 2013 to 2019 was used (n=1130 measurements of different volatile and semivolatile organic substances). Gas chromatography (GH) or high performance liquid chromatography (HPLC) for determination of substances were used. All air samples were collected on workplaces in the workers breathing zone.

Results Of the measurements of organic substances gathered in the database, 61.3% of the measurements were from substances that are part of the solvent and water-based products compositions. Of these, organic substances from water based products were 3.5% in the 2013, but 5.6% in the 2019. The proportion of measurements slightly increases, but does not correlate with used amount of chemical products.

Conclusions Over time, slow changes are observed in the targeted chemicals that are requested to be measured in work environments (for water base products components). This does not correspond to the real amounts of new substances used .

132 Health And Clinical Psychology RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Academic self-eﬃciency and cognitive load for students in distance learning

Mrs. Inguna Griskevica 1 1. Department of Health Psychology and Paedagogy, Rīga Stradiņš University

Objectives Recently the distance learning in Latvia is deﬁned as a part of regular full-time education. The procedure for their organization and implementation is determined by the Cabinet of Ministers and changes in the Education Law are envisaged. To ensure an effective distance learning implementation process this research provides the correlation study between self-eﬃciency and cognitive load aspects for students in distance learning.

Materials and Methods This is a quantitative experimental pilot study which measures these correlations in two different forms of distance learning: teacher-led and self-directed learning settings. The measurement of self-efficiency is made by adapted Generalized Self-Efficacy scale (Schwarzer & Jerusalem, 1995) and assessment of Subjective Cognitive Load Self-rating scale (Paas,1992). The measurements are compared and correlated with the final learning outcomes of students.

Results The research sample consists of high school tenth-grade students. The results demonstrate statistically signiﬁcant correlations and discrepancies between self-eﬃciency and cognitive load aspects for students in distance learning in different forms of learning.

Conclusions The measurements of cognitive load are needed for educators to be able to engineer the instructional control of appropriate cognitive load and design effective learning process for distance learning environments.

134 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Development and preliminary validation of the Psychological Resilience Scale

Ms. Viktorija Perepjolkina 1, Prof. Kristine Martinsone 2 1. Faculty of Communication, Rīga Stradiņš University, 2. Department of Health Psychology and Paedagogy, Rīga Stradiņš University

Objectives Psychological resilience can be deﬁned as the ability to remain calm during crises/chaos and to return to pre- crisis status quickly. The aim of this study was to develop a short self-report measure of psychological resilience and to perform preliminary validation of it.

Materials and Methods Based on literature analysis and existing measures of such constructs as resilience and hardiness, a preliminary item pool of 25 items was created. It was supposed to use this scale as one of the measures in the large scale survey in the frame of the National Research programme (project Nr. VPP-COVID-2020/1-0011), so it was necessary to shorten the preliminary set of items as much as possible. Based on expert ratings 12 items were retained for further analysis. The psychometric analysis was performed based on a large test-development sample (N = 2608, aged from 18 – 74, 39.7% male; n = 835 ﬁlled the survey in Russian). For the analysis of convergent validity, four measures were used: Social Problem-Solving Inventory-Revised version (SPSI-R), Emotion Regulation Skills Questionnaire (ERSQ-27), State-Trait Anxiety Inventory-Y1, and Centre for Epidemiological Studies – Depression Scale (CES-D).

Results Based on the psychometric analysis the final version of the Psychological Resilience Scale (PRS) was developed. PRS consists of 7 items, which are evaluated on a five-point Likert scale ranging (from 0 = totally disagree to 4 = totally agree); it has a single-factor structure and shows good internal consistency (Cronbach’s alpha = .87). Significant positive correlations with Positive problem orientation (r = -.43) and Emotion regulation skills (r = .47), and significant negative correlations with Negative problem orientation (r = -.46), Anxiety (r = -.46) and Depression (r = -.49) suggests good convergent validity of the PRS.

Conclusions The Psychological Resilience scale is available in Latvian and Russian, is a reliable and valid screening measure of self-rated psychological resilience.

135 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Development and psychometric properties of the Self-care Strategies Questionnaire

Ms. Viktorija Perepjolkina 1, Dr. Jelena Kolesnikova 2, Prof. Aleksejs Ruža 3, Ms. Aiva Bundzena-Ervika 2, Prof. Kristine Martinsone 2 1. Faculty of Communication, Rīga Stradiņš University, 2. Department of Health Psychology and Paedagogy, Rīga Stradiņš University, 3. Department of Psychology, Daugavpils University

Objectives The study aim was to develop a measure of self-care strategies in the Latvian population and to examine its psychometric properties.

Materials and Methods The development process included three stages. Stage 1 comprised the development of the initial set of items, based on the literature review and one focus group. Stage 2 included a standard pretest of the questionnaire draft, followed by data collection in the frame of the National research program (project Nr. VPP-COVID-2020/1- 0011), and the development of the ﬁnal version of the questionnaire based on the psychometric analysis in Stage 3 (N = 1723, mean age 45.61, SD = 13.18, 1195 Latvian speaking, and 528 Russian speaking participants).

Results The exploratory factor analysis indicated a multidimensional structure of the Self-care Strategies Questionnaire (SCS-Q) and identified four factors accounting for 60.07% of the variance of the Latvian version of the questionnaire and 52.64% of the Russian version. The final version of the Self-care Strategies Questionnaire (SCS-Q) consists of 17 items in four scales: Social Support, Spiritual Resources, Free Time Activities, and Time Man- agement. The internal consistency coefficients (Cronbach’s α) of the scales varied from .79 to .88. Item-total correlations ranged between .75 and .81 for Time management, .56 and .75 for Social Support, .64 and .85 for Spiritual resources, and .51 and .60 for Free-time activities. A Confirmatory Factor Analysis was performed to verify the four-factor solution. The fit of the proposed model was optimal (χ2 (113) = 1037.83; CFI = .937; TLI = .924; RMSEA = .069 (90% CI [.065, .073]); SRMR = .046).

Conclusions The development of the SCS-Q constitutes a signiﬁcant step towards the comprehensive measurement of self- care strategies in the Covid-19 pandemic. However, further validation study is necessary.

136 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Mystical experience has stronger relationships with spiritual intelligence than schizotypal personality traits and psychotic symptoms

Ms. Daiga Katrīna Bitēna 1 1. Department of Health Psychology and Paedagogy, Faculty of Public Health and Social Welfare, Rīga Stradiņš University

Objectives There are two conflicting notions about the mystical experience (ME) in the scientific literature. Some authors see it as a sign of mental illness, while others see it as a part of one’s psychospiritual growth and maturity and an important turning point in life that can positively affect one’s value system, suggest changes in personality, behavior, emotions, and their outlook on life. Conflicting notions about the nature of ME create confusion not only in society but also among professionals that encounter patients who reflect on ME. The aim of this study was to examine the relationship between ME and spiritual intelligence as a concept related to mental health and schizotypal personality traits, and psychotic disorders as pathological concepts in psychology. This paper explores several hypotheses about ME relationship with spiritual intelligence, schizotypal personality traits, and psychotic symptoms on one sample of 299 non-clinical Latvian women.

Materials and Methods The data was collected using four self-report questionaries – Mysticism Scale, Spiritual Intelligence Survey, Lat- vian Clinical Personality inventory, and sociodemographic data survey.

Results Results suggest that ME has stronger relationships with spiritual intelligence than schizotypal personality traits and psychotic symptoms. Results also indicate the relationship between spiritual intelligence and individual schizotypal personality traits, largely explained by the moderation of ME.

Conclusions The results of the study help to remove ambiguity and gain a clearer picture of the nature of the ME.

137 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Psychological intervention as an aspect of the professional identity of psychologists: Latvian sample

Mrs. Elīna Akmane 1, Prof. Kristīne Mārtinsone 1, Mrs. Zane Krieke 1, Mrs. Agnese Kolmane 1, Prof. Miguel Bernardo Ricou da Costa Macedo 2, Mrs. Sílvia Marina Amado Cordeiro 2

1. Rīga Stradiņš University, 2. University of Porto

Objectives Professional identity is formed by combination of several aspects, including professional practice, which, in terms of psychologists, relates to psychological interventions and assessment. Professional identity of psychologists is an important research subject because other practicing professionals are trying to perform activities linked to psychological intervention. Thus, it is essential to determine clear boundaries between psychological intervention and all other interventions. The purpose of this paper was to investigate psychological interventions and performed functions of Latvian psychologists as an aspect of their professional identity.

Materials and Methods Data were collected through an online survey developed in the framework of the international project Identity of Psychology. All procedures of translation and validation of the questions from English to Latvian were ac- complished. Sample consisted of 54 Latvian psychologists of which 49 were women and 5 were men (n = 5) aged from 25 to 60 years (M = 44.94; SD = 8.98). Data were analysed using thematic categorical content analysis.

Results Findings indicate clear diversity in the opinion about the identity of psychology among Latvian psychologists. More consensus can be seen in terms of exclusive tasks performed by psychologists. Nevertheless, during the data analysis numerous subcategories were created regarding the exclusive goal of psychological intervention and the tasks of psychologists that might be performed by other professionals. Moreover, several subcategories overlap in all three content items indicating apparent disagreement among Latvian psychologists of their professional practice.

Conclusions The results of this study indicate limited agreement and comprehension of Latvian psychologists about their professional practice which leads to necessity for further research to investigate the causes of such outcome to determine solutions on how to strengthen their professional identity. Moreover, results are in accordance with other studies in other countries as Portugal and lead us to the need to develop clear deﬁnitions about the goals of psychological intervention.

138 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Relationship between work-related cognitive reserve and overall cognitive functioning in older women: longitudinal study

Ms. Kristīne Šneidere 1, Dr. Ainars Stepens 1 1. Rīga Stradiņš University

Objectives This study aimed to investigate the changes in overall cognitive functioning over a three-year period and to examine the possible role of work-related cognitive reserve in older women.

Materials and Methods 23 women aged 68 – 80 (M = 71,78, SD = 4,77), without self-reported neurological or psychiatric disorders, participated in the study. The overall cognitive functioning was evaluated with Montreal Cognitive Assessment scale (MoCA, Nasreddine et al., 2005), which evaluates six domains of cognitive processes, while work-related cognitive reserve (CR) index was obtained with Cognitive Reserve Index questionnaire (Nucci, Mapelli, & Mondini, 2012). Data were acquired with a three-year interval between the assessments.

Results Descriptive statistics of the results indicated that all participants had medium to high cognitive reserve (CR) scores (95 – 176, M = 118.83, SD = 9.61). To identify the relationship between work-related CR and changes in overall cognitive functioning, Spearman rank correlation coeﬃcient was used and the analysis showed a statistically signiﬁcant strong association between the variables (rs= .572, p= .004). Further, linear regression analysis was used to predict the role of work-related CR in the change in MoCA scores, which showed a weak prediction (R2 = .15, F(21) = 5.01, p = .036).

Conclusions while the results initially showed a strong relationship between work-related CR and changes in overall cognitive functioning, the results did not confirm that CR plays a significant role in predicting changes in cognitive functioning over time. This may be related to the relatively small sample of participants, as well as the overall tendency of higher CR scores in the sample. Further studies with larger sample size and more increased year gaps would be beneficial.

139 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Resilience development strategies of the chronically ill: theoretical insight

Mrs. Elīna Zelčāne 1, Prof. Anita Pipere 2 1. Rīga Stradiņš University, 2. Daugavpils University

Objectives Several quantitative studies show, that people who are living with incurable chronic illnesses have a higher risk of depression and social disengagement. However, some of them are more resilient than others and show a higher level of well-being. A literature review was undertaken to aggregate the resilience development strategies, mentioned in the qualitative studies about the resilience of the chronically ill and examine, what factors affect these strategies and how these strategies change over time.

Materials and Methods The main keywords (patients with chronic illness, resilience, strategies, qualitative studies) were selected according to PCC (Participants/Concept/Context) framework. PubMed, PsychInfo, and Scopus databases were searched, and after the application of inclusion and exclusion criteria, 21 articles were included in the literature review.

Results The research shows that chronically ill people use several resilience development strategies like learning new skills, having a positive mindset, spiritual practice, help acceptance, promotion of a healthy lifestyle, and others. The choice of strategies depends on people’s life history, beliefs, self-eﬃcacy, perceptions of illness, and gained experience while living with chronic illness.

Conclusions Different strategies can be used in different phases of illness and also resilience changes during the time.

140 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Sociodemographic factors associated with social distance from children and adolescents with mental illness in the sample of psychology students

Ms. Marija Aušraitė 1, Prof. Kristina Žardeckaitė-Matulaitienė 1 1. Vytautas Magnus University

Objectives Mental illness stigma is one the main barriers to seek professional help and receive adequate treatment. It is thought that social distancing has negative impact on therapeutic relationship, resulting in poorer therapy outcomes. The aim of this study was to evaluate the role of sociodemographic factors in social distance from children and adolescents with mental illness in the sample of psychology students.

Materials and Methods 136 psychology students participated in this study (118 females and 18 males). Participants were asked to read the descriptions of children with ADHD, depression or no symptoms varying by child’s gender and age (Swords, Heary, Hennessy, 2011) and answer a number of questions assessing social distance from the hypothetical children and adolescents presented in the vignettes (Smith et al., 2019). The internal consistency of the questions was suﬃcient for the statistical analysis.

Results Psychology students preferred greater social distance from children and adolescents with ADHD and depression compared to children and adolescents with no symptoms. Social distance preferences did not differ by child’s or adolescent’s gender and age. Psychology students reported higher social distance from children and adolescents with ADHD compared to children and adolescents with depression.

Conclusions Psychology students could be a target group for interventions aimed at reducing stigmatization toward children and adolescents with mental illness. Because social distance preferences depend on disorder, it is important that different children’ and adolescents’ mental illnesses would receive an adequate attention in antistigma programs. These ﬁndings could be useful in the development of antistigama programs for psychology students through improving understanding of factors associated with social distance from children and adolescent with mental illness.

141 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The relationship between co-dependency, coping strategies and perceived social support of women in relationship with an individual addicted to psychoactive substances

Dr. Velga Sudraba 1, Mrs. Aiva Lāce 2 1. Rīga Stradiņš University, 2. Social Service of the Municipality of Kekava

Objectives The aim is to explore the relationship between co-dependency, coping strategies and perceived social support of women in relationship with an individual addicted to psychoactive substances.

Materials and Methods The study included 31 women aged 25 to 64 years (M = 42.03; SD = 9.45). 4 surveys were used in the study -Socio- Demographic Data Survey (Lace, 2019); Spann-Fisher Co-dependence Scale (adaptation in Latvian by I. Laizāne, 2003); Multidimensional scale of perceived social support (adaptation in Latvian by S. Voitkāne, 2001; repeated adaptation in Latvian by S. Voitkāne, S. Miezīte, M. Raščevska, 2005); The Ways of Coping Scale (adap-tation in Latvian was performed by L. Deklava, 2012). Spearman’s correlation analysis was used to determine the liabilities, and the prediction of coping strategies / ways of indicators was performed by linear regression analysis.

Results It was found that there is a statistically signiﬁcant relationship between co-dependency and emotion-focused coping as strategy and, consequently, the ways of coping – strategic problem- solving, escape and avoidance, taking responsibility and relationship between seeking of social support and perceived social support from family. No statistically signiﬁcant relationship was found between co-dependency and perceived social support.

Conclusions The study shows that the most current types of stress management are avoidance, seeking of social support, self-control (as emotion-focused coping and problem-focused coping). The study shows that social support is important directly from the family, compared with other studies, where it is important from friends, society. The higher level of codependency explained the use of responsibility as a type of stress management, which could be associated with a racially motivated effort to eliminate unpleasant consequences in a problem situation.

142 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The role of social problem solving and emotion regulation skills in predicting psychological resilience

Ms. Viktorija Perepjolkina 1, Dr. Jelena Kolesnikova 2, Ms. Inese Paiča 2, Prof. Kristine Martinsone 2 1. Faculty of Communication, Rīga Stradiņš University, 2. Department of Health Psychology and Paedagogy, Rīga Stradiņš University

Objectives The aim of this study was to explore the role of emotion regulation and social problem skills as predictive factors of psychological resilience during the Covid-19 crisis in Latvia.

Materials and Methods The current study was a part of the project Nr. VPP-COVID-2020/1-0011. Two sets of the multiple linear regression analyses were performed, based on a nationally representative sample (N = 2608, men 39,8%, aged from 18 – 74), and data obtained from the three parts of the survey, comprising Psychological Resilience Scale (Perepjolkina & Mārtinsone, 2020), the Emotion Regulation Skills Questionnaire (ERSQ-27; Berking & Znoj, 2008) and Social Problem-Solving Inventory-Revised version (SPSI-R; D’Zurilla, Nezu, Maydeu-Olivares, 2002).

Results In the ﬁrst model it was found that Emotion regulation skills are the strongest predictor of psychological resilience accountings for 22.1% of the variance (ß = 0.47), followed by Negative problem orientation (ΔR2 = 15.0%, ß = -0.39) and Positive problem orientation (ΔR2 = 3.7%, ß = 0.22). All together these three variables accounted for R2 = 40.8% of the variance (F(3, 2604) = 598.67, p < .001). In the second model the strongest predictor was found to be Avoidance style accountings for 8.2% of the variance in the ﬁrst step (ß = -0.28), followed by Rational problem solving in the second step (ΔR2 = 5.0%, ß = 0.22). Both variables together accounting for 13.0% of the variance of the dependent variable (F(2, 2605) = 196.49, p < .001).

Conclusions These ﬁndings suggest that successful emotion regulation and constructive optimistic orientation towards problem-solving can maintain psychological resilience, but pessimism about one’s ability to solve problems, and the tendency to become frustrated about problems, as well as procrastination and inaction are negative predictors of psychological resilience.

143 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

“Death is the only thing that scares”: the construction of meanings about inﬂuenza vaccination among non-vaccinated people in Estonia (and what role COVID-19 plays)

Dr. Kadi Lubi 1, Ms. Eliisa Metsoja 2, Ms. Kaie Eha 3, Ms. Silja Mets-Oja 2, Ms. Lilian Ruuben 3 1. Tallinn Health Care College, 2. Health Education Center, Tallinn Health Care College, 3. Medical Technological Education Center, Tallinn Health Care College

Objectives Seasonal influenza causes epidemics each year with compounding health, societal, and economic consequences. Although that vaccination against influenza is the most effective tool to prevent it, vaccination rates remain rather low. In previous research, several barriers have been identified to prevent influenza vaccine uptake among risk groups but the process of constructing the meaning of influenza vaccination and its potential influ-ence on vaccination-decision making has not been studied. This research aims to use the social constructionist theoretical approach of meaning construction to conceptualize the perceptions of influenza and its vaccination.

Materials and Methods Nine semi-structured, in-depth interviews were conducted to analyze the ways people construct and interpret meanings regarding influenza, its vaccination, and related communication. Interviews passed thematic textual analysis based on the theoretical construct of social construction of illnesses by Conrad and Barker. As the COVID-19 pandemic was announced during the research, also this dimension to the research was involved to see whether and how a real-time pandemic of an infectious disease might influence influenza vaccination related perceptions.

Results The results highlight that cultural, individual, and third-party levels are important in constructing meanings regarding influenza and vaccination, but these are not connected to the pandemic. The COVID-19 pandemic out-break has entailed some slight changes in these meanings, but COVID-19 has not influenced attitudes towards vaccination against seasonal infectious diseases. The findings reveal that people, rather, have constructed the meaning of prevention, which contains the rules and instructions recommended during the peak of the pan-demic (e.g. general hygiene, hand washing, social distancing etc.).

Conclusions People construct their meanings about infectious seasonal inﬂuenza and related vaccines on different levels. In designing messages about inﬂuenza and related vaccination, it is essential to consider the role of mediators without underestimating the role of one’s own judgement and analysis.

144 Sustaining Psychological Resilience During Covid-19 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Comparison of psychological resilience of different groups of society during COVID-19 pandemic in Latvia

Ms. Aiva Bundzena-Ervika 1, Ms. Viktorija Perepjolkina 2, Prof. Kristine Martinsone 1 1. Department of Health Psychology and Paedagogy, Rīga Stradiņš University, 2. Faculty of Communication, Rīga Stradiņš University

Objectives To examine psychological resilience (PRs) in different socio-demographics groups of society during COVID-19 pandemic in Latvia.

Materials and Methods The origin of data is national representative cross-sectional online survey (N = 2606), performed in July, 2020, from research project „Impact of COVID-19 on health care system and public health in Latvia: ways in preparing health sector for future epidemics”, project No. VPP-COVID-2020/1-0011. For the purpose of this study socio- demographical questions (gender, age, employment status, marital status, parental status, health status) and 7 items forming PRs scale (PRS; Perepjolkina & Mārtinsone, in preparation) were selected. The Independent samples T-test and one-way ANOVA was used to test statistical differences between the means of psychological resilience within groups.

Results There was statistically signiﬁcant difference between persons with children and without children, t = - 2.62, p < .01, between persons without chronic condition and persons with chronic condition, t = -2.02, p < .05. Based on PostHoc Tamhane test, there was statistically signiﬁcant difference between age groups 18-29 and 60-69 years, p = .014, Welch’s F (5, 749) = 2.68, p = .021; between occupation status groups “employed” and “unemployed” (p < .01), between “retired due to age” and “unemployed” (p < .01), Welch‘s F (5, 249) = 4.28, p < .001; between single and married (p < .001), single and divorced (p< .05), single and cohabited (p < .05), Welch’s F (5, 259) = 5.76, p < .001.

Conclusions The results of the study identiﬁed socio-demographic factors which can serve as indicators regarding to lower PRs. These factors are individuals in age 18 - 29, those who are unemployed, single, without children and with chronic condition. Recommendations due to PRs promotion during pandemics should be developed, taking into account the speciﬁcs of those groups.

146 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Global pessimism and/or disturbed future: what has philosophy to offer us?

Dr. Marija Semjonova-Reinholde 1 1. University of Latvia

Objectives The paper is inspired by the social crisis that society is facing currently – existence during and through the global pandemic regulations and restrictions and the ways Latvian society tries to survive them. The objectives are: a) to stress the question of how the concept of crisis is shown in the popular media ( nra.lv; delﬁ.lv (rus.delﬁ.lv) and other), what the society really faces (the data gained via analysis of comments on pandemia on Facebook and Instagram, using the combination of distant reading method and discourse analysis); b). to explain how and why the current social crisis is more about the feeling of the lack of ‘normal’ existence (the concept of ‘modern pessimism’ is discussed here, and c). how the concept of ‘the closeness’ and ‘the border’ is being transformed in the past 10 month since the start of the pandemic.

Materials and Methods Materials for the paper include: a). analysis of the concept of pessimism and its modern transformations (for example, Arthur Shopenhauer’s argument on pessimism as a manifestation of one’s will will be stressed); b). cluster of an online-publications regarding the current health crisis analyzed; c). comments and reactions on social media categorized and analyzed; d) the concept of border and bordered/borderless society and country stressed using nowadays anthropological perspectives on the question. Methods used: the classical philosophical texts’ and discourse and reaction (sentiment) analysis to the digitized text-cluster analysis.

Results The results of the paper are based on the ﬁeldwork data conducted in the online-format.

Conclusions In the conclusion part I will introduce several observations about the renewed formation of the concepts of border and movement, and will focus on the purposes of modern sadness about the externally putted lack on crossing the borders and the means the internal borders are being (re)constructed and saved within the Latvian smallest communities – families.

147 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Perceived changes in the frequency of emotional abuse before and during the ﬁrst wave of COVID-19 pandemic

Ms. Kristīne Šneidere 1, Prof. Sandra Mihailova 2, Ms. Viktorija Perepjolkina 2, Dr. Jelena Kolesnikova 1, Prof. Kristine Martinsone 1 1. Department of Health Psychology and Paedagogy, Rīga Stradiņš University, 2. Faculty of Communication, Rīga Stradiņš University

Objectives to retrospectively investigate the perceived changes in the frequency of emotional abuse before and during the ﬁrst wave of COVID-19 pandemic.

Materials and Methods Secondary data from research project survey of the Work package No. 2 “Associated factors and changes in psychological resilience, mental health in the general population of Latvia during and following the COVID-19 pandemic and directions for future management”, consisted of 27 thematic sections, and for the purpose of this study -speciﬁc items regarding demographics (gender, age, education, marital status), and domestic violence (10 items) were used in data analysis. The sample included 1701 participants, aged 18 – 74 (M = 46.79, SD = 13.09, 44% male), 32% of whom reported having experienced emotional violence during the ﬁrst wave of COVID-19. Only participants that noted that they either are married or in a relationship and living together were included in data analysis.

Results The Wilcoxon signed-rank test indicated differences between experiencing emotional abuse a month before COVID-19 related emergency state onset and during the emergency state (z = -2.44, p = .015), showing a slight increase in emotional abuse (M = .04, SD = .93). Additional analysis indicated that differences were present in only two age groups – 26 – 35 (z = -2.11, p = .035) and 36 – 45 (z = -2.13, p = .033).

Conclusions The study revealed that the perceived frequency of emotional abuse differed slightly depending on the timeline of COVID-19 pandemic. This was especially notable in the young adult and adult age groups. This study was conducted under project No. VPP-COVID-2020/1-0013 in collaboration with project No. VPP-COVID-2020/1-0011.

148 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Possibilities of receptive music therapy for mothers raising children with developmental disorders as a self-help tool for overcoming stress during the COVID-19 pandemic

Ms. Jautre Ramute Sinkuniene 1, Mrs. Jurgita Zalgiryte-Skurdeniene 2 1. Mykolas Romeris University, 2. Lithuanian Music Therapy Association

Objectives On March 16th, 2020, a quarantine due to COVID-19 was announced and parents of children with developmental disorders were left without help from educational and health professionals. The change in routine, work restrictions, isolation increase in parents’ level of stress. The aim of the article - to reveal the potential of online Receptive music therapy (RMT) for mothers of children with developmental disorders at the theoretical and empirical levels. The tasks: 1) to create a model of online RMT for stress reduction; 2) to evaluate the potential of RMT as a self-help therapeutic tool. The research question: how mothers can use the RMT self-help tool independently during the quarantine.

Materials and Methods A phenomenological approach using half-structured interviewing was chosen. Data was collected through analysis of music therapy sources, “Perceived Stress Scale” (PSS), “Musical Life Panorama” (MPL) interview, RMT self-help tool application register, and audio records of music therapy sessions. RMT self-help tool was developed - records with purposefully selected relaxing music. Four mothers with similar life experience of caregiv- ing to a child with developmental disorders participated in the study.

Results Empirical research has shown that RMT improved the ability of participants to better identify stressful situations, become aware of the feelings and reactions that arise during them. The evolving habit of listening to relaxing music the level of stress and tension decreased, the ability to relax, calm down, and avoid anger was strengthened, which improved the overall emotional background in the family. The clients learned to use the RMT self-help tool independently.

Conclusions The application of RMT increased clients’ ability to cope with stress and reduced the risk of recurring stressful situations. Study participants conﬁrmed the effect of the RMT self-help tool on stress reduction both during online sessions and by applying the tool independently after the therapy, during COVID-19 quarantine.

149 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Psychological resilience in time of COVID-19 crisis: emotion regulation as a protective factor

Ms. Inese Paiča 1, Prof. Kristine Martinsone 1, Ms. Viktorija Perepjolkina 2 1. Department of Health Psychology and Paedagogy, Rīga Stradiņš University, 2. Faculty of Communication, Rīga Stradiņš University

Objectives Psychological resilience is the ability to adapt successfully in the face of stress and diﬃculty. People with weak resilience are at risk of experiencing long-term negative emotions and poor recovering from the crisis, thus endangering their mental health. Adaptive emotion regulation can help maintain mental balance and increase resilience. The objective of the present study was to explore emotion regulation skills as a predictive factor of the psychological resilience during Covid-19 crisis in Latvia, after controlling for basic socio-demographic factors.

Materials and Methods The current study was a part of the National research programme „Impact of COVID-19 on health care system and public health in Latvia: ways in preparing health sector for future epidemics”, project Nr. VPP-COVID- 2020/1-0011. The study investigated inﬂuence of the predictor variables (gender, age, education, employment, marital status and emotion regulation skills) on the criterion variable (psychological resilience) using a national representative sample (N = 2608; aged from 18 to 74; 39.7 % male, 60.2 % female, 0.1% other). Measures included the Psychological Resilience Scale (Perepjolkina & Mārtinsone, in preparation) and the Emotion Regulation Skills Questionnaire (ERSQ-27; Berking & Znoj, 2008).

Results Hierarchical multiple regression analysis revealed that within socio-demographic indicators age, education, employment and marital status are weak predictors of resilience (R = .128, R2 = .017, F (5, 2527) = 8.481, p < .001). When the emotion regulation skills were added to the model, age and education became non-signiﬁcant and the only strong predictor of resilience became emotion regulation skills (R = .482 R2 = .233, F (1, 2526) = 710.905, p< .001).

Conclusions These ﬁndings improve understanding of why some people are able to adapt during and after a crisis, while others experience long-term negative mental health outcomes. Successful emotion regulation is one of the important factors in resilience and can protect against stress during and after the crisis.

150 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Socio-psychological proﬁle of Latvian inhabitants who did not comply with the COVID-19 epidemiological requirements

Mr. Gatis Upesleja 1, Dr. Viktorija Perepjolkina 1 1. Rīga Stradiņš University

Objectives The aim of this study is to examine socio-psychological proﬁle of Latvian inhabitants who did not comply with the COVID-19 epidemiological requirements.

Materials and Methods A randomized nationally representative sample (N = 2608, aged from 18 – 74, men 39.8%, women 60.2%) from the online survey, carried out in the frame of the National research program, project Nr. VPP-COVID-2020/1-0011, was used in this study. From the full survey only some socio-demographic questions (age, gender, education level, living place, employment status, marital status, and number of children), composite measure of Fear of COVID-19 (2 items), composite measure of COVID-19 Risk perception (4 items) and the statement: ”According to the instructions given by WHO, it is necessary for some precautions to be taken in order to prevent the spread of the virus. Do you believe that you take adequate precautions?” (response rate from 1 = “not at all” to 5 = “very much”) as a main variable, were used in this study.

Results The results showed that less compliant with COVID-19 epidemiological requirements were males, rural inhabitants, persons aged less than 60 years old, unemployed, with lower education level, and those, who are less afraid of COVID-19 and think that its dangerousness is exaggerated. Compliance with the restrictions was not related to the marital and parental status.

Conclusions Based on this study, policy suggestions regarding a more targeted way of the providing information of the importance of the preventive behavior for reduction of the spread of the virus.

151 Technology-Supported Social Work RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Level of statistical literacy of social work students and the possibility of using available technologies to increase it

Dr. Angela Almasiova 1, Dr. Katarina Kohutova 1 1. Faculty of Education, Catholic University in Ružomberok

Objectives The aim of the paper is to point out the importance of statistical literacy, which is very important skill generally, not only in the ﬁeld of social work. Another aim of the paper is to identify the level of statistical literacy of social work students, which was determined on the basis of a test consisting of solving statistical tasks.

Materials and Methods The statistical method of decision trees was used to process the outcome.

Results The results point out the low level of statistical literacy of students and identiﬁed possible risk predictors of low level of statistical literacy.

Conclusions At the end of the article, the authors present the possibilities of using available technologies in increasing the statistical level within the study program of social work.

153 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The role of digital competencies in the professionalism of future social worker

Prof. Irene Zemaitaityte 1, Dr. Raminta Bardauskienė 1, Dr. Daniele Markovic 2 1. Mykolas Romeris University, 2. Catholic University in Ružomberok

Objectives The analysis of EU documents highlights the main areas for increasing competences of social workers in working with children and youth. Among others upskilling social workers’ digital competence and developing digital skills of children are youth is emphasized. New technologies emerge rapidly. Digital literacy and 21st century skills play a crucial role as part of modern-day citizenship and modern life in general.

Materials and Methods The methodology is based on documents analysis, theoretical analysis of scientiﬁc literature. Document analysis was done aiming to ﬁnd out new digital skills for future social work professionals.

Results Document analysis shows that there are a lot of youth work practitioners who lack the digital skills or attitudes to fully beneﬁt from the opportunities created by digital technologies for delivering quality youth work (European Commission, 2018). Many youth workers see digital media only as social media. Their understanding of the possibilities of digital media and technology should be widened.

Conclusions Research date identiﬁed a set of innovative practices in both delivering digital youth work and also upskilling youth workers’ digital competences: using social media in sharing information, online youth counseling, supporting digital literacy, enabling participation with digital tools, supporting cultural youth work online, supporting the development of technological skills, using digital games in youth work.

154 Social Services Management: Values And Ethics RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Care, dignity and bio power at the end of terminally ill patients life

Prof. Jolanta Kuznecoviene 1 1. Lithuanian University of Health Sciences

Objectives To explore physicians approaches to digniﬁed death of terminally ill patients in the context of end- of life in Lithuania.

Materials and Methods The presentation is based on the analyses of empirical data obtained through semi- structured interviews with 20 physicians working at the intensive care units in Lithunian hospitals. All interviews were transcribed verbatim and thematic analysis was applied to analyze the data.

Results As fieldwork data revealed, our informants understand dignified death in four ways. Physicians with whom we talked and whose work observed, describe dignified death as death in peace without suffering, as “natural” dying which “succeeded to avoid “futile resuscitation”, as death based on trust in physician’s professionalism to decide to withhold or withdraw treatment and possibility to choose and express the will of the way of dying. Physicians also used to compare legal regulations of death management in Lithuania with other European countries emphasising respect paid to patient autonomy, possibility for the patient to choose the way of dying by signing advance directives up to euthanasia. According to our informants, the main barriers against ensuring terminally ill patient’s dignified death in Lithuania are not Christian values but legal regulations which imply “futile resuscitation” heavily demotivating physicians and nurses working at intensive care units of the hospitals.

Conclusions Physicians relates the dignity of terminally ill patients at the end of their lives with conﬁdence in their treatment decisions and with the implementation of instruments to ensure patient autonomy in medical practice in Lithuania.

156 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Context of practical experience and education of crisis intervention in social services facilities in Slovakia

Dr. Sona Srobarova 1 1. Catholic University in Ružomberok

Objectives Crisis intervention opens up a large space for the employment of a relatively wide range of workers, they can be professionals as well as laymen. Surveys point to a lay portfolio of instructed crisis intervention. Therefore, it is important to address the issue of education and qualiﬁcation of a social worker in the provision of crisis intervention.

Materials and Methods The main purpose of this article is to examine and analyze the perception of crisis intervention based on the practical experience of a social worker, with regard to their length of practice, age, and education, i.e., completed training in selected facilities providing crisis intervention services. The object of the survey is social workers of the full-time form of crisis intervention from selected facilities providing crisis intervention services in Slo- vakia.

Results The survey will take place in December 2020. We will usea quantitative survey and we chose the method of a questionnaire, the intention of which was to determine the perception of the crisis intervention by social workers, in speciﬁc crisis intervention facilities. Thus, it is a total of 140 inclusion of crisis intervention. When selecting the survey sample, a deliberate selection of respondents, social workers, whose common feature is the implementation of crisis intervention in the social intervention facilities of crisis intervention in Slovakia, was used. We have chosen a strategy of quantitative research; a questionnaire . Descriptive and inferential statistics will be used. We use the statistical computer program SPSS for evaluation.

Conclusions The obtained primary data will be used to understand the attitudes and opinions of social workers as crisis interventions and the results will provide answers to questions related to their subjective satisfaction with the performance of the profession and completed qualiﬁcation education in the ﬁeld of crisis intervention and to formulate recommendations for the study program social work.

157 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Demographic challenges and demand for long-term care in Riga municipality

Mr. Mārtiņš Moors 1, Mr. Juris Osis 2 1. Rīga Stradiņš University, 2. Riga City Council Welfare Department

Objectives Objective of the study is to make a forecast of the demand for long term care in institution (further - LTC) based on the analysis of demographic trends and LTC demand and supply dynamics in Riga.

Materials and Methods Multivariate regression analysis is used to determine the factors inﬂuencing the dynamics of the demand for long-term care. Linear relationship of the data was estimated using Q-Q plots. Regression model was selected based on the proper criterion and the coeﬃcient of determination. A similar calculation protocol has been used to perform regression analysis for all dependent variables.

Results Number of applications for the LTC on an annual basis can be most accurately predicted by knowing the dynamics of Riga’s population over the age of 60. The number of applications for LTC in thirteen years has tripled from 572 to 1664. Of all applications, only about 10% are rejected, which is a relatively small number of applicants. Average age of applicants for LTC is 80. If the current demand for long-term care remains, the number of applications could reach 2365 by 2029.

Conclusions Most people apply for a long-term care as they cannot take care of themselves exactly because of their age, not their disability or other social circumstances. People do not apply for a LTC immediately after receiving an old- age pension - on average, it takes 10-15 years from the day of retirement for a person to apply for LTC. LTC costs are rising due to changes in consumer prices, but average customer revenues are not rising as fast, resulting in a proportional increase in the share of municipal co-ﬁnancing. The number of applications for LTC is expected to increase by an average of 5% per year, and accordingly the number of LTC places required will need to be increased by at least 21% by 2025.

158 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Evaluation of cooperation between social and health care services for persons with chronic diseases in Latvia

Mrs. Alina Dūdele 1, Dr. Daiga Behmane 1, Mrs. Lilita Cirule 1 1. Rīga Stradiņš University

Objectives To assess current availability of social services and cooperation status between health and social service providers as well as the need for support for persons with chronic diseases.

Materials and Methods Study includes analysis of the structure of social services received by persons with chronic diseases in 2017- 2019, assessment of current regulation and two internet-based surveys: for representatives of municipality social departments (N=100) and social service providers (N=86). Survey questions were developed based on Chronic Care Model. The results were validated in four focus groups of social care providers and chronic disease patients.

Results In majority of cases (71% for granting social service and 66% for granting social support) chronic disease status is not identiﬁed. It is available in 55% of cases, when social service providers identify information about chronic disease status, in 35% of cases social departments identify information about chronic disease when granting access to social support, and in 20% of cases when granting rights to receive social services.

Conclusions Currently cooperation between social and health care providers is insuﬃcient: there is no uniﬁed approach for collection and providing access to information about persons’ chronic disease and related needs. At the same time, social departments and social service providers recognize the need for full information and the establishment of a sustainable cooperation mechanism for the provision of social services.

159 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Nonformal adult education coordinators as developers of educational activities and community interaction

Prof. Irene Zemaitaityte 1, Dr. Alina Petrauskiene 1 1. Mykolas Romeris University

Objectives The growing importance of communities and they interaction is witnessed by the growing interest in these areas: in the emphasis on community development and in the need to bring educational and social services closer to local communities. The organization of educational and learning activities in communities promotes the concentration of the local community, self-help.

Materials and Methods The aim of the research - to reveal the functions of non-formal learning coordinators in municipalities as those of the developers of learning and community developers. The focus group method was chosen for the qualitative study.

Results The analysis of the research data revealed the differences in the understanding of the needs of Nonformal Adult Education in Lithuania. The implementation of NAE in separate regions is recognized by the coordinators as a complex process, depending on the context and factors of the local municipality and community.

Conclusions The analysis of the data revealed the activities of the coordinator as a community activator and a volunteer teacher, which are implemented in communities. Community members are attracted to such trainings, which meet their needs and allow them to see the beneﬁts and applicability in everyday life here and now.

160 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Organizational culture in social services – focus on the workers’ well-being

Mrs. Lenka Chlebanova 1, Prof. Marketa Rusnakova 1 1. Faculty of Education, Catholic University in Ružomberok

Objectives In the field of social services, today the organizational culture is defined mainly through professional values, for individual social service providers by vision, mission, goal, or organizational values. Theoretical and the practical building of a healthy, ethically sensitive organizational culture of social services facilities is one of the important goals of the professional ethics of social work in Slovakia (Mátel et al., 2012). In the context of increasing the quality of services a culture supporting the clients´ well-being through the workers´ well-being (Chlebanová, Rusnáková, 2020) is an important subject of interest. The aim of the research is to find out the current state, such as the employee support is embedded in the documents defining the organizational culture of social service providers (in their vision, mission, goals, values).

Materials and Methods Review and theoretical analysis of the literature on the topic. Qualitative content analysis of documents. We analyzed documents deﬁning the organizational culture of social service providers in Slovakia. Searching for “home of social services – vision, mission, goals, values” on the internet, we obtained the documents on the provider´s web page.

Results From the documents, we found out that employee support is still given little attention. At the practical level, the support of employees was expressed like the support of education, supervision of employees, a social fund for cultural or sports activities, rewarding of employees. Employee satisfaction or a committed approach towards employees were expressed rarely.

Conclusions The provision of social services today faces many demands and also dilemmas that “social work services” bring with them (Musil, 2004). Incorporating support for employee well-being into the organizational culture of social services can be an essential step towards better client care and higher quality services.

161 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Responsibility experience for your own life through volunteering

Dr. Neringa Kurapkaitiene 1, Prof. Vida Gudzinskiene 1 1. Mykolas Romeris University

Objectives The object of the study – volunteering experience of young adult.

Materials and Methods Interpretative Phenomenological Analyses is research methodology. According to the phenomenological approach research itself is not focusing in any foreseen objectives, oriented to the volunteers experience.

Results In this article is presented part of the research, giving deeper view on one of the super-ordinates theme, with the aim: to present responsibility for your own life experience of young adults in long term and full time volunteering, while volunteered is held in social help area. In the study participated 6 research participants, 3 young man and 3 young woman in the age 20 to 30 years old and to collect the data of the research were used semi-structured interviews.

Conclusions Conclusions of the study, presented in this article shows: 1. Through volunteering experience research participants perceived power and duty of own life quality. Re- search participants in the volunteering experience getting awareness about own life quality – they can and they must to be responsible of own life. 2. This power of responsibility is hidden in themselves and change of own life depends on the decisions made of them while volunteering. Prior experience of responsibility is opening decision possibilities and freedom possibility in any change of life.

162 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The level of the legal culture of road users as an indicator of a traﬃc safety

Ms. Alina Kalinina 1, Dr. Vladyslava Batyrgareieva 1, Ms. Sabriie Shramko 1 1. Аcademician Stashis Scientiﬁc Research Institute for the Study of Crime Problems, National Academy of Law Sciences of Ukraine, Kharkiv

Objectives To analyze the role of legal awareness and legal culture in improving the highway safety and to highlight the factors that are making it.

Materials and Methods The methodological basis for the research conducting is an analysis of the specialized literature on phycology and criminologythe oﬃcial statistic data of the Prosecutor General’s Oﬃce, the State Judicial Administration of Ukraine, survey (respondents - road users).

Results During 2016-2017 about 9 400 crimes related to violation of traffic safety rules or operation of transport (Art. 286 of the Criminal Code of Ukraine) were committed every year. At the same time each year more than 2 700 persons are convicting of committing such crimes. One of the indicators of a traffic safety is the level of the legal culture of road users: drivers and pedestrians. The demonstrations of a low level of legal culture are non-using of passive safety equipment on the move, driving into oncoming traffic, speeding, driving while intoxicated, etc. The factors that are influencing on the formation of legal culture of the road users are managerial, organizational, legal, etc.

Conclusions A conscious safety culture can make traﬃc safety measures more effective and reinforce appropriate behavior of the road users.

163 Family And Child Welfare RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Animal therapy for children with functional disorders in the process of deinstitutionalisation

Mrs. Marika Lotko 1 1. Rīga Stradiņš University

Objectives In 2014 Ministry of Welfare of the Republic of Latvia introduced measures to initiate the deinstitutionalisation (DI) process. In Latvia, three target groups have been identiﬁed in the DI process, for which community-based services are to be provided: children in out-of-family care; children with functional disabilities; adults with mental disabilities.

Materials and Methods During research state‘s DI plans were analyzed to evaluate the number of needed services related to animal therapy for children with functional disabilities.

Results The regional DI plans for 2017-2020, which assess the individual needs of the target groups, have identiﬁed the need for a range of speciﬁc services in order to make rehabilitation as effective as possible for children with functional disabilities, such as equine-assisted therapy, canine-assisted therapy, arts therapy, aquatic therapy, etc. where part of them have so far been unavailable. It is concluded that the provision of animal therapy does not always meet the demand, especially considering the uneven provision of social services in remote regions of Latvia. For example, individual needs assessment data for Latgale region show that there is a strong demand for therapeutic services: music therapy (316 out of 392), equine-assisted therapy (302), sand therapy (283), arts therapy (260), canine-assisted therapy (248).

Conclusions The lack of specialists and the ability to offer the service in various regions and the increased costs of the service have a negative impact on the ability of the target groups identiﬁed in the DI plan, to receive a full basket of services based on their individual needs. Nevertheless, several cities of national importance have already had positive experience in attracting and providing equine-assisted therapy and canine-assisted therapy services.

165 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Being a father of twins – forming an equal bond with both twins and supporting their individuality

Dr. Kristiina Heinonen 1 1. Metropolia University of Applied Sciences

Objectives A multiple-birth family is one expecting or with twins, triplets or quadruplets. Parenthood in multiple-birth families has not been greatly studied. Keywords: Phenomenology, parenthood, fatherhood, twins, nursing, nurses, midwives, public health nurses.

Materials and Methods The aim of this study was to describe and explore the experiences of fatherhood of fathers of twins. The data, which was collected, analyzed 2018–2019, and consisted of the fathers’ notes and diary entries and in-depth interviews, was analyzed qualitatively. Ethics was important part during the research process.

Results Fatherhood was seen as an opportunity to be an active parent in caring for the children and organizing daily life. Fathers considered it important to form an equal bond with both twins, also by being with and giving time to each child separately. Fathers supported their spouses by being active parents, participating in daily family life and nurturing the parental relationship. Fatherhood involved responsibility for the whole family, especially the children, and concern for their own and their wife’s ability to cope. Fathers expected more attention and support for fatherhood from the staff of the child welfare clinic. Some felt that they were left out at the clinic and that its family-oriented focus was more on motherhood, even disregarding support for fathers.

Conclusions Fatherhood of twins develops gradually during pregnancy and after the children’s births through being actively present with the children. Fathers gradually establish an equal father-child relationship with each of the twins. Supporting fathers and fatherhood helps promote the well-being of the whole family. Fatherhood of twins and support for such fathers should be given more attention by social welfare and healthcare professionals.

166 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Case manager as a leader in providing social support for families and children

Dr. Jolanta Pivoriene 1 1. Mykolas Romeris University

Objectives Case management as a new model started in Lithuania in 2018 after changes in the Law on the Fundamentals of the Protection of the Rights of Child. According to Lithuanian legal documents case management is the organization and provision of comprehensive social support to the child and his/her representatives, coordinated by the case manager in order to help overcoming social difficulties, the successful resolution of which would prevent possible violations of child’s rights. Theoretical definitions of case management emphasize that it is a client cantered model, and case managers exercise many functions, roles, apply various methods in order to lead a case management process successfully. In this process case managers face many occasions to take leadership position. The goal of the presentation is to find out possible interconnections between case management and leadership.

Materials and Methods Two research questions are formulated: what are case managers experience in taking leadership and what style/-s of leadership is the closest for case manager? Scientiﬁc literature and legal documents analysis were followed by qualitative research which used semi structured interview with case managers in municipalities. Interview data was proceeded using content data analysis.

Results Case managers on everyday bases work on micro and meso levels. They have plenty of parallel processes during the day, most of the time working in the groups and/or teams inside and outside organization, taking the main responsibility for the activities and moving back and forth from giving direct services to families via managing crisis situations to inter-institutional cooperation. Even if case managers haven’t named directly to be leaders, their activities and responsibilities involve traits of leader’s activities and roles.

Conclusions Referring to leadership theories case mangers wouldn’t be named as leaders in traditional sense, but they take such leadership styles as servant, transformational, transactional and in some cases - visionary.

167 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Excessive alcohol consumption referring women and their natural recovery process

Prof. Marketa Rusnakova 1 1. Catholic University in Ružomberok

Objectives Numbers of women facing the excessive alcohol consumption never contact professional help. Part of these women go through natural recovery process and manage to abstain without any professional help. The aim of our contribution is to ﬁnd out which are the signiﬁcant areas crucial for the recovery process referring women overconsuming alcohol.

Materials and Methods The survey in the research was executed by quality design. We chose the case study to be the survey strategy. For data collecting we used the method of half-structured narrative interview and we initiated the conversation via the life line technique. We retrospectively found out the level of addiction of the individual participants by the AUDIT test in order to achieve the comparability of the survey sample. We used the narrative analysis for the phase of data processing and evaluating.

Results By the analysis of conversations ﬁve topic areas concerning the recovery process were identiﬁed: social background support, independent participation on recovery, state of health turn, professional treatment and activity. Each topic area contains other subtopics.

Conclusions We succeeded to meet the aim of research. Due to the achieved knowledge we can better understand the mechanisms eﬃcient in the recovery process and use them in the professional care for women addicted from alcohol.

168 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Individual budget model for community based social services for children with disabilities in Latvia: analysis of results of pilot project

Mrs. Alina Dūdele 1, Mrs. Lolita Cibule 1, Mrs. Gundega Klauza 2, Dr. Daiga Behmane 1 1. Rīga Stradiņš University, 2. Latvian Association for Health Economics

Objectives To estimate effectiveness of IBM pilot project in addressing social, health care and educational needs of children with disabilities and their parents.

Materials and Methods The IBM pilot project was implemented in 10 municipalities of Latvia. A total of 102 children with disabilities and their parents participated in the pilot project during 12 months period. Individual needs of every child were identified by multidisciplinary team (need assessment was carried out by social, educational and health care professionals) in close cooperation with child and family. The protocol for evaluation of functioning of children was based on International Classification of Functioning, Disability and Health (ICF). The international tool KIDSCREEN was used to assess QOL. The assessment procedure took place prior to entering to pilot project and after its completion. Effectiveness was estimated for use of resources, achieved outputs and outcomes. The pilot project was financed by European Social Fund and state budget.

Results Altogether 536 speciﬁc, measurable goals were included in individual support plans for 102 children. A total number of 402 (75%) goals were achieved. Results showed positive dynamics in functioning of 47 (46%) participants with disabilities. Decrease of activity limitations in 9 domains according ICF were obtained. Children reported higher QOL measures in 8 out of 10 dimensions of KIDSCREEN, with especially positive changes in dimensions School Environment, Peers & Social support.

Conclusions The results of the pilot project demonstrated IBM as effective tool for providing individual support to receive community based services ensuring positive change in indices of child’s functioning and QOL.

169 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Intergenerational solidarity in family: manifestations and inﬂuencing factors

Ms. Nadežda Kuļigina 1, Prof. Signe Dobelniece 2 1. Rīga Stradiņš University, 2. Latvia University of Life Sciences and Technologies

Objectives Relationship between family members of various generations has always formed a basis for various scientiﬁc discussions. Economic, demographic and social processes arising as a result of globalisation, urbanisation, fem- inisation, increased longevity and aging of population not only cause changes in the family structure itself and the functional abilities of a family, but also create new conditions of interaction between the family members.

Materials and Methods During the period from June 2019 to January 2020 was conducted a survey to research the manifestations of intergenerational solidarity in family and its inﬂuencing factors. The basis of the research was built on multidimensional construction of Bengtson and Roberts (1991) which was adapted by the author of the paper to the situation in Latvia. 410 respondents corresponded to the selection criterion of the research and participated in the empirical part of the research. The criterion was as follows: residents of Latvia who had at least one living parent.

Results The results of research show that intergenerational solidarity in family is affected by: 1) gender of the adult child; 2) social and economic factor of the parent. Expressions of strong family norms of the grown child affect provision of functional assistance to their parent; and adult children contact their parent more often if they have mutual emotional intimacy.

Conclusions 1. Intergenerational solidarity in the family is expressed as a dynamic process between an adult child and a parent wherein the emotional intimacy between an adult child and parent motivates communication and mutual assistance and support. 2. Strong normative beliefs in the family have a positive effect on provision of assistance and support, but do not stimulate communication. 3. Intergenerational solidarity in the family expressed by adult children towards their parent is more distinct with daughters than sons.

170 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Life course scenarios, family events’ sequences and the locus of control in Lithuania

Dr. Apolonijus Žilys 1 1. Vytautas Magnus University

Objectives The analysis of a life course summarizes the structure of an individual life cycle, the order of personal life choices and different pathways throughout a lifespan. Social, historical, and political factors determine one’s life choices at a specific time of our own life to behave in a certain way or express age-specific needs. Transitions of demographic events (especially related to family events, i.e. entering into marriage, childbirth, separation from spouse, etc.) can be expressed in a sequence of life events with specific needs, which can have a huge impact on the personal locus of control. The latter represents the outlook as to whether the actions are linked to what we do (internal control orientation or self-responsibility), or on events outside personal control (external control orientation which is usually associated with anxiety and stress). The objective of the presentation is to reveal the most common different event sequences in Lithuania, and the sequences (especially family events) that have an effect on differences of the locus of control.

Materials and Methods The presentation is based on national cross-sectional study ‘Experiences of (In)Security across Generations in Lithuania: Motives and Opportunities to Choose Life Trajectories’. Demographic methods were applied to analyze the data of 18–50 year-old Lithuanians.

Results Results reveal that certain life trajectories and the relative risk of family events differ within a broad 18–50 age-cohort, and the timing of life events is related to a personal internal or external locus of control.

Conclusions Since some life sequences are more prominently expressed among some age groups, a hypothesis can be pos- tulated that certain life trajectories and family events were more gruelling to reproduce for individuals who experienced Lithuanian society transformation during the post-socialist transition period, compared to other age-cohorts. This experience possibly has an effect on the individual locus of control even nowadays.

171 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Making new lives after exiting care: social orphans in Latvia

Mrs. Zoë Kessler 1, Dr. Ilze Trapenciere 2 1. University of Dundee, 2. Rīga Stradiņš University

Objectives This study intended to conceptualize the experiences of Latvian young adults with a social orphan background. Understanding the narratives of young people with a care background contributes to demystifying stereotypes and assumptions about what it means to grow up in care and create a meaningful and purposeful life after exiting social care.

Materials and Methods Through snowball sampling, there were nineteen participants selected for life story interviews. The research process in this study recorded the participants’ life experiences in great detail, covering three main life phases: 1) before placement in care, 2) while in care, and 3) transitioning to independence. As a result of the detailed data collected, the researcher employed several strategies to create meaning out of the narratives including a collaborative co-research method with the participants. A thematic analysis through NVivo software was completed as well as an analysis of Context, Critical Events and Acts of Resistance.

Results Participants’ lived experiences revealed some commonalities: factors that preceded children entering care, occurrences from care and life trajectories post-care. Notable were multiple stories of resistance to adversity, resilience and hopefulness in creating new lives full of possibility.

Conclusions Often the lives of social orphans are explored in the third person through methodologies that held participants in a passive role rather than an active one. This study positioned participants as ‘experts of their experience’ and ‘co-researchers’ to best understand the lived experiences of social orphans in Latvia. These young people exiting social care are surrounded by narratives of failure. Despite this, there are also narratives of success, hope, and resiliency.

172 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

On some implications of COVID-19 on the living conditions of children in families and out-of-family care

Ms. Ilze Trapenciere 1, Ms. Zoë Kessler 2, Prof. Lolita Vilka 1 1. Rīga Stradiņš University, 2. Salem State University

Objectives To compare the living conditions of children growing in families and out-of-family care (SOS village and municipal child and youth centre) during the Covid-19 pandemic in Latvia.

Materials and Methods

Qualitative methodology based on document analyses, media analyses, observations, semi-structured interviews with authorities, in-depth interviews with parents and social workers. The thematic analyses and mapping were employed. Results Several indictors for the comparison of living conditions of children were employed health care, nutrition, private space, access to educational facilities and readiness to emergency remote studies, socio- emotional at-mosphere, access and understanding of information.

Conclusions Mapping demonstrates different problem groups for children growing in families and out-of-family care. 1. Children growing in families had less access to health care facilities during pandemic than children from out-of-home care. During the 1st wave of pandemic when schools were closed children from poor families and smaller pupils did not receive hot lunches, and the nutrition on average was less healthy. Children from out-of-home care received healthy nutrition. 2. No sufficient private space for each family member. 3. Many families faced insufficient number computers for each family member, internet was not available at appropriate quality. Children in out-of-family care had full coverage with computers and tablets, and good network facilities. 4. Both families with children and children from out-of-home care faced socio-emotional difficulties. Major difficulties in families were related to tension, stress, conflicts among siblings, and children and adults. Major problems in institutions were related to high number of children per carer. 5. The number of children per carer in case of remote education is too high to provide sufficient assistance to help and consult children in all school subjects, help with on-line learning and the help and control of school home tasks. Institutions have employed other professionals (social workers, psychologists, even medical nurses, technical personnel) to provide educational process in the premises of the institutions.

173 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Pandemic causing infection and its impact on family health-related quality of life: quantitative study

Dr. Zanda Pucuka 1, Dr. Ieva Roģe 2, Dr. Liene Smane 3, Dr. Iveta Račko 2, Dr. Lizete Kļaviņa 2, Ms. Anna Beate Apsite 4, Dr. Inese Stars 4, Prof. Anda Ķīvīte-Urtāne 5, Prof. Jana Pavāre 3

1. Children’s Clinical University Hospital; Rīga Stradiņš University, 2. Children’s Clinical University Hospital, 3. Rīga Stradiņš University; Children’s Clinical University Hospital, 4. Rīga Stradiņš University, 5. Department of Public Health and Epidemiology, Rīga Stradiņš University

Objectives The study objective was to assess the family functioning and health-related quality of life (HRQOL) in a sample of children diagnosed with severe respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to specify the diﬃculties of family functioning they faced, as the ongoing pandemic is a unique, unprecedented situation with unrated emotional and social impact.

Materials and Methods The 36-item Pediatric Quality of life™ 2.0. Family Impact Module Scale is a multidimensional tool, involving different aspects of life and estimating self-reported Parent HRQOL Summary Score (physical, emotional, social, and cognitive functioning) and The Family Functioning Summary Score (daily activities and relationships). Scores closer to 100 index higher quality of life.

Results This module was completed by 67 families, whose children (aged 0 - 19 years) had been tested positive for SARS- CoV-2. Two negatively impacted subjects emerged in the Parent HRQL Summary Score: Emotional Functioning (mean value 56.3, SD 21.3), which involves parent’s feeling angry, sad, helpless, and Social Functioning (56.3, SD 25.1) by feeling isolated and lacking support. Mostly affected dimension in The Family Functioning Summary Score was Daily Activities (57.3, SD 26.0), that include managing household chores. Whereas, the least adversely affected aspects were Cognitive Functioning (76.9, SD 20.0) and Family Relation- ships (81.0, SD 16.1), respectively.

Conclusions A child being infected with SARS-CoV-2 affects several dimensions of family HRQOL, predominantly emotional and social functioning, and daily activities, however, to gain a more thorough understanding whether family HRQOL was negatively affected by the child’s acute illness itself or due to limitations following pandemic, a comparison with control group enrolling children with acute non- SARS-CoV-2 infections should be performed.

174 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Policy and legal framework on protecting children’s rights in Latvia and Sri Lanka

Ms. Ilze Trapenciere 1, Ms. Shelomi Perera 2, Prof. Lolita Vilka 1 1. Rīga Stradiņš University, 2. Jonkoping University

Objectives To explore the level of involvement of social work professionals on implementing children’s rights in a diverse socio-cultural and legal framework in Latvia and Sri Lanka.

Materials and Methods Mixed methods research design: a document analysis of legislation and policies, qualitative expert interviews (n=10) and a quantitative survey (n=60). The review of legal framework has been made by a content analysis of the legislation and policies.

Results Similarities and differences between the legal and policy framework of the two countries are discussed from the standpoint of the global perspective of Social work as a global profession. There is suﬃcient legal background in both countries for accomplishing children’s rights. A key difference between the two countries: in Latvia, the implementation process of protection of child rights has cross-sectoral collaboration among the main institutions and stakeholders in the ﬁeld, and in Sri Lanka, the institutions work separately in their mandates about different aspects of the child rights-related issues. In Latvia, special government bodies have established for ensuring childrens rights in Latvia. In Sri Lanka, the National child protection Authority and Probation and Childcare Services Department are main bodies that work on child protection.

Conclusions Main country similarities: • sufficient legal background, • cultural relativity of national/local contexts affects upholding children’s rights and social work practice. • rather low satisfaction level on the implementation of policies, • financial resource allocations for social work practice is not sufficient, • high workload for social workers. Country differences: • In Latvia, social work profession is a part of the social welfare system; in Sri Lanka, social workers are not part of the social welfare system, officers might not be specialised in social work. • education and training levels of social workers, • number of clients per social worker, • child situation: child employment and less leisure time in Sri Lanka, different reasons for school non- attendance, different attitudes concerning physical punishments.

175 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Selected aspects of adaptation of voluntary immigrants to life in Slovakia

Dr. Daniele Markovic 1 1. Catholic University in Ružomberok

Objectives The paper aims to recognize selected aspects of adaptation of voluntary immigrants to life in Slovakia. We focus on experience from the ﬁrst six months of their stay. We are interested in the best and worst experience they have had in a new country, and what has changed in those six months. We also examine their connection to the country of origin - what they lack from it and what contacts they keep with their natives.

Materials and Methods We have chosen a qualitative research strategy. Research design is a biographical design and grounded theory. As a research tool, we chose an individual structured interview (In-Depth Interview). For qualitative data analysis, we set descriptive and inductive codes, subcategories and categories. The subject of research is nine voluntary immigrants to Slovakia who live in Slovakia for at least one year at the time of research. Thus, they meet the long-term migration criterion. Participants were selected on a deliberate basis to cover the phenomenon of voluntary migration. These immigrants came for school, work, business, partner, family. Due to the chosen research design, theoretical sampling is the case.

Results Thanks to communication apps, participants had frequent contact with loved ones from the country of origin (daily or weekly), similar to how local people have contact with relatives in their own country. The best experiences of immigrants are in the social ﬁeld and for participants from less developed countries also with infrastructure. Very strong socialization and acculturation phenomenon is the use of the Slovak language.

Conclusions Our ﬁndings are in line with Sonn (2002), who says the adaptation of social and support systems are central to the settlement process and provides the context for the experience of belonging and identiﬁcation. Within Bronfenbrenner’s Ecological Systems Theory, the process of participant adaptation takes place at the level of microsystems and mesosystems.

176 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Social factors as the catalyst of emigration

Dr. Maruta Pranka 1, Ms. Ginta Elksne 2, Dr. Ilze Koroļeva 3

1. Rīga Stradiņš University; Institute of Philosophy and Sociology, University of Latvia, 2. Doctoral Study Programme “Sociology”, Rīga Stradiņš University; Institute of Philosophy and Sociology, University of Latvia, 3. Institute of Philosophy and Sociology, University of Latvia

Objectives The objectives of the paper are to analyze how the reasons of emigration are connected with a person’s sense of belonging and loyalty to the country of origin and the ties within the social network and the local community. Keywords: social support, well-being, emigration, community.

Materials and Methods In order to achieve the study’s goals, the qualitative study methodology is used based on biographical approach in social sciences considering personal experience as an important resource in the study of social life as well as in the analysis of the interaction in community. Quantitative data from emigrants’ survey are used in the paper as well.

Results This study is based on 25 life story interviews with expatriates who emigrated to Sweden after the restoration of Latvia independence in 1991. Thematic analysis of life stories as theoretical approach as well the data form emigrants’ survey are used for sociological study. This information reveals the social factors inﬂuencing the motivation to emigrate.

Conclusions The social factors inﬂuencing the well-being of families with children are of a great importance similarly to economic factors in decision making to emigrate. Biographical interviews and survey data reveal that poor social support (instrumental, ﬁnancial, informative, emotional) both in community as well as in closest social network, problems with access to services (education, health) and risk of social exclusion are the reasons that motivate emigration. The social support is closely connected with social integration. Access to social support, possibilities to use different kinds of it is essential factor of individual well-being, lack of social support could facilitate social exclusion and isolation. The researche is funded by the Latvian Council of Science: Project “Narrative Perspectives on Intergenerational Transmission of Memory”, project No. lzp-2018/1-0458 and “Exploring Well-Being and Social Integration in the Context of Liquid Migration: A Longitudinal Approach”, project No.Izp.-2018 - 0042.

177 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The mental health of the elderly population throughout the COVID-19 pandemic in Latvia: the role of social and support networks

Dr. Ilze Koroleva 1, Mrs. Sigita Sniķere 1, Mr. Aleksandrs Aleksandrovs 1, Dr. Ieva Reine 2, Dr. Andrejs Ivanovs 2, Mrs. Ilona Gehtmane-Hofmane 3

1. Institute of Philosophy and Sociology, University of Latvia, 2. Statistics Unit, Rīga Stradiņš University, 3. Institute of Public Health, Rīga Stradiņš University

Objectives Ageing is often accompanied by a decreased frequency and range of social contacts, and an increase in loneliness. During the Covid-19 pandemic, the social distancing requirement also reduced the social contacts of the elderly and their limited opportunities to receive social support. The aim of the study is to assess the role of social contacts and support in the changes in psycho-emotional states of the elderly.

Materials and Methods The analysis is based on Latvian data derived from The Survey of Health, Ageing and Retirement in Europe (SHARE)Wave 8 (n=1207), SHARE Covid-19 questionnaire. Indices of social isolation were constructed based on the self-reported measurements of social contacts, mutual support and assistance. Logistic regression models were calculated with dependent variables deﬁned as experienced socio-emotional disturbances to identify the impact of social isolation on mental health during the crisis.

Results Among respondents aged 50+, almost a one-ﬁfth have felt the impact of the Covid-19 crisis on their mental health. A signiﬁcantly higher proportion of those who have experienced problems in the past are single people and those vulnerable to social isolation: three times more people had experienced anxiety in the past month, twice as many people had experienced sadness, anxiety, and sleep disorders were present in 44% of this group.

Conclusions Reduced social contacts and limited availability of social support in times of crisis can become a factor in increased social exclusion and mental health deterioration. Therefore it is important to continue providing social support and assistance during the Covid-19 pandemic, involving volunteers to reduce loneliness among the elderly, as well as isolation and the associated deterioration of their mental health, and to implement strategic communication at the national level to reduce anxiety among seniors. VPP-COVID-2020/1-0011 “Impact of COVID-19 on health care system and public health in Latvia; ways in preparing health sector for future epidemics”.

178 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The process of implementation of children’s rights in healthcare system: challenges and future perspectives

Dr. Karīna Palkova 1 1. Rīga Stradiņš University

Objectives The aim of the research is to study national as well as international legislation that regulates legal relations of minor patients and medical practitioners, as well to identify the challenges and future perspectives of the implementation of children’s rights in healthcare system.

Materials and Methods The legal analysis will be made taking into account national, international laws, regulations, court decisions etc. The concept of a specific children’s rights in healthcare system applying the systemic analysis of already existing concepts of fundamental rights will be provided. General scientific methods such as synthesis, modelling, com-parative method and deductive method, methods of interpretation of legal norms ‒ grammatical, teleological, historical will be used. Theoretical base of the study is constituted by contemporary foreign scientific works. As well as there will be analyzed some authors, scientists who have provided global contribution to the devel-opment of contemporary medical law, including the relations of the children’s and medical practitioners.

Results Legal relations of minor patients and medical practitioners are regulated both at international and national level. Nevertheless, the practical implementation has some gaps. It is not clear jet how to implement in practical situation special principles of minor patients in healthcare ﬁeld. Unclear and incomplete legal framework and lack of case law make the situation more complicated. but, it is clear that medical practitioners must be informed enough about the children’s or minor patients as a new and speciﬁc legal subject rights.

Conclusions The main principles, fundamental human rights are closely connected with children’s as minor patients’ rights and must be implemented as specific and unique principles in healthcare. The principle of ensuring the best interests of the child must be given priority upon implementing different activities, oriented towards minor patients. Minor patients rights must be clarified clearly and understandable especially on national level. as specific rights.

179 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The relations between the elderly parents and adult children during the Covid-19 pandemic

Mrs. Romaniia Silinsh 1, Prof. Nadiia Khopta 1, Mr. Stepan Khopta 2, Ms. Anna Martyniuk 2, Mrs. Ella Mintsys 2

1. Ivano-Frankivsk National Medical University, 2. Vasyl Stefanyk Precarpathian National University

Objectives This research is dedicated to the inﬂuence of pandemic on the relations between elderly parents and adult children and its impact on the level of social welfare in Ukraine and Latvia. There is nothing more valuable than strong health, human life, social welfare, but today’s world are faced only with the illusion of safety. That’s why in this external instability, the internal one should be maintained. Keywords:Covid-19 pandemic, the level of social welfare, the moral quality of society, social distancing.

Materials and Methods Data from State Statistics Service of Ukraine. Analytical and comparative methods.

Results Due to the research methods, the study revealed that society are not ready to face with the real threatens and challenges caused by Covid-19 pandemic. Social distancing are leading to the alienation between people, even close people. The fear of getting infected caused the situation, when adult children had forgotten their sacred duty to take care about their elderly parents. We can observe the negative tendency of social apathy, indifference and growing poverty among the populations of both countries.

Conclusions The research proves that great attention should be paid to moral and ﬁnancial support of population, especially elderly people, must be developed and increased the level of spirituality and morality of society in order to unite it in the ﬁght against the Covid-19.

180 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The Safe School – community framework of multidisciplinary support, protection and social inclusion of children with fetal alcohol spectrum disorders

Mr. Dominik Očko 1, Dr. Oľga Okáľová 1, Prof. Marketa Rusnakova 1 1. Faculty of Education, Catholic University in Ružomberok

Objectives Children with fetal alcohol spectrum disorders (FASD) have a wide range of developmental disorders, especially behavioral or learning diﬃculties and also it‘s often a combination of these problems. Clinical standards of aftercare in the symptomatology of FASD for the individual are not speciﬁed in the Slovak Republic. We need to identify an effective multidisciplinary intervention in the care of the children with FASD. The aim of the poster is to present the project of Dr. Okáľová, called “The Safe School” and its community framework of multidisciplinary support. It contains of six parts: 1. audit of inclusive processes; 2. the multidisciplinary team; 3. creation of support plans; 4. school crisis management; 5. Long-term life training skills; and 6. community path of healthy development.

Materials and Methods ”The Safe School“ framework integrates theoretical approaches of the positive psychology, dialogical and collaborative practices, social constructivism, solution focused approach and community planning. It builds protective factors in communities. Eﬃciency framework is measured through action research of the change management. Inclusive principles of cooperation, social innovation, multidisciplinarity, support and partnership help acquire skills in the care of children with the FASD for school support team experts and community case managers.

Results “The Safe School” is implemented in the 11 schools in Slovakia. Schools verify in their practice the connection and usefulness of the concept in the context of protective factors in FASD symptomatology.

Conclusions We can separate the problem from the child, looking for uniqueness and strengths, we connect community resources and teams. We constantly audit the school prevention system, eliminate risk factors in FASD and create an environment resilience. We coordinate and advisoryly accompany the interdisciplinary and multidisciplinary support.

181 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The social work practice with vulnerable families, young people and disabled children during the COVID-19 pandemic in Latvia

Ms. Anna Broka 1, Ms. Hanna Mihailova 2

1. Department of Welfare and Social Work, Rīga Stradiņš University, 2. HESPI, Vidzeme University of Applied Sciences

Objectives The objective is to provide knowledge about the complexity of social work practice with vulnerable families, young people and disabled children during the Covid-19 pandemics in Latvia.

Materials and Methods The context of the Covid-19 pandemics was based on systematic literature review, social policy analysis and secondary data analysis. The evidence about social work practice was obtained from the qualitative open-ended interviews (n=70) and online survey with social service providers (n=443) in Latvia (conducted in Jul - Sept 2020 in the “Life with Covid-19” VPP-COVID-2020/1-0013). The content analysis was applied in order to identify the most common themes and categories.

Results During the period from 2013-2018, and upwards the social services and social work practice with families and children has developed and can be characterized as rather expansive. During the Covid-19 beside rather proactive policy measures mitigating primary health care impacts, social services and social work practice were shifted in between social, education and health care policy sectors. Availability of crucial social services for the vulnerable families, young people and disabled children were affected by three main conditions: (1) dis-tance learning, (2) flexible work environment, and (3) unemployment. The crucial shortages were identified in supportive measures in case of domestic family violence (social rehabilitation), youth and young parents (family counseling) and families with disabled children. Poor technological equipment, closed day care centres and insufficient psychological (online) help as well as individual family assistance were the main issues that did not allow to fulfill individual social rehabilitation plans in the same scope.

Conclusions Coping strategies of vulnerable groups were supported with diversified and individual flexible social work practice dominating by material support measures. Children, young parents and youth were mentioned as an important cross-sectoral target group in need for specific social services. Collaboration among authorities and partners shall be strengthened in social work practice.

182 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Transition from pediatric to adult epilepsy care: patients’ experiences of learning how to manage with epilepsy

Mrs. Jurgita Tuitaite 1, Dr. Polina Šedienė 2 1. Vytautas Magnus University, 2. Lithuanian University of Health Sciences

Objectives The purpose of this study was to explore patient’s experiences of learning how to manage with epilepsy during the transition process.

Materials and Methods A qualitative methodology, constructivist grounded theory, Charmaz version guided this study. Data collected in semi-structured interviews with 10 adults.

Results Results showed that independent individual doctor-patient communication starts in the adult epilepsy care. Family members taking care of child and protects of risk, but transition to adult care is uncertain. Pa- tient - doctor communication differences between pediatric and adult epilepsy demands assistants during the transition.

Conclusions Patients feel uncomfortable of a lack of knowledge about process of transition in adult epilepsy care. Family members feel fear and responsibility of their child and restrict self -independence of their child. Knowledge about epilepsy, reconciliation depends on patient and doctor connection.

183 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Violence against children in a close environment: situation in Lithuania

Mr. Domas Sikorskis 1, Mrs. Olga Mesceriakova-Veliuliene 2, Mrs. Jurgita Vladickiene 3, Ms. Migle Jakineviciute 1 1. Master’s Study Programme “Medicine”, Lithuanian University of Health Sciences, 2. Doctoral Study Programme “Public

Health”, Lithuanian University of Health Sciences, 3. Department of Health Management, Faculty of Public Health, Lithuanian University of Health Sciences

Objectives The aim of the study is to evaluate the situation on the violence against children in a close environment in Lithuania in 2018.

Materials and Methods The data about the violence against children in a close social environment was obtained from the Ministry of Social Security and Labour, Lithuania. The study is based on data from 2018. The statistical signiﬁcance was deﬁned as P<0.05.

Results The data revealed that 3343 children allegedly experienced violence in a close social environment and that comprised 68.8% of all the cases of violence against children. In total, 90.3% of victims of close environment violence suffered from parents or adoptive parents. The boys (52.7%) were more likely to have experienced violence than the girls (47.3%). Mostly, the children experienced psychological abuse (70.3%), least frequently – sexual abuse (1.2%). Gender was a predictor of psychological abuse, where the prevalence of psychological abuse among boys was higher (71.5%) compared to girls, while girls had a greater physical (17.5%) abuse, sexual abuse (2.1%), and neglect (11.3%). Most children have experienced violence being aged 10 to 14 years (29.6%), 20.7% – aged 4 years, and 16.6% – aged 4 to 6 years.

Conclusions Although the statistics of Ministry of Social Security and Labour show that 3343 children allegedly experienced violence in a close social environment in Lithuania, the real proportion of violence is likely higher. The reason for that might be the diﬃculty of recognition of violence, especially psychological abuse and tolerance of violence in population. It is expected that proper measures against violence will help to recognize and reduce the tolerance of it in society and thus will help to eliminate the causes of violent behavior.

184 Social Work Transformations During Covid-19 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Crisis management in the provision of social services during the COVID-19 pandemic

Mrs. Anna Višķere 1, Prof. Lolita Vilka 1, Prof. Liana Deklava 1, Ms. Ilze Trapenciere 1 1. Rīga Stradiņš University

Objectives To assess the crisis management process during the Covid-19 pandemic and to analyse inter-institutional cooperation in order to ensure the access to social services.

Materials and Methods Analysis of normative regulations, analyses of international good practice examples, semi-structured interviews, statistical data analyses.

Results After the start of the pandemic on March 12, 2020, the government introduced series of restrictions and introduced new normative acts. Crises management structures were set up in municipalities to provide all kinds of social services to the population, and targeted services to most vulnerable population (seniors, poor, disad- vantaged, persons with mental disabilities, etc.). Access to social services was mainly remoted and through voluntary support, particularly in rural areas. The format of the inter-institutional cooperation changed from the direct communication to the remote communication, therefore the provision and use of technical solutions was very important.

Conclusions 1. The crisis management process was most focused on the governmental and local authorities and organisations, and less on NGOs, despite the fact that NGOs were among the most important providers of social services in the country. 2. Although the type of the provision of the social services changed, for one part of the clients the delivery of services was not interrupted. Certain services were interrupted and were not available (for example, services of day centres, group classes, etc.) due to strict constraints of the Covid-19 pandemic. 3. The crisis management organisation was more successful and effective in those municipalities where civil protection commissions or specially designated coordinators have been in operation since the beginning of the pandemic. 4. In order to improve the effectiveness of cross-institutional cooperation and to protect population from infection, it was essential to ensure timely end effective use of vertical and horizontal information channels for internal institutional communication, and to achieve a mutually consistent ﬂow of topical information between institutions.

186 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Differentiation of social services as part of transformative social work practice during COVID-19

Ms. Anna Broka 1 1. Department of Welfare and Social Work, Rīga Stradiņš University

Objectives To analyse the transformation of social work arena in the context of Neoliberal policies during Covid-19 pandemic.

Materials and Methods The analysis consists of secondary resources (systematic literature review, document and policy analysis, data sources) and primary open-ended interviews data (n=90) (conducted from Jul- Sept2020) in the research project “Life with Covid-19” VPP-COVID-2020/1-0013).

Results The context of Neo-liberalism have affected the provision of social work services by different actors (state, municipality, NGOs, private and individual initiatives) in Europe and Latvia. Differentiation of social services mit- igated unequal distribution of social services available for the most vulnerable groups (families with disabled children, persons with intellectual disabilities, persons experiencing domestic violence etc.). The critical and most crucial social services were enlightened during the Covid-19 pandemics, e.g., social rehabilitation for persons with intellectual disabilities, young parents, disabled children, persons experiencing domestic violence etc. Main results demonstrate that existing coordination and management of social services were provided during highly uncertain and stressed working environment. Contrary, the adaptability and ﬂexibility encouraged social workers to bring forward alternative social work models in close collaborative institutional settings.

Conclusions The Covid-19 pandemics demonstrate the mobilization of social work profession on different levels. On the one hand, the neoliberalism and differentiation of social services has resulted in unequal and less controlled distribution of services. On the other, during the Covid-19 social work profession demonstrate rather active and responsive social work being able to adjust to the social complexity and individual needs. The alternative social work models include more horizontal cross-sectoral institutional collaboration inside and outside public sector, more active inclusion of NGOs and individual initiatives in family counselling, peer support, group empowerment, psychosocial rehabilitation services etc. The performance of social work profession is affected by the macro-level contextual ongoing Neo-liberal reform processed both in education, health and welfare.

187 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Loneliness of seniors in long-term care institutions and COVID-19 restrictions

Dr. Liga Rasnaca 1, Dr. Mareks Niklass 1, Ms. Dace Lina 1

1. University of Latvia

Objectives The ageing of society is one of the most significant social and economic challenges in the 21st century Europe where the proportion of seniors continues to rise. In 2019, more than one fifth of the EU-27 population was aged 65 and over. The ageing problem will become more severe in the coming decades. The share of those aged 65 years or above is projected to increase to 31% by 2100 (EU-27). Furthermore, the share of those aged 80 years or above will increase from 6% in 2018 to 15% in 2100. The aim of the article is to analyze the feeling of loneliness among seniors in long-term care institutions and how COVID-19 restrictions influence the social isolation of seniors. The feeling of loneliness is a especially exacerbated among older people.

Materials and Methods The study employs the mixed methods approach: a survey using the UCLA Loneliness Scale and semi-structured interviews with social workers in long-term care institutions during the ﬁrst wave of COVID-19 in the spring of 2020. The scale is designed to measure the subjective sense of loneliness as well as the perception of social isolation.

Results The qualitative interviews reveal inﬂuencing factors what causes loneliness to seniors in a long-term social care institution. They also indicate how social workers can reduce seniors’ sense of loneliness and social isolation caused by COVID-19 restrictions. The results show that a signiﬁcant number of seniors in long-term care experience loneliness or social isolation.

Conclusions Daily routine as well premises in long-term care institutions to some extent limit the social worker’s ability to reduce the loneliness of seniors, especially in the conditions of pandemic constraints. Loneliness is closely linked to the deﬁcit of social relations. Chronic loneliness occurs when a person is unable to establish social communication links with someone for an extended period of time.

188 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Medical and social work at the time of world pandemic

Ms. Katerina Vitanova 1 1. Medical University “Prof. Dr. Paraskev Stoyanov” – Varna

Objectives The social and medical service are facing some of the most challenging times providing urgent social care during this period of the Coronavirus crisis. The means to resolve this problem at hand are: preparing the medical staff psychologically and emotionally to tackle the imminent work, stocking the hospitals with all the required supplements and equipment. It is essential that everyone, comply with all the preventative, anti-epidemic measures in order to protect their own health and the patients’.

Materials and Methods Attached are regulatory documents analysis, survey methodology and correlational analysis. A survey was devised to assess the opinion of medical and social specialists, and students’.

Results After the new coronavirus pandemic outbreak, all the organisations of medical experts and their affiliations around the world began to encourage their members and colleagues to observe the necessary preventative measures in order to protect themselves and the communities they work with. In addition to the practical measures relating to precautionary hygiene routines, they point out the essentiality of designing measures to safeguard against psychological problems such as stress, depression, caused by family conflicts, deprivation of access to certain basics, restricted freedom. Despite all the challenges such as lack of workforce, insufficient equipment, poor preventative measures, and deficient consumables, the health practitioners are managing to tackle the current situation. Among the challenges shared by the surveyed specialists are difficulties in the restriction of careless movement and activities, lack of personal touch when dealing with patients, the worklife balance and juggle of parental and employee responsibilities.

Conclusions The isolation has a negative impact on people’s mental health. Additionally to the adversity of tackling the situation, the matter of whether the specialists will preserve their mental health and whether the lack of enough understanding of the virus will hinder in the prevention of child and employee infections has come to light.

189 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Social support provided by non-governmental organisations during COVID-19

Mrs. Marika Lotko 1

1. Rīga Stradiņš University

Objectives COVID-19 brought about social, economic and political change in the world. Social problems such as unemployment, substance abuse and poverty faced by members of society called for immediate intervention. The research was conducted with the aim to study the social support provided by NGOs in the conditions of COVID-19, when the ﬁrst state of emergency was declared in Latvia from March 12 to June 9 2020, which included a series of restrictions affecting various sectors.

Materials and Methods During the research, 10 semi-structured interviews were conducted with non-governmental organisations that have acquired the status of an association or foundation and initiatives that implement social goals. The interviewed organisations provide a number of social services: day care centre, group apartment, specialised workshops, crisis centre, HIV prevention and psychosocial services for drug users, provide the operation of creative centres, diverse assistance for people in diﬃculty, as well as provide activities to reduce loneliness, which has been reinforced by the conditions created by COVID-19.

Results The data obtained in the interviews have been grouped in several thematic blocks: access to information, supply and use of protective equipment, cooperation with other institutions, remote work, work with clients on-site and remotely, good practice and innovations, recommendations.

Conclusions The organisation of the work of the institutions during the state of emergency varied depending on the specific nature of the target group and the support provided. The staff of the institutions continued to work both on-site and, as far as possible, remotely. Client understanding of the risks posed by COVID-19 and their cooperation in the use of protective equipment were influenced by objective circumstances. Targeted support measures had to be provided both for clients to address their social problems and for social workers to avoid burn-out. New social services had to be developed when new target groups that need support were identified.

190 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Social support for balancing the situation of high-risk families during the COVID-19 pandemic

Mrs. Sigita Pulkstene-Bērtiņa 1, Ms. Ilze Trapenciere 1, Prof. Lolita Vilka 1, Ms. Anna Broka 1 1. Rīga Stradiņš University

Objectives To assess the material and psycho-emotional situation of high-risk families during the Covid-19 pandemic, to analyse whether and how the restriction affected the social needs of high-risk families.

Materials and Methods Semi-structured interviews, survey, statistical data analyses, client’s case analyses, focus group discussions.

Results The requests for material, ﬁnancial and psycho-emotional assistance from high-risk families had increased during the pandemic. Social distancing is one of the reasons. Research data prove that the number of calls to the “crisis telephone” increased. Data analyses demonstrate that number of calls increased in those municipalities where the preventive action of the inter-professional cooperation team was coordinated to prevent family conﬂicts and the risks of violence.

New services from the family assistants have been requested by high-risk families – to provide training on the use of remoted learning for pupils, and literacy skills on information technology for parents. Time planning through family work, training and leisure still remains an indispensable component of social support in stabil- ising the situation of the high-risk families. Data comparison on the experience of the “ﬁrst wave” of the pandemic in spring 2020 and the “second wave” in autumn 2020, demonstrate that that social services have better technical equipment, they have good practice experience on the work organization in critical situations with high-risk families.

Conclusions 1. The financial and pyschoemotional situation of high-risk families has worsened during the Covid-19 pandemic. Inter-professional cooperation team has been a significant measure to prevent risks of violence. In the municipalities with non-increasing number of telephone calls the increased number of high-risk conflicts were not detected. 2. In some cases of psycho-emotional stress preventive measures had been interpreted and perceived as control mechanisms. 3. In high-risk families, the remote learning has led to the responsibility transfer from schools to social services. 4. Family assistance services was a good practice example in working with high-risk families.

191 Digital Health Solutions For Rehabilitation RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Technologies for healthy and active ageing

Dr. Signe Tomsone 1, Mr. Ilona Zariņa 2, Mr. Aleksandrs Grjadovojs 3 1. Department of Rehabilitation, Rīga Stradiņš University, 2. Rīga Stradiņš University, 3. Faculty of Rehabilitation, Rīga Stradiņš University

Objectives The project GenerationTech was initiated by group of researchers from Lund University (Sweden) in order to address ageing and technologies use, related to health, from a generational perspective. Within the project Gen- erationTech technologies were viewed from a broad perspective, that is, technologies for everyday life, vehicles, computers and smart phones as well as medical technologies and assistive technologies (e.g. wheelchairs and walkers), medical measures and welfare technologies (e.g. safety alarms and security cameras). In order to validate the data gathered in Sweden and compare the ﬁndings, several international focus groups (The World Café method) took place in Germany, Italy and Latvia (autumn, 2019). The aim was to explore perceptions of and attitudes to, as well as needs and wishes of technologies, and usage among people of different generations (age 30-39, 50-59 and 70-79) as related to the technological developments they have experienced during their lifetime and how they are associated with active and healthy ageing.

Materials and Methods Participants were 12 women and 2 men, aged 30-79 years. Focus group discussions was guided by The World cafe methodology. The discussions were recorded as well as notes were taken and content analysis was performed.

Results Participants noted that generational differences exist in use of different technologies and older persons usually need assistance and guidance to learn new technologies which are developing fast. Important positive aspect of information and communication technologies is that they helps to decrease feeling of loneliness and bore- dom among older people, also everyday technologies are important as they can save time for more important activities. Besides, aspects of technologies user friendliness, security, privacy and environmental accessibility were emphasized.

Conclusions The use of technologies can signiﬁcantly increase the independence of older adults and support daily lives but they often need adequate support to develop their competences in technologies use.

193 Innovations In Rehabilitation Service RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Effect of pilates method on the motion functionality of shoulder complex for sedentary workers

Ms. Kristiana Jansone 1, Mx. Anita Gauruča 1, Dr. Una Veseta 1 1. Rīga Stradiņš University

Objectives The purpose of this study is to investigate and analyse whether exercise in the shoulder complex can be improved by exercising according to the Pilates method. The study hypothesizes that it is possible to improve the shoulder complex movement functionality for sedentary workers by using the Pilates method during group exercise classes.

Materials and Methods The study included a total of 16 participants, divided into two groups – a training group and a control group. 9 persons were included in the training group and 7 persons in the control group. In order to collect general information about the individuals and to determine whether they could be included in the study as subjects, individuals completed a questionnaire. Participants were subjected to a Fitness Screening Test to determine the motion functionality and movement pattern of their shoulder complex and other body segments. In the follow-up study, the training group was divided into two groups which exercised twice a week for a total of 16 classes using 3 different training programs under the guidance of a trainer. After completing the training programs, all participants were subjected to the Fitness Screening Test again and answered one question from the questionnaire.

Results The research ﬁndings support the hypothesis that it is possible to improve the shoulder complex movement functionality for sedentary workers by using the Pilates method during group exercise classes. Repeated Fitness Screening Test results show improvement in all test positions relating to the shoulder complex in the training group.

Conclusions The results of the study show that economically available group exercise classes can improve the functionality of the shoulder complex.

195 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Interventions used in acute rehabilitation for patients with neuro-oncological disease: scoping review

Mrs. Agnese Kārkliņa 1, Mrs. Anete Petersone 1, Dr. Guna Bērziņa 1 1. Rīga Stradiņš University; Riga East Clinical University Hospital

Objectives To identify evidence for interventions used in acute rehabilitation for patients with neuro-oncological disease.

Materials and Methods Design – scoping review. A comprehensive search was carried out in the period from December 2019 to Febru- ary 2020 using Pubmed, Science Direct, EBSCO Medline and PEDro, search terms included brain cancer, brain tumor, acute rehabilitation, rehabilitation. The search was performed based on PRISMA guidelines. The studies were selected based on inclusion (randomized controlled studies, cross-sectional studies, qualitative studies, systematic reviews, situation descriptions; studies describing patients with brain tumors; population over 18 years of age; articles published in English; articles published during the last 22 years (from January 1998 to January 2020) and exclusion (studies with animals or children; literature reviews; research protocols; articles for which a full text version is not available; conference posters; articles that do not mention rehabilitation) criteria. The level of evidence of each intervention was determined.

Results Out of 1144 identiﬁed articles 43 publications were included in the report. In total 108 interventions were iden- tiﬁed, 38 of them were unique interventions. These interventions were occupational therapy and daily activity training, cognitive training, physiotherapy, speech language therapy, comprehensive inpatient rehabilitation, resistance exercises, endurance training. 4 interventions were evidence level I, 11 interventions were evidence level II, 19 evidence level III and 4 interventions with evidence level IV.

Conclusions The interventions identiﬁed in the report are in line with those found in global guidelines for neuro-oncological patients. There is evidence in scientiﬁc literature of 38 interventions that can be used by various rehabilitation professionals in the acute rehabilitation of neuro-oncological patients. However, most of these interventions are evidence level II and III.

196 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Mindful-based dance movement therapy for depression and anxiety reduction for chronic back pain patients

Mrs. Indra Majore-Dūšele 1, Prof. Vicky (Vassiliki) Karkou 2, Prof. Inga Millere 3 1. Department of Health Psychology and Paedagogy, Rīga Stradiņš University, 2. Research Centre for Arts and Wellbeing, Faculty of Health and Social Care, Faculty of Arts and Sciences, Edge Hill University, 3. Rīga Stradiņš University; Riga East Clinical University Hospital

Objectives Psychological approaches and body-mind therapies are recognized as important contributors to chronic pain patient’s multidisciplinary rehabilitation. The Mindfulness based Dance movement therapy (MBDMT) intervention is a purposefully organized therapeutic process where, through the use of creative activities, the development of mindfulness skills, the relationship between body and mind is explored and self-regulation is targetted. The objective of the study - assess the primary outcome results of the MBDMT intervention for chronic back pain patients. It also asked the question: Does MBDMT short-term intervention reduces pain, depression and anxiety for chronic back pain patients.

Materials and Methods 38 participants (n=38) were randomly assigned to experimental (n=16) or waiting list control group (n=22), age 25-61 years old. Inclusion criteria were: chronic back pain longer then 3 months; anxiety and/or depression >5 points. The experimental group received 10 sessions of MBDMT twice a week, while the control group continued their rehabilitation plan as usual (TAU). Instruments included: Pain Numeric Rating Scale – NRS,Jensen, Karoly, & Braver, 1986; Patient Health questionnaire (PHQ-9, Kroenke & Spitzer, 2002) and General Anxiety Disorder scale (GAD-7, Spitzer et al., 2006). These were used at baseline, post-intervention and follow up (12 weeks after the intervention).

Results There was statistically signiﬁcant reduction of pain intensity and depression scores in favor of MBDMT group at post-intervention measures, but no signiﬁcant changes in anxiety scores. The follow-up scores will also be presented.

Conclusions The results may be closely linked with the length of the intervention and the break of Covid-19 and limited to the small sample size. They do however, suggest for the need for a powered Randomised Controlled Trial (RCT) that can offer more conclusive results.

197 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Mindful-based dance movement therapy for emotion regulation skills development on patients with chronic low back pain

Mrs. Madara Valberga-Porozova 1, Mrs. Indra Majore-Dūšele 1, Prof. Inga Millere 1 1. Rīga Stradiņš University; Riga East Clinical University Hospital

Objectives Chronic low back pain (CLBP) is a global problem with implementations for mindful–based methods in rehabilitation improving emotion regulation skills (ERS) and decreasing pain. Mindful–Based Dance Movement Therapy (MBDMT) is a therapeutic intervention developed to improve mindfulness, self – regulation and adaptive ERS. Objective: to determine if MBDMT improves ERS and helps to decrease pain in patients with CLBP. Following questions are: do MBDMT in a group setting helps to improve ERS and to decrease pain in patients with CLBP in short term? Is there a correlation between ERS and pain in patients with CLBP?

Materials and Methods A randomized controlled trial was done. Thirty four patients were randomly assigned to experimental (n = 13, received MBDMT twice a week, 10x) and control (n = 21, didn’t receive MBDMT) groups, aged 25 – 61. Inclu- sion criteria: low back pain intensity at least 1 (NRS) more than 3 months; age 25 – 65 years; ERSQ-27 total < 4; diagnosed with: low back pain; spondylosis; lumbosacral intervertebral disc disorders. Exclusion criteria: acute or subacute pain; cancer; trauma of central nervous system; pregnancy; dance-movement therapy con- traindications. Instruments: Emotion - Regulation Skills Questionnaire - ERSQ-27, Berking & Znoj, 2008; Pain Numeric Rating Scale – NRS,Jensen, Karoly, & Braver, 1986. For both groups ERS where measured before and after MBDMT, pain - twice a week.

Results Findings showed improvement of ERS in experimental group, compared to control (U = 55,00, p = 0,003), decrease in pain for experimental group (p = 0,048) and a correlation between ERSQ-27 scale “tolerance” with pain intensity (rs = 0,697, p = 0,021).

Conclusions There are tendencies for MBDMT to improve ERS and to decrease pain intensity and there exists a correlation between emotion tolerance and pain intensity for patients with CLBP, but there is a need for future research with more signiﬁcant results.

198 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Mindfulness-based dance movement therapy for fear-avoidance beliefs reduction in patients with chronic musculoskeletal pain

Mrs. Darja Krizska-Popova 1, Mrs. Indra Majore-Dūšele 1 1. Department of Health Psychology and Paedagogy, Rīga Stradiņš University

Objectives The objectives of this study are to identify: - whether there are statistically signiﬁcant changes of fear-avoidance beliefs and body awareness scores after the short-term Mindfulness-based dance movement therapy (MBDMT intervention group in patients with chronic musculoskeletal pain. -whether there are clinically signiﬁcant changes or the of fear-avoidance beliefs and body awareness after the short-term ABDKT in the intervention group. - if there is a correlation between the scores of body awareness and fear-avoidance beliefs.

Materials and Methods 33 participants (n=33) with chronic musculoskeletal pain were randomized into a MBDMT group (n=16) and a waiting list control group (n=17), aged 25-59. The MBDMT group was offered 10 sessions twice a week, for a 5- week period. Data were collected before and after the intervention. Fear-Avoidance beliefs and body awareness were measured by Modiﬁed Fear-Avoidance Beliefs Questionnaire (mFABQ) and Multidimensional Assessment of Interoception Awareness Version 2 (MAIA-2) at baseline, before the group allocation, and after the intervention.

Results The research results identified statistically significant changes in body awareness scores in favor of the MB- DMT group and no statistically significant changes in fear-avoidance beliefs between the groups, as well as no statistically significant changes between the pre-and post-intervention data of the MBDMT and control group. Clinically significant changes at least in one mFABQ or MAIA-2 subscales were observed in 50% of the MBDMT group. A very weak negative correlation between body awareness total scores and the physical activities and work subscale of the mFABQ scores was observed in MBDMT group.

Conclusions The results suggest that MBDMT as a short-time intervention can increase body awareness in patients with chronic musculoskeletal pain, but additional research is needed to explore its eﬃcacy on fear-avoidance reduction in this patient group.

199 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Motivation of Rīga Stradiņš University students to choose the study course “Nordic Walking” during COVID-19

Prof. Irena Upeniece 1, Ms. Indra Vīnberga 1, Ms. Lāsma Reide 1, Dr. Una Veseta 1 1. Rīga Stradiņš University

Objectives To ﬁnd out the motivation of Riga Stradiņš University students to choose the study course “Nordic Walking” during Covid-19.

Materials and Methods The method of qualitative research was used in the study, and the interview was used as a research tool. Re- specting the conditions of physical distance set by the emergency, all interviews were conducted remotely - written interviews, in the period from November 30 to December 9, 2020. According to the interview protocol, twenty-three students in total out of thirty-four (20-38 years old) from Riga Stradiņš University who had chosen the study course “Nordic Walking” during Covid-19 were interviewed. During the interviews, students’ opinions, reasons and inﬂuencing factors for choosing the study course “Nordic walking” during Covid-19 were clariﬁed. The obtained data (answers) were submitted electronically, summarized, analyzed and compared according to the method of content analysis.

Results The research data show that students for choosing study course as most important aspect mention “self and professional development”. The motivation to choose the study course “Nordic walking” in this (Covid-19) semester coincides with the answers to the ‘control question’ regarding the expectation from the study course “Nordic walking”. The same categories are visible - “to learn the technique of Nordic walking in practice and gain theoretical knowledge”, as well as “to spend time actively in the fresh air”. It is important to note that the changes observed in physical and psycho-emotional well-being during COVID-19 are in contrast to the categories after Nordic walking. The answers provided show “improved mood”, “positive emotions”, “good self-feeling”, “energy”, “peace” and “motivation”.

Conclusions The motivation of Riga Stradins University students to choose the study course “Nordic Walking” during Covid- 19 show that physical movement generally improves not only physical, but also psycho-emotional well-being, thus supporting the importance of physical activity in maintaining and improving both physical and mental health.

200 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Physical capacities and performance for rehabilitation specialists wearing protective clothing during the COVID-19 pandemic

Mrs. Darta Balcuna 1, Mr. Rudolfs Ceseiko 1, Dr. Jeļena Reste 2, Mrs. Darja Kaluznaja 2, Prof. Ivars Vanadzins 2, Prof. Inga Dāboliņa 3, Mrs. Liene Silina 4, Mrs. Eva Lapkovska 4, Mrs. Laura Kalnina 1, Mrs. Agnese Simsone 1, Prof. Aivars Vetra 1 1. Department of Rehabilitation, Rīga Stradiņš University, 2. Institute of Occupational Safety and Environmental Health, Rīga Stradiņš University, 3. Research Laboratory of Ergonomics Electrical Technologies, Institute of Industrial Electronics and Electrical Engineering, Faculty of Electrical and Environmental Engineering, Riga Technical University, 4. Institute of Design Technology, Faculty of Materials Science and Applied Chemistry, Riga Technical University

Objectives The current study aimed to measure to what extent protective clothing affects energy consumption, thermoregulation and whether it affects the level of comfort during different functional positions.

Materials and Methods Nine physical therapists (mean age 30 ±3 years) participated in the study and were tested twice (ﬁrstly, wearing sportswear and, secondly, wearing protective clothing) on the incremental treadmill at three different submax- imal intensities, also digital infrared thermography was applied to measure skin surface temperature. Addi- tionally, the level of comfort while performing ﬁve functional positions was determined.

Results Work economy increased significantly by 10% (P=0.001) using protective clothing compared to sportswear. In more demanding exertion participants wearing protective clothing exhibited an increase in oxygen uptake by 11% (P<0.001), heart rate increased by 6% (P<0.001), respiratory exchange ratio by 3% (P=0.001), and minute ventilation by 10% (P=0.002). A significant increase of skin surface temperature was observed after an incremental test in protective clothing (P=0.011). The level of comfort was significantly lower in all five functional positions with participants wearing protective clothing (P<0.001).

Conclusions Protective clothing can signiﬁcantly affect a therapist’s physical capacities during different intensity tasks. Per- forming functional activities in protective clothing rather than in daily uniform is less comfortable, affects body thermoregulation and likely can cause restrictions in physical performance and quality of work.

201 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Specialized rehabilitation program for patients with pulmonary hypertension: the experience, prerequisites and the barriers of implementing this service

Ms. Eglė Palevičiūtė 1, Ms. Lina Gumbiene 2, Ms. Elena Jueviciene 3, Ms. Toma Simbelyte 1, Ms. Ieva Lauceviciene 4, Mr. Aleksandras Laucevicius 1, Ms. Jurate Barysiene 1, Ms. Christina Eichstaedt 5, Ms. Nicola Benjamin 5, Mr. Ekkehard Gruenig 5, Ms. Jelena Celutkiene 1 1. Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 2. Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University; Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, ERN-LUNG, 3. Competence Centre of Pulmonary Hypertension, Vilnius University Hospital Santaros Klinikos, ERN-LUNG; Centre of Pulmonology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 4. Department of Rehabilitation, Physical and Sports Medicine, Vilnius University, 5. Centre for Pulmonary Hypertension, Thoraxklinik Heidelberg gGmbH at Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL)

Objectives Pulmonary hypertension (PH) is a severe progressive disease, associated with reduced exercise capacity and poor quality of life. Although scientiﬁc evidence supports the incorporation of specialized training in the treatment of PH, it is only available in a few countries.

Materials and Methods We aim to share our experience of implementing a specialized PH rehabilitation program, to summarize the barriers and prerequisites for launching this service, and to assess its early effect. We retrospectively analyzed our pathway in organizing this program, by singling out essential steps.

Results The preparation phase took about 14 months. Establishing and running of a PH rehabilitation program required dedicated rehabilitation specialists to join the multidisciplinary PH expert team. Team members needed to gain special knowledge on exercise training in severely compromised patients, thus, supervision and education by experienced consultants was crucial. The main eligibility criteria for patients were stable status, optimal medical treatment and motivation to undergo the training. The ﬁrst results evaluating the effect of a specialized PH training program in nine patients are promising. Over the period of 15 weeks, seven of them improved in functional capacity parameters - the 6 minute walking distance and peak oxygen consumption, reached on cardiopulmonary exercise test.

Conclusions Despite a number of challenges and barriers, the implementation of a specialized rehabilitation program should be encouraged in a few dedicated PH expert center(s) per country, who are capable to fulﬁll all prerequisites and organizational aspects. Local PH experts, supervision by an experienced center, in-patient rehabilitation facilities, dedicated personnel, equipment and patient’s motivation are essential.

202 Nursing RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Establishing healthy habits in children of less than three years of age – a challenge for parents

Mrs. Diana Grozdeva 1, Mrs. Katya Eguruze 1

1. Department of Nursing Care, Faculty of Public Health, Medical University – Varna

Objectives Objective of the presented study is to examine parents’ abilities to build healthy habits in children under three years of age.

Materials and Methods A direct anonymous questionnaire was conducted among parents of children less than three years of age regarding the development of healthy habits. The study covers 774 children (51,5%) who attended nurseries in Varna in July 2020. The data were statistically processed via a variation, comparative and correlation analyses.

Results More than half of parents (59,0%) share that they encounter diﬃculties in forming healthy habits in their children, and in 81,3% of cases this is due to the child resisting learning the habit. Parents report that the basic information about establishing healthy habits in children is obtained from the GP, the nurse in the nursery, and the internet. An overwhelming part of participants (92,0%) believe that both family and nursery have a vital role when creating habits in children, while 8,0% point towards the family only. Approximately a quarter of responders express the need for additional information related to establishing healthy habits in their children, and those are the parents who have informed themselves from a single source only.

Conclusions The results show that parents are well informed of the healthy habits of their young child but keep encountering diﬃculties in establishing them. The foundations of a healthy lifestyle are laid within the family environment but there is also a need for the continuation of this process in nurseries with the aid of the nurse – that collaboration is of signiﬁcant importance.

204 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Ethical and legal norms regulating the right to information and informed consent of patients related to the nurse’s activities

Prof. Anna Georgieva 1, Ms. Stanislava Mavrodinova 1

1. Medical University “Prof. Dr. Paraskev Stoyanov” – Varna

Objectives Today, the nurse profession is signiﬁcant and covers a large perimeter of general medical activity. In turn, this leads to increased responsibility in professional decision-making, requiring an increase in professional conduct standards and useful knowledge and compliance with ethical rules and requirements of legal norms regarding patients’ rights. Оbjective was to examine the relationship between the ethical and legal rules governing patients’ rights and, in particular, those governing the right to information and informed consent of patients related to the nurse’s activities. Keywords: ethical norms, nurse, patients, legal norms, right to information, right to informed consent

Materials and Methods Analysis of literary sources and documentary method are applied. A comparative analysis of the ethical and legal norms governing the right to information and informed consent of patients related to the nurse’s activities has been carried out. The survey was conducted between January and February 2014.

Results As a result, the analysis found that the ethical norms in the Code of Ethics of nurses, midwives, and associated healthcare professionals in the Republic of Bulgaria acquire a burden of legal standards, the binding force of which is strengthened by the demand for administrative and criminal responsibility in the Law on the professional organization of nurses, midwives, and associated medical professionals.

Conclusions Knowledge and compliance with the ethical and legal norms governing the right to information and informed consent of patients are a guarantee of the ethical and lawful exercise of the nursing profession and high quality of healthcare.

205 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Examining the state of practice readiness in three Canadian undergraduate nursing programs

Dr. Louela Manankil-Rankin 1, Dr. Baiba Zarins 1 1. Nipissing University

Objectives 1. Attendees gain understanding of graduating nursing student “readiness to practice” indicators. 2. Attendees explore the relationship between practice readiness and risk assessment profile subscales. 3. Attendees will partake in discussion of factors which may impact graduate perceptions of practice readiness and longitudinal risk profile assessment reflecting resilience after entry into the healthcare profession.

Materials and Methods Practice readiness is ill-defined in the literature (Mirza, Manankil-Rankin, Prentice, Hagerman, Draenos, 2019), therefore practice readiness inquiries continue despite enhancements to nursing education (Wolff, Regan, Pesut & Black, 2010). Current conceptualization of defining practice readiness highlights a reality where relevant phenomenon concepts seem invisible to current understandings (Mirza et al., 2019). Research goals aim to inform future curricula and provide stakeholders with perspectives on how students across three University nursing programs perceive themselves as practice ready. Exploring practice readiness and its relationship within identified constructs over time contributes to sustainable program evaluation. A descriptive longitudinal mixed methods research design examined practice readiness, self-efficacy, resilience, compassion, and leadership metrics. 250 participants per program ensured a stable co-variance structure (Bollen, 1989). Data was collected during the last semester, six months, and 18 months. The survey tool includes: Casey-Fink Readiness for Practice Survey (2011); Perceived Practice Readiness Scale (Hemsworth & Manankil- Rankin, 2019); General Self Efficacy (GSE) scale (Schwarzer & Jerusalem, 1995); CD-RISC 10 (Resilience) Scale (Connor & Davidson, 2003); ProQol 5 (Compassion satisfaction/Fatigue) Scale (Stamm, 2010) and Leadership Survey (RNAO, 2014). Descriptive statistics and ANOVA were utilized for comparative purposes. Structural equation modeling measured relationships across constructs (Norman & Streiner, 2000).

Results Initial data will present ﬁnding within beliefs, compassion fatigue and patient load assignment subscales.

Conclusions Presentation data ﬁndings support continued research for curricular and program development. Findings have potential to extend the current concept deﬁning practice readiness. Longitudinal results support intersectoral collaboration to promote transition to sustained career employment.

206 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Lack of nurses and nosocomial infections in Slovakia

Dr. Lukas Kober 1, Mr. Vladimir Siska 2 1. Faculty of Health, Catholic University in Ružomberok, 2. Faculty of Medicine, University of Ostrava

Objectives The lack of nurses and the restructuring of hospitals leads to a legitimate increase in concerns that these negative factors will have a signiﬁcant impact on patients. There are many scientiﬁc studies that show a direct link between the shortage of nursing staff and the increase in nosocomial infections associated with the provision of health care. The aim was to evaluate the knowledge and practical skills of nurses related to the prevention of nosocomial infections in Slovakia.

Materials and Methods In order to achieve the goals and verify the hypotheses, we conducted a questionnaire survey. The ﬁrst part consists of demographic data, which represents 5 items. The second part focuses on the theoretical knowledge of the respondents (16 items) and the third part on the practical skills of the respondents, which represents 25 items.

Results From the results we can state that the knowledge of the nurses as well as the acquired skills are suﬃcient. Respondents consider the reason for the spread of nosocomial infections to be the violation of rules aimed at controlling infections, the negligence of healthcare professionals and the routine performance of activities, or the lack of work protective equipment and personnel. However, most respondents gave a negative assessment of hospital measures to prevent and control infections. Defective infection control teams, failure to report all infections, and inadequate hospital preparation for any infection.

Conclusions The ongoing Covid19 pandemic has signiﬁcantly demonstrated the problems of health systems. Medical facilities were not prepared, both in terms of personnel and material. The shortage of professionals has proved to be the greatest threat in the situations we are experiencing today. However, healthcare professionals are able to adapt quickly to changing conditions. The lack of nurses results in mistakes, leads to damage to the health of the patient, medical staff and their families.

207 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Motor activity of nursing students in the conditions of the COVID-19 pandemic

Ms. Nikoleta Popova 1, Prof. Anna Georgieva 1, Ms. Vasilena Digalovska 1 1. Medical University “Prof. Dr. Paraskev Stoyanov” – Varna

Objectives The COVID-19 pandemic has changed all areas of human life and activity. Along with the threat to human life and health caused by the COVID-19 infection itself, there have been a number of lifestyle changes associated with health risk factors, one of which is inactivity. Our objective is to study the opinion of nursing students about their motor activity in the conditions of the COVID-19 pandemic.

Materials and Methods In our report we have applied analysis of literary sources and a survey (direct anonymous group survey). The opinion of 60 nursing students of second, third and fourth year at the Medical University – Varna was studied. The study was conducted in August 2020.- January 2021. Graphical analysis was used to visualize the observed processes and phenomena. To create the graphs we used Microsoft Oﬃce.

Results A signiﬁcant proportion of nursing students conﬁrm that the COVID-19 pandemic has affected their motor activity. More than half of the study participants shared they had been less active compared to the time before the pandemic began. The search for alternatives for movement and sports among students is hampered by a number of factors related to the changes in the organization of life and educational activities associated with measures to stop the pandemic.

Conclusions The results of this study prove that the COVID-19 pandemic has had an impact on the lifestyle of the nursing students- most of them have reduced their motor activity. The data highlights the need to ﬁnd alternatives and strategies to reduce the inactivity.

208 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Participation of nurses in laparoscopic and robotic surgery in the Republic of Bulgaria – personal research

Mrs. Milena Nankova 1 1. Medical Nursing Board, Department of Health Care, Faculty of Public Health, Medical University “Prof. Dr. Paraskev Stoyanov” – Varna

Objectives The purpose of the summary is to present summarized data from nine hospitals in the Republic of Bulgaria on the participation of nurses in laparoscopic and robotic surgery. Respondents to a structured interview were physicians (surgeons and residents), head and senior nurses. Surgical and theatre nurses were included in the study via an anonymous poll.

Materials and Methods Instruments and methods: Sociological method - structured interview (n = 122) and direct anonymous poll (n = 214).

Results 1. According to the empirical study, in minimally invasive surgery, are currently working nurses aged 22 to 67 years, with work experience from 1 year to 44 years. 2. The education of the nurses included in the study varies in degree, most of them with Higher education - specialist “Nurse” (n = 69). 3. Only 6% of surgical nurses indicate that they have acquired a specialty after Basic education. Almost half of the theatre nurses, 47%, confirm that they have a specialty in “Surgery and dressing equipment”. 4. Although an active participant in the multidisciplinary team of minimally invasive surgery, the surgical nurse is still listed, in the highest percentage, as assisting or performing. 5. According to the respondents, the necessary qualities of the nurses who work in minimally invasive surgery are, first of all, the professional qualities and secondly the organizational ones. 6. A positive attitude towards the introduction of algorithms and checklists into work in laparoscopic and robotic surgery has been established. 7. The respondent nurses are prepared to participate in postgraduate training and specialization. 8. The application of the rules of fast track surgery by the nurses is confirmed.

Conclusions Laparoscopic and robotic surgery opens up opportunities for nurses to work in a multidisciplinary team, with new technologies and gives opportunities for development as specialists both in the present and in the future.

209 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Support of activity of seniors in institutional facilities

Mrs. Mária Novysedláková 1

1. Department of Nursing, Faculty of Health, Catholic University in Ružomberok

Objectives Physical disability is the greatest threat of addiction in the elderly and is associated with an increased incidence of chronic diseases depressive states and increased need for hospitalization. Implementation of nursing rehabilitation in institutional care has a positive effect on the overall health of the senior and prevents complications. The main aim of the paper is to interpret the results of research which was focused on the support of seniors’ physical activity and self- suﬃciency and also point out the positive effect of rehabilitation in hospitalized se-niors. Keywords: Activity. Self-suﬃciency. Nursing rehabilitation. Senior

Materials and Methods The main research method was a non-standardized questionnaire focused on the support of mobility and self- sufficiency. The complementary method was observation and Activity Daily Living (ADL) test. The research group consisted of nurses. The total number was 226, of which 57.1% of nurses worked in social care facilities and 42.9% in health care facilities. The average length of nursing practice was 18.82 years. The average number of immobile clients was 50.44 ± 26.62% in institutional facilities. To compare the differences in the frequency of interventions in the field of mobility, self-sufficiency between devices, we used the methods of inductive statistics - Student’s t-test, significance level p <0.05.

Results Passive exercises and active exercises were the most common mobility interventions. The nurses paid the least attention to nursing rehabilitation ( 2.67) and the implementation of rehabilitation together with a physiotherapist ( 2.81). We found that health care facilities more often educated seniors about the need of exercise (average 2.13) than social facilities (average 2.87) - P-value 0.000.

Conclusions The research results pointed to shortcomings in teamwork and the frequency of implementation of some interventions. Physical therapy and general activation of elderly must be implemented regularly but in cooperation with other team members.

210 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

The nurses’ experience of infection control in their practice

Ms. Diana Platace 1, Dr. Velga Sudraba 1, Prof. Inga Millere 2 1. Rīga Stradiņš University, 2. Rīga Stradiņš University; Riga East Clinical University Hospital

Objectives Infection control is an integral part of nurses’ daily work. The experience of nurses shows the importance of infection control and reﬂects the strong and weak points of infection control in patient care. The aim is to explore the nurses’ experience of infection control in their practice.

Materials and Methods The study results were acquired by qualitative study method: structured interview (n=7), where a structured interview plan with open questions, designed and approved by the author was used. The interview with nurses was realized in a separate room, outside the person’s working hours and took on average 35 minutes.

Results It was found that there are many factors that affect work of nurses, such as social, material, psychologically and organizational. All interviewed nurses confirmed that infection control had improved over time. According to the nurses’ opinion, the most common reasons why nurses followed the rules of the infection control were responsibility, safety of patients and nurses and quality patient care. In interviews the nurses reflected that sometimes were felt angry, dislike and resistance during infection control. As well as nurses reported about the lack of knowledge and understanding on the significance of the infection control, an increased workload, lack of effective collaboration with professionals of infection control, on the other side there was new patient care documentation and chance sharing in nurses’ experience and knowledge in social networks for professionals.

Conclusions The study shows that strong points of infection control in nurses’ experience are new documentation in patient care and communication in social networks with professionals. There are also weak points of infection control such as an increased workload, lack of effective collaboration with professionals of infection control, lack of awareness of infection control eﬃciency and practical training of young colleagues.

211 Midwifery RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Expectancies and reality gap about the hospital accommodation and orders among patients in Maternity Hospital

Mrs. Ilze Ansule 1, Prof. Inga Millere 2, Prof. Anda Ķīvīte-Urtāne 3 1. Rīga Stradiņš University, 2. Rīga Stradiņš University; Riga East Clinical University Hospital, 3. Department of Public Health and Epidemiology, Rīga Stradiņš University

Objectives Gather the women’s, who are living with and without HIV experience about intranatal and postnatal health care in the last childbirth.

Materials and Methods There was conducted a pilot study in process of creating of the PhD thesis research “Quality of perinatal health care and it‘s inﬂuencing factors for patients who are living with HIV in Latvia” carried out in Maternity hospital postpartum unit, using the structured questionnaire. There were interviewed 50 patients,12 of them were women living with HIV. The questionnaire is meant for woman regardless of their health status during the perinatal period or co-morbidities outside this period of care.

Results In the questionnaires comment section there were identiﬁed ﬁve main theme blocks. One of them, which will be described further, was women‘s expectancies and reality gap about the hospital accommodation and orders. Regardless of HIV status women at the postpartum period had concerns about different kind of information from the medical personal in their antenatal care about hospital, where women planned to go for childbirth, accommodations and orders. They noted that they had not received clear information beforehand on the rules and procedures in both the maternity ward and the postnatal ward. Women also noted that some of unexpected rules made them feel frustrated and disturbed to feel joy about their childbirth process and newborn. For example, rule what forbids to leave labor unit during childbirth.

Conclusions Regardless of the HIV status, all women during the antenatal health care period are seeking for clear information about rules and event order in their expectant births and postpartum period at the Maternity home. At the moment there is a reality gap between received information and reality at hospital.

213 Comprehending Death And Dying At The Time of Covid-19 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

“Good death” – the circumstances in which it would be best for a person to die. The representative survey of Latvian population

Mrs. Diāna Kalniņa 1 1. Rīga Stradiņš University

Objectives The paper summarizes and analyses the opinions of Latvian residents about the desired / best conditions in which to die. The obtained answers are analyzed in different demographic groups, as well as in connection with other respondents’ perceptions and values.

Materials and Methods National representative survey of permanent residents of Latvia aged 18-75 in October 2020, N=1012.

Results The results of the study show that the possibility of dying in pain and suffering is a major concern for the majority of Latvian society, and a large percentage of people would like to leave their lives in sleep or sudden death. The results of the study also show people’s desire to be in their homes at the time of death, to die in the presence of relatives. The survey shows a statistically signiﬁcant relationship between people’s perceptions of the desired/best conditions in which to die: “good death” and a range of demographic and social factors. Early (1-6 years of age) signiﬁcant/memorable contact with death correlates with someone’s own desire to die without pain and suffering or sleep. Elderly people are expressed in a desire to be in the presence of relatives at the time of death or to die in sudden death. Maintaining control over what is happening at the time of death is more important for people with higher education and those who have been socially active in life; etc.

Conclusions The data of the study carried out provide new information on people’s perceptions of death, highlighting differences in different socio-demographic groups.

215 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Actual and preferred places of death and forms of burial in Latvia: ﬁndings from the 2020 social survey

Dr. Agita Misane 1, Dr. Ritma Rungule 1, Dr. Silva Senkane 1 1. Faculty of Communication, Rīga Stradiņš University

Objectives The annual statistical data on mortality (total numbers, demographics and causes of death) in Latvia are collected by the Central Statistical Bureau.Surveys generally collect data about the living. The objective of this paper is to demonstrate how survey data can complement regular statistics and provide a more nuanced picture of how Latvians would prefer to die and be buried vs how this currently happens.

Materials and Methods The data were gathered through a survey applying stratiﬁed randomized sampling of Latvian adult population (N=1012, aged 18 -75, collected by the public opinion research centre SKDS in October 2020). The questionnaire was designed by the authors. Part of the questionnaire concerned the circumstances of the respondents’ latest encounters with death in the family or among close friends. N=841 valid sample were obtained.

Results Majority of the respondents’ loved ones had died in institutions (hospitals, retirement or nursing homes) – 46,9% total. 44,5% had died at their own or relatives’ homes, and 8,6% - elsewhere (at workplace, due to accidents e.a.).The most common source of support for those dying at home was their family and friends (45,8%). 29,2% of the families received consultations from their family doctor and 20,5% received specialized medical consultations. 11,5% were aided by neighbours, and 17,7% had not received any help. The most common form of burial is interment in the ground (92,8%), only 7,2% of the deceased were cremated, mostly in Riga. However, a bigger number of respondents would prefer cremation for their own funeral – 23,8%; 62,7% would prefer interment.

Conclusions There is an observable discrepancy between the preferable and real circumstances of death and same applies to the forms of burial.

216 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Construction of meaning in discourses of death in Latvian society

Mrs. Ilva Skulte 1, Mr. Normunds Kozlovs 1 1. Rīga Stradiņš University

Objectives Death is often conceived as natural and material, and expressing essential relationships between (conscious) human being and his/her body. However, the meaning of death is constructed in the discourse that is based on relationships in any area of the social. The discourse of death can be described as a process of sense-making, as enculturation and / or domestication of death where death is becoming articulated in a contingent way. (Car- pentier, Van Brussel, 2012). In our paper we would like to analyse the construction of meaning of death in the discourses of contemporary Latvian society in areas as different as subcultural street art of stencils, parliamentary debates and media during COVID-19 pandemic. Our objective is to provide insight on differences and similarities in three types of discourse trying to ﬁnd out basic meaning(s) of death and attitudes toward death it provokes. Carpentier, N, Van Brussel, L. On the contingency of death: a discourse-theoretical perspective on the construction of death. Critical Discourse Studies 9.2 (2012): 99-115.

Materials and Methods Materials include collection street stencils of Riga, selection of expressions containing (all forms of) the words “death” and “die” from parliamentary corpus of Latvian Saeima and selection of articles of Latvian internet news portals from March to December, 2020. The method of analysis is discourse analysis (including multimodal discourse analysis for stencil analysis).

Results Results are driven separately from all three materials of analysis and compared.

Conclusions Preliminary conclusions show that death is understood in a material way as a biological cease or (ex)termination of life, but also as the end (of everything). The notion of death often appears in metaphorical sense as well as in phraseological units. The texts analysed (especially, in stencils and parliamentary corpus) often refer to col- lective death (mankind, nature, nation). The texts in media are rather tended to hold to rationalistic discourse.

217 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Latvian version of the DAPR-R – translation and validation of a multidimensional measurement of attitudes toward death

Dr. Silva Senkane 1, Dr. Ritma Rungule 2 1. Rīga Stradiņš University, 2. Faculty of Communication, Rīga Stradiņš University

Objectives To establish and promote death and dying studies (thanatology) as a transdisciplinary field of academic inquiry in Latvia, also contributing to broader comparative studies in this field, demands to develop the Methodology of thanatology studies in Latvian. The Death Attitude Profile- Revised (DAP-R) captures attitudes towards dying and death has been translated and tested in several countries. This study reports the translation of the Death Attitudes Profile-Revised (DAP-R) into Latvian (DAP-LVR) using a crosscultural adaption process methodology and its psychometric assessment.

Materials and Methods The DAP-R was translated following guidelines for crosscultural adaption through language triangulation (En- glish, German, Russian). The data were gathered in 2020 via stratified randomized sampling of Latvian adult population (N=1012, aged 18 -75). The measure of the DAP-R consists of 32 items, which are assigned to 5 dimensions (Fear of Death, Death Avoidance, Neutral Acceptance, Approach Acceptance, Escape Acceptance). The internal consistency of the DAP-LVR Scales was assessed with Cronbach’s alpha coefficients. Split-half reliability was estimated using Spearman-Brown coefficients. Content validity was assessed by means of exploratory factor analysis (EFA). All statistical analyses were performed using IBM SPSS Statistics 26.

Results The items showed Internal consistency of the ﬁve subscales ranged from .653 (Neutral Acceptance) to .922 (Ap- proach Acceptance). Split-half reliability was good, with a Spearman-Brown-coeﬃcient of .834. The results of EFA slightly diverged from the original scale.

Conclusions Our results suggest overall good reliability of the Latvian version of the DAP-R. The DAP-LVR promises to be a robust instrument to establish normative data on death attitudes for use in Latvia.

218 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Life-review activities applied in the music therapy-based end-of-life care programs: literature review

Ms. Jana Duhovska 1 1. Rīga Stradiņš University

Objectives To explore the incidence, aims, contents, and protocol of the life-review activities applied in the music therapy- based end-of-life care programs.

Materials and Methods Electronic search of the literature related to application of music therapy in end-of-life care in PubMed, EBSCO, The Cochrane Library, Science Direct, ProQuest Dissertations & Theses Global, PsycARTICLES and Academic Search was carried out. Out of the totalling nearly 100 articles examining the application of music therapy in end-of-life care programs, the literature review includes information from 17 sources identiﬁed as the most relevant to carry out the objective.

Results Research reveals that life-review is one of the most used music therapy activity in end-of-life care programs and is mostly utilized to decrease the psychological and existential distress of terminally ill patients, allowing them to gain a retrospective sense of acceptance and meaning of their lives. In terms of the contents, activities can be sectioned into four groups - such as musical biography, songwriting, musical improvisation, and musical journey. As from research, life-review activities are mostly applied in one-to-one sessions with music therapist, however – participation of patient’s caregivers, family, and sometimes - staff – is not uncommon.

Conclusions Life-review is one of the most used music therapy activities in end-of-life care programs, utilized in various forms to decrease the psychological and existential distress of terminally ill patients.

219 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Public attitudes toward assisted dying in Latvia

Mr. Ivars Neiders 1, Dr. Silva Senkane 1 1. Rīga Stradiņš University

Objectives Assisted dying (euthanasia and physician assisted suicide (PAS)) has been an important topic of controversy in Latvia. However, so far there have not been any study of public attitudes on this issue. Therefore, the main objective of this study is to ﬁll this gap.

Materials and Methods The paper presents the data gathered via stratiﬁed randomized sampling of Latvian adult population (N=1012, age 18 - 75). The survey was conducted by the public opinion research center SKDS from 09.10.2020 till 20.10.2020. Related-Samples Friedman’s Two-Way Analysis of Variance by Ranks with Pairwise Comparisons shows statistically signiﬁcant differences (p<0.05) between distributions of different attitudes. All statistical analyses are performed with IBM SPSS Statistics 26.

Results Our data shows that public attitudes to different practices of assisted dying varies. In general, majority of respondents (59%) agree, that it might be the case, that person’s condition might get so bad, that death is preferable to life (20.8% disagree, 19.4% are neutral). Further, 56.5% of respondents agree that euthanasia is acceptable if patient’s condition is lethal (25% disagree, 18.5% are neutral). However, if patient’s condition is not lethal, then only 26.4% of respondents agree that euthanasia is acceptable. If patient’s condition is lethal, but the patient is a teen (aged from 12 to18), then 30.3% of respondents agree that euthanasia is acceptable, 45% of respondents disagree and 24.4% are neutral. Under the same conditions, if the patient is an infant, then 36.9% of respondents agree that euthanasia is acceptable, 37.6% of respondents disagree and 25.5% are neutral. Somewhat surprisingly only 38.4% of respondents agree, that PAS is acceptable if patient’s condition is lethal. 37.1% of respondents disagree and 24.6% are neutral.

Conclusions Our data shows that majority of respondents think that euthanasia is acceptable provided that a patient is an adult in lethal condition.

220 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Suicide in general practitioner’s narratives in Latvia

Mrs. Edite Pauna 1

1. Doctoral Study Programme “Sociology”, Researcher in LCS project “Memento Mori”, Rīga Stradiņš University

Objectives This study aims to understand the suicide narrative and its changes in social and professional habitats in the general physicians’ (GPs) practice. The primary care plays an important role in recognizing the suicide ideation and preventing of suicide, since many patients have been seeing their GPs approximately a month prior to the suicide.

The main goal of this research is to understand the GPs’ individual perception of suicide in general, not on specific patient cases. The questions are constructed around the World Health Organization reference guidelines on suicide ideations’ recognition and prevention. Specifically, the interviews aim at collecting field data providing answers to what extent GPs follow the guidelines in their proactive involvement and taking proactive measures for patients’ wellbeing. Additionally, GPs personal insights on the subject of suicide are also analyzed.

Materials and Methods In total 10 in-depth, semi-structured face to face interviews were conducted with GPs from all region in Latvia, using a snowballing approach. The interviews were recorded, transcribed verbatim, and the interview notes were analyzed, using a thematic approach.

Results All GPs have recognized suicide as a serious national mental health issue, and their individual perception on suicide varies according to the personal experience, patients previous history with addictions and/or mental health issues. GPs attitude varies from patient to patient, which may inﬂuence the way they communicate with their patients. In some cases GPs blamed the persons who committed suicide because of the suicide bereave- ment on relatives.

Conclusions GPs in Latvia are the ﬁrst responders to patients’ mental health issues, and their attitude determines the provided care and interest in patients ongoing health issues. Given the inﬂuence of global pandemic on people’s mental health, the GPs narrative on suicide call for more attention and needs to be revisited with a focus on the actions taken in order to prevent suicides.

221 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Authors Index

Aavik, A. 92 Batyrgareieva, V. 163 Abolkalna, L. 129 Baumanis, T. 97 Abu Meri, H. 48 Bebrisa-Fedotova, L. 37 Afolabi, B. 2 Behmane, D. 21, 83, 84, 94, 97, 159, 169 Agyemang, Y. 62 Benjamin, N. 202 Akmane, E. 138 Benova, L. 2 Akūlova, L. 130 Bertule, D. 36 Aleksandrovs, A. 178 Bezborodovs, N. 45 Aleksejeva, E. 36, 54 Bitēna, D. 137 Blackaby, S. 81 Blankaitė, R. 46 Borisova, S. 100 Aleksejeva, J. 31 Briedite, I. 4, 6, 18, 25 Aleksejeva, J. (Rīga Stradiņš University, Faculty of124 Brinkmane, A. 17 Briģis, Ģ. 9, 74, 96 Broch, V. 81 Broka, A. 182, 187 Almasiova, A. 153 Amado Cordeiro, S. 138 Broka, A. 191 Andersone, B. 57 Bukova-Zideluna, A. 30 Andriuškevičiūtė, D. 65 Bulmanis, O. 48 Andzane, E. 98 Bundzena-Ervika, A. 136, 146 Aniscenko, A. 37 Butkevičienė, R. 85 Ansule, I. 213 Bērziņa, G. 89, 196 Apine, M. 34 Apsite, A. 174 Araja, D. 86 Caltabiano, R. 122 Asare, L. 96 Cannizzaro, E. 113 Asefa, A. 2 Castorina, S. 122 Astrom, D. 131 Celutkiene, J. 202 Auce, A. 123 Ceseiko, R. 201 Audet, C. 2 Chlebanova, L. 161 Ausekle, S. 124 Cibule, L. 169 Aušraitė, M. 141 Cirule, L. 159 Avotiņš, A. 9, 21 Cīrule, J. 109

Balcuna, D. 201 Dadeliene, R. 33 Baltane, Z. 60 Daniuliene, I. 33 Baltmane, D. 5, 13 Daniļenko, J. 47, 49 Bardauskienė, R. 154 Danuseviciene, L. 85 Barysiene, J. 202 Darģis, R. 11 Barzdins, J. 98 Daugule, I. 28

222 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Deklava, L. 32, 186 Grope, I. 80 Delvaux, T. 2 Grozdeva, D. 204 Digalovska, V. 208 Gruenig, E. 202 Dinsberga, J. 12 Grīnberga, D. 38 Djatkovičs, A. 53, 75 Grīnfelde, E. 51, 52 Dobelniece, S. 170 Gudzinskiene, V. 64, 162 Duhovska, J. 219 Gumbiene, L. 202 Dzivite-Krisane, I. 76 Gustainienė, L. 117

Hartsenko, J. 69 Dzērve, Z. 48 Heinonen, K. 166 Dāboliņa, I. 201 Hlinková, S. 8 Dūdele, A. 21, 83, 84, 94, 96, 97, 159, 169 Huysmans, E. 2 Eensalu-Lind, A. 7 Indermitte, E. 131 Eglīte, M. 109 Indriksone-Gromova, I. 28 Eguruze, K. 204 Indriliunaite, R. 63 Eha, K. 144 Isajeva, L. 74 Eichstaedt, C. 202 Isakova, J. 54 Ekweogu, U. 62 Ivanovs, A. (Rīga Stradiņš University) 3, 5, 35, 70, 178 El Ayadi, A. 2 Elksne, G. 177 Elunurm, S. 105 Jakineviciute, M. 66

Gaidule-Logina, D. 54 Gailīte, L. 54 Jakineviciute, M. 46, 184 Galkus, L. 42 Jansone, K. 195 Galle, A. 2 Jueviciene, E. 202 Gardovska, D. 103 Jurkevica, I. 28 Gauruča, A. 195 Jurkuvienė, R. 85 Gavare, I. 77 Järvis, M. (Tallinn University of Technology) 106 Gavars, D. 56 Järvis, M. 69 Gehtmane-Hofmane, I. 178 Genevičiūtė-Janonė, G. 117 Georgieva, A. 205, 208 Gobiņa, I. 9, 21, 34, 38, 40, 44, 111 Kalediene, R. 62, 66, 67 Goetz, O. 81, 99 Kalinina, A. 163 Gorel, I. 103 Kalkis, H. 115 Grantiņa, I. 54 Kalnberza Ribule, Z. 32 Grasis, J. 26 Kalnina, L. 201 Gravele, D. 54, 103 Kalniņa, D. (Rīga Stradiņš University) 215 Graviņa, M. 4, 6, 25 Kaluznaja, D. 121, 126, 131, 201 Grike, I. 80 Kalve, I. 109 Grincaitė, M. 42 Kantāne, I. 6, 16, 25 Grinfelde, I. 29, 60 Karklina, K. 88 Griskevica, I. 134 Karkou, V. 197 Grjadovojs, A. 193 Kaļinkina, G. 95 Groma, V. (Institute of Anatomy and Anthropology, Kessler, Z. (Salem State University) 173 Rīga Stradiņš University) 72 Kessler, Z. (University of Dundee) 172

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Ketners, K. 79 Laucevicius, A. 202 Khopta, N. 180 Lazdāne, G. 4, 6, 14, 16, 18, 23, 25 Khopta, S. 180 Ledda, C. (Department of Clinical and 122 Kipāne, A. 19 Klauza, G. 169 Klavina, A. 123, 132 Ledina, I. 60 Klavina-Makrecka, S. 38 Leja, M. 28 Knystautas, S. 65 Lejnieks, A. 48, 84 Kober, L. 207 Lember, M. 105 Kodinceva, A. 14 Lempu, K. 7 Kohutova, K. 153 Leonavicius, V. 68 Kojalo, I. 28 Lepiksone, J. 94, 96 Kojalo, U. 9, 44 Liepa, J. 29 Kolesnikova, J. 15, 136, 143, 148 Liinamo, A. 41 Kolmane, A. 138 Lina, D. 188 Komarovska, L. 123, 129, 130 Linde, A. 114, 116 Kontus, S. 69 Liniņa, I. 40 Koroleva, I. 178 Littva, V. 8 Koroļeva, I. 177 Logina, I. 31, 32 Kovalčikienė, K. 117 Lombardo, C. 122 Kozlovs, N. 217 Lopatina, T. 103 Kreile, M. (Clinic of Medical Genetics and Prenatal29 Loreto, C. 122 Lotko, M. 165, 190 Lubi, K. (Tallinn Health Care College) 7, 55, 92, 144 Lubi, K. (Tallinn Health Care College; Rīga Stradiņš101 University) Kreile, M. (Rīga Stradiņš University; Children’s 54 Clinical University Hospital) Lāce, A. 142 Krieke, Z. 138 Krisane, A. Madaki, Z. 62 76 Krishnavarapu, N. Majore-Dūšele, I. (Department of Health 197, 199 37 Krizska-Popova, D. Psychology and Paedagogy, Rīga Stradiņš 199 Králová, A. University) 8 Kuldkepp, K. Majore-Dūšele, I. (Rīga Stradiņš University; Riga198 105 Kurapkaitiene, N. East Clinical University Hospital) 162 Maldupa, I. 17 Kursīte, M. 10, 20, 21 Malniece, I. 60 Kuzmina, K. 23 Manankil-Rankin, L. 206 Kuznecoviene, J. 156 Markovic, D. 154, 176 Kuļigina, N. 170 Martinsone, K. 15, 135, 136, 143, 146, 148, 150 Kvitko, G. 62 Martinsone, Ž. 126, 127, 130, 131 Kārkliņa, A. 89, 196 Martyniuk, A. 180 Kļaviņa, A. 37 Matinheikki-Kokko, K. 41 Kļaviņa, L. 174 Matisane, L. 111, 114, 116, 129 Lakiša, S. 111 Mavrodinova, S. 205 Lapina, S. 76 Meija, L. 16 Lapkovska, E. 201 Merisalu, E. 119, 120 Lauceviciene, I. 202 Merits, M. 92

224 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.” Management, Faculty of Public Health, Lithuanian University of Health Sciences) Mesceriakova-Veliuliene, O. (Department of 46,Health 184 Očko, D. 181

Paegle, L. 114, 116, 123, 127 Paiča, I. 143, 150

Mesceriakova-Veliuliene, O. (Doctoral Study62, 65–67 Palevičiūtė, E. 202 Palkova, K. 26, 179 Paršutins, S. 28

Mets-Oja, S. 55, 144 Pauna, E. 221 Metsoja, E. 144 Pavlovska, I. 123 Mezale, D. 44 Pavlovska, J. 88 Mežals, M. 31 Pavāre, J. (Rīga Stradiņš University; Children’s 174 Clinical University Hospital) Mežmale, L. 48 Pavāre, J. (Rīga Stradiņš university; Children’s 24 Miezitis, A. 34 Clinical University Hospital) Mihailova, D. (Rīga Stradiņš University) 4, 25 Perepjolkina, V. (Department15, 135, of136, Sociology 143, 146, and 148, 150 Mihailova, H. 182 Mihailova, S. 148 Mikelsone, M. 5, 35, 70 Millere, A. 32 Perepjolkina, V. (Rīga Stradiņš University) 151 Millere, I. 32, 197, 198, 211, 213 Perera, S. 175 Mintsys, E. 180 Petersone, A. 89, 196 Misane, A. 216 Petrauskiene, A. 160 Miskova, A. (Rīga Stradiņš University) 57 Petrovska, S. 49 Mičule, I. 29 Petrošina, E. 14, 23 Moors, M. 158 Pfeifer, K. 126 Māliņa, J. 48 Pildava, S. 9, 94 Mārtinsone, K. 138 Pipere, A. 140 Mārtiņsone, I. 129, 130, 132 Pires, I. 128 Mūrmane, D. 29 Pitkēviča, I. (Institute of Public Health, Rīga 6 Stradiņš University) Nankova, M. 209 Pitkēviča, I. (Rīga Stradiņš University) 4, 16, 25 Naumovs, V. 72 Pivoriene, J. 167 Neiders, I. 220 Platace, D. 211 Niklass, M. 188 Poplavska, E. 88 Nikolajenkovs, V. 103 Popova, N. 208 Nikulshin, S. 76, 103 Porozovs, J. 37 Novysedláková, M. 210 Pozdniakovas, A. 64 Nulle, A. 32 Poļaka, I. 28 Nātriņa, L. 22 Pranka, M. 177 Pucuka, Z. 174 Ogbuagu, K. 62 Pudule, I. 30, 38, 45 Okáľová, O. 181 Pulkstene-Bērtiņa, S. 191 Olsena, S. 18, 25 Pumpure, E. 4, 16, 25 Orru, H. 131 Pundure, E. 51, 52 Osis, J. 158 Pučuka, Z. 24 Osite, J. 76 Oudin Astrom, D. 126 Racheva, K. 39 Oudin, A. 126, 131 Rajevska, O. 13 Ozerska, D. 102 Ramaci, T. 112

225 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Rapisarda, V. (Occupational Medicine, 110,Department 112, 122 Silinsh, R. 180 Siliņa, E. 59 Simbelyte, T. 202 Raskilienė, A. 42 Simm, K. 7 Rasnaca, L. 188 Simsone, A. 201 Rass, H. 101 Sinkuniene, J. 64, 149 Račko, I. 174 Siska, V. 207 Reide, L. 200 Skrule, J. 94, 96 Reine, A. 13 Skuja, I. 51, 52 Reine, I. 3, 70, 178 Skuja, V. (Rīga Stradiņš University; Riga East Reinhold, K. 69 48 Reste, J. 121, 128, 201 Center 4) 48 Rezeberga, D. 4, 16, 18, 25 Skulte, I. 217 Ribalkina, E. 17 Slapšinskaitė, A. 42 Ricou da Costa Macedo, M. 138 Smane, L. 24, 174 Riekstiņa, M. 73 Sniķere, S. 178 Rimaido, K. 57 Sokolova, D. 55 Roja, I. 115 Sondore, L. 28 Roja, Z. 115 Spriņģe, L. 10, 20, 40 Roģe, I. 24, 174 Sproge, K. 132 Rudņeva, I. 95 Srobarova, S. 157 Rumpe, S. 47 Stars, I. 10, 17, 20, 24, 174 Rungule, R. 216, 218 Stelmokiene, A. 117 Rusnakova, M. 161, 168, 181 Stepens, A. 139 Rutkovska, I. 88 Stepiņa, E. 73 Ruuben, L. 144 Strele, I. 77 Ruža, A. 15, 136 Strēle, I. 9, 21 Sudraba, V. 142, 211 Salmane-Kuļikovska, I. 88 Surina, S. 15 Sauliune, S. 62, 66, 67 Sļepcova, O. 17 Savicka, V. 55

Schmidt, J.International (GIZ German Cooperation Corporation GmbH) for 81 Taube, M. (Rīga Stradiņš University; Riga 102

Seile, A. 129, 130 Tauriņa, G. 29 Seksenbaeva, D. 81 Tehseen, E. 106 Sela, I. 103 Tint, P. 106, 118 Sell, P. 105 Tolmanis, I. 48 Semaan, A. 2 Tomsone, S. 3, 5, 35, 193 Semjonova-Reinholde, M. 147 Trapenciere, I. 172, 173, 175, 186, 191 Senakola, E. 17 Traumann, A. 118 Senkane, S. 216, 218, 220 Tuitaite, J. 183 Sepp, K. 101 Tzivian, L. 98 Shramko, S. 163 Sikorskis, D. (Lithuanian University of Health Uibo, A. 77 Sciences, Student) 66, 67 Upeniece, I. (Rīga Stradiņš University) 200 Sikorskis, D. (t) 46, 184 Upesleja, G. 151 Sildver, K. 55 Urbonas, G. 62, 67 Silina, L. 201 Uribe, S. 17

226 RSU the 8th International Multidisciplinary Research Conference ”Society. Health. Welfare.”

Vaitkevičiūtė, J. 42 Vīnberga, I. 200 Valaine, S. 58 White, R. 62 Valberga-Porozova, M. 198 Wisper, L. 91 Vanadzins, I. 109, 111, 114, 116, 121, 123, 127, 130,

Zalgiryte-Skurdeniene, J. 149 Veber, T. 131 201 Zarde, I. 45 Vedmedovska, N. 57 Zarins, B. 206 Veide, L. 48 Zariņa, I. 193 Veilande, O. 90 Zelčāne, E. 140 Velika, B. 38 Zemaitaityte, I. 154, 160 Veliks, V. 37 Zile-Velika, I. 60, 77 Vella, F. 112 Zvagule, T. 109 Venžega, K. 130 Zvaune, L. 87 Veseta, U. 195, 200 Čerpakovska, Z. 132 Vetra, A. 201 Ķikute, D. 88 Vettus, E. 105 Ķīvīte-Urtāne, A. 4, 6, 18, 20, 25, 55, 57, 74, 174, 213 Vilka, L. 173, 175, 186, 191 Vilkoite, I. 48 Šantare, D. 28 Vilks, A. 19 Šedienė, P. 85, 183 Villeruša, A. 9, 10, 20, 21, 30, 38, 40, 45 Šilova, N. 17 Virziņa, L. 49 Šneidere, K. 139, 148 Vitanova, K. 189 Švegžda, D. 62 Vitkute, V. 66 Šķestere, L. 11 Višķere, A. 186 Ūdre, A. 36 Vladickiene, J. 46, 66, 184 Ūpis, A. 83 Voitkeviča, A. 50 Žardeckaitė-Matulaitienė, K. 141 Volmer, D. 101 Žilys, A. 171 Vrobļevska, E. 40 Žukovs, A. 107

227 Rīga Stradiņš University the 8th International Multidisciplinary Research Conference “Society. Health. Welfare.”, 24–26 March, 2021: Abstracts. Rīga: RSU, i-xvi p., 228 p., including Author Index. https://doi.org/10.25143/rw2021.shw.abstracts-book

Chair of the Organizing Committee Dr. phil. Agrita Kiopa

Chair of the Scientific Committee Prof. Aivars Lejnieks

Authors are responsible for the content of their abstracts.

ISBN 978-9934-563-81-2 (electronic)