Care In Latvia Research Articles

Five-Year Survival Analysis and Causes of Late Deaths of Infants Admitted to the Tertiary Newborn Intensive Care in Latvia.

Background and Objectives: Studies on long-term survival following admission to neonatal intensive care units (NICUs) are scarce. The aim of this study was to analyse the epidemiology, five-year survival, and causes of late death of infants admitted to the only tertiary NICU in Latvia. Materials and Methods: The study population included all newborns admitted to the Children's Clinical University Hospital (CCUH) NICU from 1 January 2013 to 31 December 2017. The unique national identity numbers from the infants or their mothers were used to link the CCUH electronic medical records to the Medical Birth Register and the Database of Causes of Death of Inhabitants of Latvia maintained by The Centre for Disease Prevention and Control of Latvia. Results: During the study period, a total of 2022 patients were treated in the tertiary NICU. The average admission rate was 18.9 per 1000 live births per year. One hundred and four patients (5.1%) died in the tertiary NICU before hospital discharge. A total of 131 (6.5%) patients from the study cohort died before 12 months of age and 143 (7.1%) before 5 years of age. Patients with any degree of prematurity had a lower five-year mortality (0.9%, 9 out of 994 discharged alive) than term infants (3.2%, 30 out of 924 discharged alive; p < 0.001). Of the 39 patients who died after discharge from the NICU, the most common causes of death were congenital heart disease 35.9% (n = 14), multiple congenital malformations and chromosomal abnormalities 17.9% (n = 7), cerebral palsy 10.3% (n = 4), and viral infections 7.7% (n = 3). Conclusions: We observed increased mortality up to five years following NICU admission in both premature and term infants. These findings will help to guide the NICU follow-up programme.

Narratives of social orphans in Latvia: Using a life history methodology to listen to the voices of care leavers

This study investigated social orphans through narratives of young people with experiences of growing up in institutional care in Latvia. The study uses the life histories of participants to explore the phenomenon of social orphans. To date, narratives about the lived experiences of social orphans in Latvia have been told in the third person, as most studies have used methodologies that kept participants passive rather than active. The research process in this study recorded 19 care leavers’ life experiences in detail and covered three main life phases: 1) Prior to living in care; 2) Living in care; 3) Life after care. A thematic analysis was employed to analyze the data. Participants’ experiences revealed some commonalities: factors that preceded children entering care, occurrences from care and life trajectories post-care. The findings also supported a deconstruction of stereotypes and dominant assumptions about orphanage care. They provide alternative narratives to what it means to grow up as a social orphan in Latvia. Notable were the strategies of self-reliance and resistance to adversity, as well as a preference for group care and a summation of what care leavers would like from professionals during care. Finally, recommendations for policy and practice are introduced; these emerged from the study findings and the positioning of the participants as ‘knowledgeable of their experience’. This rich knowledge base can be used to support and inform the practice of children moving through the institutional care system in Latvia as well as in other contexts.

Validation of the generalized anxiety disorder scales (GAD-7 and GAD-2) in primary care settings in Latvia.

BackgroundAnxiety disorders are the most prevalent mental disorders in the world and have an important impact on the global burden of disease. Generalized anxiety disorder (GAD) is the most prevalent anxiety disorder encountered in primary care. There are no available validated anxiety screening tools in primary care in Latvia. We aimed to validate both a seven-item and a two-item generalized anxiety disorder scale (GAD-7 and GAD-2) in the Latvian and Russian languages, to detect generalized anxiety disorder (GAD) in primary care settings in Latvia.MethodsDuring a 1-week period, all patients aged 18 years or older visiting their GP (general practitioners) with any health concern at 24 primary care settings throughout Latvia were invited to complete the GAD-7 in their native language (Latvian or Russian). Criterion validity was assessed against the Mini International Neuropsychiatric Interview (MINI).ResultsThe study sample included 1,459 participants who completed the GAD-7 and the MINI. The GAD-7 items showed good internal reliability [Cronbach's alpha 0.87 for Latvian version and 0.85 for Russian version (for Latvia) of the GAD-7]. A cut-off score for detecting GAD of 5 or above was estimated for Latvian version of the GAD-7 (sensitivity 75.4%, specificity 68.9%, respectively) and 7 or above for Russian version of the GAD-7 (sensitivity 73.3%, specificity 84.1%, respectively). The internal reliability of the GAD-2 was lower for both languages (Cronbach's alpha 0.75 for Latvian version and 0.68 for Russian version of the GAD-2). A cut-off score of 2 or above was established for both the Latvian, and Russian versions of the GAD-2 (sensitivity 78.9 and 83.3%; specificity 63.7 and 69.1% for the Latvian and Russian versions of the GAD-2, accordingly) for detecting GAD.ConclusionsThis is the first study to report criterion validity of the Latvian and Russian (for Latvia) versions of the GAD-7 and GAD-2, assessed in a nationwide study conducted at the primary care level.

Latvian Primary Care Management of Children with Acute Infections: Antibiotic-Prescribing Habits and Diagnostic Process Prior to Treatment.

Background and Objectives: Primary care physicians frequently prescribe antibiotics for acutely ill children, even though they usually have self-limiting diseases of viral etiology. The aim of this research was to evaluate the routine antibiotic-prescribing habits of primary care in Latvia, in response to children presenting with infections. Materials and Methods: This cross-sectional study included acutely ill children who consulted eighty family physicians (FP) in Latvia, between November 2019 and May 2020. The data regarding patient demographics, diagnoses treated with antibiotics, the choice of antibiotics and the use of diagnostic tests were collected. Results: The study population comprised 2383 patients aged between one month and 17 years, presenting an acute infection episode, who had a face-to-face consultation with an FP. Overall, 29.2% of these patients received an antibiotic prescription. The diagnoses most often treated with antibiotics were otitis (45.8% of all antibiotic prescriptions), acute bronchitis (25.0%) and the common cold (14.8%). The most commonly prescribed antibiotics were amoxicillin (55.9% of prescriptions), amoxicillin/clavulanate (18.1%) and clarithromycin (11.8%). Diagnostic tests were carried out for 59.6% of children presenting with acute infections and preceded 66.4% of antibiotic prescriptions. Conclusion: Our data revealed that a high level of antibiotic prescribing for self-limiting viral infections in children continues to occur. The underuse of narrow-spectrum antibiotics and suboptimal use of diagnostic tests before treatment decision-making were also identified. To achieve a more rational use of antibiotics in primary care for children with a fever, professionals and parents need to be better educated on this subject, and diagnostic tests should be used more extensively, including the implementation of daily point-of-care testing.

National Legal Framework to Protect the Right to Health and Right to Provide Health Care during the Covid Emergency Situation in Latvia

Global public health emergency due to the spread of Covid-19 required the government of Latvia to implement necessary measures to control the virus. Numerous measures were introduced as novel legal requirements for the general public as well as for users and providers of health care. Numerous legal provisions established restrictions on the rights of patients and health care institutions. Our study aimed to explore how a human rights-based approach might be and is integrated into national responses to the Covid pandemic in health care in Latvia during the first emergency situation lasting from 12 March to 9 June 2020. Our research showed that restrictions on the right of patients to receive and the right of health care institutions to provide health care services were introduced broadly. We established that the legal requirements for restricting human rights in health required by the Constitution of Latvia were not observed.

Lingvistikas nozīmība veselības aprūpes un medicīnas nozarē. Kopējie izaicinājumi un iespējas veselības aprūpē

Dementia is a condition observed in persons afflicted with different brain diseases, first of all, with Alzheimer’s Disease. Alzheimer’s is the most common type of senile dementia. Limited cognitive and lingual capacity and other problems make the affected persons dependent on medical and social help. With the progression of the disease, the economic burden becomes heavy both for the family and society. So far, no effective medical treatment has been discovered, which could stop the decrease in brain capacity. However, early diagnosis of dementia symptoms is important because alternative individual preventive instruments can be implemented to slow down the progression of the disease and prolong the period of the relatively independent existence of patients. The worldwide known MoCA test is one of the most common instruments for testing persons worried about their mental condition and cognitive capacities. The test is translated and partially adapted in several languages, including Latvian. Our analysis was aimed at the question: does the Latvian test version respond to the requirements which are necessary to achieve optimal results. In other words, can it provide an objective rating of a lingual performance by the tested persons? The first critical inventory concerned three relevant parts: the formulation of tasks, the prescribed instructions, and the principles of interpretation of testing results. Several examples demonstrate that some deficits can be observed in all the analysed parts. Some tasks should be better adapted to the Latvian situation so that a lingual or cognitive test would be separated from the test of the-so-called world knowledge. The instructions should be formulated clearly, without using complicated grammatical structures (currently, some of them are more complicated than the tasks), and they should focus on the tasks instead of examiners’ activities. In some cases, the suggested interpretation principles of the test results cannot be seen as reasoned from the linguistic point of view. Some observations indicate that the translation of the test and its requirements or instructions were carried out by a person who does not deal professionally with linguistics. The main conclusion is that the current quality of the Latvian MoCA test needs a critical review and, possibly, complete revision. Thus, the interdisciplinary cooperation between linguists and physicians, as well as joint research, is an actual and necessary precondition for the improvement of health care in Latvia.

Palliative care in Latvia: Availability and the role of the family doctor

In line with rapid population aging, palliative care is becoming increasingly important. The purpose of the study is to evaluate the satisfaction with palliative care and its availability in Latvia, as well as identify factors which have a major impact on overall satisfaction with care. The paper describes the situation in Latvia by evaluating the satisfaction with the palliative care and the accessibility to it. The study relies on a quantitative methodology and primary data were obtained using structured online survey conducted during the 30-day period – in March and April 2018. In total 240 questionnaires were collected from which 131 (n = 131) were qualified for further analysis. The survey results indicated that the population of Latvia has insufficient information about the palliative care leading to low availability. The regression analysis showed that overall low assessment of the palliative care is influenced by two factors: 1) low satisfaction with the services provided by the primary care physicians (family doctors), 2) satisfaction with the received palliative care services and the availability of the services. The study indicated that there is no unified and comprehensive palliative care strategy and system in Latvia, however, some state-provided care is available for a limited number of patients. The results highlight the necessary improvements in palliative care in Latvia and may serve as a basis for health and social policymakers for the development of a unified and comprehensive population end-of-life or palliative care strategy.

Barriers to accessing adequate maternal care in Latvia: A mixed-method study among women, providers and decision-makers

IntroductionLatvia has a high maternal mortality ratio compared to other European countries, as well as major inequities in accessing adequate maternal care. Adequacy refers to the extent to which services are safe, effective, timely, efficient, equitable and people-centred. This study aims to explore stakeholder views on access to adequate maternal care in Latvia and the extent to which there was consensus. MethodsThis mixed-method study is based on an online survey among women who recently gave birth, as well as interviews with healthcare providers and decision-makers. The data were analysed using the method of directed qualitative content analysis. The extent of stakeholder consensus was determined by studying five access-related aspects of maternal care: availability, adequacy, affordability, approachability and acceptability. FindingsOur study identified barriers to accessing adequate maternal care related to availability (i.e. shortage of human resources, geographical distance) and appropriateness (i.e. inequalities in provider knowledge, care provision and use of clinical guidelines). Other challenges were related to providers’ approaches towards women (i.e. communication) and, to a lesser extent, maternal care acceptance by women (i.e. health literacy). ConclusionsThe barriers identified in our study highlight areas that should be addressed in future reforms of maternal care. These barriers also indicate the need for micro-level indicators that can facilitate a comprehensive evaluation of maternal care in Latvia and elsewhere.

PARENT SATISFACTION WITH TREATMENT AND CARE SERVICES WITHTIN THE FRAMEWORK OF PEDIATRIC PALLIATIVE CARE IN LATVIA

The number of children prenatally or after birth diagnosed with a disease with no prevent radical treatment options in Latvia and worldwide constantly increases. Pediatric palliative care in Latvia is organized in the form of a home hospice care model. It is instrumental to establish the level of patients’ satisfaction with the provided care and treatment services. The objective of the study is to evaluate patient satisfaction with care and treatment services under the offered pediatric palliative care model. The study sample comprises 153 parents with children receiving palliative care services. The study is based on the quantitative research method: patient satisfaction survey. The parental satisfaction was measured in six subcategories: networking and collaboration, follow-up care, funding, access, clinical capacity building and outreach. According to the outcomes of the study, the level of satisfaction with the provided treatment and care services under the hospice palliative care model is average. The lowest score was given to collaboration and access categories, whereas the highest score was awarded for the continuity (follow-up) of care and funding.

THE ROLE OF HEALTH LITERACY IN PREDICTING PATIENT SATISFACTION WITH HEALTH CARE

Patient satisfaction has become one of the central indicators to measure quality of provision of health care services. However, it has been made clear in previous literature that the effectiveness and efficiency of the health care services is not directly proportional to the satisfaction level, because an array of patient’s personal, psychological, and cognitive factors such as beliefs, expectations, knowledge and others may come into play. In this current article, we report on a study aiming to examine the role of health literacy in predicting patient satisfaction with health care in Latvia. In summer-autumn 2017, data were collected from a random sample of 451 participants (44 % male) in age from 18 to 81 years. The participants filled-in the questionnaire consisting of: Patient Satisfaction Questionnaire (PSQ-III, Ware, Snyder, Wright, 1976) and European Health Literacy Survey Questionnaire (HLS-EU-Q, HLS-EU Consortium, 2012). We measured four out of the seven aspects of PSQ, namely, general satisfaction, technical quality, interpersonal aspects, and communication. HLS-EU-Q contains three subscales: health care, disease prevention, and health promotion. Study results confirm that one of the health literacy aspects - health care - was the most important predictor of all patient satisfaction aspects, while health promotion predicted technical quality.

Improving quality of psychiatric care in Latvia by measuring patient experiences

In Latvia, as in many former Soviet Union countries, there used to be little priority given to systematic assessments of the quality of psychiatric care. Furthermore, using the experiences of patients as a measure of quality was unthinkable because psychiatric patients were seen as incapable of assessing quality of psychiatric services. Over the past few years, and facilitated by Latvia's progress along the route of Western democracy and participation in international organizations (EU, OECD), as well as funding support from the EU, several policy documents have been developed with the aim of improving healthcare quality. Simultaneously, several small-scale initiatives have emerged aiming at the promotion of quality of care, such as the quality award, and the quality comparison of psychiatric hospitals. Furthermore, the Psychiatric Inpatient Patient Experience Questionnaire for on-site measurement (PIPEQ-OS) has recently been adapted for use in Latvia. The first application of PIPEQ-OS in a psychiatric hospital in Riga reveals high patient responsiveness, interest and surprise about being asked to participate in the decision-making process regarding treatment and pharmaceutical choices. More widespread use of the PIPEQ-OS has considerable potential for (1) improving information about treatment shortcomings from the patients' perspective and (2) improving the treatment process by opening doors of cooperation with patients and changing deep-rooted paradigms.

Latvian health care competitiveness in relation to its infrastructure and available resources

Resources are one of the essential indicators for the functioning of the health care system. Better health care provision is an essential prerequisite for the export of services. Traditionally a competitive health care system is linked to a number of factors (price, quality, reliability, products and services) largely determined by the new technologies, innovations and implementation the new methods. The authors of this article analyzed and collected data from the European Commission Eurostat and OECD data. Current situation in health care in Latvia is characterized by populations’ restricted access to health care services, high out-of-pocket payments and poor health outcomes of the population. More than 10% of Latvian population can’t afford medical care. The ratio of public funding for healthcare in Latvia is among the lowest in EU countries. Latvia spends 5.3% (USD PPP 1217) of GDP on health, lower than the OCED country average of 8.9% (USD PPP 3453). Latvia is facing a dramatic gap between the availability of hospital beds and long term care beds and the lowest prevalence of general medical practitioners among all Baltic States 321.6 per 100 000. These mentioned factors may hinder the development of health care in Latvia and reduce the ability to participate in international health service market.

Antibiotic prescription and clinical management of common infections among general practitioners in Latvia, Lithuania, and Sweden: a pilot survey with a simple protocol

Comparative information on diagnosis-related antibiotic prescribing patterns are scarce from primary care within and between countries. To describe and compare antibiotic prescription and routine management of infections in primary care in Latvia (LV), Lithuania (LT) and two study sites in Sweden (SE), a cross-sectional observational study on patients who consulted due to sypmtoms compatible with infection was undetraken. Infection and treatment was detected and recorded by physicians only. Data was collected from altogether 8786 consecutive patients with infections in the three countries. Although the overall proportion of patients receiving an antibiotic prescription was similar in all three countries (LV and LT 42%, SE 38%), there were differences in the rate of prescription between the countries depending on the respective diagnoses. While penicillins dominated among prescriptions (LV 58%, LT 67%, SE 70%), phenoxymethylpenicillin was most commonly prescribed in Sweden (57% of all penicillins), while it was amoxicillin with or without clavulanic acid in Latvia (99%) and Lithuania (85%) respectively. Pivmecillinam and flucloxacillin, which accounted for 29% of penicillins in Sweden, were available neither in Latvia nor in Lithuania. The applied methodology was simple, and provided useful information on differences in treatment of common infections in ambulatory care in the absence of available computerized diagnosis–prescription data. Despite some limitations, the method can be used for assessment of intention to treat and compliance to treatment guidelines and benchmarking locally, nationally, or internationally, just as the point prevalence surveys (PPS) protocols have been used in hospitals all over Europe.

Prenatal exposure to maternal depression and its influences on infant development and behaviour

IntroductionDepression is one of the most common mental disorders worldwide. Women are more at risk of depression while they are pregnant, and during the first weeks and months of postpartum period. Perinatal depression, might influence the children‘s development during pregnancy as well as it can have negative affect and delay in child postnatal development.Materials and methodsPregnant women undergoing antenatal care in Latvia, Riga were interviewed using PHQ-9 and GAD-7 scales, the obtained data from the scale's results were analyzed and summarized in an analystic cross-sectional study. Literature overview.ResultsThere is a high correlation between the depressive episodes before pregnancy, during pregnancy and postpartum depression, as well as it have negative effects and delay in child postnatal development. Using Patient Health Questionnaire-9 and Generalised Anxiety Disorder Assessment-7 screening scales, was set up an inquiry among 200 pregnant women in Riga, Latvia. Depressive symptoms have 45% of pregnant women. 36% of pregnant women have mild depression symptoms, 3% moderate symptoms, 5% moderate serve symptoms and 1% serve depression symptoms. In its turn anxiety disorder screening results are following: 35% of pregnant women have mild anxiety symptoms, 9% moderate anxiety symptoms; 3% serve anxiety symptoms. Anxiety disorder symptoms note 47% of pregnant women. 36% of respondents note both depression symptoms and anxiety disorder symptoms.ConclusionHQ-9 and GAD-7 scales are informative, quick and easy for patients to complete. Children development and behavior has association with maternal depressive state during pregnancy. There is high prevalence of depression symptoms among preganant women in Latvia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Legal norms, Profesional values, and practical ethics in local government: Elderly care in Latvia, Lithuania, and Norway

This article reports findings from a comparative study of the influence of values and norms on the delivery of administrative and professional services in the public sector at the local gov-ernment level in three selected countries in the Baltic Sea Region, Latvia, Lithuania, and Norway. The research concerns the criteria that professional welfare and health professionals apply in individual cases whenever they are expected to make high-quality judgments regard-ing the care of older people. The research question seeks to ascertain whether there are signif-icant differences with regard to the effect of formal rules and norms on the effort to arrive at good solutions in providing public services in three democracies, one long-established and two recent. &#x0D; The results of this study show that in making their decisions, professionals in all countries emphasize the necessity of considering a broad range of legal and professional norms. For all respondents these considerations – in varying degrees of intensity – rank ahead of economic and administrative concerns.

Access to care in the Baltic States: did crisis have an impact?

In 2009, brief but deep economic crisis profoundly affected the three Baltic States: Estonia, Latvia and Lithuania. In response, all three countries adopted severe austerity measures with the shared goal of containing rising deficits, but employing different methods. In this article, we analyze the impact of the economic crisis and post-crisis austerity measures on health systems and access to medical services in the three countries. We use the EU-SILC data to analyze trends in unmet medical need in 2005-2012, and apply log-binomial regression to calculate the risk of unmet medical need in the pre- and post- crisis period. Between 2009 and 2012 unmet need has increased significantly in Latvia (OR: 1.24, 95% confidence interval (CI): 1.15-1.34) and Estonia (OR: 1.98, 95% CI: 1.72-2.27), but not Lithuania (OR: 0.84. 95% CI: 0.69-1.04). The main drivers of increased unmet need were inability to afford care in Latvia and long waiting lists in Estonia. The impact of the crisis on access to care in the three countries varied, as did the austerity measures affecting their health systems. Estonia and Latvia experienced worsening access to care, largely exacerbating already existing barriers. The example of Lithuania suggests that deterioration in access is not inevitable, once health policies prioritise maintenance and availability of existing services, or if there is room for reducing existing inefficiencies. Moreover, better financial preparedness of health systems in Estonia and Lithuania achieved some protection of the population from increasing unmet need due to the rising cost of medical care.

Decrease in annual incidence of acute coronary syndrome and restructuring of coronary care in Latvia

IntroductionImprovement in coronary heart disease prevention and treatment, as well as availability of coronary care facilities, is important for the reduction of acute coronary syndrome (ACS) incidence. Centralized acute coronary care system is crucial to provide optimal hospitalization and management algorithm for ACS patients. AimThe aim of the current report was to assess the annual incidence of ACS and the quality of acute coronary care in Latvia. MethodsThe Data from The Latvian Registry of Acute Coronary Syndromes were analyzed covering the time period from 2005 to 2010. ResultsSince the year 2005 the annual incidence of hospitalization due to ACS decreased significantly in Latvia. The annual incidence of non-ST-elevation ACS (NSTE-ACS) decreased from 8019 to 4613 in absolute numbers based on the registry data during six years. Improvement in the use of guidelines based therapy and early invasive strategy in ACS patients was observed. Increase in primary percutaneous coronary intervention was achieved from 7.9% in 2005 to 57.0% in 2010, contributing to reduction in the proportion of STEMI patients without any reperfusion (from 45% in 2005 to 21% in 2010). ConclusionsThe annual incidence of hospitalized ACS, especially NSTE-ACS, decreased and guidelines based management of ACS improved from 2005 to 2010 in Latvia.

Self-perceived physical and health condition of older persons (aged 65-75)

To study health habits is the way how to get information about population’s attitude and knowledge about health. The latest 2006 FINBALT monitoring questionnaire contains full spectrum of questions about health care in Latvia and the Baltic region. The aim of the current review paper is to compare some FINBALT results between the states and regions and find out new facts about self-perceived physical and health condition of older persons (65–75 years old). The data from two 2006 FINBALT Health Monitor for adults aged 55–64 surveys were used to make comparisons in physical activities and health trends between Latvia and Finland. To find out new facts about older persons (65–75 years old) we did a survey of visitors of pensioner day centres in Rezekne and Daugavpils towns. Our survey shows that there is no major difference between the results we got in pensioner day centres and in Latvia during this research, but there is a dramatic difference with the results which were got in Finland. Latvian inhabitants’ self-perceived physical and health condition results are worse than in Finland. In Latvia for older people sedentary life is common (persons who practice 30 minutes long physical exercise at least 2–3 times per week in Finland are 74%, in Latvia – 25%).

COMPETITIVENESS OF PHYSICIAN PRACTICES IN LATVIA

Human health is the most significant factor that influences the life quality of individuals. The first level of health care faced by any individual is a family physician, therefore, the availability of family physicians is of great importance. Primary health care is the key component of national health care system in providing health care. The tasks of primary health care are as follows promotion of health, prevention of diseases, treatment of diseases, rehabilitation. As regards providing health care services in the regions of Latvia, regional differences increase in this respect; in some places the situation may be regarded even as critical. The availability and quality of services is often inappropriate. To increase the accessibility of physician practices, new ways of improving the performance of physician practices in Latvia have to be searched for. One of the ways is to increase the competitiveness of physician practices to ensure sustainability in the performance of physician practices, which results in providing quality services to local residents as well as foreigners. The paper gives a definition for the nature of competitiveness and characteristics of physician practices in Latvia, and the competitiveness factors of physician practice are identified and assessed. The research object is services of physician practices in Latvia. Hypothesis: performance of physician practices is affected by both exogenous and endogenous factors of competitiveness. The research aim is to investigate the basic factors determining and limiting the competitiveness of physician practices and to identify priorities for increasing the competitiveness of physician practices in Latvia. To achieve the aim, the following research tasks were set : to characterise and assess primary health care in Latvia, to identify the key basic factors that determine and limit the competitiveness of physician practices, and to identify measures preventing the basic factors that limit the competitiveness of physician practices. To achieve the aim, the method of expert evaluation was employed. The following research methods were employed for studying the legal framework and developing proposals for its improvement: the abstract and logical methods, the monographic method, analysis and synthesis, and the calculation and constructive methods. For analysis of statistical data, statistical methods such as descriptive statistics and correlation analysis were employed. A sociological research method – questionnaire surveying – was used for identifying problems of physician practices.Finally, it was concluded that the key competitiveness factors are: qualifications of both managers of physician practices and their staff, use of medical and other modern technologies at physician practices, prices of services, location and accessibility, and government policy. The main factors limiting the competitiveness of physician practices and their prevention measures were identified. The main measures are as follows: provision of the accessibility of physician practices in rural areas by means of local government support, introduction of e-consultations or electronic consultancy via e-mail, as it enables patients to receive a consultation of specialist at a distance, setting an optimal number of patients per physician practice, planning the training of resident physicians, thus attracting new physicians for the profession of family physician, and expansion of physician practices with other medical specialists to increase the quality of health care services and cooperation among physician practices. DOI: http://dx.doi.org/10.5755/j01.eis.0.6.1497

Problems of HIV positive tuberculosis patients' health care in Latvia

The number of patients with HIV/TB alliance has increased recently. There were 1055 TB/HIV cases registered in European Union (6% out of 17 650 TB cases tested for HIV) in 2010, among them 71 in Latvia (9.5% out of all TB cases in 2010, in comparison with 0.5% in 2000). The treatment for TB/HIV cases is provided in Latvia according to WHO recommendations, including DOTS strategy. However the TB treatment results for HIV positive cases are concerning due to increasing resistance to HIV/AIDS drugs and to TB drugs.