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This paper analyses the concept of accessibility of legal aid for children in conflict with the law, searching for its essential elements in international standards and national practices. By analysing the comparative empirical data on legal regulation in different European jurisdictions, the authors of the paper discuss what it means for legal aid to be accessible to children and what could be done to strengthen it. The paper argues that the goal of improving access to legal aid for children in conflict with the law should be approached from various directions, including the provision of information on legal aid in a child-friendly and age-appropriate manner, the strengthening of children’s legal education, the dissemination of child-friendly materials, and the training and specialisation of legal aid lawyers and other professionals.

Immunotherapy treatment with checkpoint inhibitors (ICIs) has led to a breakthrough in the treatment of oncological diseases. Despite its clinical effectiveness, this treatment differs from others, such as cytotoxic chemotherapy, in that it causes immune-related adverse events. This type of toxicity can affect any organ or organ system of the body. We present a literature review and a rare clinical case from our clinical practice, in which a patient with metastatic clear cell renal carcinoma was treated with a single dose of dual checkpoint blockade (cytotoxic T-lymphocyte-4 (CTLA-4) and programmed death-1 (PD-1)) and simultaneously diagnosed with colitis, hepatitis, and nephritis. After early immunosuppressive treatment with the glucocorticoids, complete organ function recovery was achieved. The follow-up revealed a sustained complete response lasting more than a year. [ABSTRACT FROM AUTHOR]

Background and Objectives: Vaccination is one means of SARS-CoV-2 prevention and control. However, despite the effectiveness of vaccination, adverse reactions continue to require vigilance and monitoring. The researchers emphasize the possibility that some of the reported side effects may be psychological in origin. Based on this hypothesis, the main goal of this study was to evaluate the emotional dispositions of healthcare workers who experienced emotions before vaccination and adverse reactions after vaccination. Materials and Methods: This study was conducted between February and May 2021 in the Kaunas Clinics of the University of Health Sciences. A total of 2117 employees of the clinic departments who were vaccinated with two doses of the Pfizer–BioNTech vaccine participated in this study. Statistical analysis was performed on the data using IBM SPSS Statistics®. Results: Most participants (74.5%) experienced systemic (including local) adverse events; 16.5% experienced only local adverse events, and 9.1% experienced no adverse events. The frequency of systemic (including local) adverse events reduced with increasing age (p < 0.05). The main emotions that participants experienced before vaccination were anxiety (37.88%) and happiness (39.02%). Systemic (including local) adverse events occurred 1.26 times more frequently in women than men (77.44% vs. 61.6%, p < 0.05), while local adverse events occurred 1.4 times more often in male participants than in female participants (21.39% vs. 15.27%, p < 0.05). Among the respondents who did not experience adverse events, the most common emotion felt was happiness (25.5%), and most of the participants who experienced systemic (including local) adverse events felt anxiety (42.6%). Conclusions: The information about vaccination and potential adverse events should be targeted at younger persons. It is recommended that women, more than men, should receive professional counseling from psychologists or psychotherapists. The public dissemination of positive messages about the benefits and safety of vaccines prior to a vaccination campaign may alleviate the tension or anxiety felt regarding potential adverse events. Healthcare specialists—both those who work directly with vaccines and those who do not—should maintain a positive psychological attitude towards vaccination, as this can increase patient satisfaction with the benefits of vaccines. [ABSTRACT FROM AUTHOR]

This article focuses on the structure of female and male crimes and gender disparities in sentencing in Lithuania, which present a significant gap in criminological research. Using Lithuanian court decisions on five types of offenses—murder, grievous bodily harm, actual bodily harm, drug distribution, and theft—we attempt to answer whether women are punished more leniently than men. Our research demonstrates that gender is a significant factor only in some sentences. Only the length of a prison sentence showed a statistically significant difference. When the importance of legal and extralegal factors in imposing prison length is compared, legal factors are found to be more significant predictors. The prison sentence length was mainly affected by the presence of a prior conviction, additional charges, and mitigating and aggravating circumstances. Although the average prison sentence for men in cases of grievous bodily harm and drug distribution was significantly longer than for women, the regression models developed for each offence type revealed that neither gender nor other extralegal factors appeared to be significant in determining the length of the prison sentence. The results allow us to argue that future research should focus more on analyzing extralegal factors and judges' motives in discretionary sentencing decisions. [ABSTRACT FROM AUTHOR]

Background and Objectives: The safety and effectiveness of vaccines are among the key priorities in COVID-19 pandemic management. Moreover, evidence-based data regarding vaccine safety and immunogenicity can play an important role in building the trust of the community regarding vaccination. The aim of this study was to investigate the safety and immunogenicity of Pfizer-BioNTech vaccine among healthcare workers in one hospital, 21 days after first dose. Materials and Methods: This study was conducted in the Hospital of the Lithuanian University of Health Sciences between February and March 2021. Hospital employees who arrived to receive the second dose of the Pfizer-BioNTech vaccine 21 days after the first one were invited to participate in the study: they were asked to complete an anonymous adverse events questionnaire and were offered a SARS-CoV-2 IgG/IgM rapid test. The study was performed at a single point, 21 days after the first dose of the vaccine. Results: Data of 4181 vaccine recipients were analysed. The first vaccine dose was associated with a 53.6% incidence of adverse events, mainly local reactions. Adverse events occurred more frequently in younger participants and women. Moderate adverse events were experienced by 1.4% of the vaccine recipients; 6.2% were incapacitated. Of the 3439 participants who performed a rapid IgG test, 94.5% were positive for IgG antibodies after the first vaccine dose. Seroconversion rates were lower in participants older than 47 years. Conclusions: Despite 1.4% moderate adverse events, no safety concerns or anaphylaxis were identified. The Pfizer-BioNTech vaccine induced an immune response in the overwhelming majority of recipients after a single dose. Younger participants experienced adverse events and were positive for IgG antibodies more frequently than older counterparts. It is important to mention that this study specifically considered short-term safety and reactions following vaccination and that long-term adverse effects were not investigated in the study. Thus, future research into both long-term adverse reactions and immune system programming is essential. [ABSTRACT FROM AUTHOR]

Background and Objectives: Fluid disbalance is associated with adverse outcomes in critically ill patients with acute kidney injury (AKI). In this study, we intended to assess fluid status using bioimpedance analysis (BIA) and central venous pressure (CVP) measurement and to evaluate the association between hyperhydration and hypervolemia with the outcomes of severe AKI. Materials and Methods: A prospective study was conducted in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos. Forty-seven patients treated at the Intensive Care Unit (ICU) with severe AKI and a need for renal replacement therapy (RRT) were examined. The hydration level was evaluated according to the ratio of extracellular water to total body water (ECW/TBW) of bioimpedance analysis and volemia was measured according to CVP. All of the patients were tested before the first hemodialysis (HD) procedure. Hyperhydration was defined as ECW/TBW > 0.39 and hypervolemia as CVP > 12 cm H2O. Results: According to bioimpedance analysis, 72.3% (n = 34) of patients were hyperhydrated. According to CVP, only 51.1% (n = 24) of the patients were hypervolemic. Interestingly, 69.6% of hypovolemic/normovolemic patients were also hyperhydrated. Of all study patients, 57.4% (n = 27) died, in 29.8% (n = 14) the kidney function improved, and in 12.8% (n = 6) the demand for RRT remained after in-patient treatment. A tendency of higher mortality in hyperhydrated patients was observed, but no association between hypervolemia and outcomes of severe AKI was established. Conclusions: Three-fourths of the patients with severe AKI were hyperhydrated based on bioimpedance analysis. However, according to CVP, only half of these patients were hypervolemic. A tendency of higher mortality in hyperhydrated patients was observed. [ABSTRACT FROM AUTHOR]

This paper investigates Lithuanian probation officers' discretionary decisions on probation violations under strict legal regulation. Based on a quantitative survey, this paper analyses hypothetical discretionary decisions according to the type of violation committed by the probationer. The relationship between discretionary decisions and variables such as the probationer's risk level and sociodemographic characteristics are also analysed. The study revealed that, despite strict legal regulations, which generally require severe action for probation violations, probation officers tend to make more lenient decisions. The study also found that violation type, offender risk level, and probation officer's age are potential predictors of discretionary decisions. [ABSTRACT FROM AUTHOR]

This article looks at how global flows of people and policies affect penal subjectivity among prisoners in Lithuania. Those who had previously been incarcerated abroad perceive their punishment in Lithuania’s reforming penal system in comparative terms. We find that international prison experience may either diminish or increase the sense of the severity of the current punishment. Respondents often felt more comfortable in a familiar culture of punishment in Lithuania that emphasizes autonomy and communality. Moreover, internationalized prisoners perceive prison reform emulating West European models as a threat to this culture and are able to articulate comparative critiques of this reform and contest its effects. [ABSTRACT FROM AUTHOR]

As in other post-Soviet countries, carceral collectivism characterizes penal institutions in Lithuania. In these institutions, prisoners’ interactions are minimally controlled and convicts are responsible for the maintenance of order; hence, the informal rules of the criminal subculture prevail in Lithuanian correctional facilities. In this article, we examine the prison subculture and adaptation to imprisonment as a significant part of inmates’ social world in post-Soviet Lithuania. By using semi-structured interviews with male prisoners, semi-structured interviews with prison staff, and data from the inmates’ criminal records, we conceptualize both men’s adaptation to imprisonment and current transformations in the Lithuanian prison subculture. As our research shows, the importance of this subculture has decreased in recent years. This process has been influenced by structural changes such as stronger administrative control of convicts, their differentiation and division into smaller groups that limit their mutual contacts, and convicts’ motivation to obtain parole and participate in various rehabilitation programs. The prison subculture has also experienced transformations because of the increasing impact of financial resources on social life, subcultural rules, and interprisoner relationships. Despite these processes, the subculture still plays an important role in inmates’ attempts to choose different daily coping styles and types of adaptation to imprisonment. In this article, we argue that in reforming post-Soviet correctional institutions, a gradual transition to the system of individual cell–type confinement with some remaining elements of collective imprisonment would be desirable. [ABSTRACT FROM AUTHOR]

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The AUC (area under the concentration time curve) is considered the pharmacokinetic exposure parameter best associated with clinical effects. Unfortunately, no prospective studies of clinical outcomes have been conducted in adult transplant recipients to investigate properly the potential benefits of AUC(0–12) monitoring compared to the C0-guided therapy. The aim of the present study was to compare two methods, C0 (through level) and AUC(0–12) (area under the concentration time curve), for assessing cyclosporine and tacrolimus concentrations. The study included 340 kidney recipients. The AUC(0–12) was estimated using a Bayesian estimator and a three-point limited sampling strategy. Therapeutic drug monitoring of tacrolimus performed by using AUC(0–12) and C0 showed that tacrolimus in most cases is overdosed when considering C0, while determination of the AUC(0–12) showed that tacrolimus is effectively dosed for 27.8–40.0% of patients receiving only tacrolimus and for 25.0–31.9% of patients receiving tacrolimus with MMF (mycophenolate mofetil). In the 1–5 years post-transplantation group, 10% higher CsA (cyclosporine) dose was observed, which was proportionate with a 10% higher AUC(0–12) exposure value. This indicates good compatibility of the dosage and the AUC(0–12) method. The Bland–Altman plot demonstrated that C0 and AUC(0–12) might be interchangeable methods, while the ROC (receiver operating characteristic) curve analysis of the C0/AUC(0–12) ratio in the tacrolimus-receiving patient group demonstrated reliable performance to predict IFTA (interstitial fibrosis and tubular atrophy) after kidney transplantation, with an ROC curve of 0.660 (95% confidence interval (CI): 0.576–0.736), p < 0.01. Moreover, AUC(0–12) and C0 of tacrolimus depend on concomitant medication and adjustment of the therapeutic range for AUC(0–12) might influence the results. [ABSTRACT FROM AUTHOR]

Purpose: Although batterers' intervention programs (BIPs) constitute an important part of the coordinated response to intimate partner violence (IPV) and contribute to increasing the perpetrators' accountability and keeping victims safe, the effectiveness of these programs is still debated. Only recently has the focus of these debates shifted away from researching outcomes by measuring overall program effectiveness toward specific qualities of interventions across program models that may be effective for the distinct client (Babcock et al., Clinical Psychology Review, 23 (8), 1023-1053, 2004; Zarling et al., Psychology of Violence, 9 (3), 257-266, 2019). The discussion on the practical implementation of BIPs was supplemented by various significant concepts emerging from new empirical findings, such as differential treatment, motivational interviewing, and effective facilitator-client alliances (Hamel et al., Partner Abuse, 11 (4), 387-414, 2020; Holtrop et al., Journal of Interpersonal Violence, 32 (8), 1267-1290, 2017). This paper aimed to address some of the abovementioned concepts by identifying challenges that arise during the implementation of BIPs in Lithuania., Methods: Using qualitative data from semi-structured interviews and focus group discussions with BIPs facilitators, BIPs attendees, and various stakeholders, the paper discusses how to contribute to more effective BIPs outcomes., Results: According to this study, the process of implementing BIPs in Lithuania should be systematized by incorporating existing instruments, such as motivational interviewing, risk-based assessment, and differential treatment, evidence-based programs focused on different theoretical approaches, and forms of implementation., Conclusion: The study found that the consistency and integrity of the entire BIP implementation process should be prioritized, and institutional cooperation in Lithuania needs to be improved to achieve a successful coordinated response to intimate partner violence., Competing Interests: Conflict of InterestThe authors declare no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

This article focuses on the importance of the right to effective participation of children in conflict with the law in criminal (youth justice) proceedings. In particular, it explores two procedural aspects which are closely related to the right to child-friendly legal aid and the role of individual assessment. The authors claim that qualitatively identifying the needs of the child (through the instrument of individual assessment) and establishing a relationship of trust with a specifically trained legal aid lawyer is critical in raising the child's status to that of an active participant in the proceedings and ensuring that the best interests of the child are observed. The authors also suggest that such an initial encounter within the justice system forms an attitude (of either confidence or rejection) of the child towards public institutions and, accordingly, directly affects the effectiveness of further interventions. To support their position, the authors of the paper bring several examples from the comparative research carried out in two European projects, noting, regretfully, that the initial interventions often suffer from formal implementation and lack a systemic approach.

Introduction: Mortality rates for patients undergoing maintenance hemodialysis remain high. Published data regarding association between health-related quality of life (HRQOL) and mortality among hemodialysis patients are inconsistent. Very few data are published on the change in HRQOL over time as a predictor of mortality. The aim of this study was to assess whether HRQOL and change of it over time could be considered an independent predictor of mortality in hemodialysis patients., Material and Methods: This prospective observational study enrolled 183 patients undergoing maintenance hemodialysis. HRQOL was measured annually 2004-2008 using a generic Short Form 36 questionnaire. Physical component summary (PSC) and mental component summary (MSC) scores were calculated. The change of the patient's HRQOL over time was calculated as a difference between SF-36 scores of the first and the last HRQOL measurements., Results: The median follow-up was 48 months (range, 1-72 months). Cutoff values for HRQOL predicting mortality for PSC score was ≥35 and for MSC score was ≥45. In the model adjusted for age, sex, dialysis months, creatinine, albumin and hemoglobin levels, mortality risk decreased by 0.96 (95% CI, 0.95-0.99) for 1-point increase in the baseline PSC score and decreased by 0.97 (95% CI, 0.95-0.98) for 1-point increase in the baseline MSC score. A 1-point decline in the PSC score (relative risk, 1.11; 95% CI, 1.008-1.221) and MSC score (relative risk, 1.07; 95% CI, 1.002-1.149) over the period of follow-up were associated with a significant additional increase in mortality., Conclusions: Both baseline HRQOL and decline of HRQOL are independent predictors of mortality in hemodialysis patients.

Unlabelled: The aim of this study was to evaluate the risk factors for cardiovascular hospitalization in hemodialysis patients., Materials and Methods: A cross-sectional cohort analysis of risk factors during one census month (November) and one-year follow-up for cardiovascular hospitalization rates during 5 consecutive years (2002-2006) in all end-stage renal disease patients hemodialyzed in Kaunas region was carried out. During the census month, we collected data on patient's age and sex, disability status, comorbidities, anemia control, malnutrition and inflammation, calcium-phosphorus metabolism, and patient's compliance with prescribed medications. We analyzed 559 patients during 1163 patient-years of observation. Patients were considered as new patients every year (1520 cases). Kaplan-Meier method and Cox regression analysis were used to evaluate time to first hospitalization., Results: The mean number of cardiovascular hospitalizations was 0.31 per patient-year at risk, the total days of cardiovascular hospitalizations per patient-year at risk were 3.93, and the mean length of one hospitalization was 13.2±12.9 days. Cardiovascular diseases were the most frequent cause of hospitalization (25% of all hospitalizations). The relative risk of cardiovascular hospitalization increased by 1.03 for every year of age, by 1.7 for worse disability status, by 1.4 for nonadherence to medications, by 1.1 for every additional medication prescribed to the patient. Cardiovascular hospitalization risk was decreased by 0.99 with a 1-g/L rise in hemoglobin level., Conclusions: Older age, worse disability status, patient's noncompliance with medications, and higher number of medications used were associated with a higher risk for cardiovascular hospitalization. Higher hemoglobin level was associated with a lower risk for cardiovascular hospitalization.