BACKGROUND: Injury is the number one public health problem in Lithuania in terms of disability adjusted life years lost. The trauma system plays an important role in injury statistics. The objective of this article is to describe and assess the performance of Lithuanian trauma sector. METHODS: The framework for assessing the performance of health systems proposed by Murray and Frenk (2000) was employed. RESULTS: The primary intention criterion--to reduce the number of trauma cases, injury related mortality and disability rates by 30% by 2010-is well defined. The Lithuanian whole-trauma sector does not substantially contribute to improving the health of the population. The legitimate expectations of the community--respect of persons in terms of dignity, autonomy, confidentiality, client orientation--do not correspond with the responsiveness of the trauma service. Financing of the trauma sector does not correspond with the magnitude of the injury problem. Lithuanian trauma service is decentralized. There is no trauma leadership in the country. There is no national policy for unintentional injury prevention and control, no specialized injury research institute, no system of trauma centres, and no Injury Surveillance System in Lithuania. There is no such specialty as Emergency Medicine as of 2009. A political and public will to reform the trauma sector is not sound. CONCLUSION: The performance of the decentralized Lithuanian trauma sector does not match with the primary intention criterion and does not correspond to the needs of people. Lithuanian trauma service has to be conceptualized and changed to inclusive.
The Family Division of the High Court exercises jurisdiction in family proceedings in England and Wales. A broadly similar jurisdiction is exercised under the Children Act in care proceedings and in private law disputes between parents by county courts and family proceedings courts. It should be emphasised that this article is about civil, not criminal, proceedings in which the burden of proof is diVerent and the practice which I describe does not apply. 2 The most recent example is the acknowledgment by the Court of Appeal that paediatricians and child psychiatrists are entitled in family proceedings to express opinions on child abuse which are based on or take into account the expert's assessment of the child's truthfulness: see Re M and R (Child Abuse: Evidence) [1996] 2 FLR 195, CA. Equally, I do not have space to address the duties of experts generally, as to which there is agreement across all the divisions of the High Court that expert evidence presented to the court should be and should be seen to be the independent product of the expert uninfluenced as to form or content by the exigencies of litigation. In Re J [1991] FCR 191 at 226/7, Cazalet J said that in children's cases the duty to be objective and not to mislead is as vital as in any case, because the child's welfare is at stake, and his/her interests are paramount. He added that an absence of objectivity may result in a child being wrongly placed and thereby unnecessarily at risk. It must also be borne in mind that a misleading opinion from an expert may well inhibit a proper assessment of a particular case by the non-medical professional advisers and may also lead parties, and in particular parents, to false views and hopes. 3 By section 12 of the Administration of Justice Act 1960, as amended by Schedule 13, para 14 of the Children Act 1989, it is a contempt of court to publish information relating to proceedings brought (inter alia) under the Children Act. 4 Oxfordshire County Council v M [1994] Fam 151, CA: Re L (A Minor) (Police Investigation) [1996] 2 WLR 395, HL. 5 By section 1(2) the court is required to have regard to the general principle that any delay in determining questions relating to the upbringing of children is likely to prejudice their welfare. 6