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PubMed2000

Accumulation of cadmium, zinc, and copper in maternal blood and developmental placental tissue: differences between Finland, Estonia, and St. Petersburg.

Cadmium, zinc, and copper from placental tissue and blood samples at the first trimester (n = 64) and at term (n = 152) were analyzed; the welfare of newborns and placental 7-ethoxycoumarin O-deethylase (ECOD) activities in vitro were determined. The study material was collected from Finland, Estonia, and Russia. The results demonstrate that Cd starts to accumulate in the placenta during the first trimester and that Zn and Cu contents were significantly higher at the first trimester than at term. Among nonsmokers a negative correlation was found between placental Cu content and birth weight of neonates. Among smokers a positive correlation between placental Zn content and birth weight and ECOD activity was found. The birth weights correlated inversely with the length of time the mothers smoked. The highest Cd concentrations were detected in the samples collected from St. Petersburg. The data demonstrate an inverse accumulation of Zn and Cd throughout the pregnancy in the placenta and maternal blood samples. Zn may act as a positive marker or even an enzymatic enhancement for the human placental vital functions. Smoking, parity, age, and especially the place of residence affect the Cd, Zn, and Cu contents and ratios in placenta and mother's blood.

7-Alkoxycoumarin O-Dealkylase↗

PubMed1994

Electropherotypes and serotypes of human rotavirus in Estonia in 1989-1992.

The electropherotypes and serotypes of human rotaviruses circulating in Tallinn (Estonia) in 1989-1992 have been studied. Rotaviruses were found in 372 (25.8%) of 1,442 faecal specimens of pediatric patients with acute diarrhea. Polyacrylamide gel electrophoresis of RNA from 318 isolates has revealed 41 electropherotypes. Frequent genomic alterations, including a shift of predominant electropherotypes, were observed during the study period. The serotype of 158 (50.3%) of 314 tested rotavirus isolates was identified using ELISA with VP7-specific monoclonal antibodies against 4 established human rotavirus serotypes. Serotype G1 was found to be largely predominant and accounted for 70.9% of the typeable specimens, serotypes G4, G2, and G3 accounted for 12%, 9.5%, 7.6%, respectively. A major shift to serotype G4 took place in 1990-1991. Serotype G1 was represented by the largest number of electropherotypes. All G1, G3 and G4 isolates were of "long" and all G2 isolates were of "short" electropherotypes. According to our results the isolates of an identical electropherotype belong to the same serotype.

Antibodies, Monoclonal↗

PubMed2002

Analysis of river pollution data from low-flow period by means of multivariate techniques: a case study from the oil-shale industry region, northeastern Estonia.

The oil-shale industry has created serious pollution problems in northeastern Estonia. Untreated, phenol-rich leachate from semi-coke mounds formed as a by-product of oil-shale processing is discharged into the Baltic Sea via channels and rivers. An exploratory analysis of water chemical and microbiological data sets from the low-flow period was carried out using different multivariate analysis techniques. Principal component analysis allowed us to distinguish different locations in the river system. The riverine microbial community response to water chemical parameters was assessed by co-inertia analysis. Water pH, COD and total nitrogen were negatively related to the number of biodegradative bacteria, while oxygen concentration promoted the abundance of these bacteria. The results demonstrate the utility of multivariate statistical techniques as tools for estimating the magnitude and extent of pollution based on river water chemical and microbiological parameters. An evaluation of river chemical and microbiological data suggests that the ambient natural attenuation mechanisms only partly eliminate pollutants from river water, and that a sufficient reduction of more recalcitrant compounds could be achieved through the reduction of wastewater discharge from the oil-shale chemical industry into the rivers.

Biodegradation, Environmental↗

PubMed2005

Adaptation of the rheumatoid arthritis quality of life scale for Estonia.

The aim of the study was to adapt the rheumatoid arthritis quality of life scale (RAQoL) for Estonia and assess its psychometric properties. The RAQoL was translated into Estonian using the dual panel method. The translation was assessed for face and content validity by means of interviews with 15 rheumatoid arthritis (RA) patients. Reproducibility and construct validity were estimated using a further sample of 50 patients. Unidimensionality of the final scale was assessed by Rasch analysis. No major problems occurred in translating the instrument, it was well accepted by interviewees. The Estonian RAQoL had good test-retest reliability, internal consistency and ability to discriminate between groups defined by patient-perceived severity. Predicted convergent and divergent validity was demonstrated. Unidimensionality of the instrument was confirmed by excellent fit to the Rasch model. The RAQoL is appropriate for use in clinical studies and trials involving RA patients.

Arthritis, Rheumatoid↗

PubMed2001

Identification of victims from the M/S Estonia.

With 852 victims from 17 different countries, the sinking of the Estonia was Europe's most severe passenger ferry disaster. The Finnish Disaster Victim Identification (DVI) team identified all 93 victims recovered from the sea within 33 days of the accident as well as victim number 94 found 18 months later. Dental identification was established in 57 cases (60%).

Cause of Death↗

PubMed2006

Molecular epidemiology of Trichinella spp. in three Baltic countries: Lithuania, Latvia, and Estonia.

Meat of domestic pigs and wild boars has been the significant source of emerged human trichinellosis in Lithuania, Latvia, and Estonia over the past two decades. However, there is very little known on the occurrence of Trichinella spp. in main wildlife reservoirs and its transmission in domestic and sylvatic cycles in these countries. The present study demonstrated considerably higher endemicity of Trichinella spp. in main sylvatic reservoirs (28.9-42% in foxes (Vulpes vulpes) and raccoon dogs (Nyctereutes procyonoides) in all three countries than previously reported. Molecular identification of Trichinella larvae from more than 500 sylvatic and domestic animals revealed four Trichinella species (Trichinella spiralis, Trichinella britovi, Trichinella nativa, and Trichinella pseudospiralis) sympatric in a relatively small area and several as the first records for the respective countries. The nonencapsulating T. pseudospiralis is found for the first time in the Eastern Europe. Sylvatic T. britovi was found in domestic pigs in Lithuania and Latvia (16 and 57.1%, respectively) and only in these countries, domestic T. spiralis was detected in sylvatic animals in areas where domestic trichinellosis was registered. The study suggests that transmission of Trichinella between domestic and sylvatic cycles in Lithuania and Latvia is favored by improper human behavior, e.g., pig and slaughter waste management.

Animals↗

PubMed2000

The phenological calendar of Estonia and its correlation with mean air temperature.

A phenological calendar with 24 phenological phases was compiled for three meteorological stations in Estonia for the period 1948-1996. We analysed the length of the vegetation period, the order of the phenological phases, and the variability and possible changes for two incremental climate change scenarios (+/-2 degrees C), and compared the results with examples of extreme years. The statistically significant linear trends show that the spring and summer-time phenological phases occurred earlier and the autumn phases moved later during the study period. The study of extreme (minimum and maximum) years shows that 70% of the earliest dates of the 24 phases studied have occurred during the last 15 years with an absolute maximum in 1990 with 8 extreme phases. The phenological spring has shortened (slope -0.23), the summer period has lengthened (slope 0.04), and the autumn has lengthened too. The length of the growing season, determined by the vegetation of rye, has shortened (slope -0.09), which could be the result of changing agricultural technology. The correlation between the starting dates of the phenological phases with the air temperature of the previous 2-3 months is relatively high (0.6-0.8). Studying the +2 degrees C and -2 degrees C scenarios and values for the extreme years shows that, in the case of short variations of air temperature, the phenological development remains within the limits of natural variation.

Climate↗

PubMed2006

Methods to recruit hard-to-reach groups: comparing two chain referral sampling methods of recruiting injecting drug users across nine studies in Russia and Estonia.

Evidence suggests rapid diffusion of injecting drug use and associated outbreaks of HIV among injecting drug users (IDUs) in the Russian Federation and Eastern Europe. There remains a need for research among non-treatment and community-recruited samples of IDUs to better estimate the dynamics of HIV transmission and to improve treatment and health services access. We compare two sampling methodologies "respondent-driven sampling" (RDS) and chain referral sampling using "indigenous field workers" (IFS) to investigate the relative effectiveness of RDS to reach more marginal and hard-to-reach groups and perhaps to include those with the riskiest behaviour around HIV transmission. We evaluate the relative efficiency of RDS to recruit a lower cost sample in comparison to IFS. We also provide a theoretical comparison of the two approaches. We draw upon nine community-recruited surveys of IDUs undertaken in the Russian Federation and Estonia between 2001 and 2005 that used either IFS or RDS. Sampling effects on the demographic composition and injecting risk behaviours of the samples generated are compared using multivariate analysis. Our findings suggest that RDS does not appear to recruit more marginalised sections of the IDU community nor those engaging in riskier injecting behaviours in comparison with IFS. RDS appears to have practical advantages over IFS in the implementation of fieldwork in terms of greater recruitment efficiency and safety of field workers, but at a greater cost. Further research is needed to assess how the practicalities of implementing RDS in the field compromises the requirements mandated by the theoretical guidelines of RDS for adjusting the sample estimates to obtain estimates of the wider IDU population.

Data Collection↗

PubMed2006

Suicide risk among Chernobyl cleanup workers in Estonia still increased: an updated cohort study.

PURPOSE: The aim of the study is to examine the mortality experience among Chernobyl cleanup workers. METHODS: A cohort study of 4786 men from Estonia who participated in the Chernobyl cleanup from 1986 to 1991 and were traced until December 31, 2002. Standardized mortality ratio (SMR) and adjusted mortality rate ratio (RR) derived through Poisson regression analysis were calculated. RESULTS: During follow-up, 550 deaths occurred, yielding an SMR of 1.01 (95% confidence interval [CI], 0.92-1.09). Increased risks were observed for suicide alone (SMR, 1.32; 95% CI, 1.03-1.67) and suicide combined with undetermined injury (SMR, 1.29; 95% CI, 1.03-1.60). One leukemia death occurred, and no thyroid cancer deaths were found. Elevated mortality also was observed for brain cancer (SMR, 2.78; 95% CI, 1.02-6.05). The adjusted RR for suicide remained stable over the time passed since return from the Chernobyl area, showing RRs of 1.09 (95% CI, 0.56-2.10) for 5 to 9 years and 1.00 (95% CI, 0.48-2.05) for 10 or more years compared with less than 5 years. CONCLUSIONS: During the 17 years after the accident, suicide risk in the cohort was greater than in the general male population. No elevated risk in overall mortality and radiation-related cancers was observed. The long-term nature of this elevated risk provides concrete evidence that psychological consequences represent the largest public health problem caused by the accident to date.

Chernobyl Nuclear Accident↗

PubMed2006

Is a poor pregnancy outcome related to young maternal age? A study of teenagers in Estonia during the period of major socio-economic changes (from 1992 to 2002).

OBJECTIVE: To assess the risk of low birth weight, preterm birth, stillbirth, neonatal and postneonatal death among primiparous teenagers having singleton births, compared to a similar group of women aged 20-24 years in Estonia during the period of major socio-economic changes. STUDY DESIGN: Registry study using the data from the Estonian Medical Birth Registry (EMBR) for years 1992-2002; EMBR data were linked with infant deaths in the Estonian Mortality Database. Study population included 51,890 women aged 13-24 years, arranged into three groups: < or =17, 18-19, and 20-24. Crude odds ratios (OR), adjusted ORs and their 95% confidence intervals (CI) for the different outcomes were estimated using multiple logistic regression analysis. RESULTS: Compared with women aged 20-24 years, the risk of low birth weight and preterm birth was higher among teenagers. The risk of low birth weight and preterm birth within the study group as a whole did not change during the study period. Increased risks in neonatal and postneonatal death among younger teenagers of an age of 17 years and less seem to be a result of prematurity. CONCLUSIONS: Despite major socio-economic changes resulting in improvements in obstetric care and growth in incomes, teenagers remained a higher risk group.

Adolescent↗

PubMed2006

Geographical variations in hospital use in Estonia.

The purpose of this study was to analyse the utilisation of inpatient care in Estonia. Using small-area analysis the age and sex of municipality residents and travel time to the nearest hospital were linked to the frequency of use and length of stay of respective inpatients. Adjusted hospitalisation and readmission rates decreased with increasing travel time to the hospital. The travel time effect on the length of stay was inconsistent. Despite differences in hospital utilisation among municipalities, geographical access to inpatient care was substantially diminished only for 3% of the population living further than 30 min from hospital.

Adolescent↗

PubMed2006

PFGE genotyping and antimicrobial susceptibility of Campylobacter in retail poultry meat in Estonia.

In the present study, the Campylobacter isolates from retail poultry meat in Estonia were sero- and genotyped, and the antimicrobial susceptibility was determined. Forty-eight chicken (36 Estonian, 12 imported) and 22 turkey (imported) Campylobacter isolates from 580 raw broiler chicken (396 Estonian, 184 imported) and 30 turkey (imported) meat samples were studied. Of the isolates, 64 were C. jejuni, 4 C. coli, and 2 Campylobacter spp. Penner serotyping of 54 C. jejuni isolates revealed 11 different serotypes, and 22% of the isolates were nontypeable by the commercial antisera. The most common serotypes O:1,44; O:21, and O:55 accounted for 28%, 13%, and 13% of the isolates, respectively. Differences in serotype distribution were seen for chicken and turkey isolates. Genotypic characterization of all Campylobacter isolates (n=70) was performed by pulsed-field gel electrophoresis (PFGE). SmaI and KpnI yielded 29 and 34 PFGE types, respectively, revealing high diversity among isolates. The serotype distribution did not show an association with the origin of the sample, but the majority of the isolates sharing a similar PFGE genotype originated from one country. High levels of resistance to ciprofloxacin (66%), nalidixic acid (66%), tetracycline (44%), ampicillin (34%), and erythromycin (14%) were detected among the 70 Campylobacter isolates. The simultaneous resistance to two or three antimicrobial agents occurred in 60% of the isolates. The Campylobacter isolates from turkey meat had higher resistance to ampicillin, ciprofloxacin, nalidixic acid, and tetracycline than those from chicken meat. None of the chicken isolates were resistant to gentamicin, and no turkey isolates to erythromycin or gentamicin.

Animals↗

PubMed2002

Social variation in self-rated health in Estonia: a cross-sectional study.

Over the past 40 years Estonia has experienced similar developments in mortality to other former Soviet countries. The stagnation in overall mortality has been caused mainly by increasing adult mortality. However, less is known about the social variation in health. This study examines differences in self-rated health by eight main dimensions of the social structure on the basis of the Estonian Health Interview Survey, carried out in 1996/1997. A multistage random sample (n = 4711) of the Estonian population aged 15-79 was interviewed; the response rate was 78.3%. This study includes those respondents aged 25-79 (n = 4011) with analyses being performed separately for men and women. The study revealed that a low educational level, Russian nationality, low personal income and for men only, rural residence were the most influential factors underlying poor health. Education had the biggest independent effect on health ratings: for women with less than an upper secondary education the odds of having poor health were almost fourfold (OR = 3.88) when compared to those with a university education, and for men these odds were almost two and a half times (OR = 2.32). Material resources, in this study measured by personal income, were important factors in explaining some of the educational and ethnic differences (especially for Russian women) in poor self-rated health. Overall, we found no differences between men and women in their health ratings. On the contrary, when we controlled for physical health status, emotional distress and locus of control women reported better health than men. Health selection contributed to, but did not explain the differences by structural dimension. This study also showed a strong association of poor self-rated health with three correlates-physical health status, emotional distress and locus of control, although the influence of these correlates on poor health ratings was not seen equally in the different structural dimensions.

Adult↗

PubMed2003

Evaluation of primary health care reform in Estonia.

Estonia began to reform its health care system by reorganizing primary health care (PHC). Ten years ago, the health care system was inefficient, supply was biased towards institutional care, and PHC was almost non-existent in the western understanding: it was provided by different specialists in policlinics, and the financial basis of the system was in crisis. The reform had the following aims: to develop PHC by introducing family medicine, to guarantee the whole population access to family doctors' services, and to secure stable funding for these services. In 1998, a new phase in the reform was introduced through the creation of a new funding system for primary care services. The aim of this paper is to present a practically applicable set of indicators to evaluate PHC reform in terms of health economics criteria and then to apply these indicators in evaluation of the Estonian PHC reform.

Efficiency, Organizational↗

PubMed2003

Prevalence of adult epilepsy in Estonia.

Epidemiological data about epilepsy from central and eastern Europe is scarce and results are controversial. The aim of this study was to estimate the main prevalence-related characteristics of active epilepsy in an adult population in Estonia. Review of all databases and lists related to epilepsy in Tartu supplemented by re-examination of patients to identify all persons with active epilepsy aged >/=20 years on January 1, 1997. Special attention was paid to the extensive adoption of definitions and criteria proposed by ILAE guidelines for epidemiologic studies. Both, crude and age-adjusted (to the 1970 US population) prevalence rates were 5.3 per 1000. The age-specific rates were constant in age groups 30-69 years and declined in the oldest age groups. Of the seizure types, partial seizures had highest rates, over half were secondarily generalized seizures. The largest syndromic categories were localization-related symptomatic and cryptogenic epilepsies. Risk factors for epilepsy were identified in 39.6% cases. Some 22% of all subjects did not take antiepileptic medication. Prevalence of active epilepsy and other prevalence-related characteristics in the adult population of Tartu was comparable to those reported from the developed countries. The predominance of localization-related syndromes and partial seizures is due to the age distribution of the study.

Adult↗

PubMed2001

Survival of patients with primary CNS tumours in Estonia.

We studied a population-based survey that included 1417 patients with a primary central nervous system (CNS) tumour diagnosed in Estonia between 1986 and 1996. Survival rates at 1 and 5 years and median survival by histology and patient's age at diagnosis were estimated. Median survival time for all tumours was 33.2 months and 1- and 5-year survival rates were 59.3 and 46.0%, respectively. In multivariate analysis, younger age, better clinical condition (i.e. a Karnofsky Performance Status (KPS) score of 60 and more) and tumour histology were all dependent prognostic factors for better survival. Risk of death was more than 8 times greater for glioblastoma (Risk Ratio (RR) 8.31) and approximately seven times greater for anaplastic astrocytoma (RR 7.22) and other gliomas (RR 5.74) compared with meningiomas. Comparing the first (1986-1989) and the third (1994-1996) time periods, statistically significant improvements in survival occurred for all tumours and astrocytomas. Declines in survival during the second period (1990-1993) were statistically significant for all the tumour groups, but the most striking decrease took place in patients with glioblastoma. Age-specific rates showed that the increase in survival was more evident for patients aged between 45 and 64 years.

Adolescent↗

PubMedDate not supplied

Gamma-ray dose assessment after the 1994 radiation accident in Kiisa (Estonia): preliminary results.

Dose reconstruction using thermoluminescence (TL) of quartz, extracted from the ceramic plant pots, and using EPR of the sugar samples, was performed after the 1994 radiation accident in the village Kiisa (Estonia). A gamma-ray source 137Cs was located during approx. 28 days in one of the village dwelling houses. On the basis of preliminary results, some important details of the history of the accident have been clarified. It was shown, that the gamma-ray source most of the time was placed in the kitchen table drawer. Thus, the absorbed dose rate of whole-body exposure for three inhabitants of the house in Kiisa was defined by this location of the source.

Adolescent↗

PubMed2003

Impact of emission from oil shale fueled power plants on the growth and foliar elemental concentrations of Scots pine in Estonia.

To study the impact of air pollution on the growth and elemental composition of conifers, 5 sample plots were established at different distances and directions from the Estonian Power Plant (Northeast Estonia) in 1999-2000. The selected stands were 75-80(85)-yr-old parts (0.05 ha) of (Oxalis)-Myrtillus site type forest of 0.7-0.8 density. The soils of all sample plots were Gleyic Podzols (Lkg) on sands. The several times higher Ca concentration in the humus horizon of the sample plot NE from the Estonian PP is caused by the prevailing westerly and southerly winds which carry more pollutants NE from the power plant than to SSW. To ascertain the effect of power plants on the growth of Scots pine (Pinus sylvestris L.), the length growth of the needles and shoots formed in 1997-2000, dry weight of 100 needles, and density of needles on the shoots were measured. As compared to the control, the strongest inhibition of growth was revealed in the sample plots situated 22 km north-east and 17 km south-west from the Estonian Power Plant. As compared to control, the needles of trees growing on sample plots closer to the power plant showed higher contents of Ca, S and Zn. The content of Mg in needles increased with distance from the pollution source. Current year needles had higher contents of Cu and Zn than older needles. Today the amounts of fly ash emitted from Narva power plants are fallen. Long-term fly ash emission has caused changes in the measurements of morphological parameters and chemical composition of needles.

Air Pollutants↗