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PubMed2005

Cattail population in wastewater treatment wetlands in Estonia: biomass production, retention of nutrients, and heavy metals in phytomass.

The aim of this article is to evaluate and compare common cattail (Typha latifolia) biomass production and annual accumulation of nitrogen, phosphorus, carbon, and heavy metals (Cd, Cu, Pb, Zn) in phytomass in 3 treatment wetland systems in Estonia. The biomass samples (roots/rhizomes, shoots with leaves, and spadixes) and litter were collected from 1 x 1 m plots--15 plots in Tänassilma seminatural wetland, 15 plots in Põltsamaa constructed wetland, and 10 plots in Häädemeeste constructed wetland. The highest average total cattail phytomass was 2.54 kg DW m(-2) in Häädemeeste. In Tänassilma and Põltsamaa this value was 2.3 and 2.11 kg DW m(-2), respectively. The average total aboveground biomass production and roots/rhizomes phytomass was not significantly different in three studied wetland systems. We have found significantly less spadixes and litter in Tänassilma than in Põltsamaa and Häädemeeste. In Põltsamaa, the N and P content in all plant fractions were higher than in other test areas. The Cd concentration in all samples (shoots, spadixes, litter) varied from < 0.01 to < 0.02 mg/kg. The average concentration of Zn in litter varied from 12.2 mg kg(-1) in Häädemeeste to 12.6 mg kg(-1) in Tänassilma and 13.3 mg kg(-1) in Põltsamaa. There has been found a significantly higher average contents of Cu (39.3 mg kg(-1)), Pb (30.4 mg kg(-1)), and Zn (412.3 mg kg(-1)) in Tänassilma than those in Häädemeeste or Põltsamaa: Cu-11.6 and 15.9, Pb--2.3 and 3.3, and Zn--57.5 and 73.2 mg kg(-1), respectively. The highest heavy metal retention (303.2 mg Pb m(-2), 29.4 mg Zn m(-)2, 22.9 mg Cu m(-2), and 0.35 mg Cd m(-2)) was observed in root and rhizome samples from the Tänassilma wetland.

Biodegradation, Environmental↗

PubMed2000

Diphtheria in Estonia, 1991-1996.

Clinical diphtheria reappeared in Estonia in 1991. Between 1991 and 1996, 61 cases and 5 deaths occurred; 19 cases were among children 5-9 years of age, and 11 were among persons 40-49 years of age. From 1993-1995, vaccine supplies donated by Finland were used in vaccination programs. In 1995, the International Federation of Red Cross and Red Crescent Societies and the Estonian Red Cross launched a mass vaccination campaign targeting the adult population. By the end of 1997, it was estimated that 46% of adults had received at least one dose of vaccine. Although the vaccination campaigns did not target the pediatric population, vaccination coverage in school-aged children remained high due to continuing routine vaccination programs. The reappearance and epidemic of clinical diphtheria cases and the mass vaccination campaign efforts demonstrated that preventive measures are important and must be maintained in order to keep diphtheria under control.

Adolescent↗

PubMed2004

Two viral strains and a possible novel recombinant are responsible for the explosive injecting drug use-associated HIV type 1 epidemic in Estonia.

HIV-1 infection has been rare in Estonia. In 2000, an explosive epidemic among injecting drug users was detected in the Eastern border region, resulting in 3603 newly reported cases by the end of 2003. The molecular epidemiology of the outbreak was studied to establish whether the Estonian epidemic is linked to the epidemics in Eastern Europe. Over 200 newly infected individuals were prospectively sampled from June 2000 to March 2002 in a geographically representative way, with known dates of diagnosis and information of probable route of transmission. Viral regions coding for two viral gene regions were directly sequenced from plasma viral RNA and phylogenetically analyzed. In addition, a larger region coding for the entire env gene was sequenced from one sample and studied for indications of possible recombinant structure. The Estonian HIV outbreak was found to be caused by simultaneous introduction of two strains: a minor subtype A strain very similar to the Eastern European subtype A strain (approximately 8% of cases), and a second major strain (77%) found to be most closely related to the CRF06-cpx strain, previously described only from African countries. The variability in the two clusters was very low, suggesting point source introductions. Ten percent of cases seemed to be newly generated recombinants of the A and CRF06-cpx strains. Analysis of viral diversification over time revealed a rate of change within the V3 region of 0.83%/year for the CRF06-cpx strain, consistent with findings from other subtypes. Due to the relatively frequently found novel recombinant forms, the Estonian HIV-1 epidemic may allow studies of coinfection and intersubtype recombination in detail.

Disease Outbreaks↗

PubMed2004

Association between health behaviour and self-reported health in Estonia, Finland, Latvia and Lithuania.

BACKGROUND: The aim of the present study is to examine the associations of the selected health behaviours (daily smoking, frequent strong alcohol use, consumption of fresh vegetables less than 3 days a week and leisure time physical activity less than two/three times a week) to the self-assessed health after adjustment to the age and education in Estonia, Finland, Latvia and Lithuania. METHODS: Data from cross-sectional surveys carried out in all the above-mentioned countries were used. The methodology and questionnaires of the surveys were standardized between the participating countries within the Finbalt Health Monitor System. Logistic regression was used to assess the effect of self-perceived health status on prevalence of health behaviours. RESULTS: In Finland both women and men rated their health better than both genders in all the Baltic countries. In Finland self-assessment of health is significantly associated with most health behaviours, but in the Baltic counties the associations are weak or unstable. CONCLUSION: The results suggest that in Finland as in many other stable countries self-assessed health status was related to health behaviours and can be used as an indicator of health behaviours. In the Baltic countries, factors other than health behaviours may be more relevant to the self assessment of health status.

Adult↗

PubMed2004

The progress of reforms: job satisfaction in a typical hospital in Estonia.

OBJECTIVE: To evaluate the level of job satisfaction among the staff at an Estonian hospital and to describe factors related to their job satisfaction. DESIGN: Questionnaire survey. SETTING: Pärnu County Hospital in Estonia. STUDY PARTICIPANTS: All staff members of the Pärnu County Hospital (n = 673), except 56 staff members who were away from work during the study. RESULTS: Respondents (n = 473) indicated an average job satisfaction level of 3.86 +/- 0.81 on a 5-point scale. The efficiency of hospital management as measured by planning, relationships with supervisors, knowledge and communication regarding hospital goals, plans, quality of services, budgetary situation, and staffing problems was positively correlated with job satisfaction. Stress and unrealistic expectations were negatively correlated with job satisfaction. The feeling of being part of the organization was also correlated with job satisfaction. Recognition from supervisors and discussions with colleagues were found to be weakly correlated with job satisfaction. There were differences between occupational categories. CONCLUSION: The management of Pärnu County Hospital has been able to create good supervisory relationships with staff by providing sufficient information about the goals of the hospital, the quality of services, the budgetary situation, and staffing problems that arise. Stress levels reported are not excessive and staff are loyal to their hospital.

Estonia↗

PubMed1992

Insulin-dependent diabetes mellitus in native Estonians and immigrants to Estonia.

The authors compared the epidemiology of childhood insulin-dependent diabetes mellitus in Estonia during 1980-1989 between native Estonians and an immigrant group that consisted mainly of Russians. The average annual incidence of diabetes mellitus was significantly higher in Estonians (11.8 per 100,000 children aged less than 15 years; 95% confidence interval (CI) 10.4-13.3) than in non-Estonians (7.6 per 100,000 children aged less than 15; 95% CI 6.2-9.4). This difference appeared in both sexes. The highest incidence in both Estonians and non-Estonians was recorded in 1982, when the incidence in the immigrant population was twice as high as the baseline level. These data indicate that immigrant populations need not acquire the same risk of insulin-dependent diabetes as the native population.

Adolescent↗

PubMed2006

Patient and staff doses in radiology and cardiology in Estonia.

This paper presents a short description of the Estonian radiological facilities and the doses to staff in radiology and cardiology. For each major work practice, the annual (2002) average effective doses are listed: X-ray diagnostics (radiologists: 1.11 mSv; radiographers: 1.03 mSv), interventional radiology (doctors in cardioangiography: 6.04 mSv; radiologist in angiography: 2.71 mSv), nuclear medicine (radiologists: 0.91 mSv; technicians: 2.41 mSv) and radiotherapy (radiologists: 1.00 mSv; technicians: 1.04 mSv). This paper also presents the first results of adult patient dose measurements in diagnostic X-ray departments in Estonia. The average entrance skin dose for chest PA examinations was 0.3 mGy, for chest LAT 0.9 mGy, for lumbar spine AP 6.4 mGy, for lumbar spine LAT 10.7 mGy and for pelvis AP 3.9 mGy.

Cardiology↗

PubMed1997

Inclusive educational practices as perceived by prospective special education teachers in Estonia, Finland, and the United States.

A survey of 125 prospective special education teachers assessed perceptions and beliefs about inclusive education in Estonia, Finland, and the United States (Michigan). The attitudes toward inclusion were rather critical. The Estonians were the most critical group, the Finns the least critical. The meanings attached to a student with severe mental retardation were related to the educational setting assessed as the best for this student. The findings suggest that special educators perceptions about inclusion are related to the prevailing implementation of inclusive education. The results support also the idea that the meanings attached to a person with a disability are connected with behavioural intentions toward this person.

Child↗

PubMed2006

High HIV prevalence among injecting drug users in Estonia: implications for understanding the risk environment.

We found a high prevalence of HIV among injecting drug users (IDU) 54% in Tallinn and 90% in Kohtla Jarve, Estonia. Risk factors for HIV in Tallinn included use of the drug 'china white', being registered as an IDU at a drug treatment clinic, and sharing injecting equipment with sex partners. Differences existed in risk behaviour between the cities. An urgent scale-up of HIV prevention is needed. It is also important to explore how local 'risk environments' mediate the risk of HIV transmission.

Adult↗

PubMed1999

Isolation and characterization of Dobrava hantavirus carried by the striped field mouse (Apodemus agrarius) in Estonia.

Dobrava hantavirus (DOB) was isolated from the striped field mouse (Apodemus agrarius) trapped on Saaremaa Island, Estonia, and its genetic and antigenic characteristics were subsequently analysed. Phylogenetic analysis showed that the Estonian DOB strain, together with several wild strains carried by Apodemus agrarius, forms a well-supported lineage within the DOB clade. The topography of the trees calculated for the S, M and L nucleotide sequences of the Estonian DOB suggests a similar evolutionary history for all three genes of this virus and, therefore, the absence of heterologous reassortment in its evolution. A cross-neutralization comparison of the Estonian virus with the prototype DOB, isolated from a yellow-necked mouse (A. flavicollis) in Slovenia, revealed 2- to 4-fold differences in the end-point titres of rabbit and human antisera. When studied with a panel of 25 monoclonal antibodies (MAbs), the Estonian and Slovenian DOB isolates showed similar antigenic patterns that could be distinguished by two MAbs. Genetic comparison showed sequence differences in all three genome segments of the two DOB isolates, including an additional N-glycosylation site in the deduced sequence of the G2 protein from the Estonian virus. Whether any of these mutations relates to the different rodent hosts rather than to the distant geographical origin of the two isolates remains to be resolved. Taken together, our observations suggest that A. agrarius, which is known to harbour Hantaan virus in Asia, carries another hantavirus, DOB, in north-east Europe.

Animals↗

PubMed1995

Patterns of drug treatment of schizophrenic patients in Estonia, Spain and Sweden.

1. Patterns of drug treatment and the use of polypharmacy in schizophrenic in-patients were compared and evaluated in the University Teaching Hospitals of Psychiatry in Badajoz, Spain, Huddinge, Sweden, and Tartu, Estonia. 2. The medical records of up to 100 consecutively admitted patients were retrospectively reviewed using a standardized data form. 3. The male patients were significantly younger than females in all study locations, but there were no age differences between the locations. The length of stay was equal for the two series in the same hospital, but considerably longer in Tartu than in Badajoz and Huddinge. 4. The neuroleptic drugs used most commonly in Badajoz and Tartu were similar in prescription frequency and in the doses prescribed, but different from those used in Huddinge. Haloperidol was the most frequently prescribed neuroleptic in Badajoz and Tartu, accounting for one third of all neuroleptic prescriptions. In Huddinge the choice of neuroleptics was more evenly spread over several compounds. Intramuscular injections other than depot preparations were commonly used in Tartu and Badajoz, but not in Huddinge. 5. At least two neuroleptics were prescribed simultaneously on 73% of treatment days in Badajoz and 46% in both Huddinge and Tartu. The average cumulative daily doses of concomitant multiple neuroleptic treatment, expressed in chlorpromazine equivalents, were lower in Huddinge than in the other study locations and higher for male patients in Badajoz and Tartu. 6. Anticholinergics were used together with neuroleptics in 42% of treatment days in Badajoz and 30% in Huddinge as compared with 75% in Tartu. The use of anticholinergics increased in parallel to the increase in the number and the cumulative dose of concomitant neuroleptics in all study locations. 7. About 15% of patients in Badajoz and Tartu, but only 1% in Huddinge, received concomitant treatment with antidepressant drugs. The simultaneous use of antidepressants and benzodiazepines was inversely related to the number and the cumulative dose of neuroleptics in Badajoz and Tartu. In contrast, the cumulative dose and number of neuroleptics were greater, when additional benzodiazepines were prescribed in Huddinge. 8. The study in schizophrenic in-patients revealed that polypharmacy with concomitant multiple neuroleptics, additional anticholinergics and other psychotropics is an international phenomenon.

Adult↗

PubMed1998

Organizational changes in Estonia.

The situation of the blood transfusion service in Estonia is analyzed since 1991. Considerable changes towards the establishment of a cost-effective on a cost-efficient system providing self-sufficiency of good quality blood products in future have been made. National blood transfusion service based on voluntary nonremunerated donations is under development.

Blood Banks↗

PubMed2004

Monoclonal antibody characterization of rabies virus isolates from Russia, Finland and Estonia.

Five different rabies virus variants were identified among rabies virus-positive samples from Russia, Finland and Estonia, using a panel of five anti-nucleocapsid monoclonal antibodies. Two rabies virus isolates showed a different reaction pattern, suggesting the presence of a new antigenic variant. The results were compared with the data obtained by other research groups.

Animals↗

PubMed2005

The association of birthweight and contemporary size with insulin resistance among children from Estonia and Denmark: findings from the European Youth Heart Study.

OBJECTIVES: To assess the associations of birthweight, contemporary body mass index and height with insulin resistance in children. DESIGN: Cross-sectional study. PARTICIPANTS: From Estonia (n = 1174) and Denmark (n = 1018), 2192 school children aged 9 and 15 years were randomly selected. MAIN OUTCOMES: Insulin resistance (homeostasis model assessment), triglyceride levels, high-density lipoprotein cholesterol and systolic blood pressure. RESULTS: There was an inverse association between birthweight and insulin resistance and a positive association between contemporary body mass index and insulin resistance. With adjustment for maternal and paternal educational level, income, smoking and body mass index, an increase of one unit of sex, age and country standardized body mass index z-score was associated with a 5% (95% CI: 2, 7%) increase in homeostasis model assessment (HOMA) score and a one-unit z-score increase in birthweight with a 2% (95% CI: 0, 5%) decrease in HOMA score. In the 9-year-old age group, height was positively associated with insulin resistance [for a one-unit increase in height z-score HOMA score increased by 30% (95% CI: 14, 50%)], but in the 15-year-old age group there was no association between height and insulin resistance (4% (95% CI: -5, 14%), P for interaction with age group = 0.001). For both ages, those in the lowest third of the birthweight distribution and highest third of the body mass index distribution were most insulin resistant and, among 9-year olds, those in the lowest third of the birthweight distribution and highest third of the height distribution were most insulin resistant. Birthweight was only inversely associated with systolic blood pressure when adjustment was made for either contemporary body mass index or height and there was no association between birthweight and high-density lipoprotein or triglyceride concentrations. CONCLUSIONS: Taken together, these results suggest that a slow intrauterine growth trajectory and/or a fast post-natal growth trajectory is associated with greater insulin resistance in childhood.

Adolescent↗

PubMed1999

The risk of motor neurone disease and multiple sclerosis is different in Estonians and Russians. Data from South Estonia.

Epidemiological studies were performed in South Estonia to establish the prevalence rate of multiple sclerosis (MS) and motor neurone disease (MND). The case finding method included information from the hospital records of the central hospital in the region-the University Hospital (for MS from 1942 to 1989), from all neurologists in the region, from the Estonian MS Society and Association of Muscular Disorders, and from nursing homes in the region. The prevalence day was 31 December 1989. MND incidence was established for the period of 1986-1995. The results demonstrated high prevalence rates of MS among native Estonians (55.3 per 100 000), somewhat lower prevalence among native-born representatives of other nationalities (43.6 per 100 000) and the lowest prevalence rate of MS among non-Estonian immigrants (26.6 per 100 000). The differences were not statistically significant. The results for MND demonstrated the opposite pattern. The mean annual incidence rate of MND for 10 years was statistically significantly higher among people of other nationalities (2.5 per 100 000) and Russians (2.6 per 100 000), and lower in native-born Estonians (1.1 per 100 000). No differences in health care or clinical picture were established. The reasons for the demonstrated differences in MND incidence remain unclear.

Adult↗

PubMed1994

The Mother-Infant unit at Tallinn Children's Hospital, Estonia: a truly baby-friendly unit.

A mother-infant neonatal unit was established in 1979 at Tallinn Children's Hospital in Estonia to provide medical and nursing care to newborn and premature babies and their mothers. Its leading principles are 24-hour care by the mother, minimal use of technology, and little contact between the baby and medical and nursing staff. The unit was based on a conceptual model of the "psychological and biological umbilicus," which proposes that this connection binds the mother and infant together during the early weeks of life. Separation of mother and baby disrupts this important tie and may have adverse consequences for both. This paper presents data comparing weight gain during the first 30 days of life for a group of 159 preterm and full-term infants who were admitted to the unit between 1988 and 1989. Eighty-seven infants were cared for by their mothers, and 72 by nurses because their mothers were unwilling or unable to stay with the infants in the hospital. The holistic, humanistic approach used in the unit represents a truly baby-friendly hospital.

Adult↗

PubMed2001

Seropositivity to Helicobacter pylori heat shock protein 60 is strongly associated with intensity of chronic inflammation, particularly in antrum mucosa: an extension of an 18-year follow-up study of chronic gastritis in Saaremaa, Estonia.

Helicobacter pylori is a cause of chronic gastritis and leads to development of atrophy in some cases. There is evidence that the heat shock protein 60 (HSP60) of H. pylori is involved in induction of chronic inflammation. Seroprevalence of IgG antibodies to H. pylori HSP60 in an adult cohort from Saaremaa, Estonia (68 persons, median age 57 years), with a high prevalence of antibodies to cell surface proteins of H. pylori (92%) and a well characterized dynamics of chronic gastritis in an 18-year follow-up study, was tested using purified H. pylori HSP60 at a concentration of 1 microg ml(-1) with ELISA. The state of the gastric mucosa and the presence of H. pylori in histological sections in the samples of 1979 and 1997 were assessed in accordance with the Sydney system. Seropositivity for H. pylori HSP60 was 65%. Immunological response to H. pylori HSP60 is associated with the morphological presence of H. pylori in the antrum and corpus (P=0.01) and is strongly correlated with the grade of chronic inflammation, particularly in the antrum mucosa (r=0.34; P=0.003; OR=5.97 (95% CI 1.21-29.3)), but is not associated with development of atrophy during 18 years of follow-up, or with the activity of gastritis. This finding supports the evidence that immunological response to H. pylori HSP60 may play a role in triggering of the inflammatory process in the gastric mucosa.

Atrophy↗

PubMed2006

Sex work in Tallinn, Estonia: the sociospatial penetration of sex work into society.

BACKGROUND: It is important to describe and understand the underlying patterns and dynamics that govern sex work in societies undergoing rapid political and social changes, its heterogeneity across populations, and its evolution through time in order to inform future research, sound policy formation, and programme delivery. OBJECTIVES: To describe the socioeconomic and cultural determinants, organisational structure, distinct categories, and spatial patterning of sex work in Tallinn, Estonia, and identify recent temporal changes in sex work patterns. METHODS: In-depth interviews with key informants; naturalistic observations of sex work and drug use venues, geo-mapping of sex work sites, review of media, public policy, and commissioned reports, and analyses of existing data. RESULTS: Sex work takes place in a hierarchy of locations in Tallinn ranging from elite brothels and "love flats" to truck stops. These sites vary in terms of their public health importance and social organisation. There are full time, part time, and intermittent male and female sex workers. Among others, the taxi driver, madam and the bartender are central roles in the organisation of sex work in Tallinn. Cell phone and internet technology enable sex work to be highly dispersed and spatially mobile. CONCLUSION: Future research and programmatic service delivery or outreach efforts should respond to the changing profile of sex work in Tallinn and its implications for STD/HIV epidemiology.

Adolescent↗