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PubMed1999

Neonatal thyroid-stimulating hormone screening as an indirect method for the assessment of iodine deficiency in Estonia.

According to neonatal thyroid screening the incidence of congenital hypothyroidism in Estonia is 1:2,860. Transient hyperthyrotropinemia with a raised thyroid-stimulating hormone level of 5 microU/ml occurred in 17.7% of infants and was not associated with low birth weight, small birth length, low gestational age or congenital anomalies. Based on WHO criteria (WHO/UNICEF, 1994) it corresponds to mild iodine deficiency in Estonia (3% or less is in iodine-sufficient areas). This is in agreement with the previously reported median urinary iodine content of 65 microg/l in children. The frequency of infants with TSH >5 microU/ml was 16.4, 21 and 17. 2% in three regions (north, central and south) of Estonia, respectively, indicating mild to moderate iodine deficiency. These findings show the possibility of using the results of newborn screening for congenital hypothyroidism to assess the severity of iodine deficiency in Estonia. The introduction of universal iodine prophylaxis is recommended.

Congenital Hypothyroidism↗

PubMed2000

Mortality in patients with childhood-onset type 1 diabetes in Finland, Estonia, and Lithuania: follow-up of nationwide cohorts.

OBJECTIVE: To assess mortality of population-based cohorts of childhood-onset type 1 diabetic patients from the Eastern European countries of Estonia and Lithuania and compare this information with recent data from Finland. RESEARCH DESIGN AND METHODS: Estonian (n = 518) and Finnish (n = 5,156) type 1 diabetic cohorts were diagnosed between 1980 and 1994, and the Lithuanian (n = 698) cohort was diagnosed between 1983 and 1994. The mortality of these cohorts was determined in 1995. Life-table analysis, Cox survival analysis with covariates, and standardized mortality ratios (SMRs) were used. Causes of death were analyzed. RESULTS: Survival after 10 years duration of type 1 diabetes was similar in Estonia (94.3%) and Lithuania (94.0%), but much higher in Finland (99.1%). In the Cox survival analysis with covariates, the country of origin and age at diagnosis were found to be significant predictors of mortality. The SMR for the Estonian cohort was 4.35 (95% CI 2.25-7.61), the highest for the Lithuanian cohort was 7.55 (4.89-11.15), and the lowest for the Finnish cohort was 1.62 (1.10-2.28). The most common cause of death in Estonia and Lithuania was diabetic ketoacidosis (DKA), and in Finland, it was violent causes. No deaths from late complications of diabetes have been documented so far in any of the three countries. CONCLUSIONS: Our results demonstrate a high rate of short-term deaths due to DKA and inferior survival of childhood-onset type 1 diabetic patients in Estonia and Lithuania compared with Finland. In Finland, the survival of childhood-onset type 1 diabetic patients has improved and is only slightly inferior to that of the background population.

Adolescent↗

PubMed2006

Prevalence and genetic characterization of Listeria monocytogenes in retail broiler meat in Estonia.

The prevalence and genetic diversity of Listeria monocytogenes in raw broiler legs at the retail level in Estonia were studied. A total of 240 raw broiler legs (120 from Estonia and 120 of foreign origin, which had been imported to Estonia from Denmark, Finland, Hungary, Sweden, and the United States) from 12 retail stores in the two largest cities in Estonia (Tallinn and Tartu) were investigated from January to December 2002. Of these, 70% were positive for L. monocytogenes. The prevalence of L. monocytogenes in broiler legs of Estonian origin (88%) was significantly higher than in broiler legs of foreign origin (53%) (P < 0.001). Altogether, 169 (106 Estonian and 63 imported) L. monocytogenes isolates were characterized by pulsed-field gel electrophoresis (PFGE) typing after treatment with the restriction enzyme AscI. The isolates showed a wide genetic diversity, with 35 different PFGE types obtained. Of these, 11 PFGE types came only from isolates of broiler legs of Estonian origin, 4 of Danish origin, 2 of Finnish origin, and 4 of Hungarian origin. Fourteen PFGE types came from isolates of broiler legs that originated from various countries. The strains that shared the same PFGE types from isolates of Estonian origin were recovered from broiler legs that came from different stores over the course of several months. Seventy-one L. monocytogenes isolates, including all PFGE types, were serotyped, and three serotypes (1/2a, 1/2b, and 4b) were obtained. Serotype 1/2a accounted for 96% of the isolates.

Animals↗

PubMed1997

Thyroid nodularity and cancer among Chernobyl cleanup workers from Estonia.

Thyroid examinations, including palpation, ultrasound and, selectively, fine-needle aspiration biopsy, were conducted on nearly 2,000 Chernobyl cleanup workers from Estonia to evaluate the occurrence of thyroid cancer and nodular thyroid disease among men with protracted exposure to ionizing radiation. The examinations were conducted in four cities in Estonia during March-April 1995, 9 years after the reactor accident. The study population was selected from a predefined cohort of 4,833 cleanup workers from Estonia under surveillance for cancer incidence. These men had been sent to Chernobyl between 1986 and 1991 to entomb the damaged reactor, remove radioactive debris and perform related cleanup activities. A total of 2,997 men were invited for thyroid screening and 1,984 (66%) were examined. Estimates of radiation dose from external sources were obtained from military or other institutional records, and details about service dates and types of work performed while at Chernobyl were obtained from a self-administered questionnaire. Blood samples were collected for assay of chromosomal translocations in circulating lymphocytes and loss of expression of the glycophorin A (GPA) gene in erythrocytes. The primary outcome measure was the presence or absence of thyroid nodules as determined by the ultrasound examination. Of the screened workers, 1,247 (63%) were sent to Chernobyl in 1986, including 603 (30%) sent in April or May, soon after the accident. Workers served at Chernobyl for an average of 3 months. The average age was 32 years at the time of arrival at Chernobyl and 40 years at the time of thyroid examination. The mean documented radiation dose from external sources was 10.8 cGy. Biological indicators of exposure showed low correlations with documented dose, but did not indicate that the mean dose for the population was higher than the average documented dose. Ultrasound examinations revealed thyroid nodules in 201 individuals (10.2%). The prevalence of nodules increased with age at examination, but no significant associations were observed with recorded dose, date of first duty at Chernobyl, duration of service at Chernobyl, building the sarcophagus or working on the roof of neighboring buildings or close to the damaged reactor. Nodularity showed a nonsignificant (p(1) = 0.10) positive association with the proportion of lymphocytes with chromosome translocations, but associations with the frequency of variant erythrocytes in the GPA assay were weak and unstable (p(1) > or = 0.46). The majority of fine-needle biopsies taken on 77 study participants indicated benign nodular disease. However, two cases of papillary carcinoma and three benign follicular neoplasms were identified and referred for treatment. Both men with thyroid cancer had been sent to Chernobyl in May of 1986, when the potential for exposure to radioactive iodines was greatest. Chernobyl cleanup workers from Estonia did not experience a markedly increased risk of nodular thyroid disease associated with exposure to external radiation. Possible reasons for the apparent absence of effect include low radiation doses, the protracted nature of the exposure, errors in dose measurement, low sensitivity of the adult thyroid gland or the insufficient passage of time for a radiation effect to be expressed.

Adenocarcinoma, Follicular↗

PubMed1998

Drug resistant tuberculosis in Estonia.

SETTING: The incidence of drug resistant tuberculosis in Estonia has increased rapidly during the last five to six years. OBJECTIVE: To investigate the drug resistance patterns of Mycobacterium tuberculosis isolated from tuberculosis patients in Estonia. RESULTS: In 1994, 623 cases of tuberculosis were diagnosed in Estonia, 518 new cases with no previous history of tuberculosis, and 105 with a history of previous treatment for tuberculosis. All pulmonary M. tuberculosis isolates from 1994 were analysed for drug susceptibility. Of the 302 new cases (58.3%) that were culture verified, 28% had isolates resistant to one or more of the four drugs tested (isoniazid, rifampicin, streptomycin, ethambutol), and 9% had multi-drug resistant (resistant to at least isoniazid and rifampicin) strains. CONCLUSION: The incidence of drug resistance in M. tuberculosis is high in Estonia.

Adult↗

PubMed2002

Trends in cancer patient survival in Estonia before and after the transition from a Soviet republic to an open-market economy.

Cancer patients' survival is strongly dependent on socioeconomic factors, including access to and quality of medical care. During the past decade, Estonia has undergone a major political and economic change from a Soviet republic to an open-market economy country, and the health care system was transformed from a centralised state-controlled system into a decentralised health insurance-based one. Using data from the population-based Estonian Cancer Registry, we assessed trends in cancer patient survival before and after this transition by application of period analysis, a new method of survival analysis, which allows more timely disclosure of time trends than traditional survival analysis. Our study included 83,138 patients diagnosed with 1 of the 11 most frequent malignancies in Estonia from 1969-1998. Patients were followed up to the end of 1998. Despite a moderate increase in 5- and 10-year relative survival over time, prognosis for many common forms of cancer, such as stomach, colorectal, breast and ovarian cancer, remained considerably worse than the survival rates achieved in more affluent European countries many years ago. By contrast, a very steep increase in survival rates was observed for common urologic cancers, including prostate, kidney and bladder cancer, which went along with a rise in incidence rates of these cancers over time. For prostate cancer, similar survival rates as in other European countries have now been achieved. The most likely explanation for these trends is enhanced availability and utilization of laboratory and technical diagnostic equipment. Despite recent improvement, major efforts in delivering modern cancer care to the population of Estonia will be required to close the gap that continues to exist between prognosis of cancer patients in this country and other European countries.

Age Distribution↗

PubMed2003

Sequential changes in hepatitis A virus genotype distribution in Estonia during 1994 to 2001.

Hepatitis A virus (HAV) isolates from a large outbreak and from non-outbreak cases in Estonia were characterized by sequencing the aminoterminal VP1 region. From January 1998 to December 1999, a total of 1084 cases of hepatitis A were reported to the Harjumaa-Tallinn and Ida-Virumaa Health Protection Services in Estonia. The attack rate was highest among males aged 15-29. Initial cases were noted to be associated with injecting drug use. IgM anti-HAV positive sera were available from 107 hospitalized outbreak cases and from 68 patients sampled during 1994 to 2001. HAV RNA was detected in 42% of sera from 1994-1996 and in 88% of sera from 1998-2001. It was possible to obtain HAV sequences from 83 outbreak and 29 background cases. The outbreak strain was represented by five different sequences, all belonging to subtype IIIA. During the outbreak, this IIIA strain also spread into the general population. All available non-outbreak isolates from 1994 to 2001 but one belonged to genotype IA and formed distinct clusters as compared to isolates from other parts of the world. One subtype IIIA isolate from 1995 was unrelated to the outbreak strain. Subtype IA had been dominating in Estonia during 1994-2001, but the outbreak strain from 1998 to 1999 was IIIA. This subtype was encountered previously in addicts in Sweden during the 1980s and in Norway at the end of the 1990s. This study supports the use of limited sequencing within the aminoterminal VP1 region for studying the molecular epidemiology of hepatitis A.

Adolescent↗

PubMed1990

Incidence and prevalence of type 1 (insulin-dependent) diabetes in Estonia in 1988.

The objective of this study was to determine the incidence and prevalence of Type 1 (insulin-dependent) diabetes in Estonia in different sex and age groups. The data collection was based on a centralized retrospective registration of all cases of Type 1 diabetes nationwide using the records of all hospitals and polyclinics where diabetic patients are treated. In 1988, 35 new cases of Type 1 diabetes were diagnosed among children aged 0-14 years (10.3 per 100,000) and 131 among the population over 15 years. The highest incidence of Type 1 diabetes (39.9 per 100,000) was found in the age group 15-19 years. The total number of patients with Type 1 diabetes in Estonia was 2,719 in 1988. The overall prevalence was 1.72 per 1,000. It was highest in the age group 40-49 years (3.04 in males and 2.77 in females). In children under 15 years 204 cases of Type 1 diabetes were identified at the end of 1988. These data suggest that the risk of Type 1 diabetes in Estonia is not low, but is certainly not as high as in Finland where the population is ethnically and linguistically similar and where the highest incidence of Type 1 diabetes is found.

Adolescent↗

PubMed2004

Seasonality of alcohol-related phenomena in Estonia.

We studied alcohol consumption and its consequences as a seasonal phenomenon in Estonia and analysed the social and environmental factors that may cause its seasonal rhythm. There are two important questions when researching the seasonality of human activities: (1) whether it is caused by natural or social factors, and (2) whether the impact of the factors is direct or indirect. Often the seasonality of social phenomena is caused by social factors, but the triggering mechanisms are related to environmental factors like temperature, precipitation, and radiation via the circannual calendar. The indicators of alcohol consumption in the current paper are grouped as: (1) pre-consumption phenomena, i.e. production, tax and excise, sales (beer, wine and vodka are analysed separately), and (2) post-consumption phenomena, i.e. alcohol-related crime and traffic accidents and the number of people detained in lockups and admitted to alcohol treatment clinics. In addition, seasonal variability in the amount of alcohol advertising has been studied, and a survey has been carried out among 87 students of Tartu University. The analysis shows that different phenomena related to alcohol have a clear seasonal rhythm in Estonia. The peak period of phenomena related to beer is in the summer, from June to August and the low point is during the first months of the year. Beer consumption correlates well with air temperature. The consumption of vodka increases sharply at the end of the year and in June; the production of vodka does not have a significant correlation with negative temperatures. The consumption of wine increases during summer and in December. The consequences of alcohol consumption, expressed as the rate of traffic accidents or the frequency of medical treatment, also show seasonal variability. Seasonal variability of alcohol consumption in Estonia is influenced by natural factors (temperature, humidity, etc.) and by social factors (celebrations, vacations, etc.). However, distinguishing between impacts of direct and indirect relationships is complicated, as they are interlinked.

Accidents, Traffic↗

PubMed2005

Connections between climatic variables and the growth and needle dynamics of Scots pine (Pinus sylvestris L.) in Estonia and Lapland.

The relationships between climatic variables and Scots pine (Pinus sylvestris L.) growth and needle dynamics were studied in three stands in Estonia and in four stands located near the northern timberline in Lapland. The trees sampled in Estonia had low correlations with the analysed climatic variables (air temperature, precipitation and indices of atmospheric circulation). Moreover, the weak cross-correlation of the time-series of the Estonian sample trees indicated that Scots pine is affected mainly by local factors in that region. In Lapland, however, height increment and needle production correlated strongly among trees within a stand (mean r=0.45 and 0.46, respectively) and between stands (r=0.32 and 0.37). Radial increment also showed a high inter-correlation among the trees within a stand in Lapland (r=0.45). Both height increment and needle production were strongly influenced by the temperature regime of the previous summer in Lapland (mean r=0.64 and 0.64, respectively). Radial increment was correlated with the mean July temperature of the current year (mean r=0.29). The correlations between the indices of atmospheric circulation and tree attributes were weak, while the strongest correlation was between the Ponta Delgada NAO index (PD-NAO) and height increment and needle production in Lapland. Height increment, needle production and radial increment have increased since the 1990s in the trees growing in Lapland. This may indicate a positive effect of climate warming on tree growth in Lapland. In Estonia, where climatic conditions do not limit tree growth, the climate warming seems not to directly influence the growth and needle dynamics of Scots pine.

Climate↗

PubMed2005

Self-reported and serum cotinine-validated smoking in pregnant women in Estonia.

OBJECTIVES: Although widely used in epidemiological studies, self-report has been shown to underestimate the prevalence of smoking among pregnant women. Objectives of this study were to examine the discrepancy between self-reported and cotinine-validated smoking status, and the sociodemographic characteristics associated with the misclassification of real smoking status among pregnant women in Tallinn, the capital of Estonia. METHODS: Serum cotinine assays were performed on a subsample (n = 1360) of the pregnant women, who had participated in a recent study of human papillomavirus type 16 (HPV-16) seroprevalence in Estonia. In the present study, serum concentrations > or = 15 ng/ml were used to distinguish current smokers from nonsmokers. The serum-validated smoking level was compared with the self-reported level in the records of the Estonian Medical Birth Registry. For the group of self-reported non-smokers, the differences between the cotinine-validated smokers and the cotinine-validated nonsmokers, with respect to their sociodemographic characteristics (age, ethnicity, educational level, employment status, marital status, parity), were estimated by logistic regression. RESULTS: Of 1239 women who reported being nonsmokers, 259 (20.9%) had serum cotinine levels > or = 15 ng/ml, and can be regarded as current smokers. Among self-reported nonsmokers, nondisclosure of current smoking was significantly more frequent in non-Estonian, less educated, socially inactive, cohabiting and multiparous women. CONCLUSIONS: Self-reported data on smoking in pregnant women underestimates the real smoking prevalence in Estonia. Maternal unwillingness to declare smoking during pregnancy needs to be taken into account in the practice of maternal and child health to better target prenatal smoking cessation interventions.

Adolescent↗

PubMed2006

Incorporation of public hospitals: a "silver bullet" against overcapacity, managerial bottlenecks and resource constraints? Case studies from Austria and Estonia.

This paper presents a new approach for incorporating public hospitals by contrasting the experience from an "old" EU country (Austria) with a new EU member state (Estonia). In the EU (including the new member states) hospital overcapacity is a serious problem, from a technical, fiscal and political perspective. Few countries have succeeded in establishing an appropriate framework for resource management and for guaranteeing long-term financial viability of their hospital network. Many countries are in search of effective policies for improved hospital management and more cost-effective resource use in the health sector. Over the past decade, experiences in Austria and Estonia have emerged as innovative examples which may provide lessons for other EU countries and beyond. This paper describes the evolution of public hospitals from public budgetary units and public management to incorporated autonomous organizations under private corporate law, resulting in a contractual relationship between (public) owners and private hospital management. Outdated and inefficient public sector structures were replaced by more agile corporate management. The arrangement allows for investments, operating costs and budgeting according to strategic business goals as opposed to political "fiat". Shielding hospitals from local political influence is an important aspect of this concept. Horizontal integration through networking of public hospitals and introducing private management helps create a new corporate culture, allowing for more flexibility to achieve efficiencies through downsizing and economies of scale. Based on contracts the new balance between ownership and managerial functions create strong incentives for a more business-like, results-oriented and consumer-friendly management. This was achieved both in Austria and Estonia in a politically sensitive way, adopting a long-term vision and by protecting the interests of hospital owners and staff.

Austria↗

PubMed2004

Odontogenic tumours, a collaborative retrospective study of 75 cases covering more than 25 years from Estonia.

INTRODUCTION: The aim of the present collaborative study was to analyse retrospectively the character of odontogenic tumours in Estonia, involving the entire Estonian population (1.4 million), and to compare their prevalence with the figures presented in similar reports from other countries. MATERIAL AND METHODS: All material for the retrospective study was retrieved from the files of the Departments of Maxillofacial Surgery in Tartu and Tallinn, Estonia, where all in/out-patients are treated from the whole country. The final diagnosis in each case of odontogenic tumour was based on the 1992 WHO histological criteria. RESULTS: A total of 75 odontogenic tumours was found, 74 (98.6%) of which were benign, and 1 (1.3%) was malignant. The frequency of odontogenic tumours in this study was the lowest ever reported. The most common tumours were odontoma (34.3%), followed by ameloblastoma with different subtypes (25.3%), ameloblastic fibroma (16%), odontogenic myxoma (12%) and benign cementoblastoma (8%). CONCLUSION: Odontogenic tumours are relatively rare in Estonia compared with the data from other countries.

Adolescent↗

PubMed2005

Social inequalities in health care services utilisation after eight years of health care reforms: a cross-sectional study of Estonia, 1999.

Fundamental health care reforms in Estonia started in 1991 with the introduction of a social health insurance system. While increasing the efficiency of the health care system was one of the targets of the health care reforms, equity issues have received relatively less attention. The objective of this study is to provide an overview of social inequalities in health care utilisation in Estonia in 1999, after 8 years of large-scale reforms. Data were obtained from a nationally representative household interview survey including 3990 respondents aged 25-74 years. Health care utilisation was measured by the telephone consultations, visits to the general practitioner, visits to the specialist, visits to the dentist, and hospitalisation. These utilisation measures were related to variables on ethnicity, place of residence, education, income and employment, by means of direct standardisation and logistic regression models. Three different regression models were applied in order to (a) describe social differences in health care utilisation, (b) to assess whether these differences can be explained by differences in health needs, and (c) to assess the independent effect of each social variable net of all other social variables. Substantial inequalities were observed for all types of health care services and according to most social dimensions. Residents of rural areas were more likely to visit a general practitioner or to use telephone consultation, but less often used outpatient specialist care or dentist care. Ethnic differences were generally smaller, with no consistently higher use by either Russians or ethnic Estonians. Large differences were observed in relation to socio-economic status (education, income, or employment), with a more favourable socio-economic status being associated with higher probability to use health care services, especially after controlling for health needs. In case of hospitalisation, however, no notable social inequalities were found. These findings suggest that important geographic, financial and information barriers to health care utilisation exist after almost one decade of health care reforms in Estonia. Further health care reforms should aim to lessen or even remove these barriers.

Adult↗

PubMed2003

A descriptive epidemiological study of Duchenne muscular dystrophy in childhood in Estonia.

Duchenne muscular dystrophy (DMD) is the most frequent muscle disorder in childhood. There are no data on the epidemiology of muscular dystrophy in Estonia and the other Baltic States. The present study assessed the incidence and prevalence of DMD in Estonia. A descriptive epidemiological study of DMD was carried out in children born and diagnosed between 1977 and 1999 in Estonia. Patients were identified using four different approaches. DMD was considered present in children with features that corresponded to the criteria established by the European Neuromuscular Centre. 20 incidence cases and 25 prevalence cases of definite DMD were identified. We found a DMD incidence rate of 11.91 x 10(-5) (95% CI; 7.28-18.4) live born males from 1977 to 1990. The point prevalence rate of DMD was 12.76 x 10(-5) (95% CI; 8.26-18.84) of the under-20 male population as of January 1, 1998. The incidence and prevalence estimates in this report were in the range of similar studies from other countries. A muscle biopsy database and a neuromuscular disorders database were launched with this study. Considering the course of the disease, the prevalence should be estimated on the basis of the total male population <20 years of age.

Adolescent↗

PubMed2000

Prospects for phase III-IV HPV vaccination trials in the Nordic countries and in Estonia.

BACKGROUND: oncogenic, i.e. high risk human papillomavirus (hrHPV) types are the major cause of invasive cervical cancer (ICC). Putatively licensable vaccines against the hrHPVs have been developed and are approaching clinical phase III trials that use persistent HPV infection as end point. Direct extension of the phase III trials towards long-term end points (ICC and its immediate precursors: carcinoma in situ and severe dysplasia, i.e. cervical intraepithelial neoplasia grade III, CINIII) is important, to avoid early contamination of the target population by opportunistic use of licensed HPV vaccines. Country-wide registration on population and health events in a stable population of 25 million make Estonia and the Nordic countries a unique venue for long-term evaluation of cervical cancer control measures. Mass-screening programmes exist in all Nordic countries, but not in Estonia. AIM: design of phase III-IV trials for evaluation of protection against ICC and CINIII by preventive HPV vaccines based on cancer registry follow-up. RESULTS: in the Nordic countries, population based randomisation of all 15-year-old women to the vaccination (vaccine and placebo) and reference cohorts entering conventional Pap-smear screening after a clinical phase III trial would assure comparability of the cohorts. Enrollment of 10094 vaccinees +10094 placebo vaccinees +30282 other hrHPV negative women without vaccination at the age of 16 would give 80% power for the demonstration of 70% vaccine efficacy (VE) against ICC in 20 years by cancer registry follow-up. On the other hand, vaccination of 8303 Estonian hrHPV negative women among the entire 15-year-old female birth cohort (about 10000 women) with an already licensed HPV vaccine would enable demonstration of 70% VE against ICC by 20 years of registry follow-up of these and comparable 16606 women identified among the 16-19-year-old birth cohorts. CONCLUSIONS: evaluation of the protective effect of an HPV vaccine against ICC is possible both in countries with or without mass-screening. The effects of vaccination on spread of different HPVs in the population would need to be monitored, especially in Estonia. Ethical aspects, cost-benefit evaluation and comparisons with other new means of cervical cancer control warrant further investigation.

Adolescent↗

PubMed2002

Patterns of smoking in Estonia.

AIMS: To describe the pattern of current smoking and its relation to socio-demographic factors in Estonia. DESIGN: Nationwide cross-sectional survey. SETTING: Estonia in 1996. PARTICIPANTS: Stratified random sample of 2086 adults aged 30-59. MEASUREMENTS: Prevalence of current smoking; socio-demographic factors related to smoking, investigated by logistic regression analysis. FINDINGS: The prevalence of current smoking was 57.9% among men and 25.7% among women. For both genders, smoking rates were consistently lowest in the age group 50-59 years and highest in the age group 30-39 years. Smoking was significantly more common among divorced and widowed people. Education was associated with smoking among men but not among women. No relationship, however, was established between smoking and ethnicity, type of residence, and household income. CONCLUSIONS: Estonia needs an effective antismoking policy. Public health efforts need to be focused on quitting smoking in younger adults and prevention efforts should target less educated socio-economic groups.

Adult↗

PubMed1998

Atopy and allergic disorders among adults in Tartu, Estonia compared with Uppsala, Sweden.

BACKGROUND: Recent studies in children and adults indicate that the prevalence of atopy and allergic disorders is lower in previously socialist countries in Eastern Europe compared with countries with a market economy while revealed risk factors are similar. OBJECTIVES: To estimate the prevalence of atopy among adults in Tartu, Estonia and to compare the prevalence of risk factors for atopy and allergic respiratory diseases in Estonia and Sweden. METHODS: As a part of cross-sectional study-European Community Respiratory Health Survey-random samples of 20-44 year olds (n = 351 in Tartu and n = 470 in Uppsala) and persons of the same age with asthma like symptoms or on current asthma medication according to a postal questionnaire (n = 95 in Tartu and n = 201 in Uppsala) were interviewed and circulating IgE antibodies were measured. RESULTS: The prevalence of atopy was 19% in Tartu and 32% in Uppsala (P < 0.001). The prevalence of sensitization to pollen was twice lower (11.5 vs 23.2; P<0.001) and the prevalence of pollen associated asthma symptoms was four times lower (1.7 vs 6.8; P<0.001) in Tartu than in Uppsala while sensitization to pollen was an equally large risk factor for asthma in both centres. Age was inversely related to cat and pollen associated symptoms of rhinoconjunctivitis in Uppsala (OR 0.6 and 0.7, respectively, P < 0.05) but not in Tartu. CONCLUSIONS: The prevalence of atopy was lower in Tartu, Estonia than in Uppsala Sweden. Perception of allergic disorders seemed to be lower in Tartu than in Uppsala. Age did not influence the prevalence of atopy nor allergic disorders in Tartu, while in Uppsala age was inversely related to clinical allergy. This could suggest a cohort effect underlying the increasing prevalence of allergy in Western Europe.

Adult↗