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PubMed2006

Allergic sensitization to common airborne allergens among adults in Estonia.

BACKGROUND: Allergies and asthma exhibit a growing health problem in the world. Sparse data are available about the prevalence of allergic sensitization in Estonia and Eastern Europe as well. We studied the prevalence of allergic sensitization, the associations between respiratory symptoms and allergic sensitization, and the influence of age, gender, area of residence, number of siblings and other demographic attributes on allergic sensitization in the population aged 17-69 years. METHODS: We conducted a cross-sectional study with 1,346 randomly selected participants distributed in 3 geographically and culturally distinct areas of Estonia. Sensitization to 15 aeroallergens was assessed by skin prick tests. The study also included a structured interview. RESULTS: The total prevalence of allergic sensitization was 33.0%. When estimated in patients aged 20-44 years, the prevalence was 38.5%. The most common sensitizer was cockroach followed by storage mites, while sensitization to cat, dog or pollen (common sensitizers in Scandinavian countries) was low. Allergic sensitization was significantly more common in urban and suburban compared with rural areas. Storage mites were the most common sensitizers in rural areas. Living in urban or suburban areas before the age of 5 significantly increased the risk for positive skin prick tests to several allergens. CONCLUSIONS: A higher prevalence of allergic sensitization than previously believed was found. Cockroach and storage mite allergens are suggested to be included in the routine investigation panel in Estonia.

Acaridae↗

PubMed2005

Tuberculosis during fundamental societal changes in Estonia with special reference to extrapulmonary manifestations.

STUDY OBJECTIVES: To characterize the incidence of extrapulmonary tuberculosis (EPTB) in Estonia, by site and age, in conditions of marked pulmonary tuberculosis (TB) increase, ie, during the period of fundamental societal changes, but where TB incidence has not been influenced by HIV infection. DESIGN AND SETTING: A retrospective study. PATIENTS: All new cases of EPTB (n = 622) detected in Estonia from 1991 to 2000. RESULTS: The incidence of pulmonary TB in Estonia increased from 21.5 in 1991 to 44.6/100,000 in 2000. In contrast, the incidence of EPTB did not increase at the same pace, changing only from 3.6 in 1991 to 4.7/100,000 in 2000. The increase in the incidence of EPTB was significantly lower than that of pulmonary TB (p < 0.05), and the relative frequency of EPTB among overall TB steadily decreased from 17.0% in 1991 to 10.1% in 2000. The incidence of EPTB forms with a long latency period (eg, osteoarticular and urogenital TB) remained unchanged, while that of EPTB forms with a short latency period (eg, intrathoracic lymph node TB) increased (p < 0.05). The number of cases of urogenital, pleural, and osteoarticular TB increased with age; the number of cases of intrathoracic lymph node TB decreased with age. The bacteriologic confirmation rate was lower in EPTB than in pulmonary TB and varied according to site. CONCLUSION: There was no increase in the incidence of EPTB during 10 years despite the dramatic increase in overall TB. The proportion of EPTB among all TB tended to decrease with increasing age, and different EPTB sites prevailed in different age groups.

Adolescent↗

PubMed2001

Occupational exposure to carcinogens in Estonia, Latvia, Lithuania and the Czech Republic in 1997.

OBJECTIVES: The aim of the study was to estimate the numbers of workers exposed to carcinogens in Estonia, Latvia, Lithuania, and the Czech Republic. METHODS: CAREX is an international information system on occupational exposure to 139 known and suspected carcinogens. It provides exposure data and estimates of the numbers of exposed workers by country, carcinogen, and industry. The CAREX method, which has been previously applied in the member states of the European Union, was applied in the present study to the exposure situation in Estonia, Latvia, Lithuania, and the Czech Republic in 1997. The preliminary estimates generated by CAREX were reviewed and revised by national experts mainly for asbestos, benzene, and lead, which were of special interest for this project. RESULTS: The numbers of workers exposed to carcinogens covered by CAREX in 1997 were about 180,000 (29% of employed persons) in Estonia, 260,000 (28% of employed persons) in Latvia, 470,000 (28% of employed persons) in Lithuania, and 1,400,000 (28% of employed persons) in the Czech Republic. The most common exposures were solar radiation (7-13% exposed at least 75% of the worktime), environmental tobacco smoke (4-5% exposed at least 75% of the worktime), wood dust (3-5% exposed), crystalline silica (2-3% exposed), diesel exhaust (2-3% exposed), radon and its decay products (2% exposed), benzene (0.9-1.7% exposed), and lead and inorganic lead compounds (0.8-1.4% exposed). Exposure to asbestos was slightly less prevalent (0.3-1.1% exposed). CONCLUSIONS: These preliminary results indicate that a substantial proportion of the workers in the studied countries were exposed to carcinogens.

Carcinogens, Environmental↗

PubMed2004

Content and composition of the essential oil of Thymus serpyllum L. growing wild in Estonia.

OBJECTIVE: The aim of this work was to analyze the essential oil content and its composition in the drug (Serpylli herba) of wild thyme (Thymus serpyllum L.) originating from 20 different natural places of growth in Estonia. MATERIAL AND METHODS: The quantitative content of essential oil was determined according to the method of European Pharmacopoeia. Gas chromatographic analysis of essential oils was carried out using a gas chromatography with flame ionization detector on two fused silica capillary columns with bonded stationary phases NB-30 and SW-10. The identification of the oil components was accomplished by comparing their retention indices on two columns with the retention indices values of standard compounds, with our retention indices data bank and with literature data. The results obtained were confirmed by gas chromatography / mass spectrometry. RESULTS: The content of essential oil is between 0.6 and 4 ml/kg and usually is not in conformity with European Pharmacopoeia standard (3 ml/kg). There were 55 components identified in the essential oil of wild thyme of Estonian origin. Differently from the data in the literature of foreign countries, thymol and carvacrol are not the main components of the essential oil of wild thyme growing in Estonia. The main components here are (E)-nerolidol, caryophyllene oxide, myrcene, (E)-beta-caryophyllene and germacrene D. CONCLUSION: In Estonia, the (E)-nerolidol-caryophyllene oxide, (E)-nerolidol-myrcene and myrcene chemotypes of wild thyme drug are distinguishable.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2004

Patients' opinions on family doctor accessibility in Estonia.

AIM: To investigate the accessibility of family doctors in Estonia from the patients' point of view. METHODS: Face to face interviews using structured questionnaires were performed. A random sample of the Estonian residents, aged 15-74 years, was studied (n=999). RESULTS: The number of visits provided by family doctors has been continuously increasing since 1998. Out of 999 respondents, 59% visited the family doctor during the previous 12 months. The average number of visits per Estonian resident in one year is 2.48. Out of 999 interviewed persons, 72% said that they had a possibility of contacting their family doctor by phone. The waiting time for an appointment was short in most cases. The family doctor admitted 60% of the respondents on the same day the patients had requested; 22% of the patients were admitted within 1-2 days and 9% of the patients were admitted within 3-4 days. Only 9% of them had to wait more than 5 days. The current home visit fee in Estonia would have affected the decision of the home call of 58% of people. There was a correlation between the acceptability of a visit fee and the people's income. CONCLUSION: The accessibility of family doctors can be considered good in Estonia.

Adolescent↗

PubMed2004

Low socio-economic status is a risk factor for respiratory symptoms: a comparison between Finland, Sweden and Estonia.

OBJECTIVE: To assess the relation of socio-economic status to respiratory symptoms common in asthma and chronic bronchitis, and to compare risk factors for these symptoms between three neighbouring countries. DESIGN: A postal survey was performed in 1996 as a part of comparative studies in Finland, Sweden and Estonia (the FinEsS studies). A random sample of 58,661 subjects aged 20-64 years were invited, of whom 44,483 participated. RESULTS: Respiratory symptoms were most prevalent among manual workers, who were at significantly increased risk for chronic respiratory symptoms. The same pattern of increased risk appeared when the analyses were made among non-smokers only: for recurrent wheeze, manual workers in industry yielded an OR of 1.91 (95%CI 1.62-2.24) and in the service sector an OR of 1.50 (95%CI 1.27-1.78). The corresponding figures for chronic productive cough were 1.45 (95%CI 1.22-1.71) and 1.20 (95%CI 1.02-1.42), respectively. Risk factor profiles for respiratory symptoms were similar in Finland, Sweden and Estonia, except for gender differences in Estonia. CONCLUSIONS: Belonging to the socio-economic group of manual workers correlated with an increased risk for chronic respiratory symptoms, independently of smoking habits, in each country. Women manual workers in industry suffered most from respiratory symptoms.

Adult↗

PubMed1994

Childhood celiac disease in Estonia: efficacy of the IgA-class antigliadin antibody test in the search for new cases.

The incidence of celiac disease (CD) and the role of IgA-class antigliadin antibody (AGA) determination in revealing new CD cases were studied in Estonia. Altogether 36 cases of CD in Estonian children were diagnosed from January 1976 through June 1992 by criteria recommended by the European Society for Paediatric Gastroenterology and Nutrition. A significant increase was observed in the incidence of CD in Estonia (from 1:25, 130 live births during 1976-1989 to about 1:2,700 live births during 1990-1992), due mainly to the introduction of IgA-class AGA determinations in an active search for celiac patients since 1990. A total of 29 IgA-class AGA-positive cases was revealed among 1,048 children screened, and 23 of them had CD. Thus, the results show a relatively low incidence of CD in Estonia compared to the figures in neighboring countries. However, the incidence will probably increase if a larger pediatric population can be screened for CD using IgA-class AGA enzyme-linked immunosorbent assay.

Adolescent↗

PubMed1997

Abortion in the framework of family planning in Estonia.

OBJECTIVE: To analyze the legal status of abortion and trends in childbirth, abortions and contraceptive use in Estonia. DESIGN: National statistical data on induced abortions, spontaneous abortions, births and contraceptive use in Estonia. RESULTS: Even though induced abortion is legal in Estonia, the abortion rate has been declining but is still high and in 1994 was 53.8 per 1000 women of fertile age. Among young women under 20 years of age, abortions decreased slightly in the period 1992-94 (from 55.5 to 41.5 per 1000). The birth rate has been declining rapidly in recent years, resulting in a net population reduction. The use of modern contraceptives is increasing but is still low. CONCLUSION: Survey on abortion and on contraceptive sales and use are needed. To improve family planning and prevent unwanted pregnancies it is important to increase awareness among the entire population--and especially among young people--by information, education and communication. A high standard of counseling, including pre- and postabortion counseling and in the youth services, is essential.

Abortion, Induced↗

PubMed1993

HIV-infection in Estonia.

Only a few cases of clinical AIDS have been diagnosed in the Baltic countries that previously were part of the Soviet Union. This suggests that the spread of HIV-infection has been much slower than in several other countries belonging to the previous Eastern Europe. To get a more precise picture of the situation, we have analyzed the data from seroepidemiological screening programs that have been conducted in Estonia since June 1987. Large population groups were tested according to a decree by the former soviet All-Union center on AIDS. On several occasions the tests were mandatory and probably had a coverage close to 100%. After more than a million serum samples were tested, 29 HIV-infected persons, 3 women and 26 men have been identified. One of them was HIV-2 positive. Most of them live in Tallinn, the capital city of Estonia. All cases probably have a sexually transmitted infection. In one the infection has proceeded to clinical AIDS. Analysis of the gene sequences of several strains suggests that the strains are closely related and that the number of sources of infection is quite small. The study suggests that the spread of HIV in Estonia is still quite limited. A contributing factor may be the restricted possibilities for travel to the Western countries during the Soviet era.

Journal Article↗

PubMed1991

Cancer survival in Estonia from 1978 to 1987.

On the basis of the Estonian Cancer Registry's data bank, survival was examined for 36,020 incident cancer cases diagnosed from 1978 to 1987 in men and women residing Estonia. The number of cases, the proportion of cases with microscopic verification, the observed and relative 5-year survival rates, and the median survival time were determined for 25 most common cancer sites and all sites combined. The highest relative survival rates were documented for cancers of the lip, corpus uteri, and skin (melanoma, women). The lowest rates were found for acute myeloid leukemia (women), and cancers of the liver, pancreas, and esophagus (men). For most cancer sites, the survival rates of women exceeded those of men. The comparison of nationwide survival rates by selected sites in Estonia with those in Finland revealed that Estonian rates were lower. Existing information shows that the Estonian Cancer Registry has relatively good data resources for promoting more sophisticated survival studies.

Actuarial Analysis↗

PubMedDate not supplied

A policy of introducing a new contract and funding system of general practice in Estonia.

The socialist bloc of post-war Europe was obliged to follow the Soviet example with a hierarchical, centrally controlled health care system based on polyclinics and other facilities providing extensive specialist services at the first level of contact. All the countries of Central and Eastern Europe have now expressed their wish to totally change their health care systems. Changes in these countries include: the introduction of market economy mechanisms in health care, an increased focus on population health needs in guiding health care systems, and the possibility of introducing a more general type of care at primary level. Patient expectations of access, choice and convenience are factors in shaping new models of health care delivery. Appropriate timing is the key determinant of the success of reforms. In Estonia the beginning of the 1990s was the time when several interest groups in society supported changes in the health care system. The first step after regaining independence was the reintroduction of a Bismarck-type insurance system. In the late 1990s the primary care reforms have changed the initial plans and elements of a National Health Service were introduced, especially general practitioners' lists, capitation payment and gate-keeping principles. The family medicine reform in Estonia has two main objectives: introduction of general practice as a specialty into Estonian health care and changing the remuneration system of primary care doctors. The specific tasks are: to provide practising primary care doctors with opportunities for retraining to gain the specialty status of a general practitioner, to create a list system for the population to register with a primary care doctor, to introduce a partial gate-keeping system and to give the status of the independent contractor to primary care doctors.

Capitation Fee↗

PubMed1993

Time trends in cancer mortality in Estonia, 1965-1989.

Mortality rates for cancer of all sites combined and for 12 selected sites or site groups in Estonia from 1965 to 1989 were studied to assess overall progress in controlling cancer. Between 1965-1969 and 1985-1989, age-standardized mortality (world population) increased by 12.0% among males and decreased by 5.1% among females. The changes in mortality for the age-groups 20-44, 45-64, and 65 and over were -0.3%, 23.5% and 5.8% among males and 0.9%, -7.0% and -4.4% among females, respectively. In males, the most marked rise in mortality occurred for cancers of the oral cavity and pharynx, intestine and larynx. In females, the most rapid increase was observed for cancers of the lung, oral cavity and pharynx and breast. The decline in stomach cancer and cervical cancer mortality reflects worldwide trends. However, the noticeable increase in mortality rates for most of the sites indicates a need for strong preventive measures, particularly anti-smoking campaigns. In general, the time trends in mortality from all cancers combined demonstrate that in Estonia, over the last 25 years, no progress against cancer has been achieved.

Adolescent↗

PubMed2004

Characterization of tick-borne encephalitis virus from Estonia.

Tick-borne encephalitis virus (TBEV) is a severe problem in Estonia. In the present article the first genetic analysis of Estonian TBEV strains is described. In total, seven TBEV strains were isolated from ticks (Ixodes ricinus and I. persulcaus), rodents (Apodemus agrarius and Cletrionomys glareolus), and serum from a tick-borne encephalitis (TBE) patient. The nucleic acid sequences of the viral genome encoding almost the complete E protein (nt 41-1250) and the 3'-NCR-termini of the Estonian TBEV strains were determined by direct sequencing of RT-PCR products. The results showed that all three known TBEV subtypes, Western TBEV (W-TBEV), Far-Eastern TBEV (FE-TBEV), and Siberian TBEV (S-TBEV), co-circulate in Estonia. The Estonian TBEV strains of the S-TBEV and W-TBEV subtypes clustered with the previously reported strains from Latvia and Lithuania. Within the FE-TBEV subtype, however, the Estonian strain Est2546 clustered together with the strain Sofjin, originating from the Far-East of Russia, but not with the strain RK1424, isolated in the neighboring Latvia. This suggests a different evolutionary history for the Estonian and the Latvian strains in the FE-TBEV subtype. The Estonian TBEV strain (Est3535), which belonged to the S-TBEV subtype, had an organization of the 3'-NCR similar to that of strains from the Far-East of Russia (Irkutsk). The 3'-NCRs of Estonian strains of the W-TBEV subtype (Est3051, Est3053, Est3476, and Est3509) were very similar to those of the strain Ljubljana I from the Balkans. In the 3'-NCR sequence of the Estonian strain Est2546, which belonged to the FE-TBEV subtype, a deletion from position 10461 to 10810 extending approximately 10 nucleotides into the core element, was detected.

Amino Acid Sequence↗

PubMed2002

Conflict of interest in medical research in Estonia.

An area where conflicts of interest can take place in Estonia is in the conduct of clinical trials. The paper lists the main areas where such conflicts of interest can occur. The author also briefly discusses Estonia's current position with regard to regulating genetic information and the commencement of the Estonian Genome Project.

Biomedical Research↗

PubMed2006

Introducing a complex health innovation--primary health care reforms in Estonia (multimethods evaluation).

All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. We analysed changes in organisational structure, regulations, financing and service provision in Estonian PHC system as well as key informant perceptions on factors influencing introduction of reforms. Estonia has successfully implemented and scaled-up multifaceted PHC reforms, including new organisational structures, user choice of family physicians (FPs), new payment methods, specialist training for family medicine, service contracts for FPs, broadened scope of services and evidence-based guidelines. These changes have been institutionalised. PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance service innovations; investment in human resource development - was critical to the reform success.

Attitude of Health Personnel↗

PubMed2006

Satisfaction with the access to the health services of the people with chronic conditions in Estonia.

UNLABELLED: After the implementation of the primary health care reform in Estonia, most of chronic conditions are managed by family doctors (FD) in collaboration with specialists. Although the general population has demonstrated the increase in satisfaction with health care after the reform, it has been questioned if people with chronic diseases have been left on a more disadvantaged position in the new system with some restrictions in the access to specialists. OBJECTIVE: To investigate the satisfaction of people with chronic conditions with the access to the health services and compare them to those who did not have a chronic illness. METHOD: In November 2005, a random sample of Estonian residents aged 15-74 were personally interviewed using structured questionnaires (n=1446), 29% of them reported to have a chronic illness. RESULTS: The people with chronic conditions were less satisfied with the access to the health services. They were more satisfied with their family doctors, but less with the health insurance system and they often reported their problems in seeing the specialist. Compared to other respondents, the people with chronic conditions visited their FDs and specialists more often, but no significant differences were found between their waiting times to see the FD or a specialist. CONCLUSION: In Estonia, the people with chronic conditions do not have organisational barriers in their access to the health services. As frequent users of health services, they perceive the shortages of the health system more obviously than the rest of the population and it may reflect their satisfaction with the different aspects of the health system as well as the access to the health services.

Adolescent↗

PubMed2006

Epidemiological investigations on Trichinella infections in farmed fur animals of Estonia.

Farming of fur animals represents an important income in Estonia. Even though Trichinella worms does not induce a symptomatic disease in carnivores, the carcasses of skinned animals can increase the biomass of the parasite in the environment, if they are not properly destroyed. The aim of the present survey was to study the prevalence of Trichinella worms in farmed fur animals of Estonia. Of 281 muscle samples from blue foxes (Alopex lagopus), silver foxes (Vulpes vulpes fulva), minks (Mustela vison) and raccoon dogs (Nyctereutes procyonoides), which were collected in eight farms, Trichinella larvae have been detected in 21 animals (8%) from two farms by HCl-pepsin digestion. The highest number of larvae per gram of muscle was found in the front limb muscles. Larvae of the 21 isolates have been identified as Trichinella britovi or Trichinella nativa by a multiplex-PCR analysis.

Animals↗

PubMed1997

Economic reduction of acidifying deposition in Finland by decreasing emissions in Finland, Estonia and Russia.

Here we consider cost-effective solutions of emission control measures in Finland and the nearby areas of Estonia, St. Petersburg region, Karelia and Kola, in order to limit the acidifying deposition in Finland. In the study, the emission control costs of SO2, NOx and NH3 are assessed for the areas studied and an optimisation model developed for calculation of cost-optimal deposition control policies. The input data of the model consist of the cost functions describing the emission control costs to achieve lower emission levels for the gases and areas considered and of dispersion coefficients which describe the deposition due to an emission source in the deposition receptor grid squares. In addition, the model includes a description to calculate the acidifying load. The optimisation is based on linear programming. When the acidifying load of Southern Finland is reduced by minimising the total control costs, approx, three quarters of the total control costs are due to measures in the nearby areas, Estonia, St. Peterburg region, Karelia and Kola, and approx. one quarter due to measures in Finland. The distribution of costs in the cost-optimised cases depends relatively little on the level to which the acidifying load due the source areas considered are required to be reduced. If the load reduction target is moderate, the emission control measures should mainly be allocated to sulphur emissions and to some extent to ammonia emissions and, if the load reduction target is stricter, also to the emissions of nitrogen oxides.

Acid Rain↗