Towards evidence-based health care reform.
Health care reform in Europe is discussed in the light of the Ljubljana Charter, with particular reference to progress made in Estonia and Lithuania. (+info)
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. (+info)
Comparison of enterovirus-specific cellular immunity in two populations of young children vaccinated with inactivated or live poliovirus vaccines.
Enterovirus-specific cellular immunity was studied in Estonian and in Finnish children at the age of 9 months. The aim was to evaluate the level of responsiveness in two neighbouring countries with different poliovirus immunization practices and striking differences in the incidence of insulin-dependent diabetes mellitus (IDDM), a disease in which early enterovirus infections are an aetiological risk factor. The Estonian children immunized with live attenuated polio vaccine had stronger T cell responses to coxsackievirus B4 and poliovirus type 1 when compared with Finnish children immunized with inactivated polio vaccine (median stimulation indices 10.4 and 6.3 in Estonian children and 1.9 and 2.9 in Finnish children, respectively; P < 0.05). Lymphocytes stimulated by poliovirus type 1 antigen expressed interferon-gamma (IFN-gamma) mRNAs, which strongly correlated with the level of proliferation responses. Lymphocytes of Estonian children had a tendency towards stronger expression of IFN-gamma upon poliovirus challenge when compared with Finnish children. The number of children who had experienced coxsackievirus B infections, as determined by the presence of neutralizing antibodies, did not differ between Estonian and Finnish children. The results show that Finnish children have weaker cellular immunity against enteroviruses at the age of 9 months compared with Estonian children at the same age. This is most probably due to the difference in polio vaccination schedules; in Estonia live poliovirus vaccine is used and given at earlier ages than the inactivated vaccines in Finland. This leads to stronger T cell immunity which cross-reacts with other enterovirus serotypes. This may explain the lower incidence of IDDM in Estonia by providing effective protection against diabetogenic enterovirus strains in Estonian children. (+info)
Feasibility of cohort studies in Estonia.
OBJECTIVES: To describe the methodology and feasibility of follow up for vital status in retrospective cohort studies in Estonia. METHODS: A cohort of 7412 workers who had been employed at two factories in Tallinn between 1946 and 1988 was followed up for vital status from the date of first employment until death, emigration, or the end of the study, 31 December 1995, whichever occurred first. The cohort was electronically linked with the National Population Registry of Estonia that was created in 1992 and includes personal identification numbers of Estonian citizens and residents, and the Mortality Database that contains information from death certificates issued in 1983-95. A manual search was carried out on several non-computerised population data sources and archives. RESULTS: By 31 December 1995, the vital status of 6780 (91.5%) subjects could be traced (4495 (60.6%) subjects were alive, 1993 (26.9%) had died, and 292 (3.9%) had emigrated). Analysis by calendar period of leaving work showed that the proportion of subjects traced was lowest in the group of workers who had left work between 1946 and 1955 (58.4%), especially those whose age at leaving work was < 30 (53.2%) or > 60 years (42.3%). Among subjects who left work in 1956-65, 1966-75, and 1976-88, the follow up rate was 84.7%, 94.6%, and 98.2%, respectively. CONCLUSIONS: The findings, which are especially important for occupational epidemiology, confirm the feasibility of conducting retrospective cohort studies in Estonia. Most of the issues discussed in the paper apply to other former Soviet countries. (+info)
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. (+info)
Setting national standards for practice equipment. Presence of equipment in Estonian practices before and after introduction of guidelines with feedback.
BACKGROUND: During the last few years quality assurance has received increasing attention in Estonian health care as well as in family medicine, which is a new speciality in Estonia (since 1993). The modest equipment that district doctors (former primary care doctors) had at their disposal, appeared inadequate considering family doctors' work tasks. AIM: To determine the type of equipment available in primary care practices before setting a standard, and 1 year after the minimal standard of practice equipment was introduced. To follow how well family doctors adhere to this standard. METHOD: A questionnaire was sent to a random sample of district doctors (n=157) in 1992 and to all family doctors practising as independent contractors in 1998 (n=376). Quality of equipping was assessed against the standard set by consensus of the representatives of Family Doctors' Society, based on the country's needs and family doctor's job description. RESULTS: The level of primary care doctors' office equipment in 1992 was quite low. However, by the spring of 1998, substantial improvement of the equipment in family doctors' practices was estimated. The number of doctors possessing instruments for otorhinolaryngological, ophthalmological and gynaecological work as well as for taking care of children had increased two- to three-fold. About one-half of the family doctors reported that they had all the instruments listed in the standard. CONCLUSIONS: Setting a national standard helps to improve practice equipment--an important structural aspect of quality of care. Although improvement of equipment alone cannot guarantee quality of care, it may provide an important first step towards promoting it. (+info)
Social determinants of birthweight and length of gestation in Estonia during the transition to democracy.
BACKGROUND: To investigate social variation in birthweight and length of gestation in Estonia in the period of transition to a democracy and market economy. METHODS: All live births resulting from singleton pregnancies reported to the Estonian Medical Birth Registry in 1992-1997 (n = 84, 629) were studied with respect to social variation in birthweight and preterm delivery (<37 weeks gestation). The results were adjusted for maternal age, parity, education, nationality, marital status, smoking in pregnancy, sex of the infant (and gestational age). RESULTS: Between 1992 and 1997, mean birthweight increased from 3,465g to 3,497g (P < 0.001) and the preterm rate fell from 5.8% to 5.1% (P = 0.001). Maternal education, marital status and nationality were all independently related to the mean birthweight and the risk of preterm birth. The mean difference in birthweight between children of mothers with basic and university education was 87 g (95% CI : 74-100). Children born to mothers of non-Estonian compared to Estonian nationality were on average 77 g lighter (95% CI: 70-84). While the effect of nationality and marital status on birthweight was relatively stable during the study period, differences in birth outcome by maternal education became stronger. CONCLUSIONS: The mean birthweight increased and the preterm rate decreased in Estonia as a whole during the transition. However, the improvements were not shared equally by all social groups. An increase in variation in birthweight by maternal education was particularly notable. (+info)
Alcohol consumption in the Baltic Republics.
STUDY OBJECTIVES: Premature mortality associated with alcohol intake is of particular concern in several countries of the former Soviet Union. This study explored self reported alcohol consumption (beer, wine, spirits) and its determinants in the Baltic Republics. DESIGN: Cross sectional surveys conducted in 1997. SETTINGS: Estonia, Latvia and Lithuania. PARTICIPANTS: Representative samples of adults age 19-64 (Estonia n=2010; Latvia n=2258; Lithuania n=2139). METHODS: Between country differences in the frequency of alcohol intake were estimated. The odds of consuming alcohol weekly according to socioeconomic characteristics (age, ethnicity, rural/urban area, education, income) were calculated using multiple logistic regression analyses, adjusting for all variables simultaneously. MAIN RESULTS: The proportion of respondents consuming alcohol weekly varied by country (p<0.001) (men: Estonia=61% Latvia=41% Lithuania=55%; women: Estonia=26% Latvia=8% Lithuania=14%). Within each country, this proportion decreased with age in both sexes (p<0. 001), and increased with income in women (p<0.01). In Estonia, the odds of drinking alcohol weekly was significantly lower in respondents of Russian than of Estonian ethnicity (odds ratios (OR) and 95% confidence intervals (95%CI): men=0.51 (0.36, 0.71); women=0. 57 (0.39, 0.81)). In Lithuania, the odds was higher in highly educated men than in those with a low education level (OR=1.48 (1.01, 2.17)). Daily alcohol intake was higher in Estonia than in the other countries, as was the percentage of respondents drinking heavily (equivalent to 80 g/day). CONCLUSIONS: Approximately half the men and one in six women in the Baltic States reported consuming alcohol at least weekly. Age and income were the strongest and most consistent correlates of the likelihood of consuming alcohol weekly. Ethnic differences were observed only in Estonia. (+info)