Denissov G.,National Institute for Health Development
Scandinavian Journal of Public Health | Year: 2015
Aims and methods: Being easily available and having good coverage and comparability, official mortality statistics are used very widely. This in turn is because the definitions of mortality and methods of pertinent data collection are coordinated worldwide by the World Health Organization. In Estonia, registered cerebrovascular mortality has dropped 50% since 2000. A less dramatic decrease has been observed in nearly all EU Member States. To find out if this development can be explained by changing certification and coding practices, we counted all mentions of cerebrovascular diseases in the Estonian Causes of Death Registry database between 2004 and 2013 and analyzed the selection of the underlying cause of death. Results: We found that the sharp decrease in registered cerebrovascular mortality was by a half due to an increased selection of hypertension as the underlying cause of death. In cases where a cerebrovascular disease was mentioned and selected the underlying cause of death, the mean number of diagnoses per record was 2.45, in cases where a cerebrovascular disease was mentioned, but hypertension selected the underlying cause of death, the mean number of diagnoses was 3.15. Conclusions: The choice of the underlying cause of death registered in official statistics depends on the level of details provided in a death certificate, as well as updates to coding rules and use of modern quality assurance instruments in data production. © Associations of Public Health in the Nordic Countries Regions.
Rar V.,Russian Academy of Sciences |
Golovljova I.,National Institute for Health Development
Infection, Genetics and Evolution | Year: 2011
The family Anaplasmataceae includes gram-negative obligate intracellular alphaproteobacteria, which amplify within membrane-bound vacuoles. The genera Anaplasma and Ehrlichia as well as the recently specified cluster " Candidatus Neoehrlichia" comprise all bacteria of the family that are transmitted by ixodid ticks to mammalian hosts and cause infections in humans and numerous domestic and wild animal species. Totally, six Anaplasma, five Ehrlichia, and two " Candidatus Neoehrlichia" species as well as a variety of Ehrlichia bacteria with undefined taxonomic position belong to tick-borne bacteria. This review briefs the ecology, pathogenic properties, and molecular genetic diversity of Anaplasmataceae validated species, " Candidatus" species, and undefined novel Ehrlichia genetic variants. © 2011 Elsevier B.V.
Vaht M.,University of Tartu |
Merenakk L.,University of Tartu |
Maestu J.,University of Tartu |
Veidebaum T.,National Institute for Health Development |
Harro J.,University of Tartu
Psychopharmacology | Year: 2014
Rationale and objective: Prevalence of alcohol use is markedly influenced by socioeconomic conditions and is therefore subject to cohort effects. The common genetic variation 5-HTTLPR (serotonin transporter gene-linked polymorphic region) has been related to several aspects of alcohol use and addiction but with mixed results, probably due to different environmental interaction effects. We aimed at assessing whether the association between alcohol use and 5-HTTLPR genotype is subject to cohort effects as birth cohorts may be raised in significantly different environments. Methods: We used the database of the Estonian Children Personality Behaviour and Health Study (beginning in 1998). Cohorts of initially 9-year-old (recalled at ages 15 and 18) and 15-year-old (recalled at ages 18 and 25) children provided self-reports on their alcohol use in all data collection waves (complete data available n=1,075). Results: A significant genotypexgenderxcohort interaction effect on the age of consuming the first alcoholic drink was found [F(2, 1,063)=7.2, p<0.001]. Females with the s/s genotype in the older cohort were the latest experimenters with alcohol, while the s/s females of younger cohort had tried alcohol earlier than any other group. In males, there was no significant cohortxgenotype interaction, but the 5-HTTLPR genotype was associated with alcohol use, the s/s subjects reporting the highest consumption. Conclusion: Expression of genetic vulnerability to alcohol use is influenced by birth cohort effects. The 5-HTTLPR genotype is associated with alcohol consumption in general population, but the effect depends on gender and birth cohort. © 2014 Springer-Verlag.
Vaccarella S.,International Agency for Research on Cancer |
Franceschi S.,International Agency for Research on Cancer |
Zaridze D.,Russian Blokhin Cancer Research Center |
Poljak M.,University of Ljubljana |
And 3 more authors.
The Lancet Oncology | Year: 2016
Background Cervical cancer incidence remains high in several Baltic, central, and eastern European (BCEE) countries, mainly as a result of a historical absence of effective screening programmes. As a catalyst for action, we aimed to estimate the number of women who could be spared from cervical cancer across six countries in the region during the next 25 years, if effective screening interventions were introduced. Methods In this population-based study, we applied age–period–cohort models with spline functions within a Bayesian framework to incidence data from six BCEE countries (Estonia, Latvia, Lithuania, Belarus, Bulgaria, and Russia) to develop projections of the future number of new cases of cervical cancer from 2017 to 2040 based on two future scenarios: continued absence of screening (scenario A) versus the introduction of effective screening from 2017 onwards (scenario B). The timespan of available data varied from 16 years in Bulgaria to 40 years in Estonia. Projected rates up to 2040 were obtained in scenario A by extrapolating cohort-specific trends, a marker of changing risk of human papillomavirus (HPV) infection, assuming a continued absence of effective screening in future years. Scenario B added the effect of gradual introduction of screening in each country, under the assumption period effects would be equivalent to the decreasing trend by calendar year seen in Denmark (our comparator country) since the progressive regional introduction of screening from the late 1960s. Findings According to scenario A, projected incidence rates will continue to increase substantially in many BCEE countries. Very high age-standardised rates of cervical cancer are predicted in Lithuania, Latvia, Belarus, and Estonia (up to 88 cases per 100 000). According to scenario B, the beneficial effects of effective screening will increase progressively over time, leading to a 50–60% reduction of the projected incidence rates by around 2040, resulting in the prevention of cervical cancer in 1500 women in Estonia and more than 150 000 women in Russia. The immediate launch of effective screening programmes could prevent almost 180 000 new cervical cancer diagnoses in a 25-year period in the six BCEE countries studied. Interpretation Based on our findings, there is a clear need to begin cervical screening in these six countries as soon as possible to reduce the high and increasing incidence of cervical cancer over the next decades. Funding None. © 2016 International Agency for Research on Cancer
Parker R.D.,University of South Carolina |
Ruutel K.,National Institute for Health Development
AIDS and Behavior | Year: 2011
Estonia has the second highest adult HIV prevalence in Europe of 1.3%. The primary transmission is among injecting drug users (IDU), who account for 56-90% of HIV infections (Report on the Global AIDS Epidemic: UNAIDS/WHO, July 2008 and Platt et al. AIDS 20(16):2120-2123, 2006). Of those persons newly diagnosed, 50.4% reported injecting drugs in the last 12 months, 16.3% of these reported IDU as the sole risk factor and 31.2% reported IDU among other risk factors. In this sample (n = 790) 170 persons reported a high risk behavior and 51 persons received a positive result through rapid testing. The largest proportion (35.29%) was among persons reporting high risk heterosexual intercourse and second (33.33%) among persons sharing injecting equipment. Covariates in a logistic regression model indicate that male sex (OR = 2.57, 95% CI 1.00-6.59), non-Estonian ethnicity (OR = 2.68, 95% CI 1.46-4.93), higher education (OR = 0.56, 95% CI 0.40-0.80), and high risk heterosexual intercourse (OR = 2.68, 95% CI 1.19-6.02) are statistically significant in predicting a positive HIV status. © 2010 Springer Science+Business Media, LLC.
Liivlaid H.,National Institute for Health Development |
Uuskula A.,University of Tartu
Sexually Transmitted Infections | Year: 2013
Objective To describe and compare sexual behaviour patterns in 1996 (before the explosion of the HIV epidemic in 2000) and 2006, and the correlates of highrisk sexual behaviour in Estonia. Methods Data on selected sexual behaviour characteristics were obtained by interviewing a probability sample of the adult population in Estonia in 1996 and 2006. Results Data were available from 2441 sexually experienced women and 1994 men, and 3005 women and 2812 men in the year 2006. There were no changes in the proportion of sexually experienced adults, frequency of intercourse, or same gender sexual relationships. There was an increase in sex under the age of 16 (women: 8.4% vs 14.1% adjusted OR (AOR) 2.05 (1.67 to 2.53); men: 21.9% vs 28.0% AOR 1.58 (1.35 to 1.84)). From 1996 to 2006, the proportion reporting intercourse with a casual partner in the previous 12 months decreased significantly for women (10.7% vs 6.0% AOR 0.54 (95% CI 0.41 to 0.72)) and men, (24.0% vs 16.5% AOR 0.71 (0.59 to 0.85)) in parallel with a decrease in those reporting never using condoms during intercourse with a casual partner (for women: 49.3% vs 19.2% AOR 0.27 (0.14 to 0.51); and men: 35.4% vs 20.2% AOR 0.37 (0.25 to 0.56)). In 2006, the odds for not always using condoms in intercourse with casual partners increased significantly with age (eg, ≤24 vs ≥45: AOR 3.46 (1.68 to 7.13)), and were higher among those widowed/divorced/separated (AOR 2.35 (CI 1.20 to 4.60)). Conclusions From 1996 to 2006, a significant reduction in high-risk sexual behaviour has occurred in Estonia across all age groups and genders.
Innos K.,National Institute for Health Development |
Baburin A.,National Institute for Health Development |
Aareleid T.,National Institute for Health Development
Cancer Epidemiology | Year: 2014
Background: Survival from most cancers in Estonia has been consistently below European average. The objective of this study was to examine recent survival trends in Estonia and to quantify the effect on survival estimates of the temporary disruption of the Estonian Cancer Registry (ECR) practices in 2001-2007 when death certificates could not be used for case ascertainment. Patients and methods: ECR data on all adult cases of 16 common cancers diagnosed in Estonia during 1995-2008 and followed up for vital status until 2009 were used to estimate relative survival ratios (RSR). We used cohort analysis for patients diagnosed in 1995-1999 and 2000-2004; and period hybrid approach to obtain the most recent estimates (2005-2009). We compared five-year RSRs calculated from data sets with and without death certificate initiated (DCI) cases. Results: A total of 64. 328 cancer cases were included in survival analysis. Compared with 1995-1999, five-year age-standardized RSR increased 20 percent units for prostate cancer, reaching 76% in 2005-2009. A rise of 10 percent units or more was also seen for non-Hodgkin lymphoma (five-year RSR 51% in 2005-2009), and cancers of rectum (49%), breast (73%) and ovary (37%). The effect of including/excluding DCI cases from survival analysis was small except for lung and pancreatic cancers. Conclusions: Relative survival continued to increase in Estonia during the first decade of the 21st century, although for many cancers, a gap between Estonia and more affluent countries still exists. Cancer control efforts should aim at the reduction of risk factors amenable to primary prevention, but also at the improvement of early diagnosis and ensuring timely and optimal care to all cancer patients. © 2014 Elsevier Ltd.
Littvay L.,Central European University |
Metneki J.,National Institute for Health Development |
Tarnoki A.D.,Semmelweis University |
Tarnoki D.L.,Semmelweis University
Twin Research and Human Genetics | Year: 2013
The first Hungarian Twin Registry was established in Budapest in 1970 through the mandatory reporting of multiple-births. In the 1980s a second, volunteer adult registry was also founded. Unfortunately, both registries ceased to exist in the 1990s. Efforts started in 2006 to revive a Hungarian twin registry. The team spearheading this effort reports here on this progress. Currently, the voluntary Hungarian Twin Registry consists of 310 adult twin pairs and multiplets. Current research focuses on cardiovascular and respiratory health and yielded multiple awards and publications. Efforts are on the way to expand into social, psychological, and obesity studies. Copyright © The Authors 2012.
Czeizel A.E.,Foundation for the Community Control of Hereditary Diseases |
Metneki J.,National Institute for Health Development |
Beres J.,National Institute for Health Development
Congenital Anomalies | Year: 2014
The mandatory notification of patients ("cases") with different congenital abnormalities (CAs) diagnosed from birth until the end of the first postnatal year by medical doctors was ordered by the Ministry of Health in Hungary in 1962 and this CA-registry was continued as the Hungarian Congenital Abnormality Registry (HCAR) based on the international recommendation from 1970. The primary objective of the HCAR has been to determine the baseline birth prevalence rate of different CAs as reliably as possible, with three secondary objectives: (i) to detect temporal and/or spatial clusters of CAs; (ii) to evaluate increasing or decreasing time trends of CAs; and (iii) to assist in the planning of medical and social services for children and families affected by CA so that appropriate resources are allocated efficiently and effectively. This paper summarizes the activities and the evolution of the HCAR over the past 50 years (1962-2011) including the Hungarian Case-Control Surveillance of Congenital Abnormalities for postmarketing surveillance of drug teratogenicity and prevention of CAs; the special evaluation of unidentified multiple CAs; the Hungarian Surveillance of Germinal Mutations and several international collaborations. In conclusion, Hungary enjoyed optimal conditions for the HCAR due to a centralized state health system; all deliveries took place in inpatient clinics; the quality of pediatric care was high and pediatricians notified most CAs. Autopsy was mandatory in infant death, the staff of the HCAR did not consider this CA-registry only as a statistical system but the Hungarian Center for Congenital Anomaly Control and the Hungarian Case-Control Surveillance of Congenital Abnormalities based on the HCAR worked with close collaboration with the parents in order to promote the possible good quality of life of their affected children and to prevent their risk of recurrence. © 2013 Japanese Teratology Society.
Pettersson J.H.-O.,Uppsala University |
Golovljova I.,National Institute for Health Development |
Vene S.,Public Health Agency of Sweden |
Jaenson T.G.T.,Uppsala University
Parasites and Vectors | Year: 2014
Background: In northern Europe, the tick-borne encephalitis virus (TBEV) of the European subtype is usually transmitted to humans by the common tick Ixodes ricinus. The aims of the present study are (i) to obtain up-to-date information on the TBEV prevalence in host-seeking I. ricinus in southern and central Sweden; (ii) to compile and review all relevant published records on the prevalence of TBEV in ticks in northern Europe; and (iii) to analyse and try to explain how the TBE virus can be maintained in natural foci despite an apparently low TBEV infection prevalence in the vector population. Methods. To estimate the mean minimum infection rate (MIR) of TBEV in I. ricinus in northern Europe (i.e. Denmark, Norway, Sweden and Finland) we reviewed all published TBEV prevalence data for host-seeking I. ricinus collected during 1958-2011. Moreover, we collected 2,074 nymphs and 906 adults of I. ricinus from 29 localities in Sweden during 2008. These ticks were screened for TBEV by RT-PCR. Results: The MIR for TBEV in nymphal and adult I. ricinus was 0.28% for northern Europe and 0.23% for southern Sweden. The infection prevalence of TBEV was significantly lower in nymphs (0.10%) than in adult ticks (0.55%). At a well-known TBEV-endemic locality, Torö island south-east of Stockholm, the TBEV prevalence (MIR) was 0.51% in nymphs and 4.48% in adults of I. ricinus. Conclusions: If the ratio of nymphs to adult ticks in the TBEV-analysed sample differs from that in the I. ricinus population in the field, the MIR obtained will not necessarily reflect the TBEV prevalence in the field. The relatively low TBEV prevalence in the potential vector population recorded in most studies may partly be due to: (i) inclusion of uninfected ticks from the 'uninfected areas' surrounding the TBEV endemic foci; (ii) inclusion of an unrepresentative, too large proportion of immature ticks, compared to adult ticks, in the analysed tick pools; and (iii) shortcomings in the laboratory techniques used to detect the virus that may be present in a very low concentration or undetectable state in ticks which have not recently fed. © 2014 Pettersson et al.; licensee BioMed Central Ltd.