Haigusregistrite andmekvaliteedi uurimise meetodid

Rahvastikul põhinevatesse haigusregistritesse kogutakse epidemioloogilisi andmeid haiguste esinemissageduse kohta. Täiuslik register peaks sisaldama iga registreerimisele kuuluva juhu kohta ühe võimalikult täpse ja täiusliku kirje. Tegelikkuses ilmneb andmekvaliteedis puudujääke. On ülimalt tähtis teada, millised on puudujäägid registriandmete täielikkuses ja täpsuses, kuna neid andmeid kasutatakse laialdaselt kliinilistes ning epidemioloogilistes uurimustes. Eesti Arst 2003; 82 (10): 693–69

Sünnikaalukõverad Eestis ja sünnikaalu mõjutavad tegurid: registripõhine uuring

Taust. Vastsündinute keskmine sünnikaal erineb riigiti. Sünnikaalu uurimisega on võimalik kliinilises meditsiinis paremini analüüsida perinataalset suremust ja haigestumise põhjuseid, sh patsiendi hilisemas elueas.Eesmärk. Koostada sünnikaalukõverad raseduse kestuse järgi Eestis aastatel 1995–2012 elusalt sündinud poeg- ja tütarlaste andmete põhjal. Alaeesmärkideks oli võrrelda saadud tulemusi aastate 1992–1994 andmetega ning kirjeldada erinevusi ning analüüsida sünnikaalu mõjutavaid tegureid.Metoodika. Andmeallikana kasutati Eesti meditsiinilise sünniregistri (EMSR) mitteisikustatud andmeid laste kohta, kes sündisid Eestis ajavahemikul 1995–2012 (n = 240 108). Sünnikaalude analüüsimiseks kasutati protsentiile 3, 10, 25, 50, 75, 90, 97. Protsentiilid arvutati raseduskestuse järgi nädalates poiste ja tüdrukute kohta eraldi. Sünnikaalu mõjutavate teguritena analüüsiti ema sotsiaal-demograafi list tausta, rasedusaegseid riskitegureid ja varasemaid sünnitusi ja aborte. Tegureid analüüsiti kohandatud lineaarse regressioonmudeli abil. Võrdlusrühma andmed pärinesid aastatel 1992–1994 korraldatud sünnikaalu-uuringust.Tulemused. Sündide arvud rasedusnädalate järgi ning sünnikaalu protsentiilid poiste ja tüdrukute kohta toodi vahemikus 22–43 rasedusnädalat. Sünnikaalu mõjutavad lapse sugu, ema haridus, rahvus, perekonnaseis, varasemad sünnitused, abordid ning rasedusaegsed riskitegurid. Võrreldes varasema uuringuga on 25.–34. rasedusnädalal sündinute kaal vähenenud, tüdrukutel 1–71 g ja poistel 9–111 g. 35.–43. rasedusnädalal sündinute kaal on poistel suurenenud 7–140 g ning 36.–42. rasedusnädalal sündinud tüdrukutel 1–70 g.Järeldused. Võrreldes käesolevat uuringut aastatel 1992–1994 Eestis tehtud uuringuga, on lühema raseduskestuse korral elusalt sündinud laste sünnikaal vähenenud ja pikema raseduskestuse korral laste keskmine sünnikaal suurenenud. Sünnikaalu mõjutavad nii sotsiaal-demograafilised tegurid kui ka rasedusaegsed riskitegurid. Vastsündinute sünnikaal väärib regulaarset jälgimist ja sünnikaalugraafi kuid tuleb igas riigis regulaarselt uuendada.Eesti Arst 2015; 94(8):465–47

Auffindbarkeit, Wahrnehmbarkeit, Akzeptabilität

Many public authorities are now obliged to use plain language on their websites. The aim is to improve the participation of people with disabilities. But are the legal requirements and the resulting textual practice suitable for achieving this goal from the perspective of accessible communication? To answer this question, Katrin Lang looks at the categories of "findability", "perceptibility" and "acceptability", which have been little addressed in research so far. She shows why many texts created on the basis of the Disability Equality Act and the Barrier-Free Information Technology Ordinance (BITV) have deficiencies in the area of acceptability and contain a so-called "motivation barrier". In addition, Lang explains how it is possible to make official websites at federal, state and municipal level not only findable, perceptible and understandable for people with communication impairments, but also acceptable and actionable

Auffindbarkeit, Wahrnehmbarkeit, Akzeptabilität

Many public authorities are now obliged to use plain language on their websites. The aim is to improve the participation of people with disabilities. But are the legal requirements and the resulting textual practice suitable for achieving this goal from the perspective of accessible communication? To answer this question, Katrin Lang looks at the categories of "findability", "perceptibility" and "acceptability", which have been little addressed in research so far. She shows why many texts created on the basis of the Disability Equality Act and the Barrier-Free Information Technology Ordinance (BITV) have deficiencies in the area of acceptability and contain a so-called "motivation barrier". In addition, Lang explains how it is possible to make official websites at federal, state and municipal level not only findable, perceptible and understandable for people with communication impairments, but also acceptable and actionable

Lessons Learned from Two Case Studies in Higher Education

As places where future citizens are educated, knowledge is (co-)produced and societal developments are critically reflected, higher education institutions (HEIs) can play a key role in addressing sustainability challenges. In order to accelerate mutual learning, shared problem understanding, and joint development of sustainable solutions, interinstitutional exchange and collaboration between HEIs is crucial. However, little research to date has focused on institutional HEI networks in the field of sustainability. More specifically, we still understand little about the concrete development, implementation, and adaptation of such networks. This article explores early-stage HEI networks for sustainability from a conceptual and empirical stance in order to develop a framework that facilitates structured descriptions of these networks, as well as to foster cross-HEI learning on their effective performance. It therefore combines insights from an explorative literature review, two case studies and an interactive workshop at the ISCN Conference 2018. As results, we first suggest an analytical framework to facilitate a systematic characterization of HEI networks. Second, by applying the framework to the two case studies, we present and discuss lessons learned on how a single HEI can contribute to establishing a network and how it can utilize its network membership effectively to strengthen its efforts for sustainability

Logopeediline ravi Eesti tervishoiusüsteemis 2010–2022: piirkondlikult ebaühtlane kättesaadavus ja vähenemas ravimaht

Logopeedilise ravi kättesaadavust Eesti tervishoiusüsteemis ei ole varem detailselt uuritud. Uuringu eesmärk oli kirjeldada tervishoiusüsteemis osutatud logopeedilise raviteenuse kogumahtu tundides ning regionaalseid erinevusi ja ajalisi trende aastatel 2010–2022.Analüüsiti Tervisekassast päritud andmeid, kaasates kõik osutatud logopeedilised teenused, ning andmeid Eesti Maa-ameti, Tervise Arengu Instituudi ja Statistikaameti avalikest andmebaasidest.Keskmiselt osutati aastas 78 892 tundi logopeedilist ravi. Tundide kogumaht suurenes 15% vaadeldud perioodi alguses toimunud ambulatoorselt osutatud ravi mahu suurenemise arvelt, kuid edasise pideva langustrendi tõttu oli 2022. aastaks raviteenuse maht langenud 2012. aasta tasemele. Väikseim ravimaht pärast 2014. aastat ilmnes COVIDi-pandeemia ajal 2020. aastal. Piirkondlikult erines osutatud logopeedilise ravi maht suuresti. Osutatud ravimaht tundides 1000 elaniku kohta erines omavalitsustes kuni 367 korda. Piirkondlikult ebaühtlaselt kättesaadav ravi tingis patsientide rände teenuse järele kodumaakonnast väljapoole. Uuringu tulemused näitasid, et perioodil 2010–2022 suurenes mõningal määral logopeedilise ravi kogumaht perioodi algusaastatel toimunud osutatud ravi suurema ajalise mahu arvelt, kuid oli seejärel pidevas langustrendis ning ravi oli piirkondlikult ebaühtlaselt kättesaadav.Uuring on esimene detailne ülevaade logopeedilise ravi osutamisest Eesti tervishoiusüsteemis, tuues välja selle regionaalselt ebaühtlase kättesaadavuse ja kogumahu langustrendi. Eelnev viitab vajadusele üle vaadata siinse tervishoiusüsteemi võimekus osutada nii praegu kui ka tulevikus erinevates piirkondades logopeedilist ravi

Stat6-Dependent Inhibition of Mincle Expression in Mouse and Human Antigen-Presenting Cells by the Th2 Cytokine IL-4

The C-type lectin receptors (CLR) Mincle, Mcl and Dectin-2 bind mycobacterial and fungal cell wall glycolipids and carbohydrates. Recently, we described that expression of these CLR is down-regulated during differentiation of human monocytes to dendritic cells (DC) in the presence of GM-CSF and IL-4. Here, we demonstrate that the Th2 cytokine IL-4 specifically inhibits expression of Mincle, Mcl and Dectin-2in human APC. This inhibitory effect of IL-4 was observed across species, as murine macrophages and DC treated with IL-4 also down-regulated these receptors. IL-4 blocked up-regulation of Mincle and Mcl mRNA expression and cell surface protein by murine macrophages in response to the Mincle ligand Trehalose-6,6-dibehenate (TDB), whereas the TLR4 ligand LPS overcame inhibition by IL-4. Functionally, down-regulation of Mincle expression by IL-4 was accompanied by reduced cytokine production upon stimulation with TDB. These inhibitory effects of IL-4 were dependent on the transcription factor Stat6. Together, our results show that the key Th2 cytokine IL-4 exerts a negative effect on the expression of Mincle and other Dectin-2 cluster CLR in mouse and human macrophages and DC, which may render these sentinel cells less vigilant for sensing mycobacterial and fungal ligands

Krooniliste haiguste ja hulgihaigestumise levimus Eestis: rahvastikupõhine läbilõikeuuring

Eesti Arst 2022; 101(4):24

Prevalence of alcohol-related pathologies at autopsy: Estonian Forensic Study of Alcohol and Premature Death.

AIMS: Alcohol can induce diverse serious pathologies, yet this complexity may be obscured when alcohol-related deaths are classified according to a single underlying cause. We sought to quantify this issue and its implications for analysing mortality data. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study included 554 men aged 25-54 in Estonia undergoing forensic autopsy in 2008-09. MEASUREMENTS: Potentially alcohol-related pathologies were identified following macroscopic and histological examination. Alcohol biomarkers levels were determined. For a subset (26%), drinking behaviour was provided by next-of-kin. The Estonian Statistics Office provided underlying cause of death. FINDINGS: Most deaths (75%) showed evidence of potentially alcohol-related pathologies, and 32% had pathologies in two or more organs. The liver was most commonly affected [60.5%, 95% confidence interval (CI) = 56.3-64.6] followed by the lungs (18.6%, 95% CI = 15.4-22.1), stomach (17.5%, 95% CI = 14.4-20.9), pancreas (14.1%, 95% CI = 11.3-17.3), heart (4.9%, 95% CI = 3.2-7.0) and oesophagus (1.4%, 95% CI = 0.6-2.8). Only a minority with liver pathology had a second pathology. The number of pathologies correlated with alcohol biomarkers (phosphatidylethanol, gamma-glytamyl transpeptidase in blood, ethylglucuronide, ethylsulphate in urine). Despite the high prevalence of liver pathology, few deaths had alcoholic liver disease specified as the underlying cause. CONCLUSION: The majority of 554 men aged 25-54 undergoing forensic autopsy in Estonia in 2008-09 showed evidence of alcohol-related pathology. However, the recording of deaths by underlying cause failed to capture the scale and nature of alcohol-induced pathologies found