Eestis töötavad õed ja arstid vananevad

Taust ja eesmärk. Kümme aastat tagasi koostati arstide ja õdede arvu prognoosid aastaks 2032 ja siis oli suurimaks mureks nii arstide kui ka õdede lahkumine tööle välismaale. Käesoleva uuringu eesmärk oli kirjeldada ajavahemikul 2012–2021 toimunud muutusi Eestis töötavate õdede ja arstide arvus ning vanuselises koosseisus ja selle alusel hinnata koolitusvajadust lähimaks aastakümneks.Metoodika. Terviseameti tervishoiutöötajate registrist tehti õdede ja arstide nimelised väljavõtted 2021. aasta aprilli seisuga ja lingiti need 2012. aasta aprillis küsitud andmetega, et hinnata õdede ja arstide töölt lahkumist ning tööle asumist sõltuvalt vanusest.Tulemused. Võrreldes 2012. aastaga on Eesti tervishoiusüsteemis töötavate õdede keskmine vanus suurenenud 4 aasta võrra ja üle 65aastaste osakaal töötavate õdede koguarvust on kahekordistunud (6%-lt 12%-le). Töökohaga õdede koguarv on suurenenud 1487 võrra ja seda mitte uute õdede lisandumise arvel. Eesti raviasutustesse on tööle naasnud 649 õde, kes vahepeal töötasid mujal, ja pensioniikka jõudnud õed jätkavad töötamist (lisandus 674 pensioniealist õde). Eesti raviasutustes töötavate alla 65aastaste arstide arv on kogu iseseisvuse taastamise järgse aja pidevalt vähenenud, kuid arstide koguarv on püsinud samal tasemel, sest pensioniealiseks saanud arstid jätkavad töötamist. Võrreldes 2012. aastaga on Eesti tervishoiusüsteemis töötavate üle 65aastaste arstide osakaal suurenenud 17%-lt 25%-le.Järeldused. Et kahekümne aasta pärast oleks Eesti raviasutustes tööl 9 õde 1000 inimese kohta, tuleb kohe kahekordistada õendusõppe vastuvõttu 700–800 õppekohani aastas ja loota, et väljaõpetatud õdede tööleasumine välisriikidesse ei suurene. Järgmised kakskümmend aastat pidurdab Eesti tervishoiusüsteemi arengut parimas tööeas arstide defitsiit ja ainult noorte arstide piisavalt arvukas ettevalmistus suudab seda osaliselt leevendada ning tagada arstide ühtlane vanuseline koosseis

Laste allaneelatud magnetid: kirjanduse ülevaade ja Tallinna Lastehaigla haigusjuhtude analüüs

Laste allaneelatud võõrkehad on suhteliselt sage erakorralise meditsiini osakonda pöördumise põhjus. Magnetid moodustavad võõrkehadest erilise rühma, kuna juhul kui soolesein kogupaksuses või ka ainult limaskest jääb magnetite vahele kinni, võib survest tekkida sooleseina kahjustus: mulgustumine, soolesulgus või uuriste moodustumine soolelingude või soolelingu ja muu seedetrakti osa vahel. Oht on eriti suur seoses nn supermagnetitega. Artiklis on esitatud allaneelatud magneteid käsitleva kirjanduse ülevaade ning analüüsitud 12 Tallinna Lastehaigla haigusjuhtu – pöördumise põhjuseid, diagnoosimist ja rakendatud ravivõtteid ning -tulemusi. Kahe või enama allaneelatud magnetiga patsiendi käsitus on erakorraline, esmane eesmärk on magnetid seedetraktist endoskoopiliselt eemaldada. Selle ebaedu korral võib haigusnähtudeta lapsi jälgida, soovitatavalt lastekirurgia osakonnas, kuna tüsistuste tekkimine on väga tõenäoline. Magnetitega kaasnevatest ohtudest peab jätkuvalt teavitama nii lapsevanemaid kui ka meditsiinipersonali

Opioidide väljakirjutamise suundumused Eestis 2011–2017

Eesti Arst 2020; 99(10):647 &nbsp

Metabolomics reveals a link between homocysteine and lipid metabolism and leukocyte telomere length: the ENGAGE consortium

Telomere shortening has been associated with multiple age-related diseases such as cardiovascular disease, diabetes, and dementia. However, the biological mechanisms responsible for these associations remain largely unknown. In order to gain insight into the metabolic processes driving the association of leukocyte telomere length (LTL) with age-related diseases, we investigated the association between LTL and serum metabolite levels in 7,853 individuals from seven independent cohorts. LTL was determined by quantitative polymerase chain reaction and the levels of 131 serum metabolites were measured with mass spectrometry in biological samples from the same blood draw. With partial correlation analysis, we identified six metabolites that were significantly associated with LTL after adjustment for multiple testing: lysophosphatidylcholine acyl C17:0 (lysoPC a C17:0, p-value = 7.1 × 10−6), methionine (p-value = 9.2 × 10−5), tyrosine (p-value = 2.1 × 10−4), phosphatidylcholine diacyl C32:1 (PC aa C32:1, p-value = 2.4 × 10−4), hydroxypropionylcarnitine (C3-OH, p-value = 2.6 × 10−4), and phosphatidylcholine acyl-alkyl C38:4 (PC ae C38:4, p-value = 9.0 × 10−4). Pathway analysis showed that the three phosphatidylcholines and methionine are involved in homocysteine metabolism and we found supporting evidence for an association of lipid metabolism with LTL. In conclusion, we found longer LTL associated with higher levels of lysoPC a C17:0 and PC ae C38:4, and with lower levels of methionine, tyrosine, PC aa C32:1, and C3-OH. These metabolites have been implicated in inflammation, oxidative stress, homocysteine metabolism, and in cardiovascular disease and diabetes, two major drivers of morbidity and mortality

Sissejuhatus varjatud Markovi ahelatesse

https://www.ester.ee/record=b5436142*es

Cigarette smoking and smoking-attributable diseases among Estonian physicians: a cross-sectional study

Abstract Background Smoking is a risk factor for several diseases. Physicians are role models for their patients. Physicians who smoke underestimate the health risks of smoking and may be less likely to offer advice to help their patients to quit. The aim of this study was to: provide an overview of smoking behaviour among Estonian physicians; assess the relationship between smoking and ischaemic heart disease (IHD), chronic bronchitis (CB), and lung emphysema (LE); and estimate fractions of prevalences of the three diseases attributable to smoking. Methods Self-administered questionnaires were sent to practising physicians (n = 5666) in Estonia in 2014. Prevalence of smoking and relative risks for IHD, CB and LE as well as the risks of IHD, CB and LE attributable to smoking were calculated by age and sex. Post-stratification was used to compensate non-response. Results There were 535 male and 2404 female physicians participating. The prevalence of daily smoking was 12.4% (95% CI 10.4–14.4%) among men and 5.0% (95% CI 4.4–5.6%) among women. Mean duration of smoking among male and female daily smokers was 28.6 (95% CI 26.1–31.1) and 28.6 (95% CI 27.1–30.2) years. Compared to lifelong non-smokers, the age-adjusted risk for IHD was 1.29 times (95% CI 0.88–1.89) higher for men, but 1.69 times (95% CI 1.17–2.40) lower for all women who have ever smoked. The risk for CB was 2.29 (95% CI 1.30–4.03) times higher for smokers among men and, 1.32 (95% CI 0.95–1.82) among women; the risk ratio for LE was 4.92 (95% CI 1.14–21.1) among men and 2.45 (95% CI 0.63–9.52) among women. The smoking-attributable risk for IHD was 3.2% (95% CI 2.3–4.1%) among men and − 0.1% (95% CI -0.7–0.4%) among women; for CB 6.9% (95% CI 6.0–7.8%) and 4.2% (95% CI 3.5–4.8%); and for LE 18.8% (95% CI 17.0–22.5%) and 22.6% (95% CI 18.5–26.9%), respectively. Conclusion Prevalence of daily smoking was relatively low among Estonian physicians (and twice lower among female physicians). The risk attributable to smoking was higher for LE and CB than for IHD

Prevalence of injecting drug use in Estonia 2010–2015: a capture-recapture study

Abstract Background It has been observed in an earlier study that the number of people who inject drugs (PWID) in Estonia is declining. We provide nationwide estimates of the number of PWID in Estonia for years 2010–2015 and compare different modelling strategies to minimise over-coverage-induced bias in capture-recapture estimates. Methods We obtained data from the Estonian Causes of Death Registry (DR) for opioid-related deaths, the Estonian Health Insurance Fund (HIF) for opioid-related overdose and drug dependence treatment episodes, and the Estonian Police and Border Guard Board (PB) drug-related misdemeanours. Datasets were linked by identifier based on sex, date of birth, and initials; a capture-recapture method was used to estimate the number of PWID aged 15 or more, each year from 2010 to 2015. Log-linear regression maximum likelihood (ML) and Bayesian methods were used; over-coverage of police data was accounted for. Results The annual population size estimates of the number of PWID (aged 15 and over) varied from 6000 to 17,300 (ML estimates not accounting for over-coverage of PB) to 1500–2300 (Bayesian estimates accounting for over-coverage). Bayesian estimates indicated a slight decrease in the number of PWID, and the median estimates were > 2000 in years 2010–2012 and < 1800 in years 2013–2015. Conclusions Over-coverage of a registry can have a great impact on the estimates of the size of the target population. Bayesian estimates accounting for this over-coverage may provide better estimates of the target population size

Additional file 1: of Cigarette smoking and smoking-attributable diseases among Estonian physicians: a cross-sectional study

Weighted counts. Weighted counts of study participants by sex, age, smoking status, smoking duration, presence of ischaemic heart disease, lung emphysema and chronic bronchitis. (XLSX 129 kb

Another frontier for harm reduction: contraceptive needs of females who inject drugs in Estonia, a cross-sectional study

Abstract Background Despite increasing contraceptive availability, unintended pregnancy remains a global problem. Developing strategies to reverse this trend and increasing occurrence of withdrawal syndrome among newborn children of females currently injecting drugs warrants special attention. The knowledge base on the uptake of effective contraception among females who inject drugs (FWID) is scant. We aimed to examine the prevalence of and factors associated with the use of non-condom contraceptives among sexually active FWID with the focus on effective contraception. Methods In a series of cross-sectional studies (2007–2013), 265 current FWID were recruited through respondent-driven sampling (RDS), interviewed, and tested for HIV. RDS weights were used to estimate the prevalence of effective contraception (hormonal contraception, intrauterine device, sterilization) use in the last 6 months. Results Of the sexually active women with main partners (n = 196) 4.8% (95% CI 2.3–9.7) were using effective contraception, 52.7% (95% CI 42.5–62.7) less-effective or no contraception. 42.5% (95% CI 32.7–52.9) relied on condoms for contraception. The odds for using effective contraception were higher among women with > 10 years of education (OR 7.29, 95% CI 1.4–38.8). None of the women lacking health insurance (n = 84) were using effective contraception. Conclusions The very low coverage with effective contraception highlights the need to improve contraceptive services for FWID. Reproductive health service including contraception should be considered essential components of harm reduction and of comprehensive prevention and care for HIV among persons who use drugs