Cervical cancer screening patterns among HIV-positive women in Estonia: a population-based retrospective cohort study.

The World Health Organisation (WHO) calls for the elimination of cervical cancer (CC) as a public health issue. To achieve elimination, efforts must be aligned and accelerated. Women living with HIV (WLWH) have excess risk for developing, and dying from, CC over the general population. Estimates of cervical cancer screening programme coverage in Eastern European countries that have experienced HIV epidemics since the early 2000's are scarce. This population-based retrospective study uses a healthcare administrative database and follows cohorts of all WLWH in a ratio of 1:3 randomly matched (age, region) HIV negative women from 2009 to 2018. Annual and longitudinal (over the whole study period) coverage for cervical cancer screening (opportunistic, organised, HIV specific) and adjusted odds ratios (AORs) for longitudinal screening coverage predictors were estimated from 2009 to 2018. Among WLWH and HIV-negative women, the mean annual coverage with opportunistic screening was 61.45 and 65.59%; and organised screening was 20.4 and 28.7%, respectively (both: p < 0.00001). 19.01% (95% CI 18.05-19.97) HIV-negative and 13.9% (95% CI 12.35-15.45) WLWH were longitudinally covered with organised cervical cancer screening. Among WLWH, the mean annual HIV-specific cervical cancer screening coverage was 49.4, and 24.3% were longitudinally covered. Longitudinal coverage with HIV-specific cervical cancer screening was inversely associated with age, hepatitis C virus (HCV) co-infection (AOR 0.754, 95% CI 0.619, 0.916), not having insurance (AOR 0.331, 95% CI 0.264, 0.412), drug abuse (AOR 0.459, 95% CI 0.336, 0.618) and higher among those retained in HIV care (AOR 1.972, 95% CI 1.615, 2.410). Among HIV-negative women, longitudinal coverage with organised cervical cancer screening was inversely associated with residence in the region and higher among older women. Our results highlight unacceptably low coverage of cervical cancer screening of WLWH in Estonia. There is need for dedicated cervical cancer screening efforts for WLWH considering the high cancer risk and rate in the study population

The concordance of the limiting antigen and the Bio-Rad avidity assays in persons from Estonia infected mainly with HIV-1 CRF06_cpx

BACKGROUND: Serological assays to determine HIV incidence have contributed to estimates of HIV incidence, monitoring of HIV spread, and evaluation of prevention strategies. Two frequently used incidence assays are the Sedia HIV-1 LAg-Avidity EIA (LAg) and the Bio-Rad avidity incidence (BRAI) assays with a mean duration of recent infection (MDRI) of 130 and 240 days for subtype B infections, respectively. Little is known about how these assays perform with recombinant HIV-1 strains. We evaluated the concordance of these assays in a population infected mainly with HIV-1 CRF06_cpx. MATERIAL/METHODS: Remnant serum samples (n = 288) collected from confirmed, newly-diagnosed HIV-positive persons from Estonia in 2013 were tested. Demographic and clinical data were extracted from clinical databases. LAg was performed according to the manufacturer’s protocol and BRAI testing was done using a validated protocol. Samples with LAg-pending or BRAI-invalid results were reclassified as recent if they were from persons with viral loads <1000 copies/mL or were reclassified as long-term if presenting with AIDS. RESULTS: In total 325 new HIV infections were diagnosed in 2013 in Estonia. Of those 276 persons were tested with both LAg and BRAI. Using assay results only, the recency rate was 44% and 70% by LAg and BRAI, respectively. The majority of samples (92%) recent by LAg were recent by BRAI. Similarly, 89% of samples long-term by BRAI were long-term by LAg. After clinical information was included in the analysis, the recency rate was 44% and 62% for LAg and BRAI, respectively. The majority of samples (86%) recent by LAg were recent by BRAI and 91% of long-term infections by BRAI were long-term by LAg. CONCLUSIONS: Comparison of LAg and BRAI results in this mostly CRF06_cpx-infected population showed good concordance for incidence classification. Our finding of a higher recency rate with BRAI in this population is likely related to the longer MDRI for this assay

HIV incidence in the Estonian population in 2013 determined using the HIV-1 limiting antigen avidity assay

Estonia has one the highest number of new HIV diagnoses in the European Union, mainly among injecting drug users and heterosexuals. Little is known of HIV incidence, which is crucial for limiting the epidemic. Using a recent HIV infection testing algorithm (RITA) assay, we aimed to estimate HIV incidence in 2013. All individuals aged ≥18 years newly-diagnosed with HIV in Estonia January- December 2013, except blood donors and those undergoing antenatal screening, were included. Demographic and clinical data were obtained from the Estonian Health Board and the Estonian HIV-positive patient database. Serum samples were tested for recent infection using the LAg-avidity EIA assay. HIV incidence was estimated based on previously published methods. Of 69,115 tested subjects, 286 (0.41%) were newly-diagnosed with HIV with median age of 33 years (IQR: 28-42) and 65% male. Self-reported routes of HIV transmission were mostly heterosexual contact (n = 157, 53%) and injecting drug use (n = 62, 21%); 64 (22%) were with unknown risk group. Eighty two (36%) were assigned recent, resulting in estimated HIV incidence of 0.06%, corresponding to 642 new infections in 2013 among the non-screened population. Incidence was highest (1.48%) among people who inject drugs. These high HIV incidence estimates in Estonia call for urgent action of renewed targeted public health promotion and HIV testing campaign

Tartu Ülikooli Õppe- ja Katsemetskonna Kastre Peravalla metsandike plaanid (kvartalid nr 1-100)

PlaanidTartu Ülikooli Õppe- ja Katsemetskonna Kastre Peravalla metsandike takseerkirjeldused aastatest 1922, 1923, 1924, 1927. Kvartalite nr 1-100 käsikirjalised originaalplaanid on mõõtkavas 1:2500. Koloreeritud plaanid sisaldavad kvartalite numbreid, leppemärkide seletusi, ilmakaari, graafilist mõõtkava, autorite nimesid. Autorite nimedes võib esineda eksimusi. Loetamatud nimed puuduvad autorite loendis.Kaardid digitaliseeriti Keskkonnainvesteeringute Keskuse projekti raame

The Influence of Instructional Practices on Reading Motivation in Finland

Although the differences between individuals in language and literacy skills and motivation to read start before entering school, teachers and their instructional practices play an important role in the development of reading skills and the various aspects of motivation, especially children’s interest in reading. Interest in reading has been reported to contribute to the reading activity and to the amount of reading which, in turn, promote students’ reading performance. It has been assumed that children’s previous success with learning the basics of reading has provided them with positive feedback about the learning situation, thereby strengthening their interest in reading. Teachers and their instruction provide an important environment for children’s learning and motivation. Child-centered teaching practices that are sensitive to the development of children’s autonomy, competence beliefs, and social interactions with peers support interest in reading. The high-quality classroom interactions described by emotionally supportive relationships in a well-organized classroom have been shown to be of particular importance in the development of children’s reading skills and motivation, especially among children at risk of having reading difficulties. The present chapter attempts to describe the development of interest in reading and how teaching practices and the quality of teacher-child interactions observed in classrooms influence children’s reading interest, particularly among boys and at-risk children in the Finnish language context. According to international comparative education studies of achievement, Finland has a high-quality educational system and high performance outcomes across the school years. The results reported here are based on a longitudinal First Steps study among 2000 children and their teachers from kindergarten to grade 4. Reading instruction is based on phonics, and a highly transparent Finnish orthography makes decoding relatively quick and easy for children to learn.peerReviewe