HIV levik Eestis ja võimalikud tulevikuprognoosid aastani 2015

Varasemad hinnangud on Eesti HIVnakatunute arvu pakkunud vahemikku mõnest tuhandest kuni mitmekümne tuhandeni, kuid samas on praeguseks registreerituid HIV-juhtumeid alla seitsme tuhande. Uuringu eesmärgiks oli täpsustada võimalikku HIV-nakatunute arvu Eestis, kasutades epidemioloogilisi mudeleid. HIVepideemia modelleerimise tulemused näitavad, et praegu on Eestis 11 000–12 000 HIV-nakatunut. Tõenäoline on HIV-epideemia seni arvatust varasem algus ja aeglasem levik, mis tähendab aastaks 2015 praeguse registreerimisega sarnanevate kiire levimuse versioonidega võrreldes 5–10% suuremat HIV-nakatunute arvu. Eesti Arst 2009; 88(4):267−27

Suremusest ja haigestumusest põhjustatud tervisekadu Eestis

Haiguskoormuse ehk tervisekaotuse hindamise metoodika ühendab suremuse ja haigestumuse andmed ühtseks tervikuks. Meetodi väljundiks on haiguste ja nende põhjustatud surmade tõttu kaotatud eluaastad rahvastikus. Käesolevas haiguskoormus-uuringus hinnati esimest korda Eesti rahvastiku tervisekaotuse ulatust ja põhjuseid, tuginedes 2002. aasta haigekassa haigestumuse ja Statistikaameti suremuse andmetele. Eesti Arst 2005; 84 (7): 466–47

Conducting national burden of disease studies and knowledge translation in eight small European states: challenges and opportunities

Background: Several countries across Europe are engaging in burden of disease (BoD) studies. This article aims to understand the experiences of eight small European states in relation to their research opportunities and challenges in conducting national BoD studies and in knowledge translation of research outputs to policy-making. Methods: Countries participating in the study were those outlined by the WHO/Europe Small Countries Initiative and members of the Cooperation in Science and Technology (COST) Action CA18218 European Burden of Disease Network. A set of key questions targeting the research landscape were distributed to these members. WHO’s framework approach for research development capacities was applied to gain a comprehensive understanding of shortages in relation to national BoD studies in order to help strengthen health research capacities in the small states of Europe. Results: Most small states lack the resources and expertise to conduct BoD studies, but nationally representative data are relatively accessible. Public health officials and researchers tend to have a close-knit relationship with the governing body and policy-makers. The major challenge faced by small states is in knowledge generation and transfer rather than knowledge translation. Nevertheless, some policy-makers fail to make adequate use of knowledge translation. Conclusions: Small states, if equipped with adequate resources, may have the capacity to conduct national BoD studies. This work can serve as a model for identifying current gaps and opportunities in each of the eight small European countries, as well as a guide for translating country BoD study results into health policy

Validation of an Estonian version of the Parkinson's Disease Questionnaire (PDQ-39)

<p>Abstract</p> <p>Introduction</p> <p>Diagnosis and management of Parkinson's disease (PD) rely heavily on evaluation of clinical symptoms and patients' subjective perception of their condition. The purpose of this study was to evaluate the validity, acceptability, and reliability of the Estonian version of the 39-question Parkinson 's disease Questionnaire (PDQ-39).</p> <p>Methods</p> <p>Study subjects were approached during their regular clinic follow-up visits. 104 patients consented to the study and 81 completed questionnaires were used for subsequent testing of psychometric characteristics, validity and reliability.</p> <p>Results</p> <p>The content validity was assessed through qualitative content analysis during the pilot study. The patients indicated that the questions were relevant to measure the quality of life of people with PD.</p> <p>The analysis of means showed that the ceiling and floor effects of domain results were within the limits of 15% of Summary Index and of all domains except Stigma, Social Support and Communication where the ceiling effect was 16% to 24% of the responses. Convergent validity was interpreted through correlation between disease severity and PDQ-39 domains. There was a statistically significant difference between the domain scores in patients with mild versus moderate PD in domains of Mobility, ADL, and Communication but not for Stigma, Social Support and Cognition. The reliability was good, Cronbach alpha for all domains and summary index was over 0.8 and item-test correlations between domains and summary index ranged from 0.56 to 0.83.</p> <p>Conclusion</p> <p>The psychometric characteristics of an Estonian version of the PDQ-39 were satisfactory. The results of this study were comparable to the results of previous validation studies in other cultural settings in UK, USA, Canada, Spain and Italy.</p> <p>The Estonian version of the PDQ-39 is an acceptable, valid and reliable instrument for quality of life measurement in PD patients.</p

Health impact assessment of particulate pollution in Tallinn using fine spatial resolution and modeling techniques

<p>Abstract</p> <p>Background</p> <p>Health impact assessments (HIA) use information on exposure, baseline mortality/morbidity and exposure-response functions from epidemiological studies in order to quantify the health impacts of existing situations and/or alternative scenarios. The aim of this study was to improve HIA methods for air pollution studies in situations where exposures can be estimated using GIS with high spatial resolution and dispersion modeling approaches.</p> <p>Methods</p> <p>Tallinn was divided into 84 sections according to neighborhoods, with a total population of approx. 390 000 persons. Actual baseline rates for total mortality and hospitalization with cardiovascular and respiratory diagnosis were identified. The exposure to fine particles (PM_2.5) from local emissions was defined as the modeled annual levels. The model validation and morbidity assessment were based on 2006 PM₁₀or PM_2.5levels at 3 monitoring stations. The exposure-response coefficients used were for total mortality 6.2% (95% CI 1.6–11%) per 10 μg/m³increase of annual mean PM_2.5concentration and for the assessment of respiratory and cardiovascular hospitalizations 1.14% (95% CI 0.62–1.67%) and 0.73% (95% CI 0.47–0.93%) per 10 μg/m³increase of PM₁₀. The direct costs related to morbidity were calculated according to hospital treatment expenses in 2005 and the cost of premature deaths using the concept of Value of Life Year (VOLY).</p> <p>Results</p> <p>The annual population-weighted-modeled exposure to locally emitted PM_2.5in Tallinn was 11.6 μg/m³. Our analysis showed that it corresponds to 296 (95% CI 76528) premature deaths resulting in 3859 (95% CI 10236636) Years of Life Lost (YLL) per year. The average decrease in life-expectancy at birth per resident of Tallinn was estimated to be 0.64 (95% CI 0.17–1.10) years. While in the polluted city centre this may reach 1.17 years, in the least polluted neighborhoods it remains between 0.1 and 0.3 years. When dividing the YLL by the number of premature deaths, the decrease in life expectancy among the actual cases is around 13 years. As for the morbidity, the short-term effects of air pollution were estimated to result in an additional 71 (95% CI 43–104) respiratory and 204 (95% CI 131–260) cardiovascular hospitalizations per year. The biggest external costs are related to the long-term effects on mortality: this is on average €150 (95% CI 40–260) million annually. In comparison, the costs of short-term air-pollution driven hospitalizations are small €0.3 (95% CI 0.2–0.4) million.</p> <p>Conclusion</p> <p>Sectioning the city for analysis and using GIS systems can help to improve the accuracy of air pollution health impact estimations, especially in study areas with poor air pollution monitoring data but available dispersion models.</p

Current and future Burden of Communicable Diseases in the European Union and EEA/EFTA countries (BCoDE). Methodology protocol

Mangen M-J, Gibbons C, Kretzschmar M, et al. Current and future Burden of Communicable Diseases in the European Union and EEA/EFTA countries (BCoDE). Methodology protocol. ECDC Technical Report. Stockholm: ECDC; 2011