Fertility modelling

In order to describe age-specific fertility curves, different theoretical approaches are employed. By modelling a time-variant fertility curve, it is possible to forecast reproductive behaviour of Estonian women in the future. The approach provided here is a novel way to forecast fertility

Indexes in demographic statistics: a methodology using nonstandard information for solving critical problems

A new methodology for solving different problems in population statistics (estimating under- and overcoverage of census, determining the population size and residency of persons, finding the partners and placing persons into living rooms) is presented. In all cases, so-called signs of life, demonstrating the activity of persons in different registers are taken as arguments or explanatory variables for models. The weights of models are calculated using training data, when the models are in use sequentially; then every year the weights are recalculated using the data of the previous year

Alzheimeri tõve ravi memantiiniga Eestis: farmakoökonoomiline hindamine

Alzheimeri tõbi (AT) on neurodegeneratiivne haigus, mille süvenedes nõrgenevad progresseeruvalt patsientide kognitiivsed ja funktsionaalsed võimed ning kasvab hooldus sõltuvus. Eestis on AT raviks registreeritud 4 ravimit: memantiin, donepesiil, galantamiin, rivastigmiin. Töös on analüüsitud nimetatud nelja ravimi tegelikku kasutamist, AT-patsientidega seotud tervishoiukulutusi Eestis 2004. aastal ning prognoositud muutusi Eesti Haigekassa (EHK) tervishoiukulutustes AT-patsientidele juhul, kui memantiin arvatakse 75% soodustusmääraga ravimite nimekirja. Analüüsil kasutati EHK retseptide, raviarvete ja ajutise töövõimetuse hüvitiste andmebaasi. Selgus, et memantiini kasutamine vähendab märkimisväärselt kulusid ja lükkab edasi aega, kui patsient vajab pidevat hooldust ning järelevalvet. Eesti Arst 2007; 86 (2): 94–9

Residency index – a tool for measuring the population size

After the Estonian census 2011 the census team found that there was some under-coverage of the census data. To determine the amount of non-enumerated people the following procedure was used. The set of people belonging to Estonian population register as residents, but not enumerated in census 2011 were regarded as potential residents. All existing administrative registers were used to define the signs of life for these people: activity in a register during 2011 gave to a person a sign of life. The signs of life were used as binary variables to discriminant the residents and non-residents. The following task was to use the methodology for following years and to cover the whole population. Hence we decided to define for each person from the population a residency index between 0 and 1 that will be recalculated yearly using the signs of life

Arstiüliõpilaste stress, läbipõlemine ja tervis kolmel esimesel õppeaastal

Eesmärk. Kirjeldada arstiüliõpilaste hinnanguid oma stressitasemele, tervise-, meeleolu-, motivatsiooni- ja läbipõlemisnäitajatele esimesel, kolmandal ja viiendal semestril ning võrrelda tulemusi semestrite ja erialade kaupa. Metoodika. 2010. aasta sügisel korraldati esimest, kolmandat ja viiendat semestrit ülikoolis õppivate arstiüliõpilaste hulgas anonüümne ankeetküsitlus. Küsimustik oli koostatud rahvusvaheliselt valideeritud küsimustike põhjal. Vaatluse alla võeti seitse alavaldkonda: üldandmed, motivatsioon õpinguteks, eksamite soorituskindlus, meeleolu, stressitase, tervise ja läbipõlemise näitajad. Tulemuste analüüsimisel kasutati üldsagedustabeleid, c2-testi, mitteparameetrilist t-testi ja dispersioonanalüüsi. Tulemused. Valim koosnes 345 arstiüliõpilasest. Üldine keskmine vastamismäär oli 51,6% ning see oli suurim ravi- (60%) ja väikseim proviisoriüliõpilaste hulgas (25,5%). Vastajate keskmine vanus oli 20,8 ± 1,9 aastat. Vastanutest suurema osa moodustasid eestlased ja naisüliõpilased. Võrreldes esimese semestriga, oli viienda semestri üliõpilaste hulgas oluliselt rohkem neid, kes hindasid oma stressitaseme kõrgeks, terviseseisundi halvaks, õpimotivatsiooni ja eksamite soorituskindluse madalaks (p Keskmiste skooride võrdlus kinnitas, et võrreldes hinnangutega 1. ja 3. semestril, oli viiendal semestril oluliselt kõrgem stressi-, emotsionaalse kurnatuse ja küünilisuse tase ning madalam õpimotivatsioon, halvem üldine ja vaimne tervis ning rohkem haigussümptomeid ja meelolulangust (p Järeldused. Arstiüliõpilaste hinnangud stressitasemele, tervisele, läbipõlemisnäitajatele, meeleolule, õpimotivatsioonile ja eksamite soorituskindlusele sõltuvad õppesemestrist, erialast ja mõneti ka soost. Seetõttu tuleb rohkem tähelepanu pöörata arstiüliõpilaste tervisele ja seda eriti ravieriala tudengitele viiendal semestril ning naisüliõpilastele. Tudengite stressijuhtimise oskusi tuleks parandada alates õpingute algusest.Eesti Arst 2014; 93(10):561–56

Effects of RIPC on the Metabolome in Patients Undergoing Vascular Surgery: A Randomized Controlled Trial

Background: remote ischemic preconditioning (RIPC) is a phenomenon in which short episodes of ischemia are applied to distant organs to prepare target organs for more prolonged ischemia and to induce protection against ischemia-reperfusion injury. This study aims to evaluate whether preoperatively performed RIPC affects the metabolome and to assess whether metabolomic changes correlate with heart and kidney injury markers after vascular surgery. Methods: a randomized sham-controlled, double-blinded trial was conducted at Tartu University Hospital. Patients undergoing elective open vascular surgery were recruited and RIPC was applied before operation. Blood was collected preoperatively and 24 h postoperatively. The metabolome was analyzed using the AbsoluteIDQ p180 Kit. Results: final analysis included 45 patients from the RIPC group and 47 from the sham group. RIPC did not significantly alter metabolites 24 h postoperatively. There was positive correlation of change in the kynurenine/tryptophan ratio with change in hs-troponin T (r = 0.570, p r = 0.552, p r = 0.534, p r = 0.504, p < 0.001) only in the RIPC group. Conclusions: preoperative RIPC did not significantly affect the metabolome 24 h after vascular surgery. The positive linear correlation of kynurenine/tryptophan ratio with heart and kidney injury markers suggests that the kynurenine–tryptophan pathway can play a role in RIPC-associated cardio- and nephroprotective effects

Remote Ischaemic Preconditioning Reduces Kidney Injury Biomarkers in Patients Undergoing Open Surgical Lower Limb Revascularisation: A Randomised Trial

Background and Aims. Perioperative kidney injury affects 12.7% of patients undergoing lower limb revascularisation surgery. Remote ischaemic preconditioning (RIPC) is a potentially protective procedure against organ damage and consists of short nonlethal episodes of ischaemia. The main objective of this substudy was to evaluate the effect of RIPC on kidney function, inflammation, and oxidative stress in patients undergoing open surgical lower limb revascularisation. Materials and Methods. This is a subgroup analysis of a randomised, sham-controlled, double-blinded, single-centre study. A RIPC or a sham procedure was performed noninvasively along with preparation for anaesthesia in patients undergoing open surgical lower limb revascularisation. The RIPC protocol consisted of 4 cycles of 5 minutes of ischaemia, with 5 minutes of reperfusion between every episode. Blood was collected for analysis preoperatively, 2, 8, and 24 hours after surgery, and urine was collected preoperatively and 24 hours after surgery. Results. Data of 56 patients were included in the analysis. Serum creatinine, cystatin C, and beta-2 microglobulin increased, and eGFR decreased across all time points significantly more in the sham group than in the RIPC group (p=0.021, p=0.021, p=0.024, and p=0.015, respectively). Comparison of two time points, baseline and 24 hours after surgery, revealed that the change in creatinine, eGFR, urea, cystatin C, and beta-2 microglobulin was significantly different between the groups (p<0.05). Conclusions. Our finding of reduced release of kidney injury biomarkers may indicate the renoprotective effect of RIPC in patients undergoing open surgical lower limb revascularisation. The trial is registered with ClinicalTrials.gov NCT02689414

Metabolomic Profile of Abdominal Aortic Aneurysm

Abdominal aortic aneurysm (AAA) is characterized by structural deterioration of the aortic wall, leading to aortic dilation and rupture. The aim was to compare 183 low molecular weight metabolites in AAA patients and aorta-healthy controls and to explore if low molecular weight metabolites are linked to AAA growth. Blood samples were collected from male AAA patients with fast (mean 3.3 mm/year; range 1.3–9.4 mm/year; n = 39) and slow growth (0.2 mm/year; range −2.6–1.1 mm/year; n = 40), and from controls with non-aneurysmal aortas (n = 79). Targeted analysis of 183 metabolites in plasma was performed with AbsoluteIDQ p180 kit. The samples were measured on a QTRAP 4500 coupled to an Agilent 1260 series HPLC. The levels of only four amino acids (histidine, asparagine, leucine, isoleucine) and four phosphatidylcholines (PC.ae.C34.3, PC.aa.C34.2, PC.ae.C38.0, lysoPC.a.C18.2) were found to be significantly lower (p &lt; 0.05) after adjustment for confounders among the AAA patients compared with the controls. There were no differences in the metabolites distinguishing the AAA patients with slow or fast growth from the controls, or distinguishing the patients with slow growth from those with fast growth. The current study describes novel significant alterations in amino acids and phosphatidylcholines metabolism associated with AAA occurrence, but no associations were found with AAA growth rate

Atenolol’s Inferior Ability to Reduce Central vs Peripheral Blood Pressure Can Be Explained by the Combination of Its Heart Rate-Dependent and Heart Rate-Independent Effects

Objective. Whether the inferior ability of atenolol to reduce central (aortic) compared to peripheral (brachial) blood pressure (BP) is related to its heart rate (HR)-dependent or -independent effects, or their combination, remains unclear. To provide further mechanistic insight into this topic, we studied the acute effects of atenolol versus nebivolol and ivabradine on systolic blood pressure amplification (SBPA; peripheral systolic BP minus central systolic BP) in a model of sick sinus syndrome patients with a permanent dual-chamber cardiac pacemaker in a nonrandomized single-blind single-group clinical trial. Methods. We determined hemodynamic indices noninvasively (Sphygmocor XCEL) before and at least 3 h after administration of oral atenolol 50 or 100 mg, nebivolol 5 mg, or ivabradine 5 or 7.5 mg during atrial pacing at a low (40 bpm), middle (60 bpm), and high (90 bpm) HR level in 25 participants (mean age 65.5 years, 12 men). Results. At the low HR level, i.e., when the drugs could exert their HR-dependent and HR-independent effects on central BP, only atenolol produced a significant decrease in SBPA (mean change 0.74 ± 1.58 mmHg (95% CI, 0.09–1.40; P=0.028)), indicating inferior central vs peripheral systolic BP change. However, we observed no significant change in SBPA with atenolol at the middle and high HR levels, i.e., when HR-dependent mechanisms had been eliminated by pacing. Conclusion. The findings of our trial with a mechanistic approach to the topic imply that the inferior ability of atenolol to reduce central vs peripheral BP can be explained by the combination of its heart rate-dependent and -independent effects. This trial is registered with NCT03245996