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

Results from a blind and a non-blind randomised trial run in parallel: experience from the Estonian Postmenopausal Hormone Therapy (EPHT) Trial

<p>Abstract</p> <p>Background</p> <p>The Estonian Postmenopausal Hormone Therapy (EPHT) Trial assigned 4170 potential participants prior to recruitment to blind or non-blind hormone therapy (HT), with placebo or non-treatment the respective alternatives. Before having to decide on participation, women were told whether they had been randomised to the blind or non-blind trial. Eligible women who were still willing to join the trial were recruited. After recruitment participants in the non-blind trial (N = 1001) received open-label HT or no treatment, participants in the blind trial (N = 777) remained blinded until the end of the trial. The aim of this paper is to analyse the effect of blinding on internal and external validity of trial outcomes.</p> <p>Methods</p> <p>Effect of blinding was calculated as the hazard ratio of selected chronic diseases, total mortality and all outcomes. For analysing the effect of blinding on external validity, the hazard ratios from women recruited to the placebo arm and to the non-treatment arm were compared with those not recruited; for analysing the effect of blinding on internal validity, the hazard ratios from the blind trial were compared with those from the non-blind trial.</p> <p>Results</p> <p>The women recruited to the placebo arm had less cerebrovascular disease events (HR 0.43; 95% CI: 0.26-0.71) and all outcomes combined (HR 0.76; 95% CI: 0.63-0.91) than those who were not recruited. Among women recruited or not recruited to the non-treatment arm, no differences were observed for any of the outcomes studied.</p> <p>Among women recruited to the trial, the risk for coronary heart disease events (HR 0.77; 95% CI: 0.64-0.93), cerebrovascular disease events (HR 0.66; 95%CI: 0.47-0.92), and all outcomes combined (HR 0.82; 95% CI: 0.72-0.94) was smaller among participants in the blind trial than in the non-blind trial. There was no difference between the blind and the non-blind trial for total cancer (HR 0.95; 95% CI: 0.64-1.42), bone fractures (0.93; 95% CI: 0.74-1.16), and total mortality (HR 1.03; 95% CI: 0.53-1.98).</p> <p>Conclusions</p> <p>The results from blind and non-blind trials may differ, even if the target population is the same. Blinding may influence both internal and external validity. The effect of blinding may vary for different outcome events.</p> <p>Trial registration</p> <p>[<a href="http://www.controlled-trials.com/ISRCTN35338757">ISRCTN35338757</a>]</p

Rasedusaegne SARS-CoV-2-nakkus ja perinataaltulemid Eestis 2020. ja 2021. aastal: registripõhine uuring

Eesti Arst 2024; 103(3):14

Capgras’ sündroom

Capgras’ sündroom (ka negatiivne teisikuluul) on psüühiline seisund, mille puhul patsient usub, et keegi tema lähedastest on ära vahetatud teisikuga. Tegemist on levinuima luululise vääridentifitseerimise sündroomiga, mis on praktikas aladiagnoositud, kuna kaasub tihti teiste vaimse tervise häiretega ja jääb nende varju. Capgras’ sündroom on oma nime saanud prantsuse psühhiaatri Joseph Capgras’ järgi, kes oma kolleegi Jean Reboul-Lachaux’ga kirjeldas esimest korda seda sündroomi 1923. aastal. Teisikuluul on üks mitmest paranoiliste luulude alla kuuluvatest sündroomidest. Sündroomi täpsed tekkepõhjused ei ole teada ning on võimalik, et sündroomi teke on seotud mitmete teiste haigustega. Artiklis on tutvustatud Capgras’ sündroomi sümptomeid, võimalikke tekkepõhjuseid ja olemasolevaid ravivõimalusi ning esitatud mõned illustreerivad kliinilised juhud

Rinna-, emakakaela- ja jämesoolevähi sõeluuringute tulemused Eestis

Taust ja eesmärgid. Varasemad uuringud on näidanud, et Eestis korraldatavad vähi sõeluuringud ei ole toonud kaasa oodatud muutusi. Uuringu eesmärk oli hinnata sõeluuringute läbiviimist ja tulemusi.Metoodika. Kasutati Eesti vähi sõeluuringute registri, vähiregistri, surmapõhjuste registri ja WHO andmebaasi andmeid. Hinnati sihtrühmade hõlmatust sõeluuringutega, mõju haigestumus- ja suremuskordajatele ning staadiumijaotusele TNM-klassifikatsiooni järgi.Tulemused. Sihtrühmade hõlmatus sõeluuringuga jäi rinna- ja naiste jämesoolevähi korral alla 60% ning emakakaela- ja meeste jämesoolevähi korral alla 50%. Kõigi paikmete puhul vähenes hõlmatus 2020. aastal. Vanuse suhtes standarditud rinnavähisuremus on vähenenud alates 1997. aastast ja langus ilmneb kõigis vanuserühmades, v.a 70+. Rinnavähi I staadiumis diagnoositud juhtude osakaal on suurenemas ja sõeluuringul avastatud juhtudel on rinnavähk oluliselt varasemas staadiumis. Vanuse suhtes standarditud emakakaelavähi-haigestumus on vähenenud alates 2013. aastast. Oluline haigestumuse langus on ilmnenud vanuserühmades 40–49, 60–69 ja 70+. Jämesoolevähi haigestumuse kasvu võib täheldada pea kõigis vanuserühmades. Veerand juhtudest diagnoositakse endiselt IV staadiumis.Järeldused. Vaatamata vähesele hõlmatusele on sõeluuringud Eestis aidanud ära hoida uusi vähijuhte ja vähendanud vähisurmade arvu. Samas vähenes 2020. aastal sõeluuringutega hõlmatus, mis võib edaspidi neid trende mõjutada. Seetõttu on jätkuvalt tähtis keskenduda sõeluuringutega hõlmatuse ja kvaliteedi parandamisele

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 &lt; 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

Women's knowledge about cervical cancer risk factors, screening, and reasons for non-participation in cervical cancer screening programme in Estonia

<p>Abstract</p> <p>Background</p> <p>The attendance rate in Estonian cervical cancer screening programme is too low therefore the programme is hardly effective. A cross-sectional population based survey was performed to identify awareness of cervical cancer risk factors, reasons why women do not want to participate in cervical screening programme and wishes for better organisation of the programme.</p> <p>Method</p> <p>An anonymous questionnaire with a covering letter and a prepaid envelope was sent together with the screening invitation to 2942 randomly selected women. Results are based on the analysis of 1054 (36%) returned questionnaires.</p> <p>Results</p> <p>Main reasons for non-participation in the national screening programme were a recent visit to a gynaecologist (42.3%), fear to give a Pap-smear (14.3%), long appointment queues (12.9%) and unsuitable reception hours (11.8%). Fear to give a Pap-smear was higher among women aged 30 and 35 than 50 and 55 (RR 1.46; 95% CI: 0.82-2.59) and women with one or no deliveries (RR 1.56, 95% CI: 0.94-2.58). In general, awareness of cervical cancer risk factors is poor and it does not depend on socio-demographic factors. Awareness of screening was higher among Estonians than Russians (RR 1.64, 95% CI: 1.46-1.86). Most women prefer to receive information about screening from personally mailed invitation letters (74.8%).</p> <p>Conclusions</p> <p>Women need more information about cervical cancer risk factors and the screening programme. They prefer personally addressed information sharing. Minority groups should be addressed in their own language. A better collaboration with service providers and discouraging smears outside the programme are also required.</p

Symptom reporting and quality of life in the Estonian Postmenopausal Hormone Therapy Trial

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.Abstract Background The aim of the study was to determine the effect of postmenopausal hormone therapy on women's symptom reporting and quality of life in a randomized trial. Methods 1823 women participated in the Estonian Postmenopausal Hormone Therapy (EPHT) Trial between 1999 and 2004. Women were randomized to open-label continuous combined hormone therapy or no treatment, or to blind hormone therapy or placebo. The average follow-up period was 3.6 years. Prevalence of symptoms and quality of life according to EQ-5D were assessed by annually mailed questionnaires. Results In the hormone therapy arms, less women reported hot flushes (OR 0.20; 95% CI: 0.14&#8211;0.28), sweating (OR 0.56; 95% CI: 0.44&#8211;0.72), and sleeping problems (OR 0.66; 95% CI: 0.52&#8211;0.84), but more women reported episodes of vaginal bleeding (OR 19.65; 95% CI: 12.15&#8211;31.79). There was no difference between the trial arms in the prevalence of other symptoms over time. Quality of life did not depend on hormone therapy use. Conclusion Postmenopausal hormone therapy decreased vasomotor symptoms and sleeping problems, but increased episodes of vaginal bleeding, and had no effect on quality of life. Trial registration number ISRCTN35338757Published versio

Postmenopausis naiste tervise enesehinnangu ja elukvaliteedi seos

Inimese terviseseisundi ja sellega seotud elukvaliteedi hindamiseks ning eri riikide ja uuringute võrdlemiseks on välja töötatud mitmeid standardseid küsimustikke. Üks lihtsamaid võimalusi terviseseisundi subjektiivseks hindamiseks küsitlusuuringutes on paluda inimesel ise hinnata oma tervist viiepalliskaalal (väga hea, hea, rahuldav, halb, väga halb). Üks Euroopas enam kasutatud terviseseisundiga seotud elukvaliteedi küsimustikke on EQ-5D (EuroQol), mis koosneb viiest küsimusest, millest igaüks puudutab elukvaliteedi eri tahku ja millele tuleb vastajal anda hinnang kolmepalliskaalas. Lihtsa tervise enesehinnangu ja EQ-5D seost ning nende seoseid objektiivsete tervisenäitajatega pole palju uuritud, sest enamikus uuringutes on valitud vaid üks meetod terviseseisundi ja/või tervisega seotud elukvaliteedi hindamiseks. Eesti Arst 2009; 88(12):790−79

Varying ethics rules in clinical research and routine patient care - research ethics committee chairpersons' views in Finland

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