Homogenisation of Biocultural Diversity: Plant Ethnomedicine and Its Diachronic Change in Setomaa and Võromaa, Estonia, in the Last Century.

When studying the evolution of the use of medicinal plants, it is important to identify what role, and to what extent, external factors and local biocultural diversities play in shaping cultural changes. We chose as a case study, which forms part of a larger project, a religiously and linguistically distinct group, the Seto, and compared their current and past plant use with that of the surrounding Võro. Ethnobotanical fieldwork was conducted in the summers of 2018 and 2019. Current uses of plants constituted 34% of the total registered use reports and 41% of those were used to treat general diseases or used as prophylactics. In total, the medicinal use of 86 taxa was recorded, and of these 48 were prevalent. Strong erosion (the abandonment of 43, mainly wild taxa used historically) and valorisation of the uses shared with neighboring as well as distant regions once part of the Soviet Union, were evident, signalling the potential influence of the centralised distribution of knowledge. The results clearly show that the plant medicine-related biocultural diversities of the two groups have been considerably homogenised, eroded and influenced by the knowledge spread through various means during the Soviet era and over the last 30 years.

The emergence of new medical pluralism: the case study of Estonian medical doctor and spiritual teacher Luule Viilma.

Rather than the harmonious coexistence of different therapeutic practices and meaning systems, medical pluralism involves the contestation of norms and meanings related to legitimacy and authority. The implicit cultural norms that shape local understandings of health and legitimate healing methods become more during periods of social and cultural change. This paper demonstrates the contested nature of medical pluralism based on the case study of one significant figure, Estonian gynaecologist and spiritual teacher Luule Viilma. Well-known to the public as a trailblazer and prominent spokesperson for medical pluralism since the 1990s, Viilma's trajectory from doctor to healer reveals some implicit characteristics and mechanisms of power struggles as evidenced by the 'boundary work' carried out by biomedical specialists. By uniting and bridging biomedicine and spiritual self-help, Viilma became a figure whose presence and teachings gave responsibility and power to individuals and helped to legitimize pluralism in health practices. She had the ambition to redefine, in a fundamental way, perceived norms of legitimacy and authority, as well as the patient's position. From interviews with people who have used Viilma's teachings and material from internet discussion forums, it is apparent that the emergence of new forms of medical pluralism has brought several changes in health-related norms and understandings, including more active personal involvement in health-related information seeking and decision-making.

Devil Is in the Details: Use of Wild Food Plants in Historical Võromaa and Setomaa, Present-Day Estonia.

Biodiversity needs to be preserved to ensure food security. Border zones create high but vulnerable biocultural diversity. Through reviewing scattered historical data and documenting the current use of wild food plants among people currently living in historical Setomaa and Võromaa parishes, we aimed to identify cross-cultural differences and diachronic changes as well as the role borders have played on the local use of wild plants. The Seto have still preserved their distinctive features either by consciously opposing others or by maintaining more historical plant uses. People historically living in Setomaa and Võromaa parishes have already associated the eating of wild plants with famine food in the early 20th century, yet it was stressed more now by the Seto than by Estonians. Loss of Pechory as the center of attraction in the region when the border was closed in the early 1990s brought about a decline in the exchange of knowledge as well as commercial activities around wild food plants. National support for businesses in the area today and the popularity of a healthy lifestyle have introduced new wild food plant applications and are helping to preserve local plant-specific uses in the area.

The Arrival of Siberian Ancestry Connecting the Eastern Baltic to Uralic Speakers further East.

In this study, we compare the genetic ancestry of individuals from two as yet genetically unstudied cultural traditions in Estonia in the context of available modern and ancient datasets: 15 from the Late Bronze Age stone-cist graves (1200-400 BC) (EstBA) and 6 from the Pre-Roman Iron Age tarand cemeteries (800/500 BC-50 AD) (EstIA). We also included 5 Pre-Roman to Roman Iron Age Ingrian (500 BC-450 AD) (IngIA) and 7 Middle Age Estonian (1200-1600 AD) (EstMA) individuals to build a dataset for studying the demographic history of the northern parts of the Eastern Baltic from the earliest layer of Mesolithic to modern times. Our findings are consistent with EstBA receiving gene flow from regions with strong Western hunter-gatherer (WHG) affinities and EstIA from populations related to modern Siberians. The latter inference is in accordance with Y chromosome (chrY) distributions in present day populations of the Eastern Baltic, as well as patterns of autosomal variation in the majority of the westernmost Uralic speakers [1-5]. This ancestry reached the coasts of the Baltic Sea no later than the mid-first millennium BC; i.e., in the same time window as the diversification of west Uralic (Finnic) languages [6]. Furthermore, phenotypic traits often associated with modern Northern Europeans, like light eyes, hair, and skin, as well as lactose tolerance, can be traced back to the Bronze Age in the Eastern Baltic. VIDEO ABSTRACT.

Development of atopic sensitization in Finnish and Estonian children: A latent class analysis in a multicenter cohort.

BACKGROUND: The prevalence of atopy is associated with a Western lifestyle, as shown by studies comparing neighboring regions with different socioeconomic backgrounds. Atopy might reflect various conditions differing in their susceptibility to environmental factors. OBJECTIVE: We sought to define phenotypes of atopic sensitization in early childhood and examine their association with allergic diseases and hereditary background in Finland and Estonia. METHODS: The analysis included 1603 Finnish and 1657 Estonian children from the DIABIMMUNE multicenter young children cohort. Specific IgE levels were measured at age 3, 4, and 5 years, respectively, and categorized into 3 CAP classes. Latent class analysis was performed with the statistical software package poLCA in R software. RESULTS: Both populations differed in terms of socioeconomic status and environmental determinants, such as pet ownership, farm-related exposure, time spent playing outdoors, and prevalence of allergic diseases (all P < .001). Nevertheless, we found similar latent classes in both populations: an unsensitized class, a food class, 2 inhalant classes differentiating between seasonal and perennial aeroallergens, and a severe atopy class. The latter was characterized by high total and specific IgE levels and strongly associated with wheeze (odds ratio [OR], 5.64 [95% CI, 3.07-10.52] and 4.56 [95% CI, 2.35-8.52]), allergic rhinitis (OR, 22.4 [95% CI, 11.67-44.54] and 13.97 [95% CI, 7.33-26.4]), and atopic eczema (OR, 9.39 [95% CI, 4.9-19.3] and 9.5 [95% CI, 5.2-17.5] for Finland and Estonia, respectively). Environmental differences were reflected in the larger seasonal inhalant atopy class in Finland, although composition of classes was comparable between countries. CONCLUSION: Despite profound differences in environmental exposures, there might exist genuine patterns of atopic sensitization. The distribution of these patterns might determine the contribution of atopic sensitization to disease onset.

Drug Policy in Estonia.

The aim of this article was to present a general overview of the health care system as well as pricing and reimbursement environment in Estonia. In Estonia the main stakeholders in the pharmaceutical sector are the Ministry of Social Affairs, the State Agency of Medicine, and the Estonian Health Insurance Fund. The national health insurance scheme is public, and approximately 95% of the population is covered by it. It is a social insurance, and universal and equal access to health care based on national health insurance is granted. The Estonian Health Insurance Fund is financed from social taxes and state budget and is responsible for the reimbursement of pharmaceuticals in the hospital setting. It acts as an advisory body to the Ministry of Social Affairs on the process of reimbursement regarding cost effectiveness. Pharmaceutical products' reimbursement dossiers submission and decisions are dealt with on the state level. Health technology assessment analyses are required by the authorities and the Baltic Guidelines for Economic Evaluations of Pharmaceuticals have to be followed. The reimbursement lists are positive lists only, and the criteria upon which reimbursement decisions are based are officially defined. Revisions of reimbursement are performed depending on the need and they are based on the prices of reference countries.

Factors controlling the three-decade long rise in cyanobacteria biomass in a eutrophic shallow lake.

We aimed at quantifying the importance of limnological variables in the decadal rise of cyanobacteria biomass in shallow hemiboreal lakes. We constructed estimates of cyanobacteria (blue-green algae) biomass in a large, eutrophic lake (Estonia, Northeastern Europe) from a database comprising 28 limnological variables and spanning more than 50years of monitoring. Using a dual-model approach consisting in a boosted regression trees (BRT) followed by a generalized least squares (GLS) model, our results revealed that six variables were most influential for assessing the variance of cyanobacteria biomass. Cyanobacteria response to nitrate concentration and rotifer abundance was negative, whereas it was positive to pH, temperature, cladoceran and copepod biomass. Response to total phosphorus (TP) and total phosphorus to total nitrogen ratio was very weak, which suggests that actual in-lake TP concentration is still above limiting values. The most efficient GLS model, which explained nearly two thirds (r2=0.65) of the variance of cyanobacteria biomass included nitrate concentration, water temperature and pH. The very high number of observations (maximum n=525) supports the robustness of the models. Our results suggest that the decadal rise of blue-green algae in shallow lakes lies in the interaction between cultural eutrophication and global warming which bring in-lake physical and chemical conditions closer to cyanobacteria optima.

Impact of alkaline dust pollution on genetic variation of Usnea subfloridana populations.

Very little is known whether and how air pollution impacts genetic diversity of lichenized fungi that are well-known indicators of environmental quality. We studied the genetic variation of eight Usnea subfloridana populations in Pinus sylvestris-dominated boreal forest stands in southern Estonia, Northern Europe; four of these populations were exposed to long-term dust pollution released from unpaved road. The mean bark pH of lichen phorophyte differed considerably between polluted and unpolluted forest stands. We genotyped 274 Usnea thalli using nine specific fungal microsatellite markers. Genetic variation measures were calculated and compared between populations from different habitats. Allelic richness, Shannon's information index, and genetic diversity of lichen populations were significantly higher in unpolluted forest sites than in polluted forest sites. We conclude that environmental disturbances caused by alkaline dust pollution had negative impact on the genetic variation of U. subfloridana, a common species of lichenized fungi.

Perceived reasons for changes in the use of wild food plants in Saaremaa, Estonia.

Recent studies on the use of wild food plants have identified various reasons for their use and underlined their importance as an emergency food supply. This work analysed the content of narratives obtained as comments regarding the reasons for using or not using wild food plants mentioned during 48 semi-structured recorded interviews. The results show that past demand for the diversification of food experiences and taste was essential for the consumption of wild plants, while the present concern for the disappearance of wild food taxa familiar from childhood is one of the main reasons for decrease in their consumption. This indicates that people do not really feel that they need to use wild food plants anymore (except for the health benefits), and that they are concerned that their favourite plants are no longer available. The erosion of the practical use of wild food plants is also supported by the very small frequency in which the influence of teachings coming from outside the community was mentioned in discussions of both the past and present, and thus the loss of traditional uses is not really substituted by new uses acquired from elsewhere. Further research is needed to understand lay perceptions of the changes that have occurred in nature, society and the economy, in the context of their influence on the everyday use of wild food plants to appreciate the ways in which knowledge erosion takes place and to find means of retaining this basic knowledge within the society.

Initial assessment of rehabilitation needs using the WHODAS 2.0 in Estonia.

PURPOSE: Given the growing number of people with disabilities in Estonia, an initial rehabilitation needs assessment instrument that included the World Health Organization Disability Assessment Schedule (WHODAS 2.0) was developed and tested to determine its feasibility in assessing social rehabilitation needs. METHOD: WHODAS 2.0 items were complemented with questions about the nature of disability-related problems with regard to personal, social and environmental aspects of functioning. Four rehabilitation specialists assessed 101 persons' needs in face-to-face interviews. Data were analyzed using descriptive statistics and thematic analysis. RESULTS: The comprehensive initial assessment instrument tested was sufficiently informative to assess functioning and identify social rehabilitation and other social needs. Participants had difficulty in understanding some WHODAS 2.0 items, and coding and scoring respondents' answers using WHODAS 2.0 frames of reference proved challenging for interviewers. CONCLUSION: The WHODAS 2.0 is mainly related to health conditions. Complementing it with questions about the nature and severity of the difficulties social rehabilitation service applicants experienced added essential information for planning interventions. IMPLICATIONS FOR REHABILITATION: A well conceived, holistic initial assessment that addresses biological, psychological, sociocultural and environmental factors can provide substantial information for targeting services to meet a person's rehabilitation needs. The WHODAS 2.0 is a useful framework for conducting initial assessments, but since it focuses on health needs, supplementing it with additional items about personal, social and environmental factors may be necessary to address services needs from social, vocational and other rehabilitation perspectives. Rehabilitation specialists must be well prepared to use the WHODAS 2.0 and conduct the overall assessment, including providing clear instructions and support to applicants applying for services.