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1.
Health Res Policy Syst ; 20(1): 54, 2022 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-35525967

RESUMEN

BACKGROUND: Evidence briefs for policy (EBPs) represent a potentially powerful tool for supporting evidence-informed policy-making. Since 2012, WHO Evidence-Informed Policy Network (EVIPNet) Europe has been supporting Member States in developing EBPs. The aim of this study was to evaluate the process of developing EBPs in Estonia, Hungary and Slovenia. METHODS: We used a rapid appraisal approach, combining semi-structured interviews and document review, guided by the Medical Research Council (MRC) process evaluation framework. Interviews were conducted with a total of 20 individuals familiar with the EBP process in the three study countries. Data were analysed thematically, and emerging themes were related back to the MRC framework components (implementation, mechanisms of impact, and context). We also reflected on the appropriateness of this evaluation approach for EVIPNet teams without evaluation research expertise to conduct themselves. RESULTS: The following themes emerged as important to the EBP development process: how the focus problem is prioritized, who initiates this process, EBP team composition, EBP team leadership, availability of external support in the process, and the culture of policy-making in a country. In particular, the EBP process seemed to be supported by early engagement of the Ministry of Health and other stakeholders as initiators, clear EBP team roles and expectations, including a strong leader, external support to strengthen EBP team capacity and cultural acceptance of the necessity of evidence-informed policy-making. Overall, the evaluation approach was considered feasible by the EBP teams and captured rich qualitative data, but may be limited by the absence of external reviewers and long lag times between the EBP process and the evaluation. CONCLUSIONS: This process occurs in a complex system and must be conceptualized in each country and each EBP project in a way that fits local policy-making culture, priorities, leadership and team styles, roles and available resources. The use of a rapid appraisal approach, combining qualitative interviews and document review, is a feasible method of process evaluation for EVIPNet member countries.


Asunto(s)
Política de Salud , Formulación de Políticas , Europa (Continente) , Humanos , Red Social , Organización Mundial de la Salud
2.
Eur J Public Health ; 30(Suppl_1): i45-i47, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-32391896

RESUMEN

Estonia has implemented a comprehensive, multipronged approach to the reduction of alcohol consumption in the population, comprising a series of successful policy responses. The Estonian alcohol strategy (2014) builds on the Global strategy to reduce the harmful use of alcohol and the European action plan to reduce the harmful use of alcohol 2012-2010. It aims to decrease the overall yearly consumption of alcohol among the adult population to less than 8 litres of absolute alcohol per capita. Gathering support across society from a range of stakeholders, including policy-makers, researchers, parents and advocates, has been one of the key elements in the implementation of the policy. High-level political commitment and strategic timing of efforts have maintained the issue of alcohol control on the political agenda and in the public's mind.


Asunto(s)
Consumo de Bebidas Alcohólicas , Desarrollo Sostenible , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/prevención & control , Estonia/epidemiología , Humanos
3.
Health Syst Transit ; 25(5): 1-236, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38230754

RESUMEN

This analysis of the Estonian health system illustrates recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In general, Estonia spends less per capita on health than the European Union average, although public expenditure has been growing steadily, with an increasing role of government budget transfers towards the social health insurance model. Despite these efforts, more than a fifth of current health expenditure comes from out-of-pocket payments, creating pressure to develop new and strengthen existing financial protection instruments. Life expectancy in Estonia has increased rapidly over the past decade, but not fast enough to meet the targets set in strategic documents. The first years of the COVID-19 pandemic were marked by a decline in life expectancy and high excess mortality, which set back progress. Despite this, Estonia's gains in population health were more pronounced in 2022. Overall, health inequalities between socioeconomic groups remain high, prompting policymakers to take steps to increase equity in access to care. The outstanding challenges for the Estonian health system include: addressing the shortage of primary and mental health experts, especially given the growing burden of chronic conditions and other needs of the ageing population; minimizing stark socioeconomic inequalities in health outcomes; renewing the outdated public health framework; and further improving integration and coordination of care and clinical decision-making.


Asunto(s)
Atención a la Salud , Política de Salud , Humanos , Estonia , Pandemias , Gastos en Salud , Seguro de Salud , Reforma de la Atención de Salud
4.
Health Policy ; 126(5): 438-445, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35101287

RESUMEN

The Baltic countries of Estonia, Latvia, and Lithuania shared a similar response to the first wave of the COVID-19 pandemic. Using the information available on the COVID-19 Health System Response Monitor platform, this article analyzed measures taken to prevent transmission, ensure capacity, provide essential services, finance the health system, and coordinate their governance approaches. All three countries used a highly centralized approach and implemented restrictive measures relatively early, with a state of emergency declared with fewer than 30 reported cases in each country. Due to initially low COVID-19 incidence, the countries built up their capacities for testing, contact tracing, and infrastructure, without a major stress test to the health system throughout the spring and summer of 2020, yet issues with accessing routine health care services had already started manifesting themselves. The countries in the Baltic region entered the pandemic with a precarious starting point, particularly due to smaller operational budgets and health workforce shortages, which may have contributed to their escalated response aiming to prevent transmission during the first wave. Subsequent waves, however, were much more damaging. This article focuses on early responses to the pandemic in the Baltic states highlighting measures taken to prevent virus transmission in the face of major uncertainties.


Asunto(s)
COVID-19 , Países Bálticos , Estonia/epidemiología , Humanos , Letonia/epidemiología , Pandemias/prevención & control
5.
Lancet Public Health ; 7(4): e378-e390, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-35366410

RESUMEN

Clinicians, patients, policy makers, funders, programme managers, regulators, and science communities invest considerable amounts of time and energy in influencing or making decisions at various levels, using systematic reviews, health technology assessments, guideline recommendations, coverage decisions, selection of essential medicines and diagnostics, quality assurance and improvement schemes, and policy and evidence briefs. The criteria and methods that these actors use in their work differ (eg, the role economic analysis has in decision making), but these methods frequently overlap and exist together. Under the aegis of WHO, we have brought together representatives of different areas to reconcile how the evidence that influences decisions is used across multiple health system decision levels. We describe the overlap and differences in decision-making criteria between different actors in the health sector to provide bridging opportunities through a unifying broad framework that we call theory of everything. Although decision-making activities respond to system needs, processes are often poorly coordinated, both globally and on a country level. A decision made in isolation from other decisions on the same topic could cause misleading, unnecessary, or conflicted inputs to the health system and, therefore, confusion and resource waste.


Asunto(s)
Ecosistema , Evaluación de la Tecnología Biomédica , Personal Administrativo , Toma de Decisiones , Humanos
6.
Nat Commun ; 12(1): 5337, 2021 09 09.
Artículo en Inglés | MEDLINE | ID: mdl-34504101

RESUMEN

TNK1 is a non-receptor tyrosine kinase with poorly understood biological function and regulation. Here, we identify TNK1 dependencies in primary human cancers. We also discover a MARK-mediated phosphorylation on TNK1 at S502 that promotes an interaction between TNK1 and 14-3-3, which sequesters TNK1 and inhibits its kinase activity. Conversely, the release of TNK1 from 14-3-3 allows TNK1 to cluster in ubiquitin-rich puncta and become active. Active TNK1 induces growth factor-independent proliferation of lymphoid cells in cell culture and mouse models. One unusual feature of TNK1 is a ubiquitin-association domain (UBA) on its C-terminus. Here, we characterize the TNK1 UBA, which has high affinity for poly-ubiquitin. Point mutations that disrupt ubiquitin binding inhibit TNK1 activity. These data suggest a mechanism in which TNK1 toggles between 14-3-3-bound (inactive) and ubiquitin-bound (active) states. Finally, we identify a TNK1 inhibitor, TP-5801, which shows nanomolar potency against TNK1-transformed cells and suppresses tumor growth in vivo.


Asunto(s)
Proteínas 14-3-3/genética , Proteínas Fetales/genética , Linfocitos/metabolismo , Leucemia-Linfoma Linfoblástico de Células Precursoras B/genética , Proteínas Tirosina Quinasas/genética , Ubiquitina/genética , Proteínas 14-3-3/metabolismo , Células A549 , Animales , Antineoplásicos/farmacología , Línea Celular Tumoral , Proteínas Fetales/antagonistas & inhibidores , Proteínas Fetales/metabolismo , Proteínas de Fusión bcr-abl/genética , Proteínas de Fusión bcr-abl/metabolismo , Regulación Neoplásica de la Expresión Génica , Células HEK293 , Humanos , Linfocitos/efectos de los fármacos , Linfocitos/patología , Ratones , Fosfolipasa C gamma/genética , Fosfolipasa C gamma/metabolismo , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/mortalidad , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patología , Unión Proteica , Inhibidores de Proteínas Quinasas/farmacología , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Proteínas Tirosina Quinasas/metabolismo , Pirimidinas/farmacología , Factor de Transcripción STAT3/genética , Factor de Transcripción STAT3/metabolismo , Factor de Transcripción STAT5/genética , Factor de Transcripción STAT5/metabolismo , Transducción de Señal , Análisis de Supervivencia , Carga Tumoral/efectos de los fármacos , Ubiquitina/metabolismo , Ensayos Antitumor por Modelo de Xenoinjerto
7.
Am J Sports Med ; 31(1): 19-25, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12531752

RESUMEN

BACKGROUND: There are well-known problems with the use of bone-patellar tendon-bone autografts for anterior cruciate ligament reconstruction, especially in terms of donor site morbidity. Hamstring tendon grafts have been increasingly used as an alternative, but there are very few controlled studies comparing the methods. HYPOTHESIS: Use of semitendinosus tendon grafts will cause less donor site morbidity and result in better knee-walking ability. STUDY DESIGN: Prospective randomized clinical trial. METHODS: Seventy-one patients who had a unilateral anterior cruciate ligament rupture underwent arthroscopic reconstruction with interference screw fixation and use of either bone-patellar tendon-bone or semitendinosus tendon graft. Outcome assessment was performed by physiotherapists not involved in the patients' care. RESULTS: At the 2-year follow-up, no differences were found in terms of the Lysholm score, Tegner activity level, KT-1000 arthrometer side-to-side laxity measurement, single-legged hop test, or International Knee Documentation Committee classification results. The knee-walking test was rated difficult or impossible to perform by 53% of the bone-patellar tendon-bone group and by only 23% of the semitendinosus graft patients, a significant difference. CONCLUSIONS: The semitendinosus tendon graft is at least an equivalent option to the bone-patellar tendon-bone graft for anterior cruciate ligament reconstruction, and we recommend its use.


Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Artroscopía/métodos , Rótula , Tendones/trasplante , Adolescente , Adulto , Tornillos Óseos , Femenino , Estudios de Seguimiento , Indicadores de Salud , Humanos , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Músculo Esquelético/fisiología , Estudios Prospectivos , Rango del Movimiento Articular/fisiología , Trasplante Autólogo , Resultado del Tratamiento , Caminata/fisiología
12.
Kopenhaagen; Maailma Terviseorganisatsiooni Euroopa Regionaalbüroo; 2024. (WHO/EURO:2024-9990-49762-74646).
en Et | WHOLIS | ID: who-377563

RESUMEN

Käesolev ülevaade ilmub riigipõhiste uurimuste sarjas, kus avaldatakse uusi tõendeid inimeste rahalise kaitstuse kohta Euroopa ja Kesk-Aasia tervisesüsteemides, käsitledes tervishoiuteenuste taskukohasust. Rahaline kaitstus on kõikse tervisekaitse keskne aspekt ja tervisesüsteemide toimivuse põhimõõde. Eestis on rahaline kaitstus aastatel 2015–2020 seoses positiivsete muutustega ravikindlustuspoliitikas ja muude asjaoludega paranenud. Katastroofiliste tervishoiukulude tase Eestis on siiski jätkuvalt kõrgem kui paljudes teistes Euroopa Liidu riikides ja selle peamine põhjus on suur omaosalus ambulatoorsete ravimite ostmisel ja hambaravis. Eriti suur on katastroofiliste tervishoiukulude osatähtsus madala sissetulekuga leibkondade segmendis. Ka katmata ravivajaduse tase on Eestis WHO Euroopa piirkonna keskmisest palju kõrgem, mis on tingitud pikkadest järjekordadest eriarstiabis. Eesti ravikindlustuse kõigis kolmes mõõtmes esineb lünki, mis õõnestavad rahalist kaitstust ja mõjutavad ennekõike madala sissetulekuga leibkondi. Kuna tööealise elanikkonna õigus ravikindlustusele on seotud ravikindlustusmaksete tegemisega, on 10% Eesti tööealisest elanikkonnast ravikindlustuseta. Tervisekassa hüvitiste pakett on küll üpris suur, kuid täiskasvanute hambaravi hüvitised on siiski piiratud. Eesti valitsus on püüdnud omaosalust ambulatoorsete ravimite ja hambaraviteenuste puhul vähendada, kuid madalama sissetulekuga inimestele sellest piisanud ei ole. Rahalise kaitstuse parandamiseks võiks Eesti teha järgmist: siduda ravikindlustuse saamise õigus residentsusega; suurendada ja täpsustada hüvitisi, et need jõuaksid inimesteni, kes vajavad neid kõige rohkem; vähendada omaosalust pikaajalises õendus- ja hooldusabis; ja suurendada rahalist kaitstust omaosaluse eest üldiselt, eriti madala sissetulekuga leibkondade segmendis.


Asunto(s)
Gastos en Salud , Accesibilidad a los Servicios de Salud , Financiación Personal , Pobreza , Estonia
13.
Copenhagen; World Health Organization. Regional Office for Europe; 2024.
en Inglés | WHOLIS | ID: who-376806

RESUMEN

This Health System Summary is based on the Estonia: Health System Review published in 2023 in the Health Systems in Transition (HiT) series. Health System Summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.


Asunto(s)
Planes de Sistemas de Salud , Atención a la Salud , Estudios de Evaluación como Asunto , Estonia
14.
Copenhagen; World Health Organization. Regional Office for Europe; 2023.
en Inglés | WHOLIS | ID: who-374564

RESUMEN

This review is part of a series of country-based studies generating new evidence on financial protection – affordable access to health care – in health systems in Europe and central Asia. Financial protection is central to universal health coverage and a core dimension of health system performance assessment. Financial protection improved in Estonia between 2015 and 2020, reflecting positive changes in coverage policy and other factors. However, catastrophic health spending continues to be higher in Estonia than in many European Union countries – mainly driven by out-of-pocket payments for outpatient medicines and dental care – and is heavily concentrated among households with low incomes. Levels of unmet need for health care are also well above average for the WHO European Region, reflecting long waiting times for specialist care. Gaps in all three dimensions of health coverage undermine financial protection in Estonia and systematically affect households with low incomes. Linking entitlement to payment of contributions leaves 10% of working-age people without coverage. The benefits package – while quite broad – provides limited coverage of adult dental care. The Government has tried to protect people from co-payments for outpatient prescribed medicines and dental care but these efforts have not been sufficient for people with lower incomes. To improve financial protection, Estonia can change the basis for entitlement to residence; increase and fine-tune benefits to better target those in most need; reduce out-of-pocket payments in long term health care; and increase protection from all co-payments, especially for households with low incomes.


Asunto(s)
Gastos en Salud , Accesibilidad a los Servicios de Salud , Financiación Personal , Pobreza , Estonia , Atención de Salud Universal
15.
Copenhagen; World Health Organization. Regional Office for Europe; 2023.
en Inglés | WHOLIS | ID: who-366157

RESUMEN

This Health system summary is based on the Estonia: Health System Review published in 2018 in the Health Systems in Transition (HiT) series, and is significantly updated, including data, policy developments and relevant reforms as highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org). For this edition, key data have been updated to those available in July 2022 unless otherwise stated. Health system summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.


Asunto(s)
Planes de Sistemas de Salud , Atención a la Salud , Estudios de Evaluación como Asunto , Reforma de la Atención de Salud , Estonia
16.
Copenhagen; World Health Organization. Regional Office for Europe; 2019. (WHO/EURO:2019-3488-43247-60608).
en Inglés | WHOLIS | ID: who-346155

RESUMEN

Estonia has implemented a comprehensive, multipronged approach to the reduction of alcohol consumption in the population, comprising a series of successful policy responses. The Estonian alcohol strategy, adopted in 2014, builds on the “Global strategy to reduce the harmful use of alcohol” and the “European action plan to reduce the harmful use of alcohol 2012–2010”. It aims to decrease the overall yearly consumption of alcohol among the adult population to less than 8 litres of absolute alcohol per capita. Gathering support across society from a range of stakeholders, including policy-makers, researchers, parents and advocates, has been one of the key elements in the implementation of the policy.


Asunto(s)
Desarrollo Sostenible , Consumo de Bebidas Alcohólicas , Disuasivos de Alcohol , Trastornos Relacionados con Alcohol , Política Pública , Estonia , Europa (Continente)
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