Experiences from patients in mental healthcare accessing their electronic health records: results from a cross-national survey in Estonia, Finland, Norway, and Sweden.

BACKGROUND: Patients' online record access (ORA) enables patients to read and use their health data through online digital solutions. One such solution, patient-accessible electronic health records (PAEHRs) have been implemented in Estonia, Finland, Norway, and Sweden. While accumulated research has pointed to many potential benefits of ORA, its application in mental healthcare (MHC) continues to be contested. The present study aimed to describe MHC users' overall experiences with national PAEHR services. METHODS: The study analysed the MHC-part of the NORDeHEALTH 2022 Patient Survey, a large-scale multi-country survey. The survey consisted of 45 questions, including demographic variables and questions related to users' experiences with ORA. We focused on the questions concerning positive experiences (benefits), negative experiences (errors, omissions, offence), and breaches of security and privacy. Participants were included in this analysis if they reported receiving mental healthcare within the past two years. Descriptive statistics were used to summarise data, and percentages were calculated on available data. RESULTS: 6,157 respondents were included. In line with previous research, almost half (45%) reported very positive experiences with ORA. A majority in each country also reported improved trust (at least 69%) and communication (at least 71%) with healthcare providers. One-third (29.5%) reported very negative experiences with ORA. In total, half of the respondents (47.9%) found errors and a third (35.5%) found omissions in their medical documentation. One-third (34.8%) of all respondents also reported being offended by the content. When errors or omissions were identified, about half (46.5%) reported that they took no action. There seems to be differences in how patients experience errors, omissions, and missing information between the countries. A small proportion reported instances where family or others demanded access to their records (3.1%), and about one in ten (10.7%) noted that unauthorised individuals had seen their health information. CONCLUSIONS: Overall, MHC patients reported more positive experiences than negative, but a large portion of respondents reported problems with the content of the PAEHR. Further research on best practice in implementation of ORA in MHC is therefore needed, to ensure that all patients may reap the benefits while limiting potential negative consequences.

Early-career general practitioners' career intentions in Estonia: A qualitative study.

BACKGROUND: The shortage of general practitioners (GPs) is a worsening problem in many countries and poses a threat to the services provided by primary care and by extension for the entire healthcare system. Issues with GP workforce recruitment and retention can be reasons for this shortage. OBJECTIVES: To describe GP trainees and newly qualified GPs experiences and perceptions on how their training and early experiences of work influence their career intentions in primary care in Estonia. METHODS: A qualitative study with GP trainees (n = 12) and newly qualified GPs (n = 13) using semi-structured group interviews (n = 6) was conducted. Interviews were conducted from October until November 2020. Data were analysed using thematic analysis with NVivo Software. RESULTS: Although early-career GPs in Estonia envision their future roles as GP practice owners with patient list, this is often postponed due to various reasons. Early-career GPs expressed a sense of unpreparedness to fill all the roles of GPs' and found the process of establishing a GP practice and taking on a patient lists very complicated. They value work-life balance and prefer workplaces, which offer flexible working conditions. CONCLUSION: Potential strategies were identified to enhance the willingness of early-career GPs to continue their career as GP practice owners with patient list: improving the GP training program by placing more emphasis on managing skills and making the process of establishing GP practice and taking on a patient list less bureaucratic and more accessible.

This study highlights the career intentions of GP trainees and newly qualified GPs in Estonia.Participants of this study perceive the many different roles of being a GP as very challenging.Understanding early-career GPs ideas about the future work environments can be helpful in shaping future workforce strategies.

Characterising the genetic architecture of changes in adiposity during adulthood using electronic health records.

Obesity is a heritable disease, characterised by excess adiposity that is measured by body mass index (BMI). While over 1,000 genetic loci are associated with BMI, less is known about the genetic contribution to adiposity trajectories over adulthood. We derive adiposity-change phenotypes from 24.5 million primary-care health records in over 740,000 individuals in the UK Biobank, Million Veteran Program USA, and Estonian Biobank, to discover and validate the genetic architecture of adiposity trajectories. Using multiple BMI measurements over time increases power to identify genetic factors affecting baseline BMI by 14%. In the largest reported genome-wide study of adiposity-change in adulthood, we identify novel associations with BMI-change at six independent loci, including rs429358 (APOE missense variant). The SNP-based heritability of BMI-change (1.98%) is 9-fold lower than that of BMI. The modest genetic correlation between BMI-change and BMI (45.2%) indicates that genetic studies of longitudinal trajectories could uncover novel biology of quantitative traits in adulthood.

Evaluation of the Estonian Green Paper on Alcohol Policy

The Green Paper on Alcohol Policy has been Estonia’s strategy document for addressing alcohol-related harms since 2013. Its objectives include: reducing alcohol consumption and curbing harmful drinking patterns; preventing underage drinking; minimizing alcohol-related crime, social problems and health damage; and developing treatment and rehabilitation services for alcohol dependence.This technical report evaluates the public health impact of the Green Paper and associated policies, providing evidence-based insights for future alcohol control efforts in Estonia. The evaluation analyses alcohol consumption and related harms in Estonia from 2000 to 2023, focusing on periods before and after the implementation ofthe Green Paper’s recommendations.Following the Green Paper’s adoption (2013–2019), adult per capita alcohol consumption in Estonia decreased notably. Key indicators, such as age-standardized all-cause mortality and life expectancy at birth, demonstrated positive trends until the onset of the coronavirus disease pandemic. Evaluation of specific indicators revealedmixed outcomes: while there was a notable reduction in alcohol consumption and intoxication among minors, the target of reducing the annual population alcohol consumption to under 8 L per capita was not achieved. Although policy implementation coincided with decreases in alcohol-attributable injuries and mortality rates,it is challenging to attribute these improvements solely to the Green Paper.

Most people's life satisfaction matches their personality traits: True correlations in multitrait, multirater, multisample data.

Despite numerous meta-analyses, the true extent to which life satisfaction reflects personality traits has remained unclear due to overreliance on a single method to assess both and insufficient attention to construct overlaps. Using data from three samples tested in different languages (Estonian, N = 20,886; Russian, N = 768; English, N = 600), we combined self- and informant-reports to estimate personality domains' and nuances' true correlations (rtrue) with general life satisfaction (LS) and satisfactions with eight life domains (DSs), while controlling for single-method and occasion-specific biases and random error, and avoiding direct construct overlaps. The associations replicated well across samples. The Big Five domains and nuances allowed predicting LS with accuracies up to rtrue ≈ .80-.90 in independent (sub)samples. Emotional stability, extraversion, and conscientiousness correlated rtrue ≈ .30-.50 with LS, while its correlations with openness and agreeableness were small. At the nuances level, low LS was most strongly associated with feeling misunderstood, unexcited, indecisive, envious, bored, used, unable, and unrewarded (rtrue ≈ .40-.70). Supporting LS's construct validity, DSs had similar personality correlates among themselves and with LS, and an aggregated DS correlated rtrue ≈ .90 with LS. LS's approximately 10-year stability was rtrue = .70 and its longitudinal associations with personality traits mirrored cross-sectional ones. We conclude that without common measurement limitations, most people's life satisfaction is highly consistent with their personality traits, even across many years. So, satisfaction is usually shaped by these same relatively stable factors that shape personality traits more broadly. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of health spending on hospitalization rates in Baltic countries: a comparative analysis.

INTRODUCTION: This study examines the association between healthcare indicators and hospitalization rates in three high-income European countries, namely Estonia, Latvia, and Lithuania, from 2015 to 2020. METHOD: We used a sex-stratified generalized additive model (GAM) to investigate the impact of select healthcare indicators on hospitalization rates, adjusted by general economic status-i.e., gross domestic product (GDP) per capita. RESULTS: Our findings indicate a consistent decline in hospitalization rates over time for all three countries. The proportion of health expenditure spent on hospitals, the number of physicians and nurses, and hospital beds were not statistically significantly associated with hospitalization rates. However, changes in the number of employed medical doctors per 10,000 population were statistically significantly associated with changes of hospitalization rates in the same direction, with the effect being stronger for males. Additionally, higher GDP per capita was associated with increased hospitalization rates for both males and females in all three countries and in all models. CONCLUSIONS: The relationship between healthcare spending and declining hospitalization rates was not statistically significant, suggesting that the healthcare systems may be shifting towards primary care, outpatient care, and on prevention efforts.

Isolation and characterization of a phage collection against Pseudomonas putida.

The environmental bacterium, Pseudomonas putida, possesses a broad spectrum of metabolic pathways. This makes it highly promising for use in biotechnological production as a cell factory, as well as in bioremediation strategies to degrade various aromatic pollutants. For P. putida to flourish in its environment, it must withstand the continuous threats posed by bacteriophages. Interestingly, until now, only a handful of phages have been isolated for the commonly used laboratory strain, P. putida KT2440, and no phage defence mechanisms have been characterized. In this study, we present a new Collection of Environmental P. putida Phages from Estonia, or CEPEST. This collection comprises 67 double-stranded DNA phages, which belong to 22 phage species and 9 phage genera. Our findings reveal that most phages in the CEPEST collection are more infectious at lower temperatures, have a narrow host range, and require an intact lipopolysaccharide for P. putida infection. Furthermore, we show that cryptic prophages present in the P. putida chromosome provide strong protection against the infection of many phages. However, the chromosomal toxin-antitoxin systems do not play a role in the phage defence of P. putida. This research provides valuable insights into the interactions between P. putida and bacteriophages, which could have significant implications for biotechnological and environmental applications.

Comparison of Estonian Schoolchildren's Physical Activity and Fitness Indicators before and after the COVID-19 Pandemic's Period of Restricted Mobility.

It is recognized that the time adolescents spend on physical activity, and the corresponding physical fitness indicators, have diminished over time. However, the exact impact of the COVID-19 pandemic restriction period on physical activity and health-related physical fitness indicators remains unclear. This study sought to determine if and to what degree the primary indicators of physical activity (exercise frequency, exercise intensity, and outdoor physical activity) and health-related physical fitness (strength and endurance) among schoolchildren have shifted, by comparing data from before and after the coronavirus pandemic period. Students aged 12-17 years took part in the study. The physical activity questionnaire and fitness tests were conducted in the autumn of 2017 and spring of 2022. The main results show that moderate- and vigorous-intensity physical activity time and time spent actively outdoors have decreased among adolescents (p < 0.05). There were no significant changes in exercise frequency (p > 0.05). However, there was a statistically significant decline in strength (standing broad jump, bent arm hang) (p < 0.05) and endurance (20 m shuttle run, curl-up) (p < 0.01) when comparing results from before and after the COVID-19 pandemic restriction period. In conclusion, restricted mobility had the greatest impact on the time spent outdoors and, in turn, on physical fitness.

The Influence of Kindergarten Environment on the Development of Preschool Children's Physical Fitness.

The aim of this research is to find out to what extent the special qualifications of physical education teachers and the physical environment of kindergartens influence the physical development of preschoolers. Forty-four kindergartens across Estonia participated in the study, half of which had a physical education teacher (PEt), whereas the remaining 22 kindergartens were taught by non-qualified kindergarten teachers (NoPEt). Six Eurofit fitness tests were used to assess the physical development of children (n = 704; aged 6-7 years old, with an average age of 6.55 ± 0.5 years). An analysis of variance was used to compare the mean values of the fitness test results of the two groups. Linear regression analysis was applied to clarify the influence of individual and environmental factors on children's fitness scores. In kindergartens where the position of a PEt had been created, the results of children's physical fitness were statistically significantly better, more specifically in handgrip strength (m = 12.0, 95% CI = 11.8-12.3 vs. m = 11.5, 95% CI = 11.2-11.7) and in speed tests (m = 23.0, 95% CI = 22.8-23.2 vs. m = 23.6, 95% CI = 23.3-23.8). According to the teacher interviews, these kindergartens also had more rooms and areas specially created for physical exercises. The study revealed that the physical development of children is, when controlling for other individual and environmental factors, influenced by the professional qualification of the PE teacher (95% CI = 0.06-0.56) as well as children's participation in sports training (95% CI = 0.29-0.83). These findings are important for preschool institutions and municipalities in designing the optimal physical environment for facilitating children's physical fitness.

Distinct biogeographical patterns in snail gastrointestinal tract bacterial communities compared with sediment and water.

The factors that influence the distribution of bacterial community composition are not well understood. The role of geographical patterns, which suggest limited dispersal, is still a topic of debate. Bacteria associated with hosts face unique dispersal challenges as they often rely on their hosts, which provide specific environments for their symbionts. In this study, we examined the effect of biogeographic distances on the bacterial diversity and composition of bacterial communities in the gastrointestinal tract of Ampullaceana balthica. We compared the effects on the host-associated bacterial community to those on bacterial communities in water and sediment. This comparison was made using 16S ribosomal RNA gene sequencing. We found that the bacterial communities we sampled in Estonia, Denmark, and Northern Germany varied between water, sediment, and the gastrointestinal tract. They also varied between countries within each substrate. This indicates that the type of substrate is a dominant factor in determining bacterial community composition. We separately analyzed the turnover rates of water, sediment, and gastrointestinal bacterial communities over increasing geographic distances. We observed that the turnover rate was lower for gastrointestinal bacterial communities compared to water bacterial communities. This implies that the composition of gastrointestinal bacteria remains relatively stable over distances, while water bacterial communities exhibit greater variability. However, the gastrointestinal tract had the lowest percentage of country-specific amplicon sequence variants, suggesting bacterial colonization from local bacterial communities. Since the overlap between the water and gastrointestinal tract was highest, it appears that the gastrointestinal bacterial community is colonized by the water bacterial community. Our study confirmed that biogeographical patterns in host-associated communities differ from those in water and sediment bacterial communities. These host-associated communities consist of numerous facultative symbionts derived from the water bacterial community.

How Technology, Health Information Seeking, and Socioeconomic Factors Are Associated With Coronavirus Disease 2019 Vaccination Readiness in Estonians Over 50 Years?

Despite the proven effectiveness of COVID-19 vaccines in preventing severe illness, many individuals, including older adults who are most susceptible to the virus, have opted against vaccination. Various factors could shape vaccination decisions, including seeking health information (HI). The internet is the primary source of HI today; however, older adults are often referred to as those missing out on digital benefits. The study explores the correlations between information and communication technology (ICT) use, online HI seeking, socioeconomic factors, and COVID-19 vaccination readiness among individuals aged 50 and above in Estonia. The survey data were gathered from 501 people aged 50 and older after the first lockdown in 2020. The outcomes revealed that vaccination readiness positively correlated with factors such as higher educational attainment, greater income, male gender, access to ICT, a readiness to employ digital technologies for health-related purposes, a greater demand for HI, and a higher frequency of seeking it online. There was some discrepancy in the preference of HI sources; for example, vaccination consenters preferred online versions of professional press publications and specific health portals. Based on the findings, it is advisable to encourage older adults to utilize the internet and new technology for health-related purposes. This practice expands the range of information sources available to them, ultimately enabling better decision-making regarding their health behaviors.

Collaborative learning linking nursing practice and education - Interview study with master's students and teachers.

BACKGROUND: Collaborative and innovative educational approaches are essential to building nurses' competencies in responding to healthcare challenges and to enhance high-quality nursing practice. Nurses are increasingly learning in various contexts, and thus, the understanding and organising of collaborative learning needs further exploration. AIM: To describe collaborative learning in nursing practice and education from the point of view of nurses, involved as students and teachers in master's education in nursing. DESIGN AND METHODS: Qualitative study using semi-structured focus groups involving 33 nurses as master's students and teachers from Estonia and Norway. The data were analysed using inductive content analysis. FINDINGS: The essence of collaborative learning in the context of nursing practice and education was identified as the aggregation of diverse learners' skills and reflections while working towards shared aims. This fostered the development of workplace competencies, professional attitudes, and personal growth. Organising collaborative learning requires careful planning and synchronisation between clinical and educational organisations. CONCLUSIONS: Collaborative learning is an inclusive method, aiding nurses at different phases of their career to gain knowledge and enhance their soft skills, and potentially reducing professional hierarchies. Further research is needed to develop methods for evaluating the outcomes of collaborative learning.

Heterogeneous trajectories of perceived stress and their associations with active leisure: a longitudinal study during the first year of COVID-19.

Introduction: There is a plethora of literature on the dynamics of mental health indicators throughout the COVID-19 pandemic, yet research is scarce on the potential heterogeneity in the development of perceived stress. Furthermore, there is a paucity of longitudinal research on whether active leisure engagement, which typically is beneficial in reducing stress, might have similar benefits during times of major disruption. Here we aimed to extend previous work by exploring the dynamics of change in stress and coping, and the associations with active leisure engagement over the first year of COVID-19. Methods: Data from 439 adults (Mage = 45, SD = 13) in Estonia who participated in a longitudinal online study were analyzed. The participants were assessed at three timepoints: April-May 2020; November-December 2020; and April-May 2021. Results: Mean stress and coping levels were stable over time. However, latent profile analysis identified four distinct trajectories of change in stress and coping, involving resilient, stressed, recovering, and deteriorating trends. Participants belonging to the positively developing stress trajectories reported higher active leisure engagement than those belonging to the negatively developing stress trajectories. Discussion: These findings highlight the importance of adopting person-centered approaches to understand the diverse experiences of stress, as well as suggest the promotion of active leisure as a potentially beneficial coping resource, in future crises.

Tranquilisers and sedatives misuse and associated factors among adolescents in Estonia: findings from cross-sectional ESPAD surveys, 2003-2019.

OBJECTIVES: This study aimed to (1) to describe trends of tranquilliser and sedative (TS) misuse in Estonia during 2003-2019 and (2) to analyse the associations between TS misuse and explanatory factors (perceived access to TS, medical use of TS, family-related, friends-related, school-related factors, risk behaviour and leisure time physical activity). DESIGN: A cross-sectional study. SETTING: Data were collected from the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 2003 to 2019 in Estonia. PARTICIPANTS: Estonian schoolchildren aged 15-16 years old (n=11 328), 48.6% were boys. OUTCOME MEASURES: Prevalence, crude and adjusted ORs with 95% CIs for TS misuse. RESULTS: The prevalence of lifetime TS misuse significantly increased from 2003 (5.0% of boys and 12.6% of girls) to 2019 (11.3% and 17.5%, respectively) (p<0.001). Among boys, TS misuse increased significantly among those reporting medical use of TS from 21.1% to 41.4% in 2003-2019 (p=0.006). Medical use of TS multiplied the odds of misuse by 6.89 (95% CI 5.15 to 9.24) for boys and by 4.53 (95% CI 3.58 to 5.73) for girls. Perceived easy access to TS increased the odds of misuse by 6.57 (95% CI 4.13 to 10.46) times for boys and by 4.66 (95% CI 3.25 to 6.70) times for girls. Having many friends who misuse TS increased the odds of misuse by 3.27 (95% CI 2.16 to 4.95) times for boys and by 5.07 (95% CI 3.79 to 6.77) times for girls. Furthermore, higher odds of TS misuse were observed among adolescents who smoked cigarettes and engaged in less sports. CONCLUSIONS: TS misuse prevalence among Estonian adolescents increased significantly from 2003 to 2019. Misuse was strongly associated with medical use, perceived easy access and friends' TS misuse. These findings emphasise the need for targeted prevention strategies, including improving prescription practices, limiting TS access and promoting healthy behaviours and positive peer relationships among adolescents.

SARS-CoV-2 clade dynamics and their associations with hospitalisations during the first two years of the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic was characterised by rapid waves of disease, carried by the emergence of new and more infectious SARS-CoV-2 virus variants. How the pandemic unfolded in various locations during its first two years has yet to be sufficiently covered. To this end, here we are looking at the circulating SARS-CoV-2 variants, their diversity, and hospitalisation rates in Estonia in the period from March 2000 to March 2022. METHODS: We sequenced a total of 27,550 SARS-CoV-2 samples in Estonia between March 2020 and March 2022. High-quality sequences were genotyped and assigned to Nextstrain clades and Pango lineages. We used regression analysis to determine the dynamics of lineage diversity and the probability of clade-specific hospitalisation stratified by age and sex. RESULTS: We successfully sequenced a total of 25,375 SARS-CoV-2 genomes (or 92%), identifying 19 Nextstrain clades and 199 Pango lineages. In 2020 the most prevalent clades were 20B and 20A. The various subsequent waves of infection were driven by 20I (Alpha), 21J (Delta) and Omicron clades 21K and 21L. Lineage diversity via the Shannon index was at its highest during the Delta wave. About 3% of sequenced SARS-CoV-2 samples came from hospitalised individuals. Hospitalisation increased markedly with age in the over-forties, and was negligible in the under-forties. Vaccination decreased the odds of hospitalisation in over-forties. The effect of vaccination on hospitalisation rates was strongly dependent upon age but was clade-independent. People who were infected with Omicron clades had a lower hospitalisation likelihood in age groups of forty and over than was the case with pre-Omicron clades regardless of vaccination status. CONCLUSIONS: COVID-19 disease waves in Estonia were driven by the Alpha, Delta, and Omicron clades. Omicron clades were associated with a substantially lower hospitalisation probability than pre-Omicron clades. The protective effect of vaccination in reducing hospitalisation likelihood was independent of the involved clade.

Using electronic health records to evaluate the adherence to cervical cancer prevention guidelines: A cross-sectional study.

OBJECTIVE: The fight against cervical cancer requires effective screening together with optimal and on-time treatment along the care continuum. We examined the impact of cervical cancer testing and treatment guidelines on testing practices, and follow-up adherence to guidelines. METHODS: Data from Estonian electronic health records and healthcare provision claims for 50,702 women was used. The annual rates of PAP tests, HPV tests and colposcopies during two guideline periods (2nd version 2012-2014 vs 3rd version 2016-2019) were compared. To assess the adherence to guidelines, the subjects were classified as adherent, over- or undertested based on the timing of the appropriate follow-up test. RESULTS: The number of PAP tests decreased and HPV tests increased during the 3rd guideline period (p < 0.01). During the 3rd guideline period, among 21-29-year-old women, the adherence to guidelines ranged from 38.7% (44.4…50.1) for ASC-US to 73.4% (62.6…84.3) for HSIL and among 30-59-year-old from 49.0% (45.9…52.2) for ASC-US to 65.7% (58.8…72.7) for ASCH. The highest rate of undertested women was for ASC-US (21-29y: 25.7%; 30-59y: 21.9%). The rates of over-tested women remained below 12% for all cervical pathologies observed. There were 55.2% (95% CI 49.7…60.8) of 21-24-year-olds and 57.1% (95% CI 53.6…60.6) of 25-29-year-old women who received HPV test not adherent to guidelines. CONCLUSIONS: Our findings highlighted some shortcomings in guideline adherence, especially among women under 30. The insights gained from this study help to improve the quality of care and, thus, reduce cervical cancer incidence and mortality.

Diversity of Sarcocystis parasites in southeastern Baltic Sea catchment ecosystems.

Currently, research on apicomplexan Sarcocystis parasites is mainly carried out by analyzing animal carcasses. However, environmental studies would not only allow faster detection of possible sources of infection but also avoid the use of animals for investigations. Therefore, in the current study, we aimed to identify tested Sarcocystis species in sediment collected from water bodies located in the southeastern Baltic countries. A total of 99 sediment samples were collected during the summer from different types of water bodies in Estonia, Latvia, Lithuania, and Poland. Species-specific nested PCR targeting cox1 gene was used for the detection of selected Sarcocystis species (S. cruzi, S. bovifelis, S. hirsuta, S. arieticanis, S. tenella, S. capracanis, S. miescheriana, and S. bertrami) infecting livestock. The results showed a statistically lower (p < 0.05) occurrence of Sarcocystis parasites in Estonia (50%) compared to three countries, where the detection rate of Sarcocystis spp. DNA was remarkably higher, ranging from 88 to 100%. Among Sarcocystis species tested, S. cruzi (83.8%) and S. arieticanis (55.6%) using cattle and sheep as their intermediate hosts were most commonly identified. The detection rates of some of the analyzed Sarcocystis species were significantly different in southeastern Baltic countries. It is discussed that the detection rates of certain Sarcocystis species depend not only on the number of animals per 1 km2 but also on various ecological factors and farming practices that differ in the amount of contact domestic animals have with predators and the potential for animals to become infected through natural water or food sources.

Sibling bullying reported by emerging adults: Profiling the prevalence, roles, and forms in a cross-country investigation.

Prevalence estimates of sibling bullying indicate it occurs more frequently and with more negative consequences than peer bullying, yet many countries do not track or investigate the phenomenon. University students from Argentina, Estonia, and the United States were surveyed to investigate their retrospective experiences involving sibling bullying, how often it occurred, the roles held, and the forms communicated. In the aggregated data, roughly 50 % of the sampled emerging adults (N = 3477) reported experience with sibling bullying, with the dual role of bully-victim being the most frequently reported role held by males and females, with the second role being bully for males and victim for females. Verbal forms of bullying were most frequently reported by males and females, with physical, relational, and technological forms occurring less frequently, indicating the importance of studying the messages conveyed during bullying incidents. Variations between biological sex, bullying role and form were detected that indicate siblings experience bullying in ways that are unique from peer bullying. Country comparisons revealed bullying frequencies varied among males and females, suggesting sibling bullying experiences are likely to be culturally influenced. More research is warranted to examine the negative impact bullying has on sibling psycho-social development and the potential transfer to non-familial relationships and contexts. Discussion of these findings and the implications for academics and practitioners alike is provided.

Genetic determinants of plasma protein levels in the Estonian population.

The proteome holds great potential as an intermediate layer between the genome and phenome. Previous protein quantitative trait locus studies have focused mainly on describing the effects of common genetic variations on the proteome. Here, we assessed the impact of the common and rare genetic variations as well as the copy number variants (CNVs) on 326 plasma proteins measured in up to 500 individuals. We identified 184 cis and 94 trans signals for 157 protein traits, which were further fine-mapped to credible sets for 101 cis and 87 trans signals for 151 proteins. Rare genetic variation contributed to the levels of 7 proteins, with 5 cis and 14 trans associations. CNVs were associated with the levels of 11 proteins (7 cis and 5 trans), examples including a 3q12.1 deletion acting as a hub for multiple trans associations; and a CNV overlapping NAIP, a sensor component of the NAIP-NLRC4 inflammasome which is affecting pro-inflammatory cytokine interleukin 18 levels. In summary, this work presents a comprehensive resource of genetic variation affecting the plasma protein levels and provides the interpretation of identified effects.