Reducing exposure to high fluoride drinking water in Estonia-a countrywide study.

Fluoride is a naturally occurring contaminant in groundwater in Estonia. There are several regions in Estonia with fluoride contents in public water supplies as high as 7 mg/L. Long-term exposure to high-fluoride drinking water may have several adverse health effects, primarily dental fluorosis. The opportunities for exposure reduction rely highly on water treatment technologies. Since 2004 public water suppliers in Estonia have made efforts to diminish fluoride content in drinking water systems. A follow-up study on a country level was carried out in 2004-2012 to analyze the changes in population exposure to excessive (over 1.5 mg/L) fluoride in drinking water and to get information about the reduction methods applied by public water supplies (PWS) to optimize the fluoride levels in public water system. The results showed that bigger PWS have been more effective in fluoride reduction measures than small PWS. The main methods used to lower the fluoride content were reverse osmosis technology and replacement of water sources with new ones (new drilled wells). As a result of all the measures taken the overall high-fluoride exposure has been reduced substantially (82%).

Non-fatal injuries resulting in activity limitations in Estonia--risk factors and association with the incidence of chronic conditions and quality of life: a retrospective study among the population aged 20-79.

OBJECTIVES: Evidence about the health and quality-of-life outcomes of injuries is obtained mainly from follow-up studies of surviving trauma patients; population-based studies are rarer, in particular for countries in Eastern Europe. This study examines the incidence, prevalence and social variation in non-fatal injuries resulting in activity limitations and outcomes of injuries in Estonia. DESIGN: A retrospective population-based study. SETTING: Estonia. PARTICIPANTS: 7855 respondents of the face-to-face interviews of the second round of the Estonian Family and Fertility Survey conducted between 2004 and 2005 based on the nationally representative probability sample (n=11 192) of the resident population of Estonia aged 20-79. PRIMARY AND SECONDARY OUTCOME MEASURES: The cumulative incidence and prevalence of injuries leading to activity limitations was estimated. Survival models were applied to analyse variations in the injury risk across sociodemographic groups. The association between injuries and the development of chronic conditions and quality of life was examined using survival and logistic regression models. RESULTS: 10% (95% CI 9.4 to 10.7) of the population aged 20-79 had experienced injuries leading to activity limitations; the prevalence of activity limitations due to injuries was 4.4% (95% CI 3.9% to 4.9%). Significant differences in injury risk were associated with gender, education, employment, marital status and nativity. Limiting injury was associated with a doubling of the likelihood of having chronic conditions (adjusted HR 1.97, 95% CI 1.58 to 2.46). Injury exhibited a statistically significant negative association with most quality-of-life measures. Although reduced, these effects persisted after recovery from activity limitations. CONCLUSIONS: Substantial variation in injury risk across population groups suggests potential for prevention. Men and workers in manual occupations constitute major target groups for injury prevention in Estonia. The association of injury with the development of chronic conditions and reduced quality of life warrants further investigation.

Self-reported activity limitations among the population aged 20-79 in Estonia: a cross-sectional study.

BACKGROUND: Along with population ageing, limitations in activities of daily living constitute a rising health-related burden in demographically advanced countries. The present study aims to assess the prevalence of self-reported activity limitations derived from chronic conditions and social variation of limitations in the subgroups of the population aged 20-79 years in Estonia. METHODS: A cross-sectional study employs data from the second round of the Estonian Family and Fertility Survey, a national project in the framework of Gender and Generation Programme. The target population covers age groups of 20-79 years. A nationally representative probability sample was drawn from the 2000 population census. Face-to-face interviews (n = 7855) were conducted in 2004-05. RESULTS: The estimated prevalence of activity limitations with chronic conditions is 18.5% (95% CI 17.6-19.4) and the prevalence of severe limitations is 10.6% (95% CI 9.9-11.3) among the population. The logistic regression model shows significant differences in activity limitations associated with age, educational attainment and marital status. CONCLUSIONS: Judging from our results and the EU structural indicators on health, the prevalence of activity limitations derived from chronic conditions is comparatively high in Estonia. The measures to prevent activity limitations and disability should receive a higher priority in Estonia.

Exposure to high fluoride drinking water and risk of dental fluorosis in Estonia.

The purpose of this study was to assess exposure to drinking water fluoride and evaluate the risk of dental fluorosis among the Estonian population. The study covered all 15 counties in Estonia and 93.7% of population that has access to public water supplies. In Estonia groundwater is the main source for public water supply systems in most towns and rural settlements. The content of natural fluoride in water ranges from 0.01 to 7.20 mg/L. The exposure to different fluoride levels was assessed by linking data from previous studies on drinking water quality with databases of the Health Protection Inspectorate on water suppliers and the number of water consumers in water supply systems. Exposure assessment showed that 4% of the study population had excessive exposure to fluoride, mainly in small public water supplies in western and central Estonia, where the Silurian-Ordovician aquifer system is the only source of drinking water. There is a strong correlation between natural fluoride levels and the prevalence of dental fluorosis. Risk of dental fluorosis was calculated to different fluoride exposure levels over 1.5 mg/L.