Changes in nurses' work: A comparative study during the waves of COVID-19 pandemic.

AIM: The aim of this study is to describe and evaluate how nurses caring for COVID and non-COVID patients assess changes in their work and in nursing activities during the two waves of the COVID-19 pandemic. METHODS: Two cross-sectional surveys were conducted for Estonian nurses working during the first and second waves of the COVID-19 pandemic, using The impact of COVID-19 emergency on nursing care questionnaire. Based on convenience sampling, the data were collected among the members of professional organizations, unions and associations. Responses from the first (n = 162) and second wave (n = 284) were analysed using descriptive statistics, Fisher's exact test and McNemar's test. RESULTS: The COVID-19 pandemic changed the working context during both waves for nurses caring for COVID and non-COVID patients. Changes were considered to a greater extent during the second wave, when Estonia was severely affected, and by nurses caring for COVID patients. During the second wave, the number and complexity of patients increased, and nurses caring for COVID patients performed fundamental care, nursing techniques and symptom control significantly more frequently compared to nurses caring for non-COVID patients. CONCLUSION: Taking care of COVID patients is demanding, requiring nurses to perform more direct patient care. However, the pandemic also increased the frequency of activities not related with direct patient care.

Risk of SARS-CoV-2 infection and hospitalization in individuals with natural, vaccine-induced and hybrid immunity: a retrospective population-based cohort study from Estonia.

A large proportion of the world's population has some form of immunity against SARS-CoV-2, through either infection ('natural'), vaccination or both ('hybrid'). This retrospective cohort study used data on SARS-CoV-2, vaccination, and hospitalization from national health system from February 2020 to June 2022 and Cox regression modelling to compare those with natural immunity to those with no (Cohort1, n = 94,982), hybrid (Cohort2, n = 47,342), and vaccine (Cohort3, n = 254,920) immunity. In Cohort 1, those with natural immunity were at lower risk for infection during the Delta (aHR 0.17, 95%CI 0.15-0.18) and higher risk (aHR 1.24, 95%CI 1.18-1.32) during the Omicron period than those with no immunity. Natural immunity conferred substantial protection against COVID-19-hospitalization. Cohort 2-in comparison to natural immunity hybrid immunity offered strong protection during the Delta (aHR 0.61, 95%CI 0.46-0.80) but not the Omicron (aHR 1.05, 95%CI 0.93-1.1) period. COVID-19-hospitalization was extremely rare among individuals with hybrid immunity. In Cohort 3, individuals with vaccine-induced immunity were at higher risk than those with natural immunity for infection (Delta aHR 4.90, 95%CI 4.48-5.36; Omicron 1.13, 95%CI 1.06-1.21) and hospitalization (Delta aHR 7.19, 95%CI 4.02-12.84). These results show that risk of infection and severe COVID-19 are driven by personal immunity history and the variant of SARS-CoV-2 causing infection.

The use of prescription drugs and health care services during the 6-month post-COVID-19 period.

COVID-19 and other acute respiratory viruses can have a long-term impact on health. We aimed to assess the common features and differences in the post-acute phase of COVID-19 compared with other non-chronic respiratory infections (RESP) using population-based electronic health data. We applied the self-controlled case series method where prescription drugs and health care utilisation were used as indicators of health outcomes during the six-month-long post-acute period. The incidence rate ratios of COVID-19 and RESP groups were compared. The analysis included 146 314 individuals. Out of 5452 drugs analysed, 14 had increased administration after COVID-19 with drugs for cardiovascular diseases (trimetazidine, metoprolol, rosuvastatin) and psychotropic drugs (alprazolam, zolpidem, melatonin) being most prevalent. The health impact of COVID-19 was more apparent among females and individuals with non-severe COVID-19. The increased risk of exacerbating pre-existing conditions was observed for the COVID-19 group. COVID-19 vaccination did not have effect on drug prescriptions but lowered the health care utilisation during post-acute period. Compared with RESP, COVID-19 increased the use of outpatient services during the post-infection period. The long-term negative impact of COVID-19 on life quality must be acknowledged, and supportive health care and public health services provided.

Fear of COVID-19 among patients with prior SARS-CoV-2 infection: A cross-sectional study in Estonian family practices.

BACKGROUND: Fear of coronavirus disease (COVID-19) has been associated with significant health effects. OBJECTIVES: To assess COVID-19 fear and investigate factors associated with higher fear among COVID-19 survivors over 6 months after infection. METHODS: Cross-sectional study using multistage sampling (family practices within the highest 5th percentile of numbers of SARS-CoV-2 infected patients and random sample of patients within these practices) performed from March 15 to 17 July 2021. Adult patients with a laboratory-confirmed history of COVID-19 were recruited for a self-administered 79-item questionnaire including demographics, self-rated health, physical activity, COVID-19 characteristics, severity and the fear of COVID-19 Scale (FCV-19S). Comorbidity data were extracted from Estonian Health Insurance Fund. Logistic regression models were used to evaluate factors associated with COVID-19 fear. RESULTS: Of 341 participants included, 60% were women, 24.2% were hospitalised due to COVID-19 and 22.2% had long COVID, 143 (42%) participants reported high levels of fear (cut-off FCV-19S >17.8). Higher fear was associated with being female (aOR 2.12, 95% CI 1.14-3.95), age ≥61 years (aOR 3.23, 95% CI 1.28-8.16), two-member-households (aOR 3.70, 95% CI 1.40-9.77) physical inactivity 6 months prior to COVID-19 (aOR 3.53, 95% CI 1.26-9.95), and symptom severity during acute COVID-19. Long COVID was not associated with higher COVID-19 fear (aOR 1.82 95% CI 0.91-3.63). CONCLUSION: Almost half of participants reported COVID-19 fear more than 6 months after infection. Greater fear was associated with sociodemographic factors, physical activity prior to COVID-19 and COVID-19 symptom severity. There is a need to target this population to develop appropriate interventions.

A retrospective cohort study of incidence and risk factors for severe SARS-CoV-2 breakthrough infection among fully vaccinated people.

SARS-CoV-2 vaccination is currently the mainstay in combating the COVID-19 pandemic. However, there are still people among vaccinated individuals suffering from severe forms of the disease. We conducted a retrospective cohort study based on data from nationwide e-health databases. The study included 184,132 individuals who were SARS-CoV-2 infection-naive and had received at least a primary series of COVID-19 vaccination. The incidence of BTI (breakthrough infection) was 8.03 (95% CI [confidence interval] 7.95⎼8.13/10,000 person-days), and for severe COVID-19 it was 0.093 (95% CI 0.084⎼ 0.104/10,000 person-days). The protective effect of vaccination against severe COVID-19 remained constant for up to six months, and the booster dose offered an additional pronounced benefit (hospitalization aHR 0.32, 95% CI 0.19⎼0.54). The risk of severe COVID-19 was higher among those ≥ 50 years of age (aHR [adjusted hazard ratio] 2.06, 95% CI 1.25⎼3.42) and increased constantly with every decade of life. Male sex (aHR 1.32, 95% CI 1.16⎼1.45), CCI (The Charlson Comorbidity Index) score ≥ 1 (aHR 2.09, 95% CI 1.54⎼2.83), and a range of comorbidities were associated with an increased risk of COVID-19 hospitalization. There are identifiable subgroups of COVID-19-vaccinated individuals at high risk of hospitalization due to SARS-CoV-2 infection. This information is crucial to driving vaccination programs and planning treatment strategies.

Parental Participation in Their Infants' Procedural Pain Alleviation with Nonpharmacologic Methods in Estonia.

BACKGROUND: Aim: To describe parent's participation in their infants' procedural pain alleviation using nonpharmacologic methods in neonatal and neonatal intensive care units. METHOD: A descriptive cross-sectional survey study was carried out in four Estonian hospitals between 2019 and 2020. Data were collected by using a validated questionnaire comprised of three sections: (1) background information of parents and infants; (2) nonpharmacologic methods used by parents; and (3) parental guidance by nurses on the methods. Altogether 280 questionnaires were distributed to parents and 232 of them were received back. Finally, 189 of them were included in the study (response rate 67.5%). The data were analyzed using descriptive and analytical statistics. Analysis of open-ended questions followed principles of inductive content analysis. RESULTS: Most participants reported using nonpharmacologic methods, such as holding and placing the infant in a more comfortable position, nearly always/always (61%, 62%, respectively). However, rarely used methods included skin-to-skin contact (7%), breastfeeding the infant (7%), and listening to recorded music (3%). While studying a correlation between the parents' use of nonpharmacologic methods and their guidance, we found a correlation among all nonpharmacologic methods. However, almost half (48%) of the parents reported that the nurses advised them "sometimes" or "nearly always/ always" to go elsewhere during painful procedures rather than participating in alleviation of the infant´s pain. CONCLUSIONS: The parents reported using mostly the nonpharmacologic methods that were easy to implement and did not require thorough instructions in preparation. In addition, it seemed that parents wanted to be more involved in their infant's pain alleviation, but they were advised not to take part in painful procedures and pain alleviation for various reasons. Therefore, more attention should be paid to the principles of family-centered care. As health care providers, we should welcome all families as team members to involve in their infants' pain alleviation in the neonatal and neonatal intensive care units.

Driving forces of GPs' migration in Europe: an exploratory qualitative study.

BACKGROUND: The shortage of GPs is a worldwide phenomenon, which encourages the migration of GPs and consequently exacerbates the GP shortage. This shortage imposes a threat for the entire healthcare system. AIM: To explore the driving forces of GPs' migration in Europe and their reasons to stay in the new country, to migrate further, or to return to their home country. DESIGN & SETTING: An exploratory, qualitative study of European GPs who have migrated within Europe. METHOD: Individual interviews were conducted until data saturation and audio-recordings were transcribed. Thematic analysis was performed using NVivo. RESULTS: Fifteen interviews with GPs from eight different European countries were conducted. The reasons why European GPs migrate and decide to stay or to leave were grouped under the following three themes: professional development; personal reasons; and the situation in the home country or the organisation of health care. New professional challenges, better working environment, and higher quality training programmes were mentioned as the main reasons for migration. Personal reasons, such as family's satisfaction with the living environment, closeness to other family members, and financial considerations, seemed to influence the decision to stay or leave the most. CONCLUSION: Migration caused by dissatisfaction with the working and living environment is something countries could potentially work on in order to retain their GPs. As some countries in Europe rely more and more on international recruitment to combat the GP shortage, which in turn worsens the situation in other countries, a more unified Europe-wide approach to GP shortage and migration is needed.

Post-acute sequelae of COVID-19 among hospitalized patients in Estonia: Nationwide matched cohort study.

BACKGROUND: Post-acute COVID-19 sequelae refers to a variety of health complications involving different organ systems that have been described among individuals after acute phase of illness. Data from unselected population groups with long-time follow up is needed to comprehensively describe the full spectrum of post-acute COVID-19 complications. METHODS: In this retrospective nationwide cohort study, we used data obtained from electronic health record database. Our primary cohort were adults hospitalized with confirmed COVID-19 and matched (age, sex, Charlson Comorbidity Index) unaffected controls from general population. Individuals included from February 2020 until March 2021 were followed up for 12 months. We estimated risks of all-cause mortality, readmission and incidence of 16 clinical sequelae after acute COVID-19 phase. Using a frailty Cox model, we compared incidences of outcomes in two cohorts. RESULTS: The cohort comprised 3949 patients older than 18 years who were alive 30 days after COVID-19 hospital admission and 15511 controls. Among cases 40.3% developed at least one incident clinical sequelae after the acute phase of SARS-CoV-2 infection, which was two times higher than in general population group. We report substantially higher risk of all-cause mortality (adjusted hazard ratio (aHR) = 2.57 (95%CI 2.23-2.96) and hospital readmission aHR = 1.73 (95%CI 1.58-1.90) among hospitalized COVID-19 patients. We found that the risks for new clinical sequalae were significantly higher in COVID-19 patients than their controls, especially for dementia aHR = 4.50 (95% CI 2.35-8.64), chronic lower respiratory disease aHR = 4.39 (95% CI 3.09-6.22), liver disease aHR 4.20 (95% CI 2.01-8.77) and other (than ischemic) forms of heart diseases aHR = 3.39 (95%CI 2.58-4.44). CONCLUSION: Our results provide evidence that the post-acute COVID-19 morbidity within the first year after COVID-19 hospitalization is substantial. Risks of all-cause mortality, hospitalisation and majority of clinical sequelae were significantly higher in hospitalized COVID-19 patients than in general population controls and warrant targeted prevention efforts.

Clinical characteristics and risk factors for COVID-19 infection and disease severity: A nationwide observational study in Estonia.

BACKGROUND: COVID-19 pandemic has led to overloading of health systems all over the world. For reliable risk stratification, knowledge on factors predisposing to SARS-CoV-2 infection and to severe COVID-19 disease course is needed for decision-making at the individual, provider, and government levels. Data to identify these factors should be easily obtainable. METHODS AND FINDINGS: Retrospective cohort study of nationwide e-health databases in Estonia. We used longitudinal health records from 66,295 people tested positive for SARS-CoV-2 RNA from 26 February 2020 to 28 February 2021 and 254,958 randomly selected controls from the reference population with no known history of SARS-CoV-2 infection or clinical COVID-19 diagnosis (case to control ratio 1:4) to predict risk factors of infection and severe course of COVID-19. We analysed sociodemographic and health characteristics of study participants. The SARS-CoV-2 infection risk was slightly higher among women, and was higher among those with comorbid conditions or obesity. Dementia (RRR 3.77, 95%CI 3.30⎼4.31), renal disease (RRR 1.88, 95%CI 1.56⎼2.26), and cerebrovascular disease (RRR 1.81, 95%CI 1.64⎼2.00) increased the risk of infection. Of all SARS-CoV-2 infected people, 92% had a non-severe disease course, 4.8% severe disease (requiring hospitalisation), 1.7% critical disease (needing intensive care), and 1.5% died. Male sex, increasing age and comorbid burden contributed significantly to more severe COVID-19, and the strength of association for male sex increased with the increasing severity of COVID-19 outcome. The strongest contributors to critical illness (expressed as RRR with 95% CI) were renal disease (7.71, 4.71⎼12.62), the history of previous myocardial infarction (3.54, 2.49⎼5.02) and obesity (3.56, 2.82⎼4.49). The strongest contributors to a lethal outcome were renal disease (6.48, 3.74⎼11.23), cancer (3.81, 3.06⎼4.75), liver disease (3.51, 1.36⎼9.02) and cerebrovascular disease (3.00, 2.31⎼3.89). CONCLUSIONS: We found divergent effect of age and gender on infection risk and severity of COVID-19. Age and gender did not contribute substantially to infection risk, but did so for the risk of severe disease Co-morbid health conditions, especially those affecting renin-angiotensin system, had an impact on both the risk of infection and severe disease course. Age and male sex had the most significant impact on the risk of severe COVID-19. Taking into account the role of ACE2 receptors in the pathogenesis of SARS-CoV-2 infection, as well as its modulating action on the renin-angiotensin system in cardiovascular and renal diseases, further research is needed to investigate the influence of hormonal status on ACE2 expression in different tissues, which may be the basis for the development of COVID-19 therapies.

Experiences and expectation with the use of health data: a qualitative interview study in primary care.

BACKGROUND: Health data is important, however, not always well managed. The aim of this study was to investigate the experiences of patients and primary care physicians, their expectations and the obstacles encountered when using health data - both patient-generated as well as physician-generated. METHODS: We conducted a qualitative interview study. We included adult persons who were ready to talk about the topic. Participants were recruited from primary care. The interviews were recorded using a dictaphone, transcribed verbatim and analysed using a content analysis method. RESULTS: Altogether, we conducted 14 individual interviews, with patients (n = 7) and with physicians (n = 7). We found that both patients and physicians emphasized the importance of easy access to health data in digital health information systems. However, patients may not always understand medical terminology and physicians found that the quality of medical documents needs inspection. Both parties found that patient-generated data is a useful source of information, and that it should be used more often. CONCLUSIONS: The pandemic has highlighted the value of easy access to health data. The development of a health information system is useful to health care providers and patients, enables the transfer of evidence-based medicine, and supports health literacy.

Long-term mortality following SARS-CoV-2 infection: A national cohort study from Estonia.

Background: The objective of this study was to describe 12-month mortality following SARS-CoV-2 infection compared with a reference population with no history of SARS-CoV-2. Methods: Nationwide cohort study using electronic health care data on SARS-CoV-2 RNA positive cases (n= 66,287) and reference group subjects (n=254,969) with linkage to SARS-CoV-2 testing and death records. Findings: People infected with SARS-COV-2 had more than three times the risk of dying over the following year compared with those who remained uninfected (aHR 3·1, 95%CI 2·9-3·3). Short-term mortality (up to 5 weeks post-infection) was significantly higher among COVID-19 group (1623·0/10 000) than in the reference group (118/10 000). For COVID-19 cases aged 60 years or older, increased mortality persisted until the end of the first year after infection, and was related to increased risk for cardiovascular (aHR 2·1, 95%CI 1·8-2·3), cancer (aHR 1·5, 95%CI 1·2-1·9), respiratory system diseases (aHR 1·9, 95%CI 1·2-3·0), and other causes of death (aHR 1·8, 95%CI 1·4-2·2). Interpretation: Increased risk of death from SARS-CoV-2 is not limited to the acute illness: SARS-CoV-2 infection carries a substantially increased mortality in the following 12 months. This excess death mainly occurs in older people and is driven by broad array of causes of death. Funding: Research was carried out with the support of Estonian Research Council (grants PRG1197, PRG198), European Regional Development Fund (RITA 1/02-120) and European Social Fund via IT Academy program.

Effectiveness and feasibility of cardiovascular disease personalized prevention on high polygenic risk score subjects: a randomized controlled pilot study.

Aims: The aim of this study was to evaluate the effect of the intervention by proactively sharing a patient's high polygenic risk score (PRS) for coronary artery disease (CAD). Outcomes included: (i) reduction in cardiovascular disease (CVD) risk factors over 12 months; (ii) difference in purchased prescriptions of lipid-lowering and anti-hypertensive drugs between intervention group and control group subjects; and (iii) opinion of the participating physicians and subjects on PRS usefulness. Methods and results: This randomized controlled trial was conducted among middle-aged subjects with a top 20% CAD PRS in a family medicine setting. Participants were selected from 26 953 Estonian Biobank cohort participants. Subjects were informed and counselled about their PRS score and CAD risk using the visual tool at baseline (Visit I), counselling session (Visit II), and on the final Visit III at 12 months. The primary endpoint was not significantly different. However, the intervention group participants had a significantly higher probability of initiating statin treatment compared with the controls. Their levels of LDL-cholesterol (LDL-C) were significantly decreased compared with baseline on Visit III and significantly lower than in the control group. The vast majority of participating family physicians believe that finding out about genetic risks will affect the subject's lifestyle and medication compliance. Conclusion: Most of our outcome measures were in favour of this intervention. Participants achieved larger changes in cholesterol and blood pressure values. The vast majority (98.4%) of family physicians are interested in continuing to use genetic risk assessment in practice.

Nurses' perceptions of infants' procedural pain assessment and alleviation with non-pharmacological methods in Estonia.

PURPOSE: The purpose of this study was to describe nurses perceptions of infants' procedural pain assessment and alleviation with non-pharmacological methods including parental guidance in departments of neonatal and infant medicine and Neonatal Intensive Care (NICUs). DESIGN AND METHODS: A descriptive cross-sectional survey was carried out among all nurses (n= 149) who were working in neonatal and infant departments or NICUs in Estonian hospitals. Altogether, 128 questionnaires were returned and 111 respondents were eligible (75% response rate). The data were analysed using statistical methods. RESULTS: More than half of the nurses agreed that systematic documentation of the measurement of pain is necessary for nursing care and that it affects pain alleviation in infants. Half of the respondents (51%) confirmed that pain scales are important in the measurement of infants' pain, but 58% claimed they were able to assess pain in a reliable way without using pain assessment scales. Nurses also reported that they were unfamiliar with most pain scales and they were not routinely used in everyday practice. Nurses said that the most useful non-pharmacological pain alleviation methods were touching (83%) and positioning infants (78%), the most rarely used were skin-to-skin care (12%) and encouraging mothers to breastfeed the infant (34%). The majority of respondents (79%) reported that they do not know or do not have written instructions on pain assessment in their workplace, and only a few (10%) reported that they have participated in pain management courses during the last year. CONCLUSIONS: There is a need to increase the use of pain assessment scales and pain documentation in everyday practice in those hospitals in Estonia. The use of scales in pain assessment was valued by few nurses. It seems that there is a lack of knowledge on non-pharmacological methods, and nurses reported using only a few non-pharmacological pain alleviation methods and guided parents on using them. PRACTICE IMPLICATIONS: Nurses need pain management guidelines for everyday work, and in addition to nurses, written guidelines for parents are needed.

Physical-mental health comorbidity: A population-based cross-sectional study.

BACKGROUND: Multimorbidity is associated with physical-mental health comorbidity (PMHC). However, the scope of overlap between physical and mental conditions, associated factors, as well as types of mental illness involved are not well described in Eastern Europe. This study aims to assess the PMHC burden in the Estonian population. METHODS: In this population-based cross-sectional study we obtained health claims data for 55 chronic conditions from the Estonian Health Insurance Fund (EHIF) database, which captures data for all publicly insured individuals (n = 1 240 927 or 94.1% of the total population as of 31 December 2017). We assessed the period-prevalence (3 years) of chronic physical and mental health disorders, as well as associations between them, by age and sex. RESULTS: Half of the individuals (49.1% (95% CI 49.0-49.3)) had one or more chronic conditions. Mental health disorders (MHD) were present in 8.1% (8.1-8.2) of individuals, being higher among older age groups, women, and individuals with a higher number of physical conditions. PMHC was present in 6.2% (6.1-6.2) of the study population, and 13.1% (13.0-13.2) of the subjects with any chronic physical disorder also presented with at least one MHD. Dominating MHDs among PMHC patients were anxiety and depression. The prevalence of MHD was positively correlated with the number of physical disorders. We observed variation in the type of MHD as the number of physical comorbidities increased. The prevalence of anxiety, depression, and mental and behavioral disorders due to the misuse of alcohol and other psychoactive substances increased as physical comorbidities increased, but the prevalence of schizophrenia and dementia decreased with each additional physical disease. After adjusting for age and sex, this negative association changed the sign to a positive association in the case of dementia and mental and behavioral disorders due to psychoactive substance misuse. CONCLUSIONS: The burden of physical-mental comorbidity in the Estonian population is relatively high. Further research is required to identify clusters of overlapping physical and mental disorders as well as the interactions between these conditions. Public health interventions may include structural changes to health care delivery, such as an increased emphasis on integrated care models that reduce barriers to mental health care.

Reduction of cardiovascular risk factors among young men with hypertension using an interactive decision aid: cluster-randomized control trial.

BACKGROUND: Coronary heart disease (CHD) mortality among young men is very high and the prevention methods usable in family practice (FP) settings are limited (1,2). The objectives of this study were to investigate the cardiovascular risk profile among young males (18-50) visiting their family doctor (FD) and to find out if using an interactive computer-based decision aid (DA) has advantages in reducing cardiovascular risk factors compared to usual counselling at the FD's office. METHODS: The study was a cluster-randomized controlled trial including hypertensive male patients aged 18-50 recruited by their FD in 2015-2016. Patients with cardiovascular complications were not included. FDs were randomly divided into intervention groups (n = 9) and control groups (n = 11). Altogether, FDs recruited 130 patients, 77 into the intervention group (IG) and 53 into the control group (CG). IG patients were counselled about cardiovascular risk factors using a computer-based DA. CG patients received usual counselling by their FD. Data was collected with questionnaires, clinical examinations and laboratory analyses at the baseline and at the follow-up visit three months later. We compared the cardiovascular risk factors of the IG and CG patients. RESULTS: Baseline characteristics of the IG and CG patients were comparable. Of the whole study group, 51.5% (n = 67) of the patients had hypertension grade 1, 45.4% (n = 59) had grade 2 and 3.1% (n = 4) had grade 3. Twenty-seven per cent (n = 21) of the IG and 42% (n = 22) of the CG patients were smokers. We found that shared decision making with the DA was more effective in smoking reduction compared to usual FD counselling: 21 smoking patients in the IG reduced the number of cigarettes per day which is significantly more than the 22 smoking patients in the CG (- 3.82 ± 1.32 (SE Mean) versus + 2.32 ± 1.29; p = 0.001). Systolic blood pressure (SBP), diastolic blood pressure (DBP) and the number of cigarettes per day, all showed a statistically significant reduction among patients who were using the DA. Male patients with hypertension grade 2 had a significantly greater reduction in their SBP (- 6.003 ± 2.59 (SE Mean) versus + 1.86 ± 2.58; p = 0.038) grade 1. Reduction of DBP, cigarettes per day and CVD risk in general were nearly significant in the IG whereas the CG showed an increase in all of these parameters. CONCLUSION: Using interactive DAs at FD's offices for counselling of young hypertensive male patients is one possibility to help patients understand their risk factors and make changes in their treatment choices. DAs can be more effective in achieving behavioural changes like reducing smoking or blood pressure compared to normal counselling.

Prevalence of chronic conditions and multimorbidity in Estonia: a population-based cross-sectional study.

OBJECTIVES: Prevalence estimates for specific chronic conditions and multimorbidity (MM) in eastern Europe are scarce. This national study estimates the prevalence of MM by age group and sex in Estonia. DESIGN: A population-based cross-sectional study, using administrative data. SETTING: Data were collected on 55 chronic conditions from the Estonian Health Insurance Fund from 2015 to 2017. MM was defined as the coexistence of two or more conditions. PARTICIPANTS: The Estonian Health Insurance Fund includes data for approximately 95% of the Estonian population receiving public health insurance. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence and 95% CIs for MM stratified by age group and sex. RESULTS: Nearly half (49.1%) of the individuals (95% CI 49.0 to 49.3) had at least 1 chronic condition, and 30.1% (95% CI 30.0 to 30.2) had MM (2 or more chronic conditions). The number of conditions and the prevalence of MM increased with age, ranging from an MM prevalence of 3.5% (3.5%-3.6%) in the youngest (0-24 years) to as high as 80.4% (79.4%-81.3%) in the oldest (≥85 years) age group. Half of all individuals had MM by 60 years of age, and 75% of the population had MM by 75 years of age. Women had a higher prevalence of MM (34.9%, 95% CI 34.7 to 35.0) than men (24.4%, 95% CI 24.3 to 24.5). Hypertension was the most frequent chronic condition (24.5%), followed by chronic pain (12.4%) and arthritis (7.7%). CONCLUSIONS: Hypertension is an important chronic condition amenable to treatment with lifestyle and therapeutic interventions. Given the established correlation between uncontrolled hypertension and exacerbation of other cardiovascular conditions as well as acute illnesses, this most common condition within the context of MM may be suitable for targeted public health interventions.

Diabetes-related quality of life in six European countries measured with the DOQ-30.

BACKGROUND: The quantification of diabetes-related quality of life (DR-QoL) is an essential step in making Type 2 Diabetes (T2DM) self-management arrangements. The European General Practitioners Research Network (EGPRN) initiated the EUROBSTACLE study to develop a broadly conceptualised DR-QoL instrument for diverse cultural and ethnic groups; high and low-income countries. In 2016 the Diabetes Obstacles Questionnaire-30 (DOQ-30) was introduced. OBJECTIVES: The research aimed to study obstacles a patient with diabetes (PWD) may face in everyday life. First, we assessed how descriptive and clinical characteristics and the residential country were associated with the obstacles. Secondly, we calculated the proportion of respondents who expressed obstacles. METHODS: Data were collected in 2009 in a cross-sectional survey in Belgium, France, Estonia, Serbia, Slovenia, and Turkey. Multiple linear regressions were computed to detect associations between descriptive and clinical characteristics, residential country, and obstacles. Percentages of respondents who perceived obstacles were calculated. RESULTS: We found that although descriptive and clinical characteristics varied to quite a great extent, they were weakly associated with the perception of obstacles. The residential country was most often associated with the existence of some obstacle. The highest percent (48%) of all respondents perceived 'Uncertainty about Insulin Use' as an obstacle. CONCLUSION: Descriptive and clinical characteristics were weakly associated with perceived obstacles. However, the residential country plays an essential role in the decline of the QoL of PWDs. Education of both PWDs and healthcare professionals (HCPs) plays an essential role in countering the fear of insulin.

COVID-19 Vaccines Safety Tracking (CoVaST): Protocol of a Multi-Center Prospective Cohort Study for Active Surveillance of COVID-19 Vaccines' Side Effects.

BACKGROUND: Coronavirus disease (COVID-19) vaccine-related side effects have a determinant role in the public decision regarding vaccination. Therefore, this study has been designed to actively monitor the safety and effectiveness of COVID-19 vaccines globally. METHODS: A multi-country, three-phase study including a cross-sectional survey to test for the short-term side effects of COVID-19 vaccines among target population groups. In the second phase, we will monitor the booster doses' side effects, while in the third phase, the long-term safety and effectiveness will be investigated. A validated, self-administered questionnaire will be used to collect data from the target population; Results: The study protocol has been registered at ClinicalTrials.gov, with the identifier NCT04834869. CONCLUSIONS: CoVaST is the first independent study aiming to monitor the side effects of COVID-19 vaccines following booster doses, and the long-term safety and effectiveness of said vaccines.

Physical and Sedentary Activities in Association with Reproductive Outcomes among Couples Seeking Infertility Treatment: A Prospective Cohort Study.

BACKGROUND: The aim of this study was to investigate the association of physical activity (PA) with assisted reproductive technology (ART) treatment and pregnancy outcomes among couples seeking infertility treatment. METHODS: This prospective cohort study was carried out among 128 infertile individuals (64 couples), entering the infertility clinic for ART procedures. Baseline PA (before entering any treatment) was assessed using accelerometry for both women and men. For every couple the infertility treatment outcomes were recorded. RESULTS: The couples that required invasive ART procedures such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) spent less time in vigorous PA (-73 min/week per couple, woman + man) than those couples who became spontaneously pregnant after entering the study (p = 0.001). We observed no significant associations between the time spent in physical activities and positive pregnancy test or live birth. CONCLUSIONS: Our results do not support a positive nor negative relation between the time the couples spent in physical activities and the chances of getting pregnant or having a baby among patients seeking infertility treatment. However, couples undergoing invasive ART procedures did less vigorous PA than couples that became spontaneously pregnant, suggesting that PA may interfere with their reproductive health.