Do physicians address their patients' smoking behavior? Results from a nationwide survey among physicians in Estonia.

OBJECTIVES: To analyze the factors that hinder physicians addressing patients' smoking behavior in Estonia where relatively high smoking among physicians has been previously reported. STUDY DESIGN: Cross-sectional study. METHODS: Data from a nationwide cross-sectional postal survey of professionally active physicians in Estonia and multinomial logistic regression were used to explore the factors predicting the frequency (never vs always, often vs always) of addressing patients' smoking behavior. RESULTS: The majority of physicians had asked about the smoking behavior of their patients either always (14.2%) or often (75.7%). Odds of never asking (10.1% of physicians) were higher for dentists, current smokers, and for those reporting lack of time, habit, or skills. Higher odds for less frequent (vs always) asking were found for male physicians, medical residents, and among those reporting lack of time and habit. CONCLUSIONS: Addressing patients' smoking behavior is associated with physicians' demographic characteristics, specialty, and smoking status. Also, lack of time, habits, and skills are common barriers that need to be tackled for more efficient smoking cessation counseling.

Composite ß-κ-casein genotypes and their effect on composition and coagulation of milk from Estonian Holstein cows.

The objective of this study was to estimate the effect of composite ß-κ-CN genotypes on milk coagulation and composition traits, and on the additive genetic variation of these traits in Estonian Holstein dairy cattle. A total of 23,970 milk samples, repeated measurements from the first to third lactation from 2,859 Estonian Holstein cows from 78 herds across the country, were analyzed for milk yield, milk fat and protein percentages, somatic cell count, and milk coagulation properties (milk coagulation time and curd firmness). Each cow had at least 3 measurements per lactation. Two single-trait random regression animal models were fitted for the traits studied. The first model considered fixed effects of year-season of sampling and year-season of calving, calving age (nested within lactation), sample age (only for milk coagulation traits) and days in milk, and random herd, additive genetic, and permanent environmental effects. The animal and permanent environmental effects were modeled over the lactation period by using Legendre polynomials. The second model had the additional fixed ß-κ-casein effect in the form of a third-order Legendre polynomial. The 2 most frequent ß-κ-casein composite genotypes were A2A2AA and A1A2AA, both with prevalence greater than 20%. Percentages of the remaining 31 genotypes were less than 8%, including 20 genotypes with percentages less than 1%. The ß-κ-casein genotype-specific lactation curves were significantly different for milk coagulation traits and milk protein percentage. The B variant of κ-casein showed a favorable effect on both milk coagulation traits, whereas the IB haplotype had an increasing effect on curd firmness and protein percentage. Inclusion of the ß-κ-casein genotype effects in the model resulted in decreases in the mean additive genetic variations for milk coagulation time and curd firmness of 12.9 and 51.1%, respectively.

Genetic parameters for milk coagulation properties in Estonian Holstein cows.

The objective of this study was to estimate heritabilities and repeatabilities for milk coagulation traits [milk coagulation time (RCT) and curd firmness (E(30))] and genetic and phenotypic correlations between milk yield and composition traits (milk fat percentage and protein percentage, urea, somatic cell count, pH) in first-lactation Estonian Holstein dairy cattle. A total of 17,577 test-day records from 4,191 Estonian Holstein cows in 73 herds across the country were collected during routine milk recordings. Measurements of RCT and E(30) determined with the Optigraph (Ysebaert, Frepillon, France) are based on an optical signal in the near-infrared region. The cows had at least 3 measurements taken during the period from April 2005 to January 2009. Data were analyzed using a repeatability animal model. There was substantial variation in milk coagulation traits with a coefficient of variation of 27% for E(30) and 9% for the log-transformed RCT. The percentage of variation explained by herd was 3% for E(30) and 4% for RCT, suggesting that milk coagulation traits are not strongly affected by herd conditions (e.g., feeding). Heritability was 0.28 for RCT and 0.41 for E(30), and repeatability estimates were 0.45 and 0.50, respectively. Genetic correlation between both milk coagulation traits was negligible, suggesting that RCT and E(30) have genetically different foundations. Milk coagulation time had a moderately high positive genetic (0.69) and phenotypic (0.61) correlation with milk pH indicating that a high pH is related to a less favorable RCT. Curd firmness had a moderate positive genetic (0.48) and phenotypic (0.45) correlation with the protein percentage. Therefore, a high protein percentage is associated with favorable curd firmness. All reported genetic parameters were statistically significantly different from zero. Additional univariate random regression analysis for milk coagulation traits yielded slightly higher average heritabilities of 0.38 and 0.47 for RCT and E(30) compared with the heritabilities of the repeatability model.

Smoking habits and attitudes towards smoking among Estonian physicians.

OBJECTIVES: This study examined the smoking habits and attitudes towards smoking among Estonian physicians. STUDY DESIGN AND METHODS: Cross-sectional data for 2668 physicians were gathered by a self-administered postal survey. RESULTS: The current smoking prevalence was 24.9% for male physicians and 10.8% for female physicians. The percentages of ex-smokers were 32.9 and 16.8%, respectively. Smoking prevalence among physicians was below the levels reported for the highest educational bracket of the total population in Estonia. Non-smoking physicians had more unfavourable views towards smoking than those who smoked. The majority of physicians were aware of the association between smoking and various diseases, with significant differences between smokers and non-smokers. Non-smoking physicians were more active in asking patients about smoking habits than those who smoked. Most Estonian physicians, especially those who smoked, failed to perceive themselves as positive role models. CONCLUSIONS: This study found a lower prevalence of smoking among physicians compared with the general population, and demonstrated the impact of personal smoking on physicians' attitudes towards smoking. The results provide an important challenge to medical education in Estonia.

Weight satisfaction and self-esteem among teenagers in Helsinki, Moscow and Tallinn.

OBJECTIVE: Information on weight satisfaction in Eastern Europe is limited. This study compares relative weight, weight satisfaction and self-esteem of teenagers living in two post-Soviet capitals, Moscow and Tallinn, and a western capital Helsinki. METHOD: Classroom surveys including data about weight and height, weight satisfaction and self-4 esteem among 15-18-year-old girls (n = 911) and boys (n = 650) collected in 1994-95. RESULTS: Body mass index and self-esteem were highest in Helsinki. Nevertheless, feelings of over-weight were most common among Tallinn girls and feelings of over- and underweight among Muscovite girls. Boys were mostly satisfied with their current weight with no differences between cities. Low self-esteem was associated with feelings of overweight among girls and underweight among boys. DISCUSSION: Somewhat unexpectedly, girls grown in non-western cultures were more dissatisfied with their weight than girls in Helsinki. These findings may partly be attributable to rapid economic and cultural transformations that were occurring in these countries during the study period.

Anxiety about environmental hazards among teenagers in Helsinki, Moscow and Tallinn.

Comparative research of environmental attitudes has concentrated on adults of Western countries, whereas knowledge of environmental consciousness of East European people is modest. This article compares anxiety that teenagers in Helsinki, Moscow and Tallinn express about environmental hazards and their health effects. The data (Helsinki, N = 1396; Moscow, N = 618; Tallinn, N = 1268) were collected in schools by questionnaires from pupils between 13 and 18 years in 1994-1995. Air pollution, water pollution and survival of plant and animal species were considered most worrying environmental threats in every city. Environmental concern was usually highest in Moscow, but the effects of pollution on an individual's health worried Estonian teenagers most. The worry was most consistent in Moscow, where sex, class level or opinion of the state of one's own living environment did not usually have an effect on attitudes. Finnish girls and pupils in higher school classes were environmentally more conscious than boys or younger teenagers. In Tallinn, the sex and age differences in worry were smaller. Environmental worry seemed to have connections to a general sense of responsibility and risk behaviour such as heavy drinking and smoking. For all sites those pupils who often throw empty packages onto the street or into the nature expressed lower environmental concern than their more responsible peers. The differences of worry between the cities were difficult to interpret, but the greater total concern of young Muscovites may be part of their general social anxiety, which is associated with the instability of the Russian society.

Passive smoking among adolescents in Estonia.

1. The objective of this study was to assess prevalence and patterns of passive smoking in Estonia and to describe how environmental tobacco smoke is likely to initiate the desire in adolescents to start active smoking. 2. A population sample of 2170 students within the age groups of 13-14, 15-16 and 17-18 of school grades 8, 10 and 12, respectively, at Tallinn High Schools participated in this study. The data were collected using questionnaires which mainly consisted of structured multiple-choice and a few open questions. 3. Every fourth adolescent in Tallinn was either an occasional or a habitual smoker. 4. Nearly half (48%) of the respondents had no daily exposure to cigarette smoke. Almost one third (31%) was exposed daily for less than 1 h, 15% for 1-5 h and 6% for over 5 h a day. 5. The number of adolescent smokers was higher than non-smokers among those daily inhaling tobacco sidestream smoke. 6. In conclusion, environment gives considerable impact to the development of smoking habits among adolescents. Passive smoking as an inducing factor is associated with higher prevalence of smoking among the adolescents studied.