Gut microbiome in endometriosis: a cohort study on 1000 individuals.

BACKGROUND: Endometriosis, defined as the presence of endometrial-like tissue outside of the uterus, is one of the most prevalent gynecological disorders. Although different theories have been proposed, its pathogenesis is not clear. Novel studies indicate that the gut microbiome may be involved in the etiology of endometriosis; nevertheless, the connection between microbes, their dysbiosis, and the development of endometriosis is understudied. This case-control study analyzed the gut microbiome in women with and without endometriosis to identify microbial targets involved in the disease. METHODS: A subsample of 1000 women from the Estonian Microbiome cohort, including 136 women with endometriosis and 864 control women, was analyzed. Microbial composition was determined by shotgun metagenomics and microbial functional pathways were annotated using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Partitioning Around Medoids (PAM) algorithm was performed to cluster the microbial profile of the Estonian population. The alpha- and beta-diversity and differential abundance analyses were performed to assess the gut microbiome (species and KEGG orthologies (KO)) in both groups. Metagenomic reads were mapped to estrobolome-related enzymes' sequences to study potential microbiome-estrogen metabolism axis alterations in endometriosis. RESULTS: Diversity analyses did not detect significant differences between women with and without endometriosis (alpha-diversity: all p-values > 0.05; beta-diversity: PERMANOVA, both R 2 < 0.0007, p-values > 0.05). No differential species or pathways were detected after multiple testing adjustment (all FDR p-values > 0.05). Sensitivity analysis excluding women at menopause (> 50 years) confirmed our results. Estrobolome-associated enzymes' sequence reads were not significantly different between groups (all FDR p-values > 0.05). CONCLUSIONS: Our findings do not provide enough evidence to support the existence of a gut microbiome-dependent mechanism directly implicated in the pathogenesis of endometriosis. To the best of our knowledge, this is the largest metagenome study on endometriosis conducted to date.

Incidence-Based Breast Cancer Mortality Trends in Estonia Before and After the Introduction of Organized Mammography Screening: A Register-Based Study.

BACKGROUND: Despite the relatively low breast cancer incidence in Estonia, mortality remains high, and participation in mammography screening is below the recommended 70%. The objective of this register-based study was to evaluate incidence-based (IB) breast cancer mortality before and after the introduction of organized mammography screening in 2004. METHODS: Breast cancer deaths individually linked to breast cancer diagnosis were obtained from the Estonian Cancer Registry and used for calculating IB mortality. We compared age-specific IB mortality rates across 5-year birth cohorts and 5-year periods. Poisson regression was used to compare IB mortality for one age group invited to screening (50-63) and three age groups not invited to screening (30-49, 65-69, and 70+) during two periods before and after screening initiation (1993-2003 and 2004-2014). Joinpoint regression was used for age-standardized incidence and IB mortality trends. RESULTS: Age-standardized IB mortality has been decreasing since 1997. Age-specific IB mortality for birth cohorts never exposed to screening showed a continuous increase with age, while in cohorts exposed to organized screening the mortality curve flattened or declined after the age of first invitation. Significant decreases in mortality from 1993-2003 to 2004-2014 were seen in the 30-49 (age-adjusted rate ratio 0.51, 95% CI 90.42-0.63) and 50-63 (0.65, 95% CI 0.56-0.74) age groups, while no decline was seen in the 65-69 and 70+ age groups. CONCLUSIONS: The age specific IB mortality curves in birth cohorts exposed to screening and the significant mortality decline in the target age group after the initiation of the organized program suggest a beneficial effect of screening. Improved treatment without screening has not reduced mortality in older age groups. Our results support raising the upper screening age limit to 74 years.

Prevalence of chronic hepatitis C infection in the general population: results from a national survey, Estonia, July to December 2022.

IntroductionObtaining epidemiological data on chronic hepatitis C virus (HCV) infection is essential to monitor progress towards the hepatitis C elimination targets.AimWe aimed to estimate the prevalence of chronic HCV and the seroprevalence of HCV in the adult general population in Estonia.MethodsThis cross-sectional study, conducted between 12 July and 6 December 2022, included anonymised residual sera collected prospectively from patients 18 years and older visiting a general practitioner in all counties of Estonia. Specimens were considered HCV-seropositive if they tested positive for HCV antibodies by enzyme-linked immunoassay, confirmed by line-immunoblot assay. Chronic HCV infection was determined by positive RT-qPCR.ResultsWe tested a total of 4,217 specimens. The estimated HCV seroprevalence and prevalence of chronic HCV infection were 1.8% (95% CI: 1.4-2.2) and 0.8% (95% CI: 0.5-1.1), respectively, with ca 8,100 persons estimated to have chronic HCV infection in the general adult population of Estonia. No statistically significant differences in the prevalence of chronic HCV infection were observed between sexes, counties or age groups, with the highest prevalence rates observed in men (sex ratio: 1.7), Ida-Virumaa County (1.8%; 95% CI: 0.8-3.6) and the age group 40-49 years (1.7%; 95% CI: 0.9-2.9).ConclusionThis study found an overall low prevalence of chronic HCV infection in Estonia. Continued efforts should be made for the targeted screening, diagnosis and treatment of individuals with chronic HCV infection to achieve hepatitis elimination targets.

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.

Respiratory symptoms, exacerbations and sleep disturbances are more common among participants with asthma and chronic airflow limitation: an epidemiological study in Estonia, Iceland and Sweden.

BACKGROUND: Chronic airflow limitation (CAL) is a hallmark of chronic obstructive pulmonary disease but is also present in some patients with asthma. We investigated respiratory symptoms, sleep and health status of participants with and without CAL with particular emphasis on concurrent asthma using data from adult populations in Iceland, Estonia and Sweden investigated within the Burden of Obstructive Lung Disease study. METHODS: All participants underwent spirometry with measurements of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) before and after bronchodilation. CAL was defined as postbronchodilator FEV1/FVC below the lower limit of normal. IgE-sensitisation and serum concentrations of eosinophil-derived neurotoxin (S-EDN) were assessed in a subsample. The participants were divided into four groups: no self-reported doctor's diagnosed asthma or CAL, asthma without CAL, CAL without asthma and asthma and CAL: χ2 test and analysis of variance were used in bivariable analyses and logistic and linear regression when analysing the independent association between respiratory symptoms, exacerbations, sleep-related symptoms and health status towards CAL, adjusting for centre, age, sex, body mass index, smoking history and educational level. RESULTS: Among the 1918 participants, 190 (9.9%) had asthma without CAL, 127 (6.6%) had CAL without asthma and 50 (2.6%) had CAL with asthma. Having asthma with CAL was associated with symptoms such as wheeze (adjusted OR (aOR) 6.53 (95% CI 3.53 to 12.1), exacerbations (aOR 12.8 (95% CI 6.97 to 23.6), difficulties initiating sleep (aOR 2.82 (95% CI 1.45 to 5.48), nocturnal gastro-oesophageal reflux (aOR 3.98 (95% CI 1.79 to 8.82)) as well as lower physical health status. In these analyses, those with no asthma and no CAL were the reference group. The prevalence of IgE-sensitisation was highest in both asthma groups, which also had higher levels of S-EDN. CONCLUSION: Individuals with self-reported asthma with CAL suffer from a higher burden of respiratory and sleep-related symptoms, higher exacerbation rates and lower health status when compared with participants with asthma alone or CAL alone.

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.

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.

Beliefs, mindset and personality of farm managers working in large commercial dairy herds: Association with calf on-farm mortality.

This study aimed to describe the attitudes and personalities of farm managers (FMs) in large Estonian dairy herds and analyse the potential associations with calf mortality. The study included FMs from 114 free-stall farms with at least 100 cows. Each participant completed a questionnaire that comprised questions about the respondent and various statements to reveal their attitudes towards calves, calf mortality, and farming in general. A 7-point Likert scale was used to record the responses. The data on the number of live births and deaths and animal movement data were gathered from farm records and the Estonian Agricultural Registers and Information Board. The yearly calf mortality risk (%) during the first 21 days (YAG) and mortality rate between 22-90 days of age (OAG) adjusted for the animal time-at-risk were then calculated for each herd. Univariate negative binomial regression analysis was used to identify associations between calf mortality risk/rate, and the studied statements and variables with a p-value < 0.25 were included in a k-modes clustering analysis. The mean calf mortality risk was determined to be 5.9 % (range 0.0-26.8 %) during the first 21 days and mean calf mortality rate was 1.8 (range 0.0-9.2) deaths per 100 calf-months during 22-90 days of age. In both age group analyses, two FMs´ clusters formed based on 17 pre-selected statements. The FMs of the high-mortality cluster were found to be dissatisfied with the calf mortality levels. In the YAG analysis, FMs from high-mortality cluster gave lower priority to the issue of calf mortality, placed high importance on the influence of workers on calf mortality, and were more satisfied with the staff's performance compared to FMs of the cluster of herds with lower calf mortality. They were additionally less satisfied with their own performance and felt less recognized by the farm staff. They were also more inclined to try new products and practices on the farm and demonstrated greater empathy towards cattle. In the OAG analysis, the FMs from the higher-mortality cluster viewed reducing calf mortality more costly, had a less ambitious and target-driven management style, and rated their self-performance lower. This study determined that FMs working in herds with high calf mortality were dissatisfied and did not prioritize addressing calf mortality compared to managers working in farms with lower calf mortality. FMs' attitudes and management styles were associated with calf mortality, while the respondents' personality traits had little influence.

Vestiges of famine: Long-term mortality impacts of early-life exposure to the 1840s famine in Estonia.

The paper investigates whether exposure to a famine in the Russian Tsarist Province of Livland in 1844-1846 in early life negatively affected survival at later ages, using individual data from two rural parishes. We follow 18 birth cohorts born between 1834-1852 until age 75 and differentiate between timing and length of exposures. We find that relative to individuals born in pre- or post- crisis years, there were no significant differences in survival from age 21-75. Cohorts with longer exposure to famine conditions had increased mortality only in short term, up to age 20. Males were more vulnerable in younger ages than females. The negative effect of adverse early life exposure on survival in later life was constrained to lower social group - the landless, but for the better-off groups the effect was constrained to younger ages. The paper highlights the importance of accounting for sex and socio-economic differences in studies exploring the effects of early life conditions on later-life survival.

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.

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.

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.

Analysis of potential interactions between warfarin and prescriptions in Estonian outpatients aged 50 years or more / Análisis de las interacciones potenciales entre warfarina y medicamentos prescritos en pacientes ambulatorios mayores de 50 años en Estonia

In Estonia, warfarin is widely prescribed by general practitioners to prevent and treat thromboembolic diseases. To date, there has been no systematic analysis of the potential risk of warfarin interactions with other drugs in the outpatient population. Objective: The aim of the study was to analyze the incidence of potential interactions in prescription schemes in Estonia in a cohort of outpatients receiving warfarin treatment. Methods: The retrospective study population included 203,646 outpatients aged 50 years or older of whom 7,175 received warfarin therapy. Patients who had used at least one prescription drug for a minimum period of 7 days concomitantly with warfarin were analyzed. Potential drug interactions were analyzed using Epocrates online, Stockley’s Drug Interactions and domestic drug interaction databases. Results: The average number of drugs used concomitantly with warfarin was 4.8 (SD=1.9) (males: 4.7 SD=2.0, females: 4.9 SD=2.0). No potential interactions in treatment regimens were found in 38% of patients, one potential interaction was observed in 29% and two or more potential interactions were observed in 33% of patients. The mean number of all potential interactions was 1.2 per patient and about the same in men and women. Potential interactions were associated with the number of drugs. Warfarin-related interactions were detected in 57% of patients, and the number of interactions related to warfarin per patient varied from 1 to 5. Most frequent were use of warfarin with NSAIDs (14%), followed by simvastatin (9%) and amiodarone (7%). Conclusion: This study shows that 57% of outpatients in Estonia receiving warfarin have drugs potentially interacting with warfarin in their treatment schemes. Most interactions (14%) with warfarin are associated with the prescription of NSAIDs (AU)

En Estonia, la warfarina es prescrita por médicos generales para tratar enfermedades tromboembólicas. Hasta la fecha, no se ha realizado un análisis sistemático del riesgo de interacciones potenciales de la warfarina con otros medicamentos en la población ambulatoria. Objetivo: El objetivo de este estudio fue analizar la incidencia de interacciones potenciales en los esquemas prescritos en Estonia en una cohorte de pacientes ambulatorios recibiendo warfarina. Métodos: El estudio retrospectivo incluyó 203.646 pacientes ambulatorios de 50 o más años de los que 7.175 recibían tratamiento con warfarina. Se analizó a los pacientes que usaron como mínimo un medicamento de prescripción por un periodo mínimo de 7 días concomitante con warfarina. Las interacciones potenciales fueron analizadas usando Epocrates online, Stockley’s Drug Interactions, y bases de datos locales de interacciones. Resultados: El numero medio de medicamentos usados concomitantemente con warfarina fue de 4,8 (DE=1,9) (hombres 4,7 DE=2,0; mujeres 4,9 DE=2,0). No se encontraron interacciones potenciales en el 38% de los pacientes, se observó una interacción potencial en el 29%, y se encontraron dos o más interacciones potenciales en el 33% de pacientes. El número medio de interacciones potenciales fue de 1,2 por paciente, prácticamente igual en hombres y en mujeres. Las interacciones potenciales estaban asociadas con el número de medicamentos. Se detectaron interacciones relacionadas con la warfarina en el 57% de los pacientes, y el número de interacciones relacionadas con warfarina varió de 1 a 5. Las más frecuentes fueron el uso de warfarina con AINE (14%), seguidas de sinvastatina (9%) y amiodarona (7%). Conclusión: Este estudio muestra que el 57% de los pacientes ambulatorios que reciben warfarina en estonia tienen medicamentos potencialmente interaccionando con la warfarina en sus esquemas terapéuticos. La mayoría de las interacciones (14%) con warfarina estaban asociadas a los AINE (AU)

Use of a generic protocol in documentation of prescription errors in Estonia, Norway and Sweden / Uso de un protocolo genérico en la documentación de los errores de prescripción en Estonia, Noruega y Suecia

Pharmacists have an important role in detecting, preventing, and solving prescription problems, which if left unresolved, may pose a risk of harming the patient. Objective: The objectives of this study were to evaluate the feasibility of a generic study instrument for documentation of prescription problems requiring contact with prescriber before dispensing. The study was organized: 1) by countries: Estonia, Norway and Sweden; 2) by type of prescriptions: handwritten prescriptions, printouts of prescriptions in the electronic medical record and electronically transmitted prescriptions to pharmacies; and 3) by recording method - self-completion by pharmacists and independent observers. Methods: Observational study with independent observers at community pharmacies in Estonia (n=4) and Sweden (n=7) and self-completed protocols in Norway (n=9). Results: Pharmacists’ in Estonia contacted the prescriber for 1.47% of the prescriptions, about 3 times as often as in Norway (0.45%) and Sweden (0.38%). Handwritten prescriptions dominated among the problem prescriptions in Estonia (73.2%), printouts of prescriptions in the electronic medical record (89.1%) in Norway and electronically transmitted prescriptions to pharmacies (55.9%) in Sweden. More administrative errors were identified on handwritten prescriptions and printouts of prescriptions in the electronic medical record in Estonia and in Norway compared with electronically transmitted prescriptions to pharmacies in Sweden (p<0.05 for prescription types and p<0.01 for countries). However, clinically important errors and delivery problems appeared equally often on the different types of prescriptions. In all three countries, only few cases of drug interactions and adverse drug reactions were identified. Conclusion: Despite the different patterns of prescription problems in three countries, the instrument was feasible and can be regarded appropriate to document and classify prescription problems necessitating contact with prescriber before dispensing, irrespective of the type of prescription or recording method (AU)

Los farmacéuticos juegan un papel importante en la detección, prevención y resolución de problemas de prescripción, que si no se resuelven pueden poner en riesgo de daño al paciente. Objetivo: Los objetivos de este estudio fueron evaluar la factibilidad de un instrumento de genérico de estudio para documentar los problemas de prescripción que requieren contactar al prescriptor antes de dispensar. El estudio se organizó: 1) por países: Estonia, Noruega y Suecia; 2) por tipo de recetas: recetas manuscritas, recetas impresas desde el historial electrónico del médico, y prescripción electrónica; y 3) por método de registro: auto-cumplimentación por los farmacéuticos o por observadores independientes. Métodos: Estudio observacional con observadores independientes en las farmacias comunitarias en Estonia (n=4) y Suecia (n=7) y protocolos autocumplimentados en Noruega (n=9). Resultados: Los farmacéuticos en Estonia contactaron a los prescriptores en el 1.47% de las recetas, unas 3 veces más frecuentemente que en Noruega (0.45%) y Suecia (0.38%).Las recetas manuscritas dominaron entre los problemas de prescripción en Estonia (73.2%), las impresiones de recetas desde el historial electrónico (89.1%) en Noruega, y las prescripciones electrónicamente transmitidas a las farmacias (55.9%) en Suecia. Se identificaron más errores administrativos en las recetas manuscritas y en las impresas desde el historial electrónico en Estonia y Noruega, comparadas con las electrónicamente transmitidas a la farmacia de Suecia (p<0.05 para los tipos de recetas y p<0.01 para los países). Sin embargo, los errores clínicamente importantes y los problemas de entrega aparecieron igualmente entre los diferentes tipos de recetas. En los tres países, se identificaron unos pocos casos de interacciones medicamentosas y de reacciones adversas. Conclusión: A pesar de los tres patrones diferentes de prescripción en los tres países, el instrumento fue factible y puede considerarse apropiado para documentar y clasificar los problemas de prescripción que necesitan contactar con el prescriptor antes de ser dispensados, independientemente del tipo de receta o del método de registro (AU)

Effectiveness of Repeated Examination to Diagnose Enterobiasis in Nursery School Groups

The aim of this study was to estimate the benefit from repeated examinations in the diagnosis of enterobiasis in nursery school groups, and to test the effectiveness of individual-based risk predictions using different methods. A total of 604 children were examined using double, and 96 using triple, anal swab examinations. The questionnaires for parents, structured observations, and interviews with supervisors were used to identify factors of possible infection risk. In order to model the risk of enterobiasis at individual level, a similarity-based machine learning and prediction software Constud was compared with data mining methods in the Statistica 8 Data Miner software package. Prevalence according to a single examination was 22.5%; the increase as a result of double examinations was 8.2%. Single swabs resulted in an estimated prevalence of 20.1% among children examined 3 times; double swabs increased this by 10.1%, and triple swabs by 7.3%. Random forest classification, boosting classification trees, and Constud correctly predicted about 2/3 of the results of the second examination. Constud estimated a mean prevalence of 31.5% in groups. Constud was able to yield the highest overall fit of individual-based predictions while boosting classification tree and random forest models were more effective in recognizing Enterobius positive persons. As a rule, the actual prevalence of enterobiasis is higher than indicated by a single examination. We suggest using either the values of the mean increase in prevalence after double examinations compared to single examinations or group estimations deduced from individual-level modelled risk predictions.

Una encuesta sobre las opiniones de los estudiantes de la Universidad Abierta en Estonia / A survey of pharmacy students’ opinions at the Open University in Estonia

En 2004, además de los 37 estudiantes de la Universidad de Tartu que terminaron los estudios a tiempo completo, obtuvieron el título de farmacéutico también los primeros 64 auxiliares de farmacia de la Universidad Abierta (enseñanza a distancia), que ya realizaban el trabajo de auxiliar farmacéutico durante los estudios. Su formación de auxiliar farmacéutica la obtuvieron en la escuela profesional superior. Después de 3,5 años de estudios universitarios, se hizo una encuesta anónima para descubrir su opinión sobre los estudios cursados. La mayoría de los estudiantes, tanto los de la escuela profesional superior como los de la Universidad, fueron estimulados para estudiar Farmacia por sus padres, amigos, conocidos o colegas. Entre las motivaciones principales para entrar en la universidad se destacan la oportunidad de recibir un sueldo más alto y mejores posibilidades de promoción. Por lo general, están contentos con la organización de los estudios, el nivel de los conocimientos adquiridos, la instrucción recibida y los materiales de estudio. Casi la mitad reconoce que sería adecuado realizar un cambio respecto a los bloques de asignaturas en el plan de estudios – desean, en general, reducir el volumen de asignaturas basadas en química. La Universidad Abierta proporciona una buena oportunidad de formación a nivel universitario, partiendo de la base de los estudios de auxiliares de farmacia y permite este grado de formación sin límite de edad. La presente encuesta de evaluación constituye una base para la creación de un sistema de valoración y de garantía de la calidad de estudios. Esto ayuda a desarrollar el currículo de Farmacia

In the year 2004, in addition to the 37 full-time students who graduated from the University of Tartu, the first 64 are already working as pharmacist’s assistants have received their pharmacy education in the Open University (distance learning). Their pharmaceutical education comes from the professional school. After 3.5 years of studying at the university, an anonymous survey was carried out to find out the students’ opinions about the program they graduated from. The students, both in professional school and in university, have received the impulse to study pharmacy from their parents, friends or colleagues. The main motivations for entering the university were the opportunity of higher salary, and better opportunities of promotion. The students are predominately satisfied with the level of the organisation of the studies, teaching and the study aids. Almost half of the students consider it right to change the proportions of the modules in the curriculum – they wish to reduce the importance of the subjects based on chemistry. The Open University is a good opportunity to prepare pharmacists with university education on the basis of the education of the pharmacist’s assistant and enables life-long learning without age limits. The survey, as feedback, is the basis of creating a system for evaluating and ensuring the quality of the studies. This enables the development of the curricula of pharmacy