Kaja Rahu

Modest increase in seasonal allergic rhinitis and eczema over 8 years among Estonian schoolchildren

We studied time trends in the prevalence of asthma and allergic diseases in Estonian children born before and after the collapse of the Soviet Union, as this event markedly altered the lifestyle in Estonia. Two identical cross‐sectional studies were performed as part of phase I and phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). Children, aged 6–7 yr (n = 3070 in 1993–94 and 2383 in 2001–02) and 13–14 yr (n = 3476 and 3576, respectively), completed ISAAC core‐written questionnaires, and 13–14‐yr olds (n = 3427 and 3259, respectively) also video questionnaires. The prevalence of respiratory symptoms was mostly similar in the two studies. Despite this, the prevalence of diagnosed asthma increased. This was probably due to modified diagnostic criteria and increased awareness. Furthermore, the prevalence of rhinitis during the pollen season increased, e.g., rhinitis in May from 1.7% to 3.5%; sex‐adjusted prevalence odds ratio (POR) 2.09 (95% confidence interval 1.47–2.96) in 6–7‐yr olds, and from 2.6% to 5.5%; POR 2.22 (1.72–2.87) in 13–14‐yr olds. The prevalence of flexural dermatitis also increased from 12.0% to 13.5%; POR 1.20 (1.02–1.41) in 6–7‐yr olds, and from 7.7% to 9.4%; POR 1.26 (1.07–1.50) in 13–14‐yr olds. The increase was similar in children born before and after the regaining of Estonian independence, indicating that the influence of factors related to a Western lifestyle and affecting the prevalence of allergic symptoms is not restricted to infancy, but may be operative throughout childhood.

Cancer risk among chernobyl cleanup workers in Estonia and Latvia, 1986-1998

Two cohorts of Chernobyl cleanup workers from Estonia (4,786 men) and Latvia (5,546 men) were followed from 1986 to 1998 to investigate cancer incidence among persons exposed to ionizing radiation from the Chernobyl accident. Each cohort was identified from various independent sources and followed using nationwide population and mortality registries. Cancers were ascertained by linkage with nationwide cancer registries. Overall, 75 incident cancers were identified in the Estonian cohort and 80 in the Latvian cohort. The combined‐cohort standardized incidence ratio (SIR) for all cancers was 1.15 (95% confidence interval (CI) = 0.98–1.34) and for leukemia, 1.53 (95% CI = 0.62–3.17; n = 7). Statistically significant excess cases of thyroid (SIR = 7.06, 95% CI = 2.84–14.55; n = 7) and brain cancer (SIR = 2.14, 95% CI = 1.07–3.83; n = 11) were found, mainly based on Latvian data. However, there was no evidence of a dose response for any of these sites, and the relationship to radiation exposure remains to be established. Excess of thyroid cancer cases observed may have been due to screening, the leukemia cases included 2 unconfirmed diagnoses, and the excess cases of brain tumors may have been a chance finding. There was an indication of increased risk associated with early entry to the Chernobyl area and late follow‐up, though not statistically significant. Further follow‐up of Chernobyl cleanup workers is warranted to clarify the possible health effects of radiation exposure.

Alcohol consumption in Estonia and Finland: Finbalt survey 1994-2006

BackgroundAlcohol consumption has been regarded as an important contributor to the high premature mortality rates. The objective of this paper was to provide an overview and comparison of alcohol consumption and its socio-demographic determinants among adults in Estonia and Finland.MethodsThe study was based on a 25-64-year-old subsample of nationally representative postal cross-sectional surveys conducted in Estonia (n = 10,340) and Finland (n = 19,672) during 1994-2006. Abstinence, frequency, and the amount of alcohol consumed were examined. Logistic regression models were used to test the socio-demographic differences in alcohol consumption at least once a week. The effect of socio-demographic factors on pure alcohol consumed per week was calculated using linear regression.ResultsThe proportion of abstainers was 1.5 times higher among women than men in both countries. Throughout the study period, the amount of alcohol consumed per week increased for both genders in Estonia and for women in Finland, but was stable for men in Finland. In the final study year, medium risk amount of alcohol consumed per week was nearly 1.5 times higher among men in Estonia than in Finland, but about half that among women in Estonia than in Finland. Compared to ethnic majority in Estonia, alcohol consumption at least once a week was lower among men, but amount of pure alcohol drunk per week was higher among women of ethnic minority. In Finland, alcohol consumption at least once a week was more prevalent among women of ethnic minority, but the amount of pure alcohol drunk per week was lower for both gender groups of ethnic minority. Compared to married/cohabiting respondents, alcohol consumption at least once a week was less pronounced among single respondents in Finland, divorced or separated women in both countries, and widowed respondents in Estonia. Greater amount of alcohol consumed per week was more prevalent among single and divorced or separated respondents in Finland, but only among divorced or separated men in Estonia. Frequency of alcohol consumption was lower among less educated than higher educated respondents in Finland, but not in Estonia. The amount of consumed alcohol per week was higher among less educated men in Estonia, but lower among women with basic education in Finland.ConclusionsAlcohol consumption has increased in Estonia and Finland. National alcohol policies should reflect findings of alcohol epidemiology in order to introduce measures that will reduce alcohol related harm in the population effectively.

Suicides among cancer patients in Estonia: a population-based study.

The objective of this study was to determine the suicide risk among cancer patients in Estonia. This risk was examined in a cohort of 65,419 persons diagnosed with cancer in 1983-1998. Standardised mortality ratios (SMR) were calculated using the suicide rates of the population of Estonia as a reference. During 192,078 person-years of follow-up between 1983 and 2000, 197 suicides occurred in the cohort. An increased suicide risk was found for men (SMR=1.73; 95% Confidence Interval (CI) 1.45-2.01), but not for women (SMR=0.50; 95% CI 0.37-0.66). Men had the highest risk 90-179 days following their diagnosis (SMR=4.27; 95% CI 2.81-6.21). During this time interval, among men, the risk was more pronounced for cancers of the oesophagus (SMR=35.63; 95% CI 9.71-91.22) and pancreas (SMR=14.53; 95% CI 1.76-52.50). This study provides further evidence that cancer is a risk factor for suicide, at least in men.

Wood dust exposure and cancer incidence: a retrospective cohort study of furniture workers in Estonia.

BACKGROUND Occupational wood dust exposure is associated with increased risk of sinonasal cancer in men. However, little is known whether it is associated with sinonasal cancer in women or with malignancies of other sites. METHODS In a retrospective cohort study of furniture workers, cancer incidence in 3723 men and 3063 women between 1968 and 1995 was compared to the incidence in the general population of Estonia. Cancer risks were analyzed by employment duration and occupation. RESULTS The standardized incidence ratio (SIR) for all cancers did not differ significantly from one. Two men and one woman had sinonasal cancer (expected 1.07 and 0.53, respectively). Significantly increased risk of colon cancer was seen in the cohort (SIR 1.65, 95% confidence interval (CI) 1.22-2.17). Subjects employed for 10 years and over had significant excess of colon cancer (SIR 2.29, 95% CI 1.28-3.77) and rectal cancer (SIR 2.10, 95% CI 1.05-3.76) in the analysis by employment duration using exposure with a latency of 20 years. The nonsignificant excess of pharyngeal cancer in men (SIR 1.82) and lung cancer in women (SIR 1.43) was restricted to short-term workers. CONCLUSIONS This study found an excess of colon and rectal cancer in furniture workers. There was no increase in total cancer risk.

Comparison of knowledge, attitudes and behaviour regarding smoking among Estonian and Finnish physicians.

Summary.Objectives: To compare smoking behaviour, attitudes and opinions towards smoking and smoking cessation among Estonian and Finnish physicians.Methods: A cross-sectional postal survey using a self-administered questionnaire was carried out among 2 480 Estonian and 2 075 Finnish physicians.Results: Daily smoking prevalence was higher among Estonian physicians than among their Finnish counterparts in both male (18.6% and 6.7%) and female (6.6% and 3.6%). Compared to Estonia, physicians in Finland more often agreed that smoking is very harmful to their health, that trying to convince people to stop smoking is their responsibility and that smoking prevention should be part of the normal and special training of health professionals. In both countries, non-smoking physicians held more unfavourable attitudes towards smoking than those who were smoking.Conclusions: Physicians’ own smoking patterns and quitting behaviour are important because physicians serve as models for their patients and play a key role in the reinforcement of smoke-free health facilities. These results remain a challenge to medical educators, especially in Estonia. Estonia needs to improve medical education in terms of motivating physicians to ask about the smoking patterns of their patients and of training medical students and resident physicians to counsel their patients to stop smoking.Zusammenfassung.Vergleich der Kenntnisse, Einstellungen und des eigenen Verhaltens bezüglich des Rauchens zwischen der estnischen und der finnischen ÄrzteschaftFragestellung: Es werden die Unterschiede in den Rauchgewohnheiten, in der Einstellung und den Ansichten über das Rauchen und die Raucherentwöhnung zwischen estnischen und finnischen Ärzten untersucht.Methoden: Eine Querschnittsstudie mit selbstauszufüllendem Fragebogen wurde bei 2 480 estnischen und 2 075 finnischen Ärzten durchgeführt.Resultate: Die tägliche Rauchprävalenz war sowohl bei den Ärzten (18,6%) als auch bei den Ärztinnen (6,6%) in Estland höher als bei ihren finnischen Kollegen (6,7%) und Kolleginnen (3,6%). Verglichen mit Estland, waren Ärzte in Finnland öfters der Meinung, dass Rauchen sehr schädlich für ihre Gesundheit ist, dass sie dafür verantwortlich sind, ihre Patienten davon zu überzeugen, dass es wichtig ist, aufzuhören zu rauchen, und dass Tabakprävention ein Teil der normalen und speziellen Ausbildung von Gesundheitsfachleuten sein sollte. In beiden Ländern hatten nichtrauchende Ärzte gegenüber dem Rauchen eine stärker ausgeprägte negative Haltung als die rauchenden.Schlussfolgerung: Dem Rauchverhalten der Ärzteschaft selbst kommt wegen deren Vorbildfunktion gegenüber den Patienten eine Schlüsselrolle bei der Erreichung von rauchfreien Gesundheitseinrichtungen zu. Diese Resultate zeigen, dass die medizinische Ausbildung vor allem in Estland betreffend Rauchen noch ein Verbesserungspotential hat. Estland muss die medizinische Ausbildung so verbessern, dass Ärzte mehr motiviert sind, mit ihren Patienten über das Rauchen zu sprechen. Zudem sollten Studierende der medizinischen Fächer aber auch bereits praktizierende Ärzte dahingehend geschult werden, dass sie ihre Patienten stärker zur Raucherentwöhnung motivieren können.Résumé.Connaissances, attitudes et comportements des médecins estoniens et finlandais envers le tabagismeObjectifs: Comparer les habitudes de consommation de tabac, les attitudes et les opinions concernant le tabagisme et la cessation tabagique parmi les médecins estoniens et finlandais.Méthodes: Enquête par questionnaire auto administré, auprès de 2 480 médecins estoniens et de 2 075 médecins finlandais.Résultats: La prévalence du tabagisme était plus élevée parmi les médecins estoniens que parmi leurs collègues finlandais, tant pour les hommes (18,6% et 6,7%) que pour les femmes (6,6% et 3,6%). Les médecins en Finlande ont accepté plus souvent qu’en Estonie l’idée que le tabagisme est très nuisible pour leur santé, qu’il est de leur responsabilité de convaincre les gens de cesser de fumer et que la prévention du tabagisme devrait être un sujet normalement abordé dans la formation des professionnels de la santé. Dans les deux pays, les médecins non-fumeurs avaient une attitude plus défavorable envers le tabagisme que les médecins fumeurs.Conclusion: L’attitude des médecins concernant le tabagisme et la cessation tabagique est importante car ils servent de modèles pour leurs patients et ils jouent un rôle-clé pour assurer que le système de santé offre un environnement sans tabac. L’Estonie surtout a besoin d’améliorer la formation des médecins pour inciter ces derniers à interroger leurs patients sur leurs habitudes tabagiques et pour enseigner aux étudiants et aux internes comment informer leurs patients sur les programmes de cessation tabagique.

Cancer incidence and cause-specific mortality in male and female physicians: a cohort study in Estonia.

Aims: To evaluate whether the presumed knowledge of physicians about healthier lifestyle decreases their risk of cancer and mortality, a retrospective cohort study of male and female physicians was conducted in Estonia. Methods: The cancer incidence and cause-specifi c mortality of 3,673 physicians (870 M, 2,803 F ) in Estonia was compared with the rates of the general population. Information on cancer cases and deaths in the cohort between 1983 and 1998 was obtained from the Estonian Cancer Registry and the mortality database of Estonia. Results: The standardized incidence ratio (SIR) for all cancers was 1.32 (95% confi dence interval (CI) 1.15-1.48) in women and 0.92 (95% CI 0.73-1.13) in men. Female physicians had an elevated risk for breast cancer (SIR 2.03, 95% CI 1.62-2.51) and myeloid leukaemia (SIR 3.69, 95% CI 1.35-8.02). Male physicians had an excess of skin melanoma (SIR 4.88, 95% CI 1.58-11.38). A large defi cit of lung cancer was observed (SIR 0.24, 95% CI 0.11-0.48). The very low all-cause mortality in the cohort (standardized mortality ratio 0.55, 95% CI 0.50-0.61) was mainly due to large defi cits in deaths from lung cancer, cardiovascular diseases and external causes. The suicide rate in the cohort was lower than in the general population. Conclusions: No health risks were observed in the cohort that could be linked to the occupational exposures of physicians. The pattern of cancer incidence and mortality seen in physicians in Estonia is similar to the pattern seen among professional classes in other countries.

Dramatic increase in alcoholic liver cirrhosis mortality in Estonia in 1992-2008.

AIMS The aim of the study was to describe trends in alcoholic liver cirrhosis mortality rates in 1992-2008 and to examine socio-demographic differences in alcoholic liver cirrhosis mortality. METHODS Individual records of deaths from alcoholic liver cirrhosis among 25-64-year olds in 1992-2008 in Estonia were analysed. Age-standardized mortality rates for men and women aged 25-44 and 45-64 were calculated. Association between alcoholic liver cirrhosis mortality and socio-demographic variables (age, education and ethnicity) for the data of the years around the census in 2000 was measured by mortality rate ratios using Poisson regression models. RESULTS In 1992-2008, alcoholic liver cirrhosis mortality rates were higher among men than that in women and that in the older than in the younger age group. Over the whole study period, mortality from alcoholic liver cirrhosis increased steeply. The increase was sharper among men and women in the older age group. In 1998-2001, higher alcoholic liver cirrhosis mortality rates occurred in non-Estonians and those with lower levels of education. CONCLUSION Alcoholic liver cirrhosis mortality has increased steadily in Estonia, and is reflected in an increase in heavy drinking. National alcohol policies should address all strata of society. However, in order to reduce alcohol-related damage in the population most effectively, special attention should be paid to non-Estonians and people with low levels of education.

Contrasts in alcohol-related mortality in Estonia: education and ethnicity.

AIMS The aims of this study were to examine socio-demographic differences in alcohol-related mortality in Estonia, and how they changed over time. METHODS Individual death records (age at death 25-64) in Estonia from the late Soviet era (1983-1991) to Estonian re-independence (1992-2005) were analysed using a case-control design. Cases were deaths from alcohol-related causes (7981 deaths). Controls were deaths (13,820) from those neoplasms that are considered not to show variation in death risk according to the socio-demographic variables (that is, excluding cancer of the upper aero-digestive tract, lung, stomach, colon and female breast). Differences in alcohol-related mortality between socio-demographic groups were measured by mortality odds ratio. RESULTS In the study period as a whole, in both genders, an inverse relationship between the educational level and risk of alcohol-related death was apparent. Non-Estonians were more likely to die from alcohol-related causes than Estonians. Risk of alcohol-related death varied over time, being lowest just before Estonia regained its independence, and highest in the most recent period. In men, the educational gradient in the mortality odds ratio almost disappeared in 1988-1991, but reappeared in the transition period, while the impact of ethnicity remained stable over time. In women, educational contrasts in the risk of death existed throughout all subperiods, and ethnical inequalities widened in the re-independence period. CONCLUSION Rapid societal changes had profound effects on alcohol-related mortality. Strategies to prevent alcohol misuse should include all sections in society, paying special attention to less educated and non-Estonians.

Chernobyl cleanup workers from Estonia: follow-up for cancer incidence and mortality

This study examined cancer incidence (1986-2008) and mortality (1986-2011) among the Estonian Chernobyl cleanup workers in comparison with the Estonian male population. The cohort of 4810 men was followed through nationwide population, mortality and cancer registries. Cancer and death risks were measured by standardised incidence ratio (SIR) and standardised mortality ratio (SMR), respectively. Poisson regression was used to analyse the effects of year of arrival, duration of stay and time since return on cancer and death risks. The SIR for all cancers was 1.06 with 95% confidence interval 0.93-1.20 (232 cases). Elevated risks were found for cancers of the pharynx, the oesophagus and the joint category of alcohol-related sites. No clear evidence of an increased risk of thyroid cancer, leukaemia or radiation-related cancer sites combined was apparent. The SMR for all causes of death was 1.02 with 95% confidence interval 0.96-1.08 (1018 deaths). Excess mortality was observed for mouth and pharynx cancer, alcohol-related cancer sites together and suicide. Duration of stay rather than year of arrival was associated with increased mortality. Twenty-six years of follow-up of this cohort indicates no definite health effects attributable to radiation, but the elevated suicide risk has persisted.