BONJOUR L'ESTONIE

Police raid reveals 'worrying' drug use among grade schoolers

Twelve young drug users were apprehended during a two-day police raid at one of Haapsalu's schools this week.

Detection dogs initially sniffed out 23 students. A follow-up investigation revealed signs of drug use in 12, including one minor.

Margus Kaldma, chief of the Haapsalu police constabulary said that what most worries him is that so many young drug abusers were found in a single school.

"Last year, a total of 34 drug users were found in the entire Lääne County," Kaldma added.

"It is clear that the situation cannot be mended only with police checks," said Kaldma, adding that all involved parties must put their heads together and try to find a solution to substance abuse among youth.

Ingrid Teesalu

Synthetic drug Fentanyl causes overdose boom in Estonia

Everyone knows someone who has died. In the circles of Estonian friends who use "china white", death is a constant possibility. They know that. But that does not mean they can stop.

It's so addictive," says Marko, who has lost two friends to overdoses, and survived two himself. In Estonia, the drug - whose proper name is Fentanyl - is taking a heavy toll of young people. Nationally, drug overdoses now kill more people than road accidents.

Feeling trapped

Marko desperately wants to break his addiction. He started injecting seven years ago, aged 18.

I was young and stupid. I tried it with my friends when I was drunk and began to like it, and soon I was doing it every day," he says. He has managed to cut down, and is currently shooting up three or four times a month. But he needs a daily dose of methadone to cope with the withdrawal symptoms.

And the mental dependence is much harder to deal with.

Alcohol and premature death in Estonian men : a study of forensic autopsies using novel biomarkers and proxy informants

Alcohol makes an important contribution to premature mortality in many countries in Eastern Europe, including Estonia. However, the full extent of its impact, and the mechanisms underlying it, are challenging issues to research.

We describe the design and initial findings of a study aimed at investigating the association of alcohol with mortality in a large series of forensic autopsies of working-age men in Estonia.

Methods: 1299 male deaths aged 25-54 years were subject to forensic autopsy in 2008-2009. The routine autopsy protocol was augmented by a more systematic inspection of organs, drug testing, assay of liver enzymes and novel biomarkers of alcohol consumption (EtG, EtS and PEth), together with proxy interviews with next of kin for deaths among men who lived in or close to a major town.

Results: 595 augmented autopsies were performed.

Of these, 66% were from external causes (26% suicide, 25% poisoning). 17% were attributed to circulatory system diseases and 7% to alcoholic liver disease.

Blood alcohol concentrations (BAC) of [greater than or equal to]0.2 mg/g were found for 55% of deaths. Interviews were conducted with proxy informants for 61% of the subjects who had resided in towns.

Of these, 28% were reported in the previous year to have been daily or almost daily drinkers and 10% had drunk non-beverage alcohols. Blood ethanol and the liver enzyme GGT were only associated with daily drinking.

Spa resort planned for Estonian island of Muhu

A new 250-bedroom spa resort is being planned for the Estonian island of Muhu, located on the Baltic Sea.

Estonian developer Novaterra has submitted a planning application to the local council, which plans to put the proposals up for public review. Exact details of the facilities will be unavailable until then.

Muhu is located next - and is connected by a bridge - to the "spa island" of Saaremaa, which boasts a number of luxury spa resorts and is served by an airport.

There is currently only one spa on Muhu - Pädaste Manor.

Tom Walker

State to tighten regulations on mail order medicines

At a time when Estonia's consumers want the convenience of ordering medications online from abroad, Estonian customs officials are spotlighting an increasing number of illegal drug imports - nearly 1,300 last year alone.

To address this issue, policymakers at the Social Affairs Ministry are working on a new drug law with more precise guidelines about the purchase of medicinal products through the internet and setting up domestic "e-pharmacies."

Government officials hope this will help to curb illicit drug imports.

Gerd Klaasen of the State Agency of Medicines said customs statistics definitely show a spike in drug imports from abroad.

"A lot of supplements that qualify as medicines have been ordered," said Klaasen. "People tend to believe in alternative medicine and natural products. The packaging will say that it is a herbal product, but it actually contains a therapeutic substance, sometimes in dangerous quantities."

Finnish woman got dangerous breast implant in Estonia

PIP implants have been placed in Tallinn, where Finnish women regularly go for cosmetic surgery

A number of PIP (Poly Implant Prosthesis) breast implants, which are suspected of being dangerous, have been placed in women even in Tallinn, where Finnish women go to have plastic surgery done.
      Such breast augmentation trips have been particularly popular among young Finnish women.
      ”I can confirm that PIP breast implants have been used in Estonia. Unfortunately, we do not have any statistics on the number of such implants”, says Andrei Knuut, Head of Department at Estonia’s Health Protection Agency.
     
Two months ago, a breast implant was placed in a Finnish woman in her 30s.
      However, the implant was not the one agreed upon in advance.
      According to the woman, she had been promised an Allergan implant, but instead, she got an M-implant which has exactly the same type code as the PIP implant.
      On the Internet, the code leads directly to the site of the PIP breast implant.
      ”I bought a trip through a Finnish clinic. I was promised a new operation right away, but of course I do not want to go to the same surgeon again”, the woman says.
     
In France, the estimated number of dangerous breast implants placed in women is 30,000, while in Sweden the number is 2,500. In Finland itself, PIP breast implants have not been sold at all.
      On the website of the Dutch Medicines Control Board, women are urged to watch their health, if they have a PIP or M-implant.

Valga's top doc fined for crimes

Tartu County Court has convicted Valga Hospital chief surgeon Andres Sell for conducting illegal human trials and several other counts.

Under an agreement with prosecutors, Sell, 50, pled nolo contendere to conducting the trials, importing prohibited goods, influencing another person to forge a document and using the forged document.

The total fine was 31,285.25 euros. Sell was also ordered to pay procedural costs of close to 500 euros.

Sell's lawyers said Sell did not fight the accusation due to pragmatic reasons.

"Regardless of the evidence gathered in the criminal case, Andres Sell did not wish to undergo an exhausting court procedure under public scrutiny and wishes to focus on his main line of work as a doctor," said Aivar Pilv, Sell's attorney.

Pilv said that due to the plea bargain, in which Sell did not admit guilt, there was no discussion at the hearing on whether Sell's actions were a case of a drug trial, as alleged, or gathering data in the course of everyday medical practice.

According to the accusation, Sell carried out a study of the effects of an anesthetic called 2-chloroprocaine on humans, despite lacking consent from the Agency of Medicines and informed consent from patients.

Kristopher Rikken

Hepatitis-A outbreak puts Viljandi officials on alert

As of September 12, there are 41 cases of viral hepatitis in Estonia. Of those, 29 have been confirmed in Viljandi County.

Hepatitis A is an infection caused by a virus affecting the liver, causing inflammation of the organ and often jaundice (yellowing of skin). It can be caused and spread by poor hygiene, contaminated food and contact with an infected person.

The first case was confirmed in Viljandi this past February, and it was linked to travel abroad. However, since August 25, the number of cases has spiked dramatically: 28 cases reported across the county, 25 of these in the town of Viljandi.

Viljandi Mayor Lembit Kruuse called for the formation of a disease prevention task force, with a particular focus on preventing the spread of the disease.

Last week alone, in numerical terms, the number of those infected in Viljandi increased by 30 percent. Unfortunately, officials said, the disease has an incubation period of 50 days, meaning it will take some time to assess the impact.

Profile of hypertensive patients in Estonia

More than one third of adult population in Estonia has problems with elevated blood pressure (BP). The Hypertension in Estonia (HYPEST) study represents the country's first hypertension-targeted sample collection aiming to examine the epidemiological and genetic determinants for hypertension (HTN) and related cardiovascular diseases (CVD) in Estonian population.

The HYPEST subjects (n=1,966) were recruited across Estonia between 2004-2007 including clinically diagnosed HTN cases and population-based controls. The present report is focused on the clinical and epidemiological profile of HYPEST cases, and gender-specific effects on the pathophysiology of hypertension.

Methods: Current analysis was performed on 1,007 clinically diagnosed HTN patients (617 women and 390 men) aged 18-85 years.

The hypertensives were recruited to the study by BP specialists at the North Estonia Medical Center, Centre of Cardiology, Tallinn or at the Cardiology Clinic, Tartu University Hospital, Estonia. Longitudinal BP data was extracted retrospectively from clinical records.

Current and retrospective data of patient's medical history, medication intake and lifestyle habits were derived from self-administrated questionnaire and each variable was examined separately for men and women. Eleven biochemical parameters were measured from fasting serum samples of 756 patients.

Veerpalu has rare genetic mutation, says Tartu scientist

A member of the team of researchers investigating the charges of doping against Andrus Veerpalu says the substance that proved the skier's undoing was produced naturally by the skier's own body. 

Anton Terasmaa said the disgraced skier has a rare genetic mutation that causes his growth hormone levels to spike after exertion. A team of 12 Tartu scientists sequenced Veerpalu's DNA in April and May. 

The findings were sent to the international ski federation, FIS, which had ordered them to remain sealed until recently, said Terasmaa in an article in Eesti Päevaleht. "But now I can inform the Estonian public of the researchers' results: Andrus Veerpalu exhibits uniquely strong post-exertion production of growth hormone," he wrote.

A doping test had found Veerpalu to have a higher-than-permitted level of growth hormone just before the skier had suspiciously brought his career to an abrupt end on the eve of the Holmenkollen world championship in February.

Terasmaa said tests conducted from 2007 to 2010 compared the athlete's levels of the growth hormone before and after a workout. "It became evident that while other skiers had a tenfold rise in the level of growth hormone, in Veerpalu it was a hundredfold."

Terasmaa said that while the level of hormone could be expected to diminish over time even in Veerpalu, "Veerpalu was in a high-altitude chamber after the workout where the level of the hormone does not fall but could be expected to rise even more."

Kristopher Rikken

Doctors still trying to diagnose Walesa's illness

WARSAW — Former Polish President and Nobel laureate Lech Walesa could face a week in the hospital and doctors are still trying to determine what has caused a high fever and gastric problems, a hospital official said Friday.

The 67-year-old founder of the Solidarity anti-communist movement checked into a hospital in his hometown of Gdansk on Wednesday after he returned from Estonia feeling unwell.

The hospital's deputy head, Tadeusz Jedrzejczyk, said that Walesa was receiving medication for pain and fever and his condition was improving but that he was still undergoing tests that would identify the problem.

On Thursday, doctors ruled out the possibility that Walesa's ailment was tied to a pre-existing heart condition. They also said he was not infected with the E. coli bacteria that has killed 29 people in Germany and Sweden and sickened almost 3,000 others, a few also in Poland.

Jedrzejczyk said that Walesa was allowed to receive visits from family and close friends.

Estonian EHR system used by 47 % of citizens and 95 % of doctors

For € 10 million, Estonia implemented a national electronic health record (EHR) in 2009 at a cost equivalent to € 7.50 per citizen. Speaking at eHealth Week 2011 on 11 May 2011 in his capacity as EHR project manager and CEO of the Estonian eHealth Foundation, Madis Tiik described the short path to a fully integrated EHR network currently used by 47 % of the country's residents.

The EHR is built on Estonia's X-Road network, Mr Tiik told the presentation audience. X-Road is a secure gateway service architecture that hosts 3 000 eServices available to Estonian citizens. In January 2010, the eHealth Foundation launched a companion health insurance system for claims, reimbursement and prescription management.

"In many countries, I have seen that the task is to integrate the healthcare system," he said. "There is also the concept of the personal health record. In Estonia, we decided that all this functionality will be in our national EHR."

All end users of Estonia's EHR system can access their full personal health records. Physicians and patients have equal viewing access. And with nearly half the country's residents using the system within two years of its launch, the project appears viable for the long term.

Authorities may investigate sale event of MSD

An undercover Äripäev journalist visited an event organized by pharmaceutical giant MSD which was aimed at making medical doctors to prescribe the MSD medicines, writes Äripäev.

The case may be investigated by medical authorities if it is found that the company has violated the legislation that sets very strict rules on advertising medical products.

MSD had invited more than 100 gynaecologists to the event that was held in the old terminal of Tallinn Airport in late Friday, included lots of food, alcohol and entertainment and which focused on advertising a contraception product, a vaginal ring called Nuvaring.

One of the main presentations was held by Konstantin Ridnyi, a gynaecologist of East Tallinn Central Hospital who focused on the positive aspects of Nuvaring and said nothing about dangers. When Äripäev later asked Ridnyi for a comment about his presentation, he refused to say anything.

MSD itself said in reply to Äripäev’s questions later that it was not an advertising event, but an educational seminar.

Toomas Hõbemägi

HIV figure updated

Seventy new cases of HIV were diagnosed in the first two months of the year including eight in detention facilities.

Diagnosed cases continue to grow at a stable rate, but besides the regions where drug-injecting population figures have long exceeded the average like Tallinn with 37 and Ida-Viru County with 26 cases, there were also four cases diagnosed in Tartu County, two in Lääne-Viru County and one in Pärnu County, said the Health Board.  

Eight people have developed AIDS this year. Last year during the same period, 64 people tested HIV-positive for the first time. 

A total of 7,762 people are known to carry the virus in Estonia, and 363 people have been diagnosed with AIDS.

American magazine criticises medicine tests in Estonia

Two investigative journalists of the American Vanity Fair magazine paint a picture in their article in the January (2011) issue of Estonia as a country where large Western pharmaceuticals companies conduct pharmaceuticals testing on people that they would find much harder to carry out at their home country, LETA/Postimees writes.

Veteran reporters Donald L. Barlett and James B. Steele mention Estonia in the article “Killing Medicines” as one of the favourite countries for Western firms to conduct medicines testing in, alongside with Russia, Colombia, Indonesia, Malaysia, Serbia, Bulgaria and others where test subjects can be attracted to participate in the studies for relatively small amount of money, where the supervision over the tests is weak and where it is easy to obtain the kind of results that satisfy pharmaceuticals firms, writes LETA.

Estonian Pharmaceuticals Board deputy director general Alar Irs said that Estonia cannot be accused of any of these flaws that the journalists write about. “Estonia and the rest of the European Union are not places where it would be cheap to conduct tests or where it would be easy to get permission for the tests,” he said.

Social Ministry pharmaceuticals department acting head Dagmar Rüütel also said that the Estonian Pharmaceuticals Board or ethics committee are not doing a bad job when giving permissions for medicine testing or in supervising the work. He said that the poor quality of studies would come to light in any case. “This has not occurred in relation with studies conducted in Estonia,” she said.

Eating disorders in 7.7% of Estonian women

As the first study of its kind in Estonia, a fresh doctor's dissertation at the University of Tartu studied eating disorder trends in the nation.

Kirsti Akermann's research found that 7.7 percent of women and 1 percent of men in Estonia have eating disorders, wrote Eesti Päevaleht.

The number of overweight adult Estonians decreased in the 1990s; however, it began rising in the 2000s. In 2008, 56 percent of men and 45 percent of women were overweight, according to the Institute for Health Development. The share of overweight schoolchildren increased from 6.1 percent in 2008 to 9.6 in 2009.

Experts equate eating disorders – such as anorexia, bulimia and overeating – with other addictions. Likewise, many people do not look for help to overcome the problems.

University performs Estonia’s first lung transplant

A chronically ill, 61-year-old woman was given a new lung at the University of Tartu’s hospital, which has for years prepared for what is now the first lung transplant operation in Estonia.

The transplant appears to have been successful and the patient is in intensive care, said doctor Tanel Laisaar, who performed the operation with his team. The days immediately after the operation are the most critical, he said.

The hospital began preparing for such an operation three years ago in cooperation with university doctors in Vienna, where the first lung transplant for an Estonian patient took place last April.

Four more Estonians are on the waiting list for a new lung. Another 10 potential patients are being diagnosed. Laisaar said that a country the size of Estonia needs six to eight lung transplants a year.

Deaths of infants subject to forensic autopsy in Estonia from 2001 to 2005 : what can we learn from additional information ?

Deaths from childhood injury are a public health problem worldwide. A relatively high proportion of child deaths of undetermined manner in Estonia raises concerns about potential underestimation of intentional deaths, especially in infants.

This suggests that more information on the circumstances surrounding death is needed to establish the manner of death correctly and, more importantly, to prevent these deaths. The objective of this study was to detect, describe, and analyze the circumstances around deaths of infants subject to forensic autopsy in Estonia to reveal hidden cases of child abuse and more accurately determine causes of death.

Methods: Study cases included all infant deaths in Estonia from 2001 to 2005 subject to forensic autopsy at the Estonian Bureau of Forensic Medicine.

Additional information was obtained from a series of visits to general practitioners, including characteristics of infant health, family composition, parents'education and employment, living conditions, and circumstances around death as perceived by medical staff in charge of outpatient services for these families.

New TB vaccine enters clinical testing

Rockville, MD and Tallinn – At an international gathering of TB vaccine researchers in Tallinn today, the Aeras Global TB Vaccine Foundation announced it will initiate a clinical trial of an investigational live recombinant tuberculosis vaccine to be led by researchers at Saint Louis University in St. Louis, Missouri, USA. The announcement was made at the Second Global Forum on TB Vaccine Development.

Building on more than a decade of global scientific research, Aeras scientists have engineered a new investigational vaccine, called AERAS-422, which will undergo clinical trials to evaluate its properties for interrupting TB at all stages of infection, including initial infection, latency and reactivation.

Moving our lead in-house vaccine from the laboratory into clinical testing is an important milestone for Aeras and its partners. Finding a potential replacement for the currently available TB vaccine, which was invented almost 90 years ago, is a primary goal in our mission, said Thomas G. Evans, MD, Aeras Chief Scientific Officer. Based on data from pre-clinical studies, we are cautiously optimistic about the potential of this vaccine candidate to be safer and more immunogenic than the currently available vaccine.

Doctor's malpractice conviction appeal to be heard by Supreme Court

The Supreme Court decided to hear the case of Pärnu Hospital doctor Carmen Heinväli, who was convicted of criminal negligence after a baby was born with a permanent disability due to labor complications.

Heinväli's attorney, Raul Palmaru, says he wants the conviction overturned because, he argues, there was a lack of elements required to constitute criminal negligence.

In June, the Tallinn Circuit Court upheld the Pärnu County Court's verdict. Heinväli was sentenced to an eight-month suspended sentence with three years probation and was ordered to pay the equivalent of 1,500 euros.

The Pärnu County Court rejected the victim's counsel's bid for more than 60,000 euros in damages, and did not strip Heinväli of her doctor's license.

Heinväli was an on-duty physician in the case in question in early 2007. She was accused of failing to correctly evaluate the course of a patient's labor, as a result of which the health of both the mother and the newborn was severely harmed.

Heinväli maintains her innocence. The Supreme Court has yet to set a date for the first hearing.