BONJOUR L'ESTONIE

Estonian doctor denies aid to Russian patients

TALLINN - A doctor in ex-Soviet Estonia's capital Tallinn denied medical help to two Russian patients because they could not speak Estonian, Estonian television reported on Saturday.

A patient named Dmitry came to see a surgeon in a Tallinn hospital over a jaw injury on Friday, but the doctor demanded he speak Estonian and refused to examine him otherwise.

Dmitry's friend, Yekaterina, who spoke Estonian, wanted to help, but the doctor called both of them "swine" and said they should see a "psychiatrist" instead.

At the hospital's registration desk, the young people met with another Russian-speaking patient of that doctor who told them a similar story.

The patients said they would go to court if the hospital does not punish the doctor.

In televised comments, the Baltic state's social affairs minister, Hanno Pevkur, said medical aid should not be mixed up with a language exam and pledged to discuss the incidents with hospital officials.

This is not the first medical scandal involving Russian speakers in Estonia, where a doctor has been fired from a hospital for chucking the passport of a Russian patient into the dustbin because the teenager couldn't speak Estonian. The story received a lot of media attention.

The Baltic state pursues a rather controversial language policy that leads to tensions with a substantial Russian minority, most of who have lived in the republic since it was part of the Soviet Union.

Nearly one in three people with HIV do not know!

BRUSSELS — Almost one in three people infected with the virus that causes AIDS do not know they have the disease, increasing the risk of infection, the European Commission warned Monday.

In a document on combatting AIDS more than a quarter century after it surfaced, the EU's executive arm said now was not the time for Europe to drop its guard, noting that the figure was up to double in some neighbour nations.

And while efficient treatments exist to slow the evolution of the human immunodeficiency virus (HIV), no vaccine or cure has been found.

"We need to continue the political momentum in the fight against HIV/AIDS," EU Health Commissioner Androulla Vassiliou said in a statement.

"We need to encourage people to take responsibility for themselves and their partners by talking about and practicing safe sex and going for HIV testing," she said.

According to commission figures, the number of people living with HIV or AIDS in the 27 EU countries and its neighbours rose from 1.5 million in 2001 to 2.2 million in 2007, around 730,000 of whom live in the bloc.

At least 60,000 persons in Estonia are without medical insurance

Juhan Tere

Estonia has an estimated number of at least 60,000 persons without medical insurance and they are only guaranteed emergency medical care, Postimees/LETA writes.

The number of people without jobs who are not registered as unemployed as well as the number of individuals who do not work officially is growing and hence the number of people without medical insurance is also growing each day.

A major study that would ascertain who the people without medical insurance are has not been compiled in Estonia in five years. A households study carried out by the Statistical Office in 2004 showed that the majority of persons without medical insurance were jobless who had not registered themselves officially.

Since persons without medical insurance are guaranteed only emergency medical care, they generally reach doctors only when they need intense treatments which are more expensive, said Social Ministry healthcare department chief specialist Inna Vabamäe.

The cost of treating a person without medical insurance in a hospital is approximately 17 percent higher than in case of people with medical insurance as the former generally turn to the doctors when they need more intense treatment.

Estonia pharmaceuticals and healthcare report Q4 2009

Estonia’s pharmaceutical market is unlikely to be a prime target for multinational drugmakers expanding into foreign countries. Despite rapid economic growth in recent years, which has translated into strong headline growth for pharmaceutical expenditure, the country’s population of just 1.34mn means that total market size will remain among the lowest in Central and Eastern Europe (CEE).

In BMI’s Q409 update to the Estonia Pharmaceuticals & Healthcare Report, our new 10-year forecast model has been integrated. Despite the short-term economic difficulties faced by the Balkan state, the medium- to long-term outlook for pharmaceutical spending remains positive, with a compound annual growth rate (CAGR) of 4.3% forecast through to 2018.

BMI notes that Estonia has not been an exception to the general resilience shown by pharmaceutical sales in light of the global economic downturn. Instead, the depth of the country’s economic slowdown has put enough pressure on spending to cause a contraction. Real GDP is forecast to contract by 11.2% in 2009, highlighting the limited effect this has had on drug expenditure.

68 cases of swine flu registered in Estonia

The Estonian Health Protection Inspection has confirmed 68 cases of the so-called swine flu in humans in Estonia; two cases were added last week, National Brodacasting/LETA reports.

One of these two people was infected abroad, the other one by contact with a infected person in Estonia.

42 of the people who have been infected with the so-called new flu A(H1N1) have been infected abroad, 26 after contact with a sick person in Estonia.

11 people have needed hospitalization or observing but all cases have been rather easy and the patients have become well without complications.

And the list goes on ... what will happen next ?

TALLINN - The Estonian government’s Cabinet of Ministers on August 6 authorized the Minister of Social Affairs to vote for a reduction in the budget for the Health Insurance Fund ‘Haigekassa’ of 500 million kroons (32 million euros).

According to Minister of Social Affairs Hanno Pevkur, the Health Insurance Fund’s council will gather for discussions on the budget issue and for its modification on August 28.

Pevkur says “These changes will basically concern the budget for this year".

Factors influencing quality of life of people living with HIV in Estonia

Identification of factors that determine quality of life is important in order to better tailor health and social care services, and thereby improve the functioning and well being of people living with HIV. The estimated number of people living with HIV in eastern Europe and central Asia is 1.6 million.

Little is known about the quality of life of people living with HIV in this region. The main purpose of the present study was to identify the factors influencing quality of life in a sample of HIV-infected persons in Estonia.

Methods: A convenient sample of 451 patients attending three infectious diseases clinics for routine HIV clinical care visits was recruited for a cross-sectional survey.

The World Health Organization's Quality of Life HIV instrument was used to measure quality of life of the participants and medical data was abstracted from clinical records.

Results: Good overall quality of life was reported by 42.6% (95% CI: 38.0-47.2%) of the study participants (53% men, 60% self-identify as injecting drug users, 82% <30 years of age, 30% with CD4+ T cell count <300 cells/ml, and 22% on antiretroviral treatment). We identified the following variables as independent predictors of good overall quality of life: being currently employed or studying (AOR: 2.27, 95% CI: 1.18-4.38); and the absence of HIV-related symptoms (AOR: 2.31, 95% CI: 1.24-4.29).

Conclusions: A comprehensive and competent care system, including health care providers and social workers, is required for an effective response.

In addition, social interventions should seek to enhance the economic and employment opportunities for people living with HIV in the region.

Author: Kristi Ruutel - Heti Pisarev - Helle-Mai Loit - Anneli Uuskula
Credits/Source: Journal of the International AIDS Society 2009, 12:13

Ethnic differences of cancer incidence in Estonia

Two cross-sectional unlinked census based cancer incidence analyses ....

Estonian and Russian ethnic groups in Estonia differ from one another in several aspects such as historic and socio-economic background, language and culture. The aim of the current study was to examine ethnic differences in cancer incidence in Estonia, and to compare the situation before and after the profound political and economical changes in early 1990s.

Methods: Two cross-sectional unlinked census based cancer incidence analyses were performed.

Cancer incidence data were obtained from the Estonian Cancer Registry. Population denominators came from the population censuses of 1989 and 2000.

Standardised cancer incidence rates were calculated for men and women for the aggregate periods 1988-1990 and 1999-2000. The absolute differences in standardised cancer incidence rates for Estonians and Russians together with standard errors and p-values for SE-s in 1989 and 2000 were evaluated for both sexes.

Differences in cancer incidence between Estonians and Russians in 1989 and 2000 were estimated for both sexes, using standardised rate ratios with 95% confidence intervals.

Two New Orleans area teens quarantined in Estonia for swine flu

Sandra Barbier

Two New Orleans area teen-agers were quarantined this week in Tallinn, the capital of Estonia, in eastern Europe, with swine flu.

Both recovered quickly and were scheduled to be released from a hospital Saturday morning, said Russ Wise, a St. John the Baptist Parish School Board member and the father of one of the teens.

T.J. Wise, 17, of LaPlace, and Corinne Heath, 16, of Mandeville, are the only local students participating in a three-week tour of eastern Europe, organized the People to People Student Ambassador Program.

The group of 36 high school students left the United States on June 19.

Wise said several students began suffering flu-like symptoms Wednesday, after they arrived in Tallinn, located on Gulf of Finland coast.

Wise said he got the news at 1 a.m. Thursday, because of the eight-hour time difference. T.J. Wise called home and said, "Guess what!,'¤" Wise said.

"He sounded a little hoarse," and had a fever and some coughing, Wise said.

Initially, 18 students were quarantined at the hospital, where they were kept while tests were run, Wise said.

He said his son told him tests on the first day indicated two students had swine flu, then three were confirmed with the virus on the second day, including T.J. Wise and Heath.

The other students were released, but the five who were confirmed to have the H1N1 virus were being kept another night in the hospital, Wise said Friday.

Estonia Pharmaceuticals and Healthcare report Q3 2009 - New company and market analysis

Estonia Pharmaceuticals and Healthcare Report Q3 2009 - a new market research report on companiesandmarkets.com

www.companiesandmarkets.com/Summary-Market-Report/estonia-pharma ..

In the Business Environment Ranking matrix for Q309, Estonia remains seventh out of the 20 major markets surveyed in the Emerging Europe region. The country’s overall pharmaceutical rating figure continued to fall over the past few quarters, in line with worsening economic conditions and their impact on the small market, which is based on a population of just 1.34mn and of modest relative annual incomes. Therefore, over the coming months, we expect Estonia to continue losing its attractiveness for drugmakers, as the financial crisis forces the authorities to limit availability of funding for the largely reimbursement-based public healthcare system.

In fact, following the February 2009 announcement that the system of sick leave compensation would be the target of a scheme to save EUR29mn, the authorities indicated that the country’s Health Insurance Fund (HIF) should experience further budget cuts. More specifically, in April 2009, the government stated that lower tax collection revenues required an additional EUR25mn reduction in public healthcare sector budgets. Estonia is also cutting second-tier pensions in line with similar developments in Latvia and Lithuania. In the meantime, we expect real GDP growth to contract by 10.3% in Estonia during 2009, while disinflationary trends remain firmly in place.

Consequently, we forecast that the country’s pharmaceutical market, valued at EEK2.99bn (US$280mn) in 2008 at consumer prices, will grow at a compound annual growth rate (CAGR) of 5.14% in local currency terms. Its US dollar value will suffer, due to the weakening of local currency, posting a negative CAGR of -3.46% in the same period.

Europe aims to reduce cancer deaths by 15 pct by 2012

BRUSSELS - Europe is aiming to reduce its cancer deaths by 15 percent by 2020 and needs to double screenings to prevent mortality rates climbing as the population ages, the EU's health chief said on Wednesday.

Every year, 3.2 million Europeans are diagnosed with cancer, the second most common cause of death in Europe.

Breast cancer accounts for 30 percent of deaths from the disease in women, far more than cervical cancer with three percent. Colorectal cancers account for about 13 percent of cancer deaths in both men and women.

"We want to have a reduction in deaths by 15 percent by 2020," European Union Health Commissioner Androulla Vassiliou said. "We also want to double the number of people screened because ... we have had a lot of progress since we started in 2003 but only 50 percent of our target has been reached."

Vassiliou, speaking at a news conference to promote sharing of information and research on cancer across the EU's 27 member countries, said her aim was also to reduce the vast inequalities across the bloc in terms of cancer deaths.

Swine flu in Estonia

Figures announced by the World Health Organisation show that swine flu has infected more than 15,000 people in 53 countries since it was first detected in Mexico in April. The latest countries to report cases of the H1N1 virus include Cyprus, Estonia, Hungary and Slovakia in Europe, and Venezuela and Paraguay in South America.

Most people were infected after travelling to the United States or after coming into contact with people who had been in the US. The vast majority of cases are in the US and Mexico. The official death toll now stands at 99.

For body and mind

By Jana Belugina

TALLINN - With our lives getting more and more stressful everyday, most start to search for ways to relax both the body and, more importantly, the mind. A variety of body and mind training techniques are presented in every respected fitness club. Calanetic, pilates, yoga – very few haven’t heard those names and the mass devotion of celebrities to these arts makes the techniques extremely popular.
Yoga is in fashion, this is a fact that has to be admitted. Young girls gather at restaurants, eating ecologically clean lunches and discussing their yoga instructors and the new asanas they learned recently. Famous fashion designers create limited edition costumes and yoga mats. The number of yoga fans is growing everyday.

However, not many actually know what yoga really is. Yoga is not lazy fitness, as many think, it is very serious physical activity. Despite the seeming simplicity when compared with vigorous fitness trainings, yoga develops flexibility, strength and endurance.
Yoga practitioners are able to sustain heavier loads and tolerate them for longer periods of time than those who adhere to traditional workouts. Holding the postures burns fat and reduces cholesterol.
Yoga is a “sparing” activity – it develops the body gradually, without disrupting the course of a single process. One of the most important differences from other physical exercises is that yoga focuses on breathing, which is understandable as correct breathing is the key to health. 

Swine Flu - Esto in the US : This comes from a reliable source.

FYI

Hey everyone, please read the following email from my friend, a doctor, who is the medical director of an emergency room here in central Texas.
Please see his recommendations for taking a homeopathic remedy at the bottom of this email.
Avoid large public areas as much as possible.
It would be a good idea to increase your fresh organic vegetable and fruit consumption.
Increase garlic intake and onion intake.
You may also consider stocking up on groceries.
The fewer trips to the market the better for everyone.
I’ll keep you posted as I learn more.

________

After I returned from a public health meeting yesterday with community leaders and school officials in Comal County, Heather suggested I send an update to everyone, because what we are hearing privately from the CDC and Health Department is so different from what you are hearing in the media. Some of you know some or maybe all of this, but I will just list what facts I know.

- The virus is infectious for about 2 days prior to symptom onset.

- Virus sheds more than 7 days after symptom onset (possibly as long as 9 days) (this is unusual).

- Since it is such a novel (new) virus, there is no "herd immunity," so the "attack rate" is very high. This is the percentage of people who come down with a virus if exposed. Almost everyone who is exposed to this virus will become infected, though not all will be symptomatc. That is much higher than seasonal flu, which averages 10-15%. The "clinical attack rate" may be around 40-50%. This is the number of people who show symptoms. This is a huge number. It is hard to convey the seriousness of this.

Swine flu to Estonia doors

Adam Mullett

VILNIUS - Lithuania's health authorities has sent what it suspects is the country’s first case of swine flu (SIV) to London to be checked in a laboratory after a local man who recently visited Mexico reported symptoms of the virus.

Samples taken from a Lithuanian citizen who returned to the country from Mexico on April 23 have been confirmed as containing a Type A influenza virus, but must be processed in London for a confirmation.

Currently Lithuanian clinics are unable to analyze the swine flu virus samples, a Health Ministry representative told TBT.

“Our laboratory couldn’t identify it exactly. It has been sent to London and we don’t know when it will be back. The patient is in the communicable disease ward in a clinic. He feels good at the moment,” Health Ministry public relations Chief Specialist Natalja Keturkiene said.

“According to the rules, we have to send the sample to London. Our clinics are only allowed to test for seasonal influenza and so we sent the sample to the reference laboratory,” she said.

The possible victim reported flu-like symptoms on April 25 and submitted himself to tests on April 28.

It had originally been feared that the man had passed the virus on to his family who also came down with flu symptoms, but they had caught the seasonal flu, not SIV, Ketkurkiene said.

On April 29, the World Health Organization (WHO) upgraded the status of SIV’s spread to grade five out of six, indicating that a global pandemic is thought to be “imminent.”

Estonia to allocate 16.7 mln kroons for the e-health information system

Juhan Tere

Minister of social affairs of Estonia Hanno Pevkur signed the decree, allocating 16.7 million kroons to developing and administering the Estonian e-health information system, writes the National Broadcasting/LETA.

Pevkur stated that the information system needs to be developed so that it would comply with the high security standards.

"A number of establishments providing health care services have already been issued the necessary data protection licences and several of them have also acceded to the system already," commented the minister, emphasising that all other service providers need to catch up with them soon.

This year Estonia is planning to carry out comprehensive tests of the e-health information system, completing the interfaces and improving the system. Training sessions that are necessary for using the system will also continue.

The objective of the e-health system is to offer IT-based means for prevention, diagnosing, treatment and monitoring of diseases and maintaining health and forming the lifestyle. The Estonian e-health project includes the sub-projects of digital health records and health images, digital prescriptions and digital administration of appointments.

Former Soviet countries face 'widespread epidemic' of drug-resistant TB

People in China and former Soviet states are being hit hard by potentially dangerous strains of tuberculosis, researchers said Thursday.

In the medical journal The Lancet, experts from the World Health Organization said 19 per cent of tuberculosis infections are multi-drug resistant or MDR-TB, and rates were particularly high in Azerbaijan, Moldova, Estonia and Latvia.

In wealthier countries on the other hand, only one per cent of infections could not be treated with two or more main TB drugs.

"The countries of the former Soviet Union are facing a serious and widespread epidemic with the highest prevalence of MDR-TB ever reported in 13 years of global data collection," the researchers wrote.

The prevalence of MDR-TB in two Chinese provinces was seven per cent, compared with between seven per cent and 22 per cent in nine countries of the former Soviet Union.

Regionally, Eastern Europe had the highest prevalence at 19 per cent, followed by Southeast Asia at four per cent, Latin America with three per cent and Africa at two per cent, Dr. Abigail Wright and Dr. Dennis Falzon of WHO in Switzerland and their colleagues said.

Methanol poisoning damage is likely permanent

Watch it guys !

NEW YORK - Damage from methanol poisoning appears to be "irreversible," according to a follow-up report on several people exposed to the poison in September 2001.

And people who continue to drink heavily after methanol poisoning seem most at risk of developing even more problems later on, the researchers say. "Individuals affected by a methanol outbreak may benefit from counseling and other efforts aimed at reducing their alcohol abuse," Dr. Raido Paasma of Foundation Pärnu Hospital in Estonia and colleagues conclude in the online journal BMC Clinical Psychopharmacology.

Little information is available on the long-term effects of methanol poisoning, although known effects include vision problems and neurological damage.

To help fill this gap in knowledge, Paasma's team followed up with survivors of an outbreak of methanol poisoning that took place in Estonia's Pärnu region.

There were 154 people known to have consumed illegal methanol-containing spirits. Forty-three of these individuals were found dead, while the rest made it to the hospital for treatment.

Among the 86 patients who survived after being treated in the hospital, 66 appeared to have no lasting effects of exposure, while 20 did. Six years later, 26 of the survivors had died, usually from alcohol poisoning, and 33 could not be found. In the current report, Paasma and his colleagues report on 27 people, including 22 who had initially suffered no lasting ill effects and five who had.

In both groups of patients, the researchers found, 36 percent had developed new vision or neurological problems. Thirty-five percent of those who had left the hospital with symptoms had died, compared to 29 percent of those with no apparent symptoms.

Health impact assessment of particulate pollution in Tallinn using fine spatial resolution and modelling techniques

Health impact assessments (HIA) use information on exposure, baseline mortality/morbidity and exposure-response functions from epidemiological studies in order to quantify the health impacts of existing situations and/or alternative scenarios. The aim of this study was to improve HIA methods for air pollution studies in situations where exposures can be estimated using GIS with high spatial resolution and dispersion modelling approaches.

Methods : Tallinn was divided into 84 sections according to neighbourhoods, with a total population of approx.

390 000 persons. Actual baseline rates for total mortality and hospitalisation with cardiovascular and respiratory diagnosis were identified.

The exposure to fine particles (PM2.5) from local emissions was defined as the modelled annual levels. The model validation and morbidity assessment were based on 2006 PM10 or PM2.5 levels at 3 monitoring stations.

The exposure-response coefficients used were for total mortality 6.2% (95% CI 1.6-11%) per 10 mug/m3 increase of annual mean PM2.5 concentration and for the assessment of respiratory and cardiovascular hospitalisations 1.14% (95% CI 0.62-1.67%) and 0.73% (95% CI 0.47-0.93%) per 10 mug/m3 increase of PM10. The direct costs related to morbidity were calculated according to hospital treatment expenses in 2005 and the cost of premature deaths using the concept of Value of Life Year (VOLY).

Results : The annual population-weighted-modelled exposure to locally emitted PM2.5 in Tallinn was 11.6 mug/m3.

Latvia and Estonia fall out over Hepatitis A scare

Riga/Tallinn - Estonia and Latvia displayed a notable lack of Baltic brotherhood Wednesday in the wake of an Estonian government decision to advise citizens against visiting the country's southern neighbour.

The Latvian embassy in the Estonian capital, Tallinn, was moved to deliver a note to the Estonian foreign ministry, requesting the Estonian authorities to 'retract forthwith' advice that Estonians should avoid visits or risk catching Hepatitis A.

On February 18 the Estonian Health Protection Inspectorate published information about the spread of Hepatitis A in Latvia, and recommended that Estonians should not plan visits to Latvia.

'It is pointed out in the note that these announcements are not in keeping with international practice, have a negative impact on the flow of tourists between both states, and in addition, are harmful to Latvia's image abroad,' said a statement from the Latvian foreign ministry.

A spokesman told Deutsche Presse-Agentur dpa the Estonian action was 'not a friendly gesture'.

'They should not have issued such a warning. We are not the only country to have been affected - for example the Czech Republic currently has a similar problem,' he said.

There was even a hint that the Estonians may be running a dirty tricks campaign to poach tourists when the Latvian foreign ministry mentioned in its statement that it was monitoring 'unfair competition.'

Estonian tourists made up nearly 10 per cent of visitors to Latvia in the fourth quarter of 2008 according to official statistics.

Latvia's foreign ministry had already been contacted by businesses that have noticed a drop in Estonian visitors since the announcement was made public, it said.

With the Latvian hospitality sector already suffering the effects of a deep recession, a block on visitors from the north is the last thing Riga's hotels and restaurants need.

But on Wednesday afternoon the website of the Estonian Healh Inspectorate was still describing the rate of Hepatitis infection in Latvia as 'quite high' and advised all visitors to undergo immunisation at least two weeks before venturing across the border into its fellow EU member state.