BONJOUR L'ESTONIE

Five healthcare workers organizations in Estonia refuse to sign good will agreement

Five Estonian healthcare workers' organizations announced on Monday that they are not ready to sign the good will cooperation agreement aimed to guarantee sustainability of the healthcare system, claiming that it is vague and the social minister doesn’t want to take responsibility, LETA/Postimees writes.

The cooperation agreement, preparations for which started in October last year during the doctors and nurses’ strike, was convened by the social ministry and was chaired by the then social minister Hanno Pevkur. 22 healthcare organizations were invited behind the negotiations table, representatives of employees, employers, patients and state institutions.

After five meetings, a nine-page agreement was written up, that lists dozens of specific tasks with implementation deadlines that should make the system clearer for patients and healthcare workers.

Doctors Union secretary general Katrin Rehemaa said now that they submitted a number of proposals together with Healthcare Workers Vocational Union that did not reach the agreement or the wording of which was changed considerably.

The main criticism of the medical workers who refuse to sign the agreement is that the document doesn't list, as the aim of increasing healthcare financing, that it would increase to the 2010 average EU level by 2020 in Estonia.

Social minister Taavi Rõivas said that this would mean that there should be 1.5 times more money in healthcare than there is now. "This is complicated and impossible to achieve and as the social minister I cannot sign a financial obligation that exceeds the budgetary year sum," he said.

Rõivas said that a half of the organisations that compiled the agreement have said they would sign it. "Irrespective of how many signatures there will be on the agreement, work will be started on what is written in it," said the minister.

Doctors’ strike squeezes unemployment funds

TALLINN - The Estonian government coalition submitted on Nov. 7 an amendment to the Riigikogu that would reduce the planned increase of unemployment benefits, as it needs to find resources to fund the increase in wages of the medical staff, reports Postimees.

According to a plan that was already approved in 2009, the unemployment benefit was to be increased in 2013 from 65 euros, to a half a minimum wage, or 145 euros a month. According to the amendment submitted by the government on Nov. 7, the increase is being cut to 101 euros.
After the recent strike by doctors and nurses, Social Minister Hanno Pevkur said that the money for wage increases for medical staff will most likely be found by cutting the planned unemployment benefit increase next year. The amendments to the labor contracts law that Reform Party faction chairman Jaanus Tamkivi handed over to parliament proceedings on Nov. 7 confirmed the minister’s plan.

“The bill is caused by the need to find a source for 3.5 million euros that is necessary for the increase of wages of emergency medical staff and healthcare workers financed from the state budget that was agreed upon in October 2012 as the result of the doctors and healthcare workers strike,” Tamkivi said.
“This is the last thing that will be nullified for employees in the labor contract law that was signed trilaterally in April 2008,” said Trade Unions Confederation chairman Harri Taliga. He reiterated that the government changed the planned unemployment insurance compensation rates already in 2009 and this spring, ignoring the agreement.

Health more important than budget balance, says patients group

The Estonian Patients Advocacy Council says the government should act more like Ireland when it comes to national health care.

In a November 4 statement rejecting last week's proposal from the Hospitals Association to raise money for health care by increasing patient copayments, the council referred to health care funding by countries with higher budget deficits.

"Instead of starting to direct additional resources into health care in order to improve the availability of medical care similarly to Ireland, which recently had one of Europe's highest budget deficits but which is roughly on the same scale as Estonia, the government has used health care funding to maintain budget balance. The government will not find money for improving availability of health care service," the Patients Advisory Council said in a statement to the media.

The council said Ireland had invested 280,000 euros into health care in the last five months - something that was approved of by the European Commission, the European Central Bank and International Monetary Fund.

"The fact that the IMF, known as one of the world's most stringent financial institutions, approved the investment into health care by a country in very difficult financial straits renders the claims of Estonian government representatives hollow and empty," the statement said.

The council accused the government of "simply not wanting to deal substantively with the issue."

The Hospitals Association requested on Friday that the Ministry of Social Affairs raise copayment fees for doctor's visits from 3.20 to 5 euros for outpatients and from 1.60 euros to 2.50 euros for inpatients.

The citizens of EU and USA deserve an e-leap in health care : Ilves

Estonian President Toomas Hendrik Ilves said at a high-level conference in Boston, USA, that the citizens of the European Union and the United States of America deserve an e-leap in health care.

Ilves, who was invited to Boston as a keynote speaker at the top level "2012 Transatlantic Health IT/eHealth Cooperation Assembly", an eHealth event organised by the European Union and the United States of America, searched for answers to the following question in his presentation: what are the co-operation opportunities between the EU and the USA in the contemporary organisation of medicine, which is largely dependent on information technology?

President Ilves, who led the European Union e-health work group for a year and a half at the proposal of the President of the European Commission, José Manuel Barroso, highlighted placing the focus on citizens – both as patients and clients – as the most important aspect.

"We will give people access to their own medical records, teach them how to use this information and motivate them to take the responsibility for their own health," told the Estonian Head of State.

Estonia is planning a stricter tobacco policy

Last autumn, the Ministry of Social Affairs in Estonia convened a working group to draft a new concept for the tobacco policy and the group is about to finish its task, writes LETA/Postimees Online.

In November, the working group is planning to present its proposals for a stricter tobacco policy in Estonia.

Press spokesperson of the Ministry of Social Affairs Helena Nõmmik stated that the working group convened this week, in order to once again review the most important issues in the so-called green papers.

She explained that the group discussed in particular various options for limiting access of minors to tobacco products.

Pictoral warning labels on tobacco products were also discussed, in order to determine the most effective images that could be used.

The so-called Green Paper on tobacco policy will, according to plans, be sent for approval to relevant ministries. At the end of the year 2012, the Government will discuss the proposals and then the Ministry of Social Affairs will start drafting relevant legislative amendments.

Juhan Tere

Estonian doctors continue their strike

Estonian doctors continue their strike for the second week. Since October 8th, doctors from Northeastern Estonia have joined a nationwide strike until an agreement is reached on the major points - salary and workload.

Hospitals in Pärnu, Kuressaare, Viljandi and Narva joined the action. There, as in Tallinn and Tartu, scheduled outpatient appointments will not take place.
In addition, scheduled appointments in inpatient care will also be suspended. At Tallinn's hospitals, the strike affects inpatient care. In Tartu, most surgical specialties are affected, and scheduled surgeries will also be canceled.

The Hospitals Association has proposed a 6.6 percent raise for its employees, but that is contingent on whether the Health Insurance Fund agrees to make changes in its prices for service.

Finland attracts doctors from Estonia

Estonian doctors striking for better pay and working conditions.

Külvar Mand, a doctor who works in Finland and Estonia, was waking a patient up from anaesthesia at the eye clinic of the East Tallinn Central Hospital.
 
Wake up. Open your eyes too. Can you hear me?" Mand says in a soothing voice.
 
Today, Monday, Estonian doctors are waking up the whole country much less gently than Mand rouses his patient. Doctors in Estonia are launching a strike, the likes of which has never been seen in the country. Earlier, only teachers and railway workers have been on strike for more than a day in Estonia.´With their strike the doctors want to draw attention to the issue of brain drain affecting health care personnel, and to the deterioration of the Estonian health care system.

Estonian doctors strike as wage row triggers emigration

Estonian doctors and nurses at the country’s biggest hospitals began a strike, demanding higher wages to stem an exodus of medical staff from the Baltic nation.

Three hospitals in the capital, Tallinn, and one in the second-biggest city, Tartu, halted outpatient services, except for those under 18, pregnant or oncological patients, according to statements on the hospitals’ websites today. They may stop inpatient care starting Oct. 8, while hospitals in four more towns may also join the strike.

Teachers went on strike in March to demand higher salaries as Estonia became the only euro-area nation to post budget surpluses in the last two years by freezing public wages. Doctors and nurses are leaving for countries such as Finland, where vacancies are increasing, salaries are four times higher and the language is closely related to Estonian. Workloads for staff who stay have been pushed too high, the unions say.

The unions demand an increase in the lowest hourly wages for doctors to 8.6 euros ($11.1) from 7.2 euros now, with a raise to 12 euros by 2014. Nurses want hourly wages raised to 7.7 euros in two years from 3.8 euros, and hospice workers seek an increase to 4.2 euros from 2.1 euros. The employers, financed by the Health Insurance Fund, last week offered a pay increase of 6.6 percent starting next year.

Prime Minister Andrus Ansip called unions’ demands “totally unrealistic” on Sept. 26. The Cabinet approved next year’s budget earlier last week to raise minimum monthly wages for teachers by up to 18 percent to 715 euros, compared with an overall increase in public salaries of 4.4 percent.

Ott Ummelas

Estonian doctors plan to strike in October to help stem outflow

Estonian doctors called a strike for next month after attempts to negotiate wage increases with the government and employers failed.

The main goal of the work stoppage is to prevent doctors and nurses from emigrating, the doctors’ union said in an e- mailed statement today. The duration of the strike hasn’t been decided.

About a quarter of Estonia’s 4,000 specialized doctors are above pension age, and more than a third of all physicians are considering working abroad, the union said in June.

Doctors in the North Estonia Medical Center, the country’s biggest hospital, earn an average monthly wage of 2,296 euros ($2,893), compared with the national average of 900 euros, while they exceed nominal workloads by 43 percent on average, the hospital said.

Ott Ummelas 

Estonia is the 57th healthiest country in the world

Bloomberg compiled a list of the healthiest countries and determined that Estonia ranked 57th in the list, writes LETA/Äripäev.ee. Latvia is ranked 79th and Lithuania 81st.

Estonia remained behind countries such as Syria, Macedonia, Oman and Libya, for example. The healthiest country in the world is Singapore, which is followed by Italy, Australia, Switzerland, Japan, Israel etc. Finland ranked 22nd, Latvia 79th and Lithuania 81st.

The list was compiled on the basis of the life expectancy at moment of birth, child mortality rate, causes of death, the proportion of smokers to the entire population, obesity rate, sedentary lifestyle, excessive cholesterol, high blood pressure, AIDS as well as on the basis of housing and external environment pollution.

Juhan Tere

Estonian Social Ministry wants to impose further restrictions on smoking

TALLINN- While currently people can still smoke quite freely in public space outdoors in Estonia, the state intends to toughen the tobacco policy from autumn, Eesti Paevaleht writes.

"We have a proposal for the government on the table to implement a non-smoking zone in front of all public buildings," Social Ministry’s Health Sphere Deputy Chancellor Ivi Normet said.

"The agreement has not yet been achieved on how many meters the smoke-free zone should be big but it has to be there and that includes entrances of shopping centers too," she said.

Normet said that there are no direct bans under discussion but the intention is to start restricting the possibilities to smoke in workplaces too gradually, by abolishing the smoking rooms, but Normet assured that this will be a gradual process.

Smoking is prohibited in most public indoor spaces in Estonia, including bars and restaurants, being allowed only if there are specially ventilated smoking rooms present.

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.