BONJOUR L'ESTONIE

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.

Estonia takes action on record-level AIDS rate

TALLINN — Estonia has the highest percentage of HIV/AIDS infection in the European Union, and the increasing number of cases is forcing the cash-strapped government to spend more on expensive medication.

Estonian government announced Thursday that it is dedicating 12.9 million krooni (€824,458) from its reserve funds to the Ministry of Social Affairs to purchase HIV/AIDS medications. The number of patients is estimated to increase by at least 200 people over the remainder of the year.

“If there were nearly 200 infected during the first half of the year then during the second half … another 200 infected might be found,” Nelli Kalikova, deputy director of the AIDS Prevention Center said.

The Ministry of Social Affairs currently has 67.1 million krooni (€4.3 million) in funding to treat 1,758 patients. However, according to Global Health Facts organization, in 2007-2008 Estonia had 9,900 people living with HIV/AIDS and the number is growing each year. According to Estonian Health Board, already 201 infected people were discovered this year. More than 7,000 new cases were found since the HIV/AIDS epidemic began in August 2000.

Estonia ranks second in Europe in terms of use of opiates

The latest World Drugs Report indicated that Estonia ranks second in Europe in terms of use of opiates, writes LETA/National Broadcasting.

According to the report, Estonia follows closely Scotland – 1.5% of the adult population here use opium-based drugs, including heroin. Consumption of cannabis is also growing – this is used by six per cent of the adult population.

Indrek Kalikov, syringe replacement project manager of the Aids Support Centre, noted that experts have remarked an increase in drugs consumption among Estonian-speaking population in particular.

While the international anti-drugs day was celebrated across the world with a number of events on Saturday, Estonia did not pay any attention to this day.

Juhan Tere

Use of evidence-based pharmacotherapy after myocardial infarction in Estonia

Mortality from cardiovascular disease in Estonia is among the highest in Europe. The reasons for this have not been clearly explained.

Also, there are no studies available examining outpatient drug utilization patterns in patients who suffered from acute myocardial infarction (AMI) in Estonia. The objective of the present study was to examine drug utilization in different age and gender groups following AMI in Estonia.

Methods: Patients admitted to hospital with AMI (ICD code I21-I22) during the period of 01.01.2004-31.12.2005 and who survived more than 30 days were followed 365 days from the index episode.

Data about reimbursed prescriptions of beta-blockers (BBs), angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACE/ARBs) and statins for these patients was obtained from the database of the Estonian Health Insurance Fund. Data were mainly analysed using frequency tables and, where appropriate, the Pearson's chi2 test, the Mann-Whitney U-test and the t-test were used.

A logistic regression method was used to investigate the relationship between drug allocation and age and gender. We presented drug utilization data as defined daily dosages (DDD) per life day in four age groups and described proportions of different combinations used in men and women.

Physical activity of Estonian family doctors and their counselling for a healthy lifestyle

Physical activity offers major health benefits and counselling for it should be integrated into the medical consultation. Based on the literature, the personal health behaviour of the physician (including physical activity) is associated with his/her approach to counselling patients.

Our hypothesis is that family doctors (FD) in Estonia are physically active and their recommendation to counsel patients with chronic diseases to use physical activity is high. The study was also interested in how FDs value physical activity among other important determinants of a healthy lifestyle, e.g. nutrition, non-consumption of alcohol, and non-smoking.

Methods: Physicians on the electronic list were contacted by e-mail and sent a questionnaire. The first part assessed physical activity by the International Physical Activity Questionnaire (IPAQ) short form.

Self-reported physical activity during one week was calculated as total physical activity in minutes per week (MET min/week). The second part of the questionnaire included questions about the counselling of patients with chronic disease concerning their physical activity and a healthy lifestyle.

The study focused on female FDs because 95% of the FDs in Estonia are women and to avoid bias related to gender.

Overview of the National Electronic Health Record System developed by Estonia

The development of the Estonian eHealth Record System has been progressing steadily since its launch in December 2008. It will continue gradually until 2013.

The idea of an Electronic Health Record (EHR) System for Estonia emerged in 2002. The purpose was to develop a nation-wide framework (database) to facilitate the exchange of digital medical documents and of health information. These were only available in local databases and information systems which were not able to communicate with each other.

In 2005, the Estonian Ministry of Social Affairs launched a new eHealth concept by phasing in four projects, namely: 'Electronic health records', 'Digital images', 'Digital Registration' and 'Digital Prescription'. The result of their implementation is the integrated Electronic Health Record System which was launched on 17 December 2008. 

In March 2010, the EHR System contained over 1 million medical documents, including: discharge letters (inpatients and outpatients), referrals, links to digital images and electronic prescriptions (since 1 January 2010).

The Health Services Organisation Act and Associated Acts Amendment Act of 20 December 2007 established an obligation for healthcare providers to forward their patients' medical data to the EHR system as from 1 September 2008. The rules for the use of this data state that only the patient's attending physician or a medical assistant has the right to make enquiries about the patient's data. Conducting such enquiries outside of a treatment process is not allowed.

Scientists say recession may spark Baltic TB surge

The Baltic States risk seeing an upsurge in tuberculosis (TB) cases because of the recession brought about by the financial crisis, scientists said on Wednesday, and Latvia is particularly vulnerable.

Researchers who studied the effects of recession on rates of the highly infectious disease during the fall of the Soviet Union in the early 1990s found a strong link between the two and said their findings suggest a similar pattern could emerge now.

"Put simply, there's a lot less money around for spending on public health," said Nimalan Arinaminpathy of Britain's Oxford University, who led the study.

Tuberculosis, which is caused by the Mycobacterium tuberculosis bacteria, is one of three primary diseases linked to poverty, the other two being AIDS and malaria.

The scientists designed models based on economic figures and tuberculosis data and predicted that Latvia, Estonia and Lithuania could see TB increases in the coming years.

Their estimates were for 200 excess cases of tuberculosis per 100,000 people in the population in Latvia, 130 per 100,000 in Lithuania and 75 per 100,000 in Estonia compared with some 40 per 100,000 in Russia over the period of recession and recovery.

Emerging World Pharma Inc. continues its investment into generic drug manufacturing in developing countries

MANASSAS - Emerging World Pharma Inc., an investor in generic based pharmaceutical companies manufacturing within developing nations, has provided an initial investment into European Global Pharma that will be used to fund a generic drug manufacturing facility in Estonia.

The investment would entitle Emerging World Pharma to an initial 10% of profits obtained from the marketing and distribution of generic pharmaceuticals sold. The company retains an option to increase the percentage of profit on additional investments of up to 25%.

www.emergingpharma.com

93 new HIV cases have been registered in Estonia in 2010

93 new HIV cases have been registered in Estonia in 2010 (January-March), LETA/Delfi reports. 23 of the new cases were prison inmates.

In January, 33 new cases were registered, in February 31 and in March so far 29 cases.

Over the years, 7,413 cases of HIV have been registered in Estonia and 291 cases of AIDS.

Estonia donates excess new flu vaccine to World Health Organisation

The Estonian Social Ministry is considering whether to return the excess new flu vaccine to producers or donate to the World Health Organisation (WHO) for countries who need help, LETA/Postimees writes.

Since a new seasonal flu vaccine would be developed for the next winter, and that might include the new flu component, the majority of vaccine bought by Estonia will most likely remain unused.

Social Ministry people’s health department adviser Martin Kadai said that they intend to discuss with vaccine producers what the chances are of returning the excess vaccine to them. He didn’t want to comment in more detail since meetings haven’t yet taken place. Also a proposal will be made to donate the excess vaccine to WHO.

WHO’s representative in Estonia Jarno Habicht said that coordinating humanitarian aid is one of the tasks of WHO. The organisation will try to take the vaccine to many states so that it would be justly available.

“There are talks under way at present with a bit more than ten states who are making or considering making a donation of new flu vaccine to WHO,” said Habicht. Estonia hasn’t yet submitted an official proposal.

Estonia bought in December and January last year 250,000 dosages of new flu vaccine. According to Health Board data, less than 50,000 vaccinations had been carried out by the end of February. It will become clear in April how much vaccine will be unused as then healthcare staff submits the final vaccine expense reports.