Search

BackgroundHospital-acquired strains (HASs) and multiresistant strains in neonatal intensive care unit often harbour virulence and resistance mechanisms, carrying the risk of invasive infections. We describe colonisation withEnterobacteriaceaein neonates receiving early directed versus routine family-integrated care (FIC) within the first month of life.MethodsA prospective cohort study included neonates with a gestational age below 34 weeks. During the first period, neonates were admitted to an open bay unit with transfer to the single-family room if available; feeding with the mother’s own breast milk (MOBM) was introduced within 24 hours, and skin-to-skin contact (SSC) within 5 days of life (the routine care group). During the second period, following a wash-in of 2 months, care in a single-family room within 48 hours, the introduction of MOBM within two and SSC in 48 hours were applied (the intervention group).Enterobacteriaceaeisolated from neonatal stool, breast milk and parental skin swabs were genotyped, Simpson’s Index of Diversity (SID) calculated, and extended-spectrum beta-lactamases (ESBL) detected.ResultsIn 64 neonate-parents’ groups, 176Enterobacteriaceae, 87 in routine care and 89 in the intervention group were isolated; 26 vs 18 were HAS and one vs three ESBL positive, respectively. In the intervention group compared with the routine care group, SSC and MOBM feeding was started significantly earlier (pConclusionsEarly implementation of FIC measures may hold the potential to increase diversity and reduce colonisation with HASEnterobacteriaceae.

The aim of the study was to analyse health-related quality of life (HRQoL) among the Estonian general population and its socio-demographic and behavioural correlates during the COVID-19 pandemic. Longitudinal data on 1781 individuals from an Estonian rapid-assessment survey on COVID-19 were used. HRQoL was assessed with the EQ-5D-3L in June 2020 (baseline) and in May 2021 (follow-up). The HRQoL index score and its socio-demographic and behavioural variations were analysed using paired t-tests and Tobit regression modelling. Statistically significant declines in mean EQ-5D index scores were observed for all socio-demographic and behavioural variables considered. Most of these changes were due to increased reporting of problems in the pain/discomfort and anxiety/depression health domains. Older age, being unemployed or economically non-active and having financial difficulties were significantly associated with lower HRQoL in both baseline and follow-up measurements. In the follow-up data, women had significantly lower HRQoL compared to men, whereas higher education proved to be the only protective factor regarding HRQoL. Unhealthy dietary habits and low physical activity had a negative impact on the HRQoL score in the follow-up data. These results indicate that the COVID-19 pandemic has had a substantial impact on HRQoL in the Estonian population.

Aims: (1) To describe the time trends of monthly cannabis use and (2) to analyse the association between the trends of monthly cannabis use and trends of different explanatory factors among adolescents in Estonia in 2003–2019. Methods: Nationally representative data from five waves of the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) among 15–16-year-old adolescents ( n = 11,348) in Estonia were analysed. Tests for trends were used to assess significant changes in monthly cannabis use and explanatory variables over time. Logistic regression analysis was used to analyse the association between monthly cannabis use and perceived easiness of getting cannabis, perceived health risk of cannabis use, parental factors, risk behaviours, and leisure time activities. The model included interaction terms between the study year and each explanatory variable. Gender-adjusted odds ratios ( OR) with 95% confidence intervals (CI) were calculated. Results: Monthly cannabis use increased from 5.3% in 2003 to 7.7% in 2015 and thereafter decreased to 6.6% in 2019 among adolescents in Estonia ( P = 0.007). The association between monthly cannabis use and alcohol use was significant over the study period and the interaction of alcohol use with study year indicated significantly increased effect of alcohol use over time ( P = 0.038). The association between monthly cannabis use and perceived easiness of obtaining cannabis, perceived low health risk from cannabis use and smoking was significant, but remained unchanged over the study period. The relationship between monthly cannabis use and low parental control was significant in two last study years but did not show any changes over time. Conclusions: The findings of this study demonstrate the need for the implementation of multi-component substance use prevention programmes among adolescents in Estonia that also pay attention to the factors associated with the cannabis use.

ObjectivesThe aims of the study were (1) to describe trends in the prevalence of monthly alcohol use from 2003 to 2015 and (2) to analyse the associations between alcohol use and family-related and school-related factors, risk behaviours and perceived alcohol availability in Estonia compared with Latvia, Lithuania, Finland and Sweden.MethodsThe study used nationally representative data of 15–16-year-old adolescents from the European School Survey Project on Alcohol and Other Drugs. Data from Estonia, Latvia, Lithuania, Finland and Sweden collected in 2003, 2007, 2011 and 2015 were utilised (n=57 779). The prevalence of monthly alcohol use including light and strong alcohol use was calculated for each study year. A χ2 test for trend was used to evaluate statistically significant changes in alcohol use over the study period. A multilevel logistic regression analysis was used for assessing the association between alcohol use and explanatory factors. Marginal ORs with 95% CIs for each country were calculated.ResultsMonthly alcohol use decreased significantly among boys and girls in all countries from 2003 to 2015. In 2015, the prevalence of monthly alcohol use among boys was 36.1% in Estonia, 44.3% in Latvia, 32.4% in Lithuania, 32.3% in Finland and 22.4% in Sweden. Among girls, it was 39.1%, 45.9%, 35.6%, 31.8% and 29.1%, respectively. In all countries, higher odds of monthly alcohol use were observed among adolescents who skipped school, smoked cigarettes, used cannabis, perceived alcohol to be easy to access and had parents who did not know always/often about their child’s whereabouts on Saturday nights. Compared with Estonia, associations between alcohol use and explanatory factors were similar in Latvia and Lithuania but different in Finland and Sweden.ConclusionResults of cross-national comparison of alcohol use and explanatory factors could be effectively used to further decrease alcohol use among adolescents.

Objective: To study the population-level mental health responses during the first wave of coronavirus disease 2019 (COVID-19) outbreak in Estonia and analyze its socio-demographic, behavioral, and health-related variations among general population.Methods: This study used nationally representative data on 4,606 individuals, aged 18–79 years from a rapid-response cross-sectional survey conducted in April 2020. Point prevalence and mutually adjusted prevalence rate ratios for perceived stress from log-binomial regression analysis were presented for socio-demographic, behavioral, and health-related variables.Results: This study found that 52.2% of population aged 18–79 reported elevated stress levels in relation to COVID-19 outbreak. Higher levels of perceived stress were found in women, in younger age groups, in Estonians, and in those with higher self-perceived infection risk, presence of respiratory symptoms, and less than optimal health, according to self-reports.Conclusion: Although, the potential long-term health effects of the current crisis are yet unknown, the alarmingly high stress levels among people indicate that the COVID-19 pandemic might have had a widespread effect on people's mental health.

Background: Patterns of alcohol use often start developing during adolescence and are associated with alcohol use and dependence during adulthood. The aims of the study were to describe trends in the prevalence of monthly alcohol use from 2003 to 2015 and to analyze the associations between alcohol use and family-related and school-related factors, risk behavioral factors and perceived alcohol availability in Estonia, Latvia, Lithuania, Finland, and Sweden.Methods: The study used nationally representative data of 15–16-year-old adolescents from the European School Survey Project on Alcohol and Other Drugs (ESPAD). Data from Estonia, Latvia, Lithuania, Finland, and Sweden collected in 2003, 2007, 2011, and 2015 were utilized (n=57,779). The prevalence of monthly alcohol use and light and strong alcohol use was calculated for each study year in all countries. A chi-square test for trend was used to evaluate statistically significant changes in alcohol use over the study period. Logistic regression analysis was performed to analyze the association between alcohol use and different factors. Fully adjusted odds ratios with 95% confidence intervals were calculated.Results: Monthly alcohol use decreased significantly among 15–16-year-old boys and girls in Estonia, Latvia, Lithuania, Finland, and Sweden from 2003 to 2015. In 2015, the prevalence of monthly alcohol use among boys was 36.1% in Estonia, 44.3% in Latvia, 32.4% in Lithuania, 32.3% in Finland, and 22.4% in Sweden, and among girls, it was 39.1%, 45.9%, 35.6%, 31.8%, and 29.1%, respectively. In Estonia, Latvia, Lithuania, and Sweden, girls had higher odds of monthly alcohol use than boys. In all countries, higher odds of monthly alcohol use were observed among adolescents who skipped school, smoked cigarettes, used cannabis, perceived alcohol to be easy to access and had parents who did not know always/often about their child’s whereabouts on Saturday nights.Conclusion: From 2003 to 2015, monthly alcohol use decreased in Estonia as well as in neighboring countries such as Latvia, Lithuania, Finland, and Sweden. The factors related to alcohol use in all five countries were generally similar. Based on the study results, health promotion and alcohol policy interventions could be improved to decrease and prevent alcohol use among adolescents.

Background The spread of illicitly manufactured fentanyl has the potential to greatly increase the fatal overdoses in many places in the world. The purpose of this paper is to analyse the evolution of fentanyl use epidemic in Estonia. Methods this scoping review is based on extensive review and synthesis of broad range of literature: research reports, newspaper, magazine, coverage of illicit fentanyl use; policy documents, position papers, reports released by government agencies, and surveillance data. Results For an over a decade up to 2017, Estonia has had the highest overdose death mortality in Europe. The use of (injected) fentanyl is a major contributor to the Estonian overdose death epidemic. Shutting down a major producer and distributor of illicit fentanyl has been extremely effective in curbing the number of overdose deaths. Unfortunately, this supply-side intervention came ten years into the epidemic, and might be difficult to replicate in settings with decentralized production. In areas faced by fentanyl we would recommend large-scale implementation of opiate substitution treatment and naloxone distribution, syringe service programs to provide for safer injecting and link to other services (high frequencies of fentanyl injection create high risk for HIV and HCV transmission), and programs, such as “Break the Cycle,” to reduce initiation into injecting drug use. Further, the means of responding to emerging substances should match the world in which different substances can be rapidly introduced, and where people who use drugs can change preferences based on market availability. Conclusion Addressing illicitly manufactured fentanyl may serve as a public health learning experience for developing early detection and rapid response programs in rapidly changing drug use environments.

Background Alcohol is one of the most common psychoactive substances used by adolescents. The aim of the study was to describe the prevalence of alcohol use in 2003-2015 and to analyse association of alcohol use with family- and school-related factors, other risk behaviors, and perceived alcohol availability. Methods This study was based on data of 15-16-year-old adolescents (n = 9559) from the cross-sectional studies of European School Survey Project on Alcohol and Other Drugs conducted in Estonia in 2003-2015. Prevalence of past 30-day alcohol use was calculated for each study year. Chi-square test for trend was used to assess statistically significant changes of alcohol use over the study period. Logistic regression analysis was used to analyse association between alcohol use and study year, family- and school-related factors, risk behaviors, and perceived alcohol availability. Fully adjusted odds ratios with 95% confidence intervals were calculated. Results In 2003-2015, alcohol use decreased significantly among adolescents in Estonia (p < 0.001). In 2015, the prevalence of alcohol use was 36.1% (95% CI 33.4 − 38.8) among boys and 39.1% (95% CI 36.3 − 41.8) among girls. Fully adjusted logistic regression models showed that alcohol use among boys and girls was statistically significantly associated with study year, lower parental awareness where the child spends Saturday evenings, skipping the lessons, smoking, cannabis use and easy access to alcohol. Alcohol use was associated with lower socioeconomic status of the family and with unusual family structure among girls only. Compared to the first study year, alcohol use was lower in the last study year (OR = 0.52, 95% CI 0.43 − 0.64 among boys, OR = 0.46, 95% CI 0.38 − 0.56 among girls). Conclusions In order to continue reduction of alcohol use among adolescents, the health promotion interventions should take into account the factors related to alcohol use in Estonia. Key messages Alcohol use decreased among adolescents in Estonia in 2003–2015. Alcohol use was associated with study year, family- and school-related factors, other risk behaviors and perceived alcohol availability.

Background It has been observed in an earlier study that the number of people who inject drugs (PWID) in Estonia is declining. We provide nationwide estimates of the number of PWID in Estonia for years 2010–2015 and compare different modelling strategies to minimise over-coverage-induced bias in capture-recapture estimates. Methods We obtained data from the Estonian Causes of Death Registry (DR) for opioid-related deaths, the Estonian Health Insurance Fund (HIF) for opioid-related overdose and drug dependence treatment episodes, and the Estonian Police and Border Guard Board (PB) drug-related misdemeanours. Datasets were linked by identifier based on sex, date of birth, and initials; a capture-recapture method was used to estimate the number of PWID aged 15 or more, each year from 2010 to 2015. Log-linear regression maximum likelihood (ML) and Bayesian methods were used; over-coverage of police data was accounted for. Results The annual population size estimates of the number of PWID (aged 15 and over) varied from 6000 to 17,300 (ML estimates not accounting for over-coverage of PB) to 1500–2300 (Bayesian estimates accounting for over-coverage). Bayesian estimates indicated a slight decrease in the number of PWID, and the median estimates were > 2000 in years 2010–2012 and

Aim to investigate the relationship between levels of social skills and drug use among 15-16-year-old students in Estonia. Methods A total of 2,460 Estonian schoolchildren, born in 1995, participated in the ESPAD study in 2011. Individual social skills levels were measured with questions on prosocial and antisocial behaviours assessing how children perform within their social milieu. The relationship between social skills levels and drug use was estimated using chi-squared tests and logistic regression analysis. Odds ratios (OR) were adjusted for gender, parents' education and financial well-being, and 95% confidence intervals (CI) were used to estimate risks of drug use by social skills level. Results Students with lower social skills were at greater risk of starting smoking and smoking daily (50% risk increase). Students with low social skills had a higher risk of lifetime use of cannabis (OR=1.4; 95%CI 1.1-1.9), sedatives/tranquillisers without a prescription (OR=2.3; 1.4-3.9), and inhalants (OR=1.9; 1.2-3.0). The number of students with lower social skills was significantly higher among boys than girls: 35% vs 19%. Conclusions Students' social skill levels were related to their licit and illicit drug use. A low level of social skills can increase adolescents' vulnerability to drug use. As boys' social skills levels appeared much lower and their drug use higher than that of girls, we suggest that gender-related risk prevention programmes of social skills training could be beneficial in preventing drug use.

The incidence of hip fractures among individuals aged over 50 in Estonia and trends over time were assessed for 2005–2012. The incidence among women is relatively low, with the declining trend, but the rate among men is among the highest in Eastern and Central Europe. The aim of this study was to assess the incidence and trends of hip fractures among individuals over 50 years in Estonia in 2005–2012 and to increase understanding of the incidence of hip fractures in Eastern Europe. We identified all patients aged 50 years or older with hip fracture (ICD-10 codes S72.0, S72.1 and S72.2) in 2005–2012 using medical claims data from the Estonian Health Insurance Fund. Crude and age-specific incidence rates were calculated for men and women using the population of Estonia in 2005–2012. To adjust for age differences in the population, standardized incidence rates (SIR) were estimated. The SIR per 100,000 for the entire observation period was 209.2 (95 % CI 204.2 to 214.2) in women and 215.6 (95 %CI 208.2 to 223.1) in men, resulting in a female to male rate ratio of 0.97 (95 % CI 0.84 to 1.11). Over the period of 2005–2012 the estimated SIR/100,000 ranged from 211.5 (95 % CI 196.8–226.3) in 2005 to 183.7 (95 % CI 170.8–196.7) in 2012 in women, and from 238.5 (95 % CI 215.4–261.7) in 2005 to 187.9 (95 % CI 169.0–206.8) in 2012, in men. For women, the decrease in SIR for the study period approached statistical significance (p = 0.058), and for the period of 2009–2012, we observed an accelerated 16 % decrease (p = 0.008). The incidence of hip fractures among Estonian women is relatively low, whereas the rate among men is among the highest in Eastern and Central Europe. In line with many countries, we found a recent decline in incidence among women.

Background Attempts to relate patellar cartilage involvement to anterior knee pain (AKP) have yielded conflicting results. We determined whether the condition of the cartilage of the patella at the time of knee replacement, as assessed by the OARSI score, correlates with postsurgical AKP. Patients and methods We prospectively studied 100 patients undergoing knee arthroplasty. At surgery, we photographed and biopsied the articular surface of the patella, leaving the patella unresurfaced. Following determination of the microscopic grade of the patellar cartilage lesion and the stage by analyzing the intraoperative photographs, we calculated the OARSI score. We interviewed the patients 1 year after knee arthroplasty using the HSS patella score for diagnosis of AKP. Results 57 of 95 patients examined had AKP. The average OARSI score of painless patients was 13 (6–20) and that of patients with AKP was 15 (6–20) (p = 0.04). Patients with OARSI scores of 13–24 had 50% higher risk of AKP (prevalence ratio = 1.5, 95% CI: 1.0–2.3) than patients with OARSI scores of 0–12. Interpretation The depth and extent of the cartilage lesion of the knee-cap should be considered when deciding between the various options for treatment of the patella during knee replacement.

Disclosure of injecting drug use and its associations with stigma have received very little research attention. This cross-sectional study examined the role of internalized HIV and drug stigma (i.e., self-stigmatization) in the disclosure of injecting drug use among people who inject drugs (PWID) self-reporting as HIV-positive (n = 312) in Kohtla-Jarve, Estonia. The internalization of both stigmas was relatively high. On average, PWID disclosed to three disclosure targets out of seven. Disclosure was highest to close friends and health care workers and lowest to employers and casual sex partners. Internalized drug stigma was negatively associated with disclosure to other family members (AOR = 0.48; 95% CI 0.30–0.77) and health care workers (AOR = 0.46; 95% CI 0.25–0.87). Internalized HIV stigma was positively associated with disclosure to health care workers (AOR = 2.26; 95% CI 1.27–4.00). No interaction effect of internalized stigmas on disclosures emerged. We concluded that effects of internalized stigmas on disclosures are few and not uniform.

Introduction New injectors / younger drug users are an important population to target for intervention because they are often at especially high risk of HIV and HCV infection. We examined HIV prevalence and gender differences in HIV prevalence and risk behavior among new injection-drug-users in Tallinn, Estonia. Methods Respondent driven sampling (RDS) interview surveys and HIV testing were conducted in Tallinn in 2009, 2011 and 2013. We classified “new injectors” as persons who reported their first injection as occurring within three years of the study interview. Recruiting trees of the three individual RDS studies were joined to form one RDS dataset and RDS estimates for prevalence and means were derived. Bootstrap tests were used to compare data from men and women, HIV infected and uninfected. Results Among 110 new injectors (34 women and 76 men) the mean age was 24.5 (SD 7.5) years; 63% reported injecting mainly fentanyl, 34% injecting mainly amphetamine, 36% sharing syringes, 89% were sexually active, and, of these, 88% did not always use condoms in the last 6 months. HIV prevalence was 18% (95%CI 8–28%) (41% (95%CI 19–63%) among female and 7% (95%CI 2–12%) among male new injectors). Based on self-reports, 8.1% of all new injectors (and 22% of female new injectors) were HIV positive before starting to inject drugs. 40% of HIV infected reported receiving antiretroviral therapy. In multivariable analysis, gender (male: OR 0.12, 95% CI 0.03–0.45), main drug injected (fentanyl: OR 6.7, 95% CI 1.3–35.7) and syringe sharing (distributive: OR 0.11, 95% CI 0.02–0.55; and receptive: OR 3.7, 95% CI 1.0–13.5) were associated with the HIV seropositivity. Conclusions New injectors exhibit high-risk behavior and correspondingly high HIV prevalence. Sexual transmission of HIV infection, including before injection initiation, is likely to be a significant contributor to HIV risk among female new injectors. This highlights the need to identify and target new injectors and their partners with gender specific interventions in addition to interventions to reduce initiation into injecting and ensuring provision of ART to HIV positive new injectors.

This study assesses relationships between drug administration routes and HIV serostatus, drug use, and sexual behaviors among current injecting drug users (IDUs) in Tallinn, Estonia. We recruited 350 IDUs for a cross-sectional risk behavior survey. Adjusted odds ratios (AORs) were calculated to explore injection risk behavior, sexual behavior, and HIV serostatus associated with multiple route use. Focus groups explored reasons why injectors might use non-injecting routes of administration. Those reporting multiple drug administration routes were less likely to be HIV seropositive (AOR = 0.49, 95% confidence interval [CI] = 0.25–0.97) and had almost twice the odds of having more than one sexual partner (AOR = 1.90, 95% CI = 1.01–3.60) and of reporting having sexually transmitted diseases (AOR = 2.38, 95% CI = 1.02–5.59). IDUs who engage in noninjecting drug use may be reducing their risk of acquiring HIV though sharing injection equipment, but if infected may be a critical group for sexual transmission of HIV to people who do not inject drugs.

Background This study seeks to identify the prevalence of, and risk factors associated with, non-fatal overdose among people currently injecting drugs (PWID) in St. Petersburg (Russia) and in Kohtla-Järve (Estonia). Methods Five hundred eighty-eight study participants in Kohtla-Järve (in 2012) and 811 in St. Petersburg (in 2012–2013) were recruited using respondent driven sampling for interviewing and HIV testing. Results Three-quarters (76 %) of the current PWID were male. Participants from St. Petersburg were older (mean age 32.1 vs. 29.6 years, p < 0.0001) and reported a longer average duration of injecting drugs (mean duration: 13.3 vs. 10.9 years, p < 0.0001). Main drugs injected were opioids (fentanyl in Kohtla-Järve, heroin in St Petersburg). HIV prevalence was 63 % (95 % CI 59–67 %) in Kohtla-Järve and 56 % (95 % CI 52–59 %) in St. Petersburg. Two thirds of the PWID in Kohtla-Järve and St. Petersburg reported ever having experienced a drug overdose involving loss of consciousness or stopping breathing. In Kohtla-Järve, 28 % (95 % CI 24–31 %) of participants and, in St Petersburg, 16 % (95 % CI 14–19 %) of participants reported an overdose within the previous 12 months. Characteristics of injection drug use practice (longer duration of injection drug use, main drug injected), correlates of high-risk injection behaviour (higher injecting frequency, sharing), and problem alcohol use were associated with the risk of overdose within the previous 12 months. The significant factors effects did not differ between the sites. Conclusions PWID are at high risk for overdose. Effective overdose prevention efforts at the public health scale are therefore warranted.

Objective : To investigate treatment adherence and factors related to non-adherence in the Estonian postmenopausal hormone therapy (EPHT) trial. Methods : A total of 1823 postmenopausal women aged 50–64 years were recruited into the EPHT trial from 1999 to 2001. They were randomised into the blind group receiving continuous orally administered postmenopausal hormone therapy (PHT) or a placebo and to a non-blind group receiving open-label PHT or no drugs. A woman was classified as non-adherent, if she had stopped treatment for at least 6-month period in treatment arms or used PHT for at least 6-month period in the control group. Adherence was calculated by the Kaplan–Meier method, and factors affecting adherence were studied with Cox proportional hazard modelling. Results : The rate of adherent women declined approximately 50% during the first year in all treatment arms. Less than 10% of the control group women started taking prescribed PHT. Older women, with lower education, with only one birth, never used oral contraceptives (OC), with lower physical activity or who were dissatisfied with the information received from the trial staff, were more likely to discontinue. In treatment arms, the two most often cited reasons for non-adherence were side-effects and woman's loss of interest in participation. Control group women started PHT due to the menopausal symptoms or on doctor's recommendation. Conclusions : The adherence was similar to that found for PHT use in everyday life. Higher adherence was related to younger age, higher education, previous OC use, physical activity and satisfaction with received information.

Objective: The aim of this study was to develop a new radiographic measure, the patellar shift index (PSI), for the precise estimation of patellar position relative to the trochlea after a total knee replacement with an unresurfaced patella.Methods: This study included radiographs of 51 patients suffering from anterior knee pain following total knee arthroplasty. Patellofemoral axial radiographs were analyzed to compare the reliability of the PSI to the classical measures of patellofemoral congruence, the lateral patellar tilt (LPT) and patellar displacement (PD). Intra-rater reliability of the PSI, LPT and PD was estimated using the intraclass correlation coefficient (ICC) and the inter-rater reliability using Krippendorff’s alpha (Kα). Agreement proportion of was calculated for the PD. Face validity of the PSI was also tested.Results: The PSI had excellent intra (mean ICC=0.91) and inter-rater (Kα=0.92) reliability, as did LPT (mean ICC=0.96; Kα=0.89). The calculation of PD caused a low level of agreement (47.1%) between evaluators in terms of which images could be measured. The exclusion of these radiographs resulted in a high PD intra (ICC=0.96) and inter-rater (Kα=0.97) reliability.Conclusion: The PSI appears to be a reliable and valid measure for patellofemoral congruence in a replaced knee joint with an unresurfaced patella. The superiority of the PSI is the result of its consideration of the geometry and size of the replaced knee joint and independence from radiographic magnification., Amaç: Bu çalışmanın amacı patella yüzey değişimi yapılmayan total diz protezi sonrasında trokleaya göre patellanın pozisyonunun kesin tahmini için yeni bir radyografik ölçü, patellar kayma endeksi (PKE), geliştirmek idi.Çalışma planı: Çalışmaya, total diz protezi sonrası ön diz ağrısı şikayeti olan 51 hastanın radyografileri katıldı. Patellar kayma endeksi güvenilirliğini, patellofemoral uyum, lateral patellar açılanma (lateral patellar tilt, LPT) ve patellar deplasman (PD) gibi klasik ölçümlerle karşılaştırmak amacıyla patellofemoral aksiyel radyografiler incelendi. Patellar kayma endeksi LPT ve PD değerlendirici içi güvenilirliği, sınıf içi korelasyon katsayısı (intraclass correlation coefficient, ICC), değerlendiriciler arası güvenilirliği Krippendorff alfa (Ka) kullanılarak hesaplandı. Patellar deplasman için uzlaşma oranı hesaplandı. Patellar kayma endeksi yüzeysel geçerliliği de test edildi. Bulgular: Patellar kayma endeksi, tıpkı LPT gibi (ortalama ICC=0.96, Ka=0.89) mükemmel değerlendirici içi (ortalama ICC=0.91) ve arası (Ka=0.92) güvenilirliğe sahipti. PD hesaplaması, hangi görüntülerin ölçülebilir olduğu açısından değerlendiriciler arasında düşük seviyede uzlaşmaya (%47.1) neden oldu. Bu radyografilerin dışlanması, yüksek PD değerlendirici içi (ICC=0.96) ve arası (Ka=0.97) güvenilirlik ile sonuçlandı. Çıkarımlar: Patellar kayma endeksi, patella yüzey değişiminin yapılmadığı yenilenmiş diz ekleminde patellofemoral uyum için geçerli ve güvenilir bir ölçü olarak gözükmektedir. Patellar kayma endeksinin üstünlüğü, yenilenmiş diz ekleminin geometrisi ve boyutunu dikkate almasından ve radyografik büyütmeden bağımsız olmasından doğan bir sonuçtur.

Background and objective: : Anterior knee pain (AKP) may compromise the results of total knee arthroplasty in more than quarter of cases. The aim of the current work was to determine the prevalence of AKP and the severity of patellofemoral symptoms among patients who received a total knee arthroplasty with non-replaced patella in East-Tallinn Central Hospital from January 1, 2000 to December 31, 2009. Materials and methods: We carried out a retrospective study involving 1778 consecutive total knee arthroplasties with non-replaced patella. Mean follow-up time was 68 months. We collected data by two patient-reported measures: the knee pain questionnaire and the Kujala score. Results: We diagnosed AKP among 20.2% of patients, 33.6% had pain in the knee from a source other than patellofemoral joint and 46.2% were pain free. In 87.3% of AKP cases the pain emerged within the first five years of knee replacement. AKP was more prevalent among patients with osteoarthritis compared to rheumatoid arthritis and among patients below 60 years. There was no difference in the prevalence of AKP in terms of gender or mobile and fixed bearing implants. The severity of patellofemoral symptoms in case of AKP was moderate. Conclusions: AKP is a frequent complication of total knee arthroplasty with non-replaced patella and patients undergoing this procedure should be apprised of the high probability of experiencing pain in the anterior part of the replaced knee.

To explore socio-demographic factors, health risks and harms associated with early initiation of injecting (before age 16) among injecting drug users (IDUs) in Tallinn, Estonia.IDUs were recruited using respondent driven sampling methods for two cross-sectional interviewer-administered surveys (in 2007 and 2009). Bivariate and multivariate logistic regression analysis was used to identify factors associated with early initiation versus later initiation.A total of 672 current IDUs reported the age when they started to inject drugs; the mean was 18 years, and about a quarter of the sample (n = 156) reported early initiation into injecting drugs. Factors significantly associated in multivariate analysis with early initiation were being female, having a lower educational level, being unemployed, shorter time between first drug use and injecting, high-risk injecting (sharing syringes and paraphernalia, injecting more than once a day), involvement in syringe exchange attendance and getting syringes from outreach workers, and two-fold higher risk of HIV seropositivity.Our results document significant adverse health consequences (including higher risk behaviour and HIV seropositivity) associated with early initiation into drug injecting and emphasize the need for comprehensive prevention programs and early intervention efforts targeting youth at risk. Our findings suggest that interventions designed to delay the age of starting drug use, including injecting drug use, can contribute to reducing risk behaviour and HIV prevalence among IDUs.

Background Both syringe exchange programs (SEPs) and pharmacy sales of syringes are available in Estonia, though the current high incidence and high prevalence of HIV among injection drug users (IDUs) in Tallinn, Estonia requires large-scale implementation of additional harm reduction programs as a matter of great urgency. The aims of this report were to compare risk behavior and HIV infection and to assess the prevention needs among IDUs who primarily use pharmacies as their source of sterile syringes with IDUs who primarily use SEPs in Tallinn. Methods A cross-sectional study using respondent-driven sampling was used to recruit 350 IDUs for an interviewer-administered survey and HIV testing. IDUs were categorized into two groups based on their self-reported main source for syringes within the last six months. Odds ratios with 95% CI were used to compare characteristics and risk factors between the groups. Results The main sources of sterile needles for injection drug users were SEP/SEP outreach (59%) and pharmacies (41%). There were no differences in age, age at injection drug use initiation, the main drug used or experiencing overdoses. Those IDUs using pharmacies as a main source of sterile needles had lower odds for being infected with either HIV (AOR 0.54 95% CI 0.33–0.87) or HCV (AOR 0.10 95% CI 0.02–0.50), had close to twice the odds of reporting more than one sexual partner within the previous 12 months (AOR 1.88 95% CI 1.17–3.04) and engaging in casual sexual relationships (AOR 2.09 95% CI 1.24–3.53) in the last six months. Conclusion The data suggest that the pharmacy users were at a less "advanced" stage of their injection career and had lower HIV prevalence than SEP users. This suggests that pharmacies could be utilized as a site for providing additional HIV prevention messages, services for IDUs and in linking IDUs with existing harm reduction services.