Important questions remain regarding differences in geographical and age-specific mortality patterns as the COVID-19 pandemic evolved in consecutive waves, and how COVID-19 mortality compares to seasonal influenza. In a pandemic situation, excess all-cause mortality provides a more complete and robust measure than cause-specific mortality. Data submitted by 26 countries participating in the European Mortality Monitoring (EuroMOMO) network between 2020 and 2023 was analysed to quantify excess all-cause mortality during the COVID-19 pandemic. Excess mortality from this period was compared to previous influenza seasons from 2014 to 2019. Pooled estimates of excess mortality showed four main waves during the COVID-19 pandemic period, most markedly in people aged 65 years and above, with timing and magnitude that varied between countries. Here we show that prior to implementation of control measures and COVID-19 vaccination, excess mortality greatly exceeded typical seasonal influenza mortality, but later during the pandemic was at levels comparable to influenza.
Objectives:The study aimed to provide a comparative analysis of HRQoL and its health-related and socio-demographic correlates among Ukrainian refugees and general population in Estonia. Methods:Study used age and sex matched data (1249 pairs) from two representative cross-sectional surveys covering Ukrainian refugees aged 18-64 years residing in Estonia (n = 1,430), and the general population (n = 2007) of Estonia in 2024. Tobit-regression was used to compare the EQ-5D-3L index values in both groups while controlling for wide range of socio-demographic and health indicators. Results:Refugees reported less restrictions in mobility, self-care or in performing usual activities, whereas higher prevalence of pain/discomfort and anxiety/depression was found for refugees compared to control group. Refugees had slightly lower EQ-5D index score (estimate -0.017, p = 0.029) compared to population controls after adjustment for socio-demographic and health-related covariates. Conclusion:Variations in EQ-5D-3L dimensions and index scores between refugees and population controls contribute to the literature on refugee HRQoL and extend the knowledge on HRQoL of Ukrainian refugees in the context of ongoing refugee crisis in Europe while also improving knowledge for support provision to this refugee group in Estonia.
Longitudinal studies on population representative samples offer unique insights. The Estonian Children Personality Behaviour and Health Study (ECPBHS; EstChild) was launched in 1998 on two birth cohort samples at age 9 or 15 with an exceptional participation rate, has been monitored at ages 15, 18, 25 and 33, and also recruited parents of the target subjects. This multidisciplinary investigation has been focused on behavioural neuroscience, illuminating findings on what could be discerned from biomarkers, candidate genes, gene × environment interactions, and epigenetic markers in representative samples, and in birth cohorts living through societal transformation. ECPBHS analysed how biomarkers and lifestyle are associated with real-life behaviours and developmental trajectories, phenotypes such as neuroticism, bulimia, aggressiveness or attention deficit, and outcomes from incidence of psychiatric disorders to the obtaining of university education. Novel evidence has been observed on clustering of fears and the inner structure of impulsivity and reward sensitivity, together with clues how these may have co-emerged with metabolic types. New insights have been provided to understand the classic biomarkers, cholesterol and platelet monoamine oxidase activity, as well as several functional gene variants. Hypotheses how to synthetise molecular genetics and sociology, how sex or gender matters in the light of gene × environment interactions and how family and parental roles shape the behaviour of offspring have been put forward. The ECPBHS has offered clues on why in biological psychiatry many replication attempts are predestined to fail, and how to learn from such failures.
Effective cervical cancer screening and progress toward WHO elimination targets depend on complete follow-up for women with positive primary screening tests. However, real-world data on this critical step in hrHPV-based screening programs in Eastern Europe are scarce. We conducted a nationwide, population-based retrospective cohort study in Estonia, analyzing records from the Estonian Health Insurance Fund and Population Register. We included 44,282 women aged 30-65 who were invited to hrHPV-based screening between January 1, 2021, and December 31, 2022, with follow-up through March 31, 2024. Screening attendance was 45.7% (n = 20,242; 95% CI: 45.2%-46.2%), with 8.0% (n = 1615; 95% CI: 7.6%-8.4%) testing hrHPV-positive. A substantial loss to follow-up was observed: 57.7% of hrHPV-positive women did not undergo repeat hrHPV testing, colposcopy, or any post-colposcopy care within 12 months. Among those referred for further diagnosis, colposcopy was performed in 77.9% within 6 months. Treatment for High-Grade Squamous Intraepithelial Lesion (HSIL) cases was high (85.5%; n = 124; 95% CI: 78.7%-90.5%), mostly within 3 months. Predictors of lower follow-up adherence included older age and residence in South Estonia. Suboptimal screening uptake and high loss to follow-up among hrHPV-positive women are significant barriers to effective cervical cancer prevention in Estonia. These challenges mirror those seen in many organized screening programs globally. Prioritizing strategies to enhance follow-up adherence is critical for timely diagnosis and treatment, ultimately accelerating global efforts toward cervical cancer elimination.
Background. Prostate cancer (PCa) is the most frequently diagnosed cancer in men in the European Union. Following the 2022 Council Recommendation to evaluate organised screening based on prostate-specific antigen (PSA) testing and magnetic resonance imaging (MRI), PRAISE-U defined 21 harmonised key performance indicators (KPIs). We report their first empirical values from the five PRAISE-U pilots and, through a common survey, from EUCanScreen pilots and the Swedish organised prostate cancer testing (OPT) programme. Methods. In PRAISE-U, men aged 50–69 years at five pilot sites in Spain, Lithuania, Poland and Ireland were invited to risk-stratified screening comprising PSA testing, first-level risk stratification, MRI for intermediate or high risk and selective biopsy, with prospective capture in a central REDCap database. EUCanScreen pilots and the Swedish organised prostate cancer testing (OPT) programme reported the same KPIs through an online survey. Results. Twelve programmes reported KPI values. Across the five PRAISE-U pilots, participation ranged from 7.1% to 43.0%, PSA exceeded 3 ng/ml in 9.2–15.0%, and compliance was 76.4–96.0% for first-level risk assessment, 89.9–98.3% for MRI and 78.9–99.0% for biopsy. Detection ranged from 8 to 26 per 1,000 screened in PRAISE-U and from 4.3 to 28 across all programmes. ISUP grade 1 accounted for 20.3–81.4% of cancers, active-surveillance uptake for 14.8–100%, and mean time from PSA result to MRI for 19–114 days; external values fell broadly within the PRAISE-U ranges. Thirteen of 21 KPIs were fully reported by all five pilots, all describing the diagnostic pathway; retention and the three impact indicators were reported only by Sweden, which reported 19 of 21. Conclusions. Diagnostic-pathway KPIs were measurable under pilot conditions, whereas programme-level indicators required a defined target population or registry linkage. Sweden, the only population-based programme, reported retention and long-term impact, identifying the infrastructure needed before organised PCa screening can be monitored at scale.
