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Vaimse tervise veebirakendused: teaduskirjanduse ülevaade ja soovitused
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Reieluukaela murru tervise- ja majandusmõju Eestis
Full text linkVäitekirja elektrooniline versioon ei sisalda publikatsiooneReieluukaela murd vanemas eas on seotud olulise elukvaliteedi languse, liigsuremuse ja kuluga. Arenenud maades saab iga kuues üle 50-aastane naine eluea jooksul reieluukaela murru, kuni 20% haigetest sureb aasta jooksul peale murdu ja murrueelne elukvaliteet taastub vähem kui pooltel haigetest.
Samas on tervisekaotuse hinnangutes veel palju ebaselget. Esmashaigestumus Euroopa riikides varieerub, kuid erinevuse põhjused ei ole lõpuni selged. Reieluukaela murruga seotud kulud suurenevad, kuid andmed tervishoiu- ja sotsiaalteenuste kasutuse kohta on ebapiisavad. Reieluukaela murru epidemioloogilised ja kuluandmed Eestis on puudulikud.
Uurimistöö eesmärk oli reieluukaela murruga seotud tervise- ja majandusmõju hindamine ≥50-aastastel inimestel Eestis 2005-2016 aastal. Hinnati reieluukaela murru avaldumust (ökoloogiline uuring), liigsuremust (rahvastikupõhine retrospektiivne kohortuuring) ja murruhaigete elukvaliteeti, ressursikasutust ja kulusid (prospektiivne kohortuuring). Andmed saadi Eesti Haigekassast, reieluukaela murruga haigete intervjuudest ja Eesti statistika andmebaasist.
Leiti, et reieluukaela murru avaldumus Eesti naistel oli suhteliselt madal, kuid meestel üks Euroopa kõrgematest. Murdude arvu suurenemine vaatlusalusel perioodil oli tingitud rahvastiku vananemisest. Murrujärgne elukvaliteet oli vaid 7% võimalikust ja selle taastumine aeglasem kui paljudes Euroopa riikides. Murrujärgse eriarstiabi ja perearsti teenuse kasutus oli võrreldav Rootsiga, kuid taastusravi, koduõenduse ja sotsiaalabi kasutus väga madal. Seda kompenseeris lähedaste abi, mida kasutas 18 kuu jooksul 80% haigetest. Reieluukaela murru 18 kuu kogukulu oli >8000 eurot haige kohta, mis on võrreldav infarkti ja insuldi kogukuluga.
Samuti leiti, et reieluukaela murd on oluline iseseisev suremuse riskifaktor. Keskmine murrujärgne üldsuremus ühe aasta jooksul oli 28% ehk 20% võrra (3-4 korda) kõrgem kui ilma murruta isikuil, olles võrreldav dementsuse või metastaatilise vähi korral esinevaga. Liigsuremus nooremates vanusrühmades (50-69 aastat) oli Eestis suurem kui lääneriikides. Kaasuvate haiguste mõju reieluukaela murru liigsuremusele on väike ja ei oma liigsuremuse vähendamisel kriitilist rolli. Liigsuremuse vähendamine saab olla võimalik murru ja selle tüsistuste vältimise ning meditsiinilise ja sotsiaalse rehabilitatsiooni parandamisega.
Tulemused võimaldavad reieluukaela murruga seotud summaarse tervisekaotuse hindamist, sihtrühmade määratlemist murruga seotud suremuse vähendamiseks ja informeeritud tervise- ja sotsiaalpoliitiliste otsuste langetamist. Tulemusi saab kasutada ka reieluukaela murru ennetus- ja ravimeetmete kulutõhususe hindamisel. Teadaolevalt on tegemist esimese tervikliku reieluukaela murru tervise- ja majandusmõju hindamisega Kesk- ja Ida-Euroopas.Hip fracture in older age is associated with significant loss of quality of life, excess mortality, and cost. Every 6-7th woman over 50 years will experience a hip fracture, over 20% of patients die within one year, and less than half of patients recover fully.
However, the disease burden of hip fracture is not well established. The incidence among European countries varies, while the reasons for this variability are not certain. Costs are increasing, but the data on health and social care use are insufficient. The epidemiologic and cost data for Estonia are incomplete.
The aim of the research was to assess the health and economic impact of hip fracture among individuals aged over 50 years in Estonia in 2005-2016. We estimated the incidence (ecological study), excess mortality (population-based retrospective cohort study), and the loss of quality of life, resource use, and cost (prospective cohort study). The data were collected from the Estonian Health Insurance Fund database, Statistics Estonia, and from patient interviews.
The hip fracture incidence in Estonian women was among the lowest, and the rate in men among the highest in Europe. The increasing number of fractures over the period of observation was a result of population aging. Patient’s quality of life after a fracture was only 7%, and the recovery was slower than in many other European countries. Fracture-related specialty and primary care use was comparable to that in Sweden, but the use of rehabilitation, home nursing, and social care was very low. The shortfall may explain the high use of informal care. The hip fracture related societal cost during 18 months was >8000 euros per patient, comparable to that for myocardial infarction or stroke.
Hip fracture is a strong independent risk factor for death. The aggregated risk of all-cause death at 1 year after fracture was 28%, being 20% or 3-4 times higher than that without fracture, comparable to that for dementia and cancer. The excess mortality in younger (50-69 years) patients in Estonia was higher than in the Western countries. The impact of comorbidities on excess mortality was modest. Hip-fracture related deaths could be avoided by preventing fractures and their complications and by improving post-fracture care.
These findings should help to estimate the total societal burden of hip fracture, define target groups for reducing mortality after hip fracture, and inform the related health and social policy. The results may also be used in economic evaluations for selecting cost-effective interventions for hip fracture prevention and care. To our knowledge, this is the first comprehensive estimation of hip fracture health and economic impact in Central and Eastern Europe
Kroonilisi elustiilihaigusi ennetavad mittemedikamentoossed sekkumised: teaduskirjanduse ülevaade
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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