Health Services and Well-Being of Children in Estonia.

Estonia has a population of 1.3 million, which makes it one of the least populous member states of the European Union. The fertility rate was 1.65 in 2011, and the average age of women at first child birth was 4 years higher than in the early 1990s. Medical care is free for all children in Estonia. For the last 20 years, family doctors have been responsible for the primary care of children. Pediatric subspecialists work mainly in 2 children's hospitals: the Children's Clinic of Tartu University Hospital and Tallinn Children's Hospital. The average duration of hospital stay has decreased year by year. Pediatric subspecialists take care of children with long-term conditions and chronic diseases. In recent years, electronic case reports and digital receipts have been in use in Estonia. New diagnostic tests and expensive medications, which are available, make the cost of medical care very high.

Differences in Gut Microbiota Between Atopic and Healthy Children.

Although gut microbiota has been studied relatively extensively in the context of allergic diseases, there have been several contradictions between these studies. By applying high-throughput sequencing, we aimed to analyze the differences in gut microbiota between atopic and healthy children at 5 and 12 years of age. 51 stool samples were collected from 14 atopic and 15 healthy children and analyzed with 454 pyrosequencing of the 16S rRNA gene. At the ages of 5 and 12 years, Bacteroides, Prevotella, and Dialister dominated gut microbiota in both atopic and healthy groups of children. Children in the atopic group had lower abundance and prevalence of Akkermansia in gut microbiota than their healthy counterparts. Thus, the composition of gut microbiota does not seem to be significantly different between atopic and healthy children, but lower abundance and prevalence of Akkermansia indicate that this bacterium may accompany or play a role in IgE-mediated atopic diseases.

The association of gut microbiota with body weight and body mass index in preschool children of Estonia.

BACKGROUND: The gut microbiota has been shown to affect both fat storage and energy harvesting, suggesting that it plays a direct role in the development of obesity. The aim of this study was to investigate whether intestinal colonization by particular species/groups of the intestinal microbiota is related to body weight values in Estonian preschool children born in different years during the entire 1990s. METHODS: Body weight, height, body mass index (BMI), and quantitative composition of cultivable gut microbiota (staphylococci, enterococci, streptococci, enterobacteria, lactobacilli, anaerobic gram-positive cocci, bifidobacteria, eubacteria, bacteroides, clostridia, and candida) were studied in 51 healthy 5-year-old children (40 were born between 1993 and 94 and 11 were born between 1996 and 97). RESULTS: At the age of 5 years, median weight was 19.5 kg and median BMI was 15.3 kg/m(2). Significantly higher BMI (p=0.006) was found in 5-year-old children born in late versus early 1990s during the development of socioeconomic situation of Estonia (2% rise in gross domestic product). The counts of the different gut bacteria did not show any association with weight and BMI in the 5-year-old children. However, the BMI values were in positive correlation with a relative share of anaerobic gram-positive bacteria, for example, bifidobacteria when adjusted for sex and year of birth (adj R(2)=0.459, p=0.026) and eubacteria (adj R(2)=0.484, p=0.014) in the community of cultured intestinal microbiota. The relative share of bacteroides showed a negative correlation with the childrens' weight (adj R(2)=- 0.481, p=0.015). CONCLUSION: The body weight indices of preschool children of the general population are associated with the proportion of anaerobic intestinal microbiota and can be predicted by sex and particular socioeconomic situation from birth to 5 years of age.

Regional differences in diagnosing asthma and other allergic diseases in Estonian schoolchildren.

UNLABELLED: The aim of this study was to estimate the prevalence of asthma and other allergic diseases among Estonian schoolchildren of the cities lacking special (pediatric allergological) health care. MATERIAL AND METHODS: The study, carried out through 1 March to 8 May, 2003, enrolled 5th- to 12th-grade schoolchildren of 4 schools in different regions of Estonia. A three-step protocol was followed: screening questionnaire, examination by a pulmonary resident, and consultation by a pediatric allergologist. RESULTS: Of the 3132 questionnaires distributed, 1561 (49%) were returned. A total of 828 schoolchildren answered positively to any of the questions about possible allergic disease. After examination by the pulmonary resident, 255 schoolchildren (15.7%) were referred to an allergologist for final diagnosis. Asthma was diagnosed in 4.8%, allergic rhinoconjunctivitis in 4.9%, and atopic eczema in 8.3% of schoolchildren. Asthma, allergic rhinoconjunctivitis, and urticaria occurred more frequently in Narva as compared with Võru. CONCLUSION: The 12-month prevalence of asthma among Estonian schoolchildren was 4.8%, and the prevalence of allergic diseases varied from region to region. Less than half (40%) of all asthma cases identified during the study were newly diagnosed, and this clearly indicates that there is a considerable underdiagnosis of the disease among schoolchildren living outside of the centers in Estonia.

Molecularly assessed shifts of Bifidobacterium ssp. and less diverse microbial communities are characteristic of 5-year-old allergic children.

The composition of intestinal microbiota and the Bifidobacterium group community in 20 allergic and 20 nonallergic 5-year-old children was visualized by PCR-denaturing gradient gel electrophoresis (DGGE). The number of dominant bands in the DGGE profiles was smaller in allergic children than in nonallergic children (P<0.001). Allergic children mainly formed a single group upon cluster analysis, whereas nonallergic children were divided between four different groups. In allergic children the Bifidobacterium adolescentis species prevailed, and in nonallergic children the Bifidobacterium catenulatum/pseudocatenulatum prevailed (P=0.01 and P=0.01, respectively). The less diverse composition of intestinal microbiota and prevalence of particular species of Bifidobacterium were characteristic of allergic children even at the age of 5 years.