Mariliis Põld

Background Routinely collected health data can reveal recorded care around diagnosis, but disease-specific curation does not scale across thousands of conditions. We scaled a previously developed automated framework that reduces heterogeneous clinical events into standardised, diagnosis-centred summaries of real-world care patterns. Methods In this retrospective observational study, we used EST-Health-30, a pseudonymised 30% random sample of Estonian residents with health-care records from 2012 to 2024. We constructed cohorts for ICD-10 three-character diagnostic categories using the first eligible observed diagnosis after a 3-year diagnosis-free observable lookback. For each category, we summarised recorded clinical events from a 90-day pre-index window, a 30-day post-index window, and a 365-day post-index window. An enrichment-based workflow compared earlier self-comparator periods and matched population controls, then filtered and aggregated concepts across clinical domains. Diagnosis-concept relationships were assessed by rubric-guided language-model classification, and atlas plausibility and utility by ten experts. Findings Of 1645 observed diagnostic categories, 1080 met inclusion criteria, yielding 3240 diagnosis-window summaries across 509,856 individuals. Each summary characterised diagnosis-associated events by prevalence, enrichment, timing, co-occurrence, and variation between patient groups after reducing candidate concepts by 97-98%. Among 296,303 retained diagnosis-concept pairs, the language model classified 24% as directly related, 55% as indirectly related, and 21% as noisy. Experts rated the atlas highly for generating research questions (median 6.5 of 7 [IQR 6-7]), providing information difficult to obtain conventionally (6 [5-7]), and supporting observational study design (5.5 [5-6]). Interpretation The atlas makes multidimensional diagnosis-centred patterns in longitudinal health records inspectable at population scale in order to support clinical orientation, hypothesis generation, and observational study planning. Outputs represent recorded care rather than individual patient trajectories or causal effects. Funding Estonian Research Council; European Union; Estonian Ministry of Education and Research; Innovative Medicines Initiative 2 Joint Undertaking; EFPIA.

Aim: To describe nurses' self‐perceived confidence in patient safety competencies and examine how work‐ and education‐related factors influence this confidence. Design: A descriptive, explorative, cross‐sectional survey design. Methods: The Health Professional Education in Patient Safety Survey (H‐PEPSS) was administered to a convenience sample of practising nurses and master's degree students in Estonia between May and September 2023. The following background variables were included: work experience, workplace, educational level and prior patient safety training. A total of 376 respondents completed the survey. Data were analysed using descriptive statistics and multivariable logistic regression, which returned the odds ratios for associations between background factors and confidence in patient safety. Results: Nurses perceived the highest confidence in understanding human and environmental factors, and the lowest confidence in teamwork. Having longer work experience was found to demonstrate a positive association with nurses' confidence in teamwork (OR = 1.03, 95% CI = 1.01–1.05) and safety culture (OR = 1.02, 95% CI = 1.00–1.04), compared to nurses with less experience. Nurses in smaller hospitals felt more confident managing safety risks (OR = 2.19, 95% CI = 1.14–4.21), compared to nurses from bigger hospitals. Master's degree students showed significantly higher confidence in responding to adverse events and safety culture than other respondents. Prior patient safety training was associated with greater confidence across several domains. Conclusions: Confidence in patient safety competencies varies by domain and was found to be noticeably shaped by experience, education and workplace context. As such, targeted training and supportive environments are essential to ensuring high levels of competence among nursing professionals. Implications for the Profession and Patient Care: The findings underscore how improvements in training and organisational support can strengthen patient safety. Furthermore, retaining experienced and diversely educated nurses is key to building confidence and ensuring a competent workforce. The finding that respondents assess their confidence in teamwork as weak means that new educational interventions need to be designed and implemented to target this aspect of nursing care. Reporting Method: This study followed the STROBE guidelines for cross‐sectional research. Patient or Public Contribution: No patient or public contribution.

Smoking withdrawal can be difficult due to nicotine dependence (ND). The study objective was to describe ND and to analyze the association between ND and factors related to smoking cessation among daily smoking physicians in Estonia. Data was collected in 2014, using cross-sectional postal survey sampling all practicing physicians (n = 5666) in Estonia, of whom 2939 responded (corrected response rate 53.1%). The study sample was restricted to daily smoking physicians (n = 171). Results of the Fagerström Test for Nicotine Dependence (FTND) were described and ND scores calculated. Logistic regression was used to determine the association of ND (at-least-moderate vs. low) with factors related to smoking cessation. Crude and fully adjusted ORs with 95% CIs were calculated. The mean FTND score was 2.8 ± 2.1. The odds of having at-least-moderate ND decreased significantly with each year postponing smoking initiation (OR = 0.82, 95% CI 0.72–0.94). After adjustment, ND was no longer associated with the desire to quit smoking and motives to quit. In conclusion, more than half of daily smoking physicians had low ND. Higher ND was associated with younger age of smoking initiation. Knowledge of ND and factors related to smoking cessation is useful in the prevention of smoking and in development of cessation counselling tailored for physicians.

Background: For health professionals, personal and contextual factors influence addressing patients’ smoking habits. The objective of the study was to describe frequency of addressing patients’ smoking in 2002 and 2014 and to analyse factors related to addressing patients’ smoking habits. Methods: Data of physicians from 2 postal cross-sectional surveys were used (n = 4140 in 2002, n = 5666 in 2014). The number of respondents was 2747 in 2002 and 2903 in 2014. The corrected response rate was 67.8% and 53.1%, respectively. Age-standardized frequency of addressing patients’ smoking during the last 7 days was determined. Distribution of other variables along with confidence intervals (CI) was calculated. Logistic regression was used to analyse association of addressing patients’ smoking with attitudes and perceived barriers regarding addressing patients’ smoking and with background factors. Fully adjusted odds ratios (OR) with 95% CIs were calculated. Results: The age-standardized prevalence of addressing patients’ smoking habits among men was 84.4% (95% CI 80.3–88.5) in 2002 and 88.3% (95% CI (84.5–92.2) in 2014, among women 82.1% (95% CI 80.2–83.9) and 89.0% (95% CI 87.2–90.8), respectively. According to logistic regression analysis, in 2014, significantly more physicians agreed that it is doctors’ responsibility to convince people to stop smoking (among men, OR 2.32; 95% CI 1.19–4.54, among women OR 1.41; 95% CI 1.06–1.88), that smoking prevention should form part of health professionals’ training, that physicians should have smoking related hand-out materials, and that lack of time was a barrier to addressing patients’ smoking. Addressing patients’ smoking was significantly associated with attitudes and perceived barriers regarding addressing patients’ smoking, age, and other background factors (among women only). Conclusions: Addressing patients’ smoking habits was more common in 2014 than in 2002, but the change was significant among women only. Compared to 2002, in 2014 physicians’ attitudes regarding addressing patients’ smoking were more approving. Results of this study are useful for policymakers and institutions involved in organization and development of smoking prevention training and cessation services.

Background Smoking withdrawal can be difficult due to nicotine dependence (ND). Individual, environmental and social factors must be considered when researching ND. The objective of the present study is to describe ND and to analyse associations between ND and smoking-related and background factors among daily smoking Estonian physicians. Methods A cross-sectional postal survey was used to collect data from Estonian physicians in 2014. The initial sample consisted of all practising physicians in Estonia (n=5666). In total, 2939 physicians participated. The corrected response rate was 53.1%. The current study sample was restricted to physicians who smoked daily (n=171). The outcome variable was ND level, measured using the Fagerström Test for Nicotine Dependence (FTND). The mean age of smoking initiation was calculated, along with the standard deviation and the distribution of ND levels with 95% confidence intervals (CIs). T-tests and chi-square tests were used to test for differences between groups. To compensate for non-response, the data were weighted. Using multiple logistic regression, the association between ND level (at-least-moderate vs low) and smoking-related and background factors was determined. Crude and fully adjusted odds ratios (ORs) with 95% CIs were calculated. Results The mean FTND score for daily smoking physicians was 2.8±2.1, and 60.8% of them had low, 33.1% moderate and 6.1% high ND levels. The mean age of smoking initiation differed statistically between physicians with low and at-least-moderate ND levels (21.0±5.1 and 18.4±3.3, respectively) (p<0.001). In the adjusted model, having at least moderate ND levels was associated with a younger age of smoking initiation (OR=0.82, 95% CI 0.72–0.94). After adjustment, ND levels were not significantly associated with the desire to quit, motives to quit and gender. No association was found between ND level and other background factors. Conclusions More than half of daily smoking Estonian physicians had low ND levels. A higher ND level was associated with a younger age of smoking initiation. Knowledge of ND and related factors is useful in the development of smoking cessation counselling services for physicians.

Introduction: Smoking is a major health threat and quitting smoking would be a notable benefit. The aim of the present study was to explore factors associated with desire to quit smoking among Estonian physicians in 2002 and 2014. Methods: Self-reported data of current smokers were drawn...

Objectives To explore smoking prevalence and attitudes towards smoking among Estonian physicians in 2002 and 2014. Design Two self-administered cross-sectional postal surveys were conducted among practising physicians in Estonia. Participants Initial sample consisted of all practising physicians in Estonia. The corrected response rate was 67.8% in 2002 and 53.1% in 2014. Present study sample was restricted to physicians younger than 65 years (n=2549 in 2002, n=2339 in 2014). Methods Age-standardised prevalence of smoking and prevalence of agreement with seven statements concerning attitudes towards smoking was determined. To analyse association of physicians’ attitudes towards smoking with study year and smoking status, logistic regression analysis was used. Adjusted ORs of agreement with the seven statements were determined. Corresponding 95% CIs were calculated. Results The age-standardised prevalence of current smoking among men was 26.8% in 2002 and 15.3% in 2014, among women 10.4% and 5.8%, respectively. Compared with the year 2002, in 2014, prevalence of agreement with statements declaring harmfulness of smoking was higher and prevalence of agreement with statements approving smoking was lower. Adjusted ORs showed that compared with 2002, physicians’ attitudes towards smoking were less favourable in 2014, and physicians’ attitudes towards smoking were associated with their smoking status. Conclusions Compared with 2002, the age-standardised smoking prevalence among male and female physicians was lower, and attitudes towards smoking were less approving in 2014. The smoking physicians had more approving attitudes towards smoking than their non-smoking colleagues.

Smoking surveys among physicians have proved useful in highlighting the importance of physicians as healthy life style exemplars and role models in tobacco control and smoking cessation. The aim of this study was to give an overview of smoking behaviour among Estonian physicians from 1982 to 2014. Three cross-sectional postal surveys using a self-administered questionnaire were carried out among all practising physicians in Estonia. The number of physicians participating in this study was 3786 in 1982, 2735 in 2002, and 2902 in 2014. Data analysis involved calculating the age-standardized prevalences of smoking, prevalences of smoking by age group and mean age of smoking initiation. A non-parametric test for trend was used to assess significant changes in smoking over time. Age-standardized prevalence of current smoking among men was 39.7% in 1982, 20.9% in 2002, and 14.3% in 2014 and among women 12.2%, 8.0%, and 5.2%, respectively (p < 0.0001 for trends). From 1982 to 2014, the biggest decline of current smoking among men and women was in age groups under 35 (from 55.2% to 16.7% and from 16.7% to 2.8%, respectively) and 35–44 (from 47.1% to 8.3% and from 19.5% to 5.1%, respectively) (p < 0.0001 for trends). Mean age of smoking initiation decreased from 20.4 to 19.3 among men and from 24.5 to 20.4 among women over the study period. In 1982–2014, smoking prevalence among Estonian physicians declined substantially. This may influence the willingness of society to recognize the health consequences of smoking which could give a support to the decline of the smoking epidemic in the country. Differences between smoking among male and female physicians persisted over the study period, but mean age of smoking initiation decreased. A further decline in smoking among Estonian physicians should be encouraged by special efforts targeted at physicians.

Background: Previous reports have shown that physicians who smoke underestimate the effects of smoking on health and this influences their practice. This study was designed to investigate the views of Estonian physicians on the role of smoking in smoking-related diseases. Methods:...