Kaja-Triin Laisaar

Acute mesenteric ischemia (AMI) is difficult to recognize and is often diagnosed late. Currently there are no established biomarkers that can assist in diagnosis or management. The present study was a systematic review of animal data, intended to identify potentially time-sensitive biomarkers for human AMI. A systematic literature search was conducted using PubMed, Web of Science, and Scopus up to 10/02/25. Studies assessing potential biomarkers of AMI in mammalian models, with timed responses from the onset of experimental ischemia were selected. Data quality was assessed using CAMARADES, and PRISMA guidelines were followed. Searches identified 2175 publications from which 342 were selected for full text review, and 61 papers describing 103 experiments on 53 potential biomarkers were analyzed. The models were very heterogeneous and a meaningful meta-analysis was not possible for any biomarker. However, a pragmatic list of biomarkers of potential value in AMI that could warrant investigation in humans has been formulated. Those proposed are D-lactate, intestinal fatty acid-binding protein, ischaemia-modified albumin, and signal peptide-CUB-EGF domain-containing protein 1. No single biomarker has provided unambiguous evidence to promote its use in clinical practice, but several may deserve further evaluation in future human studies.Study funding: Estonian Research Council, Grant PRG 1255.Study registration: PROSPERO CRD42023400888 (reference 400888).

Background: Medication adherence is essential for treatment effectiveness and safety, but pharmacy students may find it difficult to assess adherence comprehensively during medication reviews (MRs). This study examined how pharmacy students assess medication adherence in real-world MRs and explored whether complementary adherence frameworks could support broader evaluation. Methods: This observational exploratory study was conducted in the integrated MSc (Master of Science) Pharmacy program at the University of Tartu, Estonia. During the internship, 21 pharmacy students performed a Brown Bag MR with patients aged 65 years or older who used at least 5 prescription medications. Data included patient interviews, e-prescription records, and a validated MR documentation form. An expert panel applied the World Health Organization Medication Adherence Model (WHO-MAM) and the Perceptions and Practicalities Approach (PAPA) to identify adherence determinants not captured by the student-used MR tool. Descriptive statistics and qualitative content analysis were used. Results: Students mainly documented therapy- and patient-related issues, such as incorrect dosing, side effects, and interactions, while socioeconomic and healthcare system factors were rarely identified. Students identified potential adherence-related issues in 19% of cases, whereas experts identified such issues in 57% of cases. Additional gaps included limited recognition of financial barriers, access difficulties, and social support factors. Conclusions: In this exploratory study, pharmacy students identified medication-use-related problems during MRs, but broader adherence-related determinants were less consistently documented. These preliminary findings suggest that structured frameworks such as WHO-MAM and PAPA may be useful for broadening adherence assessment in experiential pharmacy education.

Background: This study aimed to gain insight into the opinions and attitudes about, and potential barriers and facilitators to lung cancer screening (LCS) among healthcare professionals in Estonia. It also aimed to determine knowledge gaps that could be addressed when planning next steps toward a national LCS program. Methods: A cross-sectional, web-based survey was conducted in June to August 2023 among primary care providers (PCPs), pulmonologists, radiologists, oncologists, and thoracic surgeons in Estonia. Differences between PCPs and other specialists were analyzed with regard to their knowledge, beliefs and attitudes toward LCS. Results: About 146 healthcare professionals responded, 57% were family physicians. Less than half of all respondents considered existing evidence or international recommendations sufficient to support national LCS implementation, with uncertainty higher among PCPs. Adjusted analyses revealed that the PCPs had substantially higher odds of responding “Do not know” concerning international recommendations (aOR 5.06; 95% CI 1.97–13.85), and were far less likely to agree to assigning main responsibility for LCS participation to family physicians (aOR 0.10; 95% CI 0.02–0.40). PCPs also demonstrated greater uncertainty about the costs and labor intensity in LCS. Conclusion: This study reveals substantial variation in LCS knowledge, attitudes, and certainty across healthcare profession(al)s, highlighting the need for targeted training. Although for most professionals the benefits of LCS outweigh potential harms, structural constraints and uncertainty should still be carefully considered. Despite limited generalizability, study findings support evidence-informed planning and have already been considered in the Estonian LCS pilot study, the first step toward a national LCS program.

Introduction Prevention science is interdisciplinary, drawing upon multiple fields of research and practice to develop integrated knowledge. A challenge facing the field is the proliferation of different terms with the same meaning, and of terms with different meanings. This can create confusion in communication, affect evaluation standards, and ultimately also affect the implementation of preventive interventions. Contributing to the development of evidence standards for preventive interventions, this article describes the process and results of interdisciplinary prevention terminology development in Estonia. Methods Following the Participatory Action Research (PAR) approach, different co-design tools were used during a four-year process to help understand terminological needs, generate ideas, draw concept maps, and test examples of definitions in different target groups. Results Thirty-five terms were tested, refined, and published. Six of these represent the main concepts relevant to prevention and intervention evaluation: vulnerability, prevention, preventive intervention, well-being, process evaluation, and impact evaluation. Several candidate terms were omitted for being confusing, ambiguous, or misunderstood in terms of the type or mechanism of intervention, the quality of evidence, or the quality of practice. Discussion Collaborative and participatory methods can be used to bridge the divide in language and to help pursue consensus definitions. Shared understanding is needed both nationally and internationally between disciplines, sectors, implementation levels, and professions, as the involved parties include policymakers, researchers, innovators, and practitioners in the domains of healthcare and public health, education, safety, social work and welfare, justice, and culture. The development of an interdisciplinary prevention glossary described in this paper was novel in its approach and has the potential to support successful continuing interdisciplinary collaboration in the prevention field.

Computed tomography (CT) is widely used in diagnosing acute mesenteric ischemia (AMI), but robust identification of distinctive subtypes and stages of progression is lacking. Systematic literature search in PubMed, Cochrane Library, Web of Science and Scopus was conducted in May 2024. Studies including at least 10 adult patients and reporting radiological diagnosis of AMI versus no AMI or transmural ischemia versus no transmural ischemia were included. Meta-analyses on sensitivity and specificity of different radiological features in diagnosing AMI were conducted. From 2628 titles, 490 studies underwent full text review, and 81 were included in 14 meta-analyses. Diagnostic accuracy of CT angiography (CTA) was high - sensitivity of 92.0% and specificity of 98.8% (I² 45% and 79%, respectively), but lower for other CT protocols (sensitivity 75.8 and specificity 90.5; I² 83%). In most included studies, distinction of subtypes and severity of AMI (non-transmural or transmural) was not possible. Amongst the non-vascular features, absent/reduced bowel wall enhancement provided the best prognostic value (sensitivity 57.9 and specificity 90.1). CTA is the method of choice for diagnosing AMI with high diagnostic accuracy. None of the non-vascular features alone is sufficiently reliable to diagnose AMI or its progression to transmural necrosis, whereas a combination of different radiological features conveys a potential.

Objective To estimate the incidence of acute mesenteric ischaemia (AMI), proportions of its different forms and short-term and long-term mortality. Design Systematic review and meta-analysis. Data sources MEDLINE (Ovid), Web of Science, Scopus and Cochrane Library were searched until 26 July 2022. Eligibility criteria Studies reporting data on the incidence and outcomes of AMI in adult populations. Data extraction and synthesis Data extraction and quality assessment with modified Newcastle-Ottawa scale were performed using predeveloped standard forms. The outcomes were the incidence of AMI and its different forms in the general population and in patients admitted to hospital, and the mortality of AMI in its different forms. Results From 3064 records, 335 full texts were reviewed and 163 included in the quantitative analysis. The mean incidence of AMI was 6.2 (95% CI 1.9 to 12.9) per 100 000 person years. On average 5.0 (95% CI 3.3 to 7.1) of 10 000 hospital admissions were due to AMI. Occlusive arterial AMI was the most common form constituting 68.6% (95% CI 63.7 to 73.2) of all AMI cases, with similar proportions of embolism and thrombosis. Overall short-term mortality (in-hospital or within 30 days) of AMI was 59.6% (95% CI 55.5 to 63.6), being 68.7% (95% CI 60.8 to 74.9) in patients treated before the year 2000 and 55.0% (95% CI 45.5 to 64.1) in patients treated from 2000 onwards (pConclusions In adult patients, AMI is a rarely diagnosed condition with high mortality, although with improvement of treatment results over the last decades. Two thirds of AMI cases are of occlusive arterial origin with potential for better survival if revascularised. PROSPERO registration number CRD42021247148.

Estonia had the highest rate of newly diagnosed human immunodeficiency virus (HIV) cases in the European Union (24.6/100,000) and an estimated adult HIV prevalence of 1.3% in 2013. HIV medical care, including antiretroviral therapy (ART), is free of charge for people living with HIV (PLHIV). To maximise the health benefits of HIV treatment, universal access should be achieved. Using data from surveillance and administrative databases and the treatment cascade model, we assessed the number of people infected with HIV, diagnosed with HIV, linked to HIV care, retained in HIV care, on ART, and with suppressed viral load (HIV-RNA: < 200 copies/mL). We identified that about one quarter of the 8,628 HIV-positive people estimated to live in Estonia in 2013 had not been diagnosed with HIV, and another quarter, although aware of their HIV-positive serostatus, had not accessed HIV medical care. Although altogether only 12–15% of all PLHIV in Estonia had achieved viral suppression, the main gap in HIV care in Estonia were the 58% of PLHIV who had accessed HIV medical care at least once after diagnosis but were not retained in care in 2013.

Regular interactions with people living with HIV/AIDS (PLWHA) who are receiving care provide caregivers opportunities to deliver interventions to reduce HIV-related risks. We conducted a systematic review of behavioral interventions for PLWHA (provided at individual level by caregivers at HIV care settings) to determine their efficacy in reducing sexual risk behavior. Conference websites and biomedical literature databases were searched for studies from 1981 to 2013. Randomized and quasi-randomized controlled trials (with standard-of-care control groups), considering at least one of a list of HIV-related behavioral or biological outcomes in PLWHA aged ≥18 receiving HIV care with at least 3-month follow-up were included. No language or publication status restrictions were set. Standardized search, data abstraction, and evaluation methods were used. Five randomized controlled trials were included in the review. We found limited evidence that sexual risk reduction interventions increase condom use consistency in HIV transmission risk acts, and reduce the number of (casual) sexual partners. We still believe that regular interactions between HIV care providers and PLWHA provide valuable opportunities for theory-based sexual risk reduction interventions to restrain the spread of HIV.

There is limited data on and experience with interventions for antiretroviral therapy (ART) adherence support for patients on ART in Eastern Europe. We sought to identify a feasible adherence support intervention for delivery amongst HIV-positive adults receiving care in Estonia, where the HIV/AIDS epidemic has been mainly concentrated among injection drug users (IDUs). Our application of intervention mapping (IM) strategies used existing literature, formative research and multidisciplinary team input to produce a brief clinic-based intervention entitled the Situated Optimal Adherence Intervention Estonia (sOAI Estonia) which uses both Next-Step Counseling (NSC) and Information–Motivation–Behavioral Skills (IMB) Model approach to facilitate integration of ART into the context and demands of daily life. We present the intervention development process, the resulting sOAI Estonia approach, and describe a randomized controlled trial (RCT) which is under way to evaluate the intervention (results due in spring 2013).