Tallinn Health Care College

Alpha-gal syndrome (AGS) is an emerging tick-borne allergic condition associated with bites from the lone star tick (Amblyomma americanum). Unlike typical tick-borne diseases caused by bacteria or viruses, in AGS there is a delayed allergic reaction to galactose-α-1,3-galactose, a sugar referred to as alpha-gal, which is present in tick saliva; most mammalian meat, such as beef, pork, and lamb; animal-derived products, such as gelatin and dairy (including cow's milk); and certain medications containing animal products. AGS was first identified in the early part of this century, with a notable rise in reported cases in recent years. Contributing factors include climate change, altered wildlife migration, and other ecological shifts that have allowed the lone star tick to expand its range north and west across the United States. Clinically, AGS is characterized by an atypical, delayed allergic response that can occur hours after consumption of red meat. Sensitivity to alpha-gal is delayed for weeks to months after the tick bite, and the allergic reaction after ingesting something that contains the antigen is delayed by hours. Gastrointestinal manifestations are common, and patients may also develop urticaria, bronchospasm, or potentially life-threatening anaphylaxis. The condition is underdiagnosed, owing to its unusual presentation and limited awareness among clinicians. With the continued expansion of the lone star tick's habitat, the incidence of AGS is expected to rise. Enhanced awareness, targeted research, and improved education for both health care practitioners and the public are crucial to reducing misdiagnosis and improving management. Strengthening public health initiatives will be key in addressing this complex and evolving allergic condition. This article aims to describe the epidemiology; pathophysiology, including the role of A. americanum in transmission; and clinical presentation of AGS and highlight its link to tick bites; common barriers to accurate diagnosis; and current strategies for prevention.

Pediatric cholecystitis and cholelithiasis management is heterogeneous. We surveyed European centers to map current practices, training exposure, and outcomes of pediatric biliary cholecystectomy. A 24-item cross-sectional international survey was developed by the European Union of Medical Specialists (UEMS) Section of Paediatric Surgery and distributed to centers in 31 UEMS member states. Items covered institutional resources, indications and timing, surgical approach and adjuncts (ERCP, ICG), training exposure, and center-level outcomes; results are reported as n (%), median (IQR). Outcomes were reported at the center level and were self-reported by participating institutions. Thirty-two centers from 23/31 states responded (74.2%). Pediatric surgeons were primary operators in 84% (shared with adult surgeons in 16%); ERCP access was 66%. Trainee operator share was 22.5% (IQR 5-50) and simulator access 56%. ICG cholangiography was routine in 12.5% and selective in 31%. Acute calculous cholecystitis: 6% always index-admission and 59.4% interval (29-41 days) cholecystectomy; post-ERCP choledocholithiasis: 16% always index-admission cholecystectomy. In 2023, 185 cases were reported: 98.9% laparoscopic with 1.6% conversion; median age 14 years (IQR 12.25-15), operative time 90min (IQR 60-110), length of stay 2 days (IQR 1-2); 10 complications (5.4%). Substantial heterogeneity persists in both care pathways and training exposure; most centers lack formal pediatric-specific guidelines, and trainee-led operating remains limited, supporting the need for evidence-based protocols and structured training pathways.

Abstract Public health specialists (PHS) in the local government often work part-time and many of them lack occupational education. The main task of specialists responsible for public health often involves other work areas. Continuing education programs are available for PHS, but there is no overview of how well programs meet their needs and challenges. Also, the possibility and feasibility of combining study and work, is unknown. Study explored, how different factors support or hinder the integration of study activities and work. For creating the sample, the Estonian local governments were categories in subgroups based on municipality size, status of health profile strategic document, PHS employment and educational background. Semi structured interviews (10 + 9) were conducted with leaders and practitioners in 2022-2023. Qualitative content analysis was used. Results indicate that both positions find encouraging factor to study while working at the same time, if learner perceives the necessity and links with everyday work and sees an opportunity to apply the information, contacts or experience into practice among specialist's main work. The list of mentioned supportive factors were motivation, will, time resource, support from family and employer, bonuses, recognize from leader, study leave, convenient location and flexibility of studies, possibility of absence, online/hybrid version. As hindering factors highlighted lack of time management skills, education as obligatory requirement and when it's not flexible, it becomes unlikely to pursue studying. In conclusion supporting public health workforce (including health promoters) occupational training and professional development is the key component to achieve public health goals effectively and efficiently. Education is an important prerequisite and necessary to reach using systematic approaches in the field of public health by competent employees. Key messages • Most public health specialists are willing to study while working, if the studies meet their conditions (e.g. flexibility, alignment with daily work, common tasks as motivating and unifying aspect). • The presence of motivation and time resource, as well as the ability to plan it, were noted as influencing factors the combining study and work.

This study aimed to compare the immunological and immunogenetic profiles over a spectrum of childhood- and adulthood-onset T1D at diagnosis. The cross-sectional study involved participants with recently diagnosed T1D (n = 168), aged 2.9–68.2 years. HLA-II alleles, single nucleotide polymorphisms (SNP) (rs2476601, rs3087243, rs1990760, rs13266634), thyroid and coeliac disease-related autoantibodies and anti-enterovirus antibodies (anti-EV) were analysed regarding the diabetes-associated autoantibodies’ (DAA) status and the age of participants. In the longitudinal study, 19 immune checkpoint gene expression levels in children (n = 25) aged 3.6–14.5 years were measured at diagnosis and 1 year after diagnosis. The duration of symptoms before diagnosis was age-dependent. Older age increased the odds of being single DAA-positive (OR 1.05; 95% CI 1.02–1.09), while anti-EV IgG positivity increased the odds of being multiple DAA-positive (adjusted OR 4.42; 95% CI 1.62–12.04). The DAA-negative T1D participants were older than the DAA-positive individuals. The checkpoint gene expression levels between the two time points were similar, but exhibited more pronounced variability at the time of diagnosis. These results confirm immunological variability in recent-onset T1D cases between children and adults and stress the importance of further research to define the comprehensive immunological profile of the disease age-related subgroups.

Celiac disease (CD) is a chronic autoimmune disease of the small bowel mucosa that develops because of the altered immune response to gluten, which leads to intestinal epithelium damage and villous atrophy. However, studies on regeneration of the damaged small bowel mucosa and density of intestinal stem cells (ISC) in CD persons are still scarce. We aimed to evaluate the number of small bowel mucosa cells positive for LGR5, CD138/Syndecan-1, CD71 and CXCR3 in CD and in controls with normal bowel mucosa; to find relationship between these markers and degree of small intestinal atrophy and to compare these results with our previous data about the number of CD103 + , IDO + DCs, FOXP3 + Tregs, enterovirus (EV) density and serum zonulin level. The paraffin sections of the small bowel biopsies were obtained from 26 children with CD (median age 6.5years), and from 20 controls with normal intestinal mucosa (median age 14.2years) and from the tissue bank of the Department of Pathology of Tartu University Hospital (from 18 participants with CD including 14 children (median age 13.2years) and from 11subjects with normal small bowel mucosa, including one child aged 4.8years. The number of LGR5 + , CD71 + , CD138 + , and CXCR3 + cells was evaluated using immunohistochemistry. The median number of CD138 + and CXCR3 + cells was significantly higher in the small bowel mucosa in CD compared with normal mucosa (p = 0.0002 for CD138 and p = 0.006 for CXCR3). The median number of CD71 + cells was significantly higher in normal small bowel mucosa (p = 0.005). The number of LGR5 + cells did not differ between persons with CD and those with normal small bowel mucosa (p = 0.7). A markedly increased number of CD138 + and CXCR3 + cells in the small bowel mucosa of participants with CD confirms their role in the pathogenesis of this disease. There was no expected marked difference in the density of any of the studied markers between lower or higher grade of small bowel atrophy and level of tTG-IgA in CD.

Adherence to hand hygiene procedures is crucial for all populations, and the World Health Organization (WHO) has implemented specific guidelines for infection control. Frequent and correct hand hygiene can prevent infections, but non-compliance with hand hygiene is pervasive. Nursing students address this issue from the beginning of their training. In nursing training, self-efficacy is crucial in enhancing students' competence, motivation, and clinical performance. We performed a cross-sectional multicenter study in five European countries, with a cross-sectional design with an online application of an instrument measuring hand hygiene knowledge based on WHO guidelines and general self-efficacy and specific self-efficacy for infection control. A total of 638 first-year nursing students participated in this study. The mean percentage of correct answers was 67.9%, with a considerable difference depending on the items. The worst results were obtained for questions related to sources of infection and types of hand hygiene methods in different situations. Finnish students displayed significantly (p < 0.001) higher scores in HH knowledge, whereas Estonian students had significantly (p < 0.001) higher levels of self-efficacy. There were significant correlations between the hand hygiene knowledge score and the self-efficacy score (p < 0.001). A multivariate analysis by linear regression analysis showed significant associations between the hand hygiene knowledge survey score and the students' age (p < 0.001, OR = 0.18, 95% CI 0.04-0.10), as well as their country of origin (p = 0.01, OR = 0.09, 95% CI 0.03-0.34). HH knowledge is quite low among nursing students, and is correlated with self-efficacy, although the strongest predictors are age and country of origin. Different nursing curricula must favor HH knowledge, with varying degrees of emphasis depending on the country.

Due to the COVID-19 pandemic the teachers were required to adjust their previous teaching methods, test both their pedagogical skills and their digital competence, as well as the digital competence of the students. The purpose of the research was to map out teaching methods by geography teachers in Estonia, the efficiency levels of those methods, while also receiving feedback about the teaching process as it applied to remote learning. Mixed methods research was conducted amongst 76 geography teachers, data collection method was a questionnaire. The results revealed: if the most efficient methods of learning were forms of discussion which called for active communication between the students themselves, as well as between students and teachers, then the least efficient method was teacher-centered lecture. Forms of discussion were used by teachers most often in synchronized video lessons, but they requested suitable short educational videos and a uniform repository of teaching materials. Half of teachers didn`t use map-related work, minority used work with maps in the e-testing environments or into worksheets. More than half of teachers adjusted the assessment system without making any compromises in terms of learning outcomes. Half of the teachers were so far satisfied with the teaching process and with their contact with the students, half of the teachers believed that their students failed to achieve the planned learning outcomes.

The ageing global population puts heavy pressure on healthcare systems everywhere. Addressing ageing-related chronic conditions requires employment of novel innovative solutions. Telehealth technologies, including telepresence robots (TPRs), are being rapidly developed to provide healthcare services efficiently wherever needed. This article explores the role of TPRs in addressing the challenges of providing healthcare to an ageing population, emphasizing their potential advantages and drawbacks. Employing an exploratory research approach with qualitative data collection techniques, we tested three TPR usage scenarios in simulated healthcare settings: anamnesis, measurements, and falls and frailty. The study employed a non-random purposive sample comprising 25 participants, and was conducted at a medical facility in June 2023. The findings suggest that TPRs offer promising solutions for healthcare professionals and patients, especially in scenarios when physical presence is impossible or physical isolation is required to prevent contagion. However, the technology is not yet ready to substitute fully human medical workers, potentially causing patient reluctance and emphasizing the need for patient-centered approaches to technology adoption. In addition, more studies are needed to address ethical, privacy, and scalability concerns.