Tartu Health Care College

Background/Objective: Needlestick injuries (NSIs) are a significant source of bloodborne infections among nurses. This study aimed to assess the prevalence, contributing factors, and awareness of post-exposure prophylaxis (PEP) among Estonian nurses. Methods: This prospective cross-sectional study was conducted using an electronic questionnaire in September 2024. Results: The majority of the 211 nurses participating in this study were females aged 21 to 75 years. Notably, 57.1% (n = 109, aged 43.9 ± 12.2) had experienced an NSI in the past decade. Most injuries occurred during sharps' disposal (33%) and with syringe needles (72%). Among those injured, 84% washed the area with water and soap, 80% used alcohol-based disinfectants, and 69% reported the incident. However, 20.6% did not report due to perceived insignificance or lack of follow-up actions. Additionally, 14.7% were unaware of the reporting requirement, and 8.8% did not know who to report to. Conclusions: Improved training and reporting practices are essential to reduce NSIs among nurses.

Background and Objectives: The increased prevalence of knee osteoarthritis (OA) and need for total knee arthroplasty (TKA) indicate a growing need for effective prehabilitation. The effect of preoperative home exercise programs (HEPs) on gait in patients with severe knee OA is under-investigated. This study aimed to evaluate the influence of an 8-week preoperative HEP on gait characteristics, leg extensor muscle strength, knee function, and health status in women with severe knee OA scheduled for TKA and to compare them with healthy control data. Material and Methods: Eighteen women with severe knee OA (KOA, aged 61.8 ± 1.6 years) and ten age-matched healthy women (CON) participated in this study. The KOA group performed an HEP with 15 exercises aimed at improving lower limb muscle strength, motion, balance, and coordination. Gait spatiotemporal and kinetic characteristics during the loading response, isometric leg extensor strength, knee active range of motion (AROM), and The Western Ontario and McMaster Universities Arthritis Index (WOMAC) were investigated. Associations between characteristics were analyzed. Results: Improvements in ground reaction force (GRF) during the loading response of gait, leg extensor muscle strength, the knee AROM, and the WOMAC index were found post-HEP. The KOA group demonstrated lower (p < 0.05) spatiotemporal and GRF characteristics than the CON group. Knee extension moment (KEM) was lower pre-HEP (p < 0.05) but did not differ significantly from the CON group post-HEP. Gait characteristics and WOMAC were associated with leg extensor muscle strength and knee AROM and pain in the KOA group. Conclusions: An eight-week preoperative HEP improved GRF and KEM during the loading response of gait, muscle strength, knee function, and self-reported knee OA-related health status in women with severe knee OA. Preoperative HEP before TKA, focusing on leg extensor muscle strength, range of motion, and pain relief, is an effective alternative to supervised exercise therapy in women with severe knee OA.

The aim was to identify the motivators, main challenges and support for physiotherapists in setting up a private practice in Estonia. The questionnaire included three thematic blocks: 1) Motivations (18 Likert-scale items with comments), 2) Challenges and Needs (14 Likert-scale items, a free-response question, and multiple-choice on support), and 3) Business Factors (questions on experience, external services, and financial support). Results were presented as means with standard deviations (±SD), or proportions with percentages, and Likert scale (5-point) were used. A survey was conducted with 16 physiotherapists (♀=14, ♂=2; age 37.1 ±5.46 years) who had established private practices in Estonia, representing 21% of such professionals in country. The possibility of autonomy, including flexible working hours, was cited by all respondents as a motivator for starting a private practice. However, many faced financial challenges, with 63% citing difficulties in securing start-up capital and 50% reporting financial struggles in business development. While 80% found retaining clients relatively easy, 43.75% needed assistance in finding clients. Key challenges included a lack of funds, marketing skills, and time for promotion. None of the respondents felt adequately prepared by their education for entrepreneurship. Financial support was a common requirement, with 25% requesting details on available funding sources. The main motivation for physiotherapists to set up a private practice is autonomy. In the context of changes in professional legislation, it is important to ensure needs-based entrepreneurship training in cooperation with professional associations.

Rhythmic gymnasts (RG) start their heavy trainings already at early age and despite of low body fat mass, their bone parameters are higher than in untrained controls (UC). The specific role of sclerostin and preadipocyte factor-1 (Pref-1), which are the negative regulators of bone mass by inhibiting bone formation, is not well understood in puberty. The aims of the study were to compare sclerostin and Pref-1 between RG and UC, and to evaluate relationships of sclerostin and Pref-1 with bone mass. Study involved 32 RG and 32 UC girls aged 10-12 years. Bone mass and body composition were measured by dual-energy X-ray absorptiometry, and plasma sclerostin and Pref-1 concentrations were assessed from fasting blood samples. Sclerostin was higher (P<0.0001) in RG (24.2±8.8 pmol/L) compared with UC (14.7±10.0 pmol/L1), while Pref-1 was similar between the groups. In RG, sclerostin was positively correlated with lumbar spine (LS) (r=0.44; P=0.012) and femoral neck (FN) (r=0.37; P=0.039) bone mineral content (BMC), whereas in UC, sclerostin was inversely associated with LS (r=-0.37; P=0.039) and FN (r=-0.35; P=0.048) BMC. In RG, sclerostin remained positively correlated with LS BMC independent of confounding factors (r=0.60; P=0.001). Pref-1 was not correlated with any bone mass values in both groups. Early pubertal RG girls have higher plasma sclerostin levels compared UC. Sclerostin has differential associations with bone mass in RG compared to UC.

Background/Objectives: There are strict demands on body weight and shape in highly trained adolescent female athletes, and they are in the highest risk group for the development of eating disorders. This study aims to compare the behavioural eating patterns between highly trained female adolescent athletes and untrained controls (UCs), and to describe the associations between behavioural eating patterns and different energy homeostasis hormones. Methods: A total of 33 rhythmic gymnasts (RGs), 20 swimmers (SWs), and 20 UCs (n = 20) that were 14 to 18 years old participated in this investigation. Anthropometric measurements, body composition, training volume, 3-consecutive-day energy intake, and different energy homeostasis hormones were measured. For the evaluation of the individual behavioural eating pattern, an eating disorders assessment scale (EDAS) questionnaire with different subscales was used. Results: The mean EDAS subscale of restrained eating score was significantly higher in the RG group compared to the UC group (17.2 ± 7.4 vs. 11.5 ± 5.8; p < 0.05). The EDAS total score (r = 0.380) and the subscale score of preoccupation with body image and body weight (r = 0.371) were both positively correlated (p < 0.05) with serum irisin concentrations in the RG group. Conclusions: In conclusion, female rhythmic gymnasts reported a more often restrained eating pattern than untrained controls, and their more disturbed behavioural eating pattern was associated with a higher serum irisin concentration.

Fostering childhood physical activity and fitness levels could have important implications for public health, given growing concerns about high obesity rates, the amount of time spent being sedentary and not getting enough physical activity already at early childhood. World Health Organization states that from 1975 to 2016, the prevalence of children and adolescents with overweight or obesity increased more than four-fold from 4% to 18% globally. Obesity prevention is critical in controlling obesity-related noncommunicable diseases, psychological, and social problems, as well as inferior academic achievement mediated by others attitude and diminished executive cognitive function. A decline of physical activity from early childhood into middle childhood and further to adolescence has been reported. Accompanying health risks from low activity and high sedentariness are comparable to those arising from obesity, and the impact extends into adulthood. Wide range of physical, mental, and cognitive health benefits related to high physical fitness levels in children have been reported. This chapter aims to summarize current evidence clarifying whether higher physical activity is associated with higher physical fitness, and whether higher physical fitness predicts healthier body composition and better cognitive functions in children.

BackgroundChina faces a serious shortage of competent nurses who can address the healthcare needs of older people in an ageing society. Chinese higher education institutes face serious challenges when it comes to developing new curricula that are capable of educating sufficient numbers of competent gerontological nurses. Therefore, the aim of this research study was to identify and verify competencies for gerontological nurses in China that are needed to provide nursing care for the growing number of older people in all care settings. This study takes into account the possible opportunities that trends and developments may offer in the near future.MethodsIn this study, a two-phase research design was used. The first phase concerned needs analysis, including a situational analysis, a trend analysis and a competence analysis. This process resulted in a draft competence framework. The second phase addressed the verification of the competence framework through a two-round Delphi study with a panel of Chinese and European experts. This process led to the final competence framework.ResultsThe final competence framework for gerontological nursing in China included six competencies divided into 13 essential and five relevant learning outcomes. The competencies are: ‘providing gerontological care’, ‘communication and collaboration’, ‘organization of gerontological nursing care’, ‘health promotion’, ‘evidence-based nursing and lifelong learning’ and ‘professional behaviour’.ConclusionThe framework comprehensively covers the six core competencies that nurses who care for older people should possess. These competencies are well-embedded in a Chinese context. The framework therefore offers concrete, practical suggestions for the competencies and skills that nursing graduates will need to work in current and future professions related to gerontological nursing education and practice.

Background and Objectives: Physical activity has a positive impact on health, and the participation in exercise and sports, including marathons, has increased in popularity. This kind of sport requires extreme endurance, which can cause different health problems and even lead to death. Participants without sufficient preparation and, in particular, men 45 years of age and older belong to a high risk group. The aim of this study was to determine the impact of marathons and cofactors associated with marathons on the recovery of heart rate (HR) and blood pressure (BP) of non-professional ≥ 45 years old male marathoners. Materials andMethods: A total of 136 ≥ 45 year old, non-professional (amateur marathoner), male participants were recruited. Data collection involved a questionnaire, body composition measures, and BP and HR results before and after finishing the marathon. Descriptive data, t-test, Mann–Whitney or χ2 test, and Pearson’s correlation were applied. Results: Participants (skiing n = 81, cycling n = 29, running n = 26; mean age 51.7 ± 7.1 years old) had previously attended a median of 35 (IQR 17.5–66) marathons and travelled 2111.5 (IQR 920–4565) km. Recovery of HR and BP after finishing and recovery time was insufficient and not associated with marathon preparation. Running was the most burdensome for HR, and cycling was most taxing for BP. Chronic diseases did not influence participation in the marathon. Conclusions: The preparation for the marathon was mainly sufficient, but recovery after the marathon was worrisome. Marathons are demanding for ≥45 year old males and may be too strenuous an activity that has deleterious effects on health.

Uroinfections, which are mainly caused by pathogenic bacteria, especially uro-pathogenic E. coli (UPEC), are among the major health problems in the modern world. The current gold standard for the identification of uroinfection causing pathogens in urine is microbiological cultivation, but uro-pathogens are also determined with quantitative polymerase chain reaction (qPCR) and matrix assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. However, it takes several hours or days to obtain the results. A promising option for rapid identification of pathogens is the application of biosensors. The aim of the current study was to develop a biosensor for the fast detection of UPEC in urine samples allowing achieving a limit of detection below 103 CFU/mL, essential for the diagnostics of recurrent uroinfections and related diseases. First, the pathogens were attached onto a single use column and specifically detected using E. coli antibodies conjugated with a fluorescence marker. The bead-injection analysis platform for fluidics provided E. coli limits of detection and quantification in 150 µL urine samples <3 and <5 cells/mL, respectively. The time of analysis was 17 min. The biosensor results were in good correlation with the results obtained with other methods, indicating that the complex urine matrix of UPEC patients did not affect the biosensor measurements.