Publications by authors named "Tisler A"
Background: The increased knowledge of cervical cancer (CC) risk factors and suboptimal performance of present screening programs has generated interest in shifting from a universal screening approach to one based on individual risk assessment. To inform the future development of risk-based CC screening programs, it is crucial to gain insight into the factors influencing the acceptability of such approach among screening target group women. The aim of this study was to prospectively investigate the acceptability of risk-based CC screening and to identify potential barriers.
View Article and Find Full Text PDFTransitioning to an individualized risk-based approach can significantly enhance cervical cancer screening programs. We aimed to derive and internally validate a prediction model for assessing the risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) and cancer in women eligible for screening. This retrospective study utilized data from the Estonian electronic health records, including 517,884 women from the health insurance database and linked health registries.
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- - Cancers are the leading cause of death for people living with HIV, but there is limited nationwide data on cancer rates among this population.
- - A study analyzed data from Estonia (2004-2021) involving 7,011 individuals with HIV, finding that HPV-associated cancers made up 21.4% of all cancer cases, with significantly higher risk ratios for both men and women living with HIV.
- - The findings highlight the urgent need for better screening, vaccination efforts, and adherence to antiretroviral therapy to address the increased risk of HPV-related cancers among people with HIV.
Background: Cervical cancer remains a significant public health concern in Europe. Effective introduction and scaling up of human papillomavirus (HPV) detection-based cervical cancer screening (CCS) requires a systematic assessment of health systems capacity. However, there is no validated capacity assessment methodology for CCS programmes, especially in European contexts.
View Article and Find Full Text PDFSexually minoritized men (SMM) with HIV who use stimulants experience difficulties achieving and maintaining an undetectable viral load (VL). Home-based VL monitoring could augment HIV care by supporting interim, early identification of detectable VL. We describe implementation challenges associated with a home-collection device for laboratory-based VL testing among SMM with HIV who use stimulants.
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- * A study analyzed 91 lupus nephritis patients to identify predictors of major adverse cardiovascular events (MACE), finding that age, neutrophil count, and diastolic blood pressure were significant risk factors.
- * The newly proposed CANDE model uses these factors to assess MACE risk, highlighting the need for better cardiovascular screening and management in SLE patients.
Article Synopsis
- The study aimed to examine the prevalence of non-communicable diseases, particularly diabetes, among household contacts of individuals with tuberculosis (TB).
- A systematic review identified 39 studies, with 14 providing individual participant data and 25 offering aggregated data; the results showed a pooled diabetes prevalence of 8.8% among those tested properly.
- Findings indicate that diabetes prevalence among household contacts is likely underestimated, highlighting the importance of targeted interventions during TB contact investigations to identify and address these health issues.
Background: High-risk human papillomavirus (HR-HPV) is a known cause of cervical cancer (CC). Latvia has a high incidence of CC compared with the average incidence in the European Union. This study aims to fill the data gap on the HR-HPV burden in Latvia, providing information on its prevalence and associated factors.
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- The study aimed to evaluate and compare perceptions of barriers to cervical cancer screening among vulnerable women across seven European countries.
- Stakeholders, including healthcare providers and representatives of vulnerable populations, participated in meetings to discuss these barriers within their specific contexts.
- Key findings indicated that barriers varied by country and included issues like infrequent screening efforts, lack of cultural sensitivity from providers, and psychological factors such as fear and shame among women.
Article Synopsis
- Estonia has a high cervical cancer death rate despite a long-standing screening program, leading to urgent reforms to improve participation and test quality.
- Key reforms include expanding eligibility for screenings, allowing family physicians to conduct tests, and switching to HPV testing as the primary method.
- Early signs show increased participation, but further efforts are needed to overcome barriers; the establishment of the National Cancer Screening Group aims to ensure accountability and equitable access.
The era of precision medicine requires the achievement of accurate risk assessment. Polygenic risk scores (PRSs) have strong potential for increasing the benefits of nationwide cancer screening programs. The current pool of evidence on the role of a PRS as a risk stratification model in actual practice and implementation is limited.
View Article and Find Full Text PDFA large proportion of the world's population has some form of immunity against SARS-CoV-2, through either infection ('natural'), vaccination or both ('hybrid'). This retrospective cohort study used data on SARS-CoV-2, vaccination, and hospitalization from national health system from February 2020 to June 2022 and Cox regression modelling to compare those with natural immunity to those with no (Cohort1, n = 94,982), hybrid (Cohort2, n = 47,342), and vaccine (Cohort3, n = 254,920) immunity. In Cohort 1, those with natural immunity were at lower risk for infection during the Delta (aHR 0.
View Article and Find Full Text PDFIntroduction: In phenylketonuria (PKU), toxic phenylalanine (Phe) can harm other organs beyond the brain. Furthermore, the lifelong therapy of PKU consists of consumption of increased amounts of amino-acid mixture that provoke hyperfiltration in the glomeruli. Therefore, the adherence to therapy in PKU might influence the long-term kidney function in PKU patients.
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- Effective vaccinations have made COVID-19 infections milder, prompting a study on the mortality rates of hospitalized patients needing hemodialysis before vaccinations became widely available.
- Among the analyzed patients, mortality rates varied significantly, with the highest deaths seen in nCKD and CKDnonHD groups, while pHD patients showed better survival rates.
- The findings suggest that despite some limitations, patients on regular hemodialysis experienced improved survival compared to patients with normal renal function.
COVID-19 and other acute respiratory viruses can have a long-term impact on health. We aimed to assess the common features and differences in the post-acute phase of COVID-19 compared with other non-chronic respiratory infections (RESP) using population-based electronic health data. We applied the self-controlled case series method where prescription drugs and health care utilisation were used as indicators of health outcomes during the six-month-long post-acute period.
View Article and Find Full Text PDFObjectives: To describe age-specific and type-specific carcinogenic human papillomavirus (HPV) prevalence prior to large-scale effect of HPV vaccines in Estonia and to analyse the risk factors associated with carcinogenic HPV.
Design: Cross-sectional study using self-administered questionnaire and self-collected vaginal swabs for detection of HPV infection.
Setting: Estonian Biobank database.
SARS-CoV-2 vaccination is currently the mainstay in combating the COVID-19 pandemic. However, there are still people among vaccinated individuals suffering from severe forms of the disease. We conducted a retrospective cohort study based on data from nationwide e-health databases.
View Article and Find Full Text PDFAims: To inform future Baltic States-specific policy analyses, we aimed to provide an overview of cervical cancer epidemiology and existing prevention efforts in Estonia, Latvia and Lithuania.
Methods: A structured desk review: we compiled and summarized data on current prevention strategies, population demography and epidemiology (high risk human papillomavirus (HPV) prevalence and cervical cancer incidence and mortality over time) for each Baltic State by reviewing published literature and official guidelines, performing registry-based analyses using secondary data and having discussions with experts in each country.
Results: We observed important similarities in the three Baltic States: high burden of the disease (high incidence and mortality of cervical cancer, changes in TNM (Classification of Malignant Tumors) stage distribution towards later stage at diagnosis), high burden of high-risk HPV in general population and suboptimal implementation of the preventive strategies as low screening and HPV vaccination coverage.
Importance: Large-scale data on type-specific human papillomavirus (HPV) prevalence and disease burden worldwide are needed to guide cervical cancer prevention efforts. Promoting the research and application of health care big data has become a key factor in modern medical research.
Objective: To examine the prevaccination prevalence of high-risk HPV (hrHPV) and type distribution by cervical cytology grade in Estonia.
Article Synopsis
- Post-acute COVID-19 sequelae involve a range of health issues affecting different organ systems experienced by individuals after the initial COVID-19 infection.
- A nationwide cohort study assessed 3,949 hospitalized COVID-19 patients and 15,511 matched controls to determine long-term outcomes, including all-cause mortality and the development of new clinical issues.
- The study found that 40.3% of COVID-19 patients experienced at least one new clinical complication within a year, with significantly higher risks for conditions like dementia, respiratory disease, and heart disease compared to the general population.
Background: Concomitant occurrence of anti-GBM disease and anti-PLA2R positive membranous nephropathy have been previously described. However, to the best of our knowledge, this is the first case report that documents the co-occurrence of the diseases proven by both serologic and histologic methods.
Case Presentation: A 51-year-old woman presented to hospital with nausea, bilateral lower extremity edema, dyspnea, dark urine, and then anuria.