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Book ; Thesis: Dyspepsia and helicobacter pylori infection

Kolk, Helgi

the diagnostic value of symptoms, treatment and follow-up of patients referred for upper gastrointestinal endoscopy by family physicians

(Dissertationes medicinae universitatis tartuenis ; 83)

2003

Author's details	Helgi Kolk
Series title	Dissertationes medicinae universitatis tartuenis ; 83 Dissertationes medicinae Universitatis Tartuensis
Collection	Dissertationes medicinae Universitatis Tartuensis
Language	English ; Estonian
Size	145 S. : graph. Darst.
Publishing country	Estonia
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Tartu, Univ., Diss., 2003
Note	Zsfassung in estländ. Sprache
HBZ-ID	HT013742032
ISBN	9985-56-739-0 ; 978-9985-56-739-5
Database	Catalogue ZB MED Medicine, Health

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Article ; Online: Causal variation modelling identifies large inter- and intra-regional disparities in physical therapy offered to hip fracture patients in Estonia.

Prommik, Pärt / Maiväli, Ülo / Kolk, Helgi / Märtson, Aare

Disability and rehabilitation

2021 Volume 44, Issue 17, Page(s) 4729–4737

Abstract: Purpose: An essential measure of hip fracture (HF) rehabilitation, the amount of physical therapy (PT) used per patient, has been severely understudied. This study (1) evaluates post-acute PT use after HF in Estonia, (2) presents causal variation ... ...

Abstract	Purpose: An essential measure of hip fracture (HF) rehabilitation, the amount of physical therapy (PT) used per patient, has been severely understudied. This study (1) evaluates post-acute PT use after HF in Estonia, (2) presents causal variation modelling for examining inter- and intra-regional disparities, and (3) analyses its temporal trends. Materials and methods: This retrospective cohort study used validated population-wide health data, including patients aged ≥50 years, with an index HF diagnosed between January 2009 and September 2017. Patients' 6-month PT use was analysed and reported separately for acute and post-acute phases. Results: While most of the included 11,461 patients received acute rehabilitation, only 40% of them received post-acute PT by a median of 6 h. Analyses based on measures of central tendency revealed 2.5 to 2.6-fold inter-regional differences in HF post-acute rehabilitation. Variation modelling additionally detected intra-regional disparities, showing imbalances in the fairness of allocating local rehabilitation resources between a county's patients. Conclusions: This study demonstrates the advantages of causal variation modelling for identifying inter- and intra-regional disparities in rehabilitation. The analyses revealed persisting large multi-level disparities and accompanying overall inaccessibility of PT in HF rehabilitation in Estonia, showing an urgent need for system-wide improvements.Implications for rehabilitationThis study demonstrates the advantages of causal variation modelling for identifying inter- and intra-regional disparities in rehabilitation, using an essential outcome measure - used physical therapy hours.The study revealed large multi-level disparities and overall inaccessibility of physical therapy in hip fracture rehabilitation in Estonia, showing an urgent need for system-wide improvements.This study expands our knowledge on unstudied topics - hip fracture post-acute care and long-term physical therapy use.This regional analysis provides the first evidence-based regional-level basis for improving the rehabilitation system in Estonia.
MeSH term(s)	Estonia ; Hip Fractures/rehabilitation ; Humans ; Physical Therapy Modalities ; Retrospective Studies ; Subacute Care
Language	English
Publishing date	2021-04-30
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1104775-6
ISSN	1464-5165 ; 0963-8288
ISSN (online)	1464-5165
ISSN	0963-8288
DOI	10.1080/09638288.2021.1918772
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Article ; Online: Nonoperative hip fracture management practices and patient survival compared to surgical care: an analysis of Estonian population-wide data.

Prommik, Pärt / Tootsi, Kaspar / Saluse, Toomas / Märtson, Aare / Kolk, Helgi

Archives of osteoporosis

2021 Volume 16, Issue 1, Page(s) 101

Abstract: A notable proportion of hip fracture patients receive nonoperative management, but such practice is seldom analysed. Although highly variable reasons underpin hip fracture nonoperative management, none of these practices conclusively outweigh the ... ...

Abstract	A notable proportion of hip fracture patients receive nonoperative management, but such practice is seldom analysed. Although highly variable reasons underpin hip fracture nonoperative management, none of these practices conclusively outweigh the superiority of operative management. Nonoperative management should be only considered when surgery is not an option. Purpose: Reasons underpinning hip fracture (HF) nonoperative management (NOM) are seldom analysed. This study aims to identify the reasons behind NOM and assess the accuracy of these decisions using these patients' survival compared with those treated with operative management (OM). Methods: This is a retrospective cohort study based on population-wide administrative health data, including patients aged ≥ 50 with an index HF diagnosis between January 2009 and September 2017. NOM patients were subgrouped according to their expected prognoses, and their survival up to 36 months was compared with those treated surgically. Results: From a total of 11,210 included patients, 6.8% (766) received NOM. Varying reasons lead to NOM, dividing them further into five distinct subgroups: (I) 46% NOM decision due to poor expected prognosis with OM; (II) 29% NOM decision due to poor expected prognosis for mixed reasons; (III) 15% NOM decision due to good expected prognosis with NOM; (IV) 8.0% NOM decision due to patient's refusal of OM; and (V) 1.3% NOM decision due to occult HF. Only poor prognosis and patients who refused OM (I, II, IV) had worse survival than OM patients. However, a relatively high proportion of the poor prognosis patients survived 1 year (29%). Conclusion: Although there was high variability in reasons underpinning HF NOM, none of these practices conclusively outweigh OM's superiority. NOM should be considered with utmost care and only for patients for whom OM is out of the question - well-defined medical unfitness or carefully considered refusal by understanding the increased mortality risk.
MeSH term(s)	Estonia/epidemiology ; Hip Fractures/surgery ; Humans ; Prognosis ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-06-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2253231-6
ISSN	1862-3514 ; 1862-3522
ISSN (online)	1862-3514
ISSN	1862-3522
DOI	10.1007/s11657-021-00973-y
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Article ; Online: Simple Excel and ICD-10 based dataset calculator for the Charlson and Elixhauser comorbidity indices.

Prommik, Pärt / Tootsi, Kaspar / Saluse, Toomas / Strauss, Eiki / Kolk, Helgi / Märtson, Aare

BMC medical research methodology

2022 Volume 22, Issue 1, Page(s) 4

Abstract: Background: The Charlson and Elixhauser Comorbidity Indices are the most widely used comorbidity assessment methods in medical research. Both methods are adapted for use with the International Classification of Diseases, which 10th revision (ICD-10) is ... ...

Abstract	Background: The Charlson and Elixhauser Comorbidity Indices are the most widely used comorbidity assessment methods in medical research. Both methods are adapted for use with the International Classification of Diseases, which 10th revision (ICD-10) is used by over a hundred countries in the world. Available Charlson and Elixhauser Comorbidity Index calculating methods are limited to a few applications with command-line user interfaces, all requiring specific programming language skills. This study aims to use Microsoft Excel to develop a non-programming and ICD-10 based dataset calculator for Charlson and Elixhauser Comorbidity Index and to validate its results with R- and SAS-based methods. Methods: The Excel-based dataset calculator was developed using the program's formulae, ICD-10 coding algorithms, and different weights of the Charlson and Elixhauser Comorbidity Index. Real, population-wide, nine-year spanning, index hip fracture data from the Estonian Health Insurance Fund was used for validating the calculator. The Excel-based calculator's output values and processing speed were compared to R- and SAS-based methods. Results: A total of 11,491 hip fracture patients' comorbidities were used for validating the Excel-based calculator. The Excel-based calculator's results were consistent, revealing no discrepancies, with R- and SAS-based methods while comparing 192,690 and 353,265 output values of Charlson and Elixhauser Comorbidity Index, respectively. The Excel-based calculator's processing speed was slower but differing only from a few seconds up to four minutes with datasets including 6250-200,000 patients. Conclusions: This study proposes a novel, validated, and non-programming-based method for calculating Charlson and Elixhauser Comorbidity Index scores. As the comorbidity calculations can be conducted in Microsoft Excel's simple graphical point-and-click interface, the new method lowers the threshold for calculating these two widely used indices. Trial registration: retrospectively registered.
MeSH term(s)	Comorbidity ; Hip Fractures ; Hospital Mortality ; Humans ; International Classification of Diseases ; Programming Languages
Language	English
Publishing date	2022-01-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041362-2
ISSN	1471-2288 ; 1471-2288
ISSN (online)	1471-2288
ISSN	1471-2288
DOI	10.1186/s12874-021-01492-7
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Article ; Online: Isolated greater trochanter fracture may impose a comparable risk on older patients' survival as a conventional hip fracture: a population-wide cohort study.

Prommik, Pärt / Tootsi, Kaspar / Veske, Karin / Strauss, Eiki / Saluse, Toomas / Kolk, Helgi / Märtson, Aare

BMC musculoskeletal disorders

2022 Volume 23, Issue 1, Page(s) 394

Abstract: Background: Isolated greater trochanter fracture (IGT) and conventional hip fracture (HF) affect the same anatomical area but are usually researched separately. HF is associated with high mortality, and its management is well established. In contrast, ... ...

Abstract	Background: Isolated greater trochanter fracture (IGT) and conventional hip fracture (HF) affect the same anatomical area but are usually researched separately. HF is associated with high mortality, and its management is well established. In contrast, IGT's effect on mortality is unknown, and its best management strategies are unclear. This study aims to compare these patient populations, their acute- and post-acute care, physical and occupational therapy use, and up to three-year mortality. Methods: This retrospective cohort study is based on population-wide data of Estonia, where routine IGT management is non-operative and includes immediate weight-bearing as tolerated. The study included patients aged ≥ 50 years with a validated index HF or IGT diagnosis between 2009-2017. The fracture populations' acute- and post-acute care, one-year physical and occupational therapy use and three-year mortality were compared. Results: A total of 0.4% (50/11,541) of included patients had an IGT. The baseline characteristics of the fracture cohorts showed a close resemblance, but the IGT patients received substantially less care. Adjusted analyses showed that the IGT patients' acute care was 4.5 days [3.4; 5.3] shorter they had 39.2 percentage points [25.5; 52.8] lower probability for receiving post-acute care, and they had 50 percentage points [5.5: 36]] lower probability for receiving physical and occupational therapy. The IGT and HF patients' mortality rates were comparable, being 4% and 9% for one month, 28% and 31% for one year, and 46% and 49% for three years, respectively. Crude and adjusted analyses could not find significant differences in their three-year mortality, showing a p-value of 0.6 and a hazard ratio of 0.9 [0.6; 1.3] for the IGT patients, retrospectively. Conclusions: Despite IGT being a relatively minor injury, the evidence from this study suggests that it may impose a comparable risk on older patients' survival, as does HF due to the close resemblance of the two fracture populations. Therefore, IGT in older patients may signify an underlying need for broad-based medical attention, ensuring need-based, ongoing, coordinated care. Trial registration: Retrospectively registered.
MeSH term(s)	Aged ; Cohort Studies ; Femur ; Hip Fractures/epidemiology ; Hip Fractures/therapy ; Humans ; Proportional Hazards Models ; Retrospective Studies
Language	English
Publishing date	2022-04-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2041355-5
ISSN	1471-2474 ; 1471-2474
ISSN (online)	1471-2474
ISSN	1471-2474
DOI	10.1186/s12891-022-05336-3
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Article ; Online: Frailty Assessment Can Enhance Current Risk Prediction Tools in Emergency Laparotomy: A Retrospective Cohort Study.

Isand, Karl G / Hussain, Shoaib / Sadiqi, Maseh / Kirsimägi, Ülle / Bond-Smith, Giles / Kolk, Helgi / Saar, Sten / Lepner, Urmas / Talving, Peep

World journal of surgery

2023 Volume 47, Issue 11, Page(s) 2688–2697

Abstract: Objective: We set out to assess the performance of the P-POSSUM and NELA risk prediction tool (NELA RPT), and hypothesized that combining them with the Clinical Frailty Scale (CFS) would significantly improve their performance. Emergency laparotomy (EL) ...

Abstract	Objective: We set out to assess the performance of the P-POSSUM and NELA risk prediction tool (NELA RPT), and hypothesized that combining them with the Clinical Frailty Scale (CFS) would significantly improve their performance. Emergency laparotomy (EL) is a high-risk surgical intervention, particularly for elderly patients with marked comorbidities and frailty. Accurate risk prediction is crucial for appropriate resource allocation, clinical decision making, and informed consent. Although patient frailty is a significant risk factor, the current risk prediction tools fail to take frailty into account. Methods: In this retrospective single-center cohort study, we analyzed all cases entered into the NELA database from the Oxford University Hospitals between 01.01.2018 and 15.06.2021. We analyzed the performance of the P-POSSUM and NELA RPT. Both tools were modified by adding the CFS to the model. Results: The discrimination of both the P-POSSUM and NELA RPT was good, with a slightly worse performance in the elderly. Adding CFS into the P-POSSUM and NELA RPT models improved both tools in the elderly [AUC from 0.775 to 0.846 (p < 0.05) from 0.814 to 0.864 (p < 0.05), respectively]. The improvement of the NELA RPT across all age groups did not reach statistical significance. The CFS grade was associated with 30-day mortality in patients aged > 65 years. However, in younger patients, this effect was less marked than in the elderly. Conclusion: Our analysis demonstrated a significant improvement in the P-POSSUM and NELA risk models when combined with the CFS. Frailty also increases the 30-day mortality after EL in younger individuals.
Language	English
Publishing date	2023-08-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-023-07140-z
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Article: Management of Proximal Femoral Fractures

Viru, Mihkel / Juhanson, Reile / Värsi, Fred / Linde, Indrek / Kiisk, Karl / Rokk, Alar / Kolk, Helgi / Toompere, Karolin / Karjagin, Juri

Proceedings of the Latvian Academy of Sciences. 2022 June 01, v. 76, no. 3

2022

Abstract: Proximal femoral fractures are typical injuries in the elderly population. We conducted a retrospective study to estimate postoperative mortality and risk factors affecting patient outcomes at Tartu University Hospital. We retrospectively evaluated ... ...

Abstract	Proximal femoral fractures are typical injuries in the elderly population. We conducted a retrospective study to estimate postoperative mortality and risk factors affecting patient outcomes at Tartu University Hospital. We retrospectively evaluated patients who were hospitalised in 2017 with a proximal femoral fracture diagnosis and who were operated (osteosynthesis, partial and total hip replacement). In the study we included 313 patients of 361 (219 women and 94 men). We did not find statistically significant difference between the choice of anaesthesia and mortality or between the time getting to the OR and mortality. Cognitive impairment and postoperative delirium were significantly associated with increased one-year mortality was 37% (p < 0.05). In the group of the patients who did not have postoperative delirium the overall mortality was 15%. 23% of the patients had preoperatively cognitive impairment, and 45.8% of them died in the first year after the operation (p < 0.001). Mortality of patients who did not have cognitive impairment was 14%. As the sample group of patients included in the study was small, further investigation should encompass a larger group in the future.
Keywords	anesthesia ; cognitive disorders ; elderly ; femoral fractures ; fracture fixation ; hospitals ; mortality ; patients ; prostheses ; retrospective studies
Language	English
Dates of publication	2022-0601
Size	p. 377-381.
Publishing place	Sciendo
Document type	Article
ISSN	2255-890X
DOI	10.2478/prolas-2022-0058
Database	NAL-Catalogue (AGRICOLA)

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Article: High variability in hip fracture post-acute care and dementia patients having worse chances of receiving rehabilitation: an analysis of population-based data from Estonia.

Prommik, Pärt / Kolk, Helgi / Maiväli, Ülo / Pääsuke, Mati / Märtson, Aare

European geriatric medicine

2020 Volume 11, Issue 4, Page(s) 581–601

Abstract: Purpose: Rehabilitation is a fundamental part of hip fracture (HF) care; however, the best strategies are unclear. This study maps index HF patients' post-acute care (PAC) in Estonia and compares the PAC of patients with and without a diagnosis of ... ...

Abstract	Purpose: Rehabilitation is a fundamental part of hip fracture (HF) care; however, the best strategies are unclear. This study maps index HF patients' post-acute care (PAC) in Estonia and compares the PAC of patients with and without a diagnosis of dementia. Methods: A retrospective cohort study was conducted using validated population-based data from the Estonian Health Insurance Fund using inclusion criteria: age ≥ 50 years, International Classification of Diseases code (S72.0-2) indicating HF between 1 January 2009 and 30 September 2017, and the survival of PAC. The presence of dementia diagnosis was based on the 10th revision of the International Classification of Diseases codes. Results: A total of 8729 patients were included in the study, 11% of whom had a dementia diagnosis. The PAC of HF patients varied from extensive to no care: 8.7% received combined inpatient and outpatient care; 59% received hospital care (13% had a length of stay (LOS) > 6 weeks; 33% had LOS between 2-4 weeks, 14% had LOS < 2 weeks); 4% received only community-based care; 28% received no PAC. Physical therapy (PT) was received by 56% of patients and by 35% of those with dementia diagnosis. Dementia patients had 1.5-fold higher odds of not receiving PT. Conclusion: In Estonia, the PAC after index HF varies from extensive to no care, and the provision of PT is limited and unequal, affecting dementia patients in particular. Thus, there is an urgent need to standardise index HF PAC by reviewing the resources of PT and developing effective rehabilitation practices.
MeSH term(s)	Dementia/epidemiology ; Estonia/epidemiology ; Hip Fractures/epidemiology ; Humans ; Infant, Newborn ; Retrospective Studies ; Subacute Care
Language	English
Publishing date	2020-06-20
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2556794-9
ISSN	1878-7657 ; 1878-7649
ISSN (online)	1878-7657
ISSN	1878-7649
DOI	10.1007/s41999-020-00348-5
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Article: Evaluation of symptom presentation in dyspeptic patients referred for upper gastrointestinal endoscopy in Estonia.

Kolk, Helgi

Croatian medical journal

2004 Volume 45, Issue 5, Page(s) 592–598

Abstract: Aim: To investigate the structure of dyspeptic symptoms and determine the association between dyspeptic symptoms and endoscopic findings in patients referred for upper gastrointestinal endoscopy by family physicians in a country with a high prevalence ... ...

Abstract	Aim: To investigate the structure of dyspeptic symptoms and determine the association between dyspeptic symptoms and endoscopic findings in patients referred for upper gastrointestinal endoscopy by family physicians in a country with a high prevalence of Helicobacter pylori infection. Methods: Consecutive outpatients (n=172; median 36 years, range 18-75; 85 male; 87 female) were referred to upper gastrointestinal endoscopy. Patient history was recorded prior to upper gastrointestinal endoscopy using the computer-aided Glasgow Diagnostic System for Dyspepsia (GLADYS). Family physicians used open access endoscopy with a short waiting list. Two biopsies, both from the antrum and the corpus, were taken for histological assessment. Results: Out of the 172 patients studied, 81% (n=139) were H. pylori positive, 65% (n=112) were younger than 45 years. The incidence of peptic ulcer was 44% (n=75). Upper abdominal pain was the predominant complaint in 73% (n=126) of the patients, as well as the most frequent overall complaint. Hunger pain, night pain, periodical nature of symptoms, and history over 2 years were of independent value in differentiating between peptic ulcer and functional dyspepsia. The symptoms of gastroesophageal reflux disease and irritable bowel syndrome predominated in the minority of patients (11% and 5% respectively) but accompanied other complaints in almost 2/3 of the patients. In 32 out of 75 patients with peptic ulcer, the symptoms of irritable bowel syndrome and in 29 cases the presence of frequent heartburn and regurgitation were noted. Conclusions: Classical symptoms are valuable in predicting the diagnosis of peptic ulcer. Heartburn and acid regurgitation are present in both gastroesophageal reflux disease and peptic ulcer. Irritable bowel syndrome is common in patients with peptic ulcer.
MeSH term(s)	Adolescent ; Adult ; Aged ; Alcohol Drinking ; Dyspepsia/complications ; Dyspepsia/physiopathology ; Dyspepsia/psychology ; Endoscopy, Gastrointestinal ; Estonia/epidemiology ; Female ; Helicobacter Infections/complications ; Helicobacter Infections/epidemiology ; Humans ; Male ; Middle Aged ; Prevalence ; Smoking
Language	English
Publishing date	2004-10
Publishing country	Croatia
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1157623-6
ISSN	1332-8166 ; 0353-9504
ISSN (online)	1332-8166
ISSN	0353-9504
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Article ; Online: Comparative Analysis of Gut Microbiota in Centenarians and Young People: Impact of Eating Habits and Childhood Living Environment.

Sepp, Epp / Smidt, Imbi / Rööp, Tiiu / Štšepetova, Jelena / Kõljalg, Siiri / Mikelsaar, Marika / Soidla, Indrek / Ainsaar, Mare / Kolk, Helgi / Vallas, Mirjam / Jaagura, Madis / Mändar, Reet

Frontiers in cellular and infection microbiology

2022 Volume 12, Page(s) 851404

Abstract: The composition of centenarians' gut microbiota has consistently been used as a model for healthy aging studies. However, there is an incomplete understanding of how childhood living conditions and eating habits affect the development and composition of ... ...

Abstract	The composition of centenarians' gut microbiota has consistently been used as a model for healthy aging studies. However, there is an incomplete understanding of how childhood living conditions and eating habits affect the development and composition of gastrointestinal microbiota in centenarians with good cognitive functions. We compared the gut microbiota as well as the living and eating habits of the oldest-old group and the young people group. The richness and diversity of microbiota and the abundance of hereditary and environmental microbes were higher in people with longevity than young people. People with longevity ate more potatoes and cereal products. In their childhood, they had more exposure to farm animals and did not have sewers compared with young people. Young people's gut microbiota contained more butyrate-producing bacteria and bacteria that characterized an animal-based Western diet. These results expand our understanding of the effects of childhood environment and diet on the development and stability of the microbiota in people with longevity.
MeSH term(s)	Adolescent ; Aged, 80 and over ; Animals ; Bacteria/genetics ; Centenarians ; Feeding Behavior ; Gastrointestinal Microbiome ; Humans ; Microbiota
Language	English
Publishing date	2022-03-15
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2619676-1
ISSN	2235-2988 ; 2235-2988
ISSN (online)	2235-2988
ISSN	2235-2988
DOI	10.3389/fcimb.2022.851404
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