Relationship Between Atopy Patch Test with Foods and SCORAD

Background and Design: The relationship between food and atopic dermatitis (AD) is controversial. Atopy patch test (APT) gained prominence due to low specificity of “fresh prick tests” (FPT) with foods, commonly late occurrence of lesions in AD and, thus, the inconsistencies in anamneses, and being the provocative tests time consuming and risky, as well as due to the role of T lymphocytes in the pathophysiology of the disease. In this study, we investigated the relationship of APT and FPT made with food with SCORAD index assessing the disease severity.Materials and Methods: Forty-five children (21 males and 24 females) aged between 2-15 years who were diagnosed with AD in our outpatient clinic between May 2006 and May 2007 were included in the study. FPT and APT with eggs, milk and wheat flour were performed in all patients. The severity of illness was assessed using the SCORAD index. Statistical analysis was performed using SPSS version 11.0 for Windows. A p value of less than 0.05 was considered statistically significant

Hayvansal Ürün Üretimi ve Devlet Destekleri Arasındaki İlişki: Türkiye Üzerine Zaman Serisi İncelemesi

Çalışma hayvansal ürün üreticilerine verilen devlet destekleri ile ürünlerin üretim miktarı arasındaki ilişkiyi süt ve dana eti örneğinde incelemeyi amaçlamaktadır. Bu amaçla Türkiye için, 1986-2016 yılları arası veriye dayanarak süt ve dana eti için ayrı ayrı denklemlerle hata düzeltme modelleri tahmin edilmiştir. Eşbütünleme ilişkisinden kısa dönem Granger nedensellik ilişkilerine bakıldığında, süt üretim denkleminde değişkenler arasında istatistiksel olarak anlamlı bir nedensellik ilişkisi bulunamamıştır. Dana eti üretim denkleminde ise tüm değişkenler arasında çift yönlü Granger anlamda nedensellik bulunmuştur. Uzun dönem katsayılar incelendiğinde, süt üretim seviyesi ile piyasa fiyat farklılaşması arasında negatif, üretici destekleri ile pozitif bir ilişki bulunmaktadır. Öte yandan dana eti üretimi ile piyasa fiyat farklılaşması arasında pozitif ancak üretici destekleri ile negatif bir ilişki bulunmaktadır. Bulgular gerek parasal üretici desteklerinin gerekse de parasal destek dışındaki dış ticaret düzenlemesi gibi politikaların ürün türüne göre farklılaştırılması gerektiği düşüncesini desteklemektedir. Jel Kodu: Q10, Q18, Q28, H2

Alteration of Body Measurements of Some Native Sheep of Turkey at the Fattening Period

Bu araştırma, Akkaraman, Dağlıç, Kıvırcık, Malya ve Karacabey Merinosu (KM) ırkı kuzuların entansif besideki vücut gelişimlerini karşılaştırmak amacıyla yapılmıştır. Araştırmada her ırktan 10 baş olmak üzere toplam 50 baş erkek kuzu kullanılmıştır. Kuzular ortalama 20 kg canlı ağırlıkta ve yaklaşık 2.5 aylık yaşta besiye alınarak 68 gün süreyle entansif şartlarda beslenmiştir. Araştırmada kullanılan Akkaraman, Dağlıç, Kıvırcık, Malya ve KM’lerin sırasıyla cidago yüksekliğindeki artış 9.8, 5.9, 11.2, 10.5 ve 10.2 cm, sağrı yüksekliğindeki artış 13.0, 10.9, 8.6, 12.5 ve 12.2 cm, vücut uzunluğundaki artış 13.1, 8.6, 8.6, 13.8 ve 14.4 cm, göğüs çevresindeki artış 20.2, 15.6, 16.5, 23.9 ve 20.7 cm, but çevresindeki artış 22.9, 16.5, 16.2, 21.1 ve 20.5 cm olarak bulunmuştur. Entansif besi süresince Akkaraman, Malya ve KM genotiplerinin vücut gelişimi birbirine benzer seyir takip etmiş ancak Kıvırcık ve Dağlıç genotiplerinin vücut gelişiminden üstün oldukları görülmüştür.This study was carried out to determine the body growth of Akkaraman, Dağlıç, Kıvırcık, Malya and Karacabey Merino (KM) lambs at intensive fattening period. A total of 50 male lambs there are 10 lambs from each breed were used in the study. The lambs were 2.5 months of age and their live weights averaged as 20 kg at the beginning of fattening period the intensive fattening period lasted for 68 days. The increase in body measurements of Akkaraman, Dağliç, Kivircik, Malya and Karacabey Merino were determined as 9.8, 5.9, 11.2,10.5 and 10.2 cm for withers heights; 13.0, 10.9, 8.6, 12.5 and 12.2 cm for rump heights; 13.1, 8.6, 8.6, 13.8 and 14.4 cm for body lengths; 20.2, 15.6, 16.5, 23.9 and 20.7 cm for heart girths and 22.0, 16.5, 16.2, 21.1 and 20.5 cm for leg girths respectively. During the intensive fattening period Akkaraman, Malya and KM genotypes had similar body performance however these breeds had better body performance than Kivircik and Dağliç genotypes

Post abortion family planning counseling as a tool to increase contraception use

<p>Abstract</p> <p>Background</p> <p>To describe the impact of the post-abortion family planning counseling in bringing about the contraceptive usage in women who had induced abortion in a family planning clinic.</p> <p>Method</p> <p>The Diyarbakir Office of Turkish Family Planning Association (DTFPA) is a nonprofit and nongovernmental organization which runs a family planning clinic to serve the lower socio-economic populations, in Diyarbakir-Turkey. Post abortion counseling is introduced by using proper communication skills and with using appropriate methods to women. In this study we introduced contraceptive usage of women who had induced abortion one year ago and followed by DTFPA's clinic.</p> <p>Results</p> <p>55.3% of our clients were not using contraceptive methods before abortion. At the end of the one year, 75.9% of our followed-up clients revealed that they were using one of the modern contraceptive methods. There was no woman with IUD before induced abortion. At the end of one year 124 (52.3%) women had IUD. "A modern method was introduced immediately after abortion" was the most important factor increasing modern method usage.</p> <p>Conclusion</p> <p>Our results advocate that post-abortion counseling may be an effective tool to increase the usage of contraceptives. Improved and more qualified post-abortion family planning counseling should be an integral part of abortion services.</p

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat