Zależności między występowaniem nowotworów tarczycy a przewlekłym limfocytarnym zapaleniem tarczycy: zmiana zasad leczenia chirurgicznego?

Wstęp: Istnieją kontrowersje na temat zależności między występowaniem nowotworów tarczycy a przewlekłym limfocytarnym zapaleniem tarczycy (CLT). Wykazano, że ogniskowe limfocytarne zapalenie tarczycy rozwija się wtórnie do zmian nowotworowych, jednak nadal nie wyjaśniono, czy osoby z rozsianą postacią limfocytarnego zapalenia tarczycy mają skłonność do zapadania na raka tarczycy. Celem badania było określenie zależności między CLT i złośliwymi nowotworami tarczycy oraz ocena chirurgicznego leczenia CLT. Materiał i metody: Retrospektywnie analizowano dane 917 chorych operowanych z powodu chorób tarczycy. Siedemdziesiąt siedem (8,4%) osób z histopatologicznie zdiagnozowanym CLT (nieswoiste zapalenie tarczycy lub choroba Hashimoto) przebadano pod kątem nowotworów tarczycy. Do analizy włączono 15 chorych, u których stwierdzono współwystępowanie CLT i nowotworu tarczycy. Wyniki: Ocena histopatologiczna 917 przypadków wykazała zmiany nowotworowe tarczycy u 97 (10,6%) chorych, natomiast u 77 osób stwierdzono CLT. U 16 (20,8%) osób z tej grupy rozpoznano chorobę Hashimoto (swoiste CLT), natomiast u 61 (79,2%) chorych — CLT. U 15 pacjentów nowotwór tarczycy współwystępował z CLT. Wśród stwierdzonych nowotworów odnotowano 9 przypadków (60%) raka brodawkowatego, 3 przypadki (20%) raka rdzeniastego, 1 przypadek (6,6%) raka pęcherzykowego, 1 przypadek (6,6%) raka z komórek Hurtle’a i 1 przypadek (6,6%) chłoniaka. W niniejszej analizie częstość rozwoju nowotworu na podłożu CLT wynosiła 19,48%; natomiast w grupie bez CLT nowotwór rozwinął się u 9,76%; różnica między grupami jest statystycznie istotna (p = 0.008). Wnioski: Należy z większą uwagą oceniać chorych z CLT ze względu na możliwość procesów rozrostowych. W przypadku wykrycia guzka u chorego z zapaleniem tarczycy minimalna interwencja chirurgiczna powinna obejmować lobektomię. Totalna tyroidektomia jest lepszym rozwiązaniem niż subtotalna tyroidektomia, ponieważ wiąże się z większymi korzyściami, do których należą kontrola zapalenia tarczycy, eliminacja ryzyka reoperacji i stabilizacja zaburzeń hormonalnych. (Endokrynol Pol 2011; 62 (4): 303–308)Background: The relation between thyroid neoplasms and chronic lymphocytic thyroiditis (CLT) is controversial. While it is accepted that focal lymphocytic thyroiditis develops secondarily to malignancy, it is not clear whether diffuse lymphocytic thyroiditis has a tendency to develop into thyroid cancer. The aim of this study was to investigate the relation between CLT and malignant tumours of the thyroid and evaluate the surgical approach to CLT cases. Material and methods: In this study, 917 patients operated on for thyroid diseases were investigated retrospectively. Seventy-seven (8.4%) patients histopathologically diagnosed as having CLT (either non-specific or Hashimoto’s thyroiditis) were investigated for any concurrent malignant neoplasm. Fifteen patients in whom CLT and thyroid malignancy were coexisting were included in the study. Results: In the pathological evaluation of 917 cases, malignancy in the thyroid was found in 97 (10.6%) cases. Seventy-seven cases were categorised as CLT. Of these 77, 16 (20.8%) were Hashimoto’s thyroiditis (specific CLT) and the other 61 (79.2%) were non-specific CLT. In 15 cases, thyroid malignancy was found to be concurrent with CLT. Of the malignities, nine (60%) were papillary carcinoma, three (20%) medullar carcinoma, one (6.6%) follicular carcinoma, one (6.6%) Hurthle cell carcinoma, and one (6.6%) lymphoma. In our series, the rate of the development of malignancy against the background of CLT was 19.48%, while the rate in the groups without CLT was 9.76%, with a statistically significant difference between the groups (p = 0.008). Conclusions: CLT cases should be evaluated more carefully in terms of malignancy. If a nodule is detected on thyroiditis, the minimal surgical intervention should be lobectomy. Total thyroidectomy should be considered as preferable to subtotal thyroidectomy because of its many advantages such as controlling thyroiditis, removing the probability of reoperation, and hormonal stability. (Pol J Endocrinol 2011; 62 (4): 303–308

Ümraniye ilçesinde kişilerin sağlığı ve hastalığı açıklayışları, sağlık arama davranışları, iyileştirici sağlık hizmetlerini kullanımları, aldıkları sağlık hizmetinden memnuniyetleri ve bunları etkileyen etmenler

İstanbul'un Ümraniye ilçesinde yaşayan kişilerin sağlığı ve hastalığı açıklayışlarını, sağlık arama davranışlarını, genellikle ve son hastalıkta sağlık hizmetlerini kullanımlarını, başvurdukları sağlık kuruluşlarını tercih nedenlerini ve aldıkları hizmetten memnuniyetlerini ve bunları etkileyen etmenleri incelemek amacıyla planlanan kesitsel tipteki bu araştırma, 605 kişi üzerinde yürütülmüştür. Araştırmada nüfusa ağırlıklı küme örnekleme yöntemi kullanılmış ve veriler yüz yüze anket tekniği ile toplanmıştır. Verilerin analizinde Chi square, McNemar ve Kappa testleri kullanılmıştır.Ümraniye'de yaşayan kişilerin %61,4'ünün kendini rahatsız hissettiğinde değişik kaynaklardan edindiği ilaçları kullandığı, %41,1'inin doktora başvurduğu; sağlık arama davranışı üzerinde sosyal güvence ve sürekli bakım kaynağın sahip olmanın etkili olduğu saptanmıştır. Ancak ağır-ciddi ölümcül durumlarda doktora gittiğini belirtenlerin oranı %66,4 iken, yalnızca %13,9'u hemen doktora başvurduğunu belirtmiştir. Doktor başvuranların çoğu genellikle özel sağlık kuruluşlarını ve kamu finansmanlı hastaneleri tercih etmekte; tercih nedeni olarak da, en yüksek oranda sosyal güvence, ekonomik nedenler ve insanca davranışlarla karşılaşma ifade edilmektedir. Sağlık kuruluşlarına başvuranların %68,6'sı genellikle başvurduğu sağlık kuruluşundan memnun olduğunu ifade etmiştir. Son bir ay içinde herhangi bir rahatsızlık geçirme oranının %48,3'tür. Kişilerin, sağlık hizmetlerini kullanma konusunda, son hastalıkta da büyük ölçüde genellikle davrandığı gibi davrandığı saptanmıştır.ANAHTAR SÖZCÜKLER: Sağlığı ve Hastalığı Açıklama, Sağlık Arama Davranışı, Sağlık Hizmetlerinin Kullanımı, Hasta Memnuniyeti, Nüfusa Ağırlıklı Küme Örnekleme, Ümraniye.The aim of this cross-sectional study is to investigate the explanation of health and illness of people living in Umraniye District of Istanbul, their health seekİng behavior, their usual and last illness health services utilization, the reasons of health facility preferances, their patient satisfaction and the factors affecting them.The study is carried out on 605 people. Population wieghted cluster sampling method is used in the study and data is collected with face - to - face interview tecnique. In the analysis, chi square, McNemar and Kappa tests are used. It is observed that 61,4% of people living in Umraniye use drugs that are obtained from different sources; 41,1% go to doctor; when they fell sick. Social security and having a regular care resource has impact on health seeking behavior. However, 61,4% say that they go to doctor for serious-severe-deahly situations; only 13,9% go to doctor immediately. Those who go to doctor, usually prefer private health facilities and state financed hospitals; the reason for this choice is said to be social security, economical reasons and willingness to meet with humanistic approaches. 68,6% of people going to health facilities say they are satisfied with the facility. The rate of having any illness within the last month is 48,3% and it is observed that health services utilization behavior almost the same as previous illness.KEY WORDS: Explaining Health And Illness, Health Seeking Behavior, Health Services Utilization, Patient Satisfaction, Population Wieghted Cluster Sampling, Umraniye

A digital movement in the world of inactive children: favourable outcomes of playing active video games in a pilot randomized trial

WOS: 000484907200012PubMed: 31471690This parallel randomized controlled trial was aimed to evaluate whether parameters as physical fitness, reaction times, self-perception and enjoyment levels, as well as parental and children perspectives, were affected by active video games in inactive and technologically preoccupied children. Data were collected in a laboratory setting from four randomly selected urban public schools. All 1300 children in grades 3-6 were surveyed for the study. Among the 918 responders, 106 children were determined to be inactive and preoccupied with technology. Children in 3 schools (n = 53) allocated to active video game and in one school (n = 53) allocated to control group were compared by univariate covariance analyses for primary outcomes such as weight, body mass index and fat ratios at the end of 12 weeks. Active video game group significantly showed favourable responses for weight, body mass index and corresponding z scores as well as reaction times and self-perception controlling for age and baseline scores. In addition, enjoyment of the children in the game group by qualitative analysis was high indicating a motivational aspect for the continuation of the games. Diverse contributions of games to physical, social, intellectual and personal development were revealed. Conclusion: Active video games by promoting enjoyment levels and physical activity, as well as contributing to agility, alertness, socializing, and striving, led to a reduction in weight gain. They may be used as beneficial tools diverting children from inactivity and subsequent obesity. Trial registration: This study called AVGAME is registered with the number NCT03720938 in . The trial protocol can also be retrieved from the archives of Abant Izzet Baysal University.What is Known:center dot Nowadays, children prefer sedentary video games that are known to induce weight gain and obesity-related comorbidities.center dot Active video games were shown to decrease weight in overweight and obese children.What is New:center dot Active video games decrease weight increment and reaction times, thus could be used to prevent obesity in inactive non-obese children.center dot Active video games raise self-esteem, induce enjoyment, improve the personal and intellectual development of children in addition to socializing and is a safe alternative to indoor sedentary video gamesResearch Foundation of Abant Izzet Baysal University [2012.16.02.545]The work was supported by the Research Foundation of Abant Izzet Baysal University by grant number 2012.16.02.545. Research Foundation had no influence either on the protocol or on the results

Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians’ migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants’ migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22–1.54) times more likely to emigrate. The push factor that was related to emigration intention was the “working conditions in the country” (OR: 1.89, 95% CI: 1.56–2.28) whereas the “social environment/lifestyle abroad” was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45–2.06). In addition, the quality problem in medical schools also had a significant impact on students’ decisions (OR: 2.20, 95% CI: 1.83–2.65). Insights: Although the percentage of those who want to emigrate “definitely” was at the same level as in the other developing countries, the tendency to migrate “permanently” was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians