Adult male circumcision to prevent HIV?

Summary: While the HIV pandemic persists, and randomized clinical trials to evaluate the effectiveness of male circumcision as an HIV prevention measure are underway with initial results being released, there is still much debate on the implications of these studies as well as on the feasibility of such a measure. This paper summarizes and discusses the main findings of studies of the evidence underlying adult male circumcision to prevent HIV, explores its feasibility and the implication for policy and future research. While the existing biological and epidemiological evidence suggest potential reduction of the risk of HIV acquisition in circumcised men, additional evidence from randomized trials are needed to confirm this. Even if the findings are confirmed, the practical aspects of implementing adult circumcision would have to be carefully considered. The feasibility of such an intervention, particularly with respect to its cost-effectiveness, safety and acceptability, is still to be demonstrated

Results of reference pricing and reimbursement discount rate schemes of Turkey

OBJECTIVES: General Directorate of Pharmaceuticals and Pharmacy (IEGM) is responsible for setting all prices for human medicinal products. The reference pricing system is used for setting these prices. Reference countries are reviewed annually and may be subject to certain alterations. There were 5 reference countries in 2009: Spain, Italy, Germany, France and Greece. The aim of this study is to show the distribution of reference countries which were used for reference pricing.METHODS: The price list of pharmaceuticals which was published by IEGM on 15.04.2011 was used for analysis. Distribution of reference countries and prices were evaluated.RESULTS: Prices of 6,251 generic and 3,703 original products were set according to the price list. 5,283 of generics and 3,306 of originals were in the positive list for reimbursement. Reference pricing was used for 2,352 generics and 2,281 originals. Prices of the remaining were set outside of reference pricing. 32 different countries were used for reference pricing. Italy was the most popular country for reference pricing. Even if it was not a reference country, Germany was used in some of the pharmaceuticals. The average reimbursement discount rate and price were 24.43% and 249 TL, respectively. There were no colerations between price and reimbursement discount rate, or reference country and reimbursement rate.CONCLUSION: It has been shown that Italy has the highest impact on the pricing of all pharmaceuticals in Turkey. Even if it was not a reference country, Germany showed to affect pharmaceuticals more than other countries which were also not used for reference pricing. Even if reimbursement discount rates are stated by the Social Security Institution (SGK), there are different discount rates for pharmaceuticals. The analysis stated that there were correlation between price, country and discount rates. This analysis is first for the literature. Further analysis is necessary in the light of price changes and newly launched pharmaceuticals

Health technology assessment in Türkiye: Current status and perspectives on future implementation

Objective:: Türkiye's health care system reforms have led not only to increased access to health care but also to rising pharmaceutical expenditures. Therefore, health technology assessment (HTA) has become an important tool for evaluating priorities in reimbursement and budget allocation. Our study aimed to describe the current HTA environment in Türkiye and explore long-term perspectives from a broad spectrum of Turkish stakeholders on the development of HTA in the next ten years. Methods:: In 2019, we used a convenience sampling method to conduct an online survey with stakeholders from different areas in the health system. Additional face-to-face discussions were conducted to clarify answers when needed. We assessed the current evaluation process for pharmaceuticals and examined the need for HTA in Türkiye. Online survey data were extracted into Microsoft Excel for analysis. Quantitative data were summarised descriptively. Results:: A total of 27 Turkish stakeholders completed the survey; 21 were employed in the public sector, and 6, in the private sector. The majority of participants (18/27) suggested introducing HTA for all new health technologies considered for public reimbursement and instituting an additional review process for currently reimbursed technologies. Most respondents (25/27) agreed that a threshold for cost-effectiveness should be applied in the next ten years. Conclusion:: The stakeholders concurred that Türkiye must implement an HTA process soon. However, further discussion and interaction between stakeholders are essential to ensure a broad commitment to the implementation of a structured HTA process in Türkiye

Interventions to treat premature ejaculation: a systematic review short report

Background: Premature ejaculation (PE) is commonly defined as ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it. PE can be either lifelong and present since first sexual experiences (primary), or acquired (secondary), beginning later (Godpodinoff ML. Premature ejaculation: clinical subgroups and etiology. J Sex Marital Ther 1989;15:130–4). Treatments include behavioural and pharmacological interventions. Objective: To systematically review evidence for clinical effectiveness of behavioural, topical and systemic treatments for PE. Data sources: The following databases were searched from inception to 6 August 2013 for published and unpublished research evidence: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects and the Health Technology Assessment database; ISI Web of Science, including Science Citation Index, and the Conference Proceedings Citation Index-Science. The US Food and Drug Administration website and the European Medicines Agency (EMA) website were also searched. Methods: Randomised controlled trials (RCTs) in adult men with PE were eligible (or non-RCTs in the absence of RCTs). RCT data were extrapolated from review articles when available. The primary outcome was intravaginal ejaculatory latency time (IELT). Data were meta-analysed when possible. Other outcomes included sexual satisfaction, control over ejaculation, relationship satisfaction, self-esteem, quality of life, treatment acceptability and adverse events (AEs). Results: A total of 103 studies (102 RCTs, 65 from reviews) were included. RCTs were available for all interventions except yoga. The following interventions demonstrated significant improvements (p < 0.05) in arithmetic mean difference in IELT compared with placebo: topical anaesthetics – eutectic mixture of local anaesthetics (EMLA®, AstraZeneca), topical eutectic mixture for PE (Plethora Solutions Ltd) spray; selective serotonin reuptake inhibitors (SSRIs) – citalopram (Cipramil®, Lundbeck), escitalopram (Cipralex®, Lundbeck), fluoxetine, paroxetine, sertraline, dapoxetine (Priligy®, Menarini), 30 mg or 60 mg; serotonin–noradrenaline reuptake inhibitors – duloxetine (Cymbalta®, Eli Lilly & Co Ltd); tricyclic antidepressants – inhaled clomipramine 4 mg; phosphodiesterase-5 (PDE5) inhibitors – vardenafil (Levitra®, Bayer), tadalafil (Cialis®, Eli Lilly & Co Ltd); opioid analgesics – tramadol (Zydol SR®, Grünenthal). Improvements in sexual satisfaction and other outcomes compared with placebo were evident for SSRIs, PDE5 inhibitors and tramadol. Outcomes for interventions not compared with placebo were as follows: behavioural therapies – improvements over wait list control in IELT and other outcomes, behavioural therapy plus pharmacotherapy better than either therapy alone; alpha blockers – terazosin (Hytrin®, AMCO) not significantly different to antidepressants in ejaculation control; acupuncture – improvements over sham acupuncture in IELT, conflicting results for comparisons with SSRIs; Chinese medicine – improvements over treatment as usual; delay device – improvements in IELT when added to stop–start technique; yoga – improved IELT over baseline, fluoxetine better than yoga. Treatment-related AEs were evident with most pharmacological interventions. Limitations: Although data extraction from reviews was optimised when more than one review reported data for the same RCT, the reliability of the data extraction within these reviews cannot be guaranteed by this assessment report. Conclusions: Several interventions significantly improved IELT. Many interventions also improved sexual satisfaction and other outcomes. However, assessment of longer-term safety and effectiveness is required to evaluate whether or not initial treatment effects are maintained long term, whether or not dose escalation is required, how soon treatment effects end following treatment cessation and whether or not treatments can be stopped and resumed at a later time. In addition, assessment of the AEs associated with long-term treatment and whether or not different doses have differing AE profiles is required

Investigation of free radical metabolism in septic rat&#8223;s renal tissues treated with lipopolysaccharide ; Effect of vitamin D

Çoklu organ yetmezliğine neden olan sepsis, yoğun bakımlarda mortalitenin ve morbiditenin en sık nedenidir. Sepsiste LPS&#8223;nin neden olduğu aşırı immün cevap hipovolemi, şok ve çoklu organ yetmezliğine neden olur. Aşırı immün yanıt oksidatif stres oluşturarak organ yetmezliğine neden olmaktadır. Son yıllarda vitamin D&#8223;nin immün regulatuar ve antioksidan etkileriyle ilgili yapılan araştırmalarda vitamin D&#8223;nin koruyucu rolünün olduğu gösterilmiştir. Biz de alışmamızda sepsiste serbest radikal metabolizmasını incelemeyi ve bu metabolizma üzerine vitamin D&#8223;nin etkisini araştırmayı amaçladık. Çalışmada ağırlıkları yaklaşık 250-350 gr olan 24 adet dişi wistar albino rat kullanıldı. Ratlar kontrol grubu, sepsis grubu, vitamin D grubu, sepsis + vitamin D grubu olmak üzere 4 gruba bölündü. Sepsis 16 mg/kg dozunda LPS E.coli (O111.b4) intraperitoneal yolla uygulanarak oluşturuldu. D vitamini 3 gün boyunca 2 mg/kg 25(OH)Vitamin D3 (ayçiçek yağında çözülerek) gavaj yolula verildi. Ratların vücut sıcaklıkları rektal yoldan ölçüldü. Rat böbrek dokularında serbest radikal enzimleri kinetik olarak, böbrek fonksiyonlarını gösteren belirteçler Roche Cobas Integra 800 cihazında ölçüldü. Dokuların histopatolojik incelemesi yapıldı. SOD ve GSH-Px aktivitelerinde gruplar arasında fark görülmedi. CAT aktivitelerinde en fazla sepsis+vitamin D grubunda olmak üzere tüm gruplarda kontrol grubuna göre baskılanma görüldü. GST aktivitelerinin sepsis ve sepsis+vitamin D gruplarında baskılandığı görüldü. BUN ve kreatinin düzeylerinde sepsis ve sepsis+vitamin D gruplarında artış olduğu gözlendi. Kontrol ve vitamin D grupları normal histolojik yapı gösterirken, sepsis ve sepsis+vitamin D gruplarında bowman kapsülünde genişleme ve inflamasyon görüldü. Sonuç olarak sepsiste D vitamini kullanılmasının renal hücreleri toksik etkiden koruyucu bir etkisinin olmadığını, buna karşılık özellikle sepsis durumunda kullanıldığında H2O2 ve GSH metabolizmasını kullanan anti oksidan enzimler üzerine baskılayıcı etkisinin olduğunu gördük. Konunun özellikle glutatyon ve glutatyon kullanan enzimler açısından daha detaylı değerlendirilmesi gerektiğini düşünmekteyiz.Sepsis, a multiple organ dysfunction syndrome, is a common cause of morbidity and mortality in the intensive care unit. LPS-induced excessive immune response is associated with hypovolemia, shock and multi-organ damage in sepsis. Excessive immune response causes multi-organ damage by increasing oxidative stress. In last years, studies on the immune regulatory and antioxidant effects of vitamin D demonstrated its protective role. In this study, we aimed to investigate the effects of VitaminD on free radical metabolism in LPS injected rats. 24 female wistar albino rats (weigt 250-350 g.) were divided into 4 groups randomely. 1) Control , 2) Sepsis, 3) Sepsis+vitamin D, 4) Vitamin D. Sepsis was induced with single intraperitoneal injection of LPS E.coli (O111-b4) 16 mg/kg. Vitamin D was given 2 mg/kg 25(OH) single dose via gavage (in sunflower oil) for 3 days. Rectal body temperature was measured in rats. Renal function tests (BUN, creatinine) were analysed in serum by Integra 800. Tissue catalase (CAT), superoxide dismutase (SOD), glutathione peroksidase (GSH-Px) and glutathione-S-transferase (GST) levels were analysed kinetically. Additionally rat renal tissues were analysed histopathologically. SOD and GSH-Px activities were not significantly different between the groups. CAT activities were depressed in all groups compared with control group, this inhibition was mainly watched in the sepsis+vitamin D group. GST activities were depressed in sepsis ve sepsis+vitamin D group. BUN and creatinine levels were elevated in sepsis and sepsis+vitamin D group. While control and vitamin D groups showed normal histological structure, inflammation, expansion in bowman capsule and degeneration in sepsis and sespsis+vitamin D groups. In conclusion, we found that vitamin D treatment in sepsis has no protective role against renal toxicity effects on liver. However treatment vitamin D in sepsis have inhibitory effect on antioxidant enzymes which use H2O2 and GSH metabolism. We think that more detailed assessment of this subject is necessary in terms of glutathione and enzymes using glutathione

Perakende sektöründe teknolojik yenilikler ve bir araştırma

Perakende sektörü, ulusal ve uluslararası üreticilerin ürünlerini tüketicilerle buluşturduğu büyük bir hizmet platformudur. AB perakende pazarında yaşanan gelişimi ele alacak olursak, modern perakende sektörünün, geleneksel perakende sektöründen pazar payı kazanmaya başlaması, perakende sektöründeki istihdam verimliliği seviyesinin, ölçek ekonomisi ve uluslararası pazarlara yayılmanın faydalarının yanısıra, tedarik zinciri yönetiminde ve satış birimlerinde yeni teknolojilerin kullanılması ile arttığı çok açıktır. Alışveriş ortamındaki teknolojik kolaylıklar tüketicilerin satın alma tutumunu şekillendirme sürecini ve ürünleri satın alma kararlarını etkiler ve alışverişden duydukları tatminle birlikte mağazaya ilerde tekrar gelme niyetlerini tayin eder. Müşteri verilerinin yönetilmesi ve anlamlı bilgiye dönüştürülmesi ile geleceğin mağazası teknolojilerinin uygulanması sürecini deneme aşamasında yürüten firmalar olmasına karşılık, müşterilerinde yeni teknolojilerin avantajlarını hissedebilmesi ve bunlardan faydalanma, benimseme isteği işletmeler için teknoloji uygulamasında önemli etkenlerden birisi olacaktır. Bu çalışmada, perakende sektöründeki teknolojik yenilikler çercevesinde müşterinin satın alma tutumlarının belirlenmesi konusu, Türkiye’de faaliyet gösteren organize perakendeciler kapsamında anket ve mülakat araştırmaları ile irdelenmiştirABSTRACTTECHNOLOGICAL INNOVATIONS IN RETAILING SECTORAND A RESEARCHRetailing sector is a great service platform where national and international producers have their products met with the consumers. If we deal with the developments experienced in EU retailing market, it is very clear that modern retailing sector’s gaining market share from the traditional retailing sector is increased with the benefits of employment productivity level in the retailing sector, scale economy and deployment to international markets as well as utilization of new technologies in the supply chain management and sales units. Technological facilities in the shopping environment influences the process of forming the purchasing attitude of the consumers and their decisions on purchasing the products and determines their intention to pay further visits to the store together with their satisfaction from the shopping. Although there are companies which conduct the application process of the future store technologies at trial stage with management of the customer data and transformation of these into significant information, feeling the advantages of new technologies on their customers and desire to benefit from, appreciate these will be one of the most important factors for the enterprises regarding application of technology. In this study, the subject of determining the purchasing attitudes of the customer within the frame of the technological innovations in the retailing sector was examined with survey and interview researches covering the organized retailers who show activity in Turkey

Comparison Of Pharmaceutical Pricing And Reimbursement Systems In Turkey And Certain Eu Countries

Recently, the need for health care services has increased gradually and the limitations in sources allocated for this area have been recognized. Moving from this fact, it has gained a supreme importance to determine what health programs or technologies will be given priority. According to Danzon (Reference pricing: theory and evidence, reference pricing and pharmaceutical policy: perspectives on economics and innovation, springer, New York, pp 86–126, , arrangements towards controlling the expenses through price and profit controls, reimbursement methods and incentives have recently gained wide currency. This present study examines; along with the current situation in Turkey, pharmaceutical pricing methods, reimbursement methods and basic health indicators, within the scope of changing pharmaceutical policies, in Turkey, the EU countries which Turkey takes as reference and the United Kingdom, the implementations of which are of utmost importance for other countries. Upon the research conducted, it was detected that the pharmaceutical pricing in Turkey has been performed on the basis of the reference pricing system that takes Italy, Portugal, Spain, Greece and France as reference. The regulations regarding the reimbursement process are determined by SSI. For Turkey’s case; pricing and reimbursement system has been changed numerous times and the discount rates has incrementally risen. In pricing, on the other hand, during this period companies faced with difficulties in economic terms because of the fact that price discount of high rates are implemented over the reference price and that the European currency of Euro is determined as 70% of previous year average Euro sales rate which is 2,1166 for the year 2016. Each country has specific regulations and pricing and reimbursement policies of medicines based on economic situation, reimbursement methods and market size. The aim of pricing and reimbursement systems are reaching more efficient and sustainable healthcare systems.PubMedWoSScopu