An integrated economy-demography model reframed in a system dynamics setting

In recent history, there has been an increasing concern about population aging and the associated increased economic burden in terms of high health-care expenses and pension payments. The need for decision support tools that can explore population dynamics has become a prominent issue. This study presents a comprehensive framework where one can scrutinize the key demographic drives of fertility (Total Fertility Rate/Age-Specific Fertility Rate) over macroeconomic indicators (technology, education, human capital) under exogenous mortality. The integrated model in this article is developed based on a reformulation of the unified growth theory. In the reformulated model, namely the "economy-demography model," the population age/sex structure is preserved, age-specific mortality is included, and fertility is measured in conventional demographic terms. The model is then presented in system dynamics framework, and its practical use is showcased with data obtained from the Turkish Statistical Institute

Chemical Composition of The Essential Oil of The Flowers and Leaves of Calba Tea (Dorystoechas hastata Boiss & Helder. ex Bentham)

WOS: 000381628100034The essential oils of flower and leaves of Dorystoechas hastata Boiss & Helder. ex Bentham, grown in Turkey, was obtained by hydrodistillation and analysed by GC and GS-MS. Fourty components were identified in the flowers oil, which represented about 93.97 % of the total composition of the oil. The major constituents of the flower essential oil were myrcene (19.37 %), 1,8-cineole (14.30 %), beta-pinene (9.19 %), alpha-pinene (8.49 %) and beta-caryophyllene (6.18 %). Thirty-seven components were established in the leaves oil, making up 97.16 % of the total composition. The main constituents of the essential oil of the leaves were myrcene (20.71 %), 1,8-cineole (18.76 %), beta-pinene (12.51 %), alpha-pinene (8.54 %), bornyl acetate (7.28 %) and terpinene-4-ol (6.19 %). As seen, myrcere, 1,8-cineole and beta-pinene for both oils were the main components.Selcuk University Coordination of Scientific Research Projects (S.U.-BAP, Konya-Turkey)This study was supported by Selcuk University Coordination of Scientific Research Projects (S.U.-BAP, Konya-Turkey)

Mean platelet volume as an inexpensive bio-marker of endometriosis

Objective: Increased platelet activation has also been suggested to play a pivotal role in the development and progression of inflammation. Recently, mean platelet volume (MPV) has been investigated as a simple inflammatory marker in several diseases and it was found that MPV can be used as a marker of inflammatory disease. Therefore this study was designed to investigate and compare the values of MPV in patients with endometriosis and the MPV values in healthy women. Materials and methods: Patients with endometriosis (n = 297) and symptom-free, healthy, age-matched controls underwent tubal ligation (n = 36) were retrospectively evaluated and recruited to the study at three tertiary centers between January 2008 and December 2014. For further analysis, patients with endometriosis were divided into initial endometriosis (n = 129) and advanced endometriosis (n = 168) groups according to the severity of the disease. Receiver Operating Characteristic (ROC) curve and sensitivity and specificity report were performed for MPV value to evaluate differences between the groups. Results: MPV in patients with endometriosis were found to be higher than the control group (8.80 +/- 1.08 fL vs 8.11 +/- 1.03 fL, respectively; P < 0.001). There was no significant difference regarding mean MPV between the patients with advanced and initial endometriosis (8.72 +/- 1.60 fL and 8.90 +/- 0.97 fL, respectively; P = 0.15). ROC curve analysis suggested that the optimum MPV cut-off value for endometriosis was 8.55 fL, with a sensitivity, specificity, of 61% and 61%, respectively (AUC: 0.671). Conclusion: This study showed that significantly higher MPV levels were found in the patients with endometriosis and confirmed the previous studies indicating that endometriosis is an inflammatory process. MPV is an important, simple, inexpensive, and effortless hematological parameter and can be useful in evaluation of endometriosis patients

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit