Traditionality, Modernity, and Household Composition: Parent-Child Coresidence in Contemporary Turkey

We investigate the patterns and correlates of currently married adult children’s coresidence with their parents in Turkey, using data from the 1993 Turkish Demographic and Health Survey. We are particularly interested in “traditional” patterns of coresidence—that is, coresidence with one or both of the husband’s parents—and the effects of variables measuring traditionality at the individual and contextual levels on coresidence with any parent, and with the husband’s parents. The results indicate that coresidence among currently married children is not the norm. However, the odds of coresidence with the husband’s parents, given that a couple coresides with any parent, are very high. In addition, we find substantial effects of traditionality measures on coresidence especially with the husband’s parents. Continued economic development, and the social changes that accompany it, can be expected to reduce the prevalence of parent-child coresidence in Turkey

Diagnostic value of CA 19-9 in pregnancies complicated by spinal neural tube defects: a preliminary study

Objectives: Various physiological and pathological conditions can induce significant variations in plasma concentrations of tumor markers, such as CA 19-9, which is present in the serum and amniotic fluid of pregnant women. Herein, we aimed to determine the clinical importance of maternal serum CA 19-9 levels in the diagnosis of neural tube defects (NTDs). Material and methods: A total of 100 women were included in this controlled cross-sectional study. Thirty-three patients whose pregnancies were complicated by isolated meningocele or meningomyelocele constituted the study group, whereas 33 normal, healthy pregnant women constituted the control group, and 34 age- and body mass index (BMI)-matched non-pregnant women were chosen for the validation group. Results: The mean maternal serum CA 19-9 levels were 17.2 ± 17.0 IU/mL, 7.1 ± 5.9 IU/mL, and 4.7 ± 3.6 IU/mL in the study, control, and validation groups, respectively (p < 0.001). ROC analyses showed that elevated CA 19-9 values may predict NTDs (p < 0.001). The cut-off value for CA 19-9 was found to be 9.6 IU/mL at 70% (51%–84%, 95% CI) sensitivity and 84% (74%–92%, 95% CI) specificity. Conclusions: CA 19-9 may be a promising noninvasive marker for NTDs. Further studies are needed to reveal the clinical applicability and diagnostic potential of maternal serum CA 19-9 levels in the identification of NTDs

Kocaeli’de evlerde, ofislerde ve okullarda iç ortam hava kalitesinin belirlenmesi

TÜBİTAK ÇAYDAG01.01.2008Bu çalışmada, Kocaeli’de farklı bölgelerde ve farklı mikroçevrelerde (ev, okul, ofis), iç ve dış ortamda yapılan örneklemeler ile aktif ve pasif örnekleme ve ölçüm teknikleri kullanılarak 2 farklı partikül fraksiyonunda (PM2.5 ve PM10) 16 ağır metal (Al, As, Ca, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb, S, Si, Ti, V ve Zn), uçucu organik bileşikler (UOB’ler), SO2, NO2 ve O3 konsantrasyonları belirlenmiştir. Ayrıca, iç ortamda ölçülen konsantrasyonlarla maruziyet arasındaki ilişkiyi kurabilmek için, kişisel örnekleyiciler kullanılarak kişisel maruziyet düzeyleri de belirlenmiştir. NO2 için İç Ortam/Dış Ortam konsantrasyon oranlarının evlerde her 2 mevsimde de okullar ve ofislere nazaran yüksek bulunması evlerin iç ortamlarında NO2 kirletici kaynaklarının ofis ve okullara oranla daha baskın olduğu göstermektedir. İç Ortam/Dış Ortam oranlarının 1’in çok altında bulunması O3 ve SO2’in dış ortam kaynaklı bir kirletici olduğunu ve iç ortamlarda önemli bir kaynağının bulunmadığını göstermektedir. PM2.5 fraksiyonundaki toprak kaynaklı elementlerin iç ve dış ortam konsantrasyonlarının yüksek düzeylerde bulunması bu elementlerin iç ortamlara taşınımının yüksek olduğunu göstermektedir. PM2.5 kişisel maruziyet düzeylerinin As, S, V, Cu ve Cr gibi yanma kaynaklı elementler için iç ortam maruziyet düzeylerinden 2–6 kat daha yüksek olması ve bazı mevsimsel farklılıklar bulunmasına rağmen İç Ortam/Dış Ortam oranlarının genellikle 0.3–0.7 aralığında bulunması gözlenen yüksek kişisel maruziyet düzeylerinde dış ortamların etkisini göstermektedir. PM10 partikül fraksiyonunda belirlenen ağır metallerin büyük bir bölümü için İç Ortam/Dış Ortam oranlarının 1’den küçük bulunması dış ortam kirletici kaynaklarının iç ortam kirletici kaynaklarına daha baskın olduğunu göstermektedir. En yüksek UOB kirlilik düzeylerine örneklenen kişilerde rastlanırken bunu iç ortam ve dış ortam UOB kirlilik düzeyleri takip etmiştir. Her 2 mevsimde de toluen ev, ofis ve okullardaki UOB kirlilik düzeylerine en çok katkıda bulunan bileşik olurken onu etilbenzen, m,p-ksilen, stiren, nonan, hegzan, benzen, o-ksilen ve heptan bileşikleri takip etmektedir. Kentsel alanlarda elde edilen toplam UOB konsantrasyonlarının endüstriyel alanlarda elde edilen değerlerle uyum içinde bulunmuştur. Trafiğin belirteci olan bileşikler (BTEX, 1,2,4-trimetilbenzen) kentsel alanlarda yüksek bulunurken petrokimyanın belirteci olan hexane ve heptane bileşikleri endüstrinin yoğun olduğu alanlarda yüksek bulunmuştur. Ayrıca kentsel ve endüstriyel alanlarda elde edilen UOB konsantrasyonlarının sanayii ve trafikten uzak alanlarda elde edilen konsantrasyonlardan yüksek olması trafik ve sanayiinin tesbit edilen UOBlere olan katkısının ne kadar yüksek olduğunu göstermektedir. İç ortam, dış ortam ve kişisel maruziyet kirlilik düzeylerine etki ederek hava kalitesine olumsuz yönde katkıda bulunan kirletici kaynakların belirlenmesi amacıyla Pozitif Matris Faktörizasyonu (PMF) reseptör modelleme tekniği kullanılmıştır. PMF modellemesi, korelasyon analizi, iç ortam/dış ortam oranları, mikroçevre karakteristikleri, anketler ve zaman aktivite çizelgeleri incelenen kirleticilerin en önemli emisyon kaynaklarının endüstri, trafik ve sigara kullanımı olduğunu göstermektedir. İç ortam, dış ortam ve kişisel maruziyet düzeylerinin dünyanın diğer bölgelerinde yapılan çalışmalarda raporlanan düzeyler ile kıyaslanabilir olduğu bulunmuştur. Kişisel maruziyet konsantrasyonları kullanılarak çalışmada incelenen inorganik ve organik kirleticilerden kaynaklanan sağlık riski değerlendirmesi yapılmıştır. Ev, ofis ve okullarda örneklenen kişiler için hesaplanan “Toplam Kanser Riski” ve “Toplam Tehlike İndeksi” değerleri hem ortalama konsantrasyonlar hem de en kötü senaryo göz önüne alınarak incelendiğinde en yüksek risk altında bulunan kişilerin ev hanımları olduğu bunları öğretmenler ve ofis çalışanlarının takip ettiği söylenebilir. Değerlendirme kentsel, endüstriyel, endüstri ve trafikten uzak alanlar için yapıldığında her 3 alanda da yaşayan kişilerin birbirine yakın ve yüksek kanser riski taşıdıkları söylenebilir. Aynı değerlendirme sigara kullanan ve kullanmayan kişiler için yapıldığında sigara kullanan kişilerin kullanmayanlara nazaran yaklaşık %50 daha fazla kanser riski taşıdıkları gözlenmiştir.In this study, indoor and outdoor environment samples were taken from different regions and microenvironments (home, school, office) in Kocaeli. Through active and passive sampling and measurement techniques, 16 heavy metals (Al, As, Ca, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb, S, Si, Ti, V and Zn) at 2 different particle fractions (PM2.5 and PM10), volatile organic compounds (VOCs), and SO2, NO2 and O3 concentrations were determined. Moreover, in an effort to establish the relationship between exposure and the indoor concentrations measured, personal samplers were used to determine personal exposure levels. Indoor/outdoor concentration ratios for NO2 were higher in homes than in schools or offices in both summer and winter, which shows that sources of NO2 pollutants in indoor environments of homes are more dominant than those found in offices or schools. The indoor/outdoor ratios were far below 1, indicating that O3 and SO2 are pollutants originating from outdoor environments and that they do not have significant sources in indoor environments. The presence of high levels of indoor and outdoor concentrations of crustal elements at PM2.5 fractions indicates that these elements are transported into indoor environments at high levels. PM2.5 personal exposure levels were 2–6 times higher than indoor levels for combustion-related elements such as As, S, V, Cu and Cr, and although there were some seasonal differences, the indoor/outdoor environment ratios generally ranged between 0.3–0.7 and indicated the effect of outdoor environments on the observed high personal exposure levels. The indoor/outdoor ratios for a major portion of the determined heavy metals at PM10 particle fractions were smaller than 1, showing that outdoor pollutants are more dominant than indoor pollutants. The highest VOC pollution levels were encountered in individuals in the sample, and this was followed by VOC pollution levels in indoor and outdoor environments. In both seasons, toluene levels were the highest pollutants for homes, offices and schools, followed by ethylbenzene, m/p-xylene, styrene, nonane, hexane, benzene, o-xylene and heptane. Total VOC concentrations obtained from urban areas were consistent with values obtained from industrial areas. Components that are indicators of traffic (BTEX, 1,2,4-trimethylbenzene) were measured at high levels in urban areas, while hexane and heptane components, which are indicators of petrochemistry, were recorded at high levels in high- industry areas. Moreover, VOC concentrations obtained from urban and industrial areas were higher than concentrations found in areas far from industry and traffic, which demonstrates the high contribution of traffic and industry to measured VOCs. This study investigated the summer and winter concentrations of selected pollutants and the relationship between indoor and outdoor environments. In order to determine pollutant sources that negatively contribute to air quality by affecting the degree of indoor, outdoor and personal exposures, the Positive Matrix Factorization (PMF) receptor modeling technique was used, which is a multivariate statistical analysis method. PMF, correlation analyses, indoor/outdoor ratios, microenvironment characteristics, responses to questionnaires, and time activity information suggested that industry, traffic and smoking represent the main emission sources of pollutants investigated. Indoor, outdoor and personal exposure concentration values were compared to values measured in different parts of the world, thereby evaluating consistency with the observed pollution level. Based on personal exposure concentrations, an assessment was conducted concerning the health risks associated with the inorganic and organic pollutants investigated in this study. When the calculated values for “Total Health Risk” and “Total Hazard Index” for people sampled in homes, offices and schools were examined by considering both the average concentrations and the worst scenarios, it was revealed that housewives are at the highest risk, followed by teachers and office workers. An examination of urban, industrial and far from urban, industrial and traffic areas revealed that people living in all of these three areas are subjected to high cancer risks, which are at similar levels. When the same evaluation was carried out for smokers and non-smokers, it was observed that smokers have a 50% higher risk of cancer compared to non-smokers

Essays on long-term care of the elderly in the United States

This dissertation consists of three independent essays on long-term care of the elderly in the United States. Long-term care encompasses a wide array of increasingly important and rapidly changing issues. These issues can be divided into six broad categories: (1) use, cost, and financing; (2) special populations; (3) data development and methodology; (4) access and quality of care; (5) organization and delivery of care; and (6) consumer and caregiver behavior. The essays in this dissertation fall into the first three of these categories. The first essay uses a continuous-time hazard model to analyze the importance of state Medicaid policies in determining the risk of nursing home use among the elderly. We find that these state policies do not significantly affect the risk of older persons\u27 nursing home use, controlling for a variety of demographic, socioeconomic, and health-related factors. Data for this analysis come from the first two waves of the Assets and Health Dynamics of the Oldest Old (AHEAD) survey. The second essay uses a multinomial logistic regression model to examine how the use of nursing home and home health care services vary for older persons with and without children. Results indicate that older women\u27s (but not men\u27s) use of nursing home care (but not home health care) is significantly increased for those who are childless. This essay also uses data from the first two waves of the AHEAD survey. The third essay analyzes some design issues in the Second Supplement on Aging (SOA-II) to the 1994 National Health Interview Survey (NHIS) and their implications for the use of this survey by itself or in conjunction with the Supplement on Aging conducted ten years earlier. We find that especially one of the design issues, the time-lag between the 1994 NHIS and the SOA-II, could lead to biases in analyses using the SOA-II. We address the design issues by correcting for sample selection in the SOA-II and by developing a re-weighting scheme

Çocuklarda Transkatater Atriyal Septal Defekt ve Patent Foramen Ovale Kapatılması Deneyimleri, Kısa, Orta ve Uzun Dönem Sonuçların Değerlendirilmesi

In this study, we aimed to evaluate transcathater atrial septal defect (ASD) and patent foramen ovale (PFO) closure experiences, short, intermediate and long term results and investigate the effects of different methods on procedural success and complications between 2000-2013, in our department. After the archive scanning, 506 cases included for study, of 90 cases files that containing data about follow-up and diagnosis before the procedure could not be reached. Male:female ratio was 1:1,3, mean age and weight was 8,6±5,8 years and 28,9±16,4 kg respectively during procedure, mean follow-up period was 6,05±3,7 years (1 month – 13,5 years). Mean procedure and flouroscopy duration was 61,5±23,5 and 7,8±6,7 minutes respectively. The procedures were performed under TTE guidance in 90 (17,8%) cases, balloon sizing used in 214 (42%) cases. Pulmonary hypertension was observed in 67 (16%) cases. Within closure attempted 416 cases, the procedure was successful in 401 (96,3%). Procedure-fluoroscopy durations were shorter, defect and device sizes were smaller in successful group than unsuccessful group (p<0,05). The presence of deficient rim and use of “balloon sizing” were not influential on procedural success. In balloon sizing group, longer procedure-fluoroscopy duration and lower total septum/device ratio were observed (p<0,05). In selected cases, it was found that TTE guidance shorten the procedure-fluoroscopy duration(p<0,05). Rezidual shunt was seen in 32,4% and 0,9% of patients immediately after procedure and at the end of the follow-up respectively. Major (rescue surgery, thrombus, erosion) and minor (most frequently rhythm disorders) complications rate were %1,4 and %1,8 respectively. No embolisation and mortality were observed. Benign holter abnormalities were observed in 7,7% of patients. İn conclusion, transcathater ASD and PFO closure is a safe and effective method. Reducing the fluoroscopy time and not requiring general anesthesia are the additional advantages of the defect closure with TTE guidance in the presence of sufficient rim and centrally localized defect.Bu çalışmada, bölümümüzde 2000-2013 yılları arasında transkatater yöntem ile kapatılan sekundum atriyal septal defektli (ASD) ve patent foramen ovaleli (PFO) vakalarımız retrospektif olarak değerlendirilip kısa, orta ve uzun dönem sonuçların ve işlemde kullanılan farklı yöntemlerin işlem başarısı ve komplikasyonları üzerine etkilerinin araştırılması amaçlandı. Arşiv taraması sonrası 506 vaka çalışma kapsamına alındı, bunlardan 90 vakanın işlem öncesi takip ve tanı verilerini içeren dosyalarına ulaşılamadı. Çalışmamızda erkek:kız oranı 1:1,3, işlem sırasındaki ortalama yaş ve ağırlık sırasıyla 8,6±5,8 yıl ve 28,9±16,4 kg, ortalama izlem süresi 6,05±3,7 yıl (1 ay – 13,5 yıl) idi. İşlem ve skopi süreleri sırasıyla 61,5±23,5 dk ve 7,8±6,7 dk olarak bulundu. İşlem 90 (%17,8) hastada TTE eşliğinde yapıldı, 214(%42) hastada “balloon sizing” kullanıldı. Hastaların 67’sinde(%16) PH saptandı. Girişim yapılan 416 hastadan 401’inde(%96,3) başarı sağlandı. Başarılı işlem yapılan grupta başarısız gruba göre işlem-skopi süreleri kısa, defekt çapı ve kullanılan cihaz boyutları daha küçük bulundu (p<0,05). Eksik rim varlığı ve “balloon sizing” kullanımı başarı üzerine etkili bulunmadı. “Balloon sizing” kullanılan grupta işlem ve skopi süresi daha uzun, total septum/cihaz oranı ise daha küçük idi (p<0,05). Seçilmiş vakalarda, TTE eşliğinde kapatma girişiminin işlem ve skopi süresini kısalttığı görüldü (p<0,05). Katater odasında görülen %32,4’lük rezidü oranının izlem sonunda %0,9 olduğu saptandı. Major komplikasyon (kurtarıcı cerrahi, trombüs, erozyon) ve minör komplikasyon (en sık ritm bozuklukları) oranları %1,4 ve %1,8 idi. Embolizasyon ve mortalite izlenmedi. Hastaların %7,7’sinde izlemde tedavi gerektirmeyen holter bozukluğu saptandı. Çalışma sonucunda transkatater ASD ve PFO kapatma işlemlerinin deneyimli uygulayıcılar tarafından yapıldığında güvenli ve etkili bir yöntem olduğu, defektin santral yerleşim gösterdiği ve rimlerinin yeterli olduğu durumlarda TTE kılavuzluğunda yapılan işlemlerin skopi süresini azaltması ve genel anestezi gerektirmemesinin ek bir avantaj olduğu görüldü

Nrg (Tm) Rf Powered Transseptal Needle: A Useful Technique For Transcatheter Atrial Septostomy And Fontan Fenestration: Report Of Three Cases

Transseptal puncture (TSP) is a frequently performed procedure for gaining access to the left atrium for catheter ablation, hemodynamic assessment of the left heart, left ventricular assist device implantation, percutaneous left atrial appendage closure or mitral valvuloplasty during childhood and adulthood. The standard technique for tsansseptal puncture applies mechanical pressure on the fossa ovalis with a Brockenbrough needle. However, this method is not feasible when the fossa ovalis is thick and aneurysmatic. In such patients, the radiofrequency ablation energy systems can be offered as a better alternative for TSP. Here, we aimed to demonstrate the outcome of transseptal puncture performed with an NRG (TM) RF powered transseptal needle in three patients.WoSScopu

Assessment of Arterial Stiffness with Pulse Wave Velocity or Augmentation Index: Which Method is the Best?: Scientific Letter

Assesment of large arterial stiffness is increasingly used in clinal settings. Although there are several invasive and non-invasive methods such as carotid-femoral pulse wave velocity (PWV) and augmentation index (AI), researchers and clinicians still face problems in selecting the best methodology for their specific use. PWV, which is defined as the velocity of the arterial pulse for moving along the vessel wall, plays an important clinical role in defining patients under high cardiovascular risk and it is inversely correlated with arterial elasticity and relative arterial compliance. PWV along the aorta can be measured by using two ultrasound or pressure sensitive transducers fixed transcutaneously over the course of a pair of arteries separated by a known distance: the femoral and right common carotid arteries. PWV is calculated from measurements of pulse transit time and the distance, according to the following formula: PWV (m/s)= distance (m)/transit time (s). AI is defined as Dp/pp (where Dp is the difference between the late systolic peak and the mid-systolic peak and pp is the amplitude of the pulse pressure wave). Central blood pressure and pulse pressure, the AI and PWV, which are often used incorrectly as interchangeable indexes of arterial stiffness, increase with age, hypertension, diabetes mellitus and hyperlipidemia, and are associated with target organ damage such as left ventricular hypertrophy, microalbuminuria, carotid intima-media thickness and endothelial dysfunction. Althouhg the carotid-femoral (aortic) PWV is the gold standard test for assessing central arterial stiffness, the AI reflects stiffness of the systemic arterial tree. This paper summaries the advantages and disadvantages of PWV and AI in the assessment of arterial stiffness

Analysis of Gene Copy Number Variations in Patients with Congenital Heart Disease Using Multiplex Ligation-Dependent Probe Amplification

Objective: At the molecular and cellular levels, heart development entails the precise orchestration of genetic events such as the interplay of master transcriptional regulators, signaling pathways, and chromatin remodeling. Recent studies among patients with congenital heart disease (CHD) have shown the importance of recurrent copy number variations (CNVs) in a significant number of patients. Recurrent CNVs that span several genes may affect other important organs, besides the heart. Because CHD may be the first presenting symptom in such patients, the analysis of recurrent CNVs in the genomic regions containing genes associated with CHD in patients referring to cardiology clinics may lead to an early diagnosis and the treatment of extracardiac symptoms in these patients. In this study, we aimed to screen CNVs of genomic regions including GATA4, NKX2-5, TBX5, BMP4, and CRELD1 genes and to analyse the 22q11.2 chromosomal region in apparently nonsyndromic patients with cardiac septal defects. Methods: Genomic regions including GATA4, NKX2-5, TBX5, BMP4, and CRELD1 genes and the 22q11.2 chromosomal region were analyzed in apparently nonsyndromic 45 patients with cardiac septal defects using the MLPA P-311 A2 Congenital Heart Disease kit. Multiplex ligation-dependent probe amplification (MLPA) is an established technique for the detection of known CNVs. MLPA is substantially less expensive than array CGH and is relatively simple to use for clinicians without specific expertise in genomic technology; thus, MLPA could be used as a first-tier screening assay. Results: We screened 45 patients with cardiac septal defects for CNVs using the MLPA P-311 A2 kit. We identified three CNVs (n=3/45, 6.66%) and three 22q11 deletions. The CNVs were confirmed using fluorescence in situ hybridization. Conclusion: Our study confirmed that the analysis of recurrent CNVs using the MLPA assay within pediatric cardiology clinics can led to an early syndrome diagnosis in nonsyndromic patients with CHD.PubMedWoSScopu

Electrical Storm In An Adolescent With Arrhythmogenic Right Ventricle Cardiomyopathy Treated With Cardiac Transplantation

PubMe