Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Adolesan Sağlığının Izlenmesinde Aile,Okul ve Aile Hekiminin Rolü

The aim of this research was to determine adolescents’ risk taking behaviors, life styles; evaluating at the level of family, school and health services; enhancing suggestions for family, school and health services coordination in order to protect and improve adolescents’ health. First phase of the study was coss-sectional and the second phase was case-control type epidemiologic study. First phase of the study was conducted at eight middle-low income schools. No sample was selected and 1462 students were attained. Risky Health Behaviors Scale (RHBS) was used to determine adolescents with risk taking behaviors. At the second phase; 156 students were selected and information was gathered from their mothers, teachers and family practitioners. SPSS 21.0 were used for analyzes. Risk taking behaviors and risky health behaviors (RHB) were common at high schools. The awareness of healthy life behaviors weren’t develop adequately. It was seen that some RHBs had tendency to be seen together. Males, negative family attitudes, low socioeconomical status and low academical achievement were the risk factors of RHB. There wasn’t a consistency between adolescents’ answers and familys’, teachers’ and family practitioners’ answers on RHBs and family attitudes. Family, teacher and family practitioner are the closest social environment of an adolescent. They should have good communication skills in order to monitor the adolescent and RHBs. Family practitioner should consider all of the RHBs while evaluating the individuals holistically. Regarding to RHBs of adolescent period, multidisiciplinary, physical, physchological and social approach covering family, teacher and family practitioner would provide healthy outputs at adolescent health and development.Bu çalışmanın planlanmasında adolesanların yaşam tarzları ve becerilerinin saptanması; aile, okul ve sağlık hizmetleri kapsamında değerlendirilmesi, aile, okul ve sağlık hizmetlerinin adolesan sağlığının koruma ve geliştirilmesindeki koordinasyonuna ilişkin öneri geliştirebileceği düşünülmüştür. Araştırmanın birinci bölümü kesitsel; ikinci bölümü vaka-kontrol tipte epidemiyolojik çalışmadır. Araştırmanın birinci aşaması orta ve alt sosyo-ekonomik seviyeden sekiz okulda yürütülmüştür. Örneklem seçilmemiş ve 1462 öğrenciye ulaşılmıştır. Riskli Sağlık Davranışları Ölçeği’ne (RSDÖ) göre puan hesaplanması yapılmış ve puana göre ortancanın üzerinde olan öğrencilerin riskli sağlık davranışlarının (RSD) olduğu kabul edilmiştir. İkinci aşamada seçilen 156 öğrencinin aileleri, öğretmenleri ve aile hekimlerinden öğrenciler ile ilgili bilgi alınmıştır. SPSS 21.0 istatistik paket programlarında veri girişi ve analizler yapılmıştır. Bu araştırmada lise öğrencilerinde riskli sağlık davranışlarının yaygın olduğu ve sağlıklı yaşam davranışları konusunda bilinç gelişmediği gözlemlenmiştir. Çeşitli RSDlerin birlikte görülme eğiliminde olduğu saptanmıştır. Özellikle erkek öğrenciler, aile tutumları olumsuz öğrenciler, sosyoekonomik durumu düşük öğrenciler ve okul başarısı düşük öğrencilerin daha fazla risk altında olduğu değerlendirilmektedir. Adolesanların yanıtları ile aile, öğretmen ve aile hekimlerinin yanıtları arasında tutarlılık saptanmamıştır. Ailesi, öğretmeni ve aile hekimi adolesanın en yakın sosyal çevresidir. Adolesanın sosyal çevresi olarak yakın iletişim içinde bulunmalı ve adolesanın izlemlerinin yapılmasını sağlamalıdırlar. Takip ettiği bireyleri bir bütün olarak değerlendiren aile hekiminin adolesan sağlığı hizmeti verirken tüm bu riskli sağlık davranışlarını da dikkate alması önemlidir. Adolesan dönemdeki bireylerin sağlık açısından RSDleri olabileceği göz önünde bulundurularak hekim, aile ve öğretmenleri kapsayan multidisipliner ve fiziksel, psikolojik ve sosyal bir yaklaşım sağlıklı sonuçlar elde edebilmek için son derece gereklidir

Sağlık Çalışanlarında İş Sağlığı ve Güvenliği Yeterlilik Algısının Değerlendirilmesi

Amaç: COVID-19 pandemisi sürecinde sağlık çalışanlarının iş sağlığı ve güvenliği (İSG) yeterlilik algısını değerlendirmek ve saptanan eksikliklere uygun çözüm önerileri geliştirmektir. Gereç ve Yöntemler: 550 sağlık çalışanının katıldığı tanımlayıcı kesitsel tipteki araştırmada web tabanlı bir veri toplama formu kullanılmıştır. İş Sağlığı ve Güvenliği Yeterlilik Algısı Ölçeği (İSGYAÖ) ile cinsiyet, öğrenim durumu, yaş gibi bazı sosyo-demografik özellikler ve çalışma süresi, iş kazası geçirme, İSG eğitimi alma gibi bazı çalışma yaşamına ilişkin özellikleri içeren bir veri toplama formu kullanılmıştır. Tanımlayıcı ve çıkarımsal veri analizi için SPSS 20.0 versiyonu kullanılmıştır. Bulgular: Sağlık çalışanlarının %32,5’i erkek ve yaş ortalaması 40,56±12,6 yıldır. Çalışanlarının %16,5’i iş kazası geçirmiş, kadın çalışanlar erkek çalışanlara göre daha fazla iş kazası geçirdiğini belirtmiştir (p=0,025). Araştırmada ISGYAÖ puan ortalaması 97,64±27,6’dır. Kadın sağlık çalışanlarının, üniversite ve üzeri eğitim alan sağlık çalışanlarının, 31-45 yaş grubunda olanların ve hekim-hemşirelik mesleğini icra edenlerin İSGYAÖ puanı daha yüksektir (sırasıyla p=0,024, p=0,00, p=0,014, p=0,013). Katılımcıların mesleği (1,301, p=0,042) ve iş kazası geçirme durumunun (0.106, p<0.001) İSG yeterlilik algısını istatistiksel olarak anlamlı düzeyde etkilediği saptanmıştır. Sonuç: Sağlık çalışanlarının iş kazası geçirme ve meslek hastalığına yakalanma riski yüksek olmasına rağmen İSG yeterlilik algıları ortalama düzeydedir. Sağlık çalışanlarının İSG yeterliliğine dair araştırmalar düzenli aralıklarla planlanmalı ve bunların sonuçlarına göre gerekli politik ve kurumsal önlemler alınmalıdır

Evaluation of Dentistry Students' Lifelong Learning Tendencies During the COVID-19 Pandemic

Aim: Dentistry education is a life-long, continuous education. The aim of this study was to determine the lifelong learning (LLL) tendencies of the dental faculty students who were receiving distance education during the Covid-19 pandemic. Methods: 258 dentistry students participated the study. Research data was collected by 'Lifelong Learning Disposition Scale' (LDS). In the first part of the questionnaire, students were asked to reply socio-demographic questions and their ability to learn during the distance education process of the COVID-19 pandemic. In the second part, there were questions about LLL. The low score obtained from the scale indicates that the LLL tendency is high. ANOVA and t-test were used for analysis of LDS score, and the Mann Whitney-U and Kruskal Wallis tests were used for sub-dimensions. Results: During the COVID-19 Pandemic, 40.3% of the students stated their status of learning skills as medium, 28.7% as bad and 11.6% as very bad. Students' mean score on the LDS scale was 88.26 ± 9.8. The mean LDS score was statistically significant according to their class, gender and their assessment of learning skills during the COVID-19 pandemic (p lt;0.05). There was no correlation between the monthly income and academic success levels of the students and their LDS scores (p gt; 0.05). Conclusion: In this study, it was determined that the students made their own evaluations correctly during the Covid-19 pandemic. LDS scores of the students who stated their learning status as bad were significantly higher by 1,187 times. During the Covid-19 pandemic, it is important to communicate using educational methods that aim to support students' learning skills. Therefore, new interventions should be planned to increase students' LLL tendencies

Üniversite Öğrencilerinde İnternet, Sosyal Medya ve Oyun Bağımlılığının Değerlendirilmesi

Amaç: Gençlerin internet, sosyal medya ve oyun bağımlılıklarının saptanarak bu bağımlılıkların sosyodemografik ve internet kullanım özellikleriyle ilişkilerini araştırmak aynı zamanda teknolojik bağımlılıklar ile ilgili sorunların daha iyi anlaşılması böylece gençlerin sağlığını koruyucu ve iyileştirici çalışmalara katkı sağlamaktır. Gereç ve Yöntemler: 321 üniversite öğrencisinin katıldığı tanımlayıcı kesitsel tipteki araştırmada web tabanlı bir veri toplama formu kullanılmıştır. Sosyal Medya Bağımlılık Ölçeği (SMBÖ), Dijital Oyun Bağımlılığı Ölçeği (DOBÖ), Young İnternet Bağımlılığı Ölçeği (YİBÖ) ile cinsiyet, öğrenim gördüğü bölüm, yaş gibi bazı sosyo-demografik özellikler ve internet kullanım özelliklerini içeren bir veri toplama formu kullanılmıştır. Tanımlayıcı ve çıkarımsal veri analizi için SPSS 20.0 versiyonu kullanılmıştır. Bulgular: Öğrencilerin %31,20 (n=100)’si erkek, % 68,80’i (n=221) Tıp/diş hekimliği bölümündedir. Tıp/diş hekimliği öğrencilerinin diğer fakülte öğrencilerinden SMBÖ’de daha düşük puan aldıkları, dijital oyun oynayanların ise DOBÖ ve YİBÖ’de daha yüksek puana sahip oldukları, yedi yıldan fazla internet kullananlarda daha yüksek DOBÖ puana sahip oldukları belirlendi (p=0,025). Sosyal medya bağımlısı olduğunu düşünenlerin SMBÖ ve YİBÖ puanlarının daha yüksek olduğu tespit edildi (p=0,000). Sigara kullananlarda SMBÖ puanlarının (p=0,038), alkol kullananlarda ise DOBÖ puanın daha yüksek olduğu belirlendi (p=0,000). Sosyal medya bağımlılık durumu ile Young internet bağımlılığının güçlü pozitif korelasyona (r=,810, p=0,001), Young internet bağımlılığı ile Dijital oyun bağımlılığı arasında ise düşük oranda pozitif korelasyon olduğu tespit edildi (r=,292, p&lt;0,05). Sonuç: Gençler arasında teknolojik bağımlılık oldukça yüksektir ve giderek artması da beklenen önemli halk sağlığı sorunudur. Gençlerin teknolojik bağımlılıkları ile ilgili araştırmalar düzenli aralıklarla planlanmalı ve bunların sonuçlarına göre gerekli önlemler alınmalıdır

Measuring Progress From 1990 To 2017 And Projecting Attainment To 2030 Of The Health-Related Sustainable Development Goals For 195 Countries And Territories: A Systematic Analysis For The Global Burden Of Disease Study 2017

Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health -related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. Methods We measured progress on 41 health-related S DG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2.5th percentile and 100 as the 97.5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings The global median health-related SDG index in 2017 was 59.4 (IQR 35.4-67.3), ranging from a low of 11.6 (95% uncertainty interval 9.6-14.0) to a high of 84.9 (83.1-86.7). SDG index values in countries assessed at the subnational level varied substantially particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attaimnent by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation The GBD study offers a unique, robust platform for monitoring the health -related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health -related SDG indicators, NCDs, NCD-related risks, and violence -related indicators will require a concerted shift away from what might have driven past gains curative interventions in the case of NCDs towards multisectoral, prevention -oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the S DGs. What is clear is that our actions or inaction today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.WoSScopu

Global, Regional, And National Disability-Adjusted Life-Years (Dalys) For 333 Diseases And Injuries And Healthy Life Expectancy (Hale) For 195 Countries And Territories, 1990-2016: A Systematic Analysis For The Global Burden Of Disease Study 2016

Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.WoSScopu