Research capacity and training needs for non-communicable diseases in the public health arena in Turkey

Background The aim of this study is to define the research capacity and training needs for professionals working on non-communicable diseases (NCDs) in the public health arena in Turkey. Methods This study was part of a comparative cross-national research capacity-building project taking place across Turkey and the Mediterranean Middle East (RESCAP-Med, funded by the EU). Identification of research capacity and training needs took place in three stages. The first stage involved mapping health institutions engaged in NCD research, based on a comprehensive literature review. The second stage entailed in-depth interviews with key informants (KIs) with an overview of research capacity in public health and the training needs of their staff. The third stage required interviewing junior researchers, identified by KIs in stage two, to evaluate their perceptions of their own training needs. The approach we have taken was based upon a method devised by Hennessy&#38;Hicks. In total, 55 junior researchers identified by 10 KIs were invited to participate, of whom 46 researchers agreed to take part (84%). The specific disciplines in public health identified in advance by RESCAP-MED for training were: advanced epidemiology, health economics, environmental health, medical sociology-anthropology, and health policy. Results The initial literature review showed considerable research on NCDs, but concentrated in a few areas of NCD research. The main problems listed by KIs were inadequate opportunities for specialization due to heavy teaching workloads, the lack of incentives to pursue research, a lack of financial resources even when interest existed, and insufficient institutional mechanisms for dialogue between policy makers and researchers over national research priorities. Among junior researchers, there was widespread competence in basic epidemiological skills, but an awareness of gaps in knowledge of more advanced epidemiological skills, and the opportunities to acquire these skills were lacking. Self-assessed competencies in each of the four other disciplines considered revealed greater training needs, especially regarding familiarity with the qualitative research skills for medical anthropology/sociology. Conclusions In Turkey there are considerable strengths to build upon. But a combination of institutional disincentives for research, and the lack of opportunities for the rising generation of researchers to acquire advanced training skills.</p

Open reduction and percutaneous pinning for medial condyle fractures of elbow in children: is it a risk for complications?

Background: There are limited cases of humerus medial condyle fracture in the literature treated by open reduction and percutaneous pinning. This study presents cases treated by open reduction and percutaneous pinning and discussed the problems reported in the literature.Methods: Nine cases were treated by open reduction and percutaneous pinning between 2006-2014. These cases were followed for nonunion, avascular necrosis, range of motion, nerve lesion and infection for 15.3 months (range 11 to 18 months).Results: No non-union, avascular necrosis, iatrogenic nerve lesion or infection developed in our cases. All patients gained full range of motion.Conclusions: This study presents that surgical technique and early timing of surgery prevents the complications

A biomechanical comparison of two cephalomedullary nails; one using a single lag screw with antirotator blade and a nail using two lag screws for unstable intertrochanteric fractures

Background: Implant choice for fixation of intertrochanteric fractures remains controversial despite being one of the most commonly performed operations. Although use of sliding hip screws is still considered a gold standard in treatment of these fractures, there is a wide tendency in using cephalomedullary nails because of their biomechanical superiority over sliding hip screws. This trial was initiated in order to compare the biomechanical properties of two different cephalomedullary nails, aPFN and the PROFIN under axial loading, based on the questions that can a single lag screw with an antirotator blade render better rotational stability? Is there a difference between one lag screw or two lag screws with respect to superior migration or cut-out of the screws? And do different nail designs cause different types of failure and what are the pros and cons of classical and new designs from the view point of biomechanical aspects?Methods: Ten pairs of third generation synthetic bone models simulating unstable intertrochanteric fracture were used for biomechanical testing.Results: No posterior displacement of screws was recorded in both groups suggesting rotational unstability.  There was not a significant difference between forces values loaded at the time of failure.Conclusions: Although there was no statistically significant difference between compressive strengths at the time of failure, aPFN may provide equal rigid fixation with less possible cut-out which may have an important consequences in real clinical applications

Procoagulant and Anticoagulant Factors in Childhood Hypothyroidism

The aim of this study was to investigate the effects of thyroid hormone deficiencies in childhood on the elements of coagulation proteins. Consecutive 54 children with hypothyroidism and 55 healthy controls aged 1 month–16 years were enrolled. One year after Na-L-thyroxine treatment, the study parameters were reevaluated. Thyroid function tests, procoagulant and anticoagulant proteins were performed for children with hypothyroidism and healthy controls. Significant decreased results were found in children with hypothyroidism in terms of fibrinogen, TT, and anticoagulant proteins including AT, PC, PS, and fPS. Significant increases were found with respect to APTT, fibrinogen, and TT. In the evaluation of posttreatment changes a statistically significant increase was found in vWF, FVIII, AT, PC, PS, and fPS. A positive correlation was found between fT4 and vWF, FVIII, PC, and PS. We would like to emphasize that the coagulation system especially vWF and FVIII, and particularly the anticoagulant system, should be monitored closely in patients followed up for hypothyroidism. Thyroid hormones should be examined and, if necessary, hormone replacement therapy should be administered in patients followed up for a predisposition to coagulation. Additionally, further studies with larger series are needed to investigate the effects of hypothyroidism on the coagulation system

Changes in Serum Natriuretic Peptide Levels after Percutaneous Closure of Small to Moderate Ventricular Septal Defects

Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels. Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were 25.3 ± 14.3) who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure. Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in patients group during followup. Decrease in brain natriuretic peptide levels after closure were statistically significant (97.3 ± 78.6 versus 26.8 ± 15.6, P = 0.013). Conclusion. Brain Natriuretic Peptide levels are elevated in patients with ventricular septal defects as compared to controls. Percutaneous closure of Ventricular Septal Defect with Amplatzer occluders decreases the BNP levels

DNA Repair Gene Polymorphism and the Risk of Mitral Chordae Tendineae Rupture

Polymorphisms in Lys939Gln XPC gene may diminish DNA repair capacity, eventually increasing the risk of carcinogenesis. The aim of the present study was to evaluate the significance of polymorphism Lys939Gln in XPC gene in patients with mitral chordae tendinea rupture (MCTR). Twenty-one patients with MCTR and thirty-seven age and sex matched controls were enrolled in the study. Genotyping of XPC gene Lys939Gln polymorphism was carried out using polymerase chain reaction-(PCR-) restriction fragment length polymorphism (RFLP). The frequencies of the heterozygote genotype (Lys/Gln-AC) and homozygote genotype (Gln/Gln-CC) were significantly different in MCTR as compared to control group, respectively (52.4% versus 43.2%, = 0.049; 38.15% versus 16.2%, = 0.018). Homozygote variant (Gln/Gln) genotype was significantly associated with increased risk of MCTR (OR = 2.059; 95% CI: 1.097-3.863; = 0.018). Heterozygote variant (Lys/Gln) genotype was also highly significantly associated with increased risk of MCTR (OR = 1.489; 95% CI: 1.041-2.129; = 0.049). The variant allele C was found to be significantly associated with MCTR (OR = 1.481; 95% CI: 1.101-1.992; = 0.011). This study has demonstrated the association of XPC gene Lys939Gln polymorphism with MCTR, which is significantly associated with increased risk of MCTR

New Trends in Mathematical Sciences Compact and noncompact structures of the nonlinearly dispersive GNLS(m,n,k,l) equation

Abstract: In this paper, we establish exact-special solutions of the generalized nonlinear dispersion GNLS(m,n,k,l) equation. We use the ansatz method for acquiring the compactons, solitary patterns, solitons and other types of solutions

The Impact of National Health Insurance Policy to the Implementation of Health Promotion Program on Public Health Center in Indonesia

National Health Insurance (NHI) Program has been implemented in Indonesia on January 2014. That program definitely brings some changes into managerial aspect in public health center (PHC). This study aimed to determine an impact of NHI policy in the implementation of health promotion programs at PHC in South Tangerang City, Indonesia. This study was conducted using qualitative method during February and March 2016. The impact of NHI is seen on policy, budget, equipment, human resource and implementation of health promotion program. With purposive sampling method, six policy makers, eight service providers and eight service users were selected for in-depth interview. As many as 17 documents were analyzed. Observation conducted at four selected PHC. Data analysis used thematic content analysis. There was no difference of PHC’s functions before and after NHI period. Budget expended for health promotion programs had increased after NHI implemented which it could be opportunity for PHC to make innovations, procure materials and implement better health promotion programs. Capitation budget which could be used for executing health promotion program and some recently implemented health promotion programs in NHI era becomes an evidence that NHI policy has a positive impact in the implementation of health promotion program at PHCAbstrakJaminan Kesehatan Nasional (JKN) telah diimplementasikan di Indonesia pada 1 Januari 2014. Hal tersebut membawa beberapa perubahan pada aspek manajerial pada pusat kesehatan masyarakat (puskesmas). Penelitian ini bertujuan untuk mengidentifikasi dampak dari kebijakan JKN terhadap implementasi program promosi kesehatan di puskesmas di Kota Tangerang Selatan, Indonesia. Penelitian menggunakan metode kualitatif. Data dikumpulkan pada Februari – Maret 2016. Dampak program dilihat dalam hal kebijakan, pendanaan, fasilitas, sumber daya manusia dan pelaksanaan program promosi kesehatan. Dengan menggunakan metode purposive sampling, enam pengambil kebijakan, delapan pemberi layanan dan delapan penerima layanan diambil sebagai informan dalam penelitian ini. Pada analisis dokumen, 17 dokumen telah dianalisis. Observasi dilakukan dengan melihat kegiatan yang dilakukan di empat puskesmas. Analisis data menggunakan analisis konten tematik. Tidak terdapat perbedaan dari fungsi puskesmas sebelum dan setelah adanya JKN. Dana yang digunakan untuk kegiatan promosi kesehatan telah mengalami peningkatan setelah implementasi kebijakan JKN dimana dana tersebut dapat digunakan untuk berinovasi, memberi peralatan dan melakukan promosi kesehatan dengan lebih baik. Dana kapitasi yang dapat digunakan untuk melaksanakan program promosi kesehatan dan beberapa kegiatan promosi kesehatan yang baru dilaksanakan pada saat era JKN menjadi bukti bahwa kebijakan JKN memiliki dampak positif terhadap pelaksanaan program promosi kesehatan di puskesmas

Postmodernizm Açısından COVID-19 Salgını ve Halk Sağlığı Yaklaşımı

Bu çalışmada; COVID-19 pandemisinin, postmodernist görüşler içindeki yeri ve halk sağlığı yaklaşımıyla birlikte değerlendirilmesi amaçlanmıştır. Bu çalışma bir derleme çalışmasıdır. PubMed ve Google Scholar üzerinden “Postmodernizm”, “Sağlık”, “COVID-19”,”Halk Sağlığı” anahtar sözcükleriyle taranan İngilizce ve Türkçe makaleler ve dokümanlar değerlendirilmiştir. Toplam 15 doküman derlemeye dahil edilmiştir. İnsanlar pandemiyle farklı şekillerde baş etmeye çalışmışlardır. Sosyal yaşamda da sosyal mesafe, maske, izolasyon, karantina gibi kavramlarla insan ilişkilerinin zayıfladığı ve ilerde olumsuz sonuçların görülebileceği öngörülmektedir. Ancak bu dönemde gerek uluslararası kuruluşların gerekse ulusal sistemlerin kendilerini hızla gözden geçirdiği ve acil durumlara ve olası diğer pandemilere karşı daha hazır duruma geldiği görülmektedir. Halk sağlığı açısından bakıldığında ise postmodern dönemde aşı karşıtlığının artması ve bireyselliğin ön plana çıkması durumunun tam tersine döndüğü ve toplumda hem aşı desteğinin arttığı hem de bireysellik yerine toplumsallığın öneminin anlaşıldığı gözlenmektedir. Sonuç olarak bu dönem postmodernizmin olumlu ve olumsuz yanları olduğunu ve tümden reddedilmesi veya kabul edilmesinin doğru olmadığını göstermektedir.In this study; it is aimed to evaluate the COVID-19 pandemic with its place in postmodernist views and public health approach. This study is a review study. English and Turkish Articles and documents scan- ned with the keywords “Postmodernism”, “Health”, “COVID-19”, “Public Health” were evaluated through PubMed and Google Scho- lar and Google. A total of 60 articles and documents were included in this review. In this duration, there were problems in the delivery of health care. At the same time, people have tried to deal with the pandemic in different ways. In social life, it is predicted that human relations with concepts such as social distance, mask, isolation, and quarantine weaken and negative consequences may be seen in the future. However, in this period, it is seen that both international or- ganizations and national systems are rapidly reviewing themselves and are more ready for emergencies and other possible pandemics. From the point of view of public health, it is observed that in the postmodern period, the increase in vaccine hesitancy and the emer- gence of individuality is reversed and both the vaccine support has increased and the importance of public instead of individuality is understood. As a result, this period shows that postmodernism has positive and negative sides and it is not right to be rejected or ac- cepted completely