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

The outcomes of an impaired powerhouse in KRAS mutant lung adenocarcinoma cells by Elesclomol

Objectives: Lung cancer stands out as the most common cancer type worldwide. The most common genetic alteration detected in adenocarcinoma patients is KRAS. KRAS mutated patients still cannot get benefit from precision medicine approaches andlackatargetedtherapy.Elesclomolisaninvestigationalagentformelanomaand other malignancies. In this study, we evaluated its effect on cellular apoptosis, survival, and metastasis mechanisms on KRAS mutant A549 and Calu-1 cell lines. Methods: The cytotoxic effects of Elesclomol on A549 and Calu-1 cells were determinedby3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide(MTT) cell viability test. Cells were treated with IC50 concentration and then apoptosisrelated (Casp-3, Casp-9, Bcl-2, and Bcl-xL), survival-related (Akt, p-Akt, Erk, and pErk), and metastasis-related (E-cadherin, Vimentin, MMP-2, and MMP-9) protein expressions were determined by Western blot analysis. Elesclomol’s effect on cell migration was evaluated by wound healing. Total oxidant, malondialdehyde (MDA), and glutathione (GSH) levels after Elesclomol treatment were assessed. Results: Elesclomolnotonlyinducedapoptoticproteinsbutalsoinhibitedmetastatic protein expressions and migration in both cells. Also, p-Erk activity was diminished by Elesclomol treatment as a reflection of decreased proliferation. However, p-Akt was enhanced as a cellular survival mechanism. Although Elesclomol’s effects on oxidative stress parameters were puzzling, it induced total oxidant status (TOS), and MDA in Calu-1 cells. Conclusion: Elesclomol might provide an alternative treatment approach for patients with KRAS mutant lung adenocarcinoma and other solid tumor malignancies that harbor KRAS mutations. This would enable the development of biomarker-driven targeted therapy for KRAS mutant adenocarcinoma patient

Ergen Örneklemde Beş Faktör Kişilik Envanteri’nin Cinsiyetlere Göre Ortalama ve Kovaryans Yapılarıyla Ölçme Eşdeğerliği

The purpose of the present study was to investigate the measurement equivalence for boys and girls’ comparison groups in the mean and covariance structure (MACS) methods by using the data obtained from the Five Factor Personality Inventory (5FPI). The participants were 490 (63.1% girl, 36.9% boy, mean age 16.59 standard deviation .841) students from 3 high schools (2 public,1 private) in İzmir. The Cronbach’s alpha coefficients for five factors were found in the range of .78 (conscientiousness) and .93 (neuroticism). Exploratory factor analysis pointed big five for adolescents like adults. 17 sub dimensions were indicators and 5 factors were latent variables of our measurement model. Measurement equivalence across genders was tested with five nested mean and covariance structure models. As a result all configural, weak, partial strong and strict models provided acceptable fits to the data.Bu araştırmanın temel amacı, Beş Faktör Kişilik Modeli çerçevesinde geliştirilen Beş Faktör Kişilik Envanteri’nin (5FKE) ergen örneklemde yapı geçerliğini incelemektir. Bu amaç doğrultusunda kız ve erkek karşılaştırma gruplarında kişilik envanterinin cinsiyetler arası ölçme eşdeğerliği, yapısal eşitlik modellemeleri kapsamındaki ortalama ve kovaryans yapı analizi ile test edilmiştir. Araştırmanın katılımcılarını İzmir İli’ndeki 3 lisede (2 devlet, 1 özel lise) kayıtlı olan toplam 490 lise öğrencisi (%63,1 kız, %36,9 erkek, yaş ortalaması 16,59 ve standart sapması 0,841) oluşturmaktadır. 5FKE’nin iç tutarlık güvenirlik analizleri sonucunda Cronbach’s Alpha katsayıları temel faktörler düzeyinde .78 (özdenetim/sorumluluk) ve .93 (duygusal tutarsızlık) ranjları arasında bulunmuştur. Açımlayıcı faktör analizi sonucunda da ergenlerde beş faktör kişilik yapısının, yetişkinlerde saptandığı biçimde aynı faktör örüntüsüne sahip olduğu tespit edilmiştir. Ölçme modeli, 5FKE’nin gözlenen on yedi alt boyut ve beş temel örtük faktörden oluşturulmuş, cinsiyetler arası ölçme eşdeğerliği ortalama ve kovaryans yapı analizleri iç içe geçmiş beş farklı hiyerarşik model ile test edilmiştir. 5FKE’nin cinsiyet gruplarında faktör yapısını tamamen sağladığı, skalar değişmezlik aşamasında kısmi skalar modelin veriye uyum gösterdiği ve katı değişmezlik koşulunun kabul edilebilir düzeyde sağlandığı tespit edilmiştir

Prenatal radiation exposure

Pregnant women may be exposed to nonionizing, ionizing radiation and contrast media via diagnostic or therapeutic procedures and workplace exposure. When computed tomography or magnetic resonance imaging is performed on a pregnant woman, the effects of exposure to radiation, high magnetic fields and contrast media, which can be risky for a fetus, should be considered. Nonionizing radiation that is not significantly risky for a fetus includes microwave, ultrasound, radio frequency and electromagnetic waves, while ionizing radiation that can be teratogenic, carcinogenic or mutagenic includes particles and electromagnetic radiation. The effects of radiation are associated with the level of exposure and stage of fetal development. Organogenesis (two to seven weeks after conception) and the early fetal period (eight to fifteen weeks after conception) are the most sensitive stages for a fetus. Noncancerous health effects have not been determined at any stage of gestation with less than 50 mGy (5 rad) exposure dose of ionizing radiation. Higher exposure levels may lead to spontaneous abortion, growth restriction, and mental retardation. The risk of cancer is increased regardless of the dose. Although the use of iodinated contrast media is generally thought to be safe during pregnancy, the risk of fetal hypothyroidism should be considered and it should be used only when necessary. The use of gadolinium-based contrast media during pregnancy is controversial because of the lack of clinical data. The purpose of this article is to review the existing literature regarding the prenatal radiation exposure and to discuss fetal risk of radiation

Serum zonulin levels in type 2 diabetes patients with diabetic kidney disease

Introduction: Recent data have shown that diabetic kidney disease (DKD) is associated with abnormal gut microbiota composition. Zonulin is a physiological tight junction modulator and an intestinal permeability marker. In this study we aimed to investigate serum levels of zonulin and interleukin 6 (IL-6) in patients with type 2 diabetes mellitus (T2DM) and different levels of albuminuria. Material and methods: Ninety patients with T2DM and 30 healthy controls (HC) aged between 18 and 65 years were enrolled in the study. T2DM patients were divided into three groups as patients with normoalbuminuria (n = 30), microalbuminuria (n = 30), and macroalbuminuria (n = 30). Serum zonulin and IL-6 levels were measured by ELISA method. Results: There was no significant difference between groups in terms of age, gender, serum ALT, LDL-C, HDL-C, and zonulin levels (p &gt; 0.05). Significant differences between groups were present for the duration of diabetes (p &lt; 0.001), body mass index (p &lt; 0.001), fasting blood glucose (p &lt; 0.001), creatinine (p &lt; 0.001), uric acid (p = 0.037), triglyceride (p = 0.003), total cholesterol (p &lt; 0.001), glycated haemoglobin (p &lt; 0.001), and IL-6 (p &lt; 0.001) levels. IL-6 levels were significantly increased in the microalbuminuria and macroalbuminuria groups compared to the HC group, but no significant difference was determined between the HC and normoalbuminuria group. In patients with diabetic kidney disease, a significant positive correlation was found between zonulin with IL-6 and proteinuria (rho = 0.296, p = 0.008; rho = 0.190, p &lt; 0.047, respectively). The serum IL-6 level was positively correlated with microalbuminuria and proteinuria (rho = 0.451, p &lt; 0.001; rho = 0.425, p &lt; 0.001, respectively).  Conclusions: We suggest that the serum zonulin level is not a promising biomarker to assess the severity of DKD in patients with long-standing T2DM

The roles of pre–P-wave versus peri–P-wave fractionated electrograms for atrial substrate beyond entrainment response

Atrial tachycardia (AT) with alternating cycle lengths is sparsely reported, and, hence, the ideal mapping strategy has not been firmly established. Beyond the entrainment during tachycardia, some fragmentation characteristics might also give important clues for its possible participation in the macro–re-entrant circuit. We discuss a patient with prior atrial septal defect surgical closures who presented with dual macro–re-entrant ATs related to a fragmented area on the right atrial free wall (240 ms) and the cavotricuspid isthmus (260 ms), respectively. After ablation of the fastest AT on the lateral right atrial free wall, the cycle of the first AT changed to the second AT that was interrupted on cavotricuspid isthmus, proving the dual tachycardia mechanism. This case report addresses the utilization of electroanatomic mapping information as well as fractionated electrogram timing with respect to the surface P-wave as guides for ablation location

Paradoxical para-hisian pacing response

Para-Hisian pacing (PHP) is among the most useful maneuvers in cardiac electrophysiology during sinus rhythm and identifies whether retrograde conduction is dependent on the atrioventricular (AV) node. In this maneuver, the retrograde activation time and pattern are compared during capture and loss of capture of the His bundle while pacing from a paraHisian position. A common misconception about PHP is that it is useful only for septal accessory pathways (APs). However, even with left or right lateral pathways, as long as pacing from the para-Hisian region conducts to the atrium with the activation sequence being analyzed, it can be used to determine whether that activation is AV node–dependent or AP-dependent

The initial part of polymorphic ventricular tachycardia as a clue for the sustainability of tachycardia and ablation success: A varying degree of purkinje–Myocardial complicity?

The cardiac Purkinje system is capable of very rapid burst activity suggestive of its potential role in being a driver of polymorphic ventricular tachycardia (VT) (PMVT) or ventricular fibrillation (VF). It plays a pivotal role, however, not only in the triggering of but also the perpetuation of ventricular arrhythmias. A varying degree of Purkinje–myocardial complicity has been blamed in determining not only the sustained or non-sustained nature of PMVT but also the pleomorphism of the non-sustained runs. The initial part of PMVT before cascading to the whole ventricle to establish disorganized VF can give important clues for ablation of PMVT and VF. We present a case of an electrical storm after acute myocardial infarction that was successfully ablated after identifying Purkinje potentials that triggered polymorphic, monomorphic, and pleiomorphic VTs and VF

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely