Challenges and lessons learned in mental health research among refugees: a community-based study in Turkey

Background Turkey hosts nearly four million refugees and 99% live in urban areas. Research in urban settings pose different challenges and opportunities than research in refugee camps. In this article, we aimed to share the challenges and experiences we encountered in a mixed-methods study to assess mental health problems and barriers to accessing mental health care among refugees in urban areas of Turkey. Discussion In our case, the main challenges in conducting research with refugees were collecting data from a highly traumatized population, difficulties with contacting undocumented asylum seekers including trust issues and the fear of deportation, the risk of secondary traumatization among data collectors, and the bureaucracy during study approval processes. Targeting a representative sample was not feasible, because of the lack of publicly available demographic data on a district level, presence of undocumented asylum seekers and high mobility among the refugees. Although respondents with significant psychological symptoms were routinely referred to available mental health services, we were able to do less for unregistered refugees with problems in accessing health care. Language/alphabet differences and differing dialects of Arabic posed another challenge in both translation and administration of the scales. Based on cultural characteristics, a gender-balanced team was used and the interviewers were gender-matched whenever needed. Also, the research team had to work after work hours and during weekends to be able to interview male refugees, since most refugee men were at work during working hours and most days of the week. Conclusions The research team’s experience showed that refugee population characteristics including level of trauma, language, culture, gender, legal status, and urban setting characteristics including places of living, mobility, availability of publicly available demographic data, and outreach-related barriers lead to different challenges and ethical responsibilities of researchers and affect the research costs in terms of time, human resources and finance. Even in a host country with geographical, religious and cultural proximity to the refugees, profound challenges exist in conducting mental health research in urban settings. Learning from previous experience and collaborating with local researchers and institutions are vital for better public health research and practice outcomes

Leisure Time Use, Meaning of Life, and Psychological Distress: Comparing Canadian and Korean Older Adults

Older adults’ day-to-day leisure time activities both reflect and stimulate physical, cognitive, and social capacities that contribute to their quality of life. To better understand how leisure activity choices and possible impacts vary across two cultures, this questionnaire-based study compared leisure time use, perceived meaning of life, and psychological distress for 617 older adults in Canada (n=298) and the Republic of Korea (Korea) (n=319). Compared to Koreans, Canadian respondents spent more time overall in leisure activities and devoted a higher percentage of their total leisure time to active, rather than passive, activities. They spent significantly more of their time on cognitively active activities, while Koreans preferred socially and physically active ones and scored significantly higher on both meaning of life and psychological distress. Both groups spent more of their time watching television than on any other single reported activity. Age group, retirement status, health, education, and income varied across the two countries and were significantly associated with aspects of leisure time use for each group. The results identify areas for improvement if Canadian and Korean older adults’ leisure time use is to effectively support their aging well

Analiza odnosa između vještina igre i društvenih sposobnosti i vještine reguliranja emocija u predškolske djece

Developing effective social and emotional skills is an important aspect of development in all children, and children’s play skills are in constant interaction with their social and emotional competence. The aim of this research is to examine the relationship between preschool children’s play skills and their social competence and emotion regulation skills. Tools used in this study are Revised Knox Preschool Play Scale (Değirmenci, 2016), Social Competence and Behavior Evaluation-Preschool Edition, Short Form (Çorapçı, Aksan, Arslan-Yalçın & Yağmurlu, 2010) and Emotion Regulation Checklist (Batum & Yağmurlu, 2007). This study was designed as relational survey model. The research was carried out with 131 preschool children aged 48-72 months who continued their education in public and private preschool institutions of the Ministry of National Education in Istanbul during 2016-2017 school year. Pearson Product-Moment Correlation was conducted for data analysis. Results have shown that preschool children’s Revised Knox Preschool Play Scale total scores have a significant positive correlation with “Social Competence” sub-dimension scores of Social Competence and Behavior Evaluation (r= .179; p<.05) and a significant negative correlation with “Anxiety-Withdrawal” sub-dimension scores (r= -.416; p<.01). It was also found that Revised Knox Preschool Play Scale total scores have a significant positive correlation with “Emotion Regulation” sub-dimension scores of Emotion Regulation Checklist (r= .491; p<.01) and a significant negative correlation with “Lability/Negativity” sub-dimension scores (r= -.190; p<.05). In light of these findings, it can be said that as play skills of preschool children increase, their social competence and emotion regulation skills also increase; on the other hand, their levels of anxiety-withdrawal and lability-negativity decrease.Razvijanje učinkovitih društvenih i emocionalnih vještina važan je aspekt razvoja za svu djecu i dječje vještine u stalnoj su interakciji s njihovim društvenim i emocionalnim sposobnostima. Cilj ovog istraživanja jest ispitati odnos između vještina igre u predškolske djece i njihovih društvenih sposobnosti i vještine reguliranja emocija. Ta studija dizajnirana je kao model istraživanja odnosa. Istraživanje je provedeno sa 131 predškolskim djetetom u dobi od 48 do 72 mjeseca koji nastavljaju školovanje u javnim i privatnim predškolskim ustanovama Ministarstva nacionalnog obrazovanja u Istanbulu tijekom školske godine 2016./2017. godine. Instrumenti za mjerenje koji su se koristili u ovoj studiji su Knox Skala za predškolske igre (Değirmenci, 2016), Procjena društvene sposobnosti i ponašanja (Çorapçi, Aksan, Arslan-Yalçın i Yağmurlu, 2010) i Skala za regulaciju emocija (Batum i Yağmurlu, 2007). U analizi podataka koristili su se Pearson produkt-moment koeficijent korelacije i višestruka regresijska analiza. Na kraju istraživanja utvrđeno je da ukupni bodovi Knox skala za predškolske igre djece predškolske dobi imaju značajan pozitivan odnos s bodovima poddimenzije “Društvene sposobnosti” Skale procjene društvene sposobnosti i ponašanja -30 (r = .179; p<.05) i značajan negativan odnos s bodovima poddimenzije t "Povlačenje" poddimenzijskih rezultata “anksioznosti – introvertnosti” (r = -.416, p<.01).Također je ustanovljeno postojanje značajnog pozitivnog odnosa između ukupnih bodova Knox skala za predškolske igre i poddimenzijskih bodova Skale za regulaciju emocija (r = .491; p<.01), kao i značajan negativan odnos između bodova poddimenzije “promjenjivost-negativnost” (r = -.190; p<.05). U svjetlu tih rezultata, kako se povećava vještina igre u djece, tako se povećavaju i njihove društvene sposobnosti i sposobnost kontroliranja emocija. S druge se strane može reći da dolazi do smanjenja razine anksioznosti-introverzije i promjenjivosti-negativnosti

Identification of candidate genes in a family with cancer overload by whole-exome sequencing

Background. Approximately 120 out of every 1 million children in the world develop cancer each year. In Turkey, 2500-3000 children are diagnosed with new cancer each year. The causes of childhood cancer have been studied for many years. It is known that many cancers in children, as in adults, cause uncontrolled cell growth, and develop as a result of mutations in genes that cause cancer. Methods. The investigation of family history within this context in the study, a total of 13 individuals consisting of all children and adults in the family were examined using the whole-exome sequencing (WES) with the individuals who were diagnosed with cancer in the family, who were detected to have different cancer profiles, and defined as high risk and to determine the gene or genes through which the disease has developed. Results. At the end of the study, a total of 30 variants with a pathogenic record in the family were identified. A total of 10 pathogenic variants belonging to 8 different genes from these variants have been associated with various cancer risks. Conclusions. A significant scientific contribution has been made to the mechanism of disease formation by studying a family with a high cancer burden and by finding the genes associated with the disease. In addition, by the results obtained, family members with cancer predisposition were selected after a risk analysis conducted in this family, and the necessary examinations and scans were recommended to provide an early diagnostic advantage. © 2022, Turkish National Pediatric Society. All rights reserved

Cytokine Profiles of Chronic Urticaria Patients and the Effects of Omalizumab Treatment

Introduction: Cytokines are key mediators in immunological and inflammatory conditions, including chronic spontaneous urticaria (CSU). Objectives: To investigate Th1, Th2, and Th17 cytokine profiles in CSU and to evaluate the possible effect of omalizumab treatment. Methods: Patients who were followed up for CSU, as well as healthy volunteers, were included in the study. To assess urticaria activity, the 7-day-Urticaria Activity Score (UAS-7), the Urticaria Control Test (UCT), and the Chronic Urticaria Quality of Life Questionnaire (CU-QoL) were filled. Serum levels of IL-6, IL-17, IL-31, eotaxin, RANTES, TNF-α, and TSLP were analyzed by ELISA and compared in CSU and control groups. The patients were analyzed in two groups as the omalizumab group and the non-omalizumab group based on their treatment status.   Results: Total IgE, ESR, CRP, RANTES, and TNF-a were significantly different in the overall comparison of the three groups: CSU-receiving omalizumab, CSU-not receiving omalizumab, and control groups (P <0.01, 0.015, <0.01, <0.01 and <0.01 respectively). Total IgE, CRP, RANTES, and TNF-α values were similar in those who received and did not receive omalizumab, yet these biomarkers were significantly higher in both groups than in the control group (P < 0.05). Statistical significance in ESR was observed only between the CSU-receiving omalizumab group and the control group (P = 0.01). Within the CSU patients, there was a slight but significant correlation between UCT and TNF-α (P = 0.008, r = 0.32) and IL-17 (P = 0.06, r = 0.33) levels. Conclusions: The investigated cytokine profile in CSU patients may differ from healthy controls, particularly with the higher levels of RANTES and TNF-α, and omalizumab treatment does not seem to affect that profile in CSU patients

Digitalising mental health care: Practical recommendations from the European Psychiatric Association

The digitalisation of mental health care is expected to improve the accessibility and quality of specialised treatment services and introduce innovative methods to study, assess, and monitor mental health disorders. In this narrative review and practical recommendation of the European Psychiatric Association (EPA), we aim to help healthcare providers and policymakers to navigate this rapidly evolving field. We provide an overview of the current scientific and implementation status across two major domains of digitalisation: i) digital mental health interventions and ii) digital phenotyping, discuss the potential of each domain to improve the accessibility and outcomes of mental health services, and highlight current challenges faced by researchers, clinicians, and service users. Furthermore, we make several recommendations meant to foster the widespread adoption of evidence-based digital solutions for mental health care in the member states of the EPA. To realise the vision of a digitalised, patient-centred, and data-driven mental health ecosystem, a number of implementation challenges must be considered and addressed, spanning from human, technical, ethical–legal, and economic barriers. The list of priority areas and action points our expert panel has identified could serve as a playbook for this process

Do patients with diabetes use the insulin pen properly?

Aim: This study was conducted to evaluate the insulin pen application knowledge and skills of patients with diabetes. Methods: In our descriptive study, 200 patients with diabetes were asked to present the insulin pen injection technique on a mannequin and the steps of the pen injection implementation were noted on the data collection form as correct/incorrect by researchers. Results: More than 3 out of 4 (79.5%) of the participants were using the insulin pen or the cartridge after the expiry date, 70.5% were not rotating the injection site, and 63.0% were massaging the skin after injection. Injection sites complications were significantly more in those who were using the insulin pen or the cartridge after the expiry date, those who don\u2019t know the proper length of the needle and the possible body injection sites, those who don\u2019t rotate the injection sites, those who massage after injection, and those who don\u2019t use a new needle at each injection (p&lt;0.05). Conclusion: This study put into light some failures in the knowledge and skills of patients with diabetes regarding insulin pen use. Nurses should provide patients with diabetes an effective and repetitive training concerning insulin pen use. DOI: https://dx.doi.org/10.4314/ahs.v19i1.38 Cite as: Tosun B, Cinar FI, Topcu Z, Masatoglu B, Ozen N, Bagcivan G, et al. Do patients with diabetes use the insulin pen properly? Afri Health Sci. 2019;19(1). 1628-1637. https://dx.doi.org/10.4314/ahs.v19i1.3

Utility investigation of automated techniques in hematopoietic progenitor cell count and viability assessment in the Good Manufacturing Practice (GMP) settingg

Aim: To compare our parameters as regards: i) cell count via two different automated cell count techniques, and ii) viability via automated trypan blue exclusion and 7-aminoactinomycin D (7-AAD) staining. Method: We used the trypan blue exclusion technique and an automated cell counter and for viability testing, and the trypan blue exclusion technique and the 7-AAD evaluation by flow cytometry. The trypan blue exclusion and the radio frequency techniques were used for automated cell counting. Flow cytometric analysis was performed by evaluating the yielded cellular products for 7-AAD uptake during the cell count of CD34+ cells. Results: The mean values for cell count were estimated as 3.44±1.22x106/ml (range, 2.48-5.71x106/ml) and 4.14±1.94x106/ml (range, 1.77-7.43x106/ml) for the trypan blue exclusion and radio frequency techniques, respectively. Additionally, the mean values for viability analyses via the automated trypan blue exclusion and 7-AAD were 93.38±6.09% (range, 79.00-98.00%) and 99.49±0.60% (range, 98.40-100.00%), respectively. Conclusions: Our study has responded to two fundamental questions: whether the results of both of the automated techniques for cell count correspond with each other, and whether the results of the automated viability assessment conform those of the 7-AAD technique during the manufacturing processes of cellular therapy products intended for clinical use. Even though we have the opportunity to use the hemocytometer in our laboratory setting, the automated trypan blue exclusion technique gives cell count results in concordance within the range of the expectations of our Quality Management System (QMS)