Uluslararası İletişim Düzeninde Karşılıklı Bağımlılık ve Reform

Uluslararası iletişim düzenindeki asimetrik karşılıklı bağımlılık, reform tartışmalarına yol açmaktadır. Alanyazında bu sorun sıklıkla eleştirel kuram bağlamında özellikle ekonomi politik açıdan ele alınmıştır. Uluslararası İlişkiler’in temel paradigmaları realizm ve liberalizme göre yapılandırılmış olan ve güç ilişkilerine dayalı bu düzende, reforma yönelik çabalar beklentileri karşılamaktan uzaktır. Bu çalışmanın amacı, soruna farklı bir açıdan yaklaşarak, iki baskın teorinin uluslararası iletişim düzeninde reforma yönelik katkı potansiyellerinin incelenmesidir. Neorealist ve neoliberal analizlerde sosyolojik ve normatif unsurların giderek daha fazla dikkate alınmasının gerekçesi yine küreselleşmeyle artan karşılıklı bağımlılıktır. Dolayısıyla bu teorik çalışmada, karşılıklı bağımlılık ve reform kavramlarının, uluslararası iletişimin farklı analiz düzeylerini içeren (1) enformasyon toplumu, (2) kültürlerarası iletişim ve kamu diplomasisi ve (3) küresel yönetişim unsurları bağlamında betimsel ve karşılaştırmalı bir analizi yapılmaktadır. Teorik çerçeve olarak realizm ve liberalizmin seçilmesinin nedeni, realist ve liberal temellere dayalı iletişim düzeninde reformun yine bu teorilerin kavramları üzerinden tartışılmasının faydalı olacağı tezidir. Reform ve çözüm çabalarında politika üretilmesi ve harekete geçilmesi beklenen alanlar; küresel bir enformasyon toplumu, ortak değer ve çıkarlar için uluslararası kamuoyunun oluşturulmasını sağlayacak kamu diplomasisi uygulamaları ve uluslararası kuruluşlar aracılığıyla daha etkin ve adil bir küresel yönetişimdir

Vaccine rejection and hesitation in Turkey

In Turkey, primary care staffs have observed an increased rate of vaccination refusal in recent years. The aim of the present study was to determine the prevalence of vaccination refusal and hesitancy in Turkey, in addition to the demographic features and underlying reasons. The present descriptive cross-sectional study was conducted in Istanbul and Tekirdag, two big Turkish cities that are exposed to widespread internal migration. To reflect Turkey's demographic structure, 1004 participants were selected using cluster sampling based on birthplace, age, and level of education, from all individuals who attended family medicine outpatient clinics at Namik Kemal University and Sisli Hamidiye Etfal Training and Research Hospital. A face-to-face questionnaire method was used. Data show that this decline was mainly the result of the increasing rate of vaccine rejection and hesitation, for which the most important reason was found to be distrust of vaccine companies. It can be concluded that individuals who display vaccine refusal and hesitation are mostly born in the developed geographical regions of Turkey and have high income and educational levels. According to these results, we anticipate that vaccination rates may fall in Turkey in the coming years

The Impact of Open Inguinal Hernia Mesh Repair on Quality of Life

DergiPark: 700164tmsjAims: This study aims to evaluate the effect of open inguinal hernia repair with mesh on the quality of life of the patients whowere operated at a university hospital. Methods: In this cohort study, 86 patients who had undergone an open inguinal herniarepair at General Surgery Department in a university hospital between January 2017 and October 2019 were asked to fill out theCarolinas Comfort Scale questionnaire and the data were analyzed retrospectively. Results: The total number of patients in thestudy was 86. Seventy-three were male (84%) and 13 were female (16%). The median age was 53 years ranging from 18 to 82. Thedifference of pre- and post-operative scores revealed high significance in all categories and in total; laying down, bending over,sitting up, performing activities of daily life, coughing or deep breathing, walking or standing, walking up or down the stairs,exercising and total score. Conclusion: Inguinal hernia decreases the quality of daily life by limiting the movements with groinpain. Surgical low-tension repair with mesh improves the quality of life significantly. Keywords: Inguinal hernia, quality of life,mesh repai

Evaluation of the Prevalence and Associated Factors of Low Back Pain

Amaç: Bel ağrısı sık görülen bir rahatsızlık olup; prevalansı %60?80 arasında değişmektedir. Bel ağrısıbireysel olarak yaşam kalitesini etkilemesinin yanında iş gücü kaybına neden olması nedeniyle toplumuda etkilemektedir. Bu nedenle çalışmamızda; bel ağrısının görülme sıklığını ve ilişkili faktörlerindeğerlendirilmesini amaçladık.Materyal ve Metot: Bu çalışma 01/05/2016?31/07/2016 tarihleri arasında Şişli Hamidiye Etfal Eğitim veAraştırma Hastanesi Aile Hekimliği Polikliniği’nde yapıldı. Yüz yüze görüşme ile sosyodemografiközelliklerin yanı sıra bel ağrısı sıklığı ve etkileyen faktörlerin sorgulandığı, tarafımızca hazırlanan anketuygulandı. İstatistiksel analiz için SPSS 15.0 for Windows programı kullanıldı. İstatistiksel anlamlılıkseviyesi p<0,05 olarak kabul edildi.Bulgular: Çalışmaya katılanların yaş ortalaması 40,90±14,20 olup %66’sı kadın, %34’ü erkekti. Bel ağrılıhastaların yaş ortalaması 41,90±13,63 idi. Bel ağrısı nokta prevalansı %18,80(n=94), yaşam boyu prevalansise %77,40 (n=387) olarak bulundu. Kadınlarda (p=0.009), ağır yük kaldıranlarda (p=0,007); evli veboşanmış olanlarda (p=0,000), vücut kitle indeksi (VKİ) yüksek olanlarda (p=0,022) diğer gruplara görebel ağrısı yaşama sıklığı daha fazla idi. Sigara kullanım süresi ve miktarı arttıkça bel ağrısı görülmesıklığı, doktora başvuru, tetkik istenme ve tedavi alma sayısı anlamlı olarak daha fazlaydı (p<0,05).Sonuç: Çalışmamızda bel ağrısının özellikle kadın cinsiyette, evli ve boşanmış olanlarda, VKİ yüksekolanlarda ve düşük eğitim düzeyine sahip bireylerde daha sık olduğunu saptadık.Objectives: Low back pain is a common disorder and the prevalence changes between %60 – 80. Low back pain effects individual’s quality of life and affects the society due to the loss of labor force. This study was designed to determine the prevalence and risk factors of low back pain within the community. Materials and Methods: This research was made in the Family Medicine Polyclinic of Şişli Hamidiye Etfal Training and Research Hospital between 01/05/2016?31/07/2016. Volunteers filled the questionnaires out via face?to? face interview questioning sociodemographic properties as well as the frequency and affecting factors about back pain, The data were analyzed by using SPSS 15.0 software programme. Level of significance was taken as p<0,05. Results: The average age was 40.91+14.20, 66% was women, 34% was men. The avarage age of the patients who have low back pain was 41.90. The point prevalence of low back pain was 18.80% (n=94), while the lifetime prevalence was 77.40% (n=387). We identified more low back pain cases in people, who had heavy load lifting stories (p=0.007) of woman gender (p=0.009), married or divorced (p=0.000) and who had higher body mass index (BMI) (P=0.022) compared to other groups. The duration and amount of smoking were positively correlated with the prevelance of low back pain, number of doctor visits, need for laboratory examinations and number of treatments. Conclusion: In our study, we determined that; low back pain is more frequent in women, in married and divorced people,in people with higher BMIs and in people with low education level

Fenotypowe podgrupy zespołu policystycznych jajników mają różne objawy wewnątrznerkowej oporności

Objective: The polycystic ovary syndrome (PCOS) is known to be related with increased metabolic and cardiovascular risks. Various phenotypic subgroups of PCOS have been proven to have metabolic and endocrine disorders with varying degrees of severity. However, intra-renal vascular resistance, which is an indirect indication ofatherosclerosis, remains unknown in PCOS subgroups. In this study we examined whether PCOS subgroups have different intra-renal resistance symptoms. Material and Methods: 98 PCOS patients (diagnosed according to the Rotterdam criteria) 30 controls were ncluded in the study. The diagnosis of PCOS was established in the presence of at least two of the following criteria: 1- oligo and/or amenorrhea (OM); 2- clinic and/or biochemical signs of hyperandrogenism (HA); 3- polycystic ovarian morphology (PCO) detected by transvaginal ultrasonography. 37 patients (Group 1) met all three criteria (HA+OM+PCO), 29 patients (Group 2) met two of the criteria including hyperandrogenism (HA+OM or HA+PCO) and the remaining 32 patients (Group 3) had no hyperandrogenism but fulfilled the other two criteria; PCO+OM. Renal Doppler ultrasonography and hormonal/ biochemical analyses were carried out. The first outcome measure was designated as the differences in the renal resistive index (RRI) values of the groups, and the second outcome measure was designated as the relation of RRI with the insulin resistance and lipid profile. Results: In Group 1, the RRI and the homeostasis model assessment of insulin resistance (HOMA-IR) values were significantly higher than in Group 3 and controls (P < 0.031, P < 0.001, respectively, after adjusting for age and BMI). The RRI and HOMA-IR values in Group 3 were similar to those of the control group. It was determined that RRI has a positive correlation with HOMA-IR (r=0.784, PCel pracy: Zespół policystycznych jajników jest związany ze zwiększonym ryzykiem metabolicznym i sercowonaczyniowym. Fenotypowe podgrupy w obrębie zespołu PCO charakteryzują się zaburzeniami metabolicznymi i endokrynnymi o rożnym stopniu nasilenia. Jednak wewnątrznerkowa oporność naczyniowa, która jest pośrednim wykładnikiem miażdżycy, pozostaje nieznana w podgrupach zespołu PCO. W badaniu ocenialiśmy czy podgrupy zespołu PCO mają rożne objawy wewnątrznerkowej oporności. Materiał i metoda: do badania włączono 98 pacjentek z zespołem PCO (zdiagnozowanym według kryterium z Rotterdamu) oraz 30 pacjentek kontrolnych. Rozpoznanie zespołu PCO postawiono na podstawie obecności przynajmniej dwóch z poniżej wymienionych kryteriów: 1-oligo i/lub amenorrhea (OM); 2-kliniczne lub biochemiczne objawy hiperandrogenizmu (HA); 3-policystyczny obraz jajnikow (PCO) w przez pochwowym badaniu ultrasonograficznym. Grupę 1 stanowiło 37 pacjentek, które spełniły wszystkie kryteria diagnostyczne (HA+OM+PCO), grupa 2 to 29 pacjentek z dwoma kryteriami, w tym kryterium hiperandrogenizmu (HA+OM lub HA+PCO), pozostałe 32 pacjentki to grupa 3 – bez hiperandrogenizmu ale z dwoma pozostałymi kryteriami; PCO+OM. Przeprowadzono badanie dopplerowskie nerek i hormonalno-biochemiczną ocenę. Jako pierwszą zmierzono różnicę pomiędzy grupami w indeksie oporu nerkowego (RRI), następnie oceniono związek pomiędzy RRI a insulinoopornością i profilem lipidowym. Wyniki: W grupie 1, RRI i wskaźnik oceny insulinooporności (HOMA-IR) były istotnie wyższe niż w grupie 3 oraz kontrolnej (

Educational Family Health Centers' in Family Medicine Resident Training Experience of Şişli Hamidiye Etfal Training and Research Hospital

Aile hekimliği uzmanlık eğitimi Türkiye’de 1984 yılındabaşlamıştır. 2010 yılına kadar aile hekimliği uzmanlık öğrencilerinin 3 yıllık eğitim sürecinin tamamı klinik rotasyonlardan oluşmaktayken; 2010 yılından bu yana belirtilenamaçları uygulayabilmek ve yeterlilikleri kazanabilmek için,18 ay klinik rotasyon, 18 ay ise saha eğitimi olacak şekildedüzenleme yapılmıştır. Saha eğitiminin ihtiyacını karşılamak üzere Sağlık Bakanlığı tarafından 2014 yılında ‘EğitimAile Sağlığı Merkezleri’’ (E-ASM) kurulmasıyla ilgili mevzuat çıkarılmıştır. Aile hekimliği uzmanlığı saha eğitimindeönemli bir boşluğu doldurması beklenen E-ASM’lerin eğitimhizmetinin yanında diğer aile sağlığı merkezlerinin verdiğihizmetleri vermesi de beklenmektedir. E- ASM’lerin sayısıhalen yetersiz olup arttırılması için eğitim kurumlarınınfarkındalığının artırılması, malzeme temini, tadilat ve tamirat ihtiyaçlarının kolaylaştırılması gerekmektedir.Sağlık Müdürlükleri tarafından alt yapının oluşturulmasıve destek personelinin sağlanması; Aile hekimliği eğitimkurumları tarafından ise eğitici görevlendirilmesi ve eğitimgörecek uzmanlık öğrencisi planlanması alternatif olarakdüşünülmelidir. Nüfus kaydının ve hizmet planlamalarınınasistan eğitimine imkân verecek şekilde düzenlenmesi, görev yapacak eğitici, asistan ve diğer personelin ödemelerinin hak kaybına neden olmayacak şekilde yapılandırılması, sahada yapılacak araştırmalarla ilgili izin süreçlerininkolaylaştırılması gerekmektedir. Bu yazıda Sağlık BilimleriÜniversitesi Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Aile Hekimliği Kliniği’ne bağlı olarak 2016 yılıAğustos ayı itibariyle iki ayrı binada hizmet vermeye başlayan iki ayrı E-ASM’nin açılması ve işletilmesiyle ilgili deneyimler paylaşılarak sürecin iyileştirilmesine katkı sunulması amaçlanmıştır.Family medicine residency training began in 1984 in Turkey. Until 2010, 3-year education process of family medicine residency students consisted of clinical rotations. Since 2010, in order to implement the stated objectives and gain the qualifications, 18 months of clinical rotation and 18 months of field training have been arranged. In order to meet the need for field training, the Ministry of Health issued legislation on the establishment of Education Family Health Centers (E-FHC) in 2014. It is expected that the E-FHCs, which are anticipated to fill a significant gap in family medicine speciality field training, in addition to educational services they have to provide services provided by other family health centers. The number of E-FHCs is still insufficient and to increase it, the awareness of educational institutions should be increased, material procurement, modification and repair needs should be facilitated. The establishment of infrastructure by the Health Directorates and the provision of support staff, as well as the planning of the trainer by the family medicine education institutions and the planning of the specialist for the training should be considered as an alternative. It is necessary to arrange population registration and service planning in a way that will allow residence training, to make trainers, residences and other personnels to be employed in such a way that they do not cause any loss of right, and to facilitate the process of permits related to the researches in the field. In this paper, it is aimed to contribute to the improvement of E-FHC process by sharing the experiences about opening and operating of two separate E-FHCs of the Health Sciences University Şişli Hamidiye Etfal Training and Research Hospital Family Medicine Clinic which started to serve in two buildings as of August 2016

Evaluation of Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios in Rheumatoid Arthritis

Objective: The purpose of this study is to investigate the relationship of disease activity with Neutrophil-Lympho­cyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) and red blood cell distribution width (RDW). Methods: Seventy seven RA patients and 97 healthy sub­jects were examined retrospectively. People with chronic and systemic diseases were excluded from control group of the study. The disease activity scores (DAS 28) of pa­tient group, hematologic parameters and inflammation parameters of both groups were analyzed statistically us­ing independent t-test and spearman correlation test. Results: Age and gender was not found different be­tween groups. CRP and ESR levels were significantly higher in RA group (p<0.001). Hemoglobin and platelet count were lower (p<0.001 and p=0.022), while RDW, NLR, PLR and MPV levels were significantly higher in RA group (p<0.001, p<0.001. p<0.001, p<0.001, respec­tively). In patient group, ESR (p<0.001), lymphocytes (%) (p= 0.042), absolute neutrophil (p=0.047), and platelets (p= 0.019) were positively, whereas lymphocytes were negatively affected by improvement disease activity (DAS 28) scores. PLR levels significantly negatively correlated with MPV levels (r= -0.386) but showed a significant posi­tive correlation with RDW (r= 0.354) and NLR levels (r= 0.618). Conclusion: NLR and PLR are important and promising factors for disease activity estimation of rheumatoid ar­thritis and may be used in clinical practice. In our opinion, larger studies consisting larger group will help determina­tion of disease activity of RA by more specific indices us­ing these parameters

Teaching grammar is not my main responsibility”: Exploring EFL teachers’ beliefs about grammar teaching

This mixed-methods study investigated a hundred university EFL teachers’ beliefs about several issues in grammar teaching. Teachers’ beliefs about these issues such as the explicit and implicit teaching of grammar, its integration with other language skills, and the role of a teacher in grammar teaching were elicited by means of a questionnaire. Furthermore, semi-structured interviews were conducted with ten volunteer teachers to obtain more in-depth information about teachers’ reported beliefs. These results were analyzed by using the descriptive statistics and in-vivo coding. The findings of the study demonstrated that most teachers believed in the centrality of grammar instruction to helping language learners attain a substantial proficiency in English. Moreover, it was found that most teachers favored an inductive, integrative and communicative approach to grammar teaching. Although teachers’ reported beliefs were, overall, in harmony with the literature on grammar teaching, there were no hints suggesting that teachers were aware of grammar theories or their beliefs were based on SLA/grammar literature. The findings indicated that the distinction between pedagogical dichotomies proposed in the literature seemed to blur in the practice since teachers frequently referred to personal and contextual features as the main factors shaping their beliefs and practices

Where the Rivers Merge: Cognitive Diagnostic Approaches to Educational Assessment

A growing emphasis on the union of cognitive psychology with psychometrics has led to the inception of Cognitive Diagnostic Assessment (CDA). CDA can be defined as a cognitively‑grounded assessment methodology which aims to detect examinees’ strengths and weaknesses in a given domain, make reliable diagnostic classifications directly from the statistical models, and present stakeholders with fine‑grained and pedagogically‑meaningful diagnostic feedback. Although CDA holds great promise for educational assessment practices, it remains relatively unknown to many assessment specialists. Hence, this paper aims to describe the theoretical underpinnings and working principles of CDA by giving information about the developments that have led to the inception of CDA and elaborate on how CDA can be implemented in operational assessment settings either by using an inductive or retrofitted approach to foster learning and enhance accountability within educational programs. Finally, the potential that CDA bears for educational assessment is discussed and practical implications are made.Bilişsel psikolojinin psikometri ile harmanlanması Bilişsel Tanılayıcı Değerlendirme (BTD) adı verilen ölçme ve değerlendirme yaklaşımının ortaya çıkmasını sağlamıştır. BTD, bilişsel temelli, istatistiki açıdan sofistike ve alternatif bir ölçme ve değerlendirme yaklaşımıdır. Bireylerin belirli bir beceri ya da akademik alandaki güçlü ve zayıf yanlarının, eksiklerinin ve yanılgılarının saptanmasını ve bu hususlara yönelik paydaşlara (öğrenci, öğretmen, veli ve idarecilere) bireylerin halihazırdaki durumları hakkında detaylı dönüt verilmesini amaçlar. Sağlanan dönüt, pedagojik açıdan anlamlı ve öğrenme sürecini destekleyici boyutta olmalıdır. Bu değerlendirme yaklaşımının eğitim öğretim faaliyetleri için pek çok yararı olmasına karşın, BTD hem eğitim araştırmacıları hem de ölçme değerlendirme alanında çalışan araştırmacılar tarafından yeteri derecede tanınmamaktadır. Bu makalede, BTD yaklaşımının ortaya çıkmasına sebep veren eğitimsel akım ve gelişmeler ele alınmış, BTD’nin kuramsal temelleri, çalışma prensipleri, işlevleri hakkında detaylı bilgi verilmiştir. Ayrıca, BTD’nin öğrenme çıktılarını iyileştirme ve eğitim programlarının kalite ve hesap verebilirliğinin artırılması hedeflerine yönelik olarak, eğitim ve ölçme değerlendirme ortamlarında nasıl uygulanabileceği hususunda öneriler sunulmuştur