Ölümlük Bilinci Karşısında Türkiye’de Müslümanlar Tarafından Kullanılan Savunma Mekanizmaları

People who live in Turkey have experienced terrorist attacks for morethan thirty years. In the past, the goals of the terrorist organizations were tofrighten innocent civilians, but modern attacks are much more malevolent,and they have turned into indiscriminate massacres. In recent years, terroristorganizations have attacked big cities and the general population feels thatterrorism is no longer a regional problem and anyone could be in danger.The objective of this study is to determine defense mechanisms against fearof death after terrorist attacks in 2016, Ankara. Therefore, this study used aphenomenological approach as a method of qualitative research. This studyapplied open-ended questions in a semi-structured interview form on a sampleof N 26 selected by purposive sampling that lived in Ankara during June2016. End of the study, four different defense mechanisms were determined.These defense mechanisms were religious-active, religious-passive, nonreligious-passive,and non-religious active (Figure 1). As a result, theresearchers realized that neither classical Islamic philosophers’ destiny/qadar approaches nor modern psychologists’ fatalism approach could describe theMuslim Turkish population’s defense mechanism against mortality salience.Therefore, the authentic measures and concepts should be improved in orderto acquire more knowledge about this authentic sample.Türkiye’de yaşayan insanlar otuz yıldan uzun bir zamandır teröristsaldırıların hedefi olmuşlardır. Geçmişte masum insanları korkutmakamacında olan terörist organizasyonların saldırıları günümüzde kitlekatliamına dönüşmüştür. Yakın zamana kadar Türkiye’de terör bir bölgeninsorunu iken, büyük şehirlerdeki terör saldırıları sonucunda her nerde olursaolsun herkesi tehdit eden bir unsur olmuştur. Bu çalışmanın amacı, Ankara’da2016 yılında arka arkaya gelen terör saldırılardan kaynaklanlanan dehşetkarşısında insanların geliştirdikleri farklı savunma mekanizmalarının belirlenmesidir.Çalışma nitel desene göre yapılmıştır. Çalışmada fenomenolojikyaklaşım esas alınmış ve yarı yapılandırılmış görüşme formu kullanılmıştır.Açık uçlu sorular kullanılmış ve 2016 yılında Ankara’da yaşayan kişiler (N 26) çalışma grubuna alınmıştır. Çalışma sonucunda, dini-aktif, dini-pasif,dini olmayan-aktif ve dini olmayan-pasif olmak üzere dört tip savunmamekanizma belirlenmiştir (Tablo1). Gerek klasik İslam literatüründeki kaderanlayışının gerekse modern psikolojide kullanılan fatalistik yaklaşımınTürkiye’deki Müslüman örneklemin ölüm karşısındaki tutumunu aslında tamolarak yansıtmadığı ve bu konuda Türkiye’deki otantik yapıyı tanımak içinözgün yeni ölçeklerin ve kavramların geliştirilmesi gerektiği anlaşılmıştı

Clinical and molecular evaluation of MEFV gene variants in the Turkish population: a study by the National Genetics Consortium

Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disorder with recurrent fever, abdominal pain, serositis, articular manifestations, erysipelas-like erythema, and renal complications as its main features. Caused by the mutations in the MEditerranean FeVer (MEFV) gene, it mainly affects people of Mediterranean descent with a higher incidence in the Turkish, Jewish, Arabic, and Armenian populations. As our understanding of FMF improves, it becomes clearer that we are facing with a more complex picture of FMF with respect to its pathogenesis, penetrance, variant type (gain-of-function vs. loss-of-function), and inheritance. In this study, MEFV gene analysis results and clinical findings of 27,504 patients from 35 universities and institutions in Turkey and Northern Cyprus are combined in an effort to provide a better insight into the genotype-phenotype correlation and how a specific variant contributes to certain clinical findings in FMF patients. Our results may help better understand this complex disease and how the genotype may sometimes contribute to phenotype. Unlike many studies in the literature, our study investigated a broader symptomatic spectrum and the relationship between the genotype and phenotype data. In this sense, we aimed to guide all clinicians and academicians who work in this field to better establish a comprehensive data set for the patients. One of the biggest messages of our study is that lack of uniformity in some clinical and demographic data of participants may become an obstacle in approaching FMF patients and understanding this complex disease

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research