Putting the voices and insights of migrants and diverse ethnic groups at the centre of our response to COVID-19

There is increasing evidence of inequities in COVID-19 infection, disease severity, and mortality across diverse ethnic groups. Despite calls to ensure ethnicity is integral to COVID-19 research, opportunities have been missed to engage with individuals from ethnic minority groups, and even more notably, recent migrants. There is an urgent need to strengthen patient and public involvement and engagement (PPIE) and participatory research, as well as collaboration with healthcare workers from diverse migrant and ethnic backgrounds. This will require addressing multiple barriers to involvement, and a commitment to community-centred research to address the acute needs of the populations hardest hit by the pandemic

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

Background 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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

International organisations’ influences on Turkish asylum policy, 1997-2016: unpacking the transnational mechanisms from the outside-in and back

Turkey has recently developed a comprehensive legislation and domestic institutions with a view to aligning its asylum policies with international norms of the refugee regime. This incipient development represents the outcome of a complex process of policy-making that consists of a transformation from a traditional security-oriented approach towards refugees to a human rights-oriented policy while Turkey is becoming a host country to the largest number of refugees in the world.The aim of this study is to determine an explanation for the emergence of this new asylum policy in Turkey. Existing studies tended to explain the external driving power of the EU to explore this process by focusing on conditionality and socialisation mechanisms. Arguing that the new policy is a result of the interplay between international and domestic actors, this thesis questions the role of existing actors and mechanisms and seeks to explore alternative explanations of UNHCR, IOM, CoE and domestic actors. To this end, this research investigates the implications of the interactions between these international and domestic actors on the evolution of asylum policies in Turkey. In this context, the main focus is on the transnational influencing mechanisms of these actors. Seeking to find evidence to explain the asylum policy-making process, this thesis employed a systematic and comprehensive analytical framework and conducted a process-tracing analysis by drawing on the qualitative interview data and document research.The findings showed that initial reform- and strategy-building processes of the early 2000s were strongly induced by the EU’s coercive bargaining mechanism, while the reform-implementing process of 2009-2013 was shaped by a lesson-drawing mechanism spearheaded by domestic bureaucrats. A combination of state-level factors such as institutional settings and individual-level factors such as strategic entrepreneurship of the bureaucrats significantly affected the degree and the way in which domestic outcomes in asylum policy have been shaped by international sources. External organisations’ influence in the asylum area can be mobilised by domestic factors through vertical-policy making, which in turn can empower domestic actors’ position in policy-making. The interaction dynamics between these two levels allow the creation of a transnational advocacy network that would exert influence in both the outside-in and inside-out directions.<br/

Improving GP registration and access for migrant health

No abstract available

Committee assignments in a nascent party system: the case of the Turkish grand national assembly

In the USA, scholars have developed theories to explain the role of legislative committees, but these theories have not been widely tested outside the USA. This ambivalence results from the perception that the strength of political parties in parliamentary systems undermines the importance of other legislative institutions, including the committees. We surveyed members of the Turkish parliament during a period of considerable party-system turmoil to test the applicability of the prominent theories of committee organization (the distributive, informational, and partisan theories) to a parliamentary system. We found strong support for the distributive and partial support for the informational specialization and partisan theories. We consider the implications of these results for our understanding of the role of committees in parliamentary democracies and the study of parliamentary politics

The Effect of COVID-19 Crisis on Hopelessness, Loneliness and Spiritual Well-Being of Patients with Type 1 and Type 2 Diabetes in Turkey

This study aims to examine the relationship between the levels of hopelessness, loneliness, and spiritual well-being of patients with Type 1 and Type 2 diabetes during the process of COVID-19 outbreak. The study was carried out with diabetic patients living in three different cities that are in the Eastern Anatolia region of Turkey between the dates of 15 of November and 30 of November 2020. The sample of the study consisted of 500 (Type 1, n = 218, Type 2, n = 282) diabetes patients. Data were collected using a demographic information form, Beck Hopelessness Scale (BHS), Loneliness Scale (UCLA-LS), and Spiritual Well-being Scale (FACIT-Sp). While the mean scores of hopelessness and loneliness of type 1 patients were below the moderate level, the mean scores of their spiritual well-being were found to be above the moderate level. Moreover, while the mean scores of hopelessness and loneliness in type 2 patients were below the moderate level, the mean scores of their spiritual well-being were found above the moderate level. A significant relationship was found between Type 1 and Type 2 diabetes patients' levels of hopelessness, loneliness, and spiritual well-being during the COVID-19 outbreak. It was found that as the spiritual well-being levels of Type 1 and Type 2 diabetic patients increased, the levels of their loneliness and hopelessness decreased. It is recommended that mass communication that includes spiritual care practices can be used effectively to reduce diabetes patients' levels of loneliness and hopelessness during the pandemic. In addition, while providing care to diabetes patients, it can be suggested that health professionals offer a holistic approach with initiatives that will increase diabetes patients' spiritual well-being

Synthesis of block copolymers based on polyethylene by thermally induced controlled radical polymerization using Mn2 (CO) 10

International audienc