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Aim: Family health centers (FHCs) are reimbursed for their current expenditures based on a classification of four clusters in Turkey. This study compared the coordination, comprehensiveness, continuity, accessibility, and the first contact of care among different reimbursement FHC groups. Methods: The data were obtained from the Turkish data of the Quality and Costs of Primary Care in Europe study. Data was collected in provinces from six geographical regions. Physicians and patients from Classes A and B FHCs were called the first group, and others were called the second group. Results: A total of 296 physicians and 2623 patients were enrolled. According to the reimbursement groups, 593 (22.6%) patients received services from the first group and 2012 (77.4%) patients from the second group. The first contact with care and the admission frequency of 3 or more in the last six months were higher in the first group (respectively, 99.2% vs. 97.7%, p=0.027; 55.4% vs. 49.6%, p=0.015). Conclusion: The reimbursement classification did not make a difference in coordination, comprehensive care, continuity, accessibility, and being the first contact of care. Therefore, the current classification does not contribute to improving the quality of primary care in terms of service provision. [ABSTRACT FROM AUTHOR]

Objective: In this retrospective study, we analyzed the in vitro fertilization (IVF) clinical and laboratory outcome of cryptozoospermia cases compared to the extremely severe oligospermia cases in a single IVF center. Materials and Methods: All the IVF laboratory and clinical outcomes of cryptozoospermia and extremely severe oligospermia cases were analyzed and compared between January 2014 and December 2019 in Istanbul Florence Nightingale IVF Center. The same reproductive group treated all couples. Virtual azoospermia or cryptozoospermia were diagnosed once the mature sperm cells could be recognized after centrifugation (group 1). Patients without motile sperm were excluded. Extremely severe oligospermia was defined as a sperm count was less than <1 mil/mL (group 2). The study consisted of 33 virtual azoospermic patients with 40 cycles, whereas there were 40 severely oligospermic patients with 45 cycles. All patients underwent the intracytoplasmic sperm injection (ICSI) procedure and all the embryos were let to grow until the blastocyst stage on day 5. Groups were compared for clinical and laboratory reproductive outcome. Results: Both the median maternal and paternal ages were similar. All outcomes including fertilization rates, blastulation rates, clinical pregnancy and delivery rates were comparable. The miscarriage rates did not also show any statistical difference. Conclusion: Reproductive outcomes in cryptozoospermic IVF patients are comparable to those of extremely severe oligospermic patients provided that the ICSI is performed using motile spermatozoa. Our results favor using sperm from fresh ejaculate rather than surgical sperm retrieval when motile sperm is available in cryptozoospermic IVF patients. [ABSTRACT FROM AUTHOR]

Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units. [ABSTRACT FROM AUTHOR]

Purpose To assess age, refractive error and gender related changes occurring in the cornea and the anterior segment of the eye using a Scheimpflug system. Methods The study included 666 healthy eyed subjects with a mean age of 39.3 ± 19.7 years (range: 3–85 years). All analyses were based on the right eyes of the patients as all measured parameters correlated well between the right and left eyes. Each parameter was correlated with age and the right eye's spherical equivalent (SE) using Pearson correlations. Univariate linear regression models were constructed for analyses of parameters. Results The anterior corneal surface asphericity showed significant positive correlations whereas posterior corneal surface asphericity showed significant negative correlations with age. Anterior chamber depth (ACD), volume (ACV) and angle (ACA) showed significant negative correlations with age and SE. Age explained 25% of the variance in anterior corneal surface asphericity, 22% of variance in posterior corneal surface asphericity, 26% of variance in ACV, 27% of variance in ACD, and 19% of variance in ACA. In the SE model SE was identified to account for 25% of variance in ACV, 22% of variance in ACD, each, and 17% of variance in ACA. Significant differences were detected in anterior and posterior keratometry values, ACV, ACD and ACA among gender groups ( p < 0.01). Conclusions The cornea shows a tendency for a decrease in anterior corneal surface asphericity and an increase in posterior corneal surface asphericity with advancing age. Men have flatter corneas and women have shallower anterior chambers and narrower anterior chamber angles. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the effects of various background gases on the formation and sustenance of a plasma jet. A helium plasma is ignited inside a dielectric tube and introduced into a vacuum chamber where the gas composition and pressure can be controlled. The gas composition inside the chamber is altered by separately injecting various background gases, such as air, nitrogen, and argon. Here, we report that, in order to sustain a plasma jet, there needs to be a physical boundary layer around the helium flow. This boundary can be in the form of a solid surface that encapsulates the flow, or a background gas other than helium. If only helium is present inside the chamber, no propagating jet is created; rather a diffuse plasma fills the chamber. If another gas is introduced, then the diffuse plasma reverts into a jet. Additionally, we discovered what can be considered as the signature emission line from a plasma jet operating with helium. This emission line is at 587.4 nm (He). This line appears in the emission profile only in the presence of a plasma jet, and disappears as the plasma transitions to a diffuse state at the same applied power parameters and pressure. [ABSTRACT FROM PUBLISHER]

In this study, we report insights into the dynamics of atmospheric-pressure low-temperature plasma jets (APLTPJs). The plasma jet current was measured by a Pearson current monitor for different operating conditions. These jet current measurements confirmed a proposed photo-ionization model based on streamer theory. Our results are supported by intensified charged-couple device camera observations. It was found that a secondary discharge ignition, arising from the positive high-voltage electrode, causes the inhibition of plasma bullet propagation. Our observations also showed the existence of an ionization channel between the APLTPJ reactor and the plasma bullet. In addition, the maximum electron density along the plasma jet was estimated using Ohm's law, and an empirical relationship was derived between the plasma bullet velocity and the plasma bullet area. [ABSTRACT FROM AUTHOR]

The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. QUALICOPC is funded by the European Commission under the "Seventh Framework Program". In this article the background and design of the QUALICOPC study and also sample selection procedure in Turkey are described. Methods: QUALICOPC started in 2010 and will run until 2013. Data will be collected in 31 European countries (27 EU countries, Iceland, Norway, Switzerland and Turkey). Some research centers/institutes which are in Australia, Israel and New Zealand also contributing to the study. The study uses a three level approach of data collection: the health supply system, practice and patient. Surveys will be held among general practitioners (GPs) and their patients, providing evidence at the process and outcome level of primary care. These surveys aim to gain insight on the professional behavior of GPs and the expectations and actions of their patients. To gather data on the structure and national level, the study uses existing data sources such as the Primary Health Care Activity Monitor Europe (PHAMEU) database. Data collection in Turkey will take place in 6 regions, each including 1 or 2 provinces, selected according to geographical distribution. Sample selection is based on Family Medicine Centers and provinces will be selected according to starting date of family medicine scheme. At least 10% of the sample will be selected among family physicians with vocational training and their patients. Conclusions: By its design, in which different data sources are combined for comprehensive analyses, QUALICOPC will contribute to the discussion on the merit of strengthening primary care systems and to evidence based health policy development. [ABSTRACT FROM AUTHOR]

Background: Adolescence is a crucial period for development of dietary behaviors that continue into adulthood and influence the risk of chronic diseases later in life. The aim of this study was to determine the eating patterns of adolescents' and their compliance with the Food Guide Pyramid. Methods: 625 students, aged between 11-15 years, from an elementary school in Istanbul, Turkey were enrolled in this cross-sectional survey. A questionnaire of eating patterns (QEP) was administered to all participants. QEP is consisted of questions assessing the knowledge and behaviors on healthy eating, factors affecting food choice, physical activity status and demographical variables. Height and weight of all participants were measured. Physical activity status was determined by questioning about participation in regular sport activities, how much time spent watching TV, playing computer games or doing homework. Results: The mean age of the participants was 12.15 ± 1.15 and 50.5% were female. According to body mass index (BMI) percentiles, 8.3% (52) were obese and 10.2% were overweight. 51% had breakfast every day and only 1.9% met all the recommendations of the Food Guide Pyramid. Among the participants, 31% have fast food at least once every day and 60.8% skip meals. When participants were asked to rate the factors effecting their food choice according to a 10 point Likert scale, the highest mean scores (high impact on food choice) were for the factors; family, health, body perception, teachers and friends; 7.5 ± 3.1, 7.4 ± 3.1, 6.1 ± 3.2, 4.8 ± 3.3 and 4.2 ± 3.0 respectively. Total mean time spent on all passive activities (TV, computer, reading homework etc) per day was 9.8 ± 4.7 hours. Conclusions: In this study we have demonstrated that, adolescents do not have healthy eating patterns. Educational interventions should be planned to decrease the health risks attributable to their eating behaviors. [ABSTRACT FROM AUTHOR]

Background: This article is based on the experience with 'The Human in Medicine' (HIM) courses that had been a part of the preclinical program of the Marmara Medical School. Aim: The evaluation of the HIM course in terms of its efficacy and the impressions of the students. Methods: Three groups of data were collected: (a) Students' feedbacks about the courses, (b) HIM final scores and (c) a thematic/content analysis of randomly selected students' reports. Stratified random sampling was used to select student reports for qualitative analysis. Content and thematic analyses were carried out by two researchers independently. Results: In general, the HIM program was evaluated as moderate or above moderate by 60-80% of the students. Content and thematic analysis of student reports showed that there was a rich variety in individual definitions, descriptions of causal relationships and suggestions for possible solutions about themes medicalization and stigmatization. Student reports on the case were analysed in concordance with psychologic and social parameters. Conclusion: As a conclusion these results showed that program goals were mainly achieved and the multidisciplinary, preclinical HIM program can be seen as efficient starting point to complement the biologic perspective of medical education with a social and humanistic perspective. [ABSTRACT FROM AUTHOR]

Background: While bio-medically, menopause could be treated as an illness, from a psychosocial and cultural perspective it could be seen as a "natural" process without requiring medication unless severe symptoms are present. Our objective is to explore the perceptions of Turkish women regarding menopause and Hormone Therapy (HT) to provide health care workers with an insight into the needs and expectations of postmenopausal women. Methods: A qualitative inquiry through semi-structured, in-depth interviews was used to explore the study questions. We used a purposive sampling and included an equal number of participants who complained about the climacteric symptoms and those who visited the outpatient department for a problem other than climacteric symptoms but when asked declared that they had been experiencing climacteric symptoms. The interview questions focused on two areas; 1) knowledge, experiences, attitudes and beliefs about menopause and; 2) menopause-related experiences and ways to cope with menopause and perception of HT. Results: Most of the participants defined menopause as a natural transition process that one should go through. Cleanliness, maturity, comfort of not having a period and positive changes in health behaviour were the concepts positively attributed to menopause, whereas hot flushes, getting old and difficulties in relationships were the negatives. Osteoporosis was an important concern for most of the participants. To deal with the symptoms, the non-pharmacological options were mostly favoured. Conclusion: To our knowledge, this is the first qualitative study which focuses on Turkish women's menopausal experiences. Menopause was thought to be a natural process which was characterised by positive and negative features. Understanding these features and their implications in these women's lives may assist healthcare workers in helping their clients with menopause. [ABSTRACT FROM AUTHOR]

In this study, we investigate chemical and isotopic characteristics of low-temperature geothermal waters issuing from carbonate reservoirs in the Çürüksu Graben within the eastern termination of the Büyük Menderes Graben in western Turkey. Temperatures and pH values of geothermal waters vary from 20.1 to 24.6 ºC and 6.62 to 7.11 and those of cold waters are 17.1 to 19.9 ºC and 6.85 to 7.72, respectively. Geothermal waters are of Ca-HCO3 and Ca-SO4 types whereas cold waters are characterized by these two types and Mg-HCO3 as well. δ18O and δD values of samples vary from –9.27‰ to –7.69‰ (VSMOW) and –58.06‰ to –52.2‰ and indicate a meteoric origin with local recharge. Tritium contents are from 0.12 to 2.17 TU for thermal waters and 0.28 to 4.85 TU for the cold waters implying relatively longer residence time for the hot waters. Thermal water samples mostly have positive δ13C values (varying from –0.32‰ to +1.99‰) and carbon in these waters is likely derived from marine limestone or metamorphic CO2 . δ34S and δ18O values of dissolved sulfate in the waters indicate that sulfur originates from dissolution of marine evaporite deposits (e.g., gypsum). Çürüksu waters are generally oversaturated with respect to calcite, dolomite and quartz but undersaturated with respect to gypsum. Common ion effect exerted a strong control for the formation of travertine deposits in the area. Chemical and isotopic evaluations indicated that the diversity in the water chemistry of samples is attributed to a combination of processes including water-rock interaction, ion exchange and mixing of various types of waters. Çürüksu thermal waters are immature and not in chemical equilibrium with the reservoir rock. Among the various geothermometers applied to Çürüksu thermal waters, temperatures computed by chalcedony, quartz and CaMg geothermometers are 21–52 ºC, 49–83 ºC and 73–96 ºC, respectively. HCO3 -SO4 -F and anhydrite-chalcedony (quartz) diagrams estimated a temperature range of 63–86 ºC and δ18O(SO4 -H2O) isotope geothermometer yielded 67–78 ºC. [ABSTRACT FROM AUTHOR]

Objective: Coordination function of primary care (PC) enables continuous, efficient, and cost-effective health care provided to patients with chronic disease and multimorbidity (MM). The aim of this study was to identify the most common chronic diseases and to determine the prevalence of MM in PC registries. Methods: Our study is a cross-sectional study. All the individuals aged 40 and over who were registered to the primary care units (PCUs) of the Uskudar district of Istanbul have formed the population of the study. A systematic cluster sampling was used. The patient list of each family physician in Uskudar district was accepted as a cluster and an equal number of patients from each cluster were enrolled. Only the information on the patients' MM data was requested from the primary care physicians. Results: The 108 physicians of the Uskudar district (response rate: 73.4%) gave consent to participate in the study. The 1187 (40.3%) of registered patients of all PCUs were 40 years old and over. The multimorbid patients were found as 330 (27.8%). Conclusions: Approximately, one of four patients have multimorbidity. So, the policy of primary care services should be redesigned for the management of MM patients including the 'goal-oriented care' approach. [ABSTRACT FROM AUTHOR]

One of the most spectacular shows that nature offers at northern latitudes is what is known as northern lights or Aurora Borealis. The Aurora Borealis is caused by energetic particles of the solar wind, which get trapped in Earth's magnetosphere. To simulate this phenomenon on a table top scale, we ignited a plasma jet and introduced the fast traveling plasma into a chamber, where the pressure can be lowered. A magnetized ball representing Earth was placed in the middle of the chamber. Fig. 1 shows what happens when the plasma jet reaches the ball: the plasma wraps around the ball. [ABSTRACT FROM PUBLISHER]

The most effective intervention model for childhood obesity is known as family-based behavioral group treatments. There are also studies that investigate the effects of educational games for children to gain healthy eating and physical exercise habits. The aim of this study was to compare the efficacy of a family-based group treatment with an educational game (Kaledo) intervention in childhood obesity. Kaledo is a board game that was designed to improve nutritional knowledge and healthy life style habits. It is played with nutrition and activity cards that players can select from, and a total score is calculated in the end of the game according to energy intake and expenditure. Obese children between 9 and 12 ages were involved in this study. Participants randomly divided into behavioral and game intervention groups. Clinical evaluation was performed in the first and second counseling in both groups. Marmara University Family Medicine Department Obese Children and Adolescents Interview Form, Physical Activity Evaluation Form, and Three-day Food Record Form were used for this purpose. Strengths and Difficulties Questionnaire-Parent Report Version and Children's Depression Inventory were used for the assessment of psychiatric symptoms. After the clinical evaluation, an education session about healthy eating and physical activity was attended by both groups. After that, for the behavioral groups, parents and children were assigned to different groups, while for the game intervention group, parents were assigned to behavioral sessions and children were assigned to game (Kaledo) sessions. A total of six sessions with 1-h duration and 2-week interval were performed in both groups. Height and weight were measured in each session and analysis was performed on the data of the children who participated in all of the sessions. Although a total of 108 children were clinically evaluated, 52 children and their parents, 26 in the behavioral group and 26 in the game intervention group, participated in two or more sessions. Twenty-four participants, 12 in behavioral and 12 in the game intervention group, finished the study by participating in all of the six sessions. Thus, dropout rate was 74%. BMI and BMI z-scores decreased in both groups compared with the initial measures and these changes were statistically significant. For the behavioral group, these changes were - 1.01 (25.44 to 24.43, p = 0.03) and - 0.17 (2.07 to 1.90, p = 0.000) and for the game group, - 0.74 (26.98 to 26.24, p = 0.007) and - 0.09 (2.07 to 1.98, p = 0.003). There were no significant differences between behavioral and game intervention groups in point of BMI and BMI z-scores (p = 0.130 and p = 0.706).Conclusion: Family-based behavioral group treatment and game (Kaledo) intervention were found to be effective in childhood obesity management in this research. There was no significant difference between the two interventions. According to this study, these intervention models can be advised to primary care physicians to be used in the management of childhood obesity. What is Known: - Family-based behavioral group treatment is known as the most efficient model for childhood obesity management. What is New: - In this study, for the first time, a game (Kaledo) intervention was found to be effective in childhood obesity management. - Compared with family-based behavioral group treatment, there was no significant difference between the two interventions. [ABSTRACT FROM AUTHOR]

Plasma bullets have recently been used in novel applications in biology and medicine, which spurred interesting developments in the new interdisciplinary field of “Plasma Medicine.” In this paper, using high speed ICCD camera images we show that during their lifetime, plasma bullets undergo three distinctive phases: a launching phase during which the bullet velocity increases rapidly, a propagation phase during which the bullet velocity is temporarily maintained but later steadily decreases, and an ending phase during which the bullet collapses. [ABSTRACT FROM AUTHOR]

Treatment of total ruptures of adductor longus is challenging in professional sports. Time for return to pre-injury level as well as re-injury rates are of concern and surgical and conservative treatment approaches are debated; yet no consensus approach described for professional athletes. We present a case of a professional soccer player who experienced a rupture in his left adductor longus proximal tendon during a game and was treated conservatively. This case was followed-up during clinical assessment, imaging and strength testing until and after return to play. Primary outcome measure was the return to standard play condition at his pre-injury level without any functional deficits, measured by isokinetic testing. Second outcome measure was the recurrence. No recurrence was observed during the first year of follow-up. Total ruptures are very challenging for both the physician and the player to make a quick decision due to minimal or lack of pain. Functional outcomes are almost identical although operative treatments need longer time to return to play. This case report adds another example to the literature of a successful return to play after non-operative treatment of adductor longus rupture at elite level soccer. [ABSTRACT FROM AUTHOR]

It is challenging nowadays for many authors to write and submit a scientific paper to peer reviewed journals due to strict editorial and reviewer evaluation processes and the competitive environment. For the dissemination of scientific papers (original research, literature review, case presentation, position paper etc.) relevant to Primary Health Care and General Practice it is important that authors understand the perspective of journal editors and their publication policies. This workshop aims to give an insight into the editorial evaluation process of a submitted manuscript and also to discuss the main aspects of preparing a manuscript for successful publication. The workshop will have the format of a highly interactive discussion. It will focus on the preparation and submission of scientific papers with special emphasis on choosing the appropriate journal, understanding the editor's perspective, peer review process, sharing experiences, common errors and how to prevent them. At the end of the workshop, participants will be able to get information about editorial evaluation and gain practical advice on how to successfully prepare a scientific paper for publication in a peer-reviewed journal. [ABSTRACT FROM AUTHOR]

We report the learnings gleaned from a four-country panel (Australia, South Africa, Egypt and Nigeria) sharing their countries' COVID-19 primary healthcare approaches and implementation of policy at the World Organization of Family Doctor's World virtual conference in November. The countries differ considerably with respect to size, national economies, average age, unemployment rates and proportion of people living rurally. South Africa has fared the worst with respect to waves of COVID-19 cases and deaths. All countries introduced strategies such as border closure, COVID-19 testing, physical distancing and face masks. Australia and Nigeria mobilised primary care, but the response was mostly public health and hospital-based in South Africa and Egypt. All countries rapidly adopted telehealth. All countries emphasised the critical importance of an integrated response between primary care and public health to conduct surveillance, diagnose cases through testing, provide community-based care unless hospitalisation is required and vaccinate the population to reduce infection spread. [ABSTRACT FROM AUTHOR]

Purpose: To develop an algorithm for the diagnosis of Behçet's disease (BD) uveitis based on ocular findings. Methods: Following an initial survey among uveitis experts, we collected multi-center retrospective data on 211 patients with BD uveitis and 207 patients with other uveitides, and identified ocular findings with a high diagnostic odds ratio (DOR). Subsequently, we collected multi-center prospective data on 127 patients with BD uveitis and 322 controls and developed a diagnostic algorithm using Classification and Regression Tree (CART) analysis and expert opinion. Results: We identified 10 items with DOR >5. The items that provided the highest accuracy in CART analysis included superficial retinal infiltrate, signs of occlusive retinal vasculitis, and diffuse retinal capillary leakage as well as the absence of granulomatous anterior uveitis or choroiditis in patients with vitritis. Conclusion: This study provides a diagnostic tree for BD uveitis that needs to be validated in future studies. [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore the breast-feeding profiles and the factors that affect breast-feeding and weaning attitudes among mothers of 0-12 month old babies in a baby-friendly primary care unit. Material and Method: The study was conducted in a Mother and Child Health Centre in ıstanbul in May-October 2006. All 364 mothers who were registered in the health centre were enrolled. A total of 358 mothers were included in the study. Results: The frequencies of breastfeeding initiation and of breastfeeding within the first hour were 98.9 %and 62.3 %respectively. Among the babies older than 6 months (n=200), 52.5 %were weaned before 6 months. Pacifier use (OR 3.01, 95 %CI: 1.35-6.69), being preterm (OR: 3.36, 95 %CI: 1.04-10.79), having a job (OR: 2.83, 95%CI:1.14-7.04) or smoking (OR: 2.27, 95 %CI: 1.01-5.14) werefound to be risk factors for early weaning. Conclusion: Although the frequency of initiating breastfeeding is very high, the continuation duration is below the World Health Organization (WHO)'s recommendations. Physicians and other health workers should strongly recommend against smoking during, prenatal and postnatal visits. Physicians should not support pacifiers, until we have sufficient data to support its benefits. In order to increase the duration of breast feeding, health professionals should focus on preterm babies, smoking or working mothers. [ABSTRACT FROM AUTHOR]

: Objective:To report the birth of a healthy female infant from a father with nonmosaic Klinefelter syndrome (KS) and document the experience of men with KS undergoing assisted conception.: Design:Retrospective.: Setting:Private IVF center.: Patient(s):Twelve couples with male factor infertility due to Klinefelter syndrome undergoing assisted reproduction treatment.: Intervention(s):Controlled ovarian hyperstimulation, testicular sperm extraction, intracytoplasmic sperm injection (ICSI), round spermatid injection (ROSI), and preimplantation genetic diagnosis.: Main outcome measure(s):Testicular sperm retrieval rate, fertilization rate, and pregnancy outcome.: Result(s):There was a sufficient amount of motile sperm for injection into mature oocytes in 6 of the 11 testicular biopsies (54.5%). Fertilization rates for ICSI and ROSI cases were 54.2% and 41.6%, respectively. The pregnancy rate per ET was 27.2%. None of the ROSI cases resulted in pregnancy. Two patients had spontaneous abortions at 8 and 18 weeks of gestation, respectively. Only one patient delivered a healthy female baby after 36 weeks of an uneventful pregnancy.: Conclusion(s):Men with KS can benefit from assisted reproductive technologies, and the testicular sperm retrieval rate among them is promising. Although sex chromosome aberrations among the embryos from men with KS are not common, couples can be offered preimplantation genetic diagnosis before ET. [Copyright &y& Elsevier]

Background/aim: The predictability of clinical outcomes in hypertension in specific patient groups, especially underrepresented populations is the key to rational treatment. This study aimed to investigate the impact of baseline characteristics of <65-year-old hypertensive women with an increased risk of cardiovascular events, managed with standard- or intensive-approach, on their clinical outcomes and serious adverse events (SAEs). Materials and methods: Baseline characteristics of <65-year-old hypertensive women (n = 1247) in SPRINT, a multicenter randomized trial to compare standard and intensive antihypertensive treatment, were analyzed with Cox-regression method to determine potential predictors of the clinical outcomes and SAEs. The primary outcome was the composite of myocardial infarction (MI), non-MI acute coronary syndrome, stroke, heart failure, or cardiovascular death. Results: The primary outcome occurred in 3.1% and SAEs in 27.6% of the population. The treatment groups were similar in terms of the primary outcome, SAEs, or their individual components. The primary outcome occurred significantly more in current smokers vs. nonsmokers (HR: 2.85, 95% CI: 1.34–6.09). The subjects who were on aspirin in the intensive-group were significantly more likely to develop the primary outcome (HR: 3.17, 95% CI: 1.23-8.19) and MI (HR: 10.15, 95% CI: 1.19-86.88) compared with those not using aspirin. The risk of overall SAEs was significantly higher in blacks vs. nonblacks (HR: 1.27, 95% CI: 1.01-1.58), in current-smokers vs. nonsmokers (HR: 1.59, 95% CI: 1.23-2.05), and those with vs. without chronic kidney disease (CKD), (HR: 1.38, 95% CI: 1.08-1.77). The likelihood of SAEs significantly increased with age (HR: 1.04, 95% CI: 1.01-1.07). Conclusion: Smoking, aspirin, CKD, black race, and age seemed as important baseline characteristics in follow-up of <65-year-old hypertensive women, also depending on therapeutic strategy. Clinicians are expected to consider these critical parameters for effective antihypertensive management that promotes better outcomes in this middle-aged female population. [ABSTRACT FROM AUTHOR]

: ObjectiveTo report a case of cervical heterotopic pregnancy after IVF-ET treatment.: DesignCase report.: SettingPrivate IVF center.: Patient(s)A woman who had undergone controlled ovarian hyperstimulation and intracytoplasmic sperm injection–ET for primary male factor infertility.: Intervention(s)Resection of cervical heterotopic pregnancy by hysteroscopy.: Main outcome measure(s)Successful treatment of heterotopic cervical pregnancy.: Result(s)A successful pregnancy resulting in a term baby.: Conclusion(s)Hysteroscopic resection can be used to treat a cervical heterotopic pregnancy. [Copyright &y& Elsevier]

Purpose: To screen for psychological disorders in patients with active uveitis.Methods: Patients were screened for depression (BDI-II), state anxiety (STAI-I), VR-QOL (NEI-VFQ-25), and HR-QOL (SF-36). Association of depression and anxiety with sociodemographic and clinical parameters and with VR-QOL and HR-QOL were analyzed. Multivariate linear regression models were constructed for NEI-VFQ-25 and SF-36 subscales.Results: Of 99 patients, 37.3% screened positive for depression and 52.5% for anxiety. Depressed patients had lower visual acuity in the better seeing eye (p = 0.013) and more frequently panuveitis (p = 0.018). Anxious patients were younger (p = 0.009), had earlier onset of uveitis (p = 0.015), and had more frequently panuveitis (p = 0.016). Bivariate comparisons showed significant associations between psychological disorders and VR-QOL and HR-QOL. Significant bivariate associations were mostly lost in multivariate analyses for anxiety, but were preserved for depression.Conclusions: A positive screening test for depression and anxiety is common in patients with uveitis. Low vision and panuveitis are associated with depression. Depression is associated with impairment of VR-QOL and HR-QOL. [ABSTRACT FROM AUTHOR]

The article focuses on the evaluation of the reliability of the Turkish version of Pediatric Outcomes Data Collection Instrument (PODCI) for children and adolescents who have orthopedic problems. It mentions that the instrument is used for children and adolescents in a variety of chronic musculoskeletal disorders. It states that the Turkish version was called Bedensel Ë™I¸slevsellik Degerlendirme Aracı (BIDA).

Purpose: To evaluate agreement and estimate sensitivity and specificity of uveitis specialists' interpretation of ocular photographs in diagnosing Behçet uveitis. Methods: Fourteen Turkish uveitis specialists, masked to demographic and clinical features of patients, independently labeled ocular photographs (29 Behçet/30 other diagnoses) as 'Behçet uveitis' or 'non-Behçet.' Level of agreement was evaluated using kappa statistics. Photographs were categorized based on ocular signs captured and performance of observers. Results: Exact agreement with the correct diagnosis was 56-81%. Seven reviewers correctly labeled more than 70% of photographs. Interobserver agreement among those 7 reviewers revealed moderate ( κ = 0.41-0.60) or substantial ( κ = 0.61-0.80) agreement in 76% of pairs. Smooth layered hypopyon, superficial retinal infiltrate with retinal hemorrhages, and branch retinal vein occlusion with vitreous haze were correctly recognized as Behçet uveitis by majority of reviewers. Conclusions: There are ocular signs of Behçet disease that can be considered diagnostic even in the absence of any other clinical information. [ABSTRACT FROM AUTHOR]

Behavioral risk factors are associated with sudden infant death syndrome (SIDS). Education about the risk factors of SIDS is important for prevention. Our aim was to determine the knowledge and attitude of parents and health professionals about SIDS. A total of 174 health professionals and 150 mothers were enrolled in this study. Mothers' data were collected by telephone interview and health-care professionals were interviewed by the same investigator. Only 39% of mothers were aware of SIDS. Forty-six percent of the mothers preferred a supine sleeping position for their infant and 16% of the parents were bed-sharing with their infants. Seventy-three percent of health professionals selected side, 17% supine and 10% prone sleeping position as the safest sleeping position. Frequencies for awareness of risk factors were: bed-sharing (75%), soft bedding (70%), pillow use (52%), toys in bed (90%), high room temperature (67%) and smoking (88%). Total knowledge score of health professionals who selected supine sleeping position as the safest was significantly higher ( P < 0.001). Most of the mothers were unaware of SIDS and less than half preferred a supine sleeping position for their infant. Only 72% of health professionals recommended a certain sleeping position during family interviews. Health professionals are more often recommending the side sleeping position or prone. Education of families and health professionals for the risk factors of SIDS may reduce the number of deaths from SIDS in Istanbul. [ABSTRACT FROM AUTHOR]

im of this study is to introduce, evaluate, and propose a basic arthroscopy training course with interactive methods as using bovine knees, joint models but mainly focusing on practices with motor skill-learning devices. This study presents the results of a skill training program which is based on “motor skill training” theory and using “bovine knees” to simulate a specific task as arthroscopy both in education and evaluation. The participants gave feedback regarding their expectations, fulfillment, and self-evaluation on the degree of their improvement levels, after which their skills were evaluated by an expert while they performed the arthroscopic procedure. During this evaluation of the task, a four-dimensional checklist which was prepared previously by the consensus of three experts was used, and a global grading of each rater was added at the end of the checklist. In this 2-day course, small group teaching sessions are integrated with active and experiential learning methods consisting of short presentations by the educators, demonstrations using joint models and audio-visual teaching material, and significant continuous feedback by the teachers during the proceedings. Participants’ expectations and post-course feedback results were obtained using a brief questionnaire which involved mostly open-ended questions. The self-rating of “own basic diagnostic arthroscopy skill” on a scale of 0–10 was completed by the participants both previous to and following the course to establish a student-centered learning environment. Overall rating of the course was asked on a 1–5 (poor–excellent) Likert scale. The questioning of the participants who took part in the course during the last five terms involved a 100% feedback. The overall rating of the course was 4.36 ± 0.47 on the 1–5 scale. The majority of the participants (90%) mentioned that the course met their expectations. The most beneficial activities were accepted to be the arthroscopic procedure applications on bovine knee, repetition of the manipulations under the supervision of the trainers, continuous feedback by experienced staff, and chance for immediate correction during the procedures (35/64). Pre- and post-course self-ratings of the participants inquiring about their ability to perform an arthroscopy alone showed significant improvement (4.2 vs. 7.7 P = 0.000, paired samples t test). All participants were found to be competent in the evaluation of their diagnostic arthroscopy skills on bovine knees. To design a skill teaching course based on the needs of the trainees, focusing on basic motor skill training exercises, and using bovine knee as a simulator is a safe, inexpensive, humanistic, and replicable method that proves a foundation for basic arthroscopic skills learning prior to patient encounter. [ABSTRACT FROM AUTHOR]

Objective: To determine the microbiological quality of home meals and salads samples. Methodology: A total of 180 samples were collected between May 2007 and July 2007 in Ankara, Turkey. The samples were analysed for the presence of total aerobic bacteria (TAB), thermotolerant coliform bacteria (TCB), Esherichia coli, Salmonella spp. and Staphylococcus aureus. Results: In the present study, S.aureus, coliforms, E.coli, and Salmonella were not detected in cooked meat meals samples. TAB was detected in 22 (24.4%) meat dishes ranges 102-104. The cooked meat dishes samples were analyzed for the presence of TCB, and detected in 2 (2.2%) meat dishes ranges 103-104. Numbers of the aerobic mesophilic bacteria ranged from 102 to 105 cfu/g and coliforms from 37 to 1400 MPN/g in 17 (18.9%) of salad samples. E.coli was detected at level 102-103 (n=12, 13.3%) and S. aureus was detected in 9 (10.0%) at levels of 103-104 cfu/ g salad samples tested. In 4 (4.4%) of the salads samples S.aureus and E.coli were isolated together. Conclusion: The results indicate that the type of vegetable salads analysed may contain pathogenic bacteria and thereby represent a risk to the consumers in regard to foodborne diseases. Thus, it remains essential to include the significance of effective hygiene practices as an important safety measure in programmes of home hygiene, consumer education, and advice. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the serum and intrafollicular concentrations of sex steroids, epidermal growth factor (EGF) and insulin like growth factor-1 (IGF-1) in women demonstrating poor response to ovarian stimulation with gonadotropins and GnRH antagonists, and to compare the results with age-matched women displaying normal ovarian response. Study design: This is a prospective cross-sectional study conducted in a private IVF center. Forty-eight age-matched women producing 5 or fewer oocytes (poor responders) or 10 or more oocytes (normoresponders) at the end of controlled ovarian stimulation for assisted conception participated in the experiment. Gonadotropins and GnRH antagonists were used for ovarian stimulation, while ICSI was employed for assisted fertilization. Serum and follicular concentrations of FSH, LH and sex steroids (estradiol, progesterone and testosterone), and follicular concentrations of EGF and IGF-1 were assayed in both groups. Results: Serum and follicular levels of E2 and progesterone were significantly lower in the poor responder group compared to the normoresponder group. Follicular level of testosterone was also lower in poor responders, but not to a level of statistical significance. The serum FSH level was higher in the poor responder group, but follicular levels of gonadotropins did not differ between the two groups. The follicular level of IGF-1 was significantly lower in poor responders. In contrast, the EGF concentration did not differ between the two groups. Conclusions: Decreased levels of sex steroids in poor responder patients undergoing COH with GnRH antagonist, suggests that reduced IGF-1 expression acts as a modulator of impaired ovarian steroidogenesis. [Copyright &y& Elsevier]

Objective: To compare the outcome of day 2 and day 3 embryo transfers in women demonstrating poor ovarian response. Design: Prospective randomized clinical trial. Setting: Private assisted reproductive technology center. Patient(s): Two hundred eighty-one women demonstrating poor ovarian response to controlled ovarian hyperstimulation. Intervention(s): Women who were poor responders were randomly allocated to day 2 or day 3 embryo transfer following oocyte retrieval. Main Outcome Measure(s): Implantation rates and pregnancy rates per oocyte retrieval and embryo transfer. Result(s): The clinical pregnancy rates per oocyte retrieval (37.2% vs. 21.4%, respectively; P<.05) and per embryo transfer (38.9% vs. 24.1%, respectively; P<.05) were significantly higher in the day 2 embryo transfer group compared with day 3. On the other hand, implantation rates were not different between groups (23.9% vs. 17.2%, respectively; P=.08). Conclusion(s): Our results demonstrated that transfering embryos on day 2 could provide an alternative to the management of poor responder patients. [Copyright &y& Elsevier]

Purpose: To evaluate the outcome of women with hypogonadotropic hypogonadism undergoing in-vitro fertilization (IVF). Methods: We retrospectively assessed outcomes in 58 women with hypogonadotropic hypogonadism (HH) and, as matched controls, in 116 women with tubal factor (TF) infertility who underwent assisted reproduction treatment (ART). For ovulation induction, human menopausal gonadotropin (hMG) was used in HH patients and a combination of IIMG and gonadotropin releasing hormone (GnRH) agonist was used in TF patients. Conception and implantation rates, as well as duration of stimulation and number of oocytes retrieved, were the main outcome measures. Results: Of the 58 HH patients, 53 (91.3%) responded adequately to ovulation induction and underwent FT. A larger amount of gonadotropins and a longer duration of ovarian stimulation were needed in HH patients than in TF patients. The mean number of retrieved oocytes and implantation rates did not differ between the groups. In addition, there were no differences between the HH and TF groups in pregnancy (53.8 vs. 48.6%) and multiple pregnancy (63.4 vs. 48.4%) rates. In the HH group, the miscarriage rate was 3.4%, and none of these patients developed severe OHSS. Conclusion: IVF in HH patients, in which there was a background of previous failed ovulation induction, was as successful as in women with TF infertility. [ABSTRACT FROM AUTHOR]

Presents a study that analyzed the outcome of assisted reproduction treatment in poor responder patients who elect to undergo oocyte retrieval. Problem concerning poor response to ovarian stimulation for assisted reproduction treatment; Factors that affect poor ovarian response; Materials and methods used in the study; Results and discussion.