Health Services Management in Turkey: Failure or Success?

BACKGROUND: The unfair distribution and delivery of health-care resources have been recognized as a problem in the worldwide. In the past 18 years, Turkey has undergone rapid social, cultural, and economic changes. The lifestyle and dietary habits of its people have also been changing, and the rates of diabetes, obesity, cancer, and other chronic diseases have increased dramatically over the past two decades. The health transformation program (HTP) has improved the Turkish health-care system since 2003. The main goal of HTP was to progress government, to provide equality between citizens, to give satisfaction to users and providers, and to subsidise the health-care system in Turkey. AIM: The aim of this study is to assess health-care services and health care quality delivery in the Republic of Turkey with special emphasis on governmental hospitals, university hospitals, primary healthcare centers (PHC) and to make comparison with low-, medium- and high-income countries. METHODS: This is a retrospective, descriptive study. The ministry of health Annual Reports, websites of the Central Intelligence Agency (CIA), The World Fact Book, organization for economic cooperation and development report, Compendium of Health Statistics, the Google engine, and PubMed were searched for information about Turkey's health-care system and its history. Papers and websites in English were evaluated. There was no restriction on types of articles and sources. RESULTS: Turkey has made outstanding reforms in health status in the last two decades, especially after the implementation of the HTP. The doctor's perception has more influence regarding consultation length and visit than the patient's. The results of consultations in volunteer practices in Istanbul showed that the mean and SD of the consultation length for the whole sample of 360 patients was 7.95 ± 4.38, (with range = 3-25 min). Consultation time has been affected by the patients' diseases, genders that women got longer consultation time, medical practices at the urban or rural areas, and ages which older patients required longer consultation time. The current study revealed that increasing doctor's workload leads to decrease the length of consultations. Moreover, average life expectancy reached 75.3 for men and 80.7 for women in 2015. The infant mortality rate decreased to 10.7/1000 live births in 2015, down from 117.5 in 1980. The leading causes of death are diseases of the circulatory system followed by cancer. CONCLUSIONS: The Turkish health system and health-care delivery have been improved over the last decade. Still far from perfect, there is a particular planning to increase medical workforce in PHC including well-trained staffs for a specific area. An urgent need is to acquire more accurate and reliable data from hospital and PHC centers in Turkey. Additional some attempts should be made to assess quality of healthcare in relation to services and process.

Internet Addiction and the Psychometric Properties of the Nine-item Internet Disorder Scale-Short Form: An Application of Rasch Analysis.

BACKGROUND: The aim of the present study was to determine the prevalence of disordered internet use among adolescent university students and its association with various health complaints and behaviours, and most importantly to examine the psychometric properties of 9-item Internet Disorder Scale-Short Form (IDS9-SF) using factor analyses and Rasch analysis. METHODS: A total of 1988 university students aged 18 to 25 years were selected via a multi-stage stratified random sampling technique among university students in Istanbul, Turkey (September 2017 to February 2018). Data collected included socio-demographics, lifestyle and dietary habits, and the 9-item IDS9-SF. Statistical analysis included descriptive statistics, multivariate analyses, factor analyses, path analysis, and Rasch analysis. FINDINGS: Using confirmatory factor analysis (CFA), the study investigated the latent structure of the IDS9-SF instrument and results supported its reliability and validity. The prevalence of disordered internet use was 18.3% in the sample. There were significant differences between those who had disordered internet use and those who did not in gender, family income, school performance, number of bedrooms at home, and number of people living at home, as well as internet use duration. Using multivariate regression analysis, key predictors of disordered internet use included (among others): gender, body mass index (BMI), household income, number of people living at home, having a computer at home, internet facilities, duration of internet use, sleeping hours, frequency of eating fast food, watching television, headache, hurting eyes, tired eyes, and hearing problems. Rash analysis demonstrated that four of the nine items (2, 3, 6, and 7) were more difficult for individuals to endorse compared to other items. CONCLUSION: Problems arising from excessive internet use were apparent among the study sample and the IDS9-SF is a valid and reliable measure for assessing disordered internet use among Turkish adolescent population.

Effect of ramadan fasting on glycemic control and other essential variables in diabetic patients.

Background: Fasting during the holy month of Ramadan is a religious obligation for all Muslims who represent 1.8 billion of the world population (24%). This study explores the effect of Ramadan fasting on the blood glucose, glycated hemoglobin (HbA1c), lipid profile, sleeping quality, and essential lifestyle parameters and also explores the safety of fasting for a whole month among diabetic patients. Aim: The aim of the present study was to assess the impact of Ramadan fasting on the blood glucose, HbA1c, lipid profile, sleeping quality, and lifestyle parameters among patients with type 2 diabetes mellitus (T2DM) in Turkey. Subjects and Methods: A total of 1780 diabetic patients were approached, and 1246 (70%) participated in this cross-sectional study carried out during the period from May 27, 2017, to June 24, 2017. Data analysis comprised sociodemographic features, lifestyle habits, blood pressure measurements, serum lipid profiles, serum calcium, Vitamin D 25-hydroxy, uric acid, and HbA1c at before 4 weeks and after 12 weeks from Ramadan. Results: Out of 1246 patients, 593 (47.6%) were male and 653 (52.4%) were female. The mean ± standard deviation age of the patients was 50.39 ± 15.3 years. Males were significantly older than females (51.53 ± 12.56 vs. 49.26 ± 14.4; P = 0.003, respectively). Significant differences were found in Vitamin D, blood glucose, HbA1c level, creatinine, bilirubin, albumin, total cholesterol, triglycerides, high-density lipoprotein-cholesterol (female), low-density lipoprotein-cholesterol (male), uric acid, and systolic and diastolic blood pressure after and before the holy month of Ramadan (P < 0.05 for each). HbA1c (P < 0.001), physical activity (P < 0.001), hours of sleeping (P < 0.001), systolic blood pressure (BP) (mmHg) (P = 0.007), BMI (P = 0.016), diastolic BP (mmHg) (P = 0.018), family history (P = 0.021), and smoking (P = 0.045) were identified as significantly associated with Ramadan fasting as contributing factors. Conclusion: In one of the largest studies of its kind, we show that Ramadan fasting has positive effects on T2DM patients as it reduces their blood pressure, blood glucose, HbA1C, and BMI. Furthermore, there are improvements in the duration of sleep and physical activity, the role of Ramadan fasting in diabetes therapy has been confirmed.

RésuméContexte: Le jeûne pendant le mois sacré du Ramadan est une obligation religieuse pour tous les musulmans qui représentent 1,8 milliard de personnes dans le monde population (24%). Cette étude explore l'effet du jeûne du Ramadan sur la glycémie, l'hémoglobine glyquée (HbA1c), le profil lipidique, qualité de sommeil, et les paramètres essentiels de style de vie et explore également la sécurité du jeûne pour un mois entier chez les patients diabétiques. But: Le but de la présente étude était d'évaluer l'impact du jeûne du Ramadan sur la glycémie, l'HbA1c, le profil lipidique, le sommeil paramètres de qualité et de style de vie chez les patients atteints de diabète sucré de type 2 (DT2) en Turquie. Sujets et méthodes: Un total de 1780 patients diabétiques ont été approchés, et 1246 (70%) ont participé à cette étude transversale réalisée au cours de la période Du 27 mai 2017 au 24 juin 2017. L'analyse des données comprenait des caractéristiques sociodémographiques, des habitudes de vie, des mesures de la tension artérielle, les profils sériques des lipides, le calcium sérique, la vitamine D 25-hydroxy, l'acide urique et l'HbA1c avant 4 semaines et après 12 semaines de Ramadan. Résultats: Sur 1246 patients, 593 (47,6%) étaient des hommes et 653 (52,4%) étaient des femmes. L'âge moyen ± écart-type des patients était de 50,39 ± 15,3 ans. Les mâles étaient significativement plus âgés que les femelles (51,53 ± 12,56 contre 49,26 ± 14,4, P = 0,003, respectivement). Important différences ont été trouvées dans la vitamine D, la glycémie, le taux d'HbA1c, la créatinine, la bilirubine, l'albumine, le cholestérol total, les triglycérides, la densité lipoprotéine-cholestérol (femelle), lipoprotéine-cholestérol de basse densité (mâle), acide urique et tension artérielle systolique et diastolique après et avant le mois sacré du Ramadan (P <0,05 pour chacun). HbA1c (P < 0,001), activité physique (P <0,001), heures de sommeil (P <0,001), tension artérielle systolique (TA) (mmHg) (P = 0,007), IMC (P = 0,016), TA diastolique (mmHg) (P = 0,018), antécédents familiaux (P = 0,021), et le tabagisme (P = 0,045) a été identifié comme étant significativement associé au jeûne du Ramadan en tant que facteurs contributifs. Conclusion: Dans l'un des les plus grandes études de son genre, nous montrons que le jeûne du Ramadan a des effets positifs sur les patients atteints de DT2 car il réduit leur tension artérielle, le sang glucose, HbA1C et BMI. En outre, il y a des améliorations dans la durée du sommeil et de l'activité physique, le rôle du jeûne du Ramadan dans la thérapie du diabète a été confi rmée. Mots-clés: Indice de masse corporelle, diabète sucré, hémoglobine glyquée, jeûne du Ramadan, qualité de sommeil.

Assessing Breast Cancer Risk Estimates Based on the Gail Model and Its Predictors in Qatari Women.

BACKGROUND: The Gail model is the most widely used breast cancer risk assessment tool. An accurate assessment of individual's breast cancer risk is very important for prevention of the disease and for the health care providers to make decision on taking chemoprevention for high-risk women in clinical practice in Qatar. AIM: To assess the breast cancer risk among Arab women population in Qatar using the Gail model and provide a global comparison of risk assessment. SUBJECTS AND METHODS: In this cross-sectional study of 1488 women (aged 35 years and older), we used the Gail Risk Assessment Tool to assess the risk of developing breast cancer. Sociodemographic features such as age, lifestyle habits, body mass index, breast-feeding duration, consanguinity among parents, and family history of breast cancer were considered as possible risks. RESULTS: The mean age of the study population was 47.8 ± 10.8 years. Qatari women and Arab women constituted 64.7% and 35.3% of the study population, respectively. The mean 5-year and lifetime breast cancer risks were 1.12 ± 0.52 and 10.57 ± 3.1, respectively. Consanguineous marriage among parents was seen in 30.6% of participants. We found a relationship between the 5-year and lifetime risks of breast cancer and variables such as age, age at menarche, gravidity, parity, body mass index, family history of cancer, menopause age, occupation, and level of education. The linear regression analysis identified the predictors for breast cancer in women such as age, age at menarche, age of first birth, family history and age of menopausal were considered the strong predictors and significant contributing risk factors for breast cancer after adjusting for ethnicity, parity and other variables. CONCLUSION: The current study is the first to evaluate the performance of the Gail model for Arab women population in the Gulf Cooperation Council. Gail model is an appropriate breast cancer risk assessment tool for female population in Qatar.