Healthcare workers' compliance with COVID-19 prevention and control measures at De Martino Hospital, Mogadishu, Somalia: a cross-sectional study.

BACKGROUND: Healthcare workers are a high-risk group for COVID-19 and protecting them is crucial for healthcare delivery. Limited studies have explored compliance with infection prevention and control (IPC) practices among Somali healthcare workers. This study aimed to determine compliance with IPC practices among healthcare workers in De Martino Public Hospital, Somalia. METHODS: A cross-sectional study was conducted at the De Martino Public Hospital, Mogadishu, Somalia from August to October 2022, with the participation of 204 healthcare workers (response rate = 97%). Compliance was assessed using responses to 25 questions on a five-point Likert-type scale, and a median score of 20 was used to dichotomize compliance scores. A chi-square test and logistic regression analysis were performed to check the associations between healthcare workers' socio-demographic information, IPC-related factors, work conditions and practices on COVID-19, and IPC compliance during healthcare interventions using SPSS 23 version. RESULTS: In total, 58.3% of the participants had good compliance with IPC. There were significant associations between IPC compliance and the type of healthcare worker (doctors and doctor assistants: 72.3%, nurses and paramedical staff: 67.3%, non-clinical staff: 5.7%, p < 0.01). After adjusting for potential confounding factors, compared to non-clinical staff, doctors and doctor assistants (OR: 12.11, 95% CI: 2.23-65.84) and nurses and paramedical staff (OR: 21.38, 95% CI: 4.23-108.01) had higher compliance with IPC measures. There were no significant associations between compliance and sex, marital status, vaccination status, or smoking (p > 0.05 for all). CONCLUSIONS: Low levels of compliance with COVID-19 IPC measures were observed among hospital workers. Prioritizing awareness campaigns and behavior change interventions, especially among non-clinical staff, is crucial for effective COVID-19 infection prevention and control within hospitals.

Judgments of learning reflect the encoding of contexts, not items: evidence from a test of recognition exclusion.

Two sources of evidence seem to be shared by judgments of past recognition and judgments of future performance: item memory or familiarity (i.e., memory for the item independent of the context in which it was experienced) and context memory or recollection (i.e., memory for the context specific to a particular prior encounter). However, there are few studies investigating the link between these two putative memory processes and judgments of learning (JOLs). We tested memory and metamemory using a continuous exclusion procedure - a modified recognition memory task where study events for two classes of items are interleaved with test trials in which the subject must endorse items from one class and reject items from the other. This procedure allowed us to estimate the influences of memory for context and memory for item on JOLs and licenses conclusions about the relative role of item and context information in supporting JOLs. An analysis of forgetting revealed that JOLs reflect both the initial degree of learning and the rate of forgetting, but only of memory for context and not of memory for items. These findings suggest that JOLs are predictive of memory for context-bound episodes, rather than for the semantic content of those episodes.

Evaluation of Blood Pressure Status and Mortality in Turkey: Findings from Chronic Diseases and Risk Factors Cohort Study.

Background and objectives: An important Non-Communicable Disease risk factor, hypertension (HT), is highly prevalent and controlled HT rates are not sufficient which increases the risk of developing premature deaths. The purpose of the study is to evaluate differences in all-cause and cardiovascular-related mortality according to HT status by using national data from Chronic Diseases and Risk Factors Survey in Turkey (2011-2017). Materials and Methods: Cox regression models were used to estimate hazard ratios (HR) for predicting the all-cause and cardiovascular system-related mortalities. Median follow-up period was 6.2 years. Results: Among individuals with HT, 41.8% was untreated, 30.1% received treatment and had controlled blood pressure, and 28.1% were under treatment but had uncontrolled BP levels. The hazard for mortality among treated & uncontrolled hypertensive participants was significantly higher for all-cause (HR = 1.32, 95% CI = 1.06-1.65), cardiovascular (HR = 2.11, 95% CI = 1.46-3.06), heart disease (HR = 2.24, 95% CI = 1.46-3.43), and Coronary Heart Disease mortality (HR = 2.66, 95% CI = 1.56-4.53) compared to normotensive participants. Conclusions: Individuals with HT who were treated but do not have controlled blood pressure in Turkey had a significantly increased risk of Cardiovascular Disease and all-cause mortality. Along with studies investigating the causes of uncontrolled blood pressure despite initiation of treatment, support should be provided to patients in cases of non-adherence to antihypertensive medication or life change recommendations.

Blessedly forgetful and blissfully unaware: a positivity bias in memory for (re)constructions of imagined past and future events.

People frequently consider the alternatives of the events that can happen in the future and of the events that already happened in the past in everyday life. The current study investigates the effects of engaging in imagination of hypothetical future (Experiment 1) and past (Experiment 2) events on memory and metamemory. We demonstrate, across two experiments, that imagination of positive future and positive past events yielded greater memory performance than negative events, as well as receiving higher vividness and plausibility ratings. In addition, simulation of a negative event occurring positively in the future or having occurred positively in the past produced higher memory performance, compared to simulation of a positive event occurring / having occurred negatively. However, participants' predictions for their subsequent memory performance did not reflect their increased tendency to remember positive or could-be / could-have-been positive events neither for future nor past reconstructions. These findings are interpreted in the framework of positivity bias which suggests that people have a tendency towards positivity when simulating future events; and we extend this positivity bias to reconstructions of the hypothetical past events as well.

Health-related quality of life and perceived health status of Turkish population.

PURPOSE: This study was conducted to assess the health-related quality of life (HRQOL) and perceived health status of the Turkish population. METHODS: The data came from a nationwide survey, which was conducted by Ministry of Health on prevalence and risk factors for chronic diseases in Turkey, with a representative random sample of 18,477 people aged ≥ 15 years from Turkey. Each family physician invited two individuals selected from their registered population to the Family Health Center, conducted the survey by face to face interviews using an electronic form. HRQOL was determined using EQ-5D-3L scale. RESULTS: In Turkish population, each four women out of 10, two men out of 10 have problems in pain/discomfort and anxiety/depression dimensions of the scale; three women out of 10, one man out of 10 have some or severe problems in mobility. Proportion of people without health problems (health state 11,111) were 64,1% in men, 40,7% in women. The mean VAS score for males was 71.5 ± 0.2 (95% CI 70.9-72.1), 66.4 ± 0.2 (95% CI 65.8-66.9) for females (p < 0.05).The most important determinants of having a problem in any of the five dimensions are age, gender, education, diabetes mellitus, coronary heart disease, stroke, alzheimer, cancer, renal failure. The OR of having some or severe problems in any dimensions was 4.6 (95% CI 38-5.4) for over 65-74 and 7.5 (95% CI 5.8-9.6) for over 75 compared to 15-24 age group. CONCLUSIONS: The perceived health level and HRQOL is worse in women, in older age groups, in people from lower socioeconomical status.

Seroprevalence and social determinants of varicella in Turkey.

BACKGROUND: In Turkey, varicella vaccine was introduced into routine childhood immunization in 2013, with a single dose administered to children aged 12 months. However, there is limited information on the morbidity (incidence and seroprevalence), mortality and burden of disease of varicella in the overall Turkish population. AIM: To determine varicella seroprevalence and its social determinants in Manisa Province, Turkey in children aged > 2 years before single-dose varicella vaccination was introduced in 2013. METHODS: The presence of anti varicella-zoster virus IgG antibodies was determined using enzyme-linked immunosorbent assay in serum samples collected from 1250 participants. RESULTS: The overall seroprevalence was 92.8% and the seroprevalence was > 90% among all age groups except 2-9 years (55.7%). Seroprevalence was significantly associated with family size, annual per capita equivalent income, number of people per room and education level. After adjusting by age, only education level remained significantly associated with seroprevalence, reflecting the early age effect. CONCLUSION: High seroprevalance depends on natural exposure to the infectious agent itself and is not associated with social determinants. High vaccine coverage should be maintained for effective varicella control and switching to a 2-dose schedule may also be considered to reduce the number and size of outbreaks in the Turkish population.

[Seroprevalence of pertussis toxin antibody in Manisa province of Turkey, after six years implementation of acellular pertussis vaccine]. / Hücre içermeyen bogmaca asi uygulamasinin altinci yilinda Türkiye'nin Manisa ilindeki pertussis toksin antikoru seroprevalansi.

Vaccination is the most effective way of preventing pertussis disease. Turkey commenced a routine infant immunization program using whole cell (wP) pertussis vaccine in 1968. Immunization accelerated in 1985 after participation of Turkey in the Expanded Programme on Immunization initiated by the World Health Organization. Acellular vaccine (aP) replaced wP in 2008 and a booster was added to age 6 in 2010. The immunization programme was successful in reducing the morbidity rate from 20.58 per 100.000 in 1970 to the lowest level of 0.01 per 100.000 in 2009. However, reduction of vaccine-induced protection and reduced natural boosting of circulating Bordetella pertussis are likely to increase the susceptibility of the population. As a result, morbidity rate increased from 0.09 per 100.000 to 0.41 per 100.000 in 2015 compared to the previous year. The aim of this epidemiological study was to determine the seroprevalence of pertussis toxin (PT) antibodies among healthy people and its association with various social determinants in Manisa province in Turkey, 6 years after aP replaced wP vaccine. The study was conducted as a cross-sectional study with a sample of 1250 people that was randomly selected from the over 2 years of age population in Manisa in 2014. Seroprevalence of PT antibody was determined as the dependent variable of the study. Independent variables of the study were; gender, age, migration in the last 5 years, occupational class, perceived income, house ownership, number of people per room, annually per capita equivalent income. The presence of anti-PT IgG was detected by quantitatively using a commercially available ELISA kit. The antibody levels were categorized into groups according to pertussis infection or vaccination immune response status. The groups consisted of undetectable (< 5 IU/ml), mid-range (5-< 62.5 IU/ml: more than one year previously), high (62.5-< 125: with in 12 months) and very high (≥ 125 IU/ml: with in 6 months) antibody levels. The test results with ≥ 5 IU/ml were defined as seropositive. Level > 100 IU/ml detected among adolescent and adult participants indicated acute or recently recovered pertussis infection. Chi-square test was used to evaluate association between social determinants and pertussis seropositivity. The seroprevalence of the whole study population was 58.1% (95% CI 55.32-60.79) and no association was found with any of the social determinants. The highest seroprevalence was found among 2-9 age group (68.3%) followed by 70-79 age group (63.5%). The lowest seroprevalence was found among 20-29 age group (50.9%) followed by 10-19 age group (51.6%). When seropositivity levels according to ages were compared, it was found that there was a decrease one year after the first vaccination at 2nd, 4th and 6th months and the booster at the 6th year, with a lowest rate (19%) in 11 year-old. The highest seropositivity (77.3%) with a level of >100 IU/ml (13.6%) were detected at age 15 among all adolescent and adult participants. Adding an adolescent booster to immunization schedule and recommendation of vaccine to elderly people should be considered to reduce the incidence of pertussis disease in Turkey.

Estimating the potential contribution of stroke treatments and preventative policies to reduce the stroke and ischemic heart disease mortality in Turkey up to 2032: a modelling study.

BACKGROUND: Stroke and Ischemic Heart Diseases (IHD) are the main cause of premature deaths globally, including Turkey. There is substantial potential to reduce stroke and IHD mortality burden; particularly by improving diet and health behaviours at the population level. Our aim is to estimate and compare the potential impact of ischemic stroke treatment vs population level policies on ischemic stroke and IHD deaths in Turkey if achieved like other developed countries up to 2022 and 2032. METHODS: We developed a Markov model for the Turkish population aged >35 years. The model follows the population over a time horizon of 10 and 20 years. We modelled seven policy scenarios: a baseline scenario, three ischemic stroke treatment improvement scenarios and three population level policy intervention scenarios (based on target reductions in dietary salt, transfat and unsaturated fat intake, smoking prevalence and increases in fruit and vegetable consumption). Parameter uncertainty was explored by including probabilistic sensitivity analysis. RESULTS: In the baseline scenario, we forecast that approximately 655,180 ischemic stroke and IHD deaths (306,500 in men; 348,600 in women) may occur in the age group of 35-94 between 2012 and 2022 in Turkey. Feasible interventions in population level policies might prevent approximately 108,000 (62,580-326,700) fewer stroke and IHD deaths. This could result in approximately a 17% reduction in total stroke and IHD deaths in 2022. Approximately 32%, 29%, 11% and 6% of that figure could be attributed to a decreased consumption of transfat, dietary salt, saturated fats and fall in smoking prevalence and 22% could be attributed to increased fruit and vegetable consumption. Feasible improvements in ischemic stroke treatment could prevent approximately 9% fewer ischemic stroke and IHD deaths by 2022. CONCLUSIONS: Our modeling study suggests that effective and evidence-based food policies at the population level could massively contribute to reduction in ischemic stroke and IHD mortality in a decade and deliver bigger gains compared to healthcare based interventions for primary and secondary prevention.

Waist:height ratio: a superior index in estimating cardiovascular risks in Turkish adults.

OBJECTIVE: To determine the best anthropometric measurement among waist: height ratio (WHtR), BMI, waist:hip ratio (WHR) and waist circumference (WC) associated with high CHD risk in adults and to define the optimal cut-off point for WHtR. DESIGN: Population-based cross-sectional study. SETTING: Balcova, Izmir, Turkey. SUBJECTS: Individuals (n 10 878) who participated in the baseline survey of the Heart of Balcova Project. For each participant, 10-year coronary event risk (Framingham risk score) was calculated using data on age, sex, smoking status, blood pressure, serum lipids and diabetes status. Participants who had risk higher than 10 % were defined as 'medium or high risk'. RESULTS: Among the participants, 67·7% were female, 38·2% were obese, 24·5% had high blood pressure, 9·2% had diabetes, 1·5% had undiagnosed diabetes (≥126 mg/dl), 22·0% had high total cholesterol and 45·9% had low HDL-cholesterol. According to Framingham risk score, 32·7% of them had a risk score higher than 10 %. Those who had medium or high risk had significantly higher mean BMI, WHtR, WHR and WC compared with those at low risk. According to receiver-operating characteristic curves, WHtR was the best and BMI was the worst indicator of CHD risk for both sexes. For both men and women, 0·55 was the optimal cut-off point for WHtR for CHD risk. CONCLUSIONS: BMI should not be used alone for evaluating obesity when estimating cardiometabolic risks. WHtR was found to be a successful measurement for determining cardiovascular risks. A cut-off point of '0·5' can be used for categorizing WHtR in order to target people at high CHD risk for preventive actions.

Research capacity and training needs for non-communicable diseases in the public health arena in Turkey.

BACKGROUND: The aim of this study is to define the research capacity and training needs for professionals working on non-communicable diseases (NCDs) in the public health arena in Turkey. METHODS: This study was part of a comparative cross-national research capacity-building project taking place across Turkey and the Mediterranean Middle East (RESCAP-Med, funded by the EU). Identification of research capacity and training needs took place in three stages. The first stage involved mapping health institutions engaged in NCD research, based on a comprehensive literature review. The second stage entailed in-depth interviews with key informants (KIs) with an overview of research capacity in public health and the training needs of their staff. The third stage required interviewing junior researchers, identified by KIs in stage two, to evaluate their perceptions of their own training needs. The approach we have taken was based upon a method devised by Hennessy&Hicks. In total, 55 junior researchers identified by 10 KIs were invited to participate, of whom 46 researchers agreed to take part (84%). The specific disciplines in public health identified in advance by RESCAP-MED for training were: advanced epidemiology, health economics, environmental health, medical sociology-anthropology, and health policy. RESULTS: The initial literature review showed considerable research on NCDs, but concentrated in a few areas of NCD research. The main problems listed by KIs were inadequate opportunities for specialization due to heavy teaching workloads, the lack of incentives to pursue research, a lack of financial resources even when interest existed, and insufficient institutional mechanisms for dialogue between policy makers and researchers over national research priorities. Among junior researchers, there was widespread competence in basic epidemiological skills, but an awareness of gaps in knowledge of more advanced epidemiological skills, and the opportunities to acquire these skills were lacking. Self-assessed competencies in each of the four other disciplines considered revealed greater training needs, especially regarding familiarity with the qualitative research skills for medical anthropology/sociology. CONCLUSIONS: In Turkey there are considerable strengths to build upon. But a combination of institutional disincentives for research, and the lack of opportunities for the rising generation of researchers to acquire advanced training skills.

Mixed in a World of Truth and Lies: List Composition Moderates the Effects of a Lie Fabrication Manipulation on Memory and Metamemory.

Research has shown that list composition moderates the effects of encoding manipulations on memory performance; differential memory performance is observed at distinct levels of the independent variable in mixed lists, but not in pure lists. The current study aims to investigate the effect of list composition on predicted and actual memory performance using a semantic lie fabrication manipulation. In Experiment 1, participants either told the truth or fabricated a lie in response to a set of general knowledge questions in a mixed-list design, made memory predictions for each response, and received a free recall test. Experiments 2A and 2B compared the effect of list composition by employing mixed and pure lists, respectively. The results showed that the lie fabrication led to a metacognitive illusion in mixed lists by inducing a crossed double dissociation between memory and metamemory. Participants produced higher memory performance and lower memory predictions for lies than the truth. In contrast, predicted and actual memory performance were similar for truth and lies in pure lists. These findings contribute to the existing body of knowledge on list composition and have implications for situations where individuals need to maintain and remember their fabricated lies.

Prior familiarity enhances recognition memory of faces, not just images of faces, when accompanied by conceptual information.

A recent paper reported that recognition discriminability was improved for faces that were familiarized prior to study, but only if that familiarization protocol included conceptual information, like a name (Akan & Benjamin, Journal of Memory and Language, 131, 104,433, 2023). In those experiments, familiarity with each facial identity was gained through exposures to the same facial image prior to study, and memory for each facial identity was tested using the same images across study and test. That design characteristic has a serious constraint on generality, since it is possible that prior conceptual information enhances memory for images (of faces), but not for the representation of the face itself. Here we evaluated whether this finding generalizes to a paradigm in which each exposure of a face is a novel image. In two experiments, faces were familiarized with orienting tasks that induced more perceptual or more conceptual processing prior to study and test phases. Results from recognition tests replicated the results from Akan and Benjamin (2023): (1) Discriminability was enhanced when prior familiarity involved conceptual processing but not when it involved perceptual processing, and (2) familiarity gained through either perceptual or conceptual processing led to an increase in both correct and false identifications. This successful replication in a design with exclusively novel images indicates that the discriminability advantage provided by conceptual familiarity goes beyond memory for facial images and applies to memory for faces. These findings have implications in practical contexts, such as eyewitness identification situations involving suspects who are previously known or familiar to the witness.

One simple question detects motion sickness susceptibility in migraine patients.

OBJECTIVE: To find out if motion sickness susceptibility (MSS) of vestibular migraine (VM) patients and migraine only (MO) patients can be reliably detected with a single simple question: "Can you read while travelling in a car without getting motion sick?". METHOD: Ninety-two definite VM and 58 MO patients and 74 healthy control (HC) subjects were asked about their MSS and about being able to read while riding in a car without becoming motion sick. A Motion Sickness Susceptibility Questionnaire (MSSQ-Short) including childhood (MSA), adulthood (MSB) and total (MST) parts was also administered to all participants. ROC curves of MSSQ-Short were prepared for "not being able to read in a car" as the gold standard. RESULTS: Mean MSA scores were significantly higher in both VM and MO patients than in HCs (p < 0.001), but their scores were not significantly different (p = 0.171). Mean MSB and MST scores were significantly higher in VM than in MO patients (p < 0.001) and both VM and MO patients had significantly higher scores than HCs (p < 0.001). MSA scores were significantly higher than MSB scores in MO patients (p < 0.001). All sections of the questionnaire were associated with high area-under-curve values for MSS detected by the question about being able to read in a car without becoming motion sick. CONCLUSION: We propose that all migraine patients could have the same level of MSS in childhood but MO patients are able to compensate over years, but VM patients are not. A quick way to determine MSS is to ask about the ability to read without becoming motion sickness while riding a car.

Simethicone Medication Should Be Avoided in Infants Receiving Oral Lactase Treatment.

OBJECTIVE: In this retrospective study, we assessed the efficacy of oral lactase in infants with lactose intolerance in terms of sex, birth weight, and interference by other medications. METHODS: The study was conducted on patients aged 0-6 months who had been diagnosed with lactose intolerance on admission to the Department of Social Pediatrics at Dokuz Eylul University. Demographic data, the onset of symptoms, and medications used were recorded. RESULTS: We found that 86.7% of the infants responded to lactase, with no significant differences based on sex, birth weight, or age at symptom presentation. We observed, however, that the efficacy of treatment did improve over time, thereby deriving benefits from intestinal development and adaptation. Interestingly, the response to lactase was reduced in infants receiving concomitant simethicone for colic symptoms, suggesting a potential drug interaction, while probiotics had no impact on treatment outcomes. CONCLUSIONS: We advise against using additional medications with oral lactase, pointing out a possible interaction with simethicone that might decrease the effectiveness of treatment.

Decreasing trends in cardiovascular mortality in Turkey between 1988 and 2008.

BACKGROUND: Cardiovascular disease (CVD) mortality increased in developed countries until the 1970s then started to decline. Turkey is about to complete its demographic transition, which may also influence mortality trends. This study evaluated trends in coronary heart disease (CHD) and stroke mortality between 1988 and 2008. METHODS: The number of deaths by cause (ICD-8), age and sex were obtained from the Turkish Statistical Institute (TurkStat) annually between 1988 and 2008. Population statistics were based on census data (1990 and 2000) and Turkstat projections. European population standardised mortality rates for CHD and stroke were calculated for men and women over 35 years old. Joinpoint Regression was used to identify the points at which a statistically significant (p < 0.05) change of the trend occurred. RESULTS: The CHD mortality rate increased by 2.9% in men and 2.0% in women annually from 1988 to 1994, then started to decline. The annual rate of decline for men was 1.7% between 1994-2008, whilst in women it was 2.8% between 1994-2000 and 6.7% between 2005-2008 (p < 0.05 for all periods).Stroke mortality declined between 1990-1994 (annual fall of 3.8% in both sexes), followed by a slight increase between 1994-2004 (0.6% in men, 1.1% in women), then a further decline until 2008 (annual reduction of 4.4% in men, 7.9% in women) (p < 0.05 for all periods). CONCLUSIONS: A decrease in CVD mortality was observed from 1995 onwards in Turkey. The causes need to be explored in detail to inform future policy priorities in noncommunicable disease control.

Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008.

BACKGROUND: Coronary heart disease (CHD) mortality rates have been decreasing in Turkey since the early 1990s. Our study aimed to determine how much of the CHD mortality decrease in Turkey between 1995 and 2008 could be attributed to temporal trends in major risk factors and how much to advances in medical and surgical treatments. METHODS: The validated IMPACT CHD mortality model was used to combine and analyse data on uptake and effectiveness of CHD treatments and risk factor trends in Turkey in adults aged 35-84 years between 1995 and 2008.Data sources were identified, searched and appraised on population, mortality and major CHD risk factors for adults those aged 35-84 years. Official statistics, electronic databases, national registers, surveys and published trials were screened from 1995 onwards. RESULTS: Between 1995 and 2008, coronary heart disease mortality rates in Turkey decreased by 34% in men and 28% in women 35 years and over. This resulted in 35,720 fewer deaths in 2008.Approximately 47% of this mortality decrease was attributed to treatments in individuals (including approximately 16% to secondary prevention, 3% angina treatments, 9% to heart failure treatments, 5% to initial treatments of acute myocardial infarction, and 5% to hypertension treatments) and approximately 42% was attributable to population risk factor reductions (notably blood pressure 29%; smoking 27%; and cholesterol 1%). Adverse trends were seen for obesity and diabetes (potentially increasing mortality by approximately 11% and 14% respectively). The model explained almost 90% of the mortality fall. CONCLUSION: Reduction in major cardiovascular risk factors explained approximately 42% and improvements in medical and surgical treatments explained some 47% of the CHD mortality fall. These findings emphasize the complimentary value of primary prevention and evidence-based medical treatments in controlling coronary heart disease.

The presence of symptoms within 6 months after COVID-19: a single-center longitudinal study.

BACKGROUND: Characterizing the post-COVID health conditions is helpful to direct patients to appropriate healthcare. AIMS: To describe the presence of symptoms in COVID-19 patients within 6 months after diagnosis and to investigate the associated factors in terms of reporting symptoms. METHODS: Data of DEU-COVIMER (a telephone interview-based COVID-19 follow-up center established in a tertiary care hospital) was analyzed for SARS-CoV-2 RNA positive participants aged ≥ 18 years from November 1st, 2020, to May 31st, 2021. Symptom frequencies were stratified by demographic and clinical characteristics at one, three, and 6 months after diagnosis. With the patients who had symptoms at baseline, generalized estimating equations were applied to identify the factors associated with reporting of symptoms. RESULTS: A total of 5610 patients agreed to participate in the study. Symptom frequency was 37.2%, 21.8%, and 18.2% for the first, third, and sixth months. Tiredness/fatigue, muscle or body aches, and dyspnea/difficulty breathing were the most common symptoms in all time frames. In multivariate analysis, older age, female gender (odds ratio OR 1.74, 95% confidence interval 1.57-1.93), bad economic status (OR 1.37, 1.14-1.65), current smoking (OR 1.15, 1.02-1.29), being fully vaccinated before COVID-19 (OR 0.53, 0.40-0.72), having more health conditions (≥ 3 conditions, OR 1.78, 1.33-2.37), having more symptoms (> 5 symptoms, OR 2.47, 2.19-2.78), and hospitalization (intensive care unit, OR 2.18, 1.51-3.14) were associated with reporting of symptoms. CONCLUSIONS: This study identifies risk factors for patients who experience post-COVID-19 symptoms. Healthcare providers should appropriately allocate resources prioritizing the patients who would benefit from post-COVID rehabilitation.

Use of evidence to support healthy public policy: a policy effectiveness-feasibility loop.

Public policy plays a key role in improving population health and in the control of diseases, including non-communicable diseases. However, an evidence-based approach to formulating healthy public policy has been difficult to implement, partly on account of barriers that hinder integrated work between researchers and policy-makers. This paper describes a "policy effectiveness-feasibility loop" (PEFL) that brings together epidemiological modelling, local situation analysis and option appraisal to foster collaboration between researchers and policy-makers. Epidemiological modelling explores the determinants of trends in disease and the potential health benefits of modifying them. Situation analysis investigates the current conceptualization of policy, the level of policy awareness and commitment among key stakeholders, and what actually happens in practice, thereby helping to identify policy gaps. Option appraisal integrates epidemiological modelling and situation analysis to investigate the feasibility, costs and likely health benefits of various policy options. The authors illustrate how PEFL was used in a project to inform public policy for the prevention of cardiovascular diseases and diabetes in four parts of the eastern Mediterranean. They conclude that PEFL may offer a useful framework for researchers and policy-makers to successfully work together to generate evidence-based policy, and they encourage further evaluation of this approach.

Decomposing socioeconomic inequalities in self assessed health in Turkey.

INTRODUCTION: This study aimed to measure socioeconomic inequalities in Self Assessed Health (SAH) and evaluate the determinants of such inequalities in terms of their contributions amongst the Turkish population. METHODS: We used data from the Turkish part of World Health Survey 2003 with 10,287 respondents over 18 years old. Concentration index (CI) of SAH was calculated as a measure of socioeconomic inequalities in health, and contributions of each determinant to inequality were evaluated using a decomposition method. RESULTS: In total 952 participants (9.3%) rated their health status as either bad or very bad. The CI for SAH was -0.15, suggesting that suboptimal SAH was reported more by those categorised as poor. The multiple logistic regression results indicated that having secondary, primary or less than primary school education, not being married and being in the lowest wealth quintile, significantly increased the risk of having poor SAH. The largest contributions to inequality were attributed to education level (70.7%), household economic status (9.7%) and geographical area lived in (8.4%). CONCLUSION: The findings indicate that socioeconomic inequalities measured by SAH are apparent amongst the Turkish population. Education and household wealth were the greatest contributing factors to SAH inequality. These inequalities need to be explicitly addressed and vulnerable subgroups should be targeted to reduce the socioeconomic disparities.

Evaluating the Relationship between Diabetes and Cancer in a Cohort.

BACKGROUND/AIM: Epidemiological studies indicate that the risk of several types of cancer is high in diabetic patients. The aim of this study is to evaluate the association between diabetes and diabetes related cancers in a cohort design. MATERIALS AND METHODS: The baseline survey was conducted as a community screening programme from 2007 to 2009 in a population over 30 years of age. Diabetes definition was based on fasting blood glucose level ≥ 126 mg/dl and self-reported diabetes history. Data on incident cancer cases and pathological types were obtained from the Izmir Cancer Registry between 2007-2013. Odds ratios (OR) were estimated for the relationship between diabetes and diabetes-related cancer types for men and women separately and adjusted for BMI and age. Odds Ratio and 95% confidence intervals were calculated using logistic regression models in IBM SPSS Statistics 24.0. RESULTS: Data from 10,375 women (65.4%) and 5,494 men (34.6%) who did not declare any cancer in 2007 were evaluated. The cumulative incidence of diabetes related cancers was 2,293 per 100,000 in men and 1,455 per 100,000 in women. Total diabetes related cancer incidence was higher in diabetics (3,770 per 100,000) than nondiabetics (2,109 per 100,000) in men. CONCLUSION: There was no statistically significant association between diabetes and cancers. The analyses can be repeated in the future when the cohort gets older and more incident cases of cancers occur.
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