The Impact of COVID-19 on Healthcare Utilization in Turkey.

OBJECTIVES: This study investigates the impact of the COVID-19 pandemic on healthcare utilization in Turkey. METHODS: We utilized individual-level data derived from Turkish Statistical Institute's annual surveys between 2014 and 2022 and estimated probit regression models. RESULTS: We find that COVID-19 pandemic reduced healthcare utilization by 11.8% after taking into account a large set of background variables. Although our study finds that the elderly and those with health problems are more likely to use healthcare services under normal circumstances, the COVID-19 pandemic has caused notable drops in the healthcare utilization among the elderly (-6.5%) and those with health problems (-3.8%). Although those without health insurance had lower utilization of healthcare services before the pandemic, during the pandemic they were not particularly hit. CONCLUSION: We conclude that the pandemic did not lower the healthcare utilization in Turkey because of the supply constraints. Also, the evidence points to the reduced demand due to the fear of contagion rather than financial concerns.

Oncogenic context shapes the fitness landscape of tumor suppression.

Tumors acquire alterations in oncogenes and tumor suppressor genes in an adaptive walk through the fitness landscape of tumorigenesis. However, the interactions between oncogenes and tumor suppressor genes that shape this landscape remain poorly resolved and cannot be revealed by human cancer genomics alone. Here, we use a multiplexed, autochthonous mouse platform to model and quantify the initiation and growth of more than one hundred genotypes of lung tumors across four oncogenic contexts: KRAS G12D, KRAS G12C, BRAF V600E, and EGFR L858R. We show that the fitness landscape is rugged-the effect of tumor suppressor inactivation often switches between beneficial and deleterious depending on the oncogenic context-and shows no evidence of diminishing-returns epistasis within variants of the same oncogene. These findings argue against a simple linear signaling relationship amongst these three oncogenes and imply a critical role for off-axis signaling in determining the fitness effects of inactivating tumor suppressors.

The toll of COVID-19 on organ donation and kidney transplantation in Europe: Do legislative defaults matter?

This study investigates the cascading effects of COVID-19 pandemic on organ donation and transplantation in Europe. We also check whether legislative defaults for organ donation have a role in these outcomes. For this purpose, we used data from 32 European countries, between 2010 and 2021, and estimated pooled OLS regressions. We find that COVID-19 pandemic reduced deceased organ donation rates by 23.4%, deceased kidney transplantation rates by 27.9% and live kidney transplantation rates by 31.1% after accounting for health system capacity indicators. While our study finds that presumed consent legislation under normal circumstances leads to notable benefits in terms of deceased kidney transplantation and organ donation rates, the legislative defaults did not have a significant impact during the pandemic. Additionally, our findings indicate a trade-off between living and deceased transplantation that is influenced by the legislative default.

SMAD4 and TGFß are architects of inverse genetic programs during fate determination of antiviral CTLs.

Transforming growth factor ß (TGFß) is an important differentiation factor for cytotoxic T lymphocytes (CTLs) and alters the expression levels of several of homing receptors during infection. SMAD4 is part of the canonical signaling network used by members of the transforming growth factor family. For this study, genetically modified mice were used to determine how SMAD4 and TGFß receptor II (TGFßRII) participate in transcriptional programming of pathogen-specific CTLs. We show that these molecules are essential components of opposing signaling mechanisms, and cooperatively regulate a collection of genes that determine whether specialized populations of pathogen-specific CTLs circulate around the body, or settle in peripheral tissues. TGFß uses a canonical SMAD-dependent signaling pathway to downregulate Eomesodermin (EOMES), KLRG1, and CD62L, while CD103 is induced. Conversely, in vivo and in vitro data show that EOMES, KLRG1, CX3CR1, and CD62L are positively regulated via SMAD4, while CD103 and Hobit are downregulated. Intravascular staining also shows that signaling via SMAD4 promotes formation of long-lived terminally differentiated CTLs that localize in the vasculature. Our data show that inflammatory molecules play a key role in lineage determination of pathogen-specific CTLs, and use SMAD-dependent signaling to alter the expression levels of multiple homing receptors and transcription factors with known functions during memory formation.

How does Inequality Hamper Subjective Well-being? The Role of Fairness.

In this study, we aim at clarifying the role of economic inequality on the subjective well-being of individuals. For this purpose, we use more than 180,000 individuals from 51 countries in the most recent five waves (1990-2014) of the World Values Survey. We observe a significant tradeoff between life satisfaction, happiness and the Gini coefficient. Also, inequality is negatively associated with life satisfaction and happiness for lower-income groups as well as higher-income groups. Interestingly, our data also shows large scale embracement of inequality in self-reported attitudes as even almost half (49%) of the lower-income group support the statement that some inequality is necessary for sustaining individual effort. Perceived freedom, and perceived social mobility partially mediates the relationship between the Gini coefficient and subjective wellbeing indicators. Yet, there remains a substantial negative effect of inequality on subjective well-being. Nevertheless, when individuals' perception of fairness is included, the effect of inequality disappears for both higher-income and lower-income groups. Overall, our findings suggest that people are bothered by inequality primarily due to fairness concerns. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11205-021-02711-w.

Does Presumed Consent Save Lives? Evidence from Europe.

One policy tool that could affect organ donation rates is legislative defaults. In this study, we examine how presumed consent impacts cadaveric donations and kidney transplantations, using a panel dataset from the EU-27 countries plus Croatia in the period 2000-2010. We find that presumed consent countries have 28% to 32% higher cadaveric donation and 27% to 31% higher kidney transplant rates in comparison to informed consent countries, after accounting for potential confounding factors. After studying willingness to donate one's organs and registering preferences for organ donation, we find that presumed consent could increase cadaveric donation rates, because people fail to register their preferences and many have no preference for organ donation.

A psychotic disorder related to use of herbal preparation: case report.

This article deals with the increasing frequency with which herbal preparations are being used in Turkey. The ingredients of herbal preparations are multiple and include a variety of herbal seed and leaf-related components. Thus, it is not possible to pinpoint a specific chemical culprit without careful analysis of each. In this article, we present a case of psychotic manic state due to the herbal preparations.