26 research outputs found
Out-of-pocket health expenditures in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders: findings from a study in a psychiatry outpatient clinic in Turkey
No full textThe aim of this study is to explore the amount of OOP health expenditures and their determinants in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders in a psychiatry outpatient clinic of Turkey
Racial Disparities in Hospitalization Among Patients Who Receive a Diagnosis of Acute Coronary Syndrome in the Emergency Department
No full textBackground Timely hospitalization of patients who are diagnosed with an acute coronary syndrome (ACS) at the emergency department (ED) is a crucial step to lower the risk of ACS mortality. We examined whether there are racial and ethnic differences in the risk of being discharged home among patients who received a diagnostic code of ACS at the ED and whether having health insurance plays a role. Methods and Results We examined 51 022 910 discharge records of ED visits in Florida, New York, and Utah in the years 2008, 2011, 2014, and 2016/2017 using state‐specific data from the Healthcare Cost and Utilization Project. We identified ED admissions for acute myocardial infarction or unstable angina using the International Classification of Diseases, Ninth Revision (ICD‐9)/International Statistical Classification of Diseases, Tenth Revision (ICD‐10) diagnostic codes. We used generalized estimating equation models to compare the risk of being discharged home across racial and ethnic groups. We used Poisson marginal structural models to estimate the mediating role of health insurance status. The proportion discharged home with a diagnostic code of ACS was 12% among Black patients, 6% among White patients, 9% among Hispanic patients, and 9% among Asian/Pacific Islander patients. The incidence risk ratio for being discharged home was 1.26 (95% CI, 1.18–1.34) in Black patients, 1.23 (95% CI, 1.15–1.32) in Hispanic patients, and 1.11 (95% CI, 0.93–1.31) in Asian/Pacific Islander patients compared with White patients. Race and ethnicity were marginally associated with discharge home via pathways not mediated by health insurance. Conclusions Racial and ethnic disparities exist in the hospitalization of patients who received a diagnostic code of ACS in the ED. Possible causes need to be investigated
Preferences for Starting Daily, On-Demand, and Long-Acting Injectable HIV Preexposure Prophylaxis Among Men Who Have Sex With Men in the United States (2021-2022): Nationwide Online Cross-Sectional Study
No full textBackgroundLong-acting (LA) injectable preexposure prophylaxis (PrEP) and on-demand PrEP may improve overall PrEP uptake among men who have sex with men (MSM), but little is understood about the PrEP option preferences of MSM in practical scenarios where they may choose between various PrEP options.
ObjectiveThis study aims to examine the preferences for starting various PrEP options among a US nationwide online convenience sample of MSM from September 2021 to February 2022.
MethodsParticipants reporting no prior HIV diagnosis were provided brief descriptions of each PrEP option and were asked, “If [PrEP option] were available from your local doctor and you could access it for free, would you go to your doctor in the next month to start [PrEP option]?” Those who said “yes” to multiple options were asked to rank them in order of preference. MSM currently taking daily oral (DO) PrEP were asked whether they would switch to on-demand or LA PrEP options. Log binomial models were created to examine the association between willingness to start or switch to on-demand and LA PrEP with various sociodemographic and behavioral factors.
ResultsIn the analytic sample (N=7760), among the participants who did not use any PrEP in the past 12 months (n=5108, 66%), 54% (n=2445) reported willingness to start at least 1 PrEP option and 41% (n=1845) of participants showed interest in starting multiple PrEP options. Overall, the highest willingness was reported for on-demand PrEP (n=2235, 44%), followed by DO PrEP (n=2174, 43%) and LA PrEP (n=1482, 29%). LA PrEP was ranked first among those interested in multiple options. Characteristics associated with ranking LA PrEP as a first option to start PrEP versus DO or on-demand PrEP were region of residence (residing in the West vs Northeast), report of sexually transmitted infection diagnosis in the past year, report of illicit drug use other than marijuana in the past year, and prior awareness of LA PrEP. Among current DO PrEP users (n=2379, 31%), 58% (n=1386) were willing to switch to on-demand or LA PrEP, and LA PrEP was ranked first among participants who were open to switching to both options. Willingness to switch to LA PrEP was higher among those who used illicit drugs other than marijuana in the past year, who heard of LA PrEP prior to the survey, and those who took 15 or less doses of oral PrEP in the last 30 days.
ConclusionsLA PrEP was the highest-ranked option among most MSM who were willing to try multiple options or switch from DO PrEP. These findings highlight that LA PrEP might fill coverage gaps among MSM who use illicit drugs, have had a recent sexually transmitted infection diagnosis, and have less than optimal DO PrEP adherence
Research capacity and training needs for non-communicable diseases in the public health arena in Turkey
No full textBackground
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.<p></p>
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.<p></p>
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.<p></p>
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.<p></p>
Racial Differences in Recurrent Acute Myocardial Infarction: Findings From the ARIC Cohort.
No full textBACKGROUND: We examined racial differences in recurrent nonfatal acute myocardial infarction (AMI) and fatal coronary heart disease (CHD) among ARIC (Atherosclerosis Risk in Communities) cohort participants who survived a first AMI (1987-2017) and assessed whether socioeconomic and cardiovascular risk factors contribute to observed differences. METHODS: We analyzed 422 Black and 1245 White ARIC participants who survived an incident AMI during follow-up. Incidence rates of recurrent AMI and fatal CHD were calculated by race. Proportional hazards models examined differences after adjustment for socioeconomic and cardiovascular risk factors, with race-sex interactions tested. RESULTS: The mean±SD age at the time of the first incident AMI was 69.3±9.0 years for Black and 70.7±9.5 years for White participants. The incidence rate per 1000 person-years was higher in Black participants than White participants both for recurrent nonfatal AMI (incidence rate, 32.4 [95% CI, 26.8-38.8] versus 22.8 [95% CI, 20.2-25.6]) and for fatal CHD (34.2 [95% CI, 28.4-40.7] versus 17.9 [95% CI, 15.7-20.4]). In age- and sex-adjusted models, the hazard ratios comparing Black versus White participants were 1.70 (95% CI, 1.36-2.13) for recurrent nonfatal AMI and 2.10 (95% CI, 1.67-2.34) for fatal CHD. The racial differences were statistically not significant after adjustment for socioeconomic and cardiovascular risk factors. There were no significant race and sex interactions for outcomes. CONCLUSIONS: Black participants have higher rates of recurrent nonfatal AMI and fatal CHD after an initial AMI compared with White participants. These disparities are mostly explained by socioeconomic and cardiovascular risk factors
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.
No full textBACKGROUND: 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
Effect of Gluten-Free Diet on Serum Antioxidant Levels in Children with Celiac
No full textObjective: Celiac disease (CD) is an inflammatory condition of the small intestine triggered by the consumption of gluten. A strict gluten-free diet (GFD) is the only treatment that can eliminate CD complications. It was aimed to evaluate the effect of a gluten-free diet on serum total glutathione (tGSH) level, superoxide dismutase (SOD), myeloperoxida (MPO), paroxanase (PON-1) and aryl esterase (ARE) activity in patients with celiac disease, an autoimmune disease. Materials and Methods: The study was conducted with 68 participants, 39 of whom were celiac and 29 were healthy. Two groups were formed in patients with celiac disease as newly diagnosed and previously diagnosed and following a gluten-free diet. Blood samples were taken from all participants and tGSH, SOD, MPO, PON-1, and ARE measurements were made spectrophotometrically from serum samples. Results: While no significant change was observed in tGSH, SOD, and ARE levels, MPO activity was observed to be significantly lower in celiac patients compared to healthy controls, while this decrease was found to be higher in the newly diagnosed group. While PON-1 activity was significantly lower in newly diagnosed patients compared to the control group, it was higher in the gluten-compatible diet group. Conclusion: Low MPO values in celiac patients may be insufficient to function by creating oxidative stress in inflammation. While PON-1 values are significantly lower in newly diagnosed celiacs, it can be said that they reach normal values with adherence to a gluten-free diet. © 2023 Istanbul University Press. All Rights Reserved.Ethics Committee Approval: This study was approved by the Clinical Ethics Committee of Atatürk University Faculty of Medicine (12/2021 No.B.30.2.ATA.0.01.00/70). Informed Consent: Legal custodian’s assent of the children participated in the research was obtained. Peer Review: Externally peer-reviewed. Author Contributions: Conception/Design of Study-M.A.G., F.B.O., N.K., B.V., A.I., A.C.; Data Acquisition-M.A.G., F.B.O., N.K., B.V., A.I., A.C.; Data Analysis/Interpretation-M.A.G., F.B.O., N.K.; Drafting Manuscript-M.A.G., F.B.O., N.K., B.V., A.I., A.C.; Critical Revision of Manuscript-M.A.G., F.B.O., N.K. ; Final Approval and Accountability-M.A.G., F.B.O., N.K., B.V., A.I., A.C. Conflict of Interest: Authors declared no conflict of interest. Financial Disclosure: Authors declared no financial support
Additional file 1: of 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
No full textTechnical Appendix. (DOC 417 kb
Characteristics associated with the HIV Pre-exposure prophylaxis care continuum among transfeminine persons in the United States
No full textBACKGROUND: Transfeminine persons are disproportionately burdened by risk of HIV acquisition. We examined the association between various characteristics with pre-exposure prophylaxis (PrEP) care continuum among a nationwide sample of transfeminine individuals in the United States. METHODS: Sexually active transfeminine persons age 15+ were recruited online between June 2022 and October 2023. We used Poisson regression models to examine factors associated with having a PrEP discussion with a healthcare provider and PrEP use among participants at risk for HIV. RESULTS: Overall, 12% (350/3007) of participants used daily oral PrEP and 26% (783/3007) reported a PrEP discussion with a provider in the past 12 months. Among participants who used PrEP in past 12 months, 79% (265/335) were currently using PrEP. Among participants who discussed PrEP with a provider, 43% (335/783) used PrEP in the past 12 months. In multivariable modeling, participants who had a sexually transmitted infection (STI) diagnosis, had more than one partner, used illicit drugs, used a prescribed medication via injection, and used hormones for gender affirmation in the past 12 months were more likely to have discussed PrEP. PrEP use in the past 12 months was higher among Black participants and among those who reported having multiple/other types of health insurance, having an STI diagnosis, having more than one partner, exchanging sex and using a prescribed medication via injection. CONCLUSIONS: Increased engagement with healthcare system leads to higher likelihood of PrEP initiation among transfeminine persons. Reducing healthcare-related stigma can improve PrEP uptake and enhance HIV prevention among transfeminine persons
Preferences and willingness for starting daily, on-demand, and long-acting injectable HIV pre-exposure prophylaxis among transfeminine persons in the US, 2022-2023.
No full textBackgroundThere remains limited information concerning US transfeminine persons preferences across varying PrEP options. We examined PrEP option willingness, preferences, and associated factors among a US nationwide sample of transfeminine persons.MethodsSexually active transfeminine persons age 15 + were recruited online between June 2022-October 2023 through social media advertisements. Transfeminine persons not diagnosed with HIV were asked about willingness to initiate, and ranked preference, of three PrEP options- daily oral (DO), on-demand, and long-acting injectable (LA-PrEP). Log-binomial models were used to examine PrEP modality willingness and associated sociodemographic and behavioral characteristics.ResultsAmong 2657 transfeminine persons not currently using PrEP, 51% reported willingness to start at least one PrEP option. The highest willingness was reported for on-demand PrEP (42.6%), followed by DO (38.1%) and LA PrEP (27.1%). LA PrEP was ranked the most preferred PrEP option among transfeminine persons who reported willingness to start multiple PrEP options (43%, 277/651). Willingness to start on-demand PrEP was higher among participants who were 15-24 years, resided in the South, did not have health insurance, had more than one sex partners and reported prior awareness of on-demand PrEP. Willingness to use DO and LA PrEP was higher among those who had both private and public insurance, reported condomless anal sex, had more than one sex partners and had used non-injection illicit drugs. Additional factors for DO and LA PrEP willingness was residing in the South and prior awareness of LA PrEP, respectively.ConclusionsAmong transfeminine persons, the highest willingness was reported for on-demand PrEP; and LA PrEP was ranked the most preferred option among those who reported willingness to try multiple options. Offering a variety of PrEP options, informed by an understanding of individual preferences and socio-demographic and behavioral differences, can increase overall PrEP uptake and help meet diverse needs of the transfeminine community
