Analysis of Public Health Insurance Expenditures in Turkiye Between 2019-2021

Objectives: Turkiye follows low price policy for pharmaceuticals and medical devices. The aim of this study is to analyze the change in the Social Security Institution (SGK) and General Health Insurance(GHI) budgets in Turkiye between 2019-2020-2021 and the factors affecting this change. Method(s): The data of the study was obtained from the data published for the year 2021 on the official websites of the SGK and the Ministry of Treasury and Finance. The analysis was conducted via Microsoft Excel. Within the scope of the study, the number of applications made to state, university and private hospitals, the number of invoices, the number of prescriptions, the total SGK budget and the actual health expenditures were determined for the years 2019-2020-2021 and the changes between them were analyzed. Result(s): According to the analysis, number of applications decreased by 35% in 2020 compared to 2019, while amount of application invoices remained almost constant. Number of applications increased by 20% in 2021 compared to 2020, while amount of application invoices increased by 38%. While number of prescriptions decreased by 15% from 2019 to 2020, amount of prescription invoices increased by 19%. In 2021, number of prescriptions increased by 19% and amount of prescription invoices increased by 26% compared to 2020. When health expenditures and collected premiums by SGK are examined, it is seen that there were 11 billion TL, 27 billion TL and 13 billion TL budget surplus in 2019, 2020 and 2021, respectively. Conclusion(s): The analysis showed that SGK`s premium incomes and health expenditures gives a budget surplus in recent years. The highest budget surplus was belonged to 2020 as the COVID pandemic year. It is seen that the low-price policy in pharmaceuticals and medical devices is serving a saving a budget surplus for SGK. Copyright © 2022

Analysis of Nutritional Supplements' Price Change in Turkiye

Objectives: Nutritional supplements are products prepared in various forms to supplement daily nutrition, with a daily intake dose. COVID-19 pandemic increased the use of supplements which may reflect the increase of price. In this study, it was aimed to evaluate the changes in the prices of nutritional supplements containing antioxidant, fish oil, glucosamine, collagen, probiotic, probiotic and vitamin-mineral in the last 1 year during COVID-19 pandemic for Turkiye. Method(s): In this study, the price changes of the top 24 most sold products belonging to 7 subgroups of the nutritional supplements group were examined in Turkiye. The data of the study were obtained from the websites (www.akakce.com;www.cimri.com) where the prices of nutritional supplements are presented. The price changes of 7 subgroups determined during the evaluation between 08.04.2021 and 08.04.2022 were analyzed. For these price changes, calculations were conducted for each group and general price change rates were calculated. The analyzes of the study were conducted through the Microsoft Office Excel program. Result(s): As a result of the analysis, the highest price change rate was observed for glucosamines with 49.80%, while the lowest average price change rate was observed for collagen with 4.47% in Turkiye. The average price change of the groups, except for the collagen, fish oil and propolis groups, increased by more than 30%. The average price change rate of 7 different groups taken as a basis is 29.41%. Conclusion(s): As a result of the analysis, it is seen that a price increase is present in all nutritional supplement groups examined in Turkiye. For the price increase between the determined dates, it is thought that people prefer food supplements to protect and strengthen their immune system due to the COVID-19 pandemic which influences the whole world. Copyright © 2022

Psychometric Properties of the Turkish Version of the Coronavirus-Related Health Literacy Scale : Pinar Soylar

Background This study aims to assess the validity and reliability of the Coronavirus-Related Health Literacy Questionnaire adapted to Turkey and examine the levels of coronavirus-related health literacy among the adults. Methods This cross-sectional study was carried out in Turkey. The tools were applied to a total sample population of 452 people. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were calculated to determine the construct validity of the questionnaire with the IBM SPSS Amos program version 24.0. Results The validity and reliability analyses of the Coronavirus-Related Health Literacy (HLS-COVID-Q22) questionnaire were adapted to Turkish. Internal consistency was very high (α = 0,963) and construct validity suggests a sufficient model fit, making HLS-COVID-Q19 a feasible tool for assessing coronavirus-related health literacy in population surveys. The findings show that the questionnaire is a valid and reliable tool consisting of 19 items and 3 subdivisions. The mean coronavirus-related health literacy score of the participants was found to be 2.92 (±0.51), meaning that it was on average. The coronavirus-related health literacy level of 18.8% of the participants was found to be ‘inadequate’ while 37.8% had ‘problematic’ and 43.4% ‘sufficient’ health literacy. The HLS-COVID-Q19-TR scores of those in the young age group (18-29 years old), married, employed, university graduates, and vaccinated against COVID-19 were found to be higher, and a statistically significant difference was found (p = 0.049, p = 0.009, p = 0.029, p = 0.012 and p = 0.051, respectively). Conclusions The results of the research reveal that the HLS-COVID-Q19-TR is a valid and reliable tool. In this study, more than half of the participants were found to have “inadequate” or “problematic” coronavirus-related health literacy levels. For this reason, studies aimed at improving society's coronavirus-related health literacy should be conducted. Key messages There is now a valid tool to assess the Covid 19 health literacy level of individuals in Turkey. It will contribute to the determination of Covid 19 health literacy level in Turkey. An adequate level of health literacy helps people make informed decisions by combating misinformation about COVID-19 and supporting individuals’ self-management.

The prognostic significance of vitamin D deficiency in patients with COVID-19 pneumonia.

BACKGROUND: Vitamin D has anti-inflammatory and immunomodulatory effects via the downregulation of pro-inflammatory cytokines. We aimed to demonstrate the effect of vitamin D levels on survival in COVID-19 patients. MATERIALS AND METHODS: 207 COVID-19 patients were included in the study. Serum vitamin D levels were measured, and patients with levels <20 ng/ml or 21 to 30 ng received a single 300.000 IU dose of vitamin D. RESULTS: Of 207 patients, 37 received vitamin D, while 170 did not. Demographic, radiologic and mean laboratory values were similar between the groups. The mean plasma vitamin D level without vitamin D support (n=170) was 50.82±16.12 ng/ml (30.28-81.35) vs. 16.98±6.2 ng/ml (4.20-28.30) in vitamin D group. The most remarkable finding were the mortality rates; while only 1 patient (2.7 %) died in the vitamin D group, 24 patients (14.1 %) died in no vitamin D supplementation group (p=0.038). CONCLUSION: Although a few retrospective studies put forth a relation between vitamin D deficiency and COVID-19 course severity there is still paucity of data about the efficacy of vitamin supplementations in COVID-19 patients. A single 300.000 IU dose of vitamin D seems to represent a useful, practical, and safe adjunctive approach for the treatment or prevention of COVID-19 (Tab. 1, Fig. 1, Ref. 30).

Severe bullous lung disease associated with COVID-19 pneumonia in an adolescent requiring extracorporeal life support (ECLS)

Objective: Respiratory course and sequela of COVID- 19 infections are not fully known . Literature reports rare cases with development of cystic lung disease and pneumatocele. Methods: A severe bullous lung disease case after COVID infection Results: A 16 year old female with recurrent B cell acute lymphoblastic leukemia was transferred to our pediatric intensive care unit (PICU) with respiratory failure. She had received favipiravir, antibiotics, dexamethasone on the ward for Covid pneumonia during the last 2 weeks. Repeat PCR was negative twice. She was mechanically ventilated requiring high PEEP ( 12cmH2 ) and 1.0 Fi02 (SpO2/FiO2 90). After 9 days of MV she was extubated. Development of air leaks on non invasive ventilation prompted reintubation without successful oxygenation. Severe airleaks due to bullous parencyma. Femorofemoral venovenous ECLS was initiated with 3,6lt /minute flows. (Figure) Bilateral chest tubes were inserted without complication. Saturations are stabilized at 75-85 range, ventilator pressures were weaned. She had a slow recovery, decannulated 2 weeks later, and tracheostomized due to her chronic lung disease. Chest tubes were removed late at 1 month, and she was transferred to the ward on home ventilator support. Her endotracheal cultures were negative throughout her PICU stay. Conclusions: Bullous lung disease can be seen after COVID-19 pneumonia, and has a potential to cause catastrophic outcome. ECLS with low ventilator settings gave our patient a chance to survive, albeit long term follow up will shed a light about the prognosis.

Is there a relation between computed tomography findings and electrocardiography findings in COVID-19?

OBJECTIVE: COVID-19 can cause lung damage and may present with pneumonia in patients. In the present study, the correlation between the severity of pneumonia and electrocardiography parameters of COVID-19 were examined. METHODS: A total of 93 COVID-19 patients and a control group consisting of 62 volunteers were studied. Computed thorax tomography evaluation was performed;each lung was divided into three zones. For each affected zone, scores were given. The main computed thorax tomography patterns were described in line with the terms defined by the Fleischner Society and peer reviewed literature on viral pneumonia. We compared Computed thorax tomography of patients with corrected QT (QTc) and P wave dispersion (Pd) time. RESULTS: There is a significant difference between the patient and control groups in terms of QTc values (413.5+/-28.8 msec vs. 395.6+/-16.7 msec p<0.001). Likewise, the Pd value of the patient group is statistically significantly higher than that of the control group (50.0+/-9.6 ms computed thorax tomography ec vs. 41.3+/-5.8 msec p<0.001). In the patient group, a reverse correlation was detected between computed thorax tomography score and Pd value according to partial correlation coefficient analysis (correlation coefficient: -0.232, p=0.027). In the patient group, the correlation between computed thorax tomography score and QTc value was similarly determined according to partial correlation coefficient analysis (Correlation coefficient:0.224, p=0.017). CONCLUSIONS: COVID-19 prolongs QTc and P wave dispersion values;and as the severity of pneumonia increases, QTc value increases. However, whereas the severity of pneumonia increases, P wave dispersion value decreases.