Unravelling data for rapid evidence-based response to COVID-19: a summary of the unCoVer protocol.

INTRODUCTION: unCoVer-Unravelling data for rapid evidence-based response to COVID-19-is a Horizon 2020-funded network of 29 partners from 18 countries capable of collecting and using real-world data (RWD) derived from the response and provision of care to patients with COVID-19 by health systems across Europe and elsewhere. unCoVer aims to exploit the full potential of this information to rapidly address clinical and epidemiological research questions arising from the evolving pandemic. METHODS AND ANALYSIS: From the onset of the COVID-19 pandemic, partners are gathering RWD from electronic health records currently including information from over 22 000 hospitalised patients with COVID-19, and national surveillance and screening data, and registries with over 1 900 000 COVID-19 cases across Europe, with continuous updates. These heterogeneous datasets will be described, harmonised and integrated into a multi-user data repository operated through Opal-DataSHIELD, an interoperable open-source server application. Federated data analyses, without sharing or disclosing any individual-level data, will be performed with the objective to reveal patients' baseline characteristics, biomarkers, determinants of COVID-19 prognosis, safety and effectiveness of treatments, and potential strategies against COVID-19, as well as epidemiological patterns. These analyses will complement evidence from efficacy/safety clinical trials, where vulnerable, more complex/heterogeneous populations and those most at risk of severe COVID-19 are often excluded. ETHICS AND DISSEMINATION: After strict ethical considerations, databases will be available through a federated data analysis platform that allows processing of available COVID-19 RWD without disclosing identification information to analysts and limiting output to data aggregates. Dissemination of unCoVer's activities will be related to the access and use of dissimilar RWD, as well as the results generated by the pooled analyses. Dissemination will include training and educational activities, scientific publications and conference communications.

Factors Affecting Binocular Sensorial Function in Accommodative Esotropia.

OBJECTIVES: This study was an assessment of factors related to the development and maintenance of binocular sensory function after successful alignment of accommodative esotropia (AE). METHODS: A total of 107 patients aged <12 years with ≥6 months follow-up were included in the study. The variables of age at onset of deviation, duration of deviation before treatment, the amount of uncorrected distance and near deviation, hyperopia, anisometropia, and accommodative convergence to accommodation ratio (AC/A) were evaluated. RESULTS: The study patients had a mean age of 4.9±2.5 years and a mean length of follow-up of 34.3±28 months. Anisometropia was identified in 26.1% of the participants. Anisometropic patients had a greater degree of hyperopia (mean: 5.02±2.07 D) than the patients without (p>0.05). Amblyopia was seen in 25% of the patients with anisometropia, and in 19% of those without (p<0.05). The binocular visual function of the 2 groups was not significantly different (p>0.05). The age at onset of deviation and the duration of deviation did not affect the final outcome (p>0.05 for all). The degree of initial uncorrected distance deviation had a significant effect on the development of amblyopia, fusion, and contoured stereopsis (p<0.05 for all), while the degree of near deviation without correction had a significant effect only on contoured stereopsis. CONCLUSION: The degree of uncorrected distance and near deviation had a negative impact on binocular vision and stereopsis in AE. The presence of anisometropia, age at onset of deviation, duration of deviation before treatment, high hyperopia, and high AC/A did not pose a significant risk for impaired binocular function.

Environmental suitability for Aedes aegypti and Aedes albopictus and the spatial distribution of major arboviral infections in Mexico.

BACKGROUND: This paper discusses a comparative geographic distribution of Aedes aegypti and Aedes albopictus mosquitoes in Mexico, using environmental suitability modeling and reported cases of arboviral infections. METHODS: Using presence-only records, we modeled mosquito niches to show how much they influenced the distribution of Ae. aegypti and Ae. albopictus based on mosquito records collected at the municipality level. Mosquito surveillance data were used to create models regarding the predicted suitability of Ae. albopictus and Ae. aegypti mosquitos in Mexico. RESULTS: Ae. albopictus had relatively a better predictive performance (area under the curve, AUC = 0.87) to selected bioclimatic variables compared to Ae. aegypti (AUC = 0.81). Ae. aegypti were more suitable for areas with minimum temperature of coldest month (Bio6, permutation importance 28.7%) -6 °C to 21.5 °C, cumulative winter growing degree days (GDD) between 40 and 500, and precipitation of wettest month (Bio13) >8.4 mm. Minimum temperature range of the coldest month (Bio6) was -6.6 °C to 20.5 °C, and average precipitation of the wettest month (Bio13) 8.9 mm ~ 600 mm were more suitable for the existence of Ae. albopictus. However, arboviral infections maps prepared from the 2012-2016 surveillance data showed cases were reported far beyond predicted municipalities. CONCLUSIONS: This study identified the urgent necessity to start surveillance in 925 additional municipalities that reported arbovirus infections but did not report Aedes mosquito.

Dutch citizens of Turkish origin who utilize healthcare services in Turkey: a qualitative study on motives and contextual factors.

BACKGROUND: Dutch residents of Turkish origin frequently utilize healthcare in Turkey. METHODS: To investigate their motives for doing so, we conducted a qualitative study among these healthcare users using semi-structured interviews. We complemented this with informal conversations with Turkish healthcare providers and observations at the registration offices and waiting rooms of outpatient clinics in several Turkish hospitals. RESULTS: Respondents believed their perceived needs for referral to specialist care and diagnostic assessments to quantify their health were not being met in the Netherlands. CONCLUSIONS: These mismatches in expectations of what constitutes "good care" led to dissatisfaction with Dutch primary care. Consequently, respondents utilized healthcare in Turkey if the opportunity arose, and were encouraged in this by their social networks. Establishing cross-border communication between healthcare providers is necessary, because there is currently no continuity of care for cross-border patients.

Enhancing an International Perspective in Public Health Teaching through Formalized University Partnerships.

Teaching in the field of public health needs to employ a global perspective to account for the fact that public health problems and solutions have global determinants and implications as well. International university partnerships can promote such a perspective through the strengthening of cooperation, exchange, and communication between academic institutions across national boundaries. As an example for such an academic network in the field of public health, we introduce the International Public Health Partnership-a collaboration between a university in Germany and universities in India, Turkey, and Nigeria. Formed in 2005, it facilitated the exchange of information, fostered discussion about the transferability of public health concepts, contributed to the structural development of the universities involved, and promoted an intercultural dialog through a combination of local and distance learning activities. Although well accepted by students and staff, different obstacles were encountered; these included limited external funding, scarce own financial, time and personnel resources, and diverging regulations and structures of degree programs at the partnership sites. In the present article, we share several lessons that we learned during our joint collaboration and provide recommendations for other universities that are involved in partnerships with institutions of higher education or are interested to initiate such collaborations.

Estimating mortality and causes of death in Turkey: methods, results and policy implications.

BACKGROUND: Cause-specific mortality statistics are primary evidence for health policy formulation, programme evaluation, and epidemiological research. In Turkey, a partially functioning vital registration system in urban areas yields fragmentary evidence on levels and causes of mortality. This article discusses the application of innovative methods to develop national mortality estimates in Turkey, and their implications for national health development policies. METHODS: Child mortality levels from the Demography and Health Survey (DHS) were applied to model life tables to estimate age-specific death rates. Reported causes of death from urban areas were adjusted using re-distribution algorithms from the Global Burden of Disease (GBD) Study. Rural cause structure was estimated from epidemiological models. Local epidemiological data was used to adjust model-based estimates. RESULTS: Life expectancy at birth in 2000 was estimated to be 67.7 years (males) and 71.9 years (females), about 8-10 years lower than in Western Europe. Leading causes of death include major vascular diseases (ischaemic heart disease, stroke) causing 35-38% of deaths, chronic obstructive lung disease and lung cancer in men, but also perinatal causes, lower respiratory infections and diarrhoeal diseases. Injuries cause about 6-8% of deaths, although this may be an underestimate. CONCLUSIONS: Mortality estimates are uncertain in Turkey, given the poor quality of death registration systems. Application of burden of disease methods suggests that there has been progress along the epidemiological transition. Key health development strategies for Turkey include improved access to communicable disease control technologies, and urgent attention to the development of a reliable, nationally representative health information system.

Reliability and validity of the Turkish version of the Rhinosinusitis Disability Index.

OBJECTIVES: The goal of this study was to determine the validity, reliability, and internal consistency of the Rhinosinusitis Disability Index (RSDI) for evaluating nasal and sinus diseases in Turkey. PATIENTS AND METHODS: The study included 120 patients (77 males, 43 females; mean age 39+/-12 years; range 18 to 65 years) with diagnoses of allergic rhinitis, chronic rhinosinusitis, nasal polyposis, and septal deviation. Each group consisted of 30 patients. The Turkish version of the RSDI was administered to all the patients together with the SF-36 quality of life scale as the gold standard reference test. For reliability, the RSDI was re-administered to 15 patients a week after the first. Internal consistency, reliability, and validity tests were carried out to evaluate the RSDI. RESULTS: The Cronbach's alpha coefficients were between 0.7175 and 0.9308 for the subscales of the RSDI, showing internal consistency. The correlation coefficients of the functional, emotional and physical subscales of the RSDI between the first and second administrations were 0.861, 0.883, and 0.902, respectively, indicating reliability. There were significant positive correlations between similar subscales of the RSDI and the SF-36. CONCLUSION: The results of this study indicate that the Turkish version of the RSDI can be used for evaluating sinonasal diseases.

Risk factors in the development of mild and severe retinopathy of prematurity.

PURPOSE: To evaluate the risk factors in the development of mild and severe retinopathy of prematurity (ROP). METHODS: All infants (n = 88) screened for ROP at a neonatal intensive care unit over a 2-year period with gestational age

Nail disorders in hemodialysis patients and renal transplant recipients: a case-control study.

BACKGROUND: There is one published case-control study of nail disorders in hemodialysis patients. The nail changes that occur in renal transplant recipients have not been investigated specifically. OBJECTIVE: The aim of this study was to determine prevalence rates of nail disorders in hemodialysis patients and renal transplant recipients, and to investigate whether these nail pathologies are related to hemodialysis and renal transplantation. METHODS: One hundred and eighty-two hemodialysis patients and 205 renal transplant recipients were screened for the presence of nail disorders. The findings in these groups were compared with findings in 143 healthy individuals. RESULTS: One hundred and twenty-seven patients (69.8%) in the hemodialysis group and 116 patients (56.6%) in the renal transplant recipients had at least one type of nail pathology. Absence of lunula, splinter hemorrhage, and half-and-half nails were significantly more common in the hemodialysis patients than in the renal transplant recipients. Leukonychia was significantly more frequent in the renal transplant recipients than in the hemodialysis patients and controls. CONCLUSION: Hemodialysis patients and renal transplant recipients have higher rates of nail disease than the healthy population. Renal transplantation may reduce the frequencies of splinter hemorrhage and half-and-half nails. Interestingly, leukonychia increases significantly after renal transplantation.

Factors influencing breastfeeding for working mothers.

In order to evaluate the relation between breastfeeding and working conditions a descriptive study was conducted on 301 working mothers. Seventy-seven percent of mothers breastfed their infants four months and longer, and the mean breastfeeding period was 6.2 +/- 3.4 months. Forty-one percent of mothers started weaning before four months of age. The multifactorial analysis of independent factors significantly influencing breastfeeding time were, in decreasing order of significance, breastfeeding conditions at work, maternal leave period, mother's smoking habit and the use of breastpump. For weaning period, these factors were the use of breastpump, breastfeeding leave at work and maternal leave period. In conclusion, in order to support breastfeeding at work, maternal leave period must be prolonged, and breastfeeding conditions at work must be improved.