Assessing the job preferences of senior medical students for mandatory service: a discrete choice experiment.

AIM: To investigate the job preferences of senior medical students for mandatory service as general practitioners using discrete choice experiment. INTRODUCTION: Health workforce is directly associated with health service coverage and health outcomes. However, there is a global shortage of healthcare workers (HCWs) in rural areas. Discrete choice experiments can guide the policy and decision-makers to increase recruitment and retention of HCWs in remote and rural areas by determining their job preferences. The aim of this study is to investigate job preferences of senior medical students for mandatory service as general practitioners. METHODS: This cross-sectional survey was conducted among 144 medical students. To estimate students' preferences for different levels of job attributes, a mixed logit model was utilised. Simulations of job uptake rates and willingness to pay (WTP) estimates were computed. FINDINGS: All attributes had an impact on the job preferences of students with the following order of priority: salary, workload, proximity to family/friends, working environment, facility and developmental status. For a normal workload and a workplace closed to family/friends which were the most valued attributes after salary, WTPs were 2818.8 Turkish lira (TRY) ($398.7) and 2287.5 TRY ($323.6), respectively. The preference weights of various job characteristics were modified by gender, the presence of a HCW parent and willingness to perform mandatory service. To recruit young physicians where they are most needed, monetary incentives appear to be the most efficient intervention. Non-pecuniary job characteristics also affected job preferences. Packages of both monetary and non-monetary incentives tailored to individual characteristics would be the most efficient approach.

New-onset atrial fibrillation in critically ill patients with coronavirus disease 2019 (COVID-19).

Background: Mortality in critically ill patients with coronavirus disease 2019 (COVID-19) is high, therefore, it is essential to evaluate the independent effect of new-onset atrial fibrillation (NOAF) on mortality in patients with COVID-19. We aimed to determine the incidence, risk factors, and outcomes of NOAF in a cohort of critically ill patients with COVID-19. Methods: We conducted a retrospective study on patients admitted to the intensive care unit (ICU) with a diagnosis of COVID-19. NOAF was defined as atrial fibrillation that was detected after diagnosis of COVID-19 without a prior history. The primary outcome of the study was the effect of NOAF on mortality in critically ill COVID-19 patients. Results: NOAF incidence was 14.9% (n = 37), and 78% of patients (n = 29) were men in NOAF positive group. Median age of the NOAF group was 79.0 (interquartile range, 71.5-84.0). Hospital mortality was higher in the NOAF group (87% vs 67%, respectively, P = .019). However, in multivariate analysis, NOAF was not an independent risk factor for hospital mortality (OR 1.42, 95% CI 0.40-5.09, P = .582). Conclusions: The incidence of NOAF was 14.9% in critically ill COVID-19 patients. Hospital mortality was higher in the NOAF group. However, NOAF was not an independent risk factor for hospital mortality in patients with COVID-19.

Vitamin D Levels and Vitamin D Receptor (VDR) Gene Polymorphisms in Inactive Hepatitis B Virus Carriers.

OBJECTIVE: To evaluate the vitamin D receptor (VDR) gene polymorphisms and vitamin D levels in inactive hepatitis B virus (HBV) carriers. STUDY DESIGN: A cross-sectional analytical study. PLACE AND DURATION OF STUDY: From March to September 2017 at the Izmir Katip Celebi University (IKCU) Ataturk Training and Research Hospital, Izmir, Turkey. METHODOLOGY: Eighty-six inactive hepatitis B carriers and 86 control individuals were included in the study. Individuals with diseases or under medication that could affect vitamin D levels were excluded from the study. Serum vitamin D concentration of >30 ng/mL was considered as sufficient, between 20-30 ng/mL as insufficient, <20 ng/mL as deficiency and <10 ng/mL as severe deficiency. VDR gene Bsm I, Fok I, Apa I and Taq I polymorphisms were identified by the polymerase chain reaction-fragment length polymorphism (PCR-RFLP) method. RESULTS: When vitamin D levels were examined, 52.3% (n = 45) of the inactive HBV carriers had severe deficiency, 38.4% (n = 33) deficiency, 7% (n = 6) insufficiency; 45.3% (n = 39) of the control group had severe deficiency, 43% (n = 37) deficiency, and 7% (n = 6) insufficiency. There was no statistically significant relationship between VDR gene and Bsm I, Fok I, Apa I, Taq I polymorphisms and vitamin D levels in inactive hepatitis B carriers and control group (p>0.05). CONCLUSION: Vitamin D deficiency is highly prevalent both among control population as well as in chronic hepatitis patients. Key Words: Inactive HBV carrier, Vitamin D, Polymorphism, Vitamin D receptor (VDR).

Determination of the costs of falls in the older people according to the decision tree model.

PURPOSE OF THE RESEARCH: The primary aim of this study is to hypothetically examine the costs of falls experienced by the older people living in the community and fall prevention interventions implemented by nurses using the decision tree model. The secondary purpose of the study is to determine the factors affecting the cost of falls. THE MATERIALS AND METHODS: This study was planned as a costing and cost-effectiveness study. Two thousand seventy-five patient files were examined by following the research criteria. In the present study, a hypothetical analytical decision tree model was used. Three different scenarios were set up in the study, and the decision tree analyses were performed according to these scenarios. Falls will decrease by 12 % in the pessimistic scenario, by 27 % in the optimal scenario, and by 39 % in the optimistic scenario. The SPSS 22.0 (2014) and TreeAge Pro Suit (2009) programs were used for data analysis. THE PRINCIPAL RESULTS: The average cost for a person admitted to a hospital due to falls was $396.51 ± $1429.35.It was determined that costs varied according to the type of the injury.The results of this present study demonstrated that the three scenarios tested were costly but also more effective. Hence, the applicability of these interventions should be considered by policy makers taking both the costs and effectiveness into account. MAJOR CONCLUSIONS: Multidisciplinary research should be carried out in order to increase the effectiveness of the fall prevention programs to be implemented in the future, and multifaceted fall prevention programs should be developed.

Comparison of atherosclerotic inflammation and calcification in subjects with end stage renal disease (ESRD) on hemodialysis to normal controls utilizing 18F-FDG PET/CT.

OBJECTIVE: Subjects with end stage renal disease (ESRD) are exposed to increased morbidity and mortality due to cardiovascular events. The primary underlying mechanism has been suggested as accelerated atherosclerosis in these patients. Our aim was to compare the atherosclerotic inflammation and calcification in subjects with ESRD on hemodialysis to that in normal controls utilizing fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT). SUBJECTS AND METHODS: Forthy two subjects who underwent 18F-FDG PET/CT imaging were retrospectively studied. Twenty one were subjects with ESRD on hemodialysis (67±11 years old; 14 male, 7 female) and 21 were age- and gender-matched controls. Average standardized uptake value maximum (SUVmax) and SUVmean for 4 segments of the aorta (ascending, arch, descending, abdominal) and for the common iliac arteries and common femoral arteries were measured. Standardized uptake value maximum and SUVmean for right atrial blood pool were also measured as the background. Average SUVmax, average SUVmean, average SUVmax/background ratio, and average SUVmean/background ratio were compared between subject groups for all segments. Presence or absence of macroscopic calcification on CT images for each arterial segment based on visual qualitative assessment was also noted and compared. For statistical analysis, two-sided t-test was used for continuous variables, and chi-square test was used for categorical variables. We considered a P value of <0.05 as statistically significant. RESULTS: Average SUVmax and SUVmean were statistically significantly greater in subjects with ESRD than in controls in all arterial segments. Average SUVmax/background ratios were statistically significantly greater in subjects with ESRD compared to normal controls in all arterial segments except for the left femoral artery. Average SUVmean/background ratios were statistically significantly greater in subjects with ESRD compared to normal controls in all arterial segments except for the right and left femoral arteries. Presence of calcification on CT was more frequently encountered in all arterial segments in subjects with ESRD, and was statistically significantly greater for the aortic arch, descending aorta, and right and left femoral arteries. CONCLUSION: SUV measurements representing the atherosclerotic inflammatory changes and macroscopic atherosclerotic calcifications appear to be accelerated in subjects with ESRD on hemodialysis compared to normal controls. Fluorine-18 FDG PET/CT is a valuable diagnostic tool for verifying and quantifying accelerated atherosclerosis secondary to ESRD.

Evaluation of the neuropathic pain in the smokers.

OBJECTIVES: Nicotine addiction is one of the most important causes of the general failure of treatment and keeping the habit of smoking. Peripheral neuropathy is a leading factor of smoking. This study aimed to analyze the association of neuropathic pain and addiction levels of individuals. METHODS: The study was performed on the day on which the smokers visited the hospital for any reason. The Douleur Neuropathique 4 (DN-4) Scale and Fagerström Addiction Survey were administered to the individuals after obtaining their consent. RESULTS: In total, 444 individuals were included in the study, and 57.2% of them were males (n = 254). The age average of the individuals with neuropathic pain (46.4±12.3 years) was significantly higher than that of those without pain. The individuals with pain smoked approximately 31.8±18.3 packet/year cigarettes, whereas those without pain smoked approximately 22.4 ± 15.5 packet/year cigarettes; the difference was significant statistically (p<0.05). According to multivariate logistic regression analysis with the backward elimination method, the existence of pain was found to be PR = 2.22 (95% GA, 1.26-3.91) in terms of sex, DM existence was found to be PR = 1.97 (95% GA, 1.02-3.81), and for each standard deviation increase (2.7) in Fagerström scale, PR was 1.29 (95% GA, 1.14-1.46). CONCLUSION: Smoking is a risk factor for neuropathic pain. In our study, the possibility of neuropathic pain increases as the duration of smoking and addiction level increase, and with diabetes, this rate increases even more. It is extremely important that the smokers should be informed regarding these facts and possibilities.

Diabetes prevalence and awareness in adults in the Balçova district in Turkey.

BACKGROUND/AIM: To determine the prevalence and awareness of diabetes and to evaluate associated factors in a population aged 30 and over in the Balçova district of Izmir, Turkey. MATERIALS AND METHODS: In this cross-sectional study data from 12,915 people who participated in Balçova's Heart Project were evaluated. Diabetes was defined using fasting blood glucose levels according to ADA criteria. RESULTS: Diabetes prevalence was 13.0% and 87.7% of the patients were aware of the condition. Diabetes prevalence was 1.32 times higher in males, 1.31 times higher in individuals with primary school or lower level of education, 1.37 times higher in individuals who perceived their economic status as bad, 1.20 times higher in those who had quit smoking, 2.84 times higher in individuals who had chronic disease, 1.78 times higher in overweight or obese individuals, and 1.65 times higher in individuals with high blood pressure. Diabetes awareness was 1.78 times higher in women, 1.94 times higher in individuals with social security, 2.62 times higher in individuals with a chronic disease, and 3.55 times higher in individuals who perceived their economic level as poor. CONCLUSION: Diabetes prevention policies and programs that aim for early diagnosis, treatment, and prevention of complications in patients should be developed and implemented for the public.