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Sakarya, Sibel

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Sibel

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Sakarya

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2019 - 201932020 - 202328

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    Cut-off values for anthropometric indices in predicting morbidity and mortality in Turkey: a cohort
    (Oxford University Press (OUP), 2021) Erkoyun, Erdem; Eren, E. Boncukçu; Ünal, Belgin; Sözmen, Kaan; Horasan, Gönül Dinç; Ekinci, Banu; Ergör, Gül; N/A; Sakarya, Sibel; Faculty Member; School of Medicine; 172028
    Background: Anthropometric measurements are associated with cardiovascular outcomes and mortality and the association varies by community. This study aims to estimate the incidence of cardiovascular outcomes and all cause mortality and determines their association with the anthropometric measurements. Methods: The data from Turkey Chronic Diseases and Risk Factors Survey were used for the cohort which recruited two 15 years and older adults from each family physicians' list in 2011 in Turkey using simple random sampling (n = 18,477). Family physicians collected the medical history and performed anthropometric measurements. Initially healthy participants for cardiovascular morbidity (coronary heart disease (ICD-10 codes I20.0-I25.0) and stroke (ICD-10 codes I60.0-I69.0) and all participants for all-cause and cardiovascular mortality were followed-up through electronic health records by 2017. Area under the curves (AUCs) were estimated and the adiposity risk was defined as cut-off points determined using Youden Index. The sample was stratified by age-groups (<65, ≥65). Poisson and Cox models were fitted for morbidity and mortality outcomes, respectively. Results: Over six years of follow-up, 5.7% of 15,877 and 1.3% of 16,062 participants developed CHD and stroke respectively. In total, 664 all-cause deaths (4.0%) were observed with 155 caused by CVDs (0.9%). A body shape index (i.e. 0.658 for all-cause mortality among younger men), waist-to-height ratio (i.e. 0.743 for CHD incidence among younger women), and BMI had higher AUCs for the outcomes. Higher anthropometric measurement groups had almost always higher CHD incidence risk in all groups but lower all-cause mortality in older men. Higher body-mass index was associated with lower mortality in younger men. Conclusions: This cohort study in Turkey showed that having higher anthropometric measurements is mostly associated with higher CHD incidence and mostly lower mortality among older men. This association deserves further studies.
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    Policy analysis of suppression and mitigation strategies in the managementof an outbreak through the example of COVID-19 pandemic
    (DOC Design and Informatics, 2020) N/A; N/A; Kayı, İlker; Sakarya, Sibel; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 168599; 172028
    Objective: The objective of this study is to review the containment approaches adopted by countries to control COVID-19 pandemic. In our analysis, we have used Bacchi’s framework for interpretive policy analysis and examined the measures countries have taken and discussed the premise underlying containment strategies. We have included in our analysis United States of America, United Kingdom, Netherlands, Sweden, Denmark, Norway, Germany, Italy, Turkey, South Korea, Singapore, Japan and China. There are essentially two strategies that are used in the management of an outbreak: suppression or mitigation. Suppression strategy aims to lower the basic reproduction number (Ro) below 1 and thereby reduce the number of infected people or eliminate the person-to-person transmission. Mitigation approach, on the other hand, aims to generate community (herd) immunity by allowing the controlled infection of people. In this approach, the aim is not to bring Ro under 1 but to mitigate the health effects of the outbreak. It is seen that given the epidemiological features of the disease, the scope of the virus, and the limitation of the intervention resources at hand, the suppression approach is accepted more widely by the countries in terms of Covid-19 pandemic. In contrast, the mitigation strategy is approached with suspicion. The approach aiming to achieve herd immunity seems more suitable for situations in which it is possible to protect the high-risk groups by administrating vaccine. These evaluations should be carried out following the circumstances of the country in question. It is essential to form an evidence-based plan that is appropriate for the national context. It should be kept in mind that the solutions for the fight against the virus do not solely consist of those ready-made implementations by choosing one option over the other and that mixed models could be brought to the agenda when required.
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    Anthropometric indicators and diabetes incidence: results from a national cohort study, Turkey
    (Oxford University Press (OUP), 2021) Alpay, E. Emli; Ünal, Belgin; Ergör, Gül; Horasan, Gönül Dinç; Sözmen, Kaan; Ekinci, Banu; N/A; Sakarya, Sibel; Faculty Member; School of Medicine; 172028
    Background: Anthropometric indicators such as Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and Body Shape Index (ABSI) are used globally to evaluate the risk of type 2 diabetes (T2DM). Our study aimed to investigate associations between different anthropometric indicators and the risk of T2DM using data from a national cohort. Methods: The data on anthropometric measures and other risk factors of diabetes were obtained from Turkey Chronic Diseases and Risk Factors Survey in 2011 (n = 18,477). Disease information for the years 2012-2017 of the cohort has been reached through electronic health records and DM was ascertained by standard ICD-10 Codes. Four logistic regression models were generated based on different groups of confounders: unmodifiable risk factors, behavioral risk factors, comorbidities and socioeconomic variables. Categorical BMI, WC, WHR, WHtR, and ABSI values were used and adjusted RRs (95% CIs) of measurements were computed for men and women separately. Results: Median follow-up year (IQR) was 6,46 (0,06). Between 2012 and 2017, 540 people were diagnosed with new diabetes. All anthropometric measurements except ABSI were associated with T2DM risk in all models. Among the anthropometric measures, BMI showed the strongest effect on incident diabetes, both in men (BMI ≥30; RRadj: 3.06, 95% CI 1.93-4.86) and women (BMI ≥30; RRadj: 2.58; 95%CI 1.73-3.85) in model 4 (adjusting for all confounding factors). WHtR provided the second strongest association with a RRadj of 2.57 in men (95% CI 1.78-3.71) and 2.55 in women (95%CI 1.87-3.47). Conclusions: Independent of other risk factors, individuals with high BMI, WHR, WHtR and WC are at higher risk of developing T2DM. Public health strategies aimed at prevention of weight gain and obesity will probably be the most effective way to struggle with diabetes.
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    Pre-participation screening of athletes: primary health care physicians' knowledge, experience, and approach in Turkey
    (2021) Dursun, Merve; Bilir, Esra; Kaymaz, Kubilay; N/A; Sakarya, Sibel; Faculty Member; School of Medicine; 172028
    Pre-participation screening (PPS) is crucial for assessing the competitive athletes since their risk of sudden death is higher than non-athletes. In Turkey, PPS is performed at the primary health care setting by primary care physicians (PCPs) who are family medicine specialists (FMSs) or general practitioners (GPs). Although there are national guidelines, there is no legal regulation for this process. This study aims to evaluate PCPs' knowledge, experience, and approach about PPS. We prepared an online survey for PCPs and used non-probabilistic sampling. PPS attitudes and practices were analyzed and compared according to factors such as experience, education, and being GP or FMS. Of the 214 PCPs included in the study, 39.3% were female. The mean age was 44.9 years (SD:8.88). The average work experience was 7.9 years. Most participants were aware of their authorization to perform PPS (89.7%) and had previously prepared it (90.2%). However, 6.5% of them felt confident in performing PPS. Only 13.1% were aware of the guidelines. Almost 25% of the participants stated being informed about the subject at some part of their career, but this did not affect the confidence or referral decisions. In addition to medical history and physical examination, further testing was considered necessary by 96.3% of the participants. Significantly more tests were ordered by GPs than FMSs (p=0.026 and p=0.011, respectively). The accurate referral decision ratio was 59.3%, without difference between FMSs and GPs (p=0.216). We found that awareness of the guidelines was low among PCPs who lack confidence in PPS. These factors collectively increased the tendency for unnecessary further testing and referral. Therefore, the PPS implementation into medical school and residency curriculums and national legal regulation for the process is a necessity in Turkey. 
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    The attitudes, experiences, and self-competencies of pediatric endocrinology fellows and attending physicians regarding diabetes technology: the Turkey experience
    (Walter De Gruyter Gmbh, 2022) Eren, Erdal; N/A; N/A; N/A; N/A; N/A; Yeşiltepe Mutlu, Rahime Gül; Eviz, Elif; Gökçe, Tuğba; Sakarya, Sibel; Hatun, Şükrü; Faculty Member; Researcher; Doctor; Faculty Member; Faculty Member; School of Medicine; School of Medicine; N/A; School of Medicine; School of Medicine; Koç University Hospital; 153511; 327618; N/A; 172028; 153504
    Background: Unlike in Western countries, the use of diabetes technologies has been limited in Turkey, or at least until the last few years. This low adoption frequency may be attributed to the lack of experience of pediatric diabetes teams in working with new technologies. The aim of this study is to evaluate the attitudes, experiences and self-efficacies of pediatric endocrinology fellows and attending physicians in terms of use of continuous subcutaneous insulin infusion (CSII) therapy and continuous glucose monitoring (CGM) systems. Methods: The questionnaire used in this study consisted of 63 questions including 10 questions evaluating the demographic characteristics and experience of the participants, 33 Likert-type questions related to self-competency, 17 yes/no questions and 3 open-ended questions which evaluated attitudes towards our study area. This questionnaire was e-mailed to pediatric endocrinology fellows and attending physicians working in Turkey. Results: A total of 24 fellows and 28 attending physicians working in the field of pediatric endocrinology participated in the survey. Of the respondents, 61% reported that there was no formal training curriculum regarding diabetes technology at their institutions. The mean scores obtained from the Likert scale questions measuring self-competency in using CSII and CGM were 3.8 and 3.3 out of 5, respectively. Of the respondents, 55% judged themselves to be under-skilled in interpreting pump reports while 39% of the respondents reported themselves as being under-skilled in interpreting CGM reports. Conclusions While it is true that training programs for using diabetes technology have been established by the National Pediatric Endocrinology Association in Turkey, the development of a specific curriculum for institutions that provide pediatric endocrinology fellowship training in this framework will increase the self-confidence of pediatric endocrinologists in this matter and this will ultimately contribute to the improvement of the metabolic control of children with diabetes.
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    Risk assessment approach for decision makers specific to the COVID-19 outbreak
    (Sağlık ve Sosyal Yardım Vakfı, 2020) İnandı, Tacettin; Ünal, Belgin; Ergin, Işıl; N/A; Sakarya, Sibel; Faculty Member; School of Medicine; 172028
    The COVID-19 epidemic is an acute public health event that is rapidly progressing, which can adversely affect human health and requires rapid intervention. In order to prevent and control such an epidemic that does not yet have an effective treatment and vaccine and can be transmitted easily, it is necessary to make risk assessments, review interventions, and strengthen and relax the measures from time to time. In this article, the concept of risk assessment is discussed, and then, the international guidelines are reviewed and the risk indicators that can be used during the ups and downs of the COVID-19 outbreak and the intervention indicators required to manage this risk are examined. Variables that can be considered when evaluating their own situation at the provincial level are presented. In order to carry out the risk assessment required to direct the interventions to control the outbreak, it was emphasized that expert teams need to be formed, cooperation between sectors and institutions should be established, the right questions should be asked, information about the outbreak should be accessible and transparent, and effective risk communication and community participation should be assured. / COVID-19 salgını hızla ilerleyen, insan sağlığını olumsuz etkileyebilecek ve hızlı müdahale edilmesi gereken akut halk sağlığı olayıdır. Henüz etkin tedavisi ve aşısı olmayan ve kolay bulaşabilen böyle bir salgını önlemek ve kontrol altına almak; salgının her evresinde risk değerlendirmesi yapmayı, müdahalelerin gözden geçirilmesini, zaman zaman önlemlerin güçlendirilip, gevşetilmesini gerektirmektedir. Bu yazıda risk değerlendirilmesi kavramı ele alınmış, ardından ülkemizde yerel düzeyde uygulamak üzere, uluslararası rehberler gözden geçirilerek COVID-19 salgınının yükselme ve iniş dönemlerinde kullanılabilecek risk göstergeleri ile bu riski yönetmek için gerekli olan müdahale göstergeleri incelenmiştir. İl düzeyinde karar vericilerin kendi durumlarını değerlendirirken dikkate alabilecekleri değişkenler sunulmuştur. Salgının kontrolüne yönelik müdahalelere yön vermede gerekli olan risk değerlendirmesinin yapılabilmesi için, uzman ekiplerin oluşturulması, sektörler ve kurumlar arası işbirliği, doğru soruların sorulması, salgınla ilgili bilgilerin erişilebilir ve şeffaf olması, etkin bir risk iletişiminin ve toplum katılımının gerekliliği vurgulanmıştır.
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    Burnout in primary healthcare physicians and nurses in Turkey during COVID-19 pandemic
    (Cambridge University Press (CUP), 2023) Kirimli, Emrah; N/A; Ayaşlıer, Ata Arda; Albayrak, Beyza; Çelik, Esra; Özdemir, Özgür; Özgür, Özlem; Kayı, İlker; Sakarya, Sibel; Undergraduate Student; Undergraduate Student; Undergraduate Student; Undergraduate Student; Undergraduate Student; Faculty Member; Faculty Member; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; School of Medicine; N/A; N/A; N/A; N/A; N/A; 168599; 172028
    Background:Due to additional responsibilities and uncertainties during the COVID-19 pandemic, primary healthcare (PHC) workers are at increased risk of burnout. Aim:To determine and compare the burnout levels and related factors in PHC nurses and family physicians (FPs) during the COVID-19 pandemic. Methods:An online survey was delivered to PHC workers. Non-random sampling method was used. To evaluate burnout, the Maslach Burnout Inventory was used, which investigates burnout in three categories: emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). Multivariate linear regression was used to analyze factors associated with burnout for FPs and nurses separately. Findings:Among the participants, 55.7% were nurses, the mean age was 42.34. FPs and nurses experienced similar levels of burnout in terms of EE. Family physicians had higher levels of low PA and DP. Based on the results of the multivariate analysis, while higher EE levels were significantly associated with unequal distribution of workload and communication problems within the Family Health Center for physicians, the unequal distribution of PPE, lack of appreciation by patients or colleagues and restrictions on work-related rights were relevant factors for nurses. Lack of appreciation and restrictions of the rights were associated with increased DP scores in both groups. Unequal distribution of workload was also associated with reduced PA among FPs. Conclusion:PHC physicians and nurses are affected by burnout in different ways under the conditions of the COVID-19 pandemic based on gender, socioeconomic status and working conditions. To protect the mental health of PHC workers in the next public health emergency, clarification in the organization of services, empowering PHC workers in emergency risk communication and provision of timely, adequate and free PPE is essential. It is also crucial to ensure the rights of health workers through macro policy changes especially during emergencies.
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    Durinng COVID-19 outbreak situation of refugees in Turkey
    (Sağlık ve Sosyal Yardım Vakfı, 2020) Mardin, Deniz; Özvarış, Şevkat Bahar; Gürsoy, Gül; Yukarıkır, Neslihan; Başpınar, Anıl; Sakarya, Sibel; Kayı, İlker; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 172028; 168599
    Turkey is hosting sum of 5.5 million refugees and international migrants and has become the number one refugee hosting country in the world. Their right to health and access to health condition varies based on their legal status. During the pandemic both their access to health care and their living conditions are changed. After the declaration of the first COVID-19 case in Turkey on 10th of March 2020, has been published different regulations for accessing the health care of these population. However non-governmental organizations’ reports on access to health care conditions of refugees have declared that there are still barriers encountered by refugees. As an example, refugees do not have the necessary information about COVID-19, they do not have information about which hospital they can apply to, there are some problems about the registration process of undocumented migrants and language barriers are encountered during the filiation. In addition, refugees have lost their jobs during the epidemic which affects their conditions for access to shelter, nutrition and health services. In addition, it is an important problem that they do not have enough information about where to apply when there are any health problems other than COVID-19 In conclusion, in Turkey there is a need to make further efforts to provide public supports to the refugees coming from various countries either for health or for other socio economic issues by the supports of the international organizations and with the collaboration of the NGOs / Dünyada en fazla zorunlu göçmene ev sahipliği yapan Türkiye’de toplam 5,5 milyon geçici koruma altında Suriyeli, mülteci ve uluslararası göçmen bulunmaktadır. Bu kişilerin sağlık hizmetlerine erişimi ve sağlık hakkı hukuki statülerine göre farklılık göstermektedir. Salgın sürecinde ise hem sağlık hizmetlerine erişimin hem de kişilerin yaşam koşullarının değiştiği gözlemlenmektedir. Türkiye’de 10 Mart 2020 itibari ile ilk COVID-19 vakasının açıklanmasından sonra bu grupların da sağlık hizmetlerine erişimi konusunda farklı düzenlemeler yapılmıştır. Ancak, mültecilerle çalışan sivil toplum kuruluşlarının tespitlerine göre hala bazı sorunların devam ettiği görülmektedir. Mültecilerin COVID-19 konusunda gerekli bilgilendirmeye erişemedikleri, hangi hastaneye başvurabilecekleri konusunda bilgiye sahip olmadıkları, kayıtsız göçmenlerin kayıt süreçlerinde sorun yaşadıkları, filyasyon sürecinde dil bariyeri ile karşılaşıldığı belirtilmektedir. Ayrıca, mültecilerin salgın sürecinde işlerini kaybetmeleri, barınma, beslenme ve sağlık hizmetlerine erişim koşullarını da etkilemektedir. Bunların yanı sıra, COVID-19 dışında herhangi bir sağlık sorunları olduğunda nereye başvurulması gerektiği ile ilgili bilgiye sahip olmamaları da önemli bir sorundur. Sonuç olarak, Türkiye’de farklı ülkelerden gelen mültecilere yönelik, uluslararası kuruluşların desteği ve sivil toplum kuruluşların işbirliği ile kamusal olarak hem sağlık hem de sosyal ve ekonomik konularda çalışmaların yapılmasına ihtiyaç duyulmaktadır
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    COVID-19 barriers and response strategies for refugees and undocumented migrants in Turkey
    (Elsevier B.V., 2020) Bahar Özvarış, Şevkat; Mardin, Deniz; Ekzayez, Abdulkarim; Meagher, Kristen; Patel, Preeti; Kayı, İlker; Sakarya, Sibel; Faculty Member; Faculty Member; School of Medicine; School of Medicine; 168599; 172028
    Introduction: With more than 40 million confirmed cases of COVID-19 globally, the pandemic is continuing to severely challenge health systems around the world. Countries with high numbers of refugees face an additional burden on COVID-19 preventive and curative services made available and accessible to refugees. Turkey hosts the largest number of refugees globally, with a total of 4 million in 2020. Over 98% of refugees in Turkey reside in urban areas in large, crowded cities such as Istanbul, Gaziantep, and Hatay posing severe challenges for all health responses, including COVID-19. This study provides insights and analysis on the current situation for refugees, migrants under temporary protection and undocumented migrants in Turkey by focusing on the right to health and access to health care under pandemic conditions. Its main aim is to discuss the challenges and opportunities for COVID-19 responses relating to refugees, migrants under temporary protection and undocumented migrants in Turkey. Methods: This is a non- systematic and exploratory literature review from academic and grey sources. We reviewed published documents, meeting summaries, media reports/news and policy briefs in Turkish and English on the COVID-19 response in Turkey. Results: Since the start of the COVID-19 outbreak in Turkey, the Ministry of Health (MoH) has taken various steps to provide health care for all residents. However, several challenges arise when providing health care to refugees, migrants under temporary protection and other undocumented migrants including language barrier in accessing reliable information and access to health services for existing chronic conditions. Conclusion: While refugees, migrants under temporary protection and undocumented migrants have been granted access to services for COVID-19 related health problems, social and cultural barriers remain beyond the current legislation. Solidarity and whole-of-society inclusive approaches should always be the guiding principles in the COVID-19 response.
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    Hungary’s COVID-19 response
    (Türk Tabipler Birliği, 2022) N/A; Sakarya, Sibel; Faculty Member; School of Medicine; 172028
    Located in Central Europe, Hungary is a country with a population of approximately 10 million, and approximately 1.7 million of the population live in Budapest. It has been a member of the European Union (EU) since 2004. The first COVID-19 case in Hungary was seen on March 4, 2020, and the first death was seen on March 11, 2020. The government declared a State of Emergency (OHAL) on 11 March and ten taskforces were created to defend against coronavirus. The state of emergency, which was lifted in June 2020, was re-declared in November 2020, when the second and major exacerbation took place and is still ongoing. As of mid-March 2021 at the time of this writing, Hungary is experiencing the third largest peak in the COVID-19 pandemic. Pandemic response has been largely hospital-focused. Hungary has one of the highest rates of hospitalization from coronavirus. Hungary’s test policy is based on testing only people with symptoms, and it is far behind the neighboring countries in terms of the total number of tests performed by population. It is one of the countries with the highest rate in Europe in terms of COVID-19 vaccination rates and has broken off from the EU’s joint purchasing program and approved for use of 5 vaccines, including Chinese and Russian vaccines. Hungary’s pandemic response is based on mitigation strategy rather than suppression. Considering the characteristics such as the names given to the boards established for pandemic management “Movement Corps”, the “commanders” assigned to hospitals, the way the decisions were taken, the state of emergency declared, restriction of freedom of speech, amendment of the penal code, prohibition of going abroad for health personnel, it is seen that Hungary’s epidemic management style has militaristic connotations and authoritarian practices / Orta Avrupa’da yer alan Macaristan, yaklaşık 10 milyon nüfusa sahip bir ülke olup, nüfusun yaklaşık 1,7 milyonu Budapeşte’de yaşamaktadır. 2004’den bu yana Avrupa Birliği (AB) üyesidir. Macaristan’da ilk COVID-19 olgusu 4 Mart 2020’de, ilk ölüm 11 Mart 2020’de görülmüştür. Hükümet 11 Mart’ta Olağanüstü Hal (OHAL) ilan etmiş ve Koronavirüse karşı savunma için on adet görev gücü (taskforce) oluşturulmuştur. Haziran 2020’de kaldırılan OHAL, ikinci ve büyük alevlenmenin yaşandığı Kasım 2020’de yeniden ilan edilmiştir ve halen devam etmektedir. Bu yazının yazıldığı Mart 2021 ortası itibarıyla, Macaristan COVID-19 pandemisinde üçüncü büyük piki yaşamaktadır. Salgın yönetimi büyük ölçüde hastane odaklı yürütülmüştür. Macaristan, koronavirüsten en yüksek hastaneye yatış oranlarından birine sahiptir. Macaristan’ın test politikası yalnızca semptomu olan kişilere test yapılması biçimindedir ve nüfusa göre toplam yapılan test sayısı açısından komşu ülkelerden oldukça geridedir. Aşı oranları açısından Avrupa’da en yüksek orana sahip olan ülkelerden birisi olup, AB’nin ortak satın alma programından koparak, Çin ve Rusya aşılarını da içeren 5 aşıya kullanım onayı vermiştir. Macaristan’ın pandemiye yanıtı baskılamaktan çok hafifletme stratejisine dayanmaktadır. Pandemi yönetimi için kurulan kurullara verilen isimler “Hareket Kolordusu”, hastanelere atanan “komutanlar”, kararların alınış biçimi, pandeminin kontrolü gerekçesiyle ilan edilen ve hala devam eden OHAL, konuşma özgürlüğünün sınırlanması, ceza yasasının değiştirilmesi, sağlık personelinin yurt dışına çıkmasının yasaklanması gibi özellikler dikkate alındığında, Macaristan’ın salgın yönetim biçiminin militarist çağrışımlara ve otoriter uygulamalara sahip olduğu görülmektedir.