Preventive Medicine Practices Research Articles

Investigation of the effects of Ramadan and intermittent fasting on material and spiritual health

One of the most important problems for humanity is maintaining health. It is much easier and more cost-effective to protect it than to fix it after it has deteriorated. Modern medicine has also caught up with this point in recent years and has started to give more importance to preventive medicine practices, as Islam has been emphasizing for 1400 years. For this reason, preventive medicine practices such as intermittent fasting and eating less, which are recommended both in Islam and in scientific studies, are very important in terms of protecting health, reducing health expenditures and the workload of hospitals. In this study, we have compared the Qur'an and hadiths, which are the main sources of Islam, with the current medical literature datas. We have shown that they both point to the same points and make recommendations in the same parallel, such as intermittent fasting. With this study, which is the first and original in this respect, we aimed to contribute to the protection and improvement of both individual and social health and to reduce health expenditures and the workload of hospitals.

Determination of Carrier Frequency of Actionable Pathogenic Variants in Autosomal Recessive Genetic Diseases in the Turkish Cypriot Population.

Whole-exome DNA sequencing is a rich source of clinically useful information for specialists, patients, and their families, as well as elucidating the genetic basis of monogenic and complex diseases in clinical diagnosis. However, interpreting and reporting variants encompassing exome and genome sequence analysis outcome data are one of the greatest challenges of the genomic era. In this study, we aimed to investigate the frequency and allele frequency spectrum of single nucleotide variants accepted as recessive disease carrier status in Turkish Cypriot exomes. The same sequencing platform and data processing line were used for the analysis of data from 100 Turkish Cypriot whole-exome sequence analysis. Identified variants were classified according to ACMG guidelines, and pathogenic variants were confirmed in other databases such as ClinVar, HGMD, Varsome, etc. Pathogenic variants were detected in 68 genes out of 100 whole-exome sequence data. The carriage rate was the highest in the CYP21A2 gene, causing 21-hydroxylase deficiency (14.70%), 11.76% in the HBB gene causing β-thalassemia, 10.29% in the BTD gene causing biotinidase deficiency, 8.82% in the CFTR gene causing cystic fibrosis, 8.82% in the RBM8A gene causing thrombocytopenia-absent radius syndrome, which is an ultra-rare disease, and 5.88% in the GAA gene causing glycogen storage disease II. The carriage of pathogenic variants in other genes causing the disease (GJB2, PAH, GALC, CYP11B2, COL4A3, HBA1, etc.) was determined as less than 5.00%. Also, the identified variations in the mentioned gene within the examined population were reported. The most prevalent mutation in North Cyprus was a missense variant (c.1360 C>T, p.Pro454Ser) detected in the CYP21A2 gene (rs6445), and the most frequently seen variant in the HBB gene was c.93-21G>A (rs35004220). We investigated reported pathogenic variants by estimating the lower and upper limits of carrier and population frequencies for autosomal recessive diseases, for which exome sequencing may reveal additional medically relevant information. Determining the lower and upper limits of these frequencies will shed light on preventive medicine practices and governmental actions.

Machine Learning Approach for Thyroid Cancer Diagnosis Using Clinical Data

Objective: With an early diagnosis of thyroid cancer, one of the world's most significant health issues, it is feasible to treat the nodules before the spread of malignant thyroid gland cells. It has become crucial to develop models for predicting thyroid cancer. In light of this, the purpose of this study is to develop a clinical decision support model using the Bagged CART model, a machine learning (ML) model for the prediction of thyroid cancer. Methods: Between 2010 and 2012, 724 patients who applied to China Median University Shengjing Hospital comprised the study's data set. The dataset comprises information on nodule malignancies, demographic characteristics, ultrasound characteristics, and blood test results for all patients who underwent thyroidectomy. Using this open-access data set, the Bagged CART modeling technique was applied. Negative predictive value (NPV), specificity (Spe), balanced accuracy (BACC), positive predictive value (PPV), accuracy (ACC), sensitivity (Sen), and F1-score performance metrics were used to evaluate the model's predictive performance. In addition, a 10-fold cross-validation method was used to determine the validity of the model. In addition, variable importance was established, which reveals how much the input variables impact the output variable. Results: ACC, BACC, Sen, Spe, PPV, NPV, and F1-score obtained from the model performance metrics were calculated to 99.1%, 98.7%, 99.7%, 97.7%, 99.1%, 99.2%, and 99.4%, respectively, as a result of modeling. According to the variable importance values that were acquired for the input variables in the dataset that was investigated in this study, the seven variable that hold the greatest significance are as follows: size, TSH, blood flow: size, TSH, blood flow: enriched, multilateral: yes, FT4, site: isthmus, and age, in that order. Conclusion: As a result, the Bagged CART model was found to be effective at predicting thyroid cancer based on the findings of this study. In addition, in this study, risk factors for thyroid cancer were evaluated and their importance values were given. With these results, the decision-making process about the disease will be able to accelerate and thus, it will be able to effective in preventive medicine practices.

MOLECULAR PATHOGENESIS OF PROSTATE CANCER

Prostat kanseri dünya genelinde erkeklerde akciğer
 karsinomundan sonra 2. en sık ölüme yol açan
 kanserlerdir. Her ne kadar erken tedavi ve koruyucu
 hekimlik uygulamalarının PSA takibi şeklinde ön plana
 çıkmasıyla, devamında iğne biyopsilerle hastaların
 tümör gelişiminin saptanması kolaylaşmış olsa
 da tümörün özellikle tedavi öncesinde, sırasında ve
 sonrasındaki davranışlarının belirlenmesi anlamında
 elimizde risk skorlama şemaları dışında pek bir şansımız
 yoktu. Günümüzde kişiye özgü tedavi modellerini
 belirlemede ve hastalığın ileri evre olmadan prognozunu
 tahmin etmede kullanabileceğimiz moleküler imzası
 ve moleküler biyolojisi önem arz etmektedir. Tüm
 bu nedenlerle prostat kanserinin moleküler patogenezi
 ve biyolojik davranışının medikal profesyoneller tarafından
 bilinmesi hastalığı ve seyrini anlamada bize
 yardımcı olacaktır.

Türkiye’de Üç Gün Hastalığı ve Ekonomik Boyutu

Bovine Ephemeral Fever (BEF) is a viral infection that causes a significant decrease in milk and meat production, infertility in cows and bulls, abortion and a significant economic loss due to its rapid spread in the herd. Partial budgeting method was used in the study to measure the economic impact of vaccine use and non-vaccination use. In line with preventive medicine, it has been determined that if animals are vaccinated regularly, there is an average of 8.10 (dolars) vaccination cost per animal, but the average treatment cost of an animal that has not been vaccinated during the epidemic is 20.2 (dolars). It was determined in the economic analysis that in addition to the treatment costs, the loss of milk for a dairy cow increased to approximately 85 (dolars), for a livestock to 148 (dolars) with the loss of condition, but the economic loss increased due to high morbidity. In this context, early diagnosis, detection and monitoring of spreading conditions are as extremely important as vaccination in the fight against BEF infection. It can be said that the economic loss will be minimized with the vaccination and preventive medicine practices to be made by rapid intervention to the disease with the early warning system created by the Ministry of Agriculture and Forestry for this purpose in Turkey.

Modelling patient trajectories using multimodal information

Background:Electronic Health Records (EHRs) aggregate diverse information at the patient level, holding a trajectory representative of the evolution of the patient health status throughout time. Although this information provides context and can be leveraged by physicians to monitor patient health and make more accurate prognoses/diagnoses, patient records can contain information from very long time spans, which combined with the rapid generation rate of medical data makes clinical decision making more complex. Patient trajectory modelling can assist by exploring existing information in a scalable manner, and can contribute in augmenting health care quality by fostering preventive medicine practices (e.g. earlier disease diagnosis). Methods:We propose a solution to model patient trajectories that combines different types of information (e.g. clinical text, standard codes) and considers the temporal aspect of clinical data. This solution leverages two different architectures: one supporting flexible sets of input features, to convert patient admissions into dense representations; and a second exploring extracted admission representations in a recurrent-based architecture, where patient trajectories are processed in sub-sequences using a sliding window mechanism. Results:The developed solution was evaluated on two different clinical outcomes, unexpected patient readmission and disease progression, using the publicly available Medical Information Mart for Intensive Care (MIMIC)-III clinical database. The results obtained demonstrate the potential of the first architecture to model readmission and diagnoses prediction using single patient admissions. While information from clinical text did not show the discriminative power observed in other existing works, this may be explained by the need to fine-tune the clinicalBERT model. Finally, we demonstrate the potential of the sequence-based architecture using a sliding window mechanism to represent the input data, attaining comparable performances to other existing solutions. Conclusion:Herein, we explored DL-based techniques to model patient trajectories and propose two flexible architectures that explore patient admissions on an individual and sequence basis. The combination of clinical text with other types of information led to positive results, which can be further improved by including a fine-tuned version of clinicalBERT in the architectures. The proposed solution can be publicly accessed at https://github.com/bioinformatics-ua/PatientTM.

GEBELERİN COVID-19 KORKU DÜZEYLERİ İLE KULLANDIKLARI KORUYUCU, GELENEKSEL VE TAMAMLAYICI TIP UYGULAMALARI ARASINDAKİ İLİŞKİ

Çalışmada gebelerin Covid-19 korkusu ve Covid-19 riskine ilişkin kullandıkları koruyucu, geleneksel ve tamamlayıcı tıp uygulamalarının belirlenmesi amaçlanmıştır. Çalışma, 10 Temmuz-10 Eylül 2021 tarihleri arasında bir üniversite hastanesinin Perinatoloji Polikliniği’nde 594 gebe ile kesitsel olarak yapılmıştır. Veriler anket formu ve Koronavirüs Korkusu Ölçeği ile toplanmıştır. Veri analizinde tanımlayıcı istatistikler ve pearson korelasyon testi kullanılmış ve p<0.05 değeri istatistiksel olarak anlamlı kabul edilmiştir. Gebelerin Koronavirüs Korkusu Ölçeği puanı 18.33±7.15’tir. En fazla uyulan kurallar ortamların havalandırılması (%98.3), maske takma (%98.3), öksürme/hapşırma sırasında ağzı/burnu mendille kapatmadır (%97.0). En az uygulananlar ise kıyafetleri yüksek ısıda yıkama (%17.2), kişisel eşyaları ortak kullanmama (%13.1) ve ellerle, ağıza, buruna ve gözlere dokunmamadır (%12.8). Gebeler Covid-19’a karşı 29 koruyucu, geleneksel ve tamamlayıcı tıp uygulamalarından ortalama 14.35±4.89’unu yapmaktadır. En çok kullanılan uygulamalar yeşil sebze ve meyve (%93.3), et, balık ve yumurta tüketmek (%89.9), bol su içmektir (%89.2). Gebeler uygulamalara ilişkin bilgiyi en çok doktor (%25.1) ve sosyal medyadan (%20.7) edinmiştir. Gebelerde Covid-19 korkusunun artması ile yapılan koruyucu, geleneksel ve tamamlayıcı tıp uygulama sayısı ve uygulanan kural sayısı arasında pozitif yönlü zayıf düzeyde bir ilişki vardır (<0.001). Sonuçta gebeler pandemide bu uygulamaları yaygın olarak kullanmakta ve koronavirüs korkusunun artması ile bu yöntemlere başvurma durumları ve kurallara uyma eğilimleri artmaktadır.

Existing Health Practices in Shaping the Decision to Participate During Breast Cancer Screening Among 50-69 Years Old Women in Estonia.

IntroductionBreast cancer is easily detectable by mammography and many countries run national screening programs for women as a target group. Yet, the majority of these countries have screening participation rates below the recommended level of 70%.ObjectiveThe aim of the present article was to examine a connection between existing health practices and a decision to participate during breast cancer screening.MethodsMethodologically, this research was a web panel and quantitative telephone survey. The survey was conducted among 1200 Estonian women in the age group 50–69 years. Statistical data analysis was performed with SPSS using a descriptive and logistic regression model.ResultsThe findings revealed that among different background variables, age and existing health practices significantly influenced the decision-making for participating in the screening. Results also highlighted that the possibility to participate in the screening increased with existing supportive health practices and with the increasing age. Other sociodemographic factors did not have a significant influence on the decision-making of participation.ConclusionsThere is a need to educate people from an early age about the developments in health practices that could support a healthy lifestyle in terms of individual responsibility. Thus, public health campaigns should not only call for action but also focus on health education in terms of the role of preventive medicine and health practices.

Determination of factors related to coronary heart diseases by associative classification technique

Objective: The goal of this study is to categorize CHD using the relational classification approach on a CHD dataset made up of open access patients with and without CHD, as well as to disclose the disease's relationship to the risk factors that cause CHD.Methods: The associative classification model was applied to the open-access data set “CHD” in this study. The performance of the model was evaluated by accuracy, specificity, negative predictive value. According to the results of the associative classification model, the factors associated with the disease were determined by specific rules. groups, examined using Mann-Whitney U, Pearson Chi-square test, and Fisher's Exact test. p<0.05 values were considered statistically significant.Results: For the associative classification model applied to the data set, the results of the performance metrics that specificity, accuracy, and negative predictive value were calculated as 0.995, 0.852, 0.854, respectively.Conclusion: The conclusions of this investigation revealed that the study conducted on the CHD data set with the associative classification model yielded successful results. Since the results obtained from the associative classification model reveal certain rules, it is very easy for users to understand and the results can be easily interpreted. Thus, the findings obtained with this model can be used quite easily in preventive medicine practices.

PERFORMANCE EVALUATION OF MULTILAYER PERCEPTRON ARTIFICIAL NEURAL NETWORK MODEL IN THE CLASSIFICATION OF HEART FAILURE

Abstract
 Objective: The aim of this study was to compare the classification performance of heart failure using the MLP ANN model on an open-access “heart failure clinical records” data set, as well as to identify risk factors that may be linked to heart failure.
 Material and Methods: The open-access “heart failure” data collection MLP ANN model was used to classify nephritis of the renal pelvis, and risk factors that may be involved were discovered. Different output metrics are used to demonstrate MLP ANN's progress.
 Results: It has been shown that the classification of renal pelvic nephritis is quite high with MLP ANN model (AUC = 0.925, Accuracy = 93.9%, Balanced Accuracy = 89.2%, Sensitivity = 98.4%, Specificity = 80.0%). Furthermore, the MLP ANN model showed that “time” is the most significant variable among the risk factors linked to heart failure.
 Conclusion: Consequently, in the analysis with the heart failure data collection, the MLP ANN model generated very positive results. Moreover, this model has gained important information in identifying risk factors that may be associated with heart failure. Thus, it has been understood that the relevant model will provide reliable information about any disease to be used in preventive medicine practices.

Health-Promoting Leadership During an Infectious Disease Outbreak: A Cross-Sectional Study of US Soldiers Deployed to Liberia.

Infectious disease outbreaks are uniquely stressful for essential employees. One way to support workers is for supervisors to engage in behaviors promoting employees' well-being and attitudes toward preventive medicine practices. We examined whether health-promoting leadership contributes to these outcomes in a population of active-duty soldiers (N = 173) deployed to provide nonmedical support in Liberia during the 2014 Ebola epidemic using data reported in Sipos, Kim, Thomas, and Adler (Mil Med 183[3-4]:e171-e178, 2018). Soldiers completed surveys assessing posttraumatic stress disorder (PTSD), depression, anxiety, sleep problems, burnout, morale, and attitudes and rated their leaders on health-promoting behaviors. Using mixed-effects logistic regression, health-promoting leadership focused on psychological health was associated with decreased odds of PTSD, depression, anxiety, and burnout, and increased odds of high morale and avoiding unnecessary risk. Health-promoting leadership focused on preventive medicine was associated with decreased odds of depression and anxiety, and increased odds of high morale, positive attitudes, and avoiding unnecessary risk. Findings suggest health-promoting leadership could be valuable for workers responding to epidemics.

Bir Grup Hemşirelik Öğrencisinin COVID-19 Riskine Yönelik Koruyucu, Geleneksel ve Tamamlayıcı Tıp Uygulamaları

Amaç: Hemşirelik öğrencilerinin COVID-19 korunmak için uyguladığı koruyucu yöntemler ile geleneksel ve tamamlayıcı tıp uygulamalarını belirlemektir. Yöntem: Tanımlayıcı olan bu çalışmanın evrenini, 2019-2020 eğitim öğretim yılı bahar döneminde hemşirelik bölümünde öğrenim gören ve “Tamamlayıcı Tıp ve Hemşirelik” dersini alan 70 hemşirelik öğrencisi oluşturmuştur. Araştırmada örneklem seçimine gidilmemiş, evrenin tümü örnekleme alınmış olup araştırma çalışmaya katılmayı kabul eden 64 hemşirelik öğrencisi (katılım oranı %91,4) ile tamamlanmıştır. Araştırma evreninin %91,4’ine ulaşıldı. Veriler, araştırmacılar tarafından literatür taranarak 5 açık uçlu sorudan ve koruyucu önlemleri içeren 14 ifadeden oluşturulmuş anket formu ile toplandı. Verilerin değerlendirilmesinde frekans, yüzde, ortalama ve standart sapma kullanıldı. Bulgular: Öğrencilerin tamamının COVID-19’dan korunmak için belirlenen 14 kuraldan en çok “ellerinizi sık sık su ve sabun ile en az 20 saniye boyunca ovalayarak yıkayın”ı uyguladıkları belirlendi. Katılımcıların COVID-19’e karşı uyguladıkları geleneksel ve tamamlayıcı tıp uygulamaları sırasıyla; biyolojik uygulamalar, yağlar ile masaj uygulama, rahatlatıcı müzik dinlemektir. Temizlik konusunda en çok sebze ve meyvelerin yıkanmasında sirkeli suyun kullanıldığı belirlendi.Sonuç: COVID-19 sürecinde katılımcıların tamamının en az bir bitkiyle birlikte doğal beslenme yöntemini tercih ettikleri, öncelikle de bitki çayları ile bağışıklık sistemini destekleyici uygulamalar yapmaya çaba sarf ettikleri söylenebilir.

The causes and levels of lower limb amputation in geriatric patients

Aim: Lower limb amputations (LLA) are considered as a serious psychosocial condition. The causes of amputation in young persons are generally trauma, work accidents, or tumors, while in geriatric patients, it is mostly vascular problems. The aim of this study is to determine the causes and levels of LLA of geriatric patients in a tertiary care center.Materials and Methods: In order to conduct this study, information was obtained from the automation records of geriatric patients who underwent LLA in our clinic between the years 2014 and 2017. We divided our patients into three groups according to their ages. Group 1 consisted of those patients in the age group of 65-74 years, Group 2: 75-84 years, and Group 3: 84-95 years. We also classified our patients according to amputation causes and levels.We classified the patients as above-knee, transtibial, metatarsal, and toe amputation according to the level of lower extremity amputation.Results: Of the 96 patients included in the study, 70 were male (72.9%), and 26 (27.1%) were female. Group 1 consisted of 45 patients, group 2had 38 patients, and group 3 had 13 patients. It was observed that the most common cause of LLA was diabetic foot ulcers (65 patients), followed by ischemic foot as a cause of LLA in 25 patients. Moreover,4 patients were amputated due to a tumor, while amputation was performed in 2 patients as a result of a crush injury. It was observed that metatarsal and toe amputation was the most common amputation type according to amputation levels. (26 patients)Conclusion: As a result of our study, the most common cause of LLA in Geriatric patients was diabetic foot ulcers. Considering that lower extremity amputations cause severe morbidity and mortality in geriatric patients, it is crucial to identify these patients with preventive medicine practices.

Kırıkkale Üniversitesi Veteriner Fakültesi Öğrencilerinin Fizyoloji Eğitimi Hakkındaki Düşüncelerinin Belirlenmesi

This study was conducted to determine the attitudes and behaviors of 2-5th grade students who have taken the physiology course at Kırıkkale University Faculty of Veterinary Medicine, towards the course and how they evaluate it in terms of general, teaching method, professional competence and postgraduate education. Some demographic information and opinions of totally 233 students on physiology were gathered voluntarily through questionnaire. Accord-ingly, most of the students (62.7%) found it appropriate to be given physiology in 2nd grade, while about 53% of them found the theory and practice lecture hours sufficient. Students who considered physiology as necessary for their pro-fession (83.7%) thought that following the lesson (81.1%) in the class and the use of were necessary for learning physi-ology (90.1%), and it was determined that they allocated fewer than 4 hours per week to physiology while taking the course (89.3%). Although more than half of them (58.4%) stated that they did not have difficulty in learning physiology, the rate of those who really understand the subject was 39.9%. In addition, it was observed that 24% of them could consider specializing in physiology. As a result, it was revealed that most of the students consider the physiology course as one of the basic courses for veterinary education, they prefer visual education, the course meets their expec-tations, and most of them who want to pursue a doctorate pay attention to postgraduate education in this field. Based on these thoughts of the students, it has been concluded that understanding the importance of the homeostatic mecha-nisms, given in physiology classes, in preventive and curative medicine practices has been effective.

Besim Ömer’in Tabib-i Etfal Adlı Eserinde Çocuk Hastalıklarıyla Mücadele Yöntemleri ve Bunların Modern Tıpla Benzerlikleri

Aim: In the late XIXth and early XXth century Besim Ömer combined traditional methods with modern methods. Therefore he was among the founders of modern Turkish medicine. The general purpose of this research is to investigate whether Ottoman period medical books are a source of modern medicine by giving examples from Dr. Besim Ömer's medical book.Method: In this study, Ottoman medicine and today's medicine was compared and examined through Dr. Besim Ömer's book on pediatric diseases and with this method, the perspective of Ottoman medicine and modern medicine on similar diseases was examined. Results: In the Ottoman period medical work we examined, it was found that alternative treatments were offered to today's diseases. These findings were partially evaluated from the perspective of modern medicine. The findings revealed that Ottoman medicine constituted the prototype of today's diagnosis and treatment methods.Conclusion: According to the results obtained in the study, it was seen that Ottoman medicine offers different or similar treatments to the diseases that exist today. In addition to treating diseases, it is observed that the thesis of not catching the disease applied in preventive medicine practices is emphasized frequently. It is partially revealed in this study that the diseases seen in history continue today and how these diseases were diagnosed and treated in the past.

Exploring Why Adult Mexican Males Do Not Get Vaccinated: Implications for COVID-19 Preventive Actions

Vaccination is the single most important preventive medicine action worldwide. However, there are inequalities in the procurement of vaccines particularly among US ethnic and racial minority males when compared to the rest of the US population. This study explored the reasons given by adult Mexican-origin males residing in Texas, for obtaining or not, immunizations. This was a cross-sectional, exploratory study with a sample of convenience of 401 adult males (age range 18–79) who were invited to participate in the study while waiting their turn to receive administrative services at the Mexican Consulate in Austin Texas. Data was collected in Spanish with a seven-item multiple choice questionnaire, using electronic tablets. The majority of respondents received their last vaccination longer than 5 years earlier. A higher percentage of individuals in the older age groups received a vaccine in the last year, as opposed to their younger counterparts who obtained their last immunization 3 to 5 years earlier. Among the reasons given for not getting vaccinated were lack of time or money, feared injections and side effects, insufficient information, interest or motivation. Others did not get vaccines because they perceived themselves to be healthy and did not feel sick. Findings from this study have important implications for future preventive medicine and vaccination practices that reach socially excluded groups in times of COVID-19. Recommendations are made to facilitate access to vaccines to the target group of this study and other socially disadvantaged populations in the global health context.

Value that matters: intellectual capital and big data to assess performance in healthcare. An empirical analysis on the European context

PurposeThe aim of this paper is to analyze and measure the effects of intellectual capital (IC), i.e. human capital (HC), relational capital (RC) and structural capital (SC), on healthcare industry organizational performance and understanding the role of data analytics and big data (BD) in healthcare value creation (Wang et al., 2018). Through the assessment of determined variables specific for each component of IC, the paper identifies the guidelines and suggests propositions for a more efficient response in terms of services provided to citizens and, specifically, patients, as well as predicting effective strategies to improve the care management efficiency in terms of cost reduction.Design/methodology/approachThe study has a twofold approach: in the first part, the authors operated a systematic review of the academic literature aiming to enquire the relationship between IC, big data analytics (BDA) and healthcare system, which were also the descriptors employed. In the second part, the authors built an econometric model analyzed through panel data analysis, studying the relationship between IC, namely human, relational and structural capital indicators, and the performance of healthcare system in terms of performance. The study has been conducted on a sample of 28 European countries, notwithstanding the belonging to specific international or supranational bodies, between 2011 and 2016.FindingsThe paper proposes a data-driven model that presents new approach to IC assessment, extendable to other economic sectors beyond healthcare. It shows the existence of a positive impact (turning into a mathematical inverse relationship) of the human, relational and structural capital on the performance indicator, while the physical assets (i.e. the available beds in hospitals on total population) positively mediates the relationship, turning into a negative impact of non-IC related inputs on healthcare performance. The result is relevant in terms of managerial implications, enhancing the opportunity to highlight the crucial role of IC in the healthcare sector.Research limitations/implicationsThe relationship between IC indicators and performance could be employed in other sectors, disseminating new approaches in academic research. Through the establishment of a relationship between IC factors and performance, the authors implemented an approach in which healthcare organizations are active participants in their economic and social value creation. This challenges the views of knowledge sharing deeply held inside organizations by creating “new value” developed through a more collaborative and permeated approach in terms of knowledge spillovers. A limitation is given by a fragmented policymaking process which carries out different results in each country.Practical implicationsThe analysis provides interesting implications on multiple perspectives. The novelty of the study provides interesting implications for managers, practitioners and governmental bodies. A more efficient healthcare system could provide better results in terms of cost minimization and reduction of hospitalization period. Moreover, dissemination of new scientific knowledge and drivers of specialization enhances best practices sharing in the healthcare sector. On the other hand, an improvement in preventive medicine practices could help in reducing the overload of demand for curative treatments, on the perspective of sharply decreasing the avoidable deaths rate and improving societal standards.Originality/valueThe authors provide a new holistic framework on the relationship between IC, BDA and organizational performance in healthcare organizations through a systematic review approach and an empirical panel analysis at a multinational level, which is quite a novelty regarding the healthcare. There is little research focussed on healthcare industries' organizational performance, and, specifically, most of the research on IC in healthcare delivered results in terms of theoretical contribution and qualitative analyzes. The authors even contributed to analyze the healthcare industry in the light of the possible existence of synergies and networks among countries.

The importance of understanding the distribution of GSTM1 and GSTT1 genotypes and haplotypes in a region with intense agriculture activity

Brazil is one of the largest pesticide consumers in the world, mainly due to its intense agricultural activity. The State of Goias, situated in Central Brazil, is a region recognized as an essential producer of soy, corn, beans, sorghum, sugar cane, and cotton. In this study, we evaluated 602 unrelated individuals, distributed in central and southern regions in Goias, presenting combined frequencies (haplotypes) of the GSTT1 and GSTM1 genes. In all municipalities, the frequency of the GSTT1 null genotype was 38.2% and of the GSTM1 null genotype was 50.3%. Goiania, the capital of Goias, presented the highest frequencies of GSTT1 and GSTM1 null genotypes, probably due to a founder effect of non-representative colonizing ancestors. So, the ancestral population adapted to the environment, with the frequencies observed in Goiania. However, nowadays, as there is excessive use of pesticides, the community becomes susceptible to the harmful effects of xenobiotics exposure, mainly due to the high frequency of GSTT1 and GSTM1 null genotypes. As in Goias, the consumption of pesticides has shown considerable growth, haplotypes with null alleles are of high risk for the population. Our results indicated that it is essential to understand the frequencies of the GSTT1 and GSTM1 genes for the monitoring of risk groups, like farmers, who have contact with pesticides, directly or indirectly, as well as assisting in the development of preventive medicine practices.

Assessment of Knowledge and Attitudes of Patients About Cancer Screenings in Primary Care.

Incidence of cancer is increasing in the developing countries such as Turkey. Screenings are important part of preventive medicine practices which can reduce deaths due to cancer. Our aim was to identify patient's awareness and knowledge level of cancers and screenings and to create a road map of what we need to do to increase screening rates. This study was a descriptive type, and the research population was the patients between the age of 30 and 75, who went to 18 different Family Health Centres in different places in Turkey for any reason in July-September 2016. The survey was completed by face-to-face interview and consisted of 20 questions about the socio-demographic attributes, level of cancer and cancer screenings knowledge, causes of screening, and reasons for not doing. Screening rates was self-reported by patients. A total of 643 patients, 394 women (61.3%) and 249 men (38.7%), participated in the study. The average age was 45.67 ± 11.49. The most well-known cancer type was breast cancer (79%). Having no screening was high in general population (64.7%). Having a screening was statistically significantly higher in women, over 50 year olds group, divorced/widower group, housewives, primary school graduates, the group who have green-card (having very low or no income) as social security, and in the group who have a history of family member with cancer. 55.8% of patients received the information about screenings from healthcare professionals. The reasons for not having a screening were "not seeing themselves as under risk" (27.4%), not having knowledge (22.8%), and fear of the results (15%). First of all, the importance of cancer screening as an important part of the preventive health services should be understood by family doctors through in-service training. Then family doctors would share the information and experience, clear the lack of knowledge of them and by doing this rates of screening would increase.

Aile Hekimi ve Pediatristlerin Geleneksel ve Tamamlayıcı Tıbba (GETAT) Bakışı

Amaç: Son yıllarda ülkemizde ve tüm dünyada isimlendirilmesinde hâlâ fikir birliği sağlanmamış olan, bir dizi geleneksel, tamamlayıcı tıp uygulamaları hekimler/hekim dışı kişilerce uygulanır hale gelmiştir. Hekimlerin bu gelişmelere bakışı merak edilmekte ve hastaların GETAT ile ilgili uygulamalar konusunda soruları olmaktadır. Biz de hedef grup olarak Pediatrist ve Aile Hekimlerinin GETAT Uygulamalarına Bakışı, Yaklaşımı ve Bilgi Düzeylerini ölçmeyi amaçladık. Yöntem: Tanımlayıcı nitelikteki bu çalışma; Nisan-Haziran 2019 aylarında Aile Hekimleri ve Pediatristler ile Google online anket aracılığıyla yapılmıştır. Veri toplama aracı olarak; gerekli literatür taraması sonucunda oluşturulan 33 soru katılımcılara online olarak yöneltilmiştir.Bulgular: Çalışmaya 106 kişi katıldı. Katılımcıların %69’u Aile Hekimi, %31’i pediatrist idi. Aile hekimlerinin GETAT sertifikası sahip olma oranı pediatristlere göre anlamlı derecede yüksekti. Bu uygulamaları hekimlerin %47’si hastalarına önerebileceklerini ifade ederken, %22’si önermeyeceğini söyledi, geri kalanı (%31) kararsızdı. Pediatristler, aile hekimlerine göre GETAT uygulamalarını daha az tavsiye ediyordu. Hekimler; %51 oranda GETAT yöntemlerini faydalı bulurken, %18’i faydasız buldu. GETAT konusunda bilgi düzeyi sorgulandı. Hiç yok %7, Az %54, Orta %28, İyi %8, Çok iyi %3 idi. “GETAT uygulamlarının koruyucu hekimliklik uygulamaları açısından olumlu etkilerinin olup olmayacağını” sorduğumuzda %48’i olumlu katkı sunacağını düşünüyordu. Sonuç: GETAT konusunda bilgi düzeylerinin iki büyük hekim grubu olan Aile Hekimleri ve Pediatrilerde yeterli düzeyde olmadığı, eğitimin hiçbir aşamasında geleneksel ve tamamlayıcı tıp ile ilgili bir eğitim almamakla birlikte Türk toplumunun bunu pratikte kullanıyor olması bu konuda bilimsel çalışmalar yapmayı ve bilgi sahibi olmayı zorunlu kılmakta, tutum ve davranışların daha doğru alınması sonucunu doğuracaktır.