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Öğe An assessment of reliability and validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 among breast cancer patients in Qatar(Wolters Kluwer - Medknow, 2017) Bener, Abdulbari; Alsulaiman, Reem; Doodson, Lisa; El Ayoubi, Hanadi R.Introduction: Breast cancer has been the most common cancer type that affects women worldwide and subsequent treatment is oftenassociated with considerable psychological and quality of life (QoL). Aim: This study aimed to assess psychometric properties of theArabic version of the European Organization for Research and Treatment of Cancer (EORTC) general QoL questionnaire (QLQ?C30)for breast cancer patients in Qatar. Materials and Methods: This is a cross?sectional hospital?based study conducted on 678 breastcancer patients using Arabic version of the EORTC QLQ?C30 tool. Results: The mean age of women was 47.7 ± 10.2 years and33.4% of women had consanguineous parents. Six subscales out of the nine met the standards of reliability with coefficientsranging from 0.55 to 0.89. The mean score of all functioning scales was high >55. Advanced breast cancer stages of III–IV hadhigher symptomatic scores significantly than those in early stages for the physical function, cognitive, fatigue, insomnia, appetiteloss, constipation, and financial difficulties. Correlation coefficients between each item ranged from –0.113 to 0.960, and item21 (tense) and item 23 (irritable) had strongest negative correlations with their corresponding emotional functioning subscale,whereas items 29 (physical condition) and 30 (overall QoL) had the strongest positive correlation with Global Health/QoL subscale.Item 6 (limited work) showed a higher correlation with fatigue (r = 0.749). Likewise, item 19 (pain interfered with daily activities)of the pain subscale had higher correlations with physical functioning, role functioning, and fatigue subscales. Conclusion: QatariArabic version of the EORTC QLQ?C30 showed acceptable psychometric properties, which is a reliable and valid instrument, thatcan be used by oncologists.Öğe Assessing breast cancer risk estimates based on the gail model and its predictors in Qatari women(Sage Publications Inc, 2017) Bener, Abdulbari; Çatan, Funda; El Ayoubi, Hanadi R.; Acar, Ahmet; İbrahim, Wanis H.Background: The Gail model is the most widely used breast cancer risk assessment tool. An accurate assessment of individual's breast cancer risk is very important for prevention of the disease and for the health care providers to make decision on taking chemoprevention for high-risk women in clinical practice in Qatar. Aim: To assess the breast cancer risk among Arab women population in Qatar using the Gail model and provide a global comparison of risk assessment. Subjects and Methods: In this cross-sectional study of 1488 women (aged 35 years and older), we used the Gail Risk Assessment Tool to assess the risk of developing breast cancer. Sociodemographic features such as age, lifestyle habits, body mass index, breast-feeding duration, consanguinity among parents, and family history of breast cancer were considered as possible risks. Results: The mean age of the study population was 47.8 +/- 10.8 years. Qatari women and Arab women constituted 64.7% and 35.3% of the study population, respectively. The mean 5-year and lifetime breast cancer risks were 1.12 +/- 0.52 and 10.57 +/- 3.1, respectively. Consanguineous marriage among parents was seen in 30.6% of participants. We found a relationship between the 5-year and lifetime risks of breast cancer and variables such as age, age at menarche, gravidity, parity, body mass index, family history of cancer, menopause age, occupation, and level of education. The linear regression analysis identified the predictors for breast cancer in women such as age, age at menarche, age of first birth, family history and age of menopausal were considered the strong predictors and significant contributing risk factors for breast cancer after adjusting for ethnicity, parity and other variables. Conclusion: The current study is the first to evaluate the performance of the Gail model for Arab women population in the Gulf Cooperation Council. Gail model is an appropriate breast cancer risk assessment tool for female population in Qatar.Öğe Assessing the impact of serum calcium, 25-hydroxy vitamin d, ferritin, and uric acid levels on colorectal cancer risk(2024) Bener, Abdulbari; Öztürk, Ahmet Emin; Üstündağ, Ünsal Veli; Barışık, Cem Cahit; Ağan, Ahmet FarukBackground: The aim of this study is to investigate whether vitamin D, calcium, ferritin, and uric acids play a beneficial biomarker role in the prevention of colorectal cancer (CRC) risk. Methods: The case-control design was employed, including 650 CRC cases and 650 controls aged 35 to 70 years, comprising both men and women. The study encompasses sociodemographic data, clinical information, radiological diagnoses, and biochemical measurements. Results: Statistically significant differences were observed between CRC and controls in terms of age, diagnostic radiology, tomography, positron emission tomography/computed tomography (PET/CT), colonoscopy, CRC awareness, risk factors, age, genetics, exposure to chemicals, inadequate nutrition, smoking, hookah and alcohol use. Significant differences were also identified in intestinal inflammations, obesity, processed foods (P < 0.001), abdominal pain and cramps, diarrhea, constipation, blood in stool, bloating (gas), irritable bowel, nausea/vomiting, anemia, stress, fatigue, weakness, and weight loss. Regarding biochemical parameters, statistically significant differences were found between CRC and controls in terms of hemoglobin, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), vitamin D, neutrophil level, red blood cell (RBC), white blood cell (WBC), platelet level, platelet count, hematocrit, potassium, sodium (Na), calcium, creatinine, cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), bilirubin, uric acid, iron (Fe), ferritin, C-reactive protein (CRP), total protein, systolic blood pressure (SBP), and diastolic blood pressure (DBP) parameters (P < 0.001). Multivariate stepwise regression analysis was performed to find the best risk factors for the diagnosis of CRC as the dependent variable. As a result of the analysis, intestinal inflammation (P < 0.001), nausea/vomiting (P < 0.001), stomach pain (P = 0.003), hookah- smoking (P = 0.034), uric acid (P < 0.001), bilirubin (P < 0.001), cigarette smoke exposure (P = 0.033), processed food consumption (P = 0.002), calcium levels (P = 0.029), vitamin D deficiency (P < 0.001), and ferritin (P < 0.001) levels were identified as significant determinants for CRC. Conclusions: The current study demonstrated that vitamin D, calcium, ferritin, and uric acids play a beneficial biomarker role in reducing the risk of CRC prevention. The increase in CRC rates may be associated with lifestyle, environmental and hereditary factors, nutrition, alcohol consumption, hookah use, and cigarette smoking.Öğe Assessment of the role of serum 25-hydroxy vitamin D level on coronary heart disease risk with stratification among patients with type 2 diabetes mellitus(SAGE Publications Inc, 2021) Bener, Abdulbari; Al-Hamaq, Abdulla O. A. A.; Zughaier, Susu M.; Öztürk, Mustafa; Ömer, AbdulkadirWe investigated the role of vitamin D on glycemic regulation and cardiac complications in patients with type 2 diabetes mellitus (T2DM). A total of 1139 patients (49.3% males vs 50.7% females) were included. Information on sociodemographic lifestyle, family history, blood pressure (BP), and coronary heart disease (CHD) complications was collected. Significant differences were found between males and females regarding age-groups (P= .002), body mass index (BMI;P= .008), physical activity (P= .010), sheesha smoking (P= .016), cigarette smoking (P= .002), hypertension (P= .050), metabolic syndrome (P= .026), and CHD (P= .020). There were significant differences between vitamin D deficiency, insufficiency, and sufficiency in relation to age-group (P= .002), income (P= .002), waist circumference (P= .002), hip circumference (P= .028), waist-hip ratio (P= .002), and BMI (P= .002). Further, mean values of hemoglobin, magnesium, creatinine, hemoglobin A(1c)(HbA(1c)), total cholesterol, uric acid, and diastolic BP were significantly higher among patients with vitamin D deficiency compared with those with insufficiency and sufficiency. Multiple logistic regression analysis revealed that 25-hydroxy vitamin D, 25(OH)D, HbA(1c), waist circumference, uric acid, duration of T2DM, total cholesterol, systolic and diastolic BP, and BMI were strong predictor risk factors for CHD among patients with T2DM. The present study supports that 25(OH)D may have a direct effect on CHD and on its risk factors.Öğe Co-Morbidity between major depression and schizophrenia: Prevalence and clinical characteristics(Medicinska Naklada, 2020) Bener, Abdulbari; Dafeeah, Elnour Elnaem; Abou-Saleh, Mohammed T.; Bhugra, Dinesh; Ventriglio, AntonioBackround: The aim of this study was to explore the co-morbidity between Major Depressive Disorder (MDD) and Schizophrenia (SZ) among a large number of patients describing their clinical characteristics and rate of prevalence.Subjects and methods: A cohort-study was carried out on 396 patients affected by MDD and SZ who consecutively attended the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the World Health Organization - Composite International Diagnostic Interview (WHO-CIDI) and the Structured Clinical Interview for DSM-5 (SCID-5) for diagnoses. Patients were also grouped in MDD patients with and without co-morbid SZ (MDD vs MDD/SZ) for comparisons.Results: A total of 396 subjects were interviewed. MDD patients with comorbid SZ (146(36.8%)) were 42.69 +/- 14.33 years old whereas MDD without SZ patients (250 (63.2%)) aged 41.59113.59. Statistically significant differences between MDD with SZ patients and MDD without SZ patients were: higher BMI (Body Mass Index) (p=0.025), lower family income (p=0.004), higher rate of cigarette smoking (p<0.001), and higher level of consanguinity (p=0.023). Also, statistically significant differences were found in General Health Score (p=0.017), Clinical Global Impression-BD Score (p=0.042), duration of illnesses (p=0.003), and Global Assessment of Functioning (p=0.012). Rates of anxiety dimensions (e.g.: general anxiety, agoraphobia, somatisation, etc.), mood dimensions (e.g.: major depression, mania, oppositional defiant behaviour, Bipolar disorder), Attention Deficit Hyperactivity Disorder, psychotic and personality dimensions were higher among MDD with SZ patients than MDD without SZ.Conclusion: This study confirms that MDD with SZ is a common comorbidity especially among patients reporting higher level of consanguinity. MDD/SZ comorbidity presents unfavourable clinical characteristics and higher levels of morbidity at rating scales.Öğe Colorectal cancer and associated genetic, lifestyle, cigarette, nargileh-hookah use and alcohol consumption risk factors: a comprehensive case-control study(2024) Bener, Abdulbari; Öztürk, Ahmet Emin; Daşdelen, Muhammed Furkan; Barışık, Cem Cahit; Daşdelen, Zehra Betül; Ağan, Ahmet Faruk; de la Rosette, Jean J. M. C. H.; Day, Andrew S.Aim: This study aimed to investigate the causes and risk factors of colorectal cancer (CRC) in a Turkish population, focusing on various modifiable and non-modifiable risk factors. Methods: A hospital-based case-control design was employed to compare individuals with CRC (cases) to individuals without CRC (controls). Male and female participants were recruited from the surgery, internal medicine, and out-patient departments. The study encompassed socio-demographic data, clinical information, radiological diagnoses, and biochemical measurements. Univariable and multivariable logistic regressions were used to determine associated risk factors of CRC. Results: The study included 704 individuals with CRC and 704 controls. Significant socio-demographic disparities were observed between the groups, with over 30% of the cases having lower levels of education and income compared to the controls. Lifestyle factors such as obesity, higher rates of smoking (cigarettes and hookah) and alcohol consumption were more prevalent among cases than controls. Further significant associations were identified with intestinal inflammation, obesity, processed food consumption, and symptoms such as abdominal pain, cramps, diarrhea, constipation, blood in stool, bloating, irritable bowel syndrome, nausea/vomiting, anemia, stress, fatigue, weakness, and weight loss. Diet analysis revealed that individuals with CRC consumed more red meat, processed and fast foods along with less pulses and vegetables. Genetic predispositions and exposure to chemicals also correlated strongly with increased CRC risk. Multivariable regression analysis identified, nausea/vomiting, constipation, intestinal disease, genetics factor, hookah-nargileh use, history of any cancer, family history of bowel cancer, constipation, cigarette smoking, stress, milk-yogurt consumption, obesity and red meat consumption as significant determinants for CRC. Conclusion: CRC risk is influenced by dietary, lifestyle, and genetic factors. Awareness of hereditary risk and participation in screening are crucial. Lifestyle changes, such as avoiding smoking, hookah, and alcohol use, and adopting a healthy diet, are essential for prevention.Öğe Comparison of machine learning classification techniques to predict implantation success in an IVF treatment cycle(Elsevier Science Ltd, 2022) Yiğit, Pakize; Bener, Abdulbari; Karabulut, SedaResearch question: Which machine learning model predicts the implantation outcome better in an IVF cycle? What is the importance of each variable in predicting the implantation outcome in an IVF cycle?Design: Retrospective cohort study comprising 939 transferred embryos between 2014 and 2018 in an IVF centre in Turkey with 17 selected features. The algorithms were Logistic Regression (LR), Decision Tree (DT), Naive Bayes (NB), Random Forest (RF), Support Vector Machine (SVM), Neural Network (Nnet), Gradient Boost Decision Tree (GBDT), eXtreme Gradient Boosting (XGBoost) and Super Learner (SL). The results were evaluated with performance metrics (F1 score, specificity, accuracy and area under the receiver operating characteristic curve [AUROC]) with 10-fold cross-validation repeated ten times.Results: RF and SL models achieved the highest performance and showed F1 scores of 74% and 73%, specificity of 94%, an accuracy of 89%, and AUROC of 83%. In addition, the model identified the top features as maternal age, embryo transfer day, total gonadotrophin dose and oestradiol concentration.Conclusions: The present study revealed that machine learning algorithms successfully predicted implantation rates in an IVF attempt. In addition, maternal age is by far the most important predictor of IVF success when compared with other variables.Öğe COVID-19 pandemic and psychological fatigue in Turkey(SAGE Publications Ltd, 2021) Morgül, Ebru; Bener, Abdulbari; Atak, Muhammed; Akyel, Salih; Aktaş, Selman; Bhugra, Dinesh; Ventriglio, Antonio; Jordan, Timothy R.Aim: The aim of this study was to investigate the association between the COVID-19 pandemic and psychological fatigue as a mental health issue among the population of Istanbul, Turkey. Participants and methods: This is a cross-sectional study conducted in Istanbul, Turkey, between March and June 2020, where a total of 4,700 persons were approached and 3,672 (78%) of participants (64.4% males and 35.6% females ) completed the Knowledge Attitude Practices (KAP) and Fatigue Assessment Scale (FAS) questionnaires. Results: In this study, 64.1% of participants were categorized as psychologically fatigued and 35.9% as normal. There was a significant difference between fatigued and normal participants with respect to age, educational level, occupational status, place of residence and number of family members (p < .001). Other differences related to knowledge of COVID-19 were symptoms, treatment, ways of spreading (p < .001), prevention by avoiding crowded places (p =.008) and isolation (p =.002). For attitudinal items, normal participants generally showed more positive attitudes than the fatigued in believing that COVID-19 will finally be controlled, satisfaction with preventive measures taken by the authorities, reporting suspected cases with symptoms and trusting that Turkey can overcome the COVID-19 pandemic (p < .001). Multivariate stepwise regression analysis indicated that level of education, avoiding going to crowded places, eye, nose and mouth organs are sensitive organs to the virus, keeping physical distance due to epidemic affect by COVID-19 virus, isolation and treatment of people reduce the spread of COVID-19 virus and 14-days period of time, COVID-19 is mainly transmitted through contact with the respiratory droplets of an infected person, occupational status, health education programme needed and antibody treatment variables were significantly associated with fatigue after adjusting for age, gender and income variables. Conclusion: The current study provides valuable information for policymakers and mental health professionals worldwide regarding associations between the mental health of individuals and the ongoing outbreak, COVID-19.Öğe Determinants of brain drain among physicians in Turkey: Findings from a national exploratory study(2025) Bener, Abdulbari; Ventriglio, Antonio; Almas, Furkan; Bhugra, DineshBackground: The shortage of physicians in Turkey is a highly critical emergency. In fact, physicians’ migration to developing or high-income countries, defined as brain drain, threatens the sustainability of the national healthcare system. Aims: This study explored the driving factors associated with Turkish Physicians’ brain drain, including high-economic inflation, social-politics, poor-living, equity, violence, and the desire to practice medical activity abroad. Methods: A cross-sectional survey of 1,861 Turkish physicians aged 25 to 65 years old was conducted employing the Brain Drain questionnaire, the Depression Anxiety Stress Scale (DASS-21), the Patient Health Questionnaire 9 (PHQ-9), and the Fatigue Assessment Scale (FAS). Results: Significant differences were observed among physicians staying in Turkey versus considering migration to Western countries, regarding their age, gender, marital status, educational level, occupational status, work years, hospital night shifts, income, and cigarette/nargileh smoking habits (all p ⩽.018). The main reasons for brain drain included transport problems, harassment, low salary, malpractice, bad environment, job insecurity, workload, burnout, treating difficult patients, inadequate postgraduate systems, peer-pressure, health safety concerns, and favoritism in the workplace, as well as stress and depression caused by work overload. In fact, depression, anxiety, stress, fatigue, and burnout varied significantly among the different groups of physicians (all p ⩽.013). Additionally, key predictors of brain drain were better job opportunities, poor hospital management (in Turkey), job-related stress, dealing with difficult patients, research deficiencies, workload, burnout, transportation issues, short consultation time, low salary, and fatigue. Among the general factors contributing to the brain drain in the Turkish Health System, we identified significant issues related to research deficiencies, compulsory working duties, poor quality of postgraduate, inadequate medical-schools, poor hospital management, and shortage of consultants. Conclusion: Physicians’ migration is a major global public health concern, leading to substantial risks for healthcare services, especially in Turkey. Many physicians decide to migrate to work in Western countries.Öğe Driver sleepiness, fatigue, careless behavior and risk of motor vehicle crash and injury: Population based case and control study(Elsevier Science Bv, 2017) Bener, Abdulbari; Yıldırım, Erol; Özkan, Türker; Lajunen, TimoBackground: A few studies have been conducted to determine the relationship between road motor vehicle crashes (MVC) and serious injuries related to tiredness, fatigues and sleeping. Aim: To determine the effects of aggressive behaviour, driver sleepiness and fatigue on MVC and related injuries among Turkish population. Design and setting: Population-based case and control study conducted at the accident emergency departments of hospitals and roads. Subjects: 515 car drivers involved in crashes with injury were admitted to hospital and 1030 car drivers involved while driving on public roads as control group during the study period. Methods: The Manchester driver behaviour questionnaire (DBQ) measured the aberrant driving behaviours leading to accidents. Participants completed a fatigue severity scale (FSS) and Stanford Sleeping questionnaire an epworth scale with items related to socio-demographic information, driving experiences, adherence to traffic laws (such as speed limits and seat belt), and drivers 'driving records. Results: In a representative sampling, participant's age ranged from 25 to 65 and the mean and standard deviation were 36.5 +/- 7.8 for cases and 37.0 +/- 8.0 for controls. There was a significant difference in both group of drivers regarding BMI, level of education, marital status, driving experience, seat belt use, excessive speed limits, physical activity number of sleeping hours, mobile phone use, and cigarette smoking habit (p = 0.017). Also, there was a significant higher mean score on all the DBQ violation questions among case group in comparison with the control group (p < 0.001). Further, cases had higher prevalence of Epworth sleeping disorders (p < 0.001) and fatigue severity (p = 0.003) compared to control drivers. Multivariate logistic regression revealed that excessive speed, fatigue, lapses, errors, Stanford sleepiness score, violations, mobile phone use and Epworth sleepiness scale were significantly associated with injury involvement in vehicle crash, after adjusting for driving experience and annual mileage. Conclusion: The current study confirmed that drivers with chronic fatigue, acute sleepiness, and careless driver behavior may significantly increases the risk of road crash which can be lead to serious injury.Öğe Editorial: Global excellence in children and health(Frontiers Media SA, 2023) Bener, Abdulbari; Tewfik, Ihab; Zughaier, Susu M.; Day, Andrew S.Introduction Cooperation and collaboration within and between countries is an increasingly important component of tackling and overcoming the pressing issues impacting upon children’s health and wellbeing. This Research Topic (RT) aimed to highlight advances and achievements in the health and wellbeing of children across the globe. The seven included manuscripts touched on key endemic issues of diarrhoeal illnesses, micronutrient status and child development.Öğe Editorial: The role of vitamin D in gut health and disease in children(Frontiers Media SA, 2022) Day, Andrew S.; Bener, Abdulbari; Tewfik, Ihab; Vajro, Pietro; Zughaier, Susu M.The metabolism of vitamin D relies predominantly upon the synthesis of cholecalciferol (vitamin D3) in the epidermis following exposure to sunlight (specifically ultraviolet B rays) and the subsequent hydroxylation to active forms in the liver and kidney (1). Vitamin D can also be sourced from natural dietary sources such as fatty fish or from supplemented foods such as bread or cow’s milk.Öğe Essential parameters and risk factors of the patients for diabetes care and treatment(Elsevier Ltd, 2017) Bener, Abdulbari; Keskin, Fatma Ela; Kurtuluş, Eda Merve; Güzel, Mustafa; Çekirdekçi, Elif İjlal; Kadıoğlu, Pınar; Konukoğlu, Dildar; Öztürk, MustafaAim: The aim was to explore the association between Type 2 Diabetes Mellitus [T2DM] treatment satisfactions of patients regarding their socio-economic, life-style, history medication and clinical outcome in a Turkish population Subject and methods: A cross-sectional study conducted from February 2016 to September 2016. Of the total 1500 diabetic patients approached, 1094 (72.9%) gave their consent. Data analysis included, sociodemographic, serum lipid profiles (LDL, HDL), calcium, uric acid, blood pressure and glycated hemoglobin (HbA1c) at baseline and after six months. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) tools were used to measure the patient satisfaction. Results: The mean and standard deviation of age among gender, there were significant differences between males (51.81 +/- 14.40) and females (49.76 +/- 13.99) (p = 0.024). There were statistically significant differences between males and females regarding place of living (city 76% vs town 26%) p < 0.001) and consanguinity (p = 0.040). Almost of the patients with diabetes were overweight (males 44.5% vs females 41.8%) while more than a quarter (31.2%) males were obese. Among patients with diabetes, significantly larger proportion were treated for DM with insulin (females 28.8% vs males 22.5%) and 'insulin & oral anti diabetic drugs' (females 21.6% vs males 18.4%%; p < 0.001) in comparison. Reported average sleeping haours was significantly more among males (6.5 +/- 1.1 vs. 6.1 +/- 1.2; p < 0.001) than females. Males and females reported significantly greater improvements in mean values of blood glucose (-2.07 p < 0.001; vs.-2.36; p = 0.007), HbA1c (-1.72 p < 0.001; vs.-1.47 p = 0.038), potassium (+0.98 p < 0.001; vs. +0.93 p< 0.005); albumin (-3.38 p < 0.001; vs.-3.60; p < 0.001); billirubin (-0.69 p = 0.049; vs.-0.98; p < 0.001); uric acid (+11.9 p = 0.017; vs. +14.3; p < 0.001); systolic blood pressure (-3.86 p < 0.001; vs.-3.2 p < 0.001) and diastolic blood pressure (-3.17 p < 0.001; vs.-3.2 p < 0.001) in comparison to 6 months before. Multivariate stepwise regression analysis showed that the satisfaction DTSQ scores for HbAlc (p < 0.001), h of sleep (p < 0.001), neuropathy (p = 0.007), diabetic education (p = 0.014), SBP (mmHg) (p = 0.021) DBP (mmHg) (p = 0.028) were identified as significantly associated with higher treatment satisfaction. Conclusion: The study confirms a positive correlation between diabetes patient's satisfaction with care and treatment. Females DM patients compared to males had a better satisfaction score with current treatment, unacceptably low blood glucose level, flexibility in treatment and understanding of DM.Öğe Health services management in Turkey: Failure or success?(Wolters Kluwer Medknow Publications, 2019) Bener, Abdulbari; Alayoğlu, Nihat; Çatan, Funda; Torun, Perihan; Şafak Yılmaz, EsraBackground: The unfair distribution and delivery of health-care resources have been recognized as a problem in the worldwide. In the past 18 years, Turkey has undergone rapid social, cultural, and economic changes. The lifestyle and dietary habits of its people have also been changing, and the rates of diabetes, obesity, cancer, and other chronic diseases have increased dramatically over the past two decades. The health transformation program (HTP) has improved the Turkish health-care system since 2003. The main goal of HTP was to progress government, to provide equality between citizens, to give satisfaction to users and providers, and to subsidise the health-care system in Turkey. Aim: The aim of this study is to assess health-care services and health care quality delivery in the Republic of Turkey with special emphasis on governmental hospitals, university hospitals, primary healthcare centers (PHC) and to make comparison with low-, medium- and high-income countries. Methods: This is a retrospective, descriptive study. The ministry of health Annual Reports, websites of the Central Intelligence Agency (CIA), The World Fact Book, organization for economic cooperation and development report, Compendium of Health Statistics, the Google engine, and PubMed were searched for information about Turkey's health-care system and its history. Papers and websites in English were evaluated. There was no restriction on types of articles and sources. Results: Turkey has made outstanding reforms in health status in the last two decades, especially after the implementation of the HTP. The doctor's perception has more influence regarding consultation length and visit than the patient's. The results of consultations in volunteer practices in Istanbul showed that the mean and SD of the consultation length for the whole sample of 360 patients was 7.95 +/- 4.38, (with range = 3-25 min). Consultation time has been affected by the patients' diseases, genders that women got longer consultation time, medical practices at the urban or rural areas, and ages which older patients required longer consultation time. The current study revealed that increasing doctor's workload leads to decrease the length of consultations. Moreover, average life expectancy reached 75.3 for men and 80.7 for women in 2015. The infant mortality rate decreased to 10.7/1000 live births in 2015, down from 117.5 in 1980. The leading causes of death are diseases of the circulatory system followed by cancer. Conclusions: The Turkish health system and health-care delivery have been improved over the last decade. Still far from perfect, there is a particular planning to increase medical workforce in PHC including well-trained staffs for a specific area. An urgent need is to acquire more accurate and reliable data from hospital and PHC centers in Turkey. Additional some attempts should be made to assess quality of healthcare in relation to services and process.Öğe Internet addiction and the psychometric properties of the nine-item internet disorder scale-short form: An application of rasch analysis(Vesnu Publication, 2019) Bener, Abdulbari; Griffiths, Mark D.; Güler Baysoy, Nüket; Çatan, Funda; Yurtseven, ErayBackground: The aim of the present study was to determine the prevalence of disordered internet use among adolescent university students and its association with various health complaints and behaviours, and most importantly to examine the psychometric properties of 9-item Internet Disorder Scale-Short Form (IDS9-SF) using factor analyses and Rasch analysis.Methods: A total of 1988 university students aged 18 to 25 years were selected via a multi-stage stratified random sampling technique among university students in Istanbul, Turkey (September 2017 to February 2018). Data collected included socio-demographics, lifestyle and dietary habits, and the 9-item IDS9-SF. Statistical analysis included descriptive statistics, multivariate analyses, factor analyses, path analysis, and Rasch analysis.Findings: Using confirmatory factor analysis (CFA), the study investigated the latent structure of the IDS9-SF instrument and results supported its reliability and validity. The prevalence of disordered internet use was 18.3% in the sample. There were significant differences between those who had disordered internet use and those who did not in gender, family income, school performance, number of bedrooms at home, and number of people living at home, as well as internet use duration. Using multivariate regression analysis, key predictors of disordered internet use included (among others): gender, body mass index (BMI), household income, number of people living at home, having a computer at home, internet facilities, duration of internet use, sleeping hours, frequency of eating fast food, watching television, headache, hurting eyes, tired eyes, and hearing problems. Rash analysis demonstrated that four of the nine items (2, 3, 6, and 7) were more difficult for individuals to endorse compared to other items.Conclusion: Problems arising from excessive internet use were apparent among the study sample and the IDS9-SF is a valid and reliable measure for assessing disordered internet use among Turkish adolescent population.Öğe Internet addiction, fatigue, and sleep problems among adolescent students: A large-scale study(Springer New York LLC, 2019) Bener, Abdulbari; Yıldırım, Erol; Torun, Perihan; Çatan, Funda; Bolat, Erkut; Alıç, Sümmani; Akyel, Salih; Griffiths, Mark D.The aim of the present study was to examine the association between Internet addiction (IA), fatigue, and sleep problems among university students. A total of 3000 Turkish students aged 18 to 25 years were approached and 2350 students (78.3%) participated in this cross-sectional study from April 2017 to September 2017 in public and private universities in Istanbul. Data were collected via a structured questionnaire including socio-demographic details, lifestyle and dietary habits, Internet Addiction Test (IAT), Fatigue Scale, and Epworth Sleepiness Scale (ESS). Descriptive statistics, multivariate, and factorial analyses were performed. The overall prevalence of IA among the studied population was 17.7%. There were significant differences between gender, family income, father’s occupation, school performance, frequency and duration of watching television, physical activity, Internet use duration, and sleep duration (all p <0.001). Significant differences were also found between participants with IA and those without IA in having headaches, blurred vision, double vision, hurting eyes, hearing problems, and eating fast food frequently (all p <0.001). Using multivariate regression analysis, the duration of Internet use, physical and mental symptoms, headache, hurting eyes, tired eyes, hearing problems, and ESS scores were significantly associated with (and primary predictors of) IA. The present study demonstrated that IA was associated with poor dietary habits, sleep problems, and fatigue symptoms.Öğe Iron and Vitamin D levels among autism spectrum disorders children(Medknow Publications and Media Pvt. Ltd., 2017) Bener, Abdulbari; Khattab, Azhar Othman; Bhugra, Dinesh; Hoffmann, Georg F.The aim of this study was to investigate iron deficiency anemia and Vitamin D deficiency among autism children and to assess the importance of risk factors (determinants). Subjects and Methods: This was a case-control study conducted among children suffering from autism at the Hamad Medical Corporation in Qatar. A total of 308 cases and equal number of controls were enrolled. The Autism Diagnostic Observation Schedule-Generic was the instrument used for diagnosis of Autism. Results: The mean age (+/- standard deviation, in years) for autistic versus control children was 5.39 +/- 1.66 versus 5.62 +/- 1.81, respectively. The mean value of serum iron levels in autistic children was severely reduced and significantly lower than in control children (74.13 +/- 21.61 mu g/dL with a median 74 in autistic children 87.59 +/- 23.36 mu g/dL in controls) (P = 0.003). Similarly, the study revealed that Vitamin D deficiency was considerably more common among autistic children (18.79 +/- 8.35 ng/mL) as compared to healthy children (22.18 +/- 9.00 ng/mL) (P = 0.004). Finally, mean values ofhemoglobin, ferritin, magnesium; potassium, calcium; phosphorous; glucose, alkaline phosphate, hematocrit, white blood cell, and mean corpuscular volume were all statistically significantly higher in healthy control children as compared to autistic children (P < 0.001). Multivariate logistic regression analysis revealed that serum iron deficiency, serum calcium levels, serum Vitamin I) levels; ferritin, reduced physical activity; child order, body mass index percentiles, and parental consanguinity can all be considered strong predictors and major factors associated with autism spectrum disorders. Conclusion: This study suggests that deficiency of iron and Vitamin D as well as anemia were more common in autistic compared to control children.Öğe Joint venture healthcare system as common practice in developing countries: Game changing on assessing health services(Wolters Kluwer Medknow Publications, 2020) Al-Mazroei, Ahmed; Bener, Abdulbari; Arif, MohammedBackground: To explore the essence of game changing on applying joint venture (JV) approach for healthcare system improvement in developing countries. Methods: This is cross-sectional study exploring the factors influencing the successful implementation of JV for the healthcare services in low- and middle-income countries (LMICs). The study included: Qatar Statistical Authority, CIA fact book, Ministry of Health Annual Report, Hamad Medical Corporation Annual Report, Organization for Economic Cooperation and Development information, and Qatar's healthcare system history. Results: The research indicated that the LMIC healthcare system would benefit from affiliation with leading technology partner for healthcare reform. The findings support the view of LMIC healthcare systems' needs to incorporate joint venture approach in implementing JV concept for process improvement and knowledge transfer to contribute in country economic growth, development, and stability. Current study explored evidence supporting decision maker and management control of JV trends in different ways in comparison with developed countries. JV can also help the organization to share the risk and cost of large capital investment. Conclusions: The present study supports observations on expending the use of JVs as approach for improvement in LMIC healthcare system. The current study confirmed the advantages of JV which include helping businesses grow faster, increasing productivity, and generating greater profits, both parties sharing the risks and costs, accessing new markets and distribution networks.Öğe Lessons to be learned: The knowledge, attitudes, and practices of Turkish people towards the COVID-19 pandemic(Wolters Kluwer Medknow Publications, 2022) Bener, Abdulbari; Atak, Muhammed; Morgul, Ebru; Barışık, Cem CahitBackground: The world experienced the greatest pandemic of the 21 st century with the emergence of a new and readily transmissible the coronavirus disease. Understanding knowledge, attitudes, and practices (KAP) of the public towards the pandemic is an essential part of developing effective preventive strategies. Aim: The objective of this study was to investigate the knowledge, attitudes, and practices (KAP) concerning the coronavirus (COVID-19) among population in Istanbul. Methods: This is a cross-sectional and multi-stage, stratified random sampling based on multi-center population of Istanbul. A total of 5,414 persons were contacted and 4361 participants (80.5%) gave consent. The data were analyzed using descriptive and multiple regression analyses. Results: There were significant differences between low education and high educational level with respect to age groups, gender, occupation, income, residence, number of rooms and family members (P < 0.001). Responses concerning knowledge of COVID-19 indicated that subjects with high education level were significantly higher regarding knowledge of the signs and symptoms of COVID-19 and methods of detecting COVID-19 respectively. Majority of the participants consider COVID-19 risk is higher than AIDS or Cancer (75.8% of low education vs. 67.2% of high education level (P < 0.001). Multivariate stepwise regression analysis revealed that monthly income status (P < 0.001), appropriate method of detecting COVID-19 (P < 0.001), occupational status (P < 0.001), medical mask prevent against COVID-19 (P < 0.001), eating or contacting wild animals (P < 0.001), isolation and treatment of people reduce risk (P < 0.001), isolation 14 days (P < 0.001), avoid going to crowded places such as train-metro, bus, restaurants and shopping (P = 0.003), COVID-19 spreads via-respiratory droplets (P = 0.004), afraid of travel (P = 0.026) were significantly associated with COVID-19 knowledge. Conclusions: The current study results revealed that the educational level and occupation especially sedentary are correlated positively with knowledge, attitude and practices. This finding is not surprising since higher education levels and professional status are associated with good KAP in most epidemic diseases including COVID-19. Nevertheless, the recent experience with COVID-19 has provided lessons on strategy and policy making.Öğe Low vitamin D deficiency associated with thyroid disease among type 2 diabetic mellitus patients(Elmer Press, 2018) Bener, Abdulbari; Özdenkaya, Yaşar; Al-Hamaq, Abdulla O. A. A.; Barışık, Cem Cahit; Öztürk, MustafaBackground: The aim of this study was to investigate the relationship between vitamin D deficiency and thyroid diseases among type 2 diabetes mellitus (T2DM) patients.Methods: This was a cohort case and control study, 546 T2DM patients and 546 control study participants were enrolled, aged between 25 and 65 years. The subjects were also investigated for fasting blood glucose levels (FBG), post prandial glucose (PPG,) glycosylated hemoglobin (HbA1c), thyroid stimulating hormone (TSH), T3, T4, and presence of other comorbid conditions. Thyroid fine needle aspiration biopsy was suggested to patients whose thyroid nodules were greater than 1.00 cm.Results: There were significant differences between T2DM patients and control subjects regarding BMI (kg/m2), physical activity, cigarette smoking, sheesha smoking, family history of diabetes, hypertension and family history of thyroid nodules. The clinical biochemistry values among T2DM for vitamin D, calcium, magnesium, potassium, phosphorous, fasting blood glucose, cholesterol, HbA1c, HLDL, LDL, triglyceride, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were lower than control subjects, but higher in creatinine, albumin, TSH, T3, and T4 which appeared statistically significant differences (P < 0.001). Also, the study revealed statistically significant differences between subjects vitamin D deficiency and with thyroid nodules for calcium, magnesium, phosphorous, HbA1c, high density lipoprotein (HDL), SBP and DBP, TSH, T3, and T4 among T2DM patients and control subjects (P < 0.001). Multivariable stepwise logistic regression analysis showed that TSH, HbA1c, vitamin D deficiency, SBP (mm Hg), BMI, family history of DM, serum calcium level and family history of thyroid were considered at higher risk as predictors of thyroid among T2DM patients.Conclusions: This study suggests that obesity, HbA1c, the environment, and genetic susceptibility among T2DM, may increase the risk of thyroid disease and cancer. Although evidence has shown that thyroid cancer incidence has been rising more rapidly over time than the occurrence of cancers of other sites, due to an increase of obesity, diabetes and lack of physical activity, this study lacks of direct evidence supporting this conclusion.
