OBJECTIVE: The study aimed to investigate the utility of telemedicine conducted via video counseling in comparison to the previous structured approach and to compare prepandemic smoking cessation success rates with traditional counseling. MATERIAL AND METHODS: The applicants of the outpatient clinic for smoking cessation support pre- and post -pandemic periods were included in the study. The time intervals were retrospectively between 1 March and 30 August 2021 and the last 3 months of the year 2019. The data were revealed retrospectively. Age, sex, occupation, smoking history as package year, and the score of the Fagerstr & ouml;m test for nicotine dependence, accompanying chronic diseases, treatment method, and quitting status between 6 and 9 months of follow-up. RESULTS: The number of applicants was 200 (87% male) and 89 (95% male) in groups 1 and 2, respectively. The age difference was not significant. The difference was statistically significant according to having at least 1 accompanying chronic disease, specifically a lung disease. None of the parameters have affected the success of quitting smoking. The smoking cessation rate was 3.9 fold higher in the telemedicine group than in the traditional group. CONCLUSION: The main principle appears to be allocating enough time, as required on an individual basis, to clearly assess the situation, including identifying barriers and options. Since immediate systematic physical examination and laboratory testing may not be mandatory for individuals seeking smoking cessation support, telemedicine emerges as a reasonable option and a promising field for comprehensive video counseling.

Objectives: Vitamin D deficiency is a common situation for women who are in menopause due to various reasons. This study aims to investigate the effect of VDR gene polymorphisms and lifestyle on vitamin D levels of women in menopause. Materials and Methods: The study was planned in a cross-sectional descriptive design. Data was collected with a sociodemographic and lifestyle habits question form, and patients' blood samples were obtained for vitamin D levels and genetic tests. The data was evaluated by using SPSS 16.0 software. The logistic regression analysis model was created using the Backward elimination method, and the P-value below 0.05 was considered statistically significant. Results: The study was carried out on 303 menopausal women. The frequency of vitamin D deficiency in patients was 71.95%. Receiving vitamin D and Omega-3 supplements and having prolonged sleep duration were found to be protective factors from vitamin D deficiency. Of the VDR gene polymorphisms, the Bsml bb genotype was found to protect from vitamin D insufficiency, while the ApaI bb genotype increased the risk of vitamin D insufficiency. Conclusion: Vitamin D levels may be low in people who do not have sufficient sleep time. Our study found that the APA I aa genotype increased the risk of vitamin D deficiency, while the BsmI bb genotype protected from vitamin D deficiency. More studies are needed on the effects of lifestyle habits and genetic factors on serum vitamin D levels.

Background and objectives: An important Non-Communicable Disease risk factor, hypertension (HT), is highly prevalent and controlled HT rates are not sufficient which increases the risk of developing premature deaths. The purpose of the study is to evaluate differences in all-cause and cardiovascular-related mortality according to HT status by using national data from Chronic Diseases and Risk Factors Survey in Turkey (2011-2017).Materials and Methods: Cox regression models were used to estimate hazard ratios (HR) for predicting the all-cause and cardiovascular system-related mortalities. Median follow-up period was 6.2 years.Results: Among individuals with HT, 41.8% was untreated, 30.1% received treatment and had controlled blood pressure, and 28.1% were under treatment but had uncontrolled BP levels. The hazard for mortality among treated & uncontrolled hypertensive participants was significantly higher for all-cause (HR = 1.32, 95% CI = 1.06-1.65), cardiovascular (HR = 2.11, 95% CI = 1.46-3.06), heart disease (HR = 2.24, 95% CI = 1.46-3.43), and Coronary Heart Disease mortality (HR = 2.66, 95% CI = 1.56-4.53) compared to normotensive participants.Conclusions: Individuals with HT who were treated but do not have controlled blood pressure in Turkey had a significantly increased risk of Cardiovascular Disease and all-cause mortality. Along with studies investigating the causes of uncontrolled blood pressure despite initiation of treatment, support should be provided to patients in cases of non-adherence to antihypertensive medication or life change recommendations.

Abstract Background Although strong association between self-reported health and coronary heart disease (CHD) exists, health related quality of life (HRQOL) has not been conceptualized as a predictor for fatality in CHD patients. We investigated whether HRQOL may predict the risk of death in six years in CHD patients. Methods There were overall, 614 of CHD cases in the national representative Chronic Diseases and Risk Factors Survey in Turkey, 2011. Baseline self-reported health data on EuroQol- 5 Dimension (EQ-5D) and a Visual Analog Scale (VAS) were used from the same survey. The cases were followed-up for all-cause and CHD specific fatality (ICD-10 diagnostic codes: I20- I25) through electronic health records by 2017. Kaplan Meier and Cox regression models were used for data analysis. Age and sex adjusted HRs [aHR 95% CIs] were estimated for having some or extreme problems in EQ5D domains and VAS. Results Median follow-up years (IQR) was 6.46 (6.39-6.47). The number of deaths from all causes and CHD were 103 and 26, respectively. Age and sex adjusted HRs for all causes fatality were statistically significant for some or extreme problems in usual activities [2.48 (95%CI 1.60-3.83)], in pain/comfort [2.28 (95% CI 1.44-3.62)], in self-care [2.25 (95% CI 1.46-3.46)] and in mobility [1.85 (95% CI 1.16-2.96)]. Age and sex adjusted HRs for CHD specific fatality were statistically significant for some or extreme problems in self-care [3.45 (95% CI 1.48-8.07)] and pain/comfort [3.07(95% CI 1.19-7.93)]. VAS was negatively associated with overall fatality. Conclusions In CHD cases, poor self reported health might be a good indicator for overall and CHD specific fatality in 6 years. Especially having some or extreme problems in selfcare and pain/comfort are closely related with overall fatality as well as CHD specific fatality. Key messages There are strong relationships between HRQOL and all causes fatality as well as CHD specific fatality. Poor self- reported health might be a predictor for overall and CHD specific fatality in CHD cases.

Abstract 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. Key messages In Turkey, higher anthropometric measurements are associated with higher coronary heart disease incidence in among participants. In Turkey, higher anthropometric measurements are mostly associated with lower all-cause mortality in older age-groups.

Abstract Background Recent decades witnessed an increase in the burden of non-communicable diseases including adverse cardiovascular outcomes in low- and middle income countries and the burden was not equal across socioeconomic strata. This study aimed to define educational level inequalities in cardiovascular outcomes and all-cause mortality in a six-years cohort in Turkey. Methods Non-communicable Diseases and Risk Factors Cohort randomly sampled two adults (>14) from each of the registered family physicians in Turkey in July 2011 (n = 18,477). The family physicians collected demographic data. Incident coronary heart disease (CHD), cardiovascular and all-cause deaths were obtained from electronic health records in the end of 2017. Ridit score transformation was applied to the educational level by gender (illiterate, primary school, secondary school, high school or higher) and then Relative Index of Inequalities by educational level were estimated using Poisson Regression for morbidity and Cox Regression for mortality. Results There were 17,847 participants in CHD and 18,461 in the mortality cohort. During six-years 1,026 cases were diagnosed with CHD, 185 cardiovascular and 769 all-cause deaths occurred respectively. The inequalities were not significant for all outcomes however Relative Index of Inequalities were close to be significant for CHD incidence among men and all-cause mortality among women (0.721 (0.507 to 1.025) and 1.721 (0.969 to 3.057), respectively). Conclusions This is the first-ever cohort in Turkey with the aim to define educational level inequalities in cardiovascular outcomes and all-cause mortality. The inequalities may not have been observed due to the low number of outcomes. Key messages In Turkey, there were no educational level inequalities in our cohort. The possible inverse inequalities among men and inequalities among women may arise with a longer follow up.

Background: Non-dipper blood pressure is defined by less than a 10% reduction in nighttime blood pressure, and it is associated with cardiovascular disease. Inflammation is thought to play a role in the pathogenesis of both chronic obstructive pulmonary disease (COPD) and non-dipper blood pressure pattern, and both diseases are associated with lower quality of life.Objective: The aim of this study was to investigate the effects of non-dipper blood pressure pattern in patients with COPD.Methods: A cross-sectional study was carried out with 142 patients with COPD. The Saint George Respiratory Questionnaire and the Euro Quality of Life Scale were used to collect data. To understand arterial stiffness, the augmentation index and pulse wave velocity were measured, and 24-hour ambulatory blood pressure monitoring was subsequently performed. A multivariable logistic regression model was used to understand the relationship between different independent variables and blood pressure pattern. P values lower than 0.05 were considered statistically significant.Results: As a result, 76.1% (n = 108) of the patients had non-dipper blood pressure pattern. Non-dipper patients had higher C-reactive protein (OR: 1.123; 95% CI: 1.016; 1.242), augmentation index (OR: 1.057; 95% CI: 1.011; 1.105) and Saint George Respiratory Questionnaire total score (OR: 1.021; 95% CI: 1.001; 1.042) than dipper patients. Also, as the number of people living at home increased, non-dipper blood pressure pattern was found to be more frequent (OR: 1.339; 95% CI: 1.009; 1.777).Conclusion: Non-dipper blood pressure pattern may increase cardiovascular risk by triggering inflammation and may adversely affect the prognosis of COPD by lowering the disease-related quality of life.

Abstract 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. Key messages There is a strong association between anthropometric measurements and type 2 diabetes incidence. Anthropometric indicators can be used to predict the risk of type 2 diabetes in males and females by clinicians and public health practitioners.

Abstract Background Globally, 88% of deaths are caused by noncommunicable diseases (NCD) and they are increasing in our country as in many parts of the world. Effective control, prevention and treatment of NCD, can begin from knowing the disease incidence by age, sex and regions. Methods This study aimed to determine the incidence of chronic diseases (coronary heart disease, stroke, diabetes, hypertension and cancer) by record linkage of the data from the Turkey Chronic Diseases and Risk Factors Prevalence Study 2011 (TCD-RFS) with health service databases, which are Family Medicine Information System, Medulla- E-Pulse and Death Notification System. The cohort (18.477 people above age 15) from TCD-RFS is followed up to determine the incidence of coronary heart disease, hypertension, diabetes, stroke and cancer, from the electronic health record systems for the period between 2012 and 2017 (6 years). Cumulative incidences were calculated, age and sex standardized incidences were given with 95% CI. Results The age and sex standardized cumulative incidences are, 5939 (95% CI 5933-5945) for CHD 1378 (95%CI:1369-1388) for stroke, 2254 (95% CI 2 253 -2 255) for cancer, 4200 (95% CI 4194-4204) for diabetes and 20788 (95% CI 1369-1388) for hypertension (per 100,000). The annual incidences are approximately 990 for CHD, 229 for stroke, 375 for cancer, 700 for diabetes and 3464 for hypertension (per 100,000). CHD and cancer incidences are higher in men, while diabetes, hypertension and stroke incidences are higher in women. Conclusions Regardless of the difficulties in comparing incidence of NCD with other countries, we think our results show that hypertension, diabetes, stroke and CHD have higher incidence than Western European countries. We also showed that these metrics can be obtained through data linkage of National Health Records for the first time in Turkey. Key messages The NCDs needs to be monitored by surveillance using the current data sources for health services. This data can provide very useful information regularly to monitor and control NCDs if necessary actions are taken to adjust data management.

BACKGROUND: Asthma-chronic obstructive pulmonary disease overlap (ACO) is a disease characterized by persistent airflow obstruction with several features of both asthma and chronic obstructive pulmonary disease (COPD). AIM: The aim was to find patients who meet ACO criteria among COPD and asthmatics. MATERIALS AND METHODS: This cross-sectional study included outpatients who applied to our pulmonology outpatient clinic with the previous diagnosis of asthma and COPD in 2019. These participants were evaluated to determine whether they met criteria of ACO. The diagnostic criteria in Global Initiative for Asthma (GINA)-Chronic Obstructive Lung Disease (GOLD), Spanish, and American Thoracic Society (ATS) Guidelines were used as the diagnostic assessment for ACO. RESULTS: There were 156 men (56%) and 123 women (44%) with a mean age of 56.7 ± 15.6. Of the 279 patients analyzed, 25 (9%) met the ACO diagnostic criteria; 137 (49.1%) had COPD, and 117 (41.9%) had asthma. 5.5% of COPD and 12.7% of asthma patients were given the diagnosis of ACO. Eighty eight percent of ACO patients met the diagnostic criteria of GINA-GOLD, whereby 64% of them met Spanish, and 68% met ATS Guideline Criteria. Patients with ACO were of older age, had more comorbidities, higher rates of smoking, and worse spirometry parameters when compared with asthmatics (P < 0.01, P < 0.01, P = 0.017, and P < 0.01, respectively). ACO patients had a higher rate of female gender, higher mean age and more allergic symptoms than COPD patients (all P < 0.01). CONCLUSION: There were more patients who were given the diagnosis of ACO in asthma group when compared with COPD group. Clinicians may consider the diagnosis of ACO in smokers and older asthmatics and in COPD patients with atopic symptoms.

Resumo Fundamento O padrão pressórico não-dipper é definido por uma redução inferior a 10% na pressão arterial noturna e está associado a doenças cardiovasculares. Acredita-se que a inflamação desempenhe um papel na patogênese da doença pulmonar obstrutiva crônica (DPOC) e no padrão pressórico não-dipper e ambas as doenças estão associadas a uma qualidade de vida mais baixa. Objetivo O objetivo deste estudo foi o de investigar os efeitos do padrão pressórico não-dipper em pacientes com DPOC. Métodos Foi realizado um estudo transversal incluindo 142 pacientes com DPOC. O Questionário Respiratório de Saint George e a Escala de Qualidade de Vida Euro foram utilizados para a coleta de dados. Para entender a rigidez arterial, o índice de aumento e a velocidade da onda de pulso foram medidos; subsequentemente, foi realizada a monitorização ambulatorial da pressão arterial de 24 horas. Foi aplicado um modelo de regressão logística multivariável para entender a relação entre as diferentes variáveis independentes e o padrão pressórico. Foram considerados estatisticamente significativos valores de p inferiores a 0,05. Resultados Como resultado, 76,1% (n = 108) dos pacientes apresentaram o padrão pressórico não-dipper. Os pacientes com padrão não-dipper apresentaram valores mais altos de proteína C reativa (OR: 1,123; IC 95%: 1,016;1,242), índice de aumento (OR: 1,057; IC 95%: 1,011;1,105) e pontuação total no Questionário Respiratório de Saint George (OR: 1,021; IC 95%: 1,001;1,042), em comparação com os pacientes com padrão dipper. Adicionalmente, com o aumento do número de pessoas que habitavam o domicílio, verificou-se que o padrão pressórico não-dipper era mais frequente (OR: 1,339; IC 95%:1,009;1,777). Conclusão O padrão pressórico não-dipper pode aumentar o risco cardiovascular ao desencadear a inflamação e pode afetar adversamente o prognóstico da DPOC diminuindo a qualidade de vida relacionada à doença. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

This study was conducted to assess the health-related quality of life (HRQOL) and perceived health status of the Turkish population. The data came from a nationwide survey, which was conducted by Ministry of Health on prevalence and risk factors for chronic diseases in Turkey, with a representative random sample of 18,477 people aged ≥ 15 years from Turkey. Each family physician invited two individuals selected from their registered population to the Family Health Center, conducted the survey by face to face interviews using an electronic form. HRQOL was determined using EQ-5D-3L scale. In Turkish population, each four women out of 10, two men out of 10 have problems in pain/discomfort and anxiety/depression dimensions of the scale; three women out of 10, one man out of 10 have some or severe problems in mobility. Proportion of people without health problems (health state 11,111) were 64,1% in men, 40,7% in women. The mean VAS score for males was 71.5 ± 0.2 (95% CI 70.9–72.1), 66.4 ± 0.2 (95% CI 65.8–66.9) for females (p < 0.05).The most important determinants of having a problem in any of the five dimensions are age, gender, education, diabetes mellitus, coronary heart disease, stroke, alzheimer, cancer, renal failure. The OR of having some or severe problems in any dimensions was 4.6 (95% CI 38–5.4) for over 65–74 and 7.5 (95% CI 5.8–9.6) for over 75 compared to 15–24 age group. The perceived health level and HRQOL is worse in women, in older age groups, in people from lower socioeconomical status.

Objective: To determine whether vitamin D levels correlate with menopausal symptoms and female sexual functions. Study Design: A cross-sectional study. Place and Duration of Study: Izmir Katip Celebi University Hospital, Izmir, Turkey, between February and October 2017. Methodology: Menopausal and sexual active ladies aged 40-70 years were inducted. Those with psychiatric disorders, endocive abnormalities, related therapy, and malignancy were excluded. Menopause Rating Scale (MRS), and the Female Sexual Function Index (FSFI) were used to collect data. Also blood samples were collected from the patients. The study's data were examined with logistic and linear regression models. Results: Total MRS scale scores of the 303 subjects with one of the following conditions had a higher menopause symptom score; chronic disease, vaginal discharge, chronic pain, unsatisfied with sex, sleep problems, and low vitamin D level (p=0.023, p=0.007, p<0.001, p<0.001, p=0.017, and p<0.001; respectively). It was found that those who have middle income level were more likely to have better sexual function (OR: 0.209, 95% CI: 0.065; 0.671) compared to those who have low income level. It was found that those with higher MRS somatic complaint (OR: 1.274; 95% CI: 1.087; 1.494) and urogenital complaint (OR: 1.670; 95% CI: 1.326; 2.102) and ones with lower vitamin D levels (OR: 0.963; %95 CI: 0.941; 0.987) were more likely to report complaints for sexual function disorders. Conclusion: Vitamin D of all women in menopause should be evaluated. High vitamin D levels should reduce menopausal symptoms and positively affect sexual function.

Breast cancer (BC) is the most frequent type of cancer among women. Screening and early diagnosis is crucial for reducing the disease burden. However the screening rates for BC is not at desired levels. Health belief and health anxiety are two conditions that affect participation in cancer screening. The aim of this study is to explore the relationship between health beliefs regarding breast cancer screening and health anxiety among women. This cross-sectional study included 301 women between 20 and 69 years of age who were admitted to the family medicine outpatient clinic. The study data was collected using the Health Anxiety Inventory (HAI) and Champion’s Health Belief Model Scale (CHBMS). The questionnaires were filled with face-to-face interview technique. To explain the relationship between anxiety and the components of the health belief model a multivariate linear regression model was used. High anxiety levels were positively correlated with the seriousness and health motivation components and negatively correlated with the self-efficacy component of the health belief model related to breast cancer (p [Med-Science 2019; 8(2.000): 343-8]

The aim of the study is to determine the correlates of in-hospital costs for palliative care in a university hospital setting. This is a retrospective cost-of-illness study using data from the records of patients who were admitted to Katip Celebi University Hospital during December 2013- December 2015. Direct medical costs were calculated from the Social Security Institute perspective. Socio-demographic and clinical information was abstracted from patient files. A generalized linear model was used in the multivariate analysis to generate cost ratios(CR). The average exchange rate for USD/TL was 2.72 for year 2015. We included 374 in-patients in total in the study. Gastrointestinal system cancers were the most common cancer type (42.4%) followed by genitourinary system cancers (20.1%), central nervous system (16.4%), breast cancer (10,7%) respectively. Neurologic cancers (4746±3989 TL) and genitourinary system cancers (3968±3804 TL) had the highest costs. The largest proportion of the total cost was formed by medical interventions (55.8%), followed by medications (17.0%). Radiotherapy CR:1.67(95% CI: 1.19-2.34) and tramadol treatment CR:1.26(95%CI:1.01-1.59) were significant predictors of hospital costs. Palliative unit costs varied substantially, however majority of the variables could not predict the hospital cost of palliative care independently.

Clinical practice guidelines (CPGs) are defined as "Systematically developed statements to assist with practitioner and patient decisions for specific clinical circumstances". If the guidelines are based on evidence, accepted by local health professionals, and linked with performance indicators and implementation strategies, they can lead to improved quality of care and health outcomes. To reach the maximum potential, CPGs must be both well developed and effectively introduced into clinical practice. Also, CPGs should be a reference point for the reimbursement policy. This study aims to determine the gap between the evidence based clinical practice guidelines and reimbursement decisions. We selected two disease from the top ten disease in the National Burden of Disease Study,2013; low back pain and anemia. Then the back pain and anemia guidelines recommendations on diagnosis and treatment were compared with the reimbursement decisions in Turkey. The recommendations of the anemia guideline about diagnosis and treatment were in line with the reimbursement decisions. However, the recommendations in low back pain guideline about diagnosis and treatment had differences between reimbursement decisions. For example; the guideline used in primary care recommended the patients with low back pain should be x-rayed, but in Turkey we don't have the opportunity to the X-ray in primary care. Also the guideline suggested patients with chronic low back pain use gabapentin topiramat, but physicians in primary care were not auhorize to prescribe the gabapentin. CPGs served as a reference point for clinical decision making should also serve as a reference point for reimbursement decisions. Explicit considerations of how the guideline recommendations link with reimbursement decisions is needed. If a country wants evidence-informed policy, a guideline development process needs to be embedded in the health system at all levels.

The aim of the study is to evaluate cost-effectiveness of scaling up services for routine cervical cancer screening with smear test and HPV vaccine initiation for girls aged 12 from Social security and Ministry of Health perspective. This is a model based cost-effectiveness study. We generated a state-transition markov model with the help of literature which defines the natural course of the HPV infection. The model starts from the age of 12 and runs till 85 years of age in a women cohort . Model involves different health states such as; healthy, HPV infection, CIN 1,CIN 2, CIN 3, Cancer states 1 to 4) and the annual transition probabilities between cycles were obtained from literature. We evaluated 3 scenarios: 1.scaling up routine screening programme, 2.HPV vaccination 3. Both scaling up the routine screening programme and initiating HPV vaccination. Costs are presented as Turkish Lira(TL) and effectiveness as quality adjusted life years (QALY). We run the model 1000 times for probabilistic analyses. Data was analysed using Treeage 2009 programme. Compared to the assumption that existing screening rates will continue, the incremental cost-effectiveness ratio is calculated as 1072 TL / QALY for doubling the cervical smear screening rates, which was the most cost effective option. The addition of HPV vaccine to the existing screening program was dominated to other interventions The doubling of existing screening rates + 2-dose HPV vaccination strategy had an incremental cost-effectiveness ratio of 26014 TL / QALY, which was cost-effective. Increasing screening rates of cervical smear by two-folds and increasing screening rates+ 2 doses of HPV vaccination strategies were cost-effective. It is anticipated that the scaling-up the screening program in combination with initiating HPV vaccination programme will have a positive impact in terms of cost-effectivenes in Turkey.

OBJECTIVE:Fluorine-18 fluorodeoxylglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has a well-established role for detection and quantification of atherosclerotic inflammatory disease using standardized uptake value (SUV) measurements. Our aim was to compare the inflammatory and macroscopic calcification processes of atherosclerosis in the aortic segments and large arteries of subjects with insulin dependent diametes mellitus (IDDM) compared to those of age-matched controls via 18F-FDG PET/CT. PATIENTS AND METHODS:A hundred and ten subjects who underwent 18F-FDG PET/CT imaging for oncological diseases were retrospectively studied. Fifty five were diabetics on insulin and 55 were age-matched controls. Average SUVmax and SUVmean for four segments of aorta and for common iliac arteries and femoral arteries were measured and compared between subject groups. Presence or absence of macroscopic calcification on CT images for each arterial segment was also noted and compared between these groups. RESULTS:Average SUVmax and SUVmean were statistically significantly greater in subjects with IDDM compared to controls in all arterial segments (P≤0.001). Presence of calcification on CT was more frequently encountered in 6 of the 8 segments in subjects with IDDM, and there was statistically significantly difference for the descending aorta and abdominal aorta. CONCLUSION:Our results show that inflammatory component of atherosclerosis was more severe in all aortic segments in subjects with IDDM compared to those of controls. Presence of macroscopic calcification also detected to be more frequently encountered in the descending thoracic and abdominal aorta in subjects with IDDM. Fluorine-18-FDG PET/CT is a valuable diagnostic tool for detecting and semi-quantifying accelerated atherosclerotic inflammatory and calcific changes secondary to diabetes mellitus treated with insulin in the aortic segments and large arteries.

Background The management of juvenile idiopathic arthritis (JIA) includes various methods including such as medication, hospitalization, rehabilitation. Objectives To determine how much juvenile idiopathic arthritis cost; the components of this cost; how new treatments, i.e. biologics, improve the disease course and hospital expenditures. Methods This study was conducted in Dokuz Eylul University, Pediatric Rheumatology Unit between March 2015-March 2016. One-hundred six JIA patients who had a follow-up period of at least 1 year according to International Edmonton 2001 criteria were included. This retrospective cost study evaluated the data of these patients and calculated the direct cost for the follow-up period. Clinical data was collected from patient files that were in department9s archive and cost data was gathered from Probel Hospital Information Management system. Patient data form covering sociodemographic and clinical information, patient drug form and annual medical cost form was filled out for each patient. Results 58.5% (n=62) of patients was female and 41.5% (n=44) was male. The mean age was 12.0±4.3 years. 34.0% (n=36) of patients was oligoarticular type, 28.3% (n=30) was poliarticular type, 22.6% (n=24) was enthesitis related arthritis (ERA), 8,5% (n=9) was psoriatic type and 6.6% (n=7) was systemic type. The cost of medication counted for 88.3% (453244.94 TL) of total direct annual cost. Total direct medical cost was highest for ERA (n=7742.55±9891 TL). While the annual cost was calculated as 10451 TL per person for biologic using patients, for the patients using non-biologic treatments it was determined as 1472 TL per person. 1 TL=0.32 € 1 TL =0.35 $ Conclusions Medication is responsible for most of the total direct medical cost in patients with JIA. Our results showed concordance with previous studies on the subject. This situation could be attributed to biologic agents that are being used in treatment in recent years. More prospective studies on the effectiveness of cost of treatment, with greater amount of patient and more homogenous subgroups are needed. Disclosure of Interest None declared