Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20 years

This study aimed to investigate whether there was an improvement in the equitable access to maternal and child health care services by examining the effects of socioeconomic and individual factors in Turkey from 1993 to 2013 and determine the effectiveness of health care reforms implemented mainly under the Health Transformation Program since 2003 on equitable access t;o maternal and child health care services in terms of years. The study used nationally representative 5 Turkey Demographic and Health Surveys (1993, 1998, 2003, 2008, and 2013). Prenatal care utilization rate increased from 67.0% in 1993 to 96.2% in 2013 while the rate of women giving birth at health care facilities increased from 63.8% to 98.1% in 2013. Prenatal care utilization and giving birth at health care facilities were higher among women who were under health insurance coverage, first time mothers, those staying in the western region and urban areas, and those with the highest level of wealth. The findings suggest that the issue of equity in the utilization of maternal and child health care services exists in Turkey, and the latest health care reforms under HTP are not effective in diminishing the effect of wealth.     

The effect of desensitizing treatments on the bond strength of resin composite to dentin mediated by a self-etching primer

This study evaluated the bond strength of resin composite to dentin, mediated by a self-etching adhesive, following the application of various dentin desensitizing treatments and artificial saliva storage. The buccal cervical areas of 24 extracted human third molars were ground flat to expose cervical dentin. The dentin surfaces were polished with 1200-grit SiC paper, then the teeth were randomly assigned to six groups, five desensitizing treatments and one control: Group I-VivaSens; Group II-Fluor Protector; Group III-Isodan; Group IV-Futura Bond NR; Group V-Nd:YAG laser and Group VI-Control (without application of a desensitizing agent). After applying the desensitizing treatments and storing the molars in artificial saliva for 14 days at 37 degrees C, Futura Bond NR was used to bond resin composite to dentin. TPH composite build-ups were constructed incrementally to a height of 5 mm. The teeth were sectioned to obtain bonded slices of 0.7 mm thick specimens containing the resin-composite joint. The specimens were then trimmed into an hourglass shape and subsequently subjected to microtensile testing at a crosshead speed of 1 mm/minute. The data were analyzed using the Kruskal-Wallis analysis and multiple comparisons test. The control (Group VI) and Futura Bond NR self-etching treatment (Group IV) group yielded statistically significant higher bond strength values than the other desensitizing treatment groups tested (p < 0.005). While pretreatment of dentin surfaces with desensitizing agents (Fluor Protector, VivaSens and Isodan) and laser (Nd:YAG) reduced the bond strength values of the resin composite, higher bond strengths were achieved using a self-etching adhesive (Futura Bond NR) as a desensitizing agent.     

Relationship between left ventricle geometric patterns and lymphocyte DNA damage in patients with untreated essential hypertension

OBJECTIVE: To investigate the association between different the left ventricle (LV) geometric patterns and lymphocyte DNA damage in patients with hypertension (HT). METHODS: We studied 84 patients (50.0+/-6.1, years) with HT and 24 healthy control subjects (48.6+/-3.3, years). Four different geometric patterns were identified in patients according to LV mass index and relative wall thickness. Peripheral lymphocyte DNA damages and plasma levels of total antioxidant status (TAS) were determined in all subjects. RESULTS: DNA damage was increased in hypertensive patients compared with control group (p=0.001). The major increase in DNA damage was observed in concentric hypertrophic geometric pattern compared with all other geometric patterns (p<0.001, for all). In multiple linear regression analysis, lymphocyte DNA damage was independently correlated with only TAS (beta=-0.444, p<0.001), but not LV geometry (p>0.05). CONCLUSION: The major increase in lymphocyte DNA damage was observed in concentric hypertrophic geometric pattern. This result may be related to increased oxidative stress.     

Upregulation of microRNA-93-5p/microRNA-4668-5p,and promoter methylation of matrix metalloproteinase-3 and interleukin-16 genes in Turkish patients with rheumatoid arthritis

Aim of the workTo investigate promoter methylation of matrix metalloproteinase-3 (MMP-3) and interleukin-16 (IL-16) genes with the expression of miRNA-93-5p and miRNA-4668-5p which target these genes in rheumatoid arthritis (RA), respectively.Patients and methodsThe study included 49 RA patients and 38 healthy controls. Promoter methylation of MMP-3 and IL-16 was analyzed by methylation-specific PCR. The expression of miRNA-93-5p and miRNA-4668-5p were determined. Disease activity score (DAS28) was assessed.ResultsThe 49 patients (38 female, 11 male) mean age was 50.4 ± 10.5 years and disease duration of 9.1 ± 7.4 years. The mean DAS28 was 3.9 ± 1.4. The MMP-3 gene methylation frequency was significantly lower in patients (n = 37;75.5%) compared to control (n = 37;97.4%) (p = 0.004) while they were comparable for IL-16 gene (n = 46;93.9% vs n = 37;97.4%)(p = 0.45). The relative normalized expression of miRNA-93-5p and miRNA-4668-5p were significantly increased (p < 0.001) in patients (2.28 ± 3.71 and 2.47 ± 4.17-fold) compared to controls (1.12 ± 0.18 and 1.28 ± 0.53-fold) and both tended to decrease with high disease activity (r =  ? 0.104, p = 0.52; r = ?0.24, p = 0.15, respectively). There was no significant difference of miRNA-93-5p (p = 0.45), and miRNA-4668-5p (p = 0.26) expressions between patients receiving treatment and those not. A negative correlation was observed between disease activity and change in expression levels of miRNA-93-5p (r = ?0.104, p = 0.52) and miRNA-4668-5p (r = ?0.24, p = 0.15). The ROC curve analysis of target miRNAs showed the diagnostic potential of miRNA-93-5p and miRNA-4668-5p (p = 0.003 and p < 0.001 respectively).ConclusionsThe methylation status of MMP-3 promoter and expression levels of miRNA-93-5p and miRNA-4668-5p could be useful biomarkers for the pathogenesis of RA and might reflect disease activity.     

Aortic pulse wave velocity in subjects with aortic valve sclerosis

Background: Aortic stiffness is an independent risk factor for cardiovascular events and mortality. The measurement of pulse‐wave velocity (PWV) is the most simple, noninvasive, and robust method to determine aortic stiffness. Whether aortic stiffness contributes to aortic valve sclerosis (AVS) remains unknown. The aim of the present study was to examine the relationship between PWV and AVS in subjects free of clinically evident atherosclerotic disease. Methods: We enrolled 62 patients (48 men; age 65 ± 8 years) diagnosed with AVS and an additional 62 age‐, hypertension‐, diabetes mellitus‐, and history of smoking‐matched subjects without AVS. Applanation tonometry was applied to assess the augmentation index and aortic PWV. The subjects with symptomatic vascular disease were excluded from the study. AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow. Results: There was no significant difference between the two groups regarding the aortic PWV and augmentation index (11.7±3.3 vs 11.8±3.7, P=0.85; 28.0±9.4 vs 25.0±8.6, P=0. 17, respectively). The presence of AVS was significantly correlated with ejection fraction (r=0.211, P=0.011), male gender (r=0.362, P=0.0001), and age (r=0.200, P=0.026). Conclusions: The lack of an association between the aortic PWV and AVS suggests that AVS is a complex phenomenon consisting of several distinct processes, related to both atherosclerotic and nonatherosclerotic processes.     

Evaluation of silicosis in ceramic workers

This study is aimed to evaluate the incidence of silicosis and the relation of it with personal and work-related factors among workers exposed to silica in ceramic factory. Workers were evaluated by respiratory symptoms, physical examination, pulmonary function and radiological findings. Occupational and Enviromental Pulmonary Disease Evaluation Questionnaire of the Turkish Thoracic Society Enviromental and Occupational Pulmonary Diseases Working Group was used. 365 of 626 workers had exposure to silica and the rest 261 were concerned as control group. There was no difference between mean age, duration of work and smoking pack year among the groups (p> 0.05). Cough and sputum rates were higher in silicosis group FEV1 and FVC values were lower in silica group but this was not statistically significant. When the two subgroups of silica group (the workers in high dust concentration and the ones in low concentration) were compared, the high concentrated group had significantly more sputum but the other symptoms and pulmonary functional parameters were not different significantly. 24 workers had parenchymal densities adjusted with pneumoconiosis. The workers with the pneumoconistic finding, had a higher mean age and longer duration of work. As a conclusion, ceramic industry has risk for silicosis. And the risk increase by time and age.