Article: Evaluation of thyroid disease and thyroid malignancy in acromegalic patients - Minerva Endocrinology 2023 June;48(2):130-9 - Minerva Medica - Journals

Aim: To investigate the job preferences of senior medical students for mandatory service as general practitioners using discrete choice experiment. Introduction: Health workforce is directly associated with health service coverage and health outcomes. However, there is a global shortage of healthcare workers (HCWs) in rural areas. Discrete choice experiments can guide the policy and decision-makers to increase recruitment and retention of HCWs in remote and rural areas by determining their job preferences. The aim of this study is to investigate job preferences of senior medical students for mandatory service as general practitioners. Methods: This cross-sectional survey was conducted among 144 medical students. To estimate students’ preferences for different levels of job attributes, a mixed logit model was utilised. Simulations of job uptake rates and willingness to pay (WTP) estimates were computed. Findings: All attributes had an impact on the job preferences of students with the following order of priority: salary, workload, proximity to family/friends, working environment, facility and developmental status. For a normal workload and a workplace closed to family/friends which were the most valued attributes after salary, WTPs were 2818.8 Turkish lira (TRY) ($398.7) and 2287.5 TRY ($323.6), respectively. The preference weights of various job characteristics were modified by gender, the presence of a HCW parent and willingness to perform mandatory service. To recruit young physicians where they are most needed, monetary incentives appear to be the most efficient intervention. Non-pecuniary job characteristics also affected job preferences. Packages of both monetary and non-monetary incentives tailored to individual characteristics would be the most efficient approach.

Physical inactivity is a major risk factor for non-communicable diseases (NCDs) globally. In Türkiye, the prevalence of physical inactivity is notably high, ranking third in Europe, with 44.4% of the population classified as physically inactive. This study aims to estimate the population attributable fractions (PAFs) of coronary heart disease, type 2 diabetes (DM), stroke, dementia, depression, and hypertension cases, deaths and disability-adjusted life-years (DALYs) due to physical inactivity in Türkiye. Data on physical inactivity prevalence and NCDs’ incidences, mortalities and DALYs were sourced from recent national surveys and Global Burden of Disease study. Relative risks (RRs) were obtained from global meta-analyses. PAFs were calculated using Levin’s equation. PAFs of physical inactivity were 16.7% for dementia, 11.6% for depression, 9.5% for stroke, 8.8% for CHD, 7.1% for type 2 diabetes and 3.1% for hypertension. Between 3.7% (for hypertension) and 17,5% (for dementia) of NCD deaths and 3.4% (for hypertension) and 17.1% (for dementia) of the DALYs due to NCDs examined in this study were attributable to insufficient physical activity. The burden was more significant among women and older ages.This study emphasizes the need for promoting physical activity and implement interventions focusing particularly on women and the elderly to reduce the burden of NCDs in Türkiye.

Dementia affects approximately 55 million people globally, with modifiable risk factors contributing significantly to its prevalence. While global studies have explored these factors, no research has applied the Lancet Commission’s framework to the Turkish population. This study aims to estimate the population attributable fractions (PAFs) of 14 modifiable dementia risk factors in Turkey, using the updated 2024 Lancet Commission framework. Data from the 2022 Turkey Health Survey, a nationally representative dataset, were used to calculate prevalences. The 14 risk factors were categorized into early life (low education), midlife (e.g., physical inactivity, obesity, depression), and later life (e.g., social isolation, air pollution, untreated vision loss). PAFs were computed using relative risks from meta-analyses and the Lancet Commission report. Principal Component Analysis and communalities were applied to account for intercorrelations between factors. The overall weighted PAF for Turkey was 49.9%, indicating that nearly half of dementia cases could be prevented through targeted interventions. Physical inactivity was the leading midlife factor, while social isolation and low education were the most significant contributors in later and early life stages, respectively. Gender-specific analysis revealed higher PAFs in women (54.2%) compared to men (44.3%), driven by differences in physical inactivity, depression, and social isolation. This study highlights the significant preventable burden of dementia in Turkey and underscores the importance of culturally tailored, gender-sensitive interventions. Addressing modifiable risk factors, particularly physical inactivity and social isolation, is critical to reducing dementia prevalence and informing public health strategies.