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Bismarckian health systems are mainly governed by social health insurers, but their role, status, and power vary across countries and over time. We compare the role of health insurers in three distinct social health insurance systems in improving health systems' efficiency. In France, insurers work together as a single payer within a highly regulated context. Although this gives insurers substantial bargaining power, collective negotiations with providers are highly political and do not provide appropriate incentives for efficiency. Both Germany and the Netherlands have introduced competition among insurers to foster efficiency. However, the rationale of insurer competition in Germany is unclear because contracts are mostly concluded at a collective level and individual insurers have little power to influence health system efficiency. In the Netherlands, insurer competition is substantially more effective, but primarily focused on price and cost containment. In all three countries, the role of insurers has been transforming slowly to respond to common challenges of assuring care quality and continuity for an ageing population. To assure sustainability, they need to ensure that care providers cooperate with the same quality and efficiency objectives, but their capacity to do so has been limited by insufficient support to enforce public information on provider quality.
Will existing forms of artificial intelligence (AI) lead to genuine intelligence? How is AI changing our society and politics? This essay examines the answers to these questions in Brian Cantwell Smith's The Promise of Artificial Intelligence and Mark Coeckelbergh's The Political Philosophy of AI with a focus on their central concern with judgment—whether AI can possess judgment and how developments in AI are affecting human judgment. First, I argue that the existentialist conception of judgment that Smith defends is highly idealized. While it may be an appropriate standard for intelligence, its implications for when and how AI should be deployed are not as clear as Smith suggests. Second, I point out that the concern with the displacement of judgment in favor of “reckoning” (or calculation) predates the rise of AI. The meaning and implications of this trend will become clearer if we move beyond ontology and metaphysics and into political philosophy, situating technological changes in their social context. Finally, I suggest that Coeckelbergh's distinctly political conception of judgment might offer a solution to the important boundary-drawing problem between tasks requiring judgment and those requiring reckoning, thus filling a gap in Smith's argument and clarifying its political stakes.
Socio-cultural integration of refugees has received scant attention in the academic literature. Türkiye hosts the largest number of refugees, including Afghans, as the second largest asylum-seeking group in Türkiye. There is a dearth of research into the mental health and integration of Afghan refugees in Türkiye. The aim of the present study was to investigate socio-cultural integration outcomes among Afghan refugees in Türkiye by considering the role of traumatic events and post-displacement stressors. The role of mental health in integration outcomes was further examined.
A cross-sectional, web-based survey study with 785 Afghan refugees in Türkiye was conducted between April and June 2021. Data were collected on socio-demographic characteristics, potentially traumatic events (PTEs) (Harvard Trauma Questionnaire), post-displacement stressors (Post-Migration Living Difficulties Checklist), mental health symptoms (Hopkins Symptoms Checklist-25), social integration- social bonds (contact with co-ethnic group members) and social bridges (contact with the host community)- and cultural integration (Vancouver Index of Acculturation). Structural equation modelling was conducted to test the hypothesized relationship between conflict and displacement-related stressors, mental health and socio-cultural integration.
Findings showed that conflict-related traumatic events and post-displacement stressors significantly predicted higher mental health symptoms. Experiencing traumatic events significantly predicted higher levels of social bridges, adopting destination culture and lower level of maintaining heritage culture. Mental health problems predicted the relationship between stressors related to forced displacement and integration outcomes-social bridges and adopting destination culture. These findings highlight the role of mental health as an indispensable resource for socio-cultural integration. Further, conflict and displacement-related stressors are important determinants of socio-cultural integration among Afghan refugees in Türkiye.
Exposure to PTEs and post-displacement stressors were significant risk factors for the mental health and socio-cultural integration of Afghan refugees in Türkiye. These stressful experiences deteriorate refugees’ mental health, which hinders their integration into the host society.
Unmet need for family planning is a valuable concept to indicate the discrepancy between women’s fertility preferences and contraceptive use. Unmet need may lead to unintended pregnancies and unsafe abortions. These may result in health deterioration and reduced employment opportunities for women. The 2018 Turkey Demographic and Health Survey report indicated that the estimated unmet need for family planning doubled from 2013 to 2018, returning to the high levels of the late 1990s. Considering this unfavourable change, this study aims to investigate the determinants of unmet need for family planning among married women of reproductive age in Turkey by using the 2018 Turkey Demographic and Health Survey data. Logit model estimations revealed that women who were at older ages, more educated, wealthier, and had more than one child were less likely to have unmet need for family planning. Employment statuses of women and their spouses and place of residence were significantly associated with unmet need. Results emphasised that training and counselling to enhance the use of family planning methods should effectively target young, less educated, and poor women.
The social sciences and humanities in general and International Relations (IR) specifically are organised around what has been called ‘analytic bifurcation’. Analytic bifurcations artificially structure and divide analytic spaces into, for example, Europe/non-Europe, inside/outside, state/empire, and metropole/colony. Recently, these bifurcations have been problematised within IR and adjacent fields. Our article contributes to and extends these discussions by foregrounding two interrelated aspects that have not received sufficient attention: first, connections between colonies rather than between metropole and colony and, second, the construction and reproduction of the bifurcation of Europe/non-Europe. We explore how technologies of power, in our case mapping and the use of ‘blank spaces’, were used to create imaginaries of colonisable land. To do so, we trace two episodes from nineteenth-century German colonial discourse. The first episode analyses imaginaries of exploration in the Humboldtian tradition and how these imaginaries depict spaces outside of Europe, namely in Africa, as blank spaces. The second episode reconstructs the cartographic work of Paul Langhans, who focused on mapping ‘Germandom’ (Deutschtum) in Central and Eastern Europe. Juxtaposing these two episodes shows the interconnectedness between these spaces (Africa and the European East) and how techniques such as blank spaces were applied to create colonisable land.
In this paper, I develop an algorithmic impossible-worlds model of belief and knowledge that provides a middle ground between models that entail that everyone is logically omniscient and those that are compatible with even the most egregious kinds of logical incompetence. In outline, the model entails that an agent believes (knows)
just in case she can easily (and correctly) compute that
is true and thus has the capacity to make her actions depend on whether
. The model thereby captures the standard view that belief and knowledge ground are constitutively connected to dispositions to act. As I explain, the model improves upon standard algorithmic models developed by Parikh, Halpern, Moses, Vardi, and Duc, among other ways, by integrating them into an impossible-worlds framework. The model also avoids some important disadvantages of recent candidate middle-ground models based on dynamic epistemic logic or step logic, and it can subsume their most important advantages.
Everolimus is a mTOR inhibitor that has been increasingly used in high-risk cardiac rhabdomyomas in recent years. There are questions regarding the optimal dose and duration of therapy with everolimus for cardiac rhabdomyomas. The purpose of this study was to examine retrospectively the dosage-efficacy relationship in seven babies diagnosed with rhabdomyoma treated with different everolimus dose regimens retrospectively. Cardiac rhabdomyoma diagnosis was made in six of seven babies during the prenatal period. Indication of everolimus was an obstruction in six patients and supraventricular tachycardia which is resistant to antiarrhythmic drugs in the remaining one patient. The median age was 8 days (range; 2–105 days) at the time of starting everolimus. It was administered at a dose of 0.25 mg twice a day for two days a week in four patients; 0.1 mg/day in two and 0.4 mg/day in one patient. Serum everolimus level was kept between 5 and 15 ng/ml. All seven cases showed significant regression of cardiac rhabdomyoma within four weeks, and supraventricular tachycardia was controlled in two weeks after everolimus administration.
This study demonstrates that everolimus was effective in accelerating regression of the cardiac rhabdomyoma. Dose with 2 × 0,25 mg/day, 2 days a week, seems appropriate. However, lower doses such as 0.1 mg/day are also effective. But dose adjustment should be made according to serum level monitoring.
Isolated aortic coarctation performed through a left thoracotomy resection and end-to-end anastomosis results in low mortality and morbidity rates. Recoarctation and late hypertension are among the most important complications after such repairs. In this study, we reviewed the results of children who underwent left-side thoracotomy to correct an isolated aortic coarctation.
A consecutive sample of 90 patients who underwent resection and extended end-to-end anastomosis through a left-side thoracotomy in our centre between 2011 and 2021 was retrospectively analysed. The patients' preoperative characteristics, operative data, and post-operative early and long-term results were examined
All patients underwent resection and extended end-to-end anastomosis. A pulmonary artery band was applied simultaneously to three (3.3%) patients, and an aberrant right subclavian artery division was applied to one (1.1%) patient. The mean cross-clamp time was 29.13 ± 6.97 minutes. Two (2.2%) patients required reoperation in the early period. Mortality was observed in one (1.1%) patient in the early period. Eight (8.8%) patients developed recoarctation, of whom four (4.4%) underwent reoperation and four (4.4%) underwent balloon angioplasty. Twenty-two (26.8%) patients received follow-up antihypertensive treatment. The mean follow-up period was 41.3 ± 22.8 months. No mortality was observed in the late period.
Isolated coarctation is successfully treated with left-side thoracotomy resection and an extended end-to-end anastomosis technique with low mortality, morbidity, and low long-term recoarctation rates. Long-term follow-up is required due to the risks of early and late post-operative recoarctation, which requires reintervention.
Initially known as “the Turkish Godfather,” Turkish TV series Çukur (2017–2021) occasionally received criticism from government ministers and the government’s media regulatory board. This was surprising because Turkey’s and Çukur’s cultural universes converged around the masculinist protection of family and territory. So, why this political backlash despite the convergence? Wouldn’t that convergence of masculinity produce similar political imaginations? In this article we argue that in shaping the family and urban space, Çukur’s masculinities remain precarious vis-à-vis the hegemonic masculinity in “New Turkey.” Rather than being the society’s building blocks, Çukur’s families are suffocating spaces. At the same time, as opposed to cultivating neoliberal responsibility, Çukur’s familialism emerges as a space of solidarity in a precarious neighborhood to which state forces can hardly enter. Therefore, the neighborhood (mahalle) is not a space of consumption and surveillance but a haven against urban precarities. Despite their hierarchies and authoritarianism, Çukur’s men reject unquestioned political loyalty, conspicuous consumption, and entrepreneurship while endorsing the various impasses in family and urban life. Showing that absolute political obedience and economic dependence is not the only way out of neoliberal authoritarianism, Çukur confirms popular culture’s power in representing liminal spaces outside the state’s oppressive power and the markets’ commodifying logics.
Türkiye hosts 4 million refugees and asylum seekers, with Syrians and Afghans being among the largest refugee groups in country. There are limited comparative data on the conflict- and displacement-related experiences of these groups and the relation with mental health status.
To assess the mental health status of Syrians and Afghans in Türkiye, identify risk factors and explore to what extent differences in mental health conditions are related to potentially traumatic events and post-displacement stressors.
Two parallel online survey studies were conducted between April and June 2021 among 798 Syrians and 785 Afghans in Türkiye. Data were collected on sociodemographic characteristics, traumatic events (Harvard Trauma Questionnaire), post-displacement stressors (Post-Migration Living Difficulties Checklist), symptoms of depression and anxiety (Hopkins Symptoms Checklist-25) and post-traumatic stress disorder (PTSD) (Post-Traumatic Stress Disorder Checklist for DSM-5, short form).
For Syrian and Afghan participants respectively, estimated prevalence rates were: 41.1% and 50.3% for depression; 39.6% and 41% for anxiety; and 41.6% and 46.5% for PTSD. In both groups, significant predictors were female gender, exposure to potentially traumatic events, and structural and socioeconomic post-displacement stressors. Additional risk factors were older age for Afghans and higher education for Syrians.
Self-reported symptoms of common mental health problems are highly prevalent among Syrian and Afghan refugees and associated with a wide range of risk factors. After controlling for conflict- and displacement-related experiences, Afghans reported higher anxiety symptoms than Syrians, which is likely related to their legal status in Türkiye.
Studies have demonstrated an association between CHD and neurodevelopmental delay. This delay is associated with many factors like reduced blood flow and oxygen, cardiac catheterisations, and genetic factors. Apo E gene polymorphism is one of these genetic factors. This study aims to show the effect of Apo E gene polymorphism on neurodevelopmental process in children having CHD. A total of 188 children having CHD were admitted to the study. Apo E gene polymorphism of these patients was determined, and psychometric evaluation was performed. The relationship between psychometric test results and gene polymorphism was evaluated. This study shows that, similar to the literature, patients having cyanotic CHD have worse scores than acyanotic patients, and the children with CHD are under risk in terms of neuropsychiatric disorders. Other novel and important findings of this study were the lower verbal scores of ε2 allele carriers than ε4 carriers in Wechsler Intelligence Scale for Children-Revised group and the worse test score of patients having VSD than other acyanotic patients. Besides, some special disorders may be seen in this patient group.
Virtual exchange (VE) is an ideal venue for digital literacy skills development (Fuchs, Hauck & Müller-Hartmann, 2012) and for critical digital literacy (CDL) (Hauck, 2019). Yet literacy is a fluid, deictic term, the meaning of which is context dependent, and digital literacies need to be defined and conceptualised within a specific context. Recent CALL literature highlights the interest in CDL from various perspectives, but how CDL is conceptualised by the VE participants themselves is not explored. Participants of this study were 37 trainee English language teachers in the UK and Turkey who joined a 6-week VE. Their ongoing reflections on CDL were captured through reflective e-portfolio entries following each VE task. Thematic analysis revealed four components of CDL in this specific VE: (1) participants’ awareness of digital affordances for self-expression, (2) semiotic and interactional means to build connections, (3) ensuring inclusiveness of all community members, and (4) implications of socio-political contexts of each participant for meaning-making and interaction. We conclude that in future pedagogical implementations of VE, facilitators can foster trainee teachers’ CDL development through more closely guided and informed reflection on the four themes presented in this paper. As such, this study makes a novel contribution to our understanding of CDL in VE settings for ELT teacher education by offering a social semiotic second language acquisition orientation within an interpretivist paradigm.
This study is aimed to evaluate the validity and reliability of the Cancer Stigma Scale for the Turkish population (CASS-T).
The sample of the study consisted of 412 students of a foundation university located in Ankara, Turkey. The reliability of the CASS was evaluated using the Cronbach alpha reliability coefficient and item-total score correlations. Exploratory factor analyses were applied to examine the factor structure of the scale and its construct validity. To test the time invariance of the scale, the relationships between the scores obtained from the first and second applications were examined using the intraclass correlation coefficient (ICC).
The Cronbach's alpha coefficient of CASS-T was 0.83. In the factor analysis, it was confirmed that the scale has a six-dimensional structure in parallel to original version, namely Avoidance, Severity, Responsibility, Policy opposition, Awkwardness, and Discrimination. The ICC values all remained in the range that indicates the reliability of the 0.63–0.71 to be substantial. The contribution of the six factors of the CASS-T scale to the variance is 57.8.
Significance in results
The Turkish version of the CASS was confirmed to have good reliability and validity for evaluating stigma toward cancer in Turkish society.
Violence against women (VAW) is a major public health problem and a violation of women’s human rights. The coronavirus disease 2019 (COVID-19) pandemic has worsened gender inequality, resulting in a heightened incidence of VAW. This study aims to assess the characteristics of women who admit to the emergency department (ED), both before the pandemic and during the pandemic. The secondary aim is to compare the frequencies of violence cases between periods.
By single-center, retrospective, and cross-sectional design, the periods of April 10 - December 31, 2020 and April 10 - December 31, 2019 were compared. The outcomes of the study were the daily ED admission numbers of both sexes, the prevalence of VAW cases in the ED, as well as sociodemographic and clinical variables of the women who were exposed to violence.
During the pandemic period, number of VAW cases in the ED increased 13% and the ratio of VAW cases to all ED admissions tripled compared to the pre-pandemic period. Women exposed to VAW were more likely to be without social insurance, injured in the trunk part of their body, and having a life-threatening injury in the pandemic period. In both periods, women were attacked by an intimate partner, dominantly (42.6% and 54.1%, respectively). In addition, among all admissions of adults to the ED, women’s percentage decreased while men’s admission ratios increased during the pandemic period. Admissions to ED declined 47.7% during the COVID-19 pandemic compared to the year before.
Cases of VAW tend to increase during the pandemic, and health care settings should be well-organized to respond to survivors.
Although the literature on informal care-giving for older parents shows that daughters have a higher tendency to provide care compared with sons, only a few studies have focused on the gender composition of all children or parents’ entire range of care options. Our study examines the effect of children's gender composition on informal and formal care types, as well as the informal care network. Using data from the 2015 Survey of Health, Ageing and Retirement in Europe (N = 40,312), we found that parents with daughters tended to use less formal care because daughters take on additional informal care-giving responsibilities. Daughters were the main care-givers among parents’ informal care networks. Further analysis indicated that daughters-in-law play an important role in the care-giving process when parents have only sons. We concluded that the presence of a daughter among the children reduces the use of formal care. The results indicated that children's gender composition is an important factor in explaining the allocation of informal care to parents.