Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

https://www.who.int/respiratory/copd/GOLD_WR_06.pdf

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

Importance Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies. Objective To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students. Data Sources and Study Selection Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included. Data Extraction and Synthesis Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Main Outcomes and Measures Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview. Results Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2  = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, −0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P  = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2  = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2  = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%. Conclusions and Relevance In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.

https://jamanetwork.com/journals/jama/articlepdf/2589340/joi160133.pdf

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis.

A systematic review of studies of depression prevalence in university students.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)62116-4.pdf

Chronic obstructive pulmonary disease in non-smokers

The American Thoracic Society/European Respiratory Society jointly created a Task Force on "Outcomes for COPD pharmacological trials: from lung function to biomarkers" to inform the chronic obstructive pulmonary disease research community about the possible use and limitations of current outcomes and markers when evaluating the impact of a pharmacological therapy. Based on their review of the published literature, the following document has been prepared with individual sections that address specific outcomes and markers, and a final section that summarises their recommendations.

/pdf/outcomes-for-copd-pharmacological-trials-from-lung-function-4a4k924y7q.pdf

Outcomes for COPD pharmacological trials: From lung function to biomarkers

Factors determining in-hospital mortality and long-term survival of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are not precisely understood. The aim of the present study was to assess the parameters related to in-hospital mortality and long-term survival after hospitalisation of patients with AECOPD. Clinical and epidemiological parameters on admission in 205 consecutive patients hospitalised with AECOPD were prospectively assessed. Patients were followed-up for 3 yrs. Factors determining short- and long-term mortality were analysed. In total, 17 patients (8.3%) died in hospital. In-hospital mortality was significantly associated with lower arterial oxygen tension (P(a,O2)), higher carbon dioxide arterial tension, lower arterial oxygen saturation and longer hospital stay. The overall 6-month mortality rate was 24%, with 1-, 2- and 3-yr mortality rates of 33%, 39% and 49%, respectively. Cox regression analysis revealed that long-term mortality was associated with longer disease duration (relative risk (RR) = 1.158), lower albumin (RR = 0.411), lower P(a,O2) (RR = 0.871) and lower body mass index (RR = 0.830). When the model was run for the time elapsed since first hospitalisation, it also appeared as statistically significant (RR = 1.195). These findings show that patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease have poor short- and long-term survival. Prediction of survival status may be enhanced by considering arterial oxygen tension, albumin, body mass index, disease duration and time elapsed since the first hospitalisation.

https://erj.ersjournals.com/content/erj/26/2/234.full.pdf

Factors affecting survival of hospitalised patients with COPD

Anemia is considered a severe public health problem by World Health Organization when anemia prevalence is equal to or greater than 40% in the population. The purpose of this study was to determine the anemia prevalence with the associated factors in pregnant women and to determine the serum iron, folate and B12 vitamin status in anaemic pregnants in Malatya province. This is a cross-sectional survey. A multi-sage stratified probability-proportional-to-size cluster sampling methodology was used. A total of 823 pregnant women from sixty clusters were studied. Women were administered a questionnaire related with the subject and blood samples were drawn. Total blood count was performed within four hours and serum iron, folate and B12 vitamin were studied after storing sera at -20 C for six months. Anemia prevalence was 27.1% (Hb < 11.0 gr/dl). Having four or more living children (OR = 2.2), being at the third trimester (OR = 2.3) and having a low family income (OR = 1.6) were determined as the independent predictors of anemia in pregnancy. Anemia was also associated with soil eating (PICA) in the univariate analysis (p < 0.05). Of anaemic women, 50.0% had a transferrin saturation less than 10% indicating iron deficiency, 34.5% were deficient in B12 vitamin and 71.7% were deficient in folate. Most of the anemias were normocytic-normochromic (56.5%) indicating mixed anemia. In Malatya, for pregnant women anemia was a moderate public health problem. Coexisting of iron, folate and B vitamin deficiencies was observed among anaemics. To continue anemia control strategies with reasonable care and diligence was recommended.

/pdf/the-prevalence-of-nutritional-anemia-in-pregnancy-in-an-east-32913n181i.pdf

The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey

Objective The aims of this study were to explore the prevalence of depressive symptoms, ways of coping, and their relationships to sociodemographic variables among students of the Medical Faculty (MF) and the Health Services Higher Education School (HSHES) at Inonu University. Method The Beck Depression Inventory (BDI), Styles of Coping Inventory (SCI), and a sociodemographic questionnaire were used. Results Among the HSHES students (n = 128), the prevalence of depressive symptoms was higher. The MF students whose fathers had a higher level of education had higher BDI scores. The MF students from families with lower levels of income had a higher frequency of depressive symptoms. In both groups, the students with previous histories of psychiatric and physical ilness had higher BDI scores. Among the MF students, older age (OR = 2.72), and among the HSHES students, having a previous history of psychiatric disorder (OR = 5.25) and female gender (OR = 1.85) affected the prevalence of depressive symptoms. The HSHES students used passive styles of coping more frequently. Active coping styles were used more frequently by the male students in both groups. The HSHES students whose mothers had lower levels of education, had higher passive coping style scores; active coping styles and higher family income correlated positively. In both groups, BDI and active styles scores correlated positively. Passive styles were used more frequently by male and female students that had a higher frequency of depressive symptoms. Conclusion The rate of mental health problems was quite high among the students. Preventive mental health programs should be developed and implemented.

http://www.turkpsikiyatri.com/C18S2/en/prevalence.pdf

[Prevalence of depressive symptoms, ways of coping, and related factors among medical school and health services higher education students].

Background: In Turkey, violence against women was established as a critical area of concern related to women and various prevention strategies have been developed since 1980. There are limited numbers of studies on violence during pregnancy in the country. This study was performed to determine the prevalence of physical, emotional and sexual violence during pregnancy in Malatya province and the associated factors. Methods: A cross-sectional interview survey was conducted among pregnant women living in Malatya province between October 2003 and May 2004. Stratified probability-proportional-to- size sampling methodology was used for selecting the study population. A total of 824 pregnant women from 60 clusters were studied. Association between violence prevalences and womens' sociodemo- graphic, fertility and behavioural characteristics were evaluated. Results: During pregnancy 31.7% of women were exposed to any form of violence. Emotional violence was the most frequently reported form (26.7%), followed by sexual (9.7%) and physical violence (8.1%). Regular smoking (odds ratio (OR) 1.6), unwanted pregnancy (OR 1.8), living in urban area (OR 1.5), low education level of husband (OR 1.7), low family income (OR 1.9) and being in second trimester (OR 1.4) were determined to be the main predictors of overall violence during pregnancy. Conclusions: Violence during pregnancy is a common public health problem in Malatya. Low education level in partners, low family income, husband's unemployment, urban settlement, unwanted pregnancy and smoking should alert health staff towards violence at pregnancy and training of health personnel on the subject is recommended.

/pdf/physical-emotional-and-sexual-violence-during-pregnancy-in-4t511cfurq.pdf

Erkan Pehlivan

Papers

Factors affecting survival of hospitalised patients with COPD

The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey

[Prevalence of depressive symptoms, ways of coping, and related factors among medical school and health services higher education students].

Physical, emotional and sexual violence during pregnancy in Malatya, Turkey.

Prevalence of COPD: first epidemiological study of a large region in Turkey.