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Eser E, Cil E, Sen Gundogan NE, Col M, Yildirim Ozturk EN, Thomas DT, Sunter AT, Arslan HN, Citil R, Onder Y, Picakciefe M, Dede B, Demirel C, Aydin N, Caglayan C, Aker AA, Borlu A, Durmus H, Can G, Siddikoglu E, Sumer EH, Uygun T, Alkoy S, Aktas Aycan K, Koruk İ, Kuzan R, Demir LS, Hacilar E, Sari H, Kilinc Z, Onal O, Dogan E, Emek M, Terzioglu R, Yapici G, Erdal D, Eser S, Ayhan Akman E, Kosan Z, Yilmaz S, Ayoglu FN, Acikgoz B, Musal B, Suner AF, Erdogan A, Cilburunoglu İ, Saygun M, Daymaz D, Arslantas D, Onsuz MF, Beyhun NE, Ustundag MG, Ekuklu G, Ozder Tas F, Abacigil F, Oncu S, Hıdıroğlu S, Ozaydin AN, Pirincci E, Bulut I, Tozun M, Eskiocak M, Gunel P, Torun SD, Yavuz M, Hasde M, Camur D, Gunes G, Kurt B, Guler Baysoy N, Bakirci N, Demir F, Catak B, Ozyurda F, Turan M. Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study. Teach Learn Med 2023:1-13. [PMID: 37530502 DOI: 10.1080/10401334.2023.2229810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the "working conditions in the country" (OR: 1.89, 95% CI: 1.56-2.28) whereas the "social environment/lifestyle abroad" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). Insights: Although the percentage of those who want to emigrate "definitely" was at the same level as in the other developing countries, the tendency to migrate "permanently" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.
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Affiliation(s)
- Erhan Eser
- Department of Public Health, Manisa Celal Bayar University, Manisa, Türkiye
| | - Elif Cil
- Department of Public Health, Manisa Celal Bayar University, Manisa, Türkiye
| | | | - Meltem Col
- Department of Public Health, Ankara University, Ankara, Türkiye
| | | | - David Terence Thomas
- Department of Pediatric Surgery, Maltepe University, Istanbul, Türkiye
- Department of Medical Education, Maltepe University, Istanbul, Türkiye
| | | | | | - Riza Citil
- Department of Public Health, Tokat Gaziosmanpaşa University, Tokat, Türkiye
| | - Yalcin Onder
- Department of Public Health, Tokat Gaziosmanpaşa University, Tokat, Türkiye
| | - Metin Picakciefe
- Department of Public Health, Mugla Sitki Kocman University, Mugla, Türkiye
| | - Bahadir Dede
- Department of Public Health, Mugla Sitki Kocman University, Mugla, Türkiye
| | - Can Demirel
- Department of Biophysics, Gaziantep University, Gaziantep, Türkiye
- Department of Medical Education, Gaziantep University, Gaziantep, Türkiye
| | - Neriman Aydin
- Department of Medical Education, Gaziantep University, Gaziantep, Türkiye
- Department of Public Health, Gaziantep University, Gaziantep, Türkiye
| | - Cigdem Caglayan
- Department of Public Health, Kocaeli University, Kocaeli, Türkiye
| | - Ahmet Alp Aker
- Department of Public Health, Kocaeli University, Kocaeli, Türkiye
| | - Arda Borlu
- Department of Public Health, Erciyes University, Kayseri, Türkiye
| | - Hasan Durmus
- Department of Public Health, Erciyes University, Kayseri, Türkiye
| | - Gunay Can
- Department of Public Health, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Esin Siddikoglu
- Department of Public Health, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Ergun Haldun Sumer
- Department of Public Health, Sivas Cumhuriyet University, Sivas, Türkiye
| | - Tunahan Uygun
- Department of Public Health, Sivas Cumhuriyet University, Sivas, Türkiye
| | - Seval Alkoy
- Department of Public Health, Bolu Abant İzzet Baysal University, Bolu, Türkiye
| | - Kubra Aktas Aycan
- Department of Public Health, Bolu Abant İzzet Baysal University, Bolu, Türkiye
| | - İbrahim Koruk
- Department of Public Health, Harran University, Sanliurfa, Türkiye
| | - Rustem Kuzan
- Department of Public Health, Harran University, Sanliurfa, Türkiye
| | - Lutfi Saltuk Demir
- Department of Public Health, Necmettin Erbakan University Meram, Konya, Türkiye
| | - Esra Hacilar
- Department of Public Health, Necmettin Erbakan University Meram, Konya, Türkiye
| | - Hidir Sari
- Department of Public Health, Dicle University, Diyarbakir, Türkiye
| | - Zehra Kilinc
- Department of Public Health, Dicle University, Diyarbakir, Türkiye
| | - Ozgur Onal
- Department of Public Health, Suleyman Demirel University, Isparta, Türkiye
| | - Edanur Dogan
- Department of Public Health, Suleyman Demirel University, Isparta, Türkiye
| | - Mestan Emek
- Department of Public Health, Akdeniz University, Antalya, Türkiye
| | - Rıdvan Terzioglu
- Department of Public Health, Akdeniz University, Antalya, Türkiye
| | - Gulcin Yapici
- Department of Public Health, Mersin University, Mersin, Türkiye
| | - Deniz Erdal
- Department of Public Health, Mersin University, Mersin, Türkiye
| | - Sultan Eser
- Department of Public Health, Balikesir University, Balikesir, Türkiye
| | - Emine Ayhan Akman
- Department of Public Health, Balikesir University, Balikesir, Türkiye
| | - Zahide Kosan
- Department of Public Health, Ataturk University, Erzurum, Türkiye
| | - Sinan Yilmaz
- Department of Public Health, Ataturk University, Erzurum, Türkiye
| | - Ferruh Niyazi Ayoglu
- Department of Public Health, Zonguldak Bulent Ecevit Universitesi, Zonguldak, Türkiye
| | - Bilgehan Acikgoz
- Department of Public Health, Zonguldak Bulent Ecevit Universitesi, Zonguldak, Türkiye
| | - Berna Musal
- Department of Medical Education, Dokuz Eylul University Izmir, Türkiye
| | | | - Aysegul Erdogan
- Department of Public Health, Kahramanmaras Sutcu Imam University, Kahramanmaras, Türkiye
| | - İdris Cilburunoglu
- Department of Public Health, Kahramanmaras Sutcu Imam University, Kahramanmaras, Türkiye
| | - Meral Saygun
- Department of Public Health, Kirikkale University, Kirikkale, Türkiye
| | - Didem Daymaz
- Department of Public Health, Kirikkale University, Kirikkale, Türkiye
| | - Didem Arslantas
- Department of Public Health, Eskisehir Osmangazi University, Eskisehir, Türkiye
| | | | | | | | - Galip Ekuklu
- Department of Public Health, Trakya University, Edirne, Türkiye
| | - Fulya Ozder Tas
- Department of Public Health, Trakya University, Edirne, Türkiye
| | - Filiz Abacigil
- Department of Public Health, Adnan Menderes University, Aydin, Türkiye
| | - Selcen Oncu
- Department of Medical Education, Adnan Menderes University, Aydin, Türkiye
| | - Seyhan Hıdıroğlu
- Department of Public Health, Marmara University, Istanbul, Türkiye
| | | | - Edibe Pirincci
- Department of Public Health, Firat University, Elazig, Türkiye
| | - Irem Bulut
- Department of Public Health, Firat University, Elazig, Türkiye
| | - Mustafa Tozun
- Department of Public Health, Izmir Katip Celebi University, Izmir, Türkiye
| | - Muzaffer Eskiocak
- Department of Public Health, SANKO University, Gaziantep, Türkiye
- Department of Medical Education, SANKO University, Gaziantep, Türkiye
| | - Pinar Gunel
- Department of Medical Education, SANKO University, Gaziantep, Türkiye
- Department of Biostatistics, SANKO University, Gaziantep, Türkiye
| | | | - Melike Yavuz
- Department of Public Health, Bahcesehir University, Istanbul, Türkiye
| | - Metin Hasde
- Department of Public Health, University of Health Sciences - Gulhane Faculty of Medicine, Ankara, Türkiye
| | - Derya Camur
- Department of Public Health, University of Health Sciences - Gulhane Faculty of Medicine, Ankara, Türkiye
| | - Gulsen Gunes
- Department of Public Health, Yuksek Ihtisas University, Ankara, Türkiye
| | - Burak Kurt
- Department of Public Health, Yuksek Ihtisas University, Ankara, Türkiye
| | | | - Nadi Bakirci
- Department of Public Health, Acibadem University, Istanbul, Türkiye
| | - Figen Demir
- Department of Public Health, Acibadem University, Istanbul, Türkiye
| | - Binali Catak
- Department of Public Health, Kafkas University, Kars, Türkiye
| | - Ferda Ozyurda
- Department of Public Health, TOBB University of Economics and Technology, Ankara, Türkiye
| | - Mustafa Turan
- Department of Medical Education, TOBB University of Economics and Technology University, Ankara, Türkiye
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Kolgelier S, Demir NA, Inkaya AC, Sumer S, Ozcimen S, Demir LS, Pehlivan FS, Arslan M, Arpaci A. Serum Levels of Annexin A2 as a Candidate Biomarker for Hepatic Fibrosis in Patients With Chronic Hepatitis B. Hepat Mon 2015; 15:e30655. [PMID: 26587036 PMCID: PMC4644632 DOI: 10.5812/hepatmon.30655] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/31/2015] [Accepted: 08/31/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatologists have studied serologic markers of liver injury for decades. Annexins are a prominent group of such markers and annexin A2 (AnxA2) is one of the best characterized annexins. AnxA2 inhibits HBV polymerase among other functions. Its expression is up-regulated in regenerative hepatocytes. OBJECTIVES To determine if serum AnxA2 level has a role in estimating liver damage in chronic HBV infection and investigate whether AnxA2 levels correlate with hepatic fibrosis. PATIENTS AND METHODS This study included 173 patients with chronic hepatitis B (CHB) and 51 healthy controls. Liver fibrosis was graded histologically on liver biopsy samples. Blood samples were taken from patients during biopsy and serum AnxA2 levels were measured with ELISA. RESULTS In a group of adult patients with CHB, AnxA2 values were far higher than those of the control group (P = 0.001). When we assessed AnxA2 levels based on fibrosis stages, serum AnxA2 levels of patients with early stage fibrosis (stages 1 - 3) were significantly higher than those of patients with advanced stage fibrosis (stages 4 - 5; P = 0.001). CONCLUSIONS AnxA2 is a useful biomarker for early stage fibrosis in patients with CHB.
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Affiliation(s)
- Servet Kolgelier
- Department of Infectious Diseases and Clinical Microbiology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
- Corresponding Author: Servet Kolgelier, Department of Infectious Diseases and Clinical Microbiology, Adiyaman University Faculty of Medicine, Adiyaman, Turkey. Tel: +90-5052671529, Fax: +90-3322412184, E-mail:
| | - Nazlim Aktug Demir
- Department of Infectious Diseases and Clinical Microbiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Ahmet Cagkan Inkaya
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sua Sumer
- Department of Infectious Diseases and Clinical Microbiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Serap Ozcimen
- Department of Infectious Diseases and Clinical Microbiology, Konya State Hospital, Konya, Turkey
| | - Lutfi Saltuk Demir
- Department of Public Health, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Mahmure Arslan
- Department of Biochemistry, Adiyaman State Hospital, Adiyaman, Turkey
| | - Abdullah Arpaci
- Department of Biochemistry, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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Aktug Demir N, Kolgelier S, Ozcimen S, Gungor G, Sumer S, Saltuk Demir L, Inkaya AC, Ural O. Evaluation of the relation between hepatic fibrosis and basic laboratory parameters in patients with chronic hepatitis B fibrosis and basic laboratory parameters. Hepat Mon 2014; 14:e16975. [PMID: 24748897 PMCID: PMC3989596 DOI: 10.5812/hepatmon.16975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/24/2014] [Accepted: 03/06/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The hepatitis B virus is an important healthcare problem. According to current clinical practice, a liver biopsy is required for the diagnosis and treatment of chronic liver disease. However, a liver biopsy is an invasive, inconvenient procedure, which requires an expert pathologist opinion. Therefore requirement of biochemical tests, which are considered to indicate hepatic fibrosis and may be repeated easily, increases gradually today. OBJECTIVES This study evaluated the correlation between hepatic fibrosis and routine laboratory values in patients with chronic hepatitis B. PATIENTS AND METHODS The files of 456 patients with CHB (chronic hepatitis B) who were referred to the infectious diseases and clinical microbiology clinic between January 2009 and March 2012 were screened retrospectively. Liver biopsy samples were examined according to Ishak scoring. Laboratory parameters and histopathology reports were recorded, and correlations between the fibrosis grade and laboratory parameters were analyzed. RESULTS There were 320 male and 136 female patients, with a mean age 36.7 ± 12.1 years. According to liver biopsy results, a low fibrosis score (stage 0-2) was detected in 281 patients (61.6%), and a high fibrosis score (stage 3-5) was detected in 175 patients (38.4%). Patients with a high fibrosis score had significantly higher ALT (alanine amino transferase), AST (aspartate aminotransferase), and HBV-DNA values and a significantly lower platelet count compared with those with a low fibrosis score (P = 0.001, 0.001, 0.025, and 0.001, respectively). A positive correlation was detected between the fibrosis score and age, BMI, HAI, ALT, and AST values, and a negative correlation was detected between the fibrosis score and albumin and platelet counts. In the regression analysis performed to evaluate the factors associated with high-stage fibrosis, fibrosis was determined to be associated with thrombosis, ALT, and gender. The results of the regression analysis demonstrated that the risk of fibrosis was 4.6 fold higher in men. CONCLUSIONS According to the results obtained in our study, advanced age, higher BMI, AST, ALT, and HBV-DNA levels, and low albumin and platelet levels are correlated with advanced fibrosis in patients with CHB.
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Affiliation(s)
- Nazlim Aktug Demir
- Infectious Diseases and Clinical Microbiology Department, Selcuk University, Konya, Turkey
| | - Servet Kolgelier
- Infectious Diseases and Clinical Microbiology Department, Adiyaman University, Adiyaman, Turkey
| | - Serap Ozcimen
- Infectious Diseases and Clinical Microbiology Department, Konya State Hospital, Konya, Turkey
| | - Gokhan Gungor
- Gastroenterology Department, Konya Education and Training Hospital, Konya, Turkey
| | - Sua Sumer
- Infectious Diseases and Clinical Microbiology Department, Selcuk University, Konya, Turkey
- Corresponding Author: Sua Sumer, Infectious Diseases and Clinical Microbiology Department, Selcuk University, Konya, Turkey. Tel: +90-5058746251, Fax: +90-3322412184, E-mail:
| | | | - Ahmet Cagkan Inkaya
- Infectious Diseases and Clinical Microbiology Department, Hacettepe University, Ankara, Turkey
| | - Onur Ural
- Infectious Diseases and Clinical Microbiology Department, Selcuk University, Konya, Turkey
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