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Emerging research highlights the potential cognitive benefits of physical exercise (PE) programs for schizophrenia (SCZ). The few recent efficacy studies that examined augmenting cognitive training (CT) with PE suggest superior effects of the combination. The next step is to consider strategies to enhance adherence in real-world settings if this type of combined treatment is going to be effective. We present the first community effectiveness data for PE and CT that included a motivationally-enhancing, self-determined approach to exercise, in lieu of participant payment. Eighty-five outpatients with schizophrenia attending an intensive outpatient program were randomized to 18 h of either (A) self-determined PE regimen with choice from a menu of different activities; (B) tablet-based neurofeedback CT focused on processing speed (PS) and working memory (WM), or (C) a time-matched combination of PE and CT. Assessments were conducted at baseline, post, and follow-up (2 mo). All groups improved in WM from baseline to post, with greatest gains in the PE only group. At follow-up, cognitive gains originally observed in the PE-only group disappeared, while the PE + CT group evidenced improvements in WM and psychotic symptoms. Notably, attrition for PE was only 7%. Our data shows that combining PE and CT leads to lasting effects that are superior to those of either intervention alone. The low PE drop-out rate suggests a self-determined approach to the exercise regimen was tolerable, and may be an important component of future community implementation efforts. Keywords: Schizophrenia, Motivation, Physical exercise, Cognitive training

Diabetes is common and seen in one in five patients with schizophrenia. It is more prevalent than in the general population and contributes to the increased morbidity and shortened lifespan seen in this population. However, screening and treatment for diabetes and other metabolic conditions remain poor for these patients. Multiple factors including genetic risk, neurobiologic mechanisms, psychotropic medications, and environmental factors contribute to the increased prevalence of diabetes. Primary care physicians should be aware of adverse effects of psychotropic medications that can cause or exacerbate diabetes and its complications. Management of diabetes requires physicians to tailor treatment recommendations to address special needs of this population. In addition to behavioral interventions, medications such as metformin have shown promise in attenuating weight loss and preventing hyperglycemia in those patients being treated with antipsychotic medications. Targeted diabetes prevention and treatment is critical in patients with schizophrenia and evidence-based interventions should be considered early in the course of treatment. This paper reviews the prevalence, etiology, and treatment of diabetes in schizophrenia and outlines office based interventions for physicians treating this vulnerable population.

Objective: This study aims to calculate the medical costs of Covid-19 patients for hospitals based on the severity of clinical care. Design: The study was conducted in a hospital in Istanbul/Turkey. A micro-costing approach was performed using historical cost data for one year. All direct and indirect medical inputs were determined in quantities and monetary values for four types of Covid-19 patients in the hospital. Results: The analysis calculated the unit cost of an outpatient to be 459,99 ₺, while the cost per day for inpatient to be 1.184,63 ₺, for non-intubated in intensive care unit to be 1.938,11, for intubated in the intensive unit to be 2.393,99₺. The study also indicates that the total cost of a non-intubated patient in intensive care units is 1,54 times higher than the total cost per inpatient. An intubated patient’s cost is 2,08 times higher than an inpatient’s cost. Conclusion: This study indicates that Covid-19 patients incur significantly high costs for hospitals. The findings of the study provide empirical data for different types of patients which can be used in clinical management and can help all related governing bodies to plan their actions and make the decisions

INTRODUCTION: Introduction: Health systems are a sub-system directly affected by economic systems. Therefore, health systems may change as the economic systems of countries change. Regardless of which economic system is adopted and how this system is circulating to the health system, problems such as access to health, justice, equity and quality are the main problems that should be solved in health systems. As systems fail to solve such problems, individuals within the system begin to implement their own methods with the aim of eliminating/abusing deficits in the system. In this sense, informal payments can be seen as a tool for the use of such weaknesses for both health workers and healthcare consumers. Aim: The aim of this study is to draw a frame of the world wide on informal payments which may cause various injustices and degeneration of system in terms of access to health systems and quality of health services. METHODS: Methods: Systematic literature review was preferred as a method in the study and 20 studies which met inclusion criterias were included in the study. RESULTS: Results: Informal payments have a high prevalence especially in post-communist and under developed countries and the reasons of these results were examined. DISCUSSION AND CONCLUSION: Conclusion: it is recommended that a number of studies should be carried out to legitimize these kind of payments, and to monitor the results of the precautions taken into consideration in Turkey.