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1. PSA testing in primary care: is it time to change our practice?

Author: Frederique Beatrice Denijs, Hendrik Van Poppel, Arnulf Stenzl, Tiago Villanueva, Josep Maria Vilaseca, Mehmet Ungan, André Deschamps, Sarah Collen, and Monique J. Roobol
Subjects: Screening, Primary care, Prostate cancer, Prostate-specific antigen, Medicine (General), R5-920
Abstract: Abstract Background Historical prostate-specific antigen (PSA)-based screening studies reduced prostate cancer-related deaths but also led to overdiagnosis/overtreatment. Since then, opportunistic PSA testing has increased, and late-stage diagnoses and prostate-cancer related deaths are rising. Objectives To review current trends regarding PSA testing in primary care and propose a collaborative approach to improve early prostate cancer detection. Discussion Opportunistic PSA testing patterns vary among General Practitioners (GPs) and Family Doctors (FDs) based on differing guidelines, patient pressure, time constraints and personal views/preferences. However, an organised, risk-adapted strategy, as outlined by the European Association of Urology’s guidelines, could facilitate the early diagnosis of significant prostate cancer whilst sparing those unlikely to experience disease-related symptoms from further tests (overdiagnosis) as well as the psychosocial consequences of a cancer diagnosis. This could be achieved by the introduction of national prostate cancer screening programmes, which has been endorsed in the European Commission’s publication of the EU Cancer Screening Recommendations. In this scenario, GPs/FDs would still play an important role in supporting men throughout the decision pathway. However, as some men may still request a PSA test from their GP/FD, patient information as well as clear guidance and support to GPs/FDs are needed, including appropriate skills training to facilitate effective counselling and informed decision-making, and the use of risk calculators to inform referral decisions. Conclusion GPs/FDs play an important role in counselling healthy men eligible to consider PSA testing. However, clear guidance, training and support is required for them to assume this role.
Published: 2024
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2. Periodontal diseases and cardiovascular diseases, diabetes, and respiratory diseases: Summary of the consensus report by the European Federation of Periodontology and WONCA Europe

Author: David Herrera, Mariano Sanz, Lior Shapira, Carlos Brotons, Iain Chapple, Thomas Frese, Filippo Graziani, F. D. Richard Hobbs, Olivier Huck, Eva Hummers, Søren Jepsen, Oleg Kravtchenko, Phoebus Madianos, Ana Molina, Mehmet Ungan, Josep Vilaseca, Adam Windak, and Shlomo Vinker
Subjects: Periodontitis, cardiovascular diseases, diabetes, respiratory diseases, family doctors, Medicine (General), R5-920
Abstract: Background Periodontitis is a chronic inflammatory non-communicable disease (NCD) characterised by the destruction of the tooth-supporting apparatus (periodontium), including alveolar bone, the presence of periodontal pockets, and bleeding on probing.Objectives To outline, for family doctors, the implications of the association between periodontal and systemic diseases; to explore the role of family doctors in managing periodontitis as an ubiquitous non-communicable disease (NCD).Methods The consensus reports of previous focused collaborative workshops between WONCA Europe and the European Federation of Periodontology (using previously undertaken systematic reviews), and a specifically commissioned systematic review formed the technical papers to underpin discussions. Working groups prepared proposals independently, and the proposals were subsequently discussed and approved at plenary meetings.Results Periodontitis is independently associated with cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, obstructive sleep apnoea, and COVID-19 complications. Treatment of periodontitis has been associated with improvements in systemic health outcomes. The article also presents evidence gaps. Oral health care professionals (OHPs) and family doctors should collaborate in managing these conditions, including implementing strategies for early case detection of periodontitis in primary medical care centres and of systemic NCDs in oral/dental care settings. There is a need to raise awareness of periodontal diseases, their consequences, and the associated risk factors amongst family doctors.Conclusion Closer collaboration between OHPs and family doctors is important in the early case detection and management of NCDs like cardiovascular diseases, diabetes mellitus, and respiratory diseases. Strategies for early case detection/prevention of NCDs, including periodontitis, should be developed for family doctors, other health professionals (OHPs), and healthcare funders. Evidence-based information on the reported associations between periodontitis and other NCDs should be made available to family doctors, OHPs, healthcare funders, patients, and the general population.
Published: 2024
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3. How to overcome information and communication barriers in Human Papillomavirus vaccination? A SWOT analysis based on the opinions of European family doctors in contact with young people and their parents

Author: Hüsna Sarıca Çevik, A. Gülsen Ceyhun Peker, Süleyman Görpelioğlu, Shlomo Vinker, and Mehmet Ungan
Subjects: General practice, health communication, Human papillomavirus, primary prevention, vaccines, Medicine (General), R5-920
Abstract: Background Family doctors (FDs)/General practitioners (GPs) are the key contact points for young people and their parents regarding Human Papillomavirus (HPV) vaccination. However, their recommendations are influenced by communication skills.Objectives Under the EU4Health project, PROTECT-EUROPE, WONCA Europe led a task to identify and analyse strategies for clinicians’ interpersonal communication skills when discussing HPV and its vaccination with young people and their parents.Methods Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis using qualitative data focused on HPV vaccine acceptance and communication with the target population. FDs/GPs, members of WONCA Europe, were recruited using convenience and snowball sampling through surveys at conferences and emails.Results 223 FDs/GPs from 36 countries participated. Strengths included face-to-face communication, extensively used to promote the HPV vaccine. Weaknesses involved financial constraints, limited knowledge about gender-neutral vaccination, safety concerns, and time pressure during the consultations. Opportunities included confidentiality, open dialogue, trusting relationship between FDs/GPs and the target population, continuing medical education, school training, and questions & answers sessions to increase vaccine communication. Threats included social norms and cultures, stigmas against HPV, and anti-vaccination movements hindering discussions on HPV vaccination.Conclusion It is crucial to train FDs/GPs to address knowledge gaps, enhance communication skills, and maintain a trusting relationship with patients when discussing HPV vaccination. Overcoming financial barriers and ensuring gender-neutral vaccination programs are accessible across Europe are also essential. Providing accurate information through the web- and school-based channels and developing community-oriented approaches targeting sociocultural factors and different needs to eliminate HPV vaccine stigmas should be considered when recommending the vaccine.
Published: 2024
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4. Guardians of health under fire: Understanding and combating violence against doctors

Author: Kamer Billur Yücel Özden, Hüsna Sarıca Çevik, Radost Asenova, and Mehmet Ungan
Subjects: Exposición a la violencia, Violencia contra los médicos, Prevención de la violencia, Violencia en el lugar de trabajo, Medicine (General), R5-920
Abstract: Violence against physicians is not a newly emerged but an increasingly serious problem. Various studies have reported a prevalence of up to 90%. If not prevented, it not only causes physical and mental harm to physicians who are dedicated to serving humanity but also affects the entire healthcare system and, consequently, the whole community with its direct and indirect effects. Some interventions have a positive outcome when effectively managed. However, for these interventions to be permanent and effective, they need to be multidisciplinary, legally backed and adopted as public policy. In this article, the prevalence of violence against physicians in the literature, its causes, practices worldwide, and suggestions for solving this problem are compiled. Resumen: La violencia contra los médicos no es un problema recién surgido, sino un problema cada vez más grave. Varios estudios han reportado una prevalencia de hasta el 90%. Si no se previene, no solo causa daños físicos y mentales a los médicos que se dedican a servir a la humanidad, sino que también afecta a todo el sistema de salud y, en consecuencia, a toda la comunidad con sus efectos directos e indirectos. Algunas intervenciones tienen un resultado positivo cuando se gestionan eficazmente. Sin embargo, para que estas intervenciones sean permanentes y efectivas, deben ser multidisciplinarias, contar con respaldo legal y adoptarse como política pública. En este artículo se recopila la prevalencia de la violencia contra los médicos en la literatura, sus causas, prácticas a nivel mundial y sugerencias para resolver este problema.
Published: 2024
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5. The fractured lens: a controversial revision of the International Classification of Primary Care

Author: Jean K. Soler, Nicola Buono, Elena Cardillo, Thomas Frese, Shlomo Vinker, and Mehmet Ungan
Subjects: International Classification of Primary Care, family medicine, general practice, primary care, episode of care, reason for encounter, Medicine (General), R5-920
Abstract: BackgroundThe International Classification of Primary Care (ICPC) has represented the international standard reduction for measuring the content of primary care for over 30 years. In the process of its third revision, its authors, the Wonca International Classification Committee (WICC), delegated a major part of the technical work to a purposely formed Consortium. However, in the process of such revision, standard classification principles and rules have been inconsistently applied with the result that ICPC-3 has been published with major errors and an inconsistent structure.ObjectivesTo formally describe and critically appraise the revision process of ICPC-3.MethodsThe formal review of ICPC-3 performed by an expert group within WICC and commissioned by the Executive Council of Wonca Europe is presented in abridged form.ResultsICPC-3 as currently presented introduces major departures from formal classification principles and rules, besides other major errors and inconsistencies, all of which are listed and described.ConclusionMajor changes in ICPC-3 defy categorisation and conceptualisation standards. ICPC-3 now represents an untested departure from international standard presentations, without a formal academic base. The direct inclusion of measures of functioning in a classification of reasons for encounter and health problems fails to address the dichotomy of these domains, the boundaries of and relationships between which are not satisfactorily resolved by the system. Analysis of ICPC-3 data will require the development and implementation of alternative, as yet undefined, models of the relationships between disease and health. By including different domains without resolving ambiguity, and by splitting function from other body systems, ICPC-3 becomes an internally fractured instrument.
Published: 2024
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6. Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe. European General Practice Research Network，Maastricht 2009.

Author: Eva Hummers-Pradier, Martin Beyer, Patrick Chevallier, Sophia Eilat-Tsanani, Christos Lionis, Lieve Peremans, Davorina Petek, Imre Rurik, Jean Karl Soler, Henri E.J.H. Stoffers, Pinar Topsever, Mehmet Ungan, Paul van Royen
Subjects: Medicine
Published: 2022
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7. Digital maturity and its determinants in General Practice: A cross-sectional study in 20 countries

Author: Fábia Teixeira, Edmond Li, Liliana Laranjo, Claire Collins, Greg Irving, Maria Jose Fernandez, Josip Car, Mehmet Ungan, Davorina Petek, Robert Hoffman, Azeem Majeed, Katarzyna Nessler, Heidrun Lingner, Geronimo Jimenez, Ara Darzi, Cristina Jácome, and Ana Luísa Neves
Subjects: primary care, quality of care, digital technology, digital maturity, electronic health records, health information interoperability, Public aspects of medicine, RA1-1270
Abstract: BackgroundThe extent to which digital technologies are employed to promote the delivery of high-quality healthcare is known as Digital Maturity. Individual and systemic digital maturity are both necessary to ensure a successful, scalable and sustainable digital transformation in healthcare. However, digital maturity in primary care has been scarcely evaluated.ObjectivesThis study assessed the digital maturity in General Practice (GP) globally and evaluated its association with participants' demographic characteristics, practice characteristics and features of Electronic Health Records (EHRs) use.MethodsGPs across 20 countries completed an online questionnaire between June and September 2020. Demographic data, practice characteristics, and features of EHRs use were collected. Digital maturity was evaluated through a framework based on usage, resources and abilities (divided in this study in its collective and individual components), interoperability, general evaluation methods and impact of digital technologies. Each dimension was rated as 1 or 0. The digital maturity score was calculated as the sum of the six dimensions and ranged between 0 to 6 (maximum digital maturity). Multivariable linear regression was used to model the total score, while multivariable logistic regression was used to model the probability of meeting each dimension of the score.ResultsOne thousand six hundred GPs (61% female, 68% Europeans) participated. GPs had a median digital maturity of 4 (P25–P75: 3–5). Positive associations with digital maturity were found with: male gender [B = 0.18 (95% CI 0.01; 0.36)], use of EHRs for longer periods [B = 0.45 (95% CI 0.35; 0.54)] and higher frequencies of access to EHRs [B = 0.33 (95% CI 0.17; 0.48)]. Practicing in a rural setting was negatively associated with digital maturity [B = −0.25 (95%CI −0.43; −0.08)]. Usage (90%) was the most acknowledged dimension while interoperability (47%) and use of best practice general evaluation methods (28%) were the least. Shorter durations of EHRs use were negatively associated with all digital maturity dimensions (aOR from 0.09 to 0.77).ConclusionOur study demonstrated notable factors that impact digital maturity and exposed discrepancies in digital transformation across healthcare settings. It provides guidance for policymakers to develop more efficacious interventions to hasten the digital transformation of General Practice.
Published: 2023
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8. The impacts of the COVID-19 pandemic on the mental health and residency training of family medicine residents: findings from a nationwide cross-sectional survey in Turkey

Author: Hüsna Çevik and Mehmet Ungan
Subjects: Burnout, COVID-19, Depression, Education, Family medicine, Graduate medical education, Medicine (General), R5-920
Abstract: Abstract Background The COVID-19 pandemic has had a negative impact on resident training in different branches and affected the physical and mental health of frontline residents adversely. This nationwide cross-sectional survey aimed to investigate the effects of the COVID-19 pandemic on family medicine residents in Turkey, including the levels of depression and burnout. Methods An anonymous online survey was distributed to all family medicine residents via e-mail and a web link between 28.11.2020 and 12.12.2020. Information on sociodemographic data and the residency programme were evaluated, and factors associated with depression and burnout were examined using the Patient Health Questionnaire-9 (PHQ-9) and the Burnout Measure-Short Version (BMS) respectively. Results Although the weekly average working hours of the 477 respondents increased significantly during the pandemic (p
Published: 2021
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9. Academic general practice/family medicine in times of COVID-19 – Perspective of WONCA Europe

Author: Adam Windak, Thomas Frese, Eva Hummers, Zalika Klemenc Ketis, Sonia Tsukagoshi, Josep Vilaseca, Shlomo Vinker, and Mehmet Ungan
Subjects: infectious diseases, quality of care, public health and community medicine, health care organisation and management, medical education, Medicine (General), R5-920
Abstract: COVID-19 outbreak has significantly changed all aspects of general practice in Europe. This article focuses on the academic challenges for the discipline, mainly in the field of education, research, and quality assurance. The efforts of the European Region of the World Organisation of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) to support academic sustainability of the discipline in the time of pandemic are presented. Medical education was affected by the pandemic, threatening both its productivity and quality. Emerging new educational methods might be promising, but the results of their rapid implementation remain uncertain. A relatively small number of publications related to COVID-19 and general practice is available in the medical literature. There is a shortage of original data from general practice settings. This contrasts with the crucial role of GPs in fighting a pandemic. COVID-19 outbreak has opened widely new research areas, which should be explored by GPs. Maintaining the quality of care and safety of all patients during the COVID-19 pandemic is the utmost priority. Many of them suffer from poor access or inadequate management of their problems. Rapid implementation of telemedicine brought both threats and opportunities. The COVID-19 pandemic also challenged doctors’ safety and well-being. These aspects will require discussion and remedy to prevent deterioration of the quality of primary care. WONCA Europe is making a multi-faceted effort to support GPs in difficult times of the pandemic. It is ready to support future efforts to uphold the integrity of family medicine as an academic discipline.
Published: 2020
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10. General practitioners' perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study.

Author: Edmond Li, Rosy Tsopra, Geronimo Jimenez, Alice Serafini, Gustavo Gusso, Heidrun Lingner, Maria Jose Fernandez, Greg Irving, Davorina Petek, Robert Hoffman, Vanja Lazic, Ensieh Memarian, Tuomas Koskela, Claire Collins, Sandra Milena Espitia, Ana Clavería, Katarzyna Nessler, Braden Gregory O'Neill, Kyle Hoedebecke, Mehmet Ungan, Liliana Laranjo, Saira Ghafur, Gianluca Fontana, Azeem Majeed, Josip Car, Ara Darzi, and Ana Luisa Neves
Subjects: Computer applications to medicine. Medical informatics, R858-859.7
Abstract: With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs' perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June-September 2020. GPs' perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients' preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.
Published: 2022
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11. Non-alcoholic fatty liver disease: A patient guideline

Author: Sven M. Francque, Giulio Marchesini, Achim Kautz, Martine Walmsley, Rebecca Dorner, Jeffrey V. Lazarus, Shira Zelber-Sagi, Kate Hallsworth, Luca Busetto, Gema Frühbeck, Dror Dicker, Euan Woodward, Marko Korenjak, José Willemse, Gerardus H. Koek, Shlomo Vinker, Mehmet Ungan, Juan M. Mendive, and Christos Lionis
Subjects: Diseases of the digestive system. Gastroenterology, RC799-869
Abstract: Summary: This patient guideline is intended for all patients at risk of or living with non-alcoholic fatty liver disease (NAFLD). NAFLD is the most frequent chronic liver disease worldwide and comes with a high disease burden. Yet, there is a lot of unawareness. Furthermore, many aspects of the disease are still to be unravelled, which has an important impact on the information that is given (or not) to patients. Its management requires a close interaction between patients and their many healthcare providers. It is important for patients to develop a full understanding of NAFLD in order to enable them to take an active role in their disease management. This guide summarises the current knowledge relevant to NAFLD and its management. It has been developed by patients, patient representatives, clinicians and scientists and is based on current scientific recommendations, intended to support patients in making informed decisions.
Published: 2021
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12. Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study

Author: Ana Luísa Neves, Edmond Li, Alice Serafini, Geronimo Jimenez, Heidrun Lingner, Tuomas H Koskela, Robert D Hoffman, Claire Collins, Davorina Petek, Ana Claveria, Rosy Tsopra, Greg Irving, Gustavo Gusso, Braden Gregory O’Neill, Kyle Hoedebecke, Sandra Milena Espitia, Mehmet Ungan, Katarzyna Nessler, Vanja Lazic, Liliana Laranjo, Ensieh Memarian, Maria Jose Fernandez, Saira Ghafur, Gianluca Fontana, Azeem Majeed, Josip Car, and Ara Darzi
Subjects: Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract: BackgroundIn recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. ObjectiveThis study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future. MethodsThis study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers’ personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants’ characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis. ResultsData collection took place from June 2020 to September 2020. As of this manuscript’s submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing. ConclusionsThe study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design. International Registered Report Identifier (IRRID)DERR1-10.2196/30099
Published: 2021
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13. Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology ( <scp>EFP</scp> ) and the European arm of the World Organization of Family Doctors ( <scp>WONCA</scp> Europe)

Author: David Herrera, Mariano Sanz, Lior Shapira, Carlos Brotons, Iain Chapple, Thomas Frese, Filippo Graziani, F. D. Richard Hobbs, Olivier Huck, Eva Hummers, Søren Jepsen, Oleg Kravtchenko, Phoebus Madianos, Ana Molina, Mehmet Ungan, Josep Vilaseca, Adam Windak, and Shlomo Vinker
Subjects: Periodontics
Published: 2023
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14. General practitioners’ level of knowledge about their rights and criminal liabilities according to legislation in Turkey

Author: Baki Derhem and Mehmet Ungan
Subjects: medical law, medicolegal, family physicians, doctor’s rights, Medicine
Abstract: Background . To know legal regulations and to comply with them while providing health care is indispensable for physicians to work in a proper way. Ignorance of the criminal laws may not be an excuse according to Turkish Criminal Code. There is an obligation for physicians to know the law, as well as all citizens. Physicians should possess the scope of competences regarding medicolegal regulations at least. Objectives . The aim of this study is to investigate the knowledge and behaviors of GPs regarding their rights, criminal liabilities and common rules of law that are regulated by legislation. We also aimed to determine how the answers were influenced by sociodemographic factors, educational status of participants and if the participants received any punishment. Material and methods . A total number of 381 physicians working at primary health care services located in Ankara were interviewed face-to-face. We used a 38-item questionnaire that was developed according to current legislation. The collected data was analyzed using SPSS software (Version 11.5). The chi-square test was used in order to compare knowledge-based questions with sociodemographic factors. The Mann-Whitney U test was used for assessing whether the number of correct answers differs with socio-demographic factors or not. A p-value of 0.05 was considered statistically significant. Results . 21.8 percent of the participants were FM specialists, and 78.2% of them were GPs. The mean age of physicians was 46.9 ± 7.6. The median score for correct responses in 18 knowledge-based questions was 8 (min–max: 3–14). In comparison with the working experience with correct answers, there was a statistically significant difference between 1–5 years of experience and 11–15 years and ≥ 16 years (p < 0.001). There was a significant difference in correct answers between the two groups, which were separated according to whether or not they received punishment as a result of a legal investigation. In our study, the doctors who have taken education about physician’s rights and criminal liabilities before had a higher number of correct answer than those who have not taken (p < 0.001). Conclusions . As a result of our survey, we determined that our physicians have insufficient levels of knowledge about medico-legal issues. The findings reveal the requirement for comprehensive education about a doctor’s rights and liabilities during residency or via in-service trainings. The importance of the situation should be investigated by further studies and constructive steps should be initiated as soon as possible.
Published: 2017
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15. The paradigm shift from <scp>NAFLD</scp> to <scp>MAFLD</scp> : A global primary care viewpoint

Author: Taghreed M. Farahat, Mehmet Ungan, Josep Vilaseca, Jacqueline Ponzo, Pramendra Prasad Gupta, Andrew D. Schreiner, Wadeia Al Sharief, Kelly Casler, Tafat Abdelkader, Ludovico Abenavoli, Fatima‐Zohra Mchich Alami, Mattias Ekstedt, Muntadar S. Jabir, Matthew J. Armstrong, Mona H. Osman, Johannes Wiegand, Dina Attia, Veronique Verhoeven, Ashraf Abdul Qayoum Amir, Nagwa N. Hegazy, Emmanuel A. Tsochatzis, Yasser Fouad, Helena Cortez‐Pinto, and Repositório da Universidade de Lisboa
Subjects: Primary Health Care, Hepatology, Non-alcoholic Fatty Liver Disease, education, Disease Progression, Humans, Human medicine
Abstract: © 2022 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd., Half of the global overweight/obese adult population have metabolic-dysfunction-associated fatty liver disease (MAFLD), with prevalence rising, even among non-obese individuals. This increase is observed globally and mostly in low- and low-middleincome countries of Africa, Asia and South America and represents a great worldwide burden on healthcare expenditures. Lifestyle changes and a healthy diet are still the cornerstone in the clinical management of these patients as approved medications are presently lacking.
Published: 2022
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16. Research agenda in family medicine—should we adopt the Dutch approach?

Author: Shlomo Vinker and Mehmet Ungan
Subjects: Medicine (General), R5-920
Published: 2019
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17. Turkey's Struggle with Covid-19: A Cross-border View

Author: Radost Asenova and Mehmet Ungan
Subjects: 03 medical and health sciences, 0302 clinical medicine, Coronavirus disease 2019 (COVID-19), Economy, 030225 pediatrics, Political science, 030212 general & internal medicine
Abstract: SARS-COv-2 or a common COVID-19 infection caught all countries off guard. In just a few days, the lives of individuals and the functioning of all societies, starting at the smallest, have changed drastically, their health and lives have been seriously threatened. Many eyes have turned to family doctors who are at the forefront of the fight against the virus. In recent weeks, family doctors have made the highest sacrifice in their lives in the fight. In this extraordinary situation, WONCA Europe made many calls to managers and World Health Organization offices, including our country, wishing that the family doctors in Europe and their academic institutions representing them should not be kept at the lowest possible level. All our knowledge comes from the observations of the doctors, the Ministry of Health and the Media. Talking about Turkey would not be right for us nor for the foreign media because the credibility of the review without seeing and examining all the data will be a question mark. To support the management of pandemic, we need transparent and improved data collection and data delivery in all countries. Keywords: Coronavirus, Turkey, WONCA Europe, Family Practice
Published: 2020
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18. Global multi-stakeholder endorsement of the MAFLD definition

Author: Nahum Méndez-Sánchez, Elisabetta Bugianesi, Robert G Gish, Frank Lammert, Herbert Tilg, Mindie H Nguyen, Shiv K Sarin, Núria Fabrellas, Shira Zelber-Sagi, Jian-Gao Fan, Gamal Shiha, Giovanni Targher, Ming-Hua Zheng, Wah-Kheong Chan, Shlomo Vinker, Takumi Kawaguchi, Laurent Castera, Yusuf Yilmaz, Marko Korenjak, C Wendy Spearman, Mehmet Ungan, Melissa Palmer, Mortada El-Shabrawi, Hans-Juergen Gruss, Jean-François Dufour, Anil Dhawan, Heiner Wedemeyer, Jacob George, Luca Valenti, Yasser Fouad, Manuel Romero‐Gomez, Mohammed Eslam, Maria Lorena Abate, Bahaa Abbas, Ahmed Amr Abbassy, Waleed Abd El Ghany, Amira Abd Elkhalek, Emad Abd ElMajeed, Mohammad Abdalgaber, Mohamed AbdAllah, Marwa Abdallah, Nourhan Abdallah, Shereen Abdelaleem, Yasser Abdelghani, Wael Abdelghany, Safaa Mohamed Abdelhalim, Wafaa Abdelhamid, Nehal Abdelhamid, Nadia A. Abdelkader, Elsayed Abdelkreem, Aly Mohamed Abdelmohsen, Awny Ali Abdelrahman, Sherief M Abd-elsalam, Doaa Abdeltawab, Abdulbaset Abduh, Nada Abdulhakam, Maheeba Abdulla, Navid Abedpoor, Ludovico Abenavoli, Fredrik Åberg, Omala Ablack, Mostafa Abo elftouh, Yousry Esam-Eldin Abo-Amer, Ashraf Aboubkr, Alaa Aboud, Amr M. Abouelnaga, Galal A. Aboufarrag, Ashraf Aboutaleb, Leticia Abundis, Gupse Adalı, Enrique Adames, Leon Adams, Danjuma Adda, Noor Adel, Nada Adel, Muhammad Adel Sayed, Taiba Jibril Afaa, Nawal Afredj, Gulnara Aghayeva, Alessio Aghemo, Carlos A. Aguilar-Salinas, Golo Ahlenstiel, Walid Ahmady, Wafaa Ahmed, Amira Ahmed, Samah Nasser Ahmed, Heba Mostafa Ahmed, Rasha Ahmed, Elmar Aigner, Mesut Akarsu, Maisam Akroush, Umit Akyuz, Mamun Al Mahtab, Tahani Al Qadiri, Yusriya Al Rawahi, Razzaq AL rubaee, Muna Al Saffar, Shahinul Alam, Zaid Al-Ani, Agustín Albillos, Mohamed Alboraie, Said Al-Busafi, Mohamed Al-Emam, Jawaher Alharthi, Kareem Ali, Basma Abdelmoez Ali, Mohammad Ali, Raja Affendi Raja Ali, Anna Alisi, Ali Raad AL-Khafaji, Maryam Alkhatry, Rocio Aller, Yahya Almansoury, Khalid Al-Naamani, Alaa Alnakeeb, Anna Alonso, Saleh A. Alqahtani, Leina Alrabadi, Khalid Alswat, Mahir Altaher, Turki Altamimi, Jose Altamirano, Mario R. Alvares-da-Silva, Elsragy Adel M. Aly, Amgad Alzahaby, Ahmed Alzamzamy, Keisuke Amano, Maysa A. Amer, Mona A. Amin, Sayed A. Amin, Ashraf A. 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Cabral-Prodigalidad, Guillermo Cabrera-Alvarez, Wei Cai, Francesca Cainelli, Ali Riza Caliskan, Ali Canbay, Ana Cano-Contreras, Hai-Xia Cao, Zhujun Cao, Andres Carrion, Francesca Carubbi, Teresa Casanovas, Marlen Ivón Castellanos Fernández, Jin Chai, Siew Pheng Chan, Phunchai Charatcharoenwitthaya, Norberto Chavez-Tapia, Kazuaki Chayama, Jinjun Chen, Lin Chen, Zhong-Wei Chen, Huiting Chen, Sui-Dan Chen, Qiang Chen, Yaxi Chen, Gang Chen, En-Quang Chen, Fei Chen, Pei-Jer Chen, Robert Cheng, Wendy Cheng, Jack Tan Wei Chieh, Imad Chokr, Evangelos Cholongitas, Ashok Choudhury, Abhijit Chowdhury, Evaristus Sunday Chukwudike, Stefano Ciardullo, Michelle Clayton, Karine Clement, Marie Michelle Cloa, Cecilia Coccia, Cristina Collazos, Massimo Colombo, Arif Mansur Cosar, Helma Pinchemel Cotrim, Joris Couillerot, Alioune Coulibaly, Gonzalo Crespo, Javier Crespo, Maria Cruells, Ian Homer Y. Cua, Hesham K. 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L, Kaya, E, Kayasseh, M, Keenan, B, Keklikkiran, C, Keml, W, Khalaf, D, Khalefa, R, Khamis, S, Khater, D, Khattab, H, Khavkin, A, Khlynova, O, Khmis, N, Kobyliak, N, Koffas, A, Koike, K, Kok, K, Koller, T, Komas, N, Korochanskaya, N, Koulla, Y, Koya, S, Kraft, C, Kraja, B, Krawczyk, M, Kuchay, M, Kulkarni, A, Kumar, A, Kumar, M, Lakoh, S, Lam, P, Lan, L, Lange, N, Lankarani, K, Lanthier, N, Lapshyna, K, Lashen, S, Laure, K, Lazebnik, L, Lebrec, D, Lee, S, Lee, W, Lee, Y, Leeming, D, Leite, N, Leon, R, Lesmana, C, Li, J, Li, Q, Li, Y, Li, L, Li, M, Liang, H, Lijuan, T, Lim, S, Lim, L, Lin, S, Lin, H, Lin, R, Lithy, R, Liu, Y, Liu, X, Liu, W, Liu, S, Liu, K, Liu, T, Lonardo, A, Lopez, M, Lopez-Benages, E, Lopez-Jaramillo, P, Lu, H, Lu, L, Lu, Y, Lubel, J, Lui, R, Lupasco, I, Luzina, E, Lv, X, Lynch, K, Ma, H, Machado, M, Maduka, N, Madzharova, K, Magdaong, R, Mahadeva, S, Mahfouz, A, Mahmood, N, Mahmoud, E, Mahrous, M, Maiwall, R, Majeed, A, Majumdar, A, Mak, L, Maklouf, M, Malekzadeh, R, Mandato, C, Mangia, A, Mann, J, Mansour, H, Mansouri, A, Mantovani, A, Mao, J, Maramag, F, Marchesini, G, Marcus, C, Marinho, R, Martinez-Chantar, M, Martins, A, Marwan, R, Mason, K, Masoud, G, Massoud, M, Matamoros, M, Mateos, R, Mawed, A, Mbanya, J, Mbendi, C, Mccolaugh, L, Mcleod, D, Medina, J, Megahed, A, Mehrez, M, Memon, I, Merat, S, Mercado, R, Mesbah, A, Meskini, T, Metwally, M, Metwaly, R, Miao, L, Micah, E, Miele, L, Milivojevic, V, Milovanovic, T, Mina, Y, Mishkovik, M, Mishriki, A, Mitchell, T, Mohamed, A, Mohamed, M, Mohamed, S, Mohammed, S, Mohammed, A, Mohan, V, Mohie, S, Mokhtar, A, Moniem, R, Montilla, M, Morales, J, Morata, M, Moreno-Planas, J, Morise, S, Mosaad, S, Moselhy, M, Mostafa, A, Mostafa, E, Mouane, N, Mousa, N, Moustafa, H, Msherif, A, Muller, K, Munoz, C, Munoz-Urribarri, A, Murillo, O, Mustapha, F, Muzurovic, E, Nabil, Y, Nafady, S, Nagamatsu, A, Nakajima, A, Nakano, D, Nan, Y, Nascimbeni, F, Naseef, M, Nashat, N, Natalia, T, Negro, F, Nersesov, A, Neuman, M, Ng'Wanasayi, M, Ni, Y, Nicoll, A, Niizeki, T, Nikolova, D, Ningning, W, Niriella, M, Nogoibaeva, K, Nordien, R, O Sullivan, C, O'Beirne, J, Obekpa, S, Ocama, P, Ochwoto, M, Ogolodom, M, Ojo, O, Okrostsvaridze, N, Oliveira, C, Omana, R, Omar, O, Omar, H, Omar, M, Omran, S, Omran, R, Osman, M, Owise, N, Owusu-Ansah, T, Padilla- Machaca, P, Palle, S, Pan, Z, Pan, X, Pan, Q, Papaefthymiou, A, Paquissi, F, Par, G, Parkash, A, Payawal, D, Peltekian, K, Peng, X, Peng, L, Peng, Y, Pengoria, R, Perez, M, Perez, J, Perez, N, Persico, M, Pessoa, M, Petta, S, Philip, M, Plaz Torres, M, Polavarapu, N, Poniachik, J, Portincasa, P, Pu, C, Purnak, T, Purwanto, E, Qi, X, Qian, Z, Qiang, Z, Qiao, Z, Qiao, L, Queiroz, A, Rabiee, A, Radwan, M, Rahetilahy, A, Ramadan, Y, Ramadan, D, Ramli, A, Ramm, G, Ran, A, Rankovic, I, Rao, H, Raouf, S, Ray, S, Reau, N, Refaat, A, Reiberger, T, Remes-Troche, J, Reyes, E, Richardson, B, Ridruejo, E, Riestra Jimenez, S, Rizk, I, Roberts, S, Roblero, J, Robles, J, Rockey, D, Rodriguez, M, Rodriguez Hernandez, H, Roman, E, Romeiro, F, Romeo, S, Rosales-Zabal, J, Roshdi, G, Rosso, N, Ruf, A, Ruiz, P, Runes, N, Ruzzenente, A, Ryan, M, Saad, A, Sabbagh, E, Sabbah, M, Saber, S, Sabrey, R, Sabry, R, Saeed, M, Said, D, Said, E, Sakr, M, Salah, Y, Salama, R, Salama, A, Saleh, H, Saleh, A, Salem, A, Salifou, A, Salih, A, Salman, A, Samouda, H, Sanai, F, Sanchez-Avila, J, Sanker, L, Sano, T, Sanz, M, Saparbu, T, Sawhney, R, Sayed, F, Sayed, S, Sayed, A, Sayed, M, Sebastiani, G, Secadas, L, Sediqi, K, Seif, S, Semida, N, Senates, E, Serban, E, Serfaty, L, Seto, W, Sghaier, I, Sha, M, Shabaan, H, Shalaby, L, Shaltout, I, Sharara, A, Sharma, V, Shawa, I, Shawkat, A, Shawky, N, Shehata, O, Sheils, S, Shewaye, A, Shi, G, Shi, J, Shimose, S, Shirono, T, Shou, L, Shrestha, A, Shui, G, Sievert, W, Sigurdardottir, S, Sira, M, Siradj, R, Sison, C, Smyth, L, Soliman, R, Sollano, J, Sombie, R, Sonderup, M, Sood, S, Soriano, G, Stedman, C, Stefanyuk, O, Stimac, D, Strasser, S, Strnad, P, Stuart, K, Su, W, Su, M, Sumida, Y, Sumie, S, Sun, D, Sun, J, Suzuki, H, Svegliati-Baroni, G, Swar, M, Taharboucht, S, Taher, Z, Takamura, S, Tan, L, Tan, S, Tanwandee, T, Tarek, S, Tatiana, G, Tavaglione, F, Tecson, G, Tee, H, Teschke, R, Tharwat, M, Thong, V, Thursz, M, Tine, T, Tiribelli, C, Tolmane, I, Tong, J, Tongo, M, Torkie, M, Torre, A, Torres, E, Trajkovska, M, Treeprasertsuk, S, Tsutsumi, T, Tu, T, Tur, J, Turan, D, Turcan, S, Turkina, S, Tutar, E, Tzeuton, C, Ugiagbe, R, Uygun, A, Vacca, M, Vajro, P, Van der Poorten, D, Van Kleef, L, Vashakidze, E, Velazquez, C, Velazquez, M, Vento, S, Verhoeven, V, Vespasiani-Gentilucci, U, Vethakkan, S, Vilaseca, J, Vitek, L, Volkanovska, A, Wallace, M, Wan, W, Wang, Y, Wang, X, Wang, C, Wang, M, Wangchuk, P, Weltman, M, White, M, Wiegand, J, Wifi, M, Wigg, A, Wilhelmi, M, William, R, Wittenburg, H, Wu, S, Wubeneh, A, Xia, H, Xiao, J, Xiao, X, Xiaofeng, W, Xiong, W, Xu, L, Xu, J, Xu, W, Xu, K, Xu, Y, Xu, S, Xu, M, Xu, A, Xu, C, Yan, H, Yang, J, Yang, R, Yang, Y, Yang, Q, Yang, N, Yao, J, Yara, J, Yaras, S, Yilmaz, N, Younes, R, Younes, H, Young, S, Youssef, F, Yu, Y, Yu, M, Yuan, J, Yue, Z, Yuen, M, Yun, W, Yurukova, N, Zakaria, S, Zaky, S, Zaldastanishvili, M, Zapata, R, Zare, N, Zerem, E, Zeriban, N, Zeshuai, X, Zhang, H, Zhang, X, Zhang, Y, Zhang, W, Zhang, Z, Zhao, J, Zhao, R, Zhao, H, Zheng, C, Zheng, Y, Zheng, R, Zheng, T, Zheng, K, Zhou, X, Zhou, Y, Zhou, H, Zhou, L, Zhu, L, Zhu, Y, Zhu, P, Ziada, E, Ziring, D, Ziyi, L, Zou, S, Zou, Z, Zou, H, Zuart Ruiz, R, and Global Multi-Stakeholder Consensus on the Redefinition of Fatty Liver Disease
Subjects: Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Hepatology, Non-alcoholic Fatty Liver Disease, NAFLD, consensu, Gastroenterology, MAFLD, definition, Humans, MAFLD, NAFLD, Human medicine
Abstract: Contains fulltext : 252162.pdf (Publisher’s version ) (Closed access)
Published: 2022
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19. COVID-19 pandemic and the great impulse to telemedicine: the basis of the WONCA Europe Statement on Telemedicine at the WHO Europe 70th Regional Meeting September 2020

Author: Ferdinando Petrazzuoli, Donata Kurpas, Shlomo Vinker, Valentina Sarkisova, Androulla Eleftheriou, Anna Żakowicz, Diederik Aarendonk, and Mehmet Ungan
Subjects: access to care, Physician-Patient Relations, SARS-CoV-2, Public Health, Environmental and Occupational Health, COVID-19, Humans, EFPC Position Papers, rural health, telemedicine, World Health Organization, Care Planning, Pandemics
Abstract: Summary Telemedicine is the use of telecommunication and information technologies to support the delivery of healthcare at a distance, guaranteeing patients healthcare by facilitating access where barriers exist; the COVID-19 pandemic has attracted worldwide interest in this field. The purpose of this paper is to highlight the main pros and cons of telemedicine, which serve as the basis of the WONCA Europe Statement at the WHO Europe 70th Regional Meeting on 14 September 2020. Pros of telemedicine include virtual healthcare at home, where patients receive support in certain conditions without leaving their houses. During a pandemic, it can be adopted to limit physical human interaction. Unfortunately, it can negatively affect the quality of the doctor–patient relationship, the quality of the physical examination, and the quality of care. Telemedicine requires effective infrastructure and robust investments to be feasible and effective.
Published: 2021

20. The impacts of the COVID-19 pandemic on the mental health and residency training of family medicine residents: findings from a nationwide cross-sectional survey in Turkey

Author: Mehmet Ungan and Hüsna Çevik
Subjects: Medicine (General), medicine.medical_specialty, Family medicine, Coronavirus disease 2019 (COVID-19), Turkey, Cross-sectional study, education, Graduate medical education, Burnout, Education, R5-920, Surveys and Questionnaires, Pandemic, Humans, Medicine, Burnout, Professional, Pandemics, Depression (differential diagnoses), Work-related stress, Resident, SARS-CoV-2, business.industry, Depression, Research, Internship and Residency, COVID-19, Primary care, Mental health, Cross-Sectional Studies, Mental Health, Female, Family Practice, business, Residency training
Abstract: Background The COVID-19 pandemic has had a negative impact on resident training in different branches and affected the physical and mental health of frontline residents adversely. This nationwide cross-sectional survey aimed to investigate the effects of the COVID-19 pandemic on family medicine residents in Turkey, including the levels of depression and burnout. Methods An anonymous online survey was distributed to all family medicine residents via e-mail and a web link between 28.11.2020 and 12.12.2020. Information on sociodemographic data and the residency programme were evaluated, and factors associated with depression and burnout were examined using the Patient Health Questionnaire-9 (PHQ-9) and the Burnout Measure-Short Version (BMS) respectively. Results Although the weekly average working hours of the 477 respondents increased significantly during the pandemic (p p Conclusions The COVID-19 pandemic has had a negative impact on training programmes for FM residents, who are at the forefront of the pandemic in Turkey, and this situation is closely related to depression and burnout. Due to the unpredictability of the pandemic, long-term plans should be made for the training needs of residents in order to protect their physical and mental health.
Published: 2021

21. Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: An International Cross-sectional Survey Study (Preprint)

Author: Edmond Li, Rosy Tsopra, Geronimo Jimenez, Alice Serafini, Gustavo Gusso, Heidrun Lingner, Maria Jose Fernandez, Greg Irving, Davorina Petek, Robert Hoffman, Vanja Lazic, Ensieh Memarian, Tuomas H Koskela, Claire Collins, Sandra Milena Espitia, Ana Clavería, Katarzyna Nessler, Braden Gregory O’Neill, Kyle Hoedebecke, Mehmet Ungan, Liliana Laranjo, Saira Ghafur, Gianluca Fontana, Azeem Majeed, Josip Car, Ara Darzi, and Ana Luísa Neves
Abstract: BACKGROUND With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. OBJECTIVE We explored GPs’ perspectives on the main benefits and challenges of using digital remote care. METHODS GPs across 20 countries completed an online questionnaire between June – September 2020. GPs’ perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. RESULTS A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patient’s preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. CONCLUSIONS At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions, and support the long-term development of platforms that are more technologically robust, secure. INTERNATIONAL REGISTERED REPORT RR2-10.2196/30099
Published: 2021
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22. Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: From Key Lessons to a Framework for Implementation

Author: Davorina Patek, Liliana Laranjo, Sandra Milena Espitia, Tuomas Koskela, Vanja Lazic, Braden Gregory O'Neill, Saira Ghafur, Josip Car, Edmond Li, Ensieh Memarian, Mehmet Ungan, Alice Serafini, Gianluca Fontana, Katarzyna Nessler, Gustavo Diniz Ferreira Gusso, Robert M. Hoffman, Greg Irving, Kyle Hoedebecke, Ara Darzi, Claire Collins, Rosy Tsopra, Maria Jose Fernandez, Ana Clavería, Heidrun Lingner, Geronimo Larrain Gimenez, Azeem Majeed, and Ana Luisa Neves
Subjects: Flexibility (engineering), Medical education, Work (electrical), business.industry, Remuneration, Global Positioning System, Digital transformation, Organizational culture, Computer-assisted web interviewing, Business, Thematic analysis
Abstract: BackgroundWith the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems.ObjectiveWe explored GPs’ perspectives on the main benefits and challenges of using digital remote care.MethodsGPs across 20 countries completed an online questionnaire between June – September 2020. GPs’ perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data.Results1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and the accompanying legal frameworks.Main challenges included patient’s preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses.ConclusionAt the frontline of care delivery, GPs can provide important insights on what worked well, why, and how. Lessons learned during the emergency phase can be used to inform the stable adoption of virtual care solutions, and co-design processes and platforms that are technologically robust, secure, and supported by a strategic long-term plan.
Published: 2021
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23. Non-alcoholic fatty liver disease: A patient guideline

Author: Shira Zelber-Sagi, Rebecca Dorner, Giulio Marchesini, Marko Korenjak, Christos Lionis, Jeffrey V. Lazarus, Sven Francque, Achim Kautz, Luca Busetto, José Willemse, G. Koek, Dror Dicker, Kate Hallsworth, Shlomo Vinker, Gema Frühbeck, Euan Woodward, Mehmet Ungan, Juan M. Mendive, Martine Walmsley, Francque, Sven M, Marchesini, Giulio, Kautz, Achim, Walmsley, Martine, Dorner, Rebecca, Lazarus, Jeffrey V, Zelber-Sagi, Shira, Hallsworth, Kate, Busetto, Luca, Frühbeck, Gema, Dicker, Dror, Woodward, Euan, Korenjak, Marko, Willemse, José, Koek, Gerardus H, Vinker, Shlomo, Ungan, Mehmet, Mendive, Juan M, Lionis, Christos, Interne Geneeskunde, MUMC+: MA Maag Darm Lever (9), and RS: NUTRIM - R2 - Liver and digestive health
Subjects: NASH, non-alcoholic steatohepatiti, Y GASTRIC BYPASS, Disease, RC799-869, PLACEBO-CONTROLLED TRIAL, LIFE-STYLE MODIFICATION, cardiovascular disease, LDL, low-density lipoprotein, HEPATOCELLULAR-CARCINOMA, non-invasive test, T2D, GLP-1 RAs, glucagon-like receptor 1 agonists, European Association for the Study of Obesity, HCC, Gastroenterology, NASH, specific, Diseases of the digestive system. Gastroenterology, CAP, controlled attenuation parameter, CT, computed tomography, FXR, ASH, alcoholic steatohepatitis, GP, non-alcoholic steatohepatitis, GLP-1 RAs, glucagon-like receptor 1 agonist, LDL, low-density lipoproteins, medicine.medical_specialty, HDL, achievable, NASH, non-alcoholic steatohepatitis, T2D, type 2 diabetes, high-density lipoprotein, CVD, cardiovascular disease, LDL, Patient Guideline, Quality of life (healthcare), FXR, farnesoid X receptor, NAFLD, low-density lipoproteins, GP, general practitioner, NAFL, non-alcoholic fatty liver, FIB-4, fibrosis-4 index, Intensive care medicine, computed tomography, Guideline, medicine.disease, T1D, type 1 diabete, digestive system diseases, NIT, Human medicine, farnesoid X receptor, type 1 diabetes, BMI, body mass index, EASL, European Association for the Study of the Liver, Placebo-controlled study, Chronic liver disease, GLP-1 RAs, QUALITY-OF-LIFE, alcoholic steatohepatitis, European Association for the Study of Diabetes, EASD, European Association for the Study of Diabetes, Immunology and Allergy, magnetic resonance imaging, NASH Clinical Research Network, ALD, alcohol-related or alcoholic liver disease, Disease management (health), glucagon-like receptor 1 agonists, EASO, European Association for the Study of Obesity, NASH CRN, NASH Clinical Research Network, ASH, alcoholic steatohepatiti, Fatty liver, timely, hepatocellular carcinoma, CVD, magnetic resonance elastography, MRE, NAFL, FIB-4, non-alcoholic fatty liver, type 2 diabetes, T1D, type 1 diabetes, CAP, controlled attenuation parameter, CT, European Association for the Study of the Liver, MRI, fibrosis-4 index, NAFLD, non-alcoholic fatty liver disease, EASD, HDL, high-density lipoprotein, UNITED-STATES, ASH, body mass index, EASL, measurable, BMI, NIT, non-invasive test, Internal Medicine, medicine, NASH CRN, HEPATIC STEATOSIS, HCC, hepatocellular carcinoma, MRE, magnetic resonance elastography, MRI, magnetic resonance imaging, SMART, specific, measurable, achievable, relevant, timely, Disease burden, BARIATRIC SURGERY, Hepatology, SMART, business.industry, SERUM ALANINE AMINOTRANSFERASE, non-alcoholic fatty liver disease, PHYSICAL-ACTIVITY, alcohol-related or alcoholic liver disease, EASD, European Association for the Study of Diabete, EASO, ALD, general practitioner, relevant, T1D, business
Abstract: This patient guideline is intended for all patients at risk of or living with non-alcoholic fatty liver disease (NAFLD). NAFLD is the most frequent chronic liver disease worldwide and comes with a high disease burden. Yet, there is a lot of unawareness. Furthermore, many aspects of the disease are still to be unravelled, which has an important impact on the information that is given (or not) to patients. Its management requires a close interaction between patients and their many healthcare providers. It is important for patients to develop a full understanding of NAFLD in order to enable them to take an active role in their disease management. This guide summarises the current knowledge relevant to NAFLD and its management. It has been developed by patients, patient representatives, clinicians and scientists and is based on current scientific recommendations, intended to support patients in making informed decisions. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL).
Published: 2021

24. Evaluating the impact of COVID-19 on the adoption of virtual care in general practice in 20 countries (inSIGHT): rationale and study protocol (Preprint)

Author: Ana Luísa Neves, Edmond Li, Alice Serafini, Geronimo Larrain Gimenez, Heidrun Lingner, Tuomas Koskela, Robert D Hoffman, Claire Collins, Davorina Petek, Ana Claveria, Rosy Tsopra, Greg Irving, Gustavo Gusso, Braden Gregory O’Neill, Kyle Hoedebecke, Sandra Milena Espitia, Mehmet Ungan, Katarzyna Nessler, Vanja Lazic, Liliana Laranjo, Memarian Ensieh, Maria Jose Fernandez, Saira Ghafur, Gianluca Fontana, Azeem Majeed, Josip Car, and Ara Darzi
Abstract: BACKGROUND In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. OBJECTIVE This study aims to explore the perspectives of General Practitioners / Family Doctors (GPs/FDs) on a.) use of virtual care during the COVID-19 pandemic; b.) perceived impact on quality and safety of care; c.) essential factors for high-quality and sustainable use of virtual care in the future. METHODS Online cross-sectional questionnaire of GPs/FDs, distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers’ personal contact networks. General Practitioners were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and subgroup analyses will be conducted to explore the relationships between the use of virtual care and perceptions on impact on quality and safety of care, and participants’ characteristics. Qualitative data (free-text responses) will be analysed using framework analysis. RESULTS N/A CONCLUSIONS The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP/FD characteristics, and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design.
Published: 2021
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25. Lung health in LMICs: tackling challenges ahead

Author: Hilary Pinnock, Mehmet Ungan, Ee Ming Khoo, Rachel Jordan, and Donald K T Li
Subjects: medicine.medical_specialty, business.industry, Lung health, MEDLINE, Medicine, Developing country, Humans, General Medicine, Obesity, business, Intensive care medicine, Developing Countries, Lung
Published: 2021
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26. Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study

Author: Mehmet Ungan, Azeem Majeed, Kyle Hoedebecke, Edmond Li, Braden Gregory O'Neill, Liliana Laranjo, Josip Car, Ensieh Memarian, Sandra Milena Espitia, Davorina Petek, Alice Serafini, Saira Ghafur, Gianluca Fontana, Ana Clavería, Geronimo Jimenez, Tuomas Koskela, Katarzyna Nessler, Greg Irving, Ana Luisa Neves, Robert D. Hoffman, Heidrun Lingner, Claire Collins, Gustavo Diniz Ferreira Gusso, Rosy Tsopra, Maria Jose Fernandez, Ara Darzi, Vanja Lazic, Imperial College London, Local Health Authority of Modena, Leiden University Medical Center (LUMC), Universiteit Leiden, Nanyang Technological University [Singapour], Hannover Medical School [Hannover] (MHH), University of Tampere [Finland], Tel Aviv University (TAU), Irish College of General Practitioners [Dublin, Irlande] (ICGP), University of Ljubljana, Galicia South Health Research Institute, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Health data- and model- driven Knowledge Acquisition (HeKA), Inria de Paris, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École Pratique des Hautes Études (EPHE), Edge Hill University, Universidade de São Paulo = University of São Paulo (USP), Keenan Research Centre of the Li Ka Shing Knowledge Institute [Toronto], Oscar Health, Colombian Society of Family Medicine, Ankara University School of Medicine [Turkey], Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Health Center Zagreb, The University of Sydney, Macquarie University [Sydney], Lund University [Lund], Skane University Hospital [Malmo], Tampere University, Primary Health Care, and Clinical Medicine
Subjects: Medical education, Telemedicine, Data collection, media_common.quotation_subject, [SDV]Life Sciences [q-bio], MEDLINE, Quality of care, Digital-first models, Qualitative property, Context (language use), Virtual care, General Medicine, 3121 Internal medicine, Primary care, 3142 Public health care science, environmental and occupational health, Patient safety, Protocol, Social media, Quality (business), Psychology, media_common
Abstract: Background In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. Objective This study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future. Methods This study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers’ personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants’ characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis. Results Data collection took place from June 2020 to September 2020. As of this manuscript’s submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing. Conclusions The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design. International Registered Report Identifier (IRRID) DERR1-10.2196/30099
Published: 2021
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27. ECCO Essential Requirements for Quality Cancer Care: Primary care

Author: Csaba L. Dégi, Mehmet Ungan, Danica Rotar Pavlic, Joanna Kazmierska, Marc Beishon, Lynda Wyld, Agnieszka Kołacińska, Peter Selby, Richard Price, Simon Malas, Sébastien Moine, Fiona M Walter, Matti Aapro, Marije Bolt, Claire Champeix, Ian Banks, David Weller, Fiona Bonanno, Lisa Jelf Eneqvist, Walter, Fiona [0000-0002-7191-6476], and Apollo - University of Cambridge Repository
Subjects: 0301 basic medicine, media_common.quotation_subject, MEDLINE, Primary level, Primary care, Medical Oncology, 03 medical and health sciences, 0302 clinical medicine, Nursing, Survivorship curve, Neoplasms, Health care, medicine, Cancer burden, Humans, Quality (business), Societies, Medical, media_common, Quality of Health Care, Primary Health Care, business.industry, Cancer, Hematology, medicine.disease, Europe, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, business
Abstract: Background ECCO Essential Requirements for Quality Cancer Care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to cancer patients. They are written by European experts representing all disciplines involved in cancer care. This paper concerns the integration of primary care into care for all cancers in Europe. Primary care integration: • Primary care professionals play major roles in the diagnosis of cancer and care of cancer patients • There are many opportunities for extending care at the primary level to cope with the increasing cancer burden and its nature as a chronic disease, but there are also significant barriers to progress towards high-quality patient-centred care • To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper to include primary and community care in patient-centred pathways from diagnosis to treatment and survivorship.
Published: 2019
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28. The Effects of Smoking Ban in Closed Public Spaces on the Status of Smoking

Author: Selda Tekiner, Mehmet Ungan, Tuğba Yurdakul, and Gülsen Ceyhun Peker
Subjects: business.industry, Environmental health, Medicine, Smoking ban, business
Published: 2016
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29. Evalution of Hearing in Elderly Patients

Author: Güçlü Kaan Beriat, Mehmet Ungan, and Soner Ozkan
Published: 2011
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30. Family Medicine: a Contemporary Health Care Provision System

Author: Hakan Yaman, Melahat Akdeniz, and Mehmet Ungan
Subjects: medicine.medical_specialty, Nursing, business.industry, Family medicine, Health care, medicine, Self care, business
Published: 2011
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31. The Development of Family Medicine as a Discipline in Turkey

Author: Mehmet Ungan, Hakan Yaman, and Melahat Akdeniz
Subjects: medicine.medical_specialty, business.industry, Family medicine, medicine, business
Published: 2011
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32. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 5: Needs and implications for future research and policy

Author: Lieve Peremans, Davorina Petek, Mehmet Ungan, Imre Rurik, Jean Karl Soler, Henri E J H Stoffers, Eva Hummers-Pradier, Paul Van Royen, Martin Beyer, Christos Lionis, Sophia Eilat-Tsanani, Pinar Topsever, and Patrick Chevallier
Subjects: medicine.medical_specialty, Biomedical Research, Primary Health Care, business.industry, Health Policy, media_common.quotation_subject, General Practice, Alternative medicine, MEDLINE, Primary health care, Core competency, Europe, Promotion (rank), Family medicine, Needs assessment, General practice, medicine, Family Practice, business, Needs Assessment, Health policy, media_common
Abstract: The recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and highlights related needs and implications for future research and policy. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In three subsequent, articles the results for the six core competencies of the European Definition of GP/FM were presented. This article formulates the common aims for further research and appropriate research methodologies, based on the missing evidence and research gaps identified form the comprehensive literature review. In addition, implications of this research agenda for general practitioners/family doctors, researchers, research organizations, patients and policy makers are presented. The concept of six core competencies should be abandoned in favour of a model with four dimensions, including clinical, person related, community oriented and management aspects. Future research and policy should consider more the involvement and rights of patients; more attention should be given to how new treatments or technologies are effectively translated into routine patient care, in particular primary care. There is a need for a European ethics board. The promotion of GP/FM research demands a good infrastructure in each country, including access to literature and databases, appropriate funding and training possibilities.
Published: 2010
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33. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 2. Results: Primary care management and community orientation1

Author: Lieve Peremans, Patrick Chevallier, Jean Karl Soler, Henri E J H Stoffers, Eva Hummers-Pradier, Imre Rurik, Pinar Topsever, Christos Lionis, Martin Beyer, Mehmet Ungan, Sophia Eilat-Tsanani, Paul Van Royen, and Davorina Petek
Subjects: Community orientation, medicine.medical_specialty, business.industry, media_common.quotation_subject, MEDLINE, Core competency, Primary health care, Primary care, Quality of life (healthcare), Nursing, Family medicine, Health care, Medicine, Quality (business), Family Practice, business, media_common
Abstract: At the WONCA Europe conference 2009 the recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' was presented. It is a background paper and reference manual, providing advocacy of general practice/family medicine (GP/FM) in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In this second article, the results for the core competencies 'primary care management' and 'community orientation' are presented. Though there is a large body of research on various aspects of 'primary care management', it represents a very scattered rather than a meta view. Many studies focus on care for specific diseases, the primary/secondary care interface, or the implications of electronic patient records. Cost efficiency or process indicators of quality are current outcomes. Current literature on community orientation is mainly descriptive, and focuses on either care for specific diseases, or specific patient populations, or on the uptake of preventive services. Most papers correspond poorly to the WONCA concept. For both core competencies, there is a lack of research with a longitudinal perspective and/or relevant health or quality of life outcomes as well as research on patients' preferences and education for organizational aspects of GP/FM.
Published: 2010
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34. The Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe. Part 1. Background and methodology1

Author: Christos Lionis, Sophia Eilat-Tsanani, Imre Rurik, Lieve Peremans, Patrick Chevallier, Paul Van Royen, Martin Beyer, Mehmet Ungan, Eva Hummers-Pradier, Davorina Petek, Jean Karl Soler, Henri E J H Stoffers, and Pinar Topsever
Subjects: medicine.medical_specialty, business.industry, MEDLINE, Alternative medicine, Core competency, Special Interest Group, Action (philosophy), Family medicine, medicine, Family Practice, business, Publication, Health policy, Meaning (linguistics)
Abstract: At the WONCA Europe conference 2009 the recently published ‘Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe’ was presented. The Research Agenda is a background paper and reference manual for GPs/ family doctors, researchers and policy makers, providing advocacy of general practice/family medicine GP/FM in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe defi nition of GP/FM, and its meaning for researchers and policy makers. Evidence gaps and research needs are pointed out to provide a basis for planning research for which there is a need and for action that may infl uence health and research policy, i.e. applying/lobbying for research funds. WONCA Europe and its associated networks and special interest groups could consider the agenda’s research priorities when planning future conferences, courses, or projects, and for funding purposes. The European Journal of General Practice will publish a series of articles based on this document. In this fi rst article, background, objectives, methodology and relevant literature are discussed. In subsequent articles, the results will be presented.
Published: 2009
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35. Why does teaching research skills to family medicine trainees make sense?

Author: Mehmet Ungan, Zalika Klemenc-Ketis, and Janko Kersnik
Subjects: medicine.medical_specialty, New horizons, Biomedical Research, Evidence-Based Medicine, business.industry, education, Specialty, Alternative medicine, Internship and Residency, Research skills, Clinical Practice, Europe, Nursing, Education, Medical, Graduate, Family medicine, Health care, Medicine, Humans, Curriculum, business, Family Practice, Single family, Teaching research
Abstract: There are only a few countries in Europe that have incorporated research skills training in specialty training programmes. In the eyes of most practising family physicians, research traditionally is a field reserved for colleagues with academic ambitions; an activity that often is not associated with the clinical practice of family medicine. However, residents became aware that research is essential to improving healthcare provision. Research in family medicine has a long tradition. Performing or taking part in research projects opens new horizons to present and future family physicians and provides support to increase their self-esteem. Consequently, this could foster future family medicine development. The authors urge the whole family physician community to raise the awareness every single family physician towards teaching and learning research skills in specialty training and basic medical education as a generic subject.
Published: 2015

36. Bone mineral density of lumbar spine and proximal femur in healthy males

Author: Alpaslan Senkoylu, Mehmet Ungan, Sedat Isikli, Serhat Akin, and Feza Korkusuz
Subjects: musculoskeletal diseases, Orthodontics, Bone mineral, Proximal femur, business.industry, musculoskeletal, neural, and ocular physiology, Health, Toxicology and Mutagenesis, Public Health, Environmental and Occupational Health, musculoskeletal system, Pollution, Analytical Chemistry, Nuclear Energy and Engineering, Medicine, Radiology, Nuclear Medicine and imaging, Lumbar spine, business, Spectroscopy
Abstract: The aim of this study was to investigate the relationship between BMD and age at lumbar spine and proximal femur in Turkish males. Two hundred ninety healthy males (aged 20-59 years) were investigated. BMD of the lumbar spine had its peak at ages 30-39, however, the peak for the proximal femur was between the ages of 20 and 29. There was a significant decrease in BMD at proximal femur after these peak values with increasing age. In conclusion, there was a significant correlation between age and the proximal femoral BMD in males and age has a strong predictive power on proximal femur BMD score.
Published: 2004
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37. Precision of a dual energy X-ray absorptiometry device

Author: Serhat Akin, S. Işıklı, N. K. Aras, F. Forkusuz, Mehmet Ungan, and Alpaslan Senkoylu
Subjects: musculoskeletal diseases, Bone mineral, medicine.diagnostic_test, business.industry, Health, Toxicology and Mutagenesis, Coefficient of variation, Osteoporosis, Public Health, Environmental and Occupational Health, medicine.disease, Pollution, Imaging phantom, Analytical Chemistry, Nuclear Energy and Engineering, medicine, Radiology, Nuclear Medicine and imaging, Nuclear medicine, business, Spectroscopy, Dual-energy X-ray absorptiometry, Mathematics
Abstract: The standard method to diagnose and follow-up osteoporosis is the measurement of bone mineral density (BMD) using dual X-ray absorptiometry (DEXA). Manufacturers' manuals of DEXA devices state the intrascanner coefficient of variance is less than 0.01 g/cm2. The aim of this study was to evaluate the in vivo coefficient of variance of a Lunar DPX scanner in male and female healthy adult subjects. Average BMD for females and males were 1.170±0.091 g/cm2 and 1.272±0.115 g/cm2, respectively. Monthly phantom measurements provided and controlled by the manufacturer were 1.243±0.008 g/cm2 (range 1.222 to 1.257) and the coefficient of variance was 0.006. It is concluded that the in vivo coefficient of variance of DEXA devices can slightly be higher than that proposed by the manufacturer.
Published: 2004
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38. AIDS knowledge and educational needs of technical university students in Turkey

Author: Hakan Yaman and Mehmet Ungan
Subjects: Adult, Male, Health Knowledge, Attitudes, Practice, Adolescent, Turkey, Universities, Sexual Behavior, education, Sex Education, Minor (academic), law.invention, Risk-Taking, Nursing, Acquired immunodeficiency syndrome (AIDS), Condom, law, Surveys and Questionnaires, Humans, Medicine, Students, Curriculum, Reproductive health, Acquired Immunodeficiency Syndrome, Medical education, business.industry, General Medicine, medicine.disease, Sexual intercourse, Cross-Sectional Studies, Knowledge, Socioeconomic Factors, Needs assessment, Educational Status, Female, Health education, business, Attitude to Health, Needs Assessment
Abstract: AIDS is a main health problem of the recent century and is now considered a very important cause for mortality and morbidity among young people. The aim of this research is to determine the Turkish university students knowledge, sexual risk behavior, attitude towards AIDS and educational needs concerning AIDS. A cross-sectional exploratory design is utilized in this study. One thousand four hundred and twenty-seven university new registrants from the Middle East Technical University participated and answered a 32-item self-administered questionnaire. The questionnaire addressed sociodemographics, sexual risk behavior, self-assessed knowledge on HIV transmission and AIDS, attitudes towards AIDS infection and AIDS patient, source of information and need for AIDS course. The response rate was 84%. Two hundred and seventy-one (19%) participants had sexual intercourse. Eighty-one (30%) participants reported condom use during the last encounter. Seven hundred and twenty-four (51%) stated they knew "very much" about AIDS. Students of faculty of engineering (n=384, 69%), economic and administrative sciences (n=115, 55%), and architecture (n=42, 52%) declared they knew "very much" on AIDS and had a higher frequency as the students from the faculty of arts and sciences (n=119, 43%) and education (n=64, 40%). Television was reported as the major source of information about AIDS (n=871, 61%). Students in faculty of education had lower scores than others (P=0.01). Almost all students stated that there should be a course on AIDS in their curriculum. Educational and medical institutions are the minor information sources for students at universities. Therefore, schools have to integrate new courses on AIDS and sexual health in their curricula, physicians caring for these students have to take more time for health education.
Published: 2003
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39. Cure rates obtained with five different Helicobacter pylori eradication protocols in patients with duodenal ulcer: a prospective, open-label randomized study in a primary care setting in Turkey

Author: Burcak Kayhan, Mehmet Ungan, and Hakan Kulaçoǧlu
Subjects: Pharmacology, medicine.medical_specialty, education.field_of_study, biology, Helicobacter pylori eradication protocols, business.industry, Population, Lansoprazole, Helicobacter pylori, Amoxicillin, biology.organism_classification, Gastroenterology, Clarithromycin, Internal medicine, medicine, Pharmacology (medical), education, business, Omeprazole, medicine.drug, Antibacterial agent
Abstract: Background: Helicobacter pylori is the main causative agent in peptic ulcer disease. Duodenal ulcer disease is a chronic, recurring condition, and the risk of recurrence and complications does not diminish over time unless H pylori is eradicated. Several treatment protocols exist to eradicate H pylori , but their efficacy and costs vary. Because of regional variations in bacterial resistance and in treatment costs, primary care physicians must use the most appropriate protocol for their own region and population. Objective: The primary aim of this study was to compare the cure rates obtained with 5 different H pylori eradication protocols in H pylori —positive duodenal ulcer patients in Turkey. A secondary objective was to determine the accuracy of the duodenal ulcer diagnoses made by primary care physicans relying on information from physical examination and medical history alone. Methods: In a primary care setting, 2 family physicians, 5 general physicians (medical school graduates), 1 general surgeon, and 1 internal medicine specialist identified 265 symptomatic duodenal ulcer patients using medical history and physical examination results. These patients were referred to an open-access endoscopy unit for upper gastrointestinal endoscopy. Patients who had an endoscopically confirmed duodenal ulcer and who tested positive for H pylori were randomly assigned to receive 1 of 5 H pylori eradication treatments: (1) omeprazole/amoxicillin/clarithromycin; (2) lansoprazole/amoxicillin/clarithromycin; (3) omeprazole/ornidazole/amoxicillin; (4) lansoprazole/amoxicillin/clarithromycin/ornidazole, or (5) ranitidine bismuth citrate/amoxicillin/metronidazole. Follow-up endoscopies and biopsies were performed 6 weeks and 6 months after the end of treatment. Results: Of the 265 patients suspected to have duodenal ulcers based on medical history and physical examination findings, 181 (68.3%) had endoscopically confirmed duodenal ulcers. At both 6 weeks and 6 months after treatment, eradication rate were not significantly different between treatment groups in the intent-to-treat or per-protocol analyses. There was no significant difference in tolerability between the 5 regimens. Conclusions: Our results confirm the high accuracy of the duodenal ulcer diagnoses and endoscopy referrals made by primary care physicians based on physical examination and medical history of the patient. Primary care physicians should play an important role in treatment decisions regarding H pylori eradication. The 5 treatments studied are similar with respect to H pylori eradication rates. If the cost of treatment is an important consideration, the less expensive omeprazole/ornidazole/amoxicillin triple regimen may be a good choice for eradicating H pylori . In cases of resistant H pylori infection, the lansoprazole/amoxicillin/clarithromycin/ornidazole quadruple therapy appears to be the best choice for a second-line treatment if reliable culture and resistance testing are not available. Depending on regional variables, each nation needs to develop its own guidelines for the eradication of H pylori .
Published: 2001
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40. Birinci basamak için gastroenteroloji ve ESPCG kuruluşunun tanıtımı

Author: Mehmet Ungan
Published: 2008
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41. Developing a Mediterranean family medicine group

Author: Christos Lionis, Mehmet Ungan, Jean Karl Soler, Luis Pisco, Danny Tayar, Eliezer Kitai, Michael Kaloeidas, Francesco Carelli, GÖOran Almagor, Stathis Skliros, Juan M. Mendive, Evangelos Drosos, and Bishara Bisharat
Subjects: Mediterranean climate, medicine.medical_specialty, business.industry, Family medicine, General practice, Epidemiology, Medicine, Family Practice, business, Key issues
Abstract: On 9 September 2000, a meeting on General Practice/Family Medicine (GP/FM) in the Mediterranean was held at the 6th Mediterranean Congress in Malta. The creation of a Mediterranean GP/FM group was discussed among delegates from seven Mediterranean countries. Historical, cultural and epidemiological concepts supporting this initiative are presented. The main aims of this group and the key issues of the Malta consensus are clarified.
Published: 2002
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42. The research agenda for general practice/family medicine and primary health care in Europe : part 6 : reaction on commentaries, how to continue with the research agenda?

Author: Jean Karl Soler, Henri E J H Stoffers, Imre Rurik, Patrick Chevallier, Pinar Topsever, Lieve Peremans, Davorina Petek, Martin Beyer, Eva Hummers-Pradier, Mehmet Ungan, Christos Lionis, Sophia Eilat-Tsanani, Paul Van Royen, and Acibadem University Dspace
Subjects: Prioritization, medicine.medical_specialty, Biomedical Research, General Practice, research agenda, Primary health care, Translational research, challenges, Primary care, general practice/family medicine, Translational Research, Biomedical, Added value, Humans, Medicine, Primary Health Care, business.industry, Health Policy, Equity (finance), Core competency, indicators, Europe, Family medicine, General practice, Human medicine, Family Practice, business, policy
Abstract: The Research Agenda should be used as a key reference point to which new research should relate its usefulness and added value. Primary care evolves towards more interdisciplinary care, and research should focus more on the core competency of person-centred team care. There is an urgent need to develop clear definitions and appropriate research instruments for this domain. It will be a particular challenge to study comprehensive approaches in primary-care patients with multi-morbidity. The Research Agenda and the commentaries on it show future directions for primary care research. There are challenges related to a changing society, the shared responsibility and guidance of research by professionals and citizens (patients), and the need to fully integrate research as part of primary healthcare provision. There will be a need for a prioritization of spearheads to guide primary care research for the next decade: translational research, research on equity and health differences, on chronic disease and health systems research. This can not be realized without the development and maintenance of a solid research infrastructure: easily maintained and accessed observational databases, helpful information technology, strategies and techniques for patient involvement, advanced research training possibilities, and the development and validation of appropriate research instruments and outcome measures to capture the different challenges. Worldwide, primary care not only is a priority for health care policy, but it needs to become a research priority as well.
Published: 2011

43. A Practical Approach To Teaching Medical Students About Community Services

Author: Prof Mehmet Ungan, MD Professor of Family Medicine, Flegg, Karen, Bou Sleiman, Charles, Prof Mehmet Ungan, MD Professor of Family Medicine, Flegg, Karen, and Bou Sleiman, Charles
Abstract: This article is based on a presentation delivered by Dr Karen Flegg, Senior Lecturer from the Australian National University (ANU), at the WONCA Europe conference held in Basel, Switzerland, in 2009. The aims of the presentation were to describe an experiential method of medical students learning about community services; to outline the objectives of the programme; and to present an evaluation of students’ views.
Published: 2015

44. Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 2. Results: Primary care management and community orientation

Author: Eva, Hummers-Pradier, Martin, Beyer, Patrick, Chevallier, Sophia, Eilat-Tsanani, Christos, Lionis, Lieve, Peremans, Davorina, Petek, Imre, Rurik, Jean Karl, Soler, Henri Ejh, Stoffers, Pinar, Topsever, Mehmet, Ungan, and Paul, van Royen
Subjects: Europe, Biomedical Research, Primary Health Care, Humans, Physicians, Family, Community Health Services, Family Practice, Policy Making, Research Personnel, Quality of Health Care
Abstract: At the WONCA Europe conference 2009 the recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' was presented. It is a background paper and reference manual, providing advocacy of general practice/family medicine (GP/FM) in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In this second article, the results for the core competencies 'primary care management' and 'community orientation' are presented. Though there is a large body of research on various aspects of 'primary care management', it represents a very scattered rather than a meta view. Many studies focus on care for specific diseases, the primary/secondary care interface, or the implications of electronic patient records. Cost efficiency or process indicators of quality are current outcomes. Current literature on community orientation is mainly descriptive, and focuses on either care for specific diseases, or specific patient populations, or on the uptake of preventive services. Most papers correspond poorly to the WONCA concept. For both core competencies, there is a lack of research with a longitudinal perspective and/or relevant health or quality of life outcomes as well as research on patients' preferences and education for organizational aspects of GP/FM.
Published: 2010

45. The Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe. Part 1. Background and methodology

Author: Eva, Hummers-Pradier, Martin, Beyer, Patrick, Chevallier, Sophia, Eilat-Tsanani, Christos, Lionis, Lieve, Peremans, Davorina, Petek, Imre, Rurik, Jean Karl, Soler, Henri Ejh, Stoffers, Pinar, Topsever, Mehmet, Ungan, and Paul, Van Royen
Subjects: Europe, Biomedical Research, Primary Health Care, Health Policy, Research Support as Topic, Humans, Family Practice, Policy Making
Abstract: At the WONCA Europe conference 2009 the recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' was presented. The Research Agenda is a background paper and reference manual for GPs/ family doctors, researchers and policy makers, providing advocacy of general practice/family medicine GP/FM in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its meaning for researchers and policy makers. Evidence gaps and research needs are pointed out to provide a basis for planning research for which there is a need and for action that may influence health and research policy, i.e. applying/lobbying for research funds. WONCA Europe and its associated networks and special interest groups could consider the agenda's research priorities when planning future conferences, courses, or projects, and for funding purposes. The European Journal of General Practice will publish a series of articles based on this document. In this first article, background, objectives, methodology and relevant literature are discussed. In subsequent articles, the results will be presented.
Published: 2010

46. The research agenda for general practice/family medicine and primary health care in Europe. Part 3. Results: Person centred care, comprehensive and holistic approach

Author: Martin Beyer, Paul Van Royen, Imre Rurik, Pinar Topsever, Mehmet Ungan, Jean Karl Soler, Henri E J H Stoffers, Davorina Petek, Eva Hummers-Pradier, Patrick Chevallier, Christos Lionis, Sophia Eilat-Tsanani, Lieve Peremans, Public Health Care, and Acibadem University Dspace
Subjects: Community orientation, medicine.medical_specialty, Family medicine, Primary health care -- Europe, MEDLINE, Primary health care, Research agenda, Holistic health, Primary care, Holistic Health, Person centred care, Nursing, Patient-Centered Care, Medicine, Humans, Comprehensive approach, Holistic approach, general practice, General practice/family medicine, Primary Health Care, business.industry, Core competency, Physicians, Family, Europe, Family medicine -- Europe, General practice, Family doctors, Human medicine, Health Services Research, business, Family Practice
Abstract: The recently published ‘ Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe ’ summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe defi nition of GP/ FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a fi rst article, background, objectives, and methodology were discussed. In a second article, the results for the two core competencies ‘ primary care management ’ and ‘ community orientation ’were presented. This article refl ects on the three core competencies, which deal with person related aspects of GP/FM, i.e. ‘ person centred care ’ , ‘ comprehensive approach ’and ‘ holistic approach ’ . Though there is an important body of opinion papers and (non-systematic) reviews, all person related aspects remain poorly defi ned and researched. Validated instruments to measure these competencies are lacking. Concerning patient-centredness, most research examined patient and doctor preferences and experiences. Studies on comprehensiveness mostly focus on prevention/care of specific diseases. For all domains, there has been limited research conducted on its implications or outcomes., peer-reviewed
Published: 2010

47. Habitual tea drinking and bone mineral density in postmenopausal Turkish women: investigation of prevalence of postmenopausal osteoporosis in Turkey (IPPOT Study)

Author: Mehmet Ungan, Karanfil Sitmapinar, Ayfer Gemalmaz, Nezih Dağdeviren, Erhan Burgut, Unal Akça, Ilknur Devran Sencar, Serpil Aydin, Okay Başak, İsmail Hamdi Kara, Nafiz Bozdemir, Hakan Yaman, Sevgi Özcan, Hakan Işildar, Melahat Akdeniz, Zekeriya Aktürk, Hatice Kurdak, and Çukurova Üniversitesi
Subjects: Turkey, Urban Population, Cross-sectional study, Turkish, Endocrinology, Diabetes and Metabolism, Osteoporosis, Habitual tea consumption, Medicine (miscellaneous), Postmenopausal osteoporosis, Coffee, Body Mass Index, Bone Density, Surveys and Questionnaires, Epidemiology, Prevalence, Medicine, Osteoporosis, Postmenopausal, Bone mineral, Nutrition and Dietetics, Smoking, General Medicine, Middle Aged, Postmenopausal women, Postmenopause, Milk, language, Educational Status, Female, medicine.medical_specialty, Nutritional Status, Education, Interviews as Topic, Age Distribution, Environmental health, Animals, Humans, Obesity, ddc:610, Aged, Tea, business.industry, Estrogens, Feeding Behavior, medicine.disease, language.human_language, Surgery, Osteopenia, Bone Diseases, Metabolic, Cross-Sectional Studies, Progestins, business, Body mass index
Abstract: PubMedID: 18622949 Aim: In this epidemiological report, we assessed the prevalence of osteopenia and osteoporosis (OP) in postmenopausal Turkish women and the relationship between body mass index (BMI), and some nutritional factors (habitual tea, coffee, tobacco, and milk product consumption) with OP. Methods: This multicenter study was done in postmenopausal women residing in five big cities, in four different regions of Turkey between August and November 2005. An inclusion criterion was being in the postmenopausal period for at least 12 months. A semi-structured questionnaire was completed by face-to-face interview, consisting of closed- and open-ended questions about demographic characteristics, nutritional status, and habits with two or more choices as possible responses. Bone mineral density (BMD) measurements were performed with a MetriScan® Densitometer (Alara Inc., Ca, USA). Results: Seven hundred twenty-four women were included in the study. The mean age was 57.6 ± 9.6 years, and mean age at natural menopause was 46.4 ± 5.6 years. Of the participants, 51% were illiterate. According to WHO classification; 42.5% were normal in terms of BMD, 27.2% had osteopenia, and 30.2% had OP. Women with high education levels had better T-scores (p = 0.019). Increase in BMI also had a positive effect on T-scores (p < 0.0001). A linear correlation was found between age (r= -0.386, p < 0.0001), BMI (r = -0.175, p < 0.0001), and education (r = -0.317, p < 0.0001), with T-scores. The T-scores of women who consumed tea on a regular basis were found to be higher than non-consumers (-1.51 ± 1.68 vs. -1.09 ± 1.66; p = 0.070) [when smokers, those who received hormonal therapy (HT), and those > 65 years were excluded]. Conclusion: OP was determined in 1/3 of the women. Advanced age (> 65) and being illiterate were negative factors, while high education levels, being overweight, and being treated with HT had a positive effects on BMD. Habitual tea drinking also may have a positive effect on BMD. However, tea drinking was not found to be a statistically significant factor in the present study. © Hogrefe & Huber Publishers.
Published: 2007

48. EGPRN: EUROPEAN GENERAL PRACTICE RESEARCH NETWORK EGPRN is networking in many ways

Author: Davorina Petek and Mehmet Ungan
Subjects: Medical education, business.industry, Primary health, General practice, Medicine, Family Practice, business, Theme (narrative)
Abstract: THE PREVIOUS EGPRN MEETING IN KUSADASI, TURKEY, MAY 2013The theme of this EGPRN meeting was ‘Risky behaviours and healthy outcomes in primary health care.’ EGPRN received 136 abstracts, of which 72...
Published: 2013
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49. The prevalence of antibodies to hepatitis a among preschool children in an urban setting in Turkey

Author: Y. Mehmet Ungan, Nusret Taheri, and Hakan Yaman
Subjects: Male, medicine.medical_specialty, Turkey, Urban Population, viruses, Population, Hepatitis A Antibodies, Serology, Risk Factors, Seroepidemiologic Studies, Epidemiology, Prevalence, Medicine, Humans, education, Child, Hepatitis, education.field_of_study, business.industry, Hepatitis A, medicine.disease, Vaccination, Infectious Diseases, El Niño, Child, Preschool, Immunoglobulin G, Pediatrics, Perinatology and Child Health, Immunology, Female, Viral disease, business, Biomarkers, Hepatitis A Virus, Human, Demography
Abstract: The prevalence of antibodies to hepatitis A virus (HAV) was investigated in 114 children (59.7 per cent males) aged 4-6 years, in the campus area of Middle East Technical University, Ankara, Turkey. The prevalence of hepatitis A antibody in this age group was 11.4 per cent (13/114). The rate of immunized children against hepatitis A was 3.65 per cent (5/137). In conclusion the prevalence of anti-HAV demonstrates the susceptibility of other preschool children to hepatitis A. This may be a cause for considering hepatitis A vaccination before preschool attendance in Turkey.
Published: 2002

50. Health problems among UN refugees at a family medical centre in Ankara, Turkey

Author: Mehmet Ungan, Aylin Yaman, Altuğ Kut, and Hakan Yaman
Subjects: Adult, Male, medicine.medical_specialty, Pediatrics, Turkey, United Nations, Referral, Health Status, Refugee, Disease, Communicable Diseases, Stress Disorders, Post-Traumatic, Health care, Humans, Medicine, Medical Audit, Refugees, Middle East, Primary Health Care, business.industry, Medical record, fungi, Public Health, Environmental and Occupational Health, Health services research, food and beverages, Middle Aged, Family medicine, Needs assessment, Female, Health Services Research, business, Needs Assessment
Abstract: Objectives - Political lability in the Near East has brought about the migration of refugees from adjacent countries to Turkey in recent years. To provide an effective health service for refugees, a needs assessment has to be done. UN refugees referring to a family medical centre located in Ankara, Turkey, were therefore investigated for health problems. Design - Medical records were studied retrospectively for age distribution, gender, origin, diagnoses, type of treatment and referral to a secondary health care setting. Subjects - 212 refugees of different countries (mostly from Iraq, Iran and Palestine). Results - Infectious disease was the most often diagnosed condition. Post-traumatic stress disorders could be observed in 12% of refugees. Conclusion - The family physician must be careful not to misdiagnose these disorders during medical examination. Most disease can be diagnosed and treated in family practice. Special care must be taken in the case of mental disorders.
Published: 2002

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