Frequency And Factors Associated With Adverse Reactions After Administration of Inactivated COVID-19 Vaccine Among Health Workers.

BACKGROUND: The 2019 coronavirus (COVID-19) has precipitated a significant public health crisis. Our study aimed to evaluate the prevalence and risk factors associated with adverse reactions to the inactivated CoronaVac vaccine. METHODS: The study involved voluntary health workers who received CoronaVac vaccine. We documented the sociodemographic information of 2,019 participants who volunteered for our study. Of these, 1,964 and 1,702 participants were interviewed by phone 1 month after the first and second dose, respectively, during which they were queried about any adverse reactions. RESULTS: Within the first week after the first dose, adverse reactions were observed in 856 (43.3%) participants, with 133 (6.7%) experiencing them during the second week, and 96 (4.9%) people at the end of the first month. For the second dose, 276 individuals (16.2%) reported adverse reactions. The prevalence of both local and systemic adverse events ranged from 9.5-11.2% overall. Fatigue was the most common adverse reaction overall, while pain at the injection site was the most frequent local adverse reaction. CONCLUSIONS: The evaluation of both systemic and local side effects revealed no significant adverse reactions to the inactivated CoronaVac vaccine (Sinovac Life Sciences, Beijing, China). Our study found that the incidence of systemic and local adverse responses to the CoronaVac vaccination was lower than the rates reported in studies involving the recombinant adenovirus type-5, BNT162b1, and ChAdOx1nCoV-19 COVID-19 vaccines, all of which underwent the World Health Organization LULUC/PQ evaluation process.

The Evaluation Of Smoking Cessation Treatment Success and Related Factors in Adults Age 65 Years and Older.

OBJECTIVES: The aim was to evaluate smoking cessation treatment success and factors associated in older adults. METHODS: In the retrospective cohort study, the patients' sociodemographic data, smoking history, Fagerström Test for Nicotine Dependence scores (FTND), type of treatments (Pharmacological treatments, behavioral counseling, and/or both) and the number of follow-up sessions in the Smoking Cessation Outpatient Clinic were taken from hospital files of the patients. Treatment success was evaluated as one year of abstinence from smoking. RESULTS: Participants' reported with 53% classified as high-very high nicotine dependence. Overall, 36% reported abstinence from smoking for one year or more. Treatment success was associated with higher attendance at follow-up sessions. Using pharmacologic treatments and behavioral counseling together was proved to be more effective than behavioral counseling alone. CONCLUSIONS: One-year smoking cessation was achieved in one-third of older adults attending a smoking cessation clinic. In older adults in this sample low FTND scores, use of combined pharmacologic and behavioral treatment, and attendance at follow up sessions were associated with one year smoking abstinence. CLINICAL IMPLICATIONS: Older adults should be referred for smoking cessation treatment. Use of combined pharmacological and behavioral counseling is recommended. Efforts to enhance attendance at follow-up sessions should be considered.

Frequency And Factors Associated With Adverse Reactions After Administration of Inactivated COVID-19 Vaccine Among Health Workers

ABSTRACT Background: The 2019 coronavirus (COVID-19) has precipitated a significant public health crisis. Our study aimed to evaluate the prevalence and risk factors associated with adverse reactions to the inactivated CoronaVac vaccine. Methods: The study involved voluntary health workers who received CoronaVac vaccine. We documented the sociodemographic information of 2,019 participants who volunteered for our study. Of these, 1,964 and 1,702 participants were interviewed by phone 1 month after the first and second dose, respectively, during which they were queried about any adverse reactions. Results: Within the first week after the first dose, adverse reactions were observed in 856 (43.3%) participants, with 133 (6.7%) experiencing them during the second week, and 96 (4.9%) people at the end of the first month. For the second dose, 276 individuals (16.2%) reported adverse reactions. The prevalence of both local and systemic adverse events ranged from 9.5-11.2% overall. Fatigue was the most common adverse reaction overall, while pain at the injection site was the most frequent local adverse reaction. Conclusions: The evaluation of both systemic and local side effects revealed no significant adverse reactions to the inactivated CoronaVac vaccine (Sinovac Life Sciences, Beijing, China). Our study found that the incidence of systemic and local adverse responses to the CoronaVac vaccination was lower than the rates reported in studies involving the recombinant adenovirus type-5, BNT162b1, and ChAdOx1nCoV-19 COVID-19 vaccines, all of which underwent the World Health Organization LULUC/PQ evaluation process.

O Nível de Endocan Sérico pode ser Usado como Biomarcador para Prever Aterosclerose Subclínica em Pacientes Pré-Diabéticos? / Can the Serum Endocan Level Be Used as a Biomarker to Predict Subclinical Atherosclerosis in Patients with Prediabetes?

Resumo Fundamento Pacientes pré-diabéticos têm um risco aumentado de doença cardiovascular aterosclerótica, e, portanto, a detecção precoce é importante. Objetivo Nosso estudo teve o objetivo de revelar a usabilidade dos níveis de endocan sérico como biomarcador no diagnóstico de aterosclerose subclínica em pacientes pré-diabéticos, com base em medições de EIMC. Métodos Os participantes foram classificados de acordo com a presença (n=42) ou ausência (n=42) de pré-diabetes. Os valores de endocan sérico, glicemia em jejum, insulina em jejum e hemoglobina glicada (HbA1c) dos pacientes foram examinados e a EIMC foi medida. O nível de significância para a análise estatística foi 0,05. Resultados Apesar de se ter determinado que os níveis de endocan sérico são mais baixos em pacientes pré-diabéticos em comparação com o grupo de controle (p=0,042), determinou-se que os valores de EIMC são mais altos (p=0,046). A avaliação do endocan sérico por análise regressiva multivariada detectou que seu nível estava associado à EIMC, independentemente de outros parâmetros (p=0,007). Encontramos uma correlação negativa entre insulina plasmática em jejum e níveis de endocan (r=-0,320, p=0,001). Conclusões Este estudo demonstrou que a espessura íntima-média de carótida é mais alta e o nível de endocan sérico é mais baixo em pacientes pré-diabéticos. Os níveis de endocan sérico diminuídos em pacientes pré-diabéticos podem ser um fator que contribui para os mecanismos de formação de aterosclerose.

Abstract Background Patients with prediabetes have an increased risk of atherosclerotic cardiovascular disease; therefore, early detection is important. Objective The present study aimed to reveal the usability of serum endocan levels as a biomarker in the diagnosis of subclinical atherosclerosis in patients with prediabetes, based on CIMT measurements. Methods Participants were classified according to the presence (n=42) or absence (n=42) of prediabetes. Serum endocan, fasting blood sugar, fasting insulin, and glycated hemoglobin (HbA1c) values of patients were examined, and CIMT was measured. The level of significance for statistical analysis was 0.05. Results While serum endocan levels were found to be lower in patients with prediabetes, when compared to the control group (p=0.042), CIMT values were found to be higher (p=0.046). When evaluated by multivariate regression analysis, the serum endocan level was found to be associated with CIMT, regardless of other parameters (p=0.007). A negative correlation was found between plasma fasting insulin and endocan levels (r=-0.320, p=0.001). Conclusions Carotid intima media thickness was found to be high and the serum endocan level was low in patients with prediabetes. Decreased serum endocan levels in patients with prediabetes may be a contributing factor to atherosclerosis formation mechanisms.

Can the Serum Endocan Level Be Used as a Biomarker to Predict Subclinical Atherosclerosis in Patients with Prediabetes? / O Nível de Endocan Sérico pode ser Usado como Biomarcador para Prever Aterosclerose Subclínica em Pacientes Pré-Diabéticos?

BACKGROUND: Patients with prediabetes have an increased risk of atherosclerotic cardiovascular disease; therefore, early detection is important. OBJECTIVE: The present study aimed to reveal the usability of serum endocan levels as a biomarker in the diagnosis of subclinical atherosclerosis in patients with prediabetes, based on CIMT measurements. METHODS: Participants were classified according to the presence (n=42) or absence (n=42) of prediabetes. Serum endocan, fasting blood sugar, fasting insulin, and glycated hemoglobin (HbA1c) values of patients were examined, and CIMT was measured. The level of significance for statistical analysis was 0.05. RESULTS: While serum endocan levels were found to be lower in patients with prediabetes, when compared to the control group (p=0.042), CIMT values were found to be higher (p=0.046). When evaluated by multivariate regression analysis, the serum endocan level was found to be associated with CIMT, regardless of other parameters (p=0.007). A negative correlation was found between plasma fasting insulin and endocan levels (r=-0.320, p=0.001). CONCLUSIONS: Carotid intima media thickness was found to be high and the serum endocan level was low in patients with prediabetes. Decreased serum endocan levels in patients with prediabetes may be a contributing factor to atherosclerosis formation mechanisms.

FUNDAMENTO: Pacientes pré-diabéticos têm um risco aumentado de doença cardiovascular aterosclerótica, e, portanto, a detecção precoce é importante. OBJETIVO: Nosso estudo teve o objetivo de revelar a usabilidade dos níveis de endocan sérico como biomarcador no diagnóstico de aterosclerose subclínica em pacientes pré-diabéticos, com base em medições de EIMC. MÉTODOS: Os participantes foram classificados de acordo com a presença (n=42) ou ausência (n=42) de pré-diabetes. Os valores de endocan sérico, glicemia em jejum, insulina em jejum e hemoglobina glicada (HbA1c) dos pacientes foram examinados e a EIMC foi medida. O nível de significância para a análise estatística foi 0,05. RESULTADOS: Apesar de se ter determinado que os níveis de endocan sérico são mais baixos em pacientes pré-diabéticos em comparação com o grupo de controle (p=0,042), determinou-se que os valores de EIMC são mais altos (p=0,046). A avaliação do endocan sérico por análise regressiva multivariada detectou que seu nível estava associado à EIMC, independentemente de outros parâmetros (p=0,007). Encontramos uma correlação negativa entre insulina plasmática em jejum e níveis de endocan (r=-0,320, p=0,001). CONCLUSÕES: Este estudo demonstrou que a espessura íntima-média de carótida é mais alta e o nível de endocan sérico é mais baixo em pacientes pré-diabéticos. Os níveis de endocan sérico diminuídos em pacientes pré-diabéticos podem ser um fator que contribui para os mecanismos de formação de aterosclerose.

Diagnostic costs: a research in a family medicine outpatient clinic

The aim of this study is to evaluate the direct diagnostic costs for disease groups and other variables (such as gender, age, seasons) that are related to the direct diagnostic costs based on a 3-year data. The population of the study consisted of 31,401 patients who applied to family medicine outpatient clinic in Turkey between January 1st, 2016 and December 31st, 2018. With this study, we determined in which disease groups of the family medicine outpatient clinic weremost frequently admitted. Then, total and average diagnostic costs for these disease groups were calculated. Three-year data gave us the opportunity to examine the trend in diagnostic costs. Based on this, we demonstratedwhich diseases' total and average diagnostic costs increased or decreased during 3 years. Moreover, we examined how diagnostic costs showed a trend in both Turkish liras and USA dollars' rate for 3 years. Finally, we analysedwhether the diagnostic costs differed according to variables such as age, gender and season. There has been relatively little analysis on the diagnostic costs in the previous literature. Therefore, we expect to contribute to both theoristsand healthcare managers for diagnostic costs with this study.

The Fear of COVID-19 Infection in Older People.

OBJECTIVE: To determine the levels of COVID-19-related fear and to investigate fear-associated factors among older people. METHODS: This study was conducted with patients aged 65 years and older from the Family Medicine Clinic of Health Sciences University Sisli Hamidiye Etfal Hospital over a 1-month period. A telephone survey was administered to evaluate patients' sociodemographic data and knowledge level on the COVID-19 pandemic and the degree of its impact. The fear levels of participants were determined using the fear of COVID-19 scale (FCV-19 S). Statistical analysis was performed using SPSS 15.0. A p value of < 0.05 was considered to be statistically significant. RESULTS: The study included 315 participants: 178 were female and 137 were male. The mean age was 71.5 ± 5.6 (min: 65, max: 94) years, and 26 participants were living alone. Moreover, 47.6% participants considered they had sufficient information about the COVID-19 outbreak, and 61.6% received information about the pandemic from television and 22.2% from their inner circle. While 11.7% participants considered they would require psychological support after the COVID-19 pandemic, 30.8% had sleep disorders for the last month. The mean FCV-19 S score was 16.0 ± 6.4; the FCV-19 S scores were statistically higher in participants who were women, living alone, had partial information about the COVID-19 pandemic, had sleep disorders for the last month, and were in requirement of psychological support after the pandemic. CONCLUSION: It is necessary to screen the older people for the COVID-19-related fear and accompanying psychological disorders and to develop appropriate intervention programs for individuals at risk.

Is there a correlation between hypomagnesemia linked to long-term proton pump inhibitor use and the active agent?

BACKGROUND: One of the electrolyte disorders considered to be linked to proton pump inhibitors (PPI) use is hypomagnesemia. The aim of this study was to assess the incidence of hypomagnesemia linked to long-term PPI use and the correlation with active agents. METHODS: The study included 305 patients aged over 18 years with PPI use of 1 year or longer and attending the internal diseases clinic for any reason from April 2019 to December 2019. A survey study was performed about the demographic characteristics and PPI use of patients. Laboratory parameters, such as the hemogram, magnesium, phosphorus, calcium and vitamin B12 concentrations were recorded. Magnesium concentrations were measured by a colorimetric method. RESULTS: Of the patients 140 (45.9%) were female and 165 (54.1%) were male. The most commonly used PPI active agent was pantoprazole. The duration of PPI use varied from 1-25 years with a mean of 4.31 ± 4.52 years. Of the patients 51.5% reported no medication side effects. The most commonly observed side effect was constipation (n = 98, 32.1%). The mean magnesium concentration was 1.95 ± 0.02 mg/dL. Hypomagnesemia was identified in 65 (21.3%) patients and the incidence increased as age and duration of use increased. Patients using omeprazole had significantly lower magnesium levels compared to patients using pantoprazole, rabeprazole, esomeprazole and lansoprazole. CONCLUSION: In light of the data obtained it was concluded that hypomagnesemia linked to PPI use is associated with the type of PPI. While patients using rabeprazole had the lowest rates, those using omeprazole had significantly higher rates of hypomagnesemia. Additionally, there was a proportional correlation between age and duration of use with the risk of development of hypomagnesemia.

A rare case of shingles after COVID-19 vaccine: is it a possible adverse effect?

Coronavirus disease 2019 (COVID-19) exhibit mild to moderate symptoms, whereas 15% of COVID-19 cases progress to pneumonia, some associated cutaneous findings are also reported as maculopapular eruptions, morbilliform rashes, urticaria, chickenpox-like lesions, and livedo reticularis. The inactivated COVID-19 vaccines are authorized for use in some countries including Turkey. Here, we report an unusual case of varicella-zoster virus (VZV) reactivation in a 68-year-old male patient who was vaccinated against COVID-19. The patient presented to family medicine clinic with a stinging sensation and pain radiating from the right side of his chest to his back. Physical examination revealed multiple pinheaded vesicular lesions upon an erythematous base occupying an area on his right mammary region and back corresponding to T3-T5 dermatomes. He reported that he got his second dose of COVID-19 vaccine 5 days ago. As COVID 19 decreases the cell-mediated immunity, it could also increase the risk of herpes zoster (HZ). Although the exact reason remains unsolved, vaccine-induced immunomodulation caused by live attenuated vaccines and attenuated alloreactivity caused by inactivated vaccines may be responsible mechanisms for the reactivation of HZ. Epidemiological studies are needed to clarify the possible connection between vaccination and reactivation of herpesvirus infections.

Evaluating the effect of Ramadan Fasting on patients with chronic diseases.

OBJECTIVE: The study aimed to investigate the effect of Ramadan Fasting on Patients with Chronic Diseases and their experience during fasting. METHODS: This study was a descriptive research that used a researcher-designed questionnaire in face-to-face interviews with individuals who have at least one chronic disease and visit, for any reason, the Istanbul Sisli Etfal Training and Research Hospital polyclinics. We first asked each participant about fasting during Ramadan. If the participant was not fasting, we asked only the reason(s) and collected socio-demographic data. If a participant was fasting, we administered a researcher-designed questionnaire in face-to-face interviews. Our survey consisted of 19 questions that were designed to evaluate the fasting behaviors, current chronic disease and treatment status of individuals, encountered complications during fasting and their socio-demographic data. RESULTS: The study participants were 253 people (168 females [66.4%]; mean age: 58.06 ± 11,13) with non-infectious diseases. One hundred sixty (63.2%) participants were fasting during Ramadan and 33 of them (20.6%) had consulted a doctor before fasting, 62.5% (n = 100) said they never faced any symptoms during fasting. Most experienced symptom during fasting was fatigue (56.7%; n = 34). A significant relationship occurred between experiencing symptoms while fasting and gender (p = 0.023) and waking regularly for sahur (p = 0.029). CONCLUSIONS: Many people with chronic diseases fast and experience symptoms while fasting. Being woman and not waking up for sahur was related with the symptoms during Ramadan fasting. Most participants with NIDs fasted during Ramadan without consulting their doctors.

Prevalence and predictors of psychological response during immediate COVID-19 pandemic.

AIM: COVID-19 pandemic has created a serious psychological impact worldwide since it has been declared. This study aims to investigate the level of psychological impacts of the COVID-19 pandemic on the Turkish population and to determine related factors. METHODS: The study was carried out by an online questionnaire using the virtual snowball sampling method. The sociodemographic data were collected on the following subjects: participants' experience on any signs of infection within the last month, the history of COVID-19 contact-treatment-quarantine, level of compliance with precautionary measures, the sources of information and level of knowledge about the pandemic process and their belief levels on the knowledge they acquire. Besides, the questions that take place in the Depression, Anxiety and Stress Scale-21 (DASS-21), and Impact of Events Scale-Revised (IES-R) were asked to participants. RESULTS: Of the 3549 participants, anxiety was found in 15.8%, depression in 22.6%, stress in 12.9%, and psychological trauma in 20.29% based on moderate and above levels. Female gender, young age, higher education level, being single, high monthly income, presence of psychiatric illness, a large number of people living together, having any signs of infection, and contact history with COVID-19 infected person or contaminated object are identified as risk factors that may increase psychological impact. Compliance with the rules was found to reduce the risk of psychological response. CONCLUSIONS: The risk factors for the psychological impact of the COVID-19 pandemic, and acknowledging these factors can help to formulate the interventions to reduce the stress levels of the population.

Evaluation of Job Strain of Family Physicians in COVID-19 Pandemic Period- An Example from Turkey.

The purpose of this study was to evaluate family physicians' job strain during the Covid-19 pandemic and determine the effective factors. The study was carried out between 01 May 2020 and 01 June 2020 by applying an online questionnaire to family physicians who worked in primary care in Istanbul and could be reached by telephone application. The survey created by us included socio-demographic information and the Job Strain Scale Short Form. P value was accepted as 0.05, and SPSS 20 package program was used in statistical analysis. 448 Family Physicians participated in the study. Anxiety levels of the participants increased after the pandemic (p < 0.001). Job strain score increased significantly during the pandemic process (p < 0.001). The 'Workload' sub-dimension of the job strain score was affected by young age, not having children, thinking that the working hours increased, deterioration of sleep quality and increasing anxiety level. It was determined that there was an increase in the "Control" sub-dimension score of family physicians who thought that they were not provided with adequate protective equipment during the pandemic process and who did not find the use of their own personal protective equipment sufficient. 'Social support' sub-dimension mean score decreased during the pandemic period. It was determined that it significantly increased in married family physicians compared to single ones. In the pandemic process, anxiety, sleep quality deterioration and job strain increased significantly. In family physicians, after the pandemic, workload and control sub-dimension changes increased, while social support sub-dimension decreased.

Results of Influenza Vaccination: Short Follow-Up Study of a Turkish Population.

INTRODUCTION: The trivalent inactivated influenza vaccine was approved for use in Turkey during the 2018-2019 influenza season. We evaluated beliefs regarding the vaccine and vaccination outcomes in a Turkish population. METHODS: Individuals who were vaccinated with the trivalent inactivated influenza vaccine between November 1 and December 31, 2018, at the Sisli Hamidiye Training and Research Hospital in Istanbul, Turkey, were included in this study. A 15-item questionnaire was completed by a physician during a face-to-face interview with the participants. All participants were followed during the 2018-2019 influenza season through May 2019. The participants were instructed to consult the same physician in case of sudden illness. Participants' beliefs and outcomes were assessed by their vaccination status for the 2017-2018 influenza season. RESULTS: A total of 150 participants were recruited. Their median age was 66 (range, 22-88) years. During the 2017-2018 influenza season, 4.1% had been hospitalized, 53.5% had developed an upper respiratory disease (URD), and 16.2% had been diagnosed with pneumonia. There were no cases of influenza, pneumonia, or hospitalization in the 2019 season; 49.3% of the participants developed a URD (n = 74). Among participants who had been vaccinated during both influenza seasons, 47.5% had had and/or developed a URD, with a higher number of cases during the 2018-2019 season. CONCLUSIONS: After vaccination, no cases of influenza, hospitalization, and pneumonia were observed and the incidence of URD decreased compared with that of the previous season.

Are Symptoms Sufficient in the Decision to Start Antibiotics in Tonsillopharyngitis?

OBJECTIVES: Unnecessary use of antibiotics is one of the causes of antibiotic resistance. Rapid Antigen Test (RAT) is recommended to prevent unnecessary use of antibiotics by providing bacteria/virus isolation in patients with tonsillopharyngitis. However, in patients with typical symptoms, false-negative test results may lead to doubt in doctors. In this study, we aimed to evaluate the relationship between patients' symptoms and RAT results. METHODS: In this study, we chose the patients that referred to the University of Health Sciences (SBÜ) Sisli Hamidiye Etfal Training and Research Hospital Family Medicine Polyclinics and got a diagnosis of tonsillopharyngitis with RAT. This study was conducted by a retrospective file scanning method. We examined the age, sex, symptoms, RAT results and throat culture results of the patients. SPSS 15.0 for Windows program was used for the statistical analysis. The level of statistical significance was accepted as p<0.05. RESULTS: In this study, the RAT of 265 patients and the throat culture of 141 patients were examined. We found RAT positivity as 28.7%, Group A Beta Hemolytic Streptococcus (AGBHS) detection rate in throat culture was 22.5%, and the antibiotic prescription rate was 37%. There were 32 patients with AGBHS positivity in throat culture. Twenty-seven of them got RAT positivity, too. When symptoms and RAT positivity were examined, there was no significant relationship between RAT positivity and fever higher than 38 oC, but RAT was more often positive in patients with a fever higher than 38 oC. On the other hand, there is a statistically significant relationship between RAT positivity and the presence of tonsillar exudate (p=0.000). When the relationship between symptoms and RAT according to age groups was examined, the presence of LAP and tonsillitis were significant (p=0.000; p=0.001). In the age group of 18 years and over, the presence of tonsillar exudates was significant (p=0.001). CONCLUSION: In our study, tonsillar exudate was a common symptom in both age groups of <18, and ≥18 years of age; at the same time, there is a statistically significant relation with RAT. Tonsillar exudates are not seen only in bacterial infections but also in viral infections. Thus, we think that antibiotics should not be started based on symptoms, and RAT should be used effectively.

Results of Influenza Vaccination: Short Follow-Up Study of a Turkish Population

Abstract INTRODUCTION: The trivalent inactivated influenza vaccine was approved for use in Turkey during the 2018-2019 influenza season. We evaluated beliefs regarding the vaccine and vaccination outcomes in a Turkish population. METHODS: Individuals who were vaccinated with the trivalent inactivated influenza vaccine between November 1 and December 31, 2018, at the Sisli Hamidiye Training and Research Hospital in Istanbul, Turkey, were included in this study. A 15-item questionnaire was completed by a physician during a face-to-face interview with the participants. All participants were followed during the 2018-2019 influenza season through May 2019. The participants were instructed to consult the same physician in case of sudden illness. Participants' beliefs and outcomes were assessed by their vaccination status for the 2017-2018 influenza season. RESULTS: A total of 150 participants were recruited. Their median age was 66 (range, 22-88) years. During the 2017-2018 influenza season, 4.1% had been hospitalized, 53.5% had developed an upper respiratory disease (URD), and 16.2% had been diagnosed with pneumonia. There were no cases of influenza, pneumonia, or hospitalization in the 2019 season; 49.3% of the participants developed a URD (n = 74). Among participants who had been vaccinated during both influenza seasons, 47.5% had had and/or developed a URD, with a higher number of cases during the 2018-2019 season. CONCLUSIONS: After vaccination, no cases of influenza, hospitalization, and pneumonia were observed and the incidence of URD decreased compared with that of the previous season.

Relationship between anaemia during pregnancy and preterm delivery.

The purpose of this study was to analyse the relationship between preterm delivery and maternal anaemia. This retrospective cohort study was completed with 483 women; 294 of them had a normal delivery and 189 had a preterm delivery. The haemoglobin (Hb) values of all the women participating in the study were measured in the first and second trimesters, and the average Hb values were calculated. The pregnant women participating in the study were divided into three groups, according to their Hb level: those with Hb level <10 g/dl, those with Hb level between 10 and 11 g/dl and those with Hb level >11 g/dl. In crude analysis, women with low Hb levels had an increased rate of preterm delivery (odds ratio, 2.42; 95% CI, 1.07-5.49). Our study provides data that low Hb level is effective in preterm delivery. Impact statement What is already known on this subject? Serum Hb levels have inconsistent associations with a risk of preterm delivery. What the results of this study add? Compared with term delivery Hb levels are lower in preterm delivery. It is necessary to take into account the Hb levels of both the first and second trimester of the pregnancy when describing the pregnancy anaemia. What the implications are of these findings for clinical practice and/or further research? Given these results, physicians should take into account anaemia in pregnancy when considering the risk of a preterm delivery.

Early effect of the fear of terrorism on a hospital's emergency department use and on the incidence of cardiovascular events: A Turkish multicenter study.

BACKGROUND: To our knowledge, the early effect of the fear caused by terrorism on human health, especially its effect on the number of visits to medical emergency departments (EDs), has not yet been studied. OBJECTIVES: To observe the effect of fear from terrorist alerts on the use of EDs and on the rate of cardiovascular (CV) and/or cerebrovascular events. SETTING: In Istanbul, Turkey, there was a terror alert on the weekend of 19 and 20 March 2016. In this multicenter retrospective study, we compared the data of patients from that weekend with those from the preceding and following weekends. PATIENTS: A total of 12 324 adult patients' records were included in this study: 4562 patients in the first weekend, 3627 patients in the second, terror alert weekend, and 4135 patients in the third weekend. MEASUREMENTS: The ED, CV, and cerebrovascular incidence rates of the above three groups were compared. RESULTS: The rate of ED use was the least in the weekend of the terror alert; the highest rate occurred during the weekend prior to it (female applications decreased more [P = 0.03]). The medical center that was the farthest from the crowded central places of the city and from the place where suicide bombing occurred was less affected by the decrease in use. CONCLUSIONS: Fear associated with terrorism may affect human health indirectly by preventing patients from reaching the necessary emergency healthcare facilities. This finding may be a pathfinder to decision-makers in such extraordinary emergency conditions. Further studies are needed in this field.

Sociodemographic Characteristics of Patients Registered with a Home Care Unit and an Evaluation of the Health Services Offered.

OBJECTIVES: The growing aging population and the difficulties they often face in accessing health services brought attention to home care units. Home care units provide services that make it easier for the elderly to meet their healthcare needs. The aim of this study was to evaluate the sociodemographic characteristics of patients who were served by the home care unit of one hospital family medicine clinic and to assess the services provided. METHODS: The records of patients who were served by the home care unit of one hospital between January 1 and December 31, 2016,were retrospectively screened. The age, gender, diagnosis, frequency of home care visits, requested consultations and examinations, emergency service requests, and the details of patients who died were recorded. The data were statistically analyzed with a chi-square test and Student's t-test. P<0.05 was considered statistically significant. RESULTS: In 2016, 716 (64.8%) female and 389 (35.2%) male patients (total n=1105) were served by the unit. The mean age of the group was 78.24±15.43 years. When separated by age group, 87.1% of the patients were aged ≥65 years. There were more female patients than males among those older than 65 years, while the reverse was true among patients younger than 65 years of age. The most common diagnosis in the study group was Alzheimer's disease, followed by essential hypertension and diabetes mellitus. An average of 6.54 visits was made during the year. More than half (n=624, 56.5%) of the patients were visited 4 or more times. The number of visits increased with greater age. Overall, Alzheimer's disease patients received 3 or fewer visits, while 4 or more visits were made to patients with essential hypertension and endocrine disorders. A hemogram was requested for 83% (n=917) of the patients, biochemical tests for 63.5% (n=702), complete urinalysis for 34.9% (n=386), and a hormonal assay for 65.1% (n=719). In all, 39.3% (n=432) of the patients sought emergency service at least once. Consultations were not requested for 24 (2.2%) patients. A neurology consultation was the most frequently requested, for a total of 6 (0.25%) patients. During this period of follow-up, 114 (10.4%) patients died. Alzheimer's disease was statistically significantly correlated with mortality (39.5%, n=45; p=0.031). CONCLUSION: Given the aging population, the provision of home health care services is growing in importance. It is most commonly expected to serve patients over 65 years of age and those with neurological diseases. In this study, patients with a diagnosis of essential hypertension or an endocrine disorder were visited more often. Multiple illnesses among elderly patients often lead to a greater number of tests and visits, and abnormal/erroneous results also contribute to the number of visits. Requests for unnecessary analyses affect the individual and society as a result of the economic and social burden incurred. It is important to assess patients from a multidisciplinary and biopsychosocial perspective and to increase the number of adequately trained staff in order to offer quality healthcare.

Smoking Cessation with Medication and Behaviour Therapy.

BACKGROUND AND OBJECTIVE: Smoking Cessation Clinics (SCCs) involve the use of cognitive behavior therapy and effective medications provided by specialists. Our objective was to report socio-demographic data, investigative services provided, and determine the smoking cessation success. METHODS: Data from all hospitals affiliated with the Beyoglu Public Hospitals Union were obtained between January 1, 2015 and December 31, 2015. Data from Sisli Hamidiye Etfal Training and Research Hospital were reviewed via retrospective chart review in the same period. Frequency and average values were determined using statistical software. In the evaluation of related factors, chi-square and student t tests were applied; p ≤ 0.05 was considered statistically significant. RESULTS: The mean admission age was 38.72 ± 12.20 years (min 13; max 94). Women tended to be older than men at the time of admission but men started smoking younger than women. Less than the high school educated subjects started smoking at early ages. The smoking cessation rate was 39.3% (n = 219) when treated with medication and behavioral therapy. CONCLUSION: About 48% smokers stopped smoking after treatment with medications and behaviour therapy. Most of the smokers were between 30-50 years of age. More Smoking Cessation Clinics should be established to allow access to more highly educated patients to smoking cessation resources.

Association between body mass index and activities of daily living in homecare patients.

OBJECTIVE: Overweight or obesity may cause many chronic illnesses. Furthermore, several studies have shown that high body mass index is associated with mortality and morbidity among the elderly. Therefore, obesity or being overweight could adversely affect the performance of activities of daily living. In this study our aim was to investigate the association between Body Mass Index and Activity of Daily Living in Homecare Patients. METHOD: The records of 2016 from the homecare unit of Sisli Hamidiye Etfal Training and Research Hospital were retrospectively reviewed. During this period, 1105 patients visited this facility. Unconscious or bedridden patients (hemiplegia, hemiparesia, and tetraparesis) and patients with incomplete data were excluded from the study. Therefore, the survey was completed with 250 files, which included all the data needed for our research. Age, gender, Body Mass Index and Barthel Index scores were recorded to the statistical program; p≤0.05 was considered as statistically significant. RESULTS: One hundred fifty one (60.4%) were women, and 99 (39.6%) were men. The relations between gender and age, weight, and Barthel index scores were not statistically significant. There was a significant positive correlation between weight and Barthel index scores as well as between Body Mass Index and Barthel index scores (r = 0.190; p = 0.003). The patients were divided into two groups: Group-I (underweight and normal weight) and Group-II (overweight and obese). Group-II exhibited a much higher ability to perform Activity of Daily Living than Group-I (p = 0.002). CONCLUSION: Some studies report that obesity is protective against Activity of Daily Living, but the opposite is reported in some others. Our study showed increased values of Body Mass Index and Activity of Daily Living ability, which are indicative of protective effects. The relationship between Body Mass Index and physical disability is not yet proven to be linear.