How health literacy associates with healthcare utilization and health promotion behaviours in Turkey?: Contributions to discussions concerning the Anderson model and ecological models.

BACKGROUND: This study examined how health literacy (HL) levels are associated with health care utilization (HCU) and health promotion behaviours (HPB) in Turkey. METHODS: We conducted face-to-face interviews and utilised the Turkish HL Scale-32 (n = 6228). RESULTS: HL score was inversely related to the number of outpatient admissions (OAs) (ß = -0.001) and emergency department admissions (EAs) (ß = -0.006) in the Poisson regression model. Sex, age, perceived health, income group, and education level were other variables related to the number of OAs and EAs. Health literacy levels were related to physical activity (PA) (for excellent HL, OR: 3.93 (95% CI: 2.54-6.08)) and acquiring healthy eating habits (HEHs) (for excellent HL, OR: 3.56 (95% CI: 2.40-5.29) in the logistic regression model. Education levels are related to PA, HEHs, and smoking cessation or reduction. Income groups, except those with very sufficient income, are related to PA and HEHs. CONCLUSION: Improving HL can help reduce health admissions. The relationship of HCU with gender, age, education, perceived health, and income group supports the Anderson model. Limited HL groups should be prioritised as risk groups in health promotion programs. The association of HL and socio-economic variables with HPB supports the ecological model.

Evaluation of irrational drug use of individuals over the age of 18 who applied to a university hospital.

BACKGROUND: Irrational drug use not only causes a delay in the treatment of patients, failure to achieve full well-being, drug interactions and side effects, drug resistance but also creates economic negativities such as waste of resources and unnecessary workload. This study aims to investigate the irrational drug use behaviors of individuals over the age of 18 who applied to a university hospital. METHODS: This sectional study included 1247 people over the age of 18 who applied for Gazi University Health, Research and Application Center. A questionnaire was applied to the applicants by face-to-face interview technique. Logistic regression analysis was performed among the factors associated with the subcomponents of irrational drug use. RESULTS: Participants (20.1%) used medication without a doctor's prescription (self-medication), 3.4% did not comply with the recommended dose and duration for medications, 47.4% applied to the physician to prescribe the medication they wanted, 65% had medication for later use at home. It was determined that 24.1% of them used drugs without looking at the expiration date and 45.5% of them used drugs without reading the patient information leaflet. Among the risk groups identified for the different irrational drug use behaviors mentioned are the following: males, lower educational groups, housewives, not having social insurance, continuous drug users. DISCUSSION: Irrational drug use behaviors are still observed in society. The fact that the risk is higher in lower education groups is an example of the negative consequences of limited health literacy. The fact that different risk groups have been identified for different behaviors related to irrational drug use shows that intervention studies on this subject should be directed to specific groups. The effect of having social security reveals its connection with universal health coverage and rational drug use.

Nonpharmaceutical interventions in Turkey and worldwide during COVID-19 pandemic

Nonpharmaceutical interventions (NPIs) are actions apart from getting vaccinated and medications, in order to promote deceleration of the spread of illness among people and communities during pandemic. In this article, we aim to examine NPIs applied in Turkey and worldwide due to the COVID-19 pandemic. Some of the NPIs such as isolation, quarantine, and contact tracing were maintained with updates of the Ministry of Health guidelines in Turkey. Some NPIs including travel and partial or full curfew mobilization restrictions were set in accordance with the various periods by the number of cases. Periods of restrictions at autumn 2021 to summer 2022 are national partial curfews, national extended curfews, local decision-making phase, revised local decision-making phase, partial lockdown, full lockdown and gradual normalization. Mitigation and suppression have been implemented in Turkey with restrictions of varying severity throughout the course of the epidemic. It is seen that the restrictions implemented in Turkey contributed to the flattening of the epidemic curve. Even some countries mainly applied the suppression method, and others applied the mitigation method, in general, it is seen that similar methods were applied with different weights. Examples of different countries demonstrated that NPIs are effective for flattening epidemic curve. NPI have been the main instrument for a year and a half from the beginning of the epidemic to mid-2021 in Turkey as well as worldwide.

The Relationship Between Health Literacy Level and Media Used as a Source of Health-Related Information.

BACKGROUND: Previous studies have not shown the level of health literacy or associated factors on a national level in Turkey using a scale that has been adapted to the country and its culture. OBJECTIVE: This study aimed to determine health literacy levels in Turkey and to investigate the association of health literacy with socioeconomic factors as well as with the instruments used as sources of health-related information. METHODS: This cross-sectional, nationally representative study was conducted using a computer-assisted personal interview approach and included 6,228 households (response rate, 70.9%). The Turkey Health Literacy Scale was used to measure health literacy. Sources of health-related information, such as newspapers, television, internet, and smartphones, were included in the regression model for health literacy. KEY RESULTS: The proportion of participants with inadequate and problematic health literacy was 30.9% and 38%, respectively, showing that approximately 7 of 10 participants had limited health literacy. The frequencies of inadequate and problematic health literacy were higher in the disease prevention and promotion domains (37.4% and 34.2%, respectively) compared with those in the health care domain (27.1% and 31.3%, respectively). The most frequently used medium as a source of health-related information was the internet (48.6%), followed by television (33%). In controlled models, higher health literacy scores were associated with higher education and income levels. The effects of television (ß = 1,917), internet (ß = 2,803), newspapers (ß = 1,489), and smartphones (ß = 1,974) as sources of health-related information were statistically significant in the general health literacy index model. CONCLUSIONS: Health literacy in Turkey reflects social inequalities. The model accounting for socioeconomic variables demonstrated the relevance of sources of health information to level of health literacy. These findings emphasize the importance of improving sources of health information to improve health literacy. [HLRP: Health Literacy Research and Practice. 2021;5(2):e109-e117.] Plain Language Summary: This is a cross-sectional study that is representative of the population of Turkey. We reported that health literacy scores were higher for people in higher levels of socioeconomic status. We showed that using the television, internet, newspapers, and smartphones as a source of health-related information is associated with health literacy even when accounting for socioeconomic variables.

Socioeconomic Factors Related to Prevalence, Severity, and Contact Coverage of Depression in Primary Health Care.

Background: We determine factors related to the prevalence, severity, and contact coverage of depression using the Patient Health Questionnaire-9. Methods: This cross-sectional study included 1059 individuals who applied to primary health care in Ankara before the onset of pandemic restrictions. Contact coverage was evaluated to include mental health care users. Results: The prevalence of depression was 22.9%. Individuals who were unemployed (OR: 3.832; 95% CI: 2.053-7.151), women (OR: 1.646; 95% CI: 1.158-2.340), those without social support (OR: 1.933; 95% CI: 1.219-3.065), those who did not receive formal education (OR: 2.631; 95 % CI: 1.312-5.275), lower-income group (OR: 1.528; 95% CI: 1.071-2.180), and unmarried or divorced (OR: 2.644; 95% CI: 1.324-5.281) were found to be at risk of developing depression. Based on the linear regression model including patients diagnosed with depression, individuals who were unemployed (standardized ß: 0.190), women (standardized ß: 0.075), those without social support (standardized ß: 0.096), and those who were unmarried or single (standardized ß: 0.147) had the highest scale scores. Contact coverage for depression was 31.0%. Contact coverage was more likely in the upper-income group (OR: 2.239, 95% CI: 1.173-4.273). Conclusion: Although depression is common among primary health care applicants, contact coverage is low. Developing screening programs for depression in primary health care may help improve community mental health. Socioeconomic factors that contribute to the emergence, severity, and contact coverage of depression indicate health inequalities. The development and severity of depression are mostly due to unemployment, which suggests the importance of employment-enhancing policies.

Validity and reliability of the Turkish version of the European Health Literacy Survey Questionnaire.

Health literacy is a public health priority which refers to individual's knowledge, motivation and competence to access, understand, appraise and apply health information to prevent disease and promote health in daily life. This study aimed to adapt European Health Literacy Survey Questionnaire (HLS-EU-Q47) into Turkish and to investigate its psychometric properties. The questionnaire was translated into Turkish by using both group translation and expert opinion methods. Forward translation-back translation method was used for language validity and the final Turkish version (HLS-TR) was formed. HLS-EU-Q47 and Health Awareness Scale (HAS) were administered to 505 respondents. The scale reliability was examined using Crohnbach's alpha coefficient and the construct validity was assessed by principal axis factoring procedure. The convergent validity was obtained by Pearson correlation coefficients between HLS-TR and HAS scores and discriminant validity was examined comparing the scores of participants who were stratified according to ages, educational status, gender, general health status and social status. Cronbach's alpha coefficient for the whole scale was 0.95. Principal axis factoring extracted nine factors which eigenvalues were >1 and explained 50.01% of total variance. Factor matrix displayed that all items gave greater load in factor 1, showing that health literacy measured with one factor. Positive and significant correlation was found between HLS-TR and HAS. Significant relations were found between HLS-TR scores and selected determinants of health. This study revealed that the HLS-TR was a valid and reliable measuring instrument with appropriate psychometric characteristics.

IMPACT OF COMORBIDITY AND SOCIOECONOMIC STATUS ON QUALITY OF LIFE IN PATIENTS WITH CHRONIC DISEASES WHO ATTEND PRIMARY HEALTH CARE CENTRES.

AIM: The aim of the study was to analyse the impact of chronic disease on the quality of life (QoL) and how QoL changes with comorbidity and socioeconomic status in persons who attend primary health care centres. METHODS: The group of participants comprised 2,560 people who contacted six primary health care centres in Ankara. The level of QoL was determined by the World Health Organization Quality of Life Questionnaire Abbreviated Version (WHOQOL-BREF). RESULTS: Mental disorders and diabetes-hypertension comorbidity had the most negative effect on the QoL. In the physical domain of the WHOQOL-BREF, the effect of diabetes-hypertension comorbidity is greater than the additive effect of hypertension and diabetes individually. The co-occurrence of any disease with cardiovascular disease does not change QoL within any domain, except for the co-occurrence of any disease with musculoskeletal diseases which deteriorated QoL in the physical domain. The higher income and socioeconomic status corresponded to higher QoL. CONCLUSIONS: The effect of comorbidity on QoL can be different from the additive effects of the co-occurring diseases. Socioeconomic factors undoubtedly affect the relationship between chronic diseases and QoL, and this relationship points to health inequities among socioeconomic groups.

Turkey Handwashing Survey: suggestion for taking the ecological model into better consideration.

OBJECTIVES: This study is aimed to find out the handwashing habits and their relations to the socio-economic variables. METHODS: The sampling is determined regarding the address-based population registration system of the country. The multi-staged stratified cluster sampling method was used. It is conducted by a face to face questionnaire with 6854 persons. 22 questions are asked whether they are washing their hands or not related to different situations, the results are graded and the "Handwashing Habits Score" (HHS) is obtained. The reasons for not handwashing were evaluated by categorizing as individual, environmental and combined reasons. RESULTS: The HHS is increasing in the older age groups (ß = 0.148, p < 0.001), females (ß = 0.306, p < 0.001), citizens of urban settlement (ß = 0.061, p < 0.001), higher education levels (ß = 0.191, p < 0.001). The reasons for not handwashing were found as 53.3 % individual, 39.2 % environmental, 7.5 % combined. The frequency of mentioning not washing hands because of the environmental reasons is getting higher in the older age groups, in the urban side, and in the higher education level (p < 0.001). CONCLUSIONS: The handwashing habits are shaped by the determinant networks which form a complex structure by intertwining individual, socio-economic and environmental factors in different sub-groups with various weights. This result might contribute to the efforts of conceptualizing the health behaviors with ecological model.

Fighting obesity campaign in Turkey: evaluation of media campaign efficacy.

AIM: This study aims to determine the frequency of behaviour change and related factors generated in the population through the "Fighting Obesity Campaign" of the Turkish Ministry of Health. METHODS: Twelve statistical regions from NUTS-1 and 18 provinces were selected for the study sample. At least one province from each region was randomly selected, and stratawere defined as urban or rural. Of the sample selected, 2,038 respondents completed a face-to-face survey. Logistic regression analysis was used to analyse the data. Changing behaviour as result of the campaign was defined as the dependent variable. Behaviour change was defined as an individual taking at least one action to increase physical activity, calculate her/his Body Mass Index (BMI) or minimise meal portions. RESULTS: Of the sample selected, 84% of participants lived in urban areas. Of total sample selected, 49.8% were men and 50.2% were women. According to BMI categorisation, 41.4% of participants were underweight or normal weight, 34.3% were overweight and 24.3% were obese. Of the total participants, 85.2% learned about the "Fighting-Obesity Campaign" through television, 28.1% through radio, 11.0% from newspapers, 6.0% from billboards, and 19.2% from other sources. This study revealed that 28.5% of the participants adopted desired behavioural changes after exposure to the campaign. Logistic regression results demonstrated that behaviour change is greater among women, individuals living in urban settings, group of persons approving public spots, obese individuals, and among the 20-39 age group. CONCLUSION: Media campaigns may cause behavioural changes by increasing motivation to prevent obesity within the target population. Con- tinuing these campaigns can lead to success at the national level.

Vaccination coverage of children aged 12-23 months in Gaziantep, Turkey: comparative results of two studies carried out by lot quality technique: what changed after family medicine?

BACKGROUND: Health care systems in many countries are changing for a variety of reasons. Monitoring of community-based services, especially vaccination coverage, is important during transition periods to ensure program effectiveness. In 2005, Turkey began a transformation from a "socialization of health services" system to a "family medicine" system. The family medicine system was implemented in the city of Gaziantep, in December, 2010. METHODS: Two descriptive, cross-sectional studies were conducted in Gaziantep city center; the first study was before the transition to the family medicine system and the second study was one year after the transition. The Lot Quality Technique methodology was used to determine the quality of vaccination services. The population studied was children aged 12-23 months. Data from the two studies were compared in terms of vaccination coverage and lot service quality to determine whether there were any changes in these parameters after the transition to a family service system. RESULTS: A total of 93.7% of children in Gaziantep were fully vaccinated before the transition. Vaccination rates decreased significantly to 84.0% (p<0.005) after the family medicine system was implemented. The number of unacceptable vaccine lots increased from 5 lots before the transition to 21 lots after the establishment of the family medicine system. CONCLUSIONS: The number of first doses of vaccine given was higher after family medicine was implemented; however, the numbers of second, third, and booster doses, and the number of children fully vaccinated were lower than before transition. Acceptable and unacceptable lots were not the same before and after the transition. Different health care personnel were employed at the lots after family medicine was implemented. This result suggests that individual characteristics of the health care personnel working in a geographic area are as important as the socioeconomic and cultural characteristics of the community.

Evaluation of factors predictive of the prognosis in Crimean-Congo hemorrhagic fever: new suggestions.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is one of the viral hemorrhagic fevers caused by tick bites. Common symptoms of the infection are fatigue, high fever, headache, and myalgia. In some patients hemorrhage may accompany these symptoms and is a sign of a poor prognosis. Typical laboratory changes are thrombocytopenia, leukopenia, elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine phosphokinase (CPK), and lactate dehydrogenase (LDH), and prolongation of prothrombin time (PT) and activated partial thromboplastin time (aPTT). Mortality rates vary between 3% and 30%. The aim of this study was to determine the factors affecting the prognosis of CCHF. METHODS: A total of 70 patients with a diagnosis of CCHF who were followed at our clinic between 2005 and 2008 were included in this study. As well as patient clinical history, biochemical parameters tested during the first 5 days and the prognosis were evaluated. Findings were compared between patients who died and those who recovered. Non-parametric statistical tests were used for the statistical analysis. RESULTS: When the laboratory parameters of patients who died and recovered were compared, PT, aPTT, international normalized ratio (INR), AST, LDH, fibrinogen, C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), D-dimer, IgM, IgG, C3 and C4 levels, and platelet count were found to be positively related with fatality. On the other hand, there was no significant difference between groups regarding ALT, CPK, prealbumin, ceruloplasmin, protein C, protein S, and antithrombin III levels, and white blood cell counts. CONCLUSIONS: It is essential to determine the possibility of a fatal prognosis in CCHF patients using clinical history and biochemical parameters so that the necessary precautions can be taken.

Evaluation of the association of serum levels of hyaluronic acid, sICAM-1, sVCAM-1, and VEGF-A with mortality and prognosis in patients with Crimean-Congo hemorrhagic fever.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne viral hemorrhagic disease. Pathogenesis of the disease has not been well described yet. A well-known pathogenic feature of CCHF virus is its capability to damage endothelium. Increased hyaluronic acid (HA) levels indicate liver sinusoidal endothelial damage. Soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) and vascular endothelial growth factor-A (VEGF-A) play a role in the inflammatory process, vascular damage and plasma leakage. OBJECTIVES: To investigate whether or not there is a relationship between HA, sICAM-1, sVCAM-1 and VEGF-A serum levels and fatality in CCHF. STUDY DESIGN: Sixty-one patients who were confirmed by RT-PCR and serological tests for CCHF, included in the current study. HA, sICAM-1, sVCAM-1, VEGF-A levels in serum samples were analyzed by ELISA. RESULTS: There were statistically significant differences between fatal and non-fatal CCHF patients in terms of HA, sICAM-1, sVCAM-1, and VEGF-A levels. In addition, AST and ALT levels were positively correlated with HA, sICAM-1, sVCAM-1, and VEGF-A levels. CONCLUSION: HA, sICAM-1, sVCAM-1, and VEGF-A levels of the patients that died during hospitalization were statistically significantly higher than the patients that survived, and this finding suggests that the level of these molecules could be used as a prognostic marker in CCHF.

Water usage habits and the incidence of diarrhea in rural Ankara, Turkey.

This aim of this study was to determine water usage behavior and incidence of diarrhea during the summer months among people in rural areas of Turkey. Information was collected using a questionnaire during face-to-face interviews with people aged 18 years and over in their homes. Diarrhea was detected in 31.7% of the 543 households included in the study in the summer of 2003. The percentage of those living in the study area experiencing at least one bout of diarrhea was 10.0%. The diarrhea episode rate was 18.7%. A logistic regression model of factors that could influence the incidence of diarrhea showed that the reported distance between the septic tank and the well, the total monthly household income and water shortages of longer than 12h had a significant effect on diarrhea incidence (P<0.05). The fact that water shortages are the biggest risk factor for diarrhea points to the need for (i) health education to raise awareness and (ii) the supply of equipment to enable households to use both the first running water after a water shortage and the water they have collected during the shortage as drinking water.

Toxocara seroprevalence in adults with bronchial asthma.

The aim of this study was to determine the seroprevalence of toxocariasis in adult asthmatics and to assess its relationship with risk factors. A total of 124 asthmatic and 60 control group subjects were included in the study. Of the asthmatic patients, 61 (49.2%) were atopic and 63 non-atopic (50.8%). The anti-Toxocara IgG (Toxocara IgG CELISA Cellabs, Australia) positivity rate for all asthmatic cases was 9.7%. There was no significant difference between the asthmatic cases and the control group regarding anti-Toxocara IgG positivity (P>0.05). When risk factors were analyzed, there was a statistically significant difference between the control group subjects and patients with non-atopic asthma and also between the atopic asthmatic patients and the patients with non-atopic asthma regarding pets being under veterinary control (P<0.05). The percentages of those who had their pets defecate indoors were 0, 15 and 8.6%, respectively, for the control subjects, patients with non-atopic asthma and those with atopic asthma. There was a statistically significant difference when the control group subjects were compared to the patients with atopic asthma (P<0.05).

Effectiveness of inactivated influenza vaccine for prevention of otitis media in children.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of inactivated influenza vaccine in preventing acute otitis media (AOM) and otitis media with effusion (OME) in children aged 6 to 60 months who attend day care. STUDY DESIGN: This prospective, single-blind study was conducted in 8 day care centers in Ankara, Turkey. One hundred nineteen (61 vaccinated and 58 unvaccinated against influenza) healthy children were examined at study entry and at 6-week intervals for 6 months by the same 2 otorhinolaryngologists who were blinded about the vaccination status of the children. The frequency of AOM and OME is compared between the 2 groups and the effect of influenza season on frequency of episodes was evaluated. Based on national influenza laboratory data, the influenza season was determined to be the period between December 15, 2003, and January 31, 2004. RESULT: The frequencies of AOM, OME and total otitis media episodes in vaccinated children were 2.3%, 22.8% and 25.2%, respectively, and these frequencies were 5.2%, 31.1% and 36.3% in the unvaccinated group. The difference was statistically significant (P < 0.01). This difference was especially prominent in the influenza season (P < 0.05). CONCLUSION: Influenza vaccine is effective in reducing AOM and OME episodes in 6- to 60-month-old day care children, especially during influenza season.