Reliability and validity of the Turkish version of the Self-care of Hypertension Inventory Version 3.0 in adults with hypertension.

BACKGROUND: Hypertension is an important cardiovascular disease risk factor. Blood pressure control for hypertensive patients is crucial to prevent hypertension related complications. Ensuring and assessing self-care of hypertensive patients is important for blood pressure control and hypertension management. The Self-care of Hypertension Inventory (SC-HI) is an inventory developed for assessing self-care of hypertensive individuals. SC-HI has three subscales; maintenance, monitoring and management. OBJECTIVE: The aim of this study was to conduct Turkish version of SC-HI Version 3.0 (SC-HI V3.0) and assessing its psychometric properties for adults with hypertension. METHODS: We included 120 hypertensive patients in this methodological study. SC-HI V3.0 translated Turkish and tested for reliability and validity. To analyse structural validity item-total correlations and factor analyses was used. Intraclass correlation coefficient (ICC) method was selected for analysing scale's consistency and convergent validity was conducted. RESULTS: The mean age of participants were 54.74 ± 7.19 years and the mean duration from hypertension diagnosis were 38.19 ± 19.42 months. Translated Turkish version's factor loadings were ranged between 0.419 and 0.841. Cronbach's alpha coefficient values were 0.661, 0.880, 0.805 and ICC values were 1.0, 0.99, 0.99 for maintenance, monitoring and management, respectively. Convergent validity's correlation coefficients weak to very strong and statistically significant. CONCLUSIONS: Turkish version of the SC-HI Version 3.0 is reliable, valid and useful scale for assessing self-management in hypertensive adults for clinical practice and research purposes.

Adherence to Current Dyslipidemia Guideline in Patients Utilizing Statins According to Risk Groups and Gender Differences: The AIZANOI Study.

BACKGROUND: The aim of this study was to assess the adherence to the current European Society of Cardiology dyslipidemia guidelines, the ratio of reaching target values according to risk groups, and the reasons for not reaching LDL-cholesterol (LDL-C) goals in patients on already statin therapy in a cardiology outpatient population. METHODS: The AIZANOI study is a multi-center, cross-sectional observational study including conducted in 9 cardiology centers between August 1, 2021, and November 1, 2021. RESULTS: A total of 1225 patients (mean age 62 ± 11 years, 366 female) who were already on statin therapy for at least 3 months were included. More than half (58.2%) of the patients were using high-intensity statin regimens. Only 26.2% of patients had target LDL-C level according to their risk score. Despite 58.4% of very high-risk patients and 44.4% of high-risk patients have been using a high-intensity statin regimen, only 24.5% of very-high-risk patients and only 34.9% of high-risk patients have reached guideline-recommended LDL-C levels. Most prevalent reason for not using target dose statin was physician preference (physician inertia) (40.3%). CONCLUSION: The AIZANOI study showed that we achieved a target LDL-C level in only 26.2% of patients using statin therapy. Although 58.4% of patients with a very high SCORE risk and 44.4% of patients with a high SCORE risk were using a target dose statin regimen, we were only able to achieve guideline-recommended LDL-C levels in 24.5% and 34.9% of them, respectively, in cardiology outpatients clinics. Physician inertia is one of the major factors in non-adherence to guidelines. These findings highlight that combination therapy is needed in most of the patients.

Evaluation of Procedure Doses and Staff Attitudes in Interventional Cardiology in Terms of Radiation Safety.

OBJECTIVE: Ionizing radiation has long been used in the medical field. Catheter laboratories (cath labs) are recognized as areas where radiation exposure is notably high. This study aims to examine the levels of radiation exposure during various interventional procedures to raise awareness of this issue in Türkiye. METHODS: This study evaluated the procedure radiation doses (n = 2804) in the cath labs of four public hospitals with distinct characteristics. Radiation dose evaluation was conducted using Cumulative Air Kerma (CAK). The Kolmogorov-Smirnov test, Kruskal-Wallis H test, independent T-test, and Pearson correlation coefficient were utilized to analyze the data. A p-value of < 0.05 was considered statistically significant. Data were analyzed using IBM® Statistical Package for the Social Sciences (SPSS®) STATISTICS Version 26.0.0.0 (IBM Corporation, Armonk, New York, USA). RESULTS: The procedure radiation doses in the cath labs were documented. The findings are largely consistent with the literature. Notably, several outlier cases with extremely high radiation doses were identified [CAK (min-max) = 0.12 - 9.9 Gy]. Procedures such as chronic total occlusion (CTO) [Mean CAK: 3.8 (± 1.5) Gy] and percutaneous coronary interventions (PCI) [Mean CAK: 1.5 (± 1.4) Gy] were associated with high doses. Additionally, personnel attitudes toward radiation optimization in cath labs were found to be inadequate. CONCLUSION: The incidence of high radiation exposure during interventional procedures may be higher than expected in Türkiye. Further research is necessary to identify predictors and implement preventive measures to reduce these rates. For this purpose, establishing diagnostic radiation reference levels (DRLs) could help monitor national radiation levels.

Do digital health information searches of individuals with chronic diseases affect health literacy and patient empowerment? A path analysis.

OBJECTIVES: To analyze the relationship between chronically ill patients' behaviors in acquiring and verifying health information from a digital environment with health literacy and patient empowerment using a structural equation modeling approach. METHODS: This study was carried out in a public hospital in Turkey between February and May 2023. The study consisted of 365 participants and used descriptive and correlation-based designs for statistical analyses. It also executed computations for descriptive statistics and correlations to carry out a path analysis to assess model fitness and to identify direct and indirect effects. RESULTS: This study identified that Web 1.0 and health information acquisition and digital verification variables statistically and significantly affected access to information, understanding information, appraisal (valuing)/evaluation, and application/use variables. The study also found that access to information variables was statistically significant on identity/identicalness, self-control, decision-making, and recognition and comprehension. The tested model fit the data well and adequately explained the direct effects of the variables. CONCLUSION: The study concluded by suggestively improving the chronically ill patients' media or digital literacy levels through special training to stimulate their internet use effectively.

Impact of sarcopenia and vitamin D levels on the severity of lower urinary tract symptoms in older males.

OBJECTIVES: To assess the impact of sarcopenia and vitamin D levels on the severity of lower urinary tract symptoms (LUTS). METHODS: A total of 193 male patients, aged 60 years and above, who visited the geriatric outpatient clinic at Ibn-i Sina Hospital in Ankara, Turkey, between December 2019 and March 2021, were enrolled. Sarcopenia was diagnosed according to the criteria set by the European Working Group on Sarcopenia in Older People. The presence and severity of lower urinary tract symptoms were assessed using the International Prostate Symptom Score questionnaire, categorizing symptom severity as mild or moderate-to-severe. RESULTS: The median patient age was 71 years (range: 66-77). Sarcopenia affected 24.9% of the population studied. Mild LUTS was observed in 43.5% and moderate-to-severe LUTS was observed in 56.5% of patients. Sarcopenia prevalence was significantly higher in the individuals with moderate-to-severe LUTS compared to those with mild-LUTS (p=0.021). After adjusting for Charlson comorbidity index and age, only vitamin D levels were significantly associated with increased odds of moderate-to-severe LUTS (odds ratio [OR]=0.95, 95% confidence interval [CI]: [0.92-0.98], p=0.002). Sarcopenia was not significantly associated with the severity of LUTS (OR=2.04, 95% CI: [0.94-4.45], p=0.070). An inverse linear trend was observed between quartiles of 25 (OH) vitamin D and LUTS severity. As 25 (OH)vitamin D levels increased, the proportion of patients with moderate-to-severe LUTS decreased (p=0.023). CONCLUSION: Sarcopenia did not significantly impact LUTS severity, but low vitamin D levels were associated with moderate-to-severe LUTS.

Environmental awareness and sustainable consumption behaviours of Turkish nursing students.

Objectives: This study aims to determine the environmental awareness and sustainable consumption behaviours of nursing students. Methods: This cross-sectional study was conducted with 380 undergraduate nursing students studying at Faculty of Nursing, Ege University, Türkiye. The Personal Information Form, Environmental Awareness Scale (EAS), and Sustainable Consumption Behaviours Scale (SCBS) were used to collect the research data. Number, percentage, mean, Kolmogorov-Smirnov Z test, t-test, one-way analysis of variance, Pearson's correlation test, and linear regression analysis were used in statistical evaluation. Results: The mean total score on the EAS was 46.12 (SD = 6.60), and the mean total score of the SCBS was 61.83 (SD = 9.10). A significant, moderate, and positive correlation was found between students' environmental awareness and sustainable consumption behaviours. Moreover, students' gender and the people they lived with caused statistically significant differences in the EAS score. The people students lived with, the place where they lived for the longest time, and their perceived income level caused statistically significant differences in the SCBS score. Conclusions: Nursing students had high environmental awareness and moderate to good sustainable consumption behaviours. It is necessary to include the contribution of sustainable practices to the environment and the effects of these practices on human health in curricula for nurses and thus provide environmental awareness to students.

Health literacy and mammography screening behaviors among women living in a rural area of Turkey.

INTRODUCTION: Breast cancer is the most common cause of cancer-related deaths. and early diagnosis could reduce breast cancer deaths. Therefore, health literacy is one of the most important determinants of participation in cancer screening for early diagnosis. This study aimed to determine the relationship between women's mammography screening behaviors and health literacy levels. METHODS: The cross-sectional study included 312 women aged 40-69 years living in a rural area. Data were collected through face-to-face interviews using a personal information form and the Turkish Health Literacy Scale (THLS-32). RESULTS: Of the women, 28.5% had mammography in the last 2 years. Of concern was the low health literacy levels. In addition, there were significant differences in the THLS-32 subgroup scores, including the THLS-32 total score, among the mammography screening groups. CONCLUSION: Health literacy levels of women were related to mammography screening rates. For this reason, effective intervention studies aiming to increase society's health literacy levels may contribute to an increase in breast cancer screenings.

Older Adults' Metaphorical Perceptions of Aging in Turkey.

PURPOSE: To determine older adults' metaphorical perceptions of the concept of aging. METHOD: Participants in this qualitative study comprised 57 older adults as determined using convenience and criterion sampling methods. Data were obtained using a personal data form and the metaphor form and analyzed with descriptive and content analysis techniques. RESULTS: Fifty-seven metaphors were identified within three themes: 24 within Mental Aspect, 18 within Physical Aspect, and 15 within Psychosocial Aspect. CONCLUSION: The fact that most metaphors appeared within the Mental Aspect theme was interpreted as an indication that participants felt the effects of aging more in the mental dimension. Results of the research show that aging is perceived as experience and accumulation mentally, as inadequacy physically, and as the end or loneliness psychosocially. [Journal of Gerontological Nursing, 50(5), 27-34.].

Relationship Between Disaster Response Self-Efficacy and Disaster Preparedness in Nursing Students: After-Earthquake Study.

OBJECTIVE: This study was conducted to reveal the relationship between nursing students' disaster response self-efficacy and their disaster preparedness perceptions. METHODS: This cross-sectional study was conducted on nursing students after a major earthquake that occurred in Turkey on February 6, 2023 (n = 302). Data collection took place from June 2023 to October 2023, using the Disaster Response Self-Efficacy Scale (DRSES) and Disaster Preparedness Perception Scale (DPPS). Descriptive statistics, independent samples t-test, correlation, and multiple linear regression analysis were used to analyze the data. RESULTS: Nursing students' DRSES mean score was 63.35 ± 10.83 (moderate level) and DPPS mean score was 3.41 ± 0.50 (high level). A positive and moderate correlation was found between nursing students' DRSES and DPPS scores (r = 0.515; P = 0.000). Predictors affecting nursing students' disaster preparedness are disaster response self-efficacy score, being male, and making a family disaster plan. CONCLUSIONS: The results of this study highlight the importance of increasing the disaster response self-efficacy needed by nursing students to successfully assist patients in disaster situations.

Clinicopathologic Spectrum and Outcomes of Infections Diagnosed on Graft Biopsies and Nephrectomy in Live Renal Allograft Recipients: An Institutional Experience.

OBJECTIVES: Modern immunosuppressive regimens have reduced rejection episodes in renal allograft recipients but have increased the risk of opportunistic infections. Infections are considered to be the second leading cause of death after cardiovascular complications in renal allograft recipients. Data on opportunistic infections affecting the allograft itself are scarce. The present study describes the spectrum of renal opportunistic infections and their outcomes diagnosed on renal allograft biopsies and nephrectomy specimens. MATERIALS AND METHODS: Our retrospective observational study was conducted from December 2011 to December 2021. We analyzed infectious episodes diagnosed on renal allograft biopsies or graft nephrectomy specimens. We obtained clinical, epidemiological, and laboratory details for analyses from hospital records. RESULTS: BK virus nephropathy was the most common opportunistic infection affecting the allograft, accounting for 47% of cases, followed by bacterial graft pyelonephritis (25%). Mucormycosis was the most common fungal infection. The diagnosis of infection from day of transplant ranged from 14 days to 39 months. Follow-up periods ranged from 1 to 10 years. Mortality was highest among patients with opportunistic fungal infection (62%), followed by viral infections, and graft failure rate was highest in patients with graft pyelonephritis (50%). Among patients with BK polyomavirus nephropathy, 45% had stable graft function compared with just 33% of patients with bacterial graft pyelonephritis. CONCLUSIONS: BK polyoma virus infection was the most common infection affecting the renal allograft in our study. Although fungal infections caused the highest mortality among our patients, bacterial graft pyelonephritis was responsible for maximum graft failure. Correctly identifying infections on histology is important so that graft and patient life can be prolonged.

High-Risk Human Papilloma Virus Genotype Distribution and Correlation with Cervical Cytomorphological Data in Turkish and Immigrant Women in Mersin Province.

Human papilloma virus (HPV) is the most common sexually transmitted viral agent in the world and the most common cause of cervical cancer. HPV prevalence and genotype distribution vary by region and demographic data. In a province in the south of Turkey that constantly receives immigration, we aimed to determine the prevalence of high-risk HPV (HR-HPV) genotypes, evaluate the compatibility between cervical Pap smear cytology results patients and HR-HPVs, and make an up-to-date contribution to the elucidation of epidemiological data. In this single-centre study, a total of 12,641 women aged 18 and over were evaluated retrospectively from January 2019 to July 2022. HPV detection and genotyping were analysed by the PCR method. Bethesda scoring was used for Pap smear cytological evaluation. The overall prevalence of HR-HPV was 12.6% (12.7% in Turkish women, 11.2% in foreign women). Among the typed HPVs that were detected, HPV-16 (31%) was found first, followed by HPV-18 (8%). The prevalence of HR-HPV was higher in women with abnormal cytology (977/1762, 55.4%) than in women with normal cytology (620/10879, 5.7%) (p<0.001). Turkey doesn't yet have a national HPV immunisation program. We think that determining the specific regional frequency of other HR-HPVs separately will be useful in the follow-up of the natural course of the type-specific infection and in vaccine studies in the future.

Investigation of natural and artificial radioactivity levels in travertines of the Cappadocia region in Turkey.

This study determined natural and artificial radionuclide concentrations to evaluate natural radioactivity and health risk levels of nine travertines in the Yaprakhisar and Balkayasi regions in Turkey. The samples coded B1-M, B2, B5, B7, B8, and B10 represent waste derived from the Yaprakhisar travertines, as well as samples T5-M, T12, and Z1 travertines derived from Balkayasi. The levels of natural and artificial radionuclide concentrations (232Th, 40K, and 137Cs) were measured using a high-purity germanium (HpGe) detector system. The travertine activity ranged from 2.09 to 12.07 Bq kg-1 for 232Th, 4.21 to 13.41 Bq kg-1 for 40K, and 0.42-3.26 Bq kg-1 for 137Cs. The results showed that the activity concentration values for 232Th, 40K, and 137Cs were coherent with the travertine analysis results in the UNSCEAR, 2000; 2008 publications. The values obtained were lower than the average values in the UNSEAR reports. The radiological hazard parameters calculated in this study were absorbed gamma dose rate (D), radium equivalent activity (Raeq), annual gonadal dose equivalent (AGDE), exposure dose (ER), total annual effective dose (AEDEtotal), excess lifetime cancer risk (ELCRtotal), gamma representative level (GRL), internal hazard index (Hin) and external hazard index (Hex).

Determination of drug-related problems in the hematology service: a prospective interventional study.

BACKGROUND: Patients with hematological malignancies often require multidrug therapy using a variety of antineoplastic agents and supportive care medications. This increases the risk of drug-related problems (DRPs). Determining DRPs in patients hospitalized in hematology services is important for patients to achieve their drug treatment goals and prevent adverse effects. This study aims to identify DRPs by the clinical pharmacist in the multidisciplinary team in patients hospitalized in the hematology service of a university hospital in Turkey. METHODS: This study was conducted prospectively between December 2022 and May 2023 in the hematology service of Suleyman Demirel University Research and Application Hospital in Isparta, Turkey. DRPs were determined using the Pharmaceutical Care Network Europe (PCNE) 9.1 Turkish version. RESULTS: This study included 140 patients. Older age, longer hospital stay, presence of acute lymphoblastic leukemia, presence of comorbidities, higher number of medications used, and polypharmacy rate were statistically significantly higher in the DRP group than in the non-DRP group (p < 0.05). According to multivariate logistic regression analysis, the probability of DRP in patients with polypharmacy was statistically significant 7.921 times (95% CI: 3.033-20.689) higher than in patients without polypharmacy (p < 0.001).Every 5-day increase in the length of hospital stay increased the likelihood of DRP at a statistically significant level (OR = 1.476, 95% CI: 1.125-1.938 p = 0.005). In this study, at least one DRP was detected in 69 (49.3%) patients and the total number of DRPs was 152. Possible or actual adverse drug events (96.7%) were the most common DRPs. The most important cause of DRPs was drug choice (94.7%), and the highest frequency within its subcategories was the combination of inappropriate drugs (93.4%). CONCLUSIONS: This study shows the importance of including a clinical pharmacist in a multidisciplinary team in identifying and preventing DRPs in the hematology service.

The way back home: The invisible burden of the emergency healthcare services.

Ambulance services around the world vary according to regional, cultural and socioeconomic conditions. Many countries apply different health policies locally. In Turkey, transportation from hospital to home has started to form an important part of ambulance services in recent years. The increase in the number of patients whose treatment has been completed and waiting to be referred may hinder the work of the emergency services. The aim of this study was to examine the costs, indications, and impact on workload of patients sent home by ambulance. Patients were divided into two groups according to the reasons for referral. The distance to home, transport time and cost were calculated according to the reasons for transport. Patients who were transferred to other clinics or hospitals by ambulance were excluded from the study. The findings showed that the hospital-to-home transfer rate during the study period was 11.4%. Although 9.7% of all cases transferred from our hospital to home were due to social indications, these cases accounted for 16.26% of the total costs. These results suggest that providing home transport services to selected patient groups for medical reasons should be seen as part of the treatment. However, the indications for home transport should not be exceeded and an additional burden should not be placed on the fragile health service.

Comprehensive genetic analysis of the first near-complete genome of bovine coronavirus and partial genome of bovine rotavirus in Türkiye through metagenomics.

Obtaining the complete or near-complete genome sequence of pathogens is becoming increasingly crucial for epidemiology, virology, clinical science and practice. This study aimed to detect viruses and conduct genetic characterization of genomes using metagenomics in order to identify the viral agents responsible for a calf's diarrhoea. The findings showed that bovine coronavirus (BCoV) and bovine rotavirus (BRV) are the primary viral agents responsible for the calf's diarrhoea. The current study successfully obtained the first-ever near-complete genome sequence of a bovine coronavirus (BCoV) from Türkiye. The G+C content was 36.31% and the genetic analysis revealed that the Turkish BCoV strain is closely related to respiratory BCoV strains from France and Ireland, with high nucleotide sequence and amino acid identity and similarity. In the present study, analysis of the S protein of the Turkish BCoV strain revealed the presence of 13 amino acid insertions, one of which was found to be shared with the French respiratory BCoV. The study also identified a BRV strain through metagenomic analysis and detected multiple mutations within the structural and non-structural proteins of the BRV strain, suggesting that the BRV Kirikkale strain may serve as an ancestor for reassortants with interspecies transmission, especially involving rotaviruses that infect rabbits and giraffes.

Geometric morphometric evaluation of mandibles of four sheep breeds: Bardoka, Ivesi, Polish Mountain sheep and Turcana.

The enduring relationship between humans and domestic sheep has evolved over millennia, showcasing diverse uses such as meat, milk, wool, leather and fur, shaped by geographical, historical, cultural and social factors. The sheep breeds discussed include the Ivesi from Southeastern Anatolia, known for its varied animal products; the resilient Turcana breed of Romania; Kosovo's Bardoka, valued for its triple-purpose characteristics; and Poland's Polish Mountain Sheep, uniquely utilized for milk production in cheese making. Sheep, with their enduring relationship with humans and significant economic importance, have attracted scientific interest in morphometric studies of their mandibles, yielding valuable data applicable across various fields including basic anatomy, veterinary clinical anatomy, zooarchaeology and veterinary forensic medicine. Traditional morphometric studies rely on statistical methods to compare length, depth and angular ratios between anatomical formations, often highlighting differences between specific points but not fully revealing shape variations between distinct groups. Geometric morphometric analysis has emerged as a preferred method in recent years, enabling shape analyses using coordinate data from various imaging techniques, facilitating a comprehensive examination of mandibular morphometrics among sheep breeds across different countries. This study involved four sheep breeds from different countries, namely Ivesi from Turkey, Bardoka from Kosovo, Polish Mountain Sheep from Poland and Turcana from Romania, with a total of 70 mandibles sourced from various veterinary faculties. Mandibular photographs were meticulously captured, focusing on the right side of mandible pairs and placing landmarks and semi-landmarks along the entire edge, enabling geometric morphometric analysis using tpsUtil, tpsDig2 and MorphoJ software. The analysis included principal component analysis, canonical variate analysis and discriminant function analysis for pairwise comparisons, facilitating a comprehensive examination of mandibular shape variations among the different sheep breeds. Using geometric morphometric methods, this study analysed mandibles from four distinct sheep breeds sourced from different countries, revealing notable variations in regions such as the ramus mandibula, angulus mandibula and incisive areas, attributed to genetic, geographical and dietary influences, highlighting the importance of continued research to better comprehend these shape differences.

Moss as a passive biomonitoring tool for the atmospheric deposition and spatial distribution pattern of toxic metals in an industrial city.

Anthropogenic pollution impacts human and environmental health, climate change, and air quality. Karabük, an industrial area from the Black Sea Region in northern Türkiye, is vulnerable to environmental pollution, particularly soil and air. In this research on methodological aspects, we analyzed the concentrations of six potential toxic metals in the atmospheric deposition of the city using the passive method of moss biomonitoring. The ground-growing terrestrial moss, Hypnum cupressiforme Hedw., was collected during the dry season of August 2023 at 20 urban points. The concentrations of Cr, Cu, Cd, Ni, Pb, and Co were determined in mosses by the ICP-MS method. Descriptive statistical analysis was employed to evaluate the status and variance in the spatial distribution of the studied metals, and multivariate analysis, Pearson correlation, and cluster analysis were used to investigate the associations of elements and discuss the most probable sources of these elements in the study area. Cd and Co showed positive and significant inter-element correlations (r > 0.938), representing an anthropogenic association mostly present in the air particles emitted from several metal plants. The results showed substantial impacts from local industry, manufactured activity, and soil dust emissions. Steel and iron smelter plants and cement factories are the biggest emitters of trace metals in the Karabük area and the primary sources of Cr, Cd, Ni, and Co deposition.

Validity and reliability of the heart failure-specific health literacy scale in Turkish.

Inadequate health literacy is common among adults with HF. The disease management process in HF closely depends on health literacy. No questionnaire is used to assess health literacy among Turkish patients with heart failure. This study aimed to determine the validity and reliability of the Turkish form of the 'Heart Failure-Specific Health Literacy Scale'. The research is a methodological study design. The study was conducted at the cardiology clinic between May and July 2021, located in the eastern part of Türkiye. The study sample consisted of 121 patients with HF. Data were collected using the Personal Information Form and the Heart Failure-Specific Health Literacy Scale. The patients' mean age was 62.88 ± 12.55 and 66.9% were men. Based on the factor analysis, three factors with eigenvalue above 1 have been identified. These model has been determined as x2 = 80.209, sd = 49 and p = 0.003. The fit indices were as follows: x2/SD = 1.637; RMSEA = 0.073, GFI = 0.90, CFI = 0.94, IFI = 0.95, TLI = 0.92 and NFI = 0.87. The scale has a total Cronbach's alpha of 0.66. With test-retest analysis, it was determined that it had a good, positive and significant correlation in terms of both the scale and its sub-dimensions. The Turkish form of the form is a valid and reliable tool.