Return to Community Mental Health Centers after the Pandemic: A Qualitative Study on Turkish Patients' Subjective Experiences.

BACKGROUND: Community mental health centers (CMHCs) are important institutions for individuals with chronic mental illness. During the COVID-19 period, patients with mental health could not optimally access care in CMHCs. AIM: To explore the experiences of patients using a CMHC after its closure due to the COVID-19 pandemic. PATIENTS AND METHODS: This was a descriptive qualitative study that included 16 patients with mental disorders who regularly used CMHCs during the pre-pandemic period. Their data were collected between March 2022 and August 2022 using face-to-face, in-depth semi-structured interviews. All interviews were recorded and the content analysis method was used to analyze the data. RESULTS: The age range of the 16 study participants was 29-53 years with a mean age of 40.8 ± 6.5 years. Nine (56.3%) participants were men, and 7 (43.7%) were women. Ten (62.5%) participants had schizophrenia, whereas 6 (37.5%) had bipolar disorder. According to content analysis, the five main themes that emerged based on the statements of participants were the effects of change, difficulties experienced, support needs, coping experiences, and suggestions. The results showed that although patients using CMHCs are struggling with the adverse consequences of the pandemic process, they also have difficulty managing their diseases and daily life due to their inability to access psychosocial services in the CMHCs. CONCLUSION: The patients reported their negative experiences and need for support during the pandemic. The study highlights the need to adequately accommodate mental health services delivery during future pandemics that may impose movement restrictions.

Novel esophageal speech therapy method in total laryngectomized patients: biofeedback by intraesophageal impedance.

The loss of the best communication port after total laryngectomy surgery makes speech rehabilitation an important goal. Our aim was to improve the quality of esophageal speech (ES) using online esophageal multichannel intra-luminal impedance (MII) as a new biofeedback method. Twenty-six total laryngectomized patients were included. Before ES therapy, an esophageal motility test was carried out. MII catheters were placed in all subjects who were then randomized into two groups. Group 1 included 13 cases, who were retrained according to the classical method. Group 2 included 13 cases, who were retrained according to the simplified animation of air movements within the esophagus and upper stomach resulting from the modifications of intra-esophageal air kinetics gained by MII. The level of speech proficiency was evaluated relative to pretraining levels using perceptual scales in the third and sixth months. Acoustic voice was analyzed. The number of syllables read per minute and the intelligibility of monosyllabic and dissyllabic words were calculated. In this study, MII was used for the first time in alaryngeal speech rehabilitation as a biofeedback method; an overall sufficient speech level was achieved by 68.4% at the end of therapy, whereas attendance was 90%. A statistically significant improvement was found in both groups in terms of ES level compared with the pretraining period although there was no significant difference between groups. Although we did not observe the expected difference between groups suggested by our hypothesis, MII may be used as an objective tool to show patients how to swallow and regurgitate air during training, and may thus expedite ES therapy both for the speech therapist and the patient in the future.

Quality of Life Following Treatment of Trochanteric Fractures with Proximal Femoral Nail versus Cementless Bipolar Hemiarthroplasty in Elderly.

PURPOSE: There is currently no gold standard treatment for unstable intertrochanteric fractures of the elderly. Internal fixation and hemiarthroplasty are two common treatment methods but studies comparing the functional outcomes of these procedures in the elderly are limited. This study evaluates the functional outcomes of hip fracture patients treated either with internal fixation or hemiarthroplasty. METHODS: Eighty-six elderly (>60 years) patients who presented with isolated, unstable intertrochanteric fractures between 2009 and 2013 were included in the study. According to the classification of Association for Osteosynthesis/Orthopaedic Trauma Association; 12 of the patients had a 31A1.3 fracture type, 36 of the patients had 31A2.2 and 19 had 31A2.3 fracture type, 12 had 31A3.1 and seven had 31A3.3 fracture. Forty-two of 86 hip patients (Group 1) were treated with intramedullary nailing and antirotator proximal femoral nail implant (TST, Turkey), and 44 (Group 2) were treated with cementless bipolar hemiarthroplasty. Preoperative social function (Jensen) score, EQ-5D index score and mobility (Palmer/Parker) scores were obtained. Five dimensions of EQ-5D were obtained at every follow-up visit until 24 months postoperative. RESULTS: There was no statistically significant difference between two groups according to preoperative demographic variables, including mean age and sex and Jensen, Palmer/Parker,EQ-5D index, five dimensions of EQ-5D and American Society of Anesthesiologists scores. At end of 24 months follow-up, health-related quality of life had increased more in Group 1 and they reported better social functioning and mobility scores (p<0.01). CONCLUSION: Internal fixation resulted in better social functioning and mobility scores compared with cementless bipolar hemiarthroplasty at the end of 24 months in treatment of unstable pertrochanteric hip fracture in the elderly.

Eating attitude in the obese patients: the evaluation in terms of relational factors.

ACCESSIBLE SUMMARY: • Obesity has become an important health problem because of the gradually increasing incidence seen within all age groups. People with obesity problems are affected lifespan and health negatively. • Obesity can be described as disease that affects lifespan and health negatively, because of body fat deposition. • The eating attitudes, body perception, strategies for coping with stress in patient being treated for obesity and investigated the relationship between their eating attitudes and socio-demographic characteristics, body perceptions and strategies of coping with stress. • Misperception of the body and the ability to solve the problem increased as eating attitude defects increased. A positive correlation was between the eating attitude defects and habitude of pursing social support and ability of coping. ABSTRACT: Obesity, a complex disease, involves many psychological problems besides eating disorders. In this study, we aimed to examine the relationship between the eating attitude and body perception, which is thought to affect the eating attitude in the patients diagnosed as obese, the ability to solve the problem, the strategy of coping with stress and some socio-demographic features. A total of 99 adults aged between 20 and 68 years, who were examined in the Polyclinic of Endocrinology and Metabolism Diseases, Ege University, Türkiye, constituted the sample of the study. Eating Attitude Test, The Body Perception Scale and The Scale of Coping with Strategies were used in order to collect the data. Misperception of the body and the ability to solve the problem increased as eating attitude defects increased. A positive correlation was determined between the eating attitude defects and the habitude of pursuing social support and the ability of coping.

Anger and alexithymic characteristics of the patients diagnosed with insomnia: a control group study.

The research was designed with a descriptive purpose to compare the alexithymic characteristics, trait anger and anger expression styles of those who are diagnosed with insomnia with those who are not. It was conducted with 96 patients who applied to Department of Sleep Disorders and were diagnosed with insomnia and 96 volunteers were not diagnosed with any psychiatric diagnosis and had not any sleep disorders in two Medical Faculty Hospitals in west of Turkey. Three types of forms were used to collect research data. The first form is the Sociodemographic Characteristics Form, the second one is The Toronto Alexithymia Scale and the third one is the Trait Anger-Anger Expression Scale. It was determined that the patients diagnosed with insomnia had displayed much more alexithymic characteristics than control group. Insomniac patients had higher level of anger and anger expression-in than the control group was found. In accordance with the findings, it is suggested that more comprehensive data should be obtained from the patients having sleeping problems and, that the nursing interventions on the patients' recognition, expression and anger management should be reflected on the nursing holistic care.

Validity and reliability study of the Turkish psychiatric nurses of job motivation scale.

This methodological study was planned to explore the validity and reliability of the evaluation scale for measuring the job motivation of nurses who work in psychiatric clinics. The sample was composed of 378 nurses who work in all psychiatric units or psychiatric hospitals located in Turkey's four large cities - Ankara, Istanbul, Izmir and Manisa. For testing reliability of 'job motivation scale', the internal consistency tests were executed with split scale analysis, Cronbach's alpha coefficient and item-total score correlation. For construct validity, factor analysis was used. For the first part of scale, Cronbach's alpha was determined to be 0.79. For the second part, Cronbach's alpha was 0.72. Factor analysis was performed in an attempt to establish validity and underlying associations between items in the scale. The first analysis produced nine eigenvalues (>1) and nine factors were extracted. The scree test indicated that a two-factor model would be suitable. The factor structure of the tool for measuring the job motivation of nurses who work in psychiatric clinics was parallel with motivation concepts. Validity and reliability levels of the scale for measuring the job motivation of nurses who work in psychiatric clinics were found to be sufficient in the Turkish population.

Vascular graft infection by Staphylococcus aureus: efficacy of linezolid, teicoplanin and vancomycin systemic prophylaxis protocols in a rat model.

OBJECTIVE: We investigated experimentally the in vivo prophylactic efficacies of linezolid, teicoplanin and vancomycin in subcutaneously implanted dacron graft infection caused by methicillin-resistant Staphylococcus aureus (MRSA). MATERIALS AND METHODS: Dacron grafts (1 cm(2)) were aseptically implanted into subcutaneous pockets that were surgically prepared in the backs of 50 rats. Ten of these rats were used as the control group (group I). Grafts in the remaining 40 rats were infected by inoculation of MRSA at the concentration of 2 x 10(7) colony-forming units (CFU)/ml. Ten of these rats constituted the contaminated, untreated group II. The other three study groups comprising 10 rats each were contaminated and then treated with linezolid (group III), teicoplanin (group IV) and vancomycin (group V), respectively. All rats were sacrificed and the grafts were removed after seven days and evaluated. RESULTS: The bacterial count decreased in the rats from the groups treated with linezolid, teicoplanin and vancomycin. The linezolid and teicoplanin groups, however, showed a significantly lower bacterial number than the vancomycin group (p = 0.009 and p = 0.01). The intensity of inflammation was highest in the contaminated, untreated group, as expected. CONCLUSIONS: Single-dose linezolid, teicoplanin and vancomycin for peri-operative prophylaxis may prevent bacterial growth in vascular graft infections. The effect of linezolid and teicoplanin seemed similar and their effect was greater than that of vancomycin.

University students' suicidal thoughts and influencing factors.

This research was planned as a descriptive study for the purpose of examining the suicidal thoughts of first-year university students and the factors that might affect them. The research was conducted with the participation of first-year students (class of 1992) at Ege University between January 2003 and October 2004. The research data were collected on a form prepared by the researcher to determine the university students' socio-demographic characteristics and their suicidal thoughts, the trait anger, expression of anger inventory and the brief symptom inventory. It was determined that 2.4% of the students had suicidal thoughts, and 11.2% of the students had previously attempted suicide. The risk factors of the students' suicidal thoughts were determined to be issues of gender, school problems, family relationships, anger expression, somatization, hostility, psychotic symptoms, phobic anxiety, anxiety disorder and interpersonal sensitivity.

Anxiolytic- and antidepressant-like properties of ketamine in behavioral and neurophysiological animal models.

Ketamine, a dissociative anesthetic agent, appears to have rapid antidepressant effects at sub-anesthetic doses in clinically depressed patients. Although promising, these results need to be replicated in double-blind placebo-controlled studies, a strategy thwarted by the psychoactive effects of ketamine, which are obvious to both patients and clinicians. Alternatively, demonstrations of the psychotherapeutic effects of ketamine in animal models are also complicated by ketamine's side-effects on general activity, which have not been routinely measured or taken into account in experimental studies. In this study we found that ketamine decreased "behavioral despair" in the forced swim test, a widely used rats model of antidepressant drug action. This effect was not confounded by side-effects on general activity, and was comparable to that of a standard antidepressant drug, fluoxetine. Interestingly, ketamine also produced anxiolytic-like effects in the elevated-plus-maze. Importantly, the effective dose of ketamine in the plus-maze did not affect general locomotion measures, in either the plus-maze or in the open field test. While the selective N-methyl-d-aspartic acid (NMDA) receptor antagonist MK-801 also produced antidepressant-like and anxiolytic-like effects, these were mostly confounded by changes in general activity. Finally, in a neurophysiological model of anxiolytic drug action, ketamine reduced the frequency of reticularly-activated theta oscillations in the hippocampus, similar to the proven anxiolytic drug diazepam. This particular neurophysiological signature is common to all known classes of anxiolytic drugs (i.e. benzodiazepines, 5-HT1A agonists, antidepressants) and provides strong converging evidence for the anxiolytic-like effects of ketamine. Further studies are needed to understand the underlying pharmacological mechanisms of ketamine's effects in these experiments, since it is not clear they were mimicked by the selective NMDA antagonist MK-801.

Anxiolytic and antidepressant effects of intracerebroventricularly administered somatostatin: behavioral and neurophysiological evidence.

Somatostatin (SST) is a cyclic polypeptide that inhibits the release of a variety of regulatory hormones (e.g. growth hormone, insulin, glucagon, thyrotropin). Moreover, SST is widely distributed within the CNS, acting both as a neurotransmitter and as a neuromodulator of other neurotransmitter systems. However, despite its extensive expression in limbic areas, and its co-localization with GABA, a neurotransmitter previously implicated in emotion, the effects of SST on anxiety and depression have not been investigated. By performing intraventricular infusions in rats we demonstrate, for the first time, that SST has anxiolytic- and antidepressant-like effects in the elevated plus-maze and forced swim test, respectively. In addition, by performing local field potential recordings of hippocampal theta activity evoked by reticular stimulation in urethane-anesthetized rats we also show that SST application suppresses the frequency of theta in a similar fashion to diazepam. This neurophysiological signature, common to all classes of anxiolytic drugs (i.e. benzodiazepines, selective 5-HT reuptake inhibitors, 5-HT1A agonists) provides strong converging evidence for the anxiolytic-like characteristics of SST. Our pharmacological antagonism experiments with bicuculline further suggest that the anxiolytic effect of SST may be attributable to the interaction of SST with GABA, whereas the antidepressant-like effect of SST may be GABA-independent. In addition to contributing to the current understanding of the role of neuropeptides in mood and emotion, these findings support a clinical role for SST (or its analogues) in the treatment of anxiety and depression.

The effect of laparoscopic Nissen fundoplication on laryngeal findings and voice quality.

BACKGROUND: This study aimed to report the need for an ear, nose, and throat (ENT) specialist to evaluate the laryngeal findings and the voice quality of patients with gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) symptoms before and after surgery. METHODS: For this study, 38 GERD patients who had a Reflux Symptom Index (RSI) score higher than 14 underwent complete assessment in the ENT department. Standard 24-h pH monitoring, esophageal motility assessment, a detailed ENT examination including the RSI, the Reflux Finding Score (RFS), and objective voice analysis were performed for all the patients before reflux surgery, then 6 to 8 months afterward. RESULTS: The subject's mean RSI scores were 25.45 +/- 7.5 before and 16.52 +/- 5.06 after surgery (p < 0.05), and the mean RFS scores were, respectively, 10.37 +/- 2.7 and 5.5 +/- 1.45 (p < 0.05). The pre- and postoperative differences in the RSI and RFS scores and the voice parameters were statistically significant. CONCLUSIONS: Objective voice analysis, RSI, and RFS can be used to evaluate the postoperative results for GERD patients with LPR symptoms. Examination of these patients by an ENT specialist is necessary before and after the operation.