Evaluation of post-acute-COVID-19, and long-COVID symptoms with a questionnaire: Within one year, a longitudinal study.

OBJECTIVE: Long-term consequences of COVID-19 vary widely, representing a growing global health challenge. The aim of this report was to define the presence of symptoms in post-acute-COVID-19 syndrome (PCS) patients and to assess the frequency, associated factors, and the spectrum of persistent symptoms. METHODS: In this longitudinal study, 487 adults with a previously diagnosed "Severe Acute Respiratory Syndrome Coronavirus 2" (SARS-CoV-2) who admitted to COVID-19 follow-up outpatient clinic between December 1, 2020 and November 31, 2021 were interviewed face-to-face three times. Data was collected on patient demographics, comorbidities, and symptoms. A questionnaire of 160 questions was asked and organized into the following: identification and consent, socio-demographic/epidemiological characteristics, previous medical history, diagnosis and clinical presentation of acute COVID-19, as well as systematic symptoms. Data were evaluated using univariate comparisons and multiple logistic regression. RESULTS: The most prevalent symptoms among all PCS patients during their initial visit were dyspnea, weakness, forgetfulness, fatigue, and arthralgia respectively. The most common symptoms in patients with 6 months or more time from discharge to follow-up at the first and second visits, appear to be persistent. While incidence rates decreased by the third visit, the five most common symptoms remained the same. The possibility of weakness and arthralgia was found to be higher in non-hospitalized patients. Females were associated with the most common persistent symptoms and the strongest association was with arthralgia. CONCLUSION: A large number of COVID-19 survivors had continuing symptoms at the first year of post-COVID-19-infection. Neither the presence of comorbidities of the patient nor smoking status were associated with the severity of PCS symptoms. A better understanding of the mechanisms, predisposing factors and evaluation require a multidisciplinary team approach.

Association between newly diagnosed hyperglycemia/diabetes mellitus, atherogenic index of plasma and obesity in post-COVID-19 syndrome patients.

PURPOSE: The COVID-19 pandemic represents a great global concern and its associated morbidities. The goal of this study was to determine the incidence of newly diagnosed hyperglycemia and diabetes among COVID-19 survivors and to evaluate whether obesity and lipid profile have an effect on this group using the atherogenic index of plasma (AIP). METHODS: In the retrospective study, 511 adults with a previously diagnosed "Severe Acute Respiratory Syndrome Coronavirus 2" who admitted to COVID-19 follow-up outpatient clinic were evaluated. Data was collected on patient demographics, comorbidities, and some laboratory results. Logistic regression was used to estimate associated factors. RESULTS: Newly diagnosed type 2 diabetes mellitus (T2DM) was defined in 17 patients (3.32%), hyperglycemia in 86 patients (16.82%). The results of analysis were examined, gender, age, BMI and triglyceride variables were found to be significant risk factors together. Fasting blood glucose values of 22 out of 86 patients with hyperglycemia returned to normal after six months of follow-up. Undiagnosed-preexisting DM in 4 out of 17 patients diagnosed with T2DM at their first visit and in 7 out of 8 hyperglycemia patients diagnosed with T2DM at the end of six-month follow-up. CONCLUSION: COVID-19, may directly/indirectly, predispose to hyperglycemia. Obesity and hyperlipidemia are risk factors for newly diagnosed T2DM/hyperglycemia in post-COVID-19 syndrome patients. Since that some metabolic variables were found to be significantly higher in the group with high AIP values, we suggest that AIP might be used as a reference to predict the development of obesity and T2DM.

Prevalence and risk factors of psychological symptoms and quality of life in COVID-19 survivors: A cross-sectional study of three different populations.

AIM: Studies of the effects of COVID-19, especially post-acute COVID-19 syndrome, on psychological health in non-severe cases are limited. We aimed to evaluate the prevalence and associated risk factors of psychological symptoms, and quality-of-life in three groups of outpatients, hospitalized and intensive care patients. METHODS: A total 276 patients, previously confirmed with SARS-CoV-2 infection, attending the COVID-19 follow-up outpatient clinic from December 2020 to July 2021 were interviewed face-to-face. In this cross-sectional, retrospective study, all participants were asked our self-designed demographic and screening questions to assess their psychological symptoms and administered the WHQOOL-BREF survey to evaluate quality of life. RESULTS: In screening questions, major depressive disorder symptoms were detected at a rate of 20.3%, generalized anxiety disorder symptoms at a rate of 16.7%, panic attack symptoms at a rate of 10.9%, post-traumatic stress disorder symptoms at a rate of 28.6% and obsessive-compulsive disorder symptoms at a rate of 18.1%. The outpatient group with COVID-19 infection had a higher risk of developing psychological symptoms and decreased quality of life. CONCLUSION: COVID-19 infection was found to have a considerable psychological impact on those treated as outpatients despite the less severe course of their illness.

Does fetuin-A mediate the association between pro-inflammatory diet and type-2 diabetes mellitus risk?

Introduction: Introduction: recent studies indicate that diet increases T2DM risk via inflammation. Fetuin-A, identified as an acute-phase protein, plays a role in insulin resistance and is an independent predictor of type-2 diabetes. Objectives: the present study aimed to examine the association between diet and T2DM risk, and whether said association is mediated by fetuin-A, and to determine the effect of fetuin-A on T2DM risk. Methods: the case group included 40 individuals with T2DM, whereas 40 individuals without T2DM comprised the control group. The Dietary Inflammatory Index (DII), was used to determine the inflammatory potential of diet. A simple mediation analysis was used to investigate whether diet was associated with T2DM risk and whether the association was mediated by fetuin-A. Results: subjects who consumed a high pro-inflammatory diet had 2.0 times higher risk of developing T2DM (OR = 2.043; 95 % CI: 0.955 to 4.371, p = 0.066). In addition, subjects who had higher levels of fetuin-A had a 1,2 times higher risk of developing T2DM (OR = 1.155; 95 % CI: 1.030 to 1.296, p = 0.014). Both fetuin-A and hs-CRP had a significant full mediator role on the association between DII and HOMA-IR [respectively; ß = 0.371 (95 % CI: -0.029-0.770), ß = 0.424 (95 % CI: -0.007-0.856)]. Conclusion: these findings suggest that a pro-inflammatory diet, by creating an environment of increased inflammatory markers, affects in particular insulin resistance through these markers and ultimately causes T2DM. In addition, fetuin-A also acts as an important novel mediator between diet and T2DM by inducing insulin resistance.

Introducción: Introducción: estudios recientes indican que la dieta aumenta el riesgo de T2DM mediante la inflamación. La fetuína-A, identificada como proteína de fase aguda, desempeña un papel en la resistencia a la insulina y es un predictor independiente de la diabetes de tipo 2. Objetivos: el presente estudio pretende examinar la asociación entre la dieta y el riesgo de DMT2 y si la asociación está mediada por lafetuína-A, y determinar el efecto de la fetuína-A sobre el riesgo de DMT2. Métodos: en el grupo de casos se incluyeron 40 individuos con DMT2, mientras que 40 individuos sin DMT2 se incluyeron en el grupo de control. El índice de inflamación de la dieta (DII) se usó para determinar el potencial inflamatorio de la dieta. El análisis de mediación simple se usó para investigar si la dieta estaba asociada con el riesgo de DMT2 y si la asociación estaba mediada por la fetuína-A. Resultados: los sujetos que consumieron una dieta más proinflamatoria tuvieron 2 veces más riesgo de desarrollar DMT2. Además, los sujetos que tenían niveles más altos de fetuína-A tuvieron 1,2 veces más riesgo de desarrollar DMT2. Tanto la fetuína-A como la hs-CRP tuvieron un papel significativo como mediadores completos sobre la asociación entre DII y HOMA-IR. Conclusión: estos hallazgos sugieren que la dieta proinflamatoria, al crear un ambiente con marcadores inflamatorios aumentados, afecta en particular a la resistencia a la insulina a través de estos marcadores y, finalmente, causa DMT2. Además, la fetuína-A también actúa como mediador novedoso importante entre la dieta y la DMT2 al inducir la resistencia a la insulina.

Inappropriate Prescribing of Proton Pump Inhibitors in Outpatient Clinics.

Proton pump inhibitors are the commonly prescribed drugs for acid-related disorders. However, many of those prescriptions are inappropriate in inpatient and outpatient settings according to the recommended guidelines. Many studies have been conducted in inpatient clinics, but data about the appropriateness of proton pump inhibitor prescribing in outpatient clinics are scarce. Therefore, the aim of this study was to determine inappropriate proton pump inhibitor prescribing rates among patients admitted to a tertiary hospital family medicine outpatient clinic. A total of 259 patients (median age = 59 years; 72.6% women) were enrolled into the study and 35.9% of them had no proper indications to utilize proton pump inhibitors. Inappropriate proton pump inhibitor usage rate was significantly higher in patients older than 60 years compared with their younger counterparts (62.4% vs. 37.6%; p = .001). The most frequent reason to use a proton pump inhibitor with nonapproved indications was polypharmacy (41.9%). Despite endoscopic evaluation, 41.9% of the patients received a proton pump inhibitor without an approved indication. A significant proportion of nonindicated prescriptions were a consequence of continued prescribing without re-evaluating patients in outpatient clinics. Consideration of proton pump inhibitor indications according to the guidelines in every admission may prevent inappropriate prescriptions.

Assesssing an unmet healthcare demand: A survey of immunisation among homecare patients and their caregivers.

Susceptibility of the homecare patient to vaccine preventable infections and their complications is high. Hospitalization of this patient group increases costs to the healthcare system. Therefore vaccination services are of great importance for protecting these patients from complications and hospitalization. We aimed to determine vaccination status of the patients receiving home care services from a tertiary hospital in Turkey and to reveal their vaccination needs. This cross sectional study was carried out in the Division of Home Care Services of Diskapi Yildirim Beyazit Training and Research Hospital in Ankara Turkey. A questionnaire Comprised of 15 questions were administered through face to face with 336 patients and their care givers. The data obtained was analyzed with descriptive statistical methods and chi-squared test was used for comparison of proportions. A total of 86.3% of the patients and 22.6% of the caregivers were older than age 65. Approximately 45% of the patients were receiving home care due to primary neurological diagnosis such as Dementia, Parkinson's disease and Cerebrovascular Accident. In addition, 78% of the patients had at least 1 additional diagnosis other than their primary diagnosis. Although immunization indications were present among all patients included in the study and at least 22% of the care providers, only 15.2% of patients and 11.3% of care providers had been recommended to receive vaccination. Among those who had been recommended to get vaccinated, 74% of patients and 77% of care givers had been administered the recommended vaccine. This finding implied that both groups were responsive to the advice for vaccination. Moreover, since the patients receiving home care are already followed-up by a healthcare team, thus these patients can be vaccinated with very little additional logistic support.

Herbal medicine use among patients with chronic diseases.

AIM: Complementary and alternative medicine (CAM) is commonly used all over the world, and herbal medicines are the most preferred ways of CAM. The aim of this study was to determine the frequency of herbal medicine use among patients with chronic diseases. METHODOLOGY: A cross-sectional descriptive study was conducted from April 2014 to December 2014 among patients who had been diagnosed with diabetes mellitus (DM), hypertension (HT), and hyperlipidemia (HL) in Family Medicine Department of Diskapi Yildirim Beyazit Training and Research Hospital, in Ankara. A questionnaire about herbal drug use was applied by face to face interview to the participants. RESULTS: A total of 217 patients were included in this study. The mean age of the participants was 56.6 ± 9.7 years (55 male and 162 female). The rate of herbal medicine use was 29%. Herbal medicine use among female gender was significantly higher (P = 0.040). Conventional medication use was found to be lower among herbal medicine consumers. There was no relationship between herbal medicine use and type of chronic disease, living area, and occupation or education level. Most frequently used herbs were lemon (39.6%) and garlic (11.1%) for HT, cinnamon (12.7%) for DM, and walnut (6.3%) for HL. CONCLUSIONS: In this study, herbal medicine use was found to be higher among patients who had been diagnosed with chronic diseases. Therefore, physicians should be aware of herbal medicine usage of their patients and inform them about the effectivity and side effects of herbal medicines.

Depression, anxiety and quality of life in caregivers of long-term home care patients.

Family caregivers of patient in long-term care facilities often have high rates of stress, burden and psychological illness. A descriptive study was carried out with 63 caregivers. Caregivers were asked to complete a demographic questionnaire, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Short form 36 (SF-36), which measures health related quality of life (QoL). The majority of caregivers were female (79.4%), and most often the daughter of the patient in long-term care (47.6%). The mean BDI score of the sample was 18.8, and the mean BAI score was 20.0. Almost all the mean scores referring to the QoL were decreased (lower than 50), with the exception of mental health. On the SF-36 questionnaire, the lowest scores were observed on the role-emotional, role-physical, social functioning and vitality scales of the SF-36.

The relationship between BMI and blood pressure in children aged 7-12 years in Ankara, Turkey.

OBJECTIVE: Recent studies have reported an increasing prevalence of childhood hypertension. Obesity is probably the most important risk factor. The relationship between hypertension and BMI in children has not been studied in Ankara, which is the second largest city in Turkey. DESIGN: Cross-sectional study analysing direct data on height, weight and blood pressure of students. SETTING: Population-based study in Ankara, the capital city of Turkey. SUBJECTS: In three schools, 2826 students aged 7-12 years. RESULTS: The overall prevalence of hypertension was 7·9 %. Among the 222 hypertensive children, 124 (56 %) were boys and ninety-eight (44 %) were girls (P=0·40). In the whole group, 3·6 % had only systolic hypertension, 0·7 % had only diastolic hypertension and 3·5 % had both systolic and diastolic hypertension. The prevalences of overweight and obesity were both 13·9 %. BMI was significantly correlated with blood pressure (P<0·001). Overweight and obesity were more common in boys (P<0·001). CONCLUSIONS: Hypertension was more common than has been reported in other studies. Blood pressure measurement should be routine and frequent in children, especially obese children.

Thyroid-stimulating hormone (TSH) level in nutritionally obese children and metabolic co-morbidity.

OBJECTIVE: In recent years, there has been increasing focus on thyroid function in pediatric obese patients. Our aims were to investigate whether there is an association between serum thyroid-stimulating hormone (TSH) within the normal range and body mass index (BMI), and to determine if TSH levels correlate with metabolic risk factors in children. METHODS: A retrospective cross-sectional analysis was carried out on 528 euthyroid, age- and sex-matched lean, overweight, or obese children. Anthropometric indices, blood pressure, fasting blood glucose, hepatic enzymes, lipid profiles, TSH, free triiodothyronine (fT3), and free thyroxine (fT4) were assessed from medical records and compared among groups. Subjects with known presence of diabetes, using medications altering blood pressure and glucose or lipid metabolism, with TSH levels >97.5 or <2.5 percentile, or with autoimmune thyroid disease were excluded. RESULTS: Hypertension, dyslipidemia, and elevated levels of hepatic enzymes were found to be more common in overweight and obese children (p<0.001), and those metabolic changes were significantly correlated with the increase in BMI (p<0.05). Serum concentrations of TSH and fT3 within the normal range were higher in overweight and obese children (p<0.01), and TSH was positively correlated with total cholesterol, triglycerides, and systolic blood pressure (p<0.05). CONCLUSION: Our findings suggest that obese children have higher serum TSH and fT3 levels even within the normal range, and that an increase in TSH is associated with dyslipidemia and higher systolic blood pressure. It remains to be seen whether TSH might serve as a potential marker of metabolic risk factors in obese pediatric patients.

A rare adverse effect of montelukast treatment: ecchymosis.

Montelukast is a leukotriene receptor antagonist that is effective in the treatment of allergic rhinitis and asthma. We report a rare case of a 31-year-old woman with a history of allergic rhinitis and moderate persistent asthma, who experienced severe bruising on her lower extremities after starting montelukast treatment. Clinicians should be aware of the possibility of unusual bruising during montelukast therapy, and in those patients montelukast should be discontinued.

Differences between rural and urban primary care units in Turkey: implications on residents' training.

CONTEXT: Family practice training takes place at primary care based training centers linked to Education and Research State Hospitals in Turkey. There is a discussion if these units are adequate to train primary care staff and if the patients of these units reflect the applicants of primary care. AIMS: THE AIM OF OUR STUDY IS TO INVESTIGATE THE DEMOGRAPHIC CHARACTERISTICS, THE EFFECT OF DISTANCE ON PRIMARY CARE UTILIZATION, AND MOST COMMON DIAGNOSIS OF THE PATIENTS WHO APPLIED TO TWO DIFFERENT OUTPATIENT CLINICS: One urban and one rural. SETTINGS AND DESIGN: Study was conducted from the electronic health records of the patients applied to outpatient clinics of Ankara Diskapi Yildirim Beyazit Training and Research Hospital Department of Family Medicine between 1 January and 31 December 2009. RESULTS: Total number of patients applied to both of the outpatient clinics was 34,632 [urban clinic: 16.506 (47.7%), rural clinic: 18.126 (52.3%)]. Leading three diagnoses were upper respiratory tract infection (URTI), general medical examination (GME), and hypertension (HT) in the most common 10 diagnosis. CONCLUSION: In our study, the rural outpatient clinic is regarded as a primary care unit in the neighborhood of living area and the urban clinic as close to working environment. We found statistically meaningful differences in most common diagnosis, gender, age, and consultation time between the rural and urban clinics. According to our results, family practitioners' field training should take place at different primary care units according to sociodemographic characteristics of each country.

Persistence of protection of hepatitis B vaccine and response to booster immunization in 2- to 12-year-old children.

UNLABELLED: Neonatal vaccination against hepatitis B virus (HBV) infection was launched in 1998 in Turkey. The aim was to evaluate the persistence of seroprotection after HBV vaccination in order to determine the necessity of a single booster dose in 2- to 12-year-old children. This study was conducted retrospectively using hospital records of the children aged 2-12 years old who attended the pediatric outpatient clinics of Diskapi Training and Research Hospital, Ankara, Turkey between January 2010 and June 2011. Children who had received three doses of HBV vaccination in their infancy were included. A total of 530 children enrolled into the study, and 352 (66.4 %) of them had protective antibody to hepatitis surface antigens (anti-HBs) titer greater than 10 mIU/ml. The proportions of children with low, intermediate, and high anti-HB titers are different for those under 3 years of age. The majority were in the intermediate category. Those aged 4-10 years and 11 or older represented two-thirds of the children with high titers (p = 0.000). None of the children had chronic HBV infection. Unprotected children responded well after receiving the booster dose. The mean anti-HB concentration after the booster dose was more than 200 times higher than the mean antibody concentration before (p < 0.001). CONCLUSION: Our data suggest that HBV vaccination may confer long-term immunity. Use of routine booster doses of vaccine at these ages does not appear necessary to maintain long-term protection in successfully vaccinated immunocompetent children in the region.

Unilateral absence of the pulmonary artery incidentally found in adulthood.

Unilateral absence of the pulmonary artery (UAPA) or pulmonary artery agenesis is a rare congenital disorder presenting with a wide spectrum of symptoms. UAPA is usually associated with cardiac anomalies and surgically treated in childhood. We report a rare case of a 50-year-old woman who was diagnosed with left pulmonary artery agenesis without any other cardiac anomalies. Clinicians should be aware of the possibility of undiagnosed cases of UAPA in patients through a chest radiograph that suggests the diagnosis. Confirmation of the diagnosis and anatomic details can be discerned by CT scanning.

Factors affecting choice of specialty among first-year medical students of four universities in different regions of Turkey.

AIM: To determine the factors affecting medical students' choice of the specialty of family medicine. METHODS: The study was conducted in the period from 2004-2006 and comprised 770 first-year medical students from Ondokuz Mayis, Karadeniz Technical, Kocaeli, and Adnan Menderes Universities, Turkey. The questionnaire included questions on demographic data and 6 "yes/no" or open-ended questions on students' career aspirations and the specialty of family medicine. RESULTS: The response rate was 93.1% (n=717, 54.7% male). Nearly all students (n=714, 99.6%) showed an intention to specialize after receiving the medical doctor degree. A total of 187 students (26.2%) showed an intention to work in primary care without specialization "for a temporary period" to "gain some experience." Family medicine was the least preferred specialty (n=7, 0.9%). The most important reasons for the choice of specialty were "better financial opportunities" and "prestige" (n=219, 30.5%), followed by "personal development" (n=149, 20.8%), "more benefits for the patient" (n=128, 17.9%), and "wish to work in an urban area" (n=32, 4.5%). The most preferred specialties were cardiology (n=179, 25.0%), pediatrics (n=121, 16.9%), ophthalmology (n=47, 6.6%), physical therapy and rehabilitation (n=34, 4.7%), and obstetrics and gynecology (n=32, 4.5%). CONCLUSION: Prestige, money, and personal development are important factors in career decision-making among medical students in Turkey. This should be taken into consideration when conducting reforms at the primary level.

Risk factors for urinary incontinence in Turkish women. A cross-sectional study.

OBJECTIVE: To explore the association between conventional risk factors and urinary leakage among a random sample of adult Turkish women. METHODS: Six hundred and fifty patients (mean age 33.2 +/- 10.6 years; range 17-65 years) attending 6 Primary Health Care Centers in the Eastern Marmara Region, Turkey were randomly enrolled in this study, between September 2005 and December 2005. After signing their informed consent, all patients filled in a questionnaire consisting of questions inquiring any kind of urinary leakage, related symptomatology and personal medical history. RESULTS: One hundred and six women (16.4%) with urinary incontinence (UI) were reported. The most frequent type of incontinence was mixed UI (n=65, 61.3%). The prevalence of stress UI among all incontinent women was 20.8% (n=22) and urge UI 17.9% (n=19). The prevalence was associated with age, body mass index and parity. Number of pregnancies was positively correlated with prevalence of incontinence (r=0.30, p<0.001). Women who had >2 deliveries had a higher risk of UI (odds ratio = 4.04, 95% confidence interval, 2.37 to 6.89, p<0.001). CONCLUSION: The results of this study supported previous reports revealing that age, body mass index, type of deliveries and number of pregnancies/deliveries are risk factors of UI, and showed that age, body mass index and number of pregnancies should be regarded as independent risk factors.

Parents' knowledge and behaviour concerning sunning their babies; a cross-sectional, descriptive study.

BACKGROUND: For centuries, sunlight has been used for therapeutic purposes. Parents still sun their infants to treat neonatal jaundice, nappy rash or mostly to supply vitamin D for bone development as a consequence of health beliefs. In this study we aimed to assess knowledge and behaviour of parents about benefits of sunlight and sun protection. METHODS: In this study, parents attending to governmental primary healthcare units for their children's routine vaccinations, upon their informed consent, were consecutively enrolled during one month. Data were collected by a semi-structured questionnaire. RESULTS: The mean age of 118 enrolled parents and their babies were 27.9 +/- 6.5 years and 8.3 +/- 5.8 months, respectively. Most of the participants were mothers (93.2%), housewives (81.4%) with an educational level of > or =6 years (71.2%). Sunlight was considered beneficial for bone development (86.4%), diaper rash (5.9%) and neonatal jaundice (12.7%). In case of neonatal jaundice 72.0% of the participants reported that they would consult a physician. Most of the participants (82.2%) were sunning their babies outdoors. Nearly half (49.7%) of them got this information from medical staff. Fifty two percent of the parents were sunning their babies before 10-11 a.m. and/or after 3 p.m. Only 13.6% of parents reported using sunscreen for their babies, and the majority of them were using sun protecting factor > or = 15. One forth of the sunscreen users was using sunscreen according to their physicians' advice. CONCLUSION: Most of the participants were aware of the benefits of sunlight; especially for bone development. However they were displaying inappropriate behaviour while sunning their babies for health reasons. More education should be given to parents about the danger of sunlight at primary health care units while advising to sun their babies, if any.

Intentional sun exposure in infancy in Sakarya, Turkey.

OBJECTIVE: To determine the extent of intentional sun exposure in infancy, and the prevalence of maternal belief that potentially increases the children's harm risk from ultraviolet radiation. The major determinants of mothers' beliefs and behaviors regarding sunning were also assessed. METHODS: Three hundred and ninety six Caucasian women mothering 0-12 month old infants, attending to Sakarya State Hospital Healthy Infant outpatient clinic in November 2003, filled in the questionnaire after giving their informed consent. Each mother was asked 11 structured questions regarding maternal education, beliefs regarding benefits or harms of sun exposure, use of sunlight for therapeutic purposes, use of sun protection, and source of knowledge. RESULTS: The mean age of the mothers was 27.37 +/- 5.36 years and the children was 5.71 +/- 3.53 months. Two hundred and thirty-five mothers (64.1%) believed that sunlight is harmful, but 296 (79.7%) named one benefit of intentional baby sunning. Sun causes cutaneous diseases was the most frequently (n=83/126) mentioned harm and sun strengthens bones and teeth was the number one (n=250/296) benefit according to the mothers. The leading source of knowledge for the beneficial effects of the sun was health care professionals (physician, midwife, nurse) 45.7% (130/284). There was no significant correlation between mothers' sunning behavior and age, education level, being advised so by a health care professional or believing that the sun was harmful. CONCLUSION: As these results display being the leading source of knowledge and initiative of healthy/risky behaviors, primary health care physicians/workers have to be informed regarding the vitamin D supplementation and risks of sun exposure.