The impact of a "clinical adaptation psychoeducation program" grounded in the psychological flexibility model on perceived stress and coping behaviors among nursing students: A randomized controlled experimental study.

BACKGROUND: The clinical adaptation psychoeducation program grounded psychological flexibility model (PFMCAP) is consisting of six areas, fills a large gap in the literature regarding the effect of nursing students on perceived stress and coping behaviors in the clinical process. OBJECTIVES: To determine the effect of PFMCAP on perceived stress and coping behaviors of nursing students. DESIGN: This was a simple randomized controlled experimental pre-posttest design. SETTING: This study was conducted with 66 first-year students studying in the nursing department of a university in Türkiye. METHODS: A simple randomization method (computer-generated random number table) was used. Data were collected with "Sociodemographic Data Form", "Perceived Stress Scale for Nursing Students (PSSNS)" and "Stress-Coping Behaviors Scale for Nursing Students (SCBNS)". PFMCAP was conducted online with first-year nursing students, consisting of a total of six sessions, each lasting 90 min. Data were analyzed using percentiles and frequency distributions, and two-way mixed ANOVA one week after the completion of the PFMCAP. RESULTS: There was no significant difference between the groups of descriptive characteristics (p > 0.05). Post-test measurements of students in the experimental group's PSSNS total and sub-dimension scores had a significant decrease compared to the control group (p < 0.001). There was no significant difference between the groups in the post-test SCBNS total scores of the students (p > 0.05). However, there was a significant increase in the post-test SCBNS-Staying Optimistic sub-dimension scores in the experimental group (p < 0.001). CONCLUSION: The impact of PFMCAP on nursing students' perceived stress levels was not limited to only reducing stress levels; it also contributed to an increase in the students' levels of optimism. These findings demonstrate the potential of PFMCAP in supporting nursing students during the clinical adaptation process. It is observed that the integration of PFMCAP into nursing education could assist nursing students in better adapting to clinical practices and effectively managing stress.

The Effect of Acceptance and Commitment Therapy-Based Psychoeducation on Body Image, Quality of Sexual Life, and Dyadic Adjustment of Women After Breast Cancer Surgery.

OBJECTIVES: To determine the effect of acceptance and commitment therapy-based psychoeducation applied to women who have undergone breast cancer surgery on body image, quality of sexual life, and dyadic adjustment. SAMPLE & SETTING: Women who have undergone breast cancer surgery were included. The research had a single-group quasi-experimental design with pre-/post-test measurements and 31 participants. METHODS & VARIABLES: The research was carried out between February and July 2021. Data were collected using a personal information form, a body image perception scale, the Dyadic Adjustment Scale, and the Sexual Quality of Life-Female. RESULTS: The post-test mean scores of body image, quality of sexual life, and dyadic adjustment scales were significantly higher than pretest (p < 0.05). IMPLICATIONS FOR NURSING: To improve the body image, quality of sexual life, and dyadic adjustment of women who have undergone breast cancer surgery, nurses are recommended to include psychoeducation based on acceptance and commitment therapy interventions in the nursing care process and to evaluate the effectiveness.

Criteria sets for primary Sjogren's syndrome are not adequate for those presenting with extraglandular organ involvements as their dominant clinical features.

Patients with primary Sjogren's syndrome (pSS) may go undiagnosed or be misclassified due to the insidious nature and wide spectrum of the disease. The available several classification criteria emphasize glandular findings. We aimed to analyze the efficiency of various classification criteria sets in patients diagnosed on the clinical basis by expert opinion and to compare those pSS patients who fulfilled these criteria with those who did not. This is a multicenter study in which 834 patients from 22 university-based rheumatology clinics are included. Diagnosis of pSS was made on the clinical basis by the expert opinion. In this study, we only interviewed patients once and collected available data from the medical records. The European criteria, American-European Consensus Group (AECG) and American College of Rheumatology (ACR) Sjogren's criteria were applied. Majority of the patients were women (F/M was 20/1). The median duration from the first pSS-related symptom to diagnosis was significantly shorter in men (2.5 ± 2.3 vs 4.3 ± 5.9 years) (p = 0 < 0.016). When the European, AECG and ACR Sjogren's criteria were applied, 666 patients (79.9%) satisfied at least one of them. In total, 539 patients (64.4%) satisfied the European, 439 (52.6%) satisfied the AECG, and 359 (43%) satisfied the ACR criteria. Among the entire group, 250 patients (29.9%) satisfied all and 168 (20.1%) met none of the criteria. The rates of extraglandular organ involvements were not different between patients who met at least one of the criteria sets and those who met none. There is an urgent need for the modification of the pSS criteria sets to prevent exclusion of patients with extraglandular involvements as the dominant clinical features.

Identification of multiple genetic susceptibility loci in Takayasu arteritis.

Takayasu arteritis is a rare inflammatory disease of large arteries. The etiology of Takayasu arteritis remains poorly understood, but genetic contribution to the disease pathogenesis is supported by the genetic association with HLA-B*52. We genotyped ~200,000 genetic variants in two ethnically divergent Takayasu arteritis cohorts from Turkey and North America by using a custom-designed genotyping platform (Immunochip). Additional genetic variants and the classical HLA alleles were imputed and analyzed. We identified and confirmed two independent susceptibility loci within the HLA region (r(2) < 0.2): HLA-B/MICA (rs12524487, OR = 3.29, p = 5.57 × 10(-16)) and HLA-DQB1/HLA-DRB1 (rs113452171, OR = 2.34, p = 3.74 × 10(-9); and rs189754752, OR = 2.47, p = 4.22 × 10(-9)). In addition, we identified and confirmed a genetic association between Takayasu arteritis and the FCGR2A/FCGR3A locus on chromosome 1 (rs10919543, OR = 1.81, p = 5.89 × 10(-12)). The risk allele in this locus results in increased mRNA expression of FCGR2A. We also established the genetic association between IL12B and Takayasu arteritis (rs56167332, OR = 1.54, p = 2.18 × 10(-8)).

Takayasu's arteritis is associated with HLA-B*52, but not with HLA-B*51, in Turkey.

INTRODUCTION: HLA-B*51 and HLA-B*52 are two close human leukocyte antigen (HLA) allele groups with minor amino acid differences. However, they are associated with two different vasculitides (HLA-B*51 in Behçet's disease and HLA-B*52 in Takayasu's arteritis (TAK)) and with major clinical and immunological differences. In this study, we aimed to screen a large cohort of TAK patients from Turkey for the presence of HLA-B*51 and HLA-B*52 as susceptibility and severity factors. METHODS: TAK patients (n = 330) followed at a total of 15 centers were included in the study. The mean age of the patients was 37.8 years, and 86% were women. DNA samples from the patients and healthy controls (HC; n = 210) were isolated, and the presence of HLA-B*51 or HLA-B*52 was screened for by using PCR with sequence-specific primers. RESULTS: We found a significant association of HLA-B*52 with TAK (20.9% vs HC = 6.7%, P = 0.000, OR = 3.7, 95% CI = 2.02 to 6.77). The distribution of HLA-B*51 did not differ between TAK patients and HCs (22.7% vs 24.8%, OR = 0.9, 95% CI = 0.60 to 1.34). The presence of HLA-B*52 decreased in late-onset patients (> 40 years of age; 12.0%, P = 0.024, OR = 0.43, 95% CI = 0.20 to 0.91). Patients with angiographic type I disease with limited aortic involvement also had a lower presence of HLA-B*52 compared to those with all other disease subtypes (13.1% vs 26%, P = 0.005, OR = 0.43, 95% CI = 0.23 to 0.78). CONCLUSIONS: In this study, the previously reported association of TAK with HLA-B*52 in other populations was confirmed in patients from Turkey. The functional relevance of HLA-B*52 in TAK pathogenesis needs to be explored further.

PDCD1 polymorphisms are not associated with Takayasu's arteritis in Turkey.

OBJECTIVES: Takayasu's arteritis (TA) is a chronic arterial inflammation of unknown etiology involving mainly the aorta and its major branches. Based on the associations of programmed death-1 (PD-1) protein encoding gene (PDCD1) with connective tissue diseases and vasculitides, PDCD1 polymorphisms are studied for susceptibility to TA in this study. METHODS: The study group is made up of TA patients (n=229) fulfilling the 1990 ACR classification criteria and compared to 193 healthy controls (HC). PD-1.3, PD-1.5 and PD-1.6 single nucleotide polymorphisms of PDCD1 gene are genotyped by polymerase chain reaction and restriction analysis (PCR-RFLP). RESULTS: The distribution of PD-1.5 polymorphism in TA patients and HC revealed a similar presence of TT genotype in patients and controls (13.3% vs. 11.4%). PD-1.3 and PD-1.6 were less polymorphic and did not differ between the groups. Rare AA genotype of PD-1.3 (1.4% vs. 1.0%) and AG genotype of PD-1.6 was again similarly (22.4% vs. 19.2%) present in TA and HC. CONCLUSIONS: PD-1.3, 1.5 and 1.6 polymorphisms of PDCD1 gene, which were shown to be associated with various autoimmune disorders and vasculitides, are not associated with a susceptibility to TA in Turkish population.

The efficacy and safety of etanercept in patients with rheumatoid arthritis and spondyloarthropathy on hemodialysis.

We aimed to evaluate the efficacy and safety of long-term use of etanercept therapy in patients with spondyloarthropathy (SpA) and rheumatoid arthritis (RA) on hemodialysis (HD). Selected RA or SpA patients treated with etanercept under HD were retrospectively evaluated. Etanercept-related adverse events were closely recorded for all patients. At the follow-up, erythrocyte sedimentation rate and C-reactive protein levels were monitored. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for SpA patients and Disease Activity Score (DAS28) for RA patients were measured at every 3 or 6 months. In total five end-stage renal disease (ESRD) patients were enrolled to the study. The causes of ESRD in the study subjects were amyloidosis (n = 2), analgesic nephropathy (n = 2), and nephrolithiasis (n = 1). Three were diagnosed as SpA and two were RA. All patients used etanercept. The median age was 39 years (range 22-72 years). The median disease duration was 12 years (range 2-20 years). The median follow-up after etanercept therapy was 18 months (range 5-33 months). DAS28 score decreased after the treatment and did not increase during follow-up in RA patients. BASDAI score decreased after the treatment during follow-up in three patients with SpA. At the follow-up, only one patient was diagnosed with septic arthritis. As a result of our study, etanercept treatment in RA and SpA patients on HD seems to be safe, well tolerated, and effective in most of the patients. Above all, due to impaired host defense in patients with ESRD, enhanced risk of infections should be kept in mind during follow-up period and larger trials are needed to prove the safety of etanercept in HD patients.

Comparison of the four formulas of adjusting QT interval for the heart rate in the middle-aged healthy Turkish men.

OBJECTIVE: The aim of this study was to evaluate the QT intervals at different rest heart rates in healthy middle-aged Turkish men and to compare the known four QT adjusting methods for heart rate. METHODS AND RESULTS: The QT intervals were measured in electrocardiograms of 210 healthy men (mean age = 35-60 years). A curve relating QT intervals and heart rates from 45 to 135 beats/min was constructed for study population. Based on the formula of Bazett, Fridericia, and Framingham, adjusted QT intervals in these range of heart rates were separately estimated. An adjusting nomogram for different heart rates was created using a reference value, which was the measured QT interval at heart rate of 60 beats/min (QT(No) = QT + correcting number). These four QT correction methods were compared with each other. The reference value of QT interval at heart rate of 60 beats/min was 382 ms. The relationship between QT and RR interval was linear (r = 0.66, P < 0.001). Nomogram method corrected QT interval most accurately for all the heart rates compared with other three adjusting methods. At heart rates of 60-100 beats/min, the equation of linear regression was QT = 237 + 0.158 x RR (P < 0.001). Bazett's formula gave the poorest results at all the heart rates. The formulas of Fridericia and Framingham were superior to Bazett's formula; however, they overestimated QT interval at heart rate of 60-110 beats/min (P < 0.01). At lower rates (<60 beats/min), all methods except nomogram method, underestimated QT interval (P = 0.03). CONCLUSION: Among four QT correction formulas, the nomogram method provides the most accurately adjusted values of QT interval for all the heart rates in healthy men. Bazett's formula fails to adjust the QT interval for all the heart rates.

Manometric assessment of esophageal motility in patients with primary Sjögren's syndrome.

OBJECTIVE: The aim of this study was to assess the esophageal motility by manometry in patients with primary Sjögren's syndrome. METHODS: Esophageal manometry was carried out in 40 patients with primary Sjögren's syndrome (SS), 15 with rheumatoid arthritis (RA), 15 with RA and secondary SS, and 21 healthy volunteers. RESULTS: We found that the mean lower esophageal sphincter (LES) pressures measured by station pull-through and rapid pull-through techniques were significantly higher in primary SS patients than with healthy controls and RA patients with or without SS (P<0.05). Our study did not show any major differences when comparing the three patient groups (P>0.05). However, peristaltic contraction velocity was lower and peristaltic contraction duration significantly higher at the middle and lower thirds of the esophagus in primary SS patients than in healthy controls (P<0.05). CONCLUSION: The results of our study support the view that various esophageal motility disorders can be found in patients with primary SS which could be related to an increase in LES pressure. We also found no correlation of the esophageal abnormalities with other factors studied, suggesting that the cause of dysphagia is multifactorial in nature.

[Comparison of electrocardiographic abnormalities in patients with ischemic and hemorrhagic stroke]. / Iskemik ve Hemorajik Inmeli Hastalarda Elektrokardiyografik Anormalliklerin Karsilastirilmasi.

OBJECTIVE: The aim of this study was to compare the electrocardiographic (ECG) abnormalities in patients with acute ischemic and hemorrhagic stroke who had no history of heart disease. METHODS: During 12 months, 222 consecutive stroke patients were enrolled in this study. Of them 162 had ischemic stroke and 60 had hemorrhagic stroke. Frequency of arrhythmias and ECG changes were compared between two stroke groups. Electrocardiographic abnormalities included ischemia-like changes (ST-segment depression or elevation, abnormal T and U waves), QTc prolongation and arrhythmias. RESULTS: Ischemic stroke patients were elder than hemorrhagic ones (64+/-14 years vs. 57+/-13 years, p=0.003). Other clinical characteristics were comparable in both groups. Ischemia-like ECG changes were found in 65% of ischemic stroke patients while they were observed in 57% of hemorrhagic stroke patients (p=0.33). Atrial fibrillation was more frequent in ischemic stroke than in hemorrhagic stroke (34% vs. 13%, p=0.01) patients. Individually, other ECG abnormalities were not different in both groups. With relation of ECG abnormalities to location of the brain lesion, there was a trend in favor of involvement of the temporal, frontal and parietal lobes. CONCLUSION: Regardless stroke-related lesion, ECG abnormalities can be seen frequently in stroke patients without primary heart disease. They can lead to diagnostic and therapeutic difficulties for cardiologists and neurologists.

Is female predominance in irritable bowel syndrome related to fibromyalgia?

Irritable bowel syndrome (IBS) and fibromyalgia (FM) are common functional diseases in adult women. The aim of this study was to investigate whether female predominance in IBS is related to FM. Fifty patients with IBS and 50 healthy controls were enrolled. All participants answered questionnaires including personal and medical history. In addition, psychiatric interviews were conducted. Patients were divided into two groups according to the coexistence of FM ( IBS+FM or IBS only). The data obtained from patients with or without FM and the control group were compared. There was a significant female predominance in patients with IBS+FM (83.4%, F:M=5:1), but IBS-only patients consisted mainly of males (59.4%, F:M=2:3) ( P<0.01). Comparison of IBS+FM and IBS-only patients showed no significant difference in depression and anxiety status. However, both anxiety and depression scores were found to be higher in female IBS patients than their male counterparts ( P<0.01 and P<0.05, respectively). Our findings suggest that the female predominance in IBS patients may result from coexisting FM.

Does fibromyalgia affect the outcomes of local steroid treatment in patients with carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) and fibromyalgia (FM) are common diseases in adult women. The aim of this study was to investigate the effect of FM on the outcome of local steroid treatment in patients with CTS. Forty-eight female patients with CTS and 26 female patients with CTS who also met the 1990 American College of Rheumatology (ACR) criteria for FM were enrolled the study. All patients underwent single steroid injections into the carpal tunnel. Response to injection was measured using Boston Questionnaire (BQ) and electrophysiological tests. The BQ scores and electrophysiological findings showed significant improvement 3 months after the treatment in both groups ( P<0.001). However, less improvement in BQ symptom severity scores was observed in the FM group than the other group ( P<0.05). Bilateral CTS was also more common in the FM group ( P<0.05). The present data suggest that FM must be kept in mind in patients with CTS giving poor response to local steroid treatment.