Impaired perception of cardiovascular risk and health literacy in individuals with high cardiovascular diseases risk from different socioeconomic levels in Antalya, Turkey.

BACKGROUND: This study aimed to determine how the frequency of impaired perception of cardiovascular disease (CVD) risk is correlated with health literacy in individuals with high CVD risk in two regions with different socioeconomic levels. METHODS: A descriptive study was conducted. The Systematic Coronary Risk Estimation, recommended by the European and Turkish Cardiology Societies, provides recommendations based on individuals' actual CVD risk levels. According to the Systematic Coronary Risk Estimation, participants suffering from diseases were identified as high and very high risk. The perception of risk was determined by subjectively assessing the risk level of the individuals. The European Health Literacy Survey Questionnaire was used. The Mann-Whitney U test, Chi-squared test and Spearman's correlation analysis were used to analyse the data. We also conducted a logistic regression analysis to identify factors contributing to impaired perception of CVD risk. RESULTS: A total of 384 individuals, aged between 40 and 70years (with a mean age of 58.35±8.33years), were included in the study. These individuals had a high risk of CVD and were registered to family health centres from two different socioeconomic levels. Out of the 384 participants, 201 individuals belonged to the lower socioeconomic level region and 183 individuals belonged to the higher socioeconomic level region. A total of 61.7% of the participants with high CVD risk had an impaired perception of CVD risk. The health literacy level of 59.9% of individuals was either inadequate or problematic. The health literacy score of participants with impaired risk perception (29.59±9.07) was lower than those with correct risk perception (35.83±10.94; P <0.001). Factors that affected the perception of CVD risk included age, education level, working status, occupation, a family history of CVD, the CVD risk assessment by health professionals and the recommendation of health professionals to individuals for CVD screening. CONCLUSIONS: It is necessary for health care professionals to make risk assessments and perform interventions to improve health literacy to raise the awareness of individuals with high CVD risk on their actual risk.

Effects of the Omaha System- and HeartScore®-Based Impaired-Risk Perception Reduction Program on the Risk Perception of Individuals Aged 50-65 Years: A One-Group Pre-Test-Post-Test Study.

PURPOSE: This study evaluates the impact of interventions in the Omaha System and HeartScore®-based program to reduce impaired-risk perception. DESIGN: and setting: This study utilized a one-group pre-test-post-test design. SUBJECTS: The program was conducted among participants aged over 50 years from different social settings. INTERVENTION: The program had three parts: a briefing on HeartScore® recommendations, Omaha System interventions, and referral to a doctor. MEASURES: HeartScore® determined cardiovascular disease (CVD) risk, body mass index (BMI) was calculated from height and weight, and the International PA Questionnaire evaluated physical activity (PA) levels. Self-assessment was used to perceived CVD risk, BMI, and PA. ANALYSIS: We used the Wilcoxon signed-rank test to compare the pre-test and post-test scores of the Omaha System, the problem rating scale (PRS) subscales and McNemar test to measure changes in CVD risk perception, BMI, and PA level. RESULTS: 310 high-risk individuals out of 522 had impaired perception of their CVD risk. Only 201 responded to follow-up phone calls. Interventions based on HeartScore® and Omaha System improved CVD risk and PA perceptions (P < .001) but not BMI. The program significantly increased knowledge, status, and behavior scores (P < .001). After participating, 39% saw a cardiologist, and 57.2% saw a family physician within six months to reduce impaired risk perception. CVD risk perception increased to the actual level after the intervention, mostly in the group with low education level. CONCLUSIONS: The program using the Omaha System and HeartScore® can help middle-aged individuals better understand their risk of cardiovascular disease.

Development of family health nursing certificate program for Turkey: Delphi study.

BACKGROUND: There are 26,252 family medicine units and the same number of family health workers in Türkiye. However, the educational standards and professional identities of these employees differ from international definitions. OBJECTIVES: The aim of the study was to create a draft Family Health Nursing Certificate Program using the Delphi consensus technique. METHODS: The study was conducted both online and face to face from 15 March to 25 May 2022. The research encompassed academic nurses working in the field of family health nursing and family health workers working in family health centres in Türkiye. Two rounds of the Delphi survey were undertaken. The first was completed by 38 experts and the second by 35 experts. Definition, title, education level, duties, and responsibilities of the family health nurse, along with consensus regarding the necessary certification, screening, follow-up and practices among family health nurses, were evaluated for the draft Family Health Nursing Certificate Program. The criteria for consensus on Likert-type questions were a width value of 1.50 and a percentage agreement of 75 %. RESULTS: Consensus was reached at rates of 84.5 % and 62.2 % on the items in the first and second rounds, respectively, with rates of 89.2 % and 45 % on the Likert-type questions. At the end of the survey rounds, an 85.6 % consensus was reached on all topics and an 85.9 % consensus was reached on the Likert-type questions. CONCLUSIONS: The Family Health Nursing Certificate Program drafted by consensus can be used for nurses working in family health centers in Türkiye, to guide educational proficiency and standardization. It may also be used as a comprehensive guide in countries other than Türkiye.

Effectiveness of INOSEL program consisting of Integrative Nursing and Omaha System for older women feeling loneliness: a randomised controlled trial.

OBJECTIVES: To evaluate the effectiveness of an intervention combining Integrative Nursing and Omaha System on physical, mental, social, spiritual health of older women living with high level of loneliness. The second aim was to determine the effect of Omaha System interventions on knowledge, behaviour and status scores. METHODS: A randomised controlled trial was conducted with 69 older women feeling loneliness (INOSEL n = 36, control n = 33 groups). INOSEL group received group-based and person-centered intervention and control group received routine care. RESULTS: INOSEL and control groups showed an improvement in loneliness score. The decrease in loneliness score and level was higher in the INOSEL group. The physical activity, health status perception, social support, social inclusion, well-being, and spirituality scores increased in the INOSEL group. INOSEL group experienced an increase in the knowledge, behaviour and status. DISCUSSION: INOSEL program, a theoretical structure, reduced loneliness and positively affected women's health. IMPLICATIONS FOR PRACTICE: Health professionals can use this program based on Integrative Nursing and Omaha System in nursing caring. CLINICAL TRIAL REGISTRATION: NCT03695133.

Community-Dwelling Adults' Perceived Versus Actual Risk of Cardiovascular Disease, Body Mass Index, and Physical Activity Levels and Related Factors.

CONTEXT: The difference between actual and perceived risk levels shows distorted risk perception. Unrealistic perceptions of cardiovascular disease (CVD) risks and insufficient knowledge about CVD risk factors can not only hinder the adoption of a positive lifestyle change but also obstruct preventive efforts. OBJECTIVE: The aim of this study was to evaluate the concordance between perceived and actual risks, body mass index (BMI), and physical activity levels. DESIGN: This descriptive study included 522 community-dwelling adults in 2 different regions of Antalya/Turkey. The actual CVD risk level of the participants was determined using the "HeartScore program," actual body weight was determined according to BMI, and actual activity levels were found using the "International Physical Activity Questionnaire Short Form (IPAQ-SF)." The perceived risks were measured with the CVD Risk and Risk Factors Perception Determination Questionnaire. CVD Risk Factors Knowledge Level (CARRF-KL) Scale was used to calculate the participants' level of knowledge about the risk factors. RESULTS: There was no concordance between the participants' actual and perceived CVD risks. A below-average agreement was found between the participants' actual and perceived BMI levels. In terms of actual measurements, it was seen that slightly obese individuals have a realistic perception. There was a weak agreement between the actual and perceived physical activity levels of the adults. Knowledge about the CVD risk factors of adults does not affect the perception of CVD risk and BMI and physical activity. CONCLUSIONS: Adults have an optimistic risk perception regarding CVD risk, BMI, and physical activity levels. It may be beneficial to periodically assess actual risks to change skewed perceptions of CVD and risk factors. These findings will inform the development of tailored intervention strategies and policies for these adults.

The Effect of the Breast Cancer Risk Reduction Program on Women With High Breast Cancer Risk in Terms of Their Participation in Screening and Their Health Beliefs and Behavior: A Study Protocol for a Randomized Controlled Trial.

BACKGROUND: First-degree biological relatives of individuals with breast cancer have a higher risk of breast cancer. OBJECTIVE: The purpose of this study was to create a protocol for evaluating the effect of the Breast Cancer Risk Reduction Program (BrCaRRP) on the participation of women at risk in screening and on their health beliefs and risk reduction behaviors. METHODS: The research was planned as a single-site, single-blind randomized controlled experimental study with a parallel group. Participants will be assigned to intervention and control groups using the Stratified Permuted Block Randomization method. The BrCaRRP will be applied to the intervention group within the theoretical framework of the Health Belief Model and the Health Promotion Model. The BrCaRRP is a 12-week program that encompasses 6 meetings, the first being face-to-face and the others via phone. Multidisciplinary experts calculated the content validity index of BrCaRRP as being 0.954 (high); its weighted kappa statistic is 0.70 (high). RESULTS: The difference in the likelihood of participation in breast cancer screening between the BrCaRRP and control groups will be evaluated after the interventions. Findings will be presented in terms of our hypotheses. CONCLUSIONS: The BrCaRRP is a nurse-led program based on the Health Belief Model and the Health Promotion Model. The BrCaRRP has high content validity and interrater reliability. IMPLICATIONS FOR PRACTICE: This protocol can be tested as an intervention in a randomized controlled study.

Effects of Transitional Care Model-Based Interventions for Stroke Patients and Caregivers on Caregivers' Competence and Patient Outcomes: Randomized Controlled Trial.

This study evaluated the effectiveness of the Transitional Care Model Stroke Turkey for stroke patients and caregivers as regards the competence of caregivers and patient outcomes. It is a parallel-group, assessor-blinded monocenter conducted with 126 participants in total (66 intervention included 33 stroke patients and 33 caregivers; 60 control groups included 30 stroke patients and 30 caregivers), between March and August 2018. The Transitional Care Model Stroke Turkey program lasts for 13 to 20 weeks. It includes a 12-week follow-up after discharge, a minimum of three hospital visits, one home visit, minimum 18 phone calls, and Web-based training. The intervention group exhibited better caregiver competence (13.48 ± 2.31), preparation for care (28.48 ± 4.74), and e-health literacy (34.42 ± 4.74) than the control group (respectively, 11.37 ± 2.48, 20.93 ± 7.10, 26.93 ± 8.53) ( P < .001). Emotional exhaustion and depersonalization increased in the control group, but remained the same in the intervention group. Personal accomplishment decreased in the intervention group, unlike in the control group. Within 12 weeks of discharge, five patients from the intervention group and seven patients from the control group were rehospitalized. There was no statistical difference between stroke patients in either group in terms of having previously used home healthcare services. The Transitional Care Model Stroke Turkey is a practical model for stroke patients transitioning from hospital to home.

The Healthcare Environment Survey: A multicountry psychometric evaluation of nurses' job satisfaction.

AIM: To evaluate the properties of a reduced-item Healthcare Environment Survey measuring nurses' job satisfaction across eight countries. BACKGROUND: There is currently no rigorously tested international measure of nurses' job satisfaction that can be used internationally to improve the nurse work environment. METHODS: Nursing staff from 11 hospitals in eight countries participated in this study. The original 57-item, 11-facet Healthcare Environment Survey was evaluated for reliability, validity, and measurement invariance: Cronbach's alpha was used to test for reliability; construct, discriminate, and convergent testing were used to test validity; and invariance testing including configural, metric, and scalar tests were used to study measurement invariance between the countries. RESULTS: 2,046 nursing staff completed the survey. Reliability was established for all six subscales and the combined composite score. Both validity and measurement invariance were supported in every test conducted. An excellent model fit was found for the final 19-item, 6-facet Healthcare Environment Survey that explained 82% of the variance of nurses' job satisfaction. CONCLUSIONS: Findings suggest the instrument is an efficient measure of nurses' job satisfaction across multiple countries. Longitudinal testing for invariance will be needed to ensure the model remains a good fit. Testing more countries will also verify model fit. IMPLICATIONS FOR NURSING: The instrument can be used to measure nurse job satisfaction globally. IMPLICATIONS FOR NURSING POLICY: The instrument can be used to assess interventions to improve the social (patient, unit manager, and coworker) and technical (professional rewards, autonomy, and professional growth) aspects of nurse job satisfaction.

Nursing students' experiences of health screening in rural areas of southern Turkey: a qualitative study.

INTRODUCTION: Individuals in rural areas live with healthcare disadvantages relating to, for example, access to health institutions, necessary treatments, and healthcare professionals during medical emergencies. The aim of this study was to explore the experiences, beliefs and attitudes of nursing students to identify advantages and disadvantages of health screening in several rural areas in rural Turkey. METHODS: Health screening practices with senior nursing students were conducted in six rural areas. A qualitative descriptive study was performed using thematic analysis of open-ended responses to a web-based survey of 34 students aged 18 years and over. This study was conducted in March and April 2020. RESULTS: The practices of nursing students in rural areas included measuring vital signs, body mass index calculation, blood glucose and cholesterol measurement, depression screening, cancer screening and health education. Students undertook various health screening practices in rural health care including colorectal cancer screening, evaluation of scales used in diabetes and depression risk. Characteristics referred to by student nurses as part of public health nursing roles were protector, advocate, supporter, caregiver, coordinator, collaborator, educator, counsellor, researcher, therapist, case manager, leader and care provider. The main themes generated related to student emotions, feedback of screening participants to nursing students, positive nursing characteristics, advantages and disadvantages of doing health screening in rural areas, benefits of working with health professionals to nursing student education, and feedback for nursing educators and researchers. CONCLUSION: Participants recognised their emotions, and the benefits and advantages of health screening practices, and disadvantages were determined across the themes. Health services should be planned by taking these experiences into account in health screenings to be carried out in rural areas.

Effect of Telehealth Interventions on Blood Pressure Control: A Meta-analysis.

The aim of this study was to find out the effects of telehealth interventions on blood pressure control by conducting a meta-analysis. Six databases were used. The literature review covered the period between December 1, 2020, and January 26, 2021. The meta-analysis was conducted by comprehensive Meta-Analysis Software version 2.2. Categorical variables were analyzed by odds ratios at a confidence interval of 95%. In data formatting and analysis, independent groups (sample size, P value); independent groups (mean, SD); Cohen's d, SE; and paired groups (N, P value) were used. The bias risk was assessed based on the Revised Cochrane Risk-of-Bias Tool for Randomized Trials. Total sample size including 22 studies was 11 120. It was determined that interventions performed through telehealth applications had a significant effect on blood pressure control (odds ratio = -0.14; 95% confidence interval = -0.20 to -0.08; P < .001). In telehealth applications, blood pressure values decreased more when the application was performed through a Web site (-0.31; 95% confidence interval = -0.49 to -0.13), duration of the intervention was 12 months or shorter (-0.18; 95% confidence interval = -0.28 to -0.010), stroke developed in case of hypertension (-0.31, 95% confidence interval = -0.76 to 0.12), and the study was conducted in the Far East countries (-0.24; 95% confidence interval = 0.40 to -0.07). Interventions with telehealth applications are effective in blood pressure management. PROSPERO ID: CRD42021228536.

The Profile of Caring: An Internationally Tested Model to Assess and Support Nurses During Pandemic.

The psychological impact of the COVID-19 pandemic on nurses, and subsequent increases in turnover, have been extensively documented. This article examines a profile of nurses which included (1) the degree to which direct-care nurses are caring for themselves, (2) the degree to which their manager acts in a caring way, (3) the degree to which nurses have clarity about their professional role and about how the system works, and (4) the degree to which nurses are satisfied with essential social and technical dimensions of their jobs, to help understand how some of the critical internal states and working relationships of nurses fit together as a model. To test the model, authors used structural equation modeling with a 35-item measurement tool in three countries (Russia, Serbia, and Turkey; n = 984), replicating a recent 8-country study. Results revealed a good model fit, similar to the original study, despite statistically significant differences in mean scores between the countries studied. Good model fit with a second group of countries, despite differences in mean scores, suggests that results from both studies can be used for a global conversation about how caring, clarity, and job satisfaction in nursing relate to one another. These results provide evidence that health facilities should study variables such as caring for self, caring by the unit or department manager, clarity of role and system, and job satisfaction to learn about, recover, and monitor nurses' health and experience of work as they emerge from the pandemic.

Determining the Organizational Cultural Competence of Hospitals Located in the Coastal Strip of the City of Antalya.

AIM: This study aimed to determine the organizational cultural competence of hospitals located in the coastal strip of Antalya city in Turkey. METHOD: The sample of this descriptive study included 31 hospitals. Data were collected with a questionnaire developed by the researchers under the guidance of 2 guides related to organizational cultural competency standards. The questionnaire included 3 sections and 47 questions and was answered by an authorized person to provide information on behalf of the hospital. RESULTS: Among the hospitals participating in the study, 61.3% were private hospitals, 67.7% had international patient departments, 96.8% had quality departments, and 29% reported that they had a budget allocated for providing culturally appropriate care. Most of the hospitals reported that they served multi-menu option to the patients (64.5%) and provided with interpreter assistance free of cost (90.3%). Most of the hospitals stated that they provided end-of-life care for patients who died in their hospitals according to the wishes of the family members (96.8%). CONCLUSION: Hospitals seek to adopt a culturally sensitive approach in healthcare services, but their cultural competence has scope for improvement, as they do not have strategic action plans or sufficient budgets yet.

Translation and Psychometric Testing of the Healthcare Environment Survey in Turkey.

AIM: This study aimed to translate and psychometrically test the Healthcare Environment Survey, describe the strengths and needs of job satisfaction for nurses in Turkey, and advance an international discussion across countries that used Healthcare Environment Survey. The Healthcare Environment Survey was the only instrument found that measured multiple facets of nurses' satisfaction in caring for patients. Healthcare Environment Survey has been psychometrically tested in Jamaica, Scotland, and the USA. METHOD: This study was a methodological design. A convenience sample of 400 nurses from 2 hospitals in Antalya, Turkey, was asked to complete the Healthcare Environment Survey. A total of 241 nurses (60.3%) responded to all 57 items. RESULTS: Factor analysis revealed all items loaded into 10 facets, with all factor loadings greater than 0.40, except 1 item regarding executive leadership. Kaiser-Meyer-Olkin measure of 0.91 revealed a good model fit. The Healthcare Environment Survey explained 75% of the variance in nurse job satisfaction. The Cronbach alpha coefficient for the 10 facets ranged from 0.83-0.90. A comparison of these results with the other 3 countries that used the Healthcare Environment Survey revealed that caring for patients had a high factor loading in Turkey, Scotland, and the USA but a low one in Jamaica. CONCLUSION: The Healthcare Environment Survey -Turkish form was found to be a valid and reliable tool, which could be used by nurse managers to evaluate satisfied and unsatisfied areas. It provides new opportunities for national/international benchmark, cooperation, and research with others.

Effect of Transitional Care Model-Based Interventions for Patients with Stroke and Their Caregivers on Increasing Caregiver Competence and Patient Outcomes: A Study Protocol for a Randomized Controlled Trial.

AIM: This is a study protocol designed to evaluate the effect of transitional care model based interventions for patients with stroke and their caregivers on the caregivers' perceived competency, their preparedness for caregiving, increasing their electronic health literacy, reducing burnout, the rate of patients' hospital readmissions, and the frequency of pressure injuries. METHOD: The study protocol was planned as a randomized controlled trial with parallel arms. The study will include 70 patients with stroke and their caregivers. Multiple interventions (TEMpEST-Transitional Care Model Stroke Turkey), including at least 3 face-to-face interviews at the hospital, distance education via web, and telephone communications for 3 months, and 1 home visit within 7 days of discharge will be applied to the study group. The control arm will receive routine care. RESULTS: Findings will give after then when completed the study protocol. CONCLUSION: This study will evaluate the feasibility of interventions TEMpEST and its effect on patients with stroke and their caregivers. TRIAL REGISTRATION: The trial was registered with the ClinicalTrials.gov protocol registration and results system (PRS) (ClinicalTrials.gov reference NCT03708835).

Assessment of the Transitional Care Model-Based TEMpEST Program by Caregivers of Stroke Patients: A Qualitative Study.

With advancing technology, patients with stroke often survive the critical acute phase, but require supportive care by informal caregivers after discharge from the hospital. Little is known about the experiences of these caregivers during the immediate posthospital period. The purpose of this qualitative study was to explore the opinions and experiences of caregivers of stroke patients who were enrolled in the Transitional Care Model Stroke Turkey (TEMpEST) discharge planning program. Individual interviews were conducted with 23 caregivers of stroke patients about their experiences with the TEMpEST discharge program. Seven subthemes were identified: trust, information, morale, satisfaction, care and concern, follow-up, and continuity. The effectiveness of the program can be assessed by applying the TEMpEST program to different patient groups and conducting in-depth interviews with both patients and their caregivers.

Integrative Nursing and Omaha System-Based Nursing Care Interventions in Older Women Feeling Loneliness (INOSEL): Study Protocol for a Randomized Controlled Trial.

PURPOSE: This article presents the planned protocol for a study that investigates the effects of nursing care interventions based on Integrative Nursing (IN) and the Omaha System. The Omaha System is a nursing classification system focused on holistic care and used in determining nursing diagnoses and applying and evaluating interventions. DESIGN: This study protocol describes a randomized controlled trial with a parallel group design. METHOD: Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Statement 2013 checklist is used in this study. The CONSORT (Consolidated Standards of Reporting Trials) flowchart is used in this protocol. After the level of loneliness of older women is determined by the Loneliness Scale for the Elderly in a family health center, women with high levels of loneliness will be randomly assigned to the intervention and control groups. Nursing care interventions consist of group-based (sightseeing, picnics, theater, cinema, group education, and charity activities) and person-centered interventions, according to IN and the Omaha System, for 12 weeks. CONCLUSIONS: This protocol will test the effectiveness of nursing care interventions that include a comprehensive (physical, psychological, social, and spiritual) evaluation. The results will help contribute to the provision of care in terms of IN and the Omaha System and guide health professionals and researchers.

The effect of lifestyle physical activity in reducing cardiovascular disease risk factors (blood pressure and cholesterol) in women: A systematic review.

Cardiovascular diseases (CVD) are the most important cause of death in older women. Although there is strong evidence in the literature that moderate lifestyle physical activity (PA) is effective in modifiable CVD risk factors, there is limited evidence demonstrating which activities are effective in women. This systematic review was conducted to evaluate the effect of lifestyle PA interventions on CVD risk factors in women. Various databases were searched for English articles from 2000 to 2019. Eight articles met the selection criteria. It is recommended to use different combinations of interventions including moderate PA, to reduce CVD risk factors in women.

Effectiveness of a nurse-led physical activity intervention to decrease cardiovascular disease risk in middle-aged adults: A pilot randomized controlled study.

The purpose of this study was to evaluate the effectiveness of the nurse-led physical activity (PA) intervention on cardiovascular disease (CVD) risk reduction in individuals with moderate risk. A randomized controlled pilot trial was conducted with 12 individuals who have moderate cardiovascular risk meeting the inclusion criteria. Eleven individuals in the intervention group participated in a 12-week PA program (outdoor group walking with the group 5 days in a week, each lasting for 40 minutes) guided by a nurse. For determining the risk level of CVD, the "HeartScore program" was used. Height, weight, blood pressure, and cholesterol values of individuals in the intervention group were measured. At the end of nurse-led outdoor walking activity with the group for 12 weeks, systolic blood pressure (P = .041) and cholesterol (P = .001) values of individuals in the intervention group decreased based on the baseline levels and accordingly CVD risk levels decreased significantly (P = .019). There was no significant difference in the control group. This study demonstrates that health care professionals working in the family health centers can easily determine the CVD risk with the HeartScore. Outdoor group walking program guided by a nurse is effective in decreasing the CVD risk level.

Cardiovascular disease risk in Turkish family health centers.

Cardiovascular diseases (CVDs) are the leading cause of death both worldwide and in Turkey. The risk of CVD increases among those who are middle aged and among people with certain sociodemographic factors related to that risk. The objective of this study was to determine the prevalence of the risk of CVD and assess the factors related to this risk among adults aged 40-65 years. The study consisted of 327 individuals (208 [63.6%] women and 119 [36.4%] men) from a family health center (FHC) in Antalya, Turkey, who volunteered to participate in the study. The average age of the patients was 52.7 years. This cross-sectional study was conducted between April and September of 2016. The risk levels of the participants were calculated using the HeartScore program in 4 categories (low, moderate, high, and very high risk). In addition, sociodemographic and medical data were collected from the participants, as well. It was found that 3.4% of the patients were at a very high risk, 8% were at a high risk, 22% were at a moderate risk, and 66.7% were at a low risk of CVD. Major variables increasing this risk included diastolic hypertension by 7.49 (3.77-14.88) times. The individuals who completed secondary and high school had 2.44 times greater risk compared with those who completed primary school and lower education; moreover, those who completed university and higher education had the 2.24 times greater risk. Cardiovascular risk screening is important for apparently healthy individuals. The HeartScore program is practical for nurses and other health care professionals in FHCs to estimate individuals' risk of CVD.

Is home parenteral nutrition safe for cancer patients? Positive effects and potential catheter-related complications: A systematic review.

PURPOSE: Total Parenteral Nutrition began to be applied frequently in the houses of patients starting from the 1990s and is stated in literature as Home Parenteral Nutrition (HPN). The purpose of this review is to answer the question of whether or not HPN is safe for cancer patients. METHODS: Searches were conducted in Cochrane, CINAHL, PubMed, Springer, Google Scholar, and the Web of Science databases. RESULTS: The 1,949 articles were accessed in the total, and 20 articles have been included in the review. In the studies being evaluated, it can be determined that HPN has influenced the quality of life, performance status, and the nutrition level of cancer patients positively. Most frequently seen complications were infections relating to the catheter, the mechanical obstruction in the catheter and venous thrombosis. For each 1,000 days with HPN or a catheter, infections in the interval of 0.05 and 3.08, mechanical problems in the interval of 0.07 and 2.13, and thrombosis in the interval of 0.05 and 0.20 were determined. CONCLUSIONS: While HPN influenced quality of life, nutrition, and the personal performance of cancer patients positively, the rate of complications is at a level that can be managed at home.