Approaches and awareness of family physicians on diabetes management during Ramadan.

AIM: This study aimed to determine the approaches of family physicians in Turkey towards the fasting of diabetic patients and whether they used international treatment guidelines when making recommendations. In addition, this study also aimed to increase the awareness of family physicians about this issue before Ramadan, which is a month of fasting. MATERIAL AND METHOD: The study herein comprised cross-sectional, observational research. Before Ramadan 2018, a structured questionnaire form, which was unique to this study, was prepared based on the guidelines of the International Diabetes Federation (IDF) and the American Diabetes Association (ADA), through platforms where family physicians gather via social media and mail groups, and sent to family physicians in Turkey via a link using an electronic questionnaire preparation and application programme. Moreover, the total knowledge level, attitude, and approach scores were calculated from the questions prepared from the relevant guidelines. RESULTS: Participating in the survey were 262 family physicians. Only 22% of the family physicians stated that they were aware of the international guidelines for Ramadan and diabetes management, and only 10% said that they had read them. The mean knowledge level, attitude, and approach scores were determined to be lower than expected, and a significant difference was found between the scores and academic titles. CONCLUSION: The lack of international guidelines on the subject, and of knowledge and experience about Diabetes Mellitus (DM) patient management during the month of fasting, stood out as the biggest problems. This study revealed that the awareness and competence of family physicians in disease management should be increased, in addition to that of fasting before, during, and after Ramadan in patients with DM, which has increasing prevalence in Turkey.

Is there a relationship between breastfeeding status and life style changes, eating behaviors, attitudes, and orthorexia nervosa tendencies of mothers? A web-based study.

AIMS: It was aimed to compare the breastfeeding status and healthy life style changes, eating behaviors, attitudes, and orthorectic tendencies of mothers. METHODS: All volunteered mothers who have a child between the ages of 0 and 2 were included in this cross-sectional study. Five hundred fourteen individuals were included. Five parted questionnaire and "ORTO-11" test and "Eating Attitude Test" were used. RESULTS: A statistically significant relationship was found between breastfeeding status and working status and professions of mothers. Mothers who did not breastfeed, skipped main meal more frequently, and smoking and occasional alcohol consumption was higher. The mean score of the participants on the ORTO-11 scale was 25.09 ± 4.80, EAT-40 scale mean score was 18.80 ± 10.42. High-risk in eating attitudes was found in 12.0% of all participants. It was observed that mothers who did not breastfeed were mostly in high-risk group in terms of eating attitude. CONCLUSION: Mothers who did not breastfeed were mostly in high-risk group in terms of eating attitude compared with breastfeeding mothers. It is of great importance that healthcare professionals organize trainings for increasing the general level of knowledge of mothers and provide healthy living and breastfeeding counseling.

Thiol levels in mild or moderate COVID-19 patients: A comparison of variant and classic COVID-19 cases.

BACKGROUND: Various variants of the COVID-19 have started to attract attention recently. The clinical course of these variants and possible predictive parameters are being investigated. This study aimed to examine the relationship between thiol levels, which are indicators of oxidative stress, and variant COVID-19 types. METHODS: In this cross-sectional study, patients with a diagnosis of classic COVID-19 and patients with a diagnosis of variant COVID-19 with mild and moderate symptoms followed in the clinical observatory of Ankara city hospital were included in the study group. The patients were divided into two groups according to the COVID-19 type as a variant and classic COVID-19, and a healthy control group was added for comparison. A complete blood count and thiol analysis were performed from the venous blood samples. Obtained results were compared between groups, and the ROC analysis was performed. RESULTS: Thiol levels were significantly lower in patients with a diagnosis of COVID-19 compared with the control group. In terms of WBC, lymphocyte, neutrophil, NLR, ferritin and thiol parameters, patients with variant COVID-19 differed significantly from patients with a classic COVID-19 diagnosis. Thiol levels' cut-off values to distinguish between variant COVID-19 patients and control group from classical COVID-19 patients were almost identical (423 and 422 µmol/L, respectively). CONCLUSIONS: It seems possible to use thiol as a sensitive, specific and cost-effective marker to suspect variant COVID-19 cases. Since this study is probably the first example in this subject, it would form a basis for further studies.

Family planning practices and opinions on population growth of family planning healthcare providers in Turkey.

The purpose of this study was to investigate the opinions of health professionals (HPs) who provide family planning counselling (FPC) within the scope of primary health care services since they are perceived as role models by the society. The number of HPs providing family planning counselling in primary health services in Turkey was 43,000 and 40,000 of these individuals were invited to participate in this observational, cross-sectional study via e-mail and social media. There were 740 responders and all were included in the study. Physicians providing FPC within the scope of primary health care services consisted of 45.1% of the responders and the remaining were nurses. Among all HPs, 59.7% had insufficient awareness regarding Turkey's population growth. Most of the HPs (52.4%) believed that the ideal number of children was 2 or less. The abortion rate was 9.1% in all pregnancies of HPs. The rate of caesarean section was 56% in all live births. According to responses, 75.6% of all pregnancies experienced by HPs were planned. According to 42.1% of the HPs, abortion must be performed if there is a life-threatening situation for the mother or if the fetus has some abnormalities. The most common method of birth control used by married HPs between the ages of 18 and 49 was male condoms (39.9%), while the pull-out method ranked first in the general population (25.5%). It was found that HPs, who had different opinions and practices about family planning than the general population, had insufficient awareness regarding population growth. Increased awareness of demography and FPC among HPs will likely contribute to the quality of service and the general wellbeing of the population.

Can patients who apply to tertiary care with headache for the first time be managed in primary care? - a cross-sectional study

Background/aim: Headaches are one of the most common neurological symptoms. They adversely affect daily life, reduces the workforce, and have high health costs. Managing this symptom in primary care will free up secondary and tertiary health services to better treat patients who need follow-up by specialists. In the present study, we aim to show the rate at which this problem can be solved in primary care for patients who applied tertiary care services with a headache for the first time. Materials and methods: Our research is a cross-sectional study of 207 patients who applied to the neurology clinics for the first time with headache. Two questionnaires were prepared by the researchers. IBM SPSS v: 21.0 was used for statistical analysis, and the level of significance was p < 0.05. Results: The opinions of the patients on the evaluability of headache in primary care were compared. Family physicians and neurologists gave similar responses about the disease management, at a rate of 96.6%, this was found to be statistically significant and shows strong agreement. Both groups of physicians thought that 70% of patients, on average, who applied to the neurology clinics with headache for the first time could be managed in primary care. However, only 9.2% of the patients share this opinion with physicians. Primary headache cases constitute most of the cases that are thought to be solved in primary care. It was revealed that the number of patients seeking primary care with this complaint was lower than expected. Conclusion: Patients with headache applied tertiary care instead of primary care for different reasons. Both neurologists and family physicians stated that most patients evaluated in tertiary care could be managed in primary care.

The impact of circulating 25-hydroxyvitamin and oral cholecalciferol treatment on menstrual pain in dysmenorrheic patients.

This study aims to determine Vitamin-D level in patients with primary dysmenorrhea and investigate the effect of Vitamin-D replacement on symptoms. About 100 patients in the 18-30 age group followed-up with primary dysmenorrhea diagnosis were included in this observational study. The pain severity was assessed using the visual analog scale (VAS). 25-hydroxy vitamin D(25(OH)D) levels of the patients were measured and the replacement therapy was applied according to measurement results. The patients were followed for three months in total. At the end of the three-month period, the 25(OH)D level was measured and the VAS score was assessed once more after the therapy. 25(OH)D level was insufficient in 23.0%, deficient in 45.0%, and severely deficient in 32.0% of the patients. It was found that the VAS score increased as the 25(OH)D level decreased (r = -0.320; p = .002). A significant reduction was observed in VAS scores after Vitamin-D treatment in all three groups; the amount of reduction in VAS score was determined to be higher in the patients with severely deficient levels of 25(OH)D, compared to the patients with deficient or insufficient levels (p < .001). A significant and negative correlation was found between Vitamin-D and symptoms associated with dysmenorrhea in our study. The Vitamin-D replacement therapy led to a significant decrease in symptoms.

Relationship between socioeconomic level, and the prevalence of masked hypertension and asymptomatic organ damage.

BACKGROUND: This study aimed to determine the prevalence of masked hypertension (MHT) and its association with asymptomatic organ damage (AOD) in a low socioeconomic district of Ankara, Turkey. MATERIAL AND METHODS: We retrospectively reviewed data obtained from the medical records of 712 patients with no known diagnosis of hypertension who presented to a polyclinic due to symptoms related to elevated blood pressure (BP) and were screened for MHT. Essential hypertension (EHT) existed in 86 patients screened for AOD. The presence of AOD in patients diagnosed with MHT and EHT was recorded. RESULTS: Among the 712 patients, 206 were diagnosed with EHT. Among the remaining 506 patients, 73 were diagnosed with MHT. The patients with MHT had significantly higher left ventricular mass index, carotid intima-media thickness, and 24-h urinary microalbuminuria level (all indicators of AOD) than those with EHT. CONCLUSIONS: A significantly higher percentage of patients with MHT had AOD, as compared to those with EHT, in a low socioeconomic district of Ankara. Based on this finding, patients who present with hypertensive symptoms but have a normal BP should be advised to measure their BP at home.

Determinants of Smoking Cessation Outcomes and Reasons for Relapse in Patients Admitted to a Smoking Cessation Outpatient Clinic in Turkey.

The aim of this study was to identify the determinants of smoking cessation outcomes and reasons for relapse following smoking cessation treatment. Using a mixed-method design, 179 patients were recruited from the Smoking Cessation outpatient clinic of Ankara Numune Training and Research Hospital between May 2016 and May 2017. Quantitative data were collected via questionnaires or from patient files and qualitative data were obtained via 5 focus group interviews with 28 patients who relapsed to smoking following treatment. The success rate of the smoking cessation clinic at the end of one year was 26%. The number of applications to the clinic was significantly higher in the group who quit smoking. Treatment success was found to be higher in the group that applied behavioral recommendations. In focus group interviews with patients who relapsed, the most common causes were stressful events, especially workplace problems and serious health problems experienced by relatives. The presence of smokers in the immediate vicinity increased the risk of relapse. It was concluded that not stopping treatment before the recommended period, continuity in follow-up appointments, support of the environment, support of pharmacotherapy with cognitive behavioral therapy and improving patients' coping skills were important.

Why Turkish Parents Refuse Childhood Vaccination? A Qualitative Study.

BACKGROUND: Anti-vaccination is spreading among parents. In 2017, 23000 families in Turkey refused vaccinations for their children. Meanwhile an increase in infectious diseases was observed, which might be caused by vaccination rejection. The reasons why families do not vaccinate their children may be very different, such as side effects, or advocation for "healthy life" by gurus. However, the real reasons for vaccine refusal are unknown. Our aim is to determine the reasons for anti-vaccination in Turkey. METHODS: In order to reveal the real reasons for not taking the vaccine, we planned to conduct interviews with the representatives of the vaccine rejection group using qualitative research methodology with the "grounded theory" method. We searched some anti-vaccination blogs to find candidates for interviews. Within the scope of our study, parental concerns about vaccinations were classified by analyzing the data obtained from semi-structured questions and interviews recorded with voice recorders in face-to-face interviews with 21 parents in 13 cities of Turkey. RESULTS: The obtained findings were classified under the headings of ''mistrust'', ''vaccine efficacy-importance'', ''decision-making processes - bases'', and ''law-ethics''. Mistrust was the main theme, almost singularly, as the most important reason for vaccine rejection. The salient reasons for mistrusts were: Companies which produce vaccines especially international companies because of conspiratory beliefs; health authorities, because of the belief about non-transparency in epidemiologic data, immunization council etc. and healthcare professionals, because of their non-communicative and non-concerned attitude. CONCLUSION: Mistrust is hard to overcome. The beliefs of the patients cannot be easily changed. As a result of our study, we made some recommendations for health authorities, healthcare professionals, companies and other related stakeholders.

Impact of Individual, Familial and Parental Factors on Adolescent Smoking in Turkey.

The burden of adolescent cigarette smoking is substantial. We assess mothers' and fathers' attitudes and behaviours on adolescent smoking using a cross-sectional study of n = 707 adolescents. Associations between parental attitudes and behaviours in adolescent smoking were assessed using logistic regression separately for boys and girls. Occasional alcohol use by both parents increased odds of smoking once a day (OR = 2.44, 95% CI 1.26, 4.71, OR = 1.51, 95% CI 0.97, 2.35, respectively). Fathers smoking increased odds for girls (OR = 1.59, 95% CI 1.01, 2.52). A democratic mother decreased odds for boys (OR = 0.32, 95% CI 0.10, 0.93) whereas a protective, demanding mother increased the odds for girls (OR = 8.65, 95% CI 1.38, 54.22). Public health smoking prevention programs could support changing parental behaviours and attitudes in early years to address this burden in countries with authoritarian parenting styles.

Occupational Health and Disease Knowledge and Practices of Family Physicians.

OBJECTIVE: This study aims to evaluate the awareness and approaches of all family physicians from one province in Turkey regarding occupational diseases. METHODS: This study is a cross-sectional, descriptive study. A questionnaire was applied to family physicians between November 2018 and February 2019. The questionnaire investigates family physicians' knowledge, attitude, behavior, proficiency, and approaches to occupational diseases. RESULTS: Three hundred twenty four family physicians participated in our study. 59.3% had received training on occupational diseases and only 22.9% of these physicians indicated that this training was adequate. Physicians identified "lack of occupational anamnesis" as the most common reason behind the underreporting of occupational diseases, and "difficulties in identifying occupational diseases" as the second. CONCLUSIONS: Family physicians believe that they inadequately evaluate occupational diseases and find the occupational disease-related training to be insufficient.

Awareness of family physician residents of their roles in disaster health management: a cross-sectional study in Turkey.

AIM: Family physicians are role models for their societies in disaster management and have an important place in it. This study was carried out during the specialty training of the residents, who are currently family physicians fighting against COVID-19 in the field, and was aimed to identify the awareness levels of residents regarding the roles and duties of family physicians before, during, and after disasters and to increase their awareness of disaster medicine and management. BACKGROUND: The duties and responsibilities of a family physician in disasters should be a part of their specialty training. This study has contributed to the limited literature, increased awareness, and opened a new avenue of research for studies to be conducted with family physicians by demonstrating the current situation of family physicians in disaster management. METHODS: This is an observational and descriptive study. The knowledge, experience, opinions, willingness, attitudes of the residents, and the awareness levels of the residents regarding their roles and duties in a disaster were evaluated along with their sociodemographic information. The surveys were applied in the family medicine clinics of the all residents by the interview method (n = 233). FINDINGS: Only 9.2% of the residents stated that they had received training on disaster medicine where they currently work. The knowledge level of the residents on this subject was found as 'Unsure'. In total, 80% of the residents stated that family physicians should have a role in disasters. It was found that 83.3% of the residents had never joined a disaster drill, 94.3% had never participated in making or applying a disaster plan, and 97.7% had never worked in any disaster. CONCLUSION: The residents participating in the study lacked not only information on disaster management but also experience. The residents' willingness to receive training, work voluntarily, significantly question the curriculum, and specialize in disaster medicine were a positive outcome.

Factors Affecting the Behavior and Duration of Breastfeeding Among Physician Mothers.

BACKGROUND: Increasing breastfeeding duration may help physician mothers better counsel their patients. To improve the breastfeeding duration of physician mothers, the factors that may influence their breastfeeding duration should be known. RESEARCH AIM: To investigate the breastfeeding behavior and duration among physician mothers and to determine the factors that influence breastfeeding practices. METHODS: This was an online prospective cross-sectional self-report survey. A 26-item author-created data-collecting tool inquiring sociodemographic and work characteristics, medical history of delivery, and breastfeeding history was sent to female physicians who had infants between 12 and 60 months of age via an online social group, "Physician Mothers," with 11,632 members. Participants (N = 615) responded, and descriptive statistics were analyzed. RESULTS: Participants' mean duration of exclusive breastfeeding was 4.8 months (SD = 1.9). The total breastfeeding length was a mean 15.8 months (SD = 7.6). The rate of breastfeeding duration for at least 24 months was 17.8% (n = 75). The most common reason for weaning from breastfeeding was workplace-related conditions (23.6%, n = 145). Participants reported that the mean time of resuming night shifts after delivery was 8.6 months (SD = 4.7). The rate of participants who were unable to use their breastfeeding leave rights partially or completely was 43.6% (n = 268). CONCLUSION: Although legislation is in place to allow working mothers to breastfeed their infants, these legal rights were not used properly. Physician mothers should be fully supported in using their breastfeeding leave rights, and workplace conditions should be improved to enable physician mothers to breastfeed their infants for extended periods.

Clinical, sociodemographic and tobacco-use factors associated with smoking cessation rates at three years follow-up, Ankara, Turkey.

INTRODUCTION: Smoking is a well-known major cause of early preventable mortality and morbidity. Maintenance of smoke-free status is important after a smoking cessation attempt. The present study aims to compare the sociodemographic and clinical characteristics of subjects participating in a smoking-cessation program, according to the duration of smoking cessation. METHODS: A study was conducted in 261 smokers who had attended a smoking cessation clinic in a tertiary hospital, in Ankara, Turkey. The smoking status of the subjects at three years follow-up after participating in the smoking-cessation program was assessed. Sociodemographic, employment, environmental, smoking-related, health and clinical characteristics of subjects were compared according to the smoking cessation duration. RESULTS: Marital status, having a child, absence of household smoking and lower levels of nicotine dependence were significantly higher in quitters, and anxiety was lower. Parameters that significantly differed between subjects that were and were not abstinent for >36 months were marital status (p<0.001), childbearing status (p=0.007), household smoking (p<0.001), age of smoking initiation (p=0.02), psychiatric illness history (p=0.01), and number of follow-up visits (p<0.001). The number of follow-up visits at the smoking cessation clinic was an important factor of quitting and maintenance of quit status. CONCLUSIONS: Family and home environment as well as smoking-related and mental health characteristics influenced maintenance of long-term smoking cessation. Characteristics such as sociodemographic, clinical and smoking-related conditions should be considered in smoking cessation interventions. Personalized treatment strategies and follow-up visits at the smoking cessation clinic should be planned for maintenance of smoking cessation.

Exploring guideline adaptation strategy for Turkey: Is "ADAPTE" feasible or does it need adaptation as well?

RATIONALE, AIMS, OBJECTIVES: Clinical Practice Guidelines are mostly developed by 3 methods; namely, de novo, adoption, and adaptation. Nonpublished studies and authors experience shows that most guidelines in Turkey are either by adoption or by adaptation. There is no available local tool for adaptation, so the process is not standardized and most of the time not explicitly defined. The objective of this study is to search for international guideline adaptation tools and test their feasibility in Turkish context, to serve a final goal of developing a unique local strategic tool for guideline adaptation. METHODS: The methodological design of this study includes selection of an international tool for Clinical Practice Guideline adaptation, piloting this tool with selected Turkish guidelines, identifying the feasibility of this tool and exploring the needs for adaptation of the tool, drawing recommendations for adaptation of the strategies, and validation of the process by local experts. RESULTS: The study from planning phase to finalizing the guidance, including pilot studies and panel but excluding translation of ADAPTE, lasted 18 months. Nine researchers were involved in the adaptation process and 15 more experts were involved in the validation panel. Following the suggestions of the research team on modifications and validation through the expert panel; 2 steps of the ADAPTE toolkit were rejected, 2 steps were accepted by modification, 7 steps were accepted by additional recommendations. In addition, 2 tools were suggested to be added to the toolkit. CONCLUSION: This is the first study on adaptation of guidelines in Turkey. Pilot adaptation of 2 guidelines with ADAPTE revealed that ADAPTE is a useful and feasible tool in Turkish setting, but might require certain changes in recommendations and revision of tools.

Relation between serum calcium, phosphate, parathyroid hormone and 'nondipper' circadian blood pressure variability profile in patients with normal renal function.

BACKGROUND AND AIMS: In patients with renal disease, an association between abnormal circadian blood pressure profile and abnormalities in bone and mineral metabolism, including vascular calcifications, is well known. However, such a link has not yet been reported in hypertensive patients with normal renal function. We aimed to evaluate if higher serum phosphate, calcium, parathyroid hormone (PTH) level and the calcium x phosphate (Ca x P) product would be associated with a nondipper hypertension, in patients with normal renal function and without any PTH disorder. METHODS: 190 hypertensive subjects with the following inclusion criteria were enrolled: (1) normal phosphate and PTH levels; (2) glomerular filtration rate (GFR) >60 ml/min, and (3) no history of calcium, phosphate, vitamin D medication and hyperparathyroidism. RESULTS: Of the total population, 76 patients (40%) were classified as dippers and 114 (60%) as nondippers. Nondipper patients had higher levels of phosphate (3.70 +/- 0.61 vs. 3.35 +/- 0.44 mg/dl, p = 0.001), Ca x P product (35.4 +/- 6.5 vs. 31.5 +/- 5.0, p = 0.001) and PTH (75.7 +/- 28.8 vs. 46.6 +/- 17.1 pg/ml, p = 0.000) compared to dipper patients. Independent predictors (multiple regression) for nondipper hypertension were PTH (beta = 0.43, p = 0.001) and phosphate (beta = 0.9, p = 0.03). CONCLUSION: We demonstrate a graded independent relation between higher levels of phosphate, PTH, Ca x P product and the risk of nondipping in hypertensive patients with an estimated GFR of >60 ml/min and normal mineral metabolism.

The protective effect of erdosteine against cyclosporine A-induced cardiotoxicity in rats.

Cyclosporine A (CsA) is a frequently used immunosuppressive agent in transplant medicine to prevent rejection and in the treatment of autoimmune diseases. However, CsA generates reactive oxygen species, which causes nephrotoxicity, hepatotoxicity and cardiotoxicity. The use of antioxidants reduces the adverse effects of CsA. The aim of this study is to determine the protective effects of erdosteine on CsA-induced heart injury through tissue oxidant/antioxidant parameters and light microscopic evaluation in rats. CsA cardiotoxicity was induced by administrating an oral dose of 15mg/kg CsA daily for 21 days. The rats were divided into four groups: control group (n=4), CsA administrated group (15mg/kg, n=5), CsA+erdosteine administrated group (10mg/kg day orally erdosteine, n=4) and only erdosteine administrated group (10mg/kg day orally n=5). CsA treated rats showed increase in the number of infiltrated cells and disorganization of myocardial fibers with interstitial fibrosis. The number of infiltrated cells, disorganization of myocardial fibers and interstitial fibrosis was diminished in the hearts of CsA-treated rats given erdosteine. The malondialdehyde, the protein carbonyl content and nitric oxide levels were increased in the cyclosporine A group in comparison with the control and CsA plus erdosteine groups. The activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) were higher in CsA plus erdosteine group than CsA group. However, the CAT, GSH-Px and SOD activities were significantly lower in CsA group than in control group and erdosteine group. These results suggest that erdosteine has protective effect against CsA-induced cardiotoxicity.

Probrain natriuretic peptide for assessment of efficacy in heart failure treatment.

N-terminal probrain natriuretic peptide (NT-proBNP) is elevated in patients with heart failure. Numerous clinical trials have evaluated the efficacy of spironolactone in heart failure; however, no studies have directly examined the effects of spironolactone treatment on NT-proBNP level. This study investigated whether NT-proBNP levels decrease with daily spironolactone treatment. The study consisted of 117 adult patients with heart failure. All participants were divided into 3 groups, class I, class II, and class III, according to the New York Heart Association classification system. Patients were randomly assigned to receive spironolactone or were treated with another drug, other than spironolactone, as placebo. NT-proBNP plasma samples were taken at baseline and after 6 mo of treatment. A total of 62 patients were treated with daily spironolactone; 55 patients were followed with available treatment without spironolactone. The baseline demographic and laboratory parameters were similar for patients in all groups. At the end of 6 mo, spironolactone-treated patients had significantly lower NT-proBNP levels and significantly better ejection fractions than did patients in all New York Heart Association classes who were not treated with spironolactone. Results suggest that spironolactone decreases plasma NT-proBNP concentrations, and that the measurement of plasma NT-proBNP levels may be helpful in assessing therapeutic efficacy in patients who are treated for heart failure.