Frequency of SARS-COV-2 infection and COVID-19 vaccine uptake and protection among Syrian refugees : COVID-19 Vaccine among Syrian Refugees.

It is aimed to examine the frequency of COVID-19 disease, the rates of COVID-19 vaccination and the vaccine effectiveness (VE) among Syrian refugees. It is a retrospective cohort study. Syrian refugees aged 18 years and above registered to a family health center in Sultanbeyli district in Istanbul were included. Vaccine effectiveness were calculated for both Pfizer BioN-Tech and CoronaVac (Sinovac) vaccines. The data of 2586 Syrian people was evaluated in the study. The median age of the participants was 34.0 years (min:18.0; max: 90.0). Of the participants 58.4% (n = 1510) were female, 41.6% (n = 1076) were male. In our study of the refugees 15.7% had history of COVID-19 infection. Refugees having full vaccination with Biontech and Sinovac have a significantly lower COVID-19 infection rate than those without vaccination (HR = 8.687; p < 0.001). Adjusted VE for Biontech, Sinovac, and both were 89.2% (95.0% CI:83.3-93.1), 81.2% (95.0% CI:48.72-93.1) and 88.5% (95.0% CI:82.7-92.3), respectively. The results of the study highlight the importance of vaccinations against COVID-19 pandemic, since both vaccines were highly protective in refugees.

Investigation of usage of antenatal care services by Syrian immigrant pregnant women and the frequency of anaemia and hypertension during the pandemic.

During the pandemic period, the use of health services by disadvantaged groups such as immigrants has deteriorated. The study aims to evaluate the use of antenatal care services by Syrian pregnant women during the pandemic. It is a cross-sectional type of study. The population consisted of 495 pregnant women who applied to the Extended Migrant Health Center (EMHC) between August 2020 and December 2022. Demographic data and pregnancy-related health records were examined through the system records, without any contact with the pregnant women. The percentage of pregnant women who had timely follow-up for each antenatal visit were 11.5% (n=56), 17.2% (n=80), 20.0% (n=88), and 17.4% (n=73), respectively. Only 17.7% (n=87) of the pregnant women made the recommended number of visits during their pregnancy period. The recommended number of follow-ups was statistically significantly higher in women with high-risk pregnancies (p=0.045). Of the pregnant women, 27.4% had anaemia and 2.4% had hypertension. The use of antenatal care in immigrant pregnant women is very low. Interventions are needed in this regard. Increasing the utilization of antenatal care services by immigrant pregnant women is extremely important for both the health of the pregnant woman and the health of the baby.

Autism spectrum disorder: evaluation of community-based screening program.

Background/aim: This study was conducted to evaluate the results of autism spectrum disorder (ASD) screenings conducted in a region of Istanbul between 2018 and 2023. Materials and methods: This descriptive study was conducted between April 2018 and February 2023 among 25,839 children aged between 18-36 months who had been screened for autism spectrum disorder in Sultanbeyli, Istanbul. Children between 18-36 months are examined and a form consisting of 5 questions and typical symptoms of ASD is filled. Each question is answered as yes or no. Answering yes to at least one of the questions is sufficient to direct them to child psychiatry. Results: Between 2018 and 2023, a total of 25,839 children were screened for autism spectrum disorders, 1449 children were found to be at risk, and 88 were diagnosed with autism spectrum disorder. According to the sex distribution of the children, the male:female ratio is 3.6:1. The 5-year prevalence was found to be 0.9%. With the effect of the pandemic between 2020 and 2021, screening rates have decreased and the number of diagnoses has decreased. The most common symptom among those diagnosed is delay in speaking, and the second is inability to make eye contact. Conclusion: Autism spectrum disorder is a developmental disorder whose prevalence is increasing globally and for which early diagnosis is important. To recognize this disease, it is necessary to increase screening and raise awareness among families. This study will also shed light on future studies on this subject.

An acute gastroenteritis outbreak associated with a contaminated water supply system, Turkey, 2018.

Disruption of routine monitorization and chlorination of the water supply system during a week-long holiday led to a multi-organism gastroenteritis outbreak in a district with limited laboratory support. More than a 10-fold increase in patients with gastroenteritis was reported. Enteropathogenic Escherichia coli, Enteroaggregative E. coli, and norovirus were detected in human specimen samples. The main water tank and pipes were rusted; 13 out of the 19 water samples tested positive for total Coliform (1-920 colony-forming units (CFU)/100 ml) and E. coli (1-720 CFU/100 ml). Chlorine levels were below 0.2 ppm in seven of the nine samples. Information of 1,815 cases was obtained from the hospital records with a crude attack rate of 2.9%. Cases widespread in the district increased throughout the holiday, epidemic curve revealed a point-source outbreak. The case-control study revealed that consumption of drinking tap water and using it to clean vegetables/fruits were significantly associated with the illness. While drinking only bottled water had a protective effect against the illness. The culture technique showed that the water supply samples were positive for pathogenic bacteria. Upon decision in a multi-stakeholder meeting, the water tank was cleaned, and the Municipality initiated the renovation of the water supply system.

Evaluation of autism awareness and knowledge levels among Syrian migrants living in Türkiye.

This study was conducted to evaluate the autism knowledge level and awareness of individuals over the age of 18 who applied to immigrant health centers in Istanbul, Gaziantep and Kilis, where the Syrian immigrant population is dense. This cross-sectional study was conducted between December 2022 and April 2023 in 896 immigrants. The sample of the research consists of immigrants residing in Türkiye and who applied to the immigrant health centers in Istanbul, Gaziantep and Kilis for any reason at the time of the research. A questionnaire consisting of three parts was applied to the immigrant people face-to-face. While 38.4% of the participants were female, 61.6% were male. The mean age of the participants is 34.63 ± 10.74. It was determined that people's place of residence, whether they have children, marital status and income status have significant effects on autism knowledge levels (p < 0.001). Since the importance of early diagnosis in autism is known, it is of great importance for people to have knowledge and awareness on this issue. This study will investigate the awareness of the immigrant population, who are faced with traumatic events such as war and migration, and will shed light on future intervention studies.

Relative effectiveness of COVID-19 vaccine booster doses in people aged 65 and older-a retrospective cohort study in Türkiye.

Background: Immunization in the elderly population is critical due to the high frequency of health outcomes related to COVID-19. Objectives: This study aimed to compare the effectiveness levels of COVID-19 vaccine schedules in preventing SARS-CoV-2 infection in the older adult group who received at least one booster dose. Design: Retrospective cohort study. Methods: This study evaluated 8969 adults aged 65 and over in the Sultanbeyli district of Istanbul. COVID-19 vaccination and SARS-CoV-2 polymerase chain reaction testing data between January 14, 2021 and December 2, 2022 were obtained from the National Public Health Management System. Results: The median age of participants was 71 years. The vaccines were mostly administered as CoronaVac for the first and second doses (81.4% and 82.2%, respectively) and BNT162b2 for the third and fourth doses (61.8% and 73.1%, respectively). Turkovac was administered only in booster doses (third dose 0.6%, fourth dose 4.8%). The adjusted relative vaccine effectiveness (rVE) was found to be 61.8% (95% confidence interval (CI) 51.5-69.9) in two doses of inactivated vaccine and one dose of mRNA vaccine schedule compared to the homolog booster of CoronaVac primary vaccine schedule. In two booster doses receipts, the adjusted rVE was found to be 45.4% (95% CI 13.8-65.4) in three doses of inactivated and one dose mRNA vaccine schedule and 43.0% (95% CI 20.5-59.2) in two doses of inactivated and two doses of mRNA vaccines schedule compared to the two homolog boosters with CoronaVac primary vaccine schedule. Conclusion: In this study, the effectiveness of the mRNA vaccine as a booster dose was higher than that of the homologous boosters in participants receiving the CoronaVac primary series for those aged 65 and over.

Assessment of frailty, daily life activities, and nutrition of elderly immigrants: A household based cross-sectional study.

With the global migrant population on the rise, it's imperative to focus on the health status of more vulnerable groups within these communities. The elderly immigrants face myriad physical and psychosocial challenges that significantly impact their health and quality of life. This study aims to investigate the nutrition, daily life activities, and clinical frailty status of elderly immigrants residing in Türkiye. A cross-sectional design was employed in the Sultanbeyli District, focusing on Syrian immigrants aged 65 and over. Participants were surveyed face-to-face by interpreters proficient in Arabic. The questionnaire comprised sociodemographic details, health status, and scales like Katz Daily Life Activities, Clinical Frailty, and Mini Nutritional Assessment. The data analysis was executed using SPSS 22. Continuous variables were presented as mean ±â€…standard deviation (SD) and median, while categorical ones were expressed in numbers and percentages (%). A significance level of P < .05 was considered for the analyses. The average age of the participants was determined as 71.64 ±â€…6.20 years. In the study group, 49.7% were female, 75.5% were younger than 75 years old, 47.7% had less than primary school education, 56.3% were married, 42.4% had a low income level, and 56.9% lived in the same household with 5 or more people. Among the participants in the study group, 47% had walking and balance problems, 29.1% had a history of falls in the last year, 10.6% were disabled, 69.5% complained of pain, 82.8% had a chronic illness, and 43% had polypharmacy. The median value of the KATZ Daily Living Activities scale was 6, the mean score of the Clinical Frailty Score scale was 3.25 ±â€…1.25, and the mean score of the Mini Nutritional Assessment scale was 12.40 ±â€…2.15. Among immigrant elderly individuals, 88.1% were able to sustain their lives independently, 13.9% were clinically frail, and 3.3% were at risk of malnutrition. Factors such as age, level of education, socioeconomic status, marital status, number of cohabitants in the household, BMI, neurological problems, walking-balance disorders, disability, and presence of chronic diseases are associated with daily life activities, frailty, and malnutrition status. It is believed that broader field research with greater participation would be beneficial for evaluating the nutritional status of immigrant elderly individuals.

COVID-19 Vaccine Hesitancy and Related Factors among Unvaccinated Pregnant Women during the Pandemic Period in Turkey.

The COVID-19 virus appeared in Wuhan, China in 2019 and spread rapidly all over the world. Vaccination guidelines have recommended pregnant women to get vaccinated against COVID-19 to prevent disease. This study aimed to understand the willingness of pregnant women to vaccinate and the factors associated with their hesitation and resistance. This cross-sectional study was conducted between March and April 2022. The sample size was not calculated and tried to reach all pregnant women who did not have any COVID-19 vaccine. In the first part of the questionnaire, socio-demographic questions, and in the last part, the short form of the 12-item anti-vaccine scale, which was prepared as a 5-point Likert scale, were applied. The study was completed with 561 pregnant women. The mean score of the pregnant women who participated in this study from the vaccine hesitancy scale was found to be 33.40 ± 6.07. It was found that as the income of pregnant women decreased, the vaccine hesitancy scores decreased. Vaccine hesitancy scores of those who stated no one gave advice were significantly higher. The vaccination of pregnant women will bring significant success to the fight against the COVID-19 pandemic when implemented as part of the public health policies of countries.

COVID-19 Vaccine Booster Dose Acceptance among Older Adults.

This study aimed to determine the factors that cause individuals between the ages of 65 and 75 to not receive the third dose of a COVID-19 vaccination, to advise those who are hesitant, and to learn their thoughts about taking the third dose. (1) Material and Methods: This cross-sectional study was conducted between April and May 2022 among 2383 older adults aged between 65-75 who had never received a COVID-19 booster vaccination, according to the records of the District Health Directorate in the Sultanbeyli district of Istanbul. A three-part questionnaire prepared by researchers was given to the older adults via telephone. For statistical analysis of the data, the Chi-square test was used to compare variables; p < 0.05 was considered statistically significant. (2) Results: This research was completed with 1075 participants, reaching 45% of people aged 65-75 who did not receive the third dose of the COVID-19 vaccine in the region. In total, 64.2% of the participants were female and 35.8% were male, and the mean age was 69.33 ± 2.88. Those who had previously received an influenza vaccine were 1.9 times (95% CI 1.22-2.99) more likely to seek vaccination. Educational status also played a role, as older adults who were uneducated were 0.5 times (95% CI 0.42-0.76) less likely to seek vaccination. In addition, those who stated that lack of time was the reason for not vaccinating were 1.4 times (95% CI 1.01-1.98), and those who did not have it due to forgetting, 5.6 times (95% CI 2.58-12.24), more likely to seek vaccination. (3) Conclusion: This study shows, in detail, the importance of informing older adults, who have not received the third dose of vaccine for COVID-19 and who are in the risk group, as well as those who are not fully vaccinated, about the risks of not being vaccinated. We believe that it is important to vaccinate older patients; further, since immunity conferred by vaccination may decline over time, mortality rates decrease with the administration of additional doses.

Vaccine Uptake and COVID-19 Frequency in Pregnant Syrian Immigrant Women.

Immigrants have difficulties in the use of essential health services such as vaccinations. Vaccine uptake among pregnant immigrant women is very low. The aim of the study was to examine the vaccination status of pregnant immigrant women who received health services in an immigrant health center (IHC) affiliated to primary health care institutions. The research is a retrospective-designed cross-sectional type of study. The study sample consists of pregnant Syrian women who received health care from the strengthened IHC of a District Health Directorate in Istanbul between August 2020 and 2022. Age, trimesters, number of pregnancies, high-risk pregnancy status, vaccination dates and status against influenza, COVID-19 and tetanus, and vaccine types of COVID-19 were evaluated. The statistical significance level was determined as p < 0.05. None of the pregnant women had received the influenza vaccine. Of the women whose tetanus vaccine data were evaluated, 29.7% had received at least two doses of the tetanus vaccine. Of the pregnant women, 19.4% were vaccinated against COVID-19 with a minimum two doses and 4.2% had a COVID-19 infection during their pregnancy. None of the women with the COVID-19 infection were fully vaccinated against COVID-19. The vaccine uptake of pregnant immigrant women is very low. Public health interventions are needed to improve vaccination coverage among disadvantaged groups.

Prevalence and Associated Factors of Dental Caries in Syrian Immigrant Children Aged 6-12 Years.

Immigrant children are among the groups that are sensitive to problems related to dental health. The aim of this study was to examine the dental caries of Syrian immigrant children. The study is a descriptive and retrospective study. Its population consists of Syrian immigrant children aged 6-12 years who were screened for dental health in the year 2022 in Istanbul. DMF-T (permanent teeth) and dmf-t (milk teeth) indices were used, which are the (t-T) criteria obtained by dividing the sum of caries (d-D), caries extracted (m-M) and caries-filled (f-F) teeth by the number of people examined. Higher dmft and DMFT scores indicate worse dental health. Dental screening was performed on 549 Syrian immigrant children. In total, 27.2% (n = 149) were brushing their teeth once a day and 97.3% of the children (n = 534) had at least one decayed tooth. The dmft score for the 6-7 year age (6.45 ± 3.33) group was significantly higher than the 8-9 year (4.98 ± 2.78) and 10-12 year (3.22 ± 2.02) age groups (p < 0.001). In our study, the dental caries were seen at a very-high frequency among immigrant children and the habit of tooth brushing remains at a low level. Lower age was the relevant factor for dental caries in our study.

Breastfeeding Self-Efficacy, Personal Well-Being and Related Factors in Pregnant Women Living in a District of Istanbul.

In this study, we examined breastfeeding self-efficacy levels, well-being and sociodemographic factors in pregnant women. The population of this descriptive study consisted of women with a pregnancy of 27 weeks or more in the Sultanbeyli district of Istanbul, Türkiye. A questionnaire was administered via telephone calls to pregnant women aged 18 years and older. The first part of the questionnaire included questions regarding breastfeeding history and sociodemographic information. The second part included the Prenatal Breastfeeding Self-Efficacy Scale, and the last part included the Personal Well-Being Scale. Higher scale scores indicate higher levels of self-efficacy and well-being. In total, 385 women participated in the study. The median age of the pregnant women was 28.0 years (18.0-43.0). The median gestational week was 33.0 (27.0-42.0). Among women who had received breastfeeding counseling, those with a higher level of knowledge about breastfeeding had higher breastfeeding self-efficacy (p < 0.05). Women with better economic status also had higher well-being scores (p < 0.05). There was a positive correlation between well-being and breastfeeding self-efficacy approaching the statistical significance level (p = 0.052). It is important to consider factors that may be associated with women's well-being and self-efficacy.

Rational Drug and Antibiotic Use Status, E-Health Literacy in Syrian Immigrants and Related Factors: A Cross-Sectional Study.

Rational drug use is a pivotal concept linked with morbidity and mortality. Immigration plays a significant role as a determinant affecting individuals' health-related attitudes, behaviors, and the pursuit of health services. Within this context, the study was initiated to assess the factors influencing health literacy and rational drug use among Syrian immigrants in Istanbul. A cross-sectional study was undertaken on 542 Syrian adults utilizing a three-part questionnaire encompassing sociodemographics, rational drug use, and the e-health literacy scale (eHEALS). With an average age of 39.19 ± 13.10 years, a majority of participants believed medications should solely be doctor-prescribed (97%) and opposed keeping antibiotics at home (93.7%). Yet, 62.5% thought excessive herbal medicine use was harmless. The mean eHEALS score stood at 20.57 ± 7.26, and factors like age, marital status, income, and duration of stay in Turkey influenced e-health literacy. Associations were seen between low e-health literacy and being female, being older, having a lower education level, and regular medication use. Syrian immigrants displayed proper knowledge concerning antibiotics yet exhibited gaps in their understanding of general drug usage, treatment adherence, and herbal medicines. Approximately 80.3% had limited health literacy, pointing to the need for targeted interventions for enhanced health and societal assimilation.

Factors Associated with the Prevalence of Postpartum Anxiety Disorder and Depression in Syrian Migrant Women Living in Turkey: A Cross-Sectional Study.

The global migration trend has brought attention to the mental health of immigrant populations, especially postpartum women. The prevalence of postpartum anxiety and depression among these populations remains a growing concern. This study aimed to explore the factors associated with postpartum anxiety and depression among immigrant women, with a special emphasis on Syrian migrants in Turkey. A cross-sectional design was employed, enrolling postpartum women who visited the Strengthened Migrant Health Center in Istanbul between July and December 2022. Data were collected using a three-part questionnaire comprising sociodemographic details and scores from the Edinburgh Postpartum Depression Scale (EPDS) and Beck Anxiety Scale (BAI). The average age of participants was 25.73 years. The mean EPDS and BAI scores were low at 1.27 and 3.85, respectively. Notably, 97.1% of women scored below the EPDS cut-off point of 13. EPDS scores showed a significant relationship between income levels and COVID-19 vaccination status, while BAI scores were significantly associated with educational levels. There was an inverse correlation between EPDS scores and the number of cohabitants in a household. The observed low rates of postpartum depression and anxiety could be attributed to the accessible health services and psychosocial support for immigrants in Turkey. It would be useful to conduct multicenter and comprehensive epidemiological studies on migrant puerperas.

Prevalence of depression, anxiety, and associated factors in immigrant pregnant women in Türkiye: A cross-sectional study.

The prevalence of depression and anxiety in pregnant women is increasing and this is more important in migrants who are in the vulnerable group. The aim of this study was to evaluate the prevalence of depression and anxiety in Syrian immigrant pregnant women admitted to a Migrant Health Center and the associated factors. The study is a cross-sectional study. A questionnaire prepared using sociodemographic characteristics and the Beck depression and anxiety inventories in Arabic was applied to the participants. The study was conducted with immigrant pregnant women who applied to the Migrant Health Center between July 8, 2022, and December 31, 2022. The study was conducted through health workers who speak Arabic and had received training on the subject beforehand. The mean age of the research group was 26.67 ±â€…5.98 years. Of the participants, 73.0 percent (%) had primary education or less, 95.0% had low income, 87.2% had 3 or less children and 98.5% described their health status as good or very good. The mean Beck anxiety inventory score of the participants was found to be 4.65 ±â€…3.17. The mean Beck depression inventory score was found to be 4.48 ±â€…2.53. Smoking and first pregnancy status were found to be associated with anxiety, whereas smoking and history of delivery beyond 42 weeks were found to be associated with depression (P ˂ .05). Anxiety and depression levels of immigrant pregnant women were found to be very low. Minimal anxiety was found in 99.3% of the immigrant pregnant women and 97.1% had no symptoms of depression. It is thought that effective psychosocial support activities for immigrant pregnant women should be carried out in a way to cover the entire target group.

Family physicians overestimate diagnosis probabilities regardless of the test results.

Introduction: As useful tools for clinical decision-making, diagnostic tests require careful interpretation in order to prevent underdiagnosis, overdiagnosis or misdiagnosis. The aim of this study was to explore primary care practitioners' understanding and interpretation of the probability of disease before and after test results for six common clinical scenarios. Methods: This cross-sectional study was conducted with 414 family physicians who were working at primary care in Istanbul via face-to-face interviews held between November 2021 and March 2022. The participants were asked to estimate the probability of diagnosis in six clinical scenarios provided to them. Clinical scenarios were about three cancer screening cases (breast, cervical and colorectal), and three infectious disease cases (pneumonia, urinary tract infection, and COVID-19). For each scenario participants estimated the probability of the diagnosis before application of a diagnostic test, after a positive test result, and after a negative test result. Their estimates were compared with the true answers derived from relevant guidelines. Results: For all scenarios, physicians' estimates were significantly higher than the scientific evidence range. The minimum overestimation was positive test result for COVID-19 and maximum was pre-test case for cervical cancer. In the hypothetical control question for prevalence and test accuracy, physicians estimated disease probability as 95.0% for a positive test result and 5.0% for a negative test result while the correct answers were 2.0 and 0%, respectively (p < 0.001). Discussion: Comparing the scientific evidence, overestimation in all diagnostic scenarios, regardless of if the disease is an acute infection or a cancer, may indicate that the probabilistic approach is not conducted by the family physicians. To prevent inaccurate interpretation of the tests that may lead to incorrect or unnecessary treatments with adverse consequences, evidence-based decision-making capacity must be strengthened.

COVID-19 vaccine hesitancy and related factors among primary healthcare workers in a district of Istanbul: a cross-sectional study from Turkey.

OBJECTIVES: This study aimed to determine the COVID-19 risk perceptions, vaccination intentions and predictive factors of family physicians and family healthcare staff working in primary care in Üsküdar. DESIGN: A cross-sectional study was performed using an online questionnaire to determine the demographic and general characteristics of the participants and their willingness to be vaccinated. SETTING: An online questionnaire was applied to family physicians and family health workers working in primary care family health centres in Üsküdar between 25 and 29 December 2020. Multivariate analysis was performed to identify independent predictors of the willingness of individuals to be vaccinated. PARTICIPANTS: Out of 323 health workers working in 44 family health centres in the district, a total of 276 health workers were reached, including 126 physicians (n=158, 79.7%) and 150 midwives/nurses (n=165, 90.9%) (response rate 85.4%). RESULTS: 50.4% (n=139) of the healthcare workers were willing to have the COVID-19 vaccine, 29% (n=80) were undecided and 20.7% (n=57) refused the vaccine. The rate of acceptance to be vaccinated was higher in physicians, in men and in those who had not received a seasonal influenza vaccination regularly each year. CONCLUSIONS: Half of the primary healthcare workers, one of the high-risk groups in the pandemic, were hesitant or refused to be vaccinated for COVID-19. Knowing the factors affecting the vaccine acceptance rates of healthcare professionals can be considered one of the most strategic moves in reaching the target of high community vaccination rates. For evidence-based planning in vaccination studies, there is a need to investigate the reasons for COVID-19 vaccine acceptance by healthcare workers at all levels.