Efficacy of subsequent treatments in patients with hormone-positive advanced breast cancer who had disease progression under CDK 4/6 inhibitor therapy.

BACKGROUND: There is no standard treatment recommended at category 1 level in international guidelines for subsequent therapy after cyclin-dependent kinase 4/6 inhibitor (CDK4/6) based therapy. We aimed to evaluate which subsequent treatment oncologists prefer in patients with disease progression under CDKi. In addition, we aimed to show the effectiveness of systemic treatments after CDKi and whether there is a survival difference between hormonal treatments (monotherapy vs. mTOR-based). METHODS: A total of 609 patients from 53 centers were included in the study. Progression-free-survivals (PFS) of subsequent treatments (chemotherapy (CT, n:434) or endocrine therapy (ET, n:175)) after CDKi were calculated. Patients were evaluated in three groups as those who received CDKi in first-line (group A, n:202), second-line (group B, n: 153) and ≥ 3rd-line (group C, n: 254). PFS was compared according to the use of ET and CT. In addition, ET was compared as monotherapy versus everolimus-based combination therapy. RESULTS: The median duration of CDKi in the ET arms of Group A, B, and C was 17.0, 11.0, and 8.5 months in respectively; it was 9.0, 7.0, and 5.0 months in the CT arm. Median PFS after CDKi was 9.5 (5.0-14.0) months in the ET arm of group A, and 5.3 (3.9-6.8) months in the CT arm (p = 0.073). It was 6.7 (5.8-7.7) months in the ET arm of group B, and 5.7 (4.6-6.7) months in the CT arm (p = 0.311). It was 5.3 (2.5-8.0) months in the ET arm of group C and 4.0 (3.5-4.6) months in the CT arm (p = 0.434). Patients who received ET after CDKi were compared as those who received everolimus-based combination therapy versus those who received monotherapy ET: the median PFS in group A, B, and C was 11.0 vs. 5.9 (p = 0.047), 6.7 vs. 5.0 (p = 0.164), 6.7 vs. 3.9 (p = 0.763) months. CONCLUSION: Physicians preferred CT rather than ET in patients with early progression under CDKi. It has been shown that subsequent ET after CDKi can be as effective as CT. It was also observed that better PFS could be achieved with the subsequent everolimus-based treatments after first-line CDKi compared to monotherapy ET.

The postpartum period during the COVID-19 pandemic: investigating Turkish women's postpartum support and postpartum-specific anxiety.

OBJECTIVES: This study aimed to examine how Turkish women were affected by the COVID-19 pandemic in the postpartum period in terms of postpartum support and anxiety variables. METHODS: The study was conducted with 130 women who gave birth during the COVID-19 period. Data were collected online using a personal information form, Postpartum Support Scale and Postpartum Specific Anxiety Scale. Descriptive statistics were used, with Kruskal-Wallis and regression analysis performed. RESULTS: All postpartum women stated that they were affected negatively by COVID-19. The most common issues described were feeling alone (25.51%), having economic difficulties (15.5%) and experiencing difficulties accessing health services (21.7%). The mean Postpartum Support Scale score was 102.43 ± 27.67, while the mean Postpartum Specific Anxiety Scale score was 188.07 ± 96.71. COVID-19 exposure level had a significant effect on postpartum-specific anxiety (p=0.00). The variables of having a problem during pregnancy (p=0.006), having a baby willingly (p=0.007), and partner's educational status significantly predicted the degree of being affected by COVID-19 (p=0.025). The degree to which COVID-19 affected the women was determined by having problems during pregnancy, having a baby willingly, and a highly educated partner. CONCLUSIONS: These variables may inform a resource to empower postpartum women during COVID-19. Healthcare systems need to be organised considering pandemic conditions to provide increased postpartum support, evaluate psychological health, deliver healthcare services, and consider pregnancy periods.

Self-transcendence among adults 65 years and older: A meta-analysis.

INTRODUCTION: Self-transcendence is a human capacity for wellbeing by expanding one's personal boundaries and may act as a health-promoting resource among adults ≥65 years. Therefore, the objectives of this meta-analysis were to determine the mean score of self-transcendence based on place of residence and gender, and to evaluate the correlations of self-transcendence with meaning, sense of coherence, resilience and depression. METHODS: Based on inclusion criteria, 13 studies were included. Orwin Safe N and Egger's test assessed publication bias. The mean score of self-transcendence and the correlation coefficients of the selected variables were estimated by random effects models. RESULTS: The self-transcendence mean score (n = 1634) was low (M = 43.6) and a bit lower among those staying in care facilities (M = 42.8), but did not vary significantly across gender. The correlation coefficients were self-transcendence_depression (r = -0.40), self-transcendence_meaning-in-life (r = 0.53), self-transcendence_resilience (r = 0.50) and self-transcendence_sense of coherence (r = 0.28). The correlation coefficients, except for meaning-in-life, were homogeneous. CONCLUSION: In a health-promoting perspective, the concept of self-transcendence can help to better understand wellbeing among older individuals and provide guidance for health professionals in facilitating wellbeing and health. The concept and theory of self-transcendence can inspire health professionals in realising new health-promoting approaches to support older individuals in maintaining health, wellbeing and independency.

Is marital adjustment a way to increase women's identification with the motherhood role during pregnancy?: A correlational assessment.

The researchers sought to determine the correlation level and factors that affect the correlation between pregnant women's marital adjustment and their identification with the motherhood role. A total of 146 healthy, married, and pregnant women were included. There was a negative and significantly low-level correlation between marital adjustment and identification with the motherhood role. The correlation was significant among women who were multiparous, married for six to 10 years, with low level of education, and decided to marry in agreement. The authors of this study suggest promoting marital adjustment may be way to facilitate women's identification with the motherhood role.

The comparison of FOLFOX regimens with different doses of 5-FU for the adjuvant treatment of colorectal cancer: a multicenter study.

PURPOSE: We aim to compare the efficiency and toxicity of three different 5-fluorouracil (5-FU) administration types in 5-FU, leucovorin, and oxaliplatin (FOLFOX) combination treatment for adjuvant therapy in colorectal cancer (CRC). METHODS: Five hundred and seventy patients with stage III colorectal carcinoma who received different FOLFOX regimens after curative resection were included. Patients were divided into three groups as FOLFOX-4, modified FOLFOX-6 (mFOLFOX-6), and mFOLFOX-4 for comparison of toxicity and disease-free survival (DFS) and overall survival (OS) times. RESULTS: Three-year DFS rates for FOLFOX-4, mFOLFOX-6, and mFOLFOX-4 groups were 65%, 72%, and 72%, respectively. Five-year OS rates for FOLFOX-4, mFOLFOX-6, and mFOLFOX-4 groups were 69%, 75%, and 67%, respectively. There was no statistically significant difference between the three treatment groups in terms of DFS and OS (p = 0.079, and p = 0.147, respectively). Among grade 1-2 adverse events (AE), thrombocytopenia, neuropathy, and stomatitis were more common in the mFOLFOX-6-treated group. The frequency of grade 1-2 nausea and vomiting were similar in mFOLFOX-6 (36.3% and 24%, respectively) and mFOLFOX-4 (32.4% and 24.7%, respectively) groups but were higher than that in the FOLFOX-4 (19.5% and 11.3%, respectively) group. Among the most common grade 3-4 AE, neutropenia (53.4%, 9%, and 13.5%, respectively) and diarrhea (10.5%, 2.2%, and 2.4, respectively) were more common in FOLFOX-4. The rate of anemia and febrile neutropenia was similar in treatment groups (p = 0.063, and p = 0.210, respectively). CONCLUSION: In the adjuvant treatment of stage III CRC patients, three different 5-FU administration types in FOLFOX combination treatment can be used with similar efficiency and manageable toxicity.

'It was difficult, but our struggle to touch lives gave us strength': The experience of nurses working on COVID-19 wards.

BACKGROUND: Nurses are considered important healthcare professionals during the management of the pandemic process due to the considerable amount of time they spend in the face-to-face nursing of infected patients. To optimise the service of healthcare workers, it is recommended that the mental health needs of the health workforce are addressed. AIMS AND OBJECTIVES: This study aimed to explore the experiences and coping strategies of Turkish nurses working in pandemic units. METHODS: A grounded theory design was applied. In-depth interviews were conducted with 15 nurses. The data were analysed according to the constant comparative method. RESULTS: The study generated a core category ('It was difficult working in the unknown, but our struggle to touch lives gave us strength'), showing that all nurses felt heroic via the satisfaction of touching patients' lives and uncertain. Four main categories emerged: being caught in the pandemic, empowerment for coping with the struggle, challenges during the coping process and effects of the pandemic on life. CONCLUSIONS: Nurses felt that their profession was sacred and valued by society, and comprehensive support had facilitated the process. Nurses had difficulty in managing their fear of infecting others and adapting to many new elements, the learning process and a lack of understanding of their role as team members. The nurses attending to the pandemic have experienced the effects of COVID-19 on their lives, such as psychological growth, psychological symptoms and being labelled as high risk. RELEVANCE TO CLINICAL PRACTICE: Nurses would be further empowered by government and society's support and acceptance of professionalism in nursing. The findings suggest that the resources for the psychological support of nurses in the pandemic should be increased. Regular and intensive training for nursing is necessary to promote adaptation and efficacy in crisis management.

Clinical outcomes and prognostic factors of adult's Ewing sarcoma family of tumors: single center experience.

AIM OF THE STUDY: Aim of the study was to investigate the demographics of Ewing sarcoma family of tumours (ESTF) patients, treatment alternatives, clinical outcomes, and prognostic factors for survival. MATERIAL AND METHODS: We retrospectively reviewed 39 patients with ESFT who were admitted to our institute between September 2008 and September 2012. RESULTS: The patients included 32 (82.1%) males and seven (17.9%) females of median age 24 (range, 18-66) years. Among the 27 patients with a primary osseous localization, 17 (43.5%) had a central axis localization. Fifteen patients (38.5%) had metastases at the time of diagnosis. Patients were followed up for a median period of 18 (range, 2-134) months. The median event-free survival (EFS) was 23 (range, 1-64) months, and the 1- and 4-year EFS were 60% and 48%, respectively. The median overall survival (OS) was 91 (range, 1-188) months, and the 1- and 4-year OS were 78% and 54%, respectively. Gender, age, primary tumor site, and local treatment modalities, either alone or in combination, did not have a significant effect on OS (p = 0.210, p = 0.617, p = 0.644, and p = 0.417, respectively). In contrast, osseous site of peripheral localization, limited stage, and metastasis to the bone significantly affected OS (p = 0.015, p < 0.001, and p = 0.042, respectively). CONCLUSIONS: ESFTs are aggressive tumors with a high rate of relapse and metastatic potential. Patients with peripheral bone involvement and limited stage had a good prognosis. Appropriate surgical resection, radiotherapy, and aggressive chemotherapy regimens are recommended.

Progesterone receptor status in determining the prognosis of estrogen receptor positive/ HER2 negative breast carcinoma patients.

PURPOSE: To evaluate the impact of progesterone receptor (PR) status on estrogen receptor (ER)-positive and HER2-negative breast cancer. METHODS: A total of 1673 operable breast cancer patients, diagnosed from June 1984 to June 2011 were retrospectively reviewed and 400 patients with ER-positive and HER2-negative tumors were identified and evaluated. ER-positive and HER2-negative patients were classified into two groups: group A: ER+/PR-/HER2- and group B : ER+/PR+/HER2- according to PR status. RESULTS: Median follow-up was 14.2 years (range 10.1-18.2). The ratio of postmenopausal patients was significantly higher in group A (68.2%, p=0.015). Grade 1 tumor and stage I disease were significantly higher in group B (15%, p=0.007 and 15%, p=0.005, respectively). Mean overall survival (OS) and disease free survival (DFS) were significantly better in group B (15.3±1.5 years vs 8.7±0.8 years, p=0.032; 10.5±1.6 years vs 5.7±0.5 years, p=0.022) as compared with group A. Relative risk for recurrence and death were two-fold higher in group A (p=0.05 and p=0.01, respectively). CONCLUSION: PR status exerts a significant impact on prognosis of ER+/HER2- breast cancer.

Sunitinib-induced severe hypoglycemia in a diabetic patient.

INTRODUCTION: Sunitinib is an oral inhibitor of tyrosine kinase that was used for the treatment of mRCC. The general side effects are fatigue, asthenia, diarrhea, mucositis, nausea, vomiting, skin changes, hypertension, hypothyroidism and hematologic side effects. In addition, sunitinib-induced hypoglycemia has also been reported. There are limited number of case reports related to sunitinib-induced hypoglycemia. CASE PRESENTATION: In this case report, we have presented a patient with type 2 diabetes mellitus (DM) with emerging severe hypoglycemia after sunitinib treatment. It was shown that blood glucose levels were normalized two weeks after the interruption of sunitinib. CONCLUSION: Although the underlying mechanism of sunitinib-induced hypoglycemia is not completely understood, sunitinib can be regarded to have an antidiabetic effect. In the literature, there are some reports about sunitinib/other TKI induced hypoglycemia; however, life threatening hypoglycemia is rare. There is no case report of severe hypoglycemia due to imatinib; however, there are two case reports with severe hypoglycemia due to sunitinib treatment. Symptomatic hypoglycemic episodes due to sunitinib may lead to hospital admission. Diabetic patients may develop severe hypoglycaemia and it should be kept in mind that the discontinuation of antihyperglycemic treatment may be required. Therefore, blood glucose levels should be closely monitored in diabetic patients with mRCC during sunitinib therapy.

Treatment decision plans matter in elderly patients with gastrointestinal cancer: suboptimal or optimal?

PURPOSE: Aging is an important risk factor for cancer. Molecular changes and defective immunity associated with aging result in increased susceptibility to many carcinogens of the gastrointestinal system (GIS). Comorbidities and changes in drug metabolism in elderly patients make the treatment of GIS cancers difficult. METHODS: Between January 2009 and December 2012, a total of 790 patients diagnosed with GIS cancers were retrospectively evaluated. Among them, 357 patients aged ≥ 65 years constituted the study population in which the patient characteristics, disease location, TNM stage, ECOG PS, co-morbidities, chemotherapy regimens and overall survival (OS) were assessed. RESULTS: The patient median age was 71 years (range 65-94). Cancer localizations were colorectal cancer (CRC), gastric cancer, and the pancreaticobiliary system (PBS) cancer in 178 (49.9%), 124 (34.7%), and 55 (15.4%) patients, respectively. A total of 260 (69%) patients underwent chemotherapy: 167 (64.3%) patients received optimal chemotherapy, and 93 (35.7%) suboptimal chemotherapy. The median OS was 47, 14, and 11 months in CRC, gastric, and PBS cancers, respectively. OS was better in the optimally-treated group than in the suboptimally-treated group among patients with all types of cancer. OS was 67 vs 19 months (p<0.001), 17 vs 8 months (p=0.004), and 12 vs 10 months (p=0.46) in CRC, gastric, and PBS cancers in the optimal and suboptimal chemotherapy groups, respectively. Multivariate analysis showed that the disease stage in all cancer types and optimal chemotherapy in the CRC group were important predictors of survival (p<0.001 and p=0.021, respectively). CONCLUSION: Cancer is usually in advanced stage at the time of diagnosis in these elderly patients and screening programs might improve outcomes in this age group. Patients with GIS cancers (especially CRC and gastric cancer) should be encouraged to receive optimal chemotherapy regimens.

"I need to make sense of my birth experience": A descriptive qualitative study of postnatal women's opinions, and expectations about postnatal debriefing.

BACKGROUND: Evidence shows that women feel valued and satisfied after discussing their birth experiences. However, uncertainties persist surrounding the concept of postnatal debriefing practice. AIM: To explore the opinions and expectations of women relating to postnatal debriefing and their experiences when the postnatal debriefing is not presented. METHOD: A descriptive qualitative study of 20 postnatal women was conducted using in-depth semi-structured interviews from April-May 2023. Thematic analysis was applied to the data collected in interviews. RESULTS: Analysis of interview data generated three main themes and nine sub-themes. Women wanted to make sense of their birth experience They expressed their opinions on the components of postnatal debriefing They advocated for all women to be offered this practice by known healthcare professionals who interact with them They do not want to only talk about their birth experience but also meet their needs Women agree that expectations related to birth determine the need for the practice. They hoped for psychological adaptation by relieving their distress and gaining a sense of closure. The discussion process was expected to prevent reflection of trauma to the future and provide transition to the postnatal period. CONCLUSION: The present study explored women perceptions and expectations of postnatal debriefing. Healthcare professionals should behave sensitively to women's expectations and needs in relation to their birth experience. Further research is warranted to clarify the components and effects of postnatal debriefing practice to develop consolidated guidance.

Early and Long-Term Morbidity and Mortality Following Pancreaticoduodenectomy for Periampullary Tumors in Elderly Patients.

AIM: The growing elderly population is facing an increasing risk of cancers, consequently raising the pancreatic cancer surgery rate. This study aimed to determine whether advanced age is a risk factor for morbidity and mortality following pancreaticoduodenectomy (PD) for periampullary tumors. MATERIALS AND METHODS: The present study included 90 patients who underwent PD for periampullary tumors. Patients were divided into two age-related groups, including those aged 60-74 years (n = 60) (Group 1) and those aged ≥75 years (n = 30) (Group 2). Each patient's characteristics, perioperative features, morbidity, and long-term results were evaluated retrospectively. RESULTS: In both univariate and multivariate logistic regression analyses, old age (≥75 years) was not a risk factor for morbidity and hospital mortality. The multivariate analysis demonstrated that male gender (p = 0.008), pancreatic duct diameter (<3 mm) (p < 0.001), and length of hospital stay (p = 0.005) were independent risk factors for pancreatic fistula post-operation and reoperation. Additionally, hospital mortality was significantly associated with reoperation (p = 0.011). The overall median survival was 27 ± 4.1 (18.8-35.1) months. Lymph node positivity (p < 0.001), neural tumor invasion (p = 0.026), and age ≥75 years (p = 0.045) were risk factors affecting the overall survival rate. Moreover, there was no statistically significant difference in terms of PD rates during the Coronavirus disease-19 (COVID-19) period among groups, and PD during this period was not related to the occurrence of pancreatic fistula. CONCLUSION: PD can be performed effectively in selected elderly patients with tolerable morbidity and mortality rates.

Efficacy of adjuvant capecitabine in residual triple negative breast cancer: a multicenter observational Turkish Oncology Group (TOG) study.

BACKGROUND: Triple negative breast cancer (TNBC) is characterized by high rates of recurrence, especially in patients with residual disease after neoadjuvant chemotherapy (NAC). Capecitabine is being used as standard adjuvant treatment in residual TNBC. We aimed to investigate the real-life data regarding the efficacy of capecitabine in residual TNBC. DESIGN AND METHODS: In this retrospective multicenter study, TNBC patients with residual disease were evaluated. Patients, who received standard anthracycline and taxane-based NAC and adjuvant capecitabine were eligible. Overall survival (OS), disease free survival (DFS) and toxicity were analyzed. RESULTS: 170 TNBC patients with residual disease were included. Of these, 62.9% were premenopausal. At the time of analysis, the recurrence rate was 30% and death rate was 18%. The 3-year DFS and OS were 66% and 74%, respectively. In patients treated with adjuvant capecitabine, residual node positive disease stood out as an independent predictor of DFS (p = 0.024) and OS (p = 0.032). Undergoing mastectomy and the presence of T2 residual tumor was independent predictors of DFS (p = 0.016) and OS (p = 0.006), respectively. CONCLUSION: The efficacy of capecitabine was found lower compared to previous studies. Selected patients may have further benefit from addition of capecitabine. The toxicity associated with capecitabine was found lower than anticipated.

A grounded theory of resilience experiences of women with gynecological cancer.

PURPOSE: The present study aims to develop an explanatory framework to gain a deeper understanding of the resilience process in women diagnosed with gynecological cancers. METHOD: Informed by Salutogenesis Model, a Straussian-grounded theory study was conducted. In-depth interviews were conducted with 20 women with gynecological cancer between January and August 2022. Data were analyzed using open, axial, selective coding, and constant comparative methods. RESULTS: The core category encapsulated that most women defined resilience as having a dynamic process that could be promoted throughout the process. However, they expressed that they needed "individual resources for resilience" and "generated resources by the supportive interventions" to be resilient. They emphasized that these resources should make the process manageable, meaningful, and comprehensible to promote resilience. Furthermore, they defined in detail which components should be included in supportive interventions. They stated "some reflections of resilience on their cancer process" and "life gains from the process." CONCLUSION: This study developed a grounded theory that provides a guideline for healthcare professionals on how women could be encouraged to have resilience and what is the importance of resilience on women's cancer process and their lives. Salutogenesis may help to understand the resilience process in women with gynecological cancer and provides direction for how healthcare professionals should shape their clinical interventions to promote the resilience process.

A New Prognostic Index in Young Breast Cancer Patients.

OBJECTIVE: To evaluate the prognostic role of pan immune-inflammation value (PIV) in young breast cancer patients. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Medical Oncology, Afyon University of Health Sciences, School of Medicine Hospital, Turkey, between January 2010 and December 2020. METHODOLOGY: Patients who were under the age of 40 years at the time of diagnosis were included. Patients' characteristics and disease parameters were recorded. PIV was calculated according to (neutrophil x platelet x monocyte/lymphocyte, i.e. NxPxM/L) formula. Since a cut-off value with max sensitivity and specificity could not be obtained with ROC analysis, the median value of PIV was used as cut-off value. The relationship between PIV and pathological parameters was evaluated by ROC curves. The Kaplan-Meier method was used for OS and the log-rank test was used to evaluate the survival differences between the two groups, according to the optimal cut-off point. RESULTS: Based on the PIV cut-off value of 121 (49.8%) patients were in the low PIV and 122 (50.2%) patients were in the high PIV group. The patients in the high PIV group had a statistically significantly more advanced AJCC stage, and were younger patients. In the survival analysis, it was observed that the survival was worse in the high PIV group but this difference did not reach statistical significance (p=0.112). CONCLUSION: Higher PIV levels at the time of diagnosis can be another prognostic marker. However, to clarify the PIV prognostic value, it needs to be validated in larger, multi-centre prospective clinical studies. Key Words: Breast cancer, Pan immune-inflammation value (PIV), Prognosis, Young women.

The Efficacy and Safety of Treatment Regimens Used in the First-Line Setting in Metastatic Pancreatic Cancer Patients: A Multicenter Real-Life Study.

OBJECTIVE: The aim of the study is to compare the efficacy and safety of 3 chemotherapy regimens used as first-line treatments in the real-life management of metastatic pancreatic cancer. METHODS: A total of 218 patients were included in this multicenter study. Gemcitabine (Gem, n = 71), gemcitabine-cisplatin (Gem-Cis, n = 91), and FOLFIRINOX (a combination of leucovorin, 5-fluorouracil, irinotecan, and oxaliplatin [FFX], n = 56) treatments were compared. RESULTS: Overall response rate was significantly higher in the FFX group (50.0%) than in the Gem (28.2%) and Gem-Cis (27.5%) groups (P = 0.010). Median progression-free survival (8.4 vs 4.6 and 5.5 months, respectively, P < 0.001) and overall survival (16.4 vs 8.1 and 8.7 months, respectively, P = 0.002) were significantly longer in the FFX group than in the Gem and Gem-Cis groups. Toxicity of any grade was noted in 46 (64.8%), 56 (61.5%), and 49 (87.5%) patients in the Gem, Gem-Cis, and FFX groups, respectively (P = 0.003). CONCLUSIONS: In our study, FFX regimen provides a significant advantage over the other treatment regimens in terms of response rates and survival. Treatment toxicity was more frequent but manageable with the FFX regimen.

Sexual behaviours and education in adolescents and young adults with Down syndrome: A grounded theory study of experiences and opinions of their mothers in Turkey.

This study aimed to gain a deeper understanding of the experiences and opinions of mothers about sexual behaviours and sexual education of their children with DS who are AYAs in Turkey. The study utilised a classic grounded theory approach. In-depth interviews were conducted with 12 mothers. Data were analyzed by the constant comparative method. Mothers expressed that they could not address the sexual needs of their child because they did not feel they could provide sufficient care to their child. Mothers used pressure and control tactics and neglect of the sexuality to cope with their children's sexuality. Mothers described their meaning of the sexuality, fear of stigmatization and gender issues as determinant factors on the dealing with the sexuality. They stated their knowledge about sexuality is not enough to provide sexual education. Many cultural issues such as gender, meaning of the sexuality and burden of care was described as determinant factors and difficulties to providing sexual education. Therefore, educational and supportive programmes for parents should be conducted. Comprehensive, valid and individualized sexual education program also should be provided AYAs with DS.

Turkish midwives' experiences and opinions in promoting normal births: A grounded theory study.

INTRODUCTION: Worldwide, the biomedical model of maternity care has been dominant, with the overuse of interventions. AIM: This study aimed to gain a deeper understanding of the experiences and opinions of Turkish midwives regarding the promotion of normal births. METHODS: In-depth interviews were conducted with 12 midwives; data were analysed using grounded theory. The data were analysed according to the constant comparative method. FINDINGS: The study generated a core category (We want to promote normal births, but have no power to do it), which means all participants wanted to promote normal births. However, they have been disempowered by the medicalised systems of care. There were also three main categories (different ideologies in the labour ward, the midwives have no power, unempowered women). The participants reported that different ideologies in the labour ward were a challenge to promoting normal births. Their working conditions and education level were not enough to support normal birth. The pregnant women were described as unempowered due to a lack of antenatal education and having a fear of childbirth. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Normal birth could be promoted by enhancing the power and responsibilities of midwives. The women need antenatal education to have a normal birth. The normal birth may promote the enhanced readiness of women and midwives.

Investigating the cepstral acoustic characteristics of voice in healthy children.

OBJECTIVES: This study aimed to determine the cepstral acoustic parameters that vary depending on age and gender in vocally healthy children, and to establish normative data for cepstral analysis. BACKGROUND: Cepstral measurements are among the strongest predictors of auditory-perceptual evaluation of voice and differentiate between healthy and dysphonic voices. More spesificially, ceptral peak prominence is accepted to be as a strong acoustic predictor of breathiness and overall severity of dysphonia. Cepstral measures determine voice quality reliably not only in sustained vowel samples but also in running speech samples. Determining the parameters related to the acoustic profile of children with normal voices can lead us to a better understanding of the effect of changes in the larynx and vocal fold structure during growth and development. There is a limited number of norm studies examining the cepstral acoustic properties of pediatric voice. Determining norm-specific values and clinical guidelines of cepstral acoustics according to the age and gender in vocally healthy children are utmost important. METHODS: A total of 160 vocally healthy children were divided into the following four age groups: Group-I included children within the age range of 4-7 years, Group-II included 7-11 years, Group-III 11-14 years, and Group-IV included children within the age range of 14-18 years. An equal number of male and female participants were assigned to each group. PENTAX Medical CSL Model 4500 was used for recording all tasks. For acoustic analysis, Multi-Dimensional Voice Program and Analysis of Dysphonia in Speech and Voice were used. RESULTS: Cepstral Peak Prominence (CPP), Cepstral Peak Prominence Standard Deviation (CPP SD), and Low-To-High Spectral Ratio (L/H Ratio) increased with age. It is found that the CPP parameter of all-voiced sentences and nasal-weighted sentences increased with age in boys, while no significant pattern was observed in any sample for girls. For L/H ratio, it can be said that there is a general increase with age in all speech samples, except for the vowel-weighted and voiceless plosive sentence samples, evident especially in the group above the age of 15 years. This study concluded that the CPP SD parameter in the vowel-weighted sentences increased with age in boys. It was also noticed in this study that CPP F0 standard deviation (SD) intervals were narrower in vowel-weighted, easy onset, and voiceless plosive sentence samples than in all-voiced, hard glottal attack and nasal-weighted sentence samples. CONCLUSION: This study established cepstral acoustic normative values for a wide age range of the pediatric population. It is thought that age and gender specific cepstral acoustic findings presented in this study contributed to the related literature. In addition, to our knowledge, this is the first study that provides a normative cepstral acoustic database of the CAPE-V/Turkish sentences in the pediatric population.