Predictors and prevalence of stress, anxiety, depression, and PTSD among university students during the second wave of the COVID-19 pandemic in Turkey.

This study aimed to find the prevalence of stress, anxiety, depression, and PTSD; differences according to demographic variables; and predictors of mental health problems during the second wave of the coronavirus disease (COVID-19) pandemic in Turkey. Differences in exposure to COVID-19 during the first and second waves of the pandemic among students were compared. A total of 754 students from seven universities in different parts of Turkey participated in the survey between November and December 2020. Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Checklist-Civilian Version (PCL-C) scale measuring posttraumatic stress disorder (PTSD), and Satisfaction with Life Scale (SWLS) were used to measure the mental well-being of students. Descriptive statistics, one-way ANOVA, correlations, and multinomial logistic regression methods were used to analyze the data. The prevalence of high stress, high generalized anxiety (GAD-7 ≥ 10), high depression symptoms (PHQ-9 ≥ 10), and high PTSD in the total sample were 84.2, 36.2, 55.0, and 61.2%, respectively. High perceived stress, moderate generalized anxiety disorder, mild depression symptoms, high severity PTSD, and moderate satisfaction were found among students in Turkey. Religiosity and spirituality have significant negative correlations with anxiety, depression, and PTSD. Religiosity level, gender, relationship status, year of study, physical activity, symptoms of coronavirus, death of a close relative, job loss, and economic status are significant parameters for predicting psychological problems of students in Turkey.

Satisfaction with life among university students from nine countries: Cross-national study during the first wave of COVID-19 pandemic.

BACKGROUND: A cross-sectional study was performed to examine life satisfaction differences between university students from nine countries during the first wave of the COVID-19 pandemic. A cross-national comparison of the association between life satisfaction and a set of variables was also conducted. METHODS: Participants in the study were 2349 university students with a mean age of 23 years (M = 23.15, SD = 4.66). There was a predominance of women (69.26%) and individuals studying at the bachelor level (78%). The research was conducted between May and July 2020 in nine countries: Slovenia (n=209), the Czech Republic (Czechia)(n=308), Germany (n=267), Poland (n=301), Ukraine (n=310), Russia (n=285), Turkey (n=310), Israel (n=199), and Colombia (n=153). Participants completed an online survey involving measures of satisfaction with life (SWLS), exposure to COVID-19, perceived negative impact of coronavirus (PNIC) on students' well-being, general self-reported health (GSRH), physical activity (PA), and some demographics (gender, place of residence, level of study). A one-way ANOVA was used to explore cross-national differences in life satisfaction. The χ2 independence test was performed separately in each country to examine associations between life satisfaction and other variables. Bivariate and multivariate logistic regressions were used to identify life satisfaction predictors among a set of demographic and health-related variables in each of the nine countries. RESULTS: The level of life satisfaction varied between university students from the nine countries. The results for life satisfaction and the other variables differed between countries. Numerous associations were noted between satisfaction with life and several variables, and these showed cross-national differences. Distinct predictors of life satisfaction were observed for each country. However, poor self-rated physical health was a predictor of low life satisfaction independent of the country. CONCLUSIONS: The association between life satisfaction and subjective assessment of physical health seems to be universal, while the other variables are related to cross-cultural differences. Special public health attention should be focused on psychologically supporting people who do not feel healthy.

Exposure to COVID-19 during the First and the Second Wave of the Pandemic and Coronavirus-Related PTSD Risk among University Students from Six Countries-A Repeated Cross-Sectional Study.

This study aimed to reveal differences in exposure to coronavirus disease (COVID-19) during the first (W1) and the second (W2) waves of the pandemic in six countries among university students and to show the prevalence and associations between exposure to COVID-19 and coronavirus-related post-traumatic stress syndrome (PTSD) risk during W2. The repeated cross-sectional study was conducted among university students from Germany, Poland, Russia, Slovenia, Turkey, and Ukraine (W1: n = 1684; W2: n = 1741). Eight items measured exposure to COVID-19 (regarding COVID-19 symptoms, testing, hospitalizing quarantine, infected relatives, death of relatives, job loss, and worsening economic status due to the COVID-19 pandemic). Coronavirus-related PTSD risk was evaluated by PCL-S. The exposure to COVID-19 symptoms was higher during W2 than W1 among students from all countries, except Germany, where, in contrast, the increase in testing was the strongest. Students from Poland, Turkey, and the total sample were more frequently hospitalized for COVID-19 in W2. In these countries, and Ukraine, students were more often in quarantine. In all countries, participants were more exposed to infected friends/relatives and the loss of a family member due to COVID-19 in W2 than W1. The increase in job loss due to COVID-19 was only noted in Ukraine. Economic status during W2 only worsened in Poland and improved in Russia. This was due to the significant wave of restrictions in Russia and more stringent restrictions in Poland. The prevalence of coronavirus-related PTSD risk at three cutoff scores (25, 44, and 50) was 78.20%, 32.70%, and 23.10%, respectively. The prediction models for different severity of PTSD risk differed. Female gender, a prior diagnosis of depression, a loss of friends/relatives, job loss, and worsening economic status due to the COVID-19 were positively associated with high and very high coronavirus-related PTSD risk, while female gender, a prior PTSD diagnosis, experiencing COVID-19 symptoms, testing for COVID-19, having infected friends/relatives and worsening economic status were associated with moderate risk.

Pain management practices in the emergency departments in Turkey.

OBJECTIVES: This study aimed to evaluate pain management practices in the emergency departments (EDs) in Turkey and to evaluate the prevalence and etiologies of oligoanalgesia to identify possible improvement strategies. METHODS: This multicenter cross-sectional observational study was conducted in 10 tertiary care hospitals in Turkey. Patients who were admitted to the ED with pain chief complaints were included in the study. Both patients and physicians were surveyed with two separate forms by the research associates, respectively. The patient survey collected data about the pain and the interventions from the patients' perspective. The pain was evaluated using the Numerical Rating Scale. The physician survey collected data to assess the differences between study centers on pain management strategies and physician attitudes in pain management. RESULTS: Ten emergency physicians and 740 patients (male/female: 365/375) enrolled in the study. The median pain score at admission at both triage and ED was 7 (interquartile range: 5-8). The most frequent type of pain at admission was headache (n = 184, 24.7%). The most common analgesics ordered by physicians were nonsteroidal anti-inflammatory drugs (n = 505, 67.9%), and the most frequent route of administration was intramuscular injection (n = 396, 53.2%). About half of the patients (n = 366, 49.2%) received analgesics 10-30 min from ED admission. The posttreatment median pain score decreased to 3 (P < 0.001). About 79.2% of patients did not need a second analgesic administration (n = 589), and opioid analgesics were the most frequently administered analgesic if the second application was required. Physicians prescribed an analgesic at discharge from the ED in 55.6% of the patients (n = 414) and acute pain was present in 7.5% (n = 56) of the patients. CONCLUSION: Our study on the pain management practices in the EDs in Turkey suggested that high rate of intramuscular analgesic use and long emergency room stay durations are issues that should constitute the focus of our quality improvement efforts in pain management.

Mental health prevalence and predictors among university students in nine countries during the COVID-19 pandemic: a cross-national study.

The student population has been highly vulnerable to the risk of mental health deterioration during the coronavirus disease (COVID-19) pandemic. This study aimed to reveal the prevalence and predictors of mental health among students in Poland, Slovenia, Czechia, Ukraine, Russia, Germany, Turkey, Israel, and Colombia in a socioeconomic context during the COVID-19 pandemic. The study was conducted among 2349 students (69% women) from May-July 2020. Data were collected by means of the Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-8), Perceived Stress Scale (PSS-10), Gender Inequality Index (GII), Standard & Poor's Global Ratings, the Oxford COVID-19 Government Response Tracker (OxCGRT), and a sociodemographic survey. Descriptive statistics and Bayesian multilevel skew-normal regression analyses were conducted. The prevalence of high stress, depression, and generalized anxiety symptoms in the total sample was 61.30%, 40.3%, and 30%, respectively. The multilevel Bayesian model showed that female sex was a credible predictor of PSS-10, GAD-7, and PHQ-8 scores. In addition, place of residence (town) and educational level (first-cycle studies) were risk factors for the PHQ-8. This study showed that mental health issues are alarming in the student population. Regular psychological support should be provided to students by universities.

A Comparison of Depression and Anxiety among University Students in Nine Countries during the COVID-19 Pandemic.

The mental health of young adults, particularly students, is at high risk during the COVID-19 pandemic. The purpose of this study was to examine differences in mental health between university students in nine countries during the pandemic. The study encompassed 2349 university students (69% female) from Colombia, the Czech Republic (Czechia), Germany, Israel, Poland, Russia, Slovenia, Turkey, and Ukraine. Participants underwent the following tests: Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Exposure to COVID-19 (EC-19), Perceived Impact of Coronavirus (PIC) on students' well-being, Physical Activity (PA), and General Self-Reported Health (GSRH). The one-way ANOVA showed significant differences between countries. The highest depression and anxiety risk occurred in Turkey, the lowest depression in the Czech Republic and the lowest anxiety in Germany. The χ2 independence test showed that EC-19, PIC, and GSRH were associated with anxiety and depression in most of the countries, whereas PA was associated in less than half of the countries. Logistic regression showed distinct risk factors for each country. Gender and EC-19 were the most frequent predictors of depression and anxiety across the countries. The role of gender and PA for depression and anxiety is not universal and depends on cross-cultural differences. Students' mental health should be addressed from a cross-cultural perspective.

Exploring Perceived Stress among Students in Turkey during the COVID-19 Pandemic.

Students have been highly vulnerable to mental health issues during the COVID-19 pandemic, and researchers have shown that perceived stress and mental health problems have increased during the pandemic. The aim of this study was to reveal the prevalence of perceived stress and mental health among students during the pandemic and to explore predictors of stress levels. A cross-sectional study was conducted on a sample of 358 undergraduates from 14 universities in Turkey, including 200 female students (56%). The measurements used in the study were the Generalized Anxiety Disorder 7-item (GAD-7) scale, Patient Health Questionnaire (PHQ-8), Satisfaction with Life Scale (SWLS), Perception of COVID Impact on Student Well-Being (CI), Perceived Stress Scale (PSS-10), Physical Activity Scale (PA), and a sociodemographic survey. Students reported high perceived stress, mild generalized anxiety, and low satisfaction with life. More than half of the students met the diagnostic criteria of GAD (52%) and depression (63%). Female and physically inactive students had higher PSS-10 levels. A hierarchical linear regression model showed that after controlling for gender and negative CI, anxiety and physical inactivity significantly predicted high perceived stress. The study shows that students' mental health during the pandemic is at high risk.

Comparison of the efficacy of ShotBlocker and cold spray in reducing intramuscular injection-related pain in adults. A prospective, randomized, controlled trial.

OBJECTIVES: To compare the efficacy of ShotBlocker and cold spray in reducing intramuscular (IM) injection-related pain in adults. Methos: A prospective, randomized, controlled study carried out between January 2018 and March 2018 at the Department of Emergency Medicine, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey. Adult patients receiving IM injection of diclofenac sodium (75 mg/3 ml) were included. The patients were randomized into 3 groups: ShotBlocker, cold spray, and control. Each group comprised 40 patients. Patients were instructed to rate the intensity of IM injection-related pain using a 100-mm visual analog scale (VAS). Visual analog scale scores of the patients were statistically analyzed. Results: Visual analog scale scores were lower in the ShotBlocker (11 mm) and cold spray (10 mm) groups than in the control group (31 mm) (p=0.001). There were no significant differences in VAS scores between the ShotBlocker and cold spray groups. The operators' responses revealed that ShotBlocker was more difficult to administer than cold spray. Conclusion: ShotBlocker is an effective non-pharmacological method that reduces IM injection-related pain and is similar in efficacy, to cold spray.

Transpulmonary Hypothermia with Cooled Oxygen Inhalation Shows Promising Results as a Novel Hypothermia Technique.

BACKGROUND: Therapeutic hypothermia was showed to improve neurologic outcome but current therapeutic hypothermia techniques have limitations. Novel techniques such as transpulmonary hypothermia with cooled oxygen inhalation may be beneficial. AIMS: To evaluate the performance of transthoracic hypothermia with cooled medical oxygen inhalation as a therapeutic hypothermia method. STUDY DESIGN: Animal experimentation. METHODS: A total of 36 adult male Wistar-Hannover rats were used in this research. Rats were randomised into four groups: group 1, Cooled oxygen group; group 2, IV cold fluid group; group 3, Surface cooling group; group 4, control group. No hypothermia method was applied in the control group. Hypothermia techniques were administered in the other three groups until the targeted core temperature was maintained. The target temperature was continued for one hour at 32-34 °C. After that, rats were heated up with hot blankets. Once the rectal temperature reached 38 °C, rats were euthanised. The main outcomes were the rate of temperature decrease (°C per minute) (S) and the time required to reach the target body temperature (T). RESULTS: All rats survived the study protocol. When compared to the control group, T and S values were better in the cooled medical oxygen inhalation group (p<0.001). The IV cold fluid group had lower S values and higher T values compared to the cooled oxygen group (p<0.001, and p=0.003, respectively). There was no meaningful pathology in the histological samples in any group. CONCLUSION: As an easy-to-use and inexpensive method, cooled oxygen inhalation may be a beneficial hypothermia technique.

The effects of music on the cardiac resuscitation education of nursing students.

PURPOSE: The purpose of this study is to examine the effects of music on the appropriate performance of the rate and depth of chest compression for nursing students. METHODS: This randomized controlled study was conducted in the School of Nursing in Turkey between November 2014 and January 2015. The study's participants were second-year nursing school students with no previous formal cardiac resuscitation training (n=77). Participants were randomly assigned to one of two groups: an intervention group with music and a control group without music. During practical training, the intervention group performed chest compressions with music. The outcomes of this study were collected twice. The first evaluation was conducted one day after CPR education, and the second evaluation was conducted six weeks after the initial training. RESULTS: The first evaluation shows that the participants in the intervention group had an average rate of 107.33±7.29 chest compressions per minute, whereas the rate for the control group was 121.47±12.91. The second evaluation shows that the rates of chest compression for the intervention and control groups were 106.24±8.72 and 100.71±9.54, respectively. CONCLUSION: The results of this study show that a musical piece enables students to remember the ideal rhythm for chest compression. Performing chest compression with music can easily be integrated into CPR education because it does not require additional technology and is cheap.

Optimum Temperature of Oxygen for Transpulmonary Hypothermia with Cooled Oxygen Inhalation: A Preliminary Study in a Rat Model.

Cooled oxygen inhalation was hypothesized as a novel hypothermia technique in a previous study. In the current study, we aimed to determine the optimal temperature of oxygen for this method. This is a prospective, randomized, controlled, examiner-blinded experimental study conducted with 45 healthy, adult, Wistar Hannover male rats. Rats were randomly divided into five groups; group 1: +4°C intubated group (n = 7), group 2: +4°C nonintubated group (n = 9), group 3: +8°C intubated group (n = 9), group 4: +8°C nonintubated group (n = 9), and group 5: control group (n = 9). The control group received only a standardized anesthesia protocol, and no hypothermia technique was administered. Cooled oxygen was administered in the four study groups until the rectal temperature reached 34°C. The target temperature was maintained between 32°C and 34°C for 2 hours. Then, hypothermia protocols were terminated and rats were rewarmed externally with a blanket. Main outcomes were the speed (°C/minute) of temperature decrease (S) and the time required to reach the target body temperature (T). All study groups had better results than the control group in T and S values (p < 0.001) for both parameters. Group 1 had a better T value than group 4 (p = 0.01), but no difference in S value (p = 0.223). Comparison of group 2 and group 4 showed that group 4 had better results in T and S (p = 0.04 and 0.001, respectively). No pathologic changes in histologic examination were observed in any group. Our study showed that the optimal temperature of oxygen for the cooled oxygen technique was +4°C through an intubation tube.

Acute Psychotic Symptoms due to Benzydamine Hydrochloride Abuse with Alcohol.

Benzydamine hydrochloride is a locally acting nonsteroidal anti-inflammatory drug. Benzydamine hydrochloride overdose can cause stimulation of central nervous system, hallucinations, and psychosis. We presented a young man with psychotic symptoms due to benzydamine hydrochloride abuse. He received a total dose of 1000 mg benzydamine hydrochloride with alcohol for its hallucinative effects. Misuse of benzydamine hydrochloride must be considered in differential diagnosis of first-episode psychosis and physicians should consider possibility of abuse in prescribing.

Prospective, 10-year evaluation of the impact of Hispanic ethnicity on pain management practices in the ED.

INTRODUCTION: Hispanic ethnicity has been reported as an independent risk factor for oligoanalgesia in the emergency department (ED). OBJECTIVES: The objectives are to compare pain management practices in White and Hispanic patients in the ED to determine whether treatment differences exist. METHODS: Prospective analysis of a convenience sample of patients presenting to an urban, academic, tertiary-care ED over the 10-year period from 2000 to 2010. We compared patients with pain-related complaints of any nature, who self-identified their race as White or Hispanic, and evaluated initial morphine administration/dosing, arrival/disposition pain scores, and overall ED satisfaction scores (0-10 scale). RESULTS: Fifteen thousand sixty patients were enrolled. Eighty-one point 2 percent (n, 12 232) of the patients were White and 11.2% (n, 1680), Hispanic. White and Hispanic patients reported similar pain at presentation (6.7 vs 7.3, P < .001) and discharge/admission (4.6 vs 4.8, P = .14). Hispanic patients were not less likely to receive an analgesic during the ED visit (odds ratio, 1.06; confidence interval, 0.96-1.17; P = .62), nor less likely to receive an opioid analgesic (odds ratio, 0.97; confidence interval, 0.88-1.08; P = .70). Hispanic patients, on average, received similar initial doses of morphine (4.1 vs 4.3 mg, P = .29) and had similar wait times from arrival to initial dose of morphine (82 vs 86 minutes). Overall ED satisfaction scores were the same (8.7 vs 8.7, P = .65). CONCLUSION: White and Hispanic patients were similar in rates of initial morphine administration for pain-related complaints. These findings contrast with previous studies reporting lower rates of initial analgesia administration among Hispanic patients in the ED.

Longitudinal trends in the treatment of abdominal pain in an academic emergency department.

BACKGROUND: Abdominal pain is a top chief complaint of patients presenting to Emergency Departments (ED). Historically, uncertainty surrounded correct management. Evidence has shown adequate analgesia does not obscure the diagnosis, making it the standard of care. OBJECTIVE: We sought to evaluate trends in treatment of abdominal pain in an academic ED during a 10-year period. METHODS: We prospectively evaluated a convenience sample of patients in an urban academic tertiary care hospital ED from September 2000 through April 2010. Adult patients presenting with a chief complaint of abdominal pain were included in this study. Analgesic administration rates and times, pain scores, and patient satisfaction at discharge were analyzed to evaluate trends by year. RESULTS: There were 2,646 patients presenting with abdominal pain who were enrolled during the study period. Rates of analgesic administration generally increased each year from 39.9% in 2000 to 65.5% in 2010 (p value for trend <0.001). Similarly, time to analgesic administration generally decreased by year, from 116 min in 2000 to 81 min in 2009 (p < 0.001). There was no improvement in mean pain scores at discharge by year (p = 0.27) and 48% of patients during the 10-year period still reported moderate to severe pain at discharge. Patient satisfaction with pain treatment increased from a score of 7.1 to 9.0 during the study period (p < 0.005), following the trend of increase in analgesic administration. CONCLUSIONS: In patients presenting to the ED with abdominal pain, analgesia administration increased and time to medication decreased during the 10-year period. Despite overall improvements in satisfaction, significant numbers of patients presenting with abdominal pain still reported moderate to severe pain at discharge.

Disparity between mainstream and sidestream end-tidal carbon dioxide values and arterial carbon dioxide levels.

BACKGROUND: Measuring and monitoring end-tidal carbon dioxide (PETCO2) is an important aspect of caring for critically ill patients. The 2 methods used for PETCO2 measurement are the mainstream and sidestream methods. OBJECTIVE: To assess the agreement between PETCO2 measurements performed by mainstream and sidestream methods with the PaCO2 values. METHODS: This was a prospective observational study. A total of 114 subjects were enrolled in the study. PETCO2 measurements using mainstream and sidestream methods were performed simultaneously with the arterial blood sampling in subjects who were observed in the emergency department and required arterial blood gas analysis. Agreement between the PETCO2 measurements and the PaCO2 values obtained from arterial blood gas analysis were evaluated using the Bland-Altman method. RESULTS: Sixty subjects (52.6%) were female, and the mean age was 60.9 years (95% CI 58.3-63.6). The mean PaCO2 was 35.16 mm Hg (95% CI 33.81-36.51), the mainstream PETCO2 was 22.11 (95% CI 21.05-23.18), and the sidestream PETCO2 was 25.48 (95% CI 24.22-26.75). Bland-Altman analysis showed an average difference between mainstream PETCO2 and PaCO2 values of 13 mm Hg (95% limits of agreement -0.6 to 25.5) and moderate correlation (r = 0.55, P < .001). The average difference between the sidestream PETCO2 and PaCO2 values was 9.7 mm Hg (95% limits of agreement -5.4 to 24.7) and poor correlation (r = 0.41, P < .001). CONCLUSIONS: PETCO2 values obtained by mainstream and sidestream methods were found to be significantly lower than the PaCO2 values. There was essentially no agreement between the measurements obtained by 2 different methods and the PaCO2 values.

Patient anxiety may influence the efficacy of ED pain management.

OBJECTIVE: The aim of this study was to evaluate the incidence of anxiety and rates of anxiety treatment in emergency department (ED) patients presenting with pain-related complaints. METHODS: We prospectively evaluated patients in an urban academic tertiary care hospital ED from 2000 through 2010. We enrolled a convenience sample of adult patients presenting with pain and recorded patient complaint, medication administration, satisfaction, and pain and anxiety scores throughout their stay. We stratified patients into 4 different groups according to anxiety score at presentation (0, none; 1-4, mild; 5-7, moderate; 8-10, severe). RESULTS: We enrolled 10 664 ED patients presenting with pain-related complaints. Patients reporting anxiety were as follows: 25.7%, none; 26.1%, mild; 23.7%, moderate; and 24.5%, severe. Although 48% of patients described moderate to severe anxiety at ED presentation and 60% were willing to take a medication for anxiety, only 1% received anxiety treatment. Thirty-five percent of patients still reported moderate/severe anxiety at discharge. Severe anxiety at ED presentation was associated with increased demand for pain medication (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.10-1.79) and anxiety medication (OR, 4.34; 95% CI, 3.68-5.11) during the ED stay and decreased satisfaction with the treatment of pain (ß coefficient = -0.328; P < .001). After adjusting for age, sex, and presentation pain scores, patients who reported severe anxiety were more likely to receive an analgesic (OR, 1.33; 95% CI, 1.19-1.50) and an opioid (OR, 1.25; 95% CI, 1.11-1.41) during the ED stay. CONCLUSION: Anxiety may be underrecognized and undertreated in patients presenting with pain-related complaints. Patients reporting severe anxiety were less likely to report satisfaction with the treatment of their pain, despite higher rates of analgesic administration.