Evaluating the impact of aerobic and resistance green exercises on the fitness, aerobic and intrinsic capacity of older individuals.

OBJECTIVE: Our study determined the impact of 12-week aerobic exercise (AE) and aerobic + resistance exercises (AE + RE) within the green exercise concept, on senior fitness, aerobic capacity, and intrinsic capacity (IC). METHODS: The study was a multicenter, randomized controlled study conducted at two senior living facilities with individuals aged 65 and above whose cardiorespiratory and musculoskeletal conditions are suitable for moderate exercise and who have normal cognition levels. Block randomization was applied to 96 participants in a ratio of 1:1:1 to be assigned to AE, AE + RE, and control (C) groups. Intervention groups received exercise sessions led by physiotherapists within the senior living facilitiy gardens, with a frequency of once a week for 50 min, for 12 weeks. Also, they were prescribed additional exercise sessions on two additional days of the week. At the commencement of the study and 12th week, shuttle walking test, senior fitness test (SFT), intrinsic capacity assessment (with Timed Up and Go test, Mini Mental State Examination, Geriatric Depression Scale-15, Mini Nutritional Assessment, handgrip strength test) was conducted of all participants. The primary outcome was the Z score of IC, secondary outcomes were VO2max and SFT subparameters. The study was registered in the Protocol Registry and Results System (Clinicaltrials.gov PRS) with the registration number NCT05958745. RESULTS: 90 participants successfully completed the study, with 30 individuals in each of the AE, AE + RE, and C groups. By the end of the 12th week, the arm curl score was significantly higher in the AE + RE compared to the C (mean difference: 3.96, 95 % CI= 2.47 to 5.46, p = 0.01). There were significant differences in chair stand, two-minute step, 8-foot up-and-go, chair sit and reach, and back scratch tests in both AE and AE + RE compared to C. AE and AE + RE exhibited significantly higher shuttle test distances and VO2max values compared to the C (p < 0.0001). AE + RE achieved a significantly higher total IC score than the C (mean difference: 0.59, %95 CI= -0.07 to 1.26, p = 0.025). CONCLUSION: In this study within the green exercise concept, both AE and AE + RE led to similar improvements in strength, flexibility, mobility, endurance, and aerobic capacity. Notably, AE + RE demonstrated an additional benefit by increasing the total IC, while AE alone did not exhibit the same effect.

The effect of Ramadan fasting on serum osmolality in diabetic patients.

OBJECTIVE: To observe the changes of osmolarity levels due to fasting in Ramadan among type 2 diabetic patients. METHODS: The observational study was conducted from May 16 to June 3, 2019, at the Istanbul Medeniyet University, Istanbul, Turkey, and comprised adult type 2 diabetic patients of either gender visiting the diabetes outpatient clinics during the holy month of Ramadan. Those fasting were placed in Group A, while those not fasting formed Group B. Anthropometric measurements and medications in use were recorded. Blood samples were taken in the morning and before the evening meal. Serum osmolality was calculated using serum levels of sodium, glucose and blood urea nitrogen. Data was analysed using SPSS 16. RESULTS: Of the 52 patients, 27(52%) were in Group A and 25(48%) were in Group B. Overall, there were 22(42%) females and 30(58%) males. The mean morning serum osmolalities of the two groups were not different (p>0.05). The mean evening serum osmolality was not significantly different than the mean morning osmolality in Group A (p=0.22). In Group B, the mean evening serum osmolality was significantly lower than the mean morning osmolality (p=0.004). No significant difference was found between mean morning and evening serum osmolalities of those taking sodium-glucose cotransporter 2 (p>0.05). CONCLUSIONS: There was no biochemical sign of dehydration with Ramadan fasting in type 2 diabetes mellitus patients. Clinical Trial Number: [NCT04392570] Link: https://clinicaltrials.gov/.

Effect of Green Tea on Blood Pressure in Healthy Individuals: A Meta-Analysis.

Objective: The aim of this study is to evaluate the effects of green tea on blood pressure only in healthy individuals by synthesizing randomized controlled studies in order to reduce the effect of possible confounding factors. Methods: CINAHL, Cochrane Central, Medline/PubMed, Web of Science, Science Direct, YÖK National Thesis Center, and ULAKBIM electronic databases; the keywords, "green tea," "Camellia sinensis," "EGCG," "blood pressure," "systolic blood pressure," "diastolic blood pressure," and "randomized controlled trial," were searched systematically. The risk of eligible studies was evaluated by two researchers using the Cochrane Collaboration risk-of-bias tool. Results: The total sample size of the 9 studies included in the meta-analysis was 680 (experimental: 345, control: 335), the mean age of the individuals in the intervention group was 35.89 ± 8.52, while the mean age of the control group was 36.48 ± 7.68. All studies clearly described allocation randomization, none had incomplete outcome data, and all used appropriate statistical analysis. The completion rate of the consumption of green tea ranged from 85-100%. The combined results of the studies showed that green tea was effective in lowering systolic and diastolic blood pressure in individuals (MD: -2.99, 95%; CI: -3.77 to -2.22; Z = 7.57; P < .00001; I2 = 0%, MD: -0.95, 95%; CI: -1.62 to -0.27; Z = 2.75; P = .006; I2 = 0%). No publication bias was observed in the studies. Conclusion: In healthy individuals, green tea supplementation reduced systolic blood pressure by 2.99 mmHg and diastolic blood pressure by 0.95 mmHg. Our study allowed us to clearly evaluate the effect of green tea as it included healthy individuals and contributed to the literature. Considering that atherometabolic diseases are the leading cause of mortality and disability today, it is important to explain the metabolic benefits of green tea, which is easily accessible and cheap, to society.

The effect of probiotic and synbiotic use on glycemic control in women with gestational diabetes: A systematic review and meta-analysis.

AIMS: To investigate the impact of probiotic/synbiotic use on glycemic control in women with gestational diabetes. METHODS: We searched the PubMed, Medline, Scopus, ScienceDirect, Web of Science, Cochrane Central Register of Controlled Trials, Dergipark, and Council of Higher Education Thesis Center databases through March 2022. Screening was performed according to the population, intervention, comparison, outcome and study type. This systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Review and meta-analyses (PRISMA-2020) statement. RESULTS: Eight RCTs involving 551 patients were included in the meta-analysis. Probiotic use in women with gestational diabetes significantly decreased fasting blood glucose (mean difference: -1.43; 95 % CI: -2.78 to -0.09, p: 0.04) and serum insulin (mean difference: -3.66; 95 % CI: -5.04 to -2.27, p < 0.001). Moreover, the use of probiotics and synbiotics significantly reduced the HOMA-IR level compared to the control group (probiotic group: mean difference: -0.74; 95 % CI: -1.05 to -0.44, p < 0.001; synbiotic group: mean difference: -0.68; 95 % CI: -1.26 to -0.09, p: 0.02). CONCLUSIONS: The use of probiotics in women with GDM reduced fasting plasma glucose, fasting serum insulin, and HOMA-IR levels. In addition, the use of synbiotics decreased HOMA-IR. Probiotic/synbiotic use is promising as a potential therapy to assist in glycemic control in gestational diabetes. Further high-quality studies are required to determine their safety.

The Effect of Foot Care Education for Patients with Diabetes on Knowledge, Self-Efficacy and Behavior: Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to synthesize randomized controlled trials on the impact of foot care education on knowledge, self-efficacy and behavior in patients with diabetes. A search was made using PubMed, Web of Science, Science Direct, Google Scholar, YOK National Thesis Center and Google Scholar electronic databases for studies published between March 2003-January 2022. The search medical subject headings (MeSH) terms were diabetic foot, knowledge, self-efficacy, and behavior. Studies suitable for the systematic review and the meta-analysis met the following criteria (PICOS): target participants would be diagnosed with diabetes (population), diabetic foot education (intervention), comparison of the group receiving diabetic foot care education and routine care education, and the control group receiving only routine care education (comparison), studies evaluating the levels of knowledge, self-efficacy and behavior (outcome), randomized controlled trials (study design). Twenty-six studies were included in systematic review. Three studies for knowledge, 5 studies for behavior, 8 studies for self-efficacy were included in the meta-analysis (total sample: 2534, experiment: 1464, control: 1071). All of the studies had low reporting bias. The mean duration of educations for knowledge was 5.2 months. This duration was 4.8 months for behavior and 4.5 months for self-efficacy. In the random effect (since the homogeneity test: P < .001, this model was used), there were significantly difference in terms of knowledge (standardized mean difference (SMD): 1.656, 95% [CI]: 1.014-2.299, P < .001), and behavior (SMD: 1.045, 95% CI: 0.849-1.242, P < .001). But no difference was observed in terms of self-efficacy (SMD: 0.557, 95%CI: -0.402-1.517, P > .05). The results of a systematic review of twenty-six studies and a meta-analysis of 9 studies showed that diabetic foot education improved the level of knowledge and behavior of patients with diabetes, while not affecting their self-efficacy. Educational interventions with long-term follow-up are needed to address the growing health care needs of patients with diabetes.

Effectiveness of the Use of Animation and Gamification in Online Distance Education During Pandemic.

The study aimed to determine the effects on knowledge and motivation of animation and gamification in online distance education for a diabetes nursing course. This study was a randomized, controlled, prospective study implemented with 70 nursing students. The animation and gamification were applied to the experimental group. Data were collected using the "Diabetes Nursing Knowledge Test," "Instructional Materials Motivation Survey," and "Opinion Form on Diabetes Education Supported by Digital Instruments." There was a statistical difference between the Diabetes Nursing knowledge scores of the groups after the course (P < .05). The students in the experimental group had significantly higher attention and satisfaction and total scores from the Motivation Scale for Teaching Material sub-dimensions compared with the control group (P < .001). The results of our study in generation Z nursing students demonstrated that the use of animation and gamification in online distance learning in nursing students increased their knowledge as well as motivation.

The effect of acupressure on sleep quality of older people: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND OBJECTIVE: The effects of acupressure on sleep quality and insomnia symptoms have been studied in various groups of haemodialysis patients, those undergoing surgery, and those living in elderly care homes. The aim of this study is to determine the effect of acupressure on sleep quality in elderly people. METHODS: This study was conducted with a systematic review and meta-analysis. In this study, electronic databases of PubMed, Science Direct, National Thesis centre, Google Scholar, Web of Science, EBSCO were systematically scanned between December 2020 and February 2021 using the keywords "older, elderly, sleep quality, acupressure". The study included 11 articles published in English and Turkish languages without any year limitation. This systematic review and meta-analysis were done by following the PRISMA reporting system. RESULTS: The total sample size of 11 randomized controlled trials included in this systematic review and meta-analysis was 722 (experiment: 363 and control: 359), and the mean duration of acupressure interventions applied was 19.65 ± 11.28 days. The sleep quality of the acupressure group in the elderly was significantly increased compared to the control group (MD: -1.71,%95 CI: -2.31 to -1.11, Z = 5.60, p< 0.00001, I2 = 91%). After the subjects received training for acupressure application and applied acupressure themselves, their sleep quality improved compared to the control group (MD: -0.86, 95% CI: -1.39 to -0.32, p <0.001). CONCLUSIONS: We have utilized meta-analysis to try to reveal statistical significance by pooling small studies with high quality. This meta-analysis provided a potentially effective intervention on the quality of sleep in elderly people.

Effect of animal assistant therapy on quality of life in older adults: A meta-analysis.

This meta-analysis was conducted to determine the effect of animal-assistant therapy on the quality of life of older adults. This research systematically searched electronic databases (CINAHL, Cochrane Central, Medline/PubMed, Web of Science, Science Direct, and the National Thesis Centre and ULAKBIM of the Council of Higher Education) for studies published between April - June 2021. Seven studies with experimental design were used, three were quasi-experimental and four were randomly controlled studies. The total sample size in the meta-analysis was 375 (experimental group: 177 and control group: 198). The mean duration of animal-assistant therapy was 38.5 ± 12.4 min. Animal-assistant therapy had a significant effect on the quality of life of older adults (mean difference: -4.59 p: 0.03, Z:2.23). Therefore, animal assistant therapy is an effective method to improve older adults' quality of life.

Breathing therapy and emotional freedom techniques on public speaking anxiety in Turkish nursing students: A randomized controlled study.

BACKGROUND AND OBJECTIVE: Public speaking is a common challenge that university students have to face. This study aims to determine the effects of Breathing Therapy and Emotional Freedom Techniques (EFT) on public speaking anxiety in Turkish nursing students. METHODS: This randomized controlled study included 76 nursing students. Data were collected using the Descriptive Characteristics Form, Subjective Units of Disturbance Scale, The State-Trait Anxiety Inventory, and the Speech Anxiety Scale. RESULTS: Before the administration of Breathing Therapy and EFT, the students' median scores from the Subjective Units of Disturbance Scale, the State-Trait Anxiety Inventory, and the Speech Anxiety Scale were similar. However, the median scores of the Subjective Units of Disturbance Scale, the State-Trait Anxiety Inventory, and the Speech Anxiety Scale scores significantly decreased in both of the experimental groups after the interventions (p <0.001). EFT (d = 3.18) was more effective than Breathing Therapy (d = 1.46) in reducing Speech anxiety. CONCLUSION: It was found that Breathing Therapy and EFT are effective methods to reduce stress, anxiety, and speaking anxiety.

The effect of affective learning on alexithymia, empathy, and attitude toward disabled persons in nursing students: A randomized controlled study.

PURPOSE: To evaluate the effect of affective learning on alexithymia, empathy, and attitude toward disabled persons in nursing students. DESIGN AND METHODS: This prospective, randomized, controlled trial study was implemented among 70 nursing students. Based on transformative learning theory, the affective learning method was applied to the intervention group. Toronto Alexithymia Scale (TAS), Empathic Tendency Scale (ETS), and Attitudes Toward Disabled Person Scale (ATDPS) were administered to both groups. RESULTS: The intervention group showed a statistically and significantly lower score at TAS and higher score at ATDPS compared to the control group, whereas no statistically significant difference was found in ETS score. PRACTICE IMPLICATIONS: Affective learning methods could be implemented in the nursing course for improving students' attitude toward disabled persons, and reducing alexithymia.

Immunization in health employees: Relationship of confidence and attitude.

This is a cross-sectional online survey study performed to identify whether the health employees' confidence in the vaccine besides their confidence in the administrators about the vaccine had any effect on their attitudes toward the vaccine. The study was carried out on February 2021 with the participation of 402 health employees working in the pandemic hospitals. Approximately 33% of the participant health employees stated that they did not think of being vaccinated during the COVID-19 pandemic. Insufficient testing for the vaccines that are developed to fight against pandemics, having fear about their side effects, and finding them unreliable give rise to vaccine hesitancy in health employees. Besides, it was identified that the health employees' confidence in the vaccines and their confidence in the administrators about the vaccines affected their attitudes toward vaccination.

The Level of Ruminative Thought and Alexithymia of People in the COVID-19 Pandemic Process.

OBJECTIVE: The COVID-19 pandemic process caused many physiological and psychological effects on individuals. This study aims to examine the ruminative thinking and alexithymia levels of people in the COVID-19 pandemic process. METHODS: The descriptive, cross-sectional, and the correlational designed study was conducted with 852 people in ?stanbul\Turkey during the COVID-19 pandemic process between March and May 2020. The data of the research was collected with the Sociodemographic Form Toronto Alexithymia Scale and Ruminative Thought Style Questionnaire. RESULTS: It was found that the average of ruminative thought score of the people was 92.49±19.89 and the alexithymia score average was 71.76±13.70. A positive and significant relationship was found between the Ruminative Thought Style Questionnaire and the Toronto Alexithymia Scale and subscale scores (p<0.05). According to the results, ruminative thinking levels were affected by 12% alexithymia level and 9% time spent on conversation. A statistically significant relationship was found between rumination, alexithymia, and its sub-dimensions and the number of times people spend for conversation during the day and the number of people they live with (p<0.05). It was determined that those living with family/friends were lower than those who were alone, and those with good communication in relationships had lower rumination and alexithymia (p<0.05). CONCLUSION: Care should be taken against alexithymia and rumination during the COVID-19 pandemic process, and attention should be given to interpersonal relationships, conversation, and communication in the quarantine process.

Changes in Sexual Functions and Alexithymia Levels of Patients with Type 2 Diabetes During the COVID-19 Pandemic.

This study was conducted to determine the changes in sexual functioning and alexithymia levels in patients with type 2 diabetes during the COVID-19 pandemic. This descriptive, cross-sectional study was conducted with 162 patients with type 2 diabetes. Data were collected using the Information Form, Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale. For 83.3% of the participants, there was a decrease in sexual functioning after diabetes, 69.8% after the COVID-19 pandemic, and 67.2% due to both conditions. The majority of the patients stated the reasons for experiencing sexual problems related to not seeing sexuality as a priority (77.1%), and stress/anxiety experienced during the COVID-19 pandemic (67.9%). Moreover, patients' alexithymia, anxiety, and depression levels were found to be high during the pandemic, when the study was conducted. A positive correlation was identified between alexithymia and anxiety and depression. Further, multiple regression results indicated that about 50% of alexithymia levels could be explained by anxiety and depression levels. The anxiety, depression, and alexithymia scores of those who had decreased sexual functioning before and during the pandemic period were statistically significantly higher than those who did not have any change (p < 0.01). During the COVID-19 pandemic when the study was conducted, high levels of alexithymia, anxiety, and depression were observed in participants, and it was found that their sexual functioning was negatively affected. Healthcare professionals should evaluate their patients in extraordinary situations such as epidemics and pandemics in terms of sexual functioning as well as other vital functions.

Shotblocker Use in Emergency Care: A Randomized Clinical Trial.

This study was conducted to evaluate the effect of ShotBlocker on the intramuscular injection pain and satisfaction in emergency adult patients. This research was designed as a randomized controlled, double-blind, experimental study. The study was conducted with 74 patients who applied to the adult emergency department. Patients were randomized to ShotBlocker and control groups. Patient Assessment Form, Visual Analog Scale, and Visual Analog Patient Satisfaction Scale were used. The mean scores of postinjection pain and satisfaction level were analyzed between the groups; it was determined that while postinjection pain mean score of the experimental group was statistically significantly lower than that of the control group (p = 0.0001), satisfaction scores were statistically significantly higher in the experimental group than in the control group (p = 0.004). When the correlation between the intragroup Pain Scores (VAS) and the Satisfaction Scores (VAS) of the groups after injection was examined, a statistically significant and inverse correlation was found (p < 0.05). It was determined that ShotBlocker was effective in reducing intramuscular injection pain and increasing satisfaction levels.

Validity and reliability of the Turkish version of brief diabetic foot ulceration risk checklist.

OBJECTIVE: This study aims to determine the validity and reliability of the Turkish translation of brief diabetic foot ulceration risk checklist (BDURC). METHODS: This methodological study was conducted at the diabetes clinic of a state hospital in Istanbul, Turkey. The data were collected with the BDURC developed by Zhou et al. in 2018. A study was conducted with 430 patients with Type 2 diabetes. The scale was retested after 4 weeks by 60 participants. Language equivalence of the scale was provided. Experts' opinions were taken about the content validity of the scale. Reliability of the scale was determined with the test-retest reliability, item-total correlation, and internal consistency analysis. RESULTS: Confirmatory factor analysis revealed a two-factor structure with good model suitability. Cronbach's alpha coefficient for the scale and its subscales was 0.79. Test-retest scores showed no statistically significant difference between the items (p>0.05). The reliability index was higher than 0.80. CONCLUSION: The BDURC-TR is a valid and reliable tool that can be used in clinics to identify the risk factors for diabetic foot ulcers in patients with Type 2 diabetes in Turkey.

The effect of vibration stimulation on intramuscular injection pain and patient satisfaction: Single-blind, randomised controlled study.

AIMS AND OBJECTIVES: The aim of this study was to assess the effect of vibration stimulation application in ventrogluteal region on intramuscular injection pain and patient satisfaction. BACKGROUND: Intramuscular injection pain caused distress for the patients and affected their compliance with the treatment. DESIGN: This was a prospective, single-blind, cross-over study. The study complied with the guidelines of Consolidated Standards of Reporting Trials (CONSORT). METHODS: Eighty-four patients who applied to the adult emergency department received an intramuscular injection of amoxicillin\ cefuroxime sodium to the ventrogluteal site with and without vibration in a random order following a standard procedure by the same investigator. Pain and satisfaction were assessed immediately after the injection with Visual Analogue Scale (VAS), by a researcher blinded to the study. The data were evaluated using mean, standard deviation, percentage, Student's t-test, paired sample t-test, linear regression analysis and generalised linear mixed model. RESULTS: A total of 174 injections were analysed. The result of the study revealed that vibration decreased the severity of pain and increased the patient satisfaction. CONCLUSIONS: Vibration is a non-pharmacologic approach, which can be effective in decreasing the injection pain and increasing patient satisfaction. RELEVANCE TO CLINICAL PRACTICE: Intramuscular injection is the most frequently used nursing practice in the clinic. The use of vibration in decreasing pain due to intramuscular applications can help increase the self-confidence of nurses and the quality of the care they provide.

The effect of Emotional Freedom Techniques on nurses' stress, anxiety, and burnout levels during the COVID-19 pandemic: A randomized controlled trial.

BACKGROUND AND OBJECTIVE: Infectious disease outbreaks pose psychological challenges to the general population, and especially to healthcare workers. Nurses who work with COVID-19 patients are particularly vulnerable to emotions such as fear and anxiety, due to fatigue, discomfort, and helplessness related to their high intensity work. This study aims to investigate the efficacy of a brief online form of Emotional Freedom Techniques (EFT) in the prevention of stress, anxiety, and burnout in nurses involved in the treatment of COVID patients. METHODS: The study is a randomized controlled trial. It complies with the guidelines prescribed by the Consolidated Standards of Reporting Trials (CONSORT) checklist. It was conducted in a COVID-19 department at a university hospital in Turkey. We recruited nurses who care for patients infected with COVID-19 and randomly allocated them into an intervention group (n = 35) and a no-treatment control group (n = 37). The intervention group received one guided online group EFT session. RESULTS: Reductions in stress (p < .001), anxiety (p < .001), and burnout (p < .001) reached high levels of statistical significance for the intervention group. The control group showed no statistically significant changes on these measures (p > .05). CONCLUSIONS: A single online group EFT session reduced stress, anxiety, and burnout levels in nurses treating COVID-19.