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BACKGROUND: The Family Caregiver Medication Administration Hassles Scale (FCMAHS) was developed to evaluate the hassles and concerns experienced by family caregivers in medication administration. OBJECTIVE: This study aimed to evaluate the reliability and validity of the Turkish version of the Family Caregiver Medication Administration Hassles Scale (FCMAHS-TR). METHODS: The FCMAHS-TR was developed after translation, cultural adaptation, and a pilot study. The cross-sectional study was conducted among family caregivers (≥18 years) in community pharmacies. Test-retest reliability analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were performed. Hypothesis testing was used for the assessment of construct validity. RESULTS: The majority (68.7%) of the family caregivers were female (n = 470). In the test-retest reliability analysis (n = 30), the ICC value was 0.917 (P < 0.001). In EFA analysis (n = 251), the KaiserâMeyerâOlkin (KMO) measure was 0.799, 62.6% of the total variance was explained by five factors including eighteen items, and Cronbach's alpha was 0.836. According to CFA (n = 219), the root mean square error of approximation (RMSEA) was 0.0654, and the comparative fit index (CFI) was 0.918. In construct validity, family caregivers with low reading ability of health-related materials and with high care burden had significantly higher median scores for all the factors of the FCMAHS-TR (P < 0.05 for all). CONCLUSIONS: The FCMAHS-TR can be used to evaluate the hassle and concerns experienced by family caregivers in medication administration. This scale can be used by healthcare professionals to identify family caregivers who need individualized interventions for medication administration hassles.
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Cuidadores , Psicometria , Humanos , Feminino , Masculino , Reprodutibilidade dos Testes , Estudos Transversais , Turquia , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto , Análise Fatorial , Idoso , Projetos Piloto , Estresse Psicológico , TraduçõesRESUMO
PURPOSE: The aim of this study was to evaluate the validity and reliability of the Turkish version of the Medication Practical Barriers to Adherence Questionnaire (MPRAQ-TR). METHODS: This is a validation study conducted between August 2022 and March 2023 in the ambulatory services of a secondary care private hospital located in Istanbul, Türkiye, among patients (18 years of age and older) with chronic diseases. After the Turkish translation and cultural adaptation of the MPRAQ, and a pilot think-aloud study, the following psychometric properties were assessed: internal consistency by calculating the Cronbach's alpha coefficient, 2-week test-retest reliability, convergent validity by calculating Spearman's rank correlation between the MPRAQ-TR and the Turkish version of Medication Adherence Report Scale (MARS), and predictive validity by evaluating the association between the MPRAQ-TR score and nonadherence to medications. RESULTS: Among the 380 patients (response rate = 89.6%), 72.1% were nonadherent to their medications. The intraclass correlation coefficient was 0.99 for MPRAQ-TR scores (95% CI, 0.98-0.99; p < 0.001). The Cronbach's alpha of the MPRAQ-TR was 0.853. There was a moderate negative correlation between the scores on the MARS and the MPRAQ-TR (Spearman's rho = - 0.525; p < 0.01), supporting the convergent validity of the MPRAQ-TR. In the univariate analysis, the total score of MPRAQ-TR was associated with increased odds of nonadherence to medications (p < 0.01). CONCLUSION: MPRAQ-TR shows good psychometric properties and can be used to evaluate the practical adherence barriers of patients with chronic diseases.
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Radiographic progression in Ankylosing spondylitis (AS) is driven by mechanical strain. A well-balanced spine provides a favorable weight distribution across the entheses. Pelvic parameters are useful in assessing the shape of the spine. The present study aimed to prospectively investigate the predictive value of pelvic parameters for radiographic progression in AS. This non-interventional, observational, and prospective study enrolled AS patients fulfilling the modified New York criteria (mNY) currently under follow-up in the MARS (MARmara Spondyloarthritis) outpatient clinics. The primary objective was to investigate the relationship between the baseline pelvic parameters and radiographic progression in the spine. Two trained radiologists (EB, OB) independently assessed the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). An orthopedic surgeon (AHA) and a radiologist (EB) derived the pelvic parameters. Patients with no bridging or bamboo spine were included in the final analysis. Risk assessment for radiographic progression, defined as a two-unit increase in mSASSS or developing a new syndesmophyte every two years, was done using uni- and multivariate logistic regression analyses. Radiographs of 69 AS patients were analyzed. The median (IQR 25-75) prospective follow-up was 47.7 (34.6-52.8) months. Only 33.3% (23/69) had radiographic progression. The pelvic tilt (PT) was lower in patients with radiographic progression (p = 0.037) and each degree of decrease in PT provided a 9% increase in risk for radiographic progression. Male patients were 7.5 times more likely to progress. Pelvic parameters provide a prognostic insight into the radiographic progression in AS. Our observations may aid in selecting patient-specific interventions in addition to anti-inflammatory treatments.
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OBJECTIVES: COVID-19 escalated inappropriate antibiotic use. We determined the distribution of pathogens causing community-acquired co-infections, the rate, and factors associated with early empiric antibiotic (EEAB) treatment among hospitalized COVID-19 patients. METHODS: The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry including 68,428 patients from 28 countries enrolled between January 2020 and October 2021 were screened. After exclusions, 7830 patients were included in the analysis. Azithromycin and/or other antibiotic treatment given within the first 3 days of hospitalization was investigated. Univariate and multivariate analyses were performed to determine factors associated with EEAB use. RESULTS: The majority (6214, 79.4%) of patients received EEAB, with azithromycin combination being the most frequent (3146, 40.2%). As the pandemic advanced, the proportion of patients receiving EEAB regressed from 84.4% (786/931) in January-March 2020 to 65.2% (30/46) in April-June 2021 (P < 0.001). Beta-lactams, especially ceftriaxone was the most commonly used antibiotic. Staphylococcus aureus was the most commonly isolated pathogen. Multivariate analysis showed geographical location and pandemic timeline as the strongest independent predictors of EEAB use. CONCLUSIONS: EEAB administration decreased as pandemic advanced, which may be the result of intensified antimicrobial stewardship efforts. Our study provides worldwide goals for antimicrobial stewardship programs in the post-COVID-19 era.
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COVID-19 , Infecções Comunitárias Adquiridas , Humanos , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Ceftriaxona/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Sistema de RegistrosRESUMO
Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear. Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19. Study Design: Multicenter prospective observational clinical study. Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated. Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004). Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.
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Vacinas contra COVID-19 , COVID-19 , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Estado Terminal , VacinaçãoRESUMO
Background: The American Thoracic Society (ATS) Methods in Epidemiologic, Clinical, and Operations Research (MECOR) Program aims to build research capacity in low and middle-income countries. MECOR has three levels, during which students learn to develop a research protocol and write a manuscript. MECOR Turkiye has been offered every year since 2008. Objective: The aim of this paper is to report the number and impact of published articles generated from research questions developed by students in levels 1, 2, and 3 of the ATS MECOR Program in Turkiye between 2008 and 2018. Methods: We collected the research questions developed in all levels of the ATS MECOR Program in Turkiye between 2008 and 2018. We searched Google Scholar, PubMed, Web of Science, and ResearchGate in April 2022 to see how many of these research questions were published as articles and, if published, in which journals. Results: Of the 176 research questions collected, 49 had been developed in level 1, 82 had been developed in level 2, and 45 had been developed in level 3. Of those 176 research questions, 55 (31.3%) generated articles that were accepted for publication. The frequency of published articles based on MECOR-developed research questions increased linearly as the course level in which they were developed increased (18.4% in level 1, 30% in level 2, 46.7% in level 3; P = 0.012; linear-by-linear association, P = 0.003). The median time from the development of the research question to publication was three years overall and did not differ significantly among the course levels (P = 0.36). Of the research questions developed, 43 were published in Science Citation Index or Science Citation Index Expanded-indexed journals. Conclusion: Acceptance of an article for publication is one way to measure the impact of the ATS MECOR Program. Our data describe significant research output among our participants, which increases with their length of participation in the program.
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BACKGROUND AND OBJECTIVES: Evidence of immune response to COVID-19 vaccine in psoriasis patients on biological agents is lacking. This study aimed to evaluate SARS-CoV-2 antibody levels following vaccination with CoronaVac or Pfizer/BioNTech mRNA in patients using biological agents or methotrexate, high-titer antibody levels achievement rate, and impact of medications on immunogenicity. METHODS: This noninterventional, prospective cohort study included 89 patients and 40 controls vaccinated with two doses of inactivated (CoronaVac) or Pfizer/BioNTech mRNA vaccines. Anti-spike and neutralising antibodies were analysed before and three to six weeks after the second dose. Adverse effects and symptomatic COVID-19 were assessed. RESULTS: Median anti-spike and neutralising antibody titers after CoronaVac were significantly lower in patients than controls (57.92 U/mL vs 125.4 U/mL, and 1/6 vs 1/32, respectively, p < 0.05). Patients were less likely to achieve high-titer anti-spike antibody levels (25.6 % vs 50 %). Infliximab was associated with attenuated vaccine response. Pfizer/BioNTech vaccine induced comparable median anti-spike (2,080 U/mL vs 2,976.5 U/mL,) and neutralising antibody levels (1/96 vs 1/160) in patients and controls, respectively (p > 0.05). High-titer anti-spike and neutralising antibodies development rates were comparable among patients and controls (95.2 % vs 100 %, and 30.4 % vs 50.0 %, respectively, p > 0.05). Nine (10.1 %) COVID-19 cases- all mild - were identified. Psoriasis flare was seen in 6.74 %, mostly after Pfizer/BioNTech vaccine. CONCLUSION: Psoriasis patients treated with biological agents and methotrexate developed similar response to mRNA vaccine but weaker response to inactivated vaccine. Infliximab reduced response to the inactivated vaccine. Adverse effects were more frequent with mRNA vaccine, but none was severe.
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Vacinas contra COVID-19 , COVID-19 , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Psoríase , Humanos , Anticorpos Neutralizantes , Anticorpos Antivirais , Fatores Biológicos , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Imunogenicidade da Vacina , Infliximab , Metotrexato , Estudos Prospectivos , Psoríase/tratamento farmacológico , SARS-CoV-2 , Vacinas de Produtos InativadosRESUMO
Objectives: This study aimed to develop a Turkish scale to assess medication literacy and to evaluate its psychometric properties among adults having at least 12 years of education in Türkiye. Materials and Methods: After the composition of a preliminary set of items, the content validity of the scale was assessed by an e-Delphi process and a pilot study. The psychometric properties of the scale were evaluated in 358 participants, who had above 12 years of education: university students, academics and, administrative staff from two faculties (pharmacy and law) in two universities located in two major cities (Istanbul and Ankara) in Türkiye between March and May, 2021. The test-retest validity was assessed by Spearman's rho and Wilcoxon test. Internal consistency was evaluated by Kuder Richardson 20. Principal component analysis was conducted. Results: The last version of the medication literacy scale consisted of 8 items. There was a positive correlation (Spearman's rho: 0.570; p<0.01) and no significant difference (p=0.308) between the scores of the scale at baseline and after a two-week interval. Kuder Richardson 20 coefficient was 0.659. Students and graduates of health sciences and participants with high reading ability of health-related information had significantly higher scores on the medication literacy scale (p<0.001). Conclusion: Turkish version of the Medication Literacy Scale for Adults is a valid tool for evaluate medication literacy among adults, who have above 12 years of education in Türkiye. The generalizability of our findings should be evaluated with caution since this study was conducted in a sample with a significant representation from healthcare professionals. It would be useful to conduct further studies evaluating the psychometric properties of this scale in participants with diverse characteristics.
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INTRODUCTION: Polygraphy (PG) can be used as an alternative test for the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. Night-to-night variability of PG in children is not known. Our aim was to determine whether a single night PG was reliable for OSAS diagnosis in children with symptoms of sleep-disordered breathing (SDB). MATERIALS AND METHODS: Otherwise healthy children who had been evaluated for symptoms of SDB were included. Two nocturnal PGs were performed 2-7 days apart. Demographic and clinical characteristics, Pediatric Sleep Questionnaire, and modified Epworth Sleepiness Scale were recorded. OSAS was diagnosed if obstructive apnea-hypopnea index was (oAHI) ⩾ 1/h and classified as mild (oAHI: 1-4.9/h), moderate (oAHI: 5-9.9/h), and severe (oAHI ⩾ 10/h). RESULTS: Forty-eight patients were included (37.5% female, age 10.8 ± 3.9 years) to the study. There were no significant differences in oAHI values and other respiratory parameters between the two PGs (p > 0.05). Thirty-nine children were diagnosed with OSAS if the highest oAHI over any single night was used for diagnosis. Thirty-three of the 39 children (84.6%) were diagnosed with OSAS with the first PG while 35 of 39 (89.7%) children were diagnosed with OSAS with the second PG. There was an agreement for identifying OSAS and its severity between the two PGs in our study even though there were few individual intra-subject differences in oAHI. CONCLUSION: There was no significant first-night effect for PG in this study which suggests that a single night PG is adequate for diagnosis of OSAS in children with SDB- related symptoms.
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Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Criança , Humanos , Feminino , Adolescente , Masculino , Polissonografia , Síndromes da Apneia do Sono/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Sono , Testes PsicológicosRESUMO
Objective: The objective of this study was to evaluate and compare knowledge, attitude, and practice patterns between pulmonologists and allergists for adult asthma in Turkey.Methods: Questionnaire-based data were gathered from 236 pulmonologists and 62 allergists, who had been members of the Turkish Thoracic Society and Turkish National Society of Allergy and Clinical Immunology in January-March 2021. Univariate and multivariate statistics were used to determine the factors associated with primary reliever preferences.Results: Of the 298 physicians, 39% encountered at least five asthma patients daily. Spirometer was used frequently by both the allergists (82.3%) and pulmonologists (77.5%) for asthma diagnosis. Budesonide was the most preferred inhaler corticosteroid. Formoterol/budesonide was the most preferred ICS/LABA combination, followed by beclomethasone/formoterol and fluticasone/salmeterol for asthma treatment. For mild asthmatics, formoterol/ICS was the most preferred (72.6%) reliever among allergists, whereas salbutamol was the most preferred (66.1%) among pulmonologists (p < 0.001). Age and workplace were associated with salbutamol preference of doctors for mild asthmatics. Age, specialty, and patient examination time were significantly associated with salbutamol preference for severe asthmatics.Conclusions: The use of diagnostic tools, such as a spirometer, for asthma diagnosis was compatible with the guidelines. While recent updates of the guidelines indicate that salbutamol should not be used solely in mild asthmatics due to its harmful effects in long-term use, it still was the most preferred drug by pulmonologists. Postgraduate education programs are needed to improve compliance with the guidelines.
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Asma , Adulto , Humanos , Asma/diagnóstico , Asma/tratamento farmacológico , Pneumologistas , Alergistas , Conhecimentos, Atitudes e Prática em Saúde , Etanolaminas/uso terapêutico , Combinação de Medicamentos , Androstadienos/uso terapêutico , Albuterol/uso terapêutico , Budesonida/uso terapêutico , Fumarato de Formoterol/uso terapêutico , Administração por Inalação , Broncodilatadores/uso terapêuticoRESUMO
Objective: This study aimed to define the predictors of critical illness development within 28 days postadmission during the first wave of the COVID-19 pandemic. Materials and Methods: We conducted a prospective cohort study including 477 PCR-positive COVID-19 patients admitted to a tertiary care hospital in Istanbul from March 12 to May 12, 2020. Results: The most common presenting symptoms were cough, dyspnea, and fatigue. Critical illness developed in 45 (9.4%; 95% CI=7.0%-12.4%) patients. In the multivariable analysis, age (hazard ratio (HR)=1.05, p<0.001), number of comorbidities (HR=1.33, p=0.02), procalcitonin ≥0.25 µg/L (HR=2.12, p=0.03) and lactate dehydrogenase (LDH) ≥350 U/L (HR=2.04, p=0.03) were independently associated with critical illness development. The World Health Organization (WHO) ordinal scale for clinical improvement on admission was the strongest predictor of critical illness (HR=4.15, p<0.001). The patients hospitalized at the end of the study period had a much better prognosis compared to the patients hospitalized at the beginning (HR=0.14; p=0.02). The C-index of the model was 0.92. Conclusion: Age, comorbidity number, the WHO scale, LDH, and procalcitonin were independently associated with critical illness development. Mortality from COVID-19 seemed to be decreasing as the first wave of the pandemic advanced. Graphic Abstract: Graphic Abstract.
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INTRODUCTION: Plain packaging is one of the critical strategies in eliminating the promotion of tobacco products. Evidence indicates that plain packaging decreases the attractiveness of tobacco products and enhances the effectiveness of health warnings. This study aimed to explore the perceptions of undergraduate medical students of plain packaging and new pictorial warnings before they came into use in Turkey. METHODS: This qualitative study was carried out among undergraduate students in a Medical School in Istanbul in 2019. Participants were recruited through purposive sampling, and data were collected through focus group discussions. The participants were asked to discuss their perceptions regarding one original branded pack and ten plain package models. All discussions were audiotaped and thematic content analysis was conducted. RESULTS: A total of 72 students participated in the study. None of the students had seen plain packaging before. Most of the students perceived plain packaging as more favorable compared to the branded packs. The terms used to describe plain package were: 'appealing/desirable', 'attractive', 'beautiful', 'cool/eye-catching', 'charming', 'elegant', and 'special'. Some students indicated that they would have preferred plain packs over the branded ones if both types of products had been in the market and provided they were of the same brand. Pictorials had different impacts based on their content. At the same time, outer body deformities were perceived as 'real' and provoked unfavorable feelings; inner organ images were defined as 'imaginary' and had little to no impact. CONCLUSIONS: Plain packaging was perceived as a more attractive alternative to the conventional branded packs among most participants. We must be aware of the unforeseen effects of plain packaging among different subgroups in the new generations. We suggest using outer body deformities in the pictorials more frequently due to their higher impact.
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OBJECTIVES: The aim of this study was to analyze the perinatal outcomes of asymptomatic/uncomplicated SARS-CoV-2 infection during pregnancy and the relationship between gestational age at the time of infection and spontaneous preterm birth (PTB). MATERIAL AND METHODS: This was a retrospective cohort study. The study population included pregnant women who were 19-45 years old and who had been admitted to a Research and Training Hospital for singleton birth delivery. Women who had contracted SARS-CoV-2 during their pregnancy (n = 102) were compared to those who were not infected (n = 378) for the development of spontaneous PTB and other perinatal outcomes. The factors associated with spontaneous PTB were analyzed through univariate and multivariate methods. RESULTS: Spontaneous PTB developed in 22.5% of the pregnant women with a history of SARS-CoV-2 infection and in 5.3% without a history of the infection (p < 0.001). The multivariate model determined that compared to the non-infected women, the OR of spontaneous PTB among those who had contracted the virus in the first, second, and the third trimesters were 9.13 (p < 0.001), 1.85 (p = 0.292) and 7.09 (p < 0.001), respectively. Pregnancy cholestasis (3.9% vs 0.5%; p = 0.020) and placental abruption (3.9% vs 0.5%; p = 0.040) were significantly higher in cases with a history of SARS-CoV-2 infection compared to the non-infected women. CONCLUSIONS: Asymptomatic or uncomplicated SARS-CoV-2 infection during pregnancy increases the risk of spontaneous PTB. This risk is higher particularly among pregnant women who develop the infection in the first and the third trimesters.
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BACKGROUND: The objective of this study was to determine the trend of cancer-related death rates between 2009 and 2019 in Turkey for all cancers combined and the five cancer types with the highest mortality: lung, stomach, pancreas, breast, and colon cancers. METHODS: Cancer mortality data were obtained from the Turkish Statistical Institute (TURKSTAT) and standardized by age using the World Health Organization (WHO) standard population ratios. The change in cancer-related mortality over the years was evaluated using Joinpoint Regression Analysis (JRA). RESULTS: Total cancer-related deaths increased by 2.2% annually between 2009 and 2014 and decreased by 2.9% annually between 2014 and 2019 (p < 0.05). Among men; lung cancer-related deaths increased by 2.4% annually between 2009 and 2014 and decreased by 3.4% annually between 2014 and 2019 (p < 0.05), stomach cancer-related deaths decreased by 5.1% annually between 2014 and 2019 (p < 0.05), colon cancer-related deaths increased by 5.8% annually between 2009 and 2015 and decreased by 3.3% annually between 2015 and 2019 (p < 0.05), pancreatic cancer-related deaths increased annually by 5.6% in 2009-2013 (p < 0.05). Among women; lung cancer-related deaths increased by 2.5% annually between 2009 and 2016 (p < 0.05), stomach cancer-related deaths increased annually by 2.3% between 2009 and 2014 and decreased annually by 4.5% between 2014 and 2019 (p < 0.05), colon cancer-related deaths increased by 2.5% annually between 2009 and 2017 (p < 0.05), pancreatic cancer-related deaths increased by 7.4% annually between 2009 and 2013 (p < 0.05) and breast cancer-related deaths increased by 2.2% annually between 2009 and 2019 (p < 0.05). CONCLUSION: Mortality data in Turkey are collected only by TURKSTAT, which raises concern regarding the incompletion of the data. While this might lead to underestimation, the trend shows that there has been a decrease in total cancer-related deaths in Turkey. Pancreatic cancer, on the other hand, gains a higher proportion in cancer-related deaths in Turkey as in the world. Increasing deaths from lung and breast cancer in women remind of the importance of tobacco control interventions and cancer screening programs.
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Neoplasias da Mama , Neoplasias do Colo , Neoplasias Pulmonares , Neoplasias , Neoplasias Pancreáticas , Neoplasias Gástricas , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Mortalidade , Neoplasias/epidemiologia , Turquia/epidemiologiaRESUMO
WHAT IS KNOWN AND OBJECTIVE: There are no validated self-report measures to assess extent of and reasons for medication nonadherence in the Turkish language. The aim of this study is to evaluate validity and reliability of the Domains of Subjective Extent of Nonadherence Scale, which assesses extent of and reasons for nonadherence in Turkish patients with hypertension, diabetes mellitus and/or dyslipidaemia in community pharmacy settings. METHODS: The Turkish version of the DOSE-Nonadherence scale was developed through translation and cultural adaption. Psychometric properties of the scale were evaluated in a cross-sectional study among 203 patients who visited six community pharmacies located in Istanbul, Turkey between November 2020 and March 2021. For the extent of nonadherence domain, reliability was estimated through Cronbach's alpha, and convergent validity was evaluated with Spearman's rank correlation with the validated Turkish version of the Medication Adherence Report Scale (MARS). Reasons for nonadherence were characterized among participants reporting nonadherence to the extent of nonadherence items. The measure was administered at baseline and 2 weeks later to 30 patients to estimate stability of extent scores using the Wilcoxon test and intraclass correlation coefficient. p < 0.05 was set as the level of statistical significance. RESULTS: Among the 203 participants (65 male), the median (25th-75th percentiles) age was 59.0 years [51.0-67.0]. Cronbach's alpha for the extent of nonadherence scale was 0.86. A moderate negative correlation (r = -0.58; p < 0.001) was found between the extent of nonadherence scores and MARS, supporting convergent validity. The most common reasons for medication nonadherence were forgetfulness (22.5%) and mismatch between the patients' daily routine and medication taking (17.5%). The intraclass correlation coefficient was 0.97 for extent of nonadherence scores at baseline and 2 weeks (p < 0.001). WHAT IS NEW AND CONCLUSION: The DOSE-Nonadherence Scale could be used to identify nonadherent patients and their reasons for nonadherence in Turkish patients with chronic cardiometabolic conditions. This scale can be used to evaluate clinical pharmacist-led services to reduce medication nonadherence. Nonadherence could be recorded longitudinally in electronic health records to provide a more accurate picture of medication use. Pharmacists or other providers could administer interventions tailored to patients' reasons for nonadherence.
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Hipertensão , Idioma , Idoso , Estudos Transversais , Feminino , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , TurquiaRESUMO
Recent guidelines suggest non-biopsy serology-based approach for the diagnosis of celiac disease; however, there is no evidence-based data regarding noninvasive follow-up of mucosal healing. The aim of this study is to investigate the efficacy of serology in reflecting mucosal status in the follow-up of pediatric patients with celiac disease. This is a validation study conducted at a university hospital. Patients who had biopsy proven celiac disease (Marsh III) at diagnosis, and had been followed-up for at least 12 months, were prospectively evaluated with duodenal biopsies. tTG-IgA and EMA tests were performed on the day of endoscopy. One hundred four patients with a mean age of 7.4 ± 4.02 years were included in the study. The sensitivity and specificity of tTG-IgA were 85.2% and 61% respectively, with a high negative predictive value (NPV) of 92.2% but a very low positive predictive value (PPV) of 43.4%. We found that a cutoff value of 68.5 U/mL for tTG-IgA had a sensitivity, specificity of 85.2% and 85.7% respectively. The AUC was 0.891. The sensitivity and specificity of EMA was 77.8% and 87% respectively, with a high NPV of 91.8% but low PPV of 67.7%. CONCLUSION: This study suggests that negative tTG-IgA and/or EMA can be used as an indicator of mucosal improvement in the follow-up of pediatric patients with celiac disease. However, positive serology (i.e., < 10 × ULN) may be misleading in reflecting mucosal status in the follow-up of pediatric patients with celiac disease. WHAT IS KNOWN: ⢠The tissue transglutaminase IgA (tTG-IgA) and endomysium IgA (EMA) tests are widely used, sensitive and reliable diagnostic tests, but their role in monitoring adherence to dietary treatment in celiac patients has not yet been demonstrated. ⢠There is still no reliable and non-invasive marker of persistent villous atrophy or mucosal recovery. WHAT IS NEW: ⢠Negative celiac serology detected in the follow-up of pediatric patients with celiac disease was successful in demonstrating histopathological mucosal healing. ⢠Positive celiac serology, which is highly reliable in the diagnosis of celiac disease, has not been successful in reflecting mucosal status when used in the follow-up of pediatric patients with celiac disease.
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Doença Celíaca , Autoanticorpos , Doença Celíaca/diagnóstico , Criança , Pré-Escolar , Seguimentos , Proteínas de Ligação ao GTP , Humanos , Imunoglobulina A , Proteína 2 Glutamina gama-Glutamiltransferase , Sensibilidade e Especificidade , TransglutaminasesRESUMO
OBJECTIVE: This study aims to define the clinical characteristics and management strategies of children and adolescents presenting with psychiatric crises to the emergency department (ED) of a tertiary health care facility outside of working hours, and to identify predictors of multiple ED visits among them. METHODS: From January 2012 to December 2018, retrospective records of patients presenting with psychiatric symptoms to the ED and examined by a child psychiatrist after 5 p.m. on weekdays and for 24 h on weekends and public holidays were analyzed. RESULTS: Our sample consisted of 1576 visits and 1364 patient (Female:Male=1.8:1, mean age=14.86 ± 2.72). The most common reason for visits was self-injurious thought or behaviors (SITB), and the most common diagnosis was depression. While depression was statistically more common in girls, attention deficit hyperactivity disorder, autism and/or intellectual disability (ASD/ID), psychotic disorders, and bipolar disorder were more common in boys. The forensic evaluation was the most common reason for visits among children younger than 6 years old. Of visits, 23% transferred to hospitalization. A history of mental health contact was the lowest in depression (37.5%), psychosis (34.1%), and substance use disorders (33%). Of patients, 10.8% had multiple visits. A history of mental health contacts, conduct disorder, ASD/ID, bipolar disorder, psychotic disorder, and dissociative disorder were predictors of multiple visits to ED with psychiatric reasons. CONCLUSION: Emergency mental health care outside of regular working hours can be a critical step in the diagnosis and treatment of serious psychiatric disorders in children and adolescents.
Assuntos
Deficiência Intelectual , Transtornos Mentais , Adolescente , Criança , Serviço Hospitalar de Emergência , Feminino , Hospitalização , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Saúde Mental , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
BACKGROUND: E-cigarettes (ECs) are gaining popularity in Turkey among smokers. With the rapid increase of EC consumption, it is important to ascertain how family physicians (FPs) perceive ECs as they play a key role in providing smoking cessation services. AIM: Our main objectives were to determine FPs' level of awareness and harm reduction perceptions of ECs and to delineate the factors associated with their counseling practices. METHODS: This was a cross-sectional study with descriptive and analytical components. Data were collected through questionnaires. Questions mainly focused on demographic characteristics, knowledge and own use of ECs, general attitudes towards ECs, and daily practices while performing counseling on tobacco use. In order to control confounding factors, logistic regression analysis was performed. FINDINGS: Among a total of 271 FPs, 49.1% (n = 133) were males and the median age (IQR) was 41 years (32-46). Almost one-fifth of the FPs (n = 52) reported that they did not provide counseling services to their smoking patients. Only 26.6% (n = 72) of the FPs stated that they felt confident enough to advise patients on smoking cessation. Of the FPs, 6.6% have stated that they have recommended ECs to their patients for smoking cessation with the strategy of harm reduction. Factors associated with providers' recommendation of ECs to their patients as a harm reduction strategy included 'believing that ECs help smokers to quit, ECs could be vaped in closed areas, and ECs were healthier than combustible tobacco products'. CONCLUSION: In our study, FPs stated lack of confidence to advice patients on smoking cessation. Furthermore, they recommended ECs to their smoking patients as a harm reduction strategy. FPs' confidence should be increased with the trainings based on recent evidence on ECs.