Vaccination status of COVID-19 patients followed up in the ICU in a country with heterologous vaccination policy: A multicenter national study in Turkey.

OBJECTIVE: Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-2) prevents the development of serious diseases has been shown in many studies. However, the effect of vaccination on outcomes in COVID-19 patients requiring intensive care is not clear. METHODS: This is a retrospective multicenter study conducted in 17 intensive care unit (ICU) in Turkey between January 1, 2021, and December 31, 2021. Patients aged 18 years and older who were diagnosed with COVID-19 and followed in ICU were included in the study. Patients who have never been vaccinated and patients who have been vaccinated with a single dose were considered unvaccinated. Logistic regression models were fit for the two outcomes (28-day mortality and in-hospital mortality). RESULTS: A total of 2968 patients were included final analysis. The most of patients followed in the ICU during the study period were unvaccinated (58.5%). Vaccinated patients were older, had higher Charlson comorbidity index (CCI), and had higher APACHE-2 scores than unvaccinated patients. Risk for 28-day mortality and in-hospital mortality was similar in across the year both vaccinated and unvaccinated patients. However, risk for in-hospital mortality and 28-day mortality was higher in the unvaccinated patients in quarter 4 adjusted for gender and CCI (OR: 1.45, 95% CI: 1.06-1.99 and OR: 1.42, 95% CI: 1.03-1.96, respectively) compared to the vaccinated group. CONCLUSION: Despite effective vaccination, fully vaccinated patients may be admitted to ICU because of disease severity. Unvaccinated patients were younger and had fewer comorbid conditions. Unvaccinated patients have an increased risk of 28-day mortality when adjusted for gender and CCI.

Unmet health and social care needs and associated factors among older people aged ≥ 80 years in Izmir, Turkey.

BACKGROUND: The health and social care needs of people aged ≥ 80 years are a neglected topic. AIMS: To determine the prevalence of unmet health and social care needs and associated factors in community-dwelling individuals aged ≥ 80 years in Izmir District of Balçova, Turkey. METHODS: There were 1075 participants aged ≥ 80 years. The dependent variables were unmet health and social care needs. Independent variables were sociodemographic, socioeconomic and lifestyle characteristics. The data were collected in face-to-face interviews conducted at the homes and analysed by multiple logistic regression model. Ethical approval was obtained from the Non-Invasive Research Ethics Board of Dokuz Eylul University Medical Faculty (2017/26-24). RESULTS: The mean age was 84.1 (3.7) years and 61.0% were female. Healthcare needs were expressed by 88.2% of the participants and 78.9% claimed that they had social care needs. Prevalence of unmet health and social care needs was 32.5% and 46.6%, respectively. Approximately 90.0% of their needs were covered by families. Perceived low-income status was a risk factor for unmet healthcare needs, and lack of social support was a risk factor for unmet social care needs. Additionally, not receiving formal education was a protective factor in unmet social care needs. CONCLUSION: Public health policy should be developed to enable better access to care, especially for the oldest people, considering that nearly one third of the participants in this study had unmet healthcare needs and almost half had unmet social care needs.

Neurology consultations in the intensive care units.

OBJECTIVE: Critical treatment and management have advanced over the recent decades, bringing many benefits but also causing increasing complication rates. Among these complications, neurological complications have an important place and may increase in mortality rates. The aim of our study was to find the causes of neurological consultations in the level 3 adult intensive care units (ICU). METHODS: The study population consisted of patients who were requested to have neurology consultation in the level 3 Adult ICUs between April 2013 and April 2017. The records in the hospital automation system of patients required neurology consultation were evaluated retrospectively. RESULTS: A total of 906 neurology consultations were requested in ICUs and 302 patients were included in this study. Altered consciousness and unconsciousness (32.1%), seizure (26.5%), management and treatment (15.9%) were the most common reasons for neurological consultations. Epileptic seizures (16.9%), status epilepticus (9.3%) and ischemic stroke (8.6%) were the most common final neurological diagnoses after consultation. Wernicke encephalopathy, posterior reversible encephalopathy syndrome, motor neuron disease, Creutzfeldt-Jakob disease, critical illness polyneuropathy and critical illness myopathy were less frequently diagnosed (< 1%). The diagnostic benefit was 83.1%. Treatment change following neurological consultation occurred in 56.6% of the patients. CONCLUSIONS: In our study, spanning a period of 4 years, the most common diagnoses were epileptic seizure, status epilepticus, and ischemic stroke. More frequent complications, such as stroke and seizure, as well as less common complications such as Wernicke's encephalopathy and posterior reversible encephalopathy syndrome, should be intervened immediately. In case of consultation, neurologists should be able to manage neurological complications as a consultant physician in the early period and evaluate the ICU patient systematically and be familiar with the complexity of intubation, sedation and sometimes paralyzed intensive ICU patients who have had severely limited routine clinical evaluations.

Occupational class and educational level inequalities in major cardiovascular risk factors in Turkey: 2008-2016.

BACKGROUND: We aimed to investigate the magnitude of occupational class (OC) and educational level (EL) inequalities in cardiovascular risk factors in Turkey from 2008 to 2016 and compare these inequalities with neighbouring European countries. METHODS: We used the Turkey Health Survey among a representative sample of the Turkish population. We estimated relative index of inequality (RII) for four cardiovascular risk factors (obesity/overweight, hypertension, diabetes, smoking) by OC/EL with an interaction term for survey year and compared selected results with neighbouring countries. RESULTS: Men with lower OC and EL smoked more (e.g. RII for EL = 1.40 [1.26-1.55]); however, the remaining risk factors were mostly lower in these groups. Women in lower socio-economic groups smoked less (e.g. RII for EL = 0.36 [0.29-0.44]), however, had higher prevalence of the remaining risk factors. Significant interactions with survey year were only found in a few cases. The pattern of inequalities in Turkey is largely similar to neighbouring countries. CONCLUSIONS: Inequalities in cardiovascular risk factors are less systematic in Turkey than in most high-income countries, but ongoing trends suggest that this may change in the future.

The prevalence of sarcopenia risk and associated factors in patients aged 65-79 years living in a district of Izmir province of Turkey.

OBJECTIVES: This study aims to investigate the prevalence of sarcopenia risk and associated factors in a community-dwelling elderly population in a district of Izmir province of Turkey. PATIENTS AND METHODS: This cross-sectional study used a cluster sampling method to define sarcopenia risk and associated factors in population aged 65-79 years in Balcova district and a total of 254 participants (114 males, 140 females; mean age 70.0 years; range 65 to 79 years) were included between October 2014 and December 2014. The dependent variables were low gait speed (LGS), low grip strength (LGrS), having both LGS and LGrS, sarcopenia risk according to the European Group on Sarcopenia for Older People (EWGSOP) algorithm. The independent variables were socio-demographic and socio-economic variables, health-related behavioral factors, and health status variables. The gait speed was measured on a four-meter length with a stopwatch. The grip strength was measured using a hand-held dynamometer. The logistic regression models were used to identify associated risk factors for sarcopenia. RESULTS: The prevalence of LGS was found to be 45.0%, LGrS to be 49.8%, having both LGS and LGrS to be 30.1%, and sarcopenia risk according to EWGSOP to be 64.8%. The main associated factors of having any sarcopenia risk were increasing age and having a sedentary lifestyle or being underactive. CONCLUSION: Our study results show that sarcopenia risk is high in a community-dwelling elderly population living in Balcova district of Izmir province of Turkey. Physical activity levels of elderly should be increased to decrease this high burden.

Falls, fear of falling and related factors in community-dwelling individuals aged 80 and over in Turkey.

OBJECTIVE: This study aimed to determine the prevalence of falls, fear of falling (FOF) and related factors in individuals aged 80 and over living in the Balçova district of Izmir. METHODS: One thousand and seventy-five individuals aged 80 years or older participated. The dependent variables were falls and fear of falling. The independent variables were socio-demographic and socio-economic characteristics, health-related characteristics and 'safety status of home' features. RESULTS: The participants' mean age was 84.1 ± 3.7 (range, 80-101) years, and 60.8% were female (n = 582). The prevalence of falls was 35.4% in the last year, and fear of falling was 86.6%. The risk factors for falls were number of chronic diseases, moderate and high fall risk, sleep disturbance and slippery bathroom floors, whilst for fear of falling they were number of chronic diseases, female gender, living alone and moderate or high fall risk. CONCLUSION: A monitoring program is indicated to address high fall and fear of falling prevalence among people aged 80 and over.

Does lymph node localization affect prostate-specific membrane antigen uptake?

OBJECTIVE: To investigate the relationship between lymph node (LN) size and localization and prostate-specific membrane antigen (PSMA) uptake in patients with prostate cancer. PATIENTS AND METHODS: Between February 2015 and February 2017, a total of 178 patients diagnosed with prostate adenocarcinoma by gallium-68 PSMA PET/computed tomography were evaluated. Seventy-eight patients with LN PSMA uptake were included in the study.The short-axis diameter and maximum and mean standardized uptake values (SUV) were measured from axial images of LNs with PSMA uptake. LN conglomerates were considered a single lesion. Patients were divided into two groups according to the presence (group 1) or absence (group 2) of bone uptake in addition to the LN uptake; subgroups were constituted according to the short-axis diameter and PSMA-positive LN region for each group. LNs were classified according to their localization as pelvic, abdominal, or cervical/thoracic. RESULTS: In both groups, the SUV were significantly higher in LNs with short-axis diameters more than 8 mm than those with diameters up to 8 mm (P < 0.001 and < 0.001, respectively). Also, both groups showed a moderate correlation between the LN size and SUV.When the analysis was carried out according to the localization, but after excluding the LN conglomerates, the correlation between the pelvic and abdominal LNs was higher in the second group. CONCLUSION: The highest significant positive correlation between LN size and SUV was in patients with pelvic and abdominal LN metastases without bone involvement according to the gallium-68 PSMA PET/computed tomography images in our study.

Violation of the Tobacco Control Law by Drivers in Vehicles in Two Streets in Izmir: A Descriptive Study.

OBJECTIVES: After signing and approving the Framework Convention on Tobacco Control (FCTC), Turkey amended laws on tobacco control in 2008 and also expanded the smoking ban in 2013 to include drivers in all vehicles. Four years later, this amendment does not seem as effective. The aim of this study was to observe violation of the law by the drivers and to analyze the association between gender of the driver, type of the vehicle, approximate age group definition of the passenger (either child or adult), and the law violation in two streets in Konak district, Izmir, Turkey. MATERIALS AND METHODS: In this cross-sectional study, two observer teams were located in two different busy streets on the same afternoon and they collected data on the violation of the law, gender of the driver, approximate age group definition of the passengers (either adult or child), and type of the vehicle (special, taxi, or other commercial). Logistic regression for the violation of the law was conducted. RESULTS: Law violation prevalence is 7.2%. In univariate analysis, the gender of the driver and having at least one child as a passenger were associated with the violation of the law. In multivariate analysis, not having children increases (OR: 8.4) the risk of the violation of the law. CONCLUSION: The violation of the law was high, but the drivers seemed to be aware of the harms of smoking by looking at the increased risk of the violation in vehicles, in which no child was carried as passengers.