How health literacy associates with healthcare utilization and health promotion behaviours in Turkey?: Contributions to discussions concerning the Anderson model and ecological models.

BACKGROUND: This study examined how health literacy (HL) levels are associated with health care utilization (HCU) and health promotion behaviours (HPB) in Turkey. METHODS: We conducted face-to-face interviews and utilised the Turkish HL Scale-32 (n = 6228). RESULTS: HL score was inversely related to the number of outpatient admissions (OAs) (ß = -0.001) and emergency department admissions (EAs) (ß = -0.006) in the Poisson regression model. Sex, age, perceived health, income group, and education level were other variables related to the number of OAs and EAs. Health literacy levels were related to physical activity (PA) (for excellent HL, OR: 3.93 (95% CI: 2.54-6.08)) and acquiring healthy eating habits (HEHs) (for excellent HL, OR: 3.56 (95% CI: 2.40-5.29) in the logistic regression model. Education levels are related to PA, HEHs, and smoking cessation or reduction. Income groups, except those with very sufficient income, are related to PA and HEHs. CONCLUSION: Improving HL can help reduce health admissions. The relationship of HCU with gender, age, education, perceived health, and income group supports the Anderson model. Limited HL groups should be prioritised as risk groups in health promotion programs. The association of HL and socio-economic variables with HPB supports the ecological model.

Risk Factors and Frequency of Ingrown Nails in Adult Diabetic Patients.

The present study evaluated the properties of nails, frequency of ingrown nails in patients with type 2 diabetes mellitus (DM), risk factors for developing ingrown nails, and effect of diabetic polyneuropathy and vasculopathy on the development and outcome of ingrown nails. Our 6-month epidemiologic prospective study included 300 patients with type 2 DM attending a DM outpatient clinic for routine examinations. The general characteristics and foot changes of the study population were investigated. Diabetic polyneuropathy and vasculopathy were evaluated using a biothesiometer, monofilament tests, and arterial Doppler ultrasonography. The frequency of ingrown nails was 13.6%. Multivariate analysis with logistic regression showed that body mass index (odds ratio [OR] 1.077, 95% confidence interval [CI] 1.007 to 1.15; p = .03), previous trauma (OR 2.828, 95% CI 1.017 to 7,867, p = .042), a weak dorsalis pedis pulse (OR 2.72, 95% CI 1.17 to 6.30, p = .02), trimming type (OR 2.3, 95 CI 1.06 to 4.98), p = .35), onychogryphosis (OR 9.036, 95% CI 2.34 to 34.87, p = .001), and subungual hyperkeratosis (OR 4.3, 95% CI 1.99 to 9.3, p = .001) were predictive variables for ingrown nails in our population. The incidence of onychomycosis was significantly greater in patients with ingrown nails (p = .032) than in patients without ingrown nails. The nail curvature ratio was greater in the patients with ingrown nails than in the group with normal nails. Arterial Doppler ultrasound examinations showed peripheral arterial disease in 19 patients (46.9%) with ingrown nails. The prevalence of ingrown nails was greater in the patients with DM than in the healthy population. Our results indicate that nail type, nail morphology, and diabetic vasculopathy affect the formation and evolution of ingrown nails.

Planar Indium Tin Oxide Heater for Improved Thermal Distribution for Metal Oxide Micromachined Gas Sensors.

Metal oxide gas sensors with integrated micro-hotplate structures are widely used in the industry and they are still being investigated and developed. Metal oxide gas sensors have the advantage of being sensitive to a wide range of organic and inorganic volatile compounds, although they lack selectivity. To introduce selectivity, the operating temperature of a single sensor is swept, and the measurements are fed to a discriminating algorithm. The efficiency of those data processing methods strongly depends on temperature uniformity across the active area of the sensor. To achieve this, hot plate structures with complex resistor geometries have been designed and additional heat-spreading structures have been introduced. In this work we designed and fabricated a metal oxide gas sensor integrated with a simple square planar indium tin oxide (ITO) heating element, by using conventional micromachining and thin-film deposition techniques. Power consumption-dependent surface temperature measurements were performed. A 420 °C working temperature was achieved at 120 mW power consumption. Temperature distribution uniformity was measured and a 17 °C difference between the hottest and the coldest points of the sensor at an operating temperature of 290 °C was achieved. Transient heat-up and cool-down cycle durations are measured as 40 ms and 20 ms, respectively.

Spectral response modification of TiO2 MSM photodetector with an LSPR filter.

We fabricated UVB filtered TiO2 MSM photodetectors by the localized surface plasmon resonance effect. A plasmonic filter structure was designed using FDTD simulations. Final filter structure was fabricated with Al nano-cylinders with a 70 nm radius 180 nm period on 360 nm SiO2film. The spectral response of the TiO2 MSM photodetector was modified and the UVB response was reduced by approx. 60% with an LSPR structure, resulting in a peak responsivity shift of more than 40 nm. To our knowledge, this is the first published result for the spectral response modification of TiO2 photodetectors with LSPR technique.

Fighting against cigarette smoking among medical students: a success story.

A survey in the year 2007 among medical students of Ankara University Medical School to assess the smoking rates showed that 25.1 % of them were smoking. Moreover, the smoking rate was 35 % at sixth grade students and 60 % of the smokers specified that they started smoking at medical school. This report provides a successful approach to decrease smoking among medical students by measures against starting smoking. An "Antismoking Group" composed of voluntary academic staff, nurses, students, psychologists, and a social worker of the medical school was established to engage in lowering the smoking rate and eliminating it eventually among our students. Several methods including regular monthly meetings, annual "Smoking or Health" symposiums, and lectures to first, second, and third grade students to increase their awareness related to harms of smoking and their role in the fight against smoking were carried out. Our surveys in the years 2009 (641 students) and 2012 (975 students) showed that total smoking rates dropped to 15.0 and 11.0 %, respectively (p < 0.0002). Moreover, the smoking rate for the sixth grade students dropped from 35.0 % in 2007 to 21.8 and 8.8 % in the years 2009 and 2012, respectively (p < 0.0002). In 2012, the smoking rates of first year and sixth year students were 7.8 and 9.0 %, respectively. These close rates of smoking at the first and last years of medical school training and the significant drop in smoking rates in 5 years confirm that our group pursued a realistic and successful strategy against smoking.

Comparison of phenotypic features in patients with single vs multiple primary cutaneous melanomas: a prospective single-center study.

BACKGROUND: There is sparse data regarding total body nevus count (TBNC), nevus count in specific locations, phenotypic factors, anthropometric indices, sunburn, and the relation to multiple primary cutaneous melanomas (MPCM) development. We aim to compare these variables in a cohort of patients diagnosed with single primary melanoma (SPM) and MPCM with histologic diagnoses of melanoma in situ, superficial spreading, and nodular melanoma in our clinic. METHODS: Prospective observational studies for the evaluation of nevus counts in biopsy-proven melanoma patients from 2017 to 2020 at Ankara University were conducted. Age, gender, family history of melanoma, increased sun exposure, nonmelanoma skin cancers (NMSC), height, sunburn history, TBNC, and nevi count in specific anatomical locations were evaluated by multivariate logistic regression analysis. RESULTS: A total number of 156 patients consisting of 22 MPCM and 134 SPM were included. Mean TBNC for SPM vs MPCM patients were 96.87 (SD ± 124.71) vs 247.00 (SD ± 261.58), respectively (P < 0.0001). TBNC was correlated to the left arm, trunk, lower extremity, and head and neck nevus counts but not with the right arm nevus count. Multiple regression analysis showed that having more than 10 nevi on the head and neck area is associated with MPCM (OR, 3.882 [95% CI, 1.084-13.899]). TBNC and nevus count in specific locations were found to be significantly higher in MPCM. CONCLUSION: The risk of MPCM was associated with having ≥10 nevi on the head and neck.

Optimized cell type signatures revealed from single-cell data by combining principal feature analysis, mutual information, and machine learning.

Machine learning techniques are excellent to analyze expression data from single cells. These techniques impact all fields ranging from cell annotation and clustering to signature identification. The presented framework evaluates gene selection sets how far they optimally separate defined phenotypes or cell groups. This innovation overcomes the present limitation to objectively and correctly identify a small gene set of high information content regarding separating phenotypes for which corresponding code scripts are provided. The small but meaningful subset of the original genes (or feature space) facilitates human interpretability of the differences of the phenotypes including those found by machine learning results and may even turn correlations between genes and phenotypes into a causal explanation. For the feature selection task, the principal feature analysis is utilized which reduces redundant information while selecting genes that carry the information for separating the phenotypes. In this context, the presented framework shows explainability of unsupervised learning as it reveals cell-type specific signatures. Apart from a Seurat preprocessing tool and the PFA script, the pipeline uses mutual information to balance accuracy and size of the gene set if desired. A validation part to evaluate the gene selection for their information content regarding the separation of the phenotypes is provided as well, binary and multiclass classification of 3 or 4 groups are studied. Results from different single-cell data are presented. In each, only about ten out of more than 30000 genes are identified as carrying the relevant information. The code is provided in a GitHub repository at https://github.com/AC-PHD/Seurat_PFA_pipeline.

AHD2FHIR: A Tool for Mapping of Natural Language Annotations to Fast Healthcare Interoperability Resources - A Technical Case Report.

A significant portion of data in Electronic Health Records is only available as unstructured text, such as surgical or finding reports, clinical notes and discharge summaries. To use this data for secondary purposes, natural language processing (NLP) tools are required to extract structured information. Furthermore, for interoperable use, harmonization of the data is necessary. HL7 Fast Healthcare Interoperability Resources (FHIR), an emerging standard for exchanging healthcare data, defines such a structured format. For German-language medical NLP, the tool Averbis Health Discovery (AHD) represents a comprehensive solution. AHD offers a proprietary REST interface for text analysis pipelines. To build a bridge between FHIR and this interface, we created a service that translates the communication around AHD from and to FHIR. The application is available under an open source license.

The Relationship Between Health Literacy Level and Media Used as a Source of Health-Related Information.

BACKGROUND: Previous studies have not shown the level of health literacy or associated factors on a national level in Turkey using a scale that has been adapted to the country and its culture. OBJECTIVE: This study aimed to determine health literacy levels in Turkey and to investigate the association of health literacy with socioeconomic factors as well as with the instruments used as sources of health-related information. METHODS: This cross-sectional, nationally representative study was conducted using a computer-assisted personal interview approach and included 6,228 households (response rate, 70.9%). The Turkey Health Literacy Scale was used to measure health literacy. Sources of health-related information, such as newspapers, television, internet, and smartphones, were included in the regression model for health literacy. KEY RESULTS: The proportion of participants with inadequate and problematic health literacy was 30.9% and 38%, respectively, showing that approximately 7 of 10 participants had limited health literacy. The frequencies of inadequate and problematic health literacy were higher in the disease prevention and promotion domains (37.4% and 34.2%, respectively) compared with those in the health care domain (27.1% and 31.3%, respectively). The most frequently used medium as a source of health-related information was the internet (48.6%), followed by television (33%). In controlled models, higher health literacy scores were associated with higher education and income levels. The effects of television (ß = 1,917), internet (ß = 2,803), newspapers (ß = 1,489), and smartphones (ß = 1,974) as sources of health-related information were statistically significant in the general health literacy index model. CONCLUSIONS: Health literacy in Turkey reflects social inequalities. The model accounting for socioeconomic variables demonstrated the relevance of sources of health information to level of health literacy. These findings emphasize the importance of improving sources of health information to improve health literacy. [HLRP: Health Literacy Research and Practice. 2021;5(2):e109-e117.] Plain Language Summary: This is a cross-sectional study that is representative of the population of Turkey. We reported that health literacy scores were higher for people in higher levels of socioeconomic status. We showed that using the television, internet, newspapers, and smartphones as a source of health-related information is associated with health literacy even when accounting for socioeconomic variables.

First Steps to Evaluate an NLP Tool's Medication Extraction Accuracy from Discharge Letters.

INTRODUCTION: The aim of this study is to evaluate the use of a natural language processing (NLP) software to extract medication statements from unstructured medical discharge letters. METHODS: Ten randomly selected discharge letters were extracted from the data warehouse of the University Hospital Erlangen (UHE) and manually annotated to create a gold standard. The AHD NLP tool, provided by MIRACUM's industry partner was used to annotate these discharge letters. Annotations by the NLP tool where then compared to the gold standard on two levels: phrase precision (whether or not the whole medication statement has been identified correctly) and token precision (whether or not the medication name has been identified correctly within correctly discovered medication phrases). RESULTS: The NLP tool detected medication related phrases with an overall F-measure of 0.852. The medication name has been identified correctly with an overall F-measure of 0.936. DISCUSSION: This proof-of-concept study is a first step towards an automated scalable evaluation system for MIRACUM's industry partner's NLP tool by using a gold standard. Medication phrases and names have been correctly identified in most cases by the NLP system. Future effort needs to be put into extending and validating the gold standard.

Evaluation of Different Learning Algorithms of Neural Networks for Drug Dosing Recommendations in Pediatrics.

Publicly accessible databases with evidence-based information on drug dosages for children and adolescents are not available in Germany. In previous work a prototypical web-based online platform for pediatric dosing recommendation has been developed. Quality assured maintenance of such a database is a time consuming effort. Recent work has shown that it is possible to use routinely documented data for machine learning approaches in order to create models for future decision support tools. This work describes the development of a prototype for pediatric dosing recommendations on the basis of routine drug prescriptions. Since they are structured for daily clinical use, not for machine learning, they include a substantial proportion of narrative text that requires preprocessing with consideration of medical and pharmaceutical knowledge. Three different learning algorithms have been applied and compared. The genetic algorithm with backpropagation has achieved the highest accuracy in the predictions. Our study constitutes a first step towards pediatric dosing recommendations, but there are multiple additional steps to be taken before a routine use might be considered, such as an evaluation by experienced physicians.

[Frequency of light cigarette use on staff and students of Ankara University School of Medicine]. / Ankara Universitesi Tip Fakültesi ögrenci ve çalisanlarinda "light" sigara içme sikligi.

Light cigarettes which are launched as fewer harmful threaten to community health because of so many diseases related with smoking. Therefore, research of light cigarette using rates and related factors might be beneficial along with research of smoking frequency in community. The aim of this study is to evaluate light cigarette smoking habit of staff and students of school of medicine. This cross-sectional study was conducted on staff and students of Ankara University School of Medicine in 2004. 216 (34%) light cigarette smokers of 627 people (344 students, 283 staff) were evaluated in this study. Questionarie form was applied to participants by face-to-face interview, chi-square and ANOVA analyse method were used for evaluation. Participant's profile was 51.4% male and 48.6% female. Mean age of the participants was calculated as 31.17 +/- 8.84. Light cigarette use was stated by 23.7% of smokers. Relationship between light cigarette use and various factors has been examined and it was found that light cigarette use rate was higher in females (p= 0.04). Smoking start age was detected lower in light cigarette smokers (18.59 +/- 2.87) rather than smokers (19.76 +/- 3.42). One over five person was found as light cigarette smokers among the participants. Light cigarette use rate is higher in females and smoking starting age is lower in light cigarette smokers. Relationship between female gender and smaller starting ages were considered as preference of the groups that had awareness in harmful effects of smoking especially light cigarette smoking and tried to reduce risks. In opposition to light cigarette had fewer harmful health effects, community must be made conscious about this belief may cause an increase in smoking prevalence in community.

Depression scores and associated factors in pregnant and non-pregnant women: a community-based study in Turkey.

The aims of this study were to evaluate and compare the depression scores of pregnant and non-pregnant women, and to identify the factors associated with depression scores in the two groups. This community-based study was conducted in a primary health care center catchment area in Ankara (population: 17,838) in January 2003. At the beginning of the study, the trimesters of all pregnant women (n = 66) were determined and as a control group (n = 138), two non-pregnant women matched for age and parity characteristics living in the same area were selected for each pregnant woman. Each participant completed a questionnaire and the Beck Depression Inventory (BDI). One-way ANOVA, univariate correlation, and multiple linear regression analyses were used in statistical evaluation. Depression scores of pregnant and non-pregnant women, and women at different trimesters of pregnancy were similar. Using a cut-off score > or = 18 on the BDI, 26.5% of non-pregnant women, 27.3% of pregnant women, 25.0% of pregnant women in their first and second trimester, and 30.0% of third trimester pregnant women were found to be depressive. According to multiple linear regression analysis, age, age at marriage, and the number of people living in the home were associated with depression in both groups. Depression scores were similar in pregnant women and non-pregnant controls. There were different associations between depression score and the study groups' characteristics.

Evaluation of awareness of diabetes mellitus and associated factors in four health center areas.

OBJECTIVE: As in all chronic diseases, providing patients with necessary information about Diabetes Mellitus (DM) and educating them are the best method of control of DM and preventing further complication. The aim of this study was to investigate the awareness of DM and related factors in diabetics. METHODS: This cross-sectional study was conducted in four health centre areas of Ankara (n = 96,348) between 1997 and 2000. In these areas, the researches were visited every home and detected the total of 2136 diagnosed patients with DM. 62.5% of diabetics (1334) participated in the study in which a face-to-face interview was conducted to fill in a questionnaire followed by eye examination and fasting blood glucose level testing. Chi-square test and logistic regression analyses were performed to investigate the relationships between factors. RESULTS: Statistical analysis has shown that mean age of respondents was 57.4 +/- 10.9 years and majority were female (67.9%) and older onset DM (96.6%). Mean duration of DM was 7.8 +/- 6.5 years. Only 28.6% of patients (n = 382) have had informed about DM. The main information resource was found to be hospitals (76.4%), then media 19.1% and primary health care centers (PHCC) 3.9%. Patients who graduated from university were 13.5 times; who were under 50 years of age were 1.92 times; who have had prior eye examination were 1.84 times and who had co-morbidities were 1.52 times more likely to have informed about DM than the other groups. CONCLUSION: Awareness of DM amongst diabetics is very low and mainly determined by their education levels. The PHCC play a very small role in dissemination of information towards diabetics. PRACTICE IMPLICATIONS: Results from this study have implications for patient education efforts. Accurately, clinicians need to strive to improve overall levels of patients' awareness and knowledge of their specific conditions, regardless of their literacy. Many opportunities exist for raising diabetic's awareness of their disease and linking diabetic's growing health awareness with those health promoting behaviors known to reduce morbidity and mortality.

Vaginal douching and associated factors among married women attending a family planning clinic or a gynecology clinic.

OBJECTIVE: The aim of this study was to determine the vaginal douching habits and associated factors of women attending two different healthcare clinics. STUDY DESIGN: This cross-sectional study was conducted between 1 and 31 May 2004. All participants were women (n=635) who attended either a university hospital gynecology clinic or a primary health care center family planning unit. One-way ANOVA, chi-squared test, and binary and multiple logistic regression analyses were used for the statistical evaluation of data. RESULTS: The mean age of the participants was 36.90+/-10.72 years (range: 18-75). Half of the participants believed vaginal douching had a positive effect on health. They believed vaginal douching demonstrates cleanliness, prevents infections and pregnancy, removes sperm following intercourse, a necessity of Islamic doctrine, and reduces symptoms like discharge, unpleasant odor, etc. Of the women, 50.2% performed vaginal douching. Vaginal douching was associated with age, education level, type of dwelling, working outside of the home, age at marriage, age at birth of first child, parity, spontaneous abortion, history of pelvic inflammatory disease, use of contraceptives, and attending a healthcare clinic. CONCLUSION: Douching is a common habit among Turkish women. Many women are not aware of the harmful effects of douching. Public health and health professionals should monitor more closely this traditional habit in Turkey.

Validation and reliability of the Cardiff Visual Ability Questionnaire for Children using Rasch analysis in a Turkish population.

AIM: To develop a Turkish version of the 25-item Cardiff Visual Ability Questionnaire for Children (CVAQC) and to evaluate the validity and reliability of the questionnaire. METHODS: The study involved two main phases. The first phase involved a cross-cultural adaptation of the CVAQC from English into Turkish. The second phase involved the completion of the Turkish version of the CVAQC by 150 partially sighted children (6-18 years old) and validity and reliability checks. Extent and construct validity were investigated using Rasch analysis and reliability by internal consistency and person separation index (PSI). RESULTS: An adequate conceptual equivalence was achieved following the linguistic adaptation process. The dataset for validation comprised 150 participants, 88 (58.7%) of whom were male. Evidence of disordered thresholds was found for one item (item 17). This item was recorded by collapsing two categories and ordered thresholds were evident. All items of the CVAQC were found to fit the Rasch model (χ² (df)=59.90 (2), p=0.159). The internal construct validity was good (mean item fit (SD) -0.054 (1.132), person fit (SD) -0.629 (2.079)) indicating a single underlying construct. The reliability was good with Cronbach's α of 0.91 and PSI of 0.94. Differential item functioning (DIF) was tested for age, sex, diagnosis, degree of visual impairment, and comorbidity. Evidence of DIF was found on age for one item (item 10, reading the board at school). CONCLUSIONS: The Turkish version of the CVAQC is a valid, reliable, and unidimensional questionnaire for partially sighted children aged 6-18 years. TRIAL REGISTRATION NUMBER: Ankara University Ethics Committees registry number 06-177-12.

Clinical Characteristics and Low Vision Rehabilitation Methods for Partially Sighted School-Age Children.

OBJECTIVES: To determine the clinical features and the distribution of diagnosis in partially sighted school-age children, to report the chosen low vision rehabilitation methods and to emphasize the importance of low vision rehabilitation. MATERIALS AND METHODS: The study included 150 partially sighted children between the ages of 6 and 18 years. The distribution of diagnosis, accompanying ocular findings, visual acuity of the children both for near and distance with and without low vision devices, and the methods of low vision rehabilitation (for distance and for near) were determined. The demographic characteristics of the children and the parental consanguinity were recorded. RESULTS: The mean age of children was 10.6 years and the median age was 10 years; 88 (58.7%) of them were male and 62 (41.3%) of them were female. According to distribution of diagnoses among the children, the most frequent diagnosis was hereditary fundus dystrophies (36%) followed by cortical visual impairment (18%). The most frequently used rehabilitation methods were: telescopic lenses (91.3%) for distance vision; magnifiers (38.7%) and telemicroscopic systems (26.0%) for near vision. A significant improvement in visual acuity both for distance and near vision were determined with low vision aids. CONCLUSION: A significant improvement in visual acuity can be achieved both for distance and near vision with low vision rehabilitation in partially sighted school-age children. It is important for ophthalmologists and pediatricians to guide parents and children to low vision rehabilitation.

Location and Visualization of Working p-n and/or n-p Junctions by XPS.

X-ray photoelectron spectroscopy (XPS) is used to follow some of the electrical properties of a segmented silicon photodetector, fabricated in a p-n-p configuration, during operation under various biasing configurations. Mapping of the binding energy position of Si2p reveals the shift in the position of the junctions with respect to the polarity of the DC bias applied. Use of squared and triangular shaped wave excitations, while recording XPS data, allows tapping different electrical properties of the device under normal operational conditions, as well as after exposing parts of it to harsh physical and chemical treatments. Unique and chemically specific electrical information can be gained with this noninvasive approach which can be useful especially for localized device characterization and failure analyses.

An analysis of the incidence of measles in Turkey since 1960.

BACKGROUND/AIM: The aims of this study were to evaluate measles incidence and the effect of elimination strategy interventions on the disease from 1960 to 2014 in Turkey. The administration of measles vaccine started in the rural regions in 1970; it was carried out as a campaign along with the National Vaccine Campaign in 1985, and it has been employed as combined measles, mumps, and rubella under the scope of the Measles Elimination Program (MEP) since 2006 in Turkey. While a dramatic decrease in the reporting of measles was observed between 2000 and 2010, the number of the cases has increased since 2011. MATERIALS AND METHODS: The time series of measles incidence was evaluated for possible structural changes with regression models using dummy variables, autocorrelated with error terms. RESULTS: The incidence of measles showed a statistically significant decline between 1985 and 1988 (P = 0.0072) and between 2005 and 2011 (P < 0.0001). However, a statistically significant increase in incidence was noted after 2013 (P = 0.0008). CONCLUSION: Over the last 54 years, the pattern of measles cases demonstrated a significant decline in incidence. However, the increase in incidence in 2013 should be carefully analyzed and interpreted in terms of the MEP.