Demography, inequalities and Global Health Security Index as correlates of COVID-19 morbidity and mortality.

BACKGROUND: During a pandemic, the occurrence of infections and case fatality rates are expected to vary from one country to another due to several variables such as poverty, existing comorbidities, population density, access to health care, availability and quality of health system resources, and environmental factors. OBJECTIVES: Our aim is to investigate the relationship between various demographic and socioeconomic factors and reported COVID-19 morbidity and mortality indicators in different countries. Also, to determine the position of the countries relative to each other in terms of three indicators including COVID-19 cases, deaths and tests. METHODS: Canonical correlation analysis is used to investigate the intercorrelations between independent variables and the COVID-19 cases and deaths for 92 countries. Countries' performances are measured by MULTIMOORA. RESULTS: Human Development Index, smoking habits, percentage of elderly population and test frequency are the most significant variables associated with COVID-19 morbidity and mortality according to our study findings. Singapore, New Zealand and Australia are the best performed countries. CONCLUSIONS: Several significant and unexpected associations exist between socioeconomic factors and the COVID-19 cases and deaths. Singapore, New Zealand and Australia are surrounded by water, have been more successful in the pandemic process compared to other countries.

Turkish Translation and Cross-Cultural Validity of Whoqol-HIV Bref Tool.

BACKGROUND: The assessment of health-related quality of life among people living with HIV (PLWH) has gained increasing importance as it assesses their overall well-being, guides treatment decisions, and addresses psychosocial challenges, improving their quality of life. This study focuses on adapting and validating the Turkish version of the WHOQOL-HIV Bref, a tool developed by the World Health Organization (WHO) to measure health-related quality of life in PLWH. This adaptation is based on the generic WHOQOL-Bref Turkish and WHOQOL-HIV Bref inventory. METHODS: In line with WHO guidelines, the tool was translated and tested on 189 PLWH from Istanbul Sisli Hamidiye Etfal Training and Research Hospital's HIV outpatient clinic. A variety of statistical methods were employed to assess content, construct, concurrent, and known-group validity, as well as internal consistency and reliability. RESULTS: Participants' median age was 35 years (IQR: 14), with 178(94%) being male. The Turkish WHOQOL-HIV Bref showed overall satisfactory psychometric properties. Despite limitations in the spirituality domain, it demonstrated good internal consistency (alpha coefficient: 0.93) and strong validity across several metrics, including test-retest reliability (ICC: 0.79). CONCLUSION: The WHOQOL-HIV BREF in Turkish is a reliable and valid instrument for assessing the quality of life in Turkish PLWH.

An on-site comparative study of yield factors during glume removal, a primary step in the traditional processing of hulled wheats.

BACKGROUND: Glume removal represents the preliminary step of hulled wheat grain processing for human consumption. Einkorn and emmer wheat are two hulled species, cultivated in marginal areas, from the Mediterranean to the Caucasian region, and the subject of investigation in this paper. An experiment has been carried out to compare the yield of the traditional process, used in Turkey and Armenia, and an updated Italian procedure, by means of on-plant samplings. RESULTS: Crushed grains represent a product from all the plants examined. However, the relative amounts of fractions of different size and use, according to each country, varied consistently. The main Italian product is whole pearled grain. The calculated yield factors varied in the following ranges: dehulling: 0.73-0.81 kg kg(-1); food product: 0.82-0.96 kg kg(-1); overall yield: 0.56-0.95 kg kg(-1) excluding unwanted losses, and 0.42-0.74 kg kg(-1) including unwanted losses. CONCLUSIONS: This first comparative assay of hulled wheat processing showed that, not considering the kind of product obtained, glume removal can be carried out with good efficiency in continuously operating traditional plants. Modern schemes, however, allow yielding of intact kernels. Some yield factors were highly affected by the available technology, especially when the process was operating discontinuously.

Lack of effect of bioactive-rich extracts of pomegranate, persimmon, nettle, dill, kale and Sideritis and isolated bioactives on platelet function.

BACKGROUND: The health benefits of fruit and vegetable-rich diets may be partly due to modulation of platelet activity by bioactive phytochemicals. The aim of this study was to investigate the effects of bioactive-rich plant extracts and isolated bioactive metabolites on platelet function. Blood samples (n =15 subjects) were treated with extracts of bioactive-rich plants consumed as traditional foods in the Black Sea region, or with human metabolites of the bioactives quercetin and sulforaphane. Platelet function was assessed using the PFA-100. RESULTS: None of the extracts containing various flavonoids, glucosinolates and other bioactives, or isolated bioactive metabolites of quercetin or sulforaphane, caused significant changes in PFA-100 closure time (CT). In contrast, the positive controls (aspirin and Abciximab) consistently caused significant increases in CT for the platelet agonists epinephrine and ADP, respectively. CONCLUSION: These data do not support the notion that these plant bioactives can improve human platelet function.

Comparison of leafy kale populations from Italy, Portugal, and Turkey for their bioactive compound content: phenolics, glucosinolates, carotenoids, and chlorophylls.

BACKGROUND: Kales are primitive leafy Brassica oleracea L. forms, widespread in local farming systems of several European countries and employed in the preparation of traditional recipes. Kales are also potential sources of healthy bioactive phytochemical components. The present study compared the bioactive compound content of kale populations from Italy, Portugal, and Turkey, either from local sources or grown in an experimental field. RESULTS: Total phenolics, glucosinolates (GLS), carotenoids, and chlorophylls were in the ranges 8310-38 110, 755-8580, 135-2354, and 1740-16,924 mg kg(-1) dry matter, respectively. On average, locally harvested samples showed a total GLS content about twice as high as populations from the experiment. Conversely, pigments were significantly more abundant in experimental than in local kales, owing to the higher soil fertility. Portuguese samples showed higher phenolic and GLS amounts than Italian and Turkish kales, whereas some of the Italian samples were the richest in carotenoids. CONCLUSION: This paper represented the first cross-country comparison of local kale accessions with respect to bioactive compound amounts. Both geographic origin and growing environment appeared to be remarkable and discriminating factors in determining bioactive levels in leafy kales, with possible effects on their health-promoting and sensorial attributes.

New nutritional composition data on selected traditional foods consumed in Black Sea Area countries.

BACKGROUND: Traditional foods are an important part of the culture, history, identity and heritage of a region or country and are key elements in dietary patterns. In most countries there is limited information on the nutritional composition of such foods and therefore there is a need to investigate, register and promote traditional foods. One of the aims within the 'Sustainable exploitation of bioactive components from the Black Sea Area traditional foods' (BaSeFood) project is to generate for the first time new data on the nutritional composition of traditional foods from six Black Sea Area countries to promote their sustainable development and exploitation. RESULTS: Thirty-three traditional foods were analysed in an accredited laboratory to determine their nutritional composition, and the data were fully documented. The nutrient content varied widely because of the nature and variety of the analysed foods. The energy content ranged between 4 kcal per 100 g for kvass southern and 900 kcal per 100 g for mustard oil, with the exception of the analysed teas, which did not contribute to energy intake. CONCLUSION: The use of a common methodology for the study of traditional foods will enable countries to further investigate these foods. Moreover, a new nutritional knowledge base of traditional foods from Black Sea Area countries will contribute to promote local biodiversity and sustainable diets by maintaining healthy dietary patterns within local cultures.

Effects of bioactive-rich extracts of pomegranate, persimmon, nettle, dill, kale and Sideritis and isolated bioactives on arachidonic acid induced markers of platelet activation and aggregation.

BACKGROUND: The beneficial effect of fruit- and vegetable-rich diets on cardiovascular health is partly attributed to the effect of their bioactive compounds on platelet function. The aim of this study was to investigate the effects of bioactive-rich plant extracts and isolated bioactive metabolites on platelet function. Blood samples from healthy subjects (n = 4) and subjects with metabolic syndrome (n = 4) were treated with six extracts of bioactive-rich plants consumed as traditional foods in the Black Sea region, or with human metabolites of the bioactives quercetin and sulforaphane. Markers of arachidonic acid induced platelet activation and platelet-leucocyte aggregation were assessed using flow cytometry. RESULTS: In subjects with metabolic syndrome, kale extract significantly inhibited agonist induced P-selectin expression (P = 0.004). Sulforaphane-cysteine-glycine, a human plasma metabolite of the related glucosinolate, glucoraphanin, significantly inhibited P-selectin and GPIIb-IIIa expression (P = 0.020 and 0.024, respectively) and platelet-neutrophil aggregation (P = 0.027). Additionally, pomegranate extract significantly inhibited GPIIb-IIIa expression (P = 0.046) in subjects with metabolic syndrome. In healthy subjects only dill extract significantly inhibited agonist induced P-selectin expression (P = 0.025). CONCLUSION: These data show that bioactive-rich extracts of kale and pomegranate that are consumed as traditional plant foods of Black Sea area countries were effective in modulating platelet function.

Definition and documentation of traditional foods of the Black Sea Area Countries: potential nutrition claims.

BACKGROUND: Nutrition and health claims are permitted in foods marketed in the European Union under Regulation 1924/2006. Quality products such as traditional foods might benefit from this act, as it can highlight their nutritional richness. In this study the nutritional content of 33 traditional foods from the Black Sea Area Countries was evaluated against the thresholds of the Regulation for nutrition claims. RESULTS: Most of the foods were eligible to bear several nutrition claims, mostly related to their fat, sugar, fiber and sodium content. The average number of claims per traditional food was two, with a range between zero and nine. Overall, about 72 nutrition claims were potentially relevant for the 33 traditional foods studied. Foods linked with the most claims were nuts and seeds. CONCLUSION: The inclusion of traditional foods under this standardized European scheme could be an efficient way to highlight their possible beneficial nutritional properties. The production and marketing of traditional foods could be of benefit to both the health of consumers and the economic viability of producers, especially small- and medium-size enterprises.

Carotenoids, vitamins (A, B2, C and E) and total folate of traditional foods from Black Sea Area countries.

BACKGROUND: Carotenoids, vitamins (A, B2, C and E) and total folate are related to health promotion. However, there are still many food matrices for which the content of these compounds is not available. In order to fill this gap, traditional foods from Black Sea Area countries (BSAC) were analysed in order to investigate their potential health benefits. RESULTS: The most abundant carotenoid was ß-carotene. Plum jam was the sample with the highest ß-carotene content (608 µg 100 g(-1) edible portion). The group of vegetables and vegetable-based foods contributed most to ß-carotene content. Evergreen cherry laurel presented the highest l-ascorbic acid content (29.9 mg 100 g(-1) edible portion), while the highest riboflavin and total folate contents were found for roasted sunflower seeds. Approximately 61% of the analysed samples showed quantifiable amounts of α-tocopherol but did not contain retinol. CONCLUSION: Despite the great variability in the content of carotenoids, vitamins and total folate, most of the analysed traditional foods from BSAC can be considered good sources of these compounds. Therefore, owing to their putative health benefits, the consumption of those with higher contents of these compounds should be encouraged and promoted.

Comparison of the burnout among medical residents before and during the pandemic.

OBJECTIVE: This study aims to compare the level of burnout syndrome in medical residents before and during the COVID-19 pandemic and identify potential risk factors. METHODS: This cross-sectional study was conducted on medical residents from three different university hospitals in Turkey in March 2021, one year after the pandemic hit Turkey. Burnout is measured by the Maslach Burnout Inventory which assesses three dimensions of it: emotional exhaustion, depersonalization, and personal accomplishment. Collected data were combined and compared with data from a previous study which was held in the same hospitals in December 2019, three months before the pandemic. RESULTS: 412 medical residents from three universities participated. The mean age was 27.8 ± 2.4 and half of them were female. Compared to pre-pandemic levels, no significant differences in emotional exhaustion (pre:19.0 ± 7.6 post:18.8 ± 7.8), depersonalization (pre:7.3 ± 4.3 post:7.2 ± 4.4), and personal accomplishment (pre:20.8 ± 5.1 post:21.1 ± 5) scores were observed one year after pandemic. Adjusting for confounders, multiple linear regression models indicated that who are female, are in surgical specialty, have vulnerable cohabitant, and have more night shifts faces higher emotional exhaustion. Depersonalisation is higher among who spent more years in residency, have more night shifts, or COVID-19 outpatient duty. Females and those who have vulnerable cohabitant has lower levels of Personal Achievement. CONCLUSION: This study does not support the hypothesis that pandemic increases the burnout levels. Yet it identifies a couple of pandemic related factors that are associated with burnout and confirming the association of several previously known factors.

Family physicians overestimate diagnosis probabilities regardless of the test results.

Introduction: As useful tools for clinical decision-making, diagnostic tests require careful interpretation in order to prevent underdiagnosis, overdiagnosis or misdiagnosis. The aim of this study was to explore primary care practitioners' understanding and interpretation of the probability of disease before and after test results for six common clinical scenarios. Methods: This cross-sectional study was conducted with 414 family physicians who were working at primary care in Istanbul via face-to-face interviews held between November 2021 and March 2022. The participants were asked to estimate the probability of diagnosis in six clinical scenarios provided to them. Clinical scenarios were about three cancer screening cases (breast, cervical and colorectal), and three infectious disease cases (pneumonia, urinary tract infection, and COVID-19). For each scenario participants estimated the probability of the diagnosis before application of a diagnostic test, after a positive test result, and after a negative test result. Their estimates were compared with the true answers derived from relevant guidelines. Results: For all scenarios, physicians' estimates were significantly higher than the scientific evidence range. The minimum overestimation was positive test result for COVID-19 and maximum was pre-test case for cervical cancer. In the hypothetical control question for prevalence and test accuracy, physicians estimated disease probability as 95.0% for a positive test result and 5.0% for a negative test result while the correct answers were 2.0 and 0%, respectively (p < 0.001). Discussion: Comparing the scientific evidence, overestimation in all diagnostic scenarios, regardless of if the disease is an acute infection or a cancer, may indicate that the probabilistic approach is not conducted by the family physicians. To prevent inaccurate interpretation of the tests that may lead to incorrect or unnecessary treatments with adverse consequences, evidence-based decision-making capacity must be strengthened.

Knowledge and attitudes towards complementary and alternative medicine among medical students in Turkey.

OBJECTIVE: This study aims to examine knowledge and attitudes towards Complementary and Alternative Medicine among medical students in Turkey, and find out whether they want to be trained in Complementary and Alternative Medicine (CAM). METHODS: A cross-sectional study was carried out between October and December 2010 among medical students. Data were collected from a total of seven medical schools. FINDINGS: The study included 943 medical students. The most well known methods among the students were herbal treatment (81.2 %), acupuncture (80.8 %), hypnosis (78.8 %), body-based practices including massage (77 %) and meditation (65.2 %), respectively. Acupuncture, aromatherapy, herbal treatment and meditation were better known among female participants compared to males (p < 0.05). Females and first year students, generally had more positive attitudes. A larger proportion of female students compared to male students reported that a doctor should be knowledgeable about CAM (p = 0.001), and this knowledge would be helpful in their future professional lives (p = 0.015). Positive attitudes towards and willingness to receive training declined as the number of years spent in the faculty of medicine increased. CONCLUSIONS: Majority of the medical students were familiar with the CAM methods widely used in Turkey, while most of them had positive attitudes towards CAM as well as willingness to receive training on the subject, and they were likely to recommend CAM methods to their patients in their future professional lives. With its gradual scientific development and increasing popularity, there appears a need for a coordinated policy in integrating CAM into the medical curriculum, by taking expectations of and feedback from medical students into consideration in setting educational standards.

Good versus poor prescribers: the comparison of prescribing competencies in primary care.

AIM: To compare the competencies of primary care physicians (PCPs) with poor and good prescribing performance in frequently encountered indications. BACKGROUND: Primary care centers are one of the mostly visited health facilities by the population for different health issues. METHODS: In this cross-sectional study, we analyzed 6 125 487 prescriptions generated by 1431 PCPs which were selected by systematic sampling in 2016 in Istanbul. We defined PCPs as poor prescriber (n = 227) or good prescriber (n = 210) in terms of their prescribing performance per WHO/INRUD criteria. We compared solo diagnosis prescriptions of these two groups in 'percentage of prescriptions in compliance with clinical guidelines' and also rational prescribing indicators. FINDINGS: Poor prescribers and good prescribers significantly differed in each of the prescribing indicators for their all solo diagnosis prescriptions. Hypertension had the highest difference of the average cost per encounter (Δ = 284.2%) between poor prescribers (US$43.99 ± 63.05) and good prescribers (US$11.45 ± 45.0), whereas headache had the highest difference between the groups in the percentage encounters with an antibiotic (14.9% vs. 1.5%). Detailed analysis of the prescribing performances showed significantly higher values of each WHO/INRUD indicators for all examined diagnoses. We found significantly higher percentages of guideline-compliant drugs in good prescribers compared to that in poor prescribers in hypertension (40.8% vs 34.8%), tonsillopharyngitis (57.9% vs 50.7%), and acute sinusitis (46.4% vs 43.6%). CONCLUSION: This study shows that the prescribing performances of PCPs are not rational enough in terms of drug selection and prescription content. Furthermore, even the physicians who have good prescribing practice appear as not satisfactorily rational in compliance with current pharmacotherapy competencies.

Vaccine Hesitancy and Anti-Vaccination Attitudes during the Start of COVID-19 Vaccination Program: A Content Analysis on Twitter Data.

Twitter is a useful source for detecting anti-vaccine content due to the increasing prevalence of these arguments on social media. We aimed to identify the prominent themes about vaccine hesitancy and refusal on social media posts in Turkish during the COVID-19 pandemic. In this qualitative study, we collected public tweets (n = 551,245) that contained a vaccine-related keyword and had been published between 9 December 2020 and 8 January 2021 through the Twitter API. A random sample of tweets (n = 1041) was selected and analyzed by four researchers with the content analysis method. We found that 90.5% of the tweets were about vaccines, 22.6% (n = 213) of the tweets mentioned at least one COVID-19 vaccine by name, and the most frequently mentioned COVID-19 vaccine was CoronaVac (51.2%). We found that 22.0% (n = 207) of the tweets included at least one anti-vaccination theme. Poor scientific processes (21.7%), conspiracy theories (16.4%), and suspicions towards manufacturers (15.5%) were the most frequently mentioned themes. The most co-occurring themes were "poor scientific process" with "suspicion towards manufacturers" (n = 9), and "suspicion towards health authorities" (n = 5). This study may be helpful for health managers, assisting them to identify the major concerns of the population and organize preventive measures through the significant role of social media in early spread of information about vaccine hesitancy and anti-vaccination attitudes.

Attitudes and practices against COVID-19 vaccines in Turkiye.

OBJECTIVE: Vaccination is the primary way to mitigate the COVID-19 pandemic. Vaccine hesitancy and refusal are one of the most important challenges against to reach herd immunity. The aim of this study is to examine the reasons for not getting vaccinated and the attitudes toward vaccines by people in Turkiye, who were not vaccinated, even though a COVID-19 vaccine was available for them. METHODS: This cross-sectional study is conducted in Eyupsultan district of Istanbul. The study population is 12,540. A questionnaire consisted of three sections as sociodemographic characteristics, attitudes toward COVID-19 vaccines, and Vaccination Attitudes Examination (VAX) scale was used. Among the sample size, participation rate is 69.4%. RESULTS: About 50.2% of the participants (n=259) are male, 80.3% are married, 13.1% are university graduates, and 44.0% are working in a job. About 32.8% of the participants have COVID-19 history. About 34.4% of the participants stated that they would be vaccinated against COVID-19. Although those who define themselves as vaccine refuser are 5.4%, those who still refuse to be vaccinated for COVID-19 are 20.1%. In addition to this, those who are hesitant about COVID-19 vaccines are 45.6%. The most frequently preferred vaccine is comirnaty (41.7%). About 13.1% of the participants stated that "if we had a domestic COVID-19 vaccine, I would have it." The most common sources of information about vaccines are television with 78.4%, and health workers are in the last place with 14.7%. "Concerns about side effects" are the most frequently cited (85.9%) reason for not vaccinating. The mean score of the VAX scale is 42.34±10.93, and the "mistrust of vaccine benefit" is higher among primary school graduates than other educational status groups (p=0.001). CONCLUSION: Anti-vaccination attitudes have increased with the COVID-19 vaccines during pandemic. Our study is valuable in terms of examining the reasons of individuals who have not gotten vaccinated even though they had no access problems. Prominent concerns of the population should be approached seriously. Otherwise, vaccine hesitancy can be a decisive factor that would prevent the success of the struggle against pandemic.

Eating patterns of Turkish adolescents: a cross-sectional survey.

BACKGROUND: Adolescence is a crucial period for development of dietary behaviors that continue into adulthood and influence the risk of chronic diseases later in life. The aim of this study was to determine the eating patterns of adolescents' and their compliance with the Food Guide Pyramid. METHODS: 625 students, aged between 11-15 years, from an elementary school in Istanbul, Turkey were enrolled in this cross-sectional survey. A questionnaire of eating patterns (QEP) was administered to all participants. QEP is consisted of questions assessing the knowledge and behaviors on healthy eating, factors affecting food choice, physical activity status and demographical variables. Height and weight of all participants were measured. Physical activity status was determined by questioning about participation in regular sport activities, how much time spent watching TV, playing computer games or doing homework. RESULTS: The mean age of the participants was 12.15 ± 1.15 and 50.5% were female. According to body mass index (BMI) percentiles, 8.3% (52) were obese and 10.2% were overweight. 51% had breakfast every day and only 1.9% met all the recommendations of the Food Guide Pyramid. Among the participants, 31% have fast food at least once every day and 60.8% skip meals. When participants were asked to rate the factors effecting their food choice according to a 10 point Likert scale, the highest mean scores (high impact on food choice) were for the factors; family, health, body perception, teachers and friends; 7.5 ± 3.1, 7.4 ± 3.1, 6.1 ± 3.2, 4.8 ± 3.3 and 4.2 ± 3.0 respectively. Total mean time spent on all passive activities (TV, computer, reading homework etc) per day was 9.8 ± 4.7 hours. CONCLUSIONS: In this study we have demonstrated that, adolescents do not have healthy eating patterns. Educational interventions should be planned to decrease the health risks attributable to their eating behaviors.

Knowledge and attitudes of university students toward pandemic influenza: a cross-sectional study from Turkey.

BACKGROUND: During an influenza pandemic, higher education institutions with large populations of young adults can become serious outbreak centers. Since outbreak management is essential to disease control, we aimed to examine university students' knowledge of and attitudes toward the pandemic influenza A/H1N1 and vaccination and other preventive measures. METHODS: A cross-sectional study was conducted among 402 first year university students at Yeditepe University in Istanbul, Turkey between 1st and 30th of November 2009. Data regarding socio-demographic characteristics of the students, perceptions, level of knowledge and attitudes toward influenza pandemic and prevention measures were collected by means of a self-administered questionnaire. The questionnaire was distributed by the students affiliated with SANITAS, a university club of students in health related sciences. RESULTS: 25.1% (101/402) of the study group perceived their personal risk of influenza as "high", while 40.5% (163/402) perceived it as "moderate", 20.6% (107/402) viewed it as "low" and 7.7% (31/402) indicated that it was "unknown". The risk perception of males was significantly lower than that of females (p = 0.004) and the risk perception among the students of health sciences was significantly lower than that of students of other sciences (p = 0.037). Within the study group, 72.1% (290/402) indicated that their main information source regarding H1N1 was the mass media. Health sciences students tended to rely more on the internet as an information source than other students (p = 0.015). The vast majority (92.8%; 373/402) of those interviewed indicated that they would not be vaccinated. The major concerns regarding vaccination had to do with the safety and side effects of the vaccine. Most of the participants (343/402, 85.3%) were carrying out one of prevention measures and the vast majority believed that hand washing, face mask and quarantina were effective measures for prevention. CONCLUSION: The participants had enough knowledge about H1N1 pandemic about the disease although there were still gaps and confusions in some areas. In the future, when planning management strategies regarding pandemics or outbreaks in higher education institutions, new strategies should be developed to promote positive health behaviour among university students compatible with the international guidelines. Main information source is mass media, so it seems that new policies must be developed to attract attention of students to use different and more scientific-based information sources.

Youtube as an Information Source During the Coronavirus Disease (COVID-19) Pandemic: Evaluation of the Turkish and English Content.

INTRODUCTION: YouTube is an important online source of information and has two billion users globally. Its viewing numbers tend to increase exponentially in extraordinary global situations. Our aim in this study was to review and evaluate the contents of the most frequently viewed YouTube videos during the Coronavirus disease 2019 (COVID-19) pandemic.  Methods: In this qualitative study, contents of the most frequently viewed Turkish and English YouTube videos regarding the COVID-19 pandemic were examined and scored with modified DISCERN, medical information and content index (MICI), and video power index (VPI) during April 2020. RESULTS: The mean DISCERN score of Turkish videos was similar to that of English videos (2.55±1.40 and 2.43±1.25, respectively). The total MICI score tended to be higher in Turkish videos. News channels released 86.9% of all 168 videos and 65.2% of all 23 misleading videos. When the descriptive characteristics of videos were compared in terms of their content category, average view counts, view ratios, and VPIs of misleading videos were higher than those of the useful videos. Only, the likes ratio of useful videos was higher than that of the misleading videos. CONCLUSIONS: Since there is no peer-review system on YouTube, people can almost release every type of video. It is very important for the content of videos that are released through news channels to be accurate because the important messages can be spread among people in society through them. In our study, especially some Turkish videos included many different rumors and faulty statements. During the extraordinary situations such as the pandemic, the videos of official health authorities and international institutions should be more visible on YouTube.

The influence of gender roles on health seeking behaviour during pregnancy in Turkey.

OBJECTIVES: To explore the impact of gender roles in relation to health seeking behaviour during pregnancy and childbirth. METHODS: The study was conducted in neighbourhoods with low antenatal care rates in three provinces of Turkey. The study population consisted of pregnant women who never got or discontinued antenatal care and their peers, families and community leaders. Sixteen focus group discussions and 125 in-depth interviews were conducted with a total of 239 participants. RESULTS: Pregnancy and childbirth are interwoven strongly with gender roles. Since the patriarchal system acknowledges women through the means of childbirth, women are expected to have many children. Hence women experience pregnancy as a burden and are not motivated to seek antenatal care. During pregnancy, only 'serious' conditions are considered as legitimate reasons for accessing care. However, the decision regarding whether a pregnant woman is seriously sick or not belongs to the responsibilities of elder women, which delays service use. CONCLUSIONS: Providing information regarding the value of antenatal care also to elder women is essential in increasing the demand to the services. Incorporating gender perspectives into daily health practice and maintaining access to high quality reproductive care services are vital in reducing the gender based barriers to care.

The links between health-related behaviors and life satisfaction in elderly individuals who prefer institutional living.

BACKGROUND: Life satisfaction among residents of institutions is becoming an important issue in a rapidly aging population. The aim of this cross-sectional study was to investigate the links between life satisfaction and health-related behaviors amongst functionally independent elderly people who prefer institutional living in Istanbul, Turkey. METHODS: The socio-demographic characteristics, health-related behaviors, leisure-time activities and fall histories of 133 residents of an institution in Istanbul were assessed by a structured questionnaire during face-to-face interviews. A validated life-satisfaction index questionnaire (LSI-A) was completed. RESULTS: The mean age of the study group was 73.9 +/- 8.0 (range 60-90 years). Within the group, 22.6% had never married and 14.3% had university degrees. The majority (71.4%) were in the low income bracket. The overall mean LSI-A score was 20.3 +/- 5.9. Participants who declared moderate/high income levels had a significantly higher mean LSI-A score than those in the low-income bracket (p = 0.009). Multivariate analysis of the data suggested that leisure-time activities and participation in regular physical activities are significant predictors of LSI-A scores (R2: 0.112; p = 0.005 and p = 0.02, respectively). CONCLUSION: The findings imply that regular physical activity and leisure-time activities are significantly related to life satisfaction among residents in institutions. Participation in physical activity and leisure-time activity programs may help to improve the life satisfaction of elderly people living in institutions.