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Aim: It is to put a scale into the use of the academic community which measures how well the doctors can interiorize the features concerning family practice the training of family practice specialization in our country, by developing a family practice identity scale that is peculiar to Turkey. Methods: Our research is the study of developing a scale. A 5-point Likert scale is generated by creating the questionnaire and then the aforementioned scale is studied to verify the validation and reliability in Turkey. The scale has been performed on 351 people who work as academicians, specialists and residents in the field of family practice. Results: During the analyses, while the first four factors whose eigenvalues are the highest are kept fixed, the questions from the other factors are distributed according to their content similarities. As a result, forty-six questions is obtained. Kaiser-Meyer-Olkin value conformity assessment the result was obtained at a very good level (KMO: 0.940) and Cronbach's alpha value was calculated as 0.952. The sub-scales are named by the contents of the questions: Patient-doctor communication, professional satisfaction, the scope of the working area and comprehensive approach, and biopsychosocial approach. It has been concluded that the scale is a valid and reliable questionnaire in Turkey after these advanced statistical analyses. Conclusion: "The Scale of Family Practice Identification" is developed successfully. With the aforementioned scale, by observing the professional progress of residents, the doctors that have an occupational identity and sense of belonging can be trained for the community of family practice. Keywords: family practice, reliability and validity, scales

Background: Smoking is a serious public health challenge across the world. Fasting in Ramadan requires people to stay away from smoking as well as activities such as eating, drinking, and sexual intercourse. We examined the effect of fasting on cigarette smoking and nicotine addiction during the Ramadan. Methodology: This study was designed as a descriptive cross-sectional survey. A questionnaire was prepared to determine sociodemographic data and smoking habits of a sample population. The questionnaire was delivered through face-to-face interviews at several family medicine clinics in Turkey, with smokers who fast in Ramadan. Results: There were 354 persons, of which 278 were male (78.5%), 76 were female (21.5%), and the mean age was 32.92 ± 11.84 years. A significant decrease in cigarette consumption during the Ramadan was reported by 285 (80.5%) smokers (p < .001). The number of smokers who had difficulty resisting the urge to smoke was less in Ramadan than non-Ramadan periods (p < .001). Religious sentiments were reported as the most important reason for coping with nicotine abstinence (53.7%). Significantly in 14.7% of the cases, participants stopped smoking during the whole period of Ramadan. Conclusions: Religious beliefs and willpower were found to be effective in helping people reduce or temporary stop smoking. Fasting may play a significant role in changing smoking behavior. Smoking cessation along with counseling supported by the state, health authorities, and clergy can be useful in the fight against smoking in Ramadan.

Nutrition is a public health issue. Amongst populations of refugees, unmet nutritional needs have been identified. The aim of this study was to evaluate the nutritional status of Syrian refugees living outside the refugee camps in Kayseri, Turkey. Socio-demographic data and anthropometric measurements of the refugees were collected. The relationship between diet quality, which was assessed through the Healthy Eating Index (HEI-2010), and factors (including the duration of time spent outside the refugee camp, income, obesity, and waist circumference) were measured. Four hundred refugees participated in this study. The majority of refugees (77.8%) reported a ‘poor’ diet, with the remaining filling into the ‘needs improvement’ based on HEI-2010 scores. The average consumption of fruits in the study group was 101.9 g per day (g/day), while the average consumption of vegetables was 142.2 g/day. When the relationships were examined between BMI, HEI-2010 score, the time spent as a refugee, and waist circumference, statistically significant relationships were found (p < 0.001). In the linear regression analysis based on these relationships, when the results were adjusted for age and gender factors, it was observed that for every year spent as a refugee, BMI score increased by 0.17 units, and waist circumference increased by 1.14 units (p < 0.05). As a result, this study showed that refugees have low-income-related nutritional risks. In conclusion, ensuring that refugees have access to adequate nutrient-rich food is essential; therefore, analyzing and improving nutritional standards for refugees are suggested to be part of the strategies of the public and primary health care systems.

The ‘stay-at-home’ order is a kind of mass quarantine strategy and has been enforced globally in response to the COVID-19 pandemic. However, various problems have been reported as well. An electronic research was performed in PubMed and Web of Science databases to determine these problems. This study indicates in a holistic approach to determine some of the potential problems during staying at home mandates. Nutritional disorders, sedentary life, disrupted checkups, eye diseases, increase in alcohol and cigarette consumption, psychological negative influences, sleep disorders, and conflict of generations are among them.

Ethanol readily solubilizes the active components of propolis. Due to certain disadvantages of ethanolic extracts, developing new non-ethanolic extraction methods is highly desirable. This study aimed to determine the content of phenolic compounds and antioxidant activity of propolis by using lactic acid extraction compared to ethanol. Various concentrations of ethanol and lactic acid were utilized to produce extracts, and an in vitro digestion procedure was applied to the extracts to compare the bioaccessibility of phenolic compounds by using LC-MS/MS in extracts and HPLC-DAD in digested samples. The compounds detected in the lactic acid-based propolis solution had similar values to those in the ethanol solution at a propolis concentration of 10%. The propolis-lactic acid solution had a significantly higher antioxidant activity against DPPH radical than the one prepared with ethanol at the same concentration (p < 0.05). Chrysin and naringenin were found as the most abundant phenolic compounds in the initial samples during in vitro digestion experiments. Pinocembrin was the most bioaccessible component among the dialyzed IN fractions of ethanol and lactic acid-based solutions, whereas some compounds were not detected. The results suggest that lactic acid may be used as an alternative to ethanol for propolis extraction. University of California

Objective: During the Coronavirus Disease-2019 (COVID-19) pandemic, in addition to the current measures, the healthy immune system plays an essential role and various natural agents have been recommended to boost innate immunity. The aim of this study was to investigate any association between the potential immunomodulatory activity and drinking olive leaf tea (OLT) in the COVID-19 pandemic.Design: The study was conducted among the workers in a tractor factory where OLT was served in routine. Drinking at least one cup of OLT per day for a minimum of 1 month was the inclusion criteria used in the study. The workers who had a history of vaccination and COVID-19 were excluded from the study, and lymphocyte subsets, interleukin (IL)-2, IFN-gamma, COVID-19-specific IgM and IgG levels were analyzed in all the participants to determine the asymptomatic individuals among the participants and compare the immunological parameters.Results: The study was conducted among 336 workers, 183 of them were OLT drinkers and 153 were OLT nondrinkers. The results showed higher values of CD3(-)/CD16/56 (natural killer [NK]) cells, CD3(+)/CD16/56 (natural killer T [NKT]) cells, total NK (NK+NKT) cells, and serum IFN-gamma, and IL-2 levels in OLT drinkers compared to the nondrinkers. Although all the OLT drinkers and nondrinkers included in the study reported no history of COVID-19, specific COVID-19 IgG levels were found positive in 60% of OLT drinkers and 38% OLT nondrinkers.Conclusions: Peripheral NK and NKT cell values and IL-2 and IFN-gamma secretion levels were found higher in the OLT drinking group. There were positive correlations between the OLT drinking frequency and NK cell counts. Moreover, the number of individuals who had "asymptomatic" COVID-19 infection was higher in the OLT drinking group than in the nondrinking cohort.Clinical Trail: The trial has been registered in the ClinicalTrials.gov database (CTR NCT05222347).

Psoriasis is a multifaceted, chronic, inflammatory skin disease that impacts patients’ quality of life. The aim of this study was to investigate the relationship between the disease severity and quality of life of psoriasis patients and their nutritional status. The study included 40 patients in the psoriasis group, compared with 40 healthy individuals in the control group. A questionnaire for determination of socio-demographic characteristics and nutritional intake, anthropometric measurements, psoriasis area and severity index (PASI), and dermatology life quality index (DLQI) were used for the assessments. Daily food consumption details were recorded for three consecutive days to determine daily energy and nutrient intakes. Compared to the control group, the frequencies of single participants, primary school graduates, and housewives were higher in the psoriasis group (p < 0.05). The psoriasis patients weighed more and had an increased waist/hip ratio in comparison with the healthy individuals. The energy intake was lower in the psoriasis group (p < 0.01). There was not a significant statistical difference in the intake of proteins, fiber, vitamin A, vitamin E, vitamin C, Zn, Fe, and Mg supplements between the groups. However, there was an inverse correlation between the daily vitamin E intake and PASI scores (p < 0.05). There was a positive moderate correlation between the DLQI and PASI scores (p < 0.01). Our study indicated that lower daily vitamin E intake levels were associated with the severity of psoriasis. In addition to this, abdominal obesity seems to be another risk factor in psoriasis patients, even if they have a normal body mass index (BMI). An integrated healthcare approach with dermatologists, family physicians, and dietitians is essential to the management of psoriasis.

Objective: Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection that is sufficient for satisfactory sexual performance. The aim of this study was to assess the impact of acupuncture in psychogenic ED patients, in comparison with the medical treatment. Material-Method: A total of 60 male patients, with psychogenic ED were randomized into 4 groups as electro-acupuncture only, electro-acupuncture and oral sildenafil 25 mg, a placebo sham acupuncture and oral sildenafil 50 mg only. The treatment lasted for six weeks in all groups, and patients were evaluated with the International Index of Erectile Function (IIEF-5 scores).Results: After the treatment, all groups except the placebo group showed a significant increase in IIEF-5 scores, without significant differences among them. Conclusion: Acupuncture can be used in the complementary treatment of psychogenic ED patients.

Background Viral infections are among the most common problems in health-care practice. Natural products offer great promise as potentially effective antiviral drugs. Propolis is a honeybee product with biological properties and therapeutic applications. We aimed to investigate the antiviral activity of different extracts of Standardized Propolis Preparations (M.E.D.®) with glycol, ethanol, glycerol and soya oil, against herpes simplex type-1 (HSV-1) and type 2 (HSV-2) viruses. Methods Chemical composition and antiviral activity of each extract were determined. The selective index (SI=CC50/EC50) was determined as a parameter to indicate the in vitro antiviral activity of the extracts compared with acyclovir as the control. Results SI values of glycol, ethanol, glycerol, soya oil extracts and acyclovir were determined as 6.8, 4.1, 2.2, 3.3 and 6.3 against HSV-1, and as 6.4, 7.7, 1.9, 4.2 and 2.9 against HSV-2, respectively. Glycolic propolis extract was found to possess a greater antiviral activity than acyclovir for both HSV-1 and 2, while glycolic, ethanolic and soya oil preparations were found to have more significant activity than acyclovir for HSV-2. Conclusions It was determined that standardized propolis preparations have antiviral bioactivity against HSV.

Objectives: Quitting smoking plays a vital role in preventing chronic diseases. Family physicians have an important role in smoking cessation processes. This study aimed to investigate the smoking status of family physicians who were working in the Family Health Centers in Istanbul and their knowledge and attitudes toward smoking cessation. Methods: In this study, an online survey was used to collect data from family physicians in Istanbul in 2019. The survey questions were sent to the family physicians using an e-mail and the physicians were asked to voluntarily answer the questions in the survey. Results: Total 237 physicians filled out the questionnaires and 133 (56.1%) of participants was male. The number of participants with response to smoking status as current smokers, former smokers, and never smokers were 46 (21.1%), 45 (20.5%), and 128 (58.4%), respectively. Among the participants, 37 (15.6%) were family physicians who were specialists, 43 (18.2) were aged between 41 and 45 years, and 122 (51.5%) were practicing family medicine for 7 to 9 years. The median Fagerström score of smokers was 3.0 [5.0] points. Nicotine replacement therapy was the most prominent application in the smoking cessation process according to 195 (84.3%) participants. Conclusion: Family physicians need to be encouraged to quit smoking and provide smoking cessation counseling.

The World Health Organization established a strategy on traditional medicine activities to facilitate integration of traditional medicine into the national health care system. Traditional and complementary medicine is now addressed by a legislation in Turkey. The aim of this study is to explore an integrative approach from for idiopathic granulomatous mastitis. This is a retrospective study. Study was carried out on idiopathic granulomatous mastitis patients who were followed in the Breast Clinic at Istanbul Medipol University Hospital for between May 2015 and September 2018. Hirudotherapy and medical cupping therapy were applied as traditional and complementary medicine integratively in accordance with the related Regulation. Radiological imaging, microbiological and histological testing, side effects, and relapses were analyzed. Radiological response was evaluated at the end of the treatment. Follow-up consisted of clinical breast exam and imaging. Thirty patients with a mean age of 34.6 years were analyzed. The average duration of symptoms was 4.6 months. Common symptoms were breast mass (100%), tenderness to palpation (73.3%), erythema (56.6%), fistula formation and deformity (43.4%), and axillary lymph nodes (43.4%). After confirmation of diagnosis of idiopathic granulomatous mastitis, patients were treated with hirudotherapy combined with medical cupping therapy. Symptoms had completely resolved within 110.3 ± 24.70 days (range 90–180) after starting treatment, and complete radiological response was confirmed 3 months after the end of the therapy by breast ultrasound or magnetic resonance imaging (MRI). All patients were successfully treated, and no evidence of relapse was experienced within the follow-up period of 22.87 ± 12.47 months. Hirudotherapy and medical cupping therapy were observed as efficient methods. Further investigations are required to validate the results in larger numbers of patients with longer follow-up. ( ClinicalTrials.gov Identifier: NCT04096300).

Purpose Music therapy has been used for relaxation in traditional medicine. This study explored the effect of music therapy on the physical and mental parameters of cancer patients during hematopoietic stem cell transplantation (HSCT). Design and methods Thirty patients who were hospitalized for bone marrow transplantation were included. Traditional Music Therapy of Islamic Turkish Culture was applied to the patients during the transplantation process. Specific physical and psychological parameters of patients were evaluated before and after music therapy. Findings A positive relationship between anxiety and distress scores was observed. Music therapy had a significant impact on increasing levels of oxygen saturation, and decreasing anxiety and distress levels of the HSCT patients (P Practice implications Music therapy may provide positive effects for patients during HSCT.

Purpose The aim of the study was to examine the psychosocial problems and spiritual coping styles of the family caregivers related to patients receiving palliative care. Design and methods The research sample consisted of 76 family caregivers related to palliative care patients. The data collection method used were questionnaire forms. The two forms used were Hospital Anxiety Depression Scale and Religious Coping Methods Scale. Findings The mean anxiety score of the participants was 10.86 ± 4.30, mean depression score was 9.38 ± 3.66, mean positive coping scale score was 25.31 ± 3.85, and mean negative coping scale score was 10.32 ± 3.38. Practice implications Healthcare professionals involved in palliative care are encouraged to evaluate the spiritual experiences of family caregiver to support their wellbeing.

Many studies have shown that honey with high phenolic contents prevents cancer formation. Furthermore, recent studies have demonstrated that honey can be used for the treatment of cancer as well as cancer prevention. Antineoplastic effects of honey are often associated with their antioxidant phenolic contents. However, very few studies have dealt with the association of phenolic contents of honeys in terms of antiproliferative effects. The aim of this study was, therefore, to elucidate the cytotoxic, genotoxic, apoptotic, and reactive oxygen species (ROS) generating effects of honey samples on the basis of their phenolic and flavonoid contents. Fourteen different honey varieties were collected from various parts of Turkey, and their characteristics regarding total phenols, flavonoids, and antioxidant contents were determined to test their effects on gastric cancer cells (AGS). For convenience, 2 honey varieties were selected, namely, Ida Mountains Quercus pyrenaica honeydew honey (QPHH-IM) having the highest phenolic and antioxidant content and Canakkale multifloral honey (MFH-C) with the lowest phenolic and antioxidant content. Levels of 11 different phenolic compounds in QPHH-IM and MFH-C samples were determined by LC-MS/MS. AGS cells were incubated with different concentrations of QPHH-IM and MFH-C for 24 hours, then the cell viability, DNA damage, apoptosis, and generation of ROS were determined. We found that QPHH-IM had more cytotoxic, genotoxic, and apoptotic effects than that of MFH-C. We think that these effects are probably related to pro-oxidant activities due to the high phenolic contents present. Therefore, further research on high-phenolic honey may contribute to the future development of cancer therapeutics.

WOS: 000382408400016 PubMed ID: 27515884 Adenoid cystic carcinoma (ACC) is an aggressive malignant neoplasm of the secretory glands. Conventional chemotherapy has poor effectiveness against metastatic ACC. Thus, a novel effective therapy is needed against metastatic ACC. A majority of ACCs (up to 94%) express c-kit. Imatinib is monoclonal antibody with specific activity against c-kit but has not been found to be effective in treating patients with ACC in which c-kit is overexpressed and activated. The NF-kappa B and mTOR pathways have been shown that ubiquitously and concurrently activated, indicating that the inhibition of these pathways may represent a novel treatment approach for patients with ACC. Curcumin has been shown to inhibit NF-kappa B and NF-kappa B-related pathways. 43-year-old patient was diagnosed ACC from submandibular salivary gland. After complete resection of tumor adjuvant radiotherapy was initiated. Seven years later multiple lung metastases were detected and ACC was confirmed by re-biopsy. First-line chemotherapy failed. NF-kappa B and c-kit were over expressed in the metastatic specimens. Therefore, we treated the patient with metastatic chemoresistant ACC with imatinib 400 mg/day and intravenous curcumin 225 mg/m(2) twice a week plus oral bioavailable curcumin Arantal((R)) 2 x 84 mg/day. At 24 months, we observed near complete anatomic and complete metabolic response. To our knowledge, this is the first report of a patient with a c-kit-positive ACC that is successfully treated with the combination of imatinib and curcumin in an integrative approach.

WOS: 000370271100037 PubMed ID: 27511515 Background/aim: Clinical trials have shown that low glycemic index (GI) nutrition reduces mean blood glucose concentrations and insulin secretions. The aim of the present study was to determine the GI values of various monofloral (citrus, milk-vetch, chestnut, thyme, lime, pine) honeys of Turkey, and the effect of their consumption on glucose metabolism. Materials and methods: Processing data from 20 healthy volunteers, GI values were determined from the glycemia values by using the incremental area method. Serum insulin and C-peptide levels were also measured before and 120 min after the test. Results: The GI values of citrus, thyme, lime, chestnut, pine, and milk-vetch honeys were found to be 44.9, 52.6, 55.3, 55.5, 58.8, and 69, respectively. Serum insulin and C-peptide values after honey consumption were relatively lower than those after reference food (glucose) consumption. By the end of the 120 min, serum insulin levels were significantly higher, while a significant decrease was observed after the consumption of chestnut honey (P < 0.05). Conclusion: Citrus and thyme honeys were determined to have low GI, while serum insulin levels were significantly lower after the consumption of chestnut honey. Long-term research is needed to compare the effects of honey consumption on healthy and diabetic individuals. TUBITAK (the Scientific and Technological Research Council of Turkey) [1002-112S549] The authors express their gratitude for the grant by TUBITAK (the Scientific and Technological Research Council of Turkey) (code 1002-112S549). The authors also would like to express special thanks to the academicians from the Department of Biostatistics and Medical Informatics at Erciyes University for their supervision in the statistical work.

WOS: 000358579700053 PubMed ID: 25903179 In the present study, changes in erythrocyte rheology in association with mercury toxicity and the role of propolis were analyzed in rats. Forty male Wistar Albino rats that were 4-5 months old were used in the study. The control group was administered normal saline intraperitoneal (ip) injections; the mercury chloride group was administered HgCl2 (4 mg/kg, ip); the propolis group was administered propolis (200 mg/kg, by gavage); and the HgCl2+ propolis group was administered HgCl2 (4 mg/kg, ip)+ propolis (200 mg/kg, by gavage) for 3 days. The following parameters were analyzed: hematological parameters, plasma potassium (K) levels, methemoglobin, 2,3-DPG, erythrocyte deformability, and hemolysis as a percentage. The results revealed that leukocyte count significantly increased, and a significant decline occurred in the platelet count (p

This work was supported by The Republic of Turkey Ministry of Development Infrastructure Grant (no: 20111(120020 to MSS, BE) and BILGEM - TUBITAK (The Scientific and Technological Research Council of Turkey) (grant no: T439000 to MSS, BE)., Usher syndrome is a clinically and genetically heterogeneous autosomal recessive inherited disorder accompanied by hearing loss and retinitis pigmentosa (RP). Since the associated genes are various and quite large, we utilized whole-exome sequencing (WES) as a diagnostic tool to identify the molecular basis of Usher syndrome. DNA from a 12-year-old male diagnosed with Usher syndrome was analyzed by WES. Mutations detected were confirmed by Sanger sequencing. The pathogenicity of these mutations was determined by in silico analysis. A maternally inherited deleterious frameshift mutation, c.14439_14454del in exon 66 and a paternally inherited non-sense c.10830G>A stop-gain SNV in exon 55 of USH2A were found as two novel compound heterozygous mutations. Both of these mutations disrupt the C terminal of USH2A protein. As a result, WES revealed two novel compound heterozygous mutations in a Turkish USH2A patient. This approach gave us an opportunity to have an appropriate diagnosis and provide genetic counseling to the family within a reasonable rime., Republic of Turkey Ministry of Development Infrastructure Grant [2011K120020]; BILGEM - TUBITAK (The Scientific and Technological Research Council of Turkey) [T439000]

Background: There have been growing concerns about environmental pollution and public health issues associated with metal(loid)s and radionuclides. As a baseline for monitorisation, radioactivity and specific metal(loid) levels have been measured to investigate the estimated environmental health risks in Igdir province at the Turkish side of the border, in the vicinity of the Metsamor Nuclear Power Plant, an aging nuclear station without primary containment structures. Materials and Methods: Concentrations of radioactivity and accumulation of metal(loid)s in the region were measured and hazard quotient, hazard index, and the excess lifetime cancer risk vaues were calculated according to international methods and standards. Results: Hazard quotient and index values were determined to be lower than the permissible maximum levels. The average estimated excess cancer risk values for terrestrial and cosmic exposures due to radionuclides were calculated as 1.8 +/- 0.9E-04 and 2.4 +/- 0.04E-04, respectively. The average estimated excess cancer risk value for the radioactivity in water was determined as 15.2 +/- 13.6E-05. The mean excess lifetime cancer risk values due to metal(loid) exposure were as Cr