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Background: Tomatoes are a significant product of the Mediterranean region and a crucial component of the Mediterranean diet. The formulation of dried tomato products enriched with proteins and bioactive compounds could be a strategic approach to promote adherence to the Mediterranean diet. Six different novel tomato products were analyzed using different protein enrichment sources (pea proteins and leaf proteins) and drying technologies (hot-air dryer, microwave vacuum dryer, and conventional dryer). The novelty of this approach lies in combining product-specific criteria with global societal factors across their life cycles. Using 21 criteria and an analytic hierarchy process (AHP) survey of experts, the social sustainability score for each product was determined through a multi-criteria assessment., Results: The tomato product's life cycles have minimal regional impacts on unemployment, access to drinking water, sanitation, or excessive working hours. However, they affect discrimination, migrant labor, children's education, and access to hospital beds significantly. The study identified nutritional quality as the top criterion, with the most sustainable design being a tomato bar enriched with pea protein and processed using microwave vacuum drying., Conclusion: The study revealed that integrating sensory and nutrient compounds into social sustainability assessments improves food sustainability and provides a practical roadmap for social life cycle assessments of food products. It emphasized the importance of considering global social issues when reformulating Mediterranean products to ensure long-term adherence to the Mediterranean diet. Incorporating social factors into sustainability scores can also enhance the effectiveness of product information for conscious customers. © 2024 The Author(s). Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2024 The Author(s). Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Background: On 6 February, 2023, Turkey experienced a disaster resulting from two major earthquakes. The elderly population stands out as one of the most vulnerable and least adaptable. This study aims to identify the quality of life (QOL) and post-traumatic stress disorder (PTSD) symptoms among elderly earthquake survivors in Turkey., Methods: This research was conducted between 1 October, 2023 and 15 December, 2023 as a cross-sectional design. During the data collection process, survey questions prepared by the researchers (29 questions) and the Elderly Quality of Life Scale (OPQOL-Bref) and the Impact of Events Scale (IES-R) were used., Results: Three hundred and eighty-four elderly people participated in the study. PTSD was more common in those diagnosed with chronic diseases after the earthquake, in those who had a drug-free period after the earthquake, in those who smoked and quit smoking, and in those who started psychiatric medication after the earthquake. Post-traumatic stress was seen more frequently in those with low QOL scores and in those who had a longer period of not using medication after the earthquake. It was observed that QOL was better in married people, high school graduates, those with average income levels, those who did not have chronic diseases before and after the earthquake, those who did not have a drug-free period after the earthquake, those who were physically active, and those who did not use psychiatric medication after the earthquake., Conclusion: Chronic disease diagnosis post-earthquake, drug-free periods, smoking habits, and psychiatric medication usage were identified as influential factors in PTSD occurrence. Additionally, the study shed light on the profound effect of earthquake-related experiences, such as house damage, injuries, deaths in first-degree relatives, displacement, and changes in living conditions, on PTSD prevalence., (© 2024 Japanese Psychogeriatric Society.)

Purpose: During the coronavirus disease 2019 pandemic, health services offered to individuals diagnosed with mental disorders were interrupted, and use of alternative methods, such as telenursing, came to the forefront., Method: Sixty-four individuals with schizophrenia participated in the current randomized controlled trial that evaluated whether a telenursing intervention affected their drug attitudes, self-efficacy, and quality of life. Pretest, posttest, and follow-up measurements were obtained for experimental and control groups from May to August 2021. Data were collected via a Personal Information Form, Drug Attitude Inventory-10, Self-Efficacy Scale, and World Health Organization Quality of Life Questionnaire-Short Form., Results: Upon comparison of scores obtained by the experimental and control groups in pretest, posttest, and follow-up measurements, it was discerned that telenursing positively affected drug attitudes of participants in the experimental group and enhanced their quality of life. Although there was an increase in self-efficacy levels of the experimental group compared to the control group, the difference was not statistically significant., Conclusion: Telenursing is an effective intervention for the improvement of drug attitudes and quality of life but is not satisfactory for the improvement of self-efficacy in individuals with schizophrenia. [ Journal of Psychosocial Nursing and Mental Health Services, 62 (10), 15-24.].

Background: The bed bath is an important part of nursing care. There are few studies evaluating the effects of traditional and dry bed baths on patients., Aim: This study was performed with the aim of investigating the effect of traditional and dry bed baths given to intensive care unit patients on the patients' hemodynamic parameters, the duration of the bathing procedure and the cost of consumable items., Methods: This was a randomized crossover clinical trial and a prospective study. The study was conducted in a General Surgery Intensive Care Unit with 22 intensive care patients aged 18 and over, who had a nursing diagnosis of bathing personal care deficiency. Each patient was given two types of bed baths at an interval of 24 h: a traditional bed bath and a dry bed bath performed with single-use tissues. Immediately before each bath, in the 5th, 10th and 15th minute of bathing, immediately after bathing and 30 min after bathing, body temperature, heart rate, blood pressure, breathing rate and peripheral oxygen saturation measurement changes over time were compared within the group using the Friedman test. The Wilcoxon signed ranks test was used to compare the variables of bathing duration and bathing consumable item costs between the bathing procedures., Results: It was found that at the completion of traditional and dry bed bathing, the participants' body temperature, blood pressure, heart rate and breathing rate parameters were statistically significantly lower than before bathing, whereas peripheral oxygen saturation values showed a significant increase (p < 0.05). It was found that the dry bed bath took a statistically significantly shorter time than the traditional bed bath and that the cost of consumable bathing materials was less (p < 0.05)., Conclusions: It was concluded that traditional and dry bed baths given to intensive care patients affected their hemodynamic parameters and that the dry bed bath was superior to the traditional bed bath in that it took less time and that it cost less., (© 2024 John Wiley & Sons Australia, Ltd.)

In this study, the effects of the COVID-19 pandemic on physical activity and sedentary lifestyle of young adults were evaluated. The cross-sectional study was conducted on individuals aged 18-35 years between December 2021 and March 2022. In the study, sedentary life was evaluated with the International Physical Activity Questionnaire (IPAQ), screening time and the Brief Eating Behaviors Questionnaire. 397 people participated in the study and the mean age was 24.41 ± 4.18. Body Mass Index (BMI), time spent in front of the screen, need for psychosocial support, and Short Diet Behaviors Questionnaire (SDBQ) scores showed a significant increase during the pandemic compared to the pre-pandemic period (respectively; p  < 0.001, p  < 0.001, p  < 0.001, p  < 0.001). It has been observed that there is an increase in the time spent in front of the screen, worsening in eating behaviors, decrease in physical activity, and an increase in BMI values of young adults during pandemic.

The aim of the study is to examine the relationship between fathers' reading beliefs and father's and child's media habits and book reading status in the preschool period. In total, 520 fathers with children aged 2-5 years were included in the study. " z score above+1" were defined as the High Parental Reading Scale Score (HPRSS). Moreover, 72.3% of fathers spent 3 hours or more with their children on a day, and 32.9% of fathers used the screen as a reward and 35% as a punishment. Multivariable analysis showed that spending more than 3 hours with their children, not using the screen as a reward, not using it as a punishment, knowing smart signs, getting information from a book, having a screen time less than 1 hour, not using screen alone, doing another activity when not allowed were associated with the HPRSS. The father's reading belief is related to the child's media usage habits.

to examine the effect of the medium intensity coughing technique during subcutaneous low molecular weight heparin injection on pain severity and individual satisfaction in general surgery patients. the prospective, quasi-experimental study included 100 patients who had been prescribed a subcutaneous low molecular weight heparin injection once in 24 hours. Each patient received two injections by the same researcher, one using the standard injection technique with medium intensity coughing technique and the other only the standard injection technique. there was a statistically significant difference between patients' mean scores on pain severity and satisfaction levels after injections administered by the two techniques (p= 0.000). Also, it was found that gender affected pain severity relating to the injection but did not affect the level of individual satisfaction. the medium intensity coughing technique was found to reduce pain severity and increase patient satisfaction in general surgery patients receiving subcutaneous low molecular weight heparin injections. Trial registration: NCT05681338.

Aim: In our country, there are childhood vaccinations that are not included in the routine vaccination schedule and that families have to buy and have for a fee. In addition to income level, family physicians' recommendations also play a major role in getting these vaccines.Our study was planned to determine the level of knowledge, attitudes and behaviors of family physicians about rotavirus, HPV and meningococcal vaccines, which are not included in the routine vaccination scheme of the Ministry of Health., Materials and Methods: Our cross-sectional and descriptive study was carried out between May and July 2019. The population of our study consists of approximately 30 000 family physicians working as Family Physicians in Turkey. When the sample size is calculated with 5% margin of error and 95% confidence interval, it turns out to be 381. A 15-question questionnaire prepared by scanning the literature and including socio-demographic characteristics was presented to the participants. The Likert scale, which includes 12 questions about rotavirus, meningococcus, HPV and vaccines developed for these microorganisms, was administered to physicians either face-to-face or via the internet. In our study, the statistical significance level was accepted as P < 0.05, and the SPSS statistical package program was used in the calculations., Results: 81 Research Assistants, 62 Family Medicine Specialists and 234 Family Physicians participated in our study, and the participants were determined by simple random sampling method. The mean age of the participating physicians was 37.96 ± 9.3 (min: 25 and max: 68). 50.9% of the physicians were women, 79.8% were married, 85.1% were in the city center, and 62.1% were practicing family medicine as general practitioners. 74.82% of the participating physicians recommend rotavirus and 56.2% HPV vaccines to their patients. 10.6% (40 people) of the physicians participating in our study did not recommend any of the rotavirus, HPV, meningococcal, influenza and adult pertussis vaccines to their patients. In the evaluation of the reason for this, 58.7% (27 people) of physicians who did not recommend special vaccines state that they did not recommend vaccines because they are not included in the routine vaccination schedule of the Ministry of Health. Another important reason was that the vaccines are paid (30.4%, 14 people). To the question of having sufficient information about special vaccines that are not included in the routine vaccination schedule, 26% of the participants stated that they have sufficient knowledge, and 56.5% stated that they have partial knowledge. The Likert knowledge questions total score of those who recommended at least one vaccine to their patients was significantly higher than those who did not recommend it at all. Likert knowledge questions total score of those who had at least one vaccination was significantly higher than those who never had it ( P = 0.001)., Conclusion: In general, as the level of knowledge about private vaccines decreases, the rates of self-vaccination, recommending it to their patients, and asking it to be included in the national vaccine schedule decrease. For this reason, increasing the knowledge of physicians about vaccines not included in the national vaccination schedule will contribute to the dissemination of vaccines, thus increasing immunity and reducing mortality and morbidity.

Purpose: To examine the effects of psychiatric nursing e-course taught by distance learning on students' beliefs about mental illnesses., Design and Methods: This study was conducted as a pretest, posttest, and follow-up quasi-experimental study with 147 nursing students., Findings: The results showed that the psychiatric nursing e-course significantly reduced the stigmatization total and dimension scale scores of the participants, and the effect continued in the follow-up measurement. The difference between the pretest and posttest stigmatization scores of the students who concentrated during virtual classes and those who found student-instructor interaction and virtual course materials sufficient was statistically significant., Practice Implications: Our results have shown that the psychiatric nursing e-course is effective on beliefs regarding stigmatization, and distance education is promising for nursing education to continue effectively., (© 2021 Wiley Periodicals LLC.)

Purpose: It is important to investigate the negative factors affecting medication compliance to continue the treatment of schizophrenia., Design and Methods: In this descriptive and analytical study, the effects of insight, loneliness, and hope levels on medication adherence in 202 patients with schizophrenia were studied., Findings: The correlation was positive between medication adherence and insight, negative between medication adherence and loneliness, and no correlation between medication adherence and hope. A 1-point increase in insight scores increased medication adherence 1.226 times and a 1-point increase in loneliness scores decreased medication adherence 0.946 times. Medication adherence was 0.499 times lower in nonsmokers compared to smokers., Practice Implications: Further studies on patients with schizophrenia should be conducted to evaluate factors affecting medication adherence and preventing smoking in schizophrenia., (© 2022 Wiley Periodicals LLC.)

Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.

Purpose: This study investigated the experiences of healthcare professionals, exposed to physical violence, related to aggressive patients at a psychiatry service., Design and Methods: The qualitative study sample consisted of a total of 21 healthcare professionals. The data were collected through in-depth interviews. An inductive qualitative content analysis was used to analyze the data., Findings: Three themes, the effects of warning signs of violence, clinical management of violence, and effects of violence, and 13 sub-themes were determined., Practice Implications: The effects of physical violence on healthcare professionals can be seen and will contribute to planning in this regard., (© 2021 Wiley Periodicals LLC.)

Emerging evidence indicates that dysbiosis of gut microbiota plays an important role in epilepsy, although the underlying mechanisms remain unclear due to the complex nature of both microbial composition and pathophysiology of epilepsy. We investigated effects of long-term probiotics supplementation on epileptic seizures, and inflammatory and oxidant/antioxidant biomarkers in a pentylenetetrazole(PTZ)-induced seizure model in rats. Male Wistar weaner-rats were divided into four groups. The first two groups received 1 ml/day saline solution, while the other groups received 0.05 mg/1ml/day vehicle or 109cfu/1ml/day probiotic-mixture, respectively, for 60 days by gavage. Seizure was induced by a single convulsive dose of PTZ. Seizures were evaluated using Racine's scale. Concentrations of pro-inflammatory cytokines in plasma and brain tissue were determined using ELISA, while oxidant/antioxidant biomarkers were measured using an automated-colorimetric method. Probiotics supplementation exhibited anticonvulsant effects against PTZ-induced seizures by retarding onset-times of both myoclonic-jerk and generalized tonic-clonic seizure, and by shortening duration of generalized tonic-clonic seizure. Additionally, it alleviated PTZ-induced increases in levels of pro-inflammatory cytokines IL-1β, IL-6, and IL-17A, but not of IFNγ, in plasma and brain tissue. Moreover, it restored PTZinduced fluctuations in levels of oxidants TOS and disulfide, and of antioxidants native thiol and total thiol. Our findings suggest that long-term probiotics supplementation exhibits protective effects against epileptic seizures, and alleviates (neuro)inflammation and oxidative stress related to pathophysiology of epilepsy. A probiotic-rich diet provided from childhood may provide prophylaxis against epileptic seizures, especially in susceptible individuals, as the neonate diet represents a fundamental extrinsic factor in establishing gut microbiota., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: To determine the frequency of breastfeeding of mothers working in primary care, the differences between different employment groups, and the effective factors., Methods: This descriptive research study was conducted with a self-report online survey design. The snowball sampling method was used for the sample selection, and 151 family physicians and 126 family health professionals were included in the study during the research period (June 2019-December 2019). A 35-item survey was used to collect data. The response rate was 44.9% (49.5% family physicians/40.3% family health professionals)., Results: The mean duration of exclusive breastfeeding was 3.9 ± 2.0 months, and the mean duration of total breastfeeding was 16.7 ± 8.5 months. There was no significant difference between the family physicians and family health professionals in terms of exclusive breastfeeding (P = .580) and total breastfeeding (P = .325) durations. The most common reasons for weaning were reduced milk supply (25.6%) and not being able to use breastfeeding leave (23.1%) due to problems at work. Of the sample, 41.3% had problems with their coworkers and 41.9% had problems related to patient care when taking breastfeeding leave. Working in a baby-friendly centre (P = .01), prolonged exclusive breastfeeding (P < .001), and increased hours of breastfeeding leave taken (P = .001) had a positive effect on breastfeeding for ≥24 months while experiencing problems with coworkers in taking breastfeeding leave (P = .023) had a negative effect on this variable., Conclusions: All of the factors that were determined to affect the continuation of breastfeeding for ≥24 months are modifiable. It is very important for relevant authorities to undertake necessary action to improve the conditions of working mothers based on these results. Health professional that can maintain the balance between family and work will work more efficiently., (© 2021 John Wiley & Sons Ltd.)

The changes taking place in the education system along with the coronavirus disease 2019 pandemic make it compulsory to use distance education methods. For evaluating whether the assertiveness training which was offered through a hybrid education model had any effect on assertiveness and self-esteem, this study was conducted as an experimental study with the control group. In the study, the Rathus assertiveness inventory, Coopersmith self-esteem inventory, and personal information form were utilized. The participant nursing students were assigned to experimental and control groups. The measurement tools were applied to both groups while the assertiveness training was later given solely to the experimental group. At the end of the training given to the experimental group, the measurement tools were applied once again to both groups. According to the results of the study, while the assertiveness and self-esteem of the students in the experimental group increased significantly from the pre-test to the posttest measurements, no statistically significant difference was found in the measurements made in the same periods in the control group. This situation demonstrates that the technology-based hybrid assertiveness training was effective in enhancing assertiveness and self-esteem., (© 2021 Wiley Periodicals LLC.)

Aim: The aim of the study was to investigate and evaluate factors affecting levels of negative bias or attitude towards obesity, known as "fat phobia.", Methods: The study included 583 individuals who agreed to participate in this research among those presented at our outpatient clinics for any reason. Participants were asked to complete a survey after their written consent was received. The survey consisted of two parts: the first related to socio-demographic information; the second including a "Fat Phobia Scale," the "State-Trait Anxiety Inventory" and the "Beck Depression Inventory." Data analysed using SPSS 20 statistical software., Results: Of the participants, 50.6% were male, and 49.4% were female. Among participants, 49.7% had a weight problem in their family, while 50.6% had experienced weight problems. In addition, 35.7% of participants were overweight, 27.4% severely overweight, 20.1% medium-to-normal weight, 7% severely underweight, 6.7% underweight and 3.1% obese. The median score for fat phobia level did not differ by gender (P = .790) and was 3.07 in both men and women. The fat phobia level did not vary by profession, previous diets, previous weight problems and weight self-assessment (P > .05). There was no significant relationship between fat phobia and age, weight, height, body mass index, state anxiety, trait anxiety and Beck depression score (P > .05)., Conclusion: The common opinion across studies on bias is that the effective factor in being free from the relevant bias can be achieved through education. Although fat phobia is a new concept, it is an emotion that is always with us at varying levels. In order to minimise the level of fat phobia as much as possible, to draw attention to this situation and to raise awareness, weight management should be ensured for the health of individuals in addition to psychological sessions., (© 2021 John Wiley & Sons Ltd.)

Aims: Aim of this study is to translate and apply a cross-cultural adaptation of the Evidence-Based Practice Attitude Scale (EBPAS) in Turkish and investigate its validity and reliability., Methods: The original EBPAS-15 (a questionnaire assessing health professionals' attitudes to implementation of evidence-based practice) was translated into Turkish. To assess its validity and reliability, 151 family medicine residents answered the EBPAS-15 by web-based survey. In addition, relationships of family medicine residents' characteristics with EBPAS-15 total scores are examined., Results: The results showed that the EBPAS-15 has good internal consistency and reliability. The Cronbach's alpha value for EBPAS-15 was 0.828. The scores of the two scales were highly correlated (ρ = 0.72). In the scale, there was no item with a total correlation value of less than 0.40. For this reason, no item was removed due to the high reliability value of all 15 items., Conclusion: The Turkish version of the EBPAS-15 shows mainly good validity and reliability., (© 2021 John Wiley & Sons Ltd.)

Objectives: The profession of medicine is very depressing both mentally and physically. There were studies conducted to investigate the reasons of depression and burnout. Hopelessness leads to depression and may be it is the first sign. The aim of our study is to determine the despair levels of primary care physicians., Methods: This research is a descriptive study. The study conducted with family physicians and Beck Hopelessness Scale was applied. Statistical analysis of the data was performed using IBM SPSS 23., Results: 40.9% of those without children, 48.9% of those with chronic diseases, 47% of those who had been subjected to violence and 53.5% of those who are not satisfied with working in the primary care received severe hopelessness scores, and these score were significant (P < .05)., Conclusion: The dissatisfied aspects of Family Medicine System should be examined in detail, and necessary measures should be taken against violence, which is a common problem in the whole healthcare sector. In this way, employee satisfaction and therefore patient satisfaction can be achieved., (© 2021 John Wiley & Sons Ltd.)

Aims: The aim of the study was to evaluate the possible changes in sleep behavior and nutrition in children during the pandemic period., Methods: One hundred fourteen parents who accepted to participate in the study aged 18 and over and who had children between the ages of 6 and 16 were included in the study. A questionnaire was carried out after written consents were obtained. In the first part of the questionnaire, there were a total of 9 questions including socio-demographic information and nutritional characteristics, and the second part included the "Sleep Disturbance Scale for Children" (SDSC). The data were analyzed with the SPSS 20 statistical program., Results: The total number of participants was 114 parents; 64 (56%) of the children were girls and 50 (43.9%) were boys. Among the participants, the number of children who had COVID-19 was 38 (33.3%). There was no statistically significant relationship between going through COVID-19 status and the variables examined in general. The proportion of participants who stated that if the pandemic period was prolonged, COVID-19 would not change their diet was found to be statistically significant (P = .038). The SDSC score was found to be significantly high in girls (P < .05)., Conclusion: Sleep and nutritional disorders affect the quality of life for all ages for both genders, and their importance increases even more in extraordinary periods such as pandemic. Sleep problems increasing especially with an accompanying anxiety state may lead to developmental problems as well as deepening psychological disorders., (© 2021 John Wiley & Sons Ltd.)

Aims: It was aimed to compare the breastfeeding status and healthy life style changes, eating behaviors, attitudes, and orthorectic tendencies of mothers., Methods: All volunteered mothers who have a child between the ages of 0 and 2 were included in this cross-sectional study. Five hundred fourteen individuals were included. Five parted questionnaire and "ORTO-11" test and "Eating Attitude Test" were used., Results: A statistically significant relationship was found between breastfeeding status and working status and professions of mothers. Mothers who did not breastfeed, skipped main meal more frequently, and smoking and occasional alcohol consumption was higher. The mean score of the participants on the ORTO-11 scale was 25.09 ± 4.80, EAT-40 scale mean score was 18.80 ± 10.42. High-risk in eating attitudes was found in 12.0% of all participants. It was observed that mothers who did not breastfeed were mostly in high-risk group in terms of eating attitude., Conclusion: Mothers who did not breastfeed were mostly in high-risk group in terms of eating attitude compared with breastfeeding mothers. It is of great importance that healthcare professionals organize trainings for increasing the general level of knowledge of mothers and provide healthy living and breastfeeding counseling., (© 2021 John Wiley & Sons Ltd.)

Aim: The aim of this study was to describe the attitudes, views and solution proposals of family physicians (FPs) about primary healthcare problems of Syrian refugee patients. This study would be the very first study for Turkey that evaluates the attitudes, views and solution proposals of FPs about primary healthcare problems of Syrian refugee patients., Background: Following the anti-regime demonstrations that started in March 2011, the developments in Syria created one of the biggest humanitarian crises in the world and the largest number of asylum seekers continue to be hosted in Turkey. There are some studies evaluating asylum seekers' access to healthcare services in Europe, and the common result is that refugees have free access to primary healthcare services in most countries; however, they face many obstacles when accessing primary healthcare services. While there are studies in the literature evaluating the situation of access to primary healthcare services from the perspective of asylum seekers; there are few studies evaluating the opinions/views of FPs., Methods: A qualitative methodology informed by the grounded theory was used to guide the research. A total of 20 FPs were interviewed face to face through semi-structured interviews, using 12 questions about their lived experience and views caring of refugee population. Interviews were analysed thematically., Finding: The following themes were revealed: Benefiting from Primary Health Care Services, Benefiting from Rights, Differences Between the Approach/Attitudes of Turkish Citizens and Refugees, Barriers to Healthcare Delivery, Training Needs of Physicians, Solution proposals. FPs reported that there is a need for support in primary care and a need for training them and refugees in this regard and they specified refugee healthcare centres are the best healthcare centres for refugees; however, the number of these and provided services should be increased.

Objective: We aimed to learn about the experiences of family medicine research assistants during COVID-19 pandemic and to obtain information about improvement activities that can be done in similar situations., Materials and Methods: The study was conducted with the research assistants of X University Faculty of Medicine, Department of Family Medicine, who worked in the COVID-19 outpatient clinic during the pandemic period. The research was a qualitative research. Data were analysed using a thematic framework method., Results: In all, 15 research assistants (11 females and 4 males) were included in the study. No remarkable difference was detected in the opinions with respect to their gender and their working period as a physician. The analysis revealed four main themes: emotions experienced during pandemic, working environment, gains and reasons to choose "family medicine.", Conclusion: Family medicine research assistants have important roles during pandemic. However, in this period, it is very important to know their views to provide the most accurate management and to meet their training needs., (© 2020 John Wiley & Sons Ltd.)

Aims: This study aims to evaluate the changes in smoking addiction levels during the on-going Covid-19 pandemic., Methods: This study included 104 participants, ≥18 years old who were previous patients of family health clinics for a variety of reasons in the months preceding the onset of the Covid-19 pandemic. The Fagerström Test for Nicotine Dependence was administered to these patients as part of their initial intakes. The participants were asked to complete a questionnaire related to socio-demographic information and the Fagerström Test for Nicotine Dependence after obtaining agreement to participate during the pandemic period. In addition, written informed consent was obtained. The Statistical Package for the Social Sciences, version 20, was used to analyse the acquired data., Results: The participants were 48.1% and 51.9% women and men, respectively. The pre-pandemic and Covid-19 pandemic mean smoking addiction scores were 5.03 and 5.6, respectively. The smoking addiction levels before and during the Covid-19 pandemic significantly differed (P < .001). Of the individuals with low smoking addiction levels before the pandemic, 17.6% and 29.4% became moderately and highly addicted, respectively. Of the individuals with moderate smoking addiction level, 6.3% and 43.9% became lowly and highly addicted, respectively., Conclusion: The smoking addiction level may change based on various factors including behavioural changes. While increases in smoking addiction during the pandemic can be observed caused by behavioural changes and anxieties that may arise because of the pandemic, a decrease in addiction levels and even smoking cessation can also be observed during these times because of the more progressive course of Covid-19 in smokers. Health institutions should therefore take advantage of this period and focus more efforts on the cessation of smoking and other substance abuse issues., (© 2021 John Wiley & Sons Ltd.)

Objective: In this study, we aim to investigate the thoughts and attitudes of individuals towards the future COVID-19 vaccine., Methods: This descriptive study was carried out on the web between 10/06/2020 and 10/07/2020. The sample constitutes all individuals above 18 years of age using social media and smartphone. The e-survey form was shared by the researchers via the web for a month, and those who completed the survey were included in the study and formed the sample of the research., Results: Seven-hundred and fifty-nine people participated. 49.7% of the participants stated to be vaccinated; 38.4% of them stated to be vaccinated their children against COVID-19; if the vaccine for COVID-19 is developed. The request for the COVID-19 vaccine had relationship with gender, occupation, health insurance, anxiety level, having children and willing to get vaccinated for their children. "Afraid of the side effects of vaccine", "don't think it can be reliable as it will be a new vaccine" and "COVID-19 infection is a biological weapon and the vaccine will serve those who produce this virus" were the most common reasons for rejection of vaccine., Conclusion: In our study, afraid of the side effects of vaccine and not thinking it can be reliable as it will be a new vaccine are the most reasons of indecision and rejection about COVID 19 vaccine. In order for the future COVID 19 vaccination campaign to not fail, media, politicians and healthcare professionals should closely follow the vaccination development processes, inform the public transparently and consider public's concerns., (© 2020 John Wiley & Sons Ltd.)

Purpose: In our study, we aimed to evaluate the sleep quality, insomnia presence and severity, obstructive sleep apnoea syndrome (OSAS) risk of the patients who applied to family health centres and to determine the situations that might be related with these features., Methods: This study is a descriptive research and conducted in Ankara Güdül, Antalya Değirmenözü, Bursa Sırameşeler, Gaziantep Family Health Centre policlinics. The study population consisted of all patients over 18 years of age who were admitted to the family health centres for any reason. A 10-question questionnaire, Berlin questionnaire, Pittsburgh sleep quality questionare and insomnia severity questionare were applied by the researchers from October to December 2017 by using face-to-face interview method., Results: Two hundred nineteen nine people participated in study and 54.5% of them were women. According to the results of Pittsburgh Sleep Quality Questionare, it was found that 27.1% of the participants' sleep quality was good; according to the Berlin sleep questionnaire, 27.4% of the participants had high OSAS risk. According to Insomnia Severity Questionare, 27.1% of them had insomnia lower threshold, 15.4% had moderate insomnia and 3.7% severe insomnia., Conclusions: In this context, it will be very effective in terms of the quality of life of patients in order to determine the conditions that disrupt sleep hygiene and to perform the necessary interventions which can be intervened in the primary healthcare institutions and the other patients to be delivered to the related upper levels., (© 2020 John Wiley & Sons Ltd.)

Objective: The tools used for critically appraising the quality of clinical practice guidelines are complex and not suitable for the busy end users. So rapid, effective and simple instruments are more preferred. The aim of this study is to compare two critical appraisal tools: iCAHE as a rapid instrument and AGREE II as a complex instrument on guideline quality assessment., Material and Methods: The diabetes mellitus guidelines of the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Health and Clinical Excellence (NICE), the International Diabetes Federation (IDF) and the Society of Endocrinology and Metabolism of Turkey (SEMT) were assessed separately by four appraisers using the iCAHE and AGREE II instruments. The mean iCAHE criteria scores and the total and domain AGREE II scores given by the four appraisers are presented for each guideline., Results: No statistically significant difference was detected between the iCAHE scale scores of the guidelines evaluated (P = 0.063). The rank of the guidelines according to their average total iCAHE and AGREE II instrument scores was similar. The iCAHE mean scores of the guidelines were as follows: NICE, 92.85%; SIGN, 92.85%; IDF, 66.07% and SEMT, 73.21%. The AGREE II mean scores of the guidelines were as follows: NICE, 87.13%; SIGN, 78.25%; IDF, 53.44% and SEMT, 53.22%., Conclusions: In addition to being a quality scale, the iCAHE checklist is easy, practical and short to implement. It also helps the users to understand the quality of the guideline in a shorter time. To increase the use of guidelines, it is important that users with little experience and time use the iCAHE scale as a rapid appraisal tool, but more studies are needed to decide the best appraisal tool., (© The Author(s) 2020. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The aim of this study is to evaluate the attitude, knowledge and anxiety status of individuals about COVID-19 at the first period of the outbreak., Methods: This was an observational study carried out in Turkey. An online semi-structured questionnaire was developed by using google forms and the link of the questionnaire was sent through emails, WhatsApp and other social media to the contacts of the investigators between 20th March 2020 and 25th March 2020. The questionnaire contained 21 questions and Beck anxiety scale., Results: About 1070 people were included in the study. Approximately one-fifth of the participants had no idea about treatment and immunisation against COVID-19. According to the categorisation of Beck Anxiety Inventory scores 8.6% showed severe anxiety symptoms. Anxiety levels of women, healthcare workers and those with psychiatric illness were higher (P < .05). It was observed that women, healthcare professionals, those with chronic diseases and those with moderate to severe anxiety used the medical facemask more frequently (P < .05). About 73% of the participants thought that they fully implemented the proposed measures; 25.2% of them stated that population did not take any measures for the COVID-19., Conclusion: According to the results of the study individuals usually had better awareness and positive attitudes towards COVID-19 pandemic, but there were also things that needed improvement. The most important measure to be taken in order to prevent anxiety from increasing is to ensure the correct access of information and to establish psychological support lines., (© 2020 John Wiley & Sons Ltd.)

Background: Violence is an important public health problem that threatens the peace of mind in health institutions as well as in many other sectors. In recent studies, it was stated that violence occurs more frequently in healthcare centers compared to other establishments. In terms of being exposed to violence, healthcare personnel is at 16 times more risk. Violence against healthcare employees has increased gradually in Turkey and the world; it's a serious occupational hazard to consider., Aims: The aim of our study was to analyze the situation about violence against physicians, to emphasize its importance, to shed light on preventive measures and to create programs and to raise awareness of violence against physicians., Methods: This descriptive study was conducted between October-December 2017. A link was sent to the participants to participate voluntarily through the social media platforms mostly used by physicians and they were asked to fill out a questionnaire., Results: 83.3% of the 948 physicians that participated have experienced at least one episode of violence so far. The most common type of violence was verbal. More than half of violent events occurred in hospitals. One-third of the physicians did nothing in the face of violence, more than half could not report this situation due to lack of time, only one-quarter of those who sought support received it. Only 23.7% of the perpetrators were punished, while physicians saw the lack of deterrent sanctions as the main cause of violence. While 90.2% of physicians feel occupational burnout, 81.6% thought that physicians can protect themselves through effective legislation against violence in healthcare., Conclusion: The Law on Violence in Health should be enacted and put into practice as soon as possible., (© 2020 John Wiley & Sons Ltd.)

Purpose: The present study aimed to investigate the relationship between smartphone addiction risk and sleep duration and psychosocial comorbidities in health professional candidates., Design and Methods: This descriptive correlational study was conducted in Bandırma, a district of Balıkesir, a province in Turkey, between February 2019 and June 2019 and included 408 students., Findings: Although smartphone addiction risk was not associated with sleep duration, it was positively associated with attention-deficit hyperactivity disorder, depression, anxiety, and stress., Practice Implications: Peer education programs are recommended to prevent smartphone addiction., (© 2019 Wiley Periodicals, Inc.)

Aims: Diabetes mellitus is one of the most significant global health emergencies of the 21st century. Every year, an increasing number of people succumb to the condition and therefore suffer life-changing complications. So management of this disease has an important role to prevent complications. In this study, our objective is to assess the quality of guidelines related to the significant public health problem diabetes that have been developed by international and national organizations using the AGREE II tool., Methods: This observational study assesses the quality of clinical practice guidelines used in the management of diabetes with AGREE II tool. Statistical analysis was performed using the SPSS 20 program package., Results: The overall quality score of the guidelines ranges between 3 and 6.25. While NICE's guidelines scored the highest, the guidelines of the National Diabetes Foundation scored the lowest., Conclusion: More comprehensive studies are needed for assessing the quality of guidelines in every subject., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Rationale, Aims, Objectives: Clinical Practice Guidelines are mostly developed by 3 methods; namely, de novo, adoption, and adaptation. Nonpublished studies and authors experience shows that most guidelines in Turkey are either by adoption or by adaptation. There is no available local tool for adaptation, so the process is not standardized and most of the time not explicitly defined. The objective of this study is to search for international guideline adaptation tools and test their feasibility in Turkish context, to serve a final goal of developing a unique local strategic tool for guideline adaptation., Methods: The methodological design of this study includes selection of an international tool for Clinical Practice Guideline adaptation, piloting this tool with selected Turkish guidelines, identifying the feasibility of this tool and exploring the needs for adaptation of the tool, drawing recommendations for adaptation of the strategies, and validation of the process by local experts., Results: The study from planning phase to finalizing the guidance, including pilot studies and panel but excluding translation of ADAPTE, lasted 18 months. Nine researchers were involved in the adaptation process and 15 more experts were involved in the validation panel. Following the suggestions of the research team on modifications and validation through the expert panel; 2 steps of the ADAPTE toolkit were rejected, 2 steps were accepted by modification, 7 steps were accepted by additional recommendations. In addition, 2 tools were suggested to be added to the toolkit., Conclusion: This is the first study on adaptation of guidelines in Turkey. Pilot adaptation of 2 guidelines with ADAPTE revealed that ADAPTE is a useful and feasible tool in Turkish setting, but might require certain changes in recommendations and revision of tools., (© 2017 John Wiley & Sons, Ltd.)

Background: Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country., Aim: This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines., Methodology: Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the "Statistical Yearbook of Turkey 2012" were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines., Findings: 47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were;, Scope and Purpose: 64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%., Conclusion: This is the first study in Turkey regarding quality appraisal of guidelines developed by the local professional societies. It adds to the limited amount of information in the literature that comes from Turkey as well as other developing countries.

Background: Because of the growth of the older population and the prevalence of chronic diseases, home care services (HCS) have become an important aspect of healthcare worldwide. However, various difficulties and deficiencies are present in the provision of these recently implemented services in Turkey. Modifications to home healthcare services are in progress., Objective: Physicians have an active role in home healthcare services. The present study was performed to examine physicians' attitudes toward this service in detail., Methods: Twenty-six physicians who provide home healthcare services in the city of Ankara were included in the study. We conducted in-depth, semi-structured, face-to-face interviews. The interviews were audio-recorded, transcribed, and qualitatively analysed., Results: Most physicians thought that home care could be provided to patients who are bedridden, are very old, have a chronic disease, have problems leaving the house, or do not have family support. They also expressed displeasure about the abuse of services and discordance of organization between hospitals and primary care centres. They noted that real circumstances in practice were not compatible with regulations and that cooperation and coordination between departments are necessary and important., Conclusion: The current study underlines physicians' interest in and support of the home care system, which has various drawbacks and limitations. Legislation needs to be further changed to improve the quality of service and eliminate deficiencies in home healthcare.

Objectives: To understand how decisions are made in Intensive Care Unit (ICU) settings where critically-ill children require life-support decisions and what are the perceptions of health professionals and parents., Methods: In this qualitative study, in-depth, semi-structured, face to face interviews with 8 doctors, 9 nurses and 6 parents of critically ill children were conducted. Interviews were digitally recorded and transcribed. The transcriptions were further analyzed following open coding and formation of themes., Results: The themes were discussed in two major titles: perceived roles and emotions during the decision-making process. All nurses and patients agreed that the decision maker should be the physician. Nurses understood patients' emotions better and had a closer relation with the parents. Both doctors and nurses thought that parents could not have all responsibilities about treatment choices, because they do not have the required knowledge. Similarly parents were afraid to make a wrong decision, thus they wanted to leave this to the doctors., Conclusions: The present study revealed that shared-decision making is not well understood by health care professionals in Turkey. Doctor is the major decision-making authority and this is also accepted and preferred by the patients and nurses.

Patient: Male, 28 FINAL DIAGNOSIS: Posterior reversible encephalopathy syndrome Symptoms: Headache • pain around umblical region • seizures • visual disturbances, Medication: Mycophenolate mofetil Clinical Procedure: Treatment of parasitosis • antiepileptic treatment • control of hypertension • changing mycophenolate mofetil to everolimus Specialty: Transplantology., Objective: Unusual or unexpected effect of treatment., Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible neurological findings with clinical hallmarks such as headache, confusion, seizures, cortical visual disturbances, and other focal neurological signs., Case Report: A 28-year-old male patient was hospitalized secondary to diarrhea and abdominal pain. He had renal transplantation due to renal amyloidosis secondary to familial Mediterranean fever (FMF). In his clinical follow-up, he had seizures, hemiparesis, blurred vision, and vomited an Ascaris lumbricoides. MRI results led to diagnosis of PRES. Mycophenolate mofetil was changed to everolimus, his systolic blood was pressure kept below 140 mm hg, and his intestinal parasitosis was treated. During follow-up, he had no pain and no diarrhea. His neurological symptoms turned to normal within 48 hours and neuroradiological findings returned to normal within 2 weeks., Conclusions: PRES is a rare disorder of unknown incidence in renal transplantation patients. Early diagnosis is very important to prevent irreversible neurological sequelae. PRES is totally reversible with cessation of the offending agent, rapid control of hypertension, and treatment of the underlying disease. For early diagnosis and to reduce morbidity and mortality, stool sample examination should be made in patients taking immunosuppressive drugs.