The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye

Background

Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear.

Aims

To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19.

Study Design

Multicenter prospective observational clinical study.

Methods

This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated.

Results

As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004).

Conclusion

Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

Research Publications from the ATS MECOR Program in Turkiye

Background

The American Thoracic Society (ATS) Methods in Epidemiologic, Clinical, and Operations Research (MECOR) Program aims to build research capacity in low and middle-income countries. MECOR has three levels, during which students learn to develop a research protocol and write a manuscript. MECOR Turkiye has been offered every year since 2008.

Objective

The aim of this paper is to report the number and impact of published articles generated from research questions developed by students in levels 1, 2, and 3 of the ATS MECOR Program in Turkiye between 2008 and 2018.

Methods

We collected the research questions developed in all levels of the ATS MECOR Program in Turkiye between 2008 and 2018. We searched Google Scholar, PubMed, Web of Science, and ResearchGate in April 2022 to see how many of these research questions were published as articles and, if published, in which journals.

Results

Of the 176 research questions collected, 49 had been developed in level 1, 82 had been developed in level 2, and 45 had been developed in level 3. Of those 176 research questions, 55 (31.3%) generated articles that were accepted for publication. The frequency of published articles based on MECOR-developed research questions increased linearly as the course level in which they were developed increased (18.4% in level 1, 30% in level 2, 46.7% in level 3; P = 0.012; linear-by-linear association, P = 0.003). The median time from the development of the research question to publication was three years overall and did not differ significantly among the course levels (P = 0.36). Of the research questions developed, 43 were published in Science Citation Index or Science Citation Index Expanded-indexed journals.

Conclusion

Acceptance of an article for publication is one way to measure the impact of the ATS MECOR Program. Our data describe significant research output among our participants, which increases with their length of participation in the program.

Factors Associated with 28-day Critical Illness Development During the First Wave of COVID-19

Objective

This study aimed to define the predictors of critical illness development within 28 days postadmission during the first wave of the COVID-19 pandemic.

Materials and Methods

We conducted a prospective cohort study including 477 PCR-positive COVID-19 patients admitted to a tertiary care hospital in Istanbul from March 12 to May 12, 2020.

Results

The most common presenting symptoms were cough, dyspnea, and fatigue. Critical illness developed in 45 (9.4%; 95% CI=7.0%-12.4%) patients. In the multivariable analysis, age (hazard ratio (HR)=1.05, p<0.001), number of comorbidities (HR=1.33, p=0.02), procalcitonin ≥0.25 µg/L (HR=2.12, p=0.03) and lactate dehydrogenase (LDH) ≥350 U/L (HR=2.04, p=0.03) were independently associated with critical illness development. The World Health Organization (WHO) ordinal scale for clinical improvement on admission was the strongest predictor of critical illness (HR=4.15, p<0.001). The patients hospitalized at the end of the study period had a much better prognosis compared to the patients hospitalized at the beginning (HR=0.14; p=0.02). The C-index of the model was 0.92.

Conclusion

Age, comorbidity number, the WHO scale, LDH, and procalcitonin were independently associated with critical illness development. Mortality from COVID-19 seemed to be decreasing as the first wave of the pandemic advanced.

Graphic Abstract

Graphic Abstract.

How do we manage asthma? Assessment of knowledge, attitude, and practice patterns among pulmonologists and allergists

Objective: The objective of this study was to evaluate and compare knowledge, attitude, and practice patterns between pulmonologists and allergists for adult asthma in Turkey.Methods: Questionnaire-based data were gathered from 236 pulmonologists and 62 allergists, who had been members of the Turkish Thoracic Society and Turkish National Society of Allergy and Clinical Immunology in January-March 2021. Univariate and multivariate statistics were used to determine the factors associated with primary reliever preferences.Results: Of the 298 physicians, 39% encountered at least five asthma patients daily. Spirometer was used frequently by both the allergists (82.3%) and pulmonologists (77.5%) for asthma diagnosis. Budesonide was the most preferred inhaler corticosteroid. Formoterol/budesonide was the most preferred ICS/LABA combination, followed by beclomethasone/formoterol and fluticasone/salmeterol for asthma treatment. For mild asthmatics, formoterol/ICS was the most preferred (72.6%) reliever among allergists, whereas salbutamol was the most preferred (66.1%) among pulmonologists (p < 0.001). Age and workplace were associated with salbutamol preference of doctors for mild asthmatics. Age, specialty, and patient examination time were significantly associated with salbutamol preference for severe asthmatics.Conclusions: The use of diagnostic tools, such as a spirometer, for asthma diagnosis was compatible with the guidelines. While recent updates of the guidelines indicate that salbutamol should not be used solely in mild asthmatics due to its harmful effects in long-term use, it still was the most preferred drug by pulmonologists. Postgraduate education programs are needed to improve compliance with the guidelines.

Does asymptomatic/uncomplicated SARS-CoV-2 infection during pregnancy increase the risk of spontaneous preterm birth?

OBJECTIVES

The aim of this study was to analyze the perinatal outcomes of asymptomatic/uncomplicated SARS-CoV-2 infection during pregnancy and the relationship between gestational age at the time of infection and spontaneous preterm birth (PTB).

MATERIAL AND METHODS

This was a retrospective cohort study. The study population included pregnant women who were 19-45 years old and who had been admitted to a Research and Training Hospital for singleton birth delivery. Women who had contracted SARS-CoV-2 during their pregnancy (n = 102) were compared to those who were not infected (n = 378) for the development of spontaneous PTB and other perinatal outcomes. The factors associated with spontaneous PTB were analyzed through univariate and multivariate methods.

RESULTS

Spontaneous PTB developed in 22.5% of the pregnant women with a history of SARS-CoV-2 infection and in 5.3% without a history of the infection (p < 0.001). The multivariate model determined that compared to the non-infected women, the OR of spontaneous PTB among those who had contracted the virus in the first, second, and the third trimesters were 9.13 (p < 0.001), 1.85 (p = 0.292) and 7.09 (p < 0.001), respectively. Pregnancy cholestasis (3.9% vs 0.5%; p = 0.020) and placental abruption (3.9% vs 0.5%; p = 0.040) were significantly higher in cases with a history of SARS-CoV-2 infection compared to the non-infected women.

CONCLUSIONS

Asymptomatic or uncomplicated SARS-CoV-2 infection during pregnancy increases the risk of spontaneous PTB. This risk is higher particularly among pregnant women who develop the infection in the first and the third trimesters.

Validation of the Turkish version of the DOSE-Nonadherence measure among patients with cardiometabolic conditions

WHAT IS KNOWN AND OBJECTIVE

There are no validated self-report measures to assess extent of and reasons for medication nonadherence in the Turkish language. The aim of this study is to evaluate validity and reliability of the Domains of Subjective Extent of Nonadherence Scale, which assesses extent of and reasons for nonadherence in Turkish patients with hypertension, diabetes mellitus and/or dyslipidaemia in community pharmacy settings.

METHODS

The Turkish version of the DOSE-Nonadherence scale was developed through translation and cultural adaption. Psychometric properties of the scale were evaluated in a cross-sectional study among 203 patients who visited six community pharmacies located in Istanbul, Turkey between November 2020 and March 2021. For the extent of nonadherence domain, reliability was estimated through Cronbach's alpha, and convergent validity was evaluated with Spearman's rank correlation with the validated Turkish version of the Medication Adherence Report Scale (MARS). Reasons for nonadherence were characterized among participants reporting nonadherence to the extent of nonadherence items. The measure was administered at baseline and 2 weeks later to 30 patients to estimate stability of extent scores using the Wilcoxon test and intraclass correlation coefficient. p < 0.05 was set as the level of statistical significance.

RESULTS

Among the 203 participants (65 male), the median (25th-75th percentiles) age was 59.0 years [51.0-67.0]. Cronbach's alpha for the extent of nonadherence scale was 0.86. A moderate negative correlation (r = -0.58; p < 0.001) was found between the extent of nonadherence scores and MARS, supporting convergent validity. The most common reasons for medication nonadherence were forgetfulness (22.5%) and mismatch between the patients' daily routine and medication taking (17.5%). The intraclass correlation coefficient was 0.97 for extent of nonadherence scores at baseline and 2 weeks (p < 0.001).

WHAT IS NEW AND CONCLUSION

The DOSE-Nonadherence Scale could be used to identify nonadherent patients and their reasons for nonadherence in Turkish patients with chronic cardiometabolic conditions. This scale can be used to evaluate clinical pharmacist-led services to reduce medication nonadherence. Nonadherence could be recorded longitudinally in electronic health records to provide a more accurate picture of medication use. Pharmacists or other providers could administer interventions tailored to patients' reasons for nonadherence.

Emergency mental health care for chi̇ldren and adolescents outside of regular working hours: 7 years outcomes from a tertiary hospital

OBJECTIVE

This study aims to define the clinical characteristics and management strategies of children and adolescents presenting with psychiatric crises to the emergency department (ED) of a tertiary health care facility outside of working hours, and to identify predictors of multiple ED visits among them.

METHODS

From January 2012 to December 2018, retrospective records of patients presenting with psychiatric symptoms to the ED and examined by a child psychiatrist after 5 p.m. on weekdays and for 24 h on weekends and public holidays were analyzed.

RESULTS

Our sample consisted of 1576 visits and 1364 patient (Female:Male=1.8:1, mean age=14.86 ± 2.72). The most common reason for visits was self-injurious thought or behaviors (SITB), and the most common diagnosis was depression. While depression was statistically more common in girls, attention deficit hyperactivity disorder, autism and/or intellectual disability (ASD/ID), psychotic disorders, and bipolar disorder were more common in boys. The forensic evaluation was the most common reason for visits among children younger than 6 years old. Of visits, 23% transferred to hospitalization. A history of mental health contact was the lowest in depression (37.5%), psychosis (34.1%), and substance use disorders (33%). Of patients, 10.8% had multiple visits. A history of mental health contacts, conduct disorder, ASD/ID, bipolar disorder, psychotic disorder, and dissociative disorder were predictors of multiple visits to ED with psychiatric reasons.

CONCLUSION

Emergency mental health care outside of regular working hours can be a critical step in the diagnosis and treatment of serious psychiatric disorders in children and adolescents.

Pharmacokinetic characterization of favipiravir in patients with COVID-19

This prospective observational study describes the pharmacokinetic characteristics of favipiravir in adult patients hospitalized for mild to moderate COVID-19 with a positive RT-PCR test. Favipiravir was administered for 5 days, with a loading dose of 3200 mg and a maintenance dose of 1200 mg/day. Serial blood samples were collected on Day-2 and Day-4 of the therapy. Laboratory findings of the patients (n=21) and in-hospital mortality were recorded. Favipiravir concentrations exhibited substantial variability and a significant decrease during the treatment of COVID-19. The median favipiravir trough concentration (C_0-trough ) on Day-2 was 21.26 (IQR, 8.37-30.78) μg/mL whereas it decreased significantly to 1.61 (IQR, 0.00-6.41) μg/mL on Day-4, the area under the concentration versus time curve decreased by 68.5%. Day-2-C_0-trough of female patients was higher than male patients. Our findings indicate that favipiravir concentrations show significant variability during the treatment of COVID-19 and therapeutic drug monitoring may be necessary to maintain targeted concentrations.

Adaptation and validation of the Turkish version of the vaccine hesitancy 5 point Likert Scale

The decrease in vaccine acceptance has been recognized as an emerging public health problem and there is therefore a need for reliable and validated tools that identify vaccine hesitancy. The objective of this study was to adapt and validate the Turkish version of the Vaccine Hesitancy 5-point Likert Scale which was originally developed by the WHO Strategic Advisory Group of Experts on Immunization. The study was carried out in a Family Health Center (FHC) in Istanbul over the period June 1-November 30, 2020. The participants were parents who had applied to the FHC for well-child visits and had a child ≤18 months of age. After the process of translation and back-translation, the Turkish version was pilot-tested, and its test-retest reliability was evaluated among 40 parents at a two-week interval. The validation was carried out with 306 parents through exploratory factor analysis. There was no statistical difference between the test-retest scores (p = .17). The intraclass correlation coefficient was 0.98 (p < .001). Cronbach's alpha coefficient was 0.81. Factor analysis yielded two subscales that were named "confidence' and 'risk perception" and explained 63% of total variance. Our results suggest that the Turkish version of the Vaccine Hesitancy 5-point Likert Scale is a reliable and valid instrument.

Factors associated with Turkish pharmacists' intention to receive COVID-19 vaccine: an observational study

Background Pharmacists have been taking part in vaccination services during the COVID-19 pandemic. However, research identifying pharmacists’ intention to get COVID-19 vaccine is limited. Aim The objective of this study was to determine the intention to receive COVID-19 vaccine and to identify the factors related to it based on the Health Belief Model framework among Turkish pharmacists. Method This is an observational study conducted between December 2020 and January 2021. The online survey was sent to all hospital and community pharmacists working in Turkey. Transtheoretical Model of Behaviour Change and Health Belief Model were used for the development of the questionnaire. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with the intention to receive COVID-19 vaccine. Results Among all participants (n = 961), 74.7% had an intention to receive the COVID-19 vaccine. In model 1, perceived susceptibility, perceived severity, perceived benefits, and perceived barriers were associated with their intention to receive the COVID-19 vaccine (p < 0.05). In model 2, the intention to receive COVID-19 vaccine was associated with being male, years of experience in the professional field, not having contracted COVID-19, having a pharmacy staff who had contracted COVID-19, and having had received seasonal flu shot within the previous year (p < 0.05). Conclusion This study highlights the factors related to the intention of the pharmacists to receive COVID-19 vaccines. Health Belief Model is the strongest predictor for vaccination intention and could be used to develop behavioural change techniques to promote vaccination.

Geographical barriers to timely diagnosis of cystic fibrosis and anxiety level of parents during newborn screening in Turkey

BACKGROUND

Despite the availability of cystic fibrosis (CF) screening countrywide, diagnostic delay is still a crucial issue. The objectives of this study were to explore the stages of the NBS process, determine the risk factors associated with diagnostic delay and evaluate parent anxiety and experience throughout the process.

METHODS

This is a multicenter cross-sectional study. A questionnaire was completed by parents of newborns diagnosed with CF via NBS in 17 centers. Socio-demographic characteristics, parent knowledge and experiences related to NBS, sweat test availability in the region of residence, and time to the definitive CF diagnosis were assessed through this questionnaire. Parents' anxiety levels were evaluated through the State-Trait Anxiety Inventory scales 1 and 2. Delayed diagnosis (DD) was defined as a definite CF diagnosis beyond the 8th week of life. Predictors of delayed CF diagnosis were evaluated by univariate and multivariate analysis.

RESULTS

A total of 220 CF patients diagnosed via NBS were enrolled; 82 (37.3%) babies had DD. Multivariable analysis indicated that residence in the Southeast Anatolia region of Turkey (OR = 10.79, 95% CI = 2.37-49.2) was associated with a higher incidence of DD compared with other regions in Turkey. Of the total, 216 (98.1%) of the caregivers regarded the NBS program as useful and 180 (82%) reported high anxiety levels.

CONCLUSION

The organization of newborn screening should take into account regional and socio-cultural characteristics to improve the early diagnosis of CF and also reduce the anxiety level of parents.

Validation of a Knowledge Test in Turkish Patients on Warfarin Therapy at an Ambulatory Anticoagulation Clinic

Objectives

This study aimed to evaluate the validity and reliability of an oral anticoagulation knowledge (OAK) test in Turkish patients on warfarin therapy at an anticoagulant outpatient clinic.

Materials and Methods

This study was conducted at an ambulatory anticoagulation clinic and included patients older than 18 years who had been using warfarin for at least six months. Patients' demographic and clinical data were collected. Internal consistency was calculated using the Kuder-Richardson 20 (KR-20) coefficient, and the test-retest reliability of the Turkish version of the OAK test was assessed.

Results

Patients' mean age was 59.83±11.93 (26-90) years (n=240; 133 women). The mean score of the OAK test was 14.19±3.01. The test-retest reliability of the scale (n=30) was moderate for the total score (p<0.001). The KR-20 value, a measure of internal consistency, was 0.671. Patients of a younger age and higher educational level were more likely to have higher levels of anticoagulation knowledge than patients of an older age and lower education level (p<0.05 for both comparisons).

Conclusion

The Turkish version of the OAK test can be used to determine the patients' knowledge on oral anticoagulation.

Excess Mortality During COVID-19 Pandemic in İstanbul

OBJECTIVE

Epidemiological studies have shown that mortality owing to the coronavirus disease 2019 (COVID-19) could be under-reported under different conditions. Excess mortality analysis is suggested as a useful tool in estimating the impact of the disease.

MATERIAL AND METHODS

Mortality data between January 01 and May 18, 2020, were analyzed to evaluate the excess mortality owing to COVID-19 in Istanbul, the city most affected by the pandemic in Turkey. The average weekly percentage changes in the number of deaths in 4 previous years were compared with those in the year 2020 using excess mortality analysis.

RESULTS

The number of deaths in Istanbul was significantly higher in 2020 (p=0.001), with a 10% weekly increase between the 10th and 15th weeks, which started to decrease until the 20th week. The excess mortality found during the study period was 4,084 deaths, higher than the officially reported COVID-19 mortality.

CONCLUSION

Our findings demonstrated that mortality owing to COVID-19 could be higher than the official figures reported by health authorities.

COVID-19 Pandemic and the Global Perspective of Turkish Thoracic Society

It has been more than 3 months now since the first case of COVID-19 was reported in Turkey. Globally, the number of confirmed cases and deaths reached 9,653,048 and 491,128 respectively, as reported by 216 countries by June 27, 2020. Turkey had 1,396 new cases, 194,511 total cases, and 5,065 deaths by the same date. From the first case until today, the Turkish Thoracic Society (TTS) has been very proactive in educating doctors, increasing public awareness, undertaking academic studies, and assisting with public health policies. In the present report, social, academic, and management perspectives of the pandemic are presented under appropriate subtitles. During this critical public health crisis, TTS has once again demonstrated its readiness and constructive stance by supporting public health, healthcare workers, and the environment. This review summarizes the perspective of TTS on each aspect of the COVID-19 pandemic and casts light on its contributions.

Physical Activity Patterns of Primary School Teachers in a District in Istanbul, Turkey

Background

Physical inactivity (PI) is determined as the fourth leading risk factor for global mortality. Insufficient physical activity is prevalent in Turkey; approximately 4 in 10 adults are physically inactive and have less than 150 minutes of moderate activity per week. The objective of this study was to assess the prevalence of PI and the factors associated with it among primary school teachers in a district in Istanbul, Turkey.

Methods

This was a cross-sectional study conducted in a district in Istanbul, Turkey. Sample size was calculated as 434 assuming a PI prevalence of 70% with a 95% confidence level, margin of error of 0.05 and a design effect of 2. Twenty out of 39 schools were selected randomly. PI was assessed through using International Physical Activity Questionnaire short form. Logistic regression analysis was used to determine the variables associated with PI.

Results

A total of 345 teachers participated in the study (response rate: 79.5%). Among the participants the mean age was 45.6± 8.3 and %74.1 were women. PI prevalence was 49.2% (95%CI: 43.6%-54.7%). PI was significantly associated with having chronic disease (OR: 1.8, 95%CI:1.0-3.0), having children (OR: 2.9, 95%CI:1.5-5.7), using motor vehicles for transportation (OR:4.1, 95%CI:1.5-11.0) and using elevators (OR:4.4, 95%CI:1.7-11.4). Among women, PI was significantly associated with having children (OR: 10.3, %95CI:1.2-87.1) and using elevators (OR: 8.4, 95%CI: 2.3-30.8).

Conclusions

Approximately half of the teachers were physically inactive. As having children is an important determinant of PI, we need to adopt appropriate conditions so that parents, particularly women can engage in physical activity together with their children. Active transportation and use of elevators should be encouraged. Special attention should be paid to adults having chronic diseases.

Key messages

PI is highly prevalent among school teachers, particularly among the ones who have chronic diseases. Strategies supporting parents especially women to engage in physical activity together with their children, encouraging active transportation and use of elevators should be implemented.

Smoking habits among 5th and 6th degree medical students

Key messages

The primary goal should be to stop the smokers and prevent the start of the smokers. Information should be made on the harms of electronic cigarettes and the community should be informed.

Reliability and validity of the Bladder and Bowel Dysfunction Questionnaireamong Turkish children

Background/aim: We developed a Turkish version of the Bladder and Bowel Dysfunction Questionnaire (BBDQ) and evaluated its psychometric properties among Turkish pediatric patients.Materials and methods: The BBDQ was translated into Turkish and then it was back-translated into English. A total of 193 patients were asked to complete the Turkish version of the BBDQ as well as the Dysfunctional Voiding and Incontinence Scoring System (DVISS). In addition, 39 children completed the same questionnaires twice at 2-week intervals for test/retest evaluation.Results: Cronbach's alpha coefficient of the BBDQ was 0.727. Reliability of the test/retest was 0.759 (P < 0.001). Area under the curve of the receiver operating characteristic plot was 0.765. There were statistically significant differences in BBDQ scores between the controls and patients (P < 0.001). Analysis demonstrated moderate convergent validity against the DVISS (r: 0.78, r2: 0.601, P < 0.0001).Conclusion: The Turkish version of the BBDQ is a reliable and valid instrument for Turkish pediatric patients with bladder and bowel dysfunction in clinical and research settings.

Effectiveness of a sleep education program for pediatricians

BACKGROUND

The high prevalence of sleep problems in children and long-term consequences point to the need for early effective interventions, but health-care providers have limited training in pediatric sleep medicine. The aims of this study were therefore to assess the effectiveness of a sleep health-care education program and to develop a Turkish acronym for brief sleep history taking for pediatric primary caregivers in the ambulatory setting.

METHODS

This was a quasi-experimental study. Four centers were randomly selected from eight training and research hospitals as the intervention group. The control group was recruited during training in subjects other than sleep. Education was provided to the intervention group. Knowledge and attitudes were evaluated in the short and long term.

RESULTS

The intervention and the control groups consisted of 132 and 78 pediatricians, respectively. The intervention group scored significantly higher both in the short and the long term. The Turkish acronym (UYKU) was reported to be easy to remember and effective in prompting the correct questions to ask about sleep issues.

CONCLUSIONS

The Turkish acronym would be useful in the primary care setting to increase the frequency of screening of sleep problems in children. Although education significantly improved knowledge on sleep issues in children, the percentage of participants who lacked confidence in the management of sleep problems in children was still very high, even in the intervention group. We suggest that a broader educational program, carried out more than once, would be more beneficial.

Translation and psychometric evaluation of the Turkish version of the pharmacy students' perceptions of preparedness to provide pharmaceutical care scale

The aim of the study is to conduct the psychometric evaluation of the Turkish version of the Pharmacy Students' Perceptions of Preparedness to Provide Pharmaceutical Care (PREP) scale. The present study was conducted at three faculties of pharmacy among fifth-year students during a three-month period in 2015. After the translation process, the Turkish version was developed. Psychometric evaluation consisted of the calculation of inter-rater and test-retest reliability and factor analysis. The mean age of 184 students (71.2% of female) was 23.74±1.07. The mean score of the Pharmacy Students' PREP scale was 4.54±1.00 and the Cronbach's alpha was 0.971. Inter-rater and test-retest reliability and factor analysis were also in concordance with the literature. In the present study, the Turkish version of Pharmacy Students' Perceptions of Preparedness to Provide Pharmaceutical Care Scale has been determined to be a reliable and validated tool to assess students' perceptions of preparedness to provide pharmaceutical care.

Validation of the Turkish version of medication regimen complexity index among elderly patients

OBJECTIVE

The aim of this study was to validate the Turkish version of the 'Medication Regimen Complexity Index' (MRCI).

METHODS

This validation study has been conducted in prescriptions of the first 100 elderly patients who had visited the pharmacy for their prescription refill to evaluate convergent and divergent validity of the Turkish version. The reliability of the Turkish version was assessed with inter-rater and test-retest analysis after its translation and cultural adaptation.

RESULTS

The mean age of the 100 patients (53 women) was 74.9 years (SD = 7.58, 65-95). The scale showed high inter-rater reliability and test-retest reliability for the total and subscale scores (p < 0.05). A strong and positive correlation between the number of medications in a prescription and the total Medication Regimen Complexity Index scores (r = 0.930, p < 0.001) was determined. There were no statistically significant differences between age, gender and MRCI scores (p > 0.05).

CONCLUSION

These results show that the Turkish version of MRCI is a reliable and valid tool in elderly patients.

Noncompliance to smoke-free law: which hospitality premises are more prone?

OBJECTIVES

In Turkey, smoking has been banned in hospitality establishments since July 2009. The objective of this study was to determine noncompliance to the smoke-free law and its change in 2 consecutive years in enclosed spaces of hospitality venues and also to evaluate the factors associated with noncompliance.

STUDY DESIGN

This is an observational study.

METHODS

Hospitality venues in Istanbul were visited, and data were collected through direct observation and interviews. Observation of smoking, cigarette butts or existence of ashtrays were defined as noncompliance. The survey was repeated in 2 consecutive years; the venues were visited both in 2013 and 2014. Logistic regression was used to evaluate factors associated with noncompliance.

RESULTS

In 2013, 450 establishments were visited, and in the next year, 367 (81.6%) were revisited. Noncompliance for 2013 and 2014 were 49.0% and 29.7%, respectively. The highest violation was observed in bars and traditional coffeehouses. There was a significant decrease in noncompliance from 2013 to 2014 among restaurants and cafés, while such a change was not observed among bars and traditional coffeehouses. In the multivariate analysis, venues other than restaurants, venues that did not have no-smoking signs and venues which had been issued fines previously had increased probability of noncompliance.

CONCLUSIONS

While compliance to smoke-free law had increased significantly within 1 year, almost one third of the venues were still violating the law in 2014. The venues which were issued fines continued to violate the law. There is a need to strengthen enforcement efforts and revise the methods of enforcement and penalties in hospitality establishments.

Translation and validation of the Endometriosis Health Profile (EHP-5) in patients with laparoscopically diagnosed endometriosis

OBJECTIVES

To validate the Turkish-translated versions of the Endometriosis Health Profile 5 (EHP-5) for use in patients with laparoscopically proven endometriosis.

STUDY DESIGN

This case control study was conducted in a tertiary referral teaching institution between April and June 2014. Fifty-eight patients with surgically proven endometriosis were enrolled. The EHP-5 questionnaire was evaluated for patients with laparoscopically diagnosed endometriosis. Test-retest reliability, descriptive statistics, reliability analysis (internal consistency and item-total correlation), data completeness, and known-group comparison were all assessed in the validation of the EHP-5 form as translated into the Turkish language.

RESULTS

Two weeks test-retest reliability showed statistically significant correlation; Spearman's rho was 0.885 (p<0.001) for the EHP-5 core questionnaire and 0.896 (p<0.001) for the EHP-5 modular questionnaire. Cronbach's alpha values for the translated form of the EHP-5 core and modular questionnaires were 0.829 and 0.804, respectively, with a high level of internal consistency. In known group comparison, there were statistically significant differences in all subgroups except in the infertility group on the core questionnaire. Pain scales on the core questionnaire and infertility scales on the modular questionnaire showed the highest mean scores (1.14±1.16 and 1.78±1.77).

CONCLUSION

Like the original English questionnaire, the Turkish-translated version of the EHP-5 is a reliable and valid instrument for assessing symptom severity and the impact of endometriosis on health-related quality of life in Turkish-speaking women.

Trends of hepatitis B notification rates in Turkey, 1990 to 2012

Turkey is a country with intermediate endemicity for hepatitis B, and approximately 4% of the population are HBsAg-positive. A number of measures have been implemented to prevent hepatitis B infection. In 1998, hepatitis B antigen was included in the national immunisation programme, and infants have since been vaccinated with three doses. Catch-up strategies, vaccination for high risk groups and screening measures were also adopted. The aim of this study was to evaluate the impact of the prevention and control strategies on hepatitis B notification rates in Turkey in the period from 1990 to 2012, using data from the national surveillance system. Secular trends revealed that rates showed an initial increasing trend, followed by a steady decline from 2005. The most dramatic decline occurred among children younger than 15 years, highlighting the benefits of vaccination and catch-up strategies. However, vaccination cannot fully explain the decrease in this age group. Socioeconomic development, through interrupting the horizontal transmission may also have contributed. After 2005, a steady decline was achieved also among those 15 years and older. The rates in adults were higher, which indicates that stronger prevention measures are needed to target this group, particularly men.

Do perceived health risks outweigh the benefits of modern contraceptives? A qualitative study in a suburban population in Istanbul, Turkey

OBJECTIVES

To evaluate the health concerns and the perceived non-contraceptive benefits of modern contraceptive methods through utilizing qualitative methods.

METHODS

Six focus group discussions were carried out with a total of 53 married women in a socio-economically disadvantaged community in Istanbul, Turkey.

RESULTS

Women had a vague knowledge of the mechanism of menstruation. Some women believed that the uterus was filled with blood -- termed 'dirty blood' -- which should be eliminated during menstruation in order to stay healthy. For this reason, amenorrhoea was recognized as the important disadvantage of the progestin-only injectable contraceptives. While the participants mentioned fallacious and exaggerated side effects related to modern methods they did not recognize their non-contraceptive benefits. Most women gained the information concerning side effects through their social networks. Sometimes the information acquired was based on rumours that biased women against the modern contraceptives.

CONCLUSIONS

Women outweighed the risks, some of which were fallacious and exaggerated, against the benefits of modern contraceptives. It is crucial to address health concerns of women and what they 'heard' from their peers during counselling sessions. Also the non-contraceptive health benefits of modern methods should be well emphasized. Since informal sources are prevalent, the effectiveness of peer education should be studied in this community.

Radionuclide concentrations in soil and lifetime cancer risk due to gamma radioactivity in Kirklareli, Turkey

The objective of this study is to evaluate and map soil radionuclides' activity concentrations and environmental outdoor gamma dose rates (terrestrial and cosmic) in Kirklareli, Turkey. The excess lifetime cancer risks are also calculated. Outdoor gamma dose rates were determined in 230 sampling stations and soil samples were taken from 177 locations. The coordinates of the readings were determined by the Global Positioning System (GPS). The outdoor gamma dose rates were determined by Eberline smart portable device (ESP-2) and measurements were taken in air for two minutes at 1m from the ground. The average outdoor gamma dose rate was 118+/-34nGyh(-1). Annual effective gamma dose of Kirklareli was 144microSv and the excess lifetime cancer risk of 5.0x10(-4). Soil samples were analyzed by gamma spectroscopy. The average 226Ra, 238U, 232Th, 137Cs, and 40K activities were 37+/-18Bqkg(-1), 28+/-13Bqkg(-1), 40+/-18Bqkg(-1), 8+/-5Bqkg(-1) and 667+/-281Bqkg(-1), respectively. The average soil radionuclides' concentrations of Kirklareli were within the worldwide range although some extreme values had been determined. Annual effective gamma doses and the excess lifetime risks of cancer were higher than the world's average.

Rubella seroprevalence among first-grade primary school students in a district in Istanbul, Turkey

OBJECTIVES

Rubella vaccination is not included in the national immunization programme of Turkey. However, it is on the market and is recommended, mainly by the private sector, at the age of 12-15 months. Introduction of the rubella vaccine without achieving high coverage has the risk of shifting the mean age of rubella infection among the unvaccinated population to reproductive ages. The aim of this study was to evaluate the seroprevalance of rubella and the factors associated with seropositivity among primary school students in Umraniye, a district of Istanbul.

METHODS

Blood samples were collected from 489 students in 70 primary schools of Umraniye. Parents completed a concise questionnaire assessing sociodemographic characteristics and measles, mumps and rubella vaccination status.

RESULTS

Among the students screened, 163 (33.3%, 95% confidence intervals 29.2-37.7%) were susceptible to rubella. When sociodemographic variables were evaluated, paternal education was the only variable associated with seronegativity. As the level of paternal education increased, seronegativity rates decreased. This finding may suggest that rubella vaccination is practiced more commonly among children whose fathers are better educated.

CONCLUSIONS

Surveillance and control of rubella and congenital rubella syndrome must be set as public health priorities in Turkey, particularly given that rubella vaccination is practiced partially in the country.

Colour removal from model solutions by coagulation--surface charge and floc characterisation aspects

Chemical coagulation applied for colour removal from dye bearing solutions has been investigated from the point of view of surface charge progression. Two commercially used dyes, i.e. CI Acid Blue 113 and CI Disperse Blue 26 have been tested, employing three common coagulants: alum, aluminium chloride and ferric chloride. Coagulant type and dose level and pH of the dye solution have been studied as process parameters affecting surface charge and degree of colour removal after filtration of coagulated dye. It has been found, that both dyes could be almost completely removed with the tested coagulants, when supplied however at different dosages. From one side, the correlation between surface charge and colour removal suggests that destabilization of colour colloids occurs as a result of charge neutralization followed by removal by filtration. From other side, the lack of re-stabilization and continued high colour removal even at increased coagulant dosages implies enmeshment of destabilized dye colloids into the hydroxy flocs/precipitates of metal coagulant by "sweep coagulation". Finally, flocs from selected sludge samples have been examined for particle size and shape by image analysis and their key characteristics summarised.

Drug utilization and potentially inappropriate drug use in elderly residents of a community in Istanbul, Turkey

OBJECTIVE

This study investigates drug utilization and estimates the prevalence of potentially inappropriate drug use in a Turkish population aged 70 years or older.

MATERIAL AND METHODS

A cross-sectional study was carried out on a total of 1019 participants who accepted face-to-face questionnaires in home interviews in Istanbul. All medications used in the three weeks prior to the study were recorded. Some major risk factors that might influence the use of inappropriate medication such as socio-demographic characteristics and concomitant disease such as depression and dementia were also questioned. Inappropriate drug use was assessed using the Beers criteria.

RESULTS

Among the 1019 participants, 903 (88.6%) had been using at least one medication during the last three weeks. The average number of medications used was 2.9 +/- 2.0. The most frequently drugs used were cardiovascular drugs (39.9%), followed by analgesics/anti-inflammatory drugs (16.2%), vitamin/mineral preparations (10.6%) and central nervous system drugs (10.2%). Of the 1,019 participants, 9.8% were using one potentially inappropriate medication and one patient was using two inappropriate drugs. The most common of these drugs were reserpine (23.7%), dipyridamole (21.8%), antihistamines (14.8%), and benzodiazepines (10.9%). Only age and total number of medications were associated with potentially inappropriate drugs in the multivariate analysis.

CONCLUSIONS

This study revealed that drug utilization and the prevalence of inappropriate medication use in the elderly were lower than in published reports from most developed countries. Furthermore, polypharmacy and higher age were the main risk factors for potentially inappropriate drug use in the elderly.

Handwashing frequencies in an intensive care unit

As most nosocomial infections are thought to be transmitted by the hands of healthcare workers, handwashing is considered the single most important intervention to prevent nosocomial infections. However, previous studies have shown that handwashing practices are poor, especially among medical personnel. The objective of this study was to assess the rate of handwashing among intensive care unit (ICU) healthcare personnel, and then to propose realistic suggestions so that hand hygiene' could be performed at an optimal level. To achieve this, each healthcare worker in the ICU of Istanbul Medical Faculty was observed directly, and, a comprehensive microbiological investigation was carried out among personnel and of the inanimate environment. The frequency of handwashing was low; 12.9% among medical personnel. Moreover, there was a widespread contamination in the ICU and 28.1% of the healthcare workers were carriers for methicillin-resistant Staphylococcus aureus (MRSA). The factors that contributed to low compliance of handwashing protocols were: a low staff to patient ratio, excessive use of gloves and deficiencies in the infra-structure of ICU. In heavy workload conditions, alcoholic handrub solutions for quick hand decontamination can be considered as an alternative to handwashing.