A systematic review of research on illicit substance use and a meta-analysis of its prevalence among college students in Türkiye

In this study, we attempted to systematically review and meta-analysis the prevalence and risk factors for illicit substance use (ISU) in Türkiye. Based on the PRISMA 2020 statement and checklist, we considered only full-text research articles on ISU among college students (CS) in Türkiye. We searched relevant research via Web of Science, PubMed, MEDLINE, Scopus, ScienceDirect, Google Scholar, and ULAKBIM between 11.06.2022-12.31.2022. We applied double arcsin transformation to the prevalence values and used the LFK index and trim and fill method to measure publication bias. In addition, we generated doi and funnel plots of the prevalence values reported in the selected studies. Among systematically reviewed 53 studies, we identified and meta-analyzed ISU prevalence in 37 studies. The mean prevalence of ISU was determined to be 0.06 (95% CI: 0.04 to 0.07). We discovered that cannabis was the most commonly used substance, with an aggregate prevalence rate of 0.044 (95% CI: 0.026 to 0.066). Common risk factors for ISU were found to be gender, parental education, income, mental problems/suicide/attempted suicide, ISU in family members/relatives, smoking, and alcohol use. Despite the lower prevalence of ISU among students in Türkiye, the research findings emphasized that it has recently become a significant public health problem among the young.

Assessment and feedback of the COVID-19 pandemic's effects on physicians' day-to-day practices: good knowledge may not predict good behavior

The importance of doctors' knowledge and awareness of infectious diseases was felt worldwide during the COVID-19 pandemic. With this study, we aimed to evaluate the effect of the long and dynamic pandemic process on resident physicians' knowledge and protective behaviors for infection control in a tertiary hospital setting and protective behaviors for infection control in a tertiary hospital setting. The population of this cross-sectional study consisted of assistant physicians working at Suleyman Demirel University Faculty of Medicine Training and Research Hospital. A questionnaire evaluating information and protective practices for COVID-19 was applied to the participants through face-to-face interviews using the convenience sampling method, with an interval of one year. In the second year of the pandemic, resident physicians' awareness of the correct use of personal protective equipment decreased (p = 0.001). Despite the continuous training, it was determined that the residents preferred masks with high protection at a lower rate when they encountered patients who received oxygen support of 5 lt/min and above (p < 0.001). To prevent the spread of COVID-19 infection in the hospital as the pandemic progresses, it has been determined that resident physicians are less prone to evaluate possible infection symptoms in patients hospitalized for non-COVID-19 reasons (p = 0.013). As a result, the data we obtained showed that despite the regular training during the pandemic and the death of many health workers, the residents' adherence to infection control and prevention practices, which also protect them, decreased significantly in the second year of the pandemic. These valuable data showed us that good knowledge does not predict good infection control and prevention practices. Our findings show that physicians need a new education system that motivates them. In addition, psychosocial determinants, physical and mental fatigue, and institutional control factors contributing to these results and affecting individual risk perception should be recognized and prevented.

Can subclavian/infraclavicular axillary vein collapsibility index predict spinal anesthesia-induced hypotension in cesarean-section operations?

OBJECTIVE

Spinal anesthesia-induced hypotension (SAIH) is relatively common in pregnant women and has serious maternal and fetal side effects. In patients who are hypovolemic during spinal anesthesia, there may be a significant decrease in blood pressure caused by the decrease in preload. Subclavian vein sonography is a useful method for evaluating preoperative intravascular volume status. This study aimed to evaluate the efficacy of the pre-operative subclavian vein or infraclavicular axillary vein (SCV-AV) collapsibility index for predicting SAIH in cesarean-section (C-section).

PATIENTS AND METHODS

In this prospective observational study, 82 women undergoing elective C-sections were recruited. Sonographic evaluation of SCV-AV was assessed before spinal anesthesia. After spinal anesthesia, changes in blood pressure were noted. The main outcome was the association between the SCV-AV measurements (diameter and collapsibility index) and SAIH.

RESULTS

Hypotension developed in 53 (64%) patients after spinal anesthesia. The collapsibility index of the SCV-AV during spontaneous breathing and deep inspirium was not a significant predictor of a decrease in mean blood pressure (MBP) after spinal anesthesia (p<0.979, p<0.380).

CONCLUSIONS

It was found that the SCV-AV collapsibility index is not a predictor of SAIH in pregnant women undergoing elective C-sections.

Systematic review and meta-analysis of verbal and physical violence against healthcare workers in the Eastern Mediterranean Region

Background

Workplace violence is a serious threat to healthcare workers worldwide.

Aim

We aimed to determine the prevalence of physical and verbal violence against healthcare workers in the WHO Eastern Mediterranean Region and Türkiye.

Methods

We searched the Medline (via PubMed), Cochrane Library, Scopus, Science Direct, Web of Science and ProQuest databases along with reference lists from selected articles. Studies of health workers exposed to verbal and/or physical violence by patients or their relatives conducted in the WHO Eastern Mediterranean Region and Türkiye among staff working in hospitals and primary health care services were included. Seventy-five of the 3513 articles identified of studies conducted during 1999-2021 were eligible. The data were analysed using MetaXL version 5.3 and STATA version 16.

Results

This study covered 69 024 healthcare workers from 22 countries. Meta-analysis showed that 63.0% (95% CI: 46.7- 79.2) of them had experienced verbal violence and 17.0% (95.0% CI: 14.0-21.0) experienced physical violence. There was no significant difference for sample size, professional group, quality score, or response rate. The frequency of physical and verbal violence in the subgroup analysis was statistically significantly different for countries and years.

Conclusion

Findings from this study provide useful information for policymaking regarding interventions to prevent or minimize violence against healthcare workers in the Eastern Mediterranean Region and Türkiye.

The Effect of Body Mass Index on Survival in Lung Cancer

The prognostic significance of body mass index in lung cancer and the direction of this relationship are not yet clear. This study aimed to evaluate the relationship between BMI and overall survival time of advanced-stage lung cancer patients treated in a center in Turkey, a developing country. In this study, the data of 225 patients diagnosed with stage III or stage IV lung cancer between 2016 and 2020 were analyzed. The effects of BMI and other variables on survival were examined by Cox regression analysis for NSCLC and SCLC. For NSCLC and SCLC, being underweight compared to the normal group, being diagnosed at a more advanced stage, and having a worse performance score were associated with a significantly higher risk of death. Other variables significantly associated with survival were gender, type of radiotherapy for NSCLC, age group, and family history for SCLC. This study showed that being underweight relative to the normal group was associated with worse survival for NSCLC and SCLC but did not support the obesity paradox. Studies that are representative of all BMI categories and free of bias are needed to understand the BMI-lung cancer survival relationship clearly.

The level of depression, anxiety, and sleep quality in pregnancy during coronavirus disease 2019 pandemic

Aim

We aimed to evaluate the mental health and sleep quality of pregnant women in different trimesters during coronavirus disease 2019 (COVID‐19) pandemic and investigate the effect of quarantine and new lifestyle changes that come into our lives with pandemic with on this subject.

Methods

It was conducted on pregnant women (n = 149) who attended routine pregnancy prenatal visit during their pregnancy weeks. The data were collected using sociodemographic and clinical data form, Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) to evaluate maternal depression and anxiety.

Results

A significant correlation was observed between the week of gestation and depression, anxiety, and defective sleep scores (p < 0.001). A moderate positive correlation was found between the week of gestation and depression (r: 0.628). A high level of positive correlation was found between the week of gestation and defective sleep quality and anxiety scores (r: 0.858, r: 0.754). A statistically significant increase in depression, anxiety, and defective sleep quality was found in the group staying in home quarantine (p = 0.002).

Conclusion

This study showed that the COVID‐19 pandemic can cause depression, anxiety, and serious sleep disorders in pregnant women. The depression and anxiety scores of pregnant women in home quarantine were also found to be higher than the group not in quarantine. As the week of gestation progresses, mental health symptoms worsen and sleep quality deteriorates.

Validity and reliability of Turkish version of the Vaccine Hesitancy Scale

Objective

This study was planned to adapt the Vaccine Hesitancy Scale to Turkish and evaluate its validity and reliability.

Material and Methods

This research was conducted methodologically. The sample of the study consisted of 317 individuals from the patient relatives in the waiting rooms, who have children between the ages 9-16, who applied to the Suleyman Demirel University Hospital policlinic in December 2019. A questionnaire developed by the researcher and the Vaccine Hesitancy Scale were used as data collection tools.

Results

Explanatory factor analysis and confirmatory factor analysis methods were used to evaluate the validity and reliability of the Vaccine Hesitancy Scale. In the Vaccine Hesitancy Scale, the Kaiser-Mayer-Olkin coefficient was 0.897 and the Bartlett test's chi-square value was 1319.67 and the result was significant (P <0.001). Considering the factor loads of the items, it varies between 0.608 and 0.845. As a result of the explanatory factor analysis, it was seen that the scale consists of two factors. This finding is consistent with the original form of the scale. The internal consistency coefficient of the scale was found to be 0.86.

Conclusion

As a result of the validity and reliability analysis, the Vaccine Hesitancy Scale was found to be a valid and reliable scale for the Turkish society, which consists of 9 items and 2 sub-dimensions.

Survival analysis and factors affecting survival in patients who presented to the medical oncology unit with non-small cell lung cancer

Background/aim

This study aimed to investigate the effect of clinical and pathological indicators at the time of the diagnosis on overall survival in patients recently diagnosed with non-small cell lung cancer.

Materials and methods

The study population consisted of patients who were diagnosed at the Faculty of Medicine at Isparta Süleyman Demirel University Hospital between January 1, 2010 and December 31, 2017 and presented to the medical oncology outpatient clinic.

Results

A total of 518 patients were evaluated, including 260 patients with squamous cell carcinoma, 207 patients with adenocarcinoma, 50 patients with non-small cell lung cancer-not otherwise specified, and 1 patient with large cell carcinoma. The average life expectancy was found to be 11.50 ± 1.40 months in patients with squamous cell carcinoma, 12.60 ± 1.59 months in patients with adenocarcinoma, and 8.70 ± 1.87 months in the other patients. The estimated 5-year relative survival rate for non-small cell lung cancer was 8% (7% for men and 18% for women). In the multivariate analysis, sex being male (HR, 2.41; P < 0.001), a performance status >2 (HR, 1.70; P < 0.001), the stage of cancer (HR, 1.37; P = 0.045), the presence of bone or liver metastasis (HR, 1.44, P = 0.009, HR, 1.57; P = 0.016, respectively), and the patient not having received radiotherapy (HR, 3.25; P < 0.001) or chemotherapy (HR, 1.85; P = 0.001) were defined as statistically significant predictive factors that reduced the overall survival.

Conclusions

In this study, sex, stage, performance status, the presence of liver or bone metastases, and treatment had an effect on overall survival.

Evaluation of serum apelin-13 and apelin-36 concentrations in preeclamptic pregnancies

AIM

Recent studies suggest that apelin can be a novel potential therapeutic mediator to improve the diagnosis, and treatment of preeclampsia. This study aimed to investigate the association of serum apelin-13 and apelin-36 with preeclampsia and to detect their relationship with preeclampsia-associated perinatal morbidity.

METHODS

Forty-four women with preeclampsia were included as the study group. Forty-four healthy pregnant women, at similar gestational week with similar gravidity, formed the control group. The clinical findings, biochemical indicators, maternal and perinatal outcomes, and the serum concentrations of apelin-36 and apelin-13 were evaluated. The levels of apelin-13 and apelin-36 were determined with commercial kits using a competition-based enzyme-linked immunosorbent assay method.

RESULTS

The mean gestational age at sampling was 35.77 ± 2.515 weeks in the preeclamptic group, 36.45 ± 2.057 weeks in the control group (P = 0.270). Maternal serum apelin-36 and apelin-13 concentrations were significantly lower in patients with preeclampsia compared to the individuals in the control group (P = 0.030 and P = 0.005, respectively). The optimal cut-off points of apelin-36 and apelin-13 measurements for discriminating between preeclampsia and controls were evaluated by the receiver-operator curve analysis. The results showed that apelin-13 and apelin-36 are moderately successful markers to differentiate subjects with preeclampsia from healthy pregnant women. The concentrations of apelin-13 and apelin-36 in both groups were not statistically different in cases with and without adverse fetal/neonatal outcomes.

CONCLUSION

In conclusion, we investigated serum apelin-13 and apelin-36 concentrations in preeclamptic patients and demonstrated markedly lower maternal concentrations compared to healthy pregnant women.

Treatment adherence and short-term outcomes of smoking cessation outpatient clinic patients

INTRODUCTION

Previous studies have shown that adherence to treatment is fundamental to success in smoking cessation. However, smoking cessation medication regimens are limited significantly by the struggle to adhere to them. This study was conducted to evaluate the factors associated with treatment adherence and quitting success in a group of patients that applied to our smoking cessation outpatient clinic (SCC).

METHODS

Patients that applied to SCC between April 2015 and December 2016 who were evaluated, found suitable for smoking cessation interventions and started pharmacological treatment were included in this study. Only those who could be reached by phone three months after their first application became participants. Those who had used the prescribed treatment for at least 30 days were grouped as treatment-adherent.

RESULTS

In total, data for 346 patients were evaluated. Mean (±SD) age was 44.3±13.9 years; most of them were male (63%), primary school graduated (36.1%), self-employed (43.7%), and had no comorbid diseases (71%). Bupropion was started in 52% of the patients, that rate was 35.8% for varenicline and 12.1% for a combination of the nicotine patch and gum. Mean days for treatment use was 20.9±18.5; 59% of the patients were non-adherent to their treatment and 51.7% had only one control visit number. Adverse reactions due to treatment were recorded in 25% of participants, and at their third month 37.9% of them had quit smoking. In multivariate logistic regression analysis, increase in control visit number, absence of adverse reaction, and varenicline use, were each associated with higher treatment adherence (p<0.001) and only being in the treatment-adherent group was associated with quit success (OR=3.01, 95% CI: 1.88–4.81, p=0.001).

CONCLUSIONS

This study showed that most patients did not use their prescribed SC treatments adequately; a main factor that affects quit success is treatment adherence. There is a need for closer monitoring and follow-up to ensure adequate use of treatment of patients.

How does reimbursement status affect smoking cessation interventions? A real-life experience from the Eastern Black Sea region of Turkey

INTRODUCTION

In the last decade, outpatient smoking cessation clinics (SCCs) in Turkey have been extended countrywide. Initially, only counseling was covered under health insurance. In 2011 and 2015, free varenicline and bupropion preparations were distributed to SCCs, periodically. In the current study we aimed to compare outcomes between the free and paid medication periods.

METHODS

Patients applied to the local SCC in a secondary health care unit between June 2014 and June 2017. They were evaluated for SC interventions and had phone visits after their third month; these records were included in the study. Patients were grouped and evaluated according to medication’s reimbursement status: free medication period (FP) and paid medication period (PMP).

RESULTS

In total, 733 patients applied to the SCC, 77.7% of them had applied during the FP. Analyses were made involving 417 patients who had records of third-month phone visit. Mean age of the patients was 44.0±13.7 years with the majority of patients (65%) being male. Sociodemographic characteristics of patients in both groups were not statistically different, while the percentage of patients with comorbid diseases was lower in the FP group (p<0.05). Treatment choices were different— the bupropion-prescribed group’s rate was similar in both periods (53.5% in PMP vs 52.0% in FP), however varenicline was mostly prescribed in the FP (35.8% vs 14.1%) while nicotine replacement therapy was mostly prescribed in the PMP (32.4% vs 12.1%) (p<0.05). Patients who used the advised treatment for at least 30 days (treatment adherent) and the rate of quitters at the third month were higher in FP (p<0.05) from univariate analysis, however these differences were not statistically significant when a multivariate analysis was performed.

CONCLUSIONS

Our study showed that the free medication period increased the quit attempts but the increased in treatment adherence and quit success of the participating smokers was not obvious.

Prevalence and determinants of smoking status among university students: Artvin Çoruh University sample

Background and aim

Smoking is still a public health concern in many countries, especially among young adults. Consequently, we determined what factors affect university students’ smoking behavior in Turkey.

Methods

This cross-sectional study was conducted between March and June 2017 using a simple random sampling method. A self-administered questionnaire was used to collect information on participants’ (N = 2,505; mean age = 20.9 ± 2.5 years; 58.9% women) sociodemographic characteristics, cigarette smoking status, and related risk factors. Univariate analysis and multivariate logistic regression analysis were performed with the Backward likelihood-ratio method.

Results

Students were completing either two- or four-year degrees (45.6% and 54.4%, respectively). Regarding familial smoking behavior, 36.1% had a father who smoked, 10.3% had a mother who smoked, and 15.0% had siblings who smoked. Among participants, 27.9% were current smokers: 46% of the men and 15.3% of the women. Mean smoking onset age was 16.34 ± 2.72 years (15.65 ± 2.67 years for men and 16.34 ± 2.72 for women (p < .05). Mean Fagerströmtest score was 4.43 ± 1.82, and women had lower test scores than did men (p < .05). After controlling for potential confounders in multivariate analyses, five factors were significantly positively associated with current smoking: being a man (odds ratio (OR): 3.43; 95% confidence interval (CI): 2.75–4.28), studying in a two-year program (OR: 1.74; 95% CI: 1.39–2.18), having at least one immediate family member who smoked (OR: 1.63; 95% CI: 1.31–2.04), having all close friends who smoked (OR: 1.81; 95% CI: 1.40–2.33), and alcohol consumption (OR: 4.39; 95% CI: 3.51–5.49).

Conclusion

There was a higher smoking rate among our study population, both compared to similar national studies and Turkey’s overall smoking rate. Underlying factors should be evaluated via qualitative studies and preventive strategies should be implemented accordingly.

The role of nailfold capillaroscopy in interstitial lung diseases - can it differentiate idiopathic cases from collagen tissue disease associated interstitial lung diseases?

INTRODUCTION

Nailfold capillaroscopy (NFC) is a non-invasive diagnostic test that is mostly used for early diagnosis of collagen tissue diseases (CTDs). We aimed to evaluate whether NFC findings could be a clue for discriminating idiopathic interstitial lung diseases (ILD) from CTD associated ILDs (CTD-ILD). Additionally it was aimed to determine whether NFC could be helpful in discriminating usual interstitial pneumonia (UIP) pattern from non-specific interstitial pneumonia (NSIP) pattern.

MATERIALS AND METHODS

We grouped patients into three main groups: 15 CTD-ILD, 18 idiopathic ILD, and 17 patients in the control group. The CTD-ILD group was split into two subgroups: 8 patients with Sjögren's syndrome (SJS)-associated ILD and 7 with rheumatoid arthritis (RA)-associated ILD. The idiopathic-ILD group consisted of 10 idiopathic NSIP and 8 IPF patients. The control group consisted of 10 SJS and 7 RA patients without lung disease. None of the patients were on acute exacerbation at the time of examination, and none had Reynaud's phenomenon.

RESULTS

Mean capillary density was significantly reduced only in the CTD-ILD group as compared to the control group (p= 0.006). In subgroup analysis, it was determined that RA-ILD, IPF, and SJS-ILD subgroups had more severe capillaroscopic abnormalities. Mean capillary density in patients with the UIP pattern was reduced compared to patients with the NSIP pattern and those in the control group; p values were 0.008 and < 0.001, respectively.

CONCLUSION

This study is to be the first describing and comparing the nailfold capillaroscopic findings of patients with NSIP and UIP patterns. NFC findings can be helpful in discriminating UIP patterns from NSIP patterns. But to show its role in differentiating idiopathic disease, more studies with more patients are needed.