Gamze Dur

Aim: We evaluated professional commitment, general self-efficacy, perceived change in motivation, and self-rated academic performance among medical students from all six years of training and examined their interrelationships and associations with selected student characteristics.Material and Methods: This cross-sectional study included 545 of 1,226 eligible students in years 1–6 at one Turkish medical school. Commitment to Profession of Medicine Scale (CPMS) and General Self-Efficacy Scale–Turkish Form (GSE) total scores were used. Perceived change in motivation was assessed with one researcher-developed three-category item; academic performance was self-rated in a free-text 0–100 field (valid n = 536). Optional free-text explanations were used only for descriptive context. Analyses used Pearson’s chi-square, Mann–Whitney U, Kruskal–Wallis H, Spearman correlation, simultaneous multiple linear regression, and within-family false discovery rate (FDR) correction.Results: Of 545 participants, 349 (64.0%) were female. Median CPMS and GSE scores were 35 (IQR 29–39) and 61 (IQR 53–67), respectively. A perceived decrease in motivation was reported by 223 students (40.9%); the three-category distribution differed by educational phase (q = 0.001; Cramér’s V = 0.173). The gender difference in CPMS did not meet the FDR threshold (raw p = 0.047; q = 0.053). CPMS and GSE were positively correlated (ρ = 0.347; 95% CI 0.264–0.425; q < 0.001). In adjusted models, sixth-year status and non-voluntary choice of medical school were associated with lower CPMS. Female gender was associated with lower GSE, whereas self-rated academic performance and CPMS were positively associated with GSE.Conclusion: Professional commitment was lowest in the final year, and a perceived decrease in motivation was more frequent during clinical training. These cross-sectional findings support monitoring and targeted support at major educational transitions, especially the final year, but do not establish within-student decline or causality. Multicenter longitudinal studies using validated motivation measures and institutional academic records are needed.

OBJECTIVE: Cervical cancer (CC) is largely preventable through screening and human papillomavirus (HPV) vaccination; successful prevention depends on effective implementation of these interventions in primary care. We evaluated primary healthcare workers’ knowledge, awareness, attitudes, and self-reported behaviors regarding CC, HPV, and HPV vaccination.MATERIAL AND METHODS: In this cross-sectional study, data were collected using face-to-face questionnaires from 305 healthcare workers at Family Health Centers and Community Health Centers in Afyonkarahisar, Türkiye, between February 15 and June 15, 2023. Analyses were performed using IBM SPSS Statistics 26.0. Categorical variables were compared using chi-square or Fisher’s exact tests. Multivariable logistic regression assessed factors associated with HPV vaccine recommendation and willingness to vaccinate one’s child. Statistical significance was defined as p<0.05.RESULTS: Although 86.2% stated that CC is preventable, only 45.2% identified HPV infection as the most important risk factor. Awareness that HPV can cause CC (92.8%) and is sexually transmitted (97.4%) was high, whereas knowledge of its natural course was limited. Self-reported personal vaccination rates were low (bivalent 3.3%; quadrivalent 10.8%). Overall, 65.2% (n=199) recommended HPV vaccination to patients, 79.3% (n=242) were willing to vaccinate their child, and 66.9% (n=204) reported having knowledge of HPV vaccines. Compared with other healthcare workers, physicians had higher odds of recommending vaccination (adjusted odds ratio [aOR] 3.20, 95% CI 1.63–6.29). Education on CC, its treatment, and screening during professional training was associated with higher adjusted odds of recommending vaccination (aOR 3.60, 95% CI 2.11–6.13) and willingness to vaccinate one’s child (aOR 3.11, 95% CI 1.71–5.65).CONCLUSIONS: Primary healthcare workers showed item-specific gaps in knowledge of CC, HPV, and HPV vaccination, alongside low self-reported personal vaccination rates. Strengthening structured education in primary care may support HPV vaccine counseling and recommendation practices.

Aim: Tobacco use remains a major global health concern. Despite pharmacological advances, many smokers seek non-invasive interventions due to side-effect concerns. This study evaluated the 1-year effectiveness of a standardized biophysical therapy, namely Bioresonance Therapy (BRT), for smoking cessation in a primary care setting.Material and Methods: In this prospective longitudinal study, 50 adult participants (mean age 44.3 ± 10.4) underwent a standardized BRT protocol. Nicotine dependence was assessed using the Fagerström Test for Nicotine Dependence (FTND). Smoking status was verified via exhaled carbon monoxide (CO) at baseline, 1 month, and 3 months. Continuous abstinence at 12 months was defined as self-reported non-smoking. Factors associated with early relapse, including withdrawal symptoms, were evaluated.Results: The continuous abstinence rate at the 12-month follow-up was 28.0% (n=14). Early relapse within the first month was significantly associated with depressive mood (p=0.012) and sleep disturbances (p=0.008). Baseline FTND scores were not significantly associated with cessation outcomes (p=0.358). No serious adverse events were reported.Conclusion: BRT may represent a potentially useful and feasible non-pharmacological option for smoking cessation in primary care settings. Neuropsychiatric withdrawal symptoms were significantly associated with early relapse, suggesting that additional psychological support may be beneficial for patients experiencing mood or sleep-related difficulties during the cessation process. Limitations include the absence of a control group and reliance on self-report at 12 months; randomized controlled trials are warranted.

Background: Adequate iodine intake during pregnancy is essential for optimal maternal thyroid function and fetal neurodevelopment. Although universal salt iodization has been implemented in Turkey, pregnant women may remain vulnerable to iodine insufficiency. This study aimed to evaluate maternal thyroid function in relation to iodine status, and to comprehensively compare the diagnostic performance of spot urinary indices and creatinine-adjusted measures against measured 24 h urinary iodine excretion (24h-UIE) in pregnant women. Methods: A total of 227 pregnant women attending family health centers in Afyonkarahisar, Turkey, provided both spot urine samples and complete 24 h urine collections. Urinary iodine concentration (UIC), creatinine-corrected UIC (UIC/UCr), and 24h-UIE were measured. Thyroid function tests were interpreted using trimester-specific reference ranges. Correlations between urinary indices were assessed, and ROC analyses were performed using 24h-UIE as the operational reference. A structured questionnaire evaluated iodine-related dietary knowledge and salt-use practices. Results: The median spot UIC was 59.0 µg/L, indicating insufficient recent iodine intake at the population level. Based on 24h-UIE, 70% of participants had excretion levels below the Estimated Average Requirement (EAR) threshold (p < 0.001), whereas UIC/UCr demonstrated a stronger correlation (rho = 0.491, p < 0.001). In ROC analyses, UIC/UCr yielded a significantly higher AUC than spot UIC (0.774 [95% CI: 0.707–0.841] vs. 0.670 [95% CI: 0.593–0.748]; DeLong p = 0.016). Overt hypothyroidism was not observed; subclinical hypothyroidism was present in 16.3% of participants. While no overall association was found between iodine indices and thyroid status, in the first trimester, those with subclinical hypothyroidism had higher 24h-UIE medians than euthyroid peers (134.2 vs. 100.3 µg/day, p = 0.037), although both groups remained below the EAR threshold. Knowledge regarding iodine-rich foods and iodized salt use was limited among the study population. Conclusions: Iodine insufficiency remains highly prevalent among pregnant women in this region despite salt iodization. While spot UIC alone showed limited agreement with 24h-UIE, creatinine-adjusted UIC may offer improved interpretability under conditions of variable urine dilution. Preserved thyroid function in the presence of iodine insufficiency highlights the silent nature of this condition during pregnancy. Strengthened pregnancy-specific iodine surveillance and targeted antenatal education are warranted.

Objective: Gestational diabetes mellitus (GDM) is a multifactorial metabolic disorder in which redox imbalance and endothelial dysfunction may contribute to adverse maternal–fetal outcomes. We investigated whether maternal serum essential and toxic element profiles differ in GDM and whether these alterations are associated with oxidative stress indices and nitric oxide (NO) bioavailability. Methods: Serum samples from 50 women with GDM and 50 healthy pregnant controls were analyzed. Essential trace elements (Zn, Cu, Se, Fe, Mn, Cr, Mo, V) and toxic metals (Pb, Cd, As, Sn, Co) were quantified using inductively coupled plasma mass spectrometry (ICP–MS). Total antioxidant status (TAS), total oxidant status (TOS), asymmetric dimethylarginine (ADMA), and nitric oxide synthase (NOS)-related NO metabolites were measured by ELISA-based methods. Results: NOS levels were significantly reduced in GDM (p < 0.001), while TAS, TOS, and ADMA did not differ between groups. Zn, Cu, Se, Fe, Mo, and V were significantly higher in GDM, whereas toxic metals showed no group differences. In exploratory ROC analyses, selenium showed the highest discrimination for GDM (AUC = 0.754, p < 0.001), followed by iron (AUC = 0.714, p < 0.001) and vanadium (AUC = 0.700, p = 0.001). Molybdenum demonstrated modest discrimination (AUC = 0.662, p = 0.005), indicating potential—rather than strong stand-alone—predictive value. In logistic regression (per 1 SD increase), selenium and molybdenum were associated with higher odds of GDM in age-adjusted models, supporting the relevance of the multi-marker profile. Conclusion: The co-occurrence of elevated redox-active elements with reduced NO bioavailability in GDM supports a hypothesis-generating “Mo–Se–Fe–NOS signature” (an observational multi-marker profile) that warrants longitudinal and external validation to clarify mechanisms and clinical utility.

Background/aim: Spinal muscular atrophy (SMA) is a severe neuromuscular disorder with high treatment costs and significant psychosocial burden. In 2021, Türkiye launched a national premarital SMA carrier screening program integrated with in vitro fertilization (IVF) with preimplantation genetic testing (PGT) services for couples identified as carriers. This study aimed to compare the costs associated with the carrier screening and prevention program versus a no-screening (treatment-only) scenario. Materials and methods: A cost comparison model was developed using data from the Turkish Statistical Institute, the Ministry of Health, and the Social Security Institution. The annual costs of SMA treatment (with nusinersen and risdiplam) and the costs associated with carrier screening, genetic counseling, and IVF with PGT were compared. Projections estimated 115 new SMA cases annually based on national birth rates and carrier frequencies. Results: The total annual cost of the premarital carrier screening and prevention program was estimated at TRY 112,801,201.6 (EUR 2,418,550.6). In contrast, the treatment of 115 new cases of SMA with nusinersen would cost TRY 1,091,623,700 in the first year alone, reaching a cumulative cost of TRY 2,183,247,377 over three years. The three-year cumulative cost for risdiplam treatment was calculated as TRY 1,196,414,795. The cost of preventing the birth of one SMA-affected child through the screening program was estimated as TRY 854,554.6, whereas treatment costs per child reached as high as TRY 18,984,759.6 with nusinersen. Conclusion: The SMA premarital carrier screening and prevention program in Türkiye significantly reduces healthcare expenditures and disease burden. Primary prevention through carrier screening is associated with lower overall costs than long-term treatment, offering both economic and social advantages for public health policy.

Sağlık Bilimlerinde Disiplinlerarası Güncel Yaklaşımlar isimli kitabımız Tıp Fakültesi, Diş Hekimliği, Sağlık Bilimleri Fakültesi ve Sağlık Meslek Yüksek okulunda çalışan akademisyenlerimiz tarafından hazırlanmıştır. Sağlık konusuna disiplinler arası bakış açısı katmak ve sağlıktaki karmaşık ve çok boyutlu sorunlara çözüm üretebilmek için böyle bir kitap hazırlama gereği duyulmuştur. Sağlık Bilimlerinde farklı bilim alanlarının bilgi birikimini bir araya getirerek sağlık hizmetlerindeki bilgi birikimini ortaya çıkarmak ve niteliğini artırmaya yönelik kapsamlı bir bakış açısı sunduğumuzu ifade etmekteyiz. Bu eser, sağlık bilimlerinde teorik ve kilinik birikimi bir araya getirmiştir. Bu kitabın tüm sağlık bileşenlere katkı sunacağını ve disiplinler arası etkileşime etki edeceğini inanmaktayız.

Amaç: COVID-19 ile yaygın viral hepatitler olan HBV ve HCV enfeksiyonlarının birbirinin seyrini ne şekilde etkilediği kesin olarak bilinmemektedir. COVID-19 hastalarının tedavisinde kullanılan ilaçların karaciğer üzerine etkileri ve Hepatit B enfeksiyonu taşıyan hastalarda akut hepatik alevlenme riski araştırılması gereken bir diğer konudur. Tüm bu nedenler, COVID-19 ile HBV ve HCV enfeksiyonlarının ilişkisinin araştırılmasını gerektirmektedir. Bu çalışmanın amacı, COVID-19 tanılı hastalarda Hepatit B ve Hepatit C enfeksiyonlarının seroprevalansını belirlemek ve hastaların klinik özelliklerini değerlendirmektir. Yöntem: Bu çalışma kesitsel bir prevalans çalışmasıdır. Çalışmaya 1 Ocak-30 Haziran 2021 tarihleri arasında üniversite hastanesinin COVID-19 polikliniğine başvuran ve PCR testi pozitif bulunan, 18 yaşın üzerinde 1026 hasta dahil edildi. Katılımcılara çalışmanın içeriği hakkında sözel bilgi verildi ve yazılı onamları alındı. Araştırmacı tarafından kişisel bilgi formu yüz yüze görüşülerek uygulandı. COVID poliklinik hemşireleri tarafından venöz kan örneği alınarak Hepatit B yüzey antijeni (HBsAg), Anti HBs, hepatit B çekirdek antikoru (Anti-HBc IgG), Anti HCV, aspartat aminotransferaz (AST), alanin aminotransferaz (ALT), gama glutamil transpeptidaz (GGT), total bilirubin, direk bilirubin, indirek bilirubin ve hemogram değerleri çalışıldı. Verilerin istatistiksel analizi IBM SPSS Statistics sürüm 20 paket programı ile yapıldı. Gruplar arasında karşılaştırmalar için Kruskal-Wallis H ve Mann-Whitney U testleri kullanıldı. İstatistiksel anlamlılık p<0,05 olarak kabul edildi. Bulgular: Katılımcıların yaş ortalaması 45,11±16,12; %53,6’sı (n=550) kadın, %30,0’u (n=308) lise mezunu, %25,7’si (n=264) ev hanımıdır. Hastalarda öksürük %39,9; halsizlik %34,3 ve ateş %26,1 en sık belirtilen klinik şikâyetti. Katılımcıların %55,4’ünün bilinen kronik bir hastalığı yoktu. En sık görülen kronik hastalık %19,3 ile hipertansiyondu. PCR testi pozitif olan hastalarda HBsAg, anti-HCV, anti-HBs ve Anti-HBc IgG için seropozitiflik oranları sırasıyla %1,4 (n=14/1026); %0,5 (n=5/1026); %48,5 (n=498/1026); %18,2 (n=187/1026) olarak bulundu. Hastaların hepatit seroloji sonuçları cinsiyete göre karşılaştırıldığında kadınlarda Anti HBs negatifliği erkeklerden daha yüksek olarak bulundu (p=0,034). Sonuç: COVID-19 tanılı hastalarda HBV ve HCV seropozitifliği ülkemiz ve bölgemizdeki seroprevalans çalışmaları ile karşılaştırıldığında normal popülasyondan düşük bulundu. Bu veriye dayanarak, kronik viral hepatitlerin COVID-19 için primer risk faktörü olmadığı düşünülebilir. Ancak bu düşünceyi kesin olarak kanıtlamak ve COVID-19 ve viral hepatitler arasındaki etkileşimi göstermek için daha detaylı yeni çalışmalara gereksinim vardır.

Sifilis, Treponema pallidum cinsi spiroketlerin etken olduğu, deri döküntüsü, ağrısız genital ülser, lenfadenopati, mukokutanöz lezyonlar gibi pek çok farklı klinik durumla karşımıza çıkabilen cinsel yolla bulaşan bir enfeksiyondur. Kendiliğinden iyileşebilen ve yıllarca asemptomatik seyreden olgular hastalığın yayılmasına neden olabilir. Günümüzde hastalık epidemiyolojisindeki değişimler nedeniyle ileri yaşlarda da sifilis vakaları bildirilmektedir. Aile hekimliği, tıp disiplinleri arasında ayrışmamış hasta ile en sık karşılaşılan bölümlerdendir. Bu makalede, aile sağlığı merkezine genital bölgede yara, sol kasıkta şişlik ve ağrı şikayetiyle gelen bir hastaya aile hekimi tarafından sifilis teşhisinin konulması ve tedavisinin yapılması sürecini ve düşük prevalans hekimliği ve ayrışmamış hasta yaklaşımının birinci basamaktaki önemini dile getirmeyi amaçladık.

To emphasize the efficiency of vaginal cone (VC) therapy in stress urinary incontinence (SUI) through a comparison with transobturator tape (TOT). A prospective randomized controlled study was conducted at the Etlik Zübeyde Hanım Maternity and Women Hospital during a one year study period. Forty women were allocated into two equal groups; those treated with VCs for a 3 month period, and women who underwent TOT procedures. These women were followed up at 6 weeks and 6 months after the treatments. Subjective cure was assessed using Wagner's Quality of Life Questionnaire. Objective cure was evaluated through a cough stress and pad test results. Maternal demographic features were comparable among groups. We observed improvement in pad weight test among groups when compared with the pretreatment state (p=0.015, p=0.005). Although the subjective cure rate was similar in both groups at the 6th week and 6th month follow up (65% vs. 75%; 75% vs. 80%) (p>0.05), the objective cure rate was significantly higher in the TOT group than in the VC group, as expected (10% vs. 80%; 30% vs. 75%) (p<0.05). The main treatment of SUI is surgery; however, VC could be offered as an alternative treatment for women who refuse surgery, those at high risk for surgery or it could be used temporarily before surgery.