Ayşen Mert

We examined whether case classification in notifiable disease records varies by disease, level of care, and year, and how restricting analyses to confirmed-case records changes the distribution of notifications. Using surveillance records from Afyonkarahisar, Türkiye (January 2017–June 2024), we analyzed 13,806 notifications covering 42 diagnoses, excluding potential rabies exposures and Group D notifications. Each record was the latest notification for a case; level of care referred to its notifying facility. Mixed-effects logistic regression compared confirmed with suspected or probable records, adjusting for year, age group, and sex, with crossed random intercepts for diagnosis and district. Overall, 50.1% were recorded as confirmed. Compared with family medicine, adjusted odds ratios were 15.33 (95% CI 13.08–17.97) for secondary-care hospitals and 11.79 (9.75–14.25) for the university hospital; restricted to Group A diseases, they were 10.39 and 8.40. The association varied substantially between diagnoses. Year differences persisted after adjustment. Family medicine accounted for 26.6% of all notifications but 3.5% of confirmed-case records. Differences across levels of care may partly reflect how notifications are recorded and consolidated, and do not indicate differences in diagnostic accuracy or quality of care. Restricting analyses to confirmed-case records changes the distribution of notifications; studies should state which case categories are included.

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.

Natural disasters such as landslides cause not only physical damage but also lead to significant psychological consequences for affected individuals. This study aimed to evaluate the levels of post-traumatic stress and post-traumatic embitterment in individuals exposed to a landslide. A cross-sectional analytical study was conducted with 51 adults residing in a village affected by a recent landslide in Türkiye. Data were collected through face-to-face interviews using validated scales to assess post-traumatic stress and embitterment symptoms. Statistical analyses included group comparisons, correlation, and regression modeling. No significant differences were found in post-traumatic stress and embitterment scores based on sociodemographic characteristics. However, a strong positive relationship was identified between post-traumatic stress and post-traumatic embitterment levels. Disaster mental health strategies should address both stress and embitterment responses. Future research should examine these psychological outcomes in more diverse and larger populations across different types of disasters. The findings suggest that individuals experiencing high levels of post-traumatic stress are also likely to experience post-traumatic embitterment. This highlights the need for a broader understanding of emotional reactions to disasters.

Aile Hekimliğinde Akut Hastalıkların Yön.Cilt:1-2

Akut hastalık yönetimi, sağlık hizmetlerinin en kritik ve en hızlı karar verme gerektiren alanlarından biridir. Zamanla yarışılan bu süreçte doğru tanıya hızla ulaşmak, uygun tedaviyi başlatmak ve gerektiğinde doğru yönlendirmeyi yapmak, birinci basamak sağlık hizmetlerinin etkinliğini belirleyen temel unsurlardır. Aile Hekimliğinde Akut Hastalıkların Yönetimi, sahada karşılaşılan gerçek klinik gereksinimlerden doğmuş; sistematik, uygulanabilir ve güncel bir başvuru kaynağı olarak hazırlanmıştır. Aile hekimliği ilkeleri doğrultusunda yapılandırılan bu eser, akut hastalıklara yalnızca biyomedikal açıdan değil, biyopsikososyal ve kültürel boyutlarıyla bütüncül bir yaklaşım sunmaktadır. Kitap; ayrışmamış hastaya yaklaşım, hızlı ve doğru klinik karar verme, belirsizliklerin yönetimi ve sevk-izlem dengesi gibi birinci basamak pratiğinin temel zorluklarına rehberlik etmektedir. Aynı zamanda hasta merkezli bakım, etkili iletişim, etik ilkeler ve hasta güvenliği gibi modern tıbbın vazgeçilmez unsurlarını akut bakım süreçleriyle bütünleştirmektedir. Tele-tıp uygulamaları, dijital sağlık araçları ve elektronik sağlık kayıtları gibi güncel yaklaşımlar da eserde pratik bir perspektifle ele alınmaktadır. Klinik içerik açısından ise solunum, gastrointestinal, üriner ve genital, kas-iskelet, travmaya bağlı akut durumlar, kardiyovasküler, nörolojik, dermatolojik, göz, kulak, burun ve boğaz pediatrik, kadın sağlığı ve gebelik, geriatrik ve kırılgan popülasyon, psikiyatrik, metabolik ve endokrin, hematolojik, afetler ve olağanüstü durumlardaki tüm akut hastalıkları, kanıta dayalı ve sahada uygulanabilir bir çerçevede sunulmaktadır.

AMAÇ: Çalışma meslek yüksekokulu sağlık bakım hizmetleri bölümünde öğrenimini sürdüren bakım teknikeri öğrencilerinin yaşlı ayrımcılığına yönelik tutumlarını ve bunu etkileyen sosyodemografik değişkenler arasındaki ilişki düzeylerini belirlemek amacıyla gerçekleştirilmiştir. mi ve hemoglobin varyantlarının sıklığını değerlendirmektir.GEREÇ VE YÖNTEM: Tanımlayıcı türde planlanan araştırma 15 Nisan-15 Temmuz 2023 tarihleri arasında Çerkeş Meslek Yüksekokulunda öğrenim gören toplam 221 bakım teknikeri öğrencinin katılımı ile gerçekleştirilmiştir. Veri toplama aracı olarak; kişisel bilgi formu anketi ile Yaşlı Ayrımcılığı Tutum Ölçeği (YATÖ) kullanılmıştır. İstatistiksel karşılaştırmalarda Mann Whitney U testleri, t-testleri ve ANOVA testleri ile yapılmıştır. Verilerin istatistiksel anlamlılığı p<0,05 düzeyinde değerlendirilmiştir.BULGULAR: Öğrencilerin sosyodemografik özelliklerinin (cinsiyet, bölüm, sınıf, 65 yaş ve üstü birey ile birlikte yaşama durumu) ölçeğin toplam puanında anlamlı bir fark ortaya çıkardığı belirlenmiştir (p0,05). Öğrencilerin yaşlı ayrımcılığı tutum ölçeği toplam puan ortalaması 69,31±9,61 olarak belirlenmiştir.SONUÇ: Öğrencilerin yaşlı ayrımcılığına yönelik tutumlarının ortalama düzeyin üzerinde ve olumlu olduğu belirlenmiştir. Yaşlı bireylerle birlikte düzenlenen sosyal aktivite ve etkinlikler yaşlı ayrımcılığına yönelik tutumlara olumlu katkı sağlayabilir.

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.

AMAÇ: Bu çalışmada üniversite hastanesinde çalışan sağlık çalışanlarının 6331 Sayılı İş Sağlığı ve Güvenliği Kanunu ile ilgili bilgi düzeylerinin ve hastanede uygulanan iş sağlığı ve güvenliği uygulamalarına yönelik memnuniyetlerinin belirlenmesi amaçlandı. GEREÇ VE YÖNTEM: Çalışma 10 Aralık 2021 - 1 Mart 2022 tarihlerinde Afyonkarahisar Sağlık Uygulama ve Araştırma Hastanesi'nde görev yapan sağlık çalışanlarıyla gerçekleştirildi. Veri toplamak için üç bölüm ve 34 sorudan oluşan veri toplama formu ve 45 sorudan oluşan Hastanede Çalışan Sağlık Personeli İçin İş Güvenliği Ölçeği kullanıldı. Etik onay Afyonkarahisar Sağlık Bilimleri Üniversitesi Klinik Araştırmalar Etik Kurulu'ndan alındı. Veriler, IBM SPSS-V23 programı ile analiz edildi. Anlamlılık düzeyi p<0,05 olarak kabul edildi. BULGULAR: Çalışma 388 sağlık çalışanıyla tamamlandı; katılımcıların %59,0’ı kadın, %41,0’ı erkek olup yaş ortalaması 32,6±7,6 idi. 6331 Sayılı İş Sağlığı ve Güvenliği Kanunu’na ilişkin 12 sorudan alınan ortalama puan düşük bulunarak bilgi düzeylerinin yetersiz olduğu görüldü. Ölçeğin (maksimum 6 puan) ortalama skoru 2,98±0,78 olarak saptandı. Kanun bilgisi arttıkça sağlık taraması ve kayıt sistemleri (p<0,001), yönetsel destek (p=0,004), malzeme denetimi (p=0,039), koruyucu önlemler (p<0,001), fiziksel ortam uygunluğu (p=0,008) ve toplam ölçek puanında (p=0,004) anlamlı artış görüldü. Erkekler mesleki hastalıklar ve şikayetler (p<0,001) ile kazalar ve zehirlenmelerde (p=0,027); kadınlar sağlık taraması ve kayıt sistemlerinde (p=0,022) daha yüksek puan aldı. Yaş arttıkça yönetsel destek (p=0,029) ve malzeme denetimi (p=0,023) puanları yükseldi. Eğitim düzeyi, meslek grubu ve meslekte çalışma süresi bazı alt boyutlarda anlamlı fark yarattı (p<0,05). Hasta ile temasın yoğun olduğu birimlerde ölçek ve alt boyut puanları genel olarak daha düşük bulundu (p<0,05). SONUÇ: Bu çalışmada sağlık çalışanlarının iş sağlığı ve güvenliği uygulamalarına yönelik memnuniyetlerinin orta düzeyin altında olduğu saptandı. 6331 Sayılı Kanun’a ilişkin bilgi düzeyi arttıkça ölçek alt boyut puanları anlamlı şekilde yükseldi; çeşitli sosyodemografik ve çalışma özelliklerinin bu puanları etkilediği görüldü. Sonuçta iş sağlığı ve güvenliği bilgi düzeyini artırmaya yönelik eğitimlerin güçlendirilmesi ve özellikle riskli birimlerde memnuniyeti artıracak stratejilerin geliştirilmesi önerilmektedir.

This study aim was designed as an analytical cross-sectional study to assess the prevalence of frailty in patients aged 65 years and older with cardiovascular disease and to investigate its relationship with quality of life. The population consisted of a State Hospital Cardiology patients, and the sample consisted of 255 patients, who were calculated according to the incidence of the event (frequency of frailty) (25%) at the 95% confidence interval. Data were collected face to face by interview method between 25.07.2019-01.04.2020. In this study, frailty was observed in 30.9% of cardiovascular patients aged 65 and older. Frailty is mostly seen in illiterate people, women, single people, those who state that their income does not meet their expenses, and those who live alone, and there is a statistically significant difference between them (p≤ 0.05). A statistically significant relationship was found between frailty and factors such as the number of comorbidities, fall history in the past year, frequency of hospitalizations, and the number of medications taken within the last year in patients with cardiovascular disease. This study identified a negative correlation between the total score of the quality of life scale, its sub-dimension scores, and frailty (r=-0.414:p=0.000). Additionally, it was observed that patients with cardiovascular frailty experience a lower quality of life. In our study the frequency of frailty due to sociocultural factors is high in elderly individuals living alone with cardiovascular disease.