Meral Timurtaş

Aim: This study aimed to evaluate how far patient-reported and self-reported (PRO/SRO) items from the SF-36 physical function domain could substitute measured (PerfO) grip strength and gait speed in frailty classification, while also comparing the variability in frailty estimates produced by PerfO versus PRO/SRO approaches.Material and Method: This study conducted a secondary analysis of two large cohorts: NuAge, representing older adults, and MACS, comprising HIV-positive and HIV-negative men. Frailty indicators of “frail walk” and “frail handgrip” were defined according to Fried’s criteria. Associations between performance-based (PerfO) and patient-/self-reported (PRO/SRO) measures were examined using correlations and stepwise logistic regression. The PRO/SRO items were further evaluated for sensitivity and specificity. Frailty status was compared using two classifications: the adapted Fried’s Frailty Phenotype (aFFP) and the Frailty Indicator Phenotype (FIP).Results: NuAge had 1754 participants (women:914, men:840) (mean age: 4.2 ±4.1). MACS had 1151 participants (HIV- negative:679; HIV-positive:472) with complete gait speed and grip strength (mean age:56 ±5.0). The strongest predictors of frail walk were limitations in walking 200 m/several blocks and age (c-statistics: 0.71–0.87), while frail handgrip was best explained by lifting and carrying (c-statistics: 0.51–0.63). For SRO-based classifications, sensitivity ranged from 8.2% to 32.8% and specificity from 86% to 93%. In comparison, aFFP and FIP achieved markedly higher sensitivity (48%–95%) with similar specificity (86%–96%).Conclusion: SRO measures of walking 200 m and carrying objects had poor sensitivity but high specificity, making them useful for excluding non-frail gait and grip cases. In contrast, the FIP constructed entirely from PRO/SRO items demonstrated both high sensitivity and specificity, highlighting its promise as a straightforward and practical frailty screening approach.

Aim: Regular physical activity (PA) is essential for maintaining health and preventing chronic diseases. However, global evidence shows a consistent decline in PA during adolescence, with Turkish adolescents similarly experiencing increasing levels of inactivity over the last decades. Adolescence represents a critical developmental stage where PA habits are established and influence long-term health outcomes, yet longitudinal evidence from Türkiye remains limited. This study aimed to examine 18-month changes in PA among Turkish adolescents using a prospective cohort design. Method: This study was planned as a prospective cohort study.296 adolescents (grades 5–8, aged 11–13 years) who completed the baseline survey between November – December 2022, a randomly selected subsample of 192 students from one school was followed up in May-June 2024.PA levels were assessed at both time points using anthropometric measures and the validated Turkish version of the Physical Activity Questionnaire for Older Children (PAQ-C). Results: A total of 157 participants (boys, n=74; girls, n=83) completed assessments at both time points. Significant decreases were observed in six of nine PAQ-C items for boys and two of nine items for girls (p < 0.05). School-time PA (items 2–4) showed significant reductions, while spare-time and extracurricular PA (items 1 and 5–9) remained largely unchanged (p > 0.05). Gender differences indicated greater reductions among boys compared with girls. Conclusions: Over an 18-month period, PA levels among Turkish adolescents declined, with reductions most evident in school-time PA and more pronounced among boys. These findings underscore the need for longitudinal monitoring of adolescent PA in Türkiye. There is limited study estimating the follow-up on physical activity in the Turkish adolescent population.

The integration of blockchain technology into healthcare systems has emerged as a technical solution for enhancing data security, protecting privacy, and improving interoperability. Blockchain-based smart contracts offer reliability, transparency, and efficiency in healthcare services, making them a focal point of many studies. However, challenges such as scalability, regulatory compliance, and interoperability continue to limit their widespread adoption. This study conducts a comprehensive literature review to assess blockchain-driven health data management, focusing on the classification of blockchain-based smart contracts in health policy and the health protocols and standards applicable to blockchain-based smart contracts. This review includes 80 core studies published between 2019 and 2025, identified through searches in PubMed, Scopus, and Web of Science using the PRISMA method. Risk of bias and methodological quality were assessed using the Joanna Briggs Institute tool. The findings highlight the potential of blockchain-enabled smart contracts in health policy management, emphasizing their advantages, limitations, and implementation challenges. Additionally, the research underscores their transformative impact on digital health policies in ensuring data integrity, enhancing patient autonomy, and fostering a more resilient healthcare ecosystem. Recent advancements in quantum technologies are also considered as they present both novel opportunities and emerging threats to the future security and design of healthcare blockchain systems.

Integrating distributed ledger technology (blockchain) into healthcare reimbursement and clinical data governance offers the potential to make operations more efficient, transparent, and trustworthy. However, focusing only on technical, regulatory, or behavioral factors in isolation often produces fragmented solutions and undermines adoption. This study develops a blockchain-based trust framework that bridges regulation with clinical practice by aligning auditability, data privacy, and clinician trust in automated reimbursement systems. The research combined a structured literature review with participatory action research, including three workshops with cross-functional health insurance teams, four focus groups (n=16) across health IT, compliance, legal, and patient services staff, and eight in-depth semi-structured interviews with healthcare executives. Thematic analysis, supported by substantial inter-coder agreement (κ=0.86), identified five determinants of trust—transparency, accountability, fairness, privacy, and usability. These insights informed the design of a reference architecture that integrates smart contracts, hybrid on-/off-chain data management, and interoperability through FHIR standards. A compliance mapping demonstrated that the framework addresses key provisions of GDPR, HIPAA, and Japan’s APPI, while the layered design separates policy, consent, and reimbursement logic. The resulting framework operationalizes stakeholder-defined trust requirements and provides auditable governance protocols suitable for cross-jurisdictional deployment. By embedding both trust and regulatory compliance into reimbursement automation, this work moves blockchain applications beyond proof-of-concept prototypes toward practical clinical integration. The framework contributes to biomedical informatics by offering a technically feasible, ethically grounded, and legally aligned pathway to enhance both reimbursement efficiency and data governance in healthcare environments.

The integration of blockchain technology into healthcare systems has emerged as a transformative solution for enhancing data security, protecting privacy, and improving interoperability. Blockchain-based smart contracts offer reliability, transparency, and efficiency in healthcare services, making them a focal point of many studies. However, challenges such as scalability, regulatory compliance, and interoperability continue to limit their widespread adoption. This study conducts a comprehensive literature review to assess blockchain-driven health data management, focusing on the classification of blockchain-based smart contracts in health policy and the health protocols and standards applicable to blockchain-based smart contracts. The systematic review includes 80 core studies published between 2019 and 2025, identified through searches in PubMed, Scopus, and Web of Science (WoS) using the PRISMA method. Findings highlight the potential of blockchain-enabled smart contracts in health policy management, emphasizing their advantages, limitations, and implementation challenges. Additionally, the research underscores their transformative impact on digital health policies, particularly in ensuring data integrity, enhancing patient autonomy, and fostering a more resilient healthcare ecosystem. Recent advancements in quantum science and technologies are also considered, as they present both novel opportunities and emerging threats to the future security and design of healthcare blockchain systems.

Sağlık hizmetleri çok sayıda, yüksek teknolojili ve pahalı tıbbi malzeme ile araç kullanımını içermekte, bu da sağlık hizmetinin maliyeti üzerinde önemli ve kritik etki göstermektedir. Tıbbi malzemeleri kullananlar daima her şeyin ellerin altında olmasını isterken, malzemeyi tedarik edenler ise mali ve ekonomik koşullar nedeniyle konuya farklı yaklaşabilmektedir. İşte bu denge ve optimal durum sağlık hizmetlerinde iyi bir malzeme yönetimi ile mümkün olmaktadır. Öte yandan sağlık sektörünün diğer hizmet sektörlerinden farklı olarak “hizmetin ertelenememesi”, “talebinin belirsizliği”, “hakkaniyet” gibi özellik ve ilkeler ile çıktısının insan sağlığı ile ilgili olması, malzeme tedarik ve yönetimini daha da önemli getirmektedir. Malzemenin istenilen standartta olması, gerektiği anda yeterli miktarda olması, depolamasının doğru yapılması, ortamdan doğru şekilde uzaklaştırılması ve zamanında sağlık personeli ve hastaya ulaştırılmasının da yine malzeme yönetiminin önemini ortaya koymaktadır. Ayrıca başta kalite olmak üzere, etkinlik ve verimlilik açısından sağlık hizmetindeki sonuçlarda da malzeme yönetimi ön plana çıkmaktadır. Bu bağlamda malzeme yönetimi konusunda temel kavramların ve cerrahi süreçteki malzeme yönetiminin bilinmesi gerekmektedir. Healthcare services involve the use of numerous, high-tech and expensive medical material and equipment and, which has a significant and critical impact on the cost of healthcare. While those who use medical materials want everything to be at their hand, those who supply the supplies may approach the issue differently due to financial and economic conditions. This balance and optimal situation is possible with effective material management in healthcare services.On the other hand, unlike other service sectors, the health sector's features and principles such as "not being able to postpone the service", "uncertainty of demand", "equity" and the fact that its output is related to human health make material supply and management even more important. The importance of material management is to ensure that the material is at the desired standard, in sufficient quantity when needed, stored correctly, removed from the environment correctly, and delivered to the healthcare personnel and the patient on time. In addition, material management comes to the fore in the results in healthcare services, especially in terms of quality, effectiveness and efficiency. In this context, it is necessary to know the basic concepts of material management and material management in the surgical process.

Aim: This study aimed to assess the factors influencing the acceptance of telerehabilitation among physiotherapists in Istanbul. Methods: A cross-sectional study was conducted among 170 PTs (F/M: 94/76, mean age:29.4 years) working in Istanbul. Data were collected through a questionnaire regarding scales of ‘‘Unified Theory of Acceptance and Use of Technology’’ and ‘‘Perception of Innovation’’. UTAUT has 5 components which are ‘‘Performance Expectancy’’ (PE), ‘‘Effort Expectancy’’ (EE), ‘‘Social Influence’’ (SI), ‘‘Facilitating Conditions’’ (FC), ‘‘Behavioral Intention’’ (BI). The model was modified by adding ‘‘Telerehabilitation Usage Behavior’’ and ‘‘Perception of Innovation’’ to these structures. After preliminary analyses, structural equation modelling was employed to assess relationships between key constructs and variables within the proposed model Results: The modified UTAUT model demonstrated a good fit for understanding the acceptance of telerehabilitation among physiotherapists, as indicated by favorable goodness-of-fit indices (SRMR = 0.03, GFI = 0.99, AGFI = 0.92, CFI = 0.97, and RMSEA = 0.00). This model accounted for 68% of the variance in ‘‘Behavioral Intention’’ to use telerehabilitation and 28% of the variance in ‘‘Telerehabilitation Usage Behavior’’. The results revealed that ‘‘Behavioral Intention” directly influenced ‘‘Telerehabilitation Usage Behavior’’ (β = 0.53) and ‘‘Social Influence’’ directly affected ‘‘Behavioral Intention’’ (β = 4.96). Additionally, the relationship between ‘‘Social Influence’’ and ‘‘Behavioral Intention’’ was found to vary with age (β =-5.81, p