Turkish Association of Family Physicians
This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
Association between smartphone addiction and symptoms of depression and anxiety among young adults
Objective: Smartphones, now ubiquitous across the globe, have the potential to contribute to behavioral addiction. Among the psychological concerns linked to such addictions are depression and anxiety. This study aimed to investigate potential associations between smartphone addiction and symptoms of depression and anxiety in a sample of young adults. Methods: This descriptive, cross-sectional study was conducted over a two-month period among 512 university students. Participants completed a questionnaire comprising sociodemographic information and smartphone usage patterns, along with the Smartphone Addiction Scale–Short Version (SAS-SV), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Group comparisons were performed using the Kruskal–Wallis and Mann–Whitney U tests. Spearman and Pearson correlation coefficients were used to assess the strength and direction of associations. Results: The study population consisted of young adults with a mean age of 20.45 ± 1.95 years.A statistically significant relationship was found between depression-based on cut-off values-and smartphone addiction (p=0.001). Moreover, weak but statistically significant positive associations were observed between smartphone addiction and both depression (r=0.232, p=0.001) and anxiety (r=0.209, p=0.001). Participants who self-identified as smartphone addicts reported significantly higher SAS-SV scores compared to those who were unsure or did not consider themselves addicted (p=0.001). Conclusions: The findings demonstrate a significant association between smartphone addiction and symptoms of depression and anxiety. Given that individuals perceiving themselves as addicted exhibited notably higher addiction scores, self-perception may serve as a useful indicator in preventive mental health approaches—particularly within the context of primary care.
Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
Adaptation of the Gosnell Pressure Ulcer Risk Assessment Scale to Turkish: validity and reliability study
Objective: This study aimed to adapt the Gosnell Pressure Ulcer Risk Assessment Scale into Turkish and to evaluate its linguistic validity, content validity, inter-observer reliability, and construct validity through exploratory and confirmatory factor analyses. Methods: This methodological study was conducted with 150 patients treated in a palliative care unit over one year. The adaptation process consisted of two stages: linguistic validation and assessment of validity and reliability. Linguistic validity was assessed using the translation-back translation method and expert reviews. Content validity was evaluated using the Lawshe technique with input from five experts from the Department of Family Medicine. Reliability was assessed by measuring inter-observer agreement using the Kappa coefficient, Cramer’s V coefficient, and Spearman correlation analysis. To evaluate construct validity, Exploratory Factor Analysis (EFA) using Principal Component Analysis and Confirmatory Factor Analysis (CFA) using the Diagonally Weighted Least Squares (DWLS) estimation method were conducted. Results: A total of 150 participants were included, with a mean age of 74.74 years, and 58% were female. The Content Validity Ratio (CVR) for each item was calculated as 1. Regarding reliability, the Kappa coefficient for the Mental Status item was 0.903, and Cramer’s V coefficient was 0.896; for the Continence, Mobility, and Activity items, both the Kappa and Cramer’s V coefficients were 1. For the Nutrition item, the Kappa coefficient was 0.840, and Cramer’s V coefficient was 0.862. A significant and positive correlation was found between the total scores of the two observers (p<0.001). For construct validity, the EFA revealed a single-factor structure explaining 62.039% of the total variance, with a Kaiser-Meyer-Olkin (KMO) value of 0.783 and Bartlett’s test of sphericity being significant (χ²(10)=383.266, p<0.001). The subsequent CFA showed a marginal model fit (χ²/df=5.627), while all factor loadings were statistically significant (p<0.001). The Nutrition item demonstrated a relatively lower loading (0.457), suggesting possible cultural or contextual differences in the Turkish sample. Conclusion: The Turkish version of the Gosnell Pressure Ulcer Risk Assessment Scale was found to be a valid and reliable tool for use by healthcare professionals in Türkiye. The scale showed acceptable content and construct validity.
Diagnosis of metastatic prostate cancer in patient applying with drug prescription request: window of opportunity in primary care
Family Medicine healthcare centers are the primary point of contact for addressing all health issues of individuals. Comprehensive medical histories and physical assessments are crucial for the prompt identification and treatment of various illnesses. This study presents a case of metastatic malignancy without active symptoms. During the patient's visit to the family medicine outpatient clinic, laboratory tests were conducted, tests from another medical facility were analyzed, and a prescription for a medication that was frequently taken was obtained.
Challenges in achieving low-density lipoprotein targets: a cross-sectional study in statin users
Objective: Statins are commonly used in the management of dyslipidemia, with their efficacy varying based on type and dose. They are prescribed for both primary and secondary cardiovascular prevention. However, achieving recommended low-density lipoprotein cholesterol (LDL-C) targets remains a challenge in clinical practice. This study aimed to assess achievement of target LDL-C levels in statin users and to identify modifiable factors related to treatment failure. Methods: This cross-sectional study was conducted in a family medicine outpatient clinic and included adults (≥18 years) on statin therapy for at least six months. Data were collected through face-to-face interviews using a sociodemographic questionnaire and the Adherence to Refills and Medications Scale (ARMS-7). Cardiovascular risk levels were classified using the SCORE risk calculator, and LDL-C goal attainment was assessed based on risk categories. Results: Of 334 participants, 51.8% were male. LDL-C levels exceeded 100 mg/dL in 43.1% of patients. According to SCORE classifications, 55.4% were identified as being at very high cardiovascular risk. Overall, 87.1% of participants failed to achieve target LDL-C levels. Target LDL-C levels were achieved by 30.4% of participants in the low-to-moderate risk group, 16.5% in the high-risk group, and only 6.5% in the very high-risk group (p<0.001). In the study population, patients using statins solely for dyslipidemia (without a history of cardiovascular disease) and those with hypertension, were more likely to achieve LDL-C targets (p<0.05). A significantly higher proportion of male participants (16.8%) achieved the target LDL-C level compared to female participants (8.7%) (p<0.05). Conclusion: The majority of patients on statin therapy did not meet their target LDL-C levels, particularly those at high cardiovascular risk, highlighting the impact of clinical inertia and underscoring the importance of individualized statin dosing and regular monitoring based on patients’ cardiovascular risk assessments in primary care settings.
Polypharmacy in the elderly populations: frequency, outcomes and prevention approaches
Advancements in medical technologies, expanded access to healthcare services, and improvements in living conditions have significantly increased the average life expectancy worldwide. This demographic shift, coupled with declining fertility rates, has led to a rapid rise in the proportion of elderly individuals within populations. The increase in the prevalence of chronic diseases is leading to the widespread use of multiple medications and making the importance of appropriate medication use more visible in primary health care. Polypharmacy is a natural consequence of the burden of age-related chronic diseases, but it can also introduce additional risks during treatment processes. Studies report that the prevalence of polypharmacy varies widely. Among older adults, polypharmacy is associated with numerous adverse clinical and economic outcomes, including drug interactions, inappropriate medication use, poor treatment adherence, adverse drug reactions, increased risk of falls, functional decline, and higher rates of hospitalization. Prescription review programs, the implementation of guidelines that support appropriate medication use (Beers, STOPP/START, TIME, etc.), and patient-centered education approaches play an important role in preventing polypharmacy. Family physicians working in primary health care play a central role in the early detection and appropriate management of polypharmacy, thanks to their ability to conduct long-term monitoring of elderly individuals and establish continuous physician-patient relationships. Additionally, AI-powered clinical decision support systems can enhance treatment safety by facilitating the detection of drug interactions and potentially inappropriate medication use. Strengthening collaboration between physicians and pharmacists in primary healthcare services, increasing awareness of medication management among older adults, and improving health literacy are among the key elements that support the effectiveness of the process. The aim of this review is to evaluate the frequency of polypharmacy in older adults, its economic and health outcomes, and prevention approaches based on current literature.
The impact of media influence on pregnant women's perceptions of oral glucose tolerance tests in primary health care settings
Objective: Screening for gestational diabetes mellitus with the oral glucose tolerance test is recommended between the 24th and 28th weeks of pregnancy. In recent years, views opposing the oral glucose tolerance test have gained prominence in the Turkish media, potentially influencing pregnant women's decisions. This study aimed to determine how often the oral glucose tolerance test is used and by which physicians, to examine the relationship between socioeconomic status and test use, and to assess the impact of the media on those who refuse the test. Methods: This descriptive, prospective, cross-sectional study was conducted between May and August 2020 with pregnant women who presented to, and were registered and followed up at, the family medicine outpatient clinics in Çankaya, Ankara. A total of 334 pregnant women who met the inclusion criteria participated in the study. Sociodemographic caracteristics, socioeconomic status, oral glucose tolarence test acceptance status, physician recommendation variability, effect of media influence of various media sources in decision-making process was questioned by a 16-question survey. Results: Of the participants, 68.0% (n=227) had obtained a university degree, and 56.3% (n=188) reported a high income. Overall, 41.6% (n=139) said the didn’t received any information about the oral glucose tolerance test from their primary care physician. Of the informed subjects 58.8% (n=114) received information from their family doctors. 15.6% (n=52) declined the test, while 33.8% (n=113) were undecided. For those who declined the test 53.8% (n=28) pointed at negative media or social media content to be the primary reason for their decision. Pregnant women from a lower socioeconomic background were more likely to decline the test or be undecided, particularly if they had not received information about it from a healthcare professional. Conversely, physician-provided information was associated with higher acceptance rates for the oral glucose tolerance test. Conclusion: A low socioeconomic status, combined with a lack of information provided by physicians and negative media influence, was associated with higher rates of refusal or indecision regarding oral glucose tolerance test. However, providing accurate and clear information about gestational diabetes screening through family physicians was found to significantly increase the likelihood of test acceptance.
Teledermatology in Swedish primary care as a blueprint for Türkiye
Should routine iodine supplementation replace iodine testing in pregnant women in Turkey? A family medicine perspective
Smoking cessation behaviors of patients who refer to smoking cessation clinics affiliated to family medicine departments
Objective: Tobacco use continues to be one of the most important causes of preventable death and diseases globally. The present study was designed to evaluate the smoking cessation behaviors of patients who referred to smoking cessation clinics operated by family medicine departments at different universities. Methods: The present study was conducted as a cross-sectional study with the participation of 611 individuals who referred to smoking cessation clinics operated by family medicine departments at Bolu Abant Izzet Baysal University Faculty of Medicine Training and Research Hospital, Duzce University Faculty of Medicine Hospital, Suleyman Demirel University Faculty of Medicine Hospital, Balıkesir Atatürk City Hospital and who agreed to participate in the study. The survey form includes questions about the patients’ demographic information and smoking habits. The participants who agreed to participate in the study were contacted by phone six months later to learn about their smoking status along with the treatment they received. The data were analyzed using IBM SPSS Statistics 20, with a significance level set at p<0.05. Results: The study was completed with 611 individuals. Of the participants, 57.9% (n=354) were male, while 42.1% (n=257) were female. The primary reason for starting smoking was reported as friends by 63.7% (n=289). While the mean age of starting smoking was found as 19.69±6.91 (min:10-max:50) years in participants who stated that their reason for starting smoking was friends. It was found that 28.8% (n=176) of the participants who referred to the clinic had not previously attempted to quit smoking. Of the participants who had previously attempted to quit smoking, 39.7% (n=173) had decided to refer to the clinic after their first try. It was found that 20% (n=122) of the participants had previously received professional support at least once. At the end of 6 months, it was found that while 72.2% (n=439) of the participants had received pharmacotherapy, 27.8% (n=170) stated that they preferred non-pharmacological treatment. It was also found that 26.2% (n=160) of the participants had completely stopped smoking at the end of six months. The rate of smoking cessation was significantly higher in participants who had received pharmacotherapy (p=0.01). Conclusion: Smoking cessation programs should be addressed in a multidimensional manner. Smoking cessation clinics operated by family medicine departments offer a holistic approach that evaluates individuals not only biomedically, but also with psychosocial, behavioral and environmental aspects.
Bullous pemphigoid associated with dipeptidyl peptidase-4 inhibitor in primary care: Case report
Bullous pemphigoid is the most common bullous chronic autoimmune skin disease. Recent studies suggest dipeptidyl peptidase-4 inhibitors used in the treatment of type-2 diabetes as possible predisposing agents of bullous pemphigoid. It is thought to be important for primary care physicians, who are the most common referral point of patients and where drug use is examined in detail, to keep in mind that drugs such as dipeptidyl-peptidase-4 inhibitors may cause bullous pemphigoid and to refer to dermatology for early treatment. In this context, a 70-year-old female patient with a diagnosis of type 2 diabetes mellitus presented to our outpatient clinic with pruritic, erythematous bullous lesions diffusely distributed over the body, occurring one week after initiation of a vildagliptin-containing medication. There was no mucosal involvement. The patient initially received treatment with the presumptive diagnoses of allergy and scabies; however, as no improvement was observed, a detailed medical history was obtained. Based on the clinical findings, drug-induced bullous pemphigoid was suspected, and the vildagliptin-containing medication was discontinued. The patient was subsequently referred to the dermatology department. Histopathological examination and direct immunofluorescence findings were consistent with bullous pemphigoid. Following drug withdrawal and a short course of oral corticosteroid therapy, a marked improvement of the lesions was achieved. With this case, we aimed to draw attention to the approach of bullous pemphigoid disease developing as a result of vildagliptin use in a patient with type-2 diabetes who presented to primary care and to increase awareness on this issue.
Copyright © 2025 The Author(s) https://creativecommons.org/licenses/by/4.0
Evaluation of family physicians' attitudes to defensive medicine practices and its effect on providing driving licence reports
Objective: To examine the attitude of family physicians practicing at primary care units in İstanbul regarding defensive medicine practices and their effect on providing driving license health report provisions and the frequency of dispatches. Methods: 396 family physicians practicing in primary care units in Istanbul were included in this observational and descriptive study between March and April 2023. Volunteering physicians were invited to participate in an online questionnaire including sociodemographic characteristics, knowledge and experience questions about defensive medical practice (DMP), the number of examinations and driving license provisions they have issued in the last year, and the rate of referrals to secondary or tertiary health centers. Defensive Medicine Practices Attitude Scale (DMPAS) was also performed online through which negative and positive DMP attitudes were assessed. Participants were classified as having very high (55-44 points), high (43-33 points), moderate (32-22 points), and mild (21-11 points) defensive attitude. Participants' attitudes towards providing driving license health reports were scored with a 5-point Likert-type scale. DMPAS scores were compared in terms of all data. Results: Among 396 participants, more than half were female (54.3%; n=215). Mean age was 39.3±8.9 years [Min 24,0-Max 60.0]. According to DMPAS, 94.5% of the participants exhibited a moderate or higher defensive attitude. Participants who were male (p < 0.05), married (p < 0.05), and specialist physicians (p < 0.05) scored significantly higher in DMPAS compared to their counterparts. As the physicians’ age, years of experience, and the number of registered patients increased, DMPAS decreased (r = -0.668, p < 0.001; r = -0.638, p < 0.00; r = -0.154, p = 0.002, respectively). The study shows that physicians who frequently refer patients to secondary or tertiary hospitals for driving reports and who have a high demand for driving reports among those aged 17 and over in their care population exhibited significantly higher defensiveness scores (p < 0.05). In other words, physicians who had more defensive attitudes preferred to consult the provision to the secondary or tertiary hospitals rather than approving the application. Conclusion: Defensive medicine practices in family physicians are relatively high, increasing the dispatch rate in driving license reports. The increasing rate of referrals from primary care units due to defensive medicine practice results in a patient burden on secondary or tertiary healthcare institutions.
Rational drug use and associated factors in pulmonology outpatients: a cross-sectional study
Objective: Rational drug use (RDU) refers to administering medications that are appropriate to patients’ clinical needs, in doses that meet their individual needs for a sufficient duration, and at the lowest possible cost. Despite the clinical importance of RDU, irrational drug use remains prevalent, particularly in pulmonology patients. In this context, the objective of this study is to evaluate RDU knowledge and identify associated sociodemographic and clinical factors in pulmonology outpatients. Methods: The sample of this cross-sectional, single-center study consisted of 317 outpatients aged 18 years or older who presented to a secondary chest diseases hospital between February and May 2023. The patients were assessed using a structured questionnaire containing items on their sociodemographic and general health characteristics and the validated 21-item Rational Drug Use Scale (RDUS). The collected data were analyzed using parametric and chi-square tests, as well as correlation and logistic regression analyses. Results: The mean age of the study sample, 59.6% of which were females, was 50.0 ± 13.0 years. Of the 317 patients, 78.9% had chronic diseases, and 38.8% were taking ≥5 medications (polypharmacy). The mean RDUS score of the sample was 29.78±4.77, indicating insufficient knowledge. The mean RDUS score of the patients aged ≤45 years was significantly higher than that of those aged >45 years (p=0.007). The mean RDUS score of the patients living in urban areas was significantly higher than that of those living in rural areas (p=0.031). A strong correlation was found between patients’ education level and RDUS score. Accordingly, the mean RDUS score of patients with higher education was significantly higher than that of patients with other education levels (p=0.001). Multivariate analysis revealed higher education levels ([Odds Ratio (OR)=3.45, p=0.005], living in urban areas [OR=2.46, p=0.031], and young age [<45 years] [OR=0.958 per year, p=0.001]) as independent predictors of having sufficient RDU knowledge. Conclusion: In conclusion, we found that outpatient pulmonology patients’ RDU knowledge was independently associated with age, education level, and place of residence. In light of these findings, targeted educational interventions to improve medication adherence, reduce adverse events, and optimize treatment outcomes should be primarily focused on patients who are elderly, have low educational levels, reside in rural areas, and have respiratory diseases.
Relationship of thyroid hormones and metabolic parameters in euthyroid women
Objective: Thyroid hormones play a role in metabolic regulation, yet their associations with obesity and insulin resistance in euthyroid individuals remain unclear. This study aimed to evaluate the relationship between thyroid-stimulating hormone (TSH), fT3, fT4, and the fT3/fT4 ratio with metabolic parameters in euthyroid women. Methods: In this retrospective cross-sectional study, 236 euthyroid women aged 18–65 were recruited from a tertiary hospital in Istanbul between May and September 2023. Participants were categorized as individuals with normal weight, overweight, or obesity. Thyroid hormones and metabolic parameters (waist circumference, triglycerides, HDL-C, insulin resistance) were analyzed. Statistical analyses included correlation tests and ANCOVA for age adjustment. Results: No significant differences in thyroid hormone levels were found across BMI groups after adjusting for age. TSH was positively correlated with BMI and triglyceride levels. fT3 and the fT3/fT4 ratio were positively associated with insulin resistance and negatively associated with HDL-C. Conclusion: fT3 and the fT3/fT4 ratio may reflect metabolic alterations in euthyroid individuals. These findings highlight the potential relevance of thyroid hormone evaluation in assessing metabolic risk, especially among individuals with obesity or insulin resistance. Further multicenter studies are warranted.
Investigation of atrial fibrillation frequency in relation to possible thromboembolic events in geriatric patients attending family medicine outpatient clinics
Objective: Atrial fibrillation (AF) is the most common type of arrhythmia and is responsible for a large proportion of hospitalizations. In this study, we aimed to investigate the presence of atrial fibrillation(AF) without developing thromboembolic complications in patients who applied to family medicine. Methods: The study included patients over 65 who applied to A University Training and Research Hospital and a State Hospital Family Medicine polyclinic. Those who had previously been diagnosed with AF were excluded from the study. Electrocardiography (ECG) was performed on patients over 65 who applied to our polyclinics to examine the frequency of AF. To assess the risk of thromboembolism, the CHA2DS2-VASc score was utilized. This score is a widely accepted and validated risk stratification system designed to predict stroke in patients with non-valvular AF. Results: In a study involving 146 participants with a mean age of 73.86±7.38 years (61.6% female, 38.4% male), AF incidence was 11%. Isolated hypertension was the most common diagnosis, affecting 58% of patients with chronic diseases linked to AF. While AF was more prevalent in men (14.3%), the difference was insignificant (p=0.310). Most patients with AF (87.5%) had a CHA2DS2-VASc score of 2 or higher. The mean systolic blood pressure was 132.59±22.03 mmHg in non-AF patients compared to 124.00±21.62 mmHg in AF patients. A history of cardiac surgery and arrhythmias was associated with a higher incidence of AF (p=0.010). Conclusion: The prevalence of AF in individuals over 65 years of age was found to be 11%, and the presence of comorbid disease was found to constitute the most important risk group. CHA2DS2-VASc score was two or above in 87.5% of patients and formed the high-risk group for stroke. In the study, patients with AF diagnosed before the development of thromboembolic complications were referred to the cardiology clinic for thromboembolic prophylaxis. This allowed the organization of cost-effective treatments based on bleeding risk scores and clinical indications. In primary health care services, every patient presentation should be evaluated effectively, and patients with symptoms and findings from a physical examination should be examined for AF.
Investigation of the relationship between depression levels and nutritional status in elderly patients receiving home health care services
Objective: The research explores the factors influencing the nutrition levels of people aged 65 years and older enrolled in home health services, focusing on depression levels, functional dependency, existing comorbid conditions and sociodemographic characteristics. Methods: The study is a single-centered, cross-sectional, descriptive, and prospective analysis conducted with patients registered at the Home Health Services at SBÜ Izmir Bozyaka Training and Research Hospital . The sample size was estimated assuming that the prevalence of malnutrition among the elderly was 40%, with a error margin of 0.05% and a 95% confidence interval, and reaching a target of 368 individuals. Sociodemographic data were collected via surveys. Nutrition levels was measured utilizing the Mini Nutritional Assessment Scale- Long Form, functional dependence with the Barthel Index, comorbidities via the Charlson Comorbidity Index, and depression levels using the Yesavage Geriatric Depression Scale. Statistical analysis of the data was performed using IBM SPSS 26 program. Results: Among the respondents, 60.6% (n=223) were female and the mean age was 81.35±7.95 years (range: 65-99). In education terms, 84.8% had completed elementary school or less (n=312), and 79.4% received care from family members (n=292). The average body mass index was 25.4±4.2 kg/m² (min: 16.5 kg/m²; max: 49 kg/m²). Nutritional assessments showed that 29.6% were insufficiently nourished, 44% were at risk of malnutrition. In daily activities, 16.8% were fully dependent, while 47.3% were severely dependent. According to the comorbidity index, 89.1% were at very high risk for mortality. Additionally, 62.5% were confirmed as depressed, with 10.3% likely depressed. A significant association was found between nutrition status and some factors such as caregiver status, gender, dental hygiene and BMI. Conclusion: The study highlights a considerable prevalence of depression and its adverse effect on nutritional health. Depression levels were found to have a strong negative correlation with nutritional status, indicating that high levels of depression may negatively affect the nutritional well-being of older adults and emphasizing the need to address both nutrition and mental health in this demographic group.
Leveraging home healthcare to enhance adult immunization coverage
Attitudes and behaviors of patients with diabetes towards insulin treatment
Objective: Insulin treatment for diabetes helps prevent complications. The views and attitudes of people with diabetes towards insulin have a significant impact on treatment adherence and health outcomes. This study aimed to understand the attitudes of people with diabetes towards insulin treatment and the psychosocial factors associated with them. Methods: The study included 225 patients who applied to the Diabetes-Obesity Outpatient Clinic of a tertiary hospital, who were diabetic, using insulin and/or oral antidiabetic drugs (OAD), over 18 years of age, not pregnant, and able to self-inject. The patient identification form, the DASS-21, and the ITAS scales were used to collect data. Results: In our study, the mean positive attitude of the ITAS was 9.51; the mean negative attitude of the ITAS was 41.28; and the mean total score of the ITAS was 50.80. Anxiety was observed in 54.7% of the participants, depression in 44.4%, and stress in 30.7%. There was a positive correlation between age and ITAS total score (r=0.405; p<0.001). Negative ITAS attitude and ITAS total score were found to be higher in women (p=0.022 and p=0.034), in patients with type 2 diabetes (p<0.001; p<0.001), and in patients who had not received diabetes education (p=0.002; p=0.001). The total and negative attitude scores of patients using only OAD were higher than those using insulin (p<0.001). Conclusion: In our study, we found that being a woman, being older, not having received diabetes education, having a short duration of diabetes, and using only OAD were associated with negative attitudes towards insulin in people with diabetes. We also found that depression, anxiety, and stress levels were significantly higher in women and people with low income.
The effect of the presence of anemia during and after pregnancy on the development of postpartum depression symptoms
Objective: Postpartum depression is a significant mental health issue that affects mothers in the postpartum period and can be influenced by various biological and environmental factors. This study aims to examine the impact of during pregnancy and the postpartum period on the occurrence of postpartum depression symptoms. Methods: This cross-sectional observational study was conducted at Prof. Dr. Cemil Tascioglu City Hospital Training family health care center. A total of 104 patients within the first 6 months postpartum period were included in the study between September 5 and October 5, 2023. Data were collected through face-to-face interviews using questionnaires and analyzed using SPSS v.25 software. Symptoms of depression were assessed using the Edinburgh Postnatal Depression Scale (EPDS), and the results were evaluated based on this scale. Data obtained from the study were analyzed using IBM SPSS v.25 software, and p <0.05 was considered statistically significant. Results: A total of 104 postpartum women participated in the study. The mean age was 27.1±4.1 years; 50% of participants were university graduates, 53.8% were unemployed, and 94.2% were living with their spouses. Cesarean delivery was reported in 59.6% of cases. Prepartum anemia was observed in 14.4% of participants, while postpartum anemia was present in 43.3%. According to the Edinburgh Postnatal Depression Scale, the prevalence of postpartum depression symptoms was 14.4%. Low postpartum hemoglobin levels, living separately from the spouse, and the presence of postpartum anemia were found to be statistically significantly associated with depressive symptoms (p<0.05). Conclusion: This study suggests that anemia and certain sociodemographic factors may be associated with depressive symptoms in the postpartum period. In primary care settings, conducting not only physical but also psychosocial assessments during postpartum follow-up is crucial for early identification and timely provision of appropriate support services.
Night eating syndrome negatively affects the physical and mental quality of life of female university students
Background: Night eating syndrome (NES) is a clinical syndrome, which is related to sleep disturbance and depression. NES may be associated with obesity and may negatively affect quality of life of university students. The aim of this study was to examine the relationship between NES with obesity and health related quality of life in female university students. Methods: A total of 293 female university students aged 18-29 were recruited to study. The demographic characteristics of students were questioned. Students filled out the Night Eating Questionnaire and an instrument determining health related quality of life (SF-36). Anthropometric measurements (height, weight and waist circumference) of participants were taken by professionals. Correlation and linear regression analysis were run to analyze collected data. Results: About 57% of students’ mothers were illiterate or had primary school degrees. The NES prevalence was 6.8% in students. There was no significant relationship between anthropometric measurements (body mass index, waist circumference) and the presence of NES and quality of life scores (p>0.05). However, higher NES scores were associated with lower quality of life sub-scores (physical function, role limitations due to emotional problems, vitality, emotional well-being, social functioning, pain, general health perception) (p<0.05). Simple linear regression analysis results also showed that NES scores were related to lower physical and mental health related quality of life scores (p<0.05). Conclusions: Although night eating syndrome was not associated with obesity in female university students, it directly affects the physical and mental quality of life of students, adversely. Strategies to cope with night eating syndrome should be developed for university students.
Are YouTube videos on how to use nasal corticosteroid sprays helpful?
Background: People can create video content on any topic they want via the internet and social media applications. Our aim is to determine the quality, reliability, understandability and actionability levels of YouTube videos on nasal corticosteroid usage and to evaluate the nasal corticosteroid application steps. Methods: The first 200 videos were evaluated and recorded on YouTube (http://www.youtube.com) with the search term “use of nasal corticosteroid spray” on March 23, 2024. Videos regarding nasal corticosteroid use were evaluated by relevant clinicians using the Global Quality Scale (GQS), modified DISCERN (mDISCERN) and the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) scales, respectively. And the nasal corticosteroid application steps were recorded one by one. Results: The median duration of 113 (56.5%) videos included in the study was 146 (min-max: 39-3582) seconds. The median GQS score of the videos was 3 (min-max: 1-5) and the median mDISCERN score was 3 (min-max: 0-5). When we evaluated the PEMAT-A/V scores of the videos, 35 were found to be understandable and 69 were actionable. The Global Quality Scala scores were found to be significantly higher in videos that were considered understandable and actionable (p=0.012, p<0.001, respectively). Modified DISCERN scores were found to be significantly higher in videos that were considered understandable and actionable (p=0.007, p=0.005, respectively). The steps for applying nasal corticosteroid spray were not adequately stated in the videos. Conclusion: Increasing the number of actionable and quality content prepared using everyday language, far from medical terms, in the light of scientific data on social media, especially on the YouTube platform, can help larger audiences access accurate information on medical issues.
Awareness of quaternary prevention and defensive attitudes among family physicians
Objective: The aim of this study was to assess family physicians awareness of the concept of quaternary prevention and their attitudes towards defensive medicine. Materials and Methods: The populations of this descriptive study were family medicine residents and family physicians working in primary care. The authors developed a “Quaternary Prevention Awareness Form” based on the literature. A questionnaire consisting of socio-demographic questions and the Defensive Medicine Practices Attitude Scale was administered online and face-to-face. Results: The mean age of the 312 physicians was 39.22±9.55 years. Quaternary prevention had been heard of by 63.8% (n=199) of the physicians, but only 6.4% (n=20) had detailed knowledge of the concept. Although male physicians were more aware of “disease mongering” (p=0.003), females were more aware of “overtreatment” and “medical treatment management” (p=0.040; p=0.013, respectively). The results showed that males (p=0.007), residents (p=0.039) and those who had been sued for malpractice (p=0.004) had higher defensive medicine attitudes. Conclusion: This study shows the importance of physicians’ awareness and knowledge, which have been enhanced by specialisation, urban practice and training in quaternary prevention. In order to protect society from the harms of excessive medical practices, medical education needs to be reviewed to remind us of “primum non nocere”.
Evaluation of sleep quality and general health conditions in hypertension patients who apply to the family medicine outpatient clinic in Ordu
Objective: Our study aims to evaluate sleep quality in individuals aged 18 and older with and without hypertension, and to examine the relationship between sleep quality and the General Health Questionnaire-12 (GHQ-12), which is used to assess mental health status. Materials and Methods: This cross-sectional study included a total of 190 participants, consisting of 95 hypertensive patients and 95 controls without hypertension, who applied to the Family Medicine outpatient clinic at Ordu Training and Research Hospital between February and July 2024. The Pittsburgh Sleep Quality Index (PSQI) and GHQ-12 questionnaires were used in the study. Data were analyzed using IBM SPSS v23 and R software, with a significance level set at p<0.050. Results: Significant differences were observed between the hypertension group and the control group in the PSQI components of subjective sleep quality, sleep latency, habitual sleep efficiency, and sleep disturbances. A statistically significant relationship was found between hypertension, the control group, and GHQ-12 scores (p=0.001). In the hypertension group, 56.8% of participants exhibited poor mental health, compared to 33.7% in the control group. Among individuals in the hypertension group with GHQ-12 scores of 2 or higher, notable differences were detected in the components of subjective sleep quality, sleep latency, sleep disturbances, and daytime dysfunction. Conclusion: The findings of the study reveal interactions between hypertension, mental state and sleep quality. The study shows that these factors are in a cycle that feeds each other. As primary care physicians, considering the prevalence, chronicization rates, possible complications and consequences of these diseases in the society, preventing the emergence of many related new clinics or managing the complications that may occur in related conditions when they cannot be prevented is in line with the philosophy of Family Medicine Specialization.
Effectiveness of pharmacological smoking cessation treatments: a retrospective comparison of common methods
Objective: This study aimed to compare the short-term (three-month) effectiveness of three smoking cessation therapies, bupropion, nicotine patch, and cytisine, and to retrospectively evaluate the impact of cytisine therapy on craving reduction and its side effect profile under routine clinical practice conditions. Methods: A total of 565 individuals who presented to the Smoking Cessation Outpatient Clinic between February 2024 and January 2025 and completed treatment with either cytisine, bupropion, or nicotine patch were included in the study. Demographic characteristics, chronic disease status, Fagerström Test for Nicotine Dependence (FTND) scores, and smoking cessation outcomes were assessed to compare treatment success across the three therapies. Among patients treated with cytisine, early craving reduction and reported side effects during the first week were recorded and analyzed in relation to cessation outcomes. Statistical significance was set at p<0.05. Results: The mean age of participants was 41.28±12.33 years, and the mean FTND score was 6.18±2.32. Of the patients, 252 (44.7%) received cytisine, 135 (23.8%) received bupropion, and 178 (31.5%) received nicotine patch therapy. The smoking cessation rate was 61.5% in the cytisine group, 16.3% in the bupropion group, and 11.8% in the nicotine patch group. The cessation success rate in the cytisine group was significantly higher than in the other treatment groups (p<0.001). Among those who received cytisine, 161 patients (82.5%) reported a reduction in craving within the first five days of treatment. The overall side effect rate was 25%, with nausea and vomiting (22.7%) and headache (22.7%) being the most commonly reported adverse effects. Logistic regression analysis revealed a strong association between early craving reduction and successful smoking cessation among cytisine users (OR=25.79, p<0.001). Conclusion: Cytisine was associated with higher cessation rates compared to other treatments. It also appeared to reduce cravings in the early phase and had a relatively low side effect profile. Craving reduction during the first week emerged as an important predictor of success. These findings suggest that cytisine may be an effective and well-tolerated option in primary care. However, further prospective studies are needed to evaluate its comparative effectiveness more comprehensively.
Assessment of vitamin D and iron supplementation practices and their determinants in Erzincan, Türkiye: A cross-sectional study
Objective: Vitamin D and iron are crucial micronutrients, particularly for children in phases of rapid growth and development, playing significant roles in bone and dental health, immune function, cognitive development, and energy metabolism. Despite the initiation of prophylaxis programs by the Turkish Ministry of Health, adherence and effectiveness remain variable, highlighting the need for localized research to evaluate these initiatives. This study aims to assess the prevalence and continuity of vitamin D and iron supplementation among families in Erzincan, and identify determinants influencing the sustainability of these practices. Methods: A cross-sectional and descriptive study was conducted among 200 families with children aged 1-5 years in the districts of Erzincan. Participants were recruited from family health centers using a convenience sampling method. Inclusion criteria encompassed families with children who met the age requirement, while exclusion criteria included children with special health conditions requiring high-dose supplementation. Data were collected through structured face-to-face questionnaires assessing supplementation practices, sources of medical advice, parental attitudes, and socio-demographic factors. Descriptive statistics summarized the data. The chi-square test and independent samples t-test assessed categorical and continuous variables, respectively. Multiple logistic regression identified factors influencing adherence, while Kaplan–Meier survival analysis evaluated supplementation duration. Results: High rates of vitamin D (98.5%) and iron (94%) supplementation were observed, albeit with decreased adherence to the recommended durations (82.5% for vitamin D, 75.5% for iron). The absence of parental concern for their children’s health and concurrent use of another type of prophylaxis had a positive effect on prophylaxis use. A pediatrician recommended vitamin D and iron prophylaxis to 33% (n=66) of the participants, a family physician to 49% (n=98), and auxiliary health personnel to 3% (n=6) only, whereas 15% (n=32) were advised by more than one health professional. (p=0.008 for vitamin D prophylaxis; p=0.014 for iron prophylaxis). The multivariable logistic regression analyses revealed that parental concern about their infants’ health significantly impacted the continuity of vitamin D prophylaxis (p=0.010). However, demographic characteristics had no significant impact on supplementation practices. Conclusion: Although vitamin D and iron supplementation rates are high in Erzincan, challenges in sustaining recommended durations suggest areas for improvement in prophylaxis programs. This study underscores the importance of healthcare professional recommendations and parental health perceptions in influencing supplementation practices. Recommendations include enhancing health education and accessibility to prophylaxis programs to improve sustainability and adherence.
Assessment of the relationship between physical activity and burnout levels of healthcare professionals during the COVID-19 pandemic
Objective: During outbreaks, healthcare workers may encounter mental health challenges, including an increased risk of infection and burnout. Physical inactivity due to widespread restrictions may significantly worsen these adverse effects. This study aims to assess burnout and physical activity levels among healthcare workers in hospitals during the COVID-19 outbreak and to examine the relationship between these factors. Methods: This cross-sectional study involved 294 healthcare professionals, including nurses, midwives, health technicians, physiotherapists, laboratory technicians, and emergency medical technicians, working in outpatient or inpatient clinics at a university hospital, separate from the COVID-19-related study units. Research data were collected from November 10, 2021, to February 10, 2022. The Maslach Burnout Inventory, International Physical Activity Questionnaire, and a sociodemographic form were used as data collection tools. Results: Among the participants included in the study, 63.9% were female, 36.1% were male, and the mean age was 29.40±6.39 (min: 19, max: 58). Additionally, 70.1% of the participants were employed in units related to COVID-19. The emotional exhaustion and desensitization subscales were higher in physicians and nurses working in COVID-19 units (p<0.05). Furthermore, 13.9% of the participants in this study met the criteria for sufficient physical activity levels. Physical activity levels were greater among single participants (p<0.05). However, there was no significant relationship between the participants’ burnout status and physical activity levels (p>0.05). Conclusion: This study found that burnout levels among physicians and nurses were higher than those of other healthcare professionals. Additionally, burnout levels were elevated in employees working in units related to COVID-19. The physical activity levels of healthcare professionals participating in our study were low. However, no significant relationship was observed between participants’ burnout and physical activity levels.
Evaluation of blood pressure measurement rates among outpatients presenting to a university hospital
Objective: Hypertension is an important health problem that affects the entire population and causes mortality and morbidity. Although there are screening recommendations in different diagnosis and treatment guidelines, there are studies showing that blood pressure measurement is skipped during examination in practice. This study aimed to evaluate the blood pressure measurement status in adults applying to different outpatient clinics in our hospital. Methods: In our cross-sectional-analytical study, the data of patients who applied to the Karadeniz Technical University Farabi Hospital polyclinics for any reason between 01.01.2023 and 01.01.2024 were scanned retrospectively from the hospital information system. Patients who were over 18 years of age with their anamnesis taken and physical examination information completed were included in the study. Patients selected by random sampling method from 24 different branch clinics were included in the study. A sample of 215 people was calculated from each of the clinics. Patients’ age, gender, chronic disease status, medication use information, and blood pressure measurement data were collected. Results: The median age of the 5160 participants was 48 (IQR: 32-62) years. 58.4% (n=3015) of the participants were women. 13.8% of the participants had their blood pressure measured during their outpatient clinic examination. While the departments that performed the most measurements were nephrology, cardiology and general internal medicine, it was observed that none of the patients had their blood pressure measured in ten outpatient clinics, including oncology and neurosurgery. 49.7% (n=354) of the individuals whose blood pressure was measured already had hypertension diagnosis. When blood pressure staging was done according to the blood pressure measurement results, 46.1% (n=328) had increased blood pressure. 77.3% of individuals whose blood pressure was measured in the family practice outpatient clinic did not have a predetermined hypertension diagnosis. Conclusion: The results reveal that the rate of blood pressure measurement, which is a part of the physical examination in outpatient clinics, is much lower than it should be. In order to ensure early diagnosis and blood pressure control of a chronic disease such as hypertension, which is common in society and can have serious complications, every polyclinic visit of the patients should be considered as an opportunity to measure blood pressure.
Evaluation of the nutritional status of patients hospitalized in palliative care and its relationship with depression
Objective: This study aims to assess the nutritional condition of patients hospitalized in palliative care and to determine the connection between their nutritional status, depression, and daily living activities. Methods: This cross-sectional and descriptive study, carried out between November 20, 2023, and April 2024, questionnaires including sociodemographic characteristics, Mini Nutritional Assessment (MNA), Geriatric Depression Scale (GDS), and Barthel Index of Activities of Daily Living were administered to patients hospitalized in the Palliative Care Unit of Ordu University Training and Research Hospital. The data were analyzed using IBM SPSS V23, with a significance level set at p<0.05. Results: A total of 169 individuals were included in the study. The average age of the participants was 81.26±8.96 years, with ages ranging from 65 to 100 years. The average score on the Mini Nutritional Assessment (MNA) scale was 16.77, and the average score on the Geriatric Depression Scale-Short Form (GDS-SF) was 7.08. The average score for the Barthel Index of Activities of Daily Living was 45.86. When examining the relationships between the Barthel Index and GDS-SF scores, Barthel Index and MNA scores, as well as MNA and GDS-SF scores, a statistically significant correlation was found (for all; p<0.001). As MNA scores decreased, GDS-SF scores increased, while Barthel Index scores decreased. Conclusion: Patients in need of palliative care often face difficulties in meeting their own needs and tend to be dependent on their surroundings, with a predisposition to malnutrition and depression. A strong interrelationship exists between these three conditions. In our study, it was observed that as patients’ susceptibility to malnutrition increased, their tendency towards depression also heightened, which in turn led to a parallel increase in their level of dependency. In line with the findings of our study, a thorough evaluation of both nutritional status and depression in every patient during clinical practice will not only improve patients’ quality of life but also facilitate a quicker response to treatment and enhance overall health outcomes. Although our study has certain limitations, the similarities among these clinical conditions suggest that interpreting the results as a whole may serve as a critical strategy to enhance treatment success in palliative care and support improved patient follow-up and survival.
Measurement of critical thinking dispositions and comparison of critical approaches to information sources in medical residents: A cross-sectional study*
Objective: Critical thinking is the questioning of whether the information presented is real, reliable, evidence-based and unbiased. It provides a deeper understanding of the information and reaches the right conclusions by eliminating biases, erroneous and false data. Our study aimed to measure the critical thinking dispositions of medical residents and to determine the effect of this ability on the evaluation of the reliability of information sources. Methods: Our cross-sectional study was conducted with the participation of 197 medical residents from different branches working in Adana City Training & Research Hospital after ethical approval. Sociodemographic data, results of the critical thinking disposition scale and data obtained after the evaluation of two different information sources using the DISCERN measurement tool were analyzed. Results: Among the participants, 171 (86.8%) were working in clinical sciences and 26 (13.2%) were working in surgery. The mean score of the critical thinking disposition scale was 43.52±5.49. The mean scores of the Critical Openness subscale (27.51±3.65) and reflective skepticism (16.02±2.44) subscales were found to be significantly higher (p<0.001). There was no significant correlation between critical thinking dispositions and scores on the DISCERN measurement tool, which assesses the reliability and quality of information sources. (p=0.550) Conclusions: In our study, although the critical thinking disposition scale scores of resident physicians were found to be high, no relationship was found on the evaluation of the quality of medical information sources. Critical thinking, which is a metacognitive ability that future health professionals should possess, should be further examined in medical education and supported by practical applications.
An intervention study to increase knowledge of cervical cancer, HPV and HPV vaccines among family health workers
Objective: The aim of this study was to assess the knowledge and attitudes of family health workers about cervical cancer, HPV infection and HPV vaccines, and to evaluate the impact of an educational intervention on these conditions. Methods: This was an educational intervention study. Data were collected on the knowledge levels and attitudes of family health workers in Samsun province about cervical cancer, HPV infection and HPV vaccines through a pretest-posttest intervention. Data were collected using a structured questionnaire and participants received a two-hour training session. After the training, the effectiveness of the educational intervention was assessed by applying the questionnaire again. Results: Before the educational intervention, only 57.9% reported having adequate knowledge about HPV. After the educational intervention, a statistically significant increase in knowledge about HPV and HPV vaccines was observed. It was also observed that the educational intervention had a positive effect on participants’ tendency to seek HPV vaccination for themselves and their children. It was observed that the level of knowledge of family health workers about HPV screening and risk factors was relatively high, but there were deficiencies in HPV vaccines. Conclusion: This study found that family health workers had inadequate knowledge about cervical cancer, HPV and HPV vaccines, and that the educational intervention was effective in increasing family health workers’ knowledge about HPV and vaccines.
Determining the learning styles of family medicine residents and investigating their relationship with personality traits
Objective: This study aims to define the learning styles and personality traits of family medicine residents and to explore their interrelationships, contributing to a better understanding of how these factors can enhance the effectiveness of residency training. Unlike previous research, this study specifically examines the alignment between learning styles and personality traits within the context of family medicine training, providing new insights into personalized educational strategies. Methods: This cross-sectional descriptive study was conducted with 97 family medicine residents in Adana City Training and Research Hospital between 15 February 2023 and 15 April 2023. Sociodemographic data questions, Kolb Learning Styles Inventory-3 and Big Five-50 Personality Test (BFPI-50-Tr) were collected through face-to-face interviews with the participants and the data were analyzed with IBM SPSS 24.0 software. Results: The majority of the participants exhibited a diverging learning style (48.5%), followed by accommodating (29.9%) and assimilating (19.6%) styles. The highest mean score in personality traits was observed in agreeableness (40.11±4.32), while the lowest mean score was found in extraversion (30.23±6.70).There was no statistically significant relationship between personality test results and learning styles (p > 0.05). Conclusion: The findings suggest that the majority of family medicine residents prefer diverging and accommodating learning styles, which emphasize learning through experience, discussion, and practical application. To optimize residency education, training programs should incorporate group discussions, brainstorming activities, and experiential learning methods tailored to these styles. Additionally, considering the high agreeableness scores among residents, fostering collaborative and interactive learning environments may further enhance their professional development.