Publications by authors named "Bektas Murat"

74 Publications

Predicting the effect of healthy lifestyle belief on attitude toward nutrition, exercise, physical activity, and weight-related self-efficacy in Turkish adolescents.

Arch Pediatr 2021 Nov 26. Epub 2021 Nov 26.

Department of Pediatric Nursing, Dokuz Eylul University, Faculty of Nursing, İnciraltı, İzmir.

Objectives: This study was conducted to examine the effect of healthy lifestyle beliefs on their attitudes toward physical activity, nutrition, exercise, and weight-related self-efficacy lifestyles in Turkish adolescents.

Methods: This study used a methodological and descriptive design. The study was conducted with 445 adolescents aged 13-18 years. The data were collected using a Descriptive Information Form, the Healthy Lifestyle Beliefs Scale for Adolescents, the Nutrition Exercise Attitudes Scale, and the Attitudes Toward Physical Activity Scale. Mean and percentage values, t-test, ANOVA test, and linear regression analysis were used in the analysis of the research data.

Results: A statistically significant difference was found between adolescents' obesity status, paternal educational level, maternal educational level, income status, and the mean scores obtained for healthy lifestyle beliefs, nutrition and exercise attitudes, physical activity attitudes, and weight-related self-efficacy, as well as between sex and mean scores for attitudes toward nutrition, exercise, and physical activity. In the model created with regression analysis, it was found that the adolescents' healthy lifestyle beliefs and sociodemographic variables explained 96.3% of their attitudes toward nutrition and exercise, 93.6% of physical activity attitudes, and 96.5% of weight-related self-efficacy levels, with statistical significance.

Conclusion: According to the results of the study, healthy lifestyle beliefs are an important predictor of adolescents' attitudes toward nutrition, exercise, and physical activity as well as their weight-related self-efficacy. We recommend that school nurses consider healthy lifestyle beliefs when creating intervention programs for adolescents .
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http://dx.doi.org/10.1016/j.arcped.2021.11.001DOI Listing
November 2021

The impact of hydroxychloroquine and azithromycin on the corrected qt interval in patients with the novel Coronavirus disease 2019.

Rev Assoc Med Bras (1992) 2021 Jul;67(7):979-984

Eskisehir Osmangazi University, Medical Faculty Department of Cardiology - Eskisehir, Turkey.

Objective: With the coronavirus disease 2019 (COVID-19) continuing to spread all over the world, although there is no specific treatment until now, hydroxychloroquine and azithromycin have been reported to be effective in recent studies. Although long-term use of hydroxychloroquine and azithromycin has been reported to cause QT prolongation and malign arrhythmia, there is not enough data about the effect of short-term use on arrhythmia. Therefore, this study aims to assess the effect of hydroxychloroquine alone and hydroxychloroquine + azithromycin on corrected QT (QTc).

Methods: A baseline electrocardiogram and on-treatment baseline electrocardiogram were retrospectively collected in COVID-19 patients who received hydroxychloroquine and/or azithromycin. The QTc interval was calculated, and the baseline and peak QTc intervals were compared. In addition, the peak QTc intervals of monotherapy and combination therapy were compared.

Results: Of the 155 patients included, 102 (65.8%) patients were using hydroxychloroquine, and 53 (34.2%) patients were using hydroxychloroquine + azithromycin combination. The use of both hydroxychloroquine alone and hydroxychloroquine + azithromycin combined therapy significantly prolonged the QTc, and the QTc interval was significantly longer in patients receiving combination therapy. QTc prolongation caused early termination in both groups, 5 (4.9%) patients in the monotherapy group and 6 (11.3%) patients in the combination therapy group.

Conclusion: In this study, patients who received hydroxychloroquine for the treatment of COVID-19 were at high risk of QTc prolongation, and concurrent treatment with azithromycin was associated with greater changes in QTc.
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http://dx.doi.org/10.1590/1806-9282.20210380DOI Listing
July 2021

Development of quality of life assessment questionnaire associated with osmophobia in people with migraine.

Pain Med 2021 Oct 21. Epub 2021 Oct 21.

Prof. PhD, RN, Dokuz Eylul University, Faculty of Nursing, Izmir, Turkey.

Background: It is important to implement disease-specific precautions to develop quality of life in migraine. The effect of osmophobia, which is one of the specific symptoms of migraine that might help to differentiate migraine from other headache disorders, on quality of life is unknown. The aim of the present study was to develop a practicable and reliable scale that assesses the effect of osmophobia on quality of life in migraine.

Methods: This cross-sectional study was carried out with 163 patients with migraine and 110 healthy individuals for control group. The scale items were constructed based on after literature review, expert opinions, and preliminary trial stage. A semi-structured interview was conducted with the patients by the Neurologist to evaluate the presence of osmophobia retrospectively. Migraine osmophobia-related quality of life assessment (MORA) consisted of 6 items including personal care, eating or cooking, house cleaning, close relationship, social life and traveling.

Results: The Cronbach's α coefficient was 0.86; and the Guttman split-half coefficient was 0.83. Receiver operating characteristic analysis showed an area under the curve of 0.943 (95%) confidence interval [CI] = 0.902-0.984), a cut off score of > 9.5, a sensitivity of 91.6%, a specificity of 85.7%. Mean scores of the MORA differed between people with migraine (with and without osmophobia) and healthy controls (<0.001).

Conclusion: MORA is a valid and reliable self-report questionnaire that assesses the effect of osmophobia on quality of life in migraine. This questionnaire appears to be practicable diagnostic instrument in clinical practice and research.
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http://dx.doi.org/10.1093/pm/pnab314DOI Listing
October 2021

Prognostic value of D-dimer/fibrinogen ratio on in-hospital outcomes of patients with heart failure and COVID-19.

Biomark Med 2021 Nov 20;15(16):1519-1528. Epub 2021 Oct 20.

Medical Faculty Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey.

In the present study, the relationship between D-dimer/fibrinogen ratio (DFR) and in-hospital outcomes was evaluated in patients with COVID-19 and a diagnosis of heart failure (HF). In-hospital outcomes were compared in patients with high and low DFR values. With regard to in-hospital outcomes, patients in the third tertile of DFR had a higher rate of mechanical ventilation, cardiogenic shock and death (p < 0.001). The length of ICU stay was longer in the third tertile group (p < 0.001). When evaluated together with infection markers, DFR was found to be an independent predictor of outcomes. DFR can be used as a prognostic marker in patients with COVID-19 with a diagnosis of HF, and perhaps more valuable than other infection markers.
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http://dx.doi.org/10.2217/bmm-2021-0341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547277PMC
November 2021

Psychometric properties of a Turkish version of the quality of life in childhood epilepsy questionnaire.

J Pediatr Nurs 2021 Oct 5. Epub 2021 Oct 5.

RN, Dokuz Eylul University Faculty of Health Science, Izmir, Turkey.

Background: Epilepsy is a neurological disease that requires long-term treatment and monitoring and causes significant restrictions in physical, emotional, intellectual, and social life that negatively affect the quality of life of the individual. This study aimed to test the validity and reliability of the Quality of Life in Childhood Epilepsy Questionnaire in Turkey.

Methods: The study was conducted on 421 parents using a descriptive correlational method. The data of the study were collected using a Descriptive Information Form and the Quality of Life in Childhood Epilepsy Questionnaire. Data analysis and evaluation were performed using factor analysis, Cronbach's alpha, and item-total score correlation.

Findings: The scale consists of 16 items and four sub-dimensions. The four sub-dimensions recorded a variance of 87.83%. Cronbach's alpha coefficient of the Turkish version of the scale was 0.96. The two-month test-retest reliability evaluated with intra-class correlation was 0.85. Confirmatory factor analysis indicated, the model fit index results were recorded as follows: 0.93 as the Goodness-of-Fit Index; comparative fit index, 0.98 and non-normed fit index (NNFI), 0.97.

Conclusions: The study determined that the Turkish version of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-16) is a valid and reliable measurement tool when used to measure quality of life for Turkish children with epilepsy.

Practice Implications: It is recommended that the health-related quality of life should be evaluated to assess the treatment of children with epilepsy and to intervene early in potential risk factors associated with the disease management process. All healthcare professionals can use this scale in interventional studies aiming at evaluating or improving the quality of life of children with epilepsy.
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http://dx.doi.org/10.1016/j.pedn.2021.09.009DOI Listing
October 2021

The effect of an obesity prevention program on children's eating behaviors, food addiction, physical activity, and obesity status.

J Pediatr Nurs 2021 Sep 23;61:355-363. Epub 2021 Sep 23.

Dokuz Eylul University Faculty of Nursing, Inciraltı, Izmir, Turkey.

Purpose: This study was carried out to determine the effect of an obesity prevention program on children's eating behaviors, food addiction, physical activity, and obesity prevalence.

Design And Methods: A pretest-posttest quasi-experimental design was used in the study. The study was conducted with a total of 128 students, including 55 in the intervention and 73 in the control groups. The obesity prevention program was implemented in the intervention group, and a routine curriculum training program was followed in the control group. The study data were collected before the intervention and in the third, sixth, and fifteenth months after the completion of the intervention. The data were evaluated using the chi-square test, McNeamer test, Cochrane Q test, multivariate analysis of variance in repeated measures, the Bonferroni adjusted paired t-test, power analysis, effect size, and regression analysis.

Results: At the end of the study, it was determined that the body mass index values and food addiction rates of the students in the intervention group were lower than those of the students in the control group (p < .05). There was a significant difference between the mean scores of the students in the intervention and control groups obtained from the eating behavior questionnaire and the physical activity questionnaire in terms of time, group, and group * time interaction (p < .05). Also, the intervention program was found to have a large effect size (0.39) and a strong effect (0.85) on body mass index.

Conclusion: The obesity prevention intervention program was found to be effective in increasing children's positive eating behaviors and mean physical activity score and decreasing food addiction rates and body mass index values.

Practice Implications: We recommend that the intervention program implemented in this study should be used widely in the curriculum of the Ministry of Education. This program shows that the school nurse is effective in preventing obesity in children. For this reason, there should be a school nurse in schools for implementing health-promoting education programs.
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http://dx.doi.org/10.1016/j.pedn.2021.09.001DOI Listing
September 2021

Psychometric characteristics of the Turkish version of the pain flexibility scale for children with cancer.

J Pediatr Nurs 2021 Sep 21. Epub 2021 Sep 21.

Department of Pediatric Nursing, Bilecik Şeyh Edebali University, Faculty of Health, Bilecik, Turkey. Electronic address:

Purpose: This study was conducted to evaluate the validity and reliability of the Pain Flexibility Scale for children with cancer in Turkey.

Design And Method: This was a methodological-descriptive-correlational study conducted on 211 children with cancer. Data were collected using the information form and Pain Flexibility Scale for children with cancer. The data were evaluated using explanatory and confirmatory factor analysis, Cronbach's alpha, split-half, item-total score correlation, and test-retest analysis.

Results: The explained variance rate of the scale, in which factor analysis confirmed the two-dimensional structure, was 85.31%. The factor loads were greater than 0.30, and all fit indices were greater than 0.90. In addition, RMSEA was less than 0.080 and was significant. The total Cronbach's alpha value of the scale was 0.82, and the Cronbach's alpha values of its sub-dimensions were 0.82 and 0.79.

Conclusions: The Pain Flexibility Scale for children with cancer is a valid and reliable measurement tool for the Turkish sample.

Practice Implications: Pain Flexibility Scale facilitates the development of psychological interventions based on acceptance, which can enable children with cancer to cope more successfully with pain.
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http://dx.doi.org/10.1016/j.pedn.2021.09.011DOI Listing
September 2021

Development of the parental attitude scale-protecting children during COVID-19 and the relationship between parental attitudes and fear of COVID-19.

J Pediatr Nurs 2021 Sep 8. Epub 2021 Sep 8.

Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir 35340, Turkey.

Background: During the COVID-19 pandemic, parents and children have experienced stress and fear, and the attitudes of parents toward COVID-19 need to be explored.

Purpose: This study aimed to develop the Parental Attitude Scale-Protecting Children during COVID-19 (PAS-CV19S) and assess its psychometric properties. This study also aimed to determine the relationship between parental attitudes about COVID-19 and fear of COVID-19.

Design And Methods: In this methodological and correlational study, parents of children ages 6 to 18 years old were included (N = 402). The PAS-CV19S was developed for this study. The study collected data using an online sociodemographic form, a fear of COVID-19 scale, and the PAS-CV19S. The Cronbach alpha coefficient, confirmatory factor analysis, and explanatory factor analysis were used to assess the validity and reliability of PAS-CV19S. Pearson correlation analysis was used to examine the relationship between the fear of COVID-19 scale and the PAS-CV19S.

Results: The PAS-CV19S is a valid and reliable scale consisting of three factors (general health, mental health, and preventive behaviors) as subdimensions. The Cronbach alpha of the PAS-CV19S overall was 0.90; the Cronbach alphas for the general health, mental health, and preventive behaviors subdimensions were 0.78, 0.80, and 0.92, respectively. There was a significant negative correlation between fear of COVID-19 and the mental health subdimension.

Conclusion And Practice Implications: This study sheds light on parental attitudes about protecting their children from COVID-19. The fear of COVID-19 of parents did not affect attitudes other than mental health. Parental concerns and attitudes about COVID-19 need to be discussed to protect children.
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http://dx.doi.org/10.1016/j.pedn.2021.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423811PMC
September 2021

DEVELOPING THE NAUSEA AND VOMITING THERMOMETER SCALE IN CHILDREN WITH CANCER.

Turk J Med Sci 2021 Sep 21. Epub 2021 Sep 21.

Background/aim: This study aimed to develop the Nausea and Vomiting Thermometer Scale (NVTS) in children with cancer.

Materials And Methods: This methodological study was conducted on 250 children with cancer at the research and training university hospital in Turkey between September 2019 and January 2020. The t-test, the ROC analysis, the Diagnostic index, and the Youden index were used for determining the scale of the cutting point. The regression analysis, the intra-class correlation coefficient, and the Bland-Altman analysis were used for the data analysis.

Results: The scale-level content validity index was .94, which was coherent. As a result of the ROC analysis, the cut-off point was determined as three points. The NVTS showed good reliability, with an intra-class correlation coefficient of .99. In the linear regression analysis, a model was created chemotherapy drugs, nausea and vomiting type, vomiting status, and the number of children with cancer who vomited explained 44.9% of their nausea and vomiting status. The results of the Bland-Altman analysis showed that the correlation coefficient between the differences and the means was insignificant.

Conclusions: The NVTS was found to be a valid and reliable measurement tool for children with cancer in the Turkish sample.
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http://dx.doi.org/10.3906/sag-2005-88DOI Listing
September 2021

Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls.

Rheumatol Int 2021 Sep 13. Epub 2021 Sep 13.

Health Science University Turkey, Bakırköy Sadi Konuk Education and Training Hospital, Istanbul, Turkey.

Coronavirus disease-2019 (COVID-19) associated pneumonia may progress into acute respiratory distress syndrome (ARDS). Some patients develop features of macrophage activation syndrome (MAS). Elevated levels of IL-6 were reported to be associated with severe disease, and anti-IL-6R tocilizumab has been shown to be effective in some patients. This retrospective multicenter case-control study aimed to evaluate the efficacy of tocilizumab in hospitalized COVID-19 patients, who received standard of care with or without tocilizumab. Primary outcome was the progression to intubation or death. PSMATCH (SAS) procedure was used to achieve exact propensity score (PS) matching. Data from 1289 patients were collected, and study population was reduced to 1073 based on inclusion-exclusion criteria. The composite outcome was observed more frequently in tocilizumab-users, but there was a significant imbalance between arms in all critical parameters. Primary analyses were carried out in 348 patients (174 in each arm) after exact PS matching according to gender, ferritin, and procalcitonin. Logistic regression models revealed that tocilizumab significantly reduced the intubation or death (OR 0.40, p = 0.0017). When intubation is considered alone, tocilizumab-users had > 60% reduction in odds of intubation. Multiple imputation approach, which increased the size of the matched patients up to 506, provided no significant difference between arms despite a similar trend for intubation alone group. Analysis of this retrospective cohort showed more frequent intubation or death in tocilizumab-users, but PS-matched analyses revealed significant results for supporting tocilizumab use overall in a subset of patients matched according to gender, ferritin and procalcitonin levels.
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http://dx.doi.org/10.1007/s00296-021-04965-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436189PMC
September 2021

Gender differences in clinical characteristics and in-hospital and one-year outcomes of young patients with ST-segment elevation myocardial infarction under the age of 40.

J Cardiovasc Thorac Res 2021 8;13(2):116-124. Epub 2021 Feb 8.

Eskisehir Osmangazi University, Medical Faculty Department of Cardiology, Eskisehir, Turkey.

Although the incidence of acute ST-segment elevation myocardial infarction (STEMI) in the elderly population has decreased in recent years, this is not the case for young people. At the same time, no reduction in hospitalization rate after STEMI was shown in young people. Clinical characteristics, risk factors, angiographic findings, in-hospital and one-year outcomes of patients under the age of 40 and their gender differences were investigated. This study has been performed retrospectively in two centers. Between January 2015 and April 2019, 212 patients aged 18-40 years with STEMI and who underwent reperfusion therapy were included. The gender differences were compared. The median age of (male 176; 83.0% and female 36; 17.0%) patients included in the study was 36 (33-38) for men and 36 (34-38) for women. Chest pain was the most common complaint for both genders (96.0% vs. 94.4%; = 0.651). While men presented more often with Killip class 1,women presented more often with Killip class 2. The anterior myocardial infarction (MI) was the most common MI type and it was higher in women than in man ( = 0.027). At one year of follow-up, the prevalence of all-cause hospitalization was 24%, MI 3.8%, coronary angiography 15.1%, cardiovascular death 1.4%, and all-cause death 0.47%, there was no gender difference. Anterior MI was the most common type of MI and it was more common in women than in men. Left anterior descending artery was the most common involved coronary artery. The most common risk factor is smoking. In terms of in-hospital outcome, left ventricular ejection fraction was significantly lower in women. There was no significant difference in one-year outcomes between both genders.
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http://dx.doi.org/10.34172/jcvtr.2021.17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302902PMC
February 2021

Developing and Evaluating the Psychometric Properties of the Pediatric Nursing Competency Scale for Nursing Students.

Florence Nightingale J Nurs 2020 Jun 3;28(2):133-142. Epub 2020 Jul 3.

Department of Pediatric Nursing, Dokuz Eylül University Faculty of Nursing, İzmir, Turkey.

Aim: This study aims to develop and evaluate the psychometric properties of the Pediatric Nursing Competency Scale for nursing students.

Methods: This study was conducted with 318 nursing students, including third-year students enrolled in a pediatric nursing course and fourth-year students completing a pediatric nursing internship. Factor analysis, Cronbach's alpha, item-total score analysis, and known-groups comparison were used to assess the research data. In total, 16 items were eliminated from the scale on the basis of experts' recommendations.

Results: The scale consisted of 39 items and 8 sub-scales. The 8 sub-scales exhibited 66.4% of the total variance. Both exploratory factor analysis and confirmatory factor analysis (CFA) revealed that all factor loads were greater than 0.40. The CFA also revealed that all of the fit indices were greater than 0.85, and the root mean square error of approximation was less than 0.08. Cronbach's alpha was 0.96 for the entire scale, and greater than 0.80 for all sub-scales.

Conclusion: The Pediatric Nursing Competency Scale for nursing students was found to be valid and reliable.
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http://dx.doi.org/10.5152/FNJN.2020.19065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152165PMC
June 2020

Clinical characteristics and in-hospital outcomes of COVID-19 patients with history of heart failure: a propensity score-matched study.

Acta Cardiol 2021 Jul 5:1-8. Epub 2021 Jul 5.

Medical Faculty Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey.

Background: Data on the clinical course and outcomes of COVID-19 disease among patients with a history of heart failure (HF) are scarce. Therefore, the aim of this study was to assess the clinical characteristics, prognostic biomarkers and in-hospital outcomes of patients with a history of HF hospitalised with confirmed COVID-19.

Methods: A total of 8321 consecutive patients hospitalised with suspected COVID-19 disease were screened. Furthermore, 3849 patients with laboratory-confirmed SARS-CoV-2 infection were included in the study. Two hundred and forty COVID-19 patients with a history of HF and 240 without HF paired with PSM were evaluated.

Results: Mean age was 72.7 ± 9.90 years, and 64.6% were men. Oxygen saturation, systolic and diastolic blood pressure at admission were significantly lower and heart rate was significantly higher in patients with a history of HF compared to those without. Patients with HF, compared to those without, had significantly higher leukocyte count, D-dimer, CRP, procalcitonin, hsTnI, lactate and lower albumin and lymphocyte. Compared with patients without HF, those with previous HF had a longer length of stay at ICU (6.22 d vs. 3.71 d;  < 0.001), increased risk of mechanical ventilation (42.1% vs. 15.4%;  < 0.001), in-hospital death (39.2% vs. 15.4%;  < 0.001) and composite outcomes (52.9% vs. 17.1%;  < 0.001).

Conclusion: History of HF is associated with a higher risk of mechanical ventilation, cardiogenic shock, mortality and longer ICU stay in patients hospitalised for COVID-19, therefore the diagnosis of HF alone is important for predicting clinical outcomes.
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http://dx.doi.org/10.1080/00015385.2021.1945765DOI Listing
July 2021

Impact of COVID-19 outbreak on patients with ST-segment elevation myocardial ınfarction (STEMI) in Turkey: results from TURSER study (TURKISH St-segment elevation myocardial ınfarction registry).

J Thromb Thrombolysis 2021 May 29. Epub 2021 May 29.

Department of Cardiology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey.

Objective: We aimed to investigate both the impact of COVID-19 pandemic on ST-segment elevation myocardial infarction (STEMI) admission, and demographic, angiographic, procedural characteristics, and in-hospital clinical outcomes of patients with COVID-19 positive STEMI in Turkey.

Methods: This was a multi-center and cross-sectional observational study. The study population included 1788 STEMI patients from 15 centers in Turkey. The patients were divided into two groups: COVID-19 era (March 11st-May 15st, 2020; n = 733) or pre- COVID-19 era group (March 11st-May 15st, 2019; n = 1055). Also, the patients in COVID-19 era were grouped as COVID-19 positive (n = 65) or negative (n = 668).

Results: There was a 30.5% drop in STEMI admission during COVID-19 era in comparison to pre-COVID-19 era. The patients admitted to the medical centers during COVID-19 era had a longer symptom-to-first medical contact time [120 (75-240) vs. 100 (60-180) minutes, p < 0.001]. COVID-19 positive STEMI patients had higher thrombus grade and lower left ventricular ejection fraction compared to COVID-19 negative patients. COVID-19 positive patients had higher mortality (28% vs. 6%, p < 0.001) and cardiogenic shock (20% vs. 7%, p < 0.001) rates compared with those without COVID-19. Matching based on propensity scores showed higher mortality and high thrombus grade in STEMI patients who were infected by SARS-COV-2 (each p < 0.05).

Conclusions: We detected significantly lower STEMI hospitalization rates and significant delay in duration of symptom onset to first medical contact in the context of Turkey during the COVID-19 outbreak. Moreover, high thrombus grade and mortality were more common in COVID-19 positive STEMI patients.
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http://dx.doi.org/10.1007/s11239-021-02487-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164077PMC
May 2021

Effects of parental attitude and proactive and reactive aggression on cyberbullying and victimization among secondary school students.

Perspect Psychiatr Care 2021 May 18. Epub 2021 May 18.

Department of Pediatric Nursing, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.

Purpose: To predict the effect of parental attitude and proactive and reactive aggression on the cyberbully, cyber victims, and cyberbully/victim among students aged 9-14 years.

Methods: This study is a cross-sectional, correlational, and predictive study. The sample included 360 students. Data were collected with the "Adolescence Information Form," "Parental Attitude Scale," "Proactive-Reactive Aggression Scale," and "Cyberbully/Victim Questionnaire." Logistic regression analysis was used.

Findings: This study was determined that proactive-reactive aggression and parental attitude predicted 30.3% of cyberbully/victim cases. Proactive aggression and Internet usage time are essential predictors of cyberbullying cases.

Practice Implications: To protect and improve their children's health, children should be informed about cyberbullying, proactive-reactive aggression, and the duration of Internet use.
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http://dx.doi.org/10.1111/ppc.12856DOI Listing
May 2021

The effects of self-efficacy and locus of control on cyberbully/victim status in adolescents.

J Pediatr Nurs 2021 Apr 20. Epub 2021 Apr 20.

Dokuz Eylul University Faculty of Nursing, Department of Pediatric Nursing, Turkey. Electronic address:

Purpose: This study adopted a descriptive and correlational investigation of the effect of self-efficacy and locus of control on becoming a cyberbully and victim in adolescents.

Design And Methods: Data were collected through the Socio-Demographic Data Collection Form, Middle School Self-Efficacy Scale, Internal-External Locus of Control Scale, and Cyberbully/Victim Scale. Whether self-efficacy and locus of control levels predicted becoming a cyberbully and victim was analyzed through multiple linear regression analysis.

Results: This study found that the sub-dimensions of self-efficacy and locus of control scales significantly predicted cyberbully and victim becoming. Self-efficacy and locus of control explained 16.8% and 12.8% of the variance in becoming a cyberbully, respectively. The sub-dimension of protective healthcare and family relationships significantly predicted the becoming of both a cyberbully and a cyber victim. Furthermore, it predicted that peer relationships and interpersonal predicted cyberbully status (p < 0.05).

Conclusions: This study found that self-efficacy and locus of control significantly affected the becoming of a cyberbully and victim.

Practice Implications: Interventional studies involving self-efficacy and locus of control to prevent cyberbullying are recommended.
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http://dx.doi.org/10.1016/j.pedn.2021.04.004DOI Listing
April 2021

A single center survey study of systemic vasculitis and COVID-19 during the first months of pandemic

Turk J Med Sci 2021 10 21;51(5):2243-2247. Epub 2021 Oct 21.

Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, İstanbul University, İstanbul, Turkey

Introduction: COVID-19 pandemic created concerns among patients receiving immunosuppressive therapy. Frequency of COVID-19 and impact of lockdown on treatment compliance in patients with vasculitis are largely unknown.

Patients And Method: Patients with ANCA-associated and large vessel vasculitis that have been followed-up in our clinic were contacted by phone and a questionnaire containing home isolation status, treatment adherence and history of COVID -19 between March 1st and June 30th, 2020 was applied.

Results: The survey was applied to 103 patients (F/M: 59/44, mean age: 53.2±12.5). Thirty-three (32%) patients didn?t attend at least one appointment; 98(95.1%) noted that they spent 3 months in home isolation. Five patients (4.8%) received immunosuppressives irregularly and 3(2.9%) developed symptoms due to undertreatment. Four (3.9%) patients admitted to hospital with a suspicion of COVID-19, but none of them had positive PCR or suggestive findings by imaging. COVID-19 diagnosed in a patient with granulomatosis with polyangiitis during hospitalization for disease flare and she died despite treatment.

Discussion: Frequency of COVID-19 was low in patients with vasculitis in our single center cohort. Although outpatient appointments were postponed in one-third of our patients, high compliance with treatment and isolation rules ensured patients with vasculitis overcome this period with minimal morbidity and mortality.
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http://dx.doi.org/10.3906/sag-2010-267DOI Listing
October 2021

Attitudes of three generations of women toward gender roles.

Perspect Psychiatr Care 2021 Oct 26;57(4):1974-1980. Epub 2021 Mar 26.

Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey.

Purpose: This study was conducted to investigate the attitudes of three generations of women regarding gender roles.

Designs And Methods: In this study, 58 female students, their mothers, and grandmothers participated. Percentages and means, χ test, Kruskal Wallis test, and multiple regression analysis were used to analyze the data.

Findings: The findings obtained in this study showed that 91.5% of the students, 89.8% of the mothers, and 84.6% of the grandmothers had an egalitarian attitude regarding gender roles. The egalitarian attitudes of students were affected onefold by the attitudes of mothers, whereas grandmothers' attitudes affected the attitudes of students 1.1 times. These two variables explain 48% of the status of having egalitarian attitudes of the students.

Practical Implications: Students had more traditional attitudes regarding gender roles than their mothers and grandmothers.
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http://dx.doi.org/10.1111/ppc.12776DOI Listing
October 2021

Comments on efficacy and safety of non-vitamin K antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and diabetes mellitus.

Acta Cardiol 2021 Feb 26. Epub 2021 Feb 26.

Medical Faculty, Department of Cardiology, Eskisehir Osmangazi University, Eskisehir, Turkey.

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http://dx.doi.org/10.1080/00015385.2021.1883905DOI Listing
February 2021

Comments on development and validation of home delivery for ambulatory ECG monitoring.

J Electrocardiol 2021 Mar-Apr;65:121. Epub 2021 Feb 8.

Eskisehir Osmangazi University, Medical Faculty Department of Cardiology, Eskisehir 26070, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.jelectrocard.2021.01.014DOI Listing
July 2021

Predicting the Healthy Lifestyle Behaviors of Turkish Adolescents Based on their Health Literacy and Self-Efficacy Levels.

J Pediatr Nurs 2021 Jul-Aug;59:e20-e25. Epub 2021 Feb 12.

Dokuz Eylul University, Faculty of Nursing, Inciraltı, Izmir, Turkey.

Purpose: The effects of Turkish adolescents' self-efficacy and health literacy on their health behaviors are examined in this study.

Design And Method: This study employed a descriptive cross-sectional design with a sample population of 440 adolescents between the ages of 13 and 18 years old. The data were collected using a demographic data form and analyzed according to the Self-Efficacy Scale for Children, the Health Literacy Scale, and the Adolescent Lifestyle Profile.

Results: The regression analysis found that the self-efficacy and health literacy levels of adolescents predicted their healthy lifestyle behaviors (F = 141.813, p = 0.000). The self-efficacy and health literacy levels explained 41.9% of the healthy lifestyle behaviors of the subjects, with regression coefficients for self-efficacy and health literacy of 0.545 and 0.185, respectively. Self-efficacy among adolescents significantly predicted all the sub-dimensions of healthy lifestyle behaviors, such as health responsibility, physical activity, nutrition, positive life view, interpersonal relations, stress management, and spiritual health. Similarly, the health literacy levels predicted all the sub-dimensions except for physical activity and stress management.

Conclusions: In this study, the adolescents' self-efficacy levels and their health literacy levels significantly explained their health behaviors. This finding suggests that increasing the self-efficacy and health literacy levels of adolescents should be increased to develop positive health behaviors among today's youth.

Practice Implications: Nurses should identify strategies to increase self-efficacy and health literacy among adolescents to protect and improve adolescent health behavior.
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http://dx.doi.org/10.1016/j.pedn.2021.01.016DOI Listing
July 2021

A shared motif of hla-dpb1 affecting the susceptibility to pr3-anca positive granulomatosis with polyangiitis: comparative analysis of a Turkish cohort with matched healthy controls.

Rheumatol Int 2021 Sep 5;41(9):1667-1672. Epub 2021 Feb 5.

Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Topkapı, Turgut Özal Millet Cd, Fatih, 34093, Istanbul, Turkey.

We aimed to analyse the distribution of HLA Class 2 genotypes which were reported among the genetic risk factors for ANCA-associated vasculitis (AAV) among Turkish patients in comparison with healthy subjects and previously reported data of AAV cohorts. Ninety-eight patients (F/M: 47/51 and mean age: 49 ± 1.14) were enrolled in the study and records of gender and birthplace-matched 196 healthy kidney donors were used as the control group. Patients were classified according to the clinical subgroups and ANCA serotypes (MPO-AAV, PR3-AAV). DNA was isolated from venous blood from all patients, and high-resolution HLA Class 2 genotyping was carried out by using NGS-Omixon Holotype HLA Kit. The frequencies of HLA-DQB1*03:03, - *06:04, and -DPB1*13:01, -*16:01 and -*66:01:00 alleles were significantly higher, and the frequencies of HLA-DQB1*02:02, -DPB1*02:01 and -*04:01 alleles were lower in the PR3-AAV subgroup (n = 53) compared to the controls. Comparison of amino acid sequences of the associated HLA-DPB1 alleles revealed the sequence of D-E-A-V in risk alleles replaced with the G-G-P-M sequence in protective alleles between 84 and 87th positions. Structural analysis of the HLA-DPB1*02:01 showed that this shared position is in the contact area between HLA-DP α and β chains and within pocket 1 of the antigen-binding groove. First HLA genotyping analysis in Turkish AAV patients revealed a negative correlation between PR3-ANCA positivity and certain HLA-DPB1 alleles contradictory to the results reported from European cohorts. Known functional effects of D-E-A-V sequence on HLA-DPB1 support the importance of our finding, but further studies are needed to reveal its pathogenic mechanisms.
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http://dx.doi.org/10.1007/s00296-021-04789-4DOI Listing
September 2021

The effect of virtual reality on pain, fear, and anxiety during access of a port with huber needle in pediatric hematology-oncology patients: Randomized controlled trial.

Eur J Oncol Nurs 2021 Feb 1;50:101886. Epub 2020 Dec 1.

Dokuz Eylül University Hospital, Department of Paediatric Oncology, Izmir, Turkey. Electronic address:

Purpose: Port needle insertions are painful and distressing for Pediatric Hematology-Oncology patients. Virtual Reality (VR) can be used during needle-related procedures in these patients. This study aimed to investigate the effect of VR distraction during access to the venous port with a Huber needle in reducing needle-related pain, fear, and anxiety of children and adolescents with cancer.

Methods: This randomized controlled study used a parallel trial design guided by the CONSORT checklist. The sample of children (n = 42) was allocated to the VR group (n = 21) and the control group (n = 21). Port needle-related pain was assessed using the Wong-Baker Faces Pain Rating Scale after the procedure. Before and after the port needle insertion procedure, anxiety and fear assessed using self- and parent-report using the Children's Anxiety Meter and Child Fear Scale. The primary outcome was the patient-reported pain scores after the procedure and fear and anxiety scores before and after the procedure. Pain, anxiety, and fear scores of the two groups and within groups were analyzed and also Spearman correlation analysis was used.

Results: Self-reported pain scores of patients in the VR and control group were 2.4 ± 1.8 and 5.3 ± 1.8, respectively. This study found a statistically significant difference between groups in pain scores (p < .001). A statistically significant difference was found between groups according to the self- and parent-reported fear and anxiety scores after the procedure. Self-reported fear scores in the VR and control group were 0.8 ± 0.9, 2.0 ± 1.0, self-reported anxiety scores were 2.9 ± 2.0, 5.4 ± 2.0, respectively (p < .001).

Conclusion: Virtual reality is an effective distraction method in reducing port needle-related pain, fear, and anxiety in Pediatric Hematology-Oncology patients. ClinicalTrials.gov NCT04093154.
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http://dx.doi.org/10.1016/j.ejon.2020.101886DOI Listing
February 2021

Factors affecting knowledge levels of oncology nurses about skin cancer and sun protection.

Eur J Cancer Care (Engl) 2020 Nov 3;29(6):e13310. Epub 2020 Sep 3.

Faculty of Nursing, Dokuz Eylul University, İzmir, Turkey.

Objective: This is a descriptive, cross-sectional and observational study that determines the factors affecting the knowledge levels of oncology nurses for skin cancer and sun protection.

Materials & Methods: This study was performed on the members of the Turkish Oncology Nursing Association and oncology nurses working in hospitals in Turkey between November 2019 and March 2020. Data were collected by using the Nurse Information Form and Skin Cancer and Sun Knowledge (SCSK) scale. For data analysis, average and percentage calculations and multiple linear regression analyses were used. The significance level was set at p < .05.

Results: We found those female nurses who were above 40 years of age and having darker skin tone due to excessive sun exposure, with a family history of skin cancer, and educated on skin cancer, performed better on the SCSK scale. We found a statistically significant difference between the mean scores of skin cancer and sun exposure. Using multiple regression analysis, a model was created based on the relationship between variables. In this model, the personality traits of oncology nurses are responsible for higher (91.1%) knowledge levels on skin cancer and sun exposure.

Conclusion: In conclusion, it is important to consider factors that will influence an individual's behaviour while developing skin cancer and sun protection programmes.
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http://dx.doi.org/10.1111/ecc.13310DOI Listing
November 2020

The predict of metacognitive awareness of nursing students on self-confidence and anxiety in clinical decision-making.

Perspect Psychiatr Care 2021 Apr 25;57(2):747-752. Epub 2020 Aug 25.

Department of Pediatric Nursing, Faculty of Nursing, Dokuz Eylul University, İzmir, Turkey.

Purpose: This study was conducted to investigate the affect that metacognitive awareness in nursing students has on self-confidence and anxiety with respect to clinical decision-making.

Design And Methods: The sample for this descriptive, correlational, and cross-sectional study consisted of 186 nursing students who voluntarily participated. Data were collected using the Metacognitive Awareness Inventory and Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale. Correlation and regression analyses were then performed on the data.

Findings: Nursing students' metacognitive awareness level explained the three subdimensions of self-confidence in clinical decision-making by 26.7% (r  = 0.267, p < 0.01), 24.6% (r  = 0.246, p < 0.01), and 26.8% (r  = 0.268, p < 0.01), respectively. Nursing students' metacognitive awareness level explained the three subdimensions of anxiety in clinical decision-making by 3.7% (r  = 0.037, p < 0.01), 3.2% (r  = 0.03, p < 0.05), and 2.4% (r  = 0.024, p < 0.05), respectively.

Implications For Nursing Practice: Clinical decision-making skills can be supported by increasing students' metacognitive awareness.
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http://dx.doi.org/10.1111/ppc.12609DOI Listing
April 2021

Effects of Relaxation-Focused Nursing Care in Women in Preterm Labor.

Biol Res Nurs 2021 04 17;23(2):160-170. Epub 2020 Jul 17.

Nursing Faculty, 37508Dokuz Eylul University, Izmir, Turkey.

Background: Threatened preterm labor is a common problem that causes women to be hospitalized. During this period, physical problems such as a decrease in muscle functions, edema and pain, and psychological problems such as anxiety and stress may develop.

Objective: This study aimed to investigate the effect of relaxation-focused nursing care state anxiety, cortisol, contraction severity, nursing care satisfaction, knowledge, and birth weeks on threatened preterm labor.

Method: This study was a pre-post single-blind randomized controlled trial. The study was conducted with 66 women in the threatened preterm labor process, 33 in the intervention group and 33 in the control group. The intervention group received relaxation-focused nursing care, which comprises a 2-day program in four stages. The data were collected before and after the relaxation-focused nursing care, and after the birth.

Results: In the intervention group, state anxiety, cortisol level, and contraction severity were lower than those in the control group ( < .05). The knowledge level about threatened preterm labor, satisfaction from nursing care, and birth weeks were higher in the intervention group ( < .05).

Conclusion: Relaxation-focused nursing care was found to reduce the state anxiety in women, improve the knowledge level about threatened preterm labor and birth weeks, and decrease the level of cortisol. Therefore, it is recommended to use relaxation-focused nursing care in threatened preterm labor.
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http://dx.doi.org/10.1177/1099800420941253DOI Listing
April 2021

Psychometric properties of the Turkish version of the Child Three-Factor Eating Questionnaire for primary and secondary school students.

Public Health Nutr 2021 02 16;24(3):427-435. Epub 2020 Jul 16.

Division of Psychology, Faculty of Social Sciences, University of Bradford, BradfordBD7 1DP, West Yorkshire, UK.

Objective: This study aims to evaluate the validity and reliability of the Turkish version of the Child Three-Factor Eating Questionnaire for primary and secondary school students.

Design: A methodological, descriptive and correlational study design was adopted.

Setting: The study was conducted in the western and central regions of Turkey.

Participants: This methodological-descriptive-correlational study was conducted with 351 children between July 2018 and August 2018. The mean age of children is 10·74 ± 1·79 (8-14).

Results: The scale consists of seventeen items and three sub-dimensions (restraint, uncontrolled eating and emotional eating), which explained 52·88 % of the total variance. All the factor loadings were >0·40 in both exploratory factor analysis and confirmatory factor analysis (CFA). In CFA, all of the fit indices were >0·85, and root mean square error of approximation was <0·08. For the whole of the scale, Cronbach's α was 0·81 and it was found that Cronbach's α values of all sub-dimensions were >0·70.

Conclusions: The results of the study show that the Child Three-Factor Eating Questionnaire for primary and secondary school students is a valid and reliable measurement tool for Turkish sampling.
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http://dx.doi.org/10.1017/S1368980020001767DOI Listing
February 2021

Validation of the adjusted global antiphospholipid syndrome score in a single centre cohort of APS patients from Turkey.

J Thromb Thrombolysis 2021 Feb;51(2):466-474

Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey.

The adjusted global antiphospholipid syndrome score (aGAPSS) is a recently developed thrombotic risk assessment score that considers the antiphospholipid antibody (aPL) profile and conventional cardiovascular risk factors. In this retrospective study, we aimed to evaluate the validity of the aGAPSS in predicting clinical manifestations (criteria and extra-criteria) of antiphospholipid syndrome (APS) in a single centre cohort of patients. Ninety-eight patients with APS ± systemic lupus erythematosus (SLE) were classified according to clinical manifestations as vascular thrombosis (VT), pregnancy morbidity (PM) or both (VT + PM). The aGAPSS was calculated for each patient as previously defined. Mean aGAPSS of the cohort was calculated as 10.2 ± 3.8. Significantly higher aGAPSS values were seen in VT (n = 58) and VT + PM (n = 29) groups when compared to PM (n = 11) group (10.6 ± 3.7 vs 7.4 ± 2.9, P = 0.005; 10.7 ± 4 vs 7.4 ± 2.9, P = 0.008, respectively), mainly due to lower frequencies of cardiovascular risk factors in PM. Higher aGAPPS values were also associated with recurrent thrombosis (11.6 ± 3.7 vs 9.9 ± 3.6, P = 0.04). Regarding extra-criteria manifestations, patients with livedo reticularis (n = 11) and APS nephropathy (n = 9) had significantly higher aGAPSS values (12.9 ± 3.4 vs 9.9 ± 3.7, P = 0.02; 12.4 ± 2.9 vs 10 ± 3.8, P = 0.04, respectively). The computed AUC demonstrated that aGAPSS values ≥10 had the best diagnostic accuracy for thrombosis. Our results suggest that patients with higher aGAPSS values are at higher risk for developing vascular thrombosis (either first event or recurrence) and extra-criteria manifestations, especially livedo reticularis and APS nephropathy.
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http://dx.doi.org/10.1007/s11239-020-02195-4DOI Listing
February 2021

Effects of learned resourcefulness, work-life quality, and burnout on pediatric nurses' intention to leave job.

Perspect Psychiatr Care 2021 Jan 17;57(1):263-271. Epub 2020 Jun 17.

Faculty of Nursing, Dokuz Eylul University, Inciraltı, Izmir, Turkey.

Aim: This study was conducted to determine the effects of learned resourcefulness, work-life quality, and burnout level on the pediatric nurses' intention to leave work.

Design And Method: The study was conducted with 268 nurses. Data were evaluated by Pearson correlation and multiple regression analysis.

Findings: In this study, 40.7% of nurses showed the intention to leave their jobs. Work-life quality, burnout level, and learned resourcefulness explained intention to leave the job in the rate, respectively, of 21.5%, 27.6%, and 12.1%. These three factors indicate that intention to leave the job is 41%.

Practice Implication: Nurse managers can reduce nurses' intention to leave the job by providing safe, comfortable, accessible, appropriate working conditions, increasing the learned resourcefulness level, and supporting nurses.
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http://dx.doi.org/10.1111/ppc.12557DOI Listing
January 2021
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