This research aims to examine the roles of students diagnosed with attention deficit hyperactivity disorder (ADHD) who perform above their peers in Turkish language skills in the peer-supported teaching process. The research was carried out in four private education institutions operating in the Turkish Republic of Northern Cyprus. A total of 20 peer instructors from each school, including 5 students who showed high performance in Turkish language skills and were clinically diagnosed with ADHD, participated in the study. Each peer instructor guided 5 students who needed support in Turkish reading, vocabulary, and reading comprehension; thus, a total of 80 students constituted the research application group. Peer tutors participated in structured Turkish instruction activities held two days a week for eight weeks. Reading fluency, vocabulary teaching, text comprehension studies and interactive language activities were used in the teaching process. A mixed-method design was adopted in the research. The findings revealed that students who received peer support showed significant improvement in Turkish reading accuracy, vocabulary and reading comprehension scores. Effect sizes were recalculated using the corrected formula (Cohen's d = M_diff / SD_pooled), yielding medium-to-large effects (d = 0.65-0.82) consistent with educational intervention norms. In addition, significant progress was observed in the communication skills, leadership characteristics, self-efficacy perceptions and social interaction levels of students with ADHD who took on the role of instructors. In conclusion, the research reveals that peer-assisted Turkish teaching models that leverage the strengths of students with ADHD are an effective and inclusive educational approach that supports both academic success and social-emotional development.
Stigma is a major psychosocial problem for women with breast cancer during both treatment and survivorship. Assessing stigma is critical for developing supportive care strategies. This study aims to adapt the "Breast Cancer Stigma Assessment Scale (BCSAS)" into Turkish and to evaluate its psychometric properties. This methodological study included 352 women with breast cancer and its survivors. Translation and adaptation, content, construct, validity, and reliability of the "BCSAS" were examined. In the Exploratory Factor Analysis, the factor structure of the original scale, which consists of 7 factors and 28 items, was composed of 6 factors and 23 items in the Turkish version of BCSAS. The variance explained by these six factors was 64.371%. CFA confirmed the six-factor model determined in EFA with acceptable fit indices and factor loadings. The adapted Turkish version of the BCSAS was found to be a valid and reliable measurement tool for the Turkish population.
Dental aesthetics plays a key role in children's social perception and psychosocial development. However, evidence on smile perception in children remains limited, highlighting the need for valid and reliable assessment tools. This study aimed to perform the cross-cultural adaptation and psychometric validation of the Smile Perception Questionnaire for Children Aged 8-10 Years (SPQ 8-10) for use in Turkish children. This observational methodological validity-reliability study included 300 healthy children aged 8-10 years who attended the Department of Pediatric Dentistry at Bursa Uludag University and met the predefined eligibility criteria. Eligible participants were healthy children aged 8-10 years whose parents provided informed consent; children with previous or ongoing orthodontic treatment, systemic diseases, or mental, physical, hearing, or visual impairments affecting communication or questionnaire completion were excluded. The SPQ (8-10) was translated into Turkish using forward-backward translation and expert review. Standardized perioral smile images were digitally generated to represent different dental conditions, and each participant evaluated one randomly assigned image using a five-point Likert scale. Exploratory factor analysis (principal axis factoring) and confirmatory factor analysis (DWLS estimation) were conducted to assess construct validity. Internal consistency (Cronbach's α, McDonald's ω) and test-retest reliability (ICC) were evaluated. Cronbach's α coefficient for the scale was 0.844, while McDonald's ω coefficient was 0.847. The analysis yielded ICC (3,1) = 0.803, 95% CI [0.628, 0.901], indicating that the scale had good temporal stability. CFI and TLI values above 0.95 and an SRMR value below 0.06 suggest a good fit. RMSEA value was at the threshold (0.084). The final 10-item Turkish version of the SPQ (8-10) demonstrates adequate psychometric properties in terms of factorial structure, internal consistency, and temporal stability.
Delirium is a common and serious complication in intensive care units (ICUs) and is associated with adverse patient outcomes. World Delirium Awareness Day (WDAD), observed annually on the second Wednesday of March, provides a platform for international point prevalence studies to evaluate delirium burden and care practices across healthcare systems. Although WDAD studies have been conducted in numerous countries worldwide, no data from Turkiye have been reported to date. To determine the point prevalence of delirium and examine current delirium assessment practices, management strategies and barriers to evidence-based care in Turkish intensive care units on WDAD 2026. A cross-sectional point prevalence study was conducted on 11 March 2026, using the standardised WDAD survey. Delirium prevalence was assessed at 8:00 a.m. and 8:00 p.m. Representatives from 66 ICUs (52 adult and 14 paediatric) across seven geographical regions of Turkiye participated in the study. Among patients assessed for delirium, 30.8% tested positive at 8:00 a.m. (adult ICU: 32.2%; PICU: 25.0%) and 30.2% at 8:00 p.m. (adult ICU: 31.9%; PICU: 23.0%). The majority of units (87.9%) relied on clinical judgement for delirium assessment rather than validated screening tools. Written delirium protocols were present in only 30.3% of units. Dexmedetomidine was the most commonly used pharmacological agent (54.5%). Mobilisation was implemented in less than half of the units (43.9%). The most frequently reported barriers were missing knowledge (69.7%), attitude that delirium is not considered important (57.6%) and lack of awareness (50.0%). Routine use of validated delirium assessment tools, enhanced staff education and standardised protocol implementation are needed to improve delirium recognition and management in Turkish critical care settings. These findings provide the first insights into delirium care practices in Turkish ICUs, highlighting the urgent need for structured education programmes, validated screening tools and national delirium care guidelines.
The aim of this study was to evaluate the validity and reliability of the Turkish version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-ELD14 in older patients with cancer. One hundred thirteen older patients with cancer were included in the study. The validity and reliability of the EORTC QLQ-ELD14 were evaluated via exploratory and confirmatory factor analyses, correlation analyses with the EORTC QLQ-C30, known-group comparisons, Cronbach's alpha, test-retest and the intraclass correlation coefficient. Known-group comparisons were evaluated in patient groups divided according to cancer stage, Karnofsky performance status and Charlson Comorbidity Index. Factor analysis results demonstrated that the Turkish EORTC QLQ-ELD14, with its seven-factor structure, is a sufficient measurement instrument. Moderate to high correlations were observed between the EORTC QLQ-ELD14 and the QLQ-C30 (r = -0.40 to -0.83; p < 0.05). The clinical validity of the EORTC QLQ-ELD14 has been demonstrated by its ability to discriminate between different clinical profiles. Cronbach's α coefficient was determined to be 0.719. The intraclass correlation coefficients of all subscales were above 0.80. Excellent agreement was observed in test-retest reliability. The Turkish version of EORTC QLQ-ELD14 is valid and reliable and is suitable for use by researchers and clinicians.
Emotional blunting is a clinically significant yet often under-recognized alteration in emotional experience, characterized by reduced intensity of both positive and negative emotions, diminished emotional responsiveness, and impaired interpersonal engagement. First described through patients' reports of antidepressant treatment, it is now recognized as associated with both depressive illness and pharmacological treatment, underscoring the need for its direct assessment. However, no validated Turkish-language instrument specifically designed to assess emotional blunting is currently available. The present study aimed to evaluate the psychometric properties of the Turkish version of the Oxford Depression Questionnaire (ODQ) in 272 participants comprising healthy controls, drug-naïve patients with major depressive disorder (MDD), and medicated patients with MDD in remission. Confirmatory factor analysis using WLSMV estimation broadly supported the proposed four-factor structure, although fit indices were not uniform. The correlated four-factor model provided a better fit than alternative one-factor, two-factor, and second-order models, although the second-order model showed only a modest decrement in fit. The scale demonstrated acceptable to high internal consistency across dimensions, and measurement invariance analyses supported loading invariance across the three groups. ODQ scores differed significantly between groups and showed the expected associations with depressive symptom severity and with emotional reactivity and empathy, which were themselves largely independent. These findings provide evidence for the reliability and validity of the Turkish ODQ and support its use for assessing emotional blunting across healthy, untreated, and remitted medicated populations, while indicating that further evaluation of specific items is warranted in future validation studies.
Background and Purpose: Artificial intelligence (AI) is increasingly used in nursing education and clinical practice. Fear of AI among nursing students may limit the effective use of these technologies. This study aimed to adapt the Fear towards Artificial Intelligence Scale (FtAIS) into Turkish and to evaluate its validity and reliability. Methods: This study was conducted with 294 nursing students. Data were collected using the FtAIS and the Artificial Intelligence Anxiety Scale. Confirmatory factor analysis was performed to examine the scale's construct validity. Reliability was assessed through coefficient alpha, test-retest, and split-half analyses. Results: The original scale consisted of 10 items and retained its two-factor structure in the Turkish adaptation, demonstrating acceptable content and construct validity and good internal consistency (coefficient alpha = .856). Conclusions: The Turkish version of the FtAIS is a valid and reliable instrument for assessing fear of AI among nursing students.
The scarcity of locally developed assessment tools for understudied languages remains a significant issue in research on language disorders. This study aimed to examine the validity and reliability of the Pragmatic Language Skills Assessment Scale (PLSAS), developed to assess pragmatic language skills in Turkish-speaking preschool children aged 36-72 months. PLSAS, represents the first original pragmatic language assessment tool specifically designed for this population and seeks to address an important gap in the literature. Data were collected face-to-face from 121 preschool teachers in Turkey regarding 519 children enrolled in preschool education. Separate subsamples were formed to examine criterion validity, discriminant validity, and test-retest reliability. Criterion validity was assessed using the Social Communication Skills Checklist. Structural validity was evaluated through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). EFA revealed a three-factor structure (Communicative Intentions, Discourse Management Skills, and Context) comprising 23 items and explaining 69.49% of the total variance. CFA findings indicated good model fit. Internal consistency coefficients demonstrated excellent reliability (Cronbach's α = .96; McDonald's ω = .96). Test-retest results supported temporal stability. Criterion validity analysis showed a strong positive correlation with the Social Communication Skills Checklist (r = .717, p < .001). Furthermore, discriminant validity analysis indicated that the scale significantly differentiated between typically developing children and children with developmental disabilities (ASD and intellectual disability) (t = 17.508, p < .001). PLSAS is a valid, reliable, and sensitive instrument for assessing pragmatic language skills in Turkish preschool children.
This study aims to evaluate the validity and reliability of the Turkish version of the Idiopathic Toe Walking Outcome proforma (iTWO proforma-T), a clinician- and parent-reported tool designed to assess symptoms, functional performance, and treatment outcomes in children with idiopathic toe walking (ITW). Thirty-five children aged 4-14 years with ITW were included. The translation procedure followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. Construct validity was examined through correlations between individual iTWO proforma-T items and the Toe Walking Severity Scale, the Oxford Ankle Foot Questionnaire (OxAFQ), and the Pediatric Outcomes Data Collection Instrument (PODCI). Test-retest reliability was assessed in 10 of the 35 participants using intraclass correlation coefficients (ICC). Most items demonstrated excellent test-retest reliability (ICC > 0.90), including parent-reported toe-walking percentage, satisfaction, treatment adherence, pain-on-activity, and clinician-reported gait scale. Validity analyses showed significant and meaningful correlations between iTWO proforma-T items and established measures. The estimated toe-walking percentage correlated strongly with the Toe Walking Severity Scale (ρ = -0.549) and the OxAFQ emotional domain (ρ = -0.493). Functional performance items (gait scale, 2- and 6-minute walk tests) showed moderate positive correlations with toe-walking severity, whereas pain-related items correlated negatively with relevant PODCI and OxAFQ domains. The iTWO proforma-T is a valid and reliable instrument for evaluating symptoms, functional status, and treatment-related outcomes in children with idiopathic toe walking. The tool preserves the structure and measurement characteristics of the original proforma and can be confidently used by clinicians and researchers for evidence-based assessment and follow-up in Turkish-speaking pediatric populations.
This study offers a reconceptualization of online second and heritage language learning as a relationally mediated and context-dependent process, thereby addressing a key limitation in existing individualistic and technologically oriented models, which tend to treat relational dynamics as secondary rather than constitutive elements of learning. Drawing on a multi-stakeholder qualitative design, it examines how students, parents, and teachers conceptualize and experience learning Turkish in transnational online contexts, where Turkish functions as both a second/foreign language and a heritage language depending on learners' linguistic and family backgrounds. Data were collected through semi-structured interviews with 27 participants and analyzed using thematic analysis. Findings indicate that language learning is primarily grounded in relational and identity-based meanings, with family interaction and cultural continuity serving as central drivers of engagement. Beyond meaning construction, learning emerges as a dynamic system shaped by the interaction of learner characteristics, instructional mediation, and contextual conditions, with relational dynamics regulating how these elements are experienced. Online instruction is not perceived as a neutral technological medium, but as an interactionally constructed environment in which engagement and relational connection shape participation. Building on these findings, the study advances a relationally mediated learning system that integrates meaning, learning processes, and engagement within a unified framework. By foregrounding relational mechanisms as constitutive elements of learning, it offers a theoretically robust and context-sensitive account of language learning in complex, transnational, and digitally mediated environments.
Background: Early identification of posttraumatic symptoms in children and adolescents is essential for timely intervention. The Child and Adolescent Trauma Screen-2 (CATS-2) is a brief, freely accessible instrument that simultaneously assesses DSM-5 PTSD, ICD-11 PTSD, and ICD-11 complex PTSD (CPTSD) symptoms across child and caregiver report forms. Cross-cultural validation of the CATS-2 in underrepresented settings remains limited. This study examined the psychometric properties of the Turkish CATS-2 in a clinical sample.Method: Participants were 196 children and adolescents referred to a child and adolescent psychiatry outpatient clinic. ICD-11 PTSD and CPTSD diagnoses were established through clinician-administered assessments. Internal consistency, test-retest reliability, convergent and discriminant validity, child-caregiver agreement, confirmatory factor analysis (CFA), known-groups validity, and diagnostic accuracy were examined.Results: The CATS-2C showed good to excellent internal consistency (α=.81-.94) and test-retest reliability (ICC = .86-.90). CFA supported a two-factor correlated model of ICD-11 PTSD and disturbances in self-organization (DSO), and the DSM-5 four-factor model, for both forms. The CATS-2C showed strong convergent validity (r = .79-.89) and negligible associations with externalizing symptoms (r = .08-.12, ns). Known-groups validity was excellent for the CATS-2C (η² = .48-.58) but limited for the CATS-2P (η² = .076-.119). Diagnostic accuracy was good to excellent for the CATS-2C (AUC = .868-.947) and poor to acceptable for the CATS-2P (AUC = .606-.735), all subscales significant. Optimal CATS-2C cut-offs against clinician ICD-11 diagnoses were ≥7 for ICD-11 PTSD (sensitivity = 84%, specificity = 78%), ≥17 for ICD-11 CPTSD (93%, 85%), and ≥30 for DSM-5 PTSD (85%, 89%). Child-caregiver agreement was poor (ICC = .259-.344).Conclusions: The Turkish CATS-2C demonstrated sound psychometric properties, supporting its use as a reliable screening tool in child and adolescent mental health settings. The CATS-2P showed acceptable structural validity and internal consistency but more limited diagnostic discrimination, underscoring the importance of directly assessing symptoms from the child. These findings contribute preliminary evidence regarding ICD-11 PTSD and CPTSD constructs in an underrepresented, middle-income clinical setting.Trial registration: ClinicalTrials.gov identifier: NCT06975852. CATS-2 child report showed strong psychometrics across ICD-11 and DSM-5.CATS-2 caregiver report showed valid structure, weaker discrimination.ICD-11 PTSD/CPTSD cut-offs were derived against clinician diagnosis.Findings support ICD-11 PTSD/CPTSD use in a middle-income setting.
Mattering and anti-mattering are central constructs in understanding individual well-being. Traditionally, these concepts have been studied in offline social contexts. The rise of information and communication technologies has expanded the social environments in which individuals may feel valued or, conversely, insignificant. However, evidence on measurement invariance of these combined offline and online mattering scales for gender and different developmental stages remains limited in culturally diverse countries, including Turkey. This study aimed to validate four scales assessing both offline and online dimensions of mattering and anti-mattering-the General Mattering Scale, the Anti-Mattering Scale, the Online Mattering Scale, and the Online Anti-Mattering Scale-within a Turkish sample of adolescents and college students. Data were collected from 888 participants (high school students: n = 434, mean age = 15.51 ± 1.02, 63.1% female; college students: n = 454, mean age = 21.10 ± 1.67, 84.1% female). Confirmatory factor analyses (CFA) were conducted to examine the dimensional structure and reliability of the scales. Additionally, the Many-Facet Rasch Model (MFRM) was applied to test measurement invariance across educational levels and gender. CFA results indicated acceptable fit indices for all four scales across both groups, with reliability coefficients exceeding recommended thresholds. MFRM analyses further supported measurement invariance across high school and college students, as well as across male and female participants. The four-scale set appears psychometrically sound for use with Turkish adolescents and emerging adults and is well-suited to capturing the complexity of contemporary hybrid social environments, where experiences of significance and neglect can occur both offline and online.
There has been limited research among family physicians (FPs) in Türkiye regarding smoking cessation and few studies have examined their perceptions of e-cigarettes as smoking cessation aids. This study aimed to examine the knowledge, attitudes and beliefs of FPs in Istanbul about e-cigarettes and their potential role in smoking cessation. A cross-sectional online survey was distributed via email to a convenience sample of FPs in Istanbul. Participants were recruited from a list of family practice clinics provided by the Istanbul Provincial Health Directorate and other social media platforms. Data was collected from August until October 2022. Survey items were drawn from published literature and informed by the Theory of Planned Behaviour. Items were translated to Turkish and assessed knowledge, attitudes, beliefs, and willingness to recommend e-cigarettes as a smoking cessation aid to patients who had failed to quit using other methods. We received 243 responses from male (n = 116, 47.7%) and female (n = 127, 52.3%) FPs with an average age of 42 ± 10 years and an average of 9 ± 6 years clinical experience. Most participants believed it was their responsibility to aid patients in getting the correct help to quit smoking (n = 159/217, 73.3%) and that current medications are effective in helping patients quit smoking (n = 171/217, 78.8%). Most disagreed that e-cigarettes were suitable as smoking cessation aids (n = 169/217, 77.9%) or safer than regular cigarettes (n = 165/214, 77.1%). Respondents were concerned e-cigarettes were a gateway to smoking (n = 153/217, 70.5%), addictive (n = 166/217, 76.5%) and harmful to the health of the user (n = 162/215, 75.3%). Over half stated they were not confident in their level of knowledge about e-cigarettes (n = 126/200, 63%), or their ability to answer patient questions (n = 119/200, 59.5%) and talk to patients about e-cigarettes (n = 121/199, 60.8%). More than half stated they would not recommend e-cigarettes to patients that refuse to take alternative treatments (n = 121/197, 61.4%) or to patients that have failed to quit using other methods (n = 118/197, 59.9%). Family physicians in Istanbul demonstrated poor knowledge and confidence regarding e-cigarettes and generally held negative attitudes toward their use for smoking cessation. Knowledge and beliefs about effectiveness of e-cigarettes were key factors associated with recommendation practices. These findings highlight the need for education and guidance to support FPs in responding to patient enquiries about e-cigarettes, in line with the current regulatory context in Türkiye.
Nucleic acid testing (NAT) has improved blood safety by shortening the diagnostic window period (WP) for transfusion-transmissible infections. Within the context of a national NAT-based screening programme, this study evaluated temporal trends for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) among Turkish Red Crescent blood donors between 2015 and 2023. A retrospective analysis was conducted on 22,494,116 blood donations screened by serology and NAT. Prevalence, incidence and residual risk (RR) were estimated using standard incidence/WP models. Temporal trends were evaluated using linear regression, and NAT yield was assessed cumulatively. The overall confirmed positivity (per 100,000 donors) was 288.5 for HBV, 16.2 for HCV and 14.8 for HIV. HBV and HCV showed significant downward trends (p < 0.01), while HIV rose significantly (p < 0.01). Cumulative NAT yields were 189.35, 2.94 and 2.15 per million donations for HBV, HCV and HIV, respectively. Between 2015 and 2023, the estimated overall RR per million donations declined for HBV (634.79 to 238.34) and HCV (1.69 to 0.99), but rose for HIV (4.08 to 11.40). Notably, the rising HIV RR-contrasting with the decline for HCV-was driven by increasing repeat-donor incidence and differences in the WP models used for risk estimation. While NAT-based screening was associated with low, declining RR for HBV and HCV, the rising HIV trajectory is concerning. This underscores the need for enhanced behavioural screening and donor selection strategies alongside molecular testing to address rising HIV risks.
Crime victims may experience severe adversities after victimization. These can manifest themselves in the form of stigmatization within society and exposure to prejudiced perceptions, both of which result in secondary victimization. Stereotypes toward crime victims and individual levels of empathy may be important variables in predicting these prejudiced perceptions. Thus, the present study examined how stereotypical and prejudiced perceptions toward crime victims are related to empathy. Specifically, the study evaluated the mediating and moderating roles of empathy levels in this relationship. Data obtained from 937 adult participants were analyzed using RStudio, wherein the Lavaan and PROCESS packages were utilized for the mediation and moderation models, respectively. The findings revealed that empathy plays a partial mediating role in the relationship between stereotypes and prejudice. Furthermore, the moderation analyses showed that the effect of stereotypes on prejudice was significantly weaker among individuals with high empathy. Crucially, the moderating (buffering) role of empathy was determined to be stronger than its mediating role. These findings strongly suggest that empathy functions as a critical protective buffer, inhibiting the conversion of stereotypes into prejudice. This highlights the necessity for interventions-particularly for justice and social service professionals-to focus on cultivating empathy as a regulatory mechanism rather than merely treating it as a desirable outcome.
This study explores Turkish emergency nurses' experiences with climate-related health issues. Guided by Nightingale's Environmental Theory, it highlights nurses' frontline roles in recognising and managing environmental factors that influence patient outcomes during climate-related crises, with implications for public health systems and nursing policy. This research is a qualitative descriptive study using reflexive thematic analysis. Data were collected from 23 emergency department nurses using purposive and snowball sampling methods. Semi-structured interviews were conducted using an interview guide developed in consultation with experts. Thematic analysis was carried out based on Braun and Clarke's reflexive approach. Most participants were women with 5 years or more of emergency department experience. The majority reported no formal training on climate change. Three main themes were developed: (1) Defining the storm - nurses described climate change as a disruption of natural patterns, observing increases in heat-related illnesses, respiratory exacerbations and vector-borne diseases; (2) Navigating the storm - nurses managed crises through symptomatic care and self-acquired knowledge in the absence of formal protocols or training and (3) We are not in the same boat - nurses identified resource shortages, socio-economic disparities and infrastructural vulnerabilities that disproportionately affected low-income patients. Emergency nurses are increasingly confronted with climate-related health challenges, yet lack adequate training and institutional support. These findings underscore the need for national-level reforms in nursing curricula, institutional preparedness and public health policy to strengthen climate resilience in emergency healthcare.
This study aimed to evaluate the long-term neuropsychological outcomes and cognitive safety of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) compared with standard medical therapy (MED) in patients with Parkinson's disease (PD). This single-center, cross-sectional study included 56 patients with idiopathic PD (STN-DBS = 32; MED = 24), all evaluated in the on-medication state under stable treatment conditions. A concise multidomain neuropsychological battery was administered, including phonemic and semantic verbal fluency, Stroop test (time, errors, corrections), forward and backward digit span, judgment of line orientation, clock drawing, and Mini-Mental State Examination. Clinical assessments comprised Unified PD Rating Scale part III, Hoehn-Yahr stage, PD Questionnaire-39, and Hamilton Anxiety and Depression scales. The two groups were matched for age, sex, education level, motor phenotype, and on-state motor severity, while disease duration was considered in comparative analyses. Compared with the MED group, patients with STN-DBS demonstrated lower phonemic verbal fluency, shorter forward digit span, and higher Stroop error counts. Differences in forward digit span and Stroop performance persisted after considering disease duration, whereas the phonemic fluency difference was attenuated. Semantic fluency, visuospatial abilities, and global cognitive performance did not differ between groups. Within the STN-DBS cohort, higher motor severity was associated with poorer semantic fluency and clock drawing performance, while no associations were observed between DBS duration and neuropsychological outcomes. Long-term STN-DBS is associated with selective modulation of attention and executive control functions, while global cognition, semantic fluency, and visuospatial abilities remain largely preserved. These findings support the relative cognitive safety of chronic STN-DBS and underscore the importance of routine executive function monitoring during long-term follow-up.
To investigate the relationship between the second-to-fourth digit ratio (2D:4D), a marker of prenatal hormone exposure, and oral hygiene performance and gingival health. A cross-sectional study was conducted with 126 adults aged 18-55 years (71 males, 55 females) at Istanbul Okan University's Periodontology Clinic. Participants were classified by sex, hand dominance, and 2D:4D ratio (cut-off: 1). Oral hygiene was assessed using the Turesky Modification of the Quigley-Hein Plaque Index (QHPI) and Gingival Index (GI) at baseline and one week after standardised oral hygiene education. Finger lengths were measured to calculate 2D:4D. Statistical analyses included t-tests, repeated-measures ANOVA, Pearson's correlation, and Bonferroni post-hoc tests (α=0.05). No statistically significant difference in 2D:4D ratio was found between sexes (p=0.395) or hand dominance (p=0.730). QHPI and GI scores statistically significantly improved across all groups after education (p0.001). No statistically significant association was found between 2D:4D ratios and changes in QHPI or GI. However, left-handed individuals showed statistically significantly lower QHPI scores at both time points (p 0.05), and males with 2D:4D 1 reported more frequent brushing habits, though this was not reflected in clinical indices. The highest GI values were observed in males with 2D:4D ≥1, while the lowest were in females with 2D:4D<1. The 2D:4D ratio was not a reliable predictor of oral hygiene status or gingival health. However, handedness may influence oral hygiene performance. Standardized oral hygiene education led to comparable improvements regardless of biological variability.
Hemodialysis (HD) is a life-sustaining but resource-intensive therapy, consuming large volumes of water and electricity and generating substantial waste. This hybrid modeling study quantified the environmental footprint of in-center HD in Türkiye using national registry data, published parameters, and measured facility-level data from two Turkish dialysis centers. A hybrid modeling approach combined published per-session resource parameters with measured facility-level data from two Turkish hemodialysis centers (4,000 sessions/month combined). Literature-derived parameters (493 L water/session at 42% RO recovery, 6.2-19.6 kWh electricity/session, 1.5-8.0 kg waste/session) were scaled nationally for 2023 (9.27 million sessions). Measured Turkish data (390 L water, 10.8 kWh electricity, 1.19 kg hazardous waste per session) provided empirical calibration. GHG emissions were calculated using Türkiye-specific (0.494 kg CO2e/kWh for electricity) and international conversion factors. Using literature parameters, annual national estimates include 4.57 million m³ water, 57.5-181.8 GWh electricity, and 13.9-74.2 kt waste, with total GHG emissions ranging from 45.3 to 171.1 kt CO2e/year. Measured Turkish facility data yielded lower per-session water consumption (~390 L vs. 493 L, a 21% reduction) and hazardous waste generation (1.19 vs. 1.5 kg/session under good segregation), while electricity consumption (mean 10.8 kWh/session) aligned with the moderate literature scenario. Electricity was the dominant emission source (63-72%), followed by waste incineration (up to 47% with poor segregation). In-center HD in Türkiye imposes a substantial yet modifiable environmental burden. Measured Turkish facility data demonstrated that actual water consumption is meaningfully lower than international estimates, highlighting the importance of locally validated parameters. Waste segregation and electricity decarbonization represent the highest-impact intervention points for reducing the sector's carbon footprint.
Advanced glycation end products (AGEs) are formed through non-enzymatic reactions between reducing sugars and biomolecules and are associated with the development of various chronic diseases. This study investigated the effects of selected polyphenol-rich foods-aronia, cornelian cherry, green tea, and Turkish coffee-on glyoxal (GO) and methylglyoxal (MGO) levels during simulated gastrointestinal digestion. An in vitro digestion model including oral, gastric, and intestinal phases was applied, and GO, MGO, and total phenolic content (TPC) were determined using HPLC and UV-visible spectrophotometry before and after digestion. Turkish coffee exhibited the highest increase in TPC following digestion (p < 0.05). Aronia showed the lowest GO levels before digestion, whereas after digestion Turkish coffee showed the most pronounced reductions in both GO and MGO. These findings suggest that the effects of polyphenol-rich foods on AGE precursors depend on food matrix and digestive stability. Further in vivo and clinical studies are needed.