Background: Disordered eating attitudes are major public health concerns associated with adverse physical, psychological, and social outcomes. Therefore, brief, psychometrically sound screening tools are needed to identify individuals at risk early. The Eating Attitudes Test-7 (EAT-7) is a shortened screening tool developed to assess disordered eating attitudes. However, its Turkish validity and reliability have not been previously examined. Therefore, this study aimed to assess the validity and reliability of the Turkish version of the EAT-7 among Turkish-speaking adults. Methods: This methodological validation study was conducted between November 2025 and January 2026. Data were collected online using a snowball sampling technique. After a pilot study with 210 participants, the main study included 1635 adults aged ≥18 years. Exploratory factor analysis was performed with 500 participants, and confirmatory factor analysis was performed with an independent sample of 1135 participants. Internal consistency and construct validity were assessed. Convergent validity was evaluated through correlations with the EAT-26, Eating Disorder Examination Questionnaire-13 (EDE-Q-13), and Depression Anxiety Stress Scale Short Form (DASS-8). Results: The Turkish version of the EAT-7 demonstrated excellent internal consistency, with a Cronbach's alpha coefficient of 0.925. The Kaiser-Meyer-Olkin value was 0.909, and Bartlett's test results were significant. Exploratory factor analysis supported a single-factor structure explaining 70.133% of the total variance. Confirmatory factor analysis confirmed a good model fit. The total EAT-7 score was positively correlated with the EAT-26, EDE-Q-13, and DASS-8 scores. Conclusions: The Turkish version of the EAT-7 is a valid, reliable, brief, and practical screening tool for assessing disordered eating attitudes among Turkish-speaking adults.
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.
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.
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.
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.
Background and Objectives: This study aimed to translate and culturally adapt the Pictorial Fit-Frail Scale (PFFS) into Turkish and to evaluate its validity and reliability in older adults. Materials and Methods: The study included 156 community-dwelling older adults aged ≥ 65 years. Frailty status was determined using the Clinical Frailty Scale (CFS), and participants with a CFS ≥ 4 were classified as frail. All participants underwent the PFFS, Katz ADL, Lawton-Brody IADL, Short-Form Geriatric Depression Scale (GDS), Mini Nutritional Assessment-Short Form (MNA-SF), Standardized Mini-Mental State Examination (SMMSE), and Charlson Comorbidity Index (CCI). The reliability of the PFFS was assessed using internal consistency (Cronbach α), inter-rater reliability, and test-retest reliability (ICC); its construct validity was assessed using correlation analysis with the CFS. Furthermore, the diagnostic performance of PFFS in identifying frailty was analyzed using the ROC curve. Results: Of the 156 individuals participating in the study, 63.5% were women, and 89 individuals (57.1%) were frail. The Turkish version of PFFS showed high internal consistency (Cronbach α = 0.838). Inter-rater and test-retest reliability were found to be ICC = 0.995 and 0.996, respectively. A strong and positive correlation was found between PFFS and CFS scores (Spearman r = 0.760, p < 0.001). ROC analysis showed that PFFS had good performance in distinguishing frailty (AUC = 0.851, optimal cut-off ≥ 14; sensitivity = 69.7%, specificity = 83.6%). Frail individuals were older, had higher comorbidities, and showed greater dependence in activities of daily living. Conclusions: The Turkish version of the PFFS appears to be a reliable, valid, rapid, and multidimensional tool for assessing frailty in older adults. The PFFS can contribute to the effective assessment of frailty in clinical practice and research.
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.
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.
Organic anion-transporting polypeptides (OATPs) are crucial for hepatic uptake. However, the independent contribution of SLCO1B1/1B3 germline variations to hepatocellular carcinoma (HCC) susceptibility remains controversial. This study investigated SLCO1B1/1B3 polymorphisms and HCC risk in a Turkish cohort, accounting for clinical, viral, and metabolic confounders. In this retrospective case-control study (81 HCC patients, 162 healthy controls), fully adjusted multivariable logistic regression models were constructed across multiple inheritance configurations (dominant, recessive, and additive) and adjusted for age, sex, and viral status (HBV/HCV) to address demographic and etiological discrepancies. Genotyping for SLCO1B1 (c.388A>G, c.521T>C) and SLCO1B3 (c.334T>G, c.699G>A) was performed using PCR-RFLP, cross-verified via automated digital capillary electrophoresis. Exploratory univariate analysis showed the SLCO1B1 388A>G variant was more prevalent in the HCC group. However, after strict adjustments for multiplicity and controlling for background viral etiology, age (OR: 1.10) and male sex (OR: 5.82, 95% CI: 2.74-12.41) remained the primary independent predictors, whereas the statistical significance of the genetic variant completely dissolved (p = 0.673). Notably, HCC patients exhibited profound hypocholesterolemia that significantly correlated with liver dysfunction severity; a significant inverse correlation was found between Child-Pugh scores and total cholesterol (r = -0.286, p = 0.031), validating that metabolic decline is a consequence of hepatic synthetic failure rather than an independent risk factor. Ultimately, age, male sex, and background etiological factors are the primary independent determinants characterizing HCC in this cohort, confirming that common germline SLCO variations do not exert a robust independent influence once major demographic and clinical confounders are considered.
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.
Although obesity is a recognized cardiometabolic risk determinant, debate persists over the most appropriate anthropometric technique. This study evaluated different anthropometric techniques for predicting cardiometabolic risk in Turkish adolescents and aimed to develop and temporally validate a machine learning-based prediction model, reported in accordance with the TRIPOD statement. Adolescents from the Türkiye Nutrition and Health Survey in 2010 (n = 1357) and 2017 (n = 561) were included. Anthropometric and biochemical parameters were assessed. BMI z-scores, waist-to-hip and waist-to-height ratios, triponderal mass index (TMI), visceral adiposity index (VAI), and lipid accumulation product (LAP) were calculated. In ROC analysis, VAI showed the highest discrimination (AUC = 0.747, p < 0.001), followed by LAP (AUC = 0.670). In machine learning, XGBoost achieved the highest training discrimination (ROC-AUC = 0.879), whereas logistic regression was the most stable, with minimal overfitting (ΔAUC = 0.008). The logistic regression model was well calibrated (Brier score = 0.107; calibration slope 1.00 development, 1.03 external). External temporal validation showed comparable discrimination across models (AUC = 0.742-0.757), with logistic regression showing the greatest consistency. The model showed a high negative predictive value (NPV = 91.7%) and was therefore better suited to ruling out than ruling in cardiometabolic risk; positive findings warrant confirmatory testing (PPV = 35.4%). A simple logistic-based formula was derived. Machine learning approaches, together with the developed model and simplified formula, may be useful tools for estimating cardiometabolic risk in adolescents and could support a stepwise screening strategy, pending recalibration and prospective validation.
Background/Objectives: We aimed to evaluate the association between early post-treatment eosinophil (Eo) elevation and survival outcomes in metastatic renal cell carcinoma (mRCC) treated with vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs). We also assessed whether early post-treatment Eo elevation provided prognostic information beyond the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model. Methods: This Turkish retrospective multicenter cohort study included 280 patients with mRCC who received first-line VEGFR-TKI monotherapy between 2015 and 2025. Early post-treatment Eo elevation was defined as a post-baseline Eo percentage > 5% in the complete blood count obtained within 15 days before the first computed tomography assessment performed for response/progression evaluation. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier methods and compared with log-rank tests. Cox regression models assessed independent prognostic associations. Time-dependent receiver operating characteristic (ROC) curve analyses were performed to evaluate the incremental prognostic value of early post-treatment Eo elevation beyond IMDC risk. Results: The median age was 61 years, and 205 patients (73.2%) were male. Early post-treatment Eo elevation was observed in 88 patients (31.4%). Median PFS was longer in patients with early post-treatment Eo elevation than in those without Eo elevation (15.1 vs. 10.1 months; p < 0.001). Median OS was also longer in the Eo elevation group (70.0 vs. 38.6 months; p < 0.001). In multivariable analysis, early post-treatment Eo elevation remained independently associated with improved PFS (hazard ratio [HR]: 0.60, 95% confidence interval [CI]: 0.44-0.81, p = 0.001) and OS (HR: 0.51, 95% CI: 0.33-0.80, p = 0.004). The combined IMDC plus Eo model showed higher time-dependent area under the curve values than the IMDC model alone. Conclusions: Early post-treatment Eo elevation was independently associated with improved PFS and OS, and the combined model showed greater prognostic discrimination than IMDC risk alone. Given that Eo status was assessed after treatment initiation, residual selection bias cannot be excluded, and prospective validation is required before clinical implementation.
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.
Background and Objectives: PAPSS2 loss-of-function variants cause autosomal recessive brachyolmia type 4 with skeletal dysplasia. Despite over 90 documented cases, molecular characterization remains incomplete, with many variants classified as uncertain significance (VUS). Materials and Methods: We performed integrated multi-modal in silico analysis of two novel and rare homozygous missense variants [c.227T>A p.(Leu76Gln) and c.143C>G p.(Thr48Arg)] identified via whole-exome sequencing in two unrelated Turkish girls. Analysis incorporated AlphaMissense (0.92, 0.96), REVEL (0.85), CADD Phred (28.8-29.1), evolutionary conservation across seven vertebrate species (100% identity), and AlphaFold2 structural modeling. Variant reclassification followed 2015 ACMG/AMP guidelines. Results: Both variants fulfilled criteria for VUS-to-Likely Pathogenic reclassification: PS3 (functional loss), PM1 (critical APS-kinase domain localization), PM2 (population rarity), and PP3 (computational consensus). Structurally, p.(Leu76Gln) disrupts hydrophobic core stability (Grantham score 113), while p.(Thr48Arg) causes active-site steric hindrance. Both probands presented with platyspondyly, short stature, and profound DHEA-sulfate depletion (3.15 and 1.79 µg/dL). Although identical variants were reported in a 14.5-year-old with PCOS-like androgen excess, our prepubertal cases (ages 5-6 years) exhibited normal androgens, suggesting PAPSS2 loss-of-function is necessary but insufficient for androgen excess. Conclusions: Multi-modal computational analysis supports likely pathogenic reclassification of these PAPSS2 variants, enabling precision genetic counseling and advancing understanding of skeletal and endocrine heterogeneity. These findings expand the PAPSS2 variant registry to over 92 cases across 18 countries.
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.
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.
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.
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.