E-ISSN: 2148-4570 • ISSN:2148-4570
ANKARA MEDICAL JOURNAL - Ankara Med J: 23 (3)
Volume: 23  Issue: 3 - 2023
ORIGINAL ARTICLE
1.Identifying Factors Associated With Cognitive Impairment in Thyroid Disorders and Prediction of Risk Using Machine Learning Approach: A Comprehensive Study
Bhavya Poojary, Merlin Maria Wilson, Riya Jose, Sona P Sam, Ann Elizabeth George, Mallikarjuna V Jeeragi
doi: 10.5505/amj.2023.89990  Pages 256 - 268
INTRODUCTION: Thyroid disorders are a significant health concern in India and globally, being the second most common disease. Cognitive impairment associated with thyroid disorders is often neglected by healthcare providers, necessitating improved awareness and screening to identify neurocognitive changes in affected individuals. This study aimed to determine the prevalence of cognitive impairment in thyroid disorders and identify the associated risk factors. This study also predicted the risk of the development of cognitive impairment using a machine learning algorithm and was conducted in a tertiary hospital in South India.
METHODS: A prospective observational study was conducted among 202 patients with thyroid disorders over six months. In order to achieve primary and secondary goals, tools such as the M-ACE questionnaire and XGBoost algorithm were used. Data were collected using a validated form and analyzed using standard statistical methods.
RESULTS: Among the studied population, 29.21% were cognitively impaired, with an average M-ACE Score of 22.56± 2.62. Age, duration of illness, BMI, comorbidities, and tobacco chewing were significant contributors when factors were analyzed for their association with cognitive impairment. A similar number of people with hypothyroidism and hyperthyroidism had a >75% risk of developing cognitive impairment in the near future.
DISCUSSION AND CONCLUSION: This study revealed that thyroid disorders have significant effects on the cognitive status of individuals and were also successful in predicting future risk.

2.Do Healthcare Reforms Affect Health Status? Türkiye Practice
Hasan Bağcı
doi: 10.5505/amj.2023.45077  Pages 269 - 283
INTRODUCTION: The aim of this study is to determine the impact of per capita health expenditure, the number of physicians, and the Health Transformation Program (HTP) implemented in Türkiye since 2003 on infant mortality.
METHODS: In this study, while the infant mortality rate per 1,000 live births (IM) was used as the dependent variable, the per capita health expenditure in US dollars according to purchasing power parity (HEX), the number of physicians per 1,000 population (PHY), and the HTP were used as independent variables. The Autoregressive Distributed Lag (ARDL) bounds testing approach was used in this study. Data covering the years of Türkiye from 1975 to 2018 were obtained from the OECD health statistics database for HEX and PHY, and from the World Bank database for IM.
RESULTS: According to the short and long term results of ARDL limit test, it was observed that the independent variables HEX, PHY and HTP reduced IM in the short term. However, it was found that the short-term results of independent variables HEX (p=0.157), PHY (p=0.390), and HTP (p=0.420) on IM were not statistically significant. According to the ARDL bounds test, the independent variables HEX, PHY, and HTP reduce IM in the long run. The long-term results of independent variables HEX (p=0.007), PHY (p=0.004) and HTP (p=0.012) on IM are statistically significant.
DISCUSSION AND CONCLUSION: The independent variables HEX, PHY and HTP were shown to reduce IM in the long term (p<0.05). It is recommended to monitor these identified effects and to develop public health policies accordingly.

3.The Effects of VDR Gene Polymorphisms and Lifestyle Features on Vitamin D Levels of Post Menopausal Women
Meryem Çakır, Esra Meltem Koç, Mustafa Soyöz, Hatice İlayhan Karahan Çöven, Serpil Aydogmus, Kaan Sozmen
doi: 10.5505/amj.2023.03604  Pages 284 - 294
INTRODUCTION: Vitamin D deficiency is a common situation for women who are in menopause due to various reasons. This study aims to investigate the effect of VDR gene polymorphisms and lifestyle on vitamin D levels of women in menopause.
METHODS: The study was planned in a cross-sectional descriptive design. Data was collected with a sociodemographic and lifestyle habits question form, and patients' blood samples were obtained for vitamin D levels and genetic tests. The data was evaluated by using SPSS 16.0 software. The logistic regression analysis model was created using the Backward elimination method, and the P-value below 0.05 was considered statistically significant.
RESULTS: The study was carried out on 303 menopausal women. The frequency of vitamin D deficiency in patients was 71.9%. Receiving vitamin D and Omega-3 supplements and having prolonged sleep duration were found to be protective factors from vitamin D deficiency. Of the VDR gene polymorphisms, the Bsml bb genotype was found to protect from vitamin D insufficiency, while the ApaI bb genotype increased the risk of vitamin D insufficiency.
DISCUSSION AND CONCLUSION: Vitamin D levels may be low in people who do not have sufficient sleep time. Our study found that the APA I aa genotype increased the risk of vitamin D deficiency, while the BsmI bb genotype protected from vitamin D deficiency. More studies are needed on the effects of lifestyle habits and genetic factors on serum vitamin D levels.

4.Bibliometric Analysis of Medical Speciality Dissertation Studies in Family Medicine Departments and Clinics Between 2000-2020
Ayşe Karakullukçu, Cüneyt Ardıç
doi: 10.5505/amj.2023.90836  Pages 295 - 311
INTRODUCTION: This study aimed to conduct a bibliometric analysis of medical specialty dissertation studies conducted in Family Medicine departments and clinics between 2000 and 2020.
METHODS: This descriptive study was conducted between 2000 and 2020 by examining 1628 dissertations in the field of family medicine specialization. In the first process, information regarding the dissertation was recorded. In the second process, the conversion of dissertations into articles was evaluated. The journal indexes, Q classification and citation numbers of the dissertations publications were determined.
RESULTS: 1009 (61.98%) of the students were female. 977 (60.01%) of the dissertations belonged to university hospitals. The number of dissertations in which the title of advisor associate professor was 579 (35.56%). Preventive health services were the most frequently selected topic in the dissertations (8.66%). Descriptive/cross-sectional studies were the most preferred research type, with 1414 (86.85%) dissertations. Project support, laboratory, and radiological tests have decreased significantly over the years (p<0.05). 458 (28.13%) of the dissertations were published in any journal. Considering the databases of the publications, 92 (20.09%) were published in SCI/SCI-Expanded.
DISCUSSION AND CONCLUSION: About a quarter of the theses have been published in any journal, and there has been a noticeable increase in publications in international indexes in recent years. Theses with research type of case-control, intervention, laboratory and radiologic test use were more likely to be published. Concordantly, it is advised to give precedence to studies situated higher on the evidence pyramid, allocate sufficient funds to finance research, and increase backing for projects.

5.Evaluation of communication skills of family medicine assistants
Mehmet Murat Topaloğlu, Mehmet Onat Cakit, Ismaıl Arslan
doi: 10.5505/amj.2023.92053  Pages 312 - 324
INTRODUCTION: This study aimed to reveal the communication skills of family medicine residents who are new to the profession and to provide formative feedback to residents in the early stages of their education.
METHODS: 222 family medicine assistants studying in hospitals affiliated with the University of Health Sciences within the borders of Ankara province participated in the research online. The socio-demographic characteristics of the residents participating in the study were accepted as independent variables, and the Turkish version of the Health Professionals Communication Skills Scale (HP-CSS-TR) was considered as the dependent variable.
RESULTS: The mean age of the participants was 22.13±2.25 years. The assistant seniority level of the participants was 1.77±1.39 years. 80.63% of the participants reported having problems with the patients and their relatives. 99.55% stated that they encountered difficult patients or their relatives. In our study, family medicine clinical assistants' communication, empathy, respect and social skills were high. Senior participants had better communication levels (p=0.011).
DISCUSSION AND CONCLUSION: In our study, we found that family medicine residents have high communication skills, but they expressed that they have difficulties communicating with patients and wanted to receive communication training to improve their communication skills and cope with difficult patients. Giving feedback by measuring the communication skills of young assistants who are new to the profession should be included in our assistant training practice as a standard first-step assessment of the profession.

6.Evaluation of the Relationship Between Frailty, Polypharmacy, and Depression in People 65 Years of Age and Older
Irem Erdoğan, Ozge Tuncer
doi: 10.5505/amj.2023.99083  Pages 325 - 335
INTRODUCTION: This study aims to determine the level of frailty in patients aged 65 and over who apply to the family medicine clinic to evaluate the relationship between polypharmacy, depression, and socio-demographic characteristics with frailty.
METHODS: This is a single-center, cross-sectional, descriptive survey. One hundred forty-four participants aged 65 and over who applied to the family medicine clinic at Training and Research Hospital in Izmir were included. The Yesavage Geriatric Depression Scale (GDS)-Short Form was used to measure participants' depression levels, and the Edmonton Frail Scale (EFS) was used to determine the level of frailty. The data obtained were analyzed using IBM SPSS 21.0, and a statistical significance value of p <0.05 was accepted.
RESULTS: The group with the highest percentage of participants was under 75 years old, constituting 65.32% of the total group. According to the GDS score average, a significant relationship was found between depression and gender, education level, monthly income, and falls. According to the EFS-TR score average, a significant relationship was found between frailty and age, gender, education level, marital status, monthly income, lifestyle, number of medications used, number of emergency hospital admissions, and falls. A moderate positive correlation was found between GDS and EFS.
DISCUSSION AND CONCLUSION: The study found that many socio-demographic characteristics affect depression and frailty. It was observed that frailty increases as depression and polypharmacy increase, but there was no significant relationship between polypharmacy and depression. These results are important for better support and protection of elderly individuals in health and social care.

7.An Analysis of the Distribution of Patient Diagnoses Based on ICD Codes in Turkey Between 2016 and 2022: A Descriptive Study
Mustafa Mahir Ülgü, Şuayip Birinci
doi: 10.5505/amj.2023.47887  Pages 336 - 343
INTRODUCTION: It is very important for the individual to get to the hospital correctly and on time. This study aims to evaluate hospital admissions and diagnoses nationwide and guide policies to improve patient admissions.


METHODS: All data on outpatient and inpatient treatment applications between 01.01.2016 and 31.12.2022 were examined retrospectively by examining the data of the national registry system. The diagnoses entered at each visit on these dates were classified according to ICD-10 and divided into 21 categories. Data related to specialty, hospital level and seasonal information of diagnoses were evaluated.

RESULTS: During the study period, 6,662,007,644 diagnoses were entered in hospital visits. While it was seen that the number of diagnoses entered increased gradually from 2016 to 2019, it was noted that there was a decrease in 2020 due to the COVID-19 pandemic. The three most common diagnoses were musculoskeletal system diseases, circulatory system diseases, and diseases due to infectious causes. Infectious, eye, and gastrointestinal diseases were found to vary seasonally in the frequency of diagnosis.


DISCUSSION AND CONCLUSION: Evaluating seasonal and hospital-level patient applications is essential in establishing effective health policies. Raising awareness of patients and increasing the number of health personnel is necessary to use health services effectively.

8.Evaluation of medication adherence of individuals with chronic diseases during Ramadan
Tuğba Yılmaz
doi: 10.5505/amj.2023.70842  Pages 344 - 356
INTRODUCTION: Our study aimed to evaluate the adherence of individuals with chronic diseases who need to take regular medication during Ramadan.
METHODS: A total of 152 fasting individuals over 18 years with at least one chronic disease who visited Ankara City Hospital Family Medicine Outpatient Clinic for any reason within one month between April and May 2023 during Ramadan were included. A unique structured questionnaire form and the MMS (Modified Morisky Scale-Turkish version) measuring medication adherence were used in the study.
RESULTS: Among the participants of the study, 55.92% of the patients were female, 89.47% of the patients were married, and 61.18% were unemployed. 38.16% of the patients were elementary school graduates. The most common chronic diseases were found as hypertension at 54.95%, diabetes at 38.16%, and hypothyroidism at 17.11%. The rate of disruption in medication compliance was statistically higher among employed patients (p=0.040). It was observed that elementary school graduates were significantly more compliant in medication use than graduates with higher education levels (p=0.005; p=0.031). 67.11% of the patients stated that they "always" used their medications regularly.
DISCUSSION AND CONCLUSION: Medication use was found to be affected by many factors in patients with chronic diseases who should take medication regularly. There was a change in the time of taking medication during Ramadan. Most of the patients were found to have high motivation and a high level of knowledge, according to the MMS. Patients' medication compliance increased with increasing age. In light of these findings, proactive assessment by primary care physicians prior to the start of Ramadan may play a pivotal role in improving medication and treatment adherence among affected patients.

9.The Comparison of the Laboratory Parameters of Inactivated Coronavirus Vaccinated and Non-Vaccinated COVID-19 Patients Applied Hospital
Burcu Ozdemir, Levent Özdemir, Bilge Akgunduz
doi: 10.5505/amj.2023.36786  Pages 357 - 365
INTRODUCTION: The comparison of laboratory parameters of non-vaccinated and inactivated coronavirus-vaccinated patients who came down with COVID-19.
METHODS: The study was designed as a retrospective cross-sectional study between March 2020 and April 2021. 154 patients who had no vaccination(n=77) and one-dose (n=28) or two-dose (n=49) inactivated coronavirus vaccination, demographical data's, hemogram, C-reactive protein (CRP), ferritin and D-dimer levels were evaluated.
RESULTS: In total, 154 patients were included in the study (84 female, 54.5%). The mean age was 65.1±14.5 years. The ferritin level was 449.93±443.48 ml/ng in one-dose vaccinated patients, 297.68±340.32 ml/ng in two-dose vaccinated patients and 568.70±539.41 ml/ng in unvaccinated patients; this difference was statistically significant (p=0.008). The D-dimer level was 0.86±0.89 µg/L in one-dose vaccinated patients, 0.67±0.79 µg/L in two-dose vaccinated patients and 1.62±1.93 µg/L in unvaccinated patients; again, a statistically significant difference existed (p=0.002). The rates of hospitalization in the ward and intensive care unit (ICU) and D-dimer levels were lower in two-dose vaccinated patients than in unvaccinated patients (p=0.015). No significant difference was detected concerning hemogram and CRP level of non-vaccinated, one-dose vaccinated and two-dose vaccinated patients.
DISCUSSION AND CONCLUSION: Even if vaccinated, individuals can get COVID-19, but disease progression is milder, and ferritin and D-dimer levels related to disease severity are higher in unvaccinated patients.

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