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Water is a crucial resource and approximately 70% usage of it in the agriculture sector in Turkey. Water user associations are in charge of irrigation water management. The core aim of this study is to assess water user associations have command area more than 1,000 ha (WUAs) within the districts of DSI (State Hydraulic Works) and to create spatial maps to show the distribution of the performance indicators used constantly by researchers especially around Mediterranean countries during the period from 2011 to 2015. Frequency and panel data analysis are used to figure out the relationship among performance indicators and attributes such as water diversion type, management type, source of water and district no. Panel data analysis was applied to examine statistical assessment over time. As a result, current performance indicators show that excessive irrigation water used due to low technology and management problem. Performance indicators show high differences among districts due to climate, water resources, and crop pattern. Moreover, low irrigation efficiency can be increased with a transition to pressurized irrigation systems, so more are can be irrigated with less water. [ABSTRACT FROM AUTHOR]

• Data on non-HACEK Gram-negative infective endocarditis is limited to case reports and case series. • Clinicians may encounter non-HACEK Gram-negative infective endocarditis in medical wards mostly because of the high number of intravascular interventions performed and elderly patients treated. • While environmental pathogens are pan-susceptible to antimicrobials, Klebsiella species endocarditis is associated with an increased risk of drug resistance. Retrospective analysis of clinical data using 26 diagnosed non-HACEK Gram-negative infective endocarditis cases from nine hospitals in Turkey. Mean age of patients was 53 (28–84) years, with a 23% case fatality. Nineteen (73%) of the 26 patients had at least one predisposing factor. The presence of a central venous catheter was the most common predisposing factor (7/26 patients). Pseud omonas aeruginosa (7/26 patients) and Escherichia coli (7/26 patients) were the most common pathogens. The median duration of the antibiotic therapy was 42 days (range 3–84 days). Surgical procedures were performed in 10 patients. The case fatality was similar in patients who did or did not undergo surgery (20% vs. 25%). [ABSTRACT FROM AUTHOR]

Land fragmentation (LF) is a problem restrain agricultural activities and decrease mechanization level, production. Land consolidation (LC) projects are done in the World as well as Turkey to solve LF issues. Researchers created indicators to measure land fragmentation which is important to see success level of LC projects. The use of these indicators is controversial or not accurate. The core aim of the present study is to find new land fragmentation index and to find least fragmented holding with factor analysis using the other indicators which are Simmons, Januszevski, number of parcels, Shmook and Igbozurike besides new land fragmentation index. Kargılı Village land consolidation project in Mersin, Turkey was chosen as a material. Cadastral data before land consolidation, was used to calculate value of indicators, where number of parcels was 932, total area was 1,741.9 ha, the average parcel size was 1.9 ha, number of holdings was 542 and the average parcel size was village had 932 parcels. Data processing were performed with ArcMAP 10.6.1 and SPSS. A total of 18 holdings were identified randomly as sample size which were sufficient to carry out factor analysis including principle component to rank holdings (P < 0.01).As a result, new land fragmentation index found correlated with others (P < 0.01) and ranking according to new indicator performed better than ranking considering all indicators. In this context, it is possible to use new land fragmentation indicator to determine priority areas for land consolidation. [ABSTRACT FROM AUTHOR]

Water is a scarce resource and thus irrigation schemes in arid regions have become more important. The irrigation sector which uses most of the water resources has to cope with global warming, disasters and water scarcity around the world, particularly in the Mediterranean countries, including Turkey. Irrigation schemes, which were built by DSI (State Hydraulic Works) and whose operation and maintenance management was transferred to water user associations, play a crucial role in irrigated agriculture in Turkey. In order to improve the performance, weakness and strengths of irrigation schemes are determined by performance indicators (system operation, financial and production efficiency) which show the overall information about them. In the present study, seven irrigation schemes located in an arid region of central Anatolia were chosen to assess the irrigation performance using principal component, correlation and cluster analysis while quality index showed the rank of the irrigation schemes. We found that the average total annual volume of irrigation supply was 7,648.58 m³ ha-1 and the average relative water supply was 1.91 during the 11 years between 2006 and 2016. In this region, higher inverse correlations were due to using surface irrigation methods (51.3%). As of 2017, the irrigation schemes have weak water distribution systems, on an average, consisting of 55.5% open canals, 22.5% canalette and only 10% pipes. According to the quality index, financial and system operation indicators are more effective than that of production efficiency indicators. In conclusion, average irrigation ratio (55.68%) can be increased by improving the water distribution system, and the technology used on both management and farm levels. [ABSTRACT FROM AUTHOR]

Cyanide leaching of gold-silver ore, obtained from Artvin, Cerattepe region of Turkey, was investigated. The effects of NaCN concentration, solid/liquid ratio, type of pH adjustment reagent, lead nitrate and hydrogen peroxide (H2O2) additions in relation to the leaching time on gold and silver leaching efficiencies were examined and the optimum cyanide leaching conditions were determined. Almost all gold and 71% of Ag were extracted with the addition of 15g/l H2O2 during the cyanidation carried out for 48h. As a result of this study, it was proven that addition of H2O2 as an oxidant during the cyanide leaching had an increasing effect on the leaching recoveries of Au and Ag, a decreasing effect on the leaching period, and thus an accelerating effect on Ag and Au dissolutions. [ABSTRACT FROM AUTHOR]

Objective: To measure the effects kangaroo mother care (KMC) on the regional cerebral oxygen saturation (rSO 2 ) measured with near-infrared spectroscopy (NIRS) in premature infants and to study the physiological stability and comfort of the infants during such interventions., Design: This was a prospective, single-centered, single-blind, 2-arm, parallel-group randomized controlled trial conducted., Settings: The study was carried out in a tertiary neonatal intensive care unit in Medical Faculty Hospital in Konya/Turkey., Participants: Premature infants born between 24 and 36 +6 weeks. Participants were randomly assigned to one of two groups: kangaroo care (n = 20) and control groups (n = 20). The rSO 2 , oxygen saturation (%SpO 2 ), heart rate (HR), respiratory rate, body temperature, and comfort levels of the infants were evaluated in three stages., Findings: In the 60th min measurement of the intervention group, rSO 2 , body temperature, heart rate, respiratory rate, and, comfort level, the comfort level was found to be higher and significant in the 30th and 60th min measurements (p < 0.001). In the intervention group, the rSO 2 (p < 0.001), body temperature (p < 0.001), HR (p < 0.001), SpO 2 (p < 0.001), respiratory rate (p < 0.001), and comfort levels (p < 0.001) scores with the control group and the group × time interaction was significant., Key Conclusions: KMC moderately increased the rSO 2 levels and also created a moderate effect size on the physiological parameters and comfort levels of the newborns, which implicates its short-term benefits for premature infants., Practice Implications: KMC may be beneficial in stabilizing rSO 2 and physiological parameters and increasing comfort in premature infants. The trial was registered in ClinicalTrials.gov (identifier: NCT04725435)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: The relationship between comorbidities and chronic obstructive pulmonary disease (COPD) is two-sided. As the number of comorbidities increases, frequency of acute exacerbations of COPD (AECOPD) consequently increases. Comorbidity indices can be used to evaluate comorbidities while managing COPD patients. We aimed to compare comorbidity indices such as the Charlson comorbidity index (CCI), comorbidities in COPD index (COMCOLD) and COPD specific comorbidity test (COTE) regarding exacerbation frequency., Materials and Methods: Participants hospitalized for AECOPD were included in this bidirectional case-control study. Exacerbation severity, frequency, further exacerbations over a one-year follow-up period and CCI, COMCOLD, and COTE scores were recorded. High and low comorbidity groups were compared regarding AECOPD frequency, severity, and further exacerbations., Result: Ninety-two patients were enrolled. The frequency of AECOPD was significantly higher in high-comorbidity groups (p= 0.026 for CCI; 0.015 for COTE; 0.012 for COMCOLD) than that in low-comorbidity groups. Severe AECOPD was significantly higher in all high-comorbidity groups according to the indices. Median number of exacerbations during the one-year follow-up period was significantly higher in the high-comorbidity groups defined by CCI [0 (0-4) vs. 1 (0-4), p<0.001 and COMCOLD 0 (0-4) vs. 1 (0-3), p= 0.007]., Conclusions: Comorbidities are among the most important risk factors for AECOPD. Managing comorbidities begins with their identification, followed by appropriate interventions. Therefore, using at least one comorbidity index during assessment ensures that comorbidities are not overlooked during diagnostic and therapeutic processes. CCI, COTE, and COMCOLD comorbidity indices can be used in predicting COPD exacerbations.

Objectives: This study aimed to determine the effect of nurse-based breastfeeding support during the immediate postpartum period on mothers' breastfeeding self-efficacy levels., Methods: A quasi-experimental study was conducted with 256 mothers in the immediate postpartum period (128 in the intervention group who received nurse-based breastfeeding support and routine care and 128 in the control group who received routine care) during February-June 2018. Data were collected using the Mother-Infant Data Sheet, the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), and the Nurse-Parent Support Tool (NPST)., Results: BSES-SF and NPST mean scores of mothers in the intervention group were higher than those of mothers in the control group (p < 0.01). While the association between breastfeeding self-efficacy and nurse support was low in the control group (0.271), it was rather high in the intervention group (0.693) (p < 0.05). It was found that nurse support explained 48% of the variance in breastfeeding self-efficacy in the intervention group, but only 7.3% of the variance in breastfeeding self-efficacy in the control group., Conclusions for Practice: The results of the study indicate that nurse support for mothers in the immediate postpartum period based on breastfeeding training has a positive impact on breastfeeding self-efficacy., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Problem: Preventive and supportive nursing care interventions of school nurses are very important in the early adolescence period, in which the significant physical and sexual changes occur. One ramification of these changes may be social appearance anxiety. This study was carried out to investigate the effects of resilience on social appearance anxiety among early adolescents., Methods: The study was a cross-sectional design. The study data were collected between February and June 2018. Study sample consists of 495 early adolescents studying at a state secondary school in Turkey. The data were gathered using personal information form, Social Appearance Anxiety Scale (SAAS), and Child and Young Resilience Measure (CYRM-12). The data were analyzed using the independent-sample t test, one-way analysis of variance, and multiple linear regression methods., Findings: In the present study, the mean age of early adolescents was found to be 11.90 (1.07) years. The mean scores of students in SAAS and CYRM-12 were 31.79 (13.30) and 52.96 (5.86), respectively. Social appearance anxiety scores of early adolescents were found to have a negative effect on the resilience levels (β = -0.294)., Conclusions: It can be suggested to teach adolescents, the interventions about the use of active coping skills aiming to decrease social appearance anxiety and to increase the resilience., (© 2022 Wiley Periodicals LLC.)

Toxocariasis is a clinical syndrome caused by the larvae of two ascarid nematodes, namely, Toxocara canis and T. cati that live in dogs and cats as definitive hosts. Humans acquire Toxocara infection by accidental consumption of eggs contaminated foods, soil, water or larvae encapsulated in the viscera or meats of various paratenic hosts e.g., chicken. After oral ingestion, the ova hatch and the free larvae penetrate the intestinal wall to migrate to distant tissues throughout the body. Larvae may also infiltrate the intestinal wall and cause enteritis and mass occupying lesions. Here, we present a T. canis related gastroenteritis and peritonitis case successfully treated with albendazole. We reviewed the literature and found seven previously published Toxocara related peritonitis cases. To our knowledge, this is the first review about non-disseminated toxocariasis that restricted to the intestine and presented as eosinophilic ascites due to peritoneal inflammation. The most common abdominal symptoms were abdominal pain and nausea, and the most common findings were eosinophilic infiltrations on endoscopic biopsy specimens and eosinophilia in the peripheric blood samples., (Copyright © 2019. Published by Elsevier B.V.)

Candida bloodstream infections are associated with high mortality among critically ill patients in intensive care units (ICUs). Studies that explore the risk factors for candidemia may support better patient care in intensive care units. We conducted a retrospective, multicenter case-control study to investigate the risk factors for noncatheter-related Candida bloodstream infections (CBSI) in adult ICUs. Participants selected controls randomly on a 1:1 basis among all noncase patients stayed during the same period in ICUs. Data on 139 cases and 140 controls were deemed eligible. Among the controls, 69 patients died. The stratified Fine-Gray model was used to estimate the subdistribution Hazard ratios. The subdistribution hazards and 95% confidence intervals for final covariates were as follows: prior exposure to antimycotic agents, 2.21 (1.56-3.14); prior exposure to N-acetylcysteine, 0.11 (0.03-0.34) and prior surgical intervention, 1.26 (0.76-2.11). Of the patients, those exposed to antimycotic drugs, 87.1% (54/62) had breakthrough candidemia. Serious renal, hepatic, or hematologic side effects were comparable between patients those exposed and not-exposed to systemic antimycotic drugs. Untargeted administration of antimycotic drugs did not improve survival among candidemic patients (not-exposed, 63.6% [49/77]; exposed % 66.1 [41/62]; P = .899). This study documented that exposure to an antifungal agent is associated with increased the risk of subsequent development of CBSIs among nonneutropenic adult patients admitted to the ICU. Only two centers regularly prescribed N-acetylcysteine. Due to the limited number of subjects, we interpreted the positive effect of N-acetylcysteine on the absolute risk of CBSIs with caution., (© The Author(s) 2018. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)

Objectives: Social support may play a role in effective stress management and make a positive contribution to the health of women with breast cancer. The aim of this study was to determine the ways of coping with stress and levels of perceived social support of women with breast cancer, as well as the associated factors., Methods: The descriptive and cross-sectional study was conducted with 100 women with breast cancer at a training and research hospital in Turkey. Data were collected using an information form including sociodemographic and disease characteristics, the Scale of Ways of Coping with Stress, and the Multidimensional Scale of Perceived Social Support., Results: Effective ways of coping with stress were found to be significantly lower in women who were primary school graduates and who did not undergo surgery (P < .05). The women's levels of effective coping with stress decreased with increasing age, and as the score of perceived social support from family and total score of perceived social support increased, so did the levels of effective coping with stress (P < .05). It was determined that social support and age significantly predicted effective stress management (P < .05)., Conclusions: Social support given to women with breast cancer is a key reference point in effective stress management, and increased age also has an important effect on women's ability to cope with stress., (© 2018 John Wiley & Sons, Ltd.)

In this study, we aimed to determine the late relapse rate in hepatitis C patients with sustained virological response after interferon-based regimens, and evaluated the predictors of late relapse while comparing the real-life data of our country with that of others. A multicenter retrospective study was performed to investigate the data of patients infected with HCV who obtained sustained virological response after classical or pegylated interferon alpha (PegIFNα) and ribavirin (RBV) for 48 weeks. Sustained virological response was based on negative HCV RNA level by PCR at the end of six months after the therapy. The information of patients enrolled in the study was retrieved from the hospital computer operating system and outpatient follow-up archives. We evaluated the age, gender, HCV RNA levels, HCV genotype, six-month and further follow-up of patients with sustained virologic response, presence of cirrhosis, steatosis and relapse. In all, 606 out of 629 chronic hepatitis C patients (mean age was 53±12 years; 57.6% of them were female) with sustained virological response were evaluated. We excluded 23 patients who relapsed within six months after the end of treatment (EOT). The mean follow-up period of the patients was 71 months (range: 6-136) after therapy. Late relapse rate was 1.8% (n=11) in all patients. Univariate Cox proportional hazard regression models identified that cirrhosis and steatosis were associated with the late relapse [(p = 0.027; Hazard Ratio (HR) 2.328; 95% confidence interval (CI): 1.309-80.418), (p = 0.021; HR 1.446; 95% CI: 1.243-14.510, respectively]. In multivariable Cox regression analysis, steatosis was the only independent risk factor for late relapse (p = 0.03; HR 3.953; 95% CI: 1.146-13.635). Although the late relapse rate was approximately 2% in our study, clinicians should consider that pretreatment steatosis may be an important risk factor for late relapse.

Bipolar disorder (BP), at the group level, is associated with significant but modest cognitive deficits, including executive dysfunction. Among executive functions, response inhibition deficits have been suggested to be particularly relevant to BP. However, BP is associated with significant heterogeneity in neurocognitive performance and level of functioning. Very few studies have investigated neurocognitive subgroups in BP with data-driven methods rather than arbitrarily defined criteria. Other than having relatively small sample sizes, previous studies have not taken into consideration the neurocognitive variability in healthy subjects. Five-hundred-fifty-six euthymic patients with BP and 416 healthy controls were assessed using a battery of cognitive tests and clinical measures. Neurocognitive subgroups were investigated using latent class analysis, based on executive functions. Four neurocognitive subgroups, including a good performance cluster, two moderately low-performance groups, which differ in response inhibition and reasoning abilities, and a severe impairment cluster were found. In comparison to healthy controls, BP patients were overrepresented in severe impairment cluster (27% vs 5.3%) and underrepresented in good performance cluster. BP patients with lower educational attainment and older age were significantly more likely to be members of cognitively impaired subgroups. Antipsychotic use was less common in good performance cluster. These results suggest that there is a considerable overlap of cognitive functions between BP and healthy controls. Neurocognitive differences between BP and healthy controls are driven by a subgroup of patients who have severe and global, rather than selective, cognitive deficits., (Copyright © 2016 Elsevier B.V. and ECNP. All rights reserved.)

We aimed to investigate the demographic, clinical, diagnostic, treatment and outcome features of patients with urinary tuberculosis (UTB). Patients with UTB admitted to seven separate centers across Turkey between 1995 and 2013 were retrospectively evaluated. The diagnosis of UTB was made by the presence of any clinical finding plus positivity of one of the following: (1) acid-fast bacilli (AFB) in urine, (2) isolation of Mycobacterium tuberculosis, (3) polymerase chain reaction (PCR) for M. tuberculosis, (4) histopathological evidence for TB. Seventy-nine patients (49.36% male, mean age 50.1 ± 17.4 years) were included. Mean time between onset of symptoms and clinical diagnosis was 9.7 ± 8.9 months. The most common signs and symptoms were hematuria (79.7%), sterile pyuria (67.1%), dysuria (51.9%), weakness (51.9%), fever (43%) and costovertebral tenderness (38%). Cystoscopy was performed in 59 (74.6%), bladder biopsy in 18 (22.8%), kidney biopsy in 1 (1.26%) and nephrectomy in 12 (15.2%) patients. Histopathological verification of UTB was achieved in 12 (63.1%) patients who undergone biopsy and in 100% of those undergone nephrectomy. Mycobacterium tuberculosis was isolated in the urine of 50 (63.3%) cases. Four-drug standard anti-TB treatment was the preferred regimen for 87.3% of the patients. Mean treatment duration was 10.5 ± 2.7 months. Deterioration of renal function occurred in 15 (18.9%) patients two of whom progressed to end-stage renal disease and received hemodialysis. Only one patient died after 74-day medical treatment period. Cases with UTB may present with non-specific clinical features. All diagnostic studies including radiology, cyctoscopy and histopathology are of great importance to exclude UTB and prevent renal failure.

The aim of this study was to determine the independent risk factors, morbidity, and mortality of central nervous system (CNS) infections caused by Listeria monocytogenes. We retrospectively evaluated 100 episodes of neuroinvasive listeriosis in a multinational study in 21 tertiary care hospitals of Turkey, France, and Italy from 1990 to 2014. The mean age of the patients was 57 years (range, 19-92 years), and 64% were males. The all-cause immunosuppression rate was 54 % (54/100). Forty-nine (49 %) patients were referred to a hospital because of the classical triad of symptoms (fever, nuchal rigidity, and altered level of consciousness). Rhombencephalitis was detected radiologically in 9 (9 %) cases. Twenty-seven (64 %) of the patients who had cranial magnetic resonance imaging (MRI) performed had findings of meningeal and parenchymal involvement. The mean delay in the initiation of specific treatment was 6.8 ± 7 days. Empiric treatment was appropriate in 52 (52 %) patients. The mortality rate was 25 %, while neurologic sequelae occurred in 13 % of the patients. In the multivariate analysis, delay in treatment [odds ratio (OR), 1.07 [95 % confidence interval (CI), 1.01-1.16]] and seizures (OR, 3.41 [95 % CI, 1.05-11.09]) were significantly associated with mortality. Independent risk factors for neurologic sequelae were delay in treatment (OR, 1.07 [95 % CI, 1.006-1.367]) and presence of bacteremia (OR, 45.2 [95 % CI, 2.73-748.1]). Delay in the initiation of treatment of neuroinvasive listeriosis was a poor risk factor for unfavorable outcomes. Bacteremia was one of the independent risk factors for morbidity, while the presence of seizures predicted worse prognosis. Moreover, the addition of aminoglycosides to ampicillin monotherapy did not improve patients' prognosis.

Objectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A)., Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included., Primary End-Point: 14-day mortality., Secondary End-Points: Microbial eradication and clinical improvement., Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 ± 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis., Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

Twenty-two consecutive carbapenem-resistant enterobacterial isolates were recovered from patients hospitalized between January and April 2013 in different units at a university hospital in Istanbul, Turkey. These were Klebsiella pneumoniae isolates producing the carbapenemases OXA-48, NDM-1, and KPC-2, Enterobacter cloacae isolates producing NDM-1, and Escherichia coli isolates producing OXA-48. Most of the OXA-48-producing K. pneumoniae and all the NDM-1-producing E. cloacae were clonally related. The NDM-1-producing E. cloacae isolates recovered from a single neonatal intensive care unit corresponded to a single cluster, highlighting the spread of that clone in that setting.

Purpose: The aim of this study was to determine the characteristics, risk factors, and quality of life among women presenting at a urology outpatient department for evaluation and management of urinary incontinence (UI)., Methods: The target population comprised women with a complaint of UI during a 1-year period presenting at the urology outpatient department of a training hospital in Ankara, Turkey. A data collection form was developed by the authors based on literature review. Validated instruments, including the International Consultation on Incontinence Questionnaire Short Form and the Incontinence Quality of Life Scale (I-QOL), were included in the questionnaire., Results: Women aged 45 to 54 years made up 36.4% of the sample. Women reported stress UI symptoms (21.8%), urge UI symptoms (23.6%), and mixed UI symptoms (45.5%). Sixty percent stated that they experienced UI episodes several times daily, 38.2% experienced UI in large amounts, and 21.8% had experienced UI for 11 years or longer. Women suffering from UI had a total I-QOL median score of 46.36 (interquartile range = 28.18). It was found that UI moderately affects the quality of life in the Turkish women., Conclusions: Urinary incontinence exerts a major influence on health-related quality of life in affected women. Mixed UI was associated with the greatest level of social embarrassment assessed by the I-QOL.

Nurses who care for dying patients are under pressure emotionally because of their beliefs and values about death as well as the emotions and reactions of the patients and their families. This study examines the emotional difficulties of nurses caring for oncology patients in Turkey. The study used a descriptive survey design. The participants were 157 nurses from three medical oncology units in Ankara. Results showed that nurses had difficulty in talking to oncology patients about end-of-life issues and found that caring for dying patients affected their personal lives. This study also showed that the length of nurses' work experience had no effect on their feelings and perceptions toward terminally ill patients. However, the nurses who had more work experience were more likely to report difficulty in talking to patients. Most of the nurses expressed feelings of inadequacy and hopelessness about pain management and treatments.

Objective: Most of studies about adherence in hypertension highlight the adherence to the medical treatment but do not include the adherence to the other recommendations, such as lifestyle modifications. The factors effective on adherence to each type of recommendation may differ. Accordingly, we aimed in this study to show that nonadherence to each recommendation should be assessed individually., Methods: The study, which was designed as cross-sectional and descriptive, included 150 patients who were followed by the outpatient clinics for at least one year. A data collecting form with 44 questions was prepared by the investigators, and the patient adherence was assessed in five categories: medicine-related adherence, diet-related adherence, exercise-related adherence, measurement-related adherence and smoking related adherence. The face-to-face interview method was used to collect data. Statistical analysis was accomplished by Chi-square test and logistic regression analysis., Results: Of 150 subjects included in the study, 94 (63%) were female and mean age was 56+/- 12 (20-81) years. Mean duration of drug use was 6.5+/- 6.5 years and the mean number of drugs used was 1.6+/- 0.8. The adherence to recommendations of medication, diet, exercise, home-blood measurement and smoking were 72%, 65%, 31% , 63% and 83%, respectively. Each patient was adherent to at least one recommendation, while 11% of patients were adherent to one recommendation, 23% - to two, 29% - to three, 24% - to four and 13% - to five. According to the regression analysis, factors effective on each type of adherence were found to be different from others. The presence of three or more types of adherence was related to income level (OR= 0.297; 95%CI - 0.132-0.666; <0.001) and presence of any other chronic disease (OR=2.329; 95% CI - 1.114-4.859; p=0.002)., Conclusion: The rates of adherence to medicine and life-style changes were generally found to be low in hypertension. The cause of nonadherence is different according to the type of adherence. Each recommendation should be assessed individually in terms of adherence.

In this study we initially have tried to explore the wheat situation in Turkey, which has a small-open economy and in the member countries of European Union (EU). We have observed that increasing the wheat yield is fundamental to obtain comparative advantage among countries by depressing domestic prices. Also the changing structure of supporting schemes in Turkey makes it necessary to increase its wheat yield level. For this purpose, we have used available data to determine the dynamics of wheat yield by Ordinary Least Square Regression methods. In order to find out whether there is a linear relationship among these series we have checked each series whether they are integrated at the same order or not. Consequently, we have pointed out that fertilizer usage and precipitation level are substantial inputs for producing high wheat yield. Furthermore, in respect for our model, fertilizer usage affects wheat yield more than precipitation level.