Objective: The aim of this study was to investigate patients’ use of cytisine prescribed as a smoking cessation medication, the frequency of observed side effects, and smoking cessation rates at the Marmara University Family Medicine Smoking Cessation Clinic, thereby laying the groundwork for future research on cytisine use in Turkey. Methods: The descriptive study included 256 participants who applied to the Marmara University Department of Family Medicine’s Smoking Cessation Clinic between May 2024 and March 2025 and underwent cytisine treatment. Participants’ sociodemographic characteristics, smoking status, cytisine use, and treatment processes were retrospectively collected via a questionnaire administered through telephone interviews. Tobacco dependence level was assessed using the Fagerström nicotine dependence test (FNDT). The dependent variable of the study is smoking cessation status; the independent variables are age, gender, education level, smoking burden, medication completion, and attendance at follow-up appointments. Data were analyzed using SPSS 25.0 software, and p<0.05 was considered statistically significant. Results: The average age of participants was 40.7±0.9 years, the average FNDT score was 6.3±2.2, and the average smoking burden (pack/year) was 24.9±1.3. In our study, 31% of individuals who initiated cytisine treatment were not smoking at follow-up. The proportion of participants who remained non-smoking status at assessment was significantly higher among those with lower smoking burden, those who attended follow-up appointments, those with higher perceived income, and those who completed the medication (p=0.027, p=0.035, p≤0.001, p=0.020). In multivariable analysis, higher perceived income independently predicted non-smoking status at follow-up (aOR=1.91, p=0.004), whereas treatment completion showed borderline significance. At least one side effect was observed in 31.5% (n=79) of participants; the most commonly reported were nausea (10.2%), palpitations (3.9%), dizziness (3.5%), and mood changes (3.5%). Conclusion: In this real-world clinical setting, 31% of patients receiving cytisine were classified as non-smokers at follow-up. In the context of limited national data, these results offer exploratory evidence to guide the design of future randomized controlled trials.

Objective: This study aimed to evaluate the relationship between family physicians' anxiety about medical errors and their attitudes towards defensive medicine by measuring their malpractice fear and defensive medicine behaviors. Method: This descriptive study included 395 family physicians working in family health centers in İstanbul/Türkiye. The study's data was collected via an online questionnaire, which included 58 items. The questionnaire included four sections: a sociodemographic form, Malpractice Knowledge Level Form, Malpractice Fear Scale, and Defensive Medicine Behavior Scale. Spearman’s correlation coefficient and Mann-Whitney U, chi-square, and Fisher’s exact tests were used in data analysis. p<0.05 was considered a statistically significant level. Results: Of the physicians, the mean age was 38.07 years (SD=8.42 years), and 55.6% (n=219) were female. The mean duration of working as a physician was 7.38 years (SD=4.40 years), ranging from 1 to 38 years. The proportion of participants who complained due to malpractice was 12.2%, and 28.4% had received education on medical errors. The proportion of physicians with a high level of malpractice fear was 74.4%. The mean correct response rate on the Malpractice Knowledge Level Form was 69.44 (SD=13.21), with 62.9% having a sufficient knowledge level. Low-level but statistically significant negative correlations were found between increasing age and defensive medicine attitudes and malpractice fears (p<0.05 for all). Also, moderate and high levels of positive correlations were found between defensive medicine practice scores and malpractice fear scores (p<0.05 for all). Conclusion: The study showed that increased fear of medical errors causes defensive medicine attitudes among family physicians. As both malpractice fear and defensive medicine practices decrease with increasing age, young physicians should receive education to foster better patient communication without anxiety. Legal reforms and health policies that reduce the pressure physicians feel from medical error anxiety are necessary.

Objectives: In this study, it was aimed to evaluate the effect of structured short motivational interviewing in exercise and diet-related behavioral changes in type 2 diabetes patients in primary care. Methods:Participants were divided into control and intervention groups.The study was single-blinded, and only the researchers know the participants in each group.The intervention group received a motivating interview-based intervention a total of 4 times in the 1st month of the study and followed up in the 3 rd month.The control group was followed by family physicians and evaluated at 3 months without any motivational intervention.One-week pedometer, international physical activity questionnaire (IPAQ2) scores, daily calorie intake, EuroQol (EQ5D), multidimensional diabetes questionnaire (MDQ), and motivational assessment scale were used at the beginning of the study and the 3 rd -month follow-up. Results:The study included 84 (51.5%) participants in the intervention group and 79 (48.5%) patients in the control group.There was a significant difference between the control and intervention groups in terms of a 1-week pedometer ( 2785.0 [1002.0-7240.0]step/day vs. 5231.0[1364.0-11827.0]step/day, p<0.001),IPAQ2 scores (0.0 [0.0-1056.0] vs. 495.0[0.0-1396.0],p<0.001),EQ5D scale total scores (5.0 [5.0-10.0] vs. 5.0 [5.0-8.0],p=0.006), and MDQ scale total scores (607.0 [244.0-847.0]vs. 730.0[235.0-847.0],p<0.001) at the 3rd-month follow-up. Conclusion:A structured motivational interviewing model that can be used in primary care may be effective in developing lifestyle changes in type 2 diabetes mellitus patients.

Amaç: Ani ve hızlı bir çevre değişimi yaratan, böylece sosyal, kültürel ve fiziksel olarak toplumu ve bireyleri etkileyen göç, sağlık ve sağlık değişkenleri üzerinde de çok önemli etkilere sahiptir. Çalışmamızın amacı, Suriyeli sığınmacılarda kronik hastalık prevalansı ve kronik hastalığı olanların mevcut sağlık hizmetlerinden faydalanabilme durumlarını tespit etmektir. Yöntem: Çalışmamız kesitsel bir çalışmadır. Urfa ilinde Suriyeli misafirler koordinasyon merkezinde bulunan kayıtlardan saptanan verilere göre, göçmenlerin en yoğun yaşadığı mahalle olarak belirlenen Kurtuluş mahallesi seçilmiştir. Bu mahalleden randomize olarak 30 sokak seçilmiş ve seçilen her bir sokaktan rasgele belirlenen 7 hanede yaşayan 18 yaş üstü bireyler çalışmanın örneklemini oluşturmuştur. Seçilen her bir haneye ziyaret yapılarak, Arapça ve Kürtçe bilen tercüman eşliğinde tüm hane halkı hakkında kronik hastalıklara yönelik bilgi toplanmıştır. Bulgular: Toplamda 210 hanede yaşayan, 18 yaş üzeri 617 kişiye ulaşılmıştır. 40 yaş üzeri katılımcıların %27,8’inde, 65 yaş üzerinde ise %65,2’sinde en az bir kronik hastalığın var olduğu, saptanmıştır. Bu rakam tüm katılımcılar arasında %15,2’dir. Görüşülen kişilerin %40’ı sağlık hizmeti alabildiğini, %13,8’i gereksinim duyduğunda aile hekimine ulaşabildiğini belirtmiştir. Kronik hastalığı nedeniyle sağlık hizmetine başvuranların %76,5’i devlet hastanesine, %15,3’ü özel sağlık merkezine başvurmuştur. Sonuç: Çalışmamızda kronik hastalık görülme prevalansı literatürde bildirilen oranlardan nispeten düşük saptanmıştır. Suriyeli sığınmacıların kronik hastalıkları nedeniyle neredeyse hiçbir zaman birinci basamak sağlık hizmetlerinden yararlanmadıkları, hizmet ihtiyaçlarını ağırlıklı hastanelerden karşıladıkları görülmektedir. Suriyeli sığınmacıların kronik hastalıklarının yönetiminde birinci basamağının rolünü artıracak ve birinci basamak sağlık hizmetine ulaşımlarını kolaylaştıracak planlamalara ihtiyaç vardır.

Aim:Family health centers (FHCs) are reimbursed for their current expenditures based on a classification of four clusters in Turkey. This study compared the coordination, comprehensiveness, continuity, accessibility, and the first contact of care among different reimbursement FHC groups.Methods:The data were obtained from the Turkish data of the Quality and Costs of Primary Care in Europe study. Data was collected in provinces from six geographical regions. Physicians and patients from Classes A and B FHCs were called the first group, and others were called the second group.Results:A total of 296 physicians and 2623 patients were enrolled. According to the reimbursement groups, 593 (22.6%) patients received services from the first group and 2012 (77.4%) patients from the second group. The first contact with care and the admission frequency of 3 or more in the last six months were higher in the first group (respectively, 99.2% vs. 97.7%, p=0.027; 55.4% vs. 49.6%, p=0.015).Conclusion:The reimbursement classification did not make a difference in coordination, comprehensive care, continuity, accessibility, and being the first contact of care. Therefore, the current classification does not contribute to improving the quality of primary care in terms of service provision.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Patient Activation Measure (PAM) measures the activation level of patients with chronic conditions and correlates well with patient adherence behavior, health outcomes, and healthcare costs. PAM is increasingly used in practice to identify patients needing more support from the care team. We define PAM levels 1 and 2 as low PAM and investigate the performance of eight machine learning methods (Logistic Regression, Lasso Regression, Ridge Regression, Random Forest, Gradient Boosted Trees, Support Vector Machines, Decision Trees, Neural Networks) to classify patients. Primary data collected from adult patients (n=431) with Diabetes Mellitus (DM) or Hypertension (HT) attending Family Health Centers in Istanbul, Turkey, is used to test the methods. 44.5% of patients in the dataset have a low PAM level. Classification performance with several feature sets was analyzed to understand the relative importance of different types of information and provide insights. The most important features are found as whether the patient performs self-monitoring, smoking and exercise habits, education, and socio-economic status. The best performance was achieved with the Logistic Regression algorithm, with Area Under the Curve (AUC)=0.72 with the best performing feature set. Alternative feature sets with similar prediction performance are also presented. The prediction performance was inferior with an automated feature selection method, supporting the importance of using domain knowledge in machine learning.

Population Medicine considers the following types of articles:• Research Papers -reports of data from original research or secondary dataset analyses.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.These include both systematic reviews and narrative reviews.• Short Reports -brief reports of data from original research.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Methodology Papers -papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.

Objective: Knee osteoarthritis (OA) is a very common joint disease and obesity is accepted as a modifiable risk factor for knee OA. This study aims to reduce OA symptoms with dietary intervention that will provide at least 10% body weight loss in volunteers diagnosed as having knee OA and obesity. Methods: As an open, uncontrolled randomized study, it was conducted with patients admitted to Istanbul Fatih Sultan Mehmet Hospital. Fourty volunteers (mean of age: 58 +/- 10.9 years, 4 males, 36 females) having knee OA grade 22 according to Kellgren-Lawrence radiological classification and obesity [body mass index (BMI) 230 kg/m(2)] were included in the study. Individuals were given a diet program containing 50-60% carbohydrate, 15-20% protein and 25-30% fat for 16 weeks, and they were planned to lose weight and followed up. WOMAC OA index was used for the evaluation of pain, stiffness and physical functions. Results: After 16 weeks, individuals lost an average of 7.5% of their weight. A decrease of 2.75 kg/m(2) was observed in the BMI (p<0.05). A significant reduction was observed between the first and the last WOMAC pain scores (p<0.05). A significant relationship was also found between the decrease in BMI and the decrease WOMAC score (p<0.05). Conclusion: The decrease of 2.75 kg/m(2) in BMI and the weight loss of 7.5% provided decrease in ViWOMAC pain score. Weight loss should be the optimal approach in the management of obese patients with knee OA.

Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.

In this study, we investigate chemical and isotopic characteristics of low-temperature geothermal waters issuing from carbonate reservoirs in the Çürüksu Graben within the eastern termination of the Büyük Menderes Graben in western Turkey. Temperatures and pH values of geothermal waters vary from 20.1 to 24.6 °C and 6.62 to 7.11 and those of cold waters are 17.1 to 19.9 °C and 6.85 to 7.72, respectively. Geothermal waters are of Ca-HCO3 and Ca-SO4 types whereas cold waters are characterized by these two types and Mg-HCO3 as well. δ18O and δD values of samples vary from ?9.27‰ to -7.69‰ (VSMOW) and -58.06‰ to -52.2‰ and indicate a meteoric origin with local recharge. Tritium contents are from 0.12 to 2.17 TU for thermal waters and 0.28 to 4.85 TU for the cold waters implying relatively longer residence time for the hot waters. Thermal water samples mostly have positive δ13C values (varying from ?0.32‰ to +1.99‰) and carbon in these waters is likely derived from marine limestone or metamorphic CO2. δ34S and δ18O values of dissolved sulfate in the waters indicate that sulfur originates from dissolution of marine evaporite deposits (e.g., gypsum). Çürüksu waters are generally oversaturated with respect to calcite, dolomite and quartz but undersaturated with respect to gypsum. Common ion effect exerted a strong control for the formation of travertine deposits in the area. Chemical and isotopic evaluations indicated that the diversity in the water chemistry of samples is attributed to a combination of processes including water-rock interaction, ion exchange and mixing of various types of waters. Çürüksu thermal waters are immature and not in chemical equilibrium with the reservoir rock. Among the various geothermometers applied to Çürüksu thermal waters, temperatures computed by chalcedony, quartz and Ca- Mg geothermometers are 21-52 °C, 49-83 °C and 73-96 °C, respectively. HCO3-SO4-F and anhydrite-chalcedony (quartz) diagrams estimated a temperature range of 63?86 °C and δ18O(SO4-H2O) isotope geothermometer yielded 67-78 °C.

We report the learnings gleaned from a four-country panel (Australia, South Africa, Egypt and Nigeria) sharing their countries’ COVID-19 primary healthcare approaches and implementation of policy at the World Organization of Family Doctor’s World virtual conference in November. The countries differ considerably with respect to size, national economies, average age, unemployment rates and proportion of people living rurally. South Africa has fared the worst with respect to waves of COVID-19 cases and deaths. All countries introduced strategies such as border closure, COVID-19 testing, physical distancing and face masks. Australia and Nigeria mobilised primary care, but the response was mostly public health and hospital-based in South Africa and Egypt. All countries rapidly adopted telehealth. All countries emphasised the critical importance of an integrated response between primary care and public health to conduct surveillance, diagnose cases through testing, provide community-based care unless hospitalisation is required and vaccinate the population to reduce infection spread.

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