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Assessment of Breastfeeding Self-Efficacy in Nursing Mothers Following Earthquakes: A Case Study of the Kahramanmaraş Earthquakes in Turkey
(Kashan Univ Medical Sciences, 2025) Dinmez, Sinem Guven; Karaman, Ozen Esra; Bakir, Emine
Background: Natural disasters disproportionately impact vulnerable populations, particularly mothers and infants. Research indicates that during such events, mothers often favor formula and supplementary feeding over breastfeeding. Self-efficacy is a critical determinant influencing breastfeeding practices in disaster contexts.
Objectives: This study aimed to examine the breastfeeding characteristics and self-efficacy of nursing mothers following the Kahramanmara & scedil; earthquakes.
Methods: This descriptive study was conducted at the Children's Polyclinic of Iskenderun State Hospital in Turkey from August 1 to August 31, 2023. A total of 54 mothers with infants aged 0-1 year at the time of the earthquake, who continued to breastfeed (providing breast milk for at least one feeding), were selected using a non-probability purposive sampling method. During the study period, all eligible mothers visiting the polyclinic who met the inclusion criteria were evaluated. Data were collected using a "Descriptive Data Form" and the "Breastfeeding Self-Efficacy Short Form Scale". Statistical analyses were performed using SPSS version 23, employing Independent Samples t-tests, Mann-Whitney U tests, and One-Way ANOVA for group comparisons. A P-value of less than 0.05 was considered statistically significant.
Results: The mean breastfeeding self-efficacy score among mothers was 58 +/- 5.87 (minimum 40; maximum 70). Mothers who exclusively breastfed their infants had significantly higher self-efficacy scores compared to those who introduced formula (P = 0.021) Among the mothers surveyed, 81.5% reported that their breastfeeding was affected by the earthquake; 41% cited issues related to privacy, while 27% faced challenges regarding shelter. Prior to the earthquake, 72% of infants were exclusively breastfed; however, this figure decreased as 81.5% of infants began receiving complementary foods alongside breast milk post-earthquake.
Conclusion: The findings indicate that mothers breastfeeding self-efficacy is at a moderate level. Additionally, mothers reported alterations in their breastfeeding practices compared to the pre-earthquake period. These results underscore the importance of promoting breastfeeding in disaster-affected areas and highlight the critical role of midwives in supporting these efforts.
Efficiency of Mobile-Based AI-Personalized Exercise Program Versus Supervised AI-Personalized Exercise Program in Juvenile Idiopathic Arthritis: A Pilot Study
(Elsevier, 2025) Yekdaneh, A.; Arman, N.; Ayaz, N. Aktay
Motor Imagery-Based Individualized Alpha Transcranial Alternating Current Stimulation: Effects on Brain Oscillations and Motor Function
(Elsevier, 2025) Aktuerka, Tuba; Bingol, Elifnur; Bas, Busra; Varolgunes, Yaren; Karadag, Gizem; Unsal, Esra; Guntekin, Bahar
Ludwig's Angina in a 6-Year Child: Case Report
(Wiley, 2025) Akbari, Negarin; Razavi, Ali; Sabzi, Zahra; Parhiz, Jabbar
Ludwig's angina is a rare but potentially fatal cellulitis that affects the submandibular, sublingual, and submental spaces, typically triggered by dental infections. This case report details a severe presentation of Ludwig's angina in a 6-year-old girl who presented with submandibular swelling, fever, voice alterations, and respiratory distress. Diagnosis was based on clinical evaluation, supported by CT imaging, revealing significant airway narrowing and lymphadenopathy. The patient was promptly intubated to secure the airway, followed by emergency surgical drainage and intravenous antibiotics. Postoperative care included sedation, ongoing monitoring in the PICU, and close follow-up by multiple specialties. After a 10-day hospitalization, the patient showed significant recovery with no complications. The case underscores the importance of early diagnosis and intervention in preventing severe complications such as airway obstruction, sepsis, and mediastinal spread. It highlights the critical role of interdisciplinary collaboration, including pediatric infectious disease specialists, surgeons, and anesthesiologists, in managing this life-threatening condition effectively.
Evaluation of the Relationship Between Job Stress Level, Adherence to the Mediterranean Diet, and Phytochemical Index
(MDPI, 2025) Cetiner Bingul, Bengi; Bas, Murat
Background/Objectives: Job stress negatively affects physical and psychological health and can lead to behavioral changes such as unhealthy eating. This study aimed to evaluate the relationship between job stress levels, adherence to the Mediterranean diet, and the phytochemical index (PI). Methods: The study included 200 healthy individuals aged 18-50 working at the Tuzla Gum Factory. Data were collected through demographic and dietary questionnaires, two-day 24-h food records, PI values, and anthropometric measurements. Job stress was assessed using the Job Stress Scale, and Mediterranean diet adherence was assessed with the Mediterranean Diet Adherence Questionnaire. Results: Waist and hip circumference, waist/hip ratio, and BMI were significantly higher in individuals with high levels of job stress (p < 0.01). Unskilled workers reported higher stress than professionals (p < 0.01). Significant differences were found in carbohydrate and fiber intake among males and in energy, protein, carbohydrate, and vitamin A intake among females with varying stress levels (p < 0.01). No significant difference in Mediterranean diet adherence was observed between medium and high stress groups. However, women had higher adherence and PI scores than men (p < 0.01). Diet adherence was better among managers than service-sales and technical staff (p < 0.01). PI scores were higher in medium stress than high stress individuals (p < 0.05) and in those with a higher BMI compared to a normal BMI (p < 0.01). Conclusions: Job stress influences both anthropometric parameters and dietary habits. Effective stress management may improve adherence to the Mediterranean diet and phytochemical intake. Workplace strategies supporting healthy eating behaviors are recommended.
Prevalence of Fecal Incontinence After Childbirth in Turkey: Systematic Review and Meta-Analysis
(Springer London Ltd, 2025) Kaya, Husniye Dinc; Gunaydin, Sevil; Kilic, Melek; Ozdemir, Iclal Ilknur
BackgroundFecal incontinence (FI), defined as the reduced or lost ability to control the elimination of solid or liquid stool and gas due to anal sphincter dysfunction, is mostly caused by childbirth.AimThis study aimed to determine the prevalence of postpartum fecal incontinence in Turkey.MethodsThis systematic review and meta-analysis were conducted between December 1 and December 31, 2024, considering inclusion and exclusion criteria. The literature search was performed using PubMed, Science Direct, Medline, Ovid, Ebsco CINAHL Plus, and Cochrane Library databases. The methodological quality of the included studies was assessed using the checklist developed by the Joanna Briggs Institute.ResultsA total of six studies were included in this review. The combined results indicated that the prevalence of postpartum fecal incontinence in Turkey is approximately 3%. Women who delivered by cesarean section had significantly lower rates of FI than those who delivered vaginally (z = 3.10, p = 0.002, CI: 0.39 [0.21, 0.71]). Additionally, the combined results of the studies showed no significant relationship between fecal incontinence and menopausal status, indicating that premenopausal and postmenopausal women had similar rates of fecal incontinence (z = 0.02, p = 0.98, CI: 0.97 [0.10, 9.47]).ConclusionFecal incontinence can occur after childbirth. The postpartum fecal incontinence rate in Turkey is 3%, and it is associated with the mode of delivery but not with menopausal status. A thorough postpartum examination is recommended for the early detection of fecal incontinence.PROSPERO Registration No: CRD420250653603.ConclusionFecal incontinence can occur after childbirth. The postpartum fecal incontinence rate in Turkey is 3%, and it is associated with the mode of delivery but not with menopausal status. A thorough postpartum examination is recommended for the early detection of fecal incontinence.PROSPERO Registration No: CRD420250653603.
Biological Activities of Etodolac-Based Hydrazone, Thiazolidinone and Triazole Derivatives on Breast Cancer Cell Lines MCF-7 and MDA-MB
(Wiley, 2025) Sevinc, Sevgi Kocyigit; Cikla-Suzgun, Pelin; Tiber, Pinar Mega; Kucukguzel, S. Guniz; Orun, Oya
In this study, several etodolac-based hydrazone, thiazolidinone, and triazole derivatives that we synthesized and characterized in our earlier research were tested against the hormone-responsive breast cell line MCF-7 and the triple-negative MDA-MB-231, as well as the murine origin fibroblast cell line L-929, at varying doses for their effects on cell viability and toxicity and for their inhibitory activity on cyclooxygenase-2 (COX-2)/prostaglandin E2 (PGE2) formation. Cell viability and apoptosis tests were utilized to assess the anti-cancer potential of etodolac and its derivatives after the cells were exposed to varied concentrations of synthesized compounds for three different time periods. ELISA and Western blot methods were used to detect protein levels. All synthesized compounds demonstrated higher anti-cancer activity at significantly lower doses compared to etodolac (half-maximal inhibitory concentration [IC50] of 0-50 mu M range in derivatives versus 0.5-1 mM range in etodolac). Except for SGK 242, which had a major toxic effect on all cells, the chemicals SGK 206 and SGK 217 had a twice-less impact on control murine L-929 fibroblasts. Similar to proliferation, low concentrations of SGK 206 and SGK 217 (25-50 mu M) significantly induced apoptosis in breast cancer cells but not in normal cells. Additionally, they inhibited COX-2 protein expression at 50 mu M, and SGK 206 inhibited PGE2 release more effectively than etodolac in cancer cells. The results of this study suggest that, in comparison to a healthy control group, the thiazolidinone derivative SGK 206 and the thiazolidinone derivative SGK 217 are more effective than etodolac when it comes to the breast cancer cell lines MCF-7 and MDA-MB-231. SGK 206 exhibits a low IC50 value, a distinct dose-response relationship, and strong apoptotic effects, particularly on MDA-MB-231 cells.
Twenty-Year Course of Antifungal Resistance in Candida Albicans in Türkiye: A Systematic Review and Meta-Analysis
(MDPI, 2025) Kilbas, Imdat; Kahraman Kilbas, Elmas Pinar; Horhat, Florin George; Ciftci, Ihsan Hakki
This study aimed to systematically evaluate the resistance rates of Candida albicans to various antifungals based on studies conducted in Turkiye and published between 2005 and 2025 and to analyze the factors contributing to resistance. A systematic literature search was conducted using various keywords in electronic databases (PubMed, Embase, Web of Science, EBSCO, Scopus, Turk Medline and Google Scholar). A total of 42 studies were included in the meta-analysis according to the determined criteria. The quality of the studies was assessed using the Joanna Briggs Institute checklist, and the analyses were performed using appropriate statistical software. The highest resistance rates for fluconazole, itraconazole, and voriconazole were observed in the Aegean and Marmara regions. In the analyses performed with the random-effects model, heterogeneity was found to be high for itraconazole, fluconazole, posaconazole, voriconazole, and caspofungin, and the strongest explanatory variable of this heterogeneity was the geographical region variable. In our study, we determined that antifungal resistance in C. albicans strains in Turkiye is generally low; however, an increasing trend has been observed over the years, especially in amphotericin B resistance. Although the low resistance rates to major antifungal agents such as fluconazole, voriconazole and echinocandins are promising, regional differences and methodological heterogeneity necessitate the development of treatment strategies based on local data.
A Bibliometric Analysis of Nursing Research in the Field of Refugee Health Between 1980 and 2024
(Wiley, 2025) Ozturk, Gizem; Dikec, Gul; Harmanci Seren, Arzu Kader
Aim This study aimed to examine the bibliographic characteristics of publications on refugees in the nursing field.Design A bibliometric analysis design was adopted for the study.Sample Included the articles scanned in the Web of Science Core Collection database. The study excluded the other databases and gray literature.Measurements The 2120 articles published between 1980 and 2024 that met the inclusion criteria were analyzed using Bibliometrix in RStudio, VOSviewer, and Microsoft Excel software.Results The majority of publications were published in 2024. The United Kingdom, the United States, Canada, and Australia have the highest publications, citations, and international cooperation. Additionally, "mental health" is one of the most frequently used keywords in studies.Conclusions The increased migration rates and the growing need for healthcare for refugees underscore the importance of investing in nursing research within this field. Nurses and researchers should establish partnerships and share best practices with leading countries.
How Have Occupational Therapy Services Been Delivered During the COVID-19 Pandemic
(Nova Southeastern Univ., 2024) Yucel, Hulya; Aydoner, Selen
The provision of traditional healthcare services has encountered obstacles due to the Coronavirus Disease-2019 (COVID-19) pandemic. The inability of healthcare professionals and clients to survive the pandemic and the inadequacy of personal protective equipment have created uncertainties regarding the appropriate practices for addressing individuals' health conditions. Furthermore, the field of rehabilitation, including occupational therapy, has experienced changes in the delivery of traditional practices. Therefore, this review aimed to examine occupational therapy services delivered during the COVID-19 pandemic. As a result of the literature review, the most commonly provided services by occupational therapists during COVID-19 were discussed and a total of 87 references were accessed. These services were grouped under the headings of acute/intensive care unit, post-COVID-19, telerehabilitation, preventive mental health, school-based occupational therapy, occupational therapy education, and ergonomics. It was seen that occupational therapists had several challenges during the pandemic. They had to adapt their interventions according to the new conditions and so they have frequently used technology. It is crucial for the effectiveness of the rehabilitation that occupational therapy services continue in challenging and unexpected situations such as the COVID-19 pandemic. It is necessary to strengthen future occupational therapy practices based on standards through collaboration among occupational therapists. It is believed that this review will shed light on the role and importance of occupational therapy during the challenging COVID-19 pandemic.
Synergistic Effects of Amniotic Membrane and Human Milk Exosomes on Burn Wound Healing
(Elsevier Sci Ltd, 2025) Isik, Ferda; Tufan, Elif; Sivas, Guzin Goksun; Ak, Esin; Muhan, Aleyna; Sener, Goksel; Tunali-Akbay, Tugba
Background: Thermal burns are one of the most common burns. Studies are ongoing to develop synthetic or biological wound dressings to ensure painless and scarless healing of burn wounds. Objectives: This study aimed to combine the human amniotic membrane with breast milk-based exosomes and investigate their effects on burn wound healing. Methods: 24 Wistar Albino rats weighing 200-250 g and of both genders were used. Rats were divided into control, burn, burn+human amniotic membrane (hAM) and burn+hAM+Exosomes (hAM+Exo) groups. Burn injury was induced by exposing the back of rats to 90 degrees C water for 10 s. Rats were treated with hAM and hAM+ Exo for seven days after injury. At the end of the 7th day, the skin samples were taken and analyzed biochemically and histologically. TNF-alpha, IL-1(i, type III collagen, malondialdehyde (MDA), glutathione (GSH), total protein, superoxide dismutase (SOD), and tissue factor (TF) activity were determined in skin samples. Results: In the burn group, skin TNF-alpha levels increased, IL-1(i and type III collagen levels decreased. Wound healing therapy reversed these results. In the hAM+Exo group, the TNF-alpha level was lower, and IL-1 beta and type III collagen levels were higher than in the hAM group. MDA and total protein levels increased, and GSH, tissue factor, and SOD activities decreased in the burn group. In hAM and hAM+Exo groups, MDA levels decreased, and GSH and SOD activity increased compared to the burn group. The GSH levels were significantly higher in the hAM+Exo group compared to the hAM group. Conclusion: In conclusion, combining exosomes and amniotic membrane induced changes consistent with better wound healing than amniotic membrane alone.
Novel Triazole-Urea Hybrids as Promising EGFR Inhibitors: Synthesis, Molecular Modeling and Antiproliferative Activity Studies Against Breast Cancer
(Elsevier, 2025) Ture, Asli; Gulcan, Mehmet Metehan; Birgul, Serap Ipek Dingis; Erdogan, Oguz; Erdogan, Omer; Tuncay, Fulya Oz; Kucukguzel, Ilkay
Breast cancer is the second leading cause of mortality among women globally. In this study, novel promising urea derivatives containing a 4-phenyl-5-sulphanylidene-4,5-dihydro-1H-1,2,4-triazole group were synthesized and evaluated for their biological activities against breast cancer. The cytotoxicity and apoptotic profiles of these compounds were assessed on the MCF7 breast cancer cell line and the L929 fibroblast cell line. Compound 5c exhibited the strongest anticancer activity against MCF7 cells with an IC50 value of 56.97+4.22 mu M, while it showed significantly lower cytotoxicity against L929 cells (IC50 = 1651+18.39 mu M). Compound 5c also induced early apoptosis in MCF7 cells, with an apoptosis rate of 18.40% and 5.28%, respectively. Additionally, the EGFR inhibitory activities of the synthesized compounds were evaluated, with compound 5i demonstrating the most potent EGFR inhibition, showing an IC50 value of 35.1 nM. These results suggest that compound 5c likely exerts its anticancer effects through mechanisms other than EGFR inhibition, while compound 5i has significant potential as an effective EGFR inhibitor. Molecular modeling studies were conducted to suggest putative binding interactions of compounds 5d, 5e and 5i with wildtype hEGFR. Further studies are warranted to explore their activity against other cancer types.
Gait Dynamics and Locomotor Function in Familial Mediterranean Fever: A Comparative Study with Healthy Peers
(Elsevier, 2025) Seker, A. Namli; Albayrak, A.; Yekdaneh, A.; Akgun, O.; Ayaz, N. Aktay
TiO2@ZIF-8 Hybrid as a Type II Heterojunction Photocatalyst:Adsorption/Photocatalytic Properties, Kinetics, and Effect of Humidity
(Springernature, 2025) Okte, A. Neren; Tuncel, Duygu
TiO2@ZIF-8 hybrid and its humidified forms are synthesized as type 2 heterojunction systems using a facile sol-gel method at different relative humidity (RH) conditions. The hybrids' surface characteristics and optical properties are thoroughly examined, followed by investigations into adsorption capacities and photocatalytic activities using anionic-methyl orange (MO) and cationic-methylene blue (MB) dyes. TiO2@ZIF-8 hybrid generates a mesoporous structure with a higher surface area (135.6 m2 g-1) than bare TiO2 (40.1 m2 g-1). Band gap energies of TiO2@ZIF-8 (3.00 eV) and humidified hybrids (2.95-2.91 eV) decrease compared to the individual phases of TiO2 (3.08 eV) and ZIF-8 (4.9 eV). XPS analysis verifies the electron donation from ZIF-8 to TiO2. Adsorptions of MO and MB differ depending on the affinities of MO or MB's functional groups on the TiO2@ZIF-8 and humidified hybrids. TiO2@ZIF-8 demonstrates 98.7% MO and 89.5% MB degradations within 100 min irradiation. Dark adsorption studies follow Langmuir model with Langmuir constants of KL = 0.445 L mg-1 for MO in the presence of TiO2@ZIF-8 and KL = 0.409 L mg-1 for MB in the presence of TiO2@ZIF-8 (84% RH). Meanwhile, pseudo-second-order kinetic model is applicable for dark experiments with rate constants of k2 = 0.918 g mg-1 min-1 for MO in the existence of TiO2@ZIF-8 and k2 = 0.917 g mg-1 min-1 for MB in the existence of TiO2@ZIF-8 (84% RH). Under irradiation, TiO2@ZIF-8 (84% RH) has higher first-order rate constant 'k' values for both MO (0.0134 min-1) and MB (0.0146 min-1) relative to that of TiO2@ZIF-8 (0.0129 min-1 for MO and 0.0112 min-1 for MB). Based on Langmuir-Hinshelwood model, TiO2@ZIF-8 (84% RH)) shows the highest adsorption coefficients (K) of 0.164 L mg-1 for MO and 0.192 L mg-1 for MB and rate constants (k) of 0.197 mg L-1 min-1 for MO and 0.182 mg L-1 min-1 for MB. Notably, the hybrids maintain high stability and photocatalytic efficiency after four consecutive degradation cycles, highlighting their potential for sustainable environmental remediation.
The Moderating Role of Gender in Perceived Discrimination Levels and Political Participation of Turkish Women
(Walter de Gruyter Gmbh, 2025) Ozkilicci, Gokce; Yamaner, Onur
This study explores the relationship between women's political participation, perceived discrimination, and gender dynamics in Turkey. Political participation embodies an individual's aspiration to influence societal transformation and contribute to decision-making processes that shape communities. However, women's engagement in these processes has long been hindered by deeply rooted societal norms and systemic barriers. The primary objective of this research is to examine how perceived discrimination impacts women's political participation and to assess whether gender perceptions moderate this relationship. Data were collected from 313 female university students aged 18-58, utilizing the Political Participation Scale, Gender Perception Scale, and Perceived Discrimination Index. The results demonstrated a significant positive correlation between perceived discrimination and political participation, with gender perception acting as a key moderator. Women with stronger gender equality beliefs were more likely to recognize discrimination and engage in political activities. These findings emphasize the critical role of cultural, educational, and institutional strategies in enhancing women's political visibility and addressing systemic barriers. The study provides a robust foundation for developing egalitarian policies to promote women's active participation in politics, fostering a more inclusive democratic landscape.
Technical Approaches for Preservation of the Temporalis Muscle in Neurosurgery: A Systematic Review
(Lippincott Williams & Wilkins, 2025) Azab, Mohammed A.; Sarhan, Khalid; Atallah, Oday; Hernandez-Hernandez, Alan; Ibrahim, Ismail A.; Shama, Mohsen Nabih; Kammoun, Brahim
Background:The temporalis muscle is commonly dissected and mobilized during craniotomy. Cosmetic and functional complications may arise from the improper handling of this muscle. Surgery for recurrent pathologies may be challenging due to adhesions and muscle damage.Material and methods:A systematic review following PRISMA guidelines was conducted to consolidate literature on the potential techniques used for preserving the temporalis muscle during neurosurgical interventions. PubMed, Scopus, and Web of Science were systematically searched using predefined criteria from inception to 2025. A qualitative synthesis was done summarizing the primary cranial pathology, type of surgical approach, the technical clue for temporalis muscle preservation, follow up and complications.Results:We included 27 eligible articles with a total number of 811 patients. About 508 (62.6%) of patients underwent pterional approach, while 150 (18.4%) patients had decompressive craniotomies. Aneurysm clipping was the surgical indication in 172 (21.2%) patients, while decompressive surgery was done for traumatic brain injuries in about 48 (5.9%) patients. Osteoplastic temporalis muscle flap was used in 178 (21.9%) patients, while some authors sutured the temporalis muscle to the cranioplasty plate in 79 (9.7%) patients. Fixation of the temporalis muscle to the bone using sutures through small holes was done in 100 (12.33%) patients. No chewing problems were recorded among all the patients analyzed. Temporalis muscle atrophy was observed in only 13 (1.6%) patients.Conclusion:Proper manipulation of the temporalis muscle during surgery is crucial for the vitality of its fibers and to prevent postoperative functional or cosmetic drawbacks.
Development of the Pediatric Physical Activity Tracking Platform (Pedi@Ctivity) and Smartwatch-Based Big Data Analysis: A Digital Health Application in Society 5.0
(Elsevier, 2025) Arman, N.; Cakar, T.; Gullu, S.; Ayaz, N. Aktay; Yekdaneh, A.; Albayrak, A.
The Effect of Compulsory Citizenship Behaviors on Subjective Vitality Among Nurses
(Wiley, 2025) Elibol, Esengul; Yildiz, Bora; Seren, Arzu Kader Harmanci
Aim The study aims to assess the extent of compulsory citizenship behaviors (CCBs) and their impact on the nurses' subjective vitality based on self-determination theory. Background CCBs are harmful to both nurses and organizations. These behaviors mean employees are expected to perform additional tasks outside their job descriptions. Although CCBs are highlighted within the recent nursing literature, empirical evidence of their effects is lacking. Methods This is descriptive cross-sectional research. The study included 244 staff nurses using a convenience sampling method who worked in two hospitals in Istanbul. Data were collected via a survey consisting of a personal information form, the compulsory citizenship scale, and the subjective vitality scale. STROBE guidelines were followed when reporting the study. Descriptive statistical analyses, independent samples t-test, one-way ANOVA test, Pearson's correlation, and hierarchical simple linear regression analyses were used. Results The participants' mean scores for compulsory citizenship and subjective vitality were 3.34 out of 5 (SD = 1.05) and 4.15 out of 7 (SD = 1.36), respectively. Nurses' compulsory citizenship scores significantly differed according to their education level, income, and sector. Their subjective vitality scores statistically differed according to their income levels. Regression analysis revealed that CCBs were significant negative predictors of subjective vitality (beta = -0.22, p < 0.01). Conclusion By examining the CCBs and subjective vitality relationship, the current study extended the existing knowledge by drawing attention to the destructive and harmful effects of CCBs on positive psychological sources of nurses' subjective vitality. CCBs negatively predicted subjective vitality. Clinical Relevance Organizational factors such as CCBs, which leads to a lack of autonomy, affect nurses' well-being, thus affecting care quality and patient safety. As the International Council of Nurses mentioned, "Nurses cope with many physical, mental, emotional, and ethical challenges. It is essential that we address these challenges in a way that supports their overall health". In this regard, managers and policymakers in hospitals should develop preventive cautions for CCBs. However, in-service training activities should be carried out to increase awareness about the harmful effects of CCBs on nurses' psychological well-being.
Evaluation of the Barriers to Maintenance 4.0 for the Textile Industry via Pythagorean Fuzzy SWARA
(MDPI, 2025) Turan, Hakan; Buyukselcuk, Elif Caloglu
Maintenance 4.0 studies have become a focus for managers and employees when developing effective and efficient maintenance policies. In this study, the barriers to Maintenance 4.0 applications in the textile industry are investigated, and these barriers are weighted using the Stepwise Weight Assessment Ratio Analysis (SWARA) method based on Pythagorean fuzzy numbers. Solutions to address these barriers are presented. As a result of this study, Organizational and Managerial emerged as the most important main criterion. Operational was identified as the second most significant main criterion, followed by Technical Competence. Data-Related and Cybersecurity ranked fourth in terms of importance. On the other hand, Human Resources and Training and Financial were found to be the least important main criteria. These two criteria received lower importance scores compared to the others, with Financial being the criterion with the lowest overall significance. Sensitivity analyses were performed for six different scenarios by changing the importance weights of the decision-makers. The ranking of the criteria only slightly changed with the weights; this means that the results obtained in Case 1 are robust and reliable. Even in Case 6, where the expert weight ratios were completely reversed, the results did not change significantly. This highlights an important point regarding the reliability of the assessment.
Is It Fear or Pain Understanding It's Impact on Physical Performance and Rumination in Children with Rheumatic Diseases
(Elsevier, 2025) Donmez, I.; Arman, N.; Yekdaneh, A.; Albayrak, A.; Acikgoz, Y.; Ayaz, N. Aktay

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