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Objective: It has been reported that energy drink usage is increasing worldwide despite reports of severe adverse health effects. This study aimed to explore pre-clinical medical students' attitudes and perceptions in relation to energy drinks.Materials and Methods: This was a questionnaire-based descriptive study of pre-clinical medical students attending a public medical school in Istanbul, Turkey. Questions covered the students' sociodemographic characteristics, personal habits (e.g., smoking and alcohol consumption), energy drink perceptions and energy drink consumption, and their experience of side effects from energy drinks. Chi-square tests were used to compare the categorical data.Results: The mean age of the participants was 21.27 ± 1.37 (range: 19-28) years, and 54.0% (n: 81) were females and 46.0% (n: 69) were males. Overall, 68.0% (n: 102) reported that they had consumed an energy drink at least once in their lives, with 29.4% of these reporting use in combination with alcohol, 22.6% reporting use before exams, 20.6% reporting use before a physical activity, 13.7% reporting use to relieve fatigue, and 48.0% reporting that they had only tried an energy drink out of curiosity.Conclusion: A large number of participants tried energy drinks out of curiosity, but energy drink consumption was quite common in combination with alcohol. Case studies are needed to provide detailed information on the actual adverse health effects of energy drinks, but in the meantime, energy drink consumption should not be encouraged. Health care providers should educate children and families for the adverse effects of energy drinks.

Background Patient activation (PA), which is known to improve health outcomes, describes the knowledge, skills and confidence a person has in managing their own health care. We investigated the extent of PA and associated factors in adults with diabetes (DM) and/or hypertension (HT). This study is the first in Turkey evaluating PA, using the Patient Activation Measure (PAM) scale. The results of the study provide practitioners with information on the characteristics of patients who need support to increase their activation. Methods We conducted this cross-sectional study in 14 Family Health Centers in Istanbul. The participants were DM and/or HT patients. A questionnaire including the PAM, questions on patient characteristics, life style behaviors, healthcare utilization and health status was applied to 431 patients. Based on PAM score, patients were classified into two activation levels: level 1-2 (poor activation) and level 3-4 (good activation). χ2, t-test and logistic regression (LR) analysis were used. LR analysis was performed for all participants and for women and men separately. Results Of 431 patients (mean age: 63.6), 65% were women; 45% had a poor activation level (PAL). Based on LR analysis; low socioeconomic status (SES) (OR = 1.6; 95% CI:1.01-2.5), being illiterate (OR = 3.9, 95% CI: 1.5-10.7), being primary school graduate (OR = 2.1, 95% CI:1.1-4.2), lack of adult vaccination (OR = 1.9, 95% CI:1.1-3.1), higher BMI (OR = 1.1, 95% CI: 1.09-1.13) and worse self-reported health (OR = 1.2, 95% CI: 1.1-1.3) were factors associated with low PAL. The latter was associated with low PAL for both sexes; high BMI was an associated factor only among women, while low SES and lack of vaccination were factors only in men. Conclusions Almost half of the patients had low activation level in our sample. Associated factors may serve as the basis for the development of interventions needed to enhance activation for patients with DM/HT. Key messages Low patient activation is associated with low level of education, low SES, high BMI, lack of vaccination and worse self-reported health. The factors associated with patient activation vary by gender. A qualitative study with patients having different levels of activation would be useful to understand the underlying motivations.

Background/aim: The Zurich Chronic Middle Ear Questionnaire (ZCMEI-21) is a newly-developed German-language questionnaire. The purpose of this study was to analyze the quality of life (QoL) of chronic otitis media (COM) patients and translate, transculturally adapt, and validate the ZCMEI-21 into Turkish. Materials and methods:Based on internationally accepted guidelines, the ZCMEI-21 was translated into Turkish. To assess its validity, the total score of the ZCMEI-21-Tur was compared to the scores taken from the original validation study and a question that was directly related to the health-related QoL (HRQoL), as well as the general criterion EQ-5D-5L. Questionnaires were completed by healthy volunteers and the results were evaluated statistically.Results: A total of 80 COM patients and 40 healthy volunteers were prospectively enrolled in this study. Regarding internal consistency, the questionnaire showed a Cronbach α of 0.94, which indicated high internal consistency. Moreover, internal consistency was also determined to be excellent for the Cronbach α of the individual subscales, as follows: ear sign symptoms, 0.79; hearing, 0.83; psychosocial impact, 0.91, and medical resources, 0.84. Conclusions:The ZCMEI-21 was translated into Turkish and validated. Therefore, the ZCMEI-21-Tur was suitable for use in assessing HRQoL in adult patients with COM.