Ambient air pollution remains an environmental health concern, yet national evidence in Türkiye integrating multiple pollutants, WHO guideline exceedance, mortality patterns, and monitoring network changes is limited. We analyzed seven annual observations (2018–2024) for PM10, SO2, CO, NO2, and O3. For each pollutant-year, the national indicator was the unweighted mean of eligible station annual means from official bulletins; mortality outcomes were crude national rates. Linear trends were estimated by OLS regression and assessed alongside Mann–Kendall tests, Sen’s slopes, and strict common-station sensitivity analyses. PM2.5 was excluded because monitoring coverage and annual reporting were not sufficiently comparable across years. PM10 decreased from 50.4 to 41.0 µg/m3 and SO2 from 13.2 to 8.5 µg/m3, with significant negative linear trends. The all-station NO2 indicator increased from 29.2 to 34.4 µg/m3, but its linear trend was not statistically significant (slope = 0.879 µg/m3/year; p = 0.055) and was absent in the common-station analysis (slope = −0.021; p = 0.950). PM10 guideline exceedance remained nearly universal, and NO2 exceedance remained high. Among mortality outcomes, only neoplasm mortality declined significantly. Air quality trends were pollutant-specific and, for NO2, sensitive to monitoring network composition. The ecological design does not permit causal inference regarding pollutant–mortality relationships.
Ömer Acat, Sibel Acat, Okan Imre· Atmosphere· 0 citations
Background: In primary care settings, cervical cancer screening and prevention are highly dependent on healthcare provider initiatives, particularly in countries like Türkiye where the HPV vaccine is not yet integrated into the national routine immunization schedule. Since HPV vaccines provide over 90% protection against cervical cancer, the proactive guidance of primary care providers is critical. This study evaluated family physicians’ knowledge levels and awareness of HPV infection and human papillomavirus (HPV) vaccines in primary care settings in Türkiye. Methods: A total of 238 family physicians working in Türkiye participated in this descriptive cross-sectional study using a convenience sampling method. Data were collected through an online questionnaire administered via Google Forms. The survey included a sociodemographic information form and a 33-item HPV knowledge scale. Data were analyzed using descriptive statistics, normality assessment, chi-square test, Mann–Whitney U test, Kruskal–Wallis test, and hierarchical logistic regression analysis. Results: Overall, 81.1% of participants recommended the HPV vaccine, and 83.6% believed it should be included in the national schedule. Notably, only 15.1% of the participating physicians had received the HPV vaccine themselves, whereas 40.6% of the unvaccinated subgroup (82/202) stated they were considering personal vaccination. HPV knowledge levels were generally high, but lower when regarding the current national program. Vaccine recommenders and female participants had significantly higher knowledge scores, while out-of-pocket vaccine cost emerged as a major barrier to clinical recommendation. In multivariable hierarchical logistic regression, individual knowledge domains did not emerge as independent standalone predictors after controlling for demographics, with only knowledge of the current national program showing a borderline trend (p = 0.066), although the inclusion of the knowledge variables as a collective block significantly improved the overall model explanatory power (p = 0.003). Conclusions: Family physicians in Türkiye showed generally high HPV-related knowledge and a high rate of HPV vaccine recommendation. This study clarifies that primary care advocacy is shaped by the combined influence of professional knowledge and overriding structural factors, rather than individual knowledge domains acting as independent standalone predictors. While future strategies must focus on developing targeted continuous medical education to bridge specific knowledge gaps and optimize opportunistic counseling, achieving optimal immunization coverage ultimately relies on integrating the vaccine into national programs to mitigate out-of-pocket cost barriers.
F. Yurdakul, Ömer Acat, Latife Uzun· Healthcare· 0 citations
