Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Sağlıklı Bireylerde Cinsiyetler Arasındaki Kalp Hızı Değişkenliği Farklılıklarının Yaşa Göre Değişimi: Kesitsel Araştırma
Changing in Gender Differences in Heart Rate Variability in Healthy Human According to Age: Cross-Sectional Study
Gurbet Özge MERTa, Erdi BABAYİĞİTb, Selda MURATa, Muhammet DURALa, Kadir Uğur MERTa
aEskişehir Osmangazi Üniversitesi Tıp Fakültesi, Kardiyoloji ABD, Eskişehir, TÜRKİYE
bKulu Devlet Hastanesi, Kardiyoloji Bölümü, Konya, TÜRKİYE
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(3):126-34
doi: 10.5336/cardiosci.2021-82115
Article Language: TR
Full Text
ÖZET
Amaç: Kalp hızı değişkenliği (KHD), otonom sinir sistemi dinamiklerini değerlendirmede kullanılabilecek bir dizi parametreden oluşmaktadır. KHD'nin yaşa göre ve cinsiyetler arasında farklılık gösterdiği biliniyorken; cinsiyetler arasındaki farklılığın yaş ilerledikçe gösterdiği seyir hakkında yeterli veri bulunmamaktadır. Çalışmamızda, sağlıklı kadınlar ve erkeklerdeki KHD parametrelerinin, yaşa göre değişimini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışma; 01.01.2016 tarihinden 30.01.2018 tarihine kadar Eskişehir Osmangazi Üniversitesi Kardiyoloji Polikliniğine başvuran 1.833 hastanın geriye dönük 24 saatlik ambulatuvar Holter elektrokardiyogram verilerinin incelenmesi ile gerçekleştirildi. Sağlıklı bireyler olarak değerlendirilen ve 20 saatten uzun kaydı olan 477 kişi çalışmaya dâhil edildi. Hastaların dk'daki ortalama, minimum ve maksimum kalp hızı (KH), KHD parametrelerinden SDNN, SDNN indeks, rMSSD, pNN50, yüksek frekans [high frequency (HF)], düşük frekans [low frequency (LF)], çok düşük frekans değerleri, LF/HF oranları kaydedildi. Yaşa ve cinsiyete göre gruplar oluşturulduktan sonra istatistiksel analiz yapıldı. Bulgular: Hastaların, KHD parametreleri yaş gruplarına göre değerlendirildiğinde, tüm parametrelerde gruplar arasında istatistiksel olarak anlamlı düzeyde farklılık izlendi (p<0,001). KH dışında tüm parametreler, kadınlarda erkeklere göre düşük saptandı. Cinsiyetler arası farklılıkların ise 60 yaşından sonra tamamen ortadan kalktığı gözlendi. Sonuç: Çalışmamızda, yaş ilerledikçe hem KHD'de düşüklük olduğu hem de cinsiyetlere bağlı farklılıkların 60 yaşından sonra kaybolduğu gözlendi. Kadınlarda daha yüksek KH ve düşük KHD olmasına rağmen kalbin otonomik regülasyonu parasempatik sistem kontrolünde saptandı.

Anahtar Kelimeler: Kalp hızı değişkenliği; seks karakteristikleri; yaşlanma; kalp hızı
ABSTRACT
Objective: Heart rate variability (HRV) consist of parameters which can be helpful for assesment of autonomic nervous system dynamics. Whilst it is known that HRV varies according to age and between genders; there is scant data regarding how the sex differences run its course with age. We aimed to evaluate variation of gender differences in HRV with age in healthy humans. Material and Methods: This study was based on retrospective analysis of the data recorded by 24-hours ambulatory Holter electrocardiograms of around 1,833 patients, who applied to Cardiology Policlinics in Eskişehir Osmangazi University from 01.01.2016 to 30.01.2018. 477 subjects, who were assessed as healthy humans and had over 20 hours of recordings, were included. Mean, minimum and maximum heart rate (HR), SDNN, SDNN index, rMSSD, pNN50, high frequency (HF), low frequency (LF), very low frequency values, LF/HF ratios of patients were noted. Groups according to age and genders were created and statistical analysis was performed subsequently. Results: Statistically significant difference was observed between the groups according to age in all HRV parameters (p<0.001). All parameters except mean HR, were lower in women compared to men. It was observed that the differences in terms of gender completely disappeared after the age of 60. Conclusion: In addition to lower HRV parameters in older age groups; it was also observed that the differences according to gender completely vanished after the age of 60 in our study. Autonomic regulation of the heart was detected under the control of the parasympathetic system in women; despite the higher HR and lower HRV parameters.

Keywords: Heart rate variability; sex characteristics; aging; heart rate
REFERENCES:
  1. Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Front Psychol. 2014;5:1040. [Crossref]  [PubMed]  [PMC] 
  2. McCraty R, Mike A, Tomasino D, Bradley R. The coherent heart heart-brain interactions, psychophysiological coherence, and the emergence of system-wide order. Integral Review. 2009;5(2). [Link] 
  3. Segerstrom SC, Nes LS. Heart rate variability reflects self-regulatory strength, effort, and fatigue. Psychol Sci. 2007;18(3):275-81. [Crossref]  [PubMed] 
  4. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93(5):1043-65. [PubMed] 
  5. Hopkins D, Ellenberger H. Cardiorespiratory neurons in the medulla oblongata: Input and output relationships. In: Armour JA, Ardell JL, eds. Neurocardiology. 1st ed. New York: Oxford University Press; 1994. p.219-44. [Link] 
  6. Malliani A. Association of heart rate variability components with physiological regulatory mechanisms. In: Malik M, Camm AJ, eds. Heart Rate Variability. New York: Futura Publishing Company; 1995. p.173-88. [Link] 
  7. McCraty R, Shaffer F. Heart rate variability: New perspectives on physiological mechanisms, assessment of self-regulatory capacity, and health risk. Glob Adv Health Med. 2015;4(1):46-61. [Crossref]  [PubMed]  [PMC] 
  8. Umetani K, Singer DH, McCraty R, Atkinson M. Twenty-four hour time domain heart rate variability and heart rate: relations to age and gender over nine decades. J Am Coll Cardiol. 1998;31(3):593-601. [Crossref]  [PubMed] 
  9. Braune HJ, Geisendörfer U. Measurement of heart rate variations: Influencing factors, normal values and diagnostic impact on diabetic autonomic neuropathy. Diabetes Res Clin Pract. 1995;29(3):179-87. [Crossref]  [PubMed] 
  10. Vinik AI, Maser RE, Mitchell BD, Freeman R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26(5):1553-79. [Crossref]  [PubMed] 
  11. Wolf MM, Varigos GA, Hunt D, Sloman JG. Sinus arrhythmia in acute myocardial infarction. Med J Aust. 1978;2(2):52-3. [Crossref]  [PubMed] 
  12. Koenig J, Thayer JF. Sex differences in healthy human heart rate variability: A meta-analysis. Neurosci Biobehav Rev. 2016; 64:288-310. [Crossref]  [PubMed] 
  13. Dekker JM, Schouten EG, Klootwijk P, Pool J, Swenne CA, Kromhout D. Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men. The Zutphen Study. Am J Epidemiol. 1997;145(10):899-908. [Crossref]  [PubMed] 
  14. Tsuji H, Venditti FJ Jr, Manders ES, Evans JC, Larson MG, Feldman CL, et al. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation. 1994;90(2):878-83. [Crossref]  [PubMed] 
  15. Dart AM, Du XJ, Kingwell BA. Gender, sex hormones and autonomic nervous control of the cardiovascular system. Cardiovasc Res. 2002;53(3):678-87. [Crossref]  [PubMed] 
  16. Du XJ, Fang L, Kiriazis H. Sex dimorphism in cardiac pathophysiology: Experimental findings, hormonal mechanisms, and molecular mechanisms. Pharmacol Ther. 2006;111(2): 434-75. [Crossref]  [PubMed] 
  17. Sloan RP, Huang MH, McCreath H, Sidney S, Liu K, Dale Williams O, et al. Cardiac autonomic control and the effects of age, race, and sex: The CARDIA study. Auton Neurosci. 2008; 139(1-2):78-85. [Crossref]  [PubMed]  [PMC] 
  18. Aviado DM, Guevara Aviado D. The Bezold-Jarisch reflex. A historical perspective of cardiopulmonary reflexes. Ann N Y Acad Sci. 2001;940:48-58. [Crossref]  [PubMed] 
  19. Mark AL. The Bezold-Jarisch reflex revisited: Clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol. 1983;1(1):90-102. [Crossref]  [PubMed] 
  20. Airaksinen KE, Ikäheimo MJ, Linnaluoto M, Tahvanainen KU, Huikuri HV. Gender difference in autonomic and hemodynamic reactions to abrupt coronary occlusion. J Am Coll Cardiol. 1998;31(2):301-6. [Crossref]  [PubMed] 
  21. Du XJ, Riemersma RA, Dart AM. Cardiovascular protection by oestrogen is partly mediated through modulation of autonomic nervous function. Cardiovasc Res. 1995; 30(2):161-5. [Crossref]  [PubMed] 
  22. Rogers RC, Hermann GE. Hypothalamic paraventricular nucleus stimulation-induced gastric acid secretion and bradycardia suppres sed by oxytocin antagonist. Peptides. 1986;7(4):695-700. [Crossref]  [PubMed] 
  23. Higa KT, Mori E, Viana FF, Morris M, Michelini LC. Baroreflex control of heart rate by oxytocin in the solitary-vagal complex. Am J Physiol Regul Integr Comp Physiol. 2002;282(2): R537-45. [Crossref]  [PubMed] 
  24. Landgraf R, Neumann ID. Vasopressin and oxytocin release within the brain: A dynamic concept of multiple and variable modes of neuropeptide communication. Front Neuroendocrinol. 2004;25(3-4):150-76. [Crossref]  [PubMed] 
  25. Kirsch P, Esslinger C, Chen Q, Mier D, Lis S, Siddhanti S, et al. Oxytocin modulates neural circuitry for social cognition and fear in humans. J Neurosci. 2005;25(49):11489-93. [Crossref]  [PubMed]  [PMC] 
  26. Viviani D, Charlet A, van den Burg E, Robinet C, Hurni N, Abatis M, et al. Oxytocin selectively gates fear responses through distinct outputs from the central amygdala. Science. 2011;333(6038):104-7. [Crossref]  [PubMed] 
  27. Ramaekers D, Ector H, Aubert AE, Rubens A, Van de Werf F. Heart rate variability and heart rate in healthy volunteers. Is the female autonomic nervous system cardioprotective? Eur Heart J. 1998;19(9):1334-41. [Crossref]  [PubMed] 
  28. Bonnemeier H, Richardt G, Potratz J, Wiegand UK, Brandes A, Kluge N, et al. Circadian profile of cardiac autonomic nervous modulation in healthy subjects: differing effects of aging and gender on heart rate variability. J Cardiovasc Electrophysiol. 2003;14(8):791-9. [Crossref]  [PubMed] 
  29. Hayano J, Ohashi K, Yoshida Y, Yuda E, Nakamura T, Kiyono K, et al. Increase in random component of heart rate variability coinciding with developmental and degenerative stages of life. Physiol Meas. 2018;39(5): 054004. [Crossref]  [PubMed] 
  30. Oppenheimer S, Hopkins D. Suprabulbar neuronal regulation of the heart. In: Armour JA, Ardell JL, eds. Neurocardiology. 1st ed. New York: Oxford University Press; 1994. p.309-341. [Link] 
  31. Thayer JF, Hansen AL, Saus-Rose E, Johnsen BH. Heart rate variability, prefrontal neural function, and cognitive performance: the neurovisceral integration perspective on self-regulation, adaptation, and health. Ann Behav Med. 2009;37(2):141-53. [Crossref]  [PubMed] 
  32. Chow GV, Marine JE, Fleg JL. Epidemiology of arrhythmias and conduction disorders in older adults. Clin Geriatr Med. 2012;28(4): 539-53. [Crossref]  [PubMed]  [PMC] 
  33. Koenig J, Jarczok MN, Warth M, Ellis RJ, Bach C, Hillecke TK, et al. Body mass index is related to autonomic nervous system activity as measured by heart rate variability--a replication using short term measurements. J Nutr Health Aging. 2014;18(3):300-2. [Crossref]  [PubMed] 
  34. Windham BG, Fumagalli S, Ble A, Sollers JJ, Thayer JF, Najjar SS, et al. The relationship between heart rate variability and adiposity differs for central and overall adiposity. J Obes. 2012;2012:149516. [Crossref]  [PubMed]  [PMC] 
  35. Rennie KL, Hemingway H, Kumari M, Brunner E, Malik M, Marmot M. Effects of moderate and vigorous physical activity on heart rate variability in a British study of civil servants. Am J Epidemiol. 2003;158(2):135-43. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com