Turkiye Klinikleri Journal of Nursing Sciences

.: ORIGINAL RESEARCH
Tip 2 Diabetes Mellituslu Bireylerde Hipoglisemi Korkusu ile Uyku Kalitesi Arasındaki İlişki: Tanımlayıcı ve İlişki Arayıcı Çalışma
The Relationship Between Fear of Hypoglycemia and Sleep Quality in Individuals with Type 2 Diabetes Mellitus: Descriptive and Relationship Seeking Study
Fatma GÜNDOĞDUa , Muhammet Cemal KIZILARSLANOĞLUb , Serap SAYARa
aKTO Karatay Üniversitesi Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, Cerrahi Hastalıkları Hemşireliği ABD, Konya, Türkiye
bSağlık Bilimleri Üniversitesi Konya Şehir Hastanesi, Geriatri BD, Konya, Türkiye
Turkiye Klinikleri J Nurs Sci. 2024;16(1):219-26
doi: 10.5336/nurses.2023-99282
Article Language: TR
Full Text
ÖZET
 Amaç: Bu araştırma, Tip 2 diabetes mellituslu (DM) bireylerde hipoglisemi korkusu ile uyku kalitesi arasındaki ilişkiyi değerlendirmek amacıyla tanımlayıcı ve ilişki arayıcı türde yapıldı. Gereç ve Yöntemler: Araştırmanın evrenini İç Anadolu Bölgesi'nde bir kamu hastanesinde Tip 2 DM tanısıyla 20 Haziran-31 Ekim 2022 tarihleri arasında polikliniğe başvuran hastalar, örneklemini ise bu tarih aralığında araştırmaya katılmaya gönüllü olarak kabul eden ve dâhil edilme kriterlerine uyan 199 hasta oluşturdu. Verilerin toplanmasında ''kişisel bilgi formu'', ''Hipoglisemi Korku Ölçeği (HKÖ)'' ve ''Pittsburgh Uyku Kalite İndeksi (PUKİ)'' kullanıldı. Verilerin analizinde, normalite test sonuçlarına göre parametrik ve nonparametrik testler, korelasyon testi ve çoklu doğrusal regresyon analizleri kullanıldı. p<0,05 anlamlı kabul edildi. Bulgular: Hastaların HKÖ toplam puan ortalamasının 35,44±24,60, PUKİ global uyku puanı ortalamasının 5,43±3,29 puan olduğu ve %57,28'inin PUKİ global uyku puanının kötü uyku kalitesi göstergesi olan ≥5 puan olduğu belirlendi. HKÖ ile PUKİ global uyku puanı öznel uyku kalitesi, gündüz işlev bozukluğu, uyku bozukluğu, uyku ilacı kullanımı puanları arasında pozitif yönlü ilişki olduğu saptandı (tüm parametreler için p<0,05). Sonuç: Araştırmanın sonucunda Tip 2 DM'si olan bireylerde uyku kalitesinin kötü olduğu, hipoglisemi korkusu ile uyku kalitesi arasında ilişki olduğu, hipoglisemi korkusu arttıkça uyku kalitesinin olumsuz yönde etkilenebileceğine yönelik sonuçlar elde edildi.

Anahtar Kelimeler: Diabetes mellitus; hipoglisemi; korku; uyku kalitesi
ABSTRACT
 Objective: This descriptive and correlational study was conducted to evaluate the relationship between fear of hypoglycemia and sleep quality in individuals with Type 2 diabetes mellitus (DM). Material and Methods: The population of the study consisted of the patients who applied to the outpatient clinic with a diagnosis of Type 2 DM in a public hospital in the Central Anatolian Region between June 20 and October 31, 2022, and the sample consisted of 199 patients who voluntarily accepted to participate in the study and met the inclusion criteria. ''Personal information form'', ''Hypoglycemia Fear Scale (HFS)'' and ''Pittsburgh Sleep Quality Index (PSQI)'' were used for data collection. Parametric and nonparametric tests, correlation test and multiple linear regression analysis were used to analyze the data according to normality test results. p<0.05 was considered significant. Results: The mean total HFS score of the patients was 35.44±24.60, the mean PSQI global sleep score was 5.43±3.29 points, and 57.28% had a PSQI global sleep score of ≥5 points, which is an indicator of poor sleep quality. It was found that there was a statistically significant positive correlation between the HFS and PSQI global sleep score subjective sleep quality, daytime dysfunction, sleep disturbance, and sleep medication use scores (all had p<0.05). Conclusion: As a result of the study, it was concluded that sleep quality was poor in individuals with Type 2 DM, there was a relationship between fear of hypoglycemia and sleep quality, and sleep quality was negatively affected as the fear of hypoglycemia increased.

Keywords: Diabetes mellitus; hypoglycemia; fear; sleep quality
REFERENCES:
  1. Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40-50. [Crossref]  [PubMed] 
  2. Araszkiewicz A, Bandurska-Stankiewicz E, Borys S, Budzyński A, Cyganek K, Cypryk K, et al. 2021 Guidelines on the management of patients with diabetes. A position of Diabetes Poland. Clin Diabetol. 2021;10(1):1-113. [Crossref] 
  3. Ratzki-Leewing A, Harris SB, Mequanint S, Reichert SM, Belle Brown J, Black JE, et al. Real-world crude incidence of hypoglycemia in adults with diabetes: Results of the InHypo-DM Study, Canada. BMJ Open Diabetes Res Care. 2018;6(1):e000503. [Crossref]  [PubMed]  [PMC] 
  4. Emral R, Tetiker T, Sahin I, Sari R, Kaya A, Yetkin İ, et al; IO HAT investigator group. An international survey on hypoglycemia among insulin-treated type I and type II diabetes patients: Turkey cohort of the non-interventional IO HAT study. BMC Endocr Disord. 2018;18(1):9. [Crossref]  [PubMed]  [PMC] 
  5. Nakhleh A, Shehadeh N. Hypoglycemia in diabetes: An update on pathophysiology, treatment, and prevention. World J Diabetes. 2021;12(12):2036-49. [Crossref]  [PubMed]  [PMC] 
  6. Rossi MC, Nicolucci A, Ozzello A, Gentile S, Aglialoro A, Chiambretti A, et al; HYPOS-1 Study Group of AMD. Impact of severe and symptomatic hypoglycemia on quality of life and fear of hypoglycemia in type 1 and type 2 diabetes. Results of the Hypos-1 observational study. Nutr Metab Cardiovasc Dis. 2019;29(7):736-43. [PubMed] 
  7. Green MJ, Espie CA, Popham F, Robertson T, Benzeval M. Insomnia symptoms as a cause of type 2 diabetes Incidence: a 20 year cohort study. BMC Psychiatry. 2017;17(1):94. [Crossref]  [PubMed]  [PMC] 
  8. Luyster FS, Dunbar-Jacob J. Sleep quality and quality of life in adults with type 2 diabetes. Diabetes Educ. 2011;37(3):347-55. [Crossref]  [PubMed]  [PMC] 
  9. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. [Crossref]  [PubMed] 
  10. Sakamoto R, Yamakawa T, Takahashi K, Suzuki J, Shinoda MM, Sakamaki K, et al. Association of usual sleep quality and glycemic control in type 2 diabetes in Japanese: A cross sectional study. Sleep and Food Registry in Kanagawa (SOREKA). PLoS One. 2018;13(1):e0191771. [Crossref]  [PubMed]  [PMC] 
  11. Gül Ş, Duru Aşiret G, Okatan C. Tip 2 diyabetes mellituslu bireylerin hipoglisemi korkusunun incelenmesi [Examination of hypoglisemia fear of patients with type 2 diabetes mellitus]. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektron Derg. 2021;14(3):179-87. [Crossref] 
  12. Suteau V, Saulnier PJ, Wargny M, Gonder-Frederick L, Gand E, Chaillous L, et al; VARDIA study group. Association between sleep disturbances, fear of hypoglycemia and psychological well-being in adults with type 1 diabetes mellitus, data from cross-sectional VARDIA study. Diabetes Res Clin Pract. 2020;160:107988. [Crossref]  [PubMed] 
  13. Fallah LY, Namdar P, Jalalpour A, Talebi F, Mafi MH. The relationship between fear of hypoglycemia and sleep quality among type 2 diabetic patients. Clin Diabetol. 2021;10(1):149-54. [Crossref] 
  14. Cox DJ, Irvine A, Gonder-Frederick L, Nowacek G, Butterfield J. Fear of hypoglycemia: quantification, validation, and utilization. Diabetes Care. 1987;10(5):617-21. [Crossref]  [PubMed] 
  15. Erol O, Enc N. Hypoglycemia fear and self-efficacy of Turkish patients receiving insulin therapy. Asian Nurs Res (Korean Soc Nurs Sci). 2011;5(4):222-8. [Crossref]  [PubMed] 
  16. Ağargün MYA, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi İndeksi 'nin geçerliği ve güvenirliği [The validity and reliability of the Pittsburgh Sleep Quality Index]. 1996;7(2):107-15. [Link] 
  17. Zoungas S, Patel A, Chalmers J, de Galan BE, Li Q, Billot L, et al; ADVANCE Collaborative Group. Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010;363(15):1410-8. [Crossref]  [PubMed] 
  18. Yuksel M, Bektas H. Compliance with treatment and fear of hypoglycaemia in patients with type 2 diabetes. J Clin Nurs. 2021;30(11-12):1773-86. [Crossref]  [PubMed] 
  19. Çalışkan SG, Hacıağaoğlu N, Tuzun S, Öner C, Şimşek EE, Çetin H. Diyabet merkezden takipli tip 2 diabetes mellitus hastalarında hipoglisemi sıklığı ve hipoglisemi korkusu [The frequency of hypoglycemia and hypoglycemia fear in Type 2 diabetes mellitus patients with followed-up from diabetes center]. Turkish J Fam Med Prim Care. 2022;16(4):681-9. [Crossref] 
  20. Martyn-Nemeth P, Phillips SA, Mihailescu D, Farabi SS, Park C, Lipton R, et al. Poor sleep quality is associated with nocturnal glycaemic variability and fear of hypoglycaemia in adults with type 1 diabetes. J Adv Nurs. 2018;74(10):2373-80. [Crossref]  [PubMed]  [PMC] 
  21. Sakane N, Kotani K, Tsuzaki K, Nishi M, Takahashi K, Murata T, et al. Fear of hypoglycemia and its determinants in insulin-treated patients with type 2 diabetes mellitus. J Diabetes Investig. 2015;6(5):567-70. [Crossref]  [PubMed]  [PMC] 
  22. Mehrdad M, Azarian M, Sharafkhaneh A, Alavi A, Zare R, Hassanzadeh Rad A, et al. Association between poor sleep quality and glycemic control in adult patients with diabetes referred to endocrinology clinic of guilan: a cross-sectional study. Int J Endocrinol Metab. 2021;20(1):e118077. [Crossref]  [PubMed]  [PMC] 
  23. Birhanu TT, Hassen Salih M, Abate HK. Sleep quality and associated factors among diabetes mellitus patients in a follow-up clinic at the university of gondar comprehensive specialized hospital in gondar, northwest ethiopia: a cross-sectional study. Diabetes Metab Syndr Obes. 2020;13:4859-68. [Crossref]  [PubMed]  [PMC] 
  24. Wu C, Wang W, Cheng S, Zhang H, Li L, Tian C, et al. The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis. BMC Psychiatry. 2023;23(1):204. [Crossref]  [PubMed]  [PMC] 
  25. Bayrak M, Çadirci K. Quality of sleep in elderly patients with diabetes mellitus from Turkey: a cross-sectional observational study. Exp Aging Res. 2022;48(4):373-86. [Crossref]  [PubMed] 
  26. Bener A, Al-Hamaq AOAA, Agan AF, Öztürk M, Ömer A. Sleeping disturbances and predictor risk factors among type 2 diabetic mellitus patients. Ann Afr Med. 2020;19(4):230-6. [Crossref]  [PubMed]  [PMC] 
  27. Gjerløw E, Bjørgaas MR, Nielsen EW, Olsen SE, Asvold BO. Fear of hypoglycemia in women and men with type 1 diabetes. Nurs Res. 2014;63(2):143-9. [Crossref]  [PubMed] 
  28. Zhang Y, Li S, Zou Y, Wu X, Bi Y, Zhang L, et al. Fear of hypoglycemia in patients with type 1 and 2 diabetes: a systematic review. J Clin Nurs. 2020. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

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