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Determination of Human Papilloma Virus (HPV) awareness and vaccination status of women in the 18-49 age group
No full textHPV, servikal kanser başta olmak üzere diğer kanser türlerine de neden olabilen tüm ülkeleri ilgilendiren önemli bir sağlık sorunudur. Araştırma, 18-49 yaş grubundaki kadınların Human Papilloma Virüsü (HPV) farkındalık ve aşılanma durumlarının belirlenmesi amacıyla yapıldı. Biruni Üniversitesi Tıp Fakültesi Hastanesi ve Acıbadem Bakırköy Hastanesine Eylül 2024- Ocak 2025 arasında başvuran 18-49 yaş arasındaki araştırmaya katılmayı kabul eden 319 kadın ile gerçekleştirildi. Veriler Kişisel Bilgi Formu, Aşılanma ve Human Papilloma Virüsü (HPV) Bilgisi Ölçeği (The VaccinaTion & Hpv Knowledge (THinK)) kullanılarak yüz yüze görüşme yöntemiyle elde edildi. Araştırmaya katılan kadınların %41.5'inin lisans düzeyinde eğitim almış olduğu, %57.9'unun evli, %90.6'sının HPV aşısı olmadığı görüldü. Kadınların Aşılama ve HPV Bilgisi Ölçeğine ilişkin ortalama puanı 55.20±9.38 (min-maks.: 21-65) olduğu tespit edildi. Aşılar Hakkında Genel Bilgi alt boyutuna ilişkin ortalama puanın 22.10±3.34 (min-maks.: 10-25) olduğu, HPV Enfeksiyonu Hakkında Genel Bilgi alt boyutuna ilişkin ortalama puanı 20.79±4.98 (min-maks.: 5-25) olduğu, HPV'ye Karşı Aşılanmaya Yönelik Tutum alt boyutuna ilişkin ortalama puanı 13.31±3.56 (min-maks.: 3-15) olduğu belirlendi. Araştırmaya katılan kadınların aşılama ve HPV bilgisi düzeylerinin yaş, eğitim durumu, medeni durum değişkenlerine göre farklılaştığı saptandı. HPV farkındalığının kazandırılmasında ve aşılanma sürecinde hemşirelere önemli görevler düşmektedir. HPV ve HPV aşısı konusunda tüm topluma, özellikle adolesanlara eğitimler verilmesi önem arz etmektedir.HPV is a significant public health issue concerning all countries, as it can lead to cervical cancer as well as other types of cancer. This study was conducted to determine the awareness and vaccination status of women aged 18–49 regarding Human Papilloma Virus (HPV). It was carried out with 319 women aged 18–49 who applied to Biruni University Faculty of Medicine Hospital and Acıbadem Bakırköy Hospital between September 2024 and January 2025 and agreed to participate in the study. Data were collected through face-to-face interviews using the Personal Information Form and the Vaccination and Human Papilloma Virus (HPV) Knowledge Scale (The VaccinaTion & HPV Knowledge (THinK)). It was found that 41.5% of the participating women had undergraduate-level education, 57.9% were married, and 90.6% had not received the HPV vaccine. The women's average score on the Vaccination and HPV Knowledge Scale was found to be 55.20±9.38 (min-max: 21– 65). The average score for the subdimension General Knowledge About Vaccines was 22.10±3.34 (min-max: 10–25), the average score for the subdimension General Knowledge About HPV Infection was 20.79±4.98 (min-max: 5–25), and the average score for the subdimension Attitude Toward Vaccination Against HPV was 13.31±3.56 (min-max: 3–15). It was determined that the levels of vaccination and HPV knowledge among the participating women varied according to age, education level, and marital status. Nurses have important roles in increasing HPV awareness and in the vaccination process. It is crucial to provide education about HPV and the HPV vaccine to the entire population, especially adolescents
The examination of the relationship between sensory processing, leisure activities, and sleep quality in obese adolescents
No full textÇalışmanın amacı, obez adölesanların duyusal işlemleme becerileri, serbest zaman aktiviteleri ve uyku kaliteleri arasındaki ilişkiyi incelemektedir. Çalışmaya 33 obez/aşırı kilolu adölesan 33 normal kilolu toplamda 66 adölesan katılmıştır. Çalışmaya katılan adölesanlara sosyodemografik bilgi formu doldurulup bilgileri alındıktan sonra Adölesan Yetişkin Duyu Profili Anketi, Kanada Aktivite Performans Ölçeği-serbest zaman aktiviteleri, Pittsburgh Uyku Kalite İndeksi uygulanmıştır. Çalışmanın sonuçlarına göre; AYDP sonuçları incelendiğinde obez/aşırı kilolu grup ve normal kilolu grup arasında duyusal hassasiyet ve duyusal kaçınma parametrelerinde anlamlı bir sonuç bulunmştur (P 0,05). PUKİ sonuçları incelendiğinde; uyku latansı, uyku süresi, uyku bozukluğu parametrelerinde anlamlı farklılık görülmezken (P > 0,05) puki toplam, öznel uyku kalitesi, alışılmış uyku etkinliği, uyku ilacı kullanımı, gündüz işlev bozukluğu parametrelerinde obez/aşırı kilolu adölesanların puanlarının normal kilolu adölesanların puanlarına göre daha yüksek olduğu görülmüştür (P 0,05). Bu çalışma obez adölesanlarda duyusal işlemleme, serbest zaman aktiviteleri ve uyku kalitesi arasındaki ilişkiyi inceleyen ilk çalışmadır. Konu ile ilgili farklı çalışmalar yapılması önerilmektedir. Anahtar Kelimeler: Adölesan; Duyusal İşlemleme; Obezite; Serbest Zaman Aktiviteleri; Uyku KalitesiThe aim of the study is to examine the relationship between sensory processing abilities, leisure activities, and sleep quality in obese adolescents. A total of 66 adolescents participated in the study, including 33 obese/overweight adolescents and 33 normal-weight adolescents. After completing a sociodemographic information form, the Adolescents Adult Sensory Profile (AASP), the Canadian Activity Performance Scale - Leisure Activities, and the Pittsburgh Sleep Quality Index (PSQI) were administered to the participants. According to the results of the study; when the AASP results were analyzed, significant differences were found between the obese/overweight group and the normal-weight group in terms of sensory sensitivity and sensory avoidance parameters (P 0.05). Regarding the PSQI results, no significant differences were found in the parameters of sleep latency, sleep duration, and sleep disturbances (P>0.05), while significant differences were found in the PSQI total score, subjective sleep quality, habitual sleep efficiency, use of sleep medications, and daytime dysfunction parameters, with obese/overweight adolescents scoring higher than normal-weight adolescents (P 0.05). This study is the first to examine the relationship between sensory processing, leisure activities, and sleep quality in obese adolescents. It is suggested that further studies on this topic be conducted. Keywords: Adolescence; Leisure Activities; Obesity; Sensory Processing; Sleep Qualit
Otizm spektrum bozukluğuna sahip çocuklarda fonksiyonel beslenme ve duyusal işlemleme becerilerinin değerlendirilmesi
No full textOtizm Spektrum Bozukluğu (OSB) tanısı almış çocuklarda fonksiyonel beslenme ve duyusal işlemleme becerilerinin ve yaşam kalitelerinin artırılması açısından büyük önem taşımaktadır. Duyusal işlemleme, bireyin çevresel uyaranları algılama ve yorumlama sürecini ifade ederken, OSB'li çocuklarda bu beceride sıkça bozulmalar gözlemlenmektedir. Bu bozulmalar, yiyecek seçiciliği gibi beslenme davranışlarında sorunlara yol açmakta; dokusu ve kokusu gibi duyusal özelliklere aşırı tepki gösterilmesi, beslenme çeşitliliğini sınırlamaktadır. Bu bağlamda, duyu bütünleme terapisi, duyusal İşlemleme becerilerinin geliştirilmesinde etkili bir yaklaşım olarak öne çıkmaktadır. Çalışma Suda Kids Ergoterapi ve Danışmanlık Merkezi'nde gerçekleştirildi. Katılımcılar, Kasım 2024 – Şubat 2025 tarihleri arasında velilerin onayı doğrultusunda çalışmaya dahil edildi.Veri toplama aracı olarak Beslenme Problemleri Tarama Testi (STEP), Dunn Duyu Profili ve PEDI-EAT-10 ölçekleri kullanıldı.Elde edilen veriler, OSB'li çocuklarda duyusal işlemleme becerilerinde zayıflıklar olduğunu ortaya koymuştur. Yaş ilerledikçe duyusal işlemleme faktörleri ile düşük düzeyde pozitif ve anlamlı ilişkiler gözlemlenmiştir. OSB'li çocukların, tipik gelişim gösteren akranlarına göre taktil duyarlılık, işitsel işlemleme ve duyusal arayış davranışlarında belirgin farklılıklar sergilediği görülmüştür. Modülasyon bozukluğu yaşayan çocuklarda ise çevresel uyaranlara yüksek hassasiyet ve yoğun duyusal arayış dikkat çekmiştir. Ayrıca, duyusal işlemleme alt boyutları ile yeme davranışları arasında anlamlı ilişkiler bulunmuş; sosyal-duygusal tepkilerin artışının beslenme sorunlarını azalttığı tespit edilmiştir. Bu bulgular, OSB'li çocukların duyusal işlevleri ve beslenme sorunlarına ilişkin önemli veriler sunmaktadır. Anahtar Kelimeler: Besin Seçiciliği; Duyu bütünleme; Otizm spektrum bozukluğu (OSB)Enhancing functional feeding, sensory processing abilities, and quality of life in children diagnosed with Autism Spectrum Disorder (ASD).The development of functional nutrition and sensory processing abilities holds substantial significance in improving the quality of life for children diagnosed with Autism Spectrum Disorder (ASD). Sensory processing refers to the neurological process through which an individual perceives and interprets environmental stimuli, and impairments in this domain are frequently observed in children with ASD. These impairments often manifest in problematic eating behaviors, such as food selectivity, and are characterized by an exaggerated response to sensory attributes like texture and odor, thereby restricting dietary variety. In this context, sensory integration therapy emerges as a promising intervention aimed at enhancing sensory processing capabilities.The study was conducted at the Suda Kids Occupational Therapy and Counseling Center. Participants were enrolled in the study with parental consent between November 2024 and February 2025. The research utilized the Screening Tool of Feeding Problems (STEP), the Dunn Sensory Profile, and the PEDI-EAT-10 scales as instruments for data collection.The analysis of the data revealed significant deficits in sensory processing abilities among children diagnosed with ASD. A positive and statistically significant relationship was observed between age and sensory processing factors, albeit at a low level. Furthermore, children with ASD exhibited pronounced differences in tactile sensitivity, auditory processing, and sensory-seeking behaviors when compared to their typically developing peers. Among those with modulation disorders, heightened sensitivity to environmental stimuli and a pronounced sensory-seeking tendency were noteworthy. Additionally, significant correlations were found between specific sensory processing subdomains and feeding behaviors, with an increase in socio-emotional responses found to mitigate feeding problems.These findings provide valuable insights into the sensory processing and nutritional challenges faced by children with ASD, underscoring the need for targeted therapeutic interventions to address these issues. Keywords: Autism Spectrum Disorder (ASD); Food Selectivity; Sensory Integratio
A numerical method based on the piecewise Chebyshev cardinal functions for a class of third-kind nonlinear fractional integro-differential equations
No full textThis paper introduces a new class of third-kind nonlinear fractional integrodifferential equations, defined using the Caputo derivative. A numerical
method based on the piecewise Chebyshev cardinal functions is proposed
to solve these equations. In the developed approach, a substitution is
applied to initially transform these integro-differential equations into an
equivalent class of third-kind nonlinear fractional integral equations. Next,
by approximating the solution of the problem as a linear combination of the
given basis functions and applying both the ordinary and fractional integral operational matrices of these functions, the problem solving process
is transformed into solving an algebraic system of equations to determine
the coefficients of the linear combination. The theoretical convergence of
the proposed method is thoroughly examined. The validity of the scheme is
numerically evaluated through the solution of several numerical examples
Unveiling the Association Between Emotional Eating and Psychosocial Health in Spanish Adolescents: The EHDLA Study
No full textEmotional eating has been associated with several adverse health outcomes, yet research examining its relationship with psychosocial health among adolescents remains limited. The objective of the study was to investigate the association between emotional eating and psychosocial health in Spanish adolescents. Cross-sectional data were collected from 633 participants (56.9% female) aged 12-17 years from all three secondary schools in the Valle de Ricote (Spain), as part of the Eating Healthy and Daily Life Activities (EHDLA) study. Emotional eating was assessed using the Emotional Eating Scale Adapted for Use in Children and Adolescents (EES-C), while psychosocial health was measured using the Strengths and Difficulties Questionnaire (SDQ). To explore the relationship between emotional eating and psychosocial health, generalised linear models (GLMs) were applied. Results revealed significant associations between higher levels of overall emotional eating (unstandardized beta coefficient [B] = 0.04, 95% confidence interval [CI] 0.02-0.07, p = 0.001) and elevated SDQ scores. Specifically, these associations were evident in response to anger (B = 0.16, 95% CI 0.07-0.25, p = 0.001), anxiety (B = 0.13, 95% CI 0.05-0.21, p = 0.001), restlessness (B = 0.17, 95% CI 0.06-0.29, p = 0.004), and helplessness (B = 0.25, 95% CI 0.06-0.45, p = 0.011). These findings suggest that adolescents who engage in emotional eating may experience greater psychosocial challenges. This study underscores the importance of considering adolescent dietary habits as a crucial aspect in psychosocial health
Evaluaiton of the relationship between the diet quality of children with intellectual disabilities and their parents nutritional knowledge
No full textZihinsel engel, bireyin zihinsel işlevlerinde ve uyumsal davranışlarında belirgin sınırlılıkların bulunduğu bir durumdur. Zihinsel engelli çocukların beslenme alışkanlıkları büyük ölçüde ebeveynlerinin bilgi düzeyi ve tutumlarından etkilenmektedir. Bu çalışmada, zihinsel engelli çocukların diyet kalitesi ile ebeveynlerinin beslenme bilgi düzeyi arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Araştırma, İstanbul Gaziosmanpaşa Belediyesi Engelsiz Yaşam ve Dayanışma Merkezi'ne devam eden 5-13 yaş aralığındaki zihinsel engelli çocukların ebeveynlerinden toplam 100 kişinin gönüllü katılımıyla, Ekim 2024-Mart 2025 tarihleri arasında gerçekleştirilmiştir. Veriler, yüz yüze anket uygulamaları ile toplanmış; kişisel bilgi formu, Akdeniz Diyeti Kalitesi İndeksi (KIDMED) ve Beslenme Bilgi Ölçeği (BBÖ) kullanılmıştır. Araştırmada ebeveynlerin beslenme bilgi düzeyi ile çocukların diyet kalitesi arasında istatistiksel olarak anlamlı bir fark saptanmıştır (p0.05). Bu çalışmanın sonuçları, zihinsel engelli çocukların beslenme durumlarının iyileştirilmesinde ebeveynlerin bilgi düzeyinin önemli bir değişken olduğunu ortaya koymaktadır. Bu konuda literatüre katkı sağlayacak daha fazla bilimsel çalışmaya ihtiyaç duyulmaktadır. Anahtar kelimeler: Beslenme Bilgi Düzeyi; Diyet Kalitesi; KIDMED; Zihinsel Engelli ÇocuklarIntellectual disability is a condition characterized by significant limitations in intellectual functioning and adaptive behavior. The eating habits of children with intellectual disabilities are largely influenced by the knowledge level and attitudes of their parents. This study aimed to evaluate the relationship between the diet quality of children with intellectual disabilities and the nutritional knowledge levels of their parents. The study was conducted between October 2024 and March 2025 with the voluntary participation of 100 parents of children aged 5 to 13 with intellectual disabilities who were attending the Gaziosmanpaşa Municipality Center for Accessible Life and Solidarity in Istanbul. Data were collected through face-to-face questionnaires using a personal information form, the Mediterranean Diet Quality Index (KIDMED), and the Nutrition Knowledge Scale (NKS). A statistically significant difference has been determined between parents' nutritional knowledge levels and children's diet quality in the study (p0.05). The results of this study indicate that parental knowledge level is an important factor in improving the nutritional status of children with intellectual disabilities.Further scientific research is needed to contribute to the literature on this subject. Keywords: Children With Intellectual Disabilities; Diet Quality; KIDMED; Nutrition Knowledge Leve
Nurses' physical activity levels and attitudes towards healthy nutrition
No full textAraştırma, hemşirelerin fiziksel aktivite düzeyleri ve sağlıklı beslenmeye ilişkin tutumlarını belirlemek amacı ile yapıldı.Tanımlayıcı ve kesitsel tarzdaki bu araştırma, Ağustos - Kasım 2023 tarihleri arasında İstanbul ili Anadolu yakasında bulunan bir kamu hastanesinde çalışan 309 hemşire ile gerçekleştirildi. Araştırmanın verileri Kişisel Bilgi Formu, Sağlıklı Beslenmeye İlişkin Tutum Ölçeği ve Uluslararası Fiziksel Aktivite Anketi (kısa) kullanılarak elde edildi. Elde edilen veriler SPSS 25.0 paket programı aracılığyla analiz edildi. Verilerin değerlendirilmesinde tanımlayıcı istatistiksel metotların (ortalama, standart sapma, frekans, oran) yanı sıra Independent t testi, Man Whitney U testi, Oneway ANOVA testi, Kruskal Wallis testi, Ki-kare testi kullanıldı. Anlamlılık bütün değerler için p<0,05 düzeylerinde değerlendirildi. Hemşirelerin yaş ortalaması 29,17±5,27 (22-48) yıl olup; %72,5'i kadın, %54'ü bekâr ve %70,6'sı lisans mezunu, %65,7'si normal vücut ağırlığında olduğu belirlendi. Hemşirelerin Uluslararası Fiziksel Aktivite Anketi puan ortalaması 1298,43±1048,34 (min:45-max:5802) ile düşük düzeyde aktif oldukları saptandı.Hemşirelerin Sağlıklı Beslenmeye İlişkin Tutum Ölçeği puan ortalaması 72,61±12,01 olup; %62,8'nin sağlıklı beslenmeye ilişkin tutum düzeyleri yüksek ve %16,5'nin ideal düzeyde yüksek olarak belirlendi. Evlilerin, zayıf olanların ve yüksek lisans mezunlarının diğerlerine göre sağlıklı beslenme tutumlarının daha yüksek olduğu belirlendi. Hemşirelerin eğitim seviyesi artttıkça fiziksel aktivite düzeyininazaldığı, sağlıklı beslenme tutum düzeyinin ise tam tersi arttığı saptandı.The research was conducted with the aim of determining the levels of physical activity and attitudes towards healthy nutrition among nurses. This descriptive and cross-sectional study took place between August and November 2023, involving 309 nurses working at a public hospital on the Anatolian side of Istanbul. The data for the research were collected using the Sociodemographic Characteristics Questionnaire, the Attitude Scale towards Healthy Nutrition, and the International Physical Activity Survey (short). The collected data were analyzed using the SPSS 25.0 software package. In addition to descriptive statistical methods (mean, standard deviation, frequency, ratio), Independent t-test, Mann-Whitney U test, Oneway ANOVA test, Kruskal-Wallis test, and Chi-square test were employed for data evaluation. Significance was assessed at p < 0.05 for all values. The average age of the nurses was determined to be 29.17±5.27 (22-48) years, with 72.5% being female, 54% being single, and 70.6% having a bachelor's degree, while 65.7% had a normal body weight. The average score on the International Physical Activity Survey for the participating nurses indicated minimal activity, with a mean of 1298.43 ± 1048.34 (min: 45-max: 5802). The average score on the Attitude Scale towards Healthy Nutrition for the participating nurses was 72.61±12.01, with 62.8% exhibiting a high attitude and 16.5% having an ideal attitude towards healthy nutrition. It was found that married individuals, those with a thin physique, and those with a master's degree had higher levels of healthy eating attitudes compared to others. As the educational level of nurses increased, physical activity decreased, and conversely, healthy eating attitudes increased
The distribution of sport performance gene variations through COVID-19 disease severity
No full textAbstract: Background/Objectives: Since its emergence in 2020, researchers worldwide
have been collaborating to better understand the SARS-CoV-2 disease’s pathophysiology.
Disease severity can vary based on several factors, including comorbidities and genetic
variations. Notably, recent studies have highlighted the role of genes associated with athletic
performance, such as ACE, ACTN3, and PPARGC1A, in influencing muscle function,
cardiovascular health, and the body’s metabolic response. Given that these genes also
impact oxidative metabolism, inflammation, and respiratory efficiency, we hypothesized
that they might play a critical role in the host’s response to SARS-CoV-2 infection. This study
aimed to investigate the association between disease severity and genetic polymorphisms
in these sport performance-related genes, specifically ACE rs4646994, ACTN3 rs1815739,
and PPARGC1A rs8192678. Methods: A total of 422 COVID-19-positive patients were
included in this study. The participants were divided into three groups: a severe group
(77 patients) requiring intensive care unit (ICU) admission, a mild group (300 patients)
exhibiting at least one symptom, and an asymptomatic control group. Genotyping was
performed using restriction fragment length polymorphism PCR. Results: The D allele and
DD genotype of ACE and the T allele and TT genotype of ACTN3 were found to confer
protective effects against severe SARS-CoV-2 infection. Conversely, the PPARGC1A TC
genotype and the ACE-PPARGC1A ins/ins + TC combined genotype were associated with
increased disease severity (p < 0.05). Conclusions: Although vaccination has reduced the
severity of SARS-CoV-2, the virus continues to impact human health. Inter-individual
differences due to these genetic variations will broaden the horizon of knowledge on the
pathophysiology of the disease
Let-7b-5p sensitizes breast cancer cells to doxorubicin through Aurora Kinase B
No full textAbstract
MicroRNAs (miRNAs) are small, non-coding RNAs that regulate the expression level of the
target genes in the cell. Breast cancer is responsible for the majority of cancer-related
deaths among women globally. It has been proven that deregulated miRNAs may play an
essential role in the progression of breast cancer. It has been shown in many cancers,
including breast cancer, that aberrant expression of miRNAs may be associated with drug
resistance. This study investigated the effect of let-7b-5p, detected by bioinformatics methods, on Dox resistance through the Aurora Kinase B (AURKB) gene. In silico analysis using
publicly available miRNA expression, GEO datasets revealed that let-7b-5p significantly
downregulated in BC. Further in silico studies revealed that of the genes among the potential
targets of let-7b-5p, AURKB was the most negatively correlated and may be closely associated with Dox resistance. Expression analysis via quantitative PCR confirmed that let-7b-5p
was downregulated and AURKB was upregulated in breast cancer tissue samples. Later,
functional studies conducted with MCF-10A, MCF-7, and MDA-MB-231 cell lines demonstrated that let-7b-5p inhibits cancer cells through AURKB and sensitizes them to Dox resistance. In conclusion, it has been shown that the let-7b-5p/AURKB axis may be significant in
breast cancer progression and the disruption in this axis may contribute to the trigger of Dox
resistance
In vitro evaluation of cytotoxicity of fixed functional appliances
No full textAbstract
Objective: The objective of this study was to evaluate the cytotoxicity of fixed functional appliances that are commonly used in the treatment of Class II malocclusion caused by mandibular retrognathia, using the MTT cell viability assays [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] (Sigma Chemical Co., Milan, Italy).
Materials and methods: The cytotoxicity of five different fixed functional appliances commonly used in orthodontic treatments was assessed. The appliances evaluated included Jasper Jumper (American Orthodontics, Wisconsin, USA), Power Scope (American Orthodontics, Wisconsin, USA), Herbst (American Orthodontics, Wisconsin, USA), Forsus™ Fatigue Resistant Device Kits (3 M, MN, USA), and Twin Force Bite Corrector (Henry Schein Orthodontics, California, USA). Assays were conducted using one appliance from each type, resulting in a total of seven groups. Cytotoxicity testing was performed using the MTT assay on a human gingival fibroblast (HGF) cell line. Data analysis was conducted using the Kruskal-Wallis test with a significance level of p = 0.05.
Results: All appliances demonstrated cell viability rates exceeding 90%, categorizing them as non-cytotoxic under ISO 10993-5 standards. Herbst exhibited the highest proliferation index (2.62 ± 1.13), while Power Scope (2.05 ± 1.06) and Jasper Jumper (1.90 ± 1.23) showed the lowest indices. Despite these variations, statistical analysis revealed no significant cytotoxic effects when compared to the control group (p > 0.05). All appliances were confirmed as biologically safe for cell health.
Conclusion: The findings demonstrate that all evaluated appliances exhibit a biocompatible interaction with HGF cells, with no evidence of adverse cytotoxic effects. These results support the safe clinical use of these fixed functional appliances in orthodontic treatment