Salivary Sex Steroid Levels in Infants and the Relation with Infantile Colic

Objective: The hypothalamic-pituitary-gonadal axis is active during minipuberty, the timing of which coincides with infantile colic. To the best of our knowledge, the relationship between these entities has not been previously investigated. Methods: Saliva samples were collected from 15- to 60-day-old term infants (n=139) between 9 am and 5 pm. Group 1 included infants with infantile colic (n=68, 54.4% female) while the remaining healthy infants constituted Group 2 (n=71, 47.9% female). Salivary levels of estradiol (Esal) in females and testosterone (Tsal) in males were measured by ELISA in duplicate. Results: The median (25th-75th centile) age and birth week for all infants were 33 (29-43) days and 39 (38.1-40) weeks, respectively. Levels of Tsal in males [Group 1, 73.35 (59.94-117.82) pg/mL vs Group 2, 77.66 (56.49-110.08) pg/mL, p=0.956] and Esal in females [Group 1, 3.91 (2.76-5.31) pg/mL vs Group 2, 4.03 (1.63-12.1) pg/mL, p=0.683] were similar. However, in subjects with infantile colic (Group 1), Esal and body mass index (BMI) standard deviation scores of females were slightly correlated (Group 1, rs= 0.393, p=0.016 vs. Group 2, rs= 0.308, p=0.076) and there was a significant correlation between the sampling time and Tsal in males (Group 1, rs= 0.469, p=0.009 vs. Group 2, rs= -0.005, p=0.976). Conclusion: Random salivary sex steroid levels were similar in infants with and without infantile colic. However, in subjects with infantile colic, Esal levels in females were positively correlated with BMI and Tsal levels were higher later in the day among males. Thus, sex steroid production may be altered during minipuberty in subjects with infantile colic.

The linguistic validation of the gut feelings questionnaire in Turkish.

BACKGROUND: 'Gut feelings' are frequently used by general practitioners in the clinical decision-making process, especially in situations of uncertainty. The Gut Feelings Questionnaire (GFQ) has been developed in the Netherlands and is now available in English, French, German, Polish, Spanish, and Catalan, enabling cross-border studies on the subject. However, a Turkish version of the GFQ is lacking. OBJECTIVES: A Turkish version of the GFQ. METHODS: A linguistic validation procedure was conducted, which took place in six phases: forward translation (step 1), backward translation (step 2), first consensus (step 3), cultural validation (step 4), second consensus (step 5), and final version (step 6). RESULTS: The absence of literal equivalent of the term 'gut feelings' in Turkish was determined. The word 'intuition' was chosen as the Turkish literal equivalent of 'gut feelings'. There were also some challenges in finding the exact meanings of words and expressions in Turkish literature. However, we succeeded in finding adequate and responsible solutions. A Turkish version of the GFQ is available now. CONCLUSION: With these validated GFQs, Turkish GPs can facilitate studies of the role of 'gut feelings' in clinical reasoning.

Who is happier among preclinical medical students: the impact of chronotype preference.

Most studies and systematic reviews of the psychological health of medical students have investigated the negative aspects of depression and anxiety. Evidence from several studies suggests depressive symptoms are common in medical school students. Moreover, evening chronotype is considered a risk factor for the development of depression. However, surprisingly no study has assessed the possible relationship between chronotypes and happiness. The aims of this study were to: (a) assess happiness and its predictors among Turkish preclinical medical students, (b) identify chronotype preferences, and (c) determine whether these predictors mediate the relationship between chronotype and happiness. Sociodemographic and clinical data collection form, Oxford Happiness Questionnaire short form (OHQ-SF), and Morningness-Eveningness Questionnaire (MEQ) were used to collect data. In this cross-sectional study, 564 students in their pre-clinical year properly completed the questionnaires. The mean age was 19.89 ± 1.37 years (range: 17-26 years). The mean total OHQ-SF score was 23.09 ± 4.23. Female students were significantly happier than male students (p =.042). Thirty-eight (6.7%) students were morning type, 376 (66.7%) were intermediate type, and 150 (26.6%) were evening type. The distribution of chronotypes did not differ by gender (p =.085). Evening types showed significantly lower OHQ-SF scores than morning (p <.001) and intermediate types (p <.001). MEQ scores were positively correlated with OHQ-SF scores (Pearson, r =.245, p <.001). Multivariate analyses showed that gender, perceived economic resources, physical activity, depression diagnosed the previous 12 months, stressful life events and chronotypes were predictors of happiness among Turkish preclinical medical students. These six variables explained 15% of the total variance of happiness. In conclusion, this study identified evening-type individuals showed less happiness in comparison to the morning-type and intermediate-type individuals. There was a significant relationship between happiness and chronotype, even when controlling for confounding variables, such as age, gender, and others. This information could have clinical implications and contribute to chronobiological approaches for the protection of psychological health.

Long-term posttraumatic stress disorder in mine workers after a coalmining disaster

Abstract Background A coalmine disaster has occurred in Turkey on 13 May 2014, which caused the death of 301 miners. Objective This study aimed to determine the prevalence of posttraumatic stress disorder (PTSD) symptoms and the risk factors for PTSD among mine workers, 2 years after the coalmining disaster. Methods This was a cross-sectional survey conducted between June 2016 and July 2016 among mine workers who were the employees of either the mine where the accident occurred or three other mines in the same area. Sociodemographic data form and PTSD Symptom-Scale Self-Report (PSS-SR) were used to collect data. Results 672 mine workers participated in the study. At the time of the accident, 23.7% (n = 159) of them were in the mine where the accident occurred. The mean score on total PSS-SR was 4.27 (SD: ±4.49). Eighteen (2.7%) participants screened positive for PTSD. Logistic regression analysis revealed the significant risk factors for PTSD are: being single/divorced/widowed, having a chronic disease, having a family history of psychiatric illness and previously experiencing traumatic events more than one. Discussion Coalmining workers have considerably high prevalence rate of PTSD symptoms after a coalmining disaster. Assessing PTSD and associated risks is important for preventive mental health services.

Detecting Peripheral Arterial Disease in Primary Care: A Population Based Study.

BACKGROUND: Peripheral arterial disease (PAD) can progress silently without any clinical symptoms. Ankle-brachial index (ABI) is the recommended method used in primary care. We aimed to determine the prevalence of PAD and its related risk factors in primary care. METHODS: In this cross-sectional study, 250 participants aged ≥45 years were recruited randomly from the registered patients of family health center in a district of Izmir, Turkey. Patients' demographic data, PAD symptoms, and PAD risk factors were obtained. The PAD group consisted of patients with ABI levels <0.9; the non-compressible artery (NCA) group consisted of patients with ABI levels >1.3. RESULTS: The prevalence of PAD was 17.6% (22.5% in women and 11.1% in men), while that of NCA was 15.2% (12.7% in women and 25.0% in men). About 27.3% and 54.5% of patients with PAD did not have claudication and problems with walking distance, respectively. Of the NCA patients, 15.8% had problems with walking distance and 39.5% had claudication. Regression analysis revealed two predictors of PAD (age ≥65 years: odds ratio [OR], 3.51; 95% confidence interval [CI], 1.65-7.47; claudication: OR, 3.41; 95% CI, 1.58-7.39) and three predictors of NCA (age <65 years: OR, 2.55; 95% CI, 1.01-6.45; male sex: OR, 2.40; 95% CI, 1.10-5.25; triglyceride [TG] >200 mg/dL: OR, 4.11; 95% CI, 1.58-10.67). CONCLUSION: PAD had a prevalence of 17.6% and was associated with age ≥65 years and claudication. NCA had a prevalence of 15.2% and was associated with age <65 years, TG >200 mg/dL, and male sex.

To understand or not to understand: This is the problem.

BACKGROUND/AIMS: The aim of the study was to evaluate the level of readability of the informed consent used before colonoscopy in a university hospital by different methods, and to investigate related sociodemographic variables. MATERIALS AND METHODS: This descriptive, cross-sectional study included 211 subjects aged over 18. Three different measurement tools were used to evaluate the level of readability of the informed consent: The Cloze Readability Procedure, the Flesch's readability formula adapted to Turkish by Atesman, and the readability formula developed by Cetinkaya and Uzun. RESULTS: The readability scores of the text, calculated according to Atesman's formula, the Cetinkaya-Uzun, and Cloze Readability Procedure were 50.183 (the average level of difficulty), 31.021 (frustration level), and 26.68 (frustration level), respectively. The informed consent was found to be appropriate for individuals educated at the grade level 10 and above. The following participants were found to have significantly higher scores: educated above high school; reading books, magazines, digital media, and printed media every day or every other day; and previously informed about colonoscopy. CONCLUSION: Within the framework of a colon cancer screening program conducted by the Public Health Institution of Turkey, individuals who tested positive were subjected to the colonoscopy procedure, if necessary. This increases the importance of the informed consent form used prior to the colonoscopy procedure. The patients and/or patients'relatives who are at the frustration level of reading ability would have problems in reading and comprehending the text. The Cloze Test Procedure might be used in examining problematic consent forms.

The Importance of Family History in Breast Cancer Patients in Primary Care Setting: a Cross-sectional Study.

Screening recommendations of physicians are important for women to raise awareness about their risk factors and to promote appropriate screening behaviors. However, it seems challenging for primary care physicians (PCPs) to balance disease prevention and diagnosis, treatment. The objective of this study was to describe physicians' breast cancer consultancy practice including family history, cancer prevention issues for the women they care. This cross-sectional study included 577 women aged above 45 years, free of breast cancer, during their visits to their PCPs. Nearly half of the women reported their visit to PCPs for an annual examination during the year. Among them, 36.1% had first-degree relatives with cancer and 7.3% with breast cancer. But they reported to be asked about family history of cancer and informed about cancer prevention issues 35.1 and 26.4%, respectively. Cancer still seems to be a hard issue to be discussed, even with women visiting PCPs for annual examination. Asking first-degree relative with breast cancer can give PCPs the chance of determining women with increased risk and support women's appropriate understanding of their own risk in relation to their family history. This routine can make shared-decision making for developing person-centered approach for breast cancer screening possible. Further studies are needed for better understanding of loss of consultancy leadership of physicians for breast cancer.

Breast cancer risk perceptions of Turkish women attending primary care: a cross-sectional study.

BACKGROUND: As the risks and benefits of early detection and primary prevention strategies for breast cancer are beginning to be quantified, the risk perception of women has become increasingly important as may affect their screening behaviors. This study evaluated the women's breast cancer risk perception and their accuracy, and determined the factors that can affect their risk perception accuracy. METHODS: Data was collected in a cross-sectional survey design. Questionnaire, including breast cancer risk factors, risk perceptions and screening behaviors, answered by 624 women visiting primary health care center (PHCC). "Perceived risk" investigated with numeric and verbal measures. Accuracy of risk perception was determined by women's Gail 5-year risk scores. RESULTS: The mean age of the participants was 59.62 ± 1.97 years. Of the women 6.7% had a first-degree relative with breast cancer, 68.9% performed breast self-examination and 62.3% had a mammography, and 82.9% expressed their breast cancer worry as "low". The numeric measure correlated better with worry and Gail scores. Of the women 65.5% perceived their breast cancer risk accurately. Among the women in "high risk" group 65.7% underestimated, while in "average risk" group 25.4% overestimated their risk. CONCLUSIONS: Turkish women visiting PHCC are overtly and overly optimistic. This was especially obvious with the result that nearly one third had had no mammography. There is a need for further studies to understand why and how this optimism is maintained so that better screening strategies can be applied at PHCC. All health workers working at PHCC have to be aware of this optimism to prevent missed opportunities for cancer screening.

The effect of physical activity and body mass index on menopausal symptoms in Turkish women: a cross-sectional study in primary care.

BACKGROUND: Considering the fact that, due to recent evidence, many women no longer prefer hormone replacement therapy, it is especially important to develop intervention options to alleviate menopausal symptoms. Although there is conflicting evidence concerning effectiveness, there is an indication that physical activity and weight control may be useful for alleviating symptoms. The aim of this study was to investigate the effect of physical activity and body mass index on menopausal symptoms among menopausal women in Turkey. METHODS: 305 women between the ages of 45 and 60 who visited the health center for various reasons were recruited into this cross-sectional study. Menopausal women, who visited one of five family physicians working in the same area, were included in the analyses. The Menopause Rating Scale, International Physical Activity Questionnaire and a generic medical and socio-demographic information questionnaire were used. RESULTS: Women who were physically active had lower total menopausal (p < 0.001), somato-vegetative (p = 0.004), psychological (p = 0.002), and urogenital (p < 0.001) symptom scores than women who were less active. No differences in vasomotor symptoms were recorded related to physical activity level; significant differences were found for most menopausal symptoms, including sleep (p = 0.009) and sexual (p = 0.043) problems, joint and muscular discomfort (p < 0.001) and vaginal dryness (p = 0.016). BMI was not associated with total menopausal symptoms and with the subscales, excluding depressive mood (p = 0.009). A significant increasing trend in the rate of depressive mood was observed from normal through overweight to obese participants. The mean scores of the total menopausal symptoms were lower among the participants who were well educated, currently working and without chronic diseases. CONCLUSIONS: Physical activity may play an important role in alleviating menopausal symptoms. As part of preventive medicine, primary care physicians should also stress lifestyle changes, including physical activity, to manage menopausal symptoms.