Subjective well-being among primary health care patients.

BACKGROUND: The psychological importance of subjective well-being for a healthy life has been well recognized. It is also well known that depressive and anxiety disorders have a negative effect on subjective well-being. The aim of this cross-sectional, descriptive study was to assess the subjective well-being status of a group of primary healthcare patients in relation to socio-demographic characteristics, personal health and mood-status. METHODS: A total of 284 patients participated in the study. The Oxford Happiness Scale, Life Satisfaction Scale, DASS-42 (Depression, Anxiety and Stress Scales-42) and a questionnaire about socio-demographic characteristics were completed by the participants. RESULTS: In general, the participants were found to be moderately happy and satisfied with their lives. They had mild levels of depression, anxiety and stress. In terms of happiness, an older age (≥40 years), educated to secondary level or higher and not having depression or anxiety were found to be factors increasing happiness. In terms of life satisfaction, female gender, an older age (≥40 years), educated to secondary level or higher, being single and not having depression were found to increase life satisfaction. CONCLUSION: Primary healthcare providers should give more importance to the mood status of their patients. Screening for depression and anxiety should be applied at the primary healthcare level because negative mood status is more important than some socio-demographic characteristics in respect of unhappiness and dissatisfaction.

Educating medical students about the personal meaning of terminal illness using the film, "Wit".

BACKGROUND: Addressing the emotional needs of dying patients is rarely found to have a place in formal medical curriculum and is also a difficult area to teach through classical medical lectures. "Cinemeducation" is a wonderful way to educate health care providers about the magnitude of emotions that arise during those difficult situations. OBJECTIVE: The aims of this study were to test the relevance and usefulness of the movie 'Wit' in teaching medical students about the personal meaning of terminal illness and to assess the impact of this teaching method on students' attitudes toward palliative care. DESIGN: This was an education study using qualitative and quantitative data analysis of 518 first-year medical students in a single medical faculty in Turkey. Students watched the entire film, filled out an evaluation questionnaire, and answered questions about the film. Students also expressed their own feelings and thoughts about palliative care. RESULTS: Overall, 88% rated the film as excellent, very good, or good. According to 54% of the students, the emotions of terminally ill patients were fully portrayed in the film and in a very realistic way. Approximately 61.4% of the students found this film emotional. Most students (80.5%) stated that this film made them think about the emotional and spiritual suffering that dying patients go through and found this learning approach about palliative care more useful than didactic lectures and journal article readings but not more useful than bedside rounds. It was thought that caring for dying patients would be very or fairly personally satisfying for 65.3% of the students. CONCLUSIONS: The film 'Wit' gave the students an opportunity to explore their beliefs, values and attitudes in terms of the bio-psycho-social-spiritual aspects of health care and encouraged them to think more about the humanitarian issues of the medical profession.

Diagnosis of acute tonsillopharyngitis in primary care: a new approach for low-resource settings.

BACKGROUND: Diagnosing GABHS (Group A-beta Hemolytic Streptococcus) tonsillopharyngitis by clinical scoring is a recommended approach in developed countries, but there is still much controversy for low resource settings. AIM: We aimed to assess the impact of Centor criteria with the support of practical laboratory tests. METHODS: We prospectively included patients complaining sore throat (N = 282). We evaluated them in terms of Centor scoring and performed white blood cell count (WBC), C-reactive protein (CRP), rapid antigen detecting test, and throat culture. RESULTS: In GABHS cases (N = 32, 11·3%), two of the criteria were observed to be positive in more than half of the cases (N = 19, 59·3%), while 13 (40·7%) cases met three/four criteria. The specificity of having two criteria was found to be 65·5% and increased to 91·5% after including CRP and WBC. CONCLUSION: Centor criteria could be safely used to reduce unnecessary antibiotic usage for tonsillopharyngitis in developing countries.

Prevalence of depression, anxiety, stress, and anger in Turkish prisoners.

In Turkey, prison studies are rare and the mental health status of prisoners has not received proper attention. The purpose of this cross-sectional and descriptive study was to assess the prevalence of depression, anxiety, stress, and anger among a group of Turkish prisoners. Two self-reporting instruments (the Depression Anxiety Stress Scale-42 and Multidimensional Anger Scale) were filled out by 685 prisoners. Prisoners in the study group were found to be depressive, anxious, and stressed. Anger symptoms and aggressive behaviors were found to be at a moderate level. Prisoners with a history of being subjected to domestic violence in childhood had higher depression, anxiety, and stress scores than those without such a history. Young prisoners, those who had been previously imprisoned, with substance dependency and higher stress and anxiety levels reported more anger symptoms than others. Psychological support, together with stress and anger management programs, seems to be essential.

Quality of life in type II diabetic patients in primary health care.

INTRODUCTION: This study evaluated the quality of life of patients with type II diabetes in primary health care with the Turkish version of the Audit of Diabetes Dependent Quality of Life (ADDQoL) instrument. MATERIAL AND METHODS: A total of 180 patients diagnosed with type II diabetes and registered at an urban primary health care unit in Turkey were included to this study. RESULTS: The ADDQoL instrument showed good internal consistency and factor structure. Diabetes had the largest impact on "enjoyment of food" (mean impact rating -1.65) and the least impact on "others fussing" (-0.44). The duration of diabetes and insulin therapy had a significant impact on quality of life among diabetic patients. CONCLUSION: Multidimensional assessments of quality of life including both generic and disease-specific measures are important for diabetic patients in primary health care. FUNDING: not relevant TRIAL REGISTRATION: not relevant.

Psychometric properties of the Turkish version of the 42 item Depression Anxiety Stress Scale (DASS-42) in a clinical sample.

OBJECTIVE: To study the psychometric properties of the Turkish translation of the Depression Anxiety and Stress Scale (DASS-42) in a clinical group. METHODS: Outpatients diagnosed with anxiety (n = 138; mean age = 44.5 years; 74.6% female) or depression (n = 112; mean age = 46.2 years; 77.7% female) from the psychiatric outpatient clinic of a public hospital were evaluated. A group of non-clinical volunteers (n = 250; mean age = 37 years; 68% female) served as a community group for comparison. The participants completed the Turkish versions of the DASS-42, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). RESULTS: The structure of the DASS-42 was analyzed in the clinical sample using principal components extraction. The three-factor solution accounted for 56% of the total variance, with eigenvalues of 17.6, 3.0, and 2.6. The range of factor loadings was 0.55-0.85 for depression, 0.47-0.62 for anxiety, and 0.49-0.74 for stress. The Cronbach alpha values for the DASS depression, anxiety, and stress subscales were 0.94, 0.88, 0.94 respectively. The concurrent validity of the DASS was satisfactory. The non-clincal participants scored lower on all three subscales than the individuals in all of the clinical groups. CONCLUSION: The Turkish version of the DASS-42 appears to be an excellent instrument for measuring features of depression, hyperarousal, and tension in clinical groups.

Workplace violence: a study of Turkish workers.

This research was conducted to address the experience of workplace violence of Turkish workers from different sectors and to investigate the impact of the exposed violence on their psychological well-being. Data were collected anonymously with printed questionnaires from the volunteer participants and depended on self-reporting. The response rate was 79.0% (1708/2161). The prevalence of workplace violence was found to be 44.8%. The most common type was verbal violence together with mobbing (bullying). Victims of physical violence were mostly males, whereas females were found to be victims of verbal, psychological and sexual violence. Most cases did not result in legal action and the victims remained silent. Psychological well-being of exposed workers in terms of depression, anxiety and stress seemed to deteriorate. Workplace violence remains a silent epidemic in Turkey. Preventive measures against workplace violence and social support for violated workers do not exist.

Mammography utilization among Turkish women.

In Turkey, breast cancer is the leading type of cancer and cause of cancer-related deaths among women, but information is limited on mammography practices. The objectives of the present study were to identify associations between attitudes and knowledge about mammography and socio-demographic indicators and having a mammogram. The participants of this cross-sectional and descriptive study were 1,208 women who attended the primary health care unit serving as a training unit of the medical faculty or the outpatient clinic for breast diseases of the same medical faculty's hospital between October and December 2007. A printed questionnaire covering socio-demographic variables, family history of breast cancer, mammography practices, and attitudes and knowledge of mammography was filled out in face-to-face interviews with the authors. Women with previously diagnosed breast cancer were excluded from the study. We performed chi square and logistic regression analyses. We found that 12.7% of the women had no knowledge of mammography, and 57.3 % had never had a mammogram. Fifty point six percent of our study group reported that they had had a clinical breast examination at least once, and 51.1% were aware of breast self examination (BSE). Need factors such as age and health-system-related factors such as awareness of BSE and having CBE were found to be more important than the socio-economic factors in mammography use. Mammography was accepted by 92.3% as a useful screening method for early detection of breast cancer and as a necessity for women of 50 years and over by the 90.6% of the study group. We found a positive attitude towards mammography and its importance but limited usage.

Pap smear screening in the primary health care setting: A study from Turkey.

BACKGROUND: Cervical cancer is one of the ten most frequent cancers in Turkey. It is well known that cervical cancer morbidity and mortality could be significantly reduced with an active cervical smear screening (Pap smear) program. AIMS: THE AIMS OF THIS STUDY WERE: 1) to evaluate the knowledge and attitudes of women about cervical smear testing; 2) to establish a cervical smear screening program and to evaluate the cervical cytological abnormalities that were found; 3) to determine the applicability, limitations and effectiveness of this screening in a primary health care unit. PATIENTS AND METHODS: A total of 332 married women were included in our study. We collected data concerning socio-demographic and fertility characteristics, and knowledge about Pap smear testing was determined through printed questionnaires. A gynecological examination and Pap smear screening was performed on every woman in our study group. RESULTS: Over ninety percent of our study group had never heard of and had not undergone Pap smear screening before. Of the 332 smears evaluated, 328 (98.8%) were accepted as normal, whereas epithelial cell anomalies were seen in 4 (1.2%), infection in 59 (17.7%), and reactive cell differences in 223 (67.2%) of the smears. CONCLUSIONS: The frequency of epithelial cell anomalies in our study group was less than the frequencies reported from Western countries. Knowledge regarding cervical cancer and Pap smear screening was very low. Pap smears can be easily taken and evaluated through a chain built between the primary health care unit and laboratory, and this kind of screening intervention is easily accepted by the population served.

Students' views about doctor-patient communication, chronic diseases and death.

CONTEXT: Students start their medical study with the opinion that saving lives and preventing deaths are the main goals of medicine. So, what will they do when faced with dying patients? How will they feel; how will they communicate? These are important, but often unspoken and neglected, issues. OBJECTIVES: We assessed the attitudes and opinions of first-year medical students regarding doctor-patient communication, chronic diseases, death, and dying patients at Uludag University Medical School in Bursa/Turkey. Our secondary objective was to delineate the educational needs related to this field. METHODS: Cross-sectional survey of the first-year students in the class of 2004-2005. Students were evaluated using a questionnaire consisting of six questions and 18 Likert-type statements. RESULTS: Completed questionnaires were received from 253 of the 265 (95.5%) students. According to the students, the most fatal diseases were cancer and AIDS. Students strongly agreed with the importance of talking to patients, where female students agreed more than males with this statement (p<0.05). Most students disagreed that patients should be informed that they are dying. Older students feared less for the death of patients. Female students would like to work in an environment where they can communicate with their patients and where they can be with them for a longer period. CONCLUSIONS: The results of this survey indicate that the need of providing palliative care, enhancing communication skills with terminally ill patients, and integrating different teaching strategies are important aspects of the undergraduate medical curriculum.

The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students.

BACKGROUND: The mental health of university students is an area of increasing concern worldwide. The objective of this study is to examine the prevalence of depression, anxiety and stress among a group of Turkish university students. METHODS: Depression Anxiety and Stress Scale (DASS-42) completed anonymously in the students' respective classrooms by 1,617 students. RESULTS: Depression, anxiety and stress levels of moderate severity or above were found in 27.1, 47.1 and 27% of our respondents, respectively. Anxiety and stress scores were higher among female students. First- and second-year students had higher depression, anxiety and stress scores than the others. Students who were satisfied with their education had lower depression, anxiety and stress scores than those who were not satisfied. CONCLUSIONS: The high prevalence of depression, anxiety and stress symptoms among university students is alarming. This shows the need for primary and secondary prevention measures, with the development of adequate and appropriate support services for this group.

Turkish general practitioners and complementary/alternative medicine.

BACKGROUND: Complementary and alternative medicine (CAM) is in the spotlight of society. However, what is the position of physicians at this point? OBJECTIVES: To determine general practitioners' (GP) knowledge, attitudes, and approaches to CAM. METHODS: All GPs (n=521) practicing in Bursa Province, Turkey were surveyed by a questionnaire. RESULTS: Responses from 49% of GPs were analyzed. Altogether, most of our physicians (96.5%) had not received any education about CAM, wanted to learn more (74.4%), and their knowledge levels were low (60.8%). About half of them (51%) believed in the efficiency of CAM, whereas 38.0% did not. GPs desire more information about herbal medicine and acupuncture. Only 29% of GPs were using some type of CAM for themselves. CONCLUSIONS: GPs are aware of the subject's importance and want to learn more about CAM and improve their knowledge. It would be reasonable to provide training possibilities for GPs, primarily for the CAM types highly used by the population and most requested by the physicians.

Quality of life among Turkish immigrants in Sweden.

OBJECTIVES: To assess quality of life among Turkish immigrants in Sweden by using the WHOQOL-100 scale and to evaluate the domains' contribution to explain the variance in the quality of life of the immigrants. Our hypothesis was QOL among Turkish immigrants in Sweden are better than Turkish people who are living in their home country. MATERIAL AND METHODS: This study was performed in the districts of Stockholm where Turkish immigrants have mostly settled. With the help and guidance of the Turkish Association, a sample of 520 participants was selected. We collected the demographic data by printed questionnaires, and to measure the quality of life, we used the WHOQOL-100 scale Turkish version. For analysis, we used the SPSS V.13.0 and R package programs, variance analyses, and Bayesian regression. RESULTS: The quality of life among the sample of Turkish immigrants was found to be moderate, but higher than the sample of the Turkish population. The quality of life of male immigrants was found to be higher than for females. Swedish-born Turks had better quality of life perceptions. CONCLUSION: Turkish immigrants' quality of life perceptions were better than those of the Turkish sample. The best scores were received from the third generation. The first generation and female immigrants need attention in order to receive higher quality of life perceptions.

Job related affective well-being among primary health care physicians.

BACKGROUND: Job related affective well-being is important for a healthy life and job satisfaction for all individuals, including physicians. The later group, however, is most often compromised. OBJECTIVES: We aimed to investigate a group of Turkish primary health care physicians' job related emotional perceptions and to assess their reactions in terms of stress, anxiety and depression. METHODS: A descriptive, cross-sectional, self-reported questionnaire study was conducted. A total of 60 primary health care centres and 274 general practitioners who were working at these centres participated in the study. The response rate was 74%. Printed questionnaires were completed by the participants anonymously. We used the Job Related Affective Well-Being Scale (JAWS) and Depression Anxiety Stress Scale (DASS 42). Correlation analysis and hierarchic regression were performed. RESULTS: Correlations between JAWS and DASS total scores were negative and statistically significant (r = -0.52; P< 0.01). Low pleasure/high arousal (LPHA) and low pleasure/low arousal (LPLA) variations that describe negative emotional states show a positive and significant relationship with depression, anxiety and stress values. The highest mean score was obtained for the high pleasure/low arousal (HPLA) status that can be interpreted to mean that our study group was pleased with their job but was not motivated. CONCLUSIONS: Physician's job related negative emotional perceptions are associated with reactions in terms of stress, anxiety and depression. For this reason, it is critical to consider primary care physicians' job related affectations and job related stimuli.

Importance of novel sequence alterations in the FHIT gene on formation of breast cancer.

AIMS AND BACKGROUND: The character, role and impact of FHIT gene alterations, for which recent studies have shown that the gene has a role in the early stage of carcinogenesis in breast cancer, are still unclear. Thus, the current study evaluated FHIT gene mutations from breast tissue of women with malignant and benign breast disease and to elucidate the frequency and type of mutations in this gene. PATIENTS AND METHODS: Mutations in exons 5-9 of the FHIT gene were screened using the intronic primer pairs in 83 breast (67 malignant and 16 benign) tissue samples by single-strand conformational polymorphism and sequencing analysis. RESULTS: FHIT mutations were detected in 13 of the 67 malignant cases (19.4%) and 2 of the 16 benign cases (12.5%). Four different sequence variants were determined: two novel frame shift mutations (codon 90 insA, codon 146 delT), one intronic novel mutation (IVS8 -17 insA), and one previously identified silent transition type alteration (codon 88 C to T). In addition, determination of this silent alteration caused formation of new exonic splicing enhancer (ESE) motifs on mutated sequences by using the ESEfinder program. CONCLUSIONS: Our data contribute significantly to that currently known about the presence of FHIT gene mutations on the formation of breast cancer.

Risk factors for wheezing in primary school children in Bursa, Turkey.

BACKGROUND: Wheezing is the most common symptom of childhood respiratory tract illnesses. It is important not only for its associated acute morbidity, but also for the fact that early childhood wheezing confers a high risk for asthma. Epidemiological studies from various countries show that 10-15% of children <1 year of age and 25% of children <5 years of age have wheezing-associated respiratory tract illness, and one-third of these children develop asthma later in life. METHODS: In this retrospective study, we evaluated the association between a history of wheezing and prenatal, postnatal, familial, and environmental risk factors in 858 7-year-old children, randomly selected from seven primary schools in Bursa, Turkey, by means of an easy-to-understand questionnaire form. Among these children, 12.4% had a history of early transient wheezing, 7.1% had persistent wheezing, and 7.7% had late onset wheezing; 72.8% had no wheezing symptoms and 33.3% of children who experienced wheezing during the first 3 years of life had physician-diagnosed asthma. RESULTS: Notable risk factors associated with wheezing were as follows: male gender, lower socioeconomic status, premature birth, maternal smoking during pregnancy, bottle-feeding before 2 months of age, dampness and mold at home, hospitalization due to any respiratory illness in infancy, history of croup between 6 months and 5 years of age, frequent upper respiratory infections during the first 3 years of life, allergic eczema in the child, and any allergic disease in the mother or siblings. CONCLUSION: This study shows that the high rates of reported wheezing in the 858 primary school children in Bursa are clearly attributable to important risk factors that have long been recognized and discussed by researchers worldwide, and this suggests that all efforts at primary prevention may be insufficient.

Bullying in Turkish white-collar workers.

OBJECTIVES: To determine the prevalence of reported workplace bullying among a group of white-collar workers, to evaluate the association between reported bullying and its effect on health and to assess the effects of support at work for bullied workers. METHODS: A cross-sectional questionnaire survey among full-time government employees in the health, education and security sectors. Bullying was assessed using a 20-item inventory. The potential effects of reported bullying were assessed using the Job Induced Stress Scale, the Hospital Anxiety and Depression Scale, Job Satisfaction Scale and the Propensity to Leave Scale. RESULTS: The response rate was 79% (944/1,200) and 877 questionnaires were analysed after exclusion of non-complete data. Of respondents, 55% (483) reported experiencing one or more types of bullying in the previous year and 47% (416) had witnessed the bullying of others. The bully was most likely to be a superior. Sixty per cent of victims had tried to take action against bullying, but most were dissatisfied with the outcome. There were significant differences in anxiety, depression, job-induced stress and support at work scores between those reporting bullying and those not reporting bullying at work. Those who reported bullying with low support at work had the poorest scores on the mental health scales. CONCLUSIONS: Bullying is a serious problem in this group of workers and may lead to health consequences. Feeling that the work environment is supportive appears to have a protective effect in terms of the health outcomes.

Pregnant women quit smoking; what about fathers? Survey study in Bursa Region, Turkey.

AIM: To evaluate maternal and paternal smoking habits during pregnancy and determine their correlation with pregnancy complications and newborn status. METHODS: The study included 499 pregnant women who delivered at the Department of Obstetrics and Gynecology in Uludag University School of Medicine, over a period of one year. Women were interviewed about their smoking habits before and during pregnancy. They were also asked about the smoking habits of their spouses. The relationship between smoking habits and pregnancy complications and newborn status was researched. The outcomes measured included pregnancy complications, gestational age at the onset of labor, Apgar scores during labor, and fetal birth weight and height. RESULTS: The percentage of maternal smoking before pregnancy was 26.5% (n=132) and decreased to 9.8% (n=49) at the end of pregnancy, with 52.5% (n=262) of the fathers who continued to smoke at home during their wife's pregnancy. Low birth weight and preterm delivery rate were significantly higher in maternal (n=15 [30.6%], and n=12 [24.5%], respectively) and paternal smoking groups (n=52 [22.4%] and n=54 [23.3%], respectively). Paternal smoking had no effect on intrauterine growth retardation (n=10 [4.3%]) and prenatal death (n=4 [1.7%]), although maternal smoking had such an effect (n=7 [14.3%] and n=3 [6.1%], respectively). CONCLUSION: Maternal smoking is a major risk factor for preterm delivery, low birth weight, intrauterine growth retardation, and intrauterine death, but paternal smoking also carries risk for the fetus. During perinatal care, we should educate the expectant parents about the side effects, not only of maternal, but also of paternal smoking.

The knowledge of "Facts for Life".

OBJECTIVE: "Facts for Life" is an essential tool for saving the lives of children. In this study we wanted to evaluate the knowledge of "Facts for Life" among Turkish women. DESIGN: This is a cross-sectional field study. We used 25 indicator questions to evaluate the knowledge of women in the following main subjects: safe motherhood, childhood immunization, childhood diarrhoea, children's acute respiratory diseases, and household hygiene. We filled out printed questionnaires during face-to-face interviews. For each correct answer we gave 4 points, and the sum of the points was accepted as the knowledge score. SETTING: Bursa metropolitan area in Turkey. SUBJECTS: Married women between 15-44 years of age. We selected 1000 of them from the household cards of the health centers that were located at the Bursa metropolitan area by using a random selection method. RESULTS: Mean knowledge score was 72.0 +/- 0.3. About 3/5 had moderate, 1/5 good + very good, and 1/5 bad knowledge scores. Childhood diarrhoea was better known than acute respiratory diseases. The very well known "Facts for Life" were those concerning food and household hygiene. CONCLUSION: Women's knowledge about "Facts for Life" was at a moderate level. The knowledge level of older women was better than the younger. Some false beliefs still existed. Knowledge about ARI and diarrhoeal diseases in childhood were the least known facts.