A Multicenter Analysis of Subjectivity of Indirect Immunofluorescence Test in Antinuclear Antibody Screening.

Objectives: This study aims to evaluate the interpretation of the antinuclear antibody (ANA)-indirect immunofluorescence (IIF) test results based on the interpreter-related subjectivity and to examine the inter-center agreement rates with the performance of each laboratory. Patients and methods: The ANA-IIF testing was carried out in a total of 600 sera and evaluated by four laboratories. The inter-center agreement rates were detected. The same results given by the four centers were accepted as gold standard and the predictive values of each center were calculated. Results: The inter-center agreement was reported for ANA-IIF test results from 392 of 600 (65.3%) sera, while 154 of 392 results were positive. Four study centers reported 213 (35.5%), 222 (37.0%), 266 (44.3%), and 361 (60.2%) positive test results, respectively. In terms of the patterns, the highest and lowest positive predictive values were 72.3% and 42.7%, respectively, while the highest and lowest negative predictive values were 99.6% and 61.5%, respectively. The agreement for semi-quantitative evaluation at three levels of fluorescence intensity stated by four centers was detected in 100 sera at 87% 3(+), while the other two levels were 6% and 7%. The highest predictive value for the highest fluorescence intensity of 3(+) was found to be 71.9%. Conclusion: Significant differences may be observed among laboratories in terms of qualitative results, patterns, and semi-quantitative determination of the fluorescence intensity in the ANA-IIF testing, particularly at low fluorescence intensity levels and in those with speckled patterns. In case of any discrepancy between ANA-IIF test and clinical prediagnosis, the test should be repeated in another laboratory, if necessary.

Sociodemographic determinants of nonattendance in a population-based mammography screening program in the city of Manisa, Turkey.

OBJECTIVES: Community based breast cancer screening has decreased breast cancer mortality in women. This study examined the predictors of nonattendence for invitational breast cancer screening in relation to socioeconomic status in the city of Manisa, in western Turkey. STUDY DESIGN: For the evaluation of the reasons for refusing to participate in the study, two districts were selected. 446 women aged between 50 and 69 years were selected from the program database by systematic random sampling. METHODS: The questionnaire consisted of sociodemographic variables and the adapted version of Champion's Health Belief Model Scale. Univariete and multivariete logistic regression analysis were performed throughout the data analysis. RESULTS: Being from an urban district and being from the western region were the risk factors for not participating in the screening program (P = 0.014, P = 0.023). A statistical significance was found between mammography-benefit, mammography-barrier and program participation (P = 0.044, P = 0.006). Although there were many more barriers for not participating in the screening program for the women of the slum district, the attendence rate of the slum district was higher than that of the urban district. CONCLUSIONS: Increased attendance may be achieved through enhancement of breast cancer awareness and by reducing some of the modifiable barriers.

Experience of workplace violence during medical speciality training in Turkey.

AIMS: To determine the type, extent and effects of workplace violence among residents during postgraduate speciality training in various departments of medical schools in Turkey. METHODS: A cross-sectional survey was conducted in seven medical schools representing all geographical regions of Turkey. All physicians in speciality training in the selected medical schools were asked to complete a semi-structured 'violence questionnaire' addressing the type (emotional, physical and sexual) and extent of violence experienced, the perpetrators of the violence and the victim's reactions to the experience. RESULTS: A total of 1712 residents out of 2442 completed the questionnaire. In all, 68% indicated they had experienced some form of workplace violence, 67% had experienced verbal violence, 16% had experienced physical violence and 3% had experienced sexual violence. The victims' most prevalent reactions to violence included being deeply disturbed but feeling they had to cope with it for the sake of their career (39%), being distressed (26%) but considering that such events are common in all occupations and discounting it and being confused and bewildered and unsure how to respond (19%). The most frequently named perpetrators of verbal violence were relatives/friends of patients (36%) and academic staff (36%), followed by other residents/senior residents (21%), patients (20%), heads of department (13%) and non-medical hospital staff (6%). CONCLUSIONS: Physicians in speciality training in medical schools in Turkey are subject to significant verbal, physical or sexual violence. Precautions to prevent such exposure are urgently needed.

Prognostic value of initial antithrombin levels in neonatal sepsis.

OBJECTIVES: We determined whether initial antithrombin (AT) levels help in diagnosis and prognosis of neonatal sepsis. METHODS: Sepsis was diagnosed according to clinical and laboratory findings and positive culture results in 34 of the 54 newborns who presented to the hospital with suspected sepsis. Between AT levels and hematological parameters (fibrinogen levels, prothrombin time (PT), activated partial thromboplastin time (aPTT) and liver function tests), these were correlated each other and with outcome of the babies. RESULTS: Initial AT and fibrinogen levels were significantly lower in newborns with sepsis compared to control (P < 0.05). Initial AT levels were lower in the ones who developed disseminated intravascular coagulation (DIC) compared to those without DIC (P < 0.05). Initial AT levels were significantly lower in newborns who died as compared to survivors (P < 0.05). Sensitivity of AT was highest at 15 mg/dL for prognosis in neonatal sepsis (sensitivity:92.3%, specificity:61.9%, positive predictive value : 61.9 %; negative predictive value: 61.9%;). CONCLUSION: Lower initial AT levels in neonatal sepsis are associated with a severe disease and increased mortality. It may be useful in predicting clinical outcome in neonatal sepsis.

The association of self-esteem, depression and body satisfaction with obesity among Turkish adolescents.

BACKGROUND: The purpose of this study was to determine the prevalence of overweight and obesity and to examine the effects of actual weight status, perceived weight status and body satisfaction on self-esteem and depression in a high school population in Turkey. METHODS: A cross-sectional survey of 2101 tenth-grade Turkish adolescents aged 15-18 was conducted. Body mass index (BMI) was calculated using weight and height measures. The overweight and obesity were based on the age- and gender-specific BMI cut-off points of the International Obesity Task Force values. Self-esteem was measured using the Rosenberg Self-Esteem Scale, and depression was measured using Children's Depression Inventory. Logistic regression analysis was used to examine relationships among the variables. RESULTS: Based on BMI cut-off points, 9.0% of the students were overweight and 1.1% were obese. Logistic regression analysis indicated that (1) being male and being from a higher socio-economical level were important in the prediction of overweight based on BMI; (2) being female and being from a higher socio-economical level were important in the prediction of perceived overweight; (3) being female was important in the prediction of body dissatisfaction; (4) body dissatisfaction was related to low self-esteem and depression, perceived overweight was related only to low self-esteem but actual overweight was not related to low self-esteem and depression in adolescents. CONCLUSION: The results of this study suggest that school-based adolescents in urban Turkey have a lower risk of overweight and obesity than adolescents in developed countries. The findings of this study suggest that psychological well-being of adolescents is more related to body satisfaction than actual and perceived weight status is.

The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in western Turkey.

BACKGROUND: Breast cancer appears to be a disease of both the developing and developed worlds. Among Turkish women, breast cancer is the second leading cause of cancer-related deaths. The aims of this cross-sectional study were to determine levels of knowledge about breast cancer and to evaluate health beliefs concerning the model that promotes breast self- examination (BSE) and mammography in a group of women aged 20-64 in a rural area of western Turkey. METHODS: 244 women were recruited by means of cluster sampling in this study. The questionnaire consisted of sociodemographic variables, a risk factors and signs of breast cancer form and the adapted version of Champion's Health Belief Model Scale (CHBMS). Bivariate correlation analysis, Chi square test, Mann-Whitney U test and logistic regression analysis were performed throughout the data analysis. RESULTS: The mean age of the women was 37.7 +/- 13.7. 49.2% of women were primary school graduates, 67.6% were married. Although 76.6% of the women in this study reported that they had heard or read about breast cancer, our study revealed that only 56.1% of them had sufficient knowledge of breast cancer, half of whom had acquired the information from health professionals. Level of breast cancer knowledge was the only variable significantly associated with the BSE and mammography practice (p = 0.011, p = 0.007). BSE performers among the study group were more likely to be women who exhibited higher confidence and perceived greater benefits from BSE practice, and those who perceived fewer barriers to BSE performance and possessed knowledge of breast cancer. CONCLUSION: By using the CHBMS constructs for assessment, primary health care providers can more easily understand the beliefs that influence women's BSE and mammography practice.