How health literacy associates with healthcare utilization and health promotion behaviours in Turkey?: Contributions to discussions concerning the Anderson model and ecological models.

BACKGROUND: This study examined how health literacy (HL) levels are associated with health care utilization (HCU) and health promotion behaviours (HPB) in Turkey. METHODS: We conducted face-to-face interviews and utilised the Turkish HL Scale-32 (n = 6228). RESULTS: HL score was inversely related to the number of outpatient admissions (OAs) (ß = -0.001) and emergency department admissions (EAs) (ß = -0.006) in the Poisson regression model. Sex, age, perceived health, income group, and education level were other variables related to the number of OAs and EAs. Health literacy levels were related to physical activity (PA) (for excellent HL, OR: 3.93 (95% CI: 2.54-6.08)) and acquiring healthy eating habits (HEHs) (for excellent HL, OR: 3.56 (95% CI: 2.40-5.29) in the logistic regression model. Education levels are related to PA, HEHs, and smoking cessation or reduction. Income groups, except those with very sufficient income, are related to PA and HEHs. CONCLUSION: Improving HL can help reduce health admissions. The relationship of HCU with gender, age, education, perceived health, and income group supports the Anderson model. Limited HL groups should be prioritised as risk groups in health promotion programs. The association of HL and socio-economic variables with HPB supports the ecological model.

The prevalence and distribution of human papillomavirus in 4267 Turkish women with or without cervical lesions: A hospital-based study.

In the present study, it was aimed to screen the genotypes of human papillomavirus (HPV) retrospectively in women with gynecological symptoms who were admitted to a tertiary care university hospital in Ankara, Turkey. A total of 4267 cervical swab samples of women aged 18-79 years were sent to Medical Virology Laboratory from January 2017 to November 2020. Nucleic acid extraction and amplification of samples were done by an automated system. The test can detect 14 high-risk HPV (HR-HPV) types in a single analysis that performs a real-time polymerase chain reaction, by providing individual results on the highest-risk genotypes HPV 16 and HPV 18 and pooled results on other high-risk genotypes (OHR-HPV) (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68). HPV DNA positivity was detected in 14.2% (605/4267) of the samples. HPV type 16 and type 18 were detected in 2.4% and 0.7% of the samples, respectively. OHR-HPV types were found in 8.8% of the samples. Of the 1.9% and 0.4% samples had mixed types with type 16+ OHR-HPV and type 18+ OHR-HPV, respectively. The results of this study presented the rates of HR-HPV genotypes of a university hospital in Ankara, over a 4-year period. It was observed that the positivity rate of type 18 is decreasing and some OHR-HPV types are increasing. HPV vaccination is not in the national immunization program in Turkey yet, however, HPV vaccines are available and the vaccination rates for women are increasing.

Assessment of anxiety in elderly population during the COVID-19 pandemic and the impact of compulsory home-stay in the central districts of Ankara, Turkey: A quantitative, qualitative mixed method study.

OBJECTIVE: This study aimed to determine the level of anxiety in elderly individuals during the COVID-19 pandemic in Ankara province of Turkey and determine its associated factors. METHODS: A quantitative, qualitative mixed-method study performed in 1-10 June 2020 during the compulsory home-stay for elderly people in Turkey. The quantitative study was conducted using a structured online questionnaire with 278 participants aged 65 or older. The Geriatric Anxiety Inventory (GAI) was used to assess the anxiety. An in-depth interview with 20 participants was used to fill the gap of face-to-face interview due to pandemic situation and strengthen the results of quantitative survey. Qualitative and quantitative data were analyzed separately. RESULTS: Of all participants, 88 (31.7%) had a score above the cut-off point for GAI. The prevalence of Generalized Anxiety Disorder (GAD) was significantly higher in female (37.8%) than in male (23.8%). Female gender, economic loss, uncertainty, and the time participants expend to follow news about COVID-19 pandemic were risk factors of GAD. On the other hand, higher education level, hobbies, and regular physical activity were protective factors against GAD. CONCLUSION: During the pandemic, social isolation and lockdown for elderly people make serious risk factor for their mental well-being. Measures must be taken to support the psychological well-being of elderly by promoting physical activity and hobbies at home, and reducing their economic concerns.

Clinical practice in vesicoureteral reflux with respect to EAU guidelines: A multicenter study.

PURPOSE: We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to European Association of Urology (EAU) Guidelines in Urology clinics of our country. MATERIALS AND METHODS: The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to vesicoureteral reflux (VUR) (between years 2003 and 2017) in nine different institutions. Patients were divided into two groups according to time of initial treatment and also grouped according to risk factors by "EAU guidelines on VUR." RESULTS: In this series, 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (P = .046, P = .0001, respectively), while success rates were not significantly different in high risk group (P = .46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (P = .096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (P = .000 and P = .0001, respectively) after 2013. Overall success rates of endoscopic treatments and ureteroneocystostomy (UNC) operations were 65% and 92.9% before 2013 and 60% and 78.5% after 2013, respectively. Thus, the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013 (P = .000), while the difference was not significant in the injection group (P = .076). CONCLUSION: Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups despite these reliable and accepted guidelines were expected to influence our daily approach.

[Investigation of HTLV-I/II Seroprevalance of Patients with HIV Positivity being Monitored by Real-Time RT-PCR]. / HIV Pozitifligi Gerçek Zamanli RT-PCR ile Takip Edilen Hastalarin HTLV-I/II Seroprevalansinin Arastirilmasi.

Human T-lymphotropic virus-I/II (HTLV-I/II) and human immun viruses (HIVs), that have similar genomic characteristics also share the same transmission routes and infect T lymphocytes. Regarding this epidemiological similarity, HIV and HTLV infections can be seen together. HIV and HTLV-I/II coinfection occurs with variable frequencies in different populations and geographic regions. There are not any population-based studies carried out defining the number of individuals coinfected with HIV and HTLV-I/II in Turkey. The aim of this study was to determine the seropositivity rates of HTLV-I/II in patients whose HIV viral load was monitored in Gazi University Faculty of Medicine Medical Virology Laboratory Forty-seven HIV positive cases followed-up in Medical Virology Laboratory for HIV viral load monitoring between May 2017-January 2019 were included in the study. HIV seropositivity of the samples was confirmed by the chemiluminescence microparticle immunoassay method. HIV viral load values of the samples were evaluated by real-time reverse transcriptase polymerase chain reaction. The samples were screened for antibodies against HTLV-I/II using chemiluminescent microparticle immunoassay. The study population range was between 19 to 60 years of age. Among the study population, 39 (83%) patients were male and 8 (17%) patients were female. Of 47 samples, 18 samples (38.3%) had viral load of <1000 copies/ml, 10 samples (21.3%) had viral load of 1000-10000 copies/ml, 19 samples (40.4%) had viral load of ≥10000 copies/ml. HTLV serology was negative in all samples included in the study. CD4+ results were available for 42 patients and the CD4+ results of five patients could not be studied. Co-infection with different retroviruses is a well-known fact which should be thoroughly examined. HTLV-I co-infection leads to faster progression of the disease in HIV-1 positive patients. Although it is known that the co-infection has a significant effect on the progression of the disease, there are very few centers in the world and in our country that routinely perform HTLV testing in HIV-positive patients. We think that in order to evaluate the clinical and microbiological importance of the coinfection of retroviruses with each other and to determine the frequency of these infections together, there is a need for studies involving a larger number of patients, including detailed clinical backgrounds of individuals, and that the importance of this issue should be realized at the same time.

Rotavirus infections in children in Turkey: A systematic review.

We aimed to describe rotavirus epidemiology and clinical findings including extraintestinal manifestations in a setting that has yet to introduce rotavirus vaccines in the national immunization program. A literature search was performed by using the key words "Turkey" and "rotavirus." Ninety-eight studies published between 1987 and 2016 including epidemiological, clinical, and genotypical data at least 1 year duration were included. There were a total of 117 741 children with diarrhea and 26 566 rotavirus gastroenteritis with a median detection rate 31.8% (95% CI, 31.3-32.4) under 5 years of age. The rate of dehydration was 47% (95% CI, 23.4-91.6). There were 328 cases reported to be presenting with a various complication related to rotavirus in 2750 children in eight studies. The overall complication rate was 11.7% (95% CI, 10.7-12.9). The cumulative incidence of the most common genotypical combinations circulating worldwide was only 59.7% (G9[P8], 25%; G1[P8], 22%; G2[P4], 5.6%; G3[P8], 2.6%; G4[P8], 4.5%) whereas mixed, untypeable, and other genotypes were 2.4%, 15%, and 22.9% respectively. Our results point out the importance of rotavirus vaccination by presenting that rotavirus may cause severe complications besides severe gastroenteritis. The role of strain diversity in the variability of clinical presentations of rotavirus infections needs to be further investigated.

Detection of HPV DNA in Esophageal Lesions: a Cross-Sectional Study.

BACKGROUND: Several studies have documented human papillomavirus (HPV) in extra-cervical tumors. We aimed to detect HPV type 16 and HPV other than type 16 (OT-16) DNA in esophageal papilloma and esophagus squamous cell carcinoma (ESCC) samples and to compare clinicopathological features of HPV positive and negative patients. METHODS: Materials were obtained from a tertiary care public hospital and studied in an university hospital for this cross-sectional study. Seventy-six tissue samples (50 papilloma and 26 ESCC) were included. After deparaffinization by xylene and DNA extraction by phenol chloroform-isoamyl-alcohol, 76 samples were studied with a G6PDH control kit. Forty-four papilloma and 21 ESCC samples with enough tissues were studied for HPV DNA. HPV OT-16 DNA and HPV type 16 were detected by real time-polymerase chain reaction. RESULTS: Twelve (27.3%) and one (2.3%) of the papilloma samples were HPV type 16 and other than type 16 positive, respectively. Eleven (52.4%) and one (4.8%) of ESCC samples were HPV type 16 and mixed type positive, respectively. CONCLUSIONS: We suggest that HPV infection is common in esophageal papilloma and ESCC. Due to the wellknown association of HPV with premalignant and malignant conditions, follow-up of these patients accompanied by HPV should be implemented.

Is Human Papillomavirus and Helicobacter pylori Related in Gastric Lesions?

BACKGROUND: Human papillomavirus (HPV), the causative agent of cervical cancer, is also suggested as a risk factor for gastric adenocarcinoma. Many infectious agents besides Helicobacter pylori have been associated with gastritis. The aim of this study was to investigate HPV DNA and genotyping HPV type 16 DNA in gastric adenocarcinoma and Helicobacter pylori gastritis cases. METHODS: A hundred and six gastric adenocarcinoma and Helicobacter pylori gastritis samples and 26 controls were included. After deparaffinization by xylene, DNA extraction was performed by the phenol-chloroform-isoamyl alcohol method and 106 samples were studied with a G6PDH control kit (Eurogentec, Seraing, Belgium). Fifty-three adenocarcinoma and 43 Helicobacter pylori samples were thought to have enough tissue and were studied for HPV DNA. HPV types other than 16 and HPV type 16 DNA were detected by Real Time PCR using the L1 region. Amplifications of MY09/11 products were done by GP5+/GP6+ primers and Cyanine-5 labeled HPV DNA and HPV 16 DNA specific probe in Light Cycler 2.0 (Roche Diagnostics, Germany) device. RESULTS: Among gastric adenocarcinoma and Helicobacter pylori gastritis samples, 20/53 (38%) and 18/43 (41.8%) were HPV DNA positive, respectively. Five (19.2%) of 26 controls were HPV DNA positive. CONCLUSIONS: Our 38% positive result in the gastric carcinoma group is in concordance with previous reports. This is the first study revealing the HPV-H. pylori relationship in gastritis cases and we concluded that with regard to the nearly three-fold higher HPV DNA (41.8%) in gastritis cases compared to controls, Helicobacter pylori positive cases should also be evaluated in favor of HPV in the gastritis group.

Maternal mortality cases from pulmonary embolism: A nation-wide study in Turkey.

The aim of the study was to evaluate the maternal mortality cases attributed to pulmonary embolism (PE). PE constituted 7.58% of maternal deaths in 2013. Risk factors for PE were present in 15 (88.2%) of the women. Five women (29.4%) were overweight, and 5 (29.4%) were obese. Four women (23.5%) had cardiac diseases. PE occurred in the postpartum period after caesarean delivery in 9 (52.9%) patients. Eleven (64.7%) of the maternal deaths were recognised as preventable. More deaths attributed to PE occurred in the postpartum period (n = 11) than the antepartum period (n = 5). One other maternal mortality case was after therapeutic abortion. Caesarean section, obesity and cardiac diseases were important risk factors. It can be suggested that monitoring all risk factors and timely recognition of related symptoms and signs with initiation of appropriate management have paramount importance for reducing maternal mortality rate related to pulmonary embolism. Increasing awareness of healthcare professionals as well as the public, and continuously reviewing the cases are also important tools for achieving this goal.

[Assessing the knowledge in primary health care following an educational course structured in the context of GARD chronic airway diseases national control program]. / Türkiye kronik hava yolu hastaliklari önleme ve kontrol programi (GARD Türkiye) birinci basamakta çalisan hekim egitimi bilgi degerlendirme sonuçlari.

INTRODUCTION: Chronic obstructive pulmonary diseases are common causes of disease in the community and account for considerable percent of the caseload in primary health care facilities. For this reason, it is important to question and improve the knowledge of primary health care physicians. This study is designed to assess the level of knowledge for bronchial asthma and COPD of the primary healthcare physicians, both before and immediately after an educational course structured in the context of GARD Chronic Airway Diseases National Control Program. MATERIALS AND METHODS: The participating physicians attended an intensive educational course on asthma and COPD. Twenty five item questionnaires for asthma and COPD were administered to the participants both before and immediately after the end of the course. Contribution of education to the level of knowledge was investigated by comparing the percentages of the correct answers in the pre-and post-test. RESULT: From 11 different cities, 1817 and 1788 primary health care physician were attended to the asthma and COPD educations, respectively. The accuracy rate of ≥ 75% was obtained from only 4 questions in pre-test asthma questionnaire. On the contrary, in 15 questions the accuracy rate was < 50%. The mean accuracy rate for the whole asthma test was 45.8%, and this rate raised to 69.6% after education course. The accuracy rate of ≥ 75% could not be obtained from any of the questions in pre-test COPD questionnaire. On the contrary, in 19 questions the accuracy rate was < 50%. The mean accuracy rate for the whole asthma test was 42.0%, and this rate raised to 71.3% after education course. CONCLUSIONS: It has been shown that, in primary care settings, the level of knowledge in asthma and COPD should be enhanced and that this increase can be achieved with an education course.

Detection and molecular characterisation of adenovirus in children under 5 years old with diarrhoea

Background/aim: To determine the frequency, genotype distribution, and genetic relatedness of adenoviruses in children under 5 years old with diarrhoea and to investigate their distribution according to clinical findings, age, months, and seasons. Materials and methods: Stool samples were collected from 180 children with acute gastroenteritis who presented from July 2007 through June 2011 at the Ankara Training and Education Hospital. Stool samples were analysed by immune chromatographic test (ICT), enzyme immunoassay (EIA), and polymerase chain reaction (PCR). All adenovirus types were determined by nucleotide sequence analysis. A phylogenetic tree was constructed by Mega 6.0 using the neighbour-joining method. Results: Five percent of the samples were positive for adenovirus (9/180) by ICT, 6.1% (11/180) by EIA, and 13.9% (25/180) by PCR. Adenovirus gastroenteritis did not show any differences in age group, sex, month, or season. In this study, 16 (64%) of the PCR positive samples were AdV41, 6 (24%) were AdV40, 2 (8%) were AdV31, and 1 (4%) was AdV7, as determined by nucleotide sequencing. Conclusion: AdV31 and AdV7 were associated with gastroenteritis. Adenovirus serotypes showed a similarity of 80% (20/25) and 20% (5/25) with Asian and American serotypes, respectively.

Adjuvant systemic chemotherapy with or without bevacizumab in patients with resected liver metastases from colorectal cancer.

BACKGROUND: We aimed to investigate the impact of adjuvant systemic therapy with modern chemotherapy combinations on survival outcomes in patients with resected liver-confined metastases from colorectal carcinomas, and whether addition of bevacizumab (BEV) provides further benefit. METHODS: A total of 229 consecutive patients who underwent resection for liver-confined colorectal liver metastases were retrospectively analyzed. RESULTS: Of 229 patients, 204 who received chemotherapy with fluoropyrimidine-based (n = 27), irinotecan-based (n = 84) and oxaliplatin-based (n = 93) combinations were analyzed. Among these, 87 patients received BEV while 117 did not (NoBEV). With a median follow-up of 27 months after metastasectomy, the median recurrence-free survival (RFS) and overall survival (OS) were 17 and 53 months, respectively. OS rates at 3 and 5 years were 71% and 40%, respectively. No significant differences were found in the median RFS (p = 0.744) and OS (p = 0.440) among different chemotherapy regimens. The median RFS (p = 0.375) and OS (p = 0.251) were similar in BEV and NoBEV arms. In multivariate analysis, having 4 liver metastases was the only negative independent factor on both RFS and OS, while positive surgical margin was another negative independent factor for RFS. CONCLUSION: Chemotherapy type and addition of BEV have no impact on both RFS and OS in the adjuvant setting following complete resection of colorectal liver metastases.

Diagnostic potential of serum direct markers and non-invasive fibrosis models in patients with chronic hepatitis B.

AIM: Liver biopsy is recommended in the majority of patients with chronic viral hepatitis for fibrosis evaluation. Because of the disadvantages of liver biopsy, many studies related to non-invasive biomarkers and scores have been performed. In this study, we aimed to assess the diagnostic value of serum direct markers and non-invasive fibrosis models to predict liver fibrosis in the treatment-naive chronic hepatitis B (CHB) patients and to compare their diagnostic performance. METHODS: This study included 58 patients with a diagnosis of CHB virus infection and 30 healthy controls. Hyaluronic acid, tissue inhibitor of matrix metalloproteinase 1 and amino-terminal propeptide of type III procollagen were measured by enzyme-linked immunosorbent assay; and the Original European Liver Fibrosis panel, the Enhanced Liver Fibrosis (ELF) panel, PP score, aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 indexes were calculated using the formulas taken from previous publications. Fibrosis stage was determined using Ishak's scoring system. RESULTS: The fibrosis stages identified upon liver biopsy was F0 in 12 patients (20.7%), F1-2 in 36 (62.1%) and F3-5 in 10 (17.2%). The diagnostic value of all the non-invasive indices was low to detect mild fibrosis. We demonstrated that the diagnostic accuracy of HA is the best for predicting fibrosis of F3 or more (area under the receiver-operator curve, 0.902). In our study, the results from a combination of tests showed that ELF and APRI had the highest diagnostic value sensitivity of 90%, specificity of 100%, positive predictive value of 100% and negative predictive value of 96.4% for detection of fibrosis of F3 or more. CONCLUSION: In CHB patients, combination of ELF and APRI has a better diagnostic value in predicting fibrosis of F3 or more.

Clinical significance of lymph node ratio in locally advanced breast cancer molecular subtypes.

BACKGROUND: The ratio of metastatic to dissected lymph nodes (lymph node ratio; LNR) is a sensitive and superior prognostic factor for lymph node evaluation, but its relationship to cancer subtypes is unclear. PATIENTS AND METHODS: Data from 469 patients with axillary lymph node metastasis out of 640 early breast cancer cases were retrospectively analyzed. They were classified into 4 molecular subtypes; luminal A, luminal B HER2(+), HER2 overexpression, basal-like. LNRs were compared between groups and with other prognostic factors. RESULTS: The distribution of LNRs was 35.2% in luminal A, 43.2% in luminal B HER2(+), 46.9% in HER2 over-expression, and 39.1% in basal-like. A significant difference was found between luminal A and HER2 over-expression subtypes (p = 0.023). LNR was significantly correlated with tumor size and lymphovascular invasion, but not with other prognostic factors including menopausal status, laterality, grade, and perineural invasion. An LNR of 29.8% was defined as the cut-off value, and significant differences in survival rates were identified accordingly between basal-like and both luminal A (p = 0.003) and luminal B HER2(+) (p = 0.04). CONCLUSION: The LNR differs between some molecular subtypes of breast cancer, and it correlates with certain prognostic factors and survival. These data support using the LNR to assess breast cancer patients.

[Investigation of norovirus infection incidence among 0-5 years old children with acute gastroenteritis admitted to two different hospitals in ankara, Turkey]. / Akut Gastroenterit Nedeniyle Ankara'da Iki Farkli Hastaneye Basvuran 0-5 Yas Arasi Çocuklarda Norovirus Enfeksiyonu Sikliginin Arastirilmasi

Norovirus causes severe gastroenteritis requiring hospitalization especially in children less than five years of age both in developed and developing countries. Therefore, we aimed to investigate the incidence of norovirus (NoV) in 0-5 years old children with acute gastroenteritis in two large hospitals in Ankara, Turkey. Stool samples were obtained from 1000 (413 female, 587 male) children between 0-5 years old with acute gastroenteritis who attended to the Department of Paediatrics, Ministry of Health Ankara Training and Education Hospital and affiliated hospital of Gazi University Faculty of Medicine between October 2004 and June 2011. Antigens of norovirus GI and GII genogroups in the stool specimens were detected by ELISA (RIDASCREEN® Norovirus (C1401) 3rd Generation, R-Biopharm, Germany). Norovirus GI and GII antigens were determined in a total of 141 (14.1%) samples, of them 62 (15%) were female and 79 (13.5%) were male, yielding no statistically significant difference (p> 0.05). The highest NoV positivity was detected in children between 12-23 months (17.1%), however there was no statistically significant difference between ELISA positivity and age (p> 0.05). NoV detection rate was highest in 2007 (18.4%) and in 2009 (18%), and the difference regarding ELISA positivity among the study years was not statistically significant (p> 0.05). The prevalences of norovirus infection in spring, summer, autumn and winter were 13.8%, 17.7%, 14.7% and 11.2%, respectively. Therefore no seasonal variation was found in the incidence of norovirus infection. However when the monthly prevalence was analyzed, a statistically significant difference was found (p< 0.05) between the rate of norovirus infection in july (24.2%) and december (4.1%). When evaluating the clinical symptoms, all of 141 patients (100%) had diarrhoea, while 72 (51.1%) had vomiting. Stool samples were also evaluated for the presence of parasitic and bacterial agents. Coinfection rate with parasites was detected as 3.3% (4/122; norovirus + Entamoeba histolytica in three cases, norovirus + Enterobius vermicularis in one case), while no pathogenic bacteria were isolated from norovirus positive stool samples. The prevalence rate of 14.1% for NoV GI/GII infection detected in this retrospective study including 0-5 years old children in Ankara for 2004-2011 period was thought to reflect the regional data and would contribute to national epidemiological data. We anticipate that the incidence of norovirus will increase in 0-5 year old children as a result of increasing use of rotavirus vaccine in Turkish children. It was concluded that, NoV antigen detection tests should be used in routine laboratories for appropriate diagnosis of sporadic and/or epidemic norovirus infections.

Dropout and compliance to physical exercise in menopausal osteopenic women: the European "happy bones" project.

Introduction: Decline in muscle mass and bone density seem to be two of the most disabling side effects of menopause that negatively affect women's quality of life. Promoting physical activity protocols in the workplace can represent a focal point in the prevention and management of several diseases. The study aims to evaluate the compliance and drop-out of menopausal osteopenic women engaged in combined training performed inside and outside the workplace. Strength and balance were analyzed to evaluate the effect of this protocol on osteoporosis prevention and the risk of falling. Methods: 73 menopausal women were enrolled in 5 European countries. They performed 72 lessons of a combined training proposed in the working place (IW) or sport center (SC). Results: Out of the total 39 women enrolled in the IW, 12.8% had to leave the program, while out of the 34 women enrolled in SC, 41.2% did not complete the training. According to the compliance results, 47% of women that completed the trained IW and 85% in the SC recorded high compliance (p = 0.019). Moreover, the strength of the lower limbs (p < 0.001) and static balance (p = 0.001) significantly improved in the whole group. Discussion: In conclusion, proposing well-structured training in the workplace for menopausal women seems to reduce drop-out. Strength and balance results suggest its positive impact on bone health and risk of falls, despite where it is performed.

Effectiveness of pandemic influenza A/H1N1 vaccine for prevention of otitis media in children.

UNLABELLED: Our aim was to evaluate effectiveness of pandemic influenza A/H1N1 vaccine in preventing acute otitis media (AOM) and/or otitis media with effusion (OME), in a randomized, prospective and single-blind study conducted in the children aged of 6-60 months. This study was done between December 1, 2009 and April 30, 2010 during the pandemia between June 2009 and May 2010. On the healthy children, vaccinated against pandemic influenza A/H1N1 and age-matched unvaccinated controls, the rate of AOM, OME, and any otitis media (OM) attack (sum of AOM and OME attacks) confirmed by otoscopic and tympanometric examination, and their associations with risk factors were looked for. Otoscopic and tympanometric evaluation was done twice within the follow-up period of 4-8 weeks. Totally 46 vaccinated and 46 unvaccinated healthy children were enrolled. No difference in rates of AOM, OME, or OM was found between vaccinated and unvaccinated children. But logistic regression analysis revealed that unvaccinated children had 2.9-folds more risk for OME and OM, but not for AOM. Further, male gender and bottle feeding and/or using pacifier revealed significant relationships with AOM. CONCLUSION: We conclude that pandemic influenza A/H1N1 vaccine prevented OME rather than AOM attacks in children with 6-60 months of age.

Promoting adolescent health: health literacy, self-efficacy and internet use.

BACKGROUND: Adolescents are mostly considered as a healthy population; however, failure to acquire positive health behaviors during this period makes them vulnerable to poor health outcomes and long-term chronic disorders. Health literacy is one of the most influential parameters in promoting adolescent health. This study aimed to determine the level and promoters of health literacy in adolescents, emphasize the importance of internet use, and evaluate the relationship between self-efficacy and health literacy. METHODS: A total of 756 adolescents aged 15 and 18 years attending two high schools in socioeconomically different districts in Ankara, Turkey were included in this cross-sectional study. A survey consisting of descriptive questions, a health literacy survey, and a general self-efficacy scale were used to collect data. p < 0.05 was considered statistically significant. RESULTS: Among the adolescents who participated in the study, the level of health literacy was inadequatelimited in 56.1%, sufficient in 30.1%, and excellent in 13.8%. A statistically significant correlation was found between health literacy and general self-efficacy levels (r: .412, p < 0.001). There was also a statistically significant difference between the health literacy groups in terms of the education level of the adolescents` mothers, internet use frequency, and self-efficacy level. The multivariate logistic regression analysis revealed that the participants whose mothers had only received primary school education or no formal education, those that were not using the internet regularly, those that did not search health information on the internet, and those with poor self-efficacy levels were more likely to have an inadequate level of health literacy [odds ratio (OR)=2.6, 95% confidence interval (CI)=1.4-4.9; OR=5.5, 95% CI=1.2-25.1; OR=1.7, 95% CI=1.1-2.9; and OR=3.7, 95% CI=2.6- 5.2, respectively]. CONCLUSIONS: In this study, it was concluded that the adolescents` health literacy and general self-efficacy levels were related. Furthermore, the health literacy level of the adolescents was associated with internet use and maternal education status.

[Rotavirus prevalence in children with acute gastroenteritis and the distribution of serotypes and electropherotypes]. / Akut Gastroenteritli Çocuklarda Rotavirus Prevalansi, Serotip ve Elektroferotip Dagilimi

Rotavirus is the major cause of gastroenteritis in children worldwide as well as in Turkey. The aims of this study were to determine the prevalence of rotavirus infection in children with acute gastroenteritis and to investigate the prevalent rotavirus serotypes and electropherotypes. Stool specimens collected from 251 (108 female, 143 male) children age between 0-5 years old who were admitted to Gazi University Hospital between April 2009 and February 2010 were included to the study. The presence of rotavirus antigen in the stool samples were searched by ELISA (Rotaclone, Meridian Diagnostics, Inc. USA) and double-stranded RNAs were extracted from the positive samples using phenol-chloroform-isoamyl alcohol method. RNA samples were subjected to polyacrilamide gel electrophoresis for electropherotyping. G and P genotypes were determined by RT-PCR and subsequently by nested PCR, using Access-Quick RT-PCR and PCR Mastermix (Promega Corporation, Madison, WI). Fifty-three (21.1%) of the stool samples were found positive by ELISA. G and P types were detected in 31 (58.5%) and 24 (45.3%) samples, respectively. Genotypes G1 (16.1%), G2 (12.9%), G3 (38.7%), G4 (25.8%) and G9 (6.5%) constituted G types and P[8] (87.5%), P[6] (8.3%) and P[9] (4.2%) types constituted P types. G/P combination was detected in 18 samples in the following order, G3P[8], G2P[8], G4P[8], G1P[8], G9P[8], G4P[6] and G1P[6] in 7 (38.9%), 3 (16.6%), 3 (16.6%), 2 (11.1%), 1 (5.6%), 1 (5.6%) and 1 (5.6%) of the samples, respectively. In 23 (43.4%) of the samples four different electropherotypes, namely E1 (n= 10), E2 (n= 10), E3 (n= 1) and E5 (n= 2) were identified. In conclusion, it was observed that G1-4 and G9 types are still prevalent in our region, however there is a transition from the predominance of G1 to G3 and G4, and also a decrease in the prevalence of G9 genotype. For the first time the presence of P[9] type in our country was detected in this study. Instead of previously circulated G1P[8] type, G3P[8] was detected as the predominant combination. Although all E types were reported in the previous studies from our country, only four E types were detected in the present study. This study has emphasized that previously reported rates of rotavirus genotypes and electroferotypes showed a diversion as a result of globalization.

Socioeconomic Factors Related to Prevalence, Severity, and Contact Coverage of Depression in Primary Health Care.

Background: We determine factors related to the prevalence, severity, and contact coverage of depression using the Patient Health Questionnaire-9. Methods: This cross-sectional study included 1059 individuals who applied to primary health care in Ankara before the onset of pandemic restrictions. Contact coverage was evaluated to include mental health care users. Results: The prevalence of depression was 22.9%. Individuals who were unemployed (OR: 3.832; 95% CI: 2.053-7.151), women (OR: 1.646; 95% CI: 1.158-2.340), those without social support (OR: 1.933; 95% CI: 1.219-3.065), those who did not receive formal education (OR: 2.631; 95 % CI: 1.312-5.275), lower-income group (OR: 1.528; 95% CI: 1.071-2.180), and unmarried or divorced (OR: 2.644; 95% CI: 1.324-5.281) were found to be at risk of developing depression. Based on the linear regression model including patients diagnosed with depression, individuals who were unemployed (standardized ß: 0.190), women (standardized ß: 0.075), those without social support (standardized ß: 0.096), and those who were unmarried or single (standardized ß: 0.147) had the highest scale scores. Contact coverage for depression was 31.0%. Contact coverage was more likely in the upper-income group (OR: 2.239, 95% CI: 1.173-4.273). Conclusion: Although depression is common among primary health care applicants, contact coverage is low. Developing screening programs for depression in primary health care may help improve community mental health. Socioeconomic factors that contribute to the emergence, severity, and contact coverage of depression indicate health inequalities. The development and severity of depression are mostly due to unemployment, which suggests the importance of employment-enhancing policies.