Internet Addiction and Social Media Addiction in Medical Faculty Students: Prevalence, Related Factors, and Association with Life Satisfaction.

Internet addiction is a growing behavioral health problem in modern societies. In this study, we aimed to determine the prevalence of internet addiction (IA) and social media addiction (SMA) and their relationship with sociodemographic factors, lifestyle habits, and internet usage patterns among medical students. This cross-sectional study was conducted among 280 medical students in a medical faculty, in Istanbul. Self-report questionnaires comprised sociodemographic status, lifestyle habits, internet and social media usage behavior, the Young Internet Addiction Test-short form (s-IAT), and the Bergen Social media addiction scale. The total prevalence of IA was 16.1% (11.8-20.4%), 17.2% (12.8-21.7%) in males and 14.8% (10.7-19.0%) in females. The total prevalence of SMA was 6.1% (3.3-8.9%), 4.8% (2.3-7.3%) in males and 7.4% (4.3-10.5%) in females. No significant difference was found between the sexes in terms of IA and SMA. IA was higher in grade 3 students than in grade 6 students. Multivariate logistic regression analyses showed that reading books at least once per month, high life satisfaction, performing physical activity at least twice per week, and using the internet for communication purposes were independent preventive factors for IA. The current study shows that IA and SMA are common in medical school students. Moreover, IA is associated with socioeconomic characteristics and lifestyle habits such as reading books, life satisfaction, and physical activity. To protect medical school students from IA and develop healthy behaviors, it is necessary to develop prevention strategies and design and implement awareness and education programs.

An easy-to-use nomogram for predicting in-hospital mortality risk in COVID-19: a retrospective cohort study in a university hospital.

BACKGROUND: One-fifth of COVID-19 patients are seriously and critically ill cases and have a worse prognosis than non-severe cases. Although there is no specific treatment available for COVID-19, early recognition and supportive treatment may reduce the mortality. The aim of this study is to develop a functional nomogram that can be used by clinicians to estimate the risk of in-hospital mortality in patients hospitalized and treated for COVID-19 disease, and to compare the accuracy of model predictions with previous nomograms. METHODS: This retrospective study enrolled 709 patients who were over 18 years old and received inpatient treatment for COVID-19 disease. Multivariable Logistic Regression analysis was performed to assess the possible predictors of a fatal outcome. A nomogram was developed with the possible predictors and total point were calculated. RESULTS: Of the 709 patients treated for COVID-19, 75 (11%) died and 634 survived. The elder age, certain comorbidities (cancer, heart failure, chronic renal failure), dyspnea, lower levels of oxygen saturation and hematocrit, higher levels of C-reactive protein, aspartate aminotransferase and ferritin were independent risk factors for mortality. The prediction ability of total points was excellent (Area Under Curve = 0.922). CONCLUSIONS: The nomogram developed in this study can be used by clinicians as a practical and effective tool in mortality risk estimation. So that with early diagnosis and intervention mortality in COVID-19 patients may be reduced.

Mapping of carbon monoxide related death risk in Turkey: a ten-year analysis based on news agency records.

BACKGROUND: Carbon-monoxide (CO) poisoning is a substantial cause of preventable mortality. In Turkey, no nationwide data are being collected nowadays. In our study, we aimed to assess the trend in deaths related to CO exposure in all provinces of Turkey in a 10-year period by using the records of a news agency which collects the news from the majority of the national newspapers, local newspapers and television channels. METHODS: In this study, 27,881 news items that were released between January 2008 to December 2017 which included keywords of "poisoning" and "death" or "carbon monoxide" and "death" were evaluated. 2667 non-fire related deaths were used in the final analyses. RESULTS: In a 10-year period, the risk of CO-related death in Turkey was 0.35/100000. 1371 (51.4%) of the victims were male and the median age of the patients was 45 years (range, 15 days-108 years). Most of the deaths occurred ≥50 years of age. Stoves were the predominant source [n = 2096 (78.6%)]. There was a stagnating trend of CO-related deaths. Most of the incidents occurred in winter. The Middle Anatolian region was of the highest risk in CO-related mortality. CONCLUSIONS: In conclusion, CO poisoning is still a considerable public health concern in Turkey. Results of our study showed that stoves are still frequently being used and are the cause of death especially in rural areas with lower socioeconomic status. A better organized, nationwide surveillance and management approaches are needed to demonstrate the true burden CO related morbidity and mortality as well as its prevention in Turkey.

Tetanus and diphtheria immunity among term and preterm infant-mother pairs in Turkey, a country where maternal and neonatal tetanus have recently been eliminated.

UNLABELLED: The aim of our study was to investigate the anti-tetanus and anti-diphtheria antibody titres and the placental transfer of these antibodies in a group of vaccinated and unvaccinated mothers and their term or preterm offsprings. Anti-tetanus and anti-diphtheria toxoid IgG antibodies were measured quantitatively by ELISA in 91 infant-mother pairs. Protective concentrations of anti-tetanus and anti-diphtheria were found in 58.3 and 50% of mothers in the unvaccinated group and 94.5 and 85.5% of the mothers in the vaccinated group. Protective concentrations were found in 63.9 and 50% of cord samples, respectively, in the unvaccinated group and in 96.4 and 85.5% of cord samples, respectively, in the vaccinated group (p = 0.0001). There were no differences in the maternal and cord geometric mean concentrations (GMCs) of anti-toxoid antibodies between those who received two doses or one dose of Td. The GMCs of maternal and cord anti-tetanus and anti-diphtheria were statistically similar between preterm and term groups. Placental transfer ratios (TR) for anti-tetanus and anti-diphtheria were 175 and 150%, respectively, in the preterm group and 213 and 178%, respectively, in the term group. There was a strong correlation between maternal and cord anti-toxoid antibody levels. Maternal vaccination was the only predictor of having protective concentrations of anti-toxoid antibodies in cord blood. CONCLUSIONS: Vaccinating pregnant women with at least one dose of Td would confer protection for both the term and preterm infant-mother pairs. Therefore, health personnel caring for pregnant women have the responsibility to emphasize the importance of Td vaccination to avoid missed immunization opportunities.

Initial Management of Childhood Acute Immune Thrombocytopenia: Single-Center Experience of 32 Years.

Immune thrombocytopenia (ITP) is an acute self-limited disease of childhood, mostly resolving within 6 months irrespective of whether therapy is given or not. Treatment options when indicated include corticosteroids, intravenous immune globulin (IVIG), and anti-RhD immunoglobulin. We reviewed our 32 years' experience for first-line therapy of acute ITP. Five hundred forty-one children (mean age: 5.3 years) diagnosed and treated for ITP were evaluated retrospectively. Among 491 acute ITP patients, IVIG was used in 27%, high-dose steroids in 27%, low-dose steroids in 20%, anti-D immunoglobulin G (IgG) in 2%, and no therapy in 22%. When the initial response (platelets >50 × 10(9)/L) to first-line treatment modalities were compared, 89%, 84%, and 78% patients treated by low-dose steroids, high-dose steroids, and IVIG responded to treatment, respectively (P > .05). Mean time to recovery of platelets was 16.8, 3.8, and 3.0 days in patients treated with low-dose steroids, high-dose steroids, and IVIG, respectively (P < .0001). Thrombocytopenia recurred in 23% of low-dose steroid, 39% of high-dose steroid, and in 36% of IVIG (P < .0001) treatment groups. Of 108 patients who were observed alone, 4 (3%) had a recurrence on follow-up and only 2 of these required treatment subsequently. Recurrence was significantly less in no therapy group compared with children treated with 1 of the 3 options of pharmacotherapy (P < .0001). Response rates were similar between patients treated by IVIG and low- and high-dose steroids; however, time to response was slower in patients treated with low-dose steroids compared with IVIG and high-dose steroids.

Does categorizing scale scores with cutoff points affect hypothesis-testing results?

BACKGROUND: The aim of this study is to evaluate the hypothesis test results after categorizing the scale scores with cut-off points and to assess whether similar results would be obtained in that best represent the categories. METHODS: This cross-sectional study was conducted between March 15 and 20, 2023 via the Lime Survey. The questionnaire included questions about the sociodemographic and life characteristics of the participants and the Beck Depression Inventory II (BDI-II). Four groups (minimal, mild, moderate, severe depression) were formed using the cutoff points. Data analysis was performed with all participants and referred to as the conventional analysis group. Then, six subanalysis groups were determined to best represent the groups formed according to the BDI-II. In each BDI-II category, six subanalysis groups were created, including those between Q1-Q3 (IQR group), including those within ± 1 std, including those between 5p-95p (90% of the sample), including those between 2.5p-97.5p (95% of the sample). In addition, 100 different samples were randomly selected containing 50% of each group. RESULTS: Of the 1950 participants, 84.7% (n = 1652) were female and 15.3% (n = 298) were male. In terms of depression, it was observed that the significance varied in the analysis groups for sex (p = 0.039), medication use (p = 0.009) and age (p = 0.010) variables. However, these variables were not significant in some of the subanalysis groups. On the other hand, a p < 0.001 value was obtained for income, physical activity, health perception, body shape perception, life satisfaction, and quality of life variables in terms of depression in the conventional analysis group, and it was seen that the significance continued in all subanalysis groups. CONCLUSIONS: Our findings showed that variables with p < 0.001 in the conventional analysis group maintained their significance in the other analysis groups. In addition, as the p value got closer to 0.05, we observed that the significance changed according to different cutoff points in the analysis groups. In addition, 50% randomly selected samples support these results. At the end of our study, we reached results that support the necessity of secondary tests in the evaluation of scales. Although further studies are needed, we anticipate that our study will shed light on other studies.

Quality of life after stapler haemorrhoidectomy evaluated by SF-36 questionnaire.

OBJECTIVE: Hemorrhoids are normal elements of the anal canal anatomy and they become symptomatic with potential factors such as gravity or strain. When symptomatic, hemorrhoidal disease can be costly measured in time away from productive activities. The aim of the study was to assess changes in the quality of life of patients after hemorrhoidectomy using Short Form-36. MATERIAL AND METHODS: Thirty patients, 24 male and 6 female (age 28 to 65), who were diagnosed with grade III and IV internal hemorrhoidal disease at the general surgery outpatient clinic and treated with stapled hemorrhoidectomy were enrolled in the study. They filled out Short Form-36 a week before surgery and four weeks after surgery. Post-Hoc tests were evaluated with Bonferroni correction after Kruskal Wallis analysis. Wilcoxon test, Student-t-test and Mann-Whitney U test were used for statistical analysis using SPSS 15. RESULTS: Physical health (Physical functioning, Physical role restriction, Bodily pain) scores were significantly improved after surgery. CONCLUSION: Success of hemorrhoidectomy operations can be evaluated by postoperative recovery, incidence of complications or relapses. Quality of life questionnaires are another method to evaluate the success of the treatment from the patient's perspective.

The suitability of using death certificates as a data source for cancer mortality assessment in Turkey.

AIM: To compare the quality of the 2008 cancer mortality data of the Istanbul Directorate of Cemeteries (IDC) with the 2008 data of International Agency for Research on Cancer (IARC) and Turkish Statistical Institute (TUIK), and discuss the suitability of using this databank for estimations of cancer mortality in the future. METHODS: We used 2008 and 2010 death records of the IDC and compared it to TUIK and IARC data. RESULTS: According to the WHO statistics, in Turkey in 2008 there were 67255 estimated cancer deaths. As the population of Turkey was 71517100, the cancer mortality rate was 9.4 per 10000. According to the IDC statistics, the cancer mortality rate in Istanbul in 2008 was 5.97 per 10000. CONCLUSION: IDC estimates were higher than WHO probably because WHO bases its estimates on a sample group and because of the restrictions of IDC data collection method. Death certificates could be a reliable and accurate data source for mortality statistics if the problems of data collection are solved.

An assessment on loss of workforce due to COVID-19 among healthcare personnel: A university hospital experience.

BACKGROUND: Healthcare personnel are among the COVID-19 risk groups. For this reason, increased absence from work affects the loss of labor. OBJECTIVE: This study aimed to evaluate the workforce loss amongst health personnel working in our hospital due to COVID-19 in a one-year period. METHODS: Workforce loss of healthcare workers was assessed via absenteeism and life expectancy. Loss of workforce for COVID-19 PCR positive or PCR negative but CT findings compatible with COVID-19 and personnel with high-risk exposure for COVID-19 were determined with absenteeism. Healthcare personnel who passed away due to COVID-19 was determined with the consideration of the retirement age and expected life years. RESULTS: Total lost time from work was 14635 days (excluding deaths). Loss of workforce rates resulting from COVID-19 positivity for male employees was greater in comparison to the results for females (p = 0.018). High-risk exposure of healthcare personnel working in clinical sciences was higher than those in other departments (p < 0.001). Total loss in workforce for 3 people passed away was 14 years 5 months, and total life expectancy was 64 years. Healthcare personnel under the age of 40 had less absenteeism than those over 40 years (p < 0.001). CONCLUSIONS: It was observed that all occupational groups working at the hospital were impacted by COVID-19. The two most important factors that influenced absenteeism were the reason for being affected (positivity and high risk) and age. Absenteeism and daily case tracing of healthcare personnel working on the frontlines will aid in both the pandemic control and management of workload for those left behind.

Problematic Internet Use in Turkish High School Students: Prevalence and Related Factors.

Objectives: In this study, we sought to determine the prevalence of problematic Internet use (PIU) among high school students and identify demographic and socioeconomic factors related to PIU. Methods: Using a cross-sectional design, we conducted this study between November 2017 and January 2018 of 1412 students attending high schools in the Silivri District of Istanbul in Turkey. We administered a questionnaire inquiring about sociodemographic information, Internet use, and Young's Internet Addiction Test to participating students. Results: Among participants, 18.5% (male = 17.2%; females = 19.8%) were found to show PIU. PIU rates were higher among those with a high household income and lower among those who studied in science high schools, performed physical activities at least 2 days a week, and read at least one book a month. PIU rates were also higher among those who had their own bedrooms, phones, smartphones, Internet connections at home, and social networking accounts. Conclusion: The prevalence of PIU among the participants was 18.5%. Female sex, high household income, low physical activity, grade level, school type, reading fewer than one book per month, and Internet use experience were risk factors for PIU. PIU is considered a significant public health concern across the world, including in Turkey.

Measurement of serum vitamin B12-related metabolites in newborns: implications for new cutoff values to detect B12 deficiency.

OBJECTIVE: Our aim was to determine the prevalence of maternal and neonatal vitamin B12 (vit-B12) and folate deficiencies, a new cutoff value of serum vit-B12 in newborns using vit-B12-related metabolites and also cutoff values of homocysteine (Hcy), propionyl (C3) carnitine, and methyl malonic acid (MMA) in newborns using a vit-B12 cutoff value of 200 pg/mL. METHODS: Healthy pregnant women (without iron deficiency) and 98 healthy, term, singleton babies were included. Blood samples were obtained from women 0-8 h before birth and from cord blood during birth for hemogram and to measure serum vit-B12, folate, and Hcy levels. Maternal and cord blood serum vit-B12 levels were classified as low < 200 pg/mL, marginal 200-300 pg/mL, and normal ≥ 300 pg/mL. Neonatal urine MMA levels were analyzed in mothers with a vit-B12 concentration < 300 pg/mL. C3 carnitine levels of newborns were acquired from extended newborn screening. Receiver operating characteristics curve (ROC) analysis was used for serum vit-B12, urine MMA, C3 carnitine, and Hcy. RESULTS: Of total, 98 pregnant women (28.6 ± 5.5-year-old) and 98 newborn were included. Vit-B12 level was lower than 300 pg/mL in 93% of the pregnant women and 61% of cord blood samples. Folate deficiency was not found in either group. There was statistically significant negative correlation between baby C3 carnitine, cord blood folate (r = -0.265, p = .008) and cord blood vit-B12 (r = -0.220, p = .029). In backward stepwise linear regression analysis, maternal vit-B12 level exerted the most marked effect on cord blood vit-B12 level (adjusted R2 = 0.457). In ROC analysis, the Hcy cutoff value was 4.77 µmol/L (68.4% sensitivity, 58.3% specificity, p = .012) for the detection of vit-B12 deficiency. CONCLUSION: Vit-B12 deficiency remains an important health issue for pregnant women and newborns. Our study revealed a cutoff value for Hcy for the detection of nutritional vit-B12 deficiency that could be used in practice for newborns.

Iodine status of Turkish pregnant women and their offspring: A national cross-sectional survey.

BACKGROUND: This national cross-sectional survey aimed to assess the iodine status in pregnant women and their offspring, and also to demonstrate regional differences by measuring urinary iodine concentration (UIC). For each woman and her newborn a questionnaire was prepared with basic facts as age, parity number or birth weight and additional information regarding thyroid diseases, use of iodized salt in the household, extra iodine supplementation during pregnancy, education level and wage income. METHODS: The target population represented 1444 pregnant women who gave birth between January 1 st, 2018 and 2019, and their offspring. Iodine deficiency for pregnant women and their offspring were defined as urine iodine level <150 µg/L and <100 µg/L, respectively. Results are given as median (25th-75th percentile). RESULTS: The median UIC in the group of pregnant woman was 94 (52-153) µg/L. Within the sample of 1444 pregnant women, UIC indicative of mild iodine deficiency (100-149 µg/L) was present in 21 % (n = 306), moderate deficiency (50-99 µg/L) in 30 % (n = 430), and severe deficiency (<50 µg/L) in 23 % (n = 337). This study showed a prevalence of 74 % of iodine deficiency in Turkish pregnant woman. The median UIC in the group of offspring was 96 (41-191) µg/L. Within the new-borns, UIC indicative of mild iodine deficiency (50-99 µg/L) was present in 22 % (n = 323), moderate deficiency (20-49 µg/L) in 15 % (n = 222), and severe deficiency (<20 µg/L) in 13 % (n = 192). This survey showed a prevalence of 51 % of iodine deficiency in Turkish new-borns. Pregnant women with lower socioeconomic and education level, lower access to household iodized salt, lower rates of exposure to povidone-iodine containing skin disinfectant, higher parity and higher iodine deficiency had higher rates of iodine deficiency in their offspring. Regional differences were observed both in mothers and their offspring concerning their iodine status. CONCLUSIONS: Our findings suggest that iodine deficiency is still an important public health problem in Turkey. More drastic measures should be taken to decrease these important iodine deficiencies, both in pregnant women and in their offspring.

Effect of vitamin C on oxidative liver injury due to isoniazid in rats.

BACKGROUND: The aim of the present study was to investigate the effect of different doses of vitamin C on oxidative liver injury due to isoniazid (INH) in rats. METHODS: Rats were divided into four subgroups, each containing 10 rats. Group 1 was the control group; group 2, INH 50 mg/kg per day; group 3, INH 50 mg/kg per day + low-dose vitamin C (100 mg/kg per day); group 4, INH 50 mg/kg per day + high-dose vitamin C (1000 mg/kg per day). INH and vitamin C were administered into their stomachs through an oral tube. After 21 days, measurements were made in both serum and homogenized liver tissues. The levels of glutathione (GSH), superoxide dismutase (SOD) and other biochemical variables were measured. Malondialdehyde (MDA), glutathione peroxidase (GSH-px) and vitamin C were measured using commercial kits. RESULTS: Aspartate amino transferase and alanine aminotransferase in group 2 were higher than those in groups 1, 3 and 4 (P < 0.008 for both). Serum and tissue levels of MDA in group 2 were higher than that in groups 1 and 3 (P < 0.008 for both). There was no difference in the SOD levels between the four groups (P= 0.095). Erythrocyte and tissue GSH in group 2 were higher than that in groups 1 and 3 (P < 0.008 for both). Interestingly, erythrocyte and tissue GSH in group 4 were lower than those in group 1 (P < 0.008 for both). Erythrocyte level of GSH-px in group 2 was higher than that in groups 1 and 3 (P < 0.008 for both). CONCLUSIONS: INH-induced liver injury is associated with oxidative stress, and co-administration of low-dose vitamin C may reduce this damage effectively in a rat model. The antioxidant effect of high-dose vitamin C does not seem more potent compared to the low dose.

Demography of adolescent health care delivery and training in Europe.

BACKGROUND: We aimed to determine the status of and factors associated with adolescent health care delivery and training in Europe on behalf of the European Paediatric Association-UNEPSA. MATERIALS AND METHODS: A questionnaire was mailed to the presidents of 48 national paediatric societies in Europe. For statistical analyses, non-parametric tests were used as appropriate. RESULTS: Six of the countries had a paediatric (PSPCA), 14 had a combined and nine had a general practitioner/family doctor system for the primary care of adolescents (GP/FDSA). Paediatricians served children 17 years of age or older in 15 and 17, up to 16 years of age in three and six, and up to 14 years of age in six and six countries in outpatient and inpatient settings, respectively. Fifteen and 18 of the countries had some kind of special inpatient wards and outpatient clinics for adolescents, respectively. Twenty-eight of the countries had some kind of national/governmental screening or/and preventive health programmes for adolescents. In countries with a PSPCA, the gross national income (GNI) per capita was significantly lower than in those with a GP/FDSA, and the mean upper age limit of adolescents was significantly higher than in those with the other systems. In the eastern part of Europe, the mortality rate of 10-14 year olds was significantly higher than that in the western part (p=0.008). Training in adolescent medicine was offered in pre-graduate education in 14 countries in the paediatric curriculum and in the context of paediatric residency and GP/family physician residency programmes in 18 and nine countries, respectively. Adolescent medicine was reported as a recognised subspecialty in 15 countries and as a certified subspecialty of paediatrics in one country. In countries with a PSPCA, paediatric residents were more likely to be educated in adolescent medicine than paediatric residents in countries with a GP/FDSA. CONCLUSION: The results of the present study show that there is a need for the reconstruction and standardisation of adolescent health care delivery and training in European countries. The European Paediatric Association-UNEPSA could play a key role in the implementation of the proposals suggested in this paper.

The effect of maternal anemia on anthropometric measurements of newborns.

OBJECTIVE: To evaluate the relation between maternal prenatal hemoglobin concentration and neonatal anthropometric measurements. METHODS: All pregnant women who gave birth at the Obstetrics Department of Dr. LK Kartal Training and Research Hospital, Istanbul, Turkey, from January 1, 2005 to December 31, 2006, and their newborns were included in this prospective, cross-sectional study. The newborns' weight, height, head, and chest circumference were recorded. Mothers with hemoglobin concentration less than 11g/dl were evaluated as anemic. The anemic mothers were then grouped into 3 categories according to the corresponding hemoglobin concentration: mild (10.9-9.0g/dl), moderate (8.9-7.0 g/dl), and severe anemic (less than 7 g/dl). The anthropometric measurements of newborns from non-anemic and anemic mother groups were compared. RESULTS: Of the 3688 pregnant women, 1588 (43%) were found to be anemic. Among the anemic mothers, 1245 had mild (78.5%), 311 had moderate (19.5%), and 32 (2%) had severe anemia. The anthropometric measurements (height, weight, head and chest circumference) of newborns of anemic and non-anemic mother groups showed a statistically significant difference (p=0.036, p=0.044, p=0.013, and p=0.0002). There was a statistically significant difference in height, weight, and chest circumference of newborns of severe anemic and mild anemic mothers (p=0.017, p=0.008 and p=0.02). The height (1.1 cm), weight (260 g), head (0.42 cm), and chest (1 cm) circumference of neonates in the severe anemic group is less than the mild anemic group. CONCLUSION: Anemia during pregnancy affect the anthropometric measurements of a newborn. Severe anemia had significant negative effect on neonatal anthropometric measurements.

The relationship between cardiometabolic risks and vitamin D levels with the degree of obesity.

AIM: The aim of this study was to evaluate the cardiometabolic risk factors including vitamin D levels according to the degree of obesity in adolescents. MATERIAL AND METHODS: This is a retrospective cross-sectional study. A total of 363 overweight/obese adolescents aged between 11 and 18 years who were evaluated in our clinic from January 2012 to December 2015 were included in the study. The degree of obesity was calculated as the body mass index standard deviation. Hypertension, dyslipidemia, hyperinsulinemia, hyperglycemia, insulin resistance, and vitamin D deficiency were defined as cardiometabolic risk factors. Mann-Whitney U, Chi-square, Spearman and Pearson's correlation tests, and linear regressions analyses were used for statistical analyses. RESULTS: Of the 319 (n=319/363) adolescents, all of whose cardiometabolic risk factors were known, 267 (85.7%) had at least one cardiometabolic risk factor. The body mass index standard deviation had a positive correlation with the number of cardiometabolic risk factors (p<0.001). In the linear regression models in which sex and age were considered as covariates, an increase of one unit in the body mass index standard deviation led to an increase of 6.085 mm Hg in systolic blood pressure, 4.4 mm Hg in diastolic blood pressure, 1.59 points in HOMA-IR, 13% in insulin level, and a decrease of 2.16 ng/mL in vitamin D levels. CONCLUSION: In adolescents, the number of cardiometabolic risk factors increases as the degree of obesity increases. The determination of the severity of obesity can help to identify individuals at greater risk for higher blood pressure, impaired glucose metabolism, and lower serum vitamin D levels. On the other hand, the degree of obesity may not reflect the presence of abnormal lipid and glucose levels.

Glycemic control and health behaviors in adolescents with type 1 diabetes.

Yetim A, Alikasifoglu M, Bas F, Eliaçik K, Çig G, Erginöz E, Ercan O, Bundak R. Glycemic control and health behaviors in adolescents with type 1 diabetes. Turk J Pediatr 2018; 60: 244-254. The purpose of this study was to determine the health/health risk behaviors of a group of Turkish adolescents with type 1 diabetes (T1D) to determine the prevalence and explore the exact effect of these behaviors on glycemic control (GC). A total of 210 adolescents (age 12-20 years; diabetes duration > 6 months; no additional comorbidities), completed a self-administered questionnaire (including some questions from Health Behavior in School-aged Children study questionnaire). Subjects were divided into two groups based on the hemoglobin A1c (HbA1c) levels, measured in the last 3 months: good GC (HbA1c < 8%) and poor GC (HbAc1≥8%). Chi-square tests and backward stepwise logistic regression analysis were used in statistical analyses. Of the patients, 57 had good GC and 153 had poor GC. The results of the backward stepwise logistic regression analysis indicated that being overweight and frequent electronic media use were risk factors for poor GC, whereas computer use for homework for long period of time (≥2 hours/day) was found to be a protective factor in terms of GC. Screening adolescents in terms of health/health risk behaviors such as frequent electronic media use, and giving adolescents health responsibilities should be an integral part of the follow-up of these patients, and intervention programs that lead to behavioral changes should be developed.

Relationship between age and subtypes of psychotic symptoms in Parkinson's disease.

OBJECTIVE: Psychotic symptoms (PS) in Parkinson's disease (PD) usually develop as a side effect of the dopaminergic therapy and consist of hallucinations and delusions. We observed that PD patients who developed delusions tend to be younger than those with hallucinations and we aimed to investigate the validity of this observation. METHODS: The medical records of 127 PD patients with PS were reviewed and 76 patients who were on treatment with dopamine agonists with or without levodopa at the time of developing PS were included. Patients were stratified into 3 groups according to the subtypes of PS: patients with solely hallucinations (n = 46), solely delusions (n = 18), and both types (n = 12). The groups were compared with respect to the age-at-onset of PD and PS, duration of PD, Activities of Daily Living (ADL) and motor subscale scores of Unified PD Rating Scale (UPDRS), and levodopa equivalent dose of the dopaminergic agents administered at the time of PS onset. RESULTS: The mean age-at onset of PD and PS was significantly younger (p = 0.0001) in patients with delusions (49 and 55.9 years) than those with hallucinations (61.9 and 68.9 years). The same parameters were also significantly different (p = 0.002 and p = 0.001, respectively) between the groups of patients with concurrent delusions and hallucinations (51.7 and 57.2 years) and those with only hallucinations. ADL and motor subscale scores were higher in patients with hallucinations (p = 0.016 and p = 0.013) compared with those noted in patients with delusions despite similar disease duration. The mean levodopa equivalent doses of the dopaminergic agents administered at the time of onset of PS did not differ between the groups. CONCLUSION: This study supported an association of delusions with younger onset of both PD and psychosis as compared with hallucinations. However, additional factors related to this association remain to be elucidated.

Assessment of valvulopathy in Parkinson's disease patients on pergolide and/or cabergoline.

OBJECTIVE: To assess the effect of ergot derivatives on cardiac valves in patients with Parkinson's disease (PD). MATERIALS AND METHODS: Echocardiography was performed on 46 PD patients who used either pergolide or cabergoline (MonoPD) or both (MixPD) for a minimum of 1 year and 49 age-matched healthy controls. Valvular regurgitation was graded as mild, moderate and severe. MonoPD and MixPD groups were compared with regard to demographic features, drug profile and valvulopathy. RESULTS: The PD group had a mean age of 63 years, agonist duration of 3.8 years and agonist equivalent dose of 3.5mg/day. Moderate regurgitation in all three valves was significantly more common in the PD group than the controls. Severe valvular regurgitation was not observed in either group, with the exception of one PD patient. The frequency of valvulopathy and doses of agonists did not differ between MixPD and MonoPD groups. CONCLUSION: PD patients on dopamine ergot agonists are prone to moderate valvular regurgitation more than age-matched controls. However, the frequency of valvulopathy was similar in patients who used either one or more agonists.

The Relationship of Disordered Eating Attitudes with Stress Level, Bone Turnover Markers, and Bone Mineral Density in Obese Adolescents.

OBJECTIVE: To investigate the effect of stress caused by disordered eating attitudes on bone health in obese adolescents. METHODS: A cross-sectional study comprising 80 obese adolescents was performed from November 2013 to September 2014. Twenty-four-hour urinary free cortisol levels were measured as a biological marker of stress. Bone turnover was evaluated using bone-specific alkaline phosphatase, serum osteocalcin, and urinary N-telopeptide concentrations. Bone mineral density was measured using dual-energy X-ray absorptiometry. The Eating Disorder Examination Questionnaire, Dutch Eating Behavior Questionnaire, Children's Depression Inventory, and the State-Trait Anxiety Inventory for Children were used to assess eating disorders, depression, and anxiety. Psychiatric examinations were performed for binge eating disorders. RESULTS: In the Pearson's correlation test, a positive correlation was found between the 24-hour urinary cortisol level and Dutch Eating Behavior Questionnaire total and restrained eating subscale scores (p<0.05 for both). In linear regression analyses, the Dutch Eating Behavior Questionnaire total and restrained eating subscale scores were found to be significant contributors for urinary cortisol level (ß=1.008, p=0.035; ß=2.296, p=0.014, respectively). The femoral neck areal bone mineral density was found to be significantly higher in subjects who had binge eating disorder compared with those without binge eating disorder (p=0.049). CONCLUSION: Despite the lack of apparent effects on bone turnover and bone mineral density in our obese adolescents at the time of the study, our results suggest that disordered eating attitudes, and especially restrained eating attitudes, might be a source of stress. Therefore, studies in this area should continue.