The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey.

BACKGROUND: Anemia is considered a severe public health problem by World Health Organization when anemia prevalence is equal to or greater than 40% in the population. The purpose of this study was to determine the anemia prevalence with the associated factors in pregnant women and to determine the serum iron, folate and B12 vitamin status in anaemic pregnants in Malatya province. METHODS: This is a cross-sectional survey. A multi-sage stratified probability-proportional-to-size cluster sampling methodology was used. A total of 823 pregnant women from sixty clusters were studied. Women were administered a questionnaire related with the subject and blood samples were drawn. Total blood count was performed within four hours and serum iron, folate and B12 vitamin were studied after storing sera at -20 C for six months. RESULTS: Anemia prevalence was 27.1% (Hb < 11.0 gr/dl). Having four or more living children (OR = 2.2), being at the third trimester (OR = 2.3) and having a low family income (OR = 1.6) were determined as the independent predictors of anemia in pregnancy. Anemia was also associated with soil eating (PICA) in the univariate analysis (p < 0.05). Of anaemic women, 50.0% had a transferrin saturation less than 10% indicating iron deficiency, 34.5% were deficient in B12 vitamin and 71.7% were deficient in folate. Most of the anemias were normocytic-normochromic (56.5%) indicating mixed anemia. CONCLUSIONS: In Malatya, for pregnant women anemia was a moderate public health problem. Coexisting of iron, folate and B vitamin deficiencies was observed among anaemics. To continue anemia control strategies with reasonable care and diligence was recommended.

The relationship between depression and loneliness levels of the students at the faculty of health sciences and the factors affecting them.

PURPOSE: The aim of this study is to determine the relationship between the loneliness and depression levels of students studying at Inonu University, Faculty of Health Sciences, Departments of Nursing, Midwifery, Physiotherapy, Audiology and Child Development and the factors that affect these levels. DESIGN AND METHODS: This descriptive cross-sectional study which used a socio-demographic information form, the UCLA Loneliness Scale and the Beck Depression Inventory included 1004 students. FINDINGS: According to the results of the research, there was a positive relationship between loneliness and depression levels among university students. Class year, family type, place of residence, mother's education level, and economic situation were important indicators of loneliness and depression. PRACTICE IMPLICATIONS: Psychiatric nurses can help students express their psychological difficulties and help them change their behaviors and lifestyles.

Differences in parents of pediatric liver transplantation and chronic liver disease patients.

BACKGROUND: With advancements in the treatment of chronic liver disease (CLD), including liver transplantation (LT), quality of life and satisfaction after LT have become an important issue for pediatric patients and their parents. More evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their needs. AIM: To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients. METHODS: During this survey, data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017 (LT group; n = 91) and parents of pediatric patients with chronic liver disease (CLD group; n = 94). Group comparisons were made based on the pediatric health-related quality of life (PedsQL) health care parent satisfaction scale, impact on family scale (IFS) and demographic characteristics. The PedsQL was administered to parents during a phone interview and the results were used to assess the health care-related satisfaction of parents. The IFS was used to assess the impact of the child's CLD status on the family. Demographic variables such as education level (elementary vs middle vs high vs university), monthly income (low vs middle vs high), and place of residence (village vs town vs city) were compared between CLD and LT parent groups. Finally, PedsQL and IFS results were also analyzed according to demographic variables. RESULTS: A total of 185 parents aged 19 to 65 years were included. There were statistically significant differences between the LT and CLD groups in terms of career (P < 0.001), monthly income (P = 0.016), and education level (P = 0.041). According to the PedsQL results, family inclusion, communication, technical skills, emotional needs, and overall satisfaction were significantly different between the groups; the LT group had consistently higher scores (P < 0.001). Additionally, scores for the IFS parameters of financial impact, familial-social impact, personal strain, and total impact were consistently higher for the LT group (P < 0.001). There were statistically significant relationships between education level, monthly income, and place of residence according to the IFS results but not the PedsQL results. There were inverse relationships between the difficulties that parents experience because of their child's health and education levels, monthly income, and place of residence. However, no relationship was found between education level, monthly income, or place of residence and satisfaction with health care services provided in the hospital according to the PedsQL results. CONCLUSION: Parents of children who underwent LT were very satisfied with the health care services provided to their children. However, they had more difficulties than parents of children with CLD.

The epidemiology and factors associated with nocturnal enuresis among boarding and daytime school children in southeast of Turkey: a cross sectional study.

BACKGROUND: Nocturnal enuresis is an important problem among young children living in Turkey. The purpose of this study was to determine the possible differences in the prevalence of enuresis between children in boarding school and daytime school and the association of enuresis with sociodemographic factors. METHODS: This was a cross-sectional survey. A total of 562 self-administered questionnaires were distributed to parents from two different types of schools. One of them was a day-time school and the other was a boarding school. To describe enuresis the ICD-10 definition of at least one wet night per month for three consecutive months was used. Chi-square test and a logistic regression model was used to identify significant predictive factors for enuresis. RESULTS: The overall prevalence of nocturnal enuresis was 14.9%. The prevalence of nocturnal enuresis declined with age. Of the 6 year old children 33.3% still wetted their beds, while the ratio was 2.6% for 15 years-olds. There was no significant difference in prevalence of nocturnal enuresis between boys and girls (14.3% versus 16. 8%). Enuresis was reported as 18.5% among children attending day time school and among those 11.5% attending boarding school (p < 0.05). Prevalence of enuresis was increased in children living in villages, with low income and with positive family history (p < 0.05). After multivariate analysis, history of urinary tract infection (OR = 2.02), age (OR = 1.28), low monthly income (OR = 2.86) and family history of enuresis (OR = 3.64) were factors associated with enuresis. 46.4% of parents and 57.1% of enuretic children were significantly concerned about the impact of enuresis. CONCLUSION: Enuresis was more frequent among children attending daytime school when compared to boarding school. Our findings suggest that nocturnal enuresis is a common problem among school children, especially with low income, smaller age, family history of enuresis and history of urinary tract infection. Enuresis is a pediatric public health problem and efforts at all levels should be made such as preventive, etiological and curative.

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.

The effectiveness of an education program on stages of smoking behavior for workers at a factory in Turkey.

The aim of the study was to determine the smoking behavior based on "stages of change" model of the workers and to assess the effectiveness of a education program at a workplace. The first step was descriptive and the second step was an experimental study. The intervention group received an smoking cessation education. Before intervention 36% of the intervention group were at precontemplation stage. Six months after the intervention decline the percentage of those at precontemplation stage was significantly lower. In the control group there was not a significant reduction in the percentages of smokers at precontemplation stage before and after the intervention. After the 6 months the "maintenance" stage rates were 6% and 2% in the intervention and control groups, respectively. The study showed that the education in factory for workers could not be successful in quiting, however it impacted the intention and preparation of to quit in the future.

Prevalence of goiter and urinary iodine status of 7-11-year-old children in Malatya province, Turkey.

Goiter prevalence and urinary iodine excretion levels were assessed in 568 schoolchildren (317 boys and 251 girls), aged 7-11 years, living in the Malatya province, a well-known endemic goiter area in Turkey. Five hundred sixty-eight children aged 7-11 years consented to thyroid gland palpation and provided a urine sample on the day of examination in April 2004. Median urinary iodine concentration for the total group was 66 microg/L. There was an association between presence of goiter or not and urinary iodine levels (67 microg/L versus 62 microg/L, p=0.000). The median urinary iodine concentration was lower in rural areas than in urban areas (54.6 microg/L versus 59.7 microg/L, respectively) and schoolchildren living in rural areas had significantly lower urinary iodine levels (p=0.000). In conclusion, the present study reports mild iodine deficiency in the Malatya province, despite a mandatory iodization program in Turkey which has been in force since 1998.

Review of forensic assessments of female referrals to the branch of legal medicine, Malatya region, Turkey--1996-2000.

It is well recognized that the most pervasive form in gender violence is violence against women by their intimate male partners. Domestic violence (DV) crosses all cultures, races, and socioeconomic levels, affecting people of all ages and both sexes, but particularly women and children. DV refers to the chronic physical, sexual and psychological maltreatment of one family member against another in order to control. DV represents a significant health threat to women. It may also be an important precipitating factor of female suicide. As the literature has begun to document the extent of interfamilial violence, attention has focused on forensic documentation. The aim of this study is to review female victims presented at the Branch of Legal Medicine of Malatya, Turkey, regarding gender-based violence and DV in relation towards sexual offenses and suicide attempts. Accordingly, recommendations were presented to increase the awareness of DV by setting policies and in response legislative recommendations. The legal reports of women (n=2245) were reviewed. In respect of the Turkish Penal Code (TPC), paragraph 456/1, 2, 3 and 4, which covers the act of assault and battery, the severity of the injuries have been categorized into three groups according to the Turkish Injury Scale (TIS) covered by TPC 456/1, 2 and 4, into the issues of functional incapacitation according to TPC 456/2 and 3, and with regard to the presence of a mark of an injury on the face according to TPC 456/2 tables. Because of incomplete data, not all results be categorized as positive for DV. Despite the large number of blunt force injuries (699 cases out of 2245) and the high percentage of external lesions, 76% of 1796 files, found, recognition of DV was uncommon. According to TPC 456/4, in cases of small trauma-related injuries, legal proceedings are dependent upon a victim's making a complaint. The percentage of 80.4% (n=2245) represents the need for information regarding legal requirements. The frequency of sexual assault cases, 144 victims out of 162, and in suicide attempts, 95 women out of 145, in the 15-24 year age span may also reflect a society's accusative approach towards women based on moral values. Unless prosecuting DV cases purely on the evidence in regard to victim's safety, withdrawal of complaints will continue. It is essential to identify to 'name' DV when it occurs. Recognizing the serious immediate and future long-term implications for health, multifaceted intervention is important. DV has to undergo some fundamental and far-reaching reformation in Turkey regarding how the legal system deals with it appropriately.

University hospital physicians' attitudes and practices for smoking cessation counseling in Malatya, Turkey.

The aim of the study is to determine attitudes and self-reported practices performance for smoking cessation counseling of the physicians working at a university hospital in Malatya, Turkey. All physicians who were providing health care to adult patients in 19 outpatient clinics at the hospital were administered a self-reported questionnaire. Of the physicians, 26.5% reported that they were always asking about their patients' smoking history and 22.6% were always advising their smoker patients to quit. Men non-smoker physicians more often practiced counseling than men smoker physicians. Negative attitudes of physicians about smoking cessation counseling negatively effected their practices. Negative attitudes were significantly higher among men smoker physicians than non-smokers but attitudes did not differ among female smoker and non-smoker physicians. The findings showed that smoking cessation counseling was rarely practiced by physicians and physicians' practices differed by their smoking behavior, departments and attitudes towards smoking cessation.

AIDS awareness and knowledge among married women living in Malatya (Turkey): implications for province-based prevention programs.

The study was performed in 2003 to obtain baseline information on married women's knowledge of AIDS/HIV in Malatya, Turkey. The aim was to reach 1% of the population by covering 1200 married women out of 120,034 whose ages ranged from 15-49. Stratified systematic random sampling was used according to 17 health center lists. Although median HIV/AIDS knowledge score was found to be 70 (highest score was 100), it was also seen that clinical properties of the disease were not recognized adequately. The main resources of knowledge were visual (93%) and printed material (35%). These findings show that media based information does not seem to be sufficient. Therefore, it is recommended that health education should be inserted in the school curriculum and health personnel should inform the women.

[Prevalence of metabolic syndrome, its relationship with mental health (anger) and sociodemographic characteristics in women residing in central district of Malatya: a cross-sectional observational study]. / Malatya il merkezinde yasayan kadinlarda metabolik sendrom prevalansi ve öfke ve sosyodemografik özellikler ile iliskisi: Enine-kesitsel gözlemsel bir arastirma.

OBJECTIVE: The purpose of this study is to determine prevalence of metabolic syndrome (MetS) and its relationship with mental health (anger) and sociodemographic characteristics in women residing central district of Malatya. METHODS: This cross-sectional observational study was conducted between April and September 2008. The relationships between MetS and mental health (anger) and sociodemographic properties were examined. Chi-square and Student t-test were used for the statistical analysis. RESULTS: Mean age of the women included in this study was 41.9 ± 12.7 years. MetS prevalence was 30.9%, for the age group of 60 and over prevalence was 61.3%. There was a statistically meaningful relation between MetS prevalence and the educational background, marital status, body-mass index (BMI) and family type (p<0.05). There was no significant relationship between MetS and anger status in the study group (p>0.05). The most common MetS parameters findings of our study were abdominal obesity (45.6%, waist circumference>88 cm) and low high-density lipoprotein cholesterol. Among MetS diagnosed women included in this study the most common finding was fasting blood glucose (76.7%), which were followed by high triglycerides (69.4%) and hypertension (63.5%). CONCLUSION: Taking control over or avoiding obesity plays a crucial role in prevention of MetS development. There was a significant relationship between MetS prevalence and education, BMI and family type in the study group. In the current study, there was no any significant relation between MetS and anger scale.

Physical, emotional and sexual violence during pregnancy in Malatya, Turkey.

BACKGROUND: In Turkey, violence against women was established as a critical area of concern related to women and various prevention strategies have been developed since 1980. There are limited numbers of studies on violence during pregnancy in the country. This study was performed to determine the prevalence of physical, emotional and sexual violence during pregnancy in Malatya province and the associated factors. METHODS: A cross-sectional interview survey was conducted among pregnant women living in Malatya province between October 2003 and May 2004. Stratified probability-proportional-to-size sampling methodology was used for selecting the study population. A total of 824 pregnant women from 60 clusters were studied. Association between violence prevalences and womens' sociodemographic, fertility and behavioural characteristics were evaluated. RESULTS: During pregnancy 31.7% of women were exposed to any form of violence. Emotional violence was the most frequently reported form (26.7%), followed by sexual (9.7%) and physical violence (8.1%). Regular smoking [odds ratio (OR) 1.6], unwanted pregnancy (OR 1.8), living in urban area (OR 1.5), low education level of husband (OR 1.7), low family income (OR 1.9) and being in second trimester (OR 1.4) were determined to be the main predictors of overall violence during pregnancy. CONCLUSIONS: Violence during pregnancy is a common public health problem in Malatya. Low education level in partners, low family income, husband's unemployment, urban settlement, unwanted pregnancy and smoking should alert health staff towards violence at pregnancy and training of health personnel on the subject is recommended.

Color Doppler sonography examination of partially obstructed kidneys associated with ureteropelvic junction stone before and after percutaneous nephrolithotripsy: preliminary report.

AIM: To evaluate resistive index (RI) changes before and after unilateral percutaneous nephrolithotripsy in chronic partially obstructed kidneys due to ureteropelvic junction (UPJ) stones. METHODS: Intrarenal RI of obstructed and contralateral normal kidneys of 18 patients were recorded immediately before the operations and at postoperative days 1, 7 and 30. Postoperative RI measurements were compared with baseline values for all patients without grouping and separately for different groups according to the preoperative RI value of the obstructed kidney. RESULTS: Mean age and symptom duration were 27.5 years and 43.8 weeks, respectively. Preoperatively and at all postoperative controls, kidney diameters and renal parenchyma thicknesses were normal in all patients. Mean RI of obstructed kidneys decreased from 0.68 to 0.63 for all patients (P=0.032), from 0.64 to 0.63 for those with preoperative RI<0.70 (P=0.850) and from 0.73 to 0.62 for those with preoperative RI>or=0.70 (P=0.001). In patients with preoperative RI>or=0.70 in obstructed kidney, significant RI decreases were recorded at postoperative day 7 and RI differences between obstructed and contralateral kidneys disappeared after then. No difference was present pre- and postoperatively between the mean RI of obstructed and contralateral kidneys of the patients with RI<0.70. Mean RI of contralateral kidneys were normal preoperatively and showed no significant change postoperatively. CONCLUSIONS: Preoperative RI levels may indirectly reflect the presence of functionally significant obstruction in chronic obstructed kidneys related to UPJ stones. Patients with RI>or=0.70 may have a good indication for a surgical approach. Normalization of high RI occurs rapidly after percutaneous nephrolithotripsy.

Effects of micronised purified flavonoid fraction on pain, spermiogram and scrotal color Doppler parameters in patients with painful varicocele.

PURPOSE: Micronised purified flavonoid fraction (MPFF) is a phlebotropic drug improving venous tone, elasticity and lymphatic drainage, decreasing venous distensibility, venous emptying times, reflux time of venous blood and capillary hyperpermeability, and having antioxidant activities. Since varicocele is a venous pathology, we evaluated the effects of MPFF on pain, spermiogram and color Doppler parameters in patients with painful varicocele. MATERIAL AND METHODS: Semen analyses and Doppler sonography were performed in 16 patients (aged 20-62 years, mean 31.2 +/- 10.9) before and after 1,000 mg/day MPFF treatment. Pain change was assessed with visual analogue scale scored between 0 and 10. Patient satisfaction with outcome and side effects were recorded. RESULTS: Mean pain scores at 1, 3, and 6 months were 1.25 +/- 1.34, 0.25 +/- 0.68, and 0.12 +/- 0.34, respectively, all being significantly lower (p < 0.001 for each) than baseline (4.93 +/- 1.77). Mean score at 12 months (0.93 +/- 1.06) was still lower than baseline (p < 0.001) but higher than at 6 months (p = 0.019). Respectively, 14 (87.5%) and 2 (12.5%) patients reported complete and very significant resolution of pain at the 6th month. All patients were very satisfied with the outcome. While semen volume, total sperm count, sperm concentration and morphology did not change significantly, motility increased significantly (p = 0.009) due to decrease of grade 0 sperms (p = 0.006) and increase of grade 3 + 4 sperms (p < 0.001). Reflux time of left spermatic vein during the Valsalva maneuver decreased significantly (p = 0.003). No significant change occurred in reflux time of the right spermatic vein. No side effect was recorded. CONCLUSIONS: Results of this preliminary study suggest the safety and efficacy of MPFF in the treatment of varicocele-associated pain. However, no recommendation for the use of MPFF in the treatment of pain associated with varicocele can be made before these preliminary results are confirmed by a randomized placebo-controlled trial.