Body fat distribution has no effect on serum visfatin levels in healthy female subjects.

Obesity is the presence of either abnormal absolute amount or relative proportion of body fat. Contrary to gluteal obesity, visceral obesity is associated with different metabolic alterations including insulin resistance (IR). A relatively new adipocytokine visfatin is shown to be expressed predominantly in visceral fat and exhibit insulin-mimicking effects in rodents. It is still unclear whether serum visfatin levels are associated with increased total or visceral fat mass in humans. The aim of our study was to investigate the relation between visfatin and obesity parameters namely body mass index (BMI) and waist circumference (WaC) and IR in healthy female subjects. Eighty one female subjects 20 years of age, having no diagnosis of glucose intolerance or diabetes, hypertension and dyslipidemia were chosen. The patients were divided into four groups according to their BMI and WaC values. Serum visfatin and HOMA-IR levels did not differ among groups. No correlation was detected between serum visfatin levels and obesity and metabolic parameters. In conclusion, we demonstrated that body fat distribution did not affect serum visfatin levels in healthy female subjects. Further studies are needed to clarify the exact factors influencing and determining serum visfatin levels and its clinical reflections.

Getting better or worse? General health status of 9th grade students in Orhangazi, Bursa, Turkey.

Adolescence is a transition phase from childhood to adulthood. In this period, rapid changes and development in their physical, biological, psychological, and social lives take place. While adolescents have to acquire many qualifications, they are faced with many problems, especially those that risk their health. In Turkey, one of the most important issues contributing to risky behaviors is the 1st Phase Nationwide High School Exam. Students must pass this phase in order to be in good high schools and to then pass the 2nd Phase University Exam. Most of their time is spent studying in school or in private teaching institutions, and less time is spent with their families or participating in social activities. In order to examine the effects on 9th grade students after the 1st Phase exams, we conducted this study with 1192 students in Bursa, Orhangazi. Data to evaluate students by socioeconomic status, body mass index (BMI), dietary, smoking, and physical activity behaviors and psychological status were collected via classroom questionnaires. We aimed to determine and evaluate the general characteristics and physical examination findings, to some extent, in a nationally representative sample of 9th grade students a year following the Nationwide High School Exam.

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

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

Turkish general practitioners and complementary/alternative medicine.

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

To evaluate the differences of risk factors in patients with lower extremity venous disease.

OBJECTIVE: To determine whether there is a difference between risk factors in patients diagnosed to have clinically documented lower extremity venous disease after confirming the diagnosis radiologically by ultrasonographic and venographic evaluation. METHODS: This study was performed from January 2002 to January 2005 in Bursa, the fourth biggest city of Turkey, situated in the west of the country in the Marmara Region. The study center is a private imaging center working in conjunction with the Department of Health, which performs diagnostic, and therapeutic vascular protocols in the region. Five hundred and fifty-three cases with clinically and radiologically documented diagnoses were evaluated with Multi-Variate Statistical Package 3.13 for the presence of pre-defined clusters of 14 different variables. Other statistical analyses were performed by the Statistical Package for Social Sciences, version 13.0. RESULTS: Three different clusters were defined. The variables used to define the clusters were: age, gender, educational level, presence of smoking, amount of smoking (pack/per year), disease symptoms, presence of heart disease, and radiologically documented diagnosis. CONCLUSION: Chronic venous insufficiency and varicose veins are venous system diseases that are most commonly present in association with more than one concomitant risk factor.

Prehospital period in patients with myocardial infarction in Turkey.

OBJECTIVE: To identify the causes that affect the time from the onset of symptoms to admission to the hospital, in patients with a diagnosis of acute myocardial infarction (MI). METHODS: The study was carried out between January 2004 and January 2005 in the Emergency Room of the Uludag University Faculty of Medicine (UUFM) Hospital, Turkey. A total of 180 patients were included. Residents of the UUFM Department of Cardiology distributed a questionnaire to all patients. Socioeconomic level was determined by scoring the socioeconomic factors. For statistical analyses we used the SPSS 13.0 statistical software. RESULTS: Of the 180 patients, 79.4% (n=143) were admitted to the hospital within 6 hours of onset of symptoms and 20.6% (n=37) the time exceeded 6 hours of which 10% (n=18) admitted in more than 12 hours. Male patients seemed to present earlier than females (p<0.05 and p<0.05). The time to admission decreased as the socioeconomic level improved and the level of education increased. Patients with a history of MI, who had coronary angioplasty and had undergone coronary by-pass surgery admitted to the hospital earlier than those who did not have these factors p=0.042, p=0.005, p=0.026. Subjects who had anginal symptoms prior to acute MI (p<0.001) and patients with diabetes (p<0.001) had a significantly longer admission time. CONCLUSION: It is essential to inform individuals with a low level of education and socioeconomic status; patients with anginal complaints and diabetic persons; particularly females, on the symptoms of MI and the importance of early hospitalization on the outcome.

Does the anatomical localization of lower extremity venous diseases affect the quality of life?

OBJECTIVE: To investigate the effects of venous diseases at different anatomical localizations on the qualities of life of patients with varicose veins. METHODS: The study included 354 cases, which was referred to a private vascular and interventional radiology center in Bursa, Turkey between January 2005 to January 2006. The cases were diagnosed with visual inspection and were clinically indicative of varicose veins. Color Doppler ultrasonography was used to radiologically examine the varicose veins. All cases were accepted as class II criteria according to the Clinical, Etiologic, Anatomic, Pathophysiologic classification. The generic Short Form Health Survey-36 (SF-36) was used to measure physical and mental quality of life (QOL). High scores indicated good QOL. The Statistical Package for Social Sciences version 13.0 program was used for the statistical evaluation. RESULTS: When the life SF-36 quality parameters of cases with different anatomical localizations of the varicose veins were examined, only the mental health scores were found to differ in different groups (p<0.01). In females and males with superficial venous disease, significant differences were found in physical function, physical role and pain among the physical health scale components, and in vitality and emotional role scores among the mental state determinants. When females and males with deep vein disease were compared, significant differences were found among both physical and mental health determinants. CONCLUSION: Anatomical localization of lower extremity varicose veins can be accepted as a predictive factor in determining the life qualities of patients with varicosities in their lower limb, and should be used to regulate their therapy and follow up protocols.

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

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

Mammography utilization among Turkish women.

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

A survey of the public attitudes towards organ donation in a Turkish community and of the changes that have taken place in the last 12 years.

In 1990 we carried out a survey on public attitudes toward organ donation in a Turkish community. We repeated this study 12 years later in order to evaluate the changes that had taken place in the meantime. Using the same questionnaire and method, we repeated the study in a different part of the city with similar socio-economic characteristics as in the former area, which had in the meantime ceased to be our research and training area. The 983 participants were chosen by a random stratified method. Of those interviewed, 57.0% were willing to donate, while 18.3% refused and 24.7% were uncertain. A total of 52.6% consented to donation. Twelve years later, some public attitudes toward organ donation had changed. Refusal to donate for religious reasons had diminished (16.1% versus 26.2%); uncertainty whether to donate had risen (24.7% versus 15.8%). Attitudes towards organ donation were clearly related to educational level, age and sex.