The impact of online health information source preference on intolerance to uncertainty and cyberchondria in a youthful generation.

Background: The increasing utilization of the Internet to access health-related information is believed to heighten anxiety and trigger cyberchondria due to the presence of conflicting and sometimes overly detailed information. Aim: To investigate the levels of cyberchondria and intolerance of uncertainty among university students and their relationship with different online health information sources. Methods: Between June and July 2022, 420 university students (mean age = 21.5 ± 2 years, 54% female) participated in this cross-sectional study. The socio-demographic form, Uncertainty Intolerance Scale (IUS), and Cyberchondria Severity Scale (CSS) were used in data collection. Pearson correlation test and binary logistic regression analysis were used to identify factors associated with cyberchondria. Results: Forums and private hospital/clinic websites were the most frequently utilized online health information sources, while governmental websites were the least. The mean scores for CSS and IUS were 81.5 and 41.0, respectively. There was no significant gender-based difference in CSS and IUS scores. Students who used newspapers/magazines and social media for health information had significantly higher scores on both scales. Cyberchondria had a negative association with age [odds ratio (OR) = 0.90], a positive significant relationship with newspaper/magazine website use (OR = 7.24), and IUS score (OR = 1.09). There was a positive and moderate correlation between CSS and IUS scores (r = 0.39, P < 0.001). Conclusions: Our results underline the susceptibility to cyberchondria and intolerance of uncertainty among young adults who used less reliable online health information sources and highlight promoting online health literacy to reduce vulnerabilities and the need for further research on socio-demographic determinants in both mental problems.

Which is better to predict erectile dysfunction and male sexual function in the context of metabolic syndrome: triglyceride-glucose index or visceral adiposity index?: a retrospective cross-sectional study.

PURPOSE: Many factors influence male sexual function, including metabolic disorders such as metabolic syndrome (MetS). We aimed to investigate the effects of two metabolic indices, the triglyceride-glucose (TyG) index and the visceral adiposity index (VAI), on male sexual function. METHODS: A total of 400 men having sexual dysfunction were included. Anthropological data, comorbidities were recorded. Serum total testosterone, prolactin, and estradiol levels were recorded. Sex-specific VAI was calculated using the [(WC/39.68) + (1.88xMI)] × (TG/1.03) × (1.31/HDL) formula and using Ln (fasting triglycerides) × (fasting glucose)/2] formula, TyG index was calculated. Turkish-validated 15-item long-form of the International Index of Erectile Dysfunction (IIEF) questionnaire and male sexual health questionnaire (MSHQ) were used for erectile function and ejaculatory function, respectively. The ROC analysis was used to evaluate the predictive abilities of TyG and VAI cut-off values for ED risk. RESULTS: A higher TyG index and VAI were associated with an increased risk of ED. The presence of MetS further worsened sexual function, with lower scores in sexual satisfaction, orgasm, desire, and general satisfaction. The TyG index and VAI showed similar predictive abilities for ED. Patients with MetS had worse ejaculation quality compared to those without MetS. CONCLUSIONS: These findings highlight the potential of the TyG index and VAI as convenient tools for predicting and assessing sexual dysfunction in men, particularly in the context of metabolic disorders. Early detection and intervention for metabolic syndrome and insulin resistance may help to mitigate their negative impact on male sexual function.

How close are children with obesity to becoming an adult with chronic illnesses?

OBJECTIVES: Childhood obesity has become a global threat due to its serious negative consequences. We aimed to determine the patterns of metabolic syndrome and cardio-metabolic risk factors in Turkish children with obesity. METHODS: We examined 169 schoolchildren with obesity in April and May 2019 in Samsun, Turkey. After clinical evaluation and anthropometric measurements, fasting blood samples were collected to measure total cholesterol, low and high-density lipoprotein, fasting blood glucose, triglycerides, and insulin levels. RESULTS: The proportion of those who met the metabolic syndrome criteria in boys was 14.3%, but it was twice as high in girls (28.2%). The most prevalent component of cardio-metabolic risk factor was increased waist circumference (96.4%) followed by a high homeostasis model assessment insulin resistance index (74.6%) and high blood pressure (29.0%). While the average high-density lipoprotein was higher in boys than in girls, on the contrary, insulin, HbA1c, and homeostasis model assessment insulin resistance concentrations were higher in girls. The prevalence of dyslipidemia was also higher in girls (67.1%) than in boys (47.6%), as were all impaired metabolic syndrome components. CONCLUSIONS: One in five children with obesity was at risk of metabolic syndrome. For early intervention and prevention, children with obesity should be monitored in terms of cardio-metabolic risk factors, but obese girls are more prioritized.

The impact of the COVID-19 pandemic on the attitude towards childbearing of married aged 20-30 Turkish women who are not yet mothers: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic has not only changed physical health and the economy, but also changed plans for the future with its impact on social status and mental health. Changes in fertility preferences in many countries are also part of this influence. We aimed to evaluate the effect of the COVID-19 pandemic on attitude toward the childbearing in women. METHODS: This cross-sectional study was conducted on married aged 20-30 Turkish women who are not yet mothers, between January and June 2022, using Google forms. The questionnaire consisted of the sociodemographic data form, The Attitude towards Fertility and Childbearing Scale, and the Fear of COVID-19 Scale. In addition, women were asked about their exposure to COVID-19 and the severity of their illness. RESULTS: Only one-third of participants said they would like to have children in the next year; 61.2% would consider them later, while 4.5% did not. Common reasons for not intending to have children were "it is early to become a mother (34%)", "economic difficulties (25.3%)", and "career plans (16%)". The fear of COVID-19 scale score, with an arithmetic mean of 16.8 ± 5.5, was found to be significantly lower in women who did not want to have children in the next year than in women who wanted to have children (p = 0.042). Except for the profession, there was no significant difference between the COVID-19 fear scores by the participants' sociodemographic characteristics. CONCLUSIONS: Among the married aged 20-30 Turkish women who are not yet mothers, the rate of those who intend to childbearing was found still low. The main reason for women who did not want to have children in the next year was that they thought it was too early to have a child. Besides low fear of COVID-19 scale scores; economic concerns and career plans, which came in second and third place in the reason list, showed that the fear of infected with SARS-CoV-2 during the pandemic did not affect the women's attitudes toward fertility.

Comparison of the ability of HOMA-IR, VAI, and TyG indexes to predict metabolic syndrome in children with obesity: a cross-sectional study.

BACKGROUND: The increasing trend in childhood obesity needs to be closely monitored and intervened due to long-term health issues such as metabolic syndrome, cardiovascular diseases, hypertension, and type 2 diabetes. We aimed to determine and compare the cut-off values for the visceral adiposity index (VAI), triglyceride-glucose index (TyG), and HOMA-IR for predicting metabolic syndrome (MetS). METHODS: This population-based cross-sectional study was conducted in May 2019 in Samsun, Turkey. The study included 169 children with obesity aged 9 and 10 years. After anthropometric and clinical evaluation, fasting blood samples were collected from the children. The areas under the curve of the visceral adiposity index, triglyceride-glucose index, and HOMA-IR were compared by receiver-operating-characteristic (ROC) analysis in predicting the MetS. RESULTS: The total prevalence of MetS was 21.3% in children with obesity, and it was two times higher in girls than in boys. The mean values of TyG and VAI were significantly different in those who have and have not MetS in both genders. However, the HOMA-IR index was higher only in girls with MetS and did not differ in boys by having MetS. The VAI and the TyG index both had statistically significant cut-off values in both sexes and a larger ROC area than the HOMA-IR index in predicting MetS. CONCLUSIONS: The VAI and TyG index are effective indicators in assessing the MetS risk in children with obesity. Both indexes can be considered useful tools in pediatric research and the evaluation of interventions. However, the HOMA-IR index formula needs to be developed taking into account age, gender, and ethnicity.

The problem of unaccompanied children in the earthquake; insufficient enrollment.

Türkiye experienced two of the most catastrophic earthquakes of the last century on February 6, 2023. The first earthquake with a magnitude of 7.7 occurred at 4.17 a.m. in Kahramanmaras City. Nine hours later, the second earthquake with a magnitude of 7.6 hit a region, which has 10 cities and over 16 million people. After the earthquakes, the Director-General of the World Health Organization, Hans Kluge, announced that a level 3 emergency was declared.One of the problems that should be solved at the earliest period in earthquakes is the problem of orphans or unaccompanied children. These children, referred to as 'earthquake orphans', can be potential victims of violence, organized crime, organ trafficking, drug addiction, sexual exploitation, or human trafficking. The already low socioeconomic level of the region, the magnitude of the earthquake, and the turmoil in the emergency rescue organization cause concern about the fact that the number of fragile children's population that will be affected will be higher than expected. The problem of orphaned children experienced in previous major destructive earthquakes provides important experiences for earthquake preparation.

Preanalytical Errors in Clinical Biochemistry Laboratory and Relationship With Hospital Departments and Staff: A Record-Based Study.

OBJECTIVE: Despite many efforts to improve the overall quality of clinical laboratory service, errors that compromise patient safety and increase healthcare costs continue to occur even infrequently. We aimed to determine the causes of preanalytical errors and related factors by evaluating the laboratory records of a tertiary hospital. METHODS: In this retrospective study, 7,762,981 requests that were registered in the biochemistry laboratory records of Ondokuz Mayis University Health Practice and Research Center during 2019 were examined. All rejected samples were analyzed according to the department where they were collected and the reasons for rejection. RESULTS: Of the total sample rejections, 99,561 (74.8%) were preanalytical and 33,474 (25.2%) belonged to the analytical phase. The preanalytical rejection rate was 1.28%, with the highest rejection rate in the inpatients (2.26%) and the lowest in the outpatients (0.02%). Insufficient sample (43.7%), clotted sample (35.1%), and inappropriate sample (11.1%) were the first 3 rows of rejection reasons. It was determined that sample rejection rates were low during routine working hours and high during nonworking hours. CONCLUSIONS: Preanalytical errors were most common in inpatient wards and were most likely due to incorrect phlebotomy techniques. Education of health personnel on good laboratory practices, systematic monitoring of errors, and the development of quality indicators will play an important role in reducing the vulnerability of the preanalytical phase.

The Psychological Effects of the COVID-19 on Students Who Choose the Medical Profession With Different Motivational Factors: A Cross-Sectional Study.

The COVID-19 pandemic has generated mental and psychological health problems worldwide. The aim of this study was to determine whether the psychological effects of COVID-19 were different in medical students who chose the medical profession with different motivational factors. In the study, there were 389 medical school students. The survey asks about sociodemographic features and the students' reasons for choosing the medical profession. The study also included a self-assessed Hospital Anxiety-Depression Scale and Beck Hopelessness Scale. While 41% of students chose the medical profession for economic reasons, the ratio of whom have an extrinsic and intrinsic source of motivation was 37% and 22%, respectively. It was found that there was a statistically significant difference in the distribution of motivational factors by gender. Almost 50% of males were affected by economic motivation factors. The difference in motivational factors between genders was found to be statistically significant. Anxiety in females, depression in students with low-income families, and hopelessness in students older than 22 years and interns were higher than in the others (P < .05). Median scores for anxiety, depression, and hopelessness were higher for students with extrinsic motivational sources. However, only the difference in scores of anxiety and hopelessness was found statistically significant (P < .05). We found that the psychological effects of the COVID-19 pandemic varied according to both sociodemographic characteristics of the medical students and reasons for choosing medical profession. According to our results, the idealistic students interested in the medical profession, who want to support others and prioritize economic benefits, had fewer psychological issues than those who chose the medical profession due to family pressure or external factors.

The relationship between orthorexia nervosa, anxiety, and self-esteem: a cross-sectional study in Turkish faculty members.

BACKGROUND: Orthorexia nervosa (ON) may be a disorder on the spectrum of obsessive-compulsive disorders, maybe a separate eating disorder, or it may be an eating disorder on the spectrum of other eating disorders. We aimed to explore how anxiety and self-esteem affect the orthorectic tendency among higher-educated groups. METHODS: This cross-sectional study was conducted on 248 faculty members selected by stratified sampling method from Ondokuz Mayis University in Samsun, Turkey. Data were collected by face-to-face interview method using Ortho-15, Rosenberg self-esteem, and Beck Anxiety scales. RESULTS: The study group consisted of 144 (58.1%) males and 104 (41.9%) females, and the mean age was 42.5 ± 6.3 years. We found a tendency for orthorexia nervosa in 47 (19%) participants. The mean scores were 41.0 ± 2.6 for the Ortho-15 scale, 0.7 ± 1.2 for the Self-esteem scale, and 5.9 ± 5.8 for the Beck Anxiety Scale. Self-esteem scores were low, and anxiety scores were high in participants who tended to orthorexia (p < 0.001). Logistic regression analysis showed that the high self-esteem scores decrease the orthorectic tendency, while high anxiety scores increase the tendency. CONCLUSIONS: We found a significant relationship between anxiety, low self-esteem and orthorexia nervosa. This result can be considered as a preliminary finding leading to further research. Further clinical and longitudinal studies are needed to determine the characteristics of individuals with orthorexia nervosa and identify the cause and effect relationship with psychiatric comorbidities.

Non-emergent care visits in a turkish tertiary care emergency department after 2008 health policy changes: review and analysis.

BACKGROUND: The Turkish government liberalized national healthcare policies in 2008 enabling Turkish citizens to seek general care in hospital emergency departments (ED). The number of ED visits has exceeded the total population every year for the last ten years. To explain this phenomenon and to identify trends and risk factors for non-emergent visits, we retrospectively reviewed the ED records of a tertiary hospital and the Turkish Ministry of Health bulletin. METHODS: This retrospective record-based study was conducted at a tertiary hospital in Samsun province of Turkey. A total of 87,528 records of adult patients who visited the ED between January 1 and December 31, 2017, were included in this study. We evaluated the pattern of ED use for non-emergent patients by age, gender, nationality, time of visit, means of arrival, ICD (International Classification of Diseases) diagnostic codes, triage codes, number of repeated and out-of-hours visits. We used the Turkish Ministry of Health statistics bulletins to compare the number of ED visits across the country by year. RESULTS: The non-emergent visit rate in ED was found 9.9%. The rate of non-emergent ED visits was significantly higher in the 18-44 age group, in the female gender, and in those who arrived at the ED without an ambulance. The number of non-emergent visits was very similar between weekends and weekdays but was significantly higher in working hours on weekdays than out-of-hours (p<0.001). The most frequent diagnostic code was "Pain, unspecified" (R52) and the rate of repeat visits was 14.8% of non-emergent ED visits. According to binary logistic analysis, non-emergency visits were associated with 18-44 age group (OR = 2.75), female gender (OR = 1.11) and non-ambulance transportation (OR = 9.86). CONCLUSIONS: Our results showed that the 18-44 age group and female gender seek care in the ED for non-emergent problems more than the other parts of the population. The numbers of ED visits in the last decade continued to increase regardless of population growth. The health policy changes may have facilitated access to rapid physical and laboratory examination but also an exacerbation of the free-rider problem in ED services.

Prevalence of overweight and obesity among school children and parents: a cross-sectional study.

INTRODUCTION: Obesity, a complex and multifactorial disease causing severe health problems, is still the second most important cause of preventable deaths after smoking. Another risk is that childhood obesity is associated with overweight and obesity in adulthood. This study provides information on the prevalence of overweight and obesity in primary school students and their parents on location (rural v urban) and gender. METHODS: In this population-based, cross-sectional study, the anthropometric and demographic data of 9786 children and 6855 parents were analyzed. The study was conducted between 1 October 2016 and 30 November 2016 on a sample representing all public and private primary school students aged 6-10 years in Samsun province, Turkey. The multi-stage stratified sampling method was used in selecting the research sample according to the number of district students, the number of public/private primary school students, and the number of rural/urban students. In the BMI values classification, cut-off points in the age- and gender-specific growth charts of the Centers for Disease Control and Prevention were used for students, and the International Obesity Task Force cut-offs were used for parents or guardians. After the data acquisition was completed, a questionnaire form developed by the researchers was sent to the parents through the students. While children's anthropometric measurements were performed in their classrooms, parents or guardians self-reported their weight and height. Statistical Package for the social Sciences v22.0 was used for statistical analysis of the data. RESULTS: The study group consisted of 5005 (51.1%) boys and 4781 (48.9%) girls. The 6855 parents comprised 5258 (76.7%) mothers and 1597 (23.3%) fathers. The mean age was 8.2±1.2 years in children and 36.2±6.7 years in parents. Obesity prevalence was 10.5% in children and 20.2% in their parents. Childhood obesity was more prevalent in boys and in those living in urban areas (12.0% and 12.3%, respectively) than in girls and in those living in rural areas (9.0% and 4.5%, respectively). Conversely, adulthood obesity was more frequent in females and in those living in rural areas (20.4% and 21.8%, respectively) than in males and in those living in urban areas (19.7% and 20.4%, respectively). CONCLUSION: BMI values were higher among those of male gender and those living in rural areas. Combating obesity requires further multidisciplinary research to reveal the reasons for the differences based on place and gender, especially on nutrition and healthy lifestyle behaviors.

The causes of parental vaccine refusal: results of a survey from Giresun, Turkey.

BACKGROUND: While efforts have raised immunization levels in developing countries, high rates of vaccine refusal in both developing and developed countries are causing concern worldwide. We aimed to determine the causes of vaccine refusal among parents refusing or postponing the vaccination of their children. METHODS: This descriptive, cross-sectional study was performed in the Giresun province of Turkey. The study population included families who were unwilling or refused to vaccinate at least one of their children under the scope of the Turkey Enhanced Program of Immunization. Data were obtained during the year 2018 by face-toface interviews with each vaccine hesitant parent (VHP). RESULTS: Vaccine refusal incidence was 1.2% in the year 2018. In 8 (14.8%) of the children, the vaccination was recorded to be postponed due to health problems, while 46 (85.2%) children were not vaccinated due to parental vaccine refusal. Two-thirds of unvaccinated children were living outside the province center of Giresun. The parents consisted of young adults whose average age was 30.6±6.6 years. VHPs were mostly university graduates (61.1% of mothers-70.3% of fathers). While at least one of the VHPs was a religious official in 24.1%, at least one of the either VHP was a teacher in 20.3%. The most common reasons for vaccine refusal were `fear of vaccine side-effects` (55.6%), and `problems in previous vaccinations` (33.3%). In 44.4 % of refusal cases, no specific reason was stated. CONCLUSIONS: Primary healthcare providers, who are in close contact with parents, have an important role to provide the right health information. Various in-service training can be provided to improve the communication skills of healthcare providers. In these training sessions, besides comprehensive information about vaccines, it should be aimed to provide parents with the ability to understand their concerns, to approach them sensitively and to present the information they need effectively.

Impact of a high visceral adiposity index on female sexual dysfunction in sexually active women? Results of a cross-sectional study.

AIMS: To our knowledge, this is the first study investigating the impact of high visceral adiposity index (VAI) on female sexual dysfunction (FSD). We aimed to show the impact of increased levels of VAI on FSD compared with body mass index (BMI) and waist circumference (WC) particularly in those with metabolic syndrome (MeTS). METHODS: We included 158 participants in two groups: Group 1 (n = 68 with normal sexual function) and Group 2 (n = 90 with sexual dysfunction). Demographic, clinic data, presence of MeTS and comorbidities were recorded. The BMI, WC and the VAI were calculated. Sexual function was assessed using the female sexual function index. RESULTS: The mean age and all the anthropometric variables were similar between the groups (P > .05). MeTS was associated with lower arousal and lubrication scores than those without MeTS (P = .023). The higher VAI was associated with lower desire, lubrication and orgasm scores (P < .05). Each integer increase of the VAI weakly predicted decrease of desire (P = .015), arousal (P = .015), lubrication (P = .005) and satisfaction (P = .046). The WC and BMI were not a good predictor for FSD in women (OR=1.019, P = .318). CONCLUSION: The VAI was linked with lower scores in some female sexual function subdomains, but the correlation coefficient was low, indicating a weak association. Further studies with a higher number of participants are needed to conclude that the VAI may increase the risk of FSD, particularly in patients with MeTS.

The effects of the COVID-19 outbreak on physicians' psychological resilience levels.

BACKGROUND: Health-care workers exposed to coronavirus19 disease could be psychologically stressed. The objective of this study is to assess the anxiety, depression levels, and psychological resilience of physicians working during the Covid-19 outbreak and to evaluate the related factors that are associated with their psychological resilience. METHODS: The sample of this descriptive study was composed of medical doctors and dentists. The data were obtained online between April 13-23, 2020 through a survey prepared by the researchers. In addition, a questionnaire about the participants' sociodemographic characteristics, the Psychological Resilience Scale and Hospital Anxiety Depression Scale (HAD-A/HAD-D) was given. RESULTS: The average age of the 671 participants was 44.0 ± 9.0 years. Psychological resilience scores were significantly higher in those who had children, who had worked for 15 years or more, and who had received training about COVID-19 (p < 0.05). Depression scores were higher among women and in those who reported having a chronic disease, whose workload increased after the outbreak, and who had physical contact with COVID-positive patients. The anxiety scores were also higher among women and in those whose workload had increased and who had contact with COVID-positive patients (p < 0.05). The physicians with scores below the cutoff point on the HAD-D/HAD-A had significantly higher scores on the Psychological Resilience Scale (p < 0.05). DISCUSSION: Depression and anxiety levels were found to be significantly lower in physicians with greater psychological resilience. Psychological and social support of all health-care workers, especially physicians, is important in the struggle with the pandemic. It is thought that determining the variables related to psychological resilience in health-care workers will be a guide for psychosocial services.

Regional success on screening and chemoprophylaxis in contacts of patients with pulmonary tuberculosis in Turkey: a dispensary experience in 2016-2017.

BACKGROUND: Turkey has a national tuberculosis (TB) control program that follows the standards set by the World Health Organization's (WHO) global TB control program. METHODS: In this record-based retrospective study, contact screening and chemoprophylaxis of 469 TB contacts registered at the Samsun Tuberculosis Dispensary in 2016-2017 were assessed. RESULTS: On average, patients with pulmonary TB each had four contacts. Chemoprophylaxis was administered in 233 of the contacts for the following reasons: having close contact with an active TB patient (187 [80%]), being <15 y of age and tuberculin skin test (TST) positive (12 [5%]), detection of latent TB infection (27 [12%]) or not having been treated for TB before in conjunction with the discovery via radiography of a sequel lesion (7 [3%]). The remaining 236 contacts were not given chemoprophylaxis: 203 (86%) were TST negative, 10 (4%) rejected chemoprophylaxis and 23 (10%) refused to participate in an examination. Chemoprophylaxis was given to 30% of contacts in the first week and to 75% of contacts in the first month. The treatment completion rate was 80%, while the rate of chemoprophylaxis abandonment was 19.5% for males and 21.2% for females. CONCLUSIONS: The Samsun TB dispensary is successfully implementing the WHO's End TB strategy and has achieved higher treatment completion rates than other countries.

A Cross-Sectional Analysis of the Relationship among Adolescents' Perceived Social Support, Psychological State and Future Expectations among Turkish Students.

INTRODUCTION: Due to social and emotional changes alongside the cognitive and logical changes in adolescence, alterations occur in the adolescent's communication with family and friends in this period, and social support assumes greater importance. METHODS: From each of the two middle and high schools in the Ilkadim district of Samsun, a total 688 students were employed by a two-stage sampling method in this cross-sectional study. The data were collected from sociodemographic information, Multidimensional Scale of Perceived Social Support (MSPSS), Brief Symptom Inventory (BSI) and Future Expectations Scale for Adolescents (FESA) questionnaires distributed under the supervision of guidance counselors in these schools between December 2014 and February 2015. The Mann- Whitney U test and Spearman's Rank Correlation were used for statistical analysis. The significance level was accepted as p<0.05 for all tests. RESULTS: In the study group, MSPSS Family subscale had a stronger correlational relationship with all the BSI subscales including global indices and also with total score of FESA and subscales with the exception of the Marriage and Family subscale than the other two MSPSS subscales. There were moderate negative correlation between scores of MSPSS and BSI, and a low-moderate positive correlation was observed between total MSPSS and FESA scores of adolescents. The results demonstrated that adolescents who exercise regularly and avoid smoking and alcohol have higher perceptions of social support. CONCLUSION: Perceived social support from family may be more effective than perceived social support from friends or a significant other in the development of psychological well-being and positive future expectations of Turkish adolescents.

Health-seeking behavior and medical facility choice in Samsun, Turkey.

OBJECTIVE: Examining the factors that play a role in determining patient preferences for different healthcare institutions. METHOD: This descriptive study was conducted in five family health centers (FHC) and in six hospitals in Samsun Province in Turkey. The data were collected from 1700 volunteer patients by using a structured questionnaire, while they were waiting for consultation. RESULT: The average number of out-patient visits was 9.5±6.4 per person in 2012. Individuals aged less than 18 and more than 65 years old had higher preferences for FHCs, while those aged 19-64 years preferred primarily private hospitals. The order of preferences for FHC, public and private hospitals did not vary with the educational level. An increase in educational level was associated with a decrease in the preference for FHCs and in increase in the preference for private hospitals. The first three reasons given for preferring a hospital were 'the presence of a specialist', 'availability of good equipment and technology', and 'trust on the diagnosis and treatment', while 'proximity', 'receiving adequate information', and 'being treated well' were the reasons given by participants who preferred a FHC. CONCLUSION: Providing medical equipment and staff support for improving diagnostic capacity of FHCs can accommodate patient expectations and shift the demand from hospitals to FHCs.

Depression and post-traumatic stress disorder in child victims of sexual abuse: perceived social support as a protection factor.

Background Social support has been shown to play a protective role against the development of post-traumatic stress disorder (PTSD) and depression in individuals exposed to trauma. Aims The purpose of this study was to investigate the effect of perceived social support on depression and PTSD in child victims of sexual abuse and to determine the relationship between them. Method In total 182 victims of sexual abuse aged 6-18 at time of interview were assessed. Clinical interviews, the Children's Depression Inventory (CDI) and the Child Posttraumatic Stress Reaction Index (CPTS-RI) were used to assess children's psychological status, while the Perceived Social Support Scale-Revised (PSSS-R) was used to measure social support. Results Girls had significantly higher median CDI and CPTS-RI scores than boys, while no significant difference was determined between boys and girls in terms of PSSS-R scores. A statistically significant negative correlation was determined between CDI and PSSS-R scores, CPTS-RI scores and PSSS-R scores in girls, while no significant correlation was identified in male victims. Conclusions In conclusion, we think that social support networks for victims of sexual abuse need to be broadened and increased, and that importance should be attached to protective approaches in that context.

Expression of Glypican 3 in low and high grade urothelial carcinomas.

BACKGROUND: Glypican-3 (GPC3) is an oncofetal protein which is encoded by GPC3 gene and takes role in the regulation of cell division and apoptosis. Overexpression of GPC3 has been reported in some types of cancer such as hepatocellular carcinoma (HCC), melanoma, squamous cell carcinoma of the lungs and testicular germ cell tumors. The aim of this study was to investigate the immunohistochemical expression of GPC3 in the non-neoplastic urothelium and in urothelial carcinoma (UC). We also aimed to explore the alterations in the GPC3 expression according to the grade and the invasiveness of UC. METHODS: GPC3 expression was studied in 108 UC cases by using immunohistochemistry. Each section was evaluated in terms of the extensiveness and intensity of GPC3 staining. Scores of immunostaining were correlated with tumor grade and stage. RESULTS: GPC3 expression was observed in 38 cases (35.2%). GPC3 expression was positive in 43.6% of high and in 13.3% of low grade UC (p: 0.003). In 19 UC cases biopsy also harbored non-neoplastic urothelium which showed no staining for GPC3. The difference in staining percentages between low and high grade UCs, suggests that GPC3 staining could be used as an adjunctive marker in cases where the distinction between the low and high grade tumors is difficult. In addition, lack of staining in the non-neoplastic urothelial areas in 19 cases raises the possibility of the use of GPC3 staining for the distinction between neoplastic and non-neoplastic urothelium, especially in punch biopsy samples. CONCLUSIONS: Based on our results potential role of GPC3 in urothelial carcinogenesis warrants further investigation, especially the potential use of GPC3 for therapeutic and diagnostic purposes. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2260833001522844.

Child sexual abuse in Turkey: an analysis of 1002 cases.

This study investigated the characteristics of abuse suffered by children, the dimensions of the psychiatric effects associated with abuse, and the factors affecting these. One thousand two cases aged under 18, exposed to sexual abuse, and referred over a 7-year period were assessed. Girls represented 80.8% of cases, and the numbers rose with age. The aggressors were all male, and 88.2% were known to their victim. Approximately half the children were exposed to sexual abuse involving penetration. Psychological pathology was identified in 62.1%. Female gender, the presence of penetration, physical violence, and incest significantly increased the development of psychological pathology. Levels of awareness in people close to and trusted by the child must be raised to minimize the adverse effects of trauma in the long term, preventive measures must be taken, and medical and social support units from which victims can receive assistance need to be established.