Reliability and validity of Turkish version of pediatric balance scale.

Assessment tool is a key point to evaluate balance disturbances in children. The aim of this study was to analyze reliability and validity of Turkish version of pediatric balance scale. The present study included 34 children (13 girls; 21 boys) with balance impairments. The scale consists of 14 items. Eight observers assessed the video records of the participants for interrater agreement. One observer evaluated the records twice in 2 weeks for intrarater agreement. Intraclass correlation coefficient was used for the interobserver and intraobserver agreement. The Functional Reach Test was used to calculate concurrent validity. Mean age of the sample was 11.68 ± 3.53 years. The Turkish version of the scale was found to be reliable, perfectly (intraclass correlation coefficient for interobserver agreement = 0.915). Intraobserver agreement was also reliable, perfectly (ICC = 0.927). The strong correlation between pediatric balance scale and functional reach test was found (r = 0.692; p < 0.001). The Turkish version of the scale is a valid and reliable tool to evaluate children with balance impairments. Moreover, it is easy to use for health providers working with disabled children.

Comparisons between the Dosimetric and Clinical Outcomes of Tomotherapy and 3D Conformal Radiotherapy in Gastric Cancer Treatment

Introduction: Previous studies comparing tomotherapy (TOMO) and three dimensional (3D) conformal radiotherapy (3DCRT) in gastric radiotherapy are limited and tend to be based on dosimetry. The aim of the present study was to evaluate the clinical outcomes of these two treatment modalities. Methods: A total of 51 patients diagnosed with gastric cancer who were treated with postoperative adjuvant chemoradiotherapy and had subtotal/total gastrectomy and D2 lymphatic dissection were recruited to the present study: 30 patients were treated with TOMO and 21 patients were treated with 3DCRT. Results: The 3DCRT and TOMO treatment regimens were compared. There was no difference in planning target volume (PTV) 95%, but TOMO was statistically significant in regard to PTV 105% (P<0.05). TOMO was also significantly different when compared with 3DCRT when evaluating liver mean dose, liver V40, right/left kidneys mean dose, right/left kidneys V20 and spinal cord mean dose values (P<0.05). Grade 2 acute side effects were more frequent (85.7%) following 3DCRT. In addition, the median overall survival time for TOMO treated patients was 62 months while in 3DCRT treated patients it was 22.05 months. The difference in disease free survival was also significantly increased in patients treated with TOMO (66.7% vs. 19.0%; P<0.05). Conclusion: TOMO treatment resulted in lower acute side effects with better patient survival following gastric cancer radiotherapy.

Iodine status among pregnant women after mandatory salt iodisation.

I is essential for thyroid hormone synthesis and neurological development. Various changes occur in thyroid hormone metabolism during pregnancy and I requirements increase significantly. The purpose of this study was to investigate I status among pregnant women in Trabzon, formerly a severely I-deficient area but shown to have become I sufficient following mandatory iodisation of table salt based on monitoring studies among school-age children (SAC) in the area. A total of 864 healthy pregnant women with a median age of 28 (25th-75th percentile 17-47) years participated in the study. None of them were using I-containing supplement. All of them were screened for use of iodised salt, obstetric history, thyroid function tests and urinary I concentrations (UIC), and thyroid ultrasonography was performed. Median UIC was 102 (25th-75th percentile=62-143) µg/l. Median UIC of the patients according to trimesters were 122 µg/l at the 1st, 97 µg/l at the 2nd and 87 µg/l at the 3rd trimester. UIC in the 1st trimester was higher compared with the 2nd and 3rd trimesters (P<0·017). Nodules were present in 17·7% of women (n 153). The rate of iodised salt usage among pregnant women was 90·7%. Our study demonstrates that, although the I status among SAC has been rectified, I deficiency (ID) is still prevalent among pregnant women. Current knowledge is in favour of I supplementation in this group. Until the effects of maternal I supplementation in mild ID have been clarified by large-scale prospective controlled trials, pregnant women living in borderline defficient and I-sufficient areas, such as Trabzon city, should receive 100-200 µg/d of I-containing supplements in addition to iodised salt.

The prevalence and risk factors of low back pain in the eastern Black Sea region of Turkey.

BACKGROUND: Low back pain (LBP) is a public health problem commonly seen in all societies. OBJECTIVE: The aim of this study was to determine the prevalence and specific risk factors of low back pain (LBP) in the central and outlying districts of the province of Trabzon, a Black Sea region of Turkey. METHOD: A random sample of 7897 (4006 men and 3789 women) adults was collected by using sampling techniques of stratification. In this study questionnaires were completed at face-to-face interviews with participants selected on the basis of place of residence, gender and age group. The used variables in this study were: use of cigarettes, status of marriage, level of education, and presence of chronic disease, the prevalence of lifetime LBP and of LBP in the preceding year. Chronic LBP was determined as being present for more than 6 weeks. RESULTS: The lifetime prevalence of LBP in the general population was determined at 62.1%. Prevalence in the preceding year was 46.1%, and that of LBP lasting more than six week was 18.1%. Lifetime prevalence of LBP, prevalence of LBP in the preceding year and prevalence of pain lasting more than six week were all statistically significantly higher in women (p< 0.001). Use of cigarettes, female gender, marriage, a low level of education and presence of chronic disease were identified as independent risk factors for LBP (p< 0.001). CONCLUSION: Lower back pain is a common public health problem. Recommendations were made for local health services to prevent LBP, including health education through combating chronic diseases, reducing cigarette consumption, improvement of working environments and life styles.

Universal newborn hearing screening; automated transient evoked otoacoustic emissions.

OBJECTIVE: The purpose of this study is to describe the results of universal newborn hearing screening (UNHS) in 2229 newborns and to assess the effectiveness of a two-stage automated transient evoked otoacoustic emission (a-TEOAE) test protocol. MATERIALS AND METHODS: Between May 2007 and January 2008, a universal newborn hearing screening program, instituting two-stage a-TEOAE, was evaluated. The hearing status of the newborns who failed the two-stage screening tests were evaluated with the auditory brainstem response (ABR) test during the diagnostic stage. The risk factors for hearing loss determined by the Joint Committee on Infant Hearing Loss (JCIH) and prematurity, consanguineous marriage, and birth type as presumptive risk factors were recorded. RESULTS: During the study period, 2229 newborns were screened. Sensorineural hearing loss (SNHL) was identified in 8 newborns. Fourteen newborns were lost to follow-up. One hundred thirty six newborns were high-risk neonatal intensive care unit (NICU) patients. The prevalence of SNHL was 2.9% (4/136) in NICU newborns, and 0.19% (4/2079) in the well-baby nursery. SNHL prevalence in the study group overall was found to be 0.36% (8/2215). Craniofacial anomalies and family history of hearing loss were found to be significantly related to SNHL in newborns. Prematurity and consanguinity that are not listed among JCIH risk factors were also found to be statistically significantly related with SNHL. CONCLUSIONS: This is the first report of a universal hearing screening program in the Eastern Black Sea region of Turkey. Two-stage a-TEOAE is an efficient and feasible hospital-based screening protocol in newborns.

Attitudes and behavior regarding organ donation and transplantation on the part of religious officials in the Eastern Black Sea region of Turkey.

AIM: This study evaluated the opinions and attitudes toward organ donation and transplantation on the part of religious officials in the Eastern Black Sea region of Turkey. METHOD: This descriptive study was performed between December 2008 and November 2009 with 550 among Muslim religious officials, including 541 males and 9 females, who attended educational seminars on the subject arranged in collaboration with Mufti Offices in the provinces of Trabzon, Rize, Gümüshane, and Giresun in the Eastern Black Sea region of Turkey. A supervised questionnaire administered before the seminars contained questions investigating whether subjects have volunteered to donate organs, reasons for not volunteering, whether they would donate the organs of a close relative in the event such a death, and what they would think in the event they required an organ transplantation themselves. Questions were also asked regarding permission for organ transplantation and donation in 5 main religions. RESULTS: Although no female religious officials had previously volunteered to donate organs, 4 men (0.7%) had done so. After attending seminars, 32 (5.9%) volunteered to donate. The main reasons cited for not volunteering to donate organs were lack of sufficient knowledge of the procedures involved (30.6%) and lack of interest (17.4%). Three hundred five religious officials stated they would not agree to organ donation in the event of the death of a close relative. When asked "What would you think about organ donation and transplantation if you needed an organ transplant now?", 46.0% replied "I would want an organ transplant." Finally, 83.3% of religious officials stated that Islam permits organ donation and transplantation, whereas 13.6% stated that Christianity permits it, other figures being 7.3% for Judaism, 2.5% for Buddhism, and 2.0% for Hinduism. CONCLUSIONS: Religious views affect organ donation. The fact that religious officials agreed to donate organs after appropriate education emphasized that Islam is the most sensitive faith on the subject, indicating that the issues can be improved through collaboration with religious officials.

The effect of prenatal factors on the development of colon cancer.

BACKGROUND: There is some evidence that prenatal factors can play a role in the development of colon cancer. Children with an old parent age at the time of birth were observed to develop certain childhood cancers more frequently. OBJECTIVE: This trial was designed to investigate the effects of some prenatal factors on colon cancer risk. Particularly, investigation of the effect of advanced parent age on colon cancer development risk was targeted. MATERIALS AND METHODS: In this study 117 in or out patients diagnosed with colon cancer and 234 control subjects were included. Definitive diagnostic results and dates of diagnosis were determined from pathological reports. Groups were asked for the parent age, smoking habits, sociodemographic, environmental, familial and reproductive traits. The results were compared between the patients and the control group. RESULTS: It was determined that children may have higher risk if mother and father are more than 30 at birth (p = 0.018, p = 0.020). While the mean mother age at birth was 25.6 +/- 5.72 in patients, it was 24.7 +/- 6.90 in the controls. The difference was not statistically significant (p < 0.056). The mean father age at birth was 29.4 +/- 6.58 in patients and 27.4 +/- 7.47 in the controls. The difference was statistically significant (p < 0.001). Smoking of mother was one of the important risk factors of colon cancer (p = 0.044). CONCLUSION: Our data supports that some prenatal factors such as high parental age at birth and mother -smoker may be risk factors for some cancers in children. This is the first study to report that high parental age at birth and exposure to smoke prenatally increase the risk or colon cancer (Tab. 7, Ref. 28).

Relative associations of polycystic ovarian syndrome vs metabolic syndrome with thyroid function, volume, nodularity and autoimmunity.

BACKGROUND: The relative associations of polycystic ovarian syndrome (PCOS) and metabolic syndrome (MS) with the risk for thyroid disease (thyroid function, volume, nodularity and autoimmunity) are unknown.We compared thyroid features and function in patients with PCOS and control subjects by the presence of MS. METHODS: We recruited 84 women with PCOS and 81 age-matched healthy controls. PCOS was defined according to the Rotterdam criteria. Thyroid ultrasound and function tests were performed in all. RESULTS: Although thyroid disease was more prevalent in women with PCOS, ovarian disease was not significantly associated with the risk for thyroid disease. Thyroid volume did not differ between women with PCOS and control subjects (13.7±8.6 vs 12.4±4.4 ml, respectively; p=0.2); however, it differed significantly between subjects with and without MS (regardless of PCOS status): 19.1±14.8 vs 12.4±4.9 ml, respectively; p=0.001). Antithyroglobulin and antithyroid peroxidase antibody levels also were significantly higher in subjects with MS, but not in participants with PCOS vs control subjects. Overall, TSH level correlated significantly with body mass index (BMI), weight, waist circumference, diastolic blood pressure, and levels of LDL cholesterol, triglycerides, and HDL cholesterol. Thyroid volume correlated significantly with age, weight, BMI, waist circumference, systolic blood pressure, 120-min postprandial glucose and HDL level. CONCLUSIONS: PCOS alone was not associated with thyroid disease in our population. However, MS and some of its components appear to be related to thyroid volume, function, and antithyroid antibody levels.

Information, attitude, and behavior toward organ transplantation and donation among health workers in the eastern Black Sea region of Turkey.

AIM: We sought to evaluate the information, attitude, and behaviors toward organ donation among health workers in the eastern Black Sea region of Turkey. METHOD: This descriptive study was performed between December 2008 and November 2009. It involved 1,545 health personnel in 8 state hospitals in the eastern Black Sea region of Turkey, excluding the university hospitals in the towns of Trabzon, Rize, Gümüshane, and Giresun. Educational seminars regarding organ transplantation and donation were arranged for the hospitals in the study. Questionnaires on the subject distributed to the participants were collected before the seminars began. They contained questions about occupation, gender, age, previous organ donation, whether the person would consider donating if they had not already volunteered (if not, the reasons why), whether any relatives had volunteered to donate organs, whether anyone close to them had volunteered to donate organs, whether they would donate organs in the event of a relative's death, and what they might think if they were to require an organ transplant. Following the seminars, participants were given the opportunity to obtain organ donation cards from a stand on site. Data were analyzed using the chi-square test. RESULTS: Eighty-one participants (5.2%), including 46 women (5.2%) and 35 men (5.3%), had previously officially volunteered to donate organs (P = .875). One hundred thirty-seven health personnel were willing to donate organs by visiting the donation stand after the seminars. The main reasons for participants who had not volunteered to donate organs failing to do so were lack of information about donation and procedures (28.4%), lack of interest in the subject (23.2%), and Islamic religious beliefs and/or traditions (19.6%). One hundred eighty health personnel (11.7%) had family members or relatives who had volunteered to donate organs. Asked whether they would donate that person's organs in the event of the death of a relative, 93 doctors (67.6%), 225 nonphysician health personnel (41.1%), and 345 other participants (43.1%) stated that they would not (P < .0005). CONCLUSIONS: Health workers play a key role to overcome the difficulties encountered regarding organ donation. This study showed the need for constant effective education seminars to enhance knowledge and sensitivity on the part of health workers.

Ischemia-modified albumin and flap viability.

Monitoring flap viability in the postoperative period is important for the prediction of partial or total flap failure. Many alternative methods such as laser Doppler flowmetry, photoplethysmography, infrared spectroscopy, fluorescein injection, evaluation of flap color, turgor, temperature and capillary reflow have been used for this purpose. Although these methods are valuable in the determination of flap condition, they are not sufficient prognostic markers for flaps. In this study, we investigated the relationship between serum ischemia-modified albumin (IMA) values and flap viability. In 20 Wistar rats, caudal-based 9 x 3 cm dorsal flaps were prepared. IMA values were measured before the flap elevation as well as 6 h and 1 week after the surgical procedure. Seven days after the operation, the viable flap areas were calculated. The relationship between changes in the IMA level during the study and viable flap area measurements was investigated. There was no statistically significant correlation between serum IMA level alterations during the preoperative to postoperative 6th hour period and necrotic flap area measurements. This lack of correlation was also present between the change in IMA levels during the preoperative to postoperative 7th day period and necrotic flap area measurements. In conclusion, serum IMA levels do not predict rat skin flap viability.

Effect of deep vein thrombosis on ischaemia-modified albumin levels.

BACKGROUND: An increasing number of studies have shown that ischaemia-modified albumin (IMA) levels rise in a number of acute ischaemic conditions such as cerebral infarct, myocardial infarct, pulmonary infarct and mesenteric infarct, suggesting that IMA may be useful as a diagnostic marker. A study was undertaken to investigate the effect on IMA levels of deep vein thrombosis (DVT), frequently encountered at the outset or during the course of diseases such as pulmonary embolism and cerebral infarct. METHODS: A case-control study was performed in the emergency department of Karadeniz Technical University Hospital, Turkey. 41 patients presenting to the emergency and vascular surgery departments and definitively diagnosed with DVT using Doppler ultrasonography were enrolled in the study. A control group of 66 age-matched healthy volunteers served as a reference for biochemical parameters. RESULTS: Mean (SD) plasma IMA levels were 0.259 (0.066) absorbance units (ABSU) in the DVT group and 0.171 (0.045) ABSU in the control group (p<0.005). The area under the curve for IMA was 0.850 (95% CI 0.768 to 0.933). The IMA value with acceptable sensitivity and specificity capable of being raised was 0.195 ABSU (sensitivity 80.5%, specificity 71.2%). CONCLUSIONS: DVT is associated with raised serum IMA levels but IMA levels are not suitable as a diagnostic marker for DVT.

Performance of simple calculated osteoporosis risk estimation in a sample of women with suspected osteoporosis in the Turkish population.

The aim of this study was to evaluate the performance of the simple calculated osteoporosis risk estimation (SCORE) in a random sample of postmenopausal women. We collected data on 177 consecutive patients aged over 45 years. Bone mineral density (BMD) measurements were taken at the hip and lumbar spine. The test performance cut-off value was evaluated according to scores of 5, 6, 7, 8 and age distribution. When all groups were evaluated, SCORE 6 sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were 86.7, 59.1, 63, 82.5%, respectively. In the age ranged 45-49, we determined SCORE 6 results of Sn 85, Sp 100%. The test was able to identify women not requiring detailed densitometric investigation in this age group to a high level of accuracy. At SCORE 6 receiver operating characteristic (ROC) analysis, the area under the curve (AUC) was 0.6. We determined that the SCORE questionnaire performance in estimating those women with low BMD in the Turkish population was limited. However, since it is a simple, economical and practical pre-test, a SCORE 6 cut-off value can be used together with the physician's clinical analysis in sending patients with suspected low BMD for dual energy X-ray absorptiometry (DEXA) measurement.

Effect of education on the rate of and the understanding of risk factors for intravascular catheter-related infections.

OBJECTIVE: Intravascular catheters are indispensable tools in modern medical therapy. In spite of their great benefits, however, the widespread use of catheters leads to several complications, including infections that cause significant morbidity, mortality, and economic losses for hospitalized patients. DESIGN: This study was conducted at Farabi Hospital, a 495-bed facility at Karadeniz Technical University Medical School in Trabzon, Turkey, and involved 3 separate periods: preeducation, education, and posteducation. Patients with intravascular catheters were monitored daily, as were the results of their physical examinations. The information acquired was recorded in a questionnaire. RESULTS: During the preeducation period (October 2003 through March 2004), 405 intravascular catheters inserted into 241 patients were observed for 5,445 catheter-days. Seventy-one cases of intravascular catheter-related infection (CRI) were identified, giving a CRI rate of 13.04 infections per 1,000 catheter-days. The catheter-related bloodstream infection (CRBSI) rate was 8.3 infections per 1,000 catheter-days, and the exit-site infection (ESI) rate was 3.5 infections per 1,000 catheter-days. During the posteducation period (June through November 2004), 365 intravascular catheters inserted into 193 patients were observed for 5,940 catheter-days. Forty-five cases of CRI were identified, giving a rate of 7.6 infections per 1,000 catheter-days. The CRBSI rate was 4.7 infections per 1,000 catheter-days, and the ESI rate was 2.2 infections per 1,000 catheter-days. When findings from the 2 periods were compared, it was determined that education reduced CRI incidence by 41.7%. CONCLUSION: CRI can be prevented when hospital personnel are well informed about these infections. We compared the knowledge levels of the relevant personnel in our hospital before and after theoretical and practical training and identified a significant increase in knowledge after training (P<.0001). Parallel to this, although still below ideal levels, we identified a significant improvement in the incidence of CRI during the posteducation period (P=.004). The rate was low for the first 3 months of this period but increased 2.08 times after the third month. In conclusion, regular training for the residents in charge of inserting intravascular catheters and the nurses and interns who maintain the catheters is highly effective in reducing the rate of CRI in large teaching hospitals.

The prevalence of fibromyalgia in women aged 20-64 in Turkey.

OBJECTIVE: The objectives of this study were to determine the prevalence of fibromyalgia syndrome (FMS) in women aged 20-64 in the city of Trabzon, Turkey, and to evaluate associated demographic variables. METHODS: A minimum of 1825 subjects eligible for the study was calculated, and 2000 subjects were eventually planned for inclusion. Of these, 1930 subjects participated in the screening phase (a participation rate of 96.5%). The screening protocol included several interview items that have been defined as components of FMS. Subjects were also asked questions concerning demographics. Individuals with positive screening results were invited to be examined by a specialist in physical medicine and rehabilitation in order to confirm or exclude FMS using the 1990 American College of Rheumatology (ACR) classification criteria. RESULTS: Seventy of the 1930 women were diagnosed with FMS. The prevalence of fibromyalgia was 3.6% (95% CI 2.8-4.4). The prevalence was highest in the 50-59 age group (10.1%, 95% CI 8.8-11.4), in the uneducated (10.7%, 95% CI 9.3-12.1), in the widowed (8.8%, 95% CI 7.5-10.1), and in subjects with an annual household income of < USD 2000 (7.3%, 95% CI 6.1-8.5). CONCLUSION: This cross-sectional study is the first report of the prevalence of FMS in Turkey. These data will assist decision-making in the health system.

Outmoded attitudes toward organ donation among Turkish health care professionals.

AIM: Our goal was to investigate the attitudes toward and information regarding organ donation possessed by assistant and intern doctors and nurses. METHOD: A total of 70.4% of assistant doctors, 52.9% of nurses, and 94.3% of interns participated in this descriptive study. Participants were interviewed fact-to-face to ask questions investigating profession; gender; age; whether they had donated organs; if so, which organ(s); if not, which organ(s) they would consider donating; if they would not consider such donation the reason why; whether they would donated another person's organs in the event of the death of a relative; and what their thoughts would be if they themselves required an organ transplant. RESULTS: Ten (2.2%) individuals had donated organs by applying to an official health institution. Of those participants who had not yet donated organs, the main reason cited for this were lack of information regarding the donation process (28.7%), concerns about the sale of organs (22.1%), and Islamic religious beliefs (21.6%). In the event that they themselves required an organ transplant, 59.8% replied that they "would wish an organ transplant to be performed," and 57.6% of those asked whether they would donate the organs of a deceased relative replied that they would not. CONCLUSIONS: The low level of donation among health care professionals, who should be in the forefront of organ transplantation, and the predominance of ethical and religious reasons for not donating, are incompatible with the present state of medicine.