Prevalence and self-management of migraine among neurologists and neurology residents in Turkey: do neurologists apply effective rational prophylaxis to their migraines?

AIM: The aim of the study to determine the migraine prevalence and self-management of migraine among the neurologists and neurology residents registered to the Turkish Neurological Society. METHODS: This cross-sectional study includes 851 participants. Based on the "The International Classification of Headache Disorders, 3rd edition" and previous literature, an anonymous questionnaire was prepared and used to collect data online via Google Forms. The link to the study was posted on the website of the Turkish Neurological Society. RESULTS: Women (73.2%) and neurologists (77.4%) made up the majority of the participants. Of the participants, 37.9% met the diagnosis criteria for migraine. Being women and positive family history were associated with migraine compared to the tension-type headache (TTH) (both p values < 0.001). Comparing with the TTH sufferers, migraine significantly hindered work, social, and family life (all p values < 0.001). Participants with migraine had more magnetic resonance imaging (MRI) (47.4%) and electroencephalography (EEG) (4.3%) than those with TTH (both p values < 0.05). Participants with migraine received drug prophylaxis more frequently (20.1%) than those with TTH (2.3%) (p < 0.001), and these drugs were selective serotonin reuptake inhibitors (SSRIs) (7.1%), beta-blockers (5.9%), and serotonin-norepinephrine reuptake inhibitors (SNRIs) (5.3%) (all p values < 0.05). Participants with migraine received non-pharmacological prophylaxis for headache more frequently (25.7%) compared to those with TTH (p < 0.001). CONCLUSIONS: Migraine is common among neurologists and neurology residents. Identifying migraine self-management is important for preventing the loss of work and negative economic and social consequences that migraine may cause in these groups of physicians.

Sleep quality and related factors including restless leg syndrome in medical students and residents in a Turkish university.

PURPOSE: The aim was to determine sleep quality and related factors including restless leg syndrome in the 6th year medical students and medical residents in Pamukkale University, Faculty of Medicine, Denizli, Turkey. METHODS: The data collection phase of this cross-sectional study was completed between November 1st and December 31st, 2019, with a questionnaire including 59 items. Three hundred forty-one medical students and residents participated in the study. The Pittsburgh Sleep Quality Index was used to determine the participants' sleep quality. The International Restless Legs Syndrome Study Group Diagnostic Criteria and the Restless Leg Syndrome Rating Scale were used for the diagnosis and for determining the seriousness of restless leg syndrome, respectively. RESULTS: The mean age (SD ±) was 26.6 ± 3.2. Men (50%) and medical residents (59%) constituted the majority. Most of the participants (70%) had poor sleep quality, and 9% had restless leg syndrome. Despite losing their significance in multivariable analysis, a relationship existed between restless leg syndrome and sleep quality in bivariate comparisons (p = 0.04). According to the multiple variable analysis, age (p = 0.008), female gender (p = 0.04), insufficient income (p = 0.009), being on-medication (p = 0.007), being a current smoker (p = 0.01), not sleeping at the usual time (p = 0.04), and listening to music before sleeping (p = 0.03) were identified as independent risk factors for poor sleep quality. CONCLUSIONS: The prevalence of poor sleep quality and restless leg syndrome are high in the 6th year medical students and residents. Necessary measures should be taken to reduce the effect of negative conditions on these vulnerable groups.

Neuropsychiatric Effects of COVID-19 Pandemic on Alzheimer's Disease: A Comparative Study of Total and Partial Lockdown.

Objectives: Coronavirus disease 2019 (COVID-19)-related lockdown may have a negative effect on the neuropsychiatric status of Alzheimer's disease (AD) cases. In this study, it was aimed to find future implications by evaluating the neuropsychiatric conditions of AD cases during total and partial lockdown periods. Methods: It is a prospective, cross-sectional, and multicenter study that includes AD cases which have been followed for at least 1 year by outpatient clinics from different regions of Turkey. Sociodemographic data, comorbidities, mobility, existence of social interactions, clinical dementia rating (CDR) scale, and neuropsychiatric inventory (NPI) for total and partial lockdown were questioned by the caregivers with the help of case files of the patients. Results: A total of 302 AD cases were enrolled to the study (mean age: 78±8 years, mean duration of education: 5.8±9 years). The total comorbidity ratio was found to be 84%, with the most frequent comorbidity being hypertension. The mean NPI score was 22.9±21 in total lockdown and 17.7±15 in partial lockdown, which is statistically significantly different. When lockdown periods were compared with the total scores of NPI scores according to gender, existence of social interactions, mobility, and comorbidities were found higher in the total lockdown than the partial lockdown. When switching from total lockdown to partial lockdown, the presence of comorbidities, mobility, and CDR were found to be factors that had a significant effect on NPI scores. In regression analysis, CDR score was found as the most effective parameter on the neuropsychiatric status of AD cases for both lockdown periods. Conclusion: When lockdown-related restrictions were reduced, the neuropsychological conditions of AD cases were significantly improved. Lockdown rules should be considered with these data in mind.

The Impact of the COVID-19 Lockdown on the Quality of Life in Chronic Neurological Diseases: The Results of a COVQoL-CND Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases (CNDs). To reach this information, a multicenter, cross-sectional study (COVQoL-CND) was planned. Parkinson's disease (PD), headache (HA), multiple sclerosis (MS), epilepsy (EP), polyneuropathy (PNP), and cerebrovascular disease (CVD) were selected as the CND. METHODS: The COVQoL-CND study includes demographic data, the World Health Organization Quality of Life short form (WHOQOL-BREF), and Impact of Event Scale-Revised (IES-R) forms. RESULTS: The mean age of a total of 577 patients was 49 ± 17 (19-87 years), and the ratio of female/male was 352/225. The mean age of patients with PD, HA, MS, EP, PNP, and CVD were 65 ± 11, 39 ± 12, 38 ± 10, 47 ± 17, 61 ± 12, and 60 ± 15 years, respectively. The IES-R scores were found to be higher in the younger group, those with comorbid disease, contacted with CO-VID-19 patients, or diagnosed with COVID-19. In the group with a high IES-R score, the rate of DIT was found to be high. IES-R scores were negatively correlated with QoL. IES-R total scores were found highest in the CVD group and lowest in the PD group. The ratio of DIT was found highest in the PNP group and the lowest in the EP group. Contact with CO-VID-19 patients was high in the EP and HA group. CONCLUSIONS: The results of the COVQoL-CND study showed that lockdown causes posttraumatic stress and deterioration in the QoL in CND.

Evaluation of students' social hand washing knowledge, practices, and skills in a university setting.

BACKGROUND: Handwashing is an effective and inexpensive way to prevent diarrhea and acute respiratory infections. This study aimed to evaluate the Turkish University students' social hand washing knowledge, practices, skills and related factors. MATERIALS AND METHODS: All existing 1st year students in the Medical and Educational Faculty, plus all existing 2nd and 3rd year students in the Medical Faculty of Pamukkale University, Denizli, Turkey, from April to May, 2010, were eligible for the study. Participants filled in a questionnaire. The questionnaire tested the students' social hand washing knowledge (8 questions), practices (21 questions), and skills (10 questions) and it was prepared using previously published studies. Participants received 1 point for each correct answer provided. Final scores were calculated by summing up the points from all questions in the particular section divided by the number of questions in this section and multiplied by 100. The Family Affluence Scale was used to determine a socioeconomic status (SES). RESULTS: In all 303 students participated in this study. Participants' age (+/- SD) was 20.1 +/- 1.6 and the age range was between 18 and 32. Sixty two point seven percent of the participants were women. Forty four point nine percent of the participants were medical students. Fifty one point eight percent of the participants were in low SES. Twenty seven point four percent of the participants wash their hands less than 5 times a day. main reason for skipping hand washing was the participants' belief of 'no need' (63.7%). The mean scores (+/- SD) of participants' hand washing knowledge, practices, and skills were 71.2 +/- 20.7, 60.3 +/- 13.4 and 79.7 +/- 18.4, respectively. All scores were significantly higher in women. A multivariate analysis showed that gender was the main factor affecting all scores. CONCLUSIONS: Increasing quantity and/or quality of available campus based public health educational programs, creating hand-hygiene promotion programs to the general public and using the findings from this study are recommended.

[Frequency of skeletal chest injuries associated with cardiopulmonary resuscitation: forensic autopsy]. / Kardiyopulmoner resüsitasyona bagli gögüs kafesi hasarlanmalarinin sikligi: Adli otopsi sonuçlari.

BACKGROUND: Fractured ribs and sternum are frequent complications of thoracic compression during CPR (cardiopulmonary resuscitation) in adults. This study was conducted to determine the incidence of rib and sternal fractures after conventional closed-chest compression in the treatment of cardiac arrest. METHODS: We reviewed the forensic autopsy findings of 231 deaths referred to the Pamukkale University Department of Forensic Medicine over a 12-month period, 2004-2005. CPR-related chest injuries comprising rib and sternum fractures, ecchymosis and subcostal hemorrhage were compared retrospectively in 104 patients. RESULTS: Ninety-one (87.5%) of the 104 patients were adults, and 13 patients (12.5%) were children. The mean (SD) age in the pediatric group (5F/8M) was 5.48 (+/-5.96) and in the adult group (18F/73M) was 44.88 (+/-18.31). Forty-four (42.3%) of the 104 patients died of traumatic cause and 60 (57.7%) of non-traumatic cause. Ecchymosis was present in 26 (28.8%) patients, subcostal hemorrhage in 16 (17.6%) patients and fractures (sternal and costal) in 12 (13.2%) patients in adults. There were no significant differences between groups according to age, sex and traumatic-nontraumatic cause in terms of skeletal chest injuries associated with CPR in adult patients (p>0.05). CONCLUSION: This study shows a low incidence of rib and sternal fracture after closed-chest compression in the treatment of cardiac arrest in forensic autopsy cases.

Evaluation of the outcome of out-of-hospital cardiac arrest resuscitation efforts in Denizli, Turkey.

The objective of this study was to evaluate the outcomes and associated factors for short-term success and long-term survival rates of resuscitated non-traumatic out-of-hospital cardiac arrest (OHCAs) in Denizli, Turkey. All non-traumatic OHCA patients from the Emergency Departments of the Pamukkale University and City Hospitals between the dates of January 1, 2004 and March 1, 2005 were included in this study. A successful outcome was defined as the return of spontaneous circulation or breathing, or evidence of a palpable pulse or a measurable blood pressure. Information on post-resuscitation long-term survival up to 9 months also was obtained by telephone. A total of 222 adults experiencing OHCAs were resuscitated. The number of successful outcomes was 85 (38.3%); 25 (11.2%) were discharged alive; and 21 (9.4%) were alive at the 9-month follow-up. The predicted mean arrest time was 11.7 min (95% confidence interval 10.27-13.2). Type of transportation to the Emergency Department (ambulance, 32.1% vs. private vehicle, 44.5%; p = 0.057), place of arrest (home, 32.6% vs. other, 44.0%; p = 0.08), first rhythm at the scene (asystole, 22.9% vs. ventricular fibrillation-pulseless ventricular tachycardia, 48.0%, vs. pulseless electrical activity, 12.5%; p = 0.056), and advanced cardiac life support starting time (the first 8 min, 46.8% vs. later than 8 min, 32.0%; p = 0.025) had an effect on outcome. Intensive public education for diagnosis and appropriate reporting of OHCA, the importance of bystander cardiopulmonary resuscitation, and the use of automated external defibrillators have an impact on the potential to increase the number of survivors.

Intravenous administration of metoclopramide by 2 min bolus vs 15 min infusion: does it affect the improvement of headache while reducing the side effects?

OBJECTIVE: To determine the therapeutic effect (alleviation of vascular type headache) and side effects of a slow intravenous metoclopramide infusion over 15 min compared with those effects of a bolus intravenous metoclopramide infusion over 2 min in the treatment of patients with recent onset vascular type headache. MATERIAL AND METHODS: All adults treated with metoclopramide for vascular type headache were eligible for entry into this clinical randomised double blinded trial. This study compared the effects of two different rates of intravenous infusion of metoclopramide over a period of 13 months at a university hospital emergency department. During the trial, side effects and headache scores were recorded at baseline (0 min), and then at 5, 15, 30 and 60 min. Repeated measures analysis of variance was used to compare the medication's efficacy and side effects. RESULTS: A total of 120 patients presenting to the emergency department met the inclusion criteria. Of these, 62 patients (51.7%) were given 10 mg metoclopramide as a slow intravenous infusion over 15 min (SIG group) and 58 patients (48.3%) were given 10 mg metoclopramide intravenous bolus infusion over 2 min (BIG group). 17 of the 58 patients in the BIG group (29.3%) and 4 of the 62 patients (6.5%) in the SIG group had akathisia (p = 0.001). There were no significant differences between the BIG and SIG groups in terms of mean headache scores (p = 0.34) and no adverse reactions in the study period. Metoclopramide successfully relieved the headache symptom(s) of patients in both the BIG and SIG groups. CONCLUSION: Slowing the infusion rate of metoclopramide is an effective strategy for the improvement of headache and reducing the incidence of akathisia in patients with vascular type headache.

Midazolam vs. diphenhydramine for the treatment of metoclopramide-induced akathisia: a randomized controlled trial.

OBJECTIVES: To compare the effects of midazolam, which is a fast and short-acting benzodiazepine, and diphenhydramine, which is a widely used anticholinergic agent, in clinical practice for the treatment of metoclopramide-induced akathisia. METHODS: All adults older than 17 years given metoclopramide for nausea and vomiting or for headache and who had akathisia were eligible for this clinical, randomized, double-blind trial. Patients were randomized to receive diphenhydramine or midazolam. Subjective, objective, and total akathisia scores and modified Ramsay Sedation Scale scores were recorded. Repeated-measures analysis of variance was used to compare the efficacy and side effects of the medications. RESULTS: Forty-one (73.3%) of the 56 enrolled patients were women. The mean (+/-SD) age was 39.9 (+/-15.7) years in the diphenhydramine group and 40.9 (+/-16.2) years in the midazolam group. Mean subjective, objective, and total akathisia scores in the first 5 minutes declined considerably in the midazolam group compared with the diphenhydramine group (p < 0.001). However, the mean Ramsay Sedation Scale score in the first 15 minutes increased significantly in the midazolam group compared with the diphenhydramine group (p < 0.001). CONCLUSIONS: Midazolam can correct the symptoms of metoclopramide-induced akathisia faster than diphenhydramine, but it causes more sedation.

Violence toward health care workers in emergency departments in Denizli, Turkey.

This study sought to determine the frequency and types of violence that occurred during the previous year against health care workers in emergency departments in Denizli, Turkey, and to discern the views of workers on the prevention of such aggressive behavior. This study was conducted from March 1 to April 15, 2003, and included a group of 79 health care workers from the emergency departments of 3 hospitals in Denizli, namely, the Hospital of Pamukkale University Medical Faculty, the City Hospital of Denizli, and the Hospital of the Social Insurance Foundation. Data were collected from a self-administered questionnaire. In all, 88.6% of participants had been subjected to or had witnessed verbal violence, and 49.4% of them had been subjected to or had witnessed physical violence during the previous year. The most frequent reason (31.4%) for violence was abuse of alcohol and drugs by perpetrators. The second most frequent reason (24.7%) was the long waiting times typical of emergency departments. The most common type of violence was loud shouting; swearing, threatening, and hitting were the next most frequent violent behaviors. In all, 36.1% of subjects who had experienced violence reported that they developed psychological problems after the incident. Most participants commented on the insufficiency of currently available security systems within emergency departments and on the need for further training about violence. All health care personnel within emergency departments should be aware of the risk of violence and should be prepared for unpredictable conditions and events; in addition, security systems should be updated so that violence within emergency departments can be prevented.

Is thrombolytic therapy associated with increased mortality? Meta-analysis of randomized controlled trials.

BACKGROUND: Although thrombolytic therapy has shown substantial benefits in neural outcomes, concerns remain regarding the association between thrombolytic therapy and possible increased mortality. OBJECTIVE: To determine the mortality risk of certain thrombolytic agents that are a treatment option for acute ischemic stroke. DATA SOURCES, EXTRACTION, AND SYNTHESIS: Studies were identified using MEDLINE, the Cochrane Central Register of Controlled Trials, and the reference lists of the articles selected. Randomized placebo-controlled trials of thrombolytic agents for the treatment of acute ischemic stroke patients were eligible. Study quality was evaluated using a previously validated scale. Data were extracted in duplicate by two independent investigators. All-cause mortality during follow-up was the main outcome. Random effects models were used to pool the individual effects of trials. Several preplanned sensitivity and subgroup analyses were completed to explain the heterogeneity among trials. Odds ratios, absolute risk differences, and numbers needed to harm were calculated. RESULTS: Eleven placebo-controlled randomized trials of thrombolytic agents involving 3709 participants were included in the analysis. Thrombolytic therapy was associated with an insignificant increase in mortality (odds ratio, 1.07; 95% confidence interval, 0.8-1.39; P = .3). The treatment was associated with an absolute increased risk of mortality of 11 per 1000 persons (95% confidence interval, -24 to 48; P = .3), and the number needed to harm was 84 (the 95% confidence interval included 0). CONCLUSION: These findings suggest that thrombolytic therapy does not significantly increase all-cause mortality.

Depressive symptomatology among university students in Denizli, Turkey: prevalence and sociodemographic correlates.

AIM: To determine overall and subgroup prevalence of depressive symptomatology among university students in Denizli, Turkey during the 1999-2000 academic year, and to investigate whether sociodemographic factors were associated with depressive symptoms in university students. METHODS: A stratified probability sample of 504 Turkish university students (296 male, 208 female) was used in a cross-sectional study. Data were obtained by self-administered questionnaire, including questions on sociodemographic characteristics and problem areas. The revised Beck Depression Inventory (BDI) was used to determine depressive symptoms of the participants. BDI scores 17 or higher were categorized as depressive for logistic regression analysis. Student t-test and linear regression were used for continuous data analysis. RESULTS: Out of all participants, 26.2% had a BDI score 17 or higher. The prevalence of depressive symptoms increased to 32.1% among older students, 34.7% among students with low socioeconomic status, 31.2% among seniors, and 62.9% among students with poor school performance. The odds ratio of depressive symptoms was 1.84 (95% confidence interval [CI], 1.03-3.28) in students with low socioeconomic status and 7.34 (95% CI, 3.36-16.1) in students with poor school performance in the multivariate logistic model. The participants identified several problem areas: lack of social activities and shortage of facilities on the campus (69.0%), poor quality of the educational system (54.8%), economic problems (49.3%), disappointment with the university (43.2%), and friendship problems (25.9%). CONCLUSIONS: Considering the high frequency of depressive symptoms among Turkish university students, a student counseling service offering mental health assistance is necessary. This service should especially find the way to reach out to poor students and students with poor school performance.