Eating disorders, primary care, and stigma: an analysis of research trends and patterns.

Eating disorders (EDs) are a growing concern affecting millions worldwide. Early detection and treatment are crucial, but stigma can prevent people from seeking help. Primary care providers can play a critical role in early detection by coordinating care with other professionals. Understanding the research landscape on EDs, primary care, and stigma is essential for identifying knowledge gaps to direct future research and improve management. In this study, we aimed to analyze the scientific trends and patterns in research about EDs, primary care, and stigma. A bibliometric analysis was conducted using the Web of Science database to collect articles published between May 1986 and May 2023. Bibliometric indicators were utilized to examine authorship, collaboration patterns, and influential papers. Topic analysis was performed to identify stigma-related terms within the dataset. A total of 541 research articles were analyzed, and it was found that the average number of publications per year has increased linearly from nearly zero in 1986 to 41 in 2022. One of the study's main findings is that despite this linear increase over the years, the subject of stigma did not take a prominent place in the literature. Only a few stigma concepts could be identified with the topic analysis. The authors in the field are also interested in; screening, neurotic symptoms, training, adolescent, obesity-related conditions, and family. One-third of all publications were from 15 journals. However, only two of them were primary healthcare journals. Leading authors' collaborations were another critical finding from the network analysis. This may help to expand primary care related EDs research to end the mental health stigma. This study provides insights into the research trends and patterns regarding eating disorders, primary care, and stigma. Our findings highlight the need to address primary care's impact and stigma on EDs. The identified research gaps can guide future studies to improve the prevention, diagnosis, and treatment of eating disorders in primary care settings.

Group Medical Visits Versus Usual Care for Illness Perception and Hypertension: A Randomized Pilot Study.

ABSTRACT: Despite separate evidence regarding illness perception (IP) and group medical visits (GMVs) for hypertension, research on both is limited. Here, we have assessed and compared the effectiveness of GMVs and usual care (UC) on IP and blood pressure (BP) in patients with hypertension. This was a two-group parallel randomized controlled study with 1:1 allocation. Patients with essential hypertension on antihypertensive medication and no cognitive impairments were screened for BP control status and eligibility. A web-based program randomly assigned them to the GMV and UC groups. Group medical visits were held once a month for 3 months. Primary and secondary outcome measures included improvements in IP and BP control. Among 152 participants, 40 and 43 were assigned to the GMV and UC groups, respectively. The control group had a 9.3% dropout rate. The chronic timeline and illness coherence improved significantly in the intervention group ( p < .01). Systolic BP in the intervention group decreased significantly compared with that of the control group (Δ: -18.8 ± 18.4 mm Hg vs. Δ: -10.6 ± 12.5 mm Hg, p = .025). The participation in GMVs had a significant association with the odds of an increase in BP regulation (OR 3.8, 95% confidence interval 1.4-10.3, p = .007). Therefore, GMVs may be feasible for BP control in hypertensive patients with similar characteristics.

Barriers to losing weight for women attending group visits in primary care: A qualitative exploration using in-depth interviews.

BACKGROUND: Despite the accumulated evidence suggesting the positive aspects of using group visits in obesity, the number of qualitative studies that examine why and how the effects occur at an individual level is limited. OBJECTIVES: This qualitative study aimed to explore the experiences and perspectives of women who participated in group visits and had different weight loss outcomes in the programme. METHOD: Purposive maximum variation sampling was performed. Data collection and analysis were performed iteratively, and the data saturation method was used as a guideline for sample size. All participants who completed the group visits were approached, and finally, 20 individuals were included in the study. Semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and analysed thematically using a phenomenological approach. RESULTS: The mean age of the individuals was 38.5 ± 9.8 years, the education level ranged from incomplete-high school to university degree, and the weight changes were between +4.1% and -17.1%. Two main themes emerged from the thematic analysis revealing barriers: weight stigma (two sub-themes: internal and external stigma) and traumatic life events (three sub-themes: 'loss of relatives,' 'childhood traumas,' and 'conflicting intimate partner relationships'). CONCLUSION: Considering the barriers to weight loss efforts in this study, these issues need to be explicitly investigated before and during the group visits in addition to weight loss practices and behavioural changes.

Family Physician-Led Group Visits for Lifestyle Modification in Women with Weight Problems: A Pilot Intervention and Follow-Up Study.

OBJECTIVE: Lifestyle modification requires extensive information sharing and counseling. However, one-on-one primary care consultations are lacking to cover all necessary components due to time constraints. This preliminary study aims to investigate the feasibility and effects of lifestyle-changing intervention by family physician-led group visits (GVs) on weight management in overweight and obese women. METHODS: 60 volunteers fulfilling the inclusion criteria were enrolled. Baseline and 6th month assessments consisted of anthropometric measurements, SF-36 Health Survey, blood variables, exercise test, and resting metabolic rate. Weight maintenance was controlled at the 12th month. RESULTS: Although weight loss among participants varied, the mean body weights were significantly decreased by 8.2% in full-attenders (n = 30). A significant increase in HDL-cholesterol and decreases in heart rate and blood pressure were found. SF-36 summary scales were significantly improved. Weight change was moderately correlated with exercise duration, compliance to diet, and baseline mental component score. It was determined that 62.5% of the participants either lost or maintained body weight at the 12th month. CONCLUSION: Significant weight loss and quality of life improvement was achieved in this pilot study. GVs may be a promising alternative to primary care consultations for obesity management; however, the high dropout level and diverse outcomes need further assessment.

The well-being and treatment satisfaction of diabetic patients in primary care.

BACKGROUND: The quality of life in patients with diabetes is reduced and emotional coping with the disease has great impact on patient well-being. OBJECTIVES: The aim of this study was to assess the psychological well-being and treatment satisfaction in patients with type 2 diabetes mellitus in primary care. STUDY DESIGN AND SETTING: Patients (n = 112) with type 2 diabetes mellitus diagnosis for at least six months were enrolled. The Well-Being Questionnaire-22 and the Diabetes Treatment Satisfaction Questionnaire were used. Physical examination and laboratory investigations were performed. RESULTS: The rates of the achieved targets were 32.1% for hemoglobin A1c, 62.5% for cholesterol and 20.5% for blood pressure. The mean scores for the general well-being, depression, anxiety, positive well-being and energy were 44.40 +/- 13.23 (range = 16-62), 12.65 +/- 3.80 (range = 5-18), 10.57 +/- 4.47 (range = 1-18), 12.00 +/- 4.01 (range = 2-18), and 9.16 +/- 2.47 (range = 2-12), respectively. The mean scores for the treatment satisfaction, perception for hyperglycemia and perception for hypoglycemia were 22.37 +/- 9.53 (range = 0.00-36.00), 1.71 +/- 1.59 (range = 0-6), and 0.51 +/- 0.98 (range = 0-6), respectively. There were significant associations between the depression score and the educational status, compliance to diet and physical exercise, and diabetic complications; between the anxiety score and the educational status, glycemic control, compliance to diet and physical exercise; between the energy score and the educational status, compliance to physical exercise, and diabetic complications; between the positive well-being score and the educational status, compliance to diet and physical exercise, complications and type of treatment; between the general well-being score and the educational status, compliance for diet and physical exercise, and complications. Treatment satisfaction was significantly associated to the educational status, glycemic control and compliance to diet and physical exercise. A significant correlation was found between the treatment satisfaction and the well-being. CONCLUSIONS: Individualized care of patients with diabetes should consider improving the quality of life. Psychosocial support should be provided to the patients with type 2 diabetes and the negative effects of psychopathological conditions on the metabolic control should be lessened.

Self-perceived body weight status and weight-control behaviors of high school students in a southern city of Turkey.

Defining "healthy weight" is not easy and for an adolescent with all concerns about newly developing physiognomy it is even harder. The aim of this study was to find out the frequency of obesity and the association between the body mass index (BMI), weight-control behaviors and self-perceived body weight status in high school students of a southern city of Turkey. The students from 10 schools were randomly selected among 46,271 students of 72 high schools in Adana from 1999 to 2000. The response rate was 94.8% (2352/2480). The Turkish version of Youth Risk Behavior Survey Questionnaire (YRBSQ) was completed by the students. The students' weights and heights were measured. The mean age was 16.5 +/- 1.0 years of age (range = 14-21 years). The mean BMI was 21.0 +/- 3.1, 25.5% of students were underweight, 65.7% were normal, 6.4% were overweight and 2.3% were obese (p = 0.0001). Of all students, 24.3% defined themselves as thin, 45.3% as normal, 24.9% as overweight and 5.5% as obese (p = 0.0001). The percentage of girls defining their body weight as overweight and obese was significantly higher than the boys (p = 0.0001). Of all students, 35.5% wanted to lose weight, 22.3% wanted to gain weight, 27.8% wanted to keep their current weight. Intention (p = 0.0001) and interventions to lose weight such as going on a diet (p = 0.0001), provocative vomiting (p = 0.0001) and 24-hours starving (p = 0.0001) were significantly higher in girls than boys. Of students, 26.8% (n=620) were on a diet program either to lose or to keep their body weight. There was significant relationship between being on a diet program and intention to change body weight (p = 0.047). We concluded that adolescents living in Adana have relatively higher risk of being underweight than being obese and have unhealthy weight changing plans due to their misperception of their body images. Adolescents may be unconscious on plans and attempts to change their body weights and nutrition and we suggest that education on nutrition and health is required for adolescents.

The effects of regular aerobic exercise on renal functions in streptozotocin induced diabetic rats.

Diabetic nephropathy is a feared complication of diabetes since it can lead to end-stage renal failure and also it is a risk factor of cardiovascular disease. The important clinical problems caused by diabetic nephropathy are proteinuria and decreased renal function. Exercise is a cornerstone of diabetes management, along with diet and medication. Since acute exercise causes proteinuria and decreases glomerular filtration rate, the effect of exercise on diabetic nephropathy is controversial. The aim of this study was to investigate the effect of regular aerobic exercise on microalbuminuria and glomerular filtration rate in diabetic rats. Moderate diabetes was induced by streptozotocin (45 mg/kg IV) in rats and an aerobic exercise- training program on a treadmill was carried out for 8 weeks. Four groups of rats; control sedentary (CS), control exercise (CE), diabetic sedentary (DS) and diabetic exercise (DE) were included in the study. Blood glucose levels were determined from the plasma samples taken at the end of 4 weeks of stabilization period and 8 weeks of training program. Creatinine clearance (CCr) and microalbuminuria (MA) levels were determined to evaluate renal functions. The analyzed data revealed that regular aerobic exercise: 1) significantly decreased the plasma glucose level of the DE group compared to the DS group (p < 0.05), 2) significantly decreased the microalbuminuria level of the DE group compared to those of DS group (p < 0.01), 3) significantly decreased the creatinine clearance levels of the DE and CE groups compared to those of CS group (p < 0.05). The results of this study suggest that despite of decreasing creatinine clearance, regular submaximal aerobic exercise has a preventive effect on development of microalbuminuria and thus may retard nephropathy in diabetic rats. Key pointsRegular submaximal aerobic exercise can facilitate the control of blood glucose level in diabetic rats.Streptozotocin induced diabetes may cause microalbuminuria and regular submaximal aerobic exercise may have a preventive effect on renal functions.

Clonal outbreak of Trichophyton tonsurans tinea capitis gladiatorum among wrestlers in Adana, Turkey.

Tinea capitis gladiatorum and tinea corporis gladiatorum caused by the anthropophilic dermatophyte Trichophyton tonsurans are well-known clinical entities in individuals involved in combat sports, e.g., wrestlers and judo practitioners. We present an outbreak of Trichophyton tonsurans tinea capitis gladiatorum among wrestlers at a boarding school in Adana, Turkey. Fourteen of the 29 wrestlers examined (48.3%) harbored the pathogen, including eight asymptomatic scalp carriers, five with tinea capitis superficialis, and one asymptomatic trunk carrier. Dermatophytes were isolated from samples of the neck (1), nape (1), trunk (3) and inguinal area (2) in four of the five tinea capitis cases. A total of five inanimate objects, i.e., two wrestling mats, two pillowcases, and one sheet were also found to be positive for T. tonsurans. Mixed-marker strain typing examining 24 sequence variations in 12 gene loci confirmed that the outbreak was caused by a single strain of T. tonsurans.

Survey of scalp dermatophyte carriage in a Day Care Center in Turkey.

The prevalence of tinea capitis and the symptom-free colonisation of the scalp with dermatophytes were examined in 502 mentally retarded participants who attended day care centers in the Tarsus district, Mersin, Turkey. Between December 2006 and May 2007, a screening study was conducted in three centers on a total of 316 (62.9%) male and 186 (37.1%) female participants aged 12 +/- 6.2 years. The examinations were carried out in parallel with the hairbrush, toothbrush, and cotton swab methods by inoculation onto Sabouraud glucose agar. No participant was diagnosed with tinea capitis; however, we detected three carriers, all of whom were boys aged 2-16 years. The total prevalence of carrier state was 0.6%. Of three boys, T. tonsurans was seen in two cases (66.7%), and in one case a zoophilic variant of T. mentagrophytes (33.3%) was isolated. The diagnosis was made via the hairbrush method in all three carriers. We also did a screening study on ten households of the three asymptomatic carriers. T. mentagrophytes also was isolated in a 5-year-old sister of the boy with T. mentagrophytes colonisation. All the carriers were followed-up without any antimycotic treatment. In two of the participants, the carrier state persisted at the 13th and 17th week follow-ups, and mycological clearance was documented at the 20th and 24th week for these individuals. The third case and the household's culture were found negative at the 7- and 12-week follow-ups. Despite poor hygienic conditions and the participants' difficulties in performing basic hygiene practices, asymptomatic carriage was found to be surprisingly less prevalent among the mentally retarded individuals.

Lyme disease presenting as subacute transverse myelitis.

Lyme disease (borreliosis) is a systemic illness resulting from infection with the spirochete Borrelia burgdorferi. It is transmitted to humans by the bites of infected ticks belonging to several species of the genus Ixodes. After the bacteria enter the body via the dermis, most patients develop the early, localised form of Lyme disease, which is characterised by erythema migrans and influenza-like symptoms. This disease may also affect the heart, nervous system and joints. The neurological findings of this disease may include peripheral and central nervous system signs. A 21-year-old woman attended a family medicine outpatient clinic complaining of unexplained pain and muscle power loss in her lower extremities. The problem had started in her right leg 3 months earlier and worsened in the last week. She had a neurology consultation and was hospitalised. Her neurological examination revealed bilateral facial paralysis and sensory impairment. Immunoglobulin M antibody to B. burgdorferi was positive on Western blotting in both serum and cerebrospinal fluid. The patient was diagnosed with subacute neuroborreliosis and treated.

Medical education in Turkey: past to future.

Although medical education in the Republic of Turkey appears to be relatively new, there is almost 500 years of background development within the Anatolian region. Turkey has faced many difficulties in its past and present times, related to its vast and diverse geography, its crowded population, and the many ethnic groups that constitute its population. As in many other countries throughout the world, medical education in Turkey has recently been debated, reviewed and renewed. This article gives a general overview of the history of medical education and the present situation in Turkish medical schools; the quality and professionalism of medical education within the medical system, from the perspectives of undergraduate, postgraduate and continuing medical education; and an overview of the challenges and opportunities that presently exist.

The prevalence of risky behaviors related to violence in high school students in a southern city, Turkey.

Injuries are the leading cause of mortality and morbidity in adolescents and can be grouped as unintentional (such as motor vehicle crashes and fires) and intentional (violence and suicide). The aim of this study was to find the prevalence of high risk behaviors related to violence in high school students. The population comprised 2,480 randomly selected students from 10 schools among 46,271 students from 72 high schools in 1999-2000 in Adana and 2,352 (94.8%) were reached. They completed a Youth Risk Behavior Survey Questionnaire (YRBSQ). The mean age was 16.5 +/- 1 (14-21) years. 275 (11.7%) students stated that they carried a knife or a sharp weapon during the last 30 days, 151 (6.4%) carried a gun, 710 (30.2%) participated in a physical fight, 68 (2.9%) were threatened or injured by a weapon, 73 (3.1%) could not attend school because of threats from other students, 96 (4.1%) were forced into sexual intercourse. Male students were significantly more likely than female students to report all types of high risk behaviors except forced sexual intercourse. The rate of risky behaviors increased with higher grade. Violence towards and by adolescents is a severe problem. Families, teachers, and health care professionals should be aware of risk factors and be active in prevention of high risk behaviors in youth.

Habitual tea drinking and bone mineral density in postmenopausal Turkish women: investigation of prevalence of postmenopausal osteoporosis in Turkey (IPPOT Study).

AIM: In this epidemiological report, we assessed the prevalence of osteopenia and osteoporosis (OP) in postmenopausal Turkish women and the relationship between body mass index (BMI), and some nutritional factors (habitual tea, coffee, tobacco, and milk product consumption) with OP. METHODS: This multicenter study was done in postmenopausal women residing in five big cities, in four different regions of Turkey between August and November 2005. An inclusion criterion was being in the postmenopausal period for at least 12 months. A semi-structured questionnaire was completed by face-to-face interview, consisting of closed- and open-ended questions about demographic characteristics, nutritional status, and habits with two or more choices as possible responses. Bone mineral density (BMD) measurements were performed with a MetriScan Densitometer (Alara Inc., CA, USA). RESULTS: Seven hundred twenty-four women were included in the study. The mean age was 57.6 +/- 9.6 years, and mean age at natural menopause was 46.4 +/- 5.6 years. Of the participants, 51% were illiterate. According to WHO classification; 42.5% were normal in terms of BMD, 27.2% had osteopenia, and 30.2% had OP. Women with high education levels had better T-scores (p = 0.019). Increase in BMI also had a positive effect on T-scores (p < 0.0001). A linear correlation was found between age (r= -0.386, p < 0.0001), BMI (r = -0.175, p < 0.0001), and education (r = -0.317, p < 0.0001), with T-scores. The T-scores of women who consumed tea on a regular basis were found to be higher than non-consumers (-1.51 +/- 1.68 vs. -1.09 +/- 1.66; p = 0.070) [when smokers, those who received hormonal therapy (HT), and those > 65 years were excluded]. CONCLUSION: OP was determined in 1/3 of the women. Advanced age (> 65) and being illiterate were negative factors, while high education levels, being overweight, and being treated with HT had a positive effects on BMD. Habitual tea drinking also may have a positive effect on BMD. However, tea drinking was not found to be a statistically significant factor in the present study.

The effects of aerobic exercise on skeletal muscle metabolism, morphology and in situ endurance in diabetic rats.

The effects of aerobic exercise training on skeletal muscle endurance capacity were examined in diabetic rats in situ. Moderate diabetes was induced by iv injection of streptozotocin and an exercise training program on a treadmill was carried out for 8 weeks. The animals randomly assigned to one of the four experimental groups: control-sedentary (CS), control-exercise (CE), diabetic-sedentary (DS) or diabetic-exercise (DE). The changes in the muscle endurance capacity were evaluated through the square wave impulses (supramaximal) of 0.2-ms duration at 1 Hz in the in situ gastrocnemius-soleus muscle complex. Muscle was stimulated continuously until tension development reduced to the half of this maximal value. Time interval between the beginning and the end of stimulation period is defined as contraction duration. Following the training period, blood glucose level reduced significantly in the DE group compared to DS group (p < 0.05). The soles muscle citrate synthase activity was increased significantly in both of the trained groups compared to sedentary animals (p < 0.05). Fatigued muscle lactate values were not significantly different from each other. Ultrastractural abnormality of the skeletal muscle in DS group disappeared with training. Presence of increased lipid droplets, mitochondria clusters and glycogen accumulation was observed in the skeletal muscle of DE group. The contraction duration was longer in the DE group than others (p < 0.001). Fatigue resistance of exercised diabetic animals may be explained by increased intramyocellular lipid droplets, high blood glucose level and muscle citrate synthase activity. Key PointsAerobic training of diabetic animals increased the endurance capacity.Presence of abnormal ultrastructural alterations with diabetes disaapered with regular training.Increased intramyocelluler lipid droplets, high blood glucose level with citrate synthase activity may explain this finding.