Comments on: The effect of an educational program on quality of life in patients undergoing hemodialysis in Western Saudi Arabia.

[No Abstract Available].

WhatsApp embedded in routine service delivery for smoking cessation: effects on abstinence rates in a randomized controlled study.

BACKGROUND: The demand for smoking cessation services has risen in Turkey, as smokers planning to quit reached 35% in 2012. Communication technologies are used globally to support quitters, yet their integration to health services is rare. This study aims to evaluate the effect of support messages through WhatsApp application added to the usual care of a university hospital cessation unit, as compared to usual care alone, on abstinence rates at first month. METHODS: A randomized controlled intervention study was conducted with 132 patients applying to Ege University Hospital's Department of Public Health Smoking Cessation Clinic, between March and July 2017. Intervention content was prepared and 60 WhatsApp messages about having a plan of action and preventing relapse were developed through expert panels. These messages lasted for 3 months and follow-ups continued for 6 months. The primary outcome was abstinence rate at 1st month post target quit day. As secondary outcomes; the continuous abstinence rates at 3rd and 6th months, number of follow-ups, change in weight and continuity of medication were evaluated. Intention-to-treat analysis was used. RESULTS: Abstinence rate at 1st month was 65.9% in the intervention group and 40.9% in the control group (p = 0.007); 50.0 and 30.7% at 3rd month and 40.9 and 22.7% at 6th month, consecutively (both p < 0.05). Being in the intervention group increased abstinence rate by 3.50 (OR, 95% CI = 1.30-9.44) times in the 1st month. When controlled for all other factors in the multivariate logistic regression, the intervention was the only variable significantly associated with abstinence. For secondary outcomes, the intervention increased abstinence rate by 2.50 (OR, 95% CI = 1.08-6.40) times in the 3rd and 2.31 (OR, 95% CI = 1.03-5.16) times in the 6th month. In the intervention group, the number of follow-ups and face-to-face follow-ups were higher at 1st and 3rd months and continuity of medication was longer at 3rd month. CONCLUSIONS: WhatsApp support embedded in cessation service delivery increases the abstinence rate and has favorable effects on follow-up. TRIAL REGISTRATION: This trial is retrospectively registered online at ClinicalTrials.gov with the identifier NCT03714971 .

Validity and reliability of the Turkish version of the European Health Literacy Survey Questionnaire.

Health literacy is a public health priority which refers to individual's knowledge, motivation and competence to access, understand, appraise and apply health information to prevent disease and promote health in daily life. This study aimed to adapt European Health Literacy Survey Questionnaire (HLS-EU-Q47) into Turkish and to investigate its psychometric properties. The questionnaire was translated into Turkish by using both group translation and expert opinion methods. Forward translation-back translation method was used for language validity and the final Turkish version (HLS-TR) was formed. HLS-EU-Q47 and Health Awareness Scale (HAS) were administered to 505 respondents. The scale reliability was examined using Crohnbach's alpha coefficient and the construct validity was assessed by principal axis factoring procedure. The convergent validity was obtained by Pearson correlation coefficients between HLS-TR and HAS scores and discriminant validity was examined comparing the scores of participants who were stratified according to ages, educational status, gender, general health status and social status. Cronbach's alpha coefficient for the whole scale was 0.95. Principal axis factoring extracted nine factors which eigenvalues were >1 and explained 50.01% of total variance. Factor matrix displayed that all items gave greater load in factor 1, showing that health literacy measured with one factor. Positive and significant correlation was found between HLS-TR and HAS. Significant relations were found between HLS-TR scores and selected determinants of health. This study revealed that the HLS-TR was a valid and reliable measuring instrument with appropriate psychometric characteristics.

General Health Status, Music Performance Anxiety, and Coping Methods of Musicians Working in Turkish State Symphony Orchestras: A Cross-Sectional Study.

AIMS: This study assessed the general health, music performance anxiety (MPA), and coping methods of musicians working in six state orchestras in Turkey. METHODS: All musicians working in the state symphony orchestras (n=384) were invited to participate in the study. In face-to-face interviews, the authors administered a questionnaire, which consisted of five sections: sociodemographic information, history of musical performance, health status, general health questionnaire-12 (GHQ-12), and MPA scale. Mann-Whitney U-test, Student's t-test, and Spearman's correlation test were used to analyze the questionnaire data. RESULTS: The 220 musicians who participated included 121 (55%) males and 99 (45%) females, with a mean age of 42.4±11.3 yrs. For musculoskeletal symptoms, 87.6% reported at least one symptom with the most common being pain. For general health status, the GHQ-12 showed 64% of musicians were at low risk, 18.7% at moderate risk, and 17.3% at high risk in terms of mental health. The prevalence of MPA before or during performance was 81.8%, and 60% of musicians stated that performance anxiety negatively affected their performances. CONCLUSIONS: Results indicate that musicians working in Turkish state symphony orchestras encounter numerous health problems (tinnitus, hearing loss, musculoskeletal symptoms, etc.) due to their profession. No specific health support is provided, especially education and health service provision.

Screening Fabry's disease in chronic kidney disease patients not on dialysis: a multicenter study.

OBJECTIVES: Fabry's disease is an X-linked inherited, rare, progressive, lysosomal storage disorder, affecting multiple organs due to the deficient activity of α-galactosidase A (α-Gal A) enzyme. The prevalence has been reported to be 0.15-1% in hemodialysis patients; however, the information on the prevalence in chronic kidney disease not on dialysis is lacking. This study aimed to determine the prevalence of Fabry's disease in chronic kidney disease. METHODS: The patients older than 18 years, enclosing KDIGO 2012 chronic kidney disease definitions, not on dialysis, were enrolled. Dried blood spots on Guthrie papers were used to analyze α-Gal A enzyme and genetic analysis was performed in individuals with enzyme activity ≤1.2 µmol/L/h. RESULTS: A total of 1453 chronic kidney disease patients not on dialysis from seven clinics in Turkey were screened. The mean age of the study population was 59.3 ± 15.9 years. 45.6% of patients were female. The creatinine clearance of 77.3% of patients was below 60 mL/min/1.73 m2, 8.4% had proteinuria, and 2.5% had isolated microscopic hematuria. The mean value of patients' α-Gal A enzyme was detected as 2.93 ± 1.92 µmol/L/h. 152 patients had low levels of α-Gal A enzyme activity (≤1.2 µmol/L/h). In mutation analysis, A143T and D313Y variants were disclosed in three male patients. The prevalence of Fabry's disease in chronic kidney disease not on dialysis was found to be 0.2% (0.4% in male, 0.0% in female). CONCLUSION: Fabry's disease should be considered in the differential diagnosis of chronic kidney disease with unknown etiology even in the absence of symptoms and signs suggestive of Fabry's disease.

Personality disorders in a community sample in Turkey: prevalence, associated risk factors, temperament and character dimensions.

BACKGROUND: Data from Turkey on prevalence of personality disorders (PD) in the normal population are sparse. AIMS: The present study conducted in a community sample aimed to investigate personality disorders in terms of prevalence, associated risk factors and personality dimensions. METHODS: A stratified sampling procedure allowed us to compose a sample consisting of 774 participants residing in Aydin, Turkey. The DSM-IV and ICD-10 Personality Questionnaire (DIP-Q) and the Temperament and Character Inventory (TCI) were used to assess PDs and personality dimensions, respectively. RESULTS: Roughly 20% of the participants received a PD diagnosis. Among the individual PD categories, schizotypal and obsessive-compulsive PDs were the most prevalent diagnoses. Participants with PD were more likely to have lower [corrected] self-directedness and cooperativeness scores. These risk factors and personality dimensions were most strongly associated with the cluster B disorders. CONCLUSION: New versions of the diagnostic systems should include schizotypal, obsessive-compulsive and cluster B PDs as separate diagnostic categories, and impaired self-directedness as well as cooperativeness as a general diagnostic criterion for the sake of backward and forward compatibility of the research in this field.

[How is quality of life affected in women in the presence of anxiety and depression symptoms?]. / Kadinlarda yasam kalitesi anksiyete ve depresyon belirtilerinin varliginda nasil etkileniyor? kesitsel bir alan çalismasi.

OBJECTIVE: To assess how quality of life is affected among reproductive age women from the presence of anxiety and depression symptoms and the risk factors related to both. METHOD: A cross sectional analytic study was performed in person with 461 women. General Health Questionnarie-12 and WHOQOL-BREF were used. RESULTS: 35.5% of the women displayed symptoms of anxiety and depression and those who had experienced domestic violence had a 2.61-fold increase in symptom frequency and those with an income below 500 TL had a 2.49-fold more frequent occurrence of symptoms compared to others. General health quality mean score was 3.33 ± 0.804, the mean overall quality of life was 3.62 ± 0.791; Physical Health Domain: 15.95 ± 2.422; Psychological Health Domain: 14.70 ± 2.337; Social Relations Domain 14.64 ± 3,027; Environmental Domain 14:27 ± 2.20; National Domain 14:29 ± 2.144l. The total score of GHQ-12 and the first two questions of WHOQOL-BREF had a negative, moderate and highly significant correlation, whereas the Psychological HD score had a a negative,, strong and significant correlation All other domains and the total score of GHQ-12 had negative, moderate and significant correlations. CONCLUSION: Screening with GHQ-12 as well as offering the possibility of early diagnosis and treatment, is also important to prevent impairment in all areas of quality of life among women. Early diagnosis and treatment of psychological problems of women with risk factors such as exposure to domestic violence and low socio-economic status are the intervention areas with priority.

Identification of NF-kappaB1 and NF-kappaBIAlpha polymorphisms using PCR-RFLP assay in a Turkish population.

A polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay was used in a Turkish population to determine the frequency of polymorphisms of the nuclear factor-kappa (NF-kappaB1) and NF-kappaBIA genes, which have been shown to be related to several inflammatory diseases and cancer pathogenesis. Total genomic DNA was isolated from peripheral blood samples taken from 565 healthy volunteers living in Aydin Province. The genomic regions in question were amplified by PCR, and the polymorphisms in these regions were detected by a PCR-RFLP assay. The frequencies were 10.3% for the NF-kappaB1 -94ins/delATTG del/del genotype, 49.1% for del/ins, and 40.6% for ins/ins. The genotype frequencies of the NF-kappaBIA 3'UTR A --> G genotypes were A/A 19.2%, A/G 42.3%, and G/G 38.5%. Distribution of genotype frequencies was tested by Hardy-Weinberg; the NF-kappaB1 gene was in Hardy-Weinberg equilibrium (chi(2) = 3.402, P > 0.05), the NF-kappaBIA gene was not (chi(2) = 8.293, P < 0.05).

Orbital blood flow parameters in unilateral pseudoexfoliation syndrome.

PURPOSE: The evaluation of orbital blood flow parameters in patients with unilateral pseudoexfoliation syndrome (XFS) and in age-sex-matched control subjects using color Doppler imaging. METHODS: This prospective, comparative case series included 33 unilateral XFS patients and 33 age-sex-matched control subjects. Color Doppler imaging was used to evaluate the XFS-affected (Group 1) and -unaffected (Group 2) eyes that were matched with the corresponding side (Groups 3 and 4) of control subjects. All subjects were given a complete ophthalmological examination. A masked radiologist obtained the peak systolic velocity (PSV) and end diastolic velocity (EDV) of ophthalmic (OA), central retinal (CRA), nasal posterior ciliary (NPCA) and temporal posterior ciliary arteries (TPCA) as well as mean velocity of central retinal vein (CRV). Resistivity indices (RI) were calculated. RESULTS: Analysis of peak systolic and end diastolic velocity (PSV, EDV) and RI between Groups 1-2 and 3-4 did not show any significant difference. Comparing Groups 1-3 (corresponding eyes of pseudoexfoliation-affected and control subjects) and Groups 2-4 (corresponding eyes of pseudoexfoliation-unaffected and control subjects) revealed significantly low values for OA, PSV and EDV in both eyes of the XFS patients. The OA RI value in Group 1 was found to be significantly higher than that in Group 3 with the cut-off value of 0.72. CONCLUSION: These findings suggest that ophthalmic artery hemodynamic parameters change in both eyes of unilateral XFS patients, illustrating out the systemic nature of the disease. We conclude that XFS decreases OA blood flow velocities and increases vascular resistance through progressive build-up.

The comparision of IgG antibodies specific to Toxocara spp. among eosinophilic and non-eosinophilic groups.

Toxocariasis is one of the most frequently reported helminth infections worldwide. Eosinophilia is a common finding of parasitic infections. This study assessed the levels of IgG antibodies specific to Toxocara spp. by ES-ELISA method in an eosinophilic (n=350) and non eosinophilic group (n=350). There were IgG antibodies specific to Toxocara spp. in 114 (32.6%) of the eosinophilic group and in 71 (20.3%) of the non-eosinophilic group (p<0.001). Toxocariasis may be an important problem in the region and should be kept in mind for patients with eosinophilia.

The association of office intraocular pressure fluctuation in ocular hypertension with frequency doubling technology perimetry abnormality.

PURPOSE: To characterize intraocular pressure (IOP) and central corneal thickness (CCT) measurements of ocular hypertension (OHT) patients with and without frequency doubling technology (FDT) perimetry test abnormalities. PATIENTS AND METHODS: In this prospective, observational, cross-sectional, comparative case series, one eye of 33 OHT patients was randomly chosen. All OHT patients had IOP > or = 23 mmHg in 2 out of 3 measurements on the test day, normal appearing discs and nerve fiber layer, and normal white on white standard automated perimetry (SAP). Several IOP calculations (outpatient IOP, highest office IOP, mean office IOP, office IOP fluctuation, and office IOP peak), CCT, SAP and FDT parameters were compared between OHT patients with repeatable FDT perimetry abnormality and normal FDT perimetry. RESULTS: Eight (24%) of 33 OHT patients had an abnormal FDT perimetry test. The median office IOP fluctuation (5.0 vs 2.0, P = 0.007), office IOP peak (3.2 vs 1.0, P = 0.004), and FDT pattern standard deviation (PSD) (5.03 v 3.32, P = 0.000) were significantly higher in OHT patients with repeatable FDT perimetry test abnormalities compared to OHT patients with normal FDT perimetry test. Office IOP fluctuation and office IOP peak were significantly correlated with both number of significantly depressed FDT points and FDT PSD index. CCT measurements and SAP global indices did not differ significantly in OHT patients with and without FDT perimetry test abnormality. CONCLUSION: Our results suggest that currently diagnosed OHT patients who have large office IOP fluctuations and office IOP peaks are more likely to have repeatable FDT perimetry test abnormalities. These results suggest that OHT patients with large IOP fluctuations and IOP peaks are more likely to have early glaucomatous damage, and this should be taken into account when assessing the risk of conversion to primary open angle glaucoma.

Nutritional status and risk factors of chronic malnutrition in children under five years of age in Aydin, a western city of Turkey.

We aimed to assess the prevalence and risk factors of chronic malnutrition in children under five years old in Aydin province, Turkey. A cross-sectional design was used to study a group of 1,400 children. Multistage sampling, including cluster and random sampling, respectively, was used in the selection of the study group. Stunting, wasting and underweight were used as indicators of nutritional status for children. The prevalence of malnutrition in children under five years was found as 10.9% for stunting, 4.8% for underweight and 8.2% for wasted. Increased risk was found in families without social security by 2.071, with low birth weight by 2.516 and with giving no colostrum by 2.787 in stunted children. Improving social security coverage is essential. Mothers should be informed on the usefulness of breast-feeding at antenatal care services during their pregnancies and taught appropriate breast-feeding practices, including the importance of giving colostrum, at baby-friendly institutions after birth.

The effect of Blastocystis hominis on the growth status of children.

BACKGROUND: B. hominis is a protozoan parasite commonly found in the human gastrointestinal tract. The pathogenesis of B. hominis is still controversial, although it is one of the most common parasites found in stool samples. MATERIAL/METHODS: This study was conducted at the Adnan Menderes Medical Faculty between January 2002 and June 2003 to evaluate the relationship between B. hominis and growth status in children in Aydin, Turkey. Healthy children with positive stool samples for B. hominis but negative for other parasites were selected as the case group (n=89). Two controls matched to each case by age and gender were selected by random sampling of children with negative stool samples for any parasite (n=178). RESULTS: The anthropometric measurements and body mass index were significantly lower in the case group than in the control group (p<0.05). CONCLUSIONS: According to this study there is a correlation between the presence of B. hominis and lower anthropometric indexes in children.

Expression of NF-kappaB in Helicobacter pylori infection.

Helicobacter pylori colonizes the gastric mucosa in humans and causes chronic gastritis. NF-kappaB has a key role as a mediator in mucosal inflammation. In this study, we examined the expression of NF-kappaB in the antral epithelial cells of H. pylori-infected and H. pylori-uninfected biopsies and examined these processes in relationship with grade and activity of gastritis, density of H. pylori, presence of the intestinal metaplasia, and atrophy. Fifty biopsies (35 H. pylori-positive patients and 15 H. pylori-negative controls) were studied. NF-kappaB immunohistochemical stain was performed. NF-kappaB activity in H. pylori-infected biopsies were markedly enhanced compared with uninflamed biopsies (P = 0.001). We also found positive correlation NF-kappaB expression with severity of gastritis (according to Sydney score) (P = 0.001), activity of gastritis (P = 0.046) and H. pylori load (P < 0.001), and atrophy (P = 0.004). We did not find a significant relationship between NF-kappaB and the presence of intestinal metaplasia (P = 0.355). These findings suggested that expression of NF-kappaB has an important role in H. pylori gastritis.

Does the EGFR and VEGF expression predict the prognosis in colon cancer?

BACKGROUND/AIM: Epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) are frequently encountered with aggressive tumor phenotype and poor prognosis, but the relationship between EGFR/VEGF expression and survival remains unclear. The aim of our study was to further investigate the prognostic value of EGFR and VEGF expression in colon cancer. MATERIALS AND METHODS: The pathological specimens of 60 colon carcinoma patients were retrospectively evaluated and grouped according to EGFR and VEGF staining intensity and percentage of stained neoplastic cells. A final score was assigned to each case by multiplying percentage and staining score. The patients were stratified into the following categories: negative (score 0), low expression (score 1 or 2), and high expression (score 4). The remaining patient data were filtered out from the institutional cancer database. RESULTS: The mean survival time was 28.93 +/- 14.1 (range 2-52) months in the EGFR-negative group, 23.92 +/- 14.0 (range 6-46) months in the group with a low EGFR expression, and 17.00 +/- 12.8 (range 10-40) months in the group with a high EGFR expression. The median survival time was 27.50 +/- 14.7 (range 4-52) months in the VEGF-negative group, 29.33 +/- 12.8 (range 6-48) months in the group with a low VGEF expression, and 14.50 +/- 14.2 (range 2-40) months in the group with a high VGEF expression. The expression of EGFR and VEGF was not an independent factor that affects survival. CONCLUSIONS: The EGFR and VEGF expression rates of colon tumors do not predict the survival. In addition, the EGFR expression in the primary tumor was not predictive of metastatic lymph nodes. The prognostic value of EGFR/VEGF staining may be further questioned.

Prevalence and risk factors for HEV infection in pregnant women.

BACKGROUND: Hepatitis E is an infectious viral disease with clinical and morphological features of acute hepatitis, clinically similar to other forms of acute viral hepatitis except in pregnant women, in whom the illness is particularly severe and has a high mortality rate. The present study was conducted in western Turkey to investigate the prevalence and risk factors for HEV infection in pregnant women. MATERIAL/METHODS: The data for the study were acquired from health centers in urban and rural areas of Aydin province, Turkey. The study design was cross-sectional. Multistage sampling was used to select the study group. Samples were tested for anti-HEV IgG by commercial ELISA test. RESULTS: A total of 386 pregnant women were included in the study. Antibodies against HEV were detected in 27 of the 386 pregnant women (7.0%). The prevalence of HEV seropositivity was significantly lower (2.5%) in women with a higher education level when compared to women with a lower education level (9.7%) (p=0.023). No significant differences were identified between seropositive and seronegative women in terms of age, source of water supply and place of residence. CONCLUSIONS: According to our results, education seems to be the only factor affecting the prevalence of HEV infection in pregnant women. The prevalence rate we found was similar to the results obtained in previous community-based studies conducted in western Turkey.

Limb lengths of primary school children in a city from western region of Turkey.

Anthropometry has been used for the assessment of growth at different ages. Among the anthropometric measurements, weight, height, arm circumference, and lower and upper limb lengths are of the most important criteria showing the development of children in school age. The aim of the present study was to measure the lengths of upper (arm, forearm, hand) and lower (thigh, leg, foot) limbs of children studying in primary schools of Aydin, a city in the western region of Turkey, and to assess the differences according to the gender (female, male) and living areas (urban, rural). In different age groups, many differences were observed when compared for gender and area. Differences were also seen when compared with the other studies done in different part of Turkey. The data was the first one for the region and it might be useful for further regional studies or for national comparisons. More studies designed with bigger sample sizes that cover many cities belonging to the same region of the country are needed. In addition to cross-sectional studies, longitudinal studies may give more useful knowledge for understanding the growth of children.

Seroprevalence and risk factors for toxoplasma infection among pregnant women in Aydin province, Turkey.

BACKGROUND: The aims of the present study were to determine the prevalence of toxoplasmosis in pregnant women at first trimester of their pregnancy and to follow up the seroconversion for next two trimesters, and to identify the risk factors and possible contamination routes in Aydin province, Turkey. METHOD: The sample size was calculated as 423 on a prevalence of 50%, d=0.05 at a confidence level of 95% with 10% addition. It was a cross-sectional study with multistage sampling. After a questionnaire applied to the pregnant women, anti-Toxoplasma IgG antibodies were studied with ELISA and IFA, values in conflict with DA test, where IgM antibodies were studied with ELISA and for borderline or positive values of IgM avidity test was used. RESULTS: The mean age of 389 (92.9%) of pregnant women in the study was 24.28+/-4.56 years, the seroprevalence of anti-Toxoplasma IgG antibodies for toxoplasmosis was 30.1%. Seroprevalence was increased with age (p=0.001) and with drinking water consumption other than bottled water (p=0.042). No significant relations were observed between anti-Toxoplasma IgG antibodies and education level, being native or migrant, abortion history, consumption of meat, vegetable and milk/milk products, personal or kitchen hygiene habits, cat owning at home of the pregnant women. No IgM antibody was detected. CONCLUSION: One of every three pregnant women in Aydin was at risk of toxoplasmosis at the first trimester of their pregnancy. Increased seroprevalance with age was a predictable result because of increasing time of exposure. Increased seroprevalence with consumption of municipal and uncontrolled water (well/spring water) supplies was similar with latest epidemiological findings.

Female urinary incontinence in the west of Turkey: prevalence, risk factors and impact on quality of life.

OBJECTIVES: To determine the prevalence and risk factors of urinary incontinence (UI), and to assess its impact on quality of life (QOL) in Turkish women. METHODS: In this cross-sectional study, 1012 women aged over 18 years were interviewed through a questionnaire including 'International Consultation on Incontinence Questionnaire Short Form'. RESULTS: The overall prevalence of UI was 23.9% (n=242). Among these women, 62 (25.6%) had urge, 80 (33.1%) stress and 100 (41.3%) mixed type UI. The prevalence rate increased with advancing age. Eighty-nine women (36.8%) stated to have urinary leakage at least once a day or more, while 153 (63.2%) women were experiencing less than twice a week. UI was significantly associated with fecal incontinence, hypertension, history of nocturnal enuresis, and recurrent urinary tract infections. Overall, 211 (87.2%) women stated that UI have negative impact on the QOL. This effect remained mostly at the mild or moderate level. Although many (87.2%) had intention for medical assistance, only a few (14.9%) had realized it. Women with urge UI and aged 40 to 50 years looked for more assistance than others. CONCLUSIONS: UI affect approximately one of four Turkish women. The results emphasize the need for taking preventive measures and policy development for UI.

[Investigation of Serum Macrophage Migration Inhibitor Factor (MIF) levels in patients with cutaneous leishmaniasis.]. / Kutanöz leishmaniasisli olgularda serum makrofaj migrasyon inhibitör faktör (MIF) degerlerinin arastirilmasi

In this study, the possible role of MIF as an immunologic marker in cutaneous leishmaniasis was evaluated. Twenty patients with acute cutaneous leishmaniasis (CL) and 20 healthy subjects were included in the study. MIF serum levels were measured using a sandwich ELISA method. The MIF levels were 3.50 +/- 7.07 ng/ml in the control group and 69.05 +/- 149.48 ng/ml in the CL group (p < 0,001). The increase in MIF levels in CL patients may be due to the stimulation of a T cell-mediated cellular immune response by Leishmania.