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.

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.

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

[No Abstract Available].

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.

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.

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.

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.

Effect of corneal drying on central corneal thickness.

PURPOSE: To determine the amount of corneal thinning induced by corneal drying, and to discuss its possible consequences on applanation pressure. PATIENTS AND METHODS: Two sets of central corneal thickness measurement from 100 eyes of 100 patients were taken by ultrasonic pachymeter at time settings of 0, 15, 30, 45, and 60 seconds. During the first set (group 1), patients were asked to blink voluntarily between the measurements. During the second set (group 2), the same patients were prevented from blinking during the measurements. RESULTS: Mean central corneal thickness at 0 second in groups 1 and 2 were 547.0 +/- 37.4 microm, and 546.7 +/- 37.6 microm, respectively. Corneal thickness did not change significantly in group 1, but did significantly decrease in group 2. Rate of thinning increased linearly during the first 30 seconds, and then leveled around 0.3 microm/s up to 60 seconds. Mean corneal thickness decreased 3.0% during the 60 second drying. The decrease in thickness was significant when each time point in group 2 was compared with the preceding one (P < 0.01). Neither age nor 0 second corneal thickness in group 2 showed a significant correlation with the amount of corneal thinning at 60 seconds. CONCLUSION: Corneal thickness may significantly decrease during 1 minute of drying. Decreased thickness may result in underestimation of applanated pressure as well as central corneal thickness.

Assessment of germ cell apoptosis in cryptorchid rats.

AIM: To investigate the relationship between germ cell degeneration and apoptosis in cryptorchid rats. METHODS: Thirteen 21-day-old Wistar rats were made unilaterally cryptorchid by closing the left inguinal canal. At day 30 (Group 1, n=6) and day 60 (Group 2, n=7) after operation, the testes were removed for histopathological examination. The controls (n=8) were sham operated and were sacrificed at day 60. Germ cell apoptosis was assessed by means of the TUNEL method. RESULTS: Spermatogenesis was arrested and the testicular and seminiferous tubular diameters were significantly reduced In the unilateral undescended testes (UUTs) compared with the contralateral descended testes (CDTs) and the control rats. However, atrophic changes, pathological calcification, necrosis of seminiferous tubule, and absence or sloughing of germ cells were not found in all the animals. The spermatocytes were the main type of germ cells undergoing apoptosis in all the groups. In the UUTs, there was a significant and time-dependent increase in the mean apoptotic index. By 60 days after surgery, increased apoptosis in germ cells was also observed in the CDTs. CONCLUSION: Apoptosis is the predominant mechanism of germ cell death rather than atrophy and necrosis in cryptorchidism.

Intestinal parasites prevalence and related factors in school children, a western city sample--Turkey.

BACKGROUND: Intestinal parasitic infections are amongst the most common infections worldwide. Epidemiological research carried out in different countries has shown that the social and economical situation of the individuals is an important cause in the prevalence of intestinal parasites. Previous studies in Turkey revealed a high prevalence of intestinal parasitic infection. The objectives of the current study were to determine the prevalence of intestinal parasitic infections in Aydin among 7-14 years old school children and to identify associated socio-demographic and environmental factors, behavioral habits and also related complaints. METHODS: Multistage sampling was used in the selection of the study sample. A questionnaire, cellulose adhesive and a stool specimen examination were done. RESULTS: A total of 456 stool specimens were collected. 145 students (31.8%) were infected with one or more intestinal parasites. 29 (6.4%) of the students were infected more than one parasite, 26 (5.7%) with two parasites and 3 (0.7%) with three parasites. The three most common were E. vermicularis, G. intestinalis and E. coli. Intestinal parasite prevalence was higher in rural area, in children with less than primary school educated mother, in children who use hands for washing anal area after defecation, and in children who use toilet paper sometimes or never. The relation between child health and mother education is well known. Children were traditionally taught to wash anal area by hand. Toiler paper usage was not common and might be due to low income or just a behavioral habit also. Most of the complaints of the study population were not significantly related with the intestinal parasitic infection. CONCLUSIONS: Intestinal parasitic infection is an important public health problem in Aydin, Turkey. Rural residence, mother education less than primary school, sometimes or never usage of toilet paper, and washing anal area by hands after defecation were the significant associations. Interventions including health education on personal hygiene to the students and to the parents, especially to mothers are required. The ratio of uneducated women should be declined with specific programs. A multisectoral approach is needed.

A descriptive study on street children living in a southern city of Turkey.

We aimed to determine the social-demographic characteristics and rate of occurrence of hepatitis B infection of children living/working in the streets in Adana, southern city of Turkey. The application forms of 52 children were assessed. Physical examination could be performed for 39 children. The median age was 14 years. The educational status of the children and parents was low. Shoe polishing (22%), selling different goods (22%) and scavenging (33%) were the most common type of work activities. Eighteen (35%) pointed out that they were exposed to beating and attack, three (6%) were sexually abused. Twenty-one (40%) of them were involved in physical fighting and two (4%) were involved in fights resulting in stabbing. Twenty-four (67%) of the children were under 50 percentile for height. Nineteen percent of the children were heavy or medium smokers. Among the 38 children whose hepatitis B markers were checked, HbsAg was positive in 2 (5%), anti-HbcAg in 12 (32%), and anti-HbsAg in 9 (24%). Fifteen (39%) blood samples had negative results. A more nationwide, institutional approach to the problem must be created and maintained.

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.

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.

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.