Search

This study aims to evaluate the anxiety levels of employees by determining the working conditions and protective practices in the workplace of individuals who had to work during the COVID-19 pandemic. METHODS: The cross-sectional study was carried out with 801 employees from different sectors who continued to work during the COVID-19 pandemic. RESULTS: The mean age of the employees was 33.1±10.3 years, and 63.4%were male while 46.1%were workers. The GAD-7 anxiety level mean score of the participants was determined as 6.6±5.1. Per this, 25.2%of the participants showed a high tendency to anxiety and 38.5%showed a moderate tendency. A statistically significant difference was found between anxiety level and gender, sector and profession. Besides, there was a statistically significant difference between the perception of workplace risk, the way of transportation to the workplace, the social distance in the workplace, measures taken for COVID-19 in the workplace, and anxiety levels (p

Objectives: The aim of this study was to translate the Central Sensitization Inventory (CSI) into the Turkish language, to perform a psychometric validation, and to investigate its reliability in patients with chronic spinal pain with an organic origin, patients with fibromyalgia, and pain-free control individuals. Patients and methods: Between April 2016 and February 2017, the translation of the original English version of the CSI into Turkish was performed using the forward-backward translation method. A total of 100 fibromyalgia patients (6 males, 94 females; mean age: 45.0±8.4 years; range, 25 to 60 years), 100 patients with chronic spinal pain with an identified organic origin (CSPO), (10 males, 90 females; mean age: 43.8±9.7 years; range, 21 to 60 years), and 100 healthy controls (8 males, 92 females; mean age: 35.8±10.1 years; range, 25 to 55 years) were included in the study. Demographic characteristics were collected. Test-retest reliability was determined by re-administering the CSI-Turkish (CSI-Turk) two weeks after the first application. Results: The internal consistency (Cronbach's alpha) was found to be 0.92 and the intraclass correlation coefficient was 0.93. Patients with fibromyalgia, a very common central sensitivity syndrome (CSS), had the highest mean CSI-Turk scores, and healthy controls had the lowest. Using the recommended cut-off score of 40 resulted in 87% sensitivity and 90% specificity in distinguishing between fibromyalgia and control individuals. Conclusion: This study suggests that the CSI-Turk can be effectively used as a screening tool to elucidate CS-related symptomology among patients with chronic pain with a high internal consistency, test-retest reliability, sensitivity, and specificity.

Amac: Okul oncesi egitimin zorunlu egitim kapsamina alinmasi gundemi, beraberinde okul sagligi calisma kapsaminin genisletilerek planlanmasi ve uygulanmasi ihtiyacini dogurmustur. Okul oncesi egitim grubunda yer alan cocuklar, saglik riskleri bakimindan hassas gruplar arasinda olup ayni zamanda bu donem gelisimsel ozellikler nedeni ile egitim ortamlarinda cesitli kazalara maruz kalabilmektedir. Ilgili risklerin en aza indirilmesi amaciyla gerceklestirilen bu calisma, okul oncesi ogretmenlerinin saglik okuryazarligini arttirmaya yonelik katki sunmayi hedeflemektedir. Hastalar ve Yontem: Alanin uzmanlari ile belirlenen cercevede okul oncesi cocuk sagligina yonelik temel bilgiler ile acil durumlarin tespit edilmesi ve mudahalelerini iceren egitim programi olusturularak, 2016 yilinda dort grup ve her grup icin iki tam gunde egitimler tamamlanmistir. Edirne Merkez Ilcede gorev yapan toplam 106 okul oncesi ogretmene uygulanmak uzere hazirlanan egitim programina, 83 okul oncesi ogretmeni katilmistir. Calismanin verileri arastirmacilar ve egitim programinda gorev alan dokuz ayri alan uzmani tarafindan olusturulan akademik basari testi ve kisisel bilgi formu araciligi ile elde edilmistir. Soz konusu veri araclarini tam olarak dolduran ve ontest-sontest eslestirmesi yapilabilen 59 katilimcinin verileri calismaya dahil edilmistir. Bulgular: Arastirmada ogretmenlerin akademik basarilarinin verilen egitim sonunda arttigi (t(58)=17,27, p0,05) ve medeni durumlari (t(58)=0,61, p>0,05) ile son test puan ortalamalari arasinda anlamli bir fark olmadigi ortaya cikmistir. Sonuc: Okul oncesi ogretmenlerine verilen egitim ile ogretmenlerin cocuk sagligina yonelik bilgi duzeylerinin artigi belirlenmistir. Katilimcilarin saglik okuryazarligini da destekleyecegi dusunulen calisma ile egitim verdikleri cocuklarin, sagliklarini da korumak, gelistirmek ve gerekli oldugunda mudahale etmek durumunda kalan ogretmenlerin, bu cercevedeki surecleri iyi yonetmelerine destek olunacagi dusunulmektedir. Bu alanda basariya ulasilabilmesi icin uygulama kapsaminin genisletilerek yayginlastirilmasi, guncellenerek surekliligin saglanmasi gerekmektedir.

BACKGROUND Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease that affects the axial skeleton which can lead to structural and functional impairments. It has a negative impact on the person's daily life activities. Early diagnosis, exercise and patient education are factors playing a major role on prognosis. OBJECTIVE The purpose of the present study was to compare the structured theoretical and exercise educational program with routine policlinic education's effects on the parameters of the disorder in the short-term follow-up. MATERIALS AND METHODS This study was performed on 41 AS patients. The patients were randomly allocated into two groups. Structured education and exercise programs were applied to the first group patients in subgroups consisting of four to five patients each. Patients had group exercises throughout the education program. The second group followed the routine outpatient department program. The effectiveness of the treatment was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Global (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), chest expansion, Short Form-36 (SF-36), Ankylosing Spondylitis Quality of Life Scale (ASQoL) and laboratory parameters in all patients. Patients were evaluated on admission and at the end of 3 months. RESULTS Significant improvements in terms of BASFI, BASDAI and BAS-G, chest expansion, SF-36 and ASQoL indices were observed in first group patients undertaking structured education, at the end of the study. No difference could be found in BASMI and chest expansion. CONCLUSION Educational programs have positive effects on the functional status, activation of the disease, general well-being and quality of life. It also shows that education programs should be within the routine treatment program for AS.

One of the most important conditions for individuals to be happy and productive in workplaces is job satisfaction. In this study, it was aimed to determine the levels of job satisfaction in physicans and nurses who worked in hospitals in Edirne and to evaluate the effects of potential influencing factors on job satisfaction. The population of the study was composed of a total of 1376 individuals. The sample group was composed of a total of 385 healthcare staffs including 192 physicians and 193 nurses (28% of the population). The data were collected using a questionnaire form and Minnesota Job Satisfaction Scale and evaluated by SPSS (Statistical Package for Social Sciences) 20.0 package program. Job satisfaction levels were found better in the healthcare staffs who worked in private hospital. When assessed by profession, the highest level of job satisfaction was found in academic member. This study was found that 82% of the health staffs reported that they did not feel safe while working, 75% were exposed to verbal or physical abuse. When the satisfaction of the participants related to the institution where they worked and the occupation they had was examined, it was observed that approximately 37% reported that they thought to leave the institution where they worked and 25% even reported that they thought quitting their jobs. The general job satisfaction was better in individuals who were experts in their areas, who worked in private hospital, who loved their profession, whose working hours were regular, who felt themselves safe in their institutions and who worked free from violence. The worst level of job satisfaction was found in general practitioners. The job satisfaction of healthcare staffs who thought that the performance-based payment system applied in Turkey was unfair was low.

The aim of this study is to assess the prevalence and risk factors of domestic violence against married women in Edirne, Turkey. This is a cross-sectional study which included a representative sample of the married women living in the Provincial Center of Edirne. The total past year prevalence of some forms of physical domestic violence is 34% in the last 12 months. 93% of women reported that they have been experiencing different forms of verbal and psychological domestic violence. The important risk factors for physical domestic violence were being Roma woman (OR = 2.97, 95% CI: 1.44-6.12), living with more than four people in the household (OR = 2.29, 95% CI: 1.21-4.36), being unemployed (OR = 2.15, 95% CI: 1.06-4.37), and got married only with her families’ decision (OR = 4.60, 95% CI: 1.42-14.80). Our findings conclude that patriarchal and traditional values, women’s lack of financial autonomy, and low socioeconomic status are the risk factors for physical domestic violence.

The purpose of this study was to evaluate the knowledge, attitudes and practices among food service staff with regards to food hygiene in hospitals in Edirne, Turkey, and to provide baseline data for implementing HACCP in hospital food services by carrying out a questionnaire by a face-to-face interview. The current study shows that food service staff in Edirne hospitals have insufficient knowledge regarding the basics of food hygiene. And also revealed a discrepancy between attitudes and practices towards food hygiene. There is an immediate need for continuous training among food handlers regarding safe food handling practices.

The coagulation system is activated and coagulation activation markers are elevated in acute ischemic stroke with nonvalvular atrial fibrillation (NVAF). The etiology, severity, and prognosis of the ischemic stroke might be estimated with the level of the activation of the coagulation system. In this study, prothrombin F1+2 (F1+2), D-dimer, and fibrinogen levels were measured in patients with acute ischemic stroke with and without NVAF, and stroke severity was compared with these hemostatic parameters. Of 55 patients, 29 had sinus rhythm (group I), 26 had NVAF (group II); 20 healthy subjects (group III) were included in the study. Subtypes of cerebral infarction were classified. The patients underwent stroke severity, electrocardiography, echocardiography, cranial computed tomography, cervical duplex ultrasonography, and hemostatic parameter studies. In group II, F1+2 level (2.83±0.89) was significantly higher than in group I (2.33±0.80) and III (1.94±0.64) (p values: group I-II, 0.036; groups II-III, 0.001; groups I-III, 0.104). In group III, fibrinogen level (251.64±60.96) was significantly lower than that in groups I (347.97±111.49) and II (364.04±86.20) (p=0.001). D-dimer was not significantly different between groups. In group I, lacunar syndrome (LACS), and in group II, partial and total anterior circulation syndrome (PACS+TACS) were more common (p=0.013, p=0.001, respectively). In group II, Scandinavian Stroke Scale scores were lower than those in group I (group I=45.2±14, group II=35.4±18.9, p=0.02). In conclusion, activation of coagulation, demonstrated by increment F1+2, is more abundant in the stroke patients with NVAF than in the stroke patients with sinus rhythm. Our results also showed that activation of the hemostatic system might be related to stroke subtype and stroke severity. It is suggested that the oral anticoagulation treatment as prophylaxis is important in the prevention of stroke in patients with NVAF.

Background: It is known that oxygen-derived free radicals play an important role in the pathogenesis of brain injury. Melatonin is a powerful scavenger of the oxygen free radicals. In this study, the protective effect of melatonin against the damage inflicted by reactive oxygen species during brain hypoxia was investigated in newborn rats using biochemical parameters. Methods: For biochemical analyses, the levels of lipid peroxidation product (malondialdehyde ([MDA]), levels of reduced glutathione (GSH) and the activities of superoxide dismutase (SOD) and catalase (CAT) were estimated. Results: After the third day of brain hypoxia, the brain levels of MDA increased. Pretreatment of animals with melatonin abolished the rise in MDA induced by hypoxia. GSH concentration did not increase by pretreatment with melatonin. Additonally, the activities of two antioxidative enzymes (SOD and CAT) decreased after the experimental period with melatonin only preventing the change of CAT. The activity of SOD was not influenced by melatonin administration as expected. Conclusion: In this experimental study, exogenously administered melatonin effectively protected against brain injury by oxidative stress. This protective effect of melatonin may be due to its direct scavenger activity and activation of CAT. Thus, melatonin may potentially be useful in the treatment of neurodegenerative conditions that may involve free radical production, such as perinatal hypoxia.

Objectives.—The aim of our study is to determine the prevalence of migraine in Provincial Center of Edirne. Methods.—A systematic random sample of 386 inhabitants over 14 years old were interviewed face to face. Diagnosis of migraine was based on the International Headache Society (IHS) classification. Results.—Migraine was identified in 77 subjects (60 female, 17 male). The lifetime prevalence of migraine was found to be 19.9% (95% CI: 18.3–21.5) (9.34% (95% CI: 8.6–10) in males, 29.3% (95% CI: 27–31.6) in females). Conclusions.—These results show that while migraine prevalence in Turkish females is higher than that reported in previous studies from Europe and United States, lifetime prevalence is similar in all populations.

Previous literature investigating bone pain in osteoporosis has prominently focused on painful conditions following osteoporotic fractures. "Is osteoporosis really a silent disease without bone pain and tenderness unless a fracture occurs?" Our aim in this study was to answer the question by assessing the questionable tenderness on tibia bones of fracture-free patients with low bone density and to compare the findings with a normal population. One-hundred-thirty-three consecutive postmenopausal female patients with the mean age of 56 years admitted to our clinic for bone mass measurement were included in the study. Bone mineral density (BMD) values of lumbar spine (L2-L4) and right proximal femur (neck, trochanter, Ward's triangle) were measured by dual-energy X-ray absorptiometry (DXA). Patients with T scores lower than -1 formed the osteopenic-osteoporotic group of patients (low BMD group) whereas those with T scores higher than -1 constituted the normal BMD group according to the osteoporosis definition regarding T score for DXA. Mechanical pressure was applied by a hand algometer on the middle points of three equally divided sections on the anterior part of tibia, and the pressure levels starting the pain sensation (POPL) were recorded. Although the patients in the normal BMD group reported consistently high POPL at all regions of tibia for all BMD measurement sites, this difference reached to a statistical significance level only for the femur neck region. Only mean POPL for the whole tibia had independent association with only femur neck BMD by multiple linear regression analysis. These results are encouraging for assessing the significance of pressure-induced tibial pain as an indicator of low BMD in the future.

Background: The presence of increased numbers of nucleated red blood cells (NRBC) and increased levels of erythropoietin (EPO) in the circulation of neonates has been associated with states of relative hypoxia. The aim of this study is to assess the pattern of NRBC counts and EPO levels in a group of high-risk neonates under stress conditions and determine the short-term outcome for these babies by using these parameters. Methods: There were 69 high-risk neonates; 14 intrauterine growth retarded (IUGR), 25 preterm infants, 18 term infants with asphyxia and 12 infants of diabetic mothers. Control groups included healthy, term infants delivered either vaginally (n = 18) or with cesarean section (n = 19). Three blood samples were obtained from each infant within 12 h (initial), 3 days and 7 days after birth to measure NRBC counts and EPO levels. Neonatal and short-term outcomes at 3 and 6 months of age were determined. Results: There was no significant difference among the groups with regard to the initial serum EPO concentrations. The initial NRBC counts were significantly lower in the control groups compared with the study groups (P = 0.002). While there was no significant difference between patients with good and poor outcome in terms of EPO concentrations of initial samples, a significant difference existed in terms of NRBC counts (P = 0.038). Conclusions: Both serum EPO level and NRBC count provide limited clinical benefit in the detection of pathological conditions of the neonatal period, but NRBC count determination seems to be especially helpful in predicting short-term neurodevelopmental outcome.

To investigate the initial overall cognitive ability and its components as a predictor of functional improvement and ambulation during rehabilitation. Initial cognitive status is widely known to be a predictive factor in functional recovery in patients with stroke although some reports have found no such relationship.Baseline cognitive status was scored by Minimental State Examination and its subsections with such headings as "orientation," "registration," "attention and calculation," "recall," and "language" in 43 patients with postacute stroke, aged between 51 and 68 yr. Function was evaluated in terms of motor FIM and functional ambulation as categorized in "Adapted Patient Evaluation and Conference System" functional scale at the time of admission and discharge.Only total baseline Minimental State Examination score showed a significant correlation with discharge motor FIM improvement (r = 0.31, P = 0.04) and baseline orientation score correlated significantly with functional ambulation score improvement (r = 0.31, P = 0.03). In stepwise linear regression model, the same variables had an effect on similar outcome parameters.Cognitiveion evaluation should be taken as a whole to predict functional outcome in patients with postacute stroke, except for the baseline orientation score that seemed more predictive for ambulation.

Free radicals, lipid peroxidation and excitatory amino acids have been implicated in the secondary mechanisms of traumatic brain injury. We used the cold injury model in rats to assess the endogenous activity of the protective enzyme superoxide dismutase (SOD) and the lipid peroxidation level in the contused tissue at an early phase of injury. Furthermore, we treated the rats with two different N-methyl-D-aspartate receptor antagonists, namely MK-801 and CPP, and evaluated their effect on lipid peroxidation in the contused tissue. Rats were divided into four groups: sham, control, treatment 1 and treatment 2 groups (n= 16 for each group). Thirty and 60 min after craniectomy or injury, tissue samples were removed. SOD activity didn't change in this period. However, lipid peroxidation in terms of malondialdehyde (MDA) amount showed a significant increase at 60 min. Fifteen minutes after injury, MK-801 (1 mg/kg), CPP (10 mg/kg) or saline (1 ml) were applied intraperitoneally in treatment 1, treatment 2 and the control groups. Treatment with MK-801 attenuated MDA levels, whereas treatment with CPP did not. The protective effect of MK-801 achieved statistical significance. These results demonstrate that SOD activity does not change in the early period of cold injury. Moreover, these results show that lipid peroxidation increases after 60 min of cold injury, and treatment with MK-801 15 min after injury can prevent this elevation.

Studies evaluating the role of indoor molds in the development of allergic or respiratory symptoms in schools are few in childhood.This study aimed to investigate relation between indoor molds and allergic diseases or respiratory symptoms in primary school's children in Edirne, Turkey.Ten public primary schools were included into the study. A thorough assessment, using a questionnaire and inspection surveys was carried out. The concentration of culturable mold was assessed in the dust samples in the schools. Indoor temperature and humidity were measured. A total of 1374 students who completed valid questionnaires were included in the study, and dust-samples were collected from the schools.Cumulative and current prevalence rates of wheezing, asthma, allergic rhinitis, and atopic dermatitis were found as 31.4%, 9.3%, 16.2%, 6.0% and 13.4%, 11.9%, 15.1%, 2.1%, respectively. The most frequent mold-species detected in indoor dusts were Cladosporium, Penicillium, Alternaria and Aspergillus. Although the prevalence rates of allergic diseases and respiratory symptoms were high, indoor mold amounts were low in the schools in our region and no significant correlation was determined between indoor mold amount and the prevalence of these diseases in schools or classrooms.Even though allergic molds are present in schools, the mold-exposure may not be an important predisposing factor for development of allergic and respiratory diseases the schools in our region.

Objectives To investigate the effects of strontium ranelate, raloxifene and misoprostol on bone mineral density (BMD) in ovariectomized rats to contribute to the individualization of the treatment of postmenopausal osteoporosis. Study design Sixty sexually mature female Sprague–Dawley rats weighing 250g were used. The 60 rats were divided into six groups of 10 rats each: SR, MISO, RAL, SHAM, DW and OVX. All except the SHAM rats were subjected to bilateral ovariectomy. Three days after surgery, rats were administered strontium ranelate (Protelos ® , 2g, Servier, Istanbul), 1800mg/kg/day; misoprostol (Cytotec ® , 200mcg, Ali Raif, Istanbul), 200mcg/kg/day; raloxifene (Evista ® , 60mg, Lily and Company, Istanbul), 3mg/kg/day and 1cc of distilled water by gavage for 8 weeks. Bone mineral density measurements were then performed. Results The strontium ranelate (SR) group had significantly higher vertebral BMD than all other groups. Femoral density in the SR group was also significantly higher than in other groups and there was no difference between femoral density in the strontium ranelate and sham groups. Conclusions Strontium ranelate, raloxifene and misoprostol can prevent bone loss in the vertebrae, whereas strontium ranelate can also prevent bone loss in the femur of ovariectomized rats. Strontium ranelate increases greater than raloxifene and misoprostol BMD in the vertebrae. Condensation Strontium ranelate may increase both vertebral and femur BMD in ovariectomized rats while raloxifene and misoprostol may only increase lumbar spine BMD.

Measles is still a leading cause of death among young children, despite the availability of a safe and effective vaccine for the past 40 years. EURO Region of World Health Organisation including Turkey has targeted elimination of measles by the year 2010. It is concluded that there must be a sensitive surveillance system to investigate all suspicious measles cases, and diagnosis should be based on both standardized case definition and laboratory confirmation. Standardized case definition based notification has started in 2005 in Turkey. This study was carried out to determine the sensitivity and specificity of clinical measles diagnosis by physicians and families during a measles epidemic affecting 597 cases in Edirne province in 1997. Blood samples and data were collected by trained teams consisting of one physician and one nurse. Thirty clusters sampling method was used for sampling and 210 blood samples were taken from the children. The sera were then sent to Refik Saydam Hygiene Institute, Ankara, for the detection of measles specific IgG and IgM antibodies. Positive results for IgM were considered as acute measles during epidemics, and positive results for IgG were considered as acquired immunity due to vaccination or passed infection. Of 210 children, 19 were found to have recent infection (IgM+, IgG-), 101 were found immune (IgM-, IgG+), 67 were found in convalescence phase after infection (IgM+, IgG+), and 23 were found susceptible (IgM-, IgG-) to measles. The overall IgM seropositivity was detected as 40.9% in the study group. Only half of confirmed cases (43/86) were diagnosed as measles clinically by the physicians. The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of clinical diagnosis by physicians were estimated as 33%, 89%, 67% and 86%, respectively. Validity measures for measles diagnosis by the families were as follows; 8% sensitivity, 96% specificity, 6% PPV and 60% NPV. It is concluded that, all required measures should be taken for the availability of laboratory confirmation of all suspicious measles cases and field investigation via structured case investigation forms, is necessary for the success of measles surveillance system in our country.

The relation between fibronectin and coronary artery disease (CAD) according to previous study results is controversial. The aim of the present study is to investigate the predictive value of fibronectin in determining the presence and severity of CAD. Patients with stable angina (n = 62) who had angiographically documented CAD, and control patients (n = 31) who had normal coronary angiograms, were included in the study. Plasma fibronectin levels were determined in all patients. Plasma fibronectin level (milligrams per liter) in patients with CAD was higher than normal controls (364.2 ± 171 vs 265.1 ± 135.5, p = 0.006). The severity of CAD determined according to Gensini score and fibronectin level did not show any correlation (r = 0.13, p = 0.311). If fibronectin level 240 mg/l was determined as cutoff, it showed 76% sensitivity, 46% specificity, 46% negative predictive value, and 72.3% positive predictive value for predicting CAD. The present study showed that plasma fibronectin level in CAD is significantly higher than normal control subjects. However, it has no role in predicting the severity of CAD.

This study was designed to estimate the rubella seroprevalence in unvaccinated Turkish adolescent girls in urban and rural areas of Edirne, and to create preventive strategies for congenital rubella syndrome (CRS). The sample, representing 12- to 17-year-old adolescent girls, consisted of 1,600 subjects selected from school lists by systematic and random sampling, which was matched by age and urban-rural residency strata proportional to the corresponding distributions in the Edirne population. For each participant, a questionnaire was completed and rubella-specific IgG antibodies were measured. After analysis of samples, seropositivity prevalence, equivocal and seronegative samples of adolescent girls in Edirne were determined as 93.1%, 0.6% and 6.3%, respectively. Data from the present study may indicate that 6.9% of adolescent girls have considerable risk for rubella infection during pregnancy. Eliminating rubella and CRS in Turkey will require national health service efforts, including vaccination of all adolescents and all susceptible women of childbearing age.

The thyroid gland is an endocrine organ composed of stable cells. It is well known that regenerative capacity of the thyroid tissue is minimal. Various degrees of morphologic alterations do occur in chronic lymphocytic thyroiditis (CLT), including Hashimoto's thyroiditis. Eighty-five CLT cases were analyzed for these morphologic alterations. Small, irregular, atrophic or hyperplastic thyroid follicles were seen adjacent to the lymphocytic infiltration. There was nuclear enlargement, loss of nuclear polarity in thyrocytes and intrafollicular thyrocyte proliferation in these follicles. We thought that the morphologic alterations in involved follicles could be due to regenerative hyperplasia with increased proliferative activity and basement membrane abnormalities. To examine this hypothesis we investigated Ki-67 and laminin immunoreactivity in the involved follicles adjacent to lymphocytic infiltration areas. The uninvolved follicles were used as controls. Immunopositivity of Ki-67 in involved follicles was significantly higher than that in uninvolved follicles (2.97% +/- 2.16 versus 0.83% +/- 1.63, P0.001). Laminin immunostaining indicated the destruction or irregular distribution of basement membrane in involved follicles. We conclude that the increased cell proliferation activity and basement membrane abnormalities in the follicles with morphologic changes adjacent to CLT occur in conjunction with regenerative hyperplasia.

Objective Immune response against pertussis can be induced by infection and/or vaccination and vaccine induced immunity is known to wane within the decade following vaccination. Our aim was to assess the pertussis immune response among adolescent girls in the province of Edirne in Turkey. In addition we determined the relationship between the immune response and age, residence, and vaccination status. Material and methods Serum samples were collected from 359 adolescent girls, 12 to 17 years old. The subjects were selected by systematic randomisation from school rosters and sampled by age and urban-rural residence strata proportional to the corresponding distributions in the Edirne population. Pertussis immunity was determined by an in-house quantitative ELISA method for anti-PT and anti-FHA antibodies. Results Protective levels of antibody (>10 EU/ml) for anti-pertussis toxin and anti-filamentous heamagglutinin were found in 95.3% and 97.2% of the overall study group respectively. In 12- to 14-year-olds protective levels were shown in 94.1% and 97.0%, in 15- to 17-year-olds in 97.5% and 97.5%, in rural areas in 96.7% and 97.5%, and in urban areas in 94.5% and 97.5%, respectively (p >0.05). Conclusion The high percentages of protective levels of antibodies in our study population might be an indicator of previous infections, which are a threat to infants who have not completed primary immunisation. In this respect, adult immunisation should be considered.

A high incidence of iron-deficiency is a common observation among adolescent girls, whereas only limited data are available regarding the folic acid status of this group. This study was designed to determine the prevalence of biochemical folic acid deficiency in a group of Turkish adolescent girls.We surveyed the serum folic acid, complete blood count, and dietary folic acid intake of Turkish adolescent girls after using three-day self-reported food intakes in urban and rural areas of Edirne, Turkey.A sample population was composed of 704 adolescent girls; their serum folic acid levels were found to be adequate for 37.6% (or = 6 ng/mL), marginal for 46% (3 to 5.9 ng/mL), and at deficient levels for 16.3% (3 ng/mL). Folic acid deficiencies were found in 20.1% (36 of 179) and 14.7 % (61 of 416) of adolescent girls from rural and urban areas, respectively. Self-reported three-day folic acid intakes were correlated with the corresponding blood values for this nutrient. In the logistic regression analysis, three factors emerged as significant independent predictors of folic acid deficiency: low income (odds ratio [OR]: 2.4, 95% confidence interval [CI]: 1.3-4.2, p.001), low vitamin C (OR: 1.9, 95% CI: 1.1-3.5, p.05), and folic acid intake (OR: 4.8, 95% CI: 2.8-8.1, p.001).Data from the present study may indicate that serum folic acid is low in a group of Turkish adolescent girls. These low values appear to be associated with low income, and low dietary intakes of folic acid and vitamin C.

Objectives: Progression of the cell cycleis regulated by the interactions of cyclins,cyclin dependent kinases (CDKs) and CDKinhibitors (CDKIs). p27 is a member of theuniversal cyclin-dependent kinase inhibitorfamily. The level of p27 protein expressiondecreases during tumor development andprogression in some epithelial, lymphoid andendocrine tissues. It has been suggested thatp27 is an independent prognostic factor invarious human cancers. The prognostic value ofp27 protein expression is not completelyunderstood in bladder cancer yet.Aims: To investigate theimmunohistochemical expression of p27 intransitional cell bladder cancers and itsrelationship with clinicopathological data,proliferating cell nuclear antigen (PCNA) andp53 oncoprotein immunoreactivity.Methods: The expression of p27 proteinwas immunohistochemically analyzed inparaffin-embedded specimens of 75 patients withtransitional cell carcinoma of the bladder. p27expression was compared with tumor grade,stage, growth pattern, disease-free survival,progression, PCNA and p53 immunoreactivity.Results: Expression of p27 was notsignificantly related to clinicopathologicparameters, disease-free survival, progression,PCNA and p53 immunoreactivity.Conclusion: The results indicate that p27is not a good predictor for outcome oftransitional cell carcinoma of the bladder.

Objective Monitoring of the dorsal sural sensory nerve action potential (SNAP) is a sensitive method for detection of peripheral neuropathies. We tried to determine the normal dorsal sural nerve conduction values of the childhood population and assessed the clinical utility of this method in diabetic children who have no clinical sign of peripheral neuropathy. Methods In the study, 36 healthy and 27 diabetic children were included. In all subjects peripheral motor and sensory nerve studies were performed on the upper and lower limbs including dorsal sural nerve conduction studies. Results The dorsal sural SNAP mean amplitude was 8.24±3.08 μV, mean latency was 2.47±0.48 ms, mean sensory conduction velocity was 41.63±5.43 m/s in healthy children. Dorsal sural SNAPs were absent bilaterally in one diabetic patient. In the other 26 diabetic patients, the mean dorsal sural nerve distal latency was longer (2.93±0.63 ms, P =0.004), mean SCV was slower than in healthy subjects (36.68±7.66 m/s, P =0.005). However, dorsal sural nerve amplitude was not different between the groups. A dorsal sural nerve latency of more than 2.9 ms had a sensitivity of 50% and a specificity of 75%. A dorsal sural nerve velocity of less than 36 m/s had a sensitivity of 54% and a specificity of 92%. Conclusions We designated the reference values of the dorsal sural nerve in healthy children. In addition, our findings suggest that dorsal sural nerve conduction studies may have value to determine neuropathy in the early stages in children with diabetes. Significance The dorsal sural nerve conduction studies in diabetic children may have value to determine the neuropathy in its early stages.

Background: Body mass index (BMI) is the simplest way to measure obesity; therefore, it is chosen by many authorities as a screening method for adolescent obesity. Body mass index is positively correlated with the complications of childhood and adolescent obesity, such as hypercholesterolemia, insulin resistance, hyper­tension and long-term development of cardiovascular diseases. The aim of the present study was to produce percentile curves for bodyweight, height and BMI in a representative sample of adolescent girls living in urban and rural areas of Edirne, Turkey, and to compare these percentile curves with curves from other countries. Methods: The present study was a cross-sectional study, including a representative sample of 1687 adolescent girls from rural and urban areas of Edirne, who were evaluated between May and July 2001. Bodyweight and height were measured using standard procedures. Body mass index (kg/m2) was calculated as the ratio of bodyweight to body height squared. Smoothed percentiles for these variables were calculated using polynominal regression models. Crude weight, height and BMI percentile values, as well as smoothed percentile curves are presented. Results: Body mass index, weight and height reference curves for adolescent girls were produced. When we compared the BMI values of subjects in the present study with those of other countries, 85th and 95th percentiles of BMI in the present study were found to be generally lower than those for other ethnicities. Conclusion: Our findings show ethnic differences in BMI among adolescent girls. It will be usefull for each country to produce its own BMI percentiles.

This survey was designed to investigate the socio-demographic characteristics of and utilization of a Primary Heath Care Unit (PHCU) by Roma people (Turkish Gypsies), who live in the coverage area of Muradiye Primary Health Care Unit, as compared to members of the general population. This was a cross-sectional field study involving members of the Muradiye PHCU district. The study population comprised 127 Turkish gypsies resident in the region and 302 households selected by a stratified random sampling method. 889 household members were interviewed face-to-face at their home by means of a structured questionnaire. When the two sample groups were compared in terms of their social security coverage, rates of unemployment and educational levels, the situation of the Turkish Gypsies was found to be worse than that of the other members of the general population. 63% of the Gypsies applied to the PHCU because of health problems and 87% of these cases were treated successfully. Among those people making use of the PHCU services 47% evaluated them as being "satisfactory". Access to the PHCU services was found to be conditioned by educational level, being a Gypsy, the possession or not of a Green Card (available only to highly indigent people), whether or not the services were provided free of charge and the possession or not of social security coverage. Muradiye PHCU is well known and highly appreciated in its coverage area and is used by almost all of the residents. The main reason for the significant discrepancies in the level of health care obtained by the two population groups is the Gypsies' poorer economic situation. Among the Gypsies, the leading category of low rate social security coverage is the Green Card, which is granted to the very poor in order to reduce these inequalities. Unfortunately, the Green Card does not provide financial support for ambulatory care.

This study was designed to define the epidemiology of a food-borne outbreak caused by Salmonella enteritidis that affected only one squadron of a military battalion located in the vicinity of the city of Edirne in Turkey. The outbreak was analyzed by a standard surveillance form of the Centers for Disease Control and Prevention. The relationship between the eaten foods and cases was analyzed by Fisher's exact chi-square test, and odds ratios were calculated by a case-control study. The outbreak affected 60 of 168 soldiers in the squadron, 16 of whom were hospitalized. S.enteritidis was cultured in stools from 13 of the hospitalized soldiers and from 3 soldiers who had prepared the food. All strains were completely susceptible to antibiotics; their plasmid profiles were also identical. The highest attack rate detected was 55.7% in an omelet eaten 24 hours before (p < 0.001). Furthermore, it was the riskiest food according to the case-control study (OR=7.88; 95% CI=3.68-16.89). The food samples were unobtainable because they had been discarded. All of the hospitalized cases recovered, and none of the control cultures of stools yielded the pathogen after three weeks. In conclusion, although our results didn't indicate the exact source of the outbreak microbiologically, the omelet was considered to be the source based on the epidemiological proofs.

A predisposition to occlusive vascular diseases has been reported in patients with psoriasis and it has been suggested that some of these patients have some disorders of lipid metabolism. In this study, serum lipid levels were investigated in psoriatic patients to explore to the knowledge of this relationship. One hundred psoriatic patients and 100 non- psoriatic controls were included in the study. Total cholesterol, triglyceride, high-density lipoprotein-cholesterol (HDL-cholesterol), low-density lipoprotein-cholesterol (LDL-cholesterol), and very low-density lipoprotein-cholesterol (VLDL-cholesterol) levels were measured. In patients with psoriasis, total cholesterol and LDL-cholesterol levels were found to be significantly higher than those of controls. No significant differences were found in the other parameters. We concluded that psoriatic patients should be evaluated and followed up for the risk of hyperlipidemia and obstructive vascular diseases.

Ozdemir F, Birtane M, Tabatabaei R, Kokino S, Ekuklu G. Comparing stroke rehabilitation outcomes between acute inpatient and nonintense home settings. Arch Phys Med Rehabil 2001;82:1375-9. Objective: To compare outcomes in stroke survivors who received rehabilitation services in an acute inpatient rehabilitation setting (multidisciplinary rehabilitation team) with outcomes in survivors in a home-based setting (family caregivers, limited team supervision). Design: Randomized clinical trial, with mean follow-up after 60 days. Setting: Inpatient rehabilitation setting and home-based settings. Patients: Sixty patients (age range, 43-80yr) who had a stroke between 1996 and 1999 and had been referred after medical stabilization, randomly divided into 2 groups: group 1, inpatient rehabilitation; group 2, home-based rehabilitation. Interventions: Group 1: therapeutical and neuromuscular exercises with occupational therapy with professional supervision; group 2: conventional exercises with family caregiver and limited professional supervision. Main Outcome Measures: Spasticity was evaluated with the Ashworth Scale, motor status with Brunnstrom's stages, functional status with the FIM™ instrument, and cognitive status with the Mini-Mental State Examination before and after rehabilitation. Results: Patients rehabilitated in acute inpatient settings had better motor, functional, and cognitive outcomes ( p Conclusion: Intense inpatient rehabilitation services for stroke survivors provide significantly more favorable functional and cognitive outcomes with relatively low complications than did nonintense rehabilitation efforts in home settings. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Background Primary knee osteoarthritis (PKO) leads functional degenaration of knee joints and cause disability in general population. There are a lot of faýctors that effect on the intensity and functional status of PKO in various degrees. Objectives To investigate the efficacies of age, body mass index (BMI), the Kellgren Lawrence Radiological Osteoarthiritis Index (KLOAI), medial tibiofemoral joint space (MTFJS) on the intensity and functional status of PKO. Methods Fifty subjects (ages 56 to 69), 40 female (%80) and 10 male (%20), diagnosed as PKO according to American College of Rheumotology were admitted to the study. AP knee radiography of the patients were taken while standing up and MTFJS were measured. Those films were evaluated according to the KLOAI. Lequesne index (LI), Sickness Impact Profile (SIP), painless walking duration (PWD1) and painless walking distance (PWD2) were used with purpose to determine the clinical status and intensity of the PKO. Results We found these formulas according to Backward Lineer Regression Model. SIP = 202.2 + (63.9 × KLOAI) PWD1 (minutes) = 14 + (0.37 × BMI) + (3.1 × Sex) ? (3.1 × KLOAI) PWD2 (metres) = 1417 + (217.7 × Sex) Conclusion KLOAI correlated with SIP and PWD1 moderately. However, we think that all of these factors should be evaluated in clinical status of PKO. References Mc Alindon TE, Cooper C, Kýrwan JR. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis. 1993;52:258–62 Hochberg MC, Cejku ML, Scott WW. The association of body weight, body fatness and body fat distribution with osteoarthritis of the knee: data from the Baltýmore longitudinal study of aging. J Rheumatol. l995;22(3):488–93 Mankin HJ. Clinical features of osteoarthritis. In: Kelly, Harris, Rudd, Sledge, eds. Textbook of rheumatology. Vol. 4. Philadelphia: WB Saunders Company, 1993: 1374–84 Lequesne MG, Samson M. Indicis of severity for OA. Eular Balot No:3, 85, 1992 Wade DT. Measurement in neurological rehabilitation. Oxford University Press, 1992: 208 Sowers M, Zobel D, Weis FF. Progression of osteoarthritis of the hand and metacarpal bone loss. Arthritis Rheum. 1991;34(1):36–42 Dequeker J, Dieppe P. Disorders of bone, cartilage and connective tissue. In: Klippel JH, Dieppe PA, eds. Rheumatology. Philadelphia: The Mosby Company, 1998: 8.1.1–8.12.16

Aim The aim of this study is to reveal demographic, etiological and clinical characteristics of our cerebral palsy cases and to underline differences peculiar to Thrace region of Turkey. Methods One hundred and thirty five cerebral palsy cases, followed by Medical Faculty of Trakya University, Department of Pediatrics, Division Pediatric Neurology, were evaluated retrospectively. Data were obtained through out patient clinic files and patient discharge forms. Interviews by the phone were carried on in order to complete the necessary information. Demographic, etiological, laboratory and clinical characteristics of the cases were recorded. Results The mean age of the cases was 112.65±47.02 months (2–18 years) and boy/girl ratio was 1.8. The majority of the case etiologies were perinatal risk factors accounted for 61.5%. Forty per cent of the cases were term AGA. Spastic type cerebral palsy constituted 91.9% of all cases with cerebral palsy while 46% of them were quadriplegic. Quadriplegic type was encountered most (46.2%) in term deliveries, while diplegic type was the most common form in preterms (47.4%). Speech problems (77.8%) and mental retardation (75.6%) were the most accompanying problems. Epilepsy accompanied 72.6% of the cases. An increasing rate of malnutrition was detected parallel to increasing age groups. Conclusions Cerebral palsy cases showed certain differences in terms of demographic, etiological and clinical characteristics in Thrace region comparing to other regions.

Purpose Efforts for the early detection of bone loss and subsequent fracture risk by quantitative ultrasound (QUS), which is a non-invasive, radiation free, and cheaper method, seem rational to reduce the management costs. We aimed in this study to assess the probable correlation of speed of sound (SOS) values obtained by QUS with bone mineral density (BMD) as measured by the gold standard method, dual energy X-ray absorptiometry (DEXA), and to investigate the diagnostic value of QUS to define low BMD. Materials and Methods One hundred twenty-two postmenopausal women having prior standard DEXA measurements were included in the study. Spine and proximal femur (neck, trochanter and Ward's triangle) BMD were assessed in a standard protocol by DEXA. The middle point of the right tibia was chosen for SOS measurement by tibial QUS. Results The SOS values were observed to be significantly higher in the normal BMD (t score > - 1) group at all measurement sites except for the lumbar region, when compared with the low BMD group (t score < - 1). SOS was negatively correlated with age (r = - 0.66) and month since menopause (r = - 0.57). The sensitivity, specificity, and positive and negative predictive values for QUS t score to diagnose low BMD did not seem to be satisfactory at either of the measurement sites. Conclusion Tibial SOS was correlated weakly with BMD values of femur and lumbar spine as measured by DEXA and its diagnostic value did not seem to be high for discriminating between normal and low BMD, at these sites.

Objective: Immun response against pertussis can be induced by infection and/or vaccination and vaccine induced immunity is known to wane within the following decade. Our aim was to assess the pertussis immun response among adolescent girls in Edirne province in Turkey and to determine its relationship with some parameters.

The aim of this research was to estimate the community prevalence of alcoholism and the potential risk factors that affect it in the Edirne provincial centre by using a scanning test. A cross-sectional study was carried out in the Edirne provincial centre. A sample population composed of 500 women and 200 men was selected randomly after the categorisation of the population according to ethnicity, age and sex. Through face-to-face interviews, data collection sheets, which were prepared to analyse potential factors affecting alcoholism frequency, were filled in by the sample population. The Michigan Alcoholism Scanning Test (MAST) was employed. According to MAST's normal grading, individuals with 5 or more points are evaluated as alcoholics. Accordingly, 8.2% of the sample population fit the definition of alcoholic. Alcoholism frequency was considerably higher in gypsies, the self-employed, smokers, and people with higher income. From logistic regression analysis alcoholism frequency was 12.4 times higher in men than in women, 3.2 times higher in gypsies than in others, 1.9 times higher in people who earned an income in the preceding week than in the unemployed, and 3.7 times higher in individuals who had smoked more than 100 cigarettes during their life or those who had smoked at least 1 cigarette for 3 months or for a longer period than in those who hadn't smoked any cigarettes. The prevalence of alcoholism in the Edirne provincial centre was similar to that in other countries in Europe. The most important finding was that alcohol consumption decreased in the unemployed, a finding that differs from that in other parts of the world. Gypsies, who differ in tradition, way of life, and job compared to the other strata of society, also suffered from higher alcohol consumption. This group usually consumed wine and generally did not eat while drinking.