Search

Background: Mental problems are common among medical school students, and these problems affect social and academic functionality. It was aimed to determine depression, stress and burnout levels of medical school students in a university which constitutes 3.25% of the all medical students in Turkey. Methods: 1306 students studying in all classes at Gazi University Faculty of Medicine participated in this cross-sectional study. Sociodemographic data form, CES-Depression Scale (CES-D), Perceived Stress Scale (PSS), and Maslach Burnout Inventory Student Scale (MBI-SS) were applied to the participants. Results: The mean score of the MBI-SS exhaustion subscale was 15.6, cynicism was 10.4, and the efficacy subscale was 11.7. The mean score of CES- D was 21.2 and PSS was 28.3. The prevalence of depression was estimated as 64.2%. Female participants showed higher scores in PSS, but lower scores in cynicism and efficacy. For exhaustion and cynicism, 1st graders’ scores were significantly lower than all the others. For efficacy, 4th graders’ scores were significantly lower than 1st and 6th graders’. In CES-D; the 4th graders’ scores were significantly higher than the 1st and 3rd graders’. In PSS; 4th graders’ scores were significantly higher than 1sts. Conclusion: Stress, burnout, and depressive symptoms are high in medical students, especially in 4th graders and female students. It is considered to be important to raise awareness and plan preventive services on this issue.

Objective The objective of this study is to describe the current situation regarding the training, working conditions, future plans, fields of interest and satisfaction of orthopaedics and traumatology residents in Turkey. Methods A descriptive survey questionnaire consisting of 24 questions was designed to identify the problems and solution suggestions concerning training of orthopaedic residents. All orthopaedics and traumatology residents who took the 2013 Progress Testing for Speciality in Medicine (UEGS) held by Turkish Orthopaedics and Traumatology Education Council (TOTEK) were surveyed in the class at the end thereof as well as the young orthopaedic surgeons who were reached through the email groups of Turkish Society of Orthopaedics and Traumatology – Residents and Young Attendings Council (TOTBID-AGUH). Results A total of 725 residents and 132 young attendings were surveyed. The most outstanding answers are as follows: 62,7% of the respondents replied to the question “Is there a training program/Is it being applied” as “yes/yes”. It was found out that 94,3% of the respondents wanted to be involved in a rotation abroad. The “patient care” was the most common answer, with a ratio of 36,9%, to the question “What's the priority of the department you are studying in?”. Regarding work conditions, “many emergency on-calls” was found to be the most important parameter affecting life conditions (p

Introduction: We aimed to evaluate the effects of 7-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of Streptococcus pneumoniae and antibiotic resistance in children in a well-child clinic in a tertiary children’s hospital in Turkey. Methodology: We collected nasopharyngeal (NP) specimens from 557 two-month-old babies before vaccination. After the study population had received PCV7, NP samples were obtained from 135 babies. Antimicrobial susceptibility testing and serotyping were performed. Results: S. pneumoniae colonized in 48 (8.6%) of the 557 two-month-old babies before vaccination. The follow-up cohort consisted of 135 subjects. The prevalence of PCV7 strain decreased from 33.3% to 19.3% after vaccination. However, non-PCV7 types increased from 66.6% to 80.6% (p = 0.02). Of PCV7 serotypes, 19F was the most frequent serotype before and after vaccination. There was an increase in 6A and 15 of non-PCV7 serotypes after vaccination. Penicillin non-susceptible increased from 56.3% to 80.6% after vaccination (p =0.03). Serotypes 14, 18C, 9V and 6B, which were identified before vaccination, never colonized afterwards. Number of siblings and having sibling with older age of five were determined to be significant effective factors for SP colonization presence after vaccination and antibiotic use was negatively associated with pneumococcal carriage but associated with penicillin non-susceptibility. Conclusions: Nasopharyngeal carriage rate of S. pneumoniae dropped after PCV7 vaccination, and replacement by NVT pneumococci were also observed. Risk factors for nasopharyngeal carriage included household crowding and having a sibling age five years or older. Penicillin non-susceptibility increased in both VT and NVT strains.

Introduction: The aim of this retrospective study is to investigate the relationship between clinic and presence of Epstein-Barr virus (EBV) DNA and viral load by real-time polymerase chain reaction (PCR) in patients with high risk.Methods: A total of 168 samples obtained from 160 patients, hospitalized in Gazi University Hospital between March 2014 and May 2015, were included in the study. EBV antibodies were investigated by ELISA (Dia.Pro, Milano, Italy) in clinical samples of patients, and serological profiles of patients were determined. Nucleic acid isolation was performed by High Pure Viral Nucleic Acid Kit (Roche, Germany). Isolated DNAs were amplified by LightCycler® EBV Quantitative Kit (Roche, Germany) in LightCycler 2.0 (Roche, Germany) device, and results were evaluated quantitatively.Results: EBV DNA was positive for 4.2% (7/168) of the samples. The distributions of positive rates were 14.2% (1/7) for oncology, 12.5% (1/8) for intensive care units, 4.8% (4/42) for pediatric gastroenterology, and 4.1% (1/24) for pediatric hematology. Three of the patients that EBV DNA detected had liver transplant, one had non-Hodgkin’s lymphoma, one had Burkitt’s lymphoma, one had acute renal failure, and one had gingivostomatitis and pharyngotonsillitis while follow-up. In 6/7 of the samples, EBV DNA detected 104 copies/ml, and 1/7 of the samples 105 copies/ ml. The patient whose EBV DNA load was 105 copies/ml had Burkitt’s lymphoma. EBV DNA and viral capsid antigen IgM positive were detected simultaneously only in one patient (17%).Conclusion: Early diagnosis by real-time PCR is of great importance in terms of follow-up of patients by monitoring DNA amounts and prognosis. Therefore, in immunosuppressive patients who have high levels of EBV DNA, Burkitt’s lymphoma disease should be considered.

The purpose of this study was to evaluate the relationship between the plasma holoTC and serum vitamin B-12 in children and to identify a cutoff cobalamin values according to holoTC. One hundred and fifty-five children were enrolled into the study. All children were evaluated for hemoglobin, vitamin B-12, folate, ferritin and holoTC levels. Children were grouped as with low vitamin B-12 level ( 200 pg/mL, group II). Serum vitamin B-12, and holoTC levels were performed in each patient in the study. In 101 patients with low vitamin B-12 (group I) the mean holoTC was 21.74 +/- 1.14 pmol/L. In 54 children with normal vitamin B-12 (group II) mean holoTC was 44.0 +/- 2.7 pmol/L (p < 0.01). A ROC curve analysis was performed to delineate the optimum cut-off point for vitamin B-12 level and it was found to be 165 pg/mL with a sensitivity of 70% and specificity of 74%; the area under curve was 0.783 (p < 0.01). Our study displayed a positive correlation between vitamin B-12 and holoTC, and defined an optimum cutoff value for vitamin B-12 as 165 pg/mL. Further studies using the markers both MMA, tHcy and holoTC to confirm the findings are needed.

Introduction: Chronic obstructive pulmonary diseases are common causes of disease in the community and account for considerable percent of the caseload in primary health care facilities. For this reason, it is important to question and improve the knowledge of primary health care physicians. This study is designed to assess the level of knowledge for bronchial asthma and COPD of the primary healthcare physicians, both before and immediately after an educational course structured in the context of GARD Chronic Airway Diseases National Control Program. Materials and Methods: The participating physicians attended an intensive educational course on asthma and COPD. Twenty five item questionnaires for asthma and COPD were administered to the participants both before and immediately after the end of the course. Contribution of education to the level of knowledge was investigated by comparing the percentages of the correct answers in the pre-and post-test. Results: From 11 different cities, 1, NA

INTRODUCTION: Normal values of the 6-min walk distance (6MWD) for children have not been well demonstrated. This limits the interpretation of the 6MWD in children. METHODS: A cross-sectional prospective study was designed. A total of 949 (467 males, 482 females) healthy children were recruited randomly from 7 Turkish secondary schools in Ankara. The 6-min walk tests were conducted according to the American Thoracic Society guidelines. RESULTS: The mean 6MWD decreased between the ages of 12 and 14 y for both boys and girls, and then gradually increased until 17 y of age. In the best fitting and most efficient linear, quadratic, and categorical regression models, the age of the subjects, heart rate after the test, and physical activity level of the subjects were significantly related to the 6MWD. Nevertheless, these variables explained

OBJECTIVE Complementary and alternative medicine (CAM) is increasingly being used as adjunctive treatment in primary headache syndromes in many countries. In the Turkish population, no epidemiologic data have been reported about awareness and usage of these treatments in patients with headache. METHODS One hundred and ten primary headache patients attending three headache clinics completed a questionnaire regarding their headaches, the known modalities and the use and effect of CAM procedures for their headaches. RESULTS The mean age of the patients was 34.7±9.6 years (32.8-36.5). Almost two-thirds of patients had completed high school and university, and one-third of patients were housewives. Migraine without aura (45.5%) was the most frequently diagnosed type of headache followed by migraine with aura (19.1%) and tension-type headache (18.2%). In 43.6% of the patients, headache frequency was 5-10 per month. The most frequently known CAM modalities were massage (74.5%), acupuncture (44.5%), yoga (31.8%), exercise (28.2%), psychotherapy (25.5%), and rosemary (23.6%). The most frequently used CAM treatments were massage (51%) and exercise (11%). Only massage was reported to be beneficial in one-third of the primary headache patients; the other modalities were not. CONCLUSION Our findings suggest that the subgroup of primary headache patients in Turkey seek and use alternative treatments, frequently in combination with standard treatments. Neurologists should become more knowledgeable regarding CAM therapies; further randomized and controlled clinical researches with large sample sizes are needed.

The aim of the study was to evaluate the maternal mortality cases attributed to pulmonary embolism (PE). PE constituted 7.58% of maternal deaths in 2013. Risk factors for PE were present in 15 (88.2%) of the women. Five women (29.4%) were overweight, and 5 (29.4%) were obese. Four women (23.5%) had cardiac diseases. PE occurred in the postpartum period after caesarean delivery in 9 (52.9%) patients. Eleven (64.7%) of the maternal deaths were recognised as preventable. More deaths attributed to PE occurred in the postpartum period (n = 11) than the antepartum period (n = 5). One other maternal mortality case was after therapeutic abortion. Caesarean section, obesity and cardiac diseases were important risk factors. It can be suggested that monitoring all risk factors and timely recognition of related symptoms and signs with initiation of appropriate management have paramount importance for reducing maternal mortality rate related to pulmonary embolism. Increasing awareness of healthcare professionals as well as the public, and continuously reviewing the cases are also important tools for achieving this goal.

Background The limited level of HL is one of the important issues in Turkey. The validity of HLS-EU questionnaire was tested in Turkey in 2012, but it was not applied to identify the health literacy level. It is necessary to identify our society's level of health literacy and eliminate the negativities of insufficient health literacy for the individual and …

Objective: To determinate the prevalence of HPV types in patients with cervical cancers in our legion by Real time PCR and DNA sequence analysis and to make phylogenetic analysis was aimed in this study. Material and methods: From January to October 2010, cervical swap samples of 77 patients directed to colposcopy were included in the study. HPV DNA and HPV type 16 were detected by Real Time polymerase chain reaction using the L1 region. Real Time PCR amplifications of MY09/11 products were done by GP5+/GP6+ primers and Cyanine-5 labeled HPV DNA and HPV type 16 specific probe. HPV types determinate by GP5+/GP6+. Phylogenetic analysis of sequences was calculated by Kimura’s two parameters method. Statistically analyses were by using Pearson chi-square and odss ratio tests. Results: Forty seven samples (prevalence; 61%) of total seventy seven cervical samples detected as HPV DNA positive. While HPV type 16; 52%, HPV type 16+11; 4%, HPV type 16+6; 1% and non-typing HPV DNA 4% of seventy seven samples determining, 39% of samples observed as negative HPV. Participated in the study population, HPV DNA positive individuals are among 34-56 years. Most HPV DNA positivity rate of 80.0% was between the ages of 31-40. 52.2% of HPV DNA positivity between the ages of 41-50 to fall, but again, 83.3% between the ages of 51-60 to a second peak was determined that increased. 60.0% of 20 ASC-H cases, 63.8% of 36 ASC-US cases, 100% 9 of HSIL cases and 25.0% of 12 LSIL cases were positive for HPV DNA. Conclusion: The investigation of the distribution of HPV genotypes in women with cervical cancer and precancerous lesions in our region is important. Early diagnosis of HPV by using improved technological assays, play a key role to prevent the turn precancerous lesions into invasive cancers.

Norovirus causes severe gastroenteritis requiring hospitalization especially in children less than five years of age both in developed and developing countries. Therefore, we aimed to investigate the incidence of norovirus (NoV) in 0-5 years old children with acute gastroenteritis in two large hospitals in Ankara, Turkey. Stool samples were obtained from 1000 (413 female, 587 male) children between 0-5 years old with acute gastroenteritis who attended to the Department of Paediatrics, Ministry of Health Ankara Training and Education Hospital and affiliated hospital of Gazi University Faculty of Medicine between October 2004 and June 2011. Antigens of norovirus GI and GII genogroups in the stool specimens were detected by ELISA (RIDASCREEN® Norovirus (C1401) 3rd Generation, R-Biopharm, Germany). Norovirus GI and GII antigens were determined in a total of 141 (14.1%) samples, of them 62 (15%) were female and 79 (13.5%) were male, yielding no statistically significant difference (p> 0.05). The highest NoV positivity was detected in children between 12-23 months (17.1%), however there was no statistically significant difference between ELISA positivity and age (p> 0.05). NoV detection rate was highest in 2007 (18.4%) and in 2009 (18%), and the difference regarding ELISA positivity among the study years was not statistically significant (p> 0.05). The prevalences of norovirus infection in spring, summer, autumn and winter were 13.8%, 17.7%, 14.7% and 11.2%, respectively. Therefore no seasonal variation was found in the incidence of norovirus infection. However when the monthly prevalence was analyzed, a statistically significant difference was found (p< 0.05) between the rate of norovirus infection in july (24.2%) and december (4.1%). When evaluating the clinical symptoms, all of 141 patients (100%) had diarrhoea, while 72 (51.1%) had vomiting. Stool samples were also evaluated for the presence of parasitic and bacterial agents. Coinfection rate with parasites was detected as 3.3% (4/122; norovirus + Entamoeba histolytica in three cases, norovirus + Enterobius vermicularis in one case), while no pathogenic bacteria were isolated from norovirus positive stool samples. The prevalence rate of 14.1% for NoV GI/GII infection detected in this retrospective study including 0-5 years old children in Ankara for 2004-2011 period was thought to reflect the regional data and would contribute to national epidemiological data. We anticipate that the incidence of norovirus will increase in 0-5 year old children as a result of increasing use of rotavirus vaccine in Turkish children. It was concluded that, NoV antigen detection tests should be used in routine laboratories for appropriate diagnosis of sporadic and/or epidemic norovirus infections.

Background: The ratio of metastatic to dissected lymph nodes (lymph node ratio; LNR) is a sensitive and superior prognostic factor for lymph node evaluation, but its relationship to cancer subtypes is unclear. Patients and Methods: Data from 469 patients with axillary lymph node metastasis out of 640 early breast cancer cases were retrospectively analyzed. They were classified into 4 molecular subtypes; luminal A, luminal B HER2(+), HER2 overexpression, basal-like. LNRs were compared between groups and with other prognostic factors. Results: The distribution of LNRs was 35.2% in luminal A, 43.2% in luminal B HER2(+), 46.9% in HER2 over-expression, and 39.1% in basal-like. A significant difference was found between luminal A and HER2 over-expression subtypes (p = 0.023). LNR was significantly correlated with tumor size and lymphovascular invasion, but not with other prognostic factors including menopausal status, laterality, grade, and perineural invasion. An LNR of 29.8% was defined as the cut-off value, and significant differences in survival rates were identified accordingly between basal-like and both luminal A (p = 0.003) and luminal B HER2(+) (p = 0.04). Conclusion: The LNR differs between some molecular subtypes of breast cancer, and it correlates with certain prognostic factors and survival. These data support using the LNR to assess breast cancer patients.

Gebelik oncesi (prekonsepsiyonel) bakim anne ve fetus icin risk olusturan fiziksel, tibbi ve psikososyal durumlari gebelikten once saptayarak uygun sekilde cozmek veya yonlendirmek esasina dayanan bir koruyucu hizmettir. Gebelik oncesi bakim terimi, tarama ve tedavinin yani sira danismanlik kavramini da icermekte ve ozunde, eslerin sagligini ve dolayisiyla cocuk sagligi duzeyini gelistirmeyi hedeflemektedir. Gebelik oncesi bakim tum dunyada, saglik personelinin tumunun gorevi kabul edilmektedir. Turkiye’de dogum oncesi (prenatal/antenatal) bakim alaninda onemli gelismeler olmustur ancak, standart bir gebelik oncesi bakim kilavuzu henuz uygulamaya konulmamistir. Bu yazinin amaci, gebelik oncesi bakim kavramini aciklamak ve onemini dile getirmek; tum saglik calisanlarinin gozden kacirmamasi gereken, kanita dayali bicimde saptanmis evrensel gebelik oncesi bakim onerilerini ozetlemek ve ulkemizde pratik uygulamalarda kullanilabilecek bir risk belirleme listesi sunmaktir. Bu yazida dunyada gebelik oncesi bakim deneyimlerinden yola cikarak, ulusal veriler isiginda Turkiye icin gebelik oncesi tarama/destek/tedavi kapsaminda nelerin onceliklenmesi gerektigi tartisilmistir. Ayrica, gebelik oncesi bakim kapsaminda yapilmasi gereken muayeneler ile testler konusunda onermede bulunulmustur. Yazinin sonunda sunulan kontrol listesi (Gebelik Oncesi Bakim Oyku/Fizik Muayene/Tetkik Formu) saglik calisanlari icin riskleri belirleyici ve gebelik oncesi danismanlikta yonlendirici pratik bir aractir. Bu nedenle, bu derleme kapsaminda olusturulan Gebelik Oncesi Bakim Oyku/ Fizik Muayene/ Tetkik Formu ulusal gebelik oncesi bakim programimizda kullanilabilir. Anahtar Kelimeler: Gebelik oncesi bakim, gebelik, halk sagligi Preconception Care: A Public Health Perspective Abstract Preconception care is a preventive attempt to detect, solve or consult the risky physical, medical and psychosocial conditions that threaten maternal and fetal health in an appropriate way before pregnancy. The term “preconception care” covers screening, and therapy as well as counseling concepts and fundamentally intend to improve the couple’s health and consequently to improve child health status. Preconception care is accepted as a duty of the whole medical staff. In Turkey, there is considerable progress in the field of prenatal/antenatal care, but no preconception care guidelines are put into practice at present. The aim of this review is to define the preconception care, to clarify the importance of the subject, to summarize the evidence-based universal preconception care applications that no health care worker should overlook, and to prepare a practical preconception risk assessment check-list that can be used in our country. In this review, preconception screening/supplementation/treatment priorities for Turkey were discussed in the context of the preconception care experiences of the world and in the light of national data. Also, some physical examinations/ laboratory tests for preconception care were proposed. The check-list (Preconception Care History/ Physical Examination/ Laboratory Test Form) presented at the end of this review is a practical tool for health care workers to define risks and to guide preconception counseling. Thus, the Preconception Care History/ Physical Examination/ Laboratory Test Form constituted in this review can be integrated into Turkey’s national preconception care program. Key Words: Preconception Care, pregnancy, public health

Lower respiratory tract infections including mainly pneumonia represent an important public health problem leading to high mortality and mobidity rates in children aged below five years in developing countries including our country. Vitamin D deficiency has been associated with increased risk of rickets/osteomalacia, various cancers, autoimmune diseases, hyperproliferative skin diseases, cardiovascular system diseases and infectious diseases. Vitamin D has an important role in cellular and humoral immunity and pulmonary functions. Vitamin D deficiency and lower respiratory tract infection are common health problems in children in our country and no clinical study investigating the relationship between these problems has been conducted so far. In this case-control study, we aimed to assess the association between vitamin D level and lower respiratory tract infection in children.Sixty-three children aged between six months and five years with lower respiratory infections and 59 age-matched children who had no history of respiratory symptoms in the last month and no accompanying chronic disease were compared in terms of vitamin D levels. The children in the patient group were also evaluated by the clinical picture.No significant correlation was found between vitamin D levels and lower respiratory tract infection in terms of disease and its severity. However, it was found that vitamin D deficiency/ insufficiency was observed with a high rate in all children included in the study.Although no correlation was found between vitamin D level and lower respiratory tract infection, it is recommended that vitamin D level should be measured in children with lower respiratory tract infection and vitamin D supplementation should be given to all children especially in winter months based on the fact that the level of vitamin D was lower than normal in approximately half of the children included in the study and considering the effects of vitamin D on infections, pulmonary functions and immunity.

Background/aim Systemic isotretinoin treatment is an effective treatment modality for nodulocystic acne, the clinical use of which has been associated with reports of adverse events. We conducted a prospective study with the aim of determining the possible gastrointestinal and laboratory findings of nodulocystic acne patients during systemic isotretinoin treatment. Materials and methods Seventy patients with nodulocystic acne completed the study. During the monthly follow-up visits, liver function tests and lipid profiles of the patients were evaluated and gastrointestinal system complaints were examined. Results We recorded a significant elevation in liver function tests and lipid profiles of the patients, the most prominent elevation being in plasma triglyceride concentrations. We observed that nausea, dyspepsia, abdominal pain, and diarrhea were the rare gastrointestinal symptoms encountered during systemic isotretinoin therapy. Constipation and anorectal bleeding were relatively more common symptoms and there seemed to be a relation between these two symptoms. Conclusion Our study is the first to analyze the gastrointestinal findings of patients during systemic isotretinoin treatment. Dermatologists and gastroenterologists must keep in mind that, as well as known laboratory findings like hypertriglyceridemia and elevated liver function tests, systemic isotretinoin therapy may also cause significant clinical gastrointestinal findings.

Background/aim: The aim of this study was to determine the frequency of and risk factors for physical violence, verbal violence, and mobbing experienced by nurses in a university hospital. Materials and methods: This was a cross-sectional study conducted at Gazi University Medical Faculty Hospital. A questionnaire form recommended by the WHO and the International Labor Organization was administered through face-to-face interviews to determine the violence experienced in the past 12 months by nurses. Results: The prevalence of physical violence, verbal violence, and mobbing was 13.9%, 41.8%, and 17.1%, respectively. Working more than 40 h per week increased the risk of physical violence by 1.86 times. The majority of nurses who experienced verbal violence and mobbing were significantly more willing to change their work, their institution, and their profession if given the opportunity. Fewer than one-fourth of the victims indicated they reported any incident. Conclusion: We knew that the prevalence of physical violence, verbal violence, and mobbing were high among nurses and that incidents were underreported, and the study corroborated this information. What this study adds to the topic is that long working hours increased the prevalence of physical violence and was defined as an important contributory factor.

Aim: Liver biopsy is recommended in the majority of patients with chronic viral hepatitis for fibrosis evaluation. Because of the disadvantages of liver biopsy, many studies related to non-invasive biomarkers and scores have been performed. In this study, we aimed to assess the diagnostic value of serum direct markers and non-invasive fibrosis models to predict liver fibrosis in the treatment-naive chronic hepatitis B (CHB) patients and to compare their diagnostic performance. Methods: This study included 58 patients with a diagnosis of CHB virus infection and 30 healthy controls. Hyaluronic acid, tissue inhibitor of matrix metalloproteinase 1 and amino-terminal propeptide of type III procollagen were measured by enzyme-linked immunosorbent assay; and the Original European Liver Fibrosis panel, the Enhanced Liver Fibrosis (ELF) panel, PP score, aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 indexes were calculated using the formulas taken from previous publications. Fibrosis stage was determined using Ishak's scoring system. Results: The fibrosis stages identified upon liver biopsy was F0 in 12 patients (20.7%), F1–2 in 36 (62.1%) and F3–5 in 10 (17.2%). The diagnostic value of all the non-invasive indices was low to detect mild fibrosis. We demonstrated that the diagnostic accuracy of HA is the best for predicting fibrosis of F3 or more (area under the receiver–operator curve, 0.902). In our study, the results from a combination of tests showed that ELF and APRI had the highest diagnostic value sensitivity of 90%, specificity of 100%, positive predictive value of 100% and negative predictive value of 96.4% for detection of fibrosis of F3 or more. Conclusion: In CHB patients, combination of ELF and APRI has a better diagnostic value in predicting fibrosis of F3 or more.

Amac : Okul caginda saglik sorunlarina neden olan etmenlerin en onemlilerinden biri yetersiz hijyen uygulamalaridir. Okulda verilecek egitim sonucu, dogru saglik aliskanliklarinin kazandirilmasi ile bu problemin onune gecilmesi mumkundur. Yapilan bu calismada Ankara’da bir kiz meslek lisesindeki ogrencilerin menstruasyon hijyeni konusunda bilgi ve tutumlarini saptamak ve bu sonuclar dogrultusunda uygulanan egitim programinin etkinligini degerlendirmek amaclanmistir. Yontemler : Arastirma mudahale tipindedir. Ankara ilinde gecekondu bolgesindeki bir kiz meslek lisesinin 9, 10, 11’inci siniflarinda okuyan toplam 373 ogrencisinin tamami alinmistir. Calisma grubunu veri toplama surecinde okulda bulunan ve egitimden once (EO) ve egitimden 3 ay sonra (ES) anket formlarini yanitlayan n=293 ogrenci (%78.5) olusturmaktadir. Her uc anket uygulamasi da gozlem altinda yapilmistir. Bulgular : Ogrencilerin %87.3’u 15-17 yas grubundadir. Annelerinin %7.8’inin okur-yazar olmadigi, %73.3’unun de okur-yazar ya da ilkokul mezunu oldugu; babalarinin ise, %53.9’unun ilkokul mezunu, %26.6’sinin ortaokul mezunu oldugu bulunmustur. Annelerin %94.9’u ev hanimi, babalarin %40.6’si isci, %2.0’i da issizdir. Ogrencilerin menstruasyon ve perine hijyeniyle ilgili bilgi duzeylerinin dusuk oldugu saptanmistir. Eksiklikler gorulerek gelistirilen egitim programi uygulandiktan 3 ay sonraki bilgi ve tutum degerlendirmesinde; bazi konularda istatistiksel olarak anlamli gelismeler saglanmis, bazi konularda ise gelisme elde edilememistir. Bunun sebebi konferans seklinde verilmis olan egitimin kalici davranis degisiklikleri olusturmada etkinliginin kisitli olmasi olabilir. Sonuc : Arastirmadan elde edilen sonuclar dogrultusunda, ogrencilerin dogru bilgi ve davranislarinin arttirilmasi icin; perine ve menstruasyon hijyeni konusunda, dogru kaynaklardan ornegin saglik personeli ya da bu konuda ozel egitim almis ogretmenler gibi profesyonel kisilerden bilgi almasi saglanmalidir. Bu amacla toplum sagligi merkezleri tarafindan okullarda egitim programlari duzenlenmeli ya da ogretmenler egitilerek ogrencilere egitim programlari yapmalari saglanmalidir. Verilecek egitimler kucuk gruplar seklinde yapilmali, gorsel materyaller icermeli ve uygulamali olarak yapilmalidir. Anahtar Kelimeler: Menstruasyon hijyeni, egitim, lise ogrencileri Knowledge of and Attitude to Menstrual Hygiene of Students in a Vocational School and Evaluation of the Effectiveness of the Training Objective : One of the most important factors causing health problems is poor hygiene practised during school age. This problem can be prevented by acquiring correct health habits, as a result of training. In this study, the aim is to determine the knowledge and attitude towards menstrual hygiene of girl students in a vocational school for girls in Ankara and to evaluate the effectiveness of the training implemented in accordance with these results. Methods : Study was planned as intervention, all of the 373 girl students in the 9, 10, 11th classes in a girls’ vocational high school in slums in Ankara were included in the study. The study group consisted of n=273 students (78.5%) who were at school at the time of data collection, and answered the questionnaire before training (BT) and 3 months after training (AT). All three questionnaires were applied under observation. Results : 87.3% of the students were in the 15-17 age group. It was found that 7.8% of the mothers were illiterate, 73.3% were literate or primary school graduate; 53.9% of the fathers were primary school graduate, 26.6% were secondary school graduate. 94.9% of the mothers were housewives, 40.6% of the fathers were employees and 2.0% were unemployed. It was determined that the students’ level of knowledge about menstruation and perineal hygiene was low. On assessing the knowledge and attitude 3 months after application of developed training program by detecting gaps, statistically significant improvements were achieved in some issues, and in some issues no change was obtained. This may be due to the limited effectiveness of the training in a form of a conference on changing behaviours. Conclusion : In accordance with the results of the study, in order to increase the correct knowledge and behavior about perineal and menstrual hygiene, information should be provided from the proper sources such as professional people like health workers or teachers with special training in this regard. For this purpose, training programs should be provided in schools by community health centers or teachers with training. The training should be organized in small groups and must include visual materials. Key Words: Menstrual hygiene, training, high school students

This study determines the frequency of the spousal domestic violence among 1,178 married women who applied to some first level medical institutions located in Ankara, the capital of Turkey. 77.9% (n = 918) of the women who participated in the study have stated that they have been exposed to at least one of the types of spousal violence during their lifetime. The most reported type of domestic violence suffered by women throughout their lives is economic violence (60.4%). The prevalence of controlling behaviors, emotional violence, physical and sexual violence are 59.6%, 39.7%, 29.9% and 31.3% respectively.

The purpose of this study was to evaluate the perceptions and attitudes about child neglect of a group of mothers, in Ankara, Turkey, and to determine the factors affecting perception and attitudes of these mothers about child neglect. A questionnaire consisting of 15 scenarios about perception of child neglect and 12 behavioral descriptions about attitudes was given to the mothers of 513 children between 0 and 5 years who were followed in the Gazi University Well-Child Clinic. High scores indicated better perception and positive attitudes about child neglect. The scores revealed that child neglect perception scores of the mothers were lower when his or her spouse's education levels were 8 years or lower, the mother was not working, the family's monthly income was low, and the parents smoked at home. Child neglect attitude scores were low when the mother's or her spouse's education levels were 8 years or lower, the father was unoccupied, the family's monthly income was low, the parents smoked at home, the birth order of child was high, and the child's medical history revealed he or she had had previous accidents. For building effective preventive strategies, traditional community perspectives and cultural characteristics concerning child neglect should be understood.

The effect of ionizing irradiation on testes and the protective effects of melatonin were investigated by immunohistochemical and electron microscopic methods. Eighty-two adult male Wistar rats were divided into 10 groups. The rats in the irradiated groups were exposed to a sublethal irradiation dose of 8 Gy, either to the total body or abdominopelvic region using a Co-60 source at a focus of 80 cm away from the skin in the morning or evening together with vehicle (20% ethanol) or melatonin administered 24 h before (10 mg/kg), immediately before (20 mg/kg) and 24 h after irradiation (10 mg/kg), all ip. Caspace-3 immunoreactivity was increased in the irradiated group compared to control (P < 0.05). Melatonin-treated groups showed less apoptosis as indicated by a considerable decrease in caspace-3 immunoreactivity (P < 0.05). Electron microscopic examination showed that all spermatogenic cells, especially primary spermatocytes, displayed prominent degeneration in the groups submitted to total body and abdominopelvic irradiation. However, melatonin administration considerably inhibited these degenerative changes, especially in rats who received abdominopelvic irradiation. Total body and abdominopelvic irradiation induced identical apoptosis and testicular damage. Chronobiological assessment revealed that biologic rhythm does not alter the inductive effect of irradiation. These data indicate that melatonin protects against total body and abdominopelvic irradiation. Melatonin was more effective in the evening abdominopelvic irradiation and melatonin-treated group than in the total body irradiation and melatonin-treated group.

Summary The aim of this study was to evaluate the effects of ‘baby-friendly hospital initiative’ (BFHI) on breast feeding.In the four consecutive months after BFHI in Gazi University Hospital (November 2002–February 2003), breast feeding status until the second year of life in 297 babies, born in the same hospital was compared with the values of 258 babies born before BFHI (November 2001–February 2002).The exclusive breast feeding rate in the first 6 months was higher in the babies born after BFHI. Cox regression analysis revealed that BFHI increases the duration of breast feeding 1.5 times. At the end of the second year, cumulative rate of breast feeding was higher in the group after-BFHI (p = 0.0036).The rate of breast feeding was increased by BFHI implementation.

Recently a parvovirus called bufavirus (BuV) has been implicated as a causative agent of diarrhoea. To further reveal the epidemiology and genetic characteristics of BuV, this study was performed in Turkish children with diarrhoea. BuV was detected in 1.4% (8/583) of stool samples. All stool samples from healthy children (n = 148) were negative for BuV. Diarrhoea in BuV-positive patients was severe and occurred mainly during the colder months of the year. Complete genome sequences were generated from four BuVs. Only BuV3 was found, which was genetically and phylogenetically similar to Bhutanese BuV3, indicating that BuV3 is prevalent in Asian countries.

Objective: To evaluate the correlation between cyclooxygenase-2 (Cox-2) expression and clinicopathologic findings with the effect of these variables on prognosis of bladder cancer. Methods: Cox-2 expression was examined immunohistochemically in paraffin blocks of 99 patients. Correlations between Cox-2 expression and variables like cancer stage and grade, number of mitoses, angiolymphatic invasion, number and size of the lesions were determined. Results: Cox-2 expression was detected in 52 (52.5%) patients. Univariate regression analysis between Cox-2 expression and clinicopathologic findings showed a significant correlation only in the pathologic stage of the patients (p = 0.048) (OR =2.64, CI = 0.97–7.81). Multivariate regression analysis in stage T1 revealed an increasing number of mitoses as an independent prognostic factor for recurrence (p = 0.002) (OR = 1.5, CI = 1.16–1.92) and progression (p = 0.030) (OR = 8.23, CI = 1.22–55.27) although a prognostic factor was not found for progression in stage T2. Conclusion: Univariate analysis showed that only the pathologic stage correlated significantly with Cox-2 expression. Cox-2 expression revealed a significant relation with patient prognosis in stage T2 but not in stage T1. These results support the fact that Cox-2 inhibitors may play a role in progression of invasive bladder tumors.

Studies about defecation patterns have been mostly conducted on infants who were breastfed in a short term but were fed predominantly with formula. In this study, defecation patterns of 125 infants, most of them being breastfed during 12th month were evaluated.Frequency, consistency and color of the stool were analyzed in relation to the feeding pattern at the 15th day and at the 1st, 2nd, 3rd, 4th, 5th, 6th and 12th months.Frequency of defecation was highest in 15th day with a median of 6/day. It decreased with age (p=0.0001), being 4/day and 3/day in 1st and 2nd months respectively, and 2/day between 3rd-12th months. During first 5 months, the stool frequency was higher in infants who were exclusively breastfed compared to those being fed with breastfed and formula (p0.05). The effect of the feeding pattern on stool frequency disappeared in the following months (p0.05). Stool frequency decreased by half at the 2nd month when the rate of less than once/day attained its highest value (24.8%). In those who had a rate of less than once/day, stool frequency stayed low until the 6th month and exclusively breastfed rate was also found lower (p0.05).Besides the age, exclusive breastfeeding was also effective on stool frequency. It points out that infants who are fed with formula in addition to breastfeeding may defecate less than once per day hence should not be diagnosed as having constipation depending solely on defecation frequency and should not receive unneccesary treatments.

Background: Angiogenesis is essential for tumour growth and metastasis. Vascular endothelial growth factor (VEGF) has been suggested as the major angio­genic factor in breast carcinoma. Both insulin-like growth factor-I (IGF-I) and prolactin are involved in the progression of breast cancer at least partly by stimulating angiogenesis. Aim: The aim of the present study was to investigate the association between serum IGF-I, VEGF and prolactin levels and clinicopathological characteristics of breast carcinoma. Methods: Serum IGF-I, VEGF and prolactin levels were measured in breast cancer patients and controls and these levels were compared with well-known clinicopathological characteristics of breast carcinoma, including tumour size, axillary lymph node and oestrogen/progesterone receptor status, tumour grade and disease stage. Results: Serum prolactin, VEGF and IGF-I levels were found to be similar in breast cancer patients and control subjects (P > 0.05). When the patients were divided into groups according to their tumour size, axillary lymph node status, tumour grade, oestrogen/progesterone receptor status and disease stage, no significant differences in serum prolactin, VEGF and IGF-I levels were found among the groups (P > 0.05). Conclusions: The present study failed to demonstrate an association between serum levels of VEGF, IGF-I and prolactin and well-known clinicopathological characteristics of breast carcinoma. (Intern Med J 2004; 34: 310−315)

The aim of this cross-sectional study was to determine the prevalence of epilepsy in Turkey among children between the ages of 0 and 16 years. The study population consisted of 24,773,569 children living in Turkey. Because the prevalence of childhood epilepsy is reported to be 0.001 to 1% in the literature, the sample size was determined as 48,260, with 0.05 error type I and 0.10 error type 2 (power 0.90), and the effect size was 2. With the cluster sampling method, samples were selected from cities, towns, districts, and villages, and 46,813 (97%) children were reached. The study questionnaire contained sections with individual informational questions and questions for the selection of suspected epilepsy cases and physical examination results. The epilepsy classification was designed according to the classification of the International League Against Epilepsy (ILAE). The prevalence of epilepsy was determined as 0.8%; 55.2% of the subjects with epilepsy were grouped as generalized, 39% as partial, and 5.8% as unidentified. Age, place of residence, route of delivery, place of delivery, and social and economic status had no statistically significant effect on the development of epilepsy. Male gender, preterm, and post-term delivery increased the risk of developing epilepsy. Early diagnosis and treatment of epilepsy, as well as the education of health workers and families, are very important. (J Child Neurol 2004;19:271-274).

Interleukin-18 (IL-18) is a multifunctional cytokine that was previously termed interferon-gamma-inducing factor. It has been suggested that serum IL-18 level may be used as a prognostic factor in some cancer types. Nitric oxide is a potent biologic molecule involved in the pathogenesis of cancer. In this study, we measured serum IL-18 and nitrate + nitrite levels in 56 patients with nonmetastatic breast cancer and 14 control subjects. Serum IL-18* and nitrate + nitrite** levels were significantly higher in patients with breast cancer when compared to the control subjects (*p < 0.05, **p < 0.001). Serum IL-18 levels were significantly higher in patients whose tumor size was greater than or equal to 5 cm when compared to patients whose tumor size was less than or equal to 2 cut (p < 0.05). Patients who were axillary lymph node negative (ALN) had lower serum IL-18 levels when compared to patients with positive ALN (p < 0.001). Serum IL-18 levels were significantly higher in patients with stage 1113 or IIIA when compared to patients with stage I or IIA (p < 0.05). There was no significant difference in serum nitrate + nitrite levels in terms of age, tumor stage, estrogen receptor, and menopausal and ALN status (p > 0.05). In conclusion, serum IL-18 level may be a useful marker to predict prognosis of patients with breast cancer in complete remission after surgery. Long-term follow-up is required to clarify this hypothesis.

Background and aims. The impact of a stoma on a patient's life is little discussed and is often underestimated, as well as the contribution of stomatherapy to health-related quality of life (QOL). This present study examined the problems faced by patients with ileostomies or colostomies and the possible contribution of stomatherapy to QOL. Patients and methods. Forty-three selected and well-documented stoma patients who had properly constructed, well functioning end colostomies or ileostomies were analyzed. Further analyses were carried out for the subgroups of patients with irrigating colostomies (n=16), nonirrigating colostomies (n=15), and ileostomies (n=12). The digestive disease QOL questionnaire 15 (DDQ-15) was used to analyze QOL before and 3 months after stomatherapy. A second questionnaire consisting of 11 questions with yes/no answers was also used before and 3 months after stomatherapy to define more specifically the stoma-related problems of each patient as well as the frequency of each issue in a patient group at a given time. Results. Cumulatively the mean QOL score was significantly higher after stomatherapy than before. Before stomatherapy the irrigating colostomy patients had the highest QOL score and the ileostomy group the lowest. QOL scores 3 months after stomatherapy were significantly higher in all groups than before. Again, the irrigating colostomy patients had a significantly higher score than the nonirrigating colostomy and ileostomy patients. Cumulatively all of the items improved significantly after stomatherapy, such as getting dressed, bathing, and participating in sports. Conclusion. These findings confirm that colostomy or ileostomy has a profoundly negative impact on QOL. Specialized counseling of these patients by a dedicated team improves QOL significantly.

Objective: The aim our study was to establish a core curriculum (CC) for spine surgery incorporating knowledge, skills and attitudes to help define spine surgery as a medical specialty and serve as a guide for specific spine surgery training.Methods: A committee was established to prepare the CC. Five modules were established; Basic Sciences, Spinal Trauma, Degenerative Spine Diseases, Destructive Spine Pathologies and Spinal Deformity. Prepared CC modules were evaluated in a consensus meeting, translated and reevaluated in a second consensus meeting before being accepted as final.Results: In the five modules, 54 subject headings (19 for Basic Sciences, 10 for Spinal Trauma, 4 for Degenerative Spine Diseases, 4 for Destructive Spine Pathologies and 17 for Spinal Deformity) and 165 specific subjects (59 for Basic Sciences, 32 for Spinal Trauma, 10 for Degenerative Spine Diseases, 23 for Destructive Spine Pathologies and 41 for Spinal Deformity) were defined. Learning outcomes and entry and exit criteria were defined for all subjects.Conclusion: This CC may form the basis of spinal surgery training, defining spinal surgery as a medical specialty and help us spine surgeons to develop better defined identities, Amaç: Bu çalışmanın amacı omurga cerrahisi için bilgi, beceri ve yaklaşımları bir araya getiren bir çekirdek müfredat oluşturmaktı. Bu müfredat omurga cerrahisini tıbbi bir uzmanlık alanı olarak tanımlamaya yardımcı olacak ve özel bir omurga cerrahisi eğitimine yönelik bir kılavuz işlevi görecektir.Çalışma planı: Bir çekirdek müfredat komitesi kuruldu. Bu komite, müfredatı; Temel Bilimler, Spinal Travma, Dejeneratif Omurga Hastalıkları, Destrüktif Omurga Patolojileri ve Omurga Deformitesi adı altında 5 modüle bölerek hazırladı. Hazırlanan çekirdek müfredat modülleri bir konsensüs toplantısında değerlendirildi, tercüme edildi ve nihai olarak kabul edilmeden önce ikinci bir konsensüs toplantısında tekrar değerlendirildi.Bulgular: Beş modül içerisinden, (Temel Bilimler için 19, Spinal Travma için 10, Dejeneratif Omurga Hastalıkları ve Destrüktif Omurga Patolojileri için 4’er ve Omurga Deformitesi için 17 olmak üzere) toplamda 54 konu başlığı ve bunlara ait 165 konu (Temel Bilimler için toplam 59, Spinal Travma için 32, Dejeneratif Omurga Hastalıkları için 10, Destrüktif Omurga Patolojileri için 23 ve Omurga Deformitesi için 41) belirlendi. Bu konuların her biri için öğrenme çıktıları ve giriş ve çıkış kriterleri tanımlandı.Çıkarımlar: Omurga cerrahisini bir tıbbi uzmanlık alanı olarak tanımlayan bu çekirdek müfredat çalışması omurga cerrahisi için bir temel oluşturabilir ve biz omurga cerrahlarının daha iyi tanımlanmış kimlikler geliştirmesine yardımcı olabilir.

Aim Dysadherin is a cell adhesion molecule that related with aggresiveness and progression in many cancers. Dysadherin acts role either with E-cadherine dependent or CCL-2 mediated that E-cadherin independent. We studied expression and clinical importance of dysadherin and e-cadherin as adhesion molecules and CCL2 in RCC. Method Between 2006 and 2010, 38 patients with RCC were evaluated retrospectively. Median age of the patients (27 male, 11 female) was 60 (range, 33–84). While median tumor size was 5.75 cm (range, 2–30 cm), 13 patients were stage 4, one patient was stage 3, 5 patients were stage 2, 19 patients were stage 1. 15 patients were Fuhrmann grade ¾, 21 patients (55.3%) had capsule invasion, 10 patients (26.3%) had perirenal fat tissue involvement and 4 patients had (10.5%) renal vein thrombosis. Dysadherin did not express in 10 patients. Low expression (less than %30) was detected in 25 patients (65.8%), enhanced expression (more than 30%) was detected in 3 patients (%7.9). E-cadherin did not express in 11 patients (28.9%), low expression was detected in 23 patients (60.5%), moderate-high expression was detedcted 4 patients (10.6%). CCL2 did not express in 14 patients, low expression was detected in 7 patients (%18.4), moderate-high expression was detected in 17 patients (44.3%). Although moderate positive correlation between dysadherin and CCL2 (r= +0,25, p = 0.49), e-cadherin and CCL2 (r= +0.25, p = 0.33) were detected, moderate negative correlation between dysadherin and e-cadherin was detected (r= +0.22, p = 0.66). Moderate negative correlation was detected between grade of tumor and e-cadherin (r= -0.25, p = 0.49). Median overall survival (OS) was 46.6 months (range, 38.9-54.3), In univariate analysis, stage, grade of tumor, capsule invasion, tumor thrombosis, perirenal fat tissue involvement were significant interaction on OS (p 0.05). Stage and vascular thrombosis were significant on overall survival in multivariate analysis. Conclusion This is the first study that evaluated adhesion molecules in RCC and there is no association these parameters and clinical outcome. Disclosure All authors have declared no conflicts of interest.

Objective Cystic echinococcosis (hydatid cyst) is one of the most important parasitic zoonoses that affect both humans and animals and has been known since prehistoric times. The cystic echinoccosis is a major health problem in our country as well as in many countries worldwide, and serological methods, in addition to imaging techniques, are used in the diagnosis of hydatid cyst. In the present study, anti- Echinococcus antibodies were investigated by ELISA in patient's serum samples, which were routinely delivered to the Medical Microbiology Laboratory of Gazi University Faculty of Medicine due to suspected hydatid cyst. Methods A total of 186 patients with suspected hydatid cysts from several outpatient clinics and departments of Gazi University Hospital were included in the present study. IgG antibodies in serum samples of patients with anti-Echinococcus were investigated by ELISA (Novalisa Echinococcus IgG, NovaTec, Germany). Results Anti-Echinococcus IgG seropositivity was determined as 35.5% in patients with suspected hydatid cyst. There are no statistical differences in ELISA positive results relating to gender, adult/child age group and associated clinics. Conclusion Hydatid cyst seropositivity was higher among patients admitted to our hospital.

Background: We aimed to investigate the impact of adjuvant systemic therapy with modern chemotherapy combinations on survival outcomes in patients with resected liver-confined metastases from colorectal carcinomas, and whether addition of bevacizumab (BEV) provides further benefit. Methods: A total of 229 consecutive patients who underwent resection for liver-confined colorectal liver metastases were retrospectively analyzed. Results: Of 229 patients, 204 who received chemotherapy with fluoropyrimidine-based (n = 27), irinotecan-based (n = 84) and oxaliplatin-based (n = 93) combinations were analyzed. Among these, 87 patients received BEV while 117 did not (NoBEV). With a median follow-up of 27 months after metastasectomy, the median recurrence-free survival (RFS) and overall survival (OS) were 17 and 53 months, respectively. OS rates at 3 and 5 years were 71% and 40%, respectively. No significant differences were found in the median RFS (p = 0.744) and OS (p = 0.440) among different chemotherapy regimens. The median RFS (p = 0.375) and OS (p = 0.251) were similar in BEV and NoBEV arms. In multivariate analysis, having 4 liver metastases was the only negative independent factor on both RFS and OS, while positive surgical margin was another negative independent factor for RFS. Conclusion: Chemotherapy type and addition of BEV have no impact on both RFS and OS in the adjuvant setting following complete resection of colorectal liver metastases.

Our aim was to evaluate effectiveness of pandemic influenza A/H1N1 vaccine in preventing acute otitis media (AOM) and/or otitis media with effusion (OME), in a randomized, prospective and single-blind study conducted in the children aged of 6–60 months. This study was done between December 1, 2009 and April 30, 2010 during the pandemia between June 2009 and May 2010. On the healthy children, vaccinated against pandemic influenza A/H1N1 and age-matched unvaccinated controls, the rate of AOM, OME, and any otitis media (OM) attack (sum of AOM and OME attacks) confirmed by otoscopic and tympanometric examination, and their associations with risk factors were looked for. Otoscopic and tympanometric evaluation was done twice within the follow-up period of 4–8 weeks. Totally 46 vaccinated and 46 unvaccinated healthy children were enrolled. No difference in rates of AOM, OME, or OM was found between vaccinated and unvaccinated children. But logistic regression analysis revealed that unvaccinated children had 2.9-folds more risk for OME and OM, but not for AOM. Further, male gender and bottle feeding and/or using pacifier revealed significant relationships with AOM. Conclusion: We conclude that pandemic influenza A/H1N1 vaccine prevented OME rather than AOM attacks in children with 6–60 months of age.

Objectives : To determine the prevalence of primary monosymptomatic nocturnal enuresis (PMNE) and assess risk factors that can cause this disease. Methods : After the determination of 15 primary schools in the provincial center of Ankara, questionnaires were given to 15,150 students to be answered by their parents. Detailed urologic history was obtained and physical examination applied to the students whose parents answered the questionnaire. After excluding children with polysymptomatic NE, 14060 questionnaires of MNE patients were evaluated. Demographic features with social and medical history of students and their parents, general approach of family to the children, school success of the students and general behavioral attitudes, method of toilet training and the presence of nocturnal enuresis were questioned. Results : MNE was determined in 9.0% (n: 1266) of the students and nocturnal enuresis frequency was higher in boys than girls (P< 0.05). Univariate analysis revealed gender, method of toilet training, sleep problems, school success, and general approach of the family to children and general behavioral attitudes of the children as significant factors. In logistic regression analysis; age, male gender, toilette training with threatening method, deep sleeper, sleep walking, being introverted and shy, significantly increases the risk of nocturnal enuresis. Conclusions : The current study suggests that the methods of toilet training are extremely important to prevent bedwetting and behavioral disorders due to enuresis. Parents should be well-informed about the appropriate toilet training method.

Background Type 2 diabetes mellitus (DM) is a significant cause of morbidity and premature mortality especially in adults. In Turkey, there are few studies on DM incidence. This study aimed to determine the incidence of type 2 DM in women 15 years or older in Turkey. Methods This prospective cohort study was performed from December 2002 to May 2003. Preliminary population-based screening was performed in 1997 and 1998 on women 15 years or older living in 4 villages in the Gölbaşı, Ankara province. Five hundred sixty-three women who were considered nondiabetic in the first study comprised the population for the present study. Data collection was accomplished by using a questionnaire and randomly measuring the blood glucose levels of the women. The χ2 and Fisher exact tests were used to analyze the risk factors for DM. Results The 5-year incidences of type 2 DM, impaired glucose tolerance, and impaired fasting glucose were 2.3%, 0.4%, and 0.7%, respectively. The 5-year incidence of type 2 DM increased with age ( P < 0.05). The DM incidence was 6.2% in those with mixed-type hypertension and 4.0% in those with a body mass index of 30 kg/m2 or higher. At 5-year follow-up, age (≥35 years), hypertension, and body mass index (≥30 kg/m2) were the risk factors for incidence of abnormal glucose metabolism ( P < 0.05). Conclusions The incidence of abnormal glucose metabolism in this study is in accord with that in the literature. Our results will contribute to our understanding of the incidence of DM in women in Turkey.

Our study aimed to determine anti-HBc total (IgG+IgM) seroprevalence in the adult population aged >= 15 and to compare the cost of testing for HBsAg and anti-HBs in only anti-HBc positive (+) subpopulation to that in the whole population for HBV screening. The study involved a face-to-face survey and peripheral blood sampling from 452 adult subjects for HBV tests. HBV-DNA PCR was studied only in anti-HBc(+)subjects. Of the 452 subjects anti-HBc total was positive in 192 (42.47%), of which: (a) 27(14.06%) were HBsAg(+), anti-HBs negative (-), (b) 126(65.62%) were HBsAg(-), anti-HBs(+), (c) 39 were HBsAg(-), anti-HBs(-). This last group (c) were tested for HBV-DNA PCR and six (15.38%) were positive. When we perform HBsAg and anti-HBs tests in all 452 subjects as in routine practice in blood banks, the cost is 3320 Euros. However, when all subjects are tested for anti-HBc total at first and then only anti-HBc total(+) ones are tested for HBsAg and anti-HBs, the cost is 2929 Euros. The cost difference between the two methods is 391 Euros for 452 subjects. Accordingly, our HBV screening algorithm brings a financial saving of 11.78% and helps to identify the isolated anti-HBc total(+) subjects who carry potential risk for spreading HBV. (C) 2010 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Epilepsy is one of the most common serious chronic brain disorders of childhood and carries a strong social stigma. It has been generally accepted that educational programs can be beneficial in reducing the stigma of a number of chronic diseases such as epilepsy. In this article, we describe the first Turkish survey of primary school students' knowledge of and attitudes toward epilepsy and the effect of an epilepsy education program on the understanding of epilepsy in schoolchildren attending three different upper-middle schools in the city of Ankara. The epilepsy education program was found to be associated with a significant increase in knowledge of and positive attitudes toward epilepsy. In addition, students at higher socioeconomic levels performed better on both pre- and posttests. This emphasizes the importance of an educational program and the need for continued information and support for education about epilepsy. (C) 2009 Elsevier Inc. All rights reserved.

Background: Surgical resection followed by radiotherapy used to be the standard treatment in malignant gliomas. Recently, temozolomide has become a cornerstone in the treatment of these patients. We evaluated retrospectively the efficacy and the toxicity of temozolomide which was administered concomitantly with radiotherapy, and thereafter as consolidation treatment. Patients and Methods: Medical records of 64 patients with malignant glioma were reviewed. Postoperatively, temozolomide was given at a dose of 75 mg/m(2)/day concomitantly with cranial radiotherapy. After 4 weeks of rest, patients were treated with temozolomide 200 mg/m(2) on days 1-5 every 28 days for 6 cycles. Results: 62 patients were evaluable for response and toxicity. Objective response rate was 38.7% including 7 (11.3%) complete responses, and 17 (27.4%) partial responses. Median progression-free survival, and overall survival have not yet been reached in the grade III astrocytoma group at a median follow-up of 19 months. In the glioblastoma multiforme group, median progression-free survival, and median overall survival were 10 and 19 months, respectively. 2-year survival rates were 80% and 19% for the grade III astrocytoma, and for the glioblastoma multiforme groups, respectively. Toxicity was mild to moderate with rare grade 4 toxicities. Conclusion: Our data suggest that temozolomide is an active regimen for malignant gliomas. It was more effective in younger patients with better performance status.