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This study, it was aimed to determine the need for disease management in diabetes in Turkey and to reveal the recommendations for diabetes disease management policies as part of the identified needs. In this study, the research design was planned as a case study and, the snowball sampling method was used as part of the scope of qualitative research. A total of 21 individuals, 6 doctors, 3 diabetic nurses, 6 academics, and 6 adult diabetics were actualized using semi-structured forms with a thorough interview technique. The data collected were evaluated with descriptive analysis and content analysis methods. In the analysis of the data, the “Nvivo 12. Program” was used. The findings were discussed based on the relevant literature, and conclusions and recommendations were reached in line with the research purposes. The participants stated that the practices related to disease management in diabetes have improved compared to the past, but that the development process should continue. The participants stated that there is a need for a multidisciplinary systematic process structuring that will prioritize the patient and their needs and that will help patients to live their lives healthy and free from complications. In terms of the burden of disease, diabetes is a significant issue that affects both Turkey and the rest of the world. We propose that the health policy, health service delivery, health system structure, and multidisciplinary work related to the disease management approach in diabetes in Turkey should be determined and steps should be taken to improve it.

Coronavirus disease 2019 or COVID-19 caused by novel coronavirus/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or 2019-nCoV) is an ongoing pandemic that has emerging global effects and requires rapid and reliable diagnostic testing. Quantitative reverse transcription-polymerase chain reaction (q-RT-PCR) is the gold standard method for SARS-CoV-2 detections. On the other hand, new approaches remedy the diagnosis difficulties gradually. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) as one of these novel approaches may also contribute to faster and cheaper field-based testing. The present study was designed to evaluate this rapid screening diagnostic test that can give results in 30-45 min and to compare the effectiveness of LAMP to the q-RT-PCR. The 30 randomly chosen patient samples were generated by nasopharyngeal swabs with a portion of the SARS-CoV-2 nucleic sequence. The sample of quantification cycle (Cq) values was tested using RT-LAMP as well as by conventional q-RT-PCR. The patient samples were tested with four different kits (SENSObiz COVID-19 [SARS-CoV-2] LAMP Assay, the QIAseq DIRECT SARS-CoV-2 kit, Biospeedy SARS-CoV-2 Variant Plus kit, and CoVirion-CV19-2 SARS-CoV-2 OneStep RT-PCR kit) and two different PCR devices (GDS Rotor-Gene Q Thermocycler and Inovia Technologies GenX series). Based on 30 patient samples, the positive/negative ratio (P/N) was 30/0 as Biospeedy and Covirion (positivity 100%), 28/2 as Qiagen kit (positivity 93.3%) for the samples studied on the Inovia device while the same samples on the Rotor-Gene device were 30/0 as Biospeedy and Covirion (positivity 100%), 29/1 as Qiagen kit at the first day (96.7%). On the fifth day, the samples were studied in the Inovia device and the respective results were obtained: 27/3 as Biospeedy (positivity 90%), 16/14 as Qiagen (positivity 53.3%), 28/2 as Covirion kit (positivity 93.3%). When these samples were studied in the Rotor-Gene device, it was 29/1 in Biospeedy and Covirion (positivity 96.7%), 19/11 in the Qiagen kit (positivity 63.3%). When these samples were compared with the LAMP method it was found to be 19/11 (positivity 63.3%) on the first day and 18/12 (positivity 60%) on the fifth day. SARS-CoV-2 test studies will contribute to a proactive approach to the development of rapid diagnosis systems. The LAMP approach presents promising results to monitor exposed individuals and also improves screening efforts in potential ports of entry.

It has been reported that the tensions, incoordination and incompatibility between the central and local government, and the disconnection in the institutional capacity in the fight against the COVID-19 epidemic, adversely affected the epidemic management. This study was carried out to evaluate the centralization and decentralization practices in the management of the COVID-19 health crisis in the world within the scope of the literature. With the spread of COVID-19 around the world in 2020, most governments have had to take drastic central measures to reduce the spread of the virus. It was emphasized that the measures taken in most countries in the early stages of the epidemic were not taken in coordination with the local units, causing incompatibilities with the local. As of 2021, due to the different experiences of the local effects of the epidemic during the pandemic process, it has been observed that the measures applied in the countries against the epidemic differ according to the local and regions. Ensuring that coordination and harmony between central government and local government/units are important that is explained by the fact that the local effects of the epidemic are different (infection rate, population density, effectiveness of the measures taken, etc.). During the COVID-19 process, it has been observed that countries have different centralization and decentralization practices suitable for their own conditions. It is reported that the simultaneous and complementary coordination of centralization and decentralization in governance in COVID-19 and similar crises will prevent complexity at management levels and positively affect the effective management of the crisis.

COVID-19 is a devastating disease, and its control is difficult due to its high transmissibility rate and a long incubation average period (6.4 days). Additionally, more than half of the infected patients were asymptomatic young people or children. The asymptomatic virus transmission is the actual challenge to controlling the disease. Because of limited treatment options, diagnosis techniques have been the first focus all over the world, involving q-RT-PCR as a gold standard, serological tests, point of care studies, or RT-LAMP. Generally, nasopharyngeal, and oropharyngeal samples are preferred clinically as sources. However, alternative sources are being researched, particularly for healthcare professionals who have difficulty taking samples, patients who are afraid of giving samples, and pediatric patients. Herein, physiological saline has been utilized to offer an alternative source besides the swab samples for use in q-RT-PCR. In this study, 212 randomly chosen patients' samples were studied, and we evaluated the concordance and accurate q-RT-PCR results in two different sources, obtained from swab and gargle samples of patients. Herein, physiological saline is utilized, which is widely used medically as a recommended irrigating and wound dressing solution. We obtained in our experiments with this method, the confidence interval determines 74.50% positivity when compared to the routine q-RT-PCR procedure as summarized. In addition, when only the gargle sampling method is studied in low-income countries, the cost of testing for COVID-19 will decrease significantly. Because this method does not require vNAT or VTM transport solution sterile swab sticks as shown. The plastic container with a lid in which the patient can gargle with SF and spit it out is an ideal method for this. Additionally, it provides a great cost-benefit in low-income countries. Private Viromed Istanbul Central Laboratory; Imaging Center, Istanbul, Turkey This study was supported by the Private Viromed Istanbul Central Laboratory and Imaging Center, Istanbul, Turkey.

Human papilloma virus infection (HPV) is the most common sexually transmitted disease. It may increase the risk of several cancers, including those of the cervix, vulva, vagina, head and neck. HPV is usually transmitted during sexual intercourse; there are limited data about sexual dysfunction (SD) after infection with this virus. We aimed to measure the incidence of SD in women with HPV. In this study, we evaluated 67 HPV-infected female patients and 66 healthy controls. The Arizona Sexual Experience Scale (ASEX), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Socio Demographic Form were used for evaluation. Gynaecologists and psychiatrists evaluated the participants. Women with HPV were found to have significantly higher Arizona Sexual Experience Scale (ASEX) total scores and ASEX sub scores than the control group in the domains of sexual desire, arousal, genital response, orgasmic experience and their satisfaction from orgasm (p ≤ .05). The study group shows a statistically significant difference in the Beck Depression Inventory (BDI), but Beck Anxiety Inventory (BAI) scores show no significant differences between the experimental and control groups. Our study shows that HPV positivity in female patients is associated with a significant impairment in sexual function and that this impairment is not related to depression or anxiety. Impact statement What is already known on this subject? There are only a few studies concerned with sexual dysfunction in HPV patients. These studies have methodological problems, as they do not rule out the effect of depression on sexual dysfunction. It is very difficult to perform studies on sexual dysfunction and sexually transmitted diseases, because both physicians and patients are reluctant to talk about sexual problems. In the present study, only 6 out of 15 physicians accepted to contribute to the study. Although the physicians gave a questionnaire to more than 400 patients, only 133 of them completed that questionnaire. The most important difficulties in this study was to find enough patients. What do the results of this study add? Depression and sexual dysfunction are frequently seen in HPV patients. Although depression is one of the most common causes of sexual dysfunction, an HPV infection may lead to sexual dysfunction even in the patients without depression. What are the implications of these findings for clinical practice and/or further research? HPV infections may be associated with mental health problems and sexual dysfunction. The gynaecologists and other clinicians working with HPV patients should also evaluate patients psychologically and refer patients to psychiatry if required. The psychiatric problems associated with an HPV infection do not only impair sexual functions, but also may lead to difficulties in social life.

Turkey is the country that hosts most migrants worldwide. Although migrants are a risk group for alcohol and substance addiction (ASA), literature is limited. This study aims to explore and identify the present state and influencing factors of ASA among Syrian migrants in Turkey by integrating perspectives of addicts, their relatives, and local and national institutions. This qualitative study was designed by the grounded theory approach and took place in 5 cities in Turkey between 2018 and 2019. It is composed of 4 focus group discussions with 77 informants from local governmental, non-governmental, and academic organizations; 11 key person interviews with heads of national organizations; and in-depth interviews with 45 addicted Syrian migrants and 21 relatives. Themes that emerged from the data are characteristics of addicted migrants, types of addictions, predisposing and exacerbating factors, preventing factors, obtaining alcohol and substances, manners of use, consequences of use, public services and utilization of them, and the experiences of addicted migrants. The findings of this study provide guidance for future research and policies. Addicted migrants have awareness and motivation to quit but face many environmental barriers. Activities of institutions in Turkey on ASA in Syrian migrants are insufficient. Specific, well-coordinated action is needed. It should also utilize Syrian human resources. Turkish Green Crescent Society

Bu calismada saglik sektorundeki bir meslek grubu ele alinmis; is tanimlari geregi kayit islemlerini gerceklestiren calisanlarin stres karsisinda iletisim becerilerinin ne yonde etkilendiginin tespiti amaclanmistir. Bu calismada Ersanli ve Balci (1998) tarafindan gelistirilen “Iletisim Envanteri” ile Lovibond ve Lovibond (1995) tarafindan gelistirilen “DAS, Depresyon, Anksiyete, Stres” olcegi birlestirilerek; duygusal, zihinsel ve davranissal olarak tanimlayabilecegimiz iletisim becerilerinin hangisinin depresyon, anksiyete ve stres faktorlerinden ne oranda etkilendigi tespit edilmeye calisilmistir. Sonuc olarak iletisim becerileri olceginin duygusal ve davranissal boyutlarinda, egitim seviyesi acisindan %5 anlamlilik duzeyinde istatistiksel olarak anlamli farklilik gozlemlenmistir. Iletisim becerileri olceginin zihinsel iletisim becerisi boyutunda, cinsiyete gore istatistiksel olarak %5 anlamlilik duzeyinde bir farklilik gozlemlenmistir. Iletisim becerileri olceginin duygusal boyutu ile DAS olceginin her uc boyutu arasinda negatif yonlu ve %1 anlamlilik duzeyinde istatistiksel olarak anlamli bir iliski oldugu soylenilebilir.

Objective: This study was planned as a community-based research study to estimate the prevalence of osteoporosis and explore related risk factors in the Thrace region of Turkey. Material and Methods: The community-based study involved a total of 620 people, 498 women and 122 men, aged between 40 and 89 years. A questionnaire on the medical history and lifestyles of the participants was applied with a face-to-face interview. Body weight height, and arm span of each participant were measured, together with bone mineral density at the middle phalanges of the second, third, and fourth digits of the non-dominant hand using dual-energy X-ray laser absorptiometry. Results: Age, clothing, lack of regular exercise, and giving birth to more than two children seem to contribute to osteoporosis, while high education, high economic level, tea and moderate alcohol consumption, oral contraceptive use, and hormone replacement therapy seem to retard osteoporosis. Osteoporotic patients had more fractures in the past. Height and weight were significantly lower in osteoporotic women. Conclusion: Lifestyle affects the prevalence of osteoporosis. Drinking tea and alcohol seems to be controversial with regard to osteoporosis risk.

The survey aims to explore the attitudes of physicians, nurses, pharmacists, pharmaceutical representatives, and patients from two provinces of Turkey, Nevsehir and Istanbul, in context of ethical conduct within the health services and the relation between the health services and its suppliers, particularly the pharmaceutical industry. Quantitative and qualitative methods were used together. The questionnaire interviews were conveyed to a total of 1540 people and eight focus group discussions to 85 people during April–May 2009. The most common unethical acts in medical practice are “knife payment”/additional informal payment, self-referral, patient discrimination, discrediting other physicians, unnecessary tests—interventions—prescriptions, accepting promotion and demand for personal–household goods, preferring products that come along with promotion, getting cash per box, sponsored vacations in the form of medical congress. Eliminating monetary relationship between the physician and the patient; discoura...

Background Although number, frequency and healing time of oral ulcers and pain are generally used for clinical practice and studies in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS), no standardized activity index is currently present to monitor clinical manifestations associated with oral ulcers. The aim of this study was to develop a standardized composite index (CI) to assess oral ulcer activity in BD and RAS. Methods In this cross-sectional study, 121 patients with BD and 45 patients with RAS were included. Sixty-five percentage of BD and 68.9% of RAS patients were in active stage during the previous 3 months. The developed CI included the presence of oral ulcers, ulcer-related pain and functional status and was evaluated in patients with both active and inactive disease for content validity. Results Composite index score was observed to be higher in active patients with RAS (6.94 + or - 2.19) compared with active BD patients (6.01 + or - 2.04) (P = 0.04). The number of oral ulcers and healing time of oral ulcers were significantly higher in RAS compared with BD (P = 0.018, P = 0.001 respectively). CI score correlated with the number of oral ulcers in both BD and RAS (P = 0.000, P = 0.002 respectively). CI score was '0' for inactive patients without oral ulcer in BD and RAS. Conclusions The presented CI as an oral ulcer activity index seems to be a reliable and suitable tool for evaluating the clinical impact and disease-specific problems in BD and RAS.

The aim of this study was to determine the prevalence of essential tremor (ET) in a Turkish population living in Sile, a rural town located on Black Sea coast of Istanbul. This study was designed as a descriptive cross-sectional field study. People aged 18 years and over were selected for the study. Tremor surveillance questionnaire was applied by door-to-door visits. Subsequently, all subjects who answered the questionnaire had a standard tremor examination. Diagnosis was made based on Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) diagnosis and clinical evaluation scale. A total of 2227 people was screened. The prevalence of ET was found to be 3.09% (95% Cl=2.42-3.91%) in Turkish population aged over 18 years. The prevalence of ET increased by age in both genders.

Erol, Cetin/0000-0001-7396-3818 WOS: 000244821400009 PubMed: 17279356 Objective The prescribing pattern of drugs used for treating hypertension changes over time in response to changes in recommended guidelines and innovations in drug formulations, among others. In addition, the classes of antihypertensive drugs used vary among the countries. The aim of this study was to investigate the practice of antihypertensive medications in primary care units in Turkey. Methods TURKSAHA is a cross-sectional screening study conducted in 1000 primary care units considered to be representative of primary care in Turkey, with the purpose of defining the demographic characteristics, clinical features, rate of blood pressure control achieved and the antihypertensive drugs prescribed for the hypertensive patients treated in these centers. In this analysis, we investigated the agents used in the treatment regimen. Results Of the 16,270 patients considered to be eligible for inclusion in the study, 15,187 (93.3%) were on an antihypertensive treatment, and 1083 (6.7%) were receiving no treatment. Patients who received treatment but whose antihypertensive medication was not specified (2290 patients) were subsequently excluded, and the trial was carried out with the remaining 12,897 patients. The mean age of the patients was 60 +/- 11 years (60.2% female). Of the 12,897 patients, 75.7% were receiving monotherapy, 19.7% two drugs, 4.1% three drugs and 0.5% four or more drugs. The rate of successful blood pressure control (< 140/90 mmHg; for diabetics < 130/80 mm Hg) in relation to the number of drugs received was 26.3, 25.9, 24.5 and 26.2%, respectively. Among the patients receiving monotherapy, the most frequently used antihypertensive drug class was angiotensin-converting enzyme inhibitors (30.1%), followed by beta-blockers (20.6%), calcium-channel blockers (17.9%), diuretics (15.4%) and angiotensin-receptor blockers (14%). Conclusion As in other European countries, the rate of successful blood pressure control was low among hypertensive patients receiving treatment, and despite the inadequacy of monotherapy to control blood pressure, many of the patients continued this treatment regimen. Consistent with the global trend, the most frequently prescribed anti-hypertensives were angiotensin blockers.

Objective.—This epidemiological survey was conducted to investigate comprehensive characteristic and overlapping features of migraine and tension-type headache (TTH) disorders classified based on International Classification of Headache Disorders-II. Methods.—The stratified cohort of this study was composed of 2504 schoolchildren aged 10 to 17 years. A 38-item questionnaire inquiring all characteristic features of primary headache syndromes mandatory for classification was applied to selected 483 children with recurrent headache in the last 6 months. Results.—Migraine was diagnosed in 227 (47.0%) of 483 children and TTH in 154 (31.9%). Out of 125 children with definite migraine, 73 (58.4%) reported tension-type symptoms and 94 (68.1%) of 138 children with definite TTH reported migraine-type symptoms. Pressing pain (21%) and lack of aggravation of pain by physical activity (34%) were the major tension-type features in patients with migraine. Throbbing quality (43%) and aggravation by physical activity (30%) determined the main migraine-type features in patients with TTH. Conclusion.—The frequent co-occurrence of migraine and TTH symptoms suggests the presence of a common pathogenesis.

Objectives: This study aimed to investigate oral and general health related quality of life (QoL) in patients with Behcet's Disease (BD) and to assess the performance of Turkish versions of oral health related quality questionnaires. Subjects and methods: Ninety-four BD patients, 24 patients with recurrent aphthous stomatitis (RAS), 113 healthy controls (HC) and 44 dental patients were investigated. QoL was assessed by oral health impact profile-14 (OHIP-14), oral health related quality of life (OHQoL) and short form-36 (SF-36) questionnaires. Results: OHQoL, OHIP-14 and SF-36 subscale scores were significantly worse in patients with BD compared with those in HC (P

Background: Burnout is associated with decreased job performance and low career satisfaction. It has a special significance in health care, where staff experience both psychological–emotional and physical stress. Aim: To investigate levels of job satisfaction and burnout among Istanbul physicians, and the relationships between demographic characteristics, job characteristics, job satisfaction and burnout. Design: Questionnaire-based survey. Methods: We collected data from a randomly selected sample group of 598 physicians from different health-care institutions in Istanbul. A questionnaire regarding sociodemographic characteristics of the physicians, the Maslach Burnout Inventory (MBI) and the Minnesota Job Satisfaction Questionnaire (MSQ) were all administered during face-to-face interviews. Results: Job satisfaction was inversely correlated with emotional exhaustion and depersonalization, and positively correlated with personal accomplishment. Under multilevel regression, the most significant and common predictors of all burnout dimensions and job satisfaction were the number of vacations at individual level, and public ownership of healthcare facilities at group level. Number of shifts per month was also a significant predictor of all burnout dimensions. Discussion: Organizational efforts aimed at increasing the level of job satisfaction among physicians could help to prevent burnout.

Background: The aim of this cross-sectional study was to record the prevalence of underweight, overweight and obesity in primary school children living in Istanbul and to examine the relationship between increased body weight and certain cardiovascular disease (CVD) risk factors. Methods: A total of 510 randomly selected children aged 12 and 13 years of age (257 boys, 253 girls) were examined. Information regarding anthropometrical indices, energy and macronutrient intake, physical activity, physical fitness and lipid profile were collected. Classification of children in overweight and obese subgroups was based on the cut-off points proposed by Cole et al.1 Results: The prevalence of underweight, overweight and obesity was found to be 15.3%, 10.6% and 1.6%, respectively. Both overweight boys and girls were found to have lower physical fitness compared to their normal-weight counterparts, but no difference was observed for energy and macronutrient intake. Overweight boys were found to have higher total cholesterol (P < 0.001), low-density lipoprotein cholesterol (P < 0.01), triglycerides (P < 0.01) and total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio (P < 0.05) compared to their normal-weight counterparts, while overweight girls were found to have lower HDL-C (P

Background Isotretinoin is widely used in the treatment of severe, recalcitrant, nodular acne. Mucocutaneous side-effects are seen in the great majority of patients and some of them have elevations in their serum lipid and liver enzyme profiles. Recently, it has been shown that addition of vitamin E decreased the toxicity of high-dose retinoids. Objective The purpose of this investigator-blinded, randomized study was to assess whether vitamin E would reduce the side-effects of isotretinoin in the treatment of acne vulgaris. Methods Eighty two patients were randomly assigned to one of two treatment groups with isotretinoin (1 mg/kg/day) alone or combined with vitamin E (800 IU/day). The treatment duration was 16 weeks. Mucocutaneous side-effects such as facial erythema, facial dryness, cheilitis and serum lipid and liver enzyme profiles were assessed. Results There was no difference in the incidence and severity of side-effects related to isotretinoin between the two treatment groups. Conclusion Eight hundred IU/day vitamin E did not improve the side-effects of 1 mg/kg/day of isotretinoin in the treatment of acne vulgaris.

To investigate the prevalence of iron deficiency among schoolchildren of different socio-economic status (SES), living in the three largest cities of Turkey.Cross-sectional study.Primary schools of Istanbul, Ankara and Izmir.Schoolchildren aged 12 and 13 y (males: 504; females: 510) from nine primary schools. Inclusion of subjects in the study was on a voluntary basis.Data were obtained on children SES, anthropometry, haematological and biochemical indices of iron status and consumption of food items related to dietary iron bioavailability. One-way analysis of variance was mainly applied, for the evaluation of the tested hypotheses, using Bonferroni correction in order to take into account the inflation of Type I error.Iron deficiency (serum ferritin15 microg/l) prevalence was 17.5% among boys and 20.8% among girls. Furthermore, iron deficiency was significantly more prevalent among boys of lower SES, who were also found to have significantly lower levels of serum iron, serum ferritin, transferrin saturation, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration compared to those of higher SES. In terms of dietary factors affecting iron bioavailability, low SES boys exhibited significantly higher frequency of tea consumption and lower frequency of citrus fruit, red meat and fish consumption, compared to their higher SES counterparts.The prevalence of iron deficiency was relatively high, particularly among lower SES schoolboys. Higher tea and lower citrus fruits, red meat and fish consumption by boys of lower SES may provide an indication about the possible role of certain dietary patterns in the different manifestation of this medical condition among the socio-economic groups. However, further research is needed.

The objective of this in vitro study was to evaluate surface roughness, hardness and wear resistance of an Ormocer (Admira), polymerized by a plasma arc system. A secondary objective was to investigate two placement technique bulk or incremental layers.Blocks from Admira and Amelogen (a microhybrid composite) were prepared in cylinders, 3 mm in diameter, and 2 and 5 mm in thickness (bulk or incrementally placed) and polymerized by a plasma arc and a conventional light system. Surface roughness measurements were taken by a Surface Profilometer on the top of the specimens. Vickers hardness measurements, with a load of 600mN were taken on the top and bottom of 2 mm and top, intermediate and bottom of 5 mm thick specimens. For the wear test, specimes (8 mm in diameter and 2 mm in thickness) of Admira, Amelogen and amalgam were tested in a ball-on design, by circular movements of the antagonist (alumina ball; diameter 10 mm) under 10 N load. For the statistical evaluation of the results of surface roughness, microhardness and wear test; a paired samples t-test and Kruskal-Wallis analysis of variance test, were performed.Admira showed highest hardness values in all polymerization types at the top surface and this was statistically significant (p0.05). These highest hardness values were obtained with conventional polymerization (81.84 +/- 1.167 VHN). Meanwhile, the wear resistance of Admira was found to be higher than Amelogen (Wd(admira) = 0.024 +/- 0.00149 mm3; Wd(amelogen) = 0.032 +/- 0.00075 mm3). However, Admira demonstrated the highest surface roughness value compared to Amelogen, with plasma arc 5 s (0.65 +/- 0.023 microm). Amelogen was found to have the lowest surface roughness value with conventional 40 s (0.45 +/- 0.012 microm).The results indicated that Ormocer, which was developed by Ormocer technology, demonstrated higher microhardness and wear resistance when compared to a hybrid composite; however, the polishability of Ormocer needs further investigation. Also the selection of visible light activated composite resins exhibited higher surface microhardness values when polymerized with conventional rather than with plasma arc.

Bu calismanin amaci, (Dunya Saglik Orgutu) WHO tarafindan belirlenen temel saglik harcamasi gostergeleri cercevesinde, Turkiye ve diger AB uyesi-aday ulke konumundaki ulkelerin grafiksel duzlemde gosteriminin saglanarak alt gruplara ayrilmasi, aralarinda var olabilecek benzerlik ve farkliliklarin ortaya konulmasi ve ulkemizin genel egilime gore konumunun tespitinin yapilmasidir. Dunya Saglik Orgutu’nun aciklamis oldugu raporlardan ve istatistiklerden elde edilen veriler 28 ulke icin toplanmis ve ilgili veriler Cok Boyutlu Olcekleme (Multidimensional Scaling- MDS ) yontemi ile analiz edilmistir. MDS analizi sonucunda ulkelerin amaca uygun sekilde iki grup altinda toplandiklari gorulmustur. Yapilan analiz sonucunda birinci boyutta Avusturya, Danimarka, Fransa, Almanya, Luksemburg ve Hollanda analiz kapsamina alinan saglik harcamasi gostergeleri bakimindan benzer ulkelerdir ve bir alt grup olarak dusunulebilirler. Ayrica birinci boyutta Turkiye, Bulgaristan, Estonya, Letonya, Polonya, Romanya ve Makedonya’nin benzer ulke olarak algilandiklari tespit edilmistir. Saglik harcamalari acisindan Turkiye’nin en benzer oldugu ulkelerin Polonya ve Romanya oldugu gorulmustur. Yirmi sekiz Avrupa ulkesi arasinda saglik harcamasi gostergeleri bakimindan Hollanda ve Kibris birbirine en benzemez ulkelerdir. Farklilik matrisine gore Turkiye’nin saglik harcamalari acisindan en farkli oldugu ulkelerin ise Avusturya, Belcika, Kibris, Danimarka, Fransa, Almanya, Irlanda, Isvec oldugu tespit edilmistir. Kisi basina toplam saglik harcamasi duzeyi, ulusal saglik harcamasinin Gayri Safi Milli Hasila (GSMH)’daki payi, kisi basina toplam kamu saglik harcamasi duzeyi ve genel kamu harcamalari icinde kamu saglik harcamalarinin payi gibi gostergelerde Turkiye’nin gelismis Avrupa ulkelerinden geride oldugu gorulmustur.

Background: Little information exists on multiple sclerosis (MS) in Turkey. With a door-to-door survey in an urban part of Istanbul, we recently reported a prevalence rate of 101/100,000 population. We therefore investigated three rural areas of Turkey at the same latitude. Methods: The same survey methods were used for total populations of two rural areas (Kandıra and Geyve) near Istanbul, and for half the population of Erbaa, all near 40° north latitude on the Black Sea coast. Results: In Kandıra, 5 of 8 suspects were diagnosed as having MS among 8,171 screened, resulting in a prevalence rate of 61/100,000. Geyve with 7 MS cases in 17,016 screened had a prevalence of 41/100,000, and Erbaa with 15 MS cases in 28,177 screened one of 53/100,000. Together they showed a prevalence of 51/100,000. Of the 27 patients, 20 were women; 25 had definite and 2 possible MS, the former all with abnormal laboratory findings. Average ages were 30.5 years at onset and 39.1 years at diagnosis. Clinical features and course were typical of European MS. Conclusion: These findings indicate that Turkey is a high-risk MS area, similar to most regions of Mediterranean Europe, where all recent increases are likely due to (undefined) environmental factors.

We aimed to determine the prevalence of primary headache among schoolchildren in the city of Agri, located in eastern Turkey, where geographical, climatic and socio-economic conditions differ greatly from those of other regions of Turkey. A cross-sectional school-based (ages ranging from 11 to 18) study was conducted from January to April 2006. Diagnosis was based on the second edition of the International Classification of Headache Disorders. This population was evaluated by a two-stage clustered sampling procedure. In the first phase, 1385 children were asked whether they had had a headache within the past year. For the second-step interview, 540 children (38.9%) with a complaint of headache were selected. Five children who had complained of headaches in the first interview did not agree to participate in the second stage. Of the remaining 535, 473 were identified as having primary headache and 62 as having secondary headache. Overall, one-year prevalence of headache subtypes was 14.3% for migraine, 3.5% for probable migraine, 8.6% for pure tension-type headache, 4.6% for migraine plus tension-type headache, and 3.0% for probable migraine plus tension-type headache. The prevalence of migraine was higher in our study than in previous studies.

Flare of acne is common at the beginning of isotretinoin treatment. However, severe flare is rare. Multiple comedones, male gender and young age are reported as promoting factors. However, detailed information is still limited. Our aim was to investigate the incidence, types and course of acne flare and the predictive factors for its occurrence. 244 patients were enrolled. Acne grade was defined according to global acne grading system (GAGS) score. Flare was classified according to the increase in number of inflammatory nodules and treatment requirements of the patients. Risk factors (age, sex, duration of acne, basal acne grade, baseline numbers of comedones, papule-pustules, nodules, hyperandrogenism, and presence of sinuses) were investigated. 161 patients completed the study. 79 patients (32%) had facial and/or truncal flare. Flare was mild in 18% (n = 44), moderate in 10% (n = 24), and severe in 4.5% (n = 11) of the patients. For severe flare, male sex, severe acne, GAGS cut-off score greater than 28, presence of more than 44 facial comedones and 2 facial nodules and presence of truncal nodules were found to be predictive. Recognizing predictive factors for severe flare may help to take early precautions and to prevent severe flares which may result with permanent scars.

Multiple sclerosis (MS) is an immune-mediated inflammatory demyelinating disease of uncertain etiology. Although the mechanisms of inducting autoimmunity by some of the infectious agents have been investigated, there is not yet enough research on streptococcal infections.To understand the effect of past group A streptococcal infection on MS, antistreptolysin O (ASO) and antideoxyribonuclease B (ADNase B) were measured in 21 patients with relapsing-remitting MS and 21 healthy blood donors by nephelometric assay.ADNase B levels in the patients with MS were found to be significantly higher than in the controls (p0.001); however, ASO levels were similar in both groups.These findings indicate that a relationship between multiple sclerosis and streptococcal infections may exist, but to acquire a better understanding of the role of group A streptococci in the pathogenesis of multiple sclerosis, more studies with animal models are necessary.

Introduction The aim of this study was to record the prevalence of iron deficiency (serum ferritin concentration

The incidence of stroke, death, and dependency rates shows variability between countries and ethnic groups. The cost of management of stroke is extremely high. Thus, determination of controllable risk factors is important. The aim of this study was to evaluate the risk factors and the effects of risk factors on death rates, dependency, and stroke recurrence in hospitalised patients having first-ever stroke.A total of 100 patients admitting to our hospital during the period April 2002 to March 2003 inclusive who were diagnosed as stroke according to WHO criteria were included in this study and evaluated prospectively.The mean age of the patients was 66.7 +/- 9.9 years and 60% was male. 76 of the patients had ischaemic stroke; 24 had hemorrhagic stroke. The death rates were 12% in the first 28 days and 26% in 6 months. The best predictors of death rate in 6 months were stroke severity, living alone, and prestroke dementia. Stroke severity was also the best predictor for dependency. Peripheral atherosclerosis, pre-stroke dementia, and stroke severity were the best predictors for recurrent stroke.Living alone may be an important predictive factor for survival, although its importance has been underestimated.

Background: The prevalence of multiple sclerosis (MS) in Istanbul, Turkey, is unknown. We investigated the prevalence of MS in the district of Maltepe, Istanbul, Turkey. Methods: This was a cross-sectional field research study using door-to-door sampling. Maltepe is a district of Istanbul beside the sea of Marmara (population 359,298 from 2000 census). The two-phase study screened 32,531 subjects using the Poser criteria for clinical diagnosis. The χ2 test was used for analyses of frequency distributions. Results: 33 of 32,531 people were diagnosed with MS. Their average age was 41 ± 12.0 years (43 ± 12.7 years for females and 37 ± 9.6 years for males). The prevalence of MS in Maltepe was 101.4/100,000 within the total population (118.7/100,000 in the female and 76.0/100,000 in the male populations). Conclusions: The prevalence rates of MS in the Turkish population living in a district of Istanbul are considerably higher than we thought. And the prevalence rate is much higher than neighboring countries. They are similar to those recently recorded in Sicily and Germany. These figures suggest that the prevalence rate of MS is not totally dependent upon geographical variation. However, the research of our results needs to be confirmed with further investigations in order to determine the prevalence of MS in Turkey with confidence.

Erol, Cetin/0000-0001-7396-3818 WOS: 000236957500008 PubMed: 16511506 Although the management and the control rates of hypertension are generally low throughout the world, there are substantial differences between the countries. The aim of this study was to determine the control rate of blood pressure and the characteristics of the patients who have been admitted to primary care units in Turkey. Our study included 16 270 patients aged above 18 years who were diagnosed as hypertensive in representative nationwide sample of 1000 primary care units in Turkey. The mean age of the patients was 60 +/- 11 years (60.1% women). Of 16270 patients, 15187 (93.3%) were on an antihypertensive treatment, whereas 1083 (6.7%) were receiving no treatment. The patients who were women, diabetic, smoker, obese, and those who had a concomitant cardiovascular disease (CVD) had a higher rate of antihypertensive treatment. Of 15187 treated patients, 4912 (30.2%) had a controlled systolic blood pressure, 7063 (43.4%) a controlled diastolic blood pressure, and in 3931 (24.2%), both were under control. A logistic regression analysis demonstrated that age (OR 1.33), diabetes (OR 4.96), body mass index (OR 1.41) and the presence of a CVD (OR 1.19) were predictors for blood pressure being under control. The blood pressure control rates ranged between 16.6 and 30.5% among seven geographical regions. In the primary care units in Turkey, the blood pressure control rate is consistently low in treated hypertensive patients. In addition, there are differences between the geographical regions in both the proportion of those receiving medications and the blood pressure control rates.

Migraine is more common in female and onset of migraine is most commonly seen in the second and third decades of life. In this study, we aimed to estimate the prevalence and characteristics of migraine among women of ages between 15 to 45 years in Turkey. This is the first study to target this age group. The women were interviewed on a door-to-door basis, from early morning to late evening. Once responded positively to headache, an in-depth interview was performed questioning for migraine features. Diagnosis was made from a questionnaire by eight neurologists. One thousand eight hundred thirty five (1,835) out of 96,000 women living in Maltepe which is a town of Istanbul participated in this study. The prevalence of migraine in females aged 15-45 (reproductive ages) was 15.8% (95% CI, 0.142-0.176). This study showed that migraine onset occurred at a mean age of 22.7, 33% having family history, and with migraine with and without aura having near equal frequencies. The prevalence of migraine in women of reproductive ages in Istanbul as found in our study is lower than that reported in United States and Europe countries, but higher than that in Middle and Far Eastern countries.

OBJECTIVES: The purpose of this study was to evaluate the prevalence and distribution of oral lesions (OLs) in Turkish population. SUBJECTS AND METHODS: In this cross-sectional study, 765 residents (F/M: 375/390) were selected by the cluster sampling method and examined according to WHO criteria. RESULTS: Excessive melanin pigmentation (6.9%) was the most common lesion in the study population. The tongue lesions observed in this study were as follows: fissured tongue (5.2%), varices (4.1%), hairy tongue (3.8%), geographic tongue (1.0%), atrophic tongue papillae (0.7%) and ankyloglossia (0.3%). The denture-related lesions were denture stomatitis (4.3%), suction irritation (0.8%), denture hyperplasia and torus palatinus as bony lesion (0.5%) and traumatic ulcers (0.3%). In regression analysis, being 65 years old and over was found as a statistically significant risk factor for the occurrence of pigmentation, fissured tongue, varices, hairy tongue, denture stomatitis and petechiae (P < 0.05). CONCLUSIONS: Pigmentation, fissured tongue and denture stomatitis were observed to be the most common lesions in Turkish population. Elderly population was a significant risk factor for occurrence of some OLs. Oral Diseases (2005) 11, 81–87

Background It is widely accepted that the development of atherosclerosis starts at an early age. However, there are very few studies evaluating the prevalence of the common clinical and behavioral cardiovascular disease (CVD) risk factors among children, especially in developing countries. The aim of the present cross-sectional survey was to evaluate the distribution of blood lipid profile and various behavioral (i.e. dietary habits, physical activity status) factors related to CVD risk and its relationships to paternal (PEL) and maternal educational level (MEL) among primary schoolchildren in Turkey. Methods In three major metropolises in Turkey (Istanbul, Ankara and Izmir), a random sample of 1044 children aged 12 and 13 years old was examined. ANOVA was applied to evaluate the tested hypothesis, after correcting for multiple comparisons (Tukey correction). Results After controlling for energy and fat intake, physical activity status and Body Mass Index (BMI), it was found that mostly PEL had a significant positive effect for most of the subgroups examined (Lower vs. Higher and Medium vs. Higher) on TC and HDL-cholesterol and a negative effect on TC/HDL ratio for both genders. Furthermore, both boys and girls with higher PEL and MEL were found to have higher energy intake derived from fat and protein than their counterparts with Medium and Lower PEL and MEL, while the opposite was observed for the percentage of energy derived from carbohydrates. Conclusions Our study provides indications for a possible association between an adverse lipid profile, certain dietary patterns and Higher PEL and MEL among schoolchildren in Turkey. These findings underline the possible role of social status, indicated by the degree of education of both parents, in developing certain health behaviors and health indices among Turkish children and provide some guidance for Public Health Policy.

To measure the level of patient satisfaction in the dental outpatient clinics from a group of state hospitals in Turkey and explore the factors that may influence satisfaction.In a cross-sectional study, patients attending the outpatient clinics state hospitals from 9 provinces were interviewed. Data regarding socio-demographic characteristics of the respondents were collected and a patient satisfaction questionnaire, which consisted of 29 statements regarding various aspects of satisfaction, were completed during face-to-face interviews (n=641, response rate 89%).There was no difference between the mean satisfaction scores of the study group with regard to socio-demographic characteristics except for the type of health insurance held by the patient. Patients covered by state pension funds had significantly higher satisfaction scores than the self-employed group with public insurance. Patients were most satisfied with privacy (82.1% of the respondents). Waiting time was the least satisfactory issue, with only 41.8% of patients reporting satisfaction with waiting time.The type of health insurance of the patients seems to be a significant predictor of dental patient satisfaction in Turkish state hospitals. Privacy was the most satisfactory service attribute whereas the waiting time had the lowest satisfactory rating.

Objectives: This study investigates the attitudes of dentists, residents, and patients on the financing of dental services in Turkey. Methods: In this descriptive study, randomly selected groups of 860 dentists, 641 patients, and 866 residents from 9 provinces of Turkey were interviewed. Their agreement on various statements on financing issues of dental services were recorded and analyzed. Results: Eighty-two percent of the dentists, 83.8 percent of the patients, and 76.4 percent of the residents agreed that “governments should finance all dental services.” The majority of the dentists (83.6%), patients (74.7%), and residents (84.4%) stated that patients should pay a copayment for their dental treatment. Conclusion: Survey results indicate that the current financing system of dental services in Turkey is not satisfactory either for the providers or for the users.

Objectives The aim of the current study was to examine the influence of socioeconomic status (SES) on physiological (lipid profile, obesity indices) and behavioral (dietary habits, physical activity) cardiovascular disease (CVD) risk factors among primary schoolchildren in Istanbul. Design Cross sectional study. Setting One private school and two public schools from different SES districts in Istanbul. Participants 510 randomly selected children aged 12 and 13 years old (257 boys, 253 girls). Results The prevalence of overweight (15.2%) and the energy intake (p < 0.001 and p < 0.05 for boys and girls respectively) were found to be higher for the middle/ high SES group for both genders. Regarding biochemical indices, middle/ high SES children had higher values of High Density Lipoprotein-cholesterol (HDL-C) (p < 0.001 and p < 0.05 for boys and girls respectively) and lower values of TC/HDL-C ratio and LDL-C/HDL-C ratio (p < 0.05 and p < 0.001 for boys and girls respectively). This could be attributed to the higher physical activity levels observed for middle/ high SES children (p < 0.001). Conclusion The findings of the current study revealed a coexistence of both overweight and higher energy intake in middle/ high SES children, as well as a coexistence of underweight and lower physical activity levels in low SES children. These observations should guide the public health policy in developing appropriate intervention strategies to efficiently tackle these health and social issues early in life.

Aim: To assess the factors affecting the utilisation of dental service in Turkey. Method: A cross-sectional study using a sample of 866 adults randomly selected from nine provinces, collecting data on socio-demographic characteristics, frequency of dental visits and attitudes toward dental services in face-to-face interviews. Results: 40.4% of adults had visited a dentist within the previous year. Logistic regression analysis showed that gender and educational level were significant factors affecting the utilisation of dental services, with women using dental services significantly more than men and those having higher education compared to those having low education. Satisfaction from the services of the private dental offices and private hospitals was higher than from state hospitals. Age, reasons for dental visit and the place of the last visit were found to be the most significant predictors of satisfaction. Conclusion: Utilisation of dental services is low amongst Turkish adults. Women and individuals with higher levels of education use dental services more than others. The majority of the people prefer private dental offices, where the patient satisfaction is high.

Background The aim of the current study was to examine the interrelationship between certain cardiovascular disease (CVD) risk factors and overweight, as well as to provide some indication on the prevalence of underweight, overweight and obesity in primary schoolchildren in urban Turkey. Methods 1044 randomly selected children aged 12 and 13 years old from the urban areas of Istanbul, Ankara and Izmir were examined. The main variables of interest were fatness determined by body mass index and sum of skinfolds, lipid profile, dietary intake, physical fitness and habitual physical activity. Results Both overweight boys and girls were found to have lower cardiovascular fitness levels compared to their normal weight peers. Overweight boys reported lower energy and macronutrient intake than their normal weight counterparts. Regarding biochemical indices, overweight boys were found to have higher total cholesterol (TC), Low Density Lipoprotein-cholesterol (LDL-C), triglycerides (TG) and LDL-C/HDL-C ratio compared to normal weight boys, while overweight girls were found to have lower High Density Lipoprotein-cholesterol (HDL-C) and higher TG compared to their normal weight peers. Finally, the prevalence of underweight, overweight and obesity for the overall population was found to be 12%, 12% and 2%, respectively. Conclusions The study revealed that overweight and obesity in children coexisted with more unfavorable lipid profiles and lower cardiovascular fitness levels. This finding points out the emergent need for suitable measures to be implemented in order to identify and counteract these health and social problems early in life.

The effects of botulinum toxin have been demonstrated in pain syndromes such as migraine, tension headache, and postherpetic neuralgia. With this background data in hand, the authors planned a randomized, open-ended study to investigate the efficacy of botulinum injections in cases of refractory trigeminal neuralgia. In 8 patients with trigeminal neuralgia, 100 U botulinum toxin was injected into the region of the zygomatic arch. The results of their statistical analyses demonstrated that the medication can be effective in treating trigeminal neuralgia. The patients did not develop any significant adverse effects. Botulinum toxin can be used in the treatment of refractory trigeminal neuralgia.

Objectives The aim of the current study was to examine the influence of socioeconomic status (SES) on physiological (lipid profile, obesity indices) and behavioral (dietary habits, physical activity) cardiovascular disease (CVD) risk factors among primary schoolchildren in Istanbul.

AMAÇ: Profesyonellik, mesleki değerleri ve bağlılığı vurgulayan bir kavramdır. Mesleki profesyonellik ise mesleğin standartlarının oluşturulmasında ve kaliteli bakım sunulmasında yer alan önemli bir olgudur. Bu çalışma, Türkiye'de hemşirelik mesleğinin profesyonelleşmesi ve Avrupa Birliği (AB)'ne uyum sürecinde hemşirelikte profesyonelleşmeyi değerlendirmek amacıyla yapılmıştır.YÖNTEM: Araştırma niteliksel bir çalışma olup, amaçlı örnekleme yöntemi kullanılmıştır. Araştırmanın çalışma grubunu, Türkiye'deki üniversitelerin hemşirelik bölümlerinden öğretim üyeleri, hastanelerin hemşirelik hizmetleri müdürleri ve AB konusunda uzman toplam 15 kişi oluşturmuştur. Veriler, yarı yapılandırılmış derinlemesine görüşme yöntemiyle toplanmıştır. BULGULAR: Türkiye'de hemşireliğin henüz profesyonellik ölçütlerine göre bir meslek olarak kabul edilmediği belirlendi. Mesleki eğitim düzeyindeki çeşitlilik, istihdam tiplerinde görülen farklılıklar, mesleki otonomi ve örgütlenme düzeylerinin düşüklüğü mesleğin profesyonelleşme sürecindeki temel sorunları olduğu ve AB ölçütlerinin, itici bir güç olarak hemşirelik mesleğindeki profesyonelleşmenin gelişmesi adına olumlu olacağı saptandı. Çalışmanın verileri; hemşirelikte profesyonelleşmeye ilişkin değerlendirme, hemşirelikte profesyonelleşmeye ilişkin ölçütleri değerlendirme ve AB ye uyum sürecinde hemşireliğin durumu olmak üzere üç tema altında toplanmıştır. SONUÇ: Sonuç olarak, Türkiye'de hemşirelik mesleğinin profesyonellik sürecinin hala devam ettiği ve AB ye uyum standartlarının bu süreci hızlandırma adına itici güç olacağı ortaya konmuştur., AIM: Professionalism is a concept that emphasizes occupational values and commitment. Occupational professionalism is a significant phenomenon which has roles in establishing the standards of the occupation and providing high quality care. This study was conducted with the purpose of evaluation of professionalization of the occupation of nursing in Turkey and within the frame of the harmonization process to the European Union (EU). METHODS: While the study is a qualitative one, purposive sampling was used. Study group of the research consisted of total 15 individuals consisting of faculty members from nursing departments of universities in Turkey, nursing service managers of hospitals and EU experts. The data were collected using the semi-structured in-depth interview method. RESULTS: It was determined that nursing is not yet accepted as an occupation in Turkey based on criteria of professionalism. Fundamental problems in professionalization of the occupation are the variety of occupational education levels, differences seen in types of employment, and low levels of occupational autonomy and organization, and EU criteria will have positive effects as a driving force on the development of professionalization in the occupation of nursing. The study's data were collected under three themes: evaluation of professionalization in nursing, evaluation of the criteria for professionalization in nursing and situation of nursing in the EU harmonization process. CONCLUSION: In conclusion, it was established that the professionalization process of the nursing profession is still in progress in Turkey, and EU harmonization standards will be a driving force to accelerate this progress.