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Objective: Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers’ attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not).Method: Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data.Results: Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment.Conclusions: Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD.

Introduction Studies reported close associations between functional outcome and symptomatic remission as defined by the Remission in Schizophrenia Working Group. This observational study was aimed at the investigation of deficits in daily functioning, symptoms and subjective well-being in remitted and non-remitted patients with schizophrenia. Methods Symptoms (PANSS), functional outcome (FROGS, GAF), subjective well-being (SWN-K) and other characteristics were assessed in 131 patients with schizophrenia (DSM-IV) within the European Group on Functional Outcomes and Remission in Schizophrenia (EGOFORS) project. Results A significant better level of functioning was measured for remitted versus non-remitted patients, though remitted patients still showed areas with an inadequate level of functioning. Functional deficits were most often seen in social relations (40%), work (29%) and daily life activities (17%). Best functioning was assessed for self-care, self-control, health management and medical treatment. A moderate to severe level of disorganization and emotional distress was observed in 38% and impaired subjective well-being in 29% of patients defined as being in symptomatic remission. Discussion The results confirm a close association between symptomatic remission and functional outcome. However, deficits in different areas of functioning, symptoms and well-being underline the need for combined outcome criteria for patients with schizophrenia.

Summary Background Many people with schizophrenia experience stigma caused by other people's knowledge, attitudes, and behaviour; this can lead to impoverishment, social marginalisation, and low quality of life. We aimed to describe the nature, direction, and severity of anticipated and experienced discrimination reported by people with schizophrenia. Methods We did a cross-sectional survey in 27 countries, in centres affiliated to the INDIGO Research Network, by use of face-to-face interviews with 732 participants with schizophrenia. Discrimination was measured with the newly validated discrimination and stigma scale (DISC), which produces three subscores: positive experienced discrimination; negative experienced discrimination; and anticipated discrimination. Findings Negative discrimination was experienced by 344 (47%) of 729 participants in making or keeping friends, by 315 (43%) of 728 from family members, by 209 (29%) of 724 in finding a job, 215 (29%) of 730 in keeping a job, and by 196 (27%) of 724 in intimate or sexual relationships. Positive experienced discrimination was rare. Anticipated discrimination affected 469 (64%) in applying for work, training, or education and 402 (55%) looking for a close relationship; 526 (72%) felt the need to conceal their diagnosis. Over a third of participants anticipated discrimination for job seeking and close personal relationships when no discrimination was experienced. Interpretation Rates of both anticipated and experienced discrimination are consistently high across countries among people with mental illness. Measures such as disability discrimination laws might, therefore, not be effective without interventions to improve self-esteem of people with mental illness. Funding South London and Maudsley NHS Foundation Trustees, UK Department of Health SHiFT programme, German Ministry of Education and Research.

The aim of this study was to evaluate the level of anticipated discrimination in people with schizophrenia (n = 732) from 27 countries in the International Study of Discrimination and Stigma Outcomes (INDIGO).Anticipated discrimination was assessed through four questions of Discrimination and Stigma Scale. Twenty-five individuals were identified at each site who were reasonably representative of all such treated cases within the local area.Sixty-four per cent of the participants reported that they had stopped themselves from applying for work, training or education because of anticipated discrimination. Seventy-two per cent of them reported that they felt the need to conceal their diagnosis. Expecting to be avoided by others who know about their diagnosis was highly associated with decisions to conceal their diagnosis. Those who concealed their diagnosis were younger and more educated. The participants who perceived discrimination by others were more likely to stop themselves from looking for a close relationship. Anticipated discrimination in finding and keeping work was more common in the absence than in the presence of experienced discrimination, and the similar findings applied to intimate relationships.This study shows that anticipated discrimination among people with schizophrenia is common, but is not necessarily associated with experienced discrimination.

Introduction Studies indicate that patient-rated outcomes and symptomatic remission as defined by the remission in schizophrenia working group rely on different assumptions. The aim of this observational study was to assess symptomatic remission by patients with schizophrenia, family members and psychiatrists and to compare their assessments with standardized criteria and clinical measures. Methods One hundred and thirty-one patients with schizophrenia (DSM-IV), family members and psychiatrists assessed remission within the European Group on Functional Outcomes and Remission in Schizophrenia (EGOFORS) project. Symptoms (Positive and Negative Syndrome Scale [PANSS]), functional outcome (Functional Recovery Scale in Schizophrenia [FROGS]), subjective well-being (SWN-K) and demographic characteristics were investigated. Results Remission assessed by psychiatrists showed the best accordance with standardized remission (80%), followed by remission assessed by family members (52%) and patients (43%). Only in 18%, patients, relatives and psychiatrists agreed in their assessments. Good subjective well-being was most important for remission estimated by patients, good subjective well-being and symptom reduction by family members, and finally better symptom scores, well-being and functioning by psychiatrists. Discussion Self- and expert-rated clinical outcomes differ markedly, with a preference on the patients’ side for subjective outcome. Symptomatic remission as assessed by the standardized criteria plays a secondary role for patients and relatives in daily clinical practice. A more thorough consideration of patients’ and caregivers’ perspectives should supplement the experts’ assessment.

To analyze the occurrence of symptoms of unerupted mandibular third molars, to investigate associated pathologies, and to determine indications for removal of unerupted mandibular third molars in a Turkish population.A retrospective study was performed by reviewing 832 patients referred to Gulhane Military Medical Academy Dentistry Center for evaluation of their mandibular third molars. The patients were clinically examined, and unerupted and partially erupted mandibular third molars were determined from radiographs. The symptoms and pathologies associated with these teeth were analyzed. The indications for removal were classified into 10 groups.Two-thirds of the patients were between 20 and 29 years of age. Of the 832 unerupted mandibular third molars found, 557 (66.9%) teeth were partially erupted and 275 (33.1%) were completely unerupted. A total of 521 (62.6%) of all unerupted third molars had no symptoms, while 311 (37.4%) were associated with symptoms. The most frequent complaints of the patients were pain and swelling. Pericoronitis was observed as the most frequent pathology, in 142 patients. Of 832 unerupted mandibular third molars, 582 (69.9%) had complete root formation, 177 (21.2%) had two-thirds root formation, and 73 (8.9%) had one-third root formation.Patients between 20 and 29 years of age had the highest prevalence of unerupted mandibular third molars (69.3%). However, this figure decreased with increasing age. Partially erupted teeth (n = 228) caused the occurrence of symptoms more than completely erupted teeth (n = 83) in a Turkish population.

Assessment of psychiatric treatment has been a central issue in psychiatric research. Most assessment tools are based on the patient's account and mainly focus on clinical agendas. Assessment tools, which gather the perspective of attached daily needs are limited. The purpose of our study was to evaluate the inter-rater reliability and internal consistency of the Marmara Family Interview for the Assessment of Psychiatric Treatment (MFIPT) in a clinical sample.The study also aimed to explore a possible association between the investigated assessment tool and the Brief Psychiatric Rating Scale. Thirty patients were followed over a period of 6 months.The inter-rater reliability for the interview subscales were self care/hygiene: kappa= 0.77; social participation: kappa= 0.84; boundaries in daily life: kappa= 0.76; academic/work activities: r= 0.81, clinical condition/symptom severity: kappa= 0.72; attitude towards treatment: kappa=0.82; participation in family crisis/emotional support: kappa= 0.77; participation in daily routines/household activities: kappa= 0.63; use of psychiatric services: kappa= 0.62. Cronbach's alpha was found to be 0.90 for the overall internal consistency of the assessment tool. The strongest correlation between the Brief Psychiatric Rating Scale and Marmara Family Interview for the Assessment of Psychiatric Treatment was the depression subscale and the participation in family crisis/emotional support item (r= 0.151; P0.05).Marmara Family Interview for the Assessment of Psychiatric Treatment is a reliable instrument for the assessment of daily results of the treatment and daily functioning by the caregivers. Although, it has some limitations in assessing the clinical course.

The objective is to study the comorbidity rate of obsessive compulsive disorder and obsessive compulsive symptoms in patients with schizophrenia and their relation with the course of this illness.73 out-patients from Istanbul Medical Faculty Department of Psychiatry and 4th Unit of Bakirköy Mental Hospital who met the DSM III-R criteria for schizophrenia were recruited for this study. Other inclusion criteria were being out of acute exacerbation phase of schizophrenia. Yale-Brown Obsessive-Compulsive Scale, Yale Brown Obsessive Compulsive Symptom Screening Inventory were applied to patients.Comorbidity rate of obsessive-compulsive disorder in patients with schizophrenia was 9.6%, and also obsessive compulsive symptoms were detected 31% of patients. Aggressive obsessions were seen most frequently. These symptoms were also reported more frequently in the patients whose Global Assessment of Functionality score was higher than 45 points. Suicide attempts in psychiatric history were significantly higher for patients with obsessive-compulsive symptoms.Our findings indicate that obsessive-compulsive symptoms are seen more frequently than previously reported, and have no major effect upon the course of schizophrenia.

It was aimed to determine whether there was a difference in the leptin levels and short term exercise performance during the menstrual cycle of the young females who had normal menstrual cycle and no pregnancy story.Fifteen sedentary females aged 19-23 yrs were included. All had regular menstrual cycle of 28-30 days and no pregnancy story. Blood samples were taken for the analysis of serum estradiol, progesterone and leptin levels and Wingate test was applied on a Monark 818E ergometer with 75 g/kg load on the 7th, 14th and 21st cycle days, randomly.The differences in serum leptin levels and peak power, mean power and fatigue index during these days and the correlations between serum leptin and FSH, LH, estradiol and progesterone levels were not significant.We concluded that performance in a short intense exercise which require high motivation is not affected by menstrual cycle and in young females with normal menstrual cycle, serum leptin concentration does not change during the cycle. Further studies constituting more standard groups, controlling food intake, timing the blood sampling, studying more days of menstrual cycle will help to obtain more accurate results.

The aim of this study was to determine any association between anxiety and salivary cortisol levels in oral lichen planus (OLP) patients by the case-control method. DESIGN RELEVANT: Forty patients with OLP were evaluated. The OLP diagnosis was established through a composite of accepted clinical and histopathological characteristics. Forty patients from the register of patients who obtained general dental care were selected as controls.The saliva samples collected between 9:00 and 9:15 am were analysed for the level of cortisol with Cortisol EIA that used competitive enzyme-linked immunosorbent assay method. Trait and state anxiety levels of 80 patients were measured using the Spielberger's State-Trait Anxiety Inventory.The mean level of cortisol from 40 saliva samples in study group was 1.46 and 0.93 microg dl(-1) in 40 controls (P=0.001). The mean level for state anxiety in the study group were 48.85 and 39.45 in control group (P=0.001). Trait anxiety levels in study group were 49.77 and 38.51 in control group (P=0.001). We found that salivary cortisol, state and trait anxiety levels in OLP group were significantly higher than in the control group.Because of the fact that the level of anxiety and salivary cortisol of OLP patients were high, our findings concluded that this disease is closely related with stress. Thus besides traditional treatment of OLP patients, our findings suggest that psychological support is also needed.

A young man with a 13 year history of Tourette disorder and obsessive-compulsive disorder developed mania on clomipramine. Quetiapine 600 mg, daily was followed by resolution of the mania and improvement of the symptoms of Tourette disorder and obsessive compulsive disorder. It seems that quetiapine may be useful in treatment of Tourette disorder with or without comorbid disorders.

To evaluate the 2-year clinical performance of Dyract in small Class I cavities in non stress-bearing areas.On 36 patients, 87 small cavity preparations were performed. The lesions were diagnosed macroscopically with a probe. They involved fissures, were shallow and had reached dentin but the lateral spread was limited and localized in dentin. Cavities were designed to be on non stress bearing areas. Cavities' average faciolingual widths were prepared to be 1/3 or less than the intercuspal width. At baseline, 1- and 2-year recalls, the restorations were evaluated according to the modified Ryge criteria by two calibrated, experienced examiners.None of the restorations was lost and retention rate was 100% at the end of 1 year. After 2 years, one restoration (1.1%) had to be replaced due to caries lesion adjacent to its margin and the rate of retention was 98.9%. At the 2-year recall, marginal discoloration (rated Bravo) was observed in 19.8% of the restorations but did not require the replacement of any restorations. Except the failed restoration, no other was clinically unacceptable in regard to color match, wear or loss of anatomic form, marginal discoloration, caries, marginal adaptation and surface texture.

This study evaluated the three-year clinical performance of a polyacid-modified resin composite material, Dyract (DeTrey/Dentsply, Konstanz, Germany), in Class III cavities. Sixty-two Class III cavities in 30 patients were restored with Dyract. Restorations were clinically evaluated at baseline, one-, two- and three-year recalls according to the modified Ryge criteria by two experienced, calibrated examiners. After three years, the retention rate was 96.7%. At the one-year interval, one restoration had to be replaced due to sensitivity. At the two-year recall, one restoration, with a caries lesion adjacent to its margin, was clinically unacceptable and had to be replaced. Except for these two restorations, all other restorations were clinically acceptable in regard to color match, marginal discoloration, wear or loss of anatomical form, caries, marginal adaptation and surface texture after three years. At the end of three years, marginal discoloration was statistically significant (p=0.017) but did not require replacement of any of the restorations. Dyract exhibited significant marginal discoloration after three-year clinical performance in Class III cavities.

The purpose of the present study was to compare the aerobic contribution of the Wingate anaerobic test by increasing the test load and power output.The study was performed in the Physiology Department of the Faculty of Medicine, Selçuk University.Thirty sedentary male university students volunteered to this study.The subjects performed two Wingate tests against resistance of 75 g.kg-1 and 95 g.kg-1 body weight on Monark 818E bicycle ergometer. Breath-by-breath oxygen consumption rates were measured using an automated metabolic measurement chart (Sensormedics 2900). Aerobic contribution was determined by dividing energy equivalence of net oxygen consumption to the total work.The mean total work values obtained from tests performed at 75 g.kg-1 and 95 g.kg-1 loads were 13.9 +/- 1.5 kjoules and 14.5 +/- 1.8 kjoules (t = 2.32, p = 0.03). Mean total oxygen consumptions were 765 +/- 105 ml and 770 +/- 110 ml, respectively (t = 0.24, p = 0.81). Assuming 20% mechanical efficiency for both tests, aerobic contributions were calculated as 19.5 +/- 3.7% and 18.9 +/- 3.7%, respectively (t = 1.01, p = 0.30).Although the power outputs of the two tests were different, the difference between aerobic contributions was not statistically significant. So, it was failed to say that the increase in the power outputs might be related to higher contribution of anaerobic processes. However, if different mechanical efficiencies could be used, relationship between aerobic contributions of two tests might have been different.

The aim of this study was to investigate the effects of erythropoietin therapy on pulmonary functions in haemodialysis patients. Thirteen patients with chronic renal failure on regular haemodialysis and in need of treatment for anaemia were treated with 45-60 U/kg erythropoietin three times a week. Thirteen haemodialysis patients constituted the control group. Patients receiving erythropoietin were given pulmonary function tests prior to the treatment and after Hb levels had reached 10 g/dl. The interval between first and second pulmonary function tests was similar for both the control group and the erythropoietin group. There was no significant difference between the results of the first and the second pulmonary function tests of the control group. However, in the erythropoietin group, the diffusing capacity, maximal voluntary ventilation, forced vital capacity and peak expiratory flow rate values increased significantly. The existence of a relationship between the diffusing capacity and anaemia is well known. Rises in other parameters following erythropoietin administration might be the result of a gain in respiratory muscle strength consequent to anaemia correction.

Conconi et al. proposed that the point where heart rate departed from linearity in an incremental exercise test was a good indicator of the anaerobic threshold. However, the heart rate deflection points (HRDPs) can not be determined in many subjects. The aim of this study was to determine the heart rate deflection point by the Dmax method and to compare it with the conventional linear method.The study was performed in the Exercise Physiology Laboratory in the Faculty of Medicine, Selçuk University.Thirty-two untrained males (aged 18-22) performed a maximal exercise test on a cycle ergometer.The deflection from linearity of HR could not be detected in nine subjects (28%) by the linear method. The HRDPs could be detected in all subjects by the Dmax method. It was observed that the HR values in the HRDPs determined by both methods were close to the maximal HR values (approximately 90% of maximum). There were high correlations and no differences (p more than 0.05) between the deflection points expressed as oxygen uptake, HR and work rate determined by two methods (correlation coefficients 0.93, 0.93, 0.97, respectively, p less than 0.001).The Dmax method is more useful than linear method. The HRDPs of all the people can easily and objectively be found by this method.