The Reliability and Validity of the Turkish Kaiser Physical Activity Survey for Pregnant Women.

BACKGROUND: Evaluation of physical activity by condition-specific surveys provides more accurate results than generic physical activity questionnaires. The aim of this study was to investigate the reliability and validity of the Kaiser Physical Activity Survey (KPAS) in Turkish pregnant women. METHODS: In the translation and cultural adaptation of the KPAS, the 6-phase guidelines recommended in the literature were followed. The study included a total of 151 pregnant women who were assessed using the Turkish version of KPAS, the Pregnancy Physical Activity Questionnaire, and the SenseWear Pro3 Armband. To determine the test-retest reliability, the KPAS was reapplied after 7 days. The psychometric properties of KPAS were analyzed with respect to internal consistency, test-retest reliability, and concurrent validity. RESULTS: Cronbach α coefficient indicating the internal consistency of the Turkish KPAS was found to be .60 to .80, showing moderate reliability. The intraclass correlation coefficient for test-retest reliability was very strong (intraclass correlation coefficient: .96-.98). The total KPAS scores were found to be moderately correlated with the total Pregnancy Physical Activity Questionnaire score and the total energy expenditure value on the SenseWear Pro3 Armband. CONCLUSIONS: This study showed that KPAS is a valid and reliable instrument for evaluating physical activity in Turkish pregnant women in different aspects.

Reliability and validity of the Turkish King's Health Questionnaire in women with urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to translate the King's Health Questionnaire (KHQ) into Turkish and to test its reliability and validity among Turkish women with urinary incontinence (UI). METHODS: Three hundred and thirty-five women with symptoms of UI completed the Turkish versions of the KHQ, short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), and the Incontinence Severity Index (ISI). Psychometric analysis of the KHQ included assessments of test-retest reliability, internal consistency, construct, and criterion validity. Factor analysis was used to explore the underlying structure of the KHQ. RESULTS: The internal consistency (Cronbach's alpha ≥0.68) and test-retest reliability of the KHQ were found to be high (p < 0.001). Interdomain correlation analysis showed good convergent validity among Role, Physical, and Social Limitations, with relatively higher correlations and divergent validity between Personal Relationships and other domains, with relatively lower correlations. Exploratory factor analysis identified three factors, namely, Daily Life and Emotions, Personal Relationship, and General Health Perception. The KHQ was also significantly correlated with IIQ-7, UDI-6, and ISI (p < 0.01). CONCLUSIONS: The results suggest that the Turkish KHQ is a valid and reliable condition-specific quality of life instrument for Turkish women with UI.

Short-term effect of adding pelvic floor muscle training to bladder training for female urinary incontinence: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to assess whether bladder training (BT) combined with high-intensity pelvic floor muscle training (BT + PFMT) results in better outcomes in the short term than BT alone on female urinary incontinence (UI). METHODS: We randomly assigned 108 women with diagnoses of stress UI (SUI, n = 50), urgency UI (UUI, n = 16), or mixed UI (MUI, n = 42) to 6 weeks of BT + PFMT or BT alone (control group). The primary outcome measure was self-reported improvement. Secondary outcome measures were UI severity, symptom distress, quality of life (QOL), mean number of UI episodes and micturitions per day, and pelvic floor muscle strength and endurance (PFME). RESULTS: Overall and in the SUI and MUI subgroups, significantly more patients in the BT + PFMT group reported cured and improved symptoms. Overall and in SUI patients, the BT + PFMT group also improved to significantly greater degree in UI severity, symptom distress, QOL, daily UI episodes, and PFME. The only parameter showing more improvement in patients with UUI was QOL, and UI severity in patients with MUI (p < 0.05). There were no other significant differences between the two study groups in overall and subgroup analysis (p > 0.05). CONCLUSIONS: High-intensity PFMT combined with BT is more effective than BT alone in the short term for treating UI or SUI. It appears that the combination therapy may also lead to greater benefits for patients with UUI and MUI. Based on the results of this study, further studies with larger sample sizes (for UUI) and long-term follow-ups are warranted.

Two patients with marginal symptoms showing hyperthecosis at the edge of malignancy: Presentation of two cases.

It is important to define the aetiology of increased levels of androgens in women. Ovarian stromal hyperplasia (OSH) and ovarian hyperthecosis (OHT) are non-neoplastic pathologies. They show the excess of androgen production and have a wide clinical range like hirsutism, virilisation, abnormal menses, obesity, hypertension and insulin resistance. Ovarian stromal hyperplasia and hyperthecosis are commonly seen in postmenopausal women and generally involve both ovaries. Laboratory testing is the gateway; testosterone and dehydroepiandrosterone sulphate (DHEA-S) are the first hormones that should be measured. OSH and OHT could also be a reason for endometrial malignancy by unopposed oestrogenic status. Hyperthecosis must be differentiated from several other diseases, especially malignant conditions, and the treatment for postmenopausal women should be bilateral oophorectomy.

Validity and reliability of the Turkish version of the Pelvic Floor Distress Inventory-20.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to investigate the reliability and validity of the Turkish version of the Pelvic Floor Distress Inventory-20 (PFDI-20). METHODS: One hundred and twenty-eight women with pelvic floor disorders, including pelvic organ prolapse, urinary incontinence, and anal incontinence were enrolled in the study. The Turkish version was developed using forward back translation. Construct validity was examined by correlation of clinical methods. Interclass correlation coefficients (ICC) compared the PFDI-20 and subscale scores. Cronbach's alpha assessed the internal consistency of the Turkish version. RESULTS: The PFDI-20 has three subscales. The test-retest reliability of the PFDI-20 and subscale was excellent (ICC 0.96 to 0.98, p < 0.001). Cronbach's alpha value (0.79) was moderate for the PFDI-20. Construct validity demonstrated that the PFDI-20 and each subscale displayed significant correlation with other clinical methods used (p < 0.05). CONCLUSIONS: The PFDI-20 is a valid and reliable condition-specific questionnaire for Turkish women with pelvic floor disorders.

Effects of physiotherapy on pain and functional activities after cesarean delivery.

PURPOSE: To investigate the effects of a physiotherapy program on incision pain and functional activities in the early post-cesarean period. METHODS: Fifty women were evaluated after Cesarean operation with regard to times of ambulation and return of bowel activity, intensity of incision pain, difficulty in functional activities and number of analgesics required additional to routine pain control procedure. Twenty-four women received only routine nursing care, and a physiotherapy program was applied to the study group (n = 26), additionally. RESULTS: Postoperative ambulation and return of bowel activity were earlier in the study group (p < 0.05). Incision pain and difficulty in functional activities decreased significantly within 2 days in both groups, and the values were lower in the study group (p < 0.05). Study group needed less medication for pain control (p < 0.05). CONCLUSIONS: Findings revealed the effectiveness of a physiotherapy program in the early post-cesarean period in a wider perspective than the current literature, and are considered to be valuable for increasing the quality and productivity of the postnatal care, therefore improving well-being after childbirth.

Comparison of different treatment protocols in the treatment of idiopathic detrusor overactivity: a randomized controlled trial.

OBJECTIVE: To investigate and compare the effectiveness of various treatment protocols for the treatment of women with idiopathic detrusor overactivity. DESIGN: Prospective, randomized controlled trial. SETTING: Departments of Physiotherapy and Rehabilitation and Obstetrics and Gynaecology, Hacettepe University. SUBJECTS: Forty-six subjects were randomized to three groups. INTERVENTIONS: The first group received only pharmacotherapy, the second group received only physiotherapy and in the third group pharmacotherapy was combined with physiotherapy (combined therapy group). MAIN MEASURES: All patients were evaluated at the beginning and at the end of treatment. Assessment parameters were maximum cystometric capacity, electromyographic activity of pelvic floor muscles, voiding diary parameters, the amount of urine leakage and the quality of life score. RESULTS: The maximum cystometric capacity and the electromyographic activity of pelvic floor muscles increased significantly and the number of voids/day and incontinence episodes/day, and the amount of urine leakage reduced significantly (P < 0.05) in both physiotherapy and combined therapy groups while there was no significant difference in the pharmacotherapy group. After treatment, the number of voids/day increased by 0.3 ± 3.4 in the pharmacotherapy group (P > 0.05) and decreased by 5.1 ± 5.5 and 4.7 ± 5.6 in the physiotherapy and combined therapy groups, respectively (P < 0.05). Statistically significant improvements were observed in all groups according to the number of voids/night and the quality of life scores at the end of the treatment. CONCLUSION: The physiotherapy protocol we introduced in the present study with or without anticholinergic therapy has a substantial positive impact on the treatment of female patients with idiopathic detrusor overactivity.

The results of fetal echocardiography in a tertiary center and comparison of low- and high-risk pregnancies for fetal congenital heart defects.

OBJECTIVE: Fetal echocardiography (FE) is considered for fetal, maternal or hereditary reasons in pregnants with suspect of intrauterine heart disease (IUHD). However, in few studies it was reported that most of the fetuses with IUHD are in the low-risk group (suspicion of IUHD during 2nd trimester ultrasound, lack of good vision of the heart, self-referral). Our aim is to examine retrospectively the reasons for referral of pregnants, the results of FE, distribution of pregnants having fetuses with IUHD according to low- and high- risk factors and to evaluate reliability of FE. METHODS: Our study group consisted of 1395 fetuses and 1370 pregnants underwent FE between 1999 and 2006. These cases included self-referred women and the pregnants having previous child or family history of cardiac anomaly or referred by obstetricians. The prevalence of IUHDs in low- and high- risk pregnancies was compared by Chi-Square test. RESULTS: The low risk group included 453 patients and the remaining 917 women were in the high- risk group. Intrauterine heart diseases were detected in 152 (10.9%) of 1395 fetuses. The prevalence of IUHDs was 19% in the low- risk group and 7% in the high-risk group. Of the 152 fetuses 56.6% were in the low-risk group and 43.4% were in the high- risk group. The sensitivity of FE for diagnose of IUHDs was 97%, the specificity was 100%. CONCLUSION: Fetal echocardiography is highly reliable method for diagnosing of IUHDs. The most IUHDs occur in the low- risk group.

Use of hyaluronic acid for vaginal stenosis in a woman with a history of imperforate hymen and transverse vaginal septum: a case report.

BACKGROUND: Female reproductive tract abnormalities are common and may occur in various combinations. Management usually involves surgery. However, therapeutic failures may be experienced and repeated surgical interventions may be required. CASE: A 26-year-old woman who was subjected to surgery for imperforate hymen coexistent with transverse vaginal septum 10 years previously presented with hypomenorrhea and severe dysmenorrhea. Vaginal stenosis at the level of partially excised transverse septum was detected. The patient was successfully managed with complete surgical excision of transverse vaginal septum with application of hyaluronic acid to prevent restenosis. CONCLUSION: Women presenting with a reproductive tract abnormality should be evaluated carefully to detect the presence of combined abnormalities and to avoid the need for additional interventions. Also, further studies are needed to warrant the use of adhesion-preventing agents as an adjunct to surgical procedures to avoid therapeutic failures.

Interferential current versus biofeedback results in urinary stress incontinence.

BACKGROUND: Urinary stress incontinence is a common, disruptive and potentially disabling condition in which the subject complains of involuntary leakage on effort or exertion or on sneezing or coughing. AIM: This study was performed in order to compare the effects of interferential current and biofeedback applications on incontinence severity in patients with urinary stress incontinence. In addition, pelvic muscle strength and quality of life as important parameters in these subjects were investigated. METHODS: In this prospective, randomised, controlled study, forty women with moderate intensity of urinary stress incontinence as determined by one-hour pad test were included. Pelvic muscle strength was evaluated by a biofeedback device and quality of life was assessed by a 28-itemed questionnaire. All of the parameters were evaluated before and after the treatments. Twenty cases underwent interferential current therapy, while pelvic floor exercises via biofeedback were applied in the remaining cases. The treatments lasted 15 minutes per session, three times a week for a total of 15 sessions. RESULTS: All of the parameters improved after the treatments in each group (p <0.05) and both treatment modalities seemed to have similar effects on pad test (95% CI: -1.48 - 4.59), pelvic muscle strength (95% CI: -9.29 -1.78) and quality of life (95% CI: -11.91 - 5.31) outcomes. CONCLUSIONS: Physical therapy modalities used in this trial are applied easily and non invasive. Also, when the finding that no adverse effects were observed during the study period is taken into consideration, it can be concluded that both methods can be used effectively in patients with urinary stress incontinence.

[Investigation of Chlamydia trachomatis positivity in women with and without gynecologic complaints by cytologic and direct immunofluorescence methods]. / Jinekolojik yakinmalari olan ve olmayan kadinlarda Chlamydia trachomatis pozitifliginin sitolojik ve direk immonofloresans yöntemleriyle arastirilmasi.

The asymptomatic nature of the majority of Chlamydia trachomatis infections leads to persistent infections and serious complications as well as continuous transmission of bacteria in the populations. The aim of this study was to investigate the presence of C. trachomatis in non-pregnant women with and without gynecologic signs and symptoms, and to detect the rate of asymptomatic carriage. Cervical specimens collected from 200 nonpregnant women (age range: 20-81 yrs; mean age: 40.2+/-10.4 yrs) who were admitted to Gynecology and Obstetrics Clinics of Hacettepe University Hospital were included to the study. Of them 68 had clinical complaints such as vaginal discharge, itching/irritation, inflammation and inguinal pain, while 132 had not any clinical complaints. All the samples were examined by direct immunofluorescence (DFA) method (Fluorotect Chlamydia, Omega Diagnostics, UK) with fluorescein isothiocyanate labeled monoclonal antibodies against C. trachomatis serotype specific major outer membrane proteins, and the samples were simultaneously screened cytologically by Papanicolaou staining method. As a result, C. trachomatis antigen positivity was found in 49 (24.5%) of the samples by DFA method, and chlamydial inclusion bodies were detected in 19 (9.5%) of women by cytologic method. Twelve (24.5%) of the 49 DFA positive samples, and 7 (4.6%) of the 151 DFA negative samples yielded positive results cytologically. The observed proportion of overall agreement (P) was estimated as 78% between the results of methods. C. trachomatis antigen positivity was detected in 16.2% (11/68) and 28.8% (38/132) of women with and without clinical symptoms, respectively. There was no statistically significant difference between C. trachomatis positivity and neither the presence of clinical signs and symptoms nor the characteristics of the signs and symptoms (p>0.05). In conclusion, the high asymptomatic carriage rate detected in our study population indicated that, for the prevention of bacterial transmission in the populations, the women who were admitted to gynecology and obstetrics clinics should be screened for C. trachomatis positivity even if they had no clinical complaints. The use of DFA method together with the widely used, practical and economical cytologic examination method, would increase the sensitivity and specificity of C. trachomatis diagnosis.

Cytologic findings in pap smears with Actinomyces-like organisms.

OBJECTIVE: To detect whether there is a relationship between the presence ofActinomyces-like organisms (ALOs) and cytologic findings. STUDY DESIGN: Papanicolaou-stained smears from 2290 women were examined cytologically. Nineteen (0.83%) of the 2290 were diagnosed with ALOs and became the study group. Patients without infectious agents (n=1792) were the control group. Statistical analyses were conducted with the chi2 test using the SPSS program (Chicago, Illinois, U.S.A.). RESULTS: The study and control groups were compared statistically. There was a significant correlation between the presence of ALOs and other cytologic findings, such as Trichomonas vaginalis, cocci, pseudoeosinophilia, endocervical cells, superficial cells, lactobacilli and polymorphonuclear leukocytes (p < 0.05), but there was no statistically significant difference between the presence of ALOs and metaplastic cells, parabasal cells or nuclear changes (p > 0. 05). CONCLUSION: ALOs in cervicovaginal smears might provide a milieu for growing some infectious agents, such as Trichomonas vaginalis and cocci. Lactobacilli were less plentiful in these cases. Vaginal discharge and abdominal pain were also important clinicalfindings for the detection ofALOs. Another finding was long-term usage of intrauterine contraceptive devices, which can cause the overgrowth of ALOs in vaginal mucosa.