Group Medical Visits Versus Usual Care for Illness Perception and Hypertension: A Randomized Pilot Study.

ABSTRACT: Despite separate evidence regarding illness perception (IP) and group medical visits (GMVs) for hypertension, research on both is limited. Here, we have assessed and compared the effectiveness of GMVs and usual care (UC) on IP and blood pressure (BP) in patients with hypertension. This was a two-group parallel randomized controlled study with 1:1 allocation. Patients with essential hypertension on antihypertensive medication and no cognitive impairments were screened for BP control status and eligibility. A web-based program randomly assigned them to the GMV and UC groups. Group medical visits were held once a month for 3 months. Primary and secondary outcome measures included improvements in IP and BP control. Among 152 participants, 40 and 43 were assigned to the GMV and UC groups, respectively. The control group had a 9.3% dropout rate. The chronic timeline and illness coherence improved significantly in the intervention group ( p < .01). Systolic BP in the intervention group decreased significantly compared with that of the control group (Δ: -18.8 ± 18.4 mm Hg vs. Δ: -10.6 ± 12.5 mm Hg, p = .025). The participation in GMVs had a significant association with the odds of an increase in BP regulation (OR 3.8, 95% confidence interval 1.4-10.3, p = .007). Therefore, GMVs may be feasible for BP control in hypertensive patients with similar characteristics.

Epidemiological shift of hepatitis A in central Adana, Turkey.

BACKGROUND/AIMS: The aim of the study was to determine the epidemiological shift that may have occurred in the last 11 years of Hepatitis A virus (HAV) seroprevalence. MATERIALS AND METHODS: In 1998, we reported the anti-HAV seroprevalence in 711 children aged between 2 and 16 years children in Adana city center. Eleven years later we repeated the same study at the same locations in a similar population with the same method. RESULTS: From 1998 to 2009 anti-HAV seroprevalence declined from 33.9% to 22.2%, 29.5% to 25.3% (p>0,05), 52.2% to 30.8%, 69.7% to 35.2%, 66.9% to 37.7% and 71.4% to 47.3% (p<0,0001) in the age groups of 48-71, 72-95, 96-119, 120-143, 144-167 and 168-198 months respectively. CONCLUSION: Our study showed that anti-HAV seroprevalence has decreased statistically significantly during the last 11 years in school-aged children. Results showed that anti-HAV seroprevalence has shifted to further ages. Since adolescents and young adults are at risk of symptomatic HAV infection, routine hepatitis A vaccination of children will be initiated in 2012 in Turkey.

The well-being and treatment satisfaction of diabetic patients in primary care.

BACKGROUND: The quality of life in patients with diabetes is reduced and emotional coping with the disease has great impact on patient well-being. OBJECTIVES: The aim of this study was to assess the psychological well-being and treatment satisfaction in patients with type 2 diabetes mellitus in primary care. STUDY DESIGN AND SETTING: Patients (n = 112) with type 2 diabetes mellitus diagnosis for at least six months were enrolled. The Well-Being Questionnaire-22 and the Diabetes Treatment Satisfaction Questionnaire were used. Physical examination and laboratory investigations were performed. RESULTS: The rates of the achieved targets were 32.1% for hemoglobin A1c, 62.5% for cholesterol and 20.5% for blood pressure. The mean scores for the general well-being, depression, anxiety, positive well-being and energy were 44.40 +/- 13.23 (range = 16-62), 12.65 +/- 3.80 (range = 5-18), 10.57 +/- 4.47 (range = 1-18), 12.00 +/- 4.01 (range = 2-18), and 9.16 +/- 2.47 (range = 2-12), respectively. The mean scores for the treatment satisfaction, perception for hyperglycemia and perception for hypoglycemia were 22.37 +/- 9.53 (range = 0.00-36.00), 1.71 +/- 1.59 (range = 0-6), and 0.51 +/- 0.98 (range = 0-6), respectively. There were significant associations between the depression score and the educational status, compliance to diet and physical exercise, and diabetic complications; between the anxiety score and the educational status, glycemic control, compliance to diet and physical exercise; between the energy score and the educational status, compliance to physical exercise, and diabetic complications; between the positive well-being score and the educational status, compliance to diet and physical exercise, complications and type of treatment; between the general well-being score and the educational status, compliance for diet and physical exercise, and complications. Treatment satisfaction was significantly associated to the educational status, glycemic control and compliance to diet and physical exercise. A significant correlation was found between the treatment satisfaction and the well-being. CONCLUSIONS: Individualized care of patients with diabetes should consider improving the quality of life. Psychosocial support should be provided to the patients with type 2 diabetes and the negative effects of psychopathological conditions on the metabolic control should be lessened.

Self-perceived body weight status and weight-control behaviors of high school students in a southern city of Turkey.

Defining "healthy weight" is not easy and for an adolescent with all concerns about newly developing physiognomy it is even harder. The aim of this study was to find out the frequency of obesity and the association between the body mass index (BMI), weight-control behaviors and self-perceived body weight status in high school students of a southern city of Turkey. The students from 10 schools were randomly selected among 46,271 students of 72 high schools in Adana from 1999 to 2000. The response rate was 94.8% (2352/2480). The Turkish version of Youth Risk Behavior Survey Questionnaire (YRBSQ) was completed by the students. The students' weights and heights were measured. The mean age was 16.5 +/- 1.0 years of age (range = 14-21 years). The mean BMI was 21.0 +/- 3.1, 25.5% of students were underweight, 65.7% were normal, 6.4% were overweight and 2.3% were obese (p = 0.0001). Of all students, 24.3% defined themselves as thin, 45.3% as normal, 24.9% as overweight and 5.5% as obese (p = 0.0001). The percentage of girls defining their body weight as overweight and obese was significantly higher than the boys (p = 0.0001). Of all students, 35.5% wanted to lose weight, 22.3% wanted to gain weight, 27.8% wanted to keep their current weight. Intention (p = 0.0001) and interventions to lose weight such as going on a diet (p = 0.0001), provocative vomiting (p = 0.0001) and 24-hours starving (p = 0.0001) were significantly higher in girls than boys. Of students, 26.8% (n=620) were on a diet program either to lose or to keep their body weight. There was significant relationship between being on a diet program and intention to change body weight (p = 0.047). We concluded that adolescents living in Adana have relatively higher risk of being underweight than being obese and have unhealthy weight changing plans due to their misperception of their body images. Adolescents may be unconscious on plans and attempts to change their body weights and nutrition and we suggest that education on nutrition and health is required for adolescents.

Survey of scalp dermatophyte carriage in a Day Care Center in Turkey.

The prevalence of tinea capitis and the symptom-free colonisation of the scalp with dermatophytes were examined in 502 mentally retarded participants who attended day care centers in the Tarsus district, Mersin, Turkey. Between December 2006 and May 2007, a screening study was conducted in three centers on a total of 316 (62.9%) male and 186 (37.1%) female participants aged 12 +/- 6.2 years. The examinations were carried out in parallel with the hairbrush, toothbrush, and cotton swab methods by inoculation onto Sabouraud glucose agar. No participant was diagnosed with tinea capitis; however, we detected three carriers, all of whom were boys aged 2-16 years. The total prevalence of carrier state was 0.6%. Of three boys, T. tonsurans was seen in two cases (66.7%), and in one case a zoophilic variant of T. mentagrophytes (33.3%) was isolated. The diagnosis was made via the hairbrush method in all three carriers. We also did a screening study on ten households of the three asymptomatic carriers. T. mentagrophytes also was isolated in a 5-year-old sister of the boy with T. mentagrophytes colonisation. All the carriers were followed-up without any antimycotic treatment. In two of the participants, the carrier state persisted at the 13th and 17th week follow-ups, and mycological clearance was documented at the 20th and 24th week for these individuals. The third case and the household's culture were found negative at the 7- and 12-week follow-ups. Despite poor hygienic conditions and the participants' difficulties in performing basic hygiene practices, asymptomatic carriage was found to be surprisingly less prevalent among the mentally retarded individuals.

Prevalence of migraine diagnosis using ID Migraine among university students in southern Turkey.

In this prospective study, we aimed to determine the prevalence of migraine and non-migraine headaches using a questionnaire, including ID Migraine, for university students. The study was designed cross-sectionally and a questionnaire consisting of 43 questions was applied to 1,256 students. The questionnaire consisted of questions related to demographic, social, curriculum, housing and headache characteristics of the subjects. Three-item screening questions of the ID Migraine test were included at the end of the questionnaire aimed at migraine diagnosis. The mean age of 1,256 students (529 females and 727 males) enrolled in this study was 21.9 +/- 2.1 years (17-31 years). Migraine-type headache was detected in 265 subjects (21.9%) based on the ID Migraine evaluation. Of these, 145 (54.7%) were female and 120 (45.3%) were male (female/male ratio: 1.2/1). Non-migraine-type headache was identified in 864 subjects, with 357 females and 507 males. As a conclusion, ID Migraine screening test might be practical and beneficial when a face-to-face interview is not possible or to pre-determine the subjects for a face-to-face interview for migraine diagnosis in larger populations.

The prevalence of risky behaviors related to violence in high school students in a southern city, Turkey.

Injuries are the leading cause of mortality and morbidity in adolescents and can be grouped as unintentional (such as motor vehicle crashes and fires) and intentional (violence and suicide). The aim of this study was to find the prevalence of high risk behaviors related to violence in high school students. The population comprised 2,480 randomly selected students from 10 schools among 46,271 students from 72 high schools in 1999-2000 in Adana and 2,352 (94.8%) were reached. They completed a Youth Risk Behavior Survey Questionnaire (YRBSQ). The mean age was 16.5 +/- 1 (14-21) years. 275 (11.7%) students stated that they carried a knife or a sharp weapon during the last 30 days, 151 (6.4%) carried a gun, 710 (30.2%) participated in a physical fight, 68 (2.9%) were threatened or injured by a weapon, 73 (3.1%) could not attend school because of threats from other students, 96 (4.1%) were forced into sexual intercourse. Male students were significantly more likely than female students to report all types of high risk behaviors except forced sexual intercourse. The rate of risky behaviors increased with higher grade. Violence towards and by adolescents is a severe problem. Families, teachers, and health care professionals should be aware of risk factors and be active in prevention of high risk behaviors in youth.

Headache characteristics in senior medical students in Turkey.

Headache is one of the most common neurological complaints of the young population and it affects the quality of life due to limitation of daily activities. In this study, our main goal was to appraise the general headache characteristics in senior medical students just before graduation and to determine the impact of headache on the quality of life, as well as the general attitude of students about their headaches. The study group consisted of 141 senior students. As the first step, the question about "having headache within the past one year period" was asked. Of the 141 students, 127 students answering "yes" were invited to a face-to-face interview. Of these, 67 students (52.8%) participated in the second evaluation. The second evaluation consisted of history taking and neurological and physical examination. All subjects were classified according to the International Classification of Headache Disorders (2nd edition) criteria. Validated Turkish version of Migraine Disability Assessment questionnaire was given to the subjects to evaluate the socio-economical impact of headache. Tension-type headache, which is the most common form of primary headaches, was identified in 34 students (50.7%) out of 67 students. Migraine was detected in 31 students (46.3%). This is the first study performed on a face-to-face interview basis with medical students using the new classification criteria in Turkey. Astonishingly, most of the students (n:65) ignored their headaches and did not seek medication, despite the negative impact of headache on daily functioning and overall quality of life.

Which is the best anthropometric technique to identify obesity: body mass index, waist circumference or waist-hip ratio?

This study was designed to define the most suitable anthropometric technique among body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) as indices of obesity in adult people living in Adana, a Southern province of Turkey. A random sample design was used. A total of 900 individuals (men and non-pregnant women aged 25-65 years) were enrolled in the study. Of subjects, 50.9% were females. Anthropometric measurements were performed. Data were analysed using statistical package program. The prevalence of obesity among adults living in Adana was 20.8% 28.4% when defined using BMI, 30.5% by WC and 15.8% 42.0% by WHR. Truncal obesity and gynoid obesity showed similar prevalence with 26.6%, in the same age group. Waist circumference, BMI and WHR identified different proportions of the population, as measured for obesity prevalence. The most common methods for diagnosing overweight and obesity are based on BMI (kg/m2). However, BMI is suboptimal marker for total body fat percentage and even less suitable to assess body fat distribution. WHR is the most useful measure of obesity and the best simple anthropometric index in predicting a wide range of risk factors and related health conditions.

Habitual tea drinking and bone mineral density in postmenopausal Turkish women: investigation of prevalence of postmenopausal osteoporosis in Turkey (IPPOT Study).

AIM: In this epidemiological report, we assessed the prevalence of osteopenia and osteoporosis (OP) in postmenopausal Turkish women and the relationship between body mass index (BMI), and some nutritional factors (habitual tea, coffee, tobacco, and milk product consumption) with OP. METHODS: This multicenter study was done in postmenopausal women residing in five big cities, in four different regions of Turkey between August and November 2005. An inclusion criterion was being in the postmenopausal period for at least 12 months. A semi-structured questionnaire was completed by face-to-face interview, consisting of closed- and open-ended questions about demographic characteristics, nutritional status, and habits with two or more choices as possible responses. Bone mineral density (BMD) measurements were performed with a MetriScan Densitometer (Alara Inc., CA, USA). RESULTS: Seven hundred twenty-four women were included in the study. The mean age was 57.6 +/- 9.6 years, and mean age at natural menopause was 46.4 +/- 5.6 years. Of the participants, 51% were illiterate. According to WHO classification; 42.5% were normal in terms of BMD, 27.2% had osteopenia, and 30.2% had OP. Women with high education levels had better T-scores (p = 0.019). Increase in BMI also had a positive effect on T-scores (p < 0.0001). A linear correlation was found between age (r= -0.386, p < 0.0001), BMI (r = -0.175, p < 0.0001), and education (r = -0.317, p < 0.0001), with T-scores. The T-scores of women who consumed tea on a regular basis were found to be higher than non-consumers (-1.51 +/- 1.68 vs. -1.09 +/- 1.66; p = 0.070) [when smokers, those who received hormonal therapy (HT), and those > 65 years were excluded]. CONCLUSION: OP was determined in 1/3 of the women. Advanced age (> 65) and being illiterate were negative factors, while high education levels, being overweight, and being treated with HT had a positive effects on BMD. Habitual tea drinking also may have a positive effect on BMD. However, tea drinking was not found to be a statistically significant factor in the present study.

The antibiotic prescribing behaviourof physicians for acute tonsillopharyngitis in primary care.

OBJECTIVES: Acute tonsillopharyngitis is one of the most common reasons for antibiotic use although it is mostly viral. There seems to be a large variation between physicians in prescribing antibiotics. The aim of this study was to explore the antibiotic prescribing behaviour of physicians while treating cases with acute tonsillopharyngitis. PATIENTS AND METHODS: Data were collected using a questionnaire designed to investigate the effect of the antibiotics actively promoted by pharmaceutical companies, the sociodemographic details of primary care physicians, the geographic location (urban-rural) of the primary care organizations, and the effect of laboratory investigations on provider antibiotic prescribing behaviour in the treatment of acute tonsillopharyngitis. Sixty six primary care organisations (PCOs) and 316 primary care physicians working in the 66 PCOs in Adana in 2001 were involved in the study. RESULTS: Out of 66 PCOs, 55 (83%) were urban and 11 (16%) were rural. The response rate was 79%. There was significant association between antibiotic prescription for acute tonsillopharyngitis and geographic location, antibiotic promotion by pharmaceutical companies and postgraduate training for physicians (p = 0.001, p = 0.0001, p = 0.0001, respectively). There was also significant association between laboratory investigation and geographic location, postgraduate training for physicians, and period since graduation (p = 0.0001, p = 0.0001, p = 0.003, respectively). CONCLUSIONS: Antibiotics in cases with acute tonsillopharygitis are more frequently prescribed in rural areas and in PCOs where the visits and motivation from pharmaceutical companies are intensive. Physicians without postgraduate vocational training prescribe more antibiotics for cases with acute tonsillopharyngitis.

Suicidal thought and behavior in high school students in Adana, Turkey.

Fifty years ago adolescents mostly died of natural causes, whereas they now die from more preventable causes. Part of this change has been a worldwide rise in adolescent suicide rates in both developed and developing countries. Suicides are probably under reported due to cultural and religious stigma attached to self-destruction. Objectives of this study were to collect data about suicidal thoughts, plans and attempts and related sociodemographic details in high school students. The population comprised 2,480 randomly selected students among 46,271 students from 72 high schools in 1999-2000 in Adana and 2,352 (94.8%) students from 10 schools were reached and given a questionnaire modified using Youth Risk Behavior Survey Questionnaire (YRBSQ). Chi2 and Kolmogorov-Smirnov tests were used. Mean age was 16.5 +/- 1 (14-21) year, 1,187 (50.5%) students reported severe desperation, 526 students (22.4%) had suicidal thoughts, 332 (14.1%) planned committing suicide, 145 (6.2%) attempted suicide. The occurrence rate of desperation, suicidal thoughts, plans, attempts and the mean number of attempts were significantly higher in females than males. Adolescent suicide is a tragedy affecting individual, family, peers, and community. Families, teachers, and physicians should be aware of risk factors for suicide.

Predictors of smoking behavior of first year university students: questionnaire survey.

AIM: To assess the prevalence of smoking and sociodemographic factors related to smoking behavior of first year university students in Adana, Turkey. METHODS: The sample was selected from two faculties (Faculty of Engineering and Architecture and Faculty of Agriculture) using the method of simple cluster sampling, representing the university student population. The students filled out an anonymous questionnaire comprising 17 questions related to their sociodemographic characteristics and smoking behavior. The response rate was 73.5% (471 out of 640 students). RESULTS: The prevalence of daily smoking among the first year students was 21.4%, with the predominance of men (25.0%) over women (12.9%). Most students (89.1%) had positive expectations about quitting smoking in the next 5 years ("I will quit smoking", "I will decrease the number of cigarettes I smoke", and "I will continue to be a non-smoker"). The smoking behavior was significantly related to student's sex (p=0.026, Pearson's chi-square test), mother's education (p=0.029, Pearson's chi-square test), number of failed grades (p=0.011, ANOVA), student's monthly income (p<0.001, Pearson's chi-square test), and having friends who smoke (p<0.0001, Pearson's chi-square test). CONCLUSION: The main determinants of regular smoking behavior for university students in Turkey were male sex, low academic performance, having smoking friends, high level of income, and a mother with high education level. These findings call for making anti smoking policies more specific in regard to the targeted population.

Prevalence of hepatitis A in children and adolescents in Adana, Turkey.

The present study was aimed at determining the seroprevalence of anti-HAV in children and adolescents in the city of Adana, Turkey. The overall prevalence of anti-HAV was 44.4% (316/711). The prevalence increased with advancing age i.e. 28.8% (2.1-6 yr), 49.8% (6.1-12 yr), and 68% (12.1-16.5 yr) (P < 0.0001). Seroprevalence was significantly lower in children less than 6 years and belonging to higher socioeconomic status.