Coping Attitudes of Cancer Patients and Their Caregivers and Quality of Life of Caregivers.

BACKGROUNDS AND AIM: Cancer process is a traumatic period for both patients and their caregivers. Caregivers of the patients use various coping methods to minimize the effects of anxiety-creating negativities in their daily lives. The present study aimed to examine the coping attitudes adopted by the patients and caregivers and the effects of this process upon the quality of life (QoL) of caregivers. METHODS: The cross-sectional study was conducted on three groups of (i) 74 patients consisting of those hospitalized in the department of medical oncology in tertiary care hospital or coming to the health center for chemotherapy treatment as cancer outpatients and (ii) 46 caregivers of patients; and control group 46 healthy individuals. Face-to-face interviews were conducted with the study patients to administer a short sociodemographic questionnaire, coping attitudes assessment scale (COPE), and Short Form-36 (SF-36) QoL scale. RESULTS: Statistically significant differences were recorded among patients, caregivers, and control groups in terms of "problem-focused coping" and "dysfunctional coping" the COPE scale (P = 0.001, P = 0.017). According to scores taken from the SF-36 scale, there was a statistically significant difference between caregivers and control groups in all parameters (P < 0.05). CONCLUSION: Patients and caregivers should be encouraged to use the coping methods related to the source of the problem rather than the dysfunctional coping methods. Evaluation of the QoL indicators of not only the patients but also their caregivers enables to formulate a more integrated approach and detection of the expectations of the caregivers.

Comparison of ambulatory blood pressure measurement with home, office and pharmacy measurements: is arterial blood pressure measured at pharmacy reliable?

RATIONALE, AIMS AND OBJECTIVES: Standardizing arterial blood pressure (BP) measurement is difficult because of different performers like doctor or pharmacy employee. We investigated the reliability between different BP measurement methods. METHODS: The study was conducted in an internal medicine service with 160 patients in Ankara, Turkey. First, the subjects' BP was measured by doctor. Then, 24-hour BP monitoring devices were placed. Participants were then instructed to measure their BPs both at home and in pharmacy. The next day, arterial BP was measured by the doctor for the second time. RESULTS: The prevalence rates of masked and white coat hypertension were 8.8% (n = 14) and 8.1% (n = 13), respectively. There was no statistically significant differences between ambulatory measurement and home, office and pharmacy measurements (P > 0.05). The consistency rate between ambulatory and home measurements was 97.5% (kappa = 0.947, P < 0.001). The consistency rate between ambulatory and pharmacy measurements was 82.5% (kappa = 0.634, P < 0.001). When compared with ambulatory measurement, the most sensitive (98.0%) and most specific (96.8%) method was home measurement. There was a moderate positive correlation between ambulatory and other measurements in both systolic and diastolic values. There was a positive and very strong correlation between ambulatory and home measurements of systolic and diastolic ABP values (respectively; r = 0.926 and r = 0.968) and there was a statistically significant relation between these measurements (P < 0.001). CONCLUSION: The results of all measurement methods were close to each other. The most sensitive and specific method was home measurement when compared with ambulatory measurement. But both office and pharmacy measurements had also high sensitivity and specificity.

Increased medical cost metrics for patients 50 years of age and older in the collaborate care model of treatment for depression.

BACKGROUND: The collaborative care model (CCM) has been consistently shown to achieve effectiveness in depression management compared to usual care. In the present study, we aimed to determine the impact of age on cost metrics in patients who were treated with CCM for 6 months after a diagnosis of depression. METHODS: The upper quartile of age was 50 years and older (n = 56), and the comparison group was composed of patients in the three younger quartiles, aged 18-49 years (n = 163). RESULTS: Patients in the older age group had an elevated median Current Procedure Terminology cost rank of 255.5 compared to 168.0 for the younger patients (P < 0.001). Multiple logistic regression analysis revealed that being in the upper quartile of age (≥ 50 years) (odds ratio = 2.272, 95% confidence interval: 1.064-4.851; P = 0.034) and having higher numbers of clinical visits 6 months prior to index (odds ratio = 1.209, 95% confidence interval: 1.118-1.307; P < 0.001) were significant predictor variables of being cost rank outliers (>80th percentile) in patients with CCM. CONCLUSION: Medical cost utilization in the 6 months after diagnosis of depression was significantly higher in patients in the upper age quartile (≥ 50 years) enrolled in CCM than those in the lower quartiles (age < 50).

Haemoglobin levels correlates with the presence of coronary artery disease.

RATIONALE, AIMS AND OBJECTIVES: Although the condition of low haemoglobin (Hb) levels has been established as a risk factor in the development of coronary artery disease (CAD), it is still a debate particularly in patients with angiographically documented disease. In the present study, we sought to identify the relationship between Hb levels and the presence of CAD. METHODS: The study consisted of 356 consecutive patients referred for elective coronary angiography (CAG). Exclusion criteria included a history of prior MI within last 3 months, presence of neoplastic disorders or any inflammatory diseases or overt diabetes mellitus. Blood samples for haematologic and biochemical measurements were collected on admission following at least 12 hours of overnight fasting. Patients were divided into four groups based on the quartiles of Hb (quartile I < 13.50 g/dL, quartile II 13.50-14.70 g/dL, quartile III 14.71-15.74 g/dL, quartile IV > 15.74 g/dL). Additionally, patients filled out a questionnaire of asking their brief medical histories and baseline characteristics. RESULTS: Lower Hb quartiles were independently related to the presence of CAD in subjects who were referred to elective CAG. The patients with older age [P = 0.008, odds ratio (OR) = 1.042], male gender (P = 0.007, OR = 3.408), in quartile I (P = 0.003, OR = 5.697), in quartile II (P < 0.001, OR = 8.767), in quartile III (P = 0.011, P = 3.076), higher white blood cells count (P = 0.037, OR = 1.208), lower platelet count (P = 0.049, OR = 0.995), condition of current smoker (P = 0.030, OR = 2.548), higher value of fasting glucose (P = 0.014, OR = 1.038), estimated glomerular filtration rate < 60 (mL/min/1.73 m(2) ; P = 0.004, OR = 3.269) were more likely associated with the risk of the presence of CAD. CONCLUSIONS: The present study revealed that lower quartiles of Hb levels were independently related to the presence of CAD in subjects who were referred to elective CAG. Hb levels, which can be measured easily in almost all medical centres, may be considered as a potential predictor for the presence of CAD in patients at high risk for CAD.

Low-density lipoprotein-cholesterol (LDL-C) greater than 100 mg/dL as a quality indicator: locating risk in person, place and time.

RATIONALE, AIMS AND OBJECTIVES: Achieving control over elevated lipid parameters, particularly low-density lipoprotein (LDL)-cholesterol, is an acknowledged quality indicator in primary care. The Centers for Disease Control and Prevention (CDC)'s model for investigation of outbreaks (person-place-time) can be applied to the analysis of quality indicators. METHODS: A sample of 322 family medicine patients for whom lipid levels were ordered was extracted. LDL > 100 mg/dL was cross-tabulated by personal characteristics [age group, gender, body mass index (BMI), diagnoses], month (time) and ordering department (place). RESULTS: Age (except one age category), gender, time and location were not related to LDL > 100 mg/dL after adjustment for covariates. All levels of BMI above normal elevated the risk of LDL > 100 mg/dL [BMI 25-29.9: odds ratio (OR) = 3.41, confidence interval (CI) = 1.61-7.23, P = 0.0014; BMI 30-34.9: OR = 2.93, CI = 1.28-6.70, P = 0.0109; BMI ≥ 35: OR = 2.75, CI = 1.19-6.37, P = 0.0181]. Patients with coronary artery disease (CAD) and diabetes mellitus (DM) were at reduced risk for LDL > 100 mg/dL (CAD: OR = 0.47, CI = 0.24-0.91, P = 0.0254; DM: OR = 0.28, CI = 0.14-0.55, P = 0.0002). CONCLUSION: An outbreak investigation model is useful for analysing variations in this quality indicator. Patients with higher BMI and those not diagnosed with CAD or DM type I/II may be considered for intensified lipid lowering using quality improvement efforts. These might include counselling for lifestyle changes or medication therapy depending upon their calculated cardiac risk.

Tonsillectomy, adenoidectomy and adenotonsillectomy rates in school-aged children: Relative contributions of socio-demographic and clinical features.

OBJECTIVES: The present study sought to investigate the frequencies of tonsillectomy, adenoidectomy and both adenotonsillectomy (T&A) among 6-12 years old children. In addition, we tried to find out the predictors associated with these previous upper respiratory tract (URT) surgeries. METHODS: This cross-sectional study consisted of 1900 children educated in 3 different elementary schools in Ankara, Turkey. Data about demographics and health conditions were obtained from survey questionnaires completed by parents. RESULTS: Of the 1900 children, 15 children (0.8%) previously underwent tonsillectomy, 43 children (2.3%) had adenoidectomy and 80 children (4.2%) had T&A surgical histories. Multiple logistic regression analysis revealed that older students compared to younger ones [odds ratio (OR) = 1.15, p = 0.011], and those who had parent-reported apnea compared to subjects without apnea were more likely to have URT surgery histories [OR = 2.34, p = 0.001]. Those children with surgery histories were more likely to have fathers with a higher educational level [medium level: OR = 2.07, p = 0.012; high level: OR = 2.79, p = 0.001 vs. low level) and the subjects had greater BMI percentiles [overweight: OR = 1.71, p = 0.036; obesity: OR = 2.32, p = 0.003 vs. healthy weight]. Children who had 1-2 URT infections per year [OR = 0.47, p = 0.019] had less probability of URT surgery histories, whereas those children with AOM ≥ 3 times per year [OR = 2.52, p = 0.003] had more probability of URT surgery history. CONCLUSIONS: We conclude that a reasonable explanation for higher rates of URT surgery among children with a high level of paternal education may originate from their awareness about URT associated diseases and possibly due to the ease of access to health care services.

Association of renal function, estimated by four equations, with coronary artery disease.

OBJECTIVE: Individuals with impaired renal function are at increased risk of coronary artery disease (CAD). CAD is also associated with an increased likelihood of having chronic kidney disease (CKD). In the present study, we sought to determine the association between impaired renal function with CAD presence and CAD severity based on four different estimated glomerular filtration rate (eGFR) equations. METHODS: We estimated GFR values using four equations: modification of diet in renal disease (MDRD), Cockcroft-Gault (C-G), chronic kidney disease epidemiology (CKD-Epi), and Mayo Quadratic. Three hundred and fifty-six CAD patients were classified by the number of stenotic coronary arteries occluded >50%, while the CAD severity was categorized based on the number of involved coronary arteries determined to be healthy, single- and multi-vessel disease. RESULTS: The mean values of eGFR calculated by CKD-Epi, MDRD, Mayo, and C-G equations were 77.44, 71.34, 96.33, and 89.49 mL/min/1.73 m(2) respectively. Based on these equations, the prevalence of eGFR <60 mL/min/1.73 m(2) among the patients with significant CAD was 41.5, 45.2, 50, and 42.9%, respectively. eGFR values calculated by four formulas were significantly higher in healthy subjects than those with single-vessel disease (p < 0.001, p = 0.004, p = 0.003, and p = 0.028, respectively). Prediction of CAD severity was statistically significant for men but not women. After controlling for the confounding effects of other covariates, three of the equations were independently related to significant CAD: CKD-Epi (p = 0.004, ß = 0.969), MDRD (p = 0.003, ß = 0.965), and C-G (p = 0.021, ß = 0.978). CONCLUSION: The present study established that accurate eGFR equations commonly used still accurate to determine the association of the impaired renal function with CAD presence and extent.

Predictors of knowledge level and awareness towards breast cancer among Turkish females.

BACKGROUND: Breast cancer (BC) is the most-common malignancy of women worldwide. Though there are differences among developed and developing countries, BC remains the most common cancer type of women in Turkey. OBJECTIVE: This study aimed to identify the level of knowledge, awareness, and their potential predictors towards BC in Ankara, Turkey. MATERIALS AND METHODS: The present descriptive study was conducted on 376 females attending a breast health outpatient clinic. A self-administered questionnaire was designed to evaluate knowledge level about BC and predictors effecting its level. Data analysis was performed using the chi-square test. A value of p<0.05 was considered statistically significant. RESULTS: Mean age of the participants was 46.2±9.93 (22-75). The majority (92.6 %) were married; 41.5% were educated less than nine years. Most of the women were housewives (82.7%) and, were living in an urban region (86.4%). Predictors of effecting responses to seven knowledge and awareness questions about BC varied from demographic features including older age groups, higher educational levels, being married, living in an urban area, being employee, smoking, having greater BMI to additional attributes associated breast health such as the increased number of births, applying for the purpose of control, positive family history of breast diseases, any diagnoses of breast diseases and performing BSE practice. CONCLUSIONS: It was determined that females in Turkey have better knowledge of BC than other developing countries even though it is not at the desired level. These findings revealed that females should be more informed about BC risk factors, prognosis and treatments by primary health-care providers to counteract the ascending burden of this disease.

Blood pressure control in patients with hypertension: a retrospective cohort study.

RATIONALE, AIMS AND OBJECTIVES: Hypertension (HT) is prevalent in Turkey and even with pharmacological interventions HT control rates do not meet guideline recommendations. We aimed to estimate the proportion of hypertensive patients who achieved target blood pressure (BP) and seek to determine the predictors responsible for failure of to reach goals. METHODS: We conducted a retrospective cohort study involving patients with HT. A total of 437 patients were identified with a current diagnosis of HT at baseline. All available predictors for BP improvements were included in the multivariate linear regression model. RESULTS: Follow-up data on HT goal achievements was available for 276 (63.1%) participants. Only 18.1% of the patients at the baseline visit, and 48.6% at the follow-up visit achieved the overall SBP/DBP targets specified by the JNC-8 guideline. Significant differences were determined by baseline and 1st visit measurements of mean SBP/DBP levels (P < 0.001, P < 0.001, respectively). DM and baseline SBP were positively associated with SBP improvement (ß = 8.410, P = 0.003; ß = 0.692, P < 0.001, respectively), whereas being prescribing more HT medications and being older were negatively associated with improvement (ß = -7.968, P = 0.005; ß = -5.707, P = 0.037; respectively). DM, baseline DBP and HT duration were positively associated with DBP improvement (ß = 4.539, P = 0.012; ß = 0.702, P < 0.001; ß = 0.023, P = 0.012; respectively), whereas additional HT medications and GFR values were negatively associated with improvement (ß = -5.682, P = 0.002; ß = -0.098, P = 0.005; respectively). CONCLUSIONS: Although the progress in achieving in BP targets was encouraging, only half of patients had reached the HT goals. Adequate pharmacological approaches and comprehensive management strategies should be implemented in hypertensive patients.

Seasonal variation in clinical remission of primary care patients with depression: impact of gender.

RATIONALE, AIMS AND OBJECTIVES: The impact of seasonal variation on clinical remission in patients with depression has not been well studied. The hypothesis for this study was that the clinical remission rate would be lower in the winter comparing to the other seasons, specifically evaluated by gender. METHODS: The study cohort comprised 2873 primary care patients with depression as a longitudinal retrospective chart review analysis. The sample was limited to patients who were continuing in care; dropouts were excluded from the analysis. RESULTS: Multivariate logistic regression analysis of the independent variables for those participants who achieved clinical remission demonstrated that for the male patients, the season of diagnosis did not impact the rate of remission at 6 months while controlling for all other independent variables. For female patients, those that were diagnosed with depression in the fall had increased likelihood of 6-month remission compared with those patients diagnosed in the winter months (OR 1.300, CI 1.006-1.680, P=0.045) and the spring and summer patients were not significantly different in their outcome rates. When both genders were combined, the odds of remission at 6 months were not statistically significant for any season of diagnosis. CONCLUSIONS: This study demonstrates that in patients who were continuing care, women who were diagnosed with major depression or dysthymia in the fall season have improved 6-month clinical outcome of remission compared with those women diagnosed in the winter, when controlling for demographic and clinical characteristics. This effect was not seen in men or when the genders were combined into a single cohort. The assessment of the seasonality effect on depression outcomes requires further long-term follow-up studies.

Variations in lipid screening frequency in family medicine patients with cardiovascular risk factors.

RATIONALE, AIMS AND OBJECTIVES: This study was undertaken to assess the frequency of lipid screening in comparison with the United States Preventive Services Task Force guideline in a sample of family medicine patients. In addition, we sought to determine the association between testing frequency and achievement of lipid targets. METHODS: A random sample was extracted from 271 patients from among all patients cared for in our Department of Family Medicine for whom lipid screening was ordered from March to September 2012 and who had ≥2 well-defined cardiovascular risk factors. Lipid testing frequency was classified in three ways: semi-annual or less often (0-12 tests over 6 years), annual or less often (0-6 tests), or biennial (0-3 tests). RESULTS: Multiple logistic regression analysis revealed that the predictors of lipid screening more often than semi-annually were age ≥60 years [odds ratio (OR) = 3.7] and diabetes mellitus (DM) (OR = 30.6). Predictors of screening more often than annually were DM (OR = 4.3), hypertension (OR = 2.1), family history of premature coronary artery disease (OR = 5.6) and statin treatment (OR = 3.5). Lipid goal attainment was not associated with testing frequency except with regard to low-density lipoprotein levels (P = 0.043, P < 0.001, P = 0.005, by semi-annual, annual and biennial, respectively) and total cholesterol levels (P = 0.015, P = 0.025 by semi-annual and annual, respectively). CONCLUSIONS: Questionable high frequency of lipid testing was detected even when the more conservative approach of annual monitoring was assumed. Frequency of testing was not associated with goal attainment for most parameters. Physicians should request the lipid testing based on overall risk assessment and person variability in accordance with published guidelines.

Predictors affecting breast self-examination practice among Turkish women.

BACKGROUND: Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affecting the breast self-examination (BSE) performance vary in developing countries. OBJECTIVE: To determine the frequency of BSE performance and predictors of self-reported BSEs among women in the capital city of Turkey. MATERIALS AND METHODS: This cross-sectional study was conducted on 376 Turkish women using a self- administered questionnaire covering socio-demographic variables and BSE-related features. RESULTS: Of the participants, 78.7% (N=296) reported practicing BSE, whereas 9.5% (N=28) were implementing BSE regularly on a monthly basis, and only 5.7% (N=17) were performing BSE regularly within a week after each menstrual cycle. Multivariate logistic regression modeling revealed that BSE performance was more likely in younger age groups [20-39 years] (p=0.018, OR=3.215) and [40-49 years] (p=0.009, OR=3.162), women having a family history of breast disease (p=0.038, OR=2.028), and housewives (p=0.013, OR=0.353). CONCLUSIONS: Although it appears that the rates of BSE performers are high, the number of women conducting appropriate BSE on a regular time interval basis is lower than expected. Younger age groups, family history of breast diseases and not being employed were identified as significant predictors of practicing BSE appropriately. Older age and employment were risk factors for not performing BSE in this sample.

Comparison of cystatin-C and pentraxin-3 in coronary atherosclerosis.

OBJECTIVE: Inflammation is one of the numerous factors that promote atherosclerosis. Cystatin-C (Cys-C) and pentraxin-3 (PTX-3) predominantly play roles in inflammation. Thus, we evaluated whether these markers were related to the presence and severity of coronary artery disease (CAD). METHODS: Eighty-two stable patients who had undergone coronary angiography were enrolled in the study. Patients were diagnosed with significant (>50% stenosis) and nonsignificant (<50% stenosis) CAD. Patients with diabetes, chronic heart failure, chronic kidney disease, and so on were excluded from the study. RESULTS: Patients without CAD had higher Cys-C levels compared with those with CAD (1338.96±396.71 vs. 853.69±406.72 ng/ml, P<0.001). However, the PTX-3 level was inversely lower in patients without CAD (110.40±48.10 vs. 149.46±49.44 pg/ml, P=0.001). The Cys-C level was found to be 677.11±335.56, 1024.18±401.21, and 1338.96±396.71 ng/ml in patients with significant CAD and nonsignificant CAD, and healthy individuals, respectively (P<0.001). The PTX-3 level was inversely reduced in these groups: 168.43±49.09, 131.14±43.10, and 110.40±48.10 pg/ml, respectively (P<0.001). CONCLUSION: We observed that the levels of Cys-C and PTX-3 were inversely varied in the same study groups. These parameters may aid detection of the presence or identification of the severity of CAD when used in combination. Determinative values could exactly be described in the large study groups.

Relationship of cystatin C with coronary artery disease and its severity.

OBJECTIVE: Cystatin C, which is an endogenous marker for renal function, is reported to be a novel marker for coronary atherosclerosis. In this study, we aimed to evaluate its role in determining the presence and also the severity of coronary atherosclerosis in patients with coronary artery disease (CAD). MATERIALS AND METHODS: Eighty-eight patients who underwent elective coronary angiography were enrolled in the study. Patients with heart failure, renal failure, diabetes, and thyroid disease were excluded from the study. The study population was divided into three groups: individuals with normal coronary arteries, patients with critical CAD, and patients with noncritical CAD. We also analyzed the relationship of cystatin C levels with the presence and the severity of CAD and the number of vessels involved. RESULTS: The mean age of the study group was 51.73±9.21 years, and the majority were men (n=71, 80.7%). Cystatin C levels were significantly lower in patients with CAD (1334.86±93.45 vs. 836.49±411.29, P<0.001). It was significantly lower in patients with critical CAD compared with those with noncritical CAD and normal individuals (656.60±346.35, 1016.38±396.54, and 1334.86±393.45, P<0.001, respectively). Serum levels of cystatin C according to the numbers of coronary vessels such as none, single-vessel, two-vessel, three-vessel, and four-vessel disease were as follows: 1334.86±393.45, 801.67±418.70, 993.90±457.34, 744.09±354.53, and 682.30±294.43, respectively. CONCLUSION: Lower cystatin C levels may be associated with increased severity of CAD in clinically stable patients, whereas higher levels may indicate the presence of any vulnerable plaque. It may also guide the diagnostic and therapeutic options for the clinical scene on the presentation.