The Prevalence and Comorbidity Rates of ADHD Among School-Age Children in Turkey.

Objective: The aim of the present study was to explore the prevalence and comorbidity rates of ADHD in a community sample of school-age children. Method: Participants were 1,508 children aged 6 to 14 years. Parents and teachers of each child completed the Turgay Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S). Screen-positive cases were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). Diagnoses were based on DSM-IV criteria. Results: The prevalence rate of ADHD was 8%. Children from extended families had extremely high rates (46.4%) of ADHD. Sixty percent of children with ADHD had one or more comorbid diagnoses. The most common comorbidities were learning disorders (35.7%) and oppositional defiant disorder (22.6%). Conclusion: The prevalence and comorbidity rates of ADHD in school-age children in Turkey are similar to those found in previous studies in other countries.

Adaptation of the Turkish version of Nurses' Self Concept Questionnaire.

OBJECTIVES: Nurse's self-concept is significant for professionalism. We aimed to determine the reliability and validity of the Turkish version of a Nurses' Self Concept Questionnaire. METHODS: A methodological study was conducted with the participation of a group of nursing students and nurses. For the statistical analysis, structural equation models, convergent validity analyses, discriminate validity analyses, internal consistency analysis, and test-retest reliability analyses were used. RESULTS: Correlation-coefficient for the test-retest reliability of the Turkish version of Nurses' Self-Concept Questionnaire was 0.87. The internal consistency of this questionnaire was calculated with Cronbach's α coefficient and it was found high across the six subscales from 0.83 to 0.91. The goodness of fit indices was determined as acceptable. CONCLUSIONS: According to results, this Nurses' Self-Concept Questionnaire is a valid and reliable instrument for assessing nurses' and nursing students' self-concept in Turkey.

Analysis of Community Participation Levels of Individuals Who Are Physically Disabled and Working in Industrial Environments.

The purpose of this study was to determine quality of life, leisure time satisfaction, activity performance, and community participation and analyze the relationship between these determinants and community participation in both physically disabled individuals working in industrial environments and nonworking individuals who are physically disabled. Sociodemographic data was registered into a sociodemographic form. World Health Organization Disability Assessment Schedule 2.0 was used to assess community participation. Activity performance was evaluated with Canadian Occupational Performance Measure. Leisure Satisfaction Scale was used to determine leisure time satisfaction. Short Form-36 was used for evaluating quality of life. When the participants were compared in terms of working status, a significant difference according to their WHO-DAS-II total scores were found (p < 0.05). When all participants were compared in terms of activity performance, lesisure time satisfaction, quality of life a significant differences according to their WHO-DAS-II total scores were found (p>0.05). This study shows that community participation was affected by working status, disability level, activity performance, leisure time satisfaction and quality of life. In this regard, occupational therapy and physiotherapy approaches were found necessary for developing community participation. We conclude that this study's results can be used as a guide for community participation in disabled people in community based rehabilitation politics.

Evaluation of lower urinary tract dysfunction in Turkish primary schoolchildren: an epidemiological study.

OBJECTIVE: The aim was to determine the prevalence of voiding dysfunction and its related risk factors in Turkish schoolchildren. MATERIALS AND METHODS: A randomly selected, cross-sectional study was conducted using a self-administered and previously validated questionnaire. The questionnaire consisted of two parts. The first part included personal demographic and familial information, and the second part included the Dysfunctional Voiding and Incontinence Scoring System (DVISS). The questionnaires were given to 4668 children between 6 and 15 years of age, which were completed by the parents and children together. The children with a score of ≥9 were accepted as having lower urinary tract dysfunction (LUTD). RESULTS: The data were collected from 4016 children (the response rate was 86.0%), including 48.6% boys and 51.4% girls. The mean age was 10.5±2.2 years. The overall frequency of LUTD was 9.3%. While the 6-year-old children had the highest frequency (23.1%) of LUTD, this rate was 7.9% at the age of 10, and the children aged 14 years had the lowest frequency (4.9%), (p<0.001). Lower urinary tract symptoms were significantly more common in girls (7.6%) than in boys (3.2%) only for the older age group (between 12 and 15 years of age). Compared with normal children, those with LUTD (with a score of ≥9) had the following risk factors: less educated parents, a parent that had lower urinary tract symptoms when he or she was a child, more persons per room (≥2 persons), more siblings (≥4 siblings) at home, past medical history of urinary tract infections, and squatting position (in girls). CONCLUSIONS: Lower urinary tract problems are one of the most important and ongoing health problems in childhood. Determining the prevalence of lower urinary tract problems in children and their related risk factors is the first step to managing and reducing the number of children suffering from voiding problems.

Prevalence of daytime urinary incontinence and related risk factors in primary school children in Turkey.

PURPOSE: Urinary incontinence is one of the major urinary symptoms in children and adolescents and can lead to major distress for the affected children and their parents. In accordance with the definitions of the Standardization Committee of the International Children's Continence Society, daytime urinary incontinence (DUI) is uncontrollable leakage of urine during the day. The aim of this cross-sectional study was to investigate the prevalence and associated risk factors of DUI in Turkish primary school children. MATERIALS AND METHODS: The questionnaire, which covered sociodemographic variables and the voiding habits of the children, was completed by the parents of 2,353 children who were attending primary school in Denizli, a developing city of Turkey. The children's voiding habits were evaluated by use of the Dysfunctional Voiding and Incontinence Symptoms Score, which is a validated questionnaire. Children with a history of neurological or urological diseases were excluded. RESULTS: The participation rate was 91.9% (2,164 people). The overall prevalence of DUI was 8.0%. The incidence of DUI tended to decrease with increasing age and was not significantly different between genders (boys, 8.8%; girls, 7.3%; p=0.062). Age, maternal education level, family history of daytime wetting, settlement (urban/rural), history of constipation, urinary tract infection, and urgency were independent risk factors of DUI. CONCLUSIONS: Our findings showed that DUI is a common health problem in primary school children. In an effort to increase awareness of children's voiding problems and the risk factors for urinary dysfunction in the population, educational programs and larger school-based screening should be carried out, especially in regions with low socioeconomic status.

Upper extremities and spinal musculoskeletal disorders and risk factors in students using computers.

OBJECTIVE: To examine the effects of computer usage on the musculoskeletal system discomforts (MSD) of Turkish university students, the possible risk factors and study implications (SI). METHODS: The study comprised a total of 871 students. Demographic information was recorded and the Student Specific Cornell Musculoskeletal Discomfort Questionnaire (SsCMDQ) was used to evaluate musculoskeletal system discomforts. RESULTS: The neck, lower back and upper back areas were determined to be the most affected areas and percentages for SI were 21.6%, 19.3% and 16.3% respectively. Significant differences were found to be daily computer usage time for the lower back, total usage time for the neck, being female and below the age of 21 years (p<0.05) had an increased risk. CONCLUSIONS: The neck, lower back and upper back areas were found to be the most affected areas due to computer usage in university students. Risk factors for MSD were seen to be daily and total computer usage time, female gender and age below 21 years and these were deemed to cause study interference.

Assessment of awareness of diabetic retinopathy and utilization of eye care services among Turkish diabetic patients.

AIMS: Raising awareness of diabetic retinopathy (DR) was shown to be a key element for early diagnosis and treatment of this blinding disease. There is very limited data about the knowledge level, attitude, and behavior of diabetic patients regarding DR in Turkey. This study was planned to assess the awareness of DR and the utilization of eye care services among Turkish diabetic patients. METHODS: Diabetic patients who were under the care of ophthalmologists, endocrinologists, and/or primary care physicians were administered a questionnaire in order to assess their awareness of diabetes and its ocular complications. RESULTS: A total of 437 patients (51.8% female and 48.2% male) with a mean age of 55.2 ± 11.9 were included in the study. Of the 437 patients, 31.8% had not been educated about diabetes, 88.1% were aware that diabetes can affect the eyes, and 39.8% thought that diabetics with good glycaemic control might suffer from DR. While 86.7% thought that early diagnosis was possible in DR, 77.3% previously had eye examinations, and 41.9% stated that annual eye examinations were necessary for diabetics. An educational level of middle school or higher, duration of DM longer than 5 years, previous DM education, and recruitment from the university (ophthalmology department and endocrinology department) were associated with better awareness of DR. The independent factors associated with visiting an ophthalmologist on a regular basis were DM education, DM duration, and site of recruitment. CONCLUSION: Although most of the patients know that DM affects the eye, there is a lack of appropriate knowledge and behavior about the management of DR. The importance of better control of DM and regular eye examination in the prevention of DR should be emphasized.

Knowledge, attitude and behaviour of boys and parents about circumcision.

AIM: To determine the knowledge, attitude and behaviour of parents and previously circumcised early adolescent boys about circumcision. METHODS: Half of the boys attending the sixth class of the primary school in our city centre and their parents were included in this cross-sectional, descriptive study. Questionnaires were prepared by the authors, which include 38 questions for parents and 25 questions for boys. RESULTS: Sixty-six per cent of the students were circumcised at the age of 7 years and above, 26% between three and 6 years and 8% below 3 years of age. Forty-two per cent of boys were circumcised by a traditional circumciser and 64% were circumcised at home. Main reasons of circumcision for parents were religious purposes (79%) and health issues (51%). When the boys were asked about their thoughts during circumcision, they mostly stated that 'it was necessary to become a man' (58%) and 'it would hurt much' (50%). Thirty-eight per cent of boys were frightened during circumcision and 46% were worried. Boys circumcised in the 7 years and above age group were most content about their age of circumcision. CONCLUSIONS: We consider that it is reasonable to wait up to an age at which the child could understand and participate in the decision of the concept and timing of circumcision.

Work-related injuries in textile industry workers in Turkey.

BACKGROUND: This study was conducted as a survey including work-related injuries (WRI) of workers in the textile and clothing industry admitted to the emergency department (ED). METHODS: This prospective study included patients with WRI reportedly occurring in the textile and clothing industry over a two-year period. The study sample comprised only the casualties occurring at the workplace and while working de facto. RESULTS: A total of 374 patients were eligible for the study. More than three-fourths of the study sample were females (76.2%, n=285). A significant proportion of the patients were between 14 and 24 years of age (44.7%, n=167). Approximately two-thirds reported that this was their first admission to a hospital related to WRI (65.8%, n=246). WRIs occurred most frequently between 07:00-09:00 (27.3%) and 23:00-01:00 (17.9%). "Carelessness" and "rushing" were the most commonly reported causes of WRIs from the patients perspective (40.6% and 21.4%, respectively). Three-fourths of the patients reported that they were using protective equipment (74.3%, n=278). With respect to injury types, laceration/puncture/ amputation/avulsion injuries accounted for 55.6% (n=208) of the sample. Trauma to the upper extremities was the main type of injury in 75.1% (n=281) of the cases. CONCLUSION: Broad population-based studies are needed to define the situation as a whole in WRIs in the textile and clothing industry in the country. Strict measures should be undertaken and revised accordingly to prevent WRIs in these growing sectors.

One-year follow-up of penis and testis sizes of healthy Turkish male newborns.

Penile length, penile diameter and testicular volume at birth reflect the activity and normality of the hypothalamus-pituitary-testicular axis. In this prospective longitudinal study, we aimed to measure penis and testicular size in healthy newborns at birth and 6 and 12 months of age. Seven hundred forty-six term healthy male newborns were enrolled in the study. According to measurements taken within 48 hours after birth, mean penile length (MPL) was 2.81 +/- 0.32 cm, mean penile diameter (MPD) 1.04 +/- 0.09 cm, right testicular volume (TV) 1.73 +/- 0.45 ml, and left TV 1.64 +/- 0.48 ml. At 6 months of age, MPL was 3.67 +/- 0.35 cm, MPD 1.23 +/- 0.08 cm, right TV 2.07 +/- 0.31 ml, and left TV 2.00 +/- 0.27 ml. At 12 months of age, MPL was 4.47 +/- 0.43 cm, MPD 1.25 +/- 0.09 cm, right TV 2.01 +/- 0.12 ml, and left TV 2.01 +/- 0.13 ml. There was a weak albeit statistically significant correlation between weight, length and PL at birth. In conclusion, the MPL of newborns was shorter than that reported in the published data from other populations. This situation may be related to ethnicity in addition to the lower birth weight and length of our subjects when compared to the newborns in other populations. We observed a significant increase, more marked during the first six months, in MPL, MPD and TV, which can be explained by the hormonal mechanism during minipuberty.

Hospital cost analysis of management of patients with renal colic in the emergency department.

Acute severe colicky pain in the flank region is termed as renal colic (RC), which is commonly diagnosed and treated in the emergency department (ED). The present study is designed to investigate the hospital costs of patients with RC admitted to the ED and factors affecting the figures. Retrospective analysis includes all patients diagnosed with RC following physical examination and X-ray, ultrasound, computed tomography together with laboratory investigations in the university-based ED between February 2007 and February 2009. The study included 574 patients eligible for the predefined criteria. Mean total hospital cost in patients admitted to the ED due to RC was calculated to be 55.77 Euro. The greatest contribution to the total cost was made by radiological investigations in the ED (40.5%) followed by treatment costs (19.7%). Size and location of the stone and stay times in the ED were the independent variables affecting the costs. The costs were higher as the stones were bigger and as they were more distal in the ureter. Renal stones were associated with the lowest hospital costs. Radiological investigations are the greatest contributors in the ED costs in patients with RC. Effective measures need to be undertaken to reduce resultant costs. Preventive measures as well as diagnostic and therapeutic procedures should be standardized in the ED in accordance with technological advances and also cost-effectiveness when appropriate.

Factors affecting onset of puberty in Denizli province in Turkey.

The relationship between the possible factors affecting pubertal onset and pubertal timing was investigated in the Denizli province in Turkey. A total number of 3311 subjects (1562 girls, 1749 boys) aged 6-16.5 years participated in this study. Body mass index (BMI) was calculated. Pubertal stages were assessed according to methods of Marshall and Tanner. Testicular volume was determined using Prader orchidometer. Menarcheal age was recorded. All parents and students completed different questionnaires on demographic variables affecting pubertal timing such as socioeconomic conditions, psychosocial factors, exercise, nutritional status, chronic diseases, migration and birth weight. Using distribution percentiles of pubertal stages according to age, the relation between pubertal timing and factors affecting puberty was investigated. There was no significant association between exercise, birth weight, migration, chronic disease, and socioeconomic status and age of puberty onset. Menarcheal age of overweight and obese girls was significantly lower than that of girls with normal weight. In-family stress was the cause of early puberty in girls and of delayed puberty in boys.

Value of the timing of informing the emergency department patients on cardiac test results: a randomized controlled study.

OBJECTIVE: This study is designed to investigate the role of written information, and the value of its timing, provided to Emergency Department (ED) patients regarding cardiac enzyme tests (CET), on their personal concerns about their health status and their discussions with the emergency physicians as to their normal health status post-test. MATERIALS AND METHODS: This is a prospective randomized controlled study. All consecutive patients used for this study were admitted to the university-based ED within the 6-month study period with the presenting chief complaint of atypical chest pain, which was considered as the presumptive diagnosis. CET was ordered to rule out acute coronary syndromes, and these patients were enrolled into the study groups. RESULTS: The study sample included 523 patients whose CET were ordered and who were therefore eligible for the study. Three groups were similar in terms of persuasion and anxiety scores. Groups, which were informed about the test by leaflet had lower anxiety and persuasion scores. The lowest anxiety scores were found especially in the group in which the information was given before CET was drawn (P<0.001). The effects of monitoring on patients and providing information with a leaflet were found significant on reassurance scores (P=0.006, P<0.001). Reassurance scores of the patients on whom at least one of the procedures, for example, monitoring, more than one electrocardiogram and chest radiograph, had been carried out, showed significant difference compared with those on whom neither of these procedures had been done during the ED observation (P=0.001). CONCLUSION: Written information provided to patients undergoing cardiac tests in ED population was found effective on anxiety and persuasion scores.

DASH questionnaire for the analysis of musculoskeletal symptoms in industry workers: a validity and reliability study.

PURPOSE: The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The aim of this study was to evaluate the reliability and the construct validity of the DASH questionnaire by establishing its correlation to the Medical Outcomes Study Short Form-36 (SF-36) in industry workers. Also we aimed to investigate whether the DASH can be used as a standardized questionnaire to evaluate the work-related musculoskeletal disorders (WMSDs) in upper extremity in industrial settings and epidemiological studies. MATERIAL AND METHODS: The Turkish version's reliability and construct validity were evaluated in 240 industry workers with upper-extremity musculoskeletal complaints. Workers were asked to complete a packet that included the DASH and the SF-36. Test-retest reliability was assessed in all workers who filled in the DASH questionnaire 15 days later. Construct validity was evaluated by comparing the overall and work component DASH scores with SF-36 summary and subscales. RESULTS: The mean DASH score for the textile workers whose duties were confection, dyeing, sewing, quality control and packaging was calculated as 65, 55, 68, 54 and 67, respectively. As a result of this study, pain intensity in shoulder, wrist and hand was significantly associated with the DASH score (p<0.05). Internal consistency of the DASH was high (Cronbach alpha 0.91). Test-retest reliability was excellent for the overall DASH (intraclass correlation coefficient (ICC) 0.92). Moderate correlations (p<0.05) were found between the overall and work component DASH and the SF-36 summary scales. Pearson correlation coefficients of the overall and work component DASH to the SF-36 subscales ranged from -0.33 to -0.82. CONCLUSION: These results support that DASH is a reliable and valid instrument to measure functional disability and investigate the ergonomic risk factors in textile workers with upper-extremity musculoskeletal complaints.

Epidemiology of atopic dermatitis in primary schoolchildren in Turkey.

The present study aimed to investigate the prevalence of atopic dermatitis in primary schoolchildren in Denizli, Turkey, and to determine the possible risk factors for atopic dermatitis in home environment. A self-administered questionnaire was handled to the parents of 2,100 children aged 7 to 15 years, from three randomized primary schools and 1,644 (78.9%) completed and returned the questionnaire. The questionnaire included the United Kingdom Working Party diagnostic criteria and asked about conditions that could affect the course of atopic dermatitis. The prevalence of atopic dermatitis and coexisting factors that may affect the course of the disease were evaluated in 1,644 children (825 girls and 819 boys). The prevalence of atopic dermatitis was detected as 4.9%. Passive smoking, heating systems either in the house or in the child's bedroom, and the number of people living in the house had no significant effect (p > 0.005). The difference in prevalence of atopic dermatitis between developed and developing countries is striking. The determination of the factors that have an influence in this issue will probably enable us to change the course and frequency of atopic dermatitis.

A population-based questionnaire study on the prevalence and epidemiology of burn patients in Denizli, Turkey.

Epidemiological investigations of burn patients help health services to identify the need for burn care and to plan burn care facilities. Various epidemiological studies on burn injury have been conducted, but they have usually covered major burn victims who required hospitalization or minor burn victims who were treated at health care centers. Few studies have included burn victims who were not admitted to any health care center. Through a population-based questionnaire, we studied the epidemiology of the entire population of burn victims, including those who did not seek medical attention. Thus, we identified the actual frequency of hospital admission and the frequency of sequelae. In total, 1068 persons from the city of Denizli, Turkey were questioned about burns in the last 10 years and the burn prevalence was found to be 12.6%. Only 33.3% of the burn victims were treated at a health care center; thus, 66.7% of the victims were treated at home with traditional burn wound care methods. Etiologic factors such as the age and sex of each victim, the cause and anatomic location of the burn, and location of the victim when burned were all investigated. The overall percentage of sequelae was 31.3%; of these, 89.5% were cosmetic problems, 7.9% were functional impairments, and 2.9% were physiological problems. The low percentage of health care center admissions and high incidence of sequelae suggest the need for professional burn care centers that can be easily reached by burn victims.

Pubertal development of Turkish children.

AIM: To investigate the pubertal development of Turkish school children, to look for possible secular trends in pubertal development. METHODS: 1,562 girls and 1,749 boys (aged 6-16.5 years) from urban and rural schools were studied. Weight and height were measured and body mass index was calculated. Pubertal stages were assessed according to Tanner. Testicular volume was determined using an orchidometer. Menarcheal age was recorded. RESULTS: In girls, mean ages at breast stage (B) were 7.74 +/- 1.08 years for B1, 10.16 +/- 0.97 for B2, 11.72 +/- 1.29 for B3, 12.97 +/- 1.17 for B4, and 13.66 +/- 0.89 for B5. Mean ages at pubic hair stage (PH) were 8.72 +/- 1.50 years for PH1, 10.57 +/- 1.39 for PH2, 12.12 +/- 1.10 for PH3, 13.10 +/- 1.04 for PH4, and 13.87 +/- 0.83 for PH5. Mean age at menarche was 12.41 years. Menarcheal age was earlier in overweight and obese children compared with that in normal children. In boys, mean ages at each maturity stage according to testis volume (G) were 8.70 +/- 1.38 years for G1, 11.76 +/- 1.28 for G2, 12.81 +/- 1.0 for G3, 13.17 +/- 0.87 for G4, and 13.87 +/- 0.98 for G5. Mean ages at PH in boys were 9.39 +/- 1.81 years for PH1, 12.02 +/- 1.33 for PH2, 13.05 +/- 0.88 for PH3, 13.42 +/- 0.87 for PH4, and 14.02 +/- 0.92 for PH5. CONCLUSIONS: The current study provides an up-to-date reference of normal sexual maturation of Turkish children. While the mean age at onset of puberty in boys was comparable to that of other populations in the world, girls were found to start pubertal development earlier than in other populations.

Determinants of adolescent pregnancy in an urban area in Turkey: a population-based case-control study.

The aim of this study was to determine the degree to which socioeconomic status is a risk factor for first birth at age 19 or younger in married women in an urban area of Turkey. The research was a population-based case-control study. The study group comprised all married and pregnant women aged 15-19 (adolescent pregnancies) attending primary care centres (144 subjects). Married women between 20 and 29 years of age, experiencing their first pregnancy (adult pregnancies), were determined as the control group (144 subjects). A questionnaire was completed for each subject during face-to-face interviews. Adolescent pregnancy was more frequent in women from families with a low socioeconomic status, as determined by occupation (class) and income; both were associated with adolescent pregnancy. Multiple logistic regression analysis identified seven factors associated with adolescent pregnancy: exposure to violence within the family prior to marriage; families partially opposed or unopposed to adolescent marriage; secondary school or lower education level; lack of social security; living in houses in which the number of persons per room was over 1; unemployed women; and having sisters with a history of adolescent pregnancy.

Prevalence and risk factors for allergic rhinitis in primary school children.

OBJECTIVE: Allergic rhinitis is a common chronic illness of childhood. The aim of the study was to evaluate the prevalence and risk factors of allergic rhinitis in 6-12-year-old schoolchildren in Istanbul. METHODS: A total of 2500 children aged between 6 and 12 years in randomly selected six primary schools of Istanbul were surveyed by using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire between April and May 2004. RESULTS: Of them 2387 (1185 M/1202 F) questionnaires were appropriately completed by the parents with an overall response of 95.4%. The prevalence of physician-diagnosed allergic rhinitis was 7.9% (n=189). A family history of atopy (aOR=1.30, 95% CI=1.00-1.68), frequent respiratory tract infection (aOR=1.36, 95% CI=1.08-1.70) and sinusitis (aOR=2.29, 95% CI=1.64-3.19), antibiotic use in the first year of life (aOR=1.26, 95% CI=1.01-1.57), cat at home in the first year of life (aOR=2.21, 95% CI=1.36-3.61), dampness at home (aOR=1.31, 95% CI=1.04-1.65) and perianal redness (aOR=1.26, 95% CI=1.01-1.57) were significant for increased risk for allergic rhinitis. Frequent consumption of fruits and vegetables were inversely, and frequent consumption of lollipops and candies were positively associated with allergic rhinitis symptoms. CONCLUSION: Our study reconfirmed that family history of atopy, frequent respiratory tract infections, antibiotics given in the first year of life, cat at home in the first year of life, dampness at home, perianal redness and dietary habits are important independent risk factors for AR. Researchers worldwide should be focused to these factors and try to develop policies for early intervention, primary and secondary preventions for allergic diseases.