Detecting white spot lesions on post-orthodontic oral photographs using deep learning based on the YOLOv5x algorithm: a pilot study.

BACKGROUND: Deep learning model trained on a large image dataset, can be used to detect and discriminate targets with similar but not identical appearances. The aim of this study is to evaluate the post-training performance of the CNN-based YOLOv5x algorithm in the detection of white spot lesions in post-orthodontic oral photographs using the limited data available and to make a preliminary study for fully automated models that can be clinically integrated in the future. METHODS: A total of 435 images in JPG format were uploaded into the CranioCatch labeling software and labeled white spot lesions. The labeled images were resized to 640 × 320 while maintaining their aspect ratio before model training. The labeled images were randomly divided into three groups (Training:349 images (1589 labels), Validation:43 images (181 labels), Test:43 images (215 labels)). YOLOv5x algorithm was used to perform deep learning. The segmentation performance of the tested model was visualized and analyzed using ROC analysis and a confusion matrix. True Positive (TP), False Positive (FP), and False Negative (FN) values were determined. RESULTS: Among the test group images, there were 133 TPs, 36 FPs, and 82 FNs. The model's performance metrics include precision, recall, and F1 score values of detecting white spot lesions were 0.786, 0.618, and 0.692. The AUC value obtained from the ROC analysis was 0.712. The mAP value obtained from the Precision-Recall curve graph was 0.425. CONCLUSIONS: The model's accuracy and sensitivity in detecting white spot lesions remained lower than expected for practical application, but is a promising and acceptable detection rate compared to previous study. The current study provides a preliminary insight to further improved by increasing the dataset for training, and applying modifications to the deep learning algorithm. CLINICAL REVELANCE: Deep learning systems can help clinicians to distinguish white spot lesions that may be missed during visual inspection.

Determining the safety margin of mandibular lingula in sagittal split ramus osteotomy.

PURPOSE: The anatomical position of the lingula is clinically very important to prevent injuries during sagittal split ramus osteotomy. Our study aims to evaluate the localisation of the lingula by cone beam computed tomography (CBCT) and to compare the localisation of the lingula between malocclusion, gender, and lingula types. METHODS: A retrospective study was conducted to evaluate the shape and location of the lingula using CBCT. A total of 250 CBCT images were included in this study. The lingula was classified as nodular, assimilated, truncated, or triangular type. Six defined distances from the top of the lingula were measured: anterior border of the ramus (L-A), posterior border of the ramus (L-P), internal oblique ridge (L-IOR), mandibular notch (L-N), and distal surface of the mandibular second molar (L-M2) and occlusal plane (L-OP). The measured distances were compared between gender, malocclusion, and lingula types. RESULTS: The most common type of lingula was nodular (32.4%). The L-N, L-P, L-M2, and L-OP distances between genders were statistically higher in male patients than in female patients. The L-IOR, L-M2, and L-OP distances exhibited statistically significant differences found between malocclusions. No statistically significant difference was found when the distances of the lingula to the anatomical points were compared between the lingula types. CONCLUSION: These variations in positioning of the lingula depending on the dysmorphoses are developing towards a systematic 3D examination before any mandibular osteotomy to precisely visualize the position and shape of the lingula.

Detection of tooth numbering, frenulum attachment, gingival overgrowth, and gingival inflammation signs on dental photographs using convolutional neural network algorithms: a retrospective study.

OBJECTIVES: This study aimed to develop an artificial intelligence (AI) model that can determine automatic tooth numbering, frenulum attachments, gingival overgrowth areas, and gingival inflammation signs on intraoral photographs and to evaluate the performance of this model. METHOD AND MATERIALS: A total of 654 intraoral photographs were used in the study (n = 654). All photographs were reviewed by three periodontists, and all teeth, frenulum attachment, gingival overgrowth areas, and gingival inflammation signs on photographs were labeled using the segmentation method in a web-based labeling software. In addition, tooth numbering was carried out according to the FDI system. An AI model was developed with the help of YOLOv5x architecture with labels of 16,795 teeth, 2,493 frenulum attachments, 1,211 gingival overgrowth areas, and 2,956 gingival inflammation signs. The confusion matrix system and ROC (receiver operator characteristic) analysis were used to statistically evaluate the success of the developed model. RESULTS: The sensitivity, precision, F1 score, and AUC (area under the curve) for tooth numbering were 0.990, 0.784, 0.875, and 0.989; for frenulum attachment these were 0.894, 0.775, 0.830, and 0.827; for gingival overgrowth area these were 0.757, 0.675, 0.714, and 0.774; and for gingival inflammation sign 0.737, 0.823, 0.777, and 0.802, respectively. CONCLUSION: The results of the present study show that AI systems can be successfully used to interpret intraoral photographs. These systems have the potential to accelerate the digital transformation in the clinical and academic functioning of dentistry with the automatic determination of anatomical structures and dental conditions from intraoral photographs.

Using artificial intelligence models to evaluate envisaged points initially: A pilot study.

The morphology of the finger bones in hand-wrist radiographs (HWRs) can be considered as a radiological skeletal maturity indicator, along with the other indicators. This study aims to validate the anatomical landmarks envisaged to be used for classification of the morphology of the phalanges, by developing classical neural network (NN) classifiers based on a sub-dataset of 136 HWRs. A web-based tool was developed and 22 anatomical landmarks were labeled on four region of interests (proximal (PP3), medial (MP3), distal (DP3) phalanges of the third and medial phalanx (MP5) of the fifth finger) and the epiphysis-diaphysis relationships were saved as "narrow,""equal,""capping" or "fusion" by three observers. In each region, 18 ratios and 15 angles were extracted using anatomical points. The data set is analyzed by developing two NN classifiers, without (NN-1) and with (NN-2) the 5-fold cross-validation. The performance of the models was evaluated with percentage of agreement, Cohen's (cκ) and Weighted (wκ) Kappa coefficients, precision, recall, F1-score and accuracy (statistically significance: p < 0.05). Method error was found to be in the range of cκ: 0.7-1. Overall classification performance of the models was changed between 82.14% and 89.29%. On average, performance of the NN-1 and NN-2 models were found to be 85.71% and 85.52%, respectively. The cκ and wκ of the NN-1 model were changed between -0.08 (p > 0.05) and 0.91 among regions. The average performance was found to be promising except the regions without adequate samples and the anatomical points are validated to be used in the future studies, initially.

Nasopharynx evaluation in children of unilateral cleft palate patients and normal with cone beam computed tomography.

OBJECTIVE: This study aimed to examine the morphological characteristics of the nasopharynx in unilateral Cleft lip/palate (CL/P) children and non-cleft children using cone beam computed tomography (CBCT). METHODS: A retrospective study consisted of 54 patients, of which 27 patients were unilateral CL/P, remaining 27 patients have no CL/P. Eustachian tubes orifice (ET), Rosenmuller fossa (RF) depth, presence of pharyngeal bursa (PB), the distance of posterior nasal spine (PNS)-pharynx posterior wall were quantitatively evaluated. RESULTS: The main effect of the CL/P groups was found to be effective on RF depth-right (p < 0.001) and RF depth-left (p < 0.001). The interaction effect of gender and CL/P groups was not influential on measurements. The cleft-side main effect was found to be effective on RF depth-left (p < 0.001) and RF depth-right (p = 0002). There was no statistically significant relationship between CL/P groups and the presence of bursa pharyngea. CONCLUSIONS: Because it is the most common site of nasopharyngeal carcinoma (NPC), the anatomy of the nasopharynx should be well known in the early diagnosis of NPC.

Ternary V-Scheme Ag2WO4/BaO/NiO Heterojunction Photocatalysts: Very Fast Degradation Process for Congo Red under UV-Light Irradiation.

With increasing industrial production, pollutants generated in the process of bleaching or dying disperse to the natural water medium. Therefore, an effective photocatalytic material must be prepared for water treatment quickly. In the present study, a novel and effective V-scheme Ag2WO4/BaO/NiO heterostructure photocatalyst with high photocatalytic performance for the degradation of different organic pollutants was designed and formed by a simple precipitation method. Scanning electron microscopy images showed that BaO, NiO, and Ag2WO4/BaO/NiO have a nanopipe, spherical, and nanorod morphology, respectively. X-ray diffraction results indicated that cubic phases were obtained with higher crystallite structure and lower crystallite distortion. The optical properties of the samples exhibited UV-absorption regions with about 3.35, 3.38, and 3.28 eV band gaps for BaO, BaO/NiO, and Ag2WO4/BaO/NiO, respectively. The photocatalytic activity was investigated by the degradation of Congo red under UV-light irradiation. To investigate the photocatalytic mechanism, the photodegradation performance of the catalyst was analyzed with different scavengers such as isopropyl alcohol, ascorbic acid, and potassium iodide (KI), and it was shown that the main active species were •O2 - radicals and that OH• radicals have a significant contribution toward the degradation process. Compared to bare BaO and BaO/NiO samples, Ag2WO4/BaO/NiO showed excellent photocatalytic activity and about 41%, 66 and 99% of Congo red photodegraded under UV light within 30 min. The reason for this is that the Ag2WO4/BaO/NiO heterostructure displayed wider contact which promoted more charge-transfer ways to shorten the electron transportation path and increase the inhibition of electron-hole pairs.

Performance of a Convolutional Neural Network- Based Artificial Intelligence Algorithm for Automatic Cephalometric Landmark Detection.

OBJECTIVE: The aim of this study is to develop an artificial intelligence model to detect cephalometric landmark automatically en- abling the automatic analysis of cephalometric radiographs which have a very important place in dental practice and is used routinely in the diagnosis and treatment of dental and skeletal disorders. METHODS: In this study, 1620 lateral cephalograms were obtained and 21 landmarks were included. The coordinates of all landmarks in the 1620 films were obtained to establish a labeled data set: 1360 were used as a training set, 140 as a validation set, and 180 as a testing set. A convolutional neural network-based artificial intelligence algorithm for automatic cephalometric landmark detection was developed. Mean radial error and success detection rate within the range of 2 mm, 2.5 mm, 3 mm, and 4 mm were used to eval- uate the performance of the model. RESULTS: Presented artificial intelligence system (CranioCatch, Eskisehir, Turkey) could detect 21 anatomic landmarks in a lateral ceph- alometric radiograph. The highest success detection rate scores of 2 mm, 2.5 mm, 3 mm, and 4 mm were obtained from the sella point as 98.3, 99.4, 99.4, and 99.4, respectively. The mean radial error ± standard deviation value of the sella point was found as 0.616 ± 0.43. The lowest success detection rate scores of 2 mm, 2.5 mm, 3 mm, and 4 mm were obtained from the Gonion point as 48.3, 62.8, 73.9, and 87.2, respectively. The mean radial error ± standard deviation value of Gonion point was found as 8.304 ± 2.98. CONCLUSION: Although the success of the automatic landmark detection using the developed artificial intelligence model was not in- sufficient for clinical use, artificial intelligence-based cephalometric analysis systems seem promising to cephalometric analysis which provides a basis for diagnosis, treatment planning, and following-up in clinical orthodontics practice.

Flight and diabetes.

Although safe and fast, air travel can cause problems in diabetic passengers and pilots. In fact, most diabetes-related emergencies can be prevented during the flight. Diabetic passengers and pilots can fly safely with proper control and planning. In this review, we have discussed in detail the negativities caused by flights in diabetic passengers and pilots and some issues to be considered during and after the flight.

3D Evaluation of the Relationship between Different Vertical Growth Patterns and Cranial Base Angulations.

Objective This study aimed to compare cranial base angulations in subjects with high-angle, low-angle, and normal-angle vertical growth patterns using cone beam computed tomography (CBCT). Design This study is a retrospective clinical research. Settings This study was carried out at the Dentistry Faculty of Eskisehir Osmangazi University. Participants According to skeletal vertical face growth patterns, 78 subjects (48 females and 30 males, average age: 13.19 ± 1.73 years) were divided equally into three groups: high angle, low angle, and normal angle groups. Main Outcome Measures Cephalometric images were derived from CBCT, and patients were classified according to the SN-GoGn angle (sella-nasion, gonion gnathion angle). Sagittal, axial, and coronal cranial base angulations were measured in three-dimensional (3D) CBCT images. Data were analyzed using the Kolmogorov-Smirnov normality, Kruskal-Wallis, and Mann-Whitney U statistical tests. Results There were statistically significant differences between the low-angle and high-angle groups according to sagittal cranial base angulation parameters ( p = 0.01). Conversely, there were no statistically significant differences between vertical facial growth patterns according to coronal and axial cranial angle variables ( p > 0.05). Conclusion According to the study results, there were no effects of cranial base angulations in two planes (coronal and axial) on different vertical skeletal growth patterns. In the sagittal cranial base angulation parameter, the high-angle group showed greater angulation values than the low-angle group. CBCT may be helpful for evaluating, diagnosing, and predicting 3D cranial base differences.

Relationship between coarse F waves and thromboembolic events in patients with permanent atrial fibrillation.

BACKGROUND: The coarse F waves on the 12-lead surface electrocardiogram (ECG) in patients with atrial fibrillation (AF) are known as atrial viability and contractility indicator. Our aim in this study was to investigate the effect of coarse F wave on thromboembolism in patients with permanent AF. METHODS: In our study, 328 patients with permanent AF were included. Routine laboratory, echocardiographic and electrocardiographic parameters were examined. Cerebrovascular event (CVE) or acute artery occlusion was considered a thromboembolic event. RESULTS: In our study, 46 (14.0%) of the patients were found to have thromboembolic events and 282 (86%) of them were found without thromboembolic events. In the group with thromboembolic event, the number of patients with hypertension (HT) (P < .001) and history of coronary artery disease (P = .003) and elderly patients (P < .001) was significantly higher and warfarin use was significantly lower (P = .025). In the group of patients without thromboembolic events, the number of patients with a coarse F wave in surface ECG was significantly lower (P = .001). Age (OR: 1.105, 95% CI: 1.066-1.145, P < .001), HT (OR: 2.831, 95% CI: 1.266-6.331, P = .011), and coarse F wave (OR: 0.290, 95% CI: 0.126- 0.670, P = .004) were determined as independent variables for thromboembolic events. CONCLUSION: Coarse F wave in 12-lead surface ECG in patients with permanent AF may be associated with good prognosis.

Social adaptation status of Syrian refugee physicians living in Turkey.

OBJECTIVES: Since the beginning of the civil war in Syria, over 3.5 million Syrians have fled to Turkey. Considering the massive burden of healthcare service needs of this population, the Turkish government has launched an initiative as employing Syrian doctors to provide health services to their citizens in Refugee Health Centres. In this study, we aimed to explore the social adaptation status of Syrian physicians living in Turkey using a structured questionnaire and the Social Adaptation Self Evaluation Scale (SASS). METHODS: Between November 2016 and April 2018, 799 physicians who participated in "Syrian Physicians' Adaptation Training" were enrolled in the study and underwent a structured questionnaire that questioned socio-demographic data and the SASS. The participants were divided into two groups as having poor and normal/high SASS scores. The binary SASS groups were compared with some demographic data. RESULTS: The median SASS score of the respondents was found as 43 (min. 10, max. 60, IQR 10) which can be accepted as normal. In the binary grouping, it was seen that 107 (13.39%) participants had poor social adaptation, whereas 692 (86.61%) participants had normal or high social adaptation scores. The physicians who were certain about not going back to Syria had significantly higher SASS scores. CONCLUSION: The social adaptation scores of the Syrian physicians were considerably high. The adaptation status was found to be associated with some characteristics like living in Turkey for a long time and having pre-knowledge about the Turkish healthcare system.

Evaluation of the relationship between impacted canines and three-dimensional sella morphology.

PURPOSE: The purpose of this study was to assess the three-dimensional morphometric features of the sella turcica using cone beam computed tomography (CBCT) in subjects with unilateral and bilateral maxillary impacted canines and normal controls. METHODS: In this retrospective study, CBCT images captured with ultra-low dose protocol of 73 subjects (21 males, 52 females; mean age 20.01 ± 6.53 years) with unilateral or bilateral maxillary impacted canines (29 unilateral and 29 bilateral) and 15 controls were evaluated. Nineteen different measurements of the pituitary fossa were made on CBCT images. To evaluate the normality, the Kolmogorov-Smirnov test was used. The nonparametric statistical Kruskal-Wallis and Mann-Whitney U tests were applied to analyze the significant differences among and between the groups. Statistical significance was set at 5%. RESULTS: No measurement differed significantly among the groups (all p > 0.05) other than the right sella length, which differed between the unilateral and bilateral test groups and the unilateral test group and controls (both p < 0.05). The bilateral test group and control group did not differ significantly, but both exhibited greater right sella length than did the unilateral test group (p > 0.05). CONCLUSIONS: Other than the right sella length, there were no among-group differences in the mean pituitary fossa measurements of subjects with impacted unilateral and bilateral canines and normally erupted canines. The right sella length was lower in subjects with impacted unilateral canines than in those with bilateral impacted canines and normal controls.

Relationship between headache and Internet addiction in children

Background/aim: We aimed to investigate Internet addiction in pediatric patients with migraine- and tension-type headache in this study. Materials and methods: Among our 200 subjects, 103 had migraine-type headache and 97 had tension-type headache. Results: Headache triggered by computer use was more common in the migraine-type headache group. There was no difference between the Internet addiction scale score of the two groups. The Internet addiction scale scores of the patients were found to differ depending on the aim and duration of computer use. Internet addiction was found in six (6%) patients. Internet addiction prevalence was 3.7% and 8.5% in the two groups, respectively. Conclusion: The prevalence of Internet addiction in children with recurrent headache was lower than that found in their peers in Turkey, possibly due to avoidance of computer use as a headache trigger. This finding raises the question of whether migraine- or tension-type headaches actually prevent Internet addiction.

Emotional intelligence and leadership traits among family physicians.

OBJECTIVES: High emotional intelligence and leadership traits are essential for physicians in managing their responsibilities and thus building successful interactions with patients. This study explored the relationship between emotional intelligence and leadership traits among family physicians. METHODS: Participants (2975 men, 972 women, mean = 42.0 ages, SD = 7.47) were family physicians working at family health-care centers across the seven geographical regions of Turkey who were contacted by e-mail. The Trait Emotional Intelligence Questionnaire (TEIQue) and Leadership Traits Tool were used to collect data. Data were analyzed concerning physicians' sex, age, health-care experience, and geographical region. The correlation between Trait Emotional Intelligence (TEI) and leadership was also being examined. RESULTS: Our findings suggest that family physicians' TEI differs based on sex, age, health-care experience, and the geographical region where they work. Women had higher mean values than did men for well-being, emotionality, and global TEI. Physicians aged younger than 29 years had the lowest mean values for emotional intelligence. As physicians' health-care experience increased, they received higher scores for emotional intelligence. Physicians working in the Mediterranean had the highest mean TEI scores. There was a positive correlation between family physicians' emotional intelligence and leadership traits. Higher emotional intelligence was correlated with increased leadership traits. CONCLUSION: Emotional intelligence and leadership traits play crucial roles in increasing physicians' personal and professional development. This may also increase physicians' caregiving competencies and thus the quality of health services, as well as potentially decreasing physicians' burnout and health-related costs.

Subclinical atrial fibrillation frequency and associated parameters in patients with cardiac resynchronization therapy.

AIM: The presence of subclinical atrial fibrillation (SCAF) is relevant to issues such as the risk of stroke and the necessity of anticoagulant use in patients with cardiac resynchronization therapy (CRT). Our study aimed to investigate SCAF frequency and associated parameters in patients with CRT. METHODS: One hundred ninety-one patients with CRT (77 females, 114 males, mean age 65.9 ± 9.8) were included in the study. Atrial high-rate episodes detected by the device, atrial electrode impedance, P-wave sense amplitude, and atrial lead threshold values were measured during pacemaker controls. SCAF was defined as asymptomatic atrial high-rate episodes (AHRE) longer than 6 min and shorter than 24 h. Patients were divided into two groups as with and without SCAF. RESULTS: SCAF was detected in 44 (23.2%) of 191 patients with CRT. Age, sex, weight, aortic end-systolic diameter, left atrium (LA) diameter, left bundle branch block morphology, CHA2DS2-VASc score, and right atrium thresholds were associated with SCAF. In multivariate regression analysis, CHA2DS2-VASc score, LA diameter, and atrial threshold values were found to be independent predictors of SCAF occurrence. According to this analysis, every 1 point increase in CHA2DS2-VASc score, every 1 mm increase in LA diameter, and every 0.1 V increase in atrial threshold increased the risk of SCAF by 32.5, 59.6, and 14.6%, respectively. In the ROC analysis, the area under the curve (AUC) was 0.870, 0.638, and 0,652 for LA diameter, CHA2DS2-VASc score, and atrial lead threshold, respectively (p < 0.05, for all). The cut-off values were 34 mm, 3, and 0.6 V for LA diameter, CHA2DS2-VASc score, and atrial lead threshold, respectively. CONCLUSION: Patients with CRT have significantly higher frequency of SCAF than the normal population. CHA2DS2-VASc score, LA diameter, and atrial threshold values were considered to be useful and easily applicable parameters in identifying the patients to develop SCAF.

T wave positivity in lead aVR is associated with mortality in patients with cardiac resynchronization therapy.

PURPOSE: Positive T wave polarity in lead aVR (TPaVR) is associated with a poor prognostic indicator in patients with heart failure reduce ejection fraction (HFrEF). Our aim was to investigate the relationship between positive TPaVR and mortality in patients with cardiac resynchronization therapy defibrillator (CRT-D). METHODS: We included retrospectively 224 HFrEF patients with CRT-D in sinus rhythm. Laboratory, electrocardiographic (ECG), and echocardiographic data were recorded. T wave polarity was measured in lead DI, DII, and aVR from surface ECG. RESULTS: The patients were divided as living and deceased. They followed for 2.5 ± 0.9 years. Thirty-three patients (14.7%) died. Six patients (18.2%) were TPaVR positive before CRT-D and this number increased to 22 (66.6%) after CRT-D in the deceased group. Pulse (p = 0.049), hyperlipidemia (p = 0.022), and NT-proBNP levels were higher in the deceased group (p = 0.001). TPaVR before CRT-D (p < 0.001) and TPaVR after CRT-D (p < 0.001) were significantly positive in the deceased group. Positive TPaVR after CRT-D was the only independent predictor for mortality in binominal logistic regression analysis (OR 1.211, 95% CI 1.105-1.328, p < 0.001). CONCLUSIONS: In CRT-D patients, a positive TPaVR in surface ECG may be a strong mortality indicator.

The Relationship between Dental Follicle Width and Maxillary Impacted Canines' Descriptive and Resorptive Features Using Cone-Beam Computed Tomography.

OBJECTIVES: To assess the relationship between dental follicle width and maxillary impacted canines' descriptive and resorptive features with three-dimensional (3D) cone-beam computed tomography (CBCT). METHODS: The study comprised 102 patients with cone-beam computed tomography 3D images and a total of 140 impacted canines. The association between maxillary impacted canine dental follicle width and the variables of gender, impaction side (right and left), localization of impacted canine (buccal, central, and palatal), and resorption of the adjacent laterals was compared. Measurements were analyzed with Student's t-test, Kruskal-Wallis test, and Mann-Whitney U statistical test. RESULTS: According to gender, no statistically significant differences were found in the follicle size of the maxillary impacted canine between males and females (p > 0.05). Widths of the follicles were determined for the right and left impaction sides, and no statistically significant relation was found (p > 0.05). There were statistically significant differences between root resorption degrees of lateral incisors and maxillary impacted canine follicle width (p < 0.05). Statistically significant higher follicle width values were present in degree 2 (mild) resorption than in degree 1 (no) and degree 3 (moderate) resorption samples (p < 0.05). CONCLUSIONS: No significant correlation was found between follicle width and the variables of gender, impaction side, and localization of maxillary impacted canines. Our study could not confirm that increased dental follicle width of the maxillary impacted canines exhibited more resorption risk for the adjacent lateral incisors.

Attitudes and behaviors of physicians in dealing with difficult patientsand relatives: a cross-sectional study in two training and research hospitals.

BACKGROUND/AIM: The aim of this study was to examine the reasons constituting the definition of 'difficult patient' and to evaluate attitudes and behaviors of physicians in coping with these patients and their relatives. MATERIALS AND METHODS: This cross-sectional study was conducted in May and June 2013 with 400 randomly selected physicians from different specialties working in two training and research hospitals in Ankara. A questionnaire was created by reviewing the relevant literature, by family medicine clinic, and delivered to the physicians following a pilot study. RESULTS: In our study 92.8% of the physicians participating had experienced a negative contact with patients and/or their relatives, previously; 46.8% of the participants stated that they used their own experiences in coping with those situations. The frequency of negative communications was higher in surgical departments, increasing with average daily working hours and number of patients and decreasing with the experience of the physicians. The ways of coping with a difficult patient were nonjudgmental listening, patience, tolerance, and empathy, in declining order of importance. CONCLUSION: Physicians frequently experience negative communications with patients and/or relatives. Awareness of physicians about the concept of difficult patients and the causes and solutions should be enhanced.

Factors associated with Internet addiction: Cross-sectional study of Turkish adolescents.

BACKGROUND: The aim of this study was to investigate the prevalence of Internet addiction (IA), and the relationship between sociodemographic characteristics, depression, anxiety, attention-deficit-hyperactivity disorder (ADHD) symptoms and IA in adolescents. METHODS: This was a cross-sectional school-based study with a representative sample of 468 students aged 12-17 years at the first trimester of the 2013-2014 academic year. The students were assessed using Young's Internet Addiction Scale, Children's Depression Inventory, Beck Anxiety Inventory, Conners' Parent Rating Scale, Conners' Teacher Rating Scale, Hollingshead-Redlich Scale, and the information form including characteristics of Internet use and socioeconomic status (SES). The relationship between these factors and Internet use was examined. RESULTS: Approximately 1.6% of students were identified as having IA, whereas 16.2% had possible IA. There were significant correlations between IA and depression, anxiety, attention disorder and hyperactivity symptoms in adolescents. Smoking was also related to IA. There was no significant relationship between IA and age, sex, body mass index, school type, and SES. CONCLUSIONS: Depression, anxiety, ADHD and smoking addiction are associated with PIU in adolescent students. Preventive public health policies targeting the psychological wellbeing of young people are needed.

Nivel de conocimiento, actitud y experiencias de los profesionales de la salud respecto de la lactancia y la leche materna en una ciudad de Turquía: Estudio transversal / Knowledge level, attitude and own experience of health professionals about breastfeeding and breast milk in a city of Turkey: Cross-sectional study

Introducción. El consenso mundial acerca de la lactancia materna es que el bebé debe ser exclusivamente amamantado hasta los seis meses de vida. A pesar de ello, la tasa de lactancia materna exclusiva es baja durante los primeros seis meses de vida en muchos países, incluida Turquía. El objetivo de este estudio fue evaluar el conocimiento, las actitudes y las experiencias de los profesionales sanitarios en relación con la lactancia y la leche materna en una ciudad metropolitana de Turquía. Materiales y métodos. Este estudio se llevó a cabo entre julio de 2012 y diciembre de 2013. Los sujetos del estudio fueron profesionales de la salud que trabajaban en hospitales universitarios, hospitales de formación e investigación, hospitales públicos y privados, centros de servicios para niños, adolescentes, mujeres y de servicios de salud reproductiva, centros de salud general y centros de salud comunitarios ubicados en Ankara. Los datos se recogieron por medio de un cuestionario. El programa SPSS 11.5 se utilizó para el análisis estadístico. Resultados. En total, 715 personas participaron en este estudio. Entre los que tenían hijos propios, el 3,4% (n= 16) no había amamantado a sus bebés y el 7,6% (n= 36) había amamantado a sus bebés hasta el segundo año de vida. Se observó que el nivel de conocimiento sobre la lactancia y la lecha materna era deficiente en el 28,4% de los participantes, promedio en el 43,1% y adecuado en el 28,5%. Conclusión. Este estudio refleja la falta de conocimiento acerca de la lactancia y la leche materna entre los profesionales de la salud de Turquía. Si bien la gran mayoría de los participantes están de acuerdo con la recomendación de la OMS acerca de la duración de la lactancia materna, el porcentaje de profesionales de la salud que amamantaron durante el período recomendado fue muy bajo.

Introduction: Worldwide consensus about breastfeeding is that the infant should exclusively be breastfed until six months of life. Despite this, the rate of exclusive breastfeeding for the first six months of age is low in so many countries including Turkey. The aim of this study was to evaluate the knowledge, the attitudes and the own experiences of health professionals about breastfeeding and breast milk, in a metropolitan city in Turkey. Materials and methods: This study was performed between July 2012 and December 2013. Study subjects included healthprofessionals working in the university hospitals, research and training hospitals, public and private hospitals; child, adolescent, women and reproductive health services centers, family health centers, and community health centers located in Ankara. A questionnaire was used to collect data. SPSS 11.5 package program was used for statistical analysis. Results: A total of 715 people participated in this study. From those who had children themselves 3.4% (n= 16) had not breastfed their babies at all, and 7.6% (n= 36) had breastfed their baby until second year of age. It was found that 28.4% of the participants had poor, 43.1% had average and 28.5% had good knowledge level about breastfeeding and breast milk. Conclusion: This study reflects the lack of knowledge about breastfeeding and breast milk among the health professionals in Turkey. Although a great majority of participants agree the recommendation of WHO about the duration ofbreastfeeding, the percentage ofbreastfeeding of health care professionals during recommended period was very low.