Protocol for a randomized controlled trial: peer-to-peer Group Problem Management Plus (PM+) for adult Syrian refugees in Turkey.

BACKGROUND: A large proportion of Syrians have been exposed to potentially traumatic events, multiple losses, and breakdown of supportive social networks and many of them have sought refuge in host countries where they also face post-migration living difficulties such as discrimination or integration problems or both. These adversities may put Syrian refugees at high risk for common mental disorders. In response to this, the World Health Organization (WHO) developed a trans-diagnostic scalable psychological intervention called Problem Management Plus (PM+) to reduce psychological distress among populations exposed to adversities. PM+ has been adapted for Syrian refugees and can be delivered by non-specialist peer lay persons in the community. METHODS: A randomized controlled trial (RCT) will be conducted with 380 Syrian refugees in Turkey. After providing informed consent, participants with high levels of psychological distress (scoring above 15 on the Kessler-10 Psychological Distress Scale (K10)) and functional impairment (scoring above 16 on the WHO Disability Assessment Schedule 2.0, or WHODAS 2.0) will be randomly assigned to Group PM+/enhanced care as usual (Group PM+/E-CAU) (n = 190) or E-CAU (n = 190). Outcome assessments will take place 1 week after the fifth session (post-assessment), 3 months after the fifth session and 12 months after baseline assessment. The primary outcome is psychological distress as measured by the Hopkins Symptom Checklist (HSCL-25). Secondary outcomes include functional impairment, post-traumatic stress symptoms, self-identified problems, and health system and productivity costs. A process evaluation will be conducted to explore the feasibility, challenges and success of the intervention with 25 participants, including participants, facilitators, policy makers and mental health professionals. DISCUSSION: The treatment manual of the Syrian-Arabic Group PM+ and training materials will be made available through the WHO once the effectiveness and cost-effectiveness of Group PM+ have been established. TRIAL REGISTRATION: Clinical Trial Registration: ClinicalTrials.gov Identifier NCT03960892. Unique protocol ID: 10/2017. Prospectively registered on 21 May 2019.

The reliability and validity study of the Turkish version of Two Track Model of Bereavement Questionnaire.

OBJECTIVE: The aim of this study was to determine the reliability and validity of the Turkish version of the Two Track Model of Bereavement Questionnaire (TTBQ-T) (Rubin et al. 2009), a-70 items questionnaire for comprehensively evaluating the process of bereavement. MATERIALS AND METHODS: The questionnaire was initially translated from English into Turkish, and then back translated. Subsequently, it was administered to 205 bereaved individuals that lost a significant other within the last 5 years. In order to assess the questionnaire's validity, the Beck Depression Inventory (BDI) and the Impact of Event Scale-Revised (IES-R) were also administered to the participants. The factor structure, total reliability, and test-retest reliability of the TTBQ-T were evaluated. RESULTS: Factor analysis yielded results that were, for the most part, similar with those yielded by the original study; however, there were some cross loading items that yielded a 5-factor solution (Relational active grieving, Close and positive Relationship with the Deceased, Traumatic perception of the loss, Conflictual relationship with the deceased and Social Dysfunction). Cronbach's Alpha coefficients for these 5 factors were 0,91, 0,88, 0,82, 0,78 and 0,65 respectively. In order to determine if the responses were loaded under 2 tracks, a higher order factor analysis was conducted. The relationships between BDI and IES-R, and TTBQ-T total scores were examined in order to determine the construct validity of the TTBQ-T. The present findings indicate that TTBQ-T has construct validity. CONCLUSIONS: The findings indicate that TTBQ-T is a reliable and valid the questionnaire for use in Turkey. The findings are discussed in the light of the literature.

Using a Delphi process to develop an effective train-the-trainers program to train health and social care professionals throughout Europe.

Research has shown that developing a Train-the-Trainers (TTT) program is important if agencies are to implement guidelines, but the most effective way to deliver a TTT program remains unanswered. This article presents data from a 3-round Internet-based Delphi process, which was used to help develop consensus-based guidelines for a TTT programme to deliver to health and social care professionals throughout Europe a curriculum on traumatic stress. In Round 1, 74 experts rated the importance of statements relating to the TTT field and then reassessed their scores in the light of others' responses in subsequent rounds. Forty-one (67%) of 61 statements achieved consensus (defined as having a mean score >7 or < 3 on the 0-9 rating scales used and 70% of participants scoring 7 and above or 3 and below) for inclusion. Key TTT components included interactive and practical presentations, delivery to groups of 7-12 people over 2 days, external and local expert facilitation, course manuals, refresher courses, and supervision. The Delphi process allowed a consensus to be achieved in an area in which there are limitations in the current evidence.

Anaplastic astroblastoma-sarcoma in neurofibromatosis Type 1.

Astroblastoma is a distinctive brain tumor when its histologic features occur in pure form. More often, the tumor pattern is seen to emerge in infiltrative astrocytic tumors. The former are rare. Astroblastoma as a de novo component of gliosarcoma has not previously been described. Furthermore, astroblastoma has only once been reported to occur in the setting of neurofibromatosis Type I (NF1), a condition more often associated with pilocytic and diffuse or infiltrative astrocytic tumors. Herein, we describe a unique case of anaplastic de novo astroblastoma-sarcoma, in essence a variant of gliosarcoma, occurring in a 50-year-old female with documented NF1. Genetic study (fluorescence in situ hybridization) demonstrated no chromosomal losses or gains. Testing for abnormalities of chromosomes 7, 9, 10, 12, 17, 19 and 20, including the EGFR, p16, PTEN, MDM2 and NF1 gene regions, we found the tumor to exhibit a deletion of PTEN, monosomy 17 and gains of chromosomes 19 and 20q. The latter alterations, having been reported in astroblastoma, were noted in both tumor components, thus confirming the common origin of the glial and sarcomatous elements.

Correlation between birth weight, leptin, zinc and copper levels in maternal and cord blood.

Leptin and zinc are involved in the regulation of appetite. Copper is a trace element regulating the functions of several cuproenzymes that are essential for life. To evaluate the relationship between zinc and copper status and the leptin system in humans, we examined whether leptin concentrations in the mother and the newborn correlate with the weight of mother, placenta and newborn. A total of 88 pregnant women at 38-42 weeks' gestation were studied. All infants were categorized as small for gestational age (SGA) (n = 16), average for gestational age (AGA) (n = 59) or large for gestational age (LGA) (n = 13). Leptin, zinc, and copper levels were measured in maternal and cord serum at birth. Maternal BMI and placental weight of the LGA groups were significantly higher than those of the SGA and AGA groups. Cord and maternal leptin levels of the SGA groups were significantly lower than those of the AGA and LGA groups. Maternal serum leptin levels were positively correlated with BMI and maternal zinc levels in all groups. Cord serum leptin levels of all groups were positively correlated with birth weight and placental weight. Birth weight was negatively correlated with maternal and cord copper level of all groups. Umbilical leptin concentrations of SGA newborns correlated with leptin concentrations of their mothers. In all pregnancies, birth weight increases in association with increase in cord leptin level. Our results suggest that maternal zinc but not copper level has an effect on maternal serum leptin levels. The increase in copper level in both maternal and cord blood may contribute to restriction in fetal growth.

Correlation between birth weight, leptin, zinc and copper levels in maternal and cord blood

Leptin and zinc are involved in the regulation of appetite. Copper is a trace elementregulating the functions of several cuproenzymes that are essential for life. Toevaluate the relationship between zinc and copper status and the leptin system inhumans, we examined whether leptin concentrations in the mother and the newborncorrelate with the weight of mother, placenta and newborn. A total of 88 pregnantwomen at 38-42 weeks’ gestation were studied. All infants were categorized as smallfor gestational age (SGA) (n=16), average for gestational age (AGA) (n=59) or largefor gestational age (LGA) (n=13). Leptin, zinc, and copper levels were measured inmaternal and cord serum at birth. Maternal BMI and placental weight of the LGAgroups were significantly higher than those of the SGA and AGA groups. Cord andmaternal leptin levels of the SGA groups were significantly lower than those of theAGA and LGA groups. Maternal serum leptin levels were positively correlated withBMI and maternal zinc levels in all groups. Cord serum leptin levels of all groupswere positively correlated with birth weight and placental weight. Birth weight wasnegatively correlated with maternal and cord copper level of all groups. Umbilicalleptin concentrations of SGA newborns correlated with leptin concentrations of theirmothers. In all pregnancies, birth weight increases in association with increase in cordleptin level. Our results suggest that maternal zinc but not copper level has an effecton maternal serum leptin levels. The increase in copper level in both maternal andcord blood may contribute to restriction in fetal growth (AU)

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Correlation between birth weight, leptin, zinc andcopper levels in maternal and cord blood

Leptin and zinc are involved in the regulation of appetite. Copper is a trace elementregulating the functions of several cuproenzymes that are essential for life. Toevaluate the relationship between zinc and copper status and the leptin system inhumans, we examined whether leptin concentrations in the mother and the newborncorrelate with the weight of mother, placenta and newborn. A total of 88 pregnantwomen at 38-42 weeks’ gestation were studied. All infants were categorized as smallfor gestational age (SGA) (n=16), average for gestational age (AGA) (n=59) or largefor gestational age (LGA) (n=13). Leptin, zinc, and copper levels were measured inmaternal and cord serum at birth. Maternal BMI and placental weight of the LGAgroups were significantly higher than those of the SGA and AGA groups. Cord andmaternal leptin levels of the SGA groups were significantly lower than those of theAGA and LGA groups. Maternal serum leptin levels were positively correlated withBMI and maternal zinc levels in all groups. Cord serum leptin levels of all groupswere positively correlated with birth weight and placental weight. Birth weight wasnegatively correlated with maternal and cord copper level of all groups. Umbilicalleptin concentrations of SGA newborns correlated with leptin concentrations of theirmothers. In all pregnancies, birth weight increases in association with increase in cordleptin level. Our results suggest that maternal zinc but not copper level has an effecton maternal serum leptin levels. The increase in copper level in both maternal andcord blood may contribute to restriction in fetal growth (AU)

No disponible

[1999 Marmara earthquakes: a review of epidemiologic findings and community mental health policies]. / 1999 Marmara Depremleri: Epidemiyolojik Bulgular ve Toplum Ruh Sagligi Uygulamalari Uzerine Bir Gözden Geçirme.

Disasters are one of the most important priorities of community mental health. The Marmara earthquakes of August 17 and November 12, 1999 powerfully demonstrated the negative impacts of disaster trauma. Despite some methodological differences, studies clearly indicate that mental health problems related to earthquakes in Turkey are very prevalent and long lasting. Post Traumatic Stress Disorder (PTSD) and Major Depression (MD) are the most prevalent disorders in studies that are population-based and those that target high-risk groups. In various population-based studies, the PTSD prevalence ranged between 8 % and 63 % and the prevalence of MD was between 11 % and 42 %. On the other hand, PTSD prevalence was 2.7 %-8.5 % and MD was 1 %- 4.5 % for at-risk populations, such as health professionals and rescue workers. These high rates show the importance and necessity of outreach studies. Additionally, the general population and some organizations and professionals have different requirements ranging from training to psychological support and treatment. These studies highlight the development of mental health services and policies. Turkey is situated in a disaster zone; thus, such knowledge and practices could help prepare the nation's population and national policy for future disasters. In this review, first, mental health effects of disasters and some epidemiological findings of the Marmara earthquakes are discussed in light of the literature, and then mental health approaches and policies for disasters are briefly evaluated.

[Reliability and validity of the schedule for deficit syndrome in schizophrenia]. / Sizofreni'de Eksiklik Sendromu Cizelgesi (ESC)'nin Güvenilirlik ve Geçerlik Calismasi.

OBJECTIVE: The Schedule for Deficit Syndrome (SDS) is an instrument for categorizing schizophrenic patients as those with and without deficit syndrome. This schedule has been translated and adapted into the Turkish language in order to study its reliability and validity. METHOD: 30 male schizophrenic patients were included in the study. The patients had been ill for a long period of time and the course was continuous. The patients were assessed by two different raters using the SDS as a means of testing its reliability. A third rater assessed the same group of patients using the BPRS to test the validity of the SDS. RESULTS: The raters using the SDS demonstrated good inter-rater reliability for the categorization of patients with and without deficit syndrome, as well as for rating global severity (kappa: 0.88-0.93) and individual negative symptoms (kappa: 0.51-0.61). The schedule was also found to have a high validity for both categorization and measuring individual negative symptoms. (U: 60.0, P: 0.03). CONCLUSION: The results demonstrated that the Turkish version of the SDS would be a reliable and valid instrument that could be used in the study of schizophrenia.

Simultaneous bilateral trochanteric fractures during squatting in a patient with multiple myeloma.

Pathologic bone fractures are usually confined to the trunk in multiple myeloma (MM). But bilateral trochanteric fractures have not been reported in patients with MM before. Radiographic, histological and immunoelectrophoresis revealed typical features of MM. This report points out the importance of physical rehabilitation of patients in addition to chemotherapy in adaptation to the activities of daily living.

Changes in human plasma dopamine-beta-hydroxylase activity after ketamine and halothane anesthesia.

The intravenous administration of ketamine hydrochloride to fifteen patients undergoing surgery produced no change in circulating plasma dopamine-beta-hydroxylase (DBH), although it produced a significant increase both in systolic blood pressure (BP) and diastolic BP during anesthesia. Halothane anesthesia that depress BP also produced no change in plasma DBH activity.