Subjective well-being among primary health care patients.

BACKGROUND: The psychological importance of subjective well-being for a healthy life has been well recognized. It is also well known that depressive and anxiety disorders have a negative effect on subjective well-being. The aim of this cross-sectional, descriptive study was to assess the subjective well-being status of a group of primary healthcare patients in relation to socio-demographic characteristics, personal health and mood-status. METHODS: A total of 284 patients participated in the study. The Oxford Happiness Scale, Life Satisfaction Scale, DASS-42 (Depression, Anxiety and Stress Scales-42) and a questionnaire about socio-demographic characteristics were completed by the participants. RESULTS: In general, the participants were found to be moderately happy and satisfied with their lives. They had mild levels of depression, anxiety and stress. In terms of happiness, an older age (≥40 years), educated to secondary level or higher and not having depression or anxiety were found to be factors increasing happiness. In terms of life satisfaction, female gender, an older age (≥40 years), educated to secondary level or higher, being single and not having depression were found to increase life satisfaction. CONCLUSION: Primary healthcare providers should give more importance to the mood status of their patients. Screening for depression and anxiety should be applied at the primary healthcare level because negative mood status is more important than some socio-demographic characteristics in respect of unhappiness and dissatisfaction.

BRCA1/2 germline mutations and their clinical importance in Turkish breast cancer patients.

BRCA1/BRCA2 genes were screened in 117 patients with breast cancer by sequencing. Fourteen percent of patients tested positive for BRCA1/BRCA2 mutations. Four frame shift mutations, four pathogenic missense mutations, and 25 different sequence variations were detected. BRCA mutation positivity was significantly associated with Ki67 (p = .001). BRCA protein expressions were decreased in the patients harboring important mutations and polymorphisms (BRCA1;P508 stop, V1740G, Q1182R, Q1756P and BRCA2;V2466A) related with disease. Our findings contribute significantly to the types of germline BRCA1/BRCA2 mutations and their biological effects in Turkish women. These data could help guide the management of BRCA1/BRCA2 mutation-carrying patients when considering breast-conserving therapy.

Prevalence of depression, anxiety, stress, and anger in Turkish prisoners.

In Turkey, prison studies are rare and the mental health status of prisoners has not received proper attention. The purpose of this cross-sectional and descriptive study was to assess the prevalence of depression, anxiety, stress, and anger among a group of Turkish prisoners. Two self-reporting instruments (the Depression Anxiety Stress Scale-42 and Multidimensional Anger Scale) were filled out by 685 prisoners. Prisoners in the study group were found to be depressive, anxious, and stressed. Anger symptoms and aggressive behaviors were found to be at a moderate level. Prisoners with a history of being subjected to domestic violence in childhood had higher depression, anxiety, and stress scores than those without such a history. Young prisoners, those who had been previously imprisoned, with substance dependency and higher stress and anxiety levels reported more anger symptoms than others. Psychological support, together with stress and anger management programs, seems to be essential.

Quality of life in type II diabetic patients in primary health care.

INTRODUCTION: This study evaluated the quality of life of patients with type II diabetes in primary health care with the Turkish version of the Audit of Diabetes Dependent Quality of Life (ADDQoL) instrument. MATERIAL AND METHODS: A total of 180 patients diagnosed with type II diabetes and registered at an urban primary health care unit in Turkey were included to this study. RESULTS: The ADDQoL instrument showed good internal consistency and factor structure. Diabetes had the largest impact on "enjoyment of food" (mean impact rating -1.65) and the least impact on "others fussing" (-0.44). The duration of diabetes and insulin therapy had a significant impact on quality of life among diabetic patients. CONCLUSION: Multidimensional assessments of quality of life including both generic and disease-specific measures are important for diabetic patients in primary health care. FUNDING: not relevant TRIAL REGISTRATION: not relevant.

CK19, CK20, EGFR and HER2 status of circulating tumor cells in patients with breast cancer.

AIMS AND BACKGROUND: The major cause of death in breast cancer patients is metastasis. Various biomarkers have been used for the early detection of circulating tumor cells in the peripheral blood of breast cancer patients. The aims of the current study were to analyze circulating tumor cells in the blood of breast cancer patients by investigating EGFR, CK19, CK20 and HER2 expression profiles and to evaluate their prognostic importance. METHODS: CK19, CK20 and EGFR gene expression profiles were evaluated in the blood samples of 84 female patients with primary invasive ductal breast cancer and 20 healthy female volunteers using SYBR green-based real-time qPCR assays. HER2 expression analyses were conducted in 46 patients who had an HER2-positive primary tumor and in 30 healthy women to determine the cutoff level of positivity. RESULTS: The positive rates of CK20, EGFR, CK19 and HER2 mRNA expression in the peripheral blood were 28.57% (24/84), 20.23% (17/84), 5.95% (5/84) and 2.17% (1/46), respectively. The high positive ratio of CK20 mRNA expression in the peripheral blood of breast cancer was identified for the first time in the current study. Significant differences were identified in CK20 expression status and several clinical parameters related with aggressiveness of tumors using a binary logistic regression analysis. Higher CK20-positive levels were observed in patients who had lymph node metastasis and advanced-grade primary tumors, which were estrogen receptor-negative. We have demonstrated that CK20 may be a novel biomarker that is useful to identify circulating tumor cells and predict breast cancer progression. CONCLUSIONS: The results suggest that the investigation of CK20 mRNA with other biomarkers in the peripheral blood of breast cancer patients may be useful to monitor the presence of disseminated tumor cells in the blood circulation and to predict the prognosis of breast cancer.

The promoter hypermethylation status of GATA6, MGMT, and FHIT in glioblastoma.

Glioblastoma (GBM) is an aggressive and lethal cancer, accounting for the majority of primary brain tumors in adults. GBMs are characterized by large and small alterations in genes that control cell growth, apoptosis, angiogenesis, and invasion. Epigenetic alterations also affect the expression of cancer genes, either alone or in combination with genetic mechanisms. The current evidence suggests that hypermethylation of promoter CpG islands is a common epigenetic event in a variety of human cancers. A subset of GBMs is also characterized by a locus-specific and genome-wide decrease in DNA methylation. Epigenetic alterations are important in the molecular pathology of GBM. However, there are very limited data about these epigenetic alterations in GBM. Alterations in promoter methylations are important to understand because histone deacetylases are targets for drugs that are in clinical trial for GBMs. The aim of the current study was to investigate whether the promoter hypermethylation of putative tumor suppressor genes was involved in GBM. We examined the methylation status at the promoter regions of GATA6, MGMT, and FHIT using the methylation-specific polymerase chain reaction in 61 primary GBMs. Our results reveal that there is no promoter hypermethylation of FHIT in the examined GBM tissue specimens. In contrast, the promoter hypermethylation of GATA6 and MGMT was detected in 42.8 and 11.11% of GBMs, respectively. The frequency of MGMT promoter hypermethylation was low in the group of patients we evaluated. In conclusion, our study demonstrates that promoter hypermethylation of MGMT is a common event in GBMs, whereas GATA6 is epigenetically affected in GBMs. Furthermore, inactivation of FHIT by epigenetic mechanisms in GBM may not be associated with brain tumorigenesis.

Psychometric properties of the Turkish version of the 42 item Depression Anxiety Stress Scale (DASS-42) in a clinical sample.

OBJECTIVE: To study the psychometric properties of the Turkish translation of the Depression Anxiety and Stress Scale (DASS-42) in a clinical group. METHODS: Outpatients diagnosed with anxiety (n = 138; mean age = 44.5 years; 74.6% female) or depression (n = 112; mean age = 46.2 years; 77.7% female) from the psychiatric outpatient clinic of a public hospital were evaluated. A group of non-clinical volunteers (n = 250; mean age = 37 years; 68% female) served as a community group for comparison. The participants completed the Turkish versions of the DASS-42, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). RESULTS: The structure of the DASS-42 was analyzed in the clinical sample using principal components extraction. The three-factor solution accounted for 56% of the total variance, with eigenvalues of 17.6, 3.0, and 2.6. The range of factor loadings was 0.55-0.85 for depression, 0.47-0.62 for anxiety, and 0.49-0.74 for stress. The Cronbach alpha values for the DASS depression, anxiety, and stress subscales were 0.94, 0.88, 0.94 respectively. The concurrent validity of the DASS was satisfactory. The non-clincal participants scored lower on all three subscales than the individuals in all of the clinical groups. CONCLUSION: The Turkish version of the DASS-42 appears to be an excellent instrument for measuring features of depression, hyperarousal, and tension in clinical groups.

Workplace violence: a study of Turkish workers.

This research was conducted to address the experience of workplace violence of Turkish workers from different sectors and to investigate the impact of the exposed violence on their psychological well-being. Data were collected anonymously with printed questionnaires from the volunteer participants and depended on self-reporting. The response rate was 79.0% (1708/2161). The prevalence of workplace violence was found to be 44.8%. The most common type was verbal violence together with mobbing (bullying). Victims of physical violence were mostly males, whereas females were found to be victims of verbal, psychological and sexual violence. Most cases did not result in legal action and the victims remained silent. Psychological well-being of exposed workers in terms of depression, anxiety and stress seemed to deteriorate. Workplace violence remains a silent epidemic in Turkey. Preventive measures against workplace violence and social support for violated workers do not exist.

Getting better or worse? General health status of 9th grade students in Orhangazi, Bursa, Turkey.

Adolescence is a transition phase from childhood to adulthood. In this period, rapid changes and development in their physical, biological, psychological, and social lives take place. While adolescents have to acquire many qualifications, they are faced with many problems, especially those that risk their health. In Turkey, one of the most important issues contributing to risky behaviors is the 1st Phase Nationwide High School Exam. Students must pass this phase in order to be in good high schools and to then pass the 2nd Phase University Exam. Most of their time is spent studying in school or in private teaching institutions, and less time is spent with their families or participating in social activities. In order to examine the effects on 9th grade students after the 1st Phase exams, we conducted this study with 1192 students in Bursa, Orhangazi. Data to evaluate students by socioeconomic status, body mass index (BMI), dietary, smoking, and physical activity behaviors and psychological status were collected via classroom questionnaires. We aimed to determine and evaluate the general characteristics and physical examination findings, to some extent, in a nationally representative sample of 9th grade students a year following the Nationwide High School Exam.

The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students.

BACKGROUND: The mental health of university students is an area of increasing concern worldwide. The objective of this study is to examine the prevalence of depression, anxiety and stress among a group of Turkish university students. METHODS: Depression Anxiety and Stress Scale (DASS-42) completed anonymously in the students' respective classrooms by 1,617 students. RESULTS: Depression, anxiety and stress levels of moderate severity or above were found in 27.1, 47.1 and 27% of our respondents, respectively. Anxiety and stress scores were higher among female students. First- and second-year students had higher depression, anxiety and stress scores than the others. Students who were satisfied with their education had lower depression, anxiety and stress scores than those who were not satisfied. CONCLUSIONS: The high prevalence of depression, anxiety and stress symptoms among university students is alarming. This shows the need for primary and secondary prevention measures, with the development of adequate and appropriate support services for this group.

Turkish general practitioners and complementary/alternative medicine.

BACKGROUND: Complementary and alternative medicine (CAM) is in the spotlight of society. However, what is the position of physicians at this point? OBJECTIVES: To determine general practitioners' (GP) knowledge, attitudes, and approaches to CAM. METHODS: All GPs (n=521) practicing in Bursa Province, Turkey were surveyed by a questionnaire. RESULTS: Responses from 49% of GPs were analyzed. Altogether, most of our physicians (96.5%) had not received any education about CAM, wanted to learn more (74.4%), and their knowledge levels were low (60.8%). About half of them (51%) believed in the efficiency of CAM, whereas 38.0% did not. GPs desire more information about herbal medicine and acupuncture. Only 29% of GPs were using some type of CAM for themselves. CONCLUSIONS: GPs are aware of the subject's importance and want to learn more about CAM and improve their knowledge. It would be reasonable to provide training possibilities for GPs, primarily for the CAM types highly used by the population and most requested by the physicians.

Quality of life among Turkish immigrants in Sweden.

OBJECTIVES: To assess quality of life among Turkish immigrants in Sweden by using the WHOQOL-100 scale and to evaluate the domains' contribution to explain the variance in the quality of life of the immigrants. Our hypothesis was QOL among Turkish immigrants in Sweden are better than Turkish people who are living in their home country. MATERIAL AND METHODS: This study was performed in the districts of Stockholm where Turkish immigrants have mostly settled. With the help and guidance of the Turkish Association, a sample of 520 participants was selected. We collected the demographic data by printed questionnaires, and to measure the quality of life, we used the WHOQOL-100 scale Turkish version. For analysis, we used the SPSS V.13.0 and R package programs, variance analyses, and Bayesian regression. RESULTS: The quality of life among the sample of Turkish immigrants was found to be moderate, but higher than the sample of the Turkish population. The quality of life of male immigrants was found to be higher than for females. Swedish-born Turks had better quality of life perceptions. CONCLUSION: Turkish immigrants' quality of life perceptions were better than those of the Turkish sample. The best scores were received from the third generation. The first generation and female immigrants need attention in order to receive higher quality of life perceptions.

Job related affective well-being among primary health care physicians.

BACKGROUND: Job related affective well-being is important for a healthy life and job satisfaction for all individuals, including physicians. The later group, however, is most often compromised. OBJECTIVES: We aimed to investigate a group of Turkish primary health care physicians' job related emotional perceptions and to assess their reactions in terms of stress, anxiety and depression. METHODS: A descriptive, cross-sectional, self-reported questionnaire study was conducted. A total of 60 primary health care centres and 274 general practitioners who were working at these centres participated in the study. The response rate was 74%. Printed questionnaires were completed by the participants anonymously. We used the Job Related Affective Well-Being Scale (JAWS) and Depression Anxiety Stress Scale (DASS 42). Correlation analysis and hierarchic regression were performed. RESULTS: Correlations between JAWS and DASS total scores were negative and statistically significant (r = -0.52; P< 0.01). Low pleasure/high arousal (LPHA) and low pleasure/low arousal (LPLA) variations that describe negative emotional states show a positive and significant relationship with depression, anxiety and stress values. The highest mean score was obtained for the high pleasure/low arousal (HPLA) status that can be interpreted to mean that our study group was pleased with their job but was not motivated. CONCLUSIONS: Physician's job related negative emotional perceptions are associated with reactions in terms of stress, anxiety and depression. For this reason, it is critical to consider primary care physicians' job related affectations and job related stimuli.

Bullying in Turkish white-collar workers.

OBJECTIVES: To determine the prevalence of reported workplace bullying among a group of white-collar workers, to evaluate the association between reported bullying and its effect on health and to assess the effects of support at work for bullied workers. METHODS: A cross-sectional questionnaire survey among full-time government employees in the health, education and security sectors. Bullying was assessed using a 20-item inventory. The potential effects of reported bullying were assessed using the Job Induced Stress Scale, the Hospital Anxiety and Depression Scale, Job Satisfaction Scale and the Propensity to Leave Scale. RESULTS: The response rate was 79% (944/1,200) and 877 questionnaires were analysed after exclusion of non-complete data. Of respondents, 55% (483) reported experiencing one or more types of bullying in the previous year and 47% (416) had witnessed the bullying of others. The bully was most likely to be a superior. Sixty per cent of victims had tried to take action against bullying, but most were dissatisfied with the outcome. There were significant differences in anxiety, depression, job-induced stress and support at work scores between those reporting bullying and those not reporting bullying at work. Those who reported bullying with low support at work had the poorest scores on the mental health scales. CONCLUSIONS: Bullying is a serious problem in this group of workers and may lead to health consequences. Feeling that the work environment is supportive appears to have a protective effect in terms of the health outcomes.

Domestic violence: a tragedy behind the doors.

OBJECTIVE: To explore the prevalence, type, frequency and causes of domestic marital violence among Turkish women in a socio-economically developed metropolitan setting. METHODS: A cross-sectional study was performed in 2003. All married women, aged 18 years and over, who were visiting any of the 50 primary health care units for different purposes were asked to participate in the study. Of 1427 asked, 1010 gave consent and completed face-to-face interviews. Multiple correspondence analysis, and logistic regression were used for statistical analyses. RESULTS: Domestic violence was statistically significantly associated with educational level. Illiterate women reported marital abuse 2.6 times more than university or more educated women. No statistically significant relationship was observed between domestic marital violence and women's age or occupation, marital duration or family income. The most frequently reported type of violence was physical, followed by psychological. Among women reporting domestic violence, those with the lowest educational level and income were experiencing all types of domestic violence frequently. CONCLUSION: Placing more importance on educating girls could be a key component of preventing domestic violence.