Ganime Sadikoglu

Pap smear screening in the primary health care setting: A study from Turkey

Background: Cervical cancer is one of the ten most frequent cancers in Turkey. It is well known that cervical cancer morbidity and mortality could be significantly reduced with an active cervical smear screening (Pap smear) program. Aims: The aims of this study were: 1) to evaluate the knowledge and attitudes of women about cervical smear testing; 2) to establish a cervical smear screening program and to evaluate the cervical cytological abnormalities that were found; 3) to determine the applicability, limitations and effectiveness of this screening in a primary health care unit. Patients and Methods: A total of 332 married women were included in our study. We collected data concerning socio-demographic and fertility characteristics, and knowledge about Pap smear testing was determined through printed questionnaires. A gynecological examination and Pap smear screening was performed on every woman in our study group. Results: Over ninety percent of our study group had never heard of and had not undergone Pap smear screening before. Of the 332 smears evaluated, 328 (98.8%) were accepted as normal, whereas epithelial cell anomalies were seen in 4 (1.2%), infection in 59 (17.7%), and reactive cell differences in 223 (67.2%) of the smears. Conclusions: The frequency of epithelial cell anomalies in our study group was less than the frequencies reported from Western countries. Knowledge regarding cervical cancer and Pap smear screening was very low. Pap smears can be easily taken and evaluated through a chain built between the primary health care unit and laboratory, and this kind of screening intervention is easily accepted by the population served.

Body fat distribution has no effect on serum visfatin levels in healthy female subjects.

Obesity is the presence of either abnormal absolute amount or relative proportion of body fat. Contrary to gluteal obesity, visceral obesity is associated with different metabolic alterations including insulin resistance (IR). A relatively new adipocytokine visfatin is shown to be expressed predominantly in visceral fat and exhibit insulin-mimicking effects in rodents. It is still unclear whether serum visfatin levels are associated with increased total or visceral fat mass in humans. The aim of our study was to investigate the relation between visfatin and obesity parameters namely body mass index (BMI) and waist circumference (WaC) and IR in healthy female subjects. Eighty one female subjects 20 years of age, having no diagnosis of glucose intolerance or diabetes, hypertension and dyslipidemia were chosen. The patients were divided into four groups according to their BMI and WaC values. Serum visfatin and HOMA-IR levels did not differ among groups. No correlation was detected between serum visfatin levels and obesity and metabolic parameters. In conclusion, we demonstrated that body fat distribution did not affect serum visfatin levels in healthy female subjects. Further studies are needed to clarify the exact factors influencing and determining serum visfatin levels and its clinical reflections.

The Knowledge and Attitudes about Mammography in a Group of Turkish Women Who Attended a Family Medicine Clinic

To the Editor: Breast cancer is responsible for the largest proportion of female deaths from any form of cancer in Turkey and has accounted for approximately 16.7% of all cancer-related deaths in recent years (1,2). Population-based studies have shown that mammography can be effective in early detection and can reduce breast cancer mortality (3–5). The American Cancer Society recommends clinical breast examination (CBE) and mammography for the early detection of breast cancer and breast self-examination (BSE) is an option for women starting from the early 20s (6,7). In this cross-sectional study, we wanted to evaluate the associations between attitudes and knowledge about mammography and socio-demographic indicators and the mammography practices of Turkish women in an urban setting. Participants were recruited among married women who were attending the Family Medicine Clinic for various purposes from March to May 2006. Our study group consisted of 736 women who gave their written consent for participation. Questionnaires were filled out in face-to-face interviews conducted by the authors. The participation rate was found to be 85%. The dependent variable, mammography use, was defined with four categories: (1) no mammogram (never had one), (2) recent adopter (had had one mammogram, which had occurred in the previous 12 months), (3) previous user (had had one or more mammograms, but none in the previous 12 months), and (4) repeat recent user (had had two or more mammograms, including one in the previous 12 months). The study variables were selected to focus on (1) socio-economic status, such as income, education, and marital status, (2) need factors, such as age, family history of breast cancer, breast problems, and (3) health-system-related factors, such as having CBE and awareness of BSE. To assess the joint effects of the variables, a multinomial regression model was performed. The women’s mean (SEM) age was 50.5 years (0.5). Most (61.0%) were primary school graduates and housewives (72.3%). Seventy-seven percent of the study group had an annual family income below US

Getting Better or Worse? General Health Status of 9th Grade Students in Orhangazi, Bursa, Turkey

8140. The mean (SEM) number for given births was 2.6 (0.06). Only 6.3% of the women reported that they had never breastfed their children. Fiftynine percent of the women reported that they were in menopause. A family history of breast cancer among first-degree relatives was found among 4.2% of the women. Twenty-two percent of the women pointed to breast problems sometime during their entire lifespans. Only 34.3% of the study group reported that they had had a CBE at least once, and 37.6% were aware of BSE and had been taught how to perform it. Among the respondents, 14.7% had had one, 12.2% had had more than one, and 73.1% had never a mammogram. The referent group, women who had never had a mammogram, compared with the three other user groups: recent adopters, previous users, and repeat recent users. Income, education, and marital status were not found to be significant in any of the user groups. Family history of breast cancer, having at least one CBE, being at the age of 40 years or older and awareness of BSE found to be as important factors of practicing mammography.

Are “Giving bad news” difficult situations for medical students?

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.

A survey of the public attitudes towards organ donation in a Turkish community and of the changes that have taken place in the last 12 years

Backround: Discussions about end-of-life are difficult issues for physicians to initiate. What about medical students? Do they have enough education about these issues? Aim: In this study our aim was not only to learn their approaches about giving bad news but also to apply a learning method by adding role playing to the elective lesson titled as “giving bad news” to our undergraduate curriculum. Methods: Study group was the third year medical students, who were elected “Approaches to Primary Care Patients” lesson which was given from lecturers of Family Medicine Department. A questionnarie was performed in the beginning and at the end of the lesson. Between these two period a role-playing demonstration was performed from two voluntary students related the subject. Results: Fifteen female (62,5%), 9 male (37;5%), total 24 elective lesson students were par tic i pated. Most of the stu dents (79,2%) stated our pres ent un der grad u ate cur ric u lum de fi cient related giving bad news. More than 90% feeling disturbed, concerned and insecure in giving bad news. After the lesson and role-playing demonstrations more than 90% of the students found this type of training efficacious and practical. Conclusion: Giving bad news is a very important communication skill. As family physicians play a key role on patient care we need to learn the methods and as lecturer to teach them to our medical students. Student integration to the training method can be benefical to internalize the subject. Scripta Scientifica Medica 2007;39(1):95-98