Yesim Uncu

The effects of different hormone replacement therapy regimens on tear function, intraocular pressure and lens opacity

Objective. Estrogen may have adverse effects on the ocular surface, intraocular pressure (IOP), lens opacity and tear function. The aim of the present study was to elucidate the effects of different hormone replacement therapy (HRT) protocols on tear function, IOP and lens opacity. Design and setting. This was a prospective, uncontrolled study carried out at the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Uludağ University, Turkey. Patients and interventions. Thirty postmenopausal patients who had spontaneous or surgical menopause for at least 1 year and were not taking any medications were assigned to one of three groups. Group 1 comprised 19 patients (n = 38 observations) given conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 2.5 mg (Premelle 2.5®) daily; Group 2 contained six patients (n = 12 observations) given tibolone 2.5 mg (Livial®) daily; and Group 3 comprised five patients (n = 10 observations) treated with estradiol patch, 3.9 mg/12 cm2 (Climara®). Tear function, evaluated with Schirmers test, IOP and lens opacity were determined before treatment and at 6 and 12 months of treatment. Results. Mean Schirmers test score in each group and all eyes (n = 60) did not change significantly after 6 months of treatment but decreased significantly at 12 months. The percentage decrease in tear function was greatest in the estrogen-only group (Group 3). Mean IOP did not change significantly in Groups 1 and 2; however, in Group 3, IOP showed a statistically significant decrease from 14.63 ± 0.84 mmHg before treatment to 12.60 ± 0.68 mmHg (mean ± standard error) at the end of treatment. Lens opacity in women of all groups did not change during treatment. Conclusions. HRT decreased tear production, the decrease being greater in the estrogen- only group. Woman who are taking or considering HRT should be informed of the potential increased risk of dry eye syndrome with this therapy. In addition, estrogen-only treatment decreased IOP while estrogen plus progesterone and tibolone had no effect. HRT did not affect lens opacity after 12 months of treatment.

Smoking patterns among primary school students in Turkey.

Cigarette smoking continues to be a threat to global health. The number of cigarettes smoked per person tends to increase each year, and the age of starting seems to be dropping. The research related to cigarette smoking conducted among young people generally studied high school or university students. However, studies have shown that students usually start smoking during the primary school period out of curiosity or imitation. The purpose of the present study was to find the prevalence of cigarette smoking among primary school students and the reasons for starting smoking, and to determine the characteristics of cigarette smoking of their parents. This study was conducted among 17 primary schools chosen according to their socioeconomic situations in different municipality districts in Turkey, with 9,408 students participating. Data were obtained by questionnaire. The mean age to start smoking was 11.7 ± 1.6; 82.9% of the students who took part in this study had never smoked before, 13.4% had tried smoking at least once, and 3.7% had been smoking regularly. The biggest reason for smoking was just curiosity or imitation. It was determined that a risk factor for students to start smoking was parents who smoke. The 17% smoking rate among primary school students was high in our opinion and prevention studies initiated. In addition, the effects of cigarette-smoking parents on students who start smoking should also be considered.

Diagnosis of acute tonsillopharyngitis in primary care: a new approach for low-resource settings

Abstract Background: Diagnosing GABHS (Group A-beta Hemolytic Streptococcus) tonsillopharyngitis by clinical scoring is a recommended approach in developed countries, but there is still much controversy for low resource settings. Aim: We aimed to assess the impact of Centor criteria with the support of practical laboratory tests. Methods: We prospectively included patients complaining sore throat (N = 282). We evaluated them in terms of Centor scoring and performed white blood cell count (WBC), C-reactive protein (CRP), rapid antigen detecting test, and throat culture. Results: In GABHS cases (n = 32, 11·3%), two of the criteria were observed to be positive in more than half of the cases (n = 19, 59·3%), while 13 (40·7%) cases met three/four criteria. The specificity of having two criteria was found to be 65·5% and increased to 91·5% after including CRP and WBC. Conclusion: Centor criteria could be safely used to reduce unnecessary antibiotic usage for tonsillopharyngitis in developing countries.

A Meta-Analysis and the Evaluation of Trends in Obesity Prevalence among Children and Adolescents aged 5-19 in Turkey: 1990 through 2015

Objective Obesity in childhood and adolescence is one of the most serious public health problems due to a remarkable increase in prevalence in recent years and its close relationship with non-communicable diseases, such as diabetes and hypertension, resulting in increased adult morbidity and mortality. This study aims to quantify the secular trend in different regions of Turkey from 1990 to 2015 by performing a meta-analysis of childhood and adolescent obesity prevalence studies conducted. Methods Uludag University Library Database was searched for relevant articles published prior to March 2017. The heterogeneity of the studies in the meta-analysis was tested by the I2 statistic and Cochran’s Q test. The obesity trend analyses were examined by chi-square trend analysis with respect to five year periods. The statistical significance level was taken as α=0.05. Results A total of 76 papers were initially identified addressing childhood and adolescent obesity in Turkey. Fifty-eight papers were selected for analysis. The prevalence of obesity increased from 0.6% to 7.3% with an 11.6-fold increase between the periods 1990-1995 to 2011-2015. The prevalence of obesity increased in both genders. However, boys were more likely to be obese than girls. Conclusion Studies on obesity prevalence in the 5-19 age group in Turkey have gained importance, especially in the 2000s. While a remarkable number of prevalence studies, mostly regional, have been conducted between 2005-2011, a gradual decline was observed thereafter. Further national and population-based surveys on prevalence of obesity in children and adolescents are definitely needed in Turkey.

An Educational Intervention to Prevent Irrational Prescribing By Primary Care Physicians: Results from Turkey from the OTC-SOCIOMED Project Second Phase

Objective: The misuse of over-the-counter (OTC) medications is a serious issue in primary healthcare, leading to the need for better education of general physicians on appropriate prescribing behavior. This study discusses the findings from the OTC-SOCIOMED project (Assessing the Over-the-Counter Medications in Primary Care and Translating the Theory of Planned Behavior into Interventions) in Turkey. Methods: During November 2011, the implementation of intervention was done in Bursa, which was selected as the study region in Turkey. The participants were 28 family physicians in Turkey who were assigned to two study groups; a three-step training intervention—a 1-day intensive course on rational drug prescription, 4 weeks of reminder messages, and face-to-face interviews—was provided for the intervention group. Four different data collection tools were used before and after the intervention: a training assessment questionnaire, a complementary questionnaire on OTC medicines, the theory of planned behavior questionnaire, and a patient medication form. Results: Participants were satisfied with the quality of the training, the delivery of the topics, and the subsequent reminder messages. There was a significant difference in only one item (“The decision to prescribe belongs completely to me”), which evaluated behavior control in the intervention group after training. The lack of time most often explained why physicians could not inform patients about OTC medicines. Conclusion: Physicians were aware of their own need for training in rational prescribing, and this training model was quite acceptable to them. However, the short study duration was an obstacle for observing attitude changes among the doctors.

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.