The Effect of Hydrogen Peroxide Colloidal-Ag Used in Dental Unit Waterline on Shear Bond Strength of Orthodontic Brackets

BACKGROUND

The quality of the water passing through the water lines is crucial to dental procedures. Studies on bracket adhesion of hydrogen peroxide colloidal-Ag, which is widely used to prevent biofilm formation, are limited in the literature.

AIM

To determine whether disinfecting the dental units' waterlines (DUW) with hydrogen peroxide colloidal-Ag has any effect on the shear bond strength (SBS) of orthodontic brackets bonded to enamel.

MATERIALS AND METHODS

Sixty premolar teeth were divided randomly into two groups. The study and control groups consists of 30 teeth that were etched for 30 seconds with 37% phosphoric acid. Study groups washed with hydrogen peroxide colloidal-Ag water and the control group washed with municipal water. Transbond XT adhesive system was used to bond stainless steel brackets on all the teeth. A 300-g force was applied using a tension gauge to ensure a uniform adhesive thickness and light cured with 6 seconds. The SBS was quantified by means of a universal testing machine. The residual adhesive on the enamel surface was evaluated after debonding using the adhesive remnant index (ARI).

RESULTS

The t-test results indicated that there were no significant differences in the SBS. The comparison of the results of ARI scores was found statistically insignificant.

CONCLUSION

It has been found that hydrogen peroxide colloidal-Ag, which is used to reduce the amount of biofilm in DUW, does not have a negative effect on the adhesion of the brackets.

Evaluation of the recipient and donor in organ transplantation in terms of orthorexia nervosa

OBJECTIVE

The aim of this study is to evaluate recipients and donors undergoing organ transplantation in terms of orthorexia nervosa.

SUBJECTS AND METHODS

The population of the study consisted of individuals over the age of 18 who were donors or recipients undergoing organ transplantation at the Organ Transplantation Centre of Research-Application Hospital of Gaziantep University in Turkey (n=74). A questionnaire consisting of 3 parts was used as a data collection tool. While the first part includes questions that ask socio-demographic characteristics of the participants and constitute the independent variables of the study (21 questions), the second and third parts include the Orthorexia Nervosa-15 (ORTO-15) and the Eating Attitude Test (EAT-40), respectively.

RESULTS

Based on the cut-off point of the ORTO-15 scale, it was determined that while 78.4% (n=58) of the participants were normal in terms of orthorexia nervosa, 21.6% (n=16) were orthorexic. In terms of the cut-off point of EAT-40, 37.8% (n=28) of the participants did not have an eating disorder and 62.2% (n=46) suffered from an eating disorder. The ORTO-15 mean ranks were high in those who were females (p=0.035), were suffering from chronic diseases (p=0.002), did not consume fast food (p=0.004), were making arrangements before eating their daily meals (p=0.018), and were doing regular physical activity (p=0.042).

CONCLUSIONS

Consequently, it was determined that those who were females, were suffering from chronic diseases, were making arrangements before eating their daily meals and were doing regular physical activity showed a more orthorexic tendency. It is recommended for healthcare professionals to determine the orthorexic tendency level of patients, who are female, suffer from chronic diseases, adhere to a regular diet and do a regular physical activity, and evaluate the whole patient group in terms of eating disorders while healthcare professionals conduct early diagnosis screenings of the patients (recipient/donor) in the organ transplantation process or referring them.

Transcanalicular Multidiode Laser Versus External Dacryocystorhinostomy in the Treatment of Acquired Nasolacrimal Duct Obstruction

OBJECTIVES

This study was a comparison of the outcomes of transcanalicular multidiode laser dacryocystorhinostomy (TCLDCR) and external dacryocystorhinostomy (EXDCR) treatment for patients with acquired nasolacrimal duct obstruction.

METHODS

Thirty-one consecutive patients who underwent TCLDCR (TCLDCR group) and 68 consecutive patients who underwent EXDCR (EXDCR group) due to acquired nasolacrimal duct obstruction were enrolled in the study. Follow-up visits were performed on the first day, and at the first week, first month, third month, sixth month, and every six months thereafter. Surgical success was defined as achievement of a patent osteotomy and a successful bicanalicular silicone intubation during the procedure. Anatomical success was defined by observation of a patent osteotomy on lacrimal irrigation, regardless of epiphora. The surgery time and intra- and postoperative complications were noted for each patient.

RESULTS

The TCLDCR group had a significantly shorter mean surgery time (27.9±5.5 minutes) compared with the EXDCR group (58.5±12.0 minutes) (p<0.001). However, the mean anatomical and functional rates of TCLDCR (58.0% and 54.8%, respectively) were significantly lower than those of the EXDCR group (94.1% and 91.1%, respectively) (both p<0.001). Two patients had "cheese wiring" damage of the lower canaliculus and 1 patient in the TCLDCR group had a full-thickness skin defect in the medial canthal region. No serious intra- or postoperative complication occurred in the EXDCR group.

CONCLUSION

Although a TCLDCR procedure decreased the surgical time, it had a significantly lower success rate in the treatment of acquired nasolacrimal duct obstruction compared to EXDCR. The decision of the type of surgery should be made based on the cosmetic and success expectations of the patients and the presence of systemic problems.

Anti-Demodex Effect of Commercial Eyelid Hygiene Products

PURPOSE

To investigate in vitro effects of active ingredients in eye cleansing wipes and solutions on the life span of Demodex.

METHODS

Demodex mites were extracted by eyelash epilation method from volunteers who were found to have chronic demodex blepharitis during an ophthalmological examination. Preparations with three or more motile, live adult Demodex parasites were included in the study. Two drops of the test solution were dropped on the samples: saline, 2% tea tree oil (TTO; Osto®, AKD Medical products, Turkey), 7.5% TTO (Blefaritto®, Jeomed, Turkey), and 0.5% terpinen-4-ol (T4O; Blefastop plus®, NTC, Italy). Under light microscopy at 100× and 400× magnification, samples were examined and followed. The average killing time of Demodex was noted for each preparation.

RESULTS

The study was analyzed on 120 patient samples. In the control group with saline, the average killing time of Demodex had an average of 323.5 ± 21.1 min. In other groups, an average mean of 95.9 ± 25.2 min in the 2% TTO group, 67.1 ± 21.8 min in the 7.5% TTO group, and 27.3 ± 6.0 min in the 0.5% T4O group was observed. It was found that the 0.5% T4O group was significantly more effective than the other groups.

CONCLUSION

Chronic Demodex blepharitis treatment is quite difficult in ophthalmology practice. It appears that, even at very low concentrations, T4O has an effective anti-Demodex effect.

A new technique of completely diverted tube ileostomy for the protection of colorectal anastomosis: a pilot study

AIM

This study was designed to evaluate a new technique for a completely diverting tube ileostomy achieved through temporary occlusion of the distal ileum using a flexible rubber strip.

METHODS

This prospective interventional study was conducted in one centre. Patients who underwent colorectal resections with a primary anastomosis and who were deemed as requiring a defunctioning stoma were included in the study. After completion of resection and anastomosis, the tube ileostomy was fashioned by inserting a reinforced (spiral) endotracheal tube with an inner diameter of 7.5 mm into the ileum. To provide complete faecal diversion, temporary occlusion of the distal ileum was performed using a flexible rubber strip. The primary outcome of this study was the incidence of complete diversion achieved using this method.

RESULTS

Fifty consecutive patients underwent a diverted tube ileostomy using the technique described above. Defaecation before removal of the strip did not occur in any of the patients inferring that complete diversion was observed in all patients (100%). The tube was removed at postoperative week 3. After tube removal, the resulting enterocutaneous fistulas closed spontaneously in a median of 6 (2-30) days.

CONCLUSION

The diverting tube ileostomy technique using an easily removable rubber strip to defunction the colorectal anastomosis is a safe and effective method that precludes the need to fashion a stoma.

Which one predicts mortality better? Hemogram and ST elevation myocardial infarction

Objective

The aim of this study was to determine the effectiveness of hematological parameters measured at the moment of admission to the emergency room in predicting in-hospital mortality and to determine cut-off values of strongly predictive values.

Subjects and Methods

The study began with approval of the ethics committee. In total, 1,929 patients over 18 years of age, whose date could be obtained, were included in the study. From the hemogram parameters, white blood cells (WBC), red cell distribution width, mean platelet volume, and ratio of neutrophils to lymphocytes (NLR) values were determined and recorded. CK-MB and high-sensitive Troponin T values were recorded as cardiac markers. For statistical analysis, "SPSS for Windows Version 21" package program was used.

Findings

About 71.7% (n = 1384) of the patients were male and 28.3% (n = 545) of the patients were female. About 92.5% of the patients (n = 1785) were discharged from the hospital, whereas the remaining 144 patients (7.5%) were exitus in the hospital. When the efficacy of hematological parameters and cardiac markers in predicting mortality was examined by receiver operating charecteristics analysis, NLR was found to be the strongest predictor (area under the curve [AUC], 0.772, standard deviation [SD] = 0.022, 95% confidence interval [CI]). It was found that the WBC value came in second place after NLR as a strong predictor of mortality (AUC, 0.749, SD = 0.024, % 95 CI).

Conclusion

The use of predictors for the prediction of mortality for ST elevation myocardial infarction patients is of great importance for faster implementation of treatment modalities. We found that WBC and especially NLR values obtained with a simple method can be used as powerful predictors.

The effect of topical anti-muscarinic agents on subfoveal choroidal thickness in healthy adults

PurposeTo investigate the effects of tropicamide and cyclopentolate, which are two anti-muscarinic agents commonly used in the ophthalmologic practice, on subfoveal choroidal choroidal thickness (ChT) in healthy adults.MethodsA total of 74 healthy adult subjects were enrolled in the study. Subjects were randomly divided into two groups: (1) cyclopentolate group (n=37) in which the right eye (study eye) of each subject received topical cyclopentolate 1%, and the fellow eye (control eye) received artificial tears and (2) tropicamide group (n=37) in which the right eye (study eye) of each subject received topical tropicamide 1% and the fellow eye (control eye) received artificial tears. Each topical medication was applied three times with 10-min intervals. ChT measurements were performed at baseline and 40 min after the last drops of the topical medications by enhanced depth imaging (EDI) optical coherence tomography (OCT).ResultsIn the cyclopentolate group, subfoveal ChT significantly increased in the study eyes (P=0.013), whereas it did not significantly change in the control eyes (P=0.417). On the other hand, in the tropicamide group, no significant subfoveal ChT changes were observed in either the study eyes (P=0.715) or the control eyes (P=0.344).ConclusionsThe current study demonstrated that cyclopentolate caused significant choroidal thickening, whereas tropicamide had no significant effect on ChT in healthy adults. As a result, mydriasis by cyclopentolate may complicate ChT measurements by EDI OCT. Use of tropicamide may provide more reliable results for evaluation of ChT in ocular pathologies.

Influence of Pterygium on Corneal Biomechanical Properties

PURPOSE

To evaluate the influence of pterygium on corneal biomechanical properties as measured by the ocular response analyzer (ORA).

METHODS

ORA measurements of 48 eyes with primary nasal pterygium were compared with those of healthy fellow eyes. The mean age of the patients was 46.6 ± 18.9 years. Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal-compensated IOP (IOPcc) were obtained for each subject by using the ORA (Reichert Ophthalmic Instruments, Depew, NY).

RESULTS

CH and CRF were significantly lower in the eyes with pterygium than in the healthy fellow eyes (p1 = 0.011, p2 = 0.014, respectively). On the other hand, there were no significant differences between the eyes with pterygium and healthy fellow eyes concerning IOPg and IOPcc (p1 = 0.948, p2 = 0.129, respectively).

CONCLUSIONS

The present study showed that biomechanical properties measured by ORA were affected by pterygium. The eyes with primary nasal pterygium had lower CH and CRF than healthy fellow eyes. Therefore, the effect of pterygium should be taken into account in order to make correct diagnoses by ORA.

Influence of indoor and outdoor activities on progression of myopia during puberty

The purpose of this study was to investigate whether time spent on indoor and outdoor activities or the other possible risk factors including age, gender, parental history, and initial refraction was associated with progression of myopia, during puberty. Fifty eyes of 50 myopic children aged 9-14 years were enrolled in the study. The parents were interviewed to determine the amounts of time in hours per day spent on reading and writing, using computer, watching TV, and outdoor activities (i.e., sports, games, or being outdoor with no activities) on an average day. The annual myopia progression rate (diopters per year) was calculated for each subject and was used in the statistical analyses. The mean initial age of the subjects was 10.9 ± 1.5 (ranging from 9 to 14) years. The mean follow-up period was 33.3 ± 10.3 (ranging from 17 to 55) months. There was a significant increase in the mean myopia value of the subjects after follow-up period (p < 0.001). The mean daily time spent on reading and writing and initial refraction value were independently associated with annual myopic progression rate. On the other hand, age, gender, parental myopia, and the mean daily times spent on computer use, watching TV, and outdoor activities had no correlations with annual myopia progression rate. The present study showed that myopia progression was associated with time spent on reading and writing and initial refraction value, during puberty. However, myopia progression was not associated with parental myopia, age, gender, and daily times spent on using computer, watching TV, and outdoor activities.

Effect of verapamil and lidocaine on TRPM and NaV1.9 gene expressions in renal ischemia-reperfusion

BACKGROUND

To determine effects on calcium and sodium channels of Ca(2+) and Na(+) channel blockers in the present study, expression levels of TRPM1, TRPM2, TRPM3, TRPM4, TRPM5, TRPM6, TRPM7, TRPM8, and NaV1.9 genes were evaluated in kidney tissues after induced ischemia-reperfusion.

MATERIAL AND METHODS

Forty albino Wistar male rats were equally divided into 4 groups as follows: group I: control group (n = 10), group II: ischemia group (60 minutes of ischemia + 48 hours of reperfusion; n = 10), group III: ischemia (60 minutes of ischemia + 48 hours of reperfusion) + calcium channel blocker (n = 8), group IV: ischemia (60 minutes of ischemia + 48 hours of reperfusion) + sodium channel blocker (n = 8).

RESULTS

When compared to ischemia group expression levels of TRPM2, TRPM4, TRPM6, and NaV1.9 in Ca(2+) and Na(+) channel blocker groups were increased, whereas that of TRPM7 was decreased. However, expression levels of TRPM1, TRPM3, TRPM5, and TRPM8 were not determined in kidney tissue. Histologically, the Ca(2+) channel blocker verapamil and the Na(+) channel blocker lidocaine inhibited the cell death in kidney tissue compared to control.

CONCLUSION

Our study suggested that verapamil and lidocaine significantly reduce the degree of ischemia-reperfusion injury due to effects to TRPM and Nav1.9 genes.

Macrocyclic Cu(ii)-organophosphonate building block with room temperature magnetic ordering

A novel macrocyclic Cu(ii)-organophosphonate building block displaying high temperature magnetic ordering, and the structure of [{Cu(2,2′-bpy)}₂(HO₃P(CH₂)₈PO₃H₂)₄] (1).

EPR Studies of Cu2+ in dl-Aspartic Acid Single Crystals

EPR studies of Cu2+ doped dl-Aspartic Acid [NH2CH(CH2COOH)COO] powder and single crystal have been carried out at 113 and 300 K. The principal hyperfine and g values, covalancy parameter, mixing coefficients and Fermi-contact term of the complex were obtained, and the ground-state wavefuntion of the Cu2+ ion in the lattice has been constructed.

Including expectant fathers in antenatal education programmes in Istanbul, Turkey

In this article we present the results of three studies investigating methods for including men in antenatal education in Istanbul, Turkey. Participants were first-time expectant parents living in low and middle-income areas. After a formative study on the roles of various family members in health during the period surrounding a first birth, an antenatal-clinic-based education programme for women and for couples was carried out as a randomised, controlled study. Based on the results, separate community-based antenatal education programmes for expectant mothers and expectant fathers were tested. There was demand among many pregnant women and some of their husbands for including expectant fathers in antenatal education. In the short term, these programmes seemed to have positive effects on women and men's reproductive health knowledge, attitudes and behaviours. In the clinic-based programme the positive effects of including men were mainly in the area of post-partum family planning, while in the community-based programme positive effects among men were also seen in the areas of infant health, infant feeding and spousal communication and support. Free antenatal education should be made available to all expectant mothers and when possible, men should be included, either together with their wives or in a culture such as that of Turkey, in separate groups.

The effectiveness of preabortion contraception counseling

OBJECTIVE

To demonstrate the impact of preabortion counseling followed by immediate postabortal provision of the chosen method on postabortion contraceptive use.

METHODS

Three hundred and forty-two women undergoing voluntary termination of pregnancy at less than 10 weeks gestation were enrolled at the Woman and Child Health Training and Research Clinic, Medical School of Istanbul. Clinic visits and telephone surveys were performed to measure contraceptive use at 6 months following abortion.

RESULT

Two hundred and thirty-six women either visited the clinic or responded to the telephone survey. Eighty percent of the respondents reported use of a modern contraceptive as compared to less than 40% prevalence found in the national survey.

CONCLUSION

Preabortion counseling combined with immediate postabortal provision of contraceptives may significantly increase contraceptive use at 6 months postprocedure.

Immediate postabortal contraception with the levonorgestrel intrauterine device, Norplant, and traditional methods

Women seeking legal first trimester abortion were counseled concerning contraception methods available for use immediately postabortion. Fifty women each accepted hormonal methods that were available only in the clinic and were novel to the country, the levonorgestrel IUD and Norplant implants, whereas another 50 chose either coitus interruptus or abstinence. All were experienced contraceptors, but larger percentages of women selecting the levonorgestrel IUD or implants had used the pill or IUDs previously, were under age 30, and weighed less than 60 kg compared to the other study participants. In the initial 2-6 weeks postabortion, women using the long-acting hormonal methods resumed sexual activity earlier and experienced more bleeding and spotting days than did other study participants, but their hematocrits were not adversely affected. No clinically significant side effects were noted in any group in the 6 weeks following the abortion. At the end of 1 year of follow-up, women using the hormonal methods had experienced no pregnancies and had high rates of continuation. IUD and implant participants had greater weight gain than did the other participants, but their mean weight remained below that of participants using traditional methods. No significant between-group differences in levels or changes in levels from admission were noted in hematocrit and blood pressure. The women found the levonorgestrel implants and IUDs easy and safe to use and highly effective. Bleeding disturbances, including amenorrhea, were the principal features the women disliked.

Assessing the acceptability, service delivery requirements, and use-effectiveness of the diaphragm in Colombia, Philippines, and Turkey

The diaphragm is not available in many countries, despite the recommendations of numerous authors that it has important advantages as a woman-controlled method that offers some protection against sexually transmitted diseases, and one that is safe and free of side effects. An interagency team collaborated to introduce the diaphragm in Colombia, the Philippines, and Turkey, using the same protocol to assess the acceptability, service delivery requirements and use-effectiveness of the method. Eighteen public and private sector service delivery sites were involved and a total of 550 women were enrolled in the study. Provider training aimed to improve the quality of care with which all methods were delivered and included counseling about sexuality and reproductive health risks. The cumulative 12-month pregnancy rate of 10.1 (SE 1.7) per 100 woman-years is on the low end of previous studies of the diaphragm, and the 12-month continuation rate (57.2 [SE 2.4] per 100) compares favorably with that for oral contraceptives and the intrauterine device. Focus group discussions conducted with clients and providers indicated that the method was an important alternative for some women, particularly those who had experienced health problems with other methods or were unable to negotiate condom use with their partners. Provider biases diminished as they observed the strategic niche that the diaphragm filled for their clients. While providing the diaphragm requires training and good client-provider interaction, the requirements are consistent with those called for in the Programme of Action of the International Conference on Population and Development (ICPD, 1994). With proper attention to quality of care, the diaphragm can be successfully offered in resource-poor settings.

Acceptability of Norplant at a well-woman clinic in Turkey

OBJECTIVE

To make an assessment of the acceptability and cost of subdermal implants, a new method in Turkey, in a free-choice environment.

METHODS

The records of women attending a university well-woman clinic in Istanbul, Turkey, were analyzed retrospectively. Among other contraceptives registered in the country, the women were offered subdermal contraceptive implants (Norplant) during counselling sessions. The women who chose implants were invited to attend for follow-up three times during the first 12 months and were advised to return annually thereafter. An estimation of cost was performed for Norplant, using the government price of the implant and the wage rates of public-sector staff. An estimation of cost was also performed for oral contraceptives.

RESULTS

Among the 5650 women who applied to the Clinic for contraception between 1 January 1995 and 31 December 1998, 274 women decided to use implants, giving an initial acceptance rate of 5.1%. Continuation rates were 91.8%, 71.6% and 42.5% at 12 months, 24 months and 36 months, respectively. There were no pregnancies within the study period. The only demographic characteristic that was positively related to the acceptability of Norplant was younger age. The cost of contraception with Norplant was found to be lower than that for oral contraceptives.

CONCLUSION

The high initial acceptance and continuation rates, combined with its high efficacy, make Norplant a valuable tool for Turkey's National Family Planning Program. Contraception with Norplant is also a cost-effective method, at least for the public sector.

Cost benefit analysis of sexually transmitted diseases

Suggested measures to prevent transmission and sequelae of sexually transmitted diseases are almost universally agreed. But the important question to be answered is whether the interventions are worth the resources spent. To facilitate the decision making on resource allocation, the best possible information should be available concerning the relationships between health intervention programs and changes in the health status. Cost benefit analysis is the main approach used to assess the efficiency of any intervention. If the economic benefits of the program are greater than the costs, the program should be seriously considered. Although information about the costs of management of STDs is scarce in developing countries because of the complicated behavioral, social and economic issues involved, it is widely held that making treatment available for curable sexually transmitted diseases represents one of the most cost-effective ways to improve the health in the world.

Contraceptive choice and reproductive morbidity in Istanbul

A cross-sectional survey was conducted in Istanbul to investigate the relationship between contraceptive choice and reproductive morbidity. Altogether, 918 women who had ever used any means of avoiding pregnancy were interviewed at home, and, among these, 694 parous nonpregnant women were examined by three female physicians. The women were aware of bearing a considerable burden of ill health, with 81 percent reporting at least one episode of illness in the three months prior to the interview. Current users of the intrauterine device were significantly more likely than users of other methods to report menstrual disorders, but pelvic relaxation and reproductive and urinary tract infections, whether perceived or diagnosed, were not significantly related to any of the contraceptive methods. The relatively small amount of switching between methods suggests that most users tended to stay with the same method once chosen and that health concerns played an important part only in the initial choice of the method.

Asking questions about women's reproductive health: validity and reliability of survey findings from Istanbul

In countries where population-based data on health problems are scarce, the extent of reproductive morbidity can be estimated from replies in structured interviews as a complement or as an alternative to reports from physician's examination and laboratory tests. We examined the sensitivity and specificity of detected morbidity based on these replies as compared to medical diagnoses and explored the consistency of replies when the questionnaire was administered twice, by two types of interviewers in different environments. Data were collected in a cross-sectional survey in Istanbul. The presence or absence of five morbidities, reproductive and urinary tract infections (RTI and UTI), menstrual disorders, pelvic relaxation and anaemia was determined by algorithms based on the replies, and by the physician's diagnosis. Except with anaemia, questionnaire replies were more specific than sensitive in detecting morbidity, probably partly due to many morbid conditions being accepted as normal. Sepcificity exceeded 80% for home reports of menstrual disorders (93.0%), pelvic relaxation (95.7%), RTI (abnormal discharge and pain) (81.2%) and UTI (80.7%), with the corresponding figure for anaemia at 41.7%; the best sensitivity results were for anaemia (58.3%), RTI (abnormal discharge only) (49.3%) and menstrual disorders (45.4%) with figures for pelvic relaxation and UTI reaching only 17.3 and 13.0%. Reliability between the interviews (assessed by the K coefficient), was highest at 66.1% for pelvic relaxation and lowest at 39.9% for menstrual disorders. Reliability varied between the two lay interviewers, suggesting the interviewer and the interview conditions are important. Questionnaire-based information on this type of morbidity is most useful for ascertaining perceived ill-health and only of limited use for the corresponding medically defined conditions.

Clinical algorithms for the screening of Chlamydia trachomatis in Turkish women

OBJECTIVE

To test the diagnostic validity of clinical algorithms for the detection of Chlamydia trachomatis in an urban population of married women in Turkey.

DESIGN

Cross-sectional population-based survey.

SUBJECTS

A systematic sample of 867 women who reported the use of contraceptive methods.

MAIN OUTCOME MEASURES

Sensitivity, specificity and positive predictive value of clinical algorithms for the diagnosis of C trachomatis.

RESULTS

C trachomatis was diagnosed in 4.89% of the women. The WHO algorithm for use in settings where no vaginal examination could be performed had a sensitivity of 9% and a specificity of 96%. The corresponding figures for the WHO algorithm incorporating the findings of a speculum examination were 47% and 56% respectively. Algorithms incorporating symptoms or signs other than those suggested by the WHO did not yield satisfactory standards of validity.

CONCLUSIONS

The findings of this study do not support the widespread introduction of the use of clinical decision models for screening of women for chlamydia infection in primary health care settings such as family planning or antenatal clinics. The large number of false positive results with the use of the clinical algorithms tested in this study would cause unnecessary costs to the health system and unnecessary interventions to the women treated.

Palliation of malignant obstructive jaundice. Use of self-expandable metal stents

PURPOSE

The aim of this study was to analyze the clinical efficacy of metal stents in the palliation of malignant obstructive jaundice.

MATERIAL AND METHODS

Fifty patients with malignant biliary obstruction were palliated by means of drainage with a metallic self-expandable stent (Wallstent). Nineteen patients had pancreatic carcinoma, 22 cholangiocarcinoma, 4 hepatocellular carcinoma, and the remaining 5 metastatic carcinoma from a variety of primary sites. The obstruction was at the level of the liver hilum in 19 cases, in the middle common bile duct in 11, and in the lower common bile duct in 20.

RESULTS

The patients were followed over a period of 1-17 months. A total of 36 patients (72%) died; 14 (28%) survived. The mean observation time for the whole group of 50 patients was 3.3 months. The 30-day mortality rate was 14% (7 patients). Short-term complications occurred in 6 patients (12%). Long-term complications included stent occlusion requiring a 2nd intervention in 2 patients (4%), and cholangitis in 2 patients (4%). Excellent palliation was achieved in most of the patients. No stent migration was observed.

CONCLUSION

The metallic stent provides good palliative drainage, and the percutaneous insertion of metallic stents is well tolerated by the patients. The procedure is simple and safe to use and can be executed in one stage. The one-stage procedure, compared to the 2-stage procedure, may reduce hospital stays.

The effects of vaccination with inactivated uropathogenic bacteria in recurrent urinary tract infections of children

Secretory IgA (sIgA) is an important parameter in the predisposition to recurrent urinary tract infection (UTI). We investigated whether sIgA and frequency of UTI could be positively influenced by intramuscular vaccination with inactivated uropathogenic bacteria (Solco-Urovac). Ten otherwise healthy girls aged from 5 to 11 years (mean 9 1.7 years) with recurrent UTI were immunized with Solco-Urovac by i.m. injections three times at weekly intervals. A booster injection was given after 6 months. Urinary sIgA secretory component (SC) concentration was determined by radial immunodiffusion assay. Ten other age-matched girls with UTI were not immunized. Immunization therapy caused a significant reduction in the frequency of infection and an increase in urinary sIgA SC, while in the nonvaccinated group the values remained constant.

Estimation of increased hospital stay due to nosocomial infections in surgical patients: comparison of matched groups

An investigation, using a prospective cohort study, was performed to estimate the prolongation of hospital stay caused by nosocomial infections in surgical patients. An evaluation of the one-to-one matching method, as a model for similar studies was also undertaken. Between 1992 and 1994, 225 of 1482 surgical patients (15%) developed infection. Of these, 223 evaluable patients were compared with 1256 uninfected cases, in an unmatched analysis. In a further analysis, 151 infected cases were matched one-to-one with uninfected controls, and other factors such as age, length of preoperative stay, presence of malignancy or diabetes and presence of foley catheters or drains, were evaluated. Patients with infection were hospitalized for 10.6 days longer than the matched controls. In the unmatched analysis, infected patients appear to remain in hospital for a further 17 days. The difference in the prolongation of stay between matched and unmatched groups indicates the importance of matching as an essential model for such studies. In cases where matching cannot be performed, the median can be a good alternative measure to the arithmetic mean.

Postpartum family planning and health needs of women of low income in Istanbul

This study was designed to learn what types of postpartum health and family planning services are most appropriate for couples with low incomes living in Istanbul, Turkey. The methods used included focus groups, site visits, questionnaires for postpartum women, and a self-administered questionnaire for health-care providers. By five months postpartum, 86 percent of the women surveyed were using some method of family planning. Many couples used withdrawal, starting immediately upon resumption of intercourse after childbirth, intending to use a medical method after menses resumed. However, only 34 percent of users had begun to use a medical method by five months after childbirth. The health facilities visited provide little information and counseling about the postpartum period. Women said that they wanted information on infant care, breast-feeding, and family planning, either before becoming pregnant or while they are pregnant. Most women prefer that postpartum services address the needs of the whole family, not only those of the baby or the mother. Recommendations for the timing, mode, and content of postpartum health and family planning services are made based on the study's findings.

Paraprofessional women as health care facilitators in mother and child health

The aim of the study was to compare the performance of midwives with that of lady home visitors (LHV; paraprofessionals). The project area was divided into six according to the population map. One midwife or one LHV was assigned to each visiting area. Home visits were carried out to identify and offer guidance on family planning (FP), antenatal care, well-child control, immunizations and other mother and child health related issues to those at high risk. Criteria taken for evaluation were the numbers of pregnant women identified in the last trimester; pregnant women receiving antenatal care; deliveries attended by a health care provider; modern FP users; continuation rate of the new users; pregnancy rate in new users; immunization status of children; well-child visits of the children. No significant differences were found in these health measurements between areas visited by LHV and areas visited by midwives. Response rates to the invitation was also similar in both areas. An important observation was the good performance of the LHV in communicating with the families. Women with limited school attainment from the community can be used effectively and efficiently in community health services.

Experiences of a health team working in a new urban settlement area in Istanbul

A project aiming at creating a model for comprehensive maternal and child health care for urban underdeveloped areas was started in a new settlement area of migrants in the vicinity of Istanbul. The project had an impact on health care status, particularly among infants and children, but the results indicated that more effort was needed to reach the mothers. It was noted that building space and the appearance of the work place influenced the prestige of the team. Absentee problems could be partly surmounted by repeated home visits. Based on this experience, it was concluded that health services in underdeveloped areas need to be supported by non medical personnel to act as home visitors and as mediators between the community and the health team. It was also concluded that an established recording system to include both clinical data and attendance is needed to define the cases who need special care.

Acceptance of effective contraceptive methods after induced abortion

The purpose of this study was to examine possible motivating factors in switching from a relatively inadequate contraceptive method to an effective one. Three groups of women were observed: Group A had induced abortion and routine family planning education; Group B had induced abortion, routine family planning education, and special education on the health hazards of abortion; and Group C had no abortion, but did have both the routine and special education. The rate of women switching from inadequate contraceptive methods to the more effective methods was 45, 86, and 18 percent, respectively. Thus, these findings demonstrate that women who have had induced abortion are more highly motivated to switch from inadequate to effective contraceptive methods, particularly when they have been exposed to routine family planning education and additional education on the health hazards of abortion. It is recommended that emphasis be placed on providing special education for women who have had induced abortion.

[An approach to determine the scope of induced abortion in the community]

Information on the extent of abortion is generally obtained through direct enquiries of women. However, there is always the possibility of underreporting abortion due to several factors. In this article, the results of a study on underreporting of abortion in Cubuk Health Center are presented. Unlike the findings of similar studies, the overall underreporting of all abortion was only 4% and no relationship was found between the underreporting rate and sociodemographic characteristics of the women. The results have been discussed in the context of the special features of the health services provided in the study area.