Validity and reliability of the Turkish version of the Parent Attitudes About Childhood Vaccines (PACV) scale

AIMS

This study aimed to determine the validity and reliability of the Turkish version of the "Parental Attitudes toward Childhood Vaccines" (PACV) scale.

MATERIALS AND METHODS

A two-stage observational validation study was conducted. A back-translation technique was used and then the scale was validated with a sample of 343 parents with children aged 0-72 months. The test-retest method, Cronbach's alpha coefficient, Split-half analysis, and item analysis methods were used to determine the reliability of the scale, factor analyses were run to determine construct validity. Explanatory Factor Analysis and Confirmatory Factor Analysis were applied to assess construct validity.

RESULTS

Cronbach's alpha coefficient was measured as .84. The Spearman-Brown coefficient was .82 and the Guttman Split-half coefficient was .81. According to the item-total correlation and Cronbach's alpha values when the item was deleted, no item was deleted from the scale. The intraclass correlation coefficient between the test-retest measurements was .79. The three-factor structure consisting of 15 items explained 51.6% of the total variance. As a result of the confirmatory factor analysis, a sufficient fit of the model to the model proposed in the original version of the scale was evident (χ²/sd=2.214, RMSEA=.06).

CONCLUSION

The Turkish version of the PACV is a valid and reliable scale and can be used to identify parental attitudes toward childhood vaccines.

Is mean platelet volume related to disease activity in systemic lupus erythematosus?

INTRODUCTION

Systemic lupus erythematosus (SLE) is a connective tissue disease that is chronic, recurrent and multisystem with unknown aetiology. There is still no single biomarker that is pathognomonic for the disease. We know that platelets are the main part of haemostasis and thrombosis. We aimed to investigate whether there is a connection between MPV with SLE and inflammatory markers.

MATERIAL AND METHODS

We have included 39 female patients with SLE and 45 controls in this study. In both groups, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) levels and MPV levels were investigated. Clinical findings and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) were evaluated in patients.

RESULTS

There was no significant difference between the two groups in terms of demographic data. The MPV was 8.1 ± 0.5 (mean ± SD) in the patient's group and 7.6 ± 0.3 in the control group. There was a significant difference between the two groups in terms of MPV (P < .001). The ESR level was 30.7 ± 29 in the patient's group and 16.7 ± 10 in the control group. In the patient's group, the CRP levels were higher compared with that of the control group (8.2 ± 13, 4.5 ± 4, respectively). We found a statistically significant positive correlation between MPV with arthritis (r = .310,P = .004), nephritis (r = .446,P < .001), central nervous system involvement (r = .241,P = .027), vasculitis (r = .228,P = .037) and SLEDAI (r = .329,P = .002). In our study, we found increased levels of MPV in patients with SLE. Also, we observed a positive correlation among MPV with sedimentation, CRP, clinical manifestations and SLEDAI.

CONCLUSION

We consider that MPV may be a new activation indicator for the SLE.

Brief Report: Turkish Validity and Reliability of the HITS Intimate Partner Violence Screening Tool With Women

The current study examined the validity and reliability of the Turkish version of the HITS (Hurt-Insult-Threaten-Scream) tool which was developed to screen for intimate partner violence. 154 Turkish women participated and completed the Turkish version of the HITS (HITS-TR). The validity of the language and factor structure were evaluated. The internal consistency coefficient of the scale was.89. Confirmatory factor analysis (CFA), revealed a single factor structure consisting of four items that explained 76% of the total variance. A CFA was performed with a modified model upon a second sample indicating high compatibility for the revised model with χ²/df = 1.262, a root mean square error of approximation.036, goodness of fit index of.996, adjusted goodness of fit index.998, root mean square residual of.006 and standardized root mean square residual of.008. It is concluded that the HITS-TR can be used as a valid and reliable screening tool for intimate partner violence in Turkish women.

Predictors of Blood Culture Positivity in Pediatric Brucellosis

OBJECTIVE

To investigate the predictors of blood culture positivity in children with brucellosis.

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Department of Pediatric Infectious Diseases in Erzurum Regional Training and Research Hospital, Turkey, from January to December 2015.

METHODOLOGY

Eighty-six children under 16 years of age, with brucellosis, were retrospectively evaluated. Compatible clinical findings plus presence of positivity at titers of >1:160 in serum and/or Coombs agglutination tests in a single serum sample and/or a minimum fourfold increase within a 2-3 week interval were diagnostic for brucellosis. Only patients with blood cultures were included. Patients' demographical, clinical, and laboratory risk factors, such as age, gender, presence and duration of symptoms, and laboratory characteristics were analysed.

RESULTS

Brucella spp. grew in blood cultures of 24 (27.9%) patients. Children with blood culture positivity had shorter symptom duration than those with negative blood cultures (p=0.03). Absence of personal and household histories of brucellosis (p=0.02 and p=0.04, respectively), lower hemoglobin, iron, and vitamin D (p<0.001, p=0.006, and p=0.006, respectively), and higher leukocyte, CRP, and ferritin (p<0.001, p=0.001, and p<0.001, respectively) levels were associated with isolation of Brucella spp. in blood culture. Children with positive blood cultures had higher serum tube and Coombs agglutination test results (p=0.001 and p<0.001). ROC analysis showed that ferritin at a cut-off level of 122 ng/mL (CI 95% 0.86-0.97, p<0.001) and Brucella Coombs agglutination test at a cut-off level of 1/480 (CI 95% 0.84-0.96, p<0.001) were the most sensitive and specific predictors of bacteremia.

CONCLUSION

Serum hemoglobin, iron, ferritin, vitamin D, and C-reactive protein levels, Brucellar tube and Coombs agglutination tests, and leukocyte count could help to predict definitive diagnosis in pediatric brucellosis when molecular techniques are not feasible, such as in source-limited countries.

Burnout among family physicians in Turkey: A comparison of two different primary care systems

Aim

The objective of this study was to determine the prevalence of burnout syndrome and associated factors among family physicians before and after family medicine system (FMS).

Materials and Method

The first part of the study was conducted in 2008 (pre-FMS) and the second part in 2012 (post-FMS). Physician's burnout was investigated by using the Maslach Burnout Inventory (MBI). In total, 139 physicians had been participating pre-FMS and 246 physician's post-FMS.

Results

The mean pre-FMS emotional exhaustion score was 15.7 ± 5.8, increasing significantly to 17.14 ± 7.5 post-FMS (P = 0.045). Mean pre-FMS and post-FMS depersonalization and reduced personal accomplishment scores were similar (P > 0.05). Age was negatively correlated with depersonalization in this study (P = 0.012) and positively correlated with personal accomplishment (P = 0.001). The primary care physicians in the post-FMS period were older, female physicians had a greater preference for primary care, and the levels of married doctors were higher. In addition, a higher level of physicians also owned their own home and cars compared to the pre-FMS period. A negative correlation has been reported between physicians' burnout levels and home or car ownership in the present study.

Conclusion

Our findings suggest that physicians working under the family medicine system, a new primary care model, are at greater risk of emotional exhaustion, but that no change has occurred in terms of personal accomplishment or depersonalization, despite this new system.

Acupuncture for Primary Hyperhidrosis: Case Series

Three cases of primary hyperhidrosis of no known cause, with excess sweating day and night, were treated using the same acupuncture points. The patients reported that their sweating decreased and that they felt better after the treatment.

Acupuncture Decreases Matrix Metalloproteinase-2 Activity in Patients with Migraine

Objective

To evaluate the effect of acupuncture on the serum matrix metalloproteinase-2 (MMP-2) level and activity in patients with migraine.

Methods

After baseline testing, eligible patients with migraine according to the criteria of the International Headache Society who volunteered to join the study were included (n=27). The patients received 10 sessions of acupuncture treatment. The points selected were bilateral ST8, ST44, LI4, LI11, LIV3, SP6, GB1, GB14, GB20, GV14, GV20, Yintang, Taiyang and ear Shenmen. Pain was measured using a visual analogue scale (VAS). Short form-36 (SF-36) was used to determine their quality of life. Blood samples were taken before treatment and after the first and last sessions of acupuncture for measurement of MMP-2 concentration and activity.

Results

The mean VAS was 85.5±16.6 before acupuncture and was significantly decreased to 39.8±20.6 after 10 sessions of acupuncture (p<0.0001). There was a significant increase in all SF-36 scores after acupuncture compared with values before treatment (p<0.0001). No significant differences were found in MMP-2 concentrations before treatment and after the first and last sessions (p>0.05). However, there were significant changes in MMP-2 activity (p<0.0001).

Conclusions

The results of this study showed a clinically relevant decrease in MMP-2 activity in patients with migraine treated with acupuncture. The mechanism underlying the effect of acupuncture in alleviating pain may be associated with a decrease in MMP-2 activity.

The lung endothelin system: a potent therapeutic target with bosentan for the amelioration of lung alterations in a rat model of diabetes mellitus

PURPOSE

The aim of this study is to show the effect of a new mechanism on endothelin (ET) receptors in the physiopathology of diabetes-related pulmonary injury. We tested the hypothesis that dual ET-1 receptor antagonism via bosentan can reverse diabetes-induced lung injury.

METHODS

The rats (24 male) were separated into four groups: group 1 (HEALTHY): Control group; group 2 (DM): Streptozotocin 60 mg/kg (i.p.); group 3 (DM + BOS-1): Diabetes + bosentan 50 mg/kg per-os; group 4 (DM + BOS-2): Diabetes + bosentan 100 mg/kg per-os. The bosentan treatment was initiated immediately after the onset of STZ-induced diabetes and continued for 6 weeks.

RESULTS

In the treatment group, SOD activity was significantly increased, although GSH and MDA levels and TNF-α and TGF-β gene expression were decreased. Bosentan 50 mg/kg and bosentan 100 mg/kg showed a significantly down-regulatory effect on ET-1, ET-A, and ET-B mRNA expression.

CONCLUSIONS

In conclusion, increased endothelin levels in the lung associated with diabetes may be one cause of endothelial dysfunction, cytokine increase, and oxidant/antioxidant imbalance in the pathogenesis of complications that may develop during diabetes. With its multiple effects, bosentan therapy may be an effective option against complications that may develop in association with diabetes.

Peer teaching experience of the first year medical students from Turkey

OBJECTIVE

To document peer teaching activity performed by first-year medical students and their views on the teaching activity.

STUDY DESIGN

Survey.

PLACE AND DURATION OF STUDY

Medical Education Department, Ataturk University, Erzurum, Turkey, in the 2012 - 2013 academic year.

METHODOLOGY

Volunteer students were selected for peer teaching model by an academician from the Medical Education Department. Students were taught subjects selected from classes such as biochemistry and microbiology in the same way as the academicians do. Following each class activity, the teaching student was assessed by the other students on a 5-point rating scale. Written and verbal feedback was also obtained from both teaching students and participated students. Verbal feedbacks were noted by a faculty member and similar opinions were categorized. Data were analyzed by SPSS version 20 statistical program.

RESULTS

Eleven students took part in the program. Feedback was received from students 171 times. The mean number of students participated was 24.4 ± 14.3 in each program. Statistical analysis revealed that mean value for teaching materials, peer instructors and teaching environment were 4.62 ± 0.49, 4.63 ± 0.47 and 3.88 ± 1. 27 respectively.

CONCLUSION

Peer teaching method is a pretty good way of teaching for medical students. It is a practicable technique that can be used in medical training. Taking part in this program as a lecturer, student increased students' self-confidence in the learning and teaching activities. Quite positive feedbacks were received.

Self-assessment through videotaping compared with peer and trainer feedback

OBJECTIVE

To assess and compare three different types of feedback for presentation skills, self, peer and trainer feedback.

STUDY DESIGN

Cross-sectional study.

PLACE AND DURATION OF STUDY

Faculty of Medicine at Atatürk University, Erzurum, Turkey, from March 2012 to December 2012.

METHODOLOGY

Participants were faculty members and instructor nurses. Each participant gave a 10-minute presentation, which was rated by peers, course trainers and the presenter himself/herself using a thirteen-item questionnaire (designed as a 5-point Likert scale). Peers and trainers conducted the assessment during the presentation while the self-assessment was done later by watching a video recording of the presentation. Comparison of the points between the groups was made using the two-way ANOVA. Pearson correlation analysis was conducted to evaluate the relationship between the mean scores of self-assessment, peer and trainer assessment.

RESULTS

Ten faculty members, 27 instructor nurses and 4 trainers participated in the study. A total of 775 feedback reports were collected for 37 participants. There was no significant difference between the feedback scores of the evaluators as well as the occupation groups (p > 0.05). There was a strong positive and statistically significant correlation between trainer and peer (r = 0.73, p < 0.001).

CONCLUSION

Consequently, there were no differences in the evaluations of presentation skills between different stakeholders. Trainers should use the video recording method to self-evaluate their presentation skills, and they should invite their peers from time to time to improve their own personal development by using peer review methods.

Vitamin D levels in children diagnosed with acute otitis media

OBJECTIVE

To investigate the relationship between Vitamin D deficiency and acute otitis media infection.

METHODS

The randomised, single-blind, case-control study was conducted at the Paediatric Department of Ataturk University, Erzurum, Turkey, from January to April 2010. It comprised ambulatory children diagnosed with acute otitis media and healthy controls. The subjects were divided into groups according to their serum 25-hydroxy vitamin D levels. SPSS 18 was used for statistical analysis.

RESULTS

Of the 169 subjects in the study, 88(52%) were the cases and 81(48%) were controls. The mean age of the cases was 6.21±3.4 years, and 6.18±3.12 years for the controls (p<0.951). Serum 25-hydroxy vitamin D levels in the cases and controls were 20.6±10.2 ng/mL and 23.8±10.3 ng/mL (p<0.05). There was no statistically significant difference between the groups in terms of parathormone and calcium levels (p>0.05).

CONCLUSION

Serum 25-hydroxy vitamin D levels being significantly lower in children diagnosed with acute otitis media compared to the controls in two otherwise similar groups suggests that Vitamin D deficiency plays a role in otitis media infection.

Effects of Ear Acupuncture Therapy for Obesity on the Depression of Obese Women

Background

Obesity is one of the leading health risks worldwide, and depression is among the leading causes of the burden of disease. These disorders are increasingly prevalent as comorbidities. Depressive symptoms are associated with obesity, and are more common in women.

Objective

To evaluate the effectiveness of ear acupuncture for obesity on the depression of obese women.

Methods

After baseline testing, 30 eligible patients with body mass index (BMI) >29.9 kg/m2 were included. The Beck Depression Inventory for Primary Care (BDI-PC) was used to assess changes in depression. BMI was also measured. Patients had six ear acupuncture sessions, every 15 days and were followed up for 3 months. Twenty four patients completed the study.

Results

The mean±SD age of patients was 42.9±9.0 years. Their mean±SD BMI was 39.0±4.7 kg/m2 before acupuncture, decreasing to 37.2±4.3 kg/m2 after acupuncture therapy (p<0.001). The mean depression score was 4.4±2.3 before acupuncture, decreasing to 2.7±1.4 (p<0.001) after treatment. There was no significant correlation between BMI and depression score before acupuncture therapy (p=0.104). After acupuncture therapy, no significant correlation was found between the percentage reduction of BMI and percentage reduction of the depression score (p=0.119).

Conclusions

Further research into the effects of ear acupuncture in the management of obesity and depression is justified.

Antioxidant status in blood of obese children: the relation between trace elements, paraoxonase, and arylesterase values

Obesity is known to lead to complications involving several systems. The basic mechanism in obesity-related complications is chronic inflammation and increased oxidative stress. Trace element levels in obese children may vary due to poor nutritional habits. The purpose of this study was to investigate the relation between serum paraoxonase (PON1) and arylesterase (ARE) levels, markers of the oxidant-antioxidant balance in the body, and serum zinc (Zn), copper (Cu), manganese (Mn), and selenium (Se) concentrations in obese children. Fifty-seven overweight patients aged 6-17 and 48 age- and sex-matched healthy children were included in the study. Serum PON1 and ARE activity levels were measured, together with Cu, Zn, Mn, Se, total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, very low-density lipoprotein, glucose, aspartate amino transferase, and alanine amino transferase levels. PON1 and ARE activity levels were significantly lower in obese patients compared to those in healthy individuals (P < 0.05). Various changes were determined in Cu, Zn, Mn, and Se levels between the study and control groups (P < 0.05). In terms of the relation between trace elements and PON1 and ARE levels, a significant positive correlation was determined between serum Se and PON1 levels in the study group (P < 0.05, r = 0.31). No significant correlation was determined between other trace element levels and PON1 and ARE levels (P > 0.05). In conclusion, the detection in our study of a positive correlation between Se and PON1 levels in obese children may be significant in terms of showing a relation between Se and antioxidant systems in obese children.

The effect of pedometer use on physical activity and body weight in obese women

Physical activity and healthy eating are of the utmost importance in treatment of obesity. However obese generally tend to have a sedentary lifestyle. Walking is a form of physical activity that is both simple and can be performed by everyone, but it requires an objective measurement. Number of steps taken during tracking can be recorded with the pedometer, a device used to measure the level of physical activity. We aimed to investigate whether or not using pedometers as a motivational technique to increase the level of physical activity in obese women has an impact on weight loss. Eighty-four obese women who are similar age referring to Ataturk University Faculty of Medicine Healthy Living Clinic, Turkey were randomly divided into two groups. Intervention group were given pedometers, and control group were prescribed similar diet and physical activity with a three-month follow-up plan without pedometers. Mean weight in pedometer group initially was 88.9 ± 8.4 kg, which decreased to 80.2 ± 8.7 kg after the programme. Mean weight in control group was 86.1 ± 9.2 kg at the beginning, and it decreased to 84.7 ± 8.8 kg after three months. It was observed in pedometer group that the mean number of steps 8817 ± 2725 steps/day at the beginning increased to mean 9716 ± 2811 steps/day at the end of the study. Weight, body mass index, body fat percentage and waist circumference measurements decreased more greatly in the pedometer when compared to the control group (p < 0.001). Pedometers may be recommended to obese patients to monitor and increase the level of physical activity and to promote weight loss.

Evidence based medicine: teaching, learning and practice: results of a cross-sectional study from Turkey

OBJECTIVE

To assess the level of understanding related to the significance of evidence-based medicine among physicians.

METHODS

The cross-sectional study was conducted between March and October 2012 using an online questionnaire that was sent out to physicians and academics working as faculty at training hospitals across Turkey. The questionnaire consisted of questions about the knowledge, attitude and behaviour towards evidence-based medicine. Seven of the questions pertained to the learning of evidence-based medicine, six were about teaching evidence-based medicine, and six were about its practice. SPSS 20 was used for statistical analyses.

RESULTS

The questionnaire was returned duly filled by 79 physicians. Of them, 41 (51.9%) were males; and 57 (72.2%) were part of the faculty. Only 1(1.2%) participant had attended a course about evidence-based medicine during undergraduate education, while 19 (24.05)had attended one after graduation. Besides, 26 (32.9%) academics were teaching some concepts of evidence-based medicine, and 21 (26.6%) were giving some information about clinical guidelines.

CONCLUSION

The study found that levels of learning and teaching of evidence-based medicine among physicians were inadequate. They should be emphasised at both pre- and post-graduate tiers.

What do trainers think about trainer training courses?

OBJECTIVE

To evaluate the effectiveness of the training-of-trainer courses given to medical school faculty members, and to ensure the standardisation of training..

METHODS

The study comprised faculty members attending seven training-of-trainer courses held at the Ataturk University, Turkey, from November 2010 to May 2011. Tests were administered to the participants evaluating their level of knowledge on course content before and after the five-day course, which covered topics including concepts of teaching/learning, curriculum development, assessment and evaluation, training methods, and training skills. Oral and written feedbacks were obtained from all participants on the last day of each course. Volunteers from among the participants evaluated the impact of training through a questionnaire after at least two months. SPSS 20 was used for statistical analysis.

RESULTS

A total of 136 faculty members participated in the 7 training-of-trainer courses. The mean scores for the pretest and post-test were 6.6 +/- 2.2 vs. 13.9 +/- 3.7, (p < 0.001). Questions with highest percentage of correct answers in the pre-test were those about learning style 78 (70.9%) and the one about presentation skills (66.4%).

CONCLUSION

A structured training-of-trainer course is effective in increasing faculty members' level of knowledge about training. Such programmes are necessary for faculty members who work in the academic field without receiving formal training in teaching as it is the case with medical education in several countries.

An unusual cause of hoarseness: hydatid cyst of the thyroid

Hydatid cyst is a parasitic infestation that is distributed world-wide. It may be found in nearly any part of the body, most often in the liver and the lungs, but occasionally in other structures such as the thyroid gland. Thyroid gland is very rarely involved by this parasitic infection even in Turkey where the echinococcal disease is endemic. In this article we report a very rarely encountered case of thyroid cyst revealed by hoarseness, and underwent subtotal thyroidectomy and diagnosed as primary hydatid cyst disease by histological studies.

Serum vitamin D levels in children with recurrent otitis media

The aims of this study were to evaluate serum vitamin D levels in cases of recurrent otitis media and investigate the effect of vitamin D therapy on the risk of re-occurrence of the disease. This prospective study was performed by comparing serum vitamin D levels in children with recurrent otitis media and healthy children. Eighty-four children between 1 and 5 years of age and diagnosed with recurrent otitis media were enrolled as the study group. One hundred-and-eight healthy children with similar demographic characteristics were enrolled as the control group. Patients were divided into groups according to their serum 25(OH) vitamin D levels. In patients with low initial serum vitamin D levels, vitamin D therapy was administered in addition to conventional treatment for otitis media. Mean serum 25(OH) vitamin D level in the study group was 11.4 ± 9.8 ng/mL Serum 25(OH) vitamin D levels were below 20 ng/mL in 69 % (n = 58) of cases in this group. In the control group, mean serum 25(OH) vitamin D level was 29.2 ± 13.9 ng/mL and was below 20 ng/mL in 30 % (n = 32) of cases. Comparison of serum 25(OH) vitamin D levels and PTH in the study and control groups revealed a statistically significant difference (p < 0.05). Treatment was initiated in cases diagnosed with vitamin D deficiency, and patients were followed up in due course. The only episodes detected over the course of 1-year follow-up were one attack in five patients and two attacks in two. We believe that co-administration of supplementary vitamin D together with conventional treatments is appropriate in the management of upper respiratory infections such as otitis media.