Yusuf Doganer - Academia.edu (original) (raw)

Papers by Yusuf Doganer

Asian Pacific Journal of Cancer Prevention, 2014

Background: Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affe... more Background: Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affecting the breast self-examination (BSE) performance vary in developing countries. Objective: To determine the frequency of BSE performance and predictors of self-reported BSEs among women in the capital city of Turkey. Materials and Methods: This cross-sectional study was conducted on 376 Turkish women using a selfadministered questionnaire covering socio-demographic variables and BSE-related features. Results: Of the participants, 78.7% (N=296) reported practicing BSE, whereas 9.5% (N=28) were implementing BSE regularly on a monthly basis, and only 5.7% (N=17) were performing BSE regularly within a week after each menstrual cycle. Multivariate logistic regression modeling revealed that BSE performance was more likely in younger age groups [20-39 years] (p=0.018, OR=3.215) and [40-49 years] (p=0.009, OR=3.162), women having a family history of breast disease (p=0.038, OR=2.028), and housewives (p=0.013, OR=0.353). Conclusions: Although it appears that the rates of BSE performers are high, the number of women conducting appropriate BSE on a regular time interval basis is lower than expected. Younger age groups, family history of breast diseases and not being employed were identified as significant predictors of practicing BSE appropriately. Older age and employment were risk factors for not performing BSE in this sample.

Sao Paulo Medical Journal, 2015

To evaluate predictors of changes in lipid parameters consisting of LDL-C (low-density lipoprotei... more To evaluate predictors of changes in lipid parameters consisting of LDL-C (low-density lipoprotein cholesterol), TC (total cholesterol) and non-HDL-C (non-high density lipoprotein cholesterol) among primary care patients. Retrospective study conducted on family medicine patients. Demographic features and other clinically relevant information were abstracted from medical records. The primary outcome was the difference in LDL-C level from initial testing to the index test. Secondary outcomes were the changes in TC and non-HDL-C levels between two measurements. Three hundred and eleven participants were included in the final secondary analysis. Multiple linear regression revealed that male patients (β = 4.97, P = 0.040), diabetes (β = 9.75, P = 0.003) and higher LDL-C levels at baseline (β = 0.35, P < 0.001) were positively associated with LDL variance, whereas longer time period (β = -0.15, P = 0.045) and familial hypercholesterolemia history (β = -7.56, P = 0.033) were negatively associated. Male patients (β = 8.45, P = 0.002), DM (β = 9.26, P = 0.011), higher TC levels at baseline (β = 0.35, P < 0.001) and taking statins (β = 7.31, P = 0.023) were positively associated with TC variance, whilst longer time period (β = -0.183, P = 0.031) and familial hypercholesterolemia (β = -10.70, P = 0.008) were negatively associated. In the present study, patients who were male, on statin treatment, diagnosed with diabetes and had higher baseline lipid values were more likely associated with better lipid outcomes at future testing.

Turkiye Aile Hekimligi Dergisi, 2012

Turkiye Aile Hekimligi Dergisi, 2010

Standart biyokimyasal testler incelendi¤inde, karaci¤er fonksiyon testlerinde asemptomatik hastal... more Standart biyokimyasal testler incelendi¤inde, karaci¤er fonksiyon testlerinde asemptomatik hastalarda %1 ile %9 aras›nda de¤iflen oranlarda yükseklik saptanm›flt›r. Karaci¤er fonksiyon testlerinde hafif yükselmeler altta yatan ciddi bir hastal›¤›n habercisi olabile-ce¤i gibi geçici iyi seyirli bir durumdan da kaynaklanabilir. Ayr›nt›-l› de¤erlendirme; pahal› ve endifle yarat›c› tetkikler, belki de gereksiz karaci¤er biyopsisi, endoskopik retrograt kolanjiopankreatografi (ERCP) gibi invaziv giriflimlerle sonuçlanabilmektedir. Karaci¤er fonksiyon testi yüksekli¤i olan hastalar› de¤erlendirirken baz› temel prensiplere uymakta fayda vard›r. Semptomlar› de¤erlendirme sürecinde öncelikle hastan›n öyküsü göz önünde bulundurulmal›-d›r. Öyküde dikkat edilecek noktalar; hastan›n yafl›, cinsiyeti, gel-di¤i/yaflad›¤› bölge, mesle¤i, efllik eden hastal›klar, ilaç öyküsü ve aile hikayesini kapsamal›d›r. Alanin aminotransferaz (ALT) ve aspartat aminotransferaz (AST) hepatoselüler hasar›, gama-glutamiltransferaz (GGT) ve alkalen fosfotaz (ALP) kolestaz› gösterirken, bilirubin her iki nedenle de artabilir. Albümin düzeyi ve protrombin aktivitesi ise karaci¤erin sentez kapasitesini yans›tan testlerdir. Karaci¤er hastal›klar›n›n ço¤unda bu iki grup test birlikte bozulmufl olabilir. Karaci¤erin histolojik yap›s› düflünüldü¤ünde, hepatositler ile biliyer sistemin iliflkisi bu durumun bafll›ca nedenidir. Bu enzimler karaci¤er ve safra yollar›na özgü de¤illerdir. ALT ço¤unlukla karaci¤er ve böbreklerde bulunup, kalp ve iskelet kas›nda daha az miktarda mevcuttur. AST ise daha çok kalp kas›, iskelet kas-lar›nda ve karaci¤erde bulunmaktad›r. GGT hepatosit ve safra epitel hücreleri, renal proksimal tubuluslar, pankreas ve ince barsaklardan sentezlenmekte; ALP ise kemikler, ince barsaklar, böbrek ve plasentadan sentezlenmektedir.

Quality Management in Health Care, 2014

Simulate the application of the new cardiology prevention guideline on statin use in an angiograp... more Simulate the application of the new cardiology prevention guideline on statin use in an angiography clinic sample taken from a hospital in Turkey. Taking statins was used as a quality indicator. All cases (323) included in the sample met criteria for taking statins upon arrival in the angiography clinic. The study population was divided into 3 groups: critical coronary artery disease (CAD) (>50%), noncritical (<50%), or individuals with normal coronary arteries. Patient risk factors were tested for association with taking statins using multiple logistic regression analysis. Only 20.2% of patients were taking statins when they were accepted for coronary angiography. Patients with critical CAD and noncritical CAD had higher odds of receiving statins than persons with no CAD [odds ratio (OR)=12.9, P<.001 and OR=3.5, P=.025, respectively]. Patients receiving angiographic interventions for stent control were more likely to be on statins than patients with angina (OR=5.298, P=0.004). Compared to those not taking the treadmill test, both those with positive and those with negative results had reduced odds of receiving statins (OR=0.260, P=.002, and OR=0.130, P=.002, respectively). Both former and current smokers had lower odds of receiving statins than persons who had never smoked (OR=0.148, P<.001, and OR=0.161, P=.001). Patients taking aspirin were at risk of not being on statins (OR=0.238, P = .001). Most of the patients in this study were not taking statins comparing according to US guidelines. Patients who exhibited risk factors for a cardiovascular event but who had not been diagnosed with CAD were at risk for not being on statins.

Asian Pacific journal of cancer prevention : APJCP, 2015

Breast cancer (BC) is the most-common malignancy of women worldwide. Though there are differences... more Breast cancer (BC) is the most-common malignancy of women worldwide. Though there are differences among developed and developing countries, BC remains the most common cancer type of women in Turkey. This study aimed to identify the level of knowledge, awareness, and their potential predictors towards BC in Ankara, Turkey. The present descriptive study was conducted on 376 females attending a breast health outpatient clinic. A self-administered questionnaire was designed to evaluate knowledge level about BC and predictors effecting its level. Data analysis was performed using the chi-square test. A value of p<0.05 was considered statistically significant. Mean age of the participants was 46.2±9.93 (22-75). The majority (92.6 %) were married; 41.5% were educated less than nine years. Most of the women were housewives (82.7%) and, were living in an urban region (86.4%). Predictors of effecting responses to seven knowledge and awareness questions about BC varied from demographic feat...

Diabetes Mellitus is a multisystemic disease progressively seen more frequently in the general po... more Diabetes Mellitus is a multisystemic disease progressively seen more frequently in the general population. Diabetes foot, seen in patients suffering from diabetes mellitus, is a frequent result of improper foot care and requires long and serious treatment. The disease plays an important role in terms of public health and can be a cause for high morbidity and mortality rates. [TAF Prev Med Bull 2010; 9(4): 375-382]

Journal of Evaluation in Clinical Practice, 2015

Standardizing arterial blood pressure (BP) measurement is difficult because of different performe... more Standardizing arterial blood pressure (BP) measurement is difficult because of different performers like doctor or pharmacy employee. We investigated the reliability between different BP measurement methods. The study was conducted in an internal medicine service with 160 patients in Ankara, Turkey. First, the subjects&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; BP was measured by doctor. Then, 24-hour BP monitoring devices were placed. Participants were then instructed to measure their BPs both at home and in pharmacy. The next day, arterial BP was measured by the doctor for the second time. The prevalence rates of masked and white coat hypertension were 8.8% (n = 14) and 8.1% (n = 13), respectively. There was no statistically significant differences between ambulatory measurement and home, office and pharmacy measurements (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). The consistency rate between ambulatory and home measurements was 97.5% (kappa = 0.947, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The consistency rate between ambulatory and pharmacy measurements was 82.5% (kappa = 0.634, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). When compared with ambulatory measurement, the most sensitive (98.0%) and most specific (96.8%) method was home measurement. There was a moderate positive correlation between ambulatory and other measurements in both systolic and diastolic values. There was a positive and very strong correlation between ambulatory and home measurements of systolic and diastolic ABP values (respectively; r = 0.926 and r = 0.968) and there was a statistically significant relation between these measurements (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The results of all measurement methods were close to each other. The most sensitive and specific method was home measurement when compared with ambulatory measurement. But both office and pharmacy measurements had also high sensitivity and specificity.

Gulhane Medical Journal, 2015

Journal of evaluation in clinical practice, Jan 2, 2015

Although the condition of low haemoglobin (Hb) levels has been established as a risk factor in th... more Although the condition of low haemoglobin (Hb) levels has been established as a risk factor in the development of coronary artery disease (CAD), it is still a debate particularly in patients with angiographically documented disease. In the present study, we sought to identify the relationship between Hb levels and the presence of CAD. The study consisted of 356 consecutive patients referred for elective coronary angiography (CAG). Exclusion criteria included a history of prior MI within last 3 months, presence of neoplastic disorders or any inflammatory diseases or overt diabetes mellitus. Blood samples for haematologic and biochemical measurements were collected on admission following at least 12 hours of overnight fasting. Patients were divided into four groups based on the quartiles of Hb (quartile I < 13.50 g/dL, quartile II 13.50-14.70 g/dL, quartile III 14.71-15.74 g/dL, quartile IV > 15.74 g/dL). Additionally, patients filled out a questionnaire of asking their brief me...

Journal of Evaluation in Clinical Practice, 2015

Achieving control over elevated lipid parameters, particularly low-density lipoprotein (LDL)-chol... more Achieving control over elevated lipid parameters, particularly low-density lipoprotein (LDL)-cholesterol, is an acknowledged quality indicator in primary care. The Centers for Disease Control and Prevention (CDC)&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s model for investigation of outbreaks (person-place-time) can be applied to the analysis of quality indicators. A sample of 322 family medicine patients for whom lipid levels were ordered was extracted. LDL &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 100 mg/dL was cross-tabulated by personal characteristics [age group, gender, body mass index (BMI), diagnoses], month (time) and ordering department (place). Age (except one age category), gender, time and location were not related to LDL &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 100 mg/dL after adjustment for covariates. All levels of BMI above normal elevated the risk of LDL &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 100 mg/dL [BMI 25-29.9: odds ratio (OR) = 3.41, confidence interval (CI) = 1.61-7.23, P = 0.0014; BMI 30-34.9: OR = 2.93, CI = 1.28-6.70, P = 0.0109; BMI ≥ 35: OR = 2.75, CI = 1.19-6.37, P = 0.0181]. Patients with coronary artery disease (CAD) and diabetes mellitus (DM) were at reduced risk for LDL &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 100 mg/dL (CAD: OR = 0.47, CI = 0.24-0.91, P = 0.0254; DM: OR = 0.28, CI = 0.14-0.55, P = 0.0002). An outbreak investigation model is useful for analysing variations in this quality indicator. Patients with higher BMI and those not diagnosed with CAD or DM type I/II may be considered for intensified lipid lowering using quality improvement efforts. These might include counselling for lifestyle changes or medication therapy depending upon their calculated cardiac risk.

Medical Principles and Practice, 2015

To evaluate the role of pentraxin-3 (PTX-3) in determining the presence and severity of coronary ... more To evaluate the role of pentraxin-3 (PTX-3) in determining the presence and severity of coronary atherosclerosis in patients with coronary artery disease (CAD). Ninety-five patients (77 males and 18 females) who underwent elective coronary angiography were enrolled in this study. Patients with heart failure, renal failure, diabetes and thyroid disease were excluded. The study population was divided into 3 groups: individuals with normal coronary arteries, patients with critical CAD (n = 35) and patients with noncritical CAD (n = 36). The association of PTX-3 levels with the presence and severity of CAD and the number of involved vessels were analyzed. The mean age was 53.40 ± 10.25 years. The PTX-3 levels were significantly higher in patients with CAD than without CAD (146.48 ± 48.52 vs. 109.83 ± 49.06 pg/ml, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). A statistically significant difference was found among the 3 groups regarding the severity of CAD (165.66 ± 49.10, 127.83 ± 40.51 and 109.83 ± 49.06 pg/ml, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, respectively). The serum PTX-3 levels in normal arteries were 110.4 ± 48.11 pg/ml, in single-vessel disease 132.35 ± 32.96 pg/ml, in 2-vessel disease 142.57 ± 55.88 pg/ml, in 3-vessel disease 156.07 ± 50.53 pg/ml, and in 3-vessel disease 160.50 ± 30.41 pg/ml. After adjusting for baseline confounders, older age (OR = 1.107, 95% CI = 1.027-1.193, p = 0.008) and higher PTX-3 levels (OR = 1.017, 95% CI = 1.003-1.032, p = 0.021) were detected as significant predictors for the presence of CAD. Higher PTX-3 levels were associated with the presence of CAD and its increased severity in clinically stable patients. Higher PTX-3 levels may be regarded as a novel diagnostic predictor and may offer therapeutic options in the clinic. © 2015 S. Karger AG, Basel.

Psychogeriatrics, 2015

The collaborative care model (CCM) has been consistently shown to achieve effectiveness in depres... more The collaborative care model (CCM) has been consistently shown to achieve effectiveness in depression management compared to usual care. In the present study, we aimed to determine the impact of age on cost metrics in patients who were treated with CCM for 6 months after a diagnosis of depression. The upper quartile of age was 50 years and older (n = 56), and the comparison group was composed of patients in the three younger quartiles, aged 18-49 years (n = 163). Patients in the older age group had an elevated median Current Procedure Terminology cost rank of 255.5 compared to 168.0 for the younger patients (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Multiple logistic regression analysis revealed that being in the upper quartile of age (≥50 years) (odds ratio = 2.272, 95% confidence interval: 1.064-4.851; P = 0.034) and having higher numbers of clinical visits 6 months prior to index (odds ratio = 1.209, 95% confidence interval: 1.118-1.307; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) were significant predictor variables of being cost rank outliers (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;80th percentile) in patients with CCM. Medical cost utilization in the 6 months after diagnosis of depression was significantly higher in patients in the upper age quartile (≥50 years) enrolled in CCM than those in the lower quartiles (age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50).

International Journal of Pediatric Otorhinolaryngology, 2015

The present study sought to investigate the frequencies of tonsillectomy, adenoidectomy and both ... more The present study sought to investigate the frequencies of tonsillectomy, adenoidectomy and both adenotonsillectomy (T&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;A) among 6-12 years old children. In addition, we tried to find out the predictors associated with these previous upper respiratory tract (URT) surgeries. This cross-sectional study consisted of 1900 children educated in 3 different elementary schools in Ankara, Turkey. Data about demographics and health conditions were obtained from survey questionnaires completed by parents. Of the 1900 children, 15 children (0.8%) previously underwent tonsillectomy, 43 children (2.3%) had adenoidectomy and 80 children (4.2%) had T&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;A surgical histories. Multiple logistic regression analysis revealed that older students compared to younger ones [odds ratio (OR)=1.15, p=0.011], and those who had parent-reported apnea compared to subjects without apnea were more likely to have URT surgery histories [OR=2.34, p=0.001]. Those children with surgery histories were more likely to have fathers with a higher educational level [medium level: OR=2.07, p=0.012; high level: OR=2.79, p=0.001 vs. low level) and the subjects had greater BMI percentiles [overweight: OR=1.71, p=0.036; obesity: OR=2.32, p=0.003 vs. healthy weight]. Children who had 1-2 URT infections per year [OR=0.47, p=0.019] had less probability of URT surgery histories, whereas those children with AOM ≥3 times per year [OR=2.52, p=0.003] had more probability of URT surgery history. We conclude that a reasonable explanation for higher rates of URT surgery among children with a high level of paternal education may originate from their awareness about URT associated diseases and possibly due to the ease of access to health care services.

Asian Pacific journal of cancer prevention : APJCP, 2014

Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affecting the br... more Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affecting the breast self-examination (BSE) performance vary in developing countries. To determine the frequency of BSE performance and predictors of self-reported BSEs among women in the capital city of Turkey. This cross-sectional study was conducted on 376 Turkish women using a self- administered questionnaire covering socio-demographic variables and BSE-related features. Of the participants, 78.7% (N=296) reported practicing BSE, whereas 9.5% (N=28) were implementing BSE regularly on a monthly basis, and only 5.7% (N=17) were performing BSE regularly within a week after each menstrual cycle. Multivariate logistic regression modeling revealed that BSE performance was more likely in younger age groups [20-39 years] (p=0.018, OR=3.215) and [40-49 years] (p=0.009, OR=3.162), women having a family history of breast disease (p=0.038, OR=2.028), and housewives (p=0.013, OR=0.353). Although it appears that ...

International Urology and Nephrology, 2015

Individuals with impaired renal function are at increased risk of coronary artery disease (CAD). ... more Individuals with impaired renal function are at increased risk of coronary artery disease (CAD). CAD is also associated with an increased likelihood of having chronic kidney disease (CKD). In the present study, we sought to determine the association between impaired renal function with CAD presence and CAD severity based on four different estimated glomerular filtration rate (eGFR) equations. We estimated GFR values using four equations: modification of diet in renal disease (MDRD), Cockcroft-Gault (C-G), chronic kidney disease epidemiology (CKD-Epi), and Mayo Quadratic. Three hundred and fifty-six CAD patients were classified by the number of stenotic coronary arteries occluded &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 %, while the CAD severity was categorized based on the number of involved coronary arteries determined to be healthy, single- and multi-vessel disease. The mean values of eGFR calculated by CKD-Epi, MDRD, Mayo, and C-G equations were 77.44, 71.34, 96.33, and 89.49 mL/min/1.73 m(2) respectively. Based on these equations, the prevalence of eGFR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;60 mL/min/1.73 m(2) among the patients with significant CAD was 41.5, 45.2, 50, and 42.9 %, respectively. eGFR values calculated by four formulas were significantly higher in healthy subjects than those with single-vessel disease (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, p = 0.004, p = 0.003, and p = 0.028, respectively). Prediction of CAD severity was statistically significant for men but not women. After controlling for the confounding effects of other covariates, three of the equations were independently related to significant CAD: CKD-Epi (p = 0.004, β = 0.969), MDRD (p = 0.003, β = 0.965), and C-G (p = 0.021, β = 0.978). The present study established that accurate eGFR equations commonly used still accurate to determine the association of the impaired renal function with CAD presence and extent.

Journal of Family Medicine and Primary Care, 2015

Many etiological reasons are blamed for enuresis nocturna (EN). The aim of this study was to rese... more Many etiological reasons are blamed for enuresis nocturna (EN). The aim of this study was to research prevalence and severity of EN among elementary school-age children and sociodemographic risk factors related to it. The study was performed in three elementary schools in Ankara, Turkey between January and May 2011. It was planned to have 2500 students of 6-14 ages in the study. The questionnaire, which consisted of questions, aiming to evaluate the EN condition of participants and their characteristics, were distributed to the parents. It was observed that 2314 participants&amp;amp;amp;amp;amp;amp;amp;amp;#39; questionnaires (92.56%) were in accordance with evaluation criteria. The relation between EN and the sociodemographic factors was evaluated through Chi-square test and logistic regression analysis. The mean age of 2314 participants was 9.21 ± 2.08. 48.5% (n = 1123) of the students were male and 51.5% (n = 1191) were female. While the general EN prevalence was 9.9% (n = 230); 10.7% (n = 120) for males, as 9.2% (n = 110) for females. Statistical significant difference was determined between the two groups, with EN and without EN, regarding age groups (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), education level of parents (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and the number of sibling (P = 0.002), income level (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and positive family history (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). However, logistic regression analysis revealed that there was a significant difference only between EN and age groups (odds ratio [OR] =4.42, P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), education level of mother (OR = 2.13, P = 0.017) and family history (OR = 0.12, P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). As a consequence, such factors as age groups, education level of parents, positive family history could be accepted as a risk of concerning EN. It is important to perform a detailed evaluation on population, carrying risk of having EN.

Journal of Evaluation in Clinical Practice, 2015

Hypertension (HT) is prevalent in Turkey and even with pharmacological interventions HT control r... more Hypertension (HT) is prevalent in Turkey and even with pharmacological interventions HT control rates do not meet guideline recommendations. We aimed to estimate the proportion of hypertensive patients who achieved target blood pressure (BP) and seek to determine the predictors responsible for failure of to reach goals. We conducted a retrospective cohort study involving patients with HT. A total of 437 patients were identified with a current diagnosis of HT at baseline. All available predictors for BP improvements were included in the multivariate linear regression model. Follow-up data on HT goal achievements was available for 276 (63.1%) participants. Only 18.1% of the patients at the baseline visit, and 48.6% at the follow-up visit achieved the overall SBP/DBP targets specified by the JNC-8 guideline. Significant differences were determined by baseline and 1st visit measurements of mean SBP/DBP levels (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, respectively). DM and baseline SBP were positively associated with SBP improvement (β = 8.410, P = 0.003; β = 0.692, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, respectively), whereas being prescribing more HT medications and being older were negatively associated with improvement (β = -7.968, P = 0.005; β = -5.707, P = 0.037; respectively). DM, baseline DBP and HT duration were positively associated with DBP improvement (β = 4.539, P = 0.012; β = 0.702, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; β = 0.023, P = 0.012; respectively), whereas additional HT medications and GFR values were negatively associated with improvement (β = -5.682, P = 0.002; β = -0.098, P = 0.005; respectively). Although the progress in achieving in BP targets was encouraging, only half of patients had reached the HT goals. Adequate pharmacological approaches and comprehensive management strategies should be implemented in hypertensive patients.

Journal of Evaluation in Clinical Practice, 2014

The impact of seasonal variation on clinical remission in patients with depression has not been w... more The impact of seasonal variation on clinical remission in patients with depression has not been well studied. The hypothesis for this study was that the clinical remission rate would be lower in the winter comparing to the other seasons, specifically evaluated by gender. The study cohort comprised 2873 primary care patients with depression as a longitudinal retrospective chart review analysis. The sample was limited to patients who were continuing in care; dropouts were excluded from the analysis. Multivariate logistic regression analysis of the independent variables for those participants who achieved clinical remission demonstrated that for the male patients, the season of diagnosis did not impact the rate of remission at 6 months while controlling for all other independent variables. For female patients, those that were diagnosed with depression in the fall had increased likelihood of 6-month remission compared with those patients diagnosed in the winter months (OR 1.300, CI 1.006-1.680, P = 0.045) and the spring and summer patients were not significantly different in their outcome rates. When both genders were combined, the odds of remission at 6 months were not statistically significant for any season of diagnosis. This study demonstrates that in patients who were continuing care, women who were diagnosed with major depression or dysthymia in the fall season have improved 6-month clinical outcome of remission compared with those women diagnosed in the winter, when controlling for demographic and clinical characteristics. This effect was not seen in men or when the genders were combined into a single cohort. The assessment of the seasonality effect on depression outcomes requires further long-term follow-up studies.

Journal of Evaluation in Clinical Practice, 2014

This study was undertaken to assess the frequency of lipid screening in comparison with the Unite... more This study was undertaken to assess the frequency of lipid screening in comparison with the United States Preventive Services Task Force guideline in a sample of family medicine patients. In addition, we sought to determine the association between testing frequency and achievement of lipid targets. A random sample was extracted from 271 patients from among all patients cared for in our Department of Family Medicine for whom lipid screening was ordered from March to September 2012 and who had ≥2 well-defined cardiovascular risk factors. Lipid testing frequency was classified in three ways: semi-annual or less often (0-12 tests over 6 years), annual or less often (0-6 tests), or biennial (0-3 tests). Multiple logistic regression analysis revealed that the predictors of lipid screening more often than semi-annually were age ≥60 years [odds ratio (OR) = 3.7] and diabetes mellitus (DM) (OR = 30.6). Predictors of screening more often than annually were DM (OR = 4.3), hypertension (OR = 2.1), family history of premature coronary artery disease (OR = 5.6) and statin treatment (OR = 3.5). Lipid goal attainment was not associated with testing frequency except with regard to low-density lipoprotein levels (P = 0.043, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, P = 0.005, by semi-annual, annual and biennial, respectively) and total cholesterol levels (P = 0.015, P = 0.025 by semi-annual and annual, respectively). Questionable high frequency of lipid testing was detected even when the more conservative approach of annual monitoring was assumed. Frequency of testing was not associated with goal attainment for most parameters. Physicians should request the lipid testing based on overall risk assessment and person variability in accordance with published guidelines.

Asian Pacific Journal of Cancer Prevention, 2014

Background: Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affe... more Background: Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affecting the breast self-examination (BSE) performance vary in developing countries. Objective: To determine the frequency of BSE performance and predictors of self-reported BSEs among women in the capital city of Turkey. Materials and Methods: This cross-sectional study was conducted on 376 Turkish women using a selfadministered questionnaire covering socio-demographic variables and BSE-related features. Results: Of the participants, 78.7% (N=296) reported practicing BSE, whereas 9.5% (N=28) were implementing BSE regularly on a monthly basis, and only 5.7% (N=17) were performing BSE regularly within a week after each menstrual cycle. Multivariate logistic regression modeling revealed that BSE performance was more likely in younger age groups [20-39 years] (p=0.018, OR=3.215) and [40-49 years] (p=0.009, OR=3.162), women having a family history of breast disease (p=0.038, OR=2.028), and housewives (p=0.013, OR=0.353). Conclusions: Although it appears that the rates of BSE performers are high, the number of women conducting appropriate BSE on a regular time interval basis is lower than expected. Younger age groups, family history of breast diseases and not being employed were identified as significant predictors of practicing BSE appropriately. Older age and employment were risk factors for not performing BSE in this sample.

Sao Paulo Medical Journal, 2015

To evaluate predictors of changes in lipid parameters consisting of LDL-C (low-density lipoprotei... more To evaluate predictors of changes in lipid parameters consisting of LDL-C (low-density lipoprotein cholesterol), TC (total cholesterol) and non-HDL-C (non-high density lipoprotein cholesterol) among primary care patients. Retrospective study conducted on family medicine patients. Demographic features and other clinically relevant information were abstracted from medical records. The primary outcome was the difference in LDL-C level from initial testing to the index test. Secondary outcomes were the changes in TC and non-HDL-C levels between two measurements. Three hundred and eleven participants were included in the final secondary analysis. Multiple linear regression revealed that male patients (β = 4.97, P = 0.040), diabetes (β = 9.75, P = 0.003) and higher LDL-C levels at baseline (β = 0.35, P &lt; 0.001) were positively associated with LDL variance, whereas longer time period (β = -0.15, P = 0.045) and familial hypercholesterolemia history (β = -7.56, P = 0.033) were negatively associated. Male patients (β = 8.45, P = 0.002), DM (β = 9.26, P = 0.011), higher TC levels at baseline (β = 0.35, P &lt; 0.001) and taking statins (β = 7.31, P = 0.023) were positively associated with TC variance, whilst longer time period (β = -0.183, P = 0.031) and familial hypercholesterolemia (β = -10.70, P = 0.008) were negatively associated. In the present study, patients who were male, on statin treatment, diagnosed with diabetes and had higher baseline lipid values were more likely associated with better lipid outcomes at future testing.

Turkiye Aile Hekimligi Dergisi, 2012

Turkiye Aile Hekimligi Dergisi, 2010

Standart biyokimyasal testler incelendi¤inde, karaci¤er fonksiyon testlerinde asemptomatik hastal... more Standart biyokimyasal testler incelendi¤inde, karaci¤er fonksiyon testlerinde asemptomatik hastalarda %1 ile %9 aras›nda de¤iflen oranlarda yükseklik saptanm›flt›r. Karaci¤er fonksiyon testlerinde hafif yükselmeler altta yatan ciddi bir hastal›¤›n habercisi olabile-ce¤i gibi geçici iyi seyirli bir durumdan da kaynaklanabilir. Ayr›nt›-l› de¤erlendirme; pahal› ve endifle yarat›c› tetkikler, belki de gereksiz karaci¤er biyopsisi, endoskopik retrograt kolanjiopankreatografi (ERCP) gibi invaziv giriflimlerle sonuçlanabilmektedir. Karaci¤er fonksiyon testi yüksekli¤i olan hastalar› de¤erlendirirken baz› temel prensiplere uymakta fayda vard›r. Semptomlar› de¤erlendirme sürecinde öncelikle hastan›n öyküsü göz önünde bulundurulmal›-d›r. Öyküde dikkat edilecek noktalar; hastan›n yafl›, cinsiyeti, gel-di¤i/yaflad›¤› bölge, mesle¤i, efllik eden hastal›klar, ilaç öyküsü ve aile hikayesini kapsamal›d›r. Alanin aminotransferaz (ALT) ve aspartat aminotransferaz (AST) hepatoselüler hasar›, gama-glutamiltransferaz (GGT) ve alkalen fosfotaz (ALP) kolestaz› gösterirken, bilirubin her iki nedenle de artabilir. Albümin düzeyi ve protrombin aktivitesi ise karaci¤erin sentez kapasitesini yans›tan testlerdir. Karaci¤er hastal›klar›n›n ço¤unda bu iki grup test birlikte bozulmufl olabilir. Karaci¤erin histolojik yap›s› düflünüldü¤ünde, hepatositler ile biliyer sistemin iliflkisi bu durumun bafll›ca nedenidir. Bu enzimler karaci¤er ve safra yollar›na özgü de¤illerdir. ALT ço¤unlukla karaci¤er ve böbreklerde bulunup, kalp ve iskelet kas›nda daha az miktarda mevcuttur. AST ise daha çok kalp kas›, iskelet kas-lar›nda ve karaci¤erde bulunmaktad›r. GGT hepatosit ve safra epitel hücreleri, renal proksimal tubuluslar, pankreas ve ince barsaklardan sentezlenmekte; ALP ise kemikler, ince barsaklar, böbrek ve plasentadan sentezlenmektedir.

Quality Management in Health Care, 2014

Simulate the application of the new cardiology prevention guideline on statin use in an angiograp... more Simulate the application of the new cardiology prevention guideline on statin use in an angiography clinic sample taken from a hospital in Turkey. Taking statins was used as a quality indicator. All cases (323) included in the sample met criteria for taking statins upon arrival in the angiography clinic. The study population was divided into 3 groups: critical coronary artery disease (CAD) (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50%), noncritical (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50%), or individuals with normal coronary arteries. Patient risk factors were tested for association with taking statins using multiple logistic regression analysis. Only 20.2% of patients were taking statins when they were accepted for coronary angiography. Patients with critical CAD and noncritical CAD had higher odds of receiving statins than persons with no CAD [odds ratio (OR)=12.9, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001 and OR=3.5, P=.025, respectively]. Patients receiving angiographic interventions for stent control were more likely to be on statins than patients with angina (OR=5.298, P=0.004). Compared to those not taking the treadmill test, both those with positive and those with negative results had reduced odds of receiving statins (OR=0.260, P=.002, and OR=0.130, P=.002, respectively). Both former and current smokers had lower odds of receiving statins than persons who had never smoked (OR=0.148, P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001, and OR=0.161, P=.001). Patients taking aspirin were at risk of not being on statins (OR=0.238, P = .001). Most of the patients in this study were not taking statins comparing according to US guidelines. Patients who exhibited risk factors for a cardiovascular event but who had not been diagnosed with CAD were at risk for not being on statins.

Asian Pacific journal of cancer prevention : APJCP, 2015

Breast cancer (BC) is the most-common malignancy of women worldwide. Though there are differences... more Breast cancer (BC) is the most-common malignancy of women worldwide. Though there are differences among developed and developing countries, BC remains the most common cancer type of women in Turkey. This study aimed to identify the level of knowledge, awareness, and their potential predictors towards BC in Ankara, Turkey. The present descriptive study was conducted on 376 females attending a breast health outpatient clinic. A self-administered questionnaire was designed to evaluate knowledge level about BC and predictors effecting its level. Data analysis was performed using the chi-square test. A value of p<0.05 was considered statistically significant. Mean age of the participants was 46.2±9.93 (22-75). The majority (92.6 %) were married; 41.5% were educated less than nine years. Most of the women were housewives (82.7%) and, were living in an urban region (86.4%). Predictors of effecting responses to seven knowledge and awareness questions about BC varied from demographic feat...

Diabetes Mellitus is a multisystemic disease progressively seen more frequently in the general po... more Diabetes Mellitus is a multisystemic disease progressively seen more frequently in the general population. Diabetes foot, seen in patients suffering from diabetes mellitus, is a frequent result of improper foot care and requires long and serious treatment. The disease plays an important role in terms of public health and can be a cause for high morbidity and mortality rates. [TAF Prev Med Bull 2010; 9(4): 375-382]

Journal of Evaluation in Clinical Practice, 2015

Standardizing arterial blood pressure (BP) measurement is difficult because of different performe... more Standardizing arterial blood pressure (BP) measurement is difficult because of different performers like doctor or pharmacy employee. We investigated the reliability between different BP measurement methods. The study was conducted in an internal medicine service with 160 patients in Ankara, Turkey. First, the subjects&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; BP was measured by doctor. Then, 24-hour BP monitoring devices were placed. Participants were then instructed to measure their BPs both at home and in pharmacy. The next day, arterial BP was measured by the doctor for the second time. The prevalence rates of masked and white coat hypertension were 8.8% (n = 14) and 8.1% (n = 13), respectively. There was no statistically significant differences between ambulatory measurement and home, office and pharmacy measurements (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). The consistency rate between ambulatory and home measurements was 97.5% (kappa = 0.947, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The consistency rate between ambulatory and pharmacy measurements was 82.5% (kappa = 0.634, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). When compared with ambulatory measurement, the most sensitive (98.0%) and most specific (96.8%) method was home measurement. There was a moderate positive correlation between ambulatory and other measurements in both systolic and diastolic values. There was a positive and very strong correlation between ambulatory and home measurements of systolic and diastolic ABP values (respectively; r = 0.926 and r = 0.968) and there was a statistically significant relation between these measurements (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The results of all measurement methods were close to each other. The most sensitive and specific method was home measurement when compared with ambulatory measurement. But both office and pharmacy measurements had also high sensitivity and specificity.

Gulhane Medical Journal, 2015

Journal of evaluation in clinical practice, Jan 2, 2015

Although the condition of low haemoglobin (Hb) levels has been established as a risk factor in th... more Although the condition of low haemoglobin (Hb) levels has been established as a risk factor in the development of coronary artery disease (CAD), it is still a debate particularly in patients with angiographically documented disease. In the present study, we sought to identify the relationship between Hb levels and the presence of CAD. The study consisted of 356 consecutive patients referred for elective coronary angiography (CAG). Exclusion criteria included a history of prior MI within last 3 months, presence of neoplastic disorders or any inflammatory diseases or overt diabetes mellitus. Blood samples for haematologic and biochemical measurements were collected on admission following at least 12 hours of overnight fasting. Patients were divided into four groups based on the quartiles of Hb (quartile I < 13.50 g/dL, quartile II 13.50-14.70 g/dL, quartile III 14.71-15.74 g/dL, quartile IV > 15.74 g/dL). Additionally, patients filled out a questionnaire of asking their brief me...

Journal of Evaluation in Clinical Practice, 2015

Achieving control over elevated lipid parameters, particularly low-density lipoprotein (LDL)-chol... more Achieving control over elevated lipid parameters, particularly low-density lipoprotein (LDL)-cholesterol, is an acknowledged quality indicator in primary care. The Centers for Disease Control and Prevention (CDC)&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s model for investigation of outbreaks (person-place-time) can be applied to the analysis of quality indicators. A sample of 322 family medicine patients for whom lipid levels were ordered was extracted. LDL &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 100 mg/dL was cross-tabulated by personal characteristics [age group, gender, body mass index (BMI), diagnoses], month (time) and ordering department (place). Age (except one age category), gender, time and location were not related to LDL &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 100 mg/dL after adjustment for covariates. All levels of BMI above normal elevated the risk of LDL &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 100 mg/dL [BMI 25-29.9: odds ratio (OR) = 3.41, confidence interval (CI) = 1.61-7.23, P = 0.0014; BMI 30-34.9: OR = 2.93, CI = 1.28-6.70, P = 0.0109; BMI ≥ 35: OR = 2.75, CI = 1.19-6.37, P = 0.0181]. Patients with coronary artery disease (CAD) and diabetes mellitus (DM) were at reduced risk for LDL &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 100 mg/dL (CAD: OR = 0.47, CI = 0.24-0.91, P = 0.0254; DM: OR = 0.28, CI = 0.14-0.55, P = 0.0002). An outbreak investigation model is useful for analysing variations in this quality indicator. Patients with higher BMI and those not diagnosed with CAD or DM type I/II may be considered for intensified lipid lowering using quality improvement efforts. These might include counselling for lifestyle changes or medication therapy depending upon their calculated cardiac risk.

Medical Principles and Practice, 2015

To evaluate the role of pentraxin-3 (PTX-3) in determining the presence and severity of coronary ... more To evaluate the role of pentraxin-3 (PTX-3) in determining the presence and severity of coronary atherosclerosis in patients with coronary artery disease (CAD). Ninety-five patients (77 males and 18 females) who underwent elective coronary angiography were enrolled in this study. Patients with heart failure, renal failure, diabetes and thyroid disease were excluded. The study population was divided into 3 groups: individuals with normal coronary arteries, patients with critical CAD (n = 35) and patients with noncritical CAD (n = 36). The association of PTX-3 levels with the presence and severity of CAD and the number of involved vessels were analyzed. The mean age was 53.40 ± 10.25 years. The PTX-3 levels were significantly higher in patients with CAD than without CAD (146.48 ± 48.52 vs. 109.83 ± 49.06 pg/ml, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). A statistically significant difference was found among the 3 groups regarding the severity of CAD (165.66 ± 49.10, 127.83 ± 40.51 and 109.83 ± 49.06 pg/ml, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, respectively). The serum PTX-3 levels in normal arteries were 110.4 ± 48.11 pg/ml, in single-vessel disease 132.35 ± 32.96 pg/ml, in 2-vessel disease 142.57 ± 55.88 pg/ml, in 3-vessel disease 156.07 ± 50.53 pg/ml, and in 3-vessel disease 160.50 ± 30.41 pg/ml. After adjusting for baseline confounders, older age (OR = 1.107, 95% CI = 1.027-1.193, p = 0.008) and higher PTX-3 levels (OR = 1.017, 95% CI = 1.003-1.032, p = 0.021) were detected as significant predictors for the presence of CAD. Higher PTX-3 levels were associated with the presence of CAD and its increased severity in clinically stable patients. Higher PTX-3 levels may be regarded as a novel diagnostic predictor and may offer therapeutic options in the clinic. © 2015 S. Karger AG, Basel.

Psychogeriatrics, 2015

The collaborative care model (CCM) has been consistently shown to achieve effectiveness in depres... more The collaborative care model (CCM) has been consistently shown to achieve effectiveness in depression management compared to usual care. In the present study, we aimed to determine the impact of age on cost metrics in patients who were treated with CCM for 6 months after a diagnosis of depression. The upper quartile of age was 50 years and older (n = 56), and the comparison group was composed of patients in the three younger quartiles, aged 18-49 years (n = 163). Patients in the older age group had an elevated median Current Procedure Terminology cost rank of 255.5 compared to 168.0 for the younger patients (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Multiple logistic regression analysis revealed that being in the upper quartile of age (≥50 years) (odds ratio = 2.272, 95% confidence interval: 1.064-4.851; P = 0.034) and having higher numbers of clinical visits 6 months prior to index (odds ratio = 1.209, 95% confidence interval: 1.118-1.307; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) were significant predictor variables of being cost rank outliers (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;80th percentile) in patients with CCM. Medical cost utilization in the 6 months after diagnosis of depression was significantly higher in patients in the upper age quartile (≥50 years) enrolled in CCM than those in the lower quartiles (age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50).

International Journal of Pediatric Otorhinolaryngology, 2015

The present study sought to investigate the frequencies of tonsillectomy, adenoidectomy and both ... more The present study sought to investigate the frequencies of tonsillectomy, adenoidectomy and both adenotonsillectomy (T&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;A) among 6-12 years old children. In addition, we tried to find out the predictors associated with these previous upper respiratory tract (URT) surgeries. This cross-sectional study consisted of 1900 children educated in 3 different elementary schools in Ankara, Turkey. Data about demographics and health conditions were obtained from survey questionnaires completed by parents. Of the 1900 children, 15 children (0.8%) previously underwent tonsillectomy, 43 children (2.3%) had adenoidectomy and 80 children (4.2%) had T&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;A surgical histories. Multiple logistic regression analysis revealed that older students compared to younger ones [odds ratio (OR)=1.15, p=0.011], and those who had parent-reported apnea compared to subjects without apnea were more likely to have URT surgery histories [OR=2.34, p=0.001]. Those children with surgery histories were more likely to have fathers with a higher educational level [medium level: OR=2.07, p=0.012; high level: OR=2.79, p=0.001 vs. low level) and the subjects had greater BMI percentiles [overweight: OR=1.71, p=0.036; obesity: OR=2.32, p=0.003 vs. healthy weight]. Children who had 1-2 URT infections per year [OR=0.47, p=0.019] had less probability of URT surgery histories, whereas those children with AOM ≥3 times per year [OR=2.52, p=0.003] had more probability of URT surgery history. We conclude that a reasonable explanation for higher rates of URT surgery among children with a high level of paternal education may originate from their awareness about URT associated diseases and possibly due to the ease of access to health care services.

Asian Pacific journal of cancer prevention : APJCP, 2014

Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affecting the br... more Breast cancer (BC) is the most common cancer among females in Turkey. Predictors affecting the breast self-examination (BSE) performance vary in developing countries. To determine the frequency of BSE performance and predictors of self-reported BSEs among women in the capital city of Turkey. This cross-sectional study was conducted on 376 Turkish women using a self- administered questionnaire covering socio-demographic variables and BSE-related features. Of the participants, 78.7% (N=296) reported practicing BSE, whereas 9.5% (N=28) were implementing BSE regularly on a monthly basis, and only 5.7% (N=17) were performing BSE regularly within a week after each menstrual cycle. Multivariate logistic regression modeling revealed that BSE performance was more likely in younger age groups [20-39 years] (p=0.018, OR=3.215) and [40-49 years] (p=0.009, OR=3.162), women having a family history of breast disease (p=0.038, OR=2.028), and housewives (p=0.013, OR=0.353). Although it appears that ...

International Urology and Nephrology, 2015

Individuals with impaired renal function are at increased risk of coronary artery disease (CAD). ... more Individuals with impaired renal function are at increased risk of coronary artery disease (CAD). CAD is also associated with an increased likelihood of having chronic kidney disease (CKD). In the present study, we sought to determine the association between impaired renal function with CAD presence and CAD severity based on four different estimated glomerular filtration rate (eGFR) equations. We estimated GFR values using four equations: modification of diet in renal disease (MDRD), Cockcroft-Gault (C-G), chronic kidney disease epidemiology (CKD-Epi), and Mayo Quadratic. Three hundred and fifty-six CAD patients were classified by the number of stenotic coronary arteries occluded &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 %, while the CAD severity was categorized based on the number of involved coronary arteries determined to be healthy, single- and multi-vessel disease. The mean values of eGFR calculated by CKD-Epi, MDRD, Mayo, and C-G equations were 77.44, 71.34, 96.33, and 89.49 mL/min/1.73 m(2) respectively. Based on these equations, the prevalence of eGFR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;60 mL/min/1.73 m(2) among the patients with significant CAD was 41.5, 45.2, 50, and 42.9 %, respectively. eGFR values calculated by four formulas were significantly higher in healthy subjects than those with single-vessel disease (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, p = 0.004, p = 0.003, and p = 0.028, respectively). Prediction of CAD severity was statistically significant for men but not women. After controlling for the confounding effects of other covariates, three of the equations were independently related to significant CAD: CKD-Epi (p = 0.004, β = 0.969), MDRD (p = 0.003, β = 0.965), and C-G (p = 0.021, β = 0.978). The present study established that accurate eGFR equations commonly used still accurate to determine the association of the impaired renal function with CAD presence and extent.

Journal of Family Medicine and Primary Care, 2015

Many etiological reasons are blamed for enuresis nocturna (EN). The aim of this study was to rese... more Many etiological reasons are blamed for enuresis nocturna (EN). The aim of this study was to research prevalence and severity of EN among elementary school-age children and sociodemographic risk factors related to it. The study was performed in three elementary schools in Ankara, Turkey between January and May 2011. It was planned to have 2500 students of 6-14 ages in the study. The questionnaire, which consisted of questions, aiming to evaluate the EN condition of participants and their characteristics, were distributed to the parents. It was observed that 2314 participants&amp;amp;amp;amp;amp;amp;amp;amp;#39; questionnaires (92.56%) were in accordance with evaluation criteria. The relation between EN and the sociodemographic factors was evaluated through Chi-square test and logistic regression analysis. The mean age of 2314 participants was 9.21 ± 2.08. 48.5% (n = 1123) of the students were male and 51.5% (n = 1191) were female. While the general EN prevalence was 9.9% (n = 230); 10.7% (n = 120) for males, as 9.2% (n = 110) for females. Statistical significant difference was determined between the two groups, with EN and without EN, regarding age groups (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), education level of parents (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and the number of sibling (P = 0.002), income level (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), and positive family history (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). However, logistic regression analysis revealed that there was a significant difference only between EN and age groups (odds ratio [OR] =4.42, P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), education level of mother (OR = 2.13, P = 0.017) and family history (OR = 0.12, P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). As a consequence, such factors as age groups, education level of parents, positive family history could be accepted as a risk of concerning EN. It is important to perform a detailed evaluation on population, carrying risk of having EN.

Journal of Evaluation in Clinical Practice, 2015

Hypertension (HT) is prevalent in Turkey and even with pharmacological interventions HT control r... more Hypertension (HT) is prevalent in Turkey and even with pharmacological interventions HT control rates do not meet guideline recommendations. We aimed to estimate the proportion of hypertensive patients who achieved target blood pressure (BP) and seek to determine the predictors responsible for failure of to reach goals. We conducted a retrospective cohort study involving patients with HT. A total of 437 patients were identified with a current diagnosis of HT at baseline. All available predictors for BP improvements were included in the multivariate linear regression model. Follow-up data on HT goal achievements was available for 276 (63.1%) participants. Only 18.1% of the patients at the baseline visit, and 48.6% at the follow-up visit achieved the overall SBP/DBP targets specified by the JNC-8 guideline. Significant differences were determined by baseline and 1st visit measurements of mean SBP/DBP levels (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, respectively). DM and baseline SBP were positively associated with SBP improvement (β = 8.410, P = 0.003; β = 0.692, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, respectively), whereas being prescribing more HT medications and being older were negatively associated with improvement (β = -7.968, P = 0.005; β = -5.707, P = 0.037; respectively). DM, baseline DBP and HT duration were positively associated with DBP improvement (β = 4.539, P = 0.012; β = 0.702, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; β = 0.023, P = 0.012; respectively), whereas additional HT medications and GFR values were negatively associated with improvement (β = -5.682, P = 0.002; β = -0.098, P = 0.005; respectively). Although the progress in achieving in BP targets was encouraging, only half of patients had reached the HT goals. Adequate pharmacological approaches and comprehensive management strategies should be implemented in hypertensive patients.

Journal of Evaluation in Clinical Practice, 2014

The impact of seasonal variation on clinical remission in patients with depression has not been w... more The impact of seasonal variation on clinical remission in patients with depression has not been well studied. The hypothesis for this study was that the clinical remission rate would be lower in the winter comparing to the other seasons, specifically evaluated by gender. The study cohort comprised 2873 primary care patients with depression as a longitudinal retrospective chart review analysis. The sample was limited to patients who were continuing in care; dropouts were excluded from the analysis. Multivariate logistic regression analysis of the independent variables for those participants who achieved clinical remission demonstrated that for the male patients, the season of diagnosis did not impact the rate of remission at 6 months while controlling for all other independent variables. For female patients, those that were diagnosed with depression in the fall had increased likelihood of 6-month remission compared with those patients diagnosed in the winter months (OR 1.300, CI 1.006-1.680, P = 0.045) and the spring and summer patients were not significantly different in their outcome rates. When both genders were combined, the odds of remission at 6 months were not statistically significant for any season of diagnosis. This study demonstrates that in patients who were continuing care, women who were diagnosed with major depression or dysthymia in the fall season have improved 6-month clinical outcome of remission compared with those women diagnosed in the winter, when controlling for demographic and clinical characteristics. This effect was not seen in men or when the genders were combined into a single cohort. The assessment of the seasonality effect on depression outcomes requires further long-term follow-up studies.

Journal of Evaluation in Clinical Practice, 2014

This study was undertaken to assess the frequency of lipid screening in comparison with the Unite... more This study was undertaken to assess the frequency of lipid screening in comparison with the United States Preventive Services Task Force guideline in a sample of family medicine patients. In addition, we sought to determine the association between testing frequency and achievement of lipid targets. A random sample was extracted from 271 patients from among all patients cared for in our Department of Family Medicine for whom lipid screening was ordered from March to September 2012 and who had ≥2 well-defined cardiovascular risk factors. Lipid testing frequency was classified in three ways: semi-annual or less often (0-12 tests over 6 years), annual or less often (0-6 tests), or biennial (0-3 tests). Multiple logistic regression analysis revealed that the predictors of lipid screening more often than semi-annually were age ≥60 years [odds ratio (OR) = 3.7] and diabetes mellitus (DM) (OR = 30.6). Predictors of screening more often than annually were DM (OR = 4.3), hypertension (OR = 2.1), family history of premature coronary artery disease (OR = 5.6) and statin treatment (OR = 3.5). Lipid goal attainment was not associated with testing frequency except with regard to low-density lipoprotein levels (P = 0.043, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001, P = 0.005, by semi-annual, annual and biennial, respectively) and total cholesterol levels (P = 0.015, P = 0.025 by semi-annual and annual, respectively). Questionable high frequency of lipid testing was detected even when the more conservative approach of annual monitoring was assumed. Frequency of testing was not associated with goal attainment for most parameters. Physicians should request the lipid testing based on overall risk assessment and person variability in accordance with published guidelines.