Effects of individual differences, society, and culture on youth-rated problems and strengths in 38 societies

BACKGROUND

Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies.

METHODS

Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects.

RESULTS

Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects.

CONCLUSIONS

Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences.

Investigation of brucellosis in a female agricultural population in Turkey

Much epidemiological information concerning brucellosis generally depends on the evaluation of hospital-based retrospective data. The aim of this study was to determine the prevalence and risk factors of brucellosis in female farmworkers in the south-eastern region of Turkey (GAP) in order to obtain a more representative analysis. Our representative community-based cross-sectional study was conducted during four months of 2013, in all nine GAP provinces. An optimum sample size was determined and blood samples were analysed from 707 reproductive-age female farmworkers using the Rose Bengal (RBT) and standard (SAT) agglutination tests. Sociodemographic information was collected during face-to-face interviews with consenting subjects. Crude odds ratios and 95% confidence intervals were calculated, and chi-square analyses and logistic regression were performed. Employment as a seasonal farmworker and having had five or more pregnancies were the only risk factors found to be significant. This study implies much greater priority needs be given to the control, early diagnosis and treatment in this population.

Development of the Seasonal Migrant Agricultural Worker Stress Scale in Sanliurfa, Southeast Turkey

Stress is one of the main causes of health problems, especially mental disorders. These health problems cause a significant amount of ability loss and increase cost. It is estimated that by 2020, mental disorders will constitute 15% of the total disease burden, and depression will rank second only after ischemic heart disease. Environmental experiences are paramount in increasing the liability of mental disorders in those who constantly face sustained high levels of stress. The objective of this study was to develop a stress scale for seasonal migrant agricultural workers aged 18 years and older. The sample consisted of 270 randomly selected seasonal migrant agricultural workers. The average age of the participants was 33.1 ± 14, and 50.7% were male. The Cronbach alpha coefficient and test-retest methods were used for reliability analyses. Although the factor analysis was performed for the structure validity of the scale, the Kaiser-Meyer-Olkin coefficient and Bartlett test were used to determine the convenience of the data for the factor analysis. In the reliability analyses, the Cronbach alpha coefficient of internal consistency was calculated as .96, and the test-retest reliability coefficient was .81. In the exploratory factor analysis for validity of the scale, four factors were obtained, and the factors represented workplace physical conditions (25.7% of the total variance), workplace psychosocial and economic factors (19.3% of the total variance), workplace health problems (15.2% of the total variance), and school problems (10.1% of the total variance). The four factors explained 70.3% of the total variance. As a result of the expert opinions and analyses, a stress scale with 48 items was developed. The highest score to be obtained from the scale was 144, and the lowest score was 0. The increase in the score indicates the increase in the stress levels. The findings show that the scale is a valid and reliable assessment instrument that can be used in epidemiological research and planning interventions.

Prevalence and predictors of mental health among farmworkers in Southeastern Anatolia of Turkey

BACKGROUND

Mental health problems represent a major component of the global burden of disease. The primary objective of this study was to assess the prevalence and predictors of psychological wellbeing among farmworkers and to evaluate their mental health services need for in rural primary health care settings.

METHODS

The study sample comprised 1855 farmworkers (918 women, and 937 men) who were selected using probability cluster sampling method at 95% confidence interval (87.6 % response rate). The 12-item General Health Questionnaire (GHQ-12) and socio-demographic information form were used to data collection.

RESULTS

The overall prevalence of mental health problems was 31.5%; the prevalence among women was 1.4 times that of men (35%, females; 28.2%, males). Logistic regression analyses revealed that poor general health, as well as presence of chronic diseases and exposure to traumatic life events predicted mental ill health among both sex. Poor economic situation, being seasonal migrant farmworker, and pesticide exposure history affected male mental health problems; while type of settlement, history of having disabled child at birth, and not having a family physician were significant predictors of female mental ill health (P < 0.05).

CONCLUSIONS

These findings highlight the need for systematic development of community-based mental health services in conjunction with rural primary health care center and an integrated approach to health care of farmworkers. These include screening, early identification and treatment of mental health problems, development of non-communicable disease (NCD) control program, maternal health services and urgent measures to improve farmworkers' work safety and pesticide applications.

Health-risk behaviors in agriculture and related factors, southeastern Anatolian region of Turkey

Human behavior plays a central role in the maintenance of health and the prevention of diseases. This study aimed to determine the risky behaviors of farm operators selected from a province of Turkey's southeastern Anatolian region, as well as the factors related to risky behaviors. In this cross-sectional analysis, 380 farm operators were enrolled through simple random selection method, and the response rate was 85%. Health-risk behavior was measured using the Control List of Occupational Risks in Agriculture. Of 323 farm operators, 85.4% were male. The prevalence of risky behaviors related to measures of environmental risks were higher in animal husbandry, transportation, transportation and maintenance of machinery, pesticide application, child protection, thermal stress, and psychosocial factors in the work place. Education, age, duration of work, and size of agricultural area were associated with risky behaviors in a multiple linear regression (P < .05). Findings showed that a certified training program and a behavior surveillance system for agriculture should be developed.

Prevalence and associated risk factors of Toxoplasma gondii in female farmworkers of southeastern Turkey

INTRODUCTION

There are a limited number of studies of the agricultural population about the prevalence of Toxoplasma gondii (T. gondii) infection throughout the world. The aim of this study was to determine the prevalence and risk factors of toxoplasmosis in female farmworkers in the southeastern region of Turkey.

METHODOLOGY

The optimum sample size was determined using the Epi Info Program, and blood samples were collected from 684 women of reproductive age. Serum samples were analyzed by qualitative and quantitative methods for anti-T. gondii IgG and IgM antibodies with a commercially available enzyme immunoassay. Questionnaires through which socio-demographic information was collected were applied during face-to-face interviews of subjects who gave their consent to participate in the study. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and Chi-square analyses and logistic regression were performed.

RESULTS

Of the 684 women, the prevalence of toxoplasmosis was determined to be 58.3% and 1% for IgG and IgM, respectively. Employment as a seasonal farmworker, increasing age, and having had three or more pregnancies were found to be the crucial associated risk factors that affect the prevalence of T. gondii infection (p < 0.05). In contrast to these, the provincial development level was found to be a confounding factor. There was no association between toxoplasmosis and household size, education attainment, and poverty in the bivariate analyses.

CONCLUSIONS

The findings show that control and serological screening programs should be implemented nationwide in Turkey for the reliable and fast detection of congenital Toxoplasma infections.

Relationship between left atrial functions, P-terminal force and interatrial block in chronic haemodialysis patients

OBJECTIVE

Interatrial block (IAB) connotes a P wave duration ≥ 110 msec on electrocardiography (ECG). P-terminal force corresponds to a biphasic P wave with its terminal negative phase ≥ 40 msec x mm in V1 derivation on ECG. IAB and P-terminal force are closely related parameters and they are accepted as predictors for left atrial dysfunction, left atrial dilatation, atrial fibrillation and strokes. Left atrial functions in chronic haemodialysis patients becomes worse in the course of time because of long standing pressure and volume overload. The aim of this study is to evaluate the relationship between IAB, P-terminal force and left atrial functions.

PATIENTS AND METHODS

68 chronic haemodialysis patients and 60 control subjects were included in the study. Conventional echocardiography and left atrial dynamic functions were measured in all cases. The subjects with IAB and P-terminal force on ECG were identified.

RESULTS

Left ventricular size, wall thickness and left atrial diameters were significantly greater in haemodialysis patients than the control group (p < 0.001). 42 (62%) patients had IAB (≥ 110 msec) and 45 (66%) patients had P-terminal force ( ≥ 40 msec x mm) in the haemodialysis group. Left atrial reservoir, conduit and pump functions were significantly lower in the haemodialysis group than the control group (p < 0.001). There was a statistically significant correlation between left atrial functions, IAB (≥ 110 msec) and P-terminal force (≥ 40msec x mm) in all parameters (p < 0.001).

CONCLUSIONS

This study showed that decreased left atrial functions in chronic haemodialysis patients are closely correlated with IAB and P-terminal force.

Epidemiology of hepatitis B in the reproductive-age female farmworkers of southeastern Turkey

BACKGROUND

There are limited data on the prevalence of the hepatitis B virus (HBV) infection in the agricultural population worldwide.

OBJECTIVES

This study aimed to determine the prevalence of HBV infection and associated risk factors in the reproductive-age female farmworker.

MATERIALS AND METHODS

This cross-sectional study was conducted between January and April 2013 in southeastern region (SAR) of Turkey. A community-based representative agricultural sample (n = 705) from the agricultural areas of nine provinces of SAR was randomly determined by clustering method using Epi Info software. Questionnaires including demographic information and risk factors of HBV were administered to participants. The presence of HBsAg, anti-HBs, anti-HBc, and anti-HBe antibodies in blood samples were measured by ELISA.

RESULTS

The prevalence of the HBsAg, anti-HBs, anti-HBc, anti-HBe antibodies, and seropositivity were 5.7%, 25.9%, 28.9%, 16.4%, and 36.7%, respectively. There was no association between the HBsAg and the size of the household, age, education level, parity, and place of birth while the prevalence of HBsAg was higher in seasonal migratory farmworkers and people living in urban areas and the prevalence of anti-HBs antibody was significantly higher in women ≥ 35 years of age, those with a high parity, and those who gave birth without the assistance of health professionals (P < 0.05). The risk for HBV infection in the seasonal migratory group was 4.3 times higher in comparison to local workers (P = 0.00; OR = 4.3; 95% CI, 2.2-8.4), with a prevalence rate of 11%.

CONCLUSIONS

The monitoring of at-risk groups like seasonal migratory farmworkers is necessary to strengthen the healthcare service provided to this population.

Two cases of very late bare-metal stent thrombosis and literature review

BACKGROUND

Bare metal stents (BMS) are commonly used in the treatment of coronary artery disease. Very late stent thrombosis (VLST) is a quite rare clinical entity. However, it is a serious complication that often results myocardial infarction or death. Since the stent endothelialization is considered to be completed within 4 weeks after the intervention, VLST is not common with BMS.

PATIENTS AND METHODS

The pathogenesis of the VLST is poorly defined. Herein, we report two cases of VLST in which one a 62 year old male patient devoloped VLST of a BMS implanted in the right coronary artery (RCA) and presented inferior myocardial infarction and other a 48 year old male patient devoloped very late thrombosis of a BMS implanted in the RCA and presented inferior myocardial infarction, respectively.

CONCLUSIONS

On the basis of these two cases and our review of the current literature we suggest that what can be done to prevent this rare but offending complication. Moreover, in the light of new imaging modalities such as optical coherence tomography (OCT), the pathophysiology of stent thrombosis will be clearly defined and preventive measures will be taken before it occurs.

Comparison of effects of nebivolol, carvedilol and irbesartan on left ventricular hypertrophy associated with hypertension

OBJECTIVES

The aim of this study was to investigate if the new generation beta-blockers are as effective as irbesartan, which is an angiotensin receptor blocker (ARB), on left ventricular hypertrophy (LVH).

PATIENTS AND METHODS

The study included 85 patients (average age: 56.6±9.6 year) with stage 1 and 2 hypertension, who previously didn't receive an antihypertensive treatment, but diagnosed with LVH echocardiographically. The patients were divided into three different treatment groups: irbesartan (n=28), nebivolol (n=25) and carvedilol (n=32). The patients were reassessed clinically and echocardiographically at 3, 6 and 12 months after the treatments.

RESULTS

There was no statistically significant difference in baseline left ventricular mass index (LVMI) and other parameters among the three treatment groups (p > 0.05). Although there was no significant decrease in LVMI in irbesartan and carvedilol groups at 3 months after the treatment (p > 0.05), the values measured at 6 and 12 months (p < 0.0001) were significant. The decrease in LVMI in the nebivolol group was significant at 3, 6 and 12 months (p < 0.0001). There was a significant difference in measurements at 12 months (p < 0.05).

CONCLUSIONS

Both of the new generation beta-blockers were more effective than irbesartan in the regression of LVH. A significant regression in LVH was observed 3 months after nebivolol treatment and 6 months after irbesartan and carvedilol treatments.

Assessment of effect of irbesartan and nebivolol on the left atrium volume and deformation in the patients with mild-moderate hypertension

BACKGROUND

We aimed to assess the effects of irbesartan and nebivolol on the left atrium (LA) volume and deformation in the patients with mild-moderate hypertension.

PATIENTS AND METHODS

The study comprised of 160 patients (mean age: 55.6±9.6 years), who had Stage 1 or 2 hypertension according to the European Society of Cardiology (ESC) and have not been receiving antihypertensive therapy. The patients were assigned to treatment groups; irbesartan (n=80) and nebivolol (n=80). The patients were clinically and echocardiographically reevaluated on the 6th and 12th months after the onset of treatment.

RESULTS

There was no difference between the two treatment groups in terms of baseline demographic, clinical and echocardiographic characteristics. Moreover, no difference was observed between the treatment groups on the 6th and 12th months. Intragroup analyses revealed that systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly decreased in time and diastolic function parameters were improved. However, whilst significant increase was observed in conduit volume, decrease was observed in other volumes of the LA in the irbesartan and nebivolol groups. This significant change was observed on the 6th month in both treatment groups. LA global peak systolic strain (LAGLSs), LA global peak systolic strain rate (LAGLSRs), LA global peak strain rate during early ventricular diastole (LAGLSRe) and LA global peak strain rate (LAGLSRa) during late ventricular diastole (LAGLSRa) values began to be significantly increased after 6 months of treatment in both treatment groups.

CONCLUSIONS

We found that nebivolol, which is a new generation beta blocker, is effective as irbesartan with proven efficacy in improving LA volume and LA myocardial performance in patients with mild-moderate hypertension. Moreover, we determined that strain and strain rate, which are the new echocardiographic parameters, are effective as LA volumes in assessing LA functions.

The decreasing efficacy of chloroquine in the treatment ofPlasmodium vivaxmalaria, in Şanlıurfa, south–eastern Turkey

In most regions of the world, chloroquine has been the standard treatment for Plasmodium vivax malaria for more than 50 years. Recently, however, chloroquine-resistant P. vivax has been reported from Oceania, several parts of Asia, and South America. In June-August 2004, therapeutic failure following chloroquine treatment of acute P. vivax malaria was investigated among 91 patients from two sites (Karacadag and Sekerli) in the Turkish province of Sanliurfa. Each patient received a directly observed, standard, chloroquine treatment (10 mg/kg on each of days 0 and 1 and 5 mg/kg on day 2), before being followed-up for 28 days. Overall, 19 (20.9%) of the patients - 11 (23.7%) of the 46 from Karacadag and eight (17.3%) of the 45 from Sekerli - were identified as treatment failures between day 3 and day 28. The cumulative incidence of treatment failure recorded in the present study (0.219) was markedly higher than that recorded, in a similar study at the same sites, in September 2002 (0.135). Although the relatively small samples meant that this difference was not statistically significant, it seems likely that the efficacy of chloroquine for the treatment of P. vivax in Sanliurfa province is decreasing quite rapidly.

Evaluation of attempted suicide in emergency departments in Sanliurfa province, southeastern Turkey

AIM

Attempted suicide is one of the most important public health problems among preventable causes of mortality in the general population. Identifying risk factors for the prevention of suicide is a major public health goal. The aim of this study was to determine the annual rate of attempted suicide, related risk factors, and interventions, among referrals to emergency departments in the Sanliurfa province of southeastern Turkey.

SUBJECTS AND METHODS

Data were obtained from all emergency departments in the province based on the 'Suicide Attempt Registry' standardized records for the calendar year 2010. Sociodemographic characteristics, aetiology, psychiatric history, psychiatric consultations, and interventions were examined. The groups were analysed with the chi-square test; the significance level was set at p<0.05.

RESULTS

The annual rate of suicide attempts was 55.39 in 100,000 for the calendar year 2010. The rate was 3.47 times higher among women than men, and in particular 4.15 times higher for the 15-24 year age group among women than in men with the highest incidence of suicide attempts. The majority of cases were referred in April and May. Medication or toxic agent ingestions comprised 90.3 % of cases. The main reason for attempts was family problems or domestic violence among women, and economic hardships among men, and rates of physical and mental problems were similar for both sexes. Only 8.8 % of cases were subsequently referred for psychiatric consultation. Among cases with a prior suicide attempt history, 44.6 % had a reported psychiatric disorder.

CONCLUSION

The results of this investigation show that strengthening of surveillance and emergency healthcare systems, enhancement of mental health literacy, and inter-sector collaboration for development of community empowerment programmes are of vital importance for prevention of attempted suicide. The low rate of psychiatric referrals for subsequent intervention represented a major gap in urgent mental health services in the region.

Relation of interatrial duration and p wave terminal force as a novel indicator of severe mitral regurgitation

OBJECTIVES

Interatrial duration is defined as prolonged p wave on electrocardiogram. p waves with a negative terminal phase recorded in V1 enclosing an area of one small square on the electrocardiogram is significantly and strongly correlated with interatrial duration. The aim of study was to investigate whether interatrial duration with p terminal force can be used as reflection of echocardiographic severity of mitral regurgitation.

MATERIALS AND METHODS

Sixty two consecutive patients with mitral regurgitation. were prospectively studied. Age/gender matched 57 subjects who had normal mitral structure and did not have mitral regurgitation. Patients with mitral regurgitation referred to a single cardiac center for echocardiography and who met the entry criteria documented moderate or severe mitral regurgitation with sinus were included. The interatrial duration was defined on the routine 12-lead electrocardiogram (50 mm/s, 10 mm/mV) using the greatest duration of p waves from D2, D3, AVF and V1.

RESULTS

There was a positive correlation between interatrial duration (>/= 110 ms) and effective regurgitant orifice (r = 0.3, p < 0.001). However, left atrial diameter and brain natriuretic peptide were significantly higher in cases with mitral regurgitation. There was also strong correlation between interatrial duration (>/= 110 ms) and p terminal force and left atrial diameter. ROC analysis revealed that interatrial duration of > 110 msec. could predict of severe mitral regurgitation with 88% sensitivity and 100% specificity.

CONCLUSIONS

Severe mitral regurgitation, left atrial diameter was correlated with p terminal force and interatrial duration. Significant interatrial duration (>/= 110 ms) and p terminal force might be considered as novel indicators of severe mitral regurgitation.

International comparisons of behavioral and emotional problems in preschool children: parents' reports from 24 societies

International comparisons were conducted of preschool children's behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½-5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders-oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3-12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0-198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes < 1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies.

Accuracy and safety of percutaneous US-guided needle biopsies in liver metastasis and hemangiomas

AIM

The aim of this study was to compare small size aspiration and large size cutting needles on the diagnostic yield in the biopsies of liver and especially to investigate the reliability on percutaneous biopsy of liver hemangiomas.

METHODS

Nine hundred fifty patients with percutaneous ultrasonography-guided liver biopsies were evaluated retrospectively. This study enrolled 841 patients biopsied with either large size cutting needle (Tru-cut 14G-18G) or small size aspiration needle (WestCott 20G). Further evaluation was performed in 312 patients with metastasis and 48 patients with hemangiomas.

RESULTS

Diagnostic yield was higher in the large size cutting needle group (96.8%, 150/155) than in the small size aspiration needle group (84.1%, 132/157) in liver metastasis (P<0.001). There was no significant difference among diagnostic accuracies of Tru-cut 14G, 16G, and 18 G needles in metastasis (P=0.255). Accuracy rate was 77.9% (208/267) in benign and 89.5% (514/574) in malignant diseases. Sensitivity, specificity, and accuracy were 81.2% (514/633), 100% (208/208), and 85.8% (722/841), respectively. Only two major complications were found (0.16%) with small needles.

CONCLUSION

The authors suggest the use of large size cutting needles, because they provide more accurate diagnosis, and should be used in liver metastasis instead of small aspiration needles, if there is no on-site pathologist at aspiration biopsies or a more specific diagnosis is required. Among them, 18G cutting needle should be chosen. All the needles, including the large cutting type, were found safe in the biopsies of liver hemangiomas.

Intestinal parasites, nutritional status and physchomotor development delay in migratory farm worker's children

OBJECTIVE

The aim of this study was to investigate the prevalence of intestinal parasites, nutritional status and physchomotor developmental delay and anaemia in children of migratory seasonal farm worker families.

MATERIAL AND METHODS

In this cross-sectional study, 168 children aged between 6 and 59 months selected through probability sampling method were contacted in the Sanliurfa district of south-eastern Anatolia of Turkey. The data were collected using a structured questionnaire, anthropometry and Ankara Developmental Screening Inventory to measure physchomotor development. In order to evaluate the anaemia, finger-prick blood samples were used and laboratory analyses of faecal samples were conducted.

RESULTS

55.4% of children were infected by intestinal parasites. The most common infections involved the protozoan parasite Giardia intestinalis (37.2%). Of the children 17.8% had general psychomotor development delay. Regarding the nutritional status of the 168 children who participated, 38.1% were stunted, 20.8% were underweight, and 5.4% were wasted. Of these children, 16.6% were anaemic.

CONCLUSION

The findings demonstrated that the children of migratory seasonal farm workers were defined as a high-risk group in terms of nutritional status, intestinal parasites and physchomotor development delay. Therefore, the effective delivery of mobile environmental and individual primary healthcare services to the farm workers' children must be ensured both while residing in the agricultural zone and in their permanent addresses.

Mental health of adolescents reared in institutional care in Turkey: challenges and hope in the twenty-first century

The objectives of the study are (i) to describe and compare the epidemiology of emotional/behavioral problems and associated risk/protective factors among nationally representative samples of institutionally reared and similarly aged community-based adolescents brought up in their natural homes by means of youth self-reports, caregiver/parent, and teacher informants; and (ii) to identify mental health service needs and utilization. A cross-sectional survey was conducted between November 2005 through April 2006 using an equal probability cluster sample of 11-18 year old adolescents in institutional care settings (N = 350; 163 males, 187 females) and results were compared with similarly aged community sample of youth living in their natural homes (N = 2,206). The Sociodemographic Information Form, Youth Self Report (YSR), Child Behavior Checklist (CBCL) by caregivers for institutional sample and parents for the community sample, and Teacher's Report Form (TRF) were used to obtain standardized data on demographic characteristics, emotional/behavioral problems, and risk/protective factors. The prevalence of problems behaviors by YSR, caregiver/parent CBCL, and TRF were: 47, 15.1, 20.5% for the institutional versus 10.1, 7.5 and, 9.5% for the community samples, respectively (p < 0.05). Youth self-reports were fourfold, and all informant reports were twofold higher for institutional versus community comparisons. Furthermore, institutional sample had consistently higher rates, not only of Externalizing, but Internalizing, Social Problems, Attention Problems, and Thought Problems, as well as discrete DSM-oriented scales, suggesting that labeling of institutional youth as simply aggressive and delinquent contributes to their further marginalization and does not comprehensively address their mental health needs. In terms of protective factors, we found that: perceived social support, high competency scores, supportive caregiving, getting along well with peers and relatives (positive relationships), and problem solving skills were significantly protective of mental health. On the other hand fatalistic beliefs, cigarette and alcohol use were significantly associated with increased risk for problem behaviors (p < 0.05). The primary reason for institutional placement was family disruption (68.9%), poverty (15.7%), abandonment (8.4%), and physical or sexual abuse (5.4%). Only 31.2% of the youth were in fact true orphans (loss of one or both parents). It is therefore remarkable that in terms of service use, despite consistently high prevalence of problem behaviors across all informant sources, only 2.4% of the youth had received any speciality mental health services during institutional care. In conclusion, there is a pressing need to transform the social and health care policy and to provide family and community-based alternatives for youth currently in institutional care in Turkey. Before this goal is achieved, it is necessary to address their mental health needs urgently and comprehensively. The highest rates of problems by youth self-report also support the view that the youths' own voices ought to be heard and need to inform the reform process regarding their future care.

Single-session percutaneous sclerotherapy in symptomatic simple renal cysts: long-term results

AIM

To evaluate the efficacy of single-session percutaneous sclerotherapy with needle aspiration or catheter drainage, under ultrasound (US) or computed tomography (CT) guidance, based on cyst size and depth in 22 symptomatic simple renal cysts.

METHODS

Sclerotherapy with 95% alcohol for 20 min was performed in 22 symptomatic simple renal cysts in 15 patients. The method (aspiration or drainage) was chosen according to cyst size and depth: catheter drainage was done for larger (>6 cm) and shallow (<7.5 cm) cysts (N=12) and needle aspiration was done for smaller (<6 cm) or deeper (>7.5 cm) cysts (N=10). The median follow-up period was 6.0 months (range 1-62).

RESULTS

Volume reduction of cysts (mean and median, respectively) was 94.1% and 97.0%. Average cyst volume reduction (mean and median, respectively) was 94.7% and 96.0% with US-guided methods and 93.3% and 99.0% with CT-guided methods (P=0.382). Median volume loss was 97.5% with needle aspiration and 96.5% with catheter drainage (P=0.839). No correlation between the groups and volume reduction was found. All procedures were successful. No major complications or recurrences were noted.

CONCLUSIONS

Single-session percutaneous alcohol sclerotherapy with needle aspiration or catheter drainage, under US or CT guidance, is an effective and safe method for treating symptomatic simple renal cysts. CT-guided needle aspiration may be more suitable for treating deeper and/or smaller (<6 cm) cysts, while US-guided catheter drainage may be preferable in cases of shallow and/or larger (>6 cm) cysts.

Prevalence and predictors of mental disorders among women in Sanliurfa, Southeastern Turkey

BACKGROUND

Mental health is one of the most important public health issues because of major contributor to the global burden of disease. In this study, we examined the prevalence and predictors of mental disorders among married women from 15 to 49 years of age and the need for mental health services in the primary health care settings.

METHODS

In this cross-sectional study, 270 women were selected using probability cluster sampling method at 95% confidence interval (91.5% response rate). The Structured Clinical Interview for DSM-IV (SCID-I) and women socio-demographic information form were used to collect data.

RESULTS

Although the prevalence of mental disorder was 25.9% (8.5% with one diagnosis; 17.4% were two or more diagnoses), 4.7% of these women had contacted a carer in the last year for psychological reasons. According to the SCID-I assessment, the most prevalent diagnoses were major depressive disorder (7.3%), phobic disorder (4.8%) and posttraumatic stress disorder (3.6%). In this study, comorbid diagnoses were present in 67.2% of patients. Logistic regression analyses revealed that domestic violence, history of previous trauma, anemia and cutaneous leishmaniasis were significant predictors of any mental disorders (P < 0.05).

CONCLUSIONS

These findings highlight the need for systematic development of community-based mental health services in conjunction with primary health care services for the screening, early identification and treatment of women suffering from mental disorders, and the improvement of anemia and cutaneous leishmaniasis control programme.

Epidemiology of attention problems among Turkish children and adolescents: a national study

OBJECTIVE

To evaluate the epidemiology of attention problems using parent, teacher, and youth informants among a nationally representative Turkish sample.

METHOD

The children and adolescents, 4 to 18 years old, were selected from a random household survey. Attention problems derived from the Child Behavior Checklist (CBCL) (N = 4,488), Teacher Report Form (TRF) (N = 2,360), and the Youth Self Report (YSR) (N = 2,206) were examined.

RESULTS

The CBCL and TRF attention problems scores were higher among young male children, whereas the YSR reported scores were higher among older adolescents without a gender effect. The CBCL and YSR scores were also higher by urban residence.

CONCLUSION

Compared with other European samples, our national sample had higher mean attention problems scores than the Scandinavian but lower mean scores than the former Soviet Union samples. In addition to elucidating the profile of attention problems in Turkey, our results also contribute to understanding the comparative global epidemiology of attention problems.

The generalizability of the Youth Self-Report syndrome structure in 23 societies

As a basis for theories of psychopathology, clinical psychology and related disciplines need sound taxonomies that are generalizable across diverse populations. To test the generalizability of a statistically derived 8-syndrome taxonomic model for youth psychopathology, confirmatory factor analyses (CFAs) were performed on the Youth Self-Report (T. M. Achenbach & L. A. Rescorla, 2001) completed by 30,243 youths 11-18 years old from 23 societies. The 8-syndrome taxonomic model met criteria for good fit to the data from each society. This was consistent with findings for the parent-completed Child Behavior Checklist (Achenbach & Rescorla, 2001) and the teacher-completed Teacher's Report Form (Achenbach & Rescorla, 2001) from many societies. Separate CFAs by gender and age group supported the 8-syndrome model for boys and girls and for younger and older youths within individual societies. The findings provide initial support for the taxonomic generalizability of the 8-syndrome model across very diverse societies, both genders, and 2 age groups.

Testing the 8-syndrome structure of the child behavior checklist in 30 societies

There is a growing need for multicultural collaboration in child mental health services, training, and research. To facilitate such collaboration, this study tested the 8-syndrome structure of the Child Behavior Checklist (CBCL) in 30 societies. Parents' CBCL ratings of 58,051 6- to 18-year-olds were subjected to confirmatory factor analyses, which were conducted separately for each society. Societies represented Asia; Africa; Australia; the Caribbean; Eastern, Western, Southern, and Northern Europe; the Middle East; and North America. Fit indices strongly supported the correlated 8-syndrome structure in each of 30 societies. The results support use of the syndromes in diverse societies.

Prevalence and predictors of emotional and behavioral problems reported by teachers among institutionally reared children and adolescents in Turkish orphanages compared with community controls

We examined the prevalence of emotional and behavioral problems and associated risk and protective factors among children and adolescents ages 6 to 18 years reared in orphanages in Turkey (n = 461, 87.9% of all eligible subjects) compared with a nationally representative community sample of similarly-aged youngsters brought up by their own families (n = 2280). Using the 90th percentile as the cut-off criterion, it was found that the Teacher's Report Form (TRF) Total Problem score was higher for children and adolescents in orphanage care than in the community (23.2%, orphanage v. 11%, community). Multiple regression models explained 73% of the total variance of TRF Total Problems score for children and adolescents in orphanages. Regular contact with parents or relatives, between classroom teachers and orphanage staff, appropriate task involvement, perceived social support and competency were significant protective factors against emotional and behavioral problems. Younger age at first admission, being small for age, and feelings of stigmatization were associated with higher TRF Problem Scores (P<.05). Parental psychiatric disorder was unrelated to emotional and behavioral problems in children reflecting that psychosocial adversity and parenting problems in of themselves lead to institutionalization, irrespective of identifiable parental mental disorder. The findings are interpreted in the light of an urgent need for development of early intervention programs that promote community care of children by preventing separation from families, provision of support services for families in need, and development of counseling programs to prevent abandonment, abuse and neglect. Finding ways for child welfare professionals to collaborate more closely with early intervention programs would also increase the viable opportunities and rights of children and adolescents currently cared for in the system. Finally, alternative cost-effective care models need to be promoted including foster care or adoption systems and family based homes in the community.

Epidemiological comparisons of problems and positive qualities reported by adolescents in 24 countries

In this study, the authors compared ratings of behavioral and emotional problems and positive qualities on the Youth Self-Report (T. M. Achenbach & L. A. Rescorla, 2001) by adolescents in general population samples from 24 countries (N = 27,206). For problem scales, country effect sizes (ESs) ranged from 3% to 9%, whereas those for gender and age ranged from less than 1% to 2%. Scores were significantly higher for girls than for boys on Internalizing Problems and significantly higher for boys than for girls on Externalizing Problems. Bicountry correlations for mean problem item scores averaged .69. For Total Problems, 17 of 24 countries scored within one standard deviation of the overall mean of 35.3. In the 19 countries for which parent ratings were also available, the mean of 20.5 for parent ratings was far lower than the self-report mean of 34.0 in the same 19 countries (d = 2.5). Results indicate considerable consistency across 24 countries in adolescents' self-reported problems but less consistency for positive qualities.

Parasite density and serum cytokine levels in Plasmodium vivax malaria in Turkey

We aimed to investigate the relationship between quantitative Plasmodium vivax parasitaemia and serum cytokine levels in a highly endemic region of Turkey, where such a relation has not been investigated before. Active screening was done in a total of 1316 people residing in 33 villages of Sanliurfa province, Turkey. The study population consisted of 79 consecutive patients with P. vivax malaria, and a control group included 89 healthy subjects. Thick blood smears were examined for malaria parasite and parasite count. Serum samples were analysed for IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10 and IL-12 by the ELISA method. Compared to controls, levels of pro-inflammatory cytokines, i.e. IL-1beta, IL-6 and IL-12, were significantly higher in patients with parasitaemia. There was a significant positive correlation between serum IL-10 and IL-12 levels and the parasite burden (r = 0.264, P = 0.024 and r = 0.264, P = 0.024, respectively). Serum IL-8 levels showed a significant negative correlation with parasite burden (r =-0.356, P = 0.002). There was a positive correlation between IL-8 levels and age, while the opposite was observed for IL-12. High fever was correlated with IL-6 and IL-10 levels. Compared to controls, patients with a parasite count greater than 5000/microL had a significantly higher IL-1beta and IL-10 levels (P < 0.05), while the difference was not significant for patients with a parasite count less than 1000/microL. Thus, we can conclude that pro-inflammatory response against P. vivax gains more importance during periods of increased parasite burden.

Fibrinogen storage disease without hypofibrinogenemia associated with estrogen therapy

BACKGROUND

Cytoplasmic inclusion bodies within hepatocytes may have different etiologies, including the Endoplasmic Reticulum Storage Diseases (ERSDs). ERSD is a pathological condition characterized by abnormal accumulation of proteins destined for secretion in the endoplasmic reticulum of hepatocytes; it may be congenital (primary) or acquired (secondary). Fibrinogen storage disease is a form of ERSD.

CASE PRESENTATION

We present a case of fibrinogen storage disease secondary to estrogen replacement therapy. Its causal relationship to the drug is shown by histological, immunohistochemical and ultrastructural studies of paired liver biopsies obtained during and after the drug therapy.

CONCLUSION

The liver biopsies of patients with idiopathic liver enzyme abnormalities should be carefully evaluated for cytoplasmic inclusion bodies and, although rare, fibrinogen deposits.

Quality of life instrument for Turkish people with skin diseases

BACKGROUND AND OBJECTIVE

To develop a new, short, self-administrated subjective quality of life (QOL) instrument for Turkish people with skin diseases.

PATIENTS AND METHODS

The 11-item questionnaire of QOL instrument was developed from 200 consecutive dermatological patients' replies. The reliability and validity of the instrument was tested on data gathered from 278 patients with skin diseases attending a dermatology outpatient department and 49 normal subjects. Construct validity was assessed by an exploratory factor analyses and comparisons between patients rated severe and not severe, as well as between normal and patient groups. Reliability was assessed from the internal consistency of the scales and the correlations were made between scores from a 7-10-day retest by using intraclass correlation coefficient.

RESULTS

Factor analyses found six separate dimensions of QOL involving skin disease: social life, emotional life, daily activity, symptoms, cognitive life and sexual life. In addition, 81.3% of common variance was explained by the above factors, all of which correlated with the scale scores of the instrument. The instrument scales were internally consistent (Cronbach's alpha= 0.77-0.84) and scale scores were reproducible after 7-10 days (ICC = 0.63-0.88). Significantly, correlations between scale scores and physician's assessment of the severity of the skin disease were found. Significant differences between diagnostic groups were observed with higher scores for patients with psoriasis, urticaria and acne than those with eczema in the emotional life domain (P < 0.05). In the sexual life domain, however, the eczema group had higher scores than patients with psoriasis, urticaria or acne (P < 0.01).

CONCLUSION

The instrument provides valid and reliable assessments of QOL in Turkish patients with skin disease.

Malaria: knowledge and behaviour in an endemic rural area of Turkey

This cross-sectional study was conducted to determine the knowledge and behaviour of people in the Sanliurfa province of Turkey regarding the prevention of malaria. A modified 30-cluster sampling method based on the traditional Expanded Programme for Immunization coverage surveys was employed to select a representative sample from 210 households. A questionnaire that focused on sociodemographic characteristics, knowledge and behaviour of malaria prevention, treatment-seeking behaviour and the use of antimalarials was applied. Eighty-nine percent of respondents knew at least one of the classical symptoms of malaria, and fever and chills were the most commonly reported symptoms (78.6%). Of the people interviewed, 33% believed that malaria can be acquired from dirty water, by changing place of residence, by working in cotton or tomato fields, or from malaria patients' belongings. None of the respondents knew how mosquitoes acquire the parasite. Twenty-five percent of respondents believed that elimination of breeding sites was one way to prevent malaria, and 8% identified the use of bednets. Fifty-five percent of respondents reported protective behaviours that are not directly associated with malaria transmission. Almost 47% of respondents reported that they completed their antimalarials, and only 21% of respondents indicated that they would seek treatment for febrile disease from physicians or a malaria unit. Understanding community perceptions of aetiology, symptom identification and treatment of malaria is an important step towards disease control.