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Volume : 4 Issue : 3 Year : 2021

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The Anatolian Journal of Family Medicine - anatol j fm: 4 (3)
Volume: 4  Issue: 3 - 2021
1.From the Editor
Mustafa Reşat Dabak
Page I

REVIEW
2.Common Bacterial Infections of the Skin in Children
Hüseyin Dağ, Algün Polat Ekinci
doi: 10.5505/anatoljfm.2021.19870  Pages 202 - 206
Bacterial infections such as erysipelas, cellulitis, furuncle, carbuncle, or folliculitis are common infections of the skin, which is the largest organ of the body that forms a protective layer by wrapping the body. These skin bacterial infections of the skin are very important in pediatric medicine and primary health care. These infections usually occur when skin integrity is impaired. Skin integrity should be preserved with personal hygiene measures, and a multidisciplinary approach should be given to these skin infections with appropriate antibiotic regimens and when necessary, with dermatology and pediatric infectious disease consultations.

ORIGINAL RESEARCH
3.The Association of Exercise during Pregnancy with Maternal and Infant Health
Hilal Türker, Basri Furkan Dağcıoğlu
doi: 10.5505/anatoljfm.2021.08860  Pages 207 - 212
INTRODUCTION: This study was aimed to examine exercise status during pregnancy and the related factors.
METHODS: Women who applied to the Gynecology and Obstetrics clinic between January-February 2017 for birth or examination were enrolled in this study. The patients, who were divided into two groups as exercised and not exercised during pregnancy, were questioned by face-to-face interview method for various parameters related to exercise.
RESULTS: A total of 171 participants were evaluated, including 127 (74.3%) pregnant women in their last trimester and 44 (25.7%) puerperant women in the postpartum period. One hundred fourteen (67.1%) of the participants reported that they exercised during pregnancy, whereas 56 (32.9%) stated that they never exercised. Of the participants who exercised during pregnancy, 28 (24.6%) were doing moderate-paced walking or equivalent exercise at least three to four times a week, while 86 (75.4%) were doing less than two times a week. It was observed that those who regularly exercised before pregnancy were more frequent to exercise during their pregnancy, and edema formation was less in those who exercised during pregnancy (OR=1.751, 95%Cl=1.220-2.514, p=0.002 and OR=2.457, 95%Cl=1.143-5.291, p=0.021, respectively).
DISCUSSION AND CONCLUSION: Exercise during pregnancy seems to be associated with some physical findings of the mothers. Therefore, it may be beneficial for pregnant to receive counseling on the benefits and possible risks of exercise in family medicine.

4.Compliance with Salt Restriction and Drug Treatment in Patients with Hypertension
Burcu Aykanat Yurtsever, Turan Set, Elif Ateş, Ceyhun Yurtsever
doi: 10.5505/anatoljfm.2021.91885  Pages 213 - 217
INTRODUCTION: Hypertension affects a large part of the population, which can result in high morbidity and mortality. Along with regular intake of medications, compliance with salt restriction has been determined to be vital in blood pressure control. This study aims to evaluate compliance with salt restriction and drug treatment among patients with hypertension.
METHODS: This study was carried out in a university hospital between 01 and 31 December 2014. The study included patients with hypertension who applied to cardiology outpatient clinic aged 35 years and over. The participants were asked about their demographic characteristics, salt consumption, and whether they take their medications regularly.
RESULTS: One hundred and one hypertesive patients were included in the study. The mean age of the participants was 62.9±11.2 years and 52 (51.5%) of them were male. The number of patients paying attention to salt restriction is 61 (60.4%). It was found that 40 (65.6%) of the rural residents and 21 (34.4%) of the urban residents pay attention to salt restriction (p=0.041). The participants who used the drugs regularly were 93
(92.1%). It was determined that there was no significant relationship between regular drug use and age, gender, living place, educational level, presence of additional disease and disease duration (p>0.05).
DISCUSSION AND CONCLUSION: Although most hypertensive patients use medication regularly, it has been observed that almost half of them do not pay attention to salt restriction. It may be beneficial to inform hypertensive patients about salt restriction at each doctor's visit.

5.Vaccine Refusal from the Family Doctors’ Perspective: What has Changed with the COVID-19 Pandemic?
Elif Okşan Çalıkoglu
doi: 10.5505/anatoljfm.2021.30092  Pages 218 - 225
INTRODUCTION: This study aimed to determine society's tendency to vaccination from the views of family physicians during the COVID-19 pandemic.
METHODS: The population of the study was family physicians working in primary care and the data collection was done in November 2019 and December 2020 in the Erzurum province of Turkey. In 2019 and 2020, the total number of family physicians working in Erzurum city were 135 and 134, respectively. The participation rates in both study periods were 120 doctors (around 88.9-89.5% response rate).
RESULTS: The medians of the physicians’ durations in the profession in 2019 and 2020 were 8.0 (4.0-11.0) years and 8.0 (3.0-12.0) years, respectively (p=0.990). The proportion of doctors who perceived social media as the reason for vaccination refusal increased from 56 (46.7%) to 92 (76.7%) within one year (p<0.001). Besides, 22 (18.3%) of the participants, who claimed that the patient prefers catching the disease instead of being vaccinated in 2019, had increased to 45 (37.5%) in 2020 (p<0.001). Furthermore, 103 (85.8%) of the participants reported that
adult vaccination rates have increased with the COVID-19 pandemic. Also, the proportion of doctors, who takes a signed refusal instead of convincing the anti-vaxxers, had increased to 96 (80.0%) from 73 (60.8%) (p=0.001).
DISCUSSION AND CONCLUSION: The COVID-19 pandemic has significantly influenced the views of family physicians on the impact of social media on vaccine refusal. Considering the increasing social media activity during the pandemic process, accurate information activities on vaccination should be planned.

6.The Frequency of Depression in Institutionalized and Homebound Older Adults and Related Factors
Edicho López, Yuli Mendoza, Dany Natividad, Maribel Flores, Tanid Villanueva, Juan Morales
doi: 10.5505/anatoljfm.2021.52244  Pages 226 - 231
INTRODUCTION: The aim of this study was to determine and compare the frequencies of depression in institutionalized and homebound older adults.
METHODS: This descriptive study was conducted in aged over 65 years, in home-bound seniors who living with or without other family members, and institutionalized seniors who living in a geriatrics facility in Lima, Peru between July 01 and July 31, 2019. The Yesavage Geriatric Depression Scale (Short Form) was used to assess depression.
RESULTS: The study included 250 elderly adults. One hundred and twenty-five (50.0%) of the participants were in the home-bound group and 125 (50.0%) of the participants were in the institutionalized group. The mean age of the participants was 75.2±6.2 years, 134 (53.6%) were male and 100 (40.0%) were single. Among the homebound older adults, 87 (69.6%) were found to have moderate depression and the results of 15 (12.0%) suggested severe depression. In the institutionalized group, 45 (36.0%) had moderate depression, and 22 (17.6%) showed severe depression. In the elderly, 102 (60.4%) in the home-bound group and 67 (39.6%) in institutionalized group had depression (p<0.001). While 33 (19.5%) of married elderly people had depression, 5 (6.2%) did not have depression (p=0.017).
DISCUSSION AND CONCLUSION: Among older adults, a high frequency of depressive symptoms was found. Depression was observed mainly in home-bound elderly and married. The participation of governments and family members is required to ensure the provision of adequate health services and assistance for the growing elderly population.

7.Quality of Antenatal Care Services in Primary Healthcare Centers in the Federal Capital Territory, Abuja, Nigeria: A Cross-sectional Study
Victoria Nkiru Azodoh, Yinyinade Macellina Ijadunola, Moyosola Bamidele
doi: 10.5505/anatoljfm.2020.52724  Pages 232 - 237
INTRODUCTION: Antenatal care (ANC) services enhance access to providing care for pregnant women to prevent complications that could endanger the lives of the mother and unborn baby. The aim of the study was to assess the quality of ANC services in primary healthcare centers (PHCC) in the Federal Capital Territory (FCT), Abuja, Nigeria.
METHODS: This cross-sectional study was conducted among health professionals spanning four of the 48 PHCC and 386 pregnant women who applied to the ANC, based on the geographic area of Abuja Municipal District Council, FCT, Abuja, Nigeria. Independent variables such as sociodemographic and dependent variables such as patient satisfaction was evaluated in this study.
RESULTS: A total of 386 ANC users were included in the study, and 219 (56.7%) of the pregnant women were middle-income. A total of 356 (92.2%) received testing for urinalysis, 359 (93.0%) received blood tests and 187 (48.4%) were provided with deworming drugs. Two hundred ninety-seven (76.9%) were satisfied with services received and 140 (43.6%) attended ANC 3 times or more.
DISCUSSION AND CONCLUSION: The levels of necessary standard ANC quality in primary healthcare settings have been suboptimal. A need exists for a deepened commitment by the national, state, local, and community governments in Nigeria as well as other partners to ensure that the main components of ANC are received. Health workers in FCT still provide substandard ANC services with reduced satisfaction among users.

8.Cortisol Metabolism in Obese Women with Normal and Impaired Glucose Tolerance
Kağan Güngör, Nur Dokuzeylül Güngör, Mustafa Sait Gönen
doi: 10.5505/anatoljfm.2021.46036  Pages 238 - 242
INTRODUCTION: Increases in fasting plasma cortisol level in the morning has been associated with glucose intolerance and insulin resistance in patients with metabolic syndrome. This study investigated the relationship between fasting morning cortisol and insulin resistance defined by homeostasis model assessment for insulin resistance (HOMA-IR) in obese women with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT).
METHODS: The study was carried out in the Obesity outpatient clinic between June and September 2005. Total body fat mass, lean body mass, total body fluid, and basal metabolic rate were calculated via bioelectrical impedance analysis. Body mass index (BMI), fasting plasma glucose, insulin, HOMA-IR, basal cortisol, 24-h urinary free cortisol, overnight dexamethasone suppression test, lipids, oral glucose tolerance test results, and thyroid function tests were obtained from patient files in the obesity clinic.
RESULTS: This study included 38 obese women, 21 (55.3%) of which had NGT. There was no significant difference between NGT and IGT cases in terms of age, BMI, waist circumference, insulin, HOMA-IR, basal cortisol, and 24-h urinary free cortisol (p=0.484, p=0.399, p=0.517, p=0.639, p=0.973, p=0.758, p=0.161, respectively). There was no correlation between basal cortisol levels in patients with NGT, however, there was a moderate correlation between basal cortisol and HOMA-IR in patients with IGT (p=0.464, r=0.629 and p=0.007).
DISCUSSION AND CONCLUSION: Although the basal cortisol levels of NGT and IGT patients were similar, a moderate correlation exists between basal cortisol and HOMA-IR in patients with IGT.

9.Gender Differences in Terms of Psychological Symptoms and Nicotine Dependence among Smokers
Dilek Sarıkaya, Eser Sağaltıcı, Muhammed Mustafa Uzan, Ömür Günday Toker, Selim Polat
doi: 10.5505/anatoljfm.2021.95967  Pages 243 - 251
INTRODUCTION: This study aims to determine the differences between genders in terms of nicotine dependence severity and psychological symptom levels in individuals applied to the smoking cessation clinic.
METHODS: This cross-sectional study was conducted in the smoking cessation outpatient clinic of Kackar State Hospital between June 1 and December 30, 2017. Sociodemographic form, Symptom Checklist-90-revised (SCL-90-R) and Fagerström Test for Nicotine Dependence (FTND) were administered to the partici-pants.
RESULTS: A total of 224 participants were enrolled in this study and 124 (55.4%) were male. The median FTND score was 7.0 [5.0-9.0] in female and 8.0 [6.0-8.0] in male (p=0.232). FTND score was associated with somatization symptom level of SCL-90-R and daily tea consumption in male participants (r=0.215 and p=0.017; r=0.244 and p<0.006). Also, the number of cigarettes smoked per day was associated with subgroups of SCL-90-R in male participants (r=0.193 and p=0.032 for somatization; r=0.177 and p=0.049 for depression; r=0.257 and p<0.004 for anxiety; r=0.225 and p=0.012 for phobic anxiety; r=0.238 and p=0.008 for psychoticism; r=0.272 and p=0.002 for additional symptoms; r=0.220 and p=0.014 for general symptoms.
DISCUSSION AND CONCLUSION: Clinicians should keep in mind that patients who want to quit smoking may also suffer from psychological symptoms that need to be addressed. There was no difference in the level of nicotine dependence between men and women smokers, however the psychological symptom levels were noted to be higher in women, and the severity of nicotine dependence was correlated with somatization score in men.

10.Prevalence of Orthorexia Nervosa Tendency in Non-obese Population: A Cross-sectional Study
Merve Pökön, Melike Mercan Başpınar, Okcan Basat
doi: 10.5505/anatoljfm.2021.24085  Pages 252 - 256
INTRODUCTION: The prevalence of eating disorders has increased in the modern population. This study aimed to describe the presence of orthorexia nervosa (ON) tendency in non-obese population.
METHODS: Individuals over the age of 18 and with a body mass index below 25 kg/m2 who applied to the family medicine outpatient clinics of a tertiary hospital between April 2017 and October 2017 were included. The ORTO-11 scale was applied individuals to assess ON tendency
RESULTS: A total of 801 participants were included in this study, the mean age was 31.5±10.9 years, and 505 (63.0%) of the participants had an ON tendency. Three hundred two (59.8%) of the participants with ON tendency were female. The frequency of marriage and vitamin supplementation use in participants with ON tendency were 336 (66.5%) and 76 (15.0%), respectively. The presence of ON tendency was significantly different according to be married, female, and vitamin supplementation use (p=0.008, p=0.012 and p=0.007, respectively). The mean ORTO-11 score was 25.8±4.5 in the 18-30 age group, 24.6±4.4 in the 31-50 age group, and 22.6±4.4 in the over 50 age group (p<0.001). A negative correlation was found between ORTO-11 score and age (r=-0.200 and p<0.001).
DISCUSSION AND CONCLUSION: ON tendency in the non-obese population was found to be at 63%, which is a high value according to the ORTO-11 scale. In our study, an increase in the prevalence of ON tendency was observed in individuals over 50 years of age, those using vitamin supplements, married people and women.

11.Determining the Relationship between Non-HDL Cholesterol and Syntax Score in Patients with Acute Coronary Syndrome Under 45 Years of Age
Hasan Akkaya
doi: 10.5505/anatoljfm.2021.20053  Pages 257 - 262
INTRODUCTION: This study aimed to evaluate the relationship between non-HDL cholesterol level, which is a risk factor for coronary artery disease (CAD), and Syntax score.
METHODS: This retrospective study included patients less than 45 years of age who underwent coronary angiography with a diagnosis of acute coronary syndrome between August 2015 and July 2020. Syntax scores of the patients were evaluated by two experienced cardiologists using the www.syntaxscore.com version on 2.28. Metabolic parameters such as total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride and HbA1c of the patients were obtained from their files. Non-HDL cholesterol levels were calculated by subtracting HDL cholesterol from total cholesterol.
RESULTS: In total, 296 patients were included in this study, 264 (89.1%) of patients were male. The mean Syntax score of the patients was 16.7±6.5. A significant positive correlation was determined between the Syntax score and non-HDL cholesterol, total cholesterol, LDL cholesterol, triglyceride, whereas a negative correlation was noted between the Syntax score and HDL cholesterol value (r=0.360 and p<0.001; r=0.426 and p<0.001; r=0.414 and p<0.001; r=0.388 and p=0.001; r=-0.396 and p<0.001, respectively). Besides, there was a significant correlation between Syntax score and HbA1c (r=0.768 and p<0.001).
DISCUSSION AND CONCLUSION: The Syntax score which, indicates the severity and complexity of CAD, was noted to have a significant positive correlation with non-HDL cholesterol, HbA1c, total cholesterol, LDL cholesterol, triglyceride, and a negative correlation with HDL cholesterol.

12.The Relationship between Sleep Duration and Hypertension in Adult Women: A Community-based Study on Rural Population
Mohammad Fahrizal Fanani, Eka Prasetya Budi Mulia, Fitriana Kusuma Wardhani, Pipit Mei Sari, Olivia Josephine Wijaya, Cokorda Agung Paramadika, Dannu Novriandhika, Dwi Aprilawati, Wahjuni Pudjiastuti
doi: 10.5505/anatoljfm.2021.04127  Pages 263 - 267
INTRODUCTION: Sleep deprivation may increase sympathetic nervous system activity, which, in turn, could result in an increase in blood pressure. However, data examining the relationship between sleep duration and hypertension from rural populations remain to be limited. This study aimed to determine the relationship between sleep duration at night and hypertension among adult women in rural Indonesia.
METHODS: Community-based study was conducted on adult women from a rural population in Malang, East Java, Indonesia. Data was collected via interviews to obtain their sociodemographic information and sleep pattern. Blood pressure was measured using a mercury sphygmomanometer.
RESULTS: In total, 105 adult women were enrolled in this study. The prevalence rate of hypertension was found to be 63 (60.0%). The prevalence rate of subjects who sleep less than 7 hours per night was 54 (51.4%). Hypertension was observed in 46 (73.0%) of the participants who slept less than 7 hours, while hypertension was observed in 17 (27.0%) of the participants who slept more than 7 hours (p<0.001).
DISCUSSION AND CONCLUSION: Hypertension was associated with short sleep duration among the rural adult women. These results underscore the potential importance of sufficient sleep in reducing the frequency of hypertension.

13.The Relationship between Disability due to Osteoarthritis and Subclinical Atherosclerosis: A Case-Control Study
Hasan Akkaya, Ahmet Sinan Sarı
doi: 10.5505/anatoljfm.2021.92005  Pages 268 - 274
INTRODUCTION: This study aims to evaluate the association between the disability of due to osteoarthritis (OA) and subclinical atherosclerosis.
METHODS: The disability level of the OA patients attributable to OA was assessed based on the Australian Canadian Osteoarthritis Hand Index (AUSCAN) and the Western Ontario and McMaster Universities Arthritis Index. Subclinical atherosclerosis was assessed based on the results of carotid intima media thickness (CIMT), arterial stiffness index-β (ASI-β), carotid femoral pulse wave velocity (CFPWV), aortic distensibility and echocardio-graphic calcification (echo-CCS) assessments.
RESULTS: A total of 160 (%100.0) patients were divided into hand OA 40 (25.0%), knee OA 40 (25.0%), hip OA 40 (25.0%) and one control group 40 (25.0%). There was a relationship between the Kellgren-Lawrence stage of OA and CIMT, ASI-β, CFPWV, echo-CCS in the hand OA group (r=0.540 and p=0.042; r=0.530 and p=0.044; r=0.720 and p=0.001; r=0.580 and p=0.035, respectively). In addition, a statistically significant positive correlation between the AUSCAN score and CIMT, ASI-β, echo-CCS of the patients in the hand OA group (r=0.460 and p=0.025; r=0.390 and p=0.033; r=0.550 and p=0.010, respectively).
DISCUSSION AND CONCLUSION: The disability level attributable to hand OA may reflect the severity of subclinical atherosclerosis. In primary care, physicians’ awareness on the association between hand OA and subclinical atherosclerosis may be beneficial in the care of asymptomatic patients.

CASE REPORT
14.Purple Urine Bag Syndrome: A Case Report
Nur Şimşek Yurt, Mahcube Çubukçu, Emine Öztürk
doi: 10.5505/anatoljfm.2021.96729  Pages 275 - 277
Purple urine bag syndrome (PUBS) is a rare condition characterized by purple discoloration of the urinary drainage system. PUBS may be alarming for healthcare professionals and patients' relatives. PUBS is characterized by the production of indigo (blue) and indirubin (red) pigments by colonized bacteria in indwelling urinary catheters of patients. Contact of these pigments with a urinary catheter or a plastic urine bag made from polyvinyl chloride (PVC) causes purple discoloration of the urine. In this case report, we aimed to present the PUBS developing in a patient who had a history of breast cancer, chronic renal failure, stroke and hypertension and a long-term indwelling urinary catheter.

15.Combined Laparoscopic and Fluoroscopic Removal of Intrauterine Contraceptive Device Embedded in the Omentum
Çağlar Helvacıoğlu, Berna Buse Kobal
doi: 10.5505/anatoljfm.2021.59389  Pages 278 - 280
A 32-year-old female patient presented with abnormal menstrual bleeding after copper intrauterine contraceptive device (IUD) insertion. Direct abdominal radiograph showed the IUD in the lower abdomen. Fluoros-copy was required to locate the device embedded in the omentum during laparoscopy. If the IUD cannot be visualized during laparoscopy, fluoroscopic imaging can be useful.

LETTER TO THE EDITOR
16.Fighting against Infodemic during COVID-19 Vaccination
Hüsna Çevik
doi: 10.5505/anatoljfm.2021.69077  Pages 281 - 282
Abstract | Full Text PDF

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