MATERIAL METHOD
The ethics committee of our faculty approved this case control study.
Dermatology patients with acne complaints (over 18 years old,
volunteered to participate) were included through one month period. Age
and gender matched healthy relatives of the patients who applied to
Dermatology and Family Medicine Outpatient Clinics without acne and
accompanying dermatosis were included as the control group. The
exclusion criteria were: refusal to participate the study, being under
18 years old and over 65 years old, mental retardation, verbal
communication defects, people whose native language was not Turkish,
diagnosed gastrointestinal disease, previous gastrointestinal surgery,
diabetes mellitus, thyroid diseases, Addison’s disease, presence of
diseases known to alter gastrointestinal functions, pregnancy, using
drugs that affect intestinal habits such as iron preparations and
antacids 3 weeks prior to the study.
In the first part of the questionnaire, the demographic characteristics
of the participants (age, gender, marital status, educational status,
profession, economic status, smoking-alcohol habits, diagnosed diseases,
previous operations, people they live with, diet) were questioned and
the global acne score was calculated. In the second part, Bristol Stool
Scale, Rome III Criteria, International Physical Activity
Questionnaire-Short Form, Hospital Anxiety Depression, KADF (dietary
fiber information) scalesfulfilled.
The global acne grading system (GAGS) is used to determine the clinical
severity of acne. The upper part of the face, chest and back region is
divided into six parts, taking into account the width of the region and
the density and distribution of the pilosebaceous unit in that region, a
coefficient for each region are (forehead, right cheek and left cheek =
2 , nose and chin = 1, chest and upper back = 3) given. Acne lesions
were also graded between 0-4 according to their types (no lesions = 0, 1
comedone = 1, 1 papule = 2, ≥1 pustules = 3, ≥1 nodules = 4). Each
region is evaluated separately, the score obtained according to the most
severe lesion type in that region is multiplied by the coefficient of
that region, and a score is determined for each region, and the global
acne score is calculated with the sum of the scores of the six regions.
The total score ranges from 0 to 44, acne severity is determined
according to the global acne score. (0 point = no acne, 1-18 points =
mild acne, 19-30 points = moderate acne, 31-38 points = severe
acne,> 39 points = very severe acne) (8).
HAD (Hospital Anxiety-Depression) Scale:
It was developed and validated by Zigmond and Snaith in 1983(32). It
includes anxiety and depression subscales. It consists of 14 items,
seven of them are depression (2., 4., 6., 8., 10., 12., 14) and seven
are anxiety (1., 3., 5., 7., 9., 11., 13.) screening. Answers are in
Likert format and scored between zero to three. Questions 2,4,7,9,12 and
14 are scored as 0,1,2,3 points and 1, 3, 5, 6, 8, 10, 11 and 13.
questions are scored as 3,2,1,0 points. The scores from both subscales
may vary between 0-21 points. The Turkish validity and reliability study
of HADS has been conducted by Aydemir et al (33). Cut-off scores of the
Turkish version of the HADS scale are 10 points for anxiety subscale and
7 points for depression subscale(9).
KADF (Knowledge about dietary fiber) Scale:
Guine et al developed it in 2016. Its validity and reliability were
tested by multicenter studies including Turkey(10). Awareness about
Foods with Dietary Fiber is evaluated with 6 questions, the Relationship
between Dietary Fiber and Various Foods with 6 questions and the
Relationship between Dietary Fiber and Diseases with 10 questions. The
questions 3.4, 3.5, 5.2, 5.3, 5.4 and 5.6 are evaluated in reverse. The
higher scores indicate the higher the level of knowledge about food
fibers (10).
Rome III Criteria:
The Rome III criteria was published in 2006 and Turkish validity and
reliability of was performed by Uran et al in 2012(11). Presence of at
least 2 or more of the following along with recurrent abdominal pain or
discomfort that exists for at least 3 days each month for the last 3
months, provided that it began at least 6 months before diagnosis(12).
1. Defecation recovery
2. Beginning with a change in the frequency of defecation
3. Beginning with a change in the form of gaita
* Supportive symptoms (not required for diagnosis)
1. Abnormality in the frequency of defecation
2. Anomaly in the form of gaita
3. Abnormal feces passage (feeling of strain, urgency or complete
emptying)
4. Mucus outflow from the rectum
5. Feeling bloated (12).
International Physical Activity Questionnaire-Short Form (IPAQ-SF):
It was developed by the International Consensus group in Geneva in 1998
to evaluate the physical activity levels of individuals in international
standards. Then, in 2000, it was accepted as a valid and reliable scale
in 12 different countries. Sağlam et al. found in their study that both
the short and long forms of IPAQ were valid and reliable in Turkish.
This questionnaire evaluates the physical activity levels of individuals
in the last seven days in four parts such as vigorous activities,
moderate activities, walking and sitting. When calculating the total
score, when the metabolic equation (MET) values given to the
activities (intensive activity = 8 MET, moderate activity = 4 MET,
walking = 3.3 MET) are multiplied by the duration of the activities
(min) and the frequency of doing (number of days), the weekly MET- min
scores are obtained. Physical activity levels of the individuals are
divided into three categories as ”inactive”, ”minimally active” and
”very active” according to the scores obtained(13).
Statistical analysis
Number, percentage, mean and standard deviations were used to evaluate
descriptive statistics. Shapiro Wilk and Kolmogorov Smirnov tests were
used to check the compatibility of the data for normal distribution.
Chi-square test for statistical analysis of categorical data, for
statistical analysis of quantitative data, an independent t test in
paired groups, One Way ANOVA test (post hoc Tukey test) in groups with
three or more, Mann Whitney U and Kruskall Wall tests are used.
Statistical significance of the difference was accepted as p
<0.05. Correlation between parameters are made with Pearson
correlation analysis. Correlation coefficient (r); Between 0.000-0.249
will be considered as weak relationship, between 0.250-0.499 as medium,
between 0.500-0.749 as strong, between 0.750-1.000 as very strong
relationship.