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.