Association between occupational and environmental pesticide exposure in Cukurova region by hair and blood biomonitoring.

This study assesses association between occupational and environmental pesticide exposure on pesticide applicators directly exposed to pesticides and inhabitants of the Cukurova region by analyzing blood and hair samples. Hair and blood samples were collected from 132 volunteers, 66 of whom are pesticide applicators, and the rest are non-farmer residents, in 10 villages nearby the Ceyhan River between March and June in 2017. Samples were then analyzed via the liquid chromatography-tandem mass spectrometer. As the analysis result, a total number of 31 pesticides were detected in hair samples, whereas a total number of 15 pesticides were observed in blood samples. Twenty of the pesticides (64.5%) detected in the hair and 3 (20%) detected in the blood were significantly higher in the applicators than the non-farm residents. Also, 5 pesticides (16.1%) observed in the hair and 7 observed (46.6%) in the blood were banned pesticides. This study investigated the pesticide exposures on people living in the region via hair and blood samples. Our study revealed that, in addition to individuals who are occupationally exposed to pesticides, individuals from all parts of the society, especially those living in the agricultural region, have a certain level of pesticide exposure.

Vaccination rates for Syrian population under temporary protection in Turkey.

OBJECTIVES: The aim of this study was to gather information on demographic and health indicators, primarily vaccination status, of Syrians under temporary protection in five provinces of Turkey and to develop infrastructure for vaccination planning. METHODS: The population under study consists of 89,986 Syrian children, 0-4 years of age, residing in Ankara, Mersin, Gaziantep, Izmir, and Bursa. Initially, we planned to evaluate 2,339 children, although a total of 2,827 children were evaluated by the end of the study. RESULTS: Of these children, 74% were born in Turkey, while 20% were born in Syria. In addition, 22.4% (n = 634) of the children were never vaccinated, and of these, 67.0% (n = 425) were born in Turkey. In other words, one in five Syrian children born in Turkey (20.3%) had never been vaccinated. Of the Syrian children under temporary protection, the missing vaccinations were as follows: hepatitis B (54.7%); Bacillus Calmette-Guérin (62.5%); five-component combined vaccine (64.6%); conjugated pneumococcal vaccine (58.0%); oral polio vaccine (70.8%); measles, mumps, and rubella (76.6%); varicella (66.8%); and hepatitis A vaccine (76.0%). CONCLUSION: It is important to increase the immunization rates of Syrian children under temporary protection and establish regular vaccination procedures.

Knowledge Level, Attitude, and Behaviors of Farmers in Çukurova Region regarding the Use of Pesticides.

INTRODUCTION AND PURPOSE: Farmers are particularly at high risk of pesticide exposure due to added risk from occupational exposure. The aim of this study is to evaluate knowledge level of farmers in the Çukurova region of the effects of pesticides, toxic symptoms, and protective equipment as well as assessing their attitudes and practices regarding pesticides. MATERIAL AND METHOD: A total of 420 seasonal agricultural workers in Karatas District of Adana Province, Turkey, were included in the study. The questionnaire form consisting of 3 sections was administered using face-to-face interview method. RESULTS: The mean age of the participants was 40.2 ± 10.6 years. They were engaged in farming for a mean duration of 18.5 ± 10.6 years. All of them used pesticides, but none of them had been trained on the use of pesticides. Only 26.2% of them stored pesticides in a private depot. The farmers who took empty pesticide containers to special collection bins or centers constituted only 4.3% of them. While 84.0% of them thought that pesticides could have a negative impact on human health, 5.0% of them had experienced a medical problem and 1.0% of them were poisoned after applying pesticides. CONCLUSION: The results show that knowledge level of farmers of safe use of pesticides is very inadequate. This lack of knowledge adversely affects workers' quality of life as well as occupational health and safety. Appropriate training programs should be organized to increase their level of knowledge.

Investigation of the factors affecting mother's exclusive breastfeeding for six months.

AIM: The aim of this study is to investigate the socio-demographic characteristics and psychopathologic features of mothers living in Cukurova, Adana and to investigate the effect of these characteristics on exclusive breastfeeding status for the first six months. MATERIAL AND METHODS: This is a cross sectional study. 284 randomly selected women were reached in the study, between November 2015-February 2016. A questionnaire consisting of 27 questions which determine sociodemographic characteristics and brief symptom inventory were applied. As for the statistical evaluation, SPSS 19 Package Software for Windows was used. For the statistical analysis; frequency tables, average scores from the brief symptom inventory, chi square test, Mann-Whitney U and Multiple logistic regression analysis were used. RESULTS: 37.0% of the mothers gave exclusive breastfeeding for first six months. Those who graduated from high school and upper school, those who were educated in breastfeeding, those who breastfed for the half hour after birth, and those who did not work had a significantly higher rate of giving only breast milk for the six months. However, the rate of breastfeeding in first six months was significantly lower for women those who lived together with their elders and smokers. The mean scores from brief symptom inventory were significantly higher in mothers who did not give breast milk only during first six months. CONCLUSION: Exclusive breastfeeding rate was 37% in the first six months of our study. The postpartum period is a period in which the risk of psychiatric discomfort increases and the mother should be supported.

Living Conditions, Access to Healthcare Services, and Occupational Health and Safety Conditions of Migrant Seasonal Agricultural Workers in the Çukurova Region.

OBJECTIVE: Migrant seasonal agricultural workers who are employed in one of the most hazardous occupations in Turkey experience difficulties in accessing health-care services. The aim of this study is to investigate the living conditions, access to health-care services, and occupational health and safety conditions of migrant seasonal agricultural workers in the Çukurova region. METHODS: Four hundred migrant seasonal agricultural workers were contacted in the county of Karatas located in the province of Adana, Turkey. A four-section questionnaire was administered using face-to-face interview techniques. RESULTS: The mean age of the participants was 32.8 ± 12.4 years. One-fourth of the participants did not have any social security coverage. Almost all had a monthly income below minimum wage, and 98% were living in tents. One-fifth experienced health problems in the last year, and 63% of them visited a health-care facility for diagnosis and treatment. About 3.3% of the participants sustained injuries at work, and only 23% of them visited a health-care facility. CONCLUSION: The findings of the study show that migrant seasonal agricultural workers in Turkey have insufficient working conditions, wages, accommodation facilities, nutrition opportunities, health conditions, and occupational health and safety conditions. This insufficiency negatively affects life qualities of the workers, utilization of health-care services, and their occupational health status and safety.

The knowledge and high seroprevalence of hepatitis A in a high-risk group (agricultural reproductive-aged women) in the southeastern region of Turkey

Background/aim: The aim of this study was to determine the seroprevalence of antihepatitis A virus (HAV), risk factors, and the knowledge of female farm workers living in the Southeastern Anatolia Region (SAR) of Turkey. Materials and methods: This representative cross-sectional survey was conducted between January and April of 2013 in the SAR. A total of 705 reproductive-aged women were randomly selected by clustering method using Epi Info software. The sera were analyzed for anti-HAV antibodies using ELISA. Sociodemographic information and the knowledge of female farm workers regarding hepatitis A were collected using a questionnaire. Results: Of the female farm workers, 99.1% were seropositive for anti-HAV. The anti-HAV seroprevalence was significantly higher in the adults than in the adolescents (P < 0.05). Of the participants, 64.5% had 7 or more family members, 58.4% had 5 or more pregnancies, 68.1% were illiterate, 65.2% were family farmers, 90.6% were poor, 71.9% used unsafe water, 58.9% had toilets outside, and 68% had no knowledge about hepatitis A. Conclusion: Turkey is considered to have high endemicity and female farm workers are considered a high-risk group for hepatitis A. This high HAV exposure might be reduced with vaccination, as well as improvements in sanitation, living conditions, health care utilization, safer drinking water, and health education.

Knowledge, attitudes and behaviours of women regarding breast and cervical cancer in Malatya, Turkey.

The aim of this study is to gather information about the knowledge, attitudes and behaviours of women regarding breast and cervical cancer, to increase the knowledge level of the relevant age group and to begin including the relevant age group in screening programs. This cross-sectional study is composed of 6910 women aged 30-69 years in Malatya, Turkey. The study aimed to reach 1782 women with a survey, and all of them were reached. The questionnaire form was completed with face-to-face interview. For statistical analysis, data were evaluated as number and percentage distributions. The average age of the women was 45.6±11.4. Nearly half of the women (46.4%) did not know that scans for early detection of breast and cervical cancers were free. Only 22.2% of women knew that breast cancer could be diagnosed early by mammography. 72.7% had never received a mammogram. One third (31.6%) of women did not know it was possible to recognize cervical cancer early, and two thirds (64.5%) of women had not received a Pap smear test. It has been determined that Turkish women do not have adequate knowledge about cancer diagnosis, early cancer diagnosis, and screening.

Assessment of rational use of drugs and self-medication in Turkey: A pilot study from Elazig and its suburbs.

The concepts of "essential drugs" and "national drug policy" described by the World Health Assembly in 1975 were the first steps taken towards the rational use of drugs (RUD). According to WHO, more than half of all medicines worldwide are prescribed, dispensed or sold inappropriately and half of the patients fail to take them appropriately. The aim of this study has been to evaluate the habits of patients related to RUD with a specific aim to investigate the factors associated with self-medication. This descriptive survey study was carried out in Elazig, located at the Southeastern region of Turkey. A Rational Usage of Drug Questionnaire", querying the socio-demographic characteristics, health status, knowledge and manners of people with respect to rational drug use and insensible consumption of over the counter (OTC) drugs was applied to a total of 3521 patients during 19.09.2014 to 26.09.2014.The number of females and males were almost equal and the majority were in the range of 25-45 years of age. It was found that 58.9% of patients were practising some form of self-medication, 29.4% of the patients were reported using antibiotics without prescriptionand55.5% of them discontinued antibiotherapy. Self-medication was found to be more common among males, more educated patients and less frequent among patients under 18 years and over 65 years of age and patients with a chronic disease. Patient awareness about RUD is inadequate in Turkey as in many countries. Considering the high rates of haphazard use of drugs, drug usage without prescription, i.e. OTC drugs, should be discouraged. It is possible to take significant steps towards increasing awareness in terms of RUD with the cooperation of physicians, health organizations, educational institutions, non-governmental organizations and media. Might then be possible to achieve the expected benefits of the drugs.

Haemoglobinopathy Awareness among Young Students in Turkey: Outcomes of a City-Wide Survey.

The success of prevention programs demonstrated the importance of raising awareness about haemoglobinopathies since the lack of knowledge and awareness about the disorders may serve as barriers to prevention, disclosure of disease status as well as to testing for haemoglobinopathies. The aim of this study is to investigate the knowledge and attitudes of middle and high school students towards haemoglobinopathies in Hatay, where the disorders are prevalent. This cross-sectional study was conducted on 8th and 9th grade students across Hatay including all sub provinces. From May 2012 to December 2012, a total of 1925 students filled the questionnaires which query the knowledge level and attitudes of students by face to face method. Among questions regarding students' knowledge about haemoglobinopathies, the lowest correct response rate was observed in "How do these diseases transmit?" with 31.8%, meaning most of the students did not know that the diseases are transmitted by heredity. Significant differences were observed between the correct answer rates of the students and their status of being previously informed. Students who had a diseased person around were having a 2.597-fold (95%CI = 1.886-3.575); students possessing at least one parent at secondary education level or above were having a 1.954-fold higher probability of being previously informed (95%CI = 1.564-2.443). Due to the lack of knowledge about haemoglobinopathies in middle and high school students, we suggest health education programs including informative lectures particularly about the genetic basis of the disorders especially in the regions where the disorders are prevalent.

Cervical Cancer Screening in an Early Diagnosis and Screening Center in Mersin, Turkey.

Cancer is a major public health problem due to the jeavy disease burden, fatality and tendency for increased incidence. Of all cancer types, cervical cancer is reported to be the fourth most common cancer in women, and the seventh overall, with an estimated 528,000 new cases worldwide in 2012. It features a long preclinical phase with slowly progressing precancerous lesions such as CIN 2 and 3 and adenocarcinoma in situ. Therefore, screening programs such as with Pap smear tests may play an important role in cervical cancer prevention. The purpose of this study was to present results of a Pap smear screening survey for cervical cancer targeting women living in an urban area in the province of Mersin, located in the Mediterranean region of Turkey. This community- based descriptive study included women living at Akdeniz county of Mersin province. A total of 1,032 screened women between 30 and 65 ages within the routine screening programme constituted the study population. The mean age of the participants was 43.8 ± 8.6 (min. 30, max. 65) years. The percentage of the participants who had previously undergone smears was 40.6%. Epithelial cell changes were found in 26 (2.5%) participants, with ASC-US in 18 (1.7%), ASC-H in 2 (0.2%), LSIL in 5 (0.5%) and HSIL in 1 (0.1%). The most common clinical presentation together with epithelial changes was abnormal vaginal discharge. Taking into account the presence of women who had never undergone Pap test; it should be offered at primary level of health care in the form of a community-based service to achieve reduced morbidity and mortality rates.

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.

Evaluation of married haemoglobinopathic carrier couples for prevention of haemoglobinopathic births.

BACKGROUND: Abnormal haemoglobins (Hb) and thalassaemias are some of the most frequently observed hereditary disorders in the world, but especially in the Mediterranean region where Turkey is located. Hatay province is one of the largest provinces in the region, suggested as a target area to be selected for preventive programs after studies by three Turkish universities, i.e. Çukurova, Akdeniz and Hacettepe Universities in Turkey. AIMS: The aim of this study was to determine demographic and family characteristics of all haemoglobinopathy carrier married couples registered in the Hatay Provincial Health Directorate registry and to educate the target population about pregnancy, births, prenatal diagnosis and genetic counselling with the particularly emphasised scope of eliminating all haemoglobinopathic births. STUDY DESIGN: Descriptive cross-sectional and intervention study. METHODS: 1065 couples both being haemoglobinopathic carriers, registered in the Hatay Provincial Health Directorate registry were investigated for socio-demographic characteristics, obstetrical status and especially for a present pregnancy, the presence of any haemoglobinopathic patients or carrier children in the family. RESULTS: Among women with a history of pregnancy, 47.3% reported that they had never had any prenatal testing, while 33.1% had got received testing in each of their pregnancies. The most frequent reason for not having the test was declared as unawareness of the test (66.0%), followed by economic insufficiencies (17.1%), destiny/religious reasons (9.1%) and family interference (7.8%). After a series of descriptive analyses, the results of the final binary logistic regression model constructed to find out the risk factors significantly affecting the presence of a sick child in the family were grouped as risk increasing factors like age (95%CI between 1.002 and 1.122), marriage before 1994 (95%CI=1.081-4.161), and risk decreasing factors like family willingness for screening (95%CI=0.167-0.854), rate of prenatal testing (95%CI=0.147-0.414), age at first pregnancy (95%CI=0.469-0.882); while the frequency of births was found to have no significant effect (p>0.05). CONCLUSION: Besides all legal regulations and applications, time is still needed for real success against such a diffuse and congenitally transferred disease. The education of the target populations appears to be crucial. Official applications should be forced based upon present or future laws.

Evaluation of depression in newly diagnosed breast cancer cases in Hatay province of Turkey in 2011.

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females in Turkey. The main problems experienced by women with breast cancer are physical losses, emotional distress and degradation in family, work and social roles. The purpose of this cross-sectional retrospective study was to investigate the socio-demographical characteristics and depressive symptoms of 125 newly diagnosed cases with breast cancer reported to cancer control department of Hatay provincial health directorate in 2011. To evaluate the depressive symptoms the Beck Depression Inventory (BDI) was used. All 125 cases who participated in the study were female. The mean age was 49.2 ± 11.9. The mean BDI score of the cases was 17.5 ± 10.6. The number of cases whose BDI scores were 17 and above was 65 (52.0%), and the number of cases whose BDI scores were under 17 was 60 (48.0%). The most striking finding in our study was that only 4 of the cases were receiving psychological help and support. The rate of depression was found high in our study and psychological support is a must for patients with a life threatening disease such as cancer.

Cervical cancer screening in Turkey: a community-based experience after 60 years of pap smear usage.

Cervical cancer is the second most common cancer in females in the World with around 500,000 new cases occurring annually, but the first in the developing countries with a high mortality if not diagnosed early. Papanicolau (Pap) smear is a cheap, easy-to-apply and widely accepted test which has been long used to detect cervical cancer at very early stages. However, despite being available for nearly 60 years, the test can hardly be considered to have become successfully applied in many communities. We aimed in this study to present the results of a screening survey for cervical cancer which targeted a women population aged between 35 and 40 living in a semi-rural area in the province of Hatay, located in the eastern Mediterranean region of Turkey, with specific aims of increasing early diagnosis, education and raising population awareness about cancers. This community-based descriptive study covered 512 women between 35 and 40 years of age living at Armutlu with a mean age of 37.6±1.7. Gynecologic examinations revealed cervical erosion in 8 (1.6%), vaginitis in 193 (37.7%) and normal findings in 311 (60.7%); pathological evaluation reports of the smears were negative in 290 (56.6%), inflammation in 218 (42.6%) and ASC-US in 4 (0.8%), according to the 2001 Bethesda classification. It can be concluded that Pap smear test - proven to be a very valuable test at the clinical level- should also be widely used at the community level to detect cervical cancer at very early stages to reduce both the mortality and morbidity among healthy people. The need for continuous community-based cervical cancer screening programs is strongly suggested.

[Population density of Phlebotomus (Diptera; Psychodidae; Phlebotomine) species and their relationship with cutaneous leishmaniasis in Hocalli and Iurunçlu Villages (Adana)]. / Hocalli ve Turunçlu (Adana) Köylerinde Phlebotomus (Diptera; Psychodidae; Phlebotomine) Türlerinin Populasyon Yogunlugu ve Kutanöz Leishmaniasis ile Iliskisi.

The aim of this study was the detection of cutaneous leishmaniasis (CL) cases at Turunçlu and Hocalli Villages, Adana, Turkey, where local cases had been observed in recent years, and to determine possible vectors and their seasonal density distribution. This was for the purpose of encouraging public awareness and thus leading to prevention. An initial questionnaire was responded by 567 people, with a male-to-female ratio of 45% to 55%. The physician in the research group examined the whole population of both villages for CL and then made monthly visits in order to detect new cases. Adhesive paper traps and CDC light traps were placed in houses and animal stables in order to collect sandflies, whose species were later determined in the laboratory. The CL prevalence was found to be 7.2%, with 30 old cases and 11 new cases. The number of cases in the Turunçlu Village was high with 17 men and 24 women affected. The case frequencies were not different between men and women (p > 0.05). The houses being whitewashed or kind of animal feeding were not found to affect the frequency of CL. In the two villages, 88 Phlebotomus were detected. P. papatasi and P. tobbi were of the genus Phlebotomus, while the genus Sergentomia was also observed. P.papatasi was most frequent in adhesive paper traps, while P.tobbi was frequent in light traps.

High prevalence of diabetes in Adana, a southern province of Turkey.

OBJECTIVE: To determine the prevalence of diabetes and glucose intolerance and their relationship with risk factors in Adana, a southern province of Turkey, where risk factors are more prominent, probably because of social and economic reasons. RESEARCH DESIGN AND METHODS: The study population included 1637 randomly selected adults aged 20-79 years. Diagnosis of diabetes was based on plasma glucose values using the 1999 diagnostic criteria recommended by the World Health Organization. RESULTS: The crude prevalence of diabetes was 12.9% in men and 10.9% in women (P = 0.207). Total prevalence of diabetes was 11.6%. The screening process identified previously undiagnosed diabetes in 4.2% of individuals and impaired glucose homeostasis (consisting of impaired glucose tolerance and impaired fasting glucose) in an additional 4.3% of subjects. The prevalence of hypertension was 26.4% among men and 36.6% among women (P < 0.0001). Total prevalence of hypertension was 32.9%, and prevalence of obesity was 43.4%. Age, sex, BMI, waist circumference, hypertension, family history of diabetes, and triglycerides were independently associated with diabetes. CONCLUSIONS: The prevalence of diabetes in Adana is higher than expected in both urban and rural areas. Obesity and hypertension also seem to be common metabolic disorders in this area. Age, hypertension, obesity, high triglyceride level, and family history of diabetes are independently associated with diabetes. Therefore, primary prevention through lifestyle modifications may have a critical role in the control of diabetes.