Public awareness of and support for smoke-free legislation in Turkey: a national survey using the lot quality sampling technique.

Six months after new legislation in Turkey banning smoking in all public places, a national survey was carried out to assess its implementation. This paper summarizes the main findings on the public's awareness of and support for the new law. In a household interview survey of 32 972 adults representative of the Turkish adult population, a high proportion of both non-smokers and current smokers (91.4% and 67.2% respectively) strongly supported the new law. Knowledge about the health hazards of passive smoking and support for the law, however, were relatively lower among smokers than non-smokers. After controlling for smoking status, people with better knowledge about passive smoking were over 5 times more likely to support the new law. Tobacco control activities should be tailored to local needs, with afocus on increasing awareness about the health hazards of passive smoking. The study also demonstrated application of the lot quality sampling technique (LQT) for monitoring tobacco control activities in a national survey.

Maternal deaths associated with H1N1 influenza virus infection in Turkey: a whole-of-population report.

OBJECTIVE: To review the clinical and demographic characteristics of pregnant and postpartum women who died as a consequence of influenza A H1N1 (2009) infection in Turkey. DESIGN: A review of the records for pregnant and postpartum women who died as a consequence of H1N1 influenza virus infection. SETTING: Nationwide in Turkey. POPULATION: Thirty-six pregnant or postpartum women who died as a result of confirmed pandemic H1N1 influenza virus infection. METHODS: Using the General Directorate of Mother and Child Health and Family Planning (MCHFP) Registry of the Ministry of Health of Turkey, we identified all pregnant and postpartum women who died as a result of confirmed influenza A H1N1 (2009) infection between 29 October and 31 December 2009. MAIN OUTCOME MEASURE: Maternal mortality as a result of H1N1 virus infection. RESULTS: The average time from symptom onset to initial presentation for health care was approximately 2.5 days, and the mean time from symptom onset to the receipt of antiviral medication was approximately 5.5 days. Only one-fifth of all women received early antiviral treatment (administered 2 days or less after symptom onset) and only one woman was vaccinated for H1N1 influenza 1 week before the onset of symptoms. The cause-specific maternal mortality ratio for H1N1 influenza infection in Turkey was estimated to be 3.01. The calculated risk of death associated with H1N1 influenza virus infection was approximately four times higher in pregnant and postpartum women than in the general population (relative risk, 3.88; 95% confidence interval, 2.77-5.43). CONCLUSIONS: Pregnant women are at increased risk for complications of, and death from, H1N1 influenza infection. Prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. Vaccination for H1N1 influenza may reduce the total number of deaths in pregnant and postpartum women. The high cause-specific maternal mortality rate suggests that H1N1 influenza virus infection may have increased the 2009 maternal mortality ratio in Turkey.

Serosurveillance study on transmission of H5N1 virus during a 2006 avian influenza epidemic.

In 2006 an outbreak of avian influenza A(H5N1) in Turkey caused 12 human infections, including four deaths. We conducted a serological survey to determine the extent of subclinical infection caused by the outbreak. Single serum samples were collected from five individuals with avian influenza whose nasopharyngeal swabs tested positive for H5 RNA by polymerase chain reaction, 28 family contacts of the cases, 95 poultry cullers, 75 individuals known to have had contact with diseased chickens and 81 individuals living in the region with no known contact with infected chickens and/or patients. Paired serum samples were collected from 97 healthcare workers. All sera were tested for the presence of neutralizing antibodies by enzyme-linked immunoassay, haemagglutination inhibition and microneutralization assays. Only one serum sample, from a parent of an avian influenza patient, tested positive for H5N1 by microneutralization assay. This survey shows that there was minimal subclinical H5N1 infection among contacts of human cases and infected poultry in Turkey in 2006. Further, the low rate of subclinical infection following contact with diseased poultry gave further support to the reported low infectivity of the virus.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey).

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

An outbreak caused by hantavirus in the Black Sea region of Turkey, January-May 2009.

We present a preliminary report of 12 laboratory-confirmed cases of haemorrhagic fever with renal syndrome (HFRS) in Turkey, diagnosed between January and May 2009 according to the clinical symptoms and serological confirmation. Studies are still ongoing to better understand the dynamics of the reservoir population as well as the epidemiological characteristics and risk factors among humans.

Recent findings on pertussis epidemiology in Turkey.

The World Health Organization (WHO) reports that pertussis remains one of the least well-controlled vaccine-preventable diseases. It is supposed that the incidence of reported pertussis among adolescents, adults, and young infants has increased over the past decade. The aim of this study is to evaluate recent epidemiological data on pertussis in Turkey by regions. Data on vaccination coverage and pertussis incidence between 1986 and 2005 obtained from the Expanded Programme on Immunization national surveillance database of the Ministry of Health of Turkey were analyzed. Age and geographical distribution of the reported cases between 2000 and 2005 were evaluated. It was found that third-dose vaccination coverage increased from 1986 (45%) to 2005 (90%). In 2005, pertussis incidence tended to decrease (0.38 per 100,000) compared to 1986 (2.03 per 100,000). Even though only up to 6.5% of the cases were > or =15 years of age until 2005, 16.9% of them were included in this age group in 2005. It was observed that vaccination coverage rates steadily increased and pertussis incidence decreased by years despite some regional differences. In Turkey, pertussis incidence appears to be reaching the WHO targets, except East Anatolia. It is possible that waning immunity is responsible for the change of the age distribution of pertussis cases. However, priority should be given to strengthening available vaccination efforts throughout the country. A booster dose of pertussis vaccine in adolescence might be required in the future.

Cutaneous findings encountered in brucellosis and review of the literature.

BACKGROUND: Human brucellosis is an infectious disease produced by Brucella species: small, coccoid or rod-like, aerobic, Gram-negative bacteria. The infection is common in developing countries, and can also affect the skin. Its prevalence is high in our region of Turkey, where stockbreeding is one of the main economic sources, compared with the industrially developed areas of Turkey, and dermatologic complaints due to brucellosis are fairly common. MATERIALS AND METHODS: One hundred and three patients with serologically and clinically confirmed brucellosis were studied in order to investigate the prevalence of cutaneous findings and their variability in brucellosis. Fifty-two (50.49%) were males and 51 (49.51%) were females with an age range of 4-70 years (mean, 30.45 +/- 15.08 years). RESULTS: Of these patients, 14 (13.59%) had cutaneous findings probably related to brucellosis. These findings were more frequent in females (11 cases) than males, and most of the females (eight cases) were housewives; three were students. Urticaria-like papules and plaques were the most common findings; they were seen in six (35.3%) patients. One case had livedo reticularis and another palmar erythema, which have not been reported previously. No relationship was observed between the serologic values and the cutaneous findings. CONCLUSIONS: Cutaneous findings in our cases were more prevalent than in other reported studies. It is important to emphasize that cutaneous lesions are not specific to brucellosis and may be seen in a variety of other dermatologic diseases caused by many agents; therefore, these agents should be kept in mind in the differential diagnosis.

Hematological manifestations in brucellosis cases in Turkey.

The hematological findings of 233 patients with brucellosis are presented and the possible pathologies discussed. Anemia was present in 128 patients (55%), leukopenia in 49 (21%) and thrombocytopenia in 59 (26%). Bone marrow aspirates of 18 patients (8%) with pancytopenia were examined. The bone marrow was hypercellular in 15 and normocellular in 3 patients. Granulomatous lesions were detected in 12 cases (67%), and slight to moderate cytophagocytosis of erythrocytes, granulocytes and platelets existed in all patients. Blood cell counts reverted to normal within 2-3 weeks of initiating chemotherapy with recovery from the disease.