Missed opportunities for coronary heart disease diagnoses: primary care experience.

AIM: To investigate missed opportunities to reveal existing but not formerly diagnosed coronary heart disease cases and related risk factors in primary health care. METHODS: The study comprised 850 people aged over 30 years with no known history of coronary heart disease, receiving health services from a primary care center located in a suburban area of Antalya, Turkey. Data on their age, gender, education level, health insurance status, income, smoking behavior, and physical activities were collected. Undiagnosed coronary heart disease patients were determined by the Rose questionnaire, physical examination, and electrocardiogram. Height and weight, blood pressure, serum glucose and cholesterol levels were measured, and body-mass index and waist-hip ratio calculated. Each patient was given a risk score regarding age, smoking behavior, systolic blood pressure, and cholesterol levels. Estimated risk ratio of each person for developing coronary heart disease in the next decade was determined. RESULTS: The number of formerly undiagnosed coronary heart disease cases was 126 (14.8%). Overall mean (+/-standard deviation) risk score for developing coronary heart disease in the next decade in study group was 6.1+/-6.8. Diseases facilitating development of coronary heart disease: hypertension, diabetes, and hypercholesterolemia were present in 255 (30.4%), 70 (8.2%), and 364 (43.4%) participants, respectively. Obesity was detected in 315 (37.1%) subjects and there were 222 (26.1%) current smokers. For patients who attended primary health care, the estimated percentage risk for developing coronary heart disease in the next ten years was 7 to 45% in men and 2 to 45% in women. CONCLUSION: Opportunities to reveal coronary heart disease and its risk factors are being missed in primary care. Measures should be taken to ensure timely diagnosis of coronary heart disease and related risk factors.

[Investigation of cytomegalovirus seroepidemiology in Antalya with a population-based cross-sectional study and review of related data in Turkey]. / Antalya'da sitomegalovirus seroepidemiyolojisinin toplum kaynakli kesitsel bir çalisma ile arastirilmasi ve Türkiye verilerinin derlenmesi.

Since there are numerous studies on CMV seroprevalence in various groups in Turkey, the number of population based, age-stratified cross-sectional studies which include epidemiological characteristics of the virus are limited. The aim of the study was to investigate the age-stratified seroprevalence and epidemiological characteristics of CMV infection in Antalya (a province located in Mediterranean region of Turkey). Study group was selected by cluster sampling method. The sample size was calculated as 360 subjects (151 male, 209 female; age range: 1-49 years, mean age: 22.5 +/- 14.4 years), with an expected prevalence rate of 80%, at a confidence level of 95% and a sample error less than 5%. With the thought of the presence of maternal antibodies, 0-1 year age group was not included to the study. Serum samples have been screened for CMV-IgG, and those given negative results were also searched for CMV-IgM by a commercial microELISA (Radim, Italy) test. The overall seroprevalence of CMV-IgG was found as 93.6% (337/360) in Antalya municipality and IgM positivity was not detected in CMV-IgG negative sera. An increase in the seroprevalence rates was observed with age (p < 0.001), and the rate was found quite high (93.3%) for the first year of life. The seropositivities in the age groups of 1-6, 7-14 and 14-49 years were detected as 82.1%, 92% and 97.8%, respectively. The seroprevalence rate of 82.1% before the age of seven has rised to 96.8% after that age, and being > or =7 years old was found statistically significant in terms of CMV infection (p < 0.001, OR: 6.635). Ages one and seven were found to be the critical ages for CMV infection in our region. CMV seropositivity was 97.4% in woman at childbearing age (15-49 years). Gender, marital status, education, living area, residence, income, history of sexually transmitted diseases, surgery, blood transfusion and day care attendance did not contribute independently to the seroepidemiology of CMV (p > 0.01). In addition, the data of this study were evaluated and discussed together with the results obtained from the other Turkish studies, as far as accessible. In conclusion, since CMV seroepidemiology in Turkey differs as the socioeconomic changes occur, the changes in CMV serostatus and dire consequences of high seroprevalence rates on public health should be evaluated with prospective, population based studies in further years.

Effect of long-term swimming exercise on zinc, magnesium, and copper distribution in aged rats.

Trace element content of different tissues might be altered by both age and exercise training. We aimed to determine the effects of a 1-yr swimming protocol (60 min/d, 5 day/wk) on tissue levels and the distribution of zinc (Zn), magnesium (Mg), and copper (Cu) in aging rats. Three groups were formed: sedentary and trained old groups and a young control group. Tissue Zn, Mg, and Cu concentrations were measured in the kidney, heart, liver, lungs, and gastrocnemius and soleus muscles. Kidney zinc concentration significantly decreased in the sedentary old group compared to the young control group (p<0.01) and was significantly higher in the trained old group compared to the sedentary old group (p<0.01), whereas Zn levels in the soleus muscle significantly increased in the sedentary old group in comparison to young controls (p<0.05). Tissue Mg concentrations remained unchanged. The sedentary old group exhibited a significant decrease in kidney Cu concentration compared to the young control group (p<0.01). Although kidney Cu levels also decreased in trained old rats in comparison to young controls (p<0.05), they were significantly higher than in sedentary old rats (p<0.01). The decrease in kidney Zn and Cu content as a result of aging was partly prevented by long-term swimming exercise.