Colorectal cancer screening: understanding the needs of the pre-screening group.

OBJECTIVES: For the last three decades, although colorectal cancer incidence has been decreasing in those over 50 years of age, it has been increasing in those under 50 included in the pre-screening group (PSG). The present study aims to explain the screening-related factors and compliance of individuals in PSG who are not included in the colorectal cancer screening programme. METHODS: This cross-sectional study was conducted with a total of 323 participants, 143 of whom were from the pre-screening group (40-49 years), and 180 from the screening included group (SIG) (50-70 years). RESULTS: Individuals included in PSG were more likely to have accepted that both faecal occult blood test (FOBT) (2.23 ± 1.22 vs. 1.89 ± 1.33, p = 0.018) and colonoscopy (2.37 ± 0.97 vs. 2.02 ± 1.14, p = 0.003) were useful and suitable screening tests in colorectal cancer. Adequate health literacy (OR = 4.3, 95% CI: 1.8-10.0, p = 0.001) and better education level (OR = 3.3, 95% CI: 1.3-8.4, p = 0.010) were factors of increased knowledge of colorectal cancer screening. CONCLUSIONS: The findings show that PSG has different characteristics than SIG and may be more fitting in the colorectal cancer screening programme if included.

Retrospective Analysis of Dermatological Diseases in Geriatric Patients During Dermatology Outpatient Department Visits.

Introduction: The elderly population is vulnerable to experience a great number of dermatological diseases thanks to the intrinsic and extrinsic process of aging. Objectives: The aim of this study is to retrospectively investigate the prevalence of dermatological diseases in geriatric patients, their distribution by age and gender, and to provide a reference for studies on aging and skin problems. Methods: In the present study, patients who reported to the dermatology outpatient clinic between January 1 2019, and January 1 2021, were evaluated retrospectively. As a result of examining the records of patients, 887 patients over the age of 65 who met the study protocol were included. Results: The three most common diseases in all geriatric patients were fungal infections, eczematous dermatitis, and pruritus. Fungal infections were frequent in males and the 65-74 age group. In the males, the more frequent were precancerous lesions and malignant neoplasms, whereas in the females it was urticaria and adverse drug reactions. In the logistic regression model, the risk of fungal infection in geriatric patients was increased by being male (odds ratio 1.55, P = 0.006) and being in the range of 65-74 years old (odds ratio 1.46, P = 0.025). Male patients were at significantly higher risk for precancerous and malignant lesions (OR:2.81 P < 0.001) and actinic keratosis (odds ratio 3.26, P < 0.001) in this disease group. Conclusions: Men are more vulnerable to life-threatening skin diseases. It is important to determine risk factors for individuals who are more sensitive to environmental factors in terms of increasing the quality of life and protection from diseases.

Protectivity of COVID-19 Vaccines and Its Relationship with Humoral Immune Response and Vaccination Strategy: A One-Year Cohort Study.

This prospective cohort study aimed to evaluate the efficacy of COVID-19 vaccine schemes, homologous versus heterologous vaccine strategies, and vaccine-induced anti-S-RBD-IgG antibody response in preventing COVID-19 among 942 healthcare workers 1 year after vaccination with the inactivated and/or mRNA vaccines. All participants received the first two primary doses of vaccines, 13.6% of them lacked dose 3, 50.5% dose 4, and 90.3% dose 5. Antibody levels increased with the increase in number of vaccine doses and also in heterologous vaccine regimens. In both inactive, mRNA vaccines and mixed vaccination, infection rates were significantly higher in two-dose-receivers, but lower in four- or five-dose receivers and increasing the total number of vaccine doses resulted in more protection against infection: the three-dose regimen yielded 3.67 times more protection, the four-dose 8 times, and five-dose 27.77 times more protection from COVID-19 infection, compared to any two-dose vaccination regimens. Antibody levels at the end of the first year of four- or five-dose-receivers were significantly higher than two- or three-dose receivers. To conclude, an increased number of total vaccine doses and anti-S-RBD antibody levels increased the protection from COVID-19 infection. Therefore, four or more doses are recommended in 1 year for effective protection, especially in risk groups.

The Use of Pesticides in Suicide Attempts in the Eastern Mediterranean Region of Turkey. / Türkiye Dogu Akdeniz Bölgesinde Intihar Girisimlerinde Pestisit Kullanma Durumu.

OBJECTIVE: In parallel with common usage areas, pesticide poisonings are encountered in the community due to reasons such as no wearing of protective clothing and masks during use, unintentional consumption and suicide-intended intake. In this study was aimed to examine the cases who applied to the emergency department with pesticide poisoning and share of suicide cases. METHOD: This study is a retrospective record study based on the files of 234 patients who reported to the emergency department for pesticide and rodenticide poisoning between 2014 and 2018. The patients were compared in terms of sociodemographic, substance type, prognosis, and accident/suicide status. Chi-square test, Binary logistic regression analysis were used in the analysis of the data. RESULTS: Organophosphates was the most common substance recorded as a cause of poisoning, while rat poison placed second. 38% of the acute poisoning cases were suicide attempts. Poisoning among men was found to be prominently due to accident whiles among women suicidal poisoning was more prominent. While the mortality rate is 4.7% in all acute intoxication cases, the mortality rate in poisonings with suicidal purposes is 5.6%. Patients with psychiatric diseases have a 28-fold higher risk of intoxication of attempting suicide. The most common comorbid psychiatric disorders in acute pesticide poisoning are anxiety and depression. CONCLUSION: A major proportion of pesticide poisoning cases is suicide attempts. Suicide attempt is at the forefront in women and death rates are higher in people with psychiatric illness. It may be advisable to avoid the easy accessibility of pesticides.

The risk estimation and assessment of heavy metal exposure by biomonitoring in the breast milk of mothers in the Cukurova Region, Turkey.

Toxic heavy metals released into the environment through various industrial processes have potential adverse effects on the environment and human health. In order to reveal these adverse health effects, it is vital to carry out toxicological studies by performing biomonitoring. This study aimed to assess the level of Cr, As, Cd, Hg, and Pb in the breast milk samples of mothers in the Cukurova region, Turkey, and its association with health risk to infants. Ten-milliliter postpartum milk samples were collected from 34 breast-feeding mothers in the first 2 months of their postpartum period and living in the Cukurova region, Adana. The measurement of target heavy metals levels was performed by using inductively coupled plasma mass spectroscopy (ICP-MS). The average breast milk levels of Cr, As, Cd, Hg, and Pb were 8.25, 1.64, 0.37, 2.60, and 12.12 µg/L, respectively. Evaluation of breast milk samples for these toxic heavy metals revealed the high exposure level for Cr and As. However, the mothers who participated in the study were not occupationally exposed to these metals. This study showed that Cr, As, Cd, Hg, and Pb cross the placenta and blood-brain barrier prenatally and accumulate in breast milk postnatally.

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.

Effects of immunization program on morbidity and mortality rates ofvaccine-preventable diseases in Turkey

Background/aim: This study aims to serve as a unique consolidated source in Turkey's vaccination history and as an example for other countries by objectively revealing the change in mortality and morbidity rates in Turkey following the beginning of vaccination without asserting any claim on the benefits or risks of vaccines. This unbiased research will also help health professionals identify the challenges more easily when they face with the people who hesitate to vaccinate their children. Materials and methods: Descriptive research design is adopted in this study. The coverages of vaccinations, mortality, and morbidity rates were identified through a retrospective analysis of the data provided from the Ministry of Health of Turkey. The data provided by the Turkish Statistical Institute were used for the identification of the population by the year. Mortality and morbidity rates were calculated based on these data Results: Morbidity rates, mortality rates, and vaccine coverages are all presented in years. Successful interventions have been observed in the eradication of polio, the elimination of maternal neonatal tetanus, and also in combating with other diseases. A decline in pertussis mortality from 0.59 to 0.06 along with a decline in diphtheria morbidity under to 0.0001 were recognized; additionally the last death due to poliomyelitis was observed in 1998. Only 4 deaths occurred in the measles epidemic in 2013. With the initiation of vaccination, both the morbidity of the rubella with the ratio of 3.12/100,000 and the mortality of pumps with the ratio of 25/100,000 fell to zero. Also, no death due to neonatal tetanus has been recorded since 2014. Conclusion: The present study demonstrates that many possible diseases and deaths have been prevented through vaccination studies. In this regard, this study demonstrating the importance of vaccination presents that all individuals in the society have a responsibility in this scope when the communicable diseases and wars are taken into consideration. The main responsibility is to ensure that they and their children are vaccinated against communicable diseases that are risky for society's health.

An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy.

OBJECTIVES: The objectives of the study were to analyze the clinical characteristic of diabetic cheiroarthropathy (DCA) in patients with type 1 diabetes mellitus (DM), type 2 DM, and prediabetes and to evaluate the frequency of DCA among groups. METHOD: The cross-sectional study was conducted at the Division of Endocrinology and Metabolism outpatient clinic over a 14-month period. A total of 239 patients (160 female, 79 male), who had type 1 DM, type 2 DM, and prediabetes, were enrolled. The demographics, clinical variables, and laboratory outcomes were recorded. Diabetic cheiroarthropathy was defined according to physical examination. The functional disability of patients with DCA was assessed by the self-administered questionnaire (disabilities of the arm, shoulder and hand-DASH). RESULTS: Diabetic cheiroarthropathy was determined in 35.1% of all patients. The frequency of DCA was higher in patients with prediabetes (x2 = 0.009, post hoc power = 0.794). According to the logistic regression analysis, prediabetes (OR = 4.52, 95% CI 2.16-9.47, p < 0.001), presence of polyneuropathy (OR = 3.82, 95% CI 1.61-9.07, p = 0.002), and fasting glucose level (OR = 1.01, 95% CI 1.00-1.01, p = 0.004) found as the most effective risk factors in determining DCA. DASH disability scores were significantly higher in prediabetic patients than that in type 2 DM group (p = 0.021). CONCLUSION: High frequency of DCA and impaired hand function are observed in prediabetic patients. Musculoskeletal manifestations can emerge as an early sign of diabetic status. Also, people who suffer from hand involvement should be examined for diabetes along with rheumatologic diseases.

Effects of Arginine Vasopressin and V1 Receptor Antagonist on Cerebral Vasospasm Secondary to Subarachnoid Hemorrhage: An Experimental Study.

AIM: To examine morphological, radiological and biochemical effects of arginine vasopressin (AV) and V1 receptor antagonist on cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) in rabbits. MATERIAL AND METHODS: Forty male New Zealand white rabbits were randomly divided into four groups comprising 10 rabbits each. The groups were; 1) Control group, 2) SAH group, 3) SAH+AV group, 4) SAH+V1 antagonist group. Diameters of the basilar artery in all groups were measured on angiograms. All animals were sacrificed two days following basilar angiography and tissue samples of basilar artery were obtained under microscope immediate after craniectomy for ultrastructural and biochemical examinations. RESULTS: The artery diameters were found to be 50% and 50% at the 30th minute in the groups 2 and 3 respectively. In group 3, CVS was 13% more in comparison with the 2nd group. In group 4, vascular constriction was 34.5% at the 30th minute and about 30.9% at the 300th minute. Despite the increase in regional blood flow, AV did not provide morphological change. Histological appearance was related to vascular stenosis due to CVS. Histological outcome was the best in group 4 because of less CVS. CONCLUSION: Arginine vasopressin plays an important role in CVS. We detected morphological and radiological recovery in basilar artery, besides moderate improvement due to AV receptor antagonist in CVS.

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.

Investigation of depression and quality of life factors in cancer patients' caregivers.

PURPOSE: This study aimed to explore depression and quality of life (QoL) factors among caregivers of patients with cancer and to better understand who the caregivers are and how caregiving affects them. METHODS: This descriptive study was conducted at the Medical Oncology Department of Cukurova University, Balcali Hospital. The study consisted of 150 cancer patients' caregivers who had been treated between September 1 and October 15, 2015. Percent distribution was used to evaluate the sociodemographic characteristics of caregivers. One way ANOVA, t-test and frequencies were used for other analyses. A p value <0.05 was considered statistically significant. RESULTS: Of the caregivers, 42.7% (n=64) were male, 67.3% (n=101) were married, 30% (n=45) had university education, and their mean age was 40.1±13.7 years. Also, 36% were offspring of the cancer patients. Of caregivers 51.3% were sharing the caregiving process with someone else. The mean value of Beck depression inventory (BDI) was 14.08±10.9 (min-max, 0-55). According to the values of the inventory, 42% were normal, 24.7% were mildly, 20.7% were moderately and 12.7% were severely depressed. A significant association was found between BDI and overall QoL (WHOQOL-Bref) for all domains (p<0.001). CONCLUSION: We believe that these results are a step toward identifying the associated factors for reducing caregivers' depression and ameliorating their QoL.

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.

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.