The Effects of Workload Excess on Quality of Work Life in Third-Level Healthcare Workers: A Structural Equation Modeling Perspective.

Examining the workload and working conditions of healthcare workers is crucial regarding the quality of the work life of employees and the quality of services provided. This study aims to determine the effects of the perceptions of workload on the quality of work life of health personnel working in two different tertiary hospitals affiliated with the Ministry of Health and the Higher Education Institution in Türkiye with structural equation modeling. This study was conducted in two hospitals in Malatya province: Inönü University Turgut Özal Medical Center affiliated with the Higher Education Institution and Malatya Training and Research Hospital affiliated with the Ministry of Health. The mean score of the Individual Workload Perception Scale was 106.18 ± 16.5, and the mean score of the Work-related Quality of Life Scale was 66.39 ± 15.33. Total workload scores had a statistically significant positive effect on total quality of work life scores (ß1 = 0.98; p = 0.001). It was concluded that there was a statistically significant relationship between workload and quality of work life and age, unit of employment, working time in the profession, and hospital type.

Prediction of effective sociodemographic variables in modeling health literacy: A machine learning approach.

INTRODUCTION: Health literacy is becoming a more important concept for the effective use of health systems day by day. The main purpose of the study is to determine the importance levels of the variables by using Machine Learning methods in order to determine the main factors affecting health literacy, and to find the most important variables for health literacy. MATERIAL AND METHODS: 1001 participants with a mean age of 18.05 ± 0.81 standard deviations were included in the study. The European Health Literacy Scale was used to determine the health literacy level of the participants. The scale cut-off point is 25, and 516 (51.5%) of the participants have low health literacy and 485 (48.5%) have a high level of health literacy. In the study, XGBoost, random forest, logistic regression models from machine learning methods were used and indexes were calculated. RESULTS: When the results of XGBoost, random forest, logistic regression models were evaluated, it was found that the model with the best performance was XGBoost. Sensitivity, specificity, F1-score, AUROC and Brier score values for the XGBoost models were obtained as 0.979, 0.965, 0.973, 0.983, 0.054 respectively. CONCLUSION: It was found that HL levels differed significantly in the variables of gender, age, class, family education, place of residence, economic situation, and covering health expenses (p < 0.05). According to the XGBoost model, it was found that the variable with the highest level of importance was reading the newspaper, while the variable with the lowest level of importance was the educational status of the mother. With the help of the established model, the basic variables that will affect the HL level were determined. The designed model will constitute the basic step of an supporting design system to improve physician-patient communication.

The Relationship of Methylated Arginines with Urine Cadmium Levels.

BACKGROUND: In this study, we aimed to show that methylated arginines are the predictors of non-clinical atherosclerotic cardiovascular complications in metal workers exposed to Cd. METHODS: The 80 Cd-exposed metal workers and 80 non-exposed workers (control) included in the study were available for measuring arginine, ADMA, SDMA, and L-NMMA levels. RESULTS: The average urine Cd levels (CdU) found were 1.03 ± 0.8 µg/g creatinine (0.84 ± 0.65 µg/L) ranging from 0.01 to 3.00 µg/g creatinine in the control group and 5.41 ± 5.2 µg/g creatinine (4.29 ± 3.81 µg/L) ranged from 0.11 to 27.2 µg/g creatinine in metal workers. On the other hand, the median ratios of the different groups (exposed and control) were found to be 449.35 and 483.88 for arginine/ADMA and 1.28 and 1.33 SDMA/ADMA, respectively. CONCLUSIONS: The present study was undertaken to investigate the relationship between cadmium exposure and methylated arginines such as ADMA/SDMA/L-NMMA parameters which is important for the early detection atherosclerotic cardiovascular diseases.

Assessment of potential cardiovascular risk in trichloroethylene exposure by serum methylated arginine levels.

Trichloroethylene (TCE) is a widely used solvent in industrial applications and has toxic effects on various systems. Methylated arginine amino acids (eg asymmetric dimethyl arginine (ADMA), symmetric dimethyl arginine (SDMA)) cause the development of cardiovascular disease by inhibiting NO synthesis, which is considered to be heart-protector. The aim of this study is to determine the risk of cardiovascular diseases in TCE exposure by methylated arginine biomarkers. About 98 controls and 100 TCE-exposed male subjects were included in the study. Trichloroacetic acid (urinary metabolite of TCE), arginine, homoarginine, citrulline ADMA, SDMA, and N-monomethyl L-arginine (L-NMMA) levels were found significantly higher than control group (p < 0.001). The strongest correlation was found between ADMA and Trichloroacetic acid (TCA) level (r = 0.453, p < 0.01). Long-term TCE exposure, may be an important risk factor for cardiovascular diseases by increasing methylated arginine levels.

The relationship between impaired lung functions and cytokine levels in formaldehyde exposure.

Exposure to formaldehyde (FA) causes detrimental effects on respiratory system. Inflammation is one of the mechanisms responsible for these effects. Our aim is to demonstrate the possible effect of formaldehyde on inflammation biomarkers and pulmonary function tests. One hundred ninety-eight male workers in a fiber production factory are included. Eighty two of them were not exposed to FA. Thirty nine workers were exposed to FA for 4 h or more in a work shift and 77 workers were exposed less than 4 h. Statistically significant differences were found for FA, TNF-α, and IL-6 levels and pulmonary function test parameters (FEV1 and FVC) between no exposure and exposure groups. The results revealed a correlation between decrement in pulmonary function tests and an increase in cytokine levels concordant with the duration of FA exposure. The results may emphasize that FA exposure shows its effect on pulmonary system via inflammatory pathways.

Assessment of Endothelial Dysfunction with Methylated Arginines and L-arginine in Cadmium-Exposed People: a Pilot Study.

BACKGROUND: Workers can be exposed to cadmium (Cd) in various industries. On the other hand, another potential source for Cd exposure is the food chain and smoking. Environmental pollution to Cd plays an important role in the development of atherosclerosis. Asymmetric dimethyl arginine (ADMA) levels promote the development of endothelial dysfunction and atherosclerosis-related diseases such as hypertension, acute coronary syndrome, congestive heart failure, and peripheral vascular diseases. The aim of this study is to evaluate the cardiovascular risks of non-symptomatic cadmium-exposed workers and to promote the value of methylated arginines in screening of toxic exposures. METHODS: A total 176 participants were included in the study which has been separated as control group (n = 79) and Cd-exposed group (n = 94). Inductively Coupled Plasma Mass Spectrometry (ICP-MS) was used for toxicological analysis of Cd levels. Also, liquid Chromatography-Mass Spectrometry (LC-MS/MS) was used for levels of methylated arginines such as ADMA, symmetric dimethylarginine (SDMA), NG-monomethyl-L-arginine (L-NM-MA), homoarginine, and citrulline. RESULTS: Statistically significant differences were observed for control and Cd-exposed groups, respectively as follows: Cd levels (0.25 ± 0.13 µg/L and 1.33 ± 0.61 µg/L), ADMA (0.16 ± 0.04 µmol/L and 0.22 ± 0.11 µmol/L), SDMA (0.21 ± 0.06 µmol/L and 0.27 ± 0.07 µmol/L), L-NMMA(0.02 ± 0.01 µmol/L and 0.03 ± 0.01µmol/L), and arginine/ADMA levels (695.82 ± 620.63 and 478.30 ± 432.61). CONCLUSIONS: Our results suggest that workers chronically exposed to Cd showed imbalances in endothelial parameters.

Changing levels of selenium and zinc in cadmium-exposed workers: probable association with the intensity of inflammation.

Inflammation is a response mediated by multiple cytokines, such as IL-6, IL-10 and TNF-α. Cadmium (Cd) has been involved in the etiopathogenesis of many diseases via inflammation. Selenium (Se) and zinc (Zn) play a pivotal role in maintaining many physiological functions of cells as well as inhibiting Cd-induced cytotoxicity. This study investigated the anti-inflammatory effects of Se and Zn in cadmium-exposed workers by measuring the levels of IL-6, IL-10 and TNF-α cytokines in 68 control and 91 Cd-exposed subjects. Blood samples were obtained from each participant for immunological, toxicological and routine analysis. All samples were digested by microwave oven and analysed by inductively coupled plasma mass spectrometry (ICP-MS). IL-6, IL-10 and TNF-α cytokine levels were found to be statistically different (p < 0.001) between the control and Cd-exposed groups (23.50 ± 7.70 pg/mL vs. 69.05 ± 19.06 pg/mL; 28.61 ± 9.83 pg/mL vs. 51.79 ± 11.77 pg/mL; 3.44 ± 1.14 pg/mL vs. 5.79 ± 1.04 pg/mL, respectively). High positive correlations were found between Cd levels of participants and IL-6, IL-10, TNF-α and CRP levels (r = 0.568, r = 0.615, r = 0.614 and r = 0.296, respectively, p < 0.01). In terms of the regression analysis results, there were significant effects of Cd on IL-6, IL-10 and TNF-α levels (p < 0.05). The Cd, Zn and Se levels between control and exposed group were significantly different [0.26 ± 0.15 µg/L vs. 3.36 ± 1.80 µg/L; 143.91 ± 71.13 µg/dL vs. 121.09 ± 59.88 µg/dL; 92.98 ± 17.03 µg/L vs. 82.72 ± 34.46 µg/L (p < 0.001, p < 0.03, p < 0.015), respectively]. In conclusion, increasing levels of Se and Zn decreases the intensity of inflammation as measured by IL-6, IL-10 and TNF-α levels.

TNF-α and IL-6 as Biomarkers of Impaired Lung Functions in Dimethylacetamide Exposure.

BACKGROUND: Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) are well-known biomarkers of systemic inflammation that have been associated with many diseases in the past. In this study, we aimed to determine the relationship between impaired lung functions and the levels of these biomarkers in DMAc exposed people. METHODS: 101 non-exposed control subjects (Group 1) and 109 DMAc-exposed workers from the polyvinyl chloride (PVC) industry were included in the study. In the next step, the exposed group was divided into two groups according to the level of exposure (Group 2 and 3). DMAc, TNF-α, IL-6, creatinine, ALT, AST, GFR and standard spirometry measurements were carried out in all subjects. RESULTS: When compared to the control group, TNF-α and IL-6 levels were significantly high compatible with the increase of DMAc levels, in the exposed groups. Urinary DMAc Levels were 0.06 mg/L in the control group. This level is significantly low when compared to exposed and severely exposed group (2.43 mg/L and 3.17 mg/L). TNF-α levels were 56.86 pg/mL, 145.52 pg/mL and 230.52 pg/mL in control, exposed and severely exposed groups. IL-6 levels were found to be 38.08 pg/mL, 89.19 pg/mL and 116 pg/mL for control, exposed and severely exposed groups, respectively. Similarly, the FEV1/FVC ratio decreased especially in the severely exposed group (p 0.001). CONCLUSIONS: In our study, results have revealed that TNF-and IL-6 levels are promising biomarkers in the early diagnosis of lung function impairment in inhalational DMAc exposure.

The effects of occupational lead exposure on selected inflammatory biomarkers.

In exposure to toxic metals such as lead, determining lead and cytokine levels (IL-6, IL-10, and TNF-α) is essential for early detection of diseases. The aim of this study was to develop an model for early detection of inflammation and onset of atherosclerosis in the absence of clinical findings in young workers, which could help physicians take timely an action and start treatment. This study included 49 metal workers exposed to lead occupationally and 50 unexposed administrative workers (controls) who underwent immunological analysis for cytokines (IL-6, IL-10, and TNF-α) and atherosclerosis markers (h-FABP and VCAM-1), toxicological analysis for lead, and routine biochemical analysis (ALT, AST, creatinine) at the Ankara Occupational and Environmental Diseases Hospital in 2017. Lead levels correlated with IL-6, IL-10, and TNF-α (r=0.469, r=0.521 and r=0.279, respectively, p<0.01) but did not significantly affect h-FABP and VCAM-1 levels.

The effects of indoor and outdoor sports participation and seasonal changes on vitamin D levels in athletes.

OBJECTIVE: Nowadays, people tend to spend more time in the closed areas and benefit less from sunlight. In this study, we examined the results of vitamin D measurements of athletes from different disciplines in different months and aimed to determine if the synthesis of vitamin D decreases or not according to exercise environment and month. METHODS: The study was conducted in participants aged 5-52 years. A total of 555 elite-level sportsmen who were admitted to our Sports Medicine Clinic in the study participated in this study. Indoor and outdoor environmental and seasonal effects on the measurements in different months were statistically evaluated. Independent-samples test and definitive statistics were used for statistical analyses and a p-value less than 0.05 has been considered significant. RESULTS: The study group consisted of 229 male and 326 female athletes. The serum 25-hydroxyvitamin D concentration was observed; 120 (21.6%) athletes have severe serum vitamin D deficiency (<11-20 ng/mL). Vitamin D levels were not significantly different from outdoor athletes (393; 70.8%). Winter measurements of vitamin D levels were significantly lower than those measured in autumn (p = 0.000). CONCLUSION: Increasing vitamin D levels are very important especially in participating athletes and additional supplements are recommended whenever necessary. Gender and indoor/outdoor sports participation showed no statistically significant outcomes on vitamin D levels. However, winter season had a negative effect on vitamin D levels. Therefore, adequate precautions should be taken to increase vitamin D, especially during winter, to maintain the best performance of the athletes.

Arsenic-induced inflammation in workers.

Occupational and environmental exposures to metal and metalloids can result in neurotoxicity and immunotoxicity. Selenium (Se) is essential for the proper functioning of neutrophils, macrophages, natural killer (NK) cells, T-lymphocytes and other immune mechanisms, while zinc (Zn) is a trace element essential for basic cell activities, including cell growth and differentiation. Arsenic (As) may lead to different types of immunosuppressive effects. This study consisted of 62 male workers, who had been exposed to arsenic for different durations and 73 non-exposed male workers (control group) with no history of occupational toxic metal exposure. Whole blood and serum samples were taken from each participant for immunological, toxicological and routine analysis during their annual periodical examination. Arsenic, selenium and zinc levels were determined by the ICP-MS and cytokines, IL-6, IL-10, TNF-α, sE-selectin and VCAM-1, were measured by ELISA. There were statistically significant differences (p < 0.001) between control and As-exposed group in As (1.37 ± 0.42 vs. 4.27 ± 1.54 µg/L) and Se levels (106.37 ± 48.04 vs. 74.70 ± 30.45 µg/L). The changing levels of As, Zn and Se seems to affect the severity of inflammatory reactions based on IL-6, IL-10 and TNF-α levels (r = 0.755, r = 0.679 and r = 0.617, respectively, for all p < 0.01). Selenium was found to have a suppressive effect on cytokines, as evidenced by Pearson correlations and regression analysis. These findings support the need to closely monitor Se levels in individuals exposed to arsenic and benefits for Se supplementation in the case of arsenic exposure, occupationally or environmentally.

Knowledge, attitudes and behaviors of breast and cervical cancers and screenings of women working in primary health care services.

PURPOSE: Determination of information attitudes, behaviors and related factors on breast and cervical cancer screenings of primary health care workers. METHODS: The population of the study consisted of 1,130 female health workers working in health facilities (Community Health Centers, Family Health Centers) that provided primary health care services in the province of Mersin. The fieldwork was carried out in October 2017-February 2018 period. There were 62 questions in the survey form. There were questions about socio-demographic and living conditions in the first 19 questions and breast and cervical cancer in the next 43 questions. RESULTS: In the study, 87.8% of the target group could be reached, 84.8% of the physicians and 88.2% of the non-physician health professionals. The mean age was 38.93 ± 7.89. Of the group 14% were physicians and the rest were health workers such as midwives, nurses, health officers and medical secretaries, while 47.7% of the group had at least 1 relative who was diagnosed with cancer. More than 90% of the group said that breast and cervical cancer could be diagnosed early and treated if diagnosed early. Of the group 95.3% knew how to do breast self-examination (BSE) and 90.1% of those who knew were doing BSE. The most common response to the question of what should be done for early recognition of breast cancer was BSE and Pap smear test in cervical cancer. The physician group was more advantageous than the other staff in knowing and practicing BSE and in what period it should be done. The most common symptom of breast cancer was the presence of a mass or swelling in the breast. Of the subjects in the target age group, 21.9% of those who think they are at risk had never had a Pap smear test and 14.3% have not had a gynecological examination. CONCLUSIONS: Although these findings indicate that health care professionals are more knowledgable in terms of breast and cervical cancer screening than non-health care workers, it is necessary to motivate healthcare professionals to increase their level of knowledge and practice on cancer screening. The most important means of achieving this is to ensure that in-service trainings, cancer screenings and the risks to be taken in case of non-screening are mentioned seriously.

The Mersin Greenhouse Workers Study. Surveillance of Work-related Skin, Respiratory, and Musculoskeletal Diseases.

BACKGROUND: Skin, respiratory, and musculoskeletal diseases in greenhouse workers are frequently observed due to exposure to plant products and pesticides in enclosed conditions and ergonomic risks. Current studies on occupational health risks of greenhouse workers in Turkey are insufficient. OBJECTIVES: The aim of the present study was to assess work-related skin, respiratory, and musculoskeletal diseases in greenhouse workers in the Erdemli province, Mersin, an area with a workforce predominantly active as greenhouse workers. METHODS: The study population consists of adult greenhouse workers, who visited their family physician between June 12-14, 2017 and were diagnosed with dermatological, respiratory, and musculoskeletal diseases. Immediately after this consultation, occupational physicians conducted face-to-face interviews, asking questions about sociodemographic features and occupational factors including current and previous work, current exposures and relation of current symptoms with work. RESULTS: In total, 423 workers with 555 diagnoses were included in the study. Percentages of diagnoses were 30.1%, 21.6% and 48.3%, for skin, respiratory and musculoskeletal diseases respectively. Nearly half of participants had taken an absence from work due to those diseases. Mean age of onset for greenhouse working was 15.5 years. Almost all participants (96.2%) reported contact with chemicals, and usage of respiratory protection was low (17.3%). Pesticides were regarded as a risk factor by nearly two-thirds of workers with skin or respiratory system disorders. Participants' answers to questions regarding the relationship between their diseases and their work was positive for more than half of patients and patients with skin and respiratory diseases. Nearly half of the patients with musculoskeletal diseases attributed their complaints to physical overload at work. CONCLUSIONS: We found evidence of work-relatedness in almost half of the 555 greenhouse workers with dermatological, respiratory and musculoskeletal diseases. These findings are helpful in creating an awareness program. There is a need for a more detailed assessment of the cases and the related working conditions to start a tailored prevention program.

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.

[Determination of the effect on the proximal femoral load distribution of diaphyseal cement support in femoral intertrochanteric fractures with calcar defect by finite element analysis]. / Kalkar defekti olan femur intertrokanterik kiriklarinda diafizer çimento desteginin femur üst uç yük dagilimina etkisinin sonlu element analizi ile tayini.

OBJECTIVES: This study aims to investigate biomechanically positive and negative aspects of arthroplasties in combination with diaphyseal cement support as an alternative to calcar supported prosthesis on the proximal femoral load distribution, using finite element analysis method in a virtual environment in intertrochanteric fractures with calcar femoral defect. MATERIALS AND METHODS: Three femur models were created using the ANSYS method. These were named as a intertrochanteric fracture model without calcar defect, an intertrochanteric fracture model with thick cement mantle and calcar defect, and an intertrochanteric fracture model with thin cement mantle and calcar defect. In the finite element analysis setting, two regions were analyzed for load distributions. The first one was the whole femur, while the other one was the region starting from trochanter minor and extending distally to the 5 cm area. RESULTS: In the trochanteric fracture model without calcar defect, the stress value in the whole femur was found to be 22.9 MPa; whereas it was 29.2 MPa in the 5 cm long section starting at the trochanter minor. The stress values were 23.6-29.9 MPa in the intertrochanteric fracture model with thick cement mantle and 24.2-32.1 MPa in the intertrochanteric fracture model with thin cement mantle and calcar defect. The statistical analysis was performed using t-test and a p value of >0.005 was found in all. CONCLUSION: Our study results showed that forming a type of calcar to be used in a hemiarthroplasty surgery and shaping of this region with bone cement does not produce further stress on the cement/bone intersection in intertrochanteric fractures with defected calcar region.