Evaluation of Blood Pressure Status and Mortality in Turkey: Findings from Chronic Diseases and Risk Factors Cohort Study.

Background and objectives: An important Non-Communicable Disease risk factor, hypertension (HT), is highly prevalent and controlled HT rates are not sufficient which increases the risk of developing premature deaths. The purpose of the study is to evaluate differences in all-cause and cardiovascular-related mortality according to HT status by using national data from Chronic Diseases and Risk Factors Survey in Turkey (2011-2017). Materials and Methods: Cox regression models were used to estimate hazard ratios (HR) for predicting the all-cause and cardiovascular system-related mortalities. Median follow-up period was 6.2 years. Results: Among individuals with HT, 41.8% was untreated, 30.1% received treatment and had controlled blood pressure, and 28.1% were under treatment but had uncontrolled BP levels. The hazard for mortality among treated & uncontrolled hypertensive participants was significantly higher for all-cause (HR = 1.32, 95% CI = 1.06-1.65), cardiovascular (HR = 2.11, 95% CI = 1.46-3.06), heart disease (HR = 2.24, 95% CI = 1.46-3.43), and Coronary Heart Disease mortality (HR = 2.66, 95% CI = 1.56-4.53) compared to normotensive participants. Conclusions: Individuals with HT who were treated but do not have controlled blood pressure in Turkey had a significantly increased risk of Cardiovascular Disease and all-cause mortality. Along with studies investigating the causes of uncontrolled blood pressure despite initiation of treatment, support should be provided to patients in cases of non-adherence to antihypertensive medication or life change recommendations.

30-day Readmission After an Acute Exacerbation of Chronic Obstructive Pulmonary Disease is Associated with Cardiovascular Comorbidity.

OBJECTIVE: Readmission after hospitalization for a chronic disease is a major concern of interest for health care quality. Our aim was to investigate the predictors and rates of early readmission after an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in a tertiary care hospital. MATERIAL AND METHODS: Over a 3-year period, patients hospitalized in our pulmonary disease clinic with a diagnosis of chronic obstructive pulmonary disease (COPD) and who had an index hospitalization for AECOPD were included. Readmission was defined as rehospitalization within 30 days of AECOPD discharge. Demographics, comorbidities, exacerbations, prior intensive care unit (ICU) stay, and long-term oxygen therapy (LTOT), blood eosinophil count, and antibiotic and/or steroid treatment at the index AECOPD admission were recorded. RESULTS: Fifty-two (17.3%) readmissions occurred in 300 patients. Readmissions were due to AECOPD in 46.2%, pneumonia in 19.2%, and cardiovascular disease in 15.4% patients. Twenty-one (40%) of the readmitted patients were frequent exacerbators. After adjusting for individual and clinical predictors, the odds ratio for readmission was 2.11 (95% CI, 1.07-4.15, P = .03) for those with congestive heart failure, 3.30 (95% CI, 1.05-9.75, P = .04) for those with arrhythmia, and 1.99 (95% CI, 1.04-3.81, P = .04) for LTOT users prior to AECOPD. CONCLUSION: A significant majority of patients readmitted after an AECOPD mainly suffered from recurrent AECOPD. Associated congestive heart failure, arrhythmia, and prior LTOT were risk factors identified for early AECOPD readmissions in our study. Better recognition of readmission risk factors might help to reduce readmission rates of AECOPD.

The development of a globally acceptable national model for occupational hygiene in Turkey: a modified Delphi study.

BACKGROUND: Although various organizations working in developed countries established the standards and approaches used in occupational hygiene, occupational hygiene professional interests and needs continue to develop in a global context. There is thus an urgent need for expanded occupational hygiene models. For successful field implementation, these models should be based on several sets of criteria, including those related to international standards, various national requirements, and multidisciplinary approaches. This is particularly important for countries in which no occupational hygiene model has been developed. This study thus examined the consensus on occupational hygiene standards among stakeholders in Turkey regarding the development of a national model. A modified Delphi study was conducted among key occupational health experts in Turkey who could aid in the relevant implementation, policy-making, and educational processes for such a model. Participants were selected from various governmental institutions, non-governmental organizations, trade unions, universities, and occupational health practices. RESULTS: The first-round findings were obtained from open-ended questions. The results revealed several requirements, including the adoption of an international hygiene definition, the official recognition of professional and practical areas in Turkish occupational hygiene, hygienist training methods, priorities, and competent institutions. Second-round findings indicated a consensus rate of over 80% regarding the need for implementation standards, training and education standards, requirements and priorities, and competent institutions for professionals working in the field of occupational hygiene. A third-round and SWOT analysis was also conducted among the group to confirm the consensus issues. CONCLUSIONS: The search for solutions and developmental expectations increases when awareness of internationalization and the need for common global standards increase. This developmental process may provide the basis for an appropriate model in developing countries.

A novel version of Copenhagen Psychosocial Questionnaire-3: Turkish validation study.

Purpose: The aim of the study was to adapt the Copenhagen Psychosocial Questionnaire Version-3 (COPSOQ-3) into the Turkish language.Methods: This is a methodologic study. The field study occurred in four workplaces (call center, hospital, plastic and metal industries). The Kaiser-Meyer-Olkin (KMO) Measure of Sampling Adequacy and Bartlett's Test of Sphericity were used to assess the suitability of the sample for factor analysis. The principal component analysis and varimax rotation methods were used to identify the factor structure.The internal consistency was assessed using the Cronbach's alpha coefficient.Results: In total, 1076 respondents' questionnaires were evaluated. Fifty-eight percent of the participants were men and the mean age was 31.1 ± 7.7. Sampling adequacy was considered adequate (KMO =0.929). The factor analysis of the Turkish COPSOQ (COPSOQ-TR) identified 19 factors with eigenvalues higher than one and explained 66.1% of the total variance. The Cronbach's alpha values of 23 dimensions were over 0.70. The Cronbach's alpha values of control over working time and predictability were 0.54 and 0.66, respectively. The model was an excellent fit (Chi-Square = 8514.5, x2/df = 2.48, RMSEA = 0.038, SRMR = 0.053, CFI = 0.98).Conclusions: Findings show that COPSOQ-TR is a reliable and valid instrument that can be a useful tool to measure psychosocial risks in the Turkish language.

The Third Version of the Copenhagen Psychosocial Questionnaire.

INTRODUCTION: A new third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) has been developed in response to trends in working life, theoretical concepts, and international experience. A key component of the COPSOQ III is a defined set of mandatory core items to be included in national short, middle, and long versions of the questionnaire. The aim of the present article is to present and test the reliability of the new international middle version of the COPSOQ III. METHODS: The questionnaire was tested among 23,361 employees during 2016-2017 in Canada, Spain, France, Germany, Sweden, and Turkey. A total of 26 dimensions (measured through scales or single items) of the middle version and two from the long version were tested. Psychometric properties of the dimensions were assessed regarding reliability (Cronbach α), ceiling and floor effects (fractions with extreme answers), and distinctiveness (correlations with other dimensions). RESULTS: Most international middle dimensions had satisfactory reliability in most countries, though some ceiling and floor effects were present. Dimensions with missing values were rare. Most dimensions had low to medium intercorrelations. CONCLUSIONS: The COPSOQ III offers reliable and distinct measures of a wide range of psychosocial dimensions of modern working life in different countries; although a few measures could be improved. Future testing should focus on validation of the COPSOQ items and dimensions using both qualitative and quantitative approaches. Such investigations would enhance the basis for recommendations using the COPSOQ III.

Socioeconomic factors associated with tobacco smoking in Turkey: a cross-sectional, population-based study.

BACKGROUND: Gender and lower socioeconomic status are associated with smoking. AIMS: This study aimed to determine the association between socioeconomic factors and cigarette tobacco smoking in Balcova, Izmir, Turkey, with a focus on gender differences. METHODS: The study population was all men and women (36 187) aged over 30 years living in Balcova from October 2007 to May 2009. Data were collected in interviews and included smoking status (current, former, never), age, gender, marital status, educational level, occupational class/working status, health insurance and having a chronic disease. Logistic regression analysis was used to evaluate the association between socioeconomic characteristics and smoking status. RESULTS: Of the 36 187 study subjects, 16 080 (44%) agreed to participate and 15 174 (42%) with complete data were evaluated. The majority were women (66.2%); mean ages of men and women were 53.1 (SD 13.1) and 51.3 (SD 13.2) respectively. Current smoking was higher in men (41.7% versus 31.2% of women), and more men were ex-smokers (33.1% versus 13.5% of women) but more women had never smoked (55.3% versus 25.2% of men). For women, being married and having low educational level were associated with current smoking and previous smoking (P < 0.05). Current smoking was also more frequent among working women (P < 0.05). For men, low educational level and occupational class were associated with being a current smoker and an ex-smoker (P < 0.05). CONCLUSIONS: Socially disadvantaged groups, especially those with low education or unemployed men, were more likely to be current smokers and smoking cessation was lower in these groups. Smoking habits were different in men and women. Socioeconomic factors should always be considered when developing smoking cessation policies.

Changes in Employment Status after Myocardial Infarction among Men.

BACKGROUND: According to the Turkey Burden of Disease Study, 10% of the national burden of disease is attributed to cardiovascular diseases. Although the standardized coronary heart disease (CHD) rate is falling in general, CHD prevalence among young people is rising. On the other hand, as a result of increased life expectancy and higher retirement ages, the CHD rate among workers is also increasing. Therefore, work ability and return to work after diagnosis are important for population health and well-being. Socioeconomic factors and working conditions may play a key role as well as clinical conditions described in the literature that affect returning to work. AIMS: The aims of this qualitative study are exploring the changes in employment and working conditions of the patients after acute myocardial infarction (AMI) and affecting factors such as socioeconomic, personal and environmental. STUDY DESIGN: Qualitative research. METHODS: The research population are fifty-three patients who are engaged in paid employment when the people have been diagnosed with myocardial infarction for the first time between 2011 and 2012 at a university hospital coronary care unit. We intended to reach the whole population. Twenty-seven patients were contacted whose phone numbers were accessible from the hospital records. Semi-structured in-depth interviews were conducted with twelve patients in a meeting room at the hospital. The interviews were tape-recorded accompanied by note-taking and the content analysis method were evaluated. RESULTS: While many of the participants continued to work at the same job by working less, one third of them said that they were thinking about getting an easier job if they have the opportunity. On the other hand, in most cases, there were neither assessments about their work ability, nor changes to their working conditions after AMI. They had to cope with their conditions, such as economic or psychosocial, without any support. CONCLUSIONS: While the patients have to return to work for economic and social reasons, they expressed uncertainty about working after a diagnosis of AMI and could not reach professional support to assess their work abilities. Therefore, specific algorithms and assessment tools to manage the return to work of AMI patients would be useful.

Potential benefits of healthy food and lifestyle policies for reducing coronary heart disease mortality in Turkish adults by 2025: a modelling study.

OBJECTIVE: This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking, physical activity levels, dietary salt, saturated fat intake, mean body mass index (BMI) levels, diabetes prevalence and fruit and vegetable (F&V) consumption on future coronary heart disease (CHD) mortality in Turkey for year 2025. DESIGN: A CHD mortality model previously developed and validated in Turkey was extended to predict potential trends in CHD mortality from 2008 to 2025. SETTING: Using risk factor trends data from recent surveys as a baseline, we modelled alternative evidence-based future risk factor scenarios (modest/ideal scenarios). Probabilistic sensitivity analyses were conducted to account for uncertainties. SUBJECT: Projected populations in 2025 (aged 25-84) of 54 million in Turkey. RESULTS: Assuming lower mortality, modest policy changes in risk factors would result in ∼25 635 (range: 20 290-31 125) fewer CHD deaths in the year 2025; 35.6% attributed to reductions in salt consumption, 20.9% to falls in diabetes, 14.6% to declines in saturated fat intake and 13.6% to increase in F&V intake. In the ideal scenario, 45 950 (range: 36 780-55 450) CHD deaths could be prevented in 2025. Again, 33.2% of this would be attributed to reductions in salt reduction, 19.8% to increases in F&V intake, 16.7% to reductions in saturated fat intake and 14.0% to the fall in diabetes prevalence. CONCLUSIONS: Only modest risk factor changes in salt, saturated/unsaturated fats and F&V intake could prevent around 16 000 CHD deaths in the year 2025 in Turkey, even assuming mortality continues to decline. Implementation of population-based, multisectoral interventions to reduce salt and saturated fat consumption and increase F&V consumption should be scaled up in Turkey.

Determinants of inpatient costs of angina pectoris, myocardial infarction, and heart failure in a university hospital setting in Turkey.

OBJECTIVE: This study aimed to determine the correlates of in-hospital costs for angina pectoris (AP), myocardial infarction (MI), and heart failure (HF) in a university hospital setting. METHODS: This is a retrospective cost-of-illness study using data from the records of patients who were admitted with AP, MI, or HF to Dokuz Eylül University Hospital during 2008. Direct medical costs were calculated from the Social Security Institute perspective using a bottom-up approach. Socio-demographic and clinical information was abstracted from patient files. Costs were presented in Turkish lira (TL). A generalized linear model was used in the multivariate analysis. RESULTS: We included 337 in-patients in total in the study. AP was present in 26.4% (n=89), MI was present in 55.8% (n=188), and HF was present in 17.8% (n=60) of patients. MI was the most costly disease (2760 TL), followed by HF (2350 TL) and AP (1881 TL). The largest proportion of the total cost was formed by medical interventions (27.5%), followed by surgery (22.2%). Presence of DM, smoking, diagnosis of MI, HF, need for intensive care, and resulting in death were strong predictors of treatment costs. CONCLUSION: Both preadmission characteristics of patients (diabetes mellitus, smoking, use of anti-aggregant before admission) and in-patient characteristics (diagnosis, coronary artery bypass grafting, intensive care need, death) predicted the hospital cost of cardiovascular diseases (CVDs) independently. Our results may be used as input for health-economic models and economic evaluations to support the decision-making of reimbursement and the cost-effectiveness of public health interventions in healthcare.

The effect of drospirenone (3 mg) with ethinyl estradiol (30 mcg) containing pills on ovarian blood flows in women with polycystic ovary syndrome: a case controlled study.

OBJECTIVE: To evaluate whether oral contraceptive pill (OCP) therapy has any effects on ovarian stromal blood flow by using pulsed and color Doppler at the end of 3 months follow-up period of OCP-users and non-users with or without polycystic ovary syndrome (PCOS). STUDY DESIGN: 200 patients were included in the study. The patients were designed into four groups as follows; Group 1: PCOS patients that received OCP containing 30 mcg ethinyl estradiol (EE) plus 3mg drospirenone for 3 months (DRP n=50); Group 2: PCOS patients that received no medication (n=50); Group 3: Healthy controls that received OCP (EE plus DRP) (n=50); Group 4: healthy controls that received no medication (n=50). Resistance index (RI) and pulsatility index (PI) of both ovarian arteries, hormonal, anthropometric and biochemical parameters were assessed before and after 3 months. RESULTS: There was a significant increament in RI and PI of both ovarian arteries in healthy controls (Group 3) and in women with PCOS (Group 1) who received OCP (p<0.001). The increment rate in both Doppler parameters were significantly higher in women with PCOS (Group 1) than healthy controls (Group 3) (p<0.001). Whereas RI and PI values of both ovaries remained unchanged in all untreated women with or without PCOS (Groups 2 and 4). CONCLUSION: OCP therapy reduced ovarian vascularization in both PCOS and healthy users after 3 months of therapy and this decrease is especially noticeable in women with PCOS.

Smoking habits and cessation success. What differs among adults and elderly?

OBJECTIVE: To determine factors affecting smoking cessation success in different age groups. METHODS: This was an intervention study consisting of 761 patients attending the Balcova Municipality, Smoke Cessation Center, Izmir, Turkey, between November 2009 and December 2011. Variables were successful smoking cessation for one year, socio-demographic features, previous attempts at smoking cessation, a smoking spouse, nicotine dependency level, risk of depression, method of smoking cessation, presence of chronic disease, and decreasing smoking in the last year. Data was analyzed by logistic regression. RESULTS: Approximately 43.8% of the elderly, and 62.7% of the adults reduced the number of cigarettes smoked in the past year. Approximately 83.6% of the elderly and 90.6% of the adults reported previously smoking 11 or more cigarettes daily. Two-thirds of the participants in both groups had tried smoking cessation. Smoking cessation was 49% in the elderly group and 33.4% in the adult group. The logistic regression test showed that moderate and less nicotine dependency level increased the success of cessation in the elderly group (odds ratio [OR]=2.39, 95% confidence interval [95% CI] 1.11-5.17, p=0.026), while in the adult group: increasing age (OR=1.02, 95% CI: 1.01-1.04, p=0.044), male gender (OR=1.69, 95% CI: 1.07-2.68, p=0.025), moderate and less nicotine dependency level (OR=1.65, 95% CI: 1.09-2.49, p=0.018), and the use of medication (OR=1.70, 95% CI: 1.13-2.56, p=0.011) increased the success. CONCLUSION: Different variables in different age groups may affect successful smoking cessation. These should be taken into consideration in efforts at smoking cessation.