Health Risks Management Program in Schools: An Operational Study in Türkiye.

This study was carried out to improve the quality of school health services with the operational epidemiology method. The study aimed to describe the current status of the School Health Protection and Improvement Program (SHPIP), the difficulties experienced during its implementation, to develop evidence-based solution methods, and to test the proposed solutions, in a district with a population of 400,513, 20.4% of which is of school age between the ages of 5-19. The "Health Risk Management Program at Schools", which consists of the stages of putting the results into practice by sharing the results with the relevant parties, wasdeveloped. In this study, a cross-sectional research design was employed using questionnaire forms, while qualitative data were collected through the use of the phenomenological analysis method, specifically through the conduct of focus group interviews. SHPIP year-end evaluation forms of 191 schools were reviewed retrospectively, questionnaires were applied to 554 school staff and 146 family health center staff between 21 October 2019 and 21 November 2019 using the probabilistic sampling (simple random) method, and semi-structured focus group interviews were conducted with 10 school health study executives. The most common health risks in schools and the risks identified during the execution of school health services were identified. In order to eliminate the lack of in-service training, training modules for "School Health Management Teams" were developed and impact analyses were conducted. After the intervention, a significant difference was found in the compliance of schools with SHPIP, and the application of all components of the school health program increased from 10.0% to 65.6% (p < 0.05). The program has been integrated into the "School Health Protection and Improvement Program" (SHPIP) with the decisions of the District School Health Board and District Hygiene Council.

Effects of individual differences, society, and culture on youth-rated problems and strengths in 38 societies.

BACKGROUND: Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies. METHODS: Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects. RESULTS: Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects. CONCLUSIONS: Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences.

Cutaneous Leishmaniasis due to Three Leishmania Species Among Syrian Refugees in Sanliurfa, Southeastern Turkey.

Sanliurfa, a city in southeastern Turkey, is host to 477,166 Syrian refugees. The incidence of cutaneous leishmaniasis (CL) may be on the rise in areas affected by a refugee crisis, like Sanliurfa; thus, consequently, local uncommon species of Leishmania may be encountered in these regions. This might potentially make diagnosis and treatment more challenging over time. In this study, it was aimed to identify the causative agents of CL in clinical samples. A total of 154 patients (60 Syrian and 94 Turkish) who were diagnosed with CL via microscopical examination and PCR were enrolled this study. All of the samples were analyzed using internal transcribed spacer 1 genes, restriction fragment length polymorphism, DNA-sequencing, and phylogenetic analyses. In this study, Leishmania tropica was determined to be the predominant species in 140 of the patients (90.9%), followed by Leishmania major in 12 patients (7.8%), and Leishmania infantum in 2 patients (1.3%). Of the 94 Turkish patients, 94.7% were infected with L. tropica and 5.3% were infected with L. major, while none were infected with L. infantum. However, of the 60 Syrian patients, 85% were infected with L. tropica, 11.7% were infected with L. major, and 3.3% were infected with L. infantum. There was a significant association between the Leishmania species and the nations (Turkish-Syrian) (P < 0.001). The sequences were numbered from MH347941 to MH347953 and submitted to GenBank. This study confirmed that L. tropica, L. major, and L. infantum coexisted in Sanliurfa. This was the first time that the species L. infantum was reported among recent immigrants from Syria in Sanliurfa. Therefore, it is necessary to discriminate the Leishmania species for diagnosis, treatment, and controlled studies in hyper-endemic regions.

Testing Syndromes of Psychopathology in Parent and Youth Ratings Across Societies.

As societies become increasingly diverse, mental health professionals need instruments for assessing emotional, behavioral, and social problems in terms of constructs that are supported within and across societies. Building on decades of research findings, multisample alignment confirmatory factor analyses tested an empirically based 8-syndrome model on parent ratings across 30 societies and youth self-ratings across 19 societies. The Child Behavior Checklist for Ages 6-18 and Youth Self-Report for Ages 11-18 were used to measure syndromes descriptively designated as Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior. For both parent ratings (N = 61,703) and self-ratings (N = 29,486), results supported aggregation of problem items into 8 first-order syndromes for all societies (configural invariance), plus the invariance of item loadings (metric invariance) across the majority of societies. Supported across many societies in both parent and self-ratings, the 8 syndromes offer a parsimonious phenotypic taxonomy with clearly operationalized assessment criteria. Mental health professionals in many societies can use the 8 syndromes to assess children and youths for clinical, training, and scientific purposes.

Persistent Organic Chlorinated Compound Residues in the Breast Milk of Female Seasonal Agricultural Workers.

OBJECTIVE: This retrospective descriptive study aimed to investigate organochlorine compounds in women who breastfeed and work as a seasonal agricultural worker (SAW). METHODS: It was carried out on 100 woman working as SAW. Data were collected with a questionnaire by face-to-face interview and analyzed the residues of 27 items of organochlorine pesticides, dichlorodiphenyltrichloroethane (DDT) metabolites and polychlorinated biphenyls, from persistent organic pollutants in mothers' 50 mL breast milk. Descriptive statistics, Chi-square test, and correlation analysis were used to evaluate data. RESULTS: Polychlorinated biphenyl (PCB)28 component was determined in almost all women's milk and more than half of collected milk contained beta-hexachlorocyclohexane (HCH), PCB52, pp'-dichlorodiphenyldichloroethylene (DDE), hexachlorobenzene (HCB), PCB70, pp'- dichlorodiphenyltrichloroethane (DDT) ve Gamma HCH, respectively. CONCLUSION: It was recommended that necessary legal regulations and public information policy about that subject should exist.

A community-based survey on Syrian refugee women's health and its predictors in Sanliurfa, Turkey.

Reproductive characteristics, mental health symptoms, micronutrient deficiencies, and symptoms of sexually transmitted infections (STIs) were determined among married Syrian refugee women aged 15-49 years who were living outside of camps in 2015, using probability sampling. Of the 458 participants, 51.3 percent married before the age of 18 years. Early-age marriages and number of desired children increased after the war. In multivariable analyses, education (adjusted odds ratio [aOR] = 1.2; 95% confidence interval [CI] = 1.2-1.3) and length of stay in Sanliurfa (aOR = 1.2; 95% CI = 1.1-1.2) were independently associated with early marriage. Approximately 16 percent of women were pregnant, and 26.7 percent of them had not received prenatal care; 47.7 percent had had a pregnancy loss; 50.8 percent reported symptoms of STIs. Of those who were sexually active, 37.8 percent were not using contraception. The prevalence of iron, B12, and folic acid deficiencies was 50 percent, 45.6 percent, and 10.5 percent, respectively. Early marriage (aOR = 2.2; 95% CI = 1.4-3.5) and number of desired children (aOR = 5.03; 95% CI = 3.2-7.9) were associated with not using contraception. Most (89.7 percent) women reported at least two mental health symptoms; lack of social support (aOR = 2.6; 95% CI = 1.3-5.3), language barrier (aOR = 2.3; 95% CI = 1.01-5.2), and B12 deficiency (aOR = 1.8; 95% CI = 1.01-3.4) were associated with such symptoms. The findings demonstrate the need for reproductive health and psychosocial services.

The knowledge and high seroprevalence of hepatitis A in a high-risk group (agricultural reproductive-aged women) in the southeastern region of Turkey

Background/aim: The aim of this study was to determine the seroprevalence of antihepatitis A virus (HAV), risk factors, and the knowledge of female farm workers living in the Southeastern Anatolia Region (SAR) of Turkey. Materials and methods: This representative cross-sectional survey was conducted between January and April of 2013 in the SAR. A total of 705 reproductive-aged women were randomly selected by clustering method using Epi Info software. The sera were analyzed for anti-HAV antibodies using ELISA. Sociodemographic information and the knowledge of female farm workers regarding hepatitis A were collected using a questionnaire. Results: Of the female farm workers, 99.1% were seropositive for anti-HAV. The anti-HAV seroprevalence was significantly higher in the adults than in the adolescents (P < 0.05). Of the participants, 64.5% had 7 or more family members, 58.4% had 5 or more pregnancies, 68.1% were illiterate, 65.2% were family farmers, 90.6% were poor, 71.9% used unsafe water, 58.9% had toilets outside, and 68% had no knowledge about hepatitis A. Conclusion: Turkey is considered to have high endemicity and female farm workers are considered a high-risk group for hepatitis A. This high HAV exposure might be reduced with vaccination, as well as improvements in sanitation, living conditions, health care utilization, safer drinking water, and health education.

Prevalence and predictors of mental health among farmworkers in Southeastern Anatolia of Turkey.

BACKGROUND: Mental health problems represent a major component of the global burden of disease. The primary objective of this study was to assess the prevalence and predictors of psychological wellbeing among farmworkers and to evaluate their mental health services need for in rural primary health care settings. METHODS: The study sample comprised 1855 farmworkers (918 women, and 937 men) who were selected using probability cluster sampling method at 95% confidence interval (87.6 % response rate). The 12-item General Health Questionnaire (GHQ-12) and socio-demographic information form were used to data collection. RESULTS: The overall prevalence of mental health problems was 31.5%; the prevalence among women was 1.4 times that of men (35%, females; 28.2%, males). Logistic regression analyses revealed that poor general health, as well as presence of chronic diseases and exposure to traumatic life events predicted mental ill health among both sex. Poor economic situation, being seasonal migrant farmworker, and pesticide exposure history affected male mental health problems; while type of settlement, history of having disabled child at birth, and not having a family physician were significant predictors of female mental ill health (P < 0.05). CONCLUSIONS: These findings highlight the need for systematic development of community-based mental health services in conjunction with rural primary health care center and an integrated approach to health care of farmworkers. These include screening, early identification and treatment of mental health problems, development of non-communicable disease (NCD) control program, maternal health services and urgent measures to improve farmworkers' work safety and pesticide applications.

Investigation of brucellosis in a female agricultural population in Turkey.

Much epidemiological information concerning brucellosis generally depends on the evaluation of hospital-based retrospective data. The aim of this study was to determine the prevalence and risk factors of brucellosis in female farmworkers in the south-eastern region of Turkey (GAP) in order to obtain a more representative analysis. Our representative community-based cross-sectional study was conducted during four months of 2013, in all nine GAP provinces. An optimum sample size was determined and blood samples were analysed from 707 reproductive-age female farmworkers using the Rose Bengal (RBT) and standard (SAT) agglutination tests. Sociodemographic information was collected during face-to-face interviews with consenting subjects. Crude odds ratios and 95% confidence intervals were calculated, and chi-square analyses and logistic regression were performed. Employment as a seasonal farmworker and having had five or more pregnancies were the only risk factors found to be significant. This study implies much greater priority needs be given to the control, early diagnosis and treatment in this population.

Prevalence of Violence: Male and Female Seasonal Agricultural Workers' Approach to Violence in Turkey.

The objective of this study is to determine the male and female seasonal agricultural workers' perception of violence, prevalence of violence, frequency of victimization, and their related factors. Quantitative and qualitative data were used, and 89.5% of women were exposed to violence that included the restriction of their human rights. The sample consisted of 1,211 women and 1,064 men. Their marital status, duration of work, and attention to their health affected the violence exposure. Arabic people who were unmarried, had a poor educational background, and poor health perception approved of the physical violence.

[Evaluation of epidemiological data of malaria between 2001-2011 in Sanliurfa, Turkey]. / Sanliurfa'da 2001-2011 yillarina ait sitma epidemiyolojik verilerinin degerlendirilmesi.

Although Plasmodium vivax is the only cause of malaria cases detected in Turkey, an increase number of imported P.falciparum cases have begun to be observed recently. Sanliurfa is a province located at Southeastern region of Turkey where malaria is endemic and also one of the two largest malaria epidemics of Turkey was experienced with 84.345 cases in 1994. As this region has borders with countries like Iraq, Iran and Syria, cross border migration caused an increase in imported cases. In addition, climate change, alteration in temperature and humidity due to the Southeastern Anatolian Irrigation Project have led an increase in suitable breeding grounds for mosquitoes. Since new indigenous malaria cases, except imported ones are not detected in Sanliurfa nowadays, there is not enough data on the malaria epidemiology in this region including recent years. The aim of this study was to evaluate the epidemiological data in connection with malaria cases observed in Sanliurfa which is a critical region for this infection for a 11-year-period, between the years of 2001 to 2011, retrospectively. Data obtained from the Malaria Control Unit of the Communicable Diseases Division of Sanliurfa Provincial Health Directorate were analized in terms of frequency of the cases, distribution of the cases in years and months, demographical characteristics, the source and species distribution of the parasite and the locations of the disease. A total of 1.149.196 blood smear samples have been examined during 11-year-period as part of surveillance programme and 4394 (0.4%) of them were positive for Plasmodium spp. The agent was P.vivax in 99.9% (4391/4394) of the cases, while in three cases (0.07%) who were diagnosed after 2010, it was P.falciparum. Of the patients 2351 (53.5%) were male and 2043 (46.5%) were female (p> 0.05), whose age ranging from 3 months to 80 years (mean age: 19.21 ± 16.12 years). The frequencies of the cases according to the age groups 0-11 months, 1-4 years, 5-9 years, 10-14 years and 15 years were as follows; 2.5%, 15.1%, 18%, 13.9% and 50.5%, respectively. The detection of Plasmodium spp. in the samples examined in 2002 (1244/110.533; 1.1%) was the highest, and in 2011 (1/50.981; 0.002%) was the lowest. The distribution rates of 4394 cases according to the years between 2001 to 2011, were found as 25.4%, 28.3%, 17.8%, 10.9%, 8.9%, 5.6%, 1.4%, 1.4%, 0.2%, 0.009% and 0.02%, respectively. Of all cases, 80.6% were autochthonous and 19.4% were imported. Most of the cases were detected in Siverek county with a rate of 71.4%, followed by Ceylanpinar (13.5%) and Viransehir (6.6%) counties. Although malaria cases were detected throughout the year in Sanliurfa in respect to the climate, the highest numbers were recorded in September (832/4394; 18.9%) and November (1054/4394; 24%). This study emphasized that malaria cases due to local transmission declined to zero in Sanliurfa like the recent situation in Turkey. However, P.falciparum malaria cases are being reported due to the travels to endemic countries or migrations from those countries. Effective malaria control attempts, within the scope of Malaria Elimination Programme implemented in Turkey, should be continued with the same stability without any abruption in Sanliurfa province where the disease had been endemic in the past.

[Investigation of the prevalence of Trichomonas vaginalis among female Syrian refugees with the complaints of vaginitis aged between 15-49 years]. / Vajinit yakinmalari olan 15-49 yas arasindaki Suriyeli mülteci kadinlarda Trichomonas vaginalis sikliginin arastirilmasi.

Since the Syrian civil war began in 2011, most of the Syrian refugees have immigrated to Turkey due to its open gate policy and the width of the border. By the end of 2015, it was estimated that there were 2.5 million Syrian refugees in Turkey. Many of the Syrian refugees live in Sanliurfa due to its location on the border with Syria. Trichomonas vaginalis, apart from viral agents is the most common parasite among sexually transmitted infection agents. The aim of this study was to determine the prevalence of T.vaginalis among female married Syrian refugees living outside of the camps in Sanliurfa city center, aged between 15-49 years with complaints of vaginitis. This multi-purpose survey was carried out between February and March of 2015, in collaboration with the United Nations Population Fund and Harran University. This study was approved under the heading of "General Health Status of Female Syrian Refugees" by the Ethics Committee of Harran University Faculty of Medicine. A total of 460 Syrian refugees house were selected using the probability cluster sampling method, with a 95% confidence level and a 5% confidence interval with a design effect. Two women refused to participate in the study, and the response rate was 99.6%. Two Syrian nurses, one laboratory technician, and one interpreter who knew Kurdish and Arabic were hired for the field survey. A structured questionnaire written in Turkish was translated to Arabic and used to collect the sociodemographic data during face to face interviews. According to the questionnaire data, the women with the complaints of vaginal discharge, unusual vaginal bleeding and/or dyspareunia were invited to the Gynecology Department of Harran University Research and Training Hospital for a medical examination. During gynecological examination, swab samples obtained from posterior fornix were evaluated by direct microscopy and Giemsa staining methods for the presence of T.vaginalis trophozoites. Of 458 women who have participated the questionnaire survey, 232 (50.6%) have declared that they had vaginitis complaints. Accordingly, 157 symptomatic and non-pregnant women were invited to the hospital, however only 89 (56.7%) accepted the invitation. T.vaginalis infection was detected in 19 (21.3%) by direct microscopy, and in 32 (36%) by Giemsa staining of the samples taken during the examination of those 89 women (mean age: 31.6 ± 8.7 years). In the gynecological examination, 56.2% (50/89) of the women were clinically diagnosed as vaginitis. A statistically significant association was detected between T.vaginalis positivity and the cases with or without the clinical vaginitis diagnosis (p< 0.001). Our data indicated that the prevalence of T.vaginalis (36%) detected in the female Syrian refugees is higher than the prevalence (3-13%) of our general population, but it is close to the prevalence (40%) in groups with risky behaviors (sex workers). In conclusion, health screening studies and health educations about safe sex life for Syrian refugees would be useful in the prevention of sexually transmitted diseases.

[Investigation of cutaneous leishmaniasis by active screening in primary schools in Sanliurfa, Turkey]. / Sanliurfa'da ilkögretim okullarinda aktif tarama yöntemiyle kütanöz leysmanyaz arastirmasi.

Cutaneous leishmaniasis (CL) is endemic in Sanliurfa, a province located at southestern part of Turkey. The aims of this study were to determine CL cases among children aged 7-15 years attending primary schools and evaluate the demographical and clinical characteristics by active screening method. In our study, a total of 163.464 children attending to 123 primary schools have been evaluated in terms of CL prevalence between 2010 to 2012 period. Accordingly, 67.585, 72.279 and 23.600 students studying in 74, 37 and 12 primary schools were actively screened, respectively. Children suspected with CL were invited to the Center for Diagnosis and Treatment of Oriental Sore, Sanliurfa Division of Turkish Public Health Institute. Two slides were prepared from bloodless, serous fluid of the skin lesions and stained with Giemsa for the microscopic examination to identify Leishmania amastigotes. The lesions were also evaluated according to their clinical manifestations, size, duration and number. In the study, 455 (%0.3) of the children were diagnosed as CL. The incidence of CL cases was 0.41%, 0.14%, and 0.31% in 2010, 2011 and 2012, respectively. Of the CL cases, 250 (54.9%) were female and 205 (45.1%) were male with a mean age of 10.54 ± 2.42 years. Most of the cases (64.2%) were in 7-11 years old group, while 35.8% were in 12-15 years old group. The average number of the CL lesions was 1.78±0.7, ranging from one to fifteen. Single lesions were detected in 281 cases (61.8%), whereas double, triple and multiple lesions (≥ 4) were detected in 87 (19.1%), 51 (11.2%) and 36 (7.9%) of the CL cases, respectively. The lesions were mostly involved on face (n= 280, 61.5%) and especially cheeks (133/280, 47.5%), followed by upper (n= 127, 27.9%) and lower (n=39, 8.6%) extremities. The average duration of lesions was 13.40 ± 0.47 months (range: 4-104 weeks) and the average size of lesions was 10.32 ± 0.4 mm (range: 3-10 mm). Among all, mostly nodular (n= 211, 46.4%) and ulcerative (n=204, 44.8%) lesions were recorded. Of the cases 330 (72.5%) were diagnosed as acute CL (duration of lesions were ≤ 24 months), while 125 (27.5%) were chronic CL (duration of lesions were > 24 months). Leishmaniasis recidivans were identified in a total of five (1.1%) cases, of them one was acute and four was chronic CL cases. Twenty-five relatives of the children with CL were diagnosed as new CL cases in the 2011-2012 period. Most of the patients (n= 437, 96%) were successfully treated with topical pentavalent antimonials, however 18 (4%) who were unresponsive to local therapy were treated systemically. Our findings showed that local transmission is ongoing in terms of CL. It should be kept in mind that, primary school aged children might be responsible for the ongoing local transmission in endemic regions and the local transmission may be decreased with the early diagnosis and treatment of CL cases.

Development of the Seasonal Migrant Agricultural Worker Stress Scale in Sanliurfa, Southeast Turkey.

Stress is one of the main causes of health problems, especially mental disorders. These health problems cause a significant amount of ability loss and increase cost. It is estimated that by 2020, mental disorders will constitute 15% of the total disease burden, and depression will rank second only after ischemic heart disease. Environmental experiences are paramount in increasing the liability of mental disorders in those who constantly face sustained high levels of stress. The objective of this study was to develop a stress scale for seasonal migrant agricultural workers aged 18 years and older. The sample consisted of 270 randomly selected seasonal migrant agricultural workers. The average age of the participants was 33.1 ± 14, and 50.7% were male. The Cronbach alpha coefficient and test-retest methods were used for reliability analyses. Although the factor analysis was performed for the structure validity of the scale, the Kaiser-Meyer-Olkin coefficient and Bartlett test were used to determine the convenience of the data for the factor analysis. In the reliability analyses, the Cronbach alpha coefficient of internal consistency was calculated as .96, and the test-retest reliability coefficient was .81. In the exploratory factor analysis for validity of the scale, four factors were obtained, and the factors represented workplace physical conditions (25.7% of the total variance), workplace psychosocial and economic factors (19.3% of the total variance), workplace health problems (15.2% of the total variance), and school problems (10.1% of the total variance). The four factors explained 70.3% of the total variance. As a result of the expert opinions and analyses, a stress scale with 48 items was developed. The highest score to be obtained from the scale was 144, and the lowest score was 0. The increase in the score indicates the increase in the stress levels. The findings show that the scale is a valid and reliable assessment instrument that can be used in epidemiological research and planning interventions.

Prevalence and associated risk factors of intestinal parasites among children of farm workers in the southeastern Anatolian region of Turkey.

OBJECTIVE: To determine the species, prevalence, and associated risk factors of intestinal parasites in farm workers' children in a representative sample in the southeastern Anatolian region of Turkey. MATERIALS AND METHOD: A total of 333 farm workers' children, under the age of six years, were selected using the probability sampling method. Mean age of the children was 3.63 ± 0.5; 55.5% were female. Data were collected using a structured questionnaire and laboratory analysis of faecal samples. RESULTS: The overall prevalence was 44.6% and the infected children had single, double, and triple parasitic infections at 72.3%, 23.0%, and 4.7%, respectively. The most common parasite was G. intestinalis (47.97%), followed by E. vermicularis (37.84%), T. saginata (27.03%), H. nana (12.16%), and A. lumbricoides (7.43%), respectively. Age, gender, illiteracy of the households, poverty, absence of toilets, bathrooms, and kitchens at the place of residence, lack of safe potable water, geophagia (soil eating habit), and being a child of a seasonal farmworker were the most significant factors associated with intestinal parasitic infection (P<0.05). G. intestinalis and E. vermicularis were found as the most common parasites that cause salivation, abdominal pain, and tiredness (P<0.05). CONCLUSION: The study revealed that health education programmes for farm workers and farmers should be improved to increase awareness about living and working conditions, in order to control intestinal parasites. However, early diagnosis and treatment services for intestinal parasites should be provided by primary health care staff in the national child screening programme in agricultural populations.

Prevalence and associated risk factors of Toxoplasma gondii in female farmworkers of southeastern Turkey.

INTRODUCTION: There are a limited number of studies of the agricultural population about the prevalence of Toxoplasma gondii (T. gondii) infection throughout the world. The aim of this study was to determine the prevalence and risk factors of toxoplasmosis in female farmworkers in the southeastern region of Turkey. METHODOLOGY: The optimum sample size was determined using the Epi Info Program, and blood samples were collected from 684 women of reproductive age. Serum samples were analyzed by qualitative and quantitative methods for anti-T. gondii IgG and IgM antibodies with a commercially available enzyme immunoassay. Questionnaires through which socio-demographic information was collected were applied during face-to-face interviews of subjects who gave their consent to participate in the study. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and Chi-square analyses and logistic regression were performed. RESULTS: Of the 684 women, the prevalence of toxoplasmosis was determined to be 58.3% and 1% for IgG and IgM, respectively. Employment as a seasonal farmworker, increasing age, and having had three or more pregnancies were found to be the crucial associated risk factors that affect the prevalence of T. gondii infection (p < 0.05). In contrast to these, the provincial development level was found to be a confounding factor. There was no association between toxoplasmosis and household size, education attainment, and poverty in the bivariate analyses. CONCLUSIONS: The findings show that control and serological screening programs should be implemented nationwide in Turkey for the reliable and fast detection of congenital Toxoplasma infections.

Risk Factors and Relationship Between Intestinal Parasites and the Growth Retardation and Psychomotor Development Delays of Children in Sanliurfa, Turkey.

OBJECTIVE: The objective of this study was to determine the risk factors for and relationship among parasitic infections, growth retardation, and psychomotor developmental delays in children aged 6 years and below. METHODS: This case-control study was performed in Sanliurfa in southeastern Turkey between October and December 2007. Data were collected using a structured questionnaire, anthropometry, Ankara Development Screening Inventory, and laboratory analysis of stool specimens. RESULTS: The most common parasite was Giardia intestinalis (42.53%) followed by Enterobius vermicularis (27.58%), Ascaris lumbricoides (18.39%), Hymenolepis nana (5.75%), Trichuris trichiura (3.45%), Escherichia coli (1.15%), and Blastocystis spp. (1.15%). Fifty-eight percent of all children were infected with intestinal parasites; 55.2% had only one parasite, whereas 44.8% had multiple parasites. The children infected with G. intestinalis and other intestinal parasites had significantly higher levels of growth retardation and psychomotor development delay than non-infected children. Children with parasitic infections had growth delay up to 2.9 times, general development delay up to 1.9 times, language-cognitive development delay up to 2.2 times, and fine motor development delay up to 2.9 times higher than children without any parasitic infections. However, no significant relationship among intestinal parasites, gross motor development, social-self skills, and development delay was identified. The education level of parents, poor economic situation, number of households, not washing hands, playing with soil, family history of parasitic infection were the significant risk factors for intestinal parasites. CONCLUSION: Our study indicates that the presence of either malnutrition or intestinal parasites may put a child in a high-risk group for developmental delays and growth retardation. Therefore, public health interventions can embrace nationwide deworming in children.

Health-risk behaviors in agriculture and related factors, southeastern Anatolian region of Turkey.

Human behavior plays a central role in the maintenance of health and the prevention of diseases. This study aimed to determine the risky behaviors of farm operators selected from a province of Turkey's southeastern Anatolian region, as well as the factors related to risky behaviors. In this cross-sectional analysis, 380 farm operators were enrolled through simple random selection method, and the response rate was 85%. Health-risk behavior was measured using the Control List of Occupational Risks in Agriculture. Of 323 farm operators, 85.4% were male. The prevalence of risky behaviors related to measures of environmental risks were higher in animal husbandry, transportation, transportation and maintenance of machinery, pesticide application, child protection, thermal stress, and psychosocial factors in the work place. Education, age, duration of work, and size of agricultural area were associated with risky behaviors in a multiple linear regression (P < .05). Findings showed that a certified training program and a behavior surveillance system for agriculture should be developed.

[The effects of intestinal parasites on anemia of children]. / Çocuklarda Baðýrsak Parazitlerinin Anemiye Etkisi.

OBJECTIVE: In this case-control epidemiological study, we aimed to investigate the effects of intestinal parasites on the anemia of children and show the association between intestinal parasites and anemia. METHODS: A total of 50 healthy and 50 malnourished children aged 0-72 months who went to physicians of Tilfindir Primary Health Care Center were enrolled in this study. The stool specimens were examined by using native-lugol, concentration, cellophane tape, and acid fast and trichrome staining methods. The complete blood count was measured by an automatic blood device. RESULTS: A total of 58% of the children were infected with intestinal parasites; 55.2% of these were infected with only one parasite, and 44.8% of them were infected with polyparasites. Also, 50.0% of the children with parasitic infection and 19.0% of children without parasitic infection were anemic. There was a positive association between intestinal parasites and anemia statistically (p<0.05). The mean hemoglobin level of the children with parasitic infection was 11.15±1.30, and the mean hemoglobin level of the children without parasitic infection was 12.13±1.47. There was a significant difference between mean hemoglobin levels of the two groups statistically (p<0.001). CONCLUSION: Consequently, this study emphasized that intestinal parasites can affect the anemia of children adversely, and there was a positive association between intestinal parasites and anemia of children.

Parent-teacher agreement on children's problems in 21 societies.

Parent-teacher cross-informant agreement, although usually modest, may provide important clinical information. Using data for 27,962 children from 21 societies, we asked the following: (a) Do parents report more problems than teachers, and does this vary by society, age, gender, or type of problem? (b) Does parent-teacher agreement vary across different problem scales or across societies? (c) How well do parents and teachers in different societies agree on problem item ratings? (d) How much do parent-teacher dyads in different societies vary in within-dyad agreement on problem items? (e) How well do parents and teachers in 21 societies agree on whether the child's problem level exceeds a deviance threshold? We used five methods to test agreement for Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) ratings. CBCL scores were higher than TRF scores on most scales, but the informant differences varied in magnitude across the societies studied. Cross-informant correlations for problem scale scores varied moderately across societies studied and were significantly higher for Externalizing than Internalizing problems. Parents and teachers tended to rate the same items as low, medium, or high, but within-dyad item agreement varied widely in every society studied. In all societies studied, both parental noncorroboration of teacher-reported deviance and teacher noncorroboration of parent-reported deviance were common. Our findings underscore the importance of obtaining information from parents and teachers when evaluating and treating children, highlight the need to use multiple methods of quantifying cross-informant agreement, and provide comprehensive baselines for patterns of parent-teacher agreement across 21 societies.