Determination of Seroprevalence and Risk Factors of Crimean-Congo Haemorrhagic Fever (CCHF) in the Endemic Region in Turkey: A Population-Based Cross-Sectional Study.

OBJECTIVES: Turkey is one of the countries that has the most cases of CCHF in recent years among the endemic countries. The disease also poses an important health threat with high mortality rate. The aim of the study was to determine the seroprevalence and risk factors of CCHF in adults aged ≥20 years in Tokat in the endemic region, Turkey. METHODS: In this population-based cross-sectional study, a total of 85 Family Medicine Units (FMUs), from over 170 in Tokat, were randomly selected using 50% sampling. The sample size was determined among the subjects aged ≥20 who registered with the FMUs, due to gender, age group, and the urban/rural population size of Tokat using the stratified cluster sampling method. Subjects were invited to the FMUs. A questionnaire was performed face to face. The blood samples were taken, and anti-CCHFV IgG antibodies were measured with ELISA method. RESULTS: 1272 (54.9%) out of 2319 participants were female, and the mean age was 47.3 ± 15.3. Anti-CCHFV IgG seropositivity was 5.6% (n = 130). Seropositivity rates in terms of adjusted odds ratios (AOR) were higher 2.53 times (95% CI: 1.57-4.08; p=0.001) in males; 4.05 (95% CI: 2.14-7.65; p < 0.001) in age group ≥65; 0.33 (95% CI: 0.14-0.76; p < 0.001) in graduates of high school and above; 0.71 (95%CI: 0.33-1.52; p < 0.001) in ones with good income; 1.84 (95%CI: 1.18-2.86; p < 0.001) in farmers; 1.64 (95% CI: 1.04-2.27; p < 0.001) in people dealing with animal husbandry; and 1.02 (95% CI: 1.03-2.29; p < 0.001) in those with history of tick contact. CONCLUSIONS: CCHF seroprevalence is still a common public health problem in Tokat, Turkey. Male gender, advanced age group, low-educated, low-income, farmers, animal husbandry, and history of tick contact were found to be risk factors for CCHF. The importance of this kind of community-based studies to identify the seroprevalence in regional and national level increases even more.

Workplace Violence in the Health Sector in Turkey: A National Study.

Violence in the workplace is an increasing occupational health concern worldwide. Health care workers are at high risk of assault. To develop, monitor, and manage prevention policies, baseline data should be available. This cross-sectional study was designed to determine the current extent of workplace violence nationwide in Turkey. The study population of 12.944 health care workers was a stratified sample of all health care workers (612,639) in the country. A probabilistic sampling was made on the basis of the "multistage stratified random cluster sampling method." This study was conducted by a structured questionnaire in a face-to-face interview. The questionnaire items were adapted and translated into Turkish based on questionnaires of International Labor Organization, International Council of Nurses, World Health Organization, and Public Services International. The percentage of health care workers who experienced workplace violence in Turkey in the previous 12 months was 44.7%. The types of violence included physical 6.8%, verbal 43.2%, mobbing (bullying) 2.4%, and sexual harassment 1%. Multivariate analysis showed that level of health care system, type of institution, gender, occupation, age, working hours, and shift work were independent risk factors for experiencing workplace violence ( p < .05). Our study indicates that the workplace violence among health care workers is a significant problem. The results of the study can serve as the basis for future analytical studies and for development of appropriate prevention efforts.

Evaluation of iron, zinc, and copper levels in pterygium tissue.

PURPOSE: To determine the concentration of the trace elements iron, copper, and zinc in pterygium tissue and healthy conjunctiva tissue and to investigate the involvement of these elements in pterygium etiopathogenesis. METHODS: Twenty patients with pterygium were enrolled in the study. The pterygium was excised and a conjunctival rotational flap or autograft inserted. Normal conjunctiva tissue was obtained from the flap or graft. The concentrations of iron, zinc, and copper in the pterygium and conjunctiva tissues were determined by atomic absorption spectrometry after microwave digestion. RESULTS: Iron, zinc, and copper levels were significantly higher in the pterygium tissue than in the normal conjunctiva (P < 0.001). The mean iron, zinc, and copper concentrations in the pterygium tissue were 819, 214, and 3.40 µg/g, whereas the mean concentrations of these elements in the control tissue were 491, 148, and 2.19 µg/g, respectively. CONCLUSIONS: Pterygium is a fibrovascular proliferative disorder and elevated levels of trace elements in pterygium tissue may play a pathogenic role via oxidative damage.

Spatiotemporal change and ecological modelling of malaria in Turkey by means of geographic information systems.

We described the spatiotemporal change of malaria (Plasmodium vivax) in Turkey over 34 years (1975-2008), and assessed the role of environmental variables in this change. We developed seven 5-year-period raster maps by using geo-referenced malaria case data from the centres of 81 provinces and the kriging method with a spherical variogram model in a geographic information systems (GIS) model. We also modelled malaria incidence in GIS by using our average malaria incidence raster map, and complementary spatial database including the raster map layers of 14 environmental variables. We chose linear regression analysis with backward method to investigate relationships among variables and develop a model. The model was run in GIS to obtain a model incidence raster map. We tested the reliability of the model map by residual statistics, and found the model map dependable. Five-year-period maps revealed that the distribution of malaria cases moved from the East Mediterranean region to the Southeast Anatolia region due to changing human activities. The latitude, minimum temperature, distance to seas and elevation variables were found to have significant impacts on malaria. Consequently, the model incidence map established a good background for early warning systems to predict epidemics of malaria following environmental changes.

The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey.

BACKGROUND: Anemia is considered a severe public health problem by World Health Organization when anemia prevalence is equal to or greater than 40% in the population. The purpose of this study was to determine the anemia prevalence with the associated factors in pregnant women and to determine the serum iron, folate and B12 vitamin status in anaemic pregnants in Malatya province. METHODS: This is a cross-sectional survey. A multi-sage stratified probability-proportional-to-size cluster sampling methodology was used. A total of 823 pregnant women from sixty clusters were studied. Women were administered a questionnaire related with the subject and blood samples were drawn. Total blood count was performed within four hours and serum iron, folate and B12 vitamin were studied after storing sera at -20 C for six months. RESULTS: Anemia prevalence was 27.1% (Hb < 11.0 gr/dl). Having four or more living children (OR = 2.2), being at the third trimester (OR = 2.3) and having a low family income (OR = 1.6) were determined as the independent predictors of anemia in pregnancy. Anemia was also associated with soil eating (PICA) in the univariate analysis (p < 0.05). Of anaemic women, 50.0% had a transferrin saturation less than 10% indicating iron deficiency, 34.5% were deficient in B12 vitamin and 71.7% were deficient in folate. Most of the anemias were normocytic-normochromic (56.5%) indicating mixed anemia. CONCLUSIONS: In Malatya, for pregnant women anemia was a moderate public health problem. Coexisting of iron, folate and B vitamin deficiencies was observed among anaemics. To continue anemia control strategies with reasonable care and diligence was recommended.

Increased oxidative stress in patients with pseudoexfoliation syndrome.

PURPOSE: The objective of this study was to investigate the antioxidant/oxidant status of serum in patients with pseudoexfoliation syndrome (PEX). METHODS: Forty-seven patients with PEX and 32 healthy controls were included in the study. Serum total antioxidant capacity (TAC) and total oxidant status (TOS) levels were determined by using a novel automated method. RESULTS: A significant increase in serum TOS (p < 0.001) and a significant decrease in serum TAC (p < 0.0001) were observed in PEX patients compared to control subjects. CONCLUSION: TAC decreases while the oxidative stress increases in PEX.

Iodine deficiency in pregnant women in eastern Turkey (Malatya Province): 7 years after the introduction of mandatory table salt iodization.

OBJECTIVE: The aim of the present study was to evaluate the urinary I excretion of pregnant women in Malatya Province, eastern Turkey. DESIGN AND SETTING: A cross-sectional study was performed on pregnant women in urban and rural settlements of Malatya Province. SUBJECTS: Urinary I excretion was measured for 824 pregnant women who were randomly selected using a probability-proportional-to-size sampling methodology. RESULTS: Median urinary I concentration (UIC) of pregnant women was 77.4 microg/l. The percentage of pregnant women with UIC below 100 microg/l was 83.3. CONCLUSION: These results indicate that I deficiency disorders (IDD) is still a problem in Malatya Province and most certainly in other parts of the country. Proper monitoring of I content of the salt sold or used in the area, in order to strengthen the IDD intervention programme, is suggested.

The informed consent status for surgery patients in eastern Turkey: a cross-sectional study.

This study assesses the quality of the informed consent process and satisfaction with the informed consent process, for surgery patients in Turkey. Four hundred and eighty three patients were interviewed after their surgeries. More than half of the patients were satisfied with the information on eight issues that pertained to the informed consent process. A majority of patients (91 per cent) were satisfied with the information regarding why an operation necessary. However, only 205 of 483 patients(42 per cent) indicated that they had received sufficient information on the potential side effects and complications of surgery. Patients' educational level and the type of surgery--urgent or elective--were associated with the satisfaction status.

The relationship between terrorist activities and cases of malaria in the eastern and south-eastern regions of Turkey, 1984-1998.

The objective of this study was to determine whether cases of malaria are related to terrorist activities that have occurred in the eastern and south-eastern regions of Turkey. Some of the determinants related to malaria have been investigated using a national dataset for 11 provinces located in these regions of Turkey. In these regions, both terrorist activity and cases of malaria were common from 1984 to 1998. A multiple regression technique was used to identify the variables that are significantly associated with cases of malaria. Annual incidence of malaria was chosen as the dependent variable along with three independent (explanatory) variables: annual number of terrorist incidences, people per healthcare technician and number of thick blood films per 100,000 people. Based on this analysis, it is determined that the annual number of terrorist incidences has been associated with the annual number of malaria cases in these regions of Turkey since the beginning of terrorist activity in 1984.

Women's douching practices and related attitudes in eastern Turkey.

AIM: Vaginal douching is a common hygiene practice for many women all over the world, but it is associated with several health risks. Little is known about the beliefs and attitudes that promote and maintain douching practices. Therefore, the objective of the present study was to evaluate the status of vaginal douching practices of women in the Malatya province of eastern Turkey. METHODS: This was a cross-sectional study. A sample of 465 Muslim women was interviewed to ascertain the status of vaginal douching practices. All participants were between 15 and 49 years of age and all were married. Data were collected by using a questionnaire in the process of conducting face-to-face interviews in June 2004. Data analysis included descriptive statistics and logistic regression modeling. RESULTS: The present study revealed that the frequency of douching was 61.5% among women. The participants were frequently douching for feminine hygiene (47.6%). Vaginal douching practices were associated with several factors including education level (odds ratio [OR] = 1.991, 95% confidence interval [CI] = 1.154-3.434), family income (OR = 0.996, 95% CI = 0.994-0.998), marital age (OR = 0.402, 95% CI = 0.223-0.715), frequency of sexual intercourse (OR = 2.335, 95% CI = 1.532-3.554), and presence of genital syndromes/infections (OR = 1.813, 95% CI = 1.215-2.739). CONCLUSION: This study provides preliminary information about women's douching practices and attitudes in the Malatya region of Turkey. It may also provide information to health-care practitioners in their efforts to educate women on the adverse effects of vaginal douching.

Can the levels of nitric oxide in the urine, serum and tumor tissue be putative markers for bladder cancer?

AIM: To determine nitric oxide (NO) levels in serum, urine, tumor tissue and non-malignant adjacent tissue in bladder cancer patients compared with those in patients with a non-neoplastic genitourinary disease and to evaluate postoperative serum and urine NO change. METHODS: Samples was collected in 20 cancer and 41 control patients. Griess reagent was used for NO measurements. RESULTS: Mean age in the cancer and control groups was 64.2 +/- 9.9 and 63.7 +/- 8.9 years, respectively. Preoperatively, urinary infection incidence was not statistically different between groups. There were no significant differences in serum, urine and tissue NO levels in patients with and without infection in both groups. Hematuria was found to not affect urine NO level in the cancer group. Urine NO level was significantly higher than in controls preoperatively, decreased significantly following operation and remained stable after the third month. High serum NO values decreased at the early postoperative period; however, they re-increased in the long-term. No significant differences were observed in the third month in serum and urine NO levels between the patients with (no. 6) and without (no. 14) residual or relapsing tumor. No statistical difference was observed between NO levels in non-malignant adjacent and control tissues. However, tumor tissue NO level was significantly higher than those in the other two. There were no statistical differences in the first and third month serum and urine NO levels between patients who underwent bacillus Calmette-Guérin instillation therapy postoperatively and the patients who took chemotherapy or no further treatment. CONCLUSIONS: Both local and generalized host defense mechanisms seem to function in bladder cancer patients. Although further evaluation with a longer observation period and larger numbers of patients is necessary, results suggest that serum and urine NO levels are not putative and useful markers for bladder cancer.

Prevalence of goiter and urinary iodine status of 7-11-year-old children in Malatya province, Turkey.

Goiter prevalence and urinary iodine excretion levels were assessed in 568 schoolchildren (317 boys and 251 girls), aged 7-11 years, living in the Malatya province, a well-known endemic goiter area in Turkey. Five hundred sixty-eight children aged 7-11 years consented to thyroid gland palpation and provided a urine sample on the day of examination in April 2004. Median urinary iodine concentration for the total group was 66 microg/L. There was an association between presence of goiter or not and urinary iodine levels (67 microg/L versus 62 microg/L, p=0.000). The median urinary iodine concentration was lower in rural areas than in urban areas (54.6 microg/L versus 59.7 microg/L, respectively) and schoolchildren living in rural areas had significantly lower urinary iodine levels (p=0.000). In conclusion, the present study reports mild iodine deficiency in the Malatya province, despite a mandatory iodization program in Turkey which has been in force since 1998.

Physical, emotional and sexual violence during pregnancy in Malatya, Turkey.

BACKGROUND: In Turkey, violence against women was established as a critical area of concern related to women and various prevention strategies have been developed since 1980. There are limited numbers of studies on violence during pregnancy in the country. This study was performed to determine the prevalence of physical, emotional and sexual violence during pregnancy in Malatya province and the associated factors. METHODS: A cross-sectional interview survey was conducted among pregnant women living in Malatya province between October 2003 and May 2004. Stratified probability-proportional-to-size sampling methodology was used for selecting the study population. A total of 824 pregnant women from 60 clusters were studied. Association between violence prevalences and womens' sociodemographic, fertility and behavioural characteristics were evaluated. RESULTS: During pregnancy 31.7% of women were exposed to any form of violence. Emotional violence was the most frequently reported form (26.7%), followed by sexual (9.7%) and physical violence (8.1%). Regular smoking [odds ratio (OR) 1.6], unwanted pregnancy (OR 1.8), living in urban area (OR 1.5), low education level of husband (OR 1.7), low family income (OR 1.9) and being in second trimester (OR 1.4) were determined to be the main predictors of overall violence during pregnancy. CONCLUSIONS: Violence during pregnancy is a common public health problem in Malatya. Low education level in partners, low family income, husband's unemployment, urban settlement, unwanted pregnancy and smoking should alert health staff towards violence at pregnancy and training of health personnel on the subject is recommended.

AIDS awareness and knowledge among married women living in Malatya (Turkey): implications for province-based prevention programs.

The study was performed in 2003 to obtain baseline information on married women's knowledge of AIDS/HIV in Malatya, Turkey. The aim was to reach 1% of the population by covering 1200 married women out of 120,034 whose ages ranged from 15-49. Stratified systematic random sampling was used according to 17 health center lists. Although median HIV/AIDS knowledge score was found to be 70 (highest score was 100), it was also seen that clinical properties of the disease were not recognized adequately. The main resources of knowledge were visual (93%) and printed material (35%). These findings show that media based information does not seem to be sufficient. Therefore, it is recommended that health education should be inserted in the school curriculum and health personnel should inform the women.

Neurofibromatosis type 1: diffusion weighted imaging findings of brain.

PURPOSE: The purposes of this study were to evaluate the differences in apparent diffusion coefficient (ADC) values between infra and supratentorial unidentified bright objects (UBOs), between UBOs and normal appearing side (NAS, contralateral regions of the UBOs and/or normal appearing region without UBOs) in the neurofibromatosis type 1 patients (NF1) and control group and also to investigate correlation between age and ADC values. METHODS: A total of 30 patients and 26 healthy controls were included. The MRI examination consisted of routine imaging and diffusion weighted imaging (DWI). Seven distinct locations (frontal, parieto-occipital and cerebellar white matter, globus pallidum, thalamus, hippocampus, and midbrain) were selected for the analysis. The ADC values were calculated directly from these automatically generated ADC maps with ROI. RESULTS: The ADC values of UBOs were significantly increased in cerebellar white matter, hippocampus, globus pallidum, midbrain, and thalamus when compared with NAS and control group. There were statistically significant differences between NAS and control group in the ADC values obtained from hippocampus and thalamus. There were statistically significant differences between supra and infratentorial UBOs in ADC values. There was a negative correlation between age and the ADC values obtained from normal appearing midbrain, hippocampus, thalamus, and globus pallidum. CONCLUSION: ADC values both in UBOs and in the normal appearing locations as hippocampus and thalamus were detected to be higher in the patients with NF1. The detection of lesions might be independent of MRI appearance in NF1, i.e. although the brain is affected, MRI appearance may be normal. Therefore, DWI and ADC values should also be utilized in the delineation of brain involvement of NF1 patients.

The protective effect of erdosteine against ototoxicity induced by cisplatin in rats.

The elimination of cisplatin ototoxicity is an ongoing concern. This experimental study was undertaken to investigate the effect of oral erdosteine in ameliorating cisplatin-induced ototoxicity. Twenty-eight adult female Wistar albino rats were randomly divided into four equal groups. Group A received an oral carrier vehicle of the drug erdosteine with 0.2 ml of 0.9% saline. Group B was administered only erdosteine (per oral 10 mg/kg twice a day) for 6 days. Group C was injected with cisplatin intraperitoneally (i.p.) on day 0 (16 mg/kg body weight), once only. Group D was given erdosteine (per oral 10 mg/kg/day) 1 day before and for 5 days consecutively after cisplatin injection (16 mg/kg, i.p.). Distortion product otoacoustic emissions (DPOAEs) were elicited in different frequency regions, ranging from 1,001 to 6,299 Hz as DPgram and input/output (I/O) functions from the control and experimental animals. All experimental animals were killed under general anesthesia on day 5, following the last otoacoustic emission measurements. Prior to death, blood samples were drawn for measurement of superoxide dismutase, xanthine oxidase (XO), malondialdehyde and nitric oxide. Initial DPgram and I/O function baseline measurements were similar in all groups prior to any drug administration ( P>0.05). On day 5, intra-subject measurement parameters of DPgrams and I/O functions in the cisplatin group showed significant deterioration ( P <0.05). The other groups revealed no differences between their pre- and post-test drug administration DPgrams and I/O functions at any test frequency ( P>0.05). Comparison of the amplitudes of DPgrams and I/O functions between the cisplatin and control groups showed significant changes ( P <0.05). Biochemical studies noted an increased XO activity following cisplatin administration ( P <0.007). The other biochemical results did not show significant differences between the study and control groups. This study demonstrates that, in rats, erdosteine is protective for cochlear function against the disruptive effects of cisplatin as measured by DPOAEs.

University hospital physicians' attitudes and practices for smoking cessation counseling in Malatya, Turkey.

The aim of the study is to determine attitudes and self-reported practices performance for smoking cessation counseling of the physicians working at a university hospital in Malatya, Turkey. All physicians who were providing health care to adult patients in 19 outpatient clinics at the hospital were administered a self-reported questionnaire. Of the physicians, 26.5% reported that they were always asking about their patients' smoking history and 22.6% were always advising their smoker patients to quit. Men non-smoker physicians more often practiced counseling than men smoker physicians. Negative attitudes of physicians about smoking cessation counseling negatively effected their practices. Negative attitudes were significantly higher among men smoker physicians than non-smokers but attitudes did not differ among female smoker and non-smoker physicians. The findings showed that smoking cessation counseling was rarely practiced by physicians and physicians' practices differed by their smoking behavior, departments and attitudes towards smoking cessation.

Association between some educational indicators and dental caries experience of 12-year-old children in developing countries: an ecological approach.

OBJECTIVE: The aim of this study was to investigate the association between some educational indicators and dental caries experience of 12-year-old children in developing countries. BASIC RESEARCH DESIGN: The ecological association between DMFT levels amongst 12 year olds (DMFT-12 index) with six educational indicators (adult literacy rate, mean years of schooling, pupil-teacher ratio for primary level, educational expenditure as a percentage of gross national product, primary enrollment ratio and percent completing primary level) has been studied using developing countries as the unit of analysis. Pearson's correlation analysis and stepwise linear multiple regression technique were used to identify the significantly associated educational indicators with the DMFT-12 index. RESULTS: A negative association between DMFT-12 index and percent completing primary education level has been observed (r = -0.509; p < 0.01). Also, stepwise regression analysis results have shown that only percent completing primary level education is significantly associated with DMFT-12 index scores (partial regression coefficient = -0.042; 95% confidence intervals: -0.064, -0.021). CONCLUSION: Dental caries experience of 12-year-old children appears to be highest in countries with low percent of primary level completion. Percent completing primary level education may be considered a good predictor of DMFT-12 index in developing countries.

Risk factors for depression in postnatal first year, in eastern Turkey.

BACKGROUND: There are few studies reporting depression in the postnatal period in developing countries. In this study our objective was to evaluate women from eastern Turkey in the postnatal one-year period in order to analyse the risk factors for depression. METHODS: In this cross-sectional, multi-centre study, we selected a study sample from five eastern provinces. Among 2602 randomly selected women who gave birth within the last year, we included 2514 women in our analysis. The Edinburgh Postnatal Depression Scale was used for the evaluation of depression. RESULTS: The percentage of women with high depression scores was 27.2%. Excess risk of depression was associated with several factors including unemployment, low education, poverty, poor family relations, low marital age, lack of medical services, and mental health problems. CONCLUSIONS: Depression in postnatal women is an important public health problem in the less developed eastern part of Turkey.