Understanding the dynamics of compliance to smoke-free policy regulations: Exploring the perspectives of venue owners and staff in Türkiye.

INTRODUCTION: The study aims to understand the facilitators and barriers associated with enforcing and complying with Türkiye's smoke-free policy from the perspective of hospitality venue owners and employees. METHODS: A qualitative open-ended survey was conducted in Istanbul and Ankara in 2021 with 58 respondents from 3 different districts in each city from four types of venues: restaurants, traditional coffee and waterpipe houses, and European-style cafés. The open-ended survey included questions to understand the knowledge, beliefs, and attitudes of respondents about Türkiye's smoke-free policy and their perceptions of the facilitators and/or barriers to smoke-free policy implementation and changes after COVID-19. The data were analyzed using an inductive approach to identify patterns and categorize the data into themes. RESULTS: The respondents expressed that the smoke-free policy aimed to protect employees and customers from secondhand smoke (SHS), respect human health, and improve air quality. Findings suggest that the positive attitude of venue owners and staff toward the smoke-free policy serves as a facilitator. However, fear of financial impact, customers' negative attitudes, difficulties in meeting physical requirements, and insufficient enforcement were found to be barriers to implementing the smoke-free policy. The effects of the COVID-19 pandemic were reported as an initial increase in compliance and awareness among customers and staff, but some respondents noted negative changes due to the emotional and financial effects of prolonged restrictions. These challenges have led to decreased attention on the smoke-free policy among venue owners, staff and customers. Respondents' suggested improvements were related to building infrastructure, such as the ventilation systems and educating the public on the harmful health effects of smoking. CONCLUSIONS: Despite the general understanding of the dangers of secondhand smoke and the smoke-free policy, this study highlights the challenges in implementing smoke-free policy measures and the continued need to raise awareness about the importance of a 100% smoke-free venue. A comprehensive approach to addressing the tobacco epidemic as a multifaceted public health issue is essential.

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.

Pre-infection antibody levels of vaccinated healthcare workers with SARS-CoV-2 breakthrough infection: A nested case-control study.

AIM: To evaluate anti-RBD IgG antibody levels and neutralizing antibody titers between the health care workers (HCWs) with breakthrough SARS-CoV-2 infection and controls. METHODS: In this nested case-case control study, we followed 548 vaccinated HCWs with homologous (only with inactivated vaccine) or heterologous (both with inactivated and BNT162b2 vaccine) vaccination for 11 months, prospectively. We obtained blood samples from the participants for quantitative anti-RBD IgG and surrogate neutralization test. The participants with SARS-CoV-2 PCR positivity (at least 14 days after the last vaccination) were considered breakthrough infection. We chose 1:2 matched controls from the cohort, according to age, sex and vaccination status. We used R version 4.0.2 for the statistical analysis. RESULTS: Sixty-five cases and 130 controls were included in the study. The number of the breakthrough infections in HCWs were correlated with the pandemic waves in Türkiye and peaked during Omicron outbreak. The median age of the cases was 39 and 78.5% were female. The cases had more comorbidities than controls, significantly (p = 0.021). All cases experienced no or mild symptoms and recovered completely. Both pre-infection anti-RBD antibody and neutralizing antibody titers did not differ between cases and matched controls (p = 0.767, p = 0.628). CONCLUSION: In this study, we showed that there was no comparable difference in humoral response after homologous or heterologous vaccination between the cases of breakthrough infection and matched controls. Compliance with infection control measures should be ensured, in combination with vaccination.

Healthcare-Related HCV Genotype 4d Infections in Kayseri, Turkey.

BACKGROUND: The frequency of genotype 4 hepatitis C virus infection is significantly higher in a city compared to other provinces in Turkey. In this study, we aimed to investigate the epidemiology and risk factors of hepatitis C virus genotype 4 infection in Kayseri province of Turkey. METHODS: A case-control study was conducted with 61 hepatitis C virus genotype 4-infected patients and 71 controls. A questionnaire was administered to the patients and controls, asking for information about the risk factors of hepatitis C virus transmission. Core/ E1 and NS5B regions of hepatitis C virus genome were amplified and sequenced by Sanger method. Phylogenetic analysis and molecular clock analysis were performed. The risk was determined by calculating the odds ratio and 95% CI. Logistic regression analysis was performed to determine the effect of risk factors by controlling for confounding variables. RESULTS: Kayseri isolates were closely related to type 4d sequences but formed a separate cluster. According to the molecular clock analysis, hepatitis C virus genotype 4d entered Kayseri province probably between 1941 and 1988. Blood transfusion and surgical intervention were found to be significant risk factors for the infection. CONCLUSION: Epidemiological data showed that hepatitis C virus genotype 4d infections are significantly associated with unsafe medical procedures.

Evaluating the Relationship between Diabetes and Cancer in a Cohort.

BACKGROUND/AIM: Epidemiological studies indicate that the risk of several types of cancer is high in diabetic patients. The aim of this study is to evaluate the association between diabetes and diabetes related cancers in a cohort design. MATERIALS AND METHODS: The baseline survey was conducted as a community screening programme from 2007 to 2009 in a population over 30 years of age. Diabetes definition was based on fasting blood glucose level ≥ 126 mg/dl and self-reported diabetes history. Data on incident cancer cases and pathological types were obtained from the Izmir Cancer Registry between 2007-2013. Odds ratios (OR) were estimated for the relationship between diabetes and diabetes-related cancer types for men and women separately and adjusted for BMI and age. Odds Ratio and 95% confidence intervals were calculated using logistic regression models in IBM SPSS Statistics 24.0. RESULTS: Data from 10,375 women (65.4%) and 5,494 men (34.6%) who did not declare any cancer in 2007 were evaluated. The cumulative incidence of diabetes related cancers was 2,293 per 100,000 in men and 1,455 per 100,000 in women. Total diabetes related cancer incidence was higher in diabetics (3,770 per 100,000) than nondiabetics (2,109 per 100,000) in men. CONCLUSION: There was no statistically significant association between diabetes and cancers. The analyses can be repeated in the future when the cohort gets older and more incident cases of cancers occur.
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An analysis of antibody response following the second dose of CoronaVac and humoral response after booster dose with BNT162b2 or CoronaVac among healthcare workers in Turkey.

Limited data are available on the short- to midterm levels of antibodies to the CoronaVac vaccine and quantitative change in humoral response after homologous or heterologous booster doses. In this prospective cohort study, we evaluated the anti-receptor-binding domain (RBD) immunoglobulin G (IgG) levels after two doses of CoronaVac and heterologous/homologous booster administration among healthcare workers in a university hospital in Turkey. Quantitative anti-RBD IgG antibody levels were measured at first and fourth months in 560 healthcare workers who had completed two doses of CoronaVac vaccine, and within 2 months after the third dose of CoronaVac or BNT162b2. Participants were asked to complete a questionnaire during the first blood draw. The seropositivity rate was 98.9% and 89.1%, and the median antibody level was 469.2 AU/ml and 166.5 AU/ml at first and fourth month, respectively. In the fourth month, a mean reduction of 61.4% ± 20% in antibody levels was observed in 79.8% of the participants. The presence of chronic disease (odds ratio [OR]: 1.76, 95% confidence interval [CI]: 1.15-2.69) and being in the 36-50 age group (OR: 2.11, 95% CI: 1.39-3.19) were identified as independent predictors for low antibody response. The antibody level increased 104.8-fold (median: 17 609.4 vs. 168 AU/ml) and 8.7-fold (median: 1237.9 vs. 141.4 AU/ml) in the participants who received BNT162b2 and CoronaVac, respectively. During the follow-up, 25 healthcare workers (4.5%) were infected with severe acute respiratory syndrome coronavirus 2. Considering the waning immunity and circulating variants, a single booster dose of messenger RNA vaccine seems reasonable after the inactivated vaccine especially in risk groups.

Urinary microbiota; Which non-invasive urine collection method should we use?

OBJECTIVE: The aim of this study is to establish the optimal non-invasive urine sample collection method for the microbiota studies. METHODOLOGY: Twelve men with bladder carcinoma underwent first voided and midstream urine collection. Urine samples were analysed using V3-V4 regions of bacterial 16s ribosomal RNAs. Bacterial groups with relative abundance above 1% were analysed in first voided urine and midstream urine samples at phylum, class, order and family level. At the genus level, all of the identified bacterial groups' relative abundances were analysed. The statistical significance (P < .05) of differences between first voided and midstream urine sample microbiota was evaluated using the Wilcoxon test. RESULTS: According to the analysis, 8 phyla, 14 class, 23 orders, 39 families and 29 different genera were identified in the first voided and the midstream urine samples. Statistical differences were not identified between first voided and midstream urine samples of all bacteria groups except the Clostridiales at order level (p:0.04) and Clostridia at class level (P: .04). CONCLUSIONS: Either first voided or midstream urine samples can be used in urinary microbiota studies as we determined that there is no statistically significant difference between them regarding the results of 16s ribosomal RNA analysis.

Transmission dynamics and timing of key events for SARS-CoV-2 infection in healthcare workers.

BACKGROUND: Healthcare workers (HCWs) have increased risk for SARS-CoV-2 infection via contacts in hospitals, as well as via transmission in the community. Serial interval, which is defined as the time between symptom onsets in an infector-infectee pair, and the incubation period are key parameters in determining the control strategies for COVID-19. This study aimed to evaluate surveillance of HCWs and estimate the serial interval and incubation period of COVID-19. METHODS: A total of 149 HCWs and 36 certain infector-infectee pairs between 19th March 2020 and 1st November 2020 in a university hospital were included in the study. Epidemiological characteristics were recorded. Serial interval and incubation period were estimated using parametric accelerated failure time models. RESULTS: Forty HCWs (26.8%) were detected via contact-based surveillance. Of 100 HCWs epidemiologically linked with a confirmed COVID-19 case, 36 (36%) had contact with a colleague. The median serial interval was 3.93 days (95% CI: 3.17-4.83). Of symptomatic HCWs, 97.5% had developed symptoms 13.71 (95% CI: 9.39-18.73) days after symptom onset of the primary case. The median incubation period was 3.99 (95% CI: 3.25-4.84) days. Of symptomatic HCWs, 97.5% developed symptoms within 9.49 (95% CI: 6.75-12.20) days after infection. CONCLUSIONS: The serial interval and the incubation period of COVID-19 in HCWs were shorter than in the general population. Rigorous contact tracing and isolation of infected HCWs could have resulted in shorter serial intervals. Implementation of more stringent in-hospital control measures focussed on transmission between HCWs should be considered.

Cause-of-death distributions and mortality trends in Turkey between 2009 and 2017.

BACKGROUND: Making the right decisions in the field of public health depends on the reliable recording of statistical data such as death and birth. There have been radical changes and innovations in the death registration since 2009 in Turkey to improve reporting. AIMS: To examine the distribution and the trend of causes of death between the years 2009 and 2017 in Turkey. STUDY DESIGN: Descriptive study. METHODS: In this study, the causes of death were evaluated in three groups used in the Global Burden of Disease study. Group I included infectious, maternal, perinatal, and nutritional conditions; group II included noncommunicable diseases; and group III included injuries. Age-standardized mortality rates were calculated per 100,000 according to age, sex, and cause of death. Joinpoint regression was used to evaluate the trend in mortality rates. In addition, the leading causes of death were also determined. RESULTS: In total, age-standardized mortality rates increased significantly on average annually (1.5% per year). When the trends of causes of death were examined according to gender, there was a significant increase in deaths from group I in both genders and a significant increase in deaths from group III in males, whereas there was no statistically significant change in deaths from group II between 2009 and 2017. CONCLUSION: A significant quantitative improvement in death registration was seen in Turkey between the years 2009 and 2017. This is due to the increase in the number of reported deaths. The change in the distribution of causes of death is noteworthy. This research can provide the basis for further researches that will examine the change in causes of death.

The Relationship between Risk Levels of Breast Cancer and Use of Early Diagnosis and Screening Services in Healthcare Workers in Turkey.

BACKGROUND: This study aimed to determine the factors affecting early diagnosis and screening behaviors of healthcare workers concerning breast cancer and the breast cancer risk levels using the risk identification model and to evaluate the relationship between breast cancer risk levels and early diagnosis and screening behaviors. METHODS: Overall, 466 healthcare workers from Balikesir Province, Turkey participated in this cross-sectional study. Data were collected thanks to a questionnaire prepared by the researchers. Cuzick-Tyrer model was utilized to determine breast cancer risk levels. RESULTS: 78.1% of the healthcare workers regularly perform breast self-examination (BSE), 11.6% had clinical breast examination (CBE), 7.7% had breast ultrasound scan and 4.5% had mammography. BSE behavior increased, as education level got higher. Mammography screening behavior increased in those aged 40 yr and older and those with breast or ovarian cancer history in their family. There was not any relationship between breast cancer risk levels and early diagnosis and screening behaviors. CONCLUSION: Early diagnosis and screening behaviors of healthcare workers were low concerning breast cancer. Age, education level and family history are the most prominent factors affecting early diagnosis and screening behaviors of healthcare workers. Informing healthcare workers on breast cancer risk factors and screening can make positive contributions to them and the public through them.

Effect of serum 25-hydroxyvitamin D level on lung, breast, colorectal and prostate cancers: a nested case-control study.

BACKGROUND: Published studies show that vitamin D deficiency is widespread and it has been suggested that it increases the risk of lung, breast, colorectal and prostate cancers. AIMS: To investigate prospectively the effect of serum 25-hydroxyvitamin D (25(OH)D) level on lung, breast, colorectal and prostate cancers in people aged 30+ years. METHODS: In this nested case-control study, the data and collected serum samples from a cohort study, the Balçova Heart Study, during 2007-09, were used. Additional data were collected using a questionnaire in the follow-up. We determined incident lung, breast, colorectal and prostate cancer cases during 2008 and 2013. Serum 25(OH)D levels of 606 persons (179 cases and 427 controls) from the Balçova Heart Study were measured. Odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression analysis. RESULTS: Serum 25(OH)D levels did not show a significant association with breast, colorectal and prostate cancers. There was an inverse association between 25(OH)D level and lung cancer risk, where the OR values for the first, second and third quartiles, compared with the fourth quartile (1.00), were 2.92 (CI: 0.82-10.35), 3.76 (CI: 1.14-12.37) and 3.55 (CI: 1.04- 12.08) respectively. CONCLUSION: It was seen that low 25(OH)D levels were associated with a greater than threefold increased risk of lung cancer; no association was detected for breast, colorectal and prostate cancers. Cohort studies with larger populations are needed to better understand the effect of vitamin D level on cancer risk.

Risk factors and relationship between screening periodicity and risk of cervical cancer among nurses and midwives. A cross-sectional study.

BACKGROUND: If nurses and midwives undergo cervical cancer screening regularly, they can become role models for other women regarding this screening. OBJECTIVES: The aims here were (i) to determine factors associated with undergoing cervical cancer screening; and (ii) to examine the association of cervical cancer screening periodicity with cervical cancer risk levels among nurses and midwives. DESIGN AND SETTING: Cross-sectional study in a public hospital. METHODS: 466 nurses and midwives participated in this study. The relationships between undergoing Pap smear screening and sociodemographic characteristics, cervical cancer risk factors, perception of cervical cancer risk and calculated cervical cancer risk levels were examined. Cervical cancer risk levels were determined using the "Your Disease Risk" assessment tool (Washington University). RESULTS: 35% of the nurses and midwives had undergone Pap smear testing at least once in their lifetimes. The odds of having undergone Pap smear testing were higher among smokers (odds ratio, OR: 2.08; 95% confidence interval, CI: 1.24-3.48) and among those who perceived their risk of cervical cancer to be high (OR: 3.60; 95% CI: 1.36-9.51). The frequency of undergoing Pap smear testing at least once in a lifetime was higher among primiparae (OR: 17.99; 95% CI: 6.36-50.84) and secundiparae (OR: 41.53; 95% CI: 15.01-114.91) than among nulliparae. No relationship was found between Pap smear test periodicity and calculated risk level. CONCLUSION: There is a need to assess motivational barriers that might lead to low levels of Pap smear screening among nurses and midwives who are role models for women regarding cervical cancer prevention.

Smoke-free Turkey: Evaluation of outdoor areas of public places.

SIGNIFICANCE: Secondhand tobacco smoke (SHS) exposure is a major cause of morbidity and mortality around the world. The objective of this study was to evaluate the presence of smoking in outdoor areas of public places in three largest Turkish cities (Istanbul, Ankara, and Izmir). METHOD: For this cross-sectional observational study, the Turkish Statistical Institute randomly selected 10 sampling points in each city. Around each sampling point, fieldworkers visited the closest bars/nightclubs, cafes, government buildings, hospitals, restaurants, schools, shopping malls, traditional coffee houses, universities, children's playgrounds, parks and open markets. We observed smoking, ashtrays, and cigarette butts at the outdoor areas of public venues within the urban districts of each city. The fieldwork was conducted in April-May 2016. RESULTS: 477 venues were observed, covering 1017 outdoor locations in which 17,737 people were observed. Smoking in outdoor areas ranged from 3.7% around schools to 90% in open markets. Ashtrays were almost ubiquitous in hospitals (95.6%), shopping malls (92.0%), and universities (90.9%). Cigarette butts were more often observed in open markets (100%), shopping malls (96%), universities (95.5%), and parks (93.3%). Smoking at outdoor areas around schools was significantly lower than around other venues. CONCLUSION: Smoking in outdoor areas was common in most public places in Turkey except schools. The current indoor SHS legislation should be extended to cover adjacent outdoor areas of public venues in order to effectively protect people from SHS exposure in Turkey.

Evaluation of Secondhand Smoke Using PM2.5 and Observations in a Random Stratified Sample in Hospitality Venues from 12 Cities.

BACKGROUND: Turkey passed a law banning smoking in all indoor public places in 2008. In response to the indoor smoking restriction, many smokers may have relocated to outdoor areas of venues. The aim of this study was to evaluate air pollution related to SHS exposure in indoor and outdoor areas of hospitality venues in 12 cities in Turkey. METHOD: In this cross-sectional study, we evaluated hospitality venues in 12 cities in Turkey. In each visited venue, we evaluated a pre-specified number of study locations such as the outdoor area of the main entrance, indoor areas, and patios or other outdoor dining areas, completely or partially covered with window walls. We measured particulate matter 2.5 (PM2.5) in those areas. RESULTS: The fieldworkers visited 72 randomly selected hospitality venues and measured PM2.5 concentrations in 165 different locations (indoor, outdoor, and patios) of those venues. Overall, 2573 people were observed, 909 of them smoking. The median (IQR) PM2.5 concentrations were 95 (39-229) µg/m3 indoors, 25 (13-48) µg/m3 outdoors, and 31 µg/m3 (16-62) in the patios (p < 0.001). After adjustment, each additional smoker was associated with a 2% increase in PM2.5 concentrations in patio air (GMR (95% CI): 1.02 (1.00, 1.05), and a 4% increase in indoor air (GMR (95% CI): 1.04 (1.02, 1.05). CONCLUSIONS: There were unhealthy levels of smoking-caused PM2.5 concentrations, not only indoors, but also in the patios of hospitality venues. Legislative efforts to expand the smoke-free legislation to outdoor areas adjacent to indoor public places and an action plan to increase compliance with the smoke-free policy are urgently needed in Turkey.

Risk factors and relationship between screening periodicity and risk of cervical cancer among nurses and midwives. A cross-sectional study

ABSTRACT BACKGROUND: If nurses and midwives undergo cervical cancer screening regularly, they can become role models for other women regarding this screening. OBJECTIVES: The aims here were (i) to determine factors associated with undergoing cervical cancer screening; and (ii) to examine the association of cervical cancer screening periodicity with cervical cancer risk levels among nurses and midwives. DESIGN AND SETTING: Cross-sectional study in a public hospital. METHODS: 466 nurses and midwives participated in this study. The relationships between undergoing Pap smear screening and sociodemographic characteristics, cervical cancer risk factors, perception of cervical cancer risk and calculated cervical cancer risk levels were examined. Cervical cancer risk levels were determined using the "Your Disease Risk" assessment tool (Washington University). RESULTS: 35% of the nurses and midwives had undergone Pap smear testing at least once in their lifetimes. The odds of having undergone Pap smear testing were higher among smokers (odds ratio, OR: 2.08; 95% confidence interval, CI: 1.24-3.48) and among those who perceived their risk of cervical cancer to be high (OR: 3.60; 95% CI: 1.36-9.51). The frequency of undergoing Pap smear testing at least once in a lifetime was higher among primiparae (OR: 17.99; 95% CI: 6.36-50.84) and secundiparae (OR: 41.53; 95% CI: 15.01-114.91) than among nulliparae. No relationship was found between Pap smear test periodicity and calculated risk level. CONCLUSION: There is a need to assess motivational barriers that might lead to low levels of Pap smear screening among nurses and midwives who are role models for women regarding cervical cancer prevention.

Health-related quality of life and perceived health status of Turkish population.

PURPOSE: This study was conducted to assess the health-related quality of life (HRQOL) and perceived health status of the Turkish population. METHODS: The data came from a nationwide survey, which was conducted by Ministry of Health on prevalence and risk factors for chronic diseases in Turkey, with a representative random sample of 18,477 people aged ≥ 15 years from Turkey. Each family physician invited two individuals selected from their registered population to the Family Health Center, conducted the survey by face to face interviews using an electronic form. HRQOL was determined using EQ-5D-3L scale. RESULTS: In Turkish population, each four women out of 10, two men out of 10 have problems in pain/discomfort and anxiety/depression dimensions of the scale; three women out of 10, one man out of 10 have some or severe problems in mobility. Proportion of people without health problems (health state 11,111) were 64,1% in men, 40,7% in women. The mean VAS score for males was 71.5 ± 0.2 (95% CI 70.9-72.1), 66.4 ± 0.2 (95% CI 65.8-66.9) for females (p < 0.05).The most important determinants of having a problem in any of the five dimensions are age, gender, education, diabetes mellitus, coronary heart disease, stroke, alzheimer, cancer, renal failure. The OR of having some or severe problems in any dimensions was 4.6 (95% CI 38-5.4) for over 65-74 and 7.5 (95% CI 5.8-9.6) for over 75 compared to 15-24 age group. CONCLUSIONS: The perceived health level and HRQOL is worse in women, in older age groups, in people from lower socioeconomical status.

Effect of Blood Cell Subtypes Lysis on Routine Biochemical Tests.

BACKGROUND: The aim of this study is to establish the contribution of blood cells subtypes on hemolysis. METHODS: Separated blood cell subtype suspensions prepared with blood from 10 volunteers were serially diluted to obtain different concentrations of cell suspensions. The cells were fully lysed and cell hemolysates were added (1:20) to aliquots of serum pool. Thus, seven serum pools with different concentrations of interferent were obtained for each blood cell subtype. Biochemical parameters and serum indices were measured by an autoanalyzer. As cell lysis markers, free hemoglobin was measured by spectrophotometry while myeloperoxidase and ᵝ-thromboglobulin were measured by enzyme immunoassay. The percent changes in analyte levels of the serum pools were evaulated by Wilcoxon Signed Rank Test and compared with clinical thresholds defined for each test. RESULTS: The clinical thresholds were exceeded in lactate dehydrogenase, potassium, aspartate aminotransferase, creatine kinase, magnesium, total protein, total cholesterol, inorganic phosphate, glucose for red blood cells (RBC); lactate dehydrogenase, aspartate aminotransferase, total protein, inorganic phosphate and glucose for platelets (PLT). Free hemoglobin was significantly correlated with RBC (r=0.999; p=0.001), while myeloperoxidase and b thromboglobulin showed no significant correlation to white blood cells (WBC) and PLT, respectively. CONCLUSIONS: The effect of RBC hemolysis in serum on the routine biochemical tests are clearly established, yet, additional studies are required in order to verify this kind of effects of PLT and WBC hemolysis.

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.

Seasonal Influenza Vaccine Effectiveness in Preventing Laboratory Confirmed Influenza in 2014-2015 Season in Turkey: A Test-Negative Case Control Study.

BACKGROUND: Influenza has an important public health impact worldwide with its considerable annual morbidity among persons with or without risk factors and its serious complications among persons in high-risk groups. The seasonal influenza vaccine is essential for preventing the burden of influenza in a population. Since the vaccine is reformulated each season according to the virus serotypes in circulation, its effectiveness can vary from season to season. Vaccine effectiveness is defined as the relative risk reduction in vaccinated individuals in observational studies. AIMS: To calculate influenza vaccine effectiveness in preventing laboratory-confirmed influenza in the Turkish population for the first time using the national sentinel surveillance data in the 2014-2015 influenza season. STUDY DESIGN: Test-negative case-control study. METHODS: We compared vaccination odds of influenza positive cases to influenza negative controls in the national influenza surveillance in Turkey to estimate influenza vaccine effectiveness. RESULTS: The influenza vaccine effectiveness against influenza A (H1N1) (68.4%, 95% CI: -2.9 to 90.3) and B (44.6%, 95% CI: -27.9 to 66.6) were moderate, and the influenza vaccine effectiveness against influenza A (H3N2) (75.0%, 95% CI: -86.1 to 96.7) was relatively high; all had low precision given the low vaccination coverage. Overall, the influenza vaccination coverage rate was 4.2% (95% CI: 3.5 to 5.0), which is not sufficient to control the burden of influenza. CONCLUSION: In Turkey, national surveillance for influenza should be strengthened and utilised annually for the assessment of influenza vaccine effectiveness with more precision. Annual influenza vaccine effectiveness in Turkey should continue to be monitored as part of the national sentinel influenza surveillance.

Scenarios to manage the hepatitis C disease burden and associated economic impact of treatment in Turkey.

BACKGROUND: Hepatitis C virus (HCV) infection is a significant health problem. The aim of this study is to evaluate the cost-effectiveness of HCV treatment and estimate its economic burden in Turkey. METHODS: An Excel-based disease progression model was used to estimate the HCV-infected population for 2015-2030. Direct costs in US dollars (USD) including diagnostic, laboratory, and healthcare costs were provided by experts in the country. Indirect costs were estimated as lost productivity using the World Health Organization (WHO) disability-adjusted life years (DALYs) metric from the Global Burden of Disease study. Three scenarios were developed to estimate the cost-effectiveness of HCV treatment through 2030: Base 2016, Increase Treatment and SVR (where SVR is sustained virological response), and WHO Targets. Additionally, the WHO Targets scenario was assessed at three different treatment price points: 10,900 USD, 16,730 USD (base cost), and 27,285 USD. RESULTS: Cumulative total direct and indirect costs (2015-2030) for the WHO Targets scenario were estimated to be 10.8 billion USD, or a 1.5 % increase compared with Base 2016. However, by the following decade, due to a marked decline in DALYs, cumulative direct and indirect costs were estimated to be 45 % less when compared with Base 2016. At a threshold of 9125 USD, all scenarios were cost-effective. CONCLUSIONS: By implementing the WHO Targets scenario, Turkey would be able to lower HCV prevalence by 80 % and reduce the total number of liver-related deaths by >65 % by 2030. Treating HCV infection in the country is cost-effective if healthcare and indirect costs are taken into consideration.