Determinants of prelacteal feeding practice in Uganda; a population based cross-sectional study using Uganda demographic and health survey data.

Background: Breastfeeding has well-established short-term and long-term health benefits for both the mother and infant. Initiating breastfeeding immediately after birth stimulates breast milk production. Prelacteal feeding (PLF) may result in late initiation of breastfeeding, and thus insufficient production of breast milk. This study aimed to identify the determinants of PLF among children under five years in Uganda. Methods: This cross-sectional study was conducted using the data from the database of Uganda Demographic and Health Survey 2011. The data of 4,774 children/mothers were evaluated in this study. Results: The prevalence of PLF was 40.3%. The rate of PLF practice was found to be 2.15 times higher in women with moderate economic status and 2.02 times higher in women with high economic status compared to those who have low economic status. The rate of PLF practice was found to be 1.73 times higher in newborns delivered by an unskilled birth attendant and 4.35 times higher in newborns delivered with no birth attendant compared to those infants delivered by a skilled birth attendant. The ratio of PLF practice was found to be 2.49 times higher in multiple births. Mothers who initiated breastfeeding in the first 24 hours after birth had higher odds of PLF. No relationship was found between PLF practice with some sociodemographic characteristics of mother's (age, marital status, educational status, religion, residential location), maternal factors (number of children, antenatal and postnatal care attendance, place of delivery), and characteristics of the newborn infants (sex, type of delivery, birth order number) in the multivariate logistic regression analysis. Conclusions: All mothers should be informed about the importance of initiation of breastfeeding immediately after delivery, the risks associated with PLF, the optimal practices for breastfeeding, and the presence of a skilled birth attendant at delivery.

Comparison of Postoperative Pulmonary Complication Indices in Elective Abdominal Surgery Patients.

BACKGROUND: Postoperative pulmonary complications (PPC) are important problems that prolong hospital stays by increasing morbidity and mortality of patients. Early identification of risky cases through preoperative evaluation is important for reducing the complications that may be seen in patients postoperatively. The aim of this study is to calculate, evaluate and compare the risk indices for PPC in patients who will undergo elective abdominal surgery. MATERIALS AND METHODS: One hundred twenty-four patients who were hospitalized for elective abdominal surgery were included in this prospective observational study. American Society of Anesthesiologists (ASA), Epstein and Shapiro scores, respiratory failure index (RFI), pneumonia risk indexes (PI) and scores were calculated preoperatively. Patients were re-evaluated at the 48th postoperative hour, and one-week follow-up was performed. The patients with PPCs are recorded. RESULTS: The mean PPC rate was 36.8%. Based on this, pleural effusion was observed in 18.5%, prolonged mechanical ventilation in 8.9%, atelectasis in 9.7%, and respiratory failure in 5.7%, bronchospasm in 4.0%, and pneumonia in 3.2% of patients. An increased risk in PPC was determined if ASA were above 3 (odds ratio, [OR], 7.06; <0.001), PI scores were above 3 (OR, 6.67; <0.001), RFI score were above 4 (OR, 6.30, p:0.001) and Shapiro score above 2 (OR, 20.01; <0.001), respectively. CONCLUSION: The Shapiro index is the strongest predictor of pulmonary complications, whereas the PI is the strongest predictor of morbidity risk. However, RFI and the PI are equally valuable for predicting respiratory complications and may prove to be useful in abdominal surgeries for preoperative assessment.

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.

Evaluation of effectiveness of peer education on smoking behavior among high school students.

OBJECTIVES: To evaluate the effectiveness of peer education on changing the smoking behavior of high schoolage children's.  Methods: In this interventional study; transtheoretical model, which is one of the cognitive-behavioral models was used for application of the peer education. Study was conducted in Izmir during 2011-2012 education period and included 338 students from 2 high schools The independent variable of the study is peer training.  Descriptive variables for a student are age, gender, tendecy of friends to smoke inside and outside the school,  the age they have first experienced the habit,  reasons for nicotine consumption,  levels of addiction,  chatting about smoking and related harms. Family descriptive variables are education level of parents and whether their smoking tendency is present or not. Results: Approximately 18.3% of the students were current smoker. A positive behavioral change of smoking quitting among smoker students was observed after peer education. The number of students in precontemplation stage was reduced while the number of students in stages of preparation/determination  action and maintenance was increased.  Conclusion: Peer education was observed to be an effective  method in the behavioral change of smoking teens. Authors strongly suggest peer education to be one of the preferred tools in changing the teen behavior in use of  tobacco.

Does raising awareness in families reduce environmental tobacco smoke exposure in wheezy children?

INTRODUCTION: Environmental tobacco smoke (ETS) is thought to increase the severity and number of attacks in wheezy children. Objective assessments are needed to change the behavior of families to reduce the exposure of wheezy children to ETS. AIM: To determine whether informing families about their children's urinary cotinine levels curtailed the exposure of children to ETS. MATERIAL AND METHODS: A survey was used to determine the ETS exposure level, and the urinary cotinine level of each patient was tested. Children with positive urinary cotinine levels were included in the second part of the study. The families were randomly divided into two groups: an intervention group that was advised about urinary cotinine levels by telephone and a non-intervention group that was not so advised. The groups were followed-up 2 months later, and urinary cotinine levels were measured once again. RESULTS: The intervention group contained 65 children of average age of 24.4 ±8.9 months, of whom 46 (70.8%) were male. The non-intervention group contained 69 children of average age of 25.3 ±9.8 months (p > 0.05), of whom 52 (75.4%) were male. The urinary cotinine levels at the time of the second interview were lower in both groups. The number of cigarettes that fathers smoked at home decreased in the intervention group (p = 0.037). CONCLUSIONS: Presenting objective evidence on ETS exposure to families draws attention to their smoking habits. Measurement of cotinine levels is cheap, practical, and noninvasive. Combined with education, creating awareness by measuring cotinine levels may be beneficial.

The contribution of clinical assessments to the diagnostic algorithm of pulmonary embolism.

BACKGROUND: Pulmonary thromboembolism (PE) is a major disease in respiratory emergencies. Thoracic CT angiography (CTA) is an important method of visualizing PE. Because of the high radiation and contrast exposure, the method should be performed selectively in patients in whom PE is suspected. OBJECTIVES: The aim of the study was to identify the role of clinical scoring systems utilizing CTA results to diagnose PE. MATERIAL AND METHODS: The study investigated 196 patients referred to the hospital emergency service in whom PE was suspected and CTA performed. They were evaluated by empirical, Wells, Geneva and Miniati assessments and classified as low, intermediate and high clinical probability. They were also classified according to serum D-dimer levels. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated and evaluated according to CTA findings. RESULTS: Empirical scoring was found to have the highest sensitivity, while the Wells system had the highest specificity. When low D-dimer levels and "low probabilty" were evaluated together for each scoring system, the sensitivity was found to be 100% for all methods. Wells scoring with a cut-off score of 4 had the highest specificity (56.1%). CONCLUSIONS: Clinical scoring systems may be guides for patients in whom PE is suspected in the emergency department. The empirical and Wells scoring systems are effective methods for patient selection. Adding evaluation of D-dimer serum levels to the clinical scores could identify patients in whom CTA should be performed. Since CTA can only be used conservatively, the use of clinical scoring systems in conjunction with D-dimer levels can be a useful guide for patient selection.

Effect of socioeconomic status on allergic diseases and atopy in school children.

Sipahi S, Nacaroglu HT, Can D, Günay I, Ünsal-Karkiner CS, Kamali H, Özdemir A, Günay T. Effect of socioeconomic status on allergic diseases and atopy in school children. Turk J Pediatr 2017; 59: 670-677. Higher family socioeconomic status (SES) has been suggested as a risk factor for allergic diseases. We investigated the effect of SES on the prevalence of allergic diseases and atopy. The study included 13-14-year-old primary school students in Kemalpasa, Turkey. The International Study of Asthma and Allergies in Childhood phase 1 questionnaire was administered to all students to identify allergic diseases. Those identified as having allergic diseases underwent a skin prick test (SPT). Group I included students with allergic diseases and a positive SPT. Group II comprised students with allergic disease who were SPT negative. The control group was randomly selected from the students with no allergic diseases. Three weighted SES scores were calculated for each student (equally weighted, education-weighted, and social class-weighted). SES was classified as lower, middle, or upper according to the weighted SES scores. Allergic diseases were detected in 657 of the 1,373 children who participated in the study. A higher percentage of children with allergic diseases and atopy were in the lower SES group in all weighted SES analyses compared with controls (Group I: 59%, 83.1%, 67.5%; Group II: 62.9%, 80%, 63.5%; control group: 12.4%, 12.9%, 21.2%). Significantly more children with allergic and atopic diseases (Groups I and II) were in the lower SES group compared with the control group (p < 0.001). In contrast to the hygiene hypothesis, we found the incidence of atopic disease was higher in families with lower SES.

Prevalence of Tobacco Use among School Teachers and Effect of Training on Tobacco Use in Western Turkey.

BACKGROUND: Tobacco consumption is still a prevalent issue. Given that teachers are respected in society, they have a great responsibility for tobacco control. This study examines, using the Transtheoretical Model (TTM), the prevalence of tobacco use among teachers and their different stages of tobacco use. It also evaluates teachers' views on smoking and the effectiveness of training on tobacco use. METHODS: This study is quasi-experimental. Pre-test and post-test were used first with a cross-sectional group, then with a single group to determine the frequency of tobacco use. The research participation complied with the voluntary principles and the participation rate was 84.9%. The research sample comprised 450 teachers working at schools (N=17) under the Kemalpasa Directorate of Education. The data form contained 29 questions about socio-demographic characteristics and smoking habits. The Fagerstrom Test for Nicotine Dependence (FTND), Smoking Decisional Balance Scale (SDBS), and the Stage of Change were used. A pre-test was also administered, and training was given between January 13 and March 4, 2014. After the training sessions, two short messages (SMS) were sent on March 12 and March 19, 2014. A post-test was administered between April 1 and May 21, 2014. The relevant institutions and participants gave the requisite permission for the data used in this study. Percentage distribution, dependent t-tests and chi-square tests were used to evaluate the research data. RESULTS: The median age of the teachers was 37.49±7.84. The teachers' mean score for the pre-test of FTND was 5.7±2.03, and their mean score for the post-test was 3.25±2.07. Post-test scores were remarkably lower than the pre-test scores. It was found that teachers' mean scores for SDBS were different before and after training. After training, anti-smoking attitudes increased (pros-cons scores: pre-test: -3.64±4.68, post-test: -11.25±5.48). The training helped the entire group to make progress in the process change. CONCLUSION: After training on "the health effects of smoking", teachers' anti-smoking attitudes rose on the smoking decision balance scale, their nicotine dependency was reduced, and they were able to move forward in a positive direction.

Prevalence of Metabolic Syndrome and Affecting Factors among Individuals Aged 30 and over in Balçova District of Izmir.

BACKGROUND: The studies have shown that metabolic syndrome (MetS) leads to an increase twice as much in cardiovascular diseases (CVD) and four times as much in diabetes mellitus (DM) prevalence since the second half of the 20(th) century. AIMS: This study aims to determine and discuss the prevalence of the MetS and co- factors among individuals at the age of 30 and over in Balcova district of Izmir province according to the American National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III) and InternationalDiabetes Federation (IDF) criteria. STUDY DESIGN: Cross-sectional study. METHODS: Data obtained from the Balcova Heart Project in Izmir were used in the study. The dependent variable of the study is MetS existence. The independent variables were socio-demographic characteristics (age, gender, education level, and marital status), self-perceived economic status, physical activity, smoking status, healthy nutrition and body mass index (BMI). RESULTS: The prevalence of MetS was 36.9% according to the diagnostic criteria of IDF, while it was 27.4% according to ATP III criteria. According to the both criteria, increasing age, low education, poor economic status perception, physical inactivity, and obesity increase the risk of MetS. Apart from the IDF criteria, being female and a current smoker increase the risk of the MetS in the NCEP-ATP III. CONCLUSION: Compared to educational studies of MetS as of today, which are community and health-oriented studies, it is challenging that the prevalence of MetS was found to be high for both criteria in our study. Therefore, in particular, primary health care doctors must be prompted to protect the public against DM and CVD in particular.

The Prevelance of Tobacco Use and the Factors Influencing in Students Studying at Two Dentistry Faculties in Turkey.

OBJECTIVES: The objective of this study was to determine the pattern and effects of tobacco and tobacco products use among students of dentistry. MATERIAL AND METHODS: A cross sectional study was performed in the Dentistry Faculty of Ege and Dicle Universities between April and May 2013. All freshmen and senior year students receiving education in both universities were included into the study (n= 321). A questionnaire consisting of 26 questions was used to determine the smoking habits of the students and the influencing factors regarding this habit. Students replied the questions under supervision. RESULTS: A survey was conducted among 298 students out of 321 who were attending both universities. 46.6% of the participants were female and 53.4% were male. Smoking prevelance of the students was 29.9%. It was 19.9% in freshmen students and 45.8% in senior students. According to the first class of students in the fifth grade students in the prevalence of smoking in was found to be highly statistically significant (p< 0.001). Among other tobacco products the following was identified as mostly used: waterpipe, also known as narghile (27.4%), cigarwraps (9.7%), cigar (9.4%) and smoking pipe (2.0%). While 22.5% of the students stated that they started smoking after the age of 15, 36.0% started between the ages of 15 and 18 and 41.5% after the age of 19. The rate of smoking in the house was significantly higher (p< 0.001) among smokers than non-smokers. While 78.7% of the students stated that they would like to quit, 64.3% tried once or more to quit. CONCLUSION: Smoking habit was found to be higher among medical students than the social average. Smoking is more frequent in higher classes. From early years onwards, students of dentistry should be intensively educated regarding the harmful effects of tobacco on health, and efforts should be made to prevent and control of tobacco epidemic.

Smoking cessation and the effect of nicotine dependence on relapse rate in Izmir, Turkey.

BACKGROUND/AIM: Smoking is the leading preventable cause of death in the world. There is growing evidence of the need for community- based programs on smoking cessation. The main purpose of this study is to establish the rate of smoking cessation and restarting in 1 year at the Balçova Smoking Cessation Center. MATERIALS AND METHODS: This is a prospective study with a study group of 359 individuals who quit smoking at the Balçova Smoking Cessation Center for at least 4 weeks between October 2009 and April 2010. The outcomes of the study were 1-year cessation rate and relapse rate. Individuals who reported restarting and/or had CO measurements above 6 ppm were accepted as quitters who had relapsed. RESULTS: The 1-year rate of smoking cessation was 30.1% for the study group. Of the subjects who quit smoking, 50.1% started smoking again during the 1-year follow-up. Relapse rate was also higher in nicotine addicts. Pharmacological treatment was associated with increased success rates in smoking cessation. CONCLUSION: Nicotine dependency was shown to be associated with lower rates of smoking cessation and higher rates of relapse. Therefore, it is important to begin smoking cessation attempts before individuals become serious addicts.

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

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

Evaluation of awareness on radiation protection and knowledge about radiological examinations in healthcare professionals who use ionized radiation at work.

OBJECTIVE: In this study, we evaluated the knowledge and perception and mitigation of hazards involved in radiological examinations, focusing on healthcare personnel who are not in radiation-related occupations, but who use ionising radiation as a part of their work. METHODS: A questionnaire was applied to physicians, nurses, technicians and other staff working in different clinics that use radiation in their work, in order to evaluate their knowledge levels about ionizing radiation and their awareness about radiation doses resulting from radiological examinations. The statistical comparisons between the groups were analyzed with the Kruskal Wallis test using the SPSS program. RESULTS: Ninety two participants took part in the study. Their level of knowledge about ionizing radiation and doses in radiological examinations were found to be very weak. The number of correct answers of physicians, nurses, medical technicians and other personnel groups were 15.7±3.7, 13.0±4.0, 10.1±2.9 and 11.8±4.0, respectively. In the statistical comparison between the groups, the level of knowledge of physicians was found to be significantly higher than the level of the other groups (p=0.005). CONCLUSION: The present study demonstrated that general knowledge in relation to radiation, radiation protection, health risks and doses used for radiological applications are insufficient among health professions using with ionizing radiation in their work.

Prevalence of asthma among children in an industrial town.

Studies of the prevalence of asthma should be supported by objective markers. We aimed to measure the prevalence of childhood asthma in a particular area and age group using a questionnaire, and to compare the results with the rates of asthma diagnosed by objective measures. All students aged 13-14 (n=1511) in Kemalpasa, Izmir, were included in the study. Children whose responses on the ISAAC Phase-I Questionnaire revealed current wheezing were invited to the district health center. The prevalence of clinically proven asthma (current wheezing supported by objective markers) was investigated. The questionnaire was answered by 1373 (90.87%) students. Current wheezing was indicated in 428 children (31.0%), significantly more in girls than in boys (p<0.05). However, the prevalence of clinically proven asthma decreased by 42.5% when using objective markers. This study provided important epidemiologic information about the prevalence of asthma as indicated by questionnaires as opposed to that indicated by objective measures, especially in countries where the language lacks a word for "wheezing."

Investigation of inherited thrombophilias in patients with pulmonary embolism.

Inherited thrombophilias are thought to play an important role in the cause of pulmonary embolism and its recurrence. Ninety of 281 patients objectively diagnosed as pulmonary embolism between 2006 and 2009 were included in the study. The screening for thrombophilia included mutations of factor V Leiden (FVL), prothrombin (PTM) G20210A, methylene tetrahydrofolate reductase C677T-A1298C, the serum levels of antithrombin III, protein C, protein S, factor VIII and activated protein C resistance. Forty-two male (46.7%) and 48 female (53.3%) patients had a mean age of 62.6 ±â€Š13.4 years. Patients with common thrombophilias comprised 30% of all cases (FVL: 19.1%, PTM G20210A: 3.4%, antithrombin III deficiency: 1.1%, protein C deficiency: 5.7%, protein S deficiency: 13.6%). A significant association between recurrence of pulmonary embolism (10 patients, 12.2%) and protein S deficiency was established (P = 0.040). Serum level of protein C was also significantly lower in the subgroup of recurrent pulmonary embolism (P = 0.049). FVL and PTM mutations were high in cancer patients; the presence of inherited thrombophilia was low with risk factors of surgery and immobilization. Genetic risk factors were high in patients with pulmonary embolism. Protein C and S deficiencies may play a role in pulmonary embolism recurrence. DVT or family history of pulmonary embolism was not found to be related to inherited thrombophilias. Surgery and immobilization were thought not to have priorities for detection of genetic risk factors. The high percentages of FVL and PTM mutations in cancer patients should be considered.

High prevalence of cardiovascular risk factors in a Western urban Turkish population: a community-based study.

OBJECTIVE: Cardiovascular diseases (CVD) are the largest cause of morbidity and mortality in Turkey and in the World. Heart of Balçova Project is a community- based health promotion project that aims to reduce CVD incidence and prevalence through risk factor modification in the individual and population level. This paper presents results of the baseline survey that aimed to define CVD risk factors and risk of developing coronary heart disease (CHD) in the Balçova population. METHODS: The study population included 36,187 people over 30 years of age residing in Balçova in 2007. Individuals were interviewed at their homes. Anthropometrics and blood pressure were measured and in total 12914 fasting blood samples were collected for lipid and glucose analyses. CHD risk was estimated using Framingham risk equation. Student's t test, Chi-square for trend test and ANOVA were used to compare mean levels and percentages of risk factors between age groups and gender. RESULTS: In total 5552 men and 10528 women participated in the study. Smoking prevalence was 38.6% in men and 26.8% in women. The prevalence of obesity was 29.4% among men and 44.2% among women and obesity prevalence increased until the age group 75 years old. While 14.6% of men and 12.6% of women had diabetes, 39.8% of men and 41.8% of women had hypertension. The prevalence of high total cholesterol was 56.0% in men and 50.6% in women. Men had a higher risk of developing CHD compared to women in the following 10 years (13.4% vs 2.5%). CONCLUSION: The prevalence of preventable risk factors for CHD is very high in Balçova population. Community-based interventions should be planned and implemented targeting both the high-risk individuals and whole population.

[Investigation of the cases presenting to Dokuz Eylül University Hospital with tick bites]. / Dokuz Eylül Üniversitesi Hastanesi'ne Kene Tutmasi Yakinmasi ile Basvuran Olgularin Arastirilmasi.

OBJECTIVE: Determination of the properties of ticks, which are the vectors of many infectious diseases and the patients with tick bites are important for the prevention of these diseases. For tist reason, the purpose of this study is to determine the important properties of the cases presenting with tick bites to Dokuz Eylul University Hospital and of the removed ticks from the cases. METHODS: Two hundred seventy three of 294 patients, who presented with tick bites to Dokuz Eylül University Hospital, Izmir, were included in the study. Demographic parameters, symptoms related to tick borne diseases of the patients and the species and other characteristics of ticks removed from humans, also the tick population in the related habitat were investigated. RESULTS: Removed ticks were classified into five genera. The overwhelmingly dominant genera were Hyalomma and it comprised 52.4% of the collection. The majority of these ticks were nymphs. The majority (11.4%) of removed adult ticks were Rhipicephalus sanguineus (R. sanguineus). In most cases (60.7%) the ticks were removed from the patients by medical staff. CONCLUSION: There was no significant difference in removing ticks without damage between the health personnel and the patient or relatives (p=0.133).

Balcova heart study: rationale and methodology of the Turkish cohort.

OBJECTIVES: Turkey is facing increasing rates of cardiovascular disease (CVD). The study is designed to meet the growing need to obtain information about the recent status and trends of CVD risk factors and their impact on mortality. METHODS: Balcova heart study (BHS) is a prospective cohort study, focusing on reducing the CVD risk factors of people over 30 years old living in Balcova District, Izmir, Turkey. Information about risk factors, anthropometric and biochemical measurements was collected in community centers. Interventions were planned, based on the 10-year coronary heart disease (CHD) risk and lifestyle characteristics with the collaboration of university and municipality. RESULTS: Mean age of the 16,080 participants was 52 years. The percentage of current smoking was 41.6 in men and 31.1 in women. One-third of the men were physically inactive. Hypertension was reported as 25% in men and 33% in women. CONCLUSIONS: The project is unique for being the first community-based cohort on CVD risk factors in a Turkish setting. This project will have a valuable contribution on not only determining CVD risks, but also incorporating interventions for prevention.

Performance of tuberculin skin test and interferon gamma assay for the diagnosis of latent tuberculosis infection in juvenile idiopathic arthritis.

The objective of this prospective cross-sectional study was to compare a Mycobacterium tuberculosis-specific interferon gamma (IFN-γ) enzyme linked immunosorbent assay [QuantiFERON-TB Gold In-Tube (QFT-GIT)] test with tuberculin skin test (TST) for detection of latent tuberculosis infection (LTBI) in patients with juvenile idiopathic arthritis (JIA). To our knowledge, this is the first study evaluating the performance of QFT-GIT in comparison with TST in JIA. A cross-sectional study of 39 children with JIA and 40 healthy controls was conducted in Izmir, Turkey. Blood was for drawn for the QFT-GIT assay prior to administration of the TST using 5 tubercullin units (TU) of purified protein derivative (PPD-S). A positive TST was defined as ≥10 mm for JIA and ≥15 mm for controls. Statistical analysis was performed using SPSS version 16.0 for Windows. There were no significant differences between JIA patients and controls for age, sex, and Bacillus Calmette-Guérin (BCG) vaccination. Of patients, 70% had active JIA disease. The median TST induration was 5.8 mm (±5.7 mm) for JIA and 10.7 mm (±4.5 mm) for the control group, which was statistically significant (p = 0.000). The rate of patients who showed no reaction to TST was 38%, of which 93% had active disease. There were two patients who had positive IFN-γ results but negative TST, who had systemic and polyarticular type JIA, respectively. Overall agreement between TST and QFT-GIT was low both in JIA and control group (κ value =0.06 and 0.10, respectively). TST may be inadequate to diagnose LTBI in JIA patients. The IFN-γ assay may be useful to identify false negative TST response in cases with latent M. tuberculosis infection. The combination of IF QFT-GIT method with TST would provide successful diagnostic screening for LTBI in JIA, particularly prior to anti-tumor necrosis factor treatment. Long-term prospective studies are still necessary to appreciate the advantages and the applicability of these tests in pediatrics.

[Effects of social inequalities on coronary heart disease risk factors: a population-based, cross-sectional study in Izmir]. / Sosyal esitsizliklerin koroner kalp hastaligi risk etmenlerine etkisi: Izmir'de topluma dayali, kesitsel bir çalisma.

OBJECTIVE: Aim of the study was to determine effects of social inequalities on coronary heart disease risk factors in individuals living in an urban district of Izmir; namely Balçova. METHODS: In this cross-sectional study, no sampling was done and it was aimed to reach all residents living in that area aged 30 years and over (n=4409). Dependent variables were smoking, physical inactivity, unhealthy diet, obesity, hypertension, diabetes, dyslipidemia where social inequality was the independent variable. Educational status, income and social class were considered as the components of social inequality. Age, gender, family health histories were the confounding factors. Data were collected at home and in the neighborhood-house. For data analyses Chi-square test, and logistic regression analysis were used. RESULTS: Smoking is higher in men and women in lower socio economic class, where unhealthy diet is higher in self-employed men (OR=9.24, 95% CI=1.14-74.81, p=0.037) and in women who have a lower education (OR=1.53, 95% CI=1.02-2.30, p=0.040), lower income or unemployed (OR=3.43, 95% CI=1.28-9.14, p=0.014). Obesity is more frequent in lower educated women (OR=1.89, 95% CI=1.37-2.59, p<0.001) where decreased high-density lipoprotein cholesterol (HDL-C) is more frequent in men who have lower income (OR=2.21, 95% CI=1.20-4.07, p=0.011). Men who have a lower education (OR=0.61, 95% CI=0.38-0.98, p=0.039) or working as a skilled (OR=0.37, 95% CI=0.16-0.89, p=0.027) or an unskilled worker (OR=0.35, 95% CI=0.15-0.82, p=0.016) tend to have a decreased risk of obesity when working as a skilled worker (OR=0.53, 95% CI=0.29-0.95, p=0.033) decreases elevated low-density lipoprotein cholesterol. CONCLUSION: Coronary heart disease risk factors are high among participants who are aged 30 years and over. Men are under higher risk than women are. An increase in social inequalities causes decreased HDL-C in men, and increased smoking, unhealthy diet and obesity in women.