Evaluation of COVID-19 pandemic management in Türkiye.

Three years since the first cases were identified and 2 years since an effective vaccine was developed, COVID-19 continues to claim lives and impact people's health and wellbeing, both socially and economically. While the world has been waiting for its leaders to come together to form a collective response to end the pandemic, we still have not seen a multisectoral response, nor any whole-of-society approach. Like many other countries around the globe, Türkiye was caught unprepared by the pandemic. This was exacerbated by the unsuccessful management of the pandemic by the authorities. The reasoning and/or scientific explanations for enforcing or lifting public health measures have never shared with the public. Throughout the pandemic, no epidemiological details have been released on cases and deaths, other than the numbers of these two measures. Civil society organizations, professional associations, and the public in general have been kept out from policy formulation and decision making. As a result, community engagement has never been properly put into practice. In this paper, we analyzed Türkiye's pandemic management response through the continuum of the response cycle to emergencies: prevention, preparedness, readiness, response, and recovery.

Premature deaths attributable to long-term exposure to PM2.5 in Turkey.

This research aims to reveal the premature deaths caused by long-term exposure to PM2.5 in 2018 in Turkey utilizing the AirQ+ program developed by the World Health Organization. Calculation of yearly average PM2.5 concentration in provinces, acreage of provinces, and the mortality rate of the at-risk population was the data required for the operation of the AirQ+ program. With the help of the AirQ+ program, the results revealed that a total of 44,617 people (95% CI 29.882-57.709) died prematurely due to sustained exposure to PM2.5 in Turkey in 2018. The highest estimated mortality proportion attributable to PM2.5 pollution was in the provinces of Igdir and Kahramanmaras. The highest estimated number of mortality cases per 100,000 population attributable to PM2.5 pollution was in the provinces of Manisa and Afyonkarahisar. This research points out that reaching the PM2.5 limits specified by the WHO could have prevented 44,617 premature deaths in the year 2018 in Turkey.

Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey.

BACKGROUND: Natural disasters, armed conflict, migration, and epidemics today occur more frequently, causing more death, displacement of people and economic loss. Their burden on health systems and healthcare workers (HCWs) is getting heavier accordingly. The ethical problems that arise in disaster settings may be different than the ones in daily practice, and can cause preventable harm or the violation of basic human rights. Understanding the types and the determinants of ethical challenges is crucial in order to find the most benevolent action while respecting the dignity of those affected people. Considering the limited scope of studies on ethical challenges within disaster settings, we set upon conducting a qualitative study among local HCWs. METHODS: Our study was conducted in six cities of Turkey, a country where disasters are frequent, including armed conflict, terrorist attacks and a massive influx of refugees. In-depth interviews were carried out with a total of 31 HCWs working with various backgrounds and experience. Data analysis was done concurrently with ongoing interviews. RESULTS: Several fundamental elements currently hinder ethics in relief work. Attitudes of public authorities, politicians and relief organizations, the mismanagement of impromptu humanitarian action and relief and the media's mindset create ethical problems on the macro-level such as discrimination, unjust resource allocation and violation of personal rights, and can also directly cause or facilitate the emergence of problems on the micro-level. An important component which prevents humanitarian action towards victims is insufficient competence. The duty to care during epidemics and armed conflicts becomes controversial. Many participants defend a paternalistic approach related to autonomy. Confidentiality and privacy are either neglected or cannot be secured. CONCLUSION: Intervention in factors on the macro-level could have a significant effect in problem prevention. Improving guidelines and professional codes as well as educating HCWs are also areas for improvement. Also, ethical questions exposed within this study should be deliberated and actualized with universal consensus in order to guide HCWs and increase humane attitudes.

30 Years Retrospective Review of Tuberculosis Cases in a Tuberculosis Dispensary in Bursa/Nilufer, Turkey (1985-2014): Changes of Epidemics.

OBJECTIVE: The aim of this study is to describe the epidemiological and clinical aspects of patients who applied to the Bursa Nilufer Tuberculosis Dispensary by investigating the trends in epidemics over three decades. METHOD: In this retrospective observational study, the records of all tuberculosis cases (1630 patients) treated in the last 30 years (1985-2014) at the Bursa Nilufer Tuberculosis Dispensary were examined and statistically analyzed. RESULTS: Males comprised 65.2% of the patients. The ages of the patients ranged from 1 to 87 years, and the mean age was 37.4 (95% CI: 36.6-38.2). Among the cases, 86.7% were new infections and 74.1% were pulmonary tuberculosis. In the last decade, the education level, the percentage of patients who had received a BCG vaccination, the proportion of women and active employees among them increased (p<0.05), while it decreased among men (p<0.05). Clinical symptoms accompanying TB such as weakness, anorexia, weight loss, and cough, decreased to a statistically significant degree (p<0.05). In the last decade, the mortality rate was 3.6% and increased compared with previous decades (p<0.05). Mortality was higher among patients who were elderly, male, did not have a BCG scar or had a chronic disease (p<0.05). CONCLUSION: This study adds information about the change of TB epidemics in Turkey in the last 30 years. Further studies are needed to determine the risk factors associated with tuberculosis mortality and to evaluate the effectiveness control programs of this disease.

Trends in occupational injuries and fatality in Turkey.

INTRODUCTION: The aim of this study was to evaluate the trend of occupational injuries in Turkey using epidemiologic criteria such as incidence mortality and fatality/all injuries recorded - rates. MATERIALS AND METHODS: Safety and health data were obtained from the Annual Statistic Books of the Social Insurance Institution (1988-2006) and Social Security Institution (2007-2011) of Turkey. RESULTS: The results from the official data showed that although total employment is increasing the number of occupational injuries and incidence and mortality rates are decreasing. The results also demonstrate that occupational fatality/all injuries recorded - rate is increasing. The fatality/all injuries recorded - rate per 1000 injuries increased to 25.5 in 2011 from 8.6 in 1988. Each work day an average of five people died because of occupational injuries. DISCUSSION AND CONCLUSIONS: The fatality/all injuries recorded - rate (the number of fatal cases per 1000 occupational injuries) is an important indicator of the injury rate for a country. Systems of occupational injury and illness surveillance constitute a critical resource for the management and reduction of occupational injuries and illness.

Family health history and self-rated health: a study from the Turkish countryside.

Self-rated health is a good indicator for mortality and morbidity, and many of the factors affecting self-rated health are well known. However, the effect of familial disease history on an individual's health perception has not been investigated. This study examined the effects of chronic and serious diseases in mothers, fathers, and siblings, and familial deaths, on self-rated health. A history of familial cancer or stroke affected men's health perceptions negatively, and the presence of familial heart disease affected women's health perception negatively.

Evaluation of respiratory functions of residents around the Orhaneli thermal power plant in Turkey.

The aim of this cross-sectional study was to evaluate the health and respiratory function of residents around the Orhaneli thermal power plant in Turkey. The study was conducted using face-to-face interviews, and respiratory functions were measured with a spirometer. The respiratory functions of 2350 residents, 15 years and older, living in communities near the coal-fired Orhaneli thermal power plant in Turkey were measured. The control group consisted of 469 persons from similar communities without a nearby power plant. The FEV1 (forced expiratory volume after 1 s) and FVC (forced vital capacity) values of the study participants were significantly lower than those of the control group, and residents directly downwind of the plant's smokestack showed greater impairment of respiratory functions compared with residents upwind.

Occupational exposure to wood dust and health effects on the respiratory system in a minor industrial estate in Bursa, Turkey.

OBJECTIVES: The aim of this study was to estimate occupational exposure to wood dust in the furniture industry in a minor industrial estate in Bursa, Turkey. MATERIALS AND METHODS: The study was conducted between October 2006 and May 2007. In this study, a total of 656 persons, 328 woodworkers and 328 controls were included. A questionnaire was used in the study. Physical examination and the pulmonary function tests (MIR-Spirobank G) of the workers were performed. A portable Aircheck 2000 pump was used to collect the specimens of wood dust from the workplaces. NIOSH Method 0500 was employed for the gravimetric measurements of dust. RESULTS: The average dust concentration at the workplace was 2.04+/-1.53 mg/m3. It was reported that 176 of workers (53.7%) had blocked nose while working, 141 (43.0%) had redness of the eyes, 135 (41.2%) had itching eyes and 78 (23.8%) had runny nose. No symptoms were observed in the control group while they were working at the workplace. The mean FEV1 and FVC values of woodworkers, among both smokers and non smokers, were significantly low, although the FEV1/FVC value was high (p < 0.05). An increase both in FEV1 and FVC values was detected among the woodworkers who had a working period less than 10 years and were exposed to wood dust at concentrations over 4 mg/m3 compared to the woodworkers who were exposed to wood dust at less than 4 mg/m3 (p < 0.05). CONCLUSIONS: As a result, in this study it was pointed out that the exposure to wood dust adversely influenced the workers respiratory functions. Besides, in this study a question associated with the healthy worker effect that can adversely influence health of workers exposed to wood dust at less than (4 mg/m3) is revealed.

Occupational lead exposure: blood lead levels of apprentices in Bursa, Turkey.

The aim of this cross-sectional study was to compare the blood lead levels of apprentices working in lead-related industries with those of non-apprentice controls and to evaluate the influence of such occupational exposure. The study was conducted between October 2004 and June 2005 in Bursa, Turkey. Subjects included 231 apprentices and 252 male controls, age ranging from 14-19 yr old. Inductively coupled plasma mass spectrometry (ICP-MS) was used to analyze blood lead levels. The overall mean blood lead level was 3.62 microg/dl (95% CI 3.39-3.85), the apprentice mean was 4.99 microg/dl (95% CI 4.60-5.38), and the control group mean was 2.37 microg/dl (95% CI 2.22-2.51). The blood lead level of apprentices was significantly higher than that of controls (p<0.05). Results show that occupational exposure increases the blood lead levels of apprentices, although the impact on their immediate health is low. Measurement of blood lead levels of apprentices should be taken periodically, and a regular medical surveillance program should be established.

Hypertension in children (12-14 years)--a case-control study in Bursa, Turkey.

The aim of this study was to determine the cardiovascular disease risk factors (risk of overweight/overweight, dyslipidemia, paraoxonase-1 activity, positive family history, physical inactivity, smoking) that accompany hypertension and investigate the relationship between hypertension and some of these risk factors. This study included 118 hypertensives and 118 age- and sex-matched non-hypertensive controls aged 12-14 years. Among controls, 64.4% had no risk factor. Among cases, 34.8% had no risk factor other than hypertension, and 65.2% had two or more risk factors. The adjusted odds ratio (OR) (95% confidence interval [CI]) of hypertension was 5.65 (2.88-11.09) for risk of overweight/overweight. Body mass index, paraoxonase and arylesterase activities were significantly higher in hypertensives than those of the control group. We conclude that it would be useful to routinely evaluate blood pressure and body weight at schools and, additionally, considering that hypertension alone is encountered rarely, it would be appropriate to examine the hypertensive students for other risk factors.

Prevalence & risk factors of anaemia among women of reproductive age in Bursa, Turkey.

BACKGROUND & OBJECTIVE: The control of anaemia in women of childbearing age is essential to prevent low birth weight and perinatal and maternal mortality. The aim of this study was to determine the anaemia prevalence and risk factors in women of reproductive age group in Nilufer Public Health Training and Research Area, Bursa, Turkey. METHODS: In this cross-sectional study, 530 women were selected using stratified random sampling among 6,506 women in 15-49 age group and 488 women (92.1%) participated in the study. Pregnant women or women who were not sure of their pregnancy were not included in the study. The data collected were analysed by multivariate logistic regression analysis to determine the risk factors related to anaemia. RESULTS: The prevalence of anaemia was 32.8 per cent (haemoglobin level < 12 g/dl). Usage of more than 2 sanitary pads in a day during menstruation (OR=3.67, 95% CI 2.30-5.88; P=0.000) and duration of menstrual bleeding more than 5 days (OR=3.01, 95% CI 1.94-4.66; P=0.000) were found to be risk factors for anaemia. INTERPRETATION & CONCLUSION: Approximately 1 of 3 women in the study area was diagnosed to be anaemic. These data indicated the necessity of a public health programme for prevention and early diagnosis of anaemia. Starting from adolescence, all non pregnant women should be screened for anaemia every 5-10 yr throughout their childbearing years during routine health examinations. The follow up service provided by midwives at the primary health care can be used as a suitable tool for anaemia prevention.

Prevalence and risk factors of hypertension among schoolchildren aged 12-14 years in Bursa, Turkey.

OBJECTIVE: To determine the hypertension prevalence and risk factors related to hypertension among schoolchildren aged 12-14 years in Bursa, Turkey. METHODS: We conducted this study at the Bursa Provincial Center between February and June 2006. Two thousand and four hundred seventy-eight schoolchildren were randomly selected. The evaluation of elevated blood pressure was carried out according to The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. RESULTS: Of the 2,478 students screened, 350 (14.1%) has prehypertension, 147 (5.4%) has hypertension, and 40 (1.6%) has malign hypertension. There was a statistically significant relationship between hypertension prevalence and aged, gender, family history of hypertension, and body mass index >/=85th percentile. CONCLUSION: Blood pressure measurements should be in physical examinations as part of continuing care of a child. The prevention of overweight and risk of overweight can decrease the prevalence of hypertension.

Distribution of blood pressures in Gemlik District, north-west Turkey.

The objectives of the present study were to evaluate the prevalence, awareness and control of hypertension among individuals over 30 years of age and to plan a follow-up programme for the same age group. A community-based sample of 1992 individuals (952 men and 1,040 women) was selected randomly. Out of the total study population, 1,388 (69.7%) individuals had normal blood pressure according to World Health Organisation criteria (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg), and the rest (n = 604, 30.3%) had hypertension to varying degrees. Since 61 individuals with normal blood pressure were using antihypertensive medication, the overall hypertension prevalence was 33.4%. Among the study subjects with hypertension, 44.4% were aware of their condition, 37.7% were using medication and 9.2% had controlled hypertension. One out of five individuals (n = 399, 20.0%) had never had their blood pressure measured before. Females had a higher hypertension prevalence than males (36.7% and 29.7%, respectively). Hypertension prevalence increased with age and individuals with a body mass index > 25 were at greater risk. The present findings suggest that there is a need to implement an effective, community-based and low-cost management programme.

Blood lead levels of traffic policemen in Bursa, Turkey.

This study was conducted in January 2001, in Bursa, Turkey. Of the 99 traffic policemen who were included in the study, 21 were office workers. Blood lead levels were determined by using an electro-thermal atomic absorption spectrometer (ET-AAS). Average blood lead levels were 9.4 +/- 1.6 micrograms/l and 8.7 +/- 1.7 micrograms/l for policemen working outdoors and indoors, respectively. The difference between the two groups was statistically insignificant (P > 0.05). When policemen less than 15 years on duty were taken into account (n = 48) the difference between the outdoors and indoors working groups was significant (9.3 +/- 1.3 and 8.2 +/- 1.8 micrograms/l, P < 0.05). In order to prevent the negative effects of tetraethyl lead on humans and the environment the use of lead in petrol must be prohibited.