Assessment of water, sanitation, and hygiene among women living in precarious households in a Turkish urban area.

BACKGROUND: This study aimed to identify the determinants of water, sanitation, and hygiene (WASH) behaviors and conditions among women in poor neighborhoods in Izmir, Turkey, and to develop a scale for assessing WASH behaviors and conditions that is specifically designed for use in precarious urban areas. METHODS: The study used a cross-sectional design, as well as a methodological feature for developing the scale. The sample size was calculated as 243 households out of 2667 households in the Basmane neighborhood, with a 95% confidence interval and a 6% margin of error, and a woman who was responsible for cleaning was invited to participate from each household. The scales for WASH behaviors and conditions, which served as dependent variables, were developed in a four-stage process, yielding two distinct scales. The WASH-Behaviors Scale had 14 items about hand, body, and home hygiene, whereas the WASH-Conditions in Households Scale included 16 items about variables like area per capita, physical structure, and cleaning tool availability. Age, ethnicity, number of children, education, work status, and income were among the independent variables. Data was collected through household visits. The scales' validity was evaluated using exploratory factor analysis. Linear logistic regression analysis was employed to assess the determinants of WASH behaviors. RESULTS: The women, with an average age of 40.65 ± 14.35 years, faced economic challenges, as a substantial portion earned an income below the minimum wage. More than half of them were uninsured, and 72.6% were identified as migrants or refugees. Factor analysis confirmed the compatibility of both scales (KMO = 0.78-0.80, p < 0.05), elucidating 52-54% of the total variance. Factors such as ethnicity, number of children, husband's education level, income perception, and WASH conditions explained 48% of WASH behaviors. CONCLUSIONS: WASH-Behaviors and WASH-Conditions in Households scales met the validity criterion, and their scores were related to basic sociodemographic and economic characteristics like education, income, household size, and ethnicity. The scale development process emphasized the importance of considering both behaviors and household conditions, albeit using different techniques. The findings indicated that WASH conditions are more problematic than behaviors, and that behavioral interventions will not work unless the conditions are corrected.

Evaluation of occupational health and safety risk factors in Turkish marine fish hatcheries.

In this study, the approaches of employees in marine fish hatcheries to occupational health and safety were determined. Cronbach's α coefficient was calculated as 0.858 in the reliability of the scale and scale factors based on internal consistency. In addition,factor analysis according to the varimax method was found to be approximately 64%. It was determined that 68% of the employees were not aware of the relevant laws. In addition,85% of the employees are aware of the dangers and risks in their workplaces. In the event of a negative situation in the workplace,the rate of those who know their legal rights is 73% (p ≤ 0.05). In addition,91% of the employees stated that they would use their right to object in a risky situation and quit the job. Sixty per cent of the employees stated that their jobs can satisfy them sociologically and economically throughout their life.

The prevalence of hypertension and influencing factors among the employees of a university hospital.

BACKGROUND: Hypertension is a serious disease with increasing worldwide prevalence, leading to life-threatening complications. METHODS: This cross-sectional study was carried out in a university hospital. The Occupational Health and Safety Unit data concerning the health examinations of employees were used to determine the prevalence of hypertension in a university hospital and to define the relationship between hypertension and sociodemographic and occupational parameters. Logistic regression analyses were performed for the variables having a significant association with high blood pressure. RESULTS: The data generated during the periodic examination of 3,480 (92%) of all employees (3,780) were analyzed. The prevalence of hypertension was 14.8%. The prevalence of hypertension was found to be 13.5%, 13.9%, and 23.7% among physicians, non-physician healthcare personnel and officers respectively. The logistic regression model revealed a statistically significant correlation between hypertension and male gender, age and BMI. CONCLUSION: The prevalence of hypertension was highest among staff members. Special programs would facilitate the diagnosis, control, and prevention of high blood pressure among the high-risk groups, especially men, the elderly and the obese hospital employees.

Hemophagocytic Syndrome due to Leishmania Infection Diagnosed with Immunofluorescence Antibody Test.

Leishmaniasis is a reticuloendothelial system disease that mostly observed before the age of 5. Visceral infection causes long-standing fever, weight loss, weakness, pancytopenia, and hepatosplenomegaly. Leishmania infantum is responsible for visceral leishmaniasis (VL) in Turkey. We present a case of hemophagocytic syndrome due to Leishmania infection diagnosed with an immunofluorescence antibody test (IFAT). Leishmania amastigotes were not observed on bone marrow aspiration. We consider that IFAT is very important for parasite detection in the diagnosis of VL in children, particularly when amastigotes are not obtained on bone marrow aspiration.

The influence of a market-oriented primary care reform on family physicians' working conditions: A qualitative study in Turkey.

BACKGROUND: Turkey has undergone a 'Health transformation programme' putting emphasis on the reorganization of primary care (PC) services towards a more market-oriented system. OBJECTIVES: To obtain a deep understanding of how family physicians (FPs) experienced the process of the reforms by focusing on working conditions. METHODS: This phenomenological and qualitative research used maximum variation sampling and 51 FPs were interviewed in 36 in-depth and four focus-group interviews. RESULTS: Thematic analysis of interviews provided seven themes: (1) change in the professional identity of PC physicians (physician as businessperson); (2) transformation of the physician-patient relationship in PC (into a provider-customer relationship); (3) job description and workload; (4) interpersonal relationships; (5) remuneration of FPs, (6) uncertainty about the future and (7) exhaustion. Most FPs felt that the Family medicine model (FMM) placed more emphasis on the business function of family practice and this conflicted with their professional characteristics as physicians. FPs complained that some of their patients behaved as extremely demanding consumers. Continuously increasing responsibilities and extremely high workload were commonly reported problems. Most participants described the negative incentives in the performance scheme as a degrading method of punishment. The main factor was job insecurity caused by contract-based employment. FPs described the point at which they are with terms such as exhaustion. CONCLUSION: By increasing workload and creating uncertainty about the future and about income, the PC reforms have led to working conditions, which has led to changes in the professional attitudes of physicians and their practice of medicine.

Overcoming job demands to deliver high quality care in a hospital setting across Europe: The role of teamwork and positivity / La superación de las exigencias laborales para ofrecer una elevada calidad asistencial en el ámbito hospitalario en Europa: papel del trabajo en equipo y la positividad

Health care professionals deal on a daily basis with several job demands - emotional, cognitive, organizational and physical. They must also ensure high quality care to their patients. The aim of this study is to analyse the impact of job demands on quality of care and to investigate team (backup behaviors) and individual (positivity ratio) processes that help to shield that impact. Data was collected from 2,890 doctors and nurses in 9 European countries by means of questionnaires. Job demands have a negative impact on the quality of care delivered by health professionals. Backup behaviors had a mediating effect between job demands and quality of care. Also, the positivity ratio of professionals (ratio of positive and negative emotions experienced) was also found as a significant mediator between most job demands and quality of care dimensions. Finally, we found a double mediation between most job demands and quality of care, where backup behaviors influenced the positivity ratio. Quality of care in hospitals is closely related to job demands. Hospital managers should consider the importance of cooperation within health care professionals’ teams and ought to find ways to develop teamwork in order to promote patients’ safety (AU)

Los profesionales de la salud tratan a diario con múltiples exigencias laborales -emocionales, cognitivas, organizacionales y físicas. También deben garantizar la máxima calidad de atención a sus pacientes. El objetivo de este estudio es analizar el impacto de las demandas laborales en la calidad de los cuidados y de investigar los procesos de equipo (backup behaviors) e individuales (positivity ratio) que ayudan a proteger al trabajador de ese impacto. Se recogieron datos de 2.890 médicos y enfermeros en 9 países europeos a través de cuestionarios. Las demandas laborales tienen un impacto negativo en la calidad de los cuidados proporcionados por profesionales de la salud. Los procesos de equipo (backup behaviors) tuvieron un efecto de mediación entre las demandas del trabajo y la calidad de los cuidados. Además, la ratio de positividad de los profesionales (proporción de emociones positivas y negativas) también se encontró como un mediador importante entre la mayoría de demandas de trabajo y la calidad del cuidado. Por último, se encontró una doble mediación entre la mayoría de las demandas de trabajo y calidad de la atención, donde los procesos de equipo influyeron en la ratio de positividad. La calidad de los cuidados proporcionados en los hospitales está muy relacionada con las exigencias del trabajo. Los directores de hospitales deben considerar la importancia de la cooperación entre equipos de profesionales de salud y encontrar formas de desarrollar el trabajo en equipo con el fin de promover la seguridad de los pacientes (AU)

Organizational stressors, work-family interface and the role of gender in the hospital: experiences from Turkey.

OBJECTIVES: In the framework of the EU project 'Improving quality and safety in the hospital: The link between organizational culture, burnout and quality of care', focus groups (FGs) were conducted to explore hospital environment stressors and their relationship with health care professional (HP) well-being and quality of care. METHODS: Semi-structured interviews and FGs were used. Three mixed FGs with 23 health care workers, two FGs with 12 nurses, and another one with nine physicians were conducted. Thematic analyses were performed. Data were coded into main themes and subthemes. RESULTS: Three themes emerged from the discussions: (1) Organizational stressors associated with working conditions concerning the nature of the job, workload and working schedule, unclear role definition, lack of time for personal development, interpersonal relationships at work, changes in health policy, (2) work-family spillover and (3) the gendered nature of health care work and of patients' expectations, and the gendered character of the workplace. CONCLUSIONS: Health care professionals are faced with numerous challenges that create stress affecting their daily life. Job stressors related to working conditions, the negative and positive spillover of work-family interference and the gendered nature of health care work emerged as important issues for Turkish HPs. STATEMENT OF CONTRIBUTION: What is already known on this subject? In Turkey, gender has rarely been considered in the healthcare studies. Rapid changes in health reforms are making healthcare professionals more vulnerable to stress. The deteriation in the health system impacts women more than men, as higher ratios work in outsourced services. What does this study add? Despite signifcant changes in attitudes towards women, nurses are treated as "mothers" of the clinics. Women as health workers are particularly exposed to multiple stressors, that are rooted in ideals about gender. Understanding the way healthcare is organized along gendered lines is a precusor to any real organizational change.

Assessment of the effects of breast cancer training on women between the ages of 50 and 70 in Kemalpasa, Turkey.

BACKGROUND: In both developed and developing countries; breast cancer is the major cancer observed in women. The aim of this study was to assess the effect of nursing and mammographic intervention on women with breast cancer between the ages of 50 and 70. MATERIALS AND METHODS: A training program, which was quasi- experimental and had a pretest-protest design, was applied in Kemalpas?a district of Izmir, between October 2008 and August 2010. The target population was women between the ages of 50 and 70, who were registered in the list of 3rd Family Medicine Unit in Izmir's Kemalpas?a metropolis. A total of 106 women who were in conformity with the study criteria participated in the study. Research data were collected through home visits that included face-to-face interviews; Ministry of Health education material and video films were modified and used for the training. Data analysis was performed through 82 women who were paired at the first and the second phase. RESULTS: It was observed that although the rate of breast self examination significantly increased after the training (p=0.022), the rate of clinical breast examination (p=0.122) and mammographic screening (p=0.523) did not. Differences in the stages of change after training were found to be statistically significant (p<0.001) and the group showed a progression in the stages of change in general (46.3%). In women mean scores of breast cancer awareness (p<0.000), severity (p<0.000), health motivation (p<0.000) and perception of the benefits of mammography (p<0.000) increased significantly and mean score of perception of mammography barriers decreased significantly (p<0.000) after the training. CONCLUSIONS: After the training on breast cancer and mammography it was determined that nursing interventions provided positive progression of stages of change of women, affected health beliefs positively and significantly increased BSE incidences. However, it did not have a significant effect on CBE and mammographic screening.

[Evaluation of visceral leishmaniasis diagnosis using indirect fluorescent antibody tests in 4 pediatric patients]. / Dört Çocuk Hastada Indirekt Floresan Antikor Test Kullanimi ile Visceral Leishmaniasis Tanisinin Degerlendirilmesi.

Visceral Leishmaniasis (VL) in infancy is mostly seen between the ages of 2-4,and visceral infection causes long standing fever, weakness, weight loss, hepatosplenomegaly and pancytopenia. Leishmania infantum is responsible for VL in Turkey. In this study, 4 pediatric cases of VL were analysed retrospectively. Bone marrow aspirate was obtained in two cases and Leishmania amastigotes were not obtained in these cases. Leishmania antibodies by the indirect immun fluorescent antibody test (IFAT) were positive in all cases. We consider that IFAT was a suitable alternative to parasite detection in the conclusive diagnosis of visceral leishmaniasis in pediatric patients when strong clinical suspicion is present.

Helicobacter pylori seropositivity in fibromyalgia syndrome.

Although there are some studies suggesting relation between different types of infection and fibromyalgia syndrome (FM), there is presently no proof that FM is caused by an infection. Helicobacter pylori (HP) infection may cause extragastric manifestations. Inflammation is an important mediator of increased sympathetic nervous system activity and may lead to pain in fibromyalgia patients. In this study, we aimed to investigate the HP seropositivity in fibromyalgia patients compared with controls for possible role of HP infection in FM. Sixty-seven patients with fibromyalgia were evaluated. Two of them were excluded from the study because of high level of acute phase reactants. Sixty-five female patients with fibromyalgia and 41 randomly selected age-matched female healthy controls were enrolled to study. Serum HP IgA and IgG antibodies were measured by enzyme-linked immunosorbent assay technique. Fibromyalgia Impact Questionnaire was assessed in patients and controls. Seropositivity of HP IgG antibody in the fibromyalgia patients was significantly higher than in the control group. No statistically significant differences were found regarding the clinical features between fibromyalgia patients with HP IgG antibody and patients without IgG antibody. Our study suggests that former HP infection may have a role in the etiopathogenesis of fibromyalgia syndrome or may act as a triggering factor. However, high seroprevalence of HP in general population and prevalent asymptomatic infection make it difficult to interpret these results for the definite role of HP in FM. Highlighting the pathophysiologic mechanisms of FM will result in more effective treatment regimens.

The effects of an educational program on knowledge of breast cancer, early detection practices and health beliefs of nurses and midwives.

AIM: To determine the effectiveness of an educational program concerning knowledge of breast cancer, early detection practices and health beliefs of nurses and midwives. BACKGROUND: Educational programs play an important role in breast cancer preventive behaviour. DESIGN: The study was designed as an experimental post-test only, control group design. The educational program was applied only to the experimental group. The study group included 157,134 nurses and midwives respectively in the experimental and the control group. METHODS: Participants in the experimental group received an educational program on the breast cancer. One year after the educational program was delivered, data were collected from the two groups using a personal data form and the Turkish version of Champion's Health Belief Model Scale. Descriptive statistics, paired samples t-test, chi-square test and Fisher's exact test were conducted in the course of the data analyses. RESULTS: The mean total knowledge score was significantly higher in the experimental group than in the control group. The application percentage of mammography and clinical breast examination was higher in the experimental group. There were no significant differences between two groups in performing breast self-examination. The experimental group was significantly more likely to feel confident and motivated, and their total score on the health belief scale was much better than that of the control group. CONCLUSIONS: The results of this study showed that educational intervention had a positive impact on knowledge of breast cancer, on practices related to breast cancer, on early detection and on the health beliefs in the experimental group. RELEVANCE TO CLINICAL PRACTICE: The educational programs, including techniques to increase the motivation and skills for early detection of breast cancer, should be made widespread in nursing and midwifery. Health beliefs should be considered in planning educational programs about breast cancer. Interventions should be designed to enhance nurses' and midwives' confidence and motivation.

[The distribution of intestinal parasites among children in Denizli]. / Denizli'deki cocuklarda intestinal parazitlerin dagilimi.

Intestinal parasitic disease appears to be an important national health problem in our country. Parasitic infection distribution is related to the socioeconomic status and environmental factors. The aim of this study was to determine the distribution of intestinal parasites among children in the 1-15 age group in the Denizli province. Parasitic infection was observed in 256 (10.2%) out of 2518 children. The highest rate of 31.4% was that of Giardia intestinalis. The rates of Enterobius vermicularis and Blastocystis hominis were found to be 29.6% and 14% respectively.

[Cystic echinococcosis in Turkey from 2001-2005]. / Türkiye'de 2001-2005 Yillari Arasinda Kistik Ekinokokkozis.

Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is a major public health problem especially in animal-raising regions of the world. In the present study, CE cases were determined during 2001-2005 by investigating different hospital and health directorship documents and Health Ministry documents, retrospectively. Our results show that there were 2534 (13.13%) cases in the Marmara region; 2114 (16.94%), in the Aegean region; 2578 (16.09%), Mediterranean region; 5404 (38.57%), in the Middle Anatolian region; 428 (5.70%), in the Black Sea region; 844 (6.80%), in the eastern Anatolian region; and 887 (2.75%), in the southeastern Anatolian region making a total of 14,789 CE cases. Finally, it has been determined that the patients were hospitalized for a total of 149,464 days.

A case of Acremonium strictum peritonitis.

During the past two decades opportunistic fungal infections have emerged as important causes of morbidity and mortality in patients with severe underlying illnesses. A few cases of Acremonium spp. infections have been described in immunocompromised patients, but they have on occasion been reported as the cause invasive disease in immunocompetent individuals. Peritonitis is a common clinical problem that occurs in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD). Yeasts, or rarely molds, may also cause peritonitis in patients on CAPD and we present here a case caused by Acremonium strictum.

The prevalence of cryptosporidiosis in Turkish children, and genotyping of isolates by nested polymerase chain reaction-restriction fragment length polymorphism.

OBJECTIVE: To verify the incidence of cryptosporidiosis among Turkish elementary school students. METHODS: This study was conducted in the Department of Parasitology, Faculty of Medicine, Ege University, Turkey during a 3-month period in 2006. We assessed the fecal samples of 707 children using modified acid-fast and phenol-auramine staining followed by modified Ritchie concentration method. All Cryptosporidium species isolates were analyzed by nested polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) to differentiate the genotypes of the isolates. After the coprological examination, 4 samples were found to be positive for Cryptosporidium species oocysts. RESULTS: In the present study, all 4 oocysts were of zoonotic origin and belonged to Cryptosporidium parvum genotype 2 indicating that in Turkey the potential sources of human cryptosporidiosis is from animals. CONCLUSION: The application of genotyping to clinical isolates of Cryptosporidium has significantly increased our knowledge and understanding of the distribution and epidemiology of this parasite. The PCR and RFLP techniques represent a more rapid and simple method of genotyping to support epidemiological and clinical investigations than conventional analytical DNA techniques.

Acanthamoeba keratitis due to Acanthamoeba genotype T4 in a non-contact-lens wearer in Turkey.

An otherwise healthy 22-year-old man presented with Acanthamoeba keratitis (AK) in the right eye. He was not a contact lens wearer and had no history of corneal trauma. The Acanthamoeba strain isolated from a corneal scraping was identified as morphological group II and genotype T4. Three more Acanthamoeba strains isolated from sites of possible human contact with acanthamoebae in the same geographical region, including a lens storage case, tap water and soil, were subjected to morphological and molecular biological identification. Whereas the strain from tap water also exhibited genotype T4, the two other isolates were identified as morphological group I and genotype T9. To the best of our knowledge, this is the first study identifying an AK-causing Acanthamoeba strain in Turkey and the first isolation of genotype T9 in this country.

Comparison of incidence of Demodex folliculorum on the eyelash follicule in normal people and blepharitis patients.

Demodex folliculorum has been incriminated in the development of blepharitis although much controversy persist. Some authors suggest that Demodex is a direct pathogen in chronic palpebral conditions while others consider the saprophyte to be innocuous to skin. We conducted a prospective study of eyelashes in 48 patients with blepharitis (totally 96 eyes) and 48 healthy persons (totally 96 eyes), searching for Demodex folliculorum and chronic blepharitis. Microscopy in immersion oil after storage in a moist chamber was performed. It is determined Demodex follicullorum in 11 of 37 (29.72%) patients with blepharitis, in one of 11 (9.09%) patient with blepharoconjunctivitis and in 2 of 48 (4.16%) persons in healthy control group. Staphylococcus aureus was cultivated in five patients and D. folliculorum was found two of them. The incidence of Demodex folliculorum was high in patients with blepharitis compared with normal controls. Incidence was high in males. Anti-Demodex treatment is indicated when the parasite is found.

A case of nasomyiasis whose agent was Sarcophaga sp.

Sixteen larvae fell from the nose of a 16-year-old girl, who had been hospitalized in the anesthesia intensive care unit for 4 days because of a traffic accident and had been evaluated as E1M2V1 according to Glaskow Coma Scale. These larvae were examined macroscopically and microscopically and it was determined that they were second stage Sarcophage spp. larvae. There was no lesion in the nose of the patient.