Validity and reliability of the Turkish version of the European Health Literacy Survey Questionnaire.

Health literacy is a public health priority which refers to individual's knowledge, motivation and competence to access, understand, appraise and apply health information to prevent disease and promote health in daily life. This study aimed to adapt European Health Literacy Survey Questionnaire (HLS-EU-Q47) into Turkish and to investigate its psychometric properties. The questionnaire was translated into Turkish by using both group translation and expert opinion methods. Forward translation-back translation method was used for language validity and the final Turkish version (HLS-TR) was formed. HLS-EU-Q47 and Health Awareness Scale (HAS) were administered to 505 respondents. The scale reliability was examined using Crohnbach's alpha coefficient and the construct validity was assessed by principal axis factoring procedure. The convergent validity was obtained by Pearson correlation coefficients between HLS-TR and HAS scores and discriminant validity was examined comparing the scores of participants who were stratified according to ages, educational status, gender, general health status and social status. Cronbach's alpha coefficient for the whole scale was 0.95. Principal axis factoring extracted nine factors which eigenvalues were >1 and explained 50.01% of total variance. Factor matrix displayed that all items gave greater load in factor 1, showing that health literacy measured with one factor. Positive and significant correlation was found between HLS-TR and HAS. Significant relations were found between HLS-TR scores and selected determinants of health. This study revealed that the HLS-TR was a valid and reliable measuring instrument with appropriate psychometric characteristics.

[How is quality of life affected in women in the presence of anxiety and depression symptoms?]. / Kadinlarda yasam kalitesi anksiyete ve depresyon belirtilerinin varliginda nasil etkileniyor? kesitsel bir alan çalismasi.

OBJECTIVE: To assess how quality of life is affected among reproductive age women from the presence of anxiety and depression symptoms and the risk factors related to both. METHOD: A cross sectional analytic study was performed in person with 461 women. General Health Questionnarie-12 and WHOQOL-BREF were used. RESULTS: 35.5% of the women displayed symptoms of anxiety and depression and those who had experienced domestic violence had a 2.61-fold increase in symptom frequency and those with an income below 500 TL had a 2.49-fold more frequent occurrence of symptoms compared to others. General health quality mean score was 3.33 ± 0.804, the mean overall quality of life was 3.62 ± 0.791; Physical Health Domain: 15.95 ± 2.422; Psychological Health Domain: 14.70 ± 2.337; Social Relations Domain 14.64 ± 3,027; Environmental Domain 14:27 ± 2.20; National Domain 14:29 ± 2.144l. The total score of GHQ-12 and the first two questions of WHOQOL-BREF had a negative, moderate and highly significant correlation, whereas the Psychological HD score had a a negative,, strong and significant correlation All other domains and the total score of GHQ-12 had negative, moderate and significant correlations. CONCLUSION: Screening with GHQ-12 as well as offering the possibility of early diagnosis and treatment, is also important to prevent impairment in all areas of quality of life among women. Early diagnosis and treatment of psychological problems of women with risk factors such as exposure to domestic violence and low socio-economic status are the intervention areas with priority.

Local decision makers' awareness of the social determinants of health in Turkey: a cross-sectional study.

BACKGROUND: Social determinants have been described as having a greater influence than other determinants of health status. The major social determinants of health and the necessary policy objectives have been defined; it is now necessary to evaluate the effectiveness of these policies. Previous studies have shown that descriptions of the awareness level of citizens and local decision makers, practice-based research and evidence, and intersectoral studies are the best options for investigating the social determinants of health at the community level. The objective of the present study was to define local decision makers' awareness of the social determinants of health in the Aydin province of Turkey. METHODS: A total of 53 mayors serve the Aydin city center, districts and towns. Aydin city center has 22 neighborhoods and 22 headmen responsible for them. The present study targeted all mayors and headmen in Aydin - a total of 75 possible participants. A questionnaire was used to collect the data. The questionnaire was faxed to the mayors and administered face-to-face with the headmen. RESULTS: Headmen identified the three most important determinants of public health as environmental issues, addictions (smoking, alcohol) and malnutrition. According to the mayors, the major determinant of public health is stress, followed by malnutrition, environmental issues, an inactive lifestyle, and the social and economic conditions of the country. Both groups expressed that the Turkish Ministry of Health, municipalities and universities are the institutions responsible for developing health policy. Headmen were found to be unaware and mayors were aware of the social determinants of health as classified by the World Health Organisation. Both groups were classified as unaware with regard to their awareness of the Marmot Review policy objectives. CONCLUSIONS: Studies such as the present study provide important additional information on the social determinants of health, and help to increase the awareness levels of both local decision-makers and the community. Such studies must be considered a vital first step in future public health research on health determinants and their impact on national and international policies.

A population- based study on awareness of heart attack in Aydin city-Turkey.

OBJECTIVE: The study was conducted to determine the level of knowledge and awareness of risk factors and warning signs of heart attack in a selected sample of the Turkish population. METHODS: Population-based cross-sectional study was carried out with people over age 40 years in Aydin. The study group was determined by multi-stage sampling method (simple random and cluster sampling methods). Questionnaire was administered during face-to-face interviews in the participants' homes. Chi-square and t-test were used for analytical evaluation. Risk assessments were performed utilizing logistic regression analysis. RESULTS: The percentage of participants who did not know what a heart attack is and its warning signs were 42.3% and 23.2%, respectively. Overall, 11.8% were unaware of risk factors. Loss of consciousness/fainting, chest pain, radiation of pain were reported as three major warning signs. Among risk factors, stress was ranked as the most common, followed by smoking. It was determined that age, place of residence, education, occupation, self-reported risk factors had effect on the knowledge for major warning signs (p<0.05). In multivariate analysis, the factors having a negative effect on knowledge of major warning signs were having primary school/lower level of education (OR=2.447, 95%CI 1.773-3.378; p<0.0001), being older (OR=1.020, 95%CI 1.007-1.032, p=0.002), living in urban area (OR=1.493, 95%CI 1.133-1.968, p=0.004), being unemployed (OR=1.436, 95%CI 1.010-2.041, p=0.044) and absence of self-reported risk factors (OR=1.965, 95%CI 1.201-3.216, p=0.007). The percentage of participants stated that the first action to take for a person having heart attack was to put them on their back, open their collar, elevate their feet was 24.1%. They had learned information about the symptoms and the risk factors from television (28.6%) and neighbors/relatives (28.3%). CONCLUSION: This study revealed the need for increasing awareness utilizing community based education programs and the mass media.

Nutritional status and risk factors of chronic malnutrition in children under five years of age in Aydin, a western city of Turkey.

We aimed to assess the prevalence and risk factors of chronic malnutrition in children under five years old in Aydin province, Turkey. A cross-sectional design was used to study a group of 1,400 children. Multistage sampling, including cluster and random sampling, respectively, was used in the selection of the study group. Stunting, wasting and underweight were used as indicators of nutritional status for children. The prevalence of malnutrition in children under five years was found as 10.9% for stunting, 4.8% for underweight and 8.2% for wasted. Increased risk was found in families without social security by 2.071, with low birth weight by 2.516 and with giving no colostrum by 2.787 in stunted children. Improving social security coverage is essential. Mothers should be informed on the usefulness of breast-feeding at antenatal care services during their pregnancies and taught appropriate breast-feeding practices, including the importance of giving colostrum, at baby-friendly institutions after birth.

Home accidents in the elderly in Turkey.

Houses may accommodate environmental barriers that pose a risk for older people. This study aimed to identify the main characteristics of the dwellings of the elderly, and to assess the impact of those on home accidents. In that cross-sectional study, 3,277 people over 60 years of age living in Aydin province of Turkey were evaluated in December 2004, using a questionnaire and a home safety check list. The results indicated that 38.6% of the elderly have had any type of home accident within the last 12 months, and the most common type of accident was falls (31.9% of all accidents). Possible causes of accidents were analyzed and the houses were graded based on two different types of safety point scales (SP): SP1 for "house characteristics" and SP2 for "personal opinions." According to SP1, 22.7% of the houses were defined as in poor condition while this percentage was 20.1% according to SP2. Poor housing conditions, being female, living alone, having a chronic illness, physical and hearing disability, wearing eyeglasses, inactivity, use of assistive devices and more than four drugs were found to be associated with having a home accident. The environmental hazards and factors contributing to accidents or injuries were well-known. However, the information about home accidents in the elderly and the impact of dwelling characteristics was limited. This study was considered to be helpful to provide a new perspective on this subject. More studies are needed using the home safety check lists to collect additional quantitative data.

Limb lengths of primary school children in a city from western region of Turkey.

Anthropometry has been used for the assessment of growth at different ages. Among the anthropometric measurements, weight, height, arm circumference, and lower and upper limb lengths are of the most important criteria showing the development of children in school age. The aim of the present study was to measure the lengths of upper (arm, forearm, hand) and lower (thigh, leg, foot) limbs of children studying in primary schools of Aydin, a city in the western region of Turkey, and to assess the differences according to the gender (female, male) and living areas (urban, rural). In different age groups, many differences were observed when compared for gender and area. Differences were also seen when compared with the other studies done in different part of Turkey. The data was the first one for the region and it might be useful for further regional studies or for national comparisons. More studies designed with bigger sample sizes that cover many cities belonging to the same region of the country are needed. In addition to cross-sectional studies, longitudinal studies may give more useful knowledge for understanding the growth of children.

Female urinary incontinence in the west of Turkey: prevalence, risk factors and impact on quality of life.

OBJECTIVES: To determine the prevalence and risk factors of urinary incontinence (UI), and to assess its impact on quality of life (QOL) in Turkish women. METHODS: In this cross-sectional study, 1012 women aged over 18 years were interviewed through a questionnaire including 'International Consultation on Incontinence Questionnaire Short Form'. RESULTS: The overall prevalence of UI was 23.9% (n=242). Among these women, 62 (25.6%) had urge, 80 (33.1%) stress and 100 (41.3%) mixed type UI. The prevalence rate increased with advancing age. Eighty-nine women (36.8%) stated to have urinary leakage at least once a day or more, while 153 (63.2%) women were experiencing less than twice a week. UI was significantly associated with fecal incontinence, hypertension, history of nocturnal enuresis, and recurrent urinary tract infections. Overall, 211 (87.2%) women stated that UI have negative impact on the QOL. This effect remained mostly at the mild or moderate level. Although many (87.2%) had intention for medical assistance, only a few (14.9%) had realized it. Women with urge UI and aged 40 to 50 years looked for more assistance than others. CONCLUSIONS: UI affect approximately one of four Turkish women. The results emphasize the need for taking preventive measures and policy development for UI.

Intestinal parasites prevalence and related factors in school children, a western city sample--Turkey.

BACKGROUND: Intestinal parasitic infections are amongst the most common infections worldwide. Epidemiological research carried out in different countries has shown that the social and economical situation of the individuals is an important cause in the prevalence of intestinal parasites. Previous studies in Turkey revealed a high prevalence of intestinal parasitic infection. The objectives of the current study were to determine the prevalence of intestinal parasitic infections in Aydin among 7-14 years old school children and to identify associated socio-demographic and environmental factors, behavioral habits and also related complaints. METHODS: Multistage sampling was used in the selection of the study sample. A questionnaire, cellulose adhesive and a stool specimen examination were done. RESULTS: A total of 456 stool specimens were collected. 145 students (31.8%) were infected with one or more intestinal parasites. 29 (6.4%) of the students were infected more than one parasite, 26 (5.7%) with two parasites and 3 (0.7%) with three parasites. The three most common were E. vermicularis, G. intestinalis and E. coli. Intestinal parasite prevalence was higher in rural area, in children with less than primary school educated mother, in children who use hands for washing anal area after defecation, and in children who use toilet paper sometimes or never. The relation between child health and mother education is well known. Children were traditionally taught to wash anal area by hand. Toiler paper usage was not common and might be due to low income or just a behavioral habit also. Most of the complaints of the study population were not significantly related with the intestinal parasitic infection. CONCLUSIONS: Intestinal parasitic infection is an important public health problem in Aydin, Turkey. Rural residence, mother education less than primary school, sometimes or never usage of toilet paper, and washing anal area by hands after defecation were the significant associations. Interventions including health education on personal hygiene to the students and to the parents, especially to mothers are required. The ratio of uneducated women should be declined with specific programs. A multisectoral approach is needed.