How to reduce pesticide exposure in farmers: An interventional study.

BACKGROUND: Pesticide poisoning is a serious public health problem. OBJECTIVE: The aim was to investigate the effect of safe pesticide application training given to farmers on their behaviors towards compliance with protective measures. METHODS: In this interventional study, the target population was 9750 farmers living in Turkey. To achieve a study power of 95%, type I error and the effect size were assumed as 5% and 0.50 respectively. In the study, 61 farmers were selected using the systematic sampling method. Farmers were interviewed twice, before and after the training, and at each interview, they were asked questions about their pesticide use-related behaviors in the last four sprayings. In the analysis, the paired t-test, repeated measures of ANOVA (post hoc: Bonferroni) were used. RESULTS: The scores the participants obtained from the Pesticide Exposure Prevention Behavior Form which questions their compliance with protective measures taken during pesticide applications at the post-interview were significantly higher than were the scores they obtained at the pre-interview (P < 0.001). The analysis of the independent variables demonstrated that the scores obtained from the Pesticide Exposure Prevention Behavior Form at the post-interview were significantly different from those obtained at the pre-interview in almost all of the subgroups in terms of their sociodemographic characteristics. CONCLUSION: It was observed that the training given to the farmers on the safe use of pesticides encouraged the farmers to develop positive behavioral changes. The study emphasizes the importance of implementing ongoing health education programs for farmers.

Faculty members' earthquake preparedness levels and their related factors: a cross-sectional study from a university in a high-risk earthquake zone in Turkey.

BACKGROUND: This cross-sectional study aimed to determine the earthquake preparedness levels and related factors of the faculty members working at a university located in a province in a first-degree earthquake zone in Turkey. METHODS: The total number of faculty members at the university is 457, including 314 assistant professors, 63 associate professors, and 80 full professors. The study group included 177 (38.7%) of 457 faculty members. The dependent variable of the study is the attitudes of the faculty members towards earthquake preparedness. The independent variables were age, gender, marital status, having children, living with or without children, duration of residency in Karabuk. In addition, these were also included as variables, respectively, type of housing, property ownership, work experience, exposure to natural disasters in the past, and the awareness that Karabuk is a first-degree risk earthquake zone. The data were collected using a descriptive questionnaire and Mulilis-Lippa Earthquake Preparedness Scale. Data were analyzed using chi-square tests and binary logistic regression model and SPSS 20.0 software. RESULTS: There was only one (0.6%) faculty member who stated that he meets all of the preparatory criteria of the Mulilis-Lippa Earthquake Preparedness Scale. The probability of low materials preparedness score increased by 2.31 (95% CI 1.1-4.7) and 4.53 (95% CI 1.4-14.4) when the faculty members were renters and working as faculty members for 15 years and over, respectively. Being a renter also increased the probability of common knowledge and skill score by 1.95 (95% CI 1.0-3.8). CONCLUSIONS: This study showed that earthquake preparedness levels among the faculty members are insufficient and suggests that motivation of the faculty members' motivation to be appropriately prepared for future earthquake case should be increased.

Occupational acute pesticide poisoning: a cross-sectional study of Turkish vegetable and fruit farmers based on self-reported symptoms and job characteristics.

BACKGROUND: Occupational pesticide poisoning is an important public health concern worldwide, especially in developing countries. OBJECTIVES: This study was aimed at determining the prevalence and risk factors of acute pesticide poisoning (APP) among the vegetable and fruit farmers in Karacabey District in northwest Turkey. METHODS: The study group consisted of 565 farmers. The dependent variable of the study is APP defined according to the World Health Organization's APP case definition matrix. The study's independent variables are the farmers' sociodemographic characteristics and the preventive measures they use when they are applying pesticides. The chi-square and logistic regression analysis analyzed the relationship between the dependent and independent variables. RESULTS: A total of 64 (11.3%) farmers reported APP and 75% of them presented to a health institution due to symptoms. The factors associated with increased risk of APP were: illiteracy (odds ratio (OR)=2.5), 14 years and less farming experience (OR=3.3), not reading the pesticide labels (OR=6.4), and contact with liquid pesticides (OR=2.3). -Conclusions: The study shows that approximately one out of ten farmers experience APP. Training programs should be planned and monitored to improve farmers' awareness of the dangers of pesticides, and they should be encouraged to adopt and implement protective measures.

Relationship between farmers' knowledge and attitudes towards pesticide use and their sociodemographic characteristics: a cross-sectional study from north-western Turkey.

BACKGROUND: The determination of farmers' knowledge and attitudes towards pesticide use is very important in terms of preventing pesticide use-related short- and long-term damages. OBJECTIVE: This study was aimed at investigating the relationship between the sociodemographic characteristics of farmers in Karacabey District of Bursa, a province in northwest Turkey, and their knowledge and attitudes towards pesticide use. MATERIAL AND METHODS: This cross-sectional study was conducted in Karacabey district between December 2018 and April 2019. The sample size was calculated as 1924 using the Epi info program by assuming the prevalence as 50%, type I error as 5%, standard deviation as 3% and design effect as 2. The dependent variable of the study was the farmers' knowledge of and attitudes towards pesticide use whereas the independent variables were their sociodemographic characteristics. The relationship between the dependent and independent variables was analyzed using the chi-square test and binary logistic regression model. RESULTS: The mean score the participants obtained from the Knowledge and Attitude Index was 12.8±2.8 and the median value was 13. While 49.5% of the participating farmers obtained a score lower than the median, 51.5% of them obtained a score equal to or above the median. While advanced age increased the possibility of getting a low score from the Knowledge and Attitude Index 2.7 times, not being married increased it 35.7 times, not getting formal education increased it 30.1 times, living in a non-crowded household increased it 2.1 times, and low income (2000 Turkish liras equal to ≤$310 according to April 2019 exchange rates) increased it 3.1 times. CONCLUSION: The study indicated that the participating farmers' knowledge and attitudes towards the proper use of pesticides were inadequate, and that there was a strong relationship between their Knowledge and Attitude Index scores and their sociodemographic characteristics.

Level and Factors Associated with Participation in Population-Based Cancer Screening in Safranbolu District of Karabuk, Turkey.

BACKGROUND: Cervix, breast and colorectal cancers are included in the national population-based screening (PBS) program in Turkey. This study aimed to assess participation in PBSs for these cancers and to identify factors associated with participation in screenings in Safranbolu district of Karabuk, Turkey in 2016-2017. METHODS: In this cross-sectional study, separate studying groups for cervix, breast and colorectal cancers were identified, taking into account the target age range specified in the national screening standards. The sample size was determined to be 374 for cervical cancer, 371 for breast cancer and 373 for colorectal cancer in the Epi-Info StatCalc program with a prevalence of 50%, a 95% Confidence Interval (CI) and a 5% error margin. The results of the data collected through face-to-face interview using questionnaires were evaluated with Chi-square tests (P<0.05) and included in the binary logistic regression model. RESULTS: Participation in PBS at least once between 2011 and 2016 years was 26.2% for cervical cancer, 27.6% for breast cancer and 31.6% for colorectal cancer, whereas the level of PBS or opportunistic screening at least once was 51.1%, 42.7% and 32.2%, respectively. A 2.9-fold increase in participation for the cervical cancer screening was associated with informing women about cervical cancer by the family physicians. Being married and living in the district center showed associations with a higher rate of participation for colorectal cancer screening. CONCLUSION: Participation in PBS was low for the 5.5-year period. More effort is needed to increase the effectiveness of the program.

Unmet needs for family planning among married women aged 15-49 years living in two settlements with different socioeconomic and cultural characteristics: a cross-sectional study from Karabuk Province in Turkey.

AIM: The aim of the study was to investigate levels and related factors of the unmet needs for family planning among married women aged 15-49 years living in two settlements (rural and urban) having different economic, social and cultural structures in Karabuk, a province in north-western Turkey. METHOD: This cross-sectional study was conducted in the rural Cumayani village and the urban Emek neighbourhood between October 2016 and June 2017. The sample size was determined to be 289 married women aged 15-49 years from each settlement according to the effect size of 0.3, alpha error probability of 0.05 and power of 0.95. In the study, 594 currently married women (298 from Cumayani and 296 from Emek) were contacted. The dependent variable was the level of unmet need for family planning. The independent variables included the sociodemographic and reproductive characteristics of the women. The data were collected through face-to-face interviews. The characteristics of the two settlements were compared using the χ2 test. Bivariate and multivariate logistic regression analyses were carried out to examine the factors associated with the dependent variable. RESULTS: The comparison of the participants demonstrated that the education, employment and income levels of the rural women were lower than those of the urban women (p<0.001). The rural women had more pregnancies, miscarriages and stillbirths, and the mortality among their children was higher compared to the urban women (p<0.001). The level of unmet need for family planning in Cumayani village was about twice that of Emek neighbourhood (9.7% v 5.4%). The multivariate analysis was conducted separately for each settlement. Marrying by way of only a religious ceremony increased the level of unmet need for family planning by 4.61 times (95% confidence interval (CI) 1.3-16.1) (p=0.016) in Cumayani. The multivariate analysis of all the women participating in the study revealed that marriage by way of only a religious ceremony increased the level of unmet need by 4.96 times (95%CI 1.4-17.1) (p=0.011). CONCLUSION: The study showed the effects of socioeconomic and cultural factors on women's fertility behaviours and unmet needs for family planning to favour urban women. Not being married by civil marriage was a significant predictor of unmet need. These findings highlight a need for intervention, particularly for the empowerment of rural women, in order to improve reproductive health outcomes.

Challenges in Cancer Control Services Provided by Family Physicians in Primary Care: A Qualitative and Quantitative Study From Karabuk Province in Turkey.

BACKGROUND: Family physicians (FPs) play an important role in cancer control. The aim of this study was to understand the functions of FPs in cancer control and to explore FPs' perceptions of their own roles and the difficulties they face in cancer control in Karabuk province, Turkey. METHODS: The study consisted of two methodological parts. The qualitative part included a descriptive study in which data were collected from 87.5% (n=56) out of all FPs in Karabuk using a questionnaire. In the quantitative part, in-depth interviews with 15 FPs were conducted and analyzed through content analysis. RESULTS: Half of the FPs (50.0%) provided cancer prevention information for their registered people, focusing on especially smoking cessation. In the last three months, the proportion of FPs who had not invited anyone to screenings was 37.5% for the pap test, 26.8% for the mammography, 19.0% for the fecal occult blood test and 34.5% for the colonoscopy. Only 16.1% of them reported that they made home visits for cancer patients. In the qualitative part of study, the following themes were highlighted: the perceived responsibilities of FPs regarding cancer control; the effect of geographically undefined working area of FPs; the issues with coordination between FPs and specialists; the effect of the number of primary care team members. CONCLUSIONS: Cancer control services provided by FPs have significant problems in terms of the FPs' approach to the services and their content, continuity and coordination.

Reliable mortality statistics for Turkey: Are we there yet?

BACKGROUND: The Turkish government has implemented several reforms to improve the Turkish Statistical Institute Death Reporting System (TURKSTAT-DRS) since 2009. However, there has been no assessment to evaluate the impact of these reforms on causes of death statistics. This study attempted to analyse the impact of these reforms on the TURKSTAT-DRS for Turkey, and in the case of Izmir, one of the most developed provinces in Turkey. METHODS: The evaluation framework comprised three main components each with specific criteria. Firstly, data from TURKSTAT for Turkey and Izmir for the periods 2001-2008 and 2009-2013 were assessed in terms of the following dimensions that represent quality of mortality statistics (a. completeness of death registration, b. trends in proportions of deaths with ill-defined causes). Secondly, the quality of information recorded on individual death certificates from Izmir in 2010 was analysed for a. missing information, b. timeliness of death notifications and c. characteristics of deaths with ill-defined causes. Finally, TURKSTAT data were analysed to estimate life tables and summary mortality indicators for Turkey and Izmir, as well as the leading causes-of-death in Turkey in 2013. RESULTS: Registration of adult deaths in Izmir as well as at the national level for Turkey has considerably improved since the introduction of reforms in 2009, along with marked decline in the proportions of deaths assigned ill-defined causes. Death certificates from Izmir indicated significant gaps in recorded information for demographic as well as epidemiological variables, particularly for infant deaths, and in the detailed recording of causes of death. Life expectancy at birth estimated from local data is 3-4 years higher than similar estimates for Turkey from international studies, and this requires further investigation and confirmation. CONCLUSION: The TURKSTAT-DRS is now an improved source of mortality and cause of death statistics for Turkey. The reliability and validity of TURKSTAT data needs to be established through a detailed research program to evaluate completeness of death registration and validity of registered causes of death. Similar evaluation and data analysis of mortality indicators is required at regular intervals at national and sub-national level, to increase confidence in their utility as primary data for epidemiology and health policy.

Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers.

BACKGROUND: A person-list-based family medicine model was introduced in Turkey during health care reforms. This study aimed to explore from primary care workers' perspectives whether this model could achieve the cardinal functions of primary care and have an integrative position in the health care system. METHODS: Four groups of primary care workers were included in this exploratory-descriptive study. The first two groups were family physicians (FP) (n = 51) and their ancillary personnel (n = 22). The other two groups were physicians (n = 44) and midwives/nurses (n = 11) working in community health centres. Participants were selected for maximum variation and 102 in-depth interviews and six focus groups were conducted using a semi-structured form. RESULTS: Data analysis yielded five themes: accessibility, first-contact care, longitudinality, comprehensiveness, and coordination. Most participants stated that many people are not registered with any FP and that the majority of these belong to the most disadvantaged groups in society. FPs reported that 40-60% of patients on their lists have never received a service from them and the majority of those who use their services do not use FPs as the first point of contact. According to most participants, the list-based system improved the longitudinality of the relationship between FPs and patients. However, based on other statements, this improvement only applies to one quarter of the population. Whereas there was an improvement limited to a quantitative increase in services (immunisation, monitoring of pregnant women and infants) included in the performance-based contracting system, participants stated that services not among the performance targets, such as family planning, postpartum follow-ups, and chronic disease management, could be neglected. FPs admitted not being able to keep informed of services their patients had received at other health institutions. Half of the participants stated that the list-based system removed the possibility of evaluating the community as a whole. CONCLUSIONS: According to our findings, FPs have a limited role as the first point of contact and in giving longitudinal, comprehensive, and coordinated care. The family medicine model in Turkey is unable to provide a suitable structure to integrate health care services.

Synchronous primary cancers of the female reproductive tract in Turkish women.

OBJECTIVES: To evaluate the synchronous gynecologic cancers in Turkish women. MATERIALS AND METHODS: A population-based longitudinal cohort study was conducted using Izmir Cancer Registry (ICR) data on gynecologic cancer patients diagnosed in the period 1993 to 2005. The registry covers the 3.7 million population of Izmir and has been collecting data on cancer incidence and survival of cancer patients' since 1992. The ICR collects data on all new cases of cancer from all the hospitals (n = 22) in the city. RESULTS: A total of 4,185 women were identified with gynecologic cancer between 1993 and 2005, 1,526 with endometrial, 1,206 with cervical, 1,198 with ovarian, 115 with vulvar, 67 with other uterine ( sarcoma etc.), 33 with vaginal and 40 with other gynecologic cancers ( tuba uterina etc.). Fifty-five (1.3%) patients with invasive synchronous primary cancers were identified, 43 of these tumor pairs being endometrium-ovaries (81%), 66 of all lesions being endometrioid adenocarcinomas. CONCLUSIONS: Independent primary tumors of the endometrium and ovary are the most commonly encountered synchronous tumors of the female genital tractus with endometrioid adenocarcinoma as the most frequent component.

Cancer incidence rates in Turkey in 2006: a detailed registry based estimation.

PURPOSE: The purpose of this study is to provide a detailed report on cancer incidence in Turkey, a relatively large country with a population of 72 million. We present the estimates of the cancer burden in Turkey for 2006, calculated using data from the eight population based cancer registries which have been set up in selected provinces representative of sociodemographic patterns in their regions. METHODS: We calculated age specific and age adjusted incidence rates (AAIR-world standard population) for each of registries separately. We assigned a weighting coefficient for each registry proportional to the population size of the region which the registry represents. RESULTS: We pooled a total of 24,428 cancers (14,581 males, 9,847 females). AAIRs per 100 000 were: 210.1 in men and 129.4 in women for all cancer sites excluding non-melanoma skin cancer. The AAIR per 100 000 men was highest for lung cancer (60.3) followed by prostate (22.8), bladder (19.6), stomach (16.3) and colo-rectal (15.4) cancers. Among women the rate per 100 000 was highest for breast cancer (33.7) followed by colorectal (11.5), stomach (8.8), thyroid (8.8) and lung (7.7). The most striking findings about the cancer incidence in the provinces were the high incidence rates for stomach and esophageal cancers in Erzurum and high stomach cancer incidence rates in Trabzon for both sexes. CONCLUSIONS: We are thus able to present the most accurate and realistic estimations for cancer incidence in Turkey so far. Lung, prostate, bladder, stomach, colorectal, larynx cancers in men and breast, colorectal, stomach, thyroid, lung, corpus uteri cancers in women are the leading cancers respectively. This figure shows us tobacco related cancers, lung, bladder and larynx, predominate in men. Concurrently, we analyzed the data for each province separately, giving us the opportunity to present the differences in cancer patterns among provinces. The high incidences of stomach and esophageal cancers in East and high incidence of stomach cancer in Northeast regions are remarkable.