Community-acquired antimicrobial resistance among Syrian refugees and the local population in Türkiye.

BACKGROUND: The long-standing antimicrobial resistance (AMR) pandemic has proven difficult to resolve and is becoming more complex, especially in the context of increasing forced migration, with little evidence around patterns of AMR in migrant communities. This study aimed to determine the frequency in the carriage of common types of antimicrobial-resistant bacteria between Syrian refugees and the local communities in Türkiye: extended-spectrum ß-lactamase (ESBL), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). METHODS: We collected nasal swabs and stool samples from the study participants, the local community members, and refugees, between September 2020 and March 2021. We screened clinical samples for the presence of ESBL, MRSA and VRE. Antimicrobial-resistant bacterial isolates were tested by phenotypic analysis to determine the AMR status. RESULTS: The study included a total of 3960 participants: 1453 individuals in the local community (36.2%) and 2525 Syrian refugees (63.8%). Overall, a significantly greater proportion of refugees (6.7%) carried MRSA compared to the local community (3.2%) (P < 0.001). The ESBL-positivity rate was 17.9% in Syrian refugees and 14.3% in the local community (P = 0.041). Carbapenemase activity was detected in three isolates from Syrian refugees. No VRE was detected in Syrian refugees or the local community. CONCLUSIONS: This large, community-based study on the frequency and the distribution of AMR among Syrian refugees and the local population is the first study in Türkiye.

Job satisfaction among Syrian healthcare workers in refugee health centres.

BACKGROUND: Achieving universal health coverage is subject to the availability, accessibility, acceptability, and quality of health workers. Countries that host refugees and migrants, such as Turkey, must strengthen the capacity of their health systems to increase access to services, especially for refugees and migrants. The Turkish Ministry of Health adapted Syrian refugee healthcare workers in the healthcare services to boost Syrian refugees' access to healthcare. This study aimed to assess job satisfaction and the factors influencing job satisfaction among refugee physicians and nurses working in Refugee Healthcentres (RHCs) in Turkey. METHODS: A self-administered, cross-sectional survey targeted all Syrian physicians and nurses working in RHCs across Turkey. The short-form Minnesota Satisfaction Questionnaire(MSQ) was used to assess job satisfaction. In total, 555 nurse/midwives and 336 physicians responded, yielding a total response rate of 56.5%. Descriptive analyses and linear regression tests were conducted to determine the level of job satisfaction and to analyze determinant factors. RESULTS: Nurses/midwives reported the highest level of general job satisfaction, followed by specialist physicians and general physicians. Physicians who had worked as specialists in Syria but were now working as general physicians in Turkey had the lowest job satisfaction levels. Multiple regression analysis showed that professional status in Turkey, income, teamwork and team management were significantly associated with job satisfaction. CONCLUSIONS: To maintain a high level of job satisfaction in refugee healthcare workers, human resources management should consider matching job placements with training specialization and support good leadership and good teamwork. Remuneration that accounts for the cost of living and non-financial incentives could also play a significant role in job satisfaction.

Needlestick injury prevention training among health care workers in the Caribbean.

The rate of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among health care workers that is caused by sharps injuries is higher in the Caribbean and Latin America than in other regions of the world. To respond to and reduce occupational exposures to bloodborne pathogens while also strengthening capacities in the Caribbean, needlestick injury prevention training programs for health care workers were implemented, beginning in 2011. The programs included lectures, workshops, policy reviews, evaluations of safety devices, and workplace assessment. During the training, baseline data from health care workers on their personal history of needlestick injuries and bloodborne pathogen exposure was collected. That baseline data showed that 40% of the participants had sustained sharps injuries during their professional career. In this capacity-building effort, 210 health care workers from five countries have been trained, six health care centers in the Caribbean have been evaluated. and occupational safety and health committees have been established in various countries to monitor and improve safety policies and practices.

La tasa de infecciones por los virus de la inmunodeficiencia humana (VIH), de la hepatitis B (VHB) y de la hepatitis C (VHC) en los trabajadores de atención de salud debidas a heridas por materiales punzocortantes es mayor en América Latina y el Caribe que en otras regiones del mundo. Con objeto de responder a las exposiciones laborales a los agentes patógenos de transmisión sanguínea y reducirlas, además de reforzar las capacidades en el Caribe, se instituyeron programas de capacitación para la prevención de las heridas por pinchazos accidentales en los trabajadores de salud a partir del 2011. Los programas comprendían conferencias, talleres, revisión de las políticas, análisis de los dispositivos de seguridad y evaluación de los lugares de trabajo. Durante la capacitación, se recopilaron datos iniciales suministrados por los trabajadores de atención de salud sobre sus antecedentes personales de heridas por pinchazos accidentales y exposición a agentes patógenos de transmisión sanguínea. Esos datos iniciales indicaron que 40% de los participantes habían sufrido alguna herida por materiales punzocortantes a lo largo de su carrera profesional. En esta iniciativa de formación de capacidades, se han capacitado 210 trabajadores de atención de salud de cinco países, se han evaluado seis centros de atención de salud en el Caribe y se han establecido comités de seguridad y salud ocupacional en diversos países para vigilar y mejorar las normas y prácticas de seguridad.

As taxas de infecção pelo vírus da imunodeficiência humana (HIV), vírus da hepatite B (HBV) e vírus da hepatite C (HCV) em profissionais da saúde decorrentes de acidentes com materiais perfurocortantes são mais elevadas no Caribe e na América Latina que em outras regiões do mundo. Para combater e reduzir a exposição ocupacional a patógenos de transmissão sanguínea, igualmente reforçando as competências no Caribe, programas de capacitação em prevenção de acidentes com agulhas para profissionais da saúde foram implementados a partir de 2011. Os programas consistiram de palestras, seminários, análises de políticas, avaliações de dispositivos de segurança e avaliação dos locais de trabalho. Durante a capacitação, foram coletados dados de base dos profissionais da saúde relativos ao histórico pessoal de acidentes com agulhas e exposição a patógenos de transmissão sanguínea. Estes dados indicaram que 40% dos participantes haviam sofrido acidentes com materiais perfurocortantes durante a atividade profissional. Como parte desta iniciativa de capacitação, foi dado treinamento a 210 profissionais da saúde de cinco países, foram avaliados seis centros de saúde no Caribe e instituídos comitês de saúde e segurança ocupacional em diversos países para monitorar e melhorar as políticas e práticas de segurança.

Assessment of current occupational safety and health regulations and legislation in the Caribbean.

Neglecting occupational safety and health (OSH) can have adverse and even deadly consequences. While OSH is important in any nation, the issue is particularly concerning in developing countries, including ones in the Caribbean. The purpose of this study, which was carried out in 2012 and 2013, was to examine the reasons for an apparent fundamental lack of awareness of OSH in the Caribbean. We conducted a descriptive study, in which a questionnaire was administered, via telephone, to key policy-making representatives from six English-speaking Caribbean nations, in order to assess the current OSH environment in their countries. We also did a situational analysis of current OSH regulations and legislation within the six countries. We found that that some of the countries' OSH laws are out of date or are limited to a certain type of industry. We also found that there is very little documentation on research on exposure to and risks from hazards and on psychological and reproductive health as related to OSH. It is recommended that these Caribbean countries both increase national OSH awareness and strengthen enforcement of OSH regulations. Additionally, further assistance and a more coordinated effort from intergovernmental bodies could help build and fortify OSH systems in the Caribbean.

Pesticide Exposure in the Caribbean: A Case From Nutmeg Processing.

Many developed countries around the world have implemented regulations to phase out or greatly restrict the use of pesticides. Pesticides are still utilized with minimal restrictions, however, in fumigating agricultural commodities in developing countries such as Grenada. This special report presents the case of a nutmeg factory worker in Grenada who worked with various pesticides including methyl bromide, magnesium phosphide (magtoxin), and aluminum phosphide (phostoxin) without the proper awareness and utilization of health and safety measures. The nutmeg factory worker later developed metastatic bladder cancer, which may have been triggered by a combination of individual risk factors along with long-term occupational exposure to these pesticides. In this special report, the occupational health importance of prevention in a work environment with significant exposure to pesticides is highlighted as well as some of the fundamental deficiencies in awareness among workers in developing nations concerning the deleterious effects of frequent exposure to pesticides.

Correction: Factors affecting patient satisfaction in refugee health centers in Turkey.

[This corrects the article DOI: 10.1371/journal.pone.0274316.].

Factors affecting patient satisfaction in refugee health centers in Turkey.

BACKGROUND: Turkey hosts an estimated 3.7 million Syrian refugees. Syrian refugees have access to free primary care provided through Refugee Health Centers(RHC). We aimed to determine factors that influence patient satisfaction in refugee health centers. METHODS: The study was a cross-sectional quantitative study. A patient survey was administered among 4548 patients attending services in selected 16 provinces in Turkey. A quantitative questionnaire was used to collect information on patient satisfaction and experience in the healthcare facility. Information on "overall satisfaction with health services" was collected on a 5-point Likert scale and dichotomized for analysis. Logistic regression was conducted to identify factors that influenced patient satisfaction. RESULTS: We found that 78.2% of the participants were satisfied with the health services they received. Factors related to service quality and communication were significant determinants of patient satisfaction. The strongest predictors of satisfaction were having a sufficient consultation time (AOR: 2.37; 95% CI: 1.76-3.21; p< 0.0001), receiving a comprehensive examination (AOR: 2.01; 95% CI: 1.49-2.70; p < 0.0001) and being treated with respect by the nurse (AOR: 2.08; 95% CI: 1.52-2.85; p< 0.0001). CONCLUSION: Providing integrated, culturally and linguistically sensitive health services is important in refugee settings. The quality of service and communication with patients influence patient satisfaction in refugee health centers. As such, improvements in aspects such as consultation time and the quality of physician-patient interaction are recommended for patient satisfaction.

Breastfeeding practices among Syrian refugees in Turkey.

BACKGROUND: We evaluated (a) opinion of Syrian and Turkish healthcare workers (HCWs), and perceptions and attitudes of Syrian refugee mothers, pregnant women, fathers and grandmothers on age-appropriate breastfeeding, (b) the effect of cultural characteristics, migration and pandemics on Syrian's infant nutrition, and (c) the suggestions of HCWs and Syrian family members to improve breastfeeding practices in the Syrian refugee society in a qualitative study. METHODS: The qualitative study consisting of structured focus group discussions (FGDs) was held in four provinces in Turkey where Syrian refugees live intensely in September and October 2020. Seven different types of online FGDs were held with Turkish HCWs working in maternity hospitals, Syrian HCWs working in Refugee Health Centers (RHCs), Syrian pregnant women, mothers, fathers, and grandmothers. In total, we carried out 46 FGDs with 335 individuals. Thematic analysis of the transcripts in a deductive-inductive fashion was carried out with MAXQDA 11. RESULTS: Most Syrian HCWs did not get any training on breastfeeding counseling. The short duration of breastfeeding in Syrian refugees was seen to be related to the cultural characteristics, and migration. Some cultural characteristics can be summarized as "believing that breastfeeding harms mother's health", "adolescent marriages", "wanting to have as many children as possible", "giving anise to infants and not breastfeeding at night", "prelacteal feeding", "believing that milk is not enough", "over controlling mother-child interaction by grandmothers, which limits the interaction", "short pregnancy intervals", and "not using modern family planning techniques". We found out that migration increased the tendency for adolescent pregnancies, deepened the poverty, and decreased family social support. We did not observe any change in breastfeeding practices during pandemics. CONCLUSIONS: Breastfeeding counseling programs should be designed in consideration of cultural characteristics of Syrian HCWs and family members. Continuing health education programs for family members with socially appropriate interventions to prevent adolescent marriages are important.

Occupational exposures and laryngeal cancer among non-smoking and non-drinking men.

In a previous hospital-based case-control study, we found an association between laryngeal cancer and exposure to occupational silica, cotton dust, diesel exhaust, gasoline exhaust, and polycyclic aromatic hydrocarbons (PAH). We evaluated the data further to investigate risks from occupational exposure among non-smoking and non-alcohol drinking (NSND) men. We analyzed 189 male NSND primary laryngeal cancer cases and 536 NSND controls. Case group included 86 supraglottic (45.5%), 47 glottic (24.9%), and 56 subglottic and non-classified tumors (29.6%). Age-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for occupational exposure. The most prevalent exposures among cases were PAH (40.7%), diesel exhaust (29.1%), and solvents (24.9%). An excess of laryngeal cancer occurred with silica (OR, 1.7; 95% CI, 1.1-13.0) and PAH (OR, 1.5; 95% CI, 1.1-2.2). An observed excess risk from silica and PAH exposure among NSND laryngeal cancer cases supports the suggested link between occupational exposure and laryngeal cancer.

Predisposing factors related to adolescent sexuality among students in rural and urban school-based health centers in eastern North Carolina.

This study examined possible predisposing factors that may contribute to rural adolescents' early sexual behavior. Sexual behaviors, demographics, family structure, history of abuse, sexually active friends, and substance use were analyzed in 410 rural and urban adolescents, aged 10 to 19 years, who were enrolled in a school-based health center in North Carolina between 2005 and 2007. Results indicated that Black students residing in single-parent urban households were more likely to engage in sex earlier than other analyzed ethnic groups (odds ratio [OR] = 5.2; 95% confidence interval [CI] = 1.1-23.6). As age increased, risk of engaging in sex also increased. Rural students reporting history of abuse had a higher risk of engaging in early sexual behaviors than urban students (OR = 2.6; 95% CI = 1.0-6.8) with a similar history. Students residing in a single-or no-parent household had requested more health education services than those residing in a dual-parent household. An inverse association was observed between the amount of parental communication among urban adolescents and engagement in risky sexual behaviors (OR = 0.3; 95% CI = 0.1-0.9). Rural/urban location and student race should be considered as moderators of the relationships between demographic characteristics and sexual behaviors in adolescents enrolled in a school-based health center.

The trend of small cell lung cancer among young men.

In this report, we investigated the distribution of histologic types of lung cancer by age in Turkey. Among 1354 lung cancer cases diagnosed in Social Security Agency Okmeydani Hospital, Istanbul, Turkey, we included 912 male cases with data on age, smoking status, and histopathologic type. We calculated the smoking-adjusted risk for histopathologic types by age. A majority of the cases were between 45 and 64 years of age (70.5%). The smoking-adjusted risk of squamous cell carcinoma increased with advancing age, while the risk of small cell carcinoma decreased with age. The risk of small cell carcinoma was 1.6 times higher among men younger than 45 years of age compared to older men (odds ratios (OR): 1.6, 95% confidence intervals (CI): 1.1-2.3). In conclusion, we found a significant decreasing trend for small cell carcinoma by increasing age, which resulted with an excess risk among men younger than age 45.

Occupational exposure and respiratory health problems among nutmeg production workers in Grenada, the Caribbean.

BACKGROUND: The nutmeg industry is a major contributor to the Grenadian economy. However, workers in the industry face many environmental and occupational health risks. OBJECTIVES: The goal of this study was to investigate respiratory health problems and possible related occupational exposures among nutmeg production workers. METHODS: A questionnaire, spirometry and allergen skin-prick test was given to 92 nutmeg workers. Samples for measurement of airborne dust, mold, and phosphine were also collected from work environments. RESULTS: Approximately half of the workers with lower respiratory symptoms such as dry cough (49.4%) and shortness of breath (42.9%) reported that their symptoms were work related. Spirometry results showed that 18.8% of workers had obstruction. Area geometric mean (GM) inhalable dust concentrations, GM personal concentrations, and total mold spores during work activities were found to be high. CONCLUSIONS: High prevalence of respiratory symptoms among workers in this facility was consistent with measured levels of dust and mold, and was widespread over all work areas.

Exhaled nitric oxide measurement in workers in a microwave popcorn production plant.

Airways obstruction in microwave-popcorn workers has been attributed to inhalation of flavoring agents. Two former workers at a microwave-popcorn plant were found by lung biopsy to have bronchiolitis obliterans. The study's aim was to determine whether exhaled nitric oxide (FENO) levels were associated with exposure levels, respiratory symptoms, or airways obstruction. A questionnaire, spirometry, and FENO measurements were completed by 135 workers. The FENO levels of workers with high flavoring exposures (n = 107) were compared with those of workers with low exposures (n = 28) and healthy external controls (n = 31). FENO levels were significantly lower in the high-exposure group (p < 0.05). There is no indication that FENO is useful as a marker of lung injury in a flavoring-exposed worker population with a substantial lung disease burden, but the finding of low FENO in the high-exposure group should not be dismissed.

United Airway Disease Among Crop Farmers.

Although there are observed relationships between agriculture and respiratory health problems, little attention has been given to relationship between lower and upper airway problems among farmers in the United States. The objective was to investigate the possible relationship between occupational risk factors and "united airway disease" among farmers in eastern North Carolina. Farmers and farm workers were selected from eastern North Carolina by using a cluster sampling method. A total of 180 farmers and farm workers completed the questionnaire. Data analyses were conducted to test associations and correlations between working conditions and symptoms. Lower airway symptom prevalence was 35%, and 66% had upper airway symptoms. Only 1% of farmers had physician-diagnosed rhinitis. Self-reported rhinitis and asthma symptoms were significantly correlated (r = .228, P = .003) among farmer/farm workers. Upper airway diseases are prevalent yet overlooked among farmer/farm workers. Early management of upper airway symptoms may prevent severe lower airway diseases, which will lead to increased productivity in the agricultural workforce.

Work-related asthma-like symptoms among florists.

OBJECTIVES: In this study, we evaluated the prevalence of work-related asthma-like symptoms and possible risk factors among florists in Turkey. METHODS: We collected questionnaire data from 128 florists, and investigated occupational history and respiratory, ocular, dermal, and nasal symptoms. We evaluated pulmonary function tests with spirometry and atopy by using the skin-prick test. Possible risk factors were analyzed by age-adjusted, smoking-adjusted, and gender-adjusted logistic regression models comparing symptomatic and asymptomatic individuals. RESULTS: The prevalence of work-related asthma-like symptoms was 14.1% (18 patients). We observed excess risk with a high work intensity (odds ratio [OR], 7.3; 95% confidence interval [CI], 1.1 to 51.8) and long work duration (OR, 5.1; 95% CI, 1.2 to 21.6). Florists with work-related asthma-like symptoms were 5.9 times more likely (95% CI, 1.4 to 24.3) to have a positive skin test response to a flower mix allergen. We also observed an excess risk for work-related asthma-like symptoms among those with allergic rhinitis (OR, 13.2; 95% CI, 3.1 to 56.4) and conjunctivitis (OR, 8.4; 95% CI, 2.4 to 29.2). CONCLUSION: The most prominent risk factors in florists were work intensity, work duration, and specific atopy.

Risk factors for depression in postnatal first year, in eastern Turkey.

BACKGROUND: There are few studies reporting depression in the postnatal period in developing countries. In this study our objective was to evaluate women from eastern Turkey in the postnatal one-year period in order to analyse the risk factors for depression. METHODS: In this cross-sectional, multi-centre study, we selected a study sample from five eastern provinces. Among 2602 randomly selected women who gave birth within the last year, we included 2514 women in our analysis. The Edinburgh Postnatal Depression Scale was used for the evaluation of depression. RESULTS: The percentage of women with high depression scores was 27.2%. Excess risk of depression was associated with several factors including unemployment, low education, poverty, poor family relations, low marital age, lack of medical services, and mental health problems. CONCLUSIONS: Depression in postnatal women is an important public health problem in the less developed eastern part of Turkey.

Prevalence of exposure to solvents, metals, grain dust, and other hazards among farmers in the Agricultural Health Study.

Exposures to multiple chemical, physical, and biological agents in agricultural work environments can result in confounding that may obscure or distort risks observed in epidemiologic studies. The Agricultural Health Study (AHS) is a large epidemiology study being conducted to investigate health risks among pesticide applicators and their families. During enrollment in the AHS, questionnaires were administered to over 52,000 licensed pesticide applicators from North Carolina and Iowa, who were mostly farmers. Questions about the frequency of various farming tasks were used to estimate the prevalence of exposure to solvents (25%), metals (68%), grain dusts (65%), diesel exhaust fumes (93%), and other hazards, including exposure to pesticides. Most of the farmers in the AHS reported performing routine maintenance tasks at least once a month, such as painting (63%), welding (64%), and repair of pesticide equipment (58%). The majority of farmers (74% in North Carolina; 59% in Iowa) reported holding nonfarm jobs, of which the most frequent were construction and transportation. The majority of the farmers enrolled in the AHS (55%) also reported that they mixed or applied pesticides on 10 or more days per year. The associations between the use of pesticides and the frequency with which the farmers in the AHS reported performing various types of specific farming activities were assessed to evaluate potential confounding. Confounding risk ratios calculated for these activities suggest that the magnitude of bias due to confounding is likely to be minimal.

Risk of laryngeal cancer by occupational chemical exposure in Turkey.

Laryngeal cancer is the second most common cancer among men in Turkey. In this hospital based case-control study, we evaluated laryngeal cancer risks from occupational chemical exposures. We analyzed 940 laryngeal cancer cases and 1519 controls. Occupational history, tobacco, and alcohol use and demographic information were obtained by a questionnaire. The job and industries were classified by special seven-digit codes. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) based on a developed exposure matrix for chemicals, including diesel exhaust, gasoline exhaust, polycyclic aromatic hydrocarbons (PAHs), formaldehyde, and solvents. An excess of laryngeal cancer occurred with diesel exhaust (OR=1.5, 95% CI=1.3-1.9), gasoline exhaust (OR=1.6, 95% CI=1.3-2.0), and PAHs (OR=1.3, 95% CI=1.1-1.6). There was a dose-response relationship for these substances with supraglottic cancers (P<0.000). The PAH association only occurred among those who also had exposure to diesel exhaust.

Prevalence and risk factors of occupational asthma among hairdressers in Turkey.

This study was designed to evaluate the questionnaire-based prevalence and possible risk factors of occupational asthma among hairdressers in Turkey. We investigated occupational history and respiratory, ocular, dermal, and nasal symptoms using a standardized questionnaire, evaluated worksite pulmonary function tests, and performed allergen skin testing. We then determined asthma risk factors using age- and gender-adjusted logistic regression models. The prevalence of occupational asthma in hairdressers was 14.6%. The odds ratio for hairdressers in a high work intensity group was 3.6 (95% confidence interval, 1.2 to 10.9) with a significant dose-response trend (chi 2 trend = 4.875; P = 0.027). The odds ratio for occupational asthma among workers with atopy was 4.5 (95% confidence interval, 1.2 to 17.2). We also observed an excess risk of occupational asthma with allergic rhinitis and conjunctivitis. Occupational asthma did not differ among subgroups of hairdressers. We observed an important risk of occupational asthma among hairdressers. The most prominent risk factors were work intensity and atopy.