Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008.

BACKGROUND: Coronary heart disease (CHD) mortality rates have been decreasing in Turkey since the early 1990s. Our study aimed to determine how much of the CHD mortality decrease in Turkey between 1995 and 2008 could be attributed to temporal trends in major risk factors and how much to advances in medical and surgical treatments. METHODS: The validated IMPACT CHD mortality model was used to combine and analyse data on uptake and effectiveness of CHD treatments and risk factor trends in Turkey in adults aged 35-84 years between 1995 and 2008.Data sources were identified, searched and appraised on population, mortality and major CHD risk factors for adults those aged 35-84 years. Official statistics, electronic databases, national registers, surveys and published trials were screened from 1995 onwards. RESULTS: Between 1995 and 2008, coronary heart disease mortality rates in Turkey decreased by 34% in men and 28% in women 35 years and over. This resulted in 35,720 fewer deaths in 2008.Approximately 47% of this mortality decrease was attributed to treatments in individuals (including approximately 16% to secondary prevention, 3% angina treatments, 9% to heart failure treatments, 5% to initial treatments of acute myocardial infarction, and 5% to hypertension treatments) and approximately 42% was attributable to population risk factor reductions (notably blood pressure 29%; smoking 27%; and cholesterol 1%). Adverse trends were seen for obesity and diabetes (potentially increasing mortality by approximately 11% and 14% respectively). The model explained almost 90% of the mortality fall. CONCLUSION: Reduction in major cardiovascular risk factors explained approximately 42% and improvements in medical and surgical treatments explained some 47% of the CHD mortality fall. These findings emphasize the complimentary value of primary prevention and evidence-based medical treatments in controlling coronary heart disease

Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: contributions from risk factor changes and treatments

Background Middle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey. Methods Data on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995–97; 2006–09); integrated and analysed using the IMPACT model. Results Risk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1–2 kg/m2 and diabetes prevalence increased by 40%–50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria. Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake. CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder. Discussion CHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically

Determining the acute myocardial infarction and cerebrovascular accident incidence rates of central district of Manisa for the year 2011

GİRİŞ VE AMAÇ: Kalp ve damar hastalıkları, kanser, diyabet ve kronik solunum sistemi hastalıklarını içeren bulaşıcı olmayan hastalıklar tüm dünyada olduğu gibi ülkemizde de ölümlerin en sık nedenidir. Dünya Sağlık Örgütü ölümlerin ve engelliliğin önde gelen nedenlerinden olan kalp ve damar hastalıklarından ölümlerin 2030 yılında 23 milyonu geçeceğini; büyük bir bölümünün kalp krizi ve inme kaynaklı olacağını öngörmektedir. Ülkemizde koroner kalp hastalığı ve serebrovasküler olay sıklığını belirleyen çalışmalar son yıllarda artmakla birlikte yeni olguların belirlendiği insidans çalışmaları çok kısıtlı sayıdadır. Bu çalışmada, insidans hızının belirlendiği ileriye yönelik çalışmaların yapılamadığı ülkemizde Manisa ili merkez ilçesinde aile hekimine kayıtlı bireylerin sağlık kayıtları ve ölüm kayıtları gibi kaynaklar uygun şekilde kullanılarak 2011 yılı akut miyokard infarktüsü ve serebrovasküler olay insidansının belirlenmesi amaçlanmıştır. YÖNTEM: Yöneylem araştırmasıdır. Manisa İli merkez ilçesinde herhangi bir aile hekimine kayıtlıların 2011 yıl ortası nüfusu olan 337,277 kişi araştırmanın evrenini oluşturmuştur. Araştırmada örnek seçilmeyip bir yıllık süreçte yaşamı boyunca ilk kez akut miyokard infarktüsü ya da serebrovasküler olay tanısı alıp yaşayan ya da ölen bireyler Aile Hekimliği Bilgi Sistemi ve hastanelerin sağlık kayıtları kullanılarak saptanmıştır. Hekim tarafından akut miyokard infarktüsü ve serebrovasküler olay için belirlenen ICD-10 kodlarını yaşamı boyunca ilk kez alıp yaşayanların poliklinik notları ve yatış epikrizleri, ölenlerin ise yakınlarına uygulanan sözel otopsi anketleri değerlendirilip hekim tanıları doğrulanarak yeni olgular saptanmıştır. Cinsiyete, yaş gruplarına, dünya nüfusuna standardize edilerek ve olası durum senaryolarının kullanıldığı duyarlılık analizleri yapılarak insidans hızları hesaplanmıştır. BULGULAR: Manisa ili merkez ilçesi 2011 yılı akut miyokard infarktüsü insidans hızı tüm yaş gruplarında en düşük ve en yüksek yüzbinde 56.0-91.6, 35 yaş ve üzerinde ise 132.3-209.8 olarak saptanmıştır. Manisa ili merkez ilçesi 2011 yılı serebrovasküler olay insidans hızı tüm yaş gruplarında en düşük ve en yüksek yüzbinde 28.1-40.6, 35 yaş ve üzerinde ise 61.1-79.6 olarak saptanmıştır. Ölüm bildirimlerinde hekim tanıları akut miyokard infarktüsü için %19.3, serebrovasküler olay için %48.8 oranında doğrulanmıştır. SONUÇ VE ÖNERİLER: Araştırmada Manisa ili merkez ilçede 2011 yılında tüm yaş grupları ve 35 yaş ve üstü grupta akut miyokard infarktüsü insidans hızları erkeklerde daha yüksek bulunmuştur. Serebrovasküler olay insidans hızı tüm yaş gruplarında kadınlarda yüksekken 35 yaş ve üstü için hesaplandığında erkeklerde daha yüksek bulunmuştur. Tüm sağlık kurumlarından elektronik ortamda veri akışının sağlanacağı Sağlık.NET 2'nin kalıcı bir sürveyans sistemi olabilmesi için sisteme doğru, düzenli ve nitelikli veri akışı sağlanmalıdır INTRODUCTION AND OBJECTIVES: Non-communicable diseases including cardiovascular disease, cancer, diabetes, and chronic respiratory diseases are the leading causes of mortality in our country and the rest of the world. According to World Health Organization reports, in 2030, cardiovascular diseases-mainly heart attacks and stroke- will claim the lives of an estimated 23 million people and leave many more disabled. In recent years, although studies investigating the coronary heart disease and cerebrovascular prevalence in Turkey have increased in number, studies that determine incidence rates remain very limited. In this study, we aim to determine the incidence rates of acute myocardial infarction and cerebrovascular accident in the central district of Manisa province in year (during) 2011, utilizing the health records and death certificates of individuals, who are registered with a general practioner in the central district of Manisa. METHOD: This is an operational research. The target group of the study was 337,277 objects; the total number of people who have been registered with a general practitioner in the central district of Manisa during year 2011. This study is not based on random sampling but rather includes all individuals who have been diagnosed with acute myocard infarction or cerebrovascular accident for the first time and either survived or died due to the disease according to the records of General Practitioner Information System or hospitals. Among the individuals that have been given the ICD-10 code for the first time, the ones that have survived were evaluated according to polyclinic notes and their hospital records, and the ones that have been lost were evaluated according to verbal autopsy surveys conducted with their relatives, and by verification of the diagnostic reports of the doctors, new subjects have been identified. The incidence rates were calculated by standardizing the gender and age groups in respect to the standard world population and by conducting sensitivity analyses using presumptive incidence scenarios. RESULTS: Year 2011 acute myocard infarction incidence rate in the central district of Manisa is calculated to be between 56.0-91.6 in onehundredthousand in all age groups, and 132.3-209.8 in onehundredthousand in individuals 35 years and older. Year 2011 cerebrovascular event incidence rate in all age groups is 28.1-40.6 in onehundredthousand and 61.1-79.6 in onehundredthousand in individuals 35 years and older. Doctors? diagnosis in death reports is verified in 19.3% of acute myocard infarction cases and 48.8% of cerebrovascular event cases. CONCLUSION AND RECOMMENDATIONS: In this study, acute myocardial infarction incidence rate in the central district of Manisa in year 2011 is found to be higher in men in all age groups and in people 35 years and older. On the other hand, cerebrovascular accident incidence rate in all age groups is higher in women, while it is higher in men 35 years and older. A correct, continuous and high quality data entry is imperative in order to establish SAGLIK. NET 2-an online database collection of all health institutions-as a perpetual surveillance system

The effect of sugammadex on postoperative cognitive function and recovery

WOS: 000380843400008PubMed: 27157202Background and objective: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Methods: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24 h before the operation. After the operation, when the Modified Aldrete Recovery Score was >= 9 the MMSE and 1 h later the MoCA tests were repeated. Results: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p > 0.05). The time to reach TOF 0.9 was 2.19 min in Group S and 6.47 min in Group N (p < 0.0001). Recovery time was 8.26 min in Group S and 16.93 min in Group N (p < 0.0001). Conclusion: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine. (C) 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda

The effects of cognitive rehabilitation on relapsing remitting multiple sclerosis patients

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Introduction: The aims of this study were to determine the severity of cognitive impairment with Brief Repeatable Battery Neuropsychology (BRB-N) and to show the benefits of cognitive rehabilitation programs to develop coping strategies for the retardation of cognitive losses in relapsing remitting multiple sclerosis (RRMS) patients. Methods: The cognitive screening with BRB-N was performed in RRMS patients who had applied to the MS outpatient clinic of Bakırköy Psychiatric and Neurological Diseases Hospital, had an Expanded Disability Status Scale (EDSS) score between 1.0 and 5.5, and had no other cognitive disease or used drugs that effected the cognitive status. Thirty two patients with cognitive impairment underwent consecutive computer-assisted cognitive rehabilitation program once a week for 8 weeks conducted by psychologists. The effects of the program were evaluated with the tests repeated every 4 weeks.Amaç: Relaps ve remisyonla seyreden multipl skleroz (RRMS) olgularında Brief Repeatable Battery Neuropsychology (BRB-N) ile kognitif bozukluk şiddetinin belirlenerek, bilişsel kayıpların yavaşlatılması ve başa çıkma stratejileri geliştirilmesi için yürütülen kognitif rehabilitasyon programlarının faydalarının gösterilmesi amaçlanmıştır. Yöntem: Bakırköy Ruh ve Sinir Hastalıkları Hastanesi MS polikliniğine başvuran RRMS tanısı almış, Expanded Disability Status Scale (EDSS) 1,0-5,5 arasında, kognitif durumunu etkileyecek hastalığı ya da ilaç kullanımı olmayan hastalara BRB-N ile kognitif tarama yapılmıştır. Kognitif bozukluk saptanan 32 hasta, ardışık 8 hafta süresince haftada 1 kez psikolog eşliğinde bilgisayar destekli kognitif rehabilitasyon programına alınmış; 4 hafta arayla tekrarlanan testlerle kognitif rehabilitasyon programının etkileri değerlendirilmiştir

The effect of sugammadex on postoperative cognitive function and recovery

Background and objective: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Methods: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12–24 h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1 h later the MoCA tests were repeated. Results: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p > 0.05). The time to reach TOF 0.9 was 2.19 min in Group S and 6.47 min in Group N (p  0,05). O tempo para atingir TOF 0.9 foi de 2,19 min no Grupo S e de 6,47 min no Grupo N (p < 0,0001). O tempo de recuperação foi de 8,26 min no Grupo S e de 16,93 min no Grupo N (p < 0,0001) Conclusão: Mostramos que o procedimento cirúrgico e/ou procedimento anestésico de acompanhamento pode causar uma regressão temporária ou permanente da função cognitiva no pós-operatório imediato. No entanto, um desempenho cognitivo melhor não pode ser provado no grupo sugamadex em comparação com o grupo neostigmina. Keywords: Sugammadex, Neostigmine, Postoperative cognitive dysfunction, MMSE, MoCA, Palavras-chave: Sugamadex, Neostigmina, Disfunção cognitiva no pós-operatório, MMSE, MoC