Missed opportunities for tetanus immunization of 15-49 year oldwomen

Tetanoz ülkemizde ve dünyada insan saglıgını tehdit eden ası ile korunabilir hastalıklardan biridir. Kadınların tetanoza karsı bagısıklanması, hem anneyi hem de bebegi tetanozdan koruması nedeniyle son derece önemlidir. Ancak ülkemizde dogurganlık tetanoz asılama oranları, birinci basamakta bagısıklama hizmetlerindeki yetersizliklerin yanı sıra, bu konudaki bilgi ve motivasyon eksikligi nedeniyle istenen düzeyde degildir. Bu çalısmanın amacı 15-49 yas arası kadınların tetanoz bagısıklamasında, kaçırılmıs fırsat durumunun belirlenmesidir. Arastırma kesitsel tipte olup, Aydın Il Merkezi'ndeki 2 saglık ocagında gerçeklestirilmistir. Saglık ocagına herhangi bir sebeple basvuran ve arastırmaya katılmayı kabul eden 15-49 yas arası kadınlar (n=245) çalısmaya dahil edilmistir. Veri Saglık Yüksekokulu ögrencileri tarafından yüz yüze anket yöntemiyle elde edilmistir. Kadınların bagısıklama durumları ası kartı yanında olanların ası kartlarından, yanında olmayanların ise anamnezlerine göre yapılmıstır.Veri analizinde ki-kare, Fisher'in kesin testi ile Student's t testi kullanılmıstır. Bu arastırmada 15-49 yas grubu kadınlarda tetanoz asısı için kaçırılmıs fırsat oranı %24,5 olarak bulunmustur. Kaçırılmıs fırsat tespit edilen kadınların %73,3'ünde kaçırılmıs doz 3.'sü, %25,0'inde 2.'si, %1,7'sinde 1.'sidir. Kadının gebe olmaması veya ası kartı bulunmaması kaçırılmıs fırsat görülme durumunu etkilemektedir. Arastırma bölgesinde her dört kadından birinde kaçırılmıs fırsat oldugu, en fazla kaçırılmıs fırsatın 3. dozda görüldügü tespit edilmistir. Fırsatların yakalanması asılama oranlarını yükseltecegi gibi, anne ve bebek saglıgının korunması bakımından son derece önemlidir. Bu nedenle saglık ocaklarında saglık personelinin egitilerek, tetanoz bagısıklaması ile ilgili farkındalıgın ve duyarlılıgın artırılması önemlidir.Tetanus is a vaccine-preventable disease that threatens health both globally and in Turkey. Tetanus immunization of women is very important as it protects both the mother and the baby. In Turkey however, tetanus immunization coverage is not at the desired level due to insufficiencies in immunization services at health centers and lack of knowledge and motivation. The aim of this study is to determine missed opportunities in tetanus immunization among 15-49 year-old women. This is a cross-sectional study performed at 2 health centers in the city center ofAydin Province. 15-49 year-old women (n=245) were included in the study who came to the health center for any reason and accepted to participate. Data were collected by face to face interviews performed by High School of Health students. Immunization coverage was assessed by examining vaccination cards if women had one, or according to the information they gave if they did not have any. Data were analysed by chi-square, Fisher's exact test and Student's t- test. Ratio of missed opportunities for tetanus vaccination among women at reproductive age were found to be 24.5%. In 73.3% of women in whom missed opportunities were detected, the missed dose of tetanus vaccine was the third, in 25.0% the second, in 1.7% the first dose. No pregnancy or not having a vaccination card affected the rate of missed opportunities. It was found that there was a missed opportunity for 1 in 4 women in the study area and the biggest proportion of the missing vaccination is the 3rd dose. Catching opportunities is important not only in raising the immunization coverage but also good for mother and baby health. Thus, it is important to increase awareness and sensitivity about tetanus vaccination in health centers by training health personnel

Infant deaths and stillbirths in Aydın province in 2004

Amaç: Bu çalısmanın amacı, Aydın Ilinde 2004 yılında meydana gelen bebek ölümleri ve ölü dogumların bildirimlerine iliskin farklı bildirim kaynaklarının karsılastırmasını yaparak veri kalitesini degerlendirmek, ve bebek ölümleri ile ölü dogumların kisi-yer-zaman bakımından temel tanımlayıcı özellikleri ile nedenlerini saptamaktır. Yöntem: Bu çalısma, tanımlayıcı bir yöneylem arastırmasıdır. Ölü dogum ve bebek ölümlerine iliskin bir degerlendirme formu (Bebek Ölümü ve Ölü Dogum Olgu Bildirim Formu) hazırlanmıstır. Formlar, saglık ocagında bölgeden sorumlu ebe tarafından doldurulmus ve ocak hekimi tarafından kontrol edilerek Saglık Müdürlügüne gönderilmistir. Formlar, 2004 yılında ilçelerden gönderilen Birinci Basamak Saglık Kurumları Aylık ÇalısmaBildirilerinin (Form 023) yıllık dökümüyle karsılastırılmıstır. Bulgular: Çalısmada 139 bebek ölümü ve 107 ölü dogum incelenmistir. Bildirim formlarının%65,0'i tek seferde ve düzgün olarak gönderilmistir. Bebek ölümlerinin 58'i erken neonatal, 19'u geç neonatal, 57'si postneonatal dönemde meydana gelmistir. Ölü dogum hızı binde 9,6 ve perinatal ölüm hızı binde 14,8 olarak bulunmustur. Aydın'da 2004 yılı neonatal ölüm hızı binde 7,0, postneonatal ölüm hızı binde 5,2, bebek ölüm hızı binde 12,2 olarak bulunmustur. Bebek ölümlerinin nedenleri degerlendirildiginde, sırasıyla prematürite (%18,6), konjenital malformasyonlar, deformasyonlar, ve kromozom anomalileri (%10,6) ile solunum yetmezligi (% 9,7) ilk üç sırayı almıstır. Sonuç: Bebek ölümleri ve ölü dogumların birinci basamak saglık kurulusları tarafından detaylı olarak incelenmesi çok önemlidir. Bu çalısma ile, gebelikle iliskili risklerin arttıgı son trimester, dogum eylemi ile erken neonatal dönem,Aydın için bebek ölüm ve ölü dogumların azaltılmasında öncelikli alanlar olarak saptanmıstır. Bebek ölümleri ve ölü dogumların degerlendirilmesine yönelik standart bir form ve nedenler için de ICD-10'dan türetilen daha kısa bir listenin kullanılması uygun olacaktır.Objective: The aim of this study is to assess data quality by comparing different notification sources of infant deaths and stillbirths and to determine their basic descriptive characteristics in terms of person, place, time and causes. Materials and Methods: This is a descriptive operational study. An assessment form for infant deaths and stillbirths was prepared. Forms were filled in at health centers by midwives responsible of the regions where infant deaths and stillbirths occurred and sent to Provincial Directorate of Health after they were checked by physicians. They were compared with the yearly total of 'Monthly Notification of Work of Primary Health Care Institutions' (Form 023). Results: 139 infant deaths and 107 stillbirths were assessed. 58 infant deaths occurred in early-neonatal, 19 in late-neonatal and 57 in postneonatal period. Stillbirth rate was %0.96 and perinatal mortality rate %1.48. Neonatal mortality rate was %0.7, postneonatal mortality rate was % 0.2, infant mortality rate was %1.22. When causes of infant deaths were assessed, prematurity (18.6%), congenital malformations, deformations and chromosome abnormalities (10.6%) and respiratory deficiency (9.7%) were the first three causes, respectively. Conclusion: Detailed assessment of infant deaths and stillbirths by primary health care institutions is very important. Last trimester, delivery and early neonatal periods were detected as areas of priority for infant deaths and stillbirths in Aydın. For this purpose, it will be appropriate to use a standard form with a shorter list derived from ICD-10 for the assessment of infant deaths and stillbirths and their causes

Tried and true: A survey of successfully promoted academic hospitalists

BACKGROUND: Academic hospital medicine is a new and rapidly growing field. Hospitalist faculty members often fill roles not typically held by other academic faculty, maintain heavy clinical workloads, and participate in nontraditional activities. Because of these differences, there is concern about how academic hospitalists may fare in the promotions process. OBJECTIVE: To determine factors critical to the promotion of successfully promoted hospitalists who have achieved the rank of either associate professor or professor. DESIGN: A cross‐sectional survey. PARTICIPANTS: Thirty‐three hospitalist faculty members at 22 academic medical centers promoted to associate professor rank or higher between 1995 and 2008. MEASUREMENTS: Respondents were asked to describe their institution, its promotions process, and the activities contributing to their promotion. We identified trends across respondents. RESULTS: Twenty‐six hospitalists responded, representing 20 institutions (79% response rate). Most achieved promotion in a nontenure track (70%); an equal number identified themselves as clinician‐administrators and clinician educators (40%). While hospitalists were engaged in a wide range of activities in the traditional domains of service, education, and research, respondents considered peer‐reviewed publication to be the most important activity in achieving promotion. Qualitative responses demonstrated little evidence that being a hospitalist was viewed as a hindrance to promotion. CONCLUSIONS: Successful promotion in academic hospital medicine depends on accomplishment in traditional academic domains, raising potential concerns for academic hospitalists with less traditional roles. This study may provide guidance for early‐career academic hospitalists and program leaders. Journal of Hospital Medicine 2011. © 2011 Society of Hospital MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/86910/1/894_ftp.pd

Rational design, synthesis and biological evaluation of natural product mimics

This dissertation describes the design and synthesis of molecules mimicking bioactive portions of peptides, nucleoside bases and bioactive natural products. Chapter 1 details the design and implementation of catechol based peptidomimetics of urotensin II (U-II), based on the identified 3D pharmacophore. The synthesis describes orthogonal protecting group strategies for phenols. Chapter 2 summarizes an efficient protocol to annulate the 5,6-fused 2-pyridones, a ring system similar to those found in nucleoside bases. A tandem procedure comprising the condensation of propiolamide and cyclic β-ketomethyl esters in water, followed by acid or base promoted intramolecular ring closure and decarboxylation was developed. Chapter 3 provides a strategy for the design of truncated analogs of (+)-spongistatin 1 preserving conformational properties of the natural product. The solution conformers of (+)-spongistatin 1 were studied in detail leading to the design of AB- and ABEF-ring analogs. An ABEF-ring analog with low nanomolar activity was found to act through the same mode of action as (+)-spongistatin 1, proving that the bioactive portion of the molecule comprise a linear version of the ABEF-ring system. Finally Chapter 4 describes the design and synthesis of novel (+)-discodermolide analogs with improved potency. Detailed investigation of the earlier SAR and photolabeling data, combined with solution structure and docking studies revealed a possible binding mode of (+)-discodermolide that occupies known taxane binding site on β-tubulin. Attachment of aromatic side-chains mimicking the taxol tail furnished one of the most potent (+)-discodermolide analog series reported to date

Rational design, synthesis and biological evaluation of natural product mimics

This dissertation describes the design and synthesis of molecules mimicking bioactive portions of peptides, nucleoside bases and bioactive natural products. Chapter 1 details the design and implementation of catechol based peptidomimetics of urotensin II (U-II), based on the identified 3D pharmacophore. The synthesis describes orthogonal protecting group strategies for phenols. Chapter 2 summarizes an efficient protocol to annulate the 5,6-fused 2-pyridones, a ring system similar to those found in nucleoside bases. A tandem procedure comprising the condensation of propiolamide and cyclic β-ketomethyl esters in water, followed by acid or base promoted intramolecular ring closure and decarboxylation was developed. Chapter 3 provides a strategy for the design of truncated analogs of (+)-spongistatin 1 preserving conformational properties of the natural product. The solution conformers of (+)-spongistatin 1 were studied in detail leading to the design of AB- and ABEF-ring analogs. An ABEF-ring analog with low nanomolar activity was found to act through the same mode of action as (+)-spongistatin 1, proving that the bioactive portion of the molecule comprise a linear version of the ABEF-ring system. Finally Chapter 4 describes the design and synthesis of novel (+)-discodermolide analogs with improved potency. Detailed investigation of the earlier SAR and photolabeling data, combined with solution structure and docking studies revealed a possible binding mode of (+)-discodermolide that occupies known taxane binding site on β-tubulin. Attachment of aromatic side-chains mimicking the taxol tail furnished one of the most potent (+)-discodermolide analog series reported to date

A Fuzzy Risk Assessment Model for Small Scale Construction Work

Occupational risk assessment is important for providing employees with a safe and healthy work environment. When compared with other industries, the construction industry poses a higher risk for accidents due to the variety and complexity of skills required for different types of work in the sector. Small-sized construction sites have a higher risk of occupational injury. Countries without occupational safety and health (OSH) enforcement pose an additional risk increasing the need of an effective and easy-to-apply risk assessment approach. This research aims to develop and study an easy to apply risk assessment model for small-scale construction sites. The method includes opinions from experts on safety, checklists to estimate the possibility of occurrence of accidents, the identification of current site-specific safety levels, the severity of risk, and safety barriers. The model uses both historical data and fuzzy approaches to calculate risk level and was applied to four different construction sites in North Cyprus. Results reveal the risk level for each accident type and the aggregate safety level of the construction sites. Falling from height was identified as the most common accident type with the highest risk level. This study contributes to the development of sustainable OSH management systems for construction companies by highlighting the measures that must be taken to reduce occupational accidents

Investigation of structure-spectroscopy-function relationship of twodimensional J-aggregates of tetrachlorobenzimidazolorcarbocyanine preferentially oriented in poly-vinly-alcohol thin films

The structure–spectroscopy–function relationship of 1,1 0 ,3,3 0 -tetraethyl-5,5 0 ,6,6 0 -tetrachlorobenzimidazolocarbocyanine (TTBC) aggregates is studied using a combination of experimental and theoretical techniques. The aggregates are macroscopically aligned in poly-vinyl-alcohol thin films by vertical spin coating. Angular dependence of the UV–Vis spectra is measured at eleven different orientations between the electric field polarization and the macroscopic alignment axis. The aggregates are characterized by a pair of Davydov split bands with opposite polarization behaviors: an H-band (505 nm) and a J-band (594 nm) polarized respectively, close to being parallel and perpendicular to the alignment axis. Spectral response is interpreted via simulations within the Frenkel exciton formalism. TTBC aggregates are shown to assume very similar internal molecular packing (herringbone) and dynamics of excited states (phononassisted intraband and interband relaxations) in ionic aqueous solution and in thin films. The general conclusions on the structure–spectroscopy–function relationship are expected to hold for other cyanine aggregates with the same generic spectral features