Palmoplantar keratoderma is associated with esophagus squamous cell cancer in Van region of Turkey: a case control study

BACKGROUND: Esophagus squamous cell cancer (ESCC) is the most common cancer in women with 20.2% and second in men with 10.7% relative frequency among all cancer cases diagnosed in Van Region in the east of Turkey. Ninety percent of all esophageal cancer cases are ESCC and 20–30% of them have family history of esophageal cancer. The most clear defined hereditary predisposition associated with ESCC is palmoplantar keratoderma (PPK). To examine the relationship between ESCC and PPK, we have carried out this case control study. METHODS: The case group consisted of 48 subjects who had new diagnosis of ESCC and did not receive any chemo or radiotherapy. The control group consisted of 96 healthy individuals who were visitors of their relatives in the hospital. Two control persons who matched for age, gender, living place (urban /rural) and region were selected for each case. All subjects were evaluated for PPK by dermatologist. Evaluation was graded as none, mild, evident and severe. None and mild subjects were classified as negative for PPK; and others as positive. Relationship between ESCC and PPK was evaluated with odds ratios and confidence intervals for cases with or without family history of ESCC. RESULTS: The PPK frequencies were 92.3% in ESCC cases with family history, 62.5% in ESCC cases without family history, 70.8% in all ESCC cases, and 28.1% in the control group. Odds ratios for cases with or without family history of esophageal cancer, and for the whole case group were found as 30.7 (95%CI = 3.8–247.4), 4.3 (95%CI = 1.9–9.8) and 6.2 (95%CI = 2.9–13.3) respectively. CONCLUSION: Presence of PPK lesions represents genetic susceptibility for ESCC. This susceptibility for ESCC is the highest among those who have PPK lesions and a positive family history of esophageal cancer. Furthermore, a PPK sufferer has an increased risk of developing ESCC even if there is no family history of esophageal cancer

Influence of social environment in smoking among adolescents in Turkey.

BACKGROUND: The aim of this study was to examine the social determinants of smoking among adolescents attending school and/or work. METHODS: A survey was carried out on 6012 adolescents aged between 13 and 17 years in 15 cities, recruited from schools, vocational training centres and work places. A self-completed questionnaire was used for data collection. Single- and multi-level regression analyses were run to estimate models. RESULTS: Ever smoking and current smoking rates were 41.1% and 10.5% among girls, and 57.5% and 25.2% among boys. These rates were 47.0% and 13.3% among those who only attended school, 62.2% and 31.7% among those who attended school and worked simultaneously, and 67.5% and 43.0% among those who worked and did not attend school. In multi-level analysis, the major predictors of current smoking were close friends smoking [odds ratio (OR) 3.48; 95% confidence interval (CI) 1.93-6.27], no knowledge of harmful effects of short-term smoking (OR 2.15; 95% CI 1.74-2.67), vulnerability to peer pressure (OR 1.90; 95% CI 1.48-2.46), negative self-perception (OR 1.69; 95% CI 1.31-2.18) and male sex (OR 1.68; 95% CI 1.30-2.16). Mothers higher education was a predictor for girls' smoking, while mother's lower education was a predictor for boys' smoking. At the school level, smoking prevalence was a predictor of current smoking (OR 1.07; 95% CI 1.05-1.08). CONCLUSIONS: Smoking patterns were similar to Western countries in several aspects, while male prevalence rates were higher and the impact of gender-related predictors was significant. Our findings suggest that youth smoking prevention policies should address personal, familial and educational environmental level requirements, taking into consideration the gender differences in addition to international guidelines

Challenges for the adoption of evidence-based maternity care in Turkey

Evidence-based medicine is an important tool for improving the quality of maternity care. However, getting providers to change their practices may not be an easy or rapid process, and other factors, in addition to knowledge of the literature, may be important. This study documents the current state of obstetric practices at three maternity hospitals in Istanbul, Turkey, and identifies attitudes, social pressures, and perceptions that, according to the theory of planned behavior, may pose challenges for adoption of evidence-based practices. Data were collected through interviews with administrators, examination of hospital statistics, provider and client interviews, and structured observations of maternity care. Practices that did not follow current guidelines included routine episiotomy, not allowing companionship during labor, use of procedures to speed up labor without indications, routine enema, restriction of mobility, restriction of oral fluids, supine position for delivery, and non-use of active management of the third stage of labor. The findings indicate that providers had negative attitudes about some recommended practices, while they had positive attitudes towards some ineffective and/or harmful practices. We identified social pressure to comply with practices recommended by supervisors and peers, as well as the belief that limited resources affect maternity care providers, opportunities to perform evidence-based procedures. An underlying problem was the failure to involve women in decision-making regarding their own maternity care. In addition to informing providers about the evidence, it seems necessary to develop standard protocols, improve physical conditions, and implement behavior interventions that take into account provider attitudes, social pressures, and beliefs.Evidence-based practice Theory of planned behavior Maternity care Turkey