The accuracy of death certificates given at Kocaeli University Hospital

Amaç: Ölüm nedenleri ile ilgili kayıtlar, ülkelerin sağlık sistemlerinin en önemli bileşenlerinden biridir.Ölüm nedenlerinin güvenilirliği konusunda tüm ülkelerde ortak sorunlar yaşanmaktadır. Bu çalışmada, Kocaeli Üniversitesi Hastanesi’nden Başbakanlık Devlet İstatistik Enstitüsü’ne (DİE) bildirilen ölüm nedenleri ile hasta dosyasındaki bilgiler karşılaştırıldı. Çalışma Planı: 2002 ve 2003 yıllarında görülen ölümlere ait hasta dosyaları ve DİE’ye gönderilen ölüm formları geriye dönük olarak incelendi. Ölüm nedenleri Dünya Sağlık Örgütü’nün önerdiği ölçütlere göre temel, ara ve son neden olarak sınıflandırıldı. Hastalık listesi olarak ICD-10 kullanıldı. Bulgular: Toplam 744 ölümden her iki kaynakta da bulunan 665’i karşılaştırıldı. Bunların 211’inde (%31.7) ölüm nedeni olarak temel neden doğru yazılmıştı. Ölümlerin %24.4’ü (n=162) kardiyorespiratuvar arrest gibi başka hastalık veya durumlara, %16.8’i (n=112) ise son nedene bağlanmıştı. Ölüm sertifikaları nın 105’inde (%15.8) ilgisiz bir ölüm nedenine rastlandı. İki yüz on ölüme ait formların hatalı doldurulduğu; bunların %59.0’unda yanlış kısaltma kullanıldığı, %34.3’ünde ise hastalık listesinde bulunmayan sendrom/ hastalık adı yazıldığı saptandı. Sonuç: Ölüm formlarının doğru doldurulması için hem mezuniyet öncesi eğitim hem de uyum eğitimleri yapılmalıdır. Ayrıca, kesin ölüm nedenlerinin saptanması için patolojik otopsilerin yapılması önemlidir.Objectives: Registries for the causes of death constitute one of the basic components of health system in all countries. The reliability of the notified causes of death appears to be a common problem. In this study, we compared the information on death certificates routinely sent from the Kocaeli University Hospital to the State Statistics Institute (SSI) with that found on patient records. Study Design: A retrospective review was made on patient records and death certificates sent to the SSI in 2002 and 2003. The causes of death were classified as principal, contributing, and immediate causes according to the WHO criteria. Diagnoses were defined according to the ICD-10 list. Results: Of 744 deaths, records of 665 cases were present in both sources. Certificates of 211 cases (31.7%) included the correct principal death cause, while in 162 cases (24.4%) the deaths were attributed to other disease/conditions such as cardiorespiratory arrest, and in 112 cases, (16.8%), to an immediate cause. An irrelevant cause was found in 105 (15.8%) certificates. We detected a number of mistakes in 210 certificates, the most common being the use of inappropriate abbreviation (59.0%) and disease terms not available in the disease list (34.3%). Conclusion: The accuracy of death certificates may be improved with training programs among physicians. Furthermore, postmortem autopsy examinations are very important to determine the exact cause of death

Vaccination coverage and reasons for non-vaccination in a district of Istanbul

BACKGROUND: In order to control and eliminate the vaccine preventable diseases it is important to know the vaccination coverage and reasons for non-vaccination. The primary objective of this study was to determine the complete vaccination rate; the reasons for non-vaccination and the predictors that influence vaccination of children. The other objective was to determine coverage of measles vaccination of the Measles Immunization Days (MID) 2005 for children aged 9 month to 6 years in a region of Umraniye, Istanbul, Turkey. METHODS: A '30 × 7' cluster sampling design was used as the sampling method. Thirty streets were selected at random from study area. Survey data were collected by a questionnaire which was applied face to face to parents of 221 children. A Chi-square test and logistic regression was used for the statistical analyses. Content analysis method was used to evaluate the open-ended questions. RESULTS: The complete vaccination rate for study population was 84.5% and 3.2% of all children were totally non-vaccinated. The siblings of non-vaccinated children were also non-vaccinated. Reasons for non-vaccination were as follows: being in the village and couldn't reach to health care services; having no knowledge about vaccination; the father of child didn't allow vaccination; intercurrent illness of child during vaccination time; missed opportunities like not to shave off a vial for only one child. In logistic regression analysis, paternal and maternal levels of education and immigration time of both parents to Istanbul were found to influence whether children were completely vaccinated or non-vaccinated. Measles vaccination coverage during MID was 79.3%. CONCLUSION: Efforts to increase vaccination coverage should take reasons for non-vaccination into account

Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Passive smoke exposure increases the risk of lower respiratory infection (LRI) in infants, but the extensive literature on this association has not been systematically reviewed for nearly ten years. The aim of this paper is to provide an updated systematic review and meta-analysis of studies of the association between passive smoking and LRI, and with diagnostic subcategories including bronchiolitis, in infants aged two years and under.</p> <p>Methods</p> <p>We searched MEDLINE and EMBASE (to November 2010), reference lists from publications and abstracts from major conference proceedings to identify all relevant publications. Random effect pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated.</p> <p>Results</p> <p>We identified 60 studies suitable for inclusion in the meta-analysis. Smoking by either parent or other household members significantly increased the risk of LRI; odds ratios (OR) were 1.22 (95% CI 1.10 to 1.35) for paternal smoking, 1.62 (95% CI 1.38 to 1.89) if both parents smoked, and 1.54 (95% CI 1.40 to 1.69) for any household member smoking. Pre-natal maternal smoking (OR 1.24, 95% CI 1.11 to 1.38) had a weaker effect than post-natal smoking (OR 1.58, 95% CI 1.45 to 1.73). The strongest effect was on bronchiolitis, where the risk of any household smoking was increased by an OR of 2.51 (95% CI 1.96 to 3.21).</p> <p>Conclusions</p> <p>Passive smoking in the family home is a major influence on the risk of LRI in infants, and especially on bronchiolitis. Risk is particularly strong in relation to post-natal maternal smoking. Strategies to prevent passive smoke exposure in young children are an urgent public and child health priority.</p

SmokeHaz: systematic reviews and meta-analyses of the effects of smoking on respiratory health

Background: Smoking tobacco increases the risk of respiratory disease in adults and children, but communicating the magnitude of these effects in a scientific manner that is accessible and usable by public and policymakers presents a challenge. We have therefore summarised scientific data on the impact of smoking on respiratory diseases to provide the content for a unique resource, SmokeHaz. Methods: We conducted systematic reviews and meta-analyses of longitudinal studies (published to 2013) identified from electronic databases, grey literature, and experts. Random effect meta-analyses were used to pool the findings. Results: We included 216 papers. Among adult smokers, we confirmed substantially increased risks of lung cancer (Risk Ratio (RR) 10.92, 95% CI 8.28-14.40; 34 studies), COPD (RR 4.01, 95% CI 3.18-5.05; 22 studies) and asthma (RR 1.61, 95% CI 1.07-2.42; 8 studies). Exposure to passive smoke significantly increased the risk of lung cancer in adult non-smokers; and increased the risks of asthma, wheeze, lower respiratory infections, and reduced lung function in children. Smoking significantly increased the risk of sleep apnoea, and asthma exacerbations in adult and pregnant populations; and active and passive smoking increased the risk of tuberculosis. Conclusions: These findings have been translated into easily digestible content and published on the SmokeHaz website (www.smokehaz.eu)

Gender differences in self-rated health and their determinants in Turkey: A further analysis of Turkish health survey

Objective: This study analysed gender differences in self rated health status and their determinants by gender in Turkey.  Methods: This is a further analysis of a 2010 Health Survey conducted by Turkish Statistical Institute (TurkStat) A total of 5488 men and 7149 women in Turkey were included in this cross-sectional study. Self-rated health was analysed using three logistic regression models. Results: The rates of poor health were 9.8% among women and 5.2% among men, with the gender gap increasing with age. Low level of education, chronic diseases and poverty were associated with poor perceived health in both genders. For women, marriage and retirement from secure jobs were associated with good health; obesity and smoking were factors that caused poor health. For men, unemployment had a negative impact on health. Conclusion: The determinants of poor health were associated with not only on socioeconomic status but also on gender in the Turkey. Marriage may provide social protection for women where there are insufficient social policies to protect them </p

OFDM sistemlerinde taşıyıcılar arası girişimi yoketme metotlarının karşılaştırılması.

In OFDM systems carrier frequency offset is observed due to Doppler shift and transmitter-receiver frequency mismatches. This offset induces ICI (Intercarrier Interference). In this thesis, repeated data methods and pilot-aided carrier frequency offset(CFO) estimation methods and windowing techniques are used to mitigate the frequency offset problem and a performance comparison is made between these ICI cancellation techniques. Repeated data methods use only half of the bandwidth for information transmission to eliminate the ICI at the receiver. We have implemented repeated data methods including Self cancellation scheme and Symmetric Symbol Repetition (SSR) schemes to overcome ICI problem. We have also implemented Adjacent Conjugate Symbol Repetiton (ACSR) and Symmetric Conjugate Symbol Repetiton (SCSR) methods to mitigate both phase rotations and ICI. CFO estimation and correction methods generally use pilot sequences. We implemented the “Conventional Pilots” and “Clustered Pilots” pilot-aided CFO estimation techniques for ICI cancellation. Furthermore, we also implemented a new scheme by using the odd symmetry between pilot symbols. Nyquist windowing techniques apply windowing at the receiver side. We have implemented second order polynomial class of Nyquist windows and Nyquist window with Franks pulse used to mitigate ICI. These ICI cancellation methods are compared in AWGN and multipath Rayleigh fading channel models in terms of BER and carrier to interference ratio. It is shown that repeated data methods shows better performances than pilot-aided CFO estimation methods with a cost of increased bandwidth usage especially in high SNR’s.M.S. - Master of Scienc