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

The reliability and validity of the turkish version of the world health organizat on quality of life instrument-older adults module (WHOQOL-Old)

Purpose: To determine the psychometric properties of the Turkish version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-Old). Methods: The Turkish version of the WHOQOL-OLD was administered to 527 older (> 65 years) adults living in urban, suburban, and rural areas of Manisa Province, Turkey. The WHOQOL-OLD module consists of 24 items assigned to 6 facets (sen sory abilities, autonomy, past, present and future activities, so cial participation, death and dying, and intimacy) and is a supplementary module of WHOQOL-BREF. The WHOQOL-BREF and GDS-30 were also administered to the participants. A confirmatory approach was used during reliability and validity analysis. SPSS v.10.0 and LISREL v.8.54 were used for analysis. Results: Mean age of the participants was 71.06 ± 5.20 years and the overall WHOQOL-OLD score was 56.02 ± 11.86. In all, 54.5% of the participants were female and 60.5% reported to be in poor health. Both ceiling and floor effects of the WHOQOL-OLD were satisfactory ( 0.70), and item total correlations and overall scale success were satisfactory. As a measure of the construct validity of the scale, confirmatory factor analysis showed very high CFI values (range: 0.936-0.999) for each of the domains. Convergence of WHOQOL-OLD facet scores on WHOQOL-BREF domains and WHOQOL-OLD were very fine in general. Conclusions: The psychometric properties of the Turkish version of the WHOQOL-OLD were acceptable, indicating that the scale is reliable and valid for use with older Turkish adults (> 65 years)

Türkiye'ye ilişkin yaşlı sağlığı örgütlenmesi model önerisi

Dünyada ve Türkiye'de ölüm ve doğum hızlan azalmasıyla birlikte yaşlı sayısı ve oranı gittikçe artmaktadır. Bu artış ile birlikte sağlık sorunları yanında sosyal ve ekonomik sorunlar da ortaya çıkmaktadır. Ülkelerin birçoğunun sağlık örgütlenmesinde ve sağlık çalışanlarının lisans ve hizmet içi eğitimlerinin yapılandırılmasında bu değişim göz ardı edilmektedir. Türkiye'de de sağlık örgütlenmesi içinde yaşlı sağlığı hizmetleri salt gelene hizmet biçiminde ve hastalık temelli olarak yapılmaktadır. Bu nedenle Halk Sağlığı doktora Öğrencileri ve bir öğretim üyesi tarafından, 2005-2006 güz döneminde "Yaşlı Sağlığı" dersi kapsamında Türkiye'de yaşlı sağlığına ilişkin örgütlenme modeli önerisi oluşturulmuştur. Model oluşturulurken verilecek hizmetin amacının, temel özelliklerinin, kapsamının ne olacağı, nerede ve kimler tarafından verileceği ve finansmanın nasıl sağlanacağı sorularına yanıt aranmıştır.Decrease in mortality and fertility rate result an increase in elderly population in Turkey and in the world. Not only health problems but social and economical problems occur within this age group. In most of the countries this demographic transformation is neglected in medical education. In Turkey, elderly care is mainly focused on treatment of the diseases and based on "to whom who can apply" approach. Therefore the PhD students of Public Health and their supervisor create a model for elderly health care which describes the objectives of elderly health care, the main characteristics of the system, content, where the service should be given, by whom and finance of the system

The relationship between obesity and health related quality of life of women in a Turkish city with a high prevalence of obesity

The purpose of this study was to demonstrate the relationship between body weight and HRQOL in a representative sample of nonpregnant women in reproductive age period. The data of this cross-sectional study was extracted from a survey: Manisa Demographic and Health Survey (MDHS) conducted in Manisa city in 2000. The study population of MDHS is a representative sample of 1602 reproductive (15-49) age women. World Health Organization Quality of Life Questionnaire abbreviated version (WHOQOL-BREF), which was composed of four domain factors (physical, psychological, social relations and the environment), was used to assess HRQOL. Each of four domains had a possible score ranged between 0 (poor HRQOL) and 20 (excellent HRQOL). The mean age of the women was 35.29 ± 8.19 years. Among them, 35.8 % had normal weight (BMI 18.5 to 24.9), 32.3 % were overweight (BMI 25.0 to 29.9) while 31.9 % were moderate and 3.4% were morbidly obese. After adjusting for age, level of education and co-morbid illnesses, subjects with a BMI higher than normal value, had significantly lower HRQOL scores, compared to normal-weight individuals on each of the domains, except for the environmental domain. Our results suggested that the body weight alone could negatively affect HRQOL. In other words, obesity not only increased the risk of morbidity and mortality, but also affected the perceived health and life quality negatively. In conclusion, in addition to age, socioeconomic status and co-morbid illnesses, body weight should also be controlled in studies examining HRQOL

Balcova heart study: rationale and methodology of the Turkish cohort

Turkey is facing increasing rates of cardiovascular disease (CVD). The study is designed to meet the growing need to obtain information about the recent status and trends of CVD risk factors and their impact on mortality