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

Health worker densities and immunization coverage in Turkey: a panel data analysis

<p>Abstract</p> <p>Background</p> <p>Increased immunization coverage is an important step towards fulfilling the Millennium Development Goal of reducing childhood mortality. Recent cross-sectional and cross-national research has indicated that physician, nurse and midwife densities may positively influence immunization coverage. However, little is known about relationships between densities of human resources for health (HRH) and vaccination coverage within developing countries and over time. The present study examines HRH densities and coverage of the Expanded Programme on Immunization (EPI) in Turkey during the period 2000 to 2006.</p> <p>Methods</p> <p>The study is based on provincial-level data on HRH densities, vaccination coverage and provincial socioeconomic and demographic characteristics published by the Turkish government. Panel data regression methodologies (random and fixed effects models) are used to analyse the data.</p> <p>Results</p> <p>Three main findings emerge: (1) combined physician, nurse/midwife and health officer density is significantly associated with vaccination rates – independent of provincial female illiteracy, GDP per capita and land area – although the association was initially positive and turned negative over time; (2) HRH-vaccination rate relationships differ by cadre of health worker, with physician and health officers exhibiting significant relationships that mirror those for aggregate density, while nurse/midwife densities are not consistently significant; (3) HRH densities bear stronger relationships with vaccination coverage among more rural provinces, compared to those with higher population densities.</p> <p>Conclusion</p> <p>We find evidence of relationships between HRH densities and vaccination rates even at Turkey's relatively elevated levels of each. At the same time, variations in results between different empirical models suggest that this relationship is complex, affected by other factors that occurred during the study period, and warrants further investigation to verify our findings. We hypothesize that the introduction of certain health-sector policies governing terms of HRH employment affected incentives to provide vaccinations and therefore relationships between HRH densities and vaccination rates. National-level changes experienced during the study period – such as a severe financial crisis – may also have affected and/or been associated with the HRH-vaccination rate link. While our findings therefore suggest that the size of a health workforce may be associated with service provision at a relatively elevated level of development, they also indicate that focusing on per capita levels of HRH may be of limited value in understanding performance in service provision. In both Turkey and elsewhere, further investigation is needed to corroborate our results as well as gain deeper understanding into relationships between health worker densities and service provision.</p

My own patient experience: Learning to walk again like a baby

I had a left monoparalysis during a holiday abroad in July 2005. This narrative shares my experience of getting ill in a foreign country, how it is difficult to describe your troubles and, how little is known about the long recovery period of paralysis by physicans. My experience showed me that being a patient was so far from being a doctor. Social support is very important during recovery from paralysis, because you can not do anything by yourself and you are very desperate. You feel the muscles that have not gained tonus yet, like a belt and strap. Only the physiotherapist, warned me about the long recovery progress. I did not realizse how high the sidewalks are. A 1 cm height feels like a mountain to climb, and a 1 kg weight like a truck to carry. From this experince, I offer two main suggestions including 1) Language is very important for foreign patients for communication at hospitals. An online translation center for hospitals, that translators of each language work, may be benefical when it is needed at any country. 2) Be clear in communicating with patients about their diagnosis, in this case telling the patient having paralysis how long the recovery period will be in detail.</p

children in Turkey: A cohort study

Background : This aim of the present study was to estimate the frequency of diarrheal diseases among children as well as investigating the relationship between diarrheal diseases and household conditions and other factors.Methods : The study was performed over 12 month period in Binevler Health Center, Gaziantep, Turkey. Five health stations were selected by using a sampling technique with probability proportional to size, and all households with children under the age of 5 years were visited. A questionnaire on diarrhea, household conditions, socioeconomic status of the family and individual characteristics of the children was applied to the mothers by doctors. Three composite indices, including household conditions, socioeconomic status of the family and individual status of the children, were prepared and a classification was made as good, mild or poor in order to better evaluate the results of the study. Daily recordings of diarrheal disease symptoms were made by the parents and these records were collected every month for 1 year.Results : The annual mean incidence of diarrheal diseases was found to be 1.09 per child per year (median = 1). The mean was higher in children with poor household conditions (1.48 +/- 0.12) and with poor individual status (1.48 +/- 0.14), compared with good household conditions (0.76 +/- 0.07) and good individual status (0.71 +/- 0.08). The mean was also higher in children aged between 6 and 11 months (1.51 +/- 0.18), whose father graduated from primary school or lower (1.34 +/- 0.09) and with parents having no habit of washing their hands before taking care of the child (2.00 +/- 0.33). Person-month and case-month incidence rates of diarrhea were calculated to be 8.56 and 9.12%, respectively.Conclusions : Household conditions, individual status, age, education level of fathers and parents' habit of washing hands before taking care of the child were major factors affecting the incidence of diarrhea

Treatment of Class II, Division 2 Malocclusion with Miniscrew Supported En-Masse Retraction: Is Deepbite Really an Obstacle for Extraction Treatment?

A 17-year-old female patient, whose chief complaint was her unpleasing smile, had skeletal and dental class II malocclusion, hypodivergent facial type with a severely increased overbite. Among the treatment options, upper-first-premolar extractions followed by miniscrew-supported en-masse retraction was the treatment of choice. After the initial levelling and alignment, miniscrews with 1.5- to 1.4-mm diameter and 7-mm lenght, were installed between the roots of the second premolars and the first molars, bilaterally. En-masse retraction was achieved on a 0.016x0.022-inch stainless steel archwire with 7-mm long power hooks placed distal to the lateral incisors, and with nickel-titanium (NiTi) closed coil springs exerting 250-gr of force per side. At the end of the treatment, deepbite, incisor inclinations and interincisal angle were corrected, and Class II molar relationship with good intercuspation was achieved. Upper 2-2, lower 3-3 retainers were bonded for retention. As a result, deepbite and Class II canine relationship was successfully corrected with simultaneous incisor intrusion and retraction using miniscrew-supported en-masse retraction

Biomechanical Evaluation Between Orthodontic Attachment And Three Different Materials After Various Surface Treatments: A Three-Dimensional Optical Profilometry Analysis

Objectives: To determine the best bonding method of orthodontic attachment among monolithic zirconia, feldspathic porcelain, hybrid porcelain, and the impact of surface-conditioning methods using a three-dimensional optical profilometer after debonding. Materials and Methods: 56 feldspathic porcelain, 56 monolithic zirconia, and 56 hybrid porcelain samples were divided into four surface treatment subgroups: (1) hydrofluoric (HF) acid etch + silane, (2) Al2O3 sandblasting + silane, (3) silicoating (SiO2), and (4) diamond bur + silane. The specimens were tested to evaluate shear bond strength (SBS). Residual composite was removed after debonding. Three-dimensional white-light interferometry was used to obtain quantitative measurements on surface roughness. Results: The highest SBS value was found for the HF acid-etched feldspathic porcelain group. The average surface roughness values were significantly higher in all material groups in which diamond bur was applied, while roughening with Cojet provided average surface roughness values closer to the original material surface. Conclusions: Variations in structures of the materials and roughening techniques affected the SBS and surface roughness findings.WoSScopu

Vitamin A and β-Carotene Levels During Pregnancy in Gaziantep, Turkey

Vitamin A levels during pregnancy have important influences on the health of pregnant women and the growing fetus. Therefore, plasma vitamin A and β-carotene concentrations during pregnancy in Turkish women living in Gaziantep city were investigated in a prevalence study. Optimum sample size was determined as 252 for vitamin A deficiency and vitamin A and β-carotene levels were examined in 427 pregnant women aged 14–44 years. Vitamin A and β-carotene concentrations were measured spectrophotometrically by Neeld Pearson method. Vitamin A and β-carotene concentrations in pregnant women were found as 1.14 ± 0.44 μmol/L, and 1.80 ± 0.66 μmol/L, respectively. Plasma vitamin A concentrations were found in low levels (<1.05 μmol/L) in 45.5 % of pregnant women. Vitamin A deficiency (<0.7 μmol/L) was determined in 16.9% of pregnant women. A mild negative correlation was obtained between the vitamin A concentration and pregnancy period. Vitamin A levels of pregnant women were decreased significantly in the third trimester (p<0.05). The findings of present study suggest that vitamin A levels of pregnant women were poor in the region. Therefore, the intake of vitamin A with foods should be improved. Supplementation of vitamin A might benefit at improving maternal and child health especially in high-risk groups especially in developing countries. Monitoring vitamin A levels in pregnant women is very important for also determining low and high levels

Comparison of short-term effects of mini-implant-supported maxillary expansion appliance with two conventional expansion protocols

Objective: This study evaluates the dentoskeletal effects of a mini-implant-supported maxillary expansion (MISME) appliance in comparison with two types of conventional expansion methods. Methods: Records of 42 patients with bilateral or unilateral posterior crossbite were included in this study. The patients were divided into three groups. In group 1, four miniscrews were placed to the palatal region and an acrylic expansion device was bonded on these screws. A bonded maxillary expansion appliance was used in group 2, while a banded expansion appliance was used in group 3. Measurements from cephalometric, postero-anterior radiographs, and dental casts taken before and after expansion were evaluated statistically. Results: ANB angle increased significantly in group 1 and 3. MISME group also showed an increase of SNA angle. Measurements regarding the vertical dimension did not change with MISME but significant posterior rotation was found in group 2 and 3. Overbite value showed a significant decrease in group 2 and 3, but remained stable in group 1. The nasal, maxillary, maxillary intermolar widths showed significant increases in all groups. The difference between MISME group and other groups in maxillary width was significant indicating more skeletal expansion in MISME group. The maxillary molars showed significant buccal tipping in group 2 and 3, while lingual tipping of molars was found in MISME group. Conclusions: MISME can be a better alternative to bonded expansion particularly in patients with vertical growth patterns and lack of anchorage teeth

Obesity Prevalence in Gaziantep, Turkey

Background: Obesity is associated with reduced quality of life, development of serious chronic conditions such as heart disease and diabetes, increased medical care costs, and premature death. Environmental effects, especially feeding habits may cause hyperinsulinemia and obesity. A Healthy People 2010 objective is to reduce the proportion of adults who are obese to 15%. Materials and Methods: This cross-sectional study was conducted on 1647 persons in a sample representing Gaziantep, Turkey. Over the selected 329 houses, 310 houses were reached (94.2%) and data about 1315 related persons was collected. The body mass index (BMI) shows the relationship between the weight and the height of people, calculated by the ratio of mass by kg over the square value of height measure. In statistical analyses chi-square, student's t -test and logistic regression analysis were used. Results: The mean BMI increased with time for both sex, whereas decreased for 60+ age group. The fastest increase for both sex was seen while transition from 18 year to 19-29 age groups occurred. Another increase in women was in 30-39 age group; BMI=25.08±4.39 in 19-29 ages whilst BMI=29.02±5.79 in 30-39 ages. The increases in both sex in other age groups were not as much as in this group. Conclusion: Obesity is not only a problem in the Gaziantep but is also a major health concern in Europe and other regions of the world. As an accepted method against obesity, life-style changes should be put into use from childhood supported in school and family life