Sigara içme durumlarına göre öğretmenlerin sosyodemografik özelliklerinin ve yaşam kalitelerinin değerlendirilmesi: Türkiye'nin Doğu Karadeniz bölgesinden kesitsel bir çalışma

Introduction: Smoking related health disorders are particularly common after long-term cigarette use and accordingly cumulative side effects of smoking usually do not appear in younger individuals. Therefore, for evaluating the contemporary effects of smoking in healthy individuals quality of life has become a fundamental criterion. In this study our aims are evaluating factors affecting school teachers' smoking status and comparing quality of life them according to their cigarette smoking status. Materials and Methods: This cross-sectional study, conducted between March 1 and June 30, 2015, included all government school teachers in Hopa. A sociodemographic data form and World Health Organisation Quality of Life-bref (WHOQL-bref) questionnaire were used. Statistical analysis was performed via SPSS 20. To evaluate the reliability of the WHOQOL-bref questionnaire, Cronbach's alpha co-efficiency was calculated for each domain separately. Results: Statistical analysis was performed on 327 participants' data. The mean age of the teachers was 34.2 +/- 8.73 and 50.2% of them were female. Most of the teachers were never smokers (67.8%) and current smokers' made up 20.1% of the population. Mean Fagerstrom score of current smokers was 4.1 +/- 1.96. Multinominal logistic regression analysis showed that there was a positive association between male gender and current smoking (OR= 2.25; 95% CI: 1.17-4.32; p< 0.05). Perception of quality of life and perception of health status scores were lower in the current smoker group as compared to never smokers (p< 0.05). However, other quality of life domains were not significantly different among smoking groups. Also, none of the quality of life domains differed significantly according to current smokers' nicotine dependence level. Conclusion: This study reflected a decrease in current smoking prevalence among school teachers compared to previous years. Also, the perception of quality of life and perception of health status scores were lower in the current smoker group as compared to never smokers.Giriş: Sigara ile ilişkili sağlık sorunları özellikle uzun süreli kullanımından sonra sık görülür ve dolayısıyla sigaranın kümülatif yan etkileri genç yaşlarda pek görülmez. Bu nedenle, sigaranın o andaki yan etkilerini değerlendirmede yaşam kalitesi temel bir kriter haline gelmiştir. Bu çalışmamızda amaçlarımız öğretmenlerin sigara içmelerini etkileyen faktörleri değerlendirmek ve sigara içme durumlarına göre yaşam kalitelerini kıyaslamaktır. Materyal ve Metod: Bu kesitsel çalışma 1 Mart 2015 ila 30 Haziran 2015 tarihleri arasında yapıldı ve Hopa'da bulunan bütün devlet okullarındaki öğretmenler çalışmaya dahil edildi. Sosyodemografik veri formu ve WHOQOL-bref ölçeği kullanıldı. İstatistiksel analiz için SPSS 20 kullanıldı. Ölçeğin güvenilirliğini değerlendirmek için her bir alanının Cronbach alfa değerleri hesaplandı. Bulgular: İstatistiksel analiz 327 kişinin verilerine uygulandı. Öğretmenlerin yaş ortalaması 34.2 ± 8.73 idi ve %50.2'si kadındı. Öğretmenlerin çoğu (%67.8) hiç sigara içmemişti, aktif içicilerin oranı %20.1 idi. Aktif içicilerin ortalama Fagerström skoru 4.1 ± 1.96 idi. Multinominal lojistik regresyon analizi erkek cinsiyet ile aktif içicilik arasında pozitif ilişki olduğunu gösterdi (OR= 2.25;95% CI: 1.17-4.32; p< 0.05). Yaşam kalitesi algısı ve sağlık durumu algısı aktif içicilerin hiç içmeyenlere göre daha düşüktü (p< 0.05). Ancak, diğer yaşam kalitesi alanlarında sigara içme durumlarına veya bağımlılık durumlarına göre farklılık saptanmadı. Sonuç: Bu çalışma öğretmenler arasında aktif sigara içiciliği oranında önceki yıllara göre bir düşüş olduğunu, ayrıca aktif içicilerin hiç içmeyenlere göre yaşam kalitelerini ve sağlık durumlarını daha kötü algıladıklarını göstermiştir

Factors associated with current smoking in COPD patients: A cross-sectional study from the Eastern Black Sea region of Turkey

INTRODUCTION Even though smoking is a major reason for the development and progression of chronic obstructive pulmonary disease (COPD)-and quitting smoking is the only way to stop its progression-a significant number of smokers still continue to smoke after being diagnosed with COPD. The aim of this study is to compare the clinical and demographic characteristics of COPD patients who are current and former smokers and to find factors associated with their current smoking status. METHODS For this study, data were collected between June 2015 and August 2016; COPD patients who had been regularly visiting Hopa State Hospital’s outpatient clinic over the last year or longer were included. Their demographic, clinical and functional data were recorded. Patients completed a pulmonary function test, six-minute walk test (6-MWT), COPD assessment test (CAT), and modified Medical Research Council (mMRC) dyspnea scale. Comparisons were then made according to their smoking status. RESULTS In total 100 patients were included in the study; with a mean age of 63.4±10.7 years and mostly males (94%). Regarding smoking status, 49% were current smokers and 51% were former smokers. Multivariate logistic regression analysis revealed that current smoking was negatively associated with age (odds ratio, OR=0.93, 95% confidence interval, CI=0.88–0.96) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage (OR=0.32, 95% CI=0.13– 0.79), and was positively associated with six-minute walk distance (OR =1.005, 95% CI=1.001–1.009) and CAT score (OR=1.07, 95% CI=1.009–1.13). CONCLUSIONS Nearly half of the COPD patients in the study continued smoking even after having been diagnosed with COPD. The younger patients, with better lung function, better exercise capacity and poor quality of life were associated with current smoking

Treatment adherence and short-term outcomes of smoking cessation outpatient clinic patients

INTRODUCTION Previous studies have shown that adherence to treatment is fundamental to success in smoking cessation. However, smoking cessation medication regimens are limited significantly by the struggle to adhere to them. This study was conducted to evaluate the factors associated with treatment adherence and quitting success in a group of patients that applied to our smoking cessation outpatient clinic (SCC). METHODS Patients that applied to SCC between April 2015 and December 2016 who were evaluated, found suitable for smoking cessation interventions and started pharmacological treatment were included in this study. Only those who could be reached by phone three months after their first application became participants. Those who had used the prescribed treatment for at least 30 days were grouped as treatment-adherent. RESULTS In total, data for 346 patients were evaluated. Mean (±SD) age was 44.3±13.9 years; most of them were male (63%), primary school graduated (36.1%), self-employed (43.7%), and had no comorbid diseases (71%). Bupropion was started in 52% of the patients, that rate was 35.8% for varenicline and 12.1% for a combination of the nicotine patch and gum. Mean days for treatment use was 20.9±18.5; 59% of the patients were non-adherent to their treatment and 51.7% had only one control visit number. Adverse reactions due to treatment were recorded in 25% of participants, and at their third month 37.9% of them had quit smoking. In multivariate logistic regression analysis, increase in control visit number, absence of adverse reaction, and varenicline use, were each associated with higher treatment adherence (p<0.001) and only being in the treatment-adherent group was associated with quit success (OR=3.01, 95% CI: 1.88–4.81, p=0.001). CONCLUSIONS This study showed that most patients did not use their prescribed SC treatments adequately; a main factor that affects quit success is treatment adherence. There is a need for closer monitoring and follow-up to ensure adequate use of treatment of patients

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Solitary plasmacytoma of the femur: a case report

Solitary plasmacytoma (SP) is a rare type of myeloma which is a hematologic malign tumour originated from plasma cells. It is an isolated tumour which myeloma signs are not observed. SP primarily affects axial skeleton and involvement of extremity is seen rarely. We report a case of SP of proximal femur origin in a 52-year-old woman. The patient was treated with cemented modüler tumour prosthesis following tumour excision. In a one year follow up period, no recurrens or multiple myeloma signs were observed and the patient was able to walk without support and without pain so the treatment resulted successfully

Platelet-rich plasma versus steroid injection for subacromial impingement syndrome

Purpose. To compare the 6-week and 6-month outcome in 60 patients who received a single-dose injection of platelet-rich plasma (PRP) or steroid for subacromial impingement syndrome (SIS). Methods. 22 men and 38 women (mean age, 49.7 years) opted to receive a single-dose injection of PRP (n=30) or steroid (n=30) for SIS that had not responded to conservative treatment for >3 months. The PRP or a mixture of 1 ml 40 mg methylprednisolone and 8 ml prilocaine was administered via a dorsolateral approach through the interval just beneath the dorsal acromial edge. Both groups were instructed to perform standard rotator cuff stretching and strengthening exercises for 6 weeks. The use of non-steroid anti-inflammatory drugs was prohibited. Patients were evaluated before and 6 weeks and 6 months after treatment using the Constant score, visual analogue scale (VAS) for pain, and range of motion (ROM) of the shoulder. Results. No local or systemic complication occurred. Improvement in the Constant score and VAS for pain at week 6 and month 6 was significantly better following steroid than PRP injection. The difference in the Constant score was greater than the mean clinically important difference of 10.4. Nonetheless, the 2 groups were comparable for improvement in ROM of the shoulder. Conclusion. Steroid injection was more effective than PRP injection for treatment of SIS in terms of the Constant score and VAS for pain at 6 weeks and 6 months

Türkiye’ de Hekim ve Hemşirelerin Yaşam Sonu Kararları Hakkındaki Tutumları

Although the decision-makers regarding the end-of-life treatment and care are often the patient themselves or their relatives, physicians and nurses are also consulted for their views on treatment and care upon their medical experience. Therefore, the present study attempted to explore the attitudes of Turkish physicians and nurses to end-of-life decisions and variables affecting their such attitudes. This cross-sectional study was carried out with 870 (450 physicians, 420 nurses) participants conveniently selected from medical chambers and nursing associations in Turkey. In addition to a demographic form, the data were collected using a demographic information form and the End-of-life Decisions Survey (EDS) for physicians and nurses developed by Stoeckle et al. upon obtaining relevant permissions and validity and reliability analyses. The findings revealed that age, gender, marital status, and having a child were statistically significant (p ≤ 0.05) demographic variables regarding perceptions, beliefs, and practices of end-of-life decisions. Nevertheless, there were no significant differences (p > 0.05) in perceptions, beliefs, and practices of end-of-life decisions by education, occupation, department, and income level. 1.6% of the participants left a medical power of attorney, 83.2% needed additional training on the subject, 46.7% started negotiations about end-of-life decisions at least once, 43.7% It was determined that physicians and 41.8% thought that patients should initiate interviews about end-of-life decisions. Overall, the findings reveal an extensive training need of healthcare professionals in end-of-life decisions, the urgency of putting authorization statements into practice, and the importance of hospital ethics committees.Hasta bireyin kendisi veya hasta yakınları her ne kadar yaşam sonu tedavi ve bakım süreçleri ile ilgili karar verici olsalarda, bu süreçte tıbbi deneyim ve tecrübelerine dayanılarak, tedavi ve bakım konusunda fikirlerine başvurulan kişiler büyük çoğunlukla hekim ve hemşirelerdir. Bu nedenle araştırmamızda ülkemizdeki hekim ve hemşirelerin yaşam sonu kararları sürecindeki tutumlarını ve etkileyen faktörlerin hangi değişkenler olduğunu saptamayı amaçladık. Araştırma nicel, kesitsel bir çalışmadır. Araştırma için kendi hazırladığımız sosyo-demografik veri formu ve Stoeckle ve ark. tarafından hazırlanan hekim ve hemşireler için yaşam sonu kararları ölçeği gerekli izinler alındıktan ve geçerlilik ve güvenilirlik analizleri yapıldıktan sonra kullanılmıştır. Çalışmaya 870 hekim ve hemşire katılmış olup; yaş, cinsiyet, medeni durum, çocuk sahibi olma değişkenlerinin yaşam sonu kararları konusundaki algı, inanç ve uygulamalar açısından önemli ve istatistiksel olarak anlamlı (p≤0,05) sosyo-demografik değişkenler olduğu; eğitim, mesleki faktör, çalışılan birim, gelir düzeyi değişkenlerinin ise yaşam sonu kararlarında algı, inanç ve uygulamalar açısından istatistiksel olarak anlamlı farkın olmadığı (p>0,005) değişkenler olduğu saptanmıştır. Katılımcıların %1,6’sının tıbbi vekaletname bıraktığı, % 83,2’sinin konu ile ilgili eğitime ek eğitimlere ihtiyaç duyduğu, % 46,7’sinin yaşam sonu kararları ile ilgili görüşmeleri en az bir kere başlattığı, %43,7’sinin yaşam sonu kararları ile ilgili görüşmeleri hekimlerin, % 41,8’inin ise hastaların başlatması gerektiğini düşündüğü saptanmıştır. Araştırma sonuçlarımız sağlık personelinin konu ile ilgili ciddi bir eğitim gereksinimini, yetkilendirme bildirimlerinin uygulamaya konulması gerekliliğini ve Hastane Etik Kurullarının önemini ortaya koymaktadır. Alanda konu ile ilgili gereksinimlerin belirlenerek, ilgili kurumların çalışmaları önem arzetmektedir

Burdur ilindeki 65 yaş üzeri tüketicilerin süt ve süt ürünleri tüketim alışkanlıkları

Bu çalışma Burdur ili ve ilçelerinde ikamet eden 65 yaş ve üzerindeki tüketicilerin süt ve süt ürünleri tüketim alışkanlıklarını belirlemek amacı ile yapılmıştır. Çalışmada örnek hacmi, ana kitle oranlarına dayalı kümelendirilmiş tek aşamalı tesadüfî olasılık örnekleme yöntemi ile belirlenmiştir. Buna göre çalışma alanı olarak Burdur merkezi seçilmiş ve anket sayıları nüfus yoğunluklarına göre hesaplanarak belirlenen sayıda ilçelere dağıtılmıştır. Araştırmaya toplam 400 birey katılmış olup 198 (%49,5)' i kadın, 202 (%50,5)' i erkekti. Evrenin 299 (%74,8)' ini genç yaşlılar, 91 (%22,7)' sini orta yaşlılar, 10 (%2,5)' ini ileri yaşlılık döneminde olan bireyler oluşturmaktaydı. Araştırmaya katılan bireylerin yaş ortalaması 70,89±5,49'du. Bireylerin 145 (%36,3)'ü düşük gelir grubunda (0-1000 TL.), 173 (%43,3)'ü orta düzey gelir grubunda (1001-2000 TL.), 82 (%20,5)'i yüksek gelir grubunda (2001 TL. ve üzeri) bulunmaktaydı. Gelir düzeyi düştükçe yaşlıların pastörize ve UHT süt tüketimleri ve süt ve süt ürünlerine yaptıkları harcamanın düştüğü ve gruplar arasındaki farkın istatistiksel olarak da anlamlı olduğu saptandı (p0,001). Gelir gruplarına göre süt satın alınan yerlerin sıralaması yapıldığında da tercih edilen yerlerin farklılık gösterdiği ve bu farkın istatistiksel olarak da anlamlı olduğu (P0,005) saptandı.Araştırmamıza katılan bireylerin tercihen en çok (%35,2, n=141) sütü sabah saatlerinde ve sonbahar ayında (%26,75, n=107) tükettikleri ve sütü en çok (%50,5, n=202) içme sütü olarak kullandıkları saptanmıştır. Tüketicilerin açık süt alırken en çok fiyatına (%27,02 n=107), sterilize süt alırken ise en çok son kullanma tarihine (%41,45, n=160) dikkat ettikleri görülmüştür. Tüm sonuçlar değerlendirildiğinde 65 yaş ve üzeri tüketicilerde gelir düzeyi düştükçe, fiyatı daha ucuz olan açık ürünlerin daha çok tercih edildiğini ve ürünün tadının da satın alırken fiyatı kadar etkili olduğunu saptadık. Bu yaş grubu tüketiciler için aroması ve besin içeriği daha özelleştirilmiş olan ürünlerin ve hatta 65 yaş ve üzerindeki bireylerin süt tüketimini artırmak için yapılacak özel indirimlerin tüketim alışkanlıklarını ve miktarlarını değiştirebileceği kanaatindeyiz.The aim of this study was to determine the 65 aged and over consumers' milk and milk products consumption who living in Burdur province and district. The sample size of the study, based on the main mass ratio was determined by clustered single-stage random probability sampling method. Accordingly Burdur city center selected as the study area, and the number of questionnaires were distributed to the number of districts to be calculated according to population density. A total of 400 people have joined in the research, 198 (49.5%) were women and 202 (50.5%) were males. The universe of 299 (74.8%) were the young elderly, 91 (22.7%) were middle-aged, 10 (2.5%) in the period constituted individuals who are advanced age. The average age of people who involved in the research was 70.89 ± 5.49. 145 of individuals (36.3%) were in the low income group (£ 0-1000.), 173 (43.3%) were in the middle income group (1001-2000 TL.), 82 (20.5%) were in the highest income group (2001 TL. and above). The lower income level of the elderly, pasteurized and UHT milk consumption and their spending on milk and milk products were decreased. Pasteurized and UHT milk consumption and their spending on milk and milk products were decreased of the elderly people who have the lower income and the difference between groups were found to be statistically significant (p 0.001). The places where the milk was purchased, were different among income groups and the difference between groups were found to be statistically significant (p 0.005). The people who joined our research, they were mostly prefer using milk (35.2%, n = 141) during the hours morning and fall months (% 26.75, n = 107) and they consume milk mostly (50.5%, n = 202) drinking milk. The most consumers were found to be careful the price of fresh milk (27.02% n = 107), while buying sterilized milk, they were pay attention the expiration date (41.45%, n = 160). All results are evaluated over the 65 years and older consumers, the lower income level of people preferred cheaper and outdoor products and the taste of product as effective as the price while purchased it. According to us the production of aroma and nutrient content more customized products will increase the consuption and we believe that the consumption habits and quantity will increase when the special discount for the milk and milk products for this age group