Treatment uptake levels among the coronary heart disease patients at the university hospital

AMAÇ: Amaç bir üniversite hastanesinde koroner kalp hastalığı olan 35 yaş ve üzeri kişilerdeki risk etmenlerinin, uygulanan tedavi düzeylerinin belirlenmesidir. YÖNTEMLER: Tanımlayıcı tipteki araştırma Dokuz Eylül Üniversitesi Hastanesi'nde yapılmıştır. Geriye dönük taranan kayıtlara göre DEÜ Hastanesi'nde 1 Ocak- 31 Aralık 2008'de KKH ve koroner bypass tanılı hastalar çalışmanın olgularını oluşturmuştur. Toplam 392 hastaya ulaşılmıştır. Değişkenler başvuru öncesi hastalık ve risk öyküsü, ilaç kullanımı, hastanede uygulanan girişimler, taburcu olurken reçete edilen ilaçlardır. Veri sıklık dağılımları ve yüzdeler biçiminde sunulmuştur. BULGULAR: Hastaların üçte birinde diyabet, hiperlipidemi ya da sigara riski, %65.6'sında hipertansiyon bulunmaktadır. Anjinalı olguların %86.2'sine, akut MI'lıların %85.4'üne anjiyografi, anjinalı hastaların %30.9'una, akut MI'lıların %54.4'üne anjiyoplasti, anjinalıların %13.8'ine, akut MI'lıların %11.1'ine by-pass cerrahisi yapılmıştır. Hastaneden çıkışta anjinalı hastaların %68.8'ine beta bloker, %79.6'sına statin, %28.0'ına ACE inhibitörü, %88.2'sine aspirin; MI'lı hastaların %84.1'ine beta bloker, %89.7'sine statin, %60.7'sine ACE inhibitörü, %95.3'üne aspirin reçete edilmiştir. Kalp yetmezliğinde ilaçların reçete edilme oranları beta blokerde %54.0, statinde %39.7, ACE inhibitöründe %42.9, aspirinde %71.4'tür. SONUÇ: İlaçların reçete edilme oranları düşüktür. Toplumda KKH mortalitesinin azaltılmasında etkili tedavilerin reçete edilmesi ve kullanımı önemlidir. OBJECTIVE: Aim of the study was to determine the treatment uptake levels and risk factors among the coronary heart disease patients over 35 years old at the university hospital. METHODS: This descriptive study was conducted in the Dokuz Eylul University Hospital. Patients diagnosed with Coronary Heart Disease or coronary by-pass graphy between 1 January-31 December 2008 in DEU Hospital formed the study group based on the hospital records which was screened retrospectively. In total 392 patients files were screened. Variables used in the survey were; information about morbidity, risk factors and use of medications, procedures applied during hospitalization and the medications at discharge. Data were presented as frequencies and percentages. RESULTS: One third of the patients presented risk of diabetes, hyperlipidemia or smoking and 65.6% had hypertension. 86.2% of the patients with angina and 85.4% of acute MI patients had angiography procedure, 29.8% of angina patients and 54.4% of MI patients had angioplasty; 13.8% of angina patients and 11.1% of AMI patients had by-pass surgery. Prescribed medications at discharge among the angina patients were 68.8% for beta blocker, 79.6% Statin, 28.0% ACE inhibitor, 88.2% aspirin. Beta blockers were prescribed to 84.1%, Statin to 89.7%, ACE inhibitor to 60.7%, Aspirin to 95.3% of the AMI patients. Beta blocker was prescribed to 54.0%, statin to 39.7%, ACE inhibitor to 60.7%, Aspirin to 71.4% of the heart failure patients. CONCLUSION: The treatment uptake levels for most of the CHD groups at the hospital discharge are low. It is important to provide effective medications to all eligible CHD patients to reduce CHD mortality in the community

THE IMPACT OF JOB SATISFACTION ON ANXIETY AND DEPRESSION LEVELS AMONG UNIVERSTY PHYSICIANS

Doktorlarda depresyon, intihar ve madde kullanımı riski yüksektir. İş doyumu ve stres gibipsikososyal etmenlerin mental sağlık üzerine etkileri olduğu bilinmektedir.Amaç: Bu çalışmanın amacı üniversite hastanesinde çalışan hekimlerde depresyon veanksiyete düzeylerinin belirlenmesi ve iş doyumunun etkisinin incelenmesidir.Yöntem: Çalışmada Dokuz Eylül Üniversitesi Tıp Fakültesi\'nde çalışan ve sistematikörnek seçme yöntemi ile seçilen 300 hekime anket dağıtıldı, 153 hekimden yanıt alındı (%51,0). Sosyo-demografik ve çalışma yaşamı ile ilgili soruların sorulduğu, kapalı zarflardadağıtılan ve iki hafta sonra toplanan ankette depresyon ve anksiyete ölçümünde HastaneAnksiyete ve Depresyon Ölçeği kullanıldı. İş doyumunu değerlendirmek üzere tek bir soruile 1 ile 10 arasında derecelendirmeleri istendi ve işaretlenen puanlara göre iş doyumudüşük, orta ve yüksek olarak sınıflandırıldı.Bulgular: Yüksek anksiyete ve depresyon görülme sıklığı sırasıyla %18,9 ve 27,4\'tür. İşdoyumu ve anksiyete arasında anlamlı bir ilişki saptanmamıştır (p=0,239). İş doyumu düşükolanlarda, cerrahi bilimlerde çalışanlarda ve asistan konumunda çalışanlarda depresyondüzeyi anlamlı olarak yüksek bulunmuştur (p<0,0001).Sonuç: Hekimlerde anksiyete ve depresyon düzeyleri yüksek bulunmuştur. İş doyumu vedepresyon arasında ilişki saptanmıştır. Hekimlerin iş doyumları mental sağlıkları, kurumlarıve hastaları için önemlidir. İş doyumu bireysel bir sorun olarak değil kurumsal olarakdeğerlendirilmeli; izlem sistemi oluşturularak ileriye yönelik ve girişimsel çalışmalara olanaksağlanmalıdır.Studies have shown that physicians have an increased risk of mental health problemsincluding depression, suicide and substance abuse. Job satisfaction and job stress mightaffect physicians mental well being.Objective: The aim of this study was to determine the level of anxiety and depression ofmedical doctors working in a university hospital and whether job satisfaction has an impacton level of anxiety and depression.Methods: The study was completed with 153 physicians those systematically selectedfrom university medical faculty. The response rate was 51,0%. Hospital Anxiety andDepression Scale was used to measure anxiety and depression. The study group was ratedtheir job satisfaction by a continuous scale ranged one to ten. Then tertiles were calculatedin order to categorize the job satisfaction as low, modest and high.Results: Anxiety prevalence wasfound to be 18.9% and depressionwas 27.4%. Job satisfaction did notalter the anxiety levels (p=0.239).Depression were significantly higher inthe least job satisfied physicians (p<0.0001).Conclusion: Job satisfaction is an important issue for physicians\' mental well-being, theirinstitution and patients. Hence it should be considered not as an individual problem but asan organisational one. Surveillence systems should be established which allow follow-upand interventional studies

Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008.

BACKGROUND: Coronary heart disease (CHD) mortality rates have been decreasing in Turkey since the early 1990s. Our study aimed to determine how much of the CHD mortality decrease in Turkey between 1995 and 2008 could be attributed to temporal trends in major risk factors and how much to advances in medical and surgical treatments. METHODS: The validated IMPACT CHD mortality model was used to combine and analyse data on uptake and effectiveness of CHD treatments and risk factor trends in Turkey in adults aged 35-84 years between 1995 and 2008.Data sources were identified, searched and appraised on population, mortality and major CHD risk factors for adults those aged 35-84 years. Official statistics, electronic databases, national registers, surveys and published trials were screened from 1995 onwards. RESULTS: Between 1995 and 2008, coronary heart disease mortality rates in Turkey decreased by 34% in men and 28% in women 35 years and over. This resulted in 35,720 fewer deaths in 2008.Approximately 47% of this mortality decrease was attributed to treatments in individuals (including approximately 16% to secondary prevention, 3% angina treatments, 9% to heart failure treatments, 5% to initial treatments of acute myocardial infarction, and 5% to hypertension treatments) and approximately 42% was attributable to population risk factor reductions (notably blood pressure 29%; smoking 27%; and cholesterol 1%). Adverse trends were seen for obesity and diabetes (potentially increasing mortality by approximately 11% and 14% respectively). The model explained almost 90% of the mortality fall. CONCLUSION: Reduction in major cardiovascular risk factors explained approximately 42% and improvements in medical and surgical treatments explained some 47% of the CHD mortality fall. These findings emphasize the complimentary value of primary prevention and evidence-based medical treatments in controlling coronary heart disease

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