Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis.

While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.

Prognostic significance of medical therapy in patients with heart failure with reduced ejection fraction.

AIMS: The use of guideline-directed medical therapy (GDMT) among patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains suboptimal. The SMYRNA study aims to identify the clinical factors for the non-use of GDMT and to determine the prognostic significance of GDMT in patients with HFrEF in a real-life setting. METHODS AND RESULTS: The SMYRNA study is a prospective, multicentre, and observational study that included outpatients with HFrEF. Patients were divided into three groups according to the status of GDMT at the time of enrolment: (i) patients receiving all classes of HF medications including renin-angiotensin system (RAS) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRAs); (ii) patients receiving any two classes of HF medications (RAS inhibitors and beta-blockers, or RAS inhibitors and MRAs, or beta-blockers and MRAs); and (iii) either patients receiving class of HF medications (only one therapy) or patients not receiving any class of HF medications. The primary outcome was a composite of hospitalization for HF or cardiovascular death. The study population consisted of 1062 patients with HFrEF, predominantly men (69.1%), with a median age of 68 (range: 20-96) years. RAS inhibitors, beta-blockers, and MRAs were prescribed in 76.0%, 89.4%, and 55.1% of the patients, respectively. The proportions of patients receiving target doses of guideline-directed medications were 24.4% for RAS inhibitors, 11.0% for beta-blockers, and 11.1% for MRAs. Overall, 491 patients (46.2%) were treated with triple therapy, 353 patients (33.2%) were treated with any two classes of HF medications, and 218 patients (20.6%) were receiving only one class of HF medication or not receiving any HF medication. Patient-related factors comprising older age, New York Heart Association functional class, rural living, presence of hypertension, and history of myocardial infarction were independently associated with the use or non-use of GDMT. During the median 24-month period, the primary composite endpoint occurred in 362 patients (34.1%), and 177 of 1062 (16.7%) patients died. Patients treated with two or three classes of HF medications had a decreased risk of hospitalization for HF or cardiovascular death compared with those patients receiving ≤1 class of HF medication [hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.49-0.85; P = 0.002, and HR: 0.61; 95% CI: 0.47-0.79; P < 0.001, respectively]. CONCLUSIONS: The real-life SMYRNA study provided comprehensive data about the clinical factors associated with the non-use of GDMT and showed that suboptimal GDMT is associated with an increased risk of hospitalization for HF or cardiovascular death in patients with HFrEF.

How do determinants of health relate to children's quality of life? A cross-sectional study in Izmir, Turkey.

AIM: This study aims to determine health-related quality of life (QoL) and the related factors from the perspective of social determinants of health among children. BACKGROUND: Childhood is the most intense period of life, and environmental factors surrounding children, as well as individual lifestyle factors, are related to the child's physical and mental well-being. To our knowledge, there is a lack of studies evaluating the relationship between determinants of health and the QoL of healthy children in general. METHODS: This cross-sectional study was executed in the Bayrakli district of Izmir city. Stratified clustered sampling was used including 24 schools and 3367 7th-grade children, and 1284 students were targeted (50% prevalence, 95% CI, %5 margins of error, 2.25 design effect, and 20% replacement). The response rate was 84.9% (n = 1090). The Turkish KID-KINDL Health-Related Quality of Life Questionnaire for Children was used to assess QoL. Independent variables were examined in four layers using Dahlgren's Determinants of Health Model: basic characteristics, lifestyle factors, family characteristics, and life conditions. RESULTS: The mean QoL score was 71.3 ± 12.6. Our study explained 31.7% of the variance in QoL. Higher QoL scores were associated with better health status, perceived academic achievement, normal/thin body perception, physical activity (PA), and adequate sleep duration. Living with both parents and having fewer siblings positively influenced QoL. Moreover, the presence of structural problems in the household and poorer health perceptions were associated with lower QoL scores (P < 0.05) This study highlighted the multifaceted nature of QoL in Turkish children, revealing the importance of various determinants of health. The results show that in order to improve the general well-being of this population, interventions and policies are required that concentrate on elements including health status, academic accomplishment, body perception, physical activity, family structure, and living situations.

Real-World Evaluation of Anticoagulant Treatment Patterns in Patients with Atrial Fibrillation: Data from Multicenter ROTA Study.

OBJECTIVE: Oral anticoagulant therapy is the cornerstone of atrial fibrillation management to prevent stroke and systemic embolism. However, there is limited real-world information regarding stroke and systemic embolism prevention strategies in patients with atrial fibrillation. The aim of the ROTA study is to obtain the real-world data of anticoagulant treatment patterns in patients with atrial fibrillation. METHODS: The ROTA study is a prospective, multicenter, and observational study that included 2597 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January 2021 and May 2021. RESULTS: The median age of the study population was 72 years (range: 22-98 years) and 57.4% were female. The median CHA2DS2-VASc and HAS-BLED scores were 4 (range: 0-9) and 1 (range: 0-6), respectively. Vitamin K antagonists and direct oral anticoagulants were used in 15.9% and 79.4% of patients, respectively. The mean time in therapeutic range was 52.9% for patients receiving vitamin K antagonists, and 76% of those patients had an inadequate time in therapeutic range with <70%. The most common prescribed direct oral anticoagulants were rivaroxaban (38.1%), apixaban (25.5%), and edoxaban (11.2%). The rate of overuse of vitamin K antagonists and direct oral anticoagulants was high (76.1%) in patients with low stroke risk, and more than one-fourth of patients on direct oral anticoagulant therapy were receiving a reduced dose of direct oral anticoagulants. Among patients who were on direct oral anticoagulant treatment, patients with apixaban treatment were older, had higher CHA2DS2-VASc and HAS-BLED scores, and had lower creatinine clearance than the patients receiving other direct oral anticoagulants. CONCLUSIONS: The ROTA study provides important real-world information about anticoagulant treatment patterns in patients with atrial fibrillation.time in therapeutic range with <70%.

Fear of Hypoglycemia and Longer Disease Duration Associated with Physical Activity Avoidance in Children and Adolescents with Type 1 Diabetes Mellitus

Objective: To determine physical activity (PA) avoidance and its associated factors among children with type 1 diabetes in four situations: leisure time (LT) PA out of school, LT PA at school during breaks, attendance at physical education (PE) classes and activity during PE classes. Methods: Cross-sectional study. The cohort consisted of 137 children, aged 9-18 years, with type 1 diabetes registered at a tertiary center between August 2019 and February 2020, 92 of whom attended for face-to-face interview. Responses were rated on a 5-point-Likert scale for PA in the four situations. Never/rarely/occasionally responses were defined as avoidance. Chi-square, parametric/non-parametric comparison and multivariate logistic regression analysis were used to detect and confirm variables associated with each avoidance situation. Results: Among the children 46.7% avoided PA during LT out of school and 52.2% during breaks, 15.2% avoided PE classes and 25.0% avoided active play during PE classes. Older children (14-18 year-olds) avoided PE classes [odds ratio (OR)=6.49, 95% confidence interval (CI)=1.10-38.13] and PA during breaks [OR=2.85, 95% CI=1.05-7.72] and girls avoided PA out of school (OR=3.18, 95% CI=1.18-8.06) and during breaks (OR=4.12, 95% CI=1.49-11.40). Those who had a sibling (OR=4.50, 95% CI=1.04-19.40) or had a poorly-educated mother (OR=3.63, 95% CI=1.15-11.46) avoided PA during breaks and those from low-income households avoided PE classes (OR=14.93, 95% CI=2.23-99.67). As the duration of disease prolonged, avoiding PA during LT out of school increased (4-9 years; OR=4.21, 95% CI=1.14-15.52 and ≥10 years; OR=5.94, 95% CI=1.20-29.36). Conclusion: Adolescence, gender, and socioeconomic inequalities deserve greater focus for better PA behavior among young people with type 1 diabetes. As the disease duration prolongs, revising and strengthening intervention to encourage PA may be needed.

PrevAleNce and Associated factors of inappropriaTe dosing of direct Oral anticoaguLants In pAtients with Atrial Fibrillation: the ANATOLIA-AF Study.

PURPOSE: Inappropriate dosing of direct oral anticoagulants is associated with an increased risk of stroke, systemic embolism, major bleeding, cardiovascular hospitalization, and death in patients with atrial fibrillation. The main goal of the study was to determine the prevalence and associated factors of inappropriate dosing of direct oral anticoagulants in real-life settings. METHODS: This study was a multicenter, cross-sectional, observational study that included 2004 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January and May 2021. The main criteria for inappropriate direct oral anticoagulant dosing were defined according to the recommendations of the European Heart Rhythm Association. RESULTS: The median age of the study population was 72 years and 58% were women. Nine-hundred and eighty-seven patients were prescribed rivaroxaban, 658 apixaban, 239 edoxaban, and 120 dabigatran. A total of 498 patients (24.9%) did not receive the appropriate dose of direct oral anticoagulants. In a logistic regression model, advanced age, presence of chronic kidney disease and permanent atrial fibrillation, prescription of reduced doses of direct oral anticoagulants or edoxaban treatment, concomitant use of amiodarone treatment, and non-use of statin treatment were significantly associated with potentially inappropriate dosing of direct oral anticoagulants. CONCLUSION: The study demonstrated that the prevalence of inappropriate direct oral anticoagulant dosing according to the European Heart Rhythm Association recommendations was 24.9% in patients with atrial fibrillation. Several demographic and clinical factors were associated with the inappropriate prescription of direct oral anticoagulants.

Trends in socioeconomic inequalities in smoking in Turkey from 2008 to 2016.

BACKGROUND: Smoking inequalities in Turkey were previously demonstrated in an early stage of the smoking epidemic model. This paper aimed to assess the trends for socioeconomic inequalities in smoking in Turkey over the years in the context of the smoking epidemic model using data from the Global Adult Tobacco Survey (GATS) Turkey 2008-2012-2016. METHODS: Cross-sectional data were analyzed to calculate the association of smoking with, wealth, education, occupation and place of residence using age-standardized prevalence rates, odds ratios, relative index of inequality (RII) and slope index of inequality (SII). The analysis was performed separately for age groups (younger: 20-39 years/older: 40 and above years) and sex. RESULTS: Younger women with higher wealth and older women with higher wealth and education smoked more. For both age groups, smoking was increased for working class and urban women. Relative wealth inequalities in smoking narrowed and then showed a reversal for younger women (RII2008 = 3.37; 95% CI:1.64-3.40; RII2012 = 2.19; 95% CI:1.48-3.24; RII2016 = 0.80; 95% CI:0.58-1.10, p-for trend < 0.0001). Relative educational inequalities in smoking for older women also showed a narrowing (RII2008 = 21.45; 95% CI:11.74-39.19; RII2012 = 15.25; 95% CI:9.10-25.55; and RII2016 = 5.48; 95% CI:3.86-7.78, p-for trend < 0.0001). For older women, a similar narrowing was observed for wealth (RII2008 = 3.94; 95% CI:2.38-6.53; RII2012 = 2.79; 95% CI:1.80-4.32; and RII2016 = 1.34; 95% CI:0.94-1.91, p-for trend = 0.0001). The only significant trend for absolute inequalities was for younger women by wealth. This trend showed a narrowing and then a reversal (SII2008 = 0.14; 95% CI:0.09-1.20; SII2012 = 0.12; 95% CI:0.06-0.18; and SII2016 = -0.05; 95% CI:-0.12-0.02, p-for trend = 0.0001). Unlike women, smoking in men showed inverse associations for wealth and education, although not statistically confirmed for all years. Smoking was increased in working classes and unemployed men in 2012 and 2016. Inequalities did not show a trend in relative and absolute terms for men. CONCLUSIONS: For smoking inequalities in Turkey, a transition to the next stage was observed, although the previously defined Southern European pattern also existed. Low socioeconomic women deserve special attention as well as stressors at work and drivers of smoking at urban settings.

Evaluation of the nutritional habits of second-year high school students in the Seferihisar region with the ecological framework / Avaliação dos hábitos nutricionais dos alunos do segundo ano do ensino médio na Região de Seferihisar pelo modelo ecológico

ABSTRACT Objective The study aims to identify the nutritional habits of second-year high school students in Seferihisar, Turkey, and the factors associated thereof, based on the Ecological Framework. Methods In this cross-sectional study by a self-reported questionnaire, second-year high school students (n=392) attending public schools in Seferihisar had their nutritional habits measured with the Adolescent Food Habits Checklist scale. The food habit score was calculated and associated factors were evaluated in 4 layers based on the Mary Story's Ecological Framework (individual factors, social, physical and macro-level environments). The data analysis for the association of these layers with the food habits score was executed through multi-level linear regression. Results Students' participation rate was 87.7% (n=344). Of all the layers (from individual factors to the influence of the social environment and macro-level environment: nutritional literacy, the food consumption of their peers at school, availability of fruits-vegetables at home, buying junk food at the school canteen, presence of posters at school, etc.), the option for advertised food items was statistically explanatory based on the linear regression analysis (p<0.05). Conclusions The model derived from the Ecological Framework explained 45% of the nutritional habits with an equivalent contribution from the four layers. Availability of healthy food items where the students lived and higher levels of nutritional literacy led to healthy nutritional habits. Having healthy food items sold at school canteens at affordable prices, using posters to promote a healthy diet, and introducing nutrition-related courses into the curricula would support students in developing healthy nutritional habits.

RESUMO Objetivo O presente estudo almeja determinar os hábitos nutricionais de adolescentes do 2º ano do Ensino Médio em Seferihisar, Turquia, e os fatores associados a esses hábitos no âmbito da Teoria Ecológica. Métodos Neste estudo transversal de questionário autoadministrado, os hábitos nutricionais de alunos do 2º ano do Ensino Médio (n=392) de escolas públicas em Seferihisar foram avaliados através da escala da Lista de Verificação dos Hábitos Alimentares de Adolescentes. A pontuação de hábito alimentar foi calculada e os fatores associados foram avaliados em quatro camadas baseadas no modelo criado no âmbito da Teoria Ecológica de Mary Story (fatores individuais, sociais, físicos e ambientais de nível macro). A análise de dados para a associação dessas camadas com a pontuação dos hábitos alimentares foi executada através de regressão linear multinível. Resultados A taxa de participação dos alunos no estudo foi de 87,7% (n=344). Em relação a cada camada, foram avaliados desde fatores individuais, nível de conhecimento de nutrição, ambiente social, consumo de alimentos pelos colegas na escola, ambiente físico, disponibilidade de frutas e vegetais em casa, compras de comida sem qualidade na cantina da escola, presença de cartazes na escola e ambiente do nível macro. A preferência por alimentos anunciados foi estatisticamente explanatória com base na análise de regressão linear (p<0,05). Conclusão O modelo derivado da Teoria Ecológica explicou 45% dos hábitos nutricionais, com uma contribuição equivalente das quatro camadas. A presença de alimentos saudáveis no ambiente frequentado pelos alunos e um alto nível de conhecimento sobre nutrição trazem estimulam hábitos nutricionais saudáveis. A venda de alimentos saudáveis na cantina e no refeitório das escolas a presença de cartazes encorajando uma dieta saudável e a inclusão de cursos de nutrição no currículo tornarão mais conveniente aos alunos adotar um comportamento nutricional saudável.

WhatsApp embedded in routine service delivery for smoking cessation: effects on abstinence rates in a randomized controlled study.

BACKGROUND: The demand for smoking cessation services has risen in Turkey, as smokers planning to quit reached 35% in 2012. Communication technologies are used globally to support quitters, yet their integration to health services is rare. This study aims to evaluate the effect of support messages through WhatsApp application added to the usual care of a university hospital cessation unit, as compared to usual care alone, on abstinence rates at first month. METHODS: A randomized controlled intervention study was conducted with 132 patients applying to Ege University Hospital's Department of Public Health Smoking Cessation Clinic, between March and July 2017. Intervention content was prepared and 60 WhatsApp messages about having a plan of action and preventing relapse were developed through expert panels. These messages lasted for 3 months and follow-ups continued for 6 months. The primary outcome was abstinence rate at 1st month post target quit day. As secondary outcomes; the continuous abstinence rates at 3rd and 6th months, number of follow-ups, change in weight and continuity of medication were evaluated. Intention-to-treat analysis was used. RESULTS: Abstinence rate at 1st month was 65.9% in the intervention group and 40.9% in the control group (p = 0.007); 50.0 and 30.7% at 3rd month and 40.9 and 22.7% at 6th month, consecutively (both p < 0.05). Being in the intervention group increased abstinence rate by 3.50 (OR, 95% CI = 1.30-9.44) times in the 1st month. When controlled for all other factors in the multivariate logistic regression, the intervention was the only variable significantly associated with abstinence. For secondary outcomes, the intervention increased abstinence rate by 2.50 (OR, 95% CI = 1.08-6.40) times in the 3rd and 2.31 (OR, 95% CI = 1.03-5.16) times in the 6th month. In the intervention group, the number of follow-ups and face-to-face follow-ups were higher at 1st and 3rd months and continuity of medication was longer at 3rd month. CONCLUSIONS: WhatsApp support embedded in cessation service delivery increases the abstinence rate and has favorable effects on follow-up. TRIAL REGISTRATION: This trial is retrospectively registered online at ClinicalTrials.gov with the identifier NCT03714971 .

Could Mean Platelet Volume Be a Reliable Indicator for Acute Mesenteric Ischemia Diagnosis? A Case-Control Study.

Objective. Acute mesenteric ischemia (AMI) is a disease, usually seen in elderly people and accompanied by comorbid diseases. Mean platelet volume (MPV), the significant indicator of platelet activation and function, is associated with AMI. In this study, we considered that we can use MPV as a reliable indicator in the diagnosis of AMI. Methods. This study was conducted among AMI patients with two control groups. Age, gender, MPV, platelet count, concomitant diseases, abdominal computed tomography, and patient outcomes were recorded for evaluation. Control group I contained 41 healthy patients whose ages-genders were matched. Control group II contained 41 patients with no AMI, whose ages-genders-concomitant diseases were matched. Results. Of the total 41 AMI patients, 22 were female and 19 were male. The average age of them was 72.12 ± 13.2 (44-91) years. MPV was significantly increased in the AMI (p = 0.001) and control group II (p < 0.001) in comparison with healthy control groups. In the comparison of the AMI patients with their matched controls for concomitant diseases, no statistical difference was found in the MPV values. Conclusion. MPV may be used as an indicator of AMI only if the patient has no concomitant diseases. The existence of a concomitant disease brings into question the reliability of high MPV values as a suitable indicator.

Regional inequalities in self-rated health and disability in younger and older generations in Turkey: the contribution of wealth and education.

BACKGROUND: In Turkey, large regional inequalities were found in maternal and child health. Yet, evidence on regional inequalities in adult health in Turkey remains fragmentary. This study aims to assess regional and rural/urban inequalities in the prevalence of poor self-rated health and in disability among adult populations in Turkey, and to measure the contribution of education and wealth of individual residents. The central hypothesis was that geographical inequalities in adult health exist even when the effect of education and wealth were taken into account. METHODS: We analyzed data of the 2002 World Health Survey for Turkey on 10791 adults aged 20 years and over. We measured respondents' rating of their own general health and the prevalence of five types of physical disability. Logistic regression was used to estimate how much these two health outcomes varied according to urban/rural place of residence, region, education level and household wealth. We stratified the analyses by gender and age (<50 and ≥50 years). RESULTS: Both health outcomes were strongly associated with educational level (especially for older age group) and with household wealth (especially for younger age group). Both health outcomes also varied according to region and rural/urban place of residence. Higher prevalence rates were observed in the East region (compared to West) with odd ratios varying between 1.40-2.76. After controlling for education and wealth, urban/rural differences in health disappeared, while regional differences were observed only among older women. The prevalence of poor self-rated health was higher for older women in the Middle (OR = 1.69), Black Sea (OR = 1.53) and East (OR = 2.06) regions. CONCLUSION: In Turkey, substantial geographical inequalities in self-reported adult health do exist, but can mostly be explained by differences in socioeconomic characteristics of residents. The regional disadvantage of older women in the East, Middle and Black Sea may have resulted from life-long exposure to gender discrimination under a patriarchal ideology. Yet, not geographic inequalities, but the more fundamental socioeconomic inequalities, are of key public health concern, also in Turkey.

Demographic and socioeconomic inequalities for self-rated health and happiness in elderly: the situation for Turkey regarding World Values Survey between 1990 and 2013.

PURPOSE: To define the socioeconomic and demographic determinants for self-rated health and happiness for Turkish elderly (≥60) using the World Values Survey (WVS) database. METHODS: WVS data for Turkey covering 23 years (1990-2013) with five separate cross-sections (1990, 1996, 2001, 2007, 2013) were pooled for analysis (n=870). Dependent variables were self-rated health (SRH) and perception of happiness.Their relation with age, sex, number of children, marital status, income, education, employment status and class perception were evaluated. Chi-square and logistic regression analysis were used. Regression coefficients and their standard errors were derived to calculate odds ratios. RESULTS: Mean age was 66.96±5.78 (60-91), 58.16% were male and 76.32% were married. The majority (61.10%) was at lowest income level and 80.60% had education attainment at primary level or below. Very happy/quite happy were 81.77% while only 46.59% perceived their health as very good/good. The crisis year (2001) increased the risk of bad self-rated health 4.4 times, being a women 2.0 times, while being a widow had a 2.3-fold, low-income 3.0-fold effect. The odds for unhappy status was increased 4.3 times at low-income levels and 8.4 times for the divorced/separate living partners. Happiness state improved after crisis period. CONCLUSION: SRH and happiness of Turkish elderly bare demographic and socioeconomic inequalities. The inexistence of a partner, being a women, low-income level and major threats for it, like economic crisis, are important drivers for elderly health and happiness. To improve well-being of elderly, better social policies for income is essential and at economic crisis times, support policies should be prioritized for vulnerable groups, including elderly.

Socioeconomic inequalities in current daily smoking in five Turkish regions.

OBJECTIVES: To assess whether socioeconomic inequalities in smoking in five regions across in Turkey have the same pattern as observed in southern Europe. METHODS: Cross-sectional data of the World Health Survey 2002 from Turkey were analyzed (5,951 women and 4,456 men) to evaluate the association of smoking with wealth and education. Age-standardized prevalence rates and odds ratios were calculated separately by sex, region and age groups. RESULTS: Smoking prevalence was 16.7 % for women and 51.4 % for men. Smoking risk was increased in higher wealth and education groups among women in all regions and for both younger and older generations. In the East, Middle and Black Sea regions this female pattern was most pronounced. For men, smoking was less prevalent in the two highest wealth groups. Unlike among women, socioeconomic differences in smoking were approximately equally large in all regions. CONCLUSIONS: Patterns of inequalities in smoking across the five regions strongly resemble those observed in southern Europe. This fits the patterns predicted by the smoking epidemic model. Particular attention should be given to highly educated women, who may perceive smoking as a symbol of modernity, emancipation and independence.

Sociodemographic aspects of consanguineous marriage in an urban slum of a metropolitan area in Izmir, Turkey.

BACKGROUND: Consanguineous marriage is a common practice in Turkey. Sociodemographic and cultural factors associated with it are still unclear. AIM: The purpose of this study was to investigate the association between sociodemographic and fertility factors and consanguineous marriages in an urban slum of a metropolitan area in Turkey. METHODS: This community-based case-control study was conducted in Bayrakli Municipality health centres. Of the 1243 married women, 85 consanguineously married were included in the case group. A control group in non-consanguineous marriages consisted of 85 women matched to cases according to age and neighbourhood. Information about the subjects' sociodemographic features, fertility history and opinions about consanguineous marriage was collected. RESULTS: Factors that were associated with consanguinity included; having a low level of education (OR = 2.7, CI = 1.1-6.7), a brief duration time in Izmir after migration (OR = 4.7, CI = 1.9-11.6) and consanguineous parents (OR = 3.8, CI = 1.5-9.7). Despite the increased numbers in fertility features and higher perinatal mortality for first cousin marriages, there was no significant difference in the mean numbers of pregnancies, births, stillbirths and living children. CONCLUSION: Time after migration and educational background of women were the main factors associated with consanguineous marriages. Public health interventions to reduce consanguineous marriage in urban areas should target socioeconomically disadvantaged populations in cities.

Socio-economic inequalities in overweight among adults in Turkey: a regional evaluation.

OBJECTIVE: Patterns of socio-economic inequalities in obesity and overweight have not been documented for Turkey. The present study aimed to describe educational and wealth-related inequalities for overweight in Turkey, taking a regional perspective. DESIGN: Cross-sectional self-reported data of the World Health Survey 2002 for Turkey were used. BMI ≥ 25·00 kg/m2 was considered as overweight. Respondents were classified according to education years and a wealth score derived from the availability of household assets. Logistic regression analysis was applied to assess the relationship between overweight and socio-economic factors. Analyses were stratified by sex and region (West, Mediterranean, Middle, Black Sea and East). SETTING: Turkey. SUBJECTS: Among the respondents 20 years and older, 3790 women and 4057 men had data on self-reported height and weight. RESULTS: Age-adjusted overweight prevalence was 48·4 % for women and 46·1 % for men. For men, education was not systematically related to overweight while overweight was significantly increased among the highest wealth groups. For women, the prevalence of overweight was highest for low-educated and middle-wealth groups. The size of the inequalities in overweight showed only small regional variations. In the East, however, overweight prevalence was more related to higher socio-economic position than in the other regions. CONCLUSIONS: Socio-economic inequalities for overweight in Turkey are at a similar level as in most European countries, and especially comparable to Southern Europe. The smaller inequalities in the East correspond to the low level of socio-economic development in this part of the country. Prevention of overweight should focus on lower educational groups throughout the entire country and especially on low-educated women.

The change in capacity and service delivery at public and private hospitals in Turkey: a closer look at regional differences.

BACKGROUND: Substantial regional health inequalities have been shown to exist in Turkey for major health indicators. Turkish data on hospitals deserves a closer examination with a special emphasis on the regional differences in the context of the rapid privatization of the secondary or tertiary level health services.This study aims to evaluate the change in capacity and service delivery at public and private hospitals in Turkey between 2001-2006 and to determine the regional differences. METHODS: Data for this retrospective study was provided from Statistical Almanacs of Inpatient Services (2001-2006). Hospitals in each of the 81 provinces were grouped into two categories: public and private. Provinces were grouped into six regions according to a development index composed by the State Planning Organisation. The number of facilities, hospital beds, outpatient admissions, inpatient admissions (per 100 000), number of deliveries and surgical operations (per 10 000) were calculated for public and private hospitals in each province and region. Regional comparisons were based on calculation of ratios for Region 1(R1) to Region 6(R6). RESULTS: Public facilities had a fundamental role in service delivery. However, private sector grew rapidly in Turkey between 2001-2006 in capacity and service delivery. In public sector, there were 2.3 fold increase in the number of beds in R1 to R6 in 2001. This ratio was 69.9 fold for private sector. The substantial regional inequalities in public and private sector decreased for the private sector enormously while a little decrease was observed for the public sector. In 2001 in R1, big surgical operations were performed six times more than R6 at the public sector whereas the difference was 117.7 fold for the same operations in the same regions for the private sector. These ratios decreased to 3.6 for the public sector and 13.9 for the private sector in 2006. CONCLUSIONS: The private health sector has grown enormously between 2001-2006 in Turkey including the less developed regions of the country. Given the fact that majority of people living in these underdeveloped regions are uninsured, the expansion of the private sector may not contribute in reducing the inequalities in access to health care. In fact, it may widen the existing gap for access to health between high and low income earners in these underdeveloped regions.

Unintended pregnancy and prenatal care: a study from a maternity hospital in Turkey.

OBJECTIVES: To evaluate factors associated with pregnancy intention and its effects on source, content and adequacy of prenatal care for women who delivered in a large maternity hospital in Izmir, Turkey. METHODS: This cross-sectional survey was carried out using a questionnaire administered face-to-face to 351 women who had given birth in Konak Maternity Hospital in May 2002. RESULTS: Nearly half (47.3%) of the pregnancies were unintended: 31.3% were mistimed, and 16.0% unwanted. Women's and husbands' older age and lower education, lower social class, women's recent migration to Izmir, lower household income and absence of social security had a negative impact on pregnancy intention. Women with unwanted pregnancies had started procreating earlier; they had more pregnancies, deliveries, children and intentional abortions (p < 0.05). Number and contents of prenatal visits increased as intention status improved. When controlled for socio-demographic variables, women with unwanted pregnancies had less prenatal care, received less education during prenatal visits and had less iron and vitamin supplementation (p < 0.05) whereas mistimed pregnancies did not significantly differ from intended pregnancies. CONCLUSION: Unwanted pregnancies constitute a risk group that should be identified early in pregnancy. Ensuring an adequate and satisfactory prenatal care for all requires appropriate measures to be taken by public health authorities.

Maternal age, education level and migration: socioeconomic determinants for smoking during pregnancy in a field study from Turkey.

BACKGROUND: Smoking during pregnancy has been associated with socioeconomic determinants and it is recognized as the most important preventable risk factor for an unsuccessful pregnancy outcome. Turkey has national data on the prevalance of smoking during pregnancy; however there is no data on the characteristics of the high-risk population. This is a field study that aims to identify socioeconomic determinants for smoking during pregnancy as well as differentiating the daily and occasional smokers. METHOD: Cross sectional study was conducted among women with 0-5 year old children living in the area served by Primary Health Care Center (PHCC) in Burhaniye, Turkey. Face-to-face interviews were conducted by the researchers during January-March 2008 at the home of the participants with 83.7% response rate (n = 256). The relation of "smoking during pregnacy" and "daily smoking during pregnancy" with the independent variables was determined with chi2 tests. Women's age, educational level, number of previous births, place of origin, migration, partner's educational level, poverty, perceived income, social class were evaluated. Statistical significance was achieved when the p value was less than 0.05. The variables in relation with the dependent variables in the chi2 tests were included in the forward-stepwise logistic analysis. RESULTS: Prevalance of smoking during pregnancy was 22.7%. The majority (74.1%) were daily smokers. Young mothers (< 20), low educated women and migrants were at increased risk for smoking during pregnancy. Low education and being a migrant were risk factors for daily consumption (p < 0.05). CONCLUSIONS: Systematic attention should be paid to socioeconomic determinants in smoking for pregnant women, especially in countries like Turkey with high rates of infant and mother mortality and substantial health inequalities. Young mothers (< 20), low educated women and migrants are important groups to focus on.

HPV vaccine awareness and willingness of first-year students entering university in Western Turkey.

The objectives of this study were to assess the level of knowledge on HPV and HPV vaccination, and to determine vaccination attitude among Ege university students in Izmir, Turkey. A cross-sectional survey was conducted in first-year English preparatory class. Systematic cluster sampling was applied and 717 (72.6%) of students registered to the 54 classes in 17 different faculties/schools were contacted. Data were collected between April 30 and May 18, 2010, through a self-reported questionnaire including 40 questions. A knowledge score was calculated by summing up the number of correct answers given to the 12 knowledge questions. Analyses were done using t-test, chi-square test, univariate and multivariate logistic regression. The mean age of participants was 19.7±1.5 and 445 (62.1%) were female. Overall, 132 (18.9%) had experienced sexual intercourse, but only 7 of them were female. Among participants, 24.1% had heard of HPV and 25.1% about HPV vaccine. The knowledge item with the highest correct answer rate (32.3%) was that HPV caused cervical cancer. The mean total knowledge score was remarkably poor (1.8±2.6 over 12 items), with 59.6% of respondents having zero as their score. There was no difference in mean knowledge scores between males and females. Higher income, history of sexual intercourse and higher knowledge score were significant factors increasing HPV and vaccine awareness for the whole group, adjusted for gender. Genital cancer history in the family significantly increased awareness, but only among girls. Only three students (0.4%) had already been vaccinated, all being female. Among females, 11.6% intended to be vaccinated vs. 10.1% for males, without any significant difference. Visiting a gynaecologist/urologist in the last three years, a history of genital cancer in the family, vaccine awareness, a higher total knowledge score, and being from the East of Turkey were significant predictors of a positive vaccination attitude. HPVvaccination still remains as a 'hot medical topic' in Turkey, since it hasn't yet become a popular health issue. Based on their age of first intercourse, first year at the university seems to be appropriate timing to inform Turkish girls, whereas it is a bit late for boys. Thus, integration of HPV education into secondary/high school curricula should be considered.