Addressing urinary incontinence by gender: a nationwide population-based study in Turkiye.

BACKGROUND: Urinary incontinence (UI), which usually occurs in women but affects both sexes, is a significant public health challenge. This study aims to comprehensively investigate the prevalence and determinants of UI in men and women, considering gender-specific factors. METHODS: The study performed a secondary analysis on data obtained from 13,383 individuals surveyed in the 2019 Turkish Health Survey, providing a representation of the Turkish population. The dataset included sociodemographic and health-related variables like UI, body mass index (BMI), physical activity, smoking, and chronic diseases-statistical analysis employed chi-square tests and gender-stratified logistic regression models to identify UI-associated factors. RESULTS: Our results showed that UI affected 8.8% of the population, with a striking gender disparity. Women had a notably higher prevalence at 11.2%, while men had a lower rate of 5.5%. Importantly, this gender gap narrowed with age. For example, in the 34-44 age group, the female/male ratio was 6.9, but it decreased to 1.4 in the 65-74 age group. Marital status and employment status played significant roles. Separated, divorced, or widowed individuals, particularly women, had the highest prevalence at 19.3%. Employment status influenced UI prevalence, with employed men having the lowest rate (2.1%), while retired women faced the highest rate (15.0%). Higher BMI, especially in obese individuals, significantly raised UI prevalence, reaching 7.9% for men and 15.8% for women. Physical inactivity, notably in women (17.0%), and prolonged sedentary hours (13.9%) were associated with higher UI rates. Former smokers, especially women (15.9%), had a notable impact on UI. Poor perceived health and chronic conditions like Chronic Obstructive Pulmonary Disease (COPD), hypertension, and diabetes were significantly associated with higher UI prevalence. Logistic regression analysis revealed that age, education, perceived health status, COPD, and diabetes were significant factors associated with UI in both sexes, while in women, BMI, physical activity, and smoking also played notable roles. CONCLUSIONS: This extensive UI study has unveiled notable gender disparities and determinants. Notably, these disparities decrease with age, underlining UI's changing nature over time. Modifiable factors impact women more, while non-modifiable factors are linked to men. The study underscores the importance of tailoring healthcare strategies to address UI based on gender.

Endometrial Staining of CD56 (Uterine Natural Killer), BCL-6, and CD138 (Plasma Cells) Improve Diagnosis and Clinical Pregnancy Outcomes in Unexplained Infertility and Recurrent IVF Failures: Standardization of Diagnosis with Digital Pathology.

In women with unexplained infertility (UI) and recurrent in vitro fertilization (IVF) failures, the etiology is often unclear. Endometrial immune perturbations and the use of immune markers associated with these dysregulations are of great interest in the diagnosis and treatment of UI. However, reliable biomarkers and standardized quantification methods are lacking. Here, to address endometrial immune dysregulation in UI patients with recurrent IVF failures, we performed endometrial tissue sampling and immunostaining of CD56 (uNK), CD138, and BCL-6. Of these cases, 57.9% had positive CD56 in the endometrial stroma, while 46.1% had positive BCL-6 in the glandular epithelium, and 14.5% of the cases were found to be positive for CD138. Combined staining rates were 60.5%, 68.4%, and 71.05% for (CD56 or BCL-6), (CD56 or CD138), and (CD56, BCL-6, or CD138), respectively. There was a significant correlation between CD56 and BCL-6 positivity, while CD138 positivity was an independent parameter. After the recommended targeted therapy, pregnancy rates were found to increase from 58.5% to 61.6% and 73.8% in CD56-positive, (CD56- or BCL-6-positive), and (CD56-, BCL-6-, or CD138-positive) cases, respectively. Notably, a retrospective evaluation of digital pathology and light microscopy results showed a significant correlation. This study suggests that the examination of CD56, BCL-6, and CD138 in the same endometrial sample may be an effective method in determining the etiology of UI and reaching an early diagnosis and treatment options. Moreover, digital pathology can be used in the evaluation of CD56 and BCL-6 to provide objective, rapid, and reliable results.

The correlation between attack rates and urban health indicators during the third wave of the COVID-19 outbreak in Turkey.

This study aims to analyze the inter-provincial variation in the increase of attack rates in the third wave of the COVID-19 outbreak in Turkey and to determine their relationship with potential urban health indicators. In this ecological study, dependent variables were selected as the COVID-19 attack rates of provinces before the third wave and during the third peak and the attack rate increase ratio. Urban health indicators that can function as determinants of health were calculated for each province under five headings: demographic, health capacity, economic, environmental, and socio-cultural. The epidemiologic maps were produced to show the spatial distribution of COVID-19 attack rates pre- and during the third wave. The associations with urban indicators were conducted using bivariate analysis, including Pearson or Spearman correlation analysis. A multiple linear regression model was run with variables significantly associated with increased attack rates. The results of our study show significant regional variations in COVID-19 attack rates both at the beginning and during the third wave of the COVID-19 pandemic in Turkey. Among the provinces, the attack rate increase ratio has only shown significant correlations to education level and some economic indicators, such as income, employment, industrial activity measured by electric consumption, and economic activity in the manufacturing industry. The multivariate analysis determined that the indicator of economic activity in the manufacturing industry is related to the increase of the attack rate in the third wave. Our results show that the COVID-19 cases are higher in more developed cities with more manufacturing sector activity. It makes us think that it is mainly related to inequalities arising from access to health institutions and testing. It can be determined that the partly lockdown strategy, which excluded the industrial activity in the country, concluded the higher increase in the attack rates in highly industrialized provinces.

COVID-19 mortality in Istanbul in association with air pollution and socioeconomic status: an ecological study.

This study aims to reveal the relationship between the COVID-19 mortality indicators and socioeconomic status (SES) and air pollution. In this ecological study, the focus was put on the relationship between COVID-19 mortality and both air quality and socioeconomic status at the district level in Istanbul. The mortality variables of the study are the excess deaths due to the pandemic, the proportion of deaths due to the pandemic among all deaths, COVID-19 mortality rate (per 100,000), and the proportion of COVID-19 deaths among older people (above the age of 65). The daily air quality measurements of PM10, SO2, NO2, and NOx of the pre-pandemic term were included in the research to avoid bias due to decreasing traffic burden during the pandemic. Partial correlation was applied to analyze the relationship between air quality and mortality measures by controlling socioeconomic status, the percentage of the older population, and household size. Every 20% deterioration in the SES stratum has contributed to a 4% increase in excess mortality at the district level. The elderly population ratio of over 10% in the districts was found to increase the COVID-19 deaths in the total population by 35% and the deaths in the population over 65 years old by 3%. Average household size was correlated with COVID-19 deaths in the population over 65. A moderate correlation was found between the COVID-19 mortality rate per 100,000 population and PM10, SO2, and NO2 (r = 0.413, 0.421, and 0.431, respectively). Mortality during the COVID-19 pandemic in Istanbul is related to an interaction of socioeconomic characteristics and air pollution as an environmental issue.

Non-suicidal self-injury behaviors` features and relationship with adolescents` daily life activities and mental status.

Çimen ID, Coskun A, Etiler N. Non-suicidal self-injury behaviors` features and relationship with adolescents` daily life activities and mental status. Turk J Pediatr 2017; 59: 113-121. This study investigated, characteristics of the non-suicidal self-injury (NSSI) behaviors and behaviors` relationship with the sociodemographic characteristics, psychological problems and other features like daily life activities, between the ages of 12 and 17 years in the central district Izmit of Kocaeli; 555 students whose data included to study received a sociodemographic questionnaire (SQ) and Youth Self-Report (YSR). Students, who reported that they had NSSI, were additionally evaluated with the Inventory of Statements About Self-injury (ISAS). We found out a significant correlation between NSSI and the psychological problems, habits with addiction-forming potential, some daily life activities and making friends with negative characteristics. We concluded that prevention of the risk factors related to NSSI might be effective to avoid the development of this behavior. And diagnosing the behavior in the onset, might provide more effective and long-lasting results and enable the adolescent to get over this risky period with minimal harm.

Head Circumference Charts for Turkish Children Aged Five to Eighteen Years.

INTRODUCTION: Most head circumference growth references are useful during the first years of life, but they are also useful for older children when screening for developmental, neurological, and genetic disorders. We aimed to develop head circumference growth reference charts for age, height, and waist circumference for Turkish children aged 5-18 years. METHODS: Head circumference, height, and waist circumference measurements were obtained from 5079 students aged 5-18 years from Izmit, Kocaeli Province, Turkey. The LMS method was used to construct reference centile curves. RESULTS: Head circumference measurements were strongly correlated with height (r=0.74), weight (r=0.76), and waist circumference (r=0.68). The mean head circumference values for boys were larger than those for girls at all ages. Compared with data from the United States, the World Health Organization, and other studies from Turkey, our data showed a decrease in head circumference at all ages for both sexes. CONCLUSION: Local growth charts can be used to evaluate head circumference growth in older Turkish children and adolescents.

Value of autofluorescence in video-assisted thoracoscopic surgery in pleural diseases.

BACKGROUND: Autofluorescence (AF) examination in thoracoscopy has not been used frequently. Here, our aim was to determine whether AF examination contributes additional information to white-light (WL) examination when attempting to detect malignant pleural lesions. We also liked to know whether the effectiveness of WL and AF-mode combination would be different for various pathologies or lesions of the pleura. METHODS: It is a retrospective study. Thirty-three patients with unexplained exudative pleural effusions underwent AF-assisted video-assisted thoracic surgery (VATS). Patients' data from the files were evaluated. In each case, the pleural cavity was thoroughly examined under WL alone and then in AF mode. RESULTS: The sensitivity and specificity of AF-assisted VATS for detecting malignant pleural lesions were 78.7 and 85%, respectively, and there were 21.3% false negatives. In the group with metastatic pleural disease, AF VATS correctly identified all lesions as AF positive, whereas sensitivity was lower for the group with malignant mesothelioma. Seven lesions, which were not diagnosed under WL, were detected in AF mode. CONCLUSION: The overall sensitivity of AF-assisted VATS for detecting pleural malignancies was not satisfactory because of diagnostic errors in malignant mesothelioma. But it would be useful in detecting small malignant pleural lesions, which are not diagnosed under WL.

Contact sensitivity in Behçet's disease.

CONTEXT: Behçet's disease (BD) is a multisystemic inflammatory disorder with unknown etiology. Many immunological changes were reported in BD previously and these changes may affect the frequency of contact sensitivity in these patients. OBJECTIVE: We aimed to identify whether there is an interaction between contact sensitivity and BD. METHODS: The 'European standard series' with 27 allergens were performed on the upper backs of patients and healthy volunteers according to international standards using the IQ-Chamber. The test-units which contain these allergens were removed after 2 days. According to International Contact Dermatitis Research Group Recommendations test areas were evaluated on days 2, 3 and 7 to detect any delayed allergic reactions. The results of both groups were compared by using chi-square test. RESULTS: One hundred adult persons (50 BDs and 50 healthy controls) were tested. Positive patch test reaction to 1 or more allergens was observed in 7 (14%) patients in BD group and in 12 (24%) persons in control group. There was no statistically significant difference between these two groups. CONCLUSIONS: The frequency of contact sensitivity in BD is not different from healthy persons.

Prevalence of chronic obstructive pulmonary disease in kocaeli: an industrialised city in Turkey.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an important cause of mortality worldwide. AIMS: The aim of this study was to establish the prevalence of chronic obstructive pulmonary disease (COPD) in residents who were ≥40 years old and living in a heavily industrialised city of Turkey, Kocaeli, using the Burden of Obstructive Lung Disease Initiative questionnaire. STUDY DESIGN: Cross-sectional study. METHODS: 1035 residents ≥40 years old and living in Kocaeli were surveyed. Spirometry and the basic BOLD questionnaire was performed. RESULTS: 946 subjects entered into the analysis. The prevalence of stage I or higher COPD was 13.3% (8.7% for women and 16.5% for men), the prevalence of COPD at GOLD stage II or higher was 7.1% (4.1% for women and 9.2% for men). We also noted a high prevalence of COPD in never-smokers. CONCLUSION: Besides cigarette smoking, occupational exposure to fumes, chemicals and dusts might have also contributed to the high prevalence of COPD noted in residents who were ≥40 years old and living in Kocaeli, Turkey.

[Investigation of Brucella canis seropositivity by in-house slide agglutination test antigen in healthy blood donors]. / Saglikli Kan Donörlerinde Brucella canis Seropozitifliginin Laboratuvar Yapimi Lam Aglütinasyon Test Antijeni ile Arastirilmasi

Canine brucellosis which is due to Brucella canis, is transmitted to man by infected dogs or their secretions. The symptoms of canine brucellosis are similar to the symptoms of brucellosis caused by other Brucella species and endocarditis or meningitis may develop in untreated cases. There is limited data regarding B.canis infections in man and the current status of the disease is insufficiently evaluated in our country. Serological diagnosis of brucellosis is classically based on standard slide and tube agglutination tests. However, the antigens used in these tests detect antibodies that develop against species (B.melitensis, B.abortus, B.suis) with "smooth" lipopolysaccharides in their cell wall. B.canis has "rough" lipopolysaccharide in its cell wall and thus these classical tests can not detect antibodies against B.canis. Besides there is no commercial slide agglutination test which uses B.canis antigens. The aim of this study was to investigate the B.canis seropositivity by slide agglutination test (SAT), using homemade B.canis antigen, in healthy subjects and to determine the prevalence of B.canis infection in our population. A total of 1930 blood donors (age range: 18-55 years) who were admitted to the blood donation centers of different hospitals in Kocaeli province (located at Northwestern part of Turkey) between January-December 2010, have been included in the study. All of the subjects were negative in terms of Rose-Bengal plate test (B.abortus antigen test). Undiluted serum samples were initially screened by SAT, and those which were found positive were retested by SAT in the dilutions of 1/25 - 1/200. Confirmation of the positive results was performed by using 2-mercaptoethanol (2-ME) SAT. The test antigen (Alton antigen) was prepared from the less mucoid M(-) variant of B.canis, and 1/1048 titered dog antiserum was used as positive control. Of the 1930 blood donors sera, 40 (2.1%) were found positive with SAT, whereas 16 of them yielded equivocal positive (12 were 1/50, 4 were 1/100 titers) and 15 yielded positive (≥ 1/200 titer) results with 2-ME SAT. As a result, B.canis seropositivity rate in the healthy subjects in this study was estimated as 1.6% (31/1930). The integration of B.canis SAT to the routine serological tests applied for brucellosis diagnosis might aid to the data related to brucellosis epidemiology. B.canis seroprevalence determined as 1.6% in this study supplied a basic data about the infection in our country. However, larger scale, multicenter studies with different patient and risk groups should be conducted to further evaluate the epidemiology of B.canis infections in Turkey.

A serological diagnostic survey for Brucella canis infection in Turkish patients with Brucellosis-like symptoms.

The incidence of Brucella canis infection in humans is unknown in Turkey. In this study, we investigated the prevalence of B. canis infection in human sera obtained from six regions in Turkey and comparatively evaluated the results obtained by agglutination-based techniques using standardized antigens made from B. canis. The patients (n = 1,746) presented with clinical symptoms that were similar to those of brucellosis. All patients who tested negative in the Rose Bengal test for the smooth Brucella strains (abortus, melitensis, and suis) were screened for evidence of B. canis infection using the rapid slide agglutination test (RSAT), the microagglutination test (MAT), and the 2-mercaptoethanol RSAT test (2ME-RSAT). Of the samples tested, 157 (8.9%), 68 (3.8%), and 66 (3.7%) were positive for B. canis, as determined by RSAT, MAT, and 2ME-RSAT, respectively. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of RSAT were 100%, 94.6%, 42%, and 100%, respectively, and of MAT were 100%, 99.9%, 97%, and 100%, respectively. We recommend the routine use of MAT and 2ME-RSAT to check the sera of all patients with symptoms of brucellosis who are negative for brucellosis using a smooth Brucella antigen.

Frequency and correlates of psychiatric disorders in early childhood: a study of population and clinical samples in Turkey.

Behavioral and emotional problems experienced in early childhood may have a major impact on the development and functioning of a child, leading to a number of psychiatric problems at a later age. The purpose of this study was to determine the incidence of psychiatric disorders in 3-5-year-old children presenting to the Outpatients Department and in the general population, and the relationship between psychiatric disorders and the sociodemographic characteristics of the children. This was a cross-sectional study carried out in Kocaeli, Turkey. Data were collected from two different groups, one representing the general population and the other based on children presenting to the Pediatric Psychiatry Outpatients Department at Kocaeli University Faculty of Medicine. Of the 309 children in the study, 187 (60.5%) were boys and 122 (39.5%) were girls. Children aged 3-5 years (n = 81) were assessed by clinical examination. The mean age of the children was 3.94 +/- 0.81 years. No significant difference was observed between the groups in terms of parents' age groups, presence of consanguineous marriage, family structure, and siblings. The mothers were assessed in terms of regular visits to their physicians, major medical conditions, medication use, alcohol or tobacco consumption, and stress factors during their pregnancies. No significant difference was found between the study samples. The presence of a medical problem after birth was significantly more common in the clinical sample. Of the children in the clinical sample, 79% had at least one psychiatric problem, while the ratio for the general population sample was 41.7%.

Nutritional status of students in Kocaeli, Turkey: a population-based study.

BACKGROUND: The aim of this study was to determine the nutritional status of students in Kocaeli, Turkey. METHODS: This cross-sectional study was carried out among the students of secondary schools in Kocaeli. Of the students, 2491 subjects were selected using multi-stage stratified sampling. RESULTS: Of the students, 51.1% were male and 48.9% were female. Mean age was 14.35±1.87 (range 10.1-19.8) in overall subjects, 14.38±1.87 in boys and 14.31±1.85 in girls. The prevalence of obesity and of overweight was estimated as 7.3% and 11.8%, respectively. Also, 3.1% of the subjects were underweight and 2.9% were thin. The rate of obesity was 1.5 times higher in girls and that of overweight was 1.2 times higher in girls. Similarly, students aged 15 years old and younger were 1.2 times more obese and 1.7 times more overweight than older students. Students living in urban areas had a higher prevalence of obesity and of overweight. CONCLUSION: Nutritional problems in students should be dealt with by some regulations in schools; for example, providing healthy food in schools or food aid, particularly in poor regions.

Evaluation of sepsis/systemic inflammatory response syndrome, acute kidney injury, and RIFLE criteria in two tertiary hospital intensive care units in Turkey.

Sepsis is a common cause of acute renal failure in intensive care units (ICU) with mortality rates as high as 60%. In this study, the clinical and laboratory predictors of acute kidney injury (AKI) in critically ill Turkish patients with sepsis/systemic inflammatory response syndrome were identified. We studied 139 (67 females/72 males) patients admitted to our ICUs with sepsis/systemic inflammatory response syndrome without renal failure. The clinical and laboratory parameters and treatments were recorded. Patients were classified as those without AKI (n = 60; 43.20%) and those with AKI (n = 79; 56.80%) based on the RIFLE (Risk, Injury, Failure, Loss, End-stage renal disease) criteria. Those with AKI were further classified as: risk in 27 (19%), injury in 25 (17.9%), failure in 25 (17.9%), and loss in 2 (1.4%). We found that the mortality rate increased with the severity of renal involvement: 56% in risk, 68% in injury, 72% in failure, and 100% in loss categories. Patients with AKI had a more positive fluid balance, higher central venous pressure, more vasopressor use, and lower systolic blood pressure. In multivariate analysis, the sequential organ failure assessment score, blood pressure, serum creatinine, and fluid balance were risk factors for the development of AKI. In this population, the incidence of AKI was higher and contrary to previous knowledge. A positive fluid balance also carries a risk for AKI and mortality in septic ICU patients. The RIFLE criteria were found to be applicable to our ICU population.

Prevalence of metabolic syndrome in schoolchildren and adolescents in Turkey: a population-based study.

AIM: To determine prevalence of the metabolic syndrome (MS) in the pediatric population. METHODS: We studied 2,491 schoolchildren randomly selected aged 10-19 years using a multistage, stratified sampling design. Obese and overweight participants were called for further investigation (n = 456). Of these, 310 participants underwent OGTT. MS was defined according to IDF, NCEP and modified WHO guidelines. RESULTS: The prevalence of obesity and overweight were 6.8% and 11.5%, respectively. While MS was found in 2.3% of the total population according to IDF guidelines, its prevalence was increased among overweight and obese individuals. MS prevalence was similar by both IDF and NCEP definitions but higher according to WHO definition. Individuals with MS were consistent by both IDF and NCEP definitions (sensitivity = 100%, specificity = 99%, positive predictive value = 95.2%). IDF and WHO defined different individuals as having MS (sensitivity = 67.5%, specificity = 90%, positive predictive value = 67.5%). CONCLUSIONS: Although not as high as in developed countries, MS prevalence determined in schoolchildren and adolescents in Turkey warrants preventive measures. MS diagnosis in one of every three obese children shows that MS is an important public health problem in Turkey as well.

[Analysis of the results of NEQAS international external quality assessment programme for hepatitis B and C virus nucleic acid tests]. / Hepatit B ve C virus nükleik asit testlerinde NEQAS uluslararasi dis kalite kontrol degerlendirme programi sonuçlarinin analizi.

External quality assessment (EQA) has been playing an increasingly important role in the implementation of nucleic acid amplification techniques (PCR) for clinical diagnosis. In this study, the results of HBV-DNA quantification and HCV-RNA detection tests evaluated by United Kingdom National External Quality Assessment Scheme for Microbiology (NEQAS) were analysed and the performance of our laboratory was evaluated. Between April 2006-January 2008, in four different distribution panels including 16 freeze-dried serum and six plasma specimens for HBV-DNA and HCV-RNA testing, respectively, were received. Viral nucleic acids were extracted by magnetic particle technology (NucliSENS-easyMAG, bioMérieux, Boxtel, Holland). HBV-DNA and HCV-RNA tests were performed by Fluorion HBV quantitative v2.0 and Fluorion HCV quantitative v2.1 (lontek AS, Istanbul, Turkey) kits in real-time PCR (iCycler IQ v3.0a - BioRad Laboratories, Hercules, CA, USA) platform. The performance scores of all the quantification tests of HBV-DNA were 2 (completely correct result) and a strong correlation (r= 0.987) between the quantitative HBV data and the target values was found by linear regression analysis. The NEQAS scores of HCV-RNA testing, except for a false negative result (since the viral load in this specimen was very low--79 IU/ml--it was not scored by NEQAS), were 2 in all specimens. The evaluation of the data revealed 100% detection in HBV-DNA and 83.3% detection in HCV-RNA. In conclusion, the results of this study showed high accuracy of HBV quantification in the samples of HBV infected patients under antiviral therapy. However, the analytical sensitivity of HCV-RNA quantitative kit should be improved for the purpose of reliable HCV-RNA results. External quality control panels are important tools for monitoring the quality of diagnostic laboratory tests. Therefore, PCR laboratories should always have EQA in routine procedures.

Hypovitaminosis D in obese and overweight schoolchildren.

AIM: To determine the prevalence of vitamin D hypovitaminosis among obese and overweight schoolchildren. DESIGN: A cross-sectional population based sample. METHODS: In a cross-sectional study, 301 students (177 girls and 124 boys) aged 11-19 years were selected by multistage stratified sampling design. Subjects were classified according to their body mass index as obese, overweight and normal. Serum 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP) were measured in late winter months. Vitamin D deficiency was defined as a 25-OHD 20 ng/ml. RESULTS: The prevalence of hypovitaminosis D was found as 65% in all students. Vitamin D deficiency was found in 12% and insufficiency in 53% of all students. Vitamin D deficiency in female students was about two times more common than in males. In obese and overweight schoolchildren with hypovitaminosis D, serum 25-OHD levels decreased as BMI increased. There were no correlations between serum 25-OHD and ALP and iPTH levels. CONCLUSION: Vitamin D deficiency and insufficiency are common in obese and overweight schoolchildren, especially in girls. Obesity could be a risk factor in terms of hypovitaminosis D in adolescents. Vitamin D supplementation should be administered particularly to adolescent girls.

Environmental tobacco smoke exposure in school children: parent report and urine cotinine measures.

BACKGROUND: Environmental tobacco smoke (ETS) in the home continues to be a major health risk for children around the world. Measuring ETS is a central feature of clinical and epidemiological studies, with children's exposure often assessed through parental estimates. The authors examined the relationship between parent-reported estimates of children's exposure to ETS and children's urinary cotinine levels and evaluated the ETS exposure and its effect on respiratory health in children. METHODS: A total of 188 school children were included in the study. Parents were asked to complete a questionnaire about their smoking habits, their children's respiratory morbidity status and housing conditions. Urinary cotinine levels were measured in children. RESULTS: According to the responses, 72.3% of the children came from households with smokers, and 34.6% had daily exposure to ETS. When urine cotinine levels of >10 ng/mL were used as the yardstick of exposure, 76% of the children were identified as ETS exposed. No relation was detected between the symptoms of respiratory tract diseases and ETS exposure. To determine the amount of ETS exposure, the contribution of parental reports was low. CONCLUSION: To evaluate the level of ETS exposure of children, the parents' reports were not reliable. The addition of a biological measure results in a more informative estimate of ETS exposure in children.

Deaths from drug overdose and toxicity in Turkey: 1997-2001.

Turkey is located on the main overland connection between Asia and Europe, making the country potentially vulnerable to drug trafficking and its associated harms. The aim of the present study is to explore the frequency of all deaths from drug overdose and toxicity in Turkey and to describe some of the characteristics of these deaths. We collected data on all deaths from drugs in Turkey between 1997 and 2001 using records from the Council of Forensic Medicine. Data obtained from autopsy reports were retrospectively analyzed. In the present study, 374 deaths from drugs were reported in Turkey, with a mortality rate of 0.17 per 100,000 population. Highest mortality rates were found in Istanbul (0.83) and Gaziantep (0.71). The mean age was 34.0, and most cases (71.7%) were below the age of 40. The proportion of female cases was 13.6%. Opiates were implicated in 91.5% of deaths and benzodiazepines in 25.9%. Two fifths (38.8%) of the cases involved use of more than 1 drug. In 36.6% of cases, the route of final drug administration was by injection. The most common location of death was at a home (33.7%). Interventions to reduce drug use nationally are urgently required. International cooperation in social-educational activities, scientific research, and security measures is essential for this war.

Undergraduate training in occupational health at Kocaeli University Medical School: a Turkish experience.

Processes and conditions of production may produce unhealthy effects. Both must therefore be included in the education of health care personnel. Vocational training in occupational health at Kocaeli University Medical School, Turkey aims to demonstrate students that occupational health is a specific and important area of work within the context of primary health care. This research is a cross-sectional study. It was planned as a three stage study: 1- reviewing literature and grouping of countries according to their occupational health curricula; 2- reviewing the occupational health programs of medical schools in Turkey, and 3- recommendations for an occupational health curriculum to include an occupational health vocational training period of one week in the two month public health education program for medical interns. During this experience, senior students would be assigned to workplace health units. Of 283 medical schools found on the web, with occupational health teaching, only 20 have a curriculum that includes training in workplace health care units. In Turkey, there is no structured practical education on occupational health. In the third part of this study, we initiated at Kocaeli University School of Medicine's curriculum, a new occupational health education model applied in the workplace health units of factories. Practical experience of occupational health in the workplace is useful in introducing the community-based approach to occupational health in undergraduate medical education and understanding the determinants of health in industry.