[Short communication: The sensitivity of measles diagnosis by physicians and families during an intraepidemic period in Edirne: implications for measles surveillance]. / Kisa bildiri: Edirne'de bir kizamik salgini sirasinda hekimlerin ve ailelerin koydugu kizamik tanilarinin duyarliligi: kizamik sürveyansi için oneriler.

Measles is still a leading cause of death among young children, despite the availability of a safe and effective vaccine for the past 40 years. EURO Region of World Health Organisation including Turkey has targeted elimination of measles by the year 2010. It is concluded that there must be a sensitive surveillance system to investigate all suspicious measles cases, and diagnosis should be based on both standardized case definition and laboratory confirmation. Standardized case definition based notification has started in 2005 in Turkey. This study was carried out to determine the sensitivity and specificity of clinical measles diagnosis by physicians and families during a measles epidemic affecting 597 cases in Edirne province in 1997. Blood samples and data were collected by trained teams consisting of one physician and one nurse. Thirty clusters sampling method was used for sampling and 210 blood samples were taken from the children. The sera were then sent to Refik Saydam Hygiene Institute, Ankara, for the detection of measles specific IgG and IgM antibodies. Positive results for IgM were considered as acute measles during epidemics, and positive results for IgG were considered as acquired immunity due to vaccination or passed infection. Of 210 children, 19 were found to have recent infection (IgM+, IgG-), 101 were found immune (IgM-, IgG+), 67 were found in convalescence phase after infection (IgM+, IgG+), and 23 were found susceptible (IgM-, IgG-) to measles. The overall IgM seropositivity was detected as 40.9% in the study group. Only half of confirmed cases (43/86) were diagnosed as measles clinically by the physicians. The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of clinical diagnosis by physicians were estimated as 33%, 89%, 67% and 86%, respectively. Validity measures for measles diagnosis by the families were as follows; 8% sensitivity, 96% specificity, 6% PPV and 60% NPV. It is concluded that, all required measures should be taken for the availability of laboratory confirmation of all suspicious measles cases and field investigation via structured case investigation forms, is necessary for the success of measles surveillance system in our country.

Prevalence of postpartum depression in Edirne, Turkey, and related factors.

OBJECTIVE: To estimate the community prevalence of postpartum depression (PPD) in Edirne, Turkey, and the potential risk factors for it. STUDY DESIGN: The study was performed on mothers during the 6-week postpartum visit at home. A questionnaire that was devised to collect data on basic demographic information on the mothers and the Edinburgh Postnatal Depression Scale (EPDS) were applied. A total of 210 mothers were interviewed between January and April 2002, and 178 of them whose data were complete were analyzed. We evaluated EPDS cutoff scores > or =12. RESULTS: With an EPDs cutoff score of > or =12, the prevalence of PPD was 40.4%. Such factors as the husband's unemployment and a low educational level, living in a rented house, and having psychological or other problems during a previous pregnancy were the most significant risk factors for PPD. In the logistic model, the family's preference for a male infant in the previous pregnancy, female infant in the previous delivery and unwanted pregnancy were associated with PPD. The OR for these 3 variables and their 95% CI are, respectively, OR = 3.10, 95% CI 1.57-6.12; OR = 2.18, 95% CI 1.09-4.37, and OR = 2.84, 95% CI 1.22-6.61). CONCLUSION: The prevalence of PPD was high. Although the risk factors were similar to those in other studies, other family members' mention of wanting a son can cause depression in the mothers.

Alcoholism prevalence and some related factors in Edirne, Turkey.

The aim of this research was to estimate the community prevalence of alcoholism and the potential risk factors that affect it in the Edirne provincial centre by using a scanning test. A cross-sectional study was carried out in the Edirne provincial centre. A sample population composed of 500 women and 200 men was selected randomly after the categorisation of the population according to ethnicity, age and sex. Through face-to-face interviews, data collection sheets, which were prepared to analyse potential factors affecting alcoholism frequency, were filled in by the sample population. The Michigan Alcoholism Scanning Test (MAST) was employed. According to MAST's normal grading, individuals with 5 or more points are evaluated as alcoholics. Accordingly, 8.2% of the sample population fit the definition of alcoholic. Alcoholism frequency was considerably higher in gypsies, the self-employed, smokers, and people with higher income. From logistic regression analysis alcoholism frequency was 12.4 times higher in men than in women, 3.2 times higher in gypsies than in others, 1.9 times higher in people who earned an income in the preceding week than in the unemployed, and 3.7 times higher in individuals who had smoked more than 100 cigarettes during their life or those who had smoked at least 1 cigarette for 3 months or for a longer period than in those who hadn't smoked any cigarettes. The prevalence of alcoholism in the Edirne provincial centre was similar to that in other countries in Europe. The most important finding was that alcohol consumption decreased in the unemployed, a finding that differs from that in other parts of the world. Gypsies, who differ in tradition, way of life, and job compared to the other strata of society, also suffered from higher alcohol consumption. This group usually consumed wine and generally did not eat while drinking.

Utilization of primary health care services by Turkish gypsies and members of the general population at Muradiye Health Unit District in Edirne, Turkey.

This survey was designed to investigate the socio-demographic characteristics of and utilization of a Primary Heath Care Unit (PHCU) by Roma people (Turkish Gypsies), who live in the coverage area of Muradiye Primary Health Care Unit, as compared to members of the general population. This was a cross-sectional field study involving members of the Muradiye PHCU district. The study population comprised 127 Turkish gypsies resident in the region and 302 households selected by a stratified random sampling method. 889 household members were interviewed face-to-face at their home by means of a structured questionnaire. When the two sample groups were compared in terms of their social security coverage, rates of unemployment and educational levels, the situation of the Turkish Gypsies was found to be worse than that of the other members of the general population. 63% of the Gypsies applied to the PHCU because of health problems and 87% of these cases were treated successfully. Among those people making use of the PHCU services 47% evaluated them as being "satisfactory". Access to the PHCU services was found to be conditioned by educational level, being a Gypsy, the possession or not of a Green Card (available only to highly indigent people), whether or not the services were provided free of charge and the possession or not of social security coverage. Muradiye PHCU is well known and highly appreciated in its coverage area and is used by almost all of the residents. The main reason for the significant discrepancies in the level of health care obtained by the two population groups is the Gypsies' poorer economic situation. Among the Gypsies, the leading category of low rate social security coverage is the Green Card, which is granted to the very poor in order to reduce these inequalities. Unfortunately, the Green Card does not provide financial support for ambulatory care.