The Effect of Working in a Smoke-Free Workplace on use of Smoking and Smokeless Tobacco.

OBJECTIVES: The aim of this study was to evaluate whether smokeless tobacco (Maras powder) use increased among smokers working at smoke-free workplaces or not. MATERIAL AND METHODS: In Kahramanmaras city, 242 male workers who were current or former smokers, working at strictly smoke-free workplaces were included in this study. A total of 21 questions, including the Fagerstrom Test for Nicotine Dependence, were asked. RESULTS: All the participants were male with a mean age of 29.33±6.66 years, and the age range was 17-55 years. Current smokers were 90 (37.2%) and former smokers were 152 (62.8%). Former smokers were asked the reason why they quit smoking; the predominant reasons were the health hazards of smoking and the financial burden of cigarettes. The quitting rate was significantly higher among married participants (p=0.023). Maras powder users were 184 (76%), users who never smoked were 54 (22.3%), and former users were 4 (1.7%). We asked the Maras powder users if they had been using it before the smoking bans, and 96 workers (51.1%) answered "no." The question "Did the use of Maras powder increase with smoking bans"? was asked, and 118 workers (62.8%) answered "yes." The level of education among Maras powder users was significantly lower than non-users (p=0.001). CONCLUSION: Working in smoke-free workplaces is associated with increased rates of quitting smoking and also with increased use of Maras powder, a local form of oral smokeless tobacco.

Factors effecting influenza vaccination uptake among health care workers: a multi-center cross-sectional study.

BACKGROUND: The present study aimed to identify factors affecting vaccination against influenza among health professionals. METHODS: We used a multi-centre cross-sectional design to conduct an online self-administered questionnaire with physicians and nurses at state and foundation university hospitals in the south-east of Turkey, between 1 January 2015 and 1 February 2015. The five participating hospitals provided staff email address lists filtered for physicians and nurses. The questionnaire comprised multiple choice questions covering demographic data, knowledge sources, and Likert-type items on factors affecting vaccination against influenza. The target response rate was 20 %. RESULTS: In total, 642 (22 %) of 2870 health professionals (1220 physicians and 1650 nurses) responded to the questionnaire. Participants' mean age was 29.6 ± 9.2 years (range 17-62 years); 177 (28.2 %) were physicians and 448 (71.3 %) were nurses. The rate of regular vaccination was 9.2 % (15.2 % for physicians and 8.2 % for nurses). Increasing age, longer work duration in health services, being male, being a physician, working in an internal medicine department, having a chronic disease, and living with a person over 65 years old significantly increased vaccination compliance (p < 0.05). We found differences between vaccine compliant and non-compliant groups for expected benefit from vaccination, social influences, and personal efficacy (p < 0.05). Univariate analysis showed differences between the groups in perceptions of personal risks, side effects, and efficacy of the vaccine (p < 0.05). Multivariate analysis found that important factors influencing vaccination behavior were work place, colleagues' opinions, having a chronic disease, belief that vaccination was effective, and belief that flu can be prevented by natural ways. CONCLUSION: Numerous factors influence health professionals' decisions about influenza vaccination. Strategies to increase the ratio of vaccination among physicians and nurses should consider all of these factors to increase the likelihood of success.

What primary care physicians think about insulin initiation in type 2 diabetes: a field-based study.

BACKGROUND/AIM: A significant number of patients with type 2 diabetes mellitus require insulin and little is known about the possible physician-related factors that could cause a delay in the initiation of insulin treatment in patients with type 2 diabetes. This study aimed to evaluate those factors. MATERIALS AND METHODS: A total of 87 family physicians working at 36 family health centers in urban Malatya participated in our study on a voluntary basis. A self-administered survey form was structured to gather the views of the primary care physicians. The survey was developed based on a review of the literature. The survey consisted of Likert scale item questions regarding knowledge about the disease of diabetes mellitus and the views of the primary care physicians regarding insulin initiation for type 2 diabetic patients. RESULTS: Almost half of the participants (42.5%, n = 37) felt incompetent in the starting dosage adjustment and 40.2% (n = 35) of the participants felt incompetent in maintaining the appropriate dosage adjustment. In terms of sex, female family physicians were found to be more uncertain about the timing of initiating insulin treatment for diabetic patients. CONCLUSION: This study shows the necessity of continuous education activities and interventions to promote motivation in family physicians to improve care of diabetic patients in primary care.

Effect of Ramadan fasting on serum concentration of apelin-13 and new obesity indices in healthy adult men.

BACKGROUND: The aim of this study was to determine how Ramadan fasting (RF) affected the recently described new obesity indices [visceral adiposity index (VAI), waist circumference to height ratio (WHtR), body adiposity index (BAI)], and serum concentration of apelin-13 (RF) in healthy adult men. MATERIAL AND METHODS: For this purpose, 42 healthy adult men were selected. Anthropometric parameters were measured and a sample of venous blood was obtained for biochemical assays on the first and last days of Ramadan. When all subjects were evaluated, all anthropometric parameters changed except VAI. Serum apelin-13, triglyceride (TG), HDL-cholesterol (HDL-C), and insulin levels did not change. When patients were divided into 3 groups according to body mass index (BMI), BAI decreased in normal-weight subjects and WHtR decreased in other groups, but VAI and apelin-13 did not change in any groups. RESULTS: We demonstrate for the first time that while some anthropometric parameters changed, VAI and serum apelin-13 levels did not change with RF. BMI, waist circumference (WC), TG, and HDL-C were evaluated together in calculation of VAI. TG, VAI, and HDL-C remained unchanged by RF. Even if body weight (BW) and BMI decreased, apelin-13 was not affected by RF. The data on serum apelin-13 may have been influenced by the small-percentage decrease in BW, as well as insignificant improvements in metabolic parameters such as lipid profiles, glucose, and insulin. CONCLUSIONS: We found that Ramadan fasting in healthy adult men was associated with significant decreases in BW, BMI, WHtR, and BAI, but we found no significant changes in VAI and serum apelin-13 concentrations.

Use of topical anesthetic and non-medical alternatives in welding workers regarding ophthalmic problems.

PURPOSE: Welding workers' ophthalmic problems resulting from their professions are frequently observed in ophthalmic emergencies and can cause severe visual impairment. We aimed to investigate the use of topical anesthetic and non-medical alternatives of this population regarding ophthalmic problems in this study. MATERIALS AND METHODS: The study included 204 welding workers randomly selected from a population of 1852 people who had at least one-year experience as a welding worker and who were members of a chamber of welding workers. Data were collected at face to face interviews with a questionnaire composed of questions about ophthalmic problems caused by their profession and about how they eliminated these problems. Obtained data were analyzed with SPSS. RESULTS: Of 204 workers, 38.7% preferred non-medical alternatives including application of potatoes (22%), dressing with tea (17%), rinsing with cold water (3.4%) and closing eyes (2%). 30.5% of the participants used topical anesthetics (72% commercial and 28% prepared in pharmacies). There was a significant relation between use of non-medical methods and topical anesthetics, and workers' education, duration of work experience and receiving training from their seniors (p < 0.05). CONCLUSION: Use of non-medical methods and topical anesthetics by welding workers was found to be associated with low-education levels and insufficient knowledge about ophthalmologic problems due their professions and their treatment. They should be provided with appropriate training for the issue and precautions should be taken to prevent people from buying drugs without a prescription.

Longitudinal pulmonary functional loss in cotton textile workers: a 5-year follow-up study.

BACKGROUND: Occupational exposure to cotton dust causes several diseases affecting the lungs, but only limited information is available on effects of long-term exposure. In this study, we aimed to evaluate longitudinal changes in selected parameters of pulmonary function in textile workers. MATERIAL AND METHODS: This prospective cohort study began with 196 textile workers in 2006 and was completed in 2011 with 49 workers. We used standardized tests for pulmonary function on participants on the first day of the workweek in June of 2006 and 2011. Environmental samples of cotton dust were gathered with a vertical elutriator. Loss of pulmonary function was assessed based on gender and smoking status. RESULTS: The mean number of years participants worked in the textile factory was 7.61 ± 1.83 years, and the mean age was 35.3+5.8 years. The annual FEV1 loss of all workers was 53.2 ml, giving a ratio of annual FEV1 loss to baseline FEV1 of 1.4%. Pulmonary function parameters of all participants in 2011 were significantly lower than those in 2006 (for all, p<0.05). In both surveys, pulmonary function in current smokers was lower, but this difference was not significant (p>0.05). CONCLUSIONS: This study provides the first data on pulmonary functional loss in Turkish textile workers and supports the findings of other cohort studies that workers with long-term exposure to cotton dust may lose some pulmonary function. The ratio of annual FEV1 loss to baseline FEV1 appears to be a more accurate and comparable method than annual FEV1 loss for evaluating pulmonary functional loss.

Effects of smokeless tobacco (Maras powder) use on carotid intima media thickness.

BACKGROUND: The aim of this study was to investigate the effects of smokeless tobacco (Maras powder, Nicotiana rustica Linn) on carotid intima media thickness. MATERIAL/METHODS: The study included 32 Maras powder users presenting to our Family Medicine outpatient clinic and 30 non-users of Maras powder as a control group. Carotid intima media thickness was measured by duplex ultrasonography. RESULTS: The mean age of the Maras powder users was 45.4±11.3 years and the mean age of the control group was 46.3+11.6 years. All the participants were male. The mean duration of Maras powder use was 27.3±11.6 years. Carotid intima media thickness was 0.73±0.20 mm in the Maras powder users and 0.49±0.14 mm in the controls. It was significantly higher in the Maras powder users (p<0.001). Blood pressure measured before Maras powder use in Maras powder users was similar to that measured in the control group (p>0.05). Systolic blood pressure and diastolic blood pressure values were also similar between MP users before using Maras powder and controls (p>0.05). Systolic blood pressures were 136.6±12.4 mmHg and 109.7±9.7 mmHg after 30-60 minutes using Maras powder in the Maras powder users and in the controls, respectively. Diastolic blood pressures were 87.2±6.1 mmHg and 62.8±8.1 mmHg after 30-60 minutes using Maras powder in the Maras powder users and the controls, respectively. Both systolic and diastolic blood pressures after 30-60 minutes using Maras powder were significantly higher in the Maras powder users (p<0.001). Carotid intima media thickness was significantly correlated with systolic blood pressure (r=0.613, p<0.001) and diastolic blood pressure (r=0.612, p<0.001). CONCLUSIONS: Carotid intima media thickness was higher in Maras powder users than in nonusers of the powder. Increased carotid intima media thickness can be associated with an immediate increase in systolic and diastolic blood pressures. Therefore, attempts to increase public awareness about smoking should also be directed towards prevention of Maras powder use.

Temperament and character profiles of male COPD patients.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a respiratory disorder, and is characterized by persistent airflow obstruction. These patients are exposed to severe physical limitations and substantial psychosocial trouble. The aims of this study were to determine the temperament and character profiles of personality in patients with COPD and to compare the results with those of healthy controls. METHODS: Thirty-nine male COPD patients and 67 age- and gender-matched healthy controls completed the self-administered 240-item temperament and character inventory (TCI) and 14-item hospital anxiety and depression scale. The relationships between temperament and character personality profiles and clinical factors such as severity of COPD, anxiety, and depression were evaluated. RESULTS: COPD patients had significantly higher mean scores of Harm avoidance and lower mean score of Self-directedness than those of healthy controls. In the COPD patients, the anxiety score was significantly higher (P=0.03) and the depression score was found to be insignificantly higher than that of control group. The TCI profiles were not correlated with the severity of COPD. In COPD patients, Self-directedness and Cooperativeness traits of TCI character negatively correlated with anxiety, but any of traits did not correlate with depression. CONCLUSIONS: The present study defined the Harm avoidance score was higher and Self-directedness was lower in COPD patients and the COPD severity did not correlate with any of the personality trait. We suggest that during evaluation of COPD patients for treatment, personality trait should also be considered in clinical practice.

Correlation of volume, position of stone, and hydronephrosis with microhematuria in patients with solitary urolithiasis.

BACKGROUND: The aim of this study was to determine the relationship between hematuria and volume, position of stone, and hydronephrosis in patients with a solitary stone, using unenhanced multidetector computed tomography (MDCT). MATERIAL AND METHODS: This retrospective study evaluated the clinical and radiological records of 83 patients undergoing MDCT for the evaluation of acute flank pain and suspected renal colic, who also underwent a microscopic urinalysis at the emergency department of our hospital during a 1-year period. Inclusion criteria of the MDCT study were solitary urolithiasis and cumulative stone diameter under 1 cm. RESULTS: A total of 83 patients were included in the study, with a mean age of 42.1±14.4 years; 48 (57.8%) were females and 35 (42.2%) were males. Detection of 5 or more red cells on urinalysis was regarded as microscopic hematuria, and was positive in 46 patients (55.4%). There was a positive correlation between the position of the stone (especially upper two-thirds ureteral stones) and microhematuria rate (r: 0.28, p=0.009). There was a statistically significant difference in presence of hydronephrosis between the microhematuria (36 patients, 78%) and non-microhematuria (12 patients, 32%) groups (p<0.001). The median stone volume between the microhematuria and non-microhematuria groups were not statistically different, 37.5 mm3 (range 5-425) and 28 mm3 (range 4-412), respectively (p=0.39). CONCLUSIONS: Although stone volume is one of the best indicators of stone burden, it was not correlated with microhematuria. However, in patients with renal colic, microhematuria requires ultrasound examination whether hydronephrosis and ureteral stones are present or not. Further studies with larger sample sizes are warranted.

Religious officials' knowledge, attitude, and behavior towards smoking and the new tobacco law in Kahramanmaras, Turkey.

BACKGROUND: Tobacco control effort should be first started in people that are looked upon as role models for the general population. We aimed to determine the knowledge, attitude, and behavior of religious officials towards smoking and the new tobacco law. METHOD: The study group was comprised of 492 Imams and 149 Quran course instructors working in Kahramanmaras city of Turkey, 641 religious officials in total, and our survey form was applied on 406 (63.3%) of those religious officials who agreed to participate in the study. RESULTS: Twenty-eight (6.9%) participants were current smokers and 35 (8.6%) were ex-smokers. 99.8% of the religious officials believed that smoking was harmful and/or prohibited in terms of religion. While 43.6% respondents thought smoking was "haram" (forbidden by Islam), 56.2% believed it was "makruh" (something regarded as reprehensible, though not forbidden by God according to Islam). 85.2% of the participants were aware of the recent tobacco law. 55.5% of the respondents, who were aware of the recent tobacco law, evaluated their knowledge level on the law as adequate, whereas 44.5% evaluated it as inadequate 92.4% of the participants noted that religious officials should play active roles in tobacco control effort. CONCLUSION: Smoking rate among religious officials is much lower than that of general public. In order to help religious officials to take a more active role on this issue, they should be trained on the subject and appropriate platforms should be established.