Adolescent obesity and associated cardiovascular risk factors of rural and urban life (Eskisehir, Turkey).

INTRODUCTION: The purpose of this study is to determine the prevalence of obesity and to compare the associated risk factors between the adolescent children living in rural and urban areas. MATERIALS: This cross-sectional study conducted among 3,918 high school students getting education in the city centre and rural areas of Eskisehir. A specially designed questionnaire form included questions about socio-demographic characteristics as well as cardiovascular risk factors including smoking status, diet habits (breakfasting, consumption of sugar-sweetened beverages and fruit and vegetable consumption), physical activity and time spent on computer and/or television. RESULTS: The prevalence of being overweight was 10.4% and 12.2% and the prevalence of obesity was 7.9% and 11.3% in rural and urban areas, respectively. In urban areas, being overweight was accompanied by prehypertension (OR=2.3, 95% Cl 1.6-3.3), hypertension (OR= 2.3, 95% CI 1.6-3.2), and family history of cardiovascular disease (OR =1.3, 95% CI 1-1.7), and obesity was accompanied by prehypertension (OR= 2.3, 95% CI 1.6-3.3), hypertension (OR=3.9, 95% Cl 2.9-5.3), excessive use of computer/TV (OR=1.3, 95% CI 1.1-1.7), having no breakfast (OR=1.3, 95% CI 1.1-1.7), physician-diagnosed diabetes mellitus (OR=4.2, 95% CI 1.3-14.1) and consumption of sugar-sweetened beverages (OR=0.6, 95% CI 0.5-0.8). In rural areas, although the variables accompanying being overweight were parallel with those in urban areas, obesity was only associated with prehypertension (OR=6.1, 95% CI 2.6-14.1), hypertension (OR=22.1, 95% Cl 9.9-49.3) and family history of cardiovascular disease (OR=1.6, 95% CI 1.1-2.6). CONCLUSION: Risk factors may differ in the adolescents from rural and urban areas. It is important in overweight and obese children to assess the family history of cardiovascular disease, blood pressure and blood glucose, to ask about the habit of regularly breakfasting, and to evaluate time spent on computer/TV. As in urban areas, environmental regulations also become important in rural areas. Appropriate social activities for children to spent more time outdoor, e.g. in parks or playgrounds, are important in urban as well as in rural areas.

Hypertension Knowledge-Level Scale (HK-LS): a study on development, validity and reliability.

This study was conducted to develop a scale to measure knowledge about hypertension among Turkish adults. The Hypertension Knowledge-Level Scale (HK-LS) was generated based on content, face, and construct validity, internal consistency, test re-test reliability, and discriminative validity procedures. The final scale had 22 items with six sub-dimensions. The scale was applied to 457 individuals aged ≥ 18 years, and 414 of them were re-evaluated for test-retest reliability. The six sub-dimensions encompassed 60.3% of the total variance. Cronbach alpha coefficients were 0.82 for the entire scale and 0.92, 0.59, 0.67, 0.77, 0.72, and 0.76 for the sub-dimensions of definition, medical treatment, drug compliance, lifestyle, diet, and complications, respectively. The scale ensured internal consistency in reliability and construct validity, as well as stability over time. Significant relationships were found between knowledge score and age, gender, educational level, and history of hypertension of the participants. No correlation was found between knowledge score and working at an income-generating job. The present scale, developed to measure the knowledge level of hypertension among Turkish adults, was found to be valid and reliable.

Environmental asbestos exposure in rural Turkey and risk of lung cancer.

The aim of this study was to determine the risk of lung cancer in a cohort of villagers with environmental asbestos exposure. The study was carried out as a field-based epidemiological study. Information from 3143 individuals in 15 asbestos exposed villages and 2175 individuals in 12 control villages was obtained. Asbestos fiber type to which villagers were exposed mainly was tremolite or tremolite, actinolite, chrysotile mixtures. The cumulative fiber count of the villagers during their lifespan ranged from 0.19 to 4.61 fiber-years/ml. The annual average incidence ratio of lung cancer was 135.21/100,000 persons/year in men and 47.28 in women in the asbestos exposed villages. For the control villages, this ratio was 60.15/100,000 person/year in men and 15.06 in women. Being a male, advanced age, smoking and asbestos exposure were established to increase the risk of lung cancer. Environmental asbestos exposure in rural area is a risk factor for lung cancer independent of smoking.

Application of Healthy Heart program in the two semi-rural areas in Eskisehir.

OBJECTIVE: The purpose of this study was to raise awareness of people in two semi-rural regions of Eskisehir in terms of cardiovascular diseases (CVD) risk factors and to promote related heart-healthy behaviors. METHODS: The study was a semi-experimental intervention and featured as a two-phase design. In the first phase of the study, participants received visits at home. Individuals in intervention and control areas were given a participation form that indicated the Framingham Risk Score (FRS). Other training materials were distributed throughout the intervention area. The second phase was planned as a nested case- control study. The first phase included 2.766 persons and the second phase included 778 persons. In the evaluation of the data the Pearson Chi-square and Student's t-test for independent samples, Mc-Nemar Chi-square and the paired t-test for dependent samples were applied. RESULTS: During the first phase, the frequency of FRS metrics above 10% was 26.2% for males, 18.1% for females in the intervention area, 22.9% for males, and 14.9% for females in the control area. There was no difference between males and females in terms of scoring for control and intervention areas (p>0.05). Based on the FRS data, the second phase revealed a decrease of 15.4% in males (p<0.001) and 10.2% in females (p<0.001) in the intervention area and an increase of 8.2% in males (p=0.011) and 3.8% in females (p=0.078) in the control area. CONCLUSION: In this study, teaching individuals who were older than twenty years of age about cardiac health seemed to be an effective method for decreasing CVD risk factors.

The prevalence of tinea pedis and tinea manuum in adults in rural areas in Turkey.

The aim of this study was to determine the frequency of tinea pedis and manuum (dermatophyte infections of the hands and feet) in adults in rural areas of Turkey, the risk factors and self-administered treatment options. A total of 2,574 people living in a rural area were enrolled in the study. Participants were asked demographic data, hygienic habits in a questionnaire. KOH preparations and culture were performed from suspicious lesions. Medical and alternative therapy methods and former dermatophytosis diagnosis history were taken from the respondents with suspicious lesions. Microbiological samples were taken from 285 (11.1%) participants. Culture was positive in 109 (4.2%) of those. The most common agent was Trichophyton rubrum. The predisposing factors were found as age older than 40, male gender and obesity. Forty-nine (44.9%) of patients had taken a medical therapy, 56 (51.4%) had performed non-medical methods (cologne, Lawsonia inermis-Henna and softener creams). Patient's education about the treatment compliance is important.

Incidence of epilepsy in a defined area of Central Anatolia, Turkey, after 15 years of age.

BACKGROUND: The aim of this study was to establish the incidence rate, incidence-related characteristics, and epidemiological profile of epilepsy in Eskisehir, Turkey. METHODS: Cases were prospectively recorded by utilizing multiple data sources, including case records obtained through the Hospital Information System, files kept by family physicians, and files kept by private neurologists. Patients diagnosed with epilepsy between July 1, 2007, and June 30, 2008, and above the age of 15 years were included in the study. RESULTS: 219 new cases were diagnosed with epilepsy. The adjusted incidence rate was 33.51/100,000 cases in males and 42.22/ 100,000 cases in females, for a total of 37.59/100,000 persons. The incidence rates according to age were found to be highest in the 15-19-year age group and in the ≥70-year age group. Partial seizures were observed more than generalized seizures after the age of 40. Unknown etiology accounted for 77.2% of the epilepsies. Stroke was the most common etiological cause of epilepsy among the symptomatic group. CONCLUSIONS: The incidence rate of epilepsy in Eskisehir was comparable with the rates reported for developed countries.

Menopause Rating Scale as a screening tool in rural Turkey.

INTRODUCTION: Women living in rural areas of Turkey experience difficulties in accessing healthcare services, and this is attributed to distance from urban healthcare centers, financial barriers and poverty, a low education level, and gender discrimination. The purpose of this study was to test the applicability of the menopause rating scale (MRS) as a screening tool by primary healthcare professionals for identifying women with severe menopausal symptoms. The objectives of the study were to test the validity and reliability of the MRS in rural areas of Turkey, to determine estimation values for referral to the secondary level of healthcare, and to assess the prevalence of severe menopausal symptoms among rural Turkish women. METHODS: The sample size was 600 women. The Turkish version of the MRS and the Kupperman index were used to evaluate the severity of symptoms. The internal consistency coefficient (Cronbach's alpha) of the MRS was computed using the test-retest method. The influence of the MRS with regard to the decision to seek medical advice due to menopausal symptoms was considered the validity criterion, and the sensitivity and specificity of the test were established according to this criterion. Estimation values of the test were determined by ROC analysis. Independent variables for the severity of menopausal symptoms were determined using a logistic regression model. RESULTS: A positive correlation between the MRS and the Kupperman index was revealed (r=0.86, p=0.000). The estimation value or the MRS score that would predict whether a woman had visited a gynecologist at least once due to the severity of menopause symptoms was found to be 16, its sensitivity and specificity were both 60%. The MRS score was higher among participants who evaluated their general health as 'unfit' or who had advanced age, chronic disease, a history of dysmenorrhea, or who had had two or more miscarriages. CONCLUSIONS: This evaluation of the MRS indicates that the instrument is a comprehensible, useable, reliable screening test for the identification of women with severe menopausal symptoms. By screening using the MRS it is possible for primary healthcare workers in rural areas to identify women in need of referral to an upper-level healthcare institution.

Knowledge, beliefs, and practices regarding tick bites in the Turkish population in a rural area of the Middle Anatolian Region.

The aim of this study is to determine the knowledge, beliefs, and practices of a population living in a rural area in regards to tick bites and Crimean-Congo hemorrhagic fever (CCHF). The study was conducted in a rural area located in Central Anatolia in the region of Eskisehir. A total of 1,500 individuals aged 20 years and older chosen by a stratified random sample were enrolled. A questionnaire was administered in person. In 264 (17.4%) participants, there was a history of being bitten by a tick. This rate was higher in older persons, males, married persons, and farmers. The most commonly reported protective behavior was wearing long sleeves and long pants when wandering in rural areas (65.1% of participants). The least commonly reported behavior was using insect repellent on skin or clothes (3.3% of participants). Only 799 participants (54%) had heard about CCHF as a disease associated with ticks. Females, those with primary school education, housewives, and male farmers had a high frequency of having heard about CCHF. Tick bites and CCHF are important public health problems, yet the current knowledge of these problems is not sufficient in populations living in rural areas of the Middle Anatolian Region of Turkey.

Prevalence of dementia and associated risk factors in Middle Anatolia, Turkey.

This study aimed to investigate the prevalence of various cognitive disorders in the older population (age 55 years and above) of Eskisehir, Turkey, by conducting a cluster sampled door-to-door survey. A total of 3100 inhabitants were screened with the Mini-Mental State Examination (MMSE) and a questionnaire concerning demographic, occupational and social data. Individuals (n=320) with MMSE scores of 25 were assessed according to the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and were investigated in the more detailed phase 2 study. The overall prevalence of dementia was 8.4%, although it ranged from 2.2% among those aged 55-59 years to 5.3% among those aged 60-64 years, and to 30.4% among those aged 75 or above. Vascular dementia was the most common type (51.1%), followed by Alzheimer's dementia (48.8%). In a very small proportion of individuals (0.1%), dementia was due to other causes such as B12 deficiency, a tumour or hydrocephalus. Significant risk factors for dementia were female sex, low education, age, living in a rural area and a family history of dementia.

Evaluation of metabolic syndrome prevalence in semi-rural areas of Central Anatolia, Turkey.

OBJECTIVE: To assess the prevalence and clustering of components of metabolic syndrome (MetS) in semi-rural areas of Central Anatolia, Turkey. METHODS: This study was conducted between January and August 2008 on a randomly selected sample of participants from semi-rural settlement areas of the Eskisehir province, Central Anatolia, Turkey. The MetS was diagnosed as the presence of 3, or more risk factors according to the National Cholesterol Education Program-Expert Panel Adult Treatment Panel III (NCEP ATP III) criteria. The MetS prevalence was standardized according to age, and logistic regression was used to determine the risk factors affecting prevalence. RESULTS: The study group composed of 2,766 people (40.4% male, 59.6% female). The corrected MetS prevalence according to age was 27.6%, with values of 19.4% in males, and 33.2% in females. The prevalence increased with increasing age in both genders. Groups engaged in heavy physical exercise, and smoking showed decreased odds of having MetS, while MetS risk was lower in men who consumed proper amounts of red meat, fruits, and vegetables. In the MetS group, central obesity risk was higher for women, whereas hypertriglyceridemia risk was higher for men. In the non-MetS group, hypertension, and central obesity risks were higher for women, whereas hypertriglyceridemia risk was higher for men. CONCLUSION: It was concluded that MetS is a major problem in the Eskisehir province, and it is imperative that changes in lifestyle be made within this population to reduce the risk factors for the condition.

Awareness of hypertension and other cardiovascular risk factors in rural and urban areas in Turkey.

This study aims to establish the rates of hypertension among individuals living in rural and urban areas in Turkey, and to compare their level of awareness concerning cardiovascular disease risk factors and lifestyle modifications. In total, 1679 people from urban areas and 1321 individuals from rural areas who were over 40 years of age were contacted. Hypertension standardized prevalence rate was 49% in males and 51.3% in females living in urban areas, and 55.3% in males and 59.6% in females living in rural areas. The risk of hypertension was higher in those people living in urban areas with a smoking habit, obesity, a sedentary lifestyle, inappropriate salt intake or a diagnosis of hypercholesterolemia. The risk of hypertension was also higher in people living in rural areas with obesity, a sedentary lifestyle, an inappropriate consumption of fat and red meat or a diagnosis of hypercholesterolemia or diabetes. Awareness of the importance of all of the included cardiovascular risk factors and protection from those risk factors was higher in urban areas. We concluded that cardiovascular risk factor control programs should be conducted together with hypertension control programs in rural and urban areas.

[The Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) Scale: a validity and reliability study]. / Kardiyovasküler Hastaliklar Risk Faktörleri Bilgi Düzeyi (KARRIF-BD) Olçegi'nin geçerlik ve güvenirligi.

OBJECTIVES: We developed a questionnaire to measure the knowledge level of adults about risk factors for cardiovascular diseases (CVD) and assessed its validity and reliability. STUDY DESIGN: We developed the Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) Scale in the light of the literature data. It consisted of 28 items, questioning the features of CVD in the first four items, risk factors in 15 items, and the results of adopting a risk-free attitude in nine items. All the items were based on true/false statements, requiring a response in the form of "Yes", "No" or "Don't know". To determine its validity and reliability, the scale was administered to 200 participants older than 20 years, of whom 144 individuals were involved in test-retest evaluations. Internal consistency was estimated using the Cronbach's alpha. To determine the validity of the scale, individuals with CVD and/or familial history were compared with those without CVD and/or familial history. RESULTS: The rates of true responses varied between 44.5% and 96.5%. The mean score was 19.3+/-3.2 (range 5 to 27), and the median item-total correlation was 0.26 (range 0.13 to 0.51). Internal consistency coefficient (Cronbach's alpha) was 0.768. There was a strong positive correlation between the test and retest total scores (r=0.850; p=0.000). Individuals with CVD and/or familial history had a significantly higher mean score than those without CVD and/or familial history (20.2+/-3.1 vs 19.3+/-3.2; p=0.032). CONCLUSION: In Turkey, CARRF-KL is the first scale developed to measure the knowledge level of individuals about risk factors for CVD, with good indices of validity and reliability.

Two distinct training methods for a doctrine of life with healthy heart in a low socioeconomic society model.

This study was conducted in three stages in a semi-rural region of Eskisehir, Turkey. In the first stage, individuals selected by random sampling were evaluated for cardiovascular disease risk factors. In the second stage, Group I and Group II training materials were randomly distributed. In the third stage, the subjects were screened one year later to assess and determine if there had been any changes in their attitudes towards the dangers of cardiovascular diseases. The number of active smokers significantly decreased after the training in the both groups. The percentage of people with regulated blood pressure exhibited an increase in Group II more than Group I.

Prevalence of osteoporosis in middle Anatolian population using calcaneal ultrasonography method.

BACKGROUND: There are a few studies on the prevalence of osteoporosis in Turkey. Most of such studies have been performed using classical diagnostic methods. Quantitative calcaneal ultrasonography is a contemporary procedure used in the diagnosis of osteoporosis. OBJECTIVE: The aim of this study is to determine the prevalence of the osteoporosis and risk factors in middle Anatolian population aged more than 40, using quantitative calcaneal ultrasonography. SUBJECTS AND METHODS: The present study was carried out in rural and urban areas of primary health care units. Evaluation of skeletal status was based on calcaneal quantitative ultrasound measurement, carried out by the Sahara Clinical Bone Sonometer (Hologic Waltham, MA, USA). RESULTS: There were 1437 individuals, 866 were females (60.3%) and 571 were males (39.7%), aged in between 40 and 89 years. Standardized prevalence rates using Segi's population were found to be 14.0% in total, 17.1% in female and 9.2% in male. Osteoporosis prevalence increased with increasing ages. The highest prevalence value was determined in the individuals older than 70 years of age. Osteoporosis was more common among women compared to men. Osteoporosis prevalence increased in consistent with a decrease in the amount of milk, yoghurt and cheese consumption. CONCLUSION: Based on current study, it is concluded that osteoporosis is an important health problem. Requiring health education about life styles (activity and nutrition) to avoid and even control osteoporosis.

PAP smear screening among married women living in Osamangazi University ALPU training area.

An inquiry including questions about socio-demographic and fecundity properties and covering the knowledge and attitudes of women about Pap smears was applied to 585 women living in Alpu district of Eskisehir, Turkey. Smear specimens were taken from 513 women and colpography was performed before and after acetic acid application with a digital camera. The women who had cervical lesions and/or aceto-white epithelium during the gynecological examination and/or had pathological findings in the smear and/or had suspicious findings at the colpography were invited (n=125, 24.4%) to the Department of Gynecology for colposcopic evaluation. Colposcopy was performed to 77 and biopsies were taken from 40 of the women during colposcopic examination. Of the biopsy specimens, 31 were accepted as benign while 9 were reported as pathology positive, one being high grade squamous intraepithelial lesion (HGSIL) and 8 low grade squamous intraepithelial lesion (LGSIL).

Cadmium exposure from the cement dust emissions: a field study in a rural residence.

The cement dust is one of the causes of pollution in the environment. In the present study, the cadmium concentrations of soil and plant specimens taken from a rural area exposed to cement factory emissions were determined and also the blood concentrations and sensitivity conditions in humans residing in this rural area were investigated. The 108 soil (36 for control) and plant specimens were collected from eight different directions of the cement plant located in Cukurhisar town in Eskisehir city. Blood samples of the individuals residing in this area were taken from 258 subjects (258 for control) following a physical examination, and patch tests were also applied. The results show that the cadmium concentrations of the soil and plant specimens taken from different places in different directions of the factory were higher than in the control areas. The physical examination of subjects did not reveal results different from those of the control group except for the diagnosis of contact dermatitis. The analysis of venous blood samples showed that cadmium concentrations were found to be within the reference values given for both groups, but higher in the subjects (p<0.001). According to the results of patch tests, sensitivity to cadmium was found to be more frequent for the subject group than the control group (p<0.05). Those results show that, although clinical tools revealed no toxic effects for the subject, except contact dermatitis, the cement plant increases cadmium pollution on the surrounding environment.

Nickel exposure and its effects.

The aim of the study was to determine the nickel concentrations of soil and plant specimens taken from a rural area exposed to cement factory emissions and also to determine the blood concentrations and sensitivity conditions observed in humans residing in this rural area. The study was carried out in Cukurhisar, a town in Eskisehir-Turkey, between May 2000 and March 2001. Beside the 108 soil (36 for control) and plant specimens, which were taken from 8 directions from the cement factory, blood samples of the individuals residing in this area were taken from 258 subjects (258 for control) following a physical examination, and patch tests were also applied. The nickel concentrations of the soil and plant specimens taken from different places in different directions of the factory were higher than in the control areas. The physical examination of subjects did not reveal results different from those of the control group except for the diagnosis of contact dermatitis. The analyses of venous blood samples showed that nickel concentrations were found to be within the reference values given for both groups, but higher in the subjects (p < 0.001). According to the results of patch tests, sensitivity to nickel was found to be more frequent for the subject group than the control group (p < 0.05). According to these results, clinical tools revealed no toxic effects for the subjects, except contact dermatitis. However, sensitivity to patch tests showed that this subject group has been affected compared to the control group and that this effect increased with age.

Prevalence and characteristics of nosocomial infections in a Turkish university hospital.

BACKGROUND: The purpose of this study is to estimate the prevalence of nosocomial infections in a university hospital, as well as determining the groups at high risk of such infections. MATERIALS AND METHODS: Two surveys based on a modification of the British National Survey protocol for nosocomial infection were conducted in July and December 1998. RESULTS: In the first survey, hospital infections were found in 41 (13.4%) of the patients, and in the second survey in 34 (10.9%). The study showed that the risk of nosocomial infection was associated with being in the intensive care unit, undergoing surgery, and invasive procedures. CONCLUSION: Prevalence data are consistent with results reported in many other regions of the world. These findings provide the principal information for future surveillance in association with prevention programs in Turkish hospitals.

Frequency and risk factors of dermatophytosis in students living in rural areas in Eskisehir, Turkey.

Our study included 2384 students from five villages around Eskisehir, Turkey. We asked every student for their personal identification and also for their sanitation in order to get an idea about dermatophytosis. Samples taken from suspicious lesion were collected and inoculated onto Sabouraud dextrose agar slants. For identification of fungi which were grown, macroscopic appearance of colonies, microscopic examination and biochemical tests were used. We found suspicious lesions in 245 (10.3%) and diagnosed dermatophytosis in 86 (3.6%) of the students. The dermatophyte species were Trichophyton rubrum 37 (43%) at first, Trichophyton mentagrophytes 17 (19.8%), Microsporum canis 11 (12.8%), Microsporum gypseum 8(9.3%), Epidermophyton floccosum 6 (7%), Trichophyton verrucosum 6 (7%) and Trichophyton violaceum 1 (1.1%). Tinea pedis (59.3%) was the most frequent clinic form of dermatophytosis, followed by tinea corporis (22.1%), tinea capitis (9.3%), tinea manum (7.0%) and tinea unguium (2.3%). Older age, male gender, poor hygiene, living in dormitory, low level mother education, history of dermatophytosis within family and sanitary conditions were computed as independently variables associated with dermatophytosis infection. For prevention and control of dermatophyte infection in children living rural areas, field studies should be done and sanitary conditions should be improved.