Seroprevalence of human brucellosis in Turkey: A comprehensive meta-analysis.

AIMS: Brucellosis remains a common zoonotic disease, in developing countries, as well as in Turkey where it is endemic, underdiagnosed, and underreported. The aim of this meta-analysis was to provide a comprehensive estimate of seroprevalence with a large sample size, covering all regions of Turkey, including both grey literature and published studies. METHODS AND RESULTS: A systematic search was performed in MEDLINE (via PubMed), TürkMedline (National Health Sciences-Periodicals Database), and YÖKSIS database (Higher Education Council Information System) until May 5th, 2023. The quality of the studies was evaluated independently using Joanna Briggs Institute (JBI) critical assessment tool for prevalence studies. A random-effects model (DerSimion and Laird) was utilized to estimate the overall pooled prevalence. A sensitivity analysis was performed, excluding studies with a high risk of bias. The subgroup analyses and meta-regression were conducted to explore sources of heterogeneity. Egger test and funnel plot were used to assess publication bias. The meta-analysis included 30 studies in total published between 1999 and 2021 with 51,560 individuals. In Turkey, the pooled seroprevalence of human brucellosis was estimated to be 4.5% (95% confidence interval [CI]: 3.8%-5.3%). According to the subgroup analysis, a higher seroprevalence was found in rural areas (8.0%, 95% CI: 5.4%-10.7%), high-risk occupational groups (9.9%, 95% CI: 5.3%-14.6%), and the Central East Anatolia Region (13%, 95% CI: 3.2%-22.8%). The meta-regression analysis identified living in rural areas and certain geographic regions as significant risk factors associated with higher seroprevalence. CONCLUSIONS: This meta-analysis revealed a significant burden of human brucellosis in Turkey. The findings highlight the need for public health measures and targeted interventions to reduce the burden of this zoonotic disease, especially in rural areas, high-risk occupational groups, and the East Anatolia Region.

Educational intervention to improve appropriate digoxin therapeutic drug monitoring: a quasi-experimental study.

OBJECTIVES: Our previous retrospecive study evaluating the appropriateness of serum digoxin concentration (SDC) measurements revealed errors in the timing of blood specimen collection in 98% of the tests. The aim of this study is to evaluate the appropriateness of the SDC measurements and the factors involved in inappropriate test-ordering, after training health personnel in digoxin therapeutic drug monitoring. METHODS: This is a training-based quasi-experimental study. The residents and nurses of the Cardiology Clinic were trained first in December 2017, and refresher training courses were carried out every month throughout the study. The medical data of the inpatients receiving digoxin therapy were recorded prospectively, between January and December 2018. The appropriateness of the physicians' orders for SDC measurement was evaluated according to the criteria of the right indication and right timing of blood collection. The results are presented by descriptive statistics, Student's t-test and χ2 analysis. RESULTS: A total of 232 SDC tests were ordered for 121 patients (age: 71.0±12.6 years, 56.2% women). Of these orders,129 (55.6%) were considered appropriate: 205 (88.4%) for indication and 129 (62.9%) for blood collection timing. There was a significant correlation between inappropriate order for SDC test and the age of the patient, female gender, impairment of renal function tests, high levels of serum BNP and the number of medications used (P<0.005). CONCLUSIONS: Approximately a one-half decrease in inappropriate tests compared with our previous study results imply that education has a positive effect on physician behaviour. However, physicians' concerns due to increased risk factors for the patient still play a role in inappropriate test-ordering.

Unmet health and social care needs and associated factors among older people aged ≥ 80 years in Izmir, Turkey.

BACKGROUND: The health and social care needs of people aged ≥ 80 years are a neglected topic. AIMS: To determine the prevalence of unmet health and social care needs and associated factors in community-dwelling individuals aged ≥ 80 years in Izmir District of Balçova, Turkey. METHODS: There were 1075 participants aged ≥ 80 years. The dependent variables were unmet health and social care needs. Independent variables were sociodemographic, socioeconomic and lifestyle characteristics. The data were collected in face-to-face interviews conducted at the homes and analysed by multiple logistic regression model. Ethical approval was obtained from the Non-Invasive Research Ethics Board of Dokuz Eylul University Medical Faculty (2017/26-24). RESULTS: The mean age was 84.1 (3.7) years and 61.0% were female. Healthcare needs were expressed by 88.2% of the participants and 78.9% claimed that they had social care needs. Prevalence of unmet health and social care needs was 32.5% and 46.6%, respectively. Approximately 90.0% of their needs were covered by families. Perceived low-income status was a risk factor for unmet healthcare needs, and lack of social support was a risk factor for unmet social care needs. Additionally, not receiving formal education was a protective factor in unmet social care needs. CONCLUSION: Public health policy should be developed to enable better access to care, especially for the oldest people, considering that nearly one third of the participants in this study had unmet healthcare needs and almost half had unmet social care needs.

Potentially inappropriate medication use in elderly patients treated in intensive care units: A cross-sectional study using 2019 Beers, STOPP/v2 Criteria and EU(7)-PIM List.

OBJECTIVE: To determine the prevalence of and the risk factors for Potentially Inappropriate Medication (PIM), the drug groups most commonly evaluated as PIMs in elderly patients in the ICUs by using 2019 Beers Criteria, STOPP version 2 (v2) Criteria and EU(7)-PIM List. The relation between mortality rate and length of ICU stay with PIMs was also examined. METHODS: This was a cross sectional study conducted on patients aged ≥65 years, treated in ICUs (n = 139) between June 8, 2020, and January 11, 2021. Patients' demographic characteristics, clinical data and laboratory findings about the drugs used were collected prospectively. PIMs were evaluated according to each of the criteria applied. Relationship of dependent and independent variables was evaluated using chi-square analysis, t-test and logistic regression analysis. P < .05 was considered statistically significant. RESULTS: The number of patients with at least 1 PIM according to three criteria was 118 (84.9%) (80.6%, 59.7%, 48.2%, Beers, STOPP/v2 and EU(7)-PIM List, respectively). In the univariate analysis, receiving renal replacement therapy and high number of drugs were the covariates that significantly affected the presence of PIM according to all three criteria (P < .05). Combined use of anxiolytics and opioids in Beers Criteria (58.3%), antipsychotics (26.6%) in STOPP/v2 Criteria, and antiarrhythmics (23.7%) in EU(7)-PIM List were the drugs that caused PIM at most. No relationship was found between the presence of PIM and mortality. The length of ICU stay was determined significantly longer in the presence of PIM according to Beers Criteria (P = .028). CONCLUSIONS: In this study, the prevalence of PIM was determined higher in elderly patients in ICU. Our results supported that 2019 Beers Criteria for ICU patients seems to be more directive in detecting PIMs and determining the prognosis. Reducing the number of drugs administered may be the first step to decrease PIMs in elderly patients in ICU and to maintain the treatment safely.

Knowledge, opinions and attitudes of primary care physicians about generic drugs: a cross-sectional study.

BACKGROUND: Generic drug (GD) use is affected by many factors, including physicians' approach. OBJECTIVE: This study aimed to investigate the knowledge, opinions and attitudes of primary care physicians (PCPs) about GDs and potentially associated factors. METHODS: An adequately representative sample (n = 354) of PCPs was determined via stratified and simple random sample selection method in this descriptive, cross-sectional study. The research data were collected through a face-to-face 40-item survey, where the knowledge, opinions and attitudes about GDs were questioned. The prescribing percentage of GDs overall was also examined. RESULTS: The survey was completed by 305 PCPs (mean age: 49.2 ± 7.9 years; 57.4% male). The rate of correct responses about GDs was 67.6% for basic knowledge and 46.6% for the development process. The percentages of PCPs who declared that GDs were 'less efficacious', 'of lower quality' and 'less safe' than original drugs were 65.2%, 53.4% and 35.4%, respectively. More than half (60.3%) of the PCPs declared not to pay attention to whether the drug is generic while prescribing. It was observed that, as the knowledge level of the physicians increased, negative opinions and prescribing attitudes regarding the effectiveness, quality and safety of the GDs decreased. The rate of GD prescribing (51.6%) in Izmir was lower than the rest of the country (54.6%; P < 0.001). CONCLUSION: This study shows that the knowledge of PCPs about GDs is generally inadequate, which reflects negatively on their opinions and attitudes regarding the use of GDs. Educational activities can help establish awareness that GDs can be used without doubt of their effectiveness, quality and safety.

The prevalence of sarcopenia risk and associated factors in patients aged 65-79 years living in a district of Izmir province of Turkey.

OBJECTIVES: This study aims to investigate the prevalence of sarcopenia risk and associated factors in a community-dwelling elderly population in a district of Izmir province of Turkey. PATIENTS AND METHODS: This cross-sectional study used a cluster sampling method to define sarcopenia risk and associated factors in population aged 65-79 years in Balcova district and a total of 254 participants (114 males, 140 females; mean age 70.0 years; range 65 to 79 years) were included between October 2014 and December 2014. The dependent variables were low gait speed (LGS), low grip strength (LGrS), having both LGS and LGrS, sarcopenia risk according to the European Group on Sarcopenia for Older People (EWGSOP) algorithm. The independent variables were socio-demographic and socio-economic variables, health-related behavioral factors, and health status variables. The gait speed was measured on a four-meter length with a stopwatch. The grip strength was measured using a hand-held dynamometer. The logistic regression models were used to identify associated risk factors for sarcopenia. RESULTS: The prevalence of LGS was found to be 45.0%, LGrS to be 49.8%, having both LGS and LGrS to be 30.1%, and sarcopenia risk according to EWGSOP to be 64.8%. The main associated factors of having any sarcopenia risk were increasing age and having a sedentary lifestyle or being underactive. CONCLUSION: Our study results show that sarcopenia risk is high in a community-dwelling elderly population living in Balcova district of Izmir province of Turkey. Physical activity levels of elderly should be increased to decrease this high burden.

Falls, fear of falling and related factors in community-dwelling individuals aged 80 and over in Turkey.

OBJECTIVE: This study aimed to determine the prevalence of falls, fear of falling (FOF) and related factors in individuals aged 80 and over living in the Balçova district of Izmir. METHODS: One thousand and seventy-five individuals aged 80 years or older participated. The dependent variables were falls and fear of falling. The independent variables were socio-demographic and socio-economic characteristics, health-related characteristics and 'safety status of home' features. RESULTS: The participants' mean age was 84.1 ± 3.7 (range, 80-101) years, and 60.8% were female (n = 582). The prevalence of falls was 35.4% in the last year, and fear of falling was 86.6%. The risk factors for falls were number of chronic diseases, moderate and high fall risk, sleep disturbance and slippery bathroom floors, whilst for fear of falling they were number of chronic diseases, female gender, living alone and moderate or high fall risk. CONCLUSION: A monitoring program is indicated to address high fall and fear of falling prevalence among people aged 80 and over.

Appropriateness of digoxin measurement in hospitalized patients.

INTRODUCTION: Measurement of serum digoxin concentrations before steady-state is reached results in a falsely low concentration, and may affect treatment safety. We evaluated the proportion of serum digoxin measurements performed before steady-state is reached and the reasons for inappropriate sampling in hospitalized patients. MATERIALS AND METHODS: Electronic medical records of patients hospitalized between January 2011 and December 2015 treated with oral digoxin, that had more than one digoxin measurement were included. Serum digoxin measurements performed before achievement of pharmacological steady state were considered as inappropriate. The chi-square and chi-square for trend tests were used to analyse the relationship between inappropriate measurements and age, gender, diagnosis, inpatient service, serum digoxin, potassium and creatinine concentrations. RESULTS: We evaluated 2065 hospital admissions for 1621 patients and 11,407 digoxin measurements. The time between consecutive measurements was 1.9 ± 2.4 days and 97% of all measurements were classified as inappropriate. There was no releationship between patient age, gender, serum creatinine concentration and inappropriate measurement. As opposed to expected, inappropriate digoxin measurement was higher when potassium concentrations were within the normal range (P = 0.025). Share of inappropriate determinations of digoxin was higher when concentrations > 2.6 nmol/L were recorded (P < 0.05). These measurements were requested most often in coronary care unit and cardiology department. CONCLUSIONS: In our study, inappropriate serum digoxin measurement was found to be very high although only one of the appropriateness criteria was evaluated. The findings reveal the need for some strategies to prevent inappropriate measurements and reduce costs.

Prevalence and risk factors of depression among community dwelling elderly.

Depression in the elderly is associated with increased morbidity and mortality. The purpose of this study was to determine the prevalence and risk factors of depression among community-dwelling older population in an urban setting in Turkey. This cross-sectional study was conducted among 482 elderly individuals 65 years and over in an urban area. Cluster sampling method was used for sample size. Depression in the elderly had been diagnosed by a clinical interview and Geriatric Depression Scale. Data were collected by door-to-door survey. Chi square test was used for statistical analysis. P value, which was calculated by the results of chi square test and coefficient of phi (φ), below 0.05 was included in the analysis of logistic regression. Depression was significantly associated with female gender, being single or divorced, lower educational status, low income, unemployment, and lack of health insurance. However, logistic regression analysis revealed higher depression rates in the elderly with chronic obstructive pulmonary disease, psychiatric disease, cerebrovascular disease, low income and being dependent. Depression is common among community-dwelling older people in an urban area of Izmir, Turkey. Older adults living in community should be cautiously screened to prevent or manage depression.

Relationship of socioeconomic status with health behaviors and self-perceived health in the elderly: A community-based study, Turkey.

AIM: The purpose of the present study was to determine the effects of socioeconomic status on health behaviors and perceived health. METHODS: The present cross-sectional study included 2947 community-dwelling older adults aged 65 years and older. Dependent variables were health behaviors and self-perceived health. The independent variable was socioeconomic status. RESULTS: In men, the risk of unhealthy diet was higher among the uneducated group (OR 4.48) and among those with poor/very poor economic status (OR 3.31). Additionally, in men, having poor/very poor self-perceived health was found to be 3.50-fold significantly higher among the uneducated group than the secondary school and higher-educated group. Lower education level and lower social class were found to be protective factors for smoking in women. In women, the risk of unhealthy diet was found to be 1.54- and 2.18-fold significantly higher, respectively, among those who graduated from primary school and uneducated. There was also a relationship between poor/very poor economic status and unhealthy diet among elderly women (OR 2.80). In women, the risk of physical inactivity was found to be 1.98-fold significantly higher in the uneducated group and 1.79-fold significantly higher in those with poor/very poor economic status, 0.33-fold significantly lower in skilled employees/white collar workers. With regard to self-perceived health status, education level and perceived economic status were significantly related to poor/very poor health status in women (OR 2.09 and OR 4.08, respectively). CONCLUSION: In older men and women, lower socioeconomic status increases the risk of unhealthy diet and poor health perception. In older women, lower socioeconomic status is a protective factor for smoking, but it also increases physical inactivity.

Waist:height ratio: a superior index in estimating cardiovascular risks in Turkish adults.

OBJECTIVE: To determine the best anthropometric measurement among waist: height ratio (WHtR), BMI, waist:hip ratio (WHR) and waist circumference (WC) associated with high CHD risk in adults and to define the optimal cut-off point for WHtR. DESIGN: Population-based cross-sectional study. SETTING: Balcova, Izmir, Turkey. SUBJECTS: Individuals (n 10 878) who participated in the baseline survey of the Heart of Balcova Project. For each participant, 10-year coronary event risk (Framingham risk score) was calculated using data on age, sex, smoking status, blood pressure, serum lipids and diabetes status. Participants who had risk higher than 10 % were defined as 'medium or high risk'. RESULTS: Among the participants, 67·7% were female, 38·2% were obese, 24·5% had high blood pressure, 9·2% had diabetes, 1·5% had undiagnosed diabetes (≥126 mg/dl), 22·0% had high total cholesterol and 45·9% had low HDL-cholesterol. According to Framingham risk score, 32·7% of them had a risk score higher than 10 %. Those who had medium or high risk had significantly higher mean BMI, WHtR, WHR and WC compared with those at low risk. According to receiver-operating characteristic curves, WHtR was the best and BMI was the worst indicator of CHD risk for both sexes. For both men and women, 0·55 was the optimal cut-off point for WHtR for CHD risk. CONCLUSIONS: BMI should not be used alone for evaluating obesity when estimating cardiometabolic risks. WHtR was found to be a successful measurement for determining cardiovascular risks. A cut-off point of '0·5' can be used for categorizing WHtR in order to target people at high CHD risk for preventive actions.

High prevalence of cardiovascular risk factors in a Western urban Turkish population: a community-based study.

OBJECTIVE: Cardiovascular diseases (CVD) are the largest cause of morbidity and mortality in Turkey and in the World. Heart of Balçova Project is a community- based health promotion project that aims to reduce CVD incidence and prevalence through risk factor modification in the individual and population level. This paper presents results of the baseline survey that aimed to define CVD risk factors and risk of developing coronary heart disease (CHD) in the Balçova population. METHODS: The study population included 36,187 people over 30 years of age residing in Balçova in 2007. Individuals were interviewed at their homes. Anthropometrics and blood pressure were measured and in total 12914 fasting blood samples were collected for lipid and glucose analyses. CHD risk was estimated using Framingham risk equation. Student's t test, Chi-square for trend test and ANOVA were used to compare mean levels and percentages of risk factors between age groups and gender. RESULTS: In total 5552 men and 10528 women participated in the study. Smoking prevalence was 38.6% in men and 26.8% in women. The prevalence of obesity was 29.4% among men and 44.2% among women and obesity prevalence increased until the age group 75 years old. While 14.6% of men and 12.6% of women had diabetes, 39.8% of men and 41.8% of women had hypertension. The prevalence of high total cholesterol was 56.0% in men and 50.6% in women. Men had a higher risk of developing CHD compared to women in the following 10 years (13.4% vs 2.5%). CONCLUSION: The prevalence of preventable risk factors for CHD is very high in Balçova population. Community-based interventions should be planned and implemented targeting both the high-risk individuals and whole population.

Balcova heart study: rationale and methodology of the Turkish cohort.

OBJECTIVES: Turkey is facing increasing rates of cardiovascular disease (CVD). The study is designed to meet the growing need to obtain information about the recent status and trends of CVD risk factors and their impact on mortality. METHODS: Balcova heart study (BHS) is a prospective cohort study, focusing on reducing the CVD risk factors of people over 30 years old living in Balcova District, Izmir, Turkey. Information about risk factors, anthropometric and biochemical measurements was collected in community centers. Interventions were planned, based on the 10-year coronary heart disease (CHD) risk and lifestyle characteristics with the collaboration of university and municipality. RESULTS: Mean age of the 16,080 participants was 52 years. The percentage of current smoking was 41.6 in men and 31.1 in women. One-third of the men were physically inactive. Hypertension was reported as 25% in men and 33% in women. CONCLUSIONS: The project is unique for being the first community-based cohort on CVD risk factors in a Turkish setting. This project will have a valuable contribution on not only determining CVD risks, but also incorporating interventions for prevention.

[Effects of social inequalities on coronary heart disease risk factors: a population-based, cross-sectional study in Izmir]. / Sosyal esitsizliklerin koroner kalp hastaligi risk etmenlerine etkisi: Izmir'de topluma dayali, kesitsel bir çalisma.

OBJECTIVE: Aim of the study was to determine effects of social inequalities on coronary heart disease risk factors in individuals living in an urban district of Izmir; namely Balçova. METHODS: In this cross-sectional study, no sampling was done and it was aimed to reach all residents living in that area aged 30 years and over (n=4409). Dependent variables were smoking, physical inactivity, unhealthy diet, obesity, hypertension, diabetes, dyslipidemia where social inequality was the independent variable. Educational status, income and social class were considered as the components of social inequality. Age, gender, family health histories were the confounding factors. Data were collected at home and in the neighborhood-house. For data analyses Chi-square test, and logistic regression analysis were used. RESULTS: Smoking is higher in men and women in lower socio economic class, where unhealthy diet is higher in self-employed men (OR=9.24, 95% CI=1.14-74.81, p=0.037) and in women who have a lower education (OR=1.53, 95% CI=1.02-2.30, p=0.040), lower income or unemployed (OR=3.43, 95% CI=1.28-9.14, p=0.014). Obesity is more frequent in lower educated women (OR=1.89, 95% CI=1.37-2.59, p<0.001) where decreased high-density lipoprotein cholesterol (HDL-C) is more frequent in men who have lower income (OR=2.21, 95% CI=1.20-4.07, p=0.011). Men who have a lower education (OR=0.61, 95% CI=0.38-0.98, p=0.039) or working as a skilled (OR=0.37, 95% CI=0.16-0.89, p=0.027) or an unskilled worker (OR=0.35, 95% CI=0.15-0.82, p=0.016) tend to have a decreased risk of obesity when working as a skilled worker (OR=0.53, 95% CI=0.29-0.95, p=0.033) decreases elevated low-density lipoprotein cholesterol. CONCLUSION: Coronary heart disease risk factors are high among participants who are aged 30 years and over. Men are under higher risk than women are. An increase in social inequalities causes decreased HDL-C in men, and increased smoking, unhealthy diet and obesity in women.

[Do general practitioners diagnose and treat patients with alcohol use problems?]. / Pratisyen Hekimler Alkol Kullanim Sorunlari Olan Hastalari Taniyor ve Tedavi Ediyorlar Mi?

AIM: To determine the primary health care working general practitioners' knowledge, attitude and behavior towards alcohol use disorders. METHOD: In this descriptive and cross-sectional study 135 general practitioners (GPs) completed the questionnaire. RESULTS: Pre and post graduate education on alcohol use disorders is low (25.4 % and 11.7% respectively). Most of the GPs do not know the levels of risky alcohol use, screening tests, and biochemical markers. The mean knowledge score is 6.67+/-1.70. Most GPs think that alcohol use disorders are not an important issue in primary health care (57%), they do not have time to deal with patients' alcohol problems (74.1%), it is difficult to diagnose risky alcohol users without clear symptoms (91.1%), patients do not follow advice on alcohol use (85.2%), and physicians themselves are tolerant towards alcohol (71.1%). Half of the GPs reported that they find it difficult to talk about alcohol use with patients and think that patients may be angered by alcohol consumption questions. Mean attitude score is 4.44+/-2.15. Most of the GPs reported that they would ask questions about alcohol use to their patients (91.7%) and declare that the patients' problems were related to alcohol (90.2%). More than half of them reported that they would refer the patient to a specialist or an alcohol treatment center (58.5%). The mean behavior score is 5.96+/-1.46. CONCLUSION: In our country it is clear that more education and support for GPs is needed due to their important role in intervention for alcohol use problems.

Reliability and validity of revised Turkish version of Mini Mental State Examination (rMMSE-T) in community-dwelling educated and uneducated elderly.

OBJECTIVE: To evaluate the reliability and validity of the revised Turkish version of Mini Mental State Examination (rMMSE-T) in educated and uneducated community-dwelling elderly, to re-organize the present Turkish version of MMSE and to determine cut-off point of the revised test. METHODS: This cross-sectional and analytical study involved totally 490 elderly subjects selected by cluster sampling method. Receiver operating characteristic (ROC) analysis, kappa analysis and Cronbach's alpha coefficients were used for statistical analysis. RESULTS: Areas under ROC curve in educated and uneducated elderly were found as 0.953 and 0.907. Cut-off point of 22/23 of rMMSE-T in educated elderly had the highest sensitivity (90.9), specificity (97.0) and positive likelihood ratio (30.3), whereas cut-off point of 18/19 of the test in uneducated elderly had the highest sensitivity (82.7), specificity (92.3) and positive likelihood ratio (10.7). The Cronbach's alpha values of the rMMSE-T for educated and uneducated elderly were higher than 0.7 (sign of good internal consistency of the test). A significant correlations between intrarater and interrater test-retest in educated elderly subjects were observed (0.966 (p = 0.000); 0.855 (p = 0.000), respectively), and also in uneducated elderly (0.988 (p = 0.000); 0.934 (p = 0.000), respectively). Kappa value of the test in educated and uneducated elderly showed a perfect agreement interraters (1.000) and a substantial agreement in intraraters (1.000, 0.784; 0.826, 0.656, respectively). CONCLUSION: rMMSE-T had a high reliability and validity. It will be more appropriate to use the revised test and the new cut-off point for the diagnosis and screening of dementia among community-dwelling Turkish elderly population.

Home accidents in the community-dwelling elderly in Izmir, Turkey: how do prevalence and risk factors differ between high and low socioeconomic districts?

OBJECTIVE: To determine and compare the prevalence of and risk factors for home accidents in the elderly in two different districts. METHOD: This cross-sectional study involves 497 older participants ages 65 and older. Sociodemographic characteristics of the elderly and characteristics of the houses in two different regions are evaluated. Data are analyzed by chi-square and t test. RESULTS: The prevalence of home accidents was 39.3% in the low socioeconomic region and 13.1% in the high socioeconomic region within the past 6 months (p = .000). The most common type of home accident was fall (61.8%), followed by cut or piercing (22.0%). Home accidents are associated with being female and increasing age in the higher socioeconomic region, whereas being female, being unmarried, and living in a squatter house are associated with home accidents in the low socioeconomic region. DISCUSSION: The prevalence of home accidents in the elderly population who live in low socioeconomic region was higher.

Elder abuse and neglect in two different socioeconomic districts in Izmir, Turkey.

OBJECTIVE: To determine and compare the prevalence and risk factors of elder abuse in elderly population in two different districts in Izmir, Turkey. METHODS: This cross-sectional study involved 497 subjects selected by cluster sampling. RESULTS: The prevalence of physical and financial abuse among the elderly in the district of low socioeconomic status was 1.5% and 2.5%, respectively, while among the elderly in the district of high socioeconomic status, it was 2% and 0.3%, respectively. However, the prevalence of elder neglect in the two districts was 27.4% and 11.2%, respectively. Prevalence of neglect was associated with infrequent contact with relatives, little or no income, and fewer years of education among the elderly in the low socioeconomic district. In the high socioeconomic district, neglect was associated with fewer years in education, poor health status and having chronic status. CONCLUSION: The prevalence of abuse among the elderly living in the two different districts was low. However, nearly one-fifth of elderly people were exposed to neglect.

Working conditions and related neuropsychiatric problems among shoemakers in Turkey: Do child workers differ from others?

OBJECTIVE: In this cross-sectional study, we investigated working conditions and related neuropsychiatric problems of shoemakers, including child workers, working in poor conditions with high health risks. Clinical diagnosis was not the objective of this study. MATERIALS AND METHODS: We collected data from 318 workers ranging from 8-66 years of age. We evaluated working conditions, neuropathy symptoms and signs; urinary 2,5-hexanedione was used to estimate hexane exposure. We used the Zung depression scale for adult shoemakers to evaluate depression. RESULTS: All workshops employed fewer than 10 workers with median daily work duration of 12h. Smoking and alcohol consumption were high among all workers including children. Peripheral neuropathy symptoms and signs were observed in 88 workers (27.8%) and it was related to alcohol consumption. Sixty-eight workers (47.9%) had depression and it was associated with daily work duration. CONCLUSION: Extremely poor, unhygienic, working conditions and a high prevalence of neuropsychiatric disorders were the main problems observed among shoemakers. A high number of child workers increased the scale of these observed problems.

The association of job strain with coronary heart disease and metabolic syndrome in municipal workers in Turkey.

To explore the association of job strain with CHD and metabolic syndrome in municipal workers. A cross-sectional study was completed of 450 male workers. Coronary heart disease was defined as: physician diagnosed ischemic heart disease; and/or, ischemic findings in the ECG. Metabolic syndrome was defined according to the criterion set by the National Cholesterol Education Panel. The demand-control model was used to assess job strain. Self administered questionnaires were completed after a face to face interview. Logistic regression models were constructed to assess the association of job strain with CHD and metabolic syndrome. The prevalence of metabolic syndrome and CHD were 17.8% and 8.0% respectively. Both CHD and metabolic syndrome were found to be significantly higher in higher income groups. Job demand and job control were not found to be associated with either CHD or metabolic syndrome. Metabolic syndrome was significantly more prevalent among the high job strain workers, but the significance was lost when controlled for age. The findings suggest that there is no significant association between job strain and metabolic syndrome and CHD in this sample of Turkish workers. Job strain may possibly be perceived differently in different cultures and occupations. Future studies may benefit from using a combination of different stress models and more diverse study populations.