Influence of social environment in smoking among adolescents in Turkey

BACKGROUND: The aim of this study was to examine the social determinants of smoking among adolescents attending school and/or work. METHODS: A survey was carried out on 6012 adolescents aged between 13 and 17 years in 15 cities, recruited from schools, vocational training centres and work places. A self-completed questionnaire was used for data collection. Single- and multi-level regression analyses were run to estimate models. RESULTS: Ever smoking and current smoking rates were 41.1% and 10.5% among girls, and 57.5% and 25.2% among boys. These rates were 47.0% and 13.3% among those who only attended school, 62.2% and 31.7% among those who attended school and worked simultaneously, and 67.5% and 43.0% among those who worked and did not attend school. In multi-level analysis, the major predictors of current smoking were close friends smoking [odds ratio (OR) 3.48; 95% confidence interval (CI) 1.93-6.27], no knowledge of harmful effects of short-term smoking (OR 2.15; 95% CI 1.74-2.67), vulnerability to peer pressure (OR 1.90; 95% CI 1.48-2.46), negative self-perception (OR 1.69; 95% CI 1.31-2.18) and male sex (OR 1.68; 95% CI 1.30-2.16). Mothers higher education was a predictor for girls' smoking, while mother's lower education was a predictor for boys' smoking. At the school level, smoking prevalence was a predictor of current smoking (OR 1.07; 95% CI 1.05-1.08). CONCLUSIONS: Smoking patterns were similar to Western countries in several aspects, while male prevalence rates were higher and the impact of gender-related predictors was significant. Our findings suggest that youth smoking prevention policies should address personal, familial and educational environmental level requirements, taking into consideration the gender differences in addition to international guidelines.     

Prevalence of Posttraumatic Stress Disorder and Comorbid Depression in Earthquake Survivors in Turkey: An Epidemiological Study

This study examined the prevalence of posttraumatic stress disorder (PTSD) and depression 14 months after the earthquake in Turkey in 2 randomly selected samples from the epicenter (n = 530) and a suburb of Istanbul 100 km from the epicenter (n = 420). The rates of PTSD and depression comorbid with PTSD were, respectively, 23 and 16% at the epicenter and 14 and 8% in Istanbul. The strongest predictor of traumatic stress symptoms was fear during the earthquake, whereas predictions with female gender, past psychiatric illness, damage to home, participation in rescue work, past trauma, and loss of close ones were significant but weak. Our findings suggest that devastating earthquakes have long-term psychological effects. Psychological interventions reducing fear may improve PTSD in survivors.     

A survey of the public attitudes towards organ donation in a Turkish community and of the changes that have taken place in the last 12 years

In 1990 we carried out a survey on public attitudes toward organ donation in a Turkish community. We repeated this study 12 years later in order to evaluate the changes that had taken place in the meantime. Using the same questionnaire and method, we repeated the study in a different part of the city with similar socio-economic characteristics as in the former area, which had in the meantime ceased to be our research and training area. The 983 participants were chosen by a random stratified method. Of those interviewed, 57.0% were willing to donate, while 18.3% refused and 24.7% were uncertain. A total of 52.6% consented to donation. Twelve years later, some public attitudes toward organ donation had changed. Refusal to donate for religious reasons had diminished (16.1% versus 26.2%); uncertainty whether to donate had risen (24.7% versus 15.8%). Attitudes towards organ donation were clearly related to educational level, age and sex.     

Effect of several sociodemographic factors on measles immunization in children of Eastern Turkey

This study was performed to determine the status of measles immunization and the effect of several sociodemographic factors on immunization in children aged between 10 months and 6 years. Using cluster sampling, 663 healthy children were selected at random from three provinces in Eastern Turkey. The immunization histories of these children were obtained from their immunization cards. With respect to their vaccination status, children were categorized as vaccinated, unvaccinated or unknown. If the child had no immunization card, he or she was classified as unknown. Of these children, 81.6% were vaccinated and 15.1% were unvaccinated. The vaccination status was not known in 3.3% of the children. In children aged 10-12 months, the vaccination rate was 68.6%. For age groups of 1-2, 2-3, 3-4, 4-5 and 5-6 years, the vaccination rates were 84.2, 82.2, 85.3, 82.1 and 76.8%, respectively, but these differences were not significant. The vaccination rates increased in parallel with maternal education level (P = 0.009). Also, vaccination rates were significantly correlated with settlement area (P = 0.036), and were higher in urban regions than suburban and rural regions. There was no difference in vaccination rates with respect to gender, paternal education level, number of siblings and socio-economic status. The results of this study show that the level of immunization necessary for measles elimination has not yet been reached in Eastern Turkey. Priority should be given to increase the immunization levels to 90-95% among children.     

Neisseria meningitidis W135, Turkey

We describe the first case of Neisseria meningitidis W135 meningitis in Turkey. The strain was genotypically unrelated to the clone (W)ET-37, isolated from Hajj pilgrims in 2000.     

Rubella seroprevalence among first-grade primary school students in a district in Istanbul, Turkey

OBJECTIVES: Rubella vaccination is not included in the national immunization programme of Turkey. However, it is on the market and is recommended, mainly by the private sector, at the age of 12-15 months. Introduction of the rubella vaccine without achieving high coverage has the risk of shifting the mean age of rubella infection among the unvaccinated population to reproductive ages. The aim of this study was to evaluate the seroprevalance of rubella and the factors associated with seropositivity among primary school students in Umraniye, a district of Istanbul. METHODS: Blood samples were collected from 489 students in 70 primary schools of Umraniye. Parents completed a concise questionnaire assessing sociodemographic characteristics and measles, mumps and rubella vaccination status. RESULTS: Among the students screened, 163 (33.3%, 95% confidence intervals 29.2-37.7%) were susceptible to rubella. When sociodemographic variables were evaluated, paternal education was the only variable associated with seronegativity. As the level of paternal education increased, seronegativity rates decreased. This finding may suggest that rubella vaccination is practiced more commonly among children whose fathers are better educated. CONCLUSIONS: Surveillance and control of rubella and congenital rubella syndrome must be set as public health priorities in Turkey, particularly given that rubella vaccination is practiced partially in the country.     

Nosocomial Oral Myiasis by Sarcophaga sp. in Turkey

We present a case of oral myiasis in a 15-year-old boy with tuberculosis meningitis. The diagnosis was based on the visual presence of wriggling larvae about 1 cm in size and on the microscopic features of the maggots, especially those relating to stigmatic structures. The larvae were identified as third-stage larvae of Sarcophaga sp.     

Utilisation of personal protective equipment in dental practice

OBJECTIVE: To investigate personal protective equipment such as gloves, mask and protective eye wear used in dental practice in Turkey. DESIGN: An e-mail based self-report questionnaire was sent to dentists during 2002. PARTICIPANTS: Dentists in Turkey. RESULTS: 574 dentists aged 22-69 years responded. Thirty-six questionnaires were not included in the results. The results of the present study indicate that a high proportion of younger dentist respondents are using personal protective equipment in accordance with guidelines. More dentists use personal protective equipment for high-risk patients. The percentage of dentists using protective eyewear was low considering the general recommendations. CONCLUSION: The present study indicated that gloves and masks are used by a high proportion of the respondents. Further education may be appropriate in protective eyewear.     

The effectiveness of Watson's Caring Model on the quality of life and blood pressure of patients with hypertension

BACKGROUND: Nurses caring relationships with hypertensive patients can have a positive effect upon their blood pressure and may increase quality of life and prolongation of life. Hypertension affects a large number of people. It is important that those affected receive, in addition to the best available medical treatment, nursing care that best meets their needs and adds to the quality of their lives. Watson's Caring Model is one nursing approach consistent with needs of persons with hypertension, and was used in this study to guide both research and practice. AIM: To determine the effectiveness of a nurse's caring relationship according to Watson's Caring Model on the blood pressure and the quality of life of patients with hypertension. METHODS: The design of the study was a one-group pretest and post-test. The study included 52 patients with hypertension in four health care units in Erzurum, Turkey in 2000. These patients had been diagnosed with hypertension and invited to participate in a research project involving nursing care. After acceptance, patients were given questionnaires consisting of demographic characteristics; their blood pressure was measured, and a quality of life scale was administered. Each of the participating nurse researchers was prepared in the use of Watson's Theory and Model of Caring (and the 10 Carative Factors). This training formed the basis of the caring process used by the nurse researchers who then visited the patients and their families once a week for blood pressure measurement for a 3-month period. At the end of care, the quality of life scale was applied to patients, and blood pressures were measured as the post-test. RESULTS: There were statistically significant differences between mean scores of general well-being (t = 3.097, d.f. = 51, P = 0.003), physical symptoms and activity (t = 2.994, d.f. = 51, P = 0.004), medical interaction (t = 2.127, d.f. = 51, P = 0.035). There were also significant differences between blood pressure (systolic: t = 4.830, d.f. = 51, P = 0.000; and diastolic: t = 3.51, d.f. = 51, P = 0.001) in pre- and post-test. CONCLUSION: This study demonstrated a relationship between care given according to Watson's Caring model and increased quality of life of the patients with hypertension. Further, in those patients for whom the caring model was practised, there was a relationship between the Caring model and a decrease in patient's blood pressure. The Watson Caring Model is recommended as a guide to nursing patients with hypertension, as one means of decreasing blood pressure and increase in quality of life.     

Utilization of prenatal care in poorer and wealthier urban neighbourhoods in Turkey

BACKGROUND: The objectives of this study are to identify the individual- and neighbourhood-level determinants of utilization of prenatal care, and to identify self-reported reasons for not receiving prenatal care in Turkey. METHODS: A household-based cluster sample of 1249 women who had a child less than two years old were interviewed in five Turkish cities. Multilevel regression analysis was run to predict the influences of individual- and neighbourhood-level characteristics on utilization of prenatal care. RESULTS: Utilization of prenatal care and the quality of the care received were found to be significantly lower in poorer neighbourhoods. Using multilevel regression analysis (two levels), educational level, income, parity and having health insurance were found to be individual-level determinants, while quality of care offered and stability of the local population were found to be neighbourhood-level determinants of utilization of prenatal care. The most frequent self-reported reason for receiving no prenatal care was 'not having any complaint', and the second was 'insufficient financial resources'. CONCLUSION: There was a big difference between poor and wealthy neighbourhoods in utilization of prenatal care. This difference was partly due to a contextual effect of neighbourhood status; but mostly due to individual-level variables. Improving the quality of prenatal care may increase not only the benefits of prenatal care, but also its utilization, especially in the public sector. Health and social policies have to take into account diversity among individuals and neighbourhoods in the course of efforts to improve service quality.