Ahmet Soysal

The Association of Job Strain with Coronary Heart Disease and Metabolic Syndrome in Municipal Workers in Turkey

The Association of Job Strain with Coronary Heart Disease and Metabolic Syndrome in Municipal Workers in Turkey: Yucel Demiral, et al. Department of Public Health, Dokuz Eylül University School of Medicine, 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.

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. Students 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.

Management of health-care waste in Izmir, Turkey

The aim of this study was to evaluate health-care waste in the 18 districts of metropolitan municipality of the third biggest city in Turkey. This cross-sectional study was carried out with 825 health institutions established in the 18 districts of Izmir metropolitan municipality, in 2007. The total amount of health-care waste collected was 4841 tons and 621 kilograms per patients bed in 2007. Most of the medical wastes were collected from Konak, Karsiyaka and Bornova districts and were 2308, 272 and 1020 tons, respectively. Regarding to overpopulation, the number of health institutions in these districts are more than the number of health institutions in the other administrative districts. There was a statistically significant, positive correlation between the amount of health-care waste collected and population of the 18 districts (r = 0.79, p < 0.001), and number of beds/patients (r = 0.83, p < 0.001). To provide a safe health-care waste management metropolitan municipality must provide hazardous waste separation in health institutions, establish sterilization units for infectious waste, and provide the last storage of medical waste in completely different, safe and special areas apart from the municipal waste storage areas.

Bacteremia due to Acinetobacter ursingii in infants: reports of two cases

Acinetobacter ursingii is an aerobic, gram-negative, opportunistic microorganism which is rarely isolated among Acinetobacter species. We present two immunocompetent infants who developed bacteremia due to A. ursingii. The first patient is a two -month- old boy who had been hospitalized in pediatric surgery unit for suspected tracheo-esophageal fistula because of recurrent aspiration pneumonia unresponsive to antibiotic therapy. The second patient is a fourteen -month- old boy with prolonged vomiting and diarrhea. A. ursingii was isolated from their blood cultures. They were successfully treated with ampicillin-sulbactam. Although A. ursingii has recently been isolated from a clinical specimen; reports of infection with A. ursingii in children are rare. A. ursingii should be kept in mind as an opportunistic microorganism in children.

Prevalence of Metabolic Syndrome and Affecting Factors among Individuals Aged 30 and over in Balçova District of İzmir

BACKGROUND The studies have shown that metabolic syndrome (MetS) leads to an increase twice as much in cardiovascular diseases (CVD) and four times as much in diabetes mellitus (DM) prevalence since the second half of the 20(th) century. AIMS This study aims to determine and discuss the prevalence of the MetS and co- factors among individuals at the age of 30 and over in Balcova district of İzmir province according to the American National Cholesterol Education Program - Adult Treatment Panel III (NCEP ATP III) and InternationalDiabetes Federation (IDF) criteria. STUDY DESIGN Cross-sectional study. METHODS Data obtained from the Balcova Heart Project in İzmir were used in the study. The dependent variable of the study is MetS existence. The independent variables were socio-demographic characteristics (age, gender, education level, and marital status), self-perceived economic status, physical activity, smoking status, healthy nutrition and body mass index (BMI). RESULTS The prevalence of MetS was 36.9% according to the diagnostic criteria of IDF, while it was 27.4% according to ATP III criteria. According to the both criteria, increasing age, low education, poor economic status perception, physical inactivity, and obesity increase the risk of MetS. Apart from the IDF criteria, being female and a current smoker increase the risk of the MetS in the NCEP-ATP III. CONCLUSION Compared to educational studies of MetS as of today, which are community and health-oriented studies, it is challenging that the prevalence of MetS was found to be high for both criteria in our study. Therefore, in particular, primary health care doctors must be prompted to protect the public against DM and CVD in particular.

Socioeconomic factors associated with tobacco smoking in Turkey: a cross-sectional, population-based study

Background Gender and lower socioeconomic status are associated with smoking. Aims This study aimed to determine the association between socioeconomic factors and cigarette tobacco smoking in Balcova, Izmir, Turkey, with a focus on gender differences. Methods The study population was all men and women (36 187) aged over 30 years living in Balcova from October 2007 to May 2009. Data were collected in interviews and included smoking status (current, former, never), age, gender, marital status, educational level, occupational class/working status, health insurance and having a chronic disease. Logistic regression analysis was used to evaluate the association between socioeconomic characteristics and smoking status. Results Of the 36 187 study subjects, 16 080 (44%) agreed to participate and 15 174 (42%) with complete data were evaluated. The majority were women (66.2%); mean ages of men and women were 53.1 (SD 13.1) and 51.3 (SD 13.2) respectively. Current smoking was higher in men (41.7% versus 31.2% of women), and more men were ex-smokers (33.1% versus 13.5% of women) but more women had never smoked (55.3% versus 25.2% of men). For women, being married and having low educational level were associated with current smoking and previous smoking (P < 0.05). Current smoking was also more frequent among working women (P < 0.05). For men, low educational level and occupational class were associated with being a current smoker and an ex-smoker (P < 0.05). Conclusions Socially disadvantaged groups, especially those with low education or unemployed men, were more likely to be current smokers and smoking cessation was lower in these groups. Smoking habits were different in men and women. Socioeconomic factors should always be considered when developing smoking cessation policies.

Epstein-Barr Virus Encephalitis in an Immunocompetent Child: A Case Report and Management of Epstein-Barr Virus Encephalitis

Epstein-Barr virus (EBV) usually causes mild, asymptomatic, and self-limited infections in children and adults; however, it may occasionally lead to severe conditions such as neurological diseases, malignant diseases, hepatic failure, and myocarditis. Epstein-Barr virus-related neurological disorders include meningitis, encephalitis, and cranial or peripheral neuritis, which are mostly seen in immunocompromised patients. The therapeutic modalities for EBV-related severe organ damage including central nervous system manifestations are still uncertain. Herein, we describe a seven-year-old boy with EBV encephalitis who presented with prolonged fever, exudative pharyngitis, reduced consciousness, and neck stiffness. Cranial magnetic resonance imaging showed contrast enhancement in the bilateral insular cortex and the right hypothalamus. The diagnosis was made by EBV-DNA amplification in both the blood and cerebrospinal fluid samples. He was discharged with acyclovir therapy without any sequelae.

IL-12Rβ1 defect presenting with massive intraabdominal lymphadenopathy due to Mycobacterium intracellulare: A case report.

Infections due to non-tuberculous mycobacteria species are problematic for immunodeficient individuals. Mendelian susceptibility to mycobacterial diseases (MSMD) defines a group of genetic defects affecting cellular interactions and the interferon (IFN)-γ pathway. Patients with MSMD may present with a disseminated infection resulting from the Bacillus Calmette-Guerin vaccine, Mycobacterium tuberculosis complex, environmental nontuberculous mycobacteria or Salmonella species. Atypical mycobacterial infections and deficient granuloma or giant cell formation are important indicators for MSMD, especially in patients with a family history of parental consanguineous marriage. Herein we report the case of a boy with an IL-12Rβ1 defect who presented with massive intraabdominal lymphadenopathy due to Mycobacterium intracellulare infection. The patient was born to consanguineous parents, both heterozygous for the IL-12Rβ1 defect mutation. Debulking surgery was planned in order to decrease the abdominal mass, but could not be performed due to a high risk of fatal outcomes. He has been receiving linezolid, levofloxacin, azithromycin, rifabutin and IFN-γ therapy for the past 14 months. At follow-up, the patient showed significant clinical improvement and weight gain.

The metabolic syndrome prevalence and associated social and economic factors in a population of age between 30 and 69years: from the ongoing trial of Balcova Heart Study.

The term ‘socioeconomic status’ covers a wide range of measures, including education, income, occupation, living conditions, income inequality, and many other aspects of life [1]. Little is known on the association between social and economic factors and the metabolic syndrome, considered as a distinct clinical entity, specially addressing gender effects in the social patterning of the disease [2]. In this community-based cross-sectional study, prevalence of the metabolic syndrome and associated socioeconomic status was assessed among the 30–69 year old residents of an administrative quarter in Izmir, in 2008. At the time of the study, the population of the quarter in this age group was 3754. Data were collected in two stages. Firstly, detailed information was provided to the individuals who agreed to participate in the study during household visits, and every participant completed a questionnaire by face-to-face interview with trained surveyors at home. The questionnaire was defined by Boratavs [3] classification of social inequalities for the urban areas and included questions on the demographic and socioeconomic status of the participants. Education, household income and social class were considered to be the major inequalities in the study. Secondly, anthropometric measures and blood samples of the participants were collected at the community center. The study period included 30 days. After excluding participants who did not attend the first or the second visit and with missing or incorrect data in the main variables, a total of 1883 subject were included in the study with a 50.2% of response rate. Participation among women was higher than men, because, most of the men were working during office hours and failed to attend to the second visits at the community center. The mean age of the excluded subjects was 48.1±8.3 years with a male to female ratio of 2.4. To define the metabolic syndrome according to the NCEP ATP III guidelines [4], three out of five risk factor components are required, and the definition does not specify that any particular component be present. Based on the International Standard Classification of Education, illiterate, primary and secondary schools were pooled as the low educated class (LEC) [5]. Household income was assessed by self report according to the minimum wage in Turkey. Participants with missing substantial data (55 women and 11 men) were excluded from income analysis. Social classes and income were defined according to Boratav as presented in Table 1 [3]. Univariate analyses were performed to evaluate the statistical significance of the prevalence rates of the social inequalities in women and men with the metabolic syndrome. Binary logistic regression analysiswas used formen andwomen to assess the association between social inequalities and the metabolic syndrome. Covariates in the final model included level of education, household income and occupation with the presence of the metabolic syndrome as a dependent variable.

The Effects of Psychosocial Factors on Work Accidents in İzmir Konak Municipality Cleaning Workers.

AIM: The aim of this cross-sectional study was to investigate the relationship between psychosocial factors and work accidents among waste collector workers in Izmir Konak Municipality Cleaning Services Section. The study consisted 92 (%68) out of 135 workers of those accepted to participation. METHOD: face-to-face questionnaire were administered for data collection. Dependent variable was the work-related accident for previous six months. Independent variables were sociodemographic features, working conditions, mental health status, daytime sleepiness, workload and social support. The chi-square test and the logistic regression models used for data analysis. RESULTS: Work accident prevalence was 32.6% for the last 6 months. Age and workload were significantly affected work-related accidents (p=0.03; p=0.01 respectively). Social support, mental health status and daytime sleepiness status did not effect work-related accident prevalence (p=0.48; p=0.21; p=0.30 respectively). CONCLUSION: Results of the study indicated that work-related accident prevalence is high among workers in Izmir Konak Municipality. Workload was found important risk factor for the work accident among waste collector workers.