Erkan Pehlivan

Factors affecting survival of hospitalised patients with COPD

Factors determining in-hospital mortality and long-term survival of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are not precisely understood. The aim of the present study was to assess the parameters related to in-hospital mortality and long-term survival after hospitalisation of patients with AECOPD. Clinical and epidemiological parameters on admission in 205 consecutive patients hospitalised with AECOPD were prospectively assessed. Patients were followed-up for 3 yrs. Factors determining short- and long-term mortality were analysed. In total, 17 patients (8.3%) died in hospital. In-hospital mortality was significantly associated with lower arterial oxygen tension (Pa,O2), higher carbon dioxide arterial tension, lower arterial oxygen saturation and longer hospital stay. The overall 6-month mortality rate was 24%, with 1-, 2- and 3-yr mortality rates of 33%, 39% and 49%, respectively. Cox regression analysis revealed that long-term mortality was associated with longer disease duration (relative risk (RR) = 1.158), lower albumin (RR = 0.411), lower Pa,O2 (RR = 0.871) and lower body mass index (RR = 0.830). When the model was run for the time elapsed since first hospitalisation, it also appeared as statistically significant (RR = 1.195). These findings show that patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease have poor short- and long-term survival. Prediction of survival status may be enhanced by considering arterial oxygen tension, albumin, body mass index, disease duration and time elapsed since the first hospitalisation.

The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey

BackgroundAnemia is considered a severe public health problem by World Health Organization when anemia prevalence is equal to or greater than 40% in the population. The purpose of this study was to determine the anemia prevalence with the associated factors in pregnant women and to determine the serum iron, folate and B12 vitamin status in anaemic pregnants in Malatya province.MethodsThis is a cross-sectional survey. A multi-sage stratified probability-proportional-to-size cluster sampling methodology was used. A total of 823 pregnant women from sixty clusters were studied. Women were administered a questionnaire related with the subject and blood samples were drawn. Total blood count was performed within four hours and serum iron, folate and B12 vitamin were studied after storing sera at -20 C for six months.ResultsAnemia prevalence was 27.1% (Hb < 11.0 gr/dl). Having four or more living children (OR = 2.2), being at the third trimester (OR = 2.3) and having a low family income (OR = 1.6) were determined as the independent predictors of anemia in pregnancy. Anemia was also associated with soil eating (PICA) in the univariate analysis (p < 0.05). Of anaemic women, 50.0% had a transferrin saturation less than 10% indicating iron deficiency, 34.5% were deficient in B12 vitamin and 71.7% were deficient in folate. Most of the anemias were normocytic-normochromic (56.5%) indicating mixed anemia.ConclusionsIn Malatya, for pregnant women anemia was a moderate public health problem. Coexisting of iron, folate and B vitamin deficiencies was observed among anaemics. To continue anemia control strategies with reasonable care and diligence was recommended.

Prevalence of COPD: First epidemiological study of a large region in Turkey

BACKGROUND Although chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity worldwide, epidemiological data on COPD is very limited. This study was designed to obtain some baseline data on COPD in the Malatya region of Turkey. METHODS Sixty clusters from urban and rural regions were randomly selected. Ten and seven consecutive households were included in the study from each urban and rural cluster, respectively. A validated questionnaire on the epidemiology of COPD was completed for each participant over 18 by a pulmonary physician. Each subject underwent standard spirometric measurement and early bronchodilation testing. RESULTS A total of 1160 participants completed the study (93%). Some 6.9% of the participants were found to have COPD (F/M=1/4). While the prevalence of COPD was 18.1% in current smokers over 40 years of age, the prevalence was 4.5% among younger smokers. Some 25.5% of the women and 57.2% of the men were current smokers. Biomass exposure, as a sole reason for COPD, was significantly common among female patients living in rural areas (54.5%). In the development of COPD, the relative risk ratio of cigarette smoke was found to be 3.4 and 3.3 times higher than biomass exposure and occupational exposure, respectively. CONCLUSIONS Smoking rate and COPD prevalence were found to be unexpectedly high in the region, and biomass exposure is still an important cause of COPD, particularly among females living in rural areas. We think that national policies against smoking and biomass exposure should be implemented immediately.

The role of tuberculosis in COPD

Background Influence of tuberculosis (TB) on the natural course of COPD has not been well known. This study was designed to investigate the effects of history of TB on the long-term course of COPD. Methods Patients hospitalized with COPD exacerbation were consecutively included (n=598). Cases were classified into two categories: those with TB history and those without. Clinical, demographic, and radiological features were meticulously recorded, and patients were followed up for hospitalizations due to exacerbation and for overall mortality. Results A total of 93 patients (15%) had a history of TB. On average, patients with past TB history were 4 years younger than the rest of the patients (P=0.002). Our study revealed that patients with past TB were diagnosed with COPD 4 years earlier and died 5 years earlier as compared to the patients without TB. In addition, in the past TB group, rate of hospital admissions per year was higher compared to the group that lacked TB history (2.46±0.26 vs 1.56±0.88; P=0.001). Past TB group had higher arterial carbon dioxide tension (PaCO2) and lower forced expiratory volume in 1 second (FEV1; P=0.008 and P=0.069, respectively). Median survival was 24 months for patients who had past TB and 36 months for those who had not. Kaplan–Meier analysis revealed that although 3-year survival rate was lower in patients with past TB, it was not statistically significant (P=0.08). Cox regression analysis showed that while factors such as age, PaCO2, hematocrit, body mass index (BMI) and Charlson index affected mortality rates in COPD patients (P<0.05), prior history of TB did not. Conclusion Our results showed that a history of TB caused more hospitalizations, reduced respiratory functions and increased PaCO2. It was found that, despite similarity of the overall mortality, COPD diagnosis and death occurred 5 years earlier in patients with past TB. We conclude that history of TB has an important role in the natural course of COPD.

Pelvic floor muscle strength of women consulting at the gynecology outpatient clinics and its correlation with sexual dysfunction: A cross-sectional study

Objective: To investigate the pelvic floor muscle strength of the women andevaluateits possible correlation with sexual dysfunction. Methods: In this cross-sectional type study, stratified clusters were used for the sampling method. Index of Female Sexual Function (IFSF) worksheetwere used for questions on sexual function. The pelvic floor muscle strength of subjects was assessed byperineometer. The chi-squared test, logistic regression and Pearson’s correlation analysis were used for the statistical analysis. Results: Four hundred thirty primiparous women, mean age 38.5 participated in this study. The average pelvic floor muscle strength value was found 31.4±9.6 cm H2O and the average Index of Female Sexual Function (IFSF) score was found 26.5±6.9. Parity (odds ratio OR=5.546) and age 40 or higher (OR=3.484) were found correlated with pelvic floor muscle weakness (p<0.05). The factors directly correlated with sexual dysfunction were found being overweight (OR=2.105) and age 40 or higher (OR=2.451) (p<0.05). Pearson’s correlation analysis showed that there was a statistically significantlinear correlation between the muscular strength of the pelvic floor and sexual function (p=0.001). Conclusion: The results suggested subjects with decreased pelvic floor muscle strength value had higher frequency of sexual dysfunction.

FEEDING AND HEALTHY LIFE BEHAVIORS IN MEDICINE FACULTY STUDENTS

(1) Sorumlu Yazar: Çiğdem TEKİN, İnönü Üniversitesi, Tıp Fakültesi , Halk Sağlığı A.D. Malatya / Türkiye, cigdemmoz@gmail.com, Geliş Tarihi / Received: 08.02.2017 Düzeltme Tarihi / Revision: 16.02.2017 Kabul Tarihi/ Accepted: 14.04.2017 Makalenin Türü: Type of article (Araştırma ve Uygulama / Research and Application) Çıkar Çatışması / Conflict of Interest: Yok / None “Etik Kurul Raporu Var – (İnönü Üniversitesi, Bilimsel Araştırma ve Yayın Etik Kurulu 28.06.2016 Tarih ve 2016/9-11 Kararı Numarasıyla Etik Kurul İzni Alınmıştır) TIP FAKÜLTESİ ÖĞRENCİLERİNDE BESLENME VE SAĞLIKLI YAŞAM BİÇİMİ DAVRANIŞLARI(1)

Prevalence of obesity and affecting factors in physically disabled adults living in the city centre of Malatya

Objective The purpose of this study was to investigate the prevalence of obesity, and the risk factors associated with it, in physically disabled adults living in the city centre of Malatya, Turkey. Method This research was designed as a cross-sectional study conducted on physically disabled people aged 20–65 years living in the city centre of Malatya. The prevalence of obesity in disabled people was within 95% CIs, the power was calculated as 80%, and the sample size of our population was calculated as 258 individuals. Results The prevalence of obesity was found to be 13.2%. The relationship between disability type and obesity status was found to be significant. The prevalence of obesity was 21.3% in visually impaired people, 17.9% in speech-impaired people, 17.8% in hearing-impaired people and 6.5% in orthopaedically disabled people. Conclusions Educational interventions on nutrition and lifestyle can be effective considering the high prevalence of obesity in visually impaired people, the prevalence of weakness in orthopaedically disabled people and the risk related to the area in which body fat is localised even when body mass index is within the normal range. Training disabled people in sports appropriate to their disability type and building appropriate facilities for those sports might have a positive effect.

Malatya Kent Merkezinde Yetişkinlerin Haşere Mücadelesine İlişkin Farkındalıkları ve Bilgi Düzeyleri

This study was carried out to evaluate knowledge level and awareness of adults related to pest control in Malatya city center. This cross-sectional study was conducted between March and October alternately the struggle against larval and adult vectors was done every two weeks in the suburbs of city. The districts where to struggle against larvae constituted of this research universe. In health station -based 30 cluster sampling created, the 22-item questionnaire was applied randomly in 420 household with help of team chief of spraying under the supervision of researchers. 381 adult subjects answered the questionnaire. In evaluation and analysis of research data the independent samples Students t-test, Chi-square and ANOVA were used. The 44.9% were male and 55.1% female of 381 participants. Mean age was 38.4 ± 12.7, and 10.5% illiterate, 34.9% literate or primary school graduates, 46,4% were secondary or high school and 8.1% were in the higher education of the participants. 92.6% of the participants’ awareness about the mosquitoes, 76.9% the houseflies, 29.1% the midge, and also 36.5% of subcejts were announced that were made struggle against ticks with drugs. Approximately 1/3 of participants stated that the chemical agents used for pest control were harmful to human health (32.8%) and the environmental health (35.2%) also. The men who answered to the total 13 questions correctly average 6.1 ± 1.9, and for women average 6.2 ± 1.9 was similar to each other (p = 0.885). Average scores of the participants of those under the age of 30 was 6.4 ± 2.1, the ages between 40-49 was 6.1 ± 1.9 and the ages over 60 was 5.6 ± 1.7. There was no statistically significant difference with average knowledge scores although it decreased with age (p = 0.218). The mean scores of illiterates information was 5.8 ± 2.0, and with 7.3 ± 2.0 in the higher educated ones was difference statisticially (p=0.001). Although the people largely informed on the struggle against pests in the city center, the lower knowledge scores were held. It can be said that the people do not have enough awareness about the dangers of chemical agents to human and environmental health. As a result, to raise public awareness about the integrated pest management is needed.