Fuat Torun

Vaccination against pandemic influenza A/H1N1 among healthcare workers and reasons for refusing vaccination in Istanbul in last pandemic alert phase

Coverage of the HCWs as target population is one of the important determinants for the impact of vaccination. To determine the vaccination against the pandemic influenza A/H1N1 among HCWs, we conducted a cross-sectional questionnaire survey in a public hospital in Istanbul from December 7 to December 22, 2009. Out of total 941 HCWs 718 (76.3%) completed the questionnaires. Nearly one-fourth (23.1%) of the participants were vaccinated against pandemic influenza A/H1N1. Occupation (being a doctor), receiving seasonal influenza vaccine in 2009, agreement with safety of pandemic influenza A/H1N1 vaccine and being comprehend that HCWs have a professional responsibility for getting vaccinated was the strongest independent predictive factor for accepting the pandemic influenza A/H1N1 vaccine (p<.0001). The most frequent reasons for refusing pandemic vaccine were fear of side effects and doubts about vaccine efficacy. Among HCWs 59.6% were recommending pandemic influenza vaccination to a patient even if indicated. In conclusion vaccination against pandemic influenza A/H1N1 is insufficient among HCWs. Misinformed or inadequately informed HCWs are important barrier to pandemic influenza vaccine coverage of the general public also. Educational campaigns concerning HCWs should include evidence based and comprehensible information about possible adverse effects and their incidence besides the advantages of vaccine.

Healthcare workers as parents: attitudes toward vaccinating their children against pandemic influenza A/H1N1

BackgroundBoth the health care workers (HCWs) and children are target groups for pandemic influenza vaccination. The coverage of the target populations is an important determinant for impact of mass vaccination. The objective of this study is to determine the attitudes of HCWs as parents, toward vaccinating their children with pandemic influenza A/H1N1 vaccine.MethodsA cross-sectional questionnaire survey was conducted with health care workers (HCWs) in a public hospital during December 2009 in Istanbul. All persons employed in the hospital with or without a health-care occupation are accepted as HCW. The HCWs who are parents of children 6 months to 18 years of age were included in the study. Pearsons chi-square test and logistic regression analysis was applied for the statistical analyses.ResultsA total of 389 HCWs who were parents of children aged 6 months-18 years participated study. Among all participants 27.0% (n = 105) reported that themselves had been vaccinated against pandemic influenza A/H1N1. Two third (66.1%) of the parents answered that they will not vaccinate their children, 21.1% already vaccinated and 12.9% were still undecided. Concern about side effect was most reported reason among who had been not vaccinated their children and among undecided parents. The second reason for refusing the pandemic vaccine was concerns efficacy of the vaccine. Media was the only source of information about pandemic influenza in nearly one third of HCWs. Agreement with vaccine safety, self receipt of pandemic influenza A/H1N1 vaccine, and trust in Ministry of Health were found to be associated with the positive attitude toward vaccinating their children against pandemic influenza A/H1N1.ConclusionsPersuading parents to accept a new vaccine seems not be easy even if they are HCWs. In order to overcome the barriers among HCWs related to pandemic vaccines, determination of their misinformation, attitudes and behaviors regarding the pandemic influenza vaccination is necessary. Efforts for orienting the HCWs to use evidence based scientific sources, rather than the media for information should be considered by the authorities.

The efficacy of venlafaxine in treatment of depression in Parkinson`s disease / Parkinson hastalığında depresyon tedavisinde Venlafaksin’in etkinliği

Objective: Depression is the most common psychiatric disorder appearing in Parkinson‘s Disease (PD) with an average prevalence rate almost 40-50 %. Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are currently used in the treatment of depression in patients with PD, but we have not found any studies in the literature regarding this treatment choice. The aim of this prospective study was to investigate the therapeutic efficacy of venlafaxine, which is a SNRI antidepressant, in the treatment of depression in Parkinson’s disease. Method: Fourteen non-þuctuating PD patients with depression were enrolled in the study. The Hamilton Depression Rating Scale (HAM-D), the Montgomery-Asberg Depression Rating Scale (MADRS), the Unified Parkinson’s Disease Rating Scale (UPDRS), and the Hoehn-Yahr Scale (H+Y) were used to assess depression and Parkinsonism. Antiparkinson and other medications were unchanged during the study. Results: After 8 weeks of venlafaxine treatment, statistically significant improvement was seen in total scores of HAM-D and MADRS in all patients. On the other hand, the changes in UPDRS scores and H+Y stages were not statistically significant. Conclusion: The results of the study suggest that venlafaxine may be effective in the treatment of depression in patients with PD.

Efficacy of Sertraline in the Treatment of Depression in Patients with Parkinson's Disease

ABS TRACT Ob jec ti ve: We in ves ti ga ted the ef fi cacy and sa fety of ser tra li ne in the tre at ment of dep res si on in pa ti ents with Par kin son’s di se a se (PD) wit ho ut mo tor os cil la ti ons. Ser tra li ne has less po ten ti al for phar ma co ki ne tic drug in te rac ti ons than ot her an ti dep res sants and this fe a tu re ensu res an to le ra bi lity pro fi le es pe ci ally in the el derly. Ma te ri al and Met hods: Six te en pa ti ents with PD who we re di ag no sed with ma jor dep res si on ac cor ding to DSM-IV cri te ri a we re inc lu ded in this open-la bel tri al for 8th we eks. An ti-par kin so ni an me di ca ti ons ha ve not be en mo di fi ed thro ug ho ut the study pe ri od. Ini ti al ser tra li ne do se was 25 mg for the first we ek and then in cra sed to 50 mg gi ven every mor ning. For as sess ment of dep res si on, Beck Dep res si on In ven tory (BDI) and Ha mil ton Dep res si on Ra ting Sca le (HAM-D) we re used and Uni fi ed Par kin son’s Di se a se Ra ting Sca le (UPDRS) and Ho ehn-Yahr Sca le we re used for par kin so nism. Re sults: BDI and HAM-D sco res dec re a sed sig ni fi cantly (p= 0.000) and cli ni cal glo bal as sess ment of ef fi cacy re ve a led “go o d” or “ex cel len t” res pon ses in all pa ti ents. Me an par kin so ni an di sa bi lity, as as ses sed by the Uni fi ed Par kin son’s Di se a se Ra ting Sca le (UPDRS) and Ho ehn and Yahr Sta ge sca les, re ma i ned unc han ged thro ug ho ut the study in the gro up as a who le. Conc lu si on: Alt ho ugh the se pre li mi nary re sults ne ed to be con fir med in lar ge pla ce bo-con trol led tri als, the re sults of the pre sent study sug gest that ser tra li ne do es not wor sen mo tor per for man ce and may be use ful in the tre at ment of dep res si on in PD.