Kayıhan Pala

Occupational exposure to wood dust and health effects on the respiratory system in a minor industrial estate in Bursa, Turkey.

OBJECTIVES The aim of this study was to estimate occupational exposure to wood dust in the furniture industry in a minor industrial estate in Bursa, Turkey. MATERIALS AND METHODS The study was conducted between October 2006 and May 2007. In this study, a total of 656 persons, 328 woodworkers and 328 controls were included. A questionnaire was used in the study. Physical examination and the pulmonary function tests (MIR-Spirobank G) of the workers were performed. A portable Aircheck 2000 pump was used to collect the specimens of wood dust from the workplaces. NIOSH Method 0500 was employed for the gravimetric measurements of dust. RESULTS The average dust concentration at the workplace was 2.04+/-1.53 mg/m3. It was reported that 176 of workers (53.7%) had blocked nose while working, 141 (43.0%) had redness of the eyes, 135 (41.2%) had itching eyes and 78 (23.8%) had runny nose. No symptoms were observed in the control group while they were working at the workplace. The mean FEV1 and FVC values of woodworkers, among both smokers and non smokers, were significantly low, although the FEV1/FVC value was high (p < 0.05). An increase both in FEV1 and FVC values was detected among the woodworkers who had a working period less than 10 years and were exposed to wood dust at concentrations over 4 mg/m3 compared to the woodworkers who were exposed to wood dust at less than 4 mg/m3 (p < 0.05). CONCLUSIONS As a result, in this study it was pointed out that the exposure to wood dust adversely influenced the workers respiratory functions. Besides, in this study a question associated with the healthy worker effect that can adversely influence health of workers exposed to wood dust at less than (4 mg/m3) is revealed.

Blood lead levels of traffic policemen in Bursa, Turkey

This study was conducted in January 2001, in Bursa, Turkey. Of the 99 traffic policemen who were included in the study, 21 were office workers. Blood lead levels were determined by using an electro-thermal atomic absorption spectrometer (ET-AAS). Average blood lead levels were 9.4 +/- 1.6 micrograms/l and 8.7 +/- 1.7 micrograms/l for policemen working outdoors and indoors, respectively. The difference between the two groups was statistically insignificant (P > 0.05). When policemen less than 15 years on duty were taken into account (n = 48) the difference between the outdoors and indoors working groups was significant (9.3 +/- 1.3 and 8.2 +/- 1.8 micrograms/l, P < 0.05). In order to prevent the negative effects of tetraethyl lead on humans and the environment the use of lead in petrol must be prohibited.

Family planning choices and some characteristics of coitus interruptus users in Gemlik, Turkey

The objectives of this study were to gain information about some fertility issues, contraceptive method choices, and the reasons for coitus interruptus (CI) use among married women aged 15-49, in Gemlik, Turkey. One thousand nine hundred ten women were interviewed for this cross-sectional study. The pregnancy rate per woman was 2.9. 716 women (37.5%) had at least one unwanted pregnancy. Of the study population, 79.6% were using a contraceptive method (45.1% were using a modern method, 34.5% a traditional method). CI was the most preferred method (33.7%). Fertility measures of women who had used CI continuously were compared with other women. It was found that most CI users were content with the method.

Health-care reform in Turkey: far from perfect

www.thelancet.com Vol 383 January 4, 2014 25 Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ However, important issues have been overlooked. Health care in Turkey is being privatised. This can have particular advantages, such as effective and timely implementation of new technologies and better quality health care in addition to decreasing the burden on the general budget; but overall health spending and the size of the population unable to receive health care increase, while premiums required for health care rise. With an unemployment rate higher than 13% and an estimated 50% of the working population not registered to pay tax, a problem obviously exists in financing the health-care system through the SSI: at present, the premiums collected can only support less than half of the SSI spending. As a result, c o p a y m e n t s , c o m p l e m e n t a r y health insurance, and out-of-pocket spending are increasing. Moreover, the infant mortality rate in Turkey has been decreasing constantly (from 40·3 per 1000 livebirths in 1993 to 16·3 in 2008), and life expectancy has been increasing steadily since 1978, and therefore cannot be totally attributed to the Health Transformation Program (HTP). Patients’ satisfaction increased with HTP, mainly because access to health care and drugs increased. However, the number of visits to the doctor increased from 3·2 per year in 2002 to 8·2 in 2011. This fi gure is higher than the Organisation for Economic Cooperation and Development average. With the implementation of fee-forservice, physicians see large numbers of patients and the time given to each patient is about 5–10 min. According to the Turkish Surgical Association, the number of unnecessary operations and radiological investigations have increased, and due to the high workload, time spent for education decreased after HTP implementation. Medical students increased from 5253 in 2003 to 8438 in 2010, and the Universal health coverage and health laws

Evaluation of Respiratory Functions of Residents Around the Orhaneli Thermal Power Plant in Turkey

The aim of this cross-sectional study was to evaluate the health and respiratory function of residents around the Orhaneli thermal power plant in Turkey. The study was conducted using face-to-face interviews, and respiratory functions were measured with a spirometer. The respiratory functions of 2350 residents, 15 years and older, living in communities near the coal-fired Orhaneli thermal power plant in Turkey were measured. The control group consisted of 469 persons from similar communities without a nearby power plant. The FEV1 (forced expiratory volume after 1 s) and FVC (forced vital capacity) values of the study participants were significantly lower than those of the control group, and residents directly downwind of the plant’s smokestack showed greater impairment of respiratory functions compared with residents upwind.

The comparison of reproductive health data in a rural district in Turkey (1981–2001)

Objectives: The main objective was to compare new reproductive and family planning data with data from the 1981 survey. Methods: All 15-49-year-old married women living in seven villages of Gemlik were interviewed and the data were compared with the 1981 data of the same villages. Results: In 1981, 66.8% used a family planning method, 6.8% used an intrauterine device, 10.2% used oral contraceptives and 10.0% used condoms. In 2001, these values were 93.0%, 36.5%, 6.0% and 14.8%, respectively. In 1981, 51.5% and in 2001 35.5% used coitus interruptus. Conclusion: In 20 years, users of both current family planning methods and modern methods have increased; users of traditional methods have decreased.

Family Health History and Self-Rated Health: A Study from the Turkish Countryside

Self-rated health is a good indicator for mortality and morbidity, and many of the factors affecting self-rated health are well known. However, the effect of familial disease history on an individuals health perception has not been investigated. This study examined the effects of chronic and serious diseases in mothers, fathers, and siblings, and familial deaths, on self-rated health. A history of familial cancer or stroke affected mens health perceptions negatively, and the presence of familial heart disease affected womens health perception negatively.

Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey

Background Natural disasters, armed conflict, migration, and epidemics today occur more frequently, causing more death, displacement of people and economic loss. Their burden on health systems and healthcare workers (HCWs) is getting heavier accordingly. The ethical problems that arise in disaster settings may be different than the ones in daily practice, and can cause preventable harm or the violation of basic human rights. Understanding the types and the determinants of ethical challenges is crucial in order to find the most benevolent action while respecting the dignity of those affected people. Considering the limited scope of studies on ethical challenges within disaster settings, we set upon conducting a qualitative study among local HCWs. Methods Our study was conducted in six cities of Turkey, a country where disasters are frequent, including armed conflict, terrorist attacks and a massive influx of refugees. In-depth interviews were carried out with a total of 31 HCWs working with various backgrounds and experience. Data analysis was done concurrently with ongoing interviews. Results Several fundamental elements currently hinder ethics in relief work. Attitudes of public authorities, politicians and relief organizations, the mismanagement of impromptu humanitarian action and relief and the medias mindset create ethical problems on the macro-level such as discrimination, unjust resource allocation and violation of personal rights, and can also directly cause or facilitate the emergence of problems on the micro-level. An important component which prevents humanitarian action towards victims is insufficient competence. The duty to care during epidemics and armed conflicts becomes controversial. Many participants defend a paternalistic approach related to autonomy. Confidentiality and privacy are either neglected or cannot be secured. Conclusion Intervention in factors on the macro-level could have a significant effect in problem prevention. Improving guidelines and professional codes as well as educating HCWs are also areas for improvement. Also, ethical questions exposed within this study should be deliberated and actualized with universal consensus in order to guide HCWs and increase humane attitudes.

Community participation in health services and the experience of Turkey

One of the most important components of health promotion is community participation. The importance of community participation in health care was raised by the Alma-Ata Declaration in 1978. According to the Alma-Ata Declaration community participation should be ensured by planning, organization, implementation and supervision of health services at the highest levels. Nowadays, community participation is distanced from the definition in the Alma-Ata Declaration. Citizens cannot take part in the decision making process and community financing has been mentioned as a part of the community participation in health services. Community participation in the health sector in Turkey was initially regulated by the Law on the Socialization of Health Services (No. 224) published in 1961. Unfortunately, this regulation has not been put widely into practice. Community participation is regulated as a contribution to the financing of health services (prescription fee, surcharge, inpatient bed fee, etc.) by the Health Transformation Program (HTP). With HTP, the user fee for health services applies only for medical examinations provided by the Social Security Institution has increased to 2.132 billion TL in 2012 from 466 million TL in 2009. User fees in the health services only for medical examinations increased over the years and in the ratio of household health expenditures exceeded 18% for 2012. The Health Transformation Program should be discussed because of a structure that does not allow for community participation. Keywords: Community participation, health services, community financing, Turkey

Sağlık politikaları ile meslek ahlakı arasında ilişki var mı? Bursa Tabip Odası’na yapılan başvurular örneğinde bir değerlendirme

Amac: Hekimlik pratigine dair meslek orgutune yansiyan ihlal iddialarini ve belirleyenlerini incelemektir. Yontem: Arastirma, Bursa Tabip Odasi (BTO) Yonetim Kurulu’nun 1991-2014 yillari arasindaki tum kayitlarinin, Onur Kurulu dosyalarinin ve bilgisayar kayitlarinin taranmasiyla gerceklestirilmistir. Bulgular: Incelenen donemde BTO’ya yapilan 593 basvuruda toplam 623 ihlal iddiasi bulunmaktadir. Ihlal iddialarinin %46.2’si Onur Kurulu’na iletilmis ve %29.5’ine yaptirim uygulanmasina karar verilmistir. Basvurular en cok hasta, hasta yakini ya da hastanin vekili tarafindan yapilmistir (%34.1). Hakkinda basvuru yapilan hekimlerin %75.7’si uzman, %23.3’u pratisyen, %1.0’i asistan hekimdir. En sik uc ihlal iddiasi sirasiyla; tanitim kurallarinin ihlali, haksiz kazanc/rekabete aykirilik (%24.8), tibbi uygulama hatasi (%21.4) ve gercek disi belge/rapor duzenlemektir (%18.2). ‘Gercek disi belge/rapor duzenlemek’, ‘Hasta haklarina saygisizlik’ ve ‘Aracilik, yonlendirme, cikar iliskisi’ eylemlerinin Saglikta Donusum Programi (SDP) sonrasinda anlamli derecede arttigi saptanmistir. Zorunlu Mesleki Sorumluluk Sigortasi sonrasinda tibbi uygulama hatasi iddialarinin sayisinda ve bu iddia sonucunda yaptirima ugratilan hekim sayisinda anlamli bir artis saptanmamistir. Sonuc: Bu calisma ile hekimlik uygulamalarina dair meslek ahlaki ihlallerini anlayabilmek ve sorunlari saptayabilmek acisindan onemli cikarimlar elde edilmis, bulgular SDP ile uygulamaya konulan politikalarin mesleki yukumluluklerin yasama gecirilmesini guclestirebilecegi yonunde yorumlanmistir.