Songül Acar Vaizoğlu

Indoor Radon Concentrations in Ankara Dwellings

The level of radon in domestic dwellings in Ankara, Turkey, was studied using CR-39 passive alpha track detectors. During the period 1996–1997 indoor radon concentrations were measured in approximately 200 houses during a 6 months’ winter period. Detectors were placed in two separate rooms of which one was a living room and the other was the main bedroom. Subsequent measurements were performed at the Istanbul Çekmece Nuclear Research and Training Centre. Values obtained were between 2 and 408 Bq/m3. These long-term radon concentrations were found to follow a log-normal distribution. Median values for living rooms and bedrooms were 19 and 25 Bq/m3, respectively. Indoor radon concentration was found to be associated with presence of cracks on the walls, building material used for floor and walls and the type of ventilation and heating (p < 0.05).

Predisposing Preventable Factors in Patients With Bleeding due to Warfarin Usage: Evaluation of 114 Patients

Warfarin is one of the commonly used oral anticoagulant. The aim of our study is to evaluate the predisposing preventable factors among patients with bleeding due to warfarin usage. This study was performed on 114 cases who were admitted to emergency service for bleeding and whose ages range between 27 and 89 years. The mean time between the onset of the bleeding and admission to the hospital was 2.9 ± 3.4 days. The mean dose of warfarin being used at the time of admission was 31.2 ± 10.8 mg weekly. Only 37 cases were being controlled regularly. The mean number of the drugs being used other than warfarin was 4.8 ± 2.5 drugs. Forty-eight cases were using aspirin, 28 nonsteroidal anti-inflammatory drugs other than aspirin and 18 cases were using various antibiotics. Forty eight patients knew that they had to use this drug under the regular follow-up of a physician and 43 knew that during monitoring a laboratory test had to be done while using the drug named as warfarin. Only 39 patients knew that this drug may cause bleeding. It was also surprising that only 9 patients knew that there may be drug interaction and 1 knew that this drug may be affected from the dietary factors. As a result, it may be concluded that most of the patients admitting to the emergency service had a lack of basic knowledge about this drug, which might invite bleeding.

Carbon Monoxide Levels in Bathrooms Using Hot Water Boilers

The purpose of the present study was to measure carbon monoxide (CO) levels during the operation of hot water boilers that use liquefied petroleum gas or natural gas, which are widely used in Turkey. In addition, it was intended to determine how much owners of these boilers knew about their use and about CO poisoning. CO levels were measured in the bathrooms of homes in a housing area where two deaths due to CO poisoning had occurred on the same day. CO levels were measured in a total of 197 flats from a total of 400 in an area (49%) where there were such boilers and while the boilers were in operation. The bathrooms were of standard dimensions (2.5 × 3 × 3 m). Assessment of CO levels while the boilers were in operation was carried out using a Gastech standard GT-402 portable gas monitor. In 44 (22.4%) of the bathrooms studied, CO levels were above 9 ppm, which is the 8-hour limit according to the NAAQS. CO levels in 2 bathrooms (0.7%) were found to be above 35 ppm, the maximum 1-hour exposure level. CO levels above 50 ppm, ranging from 54 to 300 ppm, were determined in 12 homes (6%). The inhabitants of these homes were informed and the necessary measures were taken to solve the problem. In 8 of these 12 houses, it was determined that chimneys were blocked. We found that CO levels were higher than risk levels for intoxication in 20.0% of the houses. The level of knowledge of the households was poor concerning dangers of CO intoxication. Since it is not uncommon for CO levels in bathrooms where there are boilers to reach dangerous levels it is recommended that their use be discouraged. There should be more widespread use of central water heating systems to remove this serious public health problem.

Work Characteristics and Musculoskeletal Disorders among Postgraduate Dental Students: A Pilot Study

Abstract Objectives: Dentists are at high risk of musculoskeletal disorders [MSD], which is one of the occupational health issues in healthcare workers. The aim of this study is to determine the prevalence and risk factors of MSD and to identify ergonomic conditions of postgraduate students in the Ankara University Faculty of Dentistry. Methods: A questionnaire was administered to 264 postgraduate dental students in different departments. After the students had completed the questionnaire, observers noted the ergonomic working conditions of the students and recorded their observations. Results: The prevalence of musculoskeletal pain was found to be 49 percent in postgraduate dental students. The lower back was found to be the most commonly affected area [34%]. No statistically significant difference was found among daily working time, duration of employment, and presence and intensity of pain [p > 0.05]. The prevalence of pain was higher among female than among male students participating in this study [p < 0.05]. Conclusions: These results emphasize the need for ergonomic preventive measures in dentistry including training on ergonomic principles from the beginning of the clinical period. Also, special attention should be paid to the design of the working environment in faculties conforming to ergonomic principles.

Determining mercury levels in anchovy and in individuals with different fish consumption habits, together with their neurological effects

An increase in enviromental pollution may lead to mercury toxicity of fish origin due to the accumulative nature of methylmercury in fish. The main sources of human exposure to organic mercury compounds are contaminated fish and other seafoods. This descriptive study was planned to determine mercury levels in anchovy and in hair samples from individuals with different fish consumption habits, and to evaluate those individuals in terms of toxic effects. For that purpose, we analyzed 100 anchovies from the Black Sea and 100 anchovies from the Sea of Marmara, and assessed 25 wholesale workers in fish markets and 25 cleaning firm employees from both Ankara and Istanbul. Mercury levels in samples were measured using a cold vapor atomic absorption spectrophotometer. Participants were examined neurologically and mini mental state examination was applied to evaluate their cognitive functions. Mercury levels in fish were found to be below the national and international permitted levels. There was no statistically significant relation between mercury levels and the sea from which fish were caught. Hair mercury levels for all participants were within permitted ranges. However, hair mercury levels in both cities increased significantly with amount and frequency of fish consumption. A significant correlation was determined at correlation analysis between levels of fish consumption and hair mercury levels in the fishmongers and in the entire group (r = 0.32, p = 0.025; r = 0.23, p = 0.023, respectively). Neurological examination results were normal, except for a decrease in deep tendon reflexes in some participants in both cities. There was no correlation between Standardized Mini Mental State Examination results and hair mercury levels. We conclude that establishing a monitoring system for mercury levels in fish and humans will be useful in terms of evaluating potential neurotoxic effects.

Determination of Carbon Monoxide Levels in Coffee Shops in Ankara

Indoor environments are where people spend 80—90% of their time. They are at their riskiest in terms of air pollution when smoking is not prohibited and various combustion and/or cooking applications are performed. If such environments are where people live or work, or are recreation facilities open to everybody, experience has shown that pollution levels to which they are exposed can reach levels that are a threat to their health. This study is an investigation of coffee shops, which are such communal environments, identified according to factors such as clientele and physical accommodation. The pollution parameter chosen was the level of carbon monoxide in the air, evaluated according to its compliance to the existing standards and setting forth measures that might be taken against probable health risks. The study was performed in 384 coffee shops selected randomly from amongst those (N = 7646) located in five central municipal districts of Ankara province. Most of the environments investigated were observed to have deficiencies in respect of accident risk, hygienic features and accommodation conditions. The mean carbon monoxide level was found to be below the short and long-term threshold values. However, CO levels above long-term threshold levels were observed in 34% of the coffee shops. In conclusion, the environments investigated were found to pose risks in terms of both accommodation conditions and indoor environment air quality. It was concluded that these risks, which could affect the health of workers and clientele, could be eliminated by environmental health measures.

Afet öncesi süreçte bir çevre sağlığı planı geliştirmek: Yalova İli Merkez İlçesi’nden bir örnek

Amac: Bu calisma Yalova Ili Merkez Ilcesi icin afet oncesi surecte cevre yonetimi planinin olusturulmasini amaclamaktadir. Ayrica calisma, afete hazirlik icin mevcut durumun eksikliklerinin belirlenmesini amaclamaktadir. Gerec ve Yontem: Arastirmacilar tarafindan literatur taramasi sonrasi bir kontrol listesi olusturulmustur. Kontrol listesi yedi baslik altinda toplam 62 kriterden olusmaktadir. Kontrol listesi resmi yazisma ile ilgili uc kuruma dagitildi ve bu kurumlardan toplanildi. Degerlendirme sirasinda, her bir kriter ‘‘uygun kriter sayisi’’, ‘‘uygun olmayan kriter sayisi’’ ve ‘‘cevaplanmayan kriter sayisi’’ olarak siniflandirildi. Bulgular: Su sistemlerindeki duyarlilik analizlerinin gerceklesmedigini ve afet bolgelerinin alt bolgelere ayrilmadigini belirledik. Kentteki kimyasal depolar alt basliginda ki hicbir kriter mevcut degildi. Uc kurumun cevaplarina gore, cevaplanmayan kriter sayisi 14, uygun kriter sayisi toplamda 31 iken, uygun olmayan kriter sayisi toplamda 17 idi. Sonuc: Kontrol listesinde yer alan 17 kriterin ilgili kurumlar tarafindan mevcut olmadigini belirledik. Bu kriterler cevre sagligi planinda onemli konulardir. Bilinclendirme calismalari, uygun organizasyon ve ilgili birimlerle uygun kurul ve organizasyon gerceklestirilmelidir.

Factors affecting warfarin related knowledge and INR control of patients attending physicians and pharmacists' managed anticoagulation clinics.

We have read with a great interest the article entitled ‘‘Factors Affecting Warfarin Related Knowledge and INR Control of Patients Attending Physicians and Pharmacists’ Managed Anticoagulation Clinics’’ by Hasan et al which has been published online in Journal of Pharmacy Practice. We would like to comment on the article by referring to our study on predisposing preventable factors among patients admitted to the emergency department with bleeding due to warfarin usage. Our study was performed on 114 cases who were admitted to emergency service due to complaints of bleeding due to warfarin usage. The sociodemographic characteristics, information on warfarin usage, and their bleeding history are collected by a structured questionnaire form. The mean age of our patients was 66.65 + 13.57 years (mean + standard deviation, 27-89 years, 82 cases 60 years) and 61 (53.5%) of them were females. In Hasan et al’s study, patients on warfarin scored an average of 66.5 + 36% for their knowledge on the mechanism of action of warfarin, 42.9 + 44.9% for their knowledge on the interaction between warfarin and alcohol, and 49.2 + 21.1% for their knowledge on the side effects of warfarin. Fortyeight of the patients (42.1%) knew that they had to use this drug under the regular follow-up of a physician and 43 (37.7%) knew that during monitoring a laboratory test had to be done while using the drug named warfarin in our study. Only 39 patients (34.2%) knew this drug may cause bleeding. It was also surprising that only 9 of the patients were aware that there might be an interaction with concomitant drugs and 1 knew that this drug may be affected from the dietary factors. In Hasan et al’s study, there was a significant difference between patients’ age and knowledge on the mechanism of action of warfarin (P 1⁄4 .001), the interaction between warfarin and alcohol (P 1⁄4 .004), and the side effects of warfarin (P 1⁄4 .013). The correlation analysis showed that there was a negative correlation between age and knowledge on the mechanism of action of warfarin (P 1⁄4 .001), the interaction between warfarin and alcohol (P 1⁄4 .001), and the side effects of warfarin (P 1⁄4 .001). There was no statistically significant difference between the weekly warfarin doses used by the 82 cases who are 60 years and the 32 cases who are <60 years (30.1 + 10.4 mg/week and 33.9 + 11.9 mg/week, respectively; P 1⁄4 .107) in our study. In our study, although the weekly dose of warfarin was lower, the duration between the onset of warfarin and the time of bleeding is shorter and the bleeding frequency within the first month of treatment is higher among the 60 years age group (82 cases) when compared to patients younger than 60 years (32 patients); no statistically significant difference is found. Actually, in the literature, there are such studies in which the relationship between the older age and bleeding risk could not be shown like our study. According to the findings for their study, Hasan et al suggested that patients had satisfactory knowledge regarding the mechanism of action of warfarin and poor knowledge on the interaction between warfarin and alcohol as well as the side effects of warfarin. But, our patients who were admitted to the emergency service with bleeding have a big gap of knowledge which invited bleeding. Most patients were using drugs which are known to interact with warfarin metabolism while using warfarin. Therefore, data given by Hasan et al on the relationship between knowledge regarding the mechanism of action of warfarin and bleeding history of patients should be reevaluated. As a result, it is important developing a training program for the related specialists and general practitioners who follow-up such patients may have an effect on decreasing the morbidity and mortality caused by warfarin-induced hemorrhages.

Halk Sağlığı Uzmanlık Eğitiminde Çevre Sağlığı Eğitimi: Kavramsal Çerçeve -

Cevresel etkilenimlerin insan sagligina olan etkilerinin her gecen gun artmakta oldugu gunumuzde, insanlarin cevreleriyle olan etkilesimlerinin degerlendirilmesi, yorumlanmasi ve topluma yonelik koruyucu uygulamalar seklinde hayata gecirilmesi gerekliligi, halk sagligi uzmaninin sorumlulugunu bir kat daha artirmaktadir. Bu derleme ile cevre sagligi, cevre hekimligi kavramlari ve halk sagligi uzmanlik egitiminde yer almasi gereken cevre sagligi konulari, kavramsal bir cerceve onerisiyle sunulmustur.

Letter to the editor: Risk factors in patients with gastrointestinal bleeding due to warfarin usage

We have read with great interest the article entitled ‘‘Surgical workload, risk factors and complications in patients on warfarin with gastrointestinal bleeding’’ by Som et al. which has been published online in International Journal of Surgery.1 The authors aimed to determine the predisposing factors which cause gastrointestinal system (GIS) bleeding among patients using warfarin. We would like to comment on the article by referring to our study on predisposing preventable factors among patients admitted to the emergency department with bleeding due to warfarin usage.2 Som et al. evaluated 30 patients with a mean age of 80 years (range 63–93) who had admitted to the hospital with GIS bleeding during the period of warfarin use while we have evaluated 114 cases who admitted to emergency service with bleeding due to warfarin usage. The mean age of the our patients was 66.65 13.57 years (mean standard deviation [SD], 27–89 years, 82 cases 60 years) and 61 (53.5%) of them were females. Among 45 of our patients GIS bleeding was present at the time of admission. Melena was the most frequent type of bleeding (42/114 patients, 36.4%) followed by hematemesis (13/ 114 patients, 11.4%), and hematochezia was present in two of the cases (2/114 patients, 1.6%). Among the patients who admitted to the emergency service, 37 had described bleeding history formerly; of which 15 (15/37 patients, 40.5%) were GIS bleeding. Indication of treatment with warfarin was chronic atrial fibrillation in 32 cases (28.1%), heart valve replacement in 27 cases (23.7%), cerebrovascular event in 26 cases (22.8%), venous thrombosis and/or pulmonary embolism in 24 cases (21.0%), and peripheral arterial embolism in five cases. The mean number of the drugs being used other than warfarin was 4.8 2.5 drugs (mean SD; 0–14; median four drugs). One hundred twelve of the cases (98.2%) were using at least one drug other than warfarin at the time of admission to the emergency service with bleeding. The number of the drugs being used which are known to effect warfarin metabolism was 1.7 1.3 (0–6; median 1.5 drugs). Ninety five (83.3%) of these patients were using at