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Inayat I, Batool AI, Rehman MFU, Ahmad KR, Kanwal MA, Ali R, Khalid R, Habib SS. Seasonal Variation and Association of Heavy Metals in the Vital Organs of Edible Fishes from the River Jhelum in Punjab, Pakistan. Biol Trace Elem Res 2024; 202:1203-1211. [PMID: 37335443 DOI: 10.1007/s12011-023-03730-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
The toxic effects of heavy metals are drastic, including accumulation. Fish species are important bio-indicators of heavy metal pollution in aquatic bodies. The current study aimed to assess the seasonal variation of heavy metals in the vital organs of mostly consumed fishes in River Jhelum, Pakistan. Samples of fish, including Wallago attu (Malhi), Rita rita (Khagga), and Mystus seenghala (Singhari), were collected from four different sites, i.e., Khushab, Muhammad Wala (M. Wala), 8.R.D and Rasool barrage during summer and winter seasons. Heavy metals such as iron (Fe), lead (Pb), chromium (Cr), cobalt (Co) and Cadmium (Cd) were estimated through acid digestion and spectrometric analysis. Results showed a significantly higher (P < 0.05) amount of these metals in the liver, followed by the kidneys of fish species. There were seasonal variations in the absorption of these metals as well. Cr (11.71) and Fe (58.66) were detected in higher amounts in Khagga which showed the greatest affinity for certain metals in some cases. In contrast, Singhari showed the greatest affinity to other metals in other cases. Comparative analysis revealed that there was a highly significant (P < 0.05) difference for the accumulation of almost all metals in both seasons and summer had the highest concentration of Cd, Pb, Co, Cr and Fe as compared to winter in all four sampling stations in the case of kidney and liver of all the three fishes. Elevated levels of heavy metals were detected in the summer due to increased temperature. Heavy metals found in the River Jhelum may demonstrate that metals can significantly affect the fish species.
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Affiliation(s)
- Iram Inayat
- Department of Zoology, University of Sargodha, Sargodha, 40100, Punjab, Pakistan
| | - Aima Iram Batool
- Department of Zoology, University of Sargodha, Sargodha, 40100, Punjab, Pakistan
| | | | - Khawaja Raees Ahmad
- Department of Zoology, University of Sargodha, Sargodha, 40100, Punjab, Pakistan
| | - Muhammad Ali Kanwal
- Department of Zoology, University of Sargodha, Sargodha, 40100, Punjab, Pakistan
| | - Rabiyah Ali
- Department of Zoology, University of Sargodha, Sargodha, 40100, Punjab, Pakistan
| | - Rameen Khalid
- Department of Zoology, University of Sargodha, Sargodha, 40100, Punjab, Pakistan
| | - Syed Sikandar Habib
- Department of Zoology, University of Sargodha, Sargodha, 40100, Punjab, Pakistan.
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Demirtaş Y, Topbaş M, Çamur D, Albay M, İlter H, Ayoğlu FN, Altın A, Can M, Parlak Somuncu B, Açıkgöz B, Aydın F. Heavy Metal and Trace Element Levels in Hair Samples from Fishermen in Turkey: The Fish/Ermen Heavy Metal Study (FHMS). Biol Trace Elem Res 2024; 202:34-45. [PMID: 37014497 DOI: 10.1007/s12011-023-03653-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
Toxic chemicals from polluted seas can enter the human body through seafood consumption and cause health problems. The aim of this study was to evaluate the levels of selected heavy metals and trace elements among fishermen who frequently consumed seafood and controls who consumed seafood less frequently in four provinces on the shores of the Sea of Marmara, which is heavily polluted by industrial activities. Fourteen elements (antimony, arsenic, cadmium, chromium, copper, iron, lead, manganese, mercury, nickel, selenium, strontium, vanadium, and zinc) were analyzed in hair samples using the inductively coupled plasma-mass spectrometer method. Levels of arsenic (0.147 ± 0.067 µg/g vs. 0.129 ± 0.070 µg/g, p = 0.025), chromium (0.327 ± 0.096 µg/g vs. 0.269 ± 0.116 µg/g, p < 0.01), nickel (0.469 ± 0.339 µg/g vs. 0.403 ± 0.368 µg/g, p = 0.015), strontium (1.987 ± 1.241 µg/g vs. 1.468 ± 1.190 µg/g, p < 0.01), and zinc (103.3 ± 43.1 µg/g vs. 92.7 ± 37.4 µg/g, p = 0.047) were higher in the fisherman group than in the control group. No difference was found between the groups in terms of other elements. The findings suggest that heavy metal-trace element contamination in the Sea of Marmara may increase the exposure levels of individuals to some chemicals through seafood consumption.
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Affiliation(s)
- Yusuf Demirtaş
- Department of Public Health, Faculty of Medicine, Ordu University, Ordu, Turkey.
| | - Murat Topbaş
- Department of Public Health, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Derya Çamur
- Department of Public Health, Faculty of Gülhane Medicine, Health Sciences University, Ankara, Turkey
| | - Meriç Albay
- Faculty of Aquatic Sciences, Istanbul University, Istanbul, Turkey
| | - Hüseyin İlter
- Provincial Health Directorate, Ministry of Health, Ankara, Turkey
| | - Ferruh Niyazi Ayoğlu
- Department of Public Health, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Ahmet Altın
- Department of Environmental Engineering, Bülent Ecevit University, Zonguldak, Turkey
| | - Murat Can
- Department of Biochemistry, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | | | - Bilgehan Açıkgöz
- Department of Public Health, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Fatih Aydın
- Faculty of Aquatic Sciences, Istanbul University, Istanbul, Turkey
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Ali MU, Wang C, Li Y, Li R, Yang S, Ding L, Feng L, Wang B, Li P, Wong MH. Heavy metals in fish, rice, and human hair and health risk assessment in Wuhan city, central China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 328:121604. [PMID: 37061018 DOI: 10.1016/j.envpol.2023.121604] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/06/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023]
Abstract
The current study investigated the concentration of heavy metals (HMs) in human hair associated with fish and rice consumption in Wuhan City, central China. The mean values of As in 8/10 fish species exceeded the food safety standard of 0.015 mg/kg. The mean values (mg/kg) of HMs in rice followed a descending order of Zn (13.7)> Cu (1.9)>Cr (0.51)>As (0.11) >Cd (0.08) >Pb (0.04). The ascending order of HMs for male hair was Cd < As < Cr < Pb < Cu < Zn, while As < Cd < Cr < Pb < Cu < Zn for female. 30% of hair Cr and 22% of hair Zn contents exceeded the recommended values. The middle age (19-44) and adult (45-59) groups were the most vulnerable group, as the concentration for most elements was high in these age groups. A significant correlation was found between fish-eating frequency and hair Zn (r = 0.213; p < 0.05), and As (r = 0.204; p < 0.05). High odd ratios were found in a population with high fish-eating frequency, especially for Pb (7.19), As (3.1), Zn (3.83), and Cd (3.7). A significant non-carcinogenic risk was associated with Cr exposure through consuming herbivores, filter feeders, and omnivorous fish. The cancer risk values of Cd exposure (1.54E-04) via rice consumption and As exposure (1.25E-04) via consumption of omnivores fish indicate precautionary measures.
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Affiliation(s)
- Muhammad Ubaid Ali
- State Key Laboratory of Environmental Geochemistry, Institute of Geochemistry, Chinese Academy of Sciences, Guiyang, 550081, China
| | - Chuan Wang
- State Key Laboratory of Environmental Geochemistry, Institute of Geochemistry, Chinese Academy of Sciences, Guiyang, 550081, China
| | - Yuan Li
- School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Ruolan Li
- State Key Laboratory of Environmental Geochemistry, Institute of Geochemistry, Chinese Academy of Sciences, Guiyang, 550081, China
| | - Shaochen Yang
- Hubei Key Laboratory of Critical Zone Evolution, School of Earth Sciences, China University of Geosciences, Wuhan, 430074, China
| | - Li Ding
- School of Public Health, Guizhou Medical University, Guiyang, 550025, China
| | - Lin Feng
- State Key Laboratory of Environmental Geochemistry, Institute of Geochemistry, Chinese Academy of Sciences, Guiyang, 550081, China
| | - Bo Wang
- State Key Laboratory of Environmental Geochemistry, Institute of Geochemistry, Chinese Academy of Sciences, Guiyang, 550081, China
| | - Ping Li
- State Key Laboratory of Environmental Geochemistry, Institute of Geochemistry, Chinese Academy of Sciences, Guiyang, 550081, China.
| | - Ming Hung Wong
- Consortium on Health, Environment, Education, and Research (CHEER), And Department of Science and Environmental Studies, The Education University of Hong Kong, Tai Po, Hong Kong, China
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Leite LAR, Pedreira Filho WDR, de Azevedo RK, Abdallah VD. Bioaccumulation and health risk assessment of trace metal contamination in the musculature of the trahira fish (Hoplias malabaricus) from two neotropical rivers in southeastern Brazil. J Trace Elem Med Biol 2023; 78:127185. [PMID: 37163817 DOI: 10.1016/j.jtemb.2023.127185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/14/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Fish are an important source of nutrition for humans. Artisanal fishing plays a fundamental role in Brazil fish production. In Brazil, the unrestrained increase, diffusion, and little importance for environmental causes of other economic activities, such as the agricultural industry, has caused irreparable damage, leading to the contamination of water bodies. Among the countless pollutants that reach water bodies, trace metals are extremely problematic. Here, we evaluated the bioaccumulation and health risk of trace metal contamination in the musculature of the trahira fish (Hoplias malabaricus), collected from two rivers in southeastern Brazil. METHODS During the period from May 2017 to November 2019, 90 fish were collected, 45 from each river. River water samples were also taken during the same collection periods. From fish, muscle tissue samples were taken, and together with river water samples, analyzed for the recovery of trace metals (Al, Cr, Mn, Fe, Ni, Cu, As, Cd, and Pb) through the technique of Inductively Coupled Plasma Mass Spectrometry (ICP-MS). RESULTS In general, fish as well as the waters of the Jacaré-Guaçú River had higher concentrations of metals. The elements Al, Cr and Cd stood out from the others analyzed metals for having a hazard index (HQ) above 1 (Al), for being up to 10 times above the concentrations allowed by Brazilian legislation (Cr) and for having a high bioconcentration factor (Cd), indicating a biomagnification process through the food chain. CONCLUSION In general, trace metal concentrations in the waters and fish of the Jacaré-Guaçú were higher than in the Jacaré-Pepira, which shows that the Jacaré-Guaçú is the one that suffers more anthropogenic action between the two rivers. In addition, some elements such as Al, Cr and Cd, due to its high concentrations, should receive some attention as they can pose risks to the health of fish, which can jeopardize the survival of their populations, and especially to humans who use these animals as a food source.
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Affiliation(s)
| | - Walter Dos Reis Pedreira Filho
- Fundação Jorge Duprat de Segurança e Medicina do Trabalho (FUNDACENTRO), Centro Técnico Nacional (CTN), Divisão de Agentes Químicos, São Paulo, Brazil
| | | | - Vanessa Doro Abdallah
- Centro Universitário CESMAC, Programa de Pós-graduação em Análise de Sistemas Ambientais, Maceió, Brazil; Universidade Federal do Alagoas, Setor de Parasitologia e Patologia, Maceió, Brazil
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Ullah Z, Islam NU, Ikram M, Zahoor M, Nazir N, Naz S, Ullah R, Bari A, Shah AB. Heavy metal transportation from polluted water into human through fodder plants and farmed animals. Z PHYS CHEM 2023. [DOI: 10.1515/zpch-2023-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Abstract
Herein we have determined the heavy metals concentrations (Pb, Cd, and Ni) estimated in River Swat water, irregated soils samples, fodder plant’s parts, farmed animal milk/meat samples and human blood from two location Mingora and Barikot in District Swat, Pakistan, using atomic absorption spectrophotometer. Heavy metals such as Cd, Pb, and Ni were found 0.016 ± 0.008, 0.50 ± 0.03, and 0.022 ± 0.004 mg/L in Mingora drain water, respectively, while in the Barikot sample the aforementioned metal were in the range of 0.014 ± 0.01, 0.29 ± 0.02, and 0.108 ± 0.08 mg/L. In the field water samples of Mingora the Cd, Pb and Ni were detected in the range of 0.008 ± 0.001, 0.65 ± 0.05 and 0.032 ± 0.006 mg/L, respectively, while in the field water samples of Barikot contained Cd = 0.016 ± 0.007 mg/L, Pb = 0.48 ± 0.04 mg/L and Ni = 0.043 ± 0.003 mg/L. Drain soil of Mingora contained the highest concentrations of heavy metals, with Cd = 3.9 ± 0.62 mg/kg, Pb = 45.5 ± 3.2 mg/kg, and Ni = 19.95 ± 2.1 mg/kg, whereas field soil contained Cd = 1.6 ± 0.44 mg/kg, Pb = 54.5 ± 2.26 mg/kg, and Ni = 34.75 ± 3.2 mg/kg. Cd in the Barikot drain soil was 3.95 ± 0.71 mg/kg, while it was 0.8 ± 0.06 mg/kg in the field soil. Lead in the same drain sample was 33 ± 3.23 mg/kg, while it was 72 ± 4.15 mg/kg in the field sample. Ni concentrations in Barikot drain soil samples was 13.85 ± 1.1 mg/kg, while 6.9 ± 0.8 mg/kg was detected in field samples. From the results it can be concluded that appreciable concentrations of heavy metals are present in milk and meat samples of farmed animals whereas significant quantities are also there in human blood samples indicating the transport of the selected metals from water through fodder plants into human. However, it may not be the sole reason heavy metal contaminations in human blood other factors like inhalation etc. may also be equally responsible.
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Affiliation(s)
- Zia Ullah
- Department of Chemistry , University of Malakand , Chakdara 18800 , Pakistan
| | - Noor Ul Islam
- Department of Chemistry , University of Malakand , Chakdara 18800 , Pakistan
| | - Muhammad Ikram
- Department of Chemistry , Abdul Wali Khan University Mardan , Mardan , 23200 , Pakistan
| | - Muhammad Zahoor
- Department of Biochemistry , University of Malakand , Chakdara 18800 , Pakistan
| | - Nausheen Nazir
- Department of Biochemistry , University of Malakand , Chakdara 18800 , Pakistan
| | - Sumaira Naz
- Department of Biochemistry , University of Malakand , Chakdara 18800 , Pakistan
| | - Riaz Ullah
- Department of Pharmacognosy, College of Pharmacy , King Saud University , Riyadh 11451 , Saudi Arabia
| | - Ahmed Bari
- Department of Pharmaceutical Chemistry, College of Pharmacy , King Saud University , Riyadh , Saudi Arabia
| | - Abdul Bari Shah
- Division of Applied Life Science (BK21 Four), IALS , Gyeongsang National University , Jinju , Republic of South Korea
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Rosso JJ, Avigliano E, Fernández Cirelli A. Essential and non-essential metals in three lowland rivers of temperate South America (Argentina): Distribution and accumulation. J Trace Elem Med Biol 2022; 73:127016. [PMID: 35738095 DOI: 10.1016/j.jtemb.2022.127016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Geographic distribution of essential metals on earth is largely uneven. Therefore, regional specific approaches to assess metal contents in freshwater ecosystems are mandatory. Cd, Cu, Cr, Pb, Ni, Mn and Zn concentrations were measured in water, sediments and fish tocharacterize the partitioning of these essential and non-essential metals in three river ecosystems of the Pampean Plain==. METHODS Water, sediment and eight fish species were collected at three rivers from the Pampean Plain. After sample-specific pretreatments, Cd, Cr, Cu, Mn, Ni, Pb and Zn concentrations in water, sediment and muscle were determined in triplicate by Inductively Coupled Plasma Optical Emission Spectrometer (ICP-OES). Contamination (Hakanson´s index) and bioconcentration factors were calculated to assess the degree of contamination and the relationship between the matrices, while the target hazard quotient was estimated to explore the risk to human health from fish consumption. RESULTS Water metal concentration was below detection limit in all sampled rivers. Sediments were mostly enriched by Mn (186-474 mg kg-1) followed by Zn (36.8-40.3 mg kg-1), whereas in fish, the situation was the opposite, suggesting different biogeochemical pathways and uneven bioaccumulation of these elements. The largest concentrations for all explored metals were invariably recorded in fish from the Sauce Grande River, although only Cd, Cu and Ni in sediments were highest at this site. Indeed, the bioconcentration factor showed that Cd and Zn are actively accumulated by almost all species in all sampled rivers. The Targeted Hazard Quotient based on the muscle metal concentration tissue of the edible fish species (Odontesthes bonariensis) was less than 1. CONCLUSION None metal seemed to pose a significant risk for humans. In some sites biota-sediment concentration factors of Cd and Zn and muscle Cd, Cr, Ni, Zn and Pb levels were highest in the silurid Pimelodella laticeps, suggesting that it may be used as a sentinel species for biomonitoring programs in Neotropical fish assemblages.
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Affiliation(s)
- Juan José Rosso
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina; Centro de Estudios Transdisciplinarios del Agua (CETA), Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Av. Chorroarín 280, (C1427CWO), Ciudad Autonoma de Buenos Aires, Argentina
| | - Esteban Avigliano
- Instituto de Investigaciones en Producción Animal (INPA-CONICET-UBA), Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Av. Chorroarín 280 (C1427CWO), Ciudad Autonoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
| | - Alicia Fernández Cirelli
- Instituto de Investigaciones en Producción Animal (INPA-CONICET-UBA), Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Av. Chorroarín 280 (C1427CWO), Ciudad Autonoma de Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Yang J, Xie Q, Wang Y, Wang J, Zhang Y, Zhang C, Wang D. Exposure of the residents around the Three Gorges Reservoir, China to chromium, lead and arsenic and their health risk via food consumption. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 228:112997. [PMID: 34808509 DOI: 10.1016/j.ecoenv.2021.112997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 06/13/2023]
Abstract
Hydrological management of the Three Gorges Dam has resulted in the interception of heavy metals in the Three Gorges Reservoir (TGR). However, the exposure to heavy metals and health risks among local residents remained poorly understood. Here we collected 208 biomarker samples (hair) and 20 food species from typical regions in the TGR to assess the exposure levels of three toxic metals (Cr, Pb and As) in residents of the TGR, and subsequently investigated their health risk via dietary intake. Results indicated that hair Cr and As levels were below the reference value for normal people and threshold of skin lesions, respectively, whereas about 22% hair Pb exceeded the reference for clinical medicine, indicating a potential Pb exposure of local residents. Smoking habit and fish consumption were found to be predictors for hair Pb. In addition, the concentrations of heavy metals in all investigated food samples were below the limits of contaminants in food in China, except for Pb in the sweet potato and fish. The estimated daily intake of metals (DIMs) revealed that the intakes of Cr and As from studied food were under the recommended thresholds of Cr and As. However, the intake of Pb via diet exceeded the limit of the prevalence of chronic kidney disease and closed to the threshold for cardiovascular, which was probably associated with the high Pb concentrations of fish and sweet potato. Overall, residents around the TGR were at low exposure to Cr and As, but Pb exposure may need more attention.
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Affiliation(s)
- Jingwen Yang
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Qing Xie
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Yongmin Wang
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Juan Wang
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Yongjiang Zhang
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, College of Resources and Environment, Southwest University, Chongqing 400715, China; Department of Environment and Quality Test, Chongqing Chemical Industry Vocational College, Chongqing 401220, China
| | - Cheng Zhang
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, College of Resources and Environment, Southwest University, Chongqing 400715, China
| | - Dingyong Wang
- Interdisciplinary Research Center for Agriculture Green Development in Yangtze River Basin, College of Resources and Environment, Southwest University, Chongqing 400715, China.
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Albay M, Ozbayram EG, Camur D, Topbaş M. Recent Trends in Water and Health Studies on the Focus of Global Changes. ENVIRONMENTAL MANAGEMENT 2021; 67:437-438. [PMID: 33608755 DOI: 10.1007/s00267-021-01445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Meriç Albay
- Department of Marine and Freshwater Resources Management, Faculty of Aquatic Sciences, Istanbul University, Fatih, 34134, Istanbul, Turkey
| | - E Gozde Ozbayram
- Department of Marine and Freshwater Resources Management, Faculty of Aquatic Sciences, Istanbul University, Fatih, 34134, Istanbul, Turkey.
| | - Derya Camur
- Department of Public Health, Faculty of Gülhane Medicine, Health Sciences University, Ankara, Turkey
| | - Murat Topbaş
- Department of Public Health, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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