Workplace Violence in the Health Sector in Turkey: A National Study

Violence in the workplace is an increasing occupational health concern worldwide. Health care workers are at high risk of assault. To develop, monitor, and manage prevention policies, baseline data should be available. This cross-sectional study was designed to determine the current extent of workplace violence nationwide in Turkey. The study population of 12.944 health care workers was a stratified sample of all health care workers (612,639) in the country. A probabilistic sampling was made on the basis of the "multistage stratified random cluster sampling method." This study was conducted by a structured questionnaire in a face-to-face interview. The questionnaire items were adapted and translated into Turkish based on questionnaires of International Labor Organization, International Council of Nurses, World Health Organization, and Public Services International. The percentage of health care workers who experienced workplace violence in Turkey in the previous 12 months was 44.7%. The types of violence included physical 6.8%, verbal 43.2%, mobbing (bullying) 2.4%, and sexual harassment 1%. Multivariate analysis showed that level of health care system, type of institution, gender, occupation, age, working hours, and shift work were independent risk factors for experiencing workplace violence ( p < .05). Our study indicates that the workplace violence among health care workers is a significant problem. The results of the study can serve as the basis for future analytical studies and for development of appropriate prevention efforts.

Lipoprotein-associated phospholipase-A2 activity and its diagnostic potential in patients with acute coronary syndrome and acute ischemic stroke

BACKGROUND

The study examined the Lp-PLA₂ activity at the patients presented to the emergency department with acute coronary syndrome (ACS) or acute ischemic stroke (AIS), as well as its diagnostic value.

METHODS

The prospective study included consecutive male and female patients aged >18 years that presented to the our emergency department with ACS or AIS between November 2009 and January 2010. Blood samples were obtained immediately following diagnosis in the ACS and AIS groups. The diagnostic value of Lp-PLA₂ was determined based on receiver operating characteristic curves, sensitivity, specificity, predictive values, likelihood ratios and accuracy rates.

RESULTS

In all, 34 ACS and 32 AIS patients were included in the study, and the control group included 35 patients. Lp-PLA₂ enzyme activity was significantly lower in the ACS and AIS groups than in the control group (26.7 ± 13.8, 31.4 ± 13.6, and 41.4 ± 8.1 nmol min^-1·mL^-1, respectively; p < 0.0001, p = 0.022). In the ACS group the area under the curve (AUC) was 0.825 (95%CI: 0.722-0.929), sensitivity was 71% for an optimal Lp-PLA₂ cut-off value of 31.4 nmol min^-1·mL^-1, and specificity was 91%, whereas in the AIS group the AUC was 0.768 (95%CI: 0.652-0.884), sensitivity was 75% for an optimal Lp-PLA₂ cut-off value of 38.1 nmol min^-1·mL^-1, and specificity was 74%.

CONCLUSIONS

Lp-PLA₂ enzyme activity was significantly lower during the early stage of both ACS and AIS. The obtained statistic data suggest that low Lp-PLA₂ enzyme activity can be used for diagnostic purposes.

Vitamin B12 levels of subjects aged 0-24 year(s) in Konya, Turkey

Research reports indicate that vitamin B12 levels show racial differences, which suggests that using the reference ranges of varied populations may lead to inaccurate results. This study aimed to determine normal serum levels of vitamin B12 among children and young people in the Konya region of Turkey. It evaluated 1,109 samples; 54 were from cord-blood and 1,055 were from healthy subjects aged 0-24 year(s), who were admitted to primary healthcare centres. The normal reference levels obtained for vitamin B12 at 2.5-97.5 percentile (P2.5-P97.5) range were 127-606 pg/mL for girls, 127-576 pg/mL for boys, and 127-590 pg/mL for the entire study group. The reported reference values for vitamin B12 in other studies were higher than the current results. Vitamin B12 levels vary from country to country; comparisons between countries may not be valid, and normal levels for each population should be obtained.

Analysis of chromosomes 9 and 11 aneuploidy frequency in pleural effusions of patients with and without malignancy: By interphase FISH technique

Fluids of body cavities result in a series of pathophysiological events associated with non-malignant and malignant conditions that lead to the formation of exudative effusion. Diagnosis of effusion from the patients is frequently troublesome for the cytologist because of the differentiation and biological behavior of different cells type in effusion. In the present study, chromosomal aneuploidy status in effusion cells derived from 32 patients including 14 patients with non-malignant and 18 patients with malignant diseases [including malign mesothelioma (n = 6), adeno carcinoma (n = 10), small cell carcinoma (n = 2)] was analyzed by using fluorescence in situ hybridization (FISH) with centromere specific probes for chromosomes 9 and 11. There was significant difference in the incidence of chromosomal 9 and 11 aneuploidies when compared with controls (P = 0.000). However, aneuploidies of chromosomes 9 and 11 in effusion cells from patients with malignant disease had significantly higher than in effusion cells from patients with non-malignant (P = 0.000), suggesting that chromosomes 9 and 11 are frequently involved in the status of disease. The present study indicates that there is a association between chromosomes aneuploidies and pleural effusion cell status. Chromosome aneuploidies in non-malignant group may be an indicator of premalignancy.

Effects of sildenafil and vardenafil on erectile dysfunction and health-related quality of life in haemodialysis patients: a prospective randomized crossover study

BACKGROUND

Erectile dysfunction (ED) is prevalent in end-stage renal disease (ESRD) and has been associated with impaired health-related quality of life (HRQoL). HRQoL, in turn, is related to morbidity and mortality in ESRD patients. Previous studies have shown improved HRQoL with ED treatment using sildenafil and vardenafil. However, no study has examined the effects of sildenafil or vardenafil on HRQoL in impotent ESRD patients. Furthermore, vardenafil has never been tested and its safety profile has not been determined in ESRD patients. The aim of this randomized crossover study was to compare the effects of sildenafil and vardenafil on measures of HRQoL and on ED scores as well as to determine the safety profile of vardenafil in ESRD patients.

METHODS

In 32 haemodialysis patients with impotence, ED and HRQoL were evaluated by the International Index of Erectile Function (IIEF-5) and the 36-item Short-Form Health (SF-36) surveys, respectively. Patients were randomized into sildenafil and vardenafil groups. After a 4-week treatment and 2-week washout periods, crossover was performed and an additional 4-week treatment was administered. IIEF-5 and SF-36 surveys were given before and after each treatment period. Adverse effects were evaluated by interview. Friedman tests and Bonferroni-adjusted Wilcoxon signed-rank tests were used to compare groups and for post hoc analysis, respectively.

RESULTS

IIEF-5 and SF-36 scores were significantly improved by both sildenafil and vardenafil compared to pretreatment values. There were no differences between sildenafil and vardenafil with respect to the studied parameters. Adverse effect profiles were also similar. No patient dropped out because of side effects.

CONCLUSIONS

Sildenafil and vardenafil caused similar improvements in ED and HRQoL in haemodialysis patients. Vardenafil was well tolerated in our patient population.

Validity and reliability of Turkish version of "Hospital Survey on Patient Safety Culture" and perception of patient safety in public hospitals in Turkey

Background

The Hospital Survey on Patient Safety Culture (HSOPS) is used to assess safety culture in many countries. Accordingly, the questionnaire has been translated into Turkish for the study of patient safety culture in Turkish hospitals. The aim of this study is threefold: to determine the validity and reliability of the translated form of HSOPS, to evaluate physicians' and nurses' perceptions of patient safety in Turkish public hospitals, and to compare finding with U.S. hospital settings.

Methods

Physicians and nurses working in all public hospitals in Konya, a large city in Turkey, were asked to complete a self-administrated patient safety culture survey (n = 309). Data collection was carried out using the Turkish version of HSOPS, developed by Agency for Healthcare Research and Quality (AHRQ). Data were summarized as percentages, means, and SD values. Factor analysis, correlation coefficient, Cronbach's alpha, ANOVA, and t tests were employed in statistical analyses. Items on patient safety were categorized into 10 factors. Factor loadings and internal consistencies of dimension items were high.

Results

Most of the scores related to dimensions, and the overall patient safety score (44%) were lower than the benchmark score. "Teamwork within hospital units" received the highest score (70%), and the lowest score belonged to the "frequency of events reported" (15%). The study revealed that more than three quarters of the physicians and nurses were not reporting errors.

Conclusion

The Turkish version of HSOPS was found to be valid and reliable in determining patient safety culture. This tool will be helpful in tracking improvements and in heightening awareness on patient safety culture in Turkey.

A survey on patient safety culture in primary healthcare services in Turkey

OBJECTIVE

To evaluate the patient safety culture in primary healthcare units.

DESIGN

A cross-sectional study, utilizing the Turkish version of the Hospital Survey on Patient Safety Culture developed by the Agency for Healthcare Research and Quality and a demographic questionnaire.

SETTING

Twelve primary healthcare centers in the center of the city of Konya, Turkey.

PARTICIPANTS

One hundred and eighty healthcare staff, including general practitioners (GPs), nurses, midwives and health officers.

INTERVENTION

None.

MAIN OUTCOME MEASURE(S)

The patient safety culture score including subscores on 12 dimensions and 42 items; patient safety grade and number of events reported.

RESULTS

Fifty-four (30%) of the participants were GPs, 48 (27%) were nurses, 51 (28%) were midwives and 27 (15%) were health officers. The mean overall score for positive perception of patient safety culture in primary healthcare units was 46 +/- 20 (43-49 CI). No differences were found by staff members' profession. Among the dimensions of patient safety, those with the highest percentage of positive ratings were teamwork within units (76%) and overall perceptions of safety (59%), whereas those with the lowest percentage of positive ratings were the frequency of event reporting (12%) and non-punitive response to error (18%). Reporting of errors was infrequent with 87% of GPs, 92% of nurses and 91% of other health staff indicating that they did not report or provide feedback about errors.

CONCLUSIONS

Improving patient safety culture should be a priority among health center administrators. Healthcare staff should be encouraged to report errors without fear of punitive action.

Using WHOQOL-BREF to evaluate quality of life among Turkish elders in different residential environments

OBJECTIVE

This study used the Brief Version of The World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF) to assess and compare the quality of life in older people who live at home and older people who live in public assisted-living facilities for the elderly.

DESIGN

Cross-sectional.

SETTING

Data were collected by a research nurse in each home and in the assisted living facility.

PARTICIPANTS

PARTICIPANTS were 60 years old and older. The sample included 37 people who were living in a public assisted-living facility and 37 elderly people living in their own homes.

MEASUREMENT

The WHOQOL-BREF was used to measure participants' quality of life.

RESULTS

The groups were similar according to gender, literacy, existence of chronic diseases, and general perceived health. However, quality of life scores for social relationships and environment domains were lower in those living in an assisted living facility than those living in their own homes. The scores for elderly females staying in the assisted living facility were lower compared to the scores of males in the facility.

CONCLUSION

The results suggest that social and environmental domains of life quality are low in elderly assisted living facilities. Social activities should be diversified for elderly people staying in assisted living facilities to improve social relationships. Physical and psychological health of females in assisted living facilities should be comprehensively supported by professionals. Alternatively, elderly people may be professionally supported to live in their own homes.

The effects of mannitol and melatonin on MRI findings in an animal model of traumatic brain edema

OBJECTIVES

The aim of this study was to compare the effects of mannitol and melatonin on brain edema secondary to trauma using magnetic resonance imaging (MRI).

METHODS

A mild traumatic brain injury with the Feeney method was performed upon twelve New Zealand rabbits. Three hours after the trauma was inflicted, MRI images were obtained, then the subjects were divided into two groups: a mannitol group and a melatonin group. The mannitol group (n = 6) was given 2 gr/kg of 20% mannitol IV over 10 minutes and the melatonin group (n = 6) received 100 mg/kg of melatonin IV over 30 minutes. Thirty-three hours after the first MRI, MRI was repeated. The 3-hour and 36-hour post-trauma MRI images in both groups were scored regarding signs of edema and extent of brain tissue protrusion in a blinded fashion by a staff radiologist. Intragroup and intergroup comparisons were made using the Fisher exact test and chi square test. Comparison of brain tissue protrusion measurements was done using the Mann Whitney U test.

RESULTS

Signs of raised intraventricular pressure, contusion and parenchymal edema were more prevelant, and parenchymal protrusion was more prominent on the 36-hour MRI in both mannitol and melatonin groups. No significant difference was found between the melatonin and mannitol groups in any parameter in the MRI images performed 3 and 36 hours after the head trauma.

CONCLUSIONS

In this animal model, melatonin and mannitol had similar effects on brain edema, as demonstrated on MRI 3 and 36 hours after head trauma.

Reliability of second trimester triple screening for Down syndrome in rhesus-negative women

OBJECTIVE

To find out whether there is considerable influence on second trimester serum concentrations owing to the rhesus status.

STUDY DESIGN

This retrospective cohort study was performed at the Perinatology Unit of the GATA Haydarpasa Teaching Hospital. During the study interval, 2265 pregnancies met inclusion criteria. The blood samples were collected in 117 pregnancies with a maternal rhesus-negative blood group status. The control group consisted of 2148 pregnancies with a maternal rhesus-positive blood group status. Statistical analysis was performed by SPSS 11.0 statistical software.

RESULTS

Pregnancies with a maternal rhesus-negative blood group status were identified in 117 patients. The overall prevalence of pregnancies with a maternal rhesus-negative blood group status were 5.1% in our study. Only unconjugated estriol multiples of the median values were significantly decreased in rhesus-negative women (P<0.001). Alpha-fetoprotein and human chorionic gonadotrophin multiples of the median values did not differ significantly (P>0.05).

CONCLUSION

We conclude that if second trimester screening test to be used in Rh negative pregnancies, either the corrected value should be referred or double test result should be considered ignoring the unconjugated estriol result. Another option is the first trimester Down syndrome screening test.

Fibrinolytic markers and neurologic outcome in traumatic brain injury

AIMS

To determine the usefulness of fibrinolytic markers as early prognostic indicators in patients with isolated head trauma.

MATERIALS AND METHODS

Sixty-two consecutive patients (26 women and 36 men; mean age 61 years, range 2-76 years) with isolated head trauma seen within the first three hours of the trauma were included in the study. The Glasgow Coma score (GCS), platelet counts (Plt), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products (FDP) and D-dimer levels were measured. Head computerized tomography (CT) findings were categorized as brain edema, linear fracture, depressed fracture, contusion and bleeding. Plt counts, PT, PTT, fibrinogen, FDP, D-dimer levels and CT findings were compared with both GCS and mortality in the first week. Statistical significance was accepted at P <or=0.05.

RESULTS

A marked negative relationship was found between GCS and PT, PTT, FDP and D-dimer levels (P < 0.001). Plt levels did not correlate with GCS. Mortality was most strongly related to GCS, PT, FDP and D-dimer levels (P < 0.001, P < 0.001, P < 0.001 and P < 0.001, respectively). We found no relationship between mortality and CT findings, nor was there any significant relationship between Plt, PTT and fibrinogen levels.

CONCLUSION

GCS and fibrinolytic markers measured within the first three hours were useful in determining the prognosis of patients with isolated head trauma.

Fluid replacement via the rectum for treatment of hypovolaemic shock in an animal model

BACKGROUND

The importance of early and effective fluid resuscitation in hypovolaemic shock treatment is indisputable.

AIM

To examine the effects of fluid replacement via the rectum in an animal model of hypovolaemic shock as a possible life-saving method in situations where veins cannot be accessed quickly.

METHODS

Rabbits were randomly divided into two groups: a control group of 7 animals and a second group of 10, the fluid replacement via the rectum (FRVR) group. The femoral artery of each subject was catheterised and 15 ml blood was withdrawn over 1 min at 5-min intervals. After reaching a mean arterial pressure (MAP) of 30 mm Hg, additional blood was withdrawn until the MAP dropped to <25 mm Hg, at which time blood withdrawal ceased. At this point, control animals were given no treatment and were monitored for 30 min. The FRVR group, however, was given 0.9% sodium chloride solution (amount equal to three times the amount of blood withdrawn) via the rectum over a 15-min period. The MAPs of both groups were then measured, every 5 min after the start of resuscitation, for 30 min.

RESULTS

In the FRVR group, the MAP began to rise significantly after 15 min of receiving fluid per rectum (p = 0.035) and continued to be significantly greater than the control group at 20, 25 and 30 min (p = 0.035, 0.002 and 0.001, respectively).

CONCLUSION

FRVR is a viable alternative for fluid resuscitation in this animal model of hypovolaemic shock. This easy and non-invasive method of fluid replacement may be useful when standard intravenous access is unobtainable, and should be compared with other access routes using varying types and amounts of fluids in future animal studies.

Twelve-month prevalence of obsessive-compulsive disorder in Konya, Turkey

We conducted a household survey of 3,012 adults aged 18 and over in order to estimate the prevalence of DSM-IV obsessive-compulsive disorder (OCD) in urban areas in Konya, Turkey. Trained psychiatry interns administered the 2.1 version of the OCD section of the Composite International Diagnostic Interview (CIDI). The 12-month period prevalence rate of OCD was 3.0%. The mean age of onset of OCD was 25.9 +/- 12.5 (range, 7 to 63) years. The prevalence rate of OCD was slightly higher among females (males 2.5%, females 3.3%), but the difference was not statistically significant. The relative risk for divorced, separated, or widowed subjects was approximately 4.2 times higher for OCD than others (2.7% v 10.5%). The 1-year prevalence of OCD inversely related to age group in male subjects, but increased with age in female subjects. The prevalence rate of OCD was not different by the level of education, except it was statistically higher among subjects who were literate but had no schooling, of which the causal relationship was high prevalence rate of OCD among female literate-but no schooling subjects. Subjects with few (one or two) and more siblings (seven or more) had a significantly higher prevalence rate of OCD than subjects with moderate numbers of siblings (three to six). No significant difference was found according to employment, fertility, birth order, and income of the subjects. About 30% of subjects with OCD had only obsessions, whereas 68.5% had both obsessions and compulsions. Only one subject (1.1%) with OCD met compulsion criteria without obsessions. The prevalence rate of OCD we found in Konya, Turkey was similar to the prevalence rates of most epidemiological studies.

Job satisfaction of health care staff employed at health centres in Turkey

The objective of the study was to identify job satisfaction levels and their causes among health care workers employed at public health centres. A survey was therefore carried out of health care workers in 21 health centres in Konya, Turkey. The Minnesota Satisfaction Questionnaire was used to investigate job satisfaction. The satisfaction score and proportion of those satisfied were determined according to demographic features. The percentage of satisfied health care workers was 60% and the satisfaction score was 3.8 +/- 0.5. Midwives had the lowest satisfaction scores. Working environment and income were the most important factors for dissatisfaction. There was no correlation between global satisfaction and other demographic variables. These results showed that the health care workers at public health centres in the province have low satisfaction scores. Improving working conditions and income may improve the overall quality of health care provision.

The frequency of consanguinity in Konya, Turkey, and its medical effects

This study was conducted in the town of Konya, Turkey, on 1120 randomly selected women to find out the overall rate of consanguineous marriages among couples. The frequency of consanguineous marriages was found to be 23.2%. It was found that 14.6% of this figure was first cousin marriages and the rest was 8.6%. Consanguineous marriages were higher among women born in villages compared to those born in provinces and the town center. Based on the findings, it was not too difficult to say: the higher the level of education of women, the lower the rate of consanguineous marriages. The number of children with an abnormality was high in consanguineous marriages, while the frequency of spontaneous abortion, still-birth and infant death remained the same.