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Objective: To determine and compare the prevalence and risk factors of elder abuse in elderly population in two different districts in Izmir, Turkey.Methods: This cross-sectional study involved 497 subjects selected by cluster sampling.Results: The prevalence of physical and financial abuse among the elderly in the district of low socioeconomic status was 1.5% and 2.5%, respectively, while among the elderly in the district of high socioeconomic status, it was 2% and 0.3%, respectively. However, the prevalence of elder neglect in the two districts was 27.4% and 11.2%, respectively. Prevalence of neglect was associated with infrequent contact with relatives, little or no income, and fewer years of education among the elderly in the low socioeconomic district. In the high socioeconomic district, neglect was associated with fewer years in education, poor health status and having chronic status.Conclusion: The prevalence of abuse among the elderly living in the two different districts was low. However, nearly one-fifth of elderly people were exposed to neglect. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of the study was to compare the knowledge scores of medical students in Problem-based Learning and traditional curriculum on public health topics. Methods We planned a cross-sectional study including the fifth and sixth year medical students of Dokuz Eylul University in Turkey. The fifth year students (PBL group, n = 56) were the pioneers educated with PBL curriculum since the 1997–1998 academic year. The sixth year students (traditional education group, n = 78) were the last students educated with traditional education methods. We prepared 25 multiple-choice questions in order to assess knowledge scores of students on selected subjects of Public Health. Our data were collected in year 2002. Results Mean test scores achieved in PBL and traditional groups were 65.0 and 60.5 respectively. PBL students were significantly more successful in the knowledge test (p = 0.01). The knowledge scores of two topics were statistically higher among PBL students. These topics were health management and chronic diseases. Conclusion We found that mean total evaluation score in the PBL group was 4.5 points higher than in the traditional group in our study. Focusing only on the knowledge scores of students is the main limitation of our study. Upon the graduation of the first PBL students in the 2002–2003 academic year, we are planning additional studies regarding the other functions of a physician such as skill, behaviour and attitude.

Objectives: Our previous retrospecive study evaluating the appropriateness of serum digoxin concentration (SDC) measurements revealed errors in the timing of blood specimen collection in 98% of the tests. The aim of this study is to evaluate the appropriateness of the SDC measurements and the factors involved in inappropriate test-ordering, after training health personnel in digoxin therapeutic drug monitoring., Methods: This is a training-based quasi-experimental study. The residents and nurses of the Cardiology Clinic were trained first in December 2017, and refresher training courses were carried out every month throughout the study. The medical data of the inpatients receiving digoxin therapy were recorded prospectively, between January and December 2018. The appropriateness of the physicians' orders for SDC measurement was evaluated according to the criteria of the right indication and right timing of blood collection. The results are presented by descriptive statistics, Student's t-test and χ 2 analysis., Results: A total of 232 SDC tests were ordered for 121 patients (age: 71.0±12.6 years, 56.2% women). Of these orders,129 (55.6%) were considered appropriate: 205 (88.4%) for indication and 129 (62.9%) for blood collection timing. There was a significant correlation between inappropriate order for SDC test and the age of the patient, female gender, impairment of renal function tests, high levels of serum BNP and the number of medications used (P<0.005)., Conclusions: Approximately a one-half decrease in inappropriate tests compared with our previous study results imply that education has a positive effect on physician behaviour. However, physicians' concerns due to increased risk factors for the patient still play a role in inappropriate test-ordering., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To determine the prevalence of and the risk factors for Potentially Inappropriate Medication (PIM), the drug groups most commonly evaluated as PIMs in elderly patients in the ICUs by using 2019 Beers Criteria, STOPP version 2 (v2) Criteria and EU(7)-PIM List. The relation between mortality rate and length of ICU stay with PIMs was also examined., Methods: This was a cross sectional study conducted on patients aged ≥65 years, treated in ICUs (n = 139) between June 8, 2020, and January 11, 2021. Patients' demographic characteristics, clinical data and laboratory findings about the drugs used were collected prospectively. PIMs were evaluated according to each of the criteria applied. Relationship of dependent and independent variables was evaluated using chi-square analysis, t-test and logistic regression analysis. P < .05 was considered statistically significant., Results: The number of patients with at least 1 PIM according to three criteria was 118 (84.9%) (80.6%, 59.7%, 48.2%, Beers, STOPP/v2 and EU(7)-PIM List, respectively). In the univariate analysis, receiving renal replacement therapy and high number of drugs were the covariates that significantly affected the presence of PIM according to all three criteria (P < .05). Combined use of anxiolytics and opioids in Beers Criteria (58.3%), antipsychotics (26.6%) in STOPP/v2 Criteria, and antiarrhythmics (23.7%) in EU(7)-PIM List were the drugs that caused PIM at most. No relationship was found between the presence of PIM and mortality. The length of ICU stay was determined significantly longer in the presence of PIM according to Beers Criteria (P = .028)., Conclusions: In this study, the prevalence of PIM was determined higher in elderly patients in ICU. Our results supported that 2019 Beers Criteria for ICU patients seems to be more directive in detecting PIMs and determining the prognosis. Reducing the number of drugs administered may be the first step to decrease PIMs in elderly patients in ICU and to maintain the treatment safely., (© 2021 John Wiley & Sons Ltd.)

Background: The health and social care needs of people aged ≥ 80 years are a neglected topic., Aims: To determine the prevalence of unmet health and social care needs and associated factors in community-dwelling individuals aged ≥ 80 years in Izmir District of Balçova, Turkey., Methods: There were 1075 participants aged ≥ 80 years. The dependent variables were unmet health and social care needs. Independent variables were sociodemographic, socioeconomic and lifestyle characteristics. The data were collected in face-to-face interviews conducted at the homes and analysed by multiple logistic regression model. Ethical approval was obtained from the Non-Invasive Research Ethics Board of Dokuz Eylul University Medical Faculty (2017/26-24)., Results: The mean age was 84.1 (3.7) years and 61.0% were female. Healthcare needs were expressed by 88.2% of the participants and 78.9% claimed that they had social care needs. Prevalence of unmet health and social care needs was 32.5% and 46.6%, respectively. Approximately 90.0% of their needs were covered by families. Perceived low-income status was a risk factor for unmet healthcare needs, and lack of social support was a risk factor for unmet social care needs. Additionally, not receiving formal education was a protective factor in unmet social care needs., Conclusion: Public health policy should be developed to enable better access to care, especially for the oldest people, considering that nearly one third of the participants in this study had unmet healthcare needs and almost half had unmet social care needs., (Copyright © World Health Organization (WHO) 2021. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Generic drug (GD) use is affected by many factors, including physicians' approach., Objective: This study aimed to investigate the knowledge, opinions and attitudes of primary care physicians (PCPs) about GDs and potentially associated factors., Methods: An adequately representative sample (n = 354) of PCPs was determined via stratified and simple random sample selection method in this descriptive, cross-sectional study. The research data were collected through a face-to-face 40-item survey, where the knowledge, opinions and attitudes about GDs were questioned. The prescribing percentage of GDs overall was also examined., Results: The survey was completed by 305 PCPs (mean age: 49.2 ± 7.9 years; 57.4% male). The rate of correct responses about GDs was 67.6% for basic knowledge and 46.6% for the development process. The percentages of PCPs who declared that GDs were 'less efficacious', 'of lower quality' and 'less safe' than original drugs were 65.2%, 53.4% and 35.4%, respectively. More than half (60.3%) of the PCPs declared not to pay attention to whether the drug is generic while prescribing. It was observed that, as the knowledge level of the physicians increased, negative opinions and prescribing attitudes regarding the effectiveness, quality and safety of the GDs decreased. The rate of GD prescribing (51.6%) in Izmir was lower than the rest of the country (54.6%; P < 0.001)., Conclusion: This study shows that the knowledge of PCPs about GDs is generally inadequate, which reflects negatively on their opinions and attitudes regarding the use of GDs. Educational activities can help establish awareness that GDs can be used without doubt of their effectiveness, quality and safety., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Objective: This study aimed to determine the prevalence of falls, fear of falling (FOF) and related factors in individuals aged 80 and over living in the Balçova district of Izmir., Methods: One thousand and seventy-five individuals aged 80 years or older participated. The dependent variables were falls and fear of falling. The independent variables were socio-demographic and socio-economic characteristics, health-related characteristics and 'safety status of home' features., Results: The participants' mean age was 84.1 ± 3.7 (range, 80-101) years, and 60.8% were female (n = 582). The prevalence of falls was 35.4% in the last year, and fear of falling was 86.6%. The risk factors for falls were number of chronic diseases, moderate and high fall risk, sleep disturbance and slippery bathroom floors, whilst for fear of falling they were number of chronic diseases, female gender, living alone and moderate or high fall risk., Conclusion: A monitoring program is indicated to address high fall and fear of falling prevalence among people aged 80 and over., (© 2019 AJA Inc.)

Aim: The purpose of the present study was to determine the effects of socioeconomic status on health behaviors and perceived health., Methods: The present cross-sectional study included 2947 community-dwelling older adults aged 65 years and older. Dependent variables were health behaviors and self-perceived health. The independent variable was socioeconomic status., Results: In men, the risk of unhealthy diet was higher among the uneducated group (OR 4.48) and among those with poor/very poor economic status (OR 3.31). Additionally, in men, having poor/very poor self-perceived health was found to be 3.50-fold significantly higher among the uneducated group than the secondary school and higher-educated group. Lower education level and lower social class were found to be protective factors for smoking in women. In women, the risk of unhealthy diet was found to be 1.54- and 2.18-fold significantly higher, respectively, among those who graduated from primary school and uneducated. There was also a relationship between poor/very poor economic status and unhealthy diet among elderly women (OR 2.80). In women, the risk of physical inactivity was found to be 1.98-fold significantly higher in the uneducated group and 1.79-fold significantly higher in those with poor/very poor economic status, 0.33-fold significantly lower in skilled employees/white collar workers. With regard to self-perceived health status, education level and perceived economic status were significantly related to poor/very poor health status in women (OR 2.09 and OR 4.08, respectively)., Conclusion: In older men and women, lower socioeconomic status increases the risk of unhealthy diet and poor health perception. In older women, lower socioeconomic status is a protective factor for smoking, but it also increases physical inactivity., (© 2013 Japan Geriatrics Society.)

Objective: To determine the best anthropometric measurement among waist: height ratio (WHtR), BMI, waist:hip ratio (WHR) and waist circumference (WC) associated with high CHD risk in adults and to define the optimal cut-off point for WHtR., Design: Population-based cross-sectional study., Setting: Balcova, Izmir, Turkey., Subjects: Individuals (n 10 878) who participated in the baseline survey of the Heart of Balcova Project. For each participant, 10-year coronary event risk (Framingham risk score) was calculated using data on age, sex, smoking status, blood pressure, serum lipids and diabetes status. Participants who had risk higher than 10 % were defined as 'medium or high risk'., Results: Among the participants, 67·7% were female, 38·2% were obese, 24·5% had high blood pressure, 9·2% had diabetes, 1·5% had undiagnosed diabetes (≥126 mg/dl), 22·0% had high total cholesterol and 45·9% had low HDL-cholesterol. According to Framingham risk score, 32·7% of them had a risk score higher than 10 %. Those who had medium or high risk had significantly higher mean BMI, WHtR, WHR and WC compared with those at low risk. According to receiver-operating characteristic curves, WHtR was the best and BMI was the worst indicator of CHD risk for both sexes. For both men and women, 0·55 was the optimal cut-off point for WHtR for CHD risk., Conclusions: BMI should not be used alone for evaluating obesity when estimating cardiometabolic risks. WHtR was found to be a successful measurement for determining cardiovascular risks. A cut-off point of '0·5' can be used for categorizing WHtR in order to target people at high CHD risk for preventive actions.

Depression in the elderly is associated with increased morbidity and mortality. The purpose of this study was to determine the prevalence and risk factors of depression among community-dwelling older population in an urban setting in Turkey. This cross-sectional study was conducted among 482 elderly individuals 65 years and over in an urban area. Cluster sampling method was used for sample size. Depression in the elderly had been diagnosed by a clinical interview and Geriatric Depression Scale. Data were collected by door-to-door survey. Chi square test was used for statistical analysis. P value, which was calculated by the results of chi square test and coefficient of phi (φ), below 0.05 was included in the analysis of logistic regression. Depression was significantly associated with female gender, being single or divorced, lower educational status, low income, unemployment, and lack of health insurance. However, logistic regression analysis revealed higher depression rates in the elderly with chronic obstructive pulmonary disease, psychiatric disease, cerebrovascular disease, low income and being dependent. Depression is common among community-dwelling older people in an urban area of Izmir, Turkey. Older adults living in community should be cautiously screened to prevent or manage depression., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: To evaluate the reliability and validity of the revised Turkish version of Mini Mental State Examination (rMMSE-T) in educated and uneducated community-dwelling elderly, to re-organize the present Turkish version of MMSE and to determine cut-off point of the revised test., Methods: This cross-sectional and analytical study involved totally 490 elderly subjects selected by cluster sampling method. Receiver operating characteristic (ROC) analysis, kappa analysis and Cronbach's alpha coefficients were used for statistical analysis., Results: Areas under ROC curve in educated and uneducated elderly were found as 0.953 and 0.907. Cut-off point of 22/23 of rMMSE-T in educated elderly had the highest sensitivity (90.9), specificity (97.0) and positive likelihood ratio (30.3), whereas cut-off point of 18/19 of the test in uneducated elderly had the highest sensitivity (82.7), specificity (92.3) and positive likelihood ratio (10.7). The Cronbach's alpha values of the rMMSE-T for educated and uneducated elderly were higher than 0.7 (sign of good internal consistency of the test). A significant correlations between intrarater and interrater test-retest in educated elderly subjects were observed (0.966 (p = 0.000); 0.855 (p = 0.000), respectively), and also in uneducated elderly (0.988 (p = 0.000); 0.934 (p = 0.000), respectively). Kappa value of the test in educated and uneducated elderly showed a perfect agreement interraters (1.000) and a substantial agreement in intraraters (1.000, 0.784; 0.826, 0.656, respectively)., Conclusion: rMMSE-T had a high reliability and validity. It will be more appropriate to use the revised test and the new cut-off point for the diagnosis and screening of dementia among community-dwelling Turkish elderly population., (Copyright 2009 John Wiley & Sons, Ltd.)

Objective: To determine and compare the prevalence of and risk factors for home accidents in the elderly in two different districts., Method: This cross-sectional study involves 497 older participants ages 65 and older. Sociodemographic characteristics of the elderly and characteristics of the houses in two different regions are evaluated. Data are analyzed by chi-square and t test., Results: The prevalence of home accidents was 39.3% in the low socioeconomic region and 13.1% in the high socioeconomic region within the past 6 months (p = .000). The most common type of home accident was fall (61.8%), followed by cut or piercing (22.0%). Home accidents are associated with being female and increasing age in the higher socioeconomic region, whereas being female, being unmarried, and living in a squatter house are associated with home accidents in the low socioeconomic region., Discussion: The prevalence of home accidents in the elderly population who live in low socioeconomic region was higher.

Objective: In this cross-sectional study, we investigated working conditions and related neuropsychiatric problems of shoemakers, including child workers, working in poor conditions with high health risks. Clinical diagnosis was not the objective of this study., Materials and Methods: We collected data from 318 workers ranging from 8-66 years of age. We evaluated working conditions, neuropathy symptoms and signs; urinary 2,5-hexanedione was used to estimate hexane exposure. We used the Zung depression scale for adult shoemakers to evaluate depression., Results: All workshops employed fewer than 10 workers with median daily work duration of 12h. Smoking and alcohol consumption were high among all workers including children. Peripheral neuropathy symptoms and signs were observed in 88 workers (27.8%) and it was related to alcohol consumption. Sixty-eight workers (47.9%) had depression and it was associated with daily work duration., Conclusion: Extremely poor, unhygienic, working conditions and a high prevalence of neuropsychiatric disorders were the main problems observed among shoemakers. A high number of child workers increased the scale of these observed problems.

The aim of this study is to determine the prevalence of and risk factors of dementia in the elderly with a low socio-economical status. The study is a cross-sectional and analytic study. Two hundred and four persons aged 65 years and above were selected by using the cluster sampling method. The presence of dementia was determined by Standardized Mini Mental State Examination (SMMSE). Twenty-three and 18 cut-off points were accepted as the existence of dementia in educated and uneducated older individuals, respectively. Chi-square test, Student's t-test, and logistic regression analysis were used for data analysis. The mean age of older subjects was 70.8+/-6.45 (S.D.); 71.5+/-5.9 in males and 70.3+/-6.8 in females (p=0.19). Ninety-one percent of older people had never attended school, 54.6% were living below the poverty level, and 97% of the residences were in squatter settlements. Dementia was determined in 46 older subjects (22.9%). Dementia was found significantly higher in females, in elderly subjects aged 80 years and above, in older subjects who were in a bad or very bad self-health status and in those who had a chronic disease, did not have any occupation, had a lower monthly income, and with a depressive score eight and above (p<0.05). In our study, the prevalence of dementia in older people was higher, in agreement with many reported studies. We assumed that this was due to the fact that the ratio of the uneducated, poor, and advanced aged subjects in this study was considerably higher. The different prevalence rates in studies demonstrate that the adoption of SMMSE for the study population, the validity-reliability analyses of tests and the standardization of diagnostic criteria are necessary.

Objective: To evaluate the relationships between community acquired infections in elderly cases (> or =65 ages) not living in a nursing home and factors such as, fever and white blood cell (WBC) counts; age, gender and the presence of underlying chronic diseases as compared to the length of stay., Methods: We conducted this study in Dokuz Eylul University Hospital in Turkey as a defining cross-sectional research covering a 5-year period between January 1999 and December 2003. The data of 240 elderly cases were investigated, forms, which includes gender, existence of chronic diseases, fever, WBC counts, diagnosis, applied treatment and prognosis were prepared, and results were presented., Results: The most frequently encountered infections were urinary system infections (35.4%), acute gastroenteritis (17.9%), pneumonia (15.9%) and soft tissue infections (13.3%). We observed that WBC counts were significantly elevated, parallel with high fever (p=0.021). In elderly cases we determined the existence of underlying disease and that living in the community lengthens the hospital staying periods (p=0.001). It was determined that elderly patients with an elevated WBC are 2.02 times more likely to have a temperature of 38.3 degrees C or higher compared with patients with a normal temperature (p<0.05)., Conclusion: There was a strong association between leucocytosis and high fever in elderly cases. However, the absence of fever and leucocytosis in 78 (32.5%) of our cases, makes it hard for us to decide whether there was an infection or not. The most frequently encountered infections in elderly cases living in the community were similar to those living in nursing homes. These cases must be followed in the geriatric wards of hospital or geriatric hospitals whenever possible.

Aim: To assess the risk factors for deaths and injuries caused by earthquakes in a high-risk earthquake zone., Methods: A cross-sectional study was carried out in Eber town, Cay County, following the earthquake of February 3, 2002 in Afyon, Turkey. This area was particularly affected by the earthquake, with high number of casualties, including many fatalities. The study included 812 persons living in Eber at the time of the earthquake. The study population was interviewed at their homes to obtain information on the deaths and non-fatal injuries, along with potential risk factors for death and injuries. These included the type and degree of the damage to the building, precise location and the initial actions of victims at the moment of the earthquake, and socio-demographic data., Results: Earthquake-related mortality rate was 16 per 1,000 people, injury rate was 22 per 1,000 people, and death/injury ratio was 1:1.4. During the earthquake, 60% of the buildings collapsed or were heavily damaged. Risk factors for death and injury were higher among those who lived in collapsed or heavily damaged buildings, wooden type buildings, or those who were near the outer walls during the earthquake., Conclusion: The most important risk factor for earthquake-induced mortality and morbidity was the degree of damage to the building. Another important risk factor was the location of the individual inside the room at the time of the quake.

Background: The purpose of the study was to compare the knowledge scores of medical students in Problem-based Learning and traditional curriculum on public health topics., Methods: We planned a cross-sectional study including the fifth and sixth year medical students of Dokuz Eylul University in Turkey. The fifth year students (PBL group, n = 56) were the pioneers educated with PBL curriculum since the 1997-1998 academic year. The sixth year students (traditional education group, n = 78) were the last students educated with traditional education methods. We prepared 25 multiple-choice questions in order to assess knowledge scores of students on selected subjects of Public Health. Our data were collected in year 2002., Results: Mean test scores achieved in PBL and traditional groups were 65.0 and 60.5 respectively. PBL students were significantly more successful in the knowledge test (p = 0.01). The knowledge scores of two topics were statistically higher among PBL students. These topics were health management and chronic diseases., Conclusion: We found that mean total evaluation score in the PBL group was 4.5 points higher than in the traditional group in our study. Focusing only on the knowledge scores of students is the main limitation of our study. Upon the graduation of the first PBL students in the 2002-2003 academic year, we are planning additional studies regarding the other functions of a physician such as skill, behaviour and attitude.