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Belgin Unal

Publications and source records attributed to Belgin Unal.

16 recordsLinked to original sources
PubMed2006

Normative data and discriminative properties of short form 36 (SF-36) in Turkish urban population.

BACKGROUND: SF-36 has been both translated into different languages and adapted to different cultures to obtain comparable data on health status internationally. However there have been only a limited number of studies focused on the discriminative ability of SF-36 regarding social and disease status in developing countries. The aim of this study was to obtain population norms of the short form 36 (SF-36) health survey and the association of SF-36 domains with demographic and socioeconomic variables in an urban population in Turkey. METHODS: A cross-sectional study. Face to face interviews were carried out with a sample of households. The sample was systematically selected from two urban Health Districts in Izmir, Turkey. The study group consisted of 1,279 people selected from a study population of 46,290 people aged 18 and over. RESULTS: Internal consistencies of the scales were high, with the exception of mental health and vitality. Physical health scales were associated with both age and gender. On the other hand, mental health scales were less strongly associated with age and gender. Women reported poorer health compared to men in general. Social risk factors (employment status, lower education and economic strain) were associated with worse health profiles. The SF-36 was found to be capable of discriminating disease status. CONCLUSION: Our findings, cautiously generalisable to urban population, suggest that the SF-36 can be a valuable tool for studies on health outcomes in Turkish population. SF-36 may also be a promising measure for research on health inequalities in Turkey and other developing countries.

Adolescent↗
PubMed2006

Coronary heart disease policy models: a systematic review.

BACKGROUND: The prevention and treatment of coronary heart disease (CHD) is complex. A variety of models have therefore been developed to try and explain past trends and predict future possibilities. The aim of this systematic review was to evaluate the strengths and limitations of existing CHD policy models. METHODS: A search strategy was developed, piloted and run in MEDLINE and EMBASE electronic databases, supplemented by manually searching reference lists of relevant articles and reviews. Two reviewers independently checked the papers for inclusion and appraisal. All CHD modelling studies were included which addressed a defined population and reported on one or more key outcomes (deaths prevented, life years gained, mortality, incidence, prevalence, disability or cost of treatment). RESULTS: In total, 75 articles describing 42 models were included; 12 (29%) of the 42 models were micro-simulation, 8 (19%) cell-based, and 8 (19%) life table analyses, while 14 (33%) used other modelling methods. Outcomes most commonly reported were cost-effectiveness (36%), numbers of deaths prevented (33%), life-years gained (23%) or CHD incidence (23%). Among the 42 models, 29 (69%) included one or more risk factors for primary prevention, while 8 (19%) just considered CHD treatments. Only 5 (12%) were comprehensive, considering both risk factors and treatments. The six best-developed models are summarised in this paper, all are considered in detail in the appendices. CONCLUSION: Existing CHD policy models vary widely in their depth, breadth, quality, utility and versatility. Few models have been calibrated against observed data, replicated in different settings or adequately validated. Before being accepted as a policy aid, any CHD model should provide an explicit statement of its aims, assumptions, outputs, strengths and limitations.

Coronary Disease↗
PubMed2006

Life-years-gained from population risk factor changes and modern cardiology treatments in Ireland.

BACKGROUND: Coronary heart disease (CHD) mortality rates in Ireland have halved since the mid-1980s, and adult life expectancy has also steadily improved. This study estimated the life-years-gained by CHD treatments and by changes in cardiovascular risk factor levels. METHODS: A previously validated Irish IMPACT CHD mortality model was used to integrate large amounts of data on (i) patient numbers, (ii) treatment uptake, (iii) risk factor trends, (iv) effectiveness of cardiology treatments and risk factor reductions, and (v) median survival in patients with and without CHD, all stratified by age and sex. Results were tested in rigorous sensitivity analyses. RESULTS: There were 3763 fewer CHD deaths than expected in 2000 compared with the base year, 1985. This resulted in approximately 44,060 life-years-gained among people aged 25-84. Specific medical and surgical treatments given in 2000 for CHD patients together gained approximately 14,505 life-years. Population changes in cholesterol and smoking levels accounted for some 32,705 life-years-gained, 66% from reductions in cholesterol alone. Adverse changes in obesity and diabetes resulted in a loss of approximately 3670 life-years. CONCLUSIONS: Use of modern cardiology treatments in Ireland from 1985 to 2000 gained many thousands of life-years. However, twice as many life-years were generated by relatively modest reductions in major risk factors. Effective policies, such as the promotion of healthy diets, and weight reduction, together with the recent nationwide workplace smoking ban, will be essential to maintain and further enhance health gain.

Adult↗
PubMed2006

An important public health problem: rabies suspected bites and post-exposure prophylaxis in a health district in Turkey.

OBJECTIVE: The aim of this study was to describe rabies suspected animal bites and post-exposure prophylaxis (PEP) practices in Narlidere District in Turkey between 1999 and 2001. METHODS: One thousand five hundred and sixty-nine rabies suspected bite cases reported were identified from the District's rabies surveillance forms. RESULTS: Males comprised 66.7% of the cases, and 43.5% of the total were under 20 years old. In 74% of cases the animal involved in the bite was a dog. Only 70% of the animals had an owner, and only 17% of the animals had a rabies vaccination certificate. In terms of treatment, 68% of the human cases received PEP, and 21% of cases had an extra (sixth) vaccination dose, which is a substantial burden on the healthcare system, costing half a million US dollars per year. The place where the bite occurred (rural areas), the age of the recipient (more than 10 years old), the animal type (animals other than dogs and cats), lack of a vaccination certificate for the animal, and place of wound treatment (hospital) were significantly associated with PEP application. CONCLUSIONS: In addition to the currently recommended strategy of controlling the dog population and of vaccinating domesticated animals, adults and children should be educated about bite prevention to reduce the number of animal bites.

Adolescent↗
PubMed2006

Mortality reductions in patients receiving exercise-based cardiac rehabilitation: how much can be attributed to cardiovascular risk factor improvements?

BACKGROUND: It is unclear how much of the reduction in cardiac mortality in coronary heart disease (CHD) patients with exercise training is the result of direct effects on the heart and coronary vasculature, or to indirect effects, via primary risk factors. OBJECTIVE: The aim of this article was to quantify the cardiac mortality benefits of exercise-based rehabilitation attributable to risk factor reductions versus the direct effects on the heart and vasculature. METHODS: The IMPACT coronary heart disease model was used to examine the reduction in cardiac mortality attributable to changes in risk factors from a meta-analysis of cardiac rehabilitation randomized, controlled trials. Patients were receiving rehabilitation following an acute myocardial infarction, angina pectoris or revascularization. Outcomes considered were primary risk factors (total cholesterol, systolic blood pressure and smoking behaviour) and cardiac mortality. RESULTS: Nineteen exercise-only cardiac rehabilitation trials (including 2984 patients) were identified. Across these trials, exercise training reduced pooled cardiac mortality by 28% (relative risk, 0.72, 95% confidence interval 0.55-0.95), with 30 fewer deaths than in the control group. Applying the CHD model, approximately 17 (58%) of these 30 fewer deaths were attributable to reductions in major cardiovascular risk factors: 7.1 deaths (minimum estimate 6.2, maximum estimate 9.5) attributable to an 18% reduction in smoking prevalence; 5.9 deaths (minimum -0.6, maximum 12.6) to a 0.11 mmol/l reduction in cholesterol, and 4.4 deaths (-1.0 minimum, 6.7 maximum) to a 2.0 mmHg reduction in systolic blood pressure. CONCLUSIONS: Approximately half of the 28% reduction in cardiac mortality achieved with exercise-based cardiac rehabilitation may be attributed to reductions in major risk factors, particularly smoking.

Aged↗
PubMed2006

Explaining the recent decrease in coronary heart disease mortality rates in Ireland, 1985-2000.

STUDY OBJECTIVES: To examine the proportion of the recent decline in coronary heart disease (CHD) deaths in Ireland attributable to (a) "evidence based" medical and surgical treatments, and (b) changes in major cardiovascular risk factors. DESIGN SETTING: IMPACT, a previously validated model, was used to combine and analyse data on the use and effectiveness of specific cardiology treatments and risk factor trends, stratified by age and sex. The main data sources were published trials and meta-analyses, official statistics, clinical audits, and observational studies. RESULTS: Between 1985 and 2000, CHD mortality rates in Ireland fell by 47% in those aged 25-84. Some 43.6% of the observed decrease in mortality was attributed to treatment effects and 48.1% to favourable population risk factor trends; specifically declining smoking prevalence (25.6%), mean cholesterol concentrations (30.2%), and blood pressure levels (6.0%), but offset by increases in adverse population trends related to obesity, diabetes, and inactivity (-13.8%). CONCLUSIONS: The results emphasise the importance of a comprehensive strategy that maximises population coverage of effective treatments, and that actively promotes primary prevention, particularly tobacco control and a cardioprotective diet.

Adult↗
PubMed2006

The association of job strain with coronary heart disease and metabolic syndrome in municipal workers in Turkey.

To explore the association of job strain with CHD and metabolic syndrome in municipal workers. A cross-sectional study was completed of 450 male workers. Coronary heart disease was defined as: physician diagnosed ischemic heart disease; and/or, ischemic findings in the ECG. Metabolic syndrome was defined according to the criterion set by the National Cholesterol Education Panel. The demand-control model was used to assess job strain. Self administered questionnaires were completed after a face to face interview. Logistic regression models were constructed to assess the association of job strain with CHD and metabolic syndrome. The prevalence of metabolic syndrome and CHD were 17.8% and 8.0% respectively. Both CHD and metabolic syndrome were found to be significantly higher in higher income groups. Job demand and job control were not found to be associated with either CHD or metabolic syndrome. Metabolic syndrome was significantly more prevalent among the high job strain workers, but the significance was lost when controlled for age. The findings suggest that there is no significant association between job strain and metabolic syndrome and CHD in this sample of Turkish workers. Job strain may possibly be perceived differently in different cultures and occupations. Future studies may benefit from using a combination of different stress models and more diverse study populations.

Adult↗
PubMed2005

Modelling the decline in coronary heart disease deaths in England and Wales, 1981-2000: comparing contributions from primary prevention and secondary prevention.

OBJECTIVE: To investigate whether population based primary prevention (risk factor reduction in apparently healthy people) might be more powerful than current government initiatives favouring risk factor reduction in patients with coronary heart disease (CHD) (secondary prevention). DESIGN, SETTING, AND PARTICIPANTS: The IMPACT model was used to synthesise data for England and Wales describing CHD patient numbers, uptake of specific treatments, trends in major cardiovascular risk factors, and the mortality benefits of these specific risk factor changes in healthy people and in CHD patients. RESULTS: Between 1981 and 2000, CHD mortality rates fell by 54%, resulting in 68,230 fewer deaths in 2000. Overall smoking prevalence declined by 35% between 1981 and 2000, resulting in approximately 29,715 (minimum estimate 20 035, maximum estimate 44,675) fewer deaths attributable to smoking cessation: approximately 5035 in known CHD patients and approximately 24,680 in healthy people. Population total cholesterol concentrations fell by 4.2%, resulting in approximately 5770 fewer deaths attributable to dietary changes (1205 in CHD patients and 4565 in healthy people) plus 2135 fewer deaths attributable to statin treatment (1990 in CHD patients, 145 in people without CHD). Mean population blood pressure fell by 7.7%, resulting in approximately 5870 fewer deaths attributable to secular falls in blood pressure (520 in CHD patients and 5345 in healthy people) plus approximately 1890 fewer deaths attributable to antihypertensive treatments in people without CHD. Approximately 45,370 fewer deaths were thus attributable to reductions in the three major risk factors in the population: some 36 625 (81%) in people without recognised CHD and 8745 (19%) in CHD patients. CONCLUSIONS: Compared with secondary prevention, primary prevention achieved a fourfold larger reduction in deaths. Future CHD policies should prioritise population-wide tobacco control and healthier diets.

Adult↗
PubMed2005

Small changes in United Kingdom cardiovascular risk factors could halve coronary heart disease mortality.

BACKGROUND AND OBJECTIVE: The U.K. government recently called for a 40% reduction in cardiovascular disease mortality by 2010. We examined the potential for cardiovascular risk factor changes to achieve that target. METHODS: We applied a previously validated mortality model, IMPACT, to an England and Wales population (37.1 million, aged 25-84). The model integrates information on trends in all the major cardiovascular risk factors, plus the uptake and effectiveness of all medical and surgical treatments. The potential reductions in coronary heart disease mortality from the base year, 2000, were calculated for two contrasting scenarios: (a) if recent risk factor trends simply continued to 2010 and (b) if further small reductions in risk factors were achieved, as in Scandinavia and the United States. RESULTS: Continuation of recent risk factor trends should result in approximately 10,685 fewer coronary deaths in 2010 (minimum estimate 10,110; maximum 16,460) than in 2000. Modest additional reductions in cholesterol and smoking could potentially achieve 51,270 fewer deaths (minimum 39,435; maximum 71,510). Optimistic changes in obesity, diabetes, and physical activity, however, would have relatively small effects. CONCLUSION: Modest additional risk factor reductions in cholesterol and smoking already achieved in the United States and Scandinavia could prevent or postpone > 50,000 deaths by 2010, halving current coronary mortality.

Adult↗
PubMed2005

Life-years gained from modern cardiological treatments and population risk factor changes in England and Wales, 1981-2000.

OBJECTIVES: We estimated life-years gained from cardiological treatments and cardiovascular risk factor changes in England and Wales between 1981 and 2000. METHODS: We used the IMPACT model to integrate data on the number of coronary heart disease patients, treatment uptake and effectiveness, risk factor trends, and median survival in coronary heart disease patients. RESULTS: Compared with 1981, there were 68230 fewer coronary deaths in 2000. Approximately 925415 life-years were gained among people aged 25-84 years (range: 745 195-1 138 655). Cardiological treatments for patients accounted for approximately 194145 life-years gained (range: 142505-259225), and population risk factor changes accounted for approximately 731270 life-years gained (range; 602695-879430). CONCLUSIONS: Modest reductions in major risk factors led to gains in life-years 4 times higher than did cardiological treatments. Effective policies to promote healthy diets and physical activity might achieve even greater gains.

Adult↗
PubMed2004

Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000.

BACKGROUND: Coronary heart disease mortality rates have been decreasing in the United Kingdom since the 1970s. Our study aimed to examine how much of the decrease in England and Wales between 1981 and 2000 could be attributed to medical and surgical treatments and how much to changes in cardiovascular risk factors. METHODS AND RESULTS: The IMPACT mortality model was used to combine and analyze data on uptake and effectiveness of cardiological treatments and risk factor trends in England and Wales. The main data sources were published trials and meta-analyses, official statistics, clinical audits, and national surveys. Between 1981 and 2000, coronary heart disease mortality rates in England and Wales decreased by 62% in men and 45% in women 25 to 84 years old. This resulted in 68 230 fewer deaths in 2000. Some 42% of this decrease was attributed to treatments in individuals (including 11% to secondary prevention, 13% to heart failure treatments, 8% to initial treatments of acute myocardial infarction, and 3% to hypertension treatments) and 58% to population risk factor reductions (principally smoking, 48%; blood pressure, 9.5%; and cholesterol, 9.5%). Adverse trends were seen for physical activity, obesity and diabetes. CONCLUSIONS: More than half the coronary heart disease mortality decrease in Britain between 1981 and 2000 was attributable to reductions in major risk factors, principally smoking. This emphasizes the importance of a comprehensive strategy that promotes primary prevention, particularly for tobacco and diet, and that maximizes population coverage of effective treatments, especially for secondary prevention and heart failure. These findings may be cautiously generalizable to the United States and other developed countries.

Adult↗
PubMed2004

Is smokeless tobacco a risk factor for coronary heart disease? A systematic review of epidemiological studies.

BACKGROUND: There is on-going debate about the wisdom of substituting smokeless tobacco products for cigarette smoking as a 'harm reduction' strategy. It is generally believed that health risks associated with smokeless tobacco use (ST) are lower than those with cigarette smoking. However, the population attributable risk of smoking is higher for cardiovascular diseases than for any cancers, and few studies or reviews have considered the cardiovascular outcomes of ST use. A systematic review was therefore carried out to highlight the gaps in the evidence base. METHODS: Electronic databases were searched, supplemented by screening reference lists, smoking-related websites, and contacting experts. Analytical observational studies of ST use (cohorts, case-control, cross-sectional studies) were included if they reported on cardiovascular disease (CVD) outcomes, or risk factors. Data extraction covered control of confounding, selection of cases and controls, sample size, clear definitions and measurements of the health outcome and ST use. One or two independent reviewers carried out selection, extraction and quality assessments. RESULTS: A narrative review was carried out. Very few studies were identified; only three from Sweden consider CVD outcomes and these are discrepant. There may be a modest association between use of Swedish snuff (snus) and cardiovascular disease (e.g., relative risk=1.4, 95% confidence interval 1.2-1.6) in one prospective cohort study. Several other studies have considered associations between ST use and intermediate outcomes (CVD risk factors). CONCLUSIONS: There may be an association between ST use and cardiovascular disease. However, further rigorous studies with adequate sample sizes are required.

Cardiovascular Diseases↗
PubMedDate not supplied

Factors influencing emergency department arrival time and in-hospital management of patients with acute myocardial infarction.

Reperfusion of the infarct-related artery in the very first hour ("golden hour") of acute myocardial infarction (AMI) significantly reduces mortality rates. Several factors may delay the initiation of reperfusion therapy (ie, thrombolytic therapy or primary percutaneous transluminal coronary angioplasty [PCTA]), most of which are related to patients. A total of 520 patients with suspected AMI were evaluated in the emergency department of Dokuz Eylül University Hospital between March 1996 and October 1999. After inclusion criteria were applied, the study consisted of 178 patients with a history of AMI. Analyzed data that affected patients' arrival to the hospital were obtained from responses to a questionnaire. The Statistical Package for the Social Sciences (SPSS; SPSS Inc., Chicago, Ill), version 11.0, was used for all statistical analyses. The mean "symptom onset-hospital arrival time" was 188+/-325 min for the entire study group. The median delay was 110 min (approximately 2 h). Only 39 (22%) patients arrived to the hospital within the first hour. The mean time needed for late responders (n=109, 74%) (hospital arrival later than 1 h after symptom onset) to arrive was 245-/+363 min. According to the results of this study, many patients with AMI who may be eligible for reperfusion therapy miss the "golden hour" because of late hospital arrival. Some groups of patients (ie, elderly, women, those with diabetes) were especially late in arriving. To reduce such delays, training programs may be advised to focus on these groups of patients. Arrival times to the hospital during AMI can be greatly improved by efficient public education programs targeted to these groups.

Emergency Service, Hospital↗