Amaç: Bu çalışma, pediatri bölümlerinde çalışan hemşirelerinin çocuk istismar-ihmal vakalarını tanılama yöntemleri, tedavi ve rehabilitasyonuyla ilgili bilgi düzeylerini ve istismar ve ihmal vakaları ...ile karşılaştıklarında yaklaşımlarını belirlemek amacıyla yapılmıştır. Gereç ve Yöntemler: Araştırma özel bir hastanenin çocuk ve acil servislerinde çalışan araştırmaya katılmaya gönüllü 25 pediatri hemşiresi ile gerçekleştirildi. Olgulardan daha kapsamlı bir görüşmeye katılmaya istekli, ses kaydı kullanılmasını kabul eden beş kişiyle ayrıca yarı yapılandırılmış kalitatif görüşmeler yapılmıştır. Verilerin analizinde; SPSS 16 programı ve basit tematik analiz kullanılmıştır. Bulgular: Olguların 23’ü meslek yaşamlarında duygusal, fiziksel, cinsel istismar ve çocuk ihmali özelliklerinin tümünü taşıyan vakalarla karşılaşmalarına rağmen olguların üçü bu tip vakalarla karşılaşıldığında uygulanacak prosedür hakkında bilgilerinin olduğunu, 9’u istismar ve ihmal konusunda daha önce eğitim aldığını, 21’i eğitimin gerekli olduğunu belirtmiştir. Sonuç: Hemşirelerin aldıkları eğitimi istismar ve ihmal vakalarını tanılamak için kullanmadıkları, ancak istismar vakası ile karşılaştıklarında bu durumu doktora ve polise bildirdikleri bulunmuştur. Kalitatif görüşmelerde hemşireler istismarı tanılamada sorumlu olduklarını; ancak iş yoğunluğu nedeniyle bu sorumluluğu yerine getiremediklerini ayrıca bu vakalarla karşılaştıklarında diğer hastalara göre daha duygusal yaklaştıklarını ifade etmişlerdir.
In the Air Pollution and Health: A European Approach (APHEA2) project, the effects of ambient ozone concentrations on mortality were investigated. Data were collected on daily ozone concentrations, ...the daily number of deaths, confounders, and potential effect modifiers from 23 cities/areas for at least 3 years since 1990. Effect estimates were obtained for each city with city-specific models and were combined using second-stage regression models. No significant effects were observed during the cold half of the year. For the warm season, an increase in the 1-hour ozone concentration by 10 mug/m3 was associated with a 0.33% (95% confidence interval CI, 0.17-0.52) increase in the total daily number of deaths, 0.45% (95% CI, 0.22-0.69) in the number of cardiovascular deaths, and 1.13% (95% CI, 0.62-1.48) in the number of respiratory deaths. The corresponding figures for the 8-hour ozone were similar. The associations with total mortality were independent of SO2 and particulate matter with aerodynamic diameter less than 10 mum (PM10) but were somewhat confounded by NO2 and CO. Individual city estimates were heterogeneous for total (a higher standardized mortality rate was associated with larger effects) and cardiovascular mortality (larger effects were observed in southern cities). The dose-response curve of ozone effects on total mortality during the summer did not deviate significantly from linearity.
The Mediterranean region is particularly vulnerable to the effect of summer temperature.Within the CIRCE project this time-series study aims to quantify for the first time the effect of summer ...temperature in Eastern-Southern Mediterranean cities and compared it with European cities around the Mediterranean basin, evaluating city characteristics that explain between-city heterogeneity.
The city-specific effect of maximum apparent temperature (Tappmax) was assessed by Generalized Estimation Equations, assuming a linear threshold model. Then, city-specific estimates were included in a random effect meta-regression analysis to investigate the effect modification by several city characteristics.
Heterogeneity in the temperature-mortality relationship was observed among cities. Thresholds recorded higher values in the warmest cities of Tunis (35.5°C) and Tel-Aviv (32.8°C) while the effect of Tappmax above threshold was greater in the European cities. In Eastern-Southern Mediterranean cities a higher effect was observed among younger age groups (0-14 in Tunis and 15-64 in Tel-Aviv and Istanbul) in contrast with the European cities where the elderly population was more vulnerable. Climate conditions explained most of the observed heterogeneity and among socio-demographic and economic characteristics only health expenditure and unemployment rate were identified as effect modifiers.
The high vulnerability observed in the young populations in Eastern-Southern Mediterranean cities represent a major public health problem. Considering the large political and economic changes occurring in this region as well future temperature increase due to climate change, it is important to strengthen research and public health efforts in these Mediterranean countries.
Acute effects of ozone on mortality from the Gryparis, Alexandros; Forsberg, Bertil; Katsouyanni, Klea ...
American journal of respiratory and critical care medicine,
2004, Letnik:
170, Številka:
10
Journal Article
There are no representative population studies to date on the prevalence and risk factors of chronic bronchitis, asthma and asthma-like symptoms in the Turkish population. This cross-sectional survey ...aims to establish the prevalence information related to the above listed respiratory outcomes as well as examining the risk factors associated with these conditions. Data were collected as a part of the Istanbul Respiratory Symptoms Survey through administration of a standardized screening questionnaire. The randomized sample was designed to represent adult household representatives in two district populations of Istanbul with different ambient air pollution exposure levels. The results from the analyses of the data set indicate that after controlling for all confounders, current levels of smoking, childhood pneumonia, occupational dust exposure and workdays longer than eight hours had a strong predictive effect for an outcome of chronic bronchitis. The risk factors differed for male and female subjects. For males the effects of crowding as a socioeconomic status indicator, occupational dust exposure, work days longer than eight hours, current levels of smoking and childhood pneumonia were strongest for chronic bronchitis. Junior high school or high school education as well as being currently employed had a protective effect on chronic bronchitis outcome. Among women only current level of smoking was a significant predictor of chronic bronchitis. The risk factors for asthma-like symptoms were: fur-bearing pets in the home, self reported hay fever, dyspnea (grade II and III), body-mass index, current smoking levels, childhood pneumonia and diagnosed asthma. Among women, being born in Istanbul had a protective effect over the outcome of AS. The risk factors for ECRHS asthma were current levels of smoking, being of age 31–44, dyspnea, hay fever, sleep apnea, wood heaters in the home and previous occupational dust exposure while controlling for demographic variables. The asthma and chronic bronchitis outcomes in our study population should be examined further in a follow up study using a comprehensive main questionnaire and pulmonary function tests.
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