Cut-off values for anthropometric indices in predicting morbidity and mortality in Turkey: a cohort

Background

Anthropometric measurements are associated with cardiovascular outcomes and mortality and the association varies by community. This study aims to estimate the incidence of cardiovascular outcomes and all cause mortality and determines their association with the anthropometric measurements.

Methods

The data from Turkey Chronic Diseases and Risk Factors Survey were used for the cohort which recruited two 15 years and older adults from each family physicians' list in 2011 in Turkey using simple random sampling (n = 18,477). Family physicians collected the medical history and performed anthropometric measurements. Initially healthy participants for cardiovascular morbidity (coronary heart disease (ICD-10 codes I20.0-I25.0) and stroke (ICD-10 codes I60.0-I69.0) and all participants for all-cause and cardiovascular mortality were followed-up through electronic health records by 2017. Area under the curves (AUCs) were estimated and the adiposity risk was defined as cut-off points determined using Youden Index. The sample was stratified by age-groups (<65, ≥65). Poisson and Cox models were fitted for morbidity and mortality outcomes, respectively.

Results

Over six years of follow-up, 5.7% of 15,877 and 1.3% of 16,062 participants developed CHD and stroke respectively. In total, 664 all-cause deaths (4.0%) were observed with 155 caused by CVDs (0.9%). A body shape index (i.e. 0.658 for all-cause mortality among younger men), waist-to-height ratio (i.e. 0.743 for CHD incidence among younger women), and BMI had higher AUCs for the outcomes. Higher anthropometric measurement groups had almost always higher CHD incidence risk in all groups but lower all-cause mortality in older men. Higher body-mass index was associated with lower mortality in younger men.

Conclusions

This cohort study in Turkey showed that having higher anthropometric measurements is mostly associated with higher CHD incidence and mostly lower mortality among older men. This association deserves further studies.

Key messages

In Turkey, higher anthropometric measurements are associated with higher coronary heart disease incidence in among participants. In Turkey, higher anthropometric measurements are mostly associated with lower all-cause mortality in older age-groups.

Health-related QoL and fatality in CHD patients: findings from a national cohort study, Turkey

Background

Although strong association between self-reported health and coronary heart disease (CHD) exists, health related quality of life (HRQOL) has not been conceptualized as a predictor for fatality in CHD patients. We investigated whether HRQOL may predict the risk of death in six years in CHD patients.

Methods

There were overall, 614 of CHD cases in the national representative Chronic Diseases and Risk Factors Survey in Turkey, 2011. Baseline self-reported health data on EuroQol- 5 Dimension (EQ-5D) and a Visual Analog Scale (VAS) were used from the same survey. The cases were followed-up for all-cause and CHD specific fatality (ICD-10 diagnostic codes: I20- I25) through electronic health records by 2017. Kaplan Meier and Cox regression models were used for data analysis. Age and sex adjusted HRs [aHR 95% CIs] were estimated for having some or extreme problems in EQ5D domains and VAS.

Results

Median follow-up years (IQR) was 6.46 (6.39-6.47). The number of deaths from all causes and CHD were 103 and 26, respectively. Age and sex adjusted HRs for all causes fatality were statistically significant for some or extreme problems in usual activities [2.48 (95%CI 1.60-3.83)], in pain/comfort [2.28 (95% CI 1.44-3.62)], in self-care [2.25 (95% CI 1.46-3.46)] and in mobility [1.85 (95% CI 1.16-2.96)]. Age and sex adjusted HRs for CHD specific fatality were statistically significant for some or extreme problems in self-care [3.45 (95% CI 1.48-8.07)] and pain/comfort [3.07(95% CI 1.19-7.93)]. VAS was negatively associated with overall fatality.

Conclusions

In CHD cases, poor self reported health might be a good indicator for overall and CHD specific fatality in 6 years. Especially having some or extreme problems in selfcare and pain/comfort are closely related with overall fatality as well as CHD specific fatality.

Key messages

There are strong relationships between HRQOL and all causes fatality as well as CHD specific fatality. Poor self- reported health might be a predictor for overall and CHD specific fatality in CHD cases.

Anthropometric indicators and diabetes incidence: results from a national cohort study, Turkey

Background

Anthropometric indicators such as Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and Body Shape Index (ABSI) are used globally to evaluate the risk of type 2 diabetes (T2DM). Our study aimed to investigate associations between different anthropometric indicators and the risk of T2DM using data from a national cohort.

Methods

The data on anthropometric measures and other risk factors of diabetes were obtained from Turkey Chronic Diseases and Risk Factors Survey in 2011 (n = 18,477). Disease information for the years 2012-2017 of the cohort has been reached through electronic health records and DM was ascertained by standard ICD-10 Codes. Four logistic regression models were generated based on different groups of confounders: unmodifiable risk factors, behavioral risk factors, comorbidities and socioeconomic variables. Categorical BMI, WC, WHR, WHtR, and ABSI values were used and adjusted RRs (95% CIs) of measurements were computed for men and women separately.

Results

Median follow-up year (IQR) was 6,46 (0,06). Between 2012 and 2017, 540 people were diagnosed with new diabetes. All anthropometric measurements except ABSI were associated with T2DM risk in all models. Among the anthropometric measures, BMI showed the strongest effect on incident diabetes, both in men (BMI ≥30; RRadj: 3.06, 95% CI 1.93-4.86) and women (BMI ≥30; RRadj: 2.58; 95%CI 1.73-3.85) in model 4 (adjusting for all confounding factors). WHtR provided the second strongest association with a RRadj of 2.57 in men (95% CI 1.78-3.71) and 2.55 in women (95%CI 1.87-3.47).

Conclusions

Independent of other risk factors, individuals with high BMI, WHR, WHtR and WC are at higher risk of developing T2DM. Public health strategies aimed at prevention of weight gain and obesity will probably be the most effective way to struggle with diabetes.

Key messages

There is a strong association between anthropometric measurements and type 2 diabetes incidence. Anthropometric indicators can be used to predict the risk of type 2 diabetes in males and females by clinicians and public health practitioners.

Noncommunicable disease incidences in 2012-2017, Turkey

Background

Globally, 88% of deaths are caused by noncommunicable diseases (NCD) and they are increasing in our country as in many parts of the world. Effective control, prevention and treatment of NCD, can begin from knowing the disease incidence by age, sex and regions.

Methods

This study aimed to determine the incidence of chronic diseases (coronary heart disease, stroke, diabetes, hypertension and cancer) by record linkage of the data from the Turkey Chronic Diseases and Risk Factors Prevalence Study 2011 (TCD-RFS) with health service databases, which are Family Medicine Information System, Medulla- E-Pulse and Death Notification System. The cohort (18.477 people above age 15) from TCD-RFS is followed up to determine the incidence of coronary heart disease, hypertension, diabetes, stroke and cancer, from the electronic health record systems for the period between 2012 and 2017 (6 years). Cumulative incidences were calculated, age and sex standardized incidences were given with 95% CI.

Results

The age and sex standardized cumulative incidences are, 5939 (95% CI 5933-5945) for CHD 1378 (95%CI:1369-1388) for stroke, 2254 (95% CI 2 253 -2 255) for cancer, 4200 (95% CI 4194-4204) for diabetes and 20788 (95% CI 1369-1388) for hypertension (per 100,000). The annual incidences are approximately 990 for CHD, 229 for stroke, 375 for cancer, 700 for diabetes and 3464 for hypertension (per 100,000). CHD and cancer incidences are higher in men, while diabetes, hypertension and stroke incidences are higher in women.

Conclusions

Regardless of the difficulties in comparing incidence of NCD with other countries, we think our results show that hypertension, diabetes, stroke and CHD have higher incidence than Western European countries. We also showed that these metrics can be obtained through data linkage of National Health Records for the first time in Turkey.

Key messages

The NCDs needs to be monitored by surveillance using the current data sources for health services. This data can provide very useful information regularly to monitor and control NCDs if necessary actions are taken to adjust data management.

Educational Level Inequalities in Cardiovascular Outcomes and All-Cause Mortality in Turkey: A Cohort

Background

Recent decades witnessed an increase in the burden of non-communicable diseases including adverse cardiovascular outcomes in low- and middle income countries and the burden was not equal across socioeconomic strata. This study aimed to define educational level inequalities in cardiovascular outcomes and all-cause mortality in a six-years cohort in Turkey.

Methods

Non-communicable Diseases and Risk Factors Cohort randomly sampled two adults (>14) from each of the registered family physicians in Turkey in July 2011 (n = 18,477). The family physicians collected demographic data. Incident coronary heart disease (CHD), cardiovascular and all-cause deaths were obtained from electronic health records in the end of 2017. Ridit score transformation was applied to the educational level by gender (illiterate, primary school, secondary school, high school or higher) and then Relative Index of Inequalities by educational level were estimated using Poisson Regression for morbidity and Cox Regression for mortality.

Results

There were 17,847 participants in CHD and 18,461 in the mortality cohort. During six-years 1,026 cases were diagnosed with CHD, 185 cardiovascular and 769 all-cause deaths occurred respectively. The inequalities were not significant for all outcomes however Relative Index of Inequalities were close to be significant for CHD incidence among men and all-cause mortality among women (0.721 (0.507 to 1.025) and 1.721 (0.969 to 3.057), respectively).

Conclusions

This is the first-ever cohort in Turkey with the aim to define educational level inequalities in cardiovascular outcomes and all-cause mortality. The inequalities may not have been observed due to the low number of outcomes.

Key messages

In Turkey, there were no educational level inequalities in our cohort. The possible inverse inequalities among men and inequalities among women may arise with a longer follow up.

The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing

Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs.

Effects of Acetyl Salicylate and Ibuprofen on Fluoroquinolone MICs onSalmonella entericaSerovartyphimurium In Vitro

In this study, the effects of acetylsalicylate and ibuprofen at 2, 4 and 8 mM concentration were investigated on ofloxacin, ciprofloxacin, levofloxacin and pefloxacin minimum inhibitory concentrations (MICs) for 14 Salmonella enterica serovar typhimurium clinical isolates, one standard strain (SZH KUEN 557), SH7616 (acr mutant), SH5014 (parent strain of acr mutant) and PP120 (soxRS mutant) strains. All isolates were susceptible to the 4 fluoroquinolones. In the presence of 2, 4 and 8 mM acetylsalicylate and ibuprofen, 2- to 8-fold increases were observed in fluoroquinolone MICs. This rise was higher, especially in the presence of acetylsalicylate. In spite of this rise, none of the MICs were in the range of resistance limits in vitro. Except for a 2-fold increase in levofloxacin MICs, we did not observe any difference in MICs of ofloxacin, ciprofloxacin, and pefloxacin in the presence of 2, 4 and 8 mM acetylsalicylate and ibuprofen for SH7616 and PP120 strains. According to the in vitro results of this study, it can be suggested that use of acetylsalicylate or ibuprofen together with clinical treatment of bacteria, especially bacteria which show intermediate resistance, will cause resistance. However, since clinical data are insufficient, further studies are needed.

Hepatitis B and C seropositivity among nursing students at a Turkish university

BACKGROUND

Viral hepatitis infections are major health problems, which are especially prevalent in developing countries. In particular, health care workers are at high risk for contracting viral hepatitis. Therefore, preventive measures to minimize occupational exposure to blood borne pathogens are needed to protect both health care workers and nursing students.

OBJECTIVES

To determine the prevalence of Hepatitis B and C infections and risk factors among nursing students.

METHODS

Venous bloods were obtained from nursing students and were serologically tested using the ELISA method. A questionnaire form was also used to obtain data related to demographic and socio-economic characteristics of the participants.

RESULTS

0.7% of the nursing students were serologically positive for HBsAg, 17.0% for Anti-HBs and 7.5% were positive for Anti-HBc (IgG). No statistical relationship was determined between all independent variables and the results of serologic tests.

In vitro effects of cefotaxime and ceftriaxone on Salmonella typhi within human monocyte-derived macrophages

The main objective of this in vitro study was to assess the effects of cefotaxime and ceftriaxone in killing Salmonella typhi in infected human macrophages. Human monocyte-derived macrophages isolated from peripheral blood of human volunteers were cultured in vitro for macrophage differentiation, and subsequently infected with S. typhi strains (a clinical isolate and a standard strain TA-42) at a cell ratio of 10 : 1. MICs of cefotaxime and ceftriaxone were determined by broth microdilution, and the antibiotics were included in the culture medium at one and five times their MIC values. Samples of cell culture medium taken at 0, 3, 6 and 24 h of incubation were cultured for growth of S. typhi on nutrient agar. Gentamicin (10 mg/L) was included in each well except for the control wells, in order to prevent growth of extracellular S. typhi. Both antibiotics showed good in vitro antibacterial effects against S. typhi strains. There were no statistically significant differences between the extracellular and intracellular effects of antibiotics with regard to elimination of the bacteria. Cefotaxime and ceftriaxone are highly effective against extracellular bacterial growth. The results of our in vitro experiments suggest that cefotaxime and ceftriaxone might also be used clinically against susceptible intracellular pathogens such as S. typhi.