Temmuz – Aralik 2017 tarihleri arasinda salgin yapan hastaliklar, en son salgin yaptiklari cografik bölge ve tarih verilerek ele alinmistir. Küresel olarak salgin hakkinda bilgi verilmesi amaçlanmistir. Anahtar kelime: Salgin haberleri, salgin, epidemi The purpose of this study to inform about disease outbreaks which were seen globally between the dates July-December 2017 with geography. Key words: Epidemic news, epidemic, outbreak

Amaç: Çalismada yari kirsal alanda yasayan 50-70 yas arasindaki kisilerin kolorektal kanser tarama programlarini hakkindaki farkindaliklarinin degerlendirilmesi ve gaitada gizli kan testi ile taramalarinin yapilmasi amaçlandi. Gereç-yöntem: Çalisma, 2015 yilinda Eskisehir Osmangazi Üniversitesi Egitim-Arastirma bölgesinde yer alan Toplum Sagligi Merkezleri (TSM)’nden rastgele seçilen iki bölgede (Mahmudiye ve Beylikova) yapilan kesitsel tipte bir arastirmadir. TSM’lerin saglik kayitlarindan ilçe merkezlerinde yasayan 50-70 yas arasinda 1637 kisinin adres bilgilerine ulasildi. Çalisma gün-saatinde, belirlenmis adreslere gidildi ve 1533 kisiye (%93.6) ulasildi. Çalismaya katilmayi kabul eden 495 kisi (%32.3) ile anket formu dolduruldu. Daha sonra gaitada gizli kan tarama testini yaptirmayi kabul edenlere, testi nasil yapacaklari anlatilarak test kiti verildi. Dagitilan kitler 48 saat sonra toplandi. Alinan numuneler klavuzuna uygun olarak analiz edilerek negatif, pozitif ve geçersiz olarak degerlendirildi. Veriler IBM SPSS (versiyon 15.0) paket programinda degerlendirildi. Verilerin analizinde KiKare ve çoklu lojistik regresyon analizi kullanildi. Bulgular: Çalisma grubunu olusturanlarin yaslari 50-70 arasinda degismekte olup ortalama (standart sapma) 59.2 (5.8) yil idi. Katilimcilarin 221’i (%44.6) erkek, 450 (%90.9) evli, 295’i (%59.6) ilkokul mezunuydu. Çalisma grubunu olusturanlardan daha önce gaitada gizli kan tarama testini duyanlarin sayisi 177 (%35.8) idi. Katilimcilardan çalismadan önce kolorektal kanserler ile ilgili herhangi bir tarama testi yaptirma sikligi %19.4 (n=96) olup, tarama testlerini duyanlarda, kadinlarda ve hekim tanili kronik hastaligi olanlarda tarama testine katilma orani daha yüksekti. Çalismada 113 (%22.8) kisi gaitada gizli kan tarama testi kitini almak istemedi. Ögrenim düzeyi yüksek olan, gelir durumu kötü olan, akrabalarinda kolorektal kanser öyküsü olanlarda gaitada gizli kan tarama testine katilim sikligi daha fazlaydi. Gaitada gizli kan tarama testi kiti verilen ve sonucu degerlendirmeye alinan 307 katilimcidan 45’inin (%14.7) sonucu pozitif idi. Sonuç: Kolorektal kanser tarama programlarini duyan kisilerde tarama programlarina katilma sikligi daha yüksek bulundu. Çalismada ulasilan kisilere arastirma hakkinda bilgi verildikten gaitada gizli kan tarama testini yapmak istemeyen, kit verilse bile degerlendirmeye alinmayan kisi orantilari yüksekti. Bu durum gaitada gizli kan tarama testinin toplum tarafindan kabul edilebilirliginin az oldugunu ve uygulanabilirliginin zorlugunu göstermektedir. Anahtar Sözcükler: Kanser, kolorektal kanser, tarama programlari, farkindalik FECAL OCCULT BLOOD SCREENING IN PEOPLE LIVING IN SEMIRURAL AREA AND THEIR AWARENESS ABOUT SCREENING PROGRAMS Objective: The aim of the study is to evaluate the awareness of colorectal cancer screening programs among people aged between 50 and 70 living in semirural area and to perform their screening with fecal occult blood screening test. Material-method: This is a cross-sectional study was conducted among individuals aged 50- 70 years living in two randomly selected regions (Mahmudiye and Beylikova) from Community Health Centers (CHC) in Eskisehir Osmangazi University Training and Research Area in 2015. From the health records of CHCs, the address information of 1637 people living in the district centers between the ages of 50 and 70 was obtained. At the working day-time, the selected addresses were visited and 1533 people were reached (93.6%). A questionnaire was completed with 495 people (32.3%) who agreed to participate in the study. Those who agreed to have the fecal occult blood screening test were given a test kit describing how to carry out the test. Distributed kits were collected after 48 hours. The samples were evaluated as negative, positive and invalid according to the guidelines. The data were evaluated in the IBM SPSS (version 15.0) package program. Chi Square and multiple logistic regression analyzes were used in the analysis of the data. Results: The age of the study group ranged from 50 to 70 years with a mean (standart deviation) of 59.2 (5.8) years. 221 (44.6%) were male, and 450 (90.9%) were married; 295 (82.0%) had primary and lower education level. 177 (35.8%) were aware of hemoccult test among the study group. The frequency of any screening test for colorectal cancer before the study was 19.4% (n = 96) and the participation to the test was higher in women and in patients having physician- diagnosed chronic diseases. In the study, 113 (22.8%) participants did not want to receive the hemoccult test kit. There was a higher frequency of participation in those who had a higher education level, poor income status, and had colorectal cancer stories in their relatives. Of the 307 participants who received the fecal occult blood screening test kit and were subsequently evaluated, 45 (14.7%) were positive. Conclusion: People who were aware of colorectal cancer screening programs were more likely to participate in screening programs. After being informed about the research, the percentage of people who did not want to participate to the test and even if the kit was given, whose test can not be evaluated was high. This suggests that the community acceptability of the fecal occult blood screening test is low and its applicability is difficult. Key Words: Cancer, colorectal cancer, screening programs, awareness

The aim of this study is to determine the prevention behaviors to pesticide exposure in seasonal agricultural workers. This is a cross-sectional study in 312 seasonal agricultural workers lives in the tent regions that accepted to participate to the research in the period of intensive agricultural work in 2015. In the study, a questionnaire consisting of questions about sociodemographic characteristics and pesticide exposure prevention behaviors of seasonal agricultural workers was used. Seasonal agricultural workers expressed that; 43 (13.8%) of them had trained about pesticides, 168 (53.8%) of them had worked in the pesticide applied area and 235 (75.3%) of them had been using personal prevention equipment to prevent against pesticide exposure. There were 150 (48.1%) seasonal agricultural workers were wearing to be exposed to pesticide. Participants aged 39 and lower (78.7%) found to be wearing clothes that exposure to more pesticide than those in the age group of 40 and over (21.3%). There were 246 (78.8%) people who take off the clothes they were applying pesticide when they came home. It was seen that, persons living in the village (57.3%) take off the clothes they were applying pesticide when they come to the tent, were more than those living in the province / district (42.7%). It was found that seasonal agricultural workers did not get enough training on safe pesticide use and their pesticide exposure prevention behaviors were not sufficient. It has been concluded that employees in agriculture must be gain safe pesticide use behavior and training programs should be organized for the prevention and development of their health.

Çalismanin amaci mevsimlik tarim isçilerinin pestisit maruziyetinden korunma davranislarinin belirlenmesidir. Çalisma, 2015 yilinda tarim islerinin yogun oldugu dönemde çadir bölgelerinde bulunan ve arastirmaya katilmayi kabul eden 312 MTI üzerinde yapilan kesitsel tipte bir arastirmadir. Çalismada mevsimlik tarim isçilerinin sosyodemografik özellikleri ve pestisit maruziyetinden korunma davranislarini sorgulayan sorulardan olusan bir anket form kullanildi. Mevsimlik tarim isçilerinin 43’ü (%13.8) pestisit ile ilgili egitim aldigini, 168’i (%53.8) pestisit uygulanmis alanda çalistigini, 235’i (%75.3) pestisit maruziyetinden korunmak için kisisel koruyucu ekipman kullandigini ifade etmektedirler. Pestisite maruz kalacak sekilde giyinen ise 150 (%48.1) mevsimlik tarim isçisi vardi. Katilimcilardan 39 ve alti yas grubunda (%78.7) olanlar, 40 ve üstü yas grubunda (%21.3) olanlara göre daha fazla pestisite maruz kalacak sekilde giyindigi bulundu. Mevsimlik tarim isçilerinden pestisit uyguladigi giysileri çadira gelince çikaran 246 (%78.8) kisi mevcuttu. Köyde yasayanlarin (%57.3), il/ilçede yasayanlara (%42.7) göre çadira geldiginde pestisit uyguladigi giysileri daha fazla çikardiklari görüldü. Mevsimlik tarim isçilerinin güvenli pestisit kullanimi ile ilgili gerekli egitimi almadigi ve pestisit maruziyetinden korunma davranislarinin yeterli olmadigi bulundu. Tarim isinde çalisanlarin güvenli pestisit kullanma davranisi kazanmalarinin saglanmasi, sagliklarinin korunmasi ve gelistirilmesi için egitim programlarinin düzenlenmesi gerektigi kanaatine varildi.

Çalismada, yari kirsal alanda aile sagligi merkezlerine basvuran eriskinlerde akilci ilaç kullanimi ile ilgili tutum ve davranislarin incelenmesi amaçlandi. Eskisehir Osmangazi Üniversitesi (ESOGÜ) Egitim Arastirma Bölgesi bünyesinde bulunan dört Toplum Sagligi Merkezi(TSM) bölgelerinden, küme örnekleme yöntemiyle rastgele olarak iki TSM bölgesi seçildi. Seçilen TSM bünyesindeki aile sagligi merkezlerine(ASM) arastirma süresince basvuran 768 yetiskin çalisma grubunu olusturdu. Verilerin toplanmasinda kullanilan anket formun birinci bölümü katilimcilarin sosyodemografik ve özgeçmis özelliklerini, ikinci bölüm ise akilci ilaç kullanimi ile ilgili tutum ve davranislari sorgulayan 13 sorudan olustu. Çalismada akilci ilaç kullanma davranisi hekimin önerdigi miktar ve sürede ilaç kullanma olarak tanimlandi. Verilerin analizinde ki kare testi ile çoklu lojistik regresyon analizi kullanildi. Çalismaya katilan 768 kisinin yaslari 18-87 arasinda olup ortalamasi±SS 41.9±14.5 yil idi. Çalisma grubunun %90.6’si hekime basvurmadan ilaç kullandigi bildirirken en sik hekime basvurmadan kullanilan ilaçlar agri kesicilerdi. Çalisma grubunda akilci olmayan ilaç kullanma sikligi %53.4 olarak saptandi. Çalisma grubunda akilci olmayan ilaç kullanma davranisi 40 yas altinda, erkeklerde, gelir düzeyi kötü olanlarda riskli olarak saptandi. Çalismada katilimcilarda akilci ilaç kullanma davranisinin yetersiz oldugu, özellikle genç yaslarda akilci ilaç kullaniminin azaldigi görüldü. Bireylere akilci ilaç kullanimi ile ilgili olumlu tutum ve davranislarin kazandirilmasi için saglik egitimi verilmesi gerektigi ve birinci basamak saglik hizmetleri sunumu içine hastalarda akilci olmayan ilaç davranisina yönelik uygulamalarin yerlestirilmesinin uygun olacagi kanaatine varildi. RATIONAL DRUG USE ATTITUDES AND BEHAVIORS OF ADULTS WHO APPLY FOR PRIMARY HEALTH CARE IN SEMIRURAL AREAS The aim of the study was to investigate attitudes and behaviors related to rational drug use in adults who applied to family health centers in semirural areas. Two Community Health Center (CHC) regions were randomly selected from the four CHC regions of the Eskisehir Osmangazi University (EOU) Educational Research Zone by cluster sampling method. A total of 768 adult were recruited to the family health centers within the selected CHC regions during the survey. The first part of the questionnaire used to collect data consisted of questions about the participants sociodemographic and background characteristics and the second part consisted thirteen questions about attitudes and behaviors related to rational drug use. The rational drug use behavior in the study was defined as the use of the amount prescribed by the physician. Chi-square test and multiple logistic regression analysis were used in the analysis of the data. The mean age of the 768 participants was between 18 and 87 years and the mean ± SD was 41.9 ± 14.5 years. 90.6% of participants reported using drug without prescribed by a physician. Painkillers were the most often taken without a prescription. The incidence of irrational drug use in the study group was 53.4%. In the study group, irrational drug use behavior was found risky below 40 years of age, males and with poor income levels. Participants in the study were found inadequate of rational drug use, especially in younger age.It has been concluded that health education should be given to acquire positive attitudes and behaviors related to rational drug use by individuals and it would be appropriate to put non- rational drug behaviors into the provision of primary health care services to patients.

Diyabet, insülin üretimi ya da kullaniminda meydana gelen patolojilerden kaynaklanan ciddi kronik bir hastaliktir. Geçtigimiz birkaç dekadda diyabet prevelansi artarak, 21.yüzyilin en büyük küresel salginlarindan biri haline gelmistir. Diyabet ve diyabete bagli olusan komplikasyonlarin yol açtigi sorunlarla yasayan insan sayisi her geçen yil giderek artmakta ve büyük bir ekonomik yük olusturmaktadir. Bu yükün maliyetinin hesaplanmasinda direkt ve indirekt olmak üzere 2 bilesen vardir. Dünya çapinda diyabetin yillik direkt maliyeti 825 milyar dolardir. Diyabetli popülasyonun %75.4’ü düsük ve orta gelirli ülkelerde yasamakta ancak diyabete yönelik küresel saglik harcamalarinin sadece %19’u bu ülkelere harcanmaktadir. Dünya Saglik Örgütü’nün 2016 diyabet raporuna göre, toplam küresel diyabet harcamalarindaki artisin devam etmesi beklenmektedir. Risk faktörleri ve sonradan ortaya çikan hastaliklarin erken dönemde baslayabilecegi göz önüne alindiginda, prematur ölümlerin önlenmesi, yasam kalitesinin iyilestirilmesi ve saglik sistemi üzerindeki ekonomik yükün azaltilmasi için hastalik önleme ve sagligi gelistirme çalismalarinin yapilmasi bir gerekliliktir. THE ECONOMIC BURDEN OF DIABETES Diabetes is a serious chronic disease caused by pathologies of production or use of insulin. In the past few decades, the prevelance of diabetes has been increased and became one of the greatest global epidemics of the 21st century. The number of people living with the problems caused by diabetes and diabetes-related complications are increasing every year and occur a great economic burden. In calculation of the cost of this burden include two components named direct and indirect. The worldwide direct cost of diabetes is 825 billion dollars. Although 75,4% of the population who have diabetes live in low and middle income countries and only 19% of the worldwide health expenditures for these countries. According to report of the World Health Organization 2016 about diabetes, it is expected that the health expenditures for diabetes will continue by increasing. Considering the risk factors and subsequent disease may begin at early stage, it is essential to prevent disease and improve health promotion research for preventing of premature deaths, upgrading of the quality of life and reducing the economic burden on the health care system.

Tütün ve tütün ürünleri kullanimi nedeniyle 20’nci yüzyilda 100 milyon kisi hayatini kaybetmistir. Tütün salgini engellenemezse 21’inci yüzyilda 1 milyar kisinin ölmesi beklenmektedir. Dünya Saglik Örgütü bu tehlike kapsaminda 2003 yilinda “Tütün Kontrol Çerçeve Sözlesmesi”ni, 2008 yilinda da “MPOWER paketi”ni gündeme getirmistir. MPOWER uygulamalari zaman içinde ayni basariyi göstermemekle birlikte, baslangiçta 200 milyon insani kapsarken, 2016 yilinda 3,5 milyar insani kapsar hale gelmistir. MPOWER paketinin uygulanmasiyla beraber birçok ülkede tütün kontrolünde ilerleme kaydedilmistir. Ilerlemenin daha genis kapsamli ve güçlü olabilmesi için uygulamalar gelistirilmeli ve yayginlastirilmalidir. Anahtar kelimeler: tütün, kontrol programlari, MPOWER GLOBAL ASSESSMENT OF TOBACCO CONTROL IMPLEMENTATIONS In the 20th century 100 million people died due to the use of tobacco and products. It is expected the failure in prevention and control programmes may cause the death of 1 billion people in the 21st century."Tobacco Control Framework Convention" in 2003 and the "MPOWER package" in 2008 are the hot topics determined by WHO to take attention about this threat. Although the level of success of MPOWER implementations are not stable in the period since it is developed, initially encompassing 200 million people, the implementations managed to reached 3.5 billion people in 2016. The implementations of the MPOWER package helped and made progress in most countries about tobacco control and should be improved for comprehensive and stronger effect. Key words: tobacco, control programmes, MPOWER