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Öğe Effects of the Degree of Obesity on Achieving Target Blood Pressure and Metabolic Deterioration in Obese Individuals: A Population-Based Study(Karger, 2013) Öztürk, Serkan; Baltacı, Davut; Türker, Yasemin; Kutlucan, Ali; Yengil, Erhan; Deler, Mehmet Harun; Ankaralı, HandanBackground/Aims: This study aimed to evaluate the severity of obesity and its impact on achieving target blood pressure and metabolic derangement in obese individuals. Methods: This cross-sectional and population-based study was conducted between January and December 2012. A total of 1837 consecutive obese patients admitted to our outpatient clinic were enrolled. The anthropometric and blood pressure measurements, bioelectrical impedance fat analysis, blood sample analysis, impaired glucose status, metabolic syndrome, and insulin resistance of 1265 obese patients were compared between groups of patients separated by severity of obesity. Results: Only approximately one-third of patients with previous hypertension achieved normal blood pressure. In addition, the majority of patients without previous hypertension had higher blood pressure at the end of the study compared with baseline. The percent of patients with an impaired fasting blood glucose >= 100 mg/dL was 38.5%. The frequency of impaired glucose tolerance was 39.1% in the patients who underwent OGTT. Body mass index (BMI) was associated with impaired blood glucose, hypertension, insulin resistance, and the development of metabolic syndrome. The incidences of metabolic syndrome, insulin resistance, impaired glucose tolerance, and uncontrolled blood pressure were significantly different between groups of differing obesity severity (p<0.001, p<0.001, p=0.041, and p<0.001, respectively). Conclusion: The severity of obesity was associated with the failure to achieve target blood pressure and metabolic syndrome. Based on our data, blood pressure and metabolic parameters in obese patients should be monitored frequently and treated with caution. Copyright (C) 2013 S. Karger AG, BaselÖğe Evaluation of Clinical Effectiveness of Self-Monitoring Blood Glucose Level in Patients with Type 2 Diabetes Mellitus Treated with Non-Insulin Regimens in Duzce: Primary Care-Based Study(Duzce Univ, 2015) Baltacı, Davut; Kutlucan, Ali; Türker, Yasemin; Deler, Mehmet Harun; Sarıgüzel, Feyza; Özcan, Engin; Kara, İsmail HamdiObjective: Self-monitoring blood glucose (SMBG) is frequently recommended, beside its controversial efficacy. Herein, it was aimed to evaluate frequency of SMBG and its efficacy among patients with type 2 diabetes (T2DM) in primary care settings in Duzce Province of Turkey. Methods: The cross-sectional and primary care-based study enrolled a total of 680 patients with T2DM treated with oral anti-diabetic agents. Status of SMBG was recorded as non-use, daily, weekly and monthly. Metabolic and glycemic indexes were compared according to statuses of SMBG use. Results: Over the two-third of the patients were user of SMBG. The frequency of daily, weekly and monthly use of SMBG was 13.2%, 32.1% and 24.5%, respectively. Of them, the majority have irregularly used SMBG (59.4%). However, the ratio of patients who have regularly used SMBG was just 24.3%. No significant difference was observed between statuses of SMBG in glycemic indexes of HbA1c, Fasting blood glucose and post-prandial blood glucose (p=0.655, p=0.721 and p=0.389). Conclusions: Although the high and irregular use of SMBG, there was no difference between status of SMBG. Therefore, the family physicians should consciously advice self-monitoring blood glucose. It should be recommended after the patients are competent and empowered with education for its use. Further investigations should be carried out to general idea on clinical effectiveness SMBG in Turkey.Öğe Evaluation of serum Vitamin B12 level and related nutritional status among apparently healthy obese female individuals(Medknow Publications & Media Pvt Ltd, 2017) Baltacı, Davut; Deler, Mehmet Harun; Türker, Yasin; Ermiş, Fatih; Iliev, Darko; Velioğlu, UsameObjective: Obesity is a major public health problem and great risk for not only cardiovascular diseases but also cancer, musculoskeletal, and gynecological diseases. This study was aimed to investigate the association between serum Vitamin B12 (vitB12), body mass index (BMI), and nutritional status among obese women. Methods: This cross-sectional study enrolled consecutive female subjects. The consumptions of red meat, fish, bovine liver, egg, and mushroom were recorded. According to the Dietary Reference Intakes, the patients were categorized as insufficiency and sufficiency. Three cutoff points were defined for vitB12 status: (1) Deficiency if vitB12 is < 200 pg/mL; (2) insufficiency if vitB12 is 250-350 pg/mL, and (3) sufficient if vitB12 is >= 350 pg/mL. According to BMI, the patients were assigned to nonobese and obese groups. BMI, serum vitB12 level, consumptions of red meat, fish, bovine liver, egg, and mushroom were evaluated and compared between two groups. Results: Mean level of vitB12 was 247.8 +/- 10.4 pg/mL and significantly associated with consumption of egg (P = 0.031), bovine liver (P = 0.004), mushroom (P = 0.040), and red meat (P = 0.003). VitB12 was significantly higher in nonobese than obese group (282.5 +/- 106.8 vs. 242.5 +/- 107.5 pg/mL, P = 0.001). The ratio of vitB12 deficiency was significantly higher in obese than nonobese group (37.6% vs. 24.7%; P = 0.019). VitB12 level was negatively correlated with BMI (r = -0.155; P < 0.001), but not insulin resistance (r = -0.172; P = 0.062). Conclusion: Obesity was associated with low level of vitB12 in obese women, and more likely to be vitB12 deficient. Consumption of certain types of food contributes to increase vitB12 level.Öğe Evaluation of smoking cessation practice by physicians for hospitalized patients in a tertiary hospital(Pakistan Medical Assoc, 2016) Baltacı, Davut; Aydın, Leyla Yılmaz; Alaşan, Fatih; Deler, Mehmet Harun; Karaçam, Mehmet Serkan; Türker, Yasemin; Sarıgüzel, FeyzaObjective: To investigate physicians' smoking cessation practice, consultation for smoking intervention for hospitalised patients and its determinants. Methods: The cross-sectional study was conducted at Duzce University Hospital, Duzce, Turkey, from January to April 2013, and comprised hospitalised patients. The survey, including smoking habits and 5As (Ask, Advise, Assess, Assist and Arrange) steps of smoking intervention practiced by physicians was applied to those patients discharged from the hospital. SPSS 20 was used for statistical analysis. Results: Of the 502(31.6%) participants, 264(52.6%) were women and 238(47.4%) were men. The overall mean age was 52.8 +/- 18.2 years. Besides, 269(53.6%) respondents were at the level of elementary school education; 289(57.6%) had chronic disease; 119(23.7%) were current and 106(21.1%) were former smokers. The frequency of current smokers among men with chronic disease was significantly lower compared to those who did not have chronic disease (p = 0.017). In women, the factor was insignificant (p = 0.642). The physicians practiced the steps of "Ask, Advise, Assess, Assist and Arrange" on 354(70.5%), 240(47.9%), 194(38.7%), 88(17.6%) and 29(5.8%) patients for active smoking. Consultation during hospitalization significantly increased patient's effort to quit smoking after discharge (p = 0.012). Conclusion: Smoking intervention by physicians for hospitalised patients was associated with the status of patient's gender, education level and chronic disease.Öğe Investigation of relationship of visceral body fat and inflammatory markers with metabolic syndrome and its components among apparently healthy individuals(E-Century Publishing Corp, 2015) Türker, Yasemin; Baltacı, Davut; Türker, Yasin; Öztürk, Serkan; Sönmez, Cemil Işık; Deler, Mehmet Harun; Ankaralı, HandanMetabolic syndrome is a cluster of disorders and great risk for cardiovascular diseases. We aimed to investigate association between severity of metabolic syndrome (MetS) and anthropometric measurements, and to evaluate correlation of MetS and its components with metabolic deterioration and inflammatory indexes. The cross-sectional study enrolled 1474 patients with obesity and overweight. The patients were grouped as MetS and Non-MetS, and were sub-grouped as group 1 (three criteria), 2 (four criteria) and 3 (>= five criteria) according to NCEP ATP III. Mean age was 38.7 +/- 11.9 years and BMI was 35.1 +/- 6.3 kg/m(2). Lipid profile, anthropometric and blood pressure measurements, liver function tests, bioelectric impedance body fat compositions, insulin resistance and HbA1c, and spot urinary albumin-creatinine ratio were significantly different between groups of MetS and Non-MetS. Age, lipid profile, bioelectric impedance fat analyses, BMI, blood pressure values, glucose, insulin resistance, uric acid and hs-CRP levels were significantly different between groups of MetS component groups. ROC analysis revealed that hs-CRP was found to be more predictive for severity of metabolic syndrome components 3 and 4 (P=0.030); uric acid and visceral fat were more actual to predict severity of metabolic syndrome between 3 and 5 MetS components, (P=0.006) and uric acid was detected as more actual to predict severity of MetS between 4 and 5 components (P=0.023). In conclusion, uric acid, hs-CRP and visceral body fat composition were useful to predict to severity of MetS in primary care.Öğe Obez ve aşırı kilolu hastalarda vitamin d seviyesinin vücut kitle indeksi, beslenme, fiziksel aktivite ve güneşlenme ile ilişkisinin retrospektif olarak incelenmesi(Düzce Üniversitesi, 2014) Deler, Mehmet Harun; Baltacı, DavutVitamin D eksikliğinin kemik sağlığı üzerine etkisine ilaveten birçok iskelet dışı immün sistem bozukları, kardiyovasküler hastalıklar, diyabetes mellitus, bazı kanserlerin oluşumunu hızlandırdığı bilinmektedir. Son araştırmalarda ise obez kişilerde vitamin D seviyesinin obez olmayan bireylere göre anlamlı olarak düşük olduğu bildirilmiştir. Bu düşüklük obez hastalarda vitamin D'nin adipoz doku içinde hapsolması ve insülin direnci ile ilişkilendirilmektedir. Çalışmamızda ağustos 2013-temmuz 2014 tarihleri arasında aile hekimliği ve check-up polikliniğine ilk kez başvuran toplam 2150 hasta kayıtları retrospektif olarak taranmıştır. Araştırma kriterlerine uygun olarak vitamin D istenilen 682 hasta aşırı kilolu, obez, morbid obez olarak 3 gruba ayrılmıştır. serum vitamin D seviyesi'nin gruplar arasında, antropometrik ölçümler, metabolik parametreler, kan basıncı, fiziksel aktivite, beslenme ve güneşlenme ile ilişkisinin araştırılması amaçlanmıştır. Çalışmamızın sonuçlarına göre olguların yaş ortalaması 39,55±12,1 olup; vücut kitle indeksi 35,6±6 olarak bulunmuştur. Serum vitamin D seviyesi tüm olgularda ortalama 9,1±5,62 ng /mL olarak saptanmıştır. Olguların sadece %1,1'inde vitamin D seviyesi yeterli düzeyde olduğu bununla birlikte %68,5'inde ciddi vitamin D eksikliği saptanmıştır. Vücut vitamin D seviyesi ve depolarını etkileyen güneşlenme, besinsel faktörlerin (yumurta, balık, kırmızı et ve mantar) tüketimi ile fiziksel aktivite durumları analiz edilmiştir. Olguların %58 inde yeterli güneşlenme mevcut iken geriye %42'sinde yeterli güneşlenme olmadığı; sadece %5,9'unda haftalık olarak yeterli balık tüketildiği; %65,5' sinde yeterli miktarda yumurta tüketildiği ve sadece %18,9'inde yeterli kırmızı et tüketimi saptanmıştır. Olguların %82,7'sinde karaciğer tüketimi olmadığı ve yalnız %3,3'ünde yeterli mantar tüketimi izlenmiştir. Olguların %26,9'unda regüler egzersiz saptanmıştır. Beslenme, güneşlenme, fiziksel aktivite arasında anlamlı farklılık bulunamamıştır. Olgularda VKI ve insülin direnci ile vitamin D arasında negatif anlamlı korelasyon gözlenmiştir (p<0,001).Obez olmayan grup 1 olgularında en yüksek vitamin D seviyesi sonbahar mevsiminde (12,2±8,3 ng/mL) iken en düşük vitamin D seviyesi ilkbahar döneminde (9,2±5,7 ng/mL) izlenmiştir. Grup 2 (VKI=30-40)'deki olgularda en yüksek vitamin D seviyesi yaz döneminde (10,9±7,2 ng/mL) olup en düşük seviyesi ilkbahar mevsiminde (8,4±5,6 ng/mL) izlenmiştir. Grup 3 (VKI>40)'teki en yüksek vitamin D seviyesi yaz döneminde (9,2±5,6 ng/mL) iken en düşük seviyeler ilkbahar mevsiminde (6,9±3,2 ng/mL ) gözlemlenmiştir. Çalışmamızda da üzerinde durduğumuz nedenlerle D vitamininden zengin gıdalarla yeterli düzeyde beslenilemediği ve güneş ışınlarından yeterince faydalanılamadığı bilinmektedir. Bu durumda D vitamininden zenginleştirilmiş yiyecekler veya D vitamini destek tedavisinin önemi ortaya çıkmaktadır.Öğe Smoking cessation practice in male versus female family physicians in Turkey(European Respiratory Soc Journals Ltd, 2013) Aydın, Leyla Yılmaz; Baltacı, Davut; Alaşan,Fatih; Tanrıverdi, Mehmet Halis; Deler, Mehmet Harun…Öğe Smoking cessation practice of physicians for hospitalized patients in tertiary hospital(European Respiratory Soc Journals Ltd, 2013) Aydın, Leyla Yılmaz; Baltacı, Davut; Alaşan,Fatih; Gür, Mücahit; Deler, Mehmet Harun; Karaçam, Serkan…Öğe Smoking habits of nurses and midwives and their attitudes tobacco control; a primary care based study from four major cities of Turkey(Drunpp-Sarajevo, 2012) Aydın, Leyla Yılmaz; Baltacı, Davut; Öztürk, Serkan; Sarıtaş, Ayhan; Eröz, Recep; Celepkolu, Tahsin; Deler, Mehmet HarunIt was aimed to investigate smoking habits, knowledge about and attitudes towards tobacco control among nurses and midwifes at primary care settings in Turkey. A cross-sectional survey was applied to nurses/midwives at primary care settings. 1063 surveys were analyzed in the study. Mean age of nurses/midwives was 33.7 +/- 6.3. Current, former and never smokers' ratio among nurses/midwives were 30.1 %, 10.6 % and 59.3 %, respectively. Knowledge of nurses/midwives was observed as quite high. Majority of never smokers significantly marked as higher agreement with items related to knowledge level about smoking by than ever smokers. The lowest ratio was observed in agreement with item of "Pharmacotherapy is efficient for smoking cessation" (46.6 %). the highest ratio was observed in agreement with item of "Health professionals should routinely advise patients to avoid smoking around their children" (97.5 %). Significant differences were observed in statement of agreement with items related to attitudes of the nurses/midwives towards smoking and tobacco control between never and ever smokers. Almost all of the nurses/midwives had no any training course on smoking cessation practice (99.6 %). Majority of them were not competent for preparedness in smoking cessation (competent: 17.4 % vs. incompetent or somewhat: 82.6 %). In conclusion, knowledge and skills in smoking cessation practice and attitudes towards smoking and tobacco control in nurses/midwives were observed as low and somewhat high. Therefore, an appropriate education program should be instituted to increase motivation of them about their role in society and smoking cessation practice.
