Investigation of Nasal Methicillin Resistant Staphylococcus aureus and Coagulase Negative Staphylococcus Carriage by Various Methods in Hemodialysis Patients in Nevşehir ProvinceInfection is one of the important factors affecting morbidity and mortality in hemodialysis patients. Access to dialysis, frequent hospitalizations, and contact with healthcare personnel increase the risk of infection. Nasal Staphylococcus aureus and other staphylococci may cause vascular access infections through carrier patients and staff. In this study, nasal S. aureus and coagulasenegative Staphylococcus (CNS) carriers were detected in hemodialysis patients and staff, and methicillin resistance in isolates was investigated by various methods. In this way, it was aimed to contribute to the assessment of nosocomial infection risk. Between November 2019 and March 2020, 93 hemodialysis patients, 41 female, 52 male, and 15 dialysis personnel treated at Nevşehir State Hospital, H. Mustafa and Türkan Öbekli Dialysis Center were included in the study. Nasal swab samples were obtained after the informed consent form was signed. Methicillin resistance in staphylococci isolated from the samples was determined by the Kirby-Bauer disk diffusion method, PBP-2a latex agglutination (LA) test, and real-time polymerase chain reaction (RT-PCR). Of the patient samples (n=93), 18 (19.3%) had S. aureus, 11 (11.8%) had CNS; of the personnel samples (n=15) CNS was isolated from three (20%) and S. aureus from one (6.6%). It was determined that one of the S. aureus isolated from the patients was methicillin-resistant (1%); the rest (18.2%) and all CNS (11.8%) were methicillin-susceptible by disk diffusion method. While all of the CNS (20%) in the personnel samples were susceptible to methicillin, only S. aureus was resistant (6.6%). The PBP-2a LA test and RT-PCR were performed on all S. aureus isolates (n=19); the PBP-2a
This study aimed to examine the change in health service use and its affecting factors by comparing the findings of 2 studies conducted at different times, with the same data collection tools, in the same health service region. Material and Methods: The first cross-sectional study was conducted in 2004, in urban areas in Kayseri, with 501 households and 1,880 people in Primary Health Centers. The second was carried out in 2017, in 30 Family Health Centers, with 801 households and 2,253 people. The data were collected by the face-to-face interview method using a questionnaire. In statistical analysis, mean±standard deviation, median (Q1-Q3), Mann-Whitney U, Kruskal-Wallis, Pearson χ 2 , logistic regression analysis were used. The value p<0.05 was accepted as statistically significant. Results: The rate of health service utilization (HSU) increased from 79.6% to 84.8%, the average number of visits to physicians per person increased from 4.9 to 6.9. While the proportion of primary HSU increased to 45.8%, requests for visits to public hospital decreased to 26.4%. Healthcare use was significantly higher in male gender (2.2-2.3 times), 65 years and older (2.8-3.2 times), in people with good income (1.8-1.5 times), and in those with negative health perception (1.8-1.9
times). Conclusion:There has been a significant improvement in HSU parameters, particularly in Primary Health Care Centers services. Male gender, good level income, advanced age (≥65), and negative health perception are the main determinants of healthcare use. These results require a better understanding of the factors that make access to the health facilities difficult and the development of strategies that ensure fair use of health services.
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