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Can a city population represent a whole country? Essentials of study design for epidemiologic studies/Serum lipid profiles including non-high density lipoprotein cholesterol levels in Turkish school-children/Bir ilin populasyonu tum ulkeyi temsil eder mi? Epidemiyolojik calismalar icin calisma tasariminin temelleri/Turk okul cocuklarinda serum lipid profili ve non-HDL kolesterol duzeyleri.

Dear Editor,

We have read the manuscript entitled "Serum lipid profiles including non-high density lipoprotein cholesterol levels in Turkish school children" by Ucar et al. (1) with a great pleasure. That was a valuable observational and cross-sectional study conducted in 11 schools of Eskisehir city center and Cifteler county with 2896 participants. Results were well presented and discussed. However, the phrase of "Turkish Children", included in the title of the article, implies that the study is an epidemiological study. On the other hand, as stated in the methodology, the sample of the study comprised the cases who were randomly selected from 11 schools in Eskisehir. It is not appropriate to claim that cases selected form only one provision can represent all the Turkish children. In epidemiological studies, the most important subject is to select the sample so that it represents the population of interest. If a study is to be held in school children in Turkey, and the subject is prone to be influenced from various factors, such as geographical, cultural, economical and intellectual variables, the sample of the study should also possess these variables. The mostly correct data that represents the population of Turkey can be obtained from Turkish Statistical Institute (TSI). The sample of the study should have been selected according to the data obtained from TSI. The rural part of the study was represented by the population of Cifteler. The two thirds of the population of Cifteler is living in the county town. If the subjects were selected from those living in county town, it is impossible to say that these subjects are representing the rural area. The essential features of designing and applying a sample that represents a specific geographical area are described (2), and in our opinion multi-step stratified sampling method should be chosen for defining given population. In conclusion, the title of this valuable article should have been "Serum lipid profiles including non-high density lipoprotein cholesterol levels in a randomly selected large school children population". We think that this point has been overlooked by the referees and editors.

Mehmet Yokusoglu, Mehmet Uzun, Oben Baysan

Department of Cardiology, Faculty of Medicine,

Gulhane Medical Academy, Ankara, Turkey

References

(1.) Ucar B, Kilic Z, Dinleyici EC, Colak O, Gunes E. Serum lipid profiles including non-high density lipoprotein cholesterol levels in Turkish school-children. Anadolu Kardiyol Derg 2007; 7: 415-20.

(2.) Turkyilmaz AS, Hancioglu A, Koc I. Arastirma tasarimi. In: Turkiye Nufus ve Saglik Arastirmasi 2003. Ankara: Hacettepe Universitesi Hastaneleri Basimevi 2005. p. 169-87.

Address for Correspondence/Yazisma Adresi: Mehmet Yokusoglu, Gulhane Askeri Tip Fakultesi, Kardiyoloji Klinigi, Ankara, Turkey myokusoglu@yahoo.com

Authors reply

Dear Editor,

We appreciate the author for her/his letter in reference to our article entitled "Serum lipid profiles including non-high density lipoprotein cholesterol levels in Turkish school-children" that was recently published in Anadolu Kardiyoloji Dergisi (1). The author has some criticisms and suggestions about the selection of study population especially for the rural area.

Our study is a large epidemiological study including 2,896 schoolchildren from urban and rural parts of Eskisehir, Turkey. We did not use "Serum lipid levels in Turkey" term in the title and we preferred to use "Turkish school-children" term like in our previous published studies. Anadolu Kardiyoloji Dergisi is an international peer-reviewed journal which was recently indexed by international databases. We think that it is important to indicate the special region of Turkey where the study was performed if the article would be published in a local journal but it is not important for an article published in an internationally distributed journal. We agree that it is not appropriate to claim that cases selected form only one provision could represent all the Turkish children however it is not impossible to find appropriate population which represent Turkey's data. The author suggested that a study is to be held in school-children in Turkey, and the subject is prone to be influenced from various factors, such as geographical, cultural, economical and intellectual variables, the sample of the study should also possess these variables. Regarding this perspective, Eskisehir and our study population have no main difference about cultural, economical, intellectual variables and also nutritional variables from different parts of Turkey. The dietary habits including oil consumption of Eskisehir population which may affect the results of our study are similar to those of the middle Anatolian region. Cited study by the authors about the essential features of designing and applying a sample, was not published during our study design period. The sample selection of our study was made by consulting with our Institutes Public Health Department.

According to Turkey Prime Ministry, State Planning Organizations Report (2), "Rural area" term was recently described as living areas with <20,000 population. Cifteler county is located 64 km from Eskisehir city center and during our study period, Cifteler county population was 11,000. Cifteler's population maintains their living mainly by agriculture and livestock and 75% of the total area serves as agricultural area (3). Also the nutritional habits of the Cifteler population are different from those of Eskisehir city population. For example, unlike the urban area of Eskisehir there aren't any fast-food restaurants in Cifteler and people have their meals in home almost all the time. In addition, the selected schools were so cio-economically representative of the whole region. Children from both county center and villages attend the high schools in the count center because the high schools are mainly placed in the Cifteler county center. For this reason, Cifteler regions data represents county center and villages. So, we think that Cifteler schoolchildren population can represent the rural population of our region.

Birsen Ucar, Zubeyir Kilig, Ener Cagri Dinleyici *,

Omer Colak **, Erdogan Gunes *

Department of Pediatric Cardiology, Pediatrics *

and Biochemistry ** Faculty of Medicine,

Eskisehir Osmangazi University, Eskisehir, Turkey

References

(1.) Ucar B, Kilic Z, Dinleyici EC, Colak O, Gunes E. Serum lipid profiles including non-high density lipoprotein cholesterol levels in Turkish school-children. Anadolu Kardiyol Derg 2007; 7: 415-20.

(2.) Turkiye Cumhuriyeti Basbakanlik Devlet Planlama Teskilati 2008 Yili Yatirim Programi. Ankara. Available at URL: http://ekutup.dpt.gov.tr/program/2008/ 2008yiliyatirimprogrami.pdf

(3.) http://www.eskisehir.gov.tr/harita.asp?id=5.
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Title Annotation:Letters to the Editor/Editore Mektuplar
Author:Yokusoglu, Mehmet; Uzun, Mehmet; Baysan, Oben; Ucar, Birsen; Kilic, Zubeyir; Dinleyici, Ener Cagri;
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Article Type:Letter to the editor
Date:Apr 1, 2008
Words:1025
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