RE-AIMing COVID-19 online learning for medical students: a massive open online course evaluation.

BACKGROUND: Clinical training during the COVID-19 pandemic is high risk for medical students. Medical schools in low- and middle-income countries (LMIC) have limited capacity to develop resources in the face of rapidly developing health emergencies. Here, a free Massive Open Online Course (MOOC) was developed as a COVID-19 resource for medical students working in these settings, and its effectiveness was evaluated. METHODS: The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework was utilized to evaluate the effectiveness of MOOC in teaching medical students about COVID-19. The data sources included the student registration forms, metrics quantifying their interactions within the modules, students' course feedback, and free-text responses. The data were collected from the Moodle learning management system and Google analytics from May 9 to September 15, 2020. The research team analyzed the quantitative data descriptively and the qualitative data thematically. RESULTS: Among the 16,237 unique visitors who accessed the course, only 6031 medical students from 71 medical schools registered, and about 4993 (83% of registrants) completed the course, indicating high levels of satisfaction (M = 8.17, SD = 1.49) on a 10-point scale. The mean scores of each assessment modules were > 90%. The free-text responses from 987 unique students revealed a total of 17 themes (e.g., knowing the general information on COVID-19, process management of the pandemic in public health, online platform use, and instructional design) across the elements of the RE-AIM framework. Mainly, the students characterized the MOOC as well-organized and effective. CONCLUSIONS: Medical students learned about COVID-19 using a self-paced and unmonitored MOOC. MOOCs could play a vital role in the dissemination of accurate information to medical students in LMIC in future public health emergencies. The students were interested in using similar MOOCs in the future.

Social accountability: A national framework for Turkish medical schools.

PURPOSE: To define recommendations to the medical schools in Turkey about social accountability which meets the local needs. METHODOLOGY OF THE STUDY: The Association of Evaluation and Accreditation of Medical Education Programs (TEPDAD-Turkey) Social Accountability working group planned a study to determine national recommendations for social accountability of medical schools in two-stages. Delphi technique was used to develop the recommendations and finalize the recommendations in the first stage in which 61 members from 30 different institutions participated. Qualitative analysis was used for open questions in the first round and quantitative analysis for the data which is collected with a rating scale in the second and third rounds of the Delphi study. In the second stage, the recommendations were reviewed and finalized in a consensus workshop in which 68 members from 39 different institutions participated. RESULTS: In the Delphi study 63 recommendations were classified under five themes: the health needs of the society, health service delivery, institutional structure and management, educational program and implementation and development and evaluation of social accountability. In the consensus workshop, the 63 recommendations were evaluated and of which 54 of 63 recommendations were agreed upon. CONCLUSION: A national framework has been developed by including a wide range of experts from different institutions for the social accountability of medical schools in Turkey. Developing recommendations in a local context will enhance the conceptualization of the recommendations of social accountability in the medical schools. As an accreditation body embedding the principles in the national standards will have a further impact on this process.

Gender in Medical Education in Turkey: The Intern Perspective.

INTRODUTION: Gender insensitivity (lack of gender awareness) in the physician's professional role and practice can lead to outcomes such as gender discrimination and gender-based harassment in various areas, such as medical education, career opportunities, and specialty selection. The purpose of this study was to reveal the place that the concept of gender occupies in medical education in Turkey by canvassing the opinions of final-year medical students regarding theories of gender roles and socialization, academic capitalism, and liberal feminism. METHODS: This study was a Cross-sectional survey. The study population consisted of 1739 interns in six medical faculties in four different geographical regions of Turkey. The reason behind the selection is having different socio-economic factors. Students were selected by simple random sampling technique. For determining it is jumped five students from the lists in faculties. For the validity and reliability of the 14 survey questions, 5 expert opinions were examined and the preliminary instrument was applied to 10 students. Chi-square test was used for comparative analysis. RESULTS: The students who stated that their gender had not affected their educational lives during clinical training reported that it had adversely impacted their internships (p<0.001). More male students than female ones stated that male physicians were more confidence-inspiring and more industrious, that they managed better, and that they were more likely to recommend a male surgeon. A high number of students reported being undecided on the subjects of concepts or behaviors concerning gender/gender inequality. CONCLUSION: We recommend greater focus on role modeling and purposeful teaching of gender concepts from the earliest stages of medical education, with particular concentration on gender culture within a process of change involving all hospital personnel in order to prevent gender discrimination.

The knowledge level and perceptions toward COVID-19 among Turkish final year medical students.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has upended medical education as well as the lives of healthcare professionals. Higher education institutions have a crucial role in the solution of public health problems by training young doctor candidates, and it is also essential to increase the knowledge level of physician candidates about the epidemic. So, in this study, we aimed to examine Turkish final year medical students' knowledge level and perceptions toward the COVID-19 pandemic. METHODS: The present descriptive multicentered study was conducted with the medical students in the final year of six medical schools located in six geographic regions of Turkey. After ethical approval, data were gathered using an online questionnaire through Google forms between 10 April 2020, and 20 April 2020. RESULTS: In this national survey study, 860 volunteers answered the questions thoroughly. The median age was 24 (22-38) years. A total of 55.3% of the participants were female. The median knowledge level score was 69.0 (0-93.1). The knowledge level was moderate. A total of 34.2% of the participants had a high level of knowledge. A total of 48.7% of participants stated that they felt the most competent about performing CPR. Updates about COVID-19 were followed regularly by 84.5% of the participants. CONCLUSION: We determined that final year medical students are knowledgeable and aware of this pandemic. We, medical educators, should inculcate relevant knowledge and educate the medical students to improve practices in the current pandemic, as well as for future epidemics. Different learning techniques should be added to the curriculum, especially at the time which widespread panic and uncertainty are prevalent.

Hazardous Health Behaviour among Medical Students: a Study from Turkey.

BACKGROUND: Hazardous health behaviour in young people is an important factor that affects the individual risk for non-communicable diseases and other disorders later in life. This study aimed to determine the hazardous health behaviour of first and last class medical students of Erciyes University. MATERIALS AND METHODS: This descriptive study was carried out with 240 medical students from the first and 130 students from the last (sixth) class. Data were obtained by questionnaire between March-April 2012. In total, 339 students were included with a response rate of 91.6%. Socio-demographic characteristics, school success, self-reported economic difficulties, health perceptions, hazardous health behaviour related to chronic disease, tobacco, alcohol, substance use, body weight, height, traffic, violence and nutrition were assessed in line with the literature. RESULTS: Of the participants; 64.0% were from first and 36.0% were from the last class. Mean ages for the first and last classes were 19.4 ± 1.5 and 24.0 ± 1.5 years, respectively. In the current study, males exhibited more hazardous behaviour than females. Sime 19.8% of the students in the study group used alcohol, 35.4% used a waterpipe, and 24.8% used tobacco at least once. These rates increased in both genders in the last class and the increase in males was significant. Some 3.8% of the students in the current study used pleasure-inducing illegal substances at least once. All the students participating in the current study were single, the number of males reported not using condoms (8.6%) was 4.56 times higher compared to females. Some 64.0% of the students did not perform physical activity lasting at least 30 minutes for five times a week, 13.0% did not sleep for mean 7-8 hours daily, males having a 2.9 times higher risk. More than 1/3 of the students did not consume cooked vegetable dishes and 1/4 did not consume fresh fruits and salads, the rates were higher among males. CONCLUSIONS: In the current study, hazardous health behaviour was prevalent among medical students, with higher risks among males and last class students. According to these results, medical curriculum may be focused on decreasing hazardous health behaviour. In addition, in order to prevent unhealthy behaviour, the number of youth-friendly health facilities should be increased.

Physician exposure to violence: a study performed in Turkey.

Recently, in Turkey, there has been an increase in the number of violent acts against healthcare workers, towards doctors in particular. This study aimed to investigate the extent of violence, the causes of violence and to evaluate proposed solutions to violence. Out of 597 physicians, 86.4% indicated that they were exposed to at least one type of violence (physical, verbal, sexual) throughout their careers. Among the physicians participating in the study, 27.5% suffered physical threats and 68.6% suffered verbal violence in the past year. Only 40.4% reported the physical violence to their institution. Physicians indicated that the top three causes of violent behavior were excessive demands of patients, the expectation that the issue will be solved immediately and blaming physicians for their problems. To stop violence against themselves, physicians need to raise their voices, along with those of their personal or professional organizations, and should report and follow up incidents.

Prevalence and risk factors for methicillin resistant Staphylococcus aureus carriage among emergency department workers and bacterial contamination on touch surfaces in Erciyes University Hospital, Kayseri, Turkey.

OBJECTIVE: The aim of this study was to determine Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) nasal carriage among emergency department (ED) workers, and bacterial contamination on hand-touch surfaces at ED. METHODS: This single-centered study enrolled 105 ED workers and 190 hand-touch surfaces at ED in June 2014. Nasal and environmental samples for S. aureus carriage and for bacterial contamination were obtained. For isolation swabs were cultured on ChromAgar S. aureus and environmental samples first cultured in broth and antibiogram obtained by clinical and Laboratory Standards Institute guidelines. A questionnaire was completed for each subject. RESULTS: The S. aureus carriage rate was 18.1% (n=19), with 2.9% (n=3) MRSA positivity. There were two (1.9%) mobile phone positivities for S. aureus, one of them was MRSA, and a computer keyboard contamination for MRSA was also detected. All MRSA isolates were susceptible for the tested antibiotics. There was significant difference between gender (p=0.044) in terms of nasal carriage of S. aureus and MRSA, all three MRSA isolates were from females. CONCLUSION: Our study showed that the carriage of MRSA was not affected by clinical exposure in the hospital because of the existing infection control policy in our hospital.

Do we need a femoral artery route for transvenous PDA closure in children with ADO-I?

OBJECTIVE: The standard procedure in percutaneous closure of patent ductus arteriosus (PDA) with Amplatzer duct occluder-I (ADO-I) is transvenous closure guided by aortic access through femoral artery. The current study aims to compare the procedures for PDA closure with ADO-I: only transvenous access with the standard procedure. METHODS: This study was designed retrospectively and 101 pediatric patients were included. PDA closure was done by only femoral venous access in 19 of them (group 1), arterial and venous access used in 92 patients (group 2) between 2004 to 2012 years. The position of the device and residual shunt in group1 was evaluated by the guidance of the aortogram obtained during the return phase of the pulmonary artery injection and guidance of transthoracic echocardiography. Shapiro-Wilk's test, Mann-Whitney U, chi-squared tests were used for statistical comparison. RESULTS: The procedure was successful in 18 (95%) patients in group 1 and 90 (98%) patients in group 2. Complications including the pulmonary artery embolization (n=1), protrusion to pulmonary artery (n=1), inguinal hematoma (n=3), bleeding (n=2) were only detected in group 2. In other words, while complications were observed in 7 (7.2%) patients in group 2, no minor/major complication was observed in group 1. Complete closure in group 1 was: in catheterization room 14 (77.8%), at 24th hour in 2 (11.1%), at first month in 2 (11.1%). Complete closure in group 2 was: 66 (73.4%) patients in the catheterization room, 21 (23.3%) at 24th hour, 3 (3.3%) at first month, complete closure occurred at the end of first month. CONCLUSION: In percutaneouse PDA closure via ADO-I, this technique can be a choice for patients whose femoral artery could not be accessed, or access is impossible/contraindicated. But for the reliability and validity of this method, randomized multicenter clinical studies are necessary.

Importance of N-terminal pro-brain natriuretic peptide in monitoring acute rheumatic carditis.

PURPOSE: To detect the relationship of N-terminal pro-brain natriuretic peptide levels with clinical and laboratory findings by measuring them at diagnosis, during, and after treatment in children with acute rheumatic carditis. METHOD: A total of 40 children including 20 acute rheumatic carditis patients aged between 5 and 16 years 20 healthy children as controls were included in the study. Blood was drawn from patients at diagnosis and in the first week, first month and third month after treatment in order to detect pro-brain natriuretic peptide, C-reactive protein levels and erythrocyte sedimentation rates. All patients underwent echocardiography. RESULTS: The N-terminal pro-brain natriuretic peptide levels of children with acute rheumatic carditis were significantly higher than those of the control group at diagnosis and during treatment (p<0.05). Echocardiographic evaluation of acute rheumatic carditis patients revealed that the left atrium diameter continued to decrease during the study and that the mean left atrium diameters measured at diagnosis and in the first week were statistically higher than the mean left atrium diameters measured in the third month. There was significant correlation between left atrium diameters at diagnosis and in the first month and N-terminal pro-brain natriuretic peptide levels during the same periods in the patient group. CONCLUSION: Previous studies have used N-terminal pro-brain natriuretic peptide levels as a marker of enlargement of the left atrium, whereas in this study we want to emphasise its role as a marker of inflammation. This increase was significantly correlated with enlargement in the left atrium. N-terminal pro-brain natriuretic peptide levels were found to be a valuable determinant in indicating cardiac inflammation and haemodynamics.

Incidence and clinical features of acute rheumatic fever in Kayseri, Central Anatolia, 1998-2011.

BACKGROUND: In developing countries, acute rheumatic fever is the most common cause of acquired heart disease in the paediatric and adolescent population. It is believed that vulnerability to developing acute rheumatic fever is associated with several factors such as socio-economic and living conditions. Aim Determine the incidence and clinical characteristics of acute rheumatic fever in the Central Anatolia region of Kayseri within the last 14 years, and to make a comparison of two 7-year periods. Material and methods We performed a retrospective analysis of 624 patients who were diagnosed with acute rheumatic fever at the Department of Pediatric Cardiology in the Medical Faculty of Erciyes University between January, 1998 and December, 2011. RESULTS: The mean age of patients was 10.9±2.7 years. The female/male ratio was 1.4. When patients were categorised according to age groups, the largest group represented 376 patients (60.3%) aged between 10 and 14 years. The estimated incidence rate of acute rheumatic fever was 7.4/100,000 in the Central Anatolia region of Kayseri. Among the major findings, the most common included carditis at 54%, arthritis at 35%, Sydenham's chorea at 25%, and subcutaneous nodules at 0.5%, respectively. No significant difference was found between the first 7-year period and second 7-year period in distributions of age, gender, and major findings. CONCLUSION: Although there has been socio-economic development in Turkey in the recent years, the incidence of acute rheumatic fever is still high in the Central Anatolia region of Kayseri.

Health promoting lifestyle behaviour in medical students: a multicentre study from Turkey.

BACKGROUND: The aim of this study was to determine the predictors of health promoting lifestyle behaviour among medical students attending seven of the medical schools in Turkey. MATERIALS AND METHODS: This cross- sectional descriptive study was performed during the second semester of the first and last (sixth) years of study from March to May 2011. A questionnaire with two sections was specifically designed. The first section contained questions on demographic characteristics; the second consisted of the Health Promoting Lifestyle Profile II (HPLP) Scale. From a total of 2,309 medical students, 2,118 (response rate 91.7%) completed the questionnaire. Data were analyzed using descriptive statistics, t, Anova, Tukey test and binary logistic regression analysis. The research was approved by the Ethics Committee of Erciyes University. RESULTS: The mean age was 20.7±2.9 years and it was found that 55.1% were men, 62.3% were in the first year. The overall prevalence of smoking was 19.1%, and for drinking alcohol was 19.4%. HPLP point averages of the first year students were 129.2±17.7, and for last year 125.5±19.0. The overall mean score for the HPLP II was 2.5±0.4. They scored highest on the spiritual growth subscale (2.9±0.5), interpersonal relations (2.8±0.5), health responsibility subscale (2.3±0.5), nutrition subscale (2.3±0.5), stress management subscale (2.3±0.4), and the lowest subscale physical activity (2.0±0.5). It is established that student's grade, educational level of parents, economic status of family, marital status, smoking and general health perception of the students resulted in a significant difference in HPLP Scale total score average and the mean score of majority of subscales.There was no statistically significant difference between the total HPLP when evaluated for gender, chronic disease, alcohol drinking status and BMI. CONCLUSIONS: Based on these results, particularly in the curriculum of medical students in order to increase positive health behaviours including physical activity, health promotion issues, and giving more space to aim at behaviour change in these matters is recommended.

Awareness, knowledge, and use of folic acid among women: a study from Turkey.

PURPOSE: To investigate the awareness, knowledge, and behaviors relevant to folic acid intake in women aged 15-49 years. MATERIALS AND METHODS: A questionnaire designed by the researchers was administered to 1,083 women who attended to family health care centers for any reason, between 1 and 15 of December 2009. RESULTS: Half of the women (53.7%) surveyed did not hear or read about folic acid. Women older than 35 and less-educated women were more unaware of folic acid. Out of 171 pregnant women, 81.3% (139 women) were taking/took vitamin/folic acid supplementation but only 12.2% of the users started to take supplements at least 1 month before conception. Out of 912 non-pregnant women 81 (8.9%) said they are taking any vitamin or mineral supplement. Out of the women who are not pregnant, not using a modern contraceptive method and planning to have a child at the time of the survey, only 9 (10%) were taking vitamin/folic acid. The most common information sources on folic acid were the doctors. CONCLUSION: In order to improve the intake of folic acid during the recommended period, preconceptional counseling by the family doctors to inform women of childbearing age about the need to take folic acid to prevent NTDs seems to be important.

Knowledge, attitude about breast cancer and practice of breast cancer screening among female health care professionals: a study from Turkey.

The awareness of health professionals about breast cancer prevention is of vital importance, since their beliefs and behaviors may have a major impact on other women. The aim of this study was to investigate the knowledge, and attitudes regarding risk factors for breast cancer as well as screening such as breast self-examination, clinical breast examination and mammography among different groups of female health professionals. In this cross- sectional study, 444 female health professionals in various health centers located in Corum Province, Turkey, were interviewed using a self-administered questionnaire. The mean age was 33.1 ± 6.1 and most were married (81.3%). The rate of feeling under risk regarding breast cancer among female health personnel was 31.3%. The majority (98.4 %) perceived breast self-examination as a beneficial method for the early detection of breast cancer. Although 81.3 % of the participants stated that they did breast self examination, only 27.3 % reported doing so on a regular basis (performed monthly or once per menstrual cycle). The most common reason for not doing breast self-examination was the belief that it was not necessary (45.8 %). Of the entire group, the rate of having a mammography was 10.1% and the rate of clinical breast examination was 24.8%. Health professionals are a direct source of medical information to the public. The use of breast self-examination and mammography was found lower than expected when considering the fact that participants were health care professionals.

Seroprevalence of hepatitis B and C viruses, HIV, and syphilis infections among engaged couples.

OBJECTIVE: To evaluate seroprevalences of hepatitis B and C viruses, human immunodeficiency virus (HIV), and syphilis infections among engaged couples. METHODS: This is a cross-sectional study of all engaged couples enrolled at 20 Health Centers and one Maternity Center of Sivas Health Directorate between May and September 2005 in Sivas, a central Anatolian city, in Turkey. Seroprevalances of hepatitis B (HB) surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), anti-hepatitis C virus (HCV), anti-human immunodeficiency virus (anti-HIV), and syphilis was assessed. Serum samples of 1,332 participants of 666 couples were investigated. RESULTS: Age range of subjects was 15-74, and most (38.4%) were between 25-29 years. Out of 1,332 individuals, 22 (1.7%) were HBsAg positive, 18 (1.4%) were anti-HBs positive, one (0.1%) was anti-HCV positive, one (0.1%) was HIV positive, and one (0.1%) was syphilis positive. There was no statistical differences between their seroprevalence positivities regarding gender and age groups (p>0.05). CONCLUSION: In our country, couples should obtain a marriage certificate that includes a health report that contains the tests mentioned above. We think that this is a very good screening model for important infections. In couples all around the world, screening of these infections needs to be performed before marriage to be aware of the risks.

Enterobiasis among preschool children: a study from Kayseri, Turkey.

The infection rate of Enterobius vermicularis was investigated in 1,070 preschool children aged 5-7 years in Kayseri, Turkey by cellotape anal swab from May-September 2005. The children's parents were asked to complete questionnaires inquiring into the potential risk factors involved. The overall egg positive rate for E. vermicularis was 5.1%. The infection rate among boys and girls was similar. The association between family size, household income/month, education level of the parents, employment status of the mother and enterobiasis were found to be significant.

Antimicrobial susceptibility of Streptococcus pneumoniae in the oropharynx of healthy preschool children and identification of risk factors.

To determine the prevalence and antimicrobial susceptibility of Streptococcus pneumoniae in the oropharynx of healthy children, throat swabs were obtained from 683 children and cultured. The disk diffusion method and the E test were used to test the antimicrobial susceptibility of the isolated organisms. Twenty-nine children (4.2%) harbored S. pneumoniae in their oropharynx. Fifteen (51.7%) of the isolates showed intermediate resistance to penicillin and 14 (48.3%) were susceptible. All strains were susceptible to rifampicin and moxifloxacin. One was resistant to telithromycin. The rates of resistance to clindamycin, erythromycin, chloramphenicol and tetracycline were 41.3, 44.8, 34.4, and 44.8%, respectively. Risk factors for S. pneumoniae carriage were also assessed.

Nasal carriage of Staphylococcus aureus in healthy preschool children.

To evaluate the prevalence of Staphylococcus aureus carriage among healthy preschool children in our region, nasal swabs were collected from 5- to 7-year-old healthy children who were attending a day care center. Sociodemographic features and the data related with risk factors were obtained from the children's parents. Of the 200 children, S. aureus was isolated in 36 (18%) subjects. Methicillin-resistant S. aureus was isolated in 2 (5.6%) of these subjects, neither of whom had any identified risk factors. Antimicrobial susceptibility testing revealed that all tested strains were sensitive to gentamicin, vancomycin, trimethoprim-sulfamethoxazole, rifampicin, and mupirocin. Erythromycin, clindamycin, fusidic acid, and tetracycline resistance were determined to be 16.6, 8.3, 5.6, and 8.3%, respectively.

Carriage rate of Haemophilus influenzae among preschool children in Turkey.

This study was designed to determine the prevalence of healthy Haemophilus influenzae carriers in a random sample of the preschool population in Kayseri, Turkey. The lack of H. influenzae type b (Hib) disease surveillance and epidemiological data on the throat carriage of Turkish children has caused a delay in the introduction of conjugated Hib vaccination into proposed national vaccination programs. Oropharyngeal cultures were collected and cultured on chocolate agar supplemented with 260 microg/ml bacitracin from 683 children between May and June, 2006. One hundred seven (15,6%) of the 683 children studied were found to be as H. influenzae carriers, and 29 (4,2%) isolates were serotype b. Beta-lactamase production was detected in four isolates (3.7%). According to multivariate analysis, the sex of the child and the number of people sharing the same room with the child significantly influenced the odds of carrying H. influenzae. Age, having older siblings, passive smoking, respiratory infection during the last 30 days, number of people in the household, attending kindergarten or a day-care center, and household income were not significant variables. Our results suggest that there is a strong relationship between exposure to large numbers of children and H. influenzae carriage.