Promoting rational antibiotic use in Turkey and among Turkish migrants in Europe - implications of a qualitative study in four countries.

BACKGROUND: Antimicrobial resistance is considered one of the major threats to global health. The emergence of resistant microorganisms is a consequence of irrational use of antibiotics. In Turkey, the consumption of antibiotics is relatively high and antibiotics are among the most commonly used drugs. However, Turkey has adopted new, more restrictive policies and regulations on antibiotics. In addition, Turkish migrants to EU countries, such as Germany, the Netherlands and Sweden, may encounter health systems that promote a more restrictive and rational antibiotic use. The objective of this paper was to explore the variation in implemented policies related to rational antibiotic use that citizens in Turkey and Turkish migrants in Germany, the Netherlands and Sweden are subjected to and to discuss the implications for the promotion of rational antibiotic use. Data were collected through focus groups and individual interviews with citizens, physicians and pharmacists in the four countries. In total, 130 respondents were interviewed. Content analysis was used. RESULTS: Three relevant themes were identified: Implementation of regulations and recommendations, Access to antibiotics and Need for health communication. Irrational use of antibiotics was reported mainly in Turkey. While it had become less likely to get antibiotics without a prescription, non-prescribed antibiotics remained a problem in Turkey. In the three EU countries, there were also alternative ways of getting antibiotics. Low levels of knowledge about the rational antibiotic use were reported in Turkey, while there were several sources of information on this in the EU countries. Communication with and trust in physicians were considered to be important. There were also system barriers, such as lacking opportunities for physicians to manage care in accordance with current evidence in Turkey and factors limiting access to care in EU countries. CONCLUSIONS: Several fields of importance for promoting rational antibiotic use were identified. There is a need for harmonisation of health-related regulations and policy programmes. Antibiotics should only be available with a prescription. Programmes for rational antibiotic use should be implemented on a broad scale, in medical care, at pharmacies and in the population. Methods for health communication and patient-centred care should be further developed and implemented in this field.

The opinions of adults about the ban on cigarette sales to minors.

BACKGROUND: Selling of tobacco products to minors has been banned since 1996 by the tobacco control law in Turkey. However, it is also important for the public to support practices that prevent the access of tobacco products to minors. In addition, every individual has the responsibility of carrying out society based programs that restrict access to tobacco products especially to children and the youths. Social sensitivity is considered an important factor in the prevention of tobacco use. This study aims to learn about the opinions and attitudes of adults with regards to minors access to tobacco products. METHODS: The study was a descriptive study conducted in nine city centers in Turkey. The total number of participants reached was 3241. The questionnaire was developed by the research team and consisted of 22 questions concerning knowledge and behaviors of adults on restriction of tobacco sales to minors and their observations with regards tobacco sales to minors. Data was collected through face to face interview. Pearson chi-square test was used for the bivariate analysis whereas logistic regression was investigate the relationship between "the participant's response against tobacco sales to minors" and the following explanatory variables; "age", "educational status", "income level", "working status", "minors access to cigarettes", "smoking ratio in high school" and "sales of tobacco to minors". RESULTS: More than half of the participants (60.5%) belonged to the age group 25-44 years, 61.3% graduated from high school or university. Most of the participants were smoker (39.2%) or ex-smoker (19.1%), and 41.7% of the participants was non-smoker. A greater proportion of the participants (76.2%) believed that smoking prevalence was greater than 40% among high school students. One in four (27.8%) adults did not know that tobacco control law bans sell of tobacco products to minors in Turkey. More than half of the participants (57.1%) ever witnessed tobacco sales to minors and 63.6% of them did not act when confronted with the event. Almost all (96.8%) of the respondents thought that access of minors to tobacco products was not difficult. The results of logistic regression of participant's response against tobacco sales to minor and related factors for current smokers showed that respondents who believed smoking ratio in high school was 4-5 adolescent out of 10 (aOR: 1.59; 95% CI: 1.09-2.34) were more likely to give a warning or informing the police or other people as compared to respondents whose perception on the smoking ratio among high school students was 6-7 adolescents out of 10. The results of logistic regression of non-smokers' response against tobacco sales to minor were who are from higher educational level, higher economic status, working status and who believed smoking ratio in high school was 4-5 adolescent out of 10 and 2-3 adolescent out of 10 were more likely to give a warning or informing the police or other people as compared to the others. CONCLUSIONS: Although laws prohibiting the sale of tobacco products to the under age group is very important with regards to accessibility of minors to tobacco products, most of the study participants believed that minors can still easily access tobacco products, and more than half of the participants did not act when confronted with the event. The education, information and monitoring program most especially as it concerns salesman, should be reviewed and strengthened to obey the rules on sales of tobacco products to minors. Education program should be carried out to increase the knowledge and awareness of the community for sale of tobacco to minors. Social sensitivity is important for the prevention of tobacco use and every individual have a responsibility in carrying out this society based program, most especially as it related to prevention of tobacco usage among children and youths.

Alcohol consumption and attitudes towards banning alcohol sales on campus among European university students.

OBJECTIVES: The European Commission's new health strategy for improving health at the European Union (EU) level includes tackling alcohol consumption. This study aimed to assess the prevalence of alcohol consumption and problem drinking, as well as students' attitudes towards banning the sale of alcohol on campus. STUDY DESIGN: In total, 5826 students from universities in seven European countries (Denmark, Germany, Spain, Lithuania, Poland, Bulgaria and Turkey) took part in this cross-sectional study. METHODS: A self-administered questionnaire assessed sociodemographic information, frequency of alcohol consumption, problem drinking and attitudes towards banning the sale of alcohol on campus. RESULTS: The highest prevalence of drinking alcohol more than once per week was reported in Bulgarian (males 46%, females 64%) and Spanish students (males 59%, females 64%). Among those students who drank alcohol (n=3170), problem drinking (CAGE score >1) was found in 24% of males and 13% of females. Male gender, depressive moods and a low importance of good grades at university were risk factors for drinking alcohol more than once per week as well as for problem drinking. There were substantial country differences in the proportion of students who would support a ban of alcohol sales on campus (23% in Denmark, 88% in Poland). Support for a ban was higher among female students and among students who drank alcohol once or less per week. CONCLUSIONS: Problem drinking is a concern among students in many European countries, especially among males. Students' support for banning the sale of alcohol on campus varies between countries and should be considered in developing EU policy.

Children and firearms in Turkish homes.

BACKGROUND: Unintentional firearm injuries are an important cause of preventable deaths and disabilities among children. Keeping firearms at home and letting children to see or touch them increases the risk of injury. METHODS: This cross-sectional study was conducted to estimate the extent of the firearm problem in an Anatolian province in Turkey. A random sample of families were approached and were asked to answer a series of questions completed by research assistants. RESULTS: In 974 randomly selected households, there were 2129 children aged less than 18 years, 11.1% of the fathers have a job in the firearms industry or in the security sector, and 12.3% of the households kept a firearm at home. Only 25.6% of the firearms were kept in a safe place, and 29.3% of the firearms and ammunition were kept separately. Overall, 70.9% of the children whose parents have firearms saw the firearm and 27.2% had handled it. CONCLUSIONS: Results of this study pointed to the urgent need for preventive measures for the physical separation of guns from children. The establishment of effective firearms safety programmes requires an understanding of the culture and routine behaviours of the target population.

Hepatitis B prevalence among workers in Turkey at low risk for hepatitis B exposure

Turkey is an intermediate endemic area for hepatitis B virus infection. The study investigated the hepatitis B exposure risk and prevalence of hepatitis B infection in a group of workers of no known occupational exposure. The prevalence of seropositivity for hepatitis B surface antigen [HBsAg], hepatitis B surface antibody [anti- HBs] and hepatitis B core antibody [anti- HBc] were 6.6%, 29.9%, and 50.6% respectively. Hepatitis B infection rates were also high in the families of HBsAg- positive workers; 73.7% of family members were positive for HBsAg, anti- HBs or anti- HBc. Risk factors included ever having an injection by an unqualified practitioner [14.6%] and ever having unprotected extramarital intercourse [62.5%]

Capture-recapture methods for estimation of fertility and mortality in a rural district of Turkey.

The study used capture-recapture methods to determine if information on births, deaths and family planning use obtained from two data sources provides the same or more complete information than that available from a single source. Five different data sources used were: village heads (mukhtars), community health volunteers, primary health care centres, maternal and child care units and local administrative units (health group presidencies) in 10 selected villages in a rural area of Turkey from May to October 1999. Although the numbers of deaths and births were estimated, no estimation of the number of women using any family planning method could be made. The study highlights some data collection problems of the surveillance system in Turkey and recommends that the routine surveillance systems be strengthened.

Capture-recapture methods for estimation of fertility and mortality in a rural district of Turkey

The study used capture-recapture methods to determine if information on births, deaths and family planning use obtained from two data sources provides the same or more complete information than that available from a single source. Five different data sources used were: village heads [mukhtars], community health volunteers, primary health care centres, maternal and child care units and local administrative units [health group presidencies] in 10 selected villages in a rural area of Turkey from May to October 1999. Although the numbers of deaths and births were estimated, no estimation of the number of women using any family planning method could be made. The study highlights some data collection problems of the surveillance system in Turkey and recommends that the routine surveillance systems be strengthened

The status of child health and child survival and development programs in Turkey.

"Child Survival Activities in Turkey" are: growth monitoring programs, expanded programs of immunization (elimination of neonatal tetanus, reducing morbidity and mortality of measles, eradication of polio), control of diarrheal diseases (oral rehydration therapy), control of deaths from pneumonia (ARI), baby-friendly hospitals initiative and promotion of breast-feeding, salt iodization programs, elimination of vitamin A deficiency, safe motherhood projects, and phenylketonuria screening programs. Furthermore, family planning, nutrition and education of the mother were among the subjects covered because of their role in child health. The activities, aims and strategies related to these programs are taken up separately. The status of child health and some of the child survival and development programs (growth monitoring program, expanded program of immunization, control of diarrheal diseases, control of deaths from pneumonia, baby-friendly hospitals initiative and promotion of breast-feeding) are discussed in the article.

Adolescent health: a Middle East and North African perspective.

Adolescence is a period of physical, psychological and social transition from childhood to adulthood. At present there are 95 million young people aged between 10 and 24 years in the Middle East and North Africa. Female education is increasing in these regions, but secondary school enrollment rates for girls lag behind those of their male counterparts. Average age at first marriage varies between 17.9 and 24.3 years, but teenage marriage is quite common. Total fertility rates are higher than the world average. Pregnancy at an early age often translates into a high fertility rate and high risks for women and their children. Female children's share of food, health care, work options and general care is often less than that of boys, because they are perceived to be less valuable than boys in some countries.

[Is adolescent fertility a problem in Turkey?]. / Turkiye'de gencler arasinda dogurganlik bir sorun mudur?

PIP: The population of Turkey was about 50 million in 1985, and the 15-19 age group was 5.5 million, 10.7% of the total population. Almost half of this 5.5 million were females, the mean age at first marriage was 18.2 years and 15.6% of this group were married. The fertility rate of the 15-19 age group was 64.1 per thousand. These figures show that early marriage and early pregnancy are the main problems. The prenatal care in adolescent pregnancies which present high risks for the mother and the child usually starts in the last trimester (average: 7.15 months) and 31.6% of the deliveries take place under unsuitable conditions. The use of contraceptives in this age group is 34.5% (23.4% traditional methods, 11.1% modern methods). The main solution of the problem, that is, adolescent pregnancy, is increasing the age at first marriage. But until this goal is reached, for healthier mothers and children, prenatal care should be given earlier in adolescent pregnancy and deliveries should take place under the supervision of health personnel. (author's)^ieng

[Some health indicators in Etimesgut health training and research area (Ankara, Turkey, 1967-1988)]. / Etimesgut saglik egitim ve arastirma bolgesinde bazi saglik olcutlerinin degerlendirilmesi (1967-1988).

PIP: The author examines health indicators such as neonatal and maternal morbidity and mortality for the period 1967-1988 at the Etimesgut health training and research area, Turkey. The purpose of the study is to evaluate health care services. (SUMMARY IN ENG)^ieng