Preclinical students' views on medical ethics education: a focus group study in Turkey / Puntos de vista de estudiantes de pre-clínica sobre educación en ética médica: un estudio de grupo focal en Turquía / A perspectiva dos estudantes pré-clínicos sobre o ensino da ética médica: um estudo de grupo focal na Turquia

Abstract: 18. Aim: We aimed to receive the opinions of the preclinical medical students on medical ethics education, and to present some suggestions for the education program. Methods: Focus group discussions were held with third-grade medical students. The analyses were implemented using Creswell's six-step qualitative data analysis. Results: During the data analysis, themes with the following titles were identified: necessity of the education, content, education methods, assessment, participation, contribution of the education, moving to clinical training and suggestions. Discussion: The students stated that the discussions on movies/books/case-based scenarios are more useful than lectures. Although they believed that student assessment was necessary for the medical ethics education, they had negative attitudes towards Multiple Choice Questions. At the stage of moving to the clinical training, their feelings and thoughts about the learning outcomes they would gain from ethical education were contradictory. Conclusion: Each theme and code obtained from the students' expressions may contribute to improving medical ethics education for all institutions. Besides student education, it is also necessary the faculty development programs on medical ethics education for clinical teachers. Additionally, further studies can be conducted on the actions that need to be taken to help students internalize the ethical issues and feel the need of learning more.

Resumen: 22. Nuestro objetivo consistió en recibir las opiniones de estudiantes de medicina en pre-clínica sobre educación en ética médica y presentar algunas sugerencias para el programa de educación. Métodos: Se mantuvo discusiones de grupo focal con estudiantes de medicina de tercer grado. Se implementó el análisis cualitativo de datos de seis pasos de Creswell. Resultados: Mediante el análisis de datos, se identificaron los siguientes temas: necesidad de la educación, contenido, métodos de educación, evaluación, participación, contribución de la educación, el paso a formación clínica y sugerencias. Discusión: Los estudiantes consideraron que las discusiones sobre películas/libros/escenarios de casos eran más útiles que las clases dictadas. Aunque pensaban que la evaluación de los estudiantes era necesaria para la educación en ética médica, no valoraron positivamente las pruebas de preguntas con respuesta múltiple. En el paso a la formación clínica, sus sentimientos y pensamientos sobre los resultados del aprendizaje en educación ética eran contradictorios. Conclusión: Cada tema y código obtenido de las propuestas de los estudiantes puede contribuir a mejorar la educación en ética médica en las instituciones. Además de la educación, también es necesario desarrollar programas sobre educación ética médica para los profesores clínicos. Además, se pueden realizar más estudios sobre las acciones que se necesitan tomar para ayudar a los estudiantes a internalizar los temas éticos y sentir la necesidad de aprender más.

Resumo: 26. Objetivo: tivemos como objetivo coletar as opiniões dos estudantes pré-clínicos de medicina no ensino da ética médica e apresentar algumas sugestões para o programa de ensino. Métodos: foram realizadas discussões em grupos focais com estudantes do 3º período de medicina. As análises foram implementadas usando o método qualitativo de seis etapas de Creswell. Resultados: Durante a análise de dados, os seguintes temas foram identificados: a necessidade da educação, conteúdo, métodos de ensino, avaliação, participação, contribuição da educação, transição para o treinamento clínico e sugestões. Discussão: Os alunos concluíram que as discussões sobre filmes/livros/estudos de caso são mais úteis que aulas expositivas. Embora eles acreditassem que a avaliação de alunos era necessária para o ensino da ética médica, eles tinham atitudes negativas em relação a questões de múltipla escolha. Na fase de transição para o treinamento clínico, seus sentimentos e pensamentos sobre os resultados da aprendizagem, que eles obteriam com o ensino da ética eram contraditórios. Conclusão: Cada tema e código obtidos das opiniões dos alunos podem contribuir para melhorar o ensino da ética médica para todas as instituições. Além do ensino dirigido ao aluno, é necessário que haja também programas de desenvolvimento do corpo docente acerca da educação de ética médica. Ademais, mais estudos podem ser realizados sobre as ações que precisam ser tomadas para ajudar os alunos a interiorizar as questões éticas e sentir a necessidade de aprender mais a respeito.

PRECLINICAL STUDENTS' VIEWS ON MEDICAL ETHICS EDUCATION: A FOCUS GROUP STUDY IN TURKEY.

AIM: We aimed to receive the opinions of the preclinical medical students on medical ethics education, and to present some suggestions for the education program. METHODS: Focus group discussions were held with third-grade medical students. The analyses were implemented using Creswell's six-step qualitative data analysis. RESULTS: During the data analysis, themes with the following titles were identified: necessity of the education, content, education methods, assessment, participation, contribution of the education, moving to clinical training and suggestions. DISCUSSION: The students stated that the discussions on movies/books/case-based scenarios are more useful than lectures. Although they believed that student assessment was necessary for the medical ethics education, they had negative attitudes towards Multiple Choice Questions. At the stage of moving to the clinical training, their feelings and thoughts about the learning outcomes they would gain from ethical education were contradictory. CONCLUSION: Each theme and code obtained from the students' expressions may contribute to improving medical ethics education for all institutions. Besides student education, it is also necessary that the faculty develop programs on medical ethics education for clinical teachers. Additionally, further studies can be conducted on the actions that need to be taken to help students internalize the ethical issues and feel the need of learning more.

Nuestro objetivo consistió en recibir las opiniones de estudiantes de medicina en pre-clínica sobre educación en ética médica y presentar algunas sugerencias para el programa de educación. Métodos: Se mantuvo discusiones de grupo focal con estudiantes de medicina de tercer grado. Se implementó el análisis cualitativo de datos de seis pasos de Creswell. Resultados: Mediante el análisis de datos, se identificaron los siguientes temas: necesidad de la educación, contenido, métodos de educación, evaluación, participación, contribución de la educación, el paso a formación clínica y sugerencias. Discusión: Los estudiantes consideraron que las discusiones sobre películas/libros/escenarios de casos eran más útiles que las clases dictadas. Aunque pensaban que la evaluación de los estudiantes era necesaria para la educación en ética médica, no valoraron positivamente las pruebas de preguntas con respuesta múltiple. En el paso a la formación clínica, sus sentimientos y pensamientos sobre los resultados del aprendizaje en educación ética eran contradictorios. Conclusión: Cada tema y código obtenido de las propuestas de los estudiantes puede contribuir a mejorar la educación en ética médica en las instituciones. Además de la educación, también es necesario desarrollar programas sobre educación ética médica para los profesores clínicos. Además, se pueden realizar más estudios sobre las acciones que se necesitan tomar para ayudar a los estudiantes a internalizar los temas éticos y sentir la necesidad de aprender más.

Objetivo: Coletar as opiniões dos estudantes pré-clínicos de medicina no ensino da ética médica e apresentar algumas sugestões para o programa de ensino. Métodos: foram realizadas discussões em grupos focais com estudantes do 3° período de medicina. As análises foram implementadas usando o método qualitativo de seis etapas de Creswell. Resultados: Durante a análise de dados, os seguintes temas foram identificados: a necessidade da educação, conteúdo, métodos de ensino, avaliação, participação, contribuição da educação, transição para o treinamento clínico e sugestões. Discussão: Os alunos concluíram que as discussões sobre filmes/livros/estudos de caso são mais úteis que aulas expositivas. Embora eles acreditassem que a avaliação de alunos era necessária para o ensino da ética médica, eles tinham atitudes negativas em relação a questões de múltipla escolha. Na fase de transição para o treinamento clínico, seus sentimentos e pensamentos sobre os resultados da aprendizagem, que eles obteriam com o ensino da ética eram contraditórios. Conclusão: Cada tema e código obtidos das opiniões dos alunos podem contribuir para melhorar o ensino da ética médica para todas as instituições. Além do ensino dirigido ao aluno, é necessário que haja também programas de desenvolvimento do corpo docente acerca da educação de ética médica. Ademais, mais estudos podem ser realizados sobre as ações que precisam ser tomadas para ajudar os alunos a interiorizar as questões éticas e sentir a necessidade de aprender mais a respeito.

Exposure of Students to Emotional and Physical Violence in the School Environment.

INTRODUCTION: While peer abuse or physical violence in school is emphasized more, the physical and emotional violence caused by school staff has been emphasized less. The purpose of this study was to investigate the variables related to emotional and physical violence that students are exposed to in the school environment. METHODS: This cross-sectional and descriptive study was conducted by applying a questionnaire to 434 fifth-grade students receiving education in the primary schools in Konak district of Izmir province. Being prepared by the researchers of this study, the questionnaire consisted of questions about the socio-demographic features of the child and the family, the place where the child has been raised, family income, average grade, and the emotional and physical violence of teachers, parents, and peers s/he has been exposed to within the last year. The Chi-square test, Mann-Whitney U test, and logistic regression analysis were used for statistical analyses. RESULTS: The study group consisted of 214 (49.3%) female and 220 (50.7%) male students. Students reported that they were exposed to at least one type of emotional violence from 59.4% of teachers, 52.8% of parents, and 61.8% of children at school; they were exposed to at least one type of physical violence from 42.9% of teachers, 33.6% of parents, and 24.9% of children at school. While the rate of encountering with the beating of another child was 53%, the rate of watching this in television/cinema was 52.8%. Regarding exposure to at least one type of violence, males were found to be significantly more exposed to emotional and physical violence from male teachers, female teachers, and fathers and physical violence from children at school. The factors regarding the exposure to emotional and physical violence by teachers were evaluated using logistic regression analysis, and it was determined that the physical violence from teachers, emotional violence from children in school, and emotional violence from parents could predict the emotional violence from teachers. For males, physical violence from children in school and emotional violence from teachers could predict the physical violence from teachers. CONCLUSION: In this study, the determination of the tendency of togetherness of different types of violence applied to students from different people groups like teachers, parents, and children in school makes us think about the possibility of common risk factors in terms of violence exposure. The risk factors determined in this study may guide us in planning protective interventions aimed at violence.

Sexual attitudes, behaviour changes and opinions of interns in Izmir, Turkey.

OBJECTIVES: To evaluate sexual attitudes, behaviour and opinions of students at the end of their medical education studies in Izmir, Turkey, and compare findings with the results of the study carried out when they were first-year students. METHODS: A cross-sectional and longitudinal study, with data collected via a questionnaire. RESULTS: 'Friends' were most often mentioned as the source of their personal sexual information by students on both occasions. Use of the 'internet' increased significantly during the five years. Pornography and health professionals/specialists' also gained in importance but remained among the less frequently used sources of information. The most frequent factor affecting sexual attitudes and behaviour for both years was 'my own desire and values'. Most (74.8%) interns had taken only a few sexual health histories and 16.5% never; 35% believed their education would enable them to take one. Nearly half (48.5%) said being a medical student changed their opinions on sexuality and 25.7% said they changed their behaviour. DISCUSSION: Although changes were observed in sexual attitudes, behaviour and opinions between the two questionnaires many problems still exist. This study may add to the improvement of medical education regarding sexual health education and its practices.

Globalization of the pharmaceutical industry and the growing dependency of developing countries: the case of Turkey.

In developing countries, the effect of globalization on the pharmaceutical sector has resulted in a decrease in exportation and domestic production, accompanied by an increase in importation of pharmaceuticals and a rise in prices and expenditures. As an example of a developing country, Turkey has been facing the long-standing and increasing pressure of global regulations placed on its pharmaceutical sector. This has led to an increasing dependency on multinational companies and a gradual deterioration of an already weakened domestic pharmaceutical sector. This case study of Turkey offers points to consider in the world of increasing globalization, as it offers lessons on ways of examining the effects of globalization on the pharmaceutical industry of developing countries.

Sexual attitudes and risk-taking behaviors of high school students in Turkey.

BACKGROUND: The risk of sexually transmitted diseases is high but opportunities of sexual education for adolescents are limited in Turkey. The aim of this study was to evaluate sexual attitudes and behaviors and to determine the predictors of sexual initiation among adolescents. METHODS: A questionnaire designed by the researchers was administered to 861 senior year high school students in their classrooms. RESULTS: The rates of masturbation and sexual intercourse and the median partner numbers among males were higher than females. The rates of having negative feelings after the first sex among females were higher than males. The rates of having sexual intercourse and the mean age at first sexual intercourse among males were similar to developed countries. However, the use of a condom at first intercourse was low. Lower academic performance and grade repetition experience among males and cigarette smoking among both gender groups were related to having sexual intercourse. CONCLUSIONS: This is one of the first studies about sexual risk-taking behaviors among high school students in Turkey. Differences found between gender groups regarding attitudes and behaviors reflect the social structure in Turkey. These findings may be helpful in producing effective solutions for improving education and preventive health care.

Direct-to-consumer advertising of pharmaceuticals: developed countries experiences and Turkey.

While several major problems concerning drugs occur in the world, the attempts to direct-to-consumer advertising (DTCA) has gained a considerable impetus lately in both developed and developing countries. DTCA has increasingly become an appealing advertising alternative for the pharmaceutical industry as drug companies have come to wrestle with such problems as the expansion of the drug market; the decline of the medical representatives' work efficiency; drug reimbursement restrictions; and the escalating role of the Internet in the consumer market. Some of the main disadvantages of the DTCA are: increasing drug expenditures, unnecessary drug consumption and adverse effect risks. Even though the influence of pharmaceuticals on health services and the economy hold the same importance in the developed and developing countries, its negative consequences have increased by encompassing developing countries in its grip. Therefore, in this review, using Turkey as an example, the situation of direct-to-consumer advertisements in developing countries is analysed in relation with developed countries.

Sexual behaviours and contraception among university students in Turkey.

The aim of this study was to evaluate the sexual attitudes and behaviours of university students. An anonymous questionnaire was administered to 550 final-year university students aged 20-25 years in Izmir, Turkey. Male students opposed premarital sexual intercourse for both genders more than female students did. The frequency of sexual intercourse among male students (61.2%) was higher than that among female students (18.3%). The mean age of first sexual intercourse was lower among male than among female respondents. The rate of condom use at first sexual intercourse was 47.4%. The frequency of having two or more past sexual partners and masturbation was higher among males than females. It was found that there were culture-specific and gender-dependent differences in sexual attitudes and behaviours of the university students. These results may help in the planning of education and health policies in Turkey.

Globalization and the trends of medical technology trade in Turkey.

Medical technology trade is one of the most affected health areas by global regulations in the developing countries. The aim of the study is to examine recent changes in medical technology import and export and their results in Turkey. Data show that the total medical technology imports (MTI) increased from $ 34.6 million to $ 3427.9 million between 1970 and 2003. While MTI constituted 3.6% of total imports in 1970 and 1.3% in 1980, this ratio raised up to 4.9% in 2003. The ratio of MTI in total health expenditures were also increased from 7.6% in 1970 to 31.5% in 2003. Medical technology exports (MTE) have been increased from $ 0.9 million in 1970 to $ 303.2 million in 2003. The ratio of MTE to MTI increased from 2.7% to 13.9% between 1970 and 1990 and decreased after 1990, to 8.8%. Our study implied that the medical technology trade in Turkey has been negatively affected and in some respects differs from some other important industries in the globalization era. Nevertheless, detailed comparative studies in different developing countries such as China, Brazil, Mexico and India, are needed to explore the real state of medical technology trade, use and the effects of globalization on these topics.

Bioethics and Turkey: crossroads and challenges.

Despite extraordinary improvements in medicine, health care worldwide continues to exhibit indefensible contradictions and extreme inequalities. "Health-for-all" campaigns, and development programs targeting welfare and social security have addressed these problems with limited success, but bioethicists, who by this point in the globalization era might have been expected to be addressing these problems urgently and persistently, have had little to say. We ask if bioethics, stalled at a crossroads, is prepared to alter course. We review the bioethics experience in Turkey as a case study, considering especially globalization and Turkey's application to join the European Union.

Attention-deficit hyperactivity disorder and use of psychostimulants among children in Turkey.

Recently, the use of psychostimulant medication in children with symptoms of attention-deficit hyperactivity disorder (ADHD) has been subject to extensive debate. The problems faced while assessing and diagnosing ADHD, unnecessary prescribing of psychostimulants, the possible side-effects of psychostimulants on the developing brain, the risk of drug dependency, and the risk of stigmatising children through medicalisation of normal life events are considered among the principal objections to the use of psychostimulant medications. On the other hand, what also need to be taken into account are the increasing evidence on the genetic, biochemical and diagnostic validity of the disorder, the data showing the therapeutic effects of psychostimulants and the rarity of the above-mentioned side-effects, as well as the ethical problems created by insufficient treatment of children because of the concerns of parents. A critical evaluation of these conflicting opinions by mental health professionals might contribute to the application of ethical principles. While making this kind of evaluation, it is important to pay regard to the specific sociocultural features of the country, as well as the prevailing worldwide discussion.

What patients think about promotional activities of pharmaceutical companies in Turkey.

OBJECTIVE: Drugs, as commercial products, are subject to diverse marketing methods including promotional activities. Although the legal/ethical aspects of promotional activities have been discussed in a limited manner, the patient has remained the neglected variable of this equation. The goal of our study, therefore, is to investigate the patients' opinion on the promotional activities of pharmaceutical companies. METHOD: A descriptive study was conducted at 44 primary health care centers in Turkey and 584 volunteers who applied to these centers were included. A questionnaire consisting of 42 questions was developed with demographic information in the first section, and drug ads and promotions included in the second section. Chi-square test and logistic regression analysis were used for statistical analysis. MAIN OUTCOME MEASURE: The awareness and ethical evaluation of patients of the promotional activities. RESULTS: Nearly 83% of the participants were aware of the promotion issue. Eighty percent found it unethical, 82% suggested that promotional activities should be forbidden, restricted or regulated. 1/3 of the participants believed that physicians made their drug choices based on the gifts and ads of pharmaceutical companies. Half of them had low confidence in the prescriptions of physicians who accepted gifts from the pharmaceutical companies. 54.5% of patients also considered promotional activities as a factor which increased drug prices. CONCLUSIONS: In our study, a considerable number of patients were aware of promotions and the effects of promotion on prescriptions. The findings of our study may contribute to the development of effective regulations on this issue. Very strict measures controlling drug companies' promotion activities must be formulated. Further, these regulations must incorporate and take into consideration the patients' opinion. Today, the basic need for the proper use of drugs does not rest in pharmaceutical promotion, but in providing adequate health services and effective education for both people and physicians.

Normative data and discriminative properties of short form 36 (SF-36) in Turkish urban population.

BACKGROUND: SF-36 has been both translated into different languages and adapted to different cultures to obtain comparable data on health status internationally. However there have been only a limited number of studies focused on the discriminative ability of SF-36 regarding social and disease status in developing countries. The aim of this study was to obtain population norms of the short form 36 (SF-36) health survey and the association of SF-36 domains with demographic and socioeconomic variables in an urban population in Turkey. METHODS: A cross-sectional study. Face to face interviews were carried out with a sample of households. The sample was systematically selected from two urban Health Districts in Izmir, Turkey. The study group consisted of 1,279 people selected from a study population of 46,290 people aged 18 and over. RESULTS: Internal consistencies of the scales were high, with the exception of mental health and vitality. Physical health scales were associated with both age and gender. On the other hand, mental health scales were less strongly associated with age and gender. Women reported poorer health compared to men in general. Social risk factors (employment status, lower education and economic strain) were associated with worse health profiles. The SF-36 was found to be capable of discriminating disease status. CONCLUSION: Our findings, cautiously generalisable to urban population, suggest that the SF-36 can be a valuable tool for studies on health outcomes in Turkish population. SF-36 may also be a promising measure for research on health inequalities in Turkey and other developing countries.

Trends in diagnostic imaging utilization in a university hospital in Turkey.

OBJECTIVES: The aim of this study was to evaluate utilization trends of the diagnostic imaging examinations during the past decade in a university hospital in Turkey. METHODS: Patient registries of a university hospital were used for the years 1995 and 2003. The data set consisted of patients' admissions, social security status, and diagnostic imaging tests. RESULTS: When compared with 1995 data, the total number of diagnostic imaging examinations and patient admissions increased 65.9 percent and 81.6 percent, respectively, in the year 2003. Although the total number of diagnostic imaging tests decreased 9.0 percent, there was a 145.4 percent increase in magnetic resonance imaging (MRI) examinations. Nevertheless, radiological diagnostic procedures consisted of 12.8 percent of the total hospital revenues in 1995 and 9.4 percent in 2003. CONCLUSIONS: This study shows that approximately one third of inpatients underwent MRI and computed tomography examinations in 2003. The utilization rates of diagnostic imaging procedures, especially new technologies, need to be considered carefully with respect to appropriateness of procedures and planning of services.

An important public health problem: rabies suspected bites and post-exposure prophylaxis in a health district in Turkey.

OBJECTIVE: The aim of this study was to describe rabies suspected animal bites and post-exposure prophylaxis (PEP) practices in Narlidere District in Turkey between 1999 and 2001. METHODS: One thousand five hundred and sixty-nine rabies suspected bite cases reported were identified from the District's rabies surveillance forms. RESULTS: Males comprised 66.7% of the cases, and 43.5% of the total were under 20 years old. In 74% of cases the animal involved in the bite was a dog. Only 70% of the animals had an owner, and only 17% of the animals had a rabies vaccination certificate. In terms of treatment, 68% of the human cases received PEP, and 21% of cases had an extra (sixth) vaccination dose, which is a substantial burden on the healthcare system, costing half a million US dollars per year. The place where the bite occurred (rural areas), the age of the recipient (more than 10 years old), the animal type (animals other than dogs and cats), lack of a vaccination certificate for the animal, and place of wound treatment (hospital) were significantly associated with PEP application. CONCLUSIONS: In addition to the currently recommended strategy of controlling the dog population and of vaccinating domesticated animals, adults and children should be educated about bite prevention to reduce the number of animal bites.

Attitudes and practices of primary healthcare center patients about drug use in Turkey.

OBJECTIVE: Noncompliance is considered as a widespread but often neglected problem all over the world. In order to promote compliance, it is essential to first know the current drug use situation. Therefore, this study aims to investigate the level of drug compliance in patients of a primary healthcare centre and identify factors which affect the patients' drug compliance in Turkey. METHODS: The cross-sectional study was executed in 2003 in Ilica Health Centre; a total of 280 patients took part in the study. The patients were visited at home and a questionnaire was applied in order to obtain information on compliance. RESULTS: Overall 204 (72.8%) of patients were compliant and 76 (27.2%) were noncompliant. According to patients, the main reason for primary noncompliance was poverty. CONCLUSION: Compliance with prescription is needed to get favourable results in treatments. The results show that even in urban areas drug compliance is still an important problem in Turkey. PRACTICE IMPLICATIONS: The findings of this study may contribute to develop programmes to improve patient compliance in Turkey. The aims of these programs should include reducing the barriers, such as lack of social security, which prevent access to the prescribed drugs.