Effect of eTansiyon smartphone application on hypertension control.

AIM: To investigate the effectiveness of eTansiyon smartphone application in blood pressure control in patients with hypertension. BACKGROUND: Global prevalence of hypertension and the burden of chronic illness care, especially in primary care, are increasing in world. We have developed eTansiyon to ensure the continuity of patient-physician relationship, so it may help to improve the lifestyle of patients with hypertension, increase their adherence to treatment and achieve the target blood pressure. METHODS: This study was a non-randomized controlled study. The sample was selected by random sampling method among the patients registered in 6 Family Health Units (FHUs). Randomization was performed at the FHU level; the units were randomized to 4 control group (CG) and 2 intervention group (IG), so that randomization in this study was 2:1. Both groups were followed up for at least four months. In addition to CG, IG were provided to use eTansiyon. Obtained data were analysed to evaluate differences between groups at the beginning and end of the study, intra-group changes after follow-up and interaction between groups and follow-up period. FINDINGS: The study was performed with 124 patients in CG and 61 patients in IG. At the end of the study, the average systolic blood pressure/diastolic blood pressure (SBP/DBP) of office and home was significantly lower in IG compared to CG (P < 0.001, MD 9.5 mmHg; P = 0.007, MD 3.8 mmHg; P < 0.001, MD 10.6 mmHg; P < 0.001, MD 4.8 mmHg, respectively), and it was found that the proportion of people with target blood pressure in IG was significantly higher than CG (P < 0.001, 49.2%(n = 30) and 22.6%(n = 28), respectively). Repeated measures ANOVA and generalized estimating equations results showed that follow-up period and interaction between groups were significant in terms of office and home SBP/DBP and target blood pressure level during follow-up period (P < 0.001, P < 0.001, P < 0.001, P < 0.001, P < 0.024, respectively).

The effect of an Empowerment-Based Human Centered Educational Program on early weaning.

AIM: To determine the effects of an Empowerment-Based Human Centered Educational Program on early weaning. BACKGROUND: Exclusive breastfeeding (EBF) means that the infant receives only breast milk during the first six months of life. It is essential for the healthy growth of the infants and is supported by the main health organizations all around the world. Intervention studies performed within the antenatal period suggest that the education extends the duration of breastfeeding and increases the frequency of EBF. METHODS: This is a semi-randomized control study. An interactive training module including role-plays which contain traditional patterns, short films, short presentations, and group practice with models was prepared. The participants were recruited in the study based on the voluntary participation of pregnant women followed up for antenatal care in a total of four family health centers in Pendik, a district of Istanbul. The pregnant women of one center formed the control group while others constituted the intervention group. All of them were certified as "Baby Friendly" institution. A pretest and a posttest have been performed to measure breastfeeding knowledge in the intervention group. The mothers of the intervention group have been randomized into two subgroups: one group for reminder call and the other for routine follow-up. All the participants including control group were called at the end of the postpartum sixth month to determine the rates of EBF. RESULTS: Statistically significant increase in the rates of EBF at the end of six months showed the effectiveness of the education module (42.9 versus 22.2%, P = 0.001). Supplementary food taking time was earlier in the control group (18.5 ± 8 versus 15 ± 9.5 week, P = 0.03). The main reason of early weaning reported by the mothers was "the insufficiency of the mother's milk." CONCLUSION: The group training and postnatal reminders were found to be more effective than the individual training provided at the baby-friendly health institutions in terms of the effectiveness on increasing the frequency of EBF.

Comparison of preventive health service provision before and after reorganization of primary care in Turkey: a community-based study.

AIM: To investigate the changes in the provision of preventive health services in terms of woman and child health after reorganization of the primary health care services. BACKGROUND: The primary care system in Turkey has undergone fundamental changes as a part of Health Transformation Program during last decade. But there was no community-based study to evaluate these changes. METHOD: This community-based and cross-sectional study was conducted in 2010, just before the reorganization of primary care services and in 2015, five year after the reforms. The 30×7 cluster sampling method was used in Zümrütevler quarter of Maltepe District. The socio-demographic characteristics of the participants, the presence of the physician who can be consulted for any health problem, the presence of smokers at home were questioned. The women aged 18 years or older and gave consent provided information about history of pregnancy and birth, the number of follow-ups during pregnancy, family planning method usage, cervical and breast cancer screening, breastfeeding duration, vaccinations, and prophylactic iron and vitamin D supplementation for their children. FINDINGS: After the reorganization of primary care, more people stated that they had physicians to whom they could consult for all kinds of health problems (27.8 versus 44.7%; P<0.001) and that physician was the primary care physician (30.2 versus 64.7%; P<0.001). The reported frequency of at least one smoker at home was decreased after reorganization of primary care (63.6 versus 53.1%; P=0.034). There were no significant differences in terms unplanned pregnancy, the use of family planning method, the number of pregnancy follow-ups and the frequency of Pap smears and mammography. There are no significant differences in terms of healthy children follow-ups, vaccination, vitamin D and iron supplementation (P>0.05). It was found that the duration of total breastfeeding increased after reorganization of primary care (P<0.001).

Examination of a board game approach to children's involvement in family-based weight management vs. traditional family-based behavioral counseling in primary care.

The most effective intervention model for childhood obesity is known as family-based behavioral group treatments. There are also studies that investigate the effects of educational games for children to gain healthy eating and physical exercise habits. The aim of this study was to compare the efficacy of a family-based group treatment with an educational game (Kaledo) intervention in childhood obesity. Kaledo is a board game that was designed to improve nutritional knowledge and healthy life style habits. It is played with nutrition and activity cards that players can select from, and a total score is calculated in the end of the game according to energy intake and expenditure. Obese children between 9 and 12 ages were involved in this study. Participants randomly divided into behavioral and game intervention groups. Clinical evaluation was performed in the first and second counseling in both groups. Marmara University Family Medicine Department Obese Children and Adolescents Interview Form, Physical Activity Evaluation Form, and Three-day Food Record Form were used for this purpose. Strengths and Difficulties Questionnaire-Parent Report Version and Children's Depression Inventory were used for the assessment of psychiatric symptoms. After the clinical evaluation, an education session about healthy eating and physical activity was attended by both groups. After that, for the behavioral groups, parents and children were assigned to different groups, while for the game intervention group, parents were assigned to behavioral sessions and children were assigned to game (Kaledo) sessions. A total of six sessions with 1-h duration and 2-week interval were performed in both groups. Height and weight were measured in each session and analysis was performed on the data of the children who participated in all of the sessions. Although a total of 108 children were clinically evaluated, 52 children and their parents, 26 in the behavioral group and 26 in the game intervention group, participated in two or more sessions. Twenty-four participants, 12 in behavioral and 12 in the game intervention group, finished the study by participating in all of the six sessions. Thus, dropout rate was 74%. BMI and BMI z-scores decreased in both groups compared with the initial measures and these changes were statistically significant. For the behavioral group, these changes were - 1.01 (25.44 to 24.43, p = 0.03) and - 0.17 (2.07 to 1.90, p = 0.000) and for the game group, - 0.74 (26.98 to 26.24, p = 0.007) and - 0.09 (2.07 to 1.98, p = 0.003). There were no significant differences between behavioral and game intervention groups in point of BMI and BMI z-scores (p = 0.130 and p = 0.706). CONCLUSION: Family-based behavioral group treatment and game (Kaledo) intervention were found to be effective in childhood obesity management in this research. There was no significant difference between the two interventions. According to this study, these intervention models can be advised to primary care physicians to be used in the management of childhood obesity. What is Known: - Family-based behavioral group treatment is known as the most efficient model for childhood obesity management. What is New: - In this study, for the first time, a game (Kaledo) intervention was found to be effective in childhood obesity management. - Compared with family-based behavioral group treatment, there was no significant difference between the two interventions.

Relationship between obesity and musculoskeletal system findings among children and adolescents.

OBJECTIVES: This study aims to demonstrate the relationship between obesity and musculoskeletal system examination findings and functionality among 5-16 years old population-based sample. PATIENTS AND METHODS: This is a cross-sectional field study. Sample of this study was selected from 4,246 participants of a study, which assessed the prevalence of obesity among school children aged between 6-15 in Pendik, Istanbul, in 2013-2014 school year. Physical examination included inspection, gait, balance, muscle strength and range of motion (ROM) assessment. Turkish version of Pediatric Outcomes Data Collection Instrument (PODCI) was used. Physical examination findings and PODCI scores of "normal weight" and "overweight/obese" groups were compared. Correlation between body mass index (BMI), ROM and PODCI subscale scores were also evaluated. RESULTS: A total of 318 children were included in the study. 39.3% (n=125) were normal weight, 61.7% (n=193) were overweight/obese. Pes planus was the most common musculoskeletal problem with a rate of 23.9%. We found that pes planus was more common (p=0.000), standing time on one leg was shorter (p=0.002), time to complete timed up and go test (TUG) was longer (p=0.004) and "happiness" subscale scores of PODCI were lower (p=0.000) in overweight/obese children compared to their normal weight peers. Range of motion values were decreased, especially on the lower limbs, in overweight/obese children (p<0.05) compared to normal weight children. Body mass index values showed a negative correlation with ROM and PODCI "happiness" subscale scores (p<0.05). CONCLUSION: Musculoskeletal problems are more common in overweight/obese children than in their normal weight peers. Increase in BMI correlates with decrease in balance, emotional functionality and ROM values. It may be possible to protect overweight/obese children from serious musculoskeletal disorders by interventions that reduce BMI.

Reliability of cross-cultural adapted Turkish version of the Pediatric Outcomes Data Collection Instrument (PODCI).

BACKGROUND: The Pediatric Outcomes Data Collection Instrument (PODCI) has been created to evaluate functional status, to assess therapeutic needs and changes after treatment in 2 to 18 years old children and adolescents who have orthopedic problems. The PODCI has three forms; parent form for children, parent and self report forms for adolescents. Instrument has 86 items assessing `upper extremity and physical function', `transfer and basic mobility', `sports and physical function', `pain/comfort', `happiness', `global functioning' and `expectations from treatment domains'. The PODCI has been validated in multiple languages. The aim of this study was to investigate the reliability of the cross-cultural adapted Turkish version of the PODCI parent forms for children and adolescents in a variety of chronic musculoskeletal disorders. METHOD: This was a methodological study. The instrument was translated and cross-culturally adapted into Turkish. Turkish version was called Bedensel Islevsellik Degerlendirme Araci (BIDA). It was completed by the parents/caregivers of ninety-eight children and adolescents being treated at Marmara University Medical School Department of Physical Medicine and Rehabilitation outpatient clinics at the baseline and 2-4 weeks after between April 2013-October 2013. Internal consistency and test-retest reliability (ICC) were determined. RESULTS: Internal consistency of the subscales and test/retest cronbach alpha values were 0.90-0.91 (r= 0.71, p= 0.000) for ``upper extremity and physical function''; 0.95-0.95 (r= 0.84, p= 0.000) for ``transfer and basic mobility''; 0.93-0.91 (r= 0.78, p= 0.000) for ``sports and physical functioning''; 0.77-0.82 (r= 0.45, p= 0.000) for ``happiness'' and 0.96-0.96 (r= 0.82, p= 0.000) for ``global functioning''. Pain/comfort subscale showed low internal consistency (-0.38-0.49; r= 0.34, p= 0.004). CONCLUSION: The Turkish version of the PODCI was found to be a reliable instrument to evaluate functionality of children and adolescents with chronic musculoskeletal disorders.

Placental volume and vascularization flow indices by 3D power Doppler US using VOCAL technique and correlation with IGF-1, free beta-hCG, PAPP-A, and uterine artery Doppler at 11-14 weeks of pregnancy.

AIMS: The purpose of this study was to investigate correlations between first trimester placental volume (PV) and blood flow indexes (FIs), bilateral uterine artery pulsatility indexes, notching, and biochemical parameters: pregnancy-associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (f-ß-hCG), and insulin-like growth factor-1 (IGF-1) to predict the high-risk pregnancies in the first trimester. METHODS: We prospectively examined 310 patients at 11-14 weeks of pregnancy using transabdominal 3D gray scale and power Doppler ultrasound for assessing PV, vascularization index, FI, and vascularization FI (VFI). The acquired volumes were analyzed using VOCAL™ imaging software. The results were correlated with biochemical parameters. RESULTS: We found significant correlations between PV and biochemical parameters, and between placental blood flow studies and other parameters. Finally, PV/crown-rump length so called the placental quotient is also related to both PAPP-A and VFI. CONCLUSIONS: Placental volumetry, uterine artery Doppler studies, blood flow calculations and biochemical parameters, such as f-ß-hCG, PAPP-A, and IGF-1 could be important in the early and rapid diagnosis of high-risk pregnancies. Thus, they may be useful in first trimester prediction of fetal growth restriction presenting with alterations in PV and vascularity.

Sudden infant death syndrome: how much mothers and health professionals know.

BACKGROUND: Behavioral risk factors are associated with sudden infant death syndrome (SIDS). Education about the risk factors of SIDS is important for prevention. Our aim was to determine the knowledge and attitude of parents and health professionals about SIDS. METHODS: A total of 174 health professionals and 150 mothers were enrolled in this study. Mothers' data were collected by telephone interview and health-care professionals were interviewed by the same investigator. RESULTS: Only 39% of mothers were aware of SIDS. Forty-six percent of the mothers preferred a supine sleeping position for their infant and 16% of the parents were bed-sharing with their infants. Seventy-three percent of health professionals selected side, 17% supine and 10% prone sleeping position as the safest sleeping position. Frequencies for awareness of risk factors were: bed-sharing (75%), soft bedding (70%), pillow use (52%), toys in bed (90%), high room temperature (67%) and smoking (88%). Total knowledge score of health professionals who selected supine sleeping position as the safest was significantly higher (P < 0.001). CONCLUSION: Most of the mothers were unaware of SIDS and less than half preferred a supine sleeping position for their infant. Only 72% of health professionals recommended a certain sleeping position during family interviews. Health professionals are more often recommending the side sleeping position or prone. Education of families and health professionals for the risk factors of SIDS may reduce the number of deaths from SIDS in Istanbul.

Residents' views about family medicine specialty education in Turkey.

BACKGROUND: Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. METHODS: This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27) and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11) by e-mail and by personal contact. RESULTS: A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%). Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e-learning. Participation in courses and congresses was considered necessary. The presence of a department office and the clinical competency of the educators were more favored by state residents. CONCLUSIONS: This study gave the Board the chance to determine the needs of the residents that had not been taken into consideration sufficiently before. The length and the content of the programme will be revised according to the needs of the residents.

Using theatre in education in a traditional lecture oriented medical curriculum.

BACKGROUND: Lectures supported by theatrical performance may enhance learning and be an attractive alternative to traditional lectures. This study describes our experience with using theatre in education for medical students since 2001. METHODS: The volunteer students, coached by experienced students, were given a two-week preparation period to write and prepare different dramatized headache scenarios during three supervised meetings. A theatrical performance was followed by a student presentation about history taking and clinical findings in diagnosing headache. Finally, a group discussion led by students dealt with issues raised in the performance. The evaluation of the theatre in education lecture "A Primary Care Approach to Headache" was based on feedback from students. RESULTS: More than 90% of 43 responding students fully agreed with the statement "Theatrical performance made it easier to understand the topic". More than 90% disagreed with the statements "Lecture halls were not appropriate for this kind of interaction" and "Students as teachers were not appropriate". Open-ended questions showed that the lesson was thought of as fun, good and useful by most students. The headache questions in the final exam showed results that were similar to average exam results for other questions. CONCLUSION: Using theatrical performance in medical education was appreciated by most students and may facilitate learning and enhance empathy and team work communication skills.

Drug utilization and teratogenicity risk categories during pregnancy.

A limited number of studies have investigated in detail the use of drugs during pregnancy. Researchers in the present study investigated the details of drug utilization in pregnant women during the month before pregnancy, at the time that they became aware of the pregnancy, and during the first trimester. Face-to-face interviews were conducted with 359 pregnant women who were admitted to the fetal medicine unit at a university hospital for diagnosis and follow-up. A questionnaire was used to document sociodemographic characteristics and details of drug use. Drugs were categorized according to the US Food and Drug Administration fetal risk classification. Mean maternal age was 29.9+/-5.1 y, and mean gestational age was 19.6+/-9.5 wk. Many of the pregnant women studied (46.6%) were university graduates, and most (61.9%) had a relatively high annual income. Mean gestational age when participants first learned of their pregnancy was 39.8+/-16.4 d. One hundred seventeen participants (32.6%) used drugs during the month before conception, 54 (15%) at the time when they learned of their pregnancy, 180 (50.1%) at the time of the interview, and 289 (80.5%) during the first trimester. The percentages of drugs in categories D and X used by these subjects were 14%, 13.5%, 2.9%, and 5.9%, respectively. Most of the drugs were hormones. The total rate of drug utilization was not high before and during the first trimester of pregnancy. A considerable number of women were using drugs from the D and X categories; however, these numbers decreased significantly when women learned of their pregnancies. Intake of folic acid, vitamins, and iron was very low during the preconception period and was not high enough during the first trimester; this suggests that particular attention should be paid to the use of beneficial "safe" drugs during the preconception and early pregnancy periods.

Nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae in healthy children.

Streptococcus pneumoniae carriage is a risk factor for the development of respiratory system infections and the spread of penicillin-resistant strains. The aim of this study was to investigate nasopharyngeal carriage of S. pneumoniae in healthy children and resistance to penicillin and other antimicrobials and to assess related risk factors. Nasopharyngeal specimens collected from healthy children less than six years of age, visiting a Mother and Child Health Center for health control, were investigated microbiologically between February-March 2004. Carriage rate was 37.2% (n=112/301); 33.9% intermediate and 5.4% high penicillin resistance were detected. According to multivariate analysis, carriage rate was inversely related to number of rooms (OR:0.574) and child age (OR:0.978), while penicillin resistance was correlated well with antibiotic use in the last two months (OR:2.193). Decreased sensitivity plus resistance to other antimicrobials were: trimethoprim-sulfamethoxazole (TMP-SMX) 45.6%; erythromycin 16.1%, tetracycline 16.1%; clindamycin 9.8%, and ofloxacin 3.6% in pneumococcal isolates, which increased significantly (p<0.05) to 72.7%, 31.8%, 27.3%, 20.5%, and 6.8%, respectively, in penicillin non-sensitive S. pneumoniae (PNSSP) except for ofloxacin. Overall multidrug resistance was 17.9%, while PNSSP exhibited a resistance rate of 38.6%. In conclusion, S. pneumoniae carriage rates determined in healthy children were high and PNSSP strains also showed increased resistance to other antimicrobials.