Attitudes of Medical Students Toward Sexual Minorities: A Multicentric Survey from the Medical Education Without Discrimination Project.

This study, as a part of the 'Medical Education without Discrimination (MED) Project," focuses on investigating attitudes toward sexual minorities and demographics among Turkish medical students. In the needs assessment phase of MED Project, a survey covering demographics, sexual orientation, attitudes toward sexual minorities, and Index of Attitudes Toward Homosexuals by Hudson & Ricketts (6-point Likert) was conducted among 523 medical students of one public and two nonprofit private medical schools in Istanbul. Of the students, 4.2% declared themselves as non-heterosexual. The findings highlight that medical students are on the verge of homophobia (44th percentile). Homophobia was significantly higher among public university students, males, younger individuals, those who originated from underdeveloped settlements, those who grew up with mothers who did not graduate from university, those who considered themselves less happy, and those without LGBTI+ acquaintances. Of the respondents, 14.1% do not perceive LGBTI+ people as equals within the community, and 75.7% assert that they would conceal their own LGBTI+ identity if they were part of this community. This study highlights that the need for targeted interventions in medical education in line with the global commitment to reduce inequalities and promote inclusive health care.

Will plain packaging of cigarettes achieve the expected? Perceptions among medical students.

INTRODUCTION: Plain packaging is one of the critical strategies in eliminating the promotion of tobacco products. Evidence indicates that plain packaging decreases the attractiveness of tobacco products and enhances the effectiveness of health warnings. This study aimed to explore the perceptions of undergraduate medical students of plain packaging and new pictorial warnings before they came into use in Turkey. METHODS: This qualitative study was carried out among undergraduate students in a Medical School in Istanbul in 2019. Participants were recruited through purposive sampling, and data were collected through focus group discussions. The participants were asked to discuss their perceptions regarding one original branded pack and ten plain package models. All discussions were audiotaped and thematic content analysis was conducted. RESULTS: A total of 72 students participated in the study. None of the students had seen plain packaging before. Most of the students perceived plain packaging as more favorable compared to the branded packs. The terms used to describe plain package were: 'appealing/desirable', 'attractive', 'beautiful', 'cool/eye-catching', 'charming', 'elegant', and 'special'. Some students indicated that they would have preferred plain packs over the branded ones if both types of products had been in the market and provided they were of the same brand. Pictorials had different impacts based on their content. At the same time, outer body deformities were perceived as 'real' and provoked unfavorable feelings; inner organ images were defined as 'imaginary' and had little to no impact. CONCLUSIONS: Plain packaging was perceived as a more attractive alternative to the conventional branded packs among most participants. We must be aware of the unforeseen effects of plain packaging among different subgroups in the new generations. We suggest using outer body deformities in the pictorials more frequently due to their higher impact.

'Stepchildren of the Ministry': an examination of the difficulties endured by family physicians in Istanbul during the course of the COVID-19 pandemic.

Introduction Efforts to contain the SARS-CoV-2 virus would fall short without strong primary health care. Aim In this study, we aimed to understand family physicians' experiences of coronavirus disease 2019 (COVID-19) in Istanbul, focusing on their coping strategies in order to draw lessons for the future management of pandemics. Methods Twelve community-based physicians working in Istanbul participated in semi-structured interviews between January and May 2021. Purposive sampling was used to ensure a range of physicians' characteristics. Individual interviews were conducted with each participant on an online platform. Participants were asked 26 open-ended questions. Phenomenological analysis was performed to describe experiences of physicians. Results The physical conditions of participants' health centres were insufficient to provide service safely during the COVID-19 pandemic. Most physicians were uncomfortable about the quality and quantity of personal protective equipment received from the Ministry of Health and took additional measures themselves. Vaccine supply was thought to be insufficient and there were problems with the associated software. Many family physicians highlighted the inadequate communication from the Ministry. Insufficient knowledge about the disease caused anxiety and fear for the physicians and hindered their performance at the beginning of the pandemic. Physicians who live with their families were more anxious than those who did not. Discussion Despite challenges, routine procedures have mostly been continued, but newly added responsibilities during the COVID-19 pandemic have had significant impact on physicians' lives.

Premature deaths attributable to long-term exposure to PM2.5 in Turkey.

This research aims to reveal the premature deaths caused by long-term exposure to PM2.5 in 2018 in Turkey utilizing the AirQ+ program developed by the World Health Organization. Calculation of yearly average PM2.5 concentration in provinces, acreage of provinces, and the mortality rate of the at-risk population was the data required for the operation of the AirQ+ program. With the help of the AirQ+ program, the results revealed that a total of 44,617 people (95% CI 29.882-57.709) died prematurely due to sustained exposure to PM2.5 in Turkey in 2018. The highest estimated mortality proportion attributable to PM2.5 pollution was in the provinces of Igdir and Kahramanmaras. The highest estimated number of mortality cases per 100,000 population attributable to PM2.5 pollution was in the provinces of Manisa and Afyonkarahisar. This research points out that reaching the PM2.5 limits specified by the WHO could have prevented 44,617 premature deaths in the year 2018 in Turkey.

Perceptions of Students of a Medical School on Combined Health Warnings in Plain Packs.

OBJECTIVE: Turkey has recently adopted the regulation of plain and standard packaging for tobacco products and introduced newly designed combined health warnings. In this study, we aimed to reveal how the new combined health warnings are perceived among medical students. MATERIAL AND METHODS: The study was descriptive and the data were collected by a 3-part questionnaire. The first part covered demographic characteristics, the second part was designed to measure the saliency of the combined health warnings, and the third part evaluated their effect on the motivation to quit. RESULTS: Out of 484 students of medicine, 287 (59%) were included in the study; 54.4% of the participants were female and 45.6% were male; and the average age was 21.18 ± 1.94 years. There were 79 (27.5%) smokers and the mean duration of smoking was 39.07 ± 24.07 months. The combined health warning that reads "Smoking causes laryngeal cancer" had the highest score both in terms of saliency and motivation to quit smoking. The one that reads "Protect children: don't let them inhale your smoke" had the lowest score in both categories. Non-smokers found the stimuli more effective than smokers and quitters (P > .05). CONCLUSION: The findings point out that smoking rate is unexpectedly high among participants, and medical students perceived the warnings emphasizing the physical deformities caused by tobacco products on individuals as more effective than combined health warnings aimed at protecting "others." This study suggests that the combined health warnings should be selected in a more nuanced way for different target groups.

Persistent Ambient Air Pollution in Turkey: A 4-Year Analysis.

OBJECTIVE: Ambient air pollution is an important cause of morbidity and mortality for both individual and public health. The major contaminant that creates air pollution in Turkey is particulate matter. This study aims to demonstrate Turkey's air quality in terms of particulatematter in the last 4 years. MATERIAL AND METHODS: In this descriptive study, the public data of the National Air Quality Monitoring Network between the years 2016 and 2019 were analyzed for particulate matter (PM10). Stations with less than 75% data throughout the year were excluded from the evaluation while calculating the annual average values. The averages of the years were compared statistically with each other. RESULTS: For 111 stations that made sufficient measurements for 4 years, the annual median value of particulate matter remained constant in 12 stations (10.8%), increased in 26 stations (23.4%), and decreased in 73 stations (65.7%). The level of air pollution at 18 stations has been sustained for 4 years. It has been observed that there is no significant improvement in the criterion that the daily average PM10 level should not be higher than 50 µg/m3 for more than 35 days, and pollution is detected above the limit value permitted by the World Health Organization in all provinces and stations except a few provinces every year. Finally, during the 4-year observation, the number of stations that did not make sufficient measurements throughout the year has been found to increase over the years. CONCLUSION: Our data reveal that the air pollution attributable to particulate matter in Turkey between the years 2016 and 2019 did not regress prominently. On the contrary, air pollution has been found to gain permanency in certain provinces, and air quality monitoring has been inadequate due to insufficient measurement activities of some of the stations.

Influence of Gender on Inhaler Technique.

BACKGROUND: This study was designed to evaluate the influence of gender on the inhaler technique of subjects on inhaler therapy and to determine the factors predicting the correct inhaler technique and a change of inhaler device. METHODS: A total of 568 adult subjects (276 male, 292 female) on inhaler therapy were included in this cross-sectional, observational study. Data on sociodemographic characteristics, inhaler therapy, subject-reported difficulties, and technician-reported errors in inhaler technique were recorded. RESULTS: A change of inhaler device was noted in 71.0% of male subjects and 77.4% of female subjects, and this was based on the physicians' decision in most cases (41.7% and 51.7%, respectively). A higher percentage of female subjects reported difficulties with using inhalers (63.7% vs 40.6%, P < .001). Overall, having received training on the inhaler technique was associated with a higher likelihood of correct inhaler technique (odds ratio 12.56, 95% CI 4.44-35.50, P < .001) and a lower risk of device change (odds ratio 0.46, 95% CI 0.27-0.77, P = .004). CONCLUSIONS: Errors in the inhaler technique, including inhalation maneuvers and device handling, were common in subjects on inhaler therapy. Subject-reported difficulties with using inhalers were more prevalent among female subjects, whereas errors in the inhaler technique identified by direct observation were similarly high in both genders. Overall, a lack of training on the inhaler technique predicted a higher likelihood of errors in the inhaler technique and a change of inhaler device.

Child health, parasites and lower socioeconomic status: Outcomes of a long-term screening, intervention and training study by health volunteers in rural Nepal.

BACKGROUND: Nepal is a developing country with limited resources for health provision due to its geographic difficulties and frequent natural disasters, such as floods and earthquakes. Children are at risk of growth retardation due to inadequate food intake and unhealthy environment. Lower back pain is common among the adults and causes limitations in daily activities. MATERIAL/METHODS: A group of voluntary Turkish medical students, doctors and civil members conducted a field study, together with Nepalese doctors (MDs) and local volunteers, concerned with health-screening, intervention practices and on-site training in rural Nepal between 2013 and 2015. Physical examination of participants, together with stool examinations for parasites were done and those for whom treatment was indicated were referred to MDs who also ran a field pharmacy containing donated medications. RESULTS: Totally, 1148 individuals-725 children and 423 adults-were screened between 2013 and 2015. Musculoskeletal problems and upper respiratory tract infections were primary complaints among adults and sick children, respectively. Three-quarters of 203 collected stools had ≥ 1 parasite(s). CONCLUSIONS: Growth retardation in children observed during the study, the burden of intestinal parasites on Nepalese children and unavailability of effective health services for citizens in rural areas should direct local authorities to allocate greater resources for country's health infrastructure improvement and to provide a higher standard of childhood nutrition.

Infection of the Invisible: Impressions of a Tuberculosis Intervention Program for Migrants in Istanbul.

This paper reviews the experience of the Istanbul Tuberculosis Aid Program, which targeted tuberculosis (TB) disease in the growing irregular migrant populations of Istanbul. This experience illustrated the importance of community-based public health interventions when dealing with an infectious disease like TB among vulnerable groups. Our data is derived primarily from a qualitative study carried out with program stakeholders. We summarize lessons for success of ITAP as: (1) Strengthening impact and outreach of TB intervention among irregular migrant communities through involvement of multiple stakeholders (2) Increasing TB awareness through a community targeted approach (3) Increasing TB contact tracing and treatment success among infected irregular migrants, and, (4) Improving overall health seeking behavior of irregular migrants through empowerment and trust. Given these particularities we list our policy suggestions for revision of regulations regarding TB control and healthcare needs of irregular migrant populations.