Family physicians in an Eastern Turkish City need training on child abuse and neglect: A cross-sectional study.

AIM: The study's purpose was to determine the knowledge, competencies, and approaches of family physicians in recognizing the signs of child neglect and abuse. METHODS: This cross-sectional study was conducted between 1 March and 30 August 2019 in the Erzurum province in Turkey. The population of the study was family physicians working in primary care. The data were collected with an instrument that included the Scale of Diagnosing the Symptoms and Risks of Child Abuse and Neglect (SDRCAN) and a socio-demographic information form. RESULTS: The mean age was 37.40 ± 8.78 years (min. 26, max. 60). Of the participants, 103 (n = 58.5%) were men. The most common types of encountered child abuse/neglect were physical abuse or neglect (each 27.8%, n = 49). Having received education on child abuse/neglect among participants was only 44.9% (n = 79). On the other hand, the rate of having encountered any child abuse/neglect was 40.3% (n = 71). Another result of this study is the proportion of family physicians feeling weak regarding history taking (30.7%, n = 54), physical exam (17.0%, n = 30), and cooperation with the authorities (13.1%, n = 23). Additionally, the different responses among the participants about action in case of encountering child abuse/neglect were remarkable. Being a woman was one prominent factor that increased the SDRCAN score (P < 0.001). CONCLUSION: The awareness and knowledge of family physicians in Erzurum about child maltreatment are inadequate. We recommend focusing on child maltreatment, especially in medical faculties, including this issue in the standard core curriculums, and organizing intermittent in-service training programs during the post-graduate working period.

Burnout among family physicians in Turkey: A comparison of two different primary care systems.

AIM: The objective of this study was to determine the prevalence of burnout syndrome and associated factors among family physicians before and after family medicine system (FMS). MATERIALS AND METHOD: The first part of the study was conducted in 2008 (pre-FMS) and the second part in 2012 (post-FMS). Physician's burnout was investigated by using the Maslach Burnout Inventory (MBI). In total, 139 physicians had been participating pre-FMS and 246 physician's post-FMS. RESULTS: The mean pre-FMS emotional exhaustion score was 15.7 ± 5.8, increasing significantly to 17.14 ± 7.5 post-FMS (P = 0.045). Mean pre-FMS and post-FMS depersonalization and reduced personal accomplishment scores were similar (P > 0.05). Age was negatively correlated with depersonalization in this study (P = 0.012) and positively correlated with personal accomplishment (P = 0.001). The primary care physicians in the post-FMS period were older, female physicians had a greater preference for primary care, and the levels of married doctors were higher. In addition, a higher level of physicians also owned their own home and cars compared to the pre-FMS period. A negative correlation has been reported between physicians' burnout levels and home or car ownership in the present study. CONCLUSION: Our findings suggest that physicians working under the family medicine system, a new primary care model, are at greater risk of emotional exhaustion, but that no change has occurred in terms of personal accomplishment or depersonalization, despite this new system.

Prevalence of obesity among adolescents in Eastern Turkey: A cross-sectional study with a review of the local literature.

BACKGROUND: The World Health Organization defines obesity as an abnormal or excessive fat accumulation that can damage health. AIMS: This study aims to evaluate the prevalence of obesity and risk factors in high school students in Erzurum City Center. STUDY DESIGN AND METHODS: A cross-sectional study was conducted. The number of students participating in the study was 845, including 47.6% females and 52.4% males. Data collection was done by surveys filled in under supervision. Anthropometric measurements were performed by the researchers. Predictions of the Extended International Obesity Task Force were used for body mass index. Parents' body mass indexes were calculated by self-report and classified according to cut-off points for adults in the world health community. A systematic review of the local literature published between 2004 and 2013 was drafted. RESULTS: In girls and boys, the frequency of overweight was 26.9% and 25.7%, respectively, while the frequency of obesity was 12.4% and 9.5%. A logistic regression analysis was performed to reveal significant risk factors for overweight/obesity. Weekly exercise status [odds ratio = 3.0, 95% confidence interval CI (1.2-7.8)] and school transfer % CI = (1.1-7.2) were important independent risk factors for obesity. The local literature showed a 4.3-fold increase in the prevalence of obesity within 10 years. CONCLUSION: The prevalence of obesity and overweight in adolescents requires the implementation of effective programs to fight this epidemic. Health education targeting peers and their parents, peer education, screening of risk groups, and controlling the sale of unhealthy foods can be some interventions.

Rational drug use and prescribing behavior of family physicians in Erzurum, Turkey.

BACKGROUND: Widespread irrational medical prescription adversely affects the outcomes of patient health and medical services. AIM: This study aims to investigate the determinants of medical prescription behavior of family physicians in Erzurum Province. MATERIALS AND METHODS: This cross-sectional descriptive study was conducted during August-December 2016 on a voluntary sample of 191 out of 234 physicians (81.6%) working at family health centers in the districts of Erzurum. Physicians were visited at their workplaces, and data were collected using a self-administered and structured, 45-item questionnaire. RESULTS: The mean age of the physicians was 34.7 ± 7.9 years, and 70.7% (n = 135) of the participants were males. About 83.8% (n = 160) of physicians responded "yes" or "sometimes" to the question "Do you prescribe medicine on demand of the patients?" The two most important factors that affected the prescribing behavior of the participants were the pharmacology lectures attended during medical education (50.8%) and the prescribing experience acquired during clinical internship (46.0%). Presentations given by the representatives of drug companies, in-service training programs after graduation, and Internet/mobile phone applications had the lowest rate of contribution as behavioral determinants. The participants perceived having sufficient information in the areas of indication for use (77.5%) and daily dose (72.8%). Only 4.2% of participants deemed their knowledge of medication costs sufficient. Pharmacology lessons were found to be more effective in the prescribing behaviors of the physicians who had less than 10 years of professional experience (Chi-square = 12.131; P = 0.002). CONCLUSION: Rational medical prescription continues to be a trouble among family physicians. The study findings suggest a substantial knowledge gap in participating physicians occurring after graduation and clinical internship training, in the areas of costs of medicine and rational medical prescribing.

Levels of burnout and their associated factors among physicians working in Northeast Anatolia.

CONTEXT: The concept of burnout is a condition seen in occupational groups working face-to-face with people and resulting in emotional exhaustion, depersonalization, and low professional productivity. AIMS: The purpose of this study was to determine burnout levels and associated factors in physicians practicing in Erzurum, Northeast Anatolia, Turkey. SETTINGS AND DESIGN: This research was designed as a cross-sectional descriptive study. The research sample size was calculated at 663 participants with a 99% confidence interval and a 3% margin of error using Epi Info software. A 10% incomplete or nonresponse rate was added, for a target cohort of 730 individuals. Seven hundred and eleven physicians agreeing to take part were enrolled. SUBJECTS AND METHODS: A questionnaire consisting of questions concerning sociodemographic characteristics and the Maslach Burnout Inventory (MBI) was used as the data collection tool. The questionnaires were distributed by the authors and completed by the physicians in person. STATISTICAL ANALYSIS: Descriptive data were expressed as percentage, mean, median, and standard deviation. Data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests and binary logistic regression analysis. P < 0.05 was regarded as statistically significant. Statistical analyses were performed on SPSS 15.00 software. RESULTS: The mean age of the physicians in the study was 34.4 ± 7.7 years. Mean MBI subdimension scores were 15.6 ± 7.0 for emotional exhaustion, 5.7 ± 3.9 for depersonalization, and 21.0 ± 4.4 for personal accomplishment. Mean emotional exhaustion and depersonalization scores were significantly higher and personal accomplishment scores significantly lower in physicians aged under 25, not taking vacations, working in public hospitals, who were working as research assistants. CONCLUSIONS: Burnout levels among the participants were low (emotional exhaustion in 75%, depersonalization in 76.2%, and low personal accomplishment in 69.6%).

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.

Oral lichen planus: an unusual cause of facial and abducens nerve paralysis associated with conjunctival and oesophageal involvement.

Lichen planus (LP) is a T-cell-mediated disorder that may involve the skin, nails and mucosal surfaces. Conjunctival, laryngeal and oesophageal involvement were reported to be extremely rare manifestations of the disease. In this report, we present an oral LP case who complained of severe burning pain on his tongue and oral mucosa caused by ulcerative lesions and associated with conjunctival, laryngeal and oesophageal involvement. In addition, neurological examination revealed facial and abducens nerve palsy. To the best of our knowledge, we are presenting the first case of erosive oral LP associated with facial and abducens nerve paralysis. Although this association may be coincidental, according to an immunological concept proposed to explain the pathogenesis of Bell's palsy, degranulation of mast cells activated by complement or specific allergens with the release of histamine and other substances were to be presented responsible from nerve oedema, ischaemia and paralysis. As mast cell mediators are likely to be involved in the immunopathogenesis of OLP, we think that the cause of facial and bilateral abducens nerve palsy could be explained by the same mechanism. This case is a good example of the need for team work in lichen planus patients undergoing interdisciplinary consultations.

Serum interleukin-6, procalcitonin and C-reactive protein levels in subjects with active Behçet's disease.

BACKGROUND: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and cytokines, including serum interleukin (IL)-6, IL-8 and IL-10, and tumour necrosis factor-alpha (TNF-alpha) have been proposed as disease activity markers in Behçet's disease (BD), although studies have shown conflicting results for IL-6. Serum procalcitonin (PCT) levels in active BD have not yet been investigated. OBJECTIVE: The aim of the present study was to determine the reliability of serum IL-6 and PCT levels as well as CRP as biological markers for activity of BD. METHODS: Serum PCT, IL-6 and CRP protein levels were measured in patients with active BD (n = 15) and in healthy control subjects (n = 15). IL-6 and PCT levels were measured in serum by chemiluminescent assay. In addition, a nephelometric method was used to analyse CRP concentrations in serum. RESULTS: Serum CRP and IL-6 values were significantly higher in the subjects with active disease than in the healthy controls (P < 0.05), but there was no significant difference in the levels of PCT in the two groups. CONCLUSION: The results of our study suggest that serum CRP and IL-6 levels are elevated in patients with active BD, but that serum PCT values are not elevated in these patients.

The prevalence of Behçet's disease above the age of 10 years. The results of a pilot study conducted at the Park Primary Health Care Center in Ankara, Turkey.

PURPOSE: The aim of this study was to determine the prevalence of Behçet's disease above the age of 10 years by means of a population-based study. METHODS: The epidemiological investigation (cross-sectional study) was made between May 1997 and May 1998 at the Park Primary Health Care Center, which is one of the education and research divisions of the Department of Public Health, Faculty of Medicine, Ankara University. The research aimed to cover all 17,256 (49.2% male, 50.8% female) inhabitants over 10 years of age living in this area. The screening team first surveyed and selected patients with recurrent aphthous stomatitis. These patients were further examined, free of charge, in the Preventive Ophthalmology Unit of the Public Health Center, at Ibni Sina Hospital's Behçet Center or in other clinics if necessary. In this study the International Study Group For Behçet's disease Criteria were used. RESULTS: As the final result of the screening, 11 female and 5 male patients with Behçet's disease were found (female/male = 2.2). These patients represented 9 already known and 7 newly diagnosed cases of Behçet's disease. The prevalence of Behçet's disease over 10 years of age is 0.11%. CONCLUSION: The existing regional prevalance studies conducted in Turkey have indicated that the real number of Behçet's patients in our country is markedly higher than the number of registered patients. Therefore the National Behçet's Disease Commity and Surveillance System was founded by our research group in December 1999.

Depression, anxiety levels and general psychological profile in Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a multisystem disease with unknown etiology. Until today, the role of emotional stress and the real incidence of psychiatric symptoms in this disease have not been clarified yet. OBJECTIVE: In this study, we aimed to evaluate the general psychological profile of the patients diagnosed as having BD as well as their depression and anxiety levels in order to investigate the psychiatric aspects of this disease. MATERIAL AND METHODS: Twenty-three patients with BD and 17 patients with chronic plaque-type psoriasis who made up the control group were examined by the Beck Depression (BDI), Beck Anxiety (BAI) and Brief Symptom Inventories (BSI). RESULTS: The mean BDI score of the BD group was 11.69 +/- 6.93, and the corresponding value was 9.11 +/- 7.34 for the psoriasis group. The mean BAI score of the BD group was 21.39 + 13.68 and this level was 12.41 +/- 10.70 for psoriasis patients. The mean BSI score of the BD group was 61.30 +/- 43.66 and it was 30.41 +/- 28.77 for the control group. The mean BDI, BAI and BSI scores of the patients diagnosed as having BD were significantly higher than those of the control group (F = 0.234, F = 0.508, F = 0.549 and p < 0.05). CONCLUSION: BDI, BAI and BSI scales are useful to evaluate the psychiatric aspects of BD. The results of our study revealed that the collaboration of a dermatologist and psychiatrist is essential for the follow-up of patients with BD.

A case of Netherton's syndrome with cerebral infarction.

Netherton's syndrome, a rare congenital disease of childhood, is characterized by variable cutaneous erythematous eruptions with different manifestations. A five-year-old boy, who presented with ichthyosis linearis circumflexa, atopic manifestations and pili torti, had spastic hemiparesia due to cerebral infarction. Netherton's syndrome can easily be misdiagnosed as Leiner's disease, generalized psoriasis or nonbullous congenital ichthyosiform erythroderma, especially in the neonatal period, because of its nonspecific clinical and histological features. Pediatricians should consider this syndrome in the differential diagnosis of the generalized erythematous skin disorders of childhood associated with various abnormalities.

Acute genitocrural intertrigo: a sign of primary human immunodeficiency virus type 1 infection.

We describe a 49-year-old male patient who presented with an acute illness associated with a widespread maculopapular eruption and eroded lesions in the inguinal folds consistent with an acute intertrigo, for which search of mycological and bacteriological causes remained negative. Serological tests disclosed a high viral HIV-1 load and p24 antigenemia, while anti-HIV-1 antibodies were absent, a profile typical of acute HIV-1 infection. Since the maculopapular eruption regressed concomitantly with the orogenital lesions as well as the eroded inguinal lesions prior to specific therapy, our observation indicates that intertriginous lesions may constitute one of the early cutaneous markers of primary HIV-1 infection.

Cutis marmorata telangiectatica congenita: an unusual cause of lower extremity hypoplasia.

Cutis marmorata telangiectatica congenita is a relatively benign, rare cutaneous disorder with various manifestations. A seven-year-old girl, who presented with extremity hypoplasia, had the characteristic reticular, patchy, blue-pink cutaneous lesions, which became more prominent with exposure to cold temperatures. She had 4.8 cm shortening of her right lower extremity, which was also thinner than on the left side. The patient did not have skin atrophy, ulcers, glaucoma or macrocephaly. She is being followed for a future extremity lengthening procedure.