Infection Risk Prediction in Healthcare Settings: Lessons from COVID-19 Contact Tracing.

Objective: Contact tracing aids epidemic control by enabling early detection and isolation without overburdening healthcare systems despite potential challenges. This study aimed to evaluate the practical application of contact and risk assessment-based models in predicting SARS-CoV-2 infection following exposure among healthcare workers in a large tertiary public university hospital in Türkiye. Materials and Methods: The study was designed as a retrospective cohort study, including contact tracing data from 3389 exposed healthcare workers from March 23, 2020, to October 22, 2021. Contact-based (mask use, contact duration and distance) and exposure risk-assessment-based (low, medium, high-risk) models with and without having symptoms were generated using logistic regression. SARS-CoV-2 infection was defined as having a positive SARS-CoV-2 RT-PCR test result. Adjustments were made to the models for demographic and occupational variables, previous infection, and vaccination. Model parameters were compared. Results: Of 3389 exposed healthcare workers, 2451 underwent RT-PCR testing. Among those tested, RT-PCR positivity was 5.9% (144/2451). Lack of personal protective equipment use (odds ratio [OR]=1.64, 95% confidence interval [CI]=1.03-2.66) and ≥15 minutes of contact duration (1.89, 1.21-3.09) were significantly associated with RT-PCR positivity. In the risk-assessment model, being a high-risk contact increased the odds of RT-PCR positivity (OR=2.76, 95% CI=1.61-5.03). Adding the presence of symptoms to contact-based and risk assessment models improved model parameters (Akaike information criterion [AIC]: from 1086.1 to 1083.1; Tjur's R2: from 0.016 to 0.019, respectively). Conclusion: The inclusion of being symptomatic improved the contact-based and risk assessment-based models. Institutions should be encouraged to incorporate symptom inquiries into risk assessment protocols in response to newly emerging respiratory virus epidemics. Institutions lacking the capacity for extensive contact tracing are recommended, at minimum, to track symptomatic exposed workers for epidemic control.

Opportunities for pedagogical change in Turkish medical education revealed in the wake of the COVID-19 pandemic.

Phenomenon: As the first stage of a large-scale educational design research (EDR) study focused on the complex problem of providing authentic experiential "hands-on, minds-in" learning opportunities online during a pandemic or other exigency, we conducted a literature review and we interviewed Turkish academic staff and students about their experiences during the first year of the COVID-19 Pandemic. ApproachWe interviewed faculty members, faculty members of medical education departments, and medical students from both public and private medical schools in Türkiye between October 1 and December 31, 2020. Working in pairs, we analyzed the transcripts of 49 interviews using open qualitative coding methods with satisfactory levels of coefficients of agreement. FindingsWe defined six major themes from the qualitative analysis: 1) Fear and concern were the most common reactions when first encountering the pandemic; 2) Teaching methods during the pandemic were primarily unidirectional from faculty to students. This largely one way transmission of information occurred both synchronously and asynchronously; 3) Technological support during the pandemic shutdowns was found to be challenging for both faculties and students; 4) Evaluation of learning during the pandemic was opportunistic and had questionable rigor; 5) Healthy communication was valued by both faculty and students using an array of different tools including social media; and 6) The pandemic had both negative and positive impacts on the educational processes experienced by students and provided by faculty and resulted in recommendations for new approaches to teaching and learning in the future. Medical students were primarily concerned about the susceptibility to COVID-19 of themselves and others, and how the pandemic would affect their progress toward completing their studies. Faculty were primarily concerned about the capacity of online learning to provide clinical learning opportunities and the difficulties of assessing student clinical skills using online modalities. Medical education specialists were primarily concerned about the quality of educational opportunities offered online. InsightsOur findings were similar to other studies conducted in the USA, China, United Kingdom, and other countries. However, the interviews revealed interest among faculty and medical education specialists for further investigation of experiential or active learning models that could be applied in medical education regardless of whether the delivery mode is face-to-face, online, or most likely, blended. In the next stage of our larger scale EDR study, we will design and construct prototype learning environments that incorporate experiential, active, and authentic learning design principles.

Validity and Reliability of the COVID-19 Knowledge, Attitude and Behavior Scale.

BACKGROUND: The aim of this research is to develop a scale that will evaluate the knowledge, attitudes and behaviors of employees about COVID-19 and to test its validity and reliability. METHODOLOGY: The methodological type of research was used between August-November 2020, under observation in organized industrial zones. Information was collected from a total of 543 employees. Confirmatory factor analysis and correlation analysis were performed for the value, item-total correlations and construct validity. SPSS 25.0 (IBM Inc., Armonk, NY, USA), Jasp 0.14 (University of Amsterdam) and Lisrel 9.1(Scientific Software International, Inc., Chapel Hill, NC, USA) programs were used in the analysis. RESULTS: 83.1% of the participants in the study are male, the average age is 37.4 ± 8.0, 76.1% are married, and 49.4% are high school graduates. The Cronbach alpha value of the COVID-19 information part is 0.86 in total, the contamination information dimension is 0.71 and the protection information dimension is 0.84. The COVID-19 attitude section consists of four sub-dimensions and 13 items classified within the framework of the health belief model. In summary, the goodness of fit values for the knowledge, attitude and behavior sections, respectively, are: RMSEA values 0.05, 0.03 and 0.04; CFI values 0.98, 0.98 and 0.99; GFI values 0.97, 0.97 and 0.99. CONCLUSIONS: It has been determined that the internal consistency of the COVID-19 knowledge, attitude and behavior scale conducted on employees is high and compatible, and its validity findings are sufficient. The scale is recommended as an applicable tool to measure COVID-19 knowledge, attitudes and behaviors.

An analysis of antibody response following the second dose of CoronaVac and humoral response after booster dose with BNT162b2 or CoronaVac among healthcare workers in Turkey.

Limited data are available on the short- to midterm levels of antibodies to the CoronaVac vaccine and quantitative change in humoral response after homologous or heterologous booster doses. In this prospective cohort study, we evaluated the anti-receptor-binding domain (RBD) immunoglobulin G (IgG) levels after two doses of CoronaVac and heterologous/homologous booster administration among healthcare workers in a university hospital in Turkey. Quantitative anti-RBD IgG antibody levels were measured at first and fourth months in 560 healthcare workers who had completed two doses of CoronaVac vaccine, and within 2 months after the third dose of CoronaVac or BNT162b2. Participants were asked to complete a questionnaire during the first blood draw. The seropositivity rate was 98.9% and 89.1%, and the median antibody level was 469.2 AU/ml and 166.5 AU/ml at first and fourth month, respectively. In the fourth month, a mean reduction of 61.4% ± 20% in antibody levels was observed in 79.8% of the participants. The presence of chronic disease (odds ratio [OR]: 1.76, 95% confidence interval [CI]: 1.15-2.69) and being in the 36-50 age group (OR: 2.11, 95% CI: 1.39-3.19) were identified as independent predictors for low antibody response. The antibody level increased 104.8-fold (median: 17 609.4 vs. 168 AU/ml) and 8.7-fold (median: 1237.9 vs. 141.4 AU/ml) in the participants who received BNT162b2 and CoronaVac, respectively. During the follow-up, 25 healthcare workers (4.5%) were infected with severe acute respiratory syndrome coronavirus 2. Considering the waning immunity and circulating variants, a single booster dose of messenger RNA vaccine seems reasonable after the inactivated vaccine especially in risk groups.

Unmet health and social care needs and associated factors among older people aged ≥ 80 years in Izmir, Turkey.

BACKGROUND: The health and social care needs of people aged ≥ 80 years are a neglected topic. AIMS: To determine the prevalence of unmet health and social care needs and associated factors in community-dwelling individuals aged ≥ 80 years in Izmir District of Balçova, Turkey. METHODS: There were 1075 participants aged ≥ 80 years. The dependent variables were unmet health and social care needs. Independent variables were sociodemographic, socioeconomic and lifestyle characteristics. The data were collected in face-to-face interviews conducted at the homes and analysed by multiple logistic regression model. Ethical approval was obtained from the Non-Invasive Research Ethics Board of Dokuz Eylul University Medical Faculty (2017/26-24). RESULTS: The mean age was 84.1 (3.7) years and 61.0% were female. Healthcare needs were expressed by 88.2% of the participants and 78.9% claimed that they had social care needs. Prevalence of unmet health and social care needs was 32.5% and 46.6%, respectively. Approximately 90.0% of their needs were covered by families. Perceived low-income status was a risk factor for unmet healthcare needs, and lack of social support was a risk factor for unmet social care needs. Additionally, not receiving formal education was a protective factor in unmet social care needs. CONCLUSION: Public health policy should be developed to enable better access to care, especially for the oldest people, considering that nearly one third of the participants in this study had unmet healthcare needs and almost half had unmet social care needs.

Transmission dynamics and timing of key events for SARS-CoV-2 infection in healthcare workers.

BACKGROUND: Healthcare workers (HCWs) have increased risk for SARS-CoV-2 infection via contacts in hospitals, as well as via transmission in the community. Serial interval, which is defined as the time between symptom onsets in an infector-infectee pair, and the incubation period are key parameters in determining the control strategies for COVID-19. This study aimed to evaluate surveillance of HCWs and estimate the serial interval and incubation period of COVID-19. METHODS: A total of 149 HCWs and 36 certain infector-infectee pairs between 19th March 2020 and 1st November 2020 in a university hospital were included in the study. Epidemiological characteristics were recorded. Serial interval and incubation period were estimated using parametric accelerated failure time models. RESULTS: Forty HCWs (26.8%) were detected via contact-based surveillance. Of 100 HCWs epidemiologically linked with a confirmed COVID-19 case, 36 (36%) had contact with a colleague. The median serial interval was 3.93 days (95% CI: 3.17-4.83). Of symptomatic HCWs, 97.5% had developed symptoms 13.71 (95% CI: 9.39-18.73) days after symptom onset of the primary case. The median incubation period was 3.99 (95% CI: 3.25-4.84) days. Of symptomatic HCWs, 97.5% developed symptoms within 9.49 (95% CI: 6.75-12.20) days after infection. CONCLUSIONS: The serial interval and the incubation period of COVID-19 in HCWs were shorter than in the general population. Rigorous contact tracing and isolation of infected HCWs could have resulted in shorter serial intervals. Implementation of more stringent in-hospital control measures focussed on transmission between HCWs should be considered.

Falls, fear of falling and related factors in community-dwelling individuals aged 80 and over in Turkey.

OBJECTIVE: This study aimed to determine the prevalence of falls, fear of falling (FOF) and related factors in individuals aged 80 and over living in the Balçova district of Izmir. METHODS: One thousand and seventy-five individuals aged 80 years or older participated. The dependent variables were falls and fear of falling. The independent variables were socio-demographic and socio-economic characteristics, health-related characteristics and 'safety status of home' features. RESULTS: The participants' mean age was 84.1 ± 3.7 (range, 80-101) years, and 60.8% were female (n = 582). The prevalence of falls was 35.4% in the last year, and fear of falling was 86.6%. The risk factors for falls were number of chronic diseases, moderate and high fall risk, sleep disturbance and slippery bathroom floors, whilst for fear of falling they were number of chronic diseases, female gender, living alone and moderate or high fall risk. CONCLUSION: A monitoring program is indicated to address high fall and fear of falling prevalence among people aged 80 and over.

The development of a globally acceptable national model for occupational hygiene in Turkey: a modified Delphi study.

BACKGROUND: Although various organizations working in developed countries established the standards and approaches used in occupational hygiene, occupational hygiene professional interests and needs continue to develop in a global context. There is thus an urgent need for expanded occupational hygiene models. For successful field implementation, these models should be based on several sets of criteria, including those related to international standards, various national requirements, and multidisciplinary approaches. This is particularly important for countries in which no occupational hygiene model has been developed. This study thus examined the consensus on occupational hygiene standards among stakeholders in Turkey regarding the development of a national model. A modified Delphi study was conducted among key occupational health experts in Turkey who could aid in the relevant implementation, policy-making, and educational processes for such a model. Participants were selected from various governmental institutions, non-governmental organizations, trade unions, universities, and occupational health practices. RESULTS: The first-round findings were obtained from open-ended questions. The results revealed several requirements, including the adoption of an international hygiene definition, the official recognition of professional and practical areas in Turkish occupational hygiene, hygienist training methods, priorities, and competent institutions. Second-round findings indicated a consensus rate of over 80% regarding the need for implementation standards, training and education standards, requirements and priorities, and competent institutions for professionals working in the field of occupational hygiene. A third-round and SWOT analysis was also conducted among the group to confirm the consensus issues. CONCLUSIONS: The search for solutions and developmental expectations increases when awareness of internationalization and the need for common global standards increase. This developmental process may provide the basis for an appropriate model in developing countries.

Development and Evaluation of a Training Program on Occupational Health Research and Surveillance in Turkey.

OBJECTIVES: The aim of this study was to increase knowledge and skills regarding occupational health surveillance and research in professionals. METHODS: Following the Analysis, Design, Development, Implementation, and Evaluation model, several training modules have been designed and implemented in the course of 2016. Evaluation forms were distributed to 42 participants before the start and after each training module to measure changes in knowledge, skills, and self-efficacy. RESULTS: The majority of the participants were satisfied and found the training relevant and interesting for adult learners. The level of self-efficacy increased after the trainings. Females and occupational physicians displayed higher scores than men and other disciplines. After 1 year, the self-efficacy level decreased, but the level was still substantially higher than before the training. CONCLUSIONS: Feedback on the implemented training program was favorable. Participants were able to acquire and apply competencies in the subject matter at short and long term.

Sociodemographic risk factors for febrile seizures: A school-based study from Izmir, Turkey.

PURPOSE: Despite the fact that socioeconomic and environmental factors of a population are changing over time, there are few studies focusing on the effects of sociodemographic factors on the prevalence of febrile seizures (FS). This study was designed to find out the prevalence of FS and to investigate the effect of socio-cultural and economic factors on this prevalence among the Turkish school children. METHODS: A school-based, cross-sectional study was conducted in first and second-class children. Data were collected through a questionnaire from the parents who agreed to be involved in the study. The survey had questions about some socioeconomic and demographic features of the children and febrile seizure episodes. RESULTS: 3806 children and parent pairs accepted to participate in the survey. Febrile seizure prevalence was 4.8%. It was found that the prevalence of FS was significantly associated with the chronic illnesses of a child that requires continuous medication, developmental delay of a child, NICU history, gestational hypertension history of a mother, and lower educational level of a mother. Recurrence of FS was observed in 32.9% of children. Children whose first FS was seen below the 39 °C had 1.9 times more recurrence risk. CONCLUSION: FS prevalence rate has declined from 9.7% to 4.3% in our study population within ten years. It was thought that advancing healthcare systems in our country might be decreased the prevalence. Our study enabled us to find out sociodemographic risk factors of FS, but further studies are needed in order to confirm the effect of sociodemographic factors on FS prevalence.

Effects of participatory ergonomic intervention on the development of upper extremity musculoskeletal disorders and disability in office employees using a computer.

OBJECTIVE: To evaluate the participatory ergonomic method on the development of upper extremity musculoskeletal disorders and disability in office employees. METHODS: This study is a randomized controlled intervention study. It comprised 116 office workers using computers. Those in the intervention group were taught office ergonomics and the risk assessment method. Cox proportional hazards model and generalized estimating equations (GEEs) were used. RESULTS: In the 10-month postintervention follow-up, the possibility of developing symptoms was 50.9%. According to multivariate analysis results, the possibility of developing symptoms on the right side of the neck and in the right wrist and hand was significantly less in the intervention group than in the control group (p<0.05). Neck disability/symptom scores over time were significantly lower in the intervention group compared with the control group (p<0.05). CONCLUSION: The participatory ergonomic intervention decreases the possibility of musculoskeletal complaints and disability/symptom level in office workers.

High prevalence of cardiovascular risk factors in a Western urban Turkish population: a community-based study.

OBJECTIVE: Cardiovascular diseases (CVD) are the largest cause of morbidity and mortality in Turkey and in the World. Heart of Balçova Project is a community- based health promotion project that aims to reduce CVD incidence and prevalence through risk factor modification in the individual and population level. This paper presents results of the baseline survey that aimed to define CVD risk factors and risk of developing coronary heart disease (CHD) in the Balçova population. METHODS: The study population included 36,187 people over 30 years of age residing in Balçova in 2007. Individuals were interviewed at their homes. Anthropometrics and blood pressure were measured and in total 12914 fasting blood samples were collected for lipid and glucose analyses. CHD risk was estimated using Framingham risk equation. Student's t test, Chi-square for trend test and ANOVA were used to compare mean levels and percentages of risk factors between age groups and gender. RESULTS: In total 5552 men and 10528 women participated in the study. Smoking prevalence was 38.6% in men and 26.8% in women. The prevalence of obesity was 29.4% among men and 44.2% among women and obesity prevalence increased until the age group 75 years old. While 14.6% of men and 12.6% of women had diabetes, 39.8% of men and 41.8% of women had hypertension. The prevalence of high total cholesterol was 56.0% in men and 50.6% in women. Men had a higher risk of developing CHD compared to women in the following 10 years (13.4% vs 2.5%). CONCLUSION: The prevalence of preventable risk factors for CHD is very high in Balçova population. Community-based interventions should be planned and implemented targeting both the high-risk individuals and whole population.

Balcova heart study: rationale and methodology of the Turkish cohort.

OBJECTIVES: Turkey is facing increasing rates of cardiovascular disease (CVD). The study is designed to meet the growing need to obtain information about the recent status and trends of CVD risk factors and their impact on mortality. METHODS: Balcova heart study (BHS) is a prospective cohort study, focusing on reducing the CVD risk factors of people over 30 years old living in Balcova District, Izmir, Turkey. Information about risk factors, anthropometric and biochemical measurements was collected in community centers. Interventions were planned, based on the 10-year coronary heart disease (CHD) risk and lifestyle characteristics with the collaboration of university and municipality. RESULTS: Mean age of the 16,080 participants was 52 years. The percentage of current smoking was 41.6 in men and 31.1 in women. One-third of the men were physically inactive. Hypertension was reported as 25% in men and 33% in women. CONCLUSIONS: The project is unique for being the first community-based cohort on CVD risk factors in a Turkish setting. This project will have a valuable contribution on not only determining CVD risks, but also incorporating interventions for prevention.

Effects of perceived job insecurity on perceived anxiety and depression in nurses.

Dramatic changes in workplace structure and environment have increased the importance of psychosocial factors and job insecurity in working life. Job insecurity is shown to have a negative impact on mental and physical health. Health care transformation in Turkey increases the threat of job insecurity for many workers in the health care sector. Therefore the aim of this cross-sectional study was to determine the effects of perceived job insecurity on perceived depression and anxiety in nurses working in the private health sector in Izmir, Turkey. There were 16 private hospitals in Izmir of which 11 accepted to participate. Perceived quantitative (5 items) and qualitative (4 items) job insecurity were measured by means of structured questionnaires. The hospital anxiety and depression scale was used to evaluate subjective anxiety and depression. Job strain was assessed by the Demand-Control-Support Questionnaire. Chi2 and logistic regression tests were used for analysis. A total number of 462 nurses were surveyed. Perceived anxiety (OR: 2.2, 95% CI: 1.2-3.9) and depression (OR: 2.5, 95% CI: 1.6-4.1) were significantly associated with qualitative job insecurity. Similarly quantitative job insecurity was associated with perceived anxiety (OR: 3.4, 95% CI: 1.9-6.2) and depression (OR: 2.2, 95% CI: 1.4-5.6) in nurses. It has been concluded that qualitative and quantitative job insecurity significantly affected perceived anxiety and depression levels in nurses working in private hospitals. Prevention oriented research is needed for policy development.

Effects of sociodemographic factors on febrile convulsion prevalence.

BACKGROUND: The aim of the present study was to determine the lifetime risk (LTR) of febrile convulsion and the effects of socioeconomic factors affecting this risk among school children in Izmir province, Turkey. METHODS: Information was collected from school children aged 7-17 years in a school-based cross-sectional study. Stratified cluster sampling technique was used to define the study population, which represents the schools located in the metropolitan area of Izmir. Data were collected through a standard questionnaire from the parents. RESULTS: LTR was 9.7% (girls, 9.3%; boys, 10.1%, P > 0.05). The risk of febrile convulsion for children whose fathers' education level was equal to or less than primary school was 2.13 (95% confidence interval [CI]: 1.1-4.0) and, for children whose fathers were blue collar workers it was 1.4 (95%CI: 1.0-1.8). CONCLUSION: LTR for febrile convulsion was relatively high in this population, consistent with studies from other developing countries. Lower socioeconomic status and lack of knowledge about febrile convulsions were main factors related to this risk.

Prevalence of ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir, Turkey.

OBJECTIVE: To determine the prevalence of ankylosing spondylitis (AS) and related spondyloarthritides (SpA) in an adult urban population of Izmir, Turkey. METHODS: A survey was conducted of 2887 subjects aged 20 years or over, selected by cluster sampling. Those who responded positively to the screening questions were contacted by 2 rheumatologists and evaluated in detail to establish presence of AS (modified New York criteria) or related SpA (ESSG criteria). RESULTS: In the initial screening, 2835 subjects participated; 422 were considered screening-positive and a telephone interview was done with 328 (78%). Based on their clinical history, 145 subjects were invited to the hospital and 120 (83%) agreed to do so. After detailed evaluation, 31 subjects were classified as having SpA (including 14 with AS). The age- and sex-adjusted prevalence was estimated to be 0.49% for AS (95% CI 0.26-0.85), and 1.05% for SpA (95% CI 0.70-1.50). The prevalence of AS was 0.54% in men (95% CI 0.19-1.20) and 0.44% in women (95% CI 0.19-0.88), and that of SpA was 0.88% in men (95% CI 0.42-1.59) and 1.22% in women (95% CI 0.73-1.89). CONCLUSION: This epidemiological study suggests a high prevalence (0.49%) of AS in an adult urban population from western Turkey, which equals that of rheumatoid arthritis in the same population. The overall prevalence of SpA, including AS, was 1.05%. A minimal male predominance was noted among AS patients, which disappeared among the whole group of patients with SpA.

[Dust exposure levels and pneumoconiosis prevalence in a lignite coal miners]. / Linyit madeni isçilerinde toz maruziyet düzeyleri ve pnömokonyoz sikligi.

The effects of working conditions on health in lignite mines in Turkey have not been studied comprehensively. The aim of this study was to determine the prevalence of coal miner pneumoconiosis among lignite miners and to evaluate the effects of working conditions. The study was carried out between 2001 and 2003. All workers in the lignite mine and maintenance workers were consisted in the study. A face to face questionnaire was used to obtain demographics and work life variables. Posterior-anterior chest radiograms were evaluated by an A reader chest physician, according to ILO 1980 standard guidelines. Profusion of densities related with pneumoconiosis as 1/0 and above regarded as the "suspected pneumoconiosis". Parenchyma degeneration and/or massive opacities have been accepted as complicated silicosis. Dust concentrations in the work environment obtained from the periodical examinations. Two thousand four hundred and sixty-four X-ray were evaluated and 333 (13.5%) pneumoconiosis compatible changes were found. Among the pneumoconiosis cases, 25 (7.5%) were assigned as complicated silicosis. There was significant and positive association between worked years and pneumoconiosis prevalence (p= 0.019). Our findings indicated that pneumoconiosis prevalence among lignite miners in Turkey comparable to the USA prevalence prior to implementation of effective dust control programmes. It has been suggested that dust exposure in the work environment were high enough to developed pneumoconiosis in lignite mines. Dust control systems and measures should be re-evaluated.

Report of experience in 190 patients with the use of closed suction drainage in arthroscopic knee procedures.

The goal of this study is to report our experience with the use of suction drainage for various arthroscopic knee procedures. One hundred and ninety patients who underwent arthroscopic knee procedures participated in the study, and were divided into two groups (Group 1: Suction drainage, Group 2: No suction drainage). For every patient, the following parameters were recorded: age, gender, operative time, tourniquet or pump use, the amount of fluid collected in the hemovac drain, presence of meniscal tear, type of the operative procedure, date of the operation, and presence of effusion at the follow-up. Statistical analysis was performed to detect any significant statistical difference between the amount of fluid collected in the hemovac drain and the other mentioned parameters in Group 1; and these patients were divided into four subgroups to facilitate the statistical evaluation between the procedures and the amount of fluid collected in the hemovac drain. The partial meniscectomy subgroup had significantly lower amounts of collected fluid when compared to the subtotal meniscectomy subgroup. Drilling of the osteochondral faces led to significantly higher amounts of fluid when compared to non-drilling cases. Use of an infusion pump during surgery and shorter operation time led to lower amounts of fluid to be collected. No case in either main group suffered from effusion at the follow-up. Our investigation demonstrated that in different arthroscopic interventions, variable amounts of fluid can be collected in the hemovac drains. Subtotal meniscal resection, drilling of the osteochondral faces and longer duration of the operation increase the amount of fluid. In cases of partial meniscal resection and/or chondral debridement, limited synovial and plica resection, suction drainage is unnecessary.

Substance use among medical students and physicians in a medical school in Turkey.

BACKGROUND: This study examined substance use and abuse, including nicotine and alcohol, in subjects who were at various stages of a medical career in Dokuz Eylül University Medical School in Turkey. Anxiety and depression levels were also assessed in order to determine the relationship of the substance use and anxiety and depression. METHOD: Using an anonymous, self-administered questionnaire, we surveyed 121 junior, and 52 senior medical students, 73 residents and 80 practicing physicians who completed the questionnaire. RESULTS: Alcohol was the most frequently used substance in all groups. Two or more positive responses on the CAGE were obtained for 22.4% of the junior students, 20% of the senior students, 8.9% of the residents and 6.5% of the physicians. Lifetime smoking prevalence was as high as 50%. The age of onset for nicotine and alcohol use was earlier in first-year medical students than the other groups. Benzodiazepines (alprozolam, diazepam) were the most frequently used sedative-hypnotics. The use of illicit substances was rare in all four groups, with cannabis being the most commonly used illicit substance. The junior medical students (23.6%) had the highest level of anxiety, while the senior students (44%) had the highest level of depression, assessed by the Hospital Anxiety and Depression Scale. However, the levels of anxiety and depression did not correlate with the levels of cigarette and alcohol consumption. CONCLUSIONS: Smoking and alcohol abuse amongst medical students and physicians should be taken more seriously because their own attitudes towards substances may influence their professional behavior. There is a need for better education about substances.