Correction: Factors affecting patient satisfaction in refugee health centers in Turkey.

[This corrects the article DOI: 10.1371/journal.pone.0274316.].

Factors affecting patient satisfaction in refugee health centers in Turkey.

BACKGROUND: Turkey hosts an estimated 3.7 million Syrian refugees. Syrian refugees have access to free primary care provided through Refugee Health Centers(RHC). We aimed to determine factors that influence patient satisfaction in refugee health centers. METHODS: The study was a cross-sectional quantitative study. A patient survey was administered among 4548 patients attending services in selected 16 provinces in Turkey. A quantitative questionnaire was used to collect information on patient satisfaction and experience in the healthcare facility. Information on "overall satisfaction with health services" was collected on a 5-point Likert scale and dichotomized for analysis. Logistic regression was conducted to identify factors that influenced patient satisfaction. RESULTS: We found that 78.2% of the participants were satisfied with the health services they received. Factors related to service quality and communication were significant determinants of patient satisfaction. The strongest predictors of satisfaction were having a sufficient consultation time (AOR: 2.37; 95% CI: 1.76-3.21; p< 0.0001), receiving a comprehensive examination (AOR: 2.01; 95% CI: 1.49-2.70; p < 0.0001) and being treated with respect by the nurse (AOR: 2.08; 95% CI: 1.52-2.85; p< 0.0001). CONCLUSION: Providing integrated, culturally and linguistically sensitive health services is important in refugee settings. The quality of service and communication with patients influence patient satisfaction in refugee health centers. As such, improvements in aspects such as consultation time and the quality of physician-patient interaction are recommended for patient satisfaction.

Comparison of the Breastfeeding Practices of Refugee Syrian Mothers and Native Turkish Mothers.

Background: The World Health Organization recommends that babies be breastfed within the first hour of delivery and that they should exclusively be given breast milk in the first 6 months. The aim of this study was to ascertain the breastfeeding behaviors of refugee Syrian women and to compare their practices with those of the native mothers of the local community. Materials and Methods: This study is a cross-sectional study. The study was conducted in a Southern city in Turkey. The questionnaire was filled by face-to-face interviews. A total of 381 refugee Syrian mothers were compared with 381 native women living in the same community. Results: A significant difference was found between the two groups regarding breastfeeding. The rate of those who initiated breastfeeding within 1 hour after delivery was 61.4% for the Syrians and 71.1% for the Turkish mothers. In addition, the rates of exclusive breastfeeding (28.1 versus 34.1) and continuing breastfeeding for 12 months (55.0 versus 63.8) were lower in the Syrian refugee mothers. Maternal age and educational level were not correlated to the breastfeeding rates. Conclusions: This study is a rare study in which refugee mothers and local mothers were compared. Forced migration and refugee status are negatively associated with breastfeeding behavior.

Acute flaccid paralysis surveillance in southeastern Turkey, 1999-2010.

The aim of the study was to report the results of acute flaccid paralysis (AFP) surveillance and to evaluate the performance of surveillance in the southeastern region of Turkey in the 12 years from 1999 to 2010. We investigated cases in seven provinces of the southeastern region of Turkey. In the evaluation, AFP Case Report Form, Laboratory Investigation Form and 60-Day Case Investigation Form were used; individuals' demographic characteristics, clinical findings, status of vaccination, sample results, and 60-day follow-up were evaluated. Incidence ranged from 0.60/100,000 in 2008 to 1.60/100,000 in 1999. Dysstasia and loss of strength were the most frequently reported prodromal symptoms. Coxsackievirus and echoviruses were the most frequent viruses detected. One-quarter of the AFP cases could not be followed up in the present surveillance system.

Infant feeding knowledge and practices of mothers with 6-24-month-old babies in the "Baby-Friendly City" of Diyarbakir.

OBJECTIVE: This study examined factors related to breastfeeding behavior of mothers in the "Baby-Friendly City" of Diyarbakir, Turkey. SUBJECTS AND METHODS: The study was cross-sectional. The cluster sample technique was used in which 992 mothers from 50 clusters were contacted. Data were collected by face-to-face interview. The breastfeeding behavior of the mothers and the demographic variables affecting such behavior were recorded and collected. Analysis was performed by χ(2) test, and logistic regression used to estimate relative risks and 95% confidence intervals (CIs). RESULTS: We found that 78.3% of the mothers breastfed their babies for the first 6 months and that 92.4% gave their babies colostrum. The risk of not giving colostrum increased 2.7-fold (95% CI=1.25-5.75) in mothers giving birth at home compared with those giving birth in a hospital (p=0.011). The same risk increased 3.99-fold (95% CI=2.00-7.93) in mothers with no knowledge of breastfeeding compared with mothers instructed on the subject by health professionals (p<0.0001). CONCLUSION: The breastfeeding behavior on the part of mothers giving birth with the help of healthcare personnel and receiving information on the subject is positive.

The evaluation of the opinions and attitudes of healthcare personnel of the province Diyarbakir against influenza A (H1N1) and the vaccination.

In this study it was targeted aimed to evaluate the opinions and attitudes of healthcare personnel of the province Diyarbakir against Influenza A(H1N1) and the vaccination and to determine the undesired effects after the vaccination. In this descriptive study, 1691 healthcare personnel participated. The participants were asked about their opinions about being included in the risk group or not, status of advising and having Influenza A(H1N1) vaccination, reasons of having or not having the vaccination, their opinions and attitudes about the pandemic and influenza vaccine and the practices of the press and the Ministry of Health. Of participants, 49.6% stated that they advised pandemic influenza vaccination. Of the healthcare personnel, 35.3% stated that they had pandemic influenza vaccine. Age, sex, profession, having seasonal influenza vaccine , using Media and the Ministry of Health as a source of information were important factors for the status of advising and having Influenza A(H1N1)v vaccine. The healthcare personnel should be informed about the purpose and practices of protection programs. It might be suggested to use press, which is regarded as the most important communication media, in accordance with the conditions in order to achieve suitable risk communication with the society.

Trauma type, gender, and risk of PTSD in a region within an area of conflict.

The relation between trauma type, gender, and risk of posttraumatic stress disorder (PTSD) still remains unclear. The authors investigated the association among gender and trauma type and risk of PTSD among people living within an area of conflict. Traumatic experiences and PTSD symptoms among 708 participants were assessed. It was determined that more men (53%) were exposed to traumatic events than women (44%). They also found no difference in PTSD prevalence according to gender. However, the authors found that there was a different risk of PTSD among men and women who experienced similar traumatic events: the risk of PTSD for those who experienced military conflict was higher among men than it was among women.

Post abortion family planning counseling as a tool to increase contraception use.

BACKGROUND: To describe the impact of the post-abortion family planning counseling in bringing about the contraceptive usage in women who had induced abortion in a family planning clinic. METHOD: The Diyarbakir Office of Turkish Family Planning Association (DTFPA) is a nonprofit and nongovernmental organization which runs a family planning clinic to serve the lower socio-economic populations, in Diyarbakir-Turkey. Post abortion counseling is introduced by using proper communication skills and with using appropriate methods to women. In this study we introduced contraceptive usage of women who had induced abortion one year ago and followed by DTFPA's clinic. RESULTS: 55.3% of our clients were not using contraceptive methods before abortion. At the end of the one year, 75.9% of our followed-up clients revealed that they were using one of the modern contraceptive methods. There was no woman with IUD before induced abortion. At the end of one year 124 (52.3%) women had IUD. "A modern method was introduced immediately after abortion" was the most important factor increasing modern method usage. CONCLUSION: Our results advocate that post-abortion counseling may be an effective tool to increase the usage of contraceptives. Improved and more qualified post-abortion family planning counseling should be an integral part of abortion services.

Opinions on early-age marriage and marriage customs among Kurdish-speaking women in southeast Turkey.

OBJECTIVES: For women, marriage before the age of 18 years has adverse consequences for physical, mental and emotional well-being and constitutes a barrier for continued education. According to a national survey, about 50% of all women in Eastern Turkey were aged under 18 years at first marriage. METHODS: This study explored women's opinions and experiences of early marriage and culture-specific marriage customs in the province of Diyarbakir, a region of Turkey populated mostly by people of Kurdish ethnicity. A random sample of 966 women aged 15 years or older living in urban and rural areas of the province completed a questionnaire on age at marriage and social status. Qualitative data on women's opinions and experiences were also collected through focus group interviews with 90 women. RESULTS: The frequency of early marriage ranged from 19% in the youngest age group to 63% in women aged 60 years or older. Analysis of focus group interviews through a qualitative modified content method showed that girls were considered marriageable some years after the menarche and considerations regarding the protection of family honour were key factors leading parents to arrange the early marriage of their daughters, sometimes without their consent. Some culture-specific marriage customs included cradle betrothal, cousin marriage and berdel (exchange of brides between two families). CONCLUSION: There is a need for public health and family planning workers to create greater awareness of the adverse consequences of early marriage through parental arrangements.

Injury or body fluid splash incidence rate during three months period in elective surgery procedures, at Dicle University Hospital, Diyarbakir, Turkey.

BACKGROUND: In this study we aimed to determine the prevalence of sharp injuries (SI) and blood and body fluid (BBF) splashes in health care workers during elective surgery procedures (ESP). This study would help to plan the preventive measures for injuries and BBF splashes. METHODS: All ESP were recorded during three months period and SI and BBF splashes were analyzed in Hospital of Dicle University. Hospital employees who reported SI or BBF splashes were interviewed about the types of devices causing injury and the circumstances of the injury. RESULTS: During three months period, 1988 ESPs were recorded. SIs were reported in 111 procedures (5.6%) and BBF splashes were in 145 (7.3%). Incidence rate of SI was 2.8 per person year in teaching staff, 5.6 in residents, 6.3 in nurses and 1.5 for other health care workers. Incidence rate of BBF splashes was 14.5 per person year in trainers, 6.9 in residents, 8.4 in nurses, respectively. Duration of ESP, start time of ESP and number of employed personnel in the ESP were the factors that significantly influenced SI incidence. Duration of ESP and total person worked in ESP was effective on BBF splashes. SI was occurred in 14.4 of mandibulofacial, 12.2% of general surgery, 10.5% of chest surgery and 8.4% of brain surgery ESP. BBF splashes occurred in 14.4% of general surgery's, 13.5% of urology's, 14% of chest surgery's, 14.7% of cardiovascular surgery's ESP. The most frequently injured tissue was index finger (33.9%) and the pollex finger (31.4%). CONCLUSION: SIs and BBFs are important health risks for health professionals who are involved in surgery, as it is in all other medical practices. SI and BBF splashes should be monitored and preventive measures should be planned urgently.

Prevalence of PTSD and related factors in communities living in conflictual area: Diyarbakir case.

OBJECTIVE: In this study, we aimed to investigate the distribution of Post-Traumatic Stress Disorder (PTSD) among adults who were living in the Diyarbakir city center. METHOD: Data was obtained from 708 participants that represented the demographic structure of Diyarbakir. Houses to be visited were determined in collaboration with the Turkish Institute of Statistics. RESULTS: The prevalence of traumatic life experience was 47.9%. Most prevalent traumatic life experiences were forced emigration and witnessing of a case of murder or injury. The lifelong and current PTSD prevalence was 34.9% and 15.1% respectively. We concluded that the prevalence of traumatic experiences and subsequent PTSD was high among people who were living in areas of conflict, and treatment opportunities were inadequate. CONCLUSION: An important finding of this study is the association between the range of prevalence rates of traumatic experiences and risk factors for PTSD in an armed conflict region in Turkey. There is a need for studies that will also include people living in rural areas in order to understand the full picture of problems encountered by those in areas of conflict. Moreover, we believe in the importance of an effective approach of institutional and occupational organizations not to leave these people alone with their traumatic experiences.

Does adding misoprostol to standard intravenous proton pump inhibitor protocol improve the outcome of aspirin/NSAID-induced upper gastrointestinal bleeding?: a randomized prospective study.

Aspirin and nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal bleeding is recognized as an important health problem. We performed a single-center randomized clinical trial to compare the effect of high-dose intravenous proton pump inhibitor (omeprazole) alone (group 1) with omeprazole in combination with a low-dose prostaglandin analog (misoprostol; group 2) on clinical outcomes in patients with aspirin/NSAID-induced upper gastrointestinal bleeding. Additionally, we evaluated the contribution of Helicobacter pylori eradication therapy on the late consequences. Patients were recruited to the study if they had upper gastrointestinal bleeding with history of taking aspirin or other NSAIDs within the week before the onset of bleeding. All were evaluated in terms of probable risk factors. After the standard treatment protocol, patients with histologically proven H pylori infection were prescribed a triple eradication therapy for 14 days. The primary end points were recurrent bleeding, surgery requirement, and death rates before discharge and at the end of follow-up period. This study lasted for 2 years. A total of 249 patients with upper gastrointestinal bleeding were admitted, and 49.7% of these patients were users of aspirin/NSAIDs. There were 67 patients in group 1 and 56 in group 2. The distributions for gender, age, comorbidity, H pylori infection, and high-risk ulcer rate were similar in both groups. Among aspirin/NSAID users, endoscopy revealed duodenal ulcer in 47 (38.2%), gastric ulcer in 10 (8.1%), and erosive gastropathy in 33 (26.8%). The overall rebleeding occurred in 12.2%, death in 2.4% of the patients. The in-hospital death (P=.414), rebleeding (P=.925), and surgery (P=.547) rates were similar in both treatment groups. After the follow-up period of 3 months, overall rebleeding occurred in 4.1%, and death in 4.8% of the patients. The overall mortality rate was highest in those >65 years old, who were chronic low-dose aspirin users with comorbidity. One died of transfusion-related graft-versus-host disease. In this pilot study, we indicated that adding misoprostol (600 microg/day) to standardized proton pump inhibitor treatment did not improve or change the rebleeding or mortality rates of patients with upper gastrointestinal bleeding related to aspirin/NSAID use. Other prospective studies on higher doses of misoprostol are needed to establish the coeffect. One should bear in mind that all blood products must be irradiated before transfused to the host.

An epidemic caused by measles virus type D6 in Turkey.

In this study, the extent of measles outbreak was investigated in the Idil and Cizre counties of Sirnak Province. New cases determined in patients who applied to primary care clinics and those detected during home visits were evaluated. In 2001, a total of 2,143 cases reported in Sirnak Province were signified as a probable outbreak. Three hundred and thirty-three patients in Cizre and 219 patients in Idil applied to the primary care clinics. Of the cases, in Cizre 8.4% (n=28) and in Idil 6.4% (n=14) were infants aged nine months and younger who had not yet been vaccinated. Totally, 17 new cases (8 in Cizre and 9 in Idil) in the exanthema phase were determined during home visits and these were considered as outbreak cases. Virus isolation was achieved in 12 cases. All isolates were sent to the Centers for Disease Control (CDC) for genotyping and classified as D6 group. In conclusion, measles epidemics are still seen in our country. Therefore, measles outbreaks necessitate intensive intervention by physicians who are employed in primary health care services.

Breastfeeding patterns, beliefs and attitudes among Kurdish mothers in Diyarbakir, Turkey.

AIM: The aim was to rapidly assess existing breastfeeding patterns, beliefs and attitudes in the province of Diyarbakir, a socio-economically disadvantaged region of Turkey. METHODS: A cross-sectional survey exploring demographic and breastfeeding patterns was carried out among 921 mothers with children 6-18 mo of age. Results were quantitatively analysed. Focus group interviews dealing with beliefs and attitudes were separately carried out among 107 mothers and analysed by qualitative content analysis. RESULTS: Nearly all mothers had breastfed their infants at some time, but exclusive breastfeeding was rare. About 62.2% of the mothers had waited for at least 24 h before initiating breastfeeding. Almost half of the infants received sweetened water as a first feeding. There was agreement on the superiority of breastfeeding and awareness of its contraceptive effect. Early introduction of sugared water, water and supplementary feeds was considered desirable. Working in the fields and pregnancy were considered situations counteracting breastfeeding. CONCLUSION: The attitude to breastfeeding was highly positive, but more information is needed to encourage the use of colostrum, discourage early supplementation and promote exclusive breastfeeding during the first 6 mo of life.

Genetic characterization of measles viruses isolated in Turkey during 2000 and 2001.

BACKGROUND: Molecular epidemiologic studies have made significant contributions to measles surveillance activities by helping to identify source and transmission pathways of the virus. This report describes the genetic characterization of wild-type measles viruses isolated in Turkey in 2000 and 2001. RESULTS: Wild-type measles viruses were isolated from 24 cases from five provinces in Turkey during 2001. The viruses were analyzed using the standard genotyping protocols. All isolates were classified as genotype D6, the same genotype that was identified in Turkey in previous outbreaks during 1998. CONCLUSION: Turkey has begun implementation of a national program to eliminate measles by 2010. Therefore, this baseline genotype data will provide a means to monitor the success of the elimination program.

Neonatal tetanus in the South-Eastern region of Turkey: changes in prognostic aspects by better health care.

Neonatal tetanus is an important health problem with an estimated 500,000 deaths per year worldwide, particularly in developing countries. We analysed 56 cases of neonatal tetanus (NNT), retrospectively, who were admitted to Diyarbakir Children State Hospital between 1994 and 2001. In 1998 an intervention in a childcare intensive unit was conducted, which included a nurse education programme, increasing the number of nurses and other health staff, and more qualified management of cases. The mean age of patients was 7.9 days at admission, and the male:female ratio was 1:6. Eleven per cent of the cases had body weight under 2500 g. The mean hospitalization period was 9.9 days. All patients were born at home without medical help and 28.6 per cent were from urban areas. The case fatality rate that was formerly 88.5 per cent, decreased to 53.6 per cent by the intervention conducted in 1998. Based on our findings, we can say that improved hospitalization conditions and intensive care may reduce mortality. Enforcing preventive policies both in rural and urban areas is of great importance in the least developed regions.

Prevalence of Hepatitis C in adults in the south-eastern region of Anatolia: a community-based study.

Aim: There is a limited number of studies on the general population about prevalence of Hepatitis C virus (HCV) in Turkey. The estimated prevalence of HCV in the Southeastern region of the country was obtained from the data of the blood donors. There is no study reflecting the general population of this region, leading us to plan this study. Material and method: Four provinces in the Southeastern Anatolia were randomly selected and sample sizes were determined by Epi Info Programme, and blood samples were collected from 2888 individuals. Questionnaires in which demographic information and probable risk factors for Hepatitis C were investigated and were applied on subjects who gave their consent to participate in the study. Anti-HCV was examined by using Cobas Core II immunochemistry system (Roche). All positive samples were further tested for the presence of HCV RNA by RT-PCR. Crude odds ratios (OR) and 95% confidence intervals (CI) were calculated and Chi-square analyses were performed. Epi Info 2000 Programme was used to perform the analysis. Results: Of the 2888 individuals, 17 (0.6%) were anti-HCV positive and 13 (82%) of them were confirmed as positive for HCV-RNA. No difference was found between rural and urban regions with respect to HCV prevalence ( [Formula: see text] ). The prevalence of HCV in 35-44 years of age group was found to be different from those of the other age groups ( [Formula: see text] ). It was determined that the risk for HCV in this age group was 4.23 times ( [Formula: see text]; [Formula: see text];1.02-20.15; CI 95%:) higher with a prevalence rate of 1.6%. In this age group, anti-HCV was positive in 6 male (2.4%) and 2 female (0.8%), of whom 7 were living in urban (2.2%) and 1 in rural area (0.5%). The overall prevalence of HCV was not found to be different for sex ( [Formula: see text] ). Similarly, there was no difference between the married and single individuals for the prevalence ( [Formula: see text] ). Anti-HCV positivity did not change for the level of education. We could not determine any factor that might play a role in transmission of HCV. Conclusion: This is the first population-based study to be performed in order to determine the prevalence of HCV in the south-eastern region of Anatolia (Turkey). This region has a low prevalence of HCV. The extremely rare prevalence of homosexuality and intravenous drug addiction might have a role in this low prevalence.

The efficacy of flumazenil in subclinical to mild hepatic encephalopathic ambulatory patients. A prospective, randomised, double-blind, placebo-controlled study.

OBJECTIVES: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome associated with fulminant hepatic failure and chronic liver disease. Its pathogenesis is unclear. One of the factors implicated is enhanced GABA-ergic tone, which is probably related to increased concentrations of cerebral benzodiazepine (BNZ). In the present study, we tested flumazenil, a cerebral BNZ antagonist, in cirrhosis patients with hepatic encephalopathy. METHODS: Out of 47 patients, 7 were excluded prior to randomization for various reasons. Twenty patients were included in the flumazenil group and 20 in the placebo group in a prospective, randomized, double-blind, placebo-controlled study. Patients were given flumazenil (1 mg/h, continuous IV infusion) or an equal volume of saline solution for 5 hours. Before and after treatment, portosystemic encephalopathy (PSE) stage and number connection test (NCT) scores were checked every half hour for 5 hours. EEG was recorded 15 minutes before and 1 hour after treatment. RESULTS: While significant improvements were determined in PSE stage and NCT score in the flumazenil group, there were no such improvements in the placebo group. There was no statistically significant difference between pre- and post-treatment EEGs in either group. CONCLUSION: It was concluded that continuous IV infusion of flumazenil had beneficial and safe effects in the treatment of hepatic encephalopathy patients.