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

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

The effect of the BATHE interview technique on the empowerment of diabetic patients in primary care: A cluster randomised controlled study.

AIM: To investigate the effect of the BATHE therapeutic interview technique on the empowerment of diabetes mellitus patients in primary care. METHOD: A cluster randomised controlled study using the BATHE interview technique was conducted on diabetes mellitus patients in primary care. Physicians in the intervention group were trained in the BATHE interview technique and used it with their diabetic patients in addition to the usual care. In the control group physicians delivered only the usual care. A total of 112 diabetes mellitus patients who met the study criteria (57 intervention, 55 control) were included. Three interviews were conducted with the patients in both groups at the beginning, the 3rd and 6th months. The Diabetes Empowerment Scale (DES) was filled up at baseline and in the 6th month. RESULTS: Due to some drop outs, the study finished with 44 patients in the control and 49 in the intervention group. According to an 'Intention to treat analysis' increase in the DES total score for the intervention group was higher than for the control group (Δ=10.56±8.97; Δ=5.64±7.36; p<0.001). Using multiple regression analysis, the BATHE intervention showed a significant predictor of the DES difference (B: 8.861; CI: 6.092-11.629; p<0.001). CONCLUSION: The use of the BATHE technique in primary care has a positive effect on the empowerment of diabetes mellitus patients.

Knowledge and attitudes towards complementary and alternative medicine among medical students in Turkey.

OBJECTIVE: This study aims to examine knowledge and attitudes towards Complementary and Alternative Medicine among medical students in Turkey, and find out whether they want to be trained in Complementary and Alternative Medicine (CAM). METHODS: A cross-sectional study was carried out between October and December 2010 among medical students. Data were collected from a total of seven medical schools. FINDINGS: The study included 943 medical students. The most well known methods among the students were herbal treatment (81.2 %), acupuncture (80.8 %), hypnosis (78.8 %), body-based practices including massage (77 %) and meditation (65.2 %), respectively. Acupuncture, aromatherapy, herbal treatment and meditation were better known among female participants compared to males (p < 0.05). Females and first year students, generally had more positive attitudes. A larger proportion of female students compared to male students reported that a doctor should be knowledgeable about CAM (p = 0.001), and this knowledge would be helpful in their future professional lives (p = 0.015). Positive attitudes towards and willingness to receive training declined as the number of years spent in the faculty of medicine increased. CONCLUSIONS: Majority of the medical students were familiar with the CAM methods widely used in Turkey, while most of them had positive attitudes towards CAM as well as willingness to receive training on the subject, and they were likely to recommend CAM methods to their patients in their future professional lives. With its gradual scientific development and increasing popularity, there appears a need for a coordinated policy in integrating CAM into the medical curriculum, by taking expectations of and feedback from medical students into consideration in setting educational standards.

Factors associated with adolescents' smoking experience and staying tobacco free.

Introduction It is not expected that those who did not smoke during their adolescent years will start to smoke later in life. This study was planned to learn the thoughts of Turkish adolescents about staying tobacco free.Methods A descriptive study was conducted in 2007 with 866 adolescents aged 11 to 14 years. On a self-administered questionnaire, non-smoker students answered both multiple choice and open-ended questions about why they would not smoke in the future. The Chi-square test and logistic regression analysis was used for statistical assessment. For the answers to the open-ended questions, thematic analysis was applied.Results The mean age of the participants was 12.84 ± 1.14 years. The incidence of a smoking experience at least once in the participant's lifetime was 12% and the rate of current smoking was 3.6%. The most listed reasons for staying tobacco free were health problems directly related to smoking (64%), such as 'it can cause diseases' or 'it kills', negative effects of smoking other than health (51%), such as 'it smells bad' or 'it is toxic', and some subjective judgements related only with their self perceptions, such as 'I am happy and healthy' or 'it affects growth negatively' (20%).The most well-known problem related to tobacco use was lung cancer and the least well-known problems were bladder cancer and chronic bronchitis. Most of the smoking students (68%) were not aware that second-hand smoking was harmful (p=0.003). There were significant correlations between smoking experience and male gender, having a smoker in the household and low educational level of the mother or the father (p=0.000, p=0.018, p=0.022, p=0.044 respectively).Conclusion We suggest that the beliefs and perceptions of adolescents about smoking should be given as much consideration as the negative effects of cigarettes in planning smoking free messages.

Changes in baroreflex responses of kindled rats.

PURPOSE: This study was planned to investigate the baroreflex responses (BRs) in kindled rats during seizure-free period to put forward new data on cardiac autonomic changes in epilepsy. METHODS: Male Wistar rats were randomized into sham-operated (SO) and kindled groups where stimulation and recording electrodes were implanted stereotaxically into the basolateral amygdala and the cortex, respectively. For kindling process, rats were stimulated twice daily at their afterdischarge threshold current and accepted as being kindled after 10 grade 5 seizures. Six to 8 weeks after the establishment of the kindled state, mean arterial pressure (MAP) and heart rate (HR) were evaluated. BR was defined as the ratio of HR response to changes in MAP induced by i.v. nitroprusside (10, 25 microg/kg) or i.v. phenylephrine (10, 25 microg/kg). The sympathetic or parasympathetic component of the BR was evaluated in rats pretreated with atropine or atenolol where phenylephrine or nitroprusside was administered at 25 microg/kg. RESULTS: Basal MAP and HR values were found to be similar in SO and kindled rats. Phenylephrine increased MAP more in the kindled group (p < 0.05), but the HR decreased similarly in both groups. Nitroprusside decreased MAP at similar rates, but the increase in HR was higher in the kindled rats (p < 0.05). BRs to phenylephrine and nitroprusside were abolished after pretreatment with atenolol and atropine, whereas phenylephrine- and nitroprusside-induced changes in MAP remained unchanged in both groups. CONCLUSIONS: These results may indicate that amygdaloid kindling affects BRs in long-term seizure-free periods.