Evaluation of violence against primary care healthcare professionals through different dimensions.

BACKGROUND: Violence is common in emergency departments and is also increasing in primary care settings. It is important to research the factors that cause violence to prevent incidents. OBJECTIVE: The aim of this study is to determine the frequency, causes, and effects of violence in the workplace of primary care physicians in a province in Turkey. METHODS: This cross-sectional study was conducted among 303 family physicians working in Family Health Centers. The subjects completed a questionnaire consisting of questions designed to elicit healthcare professionals' perspectives on violence. The analysis was performed using SPSS 15.0 software, with p < 0.05 considered significant. RESULTS: The participants' mean age was 48.05±6.11. The majority (82%) stated that they had been subjected to violence throughout their professional life. Although the rate of exposure to violence was 56.4% in the previous year, they did not report these incidents to the appropriate authorities. The main reason for failing to report violent acts was "not caring" (40.1%). Respondents who believed "violent incidents should be reported" were under 50 years old (p = 0.045). The impact of violence on their lives was expressed as "losing interest in their profession" (40.8%). The most commonly cited cause of violence was "educational problems" (74.9%). CONCLUSION: Violence is prevalent in primary healthcare settings. It is suggested that there can be numerous reasons for violence, primarily a lack of education, and its effects, such as professional disengagement, are notable. Measures should be implemented to provide physicians with safe working conditions and reduce the risk of violence.

Frequency of Irritable Bowel Syndrome Among Children Aged 4 to 9 Years: A Cross-Sectional Study.

The purpose of this study is to determine the frequency of irritable bowel syndrome (IBS) and the influencing factors in children aged 4 to 9. The cross-sectional descriptive study included 1176 children between the ages of 4 and 9 who applied for Family Medicine Centers between March 1, 2017 and April 30, 2017 for various reasons. Pediatric Gastrointestinal Symptoms Questionnaire, Roma III Version (QPGS-RIII) was applied to the volunteers (children's parents or caregivers), and Beck Anxiety Scale was applied to the mothers accompanying their children. A total of 603 (51.9%) of the children included in the study were female and 559 (48.1%) were male. When the applied QPGS-RIII was evaluated with IBS diagnostic criteria, IBS was found in 137 children and IBS frequency was found to be 11.8% (95% confidence interval [CI]). Significant differences were found in socioeconomic level, eating habits, TV-watching habits, and IBS status (P < .05).

The Importance of Family History in Breast Cancer Patients in Primary Care Setting: a Cross-sectional Study.

Screening recommendations of physicians are important for women to raise awareness about their risk factors and to promote appropriate screening behaviors. However, it seems challenging for primary care physicians (PCPs) to balance disease prevention and diagnosis, treatment. The objective of this study was to describe physicians' breast cancer consultancy practice including family history, cancer prevention issues for the women they care. This cross-sectional study included 577 women aged above 45 years, free of breast cancer, during their visits to their PCPs. Nearly half of the women reported their visit to PCPs for an annual examination during the year. Among them, 36.1% had first-degree relatives with cancer and 7.3% with breast cancer. But they reported to be asked about family history of cancer and informed about cancer prevention issues 35.1 and 26.4%, respectively. Cancer still seems to be a hard issue to be discussed, even with women visiting PCPs for annual examination. Asking first-degree relative with breast cancer can give PCPs the chance of determining women with increased risk and support women's appropriate understanding of their own risk in relation to their family history. This routine can make shared-decision making for developing person-centered approach for breast cancer screening possible. Further studies are needed for better understanding of loss of consultancy leadership of physicians for breast cancer.

Adaptation, reliability, and validity study of the Hwalek-SengstockElder Abuse Screening Test (H-S/EAST): a Turkish version

Background/aim: The most important issues in elder abuse and neglect are lack of awareness and difficulties in determining the situation. Our aim is to determine the reliability and validity of the Turkish version of the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST).Materials and methods: The H-S/EAST (15-itemed, three-dimensional: direct abuse, characteristics of vulnerability, and potentially abusive situation) was translated according to the guidelines and experts evaluated it for content validity and cultural adaptation. Participants' (n = 252) mean age was 73.4 ± 6.4 years and 58.3% were female. The World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) and the Barthel Index were used for validity. Cronbach's alpha for internal consistency, exploratory factor analysis for content validity, t-test for construct validity, and discriminant ability were used. SPSS 15.0 was used for analysis and statistical significance was P < 0.05.Results: In test-retest reliability, internal consistency coefficient values for direct abuse, characteristics of vulnerability, and potentially abusive situation were 0.88, 0.73, and 0.80, respectively. Cronbach's alpha for internal consistency of the H-S/EAST was 0.741. Exploratory factor analysis obtained 5 factors, and explained variance was 61.8%. Cut-off value was 6, and sensitivity, specificity, and area under the ROC curve were 76.9%, 96.2%, and 0.938, respectively.Conclusion: The Turkish version of the H-S/EAST can be used as a reliable, valid clinical tool for the assessment of elder abuse.

Health promotion lifestyle profile scores are not associatedwith obesity in high school students.

BACKGROUND/AIM: Obesity is a cause of preventable morbidity and mortality with an increasing prevalence. Health promoting lifestyle activities maintain or improve an individual's health and in adolescence many habits are configured. The aim of this study was to determine the prevalence of overweight and obesity among adolescents and the relation between obesity and health promoting behaviors. MATERIALS AND METHODS: This is a cross-sectional study including 848 high school students aged 15-17. All students were administered a questionnaire including the Health Promotion Life-Style Profile Scale. Weight and height were measured and body mass index was calculated. Descriptive analysis, Pearson's chi-square test, Kruskal-Wallis and Mann-Whitney U tests, and multivariate logistic regression analysis were used. P < 0.05 was considered statistically significant. RESULTS: Of the included students, 80.8% (n = 685) had normal ranges of body mass index, 10.1% (n = 86) were overweight, and 9.1% (n = 77) were obese. The Health Promotion Life-Style Profile Scale average score was found to be 126.7 ± 20.4. There was no significant difference between Health Promotion Life-Style Profile Scale and obesity (P = 0.921). CONCLUSION: Adolescence is an era of development when individuals start to implement their own features to life. According to this study adolescents do not perform health promoting lifestyles whether they are obese or not.

Domestic violence survivors and their experiences during legal process.

BACKGROUND: Many victims of domestic violence do not seek recourse to the needed medical and legal services. The aim of this study was to determine the difficulties faced by and experiences of female survivors of domestic violence during their medical and legal proceedings. METHOD: We designed our study using a qualitative approach to understand the experiences of survivors during the legal process as well as their feelings and attitudes towards domestic violence through in-depth interviews. The data obtained from the participants were analyzed and synthesized using a thematic analysis procedure. RESULTS: Most of our participants reported different types of domestic violence, citing feelings of fear and loneliness during these experiences. They reported feeling dissatisfied with their complaints being ignored by the police and the perpetrators remaining unpunished. They complained of the complex procedures and negligence of staff in health-care centers such as hospitals, and they reported being shifted to several different places. CONCLUSION: We believe that an assessment of such female survivors in terms of specific standards set by specialists will help make improvements to the legal process. Education programs should be organized for professionals dealing with survivors of domestic violence. Special health-care services with fast proceedings must be established in health-care centers.

Breast cancer risk perceptions of Turkish women attending primary care: a cross-sectional study.

BACKGROUND: As the risks and benefits of early detection and primary prevention strategies for breast cancer are beginning to be quantified, the risk perception of women has become increasingly important as may affect their screening behaviors. This study evaluated the women's breast cancer risk perception and their accuracy, and determined the factors that can affect their risk perception accuracy. METHODS: Data was collected in a cross-sectional survey design. Questionnaire, including breast cancer risk factors, risk perceptions and screening behaviors, answered by 624 women visiting primary health care center (PHCC). "Perceived risk" investigated with numeric and verbal measures. Accuracy of risk perception was determined by women's Gail 5-year risk scores. RESULTS: The mean age of the participants was 59.62 ± 1.97 years. Of the women 6.7% had a first-degree relative with breast cancer, 68.9% performed breast self-examination and 62.3% had a mammography, and 82.9% expressed their breast cancer worry as "low". The numeric measure correlated better with worry and Gail scores. Of the women 65.5% perceived their breast cancer risk accurately. Among the women in "high risk" group 65.7% underestimated, while in "average risk" group 25.4% overestimated their risk. CONCLUSIONS: Turkish women visiting PHCC are overtly and overly optimistic. This was especially obvious with the result that nearly one third had had no mammography. There is a need for further studies to understand why and how this optimism is maintained so that better screening strategies can be applied at PHCC. All health workers working at PHCC have to be aware of this optimism to prevent missed opportunities for cancer screening.

Is the use of videotape recording superior to verbal feedback alone in the teaching of clinical skills?

BACKGROUND: In recent times, medical schools have committed to developing good communication and history taking skills in students. However, there remains an unresolved question as to which constitutes the best educational method. Our study aims to investigate whether the use of videotape recording is superior to verbal feedback alone in the teaching of clinical skills and the role of student self-assessment on history taking and communication skills. METHODS: A randomized controlled trial was designed. The study was conducted with 52 of the Dokuz Eylul University Faculty of Medicine second year students. All students' performances of communication and history taking skills were assessed twice. Between these assessments, the study group had received both verbal and visual feedback by watching their video recordings on patient interview; the control group received only verbal feedback from the teacher. RESULTS: Although the self-assessment of the students did not change significantly, assessors' ratings increased significantly for videotaped interviews at the second time. CONCLUSIONS: Feedback based on videotaped interviews is superior to the feedback given solely based on the observation of assessors.

What was retained? The assessment of the training for the peer trainers' course on short and long term basis.

BACKGROUND: In Turkey, the studies have reported that the age at which sexual intercourse and sexual activity starts has been steadily declining. There is an urgent need to increase social and health services for young people in order to provide them with a healthy life by changing their risky behaviors, avoiding unwanted pregnancies and sexually transmitted diseases (STDs). Sexual and reproductive health training particularly for adolescents warrants special attention and consideration. The objective of our study is to find out the short and long term effectiveness of a training course on peer education. METHODS: The study was conducted on 237 students who participated in a 40 hour Peer Trainer Training course. We utilized two types of evaluation methods to measure the effectiveness of the training on students' knowledge and attitude. The first method consisted of administering 3 tests comprised of the same 45 questions at 3 separate time intervals. Prior to the training a pre-test was given to obtain a measurement of base knowledge, and then an immediate post-test was given to evaluate the change in the knowledge and opinion of the participants.Finally, 6 months later the same test was administered to measure the retention of knowledge by the students. In the second type of evaluation, the participants' assessment of the training itself was sought by asking them to complete a Short Course Evaluation Form. We utilized SPSS 12.0 for descriptive analysis, and the Wilcoxon two related sample t-test were run. RESULTS: According to the pre and immediate post-test results, the training resulted in an increase in knowledge learned by an average of 21.6% (p < 0.05). Whereas, according to the immediate post test and the late post-test which was given six month later, there was a 1.8% decrease in the knowledge and attitude of the participants (p > 0.05). Participants thought that they had fun during training, and they became aware of what they knew and what they did not know. CONCLUSION: Peer trainers with the training methods utilized, the knowledge and counseling acquired during training sessions will be able to provide counseling to their peers on reproductive health.

What patients think about promotional activities of pharmaceutical companies in Turkey.

OBJECTIVE: Drugs, as commercial products, are subject to diverse marketing methods including promotional activities. Although the legal/ethical aspects of promotional activities have been discussed in a limited manner, the patient has remained the neglected variable of this equation. The goal of our study, therefore, is to investigate the patients' opinion on the promotional activities of pharmaceutical companies. METHOD: A descriptive study was conducted at 44 primary health care centers in Turkey and 584 volunteers who applied to these centers were included. A questionnaire consisting of 42 questions was developed with demographic information in the first section, and drug ads and promotions included in the second section. Chi-square test and logistic regression analysis were used for statistical analysis. MAIN OUTCOME MEASURE: The awareness and ethical evaluation of patients of the promotional activities. RESULTS: Nearly 83% of the participants were aware of the promotion issue. Eighty percent found it unethical, 82% suggested that promotional activities should be forbidden, restricted or regulated. 1/3 of the participants believed that physicians made their drug choices based on the gifts and ads of pharmaceutical companies. Half of them had low confidence in the prescriptions of physicians who accepted gifts from the pharmaceutical companies. 54.5% of patients also considered promotional activities as a factor which increased drug prices. CONCLUSIONS: In our study, a considerable number of patients were aware of promotions and the effects of promotion on prescriptions. The findings of our study may contribute to the development of effective regulations on this issue. Very strict measures controlling drug companies' promotion activities must be formulated. Further, these regulations must incorporate and take into consideration the patients' opinion. Today, the basic need for the proper use of drugs does not rest in pharmaceutical promotion, but in providing adequate health services and effective education for both people and physicians.

The challenge of clinical interviewing and physical examination performance for general practitioners in Turkey.

BACKGROUND AND OBJECTIVES: This study's objective was to better understand the current conditions and style of practice of generalist physicians in Turkey on clinical interviewing and physical examination skills prior to the widespread availability of family medicine postgraduate training. METHODS: This study was performed in 30 primary health centers, randomly chosen from the 110 primary health centers in Izmir, Turkey. We administered a questionnaire to 106 physicians in those centers, asking about their performance during medical encounters. We then observed 166 first-visit encounters of 37 of those physicians. Finally, we compared physicians' reported behavior (as described in the questionnaires) with their actual performance (when observed). RESULTS: In the physician questionnaire, 86.8% of participants agreed that 20 minutes or more was sufficient time for first visits, but in practice, 81.9% of the interviews lasted less than 5 minutes. The major reason cited by physicians for short interview times was overcrowding (72.6%). In 94.6% of the encounters, physicians obtained the history of present illness but the rest of the history, such as past history and family history, was gathered in less than 40% of the interviews. Except for the examination of oral cavity and pharynx, lungs, and heart, almost all the rest of the physical examination was performed in less than 10% of the cases. No written records were kept in 63.0 % of the encounters. CONCLUSIONS: The problems and difficulties present in delivering primary care in Turkey include the physicians' behavior in addition to working conditions.

Comparison of clinical skills of 3rd-year students who completed structured clinical skills program with 6th-year students who acquired clinical skills in unsystematic way.

BACKGROUND: The timing and methods of teaching clinical skills are some of the main concerns of medical education. PURPOSE: The aim of this study was to compare clinical skills of the 3rd and 6th-year students who acquired clinical skills training within different years and methods. METHODS: Randomly chosen students were observed and evaluated in the form of "did it-didn't do it" over the checklists composed of parameters of communication, history taking, and physical examination. The results were evaluated on the SPSS 10.0 for Windows program and Pearson chi-square test was used in the statistical analyses. RESULTS: Third-year students who had clinical skills training in early years and structured methods had better results for most of the parameters (p < .05). CONCLUSIONS: The clinical skills training given through a structured program that is widespread in the early years of medical school makes a great contribution to the development of students' clinical skills.