Bahar Güçiz Doğan

Cardiovascular risk factor levels in a lower middle-class community in Ankara, Turkey.

Summary Study objective  To assess the prevalence of risk factors for coronary heart disease (CHD) in a lower middle‐class urban community of Turkey.

Tooth loss and edentulism in the Turkish elderly.

The aim of this study was to evaluate partial and complete tooth loss and some related demographic factors, and oral health behaviors among Turkish elderly. According to recent censuses, elderly population of Turkey is rapidly growing. There is no nationwide information related to edentulism and natural teeth retention among 65-74 year-old people in Turkey. In this nationwide representative cross-sectional study, 1545 subjects aged 65-74 years were evaluated using the proportional stratified cluster sampling method. The data were collected via a structured, pre-tested face to face administered questionnaire and an oral examination. Chi-square test and binary logistic regression analyses were used to determine the significance of explanatory variables. 48.0% of elderly were edentate. The mean DMF-T was 25.8±8.5. These values were higher in women (p=0.016), older age (p<0.001) and rural individuals (p<0.001). Only 12.4% of the subjects had functional dentition. Age, visiting dentist, and health security were associated with edentulism. Female sex (OR=1.37), 70-74 age group (OR=2.08) and illiteracy (OR=3.25) were the independent factors of not having functional dentition. A reduction in edentulism in elderly may be achieved by the implementation of community programs promoting oral health for the prevention and treatment.

Increasing women's choices in medical abortion: A study of misoprostol 400 μg swallowed immediately or held sublingually following 200 mg mifepristone

Objectives To assess the efficacy and acceptability of two misoprostol regimens (400 μg oral or sublingual) following mifepristone for medical abortion. Methods Women seeking abortion with gestations of 56 days or less since onset of their last menstrual period were offered medical abortion as an alternative to a surgical procedure. A total of 207 eligible and consenting women were given mifepristone (200 mg oral) and the option of taking 400 μg misoprostol either orally or sublingually two days later, with the option of home-use. Two weeks later, treatment success, satisfaction, and the frequency and acceptability of side effects were assessed. Results Most women (97.6%) opted for home use of misoprostol and almost three quarters selected the oral route. Overall efficacy, acceptability of side effects and satisfaction were high in both groups. The success rate was lower after sublingual than after oral administration but not significantly so (91.3% vs. 96.3%, p = 0.23, RR: 0.93, 95% CI = 0.85–1.02). The frequency and average duration of side effects in both groups were comparable except for pain/cramps and fever/chills, which were more frequently associated with the sublingual route. Conclusions This study re-emphasises the feasibility of integrating medical abortion into health services in Turkey and the potential to increase choices for women.

The unmet need for safe abortion in Turkey: a role for medical abortion and training of medical students

Abstract Abortion has been legal and safe in Turkey since 1983, but the unmet need for safe abortion services remains high. Many medical practitioners believe that the introduction of medical abortion would address this. However, since 2012 there has been political opposition to the provision of abortion services. The government has been threatening to restrict the law, and following an administrative change in booking of appointments, some hospital clinics that provided family planning and abortion services had to stop providing abortions. Thus, the availability of safe abortion depends not only on permissive legislation but also political support and the ability of health professionals to provide it. We conducted a study among university medical school students in three provinces on their knowledge of abortion and abortion methods, to try to understand their future practice intentions. Pre-tested, structured, self-administered questionnaires were answered by 209 final-year medical students. The students’ level of knowledge of abortion and abortion methods was very low. More than three-quarters had heard of surgical abortion, but only 56% mentioned medical abortion. Although nearly 90% supported making abortion services available in Turkey, their willingness to provide surgical abortion (16%) or medical abortion (15%) was low, due to lack of knowledge. Abortion care, including medical abortion, needs to be included in the medical school curriculum in order to safeguard this women’s health service. Résumé L’avortement est légal et sûr en Turquie depuis 1983, mais les besoins non satisfaits en services d’avortement sûr demeurent élevés. Beaucoup de praticiens pensent que l’introduction de l’avortement médicamenteux pourrait y répondre. Néanmoins, depuis 2012, les services d’avortement suscitent une opposition politique. Le Gouvernement a menacé de restreindre la législation et, après un changement administratif dans la prise des rendez-vous, certains centres hospitaliers assurant des services de planification familiale et d’avortement ont dû cesser de pratiquer des avortements. La disponibilité d’avortements sûrs dépend donc non seulement d’une législation permissive, mais aussi du soutien politique et de la capacité des professionnels de santé à les pratiquer. Nous avons étudié les connaissances sur l’avortement et les méthodes d’avortement d’étudiants en médecine dans trois provinces, pour tenter de comprendre leurs intentions quant à leur future pratique. 209 étudiants en médecine de dernière année ont répondu à des questionnaires structurés testés au préalable et autoadministrés. Les étudiants connaissaient très mal l’avortement et les méthodes d’avortement. Plus des trois quarts avaient entendu parler de l’avortement chirurgical, mais 56% seulement ont mentionné l’avortement médicamenteux. Même si près de 90% soutenaient la disponibilité des services d’avortement en Turquie, ils étaient peu disposés à pratiquer l’avortement chirurgical (16%) ou médicamenteux (15%), en raison d’un manque de connaissances. L’avortement, notamment médicamenteux, doit être inclus dans le programme des études de médecine afin de garantir ce service de santé des femmes. Resumen En Turquía, el aborto es legal y seguro desde 1983, pero aún hay una gran necesidad insatisfecha de servicios de aborto seguro. Muchos profesionales médicos creen que la introducción de servicios de aborto con medicamentos resolvería esta situación. Sin embargo, desde 2012 ha habido oposición política a la prestación de servicios de aborto. El gobierno ha estado amenazando con restringir la ley y, tras un cambio administrativo en la programación de citas, algunas clínicas hospitalarias que ofrecían servicios de planificación familiar y aborto tuvieron que dejar de realizar abortos. Por tanto, la disponibilidad de servicios de aborto seguro depende no solo de una legislación permisiva sino también del apoyo político y de la capacidad de los profesionales de la salud para proporcionarlos. Realizamos un estudio entre estudiantes de facultades de medicina en tres provincias, acerca de su conocimiento del aborto y los métodos de aborto, con el fin de entender sus intenciones de ejercer su futura profesión. Cuestionarios estructurados, autoadministrados y pre-piloteados fueron contestados por 209 estudiantes de medicina en su último año. Su nivel de conocimiento del aborto y los métodos de aborto era muy bajo. Más de tres cuartas partes habían oído hablar del aborto quirúrgico, pero solo el 56% mencionó el aborto con medicamentos. Aunque casi un 90% apoyó hacer los servicios de aborto disponibles en Turquía, pocos estaban dispuestos a proporcionar servicios de aborto quirúrgico (16%) o aborto con medicamentos (15%), debido a la falta de conocimiento. Los servicios de aborto, que incluyen el aborto con medicamentos, deben integrarse en el currículo de las facultades de medicina a fin de salvaguardar este servicio de salud de las mujeres.

Introducing medical abortion in Turkey: Perspectives of physicians

To better understand the knowledge, attitudes, and perspectives on medical abortion (MA) held by physicians in Turkey.

Self-assessed Dental Status of the First Year Students of Health Related Faculties of a University in Turkey

The objectives of this study are to determine the self-assessed oral health status and behavior of entrants educating in health related faculties of a university, Ankara, Turkey. There were currently four faculties namely Medicine, Pharmacy, Dentistry and Health Sciences in Hacettepe University with 964 first year students; 853 (88.5%) of them were participated in this descriptive study. Data collected via a self-administered pre-tested questionnaire included items to evaluate the selfassessed oral health status and behaviour. All students were informed of the purpose of the study and how to fill the questionnaire. The data were analyzed using SPSS Version 15.0. Chi square test was performed to test the significance of the differences. 74.0% of the students were between 18– 19 ages; two-thirds was female. In all, 40.8% of them were dissatisfied with the appearance of their teeth. Although half of the group stated that the dentist will propose treatment if they visit a dentist, most of them did not think that the health of their teeth and gingiva was good. The percentage of dental visit at least once among females (94.2%) was more than males (82.8%) (p<0.001 ). Half of the students did not remember the age at first dental visit. 68.9% of the students had brushed their teeth at least twice a day. Improvements in preventive orientation of all health science students will also help them to play more effective roles in promoting the oral health of themselves as well as their communities.

Oral health status of children with mouth breathing due to adenotonsillar hypertrophy

OBJECTIVES Mouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3-15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Childrens Hospital of a University in Ankara, Turkey between January-July 2015. METHODS The approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p<0.05. RESULTS Of the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9 ± 2.6. Mean dmft was 3.8 ± 3.6, dmfs 9.7 ± 1.1, DMFT 0.4 ± 1.0 and DMFS 0.6 ± 1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p < 0,001). CONCLUSIONS The oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.