Hülya Akan

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

ObjectiveThis 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).MethodsA cross-sectional study was carried out between October and December 2010 among medical students. Data were collected from a total of seven medical schools.FindingsThe 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.ConclusionsMajority 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.

Rotavirus and adenovirus frequency among patients with acute gastroenteritis and their relationship to clinical parameters: a retrospective study in Turkey

BackgroundDiarrhea is the third leading cause of death related to infectious diseases all over the world. The diseases related to viral gastroenteritis are gradually increasing, particularly in the developed countries. The purpose of our study was to determine the frequency and to investigate the clinical manifestations of acute rotavirus and adenovirus gatroenteritis and to assess the diagnostic value of the related clinical findings.MethodsIn 2007-2008 patients with diarrhea and/or vomiting attended to Yeditepe University Hospital and related clinics, Istanbul, were studied. The rotavirus and/or adenovirus antigen in stool of these patients were investigated. Data regarding clinical findings were collected from the electronic records, retrospectively. Age, gender, symptoms, fever, antibiotic use, vomiting, number of vomiting and diarrhaeae, dehydration, abdominal pain, the other pathological physical examination findings were analyzed by the physicians in the study group. To investigate the rotavirus and adenovirus antigen CerTest Rota-Adeno Blister Test (CerTest, Biotec, Spain), a qualitative immunochromotographic assay was used. Statistical analysis wasperformed with SPSS v. 11,5 statistical software. X2 test was used for bivariate and logistic regression analysis was used for multivariate analysis.ResultsRotavirus positivity was 18,7% (n = 126). Concomitantly, in 596 cases adenovirus antigen test were also performed. Adenovirus positivity was 8,9% (n = 53) and rota-adenovirus co-infection was 4,4% (n = 26). Most of rotavirus positive cases were seen in December, January, February and March (p < 0.001). In clinical parameters, there was a significant difference between rotavirus positive cases and negative cases regarding to vomiting, dehydration and vomiting and diarrhea coexistence (respectively p = 0.010, p < 0.00, p = 0.007).ConclusionRotavirus can be seen in all age groups, but more frequently in childhood. Although there is no clinical gold standard to distinguish the rotavirus cases from the other gastroenteritis agents, the findings of dehydration and vomiting-diarrhea coexistence, considering months of referral may lead clinician to perform rapid antigen tests and affect approach to the treatment. Prospective studies with representative samples are needed to determine the rotavirus and adenovirus incidence and to develop safe and reliable protective policies in our country.

The sensitivity and the specifity of rapid antigen test in streptococcal upper respiratory tract infections.

BACKGROUND It is aimed to detect the sensitivity and specificity of rapid antigen detection of group A beta hemolytic streptococci from throat specimen compared with throat culture. The other goal of the study is to help in giving clinical decisions in upper respiratory tract infections according to the age group, by detection of sensitivity and positive predictive values of the rapid tests and throat cultures. MATERIALS AND METHODS Rapid antigen detection and throat culture results for group A beta hemolytic streptococci from outpatients attending to our university hospital between the first of November 2005 and 31st of December 2008 were evaluated retrospectively. Throat samples were obtained by swabs from the throat and transported in the Stuart medium and Quickvue Strep A [Quidel, San Diego, USA] cassette test was applied and for culture, specimen was inoculated on 5% blood sheep agar and identified according to bacitracin and trimethoprim-sulphametaxazole susceptibility from beta hemolytic colonies. RESULTS During the dates between the first of November 2005 and 31st of December 2008, from 453 patients both rapid antigen detection and throat culture were evaluated. Rapid antigen detection sensitivity and specificity were found to be 64.6% and 96.79%, respectively. The positive predictive value was 80.95% whereas negative predictive value was 92.82%. Kappa index was 0.91. When the results were evaluated according to the age groups, the sensitivity and the positive predictive value of rapid antigen detection in children were 70%, 90.3% and in adults 59.4%, 70.4%. DISCUSSION When bacterial infection is concerned to prevent unnecessary antibiotic use, rapid streptococcal antigen test (RSAT) is a reliable method to begin immediate treatment. To get the maximum sensitivity of RSAT, the specimen collection technique used and education of the health care workers is important. While giving clinical decision, it must be taken into consideration that the sensitivity and the positive predictive value of the RSAT is quite lower in adult age group than in pediatric age group.

A qualitative study on factors that influence Turkish medical students' decisions to become family physicians after the health transformation programme

Background: In Turkey, general practitioners were authorized to work as family physicians without specialization, within the scope of the Health Transformation Programme, due to inadequate number of family medicine specialists since 2004. With this new implementation Family Medicine specialty became a less preferable option for medical students. Aims: The study was to investigate the perspectives of medical students and understand the issues to choose Family Medicine specialty as a career option. Materials and Methods: This qualitative study was performed with 48 final year medical students using a convenience sample from two medical universities. Results: Three main categories emerged from the data viewing Family Medicine ‘as a specialty’, ‘as an employment’, and finally ‘as a system’. Very few students stated that Family Medicine would be their choice for specialty. Conclusions: Family Medicine does not seem to be an attractive option in career planning by medical students. Several factors that may constrain students from choosing Family Medicine include: not perceiving Family Medicine as a field of expertise, and the adverse conditions at work which may originate from duality in the system.

Knowledge of oral cancer, preventive attitudes, and behaviors of primary care physicians in Turkey.

Oral cancers (OCs) have a high mortality rate because of their typically late diagnosis. Primary care physicians play a vital role in early detection. In this study, we evaluated the family physicians’ (FPs) knowledge, preventive attitudes, and behaviors in terms of OCs. A semistructured questionnaire consisting of 50 questions was prepared and distributed to 200 FPs. Questions were grouped under four main headings: demographic characteristics, general protective attitudes against OCs, risk factors, and daily practices while performing the necessary examinations and referrals. Of 200 FPs, 164 responded to the questionnaire (82% response rate). The mean age of the study participants was 34.8±8.4 years and the mean duration of practice was 10±8.1 years. One-third of the physicians (29.9%, n=49) stated that they did not inquire about the amount of tobacco use. In terms of alcohol use, 45.7% (n=75) and 56.7% (n=93) did not ask about past alcohol consumption or the amount of alcohol consumed, respectively. Moreover, 69.5% (n=114) believed that they did not receive adequate smoking cessation training and 79.9% (n=131) stated that they did not receive any alcohol cessation training. To decrease morbidity and mortality associated with OCs, primary care physicians should be trained to ask their patients about high-risk behaviors, provide counseling and education on tobacco and alcohol-abuse cessation, and provide oral examinations.

Factors affecting uptake of influenza vaccination among family physicians

AIM The aim of this study was to determine the factors that influenced the decisions of family physicians working in primary care health services to receive influenza vaccines. METHODS This cross-sectional study was performed between June 2014 and September 2014. Physicians were reached electronically via e-mail. A self-reported questionnaire consisting of 50 items covering potential factors that may have influenced their decision to receive vaccination, including perceived risk, severity of the perceived risk, perceived benefit, perceived barriers, cues to action, attitudes, social influences and personal efficacy, was administered to the study participants. Cronbachs alpha for the questionnaire was determined to be 0.92 in the pilot study. RESULTS The response rate was 27.5% (n=596). Regularly vaccinated physicians accounted for 27.3% of the responses. The median age was 41.84±7.80, and the median working duration of the group was 17.0±7.8years. The factors that led to increased vaccination compliance (p<0.05) included working duration, age, chronic disease history and living with a person over 65years. Nearly all major domains, i.e., perceived risk, severity of the perceived risk, perceived benefit, perceived barriers, attitudes, social influences and personal efficacy, there were differences between the compliant and noncompliant groups. Multi-regression analyses revealed that risk perception, organizational factors such as time and convenient vaccination increased vaccine compliance. However, the perceived necessity to be vaccinated annually had a negative effect on vaccination behaviour (p<0.05). CONCLUSION Strategies aimed to increase the flu vaccination ratio among physicians that do not take different factors into account are more likely to be unsuccessful. In the planning and implementation of strategies aiming to increase the vaccination ratio among physicians, it is both necessary and important to take into account behavioural and organizational factors.

Nutritional status, Healthy Eating Index and eating attitudes of the adolescents in Istanbul: a cross-sectional study.

Abstract Background: The aim of this study was to evaluate dietary quality of adolescents by using the Healthy Eating Index (HEI) and to assess their eating attitudes by the EAT-26 Eating Attitude Test. Methods: Eight schools; four primary schools and four secondary schools were randomly selected from the school list of official website of Istanbul Education National Directorate. Five hundred and ninety-eight students who met the inclusion criteria included in the study, 24 h dietary recalls were collected to calculate their HEI scores and eating attitudes were evaluated by EAT-26 Eating Attitude Test. Their weight, height and waist circumference were measured. Results: According to HEI scores, only two (0.3%) of adolescents had high quality diet, 379 (63.4%) had diet quality that needed improvement and 217 (36.3%) had poor diet. Regarding Eating Attitude Test scores, 513 (85.8%) had normal attitudes regarding eating behaviors. Conclusion: Almost all of the participants need either development or major changes in their eating behaviors. Interventions aiming high quality diet among adolescents are strongly recommended.

Flu and Preventive Measures

Amaç: Grip, insandan insana kolaylıkla bulaşan influenza virüslerinin neden olduğu üst solunum yolu enfeksiyonudur ve her sene mevsimsel salgın yaparak milyonlarca kişinin hastalanmasına neden olur. Aile sağlığı merkezleri ve diğer sağlık kurumlarına başvuruda, iş yükü, hastane yatışlarında artış, iş ve okul kayıpları, direkt ve endirekt nedenlerle oluşan ekonomik yük ve belli oranda mortaliteye yol açması nedeni ile önemli bir halk sağlığı sorunudur. Gribe neden olan influenza virüslerine karşı etkin antiviral tedaviler, etkili ve güvenilir aşılar mevcuttur. Tedavi mevcut olmasına rağmen temel yaklaşım salgını mümkün olduğunca sınırlayacak koruyucu tedbirlerin alınması olmalıdır. Bu derlemede; influenza virüsünün özellikleri, bulaş yolları ve salgının sınırlandırılması için önerilen fiziksel bariyerler ve bağışıklama gibi koruyucu önlemler ele alınmıştır.

Evde sağlık birimine başvuran yaşlı hastaların beslenme durumları

1) Yeditepe Üniversitesi T›p Fakültesi Aile Hekimli¤i Anabilim Dal›, Doç. Dr., ‹stanbul 2) Taksim E¤itim ve Araflt›rma Hastanesi Aile Hekimli¤i Klini¤i, Uzm. Dr., ‹stanbul 3) Yeditepe Üniversitesi Sa¤l›k Bilimleri Fakültesi, Prof. Dr., ‹stanbul Y afll›l›k döneminde beslenme durumu yafllanma sonucu vücutta oluflan de¤iflikliklerden, kronik hastal›klardan, kullan›lan ilaçlardan, fiziksel ve psikolojik, sosyal ve ekonomik durumdan etkilenir. Yafllanma ile beraber k›rlganl›k ve engellilik artar ve beslenme durumu olumsuz yönde etkilenir; yiyecek al›m› azal›r ve malnütrisEvde sa¤l›k birimine baflvuran yafll› hastalar›n beslenme durumlar› Araflt›rma | Research Article doi:10.2399/tahd.13.36035 Türk Aile Hek Derg 2013;17(3):106-112