Meltem Çiçeklioğlu

Rational antibiotic use and academic staff

This study was devised to determine the knowledge, attitude and behaviour of an educated group of people towards antibiotic use and self-medication with antibiotics. Of 1380 members of academic staff (excluding those from the Faculty of Medicine) of Ege University, 602 were chosen by systematic sampling methods. Two groups were formed. Group A included academic staff from the Faculties of Dentistry and Pharmacy and Group B, members of all other faculties. The mean age was 37.4+/-11.0 and 47.0% were females. The mean antibiotic knowledge score was 7.16+/-3.32. Self-medication with antibiotics was admitted by 45.8% of the total samle and 15.6% of the respondents used antibiotics until their symptoms disappeared regardless of the period of prescription. In Group A 48.8% and in Group B 80.7% of the respondents believed that antibiotics could be used for common cold. It is concluded that priority should be given to knowledge-based behaviour education programmes for the more highly educated community; there must also be restriction on the sale of antibiotics without prescription.

Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers

BackgroundA person-list-based family medicine model was introduced in Turkey during health care reforms. This study aimed to explore from primary care workers’ perspectives whether this model could achieve the cardinal functions of primary care and have an integrative position in the health care system.MethodsFour groups of primary care workers were included in this exploratory-descriptive study. The first two groups were family physicians (FP) (n = 51) and their ancillary personnel (n = 22). The other two groups were physicians (n = 44) and midwives/nurses (n = 11) working in community health centres. Participants were selected for maximum variation and 102 in-depth interviews and six focus groups were conducted using a semi-structured form.ResultsData analysis yielded five themes: accessibility, first-contact care, longitudinality, comprehensiveness, and coordination. Most participants stated that many people are not registered with any FP and that the majority of these belong to the most disadvantaged groups in society. FPs reported that 40-60% of patients on their lists have never received a service from them and the majority of those who use their services do not use FPs as the first point of contact. According to most participants, the list-based system improved the longitudinality of the relationship between FPs and patients. However, based on other statements, this improvement only applies to one quarter of the population. Whereas there was an improvement limited to a quantitative increase in services (immunisation, monitoring of pregnant women and infants) included in the performance-based contracting system, participants stated that services not among the performance targets, such as family planning, postpartum follow-ups, and chronic disease management, could be neglected. FPs admitted not being able to keep informed of services their patients had received at other health institutions. Half of the participants stated that the list-based system removed the possibility of evaluating the community as a whole.ConclusionsAccording to our findings, FPs have a limited role as the first point of contact and in giving longitudinal, comprehensive, and coordinated care. The family medicine model in Turkey is unable to provide a suitable structure to integrate health care services.

Tumor Necrosis Factor Alpha and Interleukin 6 Productions in Response to Platelet-Activating Factor in Chronic Hepatitis B Virus Infection

Objective: The aim of this study was to determine tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) release in response to platelet-activating factor (PAF) induction in peripheral blood mononuclear cells (PBMCs) from chronic hepatitis B virus (HBV) carriers. Methods: Subjects were grouped into three subgroups. The mean age was 37 ± 10 years. Group A (n = 15), group B (n = 10) and group C (n = 9) subjects were HBV serology-negative, had natural immunity after recovery from an acute HBV infection, and were chronic HBV carriers, respectively. Results: Compared with group A, PBMCs from naturally immune subjects and chronic HBV carriers produced significantly higher amounts of TNF-α and IL-6 in response to PAF. In chronic HBV carriers, TNF-α (1,633.3 ± 793.7) and IL-6 (2,533.3 ± 466.3) production was statistically lower than TNF-α (2,630.0 ± 727.3) and IL-6 (3,870.0 ± 728.4) obtained from naturally immune subjects to HBV. Conclusion: Differences of TNF-α levels between chronic HBV carriers and naturally immune subjects suggest that TNF-α may be a critical mediator of HBV clearance.

Public health education in Ege University Medical Faculty: Developing a community-oriented model

Background: Ege University Medical Faculty (EUMF) introduced a community-oriented curriculum in 2001. Aims: To evaluate the new public health education program in EUMF curriculum. Method: The study adopted triangulated methods. Quantitatively, a comparison of the students who were exposed to a community-oriented curriculum (Year 4 in 2007) was made with the students who were exposed to the traditional curriculum (Year 4 in 2005) in terms of their assessment of their achievement of our learning objectives. A total of 255 students in 2005 (80.7%) and 243 students in 2007 (81.5%) were surveyed using a questionnaire. Qualitatively, five focus group- and five individual interviews were performed with the 2007 cohort. Results: Except the one related to teamwork (p > 0.05) all learning objectives yielded significantly higher scores in the 2007 cohort than in the 2005 cohort (p < 0.05). The qualitative analysis supported the achievement of objectives in the 2007 cohort. The students appreciated the relevance of public health education with clinical subjects and interactive methods, but criticized didactic lectures and written assignments. Conclusions: A community-oriented approach is more effective in achieving a holistic approach to health problems. Improving community-based activities and assessment methods would be more successful in integrating population health into medical training.

The influence of a market-oriented primary care reform on family physicians’ working conditions: A qualitative study in Turkey

Background: Turkey has undergone a ‘Health transformation programme’ putting emphasis on the reorganization of primary care (PC) services towards a more market-oriented system. Objectives: To obtain a deep understanding of how family physicians (FPs) experienced the process of the reforms by focusing on working conditions. Methods: This phenomenological and qualitative research used maximum variation sampling and 51 FPs were interviewed in 36 in-depth and four focus-group interviews. Results: Thematic analysis of interviews provided seven themes: (1) change in the professional identity of PC physicians (physician as businessperson); (2) transformation of the physician–patient relationship in PC (into a provider–customer relationship); (3) job description and workload; (4) interpersonal relationships; (5) remuneration of FPs, (6) uncertainty about the future and (7) exhaustion. Most FPs felt that the Family medicine model (FMM) placed more emphasis on the business function of family practice and this conflicted with their professional characteristics as physicians. FPs complained that some of their patients behaved as extremely demanding consumers. Continuously increasing responsibilities and extremely high workload were commonly reported problems. Most participants described the negative incentives in the performance scheme as a degrading method of punishment. The main factor was job insecurity caused by contract-based employment. FPs described the point at which they are with terms such as exhaustion. Conclusion: By increasing workload and creating uncertainty about the future and about income, the PC reforms have led to working conditions, which has led to changes in the professional attitudes of physicians and their practice of medicine.

Evaluation of an intensive intervention programme to protect children aged 1–5 years from environmental tobacco smoke exposure at home in Turkey

The aim of this randomized-controlled trial was to evaluate the effectiveness of an intensive intervention to reduce childrens environmental tobacco smoke (ETS) exposure at their home compared with a minimal intervention. The target population of the study was the mothers of children aged 1-5 who lived in the Cengizhan district of Izmir in Turkey, who smoked and/or whose spouses smoked. It was found that at least one parent of a total of 182 children smoked and 80 of these mothers were taken into stratified sampling based on the number of the smoking parents. Mothers were visited at their homes. During the initial visit, they were educated and urine samples were taken from their children. Following this initial visit, mothers were randomized to the intensive intervention (n = 38) or the minimal intervention group (n = 40). The levels of cotinine in the intensive intervention (P = 0.000) and minimal intervention (P = 0.000) groups in the final follow-up were significantly lower than the initial levels. The proportion of mothers reporting a complete smoking ban at home in the final follow-up was higher in the intensive intervention group than the minimal intervention group (P = 0.000). The education provided during the home visits and the reporting of the urinary cotinine levels of the children were effective in lowering the childrens exposure to ETS at their home.

Comparison of Two Different Enteral Nutrition Protocol in Critically Ill Patients

OBJECTIVE In this study, two enteral nutrition protocols with different gastric residual volumes (GRVs) and different monitoring intervals were compared with respect to gastrointestinal intolerance findings in intensive care unit (ICU) patients. METHODS The study was carried out prospectively in 60 patients in the anaesthesiology and reanimation ICU under mechanical ventilation support, who were scheduled to take enteral feeding. Patients were sequentially divided into two groups: Group 1, GRV threshold of 100 mL, and monitoring interval of 4 hours, and Group 2, GRV threshold of 200 mL, monitoring interval of 8 hours. To test the significant difference between the groups, Students t test, chi-square text and Fisher exact test were used. RESULTS In Group 1, 3.3% vomiting, 6.6% diarrhoea was observed; in Group 2, 16.6% vomiting, 10% diarrhoea. In terms of total intolerance (vomiting and/or diarrhoea) of the two groups, the incidence was significantly higher in Group 2 (33.3%) than in Group 1 (10%) (p=0.02). CONCLUSION According to the results of the study, a lower gastrointestinal intolerance rate was detected in the GRV threshold 100 mL, monitoring interval for 4 hours protocol (Group 1) than in GRV threshold 200 mL, monitoring interval for 8 hours protocol (Group 2); Group 1 may be preferred renovation.

Sociodemographic aspects of consanguineous marriage in an urban slum of a metropolitan area in İzmir, Turkey.

Background: Consanguineous marriage is a common practice in Turkey. Sociodemographic and cultural factors associated with it are still unclear. Aim: The purpose of this study was to investigate the association between sociodemographic and fertility factors and consanguineous marriages in an urban slum of a metropolitan area in Turkey. Methods: This community-based case-control study was conducted in Bayrakli Municipality health centres. Of the 1243 married women, 85 consanguineously married were included in the case group. A control group in non-consanguineous marriages consisted of 85 women matched to cases according to age and neighbourhood. Information about the subjects’ sociodemographic features, fertility history and opinions about consanguineous marriage was collected. Results: Factors that were associated with consanguinity included; having a low level of education (OR = 2.7, CI = 1.1–6.7), a brief duration time in Izmir after migration (OR = 4.7, CI = 1.9–11.6) and consanguineous parents (OR = 3.8, CI = 1.5–9.7). Despite the increased numbers in fertility features and higher perinatal mortality for first cousin marriages, there was no significant difference in the mean numbers of pregnancies, births, stillbirths and living children. Conclusion: Time after migration and educational background of women were the main factors associated with consanguineous marriages. Public health interventions to reduce consanguineous marriage in urban areas should target socioeconomically disadvantaged populations in cities.

Adaptation of the Critical Care Family Need Inventory to the Turkish population and its psychometric properties

In the complex environment of intensive care units, needs of patients’ relatives might be seen as the lowest priority. On the other hand, because of their patients’ critical and often uncertain conditions, stress levels of relatives are quite high. This study aims to adapt the Critical Care Family Need Inventory, which assesses the needs of patients’ relatives, for use with the Turkish-speaking population and to assess psychometric properties of the resulting inventory. The study was conducted in a state hospital with the participation of 191 critical care patient relatives. Content validity was assessed by expert opinions, and construct validity was examined by exploratory factor analysis (EFA). Cronbach’s alpha coefficient was used to determine internal consistency. The translated inventory has a content validity ratio higher than the minimum acceptable level. Its construct validity was established by the EFA. Cronbach’s alpha coefficient for the entire scale was 0.93 and higher than 0.80 for subscales, thus demonstrating the translated version’s reliability. The Turkish adaptation appropriately reflects all dimensions of needs in the original CCFNI, and its psychometric properties were acceptable. The revised tool could be useful for helping critical care healthcare workers provide services in a holistic approach and for policymakers to improve quality of service.