Nilgün Özçakar

What patients think about promotional activities of pharmaceutical companies in Turkey

ObjectiveDrugs, 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.MethodA 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 measureThe awareness and ethical evaluation of patients of the promotional activities.ResultsNearly 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.ConclusionsIn 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.

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.

A Case of Post-Caesarean Scar Endometrioma

Scar endometriosis is a rare disease after an abdominal surgery which is difficult to diagnose. Caesarean section scar endometriosis is a rare occurance with reported different incidences. The diagnosis is frequently made after excision of the lesion. In this case, a cesarean scar site mass was detected two years after the cesarean operation. The pathological diagnosis of the mass which was extensively excised was determined as endometriosis. Endometriosis should be kept in mind in the differential diagnosis of the masses found in the front wall of the sac in reproductive age women. This diagnosis must be supported by the presence of past gynecologic operations and symptoms associated with menstruation. In family medicine, it is important to keep in mind the rare and specific diseases as well as diseases that are common in the society. Skar endometriyozis, abdominal cerrahiler sonrasi seyrek gorulen ve tani konmasi guc bir durumdur. Sezaryen sonrasi skar dokusunda endometriyozis ise nadiren gorulmekte olup, yapilan calismalarda farkli oranlar bildirilmektedir. Tani, cogunlukla lezyonun eksizyonu ile konur. Bu olguda, sezaryen operasyonundan iki yil sonra, sezaryen skar yerinde kitle gelistigi saptandi. Genis eksizyonla cikarilan kitlenin patolojik tanisi, endometriyozis olarak belirlendi. Ureme cagindaki kadinlarda, batin on duvarinda bulunan kitlelerin ayirici tanisinda endometriyozis akilda tutulmalidir. Gecirilmis jinekolojik operasyon varligi ve semptomlarin adet donemleri ile iliskili olmasi ile de bu tani desteklenmektedir. Aile hekimliginde, toplumda sik gorulen hastaliklarin yani sira, nadir ve ozellikli hastaliklari da akilda tutarak hizmet verilmesi onemlidir.

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 individuals 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, Pearsons 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.

Yaygın anksiyete bozukluğu: Birinci basamakta görülme sıklığı ve tanı güçlükleri

1) Dokuz Eylül Üniversitesi T›p Fakültesi, Aile Hekimli¤i Anabilim Dal›, Aile Hekimli¤i Uzman›, ‹zmir 2) Dokuz Eylül Üniversitesi T›p Fakültesi, Aile Hekimli¤i Anabilim Dal›, Aile Hekimli¤i Uzman›, Yard. Doç. Dr., ‹zmir K ayg› bozukluklar› kategorisinde yer alan, afl›r› endifle ve belirgin tetikte olma davran›fl› ile seyreden Yayg›n anksiyete bozuklu¤u (YAB), 1980’ler öncesinde “anksiyete nevrozu” olarak adland›r›l›yordu. Bu bariz adland›rmaya ra¤men hastal›¤›n ba¤›ms›z, farkl› ve tedavi edilebilir bir psikiyatrik hastal›k olarak de¤erlendirilmesi ile ilgili bir karmafla söz konusudur. Avrupa’da kullan›lan ICD (International Classification of Disease) ve Amerika’da tercih edilen DSM (Diagnostic and Statistical Manual of Mental Disorders) YAB’› farkl› ölçütlerle de¤erlendirilmektedirler (Tablo 1 ve Tablo 2). 1990’larda yap›lan çok say›da çal›flma ile daha uygun tan› araçlar› gelifltirilmekle birlikte kavramsal alt yap›daki bu farkl›l›k halen sürmektedir. Yaflanan bu sürece ra¤men depresyon ve panik bozukluk gibi psikiyatrik hastal›klarla karfl›laflt›r›ld›¤›nda YAB’nun genel popülasyonda yaflam boyu prevalans› DSM kriterlerine göre %5, daha genifl kriterleri olan ICD-10 kullan›ld›¤›nda ise %6.5’tur. Türkiye Ruh Sa¤l›¤› Profili Araflt›rmas›nda YAB’nun son 12 aydaki s›kl›¤› %0.7 olarak bulunmuflDerleme | Review Türk Aile Hek Derg 2009; 13(4): 206-209 doi:10.2399/tahd.09.206