Sibel Kalaça

Prescribing habits of general practitioners in the treatment of childhood respiratory-tract infections

ObjectiveIn the present study, prescribing behavior of general practitioners (GPs) was investigated in the example of childhood upper and lower respiratory-tract infections (URTIs and LRTIs).Study designA face-to-face interview was performed with 352 parents admitted to seven primary health care centers for their children diagnosed with URTI or LRTI. Prescriptions (n=331) written by 25 GPs working at these centers were analyzed regarding legibility, format and suitability of drug choice.ResultsAlmost 60% of parents had self-medicated their children prior to admitting to the doctor. Of the patients, 29 (8.2%) were not examined by the physicians, but were directly prescribed medicine. The physicians did not tell the diagnosis to 25.3% of the patients, did not inform 41.2% of them about the drugs and did not caution 95.7% about the side effects. Further, the physicians did not inform 42.6% of the patients about drug use instructions, did not inform 83.5% about the warnings and did not inform 81.2% about non-drug treatment. Approximately 5% of the individuals remembered the name of the drugs. Only 26.3% of the prescriptions were easily readable, and only five scripts (1.5%) contained all necessary information. The majority of the patients were given antibiotics, penicillin+beta lactamase inhibitors being the first. Paracetamol was the most frequently prescribed analgesic/antipyretic for both indications, followed by nimesulide and ibuprofen.ConclusionsThe present study revealed inappropriate drug use in the treatment of respiratory-tract infections in children at the primary health care level in a district of Istanbul, Turkey. Furthermore, it has been shown that GPs practicing at primary health care centers should be trained to give adequate information about the disease and the treatment to the patients/parents to achieve good compliance and optimal drug therapy for children.

Comparison of rational pharmacotherapy decision-making competence of general practitioners with intern doctors

ObjectiveThe aim of this study was to compare rational pharmacotherapy decision-making competency of interns (final-year medical students) who had received rational pharmacotherapy education (RPE), with their classmates at another medical school and general practitioners (GPs) who had not been exposed to RPE.DesignA written, objective, structured clinical examination (OSCE), consisting of open and structured questions, was given to all participants. The participants were expected to make a treatment plan and prescribe for simple, uncomplicated β-hemolytic streptococcal tonsillitis and mild-to-moderate essential hypertension patients, explain their proposed treatment plans and reasons affecting their drug choice. After the OSCE, a questionnaire to assess knowledge of the rational use of drugs was given to the participants.ResultsFifty RPE(+) interns, 54 RPE(−) interns and 53 GPs participated in the study. Mean scores of RPE(+) interns were higher than those of GPs, which were in turn found to be higher than those of RPE(−) interns for all cases. The RPE(+) interns scored the highest regarding all components of rational pharmacotherapy process for all cases of both indications. However, participants in all groups had higher scores for the structured questions compared with the corresponding open ones for both diseases. Prescription analysis also revealed better results for RPE(+) interns regarding the number of drugs/prescription and treatment costs.ConclusionThe present study demonstrated that the final-year medical students (interns) markedly benefited from undergraduate RPE at the medical school in developing rational prescribing skills compared with their classmates from a medical school with traditional pharmacology education. Interestingly, they got higher scores than not only RPE(−) interns, but also than the GPs participating in this study, indicating the urgent need for continuous medical education programs in this field throughout the country for practicing GPs.

Natural History and Risk Factors of Early Respiratory Responses to Exposure to Cotton Dust in Newly Exposed Workers

Objective: A prospective study of newly exposed cotton workers was performed to investigate the natural history of respiratory symptoms and lung function changes. Methods: A total of 157 workers naive to cotton dust exposure were investigated by questionnaire, spirometry, and skin tests. They were examined before employment (baseline) and at the end of the first week, and the first, third, sixth, and 12th month after starting work. Acute airway response was defined as either a cross-first-shift or a cross-week fall in forced expiratory volume in one second (FEV1). The longitudinal change of lung function over the year was also calculated. Five hundred seventy-two personal dust sampling and 191 endotoxin measurements were performed to assess the exposure. Results: Forty percent of workers reported work-related symptoms in the first week of the study. Smoking, endotoxin, and dust concentrations were risk factors for all work-related symptoms. Acute airway responses were witnessed after immediate exposure. Female status was the only factor found to be predictive of acute airway response. The mean longitudinal fall in FEV1 at 1 year was 65.5 mL (standard error = 37.2). Age, early respiratory symptoms, and early fall in cross-week FEV1 were found to predict the 12-month fall in FEV1. Cross-first-shift and cross-week falls in FEV1 reduced in magnitude during the course of the study. Conclusions: This study of workers naive to cotton dust exposure has demonstrated that respiratory symptoms and acute airway responses develop early following first exposure, and a tolerance effect develops in those workers with the continued exposure. Current smoking and increasing exposure predicts the development of work-related lower respiratory tract symptoms, while early symptoms and acute airway changes across the working week predict the longitudinal loss of lung function at 1 year.

Resistance against contraception or medical contraceptive methods: a qualitative study on women and men in Istanbul

Objectives This research was carried out to reveal the attitudes of men and women about contraception in the Umraniye district of Istanbul. Methods Focus group discussions were used for data collection. Data from 20 groups of married people (ten groups of men and ten of women) living in Umraniye were analyzed. Results Most people attending the focus groups in the study were against having ‘too many’ children. Economic constraints appear to be a leading influencing factor for limiting the number of children. Urbanization also seems to have a strong influence on peoples knowledge and attitudes about contraception. Culture and religious beliefs were not found to be major barriers to contraception in general, but they would influence the selection of the type of a certain contraceptive method. More specifically, culture and religious beliefs were barriers to use of medical methods, and they were the main reasons for use of the withdrawal method, which is the most common method used in Turkey. Conclusions Men and women are not resistant to contraception, but they are reluctant to use medical methods. The provision of contraceptive services, with special attention to cultural and religious beliefs and values, and the inclusion of appropriate counseling and education sessions during service delivery, may give clients new options and increase the use of medical methods.

Antihypertensive drug utilization at health centres in a district of Istanbul

ObjectiveSince irrational use of antihypertensives has considerable clinical and economical consequences, this study was conducted to evaluate antihypertensive drug utilization in hypertension at seven State Health Centres in Istanbul.MethodA total of 297 hypertensive patients who accepted to␣participate in the study were evaluated by a face-to-face questionnaire and a copy of their prescriptions were collected for prescription analysis.ResultsAngiotensin-converting enzyme (ACE) inhibitors (31.7%), calcium channel blockers (28.8%), diuretics (16.2%), beta blockers (7.5%) and others (15.8%) have been prescribed. There were no statistically significant relation between prescribed antihypertensive drug groups and gender, age, and NSAIDs co-prescribing. The most frequent comorbidity in hypertensive patients was diabetes mellitus (10.4%) and calcium channel blockers (35.5%) have been prescribed to them as a first antihypertensive medication. Average cost per prescription was

Health system challenges of cardiovascular disease and diabetes in four Eastern Mediterranean countries.

42.7±38.1. According to the patients’ self-reporting, the majority of them (85%) were prescribed without a physical examination. The physicians failed to write the prescriptions appropriately; only 5% of the scripts contained all information about the drug(s) and use instructions in full format.ConclusionThe present study indicates that GPs working at primary healthcare centres were rational in terms of antihypertensive drug choice. However, they poorly applied rational pharmacotherapy principles such as (a) writing a “good” prescription which is easily readable by the pharmacist and the patient and that contains full essential information; (b) a medical examination of the patient to assess her/his current clinical condition; and (c) taking care of not prescribing drugs with potential interaction like antihypertensives and NSAIDs together.

Predictors of early leaving from the cotton spinning mill environment in newly hired workers

This paper presents evidence from research into health system challenges of cardiovascular disease (CVD) and diabetes in four Eastern Mediterranean countries: the occupied Palestinian territory, Syria, Tunisia and Turkey. We address two questions. How has the health system in each country been conceptualised and organised to manage the provision of care for those with CVD or diabetes? And what were key concerns about the institutional ability to address this challenge? Research took place from 2009 to 2010, shortly before the political upheavals in the region, and notably in Syria and Tunisia. Data collection involved a review of key documents, interviews with key informants and brief data collection in clinics. In analysing the data, we adopted the analytical schema proposed by Walt and Gilson, distinguishing content, actors, context and process. Key findings from each country highlighted concerns about fragmented provision and a lack of coordination. Specific concerns included: the lack of patient referral pathways, functioning health information systems and investment in staff. Regarding issues underlying these ‘visible’ problems in managing these diseases, we highlight implications of the wider systemic pressure for reform of health-sector finance in each country, based on neoliberal models.

Expanding family planning options: offering the Standard Days Method™ to women in Istanbul

Objective: This longitudinal study aimed to identify the predictors of leaving during the first year of employment from the cotton spinning mill environment in newly hired workers. Methods: One hundred and ninety eight consecutively appointed new employees were investigated by questionnaire, lung function test, and skin test. They were examined before employment and at the end of the 1st week, and the 1st, 3rd, 6th, and 12th month after starting work and when possible before leaving their job. 572 personal dust sampling and 191 endotoxin measurements were performed to assess the environmental exposure. For the univariate analysis χ2, Student t tests, ANOVA, and Kruskall Wallis tests were used. Cox proportional hazards analysis was used to identify factors associated with leaving the job. Results: Fifty three per cent of workers left the mill environment during their first working year. Work related lower respiratory tract symptoms reported at the third month were associated with an increase rate of leaving the industry compared to those remaining in the industry (25% v 4.8%; p<0.005). Having respiratory symptoms at the first month of work predicted those leaving the industry at some point in the next 11 months. According to the Cox model, increasing age and having work related lower respiratory tract symptoms were found to be predictors for leaving job at the first working year. Atopic status, dust and endotoxin levels, and lung function changes were not consistently predictive of workers who left the industry in the follow up period. Conclusion: This study demonstrated that work related respiratory symptoms can predict workers likely to leave the cotton mill environment during the first year of employment, but atopy or acute lung function changes do not.

Health policy analysis for prevention and control of cardiovascular diseases and diabetes mellitus in Turkey

Background This study introduced the Standard Days Method™ (SDM), a fertility awareness-based method of family planning, to couples in a region of Istanbul, Turkey who were using a method of low effectiveness or no family planning method. The objective was to determine potential demand for, and satisfaction with, the SDM. Methods A total of 657 couples were selected by systematic sampling and offered the SDM. Those accepting this method were interviewed 1 and 3 months after starting the SDM. Results Some 47% of the participants were satisfied with the method and intended to continue using it. Conclusions Potential demand for the SDM was 80.3% (278/346 eligible women) among couples who were using a method of low effectiveness or no family planning method. Our results suggest that adding the SDM to the contraceptive method mix may benefit Turkish women.

Cognitive Flexibility and Social Responsiveness in Children and Adolescents with Tourette Syndrome

ObjectivesCurrent capacity of the Turkish health system is reviewed to evaluate and develop appropriate policies for cardiovascular diseases (CVD), diabetes mellitus (DM) and related risk factors.MethodsThis paper qualitatively evaluates existing policies; interviews with key informants (KIs); and rapid appraisal fieldwork in clinical settings about CVD–DM through the framework of Walt and Gilson (Health Policy Plan 9:353–370, 1994).ResultsDocument review shows that prevention and control of CVD–DM were strongly addressed in Turkey, yet no document mentioned country-wide early detection or screening programs. KIs indicated over-fragmented management of CVD–DM by the Ministry of Health (MoH). Coordination among the MoH, organizational structure at provincial level and civil society organizations are poor where mutual trust is a significant problem according to KIs. Clinical setting findings point to a complete lack of a referral structure and a lack of follow-up, compounding the absence of functioning health information systems for patient records.ConclusionsPrimary care services for CVD–DM require urgent attention, focusing particularly on the training of staff in public facilities, the integration of patient data, referrals and follow-up across all levels of the health system.