Ummahan Yücel

Assessment of cervical cancer risk in women between 15 and 49 years of age: case of Izmir.

BACKGROUND The aim of the study was to determine risk factors for cervical cancer for women in Izmir. METHODS This cross-sectional, descriptive field covered a population of 4319 women of reproductive age (15-49) (household registration in the Mukhtars office-2007). A total of 1,637 women were included in the sample given a four-part questionnaire through face-to-face interview by visiting the women in their homes in order to determine socio-demographic factors, obstetric history, genital hygiene and the use of family planning methods. In addition, during the data collection process, the women were given group training in order to raise awareness of cervical cancer. The number and percentage distributions of the data were calculated. RESULTS While the average age of the women was 31.9±9.77 (Min: 15.00-Max: 49.00), education level of 43.4% of them was elementary school only. It was determined that 70.3% of the women experienced at least one pregnancy, 71.0% had vaginal delivery and 75.9% used a contraceptive method. In the study it was determined that among the cervical cancer related risks vaginal delivery, vaginal lavage and having three or more pregnancies had the highest rates, while having sexual intercourse before 16 years of age and having more than one sexual partner constituted lower rates. The rate of the women who stated not having a smear in the last three years was 82.4%. CONCLUSIONS Considering the case in terms of having Pap smear test, womens awareness on the risk factors and early diagnosis of cervical cancer was found to be low. Due to this reason, awareness of women has to be raised through education.

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.

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.

Bornova’da Yaşayan 20 Yaş ve Üzeri Kadınlarda Üriner İnkontinans Prevelansı ve Risk Faktörleri

Amac: Kesitsel tipteki bu alan arastirmasi, Bornova Ilcesi’nde ikamet eden kadinlarda uriner inkontinans gorulme sikligini ve risk faktorlerini incelemek amaciyla yapilmistir. Yontem: Bornova ilcesinde yurutulen calismanin evrenini, Bornova belediyesinde calisan ebelerin hizmet verdigi dokuz mahallede ikamet eden 20 yas ustu kadinlar (n=32.284) olusturmustur. Alinmasi gereken en kucuk ornek buyuklugu Statcalc (EpiInfoVersion 6) kullanilarak %95 guven araliginda, %26 gorulme sikligi ve %5 hata payi ile 293 olarak belirlenmistir. Orneklem grubuna alinacak kadin sayisi tabakali ornek secim yontemi kullanilarak belirlenmistir. Veriler kadinlarin sosyodemografik ozellikleri ile literatur dogrultusunda olusturulan inkontinans etyolojisinde rol oynayan faktorlerin sorgulandigi anket ve ICIQ-SF (International Consultation on Incontinence Questionnaire Short Form) (Chronbach alfa=0.71) kullanilarak toplanmistir. ICIQ-SF cut-off degeri 8’dir. Bulgular: Arastirmaya alinan kadinlarin yas ortalamasi 42.86±1.51 (min:20 max:81)’dir. Kadinlarin %72.5’inin vajinal dogum yaptigi, %59.2’sine dogumda epizyotomi uygulandigi, %7.3’unun dogumlarinda vakum kullanildigi, %63.1’ine dogumda kristeller manevrasi uygulandigi, %19.2’sinin iri bebek dogumu oldugu, %11.1’inin jinekolojik operasyon gecirdigi saptanmistir. Kadinlarin uriner inkontinans prevelansi %28.2’dir. Uriner inkontinans sorunu olan kadinlarin %31.0’inin karisik tipte idrar kacirmasi oldugu, %74.7’sinin ise az miktarda idrar kacirdigi belirlenmistir. Idrar kaciranlarin %73.6’sinin idrar kacirma nedeniyle doktora basvurmadigi, %58.6’sinin ped/koruyucu materyal kullanmadigi saptanmistir. ICIQ-SF puan ortalamasi 7.67±4.28 (min:2 max:18) olarak bulunmus, ayrica idrar kaciran kadinlarin %42.5’inin rahatsiz edici duzeyde idrar kacirma problemi yasadigi tespit edilmistir. Sonuc: Yaklasik olarak uc kadindan birinin uriner inkontinas sorunu yasadigi belirlenmistir Yas, egitim durumu, BMI, vajinal dogum, dogum sayisi, menapoz ve jinekolojik operasyon oykusu ve sik idrar yolu enfeksiyonu gecirme ile uriner inkontinas arasinda iliski saptanmistir.