Züleyha Alper

Domestic violence: a study among a group of Turkish women

Objectives: With this study we attempt to explore the reality of domestic violence, its prevalence, type and frequency among a group of Turkish women. Methods: This study was performed between October 2000 and May 2001 in the fourth largest city in Turkey. All women over the age of 15, who visited any of 50 health centres in different districts for different purposes, were asked to participate in the study. 506 of the participants who gave their consent were taken as a study group, and printed questionnaires were filled in during face-to-face interviews. Results: 297 (58.7%) of the participants had experienced domestic violence at least once in their lifetime. The male partner was the primary violent person (49.5%), followed by mother and/or father (14.1%). The type of violence seen most was a combination of physical and psychological violence (45.5%). More than half of the women (58.6%) were experiencing domestic violence frequently and continuously. Reasons given for this violent behaviour were economic hardship (18.9%), followed by alcohol consumption by the violent person (18.5%), and inadequate family relations (15.8%). Of the victims 43.8% accepted this violence, but 26.6% reacted with violence. Women were not willing to abandon their relationships despite marital violence, because of their children (48.2%). Womens and mens higher educational attainments did indicate a decrease in the prevalence of domestic violence. Conclusion: Reasons for continuing the abusive relationship and the effectiveness of the scarce support resources should be evaluated more seriously. The potential role of the primary healthcare provider in eliminating barriers for identification and assessment of domestic violence should not be forgotten. Otherwise, domestic violence will still remain a ‘family matter’, hidden and neglected.

Risk factors for wheezing in primary school children in Bursa, Turkey

Background Wheezing is the most common symptom of childhood respiratory tract illnesses. It is important not only for its associated acute morbidity, but also for the fact that early childhood wheezing confers a high risk for asthma. Epidemiological studies from various countries show that 10–15% of children <1 year of age and 25% of children <5 years of age have wheezing-associated respiratory tract illness, and one-third of these children develop asthma later in life. Methods In this retrospective study, we evaluated the association between a history of wheezing and prenatal, postnatal, familial, and environmental risk factors in 858 7-year-old children, randomly selected from seven primary schools in Bursa, Turkey, by means of an easy-to-understand questionnaire form. Among these children, 12.4% had a history of early transient wheezing, 7.1% had persistent wheezing, and 7.7% had late onset wheezing; 72.8% had no wheezing symptoms and 33.3% of children who experienced wheezing during the first 3 years of life had physician-diagnosed asthma. Results Notable risk factors associated with wheezing were as follows: male gender, lower socioeconomic status, premature birth, maternal smoking during pregnancy, bottle-feeding before 2 months of age, dampness and mold at home, hospitalization due to any respiratory illness in infancy, history of croup between 6 months and 5 years of age, frequent upper respiratory infections during the first 3 years of life, allergic eczema in the child, and any allergic disease in the mother or siblings. Conclusion This study shows that the high rates of reported wheezing in the 858 primary school children in Bursa are clearly attributable to important risk factors that have long been recognized and discussed by researchers worldwide, and this suggests that all efforts at primary prevention may be insufficient.

Domestic violence: a tragedy behind the doors.

ABSTRACT Objective: To explore the prevalence, type, frequency and causes of domestic marital violence among Turkish women in a socio-economically developed metropolitan setting. Methods: A cross-sectional study was performed in 2003. All married women, aged 18 years and over, who were visiting any of the 50 primary health care units for different purposes were asked to participate in the study. Of 1427 asked, 1010 gave consent and completed face-to-face interviews. Multiple correspondence analysis, and logistic regression were used for statistical analyses. Results: Domestic violence was statistically significantly associated with educational level. Illiterate women reported marital abuse 2.6 times more than university or more educated women. No statistically significant relationship was observed between domestic marital violence and womens age or occupation, marital duration or family income. The most frequently reported type of violence was physical, followed by psychological. Among women reporting domestic violence, those with the lowest educational level and income were experiencing all types of domestic violence frequently. Conclusion: Placing more importance on educating girls could be a key component of preventing domestic violence.

Diagnosis of acute tonsillopharyngitis in primary care: a new approach for low-resource settings

Abstract Background: Diagnosing GABHS (Group A-beta Hemolytic Streptococcus) tonsillopharyngitis by clinical scoring is a recommended approach in developed countries, but there is still much controversy for low resource settings. Aim: We aimed to assess the impact of Centor criteria with the support of practical laboratory tests. Methods: We prospectively included patients complaining sore throat (N = 282). We evaluated them in terms of Centor scoring and performed white blood cell count (WBC), C-reactive protein (CRP), rapid antigen detecting test, and throat culture. Results: In GABHS cases (n = 32, 11·3%), two of the criteria were observed to be positive in more than half of the cases (n = 19, 59·3%), while 13 (40·7%) cases met three/four criteria. The specificity of having two criteria was found to be 65·5% and increased to 91·5% after including CRP and WBC. Conclusion: Centor criteria could be safely used to reduce unnecessary antibiotic usage for tonsillopharyngitis in developing countries.

A Meta-Analysis and the Evaluation of Trends in Obesity Prevalence among Children and Adolescents aged 5-19 in Turkey: 1990 through 2015

Objective Obesity in childhood and adolescence is one of the most serious public health problems due to a remarkable increase in prevalence in recent years and its close relationship with non-communicable diseases, such as diabetes and hypertension, resulting in increased adult morbidity and mortality. This study aims to quantify the secular trend in different regions of Turkey from 1990 to 2015 by performing a meta-analysis of childhood and adolescent obesity prevalence studies conducted. Methods Uludag University Library Database was searched for relevant articles published prior to March 2017. The heterogeneity of the studies in the meta-analysis was tested by the I2 statistic and Cochran’s Q test. The obesity trend analyses were examined by chi-square trend analysis with respect to five year periods. The statistical significance level was taken as α=0.05. Results A total of 76 papers were initially identified addressing childhood and adolescent obesity in Turkey. Fifty-eight papers were selected for analysis. The prevalence of obesity increased from 0.6% to 7.3% with an 11.6-fold increase between the periods 1990-1995 to 2011-2015. The prevalence of obesity increased in both genders. However, boys were more likely to be obese than girls. Conclusion Studies on obesity prevalence in the 5-19 age group in Turkey have gained importance, especially in the 2000s. While a remarkable number of prevalence studies, mostly regional, have been conducted between 2005-2011, a gradual decline was observed thereafter. Further national and population-based surveys on prevalence of obesity in children and adolescents are definitely needed in Turkey.

An Educational Intervention to Prevent Irrational Prescribing By Primary Care Physicians: Results from Turkey from the OTC-SOCIOMED Project Second Phase

Objective: The misuse of over-the-counter (OTC) medications is a serious issue in primary healthcare, leading to the need for better education of general physicians on appropriate prescribing behavior. This study discusses the findings from the OTC-SOCIOMED project (Assessing the Over-the-Counter Medications in Primary Care and Translating the Theory of Planned Behavior into Interventions) in Turkey. Methods: During November 2011, the implementation of intervention was done in Bursa, which was selected as the study region in Turkey. The participants were 28 family physicians in Turkey who were assigned to two study groups; a three-step training intervention—a 1-day intensive course on rational drug prescription, 4 weeks of reminder messages, and face-to-face interviews—was provided for the intervention group. Four different data collection tools were used before and after the intervention: a training assessment questionnaire, a complementary questionnaire on OTC medicines, the theory of planned behavior questionnaire, and a patient medication form. Results: Participants were satisfied with the quality of the training, the delivery of the topics, and the subsequent reminder messages. There was a significant difference in only one item (“The decision to prescribe belongs completely to me”), which evaluated behavior control in the intervention group after training. The lack of time most often explained why physicians could not inform patients about OTC medicines. Conclusion: Physicians were aware of their own need for training in rational prescribing, and this training model was quite acceptable to them. However, the short study duration was an obstacle for observing attitude changes among the doctors.

Getting Better or Worse? General Health Status of 9th Grade Students in Orhangazi, Bursa, Turkey

Adolescence is a transition phase from childhood to adulthood. In this period, rapid changes and development in their physical, biological, psychological, and social lives take place. While adolescents have to acquire many qualifications, they are faced with many problems, especially those that risk their health. In Turkey, one of the most important issues contributing to risky behaviors is the 1st Phase Nationwide High School Exam. Students must pass this phase in order to be in good high schools and to then pass the 2nd Phase University Exam. Most of their time is spent studying in school or in private teaching institutions, and less time is spent with their families or participating in social activities. In order to examine the effects on 9th grade students after the 1st Phase exams, we conducted this study with 1192 students in Bursa, Orhangazi. Data to evaluate students by socioeconomic status, body mass index (BMI), dietary, smoking, and physical activity behaviors and psychological status were collected via classroom questionnaires. We aimed to determine and evaluate the general characteristics and physical examination findings, to some extent, in a nationally representative sample of 9th grade students a year following the Nationwide High School Exam.