Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study.

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the "working conditions in the country" (OR: 1.89, 95% CI: 1.56-2.28) whereas the "social environment/lifestyle abroad" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). Insights: Although the percentage of those who want to emigrate "definitely" was at the same level as in the other developing countries, the tendency to migrate "permanently" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.

Investigation of the relationship between technology addiction and sleepiness among university students in health-related departments in Turkey.

OBJECTIVE: To investigate the relationship of internet and smartphone addiction levels of university students in health-related departments with their daily sleepiness, and to identify associated factors. METHODS: The cross-sectional study was conducted from October 1 to November 30, 2019, at Gaziosmanpasa University, Tokat, Turkey, and comprised students of either gender registered with the faculties of medicine, dentistry, and health sciences, as well as the vocational school of health services. The self-administered survey form comprised the short form of the Young's Internet Addiction Test, the short version of the Smartphone Addiction Scale and the Epworth Sleepiness Scale. Data was analysed using SPSS 20. RESULTS: Of the 640 subjects, 445(68.6%) were females and 204(31.4%) were males. Scores indicated a moderate level of addiction among the students along with excessive daytime sleepiness, showing a significant correlation between the two factors (p<0.001). CONCLUSIONS: As the level of internet and smartphone addiction increased, the state of sleepiness also increased among the university students.

Determination of Seroprevalence and Risk Factors of Crimean-Congo Haemorrhagic Fever (CCHF) in the Endemic Region in Turkey: A Population-Based Cross-Sectional Study.

OBJECTIVES: Turkey is one of the countries that has the most cases of CCHF in recent years among the endemic countries. The disease also poses an important health threat with high mortality rate. The aim of the study was to determine the seroprevalence and risk factors of CCHF in adults aged ≥20 years in Tokat in the endemic region, Turkey. METHODS: In this population-based cross-sectional study, a total of 85 Family Medicine Units (FMUs), from over 170 in Tokat, were randomly selected using 50% sampling. The sample size was determined among the subjects aged ≥20 who registered with the FMUs, due to gender, age group, and the urban/rural population size of Tokat using the stratified cluster sampling method. Subjects were invited to the FMUs. A questionnaire was performed face to face. The blood samples were taken, and anti-CCHFV IgG antibodies were measured with ELISA method. RESULTS: 1272 (54.9%) out of 2319 participants were female, and the mean age was 47.3 ± 15.3. Anti-CCHFV IgG seropositivity was 5.6% (n = 130). Seropositivity rates in terms of adjusted odds ratios (AOR) were higher 2.53 times (95% CI: 1.57-4.08; p=0.001) in males; 4.05 (95% CI: 2.14-7.65; p < 0.001) in age group ≥65; 0.33 (95% CI: 0.14-0.76; p < 0.001) in graduates of high school and above; 0.71 (95%CI: 0.33-1.52; p < 0.001) in ones with good income; 1.84 (95%CI: 1.18-2.86; p < 0.001) in farmers; 1.64 (95% CI: 1.04-2.27; p < 0.001) in people dealing with animal husbandry; and 1.02 (95% CI: 1.03-2.29; p < 0.001) in those with history of tick contact. CONCLUSIONS: CCHF seroprevalence is still a common public health problem in Tokat, Turkey. Male gender, advanced age group, low-educated, low-income, farmers, animal husbandry, and history of tick contact were found to be risk factors for CCHF. The importance of this kind of community-based studies to identify the seroprevalence in regional and national level increases even more.

Prevalence of insulin resistance and identifying HOMA1-IR and HOMA2-IR indexes in the Middle Black Sea region of Turkey.

BACKGROUND: Insulin resistance (IR) is one of the most important etiological risk factors in the development of diabetes. However, there is no clear data regarding the prevalence of IR in the country. OBJECTIVE: This study evaluates the prevalence of IR and identifies the optimal threshold values for the HOMA indexes in Turkey. METHODS: This cross-sectional, population-based survey includes 2013 participants aged 20-84 years. The values of the anthropometric measurements and laboratory analysis were recorded. The 90th percentile in the non-obese and non-diabetic population was accepted as cut-off values for IR. RESULTS: The optimal threshold values for IR were 2.46 in HOMA1-IR and 1.40 in HOMA2-IR. Using the HOMA2-IR method, the overall prevalence of IR was 33.2%. The IR prevalence was higher in women (35.6%) compared to men (30.1%) [p=0.008]. There was a higher IR prevalence in men living in urban areas (p=0.001), not in women. The multivariate logistic regression analysis showed that gender, serum glucose level, serum levels of triglycerides and high-density lipoprotein cholesterol, bodymass index and income status were associated with insulin resistance. CONCLUSION: The cut-off values of HOMA1-IR and HOMA2-IR were determined in this study and we believe that these findings will be helpful to clinicians in the fight against health problems such as diabetes.

An evaluation of the mourning tradition, the "First Feast," in the context of palliative care: The possibility of incorporating cultural rituals into palliative care.

OBJECTIVE: Grief is intertwined with cultural and religious rituals that are highly appreciated in the quality standards of palliative care. Here, we aimed to investigate whether a cultural mourning ritual, the "First Feast," can be used by palliative care teams to ease the grief response of the deceased patient's relatives. METHOD: A questionnaire with 23 questions about the prevalence of the First Feast tradition, the content, the pros and cons, and whether it would be useful for the grieving relatives of deceased patients was prepared and given to the palliative care patients' relatives. The data were evaluated using the chi-square test. RESULT: A total of 427 participants were enrolled in the study; 60.7% were female and the mean age was 36 (±13.4). A total of 76.8% of the participants were from the Tokat region and 77.8% (n = 332) performed the First Feast tradition. A significant difference was observed among participants with Tokat origins and non-Tokat origins in terms of awareness of the tradition (84.8% and 69.7%, respectively; p = 0.001). Ninety-one percent of the participants acknowledged that the tradition helped to ease the grief response of the relatives. SIGNIFICANCE OF RESULTS: The First Feast, a mourning tradition performed in Tokat and other parts of Turkey, might be a useful auxiliary method for palliative care teams to help grieving families.

Investigation of Behçet's Disease and Recurrent Aphthous Stomatitis Frequency: The Highest Prevalence in Turkey.

BACKGROUND: The Recurrent Aphthous Stomatitis (RAS) is the most frequently observed painful pathology of the oral mucosa in the society. It appears mostly in idiopathic form; however, it may also be related with systemic diseases like Behçet's Disease (BD). AIMS: Determining the prevalence of RAS and BD in the Northern Anatolian Region, which is one of the important routes on the Antique Silk Road. STUDY DESIGN: Cross-sectional study. METHODS: Overall, 85 separate exemplification groups were formed to reflect the population density, and the demographic data of the region they represent. In the first stage, the individuals, who were selected in random order, were invited to a Family Physician Unit at a certain date and time. The dermatological examinations of the volunteering individuals were performed by only 3 dermatology specialists. In the second stage, those individuals who had symptoms of BD were invited to our hospital, and the Pathergy Test and eye examinations were performed. RESULTS: The annual prevalence of RAS was determined as 10.84%. The annual prevalence was determined to be higher in women than in men (p=0.000). It was observed that the prevalence was at the peak level in the 3(rd) decade, and then decreased proportionally in the following decades (p=0.000). It was also observed that the aphtha recurrence decreased in the following decades (p=0.048). The Behçet's prevalence was found to be 0.60%. The prevalence in women was found to be higher than in men (0.86% female, 0.14% male; p=0.022). CONCLUSION: While the RAS prevalence ratio was at an average value when compared with the other societies; the BD prevalence was found as the highest ratio in the world according to the literature.

[Hypovitaminosis D in Children with Hashimoto’s Thyroiditis]. / Hipovitaminosis D en niños con tiroiditis de Hashimoto.

BACKGROUND: Vitamin D deficiency or insufficiency may play a role in the pathogenesis of certain autoimmune diseases. AIM: To measure vitamin D levels in children with Hashimoto’s thyroiditis (HT) (either with subclinical or marked hypothyroidism) and in healthy controls. MATERIAL AND METHODS: We included 68 children with HT aged 12 ± 4 years (39 females) from a pediatric outpatient clinic and 68 healthy children aged 10 ± 4 years (37 females). Calcium metabolism parameters, thyroid function tests and anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG) and 25 hydroxy vitamin D (25OHD) levels were measured. RESULTS: Patients were older than controls but well matched by gender distribution. Mean 25OHD levels were significantly lower in HT patients than controls (16.8 ± 9.3 and 24.1 ± 9.4 ng/mL respectively, P < 0.01). Frequency of vitamin D deficiency was 76 and 35% in HT patients and controls, respectively (P < 0.001). CONCLUSIONS: Vitamin D deficiency is more common in children with HT than healthy controls.

Prevalence and related factors of psoriasis and seborrheic dermatitis: a community-based study.

BACKGROUND/AIM: We aimed to determine the prevalence of psoriasis (PS) and seborrheic dermatitis (SD) (erythematous-squamous diseases) in our region and reveal the frequently encountered associated factors to aid in planning appropriate healthcare. MATERIALS AND METHODS: A community-based study was conducted with 85 sample groups that reflected the population rate and demography of Tokat Province in northern Anatolia. RESULTS: In this community, the prevalence of PS in people older than 20 years of age was 1.2% and the prevalence of SD was 5.2%. SD rates were higher in patients who used tobacco and especially alcohol. SD prevalence was also higher in patients treated for depression and epilepsy. Furthermore, as education levels increased, SD prevalence increased proportionally. CONCLUSION: In general, PS prevalence in this region was higher than in Asia and Africa but lower than in Europe and the United States. Whereas SD prevalence varies between 2% and 12% throughout the world, the average SD prevalence was 5.2% in this study.

Prevalence of hypercalciuria and urinary calcium excretion in school-aged children in the province of Tokat.

AIM: Hypercalciuria is an important cause of urinary tract symptoms, and also frequently results in urolithiasis. Urinary calcium excretion varies for geographic areas. We aimed to assess percentiles of urinary calcium excretion and prevalence of hypercalciuria for school-aged children in Tokat (city located in inner northern region of Turkey). MATERIAL AND METHODS: One thousand three hundred seventy-five children aged 6 to 18 years were enrolled in the study. Urine samples were obtained randomly. The children's variables as sex, age, length, and weight were recorded. Urinary calcium and creatinine determined from the urine samples and urinary calcium/creatinine ratios (mg/mg) were calculated. Percentiles of urinary calcium/creatinine ratios were also assessed for each age of the children. RESULTS: Six hundred eighty-three of the 1 375 children were girls and 692 were boys. The mean age of the children was 11.68±3.43 years. Some 23.9% of the children were living in rural regions and 76.1% were were living in urban regions. The mean urinary calcium/creatinine ratio was 0.080±0.24 and the 95th percentile value of the urinary calcium/creatinine ratio was 0.278. The hypercalciuria prevalence for school-aged children was 4.7% when the urinary calcium/creatinine ratio value for hypercalciuria was accepted as ≥0.21. The prevalence of hypercalciuria in rural and urban regions was 7.60% and 3.82%, respectively (p<0.05). Hypercalciuria was present in 7 of 141 patients who were obese (4.96%) and 58 of 1 234 patients who were not obese (4.70%) (p>0.05). CONCLUSION: The prevalence of hypercalciuria and urinary calcium excretion vary for different geographic areas, not only for countries. The percentiles of urinary calcium excretion should be assesed for every geographic region and the prevalance of hypercalciuria should be determined with these values. There is controversy as to whether obesity is a risk factor for hypercalciuria.

Prevalence and types of androgenetic alopecia in north Anatolian population: A community-based study.

OBJECTIVE: To determine the prevalence and pattern of androgenetic alopecia in Turkey and to compare the results with different regions. METHODS: The community-based study was carried out from September 2012 to June 2013 across all the 12 districts of Tokat province of Turkey. Individuals 20-years-old or older were included, and more than two first-degree relatives were excluded. Dermatological examination of all the subjects was performed by dermatologists. The degree of androgenetic alopecia was classified according to the Hamilton-Norwood and Ludwig classifications. RESULTS: Of the 2322 volunteers, 1288(55.46%) were women and 1034(44.53%) were men. Overall mean age was 47.3±15.3 years (range: 20-87 years). Androgenetic alopecia was detected in 740(31.8%) subjects; 247(19.17%) women and 493(47.6%) men. CONCLUSIONS: The prevalence of androgenetic alopecia in Turkish society was higher than Asian and African communities; and similar to the rate in European societies hair-loss.

[The evaluation of the symptom clusters in patients with the diagnosis of terminal stage cancer]. / Son dönem kanser hastalarinda semptom kümelerinin incelenmesi.

OBJECTIVES: Palliative care has been developing rapidly throughout the world. A substantial number of palliative care patients are advanced cancer patients. Terminal cancer patients suffer from groups of symptoms called symptom clusters, rather than from individual independent symptoms. The aim of this study is to evaluate the symptoms of terminal cancer patients retrospectively and to present the symptom clusters of these patients. METHODS: After ethical approval was obtained, a total of 113 (74 female, 39 male) patients with the diagnosis of the terminal stage cancer were retrospectively evaluated in Gaziosmanpasa University, Department of Anesthesiology and Reanimation between January 2011 and January 2013. Patient records were used to obtain medical history, physical examination findings, patient complaints, accompanying persons, primary cancer site, and metastasis sites. Symptoms such as fatigue, pain, vomiting, loss of appetite,insomnia, constipation, cough and dyspnea were assessed with the Edmonton Symptom Assessment System scale (0: None, 10: Worst possible). The symptom clusters were constructed using hierarchical symptom cluster analysis. RESULTS: The mean age was 64.51 ± 11.38 years. Patients were referred to our outpatient clinic from Departments of General Surgery, Emergency Medicine, Urology, Oncology, Ear-Nose-Throat, Thoracic Surgery, Internal Medicine and Neurosurgery. Fatigue was the most-detected symptom (98.2%). Three symptom clusters were identified: nausea-vomiting-loss of appetite-constipation, dyspnea-cough, and fatigue-pain-insomnia. CONCLUSION: Although palliative cancer patients were referred mainly with the symptom of pain, at least three symptom clusters were detected. The management of terminal stage cancer patients should focus on symptom clusters rather than individual symptoms.

Oxidative stress status in patients with melasma.

BACKGROUND: Melasma is an acquired skin disease characterized clinically by development of gray-brown macules or patches. The lesions have geographic borders and most often seen on face and less frequently on the neck and forearms. Pathogenesis has not been completely understood yet. Although the disease constitutes a very disturbing cosmetic problem, it has not obtained an efficient treatment. There were not any studies in the literature that evaluates the role of oxidative stress in melasma. OBJECTIVES: The evaluation of the role of oxidative stress in melasma. METHODS: Fifty melasma patients and 50 healthy volunteers were included in the study. The diagnosis was made clinically and the patients were evaluated by Melasma Area Severity Index. Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) enzyme activities and malondialdehyde, nitric oxide, protein carbonyl levels were measured both in the melasma group and the control group. RESULTS: SOD and GSH-Px enzyme activities were significantly higher in the patient group in comparison with the control group (p < 0.001). Protein carbonyl levels were significantly lower in the patient group (p < 0.001). CONCLUSION: The results show that the balance between oxidant and anti-oxidants was disrupted and the oxidative stress increased in melasma. These results improve the understanding of etiology-pathogenesis of the disease and its treatment.

Decreased central corneal thickness in ankylosing spondylitis.

Central corneal thickness and dry eye tests were evaluated in a study population consisting of 68 ankylosing spondylitis patients diagnosed according to the modified New York criteria, and 61 age-matched controls without ankylosing spondylitis. A full ophthalmological evaluation was performed on each subject. All subjects were screened for age, gender, HLA-B27, tear break-up time test, Schirmer test, and duration of disease. Central corneal thickness was measured under topical anesthesia with an ultrasonic pachymeter. The mean central corneal thickness was 537.3 ± 30.6 µm, range 462-600 µm, in ankylosing spondylitis patients, whereas it was 551.7 ± 25.2 µm, range 510-620 µm, in controls (p = 0.005). The Schirmer test result was 7.3 ± 5.9 mm for the ankylosing spondylitis patients and 11.7 ± 5.8 mm for the control group (p = 0.002). Tear break-up time was 7.3 ± 3.2 s for the ankylosing spondylitis patients and 14.0 ± 4.5 s for the control group (p < 0.001). The possibility of a thinner cornea should be taken into consideration in ankylosing spondylitis. In addition, attention must be given to lower dry eye tests in surgical interventions such as photorefractive keratectomy and laser in situ keratomileusis in ankylosing spondylitis patients.

Opinion of women about elective abortion.

OBJECTIVE: The aim of this study was to investigate the opinions of women who presented to the hospital for elective abortion. MATERIALS AND METHODS: This descriptive study was designed and conducted at our university hospital between March 2013-April 2013 by the method of face-to-face interviews with 500 women who presented to the hospital as patient or relatives of patients. Poll consisted of 6 questions about demographic characteristics and 14 questions evaluating the opinions and attitudes about abortion. RESULTS: The age of the women who participated in the study was ranging between 18 and 75 years with the mean age of 31.5±11.9 years. Twenty-six women (5.2%) were illiterate, while 109 (21.8%) were university graduates. 70.8% of women stated that they were against elective abortion. Among the reasons against abortion on request were: "forbidden by the religion"-53.1% of women, "against human rights"-35.3%, and "unhealthy for the mother"-7.1% of women. About the prohibition of abortion, 82.4% of women said that "it may be performed under necessary conditions", 9.6% "it should be completely forbidden", and 8% stated that "it should never be forbidden". CONCLUSION: A large number of respondents reported that they have negative attitude towards elective abortion, however, in case of medical necessity, abortion should be performed. During the legal arrangements done about situations that may affect the public health, such as abortion regulations, we believe it would be useful to assess the perspective of the society on this issue.