The Prevalence of Asthma and Asthma-Like Symptoms among Seasonal Agricultural Workers.

AIM: The aim of the study was to determine the prevalence and risk factors of asthma and asthma-like symptoms in seasonal agricultural workers living in fields with toxic chemical exposure. METHODS: European Community Respiratory Health Survey (ECRHS) questionnaire was used to assess the prevalence of asthma and asthma-like symptoms in the study. RESULTS: Of the study group, 51.1% (267) were male and the age of the study group ranged from 18 to 88 years and the mean (SD) was 45.68 (13.39) years. The prevalence of asthma attacks in seasonal agricultural workers in the last one year (current prevalence) was 11.2%; the prevalence of asthma (cumulative prevalence) was 15.1%. In the study, smoking was found to be an important risk factor for current asthma. The prevalence of cumulative asthma was higher in seasonal agricultural workers with allergic rhinitis (p < 0.05 for each). CONCLUSIONS: Seasonal agricultural workers are exposed to the worst conditions of working groups. These difficult conditions also cause many health problems. Asthma has also been identified as an important health problem among seasonal agricultural workers.

Prevalence of comorbid diseases in patients with fibromyalgia: A retrospective cross-sectional study.

OBJECTIVE: To examine the prevalence of comorbid conditions in patients diagnosed with fibromyalgia. METHODS: The retrospective cross-sectional study was conducted at Eskisehir Osmangazi University, Eskisehir, Turkey, and comprised data of fibromyalgia patients aged 18 years or more admitted between January 1, 2012 and August 15, 2016. Hospital's database was investigated using the International Classification of Diseases, 10th Revision codes to identify fibromyalgia cases and predetermined comorbid conditions. SPSS 21 was used for data analysis. RESULTS: Of 509 patients, 51(10%) were males and 458(90%) were females with an overall mean age of 50.24±12.32 years. Of the total, 345(67.8%) patients had at least one comorbid disease, while 164(32.2%) had no comorbid disease. The most prevalent condition was cardiovascular diseases in 187(36.7%) patients followed by endocrine diseases in 157(30.8%). CONCLUSIONS: Fibromyalgia is a disease that is seen to be increasing in frequency in recent years. It is useful to evaluate fibromyalgia patients with their comorbid conditions on their follow-up.

Changes in primary care provision in Turkey: A comparison of 1993 and 2012.

Since the early 1990s, the primary care system in Turkey has undergone fundamental changes. In the first decade of the millennium family doctor scheme was introduced to the Turkish primary care sector and the name of the primary care doctors (PCDs) changed from "general practitioner" (GP) to "family doctor" (FD). This study aims to give an insight into those changes and to compare the service profiles of PCDs in 1993 and 2012. Data, based on cross sectional surveys among Turkish doctors working in primary care are derived from the 1993 European GP Task Profile study (n=199) and the 2012 Quality and Costs of Primary Care in Europe (QUALICOPC) study (n=299). The study focuses on the changes in the primary care service provision based on selected aspects such as the first contact of care, preventive care, and the knowledge exchange and collaboration with other health professionals. Compared to GPs in 1993, FDs in 2012 reported that their involvement in treatment of chronic diseases, first contact care, antenatal and child health care have increased. FDs have more contact with other primary healthcare workers but their contact with hospital consultants have decreased. Overall, the services provided by PCDs seem to be expanded. However, the quality of care given by FDs and its effects on health indicators are needed to be explored by further studies.

Factors Affecting Mortality and Complications in Mushroom Poisonings Over a 20 Year Period: A Report from Central Anatolia.

OBJECTIVES: Mushroom poisoning (MP) is one of the world's leading seasonal and regional health problems. The aim of this study was to analyze the relationship between clinical factors and outcomes of mushroom poisoning. METHODS: The study was conducted in the emergency department. The patients who presented between January 1st, 1991 and December 31, 2010 were retrospectively reviewed. RESULTS: 599 MP cases were enrolled into the statistical analysis. The elderly group had a higher rate of mortality (8.8%) and complications (12.3%) (p=0.005) (OR 3.98, 95% CI: 1.9291 to 8.2290; p=0.0002). The patients who presented in summer had a higher rate of mortality (9.5%) and complications (11.9%) (p≤0.001). (OR: 3.83, 95% CI 1.7068 to 8.6074, p=0.0011). The rate of mortality and complications in patients who had eaten self-harvested wild mushrooms (WM) was 6.8%, while those who purchased WM had a mortality and complication rate of 15.2% (p=0.016), (Purchased WM OR 2.46, 95% CI 1.1609 to 5.2353, p=0.0189). The rate of mortality and complications in the patients who presented with gastrointestinal symptoms was 9.9% (OR: 3.98, 95% CI 1.5503 to 10.2679; p=0.0041). CONCLUSIONS: Factors such as being elderly, summer season, purchased WM, and gastrointestinal symptoms were significantly associated with mortality and complications in our study.

Occupational allergic diseases in kitchen and health care workers: an underestimated health issue.

OBJECTIVE: This study evaluated the frequencies of allergic symptoms and rate of upper respiratory infections during the past year in the general population, kitchen workers (KW) and health care workers (HCW). METHODS: The European Community Respiratory Health Survey (ECRHS) was used to inquire retrospectively about asthma and asthma-like symptoms and the number of treatments required for previous upper respiratory tract infections (URTI: acute pharyngitis, acute sinusitis, etc.) during the past year for health care workers, kitchen workers, and members of the general population. Adjusted odds ratios by gender, age, and smoking status were calculated. RESULTS: 579 subjects (186 from the general population, 205 KW, and 188 HCW; 263 females, 316 males) participated in the study. Noninfectious (allergic) rhinitis was significantly higher in the HCW and KW groups than in the general population (P < 0.001). Cumulative asthma was significantly higher only in the HCW group (P < 0.05). In addition, the HCW and KW groups had significantly higher risks of ≥2/year URTI (OR: 1.59, 95% CI: 1.07-2.38 versus OR: 1.57, 95% CI: 1.05-2.38) than the general population. CONCLUSION: Occupational allergic respiratory diseases are an important and growing health issue. Health care providers should become familiar with workplace environments and environmental causes of occupational rhinitis and asthma.

Inappropriate use of nonsteroidal anti-inflammatory drugs and other drugs in chronic kidney disease patients without renal replacement therapy.

OBJECTIVE: The main goal of chronic kidney disease (CKD) treatment is the prevention of progression of the disease and complications. Inappropriate drug use in patients with CKD is an important issue, which may cause adverse effects on patients and progression of chronic renal failure. The aim of this study is to find the rate of inappropriate drug use among CKD patients. METHODS: The subjects of this study were selected from the patients with a CKD history of minimum one year, who did not receive renal replacement therapy. Patients were asked to provide a digital record of the drugs they used over the last one year. Individually, for each patient, the drugs that may be contraindicative and that require dose adjustment were identified based on glomerular filtration rate (GFR). RESULTS: This study includes a total of 185 participants - 97 female (52.4%) and 88 male (47.6%) patients. The average age of patients was 60.50 ± 14.56. It was shown that 149 patients (80.5%) were using inappropriate drugs. Seventy (47.0%) were using one, 79 (53.0%) two, 30 (20/1%) three, and 9 (6.4%) four inappropriate drugs. Of CKD patients, 44.3% were aged 65 or over; and in this age group, inappropriate drug use was more frequent compared to the population below 65 (86.6% vs. 75.7%). The drugs used inappropriately were, respectively, nonsteroidal anti-inflammatory drugs (65.8%), quinolone antibiotics (39.0%), ACE inhibitors (26.9%). DISCUSSION: Health professionals are required to consider renal functions of all patients, mainly those aged over 65, when administering a treatment.

Results of a national study on the awareness of and attitudes toward acute otitis media (AOM) among clinicians and the estimated direct healthcare costs in Turkey (TR-AOM Study).

AIMS: Acute otitis media (AOM) is one of the most frequent diagnoses and reasons for prescribing antibiotics in children. The aims of this prospective study were the following: (1) to assess the continuing education of physicians and the sources of information about AOM; (2) to assess the current knowledge of and attitudes toward AOM as well as the compliance with AOM guidelines; (3) to evaluate opinions about vaccines against AOM; and (4) to estimate the potential costs of AOM on the healthcare system in Turkey. METHODS: This is a web-based cross-sectional survey of a national convenience sample of 600 physicians in Turkey (325 pediatricians (PEDs), 214 family physicians/general practitioners (FP&GPs) and 61 otolaryngologists (ENTs)). RESULTS: Approximately 38.6% of participants (39.4% of PEDs, 44.3% of GP&FPs and 14.7% of ENTs) stated that pneumatic otoscopy is essential for AOM diagnosis. Regarding the most common etiological agents of AOM in children, 54.2% of PEDs, 51.4% of FP&GPs and 57.4% of ENTs stated that the most common causative agents of AOM are Streptococcus pneumoniae and non-typeable Haemophilus influenzae. Nearly 76% of participants indicated they use direct antibiotic therapy when they diagnose AOM in certain situations. The first-line choice of antibiotic therapy is amoxicillin clavulanate, and 67% of participants prefer to use antibiotic therapy for 7-10 days. Approximately 31% of all participants stated that "viruses" are the main cause of AOM; however, 62% of these participants reported using antibiotic therapy. In comparison, 32% participants from private clinics prefer to treat AOM primarily with observation, a rate that is significantly higher than that of other clinical settings. Physicians who prefer to use observation strategy also prefer the combination of paracetamol and NSAIDs. Approximately 41% of participants have undergone postgraduate medical education on the topic of AOM. In total, 73% of all participant physicians believe that otitis media is a vaccine-preventable disease. With the information from all of the participants, the calculated mean cost per case of AOM is 28 ± 4 USD. In Turkey, the estimated incidence of AOM is 24,000-33,000 cases per 10,000 children <5 years of age (1,820,000-2,100,000 cases per year), and the estimated total cost of AOM is 61,152,000 USD (not including acute otitis media-related complications and otitis media-related hospitalizations). CONCLUSION: The medical and economic burden of AOM to the health economics in Turkey is considerable. Specific educational programs and evidence-based national guidelines concerning AOM should be implemented. Improving diagnostic accuracy with education will lead to improved management, judicious use of antibiotics, decreased antibiotic resistance, and potential economic benefits. A more prudent use of antibiotics would also lower the economic burden of this disease. Vaccination seems to be promising for the prevention of AOM.

The Prevalence of Psychiatric Disorders Distribution of Subjects Gender and its Relationship with Psychiatric Help-Seeking.

INTRODUCTION: The aim of this study was to investigate the prevalance of psychiatric disorders and psychiatric help-seeking behaviours in central Eskisehir according to sociodemographic variables. METHOD: In this study, for the purpose of revealing the psychiatric disorder profile of Eskisehir city and evaluating the prevalance of psychiatric disorders according to gender differences and psychiatric help-seeking behaviours; The Primary Care Evaluation of Mental Disorders (PRIME-MD) scale and psychiatric help questionnaire were administered to 1475 subjects who were randomly selected from 24 primary health care centers in Eskisehir. RESULTS: The prevalence of psychiatric disorders was as follows: at least one mood disorder 37%, anxiety disorders 29%, somatoform disorders - 8.6% and, possible alcohol abuse 7.7%. All diagnoses except possible alcohol abuse were found to be more frequent in women than men. Also It was found that in subjects who were thougth to have a psychiatric disorder, 64% of mood disorder patients, 67% of anxiety disorder patients, 70% of somatoform disorder patients and, 61% of possible alcohol abuse patients can receive appropriate treatment. DISCUSSION: Since psychiatric disorders are common, it is important to direct such patients to appropriate treatment. Therefore, new studies are necessary to find out the prevalance of psychiatric disorders and risky groups as well as to identify the reasons that why such people do not seek for help in different regions of our country.

Residents' views about family medicine specialty education in Turkey.

BACKGROUND: Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. METHODS: This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27) and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11) by e-mail and by personal contact. RESULTS: A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%). Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e-learning. Participation in courses and congresses was considered necessary. The presence of a department office and the clinical competency of the educators were more favored by state residents. CONCLUSIONS: This study gave the Board the chance to determine the needs of the residents that had not been taken into consideration sufficiently before. The length and the content of the programme will be revised according to the needs of the residents.

Development of family medicine in the middle East.

This paper outlines the development of family medicine in seven Middle Eastern countries. Some of the first family medicine activity occurred in Turkey in 1961, in Bahrain in 1978, in Lebanon in 1979, in Jordan in 1981, and in Kuwait in 1983. Family medicine programs have also been established in Qatar, the United Arab Emirates, Libya, and Iraq. In most programs, family medicine training occurs largely in hospitals, even though few Middle Eastern family physicians practice in hospitals after completion of residency training. Thus, there is a need for better outpatient training, but resistance from those responsible for traditional medical education makes it difficult to change the current model of family medicine education. There is also need for better opportunities for professional development after graduation and for establishing research activity in family medicine.

Use of emergency departments by elderly patients in a city of Western Turkey.

OBJECTIVE: To evaluate the reasons behind the demographic characteristics of patients presented to emergency departments. METHODS: The entire patient records of all the hospitals' emergency departments in the city of Eskisehir were retrospectively assessed in this study. The study was conducted between the years 1998 and 2000. Data were evaluated using chi2, t-tests, and percent rates. RESULTS: Of 608,528 patients visiting the emergency departments, 79 123 (13.0%) were elderly patients. The treatment and discharge rate was 78.3%. Mean admission rate was 21.2%. The death rate during the visits was 0.4%. The proportion of the five most frequently seen diseases was 41.9%. CONCLUSION: Demographical trends show that emergency department visits by elderly patients would increase in time. So, in Turkey, emergency department staff should be trained to provide for the special needs of this population in emergency departments.

Attitudes to and management of fertility among primary health care physicians in Turkey: an epidemiological study.

BACKGROUND: The subject of infertility has taken its place in the health sector at the top level. Since primary health care services are insufficient, most people, especially women, keep on suffering from it all over the world, namely in underdeveloped or developing countries. The aim of this study was to determine primary care physicians' opinions about the approach to infertility cases and their place within primary health care services (PHCSs). METHODS: The study was conducted between October 2003 and April 2004. The study group comprised 748 physicians working in PHCSs. They were asked to fill in a questionnaire with questions pertaining to infertility support, laboratory and treatment algorithms, as well as the demographic characteristics. The data was evaluated using the chi square test, percentage rates and a logistic regression model. RESULTS: The multivariate analyses showed that having a previous interest in infertility and having worked for a postgraduate period of between 5-9 years and > or = 10 years were the variables that most positively influenced them in their approach to cases of infertility (p < 0.05, each one). Just 28.7% of the physicians indicated that they believed cases of infertility could be evaluated at the primary care level. The most frequently proposed reason for indicating 'difficulty in practice' (n = 533) was inadequate provision of equipment in PHCSs (55.7%). The physicians reported that they were able to perform most of the supportive treatments and proposals (between 64.6%-87.7%). The most requested laboratory investigations were the instruction of patients in taking basal body temperatures and semen analysis (89.7% and 88.7%, respectively). The most preferential course of treatment was that of sexually transmitted diseases (95.5%). CONCLUSION: It is clear that not enough importance is attached to the provision of care to infertile couples within PHCSs. This leads us to conclude that an integration of infertility services in primary care would be appropriate after strengthening the PHCSs.

Antibiotic prescribing patterns for sore throat infections in a university-based primary care clinic.

BACKGROUND: Recent studies reveal that a high percentage (over 50%) of episodes for upper respiratory tract infections (URTIs) are treated with antibiotics, regardless of appropriateness or the necessity for prescription. We identified antibiotic prescriptions in a primary health care centre (PHC) and evaluated their suitability for sore throat infections. We also explored whether symptoms, signs, diagnosis and antibiotics prescribed differed by gender. PATIENTS AND METHODS: We collected data on all patients visiting the centre over a period of 12 weeks with a main complaint of sore throat who were prescribed antibiotics after taking a blood count and throat culture. Patients older than 16 years of age were included in the study irrespective of sex, nationality, marital status, occupation or location of residence. The chi square (chi2) statistical test was used in comparing categorical variables. A P value of < 0.05 was considered significant. RESULTS: During the period of study, 579 patients with URTIs presented to the health centre, from which 339 patients with a sore throat were enrolled. Of the study group, 48.7% (165) were male and 51.3% (174) female, with the majority of patients being under 30 years old (54.3%). Throat cultures were positive in 56 patients (16.5%). Most of patients were diagnosed as having pharyngitis (22.7%), and the most frequently prescribed medicine was an oral penicillin (39.1%). Two hundred eight-six patients (84.4%) had 2 or fewer Centor criteria. CONCLUSIONS: Throat cultures were positive in only 16.5% of the patients prescribed antibiotics. This indicates that physicians in the health centre of the university are prescribing antibiotics inappropriately and inconsistently. This also highlights the need for more prescriber education, especially as the range of medications available to the general practitioner for prescribing increases.

Assessment of cardiac autonomic regulation in children with monosymptomatic nocturnal enuresis by analysis of heart rate variability.

The pathogenesis of monosymptomatic nocturnal enuresis is controversial. Various urodynamic studies showed bladder hyperactivity in enuretic children. But the exact cause is not precisely known. The aim of this study was to understand whether the autonomic nervous system dysfunction is involved in this bladder hyperactivity or not. Heart rate variability measurement is widely used for evaluation of cardiac autonomic activity. We evaluated cardiac autonomic nervous system functions in monosymptomatic nocturnal enuretic children by using 24-hour Holter electrocardiogram. The study group consisted of 32 enuretic children (20 boys and 12 girls) and the control group consisted of 20 healthy children (12 boys and 8 girls). In these two groups, we assessed cardiac autonomic regulation by analysis of heart rate variability, and found a significantly higher parasympathetic activity in enuretic children than controls. We suggest that the parasympathetic nervous system hyperactivity plays a role in nocturnal enuresis by causing vesical hyperactivity in monosymptomatic enuretic children.

Triage in terms of medicine and ethics.

Human beings are exposed to countless extraordinary events provoked by the nature or by themselves. When the available resources fail to satisfy the medical needs of numerous injured people and patients in such circumstances, triage application which means "selecting, sorting" is indispensable. This paper examines the medical ethics evaluation of triage and its position in Islam.