The correlation between fear of falling and upper extremity muscle strength.

OBJECTIVES: To determine the relationship between fear of falling (FOF) and upper extremity muscle strength. METHODS: This cross-sectional study included 112 hospitalized, mobile patients. Forty-seven (42%) were males and 65 (58%) were females, and the mean age was 72.3. The study was carried out between September 2018 and September 2019 at Balikli Rum Hospital Nursing Homes, Istanbul, Turkey. Patients were tested using geriatric tools (such as Mini-Mental State Examination) and physical tests such as handgrip, key pinch and 6-meter up and go tests. RESULTS: The average annual falling number of elderly people with FOF was statistically significantly higher than that in those without FOF (p=0.001). Right handgrip, left handgrip, right key pinch, and left key-pinch mean values in elderly individuals with FOF were statistically significantly lower than those without FOF (p< 0.001, p< 0.001, p< 0.001, p< 0.001, respectively). CONCLUSION: The measurement of upper extremity strength could be a predicting parameter of FOF.

Ethical considerations at the end-of-life care.

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients' desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients' family members and society as well as the patients, it is important to protect the rights, dignity, and vigor of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care. The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide. Five ethical principles guide healthcare professionals in the management of these situations.

Assessment of Knowledge and Attitudes of Patients About Cancer Screenings in Primary Care.

Incidence of cancer is increasing in the developing countries such as Turkey. Screenings are important part of preventive medicine practices which can reduce deaths due to cancer. Our aim was to identify patient's awareness and knowledge level of cancers and screenings and to create a road map of what we need to do to increase screening rates. This study was a descriptive type, and the research population was the patients between the age of 30 and 75, who went to 18 different Family Health Centres in different places in Turkey for any reason in July-September 2016. The survey was completed by face-to-face interview and consisted of 20 questions about the socio-demographic attributes, level of cancer and cancer screenings knowledge, causes of screening, and reasons for not doing. Screening rates was self-reported by patients. A total of 643 patients, 394 women (61.3%) and 249 men (38.7%), participated in the study. The average age was 45.67 ± 11.49. The most well-known cancer type was breast cancer (79%). Having no screening was high in general population (64.7%). Having a screening was statistically significantly higher in women, over 50 year olds group, divorced/widower group, housewives, primary school graduates, the group who have green-card (having very low or no income) as social security, and in the group who have a history of family member with cancer. 55.8% of patients received the information about screenings from healthcare professionals. The reasons for not having a screening were "not seeing themselves as under risk" (27.4%), not having knowledge (22.8%), and fear of the results (15%). First of all, the importance of cancer screening as an important part of the preventive health services should be understood by family doctors through in-service training. Then family doctors would share the information and experience, clear the lack of knowledge of them and by doing this rates of screening would increase.

Medical Students' Empathy Level Differences by Medical Year, Gender, and Specialty Interest in Akdeniz University.

BACKGROUND: As an important feature in patient-physician communication for both primary and clinical care, empathy is one of the basic competencies that physicians should possess. The primary aim of this study was to evaluate the level of empathy among medical students in all years of medical training using two different instruments: the Jefferson Scale of Physician Empathy (for clinical empathy level) and the Toronto Empathy Questionnaire (for general empathy level). MATERIALS AND METHODS: This study is a cross-sectional descriptive study conducted in 2017-2018 academic year with students studying at Akdeniz University Faculty of Medicine. Data collection form, Toronto Empathy Questionnaire (TEQ) and Jefferson Scale of Physician Empathy (JSPE) was applied to the students by the researchers. The statistical analysis was carried out by using IBM-SPSS version 23 for Mac OS. T-test, ANOVA test, Spearman and Pearson correlation analysis were used for comparisons. RESULTS: The mean TEQ score of the students was 52.8/65 and the JSPE-S score was 80.3/100. TEQ scores of students increased up to 4th year and then decreased, but the difference between the years was not statistically significant. The third year students' JSPE-S scores were significantly higher than that of the sixth year students. CONCLUSION: While the clinical empathy levels of medical students decreased significantly after 3rd year, the general empathy levels decreased less. This result shows us that we should review our medical education curriculum and educational environment, and should initiate initiatives, and devote more time to empathy education in order to prevent the decrease in empathy level and increase empathy during medical education.

Sacral stress fracture in an amateur golf player: a case report and literature review.

Sacral stress fractures are rare injuries among professional and amateur athletes and are considered to be an uncommon source of low back pain. These type of fractures are mainly seen in competitive, high-impact sports, most commonly in long-distance runners. Sacral stress fractures are usually overlooked in young patients presenting with low back pain without any trauma history. Diagnosis of sacral stress fractures is often delayed because the history and physical examination of these patients are not specific and conventional radiographic images are frequently inadequate. A high index of clinical suspicion and further radiologic imaging such as MRI utilization can provide the accurate diagnosis. The treatment mainly includes rest, pain control, nutritional support, and biomechanical optimization. Herein, we report the case of a woman amateur golf player with a sacral stress fracture who complained of aggravating low back pain. To the best of our knowledge, this appears to be the first report of a sacral stress fracture in a golf player and also the first case of this pathology in low-impact sports. Therefore, physicians should keep in mind that stress fractures can also be seen in low-impact sports. We recommend considering stress fractures in the differential diagnosis of non-traumatic, aggravating low back pain in golfers.

Assessment of Knowledge and Preferences Regarding Advance Directives Among Patients in University Family Medicine Outpatient Clinics.

Aim: The aim of this study is to draw attention to the subject of "advanced directives," to create awareness, whether or not they want to investigate to determine the preferences for medical care and applications in the period of end-of-life while individuals can specify their preferences and wishes for medical decisions and take steps for it. Materials and Methods: The study was carried out on individuals aged 20 years and older in family medicine outpatient clinics. A questionnaire consisting of 30 questions was applied to 300 people who volunteered to participate in the study by a face-to-face interview. Results: Of all participants, 70% had not heard of advance directives (ADs) before this survey. Three quarters of participants thought that advanced directives were necessary. The rate of requesting cardiopulmonary resuscitation (CPR) to prolong survival in the case of end-of-life care was 55%; the rate of requesting the continuation of life-sustaining treatment was 24%. Conclusion: Most participants want their own decision to be taken into account in end-of-life care. Family physicians should talk to their patients about ADs via effective communication when people are still healthy.

Assessment of Comorbidity and Use of Prescription and Nonprescription Drugs in Patients Above 65 Years Attending Family Medicine Outpatient Clinics.

Background and aim: Aging is often accompanied by chronic diseases, comorbidity, and polypharmacy. Use of prescription/nonprescription drugs, and over-the-counter (OTC) drugs seen frequently in the elderly. The aim of this study was to assess the comorbidity and multimorbidity status and to evaluate the use of prescription and nonprescription drugs in patients aged 65 years. Materials and Methods: In this cross-sectional and descriptive study, statistical analyses were performed using SPSS Version 22.0. Kolmogorov-Smirnov tests were applied based on meeting the assumption of a normal distribution of the data. Other statistical tests used were one-way analysis of variance tests, t tests, Pearson correlation analysis, Chi-square tests, Mann-Whitney U tests, and Spearman correlation analysis. Results: A total of 244 people participated in the study. The multimorbidity rate was 85%. Participants used an average of 4.26 drugs daily. The polypharmacy ratio was 42%. The nonprescription drug usage rate was 20%. Participants used nonprescription drugs most often with the pharmacist's advice. Conclusion: Multimorbidity, comorbidity, prescription, and nonprescription drug use were very high among elderly patients. Because older people are more susceptible to adverse drug reactions and drug interactions, physicians who provide care to older people should take a comprehensive drug history.

DREEM in primary care: students' perspectives on educational environment of family medicine internship in primary care centres: experiences at Akdeniz University Faculty of Medicine in Turkey.

Objective: In many countries, medical education programmes are expanding, and educational environments are starting to change from hospitals to primary health care centres. International organizations for medical education highlight that medical students should also be educated at primary and secondary care centres in addition to third-step health care. In this study, the evaluation of sixth-year (final year) medical students' perspectives on the educational environment of family medicine internship in primary care is presented, using the Dundee Ready Educational Environment Measurement (DREEM)Material and methods: This descriptive cross-sectional study was conducted with sixth-year medical students. Starting in the 2017-2018 academic year, sixth-year medical students started to enrol in educational courses in primary care. A total of 223 students completed internships in primary care for a two-week period, during which we applied the Dundee Ready Educational Environment Measure (DREEM) to evaluate the educational environment at the end of the internship. The collected questionnaires were analysed by using IBM-SPSS version 23 for Mac OS. Student's t-test and Mann-Whitney U Test were used for comparisons.Results: Of the 223 students, 192 (86%) completed the questionnaire. The total DREEM score was 138.62/200 (%63.5). The students rated the learning environment as positive. The mean score for students' perceptions of teaching, students' perceptions of teachers, students' academic self-perceptions, students' perceptions of the atmosphere and students' social self-perceptions were 31.65/48, 30.45/44, 23.46/32, 34.20/48 and were 18.56/28, respectively. The total mean score and subscale scores were not significantly different between males and females.Conclusion: This study suggests that students' perception of the global learning environment in primary care was more positive than negative. The lowest scores were recorded for Students' Perceptions of Learning and Students' Social Self-Perceptions, and the highest score was recorded for Students' Academic Self-Perceptions.

Chronic noncancer pain management in primary care: family medicine physicians' risk assessment of opioid misuse.

OBJECTIVE: The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs' knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse. MATERIALS AND METHODS: The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared. RESULTS: About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant. CONCLUSION: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject.

Family medicine and sports medicine students' perceptions of their educational environment at a primary health care center in Germany: using the DREEM questionnaire.

The medical learning environment is changing progressively due to its crucial importance in clinical learning and educational performance. The purpose of this study was to investigate student perceptions of the medical learning environment at a primary health care center outside of a university hospital using the Dundee Ready Educational Environment Measure (DREEM) questionnaire. Various aspects of the environment were compared between family medicine (FM) and sports medicine (SM) students to assess the role of these different rotations and their effect on student perceptions. The DREEM questionnaire, a validated tool for measuring perceptions of educational environments in medical educational environments, was completed by 110 students who were enrolled in FM and SM rotations at Wuppertal Primary Health Care and Research Center in Wuppertal, Germany. Other than 9 of the 50 items, there were no statistically significant differences in DREEM questionnaire scores between these 2 groups, indicating that students' perceptions of the educational environment were not remarkably affected by their rotations. Scores across the sample were fairly high (FM students, 139.45/200; SM students, 140.05/200; overall total score, 139.85/200). These high scores suggest that students enrolled in FM and SM health science programs generally hold positive perceptions of their course environment outside of the university hospital. The positive perception of the educational environment at this primary health care center is hopefully indicative of similar rotations' perceptions internationally. While future studies are needed to confirm this, the current findings offer a chance to identify and explore the areas that received low scores in greater detail.

Family practice in Turkey: views of family practice residents.

Turkey's family practice training program is aimed at providing further training to clinically proficient family physicians who serve the community. A survey conducted in 2001 revealed that there was a need for providing additional training and more time in a specially dedicated family practice placement for family practitioners. Recent changes in the Turkish health care system have also impacted the training environment of family practice residents. Clearly, training needs to change with time. The aims of this study are to investigate the attitudes of resident family practice physicians regarding their training in the health care system in order to gather their views on the hospital learning environment, and to estimate their burnout levels. For this research, the design included a 1-phase cross-sectional study. This study was undertaken in 2008 in departments of family medicine at universities (n = 21) and training and research hospitals of the Ministry of Health (n = 11). Approximately 250 family practice residents in Turkey were approached. In total, 174 residents participated (70% response rate). The survey instruments included a questionnaire with 25 queries and 2 scales: The Postgraduate Hospital Educational Environment Measure and the Maslach Burnout Questionnaire-Human Services Survey. The average age of the participants was 32.2 years (standard deviation, 4.5 years; range, 24-57 years). The gender distribution was 57.6% women and 42.4% men. Marital status was 34.7% single, 62.9% married, and 2.4% divorced/widowed. In our results, residents affirmed that university hospitals were the best facilities for residency training. Their future plans confirmed that most would like to work in family health centers. This sample showed average levels of emotional exhaustion, depersonalization, and lack of personal accomplishment. Perceptions of professional autonomy, quality of training, and social support were below average. It may be concluded that certain milestones in the development of family practice in Turkey have been fulfilled. The new regulation for postgraduate training has increased the share of family practice training to 50% (18 months). Establishment of educational family health centers has been planned. Introduction of the formative and summative assessment processes in family practice training is anticipated. It is expected that an assessment such as the Membership of the Royal College of General Practitioners (International) (mRCGP[INT]) examination would be helpful for Turkish residents in reaching these goals.

Are caregiving courses useful? An empirical study from Antalya, Turkey.

In 2008, the National Social and Applied Gerontology Society (NSAGS) of Turkey held free caregiving courses for women, caring seniors, as a part of European Union (EU) programs. This course drew great attention and participation was common. The aim of this study was to evaluate the outcome of this course on participants and non-participants of this course. The test-sheet and an envelope with a stamp on it, were sent to the registered addresses of the women who applied for the course. One hundred twenty-four of total 276 questionnaire returned. The average age was 39.4 ± 9.6 years (± S.D.) and the level of education was low. Most of participants (80.6%) lived with the elderly in the same house; 83.9% of them also have a job besides their caring function. Most of the participants (82.1%) were still caring for their patients. The findings presented here are based on the comparison of two groups (i.e., caregivers who attended and who did not attend the course). After caregiving training, participants felt more an "inner peace" when caring for their elderly (p ≤ 0.05). Participants (39.5%) of the course felt more efficient concerning their duty as caregiver. Non-attenders to the course made more negative statements concerning their concentration to their caregiving functioning (55.2% vs. 40.7%) (p ≤ 0.05). Perception on stress showed better results in the group of participants, who attended the course (p<0.05). More attenders (43%) of the course believed they could cope better with stress (p ≤ 0.05). This study showed that caregiving courses might be useful for caregivers of elderly people. The rapid increase of elderly people in need of care, will show a high demand for qualified caregivers. The NSAGS fulfilled an important duty by organizing these caregiving courses. This is an important signal showing that national gerontological organizations in Turkey might address the important needs concerning demographic aging in community.

Habitual tea drinking and bone mineral density in postmenopausal Turkish women: investigation of prevalence of postmenopausal osteoporosis in Turkey (IPPOT Study).

AIM: In this epidemiological report, we assessed the prevalence of osteopenia and osteoporosis (OP) in postmenopausal Turkish women and the relationship between body mass index (BMI), and some nutritional factors (habitual tea, coffee, tobacco, and milk product consumption) with OP. METHODS: This multicenter study was done in postmenopausal women residing in five big cities, in four different regions of Turkey between August and November 2005. An inclusion criterion was being in the postmenopausal period for at least 12 months. A semi-structured questionnaire was completed by face-to-face interview, consisting of closed- and open-ended questions about demographic characteristics, nutritional status, and habits with two or more choices as possible responses. Bone mineral density (BMD) measurements were performed with a MetriScan Densitometer (Alara Inc., CA, USA). RESULTS: Seven hundred twenty-four women were included in the study. The mean age was 57.6 +/- 9.6 years, and mean age at natural menopause was 46.4 +/- 5.6 years. Of the participants, 51% were illiterate. According to WHO classification; 42.5% were normal in terms of BMD, 27.2% had osteopenia, and 30.2% had OP. Women with high education levels had better T-scores (p = 0.019). Increase in BMI also had a positive effect on T-scores (p < 0.0001). A linear correlation was found between age (r= -0.386, p < 0.0001), BMI (r = -0.175, p < 0.0001), and education (r = -0.317, p < 0.0001), with T-scores. The T-scores of women who consumed tea on a regular basis were found to be higher than non-consumers (-1.51 +/- 1.68 vs. -1.09 +/- 1.66; p = 0.070) [when smokers, those who received hormonal therapy (HT), and those > 65 years were excluded]. CONCLUSION: OP was determined in 1/3 of the women. Advanced age (> 65) and being illiterate were negative factors, while high education levels, being overweight, and being treated with HT had a positive effects on BMD. Habitual tea drinking also may have a positive effect on BMD. However, tea drinking was not found to be a statistically significant factor in the present study.