Water consumption habits of a north-western Turkish community: a cross-sectional study.

The aim was to determine the drinking water preferences of people applied to a family health center. This cross-sectional study was carried out from 1 April to 31 May 2022. The data were evaluated using the chi-square test and percent ratios with a significance of p < 0.05. The mean age of all 432 respondents was 48.03 ± 15.86. It was determined that those aged 31-45 had drunk more bottled water (p < 0.01) and more spring water (p < 0.001), than those aged 65 and above and had more purified water (p < 0.001), than women who had more tap water (p < 0.001), than married people who had more demijohn and tap water (p < 0.001, each one), than divorced/widows who had more packaged and purified water (p < 0.001, each one), than the illiterate/literate who had bottled water (p < 0.001, per one) and than those who had no income/people who lived on the state or municipal assistance who had only carboy water (p < 0.001). This study suggests that the biggest factor that positively affected the drinking water preference was the packaging of the water. However, the drinking rates of mains water and spring water were quite low. Convincing the authorities to make the mains water drinkable is of great importance in terms of overcoming the public's distrust of mains water.

Prevalence of postpartum depression in mothers and fathers and its correlates.

AIMS AND OBJECTIVES: To determine the prevalence of postpartum depression and its connections in a group of mothers and their husbands. BACKGROUND: Although postpartum depression in mothers during the postnatal period has been extensively studied, the courses of depression from pregnancy to postpartum and risk factors among mothers and fathers together are not known. DESIGN: A cross-sectional design was used. METHODS: This study included 110 couples registered at a family health centre in western Turkey. For the data collection, the Mother Introduction Form, the Father Introduction Form and the Edinburgh Postpartum Depression Scale were used. The data were analysed by Mann-Whitney U, Kruskal-Wallis, Spearman correlation and logistic regression tests. RESULTS: The prevalence of postpartum depression was 9·1 and 1·8% for mothers and fathers, respectively. The Edinburgh Postpartum Depression Scale average score for mothers was 4·29 ± 5·33 points and 1·12 ± 2·75 points for fathers. The Edinburgh Postpartum Depression Scale scores were significantly higher in mothers who said that their relationship with their husbands was moderate or bad, who felt partly sufficient in the baby care, who were in difficulty in the baby care, who felt anxious for their motherhood and who said that they had not received support from anybody for baby care. The logistic analysis found that those feeling anxious about motherhood were at risk 5·6 times more than the others in developing postpartum depression. CONCLUSION: Both mothers and fathers should be given consulting services about baby care and how they can manage with postpartum depression during postpartum period. RELEVANCE TO CLINICAL PRACTICE: This study highlights the utility of screening for the risk of postpartum depression during pregnancy and also during the early postpartum period.

Menopause status and attitudes in a Turkish midlife female population: an epidemiological study.

BACKGROUND: It is a well accepted status that socio-cultural characteristics may affect the onset of menopause and its characteristics. The aims of this study were to describe the prevalence rates of menopausal symptoms and these symptoms related factors, and to assess the women's attitudes towards some climacteric issues. METHODS: This survey was conducted between Jan., 1st 2008 and March, 31st 2008 to research the menopause status of the female population in a city of western Turkey. The study group consisted of 1551 women selected with a multistage area sampling method: a random sample of individuals aged 40-65 years. The questionnaire included questions pertaining to women's sociodemographic characteristics, women's menopausal status, some statements about the climacteric, use of hormones at menopause or before menopause, and some climacteric myths. The data was analyzed by Chi-square (x2) analysis and percent (%) ratios with a significant value of P < 0.05. RESULTS: The mean age of the women was 49.1 years. Over 90% of the women were of the negative opinion that the climacteric is "the end of youth", "the end of fecundity", and "the end of unclean days". Most women said that cessation of menstrual periods was the most positive thing because they do not have to wait for monthly bleedings, use sanitary equipment, or take birth control methods. There were significant connections between age groups and nearly all the items, with the exception of the items "the end of life" and "the end of fecundity". Among the women, hot flushes were the most common complaint occurring in 96.5% of women: being severe in 32.9%, moderate in 43.1% and mild in 20.4%. This was followed by low backache or muscle pain 95.0% (25.9% severe, 46.0% moderate and mild 23.1%), headache 91.7% (21.9% severe, 34.9% moderate and 34.9% mild) and feeling tired 91.0% (15.3% severe, 38.6% moderate and 37.1% mild). CONCLUSIONS: Most of the women in this study had mixed ideas of opinions concerning the climacteric, and the majority was also suffering from climacteric complaints. This data could assist healthcare providers in the provision of culturally competent health care to midlife Turkish women.

Prevalence of disordered eating and its impact on quality of life among a group of college students in a province of west Turkey.

OBJECTIVE: To determine the prevalence of disordered eating (DE) among a group of college students and assess its impact on quality of life. MATERIAL AND METHODS: This study was conducted between December 15th, 2008 and January 15th, 2009 at a Turkish University. Eating Attitudes Test-40 (EAT-40) was used to identify DE. Health Related Quality of Life (HRQoL) was assessed by Medical Outcomes Study Short Form-36. RESULTS: The prevalence of DE was 6.8%. Presence of any physical defect (OR: 2.657), parents living separately (OR: 3.114), mothers having an education level of secondary school and over (OR: 2.583), and families not having social health insurance (OR: 2.603) were important risk factors (f<0.05). CONCLUSIONS: The HRQoL of those with DE was worse than those without it. Periodic screenings should be done to determine DE cases.

Effectiveness of foot and hand massage in postcesarean pain control in a group of Turkish pregnant women.

The aim of this study was to determine the efficiency of foot and hand massage on reducing postoperative pain in patients who had cesarean operation. This pretest-posttest design study was planned as a randomized controlled experimental study. In the light of the results, it was reported that the reduction in pain intensity was significantly meaningful in both intervention groups when compared to the control group. It was also noted that vital findings were measured comparatively higher before the massage in the test groups, and they were found to be relatively lower in the measurements conducted right before and after the massage, which was considered to be statistically meaningful. Foot and hand massage proved useful as an effective nursing intervention in controlling postoperative pain.

Prevalence of urinary incontinence among women and its impact on quality of life in a semirural area of Western Turkey.

BACKGROUND/AIMS: Urinary incontinence (UI) is a very common and bothersome condition among women, affecting up to 50% of women during their lifetime. Older women are disproportionately affected and often view UI as a normal part of aging, thus precluding contact with medical professionals. The aim of this study was to determine the frequency and risk factors of UI in women aged 20 years or older, as well as to examine its effects on women's quality of life (QOL). METHODS: The study was conducted on 1,585 women aged 20 years and over between January and March 2007. Data were obtained by a face-to-face interview, using a questionnaire consisting of questions pertaining to the women's demographic characteristics, medical and obstetric history and UI. The Short Form-36 (SF-36) scale was used to assess the QOL of the women. RESULTS: The prevalence of UI in this group of women was 49.5%. UI was significantly associated with advanced age (p < 0.05), lower education level (p < or = 0.001), recurrent urinary tract infection (p < 0.001), chronic obstructive pulmonary disease (p < 0.001), diabetes mellitus (p < or = 0.001), a history of nocturnal enuresis in childhood (p < 0.001), taking diuretics (p < 0.05) and body mass index (p < 0.001). When the QOL of the women with and without UI were evaluated, the scores for women without UI were higher than those with mild, moderate or severe UI (p < 0.001 for each). Women with UI of varying severity had lower mean domain scores on the SF-36 than women without UI (p < 0.001 for each). As the severity of UI increased, it was seen that the mean domain scores according to the scale showed a decrease (p < 0.001). CONCLUSION: It is concluded that UI is a common disorder among women in this region of Turkey and that it also negatively affects these women's QOL, suggesting the need for more social and medical study in this area.

Skin prick test reactivity in allergic rhinitis patients to airborne pollens.

The aim was to investigate the impact of atmospheric pollen in determining allergic rhinitis. It was conducted with 130 patients with allergic rhinitis in three different sites in Eskisehir, Turkey, in 2000-2001, using a gravimetric method with a Durham sampler. Skin prick test results, the symptoms of patients and their findings all confirmed the presence of allergic reactions to pollen allergens in the patients observed. During the period, a total of 47,082 pollen grains/cm(2) belonging to 45 taxa were recorded. Of the total pollen grains, 81.0% were arboreal and 18% non-arboreal. The majority of the investigated pollen grains were from Pinaceae, Salix spp., Chenopodiaceae/Amaranthaceae, Cupressaceae and Poaceae. Pollen concentrations reached the highest level in May (54.36%). The pollen allergens provoking severe sensitization were grasscereal mixtures (58.5%), followed by arboreals (33.8%). All patients (100.0%) were sensitive to grass. This study emphasizes the significance of determining the types and concentrations of pollen with a view to comparing changes in highly concentrated allergens.

Prevalence of hypertension among individuals aged 50 years and over and its impact on health related quality of life in a semi-rural area of western Turkey.

BACKGROUND: Hypertension is common, especially in individuals aged 40 years and over, and it affects about half of the population aged 60 years and over. This study aimed to determine the frequency and risk factors of hypertension among individuals aged 50 years and over, and to examine its effect on the health related quality of life (HRQOL). METHODS: This population-based cross-sectional study was conducted in two settlements in a region of western Turkey between March 1 and April 30, 2007. A questionnaire concerning life habits associated with hypertension, medical histories, and demographic characteristics was filled in by a face to face interview. The SF-36 scale was used to assess HRQOL. Body mass index (BMI) was calculated by measuring the weight and length of the body. RESULTS: Of 1599 individuals living in the region, 1193 participated in the survey (48.3% men and 51.7% women). The overall prevalence rate of hypertension was 59.5% (n=710), being 58.0% in men and 60.9% in women (P > 0.05). The variables that most positively influenced hypertension (P < 0.05, for each one) were older age (especially the age group of those aged 60 and over), single, no health insurance, consumption of animal fat in meals, and family history of hypertension. The HRQOL of the patients with hypertension was lower than that of those without hypertension (P < or = 0.05). The HRQOL was better in hypertensive patients whose blood pressure was under control, whereas it was worse in those with at least one chronic disorder accompanying hypertension (P < 0.05, for each one). CONCLUSIONS: Great emphasis should be placed on the need for a public health program for the detection, prevention, and control of hypertension, including other risk factors, as well as for the modification of foods and life habits, specifically in individuals who are most likely to be at risk of hypertension.

Prevalence of students with symptoms of depression among high school students in a district of western Turkey: an epidemiological study.

BACKGROUND: To determine the factors affecting the prevalence of depression and also to present some pertinent comments concerning prevention of depression among high school students. This study was deemed important and relevant due to the increasing importance of depression among high school students. METHODS: A sample of students aged 14-19 years from the 6 high schools of 1 district of western Turkey were surveyed. The students selected were all attending the school during March and April 2006. The Beck Depression Inventory was used as a screening test. RESULTS: During the study, a total of 846 students completed the survey. Of the study group, 51.9% (439) were male and 48.1% (407) female, with an age average of 16.3 +/- 1.1 years. According to the scale, the prevalence of depression was 30.7% (n = 260), 22.6% for males (n = 99) and 39.6% for females (n = 161). The most depression was seen in males (22.6%), those with any kind of physical problem (37.3%), those with diseases necessitating the use of medication (51.1%), those with acne vulgaris (35.2%), and those having previously experienced any kind of problem (47.3%). CONCLUSIONS: These results highlight not only the need for students' parents and teachers to be well informed on the subject of depression in terms of students' health but also the need for more education programs to be aimed at students relating to the problems they may experience during the period of adolescence. Furthermore, these results show that students identified as depressed should be referred for an appropriate diagnosis to specialized psychiatry centers.

Sexual differences in the completed suicides in Turkey.

The aim of this study was to determine whether there is a difference between men and women in terms of suicide age, suicide method and suicide reason in Turkey. This study recruited 17,327 cases that had committed suicide between 1990 and 2000. Of all the cases who committed suicide during a period of 11 years, 61.1% were men, 38.9% women. The highest suicide score fell into the age group 15-24 (P<0.001). The most frequently used methods for suicide were self-hanging (48.2%) and use of firearms (19.2%) (P<0.001). The proportion of those committing suicide taking chemicals (drugs, etc.) was higher in women than in men (P<0.001). The most frequently seen reasons for suicide were illness and (33.8%) unsatisfactory relationships (33.0%) (P<0.001, each one). Women committed suicide much more because of unsatisfactory relationships, whereas for men it was due to illness (20.8% and 14.6%, respectively). There were significant differences between men and women in terms of suicide age, suicide method and suicide reason in Turkey. When evaluating suicide cases it is essential that the differences between sexes be taken into consideration.

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.

Eating habits reported by secondary school students in a city of west Turkey.

OBJECTIVE: The prevalence of obesity and underweight has increased in recent years due to the fact that eating and drinking habits have changed all over the world. This survey was conducted to estimate the prevalence of both obesity and underweight, as well as to understand the eating and drinking habits of a group of Turkish students. METHODS: 1044 students completed the survey. Responses were analyzed, using Chi-square (chi2) test and percent (%) ratios, according to gender. Differences were considered significant for p<0.05. RESULTS: About 10% of the students (123/1044, 11.8%) were underweight, most of them were male. Most students (868/1044, 83.1%) were of the correct weight. A small percentage of the students (52/1044, 4.9%) were overweight, with just one obese student, boy. Compared to boys, girls significantly obtained higher scores when questioned on preference of bran bread (62.0% vs. 38.0%, respectively), taking pains to not gain excess weight in order not to get fat (55.6% vs. 44.4%, respectively), doing physical exercise if they felt they were gaining too much weight (54.85% vs. 45.2%, respectively), and reducing food consumption when they felt that they were gaining weight (55.0% vs. 45.0%, respectively). CONCLUSION: For most people the importance of diet was obvious. This was especially reflected in the females' reports, since they reported a continual increase in their dieting and exercise behavior in an attempt to attain the contemporary ideal of being thin and physically fit.

Identification of violence in Turkish health care settings.

This study sought to investigate the contributing factors to and frequency of violence against health care workers (HCWs) working in western Turkey. The population is composed of a random sample of 1,209 HCWs from 34 health care workplaces. Written questionnaires were given to HCWs at all sites, where staff were instructed to register all types of violence they had experienced. In all, 49.5% of HCWs reported having experienced verbal, physical, or verbal and physical violence, with this total being made up of 39.6% men and 60.4% women. A larger percentage (69.6%) of general practitioners reported experiencing verbal abuse and physical violence by patients and patients' family members or friends. Younger workers, inexperienced staff, and those in emergency services were more likely to report violence. Violence directed toward HCWs is a common occupational hazard. Public health authorities should plan preventive interventions based on the findings of this study.

AIDS knowledge and attitudes in a Turkish population: an epidemiological study.

BACKGROUND: The aim of this study was to investigate and present some pertinent comments concerning Acquired Immunodeficiency Syndrome (AIDS) knowledge, attitudes and misconceptions among the general population in a city of west Turkey. This study was deemed important and relevant due to the increasing importance of AIDS in Turkey and the other countries. METHODS: Using a multistage area sampling method, a random sample of individuals aged 11-83 years, living in 65 different quarters in the city of Eskisehir, Turkey during September, October and November 2004 were interviewed. RESULTS: In all, 1048 respondents completed the survey. In most items, respondents displayed a fairly good to excellent degree of knowledge about HIV/AIDS. Individuals with higher degrees of education indicated more correct responses in all items relating to knowledge of HIV/AIDS. In general, the respondents' attitudes towards AIDS and people with AIDS were found to be tolerant and positive, with one answer choice showing that the majority of the respondents agreed with the statement that those with HIV/AIDS must be supported, treated and helped (90.7%). Moreover, the proportions of the respondents' misconceptions were found to be significantly low for all the items. However, nearly one fourth of the respondents agreed with the misconceptions 'AIDS is a punishment by God' and 'One is not infected with HIV/AIDS if engaged in sport and well nourished'. CONCLUSION: In general HIV/AIDS related knowledge was high and people showed positive attitudes. However, people continue to hold misconceptions about AIDS and these need to be addressed by health education programs targeting those at higher risk.

Prevalence of nonvitamin, nonmineral supplement usage among students in a Turkish university.

BACKGROUND: There have been multiple studies carried out in many countries with regard to the use of nonvitamin, nonmineral (NVNM) supplements. These studies have shown that the use of NVNM supplements is on the increase throughout the world, particularly in western countries. The aim of this study was to assess the extent of NVNM supplement use among Turkish university students. METHODS: The survey was conducted between September and December 2004 at Osmangazi University, a public university located in the west of Turkey. Responses were analysed, using the chi-square (x2) test, t test and percent (%) ratios, according to gender and consumers. Differences were considered significant for p

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.

Violence toward health care workers in emergency departments in west Turkey.

The aims of this study were to describe the epidemiology of violence in Turkish emergency departments (EDs), and to provide a more specific focus on violence. This study was conducted in 18 EDs in west Turkey for 3 months. Emergency staff in the EDs were asked to recall experiences of violence directed at them at work over the previous year. We then put these experiences into five categories: verbal abuse, specific threats, physical action with or without injury, sexual violence, and the last category, acts not falling in the other four categories. The data were analyzed using chi-square test and percent ratios. Of the 195 respondents answering the questions regarding violence against them, 72.3% (141/195) had experienced some form of violence. Most of the respondents stated that they had experienced verbal/emotional abuse (69.5%), followed by specific threats (53.2%), and physical action (8.5%). Groups experiencing the highest percentage of any type of violence during the previous year were as follows: 30-39-year-olds (82.1%), nurses and physicians (80.8% and 78.0%, respectively), public hospital health care staff (81.0%), staff working for 61-120 months (82.8%), those working between 8:00 a.m. and 5:00 p.m. (81.8%), and those working in low deprivation practices (79.6%). Most of the aggressors were patients' relatives (89%) as compared with patients' themselves (52%). Half of those experiencing physical action (50% [6/12]) during the course of the last year received support and inability reports due to minor injuries. There were no major injuries such as lacerations or fractures. We recommend that training to deal with violence in the workplace be specifically targeted at members of staff who are most likely to be at risk of threats of violence and actual physical aggression.

Physical violence against women: evaluation of women assaulted by spouses.

OBJECTIVE: To investigate the characteristic of physical violence against women sent to the Forensic Medicine Council for the forensic reports with a history of being assaulted by their spouses. METHODS: One hundred and thirty five women attending judicial institutions from August 1st 2000 to January 31st 2001 were interviewed. The demographic characteristics of assaulted women and their spouses, time of violence, beginning and continuation of violence after marriage, frequency of violence, women's judgment of the reason for being assaulted, violence against children by the husbands, history of violence in the husbands' family, the husbands' manner at home, women' attitudes against violence, existence and type of physical trauma and injury severity according to Turkish Penalty Law were evaluated. The data were analyzed using chi(2) test and percent ratios. RESULTS: The majority of both women and their husbands had been born in rural areas (73.3% and 71.1%, respectively). Approximately three quarters of the men and women had secondary school or lower education levels (80.7% and 81.5%, respectively). Most women (63.7%) and 17.8% of men were unemployed. For the most part, women were assaulted between 18.01 and 06.00 h (73.3%). Nearly 80% of husbands had at least one 'bad' habit such as alcohol intake and gambling. 60.7% of the assaulted women did not react to their spouses' violence. The most frequently encountered result of violence was soft tissue lesions (91.9%). After being assaulted nearly all of the women (91.9%) were provided with forensic reports advising of between 1 and 7 days of inability to follow ordinary pursuits. CONCLUSION: Women from all socioeconomic-cultural levels reported a history of partner violence. Routine screening with structured questions during visits to doctors is necessary in order to identify assaulted women so as to prevent potential violence and to interrupt existing violence.

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.

[Evaluation of mental health services in primary health care settings in the city centre of Eskisehir]. / Eskisehir ilinde birinci basamak saglik kurumlarinda verilen ruh sagligi hizmetlerinin degerlendirilmesi.

OBJECTIVE: The purpose of this study was to determine the proportion of cases thought to have a mental disorder, and/or proposed treatment. Additionally, we assessed the relationship between age and sex regarding mental disorders, and the treatments recommended to patients diagnosed as mentally ill by their physicians. METHOD: During a one year period the out-patient polyclinic registration lists of 313,139 patients attending primary health care clinics in the centre of Eskisehir were scanned by the researchers. RESULTS: The proportion of mental disorders in patients attending primary care centres at least once owing to a mental disorder was 2.34%. However, this proportion in patients attending once was 1.04%. Compared with men, women attended primary care clinics more frequently. The most common diagnoses were depression and anxiety disorders; these were more frequent in women than in men. The most frequently prescribed medicines for mental disorders were anxiolytics and antidepressants. CONCLUSION: The low levels of diagnoses and treatments of psychiatric disorders in primary care settings are thought to be associated with the following: physicians under-recognising mental disorders despite being educated about this subject, mental screening scales not being used, patients being unaware of their diseases and giving insufficient information to physicians about mental symptoms, co-occurrence of medical diseases and psychiatric problems, the physicians' negative approach to patients, and the physicians' tendency not to give importance to drug or medical records.