The effect of macro-control and organizational support perception on nurses and physicians intention to quit during the COVID-19 pandemic.

AIM: The aim of this study is to determine the effect of organizational support and COVID-19 macro-control perception levels on intention to quit in physicians and nurses. BACKGROUND: During the pandemic process, healthcare workers faced great health risks and workloads. Many health workers are considering quitting their job. METHOD: A cross-sectional and explanatory research. The sample of the study consisted of 300 nurses and 73 physicians. To collect data, COVID-19 perception of macro-control, perceived organizational support, and intention to quit scales were used. Structural equation modeling was used. RESULTS: COVID-19 macro-control perception and perceived organizational support have a negative effect on the intention to quit. The perceived organizational support has a partial mediating role, on the COVID-19 macro-control perception and the intention to quit. CONCLUSION: This study demonstrated that the macro measures taken against the pandemic and the organizational support received by the nurses and physicians, who are the main actors in the fight against the epidemic, negatively affected their intention to leave. IMPLICATIONS FOR NURSING PRACTICE AND CLINICAL RELEVANCE: To reduce the intention to quit health workers during the COVID-19 pandemic, scientific-based macro-control measures should be taken, and organizational support should be provided.

Costs of unnecessary repeated diagnostic tests in cholecystectomy.

The purpose of this study was to calculate the number, rate and cost of unnecessarily repeated tests on the patients who underwent open cholecystectomy and laparoscopic cholecystectomy and figure out the share of the unnecessarily repeated test costs in total test expenditures and total treatment expenditures. Alkaline phosphatase, alanine aminotransferase, aspartate transaminase, gamma glutamyl transferase, Total bilirubin, whole abdominal ultrasonography, upper abdominal ultrasonography, hepatobiliary ultrasonography tests, which were among the tests used in the patients who underwent cholecystectomy. The research group included 1296 patients. All records of the patients within totally 180 days of period including 90 days of pre-cholecystectomy and 90 days of post-cholecystectomy period were analysed. Necessity/Unnecessary criteria of the tests were identified in accordance with literature data, expert opinions and American Society of Anaesthesiologists Physical Status Classification scores. It was determined that unnecessary test costs consisted of 8.48% of the total test costs and 0.93% of the total treatment expenditures. This study showed that age, gender, surgical technique, and American Society of Anesthesiologists scores significantly differentiated unnecessary repeated test costs. Reducing the use of excessive health service and the related health expenditures, working to reveal its financial and medical benefits are crucial for the reimbursement agency, health service hosts and patients.

Cluster analysis of health systems in Europe according to life expectancy at birth.

PURPOSE: The aim of this study was to group European countries according to life expectancy at birth and to determine the impact of economic growth and financial indicators on European country groups. METHOD: This study planned and conducted by using life expectancy at birth time series, economic growth and financial development indicators data for the period of 1980 to 2015. European countries are classified in terms of life expectancy (LE) at birth time series data from 1980 to 2015 by using hierarchical clustering analysis method. Random Forest and Classification and Regression Tree (CART) algorithm was used to examine predictors of European country groups in terms of long-term LE time series data by using economic growth and financial development indicators. RESULTS: The results of this study show that Eastern and Western countries are mostly in two different clusters in terms of long-term LE time series. This study sheds light on the difference between Eurosceptic countries and other European countries. This study revealed that inflation in consumer prices, which is an indicator of economic growth, outperforms financial development indicators to predict country groups in terms of long-term life expectancy at birth data. CONCLUSION: Countries in the same cluster may have similar problems and solutions in their health care systems. Priority should be given to health problems that adversely affect the life expectancy of the countries in the same cluster in order to raise the quality of life and extend life expectancy in the European continent.

A conceptual framework of quality of life in chronic kidney disease in Turkey: A patient-focused approach.

This study aimed to determine the quality of life of patients with chronic kidney disease who were receiving dialysis treatment. It also aimed to identify the factors affecting the quality of life of these patients. The independent variables analyzed were: patients' sociodemographic characteristics, organizational characteristics, adherence to treatment, patient-physician relationship, and patient activation level. The sample consisted of 328 patients with chronic kidney disease who received services from dialysis units of two university hospitals and two private dialysis centers. Data analysis was performed through multivariate regression. Results showed that receiving treatment from a hospital-based dialysis unit may have a positive effect in patients' quality of life; and patient-physician relationship, patient activity, and adherence to treatment may positively affect quality of life. Thus, planning of health service delivery that focus on improving the quality of life of patients who are more active by allowing them to establish positive relationships with their physicians and to have a better adherence to treatment should be adopted. These findings may provide health managers, health professionals, and individual patients with evidence-based information about treatment management and health service planning processes related to chronic kidney disease.

Opinions and evaluations of stakeholders in the implementation of the public-private partnership (PPP) model in integrated health campuses (city hospitals) in Turkey.

PURPOSE: This study aimed to define the public-private partnership (PPP) model, eliciting the views and assessments of stakeholders and identifying associated health policies and planning issues. METHOD: It uses qualitative research methods to examine the extent to which PPPs promote or interfere with the provision of health services, equality, efficiency, quality, health tourism, and initiatives to strengthen the national economy. Having selected an appropriate sample, researchers approached bureaucrats and experts from the Ministry of Health, Social Security Institution, Ministry of Development, Ministry of Finance, NGOs, and other state institutions and organizations. A total of 83 people were asked to complete a semi-structured questionnaire. The qualitative research data were analyzed using a descriptive-analysis method; a content analysis was carried out using a computer-based qualitative research program, MAXQDA Versions 11. RESULTS: The majority of participants expressed positive opinions about PPPs, their applicability in Turkey, and the financial viability and scope of PPPs in the health sector. They also commented on the aims, advantages, and disadvantages of such partnerships. The majority of participants believed that a PPP was an appropriate finance model for the integrated health-campus substructure of Turkey's health sector. The most positive views were expressed by public and private sector-stakeholders, while some negative views were voiced by NGO representatives. CONCLUSION: This study identified and assessed integrated health-campus projects to determine the aim, suitability, advantages, and disadvantages of the model in the health sector, particularly in relation to the cost, quality, and availability of health services. This study discusses the current positive and negative effects of integrated health-campus implementation.

An Evidence-Based Approach to Outcome Measurement in Oral and Dental Health Services: Oral Health-Related Quality of Life and Oral Health Impact.

PURPOSE: The purpose of this study was to examine the Oral Health-Related Quality of Life (OHRQOL) and Oral Health Impact Profile (OHIP) of oral and dental health patients in terms of gender, educational status, and the reason for coming to the oral health center. Also, we investigated the relationships between OHRQOL and OHIP. METHODS: This cross-sectional study was conducted and planned for dental patients in Turkey. OHRQOL-United Kingdom (OHRQOL-UK) and OHIP-14 were used for data collection. Descriptive statistics, correlation analysis, student t-tests, and ANOVA were used for data analyses. RESULTS: Of 527 respondents, 62.8% were female, and 37.2% were male. One-hundred-forty-one (26.8%) participants were illiterate. Three-hundred-fifty-four (67.20%) dental patients had an elementary school degree. Only 32 (6.10%) participants graduated from college and bachelor programs. For dimensions of the OHIP-14 and OHRQOL-UK, we detected statistically significant differences in personal characteristics. We found that gender, marital status, age, education status, and reasons for coming to the hospital have a significant impact on OHRQOL and OHIP. LINKING EVIDENCE TO ACTION: These results are expected to provide important evidence-based information to health managers and decision-makers in health planning and reimbursement policies. Clinicians and health managers should use OHIP, quality of life (QOL), and evidence-based practice to determine individual treatments and approaches to improve oral health. QOL is an outcome indicator in healthcare services and evidence-based practice. Measurements of evidence-based health outcomes in national health systems can be made, and global comparisons and policies in oral and dental health can be developed.

The Effect of Organizational Justice and Trust on Job Stress in Hospital Organizations.

PURPOSE: The primary purpose of this study was to explore the relationships among distributive justice, procedural justice, interactional justice, job stress, cognition-based trust, and affect-based trust; the secondary purpose was to determine the effect of distributive justice, procedural justice, interactional justice, cognition-based trust, and affect-based trust on job stress in hospital organizations. METHOD: Data were collected using scales of job stress, organizational justice, and organizational trust. The study was conducted in two public hospitals in Turkey. A total of 432 health personnel participated in this study. RESULTS: This study showed that both cognition-based trust and affect-based trust were significantly positively correlated to the three dimensions of organizational justice (distributive justice, procedural justice, and interactional justice), but they were significantly negatively related to job stress. According to regression analysis, organizational justice was a significant predictor for job stress. CONCLUSIONS: In the working environment of hospitals, job stress and perceptions of organizational justice are significant variables that affect employees' working processes and their feelings of trust in their organization. CLINICAL RELEVANCE: Reducing employees' job stress and improving their perceptions of organizational trust and organizational justice can improve their levels of cognition-based trust and affect-based trust regarding their managers. As the job stress of nurses decreases, the effectiveness of health services may increase as organizational trust and justice develop.

An analysis of the relationship between burnout, socio-demographic and workplace factors and job satisfaction among emergency department health professionals.

INTRODUCTION: Burnout among emergency medical practitioners and personnel negatively affects career satisfaction and job performance and can lead to mental health issues, including anxiety, depression, and suicide. PURPOSE: This study investigated the relationship between the perceptions of burnout and job satisfaction of those working in two different hospital's emergency departments assessing the effect of burnout dimensions and additional factors (age, position, marital status, annual income, employment type, gender, patient encounters, and household economic well-being) on job satisfaction. This study addresses a gap in the literature of the relationships between a) burnout and job satisfaction of emergency department's health care personnel (physicians, nurses, technicians) and b) the factors that are associated with emergency department employees' job satisfaction. METHOD: A cross-sectional survey of two hundred and fifty participants was interviewed, using validated instruments (the Maslach Burnout Scale and the Minnesota Satisfaction Questionnaire). Participants include 38 physicians, 89 nurses, and 84 medical technicians, and 39 information technicians. The Maslach Burnout Inventory Scale, which assesses emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA), and the Minnesota Satisfaction Questionnaire (MSQ), which assesses intrinsic satisfaction (IS), extrinsic satisfaction (ES) and overall satisfaction (OS), were used for data collection. RESULTS: Study findings indicate that significant relationship exists between burnout and job satisfaction; annual income and household economic-well-being had a positive association with job satisfaction, whereas gender, age, education, marital status had no significant effect on any form of satisfaction. Moreover, this study reveals that emotional exhaustion (EE) is a significant predictor of all three dimensions of job satisfaction while depersonalization (DP) had no significant showing. CONCLUSION: Results of this study suggest that it is not yet clear which factors are salient contributors in demonstrating the relationship between burnout and job satisfaction. This study may draw attention to a better understanding of this relationship will help enable health care administrators to design and implement tools to help increase job satisfaction and decrease burnout as a combined goal rather than treat each issue separately.

Quality of life and attitudes to ageing in Turkish older adults at old people's homes.

OBJECTIVES: The purpose of this study was to investigate quality of life (QOL) and attitudes to ageing in Turkish older adults at two old people's homes (nursing homes) and to explain relationship between QOL and attitudes to ageing. METHODS: This study is a quantitative and descriptive exploratory study of QOL and attitudes to ageing of older adults in nursing homes in a developing country. INSTRUMENTS: Two international data measurement tools were used for data collection. Data measurement instruments in this study are The World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) and the WHO - Attitudes to Ageing Questionnaire (AAQ). The WHOQOL-OLD module consists of 24 items assigned to six facets (sensory abilities, autonomy, past, present and future activities, social participation, death and dying and intimacy) AAQ consists of 24 items classified in three domains (psychosocial loss, physical change and psychological growth) with eight items each. PARTICIPANTS: The Turkish version of the WHOQOL-OLD and AAQ was administered to 120 older (>65 years) adults living in two old people's homes in Samsun Province, Turkey. This study was conducted and planned between on 1 November 2011 and on 31 November, 2011. RESULTS: The results indicated that there was significant relationship between QOL and attitudes to ageing of older adults. In this study, the highest significant relationship is between psychological growth subscale of attitudes to ageing and sensory abilities subscale of QOL (r = 0.579; P < 0.01). Overall QOL and overall attitudes to ageing had a significant and positive relationship (r = 0.408; P < 0.01). The dimensions of attitudes to ageing (psychosocial loss, physical change and psychological growth) were significant predictors for QOL in older adults in Turkey. It was found that the gender does not affect overall QOL in older adults. However, happiness is significant variable for overall QOL in this study. CONCLUSION: The results suggest that QOL is a complex, multidimensional concept that should be studied at different levels of analysis in Turkey and other developing countries. The results of this study emphasize the importance of QOL in older adults in older people's homes in Turkey and attitudes to ageing of nursing home residents in Turkey.

Computer anxiety in nursing: an investigation from Turkish nurses.

The purpose of this study was to determine and analyze levels of computer anxiety in nurses at a public university hospital in Turkey. This study investigated the dimensions of computer anxiety in terms of computer literacy, self-efficacy, physical arousal, affective feelings, positive beliefs, and negative beliefs. Moreover in this study it was aimed to analyze relationships among computer anxiety and some characteristics of nurses (age, gender etc.). This study based on Beckers and Schmidt's computer anxiety model. The Beckers and Schmidt's Computer Anxiety Scale (BSCAS) was used for data collection. BSCAS comprises six factors: computer literacy, self-efficacy, physical arousal in the presence of computers, affective feelings towards computers, positive beliefs, and negative beliefs. At the end of the data collection period, 175 nurses were received from the population. The response rate was 43.75%. This study showed that a majority of nurses had medium levels of computer anxiety. Overall computer anxiety means score was 12.11±1.72. Computer anxiety has significant relationship with age (r=-.153; p<.05), personal computer ownership (r=.171; p<.05). The highest correlation was between overall computer anxiety and self efficacy (r=-.859), the lowest correlation was between overall computer and negative beliefs (r=-.653). Multiple regression analysis revealed that computer anxiety of nurses was predicted significantly by self efficacy, affective feelings, physical arousal, computer literacy, positive beliefs, and negative beliefs, respectively.

Perceptions of physicians about knowledge sharing barriers in Turkish health care system.

This study was based on knowledge sharing barriers about attitudes of physicians in Turkish health care system. The present study aims to determine whether the knowledge sharing barriers about attitudes of physicians vary depending on gender, position, departments at hospitals, and hospital ownership status. This study was planned and conducted on physicians at one public hospital, one university hospital, and one private hospital in Turkey. 209 physicians were reached for data collection. The study was conducted in June-September 2014. The questionnaire (developed by A. Riege, (J. Knowl. Manag. 9(3):18-35, 2005)), five point Likert-type scale including 39 items having the potential of the physicians' knowledge- sharing attitudes and behaviors, was used in the study for data collection. Descriptive statistics, reliability analysis, student t test and ANOVA were used for data analysis. According to results of this study, there was medium level of knowledge sharing barriers within hospitals. In general, physicians had perceptions about the lowest level individual barriers, intermediate level organizational barriers and the highest level technological barriers perceptions, respectively. This study revealed that some knowledge sharing barriers about attitudes of physicians were significantly difference according to hospital ownership status, gender, position and departments. Most evidence medical decisions and evidence based practice depend on experience and knowledge of existing options and knowledge sharing in health care organizations. Physicians are knowledge and information-intensive and principal professional group in health care context.

Validation of a nurses' views on electronic medical record systems (EMR) questionnaire in Turkish health system.

Using of EMR in health services and organizations is steadily increasing for quality improvement, cost effectiveness and performance development. However, no validated national and international instruments (scale, questionnaire, index, and inventory) have assessed the effectiveness, satisfaction, health care savings, patient safety and cost minimization of electronic medical and health systems from the viewpoint and perceptions of nurses in Turkish health services. The perceptions of health care professionals especially physicians and nurses can contribute important information that may predict their acceptance of EMR and desired mode of use for EMR, evaluation performance of EMR thus guiding EMR implementation in hospitals. This article is a report of validation of the instrument to measure nurses' views on the use, quality and user satisfaction with EMR in Turkish health system. Items in the questionnaire were designed and obtained following O.G. Otieno, H. Toyama, M. Asonuma, M. Kanai-Pak, K. Naitoh's questionnaire about Use, Quality and User Satisfaction with EMR systems. Reliability and validity were examined and investigated in terms of responses from 487 nurses from one education hospital in Ankara, Turkey. This study was planned and conducted at a university hospital. The validation process was based on construct validity in this study. The response rate was 74.92%. Cronbach's alphas of three factors (use, quality and satisfaction of EMR) ranged from 0.78 to 0.94. Goodness-of-fit indices from the confirmatory factor analysis showed a reasonable model fit. Results of confirmatory factor analysis showed that χ2 statistic indicated significant result (p < 0.001) and model fit was acceptable according to relative χ2 statistic (χ2/df = 2.8 < 5). Further validation of the instrument could yield positive results in health systems in the different countries. Also further validation and reliability studies could be planned on physicians and other health professionals.

Evaluation of electronic prescription implications in Turkey: an investigation of the perceptions of physicians.

BACKGROUND: Electronic prescribing (e-prescribing) is an evolving area of healthcare information technology that aims to support physician decision-making by capturing, reviewing, and issuing medical prescriptions with high potential for improving the quality and safety of the process. PURPOSE: To describe physician perception of e-prescription use in healthcare organizations that work with social security and to evaluate their infrastructures for MEDULA (an information system for billing and other health informatics) in healthcare organizations in Turkey. METHODS: A cross-sectional survey design was used for this study. A convenience sample of physicians in eight general hospitals and in two oral and dental health centers of the Ministry of Health in Turkey were surveyed. RESULTS: Survey response rate was 47% (248/425). The majority of physicians (62%) support e-prescribing but have not used an electronic signature for prescriptions (78.2%). Almost half of them believe that e-prescriptions would positively contribute to patient safety (43%) LINKING EVIDENCE TO ACTION: Our study provides a first look at the perceptions of physicians regarding the implications of e-prescriptions, which became mandatory on January 15, 2013, in Turkey. Advocates of e-prescribing have suggested that additional efforts are needed to strengthen clinical decision systems. Physicians and nurses are better able to adopt e-prescribing systems and to view them positively if they recognize the limitations of paper-based prescribing and understand the utility of electronic systems in addressing some of these limitations. This study represents a starting point for government and related organizations to improve their knowledge on how well the implied benefits of e-prescriptions are realized in their acquisition, appraisal, and use in health policy decision-making and health systems.

An analysis of relationships among transformational leadership, job satisfaction, organizational commitment and organizational trust in two Turkish hospitals.

The purpose of this study was to investigate the relationships among employee organizational commitment, organizational trust, job satisfaction and employees' perceptions of their immediate supervisors' transformational leadership behaviors in Turkey. First, this study examined the relationships among organizational commitment, organizational trust, job satisfaction and transformational leadership in two Turkish public hospitals. Second, this investigation examined how job satisfaction, organizational trust and transformational leadership affect organizational commitment. Moreover, it was aimed to investigate how organizational commitment, job satisfaction and transformational leadership affect organizational trust. A quantitative, cross-sectional method, self-administered questionnaire was used for this study. Eight hundred four employees from two public hospitals in Turkey were recruited for collecting data. The overall response rate was 38.14%. The measurement instruments of survey were the Job Satisfaction Survey (developed by P. Spector), the Organizational Commitment Questionnaire (developed by J. Meyer and N. Allen), the Organizational Trust Inventory-short form (developed by L. Cummings and P. Bromiley) and the Transformational Leadership Inventory (TLI) (developed by P. M. Podsakoff). Five-point Likert scales were used in these measurement instruments. Correlation test (the Pearson's rank test) was used to examine relationships between variables. Also, multiple regression analysis was used to determine the regressors for organizational commitment and organizational trust. There were significant relationships among overall job satisfaction, overall transformational leadership and organizational trust. Regression analyses showed that organizational trust and two job satisfaction dimensions (contingent rewards and communication) were significant predictors for organizational commitment. It was found that one transformational leadership dimension (articulating a vision), two job satisfaction dimensions (pay and supervision) and two organizational commitment dimensions (affective commitment and normative commitment) were significant regressors for organizational trust. There is a lack of research in the health organizations regarding organizational commitment, organizational trust, job satisfaction and transformational leadership. The investigator of the proposed study intends to add to the literature and intends to prove that the proposed study would be important for healthcare organizations. A number of specific measures should be undertaken to reduce factors that negatively affect organizational commitment, organizational trust and job satisfaction of hospital personnel and to improve transformational leadership behaviors of hospital administrators.

Real-world patient-level cost-effectiveness analysis of omalizumab in patients with severe allergic asthma treated in four major medical centers in Turkey.

AIMS: To evaluate the cost-effectiveness of standard-of-care treatment (SoC) to SoC in combination with omalizumab (OML + Soc) in patients with severe asthma using real-world prospective clinical data from four major medical centers in Turkey. MATERIALS AND METHODS: Between February 2018 and November 2019, a total of 206 patients with severe asthma, including 126 of whom were in the OML + SoC group and 80 in the SoC group, were followed for 12 months to evaluate their asthma status and quality of life. Cost data for this patient-level economic evaluation were sourced from the MEDULA database of the hospitals and expressed in Turkish Lira (₺). Efficacy data were obtained by means of Turkish versions of the Asthma Control Test for asthma status, the 5-level EQ-5D-5L version (EQ-5D-5L), and the Asthma Quality of Life Scale for quality of life. A Markov model with 2-week cycles was specified, comparing costs and treatment effects of SoC vs. OML + SoC over a lifetime from the Turkish payer perspective. RESULTS: Per-patient costs were ₺23,607.08 in the SoC arm and ₺425,329.81 in the OML + Soc arm, for a difference of ₺401,722.74. Life years (LY) and quality-adjusted life years (QALY) were 13.60 and 10.08, respectively, in the SoC group; and 21.26 and 13.35, respectively, in the OML + SoC group, for differences of 7.66 LYs and 3.27 QALYs. This yielded an incremental cost-effectiveness ratio of an additional ₺52,427.04 to gain 1 LY and an incremental cost-utility ratio of an incremental ₺122,675.57 to gain 1 QALY; the latter being below the ₺156,948 willingness-to-pay threshold for Turkey referenced by WHO. One-way and multivariate sensitivity analyses confirmed the base-case results. CONCLUSION: Whereas most economic evaluations are based on aggregate data, this independent cost-effectiveness analysis using prospective real-world patient-level data suggests that omalizumab in combination with standard of care is cost-effective for severe asthma from the Turkish public payer perspective.

What is the context? Severe asthma, a subset of difficult-to-treat asthma, refers to asthma that cannot be controlled despite adherence to optimized maximal therapy and treatment of contributing factors, or asthma that worsens when high-dose therapy is reduced.Omalizumab is the first biologic therapy approved for the treatment of allergic asthma. Its main role is to prevent the release of various inflammation factors that cause severe asthma episodes.Cost-effectiveness analysis is an economic method of determining how much more a new and better treatment costs relative to the current treatment in terms of how many life years (LY) and how many quality-adjusted life years (QALY) are gained with the new treatment. Cost-effectiveness results tell us how much more money is needed over the cost of the current treatment to achieve one additional LY, regardless of the quality of life, or one additional LY with good quality of life.No cost-effectiveness data obtained from actual clinical patient data are available for Turkey. What is new? Our study found that the addition of omalizumab to the current standard of care for severe asthma increases costs but also increases life years and quality-adjusted life years. The additional cost was less than what the World Health Organization assumes is reasonable for Turkey.This study used actual clinical patient data and noted that asthma patients in the omalizumab group used fewer health services, had a better clinical course, had a better quality of life, and lived longer with their disease under control.What is the impact? In severe asthmatic patients, adding omalizumab to standard-of-care, while more costly, yields better outcomes and is therefore cost-effective.The cost-effectiveness estimates fall within the margins of being cost-responsible. The Turkish public payer should strongly consider making omalizumab available to all eligible patients. This will enable working-age patients to work, and contribute to their families, while also strengthening the Turkish economy.

Autoimmune rheumatic disease associated symptoms in fibromyalgia patients and their influence on anxiety, depression and somatisation: a comparative study.

OBJECTIVES: In this study we evaluated the frequency of autoimmune rheumatic disease associated major symptoms in fibromyalgia (FM) patients, and the association between their presence and anxiety, depression and somatisation. METHODS: Two hundred and thirty-two FM, 78 systemic lupus erythematosus (SLE) patients and 70 healthy controls were included. All subjects were questioned face-to-face for the presence of autoimmune rheumatic disease-associated symptoms and antinuclear antibody (ANA) was determined. All FM patients were questioned for the severity of pain and symptoms of FM by using a visual analogue scale. In addition, all subjects were interrogated for anxiety, depression, somatic symptoms and neuropathic pain by using different validated questionnaires. RESULTS: FM patients had significantly higher frequency of photosensitivity (27.6% vs. 11.4%) and Raynaud phenomenon (22% vs. 10%) when compared to controls (p-values, 0.005 and 0.026). FM patients had significantly lower frequencies of photosensitivity, oral ulcers, xerostomia, and xerophthalmia than SLE patients (all p-values <0.001). ANA positivity was 11.8% in FM patients and 7.1% in healthy controls. ANA-positive and negative FM patients had similar frequencies of autoimmune rheumatic disease symptoms. FM patients with photosensitivity had higher anxiety (p=0.002), somatic symptoms (p=0.015) and neuropathic pain (p=0.03) scores than others. FM patients with Raynaud had higher anxiety (p=0.004), depression (p=0.001), somatic symptom (p<0.001) and neuropathic pain scores than others. CONCLUSIONS: The presence of which findings in FM seems to be associated with anxiety, depression, and somatization rather than ANA positivity and disease severity.

Migraine headaches among university students using ID Migraine test as a screening tool.

BACKGROUND: Migraine is a significant health problem, especially for the young people, due to its frequency and accompanying morbidity, causing disability and loss of performance. In this study, our aim was to determine the prevalence of migraine headaches among university students in Edirne, a Turkish city. METHODS: In this cross-sectional and descriptive study, study population was composed of students registered to Trakya University in the academic year of 2008-2009. Out of these, 3694 of them accepted to participate. Participants who had two or more headaches in the last 3 months formed the headache group. Afterwards, two preliminary questions were applied to the headache group and participants with at least one affirmative response were asked to perform the validated ID-Migraine™ test. RESULTS: The mean age of 3694 students participated in the study was 19.23 ± 1.84 (17-39 years), with adolescents:adult ratio being 2.5:1. 1613 students (43.7%) did have at least two headaches in the last three months. Migraine-type headache was detected in 266 subjects (7.2%) based on the ID-Migraine™ test. Of the migraine group, 72 were male (27.1%) and 194 were female (72.9%). There was no significant difference in migraine prevalence between adolescent and adult age groups. CONCLUSIONS: With a prevalence similar to adults, primary care physicians should be aware of the probability of migraine headaches in university students in order to maintain a successful school performance.

Organizational trust, employee commitment and job satisfaction in Turkish hospitals: implications for public policy and health.

BACKGROUND: Understanding relationships between factors that can affect organizational outcomes such as organizational trust, employee commitment and job satisfaction is important to foster healthy work conditions in organizations. AIMS: This study aimed to determine the perception of Turkish physicians about organizational trust, employee commitment and job satisfaction and determine the relationships between them. METHODS: A questionnaire was developed based on three standard survey instruments and given to 1679 doctors in four training and research hospitals in Istanbul, Turkey, in 2013. The Pearson correlation coefficient was calculated and regression analyses were conducted. RESULTS: A total of 304 doctors completed the survey (18.1% response rate). Most were males (57%), over 30 years old (62%) and specialists (82%). A strong positive correlation was found among the study variables (P ≤ 0.001). Regression analyses indicated that organizational trust was a significant predictor of job satisfaction and commitment. CONCLUSIONS: Policy-makers need to consider implementing interventions in the health care system to improve the working conditions of current and future doctors in Turkey, in order to attract and retain them and prevent health care labour force losses.

Is iron-deficiency anemia associated with migraine? Is there a role for anxiety and depression?

BACKGROUND: In this study, we determined the frequency of migraine headache in iron-deficiency anemia (IDA) patients and whether it was related to anxiety, depression, and somatization. METHODS: We included 127 consecutive IDA patients into the study. All patients were asked validated questions about headache and migraine face-to-face. They were administered validated questionnaires for anxiety-depression The Hospital Anxiety and Depression Scale and somatization. The quality of life (QoL) disturbance associated with headache was marked on a 0-10 VAS. RESULTS: Of all IDA patients, 79.5 % defined headache at any time of their life. In addition, 36.2 % of all IDA patients defined the criteria for migraine. IDA patients with migraine were more frequently smokers and had significantly lower hemoglobin and mean corpuscular volume values (p values < 0.05). The IDA group with migraine had significantly higher mean anxiety score (p = 0.046) and headache-related QoL disturbance score (p = 0.021) than the IDA group without migraine. Migraine patients with aura had lower hemoglobin values (p = 0.02), higher depression scores (p = 0.005), and higher migraine-related QoL disturbance scores than others. CONCLUSIONS: IDA patients have a high frequency of migraine headache. The presence of anxiety and depression have great influence on the presence of migraine in IDA patients.

Gastrointestinal symptoms are closely associated with depression in iron deficiency anemia: a comparative study.

BACKGROUND AND OBJECTIVES: Until now, very few studies evaluated the association between gastrointestinal and psychiatric symptoms in iron deficiency anemia (IDA). The study investigated the frequency of functional dyspepsia (FD) in IDA patients and determined its association with depression and somatization. DESIGN AND SETTINGS: The study was conducted at the Hematology Department of Trakya University Medical Faculty, which is a tertiary referral center in northwestern Turkey. It was a case-control study. MATERIALS AND METHODS: A total of 125 consecutive IDA patients and 57 healthy control subjects were included. Patients and controls were questioned about the severity of their gastrointestinal system (GIS)-related symptoms and the presence of constipation and associated symptoms using a visual analog scale. In addition, IDA patients were administered a validated depression scale (Beck Depression Inventory, BDI) and somatization symptoms checklist. RESULTS: IDA patients had more frequent self-reported constipation compared with controls (56% vs 22.8%, P < .001). The mean scores of bloating, dyspepsia, and constipation-related quality of life (QoL) disturbance were significantly higher in the IDA group than in the control group (all P values.