Water pipe smoking among public versus private university students in Ankara, Turkey: an online survey.

BACKGROUND: Water pipe smoking has become a global public health problem as its popularity increased over time, especially among youth. The objective of our study was to estimate water pipe tobacco smoking prevalence and to assess socioeconomic factors associated with ever water pipe smoking by public and private university students in Ankara, Turkey. METHODS: This descriptive study was based on a survey conducted among public (n=2685) and private (n=2485) university students via an online questionnaire on demographics and water pipe consumption patterns. For every student in the sample, a socioeconomic status index was calculated using principal component analysis. Binary logistic regressions for the outcome variable of ever-using water pipe yielded estimates of adjusted odds ratios (aORs) for the associated factors such as the respondent's age, gender, university type, and socioeconomic status. RESULTS: The prevalence of ever use of water pipe was 69.1% (95% CI: 67.2-70.9%) among private and 59.1% (95% CI: 57.2-60.9%) among public university students. A substantial share of ever users were current users (25.5% in private versus 21.6% in public, p=0.008). On average, private university students had higher socioeconomic status than public university students (for example, access to a car (51.7% versus 35.8%, p=0.008), financial support from family (71.5% versus 65.1%, p<0.001)), also demonstrated by a higher socioeconomic status index. Being a private university student (aOR 1.57, 95% CI: 1.38-1.79), older (aORs 1.50 to 2.39, p<0.001), male (aOR 2.36, 95% CI:2.06-2.70), as well as having greater financial resources, such as having access to a car (aOR 1.24, 95% CI:1.07-1.42), or having income support from family (aOR 1.32, 95% CI:1.13-1.54), were associated with ever-using water pipe. A higher SES index was significantly associated with higher odds of ever using water pipe among both private (aOR 1.13, 95% CI:1.06,1.20) and public university (aOR 1.12, 95% CI:1.06,1.19) students. CONCLUSIONS: Water pipe smoking was common in both public and private universities; however, private university students had higher odds of ever using water pipe. There is an urgent need to implement evidence-based interventions, taking into account the socioeconomic status of young adults, to prevent them from water pipe smoking.

The impact of community pharmacists on older adults in Turkey.

OBJECTIVE: This study aimed to evaluate the impact of theory-based, structured, standardized pharmaceutical care services led by community pharmacists (CPs) on patient-related outcomes in older Turkish adults. PRACTICE DESCRIPTION: This prospective, quasi-experimental pilot study was conducted at the national level at community pharmacies in Turkey. After virtual training of CPs, pharmaceutical care services including medicine bag check-up, medication review, patient medicine card, patient education, and counseling services (including motivational interviewing) were delivered to promote medication adherence in older adults. PRACTICE INNOVATION: Theory-based, structured, standardized pharmaceutical care services addressing medication adherence problems in older Turkish adults with noncommunicable diseases. EVALUATION METHODS: Descriptive data (including demographic and clinical data, medication-related problems by using the DOCUMENT classification, potential inappropriate prescribing by using the Ghent Older People's Prescriptions Community Pharmacy Screening- (GheOP3S) tool, and pharmacy service satisfaction) were presented. Pre- and post-evaluation were compared by using the Wilcoxon test (for continuous variables) and McNemar's or McNemar-Bowker chi-square test (for categorical variables). RESULTS: One hundred and thirty-eight medication-related problems were identified among 52 older adults. The medication adherence rate was significantly increased from 51.9% to 75%, and the mean of total quality of life (QoL) score rose significantly from 51.7 to 53.4 (P < 0.05). There was a statistically significant change in the median of necessity-concern differential (baseline: 7 [2.2-10.0] vs. final: 8.0 [5-11]; P < 0.05). At baseline, all patients had at least 1 potential inappropriate prescribing according to the GheOP3S tool, and the rate was 73.1% at the final assessment. CONCLUSION: Community pharmacist-led pharmaceutical care services significantly improved patient-related outcomes (such as medication adherence, beliefs about medication, and QoL) in older adults with noncommunicable diseases. No statistically significant change was detected in their lifestyle behaviors (such as physical activity and diet program) or health awareness.

Eating disorders and needs of disabled children at primary school.

AIM: The aim of this study was to provide current information on the eating disorders, needs and confronted problems of children with disabilities during their school hours at primary schools. BACKGROUND: Eating disorders and needs of disabled children are important in their participation in school life, cognition, and academic achievement. RESULTS: In this study, It was aimed to reach all children with disabilities attending at 72 primary schools located in low, medium and high socio-economic districts in Ankara, capital of Turkey; 404 parents voluntarly accepted to participate in the study. This study has revealed that students with disabilities experienced eating disorders such as forget to eat foods at feeding time, cannot go to canteen to buy food, have sucking and/or chewing problems, lack of self-care skills and need support while eating at schools. The percentage of children who had breakfast at school was 18.1%. The percentage of those who indicated that their child had lunch at school was 59.0%. The children from low socio-economic district had the highest percentage of adequate nutrition at schools in the last week. Families whose children having lack of self-care skills (50.0%), were picky eaters (38.5%), having lack of appetite (42.1%), experienced from constipation frequently (50.0%), have reflux problem (29.0%) considered that their children needed feeding supports at school. CONCLUSION: Families whose children having eating disorders at schools considered that their children needed feeding supports. Fulfilling the needs of children with disability and providing them support as positive discrimination would ensure healthy development and participation in school life and generate positive effects on their academic achievement. The school health policies have to encompass nutritional needs of vulnerable children to benefit from right to education in an adequate and effective manner.

[Rational Use of Antibiotics Among Turkish Migrants In Germany: Knowledge, Attitudes and Interaction With Physicians and Pharmacists]. / Antibiotikanutzung bei Menschen mit türkischem Migrationshintergrund ­ Wissen, Einstellungen und Interaktion mit ÄrztInnen und ApothekerInnen.

OBJECTIVES: Due to strong transnational ties, the use of and demand for antibiotics among Turkish migrants in Germany may be influenced by cultural aspects of antibiotic use in Turkey. Research on the use of antibiotics among Turkish migrants in Germany, however, is scarce. The aim of this study was to find out how Turkish migrants in Germany use antibiotics, whether and how knowledge, underlying motives and attitudes influence demand and how Turkish migrants interact with medical professionals. MATERIALS AND METHODS: Using a qualitative approach, behavioural patterns and logic of action of adult Turkish migrants were identified. We carried out semi-structured focus group interviews with adults of Turkish origin residing in Germany and expert interviews with family physicians and pharmacists. The interviews were analysed by means of content analysis. RESULTS: While younger migrants had a generally positive, but cautious attitude towards the use of antibiotics, older migrants often showed exaggerated, unrealistic expectations resulting from a lack of factual knowledge. Overall, participants adopted a passive role in the patient-provider relationship. This led to a perpetuation of significant knowledge gaps. CONCLUSIONS: Older Turkish migrants who have less factual knowledge show exaggerated expectations concerning the effectiveness of antibiotics. In conjunction with a passive patient role, resulting in information needs not being satisfied, this can affect the patient-provider relationship. A more active communication by physicians and information materials sensitive to the needs of migrants can positively influence the interaction between migrant patients and medical professionals.

Are the health needs of children with disabilities being met at primary schools?

The aim of this study was to provide current information about the health profile and needs of mainstreamed primary school children with disabilities and special educational needs during their school hours. The Study population is composed of students with special educational needs and disabilities attending mainstream primary schools located in three selected Turkish districts with low, moderate, and high socioeconomic status and literacy rates separately. Parents of 404 students from 72 primary schools constituted the research sample. The study showed that 13.4% of the students with disabilities had chronic illnesses and 8.9% had health problems requiring access to emergency medical care when the condition recurs (such as epileptic seizures, fainting, or falling). Of the students with disabilities, 39.9% usually or sometimes needed medical care during school hours in the previous week. Health needs of nearly half of the students with disabilities were met at school. Special health needs and risks of children with disabilities also continue at school along with other possible health concerns.

Perceptions of Obesity Prevention Policies: Socioeconomic Assessment in the Turkish Capital.

PURPOSE: The purpose of this study was to inform public policy opportunities to reduce childhood obesity by identifying parents' perceptions of factors contributing to childhood obesity, attribution of responsibility, and the extent of their support for public prevention policies with attention to socio-economic status. DESIGN AND METHODS: In 2015, 2066 parent-child dyads across socio-economic strata from 43 randomly selected schools in Ankara completed surveys and measurements to examine perceptions, attribution, and prevention policies related to childhood obesity. RESULTS: Parents across the socio-demographic spectrum recognized obesity as a serious problem. Unhealthy food availability was identified as the leading cause of while industry and media were credited with having the greatest responsibility for childhood obesity. There was strong public support for policy strategies targeting schools, marketing, and the built environment, though support tempered as socio-economic status and parental education decreased. CONCLUSIONS: This survey provided insight into parents' knowledge and beliefs surrounding childhood obesity as well as their endorsement of related prevention strategies. Educational messages that address variations in SES to describe the causes of childhood obesity and connect those causes to actionable community prevention strategies may improve community support for enhanced policy actions within and beyond school settings.

The perspectives of politicians on tobacco control in Turkey.

Background: Tobacco use is a leading but preventable cause of non-communicable diseases and premature death. The legislature has a key role in setting tobacco control policies. Smoking trends are decreasing thanks to the introduction of effective tobacco control policies in Turkey and these policies may have been shaped by how politicians' interpreted social problems that were prominent during the development and implementation of tobacco regulations. Aim: This paper explores the long-term national relationship between tobacco consumption, tobacco control policies and the associated political discourse in Turkey, considering the varying influences through national leadership on this important public health agenda. This relationship is studied by comparing a time series analysis of tobacco consumption trends with a policy analysis of the minutes of deliberations at the Grand National Assembly of Turkey (GNAT). Methods: This study uses Bayesian time series analysis in order investigate whether the tobacco control policies and related activities influenced the annual per adult cigarette consumption in Turkey. We used a novel method to identify change points in tobacco trends and whether they correspond with key policy changes intended to alter usage after adjusting for the effect of other non-policy related covariates, such as the purchasing power. The policy analysis included an examination of the minutes of deliberations at the GNAT-which is the Turkish parliament and unicameral Turkish legislature-1 year before and 1 year after the break years associated with an increase or decrease in tobacco consumption. Results and recommendations: Tobacco consumption increased with the encouragement of tobacco production and the entrance of multinational companies in the country in 1976 and 1993, respectively. The National Tobacco Law of 1996 and comprehensive amendments in 2008, including smoke-free public places and tax increases, appear to have helped reduce tobacco consumption in Turkey. The focus of Parliamentary discussions throughout this period changed, becoming less supportive of tobacco over time. However, throughout the period there remained discussions focussing on concerns around the implications for the economy and the privatization agenda, national agriculture and the welfare of farmers. Effective control appears to require certain political ingredients to be implemented: politicians who are well informed on tobacco control measures and understand the range of issues surrounding the policies (not only those directly health-related); and supportive public health information in the community. Evidence-based public health policy should be introduced to the politicians.

Risk factors for prelacteal feeding in sub-Saharan Africa: a multilevel analysis of population data from twenty-two countries.

OBJECTIVE: To examine the risk factors of prelacteal feeding (PLF) among mothers in sub-Saharan Africa (SSA). DESIGN: We pooled data from Demographic and Health Surveys in twenty-two SSA countries. The key outcome variable was PLF. A multilevel logistic regression model was used to explore factors associated with PLF. SETTING: Demographic and Health Surveys in twenty-two SSA countries. SUBJECTS: Mother-baby pairs (n 95348). RESULTS: Prevalence of PLF in SSA was 32·2 %. Plain water (22·1 %), milk other than breast milk (5·0 %) and sugar or glucose water (4·1 %) were the predominant prelacteal feeds. In the multivariable analysis, mothers who had caesarean section delivery had 2·25 times the odds of giving prelacteal feeds compared with mothers who had spontaneous vaginal delivery (adjusted OR=2·25; 95 % CI 2·06, 2·46). Other factors that were significantly associated with increased likelihood of PLF were mother's lower educational status, first birth rank, fourth or above birth rank with preceding birth interval less than or equal to 24 months, lower number of antenatal care visits, home delivery, multiple birth, male infant, as well as having an average or small sized baby at birth. Mothers aged 20-34 years were less likely to give prelacteal feeds compared with mothers aged ≤19 years. Belonging to the second, middle or fourth wealth quintile was associated with lower likelihood of PLF compared with the highest quintile. CONCLUSIONS: To achieve optimal breast-feeding, there is a need to discourage breast-feeding practices such as PLF. Breast-feeding promotion programmes should target the at-risk sub-population groups discovered in our study.

Cigarette prices and smoking prevalence after a tobacco tax increase--Turkey, 2008 and 2012.

Raising the price of tobacco products has been shown to reduce tobacco consumption in the United States and other high-income countries, and evidence of this impact has been growing for low- and middle-income countries as well. Turkey is a middle-income country surveyed by the Global Adult Tobacco Survey (GATS) twice in a 4-year period, in 2008 and 2012. During this time, the country introduced a policy raising its Special Consumption Tax on Tobacco and implemented a comprehensive tobacco control program banning smoking in public places, banning advertising, and introducing graphic health warnings. The higher tobacco tax took effect in early 2010, allowing sufficient time for subsequent changes in prices and smoking to be observed by the time of the 2012 GATS. This report uses data from GATS Turkey to examine how cigarette prices changed after the 2010 tax increase, describe the temporally associated changes in smoking prevalence, and learn whether this smoking prevalence changed more in some demographic groups than others. From 2008 to 2012, the average price paid for cigarettes increased by 42.1%, cigarettes became less affordable, and smoking prevalence decreased by 14.6%. The largest reduction in smoking was observed among persons with lower socioeconomic status (SES), highlighting the potential role of tax policy in reducing health disparities across socioeconomic groups.

Urinary cotinine and breath carbon monoxide levels among bar and restaurant employees in ankara.

INTRODUCTION: Hospitality sector employees constitute one of the key groups with respect to their secondhand tobacco smoke exposure at work. This study aimed to detect urinary cotinine and breath carbon monoxide (CO) levels among bar and restaurant employees in Ankara, as well as the employees' opinions on the new antitobacco law, changes in smoking behavior, and subjective health status before and after the law entered into force. METHODS: This before-after study was conducted in 19 premises, with the participation of 65 employees before implementation and 81 employees 3 months after implementation of the new antitobacco law in the hospitality sector. Data in both phases were collected through face-to-face surveys, breath CO measurements, and urinary cotinine analysis. Descriptive statistics were used to summarize data, whereas chi-square test, paired and unpaired t tests, and analysis of variance were used to compare groups. RESULTS: Most of the restaurant and bar employees were male and below 35 years old. Before-after comparison showed that health complaints of the hospitality sector employees such as watering and itching in the eyes, difficulty in breathing, and cough (p < .001), as well as breath CO (p < .001) and urinary cotinine levels (p < .001) decreased significantly 3 months after implementation of the law. Among the smoking employees, mean number of cigarettes smoked was also found to decrease (p = .012). Majority of the employees (83.8%) were found to support the smoking ban in enclosed public places. CONCLUSIONS: Results of this study provide solid evidence on the positive health effects of smoke-free laws and employees' support for smoke-free workplaces.

[Evaluation of smoking cessation services approaches of the patients applying to Hacettepe Adult Hospital]. / Hacettepe Eriskin Hastanesine basvuran hastalarin sigara birakma hizmetleri hakkindaki yaklasimlarinin degerlendirilmesi.

INTRODUCTION: This research was conducted to determine the views and information of the society about smoking cessation services and to find out the smoking status. MATERIALS AND METHODS: This descriptive study was conducted at Hacettepe University Adult Hospital. The questionnaire was conducted to the participants with face to face interview techniques between the dates 3-8 August 2011 and asked about socio-demographic characteristics, smoking status and the views on smoking cessation methods and services. In the analysis, descriptive statistics, chi-square and Fisher's exact chi-square test was used where necessary. p< 0.05 was accepted for statistical significance. RESULTS: The average age of 599 individuals participated to the research was 36.95 ± 12.80 years and 56.6% were male. The participants declared their smoking status that 48.9% do not smoke, 15.9% quit smoking, 35.2% stated as still smoking. Among current smokers 60.2% thought to quit smoking in the last 12 months. Of the participants 42.1% have tried to quit smoking in the past 12 months. 46% percent of smokers and 56.3% non-smokers stated that they are aware of smoking cessation outpatient clinics (p= 0.033). The percentage of awareness of smoking cessation line was 67.8%, and 46.9% are aware of AMATEMs. Same percentages are as 49.5% and 28.4% for the ones who quit smoking. 59.7% of smokers think that nicotine-free preparates and 17.4% think that nicotine preparates is successful; these percentages are 89.7% and 36.7% for non-smokers. CONCLUSION: Tendency to cessation among tobacco users and have awareness about the services that support cessation and believe that the law reduces the harms of tobacco use. However, more interventions are needed to reach those who are at low-income level. Also being a role model to the children in the society and to use attitudes and behaviors in smoking cessation campaigns are thought to be effective.

Cancer prevalence, incidence, and mortality rates in Afghanistan in 2020: A review study.

BACKGROUND: Afghanistan is in an epidemiological transition, as cancer is the second leading cause of mortality due to non-communicable diseases. This study is the first to provide a comprehensive perspective on the overall cancer situation in Afghanistan by discussing the top five most common cancers, their incidence variations, risk factors, and preventive measures. The limited number of cancer studies conducted in Afghanistan highlights the importance of the present review. RECENT FINDINGS: This article provides an overview of cancer burden in Afghanistan in 2020. It utilizes IARC-generated GLOBOCAN 2020 data for one, three, and five-year prevalence rates, the estimated number of new cancer cases, and mortality rates by age group in Afghanistan. According to GLOBOCAN, the top five common cancers in both sexes in Afghanistan were breast (n = 3173, 14.3%), stomach (n = 2913, 7.8%), lung (n = 1470, 6.6%), cervix uteri (n = 1200, 5.4%), and colorectum (n = 1084, 4.9%). CONCLUSION: This study provides a brief overview of the general cancer situation in Afghanistan, and a more in-depth analysis of the five common cancers identified. Effective therapies, awareness, and prevention initiatives targeting lifestyle, immunization, early diagnosis, and environmental risk factors are essential for addressing the impact of population growth and aging on cancer incidence in Afghanistan. Further research and extensive studies are needed to better understand cancer burden in the country.

Exploring the Relationship between Drug Addiction and Quality of Life in Herat, Afghanistan: A Cross-sectional Study.

Background: Addiction is a global public health problem, with over 36 million people suffering from drug-use disorders. Afghanistan, the world's leading opium producer, has high rates of drug use owing to the easy access to drugs in this country. This study aimed to investigate drug users' quality of life in Herat, Afghanistan, and identify the factors affecting it. Methods: This cross-sectional study examined health-related quality of life at six rehabilitation camps in Herat, Afghanistan, from March to July 2019, using the short form-36 questionnaire (SF-36). Data collected through interviews were analyzed using SPSS software (version 25). Findings: A total of 240 participants from six rehabilitation camps in Herat, Afghanistan participated in this study. The majority of participants (80%) rated their overall health as "good" or "very good". Men had higher average scores for mental health and vitality than women and those aged 30-39 had the highest quality of life. Statistically significant differences were found in bodily pain (P=0.038), vitality (P=0.042), and social functioning (P=0.046) among users of different types of drugs. Opium abusers had the highest scores for the physical and mental components, followed by heroin, methamphetamine, hashish, and crack abusers. Conclusion: This study explored the relationship between drug addiction and quality of life in Herat, Afghanistan. The findings showed that young adults were more vulnerable to drug use and male addicts and opium users had the highest quality of life. This study can inform the development of effective rehabilitation programs but more research is needed for addiction treatment strategies.

Body image dissatisfaction among school children in Turkey and its potential effect on body esteem.

BACKGROUND: This study aimed to validate the Turkish version of Collins` Body Figure Perceptions and Preferences (BFPP) scale. The second aim of this study was to investigate the relationship between body image dissatisfaction (BID) and body esteem (BE), and between body mass index (BMI) and BID, among Turkish children. METHODS: A descriptive cross-sectional study was conducted among 2066 4th grade children (mean age was 10.06 ± 0.37 years) in Ankara, Turkey. The Feel-Ideal Difference (FID) index from Collins` BFPP was used to assess the degree of BID. FID ranges from -6 to +6, with scores below or above 0 indicating BID. Collins` BFPP`s test-retest reliability was evaluated in a subset of 641 children. The Turkish version of the BE Scale for Adolescents and Adults was used to evaluate the children` BE. RESULTS: More than half of the children were dissatisfied with their own body images (57.8% of girls vs. 42.2% of boys, p < .05). The lowest BE score in both genders was among adolescents who desired to be thinner (p < .01). The criterion-related validity of Collins` BFPP, in relation to BMI and weight, was at an acceptable level in girls (BMI rho= 0.69, weight rho= 0.66) and boys (BMI rho= 0.58, weight rho= 0.57), and was statistically significant in all cases (p < .01). The test-retest reliability coefficients of Collins` BFPP were found to be moderately high for both girls (rho=0.72) and boys (rho=0.70). CONCLUSIONS: Collins` BFPP scale is a reliable and valid tool for Turkish children aged 9-11 years. This study demonstrates that more Turkish girls than boys were dissatisfied with their bodies. Children who were affected by overweight/obesity and underweight had a higher BID than those with a normal weight. It is important to evaluate adolescents` BE and BID in addition to their anthropometric measurements during their regular clinical follow-up.

Evaluation of daily and social participation of children with Cerebral Palsy across different age groups with a focus on the 'F'-words: Function, family, fitness, fun, friends and future.

BACKGROUND: The impact of disability differs across cultures. This study aimed to determine the predictors of participation in children with cerebral palsy (CP) in Turkey, based on the six F-words. METHODS: Cross-sectional study exploring participation profiles of 450 children with CP, aged between 2 and 18 years. Pediatric Evaluation of Disability Inventory (PEDI) evaluated functional skills, and Assessment of Life Habits (LIFE-H) version 3.0 assessed daily and social participation. Hierarchical linear regression models were done to determine the predictors of participation in daily activities (PDA) and social roles (PSR) in three age groups (2-4, 5-13 and 14-18 years) based on the 6 F-words (mobility of PEDI for 'fitness'; four classification systems and self-care of PEDI for 'functioning'; social functions of PEDI for 'friends'; demographic information by parents for 'family'; the recreation of LIFE-H for 'fun'; and different stages of development for 'future'). RESULTS: The most important predictors for total PDA by age group were: self-care (p = 0.012) of PEDI in 2-4 y; self-care (p = 0.001) and mobility (p = 0.005) of PEDI in 5-13 y; GMFCS (p = 0.006) and mobility (p = 0.002) of PEDI in 14-18 y. Significant predictors for PSR differed by age group: self-care (p = 0.001) of PEDI in 2-4 y; self-care (p = 0.023) and mobility (p = 0.006) of PEDI in 5-13 y; and GMFCS (p = 0.004) and MACS (p = 0.003) in 14-18 y. CONCLUSIONS: Six F-words of function and fitness focussed on self-care in younger children with an increasing emphasis on mobility and ability levels according to age. Therefore, rehabilitation for different aspects of the functional levels is needed to improve participation in life across the six F-words framework; plus take into consideration context, age-differences, family's expectations, life requirements, environmental needs, and cultural differences.

[Impact of smoking ban at indoor public places on indoor air quality]. / Kapali ortamda sigara içilmesinin yasaklanmasi uygulamasinin iç ortam hava kalitesine etkisi.

INTRODUCTION: This study aims at evaluation of the effect of smoke-free policy at hospitality workplaces on indoor air quality. MATERIALS AND METHODS: Study includes 151 hospitality venues (restaurants, cafes, bars and tea-houses) at eight provinces of Turkey. PM2.5 measurements were done at each of the venues three months prior to, and 4-5 months after the implementation of smoking ban at the same venues. Measurements were done using SidePak 2.5 by two engineers. During the 30 minutes of measurement, the device takes multiple samples, measures PM2.5 particles, and calculates the average value and standard deviation of the measurements. RESULTS: Using the measurement results two kinds of evaluation were done: in each province, increase/decrease after implementation for each of the venues included in the study was evaluated, and average PM2.5 values were calculated for provinces using the PM2.5 values of the venues in the province. The average PM2.5 values before the implementation were higher than the post implementation values in general. Nevertheless, in some provinces higher values were found during the second measurements, particularly at the restaurants. CONCLUSION: Therefore, there is need to enforce the smoking ban at the hospitality workplaces.

Perspectives of physicians and pharmacists on rational use of antibiotics in Turkey and among Turkish migrants in Germany, Sweden and the Netherlands: a qualitative study.

BACKGROUND: Antimicrobial resistance may result from inappropriate use of antibiotics in health care. Turkey is one of the countries with the highest antibiotic consumption in the world. Considering the role of transnational ties between Turkish migrants and their social contacts in Turkey, the attitudes and behaviors relating to rational antibiotic use in Turkey can also affect the use of antibiotics by Turkish migrants residing abroad. This study explores physicians' and pharmacists' experiences and perspectives on rational antibiotic use among Turkish adults in Turkey and among Turkish migrants in Germany, Sweden, and the Netherlands, three European countries with large populations of Turkish migrants. METHODS: Following a qualitative study design using convenience and snowball sampling, in-depth interviews with 21 family physicians and 24 pharmacists were conducted in the aforementioned countries. We transcribed all interviews verbatim and performed content analysis separately in the countries, followed by translation, pooling and joint interpretation of the findings. RESULTS: Physicians and pharmacists encountered irrational use of antibiotics among their patients in Turkey. Physicians interviewed in the three European countries explained that Turkish migrants differ from non-migrants with respect to their attitudes towards antibiotics, for example by more often expecting to be prescribed antibiotics. All physicians and pharmacists in the selected countries reported to inform their patients on how to use antibiotics upon prescription; however, Turkish migrants' poor language proficiency was considered as a substantial communication barrier by the physicians and pharmacists interviewed in the European countries. CONCLUSIONS: The study illustrated some aspects of irrational antibiotic use among the population in Turkey and Turkish migrants in selected European countries. It emphasized the need for closer community participation, adequate information campaigns, as well as in-service training of health care providers in Turkey. The strategies and interventions on rational antibiotic use should also be supported and encouraged by health care providers, who need to reach out to people with various cultural backgrounds.

Epidemiology of Drug Use in Herat - Afghanistan.

Background: Drug addiction is one of the alarming public health and social problems in Afghanistan and around the world. Addiction denotes the habitual use or the physical or mental dependence on narcotic drugs or psychotropic substances. Methods: Drug addicts who were admitted to six public addicts' rehabilitation centers in Herat, Afghanistan between March and July 2019 were recruited for this descriptive study. A total of 299 drug addicts were included in this study. A 77-item questionnaire containing three subscales: 39 items for personal information, 32 items for drug use, and 6 items for dependence and treatment subscale were validated and used for data collection. IBM SPSS Statistics for Windows v.22.0 was used for data analyses. Findings: The median age of the participants was 30 years. Of all participants, 79.1% were male, 56.6% were illiterate, and 1.7% were university graduates. In this study, 44.8% of the participants used heroin, 20.7% used opium and 15.4% used methamphetamine. Almost half of the participants (49.5%) declared that at least one member of their families was a drug user. Of the 299 drug users included in this study, 64.9% stated that at least one person close to them (except family members) used drugs. Over two-thirds of the participants (78.4%) had easy access to drugs, 26.8% had broken laws for money/drugs at least once. Conclusion: This study revealed that male illiterate teenagers living in low-economic nuclear families were more vulnerable to drug use in Herat, Afghanistan. The most common reasons for drug use were curiosity, peer influence, and seeking pleasure.

Structural equation model of physical activity in Turkish schoolchildren: an application of the integrated behavioural model.

OBJECTIVES: Childhood obesity is increasingly prevalent in the developing world including Turkey. This study examined constructs of the integrated behavioural model associated with physical activity in a sample of schoolchildren in Ankara, Turkey using structural equation modelling. DESIGN: Cross-sectional survey by probability sampling. SETTING: Fifteen schools of different socioeconomic strata in Ankara, Turkey with grade 4 students. PARTICIPANTS: 2066 (969 girls and 1097 boys) grade 4 schoolchildren and their parents selected using a probability-based sampling frame. PRIMARY OUTCOME MEASURES: Three primary outcomes were used: moderate-to-vigorous physical activity, team sport participation, sedentary behaviour. RESULTS: Data were collected from 2066 fourth-grade children from schools of three socioeconomic strata. Missing data were imputed using multiple imputation. To examine the integrated behavioural model, a structural equation model containing latent constructs for physical activity outcome expectancies, self-efficacy, home environment and social norms were fitted with the three outcomes above. Adequate model fit was achieved in the structural equation model (χ2=1821.97, df=872, p<0.001, Comparative Fit Index=0.91, Tucker Lewis Index=0.91, root mean square error of approximation=0.02, standardised root mean square residual=0.04). All scale items were significantly associated with their respective latent constructs (all p<0.001). Several significant pathways between latent constructs and outcomes of interest were observed (p<0.05). Self-efficacy was positively associated with moderate-to-vigorous physical activity (p<0.001) and team sport participation (p<0.001) and negatively associated with sedentary behaviour (p<0.001). Negative outcome expectancies were negatively associated with moderate-to-vigorous physical activity (p<0.01) and sedentary behaviour (p<0.01) while positive outcome expectancies were positively associated with team sport behaviour (p<0.001) and negatively associated with sedentary behaviour (p<0.05). Home support was positively associated with moderate-to-vigorous physical activity (p<0.01) and team sport participation (p<0.05). Finally, physical activity social norms were negatively associated with sedentary behaviour only (p<0.05). CONCLUSIONS: This study supported the extension to Turkish children of the integrated behavioural model in relation to physical activity behaviours. Results illustrate multiple targets for interventions to increase physical activity.

Tobacco Containing Scenes in Some Selected Turkish Movies Released Between 1992 and 2016.

OBJECTIVE: Movies are among the most widely used media for advertising, promotional, and sponsorship activities of the tobacco industry, and the industry has been making huge investments in this sector for many years. In this study, the effects of movie scenes depicting the use of tobacco products, and the possible effects of the laws governing such scenes, were examined. MATERIAL AND METHODS: The sample of the study consisted of 50 films, the first 2 of which were the most watched each year, between the years 1992 and 2016, according to the data of the Center for Turkish Cinema Studies and the boxofficeturkiye.com websites. The scenes depicting the use of tobacco products were analyzed using the data collection form developed by the researchers. Each movie was evaluated separately by 2 researchers. RESULTS: A tobacco product was used in 82% of the 50 films watched. Men (87%), individuals between the ages of 25 and 64 (78.0%), and leading actors (40%) used more tobacco products, and the most frequently used product was the cigarette (93.1%). The number andduration of scenes containing tobacco was greater by 1.6 times before the first law was passed, and between the passage of the first law and the passage of the second law (P > .05, P > .05). The number and duration of the scenes decreased between the passage of the first and the second laws and after the second law was passed, by 3.6 and 5.3 times, respectively (P < .05, P < .05). CONCLUSION: Consistent and comprehensive tobacco control policies have been effective in reducing the number of scenes that contain tobacco in the movies produced in Turkey. A comprehensive and multidisciplinary approach is required to overcome the tobacco industry's impact on cinema.