The Autism-Spectrum Quotient (AQ) Adolescent's Version in Turkey: Factor Structure, Reliability and Validity.

We assessed the reliability and validity of the Turkish version of the autism spectrum quotient (AQ)-adolescent. Three assessment groups of adolescents, aged 11-18, were: 80 with Asperger syndrome/high-functioning autism (AS/HFA), 71 with other psychiatric disorders (PDs; 35 major depression, 18 obsessive-compulsive disorder, 18 social phobia), and 249 healthy controls. The scores of the AS/HFA group were significantly higher than the healthy control and PD groups. Cronbach α value was 0.829. Ordinal alpha value was 0.90. We showed the AQ-adolescent four-factor structure in the factor analysis. In the test-retest of AQ-adolescent and subscale scores, "very strong" significant correlation values were detected. A cut-off score of 24 best distinguished the autism group from healthy controls with 0.975 sensitivity and 0.991 specificity.

Performance-Based Assessment in Child and Adolescent Psychiatry Residency Training.

OBJECTIVE: This study aimed to examine the application of the Objective Structured Clinical Examination (OSCE) to the assessment of competency among child and adolescent psychiatry (CAP) residents and to analyze the feedback from the residents and the examiners. METHODS: The OSCE was administered to 53 CAP residents based on three seniority levels over a 14-year period. The results of 147 OSCEs applied to residents and the feedback received were evaluated. OSCE scores were calculated based on the scores given by the examiners and standardized patients (SPs). RESULTS: Examiners' communication skills scores were significantly higher than examiners' task performance scores but were not significantly different than the SPs' scores. Intraclass correlation coefficients indicated that examiners and SPs were very consistent in their assessments among themselves. The scores given by the examiners and the SPs were not different between genders except for female residents' communication skills scores given by SPs in the OSCE-senior. With regard to the feedback on the OSCE, it was determined that examiners gave significantly higher scores than residents on every item except for "neutrality of the examiners." CONCLUSIONS: A standard OSCE including different station types was structured to assess the progressive clinical skills of residents over the years. Using the OSCE contributed to CAP residency training far beyond assessment, creating a useful educational experience for both the trainers and the residents. Despite the challenge experienced related to SPs, the OSCE was found to be useful in improving training programs.

Exposure of Students to Emotional and Physical Violence in the School Environment.

INTRODUCTION: While peer abuse or physical violence in school is emphasized more, the physical and emotional violence caused by school staff has been emphasized less. The purpose of this study was to investigate the variables related to emotional and physical violence that students are exposed to in the school environment. METHODS: This cross-sectional and descriptive study was conducted by applying a questionnaire to 434 fifth-grade students receiving education in the primary schools in Konak district of Izmir province. Being prepared by the researchers of this study, the questionnaire consisted of questions about the socio-demographic features of the child and the family, the place where the child has been raised, family income, average grade, and the emotional and physical violence of teachers, parents, and peers s/he has been exposed to within the last year. The Chi-square test, Mann-Whitney U test, and logistic regression analysis were used for statistical analyses. RESULTS: The study group consisted of 214 (49.3%) female and 220 (50.7%) male students. Students reported that they were exposed to at least one type of emotional violence from 59.4% of teachers, 52.8% of parents, and 61.8% of children at school; they were exposed to at least one type of physical violence from 42.9% of teachers, 33.6% of parents, and 24.9% of children at school. While the rate of encountering with the beating of another child was 53%, the rate of watching this in television/cinema was 52.8%. Regarding exposure to at least one type of violence, males were found to be significantly more exposed to emotional and physical violence from male teachers, female teachers, and fathers and physical violence from children at school. The factors regarding the exposure to emotional and physical violence by teachers were evaluated using logistic regression analysis, and it was determined that the physical violence from teachers, emotional violence from children in school, and emotional violence from parents could predict the emotional violence from teachers. For males, physical violence from children in school and emotional violence from teachers could predict the physical violence from teachers. CONCLUSION: In this study, the determination of the tendency of togetherness of different types of violence applied to students from different people groups like teachers, parents, and children in school makes us think about the possibility of common risk factors in terms of violence exposure. The risk factors determined in this study may guide us in planning protective interventions aimed at violence.

Triage of Patients in the Child and Adolescent Psychiatry Outpatient Clinic.

INTRODUCTION: The aim of this study was to evaluate and describe the three-stage triage method used in a child and adolescent psychiatry outpatient clinic. METHOD: The study investigated the new allocation process of 1482 children and adolescents who were assessed using this triage system for the duration of one year, in the year 2005. Data of 1423 children and adolescents who presented in 2003 regarding the waiting time for the first appointment and the rate of nonattendance at the first appointment were used for the comparison. In triage system, new patients presenting to the outpatient clinic in the morning four days a week were assessed by a three-stage procedure: An initial Strengths and Difficulties Questionnaire screening and a structured interview administered by an intern was then followed by a clinical interview. RESULTS: Of the 1482 children and adolescents who presented to the outpatient clinic during the study period, 1291 were given further appointments. Among patients who presented in 2005, the 207 non-attendant patients were significantly more likely to have longer waiting times than the 1084 attendant patients. When compared to year 2003, it was found that there was a significant decrease in the median waiting time for the first appointment and the rate of nonattendance at the first appointment among patients who presented in 2005. CONCLUSION: The triage procedure used in this study may constitute a model for developing countries with limited health care resources.

Sexual attitudes, behaviour changes and opinions of interns in Izmir, Turkey.

OBJECTIVES: To evaluate sexual attitudes, behaviour and opinions of students at the end of their medical education studies in Izmir, Turkey, and compare findings with the results of the study carried out when they were first-year students. METHODS: A cross-sectional and longitudinal study, with data collected via a questionnaire. RESULTS: 'Friends' were most often mentioned as the source of their personal sexual information by students on both occasions. Use of the 'internet' increased significantly during the five years. Pornography and health professionals/specialists' also gained in importance but remained among the less frequently used sources of information. The most frequent factor affecting sexual attitudes and behaviour for both years was 'my own desire and values'. Most (74.8%) interns had taken only a few sexual health histories and 16.5% never; 35% believed their education would enable them to take one. Nearly half (48.5%) said being a medical student changed their opinions on sexuality and 25.7% said they changed their behaviour. DISCUSSION: Although changes were observed in sexual attitudes, behaviour and opinions between the two questionnaires many problems still exist. This study may add to the improvement of medical education regarding sexual health education and its practices.

Developmental characteristics of children aged 1-6 years with food refusal.

OBJECTIVE: The aim of this study was to compare the sociodemographic and developmental characteristics of children with food refusal and children with no history of feeding problems. DESIGN: Cross-sectional case-control study. SAMPLE: 30 children aged 1-6 years who were seen in the outpatient clinics for food refusal formed the case group, and 30 healthy children matched for age, sex, and socioeconomic status formed the control group. METHODS: Anthropometric indices and early developmental characteristics of all the children in the study were evaluated and also their developmental levels were determined using the Ankara Developmental Screening Inventory. RESULTS: The mean age of children with food refusal was 42.4+/-17.6 months, and the male/female ratio was 12/18. Children with food refusal had shorter mean breastfeeding durations and lower mean birth weights, body mass index, percentage height for age, and percentage weight for height values than those of the controls. There were no significant differences between the 2 groups in developmental delays. CONCLUSIONS: These results suggest that food refusal may be related to lower birth weight and shorter breastfeeding duration. Further research with larger samples is needed to clarify these relationships and the effects of feeding problems on the growth and development of children.

Sexual attitudes and risk-taking behaviors of high school students in Turkey.

BACKGROUND: The risk of sexually transmitted diseases is high but opportunities of sexual education for adolescents are limited in Turkey. The aim of this study was to evaluate sexual attitudes and behaviors and to determine the predictors of sexual initiation among adolescents. METHODS: A questionnaire designed by the researchers was administered to 861 senior year high school students in their classrooms. RESULTS: The rates of masturbation and sexual intercourse and the median partner numbers among males were higher than females. The rates of having negative feelings after the first sex among females were higher than males. The rates of having sexual intercourse and the mean age at first sexual intercourse among males were similar to developed countries. However, the use of a condom at first intercourse was low. Lower academic performance and grade repetition experience among males and cigarette smoking among both gender groups were related to having sexual intercourse. CONCLUSIONS: This is one of the first studies about sexual risk-taking behaviors among high school students in Turkey. Differences found between gender groups regarding attitudes and behaviors reflect the social structure in Turkey. These findings may be helpful in producing effective solutions for improving education and preventive health care.

Direct-to-consumer advertising of pharmaceuticals: developed countries experiences and Turkey.

While several major problems concerning drugs occur in the world, the attempts to direct-to-consumer advertising (DTCA) has gained a considerable impetus lately in both developed and developing countries. DTCA has increasingly become an appealing advertising alternative for the pharmaceutical industry as drug companies have come to wrestle with such problems as the expansion of the drug market; the decline of the medical representatives' work efficiency; drug reimbursement restrictions; and the escalating role of the Internet in the consumer market. Some of the main disadvantages of the DTCA are: increasing drug expenditures, unnecessary drug consumption and adverse effect risks. Even though the influence of pharmaceuticals on health services and the economy hold the same importance in the developed and developing countries, its negative consequences have increased by encompassing developing countries in its grip. Therefore, in this review, using Turkey as an example, the situation of direct-to-consumer advertisements in developing countries is analysed in relation with developed countries.

Sexual behaviours and contraception among university students in Turkey.

The aim of this study was to evaluate the sexual attitudes and behaviours of university students. An anonymous questionnaire was administered to 550 final-year university students aged 20-25 years in Izmir, Turkey. Male students opposed premarital sexual intercourse for both genders more than female students did. The frequency of sexual intercourse among male students (61.2%) was higher than that among female students (18.3%). The mean age of first sexual intercourse was lower among male than among female respondents. The rate of condom use at first sexual intercourse was 47.4%. The frequency of having two or more past sexual partners and masturbation was higher among males than females. It was found that there were culture-specific and gender-dependent differences in sexual attitudes and behaviours of the university students. These results may help in the planning of education and health policies in Turkey.

Bioethics and Turkey: crossroads and challenges.

Despite extraordinary improvements in medicine, health care worldwide continues to exhibit indefensible contradictions and extreme inequalities. "Health-for-all" campaigns, and development programs targeting welfare and social security have addressed these problems with limited success, but bioethicists, who by this point in the globalization era might have been expected to be addressing these problems urgently and persistently, have had little to say. We ask if bioethics, stalled at a crossroads, is prepared to alter course. We review the bioethics experience in Turkey as a case study, considering especially globalization and Turkey's application to join the European Union.

Attention-deficit hyperactivity disorder and use of psychostimulants among children in Turkey.

Recently, the use of psychostimulant medication in children with symptoms of attention-deficit hyperactivity disorder (ADHD) has been subject to extensive debate. The problems faced while assessing and diagnosing ADHD, unnecessary prescribing of psychostimulants, the possible side-effects of psychostimulants on the developing brain, the risk of drug dependency, and the risk of stigmatising children through medicalisation of normal life events are considered among the principal objections to the use of psychostimulant medications. On the other hand, what also need to be taken into account are the increasing evidence on the genetic, biochemical and diagnostic validity of the disorder, the data showing the therapeutic effects of psychostimulants and the rarity of the above-mentioned side-effects, as well as the ethical problems created by insufficient treatment of children because of the concerns of parents. A critical evaluation of these conflicting opinions by mental health professionals might contribute to the application of ethical principles. While making this kind of evaluation, it is important to pay regard to the specific sociocultural features of the country, as well as the prevailing worldwide discussion.

[Family functioning, personality disorders, and depressive and anxiety symptoms in the mothers of children with food refusal]. / Yeme Reddi Olan Cocuklarin Annelerinde Kisilik Bozukluklari, Depresyon ve Anksiyete Belirtileri ve Aile Islevleri.

OBJECTIVE: A review of the literature reveals that feeding problems during early childhood can be related to maternal psychiatric disorders. We aimed to evaluate the personality disorders, levels of depression and anxiety symptoms in the mothers of children with food refusal in addition to family functioning. METHOD: Thirty children aged between 1 and 6 years admitted to the clinic for food refusal and their mothers were included in the study. The control group consisted of 30 healthy children and their mothers. The Beck Depression Inventory, State-Trait Anxiety Inventory, McMaster Family Assessment Device and Structured Clinical Interview for DSM-III-R Personality Disorders were performed in mothers, and the presence of any personality disorders was evaluated with the SCID-II Interview. RESULTS: The depression and anxiety scores of the mothers of patients were higher than those of the controls. Perceived family functioning by mothers of patients was more problematic than that of the controls. Rates of maternal personality disorders were not significantly different between the two groups. CONCLUSION: Food refusal is not only related to characteristics of the child or his/her mother, but also to problems in family functioning. An integrative approach which evaluates the whole family is helpful to assess and treat children with food refusal.