Assessment of rational use of drugs and self-medication in Turkey: A pilot study from Elazig and its suburbs.

The concepts of "essential drugs" and "national drug policy" described by the World Health Assembly in 1975 were the first steps taken towards the rational use of drugs (RUD). According to WHO, more than half of all medicines worldwide are prescribed, dispensed or sold inappropriately and half of the patients fail to take them appropriately. The aim of this study has been to evaluate the habits of patients related to RUD with a specific aim to investigate the factors associated with self-medication. This descriptive survey study was carried out in Elazig, located at the Southeastern region of Turkey. A Rational Usage of Drug Questionnaire", querying the socio-demographic characteristics, health status, knowledge and manners of people with respect to rational drug use and insensible consumption of over the counter (OTC) drugs was applied to a total of 3521 patients during 19.09.2014 to 26.09.2014.The number of females and males were almost equal and the majority were in the range of 25-45 years of age. It was found that 58.9% of patients were practising some form of self-medication, 29.4% of the patients were reported using antibiotics without prescriptionand55.5% of them discontinued antibiotherapy. Self-medication was found to be more common among males, more educated patients and less frequent among patients under 18 years and over 65 years of age and patients with a chronic disease. Patient awareness about RUD is inadequate in Turkey as in many countries. Considering the high rates of haphazard use of drugs, drug usage without prescription, i.e. OTC drugs, should be discouraged. It is possible to take significant steps towards increasing awareness in terms of RUD with the cooperation of physicians, health organizations, educational institutions, non-governmental organizations and media. Might then be possible to achieve the expected benefits of the drugs.

The second report from Turkey: waist percentiles for 6-11-year-old children in Elazig Province, Eastern Anatolia.

OBJECTIVE: To construct waist percentiles for 6-11-year-old Turkish children in Elazig Province, Eastern Anatolia. METHODS: This cross-sectional study was performed with 3342 (1708 boys and 1634 girls) children from March to June 2007. Waist circumferences (WC) were measured between the lowest rib and the superior iliac crest, and centile curves were constructed with the Lambda-Mu-Sigma (LMS) method. RESULTS: Towards 6-11 years, WC 50th percentile ranged from 57.54 to 67.04 cm in boys and 55.77 to 64.58 cm in girls. For both genders, WC increased with age. At each age, boys had higher WC values than girls. For the entire sample, mean WC was 62.5 +/- 6.8 cm for boys and 59.8 +/- 6.2 cm for girls. Median WC was 62.0 cm (32.0-90.0) for boys and 59.0 cm (46.0-87.0) for girls. CONCLUSIONS: The large differences in the values obtained worldwide emphasize the necessity of providing population-specific WC reference curves from different populations, which in turn may result in an international reference standard similar to that provided for body mass index.

Weight, height and BMI references in Elazig: an east Anatolian city.

The aim of this study was to produce the growth references for Elazig children aged 6-11 years. Data were collected in eight primary schools of Elazig in 2007. Age- and gender-specific height, weight and body mass index (BMI) references were produced with LMS (Lambda-Mu-Sigma) method and compared with reported values in an Anatolian and a metropolitan city. A total of 3342 (1634 females, 1708 males) children aged 6-11 years from among 4258 students were included in the study. Age- and gender-specific height, weight and BMI references were produced. The 3rd-97th percentiles were detected to be higher than the range of percentiles between 6-11-year-old children. We consider that this first local reference for Elazig will provide a useful tool for health planning and monitoring of growth and development.

The knowledge, attitudes and practices of soldiers in a gendarmerie command headquarters about family planning and venereal diseases.

The objective of this study was to determine the knowledge, attitudes and practices of young male soldiers about family planning. This was a cross-sectional study conducted at the Gendarmerie Command Headquarters, Elazig City, eastern Turkey, carried out on 14 April 2004. One hundred ninety-one of 209 soldiers who were present at the Gendarmerie Command Headquarters were included in the study. A questionnaire, developed by the researchers evaluating the goals of the study, was filled out by the subjects prior to the Family Planning Seminar given to the soldiers. Data were assessed using SPSS and the chi-square test was used for statistical analysis. Defining family planning correctly, being familiar with planning methods and a knowledge of sexually transmitted diseases (STD) and their prevention was found to be at low levels among soldiers. A knowledge of family planning, birth control methods, identification and prevention of STD was higher with higher levels of education. The most familiar family planning methods were condom and oral contraceptive use. Soldiers constitute one of the most significant target groups for education programs.

The frequency of depression and menopause-related symptoms in postmenopausal women living in a province in Eastern Turkey, and the factors that affect depressive status.

BACKGROUND: This study was designed to determine depression in women in the postmenopausal stage in Elazig city, located in Eastern Turkey, and determine the factors affecting depressive status. MATERIAL/METHODS: The sample included 546 women and of these, 519 could be contacted. A questionnaire was conducted with the women who were included in the study. This included demographic properties, which are thought to affect depression. Subjects were given the Beck Depression Inventory (BDI). RESULTS: In total, 97.7% of women reported that they experienced a problem or had complaints during menopause, while 54.9% reported that they experienced problems in their sexual lives. The mean BDI score of women was 17.01+/-8.75. The ratio of women whose total scores were higher than the breakpoint of 17 was 42.2%. Single, widowed, and divorced women had higher ratios than married women; primary school or lower education women had higher ratios than high school or lower education graduate women; the women who reported that they had problems in their sexual lives had higher ratios than the other women within the survey; the women who were subject to violence at any time during their lives had higher ratios than the women who had not experienced violence (P<.05). CONCLUSIONS: The frequency of depression symptoms in women living in Elazig is high. The information and services that the local women receive about menopause are inadequate.

Prevalence and risk factors of overweight and obesity among urban school children in Elazig city, Eastern Turkey, 2007.

BACKGROUND: The prevalence of obesity is increasing dramatically all over the world. Very little data are currently available on the prevalence of childhood obesity in Turkey, and more research on the risk factors is required before preventive public health programmes can be put into practice. AIM: The aim of this study is to determine the prevalence of overweight and obesity and related factors in primary school students in Elazig, a city in eastern Turkey. SUBJECTS AND METHODS: In March-June 2007 a cross-sectional study of children aged 6-11 years old was performed. A total of 1782 girls and 1860 boys were observed. Weight and height were measured. Overweight and obesity using age- and sex-specific body mass index (BMI) cut-off points as defined by the International Obesity Taskforce were used. RESULTS: Prevalence of overweight and obesity were 13.2% and 1.6%, respectively. According to gender, the prevalence of obesity in boys was 2.0% and overweight was 13.9%, while in girls, obesity was 1.2% and overweight was 12.5%. We found that overweight and obesity may be related to factors such as eating while watching television, and eating fast food. CONCLUSION: It was noted as a health problem that there are overweight students aged between 6 and 11 years attending primary schools in Elazig province.

Prevalence and factors affecting the use of tobacco, alcohol and addictive substance among university students in eastern Turkey.

This study investigated the prevalence and factors affecting the use of cigarettes, alcohol and addictive substances among university students in Eastern Turkey. This cross-sectional study was conducted on 2258 students at Firat University in the city of Elazig, eastern Turkey. The subjects were students, randomly selected from each department of the university. A questionnaire was administered to the students under direct observation. The mean age of the participants was 21.36 +/- 2.93 years. Twenty-nine point three percent of the students smoked and 26.9% used alcohol. Six point six percent declared they had used an addictive substance other than cigarettes or alcohol at least once during their lifetime. Students who smoked had a higher monthly family income and allowance than nonsmokers (p < 0.05). Smoking was more prevalent among students whose fathers, siblings or close friends also smoked (p < 0.05). The use of alcohol was higher among students whose close friends used alcohol (p < 0.05). Six point three percent of participants stated they knew classmates who used addictive substances other than cigarettes or alcohol, and 12.4% declared they knew friends outside the classroom who used addictive drugs. At Firat University a large proportion of students reported using alcohol or smoking. Access to addictive drugs was also prevalent. Educational programs oriented towards young people must be prioritized in order to raise awareness regarding substance use.

The epidemiology and factors associated with nocturnal enuresis among boarding and daytime school children in southeast of Turkey: a cross sectional study.

BACKGROUND: Nocturnal enuresis is an important problem among young children living in Turkey. The purpose of this study was to determine the possible differences in the prevalence of enuresis between children in boarding school and daytime school and the association of enuresis with sociodemographic factors. METHODS: This was a cross-sectional survey. A total of 562 self-administered questionnaires were distributed to parents from two different types of schools. One of them was a day-time school and the other was a boarding school. To describe enuresis the ICD-10 definition of at least one wet night per month for three consecutive months was used. Chi-square test and a logistic regression model was used to identify significant predictive factors for enuresis. RESULTS: The overall prevalence of nocturnal enuresis was 14.9%. The prevalence of nocturnal enuresis declined with age. Of the 6 year old children 33.3% still wetted their beds, while the ratio was 2.6% for 15 years-olds. There was no significant difference in prevalence of nocturnal enuresis between boys and girls (14.3% versus 16. 8%). Enuresis was reported as 18.5% among children attending day time school and among those 11.5% attending boarding school (p < 0.05). Prevalence of enuresis was increased in children living in villages, with low income and with positive family history (p < 0.05). After multivariate analysis, history of urinary tract infection (OR = 2.02), age (OR = 1.28), low monthly income (OR = 2.86) and family history of enuresis (OR = 3.64) were factors associated with enuresis. 46.4% of parents and 57.1% of enuretic children were significantly concerned about the impact of enuresis. CONCLUSION: Enuresis was more frequent among children attending daytime school when compared to boarding school. Our findings suggest that nocturnal enuresis is a common problem among school children, especially with low income, smaller age, family history of enuresis and history of urinary tract infection. Enuresis is a pediatric public health problem and efforts at all levels should be made such as preventive, etiological and curative.

Prevalence and risk factors of female urinary incontinence in eastern Turkey.

OBJECTIVES: To evaluate the prevalence of urinary incontinence (UI) and determine risk factors for its development in women living in eastern Turkey. METHODS: A cross-sectional study was conducted on 2275 women aged between 17 and 80 years. A questionnaire examining demographic characteristics, parity and pelvic organ prolapse was given. Presence and types of incontinence were examined using a validated form of the Turkish version of the urogenital distress inventory questionnaire-short form (UDI-6). RESULTS: A total of 1054 (46.3%) women reported involuntary loss of urine. Stress UI was present in 46% of women, whereas urge UI was detected in 43% of them. Mean age of patients with and without UI were 44.57 + 11.04 and 35.04 + 9.51, respectively. Age, total number of pregnancies and number of deliveries were shown to be significantly different in patients with and without any type of UI. Multiple logistic regression analysis of the factors revealed that age, total delivery number, pelvic organ prolapse and difficult labor were significantly associated with the presence of UI. CONCLUSIONS: This is the first study examining the prevalence of UI in women living in eastern Turkey. By using a validated questionnaire, several risk factors for the development of UI were determined. Pelvic organ prolapse and increased number of births were found to be two most significant ones.

Prevalence and risk factors of overweight and obesity in Turkish academic staff.

Obesity and overweight are a significant public health problem that affects the quality of life of the individuals concerned. We studied the prevalence and related risk factors for obesity among academics. This descriptive cross-sectional study sampled 499 academic staff at Elazig Firat University, Turkey. Height, weight and blood pressure values were obtained and a descriptive survey was conducted. The age range of the participants was 22 to 65 years, with a mean age 36.5 +/- 8.1 years. The group had 29% women, and 71% men; 80% were married. The mean BMI of the participants was 24.6 +/- 3.1 kg/m2. Their mean systolic blood pressure was 117.0 +/- 12.1 mmHg and mean diastolic blood pressure was 73.1 +/- 8.0 mmHg. The overall prevalence of obesity was 7.0%; 2.1% in women and 9.0% in men. The combined prevalence of overweight and obesity was 45.9%. Nearly half the participants were either obese or overweight. A correlation was identified between overweight/obesity and sex, marital status, academic staff, physical activity, systolic and diastolic blood pressure. Although the study did not include all academics, the results reveal the need to evaluate the health impact of obesity in academics.

Prevalence and consultation behavior of self-reported rectal bleeding by face-to-face interview in an Asian community.

BACKGROUND AND AIM: Although rectal bleeding is a common gastrointestinal symptom, there are very few community-based studies, and all of these studies were conducted in the West. So far the epidemiologic characteristics of rectal bleeding have not been defined in an Asian country. We aimed to characterize self-reported rectal bleeding and its association with functional bowel disorders in Turkey. Factors affecting healthcare-seeking behavior were reviewed as well. SUBJECTS AND METHODS: In this study, 760 subjects were chosen randomly. Questionnaires were completed by nurses during face-to-face interviews with each participant. RESULTS: Of the 707 (93%) subjects included in this study, 9.5% had functional dyspepsia, 8.6% had irritable bowel syndrome (IBS), 24.5% had functional constipation, and 13.8% had functional abdominal bloating. The prevalence of rectal bleeding in the previous year was 14.7%. The recent onset of rectal bleeding was 2.7%. Rectal bleeding was more common among subjects younger than 45 years. Subjects who had functional constipation or constipation-dominant IBS reported rectal bleeding more frequently than others. The rate of consultation was only 41.3% among the subjects with rectal bleeding. Subjects aged > or =45 years and who had marked bleeding or bleeding more than twice a day or fear of cancer sought healthcare more frequently than others. CONCLUSION: Rectal bleeding is as common a symptom in Turkey as in Western countries. Advanced age and fear of cancer were independent predictors of consultation behavior in this group.

Experience of workplace violence during medical speciality training in Turkey.

AIMS: To determine the type, extent and effects of workplace violence among residents during postgraduate speciality training in various departments of medical schools in Turkey. METHODS: A cross-sectional survey was conducted in seven medical schools representing all geographical regions of Turkey. All physicians in speciality training in the selected medical schools were asked to complete a semi-structured 'violence questionnaire' addressing the type (emotional, physical and sexual) and extent of violence experienced, the perpetrators of the violence and the victim's reactions to the experience. RESULTS: A total of 1712 residents out of 2442 completed the questionnaire. In all, 68% indicated they had experienced some form of workplace violence, 67% had experienced verbal violence, 16% had experienced physical violence and 3% had experienced sexual violence. The victims' most prevalent reactions to violence included being deeply disturbed but feeling they had to cope with it for the sake of their career (39%), being distressed (26%) but considering that such events are common in all occupations and discounting it and being confused and bewildered and unsure how to respond (19%). The most frequently named perpetrators of verbal violence were relatives/friends of patients (36%) and academic staff (36%), followed by other residents/senior residents (21%), patients (20%), heads of department (13%) and non-medical hospital staff (6%). CONCLUSIONS: Physicians in speciality training in medical schools in Turkey are subject to significant verbal, physical or sexual violence. Precautions to prevent such exposure are urgently needed.

Prevalence of domestic violence during pregnancy in a Turkish community.

This study was carried out to determine the prevalence and risk factors for domestic violence victimization of women during pregnancy by intimate partner throughout marriage in a Turkish community. Pregnant women living in the servicing area of selected health centers in Elazig were considered for the study and data were obtained through a questionnaire. A total of 249 pregnant women, mean age 26.8 +/- 5.2 years and the mean gravidity 2.6 +/- 1.7, were involved. Of the 249 women, 28.9% were exposed to at least one case of physical violence throughout matrimony, 12.4% being abused during the previous year and 4.8% during the current pregnancy, 30.5% were exposed to verbal insult and 4.4% exposed to sexual abuse during the current pregnancy. In addition, 25.7% were exposed to one or more types of domestic violence during previous pregnancies. There was a significant correlation between the rate of violent victimization and number of children, and the partner's alcohol habits and socioeconomical status of the families (p < 0.05). Results from the self-report of the receiving end of violent behaviors indicate that the rates of any type of intimate partner violence were very high among pregnant women in this studied Turkish population. Efforts to reduce the incidence of this women's rights and public health problem should be given high priority.

Presentation of a device used by elderly women with prolapse in eastern part of Turkey.

OBJECTIVE: Presentation of a device used by three elderly women with prolapse in eastern part of Turkey. METHOD: Information about device is obtained by face to face interview technique. Microbiologic examination of the device and vaginal cultures were performed. RESULTS: Three women with genital polapse using an ancient device were found incidentally and information about device, their knowledge about genital prolapse, and solutions were obtained. CONCLUSION: By the help of related media and women health organizations the women especially who live in rural area should be educated about reproductive health care and if necessary health policies revisions should be considered.

Opinions of high school students in central Elazig about elderliness.

METHODS: Students attending five different types of high schools in central Elazig (a city in Turkey) during the 2009-2010 school year constitute the study population. One class was randomly selected from each high school. Out of 650 students, 640 participated in the study. The data were evaluated by using the SPSS program; percentage, mean, and chi-square analyses were used. FINDINGS: Of all the students, 41.7% defined the elderly as those who are 60 years of age or older. When asked the question "What does elderliness mean to you?", the majority of the students, 27.2%, responded "peace and resting". The second most common answer, given by 23.6% of students, was "sickness/tiredness"; 16.6% responded "wisdom/experience". Many students (30.3%) stated that the most difficult thing about living with the elderly was their interference in everything; 30.6% of students stated that there was no difficulty at all. According to 42.7% of the students, the greatest problem that the elderly face is health. Of all of the students, 58.3% stated that they feared growing old. CONCLUSION: Our study has concluded the following: 1) High school students have a conventional perception of elderliness and 2) They embrace the elderly and think that perspectives on elderliness will change through education.

The measurement of exhaled carbon monoxide in healthy smokers and non-smokers.

The measurement of exhaled carbon monoxide (CO) level may provide an immediate, non-invasive method of assessing smoking status. The aims of this study were to use a portable CO monitor to compare the exhaled CO levels in established smokers and non-smokers. The exhaled CO levels were measured in 322 subjects (243 healthy smokers, 55 healthy non-smokers, 24 passive smokers) who applied to healthy stand during the spring student activity of Firat University in Elazig. Exhaled CO concentration was measured using the EC50 Smokerlyser. The mean exhaled CO level was 17.13+/-8.50 parts per million (ppm) for healthy smokers and 3.61+/-2.15 ppm for healthy non-smokers, and 5.20+/-3.38 ppm for passive smokers. There were significant positive correlation between CO levels and daily cigarette consumption, and CO levels and duration of smoking in healthy smokers (r=+0.550, P<0.001, r=+0.265, P<0.001, respectively. Spearman's test). When smokers and non-smokers were looked at as a whole, a cutoff of 6.5 ppm had a sensitivity of 90% and specificity of 83%. In conclusion, exhaled CO level provides an easy, an immediate way of assessing a subject's smoking status.

Hearing in workers exposed to low-dose radiation for a long period.

The aim of the present study was to evaluate changes in hearing thresholds with standard and high frequency audiometry in workers exposed to low-dose ionizing radiation for a long period. A total of 57 (49 male and 8 female) technical staff working in radiology-related jobs who were exposed to occupational radiation were included in the study. The control group consisted of 32 (27 male and 5 female) volunteer subjects with normal hearing. The symptoms like tinnitus, vertigo, weakness and lack of appetite were evaluated. A standard ascending/descending method was applied to the subjects of the study and the control groups in order to determine their hearing thresholds at eleven different frequencies between 250 and 16,000 Hz. In the study group, the working duration of subjects ranged from 4 to 23 years, and the percentage of tinnitus, weakness, vertigo and lack of appetite were 47%, 28%, 24% and 17%, respectively. It was observed that pure tone hearing thresholds were markedly increased for 4,000, 6,000, 8,000, 14,000 and 16,000 Hz frequencies in the study group compared to the control group (p<0.01). Levels of static compliance and middle ear pressures of the study group were similar to the control group. Tinnitus, vertigo and hearing loss in high frequencies were observed in the subjects exposed to the radiation for a long period. Subjects under high risk should be evaluated periodically. We suggest that the use of standard and high frequency audiometry together could be beneficial in the evaluation of these subjects.

Prevalence of otitis media with effusion in first and second grade primary school students and its correlation with BCG vaccination.

OBJECTIVE: The object of this study was to determine the prevalence of otitis media with effusion (OME) in first and second grade primary school students, to analyze the causes of the difference in the prevalence, to define the effect of OME on the academic performance of the children and to investigate a correlation between the prevalence of OME and Bacillus Calmette-Guerin (BCG) vaccination. STUDY PLAN AND METHODS: The study was conducted during the September-November, 2002 period in Elazig. A total of 3675 clinically healthy primary school children attending primary schools in the central district of Elazig, living in the same region and of a similar socioeconomic status and age group were included in the study. Of the 3675 children, 2042 were in their first and 1633 in their second grade of primary school. The routine ear-nose and throat examinations of the children were carried out at their schools by the same medical team. The tympanometric test was performed in children diagnosed with OME following otoscopic examination. A scale measuring the academic performance of the children was developed. This scale was filled in by the student's teachers prior to physical examination. RESULTS: OME was diagnosed in 64 out of 2042 (3.1%) first grade and in 25 out of 1633 (1.5%) second grade students. The difference between the percentages of OME in first and second grade students was statistically significant (P < 0.05). The frequency of other ear-nose and throat pathologies accompanying OME was similar to those in children without OME. There was no statistically significant difference between the academic performances of children with and without OME (P > 0.05). CONCLUSION: The analysis of risk factors for OME revealed no difference between first and second grade students. The reason for the difference in the prevalence of OME between first and second grade students may be the positive effect on the immune system of the BCG vaccine which had been administered to the second grade students 4 months previously.

Effectiveness of a diabetes education and intervention program on blood glucose control for patients with type 2 diabetes in a Turkish community.

This study was undertaken to determine the effects of patient education and other interventions (regular exercise and diet), combined with existing oral antidiabetic therapy, on blood glucose control in patients with type 2 diabetes mellitus (DM). Two out of 16 primary health care centers present in Elazig, an eastern Turkish city, were randomly selected for this study; the patients had type 2 DM, lived in the service area of these health centers. Of a total of 100 participants, 33 were instructed to follow the standard diet for type 2 DM patients, 28 performed exercise in addition to the standard diet, and 39 did not participate in either exercise or follow the diabetic diet; they served as the control group. The percentage of glycosylated hemoglobin (HbA(1C)) was measured before and after the 8-week program and comparisons between the groups were made. At the beginning of the program, the HbA(1C) percentage in the diet-plus-exercise group (9.9 +/- 2.6%) was higher than in the diet (7.8 +/- 2.2%) and control groups (7.5 +/- 2.1%). After the intervention program, the HbA(1C) value of the control group had not changed significantly, while the most dramatic change in this value was obtained in the diet + exercise group, which was significantly reduced to 7.9 +/- 1.5%. The results of this 8-week intervention program indicate that a diabetes education and intervention program involving the combination of exercise and diet enhanced the effectiveness oral therapy on blood glucose control in patients with type 2 DM.

Prevalence of asthma, asthma-like and allergic symptoms in the urban and rural adult population in Eastern Turkey.

There is no study assessing the prevalence rates for asthma, asthma-like symptoms, and allergic symptoms in Eastern Turkey. In this study, we investigated these rates in the urban and rural adult population of Elazig Region in Eastern Turkey. A questionnaire was prepared based on the standard inquiry form of the European Community Respiratory Health Survey. The survey included 3,591 consented adults who were randomly selected. Each questionnaire was interviewed face-to-face by a physician. It was found that the cumulative prevalence rates of asthma and asthma-like symptoms of the rural and the urban respondent groups were 29.6% and 25.8%, respectively. The periodic prevalence rates of the same symptoms were 27.3% and 19.3%, respectively. The percentages of the patients living in rural and urban areas diagnosed as asthma by a physician were 5.5% and 3.1%, respectively. The proportions of patients with a history of at least one allergic disorder were 36.4% and 23.7% in the rural and urban groups, respectively. Asthma and asthma-like symptoms in patients with allergic rhinoconjunctivitis were significantly higher than those without (p < 0.01). The cumulative rates of a previous diagnosis of asthma among respondents with a history of asthma-like symptoms were 18.4% in the rural and 11.2% in the urban groups (p < 0.05). Among those who had had periodic asthma-like symptoms, the rural and urban rates of previous asthma diagnosis were 18.6% and 14.3%, respectively (p < 0.01). Unexpectedly, the prevalence rates for asthma, asthma-like and allergic symptoms in adults living in the rural areas of Elazig Region in Eastern Turkey were significantly higher than the rates in the urban population.