An Analysis of the Mode of Delivery, Risk Factors, and Subgroups with High Caesarean Birth Rates Using Robson Classification System.

OBJECTIVE: We aimed to understand the utilization of the mode of delivery and related risk factors. Further aimed to apply the Robson classification system to evaluate the data quality and analyze the CS rates in subgroups. METHODS: We conducted a retrospective descriptive study by reviewing the medical records of all women who delivered at the State Hospital in 2019. A proforma was developed for extracting data from patient records. All women with six obstetric parameters were categorized into Robson groups to determine the absolute and relative contributions of each group to the overall CS rate. RESULTS: Of 797 deliveries, 401 (50.2%) were CSs. Being older, being Turkish Cypriot, having preterm births, previous CS, multiple fetuses, and having breech or transverse fetal presentations were related to having higher risks of CS. The most common medical indication for CSs (52.3%) was a history of previous CSs. Robson Group 5 contributed the most (50.7%) to the overall CS rate, with the highest absolute contribution of 21.8%. Group 10 and Group 8 were the second and third highest contributors to the overall CS rate, with relative contributions of 25.3% and 9.0%, respectively. CONCLUSIONS: Findings revealed the substandard quality of obstetric data and a noticeably high overall CS rate. The top priority should be given to improving the quality of medical records. It underscored the necessity of implementing the Robson classification system as a standard clinical practice to enhance data quality, which helps to effectively evaluate and monitor the CS rates in obstetric populations.

Caesarean section rates are increasing worldwide, and the Robson Classification System is recommended by the WHO to evaluate and monitor the CS rates. This study is the first to use Robson classifications and revealed high CS rates in specific subgroups of the obstetric population. The inadequate, substandard data quality highlighted the areas that urgently needed improvement in clinical practices at the largest state hospital. The study lays the foundation for further nationwide studies and demonstrates the importance of the Robson classification system. Specific recommendations were provided to the hospital management for improving the quality of the obstetric data and monitoring CS rates.

The knowledge and perceptions of the first year medical students of an International University on family planning and emergency contraception in Nicosia (TRNC).

BACKGROUND: Informing the individuals on family planning including emergency contraception is a significant step for preventing unintended pregnancies. Although there is a number of studies on family planning and emergency contraception globally and in Turkey, no such data are available in the Turkish Republic of Northern Cyprus. The objective of this study was to evaluate the knowledge and perceptions on family planning and emergency contraception of the first year students of an international medical school in Nicosia, Northern Cyprus and to increase awareness for developing new policies on the issue. METHODS: The data of this cross-sectional study were collected in February 2016 by a questionnaire of 36 questions. Of the 229 students, 189 (82.5%) completed the questionnaire. The data were evaluated by SPSS 18.0 statistical program. The differences of variables were evaluated by Chi square test, p < 0.05 being accepted as significant. RESULTS: The distribution of participants from 23 countries according to nationality revealed three leading countries: Nigeria, Turkey and Syria. Of the students, 53.6% knew the definition of family planning. The sources of information were mainly school, the internet and media, with a total of 60.9% of the participants who stated having prior information on the subject. Awareness of contraceptive methods was indicated by more than 90% and emergency contraception by 66.1% of the participants. However, the students were unable to differentiate between modern and traditional family planning methods; 85.6% did not have knowledge of the most effective period for emergency contraception and 63.1%, of the definition of emergency contraceptive pills. CONCLUSIONS: In conclusion, the knowledge and awareness level of the first year medical students on family planning and emergency contraception was insufficient. Family planning and emergency contraception education should be provided for the students at the first year of all faculties as well as medical schools and relevant programs should be included in the curricula of medical education.

The Standard Days Method(®): efficacy, satisfaction and demand at regular family planning service delivery settings in Turkey.

OBJECTIVES: To evaluate the demand, efficacy, and satisfaction concerning the Standard Days Method(®) (SDM; a fertility awareness method) as an option presented among other contraceptive methods at regular service delivery settings. METHODS: The survey group consisted of 993 women who presented at the primary care units in Umraniye District of Istanbul, Turkey, between 1 October 2006 and 31 March 2008, and started to use a new method. Women were enrolled until reaching a limit of 250 new users for each method, or expiration of the six-month registration period. Participants were followed for up to one year of method use. RESULTS: The characteristics of women who chose the SDM were similar to those of participants who opted for other methods. The most common reasons for selecting it were that it is natural and causes no side effects. Fifty-one percent used the SDM for the full year, compared to 71% who chose an intrauterine device (IUD). Continuation rates were significantly lower for all other methods. During the one-year follow-up period, 12% of SDM-, 7% of pill-, 7% of condom-, 3% of monthly injection-, 1% of quarterly injection-, and 0.5% of IUD users became pregnant. CONCLUSION: The SDM had relatively high continuation rates and relatively good levels of satisfaction among participants and their husbands. It should be mentioned among the routinely offered contraceptive methods.

Prevalence and risk factors of Helicobacter pylori in Turkey: a nationally-representative, cross-sectional, screening with the ¹³C-Urea breath test.

BACKGROUND: Helicobacter pylori is an important global pathogen infecting approximately 50% of the world's population. This study was undertaken in order to estimate the prevalence rate of Helicobacter pylori infections among adults living in Turkey and to investigate the associated risk factors. METHOD: This study was a nationally representative cross sectional survey, using weighted multistage stratified cluster sampling. All individuals aged ≥18 years in the selected households were invited to participate in the survey. Ninety two percent (n = 2382) of the households in 55 cities participated; 4622 individuals from these households were tested with the ¹³C-Urea breath test. Helicobacter pylori prevalence and associated factors were analysed by the t test, chi square and multiple logistic regression with SPSS11.0. RESULTS: The weighted overall prevalence was 82.5% (95% CI: 81.0-84.2) and was higher in men. It was lowest in the South which has the major fruit growing areas of the country. The factors included in the final model were sex, age, education, marital status, type of insurance (social security), residential region, alcohol use, smoking, drinking water source. While education was the only significant factor for women, residential region, housing tenure, smoking and alcohol use were significant for men in models by sex. CONCLUSION: In Turkey, Helicobacter pylori prevalence was found to be very high. Individuals who were women, elderly adults, single, had a high educational level, were living in the fruit growing region, had social security from Emekli Sandigi, were drinking bottled water, non smokers and regular alcohol consumers, were under less risk of Helicobacter pylori infection than others.

Knowledge and Awareness of Parents Towards Human Papillomavirus (HPV) and HPV Vaccines, and Vaccine Acceptability in Northern Cyprus.

The human papillomavirus (HPV) vaccine is one of the most cost-effective public health measures for preventing cervical cancer and other HPV-related diseases. However, the vaccine uptake in many countries remains suboptimal. This cross-sectional study aimed to assess the knowledge and awareness of parents towards HPV, related diseases, and HPV vaccines, as well as to examine the effect of brief educational information on parents' vaccine acceptability. We used a structured interviewer-administered questionnaire to collect information from 227 outpatient visitors to a healthcare center who had children under the age of 19 years. We asked parents again about their acceptance of HPV vaccines after being provided brief educational information. Of all the parents, 43% were aware of HPV and related diseases, and 59% of those had sufficient knowledge regarding HPV while 45% of them reported that they were aware of HPV vaccines. Being Northern Cypriot was a predictor of having good knowledge, whilst being a female, having a higher education level, being 35 years or older, and being employed were the significant predictors of having greater awareness of HPV and related diseases. The HPV vaccine acceptance of the parents increased substantially in all sociodemographic groups after the provision of the educational information. The findings demonstrated that the vaccination rates of children of parents who have insufficient knowledge and awareness of HPV and vaccines are also very low. Effective educational interventions based on the specific sociodemographic characteristics of the patients should be given a stronger focus to improve vaccine acceptability among this population.

An Assessment of the Knowledge, Attitude, and Practice Toward Standard Precautions Among Health Workers From a Hospital in Northern Cyprus.

BACKGROUND: The objective was to assess the knowledge level, attitude, and practice of health care workers towards standard precautions, and to identify the related factors. Furthermore, it was attempted to identify the proportion of having the experience of needle stick injuries (NSIs) and associated factors among participants. METHODS: A cross-sectional study was conducted in a teaching hospital among 233 health workers using a self-administrated questionnaire. The questionnaire included eight knowledge items, seven practice items, and five attitude items. Based on the mean score of each category, responses were grouped into "satisfactory" and "unsatisfactory". Univariate, bivariate, and multivariable logistic regression analyses were done. RESULTS: The mean age of the participants 32.95 (SD ± 9.70) and 62.2% of them were women. 57.5% of the staff had a satisfactory level of correct knowledge (>5 correct answers), 37.3% had a satisfactory positive attitude (>3 correct answers), and 30.9% had a satisfactory practice (>3 correct answers) towards standard precautions. The occupation was one of the predictors as doctors were less likely to have satisfactory knowledge and practice compared to nurses (OR = 0.269, 95% CI: 0.10-0.70 and OR = 0.248, 95% CI: 0.08-0.77, respectively). Out of 174 participants, 31.6% of them reported experiencing NSIs and support staff were 71% less likely to experience NSIs compared to nurses & paramedics. CONCLUSION: The findings revealed a substandard adherence of standard precautions among participants, which highlighted the necessity of the provision of a periodic, tailored training program based on the occupation and risk exposure.

The impact of a faculty development program: evaluation based on the self-assessment of medical educators from preclinical and clinical disciplines.

Self-assessment tools have previously been used to assess the impact of a faculty development program on the teaching skills of medical educators. In this study, we aimed to assess the impact of a faculty development program on the teaching performances of faculty members in relation to their medical disciplines and academic positions. A faculty-training program consisted of "training skills" and "student assessment instruments" courses. The impact of the program was evaluated by self-reporting of faculty members (a total of 225 reports) 1-2 yr after the program. Both courses were found to be beneficial by nearly all of the attendants. Clinicians benefited more from some topics in the student assessment course and could apply the structured learning and assessment guides, structured oral examination, and objective structured clinical examination more efficiently than their peers from preclinical departments. In conclusion, the results demonstrated that the participants of the faculty development program modified their teaching activities according to the demands of their clinical practice. The correlations between the benefits and behavioral changes were statistically significant.

Health-Seeking Behaviors and its Determinants: A Facility-Based Cross-Sectional Study in the Turkish Republic of Northern Cyprus.

BACKGROUND: Understanding health-seeking behaviors and determining factors help governments to adequately allocate and manage existing health resources. The aim of the study was to examine the health-seeking behaviors of people in using public and private health facilities and to assess the factors that influence healthcare utilization in Northern Cyprus. METHODS: A cross-sectional study was conducted in 2 polyclinics among 507 people using a structured intervieweradministered questionnaire. Health-seeking behaviors were measured using four indicators including routine medical check-ups, preferences of healthcare facilities, admission while having health problems, and refusal of health services while ill. Descriptive statistics and multivariable logistic regression analyses were done to explore factors influencing the use of health services. RESULTS: About 77.3% of the participants reported to have visited health centers while they had any health problems. More than half (51.7%) of them had a routine medical check-up during the previous year, while 12.2% of them had refused to seek healthcare when they felt ill during the last five years. Of all, 39.1% of them reported preferring private health services. Current smokers (adjusted odds ratio [AOR]=1.92, 95% CI: 1.17-3.14), having chronic diseases (AOR=2.05, 95% CI: 1.95-2.16), having poor perceptions on health (AOR=2.33; 95% CI: 1.563.48), and spending less on health during the last three months (AOR=2.08, 95% CI: 1.43- 3.01) had about twice the odds of having routine checkups. Higher education (AOR=1.87, 95% CI: 1.38-2.55) was shown to be a positive predictor for the health-seeking behaviors, whereas having self-care problems (AOR=0.18, 95% CI: 0.08-0.40) and having a moderate-income (AOR=0.68, 95% CI: 0.57-0.81) were inversely associated with seeking healthcare. CONCLUSION: The utilization of public and private health sectors revealed evident disparities in the socio-economic characteristics of participants. The health-seeking behaviors were determined by need factors including chronic disease status and having poor health perception and also by enabling factors such as education, income, insurance status and ability to pay by oneself. These findings highlight the need for further nationwide studies and provide evidence for specific strategies to reduce the socioeconomic inequalities in the use of healthcare services.

Relationships between screen time, internet addiction and other lifestyle behaviors with obesity among secondary school students in the Turkish Republic of Northern Cyprus.

Asut Ö, Abuduxike G, Acar-Vaizoglu S, Cali S. Relationships between screen time, internet addiction and other lifestyle behaviors with obesity among secondary school students in the Turkish Republic of Northern Cyprus. Turk J Pediatr 2019; 61: 568-579. Obesity among children and adolescents is one of the critical public health problems worldwide, and the prevalence of obesity has been increasing rapidly over decades. We examined the associations between screen time, internet addiction and other life style behaviors with obesity among high school students in Near East College in Northern Cyprus. A cross-sectional study was conducted among 469 secondary school students with mean age 11.95 ±0.81 years. A self-administrated questionnaire was applied to assess screen time and life style behaviors. The Turkish adapted version of the short-form of internet addiction test was used to assess internet addiction problems. Height and weight were measured objectively to calculate body mass Index (BMI) and classify based on the BMI percentiles for sex and age. Descriptive analysis, Chi-Square test and multivariate regression analysis were performed, and the p- value < 0.05 was accepted as significant. Of all participants, 17.2% were overweight and obese, and 18.1% had internet addiction, while 40.7% of them reported to have screen time of more than two hours a day. After adjusting the analysis for age and sex, eating snacks while watching TV (OR,3.04; 95% CI, 1.28-7.21), self- perceived body weight (OR, 24.9; 95% CI, 9.64-64.25) and having a play station in the room (OR,4.6; 95% CI, 1.85 - 11.42) were significantly associated with obesity. Screen time (OR,4.68; 95% CI, 2.61-8.38; p=0.000) and having a computer in the bedroom (OR,1.7;95% CI, 1.01- 2.87; p=0.046) were significantly associated with internet addiction, whereas parent`s complaint about lengthy technology use (OR,0.23; 95% CI, 0.11-0.46; p=0.000) was found to be a protective factor against internet addiction. The findings highlighted the significance of a family - school based integrated approach, which should be implemented to tackle obesity problem to improve the quality of life of children and adolescents.

Potential drug-drug interactions among prescriptionsfor elderly patients in primary health care.

BACKGROUND/AIM: Elderly patients are at high risk from drug-drug interactions (DDIs). This study evaluates the potential DDIs in Turkish elderly patients at a primary health care outpatient clinic. MATERIALS AND METHODS: Online database systems were used to examine DDIs on the prescriptions of patients (n = 1206). The clinical severity of DDIs was classified by the Lexi-Interact Online database. RESULTS: Of the 5059 prescriptions, 33% were found to have DDIs. We detected 29 (0.9%) A, 380 (11.8%) B, 2494 (77.7%) C, 289 (9%) D, and 18 (0.6%) X risk rating category DDIs among the prescriptions. Prescriptions of female patients and patients aged between 65 and 72 years showed significantly higher number of DDIs. The frequency of DDIs increased both with the number of drugs and combined preparations per prescription. Acetylsalicylic acid and salbutamol were the most frequently prescribed drugs contributing to clinically important DDIs. Additionally, acetylsalicylic acid and escitalopram, which interact with each other, were found on the list of Beers criteria. The most predicted clinical outcomes of DDIs were increase in therapeutic efficacy and adverse/toxic reactions. Conclusions: Prediction of DDIs in elderly patients will provide better prescribing and drug safety. Use of nonsteroidal anti-inflammatory agents, selective serotonin reuptake inhibitors, and beta-2 adrenergic receptor agonists should be closely monitored.

Expanding family planning options: offering the Standard Days Method to women in Istanbul.

BACKGROUND: This study introduced the Standard Days Method (SDM), a fertility awareness-based method of family planning, to couples in a region of Istanbul, Turkey who were using a method of low effectiveness or no family planning method. The objective was to determine potential demand for, and satisfaction with, the SDM. METHODS: A total of 657 couples were selected by systematic sampling and offered the SDM. Those accepting this method were interviewed 1 and 3 months after starting the SDM. RESULTS: Some 47% of the participants were satisfied with the method and intended to continue using it. CONCLUSIONS: Potential demand for the SDM was 80.3% (278/346 eligible women) among couples who were using a method of low effectiveness or no family planning method. Our results suggest that adding the SDM to the contraceptive method mix may benefit Turkish women.

Health policy for the poor: an exploration on the take-up of means-tested health benefits in Turkey.

Recent healthcare reform in Turkey aims at achieving universal coverage with the introduction of General Health Insurance (GHI). As part of GHI, the state assumes the provision of health insurance coverage to those unable to afford the public health insurance premiums conditional on a means-testing procedure where the official threshold is set as one-third of the gross minimum wage. This article aims at exploring in Turkey the prevalence of non-take up of means-tested health insurance for the poor and the consequent financial burdens for those poor segments outside the coverage. Based upon Statistics of Income and Living Conditions micro data, the non-take-up rate is estimated to be around 44%, where the prevalence of non-take-up is lower yet still high, i.e. around 30%, for households with very low incomes as well as those with elderly or ill members. The results from a separate health expenditure survey on urban poor, which is specifically designed and implemented by the authors, reveal that poor households without health insurance coverage are faced with significant out-of-pocket expenditures. About 5% of those households without coverage were found to have inpatient expenditures that exceeded 20% of their annual disposable household income. Also, among the households without coverage but with at least one inpatient visit over the last two years, the median expenditure was reported as high as 8% of the annual household income as opposed to 0% median value for those with GHI. The results highlight that a large proportion of poor population still lacks public health insurance despite the overarching aim of universal coverage.

Attitudes of married individuals towards oral contraceptives: a qualitative study in Istanbul, Turkey.

OBJECTIVE: To determine positive and negative attitudes of married Turkish women and men regarding the use of oral contraceptives (OCs). METHODS: Twenty focus group discussions were conducted during the period October 1998-March 1999 in Umraniye, which is one of the densely populated districts of Istanbul. RESULTS: Most of the negative attitudes relating to OCs stemmed from concerns over side effects, particularly in the male focus groups. Health care professionals' behaviour, lack of concern or bias, and their reluctance to prescribe also limited the uptake of OCs. The female groups had very positive attitudes towards OCs compared to those of the male groups. It was identified that although OCs are largely provided free of charge in Turkey, beliefs and attitudes towards them are the important factors which affect the uptake of the method. CONCLUSION: Special efforts may be needed to educate these groups and also to teach the health professionals about family planning counselling.

Natural history and risk factors of early respiratory responses to exposure to cotton dust in newly exposed workers.

OBJECTIVE: A prospective study of newly exposed cotton workers was performed to investigate the natural history of respiratory symptoms and lung function changes. METHODS: A total of 157 workers naive to cotton dust exposure were investigated by questionnaire, spirometry, and skin tests. They were examined before employment (baseline) and at the end of the first week, and the first, third, sixth, and 12th month after starting work. Acute airway response was defined as either a cross-first-shift or a cross-week fall in forced expiratory volume in one second (FEV1). The longitudinal change of lung function over the year was also calculated. Five hundred seventy-two personal dust sampling and 191 endotoxin measurements were performed to assess the exposure. RESULTS: Forty percent of workers reported work-related symptoms in the first week of the study. Smoking, endotoxin, and dust concentrations were risk factors for all work-related symptoms. Acute airway responses were witnessed after immediate exposure. Female status was the only factor found to be predictive of acute airway response. The mean longitudinal fall in FEV1 at 1 year was 65.5 mL (standard error = 37.2). Age, early respiratory symptoms, and early fall in cross-week FEV1 were found to predict the 12-month fall in FEV1. Cross-first-shift and cross-week falls in FEV1 reduced in magnitude during the course of the study. CONCLUSIONS: This study of workers naive to cotton dust exposure has demonstrated that respiratory symptoms and acute airway responses develop early following first exposure, and a tolerance effect develops in those workers with the continued exposure. Current smoking and increasing exposure predicts the development of work-related lower respiratory tract symptoms, while early symptoms and acute airway changes across the working week predict the longitudinal loss of lung function at 1 year.

Impact of a short postgraduate course in rational pharmacotherapy for general practitioners.

AIMS: The impact of a short postgraduate course on rational pharmacotherapy planning behaviour of general practitioners (GP) was investigated via a face-to-face interview with 25 GPs working at health centres in Istanbul. METHODS: GPs were randomly allocated to control and intervention groups. Intervention group attended a 3-day-training program preceded and followed by a written exam to plan treatment for simulated cases with a selected indication. The participants' therapeutic competence was also tested at the post-test for an unexposed indication to show the transfer effect of the course. In addition, patients treated by these GP's were interviewed and the prescriptions were analysed regarding rational use of drugs (RUD) principles at the baseline, 2 weeks and 4 months after the course. RESULTS: At the baseline there was not any significant difference between the control and intervention groups in terms of irrational prescribing habits. The questionnaires revealed that the GPs were not applying RUD rules in making their treatment plans and they were not educating their patients efficiently. Training produced a significant improvement in prescribing habits of the intervention group, which was preserved for 4 months after the course. However, very low scores of the pretest indicate the urgent necessity for solutions. CONCLUSIONS: Training medical doctors on RUD not only at the under- but also at the postgraduate level deserves attention and should be considered by all sides of the problem including academia, health authorities and medical associations.

Respiratory complaints and spirometric parameters of the villagers living around the Seyitomer coal-fired thermal power plant in Kütahya, Turkey.

The aim of the study was to investigate the respiratory effects of the stack emissions of the Seyitömer coal-fired thermal power plant in the Kütahya Province of Turkey. The three villages that are located within 5 km around the power plant were investigated as our "Villages around Power Plant." Two villages which were similar to the Villages around Power Plant as far as climate, culture, and lifestyle were concerned and which were located more than 30 km away from the thermal power plant were investigated as our "Control Villages." The study design was based on the comparison of the respiratory complaints and the spirometric parameters of the individuals living in the two groups of villages. The study was carried out on individuals of 15 years of age and above living in these villages (277 of 302 individuals living in the Villages around Power Plant and 225 of 264 living in the Control Villages). Among the ones living in the Villages around Power Plant, 46.2% had complaints of chest tightness and 29.2% repeated coughing attacks present for more than one year, whereas these percentages were 28.0 and 20.4% in the Control Villages, the differences being statistically significant (P=0.001 and P=0.024, respectively). The complaint of productive coughing present for more than one year was not found to differ statistically significantly between the two groups of villages (P=0.0885). The means of the spirometric parameters of FEV1 and FEF25-75% were found to be statistically significantly lower in the individuals of the Villages around Power Plant compared to the individuals of the Control Villages (P=0.0001 and P=0.0001, respectively). When the spirometric parameters of nonsmokers were compared between the two groups of villages, FEV1, FVC, and FEF25-75% were found to be statistically significantly lower in the Villages around Power Plant compared to the Control Villages (P=0.0001, P=0.0001, and P=0.0001, respectively). No statistically significant differences of the spirometric measurements of current smokers were observed between the two groups of villages (P>0.05). The spirometric parameters revealed statistically significant adverse health effects of the Power Plant, this was particularly apparent v212nfor the nonsmokers. More specific tests to confirm the diagnosis of acute and chronic lung diseases can be suggested to be carried out in the area in further studies. Also follow-up studies can be recommended in the area to detect any new adverse health effects of the Power Plant.