Delivering the Thinking Healthy Programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study.

BACKGROUND: Women with perinatal depression and their children are at increased risk of poor health outcomes. There is a need to implement non-stigmatizing interventions into existing health systems which reduce psychosocial distress during pregnancy and prevent perinatal depression. We adapted the WHO-endorsed Thinking Healthy Programme (THP) to be delivered universally to all women attending routine online pregnancy schools in Istanbul, Turkey. This study aimed to evaluate the feasibility and acceptability of this intervention. METHODS: This mixed-methods study incorporated a two-arm pilot randomized controlled trial and qualitative evaluation of the feasibility and acceptability of the adapted THP - Brief Group version (THP-BGV) to a range of stakeholders. We recruited pregnant women at 12-30 weeks' gestation through pregnancy schools within the University Hospital's catchment area. Women in the intervention arm received five online sessions of the THP-BGV delivered by antenatal nurses. The intervention employed principles of cognitive behaviour therapy to provide psychoeducation, behaviour activation, problem-solving strategies and group support to participants. In the control arm, women received usual care consisting of routine online educational pregnancy classes aided by the antenatal nurses. The women were assessed for depressive symptoms with the Edinburgh Postnatal Depression Scale at baseline and 4-6 weeks post-intervention and also evaluated for anxiety, perceived social support, partner relationship, level of disability and sleep quality. In-depth interviews were conducted with women and other key stakeholders. RESULTS: Of the 99 consecutive women referred to the pregnancy schools, 91 (91.9%) were eligible and 88 (88.8%) consented to participate in the study and were randomized. Eighty-two (83%) completed the final assessments. Our main findings were that this preventive group intervention was feasible to be integrated into routine antenatal educational classes and it was valued by the women and delivery-agents. While the study was not powered to detect differences between intervention and control conditions, we found small trends towards reduction in anxiety and depressive symptoms favoring the intervention arm. No serious adverse events were reported. CONCLUSIONS: Given the paucity of preventive interventions for perinatal depression in low and middle-income countries, a fully powered definitive randomized controlled trial of this feasible and acceptable intervention should be conducted. TRIAL REGISTRATION: The study was registered at Clinical Trails.gov ( NCT04819711 ) (Registration Date: 29/03/2021).

Adaptation and integration of the thinking healthy programme into pregnancy schools in Istanbul, Turkey.

BACKGROUND: Perinatal mental health is a major public health concern. In Turkey, public hospitals operate pregnancy schools which provides an opportunity to integrate an evidence-based Thinking Healthy Programme (THP) for perinatal depression. The aim of this study is to adapt the THP for universal use in the group setting and to understand its acceptability and feasibility for integration into the existing antenatal care programme for both face-to-face and online delivery. METHODS: Following an expert-led adaptation process using the Bernal Framework, field testing was conducted on a group of women and facilitators followed by in-depth interviews (n:8) and group discussions (n = 13). Data were analysed using Thematic Framework Analysis. RESULTS: Minor but significant adaptations were made to the individually delivered THP for use in the universal group pregnancy schools. Initial findings indicate that the THP-group version was acceptable to its target population and could be integrated into the antenatal care plan for delivery during face-to-face and online group classes. CONCLUSION: THP is transferable to the Turkish cultural and healthcare context. The THP-group version has the potential to add value to Turkey's existing perinatal healthcare programme.

Overweight and obesity in preschool children in Turkey: A multilevel analysis.

Childhood obesity/overweight is a worldwide concern and its prevalence is increasing in many countries. The first aim of this study is to analyse the trends in overweight and obesity among children under the age of five in Turkey based on the new World Health Organization (WHO) standards, using data from the 'five-round of the Turkey Demographic and Health Surveys' (TDHSs). The second aim is to examine whether or not the maternal/household and individual-level factors are associated with overweight/obesity using TDHS 2003, 2008, and 2013 datasets. A total sample of 14,231 children under the age of five were extracted from the TDHS in 1993, 1998, 2003, 2008, and 2013 to determine the prevalence of the trend. Pooled data from 8,812 children were included in the analysis to examine factors associated with overweight/obesity. Taking into account the clustered data structure, multilevel logistic regression models were utilised. In 1993, 1998, 2003, 2008, and 2013 the prevalence of overweight children was 5.3%, 4.9%, 10.0%, 11% and 11.6%, respectively. The factors that were independently associated with overweight/obesity were as follows: living in single-parent households (adjusted odds ratio (aOR) = 2.27, 95%CI = 1.21-4.26), compared to living in dual-parent households; having an obese mother (aOR = 4.25, 95%CI = 1.73-10.44), overweight mother (aOR = 3.15, 95%CI = 1.29-7.69), and a normal-weight mother (aOR = 2.70, 95%CI = 1.11-6.59) compared to having an underweight mother; being aged between 13-24 months (aOR = 1.72, 95%CI = 1.30 to 2.27), compared to being aged 0-12 months; male gender (aOR = 1.30, 95%CI = 1.11 to 1.53); being stunted (aOR = 2.18, 95%CI = 1.74 to 2.73); high birth weight (aOR = 1.55, 95%CI = 1.08 to 2.23) compared to low birth weight. In addition, overweight was higher in children of mothers who had completed primary school (aOR = 1.21, 95%CI = 1.01 to 1.59) than children of mothers who had not completed primary school. These findings reveal that, over the years, there has been a substantial increase in obesity/overweight among children which demonstrates the importance of evaluating the overweight indicators at the maternal/household level.

Expectations, requirements, and problems of family health care workers providing home services in Turkey.

Life expectancy is increasing globally with the increase of aging populations. Care-dependent elderly and those with chronic illnesses and disabilities are increasing in numbers. Hospitalization to manage these problems lead to a heavy economic burden. Thus, the demand for home health care is rising causing a heavy workload for home workers. This study was aimed to assess problems of personnel engaged in providing home care. Data was colllected from 120 family physicians and nurses/midwives from 25 clinics. The results showed that most visits were provided for postnatal controls (69%), with only 13% provided for the elderly and disabled people despite high demands (for the elderly 73%; for those with disabilities 66%). Additionally, factors affecting workers emotionally in visits were evaluated. Difficulties and suggestions of home care workers should be considered that the quality of health care depends on the satisfaction of the care professionals as well as that of patients.

The awareness of childhood autism among residents of neuropsychiatric and other disciplines of a research and training hospital in Istanbul, Turkey.

OBJECTIVE: To assess the awareness of childhood autism among physicians undergoing residency training in various disciplines. METHODS: This cross-sectional study was conducted at a research and training hospital in Istanbul, Turkey, in February 2013 and comprised physicians undergoing residency training in various disciplines. Data was collected through a self-administered questionnaire. Questions about "awareness on autism" were prepared in the light of "Knowledge about Childhood Autism among Health Workers questionnaire. RESULTS: Of the 128 physicians, 122(95.3%) were aware that the most known characteristic of childhood autism was "failure to build-up friendship". All of the 29(22.66%) physicians at the neuropsychiatric disciplines were aware that "autism can be a genetic disorder", whereas, in other disciplines 69(69.7) physicians had that awareness. Besides, 15(51.7%) of the residents of the neuropsychiatric disciplines thought that "autism can be associated with childhood epilepsy", while 32(32.3%) physicians of other disciplines gave a similar answer (p=0.057). CONCLUSIONS: The awareness on childhood autism of residents belonging to the non- neuropsychiatric disciplines was moderate.

A study exploring the autism awareness of first grade nursing and medical students in Istanbul, Turkey.

OBJECTIVE: To assess the level of awareness about childhood autism among first-grade nursing and medical students. METHODS: The descriptive study was conducted at Marmara University, Istanbul, Turkey, in December 2012, and comprised first-grade nursing and medical students. Data was collected using a self-administered questionnaire. Association between categorical variables was determined and p<0.05 was considered statistically significant. RESULTS: Of the 175 students, 138(78.9%) were aware of autism, 14(8%) of them being highly aware and 124(70.9%) moderately aware, whereas 37(21.1%) were not aware. There was a significant difference in the awareness level as far as gender was concerned as 102(82.9%) females and 36(69.2%) males were aware (p=0.043). Moreover, 104(59.4%) participants were aware that autism was a neurodevelopmental disorder, 62(67.4%) of them being nursing and 42(50.6%) being medical students (p<0.05). CONCLUSIONS: First-grade medical and nursing students could be considered relatively well aware of autism as their awareness level was in between that of the general public and healthcare professionals.

A qualitative study on menopause described from the man's perspective.

OBJECTIVE: To look at menopause from men's point of view and to provide a better understanding of this phase to improve the care delivered to menopausal women. METHODS: The study was conducted at the health centre of a single district of Istanbul, from April 2013 to June 2013, which serves as the research and training area of the Marmara University and which receives migrations from mainly southern and eastern regions of Turkey.The study sample included 33 married men. Qualitative in-depth interviews were performed individually and main themes were noted down for analysis. RESULTS: The age range of the study population was 40-77 years. The subjects lacked basic knowledge about both menstruation and menopause. Most of the participants defined menopause as loss of fecundity, increased weight, and loss of beauty.The most important concern voiced was men's own sexual life. None of the men had heard about treatment modalities available for menopause. CONCLUSION: Interventions are needed to increase men's awareness regarding menopause in order to help these men to be able to better support their spouses so that they can both have a smooth transition into postmenopausal years.

Knowledge, attitudes and beliefs of Turkish women towards blood donation.

OBJECTIVES: To understand the knowledge, attitudes and beliefs of women towards blood donation and to help healthcare workers to plan steps to increase blood donation rates. METHODS: The qualitative study was conducted between January to May 2013 in two densely-populated districts of Istanbul, Turkey that are inhabited mostly by socio-economically disadvantaged people from different parts of the country. The area also serves as the Research and Training Area of the Marmara University. RESULTS: There were 57 women subjects in the study with an age range of 18-65 years. There were positive attitudes towards blood donation although none of the women in our sample had donated blood before. All the participants (100%) thought that men could donate blood, but it was not favourable for the women since they were "already losing blood through menstruation". The circumstances surrounding women, such as being too busy and overloaded with caring of the family, belief of impurity of female blood, suspicion of having unhealthy blood, rumours, misbeliefs and negative experiences, anxiety about the procedure (fear of needle, fear of syncope), and distrust of blood banks were the other reported barriers. CONCLUSION: Understanding the factors that motivate donors and presenting issues like rumours, misbeliefs and negative experiences will facilitate improvement in blood banks and eventually help increase the donation rates.

A survey of energy-drink consumption among medical students.

OBJECTIVE: To determine the frequency and pattern of energy drink consumption among medical school students, their knowledge of its effects and side effects and to see its relation with alcohol and cigarette usage. METHOD: The descriptive analytical study was conducted at Marmara University Medical School, Istanbul, Turkey from October 2011 and January 2012. A semi-structured questionnaire was filled by students who were asked about their socio-demographic status and their energy drink consumption. SPSS 12 was used for statistical analysis. RESULTS: The mean age of the 390 students in the study was 20.98+/-1.96 years (range:16-27). Of them, 204 (52.3%) were females and 186 (47.7%) were males. Overall 52(13.3%) were smoking regularly at least one cigarette per day; 122(31.3%) were consuming alcohol; 127 (32.6%) had consumed energy drinks at least once and 73(18.8%)more than once. In terms of perception, 110(28.2%) students said energy drinks were similar to sports drinks, while only 121(41.1%) named the brands correctly; 96 (24.6%) students did not answer this particular question. CONCLUSION: Although consumption of energy drinks was common among medical students, the knowledge of ingredients and knowledge of health risks of energy drinks among them was unsatisfactory.

Evaluation of Physical Activity Level and Related Factors in Pregnancy During the COVID-19 Period.

Objectives: It was aimed to determine the level of physical activity and related factors in pregnant women. Methods: The study is a mixed methods study. The participants are women applied to the pregnancy outpatient clinic of a hospital. The level of physical activity was assessed with the Pregnancy Physical Activity Questionnaire. Sociodemographic questions and seven questions of the International Physical Activity Environment Module were asked. Besides, in-depth interviews were conducted with 14 women. Results: The study was conducted with 304 women. The median age was 29.0 (18.0-40.0) years. The mean total activity and sedentary activity scores were 195.8 ± 107.9 and 37.22 ± 31.08 MET-hours/week, respectively. Pregnant women were mostly involved in light-intensity and housework/caregiving activities. Most of the participants mentioned that they were less active than pre-pregnancy period. The most common reasons for being less active were weakness, fatigue, lack of time and complaints such as low back pain and nausea. Conclusion: More than half of the pregnant women mentioned that they were less active during pregnancy. Thus, interventions should be planned to increase physical activity level of pregnant women.

The emotions experienced by family medicine residents and interns during their clinical trainings: a qualitative study.

BACKGROUND: The family medicine residents and final year medical students are challenged with increased workload and they experience various emotions during their clinical trainings. They are confronted with uncertainties in their role descriptions and they witness illness, suffering and deaths as part of their everyday duties which may lead to burnout. Only several studies have focused on these experiences to find out what the family medicine residents and medical students were literally feeling. AIM: The aim of this study was to explore the family medicine residents' and final year medical students' emotions during their clinical trainings. METHOD: This qualitative study was performed with 15 family medicine residents and 24 final-year medical students using a convenience sample from two medical faculties to explore and analyze their emotions. Data were gathered by means of focus group interviews, including six interviews conducted and recorded through online meetings. Data were analyzed for themes using a thematic analysis approach. Since the interviews reached saturation in terms of content, the interviews were terminated at the end of sixth focus group meetings. Each interview took an average of 45-60 min. RESULTS: Three main themes emerged from the data regarding residents' and interns' emotions. These were the "clinical climate's role", "emotions during patient encounters" and "coping strategies with negative emotions". The most commonly encountered emotions were tension and anxiety followed by frustration and uncertainty. CONCLUSIONS: The family medicine residents and final-year medical students are challenged with emotions during their clinical trainings. Therefore, medical educators have to be aware of the need to support them in reflecting their emotions by prioritizing residents'and interns' well-being.

Suicide among doctors in Turkey: Differences across gender, medical specialty and the method of suicide.

BACKGROUND: Doctors have higher rates of mental illness and suicide than the general population worldwide. Suicides of doctors are known to be underreported in developing countries. To the best of our knowledge, there are no studies investigating suicides among medical students and doctors in Turkey. OBJECTIVES: To investigate the characteristics of suicides in medical school students and doctors in Turkey. MATERIAL AND METHODS: In this retrospective study, newspaper websites and Google search engine were searched for information on medical school student and doctor suicides in Turkey between 2011 and 2021. Cases of suicide attempt, parasuicide or deliberate self-harm were not included in the study. RESULTS: Sixty-one suicides were reported between 2011-2021. There was a male predominance (45 (73.8%)), and more than half of the suicides (32 (52.5%)) occurred among specialist doctors. Self-poisoning, jumping from heights and firearms were the most common methods of suicide (18 (29.5%), 17 (27.9%) and 15 (24.6%), respectively). Cardiovascular surgery, family medicine, gynecology, and obstetrics specialties had the highest numbers of suicide deaths. Depression/mental illness was the most common speculated etiology. These results show that suicides among medical students and doctors in Turkey have characteristics that differ from both suicided among the general population in Turkey and doctor suicides in other countries. CONCLUSIONS: In this study, we identified the suicidal characteristics of medical students and doctors in Turkey for the first time. The results help us to better understand this understudied topic and provide an avenue for future studies. The data also indicate that it is important to monitor the individual and systemic difficulties experienced by doctors, starting from the medical education stage, and to provide individual and environmental support to help decrease the risk of suicide.

Decline in the Age of Menarche in Istanbul Schoolgirls Over the Last 12 Years

Objective: Menarche is the endpoint of a sequence of maturational events of female puberty. The timing of menarche is a strongly heritable trait. However, secular trends suggest that lifestyle and environmental factors are important. To assess the trend in age at menarche (AAM), and its associated factors in Istanbul over the last 12 years. Methods: A cross-sectional study was carried out between March and April 2022 on schoolgirls aged 9-18 years. A predesigned and self-administered questionnaire was filled out anonymously by the students. The data of AAM was included in the statistical analysis if the time of AAM is remembered in both months and years. A probit model was used to calculate the median AAM. The findings were compared with those from a study performed 12 years ago in the same region of Istanbul. Results: Among 9000 girls to whom the questionnaire was distributed, 1749 (19.5%) responded. The median AAM of 1374 girls whose AAM information was considered valid was 12.04 years (95% confidence interval: 12.01-12.13), 0.7 years lower than was reported 12 years ago (p<0.0001). AAM was correlated positively with maternal AAM, and negatively with body mass index (BMI) standard deviation score and maternal educational status (p<0.0001, p<0.0001 and p=0.002), respectively. There was no correlation between the AAM and birth weight. Girls with BMI percentile ≥85% (n=251) had earlier menarche than the ones with BMI percentile <85% (n=1072) (11.5 vs. 12.1 years, p<0.0001). Among the mother-daughter pairs (n=1162), AAM of girls was 0.91 years (median 0.94 years) earlier than their mothers. Conclusion: The present study demonstrates a significant downward trend in the menarcheal age in Istanbul over the last twelve years. These findings support a strong contribution from genetic factors and BMI on AAM.

Do family physicians perceive electronic cigarette use as a harm reduction strategy for smokers? A survey from Istanbul.

BACKGROUND: E-cigarettes (ECs) are gaining popularity in Turkey among smokers. With the rapid increase of EC consumption, it is important to ascertain how family physicians (FPs) perceive ECs as they play a key role in providing smoking cessation services. AIM: Our main objectives were to determine FPs' level of awareness and harm reduction perceptions of ECs and to delineate the factors associated with their counseling practices. METHODS: This was a cross-sectional study with descriptive and analytical components. Data were collected through questionnaires. Questions mainly focused on demographic characteristics, knowledge and own use of ECs, general attitudes towards ECs, and daily practices while performing counseling on tobacco use. In order to control confounding factors, logistic regression analysis was performed. FINDINGS: Among a total of 271 FPs, 49.1% (n = 133) were males and the median age (IQR) was 41 years (32-46). Almost one-fifth of the FPs (n = 52) reported that they did not provide counseling services to their smoking patients. Only 26.6% (n = 72) of the FPs stated that they felt confident enough to advise patients on smoking cessation. Of the FPs, 6.6% have stated that they have recommended ECs to their patients for smoking cessation with the strategy of harm reduction. Factors associated with providers' recommendation of ECs to their patients as a harm reduction strategy included 'believing that ECs help smokers to quit, ECs could be vaped in closed areas, and ECs were healthier than combustible tobacco products'. CONCLUSION: In our study, FPs stated lack of confidence to advice patients on smoking cessation. Furthermore, they recommended ECs to their smoking patients as a harm reduction strategy. FPs' confidence should be increased with the trainings based on recent evidence on ECs.

Does asymptomatic/uncomplicated SARS-CoV-2 infection during pregnancy increase the risk of spontaneous preterm birth?

OBJECTIVES: The aim of this study was to analyze the perinatal outcomes of asymptomatic/uncomplicated SARS-CoV-2 infection during pregnancy and the relationship between gestational age at the time of infection and spontaneous preterm birth (PTB). MATERIAL AND METHODS: This was a retrospective cohort study. The study population included pregnant women who were 19-45 years old and who had been admitted to a Research and Training Hospital for singleton birth delivery. Women who had contracted SARS-CoV-2 during their pregnancy (n = 102) were compared to those who were not infected (n = 378) for the development of spontaneous PTB and other perinatal outcomes. The factors associated with spontaneous PTB were analyzed through univariate and multivariate methods. RESULTS: Spontaneous PTB developed in 22.5% of the pregnant women with a history of SARS-CoV-2 infection and in 5.3% without a history of the infection (p < 0.001). The multivariate model determined that compared to the non-infected women, the OR of spontaneous PTB among those who had contracted the virus in the first, second, and the third trimesters were 9.13 (p < 0.001), 1.85 (p = 0.292) and 7.09 (p < 0.001), respectively. Pregnancy cholestasis (3.9% vs 0.5%; p = 0.020) and placental abruption (3.9% vs 0.5%; p = 0.040) were significantly higher in cases with a history of SARS-CoV-2 infection compared to the non-infected women. CONCLUSIONS: Asymptomatic or uncomplicated SARS-CoV-2 infection during pregnancy increases the risk of spontaneous PTB. This risk is higher particularly among pregnant women who develop the infection in the first and the third trimesters.

Factors associated with physicians' assessment and management of child abuse and neglect: A mixed method study.

Physicians are a professional group that is highly likely to encounter abused or at-risk children. The aim of this study is to investigate physicians' experiences with abuse cases, their evaluations of abuse risk factors, and their attitudes toward becoming more educated on the subject. One-hundred-sixty-four family physicians at family health centers and public health centers completed a questionnaire, and a group of residents at a university training and research hospital were interviewed in a semi-structured format. One-fifth of the participants had managed a child abuse case at least once. Nearly half of the participants reported acting alone in diagnosing and managing abuse cases. Sixty-eight percent of these physicians stated they would like to receive training on this subject. Gender and having children did not make a difference as to the abuse-management experience of these medical professionals. Female participants placed more importance on risk factors related to "children with mental disabilities" and "alcohol and substance abuse in parents" than their male counterparts. Difficulties in diagnosis, concerns about handling the abuse cases, the impact of culture, various risk factors, the importance of teamwork and a holistic approach, the need for practical training, and the importance of primary prevention were themes that emerged from this survey. This study provides inferences as to which of the physician competencies should be targeted in undergraduate medical education.

The clinical and histological characteristics of patients with biopsy-proven non-alcoholic fatty liver disease in the absence of insulin resistance.

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is closely associated with insulin resistance (IR). While a minority of patients with NAFLD does not have evidence of IR, no detailed characterization of this specific phenotype is currently available. This study was undertaken to investigate the clinical and histological characteristics of this patient group. Materials and Methods: We retrospectively reviewed the clinical records of 263 patients with biopsy-proven NAFLD. IR was defined by a Homeostatic Model Assessment of IR (HOMA-IR) score >2.73. The histological diagnosis of non-alcoholic steatohepatitis (NASH) was performed using 1) the steatosis, activity and fibrosis score and 2) the NASH Clinical Research Network (NASH CRN) criteria. Significant fibrosis was defined by the presence of a histological fibrosis score higher than F≥2. Patients with and without evidence of IR were compared concerning clinical, laboratory, and histological characteristics. Results: Of the 263 patients with biopsy-proven NAFLD, 53 (20.2%) patients had no evidence of IR. Patients without IR were younger [IR (-): 42 (22-65) years versus IR (+): 49 (22-71) years, p=0.001] and had a higher prevalence of men [IR (-): 39 (73.6%) versus IR (+): 113 (53.8%), p=0.009]. Moreover, they were characterized by a lower body mass index [IR (-): 30.06±3.61 kg/m2 versus IR (+): 33.19±5.06 kg/m2, p=0.000] and lower frequencies of metabolic risk factors-including the metabolic syndrome, diabetes, hypertension, hyperlipidemia, and lower waist/hip circumference. Liver histology was generally less severe in patients without IR; specifically, they showed a lower prevalence of NASH [IR (-): 38 (71.7%) versus IR (+): 190 (90.5%), p=0.000] and significant fibrosis [IR (-): 9 (17.0%) versus IR (+): 106 (50.5%), p=0.000] than did patients with IR. Multivariate analysis identified obesity [odds ratio (OR): 9.321, 95% confidence interval (CI): 1.031-84.261, p<0.05] and an international normalized ratio >1.1 (OR: 10.116, 95% CI: 1.325-77.225, p<0.05) as independent predictors of significant fibrosis in patients with NAFLD and no IR. Conclusion: Patients with NAFLD and no IR has less severe liver histology than patients with IR. However, obesity appears to be independently associated with significant fibrosis in this patient group.

Adaptation of the Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire: Turkish version.

OBJECTIVE: Many checklists and scales have been developed to diagnose the autism spectrum disorder in childhood. However, self-applied questionnaires/scales that can be filled out by health professionals for assessing their knowledge and consciousness of this disorder are still limited. The Knowledge about Childhood Autism among Health Workers self-administered survey was developed by Bakare et al. in 2008. This survey was recruited by many study groups in developing countries. In these countries, knowledge regarding childhood autism is inadequate within community healthcare professionals. METHODS: In our study, the agreed-upon Turkish version of the questionnaire was distributed to the 61 primary care physicians working in Maltepe District of Istanbul Province for the adaptation and validation. RESULTS: The internal consistency coefficient (Kuder-Richarson coefficient of reliability-KR20) of the measurements attained from the Turkish version of the questionnaire was 0.70. The split- half reliability analysis demonstrated that the Guttman Split-half value was 0.84. According to the principal factor analysis of the tetrachoric correlation matrix, the three factors with the highest Eigenvalues were associated with (i) Relatively easy clinical observations, (ii) the signs which require a longer observation time and detailed anamnesis, and (iii) the signs, which require detailed examination and observation. The factors explained cumulatively 65.98% of the total variance. CONCLUSION: The findings obtained in this study showed that the adapted questionnaire addressed in the scope of this study is a valid measure for Turkish society.

The influence of gender roles on health seeking behaviour during pregnancy in Turkey.

OBJECTIVES: To explore the impact of gender roles in relation to health seeking behaviour during pregnancy and childbirth. METHODS: The study was conducted in neighbourhoods with low antenatal care rates in three provinces of Turkey. The study population consisted of pregnant women who never got or discontinued antenatal care and their peers, families and community leaders. Sixteen focus group discussions and 125 in-depth interviews were conducted with a total of 239 participants. RESULTS: Pregnancy and childbirth are interwoven strongly with gender roles. Since the patriarchal system acknowledges women through the means of childbirth, women are expected to have many children. Hence women experience pregnancy as a burden and are not motivated to seek antenatal care. During pregnancy, only 'serious' conditions are considered as legitimate reasons for accessing care. However, the decision regarding whether a pregnant woman is seriously sick or not belongs to the responsibilities of elder women, which delays service use. CONCLUSIONS: Providing information regarding the value of antenatal care also to elder women is essential in increasing the demand to the services. Incorporating gender perspectives into daily health practice and maintaining access to high quality reproductive care services are vital in reducing the gender based barriers to care.

Knowledge and approaches of married men applying to a primary healthcare center in Istanbul about IUD: A qualitative study.

OBJECTIVE: This study aims to determine the knowledge and approach of men applying to a primary health care center about IUD by adopting qualitative research methods. METHODS: This study was qualitative research realized using an in-depth interview method. The interview was carried with 15 married men in a primary health care center in Umraniye, using 15 semi-structured interview questions. RESULTS: Knowledge of the men in this study about IUD and family planning was inadequate. Participants generally determined the advantages of IUD with its superiority over other methods. Adverse effects of IUD on women and men during intercourse were stated. Knowledge of men about IUD, its side effects and disadvantages were generally composed of misinformation and rumours about the subject. CONCLUSION: Men do not have adequate information and knowledge on family planning and IUD. Training provided by the health personnel might have a considerable role in demolishing misinformation and rumors and may augment the level of knowledge about IUD.