A Turkish study of medical student learning styles.

CONTEXT: A good understanding of the learning styles of students is necessary for optimizing the quality of the learning process. There are few studies in Turkey on the subject of the learning characteristics of medical students. OBJECTIVES: The aim of this study was to define the learning patterns of Turkish medical students based on the Turkish version of Vermunts Inventory of Learning Styles (ILS). METHODS: The Turkish version of the ILS was developed and administered to 532 medical students. Learning patterns were investigated using factor analysis. FINDINGS: Internal consistencies of scales ranged from 0.43 to 0.80. The Turkish version of the ILS identified four learning styles among medical students. In comparing the pre-clinical and clinical phases of medical students related to mental models of learning, statistically significant differences (p < .01) were found between the two groups for the learning characteristics: lack of regulation; certificate; self-test and ambivalent orientation; intake of knowledge; and use of knowledge. CONCLUSION: The Turkish version of the ILS can be used to identify learning styles of medical students. Our findings indicate an intermediate position for our students on a teacher-regulated to student-regulated learning continuum. A variety of teaching methods and learning activities should be provided in medical schools in order to address the range of learning styles.

Predictors of early leaving from the cotton spinning mill environment in newly hired workers.

OBJECTIVE: This longitudinal study aimed to identify the predictors of leaving during the first year of employment from the cotton spinning mill environment in newly hired workers. METHODS: One hundred and ninety eight consecutively appointed new employees were investigated by questionnaire, lung function test, and skin test. They were examined before employment and at the end of the 1st week, and the 1st, 3rd, 6th, and 12th month after starting work and when possible before leaving their job. 572 personal dust sampling and 191 endotoxin measurements were performed to assess the environmental exposure. For the univariate analysis chi2, Student t tests, ANOVA, and Kruskall Wallis tests were used. Cox proportional hazards analysis was used to identify factors associated with leaving the job. RESULTS: Fifty three per cent of workers left the mill environment during their first working year. Work related lower respiratory tract symptoms reported at the third month were associated with an increase rate of leaving the industry compared to those remaining in the industry (25% v 4.8%; p<0.005). Having respiratory symptoms at the first month of work predicted those leaving the industry at some point in the next 11 months. According to the Cox model, increasing age and having work related lower respiratory tract symptoms were found to be predictors for leaving job at the first working year. Atopic status, dust and endotoxin levels, and lung function changes were not consistently predictive of workers who left the industry in the follow up period. CONCLUSION: This study demonstrated that work related respiratory symptoms can predict workers likely to leave the cotton mill environment during the first year of employment, but atopy or acute lung function changes do not.

An high performance liquid chromatographic method for the quantification of cotinine in the urine of preschool children.

Tobacco smoke exposure is an important and preventable cause of morbidity among children. Enviromental tobacco smoke (ETS) increases respiratory symptoms and disease and also decreases lung function in children who live in a household with at least one smoker. We have developed a simple and reliable HPLC method with diode array dedection to determine the urine concentrations of cotinine in children aged 3 to 6 years, exposed to ETS. The assay involved a liquid-liquid extraction with chloroform. The HPLC method utilized a Chromasil C18 column (150 mm x 4.6 mm i.d.) and an isocratic mobile phase of phosphate buffer: acetonitrile (83:17 v/v, 0.02 M containing 0.1% triethylamine, adjusted to pH 6.72 with orthophosphoric acid), at a flow rate of 0.7 ml min(-1). The detection was performed at 260 nm and the total analysis time of analysis was less than 15 min. Linearity ranged from 0 to 80 microg L(-1); correlation coefficients (r2) for calibration curves were greater than 0.99. With 2 mL of urine for extraction, the limit of detection was 0.1 microg L(-1). The mean extraction ratio of cotinine was 88.78%. This analytical method is suitable for the determination of cotinine levels in a large number of urine samples.

The anxieties of medical students related to clinical training.

High levels of anxiety and stress during medical education may have negative effects on students' learning and may also influence students' performance, decision-making and caring capabilities. This study aims to compare the anxieties of clerkships of two medical schools that apply two different preclinical curricula; one is problem-based and the other is integrated. Dokuz Eylul University School of Medicine (DEUSM) has the basic clinical and communication skills education by the first year of medical education. However, the students of Marmara University School of Medicine (MUSM) had not any preclinical training about these issues at the time we performed this study. In order to evaluate the perceived anxiety, we used a questionnaire which comprises 39 issues presented as 4-point Likert-type scales. Eighty-six clerkships from MUSM and 115 clerkships from DEUSM participated in the study. According to the students of both of the schools, fear of making mistakes that could harm the patients was at the top of the list of sources of anxiety. The students of MUSM have additional anxieties related to the core clinical skills such as suturing patients, taking blood from patients and giving injections. On the other hand, the students of DEUSM have anxieties mostly related to difficult issues in communication such as breaking bad news. The study has revealed that medical students might have anxiety related to the clinical practice in the beginning of their clerkships. It was also shown that sources of anxiety may vary among students exposed to different preclinical curricula and different educational environment. If basic clinical and communication skills courses are integrated in preclinical curriculum, the students would meet some clinical task in the early year and would be orientated through clinical period.

Assessment of sociodemographic factors and socio-economic status affecting the coverage of compulsory and private immunization services in Istanbul, Turkey.

OBJECTIVES: The primary objective of this study was to determine the coverage of the Expanded Programme of Immunization (EPI) of the Ministry of Health and the coverage of private vaccines in the Umraniye Health District in order to establish approaches for improving vaccination services. Other objectives were to define the areas that present higher risks for non-vaccination and to determine the factors that influence vaccination coverage. METHODS: A '30 x 7' cluster sampling design was adopted as the sampling method. Thirty streets were selected at random from each health care region. Sociodemographic and socio-economic characteristics of the population, utilization of vaccination services and vaccination status of children under the age of 5 years were determined by face-to-face interviews. Odds ratios for the sociodemographic and socio-economic characteristics, health centre region and inner country immigration were assessed as possible related factors with the vaccination coverage rates for children under 5 years and under 1 year using the backward elimination method in logistic regression. RESULTS: Vaccination coverage was as follows: hepatitis B third dose, 84.6%; Bacille Calmette-Guérin, 94.8%; diphtheria, tetanus, pertussis (DPT) third dose, 90.1%; oral polio virus (OPV) third dose, 90.0%; measles, 88.7%; DPT booster dose, 79.1%; OPV booster dose, 79.0%; measles, mumps, rubella (MMR), 13.3%; haemophilus influenza type b (Hib), 9.3%; and Varicella vaccine, 3.3%. The full vaccination rates for children under 5 years and under 1 year were 68.3 and 79.5%, respectively. Higher socio-economic status was associated with a higher rate of full vaccination and private vaccination for children under 5 years of age. CONCLUSIONS: Full vaccination rates for children aged less than 1 year and less than 5 years were higher in our district than in Istanbul. However, we did not meet the EPI aims for any of the vaccines, and differences were observed in vaccination coverage rates between different socio-economic groups in the district. Therefore, an intervention programme should be considered to achieve the EPI's goals, particularly in socio-economically disadvantaged groups. Also, the coverage of private vaccination (MMR, Hib, Varicella) is low and more children from higher socio-economic groups receive these vaccines.

Minimizing missed opportunities: an approach to decrease the unmet need for family planning.

OBJECTIVES: The aim of the study was to determine the participants with unmet need and to show that family planning consultancy given to women and men attending the first-level health facilities would increase contraceptive usage and reduce unmet need for family planning. METHODS: All married women aged 15-49 years and men having wives of the same age group attending the health centers for any service other than family planning were included in the study. Among 2021 attendants, a total of 1701 participated in the study (84.2%). Participants were interviewed after they took the services for which they attended. At the end of the inquiries, all willing participants were referred to the family planning unit in the same building. RESULTS: The unmet need (need for any or more effective contraceptive methods) was 43.1%. All participants with unmet need were referred to the family planning unit in the same building and willing participants were given family planning services. Of the participants, 23.9% attended the family planning unit and 17.8% took services immediately at the time of the attendance. CONCLUSIONS: Linking family planning services with other health services can be a cheap and practical way to reduce the unmet need.

Missed opportunities for tetanus vaccination in pregnant women, and factors associated with seropositivity.

The aim of this study was to identify the seroprevalance rate of tetanus and to determine missed opportunities for tetanus vaccination. Two hundred and twenty-seven female volunteers who were hospitalized following delivery participated in the study. Blood samples were analyzed using enzyme-linked immunoassay to measure tetanus antibody levels. In addition, a questionnaire was used to investigate the factors associated with vaccination status. Sixty-five percent of the study participants had safe protective levels of antibodies. Factors associated with antibody level were age, level of education and number of doses. Only 25.7% of women who received antenatal care (ANC) had received tetanus vaccinations. Women who received ANC from primary healthcare facilities were more likely to have been vaccinated than those who received ANC from hospitals or private practice (P < 0.05). Factors associated with both tetanus vaccination and immunizations in pregnant women should be further investigated by qualitative and quantitative studies. Knowledge, attitude and practice surveys of mothers and healthcare providers on provision of the tetanus vaccine to pregnant women need to be undertaken urgently.

Resistance against contraception or medical contraceptive methods: a qualitative study on women and men in Istanbul.

OBJECTIVES: This research was carried out to reveal the attitudes of men and women about contraception in the Umraniye district of Istanbul. METHODS: Focus group discussions were used for data collection. Data from 20 groups of married people (ten groups of men and ten of women) living in Umraniye were analyzed. RESULTS: Most people attending the focus groups in the study were against having 'too many' children. Economic constraints appear to be a leading influencing factor for limiting the number of children. Urbanization also seems to have a strong influence on people's knowledge and attitudes about contraception. Culture and religious beliefs were not found to be major barriers to contraception in general, but they would influence the selection of the type of a certain contraceptive method. More specifically, culture and religious beliefs were barriers to use of medical methods, and they were the main reasons for use of the withdrawal method, which is the most common method used in Turkey. CONCLUSIONS: Men and women are not resistant to contraception, but they are reluctant to use medical methods. The provision of contraceptive services, with special attention to cultural and religious beliefs and values, and the inclusion of appropriate counseling and education sessions during service delivery, may give clients new options and increase the use of medical methods.

Comparison of rational pharmacotherapy decision-making competence of general practitioners with intern doctors.

OBJECTIVE: The aim of this study was to compare rational pharmacotherapy decision-making competency of interns (final-year medical students) who had received rational pharmacotherapy education (RPE), with their classmates at another medical school and general practitioners (GPs) who had not been exposed to RPE. DESIGN: A written, objective, structured clinical examination (OSCE), consisting of open and structured questions, was given to all participants. The participants were expected to make a treatment plan and prescribe for simple, uncomplicated beta-hemolytic streptococcal tonsillitis and mild-to-moderate essential hypertension patients, explain their proposed treatment plans and reasons affecting their drug choice. After the OSCE, a questionnaire to assess knowledge of the rational use of drugs was given to the participants. RESULTS: Fifty RPE(+) interns, 54 RPE(-) interns and 53 GPs participated in the study. Mean scores of RPE(+) interns were higher than those of GPs, which were in turn found to be higher than those of RPE(-) interns for all cases. The RPE(+) interns scored the highest regarding all components of rational pharmacotherapy process for all cases of both indications. However, participants in all groups had higher scores for the structured questions compared with the corresponding open ones for both diseases. Prescription analysis also revealed better results for RPE(+) interns regarding the number of drugs/prescription and treatment costs. CONCLUSION: The present study demonstrated that the final-year medical students (interns) markedly benefited from undergraduate RPE at the medical school in developing rational prescribing skills compared with their classmates from a medical school with traditional pharmacology education. Interestingly, they got higher scores than not only RPE(-) interns, but also than the GPs participating in this study, indicating the urgent need for continuous medical education programs in this field throughout the country for practicing GPs.