Assessment of smoking in adolescents - a sample from vocational education centre.

OBJECTIVE: The aim of this study was to analyse the knowledge and attitudes about smoking in young people between 16-20 years of age, who were both working and attending the Vocational Education Centre. METHODS: This study was conducted with high school students at the Vocational Education Centre. The socio-demographic questionnaire and the Fagerström Test of Nicotine Dependence (FTND) were applied to the students using a face-to-face interview technique. Secondly, interactive educations on smoking-free life and smoking-related diseases were given. At last, CO (carbon monoxide) levels and respiratory functions were evaluated. RESULTS: Of the students 92.9% were males, 37.4% were 16 years, 35.8% were 17 years and 26.9% were 18-20 years old. Among 46.9% of smokers, 75.8% started smoking before 15 years of age, 86.1% were living with smokers. While 70.5% of smokers smoked more than 10 cigarettes daily, 61.3% smoked their first cigarette in the first half hour after waking up. Of the smokers, 28.8% were highly dependent, 13.0% were very highly dependent. CO levels were significantly higher in those who smoked in the workplace, who smoked mostly in the morning time, and those who started smoking at 7 years of age and younger (p < 0.05). FEV1, FVC, FEF25-75 values of morning smokers were significantly lower (p < 0.05). CONCLUSION: Unfortunately, the first smoking age was very low, the first cigarette of the day was lit in a short time after waking up, and family/friend's attitudes and behaviours were encouraging in this age group. More attention should be paid to this issue and especially new preventive projects should be implemented to protect young people from smoking.

Evaluation of knowledge levels and attitudes of health management department students about epilepsy disease; a cross-sectional study.

AIM: We aimed to evaluate the knowledge levels and attitudes of the students of the Department of Health Management about epilepsy. METHOD: This descriptive and cross-sectional study was conducted with the voluntary participation of 238 health management department students in their first and third years of study who were registered at the Faculty of Health Sciences summer school exam. We collected the data through a research questionnaire form and the Epilepsy Knowledge and Attitude Scales. RESULTS: Girls accounted for 66.6% (n = 157) all participants, 53.4% of them were 1st year (n = 127), whereas 46.6% (n = 111) were third-year students. Their mean age was 19.97 ±â€¯1.46 years. Among these participants, 52.9% grew in the province (n = 126), 20.6% were smoking, 5% had epilepsy, and 36.6% had relatives with epilepsy. The mean epilepsy knowledge scale score was 5.64 ±â€¯4.41 and the mean epilepsy attitude scale score was 52.55 ±â€¯9.98. The third-year students' epilepsy knowledge score was significantly higher than their first-year counter parts (p < 0.001). We found no statistically significant difference between the first and third-year participants in attitude scores (p = 0.907). A moderate positive correlation was found between the students' knowledge level scores about epilepsy and their total attitude scores (r = 0.405, p < 0.001). The female students had a more positive attitude toward epilepsy and higher scores on the epilepsy knowledge scale than their male counterparts (p = 0.001, p = 0.005, respectively). Students who knew someone with epilepsy had higher epilepsy knowledge and attitude scale scores than those who did not (p = 0.001, p = 0.005 respectively). CONCLUSION: The epilepsy knowledge levels and attitude scale scores of health management students were found to be low. Third-year students were found to have higher knowledge levels than first-year students but there was no statistically significant difference between their attitude scores. More education opportunities should be provided for students of the Department of Health Management about this common chronic disease.

Internet addiction, substance use and alexithymic dimensions in two different faculties' students.

OBJECTIVES: The aim of this study was to evaluate the relationship between internet addiction, substance use and alexithymia among students of education faculty and medical faculty. METHODS: This cross-sectional analytical study included 1,257 faculty students aged 18 and over, studying at Meram Medical Faculty and Ahmet Kelesoglu Faculty of Education. Young's Internet Addiction Scale, Toronto Alexithymia Scale, Fagerström Tobacco Addiction Test and CAGE alcohol use tests were applied to collect data. RESULTS: The mean age of the participants was 21.12 ± 1.96 years, 71% (n = 893) of them were females and 29% (n = 364) were males, 37.9% (n = 477) were training at medical faculty, 62.1% (n = 780) were training at the faculty of education. Of the students, 1.5% were internet addicts, 15.3% were possible addicts, and 22.8% had alexithymia. Internet addiction was higher in those with higher alexithymia scores (p < 0.001). Internet addiction was significantly higher in male students, the third grade, ones with lower academic success, students who work their lessons less than 2 hours a week. Internet addiction was also significantly higher in smokers and alcohol users (p < 0.001). While there was a low negative correlation between the first internet using age and internet addiction (p < 0.001), there was a moderately significant positive correlation between spending uninterrupted time on the internet and internet addiction (p < 0.001). CONCLUSION: In this study, it was determined that the teacher and doctor candidates, who are studying at the faculties of education and medicine, were at risk of internet addiction. A teacher or a doctor who cannot develop social skills due to excessive internet use will not be a good model to communicate correctly with the target population.

Evaluation of bowel habits in patients with acne vulgaris.

PURPOSE: To evaluate the bowel habits of patients with acne vulgaris. METHOD: In this case-control study, socio-demographical characteristics of the participants (age, gender, marital status, educational status, profession, economic status, smoking-alcohol habits, chronic diseases, previous operations, people they live with and diet) were questioned and the global acne grading scores of the patients were calculated. Bristol Stool Scale, Rome III IBS Criteria, International Physical Activity Questionnaire-Short Form, Hospital Anxiety Depression and KADF (dietary fibre information) scales were completed. RESULTS: The patient group consisted of 102 participants and the control group consisted of 104 participants. The mean age was 20.9 ± 3.9 years old in the case group and 21.8 ± 5.0 years old in the control group. Patient and control groups were similar in terms of age and gender. Smoking rates were significantly higher in the patient group (P = .035). The amount of coffee consumed/day was significantly higher in the patient group (P = .040). According to the global acne grading scores, 55.9% (n = 57) had medium, 39.2% (n = 40) had mild, 3.9% (n = 4) had severe and 1% (n = 1) had very severe acne. Anxiety scores were found to be significantly higher in the patient group (P = .005). When the case and control groups were compared for IBS presence, no significant difference was found (P = .317). Also, IBS was not related to acne severity (P = .162). CONCLUSION: Further large sample sized studies are needed on this subject, as there is strong evidence about brain-gut-skin axis existence.

Validity and reliability of Turkish version of Beliefs About Third-Hand Smoke Scale: BATHS-T.

OBJECTIVE: Exposure to third-hand smoke (THS) poses health risk, especially for children. THS is mostly ignored in Turkey. The aim of this study is to adapt the Beliefs about Third-Hand Smoke (BATHS) scale to Turkish. METHODS: The BATHS scale consists of 9 items, and the data collected from 273 people was considered sufficient for analyses in this methodological study. The BATHS scale is translated into Turkish and confirmatory factor analysis (CFA) was performed for the construct validity analysis of the scale. RESULTS: The correlation between the overall BATHS scale and its two sub-dimensions was 0.937 (p < 0.001), and the correlation between the health and persistence sub-dimensions was 0.775 (p < 0.001). Since there was a statistically positive and highly significant relationship, the adapted BATHS scale was considered structurally compatible with the sub-dimensions. The reliability value of the entire scale is 0.90. Test-retest correlation values between the health and persistence dimensions were between 0.745 and 0.960, the values obtained were above 0.70 and had a statistically positive and high level of significant relationship (p < 0.001). CONCLUSIONS: It is concluded that the Turkish version of the BATHS scale is reliable and valid. This scale will allow further research and training on third-hand smoke exposure. Tobacco control programmes success will improve.

Evaluation of clinical practice guideline quality: comparison of two appraisal tools.

OBJECTIVE: The tools used for critically appraising the quality of clinical practice guidelines are complex and not suitable for the busy end users. So rapid, effective and simple instruments are more preferred. The aim of this study is to compare two critical appraisal tools: iCAHE as a rapid instrument and AGREE II as a complex instrument on guideline quality assessment. MATERIAL AND METHODS: The diabetes mellitus guidelines of the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Health and Clinical Excellence (NICE), the International Diabetes Federation (IDF) and the Society of Endocrinology and Metabolism of Turkey (SEMT) were assessed separately by four appraisers using the iCAHE and AGREE II instruments. The mean iCAHE criteria scores and the total and domain AGREE II scores given by the four appraisers are presented for each guideline. RESULTS: No statistically significant difference was detected between the iCAHE scale scores of the guidelines evaluated (P = 0.063). The rank of the guidelines according to their average total iCAHE and AGREE II instrument scores was similar. The iCAHE mean scores of the guidelines were as follows: NICE, 92.85%; SIGN, 92.85%; IDF, 66.07% and SEMT, 73.21%. The AGREE II mean scores of the guidelines were as follows: NICE, 87.13%; SIGN, 78.25%; IDF, 53.44% and SEMT, 53.22%. CONCLUSIONS: In addition to being a quality scale, the iCAHE checklist is easy, practical and short to implement. It also helps the users to understand the quality of the guideline in a shorter time. To increase the use of guidelines, it is important that users with little experience and time use the iCAHE scale as a rapid appraisal tool, but more studies are needed to decide the best appraisal tool.

Evaluation of skin problems and dermatology life quality index in health care workers who use personal protection measures during COVID-19 pandemic.

The aim of this study was to evaluate the skin problems and dermatological life quality of the health care workers (HCWs) due to personal protection equipment (PPE) use, who are at high risk for COVID-19 infection. A questionnaire about HCWs' PPE use, their skin symptoms, and prevention, management methods and Dermatology Life Quality Index (DLQI) was fulfilled. The median age of 440 participants was 33.5 (21.0-65.0) years old. Skin problems were found to be 90.2%, the most common were dryness, itching, cracking, burning, flaking, peeling and lichenification. The presence of skin problems (P < .001) was higher in those who did not use moisturizers. Of all, 22.3% (n = 98) stated that the use of PPE increased the severity of their previously diagnosed skin diseases and allergies (P < .01). Only 28.0% (n = 123) stated that they know the skin symptoms that may develop by using PPE. The proper hand washing rate was higher as education level increased (P < .001). Skin problems were higher in those using mask with metal nose bridge (P: .02 and P: .003, respectively). As the mask using period prolonged, acne was more common (P: .02). DLQI was significantly affected in women (P = .003), and with increased skin problems related to PPE (P < .001). It is important to organize trainings on prevention and management of possible skin symptoms due to PPE use according to guidelines.

Frequency of sarcopenia and associated outcomes in patients with chronic obstructive pulmonary disease

Background/aim: We aimed to evaluate the prevalence of sarcopenia and associated outcomes in patients with chronic obstructive pulmonary disease (COPD). Materials and methods: This cross-sectional study was performed on 219 patients aged 50 years and over who were diagnosed with chronic obstructive pulmonary disease (COPD) according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The study included 196 (89.5%) male and 23 (10.5%) female patients. The mean age of the patients was 66.9 ± 10.1 years. To diagnose sarcopenia, muscle function was determined by a gait speed test. Muscle strength was assessed with a hand dynamometer and muscle mass was measured with a bioelectrical impedance analysis device. Pulmonary function tests and six-min walking tests were also performed. The modified Medical Research Council (mMRC) dyspnoea scale was used to evaluate all the participants. Our sample consisted of sarcopenic patients at different stages (17 presarcopenic patients (7.8%), 32 patients with sarcopenia (14.6%), 65 patients with severe sarcopenia (29.7%), and 105 nonsarcopenic patients (47.9%). Results: Sarcopenia was significantly associated with age, BODE (body mass index (BMI), airflow obstruction, dyspnoea, and exercise capacity) index, GOLD spirometric classification, mMRC dyspnoea scale score, BMI, and educational status. Sarcopenia in COPD patients was firmly related to the severity of the disease and its prognosis. The prevalence of sarcopenia increased in severe and very severe COPD cases. The dyspnoea score was higher, and exercise capacities were lower in sarcopenic patients. Conclusions: Sarcopenia in COPD patients was closely related to the severity of COPD and a negative prognosis. The frequency of sarcopenia increased in severe and very severe COPD cases. Dyspnoea scores were higher and exercise capacities were lower in patients with sarcopenia. In patients with COPD, a diagnosis of sarcopenia should be considered, and preventive measures should be taken before irreversible changes develop.

Human papillomavirus (HPV) subtypes and their relationships with cervical smear results in cervical cancer screening: a community-based study from the central Anatolia region of Turkey.

OBJECTIVE: Cervical cancer can be diagnosed early by cancer screening programs. The aim of this study was to evaluate the cervical smear test results of healthy women. METHODS: We enrolled 94,848 healthy women from 30-65 years of age in whom both HPV typing and a cervical smear test was performed between 2014 and 2017. RESULTS: HPV was detected in 3001 women (3.16%). The mean age was 42 ± 8.94 years old. Positive HPV types were HPV16; HPV16 and multiple infection; HPV31; HPV51; HPV39; HPV52; HPV56; HPV18; HPV68; HPV35; HPV18 and multiple infection; HPV58; HPV45; HPV59; HPV16, HPV18 and multiple infection; HPV16 and 18; and HPV33, in descending order. Cytology results were normal in 63.61%. We also identified atypical squamous cells of undetermined significance in 6.60%, atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion in 0.73%, low-grade squamous intraepithelial lesion in 10%, high-grade squamous intraepithelial lesion and atypical glandular cells in 0.53%, and adenocarcinoma in situ in 0.03%. In terms of HPV subtypes, abnormal smear results were divided into an HPV16, HPV18, and multiple infection group (25%), an HPV35 group (23.61%), an HPV 16 and multiple infection group (22%), and an HPV16-only group (21.85%). Most cases of HPV (39.02%) and abnormal cytology (43.04%) were detected between the ages of 30 and 40. CONCLUSIONS: This study is remarkable because it is a community-based study and includes a large population of healthy women to detect HPV prevalence, its subtype, and abnormal smear results.

Evaluation of 25-Hydroxyvitamin D Levels in Central Anatolia, Turkey.

BACKGROUND/AIM: The aim of this study is to evaluate serum 25-hydroxyvitamin D levels measured within one year at an Education and Research Hospital in Turkey to identify vitamin D insufficiency/deficiency (which is very commonly seen in the society) and to provide a current approach to treatment management. MATERIALS AND METHODS: This retrospective descriptive study was carried out by examining the data relating to 35,667 individuals. RESULTS: Of the individuals participating in the study, 94.47% had a serum 25-hydroxyvitamin D level less than 30 ng/ml, 76.25% had a serum 25-hydroxyvitamin D level less than 20 ng/ml, and 32.20% had a serum 25-hydroxyvitamin D level less than 10 ng/ml. The mean serum 25-hydroxyvitamin D level of all individuals included in the study was 15.2±8.8 ng/ml. The mean serum 25-hydroxyvitamin D level was 14.5±8.8 ng/ml among women and 18.1±8.4 ng/ml among men, respectively (p<0.001). CONCLUSION: Vitamin D deficiency/insufficiency is widespread in the world and in Turkey. The data obtained from this study suggest that without measuring serum 25-hydroxyvitamin D level will be cost-effective in every age group (except for those are at risk of toxicity) as in children aged 0-1 year old in Turkey and that making a decision in this direction will make a great contribution to the economy of the country.

Mental health problems in children with uncomplicated epilepsy; relation with parental anxiety.

Mental health problems and parental anxiety in children with epilepsy were investigated. Parents of 83 children with epilepsy and 172 healthy children were asked to complete Strengths and Difficulties Questionnaire for their children and State-Trait Anxiety Inventory for themselves. In those with epilepsy, 39.8% (n: 33) were girls, 60.2% (n: 50) were boys and their mean age was 9.34 ± 3.99 years. Control group was more successful in school (p < 0.001). Emotional problems score in children with epilepsy was higher than control group (p < 0.001). Case group's behavior problems and attention deficit hyperactivity scores were higher (p < 0.001, p=0.009 respectively). Prosocial behavior scores of the control group were significantly higher (p=0.004). State (p=0.001) and trait (p=0.001) anxiety levels of parents of children with epilepsy were higher. Children with epilepsy have more neuro-behavioral problems; and their parents have greater anxiety levels. Physicians should be in contact with children with epilepsy for the psychological health of the family besides seizure control.

The Frequency of Autoimmune Thyroid Disease in Alopecia Areata and Vitiligo Patients.

AIM: Many studies demonstrated that alopecia areata (AA) and vitiligo are commonly associated with autoimmune thyroid diseases. We aimed to investigate the frequency of thyroid dysfunctions and autoimmunity related with vitiligo and AA. MATERIAL AND METHODS: 200 patients, 92 AA and 108 vitiligo diagnosed, were surveyed retrospectively. The control population was in reference range and from Konya, central Anatolian region of Turkey. Thyroid function tests (free T3, free T4, and TSH) and serum thyroid autoantibody (anti-TG, anti-TPO) levels were evaluated in all patients. RESULTS: In vitiligo patients, 9 (8.3%) had elevated anti-TG levels and 16 (14.8%) had elevated anti-TPO, and in 17 patients (15.7%) TSH levels were elevated and 3 (2.8%) patients had elevated fT4 levels and 5 (4.6%) had elevated fT3 levels. Within AA patients, 2 (2.2%) had anti-TG elevation and 13 (14.1%) had anti-TPO elevation, in 7 patients (7.6%) TSH were elevated, and in 1 patient (1.1%) fT4 were elevated and 5 (5.4%) patients had elevated fT3 levels. CONCLUSION: In our study, impaired thyroid functions and thyroid autoantibodies in vitiligo and AA patients were identified at lower rates than the previous studies. According to results of this study there is no need for detailed examination in alopecia areata and vitiligo patients without clinical history.

Faun tail: a rare cutaneous sign of spinal dysraphism.

Faun tail is a triangle-shaped hypertrichosis of the lumbosacral region. It is a rare condition and it can be a cutaneous marker of underlying spinal cord anomaly. We report on a 17-year-old female patient with hypertrichosis on the lumbosacral area since birth that was later diagnosed with tethered cord in magnetic resonance imaging.

Evaluation of peripheral lymphadenopathy with excisional biopsy: six-year experience.

BACKGROUND: Lymphadenopathy (LAP) may be the first symptom of many diseases. We aimed to investigate peripheral LAP results taken by excisional biopsy. METHODS: Histopathological examination of 185 lymph node biopsy specimens were evaluated between January 2009 and April 2015 in Istanbul Private Ekin Pathology Laboratory, retrospectively. RESULTS: The average age of patients ranged from 1 to 86 was 41.01 ± 20.62 years. 87 of were female, 98 of male. 62 (33.5%) of excisional biopsy materials were benign lesions and 123 (66.5%) of malignant. Benign lesions were consisted of reactive hyperplasia, cat-scratch disease, toxoplasmosis, necrotizing/non-necrotizing granulomatous. Of these patients, 40 had nodes with reactive hyperplasia (15 female/25 male, mean age: 27.35 y), 14 had necrotizing granulomatous disease (9 female/5 male, mean age: 39.86 y), 2 non-necrotizing granulomatous disease (1 female/1 male mean age: 43 y), 4 had cat-scratch disease (1 female/3 male mean age: 54.25 y), 1 toxoplasmosis (26 y, female), 1 Kikuchi disease (25 y, female). In the evaluation of malign lesions; 38 were Hodgkin lymphoma (HL) (20.5%, 17 female/21 male, mean age: 34.89 y) 77 had non-Hodgkin lymphoma (NHL) (41.6%, 37 female/40 male, mean age: 52.26 y), 8 metastasis (4.3%, 5 female/3 male, mean age: 53.5 y). Reactive LAP observed most common in cervical region, NHL in axillary-abdomen-inguinal-mediastinum and HL in the supraclavicular region. CONCLUSION: Excisional biopsy can be applied safely with minimal morbidity and mortality and a gold standard diagnostic method for LAP. Although LAP is mostly related with benign lesions, malignancy should be kept in mind in differential diagnosis.

TNM and Modified Dukes staging along with the demographic characteristics of patients with colorectal carcinoma.

AIM: Colon adenocarcinoma, is the most common cancer in gastrointesinal system (GIS). The whole world is an important cause of morbidity and mortality. TNM and modified Dukes classification which has great importance in the diagnosis and treatment of Colorectal cancer (CRC). TNM and Modified Dukes classification results of histopathological examination and the demographic characteristics of patients and their relation were investigated. MATERIALS AND METHODS: Lower gastrointestinal operation results of 85 patients were examined accepted to clinical Pathology between January 1997-November 2013. Colon cancer had been diagnosed at 85 patients with pathology materials and staging was done according to the TNM and Modified Duke classification. The demographic characteristics of patients, differentiation grade, lymph node involvement, serous involvement were evaluated retrospectively. RESULTS: In this study 37 patients (43.52%) were men and 48 (56.47%) were women. Ages of patients were between 19 and 87 with a mean age of 57.31 ± 15.31. Lymph node, differentiation, serosa involvement, Modified Dukes and TNM classification was assessed according to sex and age. TNM classification by sex was not statistically significant (p > 0.05). There was no statistically significant relationship between age and differentiation (p = 0.085). Value of differentiation increased towards from 1 to 3 inversely proportional to age. So young patients defined as well-differentiated at the conclusion. Negative relationship was evaluated between age and TNM Class variables. As a result, the relationship between age and TNM was not significant (p > 0.05). However, with increasing age the degree of staging was also found to increase. TNM classification was associated with the differentiation and it was significant (p = 0.043). CONCLUSION: Colon cancer, when contracted at an early stage, it is suitable for surgery and curative treatment can be done with minimal morbidity and mortality. However, some of the patients have advanced disease at diagnosis and their 5-year survival rate is only 8%. Every year there is prolongation of overall survival of colon cancer. It is so common cancer type so that determination of prognostic factors, disease staging and treatment strategy which affects survival is significant.

Shared decision-making in pediatric intensive care units: a qualitative study with physicians, nurses and parents.

OBJECTIVES: To understand how decisions are made in Intensive Care Unit (ICU) settings where critically-ill children require life-support decisions and what are the perceptions of health professionals and parents. METHODS: In this qualitative study, in-depth, semi-structured, face to face interviews with 8 doctors, 9 nurses and 6 parents of critically ill children were conducted. Interviews were digitally recorded and transcribed. The transcriptions were further analyzed following open coding and formation of themes. RESULTS: The themes were discussed in two major titles: perceived roles and emotions during the decision-making process. All nurses and patients agreed that the decision maker should be the physician. Nurses understood patients' emotions better and had a closer relation with the parents. Both doctors and nurses thought that parents could not have all responsibilities about treatment choices, because they do not have the required knowledge. Similarly parents were afraid to make a wrong decision, thus they wanted to leave this to the doctors. CONCLUSIONS: The present study revealed that shared-decision making is not well understood by health care professionals in Turkey. Doctor is the major decision-making authority and this is also accepted and preferred by the patients and nurses.

Attitudes toward and factors affecting influenza vaccination among physicians and nurses of a tertiary-care hospital in the Central Anatolia region of Turkey.

AIM: Similar to most international health care organizations, the Turkish Ministry of Health strongly recommends influenza vaccination for health care professionals. The aim of this study was to assess the vaccination rates and attitudes of physicians and nurses during the 2011 to 2012 seasonal influenza vaccination at a tertiary-care hospital of the Turkish Ministry of Health. METHODS: This was a descriptive cross-sectional study. The study participants were physicians and nurses working at the Konya Training and Research Hospital, located in the Central Anatolia region of Turkey. Self-reported (anonymous) questionnaires were given to 192 physicians and 411 nurses (N = 603) who agreed to participate between November 1 and 30, 2011. Frequencies, percentages, chi-square tests, and logistic regression tests were used for statistical analyses. RESULTS: Women comprised 64.1% (n = 387) of the participants, and 63% (n = 380) of participants had been working for ≥ 5 years. The seasonal influenza vaccination rate for all participants during the 2011 to 2012 season was 16.7% (n = 101). Although 9.5% (n = 57) of the study group had a chronic disease, 71.9% (n = 41) did not receive influenza vaccination (P < 0.05). Additionally, 40.8% (n = 240) reported ≥ 2 cases of influenza annually, and 82.9% (n = 204) had not been vaccinated. For 12.9% (n = 78) of participants, influenza caused absenteeism from work. Approximately 45% (n = 271) of participants had never been vaccinated, 27% (n = 163) were vaccinated in 2010, and 21.2% (n = 128) planned on being vaccinated in 2012. Among the vaccinated group, 56.4% (n = 57) experienced no side effects, 29.7% (n = 30) experienced local side effects, and 22.8% (n = 23) developed influenza-like syndrome. CONCLUSION: Similar to other studies in the literature, vaccination rates were not at the desired level. According to our Hospital Infection Committee reports, vaccination rates at our hospital were lower compared with vaccination rates of the 2009 H1N1 pandemic. The underlying causes of health care professionals abstaining from influenza vaccination should be further evaluated.

Family practice in Turkey: views of family practice residents.

Turkey's family practice training program is aimed at providing further training to clinically proficient family physicians who serve the community. A survey conducted in 2001 revealed that there was a need for providing additional training and more time in a specially dedicated family practice placement for family practitioners. Recent changes in the Turkish health care system have also impacted the training environment of family practice residents. Clearly, training needs to change with time. The aims of this study are to investigate the attitudes of resident family practice physicians regarding their training in the health care system in order to gather their views on the hospital learning environment, and to estimate their burnout levels. For this research, the design included a 1-phase cross-sectional study. This study was undertaken in 2008 in departments of family medicine at universities (n = 21) and training and research hospitals of the Ministry of Health (n = 11). Approximately 250 family practice residents in Turkey were approached. In total, 174 residents participated (70% response rate). The survey instruments included a questionnaire with 25 queries and 2 scales: The Postgraduate Hospital Educational Environment Measure and the Maslach Burnout Questionnaire-Human Services Survey. The average age of the participants was 32.2 years (standard deviation, 4.5 years; range, 24-57 years). The gender distribution was 57.6% women and 42.4% men. Marital status was 34.7% single, 62.9% married, and 2.4% divorced/widowed. In our results, residents affirmed that university hospitals were the best facilities for residency training. Their future plans confirmed that most would like to work in family health centers. This sample showed average levels of emotional exhaustion, depersonalization, and lack of personal accomplishment. Perceptions of professional autonomy, quality of training, and social support were below average. It may be concluded that certain milestones in the development of family practice in Turkey have been fulfilled. The new regulation for postgraduate training has increased the share of family practice training to 50% (18 months). Establishment of educational family health centers has been planned. Introduction of the formative and summative assessment processes in family practice training is anticipated. It is expected that an assessment such as the Membership of the Royal College of General Practitioners (International) (mRCGP[INT]) examination would be helpful for Turkish residents in reaching these goals.