High School Students' and Teachers' Mental Health Literacy Levels in Istanbul, Turkey: A Comprehensive Analysis.

BACKGROUND: Mental health literacy is important for awareness of mental illnesses in adolescence, which is the initial period of mental disorders. Determining the levels of mental health literacy guides studies in activities promoting mental health. This study aimed to determine the mental health literacy levels of high school students and teachers and related factors. METHODS: Our study is a cross-sectional study. A total of 1051 people (students and teachers) were included in the Fatih District of Istanbul were included in our study. The mental health literacy levels of the participants were evaluated with the Mental Health Literacy Questionnaire. This questionnaire includes scenarios about mental problems called "vignettes" and questions about them. RESULTS: Students' recognition percentages of depression, schizophrenia, and social phobia vignettes were found to be 28.1%, 46.5%, and 5.9%, respectively. For the person who was described in the vignettes, the "family physician" was chosen as the least by students and teachers. A statistically significant relationship was found between students' mental health literacy levels and sex, grade, father education levels, and experiencing vignette similar issues (p < .005). Additionally, teachers who were not school administrators and experienced vignette similar issues levels were higher (p < .005). CONCLUSIONS: These results showed us that mental health literacy levels are low in high schools. School-based intervention studies on this issue are of critical importance. In addition, it is seen that individuals do not consider asking for help with mental health problems from primary care services. This shows the inadequacy of the integration of primary health care services and mental health services.

Good versus poor prescribers: the comparison of prescribing competencies in primary care.

AIM: To compare the competencies of primary care physicians (PCPs) with poor and good prescribing performance in frequently encountered indications. BACKGROUND: Primary care centers are one of the mostly visited health facilities by the population for different health issues. METHODS: In this cross-sectional study, we analyzed 6 125 487 prescriptions generated by 1431 PCPs which were selected by systematic sampling in 2016 in Istanbul. We defined PCPs as poor prescriber (n = 227) or good prescriber (n = 210) in terms of their prescribing performance per WHO/INRUD criteria. We compared solo diagnosis prescriptions of these two groups in 'percentage of prescriptions in compliance with clinical guidelines' and also rational prescribing indicators. FINDINGS: Poor prescribers and good prescribers significantly differed in each of the prescribing indicators for their all solo diagnosis prescriptions. Hypertension had the highest difference of the average cost per encounter (Δ = 284.2%) between poor prescribers (US$43.99 ± 63.05) and good prescribers (US$11.45 ± 45.0), whereas headache had the highest difference between the groups in the percentage encounters with an antibiotic (14.9% vs. 1.5%). Detailed analysis of the prescribing performances showed significantly higher values of each WHO/INRUD indicators for all examined diagnoses. We found significantly higher percentages of guideline-compliant drugs in good prescribers compared to that in poor prescribers in hypertension (40.8% vs 34.8%), tonsillopharyngitis (57.9% vs 50.7%), and acute sinusitis (46.4% vs 43.6%). CONCLUSION: This study shows that the prescribing performances of PCPs are not rational enough in terms of drug selection and prescription content. Furthermore, even the physicians who have good prescribing practice appear as not satisfactorily rational in compliance with current pharmacotherapy competencies.

Safeguarding people living in vulnerable conditions in the COVID-19 era through universal health coverage and social protection.

The COVID-19 pandemic is unprecedented. The pandemic not only induced a public health crisis, but has led to severe economic, social, and educational crises. Across economies and societies, the distributional consequences of the pandemic have been uneven. Among groups living in vulnerable conditions, the pandemic substantially magnified the inequality gaps, with possible negative implications for these individuals' long-term physical, socioeconomic, and mental wellbeing. This Viewpoint proposes priority, programmatic, and policy recommendations that governments, resource partners, and relevant stakeholders should consider in formulating medium-term to long-term strategies for preventing the spread of COVID-19, addressing the virus's impacts, and decreasing health inequalities. The world is at a never more crucial moment, requiring collaboration and cooperation from all sectors to mitigate the inequality gaps and improve people's health and wellbeing with universal health coverage and social protection, in addition to implementation of the health in all policies approach.

COVID-19: Marking the Gaps in Migrant and Refugee Health in Some Massive Migration Areas.

The health of migrants and refugees, which has long been a cause for concern, has come under greatly increased pressure in the last decade. Against a background where the world has witnessed the largest numbers of migrants in history, the advent of the COVID-19 pandemic has stretched the capacities of countries and of aid, health and relief organizations, from global to local levels, to meet the human rights and pressing needs of migrants and refugees for access to health care and to public health measures needed to protect them from the pandemic. The overview in this article of the situation in examples of middle-income countries that have hosted mass migration in recent years has drawn on information from summaries presented in an M8 Alliance Expert Meeting, from peer-reviewed literature and from reports from international agencies concerned with the status and health of migrants and refugees. The multi-factor approach developed here draws on perspectives from structural factors (including rights, governance, policies and practices), health determinants (including economic, environmental, social and political, as well as migration itself as a determinant) and the human security framework (defined as "freedom from want and fear and freedom to live in dignity" and incorporating the interactive dimensions of health, food, environmental, economic, personal, community and political security). These integrate as a multi-component 'ecological perspective' to examine the legal status, health rights and access to health care and other services of migrants and refugees, to mark gap areas and to consider the implications for improving health security both for them and for the communities in countries in which they reside or through which they transit.

Withdrawal of Staphylococcus aureus from intensive care units in Turkey.

BACKGROUND: In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. METHODS: A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value ≤.01 was considered significant. RESULTS: Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001). CONCLUSIONS: The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs.

A model in environmental training--The University / Elementary School / Municipality Cooperation.

This study targets development of an effective training scheme model that can be implemented at elementary school level with focus on recovery and recycling of wasted papers in Turkey. For this purpose, three schools were chosen from a district within Istanbul. They were separated from one another as full intervention (FI), semi-intervention (SI) and control (C) schools. Different levels of educational activities carried out in the schools, mostly in the FI school, were directed toward being informative as regards recycling and the development of a positive attitude. Afterwards, in order to evaluate the effects of the training, paper wastes were collected in recycle bins placed at appropriate points in schools and weighed on a weekly basis. Quite a significant result was found (p = 0.0001), when the difference was calculated through the Kruskal Wallis Variance Analysis method, regarding the weekly average amount of paper in each of the three schools against per person. Furthermore, when the results were evaluated and compared as to the ones before the 2.5 months summer vacation and the ones after it, the seven measurements taken before (p = 0.001) and the eight taken afterwards (p = 0.0001), were found to have valid differences, once again, as against schools. The results show that the approach we provided to education is an effective method not only for the collection of paper wastes but also for applications in various areas of health education.

Courses for medical residents and trainers in Turkey for promotion of quality of reproductive health services: a pilot study.

In order to provide high quality services in reproductive health, training of health professionals is essential. In Turkey, a project for in-service training of medical residents was conducted in 2003 under the aegis of the Human Resources Development Foundation, the Turkish Ministry of Health and UNFPA. The project included a needs assessment, training programme development and evaluation activities. A seven-day course was developed to train institutional trainers in both training skills and reproductive health information. Fourteen experienced master trainers conducted four courses for 67 institutional trainers from 37 hospital departments in four cities, who in turn conducted a three-day programme on reproductive health topics in their respective institutions, using interactive teaching methods. 163 residents from departments of obstetrics and gynaecology, family medicine, urology, public health and paediatrics participated. Over three-quarters of trainers and residents who participated in the programme approved of the content of the courses. A limited number of topics, e.g. sexual health and adolescent reproductive health, were thought to need more attention. Trainers cited improvements in doctor-patient communication and quality of outpatient and in-patient care, and initiation of counselling in their institutions. We conclude that this training programme, attended by trainers and participants from different disciplines and using interactive teaching methods, has been successful as an effective training model for medical residents. The establishment of an ongoing collaboration between the Ministry of Health and other institutions involved in resident training in Turkey is needed to ensure the expansion of this programme to all residents in training.

Development of training of trainers programmes and evaluation of their effectiveness in Istanbul, Turkey.

This report presents an evaluation of the impact of the 'Training of Trainers' (TOT) courses conducted since 1997. The effects of TOT programmes were studied using a questionnaire given to the course participants immediately after and again following a minimum period of six months after completion of the course. The 85 participants included in this analysis were medical teachers from the Istanbul Faculty of Medicine, of whom 17% were instructors, 39% were associate professors and 44% full professors. Some 72% of the medical teachers stated that they were able to implement the knowledge/skills they had acquired during the TOT course in their teaching. The majority of the participants reported more feedback from students and enhancement of student-faculty interaction in their teaching experience after the course. These results appear promising and indicate that TOT courses indeed motivate the teaching staff and provide them with tools and opportunities for more effective teaching. They also appear to have a lasting impact.