Prevalence of social anxiety disorder and its associated factors among foreign-born undergraduate students in Türkiye: A cross-sectional study.

Social anxiety disorder (SAD) is prevalent among university students, yet data on its severity among foreign-born international undergraduate students in Türkiye remains limited. This study aims to determine the prevalence of SAD and its associated factors within this population. A cross-sectional study was conducted using a Google Form survey distributed across various universities from September 17, 2023, to February 1, 2024. The survey comprised two sections: sociodemographic information and 17 items of the Social Phobia Inventory (SPIN), which measures the frequency and intensity of social anxiety symptoms. Data analysis included descriptive statistics and inferential analysis, multiple regression, and binomial logistic regression. Out of 506 participants, 455 were included in the study. Results revealed that 39.1% exhibited no or very mild symptoms of SAD, while 23.7% experienced mild symptoms, 21.3% faced moderate symptoms, and 11.6% and 4.2% presented with severe to very severe symptoms, respectively. Factors such as gender (p < 0.0001), previous academic failures (p = 0.013), family history of mental health issues (p = 0.009), exercise frequency (p < 0.0001), and perceptions of relationships with classmates (p < 0.0001) were significantly associated with SAD. Females showed a higher probability of SAD compared to males (OR = 1.976). Individuals engaging in over 90 minutes of exercise per week were less likely to have SAD (OR = 0.383), and occasional smokers had a lower risk of SAD compared to non-smokers (OR = 0.422). Our study uncovered a notably elevated prevalence of Social Anxiety Disorder (SAD) among foreign-born undergraduate students in Türkiye. Factors such as being female, having a family history of mental illnesses, studying in a stressful environment, experiencing academic failure, and engaging in less frequent exercise were associated with noticeable symptoms of SAD. These findings emphasize the urgent need for heightened efforts in recognizing and addressing SAD within this population.

Knowledge, Attitudes, and Barriers Toward Research Among Medical Students: A Cross-sectional Study in Turkey.

Background: Scientific research is essential in medicine to practice evidence-based medicine and improve healthcare quality. Research experience enables students to hone their skills in thinking critically, understanding data, and evaluating the strengths and weaknesses of scientific articles. Objective: This study aims to determine knowledge, attitudes, and barriers toward research and assess research participation experience among medical students in Turkey. Methods: We conducted a cross-sectional study among medical students in Turkey. Data was collected using an online self-administered questionnaire. Results: A total of 487 students, 65.1% female, completed the questionnaire. The majority of students (78.9%) showed a poor level of knowledge regarding research, although 23.2% had previously participated in a research project. Females reported significantly higher positive attitude scores (32.2 versus 31.3, p = 0.034) than males. Graduates of high schools based abroad had substantially lower knowledge scores than Anatolian, Science, and Private High School graduates (1.4 versus 2.7, 2.6, 2.4; p < 0.001). Students with experience in a research project had significantly higher knowledge scores (2.7 versus 2.3, p = 0.045). Students who wish to participate in a scientific research project in their future career had both substantially higher positive attitude scores (32.4 versus 29.6, p < 0.001) and knowledge scores (2.5 versus 1.8, p < 0.001) than those with no interest. Conclusion: Most participants had a positive attitude but lacked research knowledge. Some perceived barriers were lack of funding, time, proper mentoring, laboratories, and facilities. Developing better training systems may help to convert students' positive attitudes toward research into improved knowledge, practices, and overcoming research barriers. Supplementary information: The online version contains supplementary material available at 10.1007/s40670-024-01987-0.

Effective alcohol policies are associated with reduced consumption among demographic groups who drink heavily.

BACKGROUND: Alcohol policies stand out among other noncommunicable disease-relevant policies for the lack of uptake. Composite indicators have been developed to measure the effects of alcohol control policy. We investigated whether drinking patterns among demographic groups from general population samples of drinkers from diverse countries are associated with alcohol control policy as measured by the International Alcohol Control (IAC) Policy Index. METHODS: Representative samples of adult drinkers from 10 countries (five high-income and five middle-income) were surveyed about alcohol consumption, using beverage and location-specific questions. MEASUREMENTS: The IAC Policy Index was analyzed with frequency, typical occasion quantity, and volume consumed. Analyses used mixed models that included interactions between country IAC Policy Index score and age group, gender, and education level. FINDINGS: Each increase in IAC policy index score (reflecting more effective alcohol policy) was associated with a 13.9% decrease in drinking frequency (p = 0.006) and a 16.5% decrease in volume (p = 0.001). With each increase in IAC Policy Index score, both genders decreased for all three measures, but men less so than women. Women decreased their typical occasion quantity by 1.2% (p = 0.006), frequency by 3.1% (p < 0.001), and total volume by 4.2% (p < 0.001) compared to men. Low and mid-education groups decreased their typical occasion quantity by 2.6% (p < 0.001) and 1.6% (p = 0.001), respectively, compared to high education, while for drinking frequency the low education group increased by 7.0% (p < 0.001). There was an overall effect of age (F = 19.27, p < 0.0001), with 18-19 and 20-24-year-olds showing the largest decreases in typical occasion quantity with increasing IAC policy index score. CONCLUSIONS: The IAC Policy Index, reflecting four effective policies, was associated with volume and frequency of drinking across 10 diverse countries. Each increase in the IAC Policy Index was associated with lower typical quantities consumed among groups reporting heavy drinking: young adults and less well-educated. There is value in implementing such alcohol policies and a need to accelerate their uptake globally.

Effective alcohol policies and lifetime abstinence: An analysis of the International Alcohol Control policy index.

INTRODUCTION: Alcohol abstinence remains common among adults globally, although low and middle-income countries are experiencing declines in abstention. The effect of alcohol policies on lifetime abstinence is poorly understood. The International Alcohol Control (IAC) policy index was developed to benchmark and monitor the uptake of effective alcohol policies and has shown strong associations with alcohol per capita consumption and drinking patterns. Uniquely, the index incorporates both policy 'stringency' and 'impact', reflecting policy implementation and enforcement, across effective policies. Here we assessed the association of the IAC policy index with lifetime abstinence in a diverse sample of jurisdictions. METHODS: We conducted a cross-sectional analysis of the relationship between the IAC policy index score, and its components, and lifetime abstinence among adults (15+ years) in 13 high and middle-income jurisdictions. We examined the correlations for each component of the index and stringency and impact separately. RESULTS: Overall, the total IAC policy index scores were positively correlated with lifetime abstinence (r = 0.76), as were both the stringency (r = 0.62) and impact (r = 0.82) scores. Marketing restrictions showed higher correlations with lifetime abstinence than other policy domains (r = 0.80), including restrictions on physical availability, pricing policies and drink-driving prevention. DISCUSSION AND CONCLUSION: Our findings suggest that restricting alcohol marketing could be an important policy for the protection of alcohol abstention. The IAC policy index may be a useful tool to benchmark the performance of alcohol policy in supporting alcohol abstention in high and middle-income countries.

Benchmarking alcohol policy based on stringency and impact: The International Alcohol Control (IAC) policy index.

This study developed a measurement tool to assess stringency and 'on-the-ground' impact of four key alcohol policy domains to create an alcohol policy index suitable for benchmarking alcohol policy and assessing change over time in middle- and high-income countries. It involved a collaboration between researchers in 12 diverse countries: New Zealand; Australia; England; Scotland; Netherlands; Vietnam; Thailand; South Africa; Turkey; Chile; Saint Kitts and Nevis and Mongolia. Data on the four most effective alcohol policy domains (availability, pricing policy, alcohol marketing, drink driving) were used to create an alcohol policy index based on their association with alcohol per capita consumption (APC) of commercial (recorded) alcohol. An innovation was the inclusion of measures of impact along with the stringency of the legislation or regulation. The resulting International Alcohol Control (IAC) Policy Index showed a very high negative correlation (-0.91) with recorded APC. Greater affordability of alcohol, an impact measure taking into account prices paid and countries' Gross Domestic Product, was predictive of higher APC (-0.80). Countries in which more modes of alcohol marketing are legally allowed and used had higher APC. Legislation on outlet density and drink driving predicted APC whereas trading hours did not. While stringency and impact measures varied between domains in terms of relationship with APC, overall, there was a strong correlation between impact and stringency (0.77). The IAC Policy Index, which includes measures of policy stringency and 'on-the-ground' impacts in relation to four key policy areas, was found to be strongly associated with commercial alcohol consumed in a number of diverse country settings. It showed a larger relationship than previous indices that include more policy dimensions. The index provides a relatively simple tool for benchmarking and communication with policy makers to encourage a strong focus on uptake of these four most effective alcohol policies.

Psychiatric symptoms, challenging behaviour and utilization of psychiatric services among adults with intellectual disabilities in Turkey.

BACKGROUND: The aim of this study was to investigate the prevalence of and the factors associated with psychiatric symptoms (PS) and challenging behaviour (CB) in adults with intellectual disabilities, and the utilization of psychiatric services in Turkey. METHOD: Psychiatric Assessment Schedule for Adults with Developmental Disorders Checklist-Revised was used for PS and a structured form for other variables in 771 participants. RESULTS: Of the participants, 50.1% had PS and 36.4% presented with CB. Multivariate analysis revealed that a higher level of needs, better verbal ability, residential living, incontinence and CB, and lifetime suicidal ideation/attempt were independently associated with PS. For CB, it emerged as male carer, PS, lifetime suicidal attempt/ideation, lower level of verbal ability and autism spectrum disorder. Barriers were experienced by 64.7% of participants within the previous year. CONCLUSIONS: Psychiatric symptoms and CB seem to be problems for a significant proportion of adults with intellectual disabilities in Turkey, and there are certain barriers to psychiatric services.

Health Services Management in Turkey: Failure or Success?

BACKGROUND: The unfair distribution and delivery of health-care resources have been recognized as a problem in the worldwide. In the past 18 years, Turkey has undergone rapid social, cultural, and economic changes. The lifestyle and dietary habits of its people have also been changing, and the rates of diabetes, obesity, cancer, and other chronic diseases have increased dramatically over the past two decades. The health transformation program (HTP) has improved the Turkish health-care system since 2003. The main goal of HTP was to progress government, to provide equality between citizens, to give satisfaction to users and providers, and to subsidise the health-care system in Turkey. AIM: The aim of this study is to assess health-care services and health care quality delivery in the Republic of Turkey with special emphasis on governmental hospitals, university hospitals, primary healthcare centers (PHC) and to make comparison with low-, medium- and high-income countries. METHODS: This is a retrospective, descriptive study. The ministry of health Annual Reports, websites of the Central Intelligence Agency (CIA), The World Fact Book, organization for economic cooperation and development report, Compendium of Health Statistics, the Google engine, and PubMed were searched for information about Turkey's health-care system and its history. Papers and websites in English were evaluated. There was no restriction on types of articles and sources. RESULTS: Turkey has made outstanding reforms in health status in the last two decades, especially after the implementation of the HTP. The doctor's perception has more influence regarding consultation length and visit than the patient's. The results of consultations in volunteer practices in Istanbul showed that the mean and SD of the consultation length for the whole sample of 360 patients was 7.95 ± 4.38, (with range = 3-25 min). Consultation time has been affected by the patients' diseases, genders that women got longer consultation time, medical practices at the urban or rural areas, and ages which older patients required longer consultation time. The current study revealed that increasing doctor's workload leads to decrease the length of consultations. Moreover, average life expectancy reached 75.3 for men and 80.7 for women in 2015. The infant mortality rate decreased to 10.7/1000 live births in 2015, down from 117.5 in 1980. The leading causes of death are diseases of the circulatory system followed by cancer. CONCLUSIONS: The Turkish health system and health-care delivery have been improved over the last decade. Still far from perfect, there is a particular planning to increase medical workforce in PHC including well-trained staffs for a specific area. An urgent need is to acquire more accurate and reliable data from hospital and PHC centers in Turkey. Additional some attempts should be made to assess quality of healthcare in relation to services and process.

Temporal trends and patterns in antimicrobial-resistant Gram-negative bacteria implicated in intensive care unit-acquired infections: A cohort-based surveillance study in Istanbul, Turkey.

OBJECTIVES: This study assessed trends and patterns in antimicrobial-resistant intensive care unit (ICU)-acquired infections caused by Gram-negative bacteria (GNB) in Istanbul, Turkey. METHODS: Bacterial culture and antimicrobial susceptibility data were collected for all GNB causing nosocomial infections in five adult ICUs of a large university hospital in 2012-2015. Multiresistance patterns were categorised as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR). Temporal patterns and trends were assessed using regression analyses. RESULTS: Of 991 pathogenic GNB recorded, the most frequent were Acinetobacter baumannii (35.3%), Klebsiella spp. (26.7%), Pseudomonas aeruginosa (18.1%) and Escherichia coli (6.7%). The overall infection rate decreased by 41% from 18.4 to 10.9 cases per 1000 patient-days in 2012 compared with 2015 (P<0.001), mostly representing decreases in bloodstream infections and pneumonias by A. baumannii and P. aeruginosa. The XDR proportion in A. baumannii increased from 52.4% in 2012 to 71.7% in 2015, but only one isolate was colistin-resistant. Multiresistance patterns remained stable in Klebsiella, with overall XDR and possible PDR proportions of 14.3% and 1.9%, respectively. A back-to-susceptibility trend was noted for P. aeruginosa in which the non-MDR proportion increased from 53.3% in 2012 to 70.6% in 2015. Moreover, 87.9% of E. coli and 39.5% of Enterobacter isolates were MDR, but none was XDR. CONCLUSIONS: Antimicrobial resistance patterns in pathogenic GNB continuously change over time and may not reflect single-agent resistance trends. The proportionate amount of antimicrobial-resistant GNB may persist despite overall decreasing infection rates. Timely regional surveillance data are thus imperative for optimal infection control.

Health and health care access for Syrian refugees living in Istanbul.

OBJECTIVES: The study was conducted to assess the health needs of urban refugees living in Istanbul. METHODS: A mixed methods approach was adopted to interview Syrian women from households, doctors, decision makers and NGO representatives. The data were collected between June and October 2015. RESULTS: The main challenges were the cost of living in Istanbul, increased rent and language barrier. Almost half (49.6%) of the interviewed women did not know about free health care rights for Syrians. In the last 30 days preceding the interview, 58.6% of the participants sought health care primarily through state hospitals, primary health care centres and pharmacies. The participants had difficulty in accessing health care due to the language barrier and a lack of knowledge of the Turkish health care system. Waiting time at hospitals and negative attitudes of health care staff reduced satisfaction in these services. CONCLUSIONS: In relation to life in Turkey, the main issues for Syrian refugees were not directly related to health. They have been given the right to access health care, although had many difficulties in understanding and accessing services in a crowded city.

Can health indicators help policy-makers? Experience from European system of urban health indicators (EURO-URHIS).

Background: This paper proposes that Population Impact Measures (PIMs), the Population Impact Number of Eliminating a Risk Factor over a time period (PIN-ER-t) and the number of events prevented in your population (NEPP), can assist in policy making as they include relevant information which describes the impact or benefits to the population of risk factors and interventions. In this study, we explore the utilization of the indicators from European System of Urban Health Indicators System to produce the two PIMs. We identified from the indicators list the health determinants, health status and health interventions which can be linked, and searched Medline for evidence of association. We then investigated whether the type of frequency measure available for the indicator match with the measure used in PIMs, and explored data availability for the City of Manchester (UK) as an urban area. Of the 39 indicators relevant to socio-economic factors, health determinants and health status, it was possible to calculate the population impact of a risk factor, i.e. the PIN-ER-t, for only six associations, and the population impact of health interventions, i.e. NEPP, for only one out of the three listed indicators, as the relevant health conditions were not included. The results of this study suggest that if an indicator system is intended to play a part in the policy making process, then the method of presentation to policy-makers should be decided before setting up the system, as it is likely that some indicators which would be essential might not be available.

Changes in the prevalence of HBV infection in pregnant women in Turkey between 1995 and 2015: a 20-year evaluation.

OBJECTIVE: To determine changes in hepatitis B virus (HBV) prevalence across three different time periods in pregnant women. METHODS: This was a retrospective study of pregnant women attending four healthcare centres between January 1995 and May 2015. Data for serum hepatitis B surface antigen (HBsAg) and anti-HBs levels were collected from routine antenatal screening records. The 20-year study was divided into three periods: 1995-2001, 2002-2008 and 2009-2015. The results are presented by the women's age and gravidity as possible determinants of HBV infection. RESULTS: 7605 pregnant women (56.0% primigravidae) (mean age 23.4±4.8 years) were tested for markers of HBV infection. 3010 pregnant women were screened between 1995 and 2001, 2995 between 2002 and 2008, and 1600 between 2009 and 2015. The overall prevalence of HBsAg and anti-HBs positivity in the 7605 pregnant women was 1.5% (n=114) and 11.5% (n=877), respectively. Regarding temporal change in the prevalence of HBV markers, HBsAg decreased significantly from 2.6% to 0.8% (p<0.01), while anti-HBs increased significantly from 9.5% to 17.5% (p<0.01), between the first and last study periods. Multigravidae and older women had higher HBsAg and anti-HBs positivity compared to primigravidae. CONCLUSIONS: The data suggest that the prevalence of HBsAg positivity is gradually decreasing among pregnant women, while the level of HBsAg antibody seropositivity is lower than expected. HBV carrier rate increases with increasing age and gravidity. In addition to the national HBV immunisation programme, the prevention of perinatal transmission should also be prioritised to decrease the HBV pool of infection.

Population Impact Analysis: a framework for assessing the population impact of a risk or intervention.

BACKGROUND: To describe an organizing framework, Population Impact Analysis, for applying the findings of systematic reviews of public health literature to estimating the impact on a local population, with the aim of implementing evidence-based decision-making. METHODS: A framework using population impact measures to demonstrate how resource allocation decisions may be influenced by using evidence-based medicine and local data. An example of influenza vaccination in the over 65s in Trafford to reduce hospital admissions for chronic obstructive pulmonary disease (COPD) is used. RESULTS: The number of COPD admissions due to non-vaccination of the over 65 in Trafford was 16.4 (95% confidence interval: 13.5; 19.5) and if vaccination rates were taken up to 90%, 11.5 (95% confidence interval: 9.3; 13.8) admissions could have been prevented. A total of 705 (95% confidence interval: 611; 861) people would have to be vaccinated against influenza to prevent one hospital admission. CONCLUSIONS: Population Impact Analysis can help the 'implementation' aspect of evidence for population health. It has been developed to support public health policy makers at both local and national/international levels in their role of commissioning services.

Are pharmacists reducing COPD'S impact through smoking cessation and assessing inhaled steroid use?

BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) COPD 2004 guidelines recommend: ∗ COPD patients who smoke should be encouraged to stop at every opportunity; ∗ Inhaled corticosteroid should be used only among patients with moderate to severe COPD; ∗ Pharmacists should identify smokers and provide smoking cessation advice. The community pharmacy contract requires pharmacists to review patients' medications, creating an opportunity for reviewing the prescribing of inhaled corticosteroids in COPD. The survey explored the degree to which community pharmacists in North West England identify and provide advice to smokers and assess prescribed inhaled corticosteroids among COPD patients. METHODS: A self-completion questionnaire was sent to 2080 community pharmacists from the 2005 pharmacist census database. RESULTS: Of the 1051 (50.5%) respondants, 37.1% mentioned COPD as a risk from smoking most or every time and 54.5% sometimes or rarely, and 19.6% routinely asked about smoking status when dispensing COPD medication. Pharmacists with more than 20 years experience were more likely to have read the Guideline compared to pharmacists with 10 years or less (OR: 1.54; 95% CI: 1.13 to 2.10). Pharmacists who had read the NICE Guideline (46.8%) were around twice as likely to mention COPD as a risk of smoking, ask about COPD if inhaled corticosteroids were dispensed and ask about smoking routinely if COPD medication was dispensed. (p<0.005). CONCLUSION: The NICE guidelines on COPD encourage community pharmacists to carry out smoking cessation and educational interventions, but further support is needed.

Potential population impact of changes in heroin treatment and smoking prevalence rates: using Population Impact Measures.

BACKGROUND: The drug misuse and asthma are major health problems in urban settings. There are effective interventions to reduce cigarette smoking and also to treat heroin use; in the context of European System of Urban Health Indicators Project (EURO-URHIS), we explored the use of Population Impact Measures (PIMs) to describe the potential for increase in methadone use and reduction in cigarette smoking to reduce deaths -from heroin use- and asthma events in examples of urban populations. METHODS: The two PIMs calculated here are the Number of Events Prevented in your Population (NEPP) and the Population Impact Number of Eliminating (or reducing the prevalence of) a Risk Factor (PIN-ER-t). RESULTS: Increasing methadone treatment uptake from its current levels to 90% would prevent 21 (95% CI: 11-34) deaths in Manchester City, 218 (95% CI: 114-339) in Greater London and overall 1 243 (95% CI: 641-1953) in England in 1 year. In males 2 (95% CI: -22 to 28), 27 (95% CI: -296 to 363) and 170 (95% CI: -1757 to 2186) and in females 36 (95% CI: 6-70), 0 and 2312 (95% CI: 934-3783) fewer asthma cases per year would have been expected in Manchester City, Greater London and overall in England respectively, if the smoking prevalence is reduced from current levels to 20% in both sexes. CONCLUSIONS: PIMs provide estimates of absolute risk and benefit to a total population, of potential use to policy-makers since current practice and intervention goals are taken into account.

Capacity-building for public health: http://peoples-uni.org.

The development of educational context around free and open-source materials available on the Internet has the ability to help build public health capacity in low- to middle-income countries. Inspiration to develop such a programme comes from the free and open-source software movement, where many hundreds of individuals have collaborated in the development of high-quality software freely available on the Internet, and its education counterpart of Open Educational Resource development. These reflect societal developments, especially those associated with Web 2.0. In a partnership across the global and digital divides, the People's Open Access Education Initiative (http://peoples-uni.org) has been established to embrace three aspects. First, identifying open-access materials linked to the competences required to tackle public health problems, with subsequent modifications to the materials by teachers and students to reflect local issues. Second, teaching through online facilitation by volunteers in conjunction with members of local universities. Third, accrediting learned competences. Situation analyses already performed suggest that the need for this education is great and that this solution may be feasible in many countries. Several partners have already agreed to be involved and exemplar course modules are being prepared. We call for volunteers to help take this initiative further.