Prevalence and Clinical Features of Idiopathic Parkinson's Disease in Western Turkey.

Introduction: We aimed to determine the prevalence and risk factors of idiopathic Parkinson's disease (IPD) in Western Turkey, which encompasses Edirne and its surrounding districts. Methods: In this study, 9887 individuals, able to communicate and agreed to participate in the study, were evaluated. The data was obtained by answering a face-to-face questionnaire consisting of 53 questions from volunteers living at 30 randomly selected family health centers in Edirne and its counties. The questionnaire included demographic information, questions to evaluate potential concomitant conditions, and questions regarding the symptomatology used in IPD diagnosis. Following the questionnaire, it was planned to determine the degree of IPD with the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr scale (HY) clinical rating scale in patients diagnosed with IPD to assess disease severity in patients diagnosed with IPD. Results: Of the 9887 individuals, 118 were diagnosed with IPD according to the questionnaire results from Edirne and its districts, and the prevalence of IPD was 1.2%. Approximately, 58.4% of the patients with IPD were male and 41.6% were female, which was not significantly different (p=0.214). Non-motor symptoms such as difficulty urinating, anxiety, depression, fatigue, REM sleep behavior disorder, and difficulty falling asleep or staying asleep were also examined in patients diagnosed with IPD. Depression was identified in 45.7% of the cases, while the control group was 4.3% (p=0.001). Fatigue was identified in 46.8% of the cases and control group was 3.5% (p=0.002). Conclusions: IPD prevalence studies will increase the awareness in the community and provide early diagnosis and treatment as well as serve as a basis to increased life expectancy, reduce morbidity, and improve life quality.

The prevalence of essential tremor in Edirne and its counties accompanied comorbid conditions.

Objective: We aimed to determine the prevalence and risk factors of Essential Tremor (ET) in Edirne and its districts, located in Western Thrace, which is the most western part of Turkey. Methods: In this study, 3008 individuals who could communicate and agreed to participate in the study were evaluated. To obtain the data from the applicants in 30 Family Health Centres in Edirne and its districts, a face-to-face questionnaire that consisted of 37 questions was prepared by the researchers. The questionnaire included general information, questions to evaluate potential concomitant comorbid conditions and questions regarding the symptomatology used in ET diagnosis, as well as questions to evaluate ET severity, was examined with the spiral test. Patients were classified by using the Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) diagnostic and clinical evaluation scale. According to the diagnostic criteria for ET (used in participants who were examined and in those whose medical records were reviewed) were similar to those used in astudy conducted in Turkey. Results: Of 3008 individuals, 173 were diagnosed with ET according to the questionnaire results from Edirne and its districts, and the prevalence of ET was 5.8%. Approximately, 43.4% of the patients with ET were male, and 56.6% were female, which was not significantly different (p > 0.05). Participants with tremor related to alcohol withdrawal, hyperthyroidism, anxiety, depression other known causes of tremor were not considered to have ET. Thyroid disease was identified in 0.0% of the cases, and the control group was detected in 1.4%, which was not significantly different (p = 0.170). Psychiatric disease was identified in 0.0% of the cases, and the control group was detected in 1.3%, which was not significantly different (p = 0.271). Conclusions: ET prevalence studies will increase the awareness of the community and provide early diagnosis and treatment, as well as serve as a basis to reduce morbidity and improve the quality of life.

The prevalence of restless legs syndrome in Edirne and its districts concomitant comorbid conditions and secondary complications.

We aimed to determine the prevalence and risk factors of restless legs syndrome in Edirne and its districts, located in Western Thrace, which is the most western part of Turkey. In this study, 4003 individuals who could communicate and agreed to participate in the study were evaluated. To obtain the data from the applicants in 30 Family Health Centres in Edirne and its districts, a face-to-face questionnaire that consisted of 54 questions was prepared by the researchers. The questionnaire included general information, questions to evaluate potential concomitant comorbid conditions and questions regarding the symptomatology used in restless legs syndrome (RLS) diagnosis, as well as questions to evaluate insomnia and tension-type headache secondary to insomnia according to the ICD-II Criteria (International Classification of Sleep Disorders-II Criteria). Of 4003 individuals, 282 were diagnosed with RLS according to the questionnaire results from Edirne and its districts, and the prevalence of RLS was 7%. Approximately, 47.9% of the patients with RLS were male, and 52.1% were female, which was not significantly different (p > 0.05). Anaemia was identified in 41.1 % of the cases and control group was detected in 19.4 %, which was significantly different (p < 0.001). Secondary insomnia was identified in 64.2% of the cases with RLS and was not detected in 35.8%, which was significantly different (p < 0.001). RLS prevalence studies will increase the awareness of the community and provide early diagnosis and treatment, as well as serve as a basis to reduce morbidity and improve the quality of life.

Migraine headaches among university students using ID Migraine test as a screening tool.

BACKGROUND: Migraine is a significant health problem, especially for the young people, due to its frequency and accompanying morbidity, causing disability and loss of performance. In this study, our aim was to determine the prevalence of migraine headaches among university students in Edirne, a Turkish city. METHODS: In this cross-sectional and descriptive study, study population was composed of students registered to Trakya University in the academic year of 2008-2009. Out of these, 3694 of them accepted to participate. Participants who had two or more headaches in the last 3 months formed the headache group. Afterwards, two preliminary questions were applied to the headache group and participants with at least one affirmative response were asked to perform the validated ID-Migraine™ test. RESULTS: The mean age of 3694 students participated in the study was 19.23 ± 1.84 (17-39 years), with adolescents:adult ratio being 2.5:1. 1613 students (43.7%) did have at least two headaches in the last three months. Migraine-type headache was detected in 266 subjects (7.2%) based on the ID-Migraine™ test. Of the migraine group, 72 were male (27.1%) and 194 were female (72.9%). There was no significant difference in migraine prevalence between adolescent and adult age groups. CONCLUSIONS: With a prevalence similar to adults, primary care physicians should be aware of the probability of migraine headaches in university students in order to maintain a successful school performance.

Dealing with uncertainty in general practice: an essential skill for the general practitioner.

Many patients attending general practice do not have an obvious diagnosis at presentation. Skills to deal with uncertainty are particularly important in general practice as undifferentiated and unorganised problems are a common challenge for general practitioners (GPs). This paper describes the management of uncertainty as an essential skill which should be included in educational programmes for both trainee and established GPs. Philosophers, psychologists and sociologists use different approaches to the conceptualisation of managing uncertainty. The literature on dealing with uncertainty focuses largely on identifying relevant evidence and decision making. Existing models of the consultation should be improved in order to understand consultations involving uncertainty. An alternative approach focusing on shared decision making and understanding the consultation from the patient's perspective is suggested. A good doctor-patient relationship is vital, creating trust and mutual respect, developed over time with good communication skills. Evidence-based medicine should be used, including discussion of probabilities where available. Trainers need to be aware of their own use of heuristics as they act as role models for trainees. Expression of feelings by trainees should be encouraged and acknowledged by trainers as a useful tool in dealing with uncertainty. Skills to deal with uncertainty should be regarded as quality improvement tools and included in educational programmes involving both trainee and established GPs.

Residents' views about family medicine specialty education in Turkey.

BACKGROUND: Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. METHODS: This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27) and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11) by e-mail and by personal contact. RESULTS: A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%). Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e-learning. Participation in courses and congresses was considered necessary. The presence of a department office and the clinical competency of the educators were more favored by state residents. CONCLUSIONS: This study gave the Board the chance to determine the needs of the residents that had not been taken into consideration sufficiently before. The length and the content of the programme will be revised according to the needs of the residents.

Sexual activity among Turkish adolescents: once more the distinguished male.

UNLABELLED: The mean age of first sexual intercourse in Western countries is around 17 years and decreasing. Although Turkey is a bridge between East and West, embracing different cultures, little data are available on sexual issues in the population. METHODS: A questionnaire was administered to all students in the study year 2004-2005, collecting demographic data, sexual activities, sexual and contraceptive attitudes, and contraceptive knowledge. Of 7,657 applicants invited, 3,970 questionnaires could be analyzed. RESULTS: Median age of the participants was 18 years (48.0% female, 52% male). Median age at first sexual intercourse was 17 years for females and 16 years for males. 46.5% of the males and 3.0% of the females had sexual intercourse experience. While 68% of the girls had their first sexual intercourse with their lovers, this ratio was 44.8 % for males (Chi square = 59.963, p <.001). Significantly more girls than boys were planning to have their sexual partner as future spouses (Chi square = 55.569, p <.001). Three fourth of the males approved premarital sex for males; this ratio was reversed for females (Chi square = 574.838, p <.001). Although both sexes disapproved premarital sexual intercourse of women, girls were significantly more conservative in this regard (78.6% vs. 92.5%) (Chi square = 110.460, p <.001). CONCLUSION: Although the adolescent sexual intercourse rate in Turkey is low compared with Western countries, there is a tendency to increase. Therefore, sexual education is needed. When augmenting sexual education programs in undergraduate education, gender difference and cultural factors should be further evaluated.

Habitual tea drinking and bone mineral density in postmenopausal Turkish women: investigation of prevalence of postmenopausal osteoporosis in Turkey (IPPOT Study).

AIM: In this epidemiological report, we assessed the prevalence of osteopenia and osteoporosis (OP) in postmenopausal Turkish women and the relationship between body mass index (BMI), and some nutritional factors (habitual tea, coffee, tobacco, and milk product consumption) with OP. METHODS: This multicenter study was done in postmenopausal women residing in five big cities, in four different regions of Turkey between August and November 2005. An inclusion criterion was being in the postmenopausal period for at least 12 months. A semi-structured questionnaire was completed by face-to-face interview, consisting of closed- and open-ended questions about demographic characteristics, nutritional status, and habits with two or more choices as possible responses. Bone mineral density (BMD) measurements were performed with a MetriScan Densitometer (Alara Inc., CA, USA). RESULTS: Seven hundred twenty-four women were included in the study. The mean age was 57.6 +/- 9.6 years, and mean age at natural menopause was 46.4 +/- 5.6 years. Of the participants, 51% were illiterate. According to WHO classification; 42.5% were normal in terms of BMD, 27.2% had osteopenia, and 30.2% had OP. Women with high education levels had better T-scores (p = 0.019). Increase in BMI also had a positive effect on T-scores (p < 0.0001). A linear correlation was found between age (r= -0.386, p < 0.0001), BMI (r = -0.175, p < 0.0001), and education (r = -0.317, p < 0.0001), with T-scores. The T-scores of women who consumed tea on a regular basis were found to be higher than non-consumers (-1.51 +/- 1.68 vs. -1.09 +/- 1.66; p = 0.070) [when smokers, those who received hormonal therapy (HT), and those > 65 years were excluded]. CONCLUSION: OP was determined in 1/3 of the women. Advanced age (> 65) and being illiterate were negative factors, while high education levels, being overweight, and being treated with HT had a positive effects on BMD. Habitual tea drinking also may have a positive effect on BMD. However, tea drinking was not found to be a statistically significant factor in the present study.

An evaluation of patient satisfaction in Turkey with the EUROPEP instrument.

Seeking to understand patient perspectives is an important step in the efforts to improve the quality of health care. Developed by the EQuiP Task Force on Patient Evaluations of General Practice Care, the EUROPEP instrument aims to collect information on patient evaluations of general practice care. In order to expose the current state of patient satisfaction and make international comparisons, a study was conducted with relevant data collected from Turkey. The Turkish version of the EUROPEP instrument was administered to 1160 patients in six different Turkish cities. Thirty-three medical practices were included in the study. In every practice, a minimum of 30 adult patients who visited the practice for a consultation were consecutively included. The results were compared with previous values from European countries. "Helping you understand the importance of following his or her advice", "Getting through to the practice on the telephone", and "Providing quick services for urgent health problems" were evaluated best (76.7%, 76.3%, and 76.2%, 'good or excellent' ratings, respectively) and "Helping to deal with emotional problems related to the health status" was rated the worst (60.2%, 'good or excellent'). Other areas which had low ratings were: "Waiting time in the waiting room" (63.0%), "Quick relief of symptoms" (61.3%), and "Involving patients in decisions about medical care" (61.3%). Patient evaluations can help to educate medical staff about their achievements as well as their failures, assisting them to be more responsive to their patients' needs. In order to get the best benefit from EUROPEP, national benchmarking should be started to enable national and international comparisons.

Use of quality circles among first year medical students and impact on student satisfaction.

Quality circles in the classroom setting are composed of students who meet regularly to identify, analyse and solve problems related to a course, and implement solutions. We recently instituted quality circles (QCs) among preclinical medical students and evaluated their impact on quality of learning and student satisfaction. Included in the study were all 135 first-year medical students of Trakya University School of Medicine in the 2000-2001 academic year. Six students were selected randomly out of 26 volunteers as circle members. Circle participants met once a week for 14 45-minute sessions to discuss educational issues, propose solutions and prepare a report for submission to the dean. A questionnaire was administered to all first-year students and the replies provided the problem pool from which the QC chose the problem to be addressed. A total of 22 problems concerned education and 28 were identified in the fields of accommodation, social activities and other issues. To evaluate the change in the perceived quality of learning, circle members prepared a questionnaire designed to compare satisfaction at the beginning and end of the study period. This questionnaire was composed of 26 items and evaluated various aspects of education. There was a significant increase in student satisfaction after the one-year study period (p = 0.001). In addition to enhancing quality of learning, quality circles improved student satisfaction as well. More studies should be conducted to test the impact of QCs on education in different settings and different classes. Our results show that the use of quality circles in first-year medical students improves quality of learning and student satisfaction.