Adaptation of the Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire: Turkish version.

OBJECTIVE: Many checklists and scales have been developed to diagnose the autism spectrum disorder in childhood. However, self-applied questionnaires/scales that can be filled out by health professionals for assessing their knowledge and consciousness of this disorder are still limited. The Knowledge about Childhood Autism among Health Workers self-administered survey was developed by Bakare et al. in 2008. This survey was recruited by many study groups in developing countries. In these countries, knowledge regarding childhood autism is inadequate within community healthcare professionals. METHODS: In our study, the agreed-upon Turkish version of the questionnaire was distributed to the 61 primary care physicians working in Maltepe District of Istanbul Province for the adaptation and validation. RESULTS: The internal consistency coefficient (Kuder-Richarson coefficient of reliability-KR20) of the measurements attained from the Turkish version of the questionnaire was 0.70. The split- half reliability analysis demonstrated that the Guttman Split-half value was 0.84. According to the principal factor analysis of the tetrachoric correlation matrix, the three factors with the highest Eigenvalues were associated with (i) Relatively easy clinical observations, (ii) the signs which require a longer observation time and detailed anamnesis, and (iii) the signs, which require detailed examination and observation. The factors explained cumulatively 65.98% of the total variance. CONCLUSION: The findings obtained in this study showed that the adapted questionnaire addressed in the scope of this study is a valid measure for Turkish society.

A qualitative study of hand hygiene compliance among health care workers in intensive care units.

INTRODUCTION: Studies indicate that adherence to hand hygiene guidelines is at suboptimal levels. We aimed to explore the reasons for poor hand hygiene compliance. METHODOLOGY: A qualitative study based on the Theory of Planned Behavior as a framework in explaining compliance, consisting four focus group discussions and six in-depth interviews. RESULTS: Participants mostly practiced hand hygiene depending on the sense of "dirtiness" and "cleanliness". Some of the participants indicated that on-job training delivered by the infection control team changed their perception of "emotionally" based hand hygiene to "indication" based. Direct observations and individual feedback on one-to-one basis were the core of this training. There was low social cohesiveness and a deep polarization between the professional groups that led one group accusing the other for not being compliant. CONCLUSIONS: The infection control team should continue delivering one-to-one trainings based on observation and immediate feedback. But there is need to base this training model on a structured behavioral modification program and test its efficacy through a quasi-experimental design. Increasing social cohesiveness and transforming the blaming culture to a collaborative safety culture is also crucial to improve compliance. High workload, problems related to work-flow and turnover should be addressed.

Knowledge and approaches of married men applying to a primary healthcare center in Istanbul about IUD: A qualitative study.

OBJECTIVE: This study aims to determine the knowledge and approach of men applying to a primary health care center about IUD by adopting qualitative research methods. METHODS: This study was qualitative research realized using an in-depth interview method. The interview was carried with 15 married men in a primary health care center in Umraniye, using 15 semi-structured interview questions. RESULTS: Knowledge of the men in this study about IUD and family planning was inadequate. Participants generally determined the advantages of IUD with its superiority over other methods. Adverse effects of IUD on women and men during intercourse were stated. Knowledge of men about IUD, its side effects and disadvantages were generally composed of misinformation and rumours about the subject. CONCLUSION: Men do not have adequate information and knowledge on family planning and IUD. Training provided by the health personnel might have a considerable role in demolishing misinformation and rumors and may augment the level of knowledge about IUD.

Expectations, requirements, and problems of family health care workers providing home services in Turkey.

Life expectancy is increasing globally with the increase of aging populations. Care-dependent elderly and those with chronic illnesses and disabilities are increasing in numbers. Hospitalization to manage these problems lead to a heavy economic burden. Thus, the demand for home health care is rising causing a heavy workload for home workers. This study was aimed to assess problems of personnel engaged in providing home care. Data was colllected from 120 family physicians and nurses/midwives from 25 clinics. The results showed that most visits were provided for postnatal controls (69%), with only 13% provided for the elderly and disabled people despite high demands (for the elderly 73%; for those with disabilities 66%). Additionally, factors affecting workers emotionally in visits were evaluated. Difficulties and suggestions of home care workers should be considered that the quality of health care depends on the satisfaction of the care professionals as well as that of patients.

The awareness of childhood autism among residents of neuropsychiatric and other disciplines of a research and training hospital in Istanbul, Turkey.

OBJECTIVE: To assess the awareness of childhood autism among physicians undergoing residency training in various disciplines. METHODS: This cross-sectional study was conducted at a research and training hospital in Istanbul, Turkey, in February 2013 and comprised physicians undergoing residency training in various disciplines. Data was collected through a self-administered questionnaire. Questions about "awareness on autism" were prepared in the light of "Knowledge about Childhood Autism among Health Workers questionnaire. RESULTS: Of the 128 physicians, 122(95.3%) were aware that the most known characteristic of childhood autism was "failure to build-up friendship". All of the 29(22.66%) physicians at the neuropsychiatric disciplines were aware that "autism can be a genetic disorder", whereas, in other disciplines 69(69.7) physicians had that awareness. Besides, 15(51.7%) of the residents of the neuropsychiatric disciplines thought that "autism can be associated with childhood epilepsy", while 32(32.3%) physicians of other disciplines gave a similar answer (p=0.057). CONCLUSIONS: The awareness on childhood autism of residents belonging to the non- neuropsychiatric disciplines was moderate.

Orthorexia nervosa tendency among students of the department of nutrition and dietetics at a university in Istanbul.

OBJECTIVE: The aim of this study was to determine an orthorexia nervosa scale score for and evaluate orthorexic tendency among students of nutrition and dietetics according to various sociodemographic characteristics. METHODS: This cross-sectional study was carried out in May and June of 2016 among 208 students in the nutrition and dietetics department at a university in Istanbul. After receiving the approval of the university ethics committee, of a total of 300 students, 208 agreed to join the study. Participants completed a questionnaire related to individual characteristics and the ORTO-11 scale during a face-to-face interview. The ORTO-11 scale is a verified Turkish scoring system in which a low score indicates orthorexic tendency. The Mann-Whitney U test, independent samples t-test, Kruskal-Wallis test, and analysis of variance were used to assess the data. P<0.05 was accepted as statistically significant. RESULTS: Orthorexic tendency was significantly higher in males (p=0.050) and students who lived with their family (p=0.002). Mean ORTHO-11 scale score did not differ significantly between groups when the participants were grouped by parameters of smoking, alcohol consumption, chronic disease status, body mass index, diet observance, or use of nutritional supplement products. CONCLUSION: The orthorexic tendency was higher in men and in students who lived with their family. Additional assessment of individual eating habits, eating behavior, and personality characteristics would shed light on the reasons for the difference between gender groups. Qualitative studies should be carried out and possible confounding factors should be determined.

The pharmacists' awareness, knowledge and attitude about childhood autism in Istanbul.

Background Being one of the key players in healthcare, pharmacists could have an important role in the early detection and care of children with autism, by familiarizing themselves with autism-related resources and helping families to find relevant professional resources. Objective The purpose of this study was to determine the awareness of pharmacists about autism, and their knowledge and attitude towards autism. Setting Istanbul Province of Turkey. Method This descriptive study was carried out in pharmacists working in Istanbul Province of Turkey in 7 municipalities out of 39. One hundred forty-one out of 150 pharmacists who agreed to participate in our study were interviewed with the help of questionnaires. Main outcome measure Knowledge about childhood ASD and the social characteristics thereoff amongst pharmacists. Results Minimum 33.4 and maximum 73.1 % of the pharmacists gave correct answers to each question. Furthermore pharmacists' knowledge about causative factors of childhood ASD proved to be lacking and they tend to believe in outdated theories. The percentage of pharmacists believing that autism holds social stigma in this community was 66.0 %. Conclusion Pharmacists' knowledge regarding ASD needs to be improved. Enhancing their awareness, especially about basic social characteristics of childhood ASD will help pharmacists direct families of children with ASD to responsible health authorities.

School Board Policies on Prevention and Management of Anaphylaxis in Istanbul: Where Do We Stand?

BACKGROUND: Allergic diseases with a potential for anaphylaxis pose a critical public health issue in schools. AIMS: This study was carried out to identify the current status of prevention and management of anaphylaxis in school children with the main goal of establishing such an action plan. STUDY DESIGN: Cross-sectional study. METHODS: Schools were randomly selected from 11 different regions of Istanbul. A questionnaire was filled out by 2596 teachers/school principals from 232 public schools. RESULTS: A school safety committee was absent in 80% of elementary schools (ES) and 60.8% of preschools (PS). Although some form of health recording system was available in many schools, no such system was available in 24.5% of ESs and 10% of PSs. A specific inquiry for detecting children with food allergies was a routine practice in only 4% of ES and 10% of PS. Approximately 27% of teachers stated that monitoring children in school places was not possible at all times. Eighty four percent stated that no written anaphylaxis treatment protocol was available in their school and only around 2.3% in ES and 3.1% in PS stated that they would perform an epinephrine injection in the event of anaphylaxis. CONCLUSION: Our survey demonstrated critical gaps in the organization of schools for the management of children at risk of anaphylaxis. Data derived from this study would provide the initiative for legislators to review the current situation of school health policies along with the relevant authorities to establish school anaphylaxis guidelines.

A study exploring the autism awareness of first grade nursing and medical students in Istanbul, Turkey.

OBJECTIVE: To assess the level of awareness about childhood autism among first-grade nursing and medical students. METHODS: The descriptive study was conducted at Marmara University, Istanbul, Turkey, in December 2012, and comprised first-grade nursing and medical students. Data was collected using a self-administered questionnaire. Association between categorical variables was determined and p<0.05 was considered statistically significant. RESULTS: Of the 175 students, 138(78.9%) were aware of autism, 14(8%) of them being highly aware and 124(70.9%) moderately aware, whereas 37(21.1%) were not aware. There was a significant difference in the awareness level as far as gender was concerned as 102(82.9%) females and 36(69.2%) males were aware (p=0.043). Moreover, 104(59.4%) participants were aware that autism was a neurodevelopmental disorder, 62(67.4%) of them being nursing and 42(50.6%) being medical students (p<0.05). CONCLUSIONS: First-grade medical and nursing students could be considered relatively well aware of autism as their awareness level was in between that of the general public and healthcare professionals.

A study exploring knowledge, attitudes and behaviours towards autism among adults applying to a Family Health Center in Istanbul.

OBJECTIVE: The aim of this study was to assess knowledge, awareness, behavior and attitudes towards autism among applicants to a Family Health Center (FHC). METHODS: This descriptive study was performed at a Family Health Center (FHC) in Istanbul in August 2013. Data was obtained via face-to-face interviews with participants older than 18 years who were admitted to the FHC. The questionnaire consisted of questions on sociodemographic characteristics, applicants' knowledge of autism and their approach to autism. RESULTS: 160 applicants participated in our survey of which 38.8% had heard the word 'autism'. Knowledge and awareness of autism, and attitudes and behaviours towards this disorder differed significantly with the educational level of the study participants (p<0.05) However, these parameters did not change with gender and income level of the participants (p>0.05). CONCLUSION: The most important outcome of our study is that awareness, or even having knowledge of the word autism is significant in breaking down stereotypes. Despite the low level of awareness of the disease, the majority of the participitants had a positive attitude towards autism.

Knowledge, attitudes and behaviors of women over 20 years old on cervix cancer in Istanbul, Turkey.

PURPOSE: The aim of the study was to evaluate knowledge, attitudes and behaviors of Turkish women over 20 years old on cervix cancer. MATERIALS AND METHODS: This descriptive study was performed at a primary care center covering 246 women using a questionnaire composed of 3 sections and 38 questions. The data were analyzed using descriptive statistics, chi-square test in univariate analysis and multivariate hierarchical logistic regression analysis. RESULTS: Of the 93.7% women who knew about cervical cancer, 68.0% of them had heard pap smear test and 46.1% had actually undergone a Pap smear once or more throughout their lives. According to the results of the hierarchical logistic regression analysis about factors affecting the Pap smear test; in Model 1, increase in age and education levels, in Model 2 and Model 3 increase in age and cervical cancer information points were determined. The most important information source for cervical cancer was TV-radio/media (59.9%) and health care workers (62.8%) for pap smear test. CONCLUSIONS: Although most women have heard of cervical cancer, knowledge about cervical cancer and also Pap smear screening rate are significantly lower. Having Pap smear test for women was affected by age and knowledge level about cervical cancer. Informing women about cervical cancer would be an important intervention.

Knowledge, attitudes and beliefs of Turkish women towards blood donation.

OBJECTIVES: To understand the knowledge, attitudes and beliefs of women towards blood donation and to help healthcare workers to plan steps to increase blood donation rates. METHODS: The qualitative study was conducted between January to May 2013 in two densely-populated districts of Istanbul, Turkey that are inhabited mostly by socio-economically disadvantaged people from different parts of the country. The area also serves as the Research and Training Area of the Marmara University. RESULTS: There were 57 women subjects in the study with an age range of 18-65 years. There were positive attitudes towards blood donation although none of the women in our sample had donated blood before. All the participants (100%) thought that men could donate blood, but it was not favourable for the women since they were "already losing blood through menstruation". The circumstances surrounding women, such as being too busy and overloaded with caring of the family, belief of impurity of female blood, suspicion of having unhealthy blood, rumours, misbeliefs and negative experiences, anxiety about the procedure (fear of needle, fear of syncope), and distrust of blood banks were the other reported barriers. CONCLUSION: Understanding the factors that motivate donors and presenting issues like rumours, misbeliefs and negative experiences will facilitate improvement in blood banks and eventually help increase the donation rates.

A Qualitative Study on Factors that Influence Turkish Medical Students' Decisions to Become Family Physicians After the Health Transformation Programme.

BACKGROUND: In Turkey, general practitioners were authorized to work as family physicians without specialization, within the scope of the Health Transformation Programme, due to inadequate number of family medicine specialists since 2004. With this new implementation Family Medicine specialty became a less preferable option for medical students. AIMS: The study was to investigate the perspectives of medical students and understand the issues to choose Family Medicine specialty as a career option. MATERIALS AND METHODS: This qualitative study was performed with 48 final year medical students using a convenience sample from two medical universities. RESULTS: Three main categories emerged from the data viewing Family Medicine 'as a specialty', 'as an employment', and finally 'as a system'. Very few students stated that Family Medicine would be their choice for specialty. CONCLUSIONS: Family Medicine does not seem to be an attractive option in career planning by medical students. Several factors that may constrain students from choosing Family Medicine include: not perceiving Family Medicine as a field of expertise, and the adverse conditions at work which may originate from duality in the system.

Knowledge of oral cancer, preventive attitudes, and behaviors of primary care physicians in Turkey.

Oral cancers (OCs) have a high mortality rate because of their typically late diagnosis. Primary care physicians play a vital role in early detection. In this study, we evaluated the family physicians' (FPs) knowledge, preventive attitudes, and behaviors in terms of OCs. A semistructured questionnaire consisting of 50 questions was prepared and distributed to 200 FPs. Questions were grouped under four main headings: demographic characteristics, general protective attitudes against OCs, risk factors, and daily practices while performing the necessary examinations and referrals. Of 200 FPs, 164 responded to the questionnaire (82% response rate). The mean age of the study participants was 34.8 ± 8.4 years and the mean duration of practice was 10 ± 8.1 years. One-third of the physicians (29.9%, n=49) stated that they did not inquire about the amount of tobacco use. In terms of alcohol use, 45.7% (n=75) and 56.7% (n=93) did not ask about past alcohol consumption or the amount of alcohol consumed, respectively. Moreover, 69.5% (n=114) believed that they did not receive adequate smoking cessation training and 79.9% (n=131) stated that they did not receive any alcohol cessation training. To decrease morbidity and mortality associated with OCs, primary care physicians should be trained to ask their patients about high-risk behaviors, provide counseling and education on tobacco and alcohol-abuse cessation, and provide oral examinations.

A qualitative study on menopause described from the man's perspective.

OBJECTIVE: To look at menopause from men's point of view and to provide a better understanding of this phase to improve the care delivered to menopausal women. METHODS: The study was conducted at the health centre of a single district of Istanbul, from April 2013 to June 2013, which serves as the research and training area of the Marmara University and which receives migrations from mainly southern and eastern regions of Turkey.The study sample included 33 married men. Qualitative in-depth interviews were performed individually and main themes were noted down for analysis. RESULTS: The age range of the study population was 40-77 years. The subjects lacked basic knowledge about both menstruation and menopause. Most of the participants defined menopause as loss of fecundity, increased weight, and loss of beauty.The most important concern voiced was men's own sexual life. None of the men had heard about treatment modalities available for menopause. CONCLUSION: Interventions are needed to increase men's awareness regarding menopause in order to help these men to be able to better support their spouses so that they can both have a smooth transition into postmenopausal years.

A survey of energy-drink consumption among medical students.

OBJECTIVE: To determine the frequency and pattern of energy drink consumption among medical school students, their knowledge of its effects and side effects and to see its relation with alcohol and cigarette usage. METHOD: The descriptive analytical study was conducted at Marmara University Medical School, Istanbul, Turkey from October 2011 and January 2012. A semi-structured questionnaire was filled by students who were asked about their socio-demographic status and their energy drink consumption. SPSS 12 was used for statistical analysis. RESULTS: The mean age of the 390 students in the study was 20.98+/-1.96 years (range:16-27). Of them, 204 (52.3%) were females and 186 (47.7%) were males. Overall 52(13.3%) were smoking regularly at least one cigarette per day; 122(31.3%) were consuming alcohol; 127 (32.6%) had consumed energy drinks at least once and 73(18.8%)more than once. In terms of perception, 110(28.2%) students said energy drinks were similar to sports drinks, while only 121(41.1%) named the brands correctly; 96 (24.6%) students did not answer this particular question. CONCLUSION: Although consumption of energy drinks was common among medical students, the knowledge of ingredients and knowledge of health risks of energy drinks among them was unsatisfactory.

[Investigation of toxin genes of Clostridium difficile strains isolated from hospitalized patients with diarrhoea at Marmara University Hospital]. / Marmara Üniversitesi Hastanesinde Yatan Ishalli Hastalardan Izole Edilen Clostridium difficile Kökenlerinde Toksin Genlerinin Arastirilmasi

Toxigenic Clostridium difficile strains cause a spectrum of antibiotic-associated diseases ranging from self-limited diarrhea to severe life-threatening colitis. Pathogenesis primarily involves the action of two important cytotoxins, namely toxin A and toxin B. However, epidemics of C.difficile-associated disease due to the novel, highly virulent strains of C.difficile (binary toxin positive and toxin A variant) have been recognised in hospitals of some countries. The aim of this study was to investigate the toxin gene profiles of C.difficile strains isolated from hospitalized patients with diarrhea. The stool specimens collected from 633 inpatients at Marmara University Hospital, Istanbul, Turkey, between September 2006-March 2008, were included to the study. The presence of C.difficile toxins in the samples has been screened by a commercial enzyme immunoassay kit (ImmunoCard Toxins A&B EIA; Meridian Diagnostics, Belgium). Stool samples were also cultivated on cycloserin-cefoxitin-fructose agar (CCFA; BioMerieux, France) at anaerobic conditions, and the isolates were identified by conventional methods and Rapid ID 32A (BioMerieux, France) system. Toxin production of C.difficile strains isolated from stool cultures have been detected by commercially available "Triage C.difficile Panel" (Biosite Diagnostics, Italy) and "ImmunoCard Toxins A&B EIA" (Meridian Diagnostics, Belgium) kits. In-house polymerase chain reaction (PCR) was performed to investigate the presence of genes for toxin A (tcdA), toxin B (tcdB) and binary toxin (cdtA and cdtB). Stool specimens from 50 (7.9%) patients (age range: 2-> 65 years; mean age: 35.9 ± 27.6 years; 26 were male) yielded C.difficile in culture. All of 50 isolates were found positive for glutamate dehydrogenase enzyme and 28 (56%) were found positive for toxin A with "Triage C.difficile Panel" kit. Toxin positivity rate was detected as 4.7% (30/633) with EIA test performed in stool samples directly, however this rate was 5.7% (36/633) in culture filtrates of the isolates (n= 50), with the same test. Since EIA test yielded false negative results in six samples, the sensitivity of this test was estimated as 85.7% by means of the detection of toxin in direct stool samples. All of the 36 toxin-producing C.difficile isolates were found positive for toxin A and toxin B genes (tcdA+/tcdB+), however there were neither variant strains (tcdA-/tcdB+) nor binary toxin gene positive isolates among tested bacteria. Our results have also indicated that 77.8% (28/36) of patients who harbored toxigenic C.difficile strains have the history of beta-lactam antibiotic (penicillin, cephalosporin and imipenem) use. It was thought that the data of this study would constitute a database on the toxin gene profiles of C.difficile in hospitalized patients with diarrhea both in our hospital and Turkey. The current data have indicated that for the time being there were no risk for isolates producing new toxin variants or binary toxin, however, continuous monitorization of such C.difficile strains is of crucial importance in order to detect the emergence of those strains and establish necessary control and preventive measures.

Resistance to vaccination: the attitudes and practices of primary healthcare workers confronting the H1N1 pandemic.

During the H1N1 pandemic, most healthcare workers in Turkey were not willing to take up the vaccine. This qualitative study aims to explore the factors that lead to vaccination resistance among a group of primary healthcare workers in Istanbul. Data were collected through focus group discussions. Thematic content analysis was conducted. All participants considered themselves at risk for infection, yet most of them were not vaccinated. Only persons with a "poor" immune system were considered by the respondents at risk for severe disease and death. Health personnel mostly did not realize their potential role in the transmission of influenza to patients. The decision of vaccination was dependent on the information source. The personnel who depended mainly on the media either did not accept vaccination or was undecided. They believed that the vaccine went through an accelerated authorization procedure. Yet the ones who accepted vaccination relied mostly on evidence-based sources and accessed information from the guidelines of the Ministry of Health, Professional Medical Associations and the World Health Organization. Social networks were also influential factors in the decision-making process. It is important to empower healthcare workers through supporting the skills of acquiring and using evidence-based information. This is particularly important for physicians who also serve as opinion leaders.

The prevalence of headache and its association with socioeconomic status among schoolchildren in istanbul, Turkey.

OBJECTIVE: The etiology and pathogenesis of migraine and other types of headache are still under discussion. An interaction of organic, psychological, and psychosocial factors is operative. In this study, we aimed to determine the prevalence of headache and its association with socioeconomic status among schoolchildren. STUDY DESIGN: A cross-sectional study was performed on 2669 schoolchildren via a parental questionnaire. Socioeconomic status was determined according to the Turkish socioeconomic status scale. RESULTS: The mean age of the students was 8.2 +/- 2.4 years. The headache prevalence was 46.2% (95% CI: 44.3-48.1). The prevalence of migraine was 3.4% (95% CI: 2.8-4.1), the prevalence of probable migraine was 8.7% (95% CI: 7.6-9.8), and that of non-migraine headache was 34.1% (95% CI: 32.3-35.9). Multivariate analysis revealed that older age, being a girl, having a family history of headache, and exposure to passive smoking at home were independently associated with headache. There was an inverse association between socioeconomic status and all 3 types of headaches after adjusting for age, sex, family history of headache, and presence of passive smoking. When the group with the lowest socioeconomic status was taken as the reference category, the odds ratios for the highest socioeconomic group were 0.33 (95% CI: 0.16-0.69, P = .003) for the migraine, 0.30 (95% CI: 0.11-0.89, P = .029) for the probable migraine, and 0.34 (95% CI: 0.16-0.72, P = 0.005) for the non-migraine headache. CONCLUSION: Headache is more common among children with lower socioeconomic groups. Social causation can play a role in the pathogenesis of headache.