Cross-cultural adaptation, reliability, and validity of the Turkish version of the obesity-specific quality of life questionnaire: quality of life, obesity, and dietetics (QOLOD) rating scale

Background/aim: Obesity is one of the main public health issues in many countries including Turkey. The aim of the study is to test cross-cultural adaptation, reliability, and validity of QOLOD rating scale in the Turkish language. Materials and methods: This methodological study was conducted among the overweight and obesity people between February-March, 2018 in Ankara Atatürk Training and Research Hospital. The data was collected through self-report and face to face interviews. The QOLOD rating scale has 36 items, a 5-point Likert scale (1­5) is used for each question. Results: In the study, of the 180 participants, 101 (56.1%) were female, 79 (43.9%) were male, and the mean age was 43.36 ± 14.28 (min-max 18­87) years. According to the CFA, the Turkish version of QOLOD rating scale shows a multidimensional structure consisting of 34 items. Two items (item 11 and item 35) were excluded from the scale according to the CFA. Cronbach's Alpha value changes between 0.927­0.930. Conclusion: Finding shows that the Turkish version of QOLOD rating scale had sufficient validity and reliability for Turkish population, had strong psychometric characteristics.

Change in the geographic distribution of human resources for health in Turkey, 2002-2016.

INTRODUCTION: Turkey, which suffers from both undersupply of physicians, nurses and midwives and imbalanced distribution of healthcare personnel, has been developing and implementing various policies to solve these problems. The Ministry of Health launched the Health Transformation Program in 2003 for effective, efficient and fair provision of healthcare services for all people. This study aimed to take a closer look at the impact of policies implemented to reduce the imbalance of the distribution of human resources for health for the past 15 years in Turkey. METHODS: Data for the distributional imbalance obtained from Ministry of Health registries was analysed by using Lorenz curves and Gini coefficient for the years 2002, 2005, 2008, 2012 and 2016. RESULTS: Geographical imbalances for healthcare professions decreased distinguishably during the 15 years. Gini coefficient was 0.33 for specialist distribution in 2002, and decreased gradually to 0.26 in 2008 and finally 0.21 in 2016. Similarly, Gini coefficients were 0.18, 0.20 and 0.25 for general practitioners, nurses and midwives, respectively, in 2002. In 2012, Gini coefficients for the same professionals were calculated as 0.09, 0.11 and 0.19, respectively. CONCLUSION: The findings indicate that the policies targeting the distribution of healthcare personnel in Turkey have yielded positive results. Yet it is evident that these results are not due to a single action. It is essential to improve existing implementations, identify the instruments and factors that satisfy and motivate healthcare personnel, and continue developing and implementing comprehensive policies.

Vaccination rates for Syrian population under temporary protection in Turkey.

OBJECTIVES: The aim of this study was to gather information on demographic and health indicators, primarily vaccination status, of Syrians under temporary protection in five provinces of Turkey and to develop infrastructure for vaccination planning. METHODS: The population under study consists of 89,986 Syrian children, 0-4 years of age, residing in Ankara, Mersin, Gaziantep, Izmir, and Bursa. Initially, we planned to evaluate 2,339 children, although a total of 2,827 children were evaluated by the end of the study. RESULTS: Of these children, 74% were born in Turkey, while 20% were born in Syria. In addition, 22.4% (n = 634) of the children were never vaccinated, and of these, 67.0% (n = 425) were born in Turkey. In other words, one in five Syrian children born in Turkey (20.3%) had never been vaccinated. Of the Syrian children under temporary protection, the missing vaccinations were as follows: hepatitis B (54.7%); Bacillus Calmette-Guérin (62.5%); five-component combined vaccine (64.6%); conjugated pneumococcal vaccine (58.0%); oral polio vaccine (70.8%); measles, mumps, and rubella (76.6%); varicella (66.8%); and hepatitis A vaccine (76.0%). CONCLUSION: It is important to increase the immunization rates of Syrian children under temporary protection and establish regular vaccination procedures.

Evaluation of the attitudes of specialist and family physicians regarding rational drug selection.

OBJECTIVE: Physicians' personal (P) drugs, which were ranked by priority, may show variations even for the same indication. We aimed to evaluate physicians' knowledge and attitudes regarding P-drug list preparation with respect to the rational use of medicine context. METHODS: A total of 1062 family physicians (FPs) and 562 specialist physicians (SPs) were interviewed and questioned about their knowledge and attitude regarding P-drug list preparation. RESULTS: Compared with SPs (64.9%), significantly more number of FPs (72.8%) prepared a P-drug list. Women were more likely to prepare the P-drug list in both groups; gender comparison showed that significantly more number of female FPs (75.9%) exhibited this attitude than female SPs (67.8%) (p=0.002). Among SPs, the trend for P-drug list preparation attitude decreased with increasing age (p=0.006), and significantly less number of senior physicians showed this attitude compared with junior physicians (p=0.007). The most common source of information referred to by FPs (78.9%) and SPs (74.3%) during P-drug list preparation was "pharmaceutical company activities." More than 80% of responders (80.9% of FPs and 83.6% of SPs) specified that a difference "exists" or "partially exists" between original and generic drugs. Approximately one in 10 physicians in both groups stated that they "rarely/never" consider their patients' "liver/kidney disease" during prescribing. CONCLUSION: More prominently in male and senior physicians, the attitude of P-drug list preparation remained lower than expected. Moreover, it is remarkable that pharmaceutical company promotions are the most common source of information for drug selection. These findings disclose the need for the rational use of medicine dissemination interventions for all physicians focusing on more effective use of P-drug list.

Patients' attitudes and knowledge about drug use: a survey in Turkish family healthcare centres and state hospitals

Background/aim: Irrational drug use is a common problem. This study aimed to evaluate patients' knowledge and habits concerning drug use, and compare them in terms of some sociodemographic characteristics. Materials and methods: A face-to-face questionnaire was given to outpatients from family healthcare centres (FHCs) and state hospitals (SHs) in 12 provinces in Turkey during May 2010. A total of 4470 patients (FHCs: 2209; SHs: 2261) responded to the questionnaire (response rate: 93.1%). Results: Getting prescriptions without a physical examination was common (second place in FHCs; third place in SHs); 51.0% stated that they wanted physicians to prescribe drugs that they had used before. More than half stated that antibiotics cured every illness. In addition, 55.9% reported that their relatives recommended drugs to them when they got ill; 37.1% reported that they recommended them to relatives as well. Of the survey respondents, 70.5% stated that they had stopped their medications before the recommended time. Patients' knowledge and attitudes about drug use showed significant differences in comparisons of sex, age, educational level, and social security. Conclusion: Patients' knowledge and attitudes about drugs were far from rational. To eliminate irrational use of drugs, public education about drug use is needed.

Effects of the Health Transformation Programme on tuberculosis burden in Turkey.

OBJECTIVE: The Fifty-ninth Turkish Government announced an emergency action plan and embarked on a comprehensive health reform named "Health Transformation Program" (HTP) in 2003. This study investigated the effects of HTP on tuberculosis (TB) burden from 2003 to 2010 in Turkey. DESIGN: TB incidence, prevalence, mortality and case detection rates, treatment success and direct observed treatment strategy (DOTS) applications rate, and contribution of these applications in the success of the TB war were retrospectively investigated. RESULTS: The annual decrease of incidence rate was 2.86 between 1995 and 2002, and 1.22 between and 2003 and 2010, (p < 0.05). The decrease of prevalence rate was 2.88 between 1995 and 2002 and 1.25 between 2003 and 2010 (p < 0.05). The annual declines in mortality were 0.44 between 1995 and 2002 and 0.22 between 2003 and 2010 (p < 0.005). The DOTS application rate increased from 0% in 2003 to 98% in 2010. After the HTP treatment success rate of TB at 85% of Turkey was firstly reached to 89% in 2005 and increased to 91% in 2007. Case detection rate of new pulmonary TB patients was 82% in 2005 and 81% in 2008 reaching the WHO target for the first time with HTP. CONCLUSION: A trend of reduced TB burden began in Turkey in 1997. As a result of the implementation of HTP beginning in 2003, the target treatment success and DOTS application rates were achieved and progress has continued even in the face of the recent worldwide economic crisis.

Changes and determinants in under-five mortality rate in Turkey since 1988.

Child survival is the focus of the fourth Millenium Developmental Goal (MDG4). This paper describes levels, trends, and differentials in Under-Five Mortality Rate (U5MR) and also summarizes state programmes in Turkey between 1988 and 2010. Turkey is among only a few countries that have already surpassed MDG4 and have reduced their under-five mortality rate by more than two-thirds. In 2010, 13 out of every 1,000 children died before their fifth birthday. Low birth weight, high-birth order, short birth intervals, rural residence, low level of maternal education and lowest wealth quintile have affected negatively children's chances of survival. Expanding the scope of free vaccination programmes for children, improving screening and disease prevention schemes aimed at children, encouraging breastfeeding, implementing an emergency obstetric care programme, improving the services provided to newborns (a newborn intensive care programme) have brought about a significant decrease in the rate of infant and under-five mortality. The implementation of state and region specific action plans should be necessary to increase the chance of an access to the Continuum of Care for each mother and infant and to surpass MDG4.

Assessment of antibiotic prescribing at different hospitals and primary health care facilities.

In this study, it was aimed to investigate the utilization of antibiotics at various health care facilities. Photocopies of 1250 prescriptions which were containing antibiotics and written out in primary health care facilities (PHCFs), public hospitals (PHs), private hospitals and university hospitals in 10 provinces across Turkey, were evaluated by some drug use indicators. The number of drugs per prescription was 3.23 ± 0.92 and it was highest in PHCFs (3.34 ± 0.84), (p < 0.05). The cost per prescription was 33.3 $, being highest in PHs while being lowest in PHCFs (38.6 $ and 28.2 $ respectively). Antibiotic cost per prescription was 16.7 $ and it was also highest and lowest in PHs and PHCFs respectively (p < 0.05). The most commonly prescribed group of antibiotics was "beta-lactam antibacterials, penicillins" (29.2%) while amoxicillin/clavulanic acid was the most commonly prescribed antibiotic (18.1%). Sixty-one percent of the antibiotics prescribed for acute infections was generics; among facilities being highest in PHCFs (66.5%) and among diagnosis being highest in acute pharyngitis. In general, the duration of antibiotic therapy was approximately 7 days for acute infections. Although much more drugs were prescribed in PHCFs than others, it was found to be in an inverse proportion with both the total cost of prescriptions and the cost of antibiotics. Broad-spectrum antibiotics, beta-lactamase combinations in particular, were considered to be more preferable in all health care facilities is also notable. These results do serve as a guide to achieve the rational use of antibiotics on the basis of health care facilities and indications.

Prescribing practices of physicians at different health care institutions.

OBJECTIVE: Irrational pharmacotherapy is a widespread health care problem, and knowing the prescription practices of physicians at an institutional level can present solutions. This study aimed to investigate whether physicians' prescribing patterns showed differences at the level of the health care institution. MATERIALS AND METHODS: Photocopies of 3201 prescriptions written at primary health care centers (PHCs), public hospitals, private hospitals, and university hospitals (UHs) were collected from 10 provinces in Turkey. The prescriptions were evaluated according to prescribing indicators, and the details of drug utilization were compared for different health care institutions. RESULTS: The average number of medicines per prescription was 2.83, and the highest average was noted in PHCs (2.96). The average cost per prescription was US $51.57, and the highest average cost was found in UHs (US $166.10). The most frequently prescribed drug group was different among health care institutions. With the exception of UHs, the "cold-cough medicines" were the most frequently prescribed medicines at all of the institutions. Thirty-nine percent of the prescriptions included antibiotics. CONCLUSION: Despite the similarities between the distributions of diagnoses on prescriptions by health care institutions, the contents of the prescriptions showed differences. The high levels of prescriptions for "cold-cough medicines," whose use is widely debated, and the widespread tendency of physicians to prescribe antibiotics suggest that there is a growing need for disseminating the principles of rational pharmacotherapy. Furthermore, institutional differences must be considered when conducting rational pharmacotherapy programs.

Physician scarcity in underdeveloped areas of Turkey: what do new graduate physicians think?

INTRODUCTION: A sufficient and balanced distribution of physicians plays a key role in access to high quality healthcare services. However, this issue presents serious problems globally. Turkey is currently experiencing physician shortages, with insufficient numbers of physicians in its rural and underdeveloped areas. The objectives of this study were to identify the views of new graduate physicians, prior to employment, on working in underdeveloped areas, in order to discover factors impacting their desire to work in these areas, and to show the actual geographic distribution of physicians in Turkey. This provides the basis for discussing future policies. METHODS: This study was conducted in Turkey from September to November 2009. All physicians (N=4753) who graduated in 2009 were included in the study via online questionnaires. The response rate was 78%. Variables potentially related to physicians' decisions to work in underdeveloped areas were analyzed using the χ(2) test. To discover the imbalance in geographic distribution of physicians, data collected by the Turkish Ministry of Health (MoH) were re-analyzed. Physician density was calculated for the six zones determined by the MoH according to socioeconomic development. RESULTS: Of the physicians who participated, 52.5% were male and 13.5% expressed a desire to work in underdeveloped areas. Male physicians were more likely to work in underdeveloped areas (17.5% and 9.1%, respectively; p<0.05). There was a significant relationship between desire to work in underdeveloped areas, regions of longest stay and birthplace (p<0.05). Physicians who had lived for a significant period in areas with a high number of underdeveloped cities (Southeastern and Eastern Turkey) and those who were born in underdeveloped cities were more likely to wish to work in these areas. The most influential factor for working in these areas was higher salaries. CONCLUSIONS: Physicians who have particular socioeconomic backgrounds such as rural origin and lower background-family income are more likely to have be motivated to work in underdeveloped areas. They are also more likely to accept work in these areas if financial and non-financial opportunities are provided. The findings of this study provide guidance for those revising health workforce policies.

Assessment of the Turkish health care system reforms: a stakeholder analysis.

BACKGROUND: The Turkish health care system has been undergoing a significant transformation with the Health Transformation Program (HTP) since 2003. The HTP's overall objective is to improve governance, efficiency, user and provider satisfaction, and long-term fiscal sustainability of the health care system in Turkey. OBJECTIVES: To systematically evaluate the effects of the HTP Phase I reforms on various stakeholders, and to outline strategic options for the implementation of the second phase of health transformation in Turkey. METHODS: A total of 47 formal structured stakeholder interviews, representing 29 different institutions, are conducted between December 2008 and January 2009. Five main components of the HTP were examined: strengthening of the Ministry of Health (MoH) capacity for stewardship, universal health insurance, reorganizing health service delivery, human resources development, and national health information system. RESULTS AND CONCLUSIONS: There is a general agreement among stakeholders that the progress made thus far is the greatest in the national health information system and the slowest in strengthening the MoH capacity for stewardship. It appears that the HTP has the capacity to deliver cost-effective health care services and the implementation progress, so far, is in congruence with the overall economic development and growth in Turkey.

Malaria in Turkey: successful control and strategies for achieving elimination.

Turkey is located in the middle of Asia, Africa and Europe, close to Caucasia, Balkans and Middle East in subtropical climate zone. Malaria has been known since the early ages of human history and it was one of the leading diseases in Anatolian history, as well. Today, chloroquine-sensitive Plasmodium vivax is the only agent of autochthonous malaria cases in Turkey. The other Plasmodium species identified are isolated from imported cases of malaria. The most common vector of malaria in Turkey is Anopheles sacharovi followed by An. superpictus, An. maculipennis and An. subalpinus. In 2009, pre-elimination stage of Malaria Program was started due to dramatic decline in the number of malaria cases in Turkey (Total, 84; 38 autochthonous cases only in 26 foci in south-eastern Anatolia, and 46 imported cases; incidence: 0.1/100,000). As there were no detected cases of new autochthonous malaria in the first 8 months of 2010, elimination stage was started. The role of the persistent policies and successful applications of the Ministry of Health, such as the strict control of the patients using anti-malarial drugs especially chloroquine, avoidance of resistant insecticides, facilitation of access to patients via Health Transformation Program (HTP), establishment of close contact with the patients' families, and improvement of reporting and surveillance system, was essential. In addition, improvement maintained in the motivations and professional rights of malaria workers, as well in the coordination of field studies and maintenance of a decline or termination in vector-to-person transmission were all achieved with the insistent policies of the Ministry of Health. Other factors that probably contributed to elimination studies include lessening of military operations in south-eastern Anatolia and the lowering of malaria cases in neighbouring countries in recent years. Free access to health services concerning malaria is still successfully conducted throughout the country.

Turkey. Health system review.

Turkey has accomplished remarkable improvements in terms of health status in the last three decades, particularly after the implementation of the Health Transformation Program (HTP (Saglikta Donus, um Programi)). Average life expectancy reached 71.8 for men and 76.8 for women in 2010. The infant mortality rate (IMR) decreased to 10.1 per 1000 live births in 2010, down from 117.5 in 1980. Despite these achievements, there are still discrepancies in terms of infant mortality between rural and urban areas and different parts of the country, although these have been diminishing over the years. The higher infant mortality rates in rural areas can be attributed to low socioeconomic conditions, low female education levels and the prevalence of infectious diseases. The main causes of death are diseases of the circulatory system followed by malignant neoplasms. Turkeys health care system has been undergoing a far-reaching reform process (HTP) since 2003 and radical changes have occurred both in the provision and the financing of health care services. Health services are now financed through a social security scheme covering the majority of the population, the General Health Insurance Scheme (GHIS (Genel Saglik Sigortasi)), and services are provided both by public and private sector facilities. The Social Security Institution (SSI (Sosyal Guvenlik Kurumu)), financed through payments by employers and employees and government contributions in cases of budget deficit, has become a monopsonic (single buyer) power on the purchasing side of health care services. On the provision side, the Ministry of Health (Saglik Bakenligi) is the main actor and provides primary, secondary and tertiary care through its facilities across the country. Universities are also major providers of tertiary care. The private sector has increased its range over recent years, particularly after arrangements paved the way for private sector provision of services to the SSI. The most important reforms since 2003 have been improvements in citizens health status, the introduction of the GHIS, the instigation of a purchaser provider split in the health care system, the introduction of a family practitioner scheme nationwide, the introduction of a performance-based payment system in Ministry of Health hospitals, and transferring the ownership of the majority of public hospitals to the Ministry of Health. Future challenges for the Turkish health care system include, reorganizing and enforcing a referral system from primary to higher levels of care, improving the supply of health care staff, introducing and extending public hospital governance structures that aim to grant autonomous status to public hospitals, and further improving patient rights.

Turkey: health system review

The Health Systems in Transition (HiT) country profiles provide an analytical description of each health system and of policy initiatives in progress or under development. They aim to provide relevant comparative information to support policy-makers and analysts in the development of health systems and reforms in the countries of the WHO European Region and beyond. The HiT profiles are building blocks that can be used: to learn in detail about different approaches to the financing, organization and delivery of health services; to describe accurately the process, content and implementation of health reform programmes; to highlight common challenges and areas that require more in-depth analysis; and to provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in countries of the WHO European Region. This series is an ongoing initiative and material is updated at regular intervals.

A macro view on human resources for health in Turkey.

This study aims to make an assessment of the current status of human resources for health in Turkey and to bring a new perspective to key issues in the development of human resources for health within the framework of a macro approach. Although a number of issues are covered in human resources for health (HRH) studies which need to be handled carefully, this study focuses on the number of health personnel, health personnel efficiency, geographic distribution, education and financing of health personnel, and migration.

How firms set prices for medical materials: a multi-country study.

OBJECTIVES: This study presents a comparison of medical material prices, discusses why differences exist, and examines methods for comparing prices. METHODS: Market prices for drug-eluting stents (DES), non-drug-eluting stents (non-DES), and percutaneous transluminal coronary angioplasty (PTCA) catheters were collected from five countries: the United States, Japan, Korea, Turkey, and Thailand. To compare prices, three adjustment methods were used: currency exchange rates, purchasing power parity (PPP), and gross domestic product (GDP) per capita. RESULTS: The ratios of medical material prices compared with those in the United States were higher in Japan (from 1.4 for DES to 5.0 for PTCA catheters) and Korea (from 1.2 for DES to 4.0 for PTCA catheters), and lower in Turkey (from 0.8 for non-DES to 1.4 for DES) and Thailand (from 0.5 for non-DES to 1.3 for PTCA catheters). The PPP-adjusted ratios changed slightly for Japan, Korea, and Turkey. When the prices were adjusted by GDP per capita, the ratios were much higher. CONCLUSIONS: Comparing prices using currency exchange rates or PPP is applicable only between countries with stable economic relations; adjustment by GDP per capita reflects the actual burden. Further study is needed to fully elucidate the factors influencing the global medical material market.