Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study.

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians' migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants' migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22-1.54) times more likely to emigrate. The push factor that was related to emigration intention was the "working conditions in the country" (OR: 1.89, 95% CI: 1.56-2.28) whereas the "social environment/lifestyle abroad" was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45-2.06). In addition, the quality problem in medical schools also had a significant impact on students' decisions (OR: 2.20, 95% CI: 1.83-2.65). Insights: Although the percentage of those who want to emigrate "definitely" was at the same level as in the other developing countries, the tendency to migrate "permanently" was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians.

Turkish validity and reliability of telemedicine awareness, knowledge, attitude and skills questionnaire.

OBJECTIVE: The aim of the study is to investigate the validity and reliability of the "Telemedicine Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine" questionnaire and to convert the questionnaire to Turkish. METHODS: The study is methodological research conducted among medical faculty students and medical residents. For the validity and reliability analysis of the "AKAS of Telemedicine" questionnaire, 425 medical faculty students and medical residents were included in the study, and the sample was 7-10 times the number of questionnaire items. Exploratory factor analysis was performed for construct validity. The test-retest method was engaged to assess reliability. Cronbach's alpha reliability coefficient and the item-total correlation coefficient were calculated for internal consistency. Descriptive statistics were given as mean, standard deviation, median, and first and third quartile values for numerical variables, and numbers and percentages for categorical variables. The Mann-Whitney U test, the Kruskal-Wallis test, and Spearman's correlation coefficient were conducted to evaluate the correlation between variables. RESULTS: The Cronbach alpha reliability coefficient of the "AKAS of Telemedicine" questionnaire was found to be 0.950, 0.851, 0.970, and 0.952 in the sub-areas, respectively. When an item was removed, the Cronbach alpha reliability coefficient values ranged between 0.826 and 0.969, and no significant difference was detected. As a result of test-retest reliability analysis, a strong positive correlation was found between the total scores (awareness r=0.848, knowledge r=0.792, attitude r=0.787, and skill r=0.816; p<0.001 for each score). CONCLUSION: The Turkish form of the "AKAS of Telemedicine" questionnaire is a valid and reliable measurement tool that can be used to evaluate the level of AKAS among physicians. It was concluded that research using the "AKAS of Telemedicine" questionnaire would be useful to determine the telemedicine AKAS levels among Turkiye, particularly in health sector workers.

Public health literacy in primary users in western Turkey.

BACKGROUND: Public health literacy (PHL) is a novel perspective on health literacy (HL). Differing from HL's individualist approach, PHL is concerned with public health events and promoting health in the whole society. OBJECTIVES: To evaluate PHL, a newly developed concept, and related factors. METHODS: In this cross-sectional study, people who visited primary healthcare centers in urban and rural settings were recruited using a questionnaire that includes Public Health Literacy Knowledge Scale (PHLKS) and Adult Health Literacy Scale (AHLS). Out of four Primary Healthcare Centers (PMCs) in western Turkey selected randomly, one PMC was located in a rural setting, while three PMCs were located in an urban setting. Multiple linear regression was used to determine the predictors for PHL. RESULTS: The study group consisted of 1672 people, of which 55.3% were male. The mean age was 40.94 ± 15.22. The median score (min-max) from PHLKS was 13.0 (0-17). Multiple linear regression showed that income level had a negative impact on PHL. Higher education, fondness for reading, hospital admission and HL, however, increased PHL levels. Additionally, living in an urban area and not having auditory problems were positively associated with PHL. CONCLUSIONS: Participants had a moderate level of PHL. Improving PHL should be a priority to tackle global and local problems that have an adverse effect on community health. To increase community engagement in public health events, people with low education and HL levels should be targeted in future training programs.

Recognition and participation of colorectal cancer screening in Turkiye: A systematic review and meta-analysis study.

Colorectal cancers (CRCs) have an important share in the prevalence and mortality among all cancers. It was aimed to make a systematic review and meta-analysis of researches about the prevalence of knowing fecal occult blood test (FOBT) and colonoscopy, which are among the CRC screening methods, and the prevalence of having these tests at any time in life. A literature search using five different databases were screened both in Turkish and English language and a total of 1176 studies were reached. Of these, 22 studies were selected to be included in this study. In the evaluation of the researches included in the study, the studies were read in a way to look for answers to PICOS questions. Open Meta-analyst demo program and random effects model was used. The prevalence rate and 95% confidence interval of knowing and having FOBT and colonoscopy were calculated. According to the meta-analysis results, the prevalence of knowing the FOBT among the CRC screening tests was 19.3%, the prevalence of having the FOBT was 13.2%, the prevalence of knowing colonoscopy was 31.7%, and the prevalence of having colonoscopy was 10.0%. As a conclusion prevalence of knowing and having FOBT and colonoscopy was low in risky individuals in Turkiye.

Evaluation of health anxiety in adults admitting to primary healthcare institutions.

OBJECTIVE: Health anxiety is defined as the negative over-interpretation of the usual physical sensations, although the person does not have any physical illness. The study aims to evaluate the health anxiety levels of individuals over the age of 18 who admit to primary healthcare institutions in Eskisehir and the factors that may be associated with it. METHODS: This is a cross-sectional study. The study was conducted in adults who admitted to primary healthcare institutions in Eskisehir. The study group consists of 1200 individuals. For the purpose of collecting data, a questionnaire including the questions regarding the factors related to health anxiety and the Health Anxiety Scale were used. In the analysis of the data, a logarithm of The Short Health Anxiety Inventory (SHAI) scores was performed to determine the factors affecting the inventory score and hierarchical multiple linear regression analysis was used. RESULTS: The total scores from The SHAI ranged from 1 to 47, with an mean of 16.4±8.7 and a median score of 15. Of 41.9% of study group scored above mean score. Female gender, deterioration of family income, presence of chronic disease, worsening of general health status, symptoms of mental and behavioral disorders, high number of admissions to health institutions, and hospitalization history were found to be factors affecting the level of health anxiety. CONCLUSION: Health anxiety was found to be an important problem among those who admitted to primary healthcare institutions in Eskisehir. Providing education to individuals in risky groups in terms of health anxiety, and these groups should be closely monitoring in terms of health anxiety and providing psychosocial support when necessary will prevent excessive use of health services in the long-term.

A Comparison Quality of Life of Children of Seasonal Agricultural Workers and Local Residents in Turkey.

OBJECTIVES: Children of seasonal agricultural workers (SAW) live in the worst conditions of agricultural labor and, consequently, face many health risks. Therefore, it is essential to evaluate the quality of life (QoL) of these children. This study aimed to compare the QoL between children of SAW and local residents in semi-rural areas of Eskisehir, Turkey, and determine the factors affecting them. METHODS: In this cross-sectional study, we included children of SAW living in temporary camp areas and those of local residents visiting the Family Health Center close to the camp areas. Basic sociodemographic data collection forms and the Pediatric Quality of Life (PedsQL) scale were employed for data collection. Univariate and multivariate analyses were used to determine factors that had a significant effect on the QoL. RESULTS: We included 324 children of SAW and 256 local children. As per the multivariate analysis, QoL was lower in children aged between 8 and 12 years, with physician-diagnosed chronic diseases, and children of SAW. Also, there was no significant association between gender, parental education levels, family income, number of siblings, school attendance status, and QoL level. CONCLUSION: The QoL of children of SAW families was significantly lower than their peer local children. Therefore, the appropriate authorities must prioritize the planning and implementation of health services for SAW families.

Relationship between Mental Disorders and Optimism in a Community-Based Sample of Adults.

Optimism should be included in efforts to protect mental health, as it can provide cognitive resources. Optimism also reduces the negative effects of stressful life events associated with the occurrence and recurrence of mental disorders. This study aimed to evaluate the relationship between mental disorders and optimism in a community-based sample of adults. The study was conducted in three semi-rural clusters determined via random sampling. After adjustment in accordance with the independent variables, the relationship between each psychiatric disorder and Life Orientation Test (LOT) was calculated using logistic models. Overall, 24.5% of participants were categorized into at least one mental disorder group, with 20.8%, 3.5%, and 0.3% having one, two, or three mental disorders, respectively. The median LOT score was lower in patients diagnosed from the Primary Care Evaluation of Mental Disorders modules, except for the somatoform disorder module. Maintaining an optimistic view reduced the risk of mood disorders by 0.86 (OR; 95% CI, 0.81-0.91), anxiety disorders by 0.89 (0.83-0.97), and probable alcohol abuse by 0.83 (0.74-0.93) times after adjustment. The role of an optimistic view in coping with mental problems should be investigated in detail.

Cardiovascular Disease Risk Factors among Migrant Seasonal Agricultural Workers: Comparison with Local Residents.

BACKGROUND: Seasonal agricultural workers group is one of the most disadvantageous groups of working life in Turkey same as many other countries. We aimed to determine the status of cardiovascular disease risk factors among migrant seasonal agricultural workers (MSAW) and to compare obtained data with local residents. METHODS: This study cross-sectional study was conducted among MSAW in Eskisehir, Turkey and closest town residents in 2015 during agricultural season. These 455 MSAW were living in camps composed of 20 or more tents. Local residents sample composed of 532 local residents were reached at their houses by using random sampling method with data acquired from health organization records. Both groups were subjected to same questionnaire. RESULTS: The prevalence of overweight/obesity among MSAW women was 40.5%, hypertension 19.9%, diabetes 4.9% and hypercholesterolemia 6.5%. These prevalences were 68.0%, 38.6%, 13.9% and 20.8% respectively among local residents. The prevalence of smoking risk among local residents was 1.5 times more than MSAW. In addition, the prevalence of overweight/obese risk was 4 times more; hypertension risk 1.8 times more, diabetes risk 3.8 times more and hypercholesterolemia risk 2.7 times more among local residents than MSAW (P<0.05). CONCLUSION: The prevalence of cardiovascular disease risk factors of MSAW was lower than local residents in the study groups. Even though health risks that MSAW faced were more linked with environment and life conditions, cardiovascular disease risk factors should not be ignored. Health services should be guided by considering obstacles that MSAW experienced in accessing health services.

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.

Assessment of health-promoting lifestyle behaviors of adults living in the semi-rural area.

OBJECTIVE: The aim of the present study was to determine the level of healthy lifestyle behaviors and related factors in the individuals who applied to the primary health-care center. METHODS: The study is a cross-sectional study of adults aged 18 years and over who applied to the primary health-care center. The sample size of the study was calculated as 992 people and 995 participants were accessible. The health-promoting behaviors of the individuals were assessed by the Health-Promoting Lifestyle Profile II (HPLP-II). In the analysis of the data, Mann-Whitney U-test, Kruskal-Wallis tests, and multiple linear regression analysis were used to determine effective variables on scale score. RESULTS: The mean age of the participants was 43.8±17.1. Of the total participants, 45.7% (n=455) of them were female. The median score obtained from the HPLP-II was 132. Health responsibility, nutrition, and interpersonal relations subscale scores of male were lower than female patients, while physical activity subscale scores were higher in male patients. In participants under the age of 48 years in the study, health responsibility, nutrition, interpersonal relations, and stress management subscale scores were higher. The scores of the married participants were higher than the areas out of the stress management subdimension. Stress management subscale scores were higher in individuals with primary and lower education levels in terms of health care, nutrition, and interpersonal relations. Those who had good family income status and health perception scores also received higher scores in terms of all subscale scores. CONCLUSION: Gender, age group, marital status, education level, income level, physician-diagnosed chronic disease history, and perceived health status were found to be related to health-promoting behaviors. Educational programs should be prepared in these issues by determining the issues that individuals are lacking in protecting and developing their health and social needs should be taken into consideration when these programs are being prepared.

Validity and Reliability of the Glaucoma Knowledge Level Questionnaire.

OBJECTIVES: The present study was conducted to develop an instrument for measuring adults' glaucoma knowledge levels and to establish the instrument's validity and reliability. MATERIALS AND METHODS: The study group consisted of 811 persons aged 40-80 years who presented to primary health care institutions and did not have a glaucoma diagnosis. A 27-item questionnaire measuring level of glaucoma knowledge was created by the study team. Following expert consultation, it was structurally evaluated. The difficulty index and discrimination index were calculated for each item. Factor analysis was used to determine construct validity, Cronbach's alpha internal consistency coefficient and item-total correlations were calculated to determine reliability. Confirmatory factor analysis was used to assess the extent to which the factor structure of the scale fit. We analysed correlation with the National Eye Health Education Program (NEHEP) Eye-Q scale in order to evaluate the validity of the scale. RESULTS: The final glaucoma knowledge level questionnaire comprised 10 items in one dimension. The discrimination index and difficulty index ranged between 0.28 to 0.65 and 33 to 61%, respectively. According to factor analysis, the Kaiser-Meyer-Olkin score was 0.760 and Bartlett's test indicated p<0.001. Confirmatory factor analysis showed acceptable scale fit and fit indices. Validity assessment revealed a positive correlation between the total score of the items of the NEHEP scale and glaucoma knowledge level questionnaire score (r=0.522; p<0.001). Scores were higher in participants who were aged 40-64, living in the city, had education level of high school or above and had previous eye examination or intraocular pressure measurement. CONCLUSION: The glaucoma knowledge level questionnaire has the distinction of being the first valid and reliable scale for assessing level of glaucoma knowledge in Turkey.

Violence and related factors among high school students in semirural areas of Eskisehir.

OBJECTIVE: The aim of the study was to determine the frequency of violence-related behaviors and related factors at school or school environment among high school students educated in the semirural areas of Eskisehir. METHODS: This was a cross-sectional study. The sample comprised 1465 high school students. Data were collected using a questionnaire that included questions regarding sociodemographic characteristics and the 2013 survey questions of the "Youth Risk Behavior Surveillance System" of the Centers for Disease Control and Prevention. RESULTS: It was found that 8.5% of students exhibited violent behaviors at school or school environment. According to multiple logistic regression analysis, sex, father's employment status, smoking, alcohol use, and feeling unsafe were effective independent variables on violence. CONCLUSION: Students had a high rate of violence-related behaviors at school or school environment. Community-based public health interventions are required to solve this problem.

Knowledge levels of and attitudes to organ donation and transplantation among university students.

OBJECTIVE: The aim of the present study was to determine knowledge levels and attitudes about organ donation and transplantation among university students. METHODS: This descriptive study was performed with third-grade students of medicine, pharmacy, and law at a university. Samples weren't selected in the study and it was executed with 145 students who had agreed to participate in the study. The data was collected using a questionnaire of 19 questions. Descriptive statistics were used to analyze the data. RESULTS: 71.7% of students had positive views about transplantation of their own organs to a suitable recipient, with half of them giving being useful to others as a reason. Among students who had negative views about organ donation, the most important reason given was that it would mean a loss of bodily integrity. 44.1% of participants had positive views about transplantation of their relatives' organs to another person after death. 51.7% of participants had positive views about transplantation of the organs of a homeless person to another person after death. CONCLUSION: Students had generally positive views about organ donation. However; organ transplantation and donation should be included in the students' educational programs in order to increase positive attitudes and organ donations, and transform attitudes into behaviors.

Participation of people living in rural areas of Eskisehir province in field researches, and factors affecting their rates of participation.

OBJECTIVE: The aim of the study was to determine participation rates of people living in the rural area of Eskisehir in field researches, and the factors influencing this. METHODS: This descriptive study was performed with 1,482 people aged 18 and above in two districts of Eskisehir. Data were collected with a 16 question questionnaire using the face-to-face interview technique. Data were analysed with descriptive statistics, chi- square test, logistic regression analysis, and factors affecting rates of participation in field researches. RESULTS: The most important reason (46.9%) given by participating for participant in field researches was the intention of "helping the interviewer". The other reasons were; believing in the usefulness of the researches (35.0%), contribution to public improvement (14.9%) and taking pleasure in talking with various people (3.2%). The most important reason (34.6%) for not participating in field researches was "considering field researches a waste of time". The other important reasons for non-participation were unnecessarily long questions in the research questionnaire forms (32.7%) and being uninformed of the research results (31.9%). In logistic regression analysis, age was found to be an influential factor in participation rates. CONCLUSION: Lower rates of participation in field researches cause bias. As far as possible high participation in field researches is important. For the achievement of higher participation rates in field researches, training courses must be provided to both research workers and the public.

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.