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.

Brief Report: Turkish Validity and Reliability of the HITS Intimate Partner Violence Screening Tool With Women.

The current study examined the validity and reliability of the Turkish version of the HITS (Hurt-Insult-Threaten-Scream) tool which was developed to screen for intimate partner violence. 154 Turkish women participated and completed the Turkish version of the HITS (HITS-TR). The validity of the language and factor structure were evaluated. The internal consistency coefficient of the scale was.89. Confirmatory factor analysis (CFA), revealed a single factor structure consisting of four items that explained 76% of the total variance. A CFA was performed with a modified model upon a second sample indicating high compatibility for the revised model with χ2/df = 1.262, a root mean square error of approximation.036, goodness of fit index of.996, adjusted goodness of fit index.998, root mean square residual of.006 and standardized root mean square residual of.008. It is concluded that the HITS-TR can be used as a valid and reliable screening tool for intimate partner violence in Turkish women.

Evaluation of the Burden of Care and the Quality of Life in the Parents of Turkish Children with Familial Mediterranean Fever.

PURPOSE: This study aimed to determine the burden of care and the quality of life in caregivers of children with FMF. DESIGN AND METHODS: A cross-sectional study was conducted. Caregivers of the 109 children with FMF followed by a pediatric nephrology department were invited to join the study. Besides demographic information, the Zarit Care Burden Scale (ZCBS) and the World Health Organization Quality of Life Questionnaire-Short Form (WHOQOL-BREF) were used to collect data. Results for 90 patients were analyzed. RESULTS: The mean (±SD) ZCBS score of the caregivers was 44.78 ±â€¯13.55. Care burden of the caregivers according to the ZCBS was categorized as; 61.1% (n = 55) mild, 25.6% (n = 23) moderate, and 13.3% (n = 12) severe. Although single caregivers were perceived as having a relatively higher burden than those who were married (80% and 36%), this difference was not significant. There were no statistically significant differences between ZCBS categories concerning caregivers' gender, educational status, and having comorbidities (p > 0.05). Also, there were no significant correlations between ZCBS and the WHOQOL-BREF domains (p > 0.05). CONCLUSION: This study showed that the quality of life of the caregivers of children with FMF was not adversely affected, but a significant number of caregivers perceived care burden in moderate severity. Attention should be paid to the needs of caregivers, and they should be provided with adequate social, economic, physical, and psychological support. PRACTICE IMPLICATION: Responsive strategies to support caregivers' should be taken as means of social, economic, physical, and psychological needs.

Use of Family Planning Methods and Influencing Factors Among Women in Erzurum.

BACKGROUND Our study aimed to determine the prevalence of family planning methods, socio-demographic characteristics and the relationship between pregnancy histories and usage of family planning methods among women aged 15-49 years old living in the Erzurum provincial center. MATERIAL AND METHODS This is a descriptive, cross-sectional study. From the total 106 669 women aged 15-49 years old living in the Erzurum provincial center, a sample of 627 individuals was selected. A questionnaire consisting of items inquiring into women's socio-demographic characteristics, birth and pregnancy history, and the use of family planning methods was administered using face-to-face interviews. Statistical analysis was performed using the SPSS 20.00 software. Descriptive statistics were expressed as mean, median, n, percentage, and standard deviation. The chi square, chi square trend, Mann-Whitney U tests, and logistic regression analysis were used for data analysis. RESULTS The mean age of the women in the study was 33.03 years (SD=7.1 years). The mean total number of pregnancies was 3.07 (SD=1.7). Of the women in the study, 77.7% (n=487) used some kind of FP, with 48.2% (n=302) using modern methods and 29.5% (n=185) using traditional techniques. The most commonly used modern methods were intra-uterine devices (IUDs) and condoms, and the most common traditional method used was withdrawal. The use of modern methods was higher among women working outside of the house. It was positively associated with higher education and income and negatively associated with the total number of pregnancies. CONCLUSIONS Appropriate use of family planning services rises in line with improvements in women's education, prosperity, and employment status.

The Effects of Auricular and Body Acupuncture in Turkish Obese Female Patients: A Randomized Controlled Trial Indicated Both Methods Lost Body Weight But Auricular Acupuncture Was Better Than Body Acupuncture.

It was aimed to observe the efficacy of body acupuncture and auricular acupuncture for the management of obesity. Fifty female obese patients were randomized into 2 groups; a Body Acupuncture Group (GBA; n=25) and an Auricular Acupuncture Group (GAA; n=25). All patients were followed up for 12 weeks. Their anthropometric measurements (body weight, body mass index, body fat percentage, waist circumference and hip circumference) were recorded for analysis in every 15 days. Patients were compared in terms of anthropometric measurements. Patients in the GAA received 6 sessions of auricular acupuncture in every 15 days. We used bilateral 2 points namely anti-aggression point and stomach point for auricular acupuncture. Bilateral L14, LIll, ST25, ST36, SP6, SP9, CV12, and CV6 points were selected for two times in a week (totally 24 sessions) in the GBA. Independent samples t test, patients in GAA completed the study. The mean age of patients was 36.2±10.5 years (GBA: 32.7±12.3; GAA: 39.1±7.9). The mean weight was 95.7±11.8 kg before acupuncture, and it decreased to 92.5±14.4 kg after acupuncture in GBA; and it was 95.1±15.6 kg before acupuncture and it decreased to 91.5±11.0 kg after acupuncture in GAA. Change in weight after acupuncture was 2.6±2.4 kg in GBA, and 4.2±3.4 kg in GAA (p<0.05). In both groups, changes in weight, body mass index, body fat percentage, waist circumference, and hip circumference were statistically significant (p<0.05). Only one patient reported side effect related to acupuncture. Body acupuncture and auricular acupuncture have the therapeutic role in the management of obesity. In this study, auricular acupuncture is more effective in reducing body weight than body acupuncture. Thus, auricular may be useful and safe, non-pharmacological treatment.

Climatic factors correlate with emergency visits due to animal injuries in Southern Turkey: A single-center retrospective study.

BACKGROUND: Animal-related injuries are among the major causes of morbidity and mortality all over the world, especially in rural areas. This study aims to determine the characteristic features of animal-related injury cases presented to the emergency department and to evaluate their temporal trends and relationships with climatic factors. METHODS: Among the animal-related injury cases, those who applied between January 1, 2017, and December 31, 2021, in a small seaside town in Turkey were included in the study. Application date, age, gender, ICD code, and prognosis constitute the variables from the hospital information management system within the relevant date range. Meteorological data were taken from Hatay Meteorological Directorate as average daily temperature ( °C) and humidity (g/m3). Descriptive statistics are presented using mean, standard error, number, percentage, and ratio. Kruskal-Wallis, Pearson correlation analysis, linear trend analysis, chi-square, and t-test were used in the analyses. The statistical significance level was accepted as p < 0.05. RESULTS: A total of 6634 animal-related injuries were included in the study. The average age of the injured was 26.1 ± 21.1 years and 60.3 % were male. Injuries were most frequently observed in the 0-9 age group (29.9 %). Of all the cases, around 0.1 % were hospitalized and there were no reported deaths. Injuries caused by mammalian species accounted for 85 % of the cases. The number of recorded cases was lowest in 2018 and highest in 2021. Over the five years, animal-related injuries showed an increase trend which was not statistically significant (R2 = 0.216, p= 0.430). The injury cases showed a marked seasonality; numbers tended to increase in March and reached the highest level between June and September. While a significant and positive relationship was observed between the daily average temperature and the number of cases (r = 0.428, p < 0.001), there was no correlation between the average relative humidity and the injury numbers (p = 0.537). CONCLUSION: This study revealed that animal-related injuries were commonly seen in children and young middle-aged adult groups and during warmer seasons. Based on the results of the study, we suggest several strategies to reduce the public health impact of animal-induced injuries, such as region-specific intervention programs adapted to animal species and seasonal changes, educational campaigns targeting children during the warmer seasons, and improved data recording systems for the cases.

Temporal tendency, seasonality and relationship with climatic factors of Crimean-Congo Hemorrhagic Fever cases (East of Turkey: 2012-2021).

Crimean-Congo Hemorrhagic Fever continues to be an important public health problem by expanding its borders. To evaluate the temporal trend, seasonality, and relationship with the climatic factors of Crimean-Congo Hemorrhagic Fever. Study data included cases treated in two different tertiary healthcare institutions between 2012 and 2021. The demographic characteristics of the cases and the dates of admission to the hospital were determined, and they were matched with the average of the measurements (temperature, cumulative precipitation, relative humidity, wind speed) of two different meteorology stations in the study area. By calculating the crude incidence rates, the trend in years was investigated. Estimates were created by removing the incidence rates, seasonality, and trend components using the additive decomposition technique. The temporal relationship between incidence rates and climatic factors was evaluated with the help of the Autoregressive Distributed Lag Bound Test. Toda Yamamoto test was used for causality verification. The mean age of the cases (n = 974) included in the study was 47.6 ± 17.7 years, and the majority (57.3%) were in the group above 45 years of age. 56.6% of the cases were male and there was a male predominance in all age groups. Incidence rates ranged from 5.5 to 23.1/100,000 over the ten-year period and there was a significant upward trend (R2 = 0.691, p = 0.003). Cases of Crimean-Congo Hemorrhagic Fever that started in March, peaked in July and ended in October, showed a clear seasonality. A cointegration relationship was observed between case incidence rates and air temperature, cumulative precipitation, and relative humidity (p < 0.05 for all). Climatic factors can only indirectly affect the occurrence of Crimean-Congo Hemorrhagic Fever cases. However, climatic conditions that become progressively more favorable for vector ticks lead to the spread of the disease. The control measures to be taken should be prepared by considering the changing climatic conditions and prioritizing the risk groups. There is a need for information and awareness-raising studies about climate change and the growing dangers associated with it, also outside of endemic regions.

Assessing the Impact of Early Childhood Caries on the Development of First Permanent Molar Decays.

Aim: The aim of this study was to evaluate whether the treated and untreated severe early childhood caries (ECC) in children would make any impact on the Permanent First Molar (PFM) decays. Materials and Methods: Our descriptive epidemiological study was conducted in Ataturk University, Faculty of Dentistry, Department of Pediatric Dentistry/Erzurum-Turkey, between 2011 and 2017. We included a total of 90 children (44 girls, 46 boys), and divided them into 3 equal groups. They were 6-9 years old with a mean age of 7.38 ± 0.89. Group 1 consisted of the patients who had previously been treated under GA, Group 2 included the patients with untreated ECC and with no previous dental treatment, and Group 3 consisted of the patients who had been periodically treated in normal clinical settings. Each patient was processed through; dmft scoring and PFM caries evaluation process in accordance with International Caries Detection and Assessment System (ICDAS), respectively. The obtained data was analyzed with SPSS v20.0. And also, we used One-way ANOVA, Kruskal-Wallis and Mann Whitney U tests. Results: In accordance with ICDAS, we found that Group 3 had the highest mean number of PFMs (2 ± 1.43) and Group 2 had the lowest (1.43 ± 1.45). In Group 2, the number of ICDAS-determined carious PFMs were significantly lower than the other groups (p < 0.05). However, ICDAS score 6 was 0 in Group 1, while it was determined higher as 4.2% in Group 2. Conclusion: In respect to our research outcomes, which revealed that regardless of treated or not severe ECC had a significant impact on the PFMs, we strongly recommend that the parent of the children experiencing ECC should be informed about the risk of future caries in PFMs.

Delivery preferences of pregnant women: Do not underestimate the effect of friends and relatives.

INTRODUCTION: The mode of delivery is of vital importance to the health of both mother and child. We aimed to determine the preferences of pregnant women for the mode of delivery and the associated factors concerning their choices. METHODS: In this descriptive study, a sample size of 418 individuals are needed to calculate an expected prevalence of 45% with an error of margin of 5%, a confidence interval of 95% and considering potential non-respondents of 10%. Sixteen subjects refused to take part in the study, 402 pregnant women presenting to hospitals in Erzurum city center during December 2016 and January 2017 consisted the study group. Distribution percentages were calculated based on the numbers of births in the hospitals. A questionnaire incluiding questions about sociodemographic characteristics, factors that may affect women's delivery preferences, delivery preferences, and the reasons for those preferences was used to collect the data. Data were analyzed on the SPSS 22.0 statistical software. The Chi-Square, Student t-tests and binary logistic regression analysis were used. p < 0.05 was regarded as statistically significant. RESULTS: The proportion of cesarean delivery preferences was 69(17.2%). Women's preferences for normal vaginal delivery (NVD) or CS deliveries were significantly affected by the previous type of delivery (p < 0.001), type of pregnancy (natural vs. assisted) (p = 0.021) and problems in CS delivery among friends and relatives (p = 0.009). No statistically significant correlation was observed between delivery preferences and women's age, monthly family income, employment status, age at marriage, duration of the marriage, previous miscarriage, age at first delivery, and possession of information concerning types of delivery (p > 0.05). Multivariate analysis proved cesarean section experience, the presence of cesarean-related problems among relatives and educational status as independent affecting factors. CONCLUSION: This investigation demonstrated women in Erzurum prefer substantially vaginal delivery. Family and relatives are essential for decision making, which suggests considering peer education as a method of information delivery.

Fertility Preferences of Women in a Province Center.

OBJECTIVE: Fertility preferences and status are important parameters involved in reproductive health. The aim of the present study was to define some characteristics of the fertility preferences of women aged 15-49 years in our region. MATERIALS AND METHODS: This cross-sectional study was conducted between 2013 and 2015. The study population consisted of 627 married women aged 15-49 years living in a city center. A questionnaire about socio-demographic characteristics, pregnancy and birth traits, and fertility preferences was applied. Chi-square, Mann-Whitney U, and Spearman correlation tests were analyzed using Statistical Package for Social Sciences (SPSS) version 20.00 (IBM, SPSS Corp.; Armonk, NY, USA) software for statistical analyses. A p<0.05 was considered statistically significant. RESULTS: The mean age of the women participating in the survey was 33.03±7.1 years. Median age at marriage was 20 years, mean age at first pregnancy was 21 years, and mean number of pregnancies was 3.07 years, with 14.6% having had more than five pregnancies and 34.6% having experienced previous miscarriages. The mean number of live births was 2.2, and 21.5% of women had waited 24 months between pregnancies. Additionally, 77.7% reported using family planning of any kind, with 62.1% using the modern method. Women's ages at first marriage varied significantly depending on education (p<0.001) and working status (p<0.001), whereas ages at first pregnancy varied significantly depending on educational status (p<0.001). The total number of pregnancies varied significantly depending on level of education, working status, and family income (p<0.001). Times between two pregnancies among women with histories of more than two pregnancies differed significantly depending on educational status (p<0.05). CONCLUSION: The most important factors in women's fertility preferences are education, work, and income. Increasing women's educational levels can lead to safe and healthy pregnancies and births.

Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial.

BACKGROUND: Some research exists on the effect of non-pharmacological approaches for labor pain relief. However, there is limited information about effectiveness of breathing exercises in pregnant women to reduce maternal pain during labor. OBJECTIVE: To determine whether breathing exercises for pregnant women during the second stage of labor have beneficial effects on maternal pain, duration of labor, and the first-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This randomized clinical trial involved 250 pregnant women, who were randomly divided into two groups: intervention group (IG; n = 125) and control group (CG; n = 125). IG received one session breathing exercise training and performed breathing exercises during the second stage of labor versus the CG that did not receive any breathing exercise training. MAIN OUTCOME MEASURES: The effects of breathing exercises on maternal pain were determined by Visual Analogue Scale (VAS), duration of the second stage of labor, and the first-minute APGAR scores. RESULTS: The mean age of the participants was (23.2 ± 4.2) (range: 18 to 42) years. Both IG and CG had similar baseline characteristics in terms of age, education level, occupation, and smoking (P > 0.05). The mean VAS scores of IG and CG were (88.2 ± 6.3) and (90.5 ± 7.0), respectively (P < 0.001). The duration of the second stage of labor was (369.6 ± 92.0) s for IG and (440.7 ± 142.5) s for CG (P < 0.001). The mean first-minute APGAR scores were (8.84 ± 0.50) for IG and (8.73 ± 0.89) for CG (P > 0.05). CONCLUSION: Based on this study, breathing exercises with deep inhalation and exhalation in pregnant women are effective in reducing the perception of labor pain and shortening the duration of the second stage of delivery. Therefore, we recommend breathing exercises as an effective modality for labor pain management and shortening the duration of labor. TRIAL REGISTRATION: This study is registered on the website of ClinicalTrials.gov (www.clinicaltrials.gov) with the number of NCT03066973.

Willingness to Receive the Influenza A(H1N1) Vaccine and its Determinants among University Students during the 2009 Outbreak in Turkey.

OBJECTIVE: The study aimed to determine the willingness to receive the Influenza A(H1N1) vaccine and its determinants in a large group of university students. MATERIALS AND METHODS: This is a self-administered questionnairre based cross-sectional study. Students being educated at health and non-health faculties were invited to participate in this attitude survey. RESULTS: A total of 974 students were included in the study, of whom 51.3% (n=500) were in health related faculties. The rate of willingness to receive the Influenza A(H1N1) vaccine was 11.9 and 7.5% for health and non-health groups, respectively (p<0.05). For the health group, having been vaccined with seasonal influenza was a significant determinant of being willingness to receive the Influenza A(H1N1) vaccine (O.R [95% C.I.]), (O.R: 2.9 [1.5-5.6]) and to believe that the Influenza A(H1N1) vaccine prevents swine flu (O.R: 1.7 [1.09-2.8]). For the non-health group, the only determinant was to believe that Influenza A(H1N1) vaccine prevents from swine flu (O.R: 19.1 [5.7-64.1]) which found to be affected by confusing news in media. CONCLUSION: The public health professionals who will organize the efforts to improve the acceptability of Influenza A vaccines during influenza outbreaks should try to increase the vaccination rates of seasonal influenza. Information provided by the media should be organized in order not to cause fear and confusion, which was shown to decrease willingness and belief in the Influenza A(H1N1) vaccine.

The changing rate of suspected rabies bites after begin to act animal shelter in erzurum city.

OBJECTIVE: We aimed to evaluate the relationship between establishing an animal shelter in Erzurum and the number of suspected rabies bites between the years 2005 and 2012. MATERIALS AND METHODS: A retrospective, repeated cross-sectional study was planned in Erzurum in the year 2013. Records between the years 2005 and 2012 were obtained from the Communicable Diseases Department of the Erzurum Health Directorate. Data for 5789 cases exposed to suspected rabies bites were analyzed. RESULTS: 5789 suspected rabies bites were encountered in Erzurum between the years 2005 and 2012. After establishing the animal shelter in 2009, 4239 dogs were collected from the streets within four years and 426 of them were released after immunization. Additionally, the following services were given in the animal shelter between 2009 and 2012: immunization of 2935 dogs, sterilization of 1735 dogs, and release of 2082 dogs back to the street. 4-years before the establishment of the animal shelter, the number of dog-bites had decreased from 3403 cases to 2386 cases; 4-years after the establishment of the shelter, it declined by 29.8%. While there were 1096 suspected rabies cases during the year 2008, this ratio decreased by 40.9% after the establishment of the animal shelter in the year 2009. During the year 2010, where we had the highest number of homeless dog collection to the animal shelter, the decrease in suspected rabies bites reached the maximum decrease, namely 51.0%. Spearman correlation analysis showed a strong negative correlation between the number of collected animals and suspected rabies bites (r = -0,862; p=0.006). CONCLUSION: Suspected rabies cases are common in Turkey and some cases of rabies are encountered. The number of suspected rabies bites in Erzurum has decreased significantly after establishing the animal shelter. It is an evident that establishing rehabilitation centers for homeless animals in all cities will have an important role in controlling zoonotic diseases including rabies.

Animal-related injuries: epidemiological and meteorological features.

This is a retrospective and registry-based descriptive study including animal- related injuries represented by the most crowded Emergency Department (ED) in Eastern Turkey over a period of two years. Animal-related injuries were 0.2% of all ED admittances; dominant in males and were high in summer. 68% of the subjects were exposed to mammalians. Most prominent injuries were dog bites (30%), horse (22%) and livestock-related injuries (12%). Hospitalization was significantly higher in mammalian animal injuries compared to non-mammalian injuries. The highest hospitalization rate was measured for equine-related injuries (15%). In our bite series, dogs were the primary source (69%) while horse-bites (17%) took the second place and they were more than two fold more when compared with cats (7.5%). Dog bites were prominent in children, thus both parents and children should be educated. Insect and snake-related injuries were both low in number and relatively silent in prognosis. Highest temperatures on site were determined for tick-bites, unspecified insect stings and bee stings, respectively. The highest humidity was determined for dog-bites, cat-bites and scorpion stings, respectively. Nonmammalian and sting injuries had higher temperature and lower humidity measurements compared to mammalian and bite injuries. Geographical and meteorological factors may directly affect descriptive epidemiology of animal-related injuries.