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.

[Longitudinal Monitoring of Seroconversion Status in SARS-CoV-2 RT-PCR Positive Healthcare Workers]. / SARS-CoV-2 RT-PCR Pozitif Saglik Çalisanlarinda Serokonversiyon Durumunun Boylamsal Izlenmesi.

The impact of the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome 2 (SARS-CoV-2) still continues. The duration of the immune response in individuals recovering from COVID-19 and its protection against future SARS-CoV-2 infection are not fully understood. This study aimed to longitudinally evaluate anti-SARS-CoV-2 seroconversion status in healthcare workers with positive SARS-CoV-2 Real-time reverse transcription polymerase chain reaction (rRT-PCR), test in Mersin University Hospital. A total of 68 healthcare workers with positive SARS-CoV-2 rRT-PCR test between 19 April and 27 November 2020 were included in the study. Blood samples were collected from healthcare workers for SARS-CoV-2 antibody testing in the 1st, 3rd and 5th months following PCR positivity. Healthcare workers were classified as symptomatic, asymptomatic and reinfected according to their clinical findings, and rRT-PCR cycle thresholds (Ct) were recorded. Elecsys Anti-SARS-CoV-2 (Roche Diagnostics, Germany) kit was used for antibody testing. Of the 68 healthcare workers; 46 were classified as symptomatic, 15 as asymptomatic, and seven as reinfected. Twenty-seven (39.7%) of the healthcare workers were male and 41 (60.3%) were female, and the mean age was 36.4 ± 9.04. Seroconversion was detected in 45 (66.2%) of 68 healthcare workers in the study, and only one person had sero-negative result at the end of the 5th month. While seroconversion was detected in 78.3% (n= 36/46) of symptomatic healthcare workers, it was observed in 26.7% (n= 4/15) of the asymptomatic healthcare workers. Seroconversion was detected in only one of the seven reinfected healthcare workers after primary infection. After reinfection, seroconversion was observed in five of seven reinfected healthcare workers. Antibody response was not detected in two of them after both infections. According to the rRT-PCR Ct values; the median of Ct value was found significantly lower in healthcare workers with seroconversion (23.26, IQR= 18.45-27.30), than the ones without seroconversion (36.20, IQR= 33.09-37.56) (p< 0.001). In those who had reinfection, the mean Ct value (31.77 ± 6.62) detected during the primary infection period was statistically higher than the Ct value (22.44 ± 5.54) detected during reinfection (p= 0.008). The most frequently recorded symptoms in healthcare workers were myalgia (57.3%), fatigue (51.5%), headache (51.5%) followed by sore throat (36.7%), fever (33.8%), cough (27.9%), diarrhea (23.5%) and dyspnea (16.2%). In addition, fever (52%) and fatigue (80.6%) were found to be significantly higher in seroconversion-positive healthcare workers than in those without seroconversion (p= 0.028; p= 0.005, respectively). As a result, a higher rate of antibody response was detected in healthcare workers who had symptomatic infection than those who were asymptomatic. It has been observed that patients with asymptomatic primary infection and without antibody response were more susceptible to reinfection. In addition, it was observed that the probability of immune response increased when the viral load increased (Ct value decreased) in symptomatic infections. Although these findings provide important information about the short-term seroconversion status of healthcare personnel; longer-term and larger-scale studies are needed to evaluate the long-term effectiveness of seroconversion and to better understand the effectiveness of the immune response developed after SARS-CoV-2 vaccine administrations.

[Assessment of COVID-19 Risky Contact of Healthcare Workers in an University Hospital]. / Bir Üniversite Hastanesindeki Saglik Çalisanlarinin COVID-19 Riskli Temas Durumlarinin Degerlendirilmesi.

Healthcare workers are the group with the highest risk of COVID-19 transmission. The illness of healthcare workers poses a risk to patients admitted to the hospital, colleagues and households besides their own health. In this study, it was aimed to determine the risk assessment and the factors associated with risk status of an university hospital healthcare workers after risky COVID-19 contact. The data of the descriptive study were obtained from 773 follow-up records of 555 healthcare workers who applied with COVID-19 risky contact between 06.04-10.05.2020. Employees who were positive for RT-PCR evaluated as "patients" and others as "risky contact". Risk assessment was classified as no risk, low, medium and high risk contact according to the "Algorithm of Assessment of Health Workers with COVID-19 Contact" of the Ministry of Health. The relationship between the risk levels of the participants and their demographic and workplace characteristics and their usage of personal protection were evaluated. Mean, standard deviation, percentage, chi-square and ANOVA tests were used in the analysis of the data. The average age of the healthcare workers was determined as 34.4 ± 7.6 years. It was determined that 56.2% of those who had contact were female, 62.9% were married and 17.5% had an additional disease. It was determined that 45.6% of the risky contacts were nurses, 18.4% were supportive personnel and 16.9% were doctors. While 46.5% of the contacts were found as medium, 28.0% low, 17.1% high risk and 8.4% risk free. 38.2% of risky contacts occurred while working in internal/surgical clinics. While 66.0% of the employees had risky contact during patient care and treatment, 25% had risky contact with colleagues in social settings. High-risk contact was higher in social relations between employees. The source of the contact was a colleague in 73.2% of the employees. The average age of high-risk employees was smaller than those of low-risk. While 54.5% of the employees wore surgical masks during contact, 67.8% of the patients did not have a mask. Of 555 employees followed, 37 (6.7%) were diagnosed as COVID-19; 48.6% of the patients were nurses and 18.9% were doctors. It was determined that 48.6% of the healthcare workers were working in the COVID-19 service, outpatient clinic or intensive care unit at the time of diagnosis. The source of the infection was thought to be a colleague in 51.6% of the patients. COVID-19 was more common in nurses and doctors. It was determined that risky contact also occurred in services other than the units where COVID-19 patients were treated and risky contact often took place while providing healthcare to the patients and during social relations between the employees. Unprotected contact of the employees with each other in the workplace was identified as an important risk source. Inadequate use of personal protective equipment by healthcare workers led to an increase in medium and high risk contacts. The use of masks by patients and their relatives during the health service delivery and the proper use of personal protective equipment by healthcare professionals will reduce the risk. With the physical improvement of the rest areas of the employees and the arrangement of the breaks, the risky contact between colleagues in the social areas will be reduced.

Prevalence and risk factors of Internet addiction in high school students.

AIM: In this study, the prevalence and risk factors of Internet addiction in high school students was investigated. MATERIAL AND METHOD: This cross-sectional study was performed in the Mersin Province in 2012. The study sample consisted of students attending high school in the central district of Mersin. The data were summarized by descriptive statistics and compared by a binary logistic regression. RESULTS: Our study population included 1156 students, among whom 609 (52.7%) were male. The mean age of the students was 16.1 ± 0.9 years. Seventy-nine percent of the students had a computer at home, and 64.0% had a home Internet connection. In this study, 175 (15.1%) students were defined as Internet addicts. Whereas the addiction rate was 9.3% in girls, it was 20.4% in boys (P < 0.001). In this study, Internet addiction was found to have an independent relationship with gender, grade level, having a hobby, duration of daily computer use, depression and negative self-perception. CONCLUSION: According to our study results, the prevalence of Internet addiction was high among high school students. We recommend preventing Internet addiction among adolescents by building a healthy living environment around them, controlling the computer and Internet use, promoting book reading and providing treatment to those with a psychological problem.

A five year retrospective surveillance; monitoring and evaluation for the regional tuberculosis control programme in Mersin, Turkey, 2004-2008.

AIM: The aim of this study is to identify and evaluate problems in regional tuberculosis control studies, using an international tuberculosis indicator. METHODS: In this retrospective cohort study, the records of a total of 1,776 patients diagnosed with tuberculosis, followed up and treated from 2004-2008 in Mersin were evaluated. Indicators recommended by the World Health Organization were used as assessment criteria. Descriptive statistics were used to summarize data. The Mantel-Haenszel test was used for calculation of the risk between urban/rural, and between male/ female which were in different age groups. RESULTS: During the five year period, new case notification rates were reduced and tuberculosis risk shifted to advanced age groups in our region. Tuberculosis development risk increased two-fold among males (p < 0.001). One-fifth of the tuberculosis cases had been diagnosed without sputum smears. Sputum microscopy was not done at the end of the initial phase in one-fifth of patients. During the five-year follow-up period, tuberculosis treatment success rate increased from 83% to 91% and cure rate increased from 49% to 67%. The death rate, treatment failure rate, default rate, and transmission rate decreased, and the directly observed treatment implementation increased. CONCLUSION: Improvements were seen in diagnosis and treatment indicators beginning from 2006; the year when the directly supervised treatment application started. However, use of sputum smear microscopy is inadequate for the diagnosis and treatment of tuberculosis. Tuberculosis control studies should be monitored and evaluated using a tuberculosis indicator.

Knowledge of emergency contraception among women aged 15-49 years in Mersin, Turkey.

OBJECTIVE: To determine the knowledge of, use of and willingness to use emergency contraception (EC) among women in Turkey. STUDY DESIGN: This cross-sectional study was conducted among 1,298 women at 12 primary health care centers in Mersin. Chi-square, Student's t test, Mann-Whitney U and binary logistic regression tests were performed for statistical analysis. RESULTS: Overall, 18.1% of the women had heard of EC, and of those, 73.6% correctly identified the time limit for the method's use. Among women who had heard about EC, the most commonly cited source of information was health care centers. Knowledge of EC was independently associated with younger women, higher education, having received counseling about family planning, having had an unintended pregnancy, and being employed. Of women who had been sexually active, 4.4% reported having used EC. CONCLUSION: These data suggest that in general a low percentage of the study population has heard of EC. Health care providers and media have an important role to play in the education of women for accurate information about EC. Providing information about EC may help to prevent some unintended pregnancies and induced abortions.

Awareness of emergency contraception among university students in Mersin, Turkey.

AIM: The aim of this study is to determine the degree of knowledge, behavior and attitude of university students in Mersin towards emergency contraception (EC). MATERIAL & METHODS: This cross-sectional study was carried out among the students of the University of Mersin in December 2008. One thousand and forty-two voluntary students participated in this study and answered the questions presented in the self-administered questionnaire. The questionnaire consisted of demographic information and the students' awareness, knowledge and use of EC. RESULTS: The study sample consisted of 532 males and 510 females. The mean age of the participants was 20.4 ± 1.8. Overall, 149 (14.3%) students were aware of EC, and among those, 125 (83.9%) students correctly identified 72 h as the time limit for the methods to be used. The main sources of knowledge about EC were schools (38.9%), friends (18.8%), healthcare providers (17.4%), media (16.1%) and other sources (8.7%). EC awareness was positively associated with female gender, age, studying Health Sciences, father's level of education and level of monthly income. A total of 37 respondents (3.6%) reported that they had unprotected intercourse. Only 20 students or their partners had previously used emergency contraceptive pills. CONCLUSION: Awareness and knowledge of EC was low among the students of Mersin University. Our results demonstrated that males are less aware about EC when compared to females. We strongly recommend that education and counseling about sexual health and family planning be offered to this age group.

Assessment of Environmental Attitudes and Risk Perceptions among University Students in Mersin, Turkey.

BACKGROUND: Environmental destruction is one of the most important problems in this century. OBJECTIVE: The aim of the study was to determine the environmental attitudes and perceived risks associated with environmental factors of the students. METHODS: This cross-sectional study was conducted in 7 faculties of Mersin University. The research data were collected using a questionnaire. The questionnaire included sociodemographic characteristics, the "Environmental Attitudes Scale," and the "Environmental Risk Perception Scale." 774 students who filled out questionnaires were evaluated. RESULTS: The sample included 55.8% females. Environmental Attitudes Scale mean scores of students were identified as 81.1 ± 11.3. The highest perceived risk was release of radioactive materials associated with nuclear power generation. The environmental attitudes and risk perception scores were higher in Health Sciences than in the other faculties. Females were more positive towards the environment and had higher risk perceptions than the men. There is a negative correlation between age and resource depletion risk and global environmental risk score. CONCLUSION: Students had a positive attitude to the environment and had moderate-level risk perception about the environment. Environmental awareness of students, especially those studying in the Social Sciences, should be increased. The environmental education curriculum should be revised throughout all the courses.

Assessment of physical violence against research assistants and nurses in an university hospital / Evaluación de la violencia física contra investigadores asociados y enfermeras en un hospital universitario / Avaliação da violência física contra assistentes de pesquisa e enfermeiros em um hospital universitário

Abstract: 14. The aim of this study was to determine the prevalence of physical violence and related factors among assistants and nurses. This cross-sectional study was included 166 research assistants and 209 nurses who worked at the University Hospital. The data was collected with a self-administered questionnaire. As 12.0% participants had a history of physical violence at workplace within the last 6 months. The perpetrator was a patient relative in 41 (78.8%) and the patient himself/herself in 18 (34.6%).The most common place of violence was emergency unit for the assistants and in-patient unit for the nurses. The emergency unit was observed to have a higher incidence of violence than other departments. One of every ten health care workers appears to be a victim of physical workplace violence. Between health care workers with patient/the relatives of the patient of the impact on relations the close of violence to be examined separately according to occupational groups. As a result, professional differences between nurses and doctors should be taken into consideration while investigating health violence. Each professions of healthcare have different professional practice and ethical obligations on the relationship between health care provider and patient /relatives.

Resumen: 18. El objetivo de este estudio consiste en determinar la prevalencia de la violencia física y otros factores relacionados contra investigadores asociados y enfermeras. Este estudio transversal incluyó 166 investigadores asociados y 209 enfermeras trabajadores del hospital universitario. Los datos fueron recolectados mediante un cuestionario autoadministrado. 12% de los participantes informaron de violencia física en su lugar de trabajo en los últimos seis meses. El perpetrador fue un familiar de un paciente en 41 de los casos (78,8%) y pacientes en 18 casos (34,6%). La unidad de emergencia fue el lugar más común donde ocurrió la violencia para los investigadores asociados y la unidad de pacientes para las enfermeras. Se observó que la unidad de emergencia tuvo una mayor incidencia de violencia que otras unidades. Uno de cada 10 trabajadores de la salud es víctima de violencia física en el trabajo. Se examinó separadamente, según grupos de trabajo, el impacto en las relaciones de la violencia contra trabajadores de la salud por parte de pacientes o familiares de estos. Como resultado, se aconseja tener en consideración diferencias profesionales entre médicos y enfermeras cuando se investiga la violencia en el cuidado de la salud. Cada profesión del cuidado de la salud tiene diferentes prácticas profesionales y obligaciones éticas entre el proveedor de salud y el paciente y familiares.

Resumo: 22. O objetivo deste estudo foi determinar a prevalência de violência física e fatores relacionados entre assistentes e enfermeiros/as. Este estudo transversal incluiu 166 assistentes de pesquisa e 209 enfermeiras que trabalhavam no Hospital Universitário. Os dados foram coletados através de um questionário autoaplicável. Como resultado, 12,0% participantes apresentaram um histórico de violência física no local de trabalho nos últimos 6 meses. Como autores da violência foram identificados: os familiares dos pacientes em 41 questionários (78,8%) e o paciente em si em 18 (34,6%). O local mais comum de violência foi a unidade de emergência para os assistentes de pesquisa e a unidade de internação hospitalar para os enfermeiros/as. Na unidade de emergência, observou-se que há uma maior incidência de violência do que em outros departamentos. Um de cada dez trabalhadores na área de saúde demonstra ser vítima de violência física no local de trabalho. O impacto das relações de violência entre profissionais de saúde e pacientes/familiares deve ser examinado separadamente, de acordo com cada grupo ocupacional. Como resultado, diferenças profissionais entre médicos e enfermeiros/as devem ser consideradas ao investigar violência na área da saúde. Cada profissional de saúde possui diferentes práticas profissionais e obrigações éticas na relação entre médico e paciente / familiares.

Patients', who applied to the anesthesia clinic, perceptions and knowledge about anesthesia in Türkiye.

BACKGROUND: Pre-operative evaluation includes determining the patient's physiological and psychological situation, taking information about pharmacological and therapeutic history, laboratory examinations, and identifying the anesthesia risks. The aim of this study is to learn the patients', who planned for elective surgery, knowledge and perception about anesthesia, to determine the causes of fears, to investigate whether age, gender, education level, and history of operation affect the outcome of the survey. METHODS: A questionnaire consisting of 21 questions was asked to fill by the patients who applied to the anesthesia clinic. In our study, totally 250 patients, aged between 16 and 75 were included. The questionnaire consists of two parts: The first part includes demographic data such as age, gender, education level, occupation; the second part includes the questions about anesthesia experience and knowledge. RESULTS: Of the 250 patients studied, 59% were females and 41% were males. Of these patients, 37.6% had secondary education. As occupation, the highest percentage was belonging to the housewives (33.6%). In the second part of the questionnaire, it was showed that having an anesthesia experience and high education status statistically significantly affect the level of information about anesthesia (P=0.001; P=0.001). CONCLUSION: In this study, it was showed that there is an important relationship between education and past anesthesia experience and having information about anesthesia and anesthetists. But, generally it was also showed that the patients not having adequate information about anesthesia and anesthetists and to provide the public more informed about anesthesia, with hospital policies and studies of increasing education level, the individual attempts of anesthetists and continuous studies for anesthesia displaying are needed.

Lead and cadmium exposure in children living around a coal-mining area in Yatagan, Turkey.

The study was designed to determine asymptomatic lead poisoning prevalence and cadmium exposure of preschool children living in a coal-mining area in Yatagan, Mugla, Turkey. The research was conducted between May and June 2002. The study included 236 children (53.4% female and 46.6% male) who were identified among the healthy children between the ages of 6 months and 6 years, using a systematic sampling method, from the records of the local medical centre of Yatagan. Assessments of the levels of blood lead and cadmium were performed by an atomic absorption spectrophotometer, in the Department of Biophysics, Cerrahpasa Medical Faculty. The mean age of females and males were 49+/-18 and 43+/-19 months, respectively. The mean blood lead level was 33.8+/-15.6 microg/dL in females and 38.8+/-16.0 microg/dL in males. The mean blood lead level of the males was significantly higher than the females (P<0.05). Correlation analysis showed a statistically significant negative correlation between blood lead level and age in both sex groups (r= -0.367, P<0.001). The blood lead level was found to be > 10 microg/dL in 95.7% and >20 microg/dL in 87.6% of all children. The mean blood cadmium level of all children was 1.31+/-0.72 microg/dL. The blood cadmium level was found to be >0.5 microg/dL, which is considered to be toxic, in 85% of all children. The difference in blood cadmium levels between sexes was not significant. A statistically significant negative correlation was found between blood cadmium level and age of all children (r= -0.382, P<0.001). Although it is not possible to understand from this study what proportion of the biological lead and cadmium burden results from mining waste and what proportion comes from other sources, such as paint and gasoline residue deposited in soil and air, these results do indicate that asymptomatic lead poisoning and cadmium exposure are significant problems in children living in the Yatagan area. In conclusion, environmental lead measurements (house dust, soil, drinking water and air) must be performed, the results must be compared with the normal limits, and precautions must be taken if necessary in the Yatagan area. Future public health research efforts should focus on reducing the excessive levels of lead and cadmium in the environment.