Why do European primary care physicians sometimes not think of, or act on, a possible cancer diagnosis? : A qualitative study

Funding The Swedish application for ethical approval was funded by the Jämtland Cancer and Nursing Foundation. The study had no other external fundingPeer reviewedPostprin

Effectiveness of combining patient follow-up with an educational intervention on self management skills of Type 2 Diabetes Mellitus patients: a primary care pragmatic trialcess: a single center survey analysis

Background: Self-management tools and programs have been developed to help Diabetes Mellitus (DM) patients manage their disease. However, these methods may not be very effective in patients with low health literacy. Research questions: Can a shared follow-up plan combined with education, facilitate patients’ diabetes self-management skills in primary care? Is this effect affected by patients’ current health literacy levels? Method: This is a non-randomized controlled clinical trial. We enrolled 84 Type 2 DM patients from three primary care centers in Istanbul, at least 40 participants being in the intervention (IG) and control groups (CG) (%80 power and %95 confidence level). A set of questions including patient characteristics, diabetes self-management scale and health literacy scale were used. Patients in the IG had three meetings with the researcher, in which, a \"DM Identity Card\" and a \"DM Diary\" developed by the researchers were given to the patients combined with an education session. The participants in the CG, were called by the researcher three times and briefly informed about DM. Diabetes self-management scale and health literacy scale were used. Results: The mean age of IG was 55,10(±8,40) and the CG was 59,51(±9,04). The participants of the both groups were predominantly female (IG: %58,5-CG: %60,5). After a three-months follow-up, the mean selfmanagement score of the IG increased from 65.53(SD=11,69) to 73.64(SD=11,50) (p<0,05), whereas the mean score of the CG increased from 57.3(SD=11,72) to 58.3(SD=9,36). No statistically significant relationship was found between the increase in self-management scores and the current health literacy of the participant (r=0,11 p>0,05). Conclusions: In conclusion, the follow-up method we developed with this study may increase the Type 2 DM patients’ selfmanagement skills regardless of the level of health literacy in primary care

Sarcopenia among Genders in Type 2 Diabetes Mellitus Patients Using Different Formulas of Bioimpedance Analysis

Objective: To assess the frequency of sarcopema in type 2 diabetes mellitus (DM) patients using different formulas of bioimpedance analysis (BIA) Study Design: Cross-sectional study. Place and Duration of Study: Obesity Clinic, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey, between March and June 2015. Methodology: The present study included DM patients at >= 18 years of age with BMI >= 30 kg/m(2). BIA measurements consisted of body weight, height, total muscle mass and sum of the muscle masses of the four limbs (ALM). Skeletal muscle index, total muscle index, skeletal muscle percentage, total muscle percentage, and ALM/BMI were used for muscle-related analyses. The data were presented as frequency, mean +/- standard deviation, and percentage Student t-test was used to compare differences between two independent groups. Results: A total of 295 DM patients were enrolled in the study, of whom 176 (59.66%) were females, 119 (40.34%) were males, 47 (15.93%) were over the age of 65 years, and the mean age was 53.39 +/- 10.39 years. Sarcopenia was determined in 40 males (33.61%) by body muscle ratio, in 15 males (12.60%) by ALM/BMI ratio, and in one male participant (0.84%) by skeletal muscle index. Among female participants, while sarcopenia was determined in 61 (34.65%) by body muscle ratio and in 1 (0.56%) by ALM/BMI ratio, no sarcopenia case was detected using skeletal muscle index. Conclusion: The frequency of sarcopenia in obese diabetic patients is found to be lower when skeletal muscle index and ALM/BMI ratio is used, but higher with body muscle ratio

What factors empower general practitioners for early cancer diagnosis? A 20-country european delphi study

BACKGROUND: Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. AIM: To identify the factors that affect European GPs\" empowerment in making an early diagnosis of cancer. METHODS: This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale.The final list of statements indicated those that were considered by consensus to be the most relevant. RESULTS: In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs\" working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. CONCLUSION: GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis

Evaluation of the Covid-19 vaccination process in Family Health Centers: A descriptive study

Giriş ve Amaç:Türkiye’de Covid-19 pandemisi ile mücadele kapsamında 13 Ocak 2021’den itibaren inaktif aşı olan Sinovac/Coronovac ve 12 Nisan 2021 tarihinden itibaren mRNA aşısı olan Pfizer/BioNTech uygulanmaya başlamıştır. Özellikle bir flakonunda birden fazla doz bulunan Pfizer/BioNTech aşısının kullanıma girmesi ile birlikte aşının uygulama alanına ulaştırılması, saklanması ve uygulanması sırasında çeşitli sorunlar yaşanmıştır. Bu çalışma, aşılamada etkin görev alan Aile Sağlığı Merkezleri (ASM) çalışanlarının Covid-19 aşılama sürecinde yaşanan zorluklara ilişkin deneyimlerini, aşılamayı etkileyen faktörler hakkındaki düşüncelerini ve çözüm önerilerini değerlendirmeyi ve bu bulgular ışığında benzer sorunların endüstri mühendisliği literatüründeki strateji ve yöntemleri kullanarak nasıl ele alınabileceğini tartışmayı amaçlamaktadır.Gereç ve Yöntem:Tanımlayıcı bir araştırmadır. ASM’de çalışan ve Covid-19 aşılaması yapan aile hekimi ve aile sağlığı çalışanları araştırmanın evrenini oluşturmuştur. Örneklem hesaplanmamış, çevrimiçi platformlar aracılığı ile katılımcılara erişilmiştir. Veriler 10.8.2021-10.10.2021 tarihleri arasında google forms kullanılarak bir anket ile toplanmıştır. Verilerin sıklık dağılımları Microsoft® Excel® for Microsoft 365 MSO (Version 2203 Build 16.0.15028.20152) 64-bit programda hesaplanmıştır.Bulgular:Araştırmamız toplamda 124 ASM çalışanı ile yürütülmüştür. Bunların 102’si hekim (%82,2), 22’si (%17,8) ise diğer sağlık çalışanlarından oluşmaktadır. Katılımcıların %80,6’sı bir flakonu açmak için aşı olacak 6 kişinin beklenmesi gerekliliğinin aşılama etkinliğini düşürdüğünü belirtmişlerdir. Covid-19 aşılama sürecinde yaşanan sorunları aşmak için katılımcıların % 75,2’si gün içinde mola vermeden çalıştıklarını ifade etmişlerdir.Sonuç:Covid-19 aşı uygulamalarında çok dozlu flakonlardaki aşılarda bir flakonu açmak için altı kişinin gerekliliği, randevu sisteminin etkin tasarlanamaması ve ASM’lerin günlük işleri ile aşılama randevularının çakışması benzeri aşı lojistiği ve yönetimi ile ilgili problemler yaşanmıştır. Bu sorunların endüstri mühendisliğinde yaygın şekilde kullanılan strateji ve yöntemler ile ele alınıp çözülebilecek nitelikte olduğu görülmektedir.Introduction and Aim: To overcome the effects of the Covid-19 pandemic, in Turkey, the inactivated vaccine Sinovac/ Coronovac and the mRNA vaccine Pfizer/BioNTech have been applied since January 13, 2021 and April 12, 2021 respectively. Especially with the introduction of Pfizer/BioNTech vaccine, which contains more than one dose in one vial, various problems have been experienced during the delivery, storage and application of the vaccine. This study aims to understand the challenges faced by practitioners in the Covid-19 vaccination process in Family Health Centers (FHC), determine the factors causing these difficulties and the solutions produced by the practitioners, and discuss how similar problems encountered in vaccination processes are addressed by the strategies and the methods in the industrial engineering literature. Materials and Methods: A descriptive study was planned. Family physicians and family health workers working in the FHC and vaccinating against Covid-19 formed the universe of the research. The sample was not calculated, the participants were accessed via online platforms (Google forms). Data were collected between 10.8.2021 and 10.10.2021. The frequency distributions of the data were calculated in Microsoft® Excel® for Microsoft 365 MSO (Version 2203 Build 16.0.15028.20152) 64-bit program. Results: Our research was conducted with a total of 124 FHC employees. Of these, 102 (82.2%) are physicians and 22 (17.8%) are other healthcare professionals. To the question “What are the factors that reduce the effectiveness of the vaccination that you experience during the Covid-19 vaccination process?” we asked the participants, 80.6% answered that 6 people to be vaccinated should wait to open a vial. 75.2% of the participants stated that they worked without taking a break during the day to overcome the problems during the Covid-19 vaccination process. Conclusion: Various problems related to vaccine logistics and management have been identified such as the requirement of gathering six people to be able to administer the Pfizer/BioNTech vaccine, the inability to design an effective appointment system, and the conflicts of the routine work of FHCs and the vaccine administration tasks. These problems can be handled and solved with the strategies and methods commonly used in the industrial engineering literatur

Birinci basamakta hasta-hekim iş birliği ile oluşturulan ortak takip planının tip 2 diyabetes mellitus hastalarının öz yönetimine etkisi: randomize olmayan kontrollü bir çalışma

Giriş: Tip 2 Diayabetes Mellitus(DM) hastalarına yönelik, komplikasyonları önlemeye, geciktirmeye yardımcı olmak ve diyabetlerini yönetmeyi öğrenmelerini sağlamak için bir dizi kendi kendine yönetim araçları ve programlar geliştirilmiştir. Ancak bu yöntemler sağlık okur yazarlığı(SOY) düşük bireylerde çok etkili olmayabilir. Bu çalışmanın amacı; birinci basamakta diyabet yönetimi ve takibini kolaylaştırmak için hekimle hastanın birlikte geliştireceği ortak takip planını içeren müdahalenin diyabet özyönetim düzeyine etkisini ve bu etkinin hastaların mevcut SOY düzeyleriyle ilişkisini değerlendirmektir. Yöntem: Bu araştırma randomize olmayan kontrollü klinik çalışma olarak yapılmıştır. İstanbul ili Pendik ilçesinde bulunan 3 aile sağlığı merkezinden(ASM) müdahale(MG) ve kontrol(KG) gruplarında %95 güven aralığında %80 güçle yapılan örneklem hesabına göre en az 40’ar katılımcı ve grupları oluşturan katılımcılar farklı ASMlerden olacak şekilde 84 DM hastası ile çalışma yürütülmüştür. İlk görüşmede tüm katılımcılara diyabet özyönetim ölçeği ve SOY ölçeği uygulanmıştır. MG ile ayda bir kere görüşme yapılarak DM hastalığına ve komplikasyonlarına yönelik eğitim verilmiş, araştırmacılar tarafından geliştirilmiş kolay anlaşılabilir ve doldurulabilir takip araçları; diyabet kimlik kartı ve diyabet günlüğü hastalara verilerek hastalarla birlikte bir takip planı yapılmıştır. KG oluşturan katılımcılarla ayda bir kere telefon ile DM hastalığına yönelik bilgilendirmeleri içeren görüşmeler yapılmıştır. Üçüncü ayda tüm katılımcılara diyabet özyönetim ölçeği yeniden uygulanmıştır. Gruplar independent samples T test ile karşılaştırılmıştır. Bulgular: Katılımcıların yaş ortalaması MGde 54,97±8,20, KGde 59,00±8,82dir. Gruplar arasında SOY düzeyleri arasında fark bulunmamakta iken özyeterlilik MG daha yüksek bulunmuştur. Araştırma sonunda yapılan son test değerlerine göre MG özyönetim puanı 65,53’ten 73,64’e yükselmiştir(p<0.05), KG puanı ise 57,34’ten 58,26’ya yükselmiştir(p>0.05). Katılımcılara yapılan müdahale sonrası özyönetim puanlarının artışı ile mevcut SOY arasında istatistiksel olarak anlamlı bir ilişki bulunamamıştır. Sonuç: Bu çalışma ile geliştirdiğimiz ortaklaşa plan ve takip yönteminin, birinci basamakta SOY hangi düzeyde olursa olsun DM hastalarının özyönetimlerini artırılabileceği sonucuna varılmıştı

The process of diagnosis of cancer and the effect of the primary care in this process: a single center survey analysis

Background: Cancer diagnosis process can be affected by many factors related to the patient, physician and health system. In order to increase early diagnosis, problems at each step should be determined and precautions should be taken. There are studies showing that cancer misdiagnosis constitutes the majority of diagnostic errors in primary care. In this study, our aim is to determine the factors affecting the timely diagnosis of cancer and the role of primary care in this process. Research questions: What are the effects of primary care and other effective factors in the cancer diagnosis process? Method: Our research has conducted in various outpatient clinics of Marmara Univercity Pendik Training and Research Hospital, between February 1 and May 31, 2019. Aged over 18 and diagnosed with cancer in the last six months included. The data collected through a questionnaire, by face-to-face interview. Results: 176 patients with a mean age of 55 participated, 45% of them stated that they applied to the primary care first when they had a complaint. Median time between first recognizing the sypmtoms to admission was 30 days. 45% of the patients stated that they waited for the symptoms to go away on their own. The mean time from the first suspicion of cancer to diagnosis was 39.7 days.19% of them stated that they applied to primary care with the symptoms that were present at the time of diagnosis. There was no significant difference between the diagnostic interval and diagnosis stage and the health institution patients first applied. Conclusions: There is no referral system in our country, patients can apply to any health institution. In our study, there was no relationship between admission steps and early diagnosis. Primary care has a significant advantage in the early diagnosis of cancer with its accessibility and holistic approach, its role in this field needs to be increased

I should live and finish it: A qualitative inquiry into Turkish women's menopause experience

Background: While bio-medically, menopause could be treated as an illness, from a psychosocial and cultural perspective it could be seen as a natural process without requiring medication unless severe symptoms are present. Our objective is to explore the perceptions of Turkish women regarding menopause and Hormone Therapy (HT) to provide health care workers with an insight into the needs and expectations of postmenopausal women. Methods: A qualitative inquiry through semi-structured, in-depth interviews was used to explore the study questions. We used a purposive sampling and included an equal number of participants who complained about the climacteric symptoms and those who visited the outpatient department for a problem other than climacteric symptoms but when asked declared that they had been experiencing climacteric symptoms. The interview questions focused on two areas; 1) knowledge, experiences, attitudes and beliefs about menopause and; 2) menopause-related experiences and ways to cope with menopause and perception of HT. Results: Most of the participants defined menopause as a natural transition process that one should go through. Cleanliness, maturity, comfort of not having a period and positive changes in health behaviour were the concepts positively attributed to menopause, whereas hot flushes, getting old and difficulties in relationships were the negatives. Osteoporosis was an important concern for most of the participants. To deal with the symptoms, the non-pharmacological options were mostly favoured. Conclusion: To our knowledge, this is the first qualitative study which focuses on Turkish women's menopausal experiences. Menopause was thought to be a natural process which was characterised by positive and negative features. Understanding these features and their implications in these women's lives may assist healthcare workers in helping their clients with menopause

Frequency and Risk Factors of Sleep Problems Among High School Students Who Will Undergo University Entrance Exam as a Stressful Experience

Objective: Prevalence of sleep disturbances is 15-35%, which is more frequent during adolescence. Stress is known to cause sleep disturbance, in particular insomnia. In this study it is aimed to evaluate the frequency of sleep disturbances among high school students who will undergo a university entrance exam as a stress factor, and relationship of sleep disturbances with the suggested variables. Material and Methods: This descriptive study was conducted in four different types of high schools and a private university preparing exam course in Istanbul. One senior and one junior class from all schools and four classes from the private course were selected by simple randomization and all students were invited to take place in the study. Of the students, 324 accepted to participate and 302 who fully-filled questionnaires were included in the analysis. A self-report questionnaire about main symptoms of sleep disorders and gastro-esophageal reflux, chronic wheezing or cough at nights, coffee and/or tea intake, alcohol and drug use, cigarette smoking, history of chronic diseases and current medications was used to get the data. Chi-square, Student's t-test and binary logistic regression analysis were used. Results: Of the participants, 33.4% (101) reported excessive daytime sleepiness. The participants who reported insomnia were %20.2 (61). The risk factors for insomnia were; addictive drug use, chronic cough and wheezing and depressive symptoms [Odds ratio (OR): 7.33-95% CI: 1.67-32.30, OR: 2.43-95% Cl: 1.31-4.64, 95% OR: 2.10-CI: 1.01-4.10 respectively]. The number of participants who declared that they had sleep disturbances was 121 (40.1%), and 75(24.8%) of the participants reported Obstructive Sleep Apnea (OSA) symptoms. The risk factors for OSA symptoms were; chronic cough and wheezing, gastro-esophageal reflux symptoms and being overweight-obese (OR: 5.07-95% CI: 2.62-9.84, OR: 2.85-95% CI; 1.75-4.67, OR: 95%3.74-CI: 1.75-7.99 respectively). Conclusion: Although sleep difficulties seemed to be very common, this was related to obesity, chronic cough, gastro-esophageal reflux symptoms, cigarette smoking, addictive drug use and depressive symptoms more than exam stress. Thus the students with asthma and those who are overweight may be asked and managed about sleep disorders

Is there a role for the family and close community to help reduce the risk of postpartum depression in new mothers? A cross-sectional study of Turkish women

Objectives Postpartum depression is an important and under-diagnosed problem. The aims of this study were (1) to compare the prevalence of depressive symptomology in Turkish mothers who were 1-3 months postpartum with the prevalence of depressive symptomology in mothers who had not been pregnant for at least 1 year, (2) to identify risk factors associated with depression in both groups, and (3) to examine the effect of postpartum depression on breastfeeding by the mothers. Design Cross-sectional study Setting Well-baby clinic Participants 326 women enrolled in January 2001; 163 were 1-3 months postpartum, and 163 had not been pregnant in the previous year. Results The prevalence of depressive symptomology in the postpartum and non-postpartum groups was 17% (28/163) and 24.5% (40/163), respectively; this was not statistically significant (P = 0.102). When we compared mean Beck Depression Inventory (BDI) scores, the difference between the two groups was statistically significant (10.75 +/- 8.06 and 12.63 +/- 8.81, respectively, P = 0.045). Premenstrual tension and a history of depression were risk factors for depressive symptomology in both groups. Three or more births and a history of induced abortion were risk factors for depressive symptomology in the non-postpartum group. In the postpartum group, the effect of depression on breast-feeding was not statistically significant (P = 0.7). The generalisability of the study results to the community is limited. Conclusion In this study, the prevalence of depressive symptomology in the postpartum and non-postpartum groups did not show a significant difference, but the prevalence of depressive symptomology was high in both groups. Postpartum depression did not have a negative effect on breast-feeding. Lower BDI scores in the postpartum period may be the result of the protective factors of motherhood which is a respected status for women in populations where the preservations of traditions and customs are valued