Missed Opportunities for Coronary Heart Disease Diagnoses: Primary Care Experience

Cilj Istražiti propuštene prilike da se u primarnoj zdravstvenoj zaštiti otkriju postojeće koronarne srčane bolesti koje prethodno nisu bile dijagnosticirane i rizične čimbenike koji su povezani s njima. Methods Istraživanje je obuhvatilo 850 osoba starijih od 30 godina, koji u povijesti bolesti nisu imali koronarnu srčanu bolest, a bili su pacijenti centra primarne zdravstvene zaštite u prigradskom dijelu grada Antalya u Turskoj. Prikupili smo podatke o njihovoj dobi, spolu, stupnju izobrazbe, zdravstvenom osiguranju, prihodima, pušenju i fizičkim aktivnostima. Pacijente s nedijagnosticiranom koronarnom srčanom bolešću otkrili smo s pomoću Roseova upitnika, fizikalnim pregledom i elektrokardiogramom. Mjerili smo im visinu, težinu, krvni tlak, serumsku koncentraciju glukoze i kolesterola, a indeks tjelesne težine i omjer opsega struka i bokova smo izračunali. Svakom je pacijentu dodijeljen broj bodova za rizične čimbenike koji su uključivali dob, spol, pušenje, sistolički krvani tlak i koncentraciju kolesterola. Za svakoga je pojedinca izračunat rizik da u sljedećem desetljeću razvije koronarnu srčanu bolest. Rezultati Bilo je 126 (14.8%) prethodno nedijagnosticiranih slučajeva nedijagnosticirane koronarne srčane bolesti. Ukupni srednji (±standardna devijacija) broj bodova za rizik dobivanja koronarne srčane bolesti u sljedećem desetljeću bio je 6.1±6.8. Bolesti koje potiču razvitak koronarne srčane bolesti – hipertenzije, šećerne bolesti i hiperkolesterolemije otkrivene su u 255 (30.4%), odnosno u 70 (8.2%) i u 364 (43.4%) ispitanika. Debljina je utvrđena u 315 (37.1%) ispitanika, a 222 (26.1%) su bili pušači. Za osobe koje se koriste primarnom zdravstvenom zaštitom procijenjeni postotni rizik za razvitak koronarne srčane bolesti u sljedećem desetljeću bio je 7 do 45% za muškarce i 2 do 45% za žene. Zaključak U primarnoj se zdravstvenoj zaštiti propušta prilika za bolje otkrivanje koronarne srčane bolesti kao i topoglednih rizičnih čimbenika. Potrebno je poduzeti mjere da se oni na vrijeme otkrivaju.Aim To investigate missed opportunities to reveal existing but not formerly diagnosed coronary heart disease cases and related risk factors in primary health care. Methods The study comprised 850 people aged over 30 years with no known history of coronary heart disease, receiving health services from a primary care center located in a suburban area of Antalya, Turkey. Data on their age, gender, education level, health insurance status, income, smoking behavior, and physical activities were collected. Undiagnosed coronary heart disease patients were determined by the Rose questionnaire, physical examination, and electrocardiogram. Height and weight, blood pressure, serum glucose and cholesterol levels were measured, and body-mass index and waist-hip ratio calculated. Each patient was given a risk score regarding age, smoking behavior, tolic blood pressure, and cholesterol levels. Estimated risk ratio of each person for developing coronary heart disease in the next decade was determined. Results The number of formerly undiagnosed coronary heart disease cases was 126 (14.8%). Overall mean (±standard deviation) risk score for developing coronary heart disease in the next decade in study group was 6.1 ± 6.8. Diseases facilitating development of coronary heart disease: hypertension, diabetes, and hypercholesterolemia were present in 255 (30.4%), 70 (8.2%), and 364 (43.4%) participants, respectively. Obesity was detected in 315 (37.1%) subjects and there were 222 (26.1%) current smokers. For patients who attended primary health care, the estimated percentage risk for developing coronary heart disease in the next ten years was 7 to 45% in men and 2 to 45% in women. Conclusion Opportunities to reveal coronary heart disease and its risk factors are being missed in primary care. Measures should be taken to ensure timely diagnosis of coronary heart disease and related risk factors

The incidence of smoking and risk factors for smoking initiation in medical faculty students: cohort study

BACKGROUND: Medical education requires detailed investigation because it is a period during which the attitudes and behaviors of physicians develop. The purpose of this study was to calculate the yearly smoking prevalence and incidence rates of medical faculty students and to identify the risk factors for adopting smoking behaviour. METHODS: This is a cohort study in which every student was asked about their smoking habits at the time of first registration to the medical faculty, and was monitored every year. Smoking prevalence, yearly incidence of initiation of smoking and average years of smoking were calculated in analysis. RESULTS: At the time of registration, 21.8% of the students smoked. At the end of six years, males had smoked for an average of 2.6 ± 3.0 years and females for 1.0 ± 1.8 years (p < 0.05). Of the 93 medical students who were not smokers at the time of registration, 30 (32.3%) were smokers at the end of the 6 years of the course. CONCLUSION: The first 3 years of medical education are the most risky period for initiation of smoking. We found that factors such as being male, having a smoking friend in the same environment and having a high trait anxiety score were related to the initiation of smoking. Targeted smoking training should be mandatory for students in the Medical Faculty

Evaluation of Dermatology Residents Using the Multisource (360-Degree) Assessment Method

WOS: 000269255400003Objective: To test the applicability of the 360-degree assessment method of postgraduate medical education (dermatology) in a Turkish setting and discover the possible areas of improvement Design: Cross-sectional research Setting: Akdeniz University Faculty of Medicine, Antalya, Turkey Subjects and Methods: Using the competencies framework of the The American Accreditation Council for Graduate Medical Education (ACGME), a 71 item containing pool was formed. Based on evaluation aspects of possible evaluator groups, the pool was converted into seven different evaluation forms for the following groups: teachers (faculty), nurses, peers, secretaries, auxiliary staff, patients and self. All seven residents and members from each department voluntarily participated in the study. Data was collected over a period of three months. Main Outcome Measures: In the data analysis process, mean scores, and internal consistency scores were measured and evaluator groups' scores and resident's ranks in competency areas were compared to find out differences. Results: A total of 259 forms were filled out by seven groups to evaluate seven residents. All the staff in the dermatology clinic participated in the process. The reliability coefficient for the faculty members was 0.99 while it was 0.60 for the auxiliary staff. Low scores were clustered. I. Conclusions: Our results show that the 360-degree assessment is very well received by the evaluator group and residents and the method is acceptable in the Turkish setting of postgraduate dermatology specialist training. There is a need for larger sample study for other settings.Akdeniz University Research FoundationAkdeniz UniversityThis study was supported by Akdeniz University Research Foundation

Lower Urinary Tract Symptoms and Urinary Incontinence During Pregnancy

WOS: 000374988000007PubMed: 27111624Objective: Lower urinary tract symptoms (LUTS) can frequently be seen in pregnant women. Pregnancy and delivery have been considered as risk factors in the occurrence of pelvic floor dysfunction and determinants of LUTS. the main associated risk factor is parity. in the present study, we aim to determine the frequency of LUTS and urinary incontinence (UI) during pregnancy and the associated risk factors. Methods: This prospective study was carried out in a total of 250 women during their 28- and 40-gestational week checks. the Urinary Distress Inventory-6, the Incontinence Impact Questionnaire-7, and International Consultation on Incontinence Questionnaire-Short Form were used to determine LUTS and its effect on quality of life. Results: the mean age and gestational age of the participants were 29.41 +/- 5.70 year (range 18-44) and 35.45 +/- 2.98 weeks (range 28-40), respectively. the prevalence of LUTS was 81.6%. the prevalence of UI during pregnancy was 37.2%. Stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were diagnosed as 15.6, 4.8 and 16.8%, respectively. We found that advanced age, smoking and multiparity were risk factors associated with incontinence. Incontinence reduced pregnant women's quality of life. Conclusions: Lower urinary tract symptoms are commonly seen among pregnant women and these symptoms negatively affect the quality of life of pregnant women. Advanced age, smoking and multiparity were risk factors associated with urinary incontinence and LUTS. Obstetricians should be on the lookout for individual urological problems in pregnancy. Resolving any urological issues and cessation of smoking for the affected individuals will help alleviate the problem