Health reforms,primary health care services and nurses:What will future bring ?

Sağlık reformları sağlık hizmetlerinin finansmanı, sağlık hizmet sunumu, sağlık çalışanlarının konumu gibi pek çok konuda belirgin değişimler içerir. Dolayısıyla, sağlık reformları sadece sağlık çalışanlarını değil, toplumu ve toplumsal sağlık ölçütlerini de etkiler. Ülkemizde sağlık reformları ile ilgili yaşanan süreç küreselleşmenin bir sonucudur ve kamu yönetimi reformu ve sosyal güvenlik reformu gibi değişimlerin bir alt başlığı olarak kamusal sağlık hizmetlerinin özelleştirilmesini amaçlamaktadır. Genel Sağlık Sigortası ve Aile Hekimliği Modeli ile yapılandırılan sağlık reformları sağlık çalışanlarını, özellikle de hemşireleri niteliksiz ve ucuz emek gücüne dönüştürerek olumsuz etkileyecektir. Sağlık reformlarının bir diğer olası sonucu ise Temel Sağlık Hizmetlerinin ana öğelerinden, özellikle de koruyucu uygulamalardan vazgeçilmesi ve sağaltım öncelikli hizmet sunumuna geçilmesidir. Bu yaklaşım toplumun sağlık düzeyini olumsuz etkileyecek pek çok risk içermektedir.Health reforms include prominent transformation on many subjects as financing of health care services, presentation of health çare and status of health professionals. For this reason, health reforms effect not only health professonals but also community and their health measurements. In our country, health reform enterprise is a result of globalization and the main aim of this trend is to marketing of public health care services as a subtopic of reform on public management and social security. Health reforms, structered by General Health Insurence and Family Physician, will effect health professionals, especially nurses negatively by transforming their workpower to unqualified and cheaper. Another probable result of health reforms is attaching importance to treatment instead of Primary Health Care principles, especially preventive applications. This approach include many risks that will effect community health measurements negatively

The Effect of Adolescent Training Program on Risky Health Behaviours and Health Perception

Çalışma lise eğitimine devam eden ergenlerin riskli sağlık davranışlarının belirlenerek, bu davranışlardan korunma ve çözüm önerilerine yönelik modül bazlı eğitimler verilmesi (üreme sağlığı ve doğum kontrolü, cinsel yolla bulaşan infeksiyonlar, zararlı alışkanlıklar, psikososyal davranışlar) yoluyla öğrencilerin bilinçlendirilmesi amacıyla gerçekleştirilmiştir. Kesitsel tipte planlanan çalışma, Eylül 2013-Haziran 2014 tarihleri arasında, Zonguldak Merkez’deki üç devlet ve bir özel lisede eğitim gören, 14-19 yaş aralığında öğrencilerle yapılmıştır. Çalışmaya eğitim öncesi 926 ve eğitim sonrası 534 öğrenci katılmıştır. Ergenlere verilen riskli davranışları önleme eğitimlerinin sonucunda; şiddete yönelik tutumlar ölçeği, risk alma ölçeği ve toplumsal konumla ilgili risk alma, trafikle ilgili risk alma, madde kullanımı ile ilgili risk alma alt grup puanları ortalamalarının düştüğü belirlenmiştir. Ergenlerde sorunlarla başa çıkma ölçeği ve alt grupları, beslenme davranış ölçeği ve beslenme tutum ölçeği puanları ortalamalarında ise yükselme olmuştur. Yine hijyen, uyku, egzersiz gibi ergenin sağlık algısını yansıtan alan puanlarında yükselme olurken, karın ağrısı, baş ağrısı, halsizlik gibi somatik belirtileri gösteren alan puanlarında düşme olmuştur. Sonuç olarak; ergenlere riskli sağlık davranışları hakkında verilen eğitimin, riskli davranışlardan korunma ve olumlu sağlık algısı geliştirilmesi yönünde etkili olduğu görülmüştür.The aim of this study was to determine the risky health behaviors and to raise the awareness of adolescents (attending high school education) about prevention of risky behaviors and solutions by the effect of module-based training courses (about reproductive health and birth control, sexually transmitted infections, harmful habits, psychosocial behavior). Being planned as cross-sectional, this study was performed between September 2013-June 2014 in three states and a private high school in Zonguldak and conducted with a group of students aged between 14 and 19.926 students have participated before the training and 534 students have participated after training. It was seen that the mean scores of ‘The Adolescent Risk-Taking Questionnaire’, ‘The Adolescent’s Attitudes Towards Violence Scale’ and ‘taking risk about social status’, ‘traffic’, ‘subtance use’ subscales have decreased after the risk prevention trainings. The means scores of ‘Adolescent Coping with Problems Scale’, ‘Nutrition Behaviour Scale’ and ‘Nutrition Attitude Scale’ have raised. Hence, the scores of domains reflecting adolescent health perception such as hygiene, sleep and exercise have raised while the scores of somatic symptoms domain, such as abdominal pain, headache, and fatigue have been failed. Consequently, it was determined that the training courses about risky health behaviours were effective in preventing risky health behaviors and creating positive health perceptions of adolescents

Potentially Inappropriate Treatments in Intensive Care Units (INAPPT-ICU): Point Prevalence Study

Objective: Technological advances increased prolonged life expectancy of the terminal patients, who had end-stage diseases. End-of-life care in intensive care units (ICU) has increased with the rise in admissions of terminal patients to ICU. Our aims in this study were to determine the prevalence of terminal patients, and to find the reasons for potentially inappropriate treatments in ICUs. Materials and Methods: It was nationwide, multicenter, point prevalence and observational study. All adult patients, who stayed more than 48 h in the ICU, were enrolled. All patients were recorded on an electronic case record form, consisting of data on patient demographics, treatments, family participation and mini survey for physicians. The study was conducted on October 15, 2018 with a follow-up for 30 days. Results: Of 1127 patients 286 (25%) ICU patients were diagnosed as terminal patients by ICU physicians depending on primary physician statement. Terminal patients relatives requests and physicians legal concerns reduced end-of-life care quality. Terminal patients had significantly increased usage of mechanical ventilation, inotropic drugs, and poor end-of-life care quality (p0.001). Fifty-four percent of the terminal patients didn’t have any end-of-life decisions at discharge. Half of the terminal patient relatives requested the full code. Without legal concerns, most of the physicians would apply do not resuscitate (86%), withhold (77%) and withdraw (53%) to terminal patients at the end-of-life. Conclusion: Terminal patients occupy an important place in the ICU. To increase the quality of terminal patients’ end-of-life care in the ICU, advanced care planning and legal arrangements should be conducted properly

Alcohol consumption work related occupational injuries

İş kazaları çalışma yaşamı ile ilgili sağlık sorunları içinde hem adli durum hem de acil hizmeti gerektirmesi nedeniyle önemli bir konudur. Ülkemizde iş kazalarında alkollü olma sıklığını irdeleyen yeterli çalışma bulunmamaktadır. Yöntem: Bu çalışmada acil servis kayıtlarından sosyal sigorta kurumuna bildirilen iş kazası olgularından (n=1845) dosya kayıtlarında alkollü olma bilgisi bulunanlar (n=1110) geriye dönük olarak değerlendirildi. Sonuçlar: İş kazası olgularının % 7.2'sinin acil servis başvurusu sırasında alkollü olduğu saptandı. Değerlendirme: Bu doğrultuda, iş kazası yaralanmalarında alkol ve ilgili sorunların araştırılması ve kayıtlara yansıtılması ile neden sonuç ilişkilerini aydınlatmaya yönelik çalışmaların önünü açılacaktır.Objective: Occupational injuries are important in workplace because they require emergency health care and they have legal implications. There is not enough research done in our country about work-related injuries that occurred due to alcohol. Method: In this study 1845 occupational injury cases that were reported from emergency wards to the social security authority were evaluated retrospectively. Result: 7.2% of work-related-accident cases were found to have consumed alcohol prior to the accident at the emergency room admission. Discussion: It is necessary to explore and determine alcohol consumption and related problems with occupational injuries and records must be kept accordingly. Thus, helping future studies evaluating causality

Usefulness of APACHE-II, SOFA, ISARIC/WHO 4C Mortality Score and CO-RADS for Mortality Prediction of Critically Ill Coronavirus Disease-2019 Patients

Objective: It was aimed to report the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score, Sequential Organ Failure Assessment (SOFA) score, Glasgow coma scale (GCS), 4C mortality score and the coronavirus disease-2019 (COVID-19) Reporting and Data System (CO- RADS) in predicting the outcome of critically ill COVID-19 patients. Materials and Methods: Patients with laboratory-confirmed COVID-19 infection or clinical and radiological confirmed COVID-19 infection who were admitted to adult intensive care unit (ICU) were included. Clinical characteristics, outcomes, APACHE-II score, SOFA score, International Severe Acute Respiratory and Emerging Infections Consortium/World Health Organization 4C mortality score and CO-RADS classification were reported at admission. Results: Two hundred seventy six patients were included in this study. The mean age was higher in non-survivor patients. The most common cause of hospitalization was respiratory failure (67%). The common co-morbidities were hypertension (51.8%), cardiac disease (43.4%) and diabetes (33.6%). Organ failure was present in 61.5% of the patients. The mean APACHE-II, SOFA, GCS and 4C mortality scores were higher in non-survivor patients. 4C mortality and SOFA scores showed higher predictive accuracy for mortality with an area under the curve 0.736 and 0.706, respectively. 4C mortality had sensitivity of 78.9% and specificity of 58.1% whereas of SOFA had a sensitivity of 78.9% and a specificity of 53.3%. Conclusion: 4C mortality and SOFA scores could be a predictors of mortality in COVID-19 patients in the ICU