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A limited number of studies have investigated in detail the use of drugs during pregnancy. Researchers in the present study investigated the details of drug utilization in pregnant women during the month before pregnancy, at the time that they became aware of the pregnancy, and during the first trimester. Face-to-face interviews were conducted with 359 pregnant women who were admitted to the fetal medicine unit at a university hospital for diagnosis and follow-up. A questionnaire was used to document sociodemographic characteristics and details of drug use. Drugs were categorized according to the US Food and Drug Administration fetal risk classification. Mean maternal age was 29.9+/-5.1 y, and mean gestational age was 19.6+/-9.5 wk. Many of the pregnant women studied (46.6%) were university graduates, and most (61.9%) had a relatively high annual income. Mean gestational age when participants first learned of their pregnancy was 39.8+/-16.4 d. One hundred seventeen participants (32.6%) used drugs during the month before conception, 54 (15%) at the time when they learned of their pregnancy, 180 (50.1%) at the time of the interview, and 289 (80.5%) during the first trimester. The percentages of drugs in categories D and X used by these subjects were 14%, 13.5%, 2.9%, and 5.9%, respectively. Most of the drugs were hormones. The total rate of drug utilization was not high before and during the first trimester of pregnancy. A considerable number of women were using drugs from the D and X categories; however, these numbers decreased significantly when women learned of their pregnancies. Intake of folic acid, vitamins, and iron was very low during the preconception period and was not high enough during the first trimester; this suggests that particular attention should be paid to the use of beneficial "safe" drugs during the preconception and early pregnancy periods. [ABSTRACT FROM AUTHOR]

Abstract Background Opinion surveys about potential causes of violence against women (VAW) are uncommon. This study explores academic women's opinions about VAW and the ways of reducing violence. Methods Quantitative and qualitative methods were used in this descriptive study. One hundred-and-fifteen academicians participated in the study from two universities. A questionnaire was used regarding the definition and the causes of VAW, the risk groups and opinions about the solutions. Additionally, two authors interviewed 8 academicians from universities other than that of the interviewing author. Results Academicians discussed the problem from the perspective of "gender-based violence" rather than "family violence". The majority of the participants stated that nonworking women of low socioeconomic status are most at risk for VAW. They indicated that psychological violence is more prevalent against educated women, whilst physical violence is more likely to occur against uneducated and nonworking women. Perpetrator related factors were the most frequently stated causes of VAW. Thirty-five percent of the academicians defined themselves as at risk of some act of VAW. Recommendations for actions against violence were empowerment of women, increasing the educational levels in the society, and legal measures. Conclusions Academic women introduced an ecological approach for the explanation of VAW by stressing the importance of taking into account the global context of the occurrence of VAW. Similar studies with various community members -including men- will help to define targeted interventions.

This study examined cognitive flexibility and social responsiveness in children and adolescents with Tourette Syndrome (TS). Thirty one subjects with TS were compared to 32 age-matched healthy controls. Assessments included semi-structured interviews to assess psychopathology, parent-rated Social Responsiveness Scale (SRS) and a brief neuropsychological battery selected as measures of cognitive flexibility. Completion time for both Trail Making Tests (TMT-A and TMT-B) were significantly longer for TS group than controls, however the difference in perseverative errors on Wisconsin Card Sorting Test (WCST) was not significant. SRS total score was significantly higher in the TS group compared to controls, indicating greater impairment in social responsiveness. Group difference for TMTs and SRS failed to reach significance after controlling for co-occurring conditions. Clinicians might consider social impairment in the evaluation plan of children and adolescents with Tourette syndrome.

This study examined compulsive-like behaviors (CLBs) which are higher-order types of Repetitive Behaviors And Restricted Interests (RBRIs) in typically developing children in Turkey. Caregivers of 1,204 children between 8 and 72 months were interviewed with Childhood Routines Inventory (CRI) by trained interviewers in a cross-sectional survey. Factor analysis of the CRI revealed two factor structures comprising "just right behaviors" and "repetitive/sensory sensitivity behaviors". CLB frequency peaked at 2-4 years with declines after age four. In contrast to the previous CRI studies reporting no gender difference, CLBs were more common in males in 12-23 and 48-59 month age groups on both total CLB frequency and repetitive/sensory sensitivity behaviors. Also ages of onsets for CRI items were somewhat later than reported in other samples. Our findings supported the findings of the previous CRI studies while also revealing new perspectives in need of further investigation.

This paper presents evidence from research into health system challenges of cardiovascular disease (CVD) and diabetes in four Eastern Mediterranean countries: the occupied Palestinian territory, Syria, Tunisia and Turkey. We address two questions. How has the health system in each country been conceptualised and organised to manage the provision of care for those with CVD or diabetes? And what were key concerns about the institutional ability to address this challenge? Research took place from 2009 to 2010, shortly before the political upheavals in the region, and notably in Syria and Tunisia. Data collection involved a review of key documents, interviews with key informants and brief data collection in clinics. In analysing the data, we adopted the analytical schema proposed by Walt and Gilson, distinguishing content, actors, context and process. Key findings from each country highlighted concerns about fragmented provision and a lack of coordination. Specific concerns included: the lack of patient referral pathways, functioning health information systems and investment in staff. Regarding issues underlying these 'visible' problems in managing these diseases, we highlight implications of the wider systemic pressure for reform of health-sector finance in each country, based on neoliberal models.

There is no consensus on whether or not the diagnostic criteria of metabolic syndrome (MS) defined for adults [National Cholesterol Education Panel (NCEP) and World Health Organization (WHO)] can be used in childhood as well. We aimed to compare prevalence of metabolic syndrome among obese children and adolescents using WHO and NCEP guidelines. A total of 112 obese children and adolescents were assessed. MS was diagnosed according to both modified WHO and NCEP criteria using cut-off values for children. Abnormal glucose homeostasis was identified in 46.6% of the subjects. Fasting glucose levels for all subjects were less than 110 mg/dl and no subjects had type 2 diabetes. Overall, dyslipidemia was present in 42.9% and hypertension in 42.9% of the subjects. While 24% of the subjects were diagnosed as MS according to NCEP, a rate of 38.8% were diagnosed according to WHO-defined MS. There was a moderate agreement between NCEP and WHO guidelines. More children were diagnosed as MS based on the WHO guidelines. This may lead to better monitoring for these children and prevention of their chronic diseases in the future. Therefore, we recommend using WHO guidelines in the diagnosis of MS with a specific emphasis on definition of abnormal glucose homeostasis.

Streptococcus pneumoniae carriage is a risk factor for the development of respiratory system infections and the spread of penicillin-resistant strains. The aim of this study was to investigate nasopharyngeal carriage of S. pneumoniae in healthy children and resistance to penicillin and other antimicrobials and to assess related risk factors. Nasopharyngeal specimens collected from healthy children less than six years of age, visiting a Mother and Child Health Center for health control, were investigated microbiologically between February-March 2004. Carriage rate was 37.2% (n=112/301); 33.9% intermediate and 5.4% high penicillin resistance were detected. According to multivariate analysis, carriage rate was inversely related to number of rooms (OR:0.574) and child age (OR:0.978), while penicillin resistance was correlated well with antibiotic use in the last two months (OR:2.193). Decreased sensitivity plus resistance to other antimicrobials were: trimethoprim-sulfamethoxazole (TMP-SMX) 45.6%; erythromycin 16.1%, tetracycline 16.1%; clindamycin 9.8%, and ofloxacin 3.6% in pneumococcal isolates, which increased significantly (p<0.05) to 72.7%, 31.8%, 27.3%, 20.5%, and 6.8%, respectively, in penicillin non-sensitive S. pneumoniae (PNSSP) except for ofloxacin. Overall multidrug resistance was 17.9%, while PNSSP exhibited a resistance rate of 38.6%. In conclusion, S. pneumoniae carriage rates determined in healthy children were high and PNSSP strains also showed increased resistance to other antimicrobials.

Objective: Since irrational use of antihypertensives has considerable clinical and economical consequences, this study was conducted to evaluate antihypertensive drug utilization in hypertension at seven State Health Centres in Istanbul., Method: A total of 297 hypertensive patients who accepted to participate in the study were evaluated by a face-to-face questionnaire and a copy of their prescriptions were collected for prescription analysis., Results: Angiotensin-converting enzyme (ACE) inhibitors (31.7%), calcium channel blockers (28.8%), diuretics (16.2%), beta blockers (7.5%) and others (15.8%) have been prescribed. There were no statistically significant relation between prescribed antihypertensive drug groups and gender, age, and NSAIDs co-prescribing. The most frequent comorbidity in hypertensive patients was diabetes mellitus (10.4%) and calcium channel blockers (35.5%) have been prescribed to them as a first antihypertensive medication. Average cost per prescription was $42.7 +/- 38.1. According to the patients' self-reporting, the majority of them (85%) were prescribed without a physical examination. The physicians failed to write the prescriptions appropriately; only 5% of the scripts contained all information about the drug(s) and use instructions in full format., Conclusion: The present study indicates that GPs working at primary healthcare centres were rational in terms of antihypertensive drug choice. However, they poorly applied rational pharmacotherapy principles such as (a) writing a "good" prescription which is easily readable by the pharmacist and the patient and that contains full essential information; (b) a medical examination of the patient to assess her/his current clinical condition; and (c) taking care of not prescribing drugs with potential interaction like antihypertensives and NSAIDs together.

Tobacco smoke exposure is an important and preventable cause of morbidity among children. Enviromental tobacco smoke (ETS) increases respiratory symptoms and disease and also decreases lung function in children who live in a household with at least one smoker. We have developed a simple and reliable HPLC method with diode array dedection to determine the urine concentrations of cotinine in children aged 3 to 6 years, exposed to ETS. The assay involved a liquid-liquid extraction with chloroform. The HPLC method utilized a Chromasil C18 column (150 mm x 4.6 mm i.d.) and an isocratic mobile phase of phosphate buffer: acetonitrile (83:17 v/v, 0.02 M containing 0.1% triethylamine, adjusted to pH 6.72 with orthophosphoric acid), at a flow rate of 0.7 ml min(-1). The detection was performed at 260 nm and the total analysis time of analysis was less than 15 min. Linearity ranged from 0 to 80 microg L(-1); correlation coefficients (r2) for calibration curves were greater than 0.99. With 2 mL of urine for extraction, the limit of detection was 0.1 microg L(-1). The mean extraction ratio of cotinine was 88.78%. This analytical method is suitable for the determination of cotinine levels in a large number of urine samples.

Objective: Providing adequate information to the patients about their drugs is an essential principle of rational pharmacotherapy. This study investigates the knowledge of general practice patients about their drugs, since the level of knowledge of the patient about the medication is highly associated with the outcome of the therapy., Methods: A total of 1618 patients who applied to primary healthcare centers in Istanbul and accepted to participate in the study were asked about the name(s) and effect(s) of the drug(s) on their prescriptions. Factors that might influence the background knowledge and perception of patients such as sociodemographic characteristics, drug-use habits and practitioners' attitudes were also questioned. Information provided by the patients was compared with the prescriptions., Results: Only 10.9% of the respondents could recall the names of their drug(s) correctly. Level of education, and gender, had a positive impact on recalling drug names. Patients, who received a refill prescription, with a chronic disease, and who had self-medication before applying to the health center reported more accurate information. Less than half of the practitioners had informed their patients about the drug effects; and 7% of the patients have been requested to repeat the instructions and warnings about his/her medication(s). The patients to name their drugs correctly also knew the drug effects twice as much the patients who could not recall their drug(s)' name. The drugs which were correctly named were the ones used in chronic diseases., Conclusion: It appears that patients, particularly who are poorly educated, males, and who received a first prescription know little about their prescribed drugs. These results suggest that patients' education about drugs is an important issue regarding rational drug use which deserves urgent improvement., (Copyright 2004 John Wiley & Sons, Ltd.)

Premature infants are at high risk of developing candidal infections originating from their own normal flora or from the hospital environment. This study involves the surveillance cultures and blood cultures of candidemic preterm infants with low birth weights who have been analyzed for colonization period and status, and for virulence factors such as acid proteinase and phospholipase. Arbitrarily primed-polymerase chain reaction (AP-PCR) was applied to the blood culture isolates of the babies with candidemia and their last colonizing strains in order to determine whether the source of fungemia was the rectum. Of 65 colonized infants, 6.2% developed candidemia with identical strains originating from their rectum according to their PCR patterns. Our findings indicate that the properties of the colonizing yeasts such as increase in number--although not statistically significant because of the small sample size--and/or exhibition of strong hydrolytic enzyme activities through a long duration of colonization might contribute to the development of candidemia in preterms.

Objective: In the present study, prescribing behavior of general practitioners (GPs) was investigated in the example of childhood upper and lower respiratory-tract infections (URTIs and LRTIs)., Study Design: A face-to-face interview was performed with 352 parents admitted to seven primary health care centers for their children diagnosed with URTI or LRTI. Prescriptions ( n=331) written by 25 GPs working at these centers were analyzed regarding legibility, format and suitability of drug choice., Results: Almost 60% of parents had self-medicated their children prior to admitting to the doctor. Of the patients, 29 (8.2%) were not examined by the physicians, but were directly prescribed medicine. The physicians did not tell the diagnosis to 25.3% of the patients, did not inform 41.2% of them about the drugs and did not caution 95.7% about the side effects. Further, the physicians did not inform 42.6% of the patients about drug use instructions, did not inform 83.5% about the warnings and did not inform 81.2% about non-drug treatment. Approximately 5% of the individuals remembered the name of the drugs. Only 26.3% of the prescriptions were easily readable, and only five scripts (1.5%) contained all necessary information. The majority of the patients were given antibiotics, penicillin+beta lactamase inhibitors being the first. Paracetamol was the most frequently prescribed analgesic/antipyretic for both indications, followed by nimesulide and ibuprofen., Conclusions: The present study revealed inappropriate drug use in the treatment of respiratory-tract infections in children at the primary health care level in a district of Istanbul, Turkey. Furthermore, it has been shown that GPs practicing at primary health care centers should be trained to give adequate information about the disease and the treatment to the patients/parents to achieve good compliance and optimal drug therapy for children.

Aims: The impact of a short postgraduate course on rational pharmacotherapy planning behaviour of general practitioners (GP) was investigated via a face-to-face interview with 25 GPs working at health centres in Istanbul., Methods: GPs were randomly allocated to control and intervention groups. Intervention group attended a 3-day-training program preceded and followed by a written exam to plan treatment for simulated cases with a selected indication. The participants' therapeutic competence was also tested at the post-test for an unexposed indication to show the transfer effect of the course. In addition, patients treated by these GP's were interviewed and the prescriptions were analysed regarding rational use of drugs (RUD) principles at the baseline, 2 weeks and 4 months after the course., Results: At the baseline there was not any significant difference between the control and intervention groups in terms of irrational prescribing habits. The questionnaires revealed that the GPs were not applying RUD rules in making their treatment plans and they were not educating their patients efficiently. Training produced a significant improvement in prescribing habits of the intervention group, which was preserved for 4 months after the course. However, very low scores of the pretest indicate the urgent necessity for solutions., Conclusions: Training medical doctors on RUD not only at the under- but also at the postgraduate level deserves attention and should be considered by all sides of the problem including academia, health authorities and medical associations.

Objectives: To investigate for the first time the prevalence of diabetes and impaired glucose tolerance (IGT) nationwide in Turkey; to assess regional variations and relationships between glucose intolerance and lifestyle and physical risk factors., Research Design and Methods: The Turkish Diabetes Epidemiology Study (TURDEP) is a cross-sectional, population-based survey that included 24,788 subjects (age > or =20 years, women 55%, response 85%). Glucose tolerance was classified according to World Health Organization recommendations on the basis of 2-h blood glucose values., Results: Crude prevalence of diabetes was 7.2% (previously undiagnosed, 2.3%) and of IGT, 6.7% (age-standardized to world and European populations, 7.9 and 7.0%). Both were more frequent in women than men (P < 0.0001) and in those living in urban rather than rural communities (P < 0.001). Prevalence rates of hypertension and obesity were 29 and 22%, respectively. Both were more common among women than men (P < 0.0001). Prevalence of diabetes and IGT increased with rising BMI, waist-to-hip ratio (WHR), and waist girth (P < 0.0001). Multiple logistic regression analysis revealed that age, BMI, WHR, familial diabetes, and hypertension were independently associated with diabetes, age, BMI, WHR, familial diabetes, and hypertension with IGT (except for familial diabetes in women with IGT). Education was related to diabetes in men but was protective for diabetes and IGT in women. Socioeconomic status appeared to decrease the risk of IGT in men while it increased the risk in women. Smoking had a protective effect for IGT in both sexes., Conclusions: Diabetes and IGT are moderately common in Turkey by international standards. Associations with obesity and hypertension have been confirmed. Other lifestyle factors had a variable relationship with glucose tolerance.