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.

Impact of high visceral adiposity index associated with metabolic syndrome on erectile function in sexually active men: Results of a cross-sectional study

AIMS

Erectile dysfunction (ED) is a common condition affected by many factors. We aimed to show the impact of the metabolic syndrome (MeTS) on male sexual function based on visceral adiposity index (VAI).

METHODS

Participants who met MeTS criteria (Group 1, n = 96) and did not meet MeTS criteria (Group 2, n = 189) were included in this cross-sectional study. The MeTS diagnosis was made in the presence of at least 3 of the following criteria: fasting serum glucose level higher than 100 mg/dL, HDL cholesterol level below 40 mg/dL, triglyceride level higher than 150 mg/dL, waist circumference higher than 102 cm and blood pressure higher than 130/85 mmHg. Demographic data were recorded; biochemical and hormonal tests were measured. Erectile and other sexual function scores were recorded. The VAI was calculated using the [(Waist Circumference/39.68) + (1.88 × body mass index)] × triglyceride/1.03 × 1.31/HDL formula.

RESULTS

Mean age, smoking volume, testosterone (T) and testosterone/estradiol (T/E₂ ) ratios of the groups were similar (P > .05). The mean VAI was two-fold higher in patients in Group 1 (P < .001) and erectile function score was lower in Group 1 than Group 2 (P = .001). Other sexual function scores were similar (P > .05). The METS was associated with an increased risk of ED (P = .001). Logistic regression analysis showed that each integer increase in the VAI was associated with a 1.4-fold increased risk of ED (P < .001). Higher T values were associated with a better erectile function (P = .03). For the VAI = 4.33, receiver-operating characteristic analysis showed a sensitivity of 89.6% and specificity of 57.7%.

CONCLUSION

Compared with non-MeTS, the presence of MeTS has emerged as a risk factor for patients with ED with high VAI levels while the other sexual functions are preserved. Management of ED patients with MeTS should cover a comprehensive metabolic and endocrinological evaluation in addition to andrological work up.

Evaluation of painkillers according to the principles of rational drug use in patients registered to a family medicine unit

AIMS

We aimed to evaluate knowledge, attitudes and usage of the painkillers within the framework of rational drug use.

METHODS

This study was conducted in a family medicine unit with a questionnaire consists of 27 questions.

RESULTS

Total of 506 patients participated in the study. The number of people who used pain medication every day was 29 (5.7%) and paracetamol was the most common analgesic (51.1%). The use of painkillers was more common in women and amongst the patients over 65 years of age. The rate of those who preferred painkillers in the form of pills was higher in married patients and the singles preferred injectables (P = .004). Inappropriate use of painkillers was much more prominent in nonsteroidal antiinflammatory drug users (P < .05).

CONCLUSION

Demographic features and disease characteristics were the notable factors that affected painkillers selection and the level of knowledge about them.

Determinants of Patient Satisfaction with an Emergency Department Observation Unit

Introduction

Patient satisfaction is a measure of healthcare quality. The aim of this study was to determine the factors affecting patient satisfaction in an emergency department (ED) multipurpose observation unit (OU) and developing strategies that will improve patient satisfaction.

Methods

In this cross-sectional study adult patients who were observed in and discharged from an OU were recruited voluntarily to complete the questionnaire over a one-year period. The global indices of satisfaction – overall satisfaction with care and willingness to return to the same OU – served as the dependent variables and were assessed on a 5-point Likert scale.

Results

Three hundred patients completed the questionnaire. Their mean age was 46.8±19.8 years, and 187 (62.3%) were female. With the exception of the patient's income, none of the demographic variables was related to the patient's rating of overall satisfaction. Overall satisfaction was significantly related to the doctor's explanation, the nurse's attitude, teamwork, technical quality of care, cleanliness of the unit, and quality of hospital food. In addition, likelihood of the patient's willingness to return was related to the patient's income, quality of hospital food, and overall satisfaction.

Conclusions

Overall satisfaction in the OU is affected by the patient's perception of care rather than demographic variables, it is an important predictor for willingness to return. Improvement in patient communication skills, the process of care and environmental factors in the OU will enhance patient satisfaction and increase the likelihood of their willingness to return.

Morphometric analysis in cytologic evaluation of papillary thyroid carcinoma

OBJECTIVE

To compare the morphometric features of papillary carcinomas with follicular neoplasias and benign lesions and to determine the potential role of nuclear morphometric features in their differential diagnosis.

STUDY DESIGN

Morphometric features were investigated in the cytologic samples of 64 cases, including 27 benign lesions, 6 follicular neoplasias and 31 papillary carcinomas. We analyzed 6 morphometric parameters: nuclear area, nuclear perimeter, maximum diameter (MaxD), minimum diameter (MinD), form factor and ratio of MaxD/MinD.

RESULTS

There were no significant differences between the benign lesion and follicular neoplasia groups for any nuclear parameters. However, between benign lesions and papillary carcinomas, there were significant differences for all parameters, except for form factor. Between follicular neoplasms and papillary carcinomas, only the MaxD/MinD ratio was significantly different.

CONCLUSION

The results of this study indicate that the ratio of MaxD/MinD is a distinct nuclear morphometric feature for distinguishing papillary carcinoma from other thyroid lesions, and it may be employed with other cytologic criteria in diagnosing problematic cases.

The frequency of the psychiatric symptoms in the patients with dyspepsia at a university hospital

OBJECTIVE

According to the psychiatric hypothesis, the symptoms of dyspepsia may be due to depression, anxiety or a somatization disorder. We investigated the frequency of psychiatric symptoms in patients undergoing endoscopic procedures with dyspepsia, either with or without pathological findings, and compared this with control subjects without dyspeptic symptoms.

METHODS

Ninety patients with dyspeptic symptoms and 90 control subjects participated in the study. Both the patients and the controls were asked to complete a questionnaire about socio-demographic characteristics, the Turkish version of the Spielberger State-Trait Anxiety Inventory (STAI) and the Symptom Check List-90 (SCL-90). In order for us to determine whether the criteria for any of the conditions listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were met, the patients were asked to take part in the Structured Clinical Interview for DSM-IV disorders.

RESULTS

Of the participants, 47.8% had a psychiatric disorder according to DSM-IV criteria, somatoform disorder (44.2%) being the most common. While 42.2% patients were determined to have a pathological finding using endoscopic evaluation, 57.8% had no findings. Together with the somatization and obsessive-compulsive disorder subscale scores, the total SCL-90 score and the mean trait anxiety score were statistically significantly higher in participants with no pathological findings. There were trends for anxiety (13.2% vs. 7.7%) and mood (2.6% vs. 0.0%) disorders to be more frequent in patients with pathological findings, while somatoform disorder+depressive disorder (17.3% vs. 5.2%) was more frequent in patients with no findings, although the differences were not statistically significant (Z=0.7, P>.05). The scores of state-trait anxiety, somatization, obsession-compulsion, depression, anxiety, phobic anxiety and psychotism subscales, and the total SCL-90 score were statistically significantly higher in those participants without a pathological finding than in the controls.

CONCLUSIONS

Regarding the high frequency of psychiatric disorders in patients with dyspeptic symptoms, we think that such patients should be evaluated by two separate departments, gastroenterology and psychiatry.

Survey of general practitioners' knowledge about Helicobacter pylori infection

Background

Helicobacter pylori, occurring throughout the world and causing gastroduodenal diseases, is one of the most common chronic bacterial agents in humans. The purpose of this study was to measure the general practitioners' (GPs) knowledge and practices pertaining to H. pylori infection.

Methods

A cross-sectional type questionnaire survey was conducted in all of 19 primary health care centres (PHCC) in Samsun, Turkey, between November 1 and December 31, 2003. The questionnaire was sent to 124 GPs and 109 (87.9 %) of those filled in. They were requested to answer the questions on the knowledge, sources of medical information, diagnostic tests and treatment to H. pylori.

Results

Medical journals were the most frequently used source of information on H. pylori, being cited by 86 (78.9%) of GPs. Ninety-two (84.4%) of the GPs reported having used one or more tests and 17 (15.6%) never used any test for the diagnosis of H. pylori infection. Only 9.8% had used stool antigen test for diagnosis. GPs reported that they would prescribe symptomatic treatment without ordering diagnostic tests for 29 (26.6%). 54.1% of the GPs explain that they sent patients with H. pylori infection to a specialist, and most used a triple drug regimen containing a PPI. Treatment duration varies between 7 to 28 days. 80.7 of the GPs treat patients for 14 days.

Conclusion

GPs may not have enough knowledge about the importance of stool antigen test or possibility of usage of this test. GPs have not sufficient knowledge about the difference between symptomatic and asymptomatic individuals. It is thought that GPs preferred to treat the patients with suspected ulcer empirically or to send them to a specialist because of the limited diagnostic conditions. The efforts to educate the GPs about the algorithms regarding the management of H. pylori infection during post-graduation period should be improved in PHCCs.

Primary care physicians' approach to diagnosis and treatment of hepatitis B and hepatitis C patients

Background

Infections caused by hepatitis B virus (HBV) and hepatitis C virus (HCV) are considered to be important health problems worldwide. The purpose of this study was to measure the general practitioners (GPs)' basic knowledge on HBV and HCV risk factors in determining their practice about this subject.

Methods

A cross-sectional type questionnaire survey was carried out at all of 32 primary healthcare centers (PHCCs) in Samsun, Turkey, between March 1 and April 31, 2002. The questionnaires were sent to 160 GPs and 129 (80.6%) of them answered the questionnaires. Knowledge, role responsibility, self-efficacy and attitudes and beliefs regarding to viral hepatitis B and hepatitis C were asked.

Results

Most of the GPs had adequate knowledge about transmission of HBV and HCV and also about risk factors for transmission of viruses. Most of the GPs (83.7%) were aware of recommendations for approach to a baby, born from HBsAg positive mother. They have limited facilities in diagnosis of viral hepatitis. Of the participants, 108 (83.7%) expressed that they could not diagnose HBV infections and 126 (97.7%) of them stated that they could not make the diagnoses of HCV infection in their local healthcare centers. The knowledge about treatment of chronic viral hepatitis B (21.8%) and C patients (17.8%) with elevated ALT is not sufficient.

Conclusion

GPs' knowledge about risks of viral hepatitis was adequate in this study. They were not able to diagnose and follow up of these infections at PHCCs because of limited knowledge about chronic viral hepatitis and diagnostic facilities. GPs should be informed about current advice in diagnosis and treatment of chronic of HBV and HCV infections.

Comparison of trimethoprim-sulfamethoxazole, cephadroxil and cefprozil as prophylaxis for recurrent urinary tract infections in children

The aim of this study was to compare the efficacy of prophylactic trimethoprim-sulfamethoxazole (TMP/SMZ), cefprozil and cephadroxil treatments in children who have recurrent urinary tract infection, but no urinary tract pathology. After acute urinary tract infections (UTIs) were treated, the patients were divided into 3 groups randomly and TMP/SMZ was given to 21 patients, cephadroxil was given to 25 patients and cefprozil was given to 34 patients for 3 months--one dose at night. All patients were followed for 6 months following prophylaxis. The frequency of symptomatic UTIs among groups during prophylaxis was not statistically different, however the number of symptomatic UTIs in the cephadroxil group was lower than the other groups. Asymptomatic bacteriuria episodes were detected in TMP/SMZ and cefprozil groups, whereas no asymptomatic bacteriuria episodes were seen in the cephadroxil group. The number of patients with symptomatic UTI during the follow-up period was not different between groups, however all the asymptomatic bacteriuria episodes were encountered in the cefprozil group. In conclusion, in this study cephadroxil was found to be slightly superior to TMP/SMZ and cefprozil in preventing asymptomatic bacteriuria episodes and symptomatic UTIs in children with recurrent UTI and normal urinary tract system.

[The effect of giving information forms about side effects of intravenous iodinated contrast material on the anxiety level of patients]

PURPOSE

We aimed to determine the effect of informing patients about side effects of the contrast material on the level of patients' anxiety.

MATERIALS AND METHODS

Two hundred-ninety seven patients undergoing computed tomography examination were enrolled in the study. Patients were grouped in three categories: (1) patients informed about adverse effects of contrast material and waiting for i.v. contrast material injection, (2) uninformed patients waiting for i.v. contrast material injection, (3) uninformed patients undergoing unenhanced CT examination. All patients were requested to complete a questionnaire including a standard anxiety test. The results were compared statistically.

RESULTS

The mean anxiety scores calculated by variant analysis were 39.2 +/- 11.7, 42 +/- 10.4, and 38.6 +/- 9.5 in groups 1, 2, and 3, respectively. No statistically significant difference was found between the anxiety scores of the 3 groups.

CONCLUSION

Informing patients about the adverse effects of the contrast material does not affect their anxiety level.

Antibiotic prescribing and urinary tract infection

The aim of this study was to evaluate the diagnostic and therapeutic approach to urinary tract infections (UTIs) by primary care physicians, in Samsun, Turkey. Data were obtained from the records of 2083 visits at eight primary care areas. Trained research students were stationed on site at each of the eight primary care centres between 1 June, 1999 and 1 July, 1999. Patients who had acute cystitis, recurrent UTIs, acute pyelonephritis and acute urethritis were included in the study. A total of 2083 office visits were recorded and 419 (20.1%) of the patients had UTIs and acute urethritis. Antibiotics were prescribed for 94.7% of the patients with UTIs and urethritis. Some 74% of prescriptions were consistent with current recommendation, but only 41% of the antibiotic prescriptions were rational according to dosage, dosage interval and duration of therapy. Urinary antiseptic agents were prescribed to 75% of patients with UTIs. These data indicate that polypharmacy is widespread in our region; primary care physicians need to review their knowledge about the diagnosis and treatment of UTIs and acute urethritis.