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Öğe Challenges in Cancer Control Services Provided by Family Physicians in Primary Care: A Qualitative and Quantitative Study From Karabuk Province in Turkey(Korean Soc Cancer Prevention, 2018) Ozdemir, Raziye; Ural, Sevda; Karacali, MerveBackground: Family physicians (FPs) play an important role in cancer control. The aim of this study was to understand the functions of FPs in cancer control and to explore FPs' perceptions of their own roles and the difficulties they face in cancer control in Karabuk province, Turkey. Methods: The study consisted of two methodological parts. The qualitative part included a descriptive study in which data were collected from 87.5% (n=56) out of all FPs in Karabuk using a questionnaire. In the quantitative part, in-depth interviews with 15 FPs were conducted and analyzed through content analysis. Results: Half of the FPs (50.0%) provided cancer prevention information for their registered people, focusing on especially smoking cessation. In the last three months, the proportion of FPs who had not invited anyone to screenings was 37.5% for the pap test, 26.8% for the mammography, 19.0% for the fecal occult blood test and 34.5% for the colonoscopy. Only 16.1% of them reported that they made home visits for cancer patients. In the qualitative part of study, the following themes were highlighted: the perceived responsibilities of FPs regarding cancer control; the effect of geographically undefined working area of FPs; the issues with coordination between FPs and specialists; the effect of the number of primary care team members. Conclusions: Cancer control services provided by FPs have significant problems in terms of the FPs' approach to the services and their content, continuity and coordination.Öğe Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers(Bmc, 2014) Ocek, Zeliha Asli; Ciceklioglu, Meltem; Yucel, Ummahan; Ozdemir, RaziyeBackground: A person-list-based family medicine model was introduced in Turkey during health care reforms. This study aimed to explore from primary care workers' perspectives whether this model could achieve the cardinal functions of primary care and have an integrative position in the health care system. Methods: Four groups of primary care workers were included in this exploratory-descriptive study. The first two groups were family physicians (FP) (n = 51) and their ancillary personnel (n = 22). The other two groups were physicians (n = 44) and midwives/nurses (n = 11) working in community health centres. Participants were selected for maximum variation and 102 in-depth interviews and six focus groups were conducted using a semi-structured form. Results: Data analysis yielded five themes: accessibility, first-contact care, longitudinality, comprehensiveness, and coordination. Most participants stated that many people are not registered with any FP and that the majority of these belong to the most disadvantaged groups in society. FPs reported that 40-60% of patients on their lists have never received a service from them and the majority of those who use their services do not use FPs as the first point of contact. According to most participants, the list-based system improved the longitudinality of the relationship between FPs and patients. However, based on other statements, this improvement only applies to one quarter of the population. Whereas there was an improvement limited to a quantitative increase in services (immunisation, monitoring of pregnant women and infants) included in the performance-based contracting system, participants stated that services not among the performance targets, such as family planning, postpartum follow-ups, and chronic disease management, could be neglected. FPs admitted not being able to keep informed of services their patients had received at other health institutions. Half of the participants stated that the list-based system removed the possibility of evaluating the community as a whole. Conclusions: According to our findings, FPs have a limited role as the first point of contact and in giving longitudinal, comprehensive, and coordinated care. The family medicine model in Turkey is unable to provide a suitable structure to integrate health care services.Öğe Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers(Biomed Central Ltd, 2015) Ocek, Zeliha Asli; Ciceklioglu, Meltem; Yucel, Ummahan; Ozdemir, Raziye[No abstract available]Öğe How to reduce pesticide exposure in farmers: An interventional study(Ios Press, 2023) Cevik, Celalettin; Ozdemir, Raziye; Ari, SezginBACKGROUND: Pesticide poisoning is a serious public health problem. OBJECTIVE: The aim was to investigate the effect of safe pesticide application training given to farmers on their behaviors towards compliance with protective measures. METHODS: In this interventional study, the target population was 9750 farmers living in Turkey. To achieve a study power of 95%, type I error and the effect size were assumed as 5% and 0.50 respectively. In the study, 61 farmers were selected using the systematic sampling method. Farmers were interviewed twice, before and after the training, and at each interview, they were asked questions about their pesticide use-related behaviors in the last four sprayings. In the analysis, the paired t-test, repeated measures of ANOVA (post hoc: Bonferroni) were used. RESULTS: The scores the participants obtained from the Pesticide Exposure Prevention Behavior Form which questions their compliance with protective measures taken during pesticide applications at the post-interview were significantly higher than were the scores they obtained at the pre-interview (P < 0.001). The analysis of the independent variables demonstrated that the scores obtained from the Pesticide Exposure Prevention Behavior Form at the post-interview were significantly different from those obtained at the pre-interview in almost all of the subgroups in terms of their sociodemographic characteristics. CONCLUSION: It was observed that the training given to the farmers on the safe use of pesticides encouraged the farmers to develop positive behavioral changes. The study emphasizes the importance of implementing ongoing health education programs for farmers.Öğe Level and Factors Associated with Participation in Population-Based Cancer Screening in Safranbolu District of Karabuk, Turkey(Iranian Scientific Society Medical Entomology, 2020) Ozdemir, Raziye; Turkmen Cevik, Fatma; Kes, Duygu; Karacali, Merve; Ozguner, SimgeBackground: Cervix, breast and colorectal cancers are included in the national population-based screening (PBS) program in Turkey. This study aimed to assess participation in PBSs for these cancers and to identify factors associated with participation in screenings in Safranbolu district of Karabuk, Turkey in 2016-2017. Methods: In this cross-sectional study, separate studying groups for cervix, breast and colorectal cancers were identified, taking into account the target age range specified in the national screening standards. The sample size was determined to be 374 for cervical cancer, 371 for breast cancer and 373 for colorectal cancer in the Epi-Info StatCalc program with a prevalence of 50%, a 95% Confidence Interval (CI) and a 5% error margin. The results of the data collected through face-to-face interview using questionnaires were evaluated with Chi-square tests (P<0.05) and included in the binary logistic regression model. Results: Participation in PBS at least once between 2011 and 2016 years was 26.2% for cervical cancer, 27.6% for breast cancer and 31.6% for colorectal cancer, whereas the level of PBS or opportunistic screening at least once was 51.1%, 42.7% and 32.2%, respectively. A 2.9-fold increase in participation for the cervical cancer screening was associated with informing women about cervical cancer by the family physicians. Being married and living in the district center showed associations with a higher rate of participation for colorectal cancer screening. Conclusion: Participation in PBS was low for the 5.5-year period. More effort is needed to increase the effectiveness of the program.Öğe Occupational acute pesticide poisoning: a cross-sectional study of Turkish vegetable and fruit farmers based on self-reported symptoms and job characteristics(Mattioli 1885, 2020) Cevik, Celalettin; Ozdemir, Raziye; Ari, SezginBackground: Occupational pesticide poisoning is an important public health concern worldwide, especially in developing countries. Objectives: This study was aimed at determining the prevalence and risk factors of acute pesticide poisoning (APP) among the vegetable and fruit farmers in Karacabey District in northwest Turkey. Methods: The study group consisted of 565 farmers. The dependent variable of the study is APP defined according to the World Health Organization's APP case definition matrix. The study's independent variables are the farmers' sociodemographic characteristics and the preventive measures they use when they are applying pesticides. The chi-square and logistic regression analysis analyzed the relationship between the dependent and independent variables. Results: A total of 64 (11.3%) farmers reported APP and 75% of them presented to a health institution due to symptoms. The factors associated with increased risk of APP were: illiteracy (odds ratio (OR)=2.5), 14 years and less farming experience (OR=3.3), not reading the pesticide labels (OR=6.4), and contact with liquid pesticides (OR=2.3). Conclusions: The study shows that approximately one out often farmers experience APP Training programs should be planned and monitored to improve farmers' awareness of the dangers of pesticides, and they should be encouraged to adopt and implement protective measures.Öğe Prevalence and risk factors for elder abuse: A community-based cross-sectional study from North West Turkey(Springer, 2023) Cevik, Celalettin; Ozdemir, Raziye; Koran, Nurullah; Agin, AbdurrahmanThe aim of the authors of this community-based study was to determine the prevalence of abuse perpetrated against the elderly living in a neighborhood in northwestern Turkey and related factors. This cross-sectional study was carried out in Balikesir between November 2018 and May 2019. The Sample size was calculated as 520 in the Epiinfo program (95% confidence level, 50% prevalence, 4% deviation and 1.5% design effect). The chi-square, student t tests and logistic regression mode were used analysis. Having income equal to or less than expenses increased the risk of being abused 5.4 times (p = 0.011), living in residential areas outside the district for a long time increased it 2.5 times (p = 0.018), having a secondary or lower education increased it 2.1 times (p = 0.022), having sleep problems increased it 1.9 times (p = 0.023). The results of the study show that one out of every five elderly was subjected to abuse. Economic problems are the most important factor increasing the risk of exposure to abuse. There is a need for comprehensive public health approaches and social policies in planning services for the elderly.Öğe Reliable mortality statistics for Turkey: Are we there yet?(Bmc, 2015) Ozdemir, Raziye; Rao, Chalapati; Ocek, Zeliha; Horasan, Gonul DincBackground: The Turkish government has implemented several reforms to improve the Turkish Statistical Institute Death Reporting System (TURKSTAT-DRS) since 2009. However, there has been no assessment to evaluate the impact of these reforms on causes of death statistics. This study attempted to analyse the impact of these reforms on the TURKSTAT-DRS for Turkey, and in the case of Izmir, one of the most developed provinces in Turkey. Methods: The evaluation framework comprised three main components each with specific criteria. Firstly, data from TURKSTAT for Turkey and Izmir for the periods 2001-2008 and 2009-2013 were assessed in terms of the following dimensions that represent quality of mortality statistics (a. completeness of death registration, b. trends in proportions of deaths with ill-defined causes). Secondly, the quality of information recorded on individual death certificates from Izmir in 2010 was analysed for a. missing information, b. timeliness of death notifications and c. characteristics of deaths with ill-defined causes. Finally, TURKSTAT data were analysed to estimate life tables and summary mortality indicators for Turkey and Izmir, as well as the leading causes-of-death in Turkey in 2013. Results: Registration of adult deaths in Izmir as well as at the national level for Turkey has considerably improved since the introduction of reforms in 2009, along with marked decline in the proportions of deaths assigned ill-defined causes. Death certificates from Izmir indicated significant gaps in recorded information for demographic as well as epidemiological variables, particularly for infant deaths, and in the detailed recording of causes of death. Life expectancy at birth estimated from local data is 3-4 years higher than similar estimates for Turkey from international studies, and this requires further investigation and confirmation. Conclusion: The TURKSTAT-DRS is now an improved source of mortality and cause of death statistics for Turkey. The reliability and validity of TURKSTAT data needs to be established through a detailed research program to evaluate completeness of death registration and validity of registered causes of death. Similar evaluation and data analysis of mortality indicators is required at regular intervals at national and sub-national level, to increase confidence in their utility as primary data for epidemiology and health policy.Öğe The role of endocervical curettage in the diagnosis of cervical intraepithelial neoplasia in human papillomavirus positive patients(K Faisal Spec Hosp Res Centre, 2024) Gulhan, Ibrahim; Ozdemir, Raziye; Ileri, Alper; Ileri, Hande; Ozcan, Sena; Ozturk, Ayse Betul; Gokcu, MehmetBACKGROUND: The role of endocervical curettage (ECC) in the diagnosis of cervical intraepithelial neoplasia (CIN) is a controversial topic. OBJECTIVES: Investigate the role of ECC in the diagnosis of CIN in human papillomavirus (HPV) positive patients. DESIGN: Retrospective SETTING: A tertiary training and research hospital PATIENTS AND METHODS: This study included patients who were referred for colposcopy between 2018-2022 because of abnormal screening results. ECC results, age, cytology, HPV status, and colposcopic impression of the patients were extracted from the medical records. Multinomial logistic regression analyses were performed to identify factors that could predict CIN on ECC. MAIN OUTCOME AND MEASURES: The likelihood of high-grade squamous intraepithelial lesions (HSIL) in ECC in patients with cervical biopsy results of normal and low-grade squamous intraepithelial lesion (LSIL). SAMPLE SIZE: 2895 women RESULTS: In patients with normal and LSIL cervical biopsy results, HSILs were detected in 6.7% of ECC results. There was no difference in the detection rates of CIN in ECC among groups with smear results negative for intraepithelial lesions or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US), and LSIL. The likelihood of HSIL being observed in ECC was 2.2 times higher in patients with HPV16. The probability of LSIL disanois was 2.3 times higher in women aged 50-59 years and 2.8 times higher in women >= 60 years compared to the reference group of <30 years. The probability of LSIL was 2.3 and HSIL by ECC was 2.2 times higher in both age categories (P<.012 P <.012 and P =.032, respectively) than the reference group of <30 years. CONCLUSION: Regardless of colposcopic findings, ECC should be performed in patients with smear results of NILM who are positive for HPV16, in patients with smear results of ASC-US and LSIL who are positive for any oncogenic type of HPV and in patients 50 and above with any result of smear or any oncogenic HPV type. LIMITATIONS: We did not have the components of the HPV types in mixed groups.Öğe Unmet needs for family planning among married women aged 15-49 years living in two settlements with different socioeconomic and cultural characteristics: a cross-sectional study from Karabuk Province in Turkey(Coll Medicine & Dentistry James Cook Univ Townsville, 2019) Ozdemir, Raziye; Cevik, Celalettin; Ciceklioglu, MeltemAim: The aim of the study was to investigate levels and related factors of the unmet needs for family planning among married women aged 15-49 years living in two settlements (rural and urban) having different economic, social and cultural structures in Karabuk, a province in north-western Turkey. Method: This cross-sectional study was conducted in the rural Cumayani village and the urban Emek neighbourhood between October 2016 and June 2017. The sample size was determined to be 289 married women aged 15-49 years from each settlement according to the effect size of 0.3, alpha error probability of 0.05 and power of 0.95. In the study, 594 currently married women (298 from Cumayani and 296 from Emek) were contacted. The dependent variable was the level of unmet need for family planning. The independent variables included the sociodemographic and reproductive characteristics of the women. The data were collected through face-to-face interviews. The characteristics of the two settlements were compared using the chi(2) test. Bivariate and multivariate logistic regression analyses were carried out to examine the factors associated with the dependent variable. Results: The comparison of the participants demonstrated that the education, employment and income levels of the rural women were lower than those of the urban women (p<0.001). The rural women had more pregnancies, miscarriages and stillbirths, and the mortality among their children was higher compared to the urban women (p<0.001). The level of unmet need for family planning in Cumayani village was about twice that of Emek neighbourhood (9.7% v 5.4%). The multivariate analysis was conducted separately for each settlement. Marrying by way of only a religious ceremony increased the level of unmet need for family planning by 4.61 times (95% confidence interval (CI) 1.3-16.1) (p=0.016) in Cumayani. The multivariate analysis of all the women participating in the study revealed that marriage by way of only a religious ceremony increased the level of unmet need by 4.96 times (95%CI 1.4-17.1) (p=0.011). Conclusion: The study showed the effects of socioeconomic and cultural factors on women's fertility behaviours and unmet needs for family planning to favour urban women. Not being married by civil marriage was a significant predictor of unmet need. These findings highlight a need for intervention, particularly for the empowerment of rural women, in order to improve reproductive health outcomes.Öğe Validation and reliability study of the Turkish version of the social health scale for the elderly(Galenos Publishing House, 2024-12-30) Cevik, Celalettin; Baydur, Hakan; Ozdemir, Raziye; Sonmez, SaitObjective: To evaluate the psychometric properties of the Turkish version of the Social Health Scale for The Elderly (SHSE) scale. Materials and Methods: This methodological study was conducted with aged ≥60 years living in two urban and semi-urban neighborhoods in Balikesir between September 2020 and November 2020 by holding face-to-face interviews. The data of the study were collected using the SHSE, multidimensional scale of perceived social support, EuroQol-5D (EQ-5D) quality of life questionnaire, and WHO-5 Well-Being Index. In the analysis, in addition to descriptive findings, Cronbach’s alpha value and confirmatory factor analysis were performed using SPSS 25.0, jasp 0.14, and lisrel 9.1. Results: Cronbach’s alpha values for the overall SHSE and its perceived environmental resource (PER), social adjustment (SA), and social support (SS) subdimensions were 0.89, 0.95, 0.63, and 0.54, respectively. The confirmatory factor analysis summary goodness of fit values of the scale were 0.067 for the root mean square error of approximation, 0.968 for the comparative fit index, and 0.087 for the standardized root mean square residual. The test-retest correlation coefficient of the scale was 0.99 for the overall SHSE and 1.00, 1.00, and 0.95 for its PER, SA, and SS subdimensions, respectively. Conclusion: The SHSE used in this study is a valid and reliable scale for Turkish society. It contains psychometric features that can be used in the assessment of the social health of the elderly. The SHSE can be used not only to investigate the risks or protective factors of social health but also to comprehensively assess health status in conjunction with other health domains.
