EURASIAN JOURNAL OF FAMILY MEDICINE Avrasya Aile Hekimliği Dergisi

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3 Euras J Fam Med EURASIAN JOURNAL OF FAMILY MEDICINE Avrasya Aile Hekimliği Dergisi VOLUME CİLT YEAR YIL 03 SUPPLEMENT EK DECEMBER ARALIK 03 ISSN: ABSTRACTS OF THE 4. CONGRESS OF FAMILY MEDICINE WITH INTERNATIONAL CONTRIBUTION 4. ULUSLARARASI KATILIMLI AİLE HEKİMLİĞİ KONGRESİ BİLDİRİ KİTABI

4 Euras J Fam Med EURASIAN JOURNAL OF FAMILY MEDICINE Avrasya Aile Hekimliği Dergisi VOLUME CİLT YEAR YIL 03 SUPPLEMENT EK DECEMBER ARALIK 03 ISSN: PUBLISHED THREE TIMES A YEAR Editor-in-Chief H. Nezih Dağdeviren Editors Zekeriya Aktürk Mehmet Ungan Serdar Öztora Ayşe Çaylan Erdem Birgül Necdet Süt (Biostatistics Editor) Amanda Barnard (Australia) Amanda Howe (UK) Ayfer Gemalmaz (Türkiye) Bruce LW. Sparks (South Africa) Chris van Weel (Netherlands) Christos Lionis (Greece) Daniel M. Thuraiappah (Malaysia) Davorina Petek (Slovenia) Denis Puchain (France) Dilek Toprak (Türkiye) Eliezer Alkalay (Israel) Ersin Akpınar (Turkey) Esra Saatçi (Türkiye) Faisal A. Latif Alnasir (Kingdom of Bahrain) Ferdinando Petrazuoci (Italy) Füsun Ersoy (Türkiye) Garth Manning (Thailand) Howard Tandeter (Israel) Igor Svab (Slovenia) Iona Heath (UK) İlhami Ünlüoğlu (Türkiye) İsmail Hamdi Kara (Türkiye) Joao Sequiera Carlos (Portugal) Johan Wens (Belgium) John Murtagh (Australia) International Editorial Board José Miguel Bueno Ortiz (Spain) Luc Martinez (France) Luis Pisco (Portugal) Kamile Marakoğlu (Turkey) Karen M. Flegg (Australia) Marius Marginean (Romania) Mehmet Uğurlu (Türkiye) Michael Kidd (Australia) Murat Ünalacak (Türkiye) Mümtaz Mazıcıoğlu (Türkiye) Nabil Alkurashi (Saudi Arabia) Paul Van Royen (Belgium) Peter Kotanyi (Hungary) Pinar Topsever (Türkiye) Richard Hobs (UK) Richard Roberts (USA) Sarah Larkins (Australia) Süleyman Görpelioğlu (Türkiye) Teresa Pawlikowska (UK) Tuncay Müge Alvur (Türkiye) Turan Set (Türkiye) Valentina Madjova (Bulgaria) Wesley Fabb (Australia) Young-Sik Kim (Korea) Zorayda E. Leopando (Philippines) Owner: H. Nezih Dağdeviren (On Behalf of ESFAM) Responsible Managing Editor: Serdar Öztora Editorial Office: Trakya University Medical Faculty, Department of Family Medicine (Aile Hekimligi), Balkan Campus, 030, Edirne, Türkiye Printed in: Trakya University Press, Edirne, Turkey Indexed in: Index Copernicus International Turkiye Citation Index

5 Euras J Fam Med ORAL PRESENTATIONS SÖZLÜ BİLDİRİLER

6 Euras J Fam Med 03; (Suppl ): S [ABSTRACT:0003] Babak Nakhostin Roohi, Aghdas Sojudi, Mahdi Khorshidi Hosseni Ardabil Branch, Islamic Azad University, Ardabil, Iran Magnitude of the smoking problem, knowledge, attitude and practice among family members of primary school students OBJECTIVE: The purpose of this study was to collect baseline information about the magnitude of the smoking problem, knowledge, attitude and practice, among family members of primary school students in the northwest region of Iran. METHOD: Of primary school students (the 3th, 4th and 5th grades), 7.% of them (n=3954) were selected using randomized multi-stage cluster sampling. Data collection was conducted in April, May and June 0, by means of self-administered two-page questionnaire. CONCLUSION: A total of 3954 students (57.6% boys and 4.3% girls) with a mean age of 0.46±.09 years were evaluated. According our data, prevalence of cigarette smoking among fathers was more than other family members (7.% versus 7.8%) whereas the prevalence of waterpipe smoking among fathers and other family members was almost similar (9.% and 9.7% respectively). None of smoking type was prevalent among mothers (cigarette: % and waterpipe:.%). Considerable numbers of all understudy students had been exposed to secondhand smoke at home (cigarette: 9.8% and waterpipe: 7.7%). DISCUSSION: Considering our study findings, two recommended procedures to prevail the problem are to provide greater of education about hazards of tobacco consumption among students and their family; and to legislate new laws by officials for ban of tobacco use at home. KEYWORDS: Smoking, family members, waterpipe, cigarette. [ABSTRACT:0005] Fikret Kurt, Faruk Şahin, Emine Neşe Yeniçeri Muğla Merkez No'lu ASM Muğla Halk Sağlığı Müdürlüğü Bulaşıcı Olmayan Hastalıklar Şube Müdürlüğü AHBS Bilgisayar programlarının geliştirilmesinin aile hekimlerinin erişkin bağışıklama oranlarına katkısı AMAÇ: Bilgisayar programcıları ile hekimlerin birlikte ortaya koydukları çalışmalarla tıp alanında çok ciddi ilerlemeler kaydedilmiştir. Bu çalışmada da Aile Hekimlerinin kullandığı bir AHBS programına eklenen bir sorgulama modülü ile erişkinlerde yapılan aşılama sayılarının artırılması planlanmıştır. YÖNTEM: Çalışmada bir AHBS programına eklenen bir sorgulama modülü ile poliklinik için hekime başvuran 65 yaş üstü erişkinlere geriye dönük belirlenen periyotlar içinde, bilgileri girilen erişkin aşısının yapılıp yapılmadığı sorgulanmakta ve yapılmadı ise o kişinin reçetesine belirtilen aşıyı ekleme konusunda hatırlatma yapmaktadır. Bu çalışmada Muğla ili No lu AHB ye Türkiye de influenza aşılama dönemi olarak kabul edilen dönemi ile AHBS programına sorgulama modülünün eklendiği dönemi verileri karşılaştırılmıştır. SONUÇ: tarihleri arasında aynı birime 730 kişi başvurmuştur (mükerrer kayıtlar çıkarılmıştır).730 kişiden 54(9.7) ü 65 yaş üzerinde olup, bu kişilerin 04 (%39.69) üne influenza aşısı yapılmıştır. Yine aynı birime tarihleri arasında 808 kişi başvurmuştur(mükerrer kayıtlar çıkarılmıştır).808 kişiden 65(%34.56) i 65 yaş üzerinde olup bu kişilerin 598 (%95.68) ine influenza aşısı yapılmıştır.bu çalışmada döneminde AHBS programına 65 yaş üstü erişkin bağışıklama programı sorgulama modülünün eklenmesinin influenza aşılama oranını önemli ölçüde artırdığı saptanmıştır. TARTIŞMA: Influenza aşılamasının, influenzaya bağlı hastalıklara karşı en etkili yöntem olmasına karşın birçok toplumda aşılama oranları optimal düzeyde değildir. Bilgisayar programı kullanılarak hekimlere hatırlatma yöntemi ile aşılama oranları artırılabilmektedir. Bu çalışma ile bilgisayar programcılığının tıp alanındaki önemi bir kez daha gösterilmiştir. Fakat bu sorgulama modülünün her

7 Euras J Fam Med 03; (Suppl ): S AHBS programında olmaması, modülün programda kullanıcı tarafından aktive edilmesinin çok yaygın olmaması, sorgulama modüllerinin eksik yönlerinin de geliştirilmesi gerektiği ve bu modülün aile hekimleri tarafından daha çok kullanılabilmesi amacıyla farkındalık çalışmalarının yapılması gerektiği düşünülmektedir. Program şu an tek bir AHBS firması tarafından kullanılabilmektedir. Hatta yine bilgisayar programcıları ile ortak hareketle Kronik Hastalığı olanlarda da yaş sınırı olmaksızın aynı modülde hatırlatma sorguları eklenmelidir. ANAHTAR KELİMELER: AHBS programı, erişkin bağışıklama programı, influenza, aşılama. Şekil : SOrgulama ekranı görüntüsü [ABSTRACT:009] Rafaqat Bota Dow Medical College, Karachi, Pakistan Skin cancer knowledge and sun protection behaviors in medical and non-medical university students in Karachi, Pakistan OBJECTIVE: To examine skin cancer knowledge and sun protection behaviors in medical and nonmedical university students in Karachi, Pakistan. METHODS: We surveyed 768 students (6-7 years) at two large public sector universities (40 medical students and 367 non-medical students) in Karachi, Pakistan. Survey data were collected regarding skin cancer knowledge and sun protection behaviors. Differences between the groups were compared with chi-squared test. RESULTS: Of all the respondents, sun exposure as a risk factor for skin cancer was identified by 77.7%, genetics by 44%, ultraviolet radiation by 87.%, multiple skin moles by 9.% and fair complexion by 7.7%. Knowledge of risk factors was greater among the medical students as compared to the non-medical students. Of the total, 56% of the participants always wears sun-protective clothing, 4.4% always wears hat/dupatta, 3.% always seeks shade, 0.5% always wears sun glasses, and 7.9% always or most of times apply sunscreen with sun protection factor of >= 5. The most frequent method of sun protection was found to be wearing sun-protective clothing, which was significantly more common among the medical students (64.% vs 47.%, p<.00); while wearing of sun-glasses was significantly more common among the non-medical students (5.8% vs 5.7%, p<. 00). In terms of the wearing of hat/dupatta, seeking shade and wearing sunscreen, no significant difference was evident between medical and non-medical students. CONCLUSION: University programs for increasing knowledge of skin cancer risk are warranted. Changing attitude and behaviors regarding exposure and protective measures is increasingly important. KEYWORDS: Skin cancer knowledge, sun protection behavior, medical students, non-medical students, Pakistan.

8 Euras J Fam Med 03; (Suppl ): S3 [ABSTRACT:007] Almoutaz Alkhier Ahmed Department of primary health care, National Guard Health Affairs - WR Screening and evaluation of risk factors for cardiovascular diseases among Saudi diabetic patients attending primary health care service BACKGROUND: Cardiovascular disease is currently the primary cause of morbidity and mortality in patients with diabetes. For each risk factor present, the risk of cardiovascular death is about three times greater in people with diabetes than people without diabetes. OBJECTIVES: To determine the risk factors for cardiovascular disease among patients with type diabetes and stratify the patients into risk categories to develop coronary arteries disease (CAD) based on the British Joint Societies risk chart and to assess the awareness and implementation of the risk assessment charts by primary care physicians METHODS: Cross sectional study was designed. Sixty six diabetic patients were selected randomly by simple selection, from them 9 were males and 37 were females. Patients' Medical records were reviewed. The following parameters were detected; blood pressure, lipid profile, weight, height, smoking and degree of glycemic control. A questionnaire was designed and distributed to randomly selected physicians working in primary health care assessed their awareness and implementation of risk assessment charts. RESULTS: Uncontrolled diabetes was found to be the common risk factor followed by uncontrolled lipid profile, obesity, uncontrolled systolic blood pressure and smoking. Seven percent of male group felled in highest risk group in compare with % in female group (p<0.05),while 3% in male group felled in mild risk group in comparison with 90% in female group (p<0.05). Sixty two percent in male group felled in high risk group in comparison with 9% in female group (p<0.05). Criteria for ranking in risk class differed between male and female group. Twenty nine physicians out of forty one were responded to the questionnaire. Twenty two informed that they were aware about risk assessment score systems. Fourteen physicians informed that they were aware about the BJSs charts but only two informed that they had used it to assess their patients. CONCLUSION: Clustering of multi risk factors is a serious event which may raise the risk category of diabetic patients. For each risk category, the risk factors may differed between male and female patients. More studies are recommended to study distribution of risk factors between male and female diabetic patients. Attention should be directed towards raising the awareness about the risk assessment scoring system and encouraging physicians to use it. KEYWORDS: Diabetes type, risk chart, coronary artery disease.

9 Euras J Fam Med 03; (Suppl ): S4 [ABSTRACT:008] Lost and found: the accessory spleen Calin Bumbulut, Andrei Bumbulut, Andrea Oprea 3 Medical Civil Society dr Bumbuluţ-dr Balaj, Satu Mare, România Faculty of Medicine and Pharmacy, Oradea University, România 3 Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj Napoca, România OBJECTIVE: An accessory spleen is an incidental finding of no clinical significance in most patients. Ultrasound is a widely available, noninvasive, and useful means of diagnosing splenic abnormalities. METHOD: We present an ultrasound detected case of accessory spleen in splenic hilum, at a 56-year woman with macrocytic anemia; the investigation was performed in our practice. Ultrasound control, performed 0 months later, kept the previous characteristics. CONCLUSIONS: Ultrasound in family medicine practice proves to be a very useful method, cost, availability, patient compliance and the results are arguments to equip family physicians with this imaging technique. Ultrasound is a tool widely available, noninvasive and useful for the diagnosis of splenic abnormalities. Accessory spleen is a diagnosis that should be considered in clinical situations such as the one presented here. Pathologic processes affecting the spleen also affect the accessory spleen, indicating that they have the same developmental origin. As it poses no danger, accurate diagnosis is necessary to avoid unnecessary treatment. DISCUSSION: Accessory spleen is present in 6% of patients undergoing contrast-enhanced abdominal tomography. Their most frequent location (%) is posteromedial to the spleen; anterolateral to the upper pole of the left kidney; and lateral, posterior, and superior to the tail of the pancreas, respectively. In a study, on patients referred for splenectomy, preoperative CT scan detected AS in 9% of cases, postoperative were found in %, in conclusion Accessory spleen can be readily detected at laparoscopy in the vicinity of the spleen; preoperative CT scan for their detection and localization may not be necessary. However, one should keep in mind that multiple accessory spleens may be found in one person and detected by ultrasound. In these special cases CT should be taken into consideration. Ultrasonography is a widely available, noninvasive, and useful means of diagnosing splenic abnormalities. A combination of ultrasonic characteristics and clinical data may provide an accurate diagnosis. If the US appearance alone is not enough, US may also be used to guide biopsy of suspicious lesions. Conflict of interest: The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript. KEYWORDS: Accessory spleens, diagnosis, abdominal CT, ultrasonography. Accessory Spleen S = spleen, SA = accessory spleen, RS = left kidney.

10 Euras J Fam Med 03; (Suppl ): S5 [ABSTRACT:009] Romanian college of physicians: national report Calin Bumbulut, Constantin Carstea, Viorel Radulescu 3 Professional, Scientific& Medical Education Department, Romanian College of Physicians Economic-Social Department & Health Insurances, Romanian College of Physicians 3 Department of Administrative & Financial-Accounting Activities, Romanian College of Physicians OBJECTIVE: Presentation of Romanian College of Physicians (RCP), a non-governmental association in autonomous relationship to any public authority; together with the Romanian Ministry of Health, the RCP is a competent authority in regulating the medical practice in Romania. METHOD: Description of RCP role, management, members, goals, relations with other organisations; situation of GP in Romania, relations with National Insurance Health House, role of GP in Romanian healthcare system, free practice, remuneration, training and residency, specialisation of FM/GM, situation after joining EU. CONCLUSIONS: General medical practice should and can exist on two different levels within the European countries: either as basic specific training in GP or as specialist. The free practice is possible only for the members of the RCP. Romanian GPs are medical specialists in Family Medicine on the same level as other specialists since 99. The specialisation of family medicine is equal to the other medical specialties and should be recognised as such by EU legislation, and primary care should be considered as a part of health care systems like all others. If we all are going to reach a consensus on a european curriculum of specialisation in Family Medicine/General Practice, as we are keen, included in the Professional Qualifications Directive, well, this is going to be a great succes and a deserved reward for our profession. DISCUSSION: The RCP has, as its main activity object, the control and supervision of the medical profession, the application of laws and regulations that rule the liberal exercise of the profession, representing the interests of its members, the overall of the romanian physicians, keeping and strengthening their prestige in society. The family physician is the patient's buffer and first contact with the healthcare system. Most GPs are independent managers and some of them are working in a partnership or in group practices. The Romanian residency training program takes three years. This training became mandatory in Family Medicine training after 993. EU membership in 007 has meant for our country a massive loss of specialists, one third of whom were family physicians. Conflict of interest: The authors declared that they do not have anything to disclose regarding funding, all three are members in Executive Bureau of RCP which is presented. KEYWORDS: Non-governmental association, competent authority, family medicine, training, specialisation

11 Euras J Fam Med 03; (Suppl ): S6 [ABSTRACT:0034] Enda Murphy General Practitioner Training Scheme, Health Service Executive, Dublin, Ireland Management of depression in primary care The WHO recognizes depression as the nd largest health concern in the world today. 80% of people who experience depression will have their GP as their only health resource. This is particularly true in rural practice where access to mental health services is limited Successful treatment of depression depends on a holistic combination of lifestyle changes, pharmacotherapy and psychotherapy best delivered at primary care level. In order to have relevance for patients, these treatment principles must be translated into each country s cultural ideology in order for prejudices to be overcome and for best practice guidelines to be accepted. This presentation will look at how National Institute of Clinical Excellence (NICE) treatment strategies can be successfully and easily translated into different Cultural settings leading to very positive outcomes. Participants are also invited to bring along case histories for discussion regarding diagnosis and treatment with the author both at and after the workshop. KEYWORDS: Depression, treatment, primary care. [ABSTRACT:0036] Enda Murphy General Practitioner Training Scheme, Health Service Executive, Dublin,Ireland The practical application of cognitive behavior therapy in general physician s clinical practice The National Institute for Clinical Excellence (NICE) has stated that, for the common mental health problems that present to General Practitioners, Cognitive Behaviour Therapy (CBT) is the main evidence-based psychological treatment recommended. Studies have shown that depression and anxiety account for 93% of the mental health issues seen by General Practitioners/Primary Care physicians. Unfortunately,very few GP's have received training in practical psycho therapeutic techniques. Evidence shows that a simple CBT model can be as effective as the full CBT package and NICE recommends training for GP's in brief CBT techniques which can be used within the constraints encountered in a busy primary care setting. This workshop will focus on providing participants with an insight into how CBT works in practice along with giving practical skills which can be used by GP/Primary care physicians in the treatment of panic attacks, anxiety and depression. Participants are invited to bring along case histories for discussion both in the workshop and after wards with the presenter. KEYWORDS: Cognitive behaviour therapy. primary care

12 Euras J Fam Med 03; (Suppl ): S7 [ABSTRACT:005] Tijen Acarkan, Hüseyin Nazlıkul Özel muayenehane, İstanbul Postherpetik pelvik ağrı: olgu sunumu OLGU: 38 yaşında kadın hasta. Vajina ve klitoral bölgede yoğun olmak üzere tüm genital bölgede şiddetli ağrı. yıl önce geçirilen Herpes simpleks tip enfeksiyonu ile başlayan, lezyonların iyileşmesine rağmen gelişen nevralji tipi pelvik ağrı. Ağrı tüm pelvis tabanında tarif ediliyor; vajina ve klitoral bölgede yoğun, devamlı karakterde ve her çeşit ağrı tedavi ajanlarına dirençli. FİZİK MUAYENE: 65 cm 55 kg. Şiddetli ağrı sebebi ile sorulara zor cevap veriyor. Cildi ıslak, nemli ve soluk. Ağrıdan kaynaklı uykusuzluk ve yemek yiyememe sebebi ile kilo kaybı tarif eden hastanın batın serbest, suprapubik bölge ile başlayan hassasiyeti ve dehidrate görüntüsü mevcut. Bakışları kaygılı, tedirgin ve yorgun. Solunum sistemi, kardiyovasküler sistem, gastrointestinal sistemde özellik yok. TANI: Postherpatik nevralji (pelvialji) UYGULANAN TEDAVİ: Nöralterapi, akupunktur, manyetik alan kombinasyonu. Nöralterapi %'lik lidokain ile yapılan bir enjeksiyon yöntemidir. Torakal 9'dan sakral 5'e kadar quadel enjeksiyonları, bilateral lumbal trunkus blokajı, pleksus uterovaginalis, sakral epidural, bilateral gangliyon impar enjeksiyonu ile yapılan nöralterapi yöntemine, kulak akupunkturu ve manyetik alan tedavisi ile sumatif bir sonuç elde edilmiştir. SONUÇ: İlk seans sonrasında ağrılarında %50 azalma, 5. tedavisi sonrasında ağrıları tamamen ortadan kalktı. Bir yıl takibinde nevraljisi tekrarlamadı. YORUM: -40ile -90 mv'luk sağlıklı hücre dinlenme potansiyeli hastalanan hücrede düşer ve ileti kaybolur. Tüm lokal anestezik maddeler hücre aksiyon potansiyelini -90 mvoltluk gücü ile hücreyi hiperpolarize eder ve yeniden -40ile -90 mv'a yani ileti yapabileceği potansiyele ulaşır; hücreyi yeniden çalışır hale getirir. Lokal anestezik maddeler ile sağlanan bu ileti regülasyonu ilgili segmente yapılan quadellar ve segmentin innervasyonunu sağlayan gangliyon uyarısı ile ilgili vakada olduğu gibi pelvis bölgesinin vejetatif sinir sistemi inervasyonu, perfüzyonu ve lenfatik sirkülasyonu düzenlenerek; sempatik inervasyonunu L-4 ve parasempatik inervasyonunu S-4 seviyesinden alan pelvisin otonom liflerine yerleşmiş olan Herpes Simpleks virüsünün postenflamatuar süreçte yarattığı vejetatif disfonksiyona bağlı nevralji tablosu, nöralterapi enjeksiyonları sayesinde regüle olmuştur. TARTIŞMA: Nöralterapi bedenimizdeki 500 bin km'lik vejetatif sinir sisteminin regülasyonunu sağlayan ve her türlü tedavi ile kombine kullanılabilen modern çağın tedavi yöntemidir. ANAHTAR KELİMELER: Akupunktur, alternatif tedavi, ağrı, nevralji, nöralterapi, nelvik ağrı, tamamlayıcı tıp.

13 Euras J Fam Med 03; (Suppl ): S8 [ABSTRACT:0054] Hüseyin Nazlıkul, Demet Erdoğan Muayenehane Hekimi, Fulya- İstanbul Muayenehane Hekimi, 4. Levent - İstanbul Dirençli migren vakalarında akupunktur ve nöralterapi ile çözüm mümkün mü? Migren, ataklar halinde ortaya çıkan bir baş ağrısı türüdür. Ataklar 4 saat ile 7 saat arasında sürebilir. Ataklar arasında kişi kendini tamamıyla normal hisseder ancak bir sonraki atağın endişesi içindedir. Migren, hem kişinin kendisi hem de yakınlarının yaşam kalitesini bozan bir sağlık sorunudur. İş gücü kaybı nedeniyle de ülke ekonomisine de yük getirmektedir. Migren tedavisinde gelişmeler olsa da ilaçlar çoğunlukla semptomatik tedavidir ve ağrıyı an itibarıyla ortadan kaldırmakta ancak atakları tamamıyla yok edememektedir. Komplementer tıp ile migrene yaklaşım sebebe yöneliktir. Amaç migren şikayetlerini ortaya çıkaran nedeni bulmak, onu etkisizleştirmek, regüle etmek diğer bir deyişle dengelemektir. Kullanılan Tamamlayıcı Tıp Yöntemleri:: NÖRALTERAPİ: Terim olarak, vücudun kendi nörovejetatif sistemini kullanarak etkili olan bir tedaviyi ifade eder. Bu yöntemde lokal anestezikler (% 0,5- lidokain) kullanılır. Nöralterapi modern bir regülasyon tedavisidir. Modern tıp ile doğal tamamlayıcı tedaviler arasında bir köprü oluşturur. Kullanılan lokal anestezik ve uygulama teknikleri ile modern tıp ile yakın dururken, tanı ve tedavide bütünsel bakış açısı ile de bir tamamlayıcı tıp yöntemidir. Her türlü tedavi ile kombine olarak kullanılabilir. Mevcut klinik çalışmalar ve olgu sunumları akut ve kronik ağrıda, fonksiyonel hastalıklarda, CRPS gibi vejetatif rahatsızlıklarda ve kronik inflamasyonda etkili olduğunu göstermektedir. AKUPUNKTUR: Ağrı yolakları üzerinde etkisi olduğu özellikle de başağrıları üzerinde etili olduğu hakkında pek çok yayın bulunmaktadır.akupunktur un bilinen başlıca etkileri; ağrı giderici analjezik, homeostazis, sedasyon yapıcı, gevşeme sağlayıcı, immün modülatör ve vasodilatasyon yapıcı etkileri olarak sayılabilir. FİTOTERAPİ: Bugün modern fitoterapide ilaç haline getirilmiş fitoterapötikler kullanılmaktadır. Tıbbi fitoterapide standardize edilmiş etkisi kanıtlanmış, ilaç haline getirilmiş bitki preparatları kullanılmaktadır.akupunktur ve nöralterapi ile dirençli migren vakalarında başarılı sonuçlar almak mümkündür. Bunlara ek olarak fitoterapik preparatların kullanımı da mümkündür. ANAHTAR KELİMELER: Migren, akupunktur, nöralterapi. [ABSTRACT:0057] Aile hekimlerinin aile danışmanlığı uygulamaları ile ilgili görüşleri Kenan Taştan, Turan Set, Yasemin Çayır, Zeliha Cansever Atatürk Üniversitesi, Tıp Fakültesi Aile Hekimliği Anabilim Dalı, Erzurum Atatürk Üniversitesi, Tıp Fakültesi Tıp Eğitimi Anabilim Dalı, Erzurum AMAÇ: Bu çalışmada Türkiye deki aile hekimlerinin, aile danışmanlığı ile ilgili görüşlerinin değerlendirilmesi amaçlanmıştır. YÖNTEM: Çalışma Haziran 03 tarihinde Türkiye deki aile hekimleri arasında kesitsel olarak yapıldı. Araştırmacılar tarafından geliştirilen, aile hekimlerinin demografik özelliklerini ve aile danışmanlığı ile ilgili görüşlerini sorgulayan anket katılımcılara internet üzerinden uygulandı. Toplam 4 katılımcının sonucu analiz edildi. BULGULAR: Katılımcıların yaş ortalaması 4,7±7, yıldı. Cinsiyet dağılımı %67, i erkek (n=8) ve %3,9 u kadın (n=38) şeklindeydi. Katılımcıların %79,0 u (n=34) aile hekimlerinin aile danışmanlığı eğitimi almaları gerektiğini, %,0 i (n=86) bu eğitimin alınmasının gerekmediğini belirtti. Aile hekimleri aile danışmanlığı hizmeti sunmalı mı? sorusuna katılımcıların %65, i (n=69) evet cevabını verirken, %34,9 u (n=44) hayır cevabı verdi. Aile danışmanlığı eğitimi alanlara pozitif performans uygulanmalı mı? sorusuna ise katılımcıların %75,7 si (n=3) evet, %4,3 ü (n=00) hayır dedi. Katılımcılara Belli sayıda aile hekiminin nüfusuna hizmet vermek üzere aile danışmanları tahsis edilmeli mi? diye sorulduğunda ise %85,8 i (n=356) evet derken, %4, si (n=59) hayır cevabını verdi (Grafik ). TARTIŞMA: Aile hekimlerinin çoğunluğu aile danışmanlığı eğitimi alınması gerektiğini ve aile danışmanlığı hizmetini de kendilerinin vermesi gerektiğini düşünmektedirler. Bu durum aile içi problemlerine yeterli çözüm üretememelerine bağlı olabilir. Aile hekimleri aile danışmanlığı hizmetini sunmaları halinde pozitif performansa yansıması gerektiğini savunmaktadırlar. Bu durum aile

14 Euras J Fam Med 03; (Suppl ): S9 danışmanlığı gibi kapsamlı bir konuyla ilgilenmek zorunda kalmalarının bir karşılığı olması gerektiğini düşündüklerini göstermektedir. Katılımcılar, aile danışmanlarının istihdam edilmesini gerektiğini düşünmektedirler. Aile içi problemlerin giderek artması aile hekimlerinin bu konudaki iş yükünü artırmıştır. Bu nedenle belirli sayıda nüfusa aile danışmanlarının tahsis edilmesi, hem aile hekimlerinin iş yükünü azaltacak, hem de aile danışmanlığı konularında profesyonel destek sağlanmış olacaktır. SONUÇ: Aile danışmanlığı konusunda eğitim almak isteyen aile hekimlerine eğitim verilmesi ve sundukları hizmetin pozitif performansa yansıması bu hizmetin daha etkin verilmesine katkıda bulunabilir. Ayrıca nüfusa göre aile danışmanı istihdam edilmesi bu hizmetin daha yaygın ve etkili olarak verilmesi açısından faydalı olacaktır. ANAHTAR KELİMELER: Aile hekimi, aile danışmanlığı, eğitim. Grafik: Aile hekimlerinin aile danışmanlığı ile ilgili görüşleri

15 Euras J Fam Med 03; (Suppl ): S0 POSTER PRESENTATIONS POSTER BİLDİRİLER

16 Euras J Fam Med 03; (Suppl ): S [ABSTRACT:0009] Nasrin Aliramaei, Simin Nazarian Nazarian, Ladan Teyfori Teyfori Faculty of Nursing and midwifery-kurdistan University of medical science -Sanandaj Study of relationship between prenatal care and demographic characteristics of pregnants INTRODUCTION: During the past 0 years, new technology has been introduced to assess the fetus ante partum, including electronic fetal monitoring, sonography and amniocentesis, with the fetus emerging as a patient in utero. Prevention of morbidity as well as mortality is now the goal. The goal of prenatal care is to help the mother maintain her well-being and achieve a healthy out come for herself and her infant. METHODS: This research was a descriptive and analytical study. The research community includes pregnant women referred to somaie center.the data collecting based on goals and easy method. The questionnaires were filled out through interview and analyzed using the statistical softeware SPSS. RESULTS: The obtained results showed that most of the units under study (high school) 3.8%, homemaker 95.5%, under 8 years married 43.3%.The most refer were the first trimester.there was a significant statistical relationship between age married,age less 35 years, level of educational husbands with prenatal care. DISCUSSION: Pregnant women had been difficulties such as nausea and vomiting, burning, constipation, back pain, increase vaginal secretion, efficacy of prenatal care also depends on the quality of care provided by the caretaker. KEYWORDS: Prenatal care, pregnant, women. [ABSTRACT:000] Nasrin Aliramaei, Kian Zobeiry Faculty of nursing and midwifery-kurdistan University of medical science - Sanandaj Iran university of medical science-tehran Body mass index associated with the number of pregnancies in women referred to health centers Sanandaj INTRODUCTION:. Obesity is created for any reason, should be treated as a chronic disease. Based on results of research conducted, the most appropriate body mass index is below 5. Pregnant women are considered among the most vulnerable groups of any population. Pregnant women are suffering from a variety of problems during the ninth month of pregnancy. Most discomfort caused by physical and physiological changes of pregnancy. METHODS: This is a descriptive analytical research and researcher had chosen the research environment as cluster sampling method geographically. Information was gathered through a questionnaire made, regular interview and measured weight and height of 300 women referred to health centers. RESULTS: Results showed BMI was 47% overweight and 4% obesity and severe obesity. Were only 7.% low-weight. There was also significant correlation between BMI with age and parity. The majority of women age with 6.7% was between 5-0 years and the most of them were married (90.3%). Their job housewife (80%). Majority with 39.7% had primary education up to sixth. With 66.3% did not mention a specific disease. Results also showed with 69.7% number of pregnancies was - times. DISCUSSION: Today, with the emphasis on population control and birth limitation, gradually the role of women have been less important in the family collection of children, increasing family size. According to these results, 47% of women were overweight, and 4% were obese and severely obese. Due to poor awareness of pregnant women seems necessary development and execution of educational programs and prenatal care. KEYWORDS: Body mass index, number of pregnancies.

17 Euras J Fam Med 03; (Suppl ): S [ABSTRACT:00] Nasrin Aliramaei, Kian Zobeiry Faculty of Nursing and Midwifery- Kurdistan University of Medical Science, Sanandaj, Iran Iran University of Medical Science, Tehran, Iran. Prevalence of diabetes and hypertension and its association with depression in the elderly retired employees in Sanandaj City, Iran INTRODUCTION: One of the major problems threatening the elderly and their families is mental health disorders. Stress in the elderly make their quality of life is being torn apart. Also, people with chronic disease at high risk of depression, which often responds to treatment. Reduced social support from family and community is one of the risk factors for depression METHODS: This descriptive study, an analysis and includes all employees were aged over 65 years of age. Environmental Research Institute retirees were included. The purpose of sampling and censusa and 384 patients were enrolled with their desire. Data gathered by questionnaire in two parts: Part I;4 questions characterize and profile Hamilton Depression test with 4 questions.for data analysis using computer software SPSS of descriptive and inferential statistics were used and X. RESULTS: Results showed the majority were male (9.9%) with the majority of the 35.9% age (80-76) years. Also, 6% had disease; the majority of 40.% with heart disease and high blood pressure, and 9.9% had diabetes. 43.5% in depressed border and 8.6% depression, and only 4.% had severe depression. Between depression and age, sex was a significant relationship but with diabetes and high blood pressure p= 0.00, relationship was no significant. DISCUSSION: The results showed that among 384 elderly depression existe since population aging is going to and to create new issues psychological and physical diseases such as diabetes have high blood pressure and identify the causes and factors to be considered. KEYWORDS: Depression, diabetes, high blood pressure, elderly. [ABSTRACT:00] Evaluation of women with hirsutism in dermatology clinic in Sanandaj in year period Roxana Yaghmaei, Farokh Rad Kurdistan University of Medical Science, Sanandaj, Iran INTRODUCTION: Determination of the causes of hirsutism in hirsute patients who referred to dermatologic clinic in Sanandaj from 003 till the end of 004. Hirsutism is the growth of coarse terminal hair in a male pattern distribution in females. METHODS: This is a cross sectional study comprising 80 hirsute patients in Sanandaj, ( ). The method of sampling was census and the data were collected by use of questionnaires. The patients were interviewed and examined. Relevant tests and sonography of ovaries were requested. The data collected, were analyzed by means of SPSS and chi square tests. RESULTS: Menstrual irregularities, acne vulgaris, family history of hirsutism and hair loss were detected in 36.%, 37.7%, 47.8% and 6.7% of the patients, respectively. Regarding Para clinical Tests, high serum levels of testosterone, prolactin, DHEA-SO4 were detected in 5%, 6%, % respectively and 3% of patients had high urine level of cortisol. 6.7% of patients had mild hirsutism, chin was the most common site of involvement (47.7%). No significant relationship between the age of the patients and severity of hirsutism was observed ( p=0.000). CONCLUSION: It has been stated that polycystic ovary syndrome is the most common cause of hirsutism, but in our study, most patients had the idiopathic type of disease. Therefore factors such as genetics, nutrition, and inappropriate use of medicines and lack of suitable diagnostic facilities may be regarded as possible explanations for the results of this study. KEYWORDS: Hirsutism, polycystic ovary syndrome, acne vulgaris.

18 Euras J Fam Med 03; (Suppl ): S3 [ABSTRACT:003] Roxana Yaghmaei, Farokh Rad Kurdistan University of Medical Science, Sanandaj, Iran Prevalence of pediculus capitis in primary school students BACKGROUND AND OBJECTIVE: Pediculus capitis is a worldwide problem and is still a common disease in some countries. Although pediculus capitis can occur in all ago groups, it is more prevalent among children of primary school age group and especially in girls. In this study, the prevalence of pediculus capitis and the factors influencing its prevalence in primary school female students in Sanandaj in year 005 is evaluated. MATERIAL-METHODS: In this study, 600 female students at the level of primary girls school that were chosen randomly in different parts of Sanandaj and in every school 50 students were chosen by chance and examined. The major criterion of diagnosis were detection of the mature parasite or its egg (nit) on the hair of students. The information obtained by this physical examination and the demographic information about all students were recorded in separate questionnaires. Then the information was analyzed by SPSS and chi square and T test statistical tests. RESULTS: Among the 600 girls, 46 (7.7%) has pediculus capitis. There are no meaningful correlation between the rate of infestation and the length of hair t occupation and the level of education of fathers, but there is a statistical correlation between rate of infestation and the level of education of mothers. CONCLUSION: Student's parents and teachers will be trained about this problem and be ways of spread of louse in family and school in order to limit breakout of infestation. Therefore the complications and expenditure of treatment of the disease will be reduced. KEYWORDS: Pediculus, student, Sanandaj. [ABSTRACT:004] Roxana Yaghmaei, Farokh Rad Kurdistan University of medical science, Sanandaj, Iranı A study on frequency of skin complications in diabetic patients referring to dermatological clinic in Sanandaj in 009 INTRODUCTION: Glucose is the major source of energy for most mammalian cells. However abnormally high levels of glucose, as seen in diabetes, may lead to development of chronic complications. The aim of this study was to determine the frequency of skin complications in diabetic patient visited in dermatologic clinics in Sanandaj. METHODS: Study population included all diabetic patients (34 patients) during the first six month of 009. They were examined and the data concerning their dermatologic status were collected and introduced in SPSS, with software and analyzed by means of descriptive statistics. RESULTS: 38 patients (8.4%) were male and 96 (7.6%) were female. The mean age of the patients was 54.5% years (sd=) with an age range of 4 to 79 years. 48 patients (35.8%) had no skin problem. While 86 patients (64.%) had one of the skin complications. Pruritus was the most common skin complication, order skin problems detected in our patients in order of frequency were hair loss, chronic ulcers, vitiligo, genital pruritus, candidiasis and leg ulcer. CONCLUSION: It seems that the prevalence of skin complication in diabetic patients in our study is similar to those of other studies in the world, but the severity of the skin problems in our patients was less than that of other studies which may be due to good management of diabetes in our patients. KEYWORDS: Diabetes mellitus, skin complications.

19 Euras J Fam Med 03; (Suppl ): S4 [ABSTRACT:005] Depression after the stroke Kian Zobeiry, Nasrin Aliramaei Iran University of Medical Science, Tehran, Iran Kurdistan University of Medical Science, Sanandaj, Iran INTRODUCTION: Depression frequently in patients with brain disorders, neurological disorders, especially cerebral vessels occurs. Statistics have shown for the individual patient depression diet control, accurate set of physical activities. See your doctor regularly, keeping the other criteria, treatment, reduced, and lack of cooperation in the implementation of measures leading treatment. Therefore, the medical team with the first step in the field of cognitive Ysty Risk factors of depression after stroke attack have sufficient knowledge. METHODS: Study a descriptive-analytical study is to assess depression in patients with CVA clients after discharge in the Medical Center of Sanandaj were towhid. Information on two occasions early in the admission and after till months of disease using a questionnaire ( question test Beck and demographic questions) were collected and statistical analysis ed. RESULTS: Test Beck admission 69% healthy and 3% require some degree of mild depression and had to consult with a physician, but after two months of healthy patients, % and 79% had some degree of mild to severe depression. Significant relationship between demographic characteristics (age, education, speak disorder, the previous history of stroke attack, the need to assist others in doing daily) and depression were observed. DISCUSSION: The fact that stroke is one health problem worldwide and as one of the most debilitating factors is considered, can be on your person, family, community to put a negative effect. In addition to the exorbitant costs of treatment to patients with mental disorders, which clearly can be seen in older people. KEYWORDS: Depression, stroke. [ABSTRACT:006] Kian Zobeiry, Nasrin Aliramaei Iran University of Medical Science, Tehran, Iran Kurdistan University of Medical Science, Sanandaj, Iran Studying level of anxiety in clients with diabetes who referred to medical center towhid Sanandaj INTRODUCTION:. Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the cells of the body. Patient s requiring long term are often concerned about the unpredictability of the illness and the disruption of their lives. Clients may experience anxiety as the result of a specific medical condition, as a result of treatment for a specific medical condition or as a result of changes in employment or life style due to a medical condition. Thus the nurse needs to give the patient and family the opportunity to express feeling of anger and concern over the limitations that the disesase and treatment impose and over possible financial problems and job insecurity. METHODS: This research is descriptive analytic and the research society contains all clients with diabetes who refer to the research place the number of samples 98 and tool used is a questionaire containing parts. individual characteristics, and also Hamilton questionaires. The information was completed and the scord and the statisticaly analyzed. RESULTS: The findings showed that the most samples were housewife (57%) and (93%) married, (86%) with diploma and mostly for -5 years who had diabetes history, age was between 3-40 years (66%). Regarding finding anxiety level 0% had low, 69% had middle, % light, also between demographic charachteristics and level of anxiety was shown a significant relationship. DISCUSSION: Regarding significant statistical relationship between personal information with level anxiety, obtained in this study. thus, clinical nures especialists, psychological, and social worker may be helpful in assisting the patient and family to cope with the change brought about by diabetes and its treatment. KEYWORDS: Diabetes, anxiety.

20 Euras J Fam Med 03; (Suppl ): S5 [ABSTRACT:007] Frequency of hepatitis B and C in surgical patients, civil hospital, Karachi R. Rafaqat Bota Dow Medical College, Karachi, Pakistan BACKGROUND: Hepatitis B and C are serious health problems worldwide. Infections with hepatitis B and C virus have been escalating in Pakistan and it has reached in endemic state. This study was carried out to determine the frequency of hepatitis B and C in surgical patients. METHODS: This cross-sectional study was conducted in Civil Hospital Karachi. Total 66 patients admitted in surgical department were approached. All patients were screened for HBsAg and anti- HCV using immunochromatography ICT. The information about risk factors was also assessed. The data was analyzed on SPSS 7. RESULTS: Out of 66, 35 (49.%) were males and 337 (50.9%) were females. Mean age of patients was Hepatitis B surface antigen (HBsAg) was positive in 9 (.9%) and Hepatitis C (anti-hcv) in 45 (6.8%) patients. HBsAg was positive in (63.5%) males and 7 (36.84%) females, whereas anti-hcv was positive in (46.66%) males and 4 (53.33%) females. The results show that out of 9 positive patients for HBsAg, 7 (89.47%) have history of intravenous injections and out of 45 anti- HCV, 44 (97.77%) have the same history. The other major risk factors found were blood transfusion, sexual contacts, blood donation, ear-nose piercing, dental procedure and barber shave. CONCLUSION: The study suggests a moderate to high prevalence of hepatitis B and hepatitis C in surgical patients. Routine serological screening prior to surgery should be made mandatory so that health care workers especially surgeons can take precaution before surgery. KEYWORDS: Hepatitis B and C, prevalence, surgical patients, screening. [ABSTRACT:008] Rafaqat Bota Dow Medical College, Karachi, Pakistan Knowledge and self-perceived practices regarding infection control among nursing students of a tertiary care hospital BACKGROUND: Health care-associated infections (HAIs) are a major cause of preventable illness and deaths. Risk in developing countries is 0 folds more than in developed countries. Nurses can play a dominant role in infection prevention and control. Therefore this study aimed to assess knowledge and self- perceived practices regarding infection control among nursing students. METHODS: A cross-sectional study was conducted at a tertiary care hospital. Questionnaire comprising demographic characteristics, a knowledge part and a practice part was used to interview nursing students. Data was analyzed on SPSS Version 7. RESULTS: Total 4 students were interviewed among them 4.5% were males and 58.5% females. Among all the students 80.9% were aware of the fact that there are certain guidelines by WHO on hand washing, but only 0.3% performed 6 steps completely. Only 53.% students were aware of the term Health-care Associated Infections (HAIs). Risk of transmitting a HAI was thought to be increased due to lack of hand washing before and after procedures by 67.%, unhygienic environment of hospital by 63.%, lack of glove usage by 53.% and lack of appropriate disinfectant procedures by 38.6% of the students. CONCLUSION: Knowledge about common health-care associated infections, hand hygiene and other infection control practices were found inadequate. Steps should be taken to improve infection control knowledge and practices with particular emphasis on nurses. KEYWORDS: Health-care associated infections; infection control practices; hand washing; nursing students.