Prevalence of text neck syndrome among Iraqi medical students: a cross-sectional study

Background: Excessive use of portable electronic devices causes neck flexion and the emergence of text neck syndrome (TNS). This study aims to explore the prevalence of TNS among medical students during the COVID-19 lockdown in Iraq. Methods: A prospective cross-sectional web-based study was conducted from 1st to 20th March 2021 at the faculty of medicine, Diyala University, Iraq. A self-administered questionnaire was distributed among the medical students using Google Form through social media (WhatsApp group). The semi-structured questionnaire included the sociodemographic, the valid smartphone addiction scale-short version (SAS-SV), and the neck disability index (NDI). Univariate, bivariate, and multiple logistic regression were used to analyze the data. SPSS version 16. The statistical significance is considered at less than 0.05. Results: Out of 273 medical students included in the study, 59.3% were males, unmarried (88.3%), and from the 1st year (21.6%). The mean age of students was 21.27 ± 1.74 years. The prevalence of text neck syndrome was 64.5%. About two-thirds (61.5%) of students were addicted to their smartphones and used them more than five h/daily (63.7%). Factors associated with neck disability were the students who did not warm up neck muscles before using the smartphone (OR = 8.796, 95% CI: 1.724 to 24.884), addicted to the smartphone (OR = 6.803, 95% CI: 3.455 to 13.397), experienced increase in daily hours using the smartphone during the COVID-19 related quarantine (OR = 5.370, 95% CI: 2.523 to 11.427), maintained smartphone use five hours and more daily (OR = 2.818, 95% CI: 1.422 to 5.587), had neck pain (OR = 2.876, 95% CI: 1.356 to 6.098), the female gender (OR = 2.756, 95% CI: 1.221 to 6.221), and those who did not have a frequent break when using the smartphone (OR = 2.693, 95% CI: 1.329 to 5.454). Conclusion: In conclusion, the prevalence of neck disability was high among the surveyed medical students. Addiction and excessive smartphone use with a lack of attention to warm up the neck muscles before usage was the most prominent predictors of neck disability.

Attitude and intention of Iraqi healthcare providers to get vaccinated against COVID-19: a cross-sectional study

Background: International efforts to confront the COVID-19 pandemic are joining forces by accelerating the pace of vaccination. This study aims to explore the attitude and the intent to get vaccinated against COVID-19 among healthcare providers (HCPs) in Iraq. Methods: A cross-sectional survey was conducted in January 2021 using web-based facilities to access the respondents. The data were collected through a semi-structured and self-administered questionnaire, including sociodemographic and close-ended questions related to attitude and intention toward COVID-19 vaccination. Bivariate and multivariate logistic regression were recruited to predict variables. The statistical significance is considered at less than 0.05. Results: Data of 209 HCPs with a mean age of 45.12 (± 6.37) years have undergone final analysis. Most of the HCPs were males (112, 53.6%) and nurses (110, 52.6%), who had close contact (64.6%) with COVID-19 patients, and forty percent have been infected with COVID-19. Overall, 115 HCPs (58.0%) reported intention to get vaccinated compared to 94 (42.0%) who declined vaccination. Variables associated with intention to get vaccinated among HCPs were high attitude toward COVID-19 vaccination (odds ratio (OR) =  1.740, 95% confidence interval (CI): 0.799, 3.786), aged less than 45 years (OR = 3.713; 95% CI: 1.647, 8.367), married (OR = 2.155; 95% CI: 0.984, 4.720), highly educated (OR = 2.657; 95% CI: 1.202, 5.871), doctors (OR = 3.153; 95% CI: 1.428, 6.963), contracted with COVID-19 (OR = 4.119; 95% CI: 1.623, 10.455), directly engaged in management of COVID-19 patients (OR = 3.962; 95% CI: 1.569, 10.005), and had lost a close relative due to COVID-19 (OR = 5.698; 95% CI: 1.506, 12.564). Conclusion: The urgent need to improve the COVID-19 vaccine uptake rates among Iraqis requires a positive attitude and a high vaccination rate among HCPs.

knowledge and attitude of Iraqi women in reproductive age group about risk factors in pregnancy

Improved knowledge among women about maternal risk factors significantly reduced the likelihood of adverse events in pregnancy and childbirth. This study aimed to explore Iraqi women's knowledge and attitudes about maternal risk factors in pregnancy. A multicenter cross-sectional survey was conducted from 01 January to 31 March 2019 among women of the reproductive age (15-49 years). A convenient sampling technique using a semi-structured questionnaire was recruited to interview the sample. SPSS version 16.0 was used to analyze the data. Descriptive and inferential statistics (Chi-square test) were used to present data with the significance level considered at <0.05. Data of 250 women underwent final analysis. The mean age of respondents was 27.76 (±6.3 years). Most of the respondents (79.9%) correctly knew the maternal risk factors in pregnancy. A large percentage of women knew that poor nutrition, anemia (95.6%), smoking and passive smoke (95.6%), and obesity (85.2%) during pregnancy are risk factors affecting the fetus’ health. However, about 40.0% of women thought there was no harm during pregnancy, and therefore there was no need for medical check-ups regularly. In bivariate analysis, there was a significant association between knowledge and level of education. The higher the level of education, the greater the women's knowledge about risk factors such as malnutrition and anemia (P=<0.001), obesity (P=0.04), diabetes (P=0.002), repeated urinary tract infection (P=0.017), Rh incompatibility (<0.001), history of previous cesarean section (P=0.010), smoking and passive smoking (P=0.014) and evidence of bleeding (P=0.001). In conclusion, Iraqi pregnant women demonstrated a good level of knowledge about the risk factors during the pregnancy.

Evaluation of health system in Iraq from people's point of view: a comparative study of two different eras

Background: Since the 2003 United States–British coalition military invasion, Iraq has been in a state of continuous deterioration at all levels, including the health sector. This study aimed to elicit the viewpoints of the Iraqi people on the current health system, focusing on many provided health services and assessing whether the public prefers the current health system or that was provided before the invasion. Methods: A cross-sectional survey designed to explore the Iraqi people’s opinions on their health system. A self-administered questionnaire using a multi-stage sampling technique was distributed in five geographical regions in Iraq to collect the data from the head of household between 1st October and 31st of December 2019. Multiple logistic regressions were recruited to determine the significant contributing variables in this study. Results: A total of 365 heads of households (response rate: 86.1%) with the mean age of 48.36 + 11.92 years (ranged 35-78) included in the study. Most of the respondents (61.4%) complained of healthcare inaccessibility, 59.7% believed that health resources were not available, 53.7% claimed a deterioration in the quality of care, and 62.2% believed that the political / media position did not contribute to positive changes during the past two decades. Indeed, most respondents (66.0%) believe that the current healthcare system is worse than before. In the multivariate analysis, there was a statistically significant relationship between the characteristics and opinions of the respondents. Old age group (p = 0.003), men (p = < 0.001), married (p = 0.001), low educated (p = < 0.001), rural resident (p = < 0.001), unemployed (p = 0.003), monthly income of less than USD 400 (p = < 0.001), consider themselves to be unhealthy (p = 0.001),  and those who think that people are unhappy now than two decades ago (p = 0.012) have a more negative opinion of the health system. Conclusion: Most Iraqis surveyed expressed disappointment from the health system after the 2003 United States–British Coalition military invasion. The current health system is faltering at all levels and does not meet the citizens' basic needs. Health Transformation Program (HTP) has become inevitable to develop an accessible, affordable, high-quality, efficient, and effective health system.

Knowledge, attitude, and practice towards COVID-19 among Libyan people- a web-based cross-sectional study

Background: Successful plans in disaster and epidemics management depend on the feedback response and the assessment of knowledge, attitudes, and practices among the target population. This study aims to assess the knowledge, attitude, and practice towards COVID-19 among Libyan people.  Methods: A cross-sectional web-based survey designed to assess the knowledge, attitude, and practice towards COVID-19 among the Libyan people from 13-20 October 2020. A self-administered questionnaire was recruited to collect the data of 287 participants. SPSS version 16.0 was used to analyze the data using univariate and multivariable regression data analyses. Results: More than half of respondents were males (53.7%), married (61.3%), aged less than 45 years old, highly educated (46.3%), employed (44.6%), urban resident(79.8%), experience good or very good health (71.1%) and earned more than USD 200 monthly (84.3.%). The participants showed a high rate of good knowledge (81.0%), attitude (71.1%), and practice (83.7%) towards COVID-19, respectively. Regression analysis showed that married (P=0.056), female (P=0.037), living in the urban regions (P<0.001) with good income of more than USD 2020 (P=0.001) were significantly associated with upper knowledge score. Females (P=0.040) were more significantly associated with positive attitude scores than males. Regarding practice score, married (P=0.001), females (P=0.059) had better practice, but poor-rated health status (P=0.018) was significantly associated with the weak practice. Conclusion: The distinction of urban regions with good knowledge, optimistic attitudes, and acceptable practices towards COVID-19 determines the government's action compass towards more interest in supporting males, unhealthy, and those living in the rural areas with accurate and timely knowledge.

Covid-19 in Iraq: an estimated cost to treat patients at a private clinic

The impact of the COVID-19 pandemic extended to health, social and economic aspects of human life. The international failure to combat this crisis has left many countries suffering under the influence of successive waves of the pandemic. In this report, we present a private medical clinic's experience dealing with the COVID-19 epidemic in Iraq. The adopted protocol to treat COVID-19 patients has briefly been discussed with an estimated cost of treatment in the private sector. We found that most COVID-19 patients recovered from the disease, except for cases that were associated with co-morbidities. The cost of treatment in the private sector is expensive, and most infected people could not afford it without public sector support.

Knowledge, attitude, and practice towards COVID-19 among Syrian people resident in Turkey

Background: Measuring knowledge, attitude, and practice towards COVID-19 helps policymakers observe knowledge gaps and provide key messages to people to act better against the pandemic. This study aims to assess the knowledge, attitude, and practice towards COVID-19 among Syrian people resident in Turkey.  Methods: A cross-sectional study designed to assess the knowledge, attitude, and practice towards COVID-19 among the Syrian people resident in Turkey. The data were collected via a web-based and self-administered questionnaire of 313 participants from 17-31 July 2020. SPSS version 16.0 was recruited to analyze the data using univariate and multivariable regression data analyses. Results: Our finding as the first study among Syrian people resident in Turkey found a high rate of good knowledge, attitude, and practice towards COVID-19 accordingly with 83.0%, 72.0%, 84.0%. Regression analysis showed that age-group of 45 years and more years, marital status of being married, female gender, living in urban area were significantly associated with upper knowledge score. Age-group of 45 years and more significantly associated with positive attitude score but inversely being married and unemployed statues significantly associated with a negative attitude. Regarding practice score, married and female people had better practice, but poor-rated health status was significantly associated with the weak practice. Conclusion: Although our finding showed a good rate for knowledge, attitude, and practice towards COVID-19, but it needs to improve cause of many barriers on Syrian people resident in Turkey, such as living in a crowded place, distant from health care services, losing whole or part of their income due to COVID-19 as an economic crisis, different language barriers. Some groups like men, people living in a rural area, and those unemployed or lost their job should be exposed by timely and accurate knowledge.

Knowledge, attitude, and practice toward COVID-19 among Iraqi people: a web-based cross-sectional study

Background: Iraq was among the first countries invaded by the novel human coronavirus (SARS-COV-2) after China. This study aimed to assess the Iraqi people's knowledge, attitudes, and practices toward COVID-19 during the pandemic.  Methods: A cross-sectional study recruiting an online self-reported survey conducted from 17-31 July 2020. Data of 877 participants have undergone descriptive, univariate, and multivariable regression analyses, respectively, to assess the differences in mean scores and identify factors associated with knowledge, attitudes, and practices (KAP) toward COVID-19. Results: Most of the respondents (78.8%) from the urban region, highly educated (69.7%), aged less than 45 years (61.2%), females (58.3%), married (51.9%), and 74.0% self-ranked health as good. Less than half (45.4%) were employed; however, the average monthly income was USD 400 or more in about 66.8% of them. The mean knowledge, attitude and practice score was 15.57 ± 2.46 (range: 0-20), 38.88 (SD = 3.57, (range: 11-55), and 5.13 (SD = 1.14, range: 0–6), respectively. Findings of regression analysis showed that higher educated (p< 0.001), urban residents (P <0.001), employed (P =0.040), and having an income level of USD 400 or more (P <0.001) were significantly associated with upper knowledge score. Female gender and employed respondents are significantly associated with positive attitude scores, but inversely respondents with an income of USD 400 or more are significantly associated with a negative attitude. Regarding practice score, the female gender and those living in an urban region had better practice, but the young age group (0-44 years) was significantly associated with the weak practice. Conclusion: Although Iraq has adopted a preventive and precautionary plan to control the spread of coronavirus. However, the public's knowledge and attitude toward COVID-19, coupled with the unstable political and security situation, have greatly affected the commitment to preventive measures.

The second wave of COVID-19 is knocking at the doors: have we learned the lesson?

In light of escalating rates of COVID-19 cases, the world stands stunned. The health, social, and global economic situation continues to deteriorate. The seriousness of the situation became evident to most people, yet no one had a radical solution. Scientifically, there is no sure treatment for viral infections other than strengthening the immune system. Therefore, the idea of ​​a vaccine is the most appropriate to reduce infections. However, vaccines will not be accessible to everyone, considering the genetic changes that the virus may create later. The idea of ​​re-imposing a global quarantine, with international leadership for a limited period, is emerging as a strategic alternative, on the condition that it should be launched simultaneously in all countries of the world. To ensure the quarantine's success, all countries must adhere to the comments of the World Health Organization and the Centers for Disease Control and Prevention.   References World Health Organization, Novel Coronavirus 2019-nCoV) SITUATION REPORT –1, 21 JANUARY 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf [Accessed on 08 October 2020]. Fani M, Teimoori A, Ghafari S. Comparison of the COVID-2019 (SARS-CoV-2) pathogenesis with SARS-CoV and MERS-CoV infections. Future Virol. 2020:10.2217/fvl-2020-0050. https://doi.org/10.2217/fvl-2020-0050 Ali Jadoo, SA. Was the world ready to face a crisis like COVID-19? Journal of Ideas in Health2020;3(1):123-4. https://doi.org/10.47108/jidhealth.Vol3.Iss1.45 Worldometer, Coronavirus Cases. Available from: https://www.worldometers.info/coronavirus/? [Accessed on 08 October 2020] Cyranoski D. Profile of a killer: the complex biology powering the coronavirus pandemic. Nature, 04 MAY 2020. Available from: https://www.nature.com/articles/d41586-020-01315-7 [Accessed on 08 October 2020]. CDC, Centers for Disease Control and Prevention. Considerations for Wearing Masks Help Slow the Spread of COVID-19. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html [Accessed on 08 October 2020]. Atalan A. Is the lockdown important to prevent the COVID-9 pandemic? Effects on psychology, environment and economy-perspective. Ann Med Surg (Lond). 2020; 56:38-42. https://doi.org/10.1016/j.amsu.2020.06.010. Gewin V. On the front lines of the coronavirus-vaccine battle. Nature; 2020 Apr 16. Available from: https://www.nature.com/articles/d41586-020-01116-y [Accessed on 08 October 2020]. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, Azman AS, Reich NG, Lessler J. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020;172(9):577-582. https://doi.org/10.7326/M20-0504. Acter T, Uddin N, Das J, Akhter A, Choudhury TR, Kim S. Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as coronavirus disease 2019 (COVID-19) pandemic: A global health emergency. Sci Total Environ. 2020; 730:138996. https://doi.org/10.1016/j.scitotenv.2020.138996. Ali Jadoo SA. COVID -19 pandemic is a worldwide typical biopsychosocial crisis. Journal of Ideas in Health2020;3(2):152-4. https://doi.org/10.47108/jidhealth.Vol3.Iss2.58.

Patient satisfaction in outpatient medical care: the case of Iraq

  Background: Healthcare providers are increasingly interested in patient satisfaction as an indicator to assess the quality of health services. This study investigates the level of satisfaction among Iraqi patients attending the outpatient (OP) clinic. Methods: This was a cross-sectional study conducted from October to December 2019 among outpatient attendees in two busiest centers in Iraq. A convenience sample of 235 (response rate of 88.0%) completed the self-administered short-form patient satisfaction questionnaire (PSQ-18). The independent variables included socio-demographic, economic, and self-perceived health status. Data were analyzed in SPSS, where descriptive analysis (mean ± standard deviation) and univariate (independent sample t-test, ANOVA test) and multivariate linear regression “Enter technique” was done at 0.05 level of significance and 95% confidence interval. Results:  The mean age of respondents was 39.3 (±14.8). The sample was mostly women (55.3%), and 37.4% in the age group of 30-49 years.  More than half of participants residing in the urban regions (54.5%) from families of monthly household income less than 500,000 Iraq Dinars (USD 400). However, the majority (70.6%) have the first visit to the OP clinic, and 53.6% self-perceived health as good or very good. Results of multiple linear regression showed that patients residents in rural regions (B= 5.4 , P <0.001), married (B= 4.8, P <0.001), unemployed (B= 4.7, P <0.001)  and low educated (B= 1.5, P <0.051)  exhibited higher service satisfaction score compared to urban residents, single, employed and high educated participants respectively. However, patients aged fifty years and more (B= -2.1, P <0.001) and those with poor health (B=-2.5, P <0.001) exhibited lower service satisfaction scores compared to young age patients and the healthy participants, respectively. Conclusion: The high demand for the use of health resources in metropolitan cities by the rural population indicates inequality in the distribution of health services and an increase in the rural-to-urban displacement.

Gender differences in the domains of job satisfaction: a questionnaire survey among doctors

Background: The impact of gender differences in the labor market cannot be neglected when studying job satisfaction among doctors. This study aimed to assess the gender differences in a ten-items Warr–Cook–Wall (WCW) job satisfaction scale among Iraqi medical doctors.  Methods: A cross-sectional study was conducted between January and June 2014 in Iraq. The multistage sampling technique was recruited to collect the data from 20 health institutions. A total of 576 doctors returned the self-administered questionnaire (response rate= 87.3%). Student t-test and the Pearson correlation tests were used to analyzing the data. Results:  Female doctors rated the overall job satisfaction index significantly higher than their peer male colleagues (P <0.001). Findings of student t-test showed a significant gender difference; women doctors appeared more satisfied than men in the freedom to choose the method of working, satisfied with their colleagues and fellow workers, amount of responsibility given to them, income, opportunity to use their abilities, hours of work and the amount of variety in the job. In contrast, the Pearson correlation coefficient results indicated a high satisfaction among male doctors than females in terms of recognition for good work (P =0.02) and the physical working condition (P =0.04), respectively. Conclusion: Analysis of data based on indices rather than the only overall job satisfaction appeared as an efficient method to understand gender differences. The possibility of increasing the representation of women in recognition and awards may raise the level of job satisfaction.

COVID -19 pandemic is a worldwide typical biopsychosocial crisis

Since December 2019, the world has been stunned by the speed of the spread of the COVID-19. All the possibilities were likely, except that people would hide in their homes for fear of contracting the disease, as it was very unlikely. The lockdown was imposed severely, and people panicked, and their interest has limited to providing food and caring for health and family. The effect of isolation and the prevention of social interaction was apparent in the individuals' psychological behavior. Unfortunately, the incidence of depression, anxiety, and domestic violence increased, which negatively impact family stability in the short and medium-term. The pathological, psychological, and social impact of COVID-19 imposes a framework for dealing with the pandemic based on the biopsychosocial model.

Gender differences in the factors influencing the choice of future career among the final stage Turkish medical students

Background: Turkey has a marked increase in the proportion of female medical students and graduates doctors compared to males. However, females are still underrepresented in some disciplines and grouped in other branches of medicine. It is essential to regularly assess the medical students' trends toward the specialty and avoid the shortage and maldistribution in some critical specialties. This study aims to investigate the gender differences in Turkish medical students’ specialty preferences and influencing factors. Methods: A descriptive cross-sectional study carried out among final year students at the Bezmialem Vakif University (BVU), Faculty of Medicine in Istanbul, Turkey. Data collected from March to April 2018 using a pre-tested self-administered questionnaire included socio-demographic characteristics of the population, first choices for specialization, and the factors influencing those choices. An independent sample t-test performed to test the gender differences in different influencing factors. Data were analyzed using SPSS version 16. Results:  A total of seventy (70) students (response rate of 69.5 %) included in the data analysis. The mean age of total respondents was 24.9 ± 0.96 (ranged 23-27), and the male to female ratio of students was approximately 1:1.4. Out of nineteen (19) factors, statistically significant gender differences noted in the mean scores of six factors. Male students were more influenced by family expectations (2.76 ± 0.87, p=0.008), geographical consideration (2.97 ± 0.91, p=0.053), and high income expectations (2.90 ± 0.90, p=0.024) compared to female students. However, female students were more influenced by personal interests (3.61 ± 0.49, p=0.041), personality characteristics (3.59 ± 0.55, p=0.010) and malpractice (2.73 ± 1.03, p=0.015) compared to male students. Conclusion: There is a significant difference between the sexes in terms of priorities; family, income, and geographical distribution significantly impacted on men, while women were more concerned with lifestyle, well-being and avoiding responsibility.

Impact of internal displacement on psychosocial and health status of students residing in the hostel of Anbar University, Iraq

Background: Displacement in Iraq has been widespread and for frequent periods. Education was one of the most prominent victims of displacement at all levels, including higher education. This study aims to assess the impact of displacement on the psychosocial and health status of undergraduate students living in student accommodation of Anbar University, Iraq.    Methods: A retrospective cross-sectional study was conducted from 3rd to 17th April 2017. Data was collected using a universal sampling technique. A total of 355 students (Response Rate: 82.1%.) completed a self-administered questionnaire consisting of 26 close-ended questions related to the socio-demographic and economic characteristics of students. Data were analyzed using SPSS version 16. Descriptive data presented as the mean and standard deviation (±SD). Results:  The mean age (±SD) was 22.1 (±1.7) years (range 18-29). About two-third (240, 67.6%) of students experienced some mental disorders. Moreover, 25.1% of students confirmed that the mental disorders were negatively related to their level of performance in college, and the treatment was not available for 31.0% of them. Because of ID, about 45.4% of surveyed students had lost at least one academic year, and 17.5% began to smoke tobacco during the ID period. However, the social and psychological support was absent for about 57.4% of respondents. Conclusion: Our results suggest an urgent and strategic plane to improve the quality of logistics, health, and infrastructure of student accommodation.

Was the world ready to face a crisis like COVID-19?

One of the most prominent flaws in the world revealed by COVID-19 is the lack of prior preparation to collectively face international crises. Even at the national level, preparation was meager, as demonstrated by reading the size of the budget approved for health and education versus the budget approved for armament and military actions. It seems that the world was busy preparing for wars and forgot to promote the individual, community, and global health.

Time to change to improve health: clinical pharmacy and pharmaceutical care education in Turkey

The practice of clinical pharmacy had a positive impact on the profession by giving pharmacists more job opportunities. Moreover, the pharmacy began to gain the status it deserved, which was lost many years ago. In this paper, we aimed to give a brief explanation of the clinical pharmacy philosophy and definition of pharmaceutical care. What are the general and specific roles of clinical pharmacists in the modern world healthcare system? Also, how to implement clinical pharmacy in education to obtain competent pharmacists. We shared our observation and experience, specifically on the progress of implementation of clinical pharmacy education in Turkey. The stepwise method has been successfully followed in the implementation of clinical pharmacy education in Turkey. In the undergraduate program, the first step taken was the addition of clinical courses, such as the role of clinical pharmacy, patient education, etc. and practical hospital rounds (internal medicine, pediatrics, and surgery). The post-graduate program, such as master (MSc) and doctoral (Ph.D.) degrees, also offered to prepare clinically oriented pharmacy academicians. The continuous education programs were structured to implement clinical pharmacy idea for the pharmacists in practice. In conclusion, the stepwise approach significantly smoothed the transition from the product-oriented to the patient-oriented pharmacy education. Moreover, the adoption of the skills education system to educate pharmacists needs to review the policy regularly and gradually change it accordingly.

Knowledge, attitude, and practice of mothers about complementary feeding for infants aged 6-12 months in Anbar Province, Iraq

Background: The understanding of what mothers think about breastfeeding helps in developing successful breastfeeding promotion programs. This study aims to assess the maternal knowledge, attitude, and practice about the complementary feeding for infants aged 6-12 months. Methods: A cross-sectional study designed to interview 219 mothers with children between 6-12 months. Data was collected between 1st March and 30th April 2019 from ten maternal and child health clinics (MCHCs) in Anbar Province, Iraq. SPSS version 16.0 was recruited to analyze the data. Descriptive and inferential statistics such as Chi-square used to present data with the significance level set at less than 0.05. Results:  The mean age of respondents was 27.76 ± 6.3 years, and 31% were at the primary school level. Two third (66.82%) of the surveyed mothers exclusively used breastfeeding to feed their infants. Most women (84.09%) have the correct knowledge about the best time to start complementary food. The vast majority of women (93.64%) refused to give vitamins to children even with signs of malnutrition. Conclusion: Although exclusive breastfeeding is common among mothers of the western region in Iraq, there is still a considerable percentage depend on the mixture of breastfeeding and bottle feeding. The positive impact of the family and society on mothers was evident. However, more attention should be given to improve knowledge, attitude, and practice through qualified healthcare providers.

Does the quality and novel work save the researcher's effort and raise the likelihood of acceptance?

Research is known to be of high quality when it passes the test of experienced peers, has a potential impact on the development of scientific research, and positively contributes to improving society. While the research considered novel when the researcher has his fingerprint in the world of scientific research, i.e., the outputs brought something new or not known before in the research world. Different reasons, such as repeated studies, plagiarism, grammatical errors, out of the journal scope, and nothing new contribute to pushing the research away from the interest of the publishers. 

Female doctors are more emotionally exhausted than their male counterparts in Iraq

Background: The increasing number of women graduating from medical schools doubles the level of responsibility and increases competition with males. Therefore, the assessment of the emotional exhaustion impact on women has become necessary to avoid over-stress at work. This study aims to assess and discuss the gender differences in nine-item emotional exhaustion (EE) subscale of the validated Maslach Burnout Inventory (MBI) among a sample of Iraqi physicians.  Methods: A descriptive cross-sectional study conducted over the first half of 2014. Data was collected from 576 doctors using a self-administered questionnaire with a multistage sampling technique. An independent sample t-test used to compare the means. Results: More than half of respondents (310, 53.8%) were females with a mean age (±SD) of 40.43 years (±8.59). Female doctors are less affected than males in term of emotional draining from work (p=0.008) and strained by people (p=0.009) respectively. Male doctors are less affected than females in being used up at the end of the week (p<0.001), stressed by working with people (p<0.001), burned out from work (p<0.001) and frustrated by job (p<0.001). However, both male and female doctors are equal in feeling fatigue in the morning (p=0.286), feeling of working too hard (0.284) and of being unable to stand (0.358). Conclusion: This study supports the results of previous studies that female doctors show more empathy when dealing with patients, however, they appeared more prone to burnout and stress.

Workplace violence against medical students- A Turkish perspective

Background: Workplace violence against healthcare providers including the medical students being an important issue all over the world. The aim of this study is to survey the medical students about exposure to workplace violence (WPV) while they are doing their medical training in private tertiary hospitals. Methods: This was a cross-sectional study carried out among all medical students (4th, 5th, and 6th class) attending a teaching hospital at Bezmialem Vakif University (BVU), Istanbul, Turkey. A total of 150 students in the 2017-2018 academic year were recruited in this study. Data were collected using a modified questionnaire through a face to face interview. Data were analyzed using SPSS 16. Results: About one-third of the surveyed students (54, 36.0%) exposed to violence and 71.3% of them witnessed incidents of violence against healthcare providers at the workplace. The prevalence of physical violence and verbal abuse among medical students was reported at 5.5% and 92.6% respectively. About 81.5% were females compared to 18.5% of their counterparts. Patients (38.9%) and their relatives (61.1%) were the main sources of the violence respectively. More than half (57.0%) of students exposed to violence at outpatient services and 25.9% at the emergency room and 16.7% at inpatient wards. Few of them (22, 14.7%) thought that they will get support if they make a complaint. Conclusion: Being a medical student and has direct contact with patients and their relative is not always safe practice. Our results suggested a high prevalence of verbal and physical abuse against medical students. Health sector authorities should adopt a restrictive and clear strategy to protect medical students and other healthcare providers.

Predictive factors of successful extracorporeal shockwave lithotripsy (ESWL) for renal stones: evidence of retrospective study

Background: Extracorporeal shockwave lithotripsy (ESWL) has proved to be effective in treating ureterolithiasis. This study aimed to investigate the predictive factors related to success ESWL among patient presented with renal stone. Methods: A retrospective study was conducted among 40 patients who underwent ESWL at the urology department, Baquba Teaching Hospital, Diyala University, Iraq. Data was collected between1st October 2018 and 31st January 2019 for renal stones diagnosed by non-enhanced spiral computed tomography (NCCT). The success rate defined as no stone or the remnant stones < 4 mm. We analyzed predictive factors by using multiple linear regression. Results: The success rates ranged from 50-90%. In the univariate analysis, body mass index (BMI), skin-to-stone distance (SSD)and the renal stone-attenuation value (in Hounsfield units, HU) were found to be significantly correlated with the outcome of ESWL (p<0.05). However, in the multiple linear regression, only the HU (B = -0.619, P < 0.0001; 95% confidence interval [CI]:0.03 to 0.07) was theindependent predictive factor. Conclusion: Hounsfield Unit is an independent predictive factor influencing the success of ESWL for treating renal stones.

The impact of displacement on the social, economic and health situation on a sample of internally displaced families in Anbar Province, Iraq

Background: Internally displaced people in Iraq are still suffering because the solutions were not radical. This study aims to assess the impact of displacement on the socio-economic, well-being, and mental health status of internally displaced families in Anbar province, Iraq. Methods:  A descriptive cross-sectional study was conducted from 3rd to 17th April 2017. Data was collected using a universal sampling technique. A total of 355 households interviewed with a modified questionnaire consisting of 26 close-ended questions related to the socio-economic, demographic, wellbeing, and mental health characteristics. Results: At the time of the study, about 55.5% of the surveyed displaced families have not returned home yet. Big families of more than seven members (59.4%) and residency in renting houses (82.8%) are two variables that may contribute to an economic burden. Mental health disorders such as depression and anxiety spread among 62.3% of surveyed families. Significant rise in chronic diseases from 64 (18.0%) cases before displacement to 102 cases (28.7%) after displacement. Few of them (21.6%) were able to access public health services. People who experienced violence are verbally abused at 52.1%. Lack of services (50.3%), the inability to repair the destroyed houses (26.4%), and the loss of houses due to complete destruction (23.3%) were the significant factors that inhibited families to return home back. Conclusion: Our findings indicate the need for urgent and strategic plans to improve the quality of logistics, health, and infrastructure services to motivate the displaced families to return back to their homes.

Predictors of emotional exhaustion among physicians from Iraq - a descriptive cross-sectional multicentre study

Background: Doctors and paramedics in countries suffering from long-acting conflicts, including Iraq, are working in severe and exceptional conditions, putting them under severe physical and psychological pressure, therefore examining burnout is important when dealing with the quality of care and working conditions. This study aimed to assess the point prevalence and to explore factors associated with emotional exhaustion (EE) among medical doctors in Iraq. Methods: Descriptive and a cross-sectional study was conducted (January to June 2014) among a randomly selected sample of medical doctors (n=576, 87.3% response rate) working in twenty large general hospitals and medical centers. In addition to EE, the self-administered questionnaire used was consisting of questions on sociodemographic, work-related characteristics, conflict-related variables, and job satisfaction. EE was measured using the emotional exhaustion subscale of the Maslach Burnout Inventory (MBI). Results: The prevalence of EE reported by 60.0% of the respondents. In multiple linear regression analysis, the emotional burnout was higher among doctors who were married, female, bearing children, being threatened, displaced internally, non-specialist doctors, working more than 40 hours per week, experienced unsafe medical practice, disagreed with the way manager handle the staff and those who reported that the doctor-patient relationship as not excellent.  Conclusion: Our findings suggest that job dissatisfaction, conflict, and violence-related factors were significantly associated with a high level of emotional exhaustion among Iraqi physicians.

Upper respiratory tract infection and otitis media are clinically and microbiologically associated

Background: Although significant improvement has been achieved in terms of antibiotic care, otitis media (OM) continues to be a worldwide health problem that may develop serious complications. This study aimed to detect the growth of organisms and to find out the most susceptible factors related to OM among the Iraqi population. Methods: A prospective cross-sectional study was conducted at the out-patient department (OPD) of Ear, Nose, and Throat (ENT) at the Baquba teaching hospital at the Faculty of medicine, Diyala University from November 2017 to March 2018. A total of 300 ear samples collected from 87 (29.0%) patients of acute otitis media (AOM), 104 (34.7%) patients of otitis media with effusion (OME), and 109 (36.3%) patients of chronic otitis media (COM). Standard microbiological procedures were recruited to investigate the samples using aerobic and anaerobic culture methods. Results: The highest incidence of OM 218 (72.7%) was observed among the age group of fewer than ten years old. The most common bacteria isolated were Pseudomonas aeruginosa (35.0%), Staphylococcus aureus (25.0%), Proteus spp. (24.0%), Escherichia coli (7.0%), Streptococcus pneumonia (6.0%), Klebsiella pneumonia (2.0%) and Streptococcus pyogenes (1.0%). It was found that upper respiratory infection (URTI), adenoid inflammation with (URTI), adenoid inflammation, the practices of complementary and alternative medicine (CAM), and the accident or trauma are the main factors related to OM in about (42.0%), (31.0%), (11.0%), (10.0%) and (6.0%) of cases respectively. Conclusion: Our findings suggest that OM was effectively related to URTI and adenoid inflammation with (URTI) in about 73.0% of cases. More attention should be given to early diagnosis and treatment of URTI before progressing to undesirable OM.

Iraqi medical students are still planning to leave after graduation

Background: Medical students constitute the backbone of the future human resource for health, and therefore, as much as attention should be given to secure a high level of education, it should also be given to understand their wishes to leave or to stay at home country. This study aimed to find out the prominent factors associated with Iraqi medical students' planning to leave their country after graduation. Methods: A descriptive cross-sectional study was conducted among clinical medical students (fourth, fifth, and sixth classes) of two medical colleges (the University of Anbar and University of Fallujah) in Anbar Governorate from 1st to 14th March 2018. A total of 183 students (Response Rate: 72,6%.) completed a self-administered questionnaire consisting of 15 close-ended questions related to the socio-demographic factors, economic characteristics, and some other factors inspired from Iraq's situation. Moreover, one open-ended question was designed to explore the main reasons for migration from the student's point of view. Results: Although 109 students (60%) felt that serving their citizens and country is a priority, however, the vast majority of 133 (73%) of the surveyed students had a plan to leave Iraq. About two thirds (69 %) of students intended to migrate as soon as they manage to: obtain their graduation certificate (49%); have enough money (34%), and the remaining 18% when they get parents’ permission. Conclusion: Our results suggest that living environments and work-related variables are significantly associated with medical students' intention of migration; however, social reasons and inspiring academic achievement were the main factors triggering students to leave Iraq.

Impact of conflict related and workplace related violence on job satisfaction among physicians from Iraq - a descriptive cross-sectional multicentre study

Background: During the last decade, the events of violence against healthcare providers have been escalated, especially in the areas of conflicts. This study aimed to test the impact of conflict-related and workplace-related violence on job satisfaction among Iraqi physicians. Methods: A cross-sectional study with a self-administered survey was conducted among medical doctors in Iraq from January to June 2014. Participants (n=535, 81.1% response rate) were selected at random from 20 large general and district hospitals using a multistage sampling technique. Results: The mean (+SD) value on the total job satisfaction score was 42.26 (+14.63). The majority of respondents (67.3%) experienced unsafe medical practice; however, the conflict- related violence showed no significant difference in job satisfaction scores. In backward regression analysis, two socio-demographic variables (age, gender), and three work-related variables (being a specialist, working less than 40 hours per week, working in both government and private sector) were positively related to job satisfaction, while the workplace violence variables were negatively related. It was found that increases in physical attack, verbal abuse, bullying, and racial harassment brought about decreases in job satisfaction scores of 6,087, 3.014, 9,107, and 4,242, respectively. Conclusion: Our results suggest that work-related variables and workplace violence do affect job satisfaction. Specifically, when physicians have been physically attacked, verbally abused, bullied, and racially harassed, their job satisfaction decreases significantly.

Syrian mothers, why to accept or to refuse HPV vaccine for their teen girls

Background: Cervical cancer (CC) ranks the eighth most frequent cancer among Syrian women with crude incidence rates 1.4 per 100, 000 populations per year. This study aimed to test the acceptance of the human papillomavirus (HPV) vaccine among mothers of schoolgirls in sixth-grade class. Methods: A cross-sectional survey was conducted through a structured and self-administrated questionnaire. A total of 400 Syrian mothers of schoolgirls were selected randomly by the cluster sampling method in Aleppo city, Syria, in 2011. Significant variables from univariate analysis were included in an enter technique multiple logistic regression analysis. Results: The response rate was 86%. If the vaccine was free, 282 (81.7%) mothers would accept the vaccine for themselves and 236 (68.4%) for their daughters, respectively. However, the acceptance rate grossly decreased to 24.6% and 15.1%, respectively, if the vaccine was not provided free. The high cost of the HPV vaccine and lack of knowledge were the significant barriers for mothers' acceptance of the HPV vaccine. Protection of daughters and the trust with health authority were the main encouraging reasons to accept the HPV vaccine. Findings from logistic regression analysis revealed that the employed mothers (odds ratio = 2.4; 95% CI: 1.3–4.4), with a positive history of gynecological examination (OR = 2.1; 95% CI: 1.6–2.9) and having sound knowledge (OR = 2.4; 95% CI: 1.0–5.7) are independent factors related to the acceptance of the HPV vaccine for their daughters. Conclusion: The results from this study suggest that mothers from different cultural backgrounds, including Syrian mothers, are holding different beliefs on privacy and health that may affect their willingness to accept the HPV vaccine.

Impact of training on practical skills of Iraqi health providers towards integrated management of neonate and child health - a multicentre cross- sectional study

Background: This study aims to assess the mandatory practical skills of caregivers towards the implementation of the Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy in primary health care (PHC) centers of Salah al-Din governorate in Iraq. Methods: A cross-sectional comparative study was conducted from January to May 2014. An equal sample of 42 trained and 42 non-trained caregivers who are working in 20 PHC centers in Tikrit city and other districts of Salah al-Din governorate of Iraq were included. The study tool was a semi-structured questionnaire with 20 questions covering different required practical skills that caregivers should have. The total score was 100 and in a range of 4- 6 points for each question. An independent sample t-test was used to compare the means of numerical variables. Results: The mean age of total respondents were (33.18 ± 5.82Years), and the vast majority (63, 75.0%) were females. More than two-third (58, 69.0%) were paramedical compared to 26 (31.0%), who were doctors. Trained caregivers had statistically significant better practice (73.48 ± 13.46) compared to non- trained caregivers (63.95 ± 17.44). Trained doctors had statistically significant better practice (88.15 ± 2.70) compared to trained paramedical staff (66.90 ± 10.84). Trained caregivers from Tikrit city had statistically significantly better practice (80.26 ± 7.38) compared to trained caregivers from districts (67.89± 14.85). The highest proportion (97.5%) of trained caregivers felt the child for fever or body hotness appropriately, and the lowest proportion (59.5%) of them recorded age, height, and weight correctly. Conclusion: This study showed that training has a positive influence on the implementation of IMNCI interventions. IMNCI-trained caregivers were more likely to correctly classify illnesses than non-trained caregivers.

Factors Influencing the Total Inpatient Pharmacy Cost at a Tertiary Hospital in Malaysia: A Retrospective Study

The steady growth of pharmaceutical expenditures is a major concern for health policy makers and health care managers in Malaysia. Our study examined the factors affecting the total inpatient pharmacy cost (TINPC) at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). In this retrospective study, we used 2011 administration electronic prescriptions records and casemix databases at UKMMC to examine the impact of sociodemographic, diagnostic, and drug variables on the TINPC. Bivariate and multivariate analyses of the factors associated with TINPC were conducted. The mean inpatient pharmacy cost per patient was USD 102.07 (SD = 24.76). In the multivariate analysis, length of stay (LOS; B = 0.349, P < .0005) and severity level III (B = 0.253, P < .0005) were the primary factors affecting the TINPC. For each day increase in the LOS and each increase of a case of severity level III, there was an increase of approximately USD 11.97 and USD 171.53 in the TINPC per year, respectively. Moreover, the number of prescribed items of drugs and supplies was positively associated with the TINPC (B = 0.081, P < .0005). Gender appears to have affected the TINPC; male patients seem to be associated with a higher TINPC than females (mean = 139.55, 95% confidence interval [CI]: 112.97-166.13, P < .001). Surgical procedures were associated with higher cost than medical cases (mean = 87.93, 95% CI: 61.00-114.85, P < .001). Malay (MYR 242.02, SD = 65.37) and Chinese (MYR 214.66, SD = 27.99) ethnicities contributed to a lower TINPC compared with Indian (MYR 613.93, SD = 98.41) and other ethnicities (MYR 578.47, SD = 144.51). A longer hospitalization period accompanied by major complications and comorbidities had the greatest influence on the TINPC.

Concomitant measurements of serum annexin A5 levels and hematological indices as markers in recent and old myocardial infarction with low ejection fraction: A preliminary study

BACKGROUND

Serum annexin A5 (anxA5) level is significantly increased in patients with acute coronary syndrome. Hematological indices are significantly increased in patients with ischemic heart disease. This study aimed to demonstrate the changes in the distribution of blood cells and the levels of anxA5 in patients presented with significant low ejection fraction ST-elevation acute myocardial infarction (STEMI) in comparison with corresponding patients with ischemic heart disease.

METHODS

Patients with low ejection fraction presenting at Hospital of Diyala University of Iraq were enrolled. Electrocardiograph (ECG), echocardiograph, hematological indices, serum annexin V (anxV) levels and the determinants of the cardio-metabolic risk factors were performed. Based on clinical examination, ECG findings and laboratory tests, patients were divided into healthy subjects (n=20); patients with acute MI (n=40) and with chronic MI (n=12).

RESULTS

Acute MI has significant high levels of serum triglyceride, uric acid and high mean value of red cell distribution width (RDW) compared with healthy subjects and chronic MI. Platelet distribution width (PDW) is significantly reduced in patients of acute MI and chronic MI compared with healthy subjects, whereas the plateletcrit (PCT) is significantly higher in acute MI compared with healthy subjects. There is an insignificant difference between the means of serum anxA5 levels of acute MI (35.6±7.2ng/ml) and chronic MI (32.4±8.9ng/ml), but significantly higher than the cutoff level of the healthy subjects (5ng/ml).

CONCLUSIONS

Measurement of serum annexin level is a useful diagnostic marker of acute or chronic MI with low ejection fraction.

Job satisfaction and turnover intention among Iraqi doctors--a descriptive cross-sectional multicentre study

BACKGROUND

During the last two decades, the Iraqi human resources for health was exposed to an unprecedented turnover of trained and experienced medical professionals. This study aimed to explore prominent factors affecting turnover intentions among Iraqi doctors.

METHODS

A descriptive cross-sectional multicentre study was carried out among 576 doctors across 20 hospitals in Iraq using multistage sampling technique. Participants completed a self-administered questionnaire, which included socio-demographic information, work characteristics, the 10-item Warr-Cook-Wall job satisfaction scale, and one question on turnover intention. Descriptive and bivariate and multiple logistic regression analyses were conducted to identify significant factors affecting turnover intentions.

RESULTS

More than one half of Iraqi doctors (55.2%) were actively seeking alternative employment. Factors associated with turnover intentions among doctors were low job satisfaction score (odds ratio (OR) = 0.97; 95% confidence interval (CI): 0.95, 0.99), aged 40 years old or less (OR = 2.9; 95% CI: 1.74, 4.75), being male (OR = 4.2; 95% CI: 2.54, 7.03), being single (OR = 5.0; 95% CI: 2.61, 9.75), being threatened (OR = 3.5; 95% CI: 1.80, 6.69), internally displaced (OR = 3.1; 95% CI: 1.43, 6.57), having a perception of unsafe medical practice (OR = 4.1; 95% CI: 1.86, 9.21), working more than 40 h per week, (OR = 2.3; 95% CI: 1.27, 4.03), disagreement with the way manager handles staff (OR = 2.2; 95% CI: 1.19, 4.03), being non-specialist, (OR = 3.9, 95% CI: 2.08, 7.13), and being employed in the government sector only (OR = 2.0; 95% CI: 1.09, 3.82).

CONCLUSION

The high-turnover intention among Iraqi doctors is significantly associated with working and security conditions. An urgent and effective strategy is required to prevent doctors' exodus.

Development of MY-DRG casemix pharmacy service weights in UKM Medical Centre in Malaysia

BACKGROUND

The service weight is among several issues and challenges in the implementation of case-mix in developing countries, including Malaysia. The aim of this study is to develop the Malaysian Diagnosis Related Group (MY-DRG) case-mix pharmacy service weight in University Kebangsaan Malaysia-Medical Center (UKMMC) by identifying the actual cost of pharmacy services by MY-DRG groups in the hospital.

METHODS

All patients admitted to UKMMC in 2011 were recruited in this study. Combination of Step-down and Bottom-up costing methodology has been used in this study. The drug and supplies cost; the cost of staff; the overhead cost; and the equipment cost make up the four components of pharmacy. Direct costing approach has been employed to calculate Drugs and supplies cost from electronic-prescription system; and the inpatient pharmacy staff cost, while the overhead cost and the pharmacy equipments cost have been calculated indirectly from MY-DRG data base. The total pharmacy cost was obtained by summing the four pharmacy components' cost per each MY-DRG. The Pharmacy service weight of a MY-DRG was estimated by dividing the average pharmacy cost of the investigated MY-DRG on the average of a specified MY-DRG (which usually the average pharmacy cost of all MY-DRGs).

RESULTS

Drugs and supplies were the main component (86.0%) of pharmacy cost compared o overhead cost centers (7.3%), staff cost (6.5%) and pharmacy equipments (0.2%) respectively. Out of 789 inpatient MY-DRGs case-mix groups, 450 (57.0%) groups were utilized by the UKMMC. Pharmacy service weight has been calculated for each of these 450 MY-DRGs groups. MY-DRG case-mix group of Lymphoma & Chronic Leukemia group with severity level three (C-4-11-III) has the highest pharmacy service weight of 11.8 equivalents to average pharmacy cost of RM 5383.90. While the MY-DRG case-mix group for Circumcision with severity level one (V-1-15-I) has the lowest pharmacy service weight of 0.04 equivalents to average pharmacy cost of RM 17.83.

CONCLUSION

A mixed approach which is based partly on top-down and partly on bottom up costing methodology has been recruited to develop MY-DRG case-mix pharmacy service weight for 450 groups utilized by the UKMMC in 2011.

Validity and Reliability Analysis of Knowledge of, Attitude toward and Practice of a Case-mix Questionnaire among Turkish Healthcare Providers

Objectives: This study was aimed to assess validation and reliability of knowledge of, attitude toward and practice (KAP) of a Case-mix and Diagnosis Related Group (DRG) system questionnaire. Methods: A sample of 238 health care providers selected conveniently from three public hospitals in Turkey was enrolled in a cross-sectional study from September 1 until November 30, 2012. The mean age was 38.63 years (standard deviation [SD] 10.52), ranging from age 21 to 60 years. More than one-half were males (52.1%), nearly two-fifths were medical doctors (39.9%), one-third were nurses (33.2%), one-sixth were auxiliary staff (16.4%) and the remaining were coders (10.5%). Only one-third (33.6%) of respondents attended a workshop or training program in the Case-mix or DRG system. After examining content validity, factor analysis was conducted, internal consistency of the questionnaire was assessed by Cronbach's alpha estimate, and test-retest reliability was evaluated. Results: The sample adequacy for extraction of the factors was confirmed by the Kaiser-Meyer-Olkin test (0.915) and the Bartlett test (1052). Factor analysis showed three factors, including attitude (36.43%), practice (23.39%) and knowledge (17%), with a total variance of 76.82%. The reliability of each section of the questionnaire was as follows: knowledge (0.963), attitude (0.964) and practice (0.973). Cronbach's alpha total was 0.941, which showed excellent internal consistency. Conclusions: This study demonstrated that the designed questionnaire provided high construct validity and reliability, and could be adequately used to measure KAP among health care staff of the Case-mix and DRG system in Turkey.

Turkish health system reform from the people's perspective: a cross sectional study

Background

Since 2003, Turkey has implemented major health care reforms to develop easily accessible, high-quality, efficient, and effective healthcare services for the population. The purpose of this study was to bring out opinions of the Turkish people on health system reform process, focusing on several aspects of health system and assessing whether the public prefer the current health system or that provided a decade ago.

Methods

A cross sectional survey study was carried out in Turkey to collect data on people’s opinions on the healthcare reforms. Data was collected via self administered household’s structured questionnaire. A five-point Likert-type scale was used to score the closed comparative statements. Each statement had response categories ranging from (1) “strongly agree” to (5) “strongly disagree.” A total of 482 heads of households (response rate: 71.7%) with the mean age of (46.60 years) were selected using a multi stage sampling technique from seven geographical regions in Turkey from October 2011 to January 2012. Multiple logistic regressions were performed to identify significant contributing factors in this study.

Results

Employing descriptive statistics it is observed that among the respondents, more than two third of the population believes that the changes have had positive effects on the health system. A vast majority of respondents (82.0%) believed that there was an increase in accessibility, 73.7% thought more availability of health resources, 72.6% alleged improved quality of care, and 72.6% believed better attitude of politician/mass media due to the changes in the last 10 years. Indeed, the majority of respondents (77.6%) prefer the current health care system than the past. In multivariate analysis, there was a statistically significant relationship between characteristics and opinions of the respondents. The elderly, married females, perceived themselves healthy and those who believe that people are happier now than 10 years ago have a more positive opinion of the changes. While, the single unemployed from rural region who perceived themselves as unhealthy and believe that people are unhappy now compare to ten years ago showed less positive opinions.

Conclusions

Hence, we conclude that from the people’s perspective overall the health system reforms were most likely successful.