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Revisions to existing program evaluation approaches of the Dokuz Eylul University School of Medicine (DEUSM) were made by the Medical Education Department in June 2005. After considering several evaluation models, a mixed evaluation model was developed to meet institutional needs. The general program evaluation plan was structured as areas of inquiry under the three main program evaluation questions: what are the effects of the educational program on students and graduates, what are the effects of the educational program on trainers, and is the educational program being implemented as planned. The School's first report made through its new program evaluation approach was prepared in July 2006, leading to important revisions to the educational program. This article presents DEUSM's project to revise its program evaluation approach and briefly discusses its early implementation. [ABSTRACT FROM AUTHOR]

Background: The relationship between students and instructors is of crucial importance for the development of a positive learning climate. Learning climate is a multifaceted concept, and its measurement is a complicated process. The aim of this cross-sectional study was to determine medical students' perceptions about the clinical learning climate and to investigate differences in their perceptions in terms of various variables., Methods: Medical students studying at six medical schools in Turkey were recruited for the study. All students who completed clinical rotations, which lasted for 3 or more weeks, were included in the study (n=3,097). Data were collected using the Clinical Learning Climate Scale (CLCS). The CLCS (36 items) includes three subscales: clinical environment, emotion, and motivation. Each item is scored using a 5-point Likert scale (1: strongly disagree to 5: strongly agree)., Results: The response rate for the trainees was 69.67% (n=1,519), and for the interns it was 51.47% (n=917). The mean total CLCS score was 117.20±17.19. The rotation during which the clinical learning climate was perceived most favorably was the Physical Therapy and Rehabilitation rotation (mean score: 137.77). The most negatively perceived rotation was the General Internal Medicine rotation (mean score: 104.31). There were significant differences between mean total scores in terms of trainee/intern characteristics, internal medicine/surgical medicine rotations, and perception of success., Conclusion: The results of this study drew attention to certain aspects of the clinical learning climate in medical schools. Clinical teacher/instructor/supervisor, clinical training programs, students' interactions in clinical settings, self-realization, mood, students' intrinsic motivation, and institutional commitment are important components of the clinical learning climate. For this reason, the aforementioned components should be taken into consideration in studies aiming to improve clinical learning climate.

The objective of this study was to investigate the parents' attitudes towards and identify the possible factors associated with pandemic H1N1 vaccine uptake that was recommended to children between 6 months and 5 years of age. A questionnaire exploring the attitudes of parents to H1N1 vaccine was given to parents of children 6 through 60 months of age attending to Akdeniz and Gazi University Hospitals' well-child departments between 15 November 2009 and 15 January 2010. The questionnaire included questions on demographic characteristics, parental perception of the severity of the pandemic, the presence of anyone in their environment who suffered from pandemic influenza, their decision on whether or not to vaccinate their child, the factors that influenced them during decision-making process and possible factors that might have influenced the opponents of their decision. Those who accepted to get their children vaccinated got it immediately, free of charge. Out of 611 parents who responded the questionnaire 226 (36.7%) had their children vaccinated. Parental education period of less than 12 years, not being a close relative of a health care worker, not having a relative who suffered from the disease, having a child younger than 36 months, being influenced by the relatives' opinions or from the politicians or from the media all decreased vaccine acceptance. Factors that were most significantly associated with vaccine refusal were thinking that the pandemic was exaggerated (OR 9.44, 95% CI 4.28-20.82) and believing that other preventive measures were more effective than H1N1 vaccine (OR 15.61, 95% CI 7.37-33.08). Lessons learned from influenza H1N1/2009 pandemic may help national authorities, health care providers and media on how to keep the public well informed and find ways of better risk-benefit communication with the parents on vaccines.

Objectives: The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome., Methods: A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software., Results: Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period., Conclusions: A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear., Practice Implications: Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

Aim: This study was designed to investigate the longitudinal and dynamic profile of leptin and its relationship with sex hormones including luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2) and testosterone (TTE) in neonatal 'minipuberty'. We also investigated the effects of leptin in the regulation of body weight gain and body mass index (BMI) in the first 3 months of life., Methods: A longitudinal study was carried out in a cohort of 15 male and 15 female term infants during the first 3 months of life. Blood samples were collected in the morning from the infants on the 3rd, 15th, 30th, and 90th days of life. At each sample collection, anthropometric measurements were recorded. Serum leptin, LH, FSH, E2 (girls only) and TTE (boys only) concentrations were analyzed using standard biochemical methods. Association of leptin with weight gain, BMI, and these hormones during infancy was evaluated., Results: Leptin levels increased significantly between the 3rd and 90th days of life in both boys and girls. BMI of both groups increased significantly from the 3rd to the 90th day. There was no significant difference in the leptin levels and leptin/BMI ratios of the two sexes at different time points. Leptin levels on the 30th and 90th days correlated significantly with BMI in both sexes. LH and FSH levels in both groups were found to be significantly higher on the 15th day of life. No correlation was observed between leptin and LH, FSH, E2 or TTE levels throughout the study., Conclusions: Leptin levels do not differ between the two sexes during early infancy and possibly there is no role for leptin in the surge of gonadotropins or sex steroids in neonatal minipuberty. The relationship between leptin and BMI could not be seen in the first postnatal days and the transient lack of the regulatory effect of BMI on leptin concentrations might reflect an adaptive resistance in the production of leptin to support catch-up growth after initial physiological weight loss in newborns.

Objective: Bacille Calmette-Guerin (BCG) is given at 2-months of age; diphtheria toxoid, tetanus toxoid, whole cell pertussis, oral polio are given at 2, 3, 4 months, and hepatitis B virus (HBV) vaccine is given at 3, 4, 9 months of age. The aim was to evaluate the sero-protection rate of HBV vaccine which has been given at 2, 3, and 9 months of age and coincided with BCG vaccine at the first dose., Methods: Hepatitis B virus vaccine was administered to 3 groups of infants at 2, 3, 9 months (n=20), 3, 4, 9 months (n=20) concurrently with BCG or other vaccines, and at 0, 1, 6 months with no other coinciding another vaccine (n=20). These 60 infants who were born between June 2001 and September 2001 have been vaccinated at the Akdeniz University School of Medicine, Antalya, Turkey. Antibodies to hepatitis B surface antigen analyzed by enzyme-linked immunosorbent assay., Results: The simultaneous administration of BCG and HBV vaccines did not influence the immune response to HBV vaccine. We showed that all 3 schedules can induce the sero-protective levels of antibody concentrations to HBV both one month and one year after the vaccination., Conclusion: Bacille Calmette-Guerin and HBV vaccinations can be performed at the same time in endemic countries.

Background: Acute respiratory infections (ARI) are one of the major problems of childhood in developing countries. The objective of the study was to obtain the incidence of ARI and its risk factors in Antalya, Turkey., Methods: We carried out a prospective cohort study on 204 infants who were born between 1 November and 31 December 1997, in the area of two primary health-care units in the Antalya city center. The research group was followed periodically every 2 months by home visits and the infants were investigated to determine their symptoms of ARI. The weight and length of children were measured in every home visit. Additional questions about socioeconomic status, some environmental characteristics, and nutrition practice were asked. Data were entered into the computer and the Z-scores were calculated by the Epi Info 5 package program. The incidence rates, relative risks and confidence intervals were calculated by Microsoft Excel version 5.0 program., Results: The incidence of ARI was 6.53 episodes per child per year among the children in the research group. The factors that influenced the incidence of ARI were lack of mother's and father's education, heating by wood stove, being a low-birthweight infant, not being completely breast-fed in the first 4 months of life and being stunted. There were no associations between the number of persons per room or smoking status of family members with ARI incidence., Conclusion: Our results demonstrated that ARI were also associated with some socioeconomic, environmental and nutritional status characteristics such as paternal education, house ownership, breast-feeding, stunting, prematurity and burning of biomass fuels in Turkey.

Hepatitis A and hepatitis E are enteric transmitted viral diseases occurring in epidemic and sporadic forms especially in developing countries. Previous studies in Turkey showed that most residents are infected with HAV by the second decade of life. Since HEV is generally transmitted by the same route as HAV we conducted a community-based seroprevalence study for HAV and HEV infection in Ahatli area in Antalya, Turkey where socioeconomic conditions are low. Anti-HAV total immunoglobulin was tested by using a microparticle EIA (Axsym-Abbott Lab). Anti-HEV IgG was assayed by a micro ELISA method (Genelabs-Singapore). Of the 338 sera tested, 112 (33.1%) were positive for anti-HAV total antibody. Anti-HEV IgG was detected in three (0.89%) of the serum samples. Seropositivity rates of HAV in preschool and school children were 19.9% and 43.9% respectively (p < 0.001). No antibody to HEV was detected in preschool children, while the prevalence of anti-HEV IgG was 1.6% in children attending school. Our data showed that seroprevalence of anti-HAV is high among children samples but HEV infection appears to be relatively rare in pediatric age groups.