BACKGROUNDAlthough high antituberculosis (anti-TB) drug resistance rates have been reported in Turkey, the clinical characteristics and implications for the outcome of anti-TB treatment have not been fully investigated. We determined the prevalence of anti-TB drug resistance and examined demographic data, clinical characteristics and treatment outcome in relation to patterns of resistance.METHODSFrom the TB case registry of a university hospital and the two largest dispensaries in Manisa city, we identified all pulmonary TB cases with a culture-proven definitive diagnosis and antimicrobial susceptibility results for a 7-year period. We collected and analyzed demographic and clinical data and information on treatment outcome for those cases in relationship to anti-TB drug resistance.RESULTSOf 355 M. tuberculosis strains, 71.5% were susceptible to streptomycin, isoniazid, rifampicin and ethambutol. Any drug resistance and multi-drug resistance (MDR ) rates were 21.1% and 7.3% and were higher in males (53% and 9%, respectively) than in females (22% and 1%, respectively). Drug resistance was significantly higher in old cases (acquired drug resistance) vs new cases (primary drug resistance), and was associated with treatment failure (P<0.001). The prevalence of MDR was significantly higher in the old cases (22.4%) than in the new cases (4.4%) (P<0.001). Symptoms, radiographic findings, associated diseases, and sputum smear positivity were unrelated to the development of resistance. The prevalence of any drug resistance and MDR was significantly higher in those with treatment failure than in patients with treatment success.CONCLUSIONHigh resistance rates, particularly for acquired MDR, indicate a need for improvement in the TB control programme in our region.

Introduction. Awareness of the healthcare providers on chronic obstructive pulmonary disease (COPD), which is an important cause of mortality and morbidity in our country and all over the world, and on pulmonary rehabilitation (PR) which plays an important role in its nonpharmacological treatment will provide effectiveness in diagnosis and treatment of COPD. The present study aimed at determining knowledge level of the healthcare providers about COPD and PR. Materials and Methods. In this cross-sectional study, family practitioners and staff of home-care in central county of Manisa City were applied a questionnaire in order to determine their knowledge level on COPD and pulmonary rehabilitation during the in-service training on “pulmonary rehabilitation, home-care services for the pulmonary diseases, and respiratory exercises.” Results. 65.5% of the healthcare providers responded to the survey. Rate of those correctly knowing at least one of four items was 97.2%. No responder knew all items correctly. Average value for correct answers was 5.30 ± 2.1 (range: 1–10). The physicians, men, and those working in family health centers had higher level of knowledge on COPD compared to nonphysician healthcare providers (p = 0.006), women (p = 0.002), and those working in other practices (p = 0.019), respectively. Conclusion. Knowledge level of the primary healthcare providers on COPD and PR remains inadequate. Dynamic postgraduate training on this topic will be useful in referring the patients to centers giving service for this condition.

Manisa ‹lindeki aile hekimli¤i birimlerinde 2011 y›l›nda sunulan hizmetler ve kay›tl› nüfusun say›sal olarak de¤erlendirilmesi; bölge ve ülke verisiyle karfl›laflt›r›lmas›; kay›tl› hizmetlere göre ifl yükünün incelenmesi ve ideal birim hizmet süreleri göz önüne al›narak gereken aile hekimi say›s›n›n belirlenmesidir. Yöntem: Araflt›rma, 2012 y›l›nda yürütülmüfl kesitsel bir çal›flma-d›r. Aile hekimleri ve hizmetlerine yönelik veri Manisa-AHBS'den derlenmifl; sayma ve karar verme arayüzleri için php-Oracle ortam-lar› kullan›lm›flt›r. Y›ll›k ifl yükü ve ifl gücü a盤›, her hizmet türü için Bakanl›k veya araflt›rmac› taraf›ndan belirlenen süre ile y›ll›k fiili ça-l›flma süresi dikkate al›narak hesaplanm›flt›r. Tan›mlay›c› istatistikler yüzde ve aritmetik ortalama±standart sapma olarak verilmifltir. Çözümlemede SPSS for Windows 15.0 program›ndan yararlan›l-m›flt›r. Verilerin analizinde ki-kare ve ba¤›ms›z gruplarda t testi kul-lan›lm›flt›r. Bulgular: Aile hekimlerinin (n=378) %74.9'u erkek, yafl ortalamas› 44.5±5.7'dir. Aile sa¤l›¤› merkezlerinin (n=154) %53.2'si, hekimlerinin %28.8'i k›rsal bölgededir. Aile hekimlerinin %51.9'u, nüfusun %18.4'ünü oluflturan gezici nüfusa (n=242.402) hizmet sunmakta-d›r. Aile hekimlerinin ortalama nüfusu 3486.6±465.9; bebek say›s› 47.1±18.2; 15-49 yafl kad›n 915.4±176.4; 65 yafl ve üzeri nüfusu 324.2±116.6'd›r. Aile hekimlerinin 2011'de sundu¤u hizmetlerin (n=6.272.831) %56.1'i poliklinik, %24.0'ü laboratuvar+poliklinik, %7.1'i afl›lama, %12.8'i izlemlerdir. Aile hekimi bafl›na ortalama günlük poliklinik say›s› 60.2, afl›lama 5.4, bebek izlem 1.4, çocuk izlem 1.6, gebe izlem 1.3, kad›n/aile planlamas› izlem 4.3, lohusa izlem 0.4, obezite izlem 0.7'dir. Manisa'da gebeler 5.1, bebekler 6.9; 1-5 yafl çocuklar 1.5; lohusalar 1.6; 15-49 yafl kad›nlar 1.0 ortalama ile aile hekimleri taraf›ndan izlenmifllerdir. Kifli bafl›na y›ll›k ortalama poliklinik say›s› 4.3'tür. Nüfusun %75.7'si poliklinik hizmetinden ya-rarlanm›flt›r. Yararlananlar›n %40.0'› 1-5 kere hizmet alm›flt›r. Y›ll›k poliklinik ortalamalar› 0 yaflta 3.2; 65 yafl ve üzerinde 7.4'tür. Üretilen hizmete göre, ilde bulunmas› gereken aile hekimi say›s› 446 olarak belirlenmifltir. Sonuç: AH'lerinin iflyükünün %80'ini poliklinik hizmetleri olufltur-maktad›r. Bu oran %76.8'lik KDS 2011 Türkiye ve %70'lik Birleflik Krall›k 2006/2007 iflyükü araflt›rmas› verisinden yüksektir. Manisa'daki AH'leri günlük ortalama 60 baflvuruyu karfl›lamakta olup; Birleflik Krall›k'ta bu say› 35'tir. AH'lerinin kay›tl› nüfus plan-lanmas›nda hizmete en çok ihtiyaç duyan gruplar dikkate al›nma-l›d›r. Yöneylem çal›flmalar› için aile sa¤l›¤› personelinin de dahil edildi¤i çal›flana özel iflyükü ve performans de¤erlendirilmelerine ihtiyaç duyulmaktad›r.

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