Untitled [PDF]

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

- 2 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

CONTENTS

COMMITTEES

4

SCIENTIFIC PROGRAMME

6-13

LIST OF ORAL PRESENTATIONS

14-18

LIST OF POSTER PRESENTATIONS

19-29

FULL TEXTS OF INVITED FACULTY LECTURES

31

PLENARY LECTURES

33

PANELS

38

ROUND TABLES

61

MEET THE EXPERT SESSIONS

91

COURSES

113

WORKSHOPS

129

ABSTRACTS

141

ORAL PRES PRESENTATIONS

143

POSTER PRES PRESENTATIONS

161

AUTHORS INDEX

237

- 3 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

COMMITTEES CONGRESS CO-CHAIRS Ljubin SUKRIEV, President of AGP/FM Macedonia Okay BAfiAK, President of TAHUD, Turkey HONORARY BOARD Ayfle ÇAYLAN, Turkey Süleyman ÖMER, Macedonia

SCIENTIFIC COMMITTEE SEE, President ‹lhami ÜNLÜO⁄LU, Turkey Vice-Presidents Arzu UZUNER, Turkey Ljiljana KOCANKOVSKA, Macedonia Suzana STANKOVIC, Serbia

ORGANIZING COMMITTEE President M. Mümtaz MAZICIO⁄LU, Turkey Vice-Presidents Hakan ÖZDEM‹R, Turkey Katerina KOVACEVA, Macedonia Kurtulufl ÖNGEL, Turkey Svetlin MITEV, Bulgaria Members Dean KLANCIC, Slovenia Elif ALTUNBAfi, Turkey Fatih YÜKSEL, Turkey Lenka STOJANOVA, Macedonia Levent ÖZSEVEN, Turkey Ljiljana BALOS, Serbia Ljiljana ZOGOVIC, Montenegro Murat ÇEV‹K, Turkey Mustafa ÖZÜNAL, Turkey Melida HASANAGIC, FBIH Malijoka PETROVIC, Macedonia Nebi SÖKMEN, Turkey Radojka PERIC, Rebuplic of Srpska Reflat DABAK, Turkey Vjollka KONICA, Albania Zübeyde ANADOL, Turkey

Members Alis ÖZÇAKIR, Turkey Anesa SMAJLBEGOVIC, FBIH Ayça V‹TR‹NEL, Turkey Cahit ÖZER, Turkey Diana TCHINARSKA Dilek GÜLDAL, Turkey Ekrem ORBAY, Turkey Ergun ÖKSÜZ, Turkey Erhan SAYALI, Turkey Georgy IVANOV, Bulgaria Gorica ZAFIROVSKA-PIROVSKA, Macedonia Hasan Basri ÜSTÜNBAfi, Turkey Hüseyin Avni fiAH‹N, Turkey ‹smail Hamdi KARA, Turkey Janko KERSNIK, Slovenia Kamile MARAKO⁄LU, Turkey Ksenija TUSEK-BUNC, Slovenia Lubomir KIROV, Bulgaria Maja RACIC, Rebuplic of Srpska Mehmet SARGIN, Turkey Mirjana MOJKOVIC, Serbia Muamera MUJCINAGIC-VRABAC, FBIH Murat ÜNALACAK, Turkey Nafiz BOZDEM‹R, Turkey Nazan B‹LGEL, Turkey Nejat DEM‹RCAN, Turkey Radmila STANISIC, Montenegro Recep Erol SEZER, Turkey Rengin ERDAL, Turkey Selma Ç‹V‹, Turkey Serpil ‹NAN, Turkey Slavoljub ZIVANOVIC, Serbia Valentina MADJOVA, Bulgaria Zeynep TUZCULAR VURAL, Turkey

- 4 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

Dear Colleagues, It is our great honor and privilege to welcome you in Antalya, Turkey for the 2nd Congress of Association of General Practice/Family Medicine of South-East Europe. This Congress, which is being organized with the collaboration of the Turkish Association of Family Physicians (TAHUD) and the Association of Family Medicine and General Practice of South-East Europe, is an opportunity to meet our colleagues from South-East Europe countries, to enhance communication between them for sharing information, developing continuing medical education and promoting research in the field of primary health care. The 2nd Congress of Association of General Practice/Family Medicine of South-East Europe will also help to build awareness about common and overwhelming problems in the region and to update current knowledge on the recent advances in the medical field. The scientific programme to be held in four parallel meeting halls, covers a lot of important topics of general practice/family medicine. It consists of 4 plenary sessions, 7 panels, 3 round table sessions, 3 courses, 3 workshops, 5 meet the expert sessions, 3 meetings, 42 oral presentations and 160 poster presentations in totally 35 sessions most of which are parallel. We wish all participants a fine, informative and unforgettable stay in Antalya. With our very best regards.

Prof. Dr. Okay BAfiAK Turkish Association of Family Physicians President

Prim. Dr. Ljubin SUKRIEV Association of General Practice/Family Medicine of South-East Europe President

- 5 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

SCIENTIFIC PROGRAMME APRIL 22, 2010 08:30 – 15:00 Registration & Check-in 15:00 – 16:20 COURSE 1, PART 1 (Session in Turkish) (HALL A) Physical growth and development and thyroid hormone in physical growth (Büyüme geliflmenin takibi ve büyüme geliflmede tiroid hormonunun yeri) M. Mümtaz Maz›c›o¤lu; Brain storming: Physical growth and development; impressions (Beyin f›rt›nas› : Büyüme geliflme; izlenimlerin toplanmas›) Servet Kesim; Development of tooth; development process of teeth according to the ages (Difl geliflimi; yafllara göre difllerin geliflim süreci) M. Mümtaz Maz›c›o¤lu; Methodology for following the physical growth; standards and methods of analysis (Büyümenin izlenmesinde metodoloji; standartlar ve analiz yöntemleri ) 16:20 – 16:30

Coffee Break

16:30 – 17:25

COURSE 1, PART 2 (Session in Turkish) (HALL A) Physical growth and development and thyroid hormone in physical growth (Büyüme geliflmenin takibi ve büyüme geliflmede tiroid hormonunun yeri) Selim Kurto¤lu; Discussion on growth curves (Büyüme e¤rileri üzerinde tart›flma) Ahmet Öztürk; Statistical analysis for following physical growth; persentile calculation by a practical way (Büyümenin izlenmesinde istatistik analiz; pratik yolla persentil hesab› yap›lmas›)

17:25 – 17:35

Coffee Break

17:35 – 19:05

COURSE 1, PART 3 (Session in Turkish) (HALL A) Physical growth and development and thyroid hormone in physical growth (Büyüme geliflmenin takibi ve büyüme geliflmede tiroid hormonunun yeri) Selim Kurto¤lu; Following physical growth and development (Büyüme geliflmenin izlenmesi ) Selim Kurto¤lu; Thyroid hormones and physical growth and development (Tiroid hormonlar› ve büyüme geliflme) Servet Kesim, Selim Kurto¤lu, M. Mümtaz Maz›c›o¤lu, Ahmet Öztürk; Course assessment (Seth rating scale) (Kursun de¤erlendirilmesi (Seth de¤erlendirme ölçe¤i) )

19:00 – 21:00

SPECIAL SESSION Turkish Association of Family Physicians (TAHUD, Türkiye Aile Hekimleri Uzmanl›k Derne¤i )

- 6 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

SCIENTIFIC PROGRAMME APRIL 23, 2010 08:30 – 09:30

OPENING CEREMONY (HALL A) Master of Ceremony: Ifl›k Gönenç Okay Baflak, Ljubin Sukriev, ‹lhami Ünlüo¤lu, M. Mümtaz Mazicioglu, Seracettin Çom

09:30 – 10:15

PLENARY SESSION 1 (HALL A) Association of General Practice and Family Medicine of South East Europe (Güneydo¤u Avrupa Aile Hekimleri ve Pratisyen Hekimler Birli¤i) Moderator : Erhan Sayal› Ljubin Sukriev

10:15 – 10:45

Coffee Break

10:45 – 12:15

PANEL 1 (HALL A) Violence in Family; the Europe and AGP/FM SEE (Aile içi fliddet; Avrupa ve “Güneydo¤u Avrupa Aile Hekimleri ve Pratisyen Hekimler Birli¤i”) Moderators: Suzana Stankovic, Kurtulufl Öngel Leo Pas; Europe (Avrupa) Sabahat Tezcan; Turkey (Türkiye) Suzana Stankovic; SEE short report (Güneydo¤u Avrupa özet raporu)

10:45 – 12:15

SPECIAL SESSION (HALL B) Turkish Association of Family Physicians (TAHUD, Türkiye Aile Hekimleri Uzmanl›k Derne¤i)

12:15 – 14:45

Lunch & Poster Session 1

14:45 – 16:15

ROUND TABLE 1 (HALL A) Current health situation and health systems in South East Europe (Güney Do¤u Avrupa’da mevcut sa¤l›k durumu ve sa¤l›k sistemleri) Moderators: Lubomir Kirov, ‹lhami Ünlüo¤lu Ljiliana Kocankovska; Macedonia (Makedonya) Lubomir Kirov; Bulgaria (Bulgaristan) Ljiliana Zogovic-Vokovic; Montenegro (Karada¤) Mirjana Mojkovic; Serbia (S›rbistan) Murat Ünalacak; Turkey (Türkiye) Miro Popovic; Rebublika Srpska (S›rp Cumhuriyeti), Vjolka Konica; Albania (Arnavutluk) Azijada Beganlic; Bosnia & Herzegovina (Bosna Hersek) Ksenija Tusek-Bunc; Slovenia (Slovenya)

- 7 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

SCIENTIFIC PROGRAMME 14:45 – 16:15

ORAL PRESENTATIONS 1 (HALL B) Moderators : Fisun Sözen, Katerina Kovaceva

14:45 – 16:15

PANEL 2 (HALL C) Type 2 DM advances in therapy insulin and new antidiabetic agents (Tip 2 Diabetes mellitus tedavisinde insülin ve yeni antidiabetik ajanlardaki son geliflmeler) Moderator: Reflat Dabak Zuhal Sa¤lam; Following up the patient (Hasta takibi) Ekrem Orbay; Insulin treatment (‹nsülin tedavisi) Mehmet Sarg›n; Innovations in treatments (Tedavide yenilikler)

14:45 – 16:15

WORKSHOP 1, PART 1 (HALL D) Alternative medicine tabu and reality (Alternatif t›p : Tabu ve gerçek) Moderator: Rengin Erdal Marco Ephraim

16:15 – 16:45

Coffee Break

16:45 – 18:15

ROUND TABLE 2 (HALL A) Reform in primary health care system (Birinci basamak sa¤l›k sistemi reformu) Moderators: Lubomir Kirov, ‹lhami Ünlüo¤lu Ljiliana Kocankovska; Macedonia (Makedonya) Lubomir Kirov; Bulgaria (Bulgaristan) Ljiliana Zogovic-Vokovic; Montenegro (Karada¤) Mirjana Mojkovic; Serbia (S›rbistan) Murat Ünalacak; Turkey (Türkiye) Miro Popovic; Rebublika Srpska (S›rp Cumhuriyeti), Vjolka Konica; Albania (Arnavutluk) Azijada Beganlic; Bosnia & Herzegovina (Bosna Hersek) Ksenija Tusek-Bunc; Slovenia (Slovenya)

16:45 – 18:15

ORAL PRESENTATIONS 2 (HALL B) Moderators: Nazan Karao¤lu, Lenka Stojanova

16:45 – 18:15

PANEL 3 (HALL C) Journey from the sinuses to the Bronchi (Sinüslerden bronfllara yolculuk) Moderator: Dilek Güldal Dilek Güldal Sema Baflak Fad›l Öztürk

- 8 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

SCIENTIFIC PROGRAMME 16:45 – 18:15

WORKSHOP 1, PART 2 (HALL D) Alternative medicine tabu and reality (Alternatif t›p : Tabu ve gerçek) Moderator: Rengin Erdal Marco Ephraim

18:15 – 19:15

WELCOME COCKTAIL

APRIL 24, 2010 08:30 – 09:15

PLENARY SESSION 2 (HALL A) CME and continuous professional development European experience and SEE (Sürekli T›p E¤itimi ve sürekli mesleki geliflim, Avrupa deneyimi ve Güneydo¤u Avrupa) Moderator: Arzu Uzuner Marko Kolsek

09:15 – 10:45

PANEL 4 (HALL A) FM in SEE Management of FM Finance of the team “need and reality” (Güneydo¤u Avrupa’da Aile Hekimli¤i, Aile Hekimli¤i ekibinin mali yönetimi, ihtiyaçlar ve gerçek durum) Moderators: Cahit Özer, Svetlin Mitev Azijada Beganlic Seracettin Çom Elif Altunbafl Slavoljub Zivanovic Gorica Zafirovska-Pirovska

09:15 – 10:45

ORAL PRESENTATIONS 3 (HALL B) Moderators: Pemra Ünalan, Anesa Smajlbegovic

09:15 – 10:45

PANEL 6 (HALL C) The new face of influenza, H1N1 : The anatomy of a pandemic (Gribin yeni yüzü H1N1: Bir pandeminin anatomisi) Moderators: Hüseyin Avni fiahin Selim Badur; Growth of the pandemic-vaccines (Pandeminin geliflimi-afl›lar) Gaye Usluer; Clinic of H1N1, treatment, usage of antivirals (H1N1 klini¤i, tedavi, antivirallerin kullan›m›)

09:15 – 10:45

WORKSHOP 2, PART 1 (HALL D) Communication, communication skills and interactive way of work (‹letiflim, iletiflim becerileri ve interaktif çal›flma yollar›) Suzana Stankovic Valentina Madjova - 9 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

SCIENTIFIC PROGRAMME 10:45 – 11:15

Coffee Break

11:15 – 12:15

ROUND TABLE 3 (HALL A) Management of FM Quality of/in FM (Aile hekimli¤inde kalite yönetimi) Moderator: Nejat Demircan Zekeriya Aktürk Melida Hasanagic Georgy Ivanov

11:15 – 12:15

ORAL PRESENTATIONS 4 (HALL B) Moderators: Levent Özseven, Radmila Stanisic

11:15 – 12:15

MEET THE EXPERT 2 (HALL C) Medical abortus (T›bbi düflükler) Zeynep Tuzcular Vural Ifl›k Gönenç Kenan Ertopçu

11:15 – 12:15

WORKSHOP 2, PART 2 (HALL D) Communication, communication skills and interactive way of work (‹letiflim, iletiflim becerileri ve interaktif çal›flma yollar›) Suzana Stankovic Valentina Madjova

12:15 – 14:45

Council Meeting of Association of General Practice / Family Medicine of South East Europe

12:15 – 14:45

Lunch & Poster Session 2

14:45 – 16:15

MEET THE EXPERT 1 (HALL A) Management of the elderly patient (Yafll› hastaya yaklafl›m) Moderator: Ümit Aydo¤an Mladen Davidovic

14:45 – 16:15

ORAL PRESENTATIONS 5 (HALL B) Moderators : Zübeyde Anadol, Ljiljana Balos

14:45 – 16:15

MEET THE EXPERT 3 (HALL C) Pain management in chronical diseases (Kronik hastal›klarda a¤r›ya yaklafl›m) Moderator: Nafiz Bozdemir Süleyman Özyalç›n Osman Nuri Ayd›n - 10 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

SCIENTIFIC PROGRAMME 14:45 – 16:15

WORKSHOP 3, PART 1 (HALL D) ECG (EKG) Moderator: Hasan Basri Üstünbafl Ljiljana Kocanskova Ljubin Sukriev

16:15 – 16:45

Coffee Break

16:45 – 18:15

PANEL 5 (HALL A) Hypertension at goal in SEE new guidelines (Güneydo¤u Avrupa’da hipertansiyon tedavisindeki hedefler ve yeni klavuzlar) Moderators: Murat Ünalacak, Dean Klancic ‹smet Tamer; Introduction : How to make guidelines? (Girifl : Klavuzlar nas›l haz›rlanmal›?) Suzana Stankovic; Comparison (Karfl›laflt›rma) Lubomir Kirov; Implementation (Uygulama)

16:45 – 18:15

MEETING 1 (HALL B) Project Collaboration and Foundation in SEE “Project Presentations” (Güneydo¤u Avrupa’da Proje ‹flbirli¤i ve ‹flletmesi “Proje Sunumlar›”) Moderator: Kurtulufl Öngel

16:45 – 18:15

MEET THE EXPERT 4 (HALL C) Management of tiroid disease (Tiroid hastal›¤›na yaklafl›m) Alis Özçak›r Hakan Özdemir

16:45 – 18:15

WORKSHOP 3, PART 2 (HALL D) ECG (EKG) Moderator: Hasan Basri Üstünbafl Ljiljana Kocanskova Ljubin Sukriev

20:00 – 23:30

GALA DINNER

APRIL 25, 2010 08:30 – 09:15

PLENARY SESSION 4 (HALL A) Family medicine : Do we have identity problem? (Aile hekimli¤i : Kimlik sorunumuz var m›?) Moderator : Georgy Ivanov Okay Baflak

- 11 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

SCIENTIFIC PROGRAMME 09:15 – 10:45

PANEL 7 (HALL A) Artritis management (Artrite yaklafl›m) Moderators: Murat Çevik, Muamera Mujcinagic-Vrabac Hüseyin Demir; Inflammatory artritis (‹ltihapl› artrit) P›nar Borman; Osteoartritis (Osteoartrit)

09:15 – 10:45

MEETING 3 (HALL B) Vocational training in family medicine (Aile hekimli¤inde mesleki e¤itim) Moderators: Fatih Yüksel, Mustafa Özünal This meeting will bring the trainees of family medicine/general practice specialty training together, an opportunity to share common points regarding their programmes, their needs and problems. All the residents and the trainees of FM and GP’s are invited to participate this meeting.

09:15 – 10:45

COURSE 2, PART 1 (HALL C) Basic life support training (Temel yaflam deste¤i e¤itimi) Moderators: Nebi Sökmen Kurtulufl Öngel Mehmet Ali Karaca Bülent Erbil Nebi Sökmen

09:15 – 10:45

COURSE 3, PART 1 (Session in Turkish) (HALL D) Course on epidemiology and statistics in primary care (Birinci basamakta epidemiyoloji ve istatistik kursu) Ahmet Öztürk; - Epidemiologic researches in general practice (Birinci basamakta epidemiyolojik araflt›rmalar›n yeri) - Variables and types (De¤iflkenler ve tipleri) - Which statistical test? (Hangi istatistik test daha uygundur?) - Introduction of statistical programs (‹statistiksel paket programlar›n tan›t›m›)

10:45 – 11:15

Coffee Break

11:15 – 12:15

MEETING 2 (HALL A) Journals in SEE (Güneydo¤u Avrupa’da yay›nlanan dergiler) Moderators: Slavoljub Zivanovic, Zeynep Tuzcular Vural This meeting will provide a good opportunity to meet the colleagues interested in scientific periodic journals, especially the editors and the editorial boards of the journals from the SEE.

- 12 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

SCIENTIFIC PROGRAMME 11:15 – 12:15

MEET THE EXPERT 5 (HALL B) Tobacco addiction (Tütün ba¤›ml›l›¤›) Kamile Marako¤lu Recep Erol Sezer

11:15 – 12:15

COURSE 2, PART 2 (HALL C) Basic life support training (Temel yaflam deste¤i e¤itimi) Moderators: Nebi Sökmen Kurtulufl Öngel Mehmet Ali Karaca Bülent Erbil Nebi Sökmen

11:15 – 12:15

COURSE 3, PART 2 (Session in Turkish) (HALL D) Course on epidemiology and statistics in primary care (Birinci basamakta epidemiyoloji ve istatistik kursu) Ahmet Öztürk; Biostatistical analysis out of actual data (Gerçek veriler üzerinden biyoistatistik analizler)

12:15 – 13:15

CLOSING CEREMONY (HALL A)

- 13 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF ORAL PRESENTATIONS ORAL PRESENTATIONS 1 April 23, 2010 / 14:45 - 16:15 Each presentation is planned to be made in 10 minutes time which will be used as 7 minutes for presentation and 3 minutes for discussion. OP-9 EMPATHIC TENDENCY OF FAMILY PHYSICIANS COMPARED TO OTHER SPECIALTIES N. KARAOGLU, F. SIVRI OP-10 TAKING A STEP TO OUR FUTURE: AGE FRIENDLY PRIMARY HEALTH CENTRES B. PALA, F. YUKSEL, M. UNALACAK, I. UNLUOGLU OP-11 THE CHANGE IN THE SATISFACTION LEVEL OF FAMILY MEDICINE RESIDENTS BY TIME S. OZCAN, N. BOZDEMIR, E. SAATCI, H. KURDAK, E. AKPINAR OP-14 FAMILY DOCTOR AND WORKERS HEALTH L. CVEJANOV KEYUNPVOC, M. GRBOVIC, S.A. MICANOVIC OP-15 MONTENEGRO EXPERIENCE AT RETAINING ON FAMILY PRACTICE PROFESSIONALS L. CVEJANOV KEYUNPVOC, S.A. MICANOVIC, M. GRBOVIC OP-18 CHOSEN MEDICAL PRACTIOTIONERS FOR CHILDREN - WORK ANALYSIS D. OSTOJIC, S. MALOVIC, M. GRBOVIC OP-19 CHOSEN MEDICAL PRACTIOTIONERS FOR ADULTS - WORK ANALYSIS M. GRBOVIC, D. OSTOJIC, S. MALOVIC, OP-24 CHANGES IN HEALTH CARE INDICATORS AND HEALTH CARE SERVICES BEFORE AND AFTER A PILOT APPLICATION OF FAMILY MEDICINE CARE C. OZCAN, Y. CETINEL, E. TORE, M.G. EMINSOY, A. KUT OP-31 PRIMARY HEALTH CARE REFORM IN MONTENEGRO M. DOBROVIC-MILOSEVIC, S. VUKOTIC

- 14 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF ORAL PRESENTATIONS ORAL PRESENTATIONS 2 April 23, 2010 / 16:45 - 18:15 Each presentation is planned to be made in 10 minutes time which will be used as 7 minutes for presentation and 3 minutes for discussion. OP-4 VENOUS THROMBOSIS - A PROSPECTIVE STUDY OF ETIOLOGICAL FACTORS J. DELIC, M. DELIC OP-13 URINARY INFECTIONS IN PATIENTS WITH DIABETES MELLITUS I. ILIC, J. STOJAKOVIC, B. JOKOVIC, L. BUNJAK, M. MILOSAVLJEVIC OP-22 RISK VALUATION OF DEVELOPING DM TYP II S. MICANOVIC, L. CVEJANOV-KEZUNOVIC, M. GRBOVIC OP-26 CONTROL AND PREVENTION OF EARLY DIABETIC COMPLICATIONS AMONG BULGARIAN ADOLESCENTS IN GENERAL PRACTICE V. MADJOVA, V. TODOROVA, R. ASSENOVA, G. FOREVA OP-29 DENTISTS' SPINAL DISCOMFORTS AND PHYSICAL EXERCISE HABITS P.C. UNALAN, N. TOPSAKAL, M. KARAHAN, S. CIFCILI, G. YIGIT OP-35 THE FREQUENCY OF THE CARDIAL ARRHYTHMIES OF THE PATIENTS WHO SUFFER FROM THE CHRONIC OBSTRUCTIVE PULMONARY DISEASES D. V. NIKOLIC GROZDANOVIC, I.J. STOJKOVC, B. RAKIC, B. SARAC OP-36 DIABETES MELLITUS - THE MOST COMMON DISEASE OF OLDER AGE V. BANKOVIC, L. SIMONOVIC, B. SARAC, S.V. CEKIC OP-37 DIABETIC MELLITUS-METABOLIC SYNDROME V. VUKOVIC IGOV, S. PEJCIC, B. RAJKOVIC OP-39 BEHAVIOURS AND ATTITUDES OF FAMILY PHYSICIANS AGAINST PHYSICAL ACTIVITY I. KARATAS ERAY, E. ALTUNBAS, S. GUREL

- 15 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF ORAL PRESENTATIONS ORAL PRESENTATIONS 3 April 24, 2010 / 09:15 - 10:45 Each presentation is planned to be made in 10 minutes time which will be used as 7 minutes for presentation and 3 minutes for discussion. OP-21 OBESITY AS A RISK FACTOR FOR MORBIDITY IN AMBULATORY CARE OF FAMILY DOCTOR S. MICANOVIC, Z. DAUTOVIC, M. GRBOVIC OP-23 COMPARISON OF BIOMEDICAL AND BIOPSYCHOSOCIAL APPROACHES IN THE TREATMENT OF OBESITY A. KUT, M.G. EMINSOY, M. SENAY, Y. CETINEL, H.S. AKGUN, A. GURSOY OP-25 PSYCHOSOCIAL AND CLINICAL EVALUATION OF PATIENTS WITH UNCONTROLLED BLOOD PRESSURE IN COMPARISON WITH THE EFFECT OF SSRI\'S ON BLOOD PRESSURE CONTROL A. KUT, M.G. EMINSOY, C. GOKTEKIN, Y. CETINEL, C. OZCAN, R. ERDAL OP-28 PROFILE OF 213 CASES INFECTED WITH INFLUENZA A (H1N1) IN EASTERN ANATOLIA S. VANCELIK, Z. AKTURK, R. CETIN SECKIN, H. ACEMOGLU OP-30 HYPERTENSION IN MONTENEGRO L. DRAGIC, L. DJUROVIC OP-32 ARTERY HYPERTENSION IN THE WORK OF CHOSEN DOCTOR V. PANTOVIC, T. CULAFIC, J. OBADOVIC, B. SCEKIC OP-38 PREVALANCE OF METABOLIC SYNDROME AND RELATED RISK FACTORS IN HYPERTENSIVE CHILDREN AND ADOLESCENTS D. YILDIZHAN, M. BAYAT, M.M. MAZICIOGLU, S. ISMAILOGULLARI, S. KURTOGLU, E. YILMAZ, H.B. USTUNBAS OP-42 THE INVESTIGATION OF METABOLIC DISORDERS IN NEWLY DIAGNOSED HYPERTENSION PATIENTS U. AYDOGAN, A. PARLAK, K. SAGLAM OP-43 THE EVALUATION OF KNOWLEDGE AND LIFE STYLES OF HYPERTENSIVE PATIENTS U. AYDOGAN, A. PARLAK, K. SAGLAM

- 16 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF ORAL PRESENTATIONS ORAL PRESENTATIONS 4 April 24, 2010 / 11:15 - 12:15 Each presentation is planned to be made in 10 minutes time which will be used as 7 minutes for presentation and 3 minutes for discussion. OP-2 ADOLESCENT PREGNANCY: TRENDS, CHARACTERISTICS AND OUTCOMES IN EAST TURKEY T. EDIRNE, M. CAN, R. YILDIZHAN, A. KOLUSARI, E. ADALI, B. AKDAG OP-6 BENIGN PROSTATE HYPERPLASIA-IMPORTANCE OF ULTRASOUND DIAGNOSTICS IN PRIMARY HEALTH CARE N. PERISIC, S. ANDJELKOVIC, Z. STANKOVIC OP-16 BENIGN PROSTATIC HYPERPLASIA - ECHOSONOGRAPHIC DIAGNOSTICS IN PRIMARY HEALTH CARE N. PERISIC, S. ANDJELKOVIC, Z. STANKOVIC OP-27 SERUM PLASMA AND LEUKOCYTE ZINC LEVELS IN MOTHERS OF NORMAL AND LOW BIRTH WEIGHT INFANTS AND COMPARISON OF ITS EFFECT ON INFANT BIRTH WEIGHT A. KUT, Y. UCKARDES, H. GUNTURKUN, F. SOZEN, Y. CETINEL, R. ERDAL OP-34 BHP AND THE QUALITY OF LIFE D. MILOSEVIC, S. NIKOLIC OP-41 LOW DOSE ADMINISTRATION OF ORAL POWDER ANTIBOTICS DUE TO INAPPROPRIATE PREPARATION C. APAYDIN KAYA, S. CAGATAY, E. BUYUKKARA, O. OZLUK, A.I. CELIK, N. TOSUN

- 17 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF ORAL PRESENTATIONS ORAL PRESENTATIONS 5 April 24, 2010 / 14:45 - 16:15 Each presentation is planned to be made in 10 minutes time which will be used as 7 minutes for presentation and 3 minutes for discussion. OP-1 WHAT DO PATIENTS KNOW ABOUT CANCER? N. OZCAKAR, M. KARTAL, C. ISIKLAR OP-3 A CASE-CONTROL STUDY EVALUATING DEPRESSION AND QUALITY OF LIFE IN HIGH-RISK PREGNANT WOMEN M.S. SAHSIVAR, K. MARAKOGLU OP-5 THE PRESENCE OF ANXIETY AND DEPRESSION IN THE ADULT POPULATION OF FAMILY PRACTICE PATIENTS WITH CHRONIC DISEASES K. TUSEK BUNC, Z. KLEMENC KETIS, J. KERSNIK, E. TRATNIK OP-7 OSTEOPOROSIS-METABOLIC ARTHROSIS D. PUNOSEVAC, A. KARAPANDZIC, M. ZIVIC OP-8 CASE REPORT OF ADULT STILL'S DISEASE M. VUCUREVIC, D. NIKOLIC, M. SOCIVICA, G. MARINKOVIC OP-12 PREVENTION OF MENTAL DISEASES BY GENERAL PRACTICE DOCTOR IN MONTENEGRO O. PRVULOVIC, S. STRAHINIC OP-17 THE COMPARATIVE EFFICIENCY OF DIFFERENT METHODS TREATMENT IN ESSENTIAL (CLASICAL) TRIGEMINAL NEURALGIA C. BUSNEAG, A. BUSNEAG OP-20 FALL RELATED FACTORS IN ELDERLY D. KARADENIZLI, T. ALIC, B. GULMAN, P. UNALAN OP-33 IPP-THE FIRST STEP IN TREATING FUNCTIONAL DYSPEPSIA D. MILOSEVIC, S. NIKOLIC

- 18 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS There will be two Poster Sessions during the congress scientific programme. Presenters are responsible for setting up the posters in the morning of their presentation date and removing at the end of the day. At least one of the authors should be ready at the Posters’ Area during the related Poster Session.

POSTER SESSION 1 April 23, 2010 / 12:15 - 14:45. Po-1 SMOKING AND DEPRESSION SYMPTOMS AMONG MEDICAL STUDENTS IN TURKEY K. MARAKOGLU, D. TOPRAK, S. OZDEMIR, D. ERDEM KOROGLU, S. SAHSIVAR

Po-9 ANXIETY AND DEPRESSION LEVELS OF PRECLINICAL MEDICAL STUDENTS IN SELCUK UNIVERSITY N. KARAOGLU, M.SEKER

Po-2 DEPRESSION AND RHEUMATOID ARTHRITIS – CASE REPORT V. ILIC, N. ILIC

Po-10 XANTHOMA ERUPTIVUM AND DIABETES MELLITUS AT OUT- PATIENT VISIT AT POLIAMBULATORY OF SPECIALITIES NR 2 TIRANE, ALBANIA. B. GJONI, M. KELMENDI, N. DHALES, A. BITRI, V. KONICA

Po-3 EVALUATION OF THE LEVELS OF OXIDATIVE STRESS FACTORS AND ISCHEMIA MODIFIED ALBUMIN IN THE CORD BLOOD OF SMOKER AND NON SMOKER PREGNANT WOMEN A.S. SAHINLI, K. MARAKOGLU, A. KIYICI Po-4 DEPRESSION AND ANXIETY WITH DOCTORS PROVOCATIVE TOPIC, MISTAKE OR REALITY? N. ILIC, V. ILIC Po-5 KNOWLEDGE AND ANTICIPATED ATTITUDES OF THE COMMUNITY ABOUT BIRD FLU OUTBREAK IN TURKEY; A SURVEY-BASED DESCRIPTIVE STUDY T. EDIRNE,D. KUSASLAN, B. ATMACA, M. ASLAN

Po-12 DOES THE MOBING HAVE THE INFLUENCE ON THE TYPE OF PERSONALITY? A. BEGANLIC, O. BATIC-MUJANOVIC, S. HERENDA, M. HASANAGIC, A. BRKOVIC Po-13 POPULATION GROWING OLD - OLD PEOPLE’S SOCIAL AND MEDICAL NEEDS Z. STANKOVIC, D. ANDJELKOVIC, N. PERISIC

Po-6 HAIR MESOTHERAPY IN TREATMENT OF ALOPECIA S. OZDOGAN, M. ERDAL Po-7 DERMATOLOGIC ANALYSIS IN ELDERLY PATIENTS DURING BALNEOTHERAPY S. OZDOGAN, E. KAYA, A.H. KAYAR, M. ERDAL Po-8 FAMILY PHYSICIANS’ CALENDER IN TURKEY SINCE 1997: EVALUATION OF THE TURKISH JOURNAL OF FAMILY PRACTICE N. KARAOGLU,2M.A. KARAOGLU

Po-11 MORBIDITY OF DERMATOLOGICAL DISEASES OF THE PEDIATRIC AGE DURING 2005-2009 AT HEALTH CLINIC OF SPECIALTIES NR 2 AND HEALTH CLINIC OF QUARTER NR 9,TIRANA, ALBANI B. GJONI, N. DHALES, M. KELMENDI, V. KONICA, A. BITRI, E. CUKANI

Po-14 CANCER IS NOT A DEATH SENTENCE, EARLY DETECTION SAVES LIFE Z. STANKOVIC, D. ANDJELKOVIC, N. PERISIC Po-15 ACUTE URTICARIA AT THE PEDIATRIC AGE, VISIT AT POLICLINIC OF SPECIALTIES NR 2 & HEALTH CLINIC NR 9 DURING JANUARY 2009- DECEMBER 2009. B. GJONI, M. HASANAJ, B. VACARRI,

- 19 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS V. KONICA, M. KELMENDI, N. DHALES, A. BITRI, Po-16 ACCESS OF ELDERLY PATIENTS TO PRIMARY MEDICAL CARE L. GEORGIEVA, S. POPOVA, V. MADJOVA Po-17 WHY THEY DONT WANT TO BE A FAMILY PHYSICIAN? FAMILY MEDICINE FROM THE VIEW OF MEDICAL EDUCATION N. KARAOGLU, M.A. KARAOGLU

Po-26 TUBAL STERILIZATION VERSUS VASECTOMY (DEMOGRAPHIC EXAMINATION OF 3404 CASES) L. AKOGLU, K. ERTOPCU, S.H. KARAHAN, A. DONMEZ, M. OZEREN,M. HELVACI, I. OZELMAS, A. TASYURT

Po-19 THE EVALUATION OF CASES OF DRUG INTOXICATION THAT ARE HOSPITALIZED O. ERDEM, I.H. KARA, O. AYYILDIZ Po-20 SERUM MAGNESIUM LEVELS IN GESTATIONAL DIABETES K. INCI, D. SUNAY, U. UCKAN Po-21 PREVALENCE OF HIPERTENSION IN NON TOXIC MULTINODULAR GOITRE AT THE OUTPATIENT VISIT AT POLICLINIC OF SPECIALITIES NR 2 & POLICLINIC NR 9, TIRANE, ALBANIA M. KELMENDI, G. HYSI, A. BITRI, B. GJONI, A. VESELI, A. STOJKU

Po-23 EVALUATION OF TEN YEARED FOLLOW UP OF ‹NTERNAL AND POSTABORTIVE APPL‹ED CUT380A INTRAUTERINE DEV‹CES

Po-24 FREQUENCY OF PHYSICAL DEVELOPMENT DISORDERS IN CHILDREN FROM PRIMARY SCHOOL \"EDHEM MULABDIC\" IN ME?E?A S. BISANOVIC, S. SIVIC, O. BATIC-MUJANOVIC Po-25 PREVALENCE OF DIABETES FOOT IN OUTPATIENT VISIT AT ENDOCRINOLOGIST AND DERMATOLOGICAL SERVICES OF THE HEALTH CENTER OF SPECIALTIES NR. 2, TIRANE, ALBANIA. M. KELMENDI, B. GJONI, G. HYSI, A. STOJKU, N. DHALES, A. BITRI,

Po-18 CONGENITAL STARDGARD\'S DISEASE, CASE REPORT N. BURDA, B. GJONI, M. KELMENDI, A. STOJKU

Po-22 EVALUATION OF KNOWLEDGE, ATTITUDE AND BEHAVIOUR OF MEN ABOUT FAMILY PLANNING G. OZCEYLAN, K. ERTOPCU, S.H. KARAHAN, S. KELEKCI, A. DONMEZ, G. SOP

B. BULUT, K. ERTOPCU, A. DONMEZ, S. TINAR, I. OZELMAS, M. HELVACI, A. TASYURT

Po-27 IMPLANON-SIDE EFFECTS,SAFETY,SATISFACTIONS,CONTINUITY S. KURNUC, K. ERTOPCU, Y. YILDIRIM, S.H. KARAHAN, G. SOP, A. TASYURT Po-28 THE DIAGNOSTICS OF DIABETIC POLYNEUROPATHY Z. DAUTOVIC, S. MICANOVIC Po-29 CARDIO-METABOLIC SYNDROME-INVASIVE TRATMENT OF PATIENTES L. ZOGOVIC VUKOVIC Po-30 HOW MANY PATIENTS WITH A STROKE HAS FULFILLED QUALITY INDICATORS OF CLINICAL PRACTICE? A. BEGANLIC, M. MUJCINAGIC-VRABAC, O. BATIC-MUJANOVIC, M. HASANAGIC, S. HERENDA

- 20 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS Po-31 RISC FACTORS FOR DEVELOPMENT OF DIABETIC RETINOPATHY E. RAMIC, A. BEGANLIC, E. ALIBASIC, E. KARIC, S. SELMANOVIC, O. BATIC-MUJANOVIC Po-32 NON-CONTAGIOUS DISEASES AS CAUSE OF TEMPORARY INCAPABILITY FOR WORK L. DELEVIC Po-33 DIABETES MELLITUS – MONITORING REGISTERED PATIENTS FROM ASPECT OF PRIMARY HEALTH PROTECTION A. BAJRAMSPAHIC Po-34 ANTENATAL FOLLOW UP OF 100 WOMEN WHO GIVE BIRTH AT MINISTRY OF HEALTH,EGE TRAINING AND RESEARCH HOSPITAL OF OBSTETRICS & GYNECOLOGY S.H. KARAHAN, K. ERTOPCU, T. GULEN, C.E. TANER, M. HELVACI, A. TASYURT, S. TINAR Po-35 PPD POSITIVITY IN HOSPITALIZED CHILDREN C. ONER, M.C. GUNERI

YILDIRIM, A. DONMEZ, G. SOP, I. OZELMAS, A. TASYURT Po-39 COMPARISON OF DEMOGRAPHIC CHARACTERISTICS OF INTERVAL AND POSTABORTIVE TUBAL STERILIZATION (1407 CASES) L. AKOGLU, K. ERTOPCU, B. TUNCAY, A. DONMEZ, I. OZELMAS, M. HELVACI, A. TASYURT Po-40 MONITORING OF CARDIOVASCULAR RISK FACTORS AMONG PATIENTS WITH STROKE IN FAMILY MEDICINE PRACTICE O. BATIC-MUJANOVIC, N. DAJANOVIC, H. DEMIC, L. GAVRAN, M. BECAREVIC, S. BISANOVIC, A. BEGANLIC, S. HERENDA, A. BRKOVIC, M. HASANAGIC Po-41 PAP SMEAR- SCREENING AND KNOWLEDGE ABOUT IT A. BEGANLIC, S. HERENDA, E. RAMIC, O. BATIC-MUJANOVIC, A. BRKOVIC Po-42 TAKING PILLS DOESN’T MEAN THAT YOU HAVE CONTROLLED BLOOD PRESSURE! V. ALEKSOV, L. SUKRIEV, D. ALEKSOV

Po-36 RISK FACTORS FOR ECTOPIC PREGNANCY C. ONER, M.C. GUNERI, O. UNAL, B. KARS Po-37 DIABETIC RETINOPATHY AND CLINIC PREDISPOSING FACTORS TO THE PATIENTS WITH DIABETUS MELLITUS AT POLICLINIC OF SPECIALTIES NR 2 TIRANE, ALBANIA. N. BURDA, M. KELMENDI, B. GJONI, A. STOJKU, E. XHOKAXHIU, A. VESELI Po-38 COMPARISON OF DEMOGRAPHIC CHARACTERISTICS OF WOMEN WHO APPLIED FOR CONSULTING TO THE WOMEN APPLIED FOR ABORTION BECAUSE OF UNWANTED PREGNANCIES I.A. ERCAN, K. ERTOPCU, S.H. KARAHAN, Y.

Po-43 FOCUSING TO UNKNOWN WITH EVIDENCE BASED MEDICINE IN PRIMARY CARE F. YUKSEL, B. PALA, M. UNALACAK Po-44 ALCOHOL CONSUMPTION BEHAVIOUR OF STUDENTS OF A HIGH SCHOOL IN A SOUTHERN CITY OF TURKEY E. SAATCI, D. ANTEPUZUMU, Y. INCECIK, O.OZMEN, N. BOZDEMIR Po-45 THE EVALUATION OF NUTRITIONAL HABITS OF HYPERTENSION PATIENTS A. PARLAK, U. AYDOGAN, A. DIKILILER, K. SAGLAM

- 21 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS Po-46 THE EVALUATION OF LIVER, KIDNEY AND THYROID FUNCTIONS OF NEWLY DIAGNOSED HYPERTENSION PATIENTS A. PARLAK, U. AYDOGAN, S. MUTLU, K. SAGLAM Po-47 THE EFFECT OF LABIAL FUSION ON CLINICAL OUTCOMES E. ALTUNBAS, N. TEKIN, I. KARATAS ERAY Po-48 FOLLOW UP RESULTS OF CHRONIC IDIOPATHIC LOW BACK PAIN PATIENTS ACCORDING TO FAMILY MEDICINE PRINCIPLES I. TANYILDIZI, V. MEVSIM Po-49 AFFIRMATION OF PREVENTIVE PROGRAMS IN FAMILY MEDICINE R. AGIC, A. BAJRAMSPAHIC

Po-54 FREQUENCY OF UNRECOGNIZED DEPRESSION IN ERDERLY PATIENTS A. SOFTIC-OMEROVIC, J. EREIZ, A. BEGANLIC Po-55 THE USE OF TONOPEN APPLANATION TONOMETER IN HOME TREATMENT. T. PAVLOVIC, J. IVANCEVIC Po-56 THE USE OF ANTIBIOTICS FOR RESPIRATORY TRACT INFECTIONS J. IVANCEVIC, T. PAVLOVIC Po-57 ANXIETY AND DEPRESSION RELATED SOCIODEMOGRAPHIC FEATURES FOR DENTURED HEART FLAP PAT‹ENTS: PRELIMINARY STUDY Y. TURKER, K. ONGEL, M. OZAYDIN Po-58 OSTEOPOROSIS SCALE TO USE IN PRIMARY CARE SETTINGS: PRELIMINARY STUDY H. KAYACAN, K. ONGEL

Po-50 THE HEALTH CONDITION OF GERIATRIC PATIENTS IN PETROVAC ON THE SEA K. RASKOCIC, M. VRANES-GRUJICIC, L. DJUROVIC, I. GALIC Po-51 ATTENDANCES IN FAMILY DOCTORS’ HEALTH CENTERS P. TSEKOVA Po-52 FREQUENCY OF RECOCNIZED DEPRESSION IN ERDERLY PATIENTS A. SOFTIC-OMEROVIC, J. EREIZ, A. BEGANLIC Po-53 THE RELATIONSHIP BETWEEN HYPERTENSION AND SLEEP DISORDER IN CHILDREN AND ADOLESCENTS R. PICAK, M. BAYAT, M.M. MAZICIOGLU, S. ISMAILOGULLARI, S. KURTOGLU, E. YILMAZ, D. YILDIZHAN, H.B. USTUNBAS

Po-59 WHAT DOES THE INCREASE OF PSA MEANS FOR THE GENERAL PRACTITIONER? B. STOJANOVSKI, V. GEORGIEV, O. IVANOVSKI Po-60 HELICOBACTER PYLORI – PREVALENCE AND ERADICATION L. JANEVA, N. JANEV, L. ANGELOVSKA Po-61 HYPERLIPOPROTEINEMIA AND CARDIOVASCULAR DISEASES L. JANEVA, N. JANEV, L. ANGELOVSKA Po-62 CHRONIC COMPLICATIONS WITH PATIENTS SUFFERING FROM DIABETES MELLITUS TYPE II L. JANEVA, N. JANEV, L. ANGELOVSKA

- 22 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS Po-63 THE PREVALENCE OF CHRONICALLY NONCOMMUNICABLE DISEASES IN FAMILY PRACTICE TEAMS IN CANTON TUZLA S. SELMANOVIC, A. BEGANLIC, S. SRABOVIC, M. MUJCINAGIC-VRABAC, J. JASIC, A. SOFTIC

Po-70 TREATMENT OF HYPOGLYCEMIC CONDITIONS AT THE EMERGENCY MEDICAL SERVICES OF THE CITY OF BELGRADE S. ZIVANOVIC, D. STEVOVIC GOJGIC, V. STEFANOVIC

Po-64 MODIFABLE CARDIOVASCULAR RISK FACTORS AMONG PATIENTS WITH STROKE IN FAMILY MEDICINE PRACTICE 1. BATIC-MUJANOVIC, S. BISANOVIC, L. GAVRAN, E. RAMIC, M. BECAREVIC, E. ALIBASIC

Po-71 THE IMPACT OF SMOKING ON THE CHANGES IN THE ORAL CAVITY D. TRIFUNOVIC BALANOVIC

Po-65 KNOWLEDGE AND ATTITUDES OF UNIVERSITY STUDENTS TOWARD PANDEMIC INFLUENZA: A CROSSSECTIONAL STUDY FROM TURKEY H. AKAN, Y. GUROL, G. IZBIRAK, S. OZDATLI, G. YILMAZ, A. VITRINEL, O. HAYRAN Po-66 DEPRESSION IN THE ELDERLY AND FAMILY MEDICINE – CLINICAL TRIAL S. GEORGETA, M. ARMASU, G. COSTINELA, P.C. CIUDIN, C. VORNICU Po-67 VIOLENCE AND THE FAMILY DOCTOR (CLINICAL TRIAL) S. GEORGETA, M. ARMASU, G. COSTINELA, R. TRACIUC, E. TRACIUC, C. VORNICU Po-68 INCREASED NUMBER OF DESEASED PATIENTS FROM PAROTITIS EPIDEMICA IN 2008 IN PRIVATE HEALTH INSTITUTION, VITALIS,-STRUMICA, R. MACEDONIA V. PEVKEVA, V. MANCHEV, L. MATKOVA, V. MANCHEVA Po-69 LIFESTYLE FACTORS IMPACT ON FERTILITY E. ALIBASIC, F. LJUCA, D. LJUCA, E. RAMIC, O. BATIC-MUJANOVIC, A. TULUMOVIC, A. BEGANLIC

Po-72 URINARY BLADDER FUNCTION IN MEN WITH DIABETES TYPE 2 E. ALIBASIC, F. LJUCA, D. LJUCA, E. RAMIC, O. BATIC-MUJANOVIC, A. TULUMOVIC, A. BEGANLIC Po-73 CORONARY ARTERY DISEASE(CAD), SOCIODEMOGRAPHIC FEATURES AND SEARCHING RISC FACTORS IN FAMILY A. PARLAK, H. AKBULUT, U. AYDOGAN, O. SARI, C. BARCIN, K. SAGLAM Po-74 COMPARISION OF HIPOCALSEMIA FREQUENCY AFTER THYROIDECTEMIA IN BENING OR MALIGN THYROID CANCERS O. SARI, U. AYDOGAN, H. DINCER, H. AKBULUT, S. KAVUK, K. SAGLAM Po-75 PARAMETRIC CHANGES IN RDW AND MCV FOR RADIATION HEALTH EMPLOYEES PERIODIC INSPECTIONS C. BOCUTOGLU, K. ONGEL Po-76 COMPARISON OF THE HAEMATOLOGIC PARAMETERS FOR THE DIAGNOSIS OF IRON DEFICIENCY ANEMIA BETWEEN PREGNANT AND NON-PREGNANT WOMEN C. BOCUTOGLU, K. ONGEL, M. Tamer MUNGAN

- 23 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS Po-77 LONELINESS OF FAMILY PHYSICIANS: A PRELIMINARY STUDY N. KARAOGLU, F. SIVRI Po-78 CELIC DISEASE - CASE STUDY M. STANISIC

Po-79 MANAGEMENT OF PATIENT WITH CONSTIPATION COMPLAINT IN PRIMARY CARE M. KORKMAZ, F. YUKSEL, M.UNALACAK, I. UNLUOGLU Po-80 PREVALENCE OF CARDIOVASCULAR RISK FACTORS IN MENOPAUSES O. BATIC-MUJANOVIC, A. KURT, B. SENAIDA, G. LARISA, B. MUNEVERA

POSTER SESSION 2 April 24, 2010 / 12:15 - 14:45. Po-81 PRESENCE OF SPIROMETRY IN PRIMARY HEALTH CARE (PHC) IN SKOPJE. RECOMMENDATION FOR INTEGRATIVE APPROACH – COPD CENTERS K. SOLESKI, F. LOKVENEC, D. ILIEV, M. MIHAJLOV, S. SOKOLSKA, S. KARALIESKI Po-82 THE EFFECTS OF SUPPLEMENTS IN HIPERLIPIDEMY TREATMENT K. SOLESKI Po-83 SMOKING AS A RISK FACTOR IN GYPSY POPULATION T. PAVLOVIC, J. IVANCEVIC Po-84 THE EFFECT OF THYROID REPLACEMENT THERAPY TO LEVELS OF ANXIETY AND DEPRESSION IN SUBCLINICAL HYPOTHYROID PATIENTS M.Y. YARPUZ, U. AYDOGAN, O. SARI, A. AYDOGDU, G. UCKAYA, K. SAGLAM Po-85 DO THE FAMILY MEDICINE PRACTITIONERS TAKE CARE EQUALY OF PATIENTS WITH MENTAL DISORDERS? M. MUJCINAGIC-VRABAC, S. HERENDA, A. BEGANLIC, S. SELMANOVIC, O BATICMUJANOVIC, S. SRABOVIC

Po-86 RESEARCHING PSYCHOLOGICAL SYMPTOMS IN YOUNG ADOLESCENT MALES ACCORDING TO THE SYMPTOM CHECKLIST-90-R (SCL-90-R) H. AKBULUT, U. AYDOGAN, O. SARI, S. MUTLU, M. CELIKTEPE, K. SAGLAM Po-87 COMPARING DIFFERENT DEMOGRAPHIC DATA TO THE SPREAD OF SMOKING AMONG YOUNG ADOLESCENT MALES IN OUR COUNTRY U. AYDOGAN, O. SARI, H. AKBULUT, P. NERKIZ, O. GEVREK, K. SAGLAM Po-88 COMORBID PSYCHIATRIC DISORDERS IN PATIENTS WITH SOMATIZATION DISORDER ACCORDING TO THE SYMPTOM CHECKLIST90-R (SCL-90-R) O. SARI, U. AYDOGAN, H. AKBULUT, O. GEVREK, S. YUKSEL, K. SAGLAM Po-89 HYPERTENSION IN CONTEXT OF METABOLIC SYNDROME X S. MILOVANCEVIC, J. VUKOTIC Po-90 DETAILED ANALYSIS OF GERIATRIC PATIENTS VISITING THE EMERGENCY ROOM T. TAYMAZ

- 24 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS Po-91 THE CHARACTERISTIC OF MORBIDITY IN THE ELDERLY AREA MUNICIPALITIES SM.PALANKA D. NIKOLIC, G. COSIC, S. MAJSTOROVIC Po-92 INCIDENCE OF OBESITY AND GROWTH RETARDATION IN CHILDREN IN THREE DIFFERENT REGIONS OF TURKEY T. TAYMAZ, N. MEMIOGLU, S.M. KAYIRAN, B. TAYMAZ

Po-100 HEALTHCARE AND PATIENT MANAGEMENT IN OUT-OF-OFFICE HOURS IN GENERAL PRACTICE A. ZABUNOV, V. MADJOVA, P. MANCHEVA, S. HRISTOVA Po-101 QUALITY OF LIFE EVALUATION IN PATIENTS WITH OSTEOARTHROSIS IN PRIMARY HEALTHCARE S. HRISTOVA, V. MADJOVA, A. ZABUNOV, P. MANCHEVA

Po-93 THE ELECTRONIC PRESCRIPTION (OUR EXPERIENCE IN 2009) S. SIMOVIC, O. KNEZEVIC, S. MARKOVIC Po-94 ABNORMAL REACTION ON ALCHOCOL IN PATIENTS WITH POST TRAUMATIC STRESS DISTURBANCE (PTSD) B. RANCIC

Po-102 ASSESSMENT OF THE PREDICTIVE VALUE OF OBESITY MARKERS FOR THE DIAGNOSIS OF METABOLIC SYNDROME IN GENERAL PRACTICE D. VANKOVA, D. GEROVA, D. IVANOVA, S. TOMCHEVA, V. MADJOVA

Po-95 RELATIONSHIP BETWEEN HELICOBACTER PYLORI INFECTION AND HYPERLIPIDEMIA A.F. ERDOGAN, S. ASMA, C. GEREKLIOGLU Po-96 EVALUATION OF PATIENTS WHO APPLIED TO THE FAMILY MEDICINE CLINIC WITH OBESITY A.F. ERDOGAN, S. ASMA, C. GEREKLIOGLU Po-97 HEALTHY EATING IN OLD INDIVIDUALS AND SOME RECOMMENDATIONS ABOUT MICROELEMENTS V. MADJOVA, V. TODOROVA, L. SAVOV Po-98 EXOPHTALMIA REFERENCES OF TURKISH CHILDREN AGED 6-18 YEARS T. KARA, S. KURTOGLU, M.M. MAZICIOGLU, A. OZTURK, M. OZDOGRU, H.B. USTUNBAS

Po-99 ULTRASOUND IN THE WORK OF A GP/FAMILY DOCTOR – MY EXPERIENCE B. SEVO-ALEKSIC

Po-103 CONSULTING PATIENTS WITH CHRONIC MENTAL DISEASE IN GENERAL PRACTICE - INDISPENSABLE PART OF THEIR PSYCHO-SOCIAL REHABILITATION P. MANCHEVA, V. MADJOVA, A. ZABUNOV, S. HRISTOVA Po-104 FAMILY PHYSICIANS’ PERSPECTIVES ON IDENTIFYING THE PATIENTS “FOR PALLIATIVE CARE” - A STUDY AMONG BULGARIAN GPS G. FOREVA, R. ASSENOVA, V. MADJOVA Po-105 PSYCHOLOGICAL CO-MORBIDITIES IN OBESE CHILDREN R. ASSENOVA, G. FOREVA, V. MADJOVA

- 25 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS Po-114 STATIN THERAPY IN HYPERTENSIVE PATIENS WITH HYPERLIPIDEMIA B. GRUJIC, L. BUNJAK, S. MILOVANCEVIC, J. VUKOTIC

Po-106 ARE SECOND LINE HELICOBACTER PYLORI TREATMENTS ALARMING? A.F. ERDOGAN, S. ASMA, C. GEREKLIOGLU Po-107 PREVALENCE OF ADULT PATIENTS THAT INFLUENZA AND PNEUMOCOCCAL VACCINATION SHOULD BE RECOMMENDED IN FAMILY MEDICINE OUTPATIENT CLINIC A.F. ERDOGAN, S. ASMA, C. GEREKLIOGLU

Po-115 ECHINOCOCCOSIS HEPATIS IN PRIMARY HEALTH CARE D. JOKSIMOVIC STEVANOVIC, S. MILJKOVIC, V. ZDRAVKOVIC VASIC, M. MILJKOVIC

Po-108 DOMESTIC VIOLENCE L. MILJKOVIC, D. TRIFUNOVIC BALANOVIC, G. ZELJKOVIC

Po-116 DOMESTIC VIOLENCE CASE INTRODUCTION L. MILJKOVIC, D. TRIFUNOVIC BALANOVIC, G. ZELJKOVIC

Po-109 THE MOST FREQUENT CHRONIC NON-INFECTIONS DISEASES (HNO) IN ORDINATION OF GENERAL PRACTICE M. MILJESIC, L. NOZINIC-VILUS

Po-117 AFFECTS OF RISK FACTORS TO RESPIRATORY SYMPTOMS: A FIELD RESEARCH Z. GUNAYI, V. MEVSIM

Po-110 PREVENTION OF COGNITIVE IMPAIRMENTS IN PRIMARY HEATH CARE M. RACIC, P. MIRA, K. SREBRENKA, K. LJILJA

Po-118 SYMPTOMATIC ARTERIAL HYPERTENSION IN CHILDREN - CLINICAL OBSERVATION L. MARINOV, D. BLIZNAKOVA, P. SHIVACHEV Po-119 CARDIAC TUMORS AMONG CHILDREN – TWO CASE REPORTS L. MARINOV, P. SHIVACHEV, S. LAZAROV

Po-111 PREMENSTRUAL SYNDROME AND ASSOCIATED FACTORS AMONG UNIVERSITY GIRLS K. MARAKOGLU, M.S. SAHSIVAR, H. ULU, D. ERDEM KOROGLU, F. CEVIZCI

Po-120 ASSOCIATION OF CUTANEOUS MANIFESTATIONS WITH BODY MASS INDEX AND HbA1c LEVELS IN TYPE II DIABETES MELLITUS PATIENTS N. SENSOY, G. GENCOGLAN

Po-112 SMOKING BEHAVIOUR, KNOWLEDGE, ATTITUDES AND PRACTICE AMONG HEALTH CARE PROVIDERS IN KAHRAMANMARAS CITY, TURKEY M. CELIK, A. OZER, H.C. EKERBICER, F.O.ORHAN Po-113 EFFECTS OF PHARMACOLOGICAL TREATMENT OF HYPERLIPIDEMIA L. BUNJAK, B. GRUJIC, S. MILOVANCEVIC, J. VUKOTIC

Po-121 VENOUS THROMBOEMBOLIC DISEASE COMPLICATED WITH BRAIN THROMBOSIS AND ANTITHROMBIN III DEFICIENCY– A CASE REPORT L. MARINOV, M. ZHELEVA, B. VARBANOVA, D. BLIZNAKOVA, P. SHIVACHEV

- 26 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS Po-129 IMPORTANCE OF ACKNOWLEDGEMENT OF PATIENT IN PRIMARY CARE PHYSICIAN PERFORMANCE IN TERMS OF VALUE OF HUMANITY N. KIRIMLIOGLU, A.T. KOKCU, N. DEMIRSOY, I. UNLUOGLU

Po-122 CARDIAC COMPLICATIONS IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA L. MARINOV, P. SHIVACHEV, M. BELCHEVA, E. PETEVA, V. KALEVA Po-123 REVIEW OF CONTEMPORARY POCT TESTING AND SYSTEMS. POSSIBILITIES OF THEIR APPLICATION TO PRIMARY MEDICAL SERVICES S. KASHLOVA, M. BONCHEVA, V. MADJOVA

Po-130 TREATMENT OF DIABETES MELLITUS TYPE 2 WITH METFORMIN AND GLIMEPIRID L. MAKSIMOVIC, K. MARKOVIC, S. RASOVIC

Po-124 A WIDELY HEALTH SCREENING IN KOSOVO T. TAYMAZ, A. ERDIL, R. BAYAR, C. HICYILMAZ, B. TAYMAZ, A. OZGENECI, A. DURHAN, Y. SIVRIKAYA, U. POYRAZ Po-125 RESEARCH OF ANXIETY AND DEPRESSION SEVERITY AMONG CANCER PATIENTS Y.C. DOGANER, U. AYDOGAN, O. SARI, B. OZTURK, S. KOMURCU, K. SAGLAM

Po-131 IMPORTANCE OF GERIATRIC PATIENTS’ INFORMED CONSENT IN PRIMARY CARE PHYSICIAN PERFORMANCE N. DEMIRSOY, A.T. KOKCU, O. ELCIOGLU, M. UNALACAK Po-132 COMORBID DISEASES IN PATIENTS DIAGNOSED WITH ANXIETY DISORDER H. AKBULUT, U. AYDOGAN, A. PARLAK, Y.C. DOGANER, A. CUCELOGLU, K. SAGLAM

Po-126 ASSOCIATION BETWEEN DOMESTIC VIOLENCE AND DEPRESSION IN TURKISH PREGNANT WOMEN T. EDIRNE, R. YILDIZHAN, A. KOLUSARI, E. ADALI, M. CAN, V. KARS

Po-133 COMPLICATIONS AND COMORBID DISEASES IN TYPE 2 DIABETIC PATIENTS U. AYDOGAN, H. AKBULUT, A. AYDOGDU, Y.C. DOGANER, E. BOLU, K. SAGLAM

Po-127 A KIND OF SMOKELESS TOBACCO IN TURKEY: MARAfi OTU (MARAS POWDER)-A REVIEW M. CELIK, H.C. EKERBICER, U.G. OZER, A. OZER, F.O. ORHAN

Po-134 ANXIETY LEVELS IN PATIENTS DIAGNOSED WITH AND BEING TREATED FOR HYPOGONADISM A. AYDOGDU, U. AYDOGAN, H. AKBULUT, O. SARI, E. BOLU, K. SAGLAM

Po-128 IMPORTANCE OF FAMILY PRACTITIONERS IN IMPLEMANTATION OF ISTANBUL PROTOCAL O. ELCIOGLU, A.T. KOKCU, N. KIRIMLIOGLU, M. UNALACAK, T. GUNDUZ

Po-135 SEASONAL INFLUENZA VACCINATION RATES AND IMMUNIZATION AWARENESS OF ADULTS IN RISK GROUPS M. SAV AYDINLI, A.G. CEYHUN PEKER, A.S. TEKINER, Z. DAGLI, F. AK PARLAK, S. INAN

- 27 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS Po-145 ARTERIAL HYPERTENSION WITH DIABETICS L. MILOJKOVIC, L. NEDELJKOVIC

Po-136 OBESITY - RISK FACTOR FOR ARTERIAL HYPERTENSION IN ADULTS WITH INITIAL OPTIMAL BLOOD PRESSURE J. VUKOTIC, S. MILOVANCEVIC

Po-146 RISK FACTORS AND PREVENTIVE MEASURES WITH OBESITY L. MILOJKOVIC, L. NEDELJKOVIC

Po-137 A WIDELY HEALTH SCREENING IN AZERBAIJAN T. TAYMAZ, A. ERDIL, I. YILDIZ, B. KARADAG

Po-147 POSSIBILITIES OF RECOGNIZING THE INITIAL PHASE OF DIABETIC FOOT IN THE SELECTED DOCTOR’S CLINIC M. DJUROVIC, L. MARKOVIC

Po-138 DISABILITY AND HEALTH S. INAN, A.G. CEYHUN PEKER, A.S. TEKINER, M.K. KOPUK Po-139 DETERMINATION OF THE AWARENESS LEVEL OF THE WOMEN IN TERMS OF URINARY INCONTINENCE N. SENSOY, N. DOGAN, B. OZEK, L. KARAASLAN Po-140 THE USE OF ANXIOLYTICS IN GENERAL PRACTITIONER’S OFFICE B. JOVICEVIC, O. RADOSAVLJEVIC Po-141 HEALTH TOURISM IN ULCINJ G. KARAMANAGA Po-142 PULMONARY ECHINOCOCCOSIS G. KARAMANAGA Po-143 GERIATRIC SYNDROME L. DJUROVIC, V. OBORINA, K. RASKOVIC Po-144 Alternative Tradicional Medicine (CAM) L. DJUROVIC, K. RASKOVIC, J. DAMJANOVIC

Po-148 THE QUALITY OF LIFE WITH EXTENSIVE POST-BURN SCARS L. MARKOVIC, M. DJUROVIC Po-149 EPIDEMIOLOGICAL CHARACTERISTICS AND THE IMPORTANCE OF THE PRESENCE OF HIPERTENSIVE DISEASES IN PATOLOGY AND EMERGENCY IN THE FORTH THREE - MONTHLY PERIOD OF 200 M. RADOMIR MILENKOVIC, A. SPIRKOSKA, V. SPIRKOSKI, S. PECOVSKA, T. RISTESKI, V. MILENKOVIC, P. KARAGOZOV Po-150 ASPIRIN IN PREEKLAMPSIJA PREVENTION P. KOSTOVSKA, G. AVRAMOVSKI Po-151 ECONOMIC REASONS FOR PERFORMING LAPAROSCOPIC CHOLECYSTECTOMY AS A STANDARD SURGICAL PROCEDURE S. PEJCIC, V. PEJCIC, T. BOJIC, A. PRAZIC Po-152 RHEUMATOID ARTHRITIS-THE ROLE FOREIGN DEVELOPMENT AND COURSE OF DISEASE V. VUKOVIC IGOV, S. PEJCIC, B. RAJKOVIC

- 28 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

LIST OF POSTER PRESENTATIONS Po-157 COMPARISON OF CERVICAL SMEAR CULTURE RESULTS OF WOMEN USING AND NOT USING THE INTRA UTERINE DEVICE S. GUNHER ARICA

Po-153 WATER QUALITY AND HEALTH - HYGIENIC AND EPIDEMIOLOGICAL ASPECTS J. LUKIC Po-154 VALUE OF WBC AND SEDIMENTATION IN THE DIAGNOSE OF DIFFERENT DISEASES. G. CESUR, B. TURHAN, A. TUMERDEM, K. ONGEL

Po-158 THE ASSESSMENT OF BODY MASS INDEXES AND NUTRITIONAL HABITS OF THE STUDENTS ATTENDING PRIMARY SCHOOL V. ARICA, S. GUNHER ARICA

Po-155 BURNOUT SYNDROME IN BUS DRIVERS IN ISTANBUL A. UZUNER, S. TUZUN, F. EKINCI, G. SAHOGLU, P. UNALAN

Po-159 PREVALENCE OF OBESITY AND ASSOCIATED FACTORS IN A KINDERGARDEN IN VAN S. GUNHER ARICA, V. ARICA

Po-156 FOLLOW UP RESULTS OF CHRONIC IDIOPATHIC LOW BACK PAIN PATIENTS ACCORDING TO FAMILY MEDICINE PRINCIPLES I. TANYILDIZI, V. MEVSIM

Po-160 TREATMENT OF ACUTE SINUSITIS WITH INTERMITTENT AZITHROMYCIN AND CEFUROXIME: A COMPARATIVE STUDY V. ARICA, S. GUNHER ARICA, M. DOGAN

- 29 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

- 30 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

FULL TEXTS OF INVITED FACULTY LECTURES

- 31 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

- 32 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

PLENARY SESSIONS PLENARY SESSION 1 (Ple-1) April 23, 2010 / 09:30 – 10:15 / Hall A Association of General Practice and Family Medicine of South East Europe (Güneydo¤u Avrupa Aile Hekimleri ve Pratisyen Hekimler Birli¤i) Moderator : Erhan Sayal› Ljubin Sukriev Association of GP/FM SEE -bridge for collaboration and developmentL. SUKRIEV Military Hospital, Skopje, R.of Macedonia Looking forward the identical problems of the region of South-East Europe in the Primary Health Care protection,an idea appeared to Form the Association of doctors of General Practice/Family Medicine of SEE in 2002.This idea was realized in 2003 in Ohrid,R.of Macedonia,where the Association was formed. From its constitutien till today,a lot of meetings were held,two studies in South-Eastern-Europe were conducted,and one Congress and Conferences of the Association were held. There were a lot of works published as well. The aim of the Association is the bring closer the opposites meanings, to change the experiences,to intense the collaboration between the country members of the Association,and all this in a way to afirmate General Practice/Family Medicine in the region and established its in the society through the institutions. Collaboration with other Associations ,especially with Wonca World and Wonca Europe, is a necessity. A lot of countries are members in the Associations. Forming a Cathedra of Family Medicine in the country members of the Association and establish a permanent development of CME and CPD in order to provide the doctors with academic experiences in the field of medicine,is our primary goal and imperativ to achieve in the future. Coordination and mutual collaboration with the institutions should be enhance in the future and the problems should be solved in the frame of the institutions.

PLENARY SESSION 2 (Ple-2) April 24, 2010 / 08:30 – 09:15 / Hall A CME and continuous professional development European experience and SEE (Sürekli T›p E¤itimi ve sürekli mesleki geliflim, Avrupa deneyimi ve Güneydo¤u Avrupa) Moderator: Arzu Uzuner Marko Kolsek CME and continuous professional development European experience and SEE M. KOLSEK Dept of Family Medicine, University of Ljubljana Medical Faculty, Slovenia “General practice is the easiest job in the world to do badly, but the most difficult to do well.” Professor Sir Denis Pereira Gray

Learning is a life-long process. We start to learn some elements of a good general practitioner or family doctor already in our childhood. Medical school adds some specific elements. In the end, in Europe at least three - 33 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya years of vocational training or specialization gives a doctor the right to work independently with patients in general practice or family medicine. It is important that already medical school start to teach family medicine or general practice all medical students to make them understand the importance of family medicine in health system, to understand our phylosophy and approach to health problems and to our patients. All medical students should get an overview of strength, advantages and possibilities of family medicine, but also our limitations. Family medicine is best learned in a GP-setting, although specific competences and skills can be learned in environments of other disciplines. After medical school postgraduate learning comes and after that practice with continuing learning. Countries of European Union are aiming to harmonize the content and the level of the training for GPs to reach common learning outcomes considering 11 characteristics in 6 core competencies of a GP. Such postgraduate training should last at least three years and at least half of this should be taught in general practice settings. The first comptence is Primary care management which includes: first contact with unselected problems of the full range of health conditions, coordination of care with other health professionals and utilize health services effectively and appropriately. The second competence is Person-centred care which includes: an effective doctor-patient relationship and communication considering patient's circumstances and autonomy in longitudinal continuity of care. The third comptence is Specific problem solving skills which includes: ability to selectively gather, interpret and manage patient's information, selectively and effectively use of diagnostic and therapeutic interventions considering the prevalence of illnesses, effectively use of time and tolerate uncertainty. The forth competence is Comprehensive approach which includes: management of simultaneously multiple complaints and pathologies in the individual and co-ordination of health promotion, prevention, cure, care and palliation and rehabilitation. The fifth competence is Community orientation which includes: awareness and understanding of inequalities in health care, the impact of poverty, ethnicity and local epidemiology on health; considering issues on sick leave, referral system, co-payment and other legal issues for the management of the health needs of individual patients and of the community in balance with available resources which usualy are limited. And the last competence Holistic approach which means: “caring for the whole person in the context of the person’s subjective and sometimes mystical values, his family beliefs, the family system, and the culture and the socio-ecological situation in the larger community, and considering a range of therapies based on the evidence of their benefits and cost”. All illnesses have both mental and physical components and that there is a dynamic relationship between biological, psychological and social components of system according to general systems theory. In other words, Holistic approach means use of a bio-psycho-social model of understanding ilnesses and patients. In applying these competences to the teaching, learning and practice of family medicine 3 essential features should be considered: contextual, attitudinal and scientific. These features determine GP's ability to apply the core competences in real life in the work setting. They consider the impact of the local community, culture, facilities, workload, financies, legislation on GP's work, the impact of GP's own professional capabilities, values and ethics, his attitudes and feelings, and also his private life, and finnaly these features include GP's critical approach to his work considering evidence based practice, his ability to assess medical literature and maintain continuing quality improvement. All these 11 characteristics, 6 competences and 3 features are joined in EURACT Educational Agenda. But, when a trainee finishes his vocational training and passes the final exam this is not really the end but - 34 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya it's the beginning of a continuous process of professional development. All medical specialists have to renovate, improve, upgrade and expand their knowledge, skills, attitudes and also relationships according to novelties, inovations and new approaches to different problems. This is especially true for us – GPs/family doctors: we have to know »everything«. We would like this, our patients expect this, clinical specialists expect this, politicians and journalists as well. And this is the reason why we are here at this Conference. We used to call this long lasting learning »continous medical education – CME«. Analyzing the content of this process European experts came to the conclusion that it is not the best expression: this learning is much more than that. So, we now call it »continuos professional development - CPD«. It means all doctor's activities which maintain and improve his professional competence and performance as close as possible to excellence. Doctor's excellent performance has clinical, managerial, social and personality elements to fulfil patients' needs, because good doctor cures also with his personality not only with guidelines. In many European countries such learning has been and is still now mandatory for doctors if they want to practice. With different learning activities that are approaved by an official professional body they have to collect a certain amount of so called »educational points« each year or in a period, e.g. in 7 years as to renew the working licence. All this in order to garantee quality of care and to stimulate doctors to endeavour toward excellence. In last decades it becomes clear that different learning activities are not equally effective: it is not the same sitting and listening a lecture or actively participate at a workshop or prepare a presentation. That is the reason why passive or active participation on a Congress should not be awarded by the same amount of »educational points«. In order to help doctors to maintain these learning activities professional associantions organize different educational events. To be more effective they combine different approaches, e.g. lectures, round tables, workshops, courses, practical training and work in small groups, oral presentations and posters prepared by participants, etc. If you look at the scientific programme of this Conference you can see that it is a good example of such a combination. There are also other learning activities that are effective, e.g. studying a literature, conducting audit procedure, making educational visits of colleague's practice, writing an article for a journal, preparing a protocol for management, analyzing an incident, preparing an information leaflet or guidelines for patients, preparing a case report or a family report for colleagues of a group practice, role playing, running a quality circle, participating in a Ballint group, using internet options for CME and CPD, etc. We are aware of the need to renovate our knowledge and skills on and on. But, what knowledge or skill should be renovate now, next month or this year? Many of us for years prefer to study a topic or to participate at an activity related to a topic which we like. Usualy we already know a lot on this issue and are familiar with it already. Sometimes we do not like to admit ourselves in which issues we feel a little unsecure where we are not very sure, and sometimes we try to avoid them, in a way we overlook them. I remember myself being a medical student: I didn't like the issue of vitamins – different hyper and hypovitaminosis. Studying internal medicine I've just browsed vitamins chapter hoping that the professor would not ask me that. I was lucky then – he didn't. I was lucky but under stress – scared to be asked. But for everyday practice is this the best solution? In everyday practice we are under stress mostly if we are not really sure in what we are doing, if we are unsecure of our knowlegde and skills. There is a solution to avoid this challenge of overlooking some issues and being unsecure, being under unnecessary stress. The solution reflects in continuos learning – continous professional development. I should think about my real educational needs, maybe discuss it with my colleagues. What do I need to renovate? Which topic I do not like so much and not know enough? Which of my skills is not good enough? Which clinical problems are difficult for me? Which patients I would like to be managed by somebody else? Were there any comments of my colleagues on my management? After thinking and considering my personality, my community, possibilities I will find my needs; than I can prepare my personal education plan. - 35 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya Personal education plan or personal development plan in continuos professional development - CPD is a process of planned and individually tailored learning in practice with a focus on the quality of care. It includes the identification of learning needs, construction of a learning agenda, drawing a concrete learning plan, and controlling this in an educational portfolio format. Exact plan should be realistic, relevant, feasible and time limited. For example: I realized I always have a problem when I suspect that a patient have problem because of alcohol drinking. I've never been sure what would be the best to do: how should I start our conversation, should I ask him directly about his drinking, should I just tell him not to drink, should I refer him, would he be offended, would this have an impact on our relationship? So, I've realized that the management of alcohol problems is my need. What now? I've prepared my personal plan: in this year I will improve my knowledge on alcohjol related issues and improve my skills to manage patients with alcohol drinking related problems. Next two months I will read »Clinical guidelines on identification and brief interventions for primary health care on alcohool related problems«, in next four month I'll participate at the workshop on this topic organized by my association and then try to use these new knowledge and new skills in my practice. After 10 months I'll think over to evaluate if I feel more confident and competent when a patient with alcohol related problem comes to me. It is important having in mind that the competence is not enough – it is not enough to know something how to show it if asked or assessed for it. The main thing is to use knowledge and skills and to do it in real practice at everyday work with patients – to perform it. Let's go back from an individual doctor to national professional associations: they should have a lot of close contacts with us that are working in everyday practices to realize our needs and organize educational activities on topics we need and are relelvant to our practice, to our patients and to our country specific situation. They should also organize activities that promote new not enough known knowledge and skills or approaches for the management of old or new problems. Which countries are the most successful in continuos professional development of their GPs? Here are some of their common characteristics that enable or improve possibilities for good results: • strong GPs' professional organisations with enthusiastic and altruistic leaders that are capable to listen to and coordinate different opinions • professional dedication to quality of care • shared responsibility for policy • strong academic position (education, research) • organized training opportunities are continuos, needs based and monitored, and teaching methods reflect learning needs • good public image. Coming to the end, let me look at learning opportunities and possibilities from another side: what seem to be a kind of problem or a challenge already now and what problems or challenges may we face in future? farmaceutical industry: in many countries in a way enables continuos professional development by sponsorship of conference fees for individual doctors, for congress or workshop organizers, by donating funds for medical equipment, etc. But on the other hand farmaceutical industry can sometimes in a way force doctors to decide the opposite of guidelines, it can interfere with scientific content of a professional meeting, misuse congresses for own promotion multimorbidity: there is almost no patients any more with only one problem. Getting older problems are multiplying – especially the chronic ones. There are more and more old people in Europe, so there is also more and more peolpe with multiple problems. GP is the main health professional that have to be able to coordinate the management of different problems at the same patient and to help patients to use health system in accordance with their needs and communitiy possibilities. As Chris van Weel has said. A GP has to be an - 36 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya expert for the management of multimorbid chronic patients. medicalisation: in the last decades medicine is entering step by step in all parts of our life from the conception – better already before the conception through pregnancy, delivery, childhood, adolescence, adult period, old age, death and even after that. Is there anybody or anything at all that is still complitely healthy, normally and doesn't need any help or support by a doctor, nurse or some kind of medicine? Should really all we, that we think are healthy, have to take the »polypill« to be more healthy now and in our old age? Should really we treat normal changes that come with ages? What should we learn, what should we teach? information overloading: already in 60th and 70th of the 20th century there was so many important professional journals that nobody could have an overview of what was happening in the scientific world of medicine. Next step was internet which brought an infinite pool of information of different quality. We already now have problems to orientate ourselves in this pool and it will be even worse in the next decades. Can we imagine our patients – what they can do in this pool of information? Are we prepared to help them to orientate and to take over the responsibility in decision making process and for their health? information technology: in last decades we are slowly moving from paper to monitor, from paper medical record to computer based patients data set, to on-line exchange of information between medical professionals and also between doctor and patient. Are we prepared to overcome the danger of loosing the true and real interpersonal doctor – patient relationship? Will we be able to keep eye contact, to notice those small changes in patients eyes, his face, or small moves of his fingers, to be empathic and communicate with him as a human being not only as an expert and not losing in all possible information on the monitor? overloaded doctors: health needs of population are growing each year and it looks that such trend is not going to stop in near future. Many GPs are overloaded already now, already now they think twice before they decide to take some days for learning or for holidays becasuse of their bad experience. When they come back to their practice they have to make up for the missing days. In many countries in West Europe there is also a lack of GPs, and also in some countries in South East Europe similar situation is coming already. Who knows what will be in ten years? This is followed with more overloading of the rest GPs. Supposing that we - GPs are also human beings with our families: how can we coordinate all these professional expectations with our private life, with our families, with our hobbies to fill our »life batteries«? All these factors can sometimes make doctor to be »lost in the space« Let me finish: Where am I now? Each of us has to put this question to himself and give an answer. How often should I ask myself? For example: once a year. Where do I want to go to? The answer is preparation of my personal life plan and personal education plan that should consider step by step solutions. Professional plan should be prepared according to my needs on the way to excellence considering also my limitations and challenges that are coming. Next step is to follow this plan and after some time to make an audit or evaluation of the results. And then next year is here. And where Europe is now - where SEE countries are now and where they want to go to? All professional organizations in each country should put this question to themselves and answer it by analysing the situation and their members' needs. The direction should be EURACT Educational Agenda. Finding the needs, next step is to plan and organize different effective educational events in order to support and help their members to fulfil their personal education plans. This is the way to my (our) excellence which is expected by my (our) patients, colleagues, politicians and least but not last certainly by myself (ourselves).

- 37 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

PANELS PANEL 1 (Pa-1) April 23, 2010 / 10:45 – 12:15 / Hall A Violence in Family; the Europe and AGP/FM SEE (Aile içi fliddet; Avrupa ve “Güneydo¤u Avrupa Aile Hekimleri ve Pratisyen Hekimler Birli¤i”) Moderators: Suzana Stankovic, Kurtulufl Öngel Leo Pas; Europe (Avrupa) Sabahat Tezcan; Turkey (Türkiye) Suzana Stankovic; SEE short report (Güneydo¤u Avrupa özet raporu) Prevalence and characteristics of domestic violence against women in Turkey, 2008 S. TEZCAN , F.H. TUNCKANAT 1 Director of Hacettepe University Institute of Population Studies, Ankara, Turkey 2 Research Asistant at Hacettepe University Institute of Population Studies, Ankara, Turkey Introduction: Domestic violence againts women is a widespread problem experienced by all women of the world in all societies and various social groups though some variations exists in its prevelance intensity and types. The issue of domestic violance againts women has taken place in the international agenda and especially in the developed countries, with the efforts of women’s movements which has become effective since 1960. In the last 30 years, domestic violence againts women is being considered as part of the violations of human rights. Women experience various types and degrees of violance in their homes, where they should feel safe, however they are exposed to violance by the people they rely on such as their fathers, brothers, and especially their husbands/partners with whom they share their lives. In addition to its physical harms on women, domestic violence againts women causes loss of self confidence and self-respect, which forms unpleasent model for next generations and destroys the pyhsical and mental health of women and children. That is why, it is an important public health problem that stems from strong social and cultural basis. In Turkey, the issue of violence againts women has entered the agenda of the country through the struggle of the women’s movement in the late 1980’s. Since the 1990s institutionalization accelerated, the Directorate General on the Status of Women (DGSW) was established under the Prime Ministry, woman research centers were formed in universities and the number of women nongovermental organizations increased. The issue of domestic violence againts women in Turkey has stayed on the agenda through the collabration and activities of all these institutions. In Turkey, besides the various local studies on domestic violence few national studies were conducted in recent years. The lack of data and prevalence and causes of violence againts women and how its perceived by people has been one of the most important factors impeding the development and implementation of national programs to combat violence. Thus “National Research on Domestic Violence Against Women in Turkey” of which the DGSW is the beneficiary institution, has been conducted by a three partner consortium consisting of ICONInstitut Public Sector, Hacettepe University Institute of Population Studies and BNB Consulting. The research, of which the Central Finance and Contracting Unit is the contracting authority, has been realized with the financial support of the European Commission. The aim of this study is to present the prevelance of domestic violence againts women in differenet forms and health consequences by using the results of quatitative study of National Research on Domestic Violence Against Women in Turkey, 2008. - 38 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya National Research on Domestic Violence against Women in Turkey, 2008: The National Research on Domestic Violence against Women in Turkey is the first most comprehensive survey carried out on the domestic violence against women with a nation-wide representativeness, and with the most wide range sample providing information about violence against women on urban and rural settlements, 12 regions and some basic characteristics. Among the surveys done in the world on this subject is also the biggest survey with regard to the sample size and in the context of the method employed (face to face interview technique). As the quantitative phase of the research has been realized by adapting the questionnaire, which WHO has applied in many countries, the results enable us to make international comparison. With the research both the prevalence of the different forms of domestic violence against women has been revealed through the quantitative survey, and information about how women as well as men and some professionals perceive violence has been obtained through the qualitative research. The target population of the research in the 15-59 age groups in Turkey. It meets the need of data with the information it presents about the prevalence of the domestic violence women experience, the forms of violence, the reasons and results, the determination of risk factors and the perception of violence. The methodology of Research on Domestic Violence against Women in Turkey is designed in a way to ensure the gathering of data in the most reliable way possible, which is one of the basic requirements of combating against the issue. In the research, information about physical and sexual violence against women from perpetrators other than husband or intimate partner(s), and childhood sexual abuse has been collected as well. Reliable estimates of prevalences of different forms of violence have been obtained for national level, urban and rural settlements and 12 Region* by utilizing quantitative research methodology. The sample design for Research on Domestic Violence Against Women in Turkey utilized a weighted, stratified and multi-staged cluster sample approach. The major aim of the sample design was to achieve estimates of indicators related to violence against women for the national level as well as the 12 regions and urban/rural strata. In the quantitative study of the research a household questionnaire and a woman questionnaire were used. They were designed according to the requirements of the country, taking the questionnaires of the World Health Organization’s Multi-country Study on Women’s Health and Domestic Violence against Women into consideration. Information on Household population and housing characteristics of the households, background characteristics of women and marriage histories of women, general health and reproductive health, behavioral problems of children, background characteristics and behavioral patterns of the husband/partner, physical and sexual violence, emotional and economic violence/abuse experienced by women during lifetime and in the last 12 months prior to interviews, perpetrated by husband or intimate partner, physical and sexual violence against women by perpetrators other than intimate partners, after 15 years of age, sexual abuse before 15 years of age, attitudes of women towards gender roles and violence, violence during pregnancy and injuries due to violence and the methods of coping with violence by women who experience domestic partner violence were collected. In addition to these, respondents were shown cards with one smiling and one crying face on, and were asked to mark the appropriate one in order to understand whether they been subjected to sexual abuse before the age of 15. In the qualitative stage of the research is to get detailed information about attitudes, beliefs and experiences of women and men. Information on institutions that provide counseling and service to women who have been subjected to domestic violence has also been gathered which could not be obtained from the quantitative component of the research. Information obtained through qualitative research has not only given directions on questionnaire wording, but also has been analyzed. A combination of in-depth and semi-structured interviews and focus groups has been used in the qualitative research. *12 Regions; The NUTS (Nomenclature of Territorial Units) system is a statistical region classification determined for Turkey’s accession to the European Union. There are three different NUTS levels. The 12 regions represent the NUTS 1 level composed of ‹stanbul, West Marmara Aegean ,East Marmara, West Anatolia , Mediterranean, Central Anatolia , West Black Sea, East Black Sea, Northeast Anatolia , Central East Anatolia Southeast Anatolia

- 39 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya During the interviews conducted in Research on Domestic Violence against Women in Turkey, women were asked whether they had experienced certain acts of violence in order to be able to measure the violence the women are experiencing. These acts are: Physical violence against women by husband or partner(s): • He slapped her or threw something at her that could hurt her • He pushed or shoved her or pulled her hair • He hit her with his fist or something else that could hurt her • He kicked her, dragged her or beat her up • He choked or burnt her on purpose • He threatened to use or actually used a gun, knife or other weapon against her Sexual violence against women by husband or partner(s): • He physically forced her to have sexual intercourse when she did not want to • He had sexual intercourse when she did not want to because she was afraid of what he might do • He forced her to do something sexual that she found degrading or humiliating Emotional violence/abuse against women by husband or partner(s): • He insulted her or cursed her • He belittled or humiliated her in front of other people • He scared or threatened her • He threatened to hurt her or someone she cared about Economic violence/abuse against women by husband or partner(s): • He prevented her from working or caused her to quit her job • He was not giving money for household expenses • He deprived her of her income Physical violence against women by non-partners: She was beaten or physically mistreated in any way by anyone other than husband or partner, since the age of 15 years Sexual violence against women by non-partners: She was forced to have sex when she did not want to or to perform a sexual act which she found humiliating or degrading, by anyone (other than husband or partner) since the age of 15 years Childhood sexual abuse: She was exposed to an unwanted sexual act or to sexually disturbing touching before the age of 15 years. The women, who confirmed having been exposed to any of the acts, were asked more detailed questions on when and how frequent the act had happened. Regarding the timing of the act, two different periods were considered: any period in their life and the last 12 months preceding the interview. Findings: According to results of the research, 39 percent of women reported to have experienced physical violence at any time in their lives. In other words, 4 out of 10 women have been exposed to physical violence by their husbands or intimate partner(s). Although there is not a significant variation between type of residence at national level, there is significant variation between regions with regards to experiencing physical violence. The proportions of women experiencing physical violence vary between 25 and 53 among regions. Nearly 1 out of 2 - 40 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya women living in the Northeast Anatolia region reported having been exposed to physical violence. When looking at the 12 months prior to the interview, countrywide 1 in 10 women report physical violence in this recent period.

*Source: National Research on Domestic Violence against Women in Turkey, 2008 The prevalence of sexual violence, like physical violence, displays a significant variation between regions. While in the West Marmara region 9 percent of married women reported sexual violence at any time in their lives, in the Northeast Anatolia region this is 29 percent. For the remaining regions the prevalence varies between 11 and 23 percent. When looking at sexual violence in the last 12 months prior to the interview, we find that nationwide almost half of these women who reported sexual violence ever in their life, do report a recent experience of sexual violence.

*Source: National Research on Domestic Violence against Women in Turkey, 2008 Injuries due to violence: In the National Research on Domestic Violence Against Women in Turkey 2008, women who have experienced physical or sexual violence from their husbands or intimate partner(s) have been asked questions about the injuries occurred due to that violence, the number, severeness and types of the injuries. According to Table 1, one fourth of the ever-married women have reported to have been injured as a result of the physical or sexual violence experienced in Turkey. This ratio is also similar in urban or rural settlements. When regarded according to regions it is seen that the prevalence of injuries due to violence varies between 17.7 percent (East Marmara) and 32.9 percent (Central Anatolia). The prevalence of injuries due to violence among the women living in the Central Anatolia, West Anatolia, Mediterranean and Northeast Anatolia regions is higher compared to women living in other regions. Nearly one out of three women who has experienced violence from her husband or intimate partner, has been injured as a result of the violence experi- 41 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya enced. Whereas the prevalence of injuries due to physical or sexual violence experienced lifetime is 19.5 percent among ever-married women between the ages 15-24, it is 26.8 among the women between the ages 4559. This finding is related with the cumulative increase of lifetime violence experiences from husbands or intimate partners among women in the higher age group.

The women who reported to have been injured due to the lifetime physical or sexual violence experienced from husband or intimate partner(s), have been asked how many times they were injured until the date of the research. In addition, information of whether any of these injuries were severe enough to require treatment was also obtained. Turkey, 57.6 percent of the women injured due to violence have reported to have been injured 3 or more times. One out of 5 women who have been injured due to violence has reported to have been injured more than 5 times (Table 2). Four out of 10 women who have been injured due to violence have reported to have been injured severe enough to require treatment at least once. The findings reveal that injuries due to violence are not coincidental, on the contrary that injuries occur frequently and in severe levels.

- 42 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

When regarding the number of injuries due to the violence experienced with respect to the basic characteristics of women, it is seen that the number of injuries is lower among women with higher education and wealth level. While 43.5 percent of the women with no education/ have not finished primary school who have been injured due to violence have reported to have been injured more than 5 times, the proportion of women with an injury number of more than 5 among the women who have high school or higher education is 19.2 percent (Table 2). For all that, except the women with highest education, injury severe enough to require treatment at least once does not vary according to the education and wealth level of the women.

*Source: National Research on Domestic Violence against Women in Turkey, 2008

- 43 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya The injuries occuring due to acts of physical or sexual violence experienced lifetime occur in different forms. When regarding these forms of injuries, it is seen that in the whole of Turkey the injuries occur most commonly as ‘scratch, graze or bruise’ (66 percent) and ‘tear of eardrum, injury or blackening of eye’ (60 percent) (Figure 3). 17 percent of the women who have been injured due to violence have reported to have been injured in the forms of ‘cuts or grazes’, ‘twisting, dislocation’ and ‘cracks or cuts in the bones’. The high prevalence of severe injuries among the forms of injuries also overlaps with the information collected within the scope of the qualitative research. Women have reported the violence experienced from their husbands or intimate partner(s) to be experienced in severe level during this research as well. More than 7 out of 10 injured women living in the Mediterranean, Northeast Anatolia and Southeast Anatolia regions have reported to have been injured in the form of ‘scratch, graze or bruise’, nearly 6 out of 10 injured women living in the other regions have reported to have been injured in a similar way. In injuries in the form of ‘scratch, graze or bruise’, a certain variation is seen according to the education level of women and the wealth level of the household they live in.

*Source: National Research on Domestic Violence against Women in Turkey, 2008 In the National Research on Domestic Violence Against Women in Turkey, women who have at least one child in school age (between 6-14 ages) were asked whether any of those children were displaying behavioural disorders. The questions asked in relation to the behaviour of the child, were asked before the questions related to domestic violence experienced from husbands or intimate partner(s) so as to ensure to obtain answers without being under effect. In Figure 4, the proportion of behavioural problems of children of women who have experienced physical or sexual violence is given in the whole of Turkey. According to this, behavioural problems are more prevalent in children of women who have experienced violence, than in children of women who have not experienced violence. For example, while in the children of 4 out of 10 women who have experienced violence the behaviour of ‘being aggressive towards the mother or other children’ is seen, this proportion reduces to half among children of women who have not experienced violence. Conclusion: When we focused on physical or sexual violence and general health, it is possible to observe that in Turkey as a whole, mentioning of health condition as “bad or very bad” is twice as common among women who have experienced physical or sexual violence in their lifetime, than it is among women who have never experienced violence. It is seen that this difference exists among women living in urban and rural areas. When regarding in the aspect of region lived in, women who have experienced violence in Northeast Anatolia, Centraleast Anatolia and Southeast Anatolia make negative evaluations about their general health conditions in a higher ratio, than women in other regions. The research has revealed that violence experienced from husband or intimate partner(s) has direct and indi- 44 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya rect negative effects in many aspects on the health of women. As this research is a cross section research, except the injuries, it is not possible to determine whether experiencing violence is the direct reason of women experiencing certain health problems. Nevertheless, when the research findings are studied, it is seen that there may be a strong relation between women experiencing violence and showing symptoms of some physical and mental health problems. Also when the findings are studied according to the settlements and basic characteristics of women, consistent results are revealed indicating the presence of such a relation. Regardless of the settlement and basic characteristics of women, negative reporting about physical and mental health conditions among women who have experienced violence is nearly 2 or 3 times more prevalent than among women have not experienced violence. Likewise, some mental behavioural problems of children between the ages 6-14 whose mothers have experienced violence is seen more prevalent compared to children of mothers who have not experienced violence. Reference: Kad›n›n Statüsü Genel Müdürlü¤ü , 2009, “Domestic Violence Against Women in Turkey (Türkiye'de Kad›na Yönelik Aile ‹çi fiiddet) ISBN:978-975-19-4498-6, KSGM Press. *** Family violence and violence in the partner relationships in the Region of Southeast Europe S. STANKOVIC Family violence is a complex and socially conditioned phenomenon, which has very serious consequences for the individual and at the social level. Coordinated action of medical, governmental and social institutions, as well as permanent education of the general population through media about the appearance of violence in the family, its consequences and the system of legal protection against violence, present the starting point in designing appropriate prevention and repression strategies against family violence. There are no official statistics about the volume and prevalence of family violence, due to failure in registration and report of cases, as committed criminal acts. Family Violence is an endemic phenomenon, and violence against women by their partners is something that cuts all cultural, religious and regional boundaries. For these reasons, the research in the Association of General medical and Family physicians of South East Europe has been organized, with the objectives to observe the representation of violence against women in partner relationship in the countries the members of the Association. During this study an unequal number of registered cases of violence was recorded .The number of patients involved in the studies from different countries, members of the Association was uneven, which was of course affecting the structure of collected data, but the question was, whether this was the only reason of the different prevalence of family violence in these areas? Is the violence in some areas represented in greater percentage, or the population has been sensitive for this problem and there was a greater willingness to speak about this problem? Of course, due to uneven number of patients who were included into study, the possibility of making certain conclusions was not present, but the results of this study are still determined to encourage reflection, sharing experiences and suggestions for standardization of protocols on treatment of victims of violence. During the study, subjects were declared the existence of psychological violence in the majority of all communities, regardless of the number of patients that were surveyed, followed by physical violence, sexual violence and the fear of partner. Different is the readiness of the examinee, to talk about the problem of violence, regardless of them being the victims of violence or not. If in the areas where the women are in a small percentage have come out with the existence of family violence, and at the same time they are in much smaller percentage and are ready to report this problem, to talk to someone. There is a general lack of support and understanding from society, for women the victims of family violence, or maybe the readiness to speak about is connected with the intensity and prevalence of violence in some areas. These questions and the relevance of the given results have been discussed at the round table of representatives of all countries participating in the research. We came to conclusion, it still - 45 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya seems insufficient what has been done in all areas about understanding this problem. There is a large area of ignorance, misconceptions and prejudices among professionals which, within their institutions, should deal with the problem of violence, as well as the whole range of shortcomings in understanding their own role, in the relations and procedures with victims of violence. Although a large number of professionals in institutions that deal with the problem of violence is considering, that the detection and documentation of violence, their scope of work, not in any institution at the local level exist insufficient education on a given topic, as well as specific or well-planned strategy for handling cases of violence, and the problem of violence is left only to the individuals. Such approach does not ensure the necessary support to victims and collection of evidence from the perspective of the potential of taking legal action without the additional application of psychological pain that is secondary victimization of victims. For these reasons it is necessary to provide an adequate professional training to as many employees in these institutions actively and properly involved in the fight against gender violence qualifying. Education of professionals return the confidence into institutions. Training should include the core of the problem-definition, forms and scale of violence, its consequences on victims, how the perpetrators deny and reject responsibility, financial and social costs of violence, specific guidelines for treatment in case of violence, safety assessment and safety planning for victims. It is best if there are no institutional barriers in one area, and if people from these institutions can be linked and if necessary can make personal contact. The multi-sectoral approaches are not automatic and efficient. The prevention of violence will be effective only if the relevant organizations cooperate and coordinate their interventions in an efficient manner. The mediation is a necessary condition for cooperation between institutions and organizations responsible for solving the problem of family violence, exchange of information about competencies and ways of action, knowledge in the responsibility domain (who is addressing whom and what is the issue) always and precise definition of the competence of other institutions and organizations, which in our environment does not exist, and which can be resolved by drafting and signing of cooperation protocols, in which development will participate all representatives from all relevant institutions that have the will and competence to change the existing practice. In all countries, is still widespread opinion that this form of family violence is a private matter and that the state should not interfere, that the woman that causes the tension in the family or relation, and that she therefore deserves violence that occurred, and since women are expected to remain silent about violence because it is her shame and failure, she should remain in the relationship and suffer the violence, according to these opinions, family obligations take priority over the personal rights of women.

Such extreme beliefs are often reflected and argumented, that staying in a violent relation is a need for the "welfare" of children. The conclusion at the round table that other factors affect the willingness of women to continue maintaining silence abusive relationship? Economic dependence, concern for children, the fear of escalation of violence if they charge the partner with violence, or fear that the violent partner will become even worse after the police leave, because the state did not create a system that would provide support to victims and facilitate the search and adequate help? Thus, women victims of violence have little hope for the possibility of survival outside of a violent community, feel helpless and hopeless because they have been blacmailed by partners, oppressive environment and the state, so they chose to stay silent. Despite that in the most countries, family violence is regulated by law sanctioning, a small number of family violence cases has been processed. Usually the problem of violence speaks only when extreme situations occur, the problem of violence at that moment becomes current, then it is forgeten until the next extreme cases. The question that arises whether or not and which country the member of the Association or Europe has an adequate response to this social problem that can serve as a model for others? - 46 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya PANEL 4 (Pa-4) April 24, 2010 / 09:15 – 10:45 / Hall A FM in SEE Management of FM Finance of the team “need and reality” (Güneydo¤u Avrupa’da Aile Hekimli¤i, Aile Hekimli¤i ekibinin mali yönetimi, ihtiyaçlar ve gerçek durum) Moderators: Cahit Özer, Svetlin Mitev Azijada Beganlic Seracettin Çom Elif Altunbafl Slavoljub Zivanovic, Gorica Zafirovska-Pirovska

Primary health care management in Serbia Finance management S. ZIVANOVIC General Practice Specialist & Gerontologist, Serbia The Bismarck Model of Health Care System Pay as much as you can and use as much as you need. Contributions to health care and gross national income have been on the rise in Serbia in the period 20042009. Compared to other European countries contributions per capita in our country have been 282 EUR whereas in Switzerland it is 7000 EUR. Relations: • Insured • Health care providers • Health care institutions • Contributors • Health Insurance Plan Provider Our goal is to accomplish the following results in health care management: • Specific • Measurable • Achievable • Realistic • Time bounding At present time, we have the following: • Health care centres with no information technology implemented • Health care centres that are partially using some applications for specific services only • Health care centres that are currently in system development phase • Health care centres with information systems up to the level of Electronic Medical Records (EMR) in most services and that are covering most of the business processes • Serbian health insurance plan provider has offered help in implementing EMRs. They have indicated what their vision of EMRs would be, however they will rely heavily on the feedback from the profession on how that EMR works in practice, so changes to it will be likely. There will be an open bidding for the project of EMR in Serbia. Once this final version has been selected and approved, the former EMR will be nulled. • Since year 2007, health care centres in Serbia have been using an application of the Health Insurance Plan - 47 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya Provider of Serbia, i.e. the Software for electronic invoice generation, and since 2008 the application for patient registration with preferred general practitioners, all of which is in accordance with the process of ”per capita payment” implementation. • Implementation of these applications will necessarily lead to the need for EMR introduction into the health care system in Serbia. The EMRs would systematically indicate all information relating to patients’ health problems, activities and outcomes, patient demographic and administrative information, as well as all services provided and other information management according to the Law of mandatory reporting of activities of the Republic Health Insurance Plan Provider (RHIPP). • Electronic invoice • A simple application has been provided to all health care centres in Serbia in the year 2007 and is constantly being improved. It enables individual data collection and also reporting to the Republic Health Insurance Plan Provider about the services provided for all insured individuals. This, in fact, represents invoice specifications that are directed from health care centres to RHIPP. • Development of the Unique database of all insured • Central Information Service system • Improvement of the Primary Health Care system software • Software developed within Primary Health Care System project – Not used in all Health Care Centres • EU projects – Ministry of Health /European agency for reconstruction: A. Electronic Medical Records No issues with bylaws. B. Project of “Implementation of payment per capita” In collision with current bylaws. • In the process of defining the ‘per capita’ formula, RHIPP has proposed four categories to be used for classification of selected general practitioners, i.e. respective Health Care Centres. These categories would later on represent elements for contract stipulation between RHIPP and Health care centres through annexed labour agreements, which would subsequently lead to bylaw changes if adopted by the government (which is a long and complicated procedure, as well as uncertain) • It is unclear who the employer would be: RHIPP or the Ministry of Health? Capitation Participation in total: • Rationality 40% • Efficiency 10% • Prevention – quality 10% • Total 100% • 70% of total income is fixed and the rest of 30% is assigned from the four categories (of per capita formula) • The variable part of the income represents the essence of capitation and differentiates between the ones who work more from the ones who work less and also who perform better or worse Patient registration • Firstly, there began a registration process of insured with a preferred physician • All physicians have to register all of their patients again • There is a large number of medical records in physicians’ offices, however only those patients who have signed the new registration forms count in. Other patients who rarely come are considered to have “passive medical records” and therefore do not count. Serbian average number of patients per physician is around 1000. If a physician has less patients than Rationalization • The average monetary value of the drugs prescribed per physician/insured is established by the RHIPP. • Drugs that are exempted from this are: neoplasm, HIV, hormone growth drugs and other expensive drugs. - 48 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya There is a limited list of drugs in this category (suggestion was to exempt all drugs that have the acquisition price of 7,5 EUR or more) • According to the capitation formula if physicians surpass their limit allowed by the RHIPP, there is a repercussion in form of income reduction New physician ID numbers • Every physician will be reimbursed according to contract stipulated with have his/her own records archive or be associated with someone who has order and work integrity. • Evidence of number of patients will be retained at the RHIPP and every Electronic database and the coefficient (calculated in the formula), however formance will not be evident

RHIPP and each physician has to one. This introduces more practice physician will have access to their the ratio between income and per-

Efficiency • Represents ratio between ‘Completed’ to ‘Agreed on’ • Completed – is the norm for the Institute for Public Health • RHIPP calculates expenditure based on real number of working days and hours Prevention-Quality • Number of preventative versus the total number of examinations at institution level, and also for every physician separately. This is the future! • Lower limit of number of examinations will be established, there will be no credits awarded below this limit • There is no upper limit for the number of examinations • Corrective factor according to patient population: 0-1 year of age 3,00 1-6 years of age 1,90 7-18 years of age 0,88 19-49 years of age 0,84 50-64 years of age 1,40 65-74 years of age 2,20 over 75 years of age 3,00 • Number of patients registered with a preferred physician is in accordance with article n. 24 of the Book of regulations on conditions and proceedings in mandatory health insurance. For ranking physicians with respect to patient registration, we have used the number of registered patients compared to number of health insurance cards issued in the community to which that specific health care centre belongs • In general practice, there is a shortage of 4,5% physicians and surplus of 4,7% nurses. Every month we have: • 7 000 000 insured • 20 000 health care workers • 10 000 000 services provided • 5 500 000 prescriptions filled • 300 000 various data Literature: 1. Vukasin Radulovic, Mech.Eng., Republic Health Insurance Plan Provider, Capitation, first step Institute for Health Insurance ) 2. Patient’s electronic medical record in primary health care - Serbia 2008 3. Recommendation for capitation formula in primary health care in the Republic of Serbia 4. Benefits of Electronic health care in Serbia 5. Book of regulations on conditions and proceedings in mandatory health insurance - 49 -

(Republic

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya PANEL 5 (Pa-5) April 24, 2010 / 16:45 – 18:15 / Hall A Hypertension at goal in SEE new guidelines (Güneydo¤u Avrupa’da hipertansiyon tedavisindeki hedefler ve yeni klavuzlar) Moderators: Murat Ünalacak, Dean Klancic ‹smet Tamer; Introduction : How to make guidelines? (Girifl : Klavuzlar nas›l haz›rlanmal›?) Suzana Stankovic; Comparison (Karfl›laflt›rma) Lubomir Kirov; Implementation (Uygulama) Recommendations for antihipertensive treatment S. STANKOVIC The importance of the risk profile assessment and determination of the range values of blood pressure. What are the values of blood pressure that will affect our decision to start pharmacological therapy? It was considered, in the beginning that the diastolic blood pressure, better indicator for the occurrence of cardiovascular disease and depending on the values of diastolic blood pressure the starting point for antihypertensive therapy was determined. Framingham Heart Study showed that systolic blood pressure is a better indicator of cardiovascular risk, and a number of researchers advocated that antihypertensive therapy should be started if the values of systolic or diastolic blood pressure, or both at the same time, were elevated above 140/90 mmHg. Today in diabetics, and people with cerebrovascular diseases, coronary or disease of peripheral arteries, the group with higher range values or normal values of arterial blood pressure, gets a higher importance, which is why the new criteria for the diagnosis of arterial hypertension, means continuous scrolling of borders of recommended values, which is very important primarily from the standpoint of the early start of the treatment and prevention of complications of the disease (diabetes >> Risk Prosedür/ tedavi veya tan›sal test/ inceleme, yap›lmal›/verilmeli Class IIa Yarar>>Risk Prosedür/tedaviyi vermek mankt›kl› veya tan›sal test/inceleme Yap›lmal› Class IIb Yarar?Risk Prosedür/tedavi veya tan›sal test/inceleme, düflünülebilir, yap›labilir Class III Risk?Yarar Prosedür/tedavi veya tan›sal test/inceleme, yap›lmamal›/verilmemeli. Yararl› de¤ildir ve zararl› olabilir. Class Indeterminate (Belirsiz) Çal›flmalar yeni bafllam›fl veya hala çal›flmalar devam etti¤i alan ‹leri çal›flmalar sonuçlan›ncaya kadar herhangi bir tavsiye olmayan (örn: tavsiye veya karfl› görüfl bulunmayan)

- 128 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

WORKSHOPS WORKSHOP 1 (Wo-1) April 23, 2010 / 14:45 – 16:15 & 16:45 – 18:15 / Hall D Alternative medicine tabu and reality (Alternatif t›p : Tabu ve gerçek) Moderator: Rengin Erdal Marco Ephraim

Alternative Medicine: Threat or Challenge? Ignore or Explore? 'Or' or 'and'? M. EPHRAIM Dept of Family Medicine, Primary Health Centre “Therapeuticum Aurum”, Zoetermeer, The Netherlands Patients and doctors worldwide show an increasing interest in 'complementary and alternative medicine' (CAM) or ‘integrative medicine’ (IM). Mean streams are e.g.: natural medicine, acupuncture, anthroposophic medicine, neural therapy and homeopathy. CAM generally aims to recover health by supporting the self-healing capacities and by supporting personal develepment (‘salutogenesis’, Antonowsky). Patients report high patient satisfaction in CAM: Does this rely on specific treatments or specific attitudes? Can more research and integration avoid shopping behavour and delay of good treatment? Integration requires research, training and quality control. From a scientific approach the question should not be if a certain treatment is alternative or not, but if it is (on the way to be) evidence-based or not, and if it is save, applicable, payable. For some research results see e.g.: www.camnetwerk.nl; www.nikim.nl; www.iocob.nl; www.ifaemm.de, www.anthromed.org, www.louisbolk.org/companions. Examples: a Cochrane-study (2008) about the treatment of depression with extract of Hypericum (St.Johns wort) and a double cohort study about the anthroposophic vs. the conventional treatment of acute airway diseases (Hamre, 2005). Integration on an academic level: The Institute of Complementary Medicine (KIKOM, www.kikom.unibe.ch), part of the University of Bern. Anthroposophic Medicine is one example of CAM which is well integrated in conventional medicine (international: www.ivaa.info), practised in some hospitals (example: www.havelhoehe.de) and in many primary health centres (example: www.stlukesmedicalcentre.org). How is it to work as GP in such a centre? The health centre in which I work as GP and GP-trainer will shortly be presented.

- 129 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya WORKSHOP 2 (Wo-2) April 24, 2010 / 09:15 – 10:45 & 11:15 – 12:15 / Hall D Communication, communication skills and interactive way of work (‹letiflim, iletiflim becerileri ve interaktif çal›flma yollar›) Suzana Stankovic Valentina Madjova

Communication skills in medicine V. MADJOVA Department of Family Medicine, Varna Medical University, Bulgaria National Consultant of Family Medicine of Bulgaria What is the meaning of “communication”? • Communicate = to impart, to share (Latin orig.) • Communicating is imparting, conveying or exchanging ideas, knowledge etc. What does the communication mean in medicine? • “Communication is not an “add on” – it is at the heart of patient care!” • “Good communication is difficult: few can master it without special tuition and constant attention to its effectiveness” (Fletcher CM, 1973) • The ability to communicate is by far the most precious skill that a doctor can learn. • It is such a multifaceted art that it is difficult to define what exactly it means, but an aspect of prime importance is the ability to listen. Why is good communication important? • Better care for our patients • Accurate, relevant and comprehensive history-taking and diagnosis • Doctors, trained in communication skills are more likely to diagnose patients’ psychiatric morbidity • Detection emotional distress in patients • Patients’ satisfaction with the care they’ve received • Patients’ compliance with their treatment plan and follow the advice given • Positive effect on the patient’s physical condition-BP

- 130 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya Factors influencing doctor-patient communications are divided into: 1. Patient-related factors: • Physical symptoms • Psychological factors related to illness and/or medical care (anxiety, depression, anger, denial) • Previous experience of medical care • Current experience of medical care 2. Doctor-related factors: • Training in communication skills • Self-confidence in ability to communicate • Personality • Physical factors (e.g. tiredness) • Physiological factors (e.g. anxiety) 3. The interview setting (requirements): • Privacy • Comfortable surroundings • An appropriate seating arrangement 4. Other factors: • The patient’s belief about health and illness • The problem they wish to discuss • Their expectations of what the doctor will do (often based on previous experience) • How they perceive the role of the doctor

Fig.1. Developing a management plan for a patient Beginning the interview • Make a comfortable seating • Greet the patient by name and shake hands, if it seems appropriate • Ask the patient sit down • Explain the purpose of the interview • Say how much time is available • Explain the need to take notes and ask if this is accepted Main part of the interview • Maintain a positive atmosphere, warm manner, good eye contact • Use open questions at the beginning as often as possible (an easy first question) • Listen carefully - 131 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya • • • • •

Be alert and response to verbal and non-verbal cues Facilitate the patient both verbally (“tell me more”) and non-verbally (using posture and head nods) Use specific (focused and closed) questions when appropriate Clarify what the patient has told you Encourage the patient to be relevant

Basic rules in asking questions: 1. Do not: • Ask too many questions and do not allow the patient to tell his (her) story in his (her) own words • Ask questions which are too long, too complicated and confusing • Ask questions in such a way that they may be bias the answers given • Ignore questions which patients may ask 2. Use: • Open questions at the beginning • Focused and closed questions in obtaining specific information • Probing questions to clarify, check accuracy and to help the patient expand on what he/her has said • Simpler language when rephrase a question if the patient do not understand or if his/her answer is unclear 3. Avoid: • Using leading questions • Asking several questions at once: this is confusing • Lack of time for answering the patient Open questions – advantages: • More relevant information can be obtained in a given time • The patient feel more involved in the interview • The patient can express all the concerns and anxieties about his/her problems (this can be missed in closed questions) Disadvantages • The interview may take longer and be more difficult to control • Some of the information may be not relevant • Recording answers may be more difficult Closed questions- limitations: • The information obtained is restricted to the questions asked • The interview is controlled by the doctor who decides the content of the questions • The interviewee has little opportunity to express his/her concerns and feelings • This kind of conducting interview (with closed questions) may make the patient fell frustrated Questions to be avoided: • COMPLEX QUESTIONS – encompass several questions in one and are likely to confuse both the patient and the interviewer • LEADING QUESTIONS – encourage the patient responding to give the answer which the interviewer expects or wants. Listening: • Listening is one of the core skills of good communication • Allow patients to talk without interruption • Effective listening means concentrating on what the patient says • Be alert to verbal and non-verbal cues • To demonstrate your attention use appropriate body language and facilitate comments - 132 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya Active listening: • Gathering and • Understanding • Responding to • Demonstrating

retaining the information accurately the implications for the patient of what is being said verbal and non-verbal signals or cues that you are paying attention and trying to understand

What helps us to listen actively? • Taking notes • Asking the speaker to repeat or clarify parts which are not clear • Checking that the information received is accurate by repeating or summarizing it How to demonstrate an active listening? • Facilitation • Clarification • Reflection • Helping the patient to be relevant • Silence • Summarising NON-VERBAL CUES (BODY LANGUAGE) The meaning of body language is “how to read others’ thoughts by their gestures” (A. Pease) Eye contact • Difficulty in maintaining eye contact may indicate that the patient feels depressed, embarrassed about what he/she is saying, or uninterested in the conversation. • Conversely, excessive eye contact may indicate anger and aggression. Posture • The confident person will sit upright • The patient who feels depressed may sit slouched with head bent forward • The proper posture of the doctor is of great importance, too Gestures • The angry patient may be with clenched fists • The anxious patient wrings his/her hands or taps his/her feet continuously Voice • Tone • Timing • Emphasis on certain words Ending the interview • Summarize what the patient has told • Ask the patient to check the accuracy of what you have said • Ask the patient if you have left out any information which he/she feels is important • Enquire if the patient would like to add anything important • End by thanking the patient The importance of summarising • Allows the doctor to check the accuracy of the patient’s story by providing him/her with an opportunity to - 133 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya correct any misunderstandings • Enables the doctor to review the patient’s story and deduce what else need to be explored. • Allows the doctor to “buy time”, if he/she get stuck and can’t think of what to ask next Gestures in Context

NONVERBAL COMMUNICATION

“Dead fish” and normal greetings

Other factors affecting interpretation: • A man who has a ‘dead fish’ hand shake is likely to be accused of having a weak character. • A man has arthritis in his hands, it is likely that he will use a ‘dead fish’ hand shake to avoid the pain of a strong one. • Persons like artists, musicians, surgeons and those in vocations, whose work is delicate and involves use of their hands, generally prefer not to shake hands, but, if they are forced to do so, they may use a ‘dead fish’ to protect them.

FOLDED ARMS GESTURES Standard Arm-Cross Gesture and Leg lock position

- 134 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya Defensive or Cold?

Seated Body Formations

The Co-operative Position (B1-B2)

CONCLUSION: KEY COMMUNICATIVE SKILLS IN EFFECTIVE INTERVIEW • Questioning (ask appropriate questions) • Listening (listen attentively and demonstrate interest) • Facilitating (help the doctor to continue if you get stuck) • Summerising *** Workshop - What is it about? S. STANKOVIC, V. MADJOVA, M. MOJKOVIC, L. BALOS The workshop means, the specific work method, which emphises the process and the way of work in the presence of the leader who directs the work.The workshops have clearly defined rules that explain it’s working way, by having their own forms and working techniques, as well as the ways of checking the performance success, but what is the most common for each workshop? The workshop includes personal and active commitment of each participant, the communication diversity, respect for diversity, development of tolerance and mutual acceptance, as well as sharing personal experiences and the development of positive authority. Workshop - 135 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya presents the various forms of group discussions, actions or meetings which main component is the self – support or self – affirmation way of work. Since the main goal of the educational workshop, is the knowledge, it is very clear, that talks, actually, about learning. Together with the active method (which means mental and motor activity of participants during the work), the experiential learning method has been used. Shaping personal experience is performed through exchange with the other participants and the group leader, so we talk about cooperative learning. In the workshops we meet “learning by the model”, because the participants have the opportunity to observe the other participants as well as the workshop leaders, in different situations and roles, and thus create a good assumption for correction and formation of your own behavior. Workshop activities usually present the problem solution, while combining convergent (the learning of desired solution) and divergent learning (by encouraging the search for different ways - ways of coming to the solution). When you pass the workshop training and when its basic characteristics are realized, it becomes a part of everyday thinking and it becomes easy applicable in the work. The workshops differ in their content, purpose and age that are intended, so therefore they can be classified. The number of participants that is recommended in a single workshop ranges between 15 and 25. Workshop, as a form of work, can be applied to all ages, with the issue volume, dynamics and organization of activities, adapts to all age differences. One workshop, which includes several activities, usually takes 1 and a half to 2 hours. Workshop is guided by the two leaders at the same time, each sharing the role. Each workshop has a very clear and pre-defined plan - the script, which quality largely determines its success. The essence of the scenario consists: structured activities that occur as a result of specific requests which is introduced by the workshop leader, and are integrated into one theme. The scenario through the concrete requests, directs the personal involvement of participants. A good scenario encourages cooperation, not competition and discrimination. Each workshop runs through several basic stages: • Evocation of personal experience - which in the context of cognitive workshop means bearing the new content throughout your own experience, • Shaping your own personal experience - which is usually concretized through the words; • Exchange - follows the shaping function and has the function of enrichment in personal experience. The exchange conditions have to be provided after each activity. • Processing – as the last phase in which the exchanged and enriched experience converse into knowledge. The role of the leader is especially important here, because it summarizes, generalizes, and meaningfully connects all that is given throughout the work, and ''returns'' to the participants (with an open space for their comment). WORKSHOP TECHN‹QUES AND FORMS OF WORK The workshop scenario should always specify precisely which forms of group work, for example techniques are predicted. Most common work methods in the workshop are: • Exchange in the whole group is the basic form of work that begins and ends in each workshop. Regardless of the exchange form that is usually applied through the workshop the leader at the end summarizes the conversation. The most common forms of practice are the following: • The talk in the circle - a structured exchange in which the participants speak by the sitting row; • The group discussion - less structured exchange in which is very important to ensure that a large number of participants is involved, • Brainstorming – the most creative form of exchange in which participants feel free to associate to an existing topic. The leader encourages as many ideas as possible and records them on the board or panel without the selection and evaluation. The last phase is the organization and processing of what is produced. • Working in pairs or small groups - sometimes it is desirable, and sometimes not, small group members know each other well, which will depend on the content of the activity itself. Keep in mind that during work the group does not interfere with one another, providing an optimal operational group with 3 to 5 members. • It is best to use ''open minded'' questions (How? Why?), which develop the communication. Always be - 136 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya aware of their reactions to the opinions of participants and ensure that all the different experiences are equally accepted (''OK'', ''good''). It is necessary to encourage new ideas and different opinions (''Is there anybody who has a different opinion?'', ''Does anyone wants anything else to add?''). • Encourage passive and uninterested participants in the workshop with a note, that there is no right or wrong answer of solutions. • Workshops are characterized by different techniques that aim to provoke deeper - personal experiences of participants, as well as the organization of these experiences into concrete units. The workshop techniques include: • Guided fantasy - techniques in which participants, in a relaxed atmosphere, and directed by the leader, talk about the imaginary experience that is needed for further elaboration of new content in the workshop. • Sculpture – the media workshop in which participants should express their feelings or their vision problems by placing their partner in appropriate position which expresses his-her idea. • Aquarium – a technique in which, the scenario is in the middle of the circle - so that all participants can see, certain role takes place, that talks about the experience of actors who are in the "scene". It represents a transitional form of work between the small groups and the whole group. • Role Play – a technique that allows the assessment of the situation from another perspective. The participants play different roles and situations and thus they adopt new skills. • Games - can be used independently of the workshop program. They round the whole of the dynamics of the group and must be thematically related to the objective of the workshop. The division of the games in general: • Introductory games that can be divided into: • Introduction Games - the participants has been given the chance to learn more about others in the interesting way; • The relaxation games - introduce the participants to the relaxed state in which they will be ''open'' for the contents offered by the leader. Frequently used for ''warm ups'', for example, the workshop introduction. • Games which divide participants in pairs or small groups - this is the way to avoid the same participant working together all the time. Since these games are often used to activate and wake up the participants, it is especially recommended after long verbal activity; • Final game can be divided into: • Relaxation Games - the main function of these games is relaxation of the participants, cheer them up and leave the workshop in a good mood; • Games on '' closing workshop '' - these games have a function of summary on the workshop topic and settlement of the impression of the workshop; • Evaluation Games - the objective of these games is that leader gives the information about how the participants liked certain activities in the workshop and how to assess them. • Independent Games: These are the games that can be either opening or final games, as well as to serve as a framework for the main activity in the workshop. Workshop rules In any group work the rules are necessary because, they provide stability and "lighter" work in the group. Rules are being introduced at the beginning of the group work and they become the rules of all members. Presenter and participants refer to them whenever they break. The rules are always placed in a visible place so that all may become familiar with them, and must be formulated in a way that describes clear, desirable - 137 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya behavior. Also, should clearly indicate, what will be the consequences, if one of the group members does not comply with the defined rules. Except basic rules, which are being introduced to participants by the leader, the leader can introduce the additional rules, depending on the objectives and content of each specific workshop. The rules may alter with the approval of all of the group members. Authority of the workshop Leader The leader of the workshop supports the development of the authority which main characteristics is the knowledge, which the participant posses in the relation to the topic and to the actual group. The basic question that arises is: "What is it that I want the participants to learn and how shall I accomplish that?” The workshop leader controls the conditions and the environment in which the work takes place, but not the participants themselves, and develops self-discipline and responsibility versus obedience, as well as external motivation of the participants. The objective of the workshop leader is to achieve the participants do not do whatever they want, but that they want what they do. THE WORKSHOP LEADING SKILLS The workshop leading skills are all skills that enable a good atmosphere, acceptance and appreciation of all participants and expressions freedom in a way that suits them all. Since the main objective of the workshop is to encourage participants to personally engage in learning new, interesting ways. This goal can be achieved only in the relaxed acceptance and atmosphere of appreciation. The task of the workshop leader is to provide, an atmosphere in which participants will learn from one another, exchange experiences and where they all will feel comfortable. The leader does not pressure, does not offer pre-finished solution, but helps the participants by guiding them in their independent search for possible solutions. Each solution, no matter how incorrect, has been used as a new learning situation, for example; as a significant example, which may encourage further exchanges within the group. The leader fosters a positive approach and encourages each participant to present his/her own experiences and thoughts and thus the way of work within the group, to respect the participants resistance, if someone does not want to participate in an activity, by listening with particular attention and open mindedness. This is not an easy task and many workshop leaders because of that have higher expectations of themselves, which often leads to bad feelings in situations where the expectations are not fully met. COMMUNICATION SKILLS AS A PREREQUISITE OF EFFECTIVNESS IN WORKSHOP MANAGEMENT Communication that leads to dissatisfaction and conflict During workshop there are different situations in which participants do or say something that the leader of the workshop dislikes. In this situation the leader can react in many different devastating ways for the continuous communication. The safest way to achieve that is to send the “YOU” message: • The solutions messages - offer ready solutions for problems that the other party should, or must accept. • humiliating messages - show the other side in a negative light, challenging his/her character and have a bad influence on self-esteem. • Indirect messages - this group includes jokes, sarcasm, teasing and distracting comments. Often not understandable and have no effect on change in behavior of the person which is addressed. No matter what kind of the “YOU” messages we speak about, these messages usually interrupt the communication with the person to whom they are communicated. The other person hears these messages as compulsory, ordering, labeling.

- 138 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya COMMUNICATION THAT CONNECTS US WITH OTHERS In situations where the leader has a problem and wants to communicate, one way to do this is to clearly state what is in his mind, but in a way that is not accusing, or criticizing and labeling. “I” messages are a call to communication and attempt to resolve the problem and are consisting of four components: • Perception - what we perceive that the other person does, or says, and what bothers us. In this step, it is important to distinguish between the description of the behavior that bothers us and our interpretation of that behavior; • Feelings in relation to what we perceive; • Needs - Recognizing and talking about the needs to communicate, is one of the fundamental difference between “I” and “YOU” messages. Through “YOU” message we announce that something is wrong with someone / others and therefore we feel bad. Through the “I” message we clearly communicate to the people what they do and what bothered us, how do we feel, but we talk about the need that was not satisfied which caused our bad feelings. • Request - the concrete actions that we want to be undertaken so that our needs could be satisfied. Since the “I” messages are not accusatory, offensive and do not assess the other person, the better are the chances that the other side hears us and meet our request. WHEN THE “I” MESSAGES ARE USED IN THE WORKSHOP? The “I” messages are used when the leader has a problem, for example, when participants do something that endangers the leader. In these situations it is very important that leader sends the clear “I” message. Sometimes the problem arises when one participant talks a lot so the other participants do not have the opportunity to say something. In these situations the “I” message puts a clear knowledge to the presenter, to respect the need, of the participants, to talk about something important for him, but it is also important to hear others. In a situation of conflict of opinions, some of the participants can express their disagreement in a way to assess, label and disparage the opinion of others. The leader uses the “I” message to clarify that he dislikes this behavior. Sometimes it happens that the group is calm, not answering questions that leader asked. In these situations leader clearly expresses what is happening within himself as a reaction to the silence and seeks an explanation from the group. Listening Skills In situations when participants have the problem, the leader listens carefully to what happens within them, and thus shows the participants that he understands and accepts. Each person is unique, and has different motivations, experiences and knowledge. Active listening means the attempt to understand the feelings, needs and demands of others. The active listening is to help us with understanding of what the speaker wants to tell us, as well as the feedback that we've heard and understood. In the process of active listening, we register the the messages and feelings that accompany it. Active listening means understanding, not necessarily or relaxation, perseverance of your own needs and requirements.

- 139 -

purpose of to provide content of agreement,

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya Conflicts During workshop may be a conflict between participants or between leader and participants. Each of the above mentioned situations could result in deepening the conflict and it is important that the leader knows how to react in these situations. What is important to know about conflicts? Conflict provides us the opportunity to grow and develop - the conflicts are at the same time the risk, but the opportunity and challenge. There is unnecessarily a "right" solution to the conflict - through work with the conflicts; we learn how to deal with them in a successful manner, which means to test different possible solutions and to choose those which are most adequate in this situation. Often seen compromise, is the best possible outcome of the conflict, however, to compromise, each party thinks that maybe could get more, so that frustration often remains. How to come to the solution, in which both parties gain? The process of coming to solution, in which both parties will be satisfied, consists of six steps. Workshop Evaluation Detailed analyses of the scenario workshops, we will be able to determine: to what extent the workshops were taking place as expected – the evaluation process and what are their effects compared with the set goals – the effect evaluation. This way we shall better observe what is done with the goals for correction and improvement. No matter how much experience we have in the organization and conduction the workshop, the evaluation is necessary. Each workshop has pre - designed and pre - defined scenario. This, however, does not mean that the scenario is not subject to changes, if it has not been proved as good enough. On the other hand, some good workshops, does not have to cause equally good effects in various participants.

- 140 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

ABSTRACTS

- 141 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

- 142 -

2nd Congress of Association of General Practice/Family Medicine of South East Europe (AGP/FM SEE) 22-25 April 2010, Antalya

ORAL OP-1 WHAT DO PATIENTS KNOW ABOUT CANCER? N. OZCAKAR, M. KARTAL, C. ISIKLAR Dept. of Family Medicine, Dokuz Eylul University Medical Faculty, Izmir, Turkey Cancer is a hard issue to discuss for both physicians and patients. However it is essential for patients to be informed about cancer prevention. Our aim was to determine characteristics and cancer prevention knowledge of the patients. The collected data with a questionnaire from 242 patients followed in a Family Medicine Department was analyzed as frequencies and chi-square test by using SPSS 11.0. Of the patients 62.0% were women, mean age was 39.7±11.2 years (18-82). 40.9% of the patients had a family member with cancer. Although they wanted to be informed by their doctors/family physicians (64.5%) mostly had information from media (47.2%). They considered their knowledge low (58.3%) and didn’t think that cancer substantially is a preventable disease (38.3%). After the exclusion of two cancer patients, early diagnosis (87.5%) and screening (86.2%) were generally well-known issues. “Breast cancer occurrence in a family member is not an important risk factor”, “Vaccination can be used for prevention of cervix cancer” and “Early diagnosis of prostate cancer is not important” statements were accepted by 54.5%, 41.2% and 34.6%. Although there was no gender difference for cancer knowledge level women had higher accurate answers for the first two statements (p=0.000). Patients having relatives with cancer remarkably noted higher risk for themselves (p=0.000), their answers for the statements didn’t differ from the others (p values between 0.117-0.770). Cancer prevention has to be discussed with patients to increase awareness and knowledge. Family physicians have a great role in patient education for prevention of cancer. OP-2 ADOLESCENT PREGNANCY: TRENDS, CHARACTERISTICS AND OUTCOMES IN EAST TURKEY 1T. EDIRNE, 2M. CAN, 3R. YILDIZHAN, 3A. KOLUSARI, 3E. ADALI, 4B. AKDAG 1 2 3 4

Dept. Dept. Dept. Dept.

of of of of

Family Medicine, University of Pamukkale Medical Faculty, Denizli, Turkey Forensic Medicine, University of Balikesir Medical Faculty, Balikesir, Turkey Obstetrics and Gynecology, University of Yuzuncu Yil Medical Faculty, Van, Turkey Statistics, University of Pamukkale, Denizli, Turkey

Abstract Objective: To determine the proportion of adolescent births in Van, Turkey, and to identify characteristics and related outcomes. Methods: Mothers who gave birth at three maternity centers in Van, Turkey were chosen randomly and offered a faceto-face questionnaire. Participants were asked for demographic information and pregnancy history. Pregnancy outcomes were obtained from the birth records. Results: Of 1872 mothers who completed the questionnaires, 211 (11.3%) were younger than 19 years. Adolescent mothers showed significantly more inappropriate education for age (82.5% vs. 70.1, p