Objective: The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs’ knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse. Materials and methods: The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared. Results: About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant. Conclusion: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject.

Objective: In many countries, medical education programmes are expanding, and educational environments are starting to change from hospitals to primary health care centres. International organizations for medical education highlight that medical students should also be educated at primary and secondary care centres in addition to third-step health care. In this study, the evaluation of sixth-year (final year) medical students’ perspectives on the educational environment of family medicine internship in primary care is presented, using the Dundee Ready Educational Environment Measurement (DREEM) Material and methods: This descriptive cross-sectional study was conducted with sixth-year medical students. Starting in the 2017-2018 academic year, sixth-year medical students started to enrol in educational courses in primary care. A total of 223 students completed internships in primary care for a two-week period, during which we applied the Dundee Ready Educational Environment Measure (DREEM) to evaluate the educational environment at the end of the internship. The collected questionnaires were analysed by using IBM-SPSS version 23 for Mac OS. Student’s t-test and Mann-Whitney U Test were used for comparisons. Results: Of the 223 students, 192 (86%) completed the questionnaire. The total DREEM score was 138.62/200 (%63.5). The students rated the learning environment as positive. The mean score for students’ perceptions of teaching, students’ perceptions of teachers, students’ academic self-perceptions, students’ perceptions of the atmosphere and students’ social self-perceptions were 31.65/48, 30.45/44, 23.46/32, 34.20/48 and were 18.56/28, respectively. The total mean score and subscale scores were not significantly different between males and females. Conclusion: This study suggests that students’ perception of the global learning environment in primary care was more positive than negative. The lowest scores were recorded for Students’ Perceptions of Learning and Students’ Social Self-Perceptions, and the highest score was recorded for Students’ Academic Self-Perceptions.

To assess the prevalence of medication and nutritional supplement use in male Football Super League players and to observe the long term changes of players' attitudes during 5 years period (4 seasons). Retrospective study. Review and analysis of 4176 doping control forms -declaration reports- about players' medication intake including; Super League, UEFA Cup and the UEFA Champions League matches. Team physician was asked to document all medications and nutritional supplements taken by the Football Super League players in the last 72 hours before each match. A total intake of 5939 substances were documented, of which almost half 49.2% (n=2921) were classified as medications and 50.8% (n=3018) were nutritional supplements. The average consumption per player was 1.42 substance/match; 0.70 were medications and 0.72 of nutritional supplements. The supplements used most frequently were NSAIDs 24.6% (n=1460) accounting for almost one in four of all reported supplements. Diclofenac Sodium was the most frequently reported active pharmaceutical ingredient. Second most frequently used supplements were vitamins (22.2%). The average drug consumption reported per player has been increasing every passing year. It was 0.7 substance/match/player (0.4 medication; 0.3 nutritional supplement) in 2003-2004 season; was increased to 1.8 substance/match (0.8 medication; 1.0 nutritional supplement) in 2006-2007 season. The trends seen in this survey point to an overuse of NSAIDs and vitamins in comparison with other medications, amoung Turkish Super League football players (p<0.001). The use of NSAIDs has increased but the medication groups did not differ significantly between seasons, in terms of distribution. This increasing use of medications especially of non-steroidal anti-inflammatory drugs and nutritional supplements is alarming and needs to be argued.

Giriş Aile hekimleri yaş, cinsiyet ve rahatsızlık ayrımı yapmaksızın tıbbi bakım arayan her bireye sürekli ve kapsamlı tıbbi bakım sağlamadan sorumudurlar.

Sacral stress fractures are rare injuries among professional and amateur athletes and are considered to be an uncommon source of low back pain. These type of fractures are mainly seen in competitive, high-impact sports, most commonly in long-distance runners. Sacral stress fractures are usually overlooked in young patients presenting with low back pain without any trauma history. Diagnosis of sacral stress fractures is often delayed because the history and physical examination of these patients are not specific and conventional radiographic images are frequently inadequate. A high index of clinical suspicion and further radiologic imaging such as MRI utilization can provide the accurate diagnosis. The treatment mainly includes rest, pain control, nutritional support, and biomechanical optimization. Herein, we report the case of a woman amateur golf player with a sacral stress fracture who complained of aggravating low back pain. To the best of our knowledge, this appears to be the first report of a sacral stress fracture in a golf player and also the first case of this pathology in low-impact sports. Therefore, physicians should keep in mind that stress fractures can also be seen in low-impact sports. We recommend considering stress fractures in the differential diagnosis of non-traumatic, aggravating low back pain in golfers.