An evaluation of quality of life of mothers of children with enuresis nocturna.

The aim of this study was to evaluate the impact of enuresis nocturna on quality of life of the mothers. Mothers who have a child with monosymptomatic nocturnal enuresis (n=28) and mothers who have a child without any health problems (n=38) were enrolled in the study. Groups were in balance for background variables (child's age, gender, and number of siblings; mother's age, marital status, highest year of education completed, and occupation; presence of health insurance; and type of residence). Short-Form Health Survey (SF-36) Questionnaire, the Beck Depression Inventory (BDI), and Spielberg's State-Trait Anxiety Inventory (STAI) were applied to all mothers. The mothers of children with enuresis had significantly lower quality-of-life scores in the SF-36 for the bodily pain (p=0.015) and role emotional (p=0.014) subscales. We observed significant difference between groups according to BDI; mean score was higher in mothers who have a child with enuresis nocturna (p=0.017). There was no significant difference between groups according to the STAI. Significant differences according to bodily pain and role emotional subscales of SF-36, and the BDI scores, show that the mothers were negatively affected by having a child with monosymptomatic nocturnal enuresis.

Frequency and characteristics of mongolian spots among Turkish children in Aegean region.

Mongolian spots, which are benign congenital lesions observed in the first years of life, can cause distress for parents due to aberrant localization as well as unexpected number and size. Therefore, efficient differential diagnosis is necessary. The aim of this study was to determine the frequency and characteristics of mongolian spots in 1-12-month-old children in a west Anatolian city and to evaluate parental approach to these lesions. The study included 924 children who presented to Ege University Hospital Healthy Child Outpatient Department between January and August 2003. A questionnaire was applied to the families while all children were examined scrupulously for the presence of mongolian spots. The frequency of these lesions in the study population was determined to be 26%; this rate was 20% and 31% in boys and girls, respectively. No lesion was detected in blond-haired children; however, it was detected in 47% of brunettes. Most common localizations were lumbosacral, gluteal, and back, though knee, scalp and feet were also encountered. Upon questioning, most parents stated it was a birth mark; however, 10% accepted to consult a doctor about the issue. In conclusion, identifying mongolian spots and informing parents are essential to strengthen the family-doctor relationship.

Interaction of two public health problems in Turkish schoolchildren: nutritional deficiencies and goitre.

OBJECTIVE: The aim of the present study was to determine the interaction of and association between frequency of goitre detected by palpation, nutritional status evaluated by anthropometric indices and socio-economic status in school-aged children. SUBJECTS: One thousand and eighteen prepubertal and pubertal children (aged 6-14 years) attending primary schools in an urban area were included in this study. DESIGN AND SETTING: All subjects were evaluated for the presence of goitre and nutritional status. Thyroid size was assessed using the World Health Organization's (WHO) palpation system (1960). Severity of protein-energy malnutrition (PEM) was based on WHO criteria. Children were grouped into four categories of socio-economic status. RESULTS: Eight per cent of children were detected to have goitre by palpation. Body mass index and weight-for-height were significantly lower in children who had palpable goitre than in children who did not have goitre (P<0.05). Frequencies of having palpable goitre and being stunted and underweight were especially higher in children with very low socio-economic status (P=0.016, 0.01 and 0.01, respectively). Frequency of being stunted, underweight and wasted in children with palpable goitre did not change significantly according to socio-economic status (P>0.05). In logistic regression analyses, the most important factor in detection of palpable goitre was socio-economic status (B=0.517, P=0.004). Fathers' education and occupation were found to be most significant (P=0.031 and 0.020, respectively). CONCLUSION: Children detected to have palpable goitre were thinner. However, nutritional disorders were not more frequent among children with palpable goitre compared with children without goitre. Goitre and nutritional deficiencies were more common in children with lower socio-economic status but the frequency of nutritional disorders in children with palpable goitre did not change according to socio-economic status.

Evaluation of association between hepatitis A and Helicobacter pylori infections and routes of transmission.

Previous research about coexistence of Helicobacter pylori (HP) and hepatitis A virus (HAV) infections and the factors that increase their prevalence has suggested that the route of transmission of HP infection includes oral-oral and water-foods as well as the fecal-oral route. The aim of this study was to evaluate the routes of transmission of HP by comparing the seroprevalences of HP and HAV in children. One hundred and two children aged 1-18 years living in rural and urban regions of Izmir were included in this study. Anti-HP IgG and anti-HAV IgG antibodies were measured via enzyme immunoassay method. Seropositivities for HP and HAV were 56.8% and 51.9%, respectively. Seroprevalence for both infections increased with increasing age. However, a significant difference could not be detected between rural and urban areas. Sex did not have a significant effect. There was no infection in 22.1% of children, while 30.8% had both of the infections. 21.1% were positive only for HAV while 26% were positive only for HP. No significant correlation between seroprevalences of HP and HAV was detected. This study suggests the existence of various other routes of transmission of HP apart from the fecal-oral route.

Parental presence during invasive procedures and resuscitation: attitudes of health care professionals in Turkey.

OBJECTIVES: An agreement among physician, nurse, and family on the issue and a solution developed by all will improve the quality of work. The aims of this study were to determine health care professionals' (physicians and nurses) attitude toward parental presence during invasive procedures and toward parental participation in this decision and to investigate the difference between the approach of physicians and nurses. METHODS: This study was performed on the physicians and nurses of the Medical Faculty of the Department of Pediatrics of Ege University between December 2003 and March 2004. The questionnaire delivered was completed by 49 (94%) of 52 nurses and 51 (89%) of 57 physicians. RESULTS: Parental presence during blood sampling, simple wound repair/suture, lumbar puncture, and bone marrow aspiration/biopsy was approved by 72.5%, 27.5%, 66.7%, and 82.4% of the physicians and 53.1%, 57.1%, 81.6%, and 85.7% of the nurses, respectively. None of the health care professionals preferred parents to attend during any kind of resuscitation. Attitudes of the nurses and physicians were found to be similar between the 2 groups except for simple wound repair. Major determinants of the decision about the agreement for parental presence were procedural invasiveness for physicians (reported by 82.5%) and level of sedation for nurses (reported by 75.5%). The mean ages of both groups of health care professionals who did not approve parental presence during invasive procedures were lower than that of the ones who approved for all procedures. CONCLUSION: The physicians and nurses in the study population tended to prefer parents not to be present during procedures as the level of invasiveness increased. An agreement between the attitudes of physicians and nurses toward parental presence during invasive procedures is essential for improving quality of service, especially in the dynamic environment of the emergency department.

Evaluation of voiding dysfunctions in children with chronic functional constipation.

There are controversial results about the role of dysfunctional bowel emptying in disorders of the urinary tract like urinary tract infection (UTI), vesicoureteral reflux (VUR) and enuresis. Constipation may cause UTI, enuresis and VUR due to the uninhibited bladder contraction. The aim of this study was to investigate the frequency of nocturnal enuresis, UTI and instability symptoms in chronic functional constipation (CFC). This study included 38 children with CFC and 31 children as the control group. Detailed past and present history of UTIs or symptoms pointing to this diagnosis, enuresis, encopresis, urgency and urge incontinence was obtained from both groups as well as the family history of UTI. Urinalysis, urine culture and stool parasite analysis as well as abdominal ultrasonography were performed on both groups. Age range of the children with CFC was 6-192 months (mean +/- standard deviation (SD) 63.5 +/- 51 months); that of the control group was 4-180 months (mean +/- SD 82 +/- 46.2 months). Frequency of UTI and urgency was significantly higher in the CFC group. However, frequencies of urge incontinence, nocturnal enuresis, and genitourinary abnormalities were not different between the two groups. In conclusion, risk of UTI and urgency is increased in CFC, but that of other voiding dysfunctions like urge incontinence do not change significantly. Therefore, we suggest that UTI and urgency should be questioned in children with CFC and vice versa.

A very rare cause of recurrent apnea: congenital nasopharyngeal teratoma.

A three-month-old girl patient born at the 37th week of gestation as one of twins was admitted to our hospital with cardiac arrest. There was past medical history of multiple hospitalizations with symptoms of cyanosis, respiratory distress, and frequent and severe attacks of apnea since her birth. On nasopharyngeal computerized tomography a mass (25x24 mm) occupying the right side of the nasopharynx was detected. The pathological evaluation of the excised mass revealed benign teratoma. After the removal of the nasopharyngeal mass under general anesthesia, respiratory distress and attacks of apnea disappeared completely. In every neonate with unexplained stridor and recurrent apnea, beside the common causes like respiratory distress syndrome, sepsis, and asphyxia, the possibility of oropharyngeal and nasopharyngeal mass should be kept in mind.

Mothers' attitudes towards their own presence during invasive procedures on their children.

This study assessed of the preferences 742 mothers regarding their own presence during invasive procedures performed on their children. The relationships between socio-demographical characteristics and preferences of the mothers and disease characteristics of the children were examined. A mother's desire to be present was found to increase with decreasing invasiveness of the procedure as well as with increasing analgesia and sedation provided. The desire to be present was higher in young mothers with higher socio-economic levels and educational backgrounds, with younger children and with children who had undergone prior recurrent interventions. This study demonstrated that most of the mothers preferred to be present during the procedure, and that the ratio of mothers willing to do so increased significantly if the children were sedated. The results suggested that pediatricians can improve the quality of service and physician-patient-family relationship by taking mothers' preferences into consideration.

A generally neglected threat in infant nutrition: incorrect preparation of infant formulae.

Breast milk is the most appropriate food for infants. At least 4-6 months of breast feeding is sufficient for all babies if appropriate growth is monitored monthly. However, for those infants unable to breast-feed sufficiently or at all, formula can be given as an alternative. However, serious health problems such as hypernatremic dehydration, malnutrition, and obesity may develop if powdered formula is not appropriately prepared. In the present study, our aim was to investigate whether or not mothers of formula-fed babies in Ozkanlar (Izmir, Turkey) district prepared powdered infant formula appropriately. For this purpose, we visited all (328) families with infants younger than 12 months of age. Forty-two (13%) of these 328 infants were still fed formula. The mothers of the infants were asked to prepare formula for two different meals, and duplicate samples from each prepared formula were taken for the measurement of dry matter. Fifty percent of the mothers diluted formula with 10% more or 10% less water for the second meal as compared with the first meal. Four (10%) mothers diluted formula with 10% or less of the required water, while 27 (64%) prepared formula with 10% or more of the required water. It is concluded that mothers must be informed about the preparation of formula when formula is prescribed for their babies.