The determination of infant feeding attitudes among Turkish mothers using the Iowa Infant Feeding Attitude Scale.

OBJECTIVE: To assess whether the Iowa Infant Feeding Attitude Scale is a valid and reliable scale for Turkish mothers, and to assess maternal attitudes toward various aspects of infant feeding. METHODS: This methodological, analytical study was conducted at the obstetrics and gynaecology department of Sakarya Training and Research Hospital, Sakarya, Turkey, from June to August 2015, and comprised mothers of newborn babies. Data was collected using the Turkish version of Iowa Infant Feeding Attitude Scale. SPSS 23 was used for data analysis. RESULTS: There were 391 participants in the study. Five items of the original Iowa Infant Feeding Attitude Scale were excluded due to the low correlation with the scale integrity (Cronbach's alpha=0.67). The total mean score of the mothers was 48.11±6.57. A statistically significant difference was found between the educational status, having social security, what the mothers having other children fed these children in the first 6 months and family types (p=0.05 each). Significant difference was also found between the mothers only breastfeeding and the mothers feeding with mother's milk and formula (p=0.008). CONCLUSIONS: The scale was found to be culturally acceptable, reliable and valid scale for Turkish mothers.

Assessment of resting electrocardiogram, P wave dispersion and duration in different genders applying for registration to the School of Physical Education and Sports - results of a single centre Turkish Trial with 2093 healthy subjects.

BACKGROUND: The 12-lead electrocardiogram shows a broad range of abnormal patterns in trained athletes. The primary end point of this study was to investigate P wave dispersion, and P wave durations and related factors in different genders applying for registration to the School of Physical Education and Sports. METHODS AND RESULTS: From 2006 to 2009, a total of 2093 students - 1674 boys with a mean age of 19.8 plus or minus 1.9 years and 419 girls with a mean age of 19.1 plus or minus 1.8 years - were included in the study. All 12 leads of the resting electrocardiogram were evaluated for P wave dispersion and electrocardiogram abnormalities. Baseline parameters such as age, body weight, body height, and body mass index, as well as electrocardiogram findings such as P wave maximal duration and P wave dispersion, were significantly higher in boys than in girls. Of all the parameters tested with correlation analysis, only gender (p = 0.03) (r = 0.04), body weight (p < 0.001) (r = 0.07), body height (p = 0.004) (r = 0.06), and body mass index (p = 0.01) (p = 0.05) were correlated with P wave dispersion. CONCLUSION: The frequencies of all electrocardiogram abnormalities, P wave dispersion, and P wave maximal duration were higher in boys as compared with girls in an unselected student population applying for registration to the School of Physical Education and Sports; in addition, P wave dispersion was correlated with gender, body weight, body height, and body mass index.

[Postpartum Depression in Fathers and Associated Risk Factors: A Systematic Review]. / Babalarda Postpartum Depresyon ve Iliskili Risk Faktörleri: Sistematik Derleme.

OBJECTIVE: The postpartum period is a process that affects mothers and fathers mentally. In this systematic review, we aimed to investigate the literature on postpartum depression and elucidate the factors associated with depression in fathers/men; and eventually to draw attention to the subject. METHODS: A literature search was conducted between April-May 2019 including qualitative and quantitative research articles published between 2009-2019 in Pubmed, Science Direct, EBSCOhost, Turkish Psychiatric Index and Ulakbim Medical Databases. A total of 18 articles in English (n = 17) and Turkish (n = 1) were included. RESULTS: The majority of studies were quantitative (n=17) and 1 had a qualitative design. 22.2% were carried out in the Americas, 61.1% in Europe and 16.7% in Asia. In 16 of the studies, Edinburgh Postpartum Depression Scale was used to diagnose postpartum depression in fathers, and 4 of them assessed psychometric properties. According to the results of the findings, unemployment, age, economic status and social support were among the factors affecting postpartum depression in fathers. CONCLUSION: Besides the factors affecting the mothers such as age, education, social support, whether the pregnancy was planned, parenting stress, parental stress/sense of competence, quality of the relationship with the spouse, history of depression, number of people living at home; factors such as housing status, economic situation and unemployment affect postnatal depression in fathers. Since there was only one research article from Turkey, we believe that there is a need for research on this subject in our country.

Assessment of P-wave dispersion on 12-lead electrocardiography in students who exercise regularly.

BACKGROUND: P-wave dispersion, an electrocardiographic marker, is an independent predictor of atrial fibrillation. P-wave dispersion is associated with inhomogeneous and discontinuous propagation of sinus impulses. The aim of this study was to investigate P-wave dispersion in students who apply for registration to School of Physical Education and Sports. METHODS: Totally 984 students (810 boys [mean age: 19.8 +/- 2.0 years] and 174 girls [mean age: 19.0 +/- 1.8 years]) who applied for registration to School of Physical Education and Sports with a training history of some years were included in the study. P-wave duration was calculated in all 12 leads of the surface electrocardiography, which were simultaneously recorded. The difference between P maximum and P minimum durations was defined as P-wave dispersion. RESULTS: Age, body mass index (BMI), systolic blood pressure, diastolic blood pressure, P-wave maximal duration, and P-wave dispersion were increased in boys as compared with girls. Of age (P = 0.53), systolic blood pressure (P = 0.42), diastolic blood pressure (P = 0.50), pulse pressure (P = 0.73), gender, heart rate, and BMI tested with univariate linear regression analysis in all subjects; only gender (P < 0.001), BMI (P = 0.01), and heart rate (P = 0.02) were associated with P-wave dispersion (F = 5.16, P < 0.001, R(2)= 0.03). CONCLUSIONS: P-wave dispersion was increased in boys as compared with girls who exercise regularly. P-wave dispersion is affected by gender, BMI, and heart rate in healthy students.

Serum ghrelin levels in children with primary protein-energy malnutrition.

BACKGROUND: Ghrelin, an appetite-stimulating peptide, increases in cachectic conditions. It probably reflects peripheral nutritional status and influences nutrient intake and growth. The aim of the present study was to determine serum ghrelin levels in children with primary protein-energy malnutrition (PEM) and to find if any correlation exists between serum ghrelin levels and the clinical presentation of those patients. METHODS: Twenty-eight children with primary PEM and 10 healthy children were included. Serum fasting ghrelin levels were measured using radioimmunoassay. RESULTS: Mean serum ghrelin level of healthy children and those with PEM were 107.7 +/- 40.1 pg/mL and 141.6 +/- 123.8 pg/mL, respectively (P < 0.001). Ghrelin levels were independent of age and sex (P > 0.05). Ghrelin was negatively correlated with body mass index in healthy children (P < 0.01), but not in those with PEM (P > 0.05). Mean serum ghrelin level of children with moderate malnutrition was higher than that of children with severe malnutrition (199.2 +/- 154.1 pg/mL vs 98.4 +/- 74.3 pg/mL, P < 0.05). Mean serum ghrelin levels of patients with kwashiorkor, marasmic kwashiorkor, and marasmus were 127.9 +/- 97.8 pg/mL, 138.7 +/- 95.8 pg/mL, and 162.3 +/- 185.0 pg/mL, respectively (P > 0.05). CONCLUSION: Serum ghrelin level is higher in patients with PEM, especially in those with marasmus, compared to healthy children. Although this observation suggests that ghrelin helps to fight malnutrition in children, it is obvious that further studies are needed to clarify the exact pathogenetic mechanism regarding this condition.

Breast-feeding duration and childhood acute leukemia and lymphomas in a sample of Turkish children.

OBJECTIVES: Whether breast-feeding is associated with decreased incidence of the lymphoid malignancies in children is uncertain. We evaluated childhood acute leukemia and lymphoma in relation to duration of breast-feeding. METHODS: We investigated this issue in a case-control study comprising 137 patients, aged 1 to 16 years, with acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin or non-Hodgkin lymphoma, in addition to 146 controls matched for age and sex. RESULTS: The median duration of breast-feeding among patients was shorter than that of controls (10 vs 12 months). Patients with ALL and AML had shorter mean breast-feeding duration compared with healthy children (P = 0.001 and P < 0.001, respectively). The shortest mean breast-feeding duration was noted in the children with AML. Breast-feeding for a duration of 0 to 6 months, when compared with feeding of longer than 6 months, was associated with increased odds ratios (ORs) for ALL [OR = 2.44, 95% confidence interval (CI) = 1.17-5.10], AML (OR = 6.67, 95% CI = 1.32-33.69), Hodgkin lymphoma (OR = 3.33, 95% CI = 0.60-18.54), non-Hodgkin lymphoma (OR = 1.90, 95% CI = 0.68-5.34) and overall (OR = 2.54, 95% CI = 1.51-4.26). CONCLUSIONS: Our findings suggest that breast-feeding of more than 6 months is protective against childhood lymphoid malignancies, especially for AML and ALL.

Adolescent immunization rates and the effect of socio-demographic factors on immunization in a cosmopolitan city (ERZURUM) in the eastern Turkey.

OBJECTIVE: Pediatric vaccinations have decreased the incidence and mortality from infectious diseases in children, but adolescents continue to be adversely affected by vaccine preventable disease. The present study was performed to determine the status of adolescents immunization and to investigate the effect of several socio-demographic factors on immunization. MATERIAL AND METHOD: Using the cluster-sampling method, 817 adolescents were selected in 24 high schools (15,000 students) in central district of Erzurum (Turkey). Adolescents were categorized as completely vaccinated, incompletely vaccinated, unvaccinated or vaccination status unknown. RESULTS: Of the 817 adolescents, 6.9% were completely vaccinated, 24.4% were incompletely vaccinated and 64.1% were unvaccinated. The vaccination status of 4.6% of adolescents was unknown. A significantly correlation was seen between the number of siblings, the level of mother and father education, the level of parent's socio-economics status, health insurance and immunization status. CONCLUSION: Our findings indicated a small percentage of adolescents receive all of the recommended vaccine. In immunization programs in Turkey, priority should be given to increase adolescent immunization rate with a middle school and/or adolescents, vaccination.

Seroepidemiology of varicella-zoster virus infection in a cosmopolitan city (Erzurum) in the eastern Turkey.

OBJECTIVE: The aim of the study was to determine VZV seroprevalence under age 30 and to identify the relationship of VZV seroprevalence and several sociodemographic characteristics of the study subjects. The results were presented in order to design a strategy for vaccination against varicella-zoster virus (VZV). MATERIAL AND METHOD: It was planned to include a total of 568 subjects. The sampling method of 30 clusters recommended for field studies was used for selecting subjects of a predetermined number in the rural and urban areas in eastern Turkey. ELISA method was used to examine the blood samples for VZV seropositivity. Age, gender, place of living, educational level, family size and socioeconomic status was investigated in the study subjects. RESULTS: Positive VZV seroprevalence was detected in 78% of 559 subjects. Seroprevalence increased with age. Seroprevalence was 16.67% at the age of 1 year, subsequently increased to 57.58% at the age of 4 years, 70% at the age of 7 years, 92.31% at the age of 10 years and then remained 86.78-96.36% in subjects over the age of 10 years. No association was found between sociodemographic variables studied and prevalence levels of antibodies except for educational level in the 0-14 year group. CONCLUSION: These results suggest that the majority of VZV infections occur during the early childhood; the best option to reduce the circulation of wild type VZV in the population would be the immunization of young children. VZV vaccine should be introduced into the routine childhood vaccination programme in Turkey.

The relationship between maternal attachment, perceived social support and breast-feeding sufficiency.

OBJECTIVE: To determine the relationship between maternal attachment, perceived social support and breast-feeding sufficiency. STUDY DESIGN: Descriptive correlational design. PLACE AND DURATION OF STUDY: A state hospital and two family health centers in Sakarya, Turkey, between June to December 2011. METHODOLOGY: The sample was 122 voluntary mothers who had healthy babies of 1 - 2 months old. The data were collected by a Personal Information Form, Maternal Attachment Inventory (MAI), Multidimensional Scale of Perceived Social Support (MSPSS) and Breast-feeding Self-Efficacy Scale-Short Form (BSES-SF). The data collected were analysed by percentage distribution, mean square, independent sample t-test, Mann-Whitney U, Kruskall-Wallis and Pearson correlation. RESULTS: The mean age of the mothers was 25.01 ± 2.2 years, and 48.4% of them were primary school graduates. BSESSF was 61.02 ± 8.44 (16 - 70), MAI was 99.07 ± 7.19 (56 - 100) and MSPSS was 66.40 ± 13.58 (37 - 84). There was a positive, medium level, significant relationship between the total scores of BSES-SF and MAI (r=0.370, p < 0.001). There was a positive, medium level, significant relationship between the total score of BSES-SF and the score from family subdimension of MSPSS (r=0.255, p < 0.01).There was a positive, medium level, significant relationship between the total score of MAI and the total score of family subdimension of MSPSS (r=0.339, p < 0.001). CONCLUSION: Successful maternal attachment and familial support positively affected the breast-feeding sufficiency of the mother.

Mothers' knowledge and attitudes about HPV vaccination to prevent cervical cancers.

BACKGROUND: Cervical cancer which is one of the most preventable cancers is an important public health problem worldwide, and especially in developing countries. The aim of this study was to determine knowledge and attitudes about the HPV vaccination of mothers with 0- to 18-year old children. MATERIALS AND METHODS: Written approval was taken from the local authorities. The study subjects consisted of 799 mothers who agreed to participate. The data were collected via a "Personal Information Form" which included 30 questions that were prepared by the researchers themselves in line with the literature. The data were collected by face to face interviews with the mothers. Analyses were performed using commercial software. RESULTS: The mean age of the mothers who participated in the study was 32.0 ± 6.52, and 88.1% reported no information about HPV, and 83.5% no information about HPV vaccination. Only 0.7% of the mothers had daughters who had HPV vaccination, and 44.3% of the mothers who had sons were found out to be indecisive about having HPV vaccination. There was a significant corelation between the educational status of the mothers and their knowledge about HPV vaccination (p<0.05). However, there was no significant correlation in terms of economic conditions (p>0.05). CONCLUSIONS: This study suggested that mothers had very little information on HPV and HPV vaccination. Knowledge of the disease and its vaccination is an essential factor for the success of the vaccination program. It is of great importance that mothers are trained in this subject by health professionals.

Turkish parents' management of childhood fever: a cross-sectional survey using the PFMS-TR.

BACKGROUND: To explore Turkish parents' practices in childhood fever management. METHODS: A cross-sectional study with 205 randomly selected Turkish parents of febrile children 6-months to 5-years from the paediatric hospital and two family health centres in Sakarya, Turkey in 2009. Data explored general fever management practices on the 8-item Parents' Fever Management Scale - Turkish version (5-point Liket scale; 1=never to 5=always) and socio-demographics. RESULTS: Parents wanted to know their child's temperature (61.5%), took temperatures (60%), slept in the same room (58.5%) and sought medical advice (53.7%). Non-evidence-based-practices included over-the-counter medications (42.4%); waking children during the night for fever reducing medication (33.2%). Evidence-based-practice ensured febrile children had plenty to drink (30.2%) and febrile children were checked during the night (59%). CONCLUSIONS: Parents' reports indicate high levels of concern about fever, overuse of over-the-counter medications and health services. Practices increase parents' burden of care, are disruptive of family life and lead to parental fatigue. The study confirms the appropriateness and applicability of the fever management instrument, a simple tool to incorporate into assessment of febrile children, in identifying Turkish parents' fever management practice.

P-wave dispersion and P-wave duration in children with stable asthma bronchiale.

OBJECTIVE: P-wave dispersion is associated with inhomogeneous and discontinuous propagation of sinus impulses. The aim of this present study was to investigate the impact of P-wave dispersion in children with stable asthma. METHODS: In this cross-sectional study, the study group consisted of 20 children (12 boys, 8 girls) with stable asthma and mean age of 7.7 +/- 2.0 years. During the study, these patients were treated with low dose inhaled corticosteroids for at least six months. Control group consisted of 20 healthy children matched by same sex and age population. Age, weight, height, echocardiographic values, P-wave maximum duration and P-wave dispersion were compared between asthmatic and healthy children. P-wave duration was calculated in 12-leads of the surface electrocardiography. The difference between P maximum and P minimum durations was defined as P-wave dispersion. The obtained results were compared by independent samples t test and Mann-Whitney U test. Correlations for P-wave dispersion were calculated using Pearson test. RESULTS: P-wave maximum duration is slightly increased in patients with stable asthma (0.092 +/- 0.017 ms) as compared with healthy controls (0.083 +/- 0.011 ms) (p=0.07). We found significant correlation between P-wave dispersion and age (r=0.40, p=0.01), weight (r=0.41, p=0.008) and height (r=0.41, p=0.008). CONCLUSION: P-wave maximum duration is slightly increased and P-wave dispersion is correlated with age, weight and height in children with stable asthma.

Munchausen's Syndrome.

Although the differential diagnosis of hemoptysis is extensive, consideration of a factitious cause is rarely contemplated. Factitious hemoptysis is uncommon in children. We report a dramatic case of factitious hemoptysis in a 12-year-old girl. The features of Munchausen's syndrome are also reviewed.

Celiac disease in childhood: evaluation of 140 patients.

OBJECTIVE: Celiac disease (CD) is a lifelong gluten-sensitive intestinal enteropathy that is multifactorial in its etiology. In the present study, we evaluated basic anthropometric, clinical, laboratory, and histological features of 140 Turkish children with CD. We particularly underscored the association of CD with other autoimmune diseases. MATERIALS AND METHODS: During the period from 1999 to 2005, CD was diagnosed in 140 children according to ESPGAN criteria. The age, gender, clinical findings, hematological, and biochemical parameters at diagnosis were noted. Symptoms and signs were recorded. Endoscopic intestinal biopsies were taken from all children. RESULTS: Of the 140 children with CD, 75 (53.6%) were female, and 65 (46.4%) were male. Mean age was 8.56 ± 4.43 years (range 13 months to 18 years). The most frequent symptom was failure to thrive (81.4%), followed by chronic diarrhea (60%). Of the children with CD, nine (6.4%) had type 1 diabetes mellitus (DM), six (4.3%) had familial Mediterranean fever, three (2.1%) had alopecia areata, three (2.1%) had vitiligo, three (2.1%) had Down syndrome, two (1.4%) had lung tuberculosis, two (1.4 %) had autoimmune hepatitis, two (1.4%) had growth hormone deficiency, one (0.7%) had osteogenesis imperfecta, and one (0.7%) had Floating Harbor Syndrome. Elevated serum levels of ALT, CK and AST were detected in 48(34.8%), 50 (38.2%) and 67 (48.6%) children, respectively. CONCLUSION: The spectrum of clinical findings is very wide. In order to avoid overlooking CD in patients with extra intestinal symptoms and signs, physicians, especially pediatricians, should be informed about new atypical manifestations of CD.

Epidemiological factors affecting hepatitis a seroprevalence in childhood in a developing country.

OBJECTIVE: The aim of this study was to determine the prevalence rate of hepatitis A virus (HAV) and the socio-epidemiological factors affecting HAV among children aged 0-18 years in Eastern Turkey. MATERIALS AND METHODS: The study sample consisted of 226 children aged 0-18 years who were registered at the Pediatrics Department of Atatürk University Medical Faculty for any reason except jaundice between January and May 2002. The presence of anti-HAV immunoglobulin G (IgG) in the children was determined by ELISA. RESULTS: The percentage of HAV IgG seropositivity among the 226 children was 59.7%. We detected an increase of HAV prevalence with age. The prevalence of HAV did not differ significantly in relation to gender. HAV prevalence was higher in children of rural areas than in children of urban and suburban areas (P<0.001). Only two of the 226 children had received the HAV vaccine. The percentage of HAV IgG seropositivity of unvaccinated children was 59.3%. HAV seroprevalence was higher in subjects who had a history of jaundice (84.6%) than in those who did not (58.2%). An increase in HAV prevalence was observed with a decrease in socio-economic status (P<0.001). CONCLUSION: HAV prevalence was markedly high, but HAV vaccination of children was very low in Erzurum. The socio-demographic factors of age, settlement area, and socio-economic status of family were significantly associated with HAV prevalence.

Hyper-CK-emia in pediatric celiac disease: prevalence and clinical importance.

Hyper-transaminasemia (HT) is a well-known laboratory sign of celiac disease (CD); however, hyper-creatine phosphokinase (CK)-emia (HCK) is not so familiar. As there are reported cases of myopathy associated CD in the literature, we aimed to investigate serum CK levels of children with CD. Newly diagnosed 126 children were included. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and CK levels were determined. Mean age was 8.7+/-4.4 years (11 mo to 18 y). Of patients, 77 (61.1%) had classic form, 49 (38.9%) had atypical form. Elevated levels of AST, ALT, and CK, respectively, were found in 65 (51.6%), 45 (35.7%), and 50 (39.7%) patients. Isolated HCK was detected in 9 (7.1%) patients. AST, ALT, and CK were all elevated in 29 (23.0%) children. Mean serum AST, ALT, and CK levels were found as 56.1+/-53.7 U/L (11 to 403), 44.7+/-44.0 U/L (7 to 290), and 258.0+/-686.5 U/L (36 to 5956), respectively. In 95 (75.4%) children, AST/ALT value was greater than 1, and in 19 (15.1%) it was greater than 2. We found positive correlations with the level of CK and AST, and ALT (P=0.01). CK level was inversely correlated with hemoglobin and cholesterol levels (P=0.013 and 0.007). In conclusion, this is the first study, which determined elevated serum levels of CK in CD and demonstrated that HCK is as common as HT in children with CD. We emphasize that HT seen in CD is not necessarily a sign of liver injury, but may also be due to myopathy.

Serum ghrelin levels in children with celiac disease.

OBJECTIVES: Ghrelin, a gastrointestinal hormone, has effects on nutrient intake and growth. Because celiac disease (CD) has intestinal histopathologic alterations and subsequent malnutrition and/or growth failure, we hypothesized that there would be alterations in serum ghrelin levels of those patients. In this study, we aimed to determine serum ghrelin levels in childhood CD, to observe probable alterations under gluten-free diet (GFD), and to see whether there is a relationship between ghrelin levels and the presentation of the disease and/or diet compliance. METHODS: Thirty-six children with CD and 10 healthy children were included. Serum fasting ghrelin level was measured using radioimmunoassay method. After 6 months under GFD, sera of 19 patients were retested for ghrelin level. RESULTS: Mean serum ghrelin levels in children with CD and in controls were 478.2+/-154.6 and 108.3+/-49.1 pg/mL, respectively (P<0.001). Serum ghrelin level was not different in different clinical presentations. Ghrelin was negatively correlated with body mass index, both in healthy children and in children with CD on admission (P<0.01). Ghrelin level was lower after 6 months under GFDcompared with the level detected on admission (P<0.001), but was still higher compared with that of healthy children (P<0.001). Strict diet compliance lowered ghrelin level, although not statistically. CONCLUSIONS: Ghrelin is increased in childhood CD and is responsive to GFD. Further studies are needed to clarify the mechanism underlying its action in CD.