Prevalence of multiple non-communicable diseases risk factors among adolescents in 140 countries: A population-based study.

Background: Modifiable non-communicable disease (NCD) risk factors are becoming increasingly common among adolescents, with clustering of these risk factors in individuals of particular concern. The aim of this study was to assess global status of clustering of common modifiable NCD risk factors among adolescents. Methods: We used latest available data from nationally representative survey for 140 countries, namely the Global School-based Student Health Survey, the Health Behaviour in School-Aged Children and the longitudinal study of Australian Children. Weighted mean estimates of prevalence with corresponding 95% confidence intervals of nine NCD risk factors - physical inactivity, sedentary behaviour, insufficient fruits and vegetable consumption, carbonated soft drink consumption, fast food consumption, tobacco use, alcohol consumption and overweight/obesity - were calculated by country, region and sex. Findings: Over 487,565 adolescents, aged 11-17 years, were included in this study. According to trend analysis, prevalence of four or more NCD risk factors increased gradually over time. Prevalence of four or more NCD risk factors was 14.8% in 2003-2007 and increased to 44% in 2013-2017, an approximately three-fold increase (44.0%). Similar trends were also observed for three and two risk factors. Large variation between countries in the prevalence of adolescents with four or more risk factors was found in all regions. The country level range was higher in the South-East Asia Region (minimum Sri Lanka = 8%, maximum Myanmar = 84%) than Western Pacific Region (minimum China = 3%, maximum Niue = 72%), European Region (minimum Sweden = 13.9%, maximum Ireland = 66.0%), African Region (minimum Senegal = 0.8%, maximum Uganda = 82.1%) and Eastern Mediterranean Region (minimum Libya = 0.2%, maximum Lebanon = 80.2%). Insufficient vegetable consumption, insufficient fruit consumption and physically inactivity were three of the four most prevalent risk factors in all regions. Interpretation: Our results suggest a high prevalence of four or more NCD risk factors in adolescents globally, although variation was found between countries. Results from our study indicate that efforts to reduce adolescent NCD risk factors and the associated health burden need to be improved. These findings can assist policy makers to target the rollout of country- specific interventions. Funding: None.

Modified Checklist for Autism in Toddlers Revised (MCHAT-R/F) in an Urban Metropolitan Sample of Young Children in Turkey.

The study assessed the feasibility of using a Turkish-version of the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R/F) as a screening tool for an urban low risk population of young children. M-CHAT-R/F was completed for 6712 children between ages 16 and 36 months living in Istanbul, Turkey. Autism Diagnostic Observation Schedule-2 was served as the main measure for diagnosis. M-CHAT-R/F screen was positive for 9.8% of children. At follow up interview, 39.7% of initial screen-positive children met criteria for ASD. The study identified 57 (1 in 117) children with ASD (0.8%; 95% CI 0.063-1.05%). M-CHAT-R/F performed comparably in Turkey as in United States. Implications of the study for future universal screening for autism in Turkey is also discussed.

A COMPARATIVE ANALYSIS OF BIOETHICAL ISSUES FROM VIEW POINTS OF RELIGIOUS AFFAIRS ADMINISTRATION IN TURKEY, ROMAN CATHOLICISM AND ORTHODOX JUDAISM.

The arguments set forth by religious authority are important since they play a crucial role in shaping the social values of the public and influence the decision of individuals in practice pertaining to bioethical issues. The Religious Affairs Administration (RAA) was established at the inception of the Republic of Turkey in 1924 to guide religious considerations moving out of the Ottoman caliphate to a secular bioethical framework. In this article, the bioethical views of the RAA under Islamic tradition is examined and contrasted with those influenced by the Roman Catholic and Orthodox Judaic traditions. On bioethical deliberations related to the beginning and end-of-life, all three religious traditions justify sacredness of life and that of God's will in its preservation it. Assisted reproduction techniques between spouses is considered to be appropriate, although third party involvement is explicitly forbidden. Organ transplantation is approved by all three religious traditions, except uterine transplantation. Contraceptive practices are approved under certain conditions - views differ most on approaches to contraception and the appropriateness of methods. The RAA judgement on cloning is to prohibit it, like Roman Catholicism and Orthodox Judaism. In other topics, cosmetic surgery and gender determination are approved only for treatment.

A comparative analysis of bioethical issues from view points of religious affairs administration in Turkey, Roman Catholicism and Orthodox Judaism / Análisis comparativo de temas bioéticos desde el punto de vista de la Administración de Asuntos Religiosos, la iglesia católica romana y la judía ortodoxa en Turquia / Análise comparativa de questões bioéticas do ponto de vista da Administração de Assuntos Religiosos, Igreja Católica Romana e Judaísmo Ortodoxo na Turquia

Abstract: The arguments set forth by religious authority are important since it play a crucial role in shaping the social values of the public and influence the decision of individuals in the practice pertaining to bioethical issues. The Religious Affairs Administration (RAA) was established at the inception of the Republic of Turkey in 1924 to guide religious considerations moving out of the Ottoman caliphate to a secular bioethical framework. In this article, the bioethical views of the RAA under Islamic tradition is examined and contrasted with those influenced by the Roman Catholic and Orthodox Judaic traditions. On bioethical deliberations related to the beginning and end-of-life, all three religious traditions justify sacredness of life and that of God's will in preservation it. Assisted reproduction techniques between spouses is considered to be appropriate, although third party involvement is explicitly forbidden. Organ transplantation is approved by all three religious traditions, except uterine transplantation. The contraceptive practices are approved under certain conditions - the views differ most on approaches to contraception and the appropriateness of methods. The RAA has judgement on cloning is to prohibit it, like Roman Catholicism and Orthodox Judaism. In other topics, cosmetic surgery and gender determination are approved only for treatment.

Resumen: Los argumentos expuestos por autoridades religiosas son importantes ya que juegan un rol crucial en la formación de valores sociales de las personas e influyen en las decisiones individuales en la práctica en temas bioéticos. La Administración de Asuntos Religiosos (AAR) se estableció en el inicio de la República de Turquía en 1924 para guiar consideraciones religiosas desde el califato Otomano hacia una estructura bioética secular. En este artículo, se examinan los puntos de vista bioéticos de la AAR bajo la tradición islámica y se contrasta con aquellos de la tradición Católica Romana y la Judía Ortodoxa. En la deliberación bioética sobre el comienzo y el final de la vida, las tres tradiciones religiosas justifican que la vida es sagrada y que es la voluntad de Dios preservarla. La reproducción asistida entre esposos es considerado apropiada, aunque la participación de un tercero es explícitamente prohibido. Las tres tradiciones religiosas aprueban el trasplante de órganos, excepto el trasplante de útero. Las prácticas anticonceptivas se aprueban bajo ciertas condiciones -los puntos de vista difieren en su mayor parte en la forma de aproximarse y en la propiedad de los métodos. AAR juzga la clonación y la prohíbe, así como el Catolicismo Romano y el Judaísmo Ortodoxo. En otros temas, la cirugía cosmética y la determinación de género se aprueban solo para tratamiento.

Resumo: Os argumentos estabelecidos por autoridades religiosas são importantes uma vez que eles desempenham um papel crucial na formação de valores sociais na população e influenciam a decisão dos indivíduos na prática referentes às questões de bioéticas. A Administração de Assuntos Religiosos (AAR) foi criada na concepção da República da Turquia em 1924 para guiar considerações religiosas, deslocando-se do califado otomano para uma estrutura bioética secular. Neste artigo, as perspectivas bioéticas da RAA sob tradição islâmica são examinadas e contrastadas com aquelas sob influência da Igreja Católica e de tradições judaicas ortodoxas. Sobre deliberações bioéticas relacionadas com o início e o fim da vida, todas as três tradições religiosas justificam a sacralidade da vida e que a vontade de Deus está em sua preservação. Técnicas de reprodução assistida entre cônjuges são consideradas adequadas, embora o envolvimento de terceiros é explicitamente proibido. Transplantação de órgãos é aprovada por todas as três tradições religiosas, exceto transplante uterino. As práticas contraceptivas são aprovadas sob certas condições - os pontos de vista diferem em abordagens sobre a contracepção e a adequação dos métodos. A decisão da AAR a respeito da clonagem é a sua proibição, assim como no catolicismo romano e no judaísmo ortodoxo. Em outros tópicos, cirurgia plástica e a determinação de gênero são aprovadas somente para tratamento.

Three-item Direct Observation Screen (TIDOS) for autism spectrum disorder.

We compared ratings on the Three-Item Direct Observation Screen test for autism spectrum disorders completed by pediatric residents with the Social Communication Questionnaire parent reports as an augmentative tool for improving autism spectrum disorder screening performance. We examined three groups of children (18-60 months) comparable in age (18-24 month, 24-36 month, 36-60 preschool subgroups) and gender distribution: n = 86 with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) autism spectrum disorders; n = 76 with developmental delay without autism spectrum disorders; and n = 97 with typical development. The Three-Item Direct Observation Screen test included the following (a) Joint Attention, (b) Eye Contact, and (c) Responsiveness to Name. The parent Social Communication Questionnaire ratings had a sensitivity of .73 and specificity of .70 for diagnosis of autism spectrum disorders. The Three-Item Direct Observation Screen test item Joint Attention had a sensitivity of .82 and specificity of .90, Eye Contact had a sensitivity of .89 and specificity of .91, and Responsiveness to Name had a sensitivity of .67 and specificity of .87. In the Three-Item Direct Observation Screen test, having at least one of the three items positive had a sensitivity of .95 and specificity of .85. Age, diagnosis of autism spectrum disorder, and developmental level were important factors affecting sensitivity and specificity. The results indicate that augmentation of autism spectrum disorder screening by observational items completed by trained pediatric-oriented professionals can be a highly effective tool in improving screening performance. If supported by future population studies, the results suggest that primary care practitioners will be able to be trained to use this direct procedure to augment screening for autism spectrum disorders in the community.

Total exposure duration and proximity of cessation of cannabis use predict severity of sub-clinical psychotic symptoms among former users.

In a non-clinical military enrolment setting, former cannabis users (N=81), compared to substance-naïve controls (N=132), endorsed markedly elevated rates of schizotypy subscale scores on the Schizotypal Personality Questionnaire (SPQ). Total duration of exposure and proximity of cessation of cannabis use also had an important impact on the severity of psychosis-like symptoms.

Association of hypomelanotic skin disorders with autism: links to possible etiologic role of vitamin-D levels in autism?

Vitamin D is crucial for several key physiological processes, including brain development, DNA repair, and regulation of many genes. Much evidence indicates prenatal and early postnatal vitamin-D deficiency increases autism risk, probably through multiple effects, including impaired brain development and increased de novo mutations. High autism rates in several genetically based hypomelanotic skin disorders are puzzling, because ultraviolet-B radiation (UVB) in sunlight acting on skin is a key source of vitamin-D, and lighter skin protects against vitamin-D deficiency, especially at high latitudes. We consider two hypotheses to help explain autism's co-morbidity with hypomelanosis. 1) Because genetic and epigenetic variants that produce hypomelanosis help protect against vitamin-D deficiency, they increase reproductive fitness of individuals who also have other autism risk factors. 2) Hypomelanotic children have increased autism risk because photosensitivity and skin-cancer concerns lead families to excessively reduce children's sun exposure. Hypothesis testing could involve studies comparing genomes, epigenetic markers, skin pigmentation, and vitamin-D levels in autistic individuals with and without hypomelanosis, their relatives and controls. Conducting such studies in samples from regions that differ widely in UVB availability would provide particularly valuable data. Support for either hypothesis would elucidate vitamin-D's role in autism and suggest vitamin-D enhancement may aid treatment and prevention of autism.

Associations of hypomelanotic skin disorders with autism: Do they reflect the effects of genetic mutations and epigenetic factors on vitamin-D metabolism in individuals at risk for autism?

Vitamin D is crucial for full functioning in many genes, and vitamin-D deficiency interferes with many processes, including brain development and DNA repair. Several lines of evidence suggest that prenatal and early postnatal vitamin-D deficiency increases risk for autism, probably through multiple effects that include impaired brain development and increased de novo mutations. High rates of autism in several genetically based hypomelanotic skin disorders present a puzzle, because ultraviolet-B (UVB) radiation acting on skin is the major natural source of vitamin D, and lighter skin, which increases UVB penetration, helps protect against vitamin-D deficiency, especially at higher latitudes. Understanding autism's association with hypomelanosis may elucidate autism's etiology. We consider two hypotheses that may help explain autism's association with hypomelanotic disorders. Hypothesis 1) Because genetic and epigenetic variants that produce hypomelanotic conditions may help protect against vitamin-D deficiency, especially at higher latitudes, these variants may tend to decrease mortality - and increase the fertility - of individuals who also carry genetic or epigenetic factors that increase vulnerability to autism. Hypothesis 2) Children with hypomelanotic conditions will be more likely to develop autism, because children's photosensitivity and parental concerns about sunburn and skin cancer lead them to excessively reduce children's sun exposure and resultant vitamin-D levels. One approach to testing these hypotheses would involve comparing the genomes, epigenetic markers, skin pigmentation, and serum and brain levels of the active form of vitamin D in autistic individuals, with and without co-morbid hypomelanoses, as well as in their relatives and controls. Because availability of UVB radiation varies widely around the world, epidemiological and genetic studies of the co-morbidity in different regions would provide complementary means of testing the hypotheses. If test results support either hypothesis, they will add important evidence for an etiologic role of vitamin-D deficiency in autism, as well as supporting investigation of whether vitamin-D enhancement may aid treatment and prevention of autism.

Mental health of adolescents reared in institutional care in Turkey: challenges and hope in the twenty-first century.

The objectives of the study are (i) to describe and compare the epidemiology of emotional/behavioral problems and associated risk/protective factors among nationally representative samples of institutionally reared and similarly aged community-based adolescents brought up in their natural homes by means of youth self-reports, caregiver/parent, and teacher informants; and (ii) to identify mental health service needs and utilization. A cross-sectional survey was conducted between November 2005 through April 2006 using an equal probability cluster sample of 11-18 year old adolescents in institutional care settings (N = 350; 163 males, 187 females) and results were compared with similarly aged community sample of youth living in their natural homes (N = 2,206). The Sociodemographic Information Form, Youth Self Report (YSR), Child Behavior Checklist (CBCL) by caregivers for institutional sample and parents for the community sample, and Teacher's Report Form (TRF) were used to obtain standardized data on demographic characteristics, emotional/behavioral problems, and risk/protective factors. The prevalence of problems behaviors by YSR, caregiver/parent CBCL, and TRF were: 47, 15.1, 20.5% for the institutional versus 10.1, 7.5 and, 9.5% for the community samples, respectively (p < 0.05). Youth self-reports were fourfold, and all informant reports were twofold higher for institutional versus community comparisons. Furthermore, institutional sample had consistently higher rates, not only of Externalizing, but Internalizing, Social Problems, Attention Problems, and Thought Problems, as well as discrete DSM-oriented scales, suggesting that labeling of institutional youth as simply aggressive and delinquent contributes to their further marginalization and does not comprehensively address their mental health needs. In terms of protective factors, we found that: perceived social support, high competency scores, supportive caregiving, getting along well with peers and relatives (positive relationships), and problem solving skills were significantly protective of mental health. On the other hand fatalistic beliefs, cigarette and alcohol use were significantly associated with increased risk for problem behaviors (p < 0.05). The primary reason for institutional placement was family disruption (68.9%), poverty (15.7%), abandonment (8.4%), and physical or sexual abuse (5.4%). Only 31.2% of the youth were in fact true orphans (loss of one or both parents). It is therefore remarkable that in terms of service use, despite consistently high prevalence of problem behaviors across all informant sources, only 2.4% of the youth had received any speciality mental health services during institutional care. In conclusion, there is a pressing need to transform the social and health care policy and to provide family and community-based alternatives for youth currently in institutional care in Turkey. Before this goal is achieved, it is necessary to address their mental health needs urgently and comprehensively. The highest rates of problems by youth self-report also support the view that the youths' own voices ought to be heard and need to inform the reform process regarding their future care.

Refractive errors and strabismus in children with tuberous sclerosis: a controlled study.

PURPOSE: To evaluate the prevalence of refractive errors and strabismus in children with tuberous sclerosis and in control subjects. METHODS: Twenty-three children with tuberous sclerosis and 151 control subjects were evaluated. All children underwent cycloplegic autorefraction or retinoscopy, slit-lamp biomicroscopy, and dilated fundus examination. Ocular alignment was assessed by the Hirschberg, Krimsky, or prism cover test. RESULTS: The total prevalence of hypermetropia and amblyopia was significantly higher in patients with tuberous sclerosis (P = .035) than in the control subjects (P = .002). CONCLUSION: A high prevalence of hypermetropia seems to be an additional feature of tuberous sclerosis. Early screening for this amblyogenic factor is indicated in patients with tuberous sclerosis.

A window of opportunity for the transformation of national mental health policy in Turkey following two major earthquakes.

Striking at the nation's highly populated industrial heartlands, two massive earthquakes in 1999 killed over 25,000 people in Turkey. The economic cost and the humanitarian magnitude of the disaster were unprecedented in the country's history. The crisis also underscored a major flaw in the organization of mental health services in the provinces that were left out of the 1961 reforms that aimed to make basic health services available nationwide. In describing the chronology of the earthquakes and the ensuing national and international response, this article explains how the public and governmental experience of the earthquakes has created a window of opportunity, and perhaps the political will, for significant reform. There is an urgent need to integrate mental health and general health services, and to strengthen mental health services in the country's 81 disparate provinces. As Turkey continues her rapid transformation in terms of greater urbanization, higher levels of public education, and economic and constitutional reforms associated with its projected entry into the European Union, there have also been growing demands for better, and more equitably distributed, health care. A legacy of the earthquakes is that they exposed the need for Turkey to create a coherent, clearly articulated national mental health policy.