Evaluation of measles immunity in Turkey: is it still a threat?

Background/aim: Measles is one of the important vaccine-preventable diseases with many complications in childhood. This study presents cross-sectional seroepidemiological data, beginning from neonatal cord blood in infants to children under 6 years of age, about waning of measles antibody and tries to suggest the proper time for measles immunization. Materials and methods: A total of 564 blood samples consisting of neonatal cord blood and samples taken from infants and children at ages of 6, 9, 24­48, and 49­72 months were analyzed for measles seropositivity in a period of 6 months. Results: Measles seropositivity rate was 72.5% in 109 cord blood samples, 2.6% in 117 infants of 6 months of age, and 3.6% in 111 infants of 9 months of age. Seropositivity was determined in 118 children at 24­48 months and in 109 children at 49­72 months and was 80.5% and 66%, respectively (P = 0.001). These children were vaccinated in the 12th month. Conclusion: Though measles immunization coverage is 97% in Turkey, population immunity is somewhat lower than expected. Increases of measles cases in Europe and the refugee problem in the country could easily lead to outbreaks. Implementing the first dose of the immunization at 9 months may be an option.

Effectiveness of pandemic influenza A/H1N1 vaccine for prevention of otitis media in children.

UNLABELLED: Our aim was to evaluate effectiveness of pandemic influenza A/H1N1 vaccine in preventing acute otitis media (AOM) and/or otitis media with effusion (OME), in a randomized, prospective and single-blind study conducted in the children aged of 6-60 months. This study was done between December 1, 2009 and April 30, 2010 during the pandemia between June 2009 and May 2010. On the healthy children, vaccinated against pandemic influenza A/H1N1 and age-matched unvaccinated controls, the rate of AOM, OME, and any otitis media (OM) attack (sum of AOM and OME attacks) confirmed by otoscopic and tympanometric examination, and their associations with risk factors were looked for. Otoscopic and tympanometric evaluation was done twice within the follow-up period of 4-8 weeks. Totally 46 vaccinated and 46 unvaccinated healthy children were enrolled. No difference in rates of AOM, OME, or OM was found between vaccinated and unvaccinated children. But logistic regression analysis revealed that unvaccinated children had 2.9-folds more risk for OME and OM, but not for AOM. Further, male gender and bottle feeding and/or using pacifier revealed significant relationships with AOM. CONCLUSION: We conclude that pandemic influenza A/H1N1 vaccine prevented OME rather than AOM attacks in children with 6-60 months of age.

New opportunity for vaccinating older people: well-child clinic visits.

BACKGROUND: Streptococcus pneumoniae causes considerable morbidity and mortality in the elderly. As aging of the population is making the health of the elderly a universal priority, preventive measures, such as vaccination, will become increasingly important. METHODS: We designed a prospective interventional study to determine whether recommendations to vaccinate grandparents of children attending well-child clinics would increase the pneumococcal vaccination rate in the elderly. Children younger than 5 years of age, attending a university well-child clinic from 1 May to 31 September 2008 who had grandparents over 65 years of age were eligible. A survey including the questions about the demographic characteristics of children, their parents and grandparents over 65 was carried out by face-to-face interview with the parents. High-risk medical conditions and vaccination history of grandparents was also noted and the benefits and necessity of pneumococcal vaccination (23vPPV) for the elderly was emphasized. Four months later these families were contacted to determine whether this intervention had increased the pneumococcal vaccination rates of the elderly. RESULTS: Information was obtained from 938 grandparents of 545 children. Before the interview, among all grandparents, only 0.9% were vaccinated with 23vPPV. Four months after this intervention, immunization coverage increased to 19.1%. The sex of the grandchild (OR: 1.99) and previous hepatitis B or influenza immunization of the grandparents (OR: 2.73) were the significant parameters accounting for higher immunization rates. CONCLUSION: Reminding elderly grandparents about vaccines in well-child clinics could be an opportunity in this field.

Factors associated with parental acceptance and refusal of pandemic influenza A/H1N1 vaccine in Turkey.

The objective of this study was to investigate the parents' attitudes towards and identify the possible factors associated with pandemic H1N1 vaccine uptake that was recommended to children between 6 months and 5 years of age. A questionnaire exploring the attitudes of parents to H1N1 vaccine was given to parents of children 6 through 60 months of age attending to Akdeniz and Gazi University Hospitals' well-child departments between 15 November 2009 and 15 January 2010. The questionnaire included questions on demographic characteristics, parental perception of the severity of the pandemic, the presence of anyone in their environment who suffered from pandemic influenza, their decision on whether or not to vaccinate their child, the factors that influenced them during decision-making process and possible factors that might have influenced the opponents of their decision. Those who accepted to get their children vaccinated got it immediately, free of charge. Out of 611 parents who responded the questionnaire 226 (36.7%) had their children vaccinated. Parental education period of less than 12 years, not being a close relative of a health care worker, not having a relative who suffered from the disease, having a child younger than 36 months, being influenced by the relatives' opinions or from the politicians or from the media all decreased vaccine acceptance. Factors that were most significantly associated with vaccine refusal were thinking that the pandemic was exaggerated (OR 9.44, 95% CI 4.28-20.82) and believing that other preventive measures were more effective than H1N1 vaccine (OR 15.61, 95% CI 7.37-33.08). Lessons learned from influenza H1N1/2009 pandemic may help national authorities, health care providers and media on how to keep the public well informed and find ways of better risk-benefit communication with the parents on vaccines.

Growth patterns of large, small, and appropriate for gestational age infants: impacts of long-term breastfeeding: a retrospective cohort study.

BACKGROUND: In several studies, since high and low birth weights are demonstrated as associated with obesity in childhood, these values should be followed up and documented carefully. OBJECTIVE: The aim of this retrospective cohort study is to demonstrate the variation on body mass index outcomes of large (LGA), small (SGA), appropriate (AGA) for gestational age infants from birth to the end of fourth year of age and the effects of breastfeeding duration on these outcomes. METHODS AND RESULTS: Four hundred and seven infants were recruited in the study (304AGA, 85 LGA, 18 SGA infants). LGA was frequent in boys and SGA in girls (p = 0.001). The mothers with gestational diabetes mellitus did have LGA infants (10.0% vs. 3.3%) (p = 0.022). The SGA infants performed rapid catch-up growth in the second month while the LGA infants performed catch-down growth in the ninth month. After the first 4 months, there was no difference on the values of BMI depending on breastfeeding time, less or more than 4 months, on the basis of the AGA and LGA infants. However, the body mass index (BMI) of LGA infants breastfed more than 12 months were not different from the AGA; unless the breastfeeding ceased earlier, the means of BMI remained significantly higher until 3 years. CONCLUSION: Consequently, long duration of breastfeeding might protect LGA infants from childhood obesity risk.

Reference values for urinary calcium, sodium and potassium in healthy newborns, infants and children.

The urinary calcium/creatinine ratio (UCa/Cr) in spot urine samples has been used extensively for screening and diagnosis of hypercalciuria (HC). The aim of this study was to determine the normal values for UCa/Cr, urinary sodium/creatinine (UNa/Cr), urinary potassium/creatinine (UK/Cr) and urinary sodium/potassium (UNa/K) ratios in healthy Turkish children aged 0-5 years. A total of 425 children were enrolled in the study. The urine samples were obtained from the second morning urine in children after breakfast and the first urine after feeding in infants. Urine Ca, Cr, Na and K levels were studied. A positive correlation was found between the UCa/Cr, UNa/Cr, UK/Cr and UNa/K ratios. Our results suggest that UCa/Cr is age-related and declines in the first five years of life except for in the newborn period. It might be concluded that determination of the upper limit of UCa/Cr in children less than five years old for every population can prevent unnecessary laboratory investigations and misdiagnosis of hypercalciuria.

Six-year experience of a hospital-based child protection team in Turkey.

The objective of this article was to review the case series' profile followed up by the Gazi University Multidisciplinary Team for Child Protection and to describe the challenges in our child protection system. The cases referred to this team between February 2001 and January 2007 were analyzed. In addition to the clinical management, challenges encountered during follow-up due to gaps in the child protection system were reviewed. A total of 139 patients were referred to the team during the study period. Mean age for physical abuse, sexual abuse, and neglect were 8.9 +/- 6.2, 10.8 +/- 4.2, and 5.1 +/- 5.5 years, respectively. Sexual abuse was significantly less common while neglect was significantly more common in the 0-5 years of age group. In addition to the gaps within each link of the child protection system (medical, legal and social services) in Turkey, interagency collaboration seems to be inadequate. Hospital-based multidisciplinary teams can start such a collaboration.

Impact of PCV7 vaccination on nasopharyngeal carriage and antimicrobial resistance among children in Turkey.

INTRODUCTION: We aimed to evaluate the effects of 7-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of Streptococcus pneumoniae and antibiotic resistance in children in a well-child clinic in a tertiary children's hospital in Turkey. METHODOLOGY: We collected nasopharyngeal (NP) specimens from 557 two-month-old babies before vaccination. After the study population had received PCV7, NP samples were obtained from 135 babies. Antimicrobial susceptibility testing and serotyping were performed. RESULTS: S. pneumoniae colonized in 48 (8.6%) of the 557 two-month-old babies before vaccination. The follow-up cohort consisted of 135 subjects. The prevalence of PCV7 strain decreased from 33.3% to 19.3% after vaccination. However, non-PCV7 types increased from 66.6% to 80.6% (p = 0.02). Of PCV7 serotypes, 19F was the most frequent serotype before and after vaccination. There was an increase in 6A and 15 of non-PCV7 serotypes after vaccination. Penicillin non-susceptible increased from 56.3% to 80.6% after vaccination (p =0.03). Serotypes 14, 18C, 9V and 6B, which were identified before vaccination, never colonized afterwards. Number of siblings and having sibling with older age of five were determined to be significant effective factors for SP colonization presence after vaccination and antibiotic use was negatively associated with pneumococcal carriage but associated with penicillin non-susceptibility. CONCLUSIONS: Nasopharyngeal carriage rate of S. pneumoniae dropped after PCV7 vaccination, and replacement by NVT pneumococci were also observed. Risk factors for nasopharyngeal carriage included household crowding and having a sibling age five years or older. Penicillin non-susceptibility increased in both VT and NVT strains.

Factors associated with defecation patterns in 0-24-month-old children.

To identify the normal defecation patterns and the factors affecting these patterns in the first two years of life, a questionnaire was given to the parents of 1,021 children who were followed in a well-child clinic. The time of first meconium passage, presence of colic symptoms, frequency, color, and consistency of stools were recorded.Mann Whitney U, Wilcoxon, chi-square, and correlation tests were used in the statistical analyses. The median number of defecations per day was six in the first month of life. This decreased to once in the second month and almost all cases remained so until the end of the 24th month. At the second month of age, 39.3% of infants passed stools less than once a day. This pattern of rare defecation was seen until the end of 6 months, when supplemental foods were started. Stool frequency was higher in exclusively breast-fed infants (p = 0.0001). Infants who had colic symptoms in the first 2 months had less frequent defecation during the first 2 years of life (p = 0.0001). In addition to confirming the previously observed defecation patterns of 0-2-year-old infants, this study provides the relationship between colic symptoms and stool frequency, and showed that the second month of life was unique in the sense that the frequency of stooling decreased to half of the previous month and 39.3% of these infants defecated less than once a day.

Diagnostic value of rapid antigen detection test for streptococcal pharyngitis in a pediatric population.

Acute upper respiratory tract infections in children may result in overuse of antibiotics as throat culture cannot be performed in every setting and results cannot be obtained early. A rapid and reliable test might decrease unnecessary antibiotic usage. The purpose of this study was to determine the prevalence of group A beta-hemolytic Streptococcus (GABHS) infections in different pediatric age groups and to assess the diagnostic value of rapid antigen detection test (RADT) for streptococcal pharyngitis. This study was performed in a pediatric outpatient clinic. All children who were admitted with signs and symptoms of acute upper respiratory tract infections were included in the study. Throat culture and RADT were performed and prevalence of GABHS was assessed. Diagnostic value of RADT was determined. This study included 1248 children with a mean age of 6.3+/-3.6 years. There were 655, 518, and 75 children in age groups of 0-6, 7-12 and 13+ years, respectively. The overall prevalence of GABHS was 38.1% (475/1248), as judged by throat culture. The prevalence was highest in the 7-12-year age group (53.9%) and lowest in the 0-6-year age group (25.2%). Considering all patients, RADT gave a sensitivity of 89.7%, specificity of 97.2%. The sensitivity and specificity of RADT were similar in different age groups (p values >0.05). Diagnostic value of RADT is high and can be used safely in populations where streptococcal pharyngitis and its complications such as acute rheumatic fever and acute glomerulonephritis are common.

Factors affecting the timing of teething in healthy Turkish infants: a prospective cohort study.

BACKGROUND: Teething is a developmental process and occurs over a broad chronological age range. OBJECTIVE: The objective of this study was to evaluate the effects of feeding pattern and growth parameters on teething time of healthy infants. METHODS: A total of 1200 term newborn infants followed up in Gazi University well-child clinic infants were evaluated, and their growth parameters, feeding patterns, and timing of the eruption of the first tooth were noted. The routine visit times of the clinic were chosen as the cut-off values for teeth eruption for logistic regression analysis for investigating factors that determine the timing of teeth eruption. RESULTS: Timing of the eruption of the first tooth ranged from 4 to 13 months. On the sixth month visit, 24.3%, and on the ninth month visit 84.5% of all infants had at least one tooth. Height-adjusted weight and height percentiles being less than 50, being fed by cow's milk or by formula in the first year, were independent factors negatively influencing teeth eruption by the sixth month, while all but height-adjusted weight percentiles being less than 50 had negative impact on tooth eruption by the ninth month. CONCLUSION: Growth parameters and feeding pattern may be determinants of the timing of teeth eruption in healthy infants.

Attitudes of physicians concerning vaccines not included in the national immunization schedule.

Çatakli T, Duyan-Çamurdan A, Aksakal-Baran FN, Güven AE, Beyazova U. Attitudes of physicians concerning vaccines not included in the national immunization schedule. Turk J Pediatr 2018; 60: 290-297. The aim of this study was to identify attitudes of family physicians and pediatricians working in sub-provinces of central Ankara concerning rotavirus (RV), human papilloma virus (HPV), meningococcal conjugate vaccine (MenACWY-MCV4) and adolescent and adult pertussis (Tdap) vaccines which are not included in the National Immunization Schedule (NIS). Questionnaires were conducted with 300 family physicians and 230 pediatricians who were selected by random sampling. RV vaccine is the most commonly recommended vaccine by physicians (60.5%). It is the vaccine they want to be added to the NIS the most (48.5%). Tdap vaccine is the least recommended vaccine (24.1%) and the least preferred for inclusion in the NIS (19.6%). Of the physicians recommending the RV vaccine 94.0% believe that `RV-related diarrhea cases exhibit a severe course of illness in children younger than two years old.` Pediatricians recommend RV, meningoccocal and Tdap vaccines more than family physicians (p < 0.05). Of the physicians who do not recommend RV, HPV, and conjugated meningococcal vaccine 87.5%, 96.7% and 27.6% found the vaccines expenive, respectively. Of the physicians who do not recommend Tdap vaccine 90.4% think that `Tdap vaccination is not a health problem of priority for their country.` In conclusion physicians are recommending vaccines which are not included in the NIS. Their common concern for not recommending these vaccines is expensive price.

Effectiveness of inactivated influenza vaccine for prevention of otitis media in children.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of inactivated influenza vaccine in preventing acute otitis media (AOM) and otitis media with effusion (OME) in children aged 6 to 60 months who attend day care. STUDY DESIGN: This prospective, single-blind study was conducted in 8 day care centers in Ankara, Turkey. One hundred nineteen (61 vaccinated and 58 unvaccinated against influenza) healthy children were examined at study entry and at 6-week intervals for 6 months by the same 2 otorhinolaryngologists who were blinded about the vaccination status of the children. The frequency of AOM and OME is compared between the 2 groups and the effect of influenza season on frequency of episodes was evaluated. Based on national influenza laboratory data, the influenza season was determined to be the period between December 15, 2003, and January 31, 2004. RESULT: The frequencies of AOM, OME and total otitis media episodes in vaccinated children were 2.3%, 22.8% and 25.2%, respectively, and these frequencies were 5.2%, 31.1% and 36.3% in the unvaccinated group. The difference was statistically significant (P < 0.01). This difference was especially prominent in the influenza season (P < 0.05). CONCLUSION: Influenza vaccine is effective in reducing AOM and OME episodes in 6- to 60-month-old day care children, especially during influenza season.

The relationship between urinary calcium, sodium, and potassium excretion in full-term healthy newborns.

The objective of this study was to determine the specific reference values for urinary calcium/creatinine (UCA/Cr) (mg/mg) in healthy breast-fed newborns, and to evaluate the relationship between UCa/Cr, urinary sodium/creatinine (UNa/Cr), urinary potassium/creatinine (UK/Cr) and UNa/UK ratios in the same group. A total of 88 infants aged between 0-28 days were enrolled in this study. They were divided into two age groups as follows: Group I: < or = 7 days of age; Group 2 infants aged between 8-28 days. Non-fasting spot urine was analyzed for Ca, Na, K and Cr. Significant differences were observed between the two groups in terms of UCa/Cr (0.11+/-0.10 vs 0.27+/-0.23, p<0.001), UNa/Cr (1.29+/-1.63 vs 5.5+/-4.83, p<0.001), and UK/Cr (0.94+/-0.99 vs 2.82+/-2.3, p<0.001). The data showed positive correlation between UCa/Cr and age (r=0.38, p<0.001) as well as between age and UNa/Cr ratio (r=0.68, p=0.0001) and between age and UK/Cr ratio (r=0.57, p<0.0001). Additionally, there was a positive correlation between UNa/UK and age (r=0.40, p=0.001). The UCa/Cr ratio positively correlated with UNa/Cr whereas no correlation was found between UCa/Cr and UNa/Uk ratio. Our data suggest that the healthy neonates differ from the hypercalciuric patients by exhibiting a linear correlation between Na/K and UCa/Cr. As the normal values of UCa/Cr, UNa/Cr, UK/Cr, UNa/UK ratios in the early neonatal period differ from those in the late neonatal period, these differences should be taken into consideration when assessing urinary excretion of these parameters for diagnostic purposes in the early and late newborn periods.

Diphtheria immunity of different age groups in Turkey.

In Turkey, the immunization policy against diphtheria involves childhood vaccination, and no routine booster dose is administered after 12 years of age. Information about the immune status of the population is important to predict the potential for epidemics, several of which have occurred recently in neighboring countries. The aim of this study was to assess the immune status of different age groups in Turkey against diphtheria. A total of 497 blood samples were collected, and diphtheria antitoxin levels were measured by the Enzyme Linked Immunosorbent Assay method. Titers below 0.1 IU/ml were considered to show insufficient immunity. Overall, 35.8% of the population studied showed insufficient immunity against diphtheria. Immunity rates varied significantly among different age groups (P < 0.01). Protective immunity rates were highest in the 3- to 6-year age group (81.3%) and the over 60 age group (81.2%). In subjects between the ages of 10 and 59 the percentage of people with insufficient immunity was above 30%. The lowest immunity rate was observed in 20- to 29-year age group. No significant difference was seen between males and females in terms of protective effect of vaccination. This study indicates that people between the ages of 10 and 59 are susceptible to diphtheria in our country. Therefore, revaccination of adults with tetanus-diphtheria toxoids at every opportunity (military service, pregnancy, admittance to emergency room) should be considered as an immunization policy.

Munchausen syndrome by proxy: a case report.

Munchausen syndrome by proxy (MSBP) is a serious form of child abuse, which is characterized by a child with symptoms and signs of an illness that have been fabricated by the mother. Here, we present a case of MSBP, who at four months of age was brought to our hospital by her mother because of rectal bleeding. The patient underwent many invasive procedures until the diagnosis of MSBP was finally considered. The mother reported no rectal bleeding for almost a year, during follow-up at the well-child outpatient department. At 19 months of age, another episode of rectal bleeding occurred, when a bloody diaper was presented to the attending physicians. The blood group and DNA analysis of the blood in the diaper confirmed the diagnosis. The case was reported to the social services and the patient was placed in the custody of her father's sister. The mother is still undergoing treatment in our psychiatry department.

Defecation patterns of the infants mainly breastfed from birth till the 12th month: Prospective cohort study.

BACKGROUND/AIMS: Studies about defecation patterns have been mostly conducted on infants who were breastfed in a short term but were fed predominantly with formula. In this study, defecation patterns of 125 infants, most of them being breastfed during 12th month were evaluated. MATERIALS AND METHODS: Frequency, consistency and color of the stool were analyzed in relation to the feeding pattern at the 15th day and at the 1st, 2nd, 3rd, 4th, 5th, 6th and 12th months. RESULTS: Frequency of defecation was highest in 15th day with a median of 6/day. It decreased with age (p=0.0001), being 4/day and 3/day in 1st and 2nd months respectively, and 2/day between 3rd-12th months. During first 5 months, the stool frequency was higher in infants who were exclusively breastfed compared to those being fed with breastfed and formula (p<0.05). The effect of the feeding pattern on stool frequency disappeared in the following months (p>0.05). Stool frequency decreased by half at the 2nd month when the rate of less than once/day attained its highest value (24.8%). In those who had a rate of less than once/day, stool frequency stayed low until the 6th month and exclusively breastfed rate was also found lower (p<0.05). CONCLUSION: Besides the age, exclusive breastfeeding was also effective on stool frequency. It points out that infants who are fed with formula in addition to breastfeeding may defecate less than once per day hence should not be diagnosed as having constipation depending solely on defecation frequency and should not receive unneccesary treatments.

Growth status of children in well-baby outpatient clinics and related factors.

AIM: The aim of this study was to determine the state of growth during follow-up of healthy children and the factors affecting growth. MATERIAL AND METHODS: The patient cards of the infants who were born in 2002 and followed up in the well-baby outpatient clinic in Gazi University, Medical Faculty regularly for at least 18 months were examined retrospectively. Their sociodemographic properties including age, education level, occupation of the parents, if the mother was working, caretakers and gender, gestational week, birth weight, birth height and mode of nutrition (breastmilk, formula, cow's milk, period of feeding, etc.) and growth of the babies (month, percentile) were recorded. Number of siblings and ages of the siblings were also recorded and the children with and without growth problems were compared in terms of these properties. RESULTS: It was found that 290 (39.3%) of 739 children who were followed up continued to grow up in the percentile in which they started (normal growth), 188 (25.4%) lost 2 or more percentiles in any month (growth retardation) and 261 (35.3%) lost less than 2 percentiles (decelerated growth). Deceleration/retardation in growth was observed most commonly in the 9(th) month. Deceleration in growth was found in the 6(th) month in 23.6% of the group with deceleration in growth, in the 9(th) month in 50.2%, in the 12(th) month in 15.8% and in the 18(th) month in 3.9%. Growth retardation was found in the 6(th) month in 35.8% of the group with growth retardation, in the 9(th) month in 38.0% and in the 18(th) month in 4.3%. It was found that receiving formula and presence of infection were the main risk factors in terms of deceleration of growth and unemployed mother, the lenght of the total time of breastfeeding and presence of infection were the main risk factors in terms of growth retardation. CONCLUSIONS: This study shows the importance of follow-up of growth of children in outpatient clinics for healthy children. It was found that detailed examination and recording of non-organic causes is necessary in addition to investigation of pathological causes of growth retardation. Since it was observed that elimination of the defects determined and educating the family about nutrition and supporting growth had a positive impact on growth retardation, it was concluded that all children should be followed up regularly especially in the first years of life.

Long-term outcomes of the shaken baby syndrome prevention program: Turkey's experience.

AIM: Shaken baby syndrome (SBS) is a condition which may cause to serious health problems in the baby. SBS may be prevented by increasing awareness with giving education to parents especially in the early postnatal period. In shaken baby prevention programs, education is recommended to be given before the 2-4(th) month during which the frequency of crying is increased. It is important that education given in the early period is permanent until the period during which the frequency of crying is increased. The aim of this study was to evaluate the persistency of the benefit of the SBS prevention program until the 2-4(th) month during which crying is intensified. MATERIAL AND METHODS: This study is an interventional study. When the babies became 2-4 months old, a questionnaire which questioned the usefulness of education and the experiences with babies was applied to a group selected randomly among the mothers who received SBS prevention education during pregnancy or in the first 7 postnatal days (group A). The same questionnaire was applied to 143 mothers whose babies completed their first 2 months, who presented to the hospital for vaccination and who did not receive education about SBS as the control group (group B). The data were evaluated using the Statistical Program for Social Sciences (SPSS) 15.0 statistical analysis package program. Ethical approval was obtained from the local ethics committee (30.12.2009, 2785). RESULTS: The rate of the mothers who stated "yes" to the sentence "babies occasionally cry" which was one of the main messages of the education was statistically significantly higher in group A compared to group B (p=0.001). The rate of the mothers who stated "I agree" to the sentence "battering is harmful for babies" was statistically significantly higher in group A compared to group B (p=0.001). CONCLUSIONS: Conclusively, it was found that SBS prevention program education was permanent until the 2-4(th) month.

The rate of seasonal influenza vaccination in diabetic children, the effect of recommendation and the factors influencing the acceptance of recommendation: an interventional study.

OBJECTIVE: To investigate the vaccination rate of influenza in diabetic children and the effect of recommendation and other factors on vaccination rate. MATERIAL AND METHODS: On July 2011, 144 diabetic children and their families were informed about and were recommended to receive the influenza vaccine every year, in September. On December 2011, parents were questioned about the vaccination. RESULTS: Influenza vaccination rate of the previous season (28.3%) increased to 50.0% (p<0.05). Receiving the vaccine in 2010 was the only contributing factor to the recommendation success. The reasons given by the non-receivers were; forgetting (50.0%), fear of adverse-effects (26.4%), not believing in usefulness (15.2%), rejection by the child (4.2%) and effects of media (4.2%). 88.9% of those who forgot declared that they would receive if they were reminded at the beginning of the season. CONCLUSION: The rate of influenza vaccination was low. The majority of those who didn't recieve the vaccination declared that they would if they were reminded at the beginning of the season and the fact that "receiving the vaccine in 2010" was the only factor influencing the recommendation success indicate that recommending isn't enough but that reminding and giving detailed information about the vaccine will increase vaccination rates independent of other factors.