Bronchiectasis After Solid-Organ Transplant: A Retrospective Single Center Study.

OBJECTIVES: Bronchiectasis is characterized by abnormal, persistent, and irreversible enlargement of the bronchi. Many etiological factors have been described, but there are limited data on the development of bronchiectasis after organ transplantation. Our study is the first to study evaluate the frequency of bronchiectasis in heart and liver transplants as well as kidney transplants. Our aim is to analyze the frequency of bronchiectasis development after solid-organ transplant and the characteristics of the cases and to evaluate potential relationships. MATERIALS AND METHODS: We retrospectively analyzed data of patients who underwent solid-organ transplant at the Baskent University Faculty of Medicine Hospital through the hospital electronic information system. Demographic, clinical, and laboratory data and thoracic computed tomography scans were evaluated. RESULTS: The study included 468 patients (151 females/317 males). Kidney transplant was performed in 61.5% (n = 207), heart transplant in 20.3% (n = 95), and liver transplant in 18.2% (n = 85) of patients. Development of bronchiectasis was detected in only 13 patients (2.7%). We determined a 13.64-fold risk of developing bronchiectasis in patients with chronic obstructive pulmonary disease and 10.08-fold risk in patients with pneumonia by multivariate regression analyzes, in which all possible risk factors for the development of bronchiectasis after transplant were evaluated. CONCLUSIONS: The pathophysiology of transplantassociated bronchiectasis has not yet been clarified. Underlying diseases, recurrent pulmonary infections, and potential effects from immunosuppressive drugs may contribute to the pathogenesis of bronchiectasis. Further prospective studies are needed to include long-term health outcomes in transplant patients with and without bronchiectasis.

Raccoon Eyes Presentation in a Child Diagnosed With Acute Lymphoblastic Leukemia: A Case Report.

Raccoon's eyes (periorbital ecchymosis) may present as the first sign in patients with skull base/base/facial fractures and tumors. In childhood, orbital metastases of neuroblastoma should be considered in the absence of trauma history. Herein, we report a 3-year-old girl diagnosed with acute lymphoblastic leukemia who presented with periorbital ecchymosis. To the best of our knowledge, this is the first pediatric patient with acute lymphoblastic leukemia in the literature who presented with raccoon eyes.

How close are children with obesity to becoming an adult with chronic illnesses?

OBJECTIVES: Childhood obesity has become a global threat due to its serious negative consequences. We aimed to determine the patterns of metabolic syndrome and cardio-metabolic risk factors in Turkish children with obesity. METHODS: We examined 169 schoolchildren with obesity in April and May 2019 in Samsun, Turkey. After clinical evaluation and anthropometric measurements, fasting blood samples were collected to measure total cholesterol, low and high-density lipoprotein, fasting blood glucose, triglycerides, and insulin levels. RESULTS: The proportion of those who met the metabolic syndrome criteria in boys was 14.3%, but it was twice as high in girls (28.2%). The most prevalent component of cardio-metabolic risk factor was increased waist circumference (96.4%) followed by a high homeostasis model assessment insulin resistance index (74.6%) and high blood pressure (29.0%). While the average high-density lipoprotein was higher in boys than in girls, on the contrary, insulin, HbA1c, and homeostasis model assessment insulin resistance concentrations were higher in girls. The prevalence of dyslipidemia was also higher in girls (67.1%) than in boys (47.6%), as were all impaired metabolic syndrome components. CONCLUSIONS: One in five children with obesity was at risk of metabolic syndrome. For early intervention and prevention, children with obesity should be monitored in terms of cardio-metabolic risk factors, but obese girls are more prioritized.

Restrictive effects of thalassemia on respiratory functions: One center experience.

OBJECTIVE: Respiratory functions in thalassemia major (TM) patients concerning poor chelation are a frequently researched issue. Our study aims to evaluate the lung functions of our patients with TM in the chronic transfusion program and to correlate them with their age, ferritin levels, and pre-transfusion hemoglobin values. METHODS: Height, weight, pulmonary function test (PFT) results, pre-transfusion hemoglobin levels, and ferritin levels of 97 patients (55 boys and 42 girls) without any underlying cardiac or chronic respiratory disease were recorded. PFT is consisted of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), the ratio of FEV1/FVC to peak expiratory flow (PEF), and forced mid-exhaled flow between 25% and 75% of mid-expiratory flow (MEF25-75). Data were analyzed with IBM SPSS V25. RESULTS: Low FVC was observed in 58 patients (60%), and low FEV1 was observed in 26 patients (27.6%). Low PEF was observed in 62 patients (64.5%), and low MEF25-75 was observed in 8 (8.3%). PFT was affected in 75 patients (78.1%). The pattern of involvement was restrictive. Age, height, and ferritin values significantly affected the MEF25-75 (p<0.05). Age and pre-transfusion hemoglobin values had a significant effect on the FVC test (p<0.05). There was a weak negative correlation between ferritin values and MEF25-75 (r=-0.221) and a weak positive correlation between pre-transfusion hemoglobin and FVC (r=0.222). CONCLUSION: Age and height are the main risk factors affecting FEV1, MEF25-75, and PEF. Serum ferritin has only an effect on MEF25-75 in our study. The respiratory functions of TM patients were affected in a restrictive pattern.

Neonatal portal vein thrombosis: risk factors, diagnosis, treatment recommendations and review of the literature.

BACKGROUND: Neonatal portal vein thrombosis (PVT) is currently more commonly encountered as a result of advances in diagnostic tools and increase in invasive interventions. METHODS: In this study, 11 premature and 12 term infants diagnosed with PVT were retrospectively evaluated for clinical and laboratory characteristics, umbilical catheterization procedure, PVT location, risk factors, treatments, and long-term outcomes. RESULTS: Median age of the patients at diagnosis was 10 days (range 3-90 days), and 69.6% of patients were girls. Of the 23 patients, 87% had left PVT and, 91.3% had at least one thrombosis risk factor, which was sepsis in 73.9% of patients, and presence of umbilical venous catheter in 87%. Totally, 59.1% of PVTs were completely resolved in a median follow-up of 7 months (1 month to 12 months), and 78.3% of these patients had no anticoagulant therapy (ACT). Partial thrombus resolution was achieved in 9 patients (40.9%). Five patients (%21) received ACT. Overall, 34.8% of patients had long-term complications. neonatal PVT is most commonly reported in the left portal vein and there is no evidence for the impact of ACT on reducing the short- or long-term complications. Well designed and larger studies are necessary to clarify this issue, which can facilitate developing appropriate management algorithms. CONCLUSION: Neonatal PVT is most commonly reported in the left portal vein and there is no evidence for the impact of ACT on reducing the short- or long-term complications. Well designed and larger studies are necessary to clarify this issue, which can facilitate developing appropriate management algorithms.

Oncology mortality: weekend and summer vacation effect.

OBJECTIVES: In this study, we investigated the effect of the weekend and summer vacation on mortality in patients with cancer. METHODS: All patient data were obtained from their hospital registry records and the Death Notification System of the Ministry of Health. RESULTS: The majority of patients died in the hospital compared at home, 80.8% versus 19.2%, respectively. Patients aged <65 died mostly in hospital, which was the opposite of those aged ≥65, who died at home. While tumour location and histopathological type had no effect on the place of death, patients with metastasis (including single organ metastasis), diffuse metastases (diffuse metastases: multiple organ metastases) and patients with locally advanced stage disease were found to die more frequently in the hospital. Deaths in the hospital occurred most frequently in August, while deaths at home occurred most frequently in April and October. Deaths in the hospital occurred most frequently on Friday, Saturday and Sunday, while deaths at home occurred more frequently on Monday. It was determined that the deaths in the hospital were significantly higher at the weekend. CONCLUSION: This study contains data supporting the weekend effect in oncology patients. Moreover, it provides new data on the increased death rates in August, which coincides with the summer vacation leave month.

Comparison of the ability of HOMA-IR, VAI, and TyG indexes to predict metabolic syndrome in children with obesity: a cross-sectional study.

BACKGROUND: The increasing trend in childhood obesity needs to be closely monitored and intervened due to long-term health issues such as metabolic syndrome, cardiovascular diseases, hypertension, and type 2 diabetes. We aimed to determine and compare the cut-off values for the visceral adiposity index (VAI), triglyceride-glucose index (TyG), and HOMA-IR for predicting metabolic syndrome (MetS). METHODS: This population-based cross-sectional study was conducted in May 2019 in Samsun, Turkey. The study included 169 children with obesity aged 9 and 10 years. After anthropometric and clinical evaluation, fasting blood samples were collected from the children. The areas under the curve of the visceral adiposity index, triglyceride-glucose index, and HOMA-IR were compared by receiver-operating-characteristic (ROC) analysis in predicting the MetS. RESULTS: The total prevalence of MetS was 21.3% in children with obesity, and it was two times higher in girls than in boys. The mean values of TyG and VAI were significantly different in those who have and have not MetS in both genders. However, the HOMA-IR index was higher only in girls with MetS and did not differ in boys by having MetS. The VAI and the TyG index both had statistically significant cut-off values in both sexes and a larger ROC area than the HOMA-IR index in predicting MetS. CONCLUSIONS: The VAI and TyG index are effective indicators in assessing the MetS risk in children with obesity. Both indexes can be considered useful tools in pediatric research and the evaluation of interventions. However, the HOMA-IR index formula needs to be developed taking into account age, gender, and ethnicity.

Differences between adult and pediatric chronic spontaneous urticaria from a cohort of 751 patients: Clinical features, associated conditions and indicators of treatment response.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a common disease both in the pediatric and in the adult population. However, there are differences between the two patient populations with respect to etiological factors, comorbidities, and treatment responses. Our aim was to determine differences between pediatric and adult CSU in terms of clinical characteristics, laboratory parameters, comorbidities, response to treatment, and indicators of response. METHODS: A retrospective analysis of CSU patients was performed. Data regarding differences between pediatric and adult CSU patients were analyzed. Indicators of treatment response were determined separately in both pediatric and adult patients. RESULTS: Of 751 CSU patients (162 pediatrics and 589 adults), female dominancy (48.8% vs. 69.6%) and rate of angioedema (19.1% vs. 59.8%) were lower, and disease duration (5 months vs. 12 months) was shorter in pediatric patients. Anti-TPO positivity (24.7% vs. 9%), elevated CRP (46.5% vs. 11.1%), eosinopenia (38.5% vs. 18.1%), and skin prick test positivity (39.3% vs. 28.8%) were significantly more frequent in adult patients. Response to antihistamines was higher in the pediatric group, and only 7% used omalizumab versus 20.8% in the adults. The comparisons were also performed between <12-year and ≥12-year patients and yielded similar results. CONCLUSION: Pediatric CSU shows distinct characteristics such as lower incidence of angioedema and antithyroid antibodies, and it responds better to antihistamines. These suggest that CSU becomes more severe and refractory in adolescents and adults. Adolescent CSU shows features similar to adult CSU rather than pediatric CSU.

The problem of unaccompanied children in the earthquake; insufficient enrollment.

Türkiye experienced two of the most catastrophic earthquakes of the last century on February 6, 2023. The first earthquake with a magnitude of 7.7 occurred at 4.17 a.m. in Kahramanmaras City. Nine hours later, the second earthquake with a magnitude of 7.6 hit a region, which has 10 cities and over 16 million people. After the earthquakes, the Director-General of the World Health Organization, Hans Kluge, announced that a level 3 emergency was declared.One of the problems that should be solved at the earliest period in earthquakes is the problem of orphans or unaccompanied children. These children, referred to as 'earthquake orphans', can be potential victims of violence, organized crime, organ trafficking, drug addiction, sexual exploitation, or human trafficking. The already low socioeconomic level of the region, the magnitude of the earthquake, and the turmoil in the emergency rescue organization cause concern about the fact that the number of fragile children's population that will be affected will be higher than expected. The problem of orphaned children experienced in previous major destructive earthquakes provides important experiences for earthquake preparation.

Evaluation of Knowledge and Attitudes of Anesthesiology Specialists and Residents Toward Patients Infected with the Monkeypox Disease: A National Survey Study.

Background: Monkeypox is a zoonotic disease native to West and Central Africa that is now becoming a global public health concern. By August 19, 2022, approximately 40,220 cases of monkeypox in 94 countries were reported outside the endemic region. Anesthesiologists are at high risk of exposure to infection, given the potential for respiratory transmission of the virus. This study aims to raise awareness by evaluating the knowledge of anesthesiology specialists and residents regarding monkeypox and their attitudes toward the management of infected patients. Methods: This descriptive study collected data through an online questionnaire (SurveyMonkey, San Mateo, CA) between August 11, 2022, and September 4, 2022. Members of the Turkish Society of Anesthesiology and Reanimation were contacted via e-mail and other social media applications (WhatsApp, Twitter, and LinkedIn); those who agreed to participate in the study were asked to answer the survey questions. Results: A total of 282 anesthesiology specialists and residents participated in the study. The accuracy rates of answers to the knowledge-related questions suggested that a sufficient level of knowledge about this disease has not yet been reached. However, the rate of agreement with the literature recommendations regarding peri-operative safety measures that should be taken was high. Conclusions: The increasing number of cases worldwide necessitates all branches of medicine including anesthesiology to be vigilant and take adequate precautions. Regional and international systematic strategies should be developed to increase the knowledge of anesthetists to provide high-quality healthcare and reduce the risk of transmission.

Clinical Evaluation of Patients with COVID-19 Within the Framework of Comorbidities.

Objectives: Chronic systemic diseases (CSD) and cancer are closely related to the clinical course, severity and mortality of COVID-19 due to the immunosuppressive conditions caused by these diseases. The purpose of this study was to investigate the differences between the effects of cancer and CSD on the clinical and laboratory parameters of patients with COVID-19. Methods: The study included patients who received inpatient treatment with the diagnosis of COVID-19 at Ondokuz Mayis University between March 16, 2020, and December 1, 2020. The participants were divided into four groups as follows: Those without comorbidities (Group 1), those with only CSD (Group 2), those with only cancer (Group 3), and those with both CSD and cancer (Group 4). Comparative statistical evaluation was performed in terms of clinical symptoms, biochemical parameters, and admission to intensive care and survival. Results: In total, 750 patients were included: 242 patients in Group 1, 442 in Group 2, 27 in Group 3, and 39 in Group 4. The mean age of the patients was 57.1±9.4 years and 53.7% were male. Patients of Group 1 were significantly different from those of the other groups in terms of age, requirement for intensive care and intubation, complications, survival, white blood cell and lymphocyte count, neutrophil/lymphocyte ratio and levels of hemoglobin, lactic acid dehydrogenase, ferritin, D-dimer, and C-reactive protein (for each p<0.001). Conclusion: No difference was observed among laboratory parameters, intensive care admission, intubation need, complication frequency, and survival rates in patients with CSD or cancer. It was detected that all three groups with CSD and cancer were worse than Group 1 in terms of intensive care need, intubation, and survival.

Incidence and risk factors for retinopathy of prematurity in premature, extremely low birth weight and extremely low gestational age infants.

BACKGROUND: The aim of the study was to determine the incidence and risk factors of retinopathy of prematurity (ROP) in premature, extremely low birth weight (BW, ELBW) and extremely low gestational age (GA, ELGA) infants. METHODS: The medical records of preterm infants who were screened for ROP between January 2012 and December 2020 were retrospectively reviewed. Only one eye of each infant with higher grade ROP was included in the study. BW; GA; medical characteristics; the presence, severity, and need for treatment of ROP were recorded. Infants were divided into groups according to BW (≤1000 g, 1001-1750 g, > 1750 g) and GA (≤25w, 26-28w, 29-31w, 32-34w, ≥35w) and data were analyzed. RESULTS: Data of 2186 infants were evaluated. The overall incidences of any stage ROP and ROP requiring treatment were 43.5 and 8.0%, respectively. These rates were 81.1 and 23.9% in ELBW (≤1000 g) infants and were 92.9 and 64.3% in ELGA (≤25w) infants, respectively. The rates of ROP, the median duration of oxygen therapy and systemic diseases increased significantly as BW and GA decreased. The median duration of oxygen therapy and the rates of sepsis, pulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) were statistically higher in infants with ROP compared to those without ROP (p < 0.001). Multivariate regression analysis demonstrated that low BW and GA; prolonged duration of oxygen therapy; presence of PDA and necrotizing enterocolitis (NEC) were important risk factors for ROP. CONCLUSIONS: ELBW and ELGA infants develop higher rates of ROP and severe ROP. Prolonged duration of oxygen therapy, the presence of concomitant neonatal sepsis, BPD, IVH, PDA, and NEC further increases the risk of ROP.

The Psychological Effects of the COVID-19 on Students Who Choose the Medical Profession With Different Motivational Factors: A Cross-Sectional Study.

The COVID-19 pandemic has generated mental and psychological health problems worldwide. The aim of this study was to determine whether the psychological effects of COVID-19 were different in medical students who chose the medical profession with different motivational factors. In the study, there were 389 medical school students. The survey asks about sociodemographic features and the students' reasons for choosing the medical profession. The study also included a self-assessed Hospital Anxiety-Depression Scale and Beck Hopelessness Scale. While 41% of students chose the medical profession for economic reasons, the ratio of whom have an extrinsic and intrinsic source of motivation was 37% and 22%, respectively. It was found that there was a statistically significant difference in the distribution of motivational factors by gender. Almost 50% of males were affected by economic motivation factors. The difference in motivational factors between genders was found to be statistically significant. Anxiety in females, depression in students with low-income families, and hopelessness in students older than 22 years and interns were higher than in the others (P < .05). Median scores for anxiety, depression, and hopelessness were higher for students with extrinsic motivational sources. However, only the difference in scores of anxiety and hopelessness was found statistically significant (P < .05). We found that the psychological effects of the COVID-19 pandemic varied according to both sociodemographic characteristics of the medical students and reasons for choosing medical profession. According to our results, the idealistic students interested in the medical profession, who want to support others and prioritize economic benefits, had fewer psychological issues than those who chose the medical profession due to family pressure or external factors.

Investigation of Granulomatous Inflammations in Terms of Tuberculosis Diagnosis: A 5-Year Multi-center Laboratory Study.

OBJECTIVE: Granulomatous inflammation showing "caseification necrosis" is considered pathognomonic for tuberculosis. This study aimed to evaluate patients with granulomatous inflammation and some characteristics to diagnose tuberculosis. MATERIAL AND METHODS: This is a cross-sectional descriptive study. The study includes all pathology laboratories in Samsun between the years 2012 and 2017. Pathology reports that contained the term granulomatous were selected between all patient reports of these laboratories. The patient reports were examined by comparing the dispensary records and the presence of a diagnosis of tuberculosis. RESULTS: In the 703 pathology reports, it was found that 38% were only granulomatous and 33% were caseous granulomatosis lesions. When the prevalence of tuberculosis according to the presence of microscopic necrosis was observed in granulomatous tissue samples, 85% tuberculosis was found in patients with necrotic granulomatous tissue and 14% tuberculosis was found with non-necrotic lesions. The presence of tuberculosis in necrotic granulomatous tissues was statistically significantly higher (P < .00001). CONCLUSION: As a result, when examining a pathology report for the presence of tuberculosis, the existence of a granulomatous reaction should be considered first. Getting stuck on the definition of caseification necrosis will cause the case to be skipped. An indication of necrosis in the pathologic evaluation will guide the diagnosis of tuberculosis.

Investigating the Effects of Protective Face Masks on the Respiratory Parameters of Children in the Postanesthesia Care Unit During the COVID-19 Pandemic.

PURPOSE: The purpose of this study was to investigate the effect of protective face mask usage during the postoperative period on carbon dioxide retention in children during the COVID-19 pandemic. DESIGN: This study was designed as a prospective, randomized trial including 40 ASA I-II patients aged 3 to 10 years who were scheduled for elective surgery. METHODS: Patients were randomly allocated to two groups. The first group (group 1) received O2 treatment over the protective face mask. In the second group (group 2), the protective face mask was worn over the O2 delivery system. Heart rate, oxygen saturation (SPO2) level, end-tidal carbon dioxide (EtCO2) level, and respiratory rate were measured using a patient monitor at 0, 5, 10, 15, 30, and 45 minutes and recorded. The primary outcome of the study was the determination of the EtCO2 levels, which were used to assess the safety of the mask in terms of potential carbon dioxide retention. FINDINGS: None of the participants' SPO2 levels fell below 92% while wearing masks. There was no statistically significant difference between the groups in terms of EtCO2, heart rate, SPO2, and respiratory rate (P > .05). CONCLUSIONS: During the COVID-19 pandemic, protective surgical face masks can be used safely in the postoperative period for pediatric patients aged 3 to 10 years.

Diffusion-Weighted Imaging of Brain Metastasis: Correlation of MRI Parameters with Histologic Type.

AIM: To compare the diffusion properties of brain metastases as imaging biomarkers in various types of tumours, to determine their histology and origin. MATERIAL AND METHODS: Magnetic Resonance Imaging (MRI) and diffusion-weighted imaging (DWI) were used to retrospectively study the data of 143 patients suffering from brain metastases. Four categories of primary tumours with metastases to the brain were included: lung carcinoma (n=102, 71.3%); breast carcinoma (n=27, 18.8%); colon carcinoma (n=8, 5.6%); and others (n=6, 4.2%). The Apparent Diffusion Coefficient (ADCmin ) values, as well as the normalised ADC ratio (nADC), were determined. The lesions on the DWI were categorised as follows: type 1, with negative findings on DWI; type 2, which were isointense with the normal cortical grey matter; type 3, which were hyperintense compared to the normal cortical grey matter. RESULTS: The diffusion type, mean ADCmin, and mean nADC showed statistically significant differences in different types of metastases. In the subgroup analysis, it was found that type 3 was the diffusion type found most extensively in the brain metastases of small cell carcinoma (SCLC) (n=52, 65.8%, p < 0.000). Furthermore, the mean ADCmin and nADC values were the least for the brain metastases of the SCLC (552.0 ± 134.2 and nADC = 0.8 ± 0.1, p < 0.000, respectively). The value of the mean ADCmin was low in the human epidermal growth factor receptor 2 (HER-2) negative groups than in the HER-2 positive groups at 786.8 ± 299.1 vs 844.8 ± 141.3 (p < 0.006). CONCLUSION: Our findings indicated that there is a correlation between diffusion parameters as imaging biomarkers of the solid component of brain metastases of primary tumours and the tumour histology.

Drug Allergy in Children: What is the Actual Frequency of Drug Allergies?

Objectives: Drug hypersensitivity reactions are immunologically mediated reactions resulting in the production of drug-specific antibodies and/or T-cells and constituting only <15% of all drug reactions. Based on the clinical observations, both patients and their parents refer to any undesirable drug reactions as drug allergy, regardless of whether the underlying mechanism is immunological or not. After allergy examinations, only a small percentage of the patients who were reported positive for drug reactions based on their clinical history are actually confirmed to have hypersensitivity. This study aims to determine the actual frequency of drug allergies in children, the drugs that cause the most common allergies in patients with a complaint of drug allergy and evaluate the accompanying demographic and clinical features. Methods: The study evaluated data from a total of 266 patients (ages of 0-18) with suspected drug allergy during a 3-year period. Twenty-four patients with doctor-diagnosed drug-related anaphylaxis and 85 patients who did not accept diagnostic tests were excluded from the study and the study continued with a total of 157 patients. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines. Results: Data from a group of 157 patients (M [54.6%]; F [45.4%]) were retrospectively analyzed. Beta-lactams (BLs) were the most common drugs involved in the reported clinical history followed by non-steroidal antiinflammatory drugs (NSAIDs). Allergic reactions occurred on the median 1st day (min: 1-max: 8) after drug intake and were most frequently observed as urticaria (55.3%). Immediate reactions (IRs) were observed in 53.5% and non-IRs in 46.5% of the patients. Conclusion: Our data demonstrated that only 15.5% of patients confirmed to be positive to allergy during testing which is in line with the data in the literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.

Prevalence of overweight and obesity among school children and parents: a cross-sectional study.

INTRODUCTION: Obesity, a complex and multifactorial disease causing severe health problems, is still the second most important cause of preventable deaths after smoking. Another risk is that childhood obesity is associated with overweight and obesity in adulthood. This study provides information on the prevalence of overweight and obesity in primary school students and their parents on location (rural v urban) and gender. METHODS: In this population-based, cross-sectional study, the anthropometric and demographic data of 9786 children and 6855 parents were analyzed. The study was conducted between 1 October 2016 and 30 November 2016 on a sample representing all public and private primary school students aged 6-10 years in Samsun province, Turkey. The multi-stage stratified sampling method was used in selecting the research sample according to the number of district students, the number of public/private primary school students, and the number of rural/urban students. In the BMI values classification, cut-off points in the age- and gender-specific growth charts of the Centers for Disease Control and Prevention were used for students, and the International Obesity Task Force cut-offs were used for parents or guardians. After the data acquisition was completed, a questionnaire form developed by the researchers was sent to the parents through the students. While children's anthropometric measurements were performed in their classrooms, parents or guardians self-reported their weight and height. Statistical Package for the social Sciences v22.0 was used for statistical analysis of the data. RESULTS: The study group consisted of 5005 (51.1%) boys and 4781 (48.9%) girls. The 6855 parents comprised 5258 (76.7%) mothers and 1597 (23.3%) fathers. The mean age was 8.2±1.2 years in children and 36.2±6.7 years in parents. Obesity prevalence was 10.5% in children and 20.2% in their parents. Childhood obesity was more prevalent in boys and in those living in urban areas (12.0% and 12.3%, respectively) than in girls and in those living in rural areas (9.0% and 4.5%, respectively). Conversely, adulthood obesity was more frequent in females and in those living in rural areas (20.4% and 21.8%, respectively) than in males and in those living in urban areas (19.7% and 20.4%, respectively). CONCLUSION: BMI values were higher among those of male gender and those living in rural areas. Combating obesity requires further multidisciplinary research to reveal the reasons for the differences based on place and gender, especially on nutrition and healthy lifestyle behaviors.

The causes of parental vaccine refusal: results of a survey from Giresun, Turkey.

BACKGROUND: While efforts have raised immunization levels in developing countries, high rates of vaccine refusal in both developing and developed countries are causing concern worldwide. We aimed to determine the causes of vaccine refusal among parents refusing or postponing the vaccination of their children. METHODS: This descriptive, cross-sectional study was performed in the Giresun province of Turkey. The study population included families who were unwilling or refused to vaccinate at least one of their children under the scope of the Turkey Enhanced Program of Immunization. Data were obtained during the year 2018 by face-toface interviews with each vaccine hesitant parent (VHP). RESULTS: Vaccine refusal incidence was 1.2% in the year 2018. In 8 (14.8%) of the children, the vaccination was recorded to be postponed due to health problems, while 46 (85.2%) children were not vaccinated due to parental vaccine refusal. Two-thirds of unvaccinated children were living outside the province center of Giresun. The parents consisted of young adults whose average age was 30.6±6.6 years. VHPs were mostly university graduates (61.1% of mothers-70.3% of fathers). While at least one of the VHPs was a religious official in 24.1%, at least one of the either VHP was a teacher in 20.3%. The most common reasons for vaccine refusal were `fear of vaccine side-effects` (55.6%), and `problems in previous vaccinations` (33.3%). In 44.4 % of refusal cases, no specific reason was stated. CONCLUSIONS: Primary healthcare providers, who are in close contact with parents, have an important role to provide the right health information. Various in-service training can be provided to improve the communication skills of healthcare providers. In these training sessions, besides comprehensive information about vaccines, it should be aimed to provide parents with the ability to understand their concerns, to approach them sensitively and to present the information they need effectively.