An Overview on Child Health Care in Turkey.

The general health status of the Turkish people has improved significantly in recent years. Improvements in the health status of the child population followed the introduction of health reforms, such as the Health Transformation Program. Presently, Turkey is undergoing further important changes concerning its medical system. The changes introduced during 2005-2015 have provided almost complete health insurance coverage and increased accessibility to primary health care givers. However, health providers realize that there are ongoing inefficiencies and deficiencies in both the health care system and health education. There is a need for continuous improvement; challenges lie ahead for improving services beyond primary care. The main criticism of previous health care reforms has come mainly from professionals in the health care sector because of their privileged position as inside observers being able to analyze pros and cons of the system. Quality and sustainability of future reform programs will rely not only on the economic support of the public health and health care sector, but also on the high standards of service pathways and satisfaction of both patients and providers of care by multifactorial quality assurance and continuous quality improvement analyses of basic elements of health care.

Helicobacter pylori stool antigen test.

OBJECTIVE: Helicobacter pylori ( H.pylori ) infection is usually acquired in early childhood. Invasive techniques used for diagnosis of H.pylori infection require endoscopic examination which is expensive and inconvenient and may cause complications. The aim of this study was to evaluate the performance of a new noninvasive diagnostic method, stool antigen test for H.pylori in untreated children with recurrent abdominal pain. METHODS: Eighty children (35 female, 45 male) who have undergone upper gastrointestinal endoscopy due to recurrent abdominal pain were included in the study. The H.pylori stool antigen test (HpSA) is based on a sandwich enzyme immunoassay with antigen detection. HpSA sensitivity, specificity, and positive and negative predictive values were determined with reference to the results of both histology and rapid urease test as a gold standard ( H. pylori status). RESULTS: While 49 of the 80 children (61%) tested were positive for H.pylori according to the results of both histology and rapid urease test, 28 children had negative H.pylori status. Among those 49 children, 48 were found to be positive by HpSA. Of 28 patients with negative H.pylori status, 28 were H.pylori -negative also in the stool test. The sensitivity, specificity, and positive and negative predictive values of HpSA were found to be 98%, 100%, 100%, and 96.5%, respectively. CONCLUSION: These findings have demonstrated that HpSA as a relatively simple, inexpensive and time saving noninvasive test is a reliable method for detection of H.pylori infections in children.

Clinical spectrum of acute abdominal pain in Turkish pediatric patients: a prospective study.

BACKGROUND: The aim of the present study was to determine the prevalence, associated symptoms, and clinical outcomes of children with acute abdominal pain who had been admitted to an emergency department. METHODS: Children aged between 2 and 16 years who presented to the emergency department of Cerrahpasa Medical School, Istanbul University between July 2001 and August 2002 with acute abdominal pain were enrolled in this study. A questionnaire was completed each patient admitted to our pediatric emergency unit for acute abdominal pain. Data collected included presenting signs and symptoms, the hospital follow up for all children who returned within 10 days, test results, and telephone follow up. RESULTS: The number of children referred to the emergency department was 7442, with 399 (5.4%) of these having acute abdominal pain. The mean age of the study population was 6.9 +/- 3.5 years, and 201 of the patients were male. The five most prevalent diagnoses were: (i) upper respiratory tract infection and/or complicated with otitis media or sinusitis (23.7%); (ii) abdominal pain with uncertain etiology (15.4%); (iii) gastroenteritis (15.4%); (iv) constipation (9.4%); and (v) urinary tract infection (8%). The most common associated symptoms were decreased appetite, fever and emesis. Because of follow-up deficiency the progress of 28 patients was not obtained. Eighty-two children were referred to the department of pediatric surgery, but only 17 of 82 (20.7%) required surgical intervention (15 of these 17 for appendicitis). Eleven patients returned within 10 days for re-evaluation, but the initial diagnosis was not changed. The complaints of 57 patients with uncertain etiology were resolved within 2 days. CONCLUSIONS: An acute complaint of abdominal pain was usually attributed to a self-limited disease. However, the percentage of surgical etiology is not negligible.

Management of portal hypertension in children: a retrospective study with long-term follow-up.

OBJECTIVES: Data regarding the management of the portal hypertensive haemorrhage in the paediatric patients have yielded conflicting results. The purpose of this study was to evaluate the efficacy of beta-blocker (propranolol) alone, sclerotherapy alone and beta-blocker + sclerotherapy combination in the management of portal hypertension in the paediatric population. METHODS: Medical information was retrieved from the records of 62 children with portal hypertension who were under treatment during at least two years of follow-up period. Data collected included diagnosis, type of portal hypertension, age at initiation of therapy, bleeding episodes before and during therapy. RESULTS: Sixteen of 62 patients were diagnosed as extrahepatic portal hypertension, 46 as intrahepatic portal hypertension. The mean age of study population was 7.6 +/- 4.2 years, 45 percent being females. The mean duration of follow-up under therapy was 5.2 +/- 2.5 years. Among the patients with intrahepatic portal hypertension, 29 received propranolol + sclerotherapy, 12 received only propranolol and 5 received only sclerotherapy. There was no significant decrease in bleeding episodes during propranolol or sclerotherapy. However patients under propranolol + sclerotherapy, showed significant decrease in bleeding episodes during therapy (23/29 before therapy, 15/29 during therapy, p < 0.05). Rebleeding index in patients with IHPH was significantly long in the group treated by propranolol + sclerotherapy (p = 0.0001) compared with before therapy. Because the numbers of patients in the groups are small, Kaplan Meier estimation suggest that propranol treatment is more effective. But there isn't significant difference when the results were compared with those of before therapy, except in the combined treatment group. CONCLUSION: The monotherapy is not sufficient for longterm follow-up of portal hypertensive patients. The combination therapy with propranolol + sclerotherapy appears more encouraging in the prevention of portal hypertensive haemorrhage, but this needs to be assessed in randomized trials.

The role of nitric oxide in pediatric patients with portal hypertension.

The hyperdynamic circulation of cirrhosis and portal hypertension has been postulated to be due to the vasodilatory effects of nitric oxide. However, there have been conflicting results in adults and no studies in children. We aimed to measure the nitric oxide level in serum of pediatric patients with portal hypertension with and without cirrhosis, in order to assess its role in the development of hemodynamic changes. We measured nitric oxide levels in 41 pediatric patients (21 patients with intrahepatic portal hypertension and 20 with extrahepatic portal hypertension). The mean age of the study population was 11.2 +/- 4.6 years; 53 per cent were female. Twenty healthy children were included as a control group. Nitric oxide levels were measured by Boehringer-Mannheim colorimetric assay and the statistical significance was calculated by Kruskal-Wallis one-way ANOVA. Significantly higher nitric oxide levels were found in patients independent of the type of portal hypertension compared with the control group (29.4 +/- 6 in patients with intrahepatic portal hypertension, 29.5 +/- 5.8 in patients with extrahepatic portal hypertension, and 23.6 +/- 6.5 in the control group; p < 0.007). These data showed a difference between the groups and suggest that nitric oxide, predominantly independent of cirrhosis, plays a primary role in the pathogenesis of portal hypertension.