Mothers' and fathers' attitudes toward stuttering in the Middle East compared to Europe and North America.

BACKGROUND: Parents play a central role in the treatment of childhood stuttering. Addressing parental attitudes toward stuttering is helpful therapeutically. The extent to which differences in attitudes toward stuttering exist on the basis of sex, geographical region and parental status (e.g., parent of a stuttering child, parent of a nonstuttering child, nonparent) is unclear. Many studies investigating such factors have used the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) questionnaire. A large POSHA-S database has collected responses from over 20 000 people from 49 countries. AIMS: The aim of this study was to use the POSHA-S database to examine the extent to which the following variables influence attitudes toward stuttering: (a) parents' sex (mothers vs. fathers), (b) geographic region (Middle East vs. Europe and North America), (c) parents' children (stuttering vs. nonstuttering) and (d) parental status (parents versus nonparents). METHODS & PROCEDURES: Data used in this study were extracted from selected, relevant studies that administered the POSHA-S to respondents. The Overall Stuttering Scores were compared on the basis of sex and parent status (i.e., mothers and fathers; nonparent women and men) and were then compared within and across the two geographical areas. Group comparisons were performed using analysis of variance followed by independent t tests, and Cohen's d was calculated to determine effect sizes. OUTCOMES & RESULTS: Statistically significant differences were observed upon the basis of geographical region. In general, male parents and nonparents tend to have more positive stuttering attitudes among the Middle Eastern samples while female parents and nonparents tend to show more positive attitudes in European and North American samples in the POSHA-S database. Effect sizes were small for all comparisons. CONCLUSIONS & IMPLICATIONS: The effect of geographic region and culture may predict sex-based differences among mothers' and fathers' attitudes toward stuttering; however, the clinical significance is unclear. Additional research is needed to better understand how children who stutter are affected by their parents' attitudes toward stuttering. WHAT THIS PAPER ADDS: What is already known on this subject The research clearly indicates that attitudes toward stuttering vary according to geographical region. Less clear is whether mothers and fathers from geographically diverse backgrounds hold different attitudes toward stuttering and the extent to which parental status (being a parent, parent of a child who stutters or nonparent) affects attitudes toward stuttering. What this study adds This study's findings confirm that geographical differences do influence attitudes toward stuttering. Male parents and nonparents tend to have equal or more positive attitudes toward stuttering in Middle Eastern samples, whereas non-Middle Eastern female parents and nonparents tend to show hold more positive attitudes. What are the clinical implications of this work? In addition to being culturally sensitive when working with parents of children who stutter, clinicians should also consider that mothers and fathers may have some differences in attitudes and behaviours toward their child's stuttering. These differences should be considered when designing treatment plans. It should also be noted that, despite statistical significance, the effect sizes in this study were low, suggesting that further research as well as close collaboration with parents of children who stutter is warranted.

Turkish adaptation of the self-stigma of stuttering scale (4S): Study of validity and reliability (4S-TR).

PURPOSE: This study aimed to adapt the Self-Stigma of Stuttering Scale (4S) into Turkish and evaluate its factor structure, reliability, and validity in Turkish culture. METHODS: The original 4S scale was translated into Turkish (4S-TR) using a forward-backward translation technique and was administered to 350 adults who stutter (AWS). To discover latent variables evaluated on the scale, two-factor analyses were performed. Internal consistency and temporal stability were calculated to ensure reliability. Test-retest reliability correlation scores were calculated with multiple applications of the scale within about two weeks. To verify construct validity, participants also completed the Turkish versions of the Self-Esteem Rating Scale-Short Form (BSDÖ-KF) and the Satisfaction with Life Scale(YDÖ). RESULTS: The explanatory factor analysis showed three factors explaining 74.76 % of the total variance. The findings were also validated by confirmatory factor analysis. High levels of internal consistency (r = .89) and test-retest reliability (r = .96) were obtained. In terms of construct validity, our findings revealed that self-stigma has a significant negative correlation with self-esteem (r = -.41) and life satisfaction (r = -.38) as was predicted. CONCLUSIONS: The findings demonstrate preliminary evidence that the 4S-TR is a viable and valid instrument for self-stigma evaluation in three domains (stigma awareness, stereotype agreement, and self-concurrence). The 4S-TR can be applied for research and clinical purposes in Turkish.

Closure of transcatheter ventricular septal defect using LifetechTM Konar-MF Occluder in children weighing less than 10 kilograms: mid-term results, a tertiary single center experience.

OBJECTIVE: Transcatheter closure of medium and large ventricular septal defects (VSDs) in young children is limited due to the use of over-sized devices that can cause hemodynamic instability and arrhythmia. In this study, we aimed to retrospectively evaluate the safety and efficacy of the device in the mid-term in children weighing less than 10 kg whose transcatheter VSD was closed only with the Konar-MFO device. PATIENTS AND METHODS: Among 70 children whose transcatheter VSD was closed between January 2018 and January 2023, 23 patients weighing less than 10 kg were included in the study. Retrospectively, the medical records of all patients were reviewed. RESULTS: The mean age of the patients was 7.3 (4.5-26) months. 17 of the patients were females, 6 of them were males, F/M: 2.83. The average weight was 6.1 (3.7-9.9) kg. The mean the pulmonary blood flow/ systemic blood flow (Qp/Qs) was 3.3 (1.7-5.5). The mean defect diameter was 7.8 mm (5.7-11) for the left ventricle (LV) side, and 5.7 mm (3-9.3) for the right ventricle (RV) side. Based on the utilized device dimensions, the measurements on the LV side were recorded as 8.6 mm (range 6-12), while those on the RV side were recorded as 6.6 mm (range 4-10). Antegrade technique was applied to 15 (65.2%) patients and retrograde technique was applied to 8 (34.8%) patients in the closure procedure. The procedure success rate was 100%. The incidence of death, device embolization, hemolysis, or infective endocarditis was zero. CONCLUSIONS: Perimembranous and muscular VSDs in children under 10 kg can be successfully closed under the management of an experienced operator with the Lifetech Konar-MFO device. This is the first study in the literature to evaluate the efficacy and safety of the device in children under 10 kg in whom only Konar-MFO VSD occluder device is used for transcatheter VSD closure.

Sham-derived effects and the minimal reliability of theta burst stimulation.

Theta-burst stimulation (TBS) is a patterned form of repetitive transcranial magnetic stimulation (rTMS) that has been used to induce long-term modulation (plasticity) of corticospinal excitability in a drastically shorter duration protocol than conventional rTMS protocols. In this study we tested the reliability of the effects of two well defined TBS protocols, continuous TBS (cTBS) and intermittent TBS (iTBS), especially in relation to sham TBS, within and across the same 24 participants. All TBS protocols were repeated after approximately 1 month to assess the magnitude and reliability of the modulatory effects of each TBS protocol. Baseline and post-TBS changes in motor evoked potentials (MEP-measure of corticospinal excitability) amplitudes were compared across the cTBS, iTBS and sham TBS protocols and between the initial and retest visits. Overall, across participants, at the initial visit, iTBS facilitated MEPs as compared to baseline excitability, with sham eliciting the same effect. cTBS did not show a significant suppression of excitability compared to baseline MEPs at either visit, and even facilitated MEPs above baseline excitability at a single time point during the repeat visit. Otherwise, effects of TBS were generally diminished in the repeat visit, with iTBS and sham TBS replicating facilitation of MEPs above baseline excitability at similar time points. However, no protocol demonstrated consistent intra-individual modulation of corticospinal excitability upon retest. As the first study to test both iTBS and cTBS against sham TBS across repeat visits, our findings challenge the efficacy and reliability of TBS protocols and emphasize the importance of accounting for sham effects of TBS. Furthermore, given that therapeutic effects of TBS are hypothetically derived from consistent and repeated modulation of brain activity, the non-replicability of plasticity and sham effects call into question these basic mechanisms.

P Wave Duration/P Wave Voltage Ratio Plays a Promising Role in the Prediction of Atrial Fibrillation: A New Player in the Game.

BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. Identification of patients at risk for developing AF and the opportunity for early targeted intervention might have a significant impact on morbidity and mortality. Prolonged P wave duration and decreased P wave voltage have been shown to be independent predictors of AF. The present study aimed to investigate the role of P wave duration/P wave voltage in predicting new-onset AF. METHODS: We screened a total of 640 consecutive patients who admitted to cardiology outpatient clinic with a complaint of palpitation between 2012 and 2014. 24-h Holter monitoring, echocardiography, and electrocardiography (ECG) recordings were reviewed to identify new-onset AF. Patients were assigned into two groups based on presence (n = 150) and absence (n = 490) of new-onset AF. Previous ECGs with sinus rhythm were analyzed. P wave duration was measured in inferior leads, and P wave voltage was measured in lead one. P wave duration/P wave voltage was also calculated for each patient. RESULTS: One hundred fifty subjects (23.4%) had new-onset AF among 640 patients. P wave duration (123.27 ± 12.87 vs. 119.33 ± 17.39 ms, p=0.024) and P wave duration/P wave voltage (1284.70 ± 508.03 vs. 924.14 ± 462.06 ms/mV, p < 0.001) were higher, and P wave voltage (0.12 ± 0.04 vs. 0.13 ± 0.04 mV, p < 0.001) was significantly lower in the new-onset AF group compared with non-AFs. P wave duration/P wave voltage, with a cut off of 854.5 ms/mV, had 83.3% sensitivity and 62.0% specificity in a receiver operating characteristic curve (AUC 0.728, 95% CI 0.687-0.769; p < 0.001). Their negative and positive predictive values were 78.7% and 68.6%, respectively. In a univariate regression analysis, age, smoking, C-reactive protein, brain natriuretic peptide, left atrial diameter, left atrial volume index, P wave duration, P wave voltage, and P wave duration/P wave voltage were significantly associated with the development of new-onset AF. Moreover, smoking (OR 4.008, 95% CI 1.707-9.409; p=0.001), left atrial volume index (OR 7.108, 95% CI 4.400-11.483; p < 0.001), and P wave duration/P wave voltage (OR 1.002, 95% CI 1.000-1.003; p=0.044) were found to be significant independent predictors of new-onset AF in a multivariate analysis, after adjusting for other risk parameters. CONCLUSION: The P wave duration/P wave voltage ratio is a practical, easy-to-use, cheap, and reliable electrocardiographic parameter, which can play a promising role for both in predicting and elucidating a mechanism of new-onset AF.

Assessment of novel biomarkers: sTREM-1, pentraxin-3 and pro-adrenomedullin in the early diagnosis of neonatal early onset sepsis.

BACKGROUND: Early onset bacterial sepsis in neonates (EOS) is recognized as an important health condition. Early diagnosis is crucial. However, blood culture results are released in 48-72 hours. Many biomarkers have been investigated but none have been accepted as the gold standard. This study aimed to investigate the diagnostic value of the molecules: soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1), pentraxin-3 (PTX-3) and pro adrenomedullin (pro-ADM) in EOS and compare with currently used biomarkers. METHODS: In this multicenter prospective study, patients were enrolled from different NICUs around the Turkey. Patient data were collected via web-based registry system from attending centers. Neonates, hospitalized with a suspicion of EOS were enrolled. Blood culture and routine blood tests were collected and a serum sample was obtained and kept in - 80°C for studying the molecules. According to laboratory results, patients were divided into three groups as; proven sepsis, clinical sepsis and control group. Groups were compared in terms of demographic, clinical and laboratory findings. The primary outcome of the study was to assess any difference between groups in terms of the diagnostic value of the markers aforementioned. RESULTS: A total of 130 patients were enrolled; proven sepsis (n = 36), clinical sepsis (n = 53) and control (n = 41) groups. Groups were similar in terms of demographic findings; mean WBC (P = 0.445), procalcitonin (PCT) (P = 0.083) and IL-6 (P = 0.814) levels. Mean C-reactive protein (CRP) level was significantly higher in clinical sepsis and proven sepsis groups compared to control group (P < 0.001). Mean PTX-3 (P = 0.547), pro-ADM (P = 0.766) and sTREM-1 (P = 0.838) levels were similar between groups. CONCLUSION: These promising molecules failed to help in early diagnosis of EOS. Their relation to correlation with disease progression may make more sense as they seem to be expressed in higher amounts with the progression of the disease in previous studies. CRP was the most frequently used biomarker for detecting the sepsis in our study population.

Sirenomelia associated with Hypoplastic Left Heart in a Newborn.

Sirenomelia, also known as "mermaid malformation/syndrome," is a rare, serious congenital anomaly characterized by variable degrees of fusion of the lower limbs and associated with severe malformations of vertebral, genitourinary, cardiovascular system and single umbilical artery. The first pregnancy of a 25-year-old woman resulted in one twin born by Cesarian section at 32 weeks' gestation, who was referred to our hospital with cyanosis, a congenital anomaly and respiratory distress. On physical examination, there was no urogenital region and anal fissure and gender was indeterminate. The arms were in adduction and wrist in flexion position with four fingers on the right hand and two fingers on the left hand. There was a single lower extremity with a webbed single foot and two toes consistent with sirenomelia type IV radiologically. Abdominal ultrasonography showed urogenital system agenesis and echocardiography detected hypoplastic left heart. However, the patient died 4 hours after birth. The other twin was followed for 1 week for nutrition and respiratory support and was then discharged without any problems.

An evaluation of cause-of-death trends from recent decades based on registered deaths in Turkey.

OBJECTIVES: Although cause-of-death analyses are very important to define public health policy priorities and to evaluate health programs, there is very limited knowledge about mortality profiles and trends in Turkey. The aim of this study was to measure the trends in mortality within three broad cause-of-death groups and their distribution by age groups and gender and to describe the changes of leading causes of death between 1980 and 2013 in Turkey. STUDY DESIGN: Descriptive study. METHODS: In the study, data on the number of deaths by year, gender, age and cause was obtained from the Turkish Statistical Institute. The causes of death were classified as group I: communicable, maternal, perinatal, and nutritional conditions; group II: non-communicable diseases (NCDs); and group III: injuries. Unknown or ill-defined causes of death were distributed within group I and group II. The percentage distribution of the cause-of-death groups by gender and age groups between 1980 and 2013 was identified. Age-standardized mortality rates (ASMRs) per 100,000 of broad causes-of-death groups were calculated using European Standard Population 1976 between 1980 and 2008. Changes in mortality rates per hundred were calculated using the formula ([the rate of last year of the period-the rate of the first year of the period]/the rate of the first year of the period). Gender and age-specific data were analyzed using the Joinpoint software to examine trends and significant changes in trends of mortality rates. RESULTS: Crude death rates for group I, group II, and group III were 157.3, 147.2, and 21.4 per 100,000 in 1980 and 35.3, 377.5, and 15.8 in 2008 for males; 161.8, 120.2, and 5.8 in 1980 and 38.6, 318.4, and 6.4 in 2008 for females, respectively. ASMRs for group I, group II, and group III were 146.3, 394.3, and 29.3 per 100,000 in 1980 and 49.7, 723.6, and 18.8 in 2008 for males; 138.0, 291.5, and 7.6 per 100,000 in 1980 and 47.7, 478.8, and 7.2 in 2008 for females, respectively. The mortality rates of group I for almost all age groups particularly below 5 years of age decreased significantly. CONCLUSION: This study indicates that Turkey is at an advanced stage in the epidemiological transition, with the majority of the causes of death from NCDs. Considering the regional differences, it is necessary to carry out studies on the specific details of epidemiological transition and the social determinants of deaths in Turkey.

Analysis of urine biomarkers for early determination of acute kidney injury in non-septic and non-asphyxiated critically ill preterm neonates.

OBJECTIVE: We designed the present study to test the hypothesis that urinary biomarkers might predict acute kidney injury (AKI) development in non-septic and non-asphyxiated critically ill preterm infants. We evaluated urine (u) sistatin-C (uCys-C), kidney injury molecule-1 (uKIM-1) and neutrophil gelatinase associate lipocaline (uNGAL) as markers of AKI. METHODS: Sixty-four preterm infants with gestational age between 28 and 32 weeks were included in this study. Biomarkers were measured on day of life (DOL) 1, 3, and 7. RESULTS: uNGAL levels in the AKI group were significantly higher than in no-AKI group on DOL 1, 3 and 7 (p = 0.016, p = 0.007 and p = 0.0014, respectively). CONCLUSIONS: uNGAL is sensitive, early, and noninvasive AKI biomarkers, increasing significantly in non-septic and non-asphyxiated critically ill preterm neonates.

Red blood cell distribution width: can it be a predictive marker for long-term valvular involvement in children with acute rheumatic carditis?

INTRODUCTION: In this study, we aimed to evaluate Red blood cell distribution width (RDW) in patients with acute rheumatic carditis during the acute phase and after anti-inflammatory therapy. METHODS: Pediatric patients diagnosed with acute rheumatic carditis (ARC) between 2006 and 2014 and age- and sex-matched controls were retrospectively analyzed. At the time of diagnosis and after 2 months of medical therapy, we reviewed the obtained demographic features; echocardiographic data; complete blood count reports, including RDW; acute phase reactants, including C-reactive protein; and erythrocyte sedimentation rate values. RESULTS: The number of the cases with ARC and age- and sex-matched controls were 100 and 110, respectively. The mean age of patients was 11.6 ± 2.5 years. WBC and platelet counts, RDW were found to be significantly higher in patient group compared with controls at the time of diagnosis, prior to the onset of treatment. RDW, platelet count, CRP, and ESR levels significantly decreased after an 8 weeks of medical treatment. RDW values after the medical treatment were still significantly higher compared with controls. RDW values were significantly higher in patients with multiple valvular involvement both prior to and after the treatment. Moreover, we found a significant and positive correlation between the RDW and the severity of mitral regurgitation in our patients (r: 0.46, P < 0.001). CONCLUSIONS: High levels of RDW after initial medical treatment may indicate an ongoing subtle inflammatory process that leads to future stenotic valvular lesions. However, long-term follow-up studies are needed involving adulthood period to support this hypothesis.

Effect of maternal cervical bacterial colonization on neonatal outcome in high-risk pregnancies: results from a tertiary maternity center in Turkey.

PURPOSE: To evaluate and compare the morbidity and mortality of neonates born to pregnant women with positive and negative cervical cultures. MATERIALS AND METHODS: The demographic and clinical features of mothers included in this study, along with details of the microorganisms isolated on maternal cervical cultures and the number of days between a positive cervical culture and delivery were recorded. Neonates were stratified into two groups based on cervical culture results of their mothers--Group 1, positive cervical culture; Group 2, negative cervical culture. RESULTS: A total of 216 women who delivered 242 infants were included in the study. Group 1 consisted of 90 neonates while Group 2 had 152 newborns. The difference between the groups with demographic characteristics was statistically insignificant. Mean levels of the acute phase reactants, CRP, and IL-6, obtained six hours after delivery were significantly higher in Group 1 compared to Group 2 (p < 0.05 for C-reactive protein (CRP) andp < 0.001 for IL-6). Although there was no difference between groups in terms of duration of respiratory support, mean duration of hospitalization, as well as mortality rate were significantly higher in Group 1 (p < 0.001, p < 0.05, respectively). CONCLUSIONS: Women diagnosed with a high-risk pregnancy should be treated with antibiotics immediately after a positive cervical culture result, and delivery should be delayed until the success of antibiotic treatment can be evaluated. Early initiation of maternal antibiotic therapy is associated with shorter durations of hospital stay for newborns. Close follow-up of mothers with high-risk pregnancies and extension of treatment duration are critical for determining prognosis in newborn infants.

Human milk banking and milk kinship: perspectives of religious officers in a Muslim country.

OBJECTIVE: The present study aims to determine the knowledge, attitudes and views of the Muslim religious officers regarding infant feeding, breast milk, wet nursing, milk kinship and human milk banks (HMBs). STUDY DESIGN: A total of 401 religious officers were included in the study. Participants included 355 community service religious officers and 46 faculty religious officers. RESULTS: Two hundred fifty-four (63.3%) participants were in favor of administering donor human milk when breast milk is not available from the mothers. To the question 'What kind of human milk bank would you approve as far as the religious sensitivity is concerned?' a majority of the religious officers (71.3%) responded that they would only approve if the milk pool contained a restricted HMB where a limited number of recipients were allowed to use the mixtures in these milk pools. Only 7 (1.7%) participants advocated initiating Western-style HMBs in Turkey. CONCLUSION: Turkish religious officers have revealed that they would only approve the establishment of an alternative HMB by a maximum three donors where up to three recipients whose identities are known by one another are allowed to use donor milk from each milk pool.

Sphingomonas paucimobilis bacteraemia and shock in a patient with rheumatic carditis.

Acute rheumatic fever (ARF) carditis is treated with steroids, which can cause changes in the cellular immune response, especially decreased CD3 (+) T cells. Nosocomial infections due to steroid use for treatment of ARF carditis or secondary to the changes in the cellular immune response have not been reported in the literature. Sphingomonas paucimobilis is a Gram-negative bacillus causing community- and hospital-acquired infections. It has been reported as causing bacteraemia/sepsis, pneumonia or peritonitis in patients with malignancies, immunosuppression or diabetes. We present a case with S. paucimobilis bacteraemia/sepsis and shock after administration of steroids for treatment of ARF carditis. We suggest early identification of the causative agent and appropriate adjustments of the treatment plan to avoid shock and possible mortality. This is the first reported case of S. paucimobilis bacteraemia/sepsis in the setting of steroid use for ARF carditis.

Severe semilobar holoprosencephaly and lissencephaly associated with cebocephaly in a newborn.

Holoprosencephaly is frequently accompanied by midline facial abnormalities such as hypotelorism, cyclopia, etmocephaly and cebocephaly. Cebocephaly is a very rare congenital anomaly combining with semilobar holoprosencephaly. Chromosomal analysis shows normal karyotyping. Lissencephaly and holoprosencephaly are rare associations, that have not been reported yet with cebocephaly. Herein we present the first case of cebocephaly with severe semilobar holoprosencephaly and lissencephaly.

The association between respiratory tract Ureaplasma urealyticum colonization and severe retinopathy of prematurity in preterm infants ≤1250 g.

AIM: To evaluate the association between respiratory tract Ureaplasma urealyticum (Uu) colonization and development of retinopathy of prematurity (ROP) requiring treatment. METHODS: The infants with birthweight (BW) ≤1250 g born in a third-level neonatal intensive care unit between March 2009 and May 2010 were prospectively identified. Nasopharyngeal swabs for Uu colonization were taken in postnatal first 3 days. Culture-positive patients were reevaluated on the twelfth day by nasopharyngeal swabs for Uu. The primary outcome was to define whether there was an association between respiratory tract Uu colonization and severe ROP requiring treatment. Independent sample's t-test or Mann-Whitney U-test was used to compare continuous variables and Chi-square test or Fisher's exact test for categorical variables. Multivariate (backward) logistic regression analysis was performed to simultaneously measure the influence of the independent variables with ROP as the dependent variable. RESULTS: A total of 25 (12.1%) infants developed severe ROP requiring treatment among 206 infants who underwent ROP screening. Mean BW and gestational age of total cohort were 1013±159 g and 27.9±1.6 weeks, respectively. Multivariate analysis demonstrated that BW (OR: 0.64 (95% Cl 0.47-0.88); P=0.006), duration of mechanical ventilation (OR: 1.17 (95% Cl 1.06-1.28); P=0.001), premature rupture of membrane >18 h (OR: 3.83 (95% Cl 1.2-12.2); P=0.02), and Uu positivity in both cultures (OR: 5.02 (95% Cl 1.8-13.9); P=0.002) were independent risk factors for the development of severe ROP requiring treatment. CONCLUSIONS: Respiratory tract colonization with Uu was independently associated with severe ROP requiring treatment.

Public attitudes toward stuttering in Turkey: probability versus convenience sampling.

PURPOSE: A Turkish translation of the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) was used to compare probability versus convenience sampling to measure public attitudes toward stuttering. METHOD: A convenience sample of adults in Eskisehir, Turkey was compared with two replicates of a school-based, probability cluster sampling scheme. RESULTS: The two replicates of the probability sampling scheme yielded similar demographic samples, both of which were different from the convenience sample. Components of subscores on the POSHA-S were significantly different in more than half of the comparisons between convenience and probability samples, indicating important differences in public attitudes. CONCLUSIONS: If POSHA-S users intend to generalize to specific geographic areas, results of this study indicate that probability sampling is a better research strategy than convenience sampling. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) discuss the difference between convenience sampling and probability sampling; (2) describe a school-based probability sampling scheme; and (3) describe differences in POSHA-S results from convenience sampling versus probability sampling.

Stuttering attitudes among Turkish family generations and neighbors from representative samples.

PURPOSE: Attitudes toward stuttering, measured by the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S), are compared among (a) two different representative samples; (b) family generations (children, parents, and either grandparents or uncles and aunts) and neighbors; (c) children, parents, grandparents/adult relatives, and neighbors of the same family/neighbor units vs. individuals from different family/neighbor units; and (d) attitudes from one Turkish city with an international database archive. METHODS: Following a school-based, three-stage, cluster probability sampling scheme, two sets of children, parents, grandparents/adult relatives, and neighbors (50 each) in Eskisehir, Turkey (PROB1 and PROB2) completed Turkish translations of the POSHA-S. The POSHA-S measures attitudes toward stuttering within the context of other attributes, such as obesity and mental illness. RESULTS: Both replicates of the sampling procedure yielded strikingly similar attitudes for stuttering between children, parents, grandparents/adult relatives, and neighbors in PROB1 vs. PROB2, and between all pair-wise comparisons within PROB1 and PROB2. By contrast, attitudes toward obesity and mental illness were dissimilar. Correlations were small to moderate among attitudes of the same family/neighbor units but were essentially nonexistent between different family/neighbor units. Attitudes toward stuttering in Eskisehir were estimated to be less positive than attitudes from a wide range of samples around the world, although exceptions occurred. CONCLUSIONS: A school-based probability sampling procedure yielded consistent findings that are likely different from results from convenience samples. Families appear to be an important influence in determining public attitudes toward stuttering and other human attributes. EDUCATIONAL OBJECTIVES: The reader will be able to: (i) identify similarities and differences among attitudes toward stuttering across generations; (ii) identify similarities and differences among attitudes toward stuttering in Turkey vs. other places in the world; (iii) describe a school-based probability sampling scheme; (iv) describe advantages of using a standard instrument to measure public attitudes toward stuttering.

Effects of transcatheter closure of atrial septal defects on heart rate variability.

This study evaluated heart rate variability and its changes in 30 patients before and after transcatheter closure of secundum atrial septal defects. Heart rate variability data from 30 healthy volunteers with normal echocardiographic parameters and no history of atrial septal defects were included as controls. Values for the SD of all the normal RR intervals (SDNN), the SD of the means of all the 5-min segment normal RR intervals (SDANN), and the mean of all the 5-min SDs of normal RR intervals during the 24-h period (SDNN index) in patients with atrial septal defects before transcatheter closure were statistically significantly different from controls. At 6 months after closure of the defects these values were not statistically different from controls. It is concluded that transcatheter closure of secundum atrial septal defects had positive effects on heart rate variability and, consequently, may contribute to less mortality and morbidity.