Environmental risk perception of mothers and presence of risk factors in rural and urban areas in Adana, Turkey.

This cross-sectional study with an open-ended manner aimed (1) to evaluate the environmental risk perception levels of mothers having at least one child and living in Adana and (2) to determine their awareness of the risk factors in their environment. Of mothers, 30.2% did not know the concept of environmental risk factor. Most frequent perceived risks were violence (17%), air pollution (15.5%) and undefined pollution (15%). The most common mentioned problems in their environment were air pollution (9.9%), violence (7.9%) and municipal service problems (8.4%). Mothers living in the urban area reported more violence, air pollution and undefined pollution as environmental threats than those living in the countryside. The place of residence, the education level of the mother and the number of people in the house significantly were related with the risk perception. There is a need for studies in other regions to determine the environmental literacy of mothers.

Video game playing among preschoolers: prevalence and home environment in three provinces from Turkey.

We aimed to investigate the video game habits and their relationship with home environment in children 2-5 years in Turkey. A structured questionnaire about the child's demographic, screen, and video gaming characteristics was completed by parents in five health centers from three provinces. One-quarter of 1245 preschoolers were found to play video games. The prevalence of playing video games was higher in older age, male gender, low parental education, families with 3 or more children, having a game console, computers and tablets at home, child's screen time of more than 2 hours per day, child's non-compliance with the parental screen rules, and presence of someone else playing videogame at home. Of the parents, 54.5% did not know the name of the video game the child was playing. Parents should be counseled about supervising on their children's video game playing habits and selection of well-designed games with the right content.

Validity Analysis on the Findings of Dehydration in 2 to 24-Month-Old Children With Acute Diarrhea.

OBJECTIVE: The most common cause of diarrheal mortality in children is dehydration. In this study, we aimed to assess the validity (sensitivity and specificity) of history and the clinical and laboratory findings in in the diagnosis of dehydration in children younger than 2 years with acute diarrhea. METHODS: One hundred twenty-six 2 to 24-month-old children with acute diarrhea, who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital's Diarrheal Diseases Treatment and Training Unit, were included. The patients were examined on admission for clinical findings of dehydration. Percent weight loss on admission was calculated by using the weight on admission and the weight after the diarrhea resolution and was used as the golden standard for analyzing the validity of clinical and laboratory findings. RESULTS: Compared with the golden standard, dehydration was overestimated in 13% of the cases and underestimated in 7% when using only the World Health Organization criteria. Dehydrated children had higher diarrheal frequency and longer anuria time. Thirst, weakness, sunken fontanelle, sunken eyes, decreased tears, dry mucous membranes, and dry lip were detected in children with 2% or greater of weight loss. The most valid laboratory findings were low serum pH (<7.30), low bicarbonate (<15 mmol/L), and hyperurisemia (>5.8 mg/dL). In multivariate analysis, physical findings, such as thirst, dry mucous membranes, weakness, sunken eyes, hoarse crying, and low pH, were found to be significant for the diagnosis of dehydration. CONCLUSIONS: In children with acute diarrhea, diarrheal frequency and last urination time should be asked, thirst, dry mucous membranes, weakness, sunken eyes, and hoarse crying should be examined.

A comparison between the feeding practices of parents and grandparents.

The aim of this study is to evaluate and compare mothers' and grandparents' feeding behaviours, the differences between the behaviours, the relationship between children's feeding problems and grandparents' feeding behaviours, as well as the relationship between grandparents' feeding behaviour and children's body mass index (BMI). This study prompts physicians to pay attention to the on feeding behaviours of grandmothers when evaluating the feeding problems and behaviours of children. This study is a controlled case study. Two hundred children (between 2 and 5 years of age) were included. Amongst these children, 150 of them were only fed by their mothers and 50 of them were fed by both their mother and grandmother. The feeding behaviour was evaluated by the Comprehensive Feeding Practices Questionnaire (CFPQ).Three domains emerged in this study: Some of the feeding behaviours were significantly different between the mothers and grandmothers who were questioned in the CFPQ. The feeding behaviours are related to the feeding problems; in this study, we show that, in some cases, whether some feeding behaviours were applied either more or less had a significant influence on feeding problems. There were positive correlations between the feeding behaviours of mothers and grandmothers. Conclusion: There is limited research about grandmothers' influence on child feeding. Research in grandmothers' feeding behaviours may reveal key concerns in children feeding problems and in preventing childhood obesity. What is Known: • According to studies, there are differences between the feeding behaviours of mothers and grandmothers. What is New: • This study is the first to explore the relationship between the feeding problems and feeding behaviours of both mothers and grandmothers. Also, a comparison of the mothers' and fathers' mothers' feeding behaviours has not yet been carried out.

A community-based iron supplementation program, "Iron-Like Turkey", and the following prevalence of anemia among infants aged 12-23 months.

During the second year of the "Iron-like Turkey" Project, in which all children aged 4-6 months in Turkey receive iron supplementation for 5 months, we aimed to assess the utilization of iron supplementation in the field, as well as the prevalence of anemia in healthy infants aged 12-23 months, while determining a variety of sociodemographic and nutritional factors for anemia in three of the 12 NUTS (Nomenclature of Territorial Units for Statistics) regions (regions with the highest, lowest and middle under-5 malnutrition levels). In a community-based, cross-sectional survey using a multi-staged, weighted, cluster-selected sample, children aged 12-23 months with birthweight ≥2500 g, no chronic illness, no history of blood disease, and from term and singleton pregnancy were enrolled; 1589 children met the criteria. The mean±SD age of children surveyed was 17.8±3.6 months. Of the parents, 72.4% claimed that their physician had recommended iron supplementation, and 68.8% had given supplementation to their children. Overall prevalence of anemia was 7.3%. Multivariate analysis revealed that the frequency of anemia decreased significantly in older infants, when supplementation was recommended by health providers, when an infant was breastfed longer than 6 months, and when the mother received iron supplementation during pregnancy. However, anemia prevalence increased when the infant received iron supplementation at a later age (³9 months), lived in a crowded family (³6 persons), and when the mother had a history of iron deficiency anemia. Anemic infants had significantly lower z scores of weight for age than non-anemic ones. This survey suggests that iron supplementation during pregnancy, initiation of iron supplementation in infants at 4-6 months of age, effective counseling on supplementation, subsequent compliance, support of breastfeeding, and effective training of health care personnel are effective strategies for prevention of anemia in the community.

Association of bisphenol A with 25(OH)D, 1,25(OH)2D levels and 1,25(OH)2D/25(OH)D ratio in cord blood.

The aim was to investigate the association between bisphenol A (BPA), 25-hydroxy vitamin D [25(OH)D], and 1α,25 dihydroxy vitamin D [1,25(OH)2D] levels in the cord blood of newborn babies. BPA was measured by high pressure liquid chromatography (HPLC) and vitamin D levels by commercial ELISA or ECLIA kits. BPA and Vitamin D levels were grouped according to tertile values. In the cord blood, the median 25(OH)D level was 14.9 ng/mL (IQR: 8.5-20.8) and median 1,25(OH)2D level was 53.3 pg/dL (IQR: 42.3-98.4). 25(OH)D levels were < 20 ng/mL in 76.5% of the babies. BPA was detectable in 72.4% of the cord blood samples; median BPA level was 1.57 ng/mL (IQR: < DL-4.05 ng/mL). Frequencies of vitamin D deficiency and frequencies of cases having the highest tertile active vitamin D levels were similar in groups of BPA tertiles in both univariate and multivariate analysis. In conclusion, both BPA exposure and insufficient vitamin D transfer via cord blood are common in newborns. Bisphenol A levels were not correlated with vitamin D levels in cord blood of healthy mother-fetus pairs.

Family and infant characteristics in relation to age at walking in Turkey.

The purpose of this study was to assess the onset of independent ambulation relative to possible relationships with maternal and infant characteristics. In a cross-sectional study, the health files of 1,553 Turkish children aged 12-23 months were selected by the multistage sampling method in the Nomenclature of Territorial Units for Statistics (NUTS) regions coded as low, medium and high malnutrition levels in Turkey. Children were selected from health centers by systematic sampling technique in each region. Kaplan-Meier analysis and estimated mean values were used for data description; log-rank test and the Cox multivariable regression analysis were applied for data analysis. Maternal education level, occupation, region of residence, gestational iron supplementation, child's gender, child's nutritional status, and presence of anemia in the infant during the survey period demonstrated significant relationships with walking unassisted in the univariate analysis. However, multivariable analysis showed that high maternal education, absence of parental consanguinity and appropriate weight-for-age Z score were positively associated with earlier age of walking. These findings showed the importance of improvement in girls' education, prevention of postnatal growth retardation and improvement in diet quality for children's gross motor development. In addition, counseling programs should be given to decrease the rate of parental consanguinity.

Mercury exposure via breast-milk in infants from a suburban area of Ankara, Turkey.

The objective of this study was to evaluate mercury (Hg) levels in breast-milk in the postpartum 2nd month and to determine the relationship between Hg levels and sociodemographic parameters, maternal nutritional habits, presence of dental amalgam, maternal depression, maternal anemia, and growth status of infants. One hundred forty-four mothers residing in a suburban area in Ankara were invited at the 2nd month postpartum. A questionnaire concerning sociodemographic characteristics, vitamin intake during pregnancy and in the 2nd month postpartum, consumption of fish and viscera, smoking habits, and presence of dental fillings was applied. Hg could be detected in samples of 18% of the mothers, all levels of which were higher than the Hg limit in breast-milk reported by the World Health Organization. The Hg levels were higher in mothers who consumed viscera than in those who did not. Turkish women can still safely breastfeed their children, but Hg contamination in breast-milk should be monitored during the lactation period.

Salmonella gastroenteritis in children (clinical characteristics and antibiotic susceptibility): comparison of the years 1995-2001 and 2002-2008.

We document herein the prevalence and serotype distribution among Salmonella enterica strains isolated from children treated for diarrhea over two seven-year periods spanning 14 years. Four hundred and eight (1.38%) S. enterica cases were isolated among 29,601 diarrheal admissions. Among the Salmonella isolates, 63.7% were serogroup D and 29.9% were serogroup B. Overall, 21.7% of cases were under one year of age, with 2.1% being younger than three months. Bloody diarrhea was found in 18.8% of the cases. The resistance rates were 25.8%, 18.2%, 7.0%, 4.7%, and 0.3%, to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ceftriaxone, and ciprofloxacin, respectively. In conclusion, our study has revealed that the predominance of Salmonella serogroup D continues. The clinical features of our patients were mostly mild, with no deaths or severe complications. While resistance to antimicrobial agents changes constantly, it is important to keep these strains under surveillance in order to formulate policies for the rational use of antimicrobial agents.

The analysis of child abuse and neglect cases assessed by a multidisciplinary study group between 2005-2008.

This study aimed to evaluate the diagnosis, treatment and follow-up of child abuse and neglect (CAN) cases. Subjects were 102 cases that were clinically assessed by the multidisciplinary hospital team. Early and late childhood cases (according to the age at first abuse) were compared by means of characteristics of abuse. Among the 102 subjects, 64 were female and 38 were male (mean age: 8.68 years). Being abused by someone within the family was found to be significantly higher in preschool children compared to children in late childhood. 27.5% (n: 28) of the cases concomitantly had low socioeconomic and educational level and high parental psychological problems and 64.8% had psychiatric problems. A limited number of studies have compared characteristics of early and late childhood abuse considering the age of onset of maltreatment. Consistent with the literature, our study showed that early age of onset of maltreatment is a poor prognostic factor in many ways.

Hepatitis A seroprevalence among infants aged 12 months in Ankara.

Seroprevalence studies in various age groups contribute to a better understanding of hepatitis A infection and response to hepatitis A immunization. Hepatitis A seroprevalence in 12-month-old infants from Ankara was studied. Among 601 healthy infants, overall hepatitis A seropositivity was found to be 23.5%. There were no gender differences in seropositivity (22.6% for male and 24.5% for female infants). Although vaccination of infants would be an ideal prevention strategy, presence of maternal anti-hepatitis A virus (HAV) antibody interferes with the immune response to hepatitis A vaccine in infants and young children. Therefore, further knowledge about decay of maternal antibody in infants is important in determining the optimal age for vaccination against hepatitis A. There is no recommendation for routine hepatitis A vaccination in Turkey. However, we need more seroprevalence studies in different age groups to decide the appropriate timing/age of vaccination.

Urinary bisphenol A levels in prepubertal children with exogenous obesity according to presence of metabolic syndrome.

OBJECTIVES: Recent studies have shown a potential link between chronic exposure to Bisphenol A (BPA) and exogenous obesity, the prevalence of which has been increasing dramatically in all age groups and particularly among children in the last decades. In this study, we aimed at comparing BPA exposure levels between controls and otherwise healthy, drug-naive, pre-pubertal children having exogenous obesity with/without metabolic syndrome. METHODS: A total of 63 pre-pubertal children with exogenous obesity whom 27 of them having metabolic syndrome attending Hacettepe University Ihsan Dogramaci Children's Hospital were included in this study. The control group consisted of 34 age- and sex-matched healthy children with no significant underlying medical conditions. Urinary BPA levels were measured using LC-MS/MS (high-performance liquid chromatography coupled with tandem mass spectrometry) methodology. RESULTS: Urinary BPA levels among obese children were significantly higher than those of the control group (median: 22.9 µg/g-creatinine and 6.9 µg/g-creatinine, respectively; p=0.0001). When adjusted with generalized linear models for age, gender and z scores of body mass index, obese children having metabolic syndrome had significantly higher urinary BPA levels than obese children without metabolic syndrome and both obese groups had considerably elevated levels of urinary BPA than the controls (estimated marginal mean ± standard error: 42.3 ± 7.4 µg/g-creatinine, 22.6 ± 3.5 µg/g-creatinine and 12.1 ± 2.5 µg/g-creatinine, respectively, p=0.0001). CONCLUSIONS: This study shows much higher BPA exposure among obese children with metabolic syndrome during the prepubertal period.

Serological response to influenza vaccine after hematopoetic stem cell transplantation.

Vaccination is the best strategy to prevent influenza infection that is a potential cause of morbidity and mortality in immunosuppressed patients. Here, we evaluated the factors that may affect serological response to influenza vaccine in patients who have undergone hematopoetic stem cell transplantation (HSCT). Sixty-one HSCT recipients were included in the study during the 2007-2008 influenza season. Serum samples prior to vaccination and 6-10 weeks after vaccination were collected. Samples were assayed for antibodies to influenza virus A/H1N1, A/H3N2, and B strains by hemagglutination-inhibition assay. The patients were followed in terms of clinical symptoms up to the next influenza season and for adverse effects within a month after vaccination. Overall, pre-vaccine seroprotection rate against all vaccine antigens (A/H1N1, A/H3N2, and B antigens) was 45.1%, post-vaccine seroprotection rate 91% and seroconversion rate was 28.3%. Seroconversion rates were found to be low against B in patients who were vaccinated in the late influenza season (p = 0.018; respectively). Five patients (10.9%) had no immune response against H1N1. Adverse events were reported in 19.6% (n = 9/46) of the patients. In conclusion, the patients should be vaccinated as early as possible in the influenza season, before they are exposed to the virus.

Why are they having infant colic? A nested case-control study.

We aimed to analyse infant (birth characteristics, feeding type, faecal enzyme activities) and environmental (maternal smoking, nutrition and psychological status, mother-child bonding, family structure, support for the mother, familial atopy) risk factors for infant colic and to follow infants with respect to physical growth, sleeping status up to 8 months of age in a nested case-control study. 660 mothers who delivered at Dr Zekai Tahir Burak Maternity Hospital, were enrolled within 3-72 h post delivery. Each infant with inconsolable persistent crying and four matched infants with no crying episodes were invited by phone to Hacettepe University Ihsan Dogramaci Children's Hospital at 30-45 days post partum. At 40-55 days, we examined the infants and gave mothers a questionnaire, including crying characteristics of the infants; 47 infants were diagnosed with colic and 142 as non-colic. When the infants were 7-8 months old, another interview was done. The colic group had higher proportions of less-educated (≤ 8 years) and smoking mothers, extended family and families with domestic violence than the non-colic group. The colic group of mothers had significantly higher rates of 'impaired bonding' in the Postpartum Bonding Questionnaire, higher scores on the Edinburgh Postnatal Depression Scale, higher scores for hostility subscales of the Brief Symptom Inventory and a more irregular sleep pattern than the non-colic group. No differences were revealed for faecal enzyme activities. At 7-8 months, the colic group was shorter than the non-colic group. Colic was associated with various perinatal factors (maternal education, smoking habits, cheese consumption, hostility scores and domestic violence) and having colic in infancy negatively affected the sleeping pattern and the height of the infant.

Measles, mumps, and rubella antibody status and response to immunization in children after therapy for acute lymphoblastic leukemia.

Seventy-seven patients with acute lymphoblastic leukemia (ALL) who were in complete remission and whose therapies had been stopped for at least 6 months before enrollment in this study were retrospectively analyzed regarding their antibody status for measles, mumps, and rubella, with the aim to demonstrate the seropositivity rate after treatment in the authors' group. Each patient's serum samples were analyzed by enzyme-linked immunosorbent assay (ELISA) method to determine the antibody titers before and after immunization. Measles serology was available in 77 children; 45 (58%) were seronegative. Initial ages of measle-seronegative patients were statistically lower than those of seropositive cases (median 3.29 versus 4.91 years, respectively). Mumps serology was available in 76 children; 36 (47%) were seronegative. Mumps-seropositive cases tended to have more frequent previous history of infection than seronegative cases (55.0% versus 28.6%, respectively, P = .05). Rubella serology was available in 76 children, and 20 (26.3%) were seronegative. It was determined that initial ages of rubella-seronegative patients were statistically lower than those of seropositive cases (median 3.03 versus 4.32 years, respectively). The authors concluded based on the results of their study that at a median of 3.31 years after completion of chemotherapy for ALL, the majority of cases had antibody levels lower than protective values for measles (58.4%); however, these values were 47.3% for mumps and 26.3% for rubella. Seroconversion rates after measles (55%) and mumps vaccination (57.1%) were still low. However, in the available cases, relatively adequate response to rubella vaccination (92.3%) was observed.

Effect of glutamine supplementation on lymphocyte subsets in children with acute diarrhea.

To study the effect of glutamine supplementation on lymphocyte subpopulation counts in children with acute diarrhea, children aged 6-24 months were enrolled in a double-blind randomized study. Cases had received either 0.3 g/kg/day of glutamine or placebo orally for seven days. The counts of blood leukocytes, lymphocytes and lymphocyte subpopulations (CD3+, CD4+, CD8+, CD19+, CD16+CD56+) were determined both on admission and seven days later using a flow cytometry. When adjusting for sex, current breastfeeding status, dehydration, and nutritional status of children, lymphocyte subpopulations did not differ significantly between the glutamine- and placebo-supplemented groups on the 7th day of intervention.

Sensitivity and specificity of bloody diarrhea in shigella gastroenteritis.

The sensitivity and specificity of bloody diarrhea in the diagnosis of shigella gastroenteritis in a Shigella sonnei prevalent center was investigated. The shigella-proven gastroenteritis cases who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital Diarrheal Diseases Unit (Jan 2003 - Oct 2006) constituted the study group (n=65). Age- and sex-matched children admitting to the same center with non-shigella diarrhea constituted the control group (n=65). The sensitivity, specificity, and positive and negative predictive values of bloody diarrhea were found to be 30%, 100%, 100% and 58%, respectively. Sensitivity of bloody diarrhea in the diagnosis of shigella gastroenteritis was low in this center. New strategies and recommendations in the management of mild nonbloody cases are needed.

The urinary cotinine levels of infants and the determinants.

The aim of this study was to determine the effect of the route of tobacco smoke exposure on urinary cotinine levels of infants. A cross-sectional analysis was done on 254 six-month-old infants. The infants were grouped according to the route of tobacco smoke exposure. The urinary cotinine/creatinine ratios were determined. Forty-nine percent (124/254) of mothers were smokers. Urinary cotinine levels in infants of smoking mothers were statistically significantly higher than levels in infants of non-smoking mothers. The highest mean cotinine/creatinine level was found in the breast-milk-exposed group. Linear regression analysis showed that maternal smoking increased urinary cotinine level by 541 times and breastfeeding increased it by 171 times, whereas early start of formula feeding decreased it by 63 times. Tobacco exposure by breastfeeding may be more harmful than other routes of exposure. Mothers should be encouraged to stop smoking during the breastfeeding period even if they avoid exposing their infants to passive tobacco smoke.

Maternal and environmental determinants of breast-milk mercury concentrations.

We aimed to evaluate the maternal factors [including dietary habits, dental care, smoking, anemia, levels of breast-milk zinc (Zn) and iron (Fe), and levels of serum selenium (Se), Zn and copper (Cu)] that influence breast-milk mercury (Hg) concentrations and to investigate whether there is any relation between Hg concentrations and infant growth and development during the exclusive breastfeeding period and in the second year of life. Forty-four healthy mother-infant pairs in the 10-20-day postpartum period were enrolled in the study. Maternal history and blood samples for hemoglobin, Fe, Fe binding capacity, ferritin, Se, Zn, and Cu and breast-milk samples for Fe, Zn and Hg were taken. Infant growth and development during the exclusive breastfeeding period and in the second year of life were followed. The mean concentration of breast-milk Hg was 3.42 +/- 1.66 microg/L. Serum Se levels were negatively correlated with milk Hg levels. Multivariate analysis revealed that active/passive smoking and offal intake during pregnancy and presence of maternal anemia had an impact on increased milk Hg concentrations. Preventive strategies for mercury exposure should include management of iron deficiency anemia, cessation of smoking exposure and proper nutrition during the pregnancy period.

Factors associated with breastfeeding initiation time in a Baby-Friendly Hospital.

The purpose of this study was to investigate maternal, gestational, and neonatal features associated with the early initiation of breastfeeding. A descriptive study was done between July-October 2006 in the maternity ward of Dr. Zekai Tahir Burak Maternity and Research Hospital, a certificated Baby-Friendly Hospital. Babies with postpartum health problems and those hospitalized in the newborn intensive care unit were not included into the study. A total of 577 mothers participated within 4 to 36 hours' postpartum on a voluntary basis. The mothers completed a questionnaire about the gestational, maternal, neonatal, and first suckling characteristics. Of the 577 cases, 35.2% initiated breastfeeding within the first hour while 72.8% of them initiated breastfeeding within the first two hours of birth. In the multivariate logistic analysis, it was found that the factors affecting early breastfeeding status (within the first 2 hours of birth) were maternal illness during pregnancy, cesarean section and preterm birth. We concluded that the prevention of premature birth, limitation of cesarean section indication, management of maternal anemia, regular and effective pregnancy follow-up visits are important for the early initiation of breastfeeding.