Young children's sleep patterns and problems in paediatric primary healthcare settings: a multicentre cross-sectional study from a nationally representative sample.

Studies describing paediatric sleep patterns are needed by taking culture into consideration. The aim of this study was to identify parent-reported sleep-wake patterns in young children and explore possible factors influencing sleep problems. The mothers of 2,434 young children enrolled from well-child outpatient clinics in Turkey completed an online survey including sociodemographic variables, Brief Infant Sleep Questionnaire, Edinburgh Postnatal Depression Scale and Generalised Anxiety Disorder scales. Overall, young children in Turkey go to bed late (10:00 p.m.), awaken twice per night for 30 min, and obtain 11.5 h of total sleep, showing no sex-specific differences. Distinct night-time sleep patterns emerged after 18 months of age. Importantly, although currently breastfed healthy children were 3.8-times less likely to sleep through the night, total sleep duration and exclusive breastfeeding duration were higher in children who were not sleeping through the night. Overall, bedsharing was identified in 11.5%, and only room sharing was reported in 52.9%. Parental perception of a child's sleep as problematic was 35.8%. Mothers with higher educational attainment were more likely to perceive their children's sleep as a problem. Maternal depressive and anxious symptoms and a history of excessive infant crying were the determinants predicting the likelihood of both parent-perceived sleep problems and poor sleepers. The present analysis of sleep structure in infancy and toddlerhood provides reference data for well-child visits. These findings highlight the importance of considering maternal anxiety, depression and behaviour management techniques to cope with fussy infants in addressing childhood behavioural sleep problems.

Clinical practice guidelines for the diagnosis and treatment of scabies.

Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global impact is considerable, affecting more than 200 million individuals annually and posing significant challenges to healthcare systems worldwide. Transmission occurs primarily through direct skin-to-skin contact, contributing to its widespread prevalence and emergence as a substantial public health concern affecting large populations. This review presents consensus-based clinical practice guidelines for diagnosing and managing scabies, developed through the fuzzy Delphi method by dermatology, parasitology, pediatrics, pharmacology, and public health experts. The presence of burrows containing adult female mites, their eggs, and excreta is the diagnostic hallmark of scabies. Definitive diagnosis typically involves direct microscopic examination of skin scrapings obtained from these burrows, although dermoscopy has become a diagnostic tool in clinical practice. Treatment modalities encompass topical agents, such as permethrin, balsam of Peru, precipitated sulfur, and benzyl benzoate. In cases where topical therapy proves inadequate or in instances of crusted scabies, oral ivermectin is recommended as a systemic treatment option. This comprehensive approach addresses the diagnostic and therapeutic challenges associated with scabies, optimizing patient care, and management outcomes.

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

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

Educating children through their parents to prevent child sexual abuse in Turkey.

PURPOSE: The aims of this study were to train parents to recognize and prevent child sexual abuse (CSA); evaluate the problems encountered by parents; and evaluate the overall effectiveness of the CSA training program. DESIGN AND METHODS: The study used a pretest/posttest design. The study was conducted with a sample of 58 children (aged 3-6 years) and 64 parents. FINDINGS: Children who received CSA prevention education from their parents demonstrated improved knowledge about private parts and about what they should do if they suspect sexual abuse. The parents stated that they encountered some problems (other family members objected to the child being given such training). PRACTISE IMPLICATIONS: Children's risk of abuse may be reduced if their parents teach them about CSA correctly.

Viral seroprevalence in pediatric kidney transplant recipients.

AIM: Viral infections commonly affect kidney transplant recipients and may lead to graft failure and death. The aim of this study was to evaluate the antibody seroprevalence against viral agents in kidney transplant recipients. MATERIAL AND METHODS: The records of children who underwent kidney transplantation between 2008 and 2018 in Akdeniz University Faculty of Medicine were retrospectively reviewed. Epstein-Barr virus, cytomegalovirus, hepatitis A virus, hepatitis B virus, varicella, measles, rubella and mumps serologies evaluated before transplantation, were recorded. The clinical characteristics of seronegative and seropositive patients were compared, and factors that affected seropositivity were investigated. RESULTS: The study included 253 children with a mean age of 16.7±6.23 years. The mean age at transplantation was 11.4±5.01 years. The seropositivity rates for vaccine-preventable viral infections varied: hepatitis B 89.7%, hepatitis A 60.5%, measles 78.7%, rubella 88.1%, mumps 61.2%, and varicella 71.9%. Cytomegalovirus seropositivity was 92.1% and Epstein-Barr virus seropositivity was 82.2%. Hepatitis B antibody positivity was 91.8% in patients undergoing hemodialysis, 94.5% in patients undergoing peritoneal dialysis, and 84.9% in pre-emptive transplantation patients (p=0.037). The mean age at transplantation was higher in patients with seropositivity for both cytomegalovirus and Epstein-Barr virus compared with seronegative patients (p<0.001 for both). The mean age at transplantation and diagnosis of glomerular disease was found to be effective for varicella seropositivity in multivariate regression analysis (OR 0.860, 95% CI: 0.808-0.915, p<0.001 and OR 2.502, 95% CI: 1.321-4.739, p=0.005, respectively). CONCLUSION: It is important to screen patients with chronic kidney disease in terms of vaccine-preventable diseases to identify risky groups of patients and to immunize these patients before end-stage kidney disease develops.

Leptin profile in neonatal gonadotropin surge and relationship between leptin and body mass index in early infancy.

AIM: This study was designed to investigate the longitudinal and dynamic profile of leptin and its relationship with sex hormones including luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2) and testosterone (TTE) in neonatal 'minipuberty'. We also investigated the effects of leptin in the regulation of body weight gain and body mass index (BMI) in the first 3 months of life. METHODS: A longitudinal study was carried out in a cohort of 15 male and 15 female term infants during the first 3 months of life. Blood samples were collected in the morning from the infants on the 3rd, 15th, 30th, and 90th days of life. At each sample collection, anthropometric measurements were recorded. Serum leptin, LH, FSH, E2 (girls only) and TTE (boys only) concentrations were analyzed using standard biochemical methods. Association of leptin with weight gain, BMI, and these hormones during infancy was evaluated. RESULTS: Leptin levels increased significantly between the 3rd and 90th days of life in both boys and girls. BMI of both groups increased significantly from the 3rd to the 90th day. There was no significant difference in the leptin levels and leptin/BMI ratios of the two sexes at different time points. Leptin levels on the 30th and 90th days correlated significantly with BMI in both sexes. LH and FSH levels in both groups were found to be significantly higher on the 15th day of life. No correlation was observed between leptin and LH, FSH, E2 or TTE levels throughout the study. CONCLUSIONS: Leptin levels do not differ between the two sexes during early infancy and possibly there is no role for leptin in the surge of gonadotropins or sex steroids in neonatal minipuberty. The relationship between leptin and BMI could not be seen in the first postnatal days and the transient lack of the regulatory effect of BMI on leptin concentrations might reflect an adaptive resistance in the production of leptin to support catch-up growth after initial physiological weight loss in newborns.

The effect of concurrent use of hepatitis B and Bacille Calmette-Guérin vaccination on anti-hepatitis B response.

OBJECTIVE: Bacille Calmette-Guerin (BCG) is given at 2-months of age; diphtheria toxoid, tetanus toxoid, whole cell pertussis, oral polio are given at 2, 3, 4 months, and hepatitis B virus (HBV) vaccine is given at 3, 4, 9 months of age. The aim was to evaluate the sero-protection rate of HBV vaccine which has been given at 2, 3, and 9 months of age and coincided with BCG vaccine at the first dose. METHODS: Hepatitis B virus vaccine was administered to 3 groups of infants at 2, 3, 9 months (n=20), 3, 4, 9 months (n=20) concurrently with BCG or other vaccines, and at 0, 1, 6 months with no other coinciding another vaccine (n=20). These 60 infants who were born between June 2001 and September 2001 have been vaccinated at the Akdeniz University School of Medicine, Antalya, Turkey. Antibodies to hepatitis B surface antigen analyzed by enzyme-linked immunosorbent assay. RESULTS: The simultaneous administration of BCG and HBV vaccines did not influence the immune response to HBV vaccine. We showed that all 3 schedules can induce the sero-protective levels of antibody concentrations to HBV both one month and one year after the vaccination. CONCLUSION: Bacille Calmette-Guerin and HBV vaccinations can be performed at the same time in endemic countries.

Incidence of acute respiratory infections and the relationship with some factors in infancy in Antalya, Turkey.

BACKGROUND: Acute respiratory infections (ARI) are one of the major problems of childhood in developing countries. The objective of the study was to obtain the incidence of ARI and its risk factors in Antalya, Turkey. METHODS: We carried out a prospective cohort study on 204 infants who were born between 1 November and 31 December 1997, in the area of two primary health-care units in the Antalya city center. The research group was followed periodically every 2 months by home visits and the infants were investigated to determine their symptoms of ARI. The weight and length of children were measured in every home visit. Additional questions about socioeconomic status, some environmental characteristics, and nutrition practice were asked. Data were entered into the computer and the Z-scores were calculated by the Epi Info 5 package program. The incidence rates, relative risks and confidence intervals were calculated by Microsoft Excel version 5.0 program. RESULTS: The incidence of ARI was 6.53 episodes per child per year among the children in the research group. The factors that influenced the incidence of ARI were lack of mother's and father's education, heating by wood stove, being a low-birthweight infant, not being completely breast-fed in the first 4 months of life and being stunted. There were no associations between the number of persons per room or smoking status of family members with ARI incidence. CONCLUSION: Our results demonstrated that ARI were also associated with some socioeconomic, environmental and nutritional status characteristics such as paternal education, house ownership, breast-feeding, stunting, prematurity and burning of biomass fuels in Turkey.