The validity and reliability of preschool age psychiatric assessment (PAPA) in Turkish population.

INTRODUCTION: The Preschool Age Psychiatric Assessment (PAPA) was developed in response to the need for a standard and reliable tool for assessing preschool-age psychiatric disorders. The aim of this study was to translate PAPA into the Turkish language and evaluate the validity and reliability. METHODS: The researchers translated the original PAPA to Turkish, and the Turkish version of PAPA was translated back into its original language by professional translators. After the psychiatric assessment of the 300 patients by child psychiatrist, the PAPA interview was implemented with the parents. The sociodemographic data form and the PAPA short forms were filled out by the clinician conducting the interview. The Child Behavior Checklist for Ages 1.5-5 (CBCL/1½-5) was completed by parents. RESULTS: The rate of detecting true positives and true negatives in all subscales when comparing PAPA with CBCL in children under 60 months ranged from 65% to 88%. The AUC values were above 50%, ranging from 0.56 to 0.72, indicating that PAPA performed reasonably well in detecting true positives and true negatives compared to CBCL. According to DC: 0-5, it was found that the adjustment was good for total psychopathologies, separation anxiety disorder, social anxiety disorder, and depression (κ = 0.67-0.79), and excellent for GAD and PTSD (κ = 0.81-1.00) CONCLUSION: The validity and reliability obtained from this study are valuable in our country for the objective identification of preschool children showing problematic symptom levels and for distinguishing them from children showing typical characteristics.

Turkish Adaptation Study of the Ask Suicide-Screening Questions in Adolescents.

Introduction: This study aimed to demonstrate the validity of the Ask Suicide-Screening Questions (ASQ) in a clinical sample consisting of adolescents admitted to child and adolescent psychiatry (CAP), and then to confirm its validation in those presenting to the pediatric emergency department (PED), which was the main target group for the study. Method: This cross-sectional study evaluated the compatibility of the ASQ with the suicide probability scale, which is a standardized measure, to identify cases with suicide risk in 248 adolescents aged 10-18 years. To demonstrate the clinical validity of the scale, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), Kappa, and area under the curve (AUC) performance metrics and 95% confidence interval (CI) values were calculated. Results: Positive screening rate, sensitivity, specificity, PPV and NPV for the CAP patients were calculated as 31.8%, 100% (95% CI: 100.0-100.0), 70.9% (95% CI: 63.4-78.4), 12.8% (95% CI: 3.2-22.3) and 100% (95% CI: 100.0-100.0), respectively. The PLR and AUC were calculated as 3.4% (95% CI: 2.7-4.5) and 0.855 (95% CI: 0.817-0.892), respectively. Positive screening rate, sensitivity, specificity, PPV and NPV for the PED patients were calculated as 28%, 100% (95% CI: 100.0-100.0), 75.3% (95% CI: 66.3-84.2), 21.4% (95% CI: 6.2-36.6) and 100% (95% CI: 100.0-100.0), respectively. The PLR, Kappa and AUC were 4.05% (95% CI: 2.82-5.81), 0.278 and 0.876 (95% CI: 0.832-0.921), respectively. Conclusion: This study showed the first evidence that Turkish adaptation of the ASQ is a valid screening tool for identifying those at risk of suicide among adolescents who applied to the CAP and PED.

Body image dissatisfaction among school children in Turkey and its potential effect on body esteem.

BACKGROUND: This study aimed to validate the Turkish version of Collins` Body Figure Perceptions and Preferences (BFPP) scale. The second aim of this study was to investigate the relationship between body image dissatisfaction (BID) and body esteem (BE), and between body mass index (BMI) and BID, among Turkish children. METHODS: A descriptive cross-sectional study was conducted among 2066 4th grade children (mean age was 10.06 ± 0.37 years) in Ankara, Turkey. The Feel-Ideal Difference (FID) index from Collins` BFPP was used to assess the degree of BID. FID ranges from -6 to +6, with scores below or above 0 indicating BID. Collins` BFPP`s test-retest reliability was evaluated in a subset of 641 children. The Turkish version of the BE Scale for Adolescents and Adults was used to evaluate the children` BE. RESULTS: More than half of the children were dissatisfied with their own body images (57.8% of girls vs. 42.2% of boys, p < .05). The lowest BE score in both genders was among adolescents who desired to be thinner (p < .01). The criterion-related validity of Collins` BFPP, in relation to BMI and weight, was at an acceptable level in girls (BMI rho= 0.69, weight rho= 0.66) and boys (BMI rho= 0.58, weight rho= 0.57), and was statistically significant in all cases (p < .01). The test-retest reliability coefficients of Collins` BFPP were found to be moderately high for both girls (rho=0.72) and boys (rho=0.70). CONCLUSIONS: Collins` BFPP scale is a reliable and valid tool for Turkish children aged 9-11 years. This study demonstrates that more Turkish girls than boys were dissatisfied with their bodies. Children who were affected by overweight/obesity and underweight had a higher BID than those with a normal weight. It is important to evaluate adolescents` BE and BID in addition to their anthropometric measurements during their regular clinical follow-up.

Comparison of the Ankaferd Blood Stopper Tampon and the Merocel Nasal Tampon after Septoplasty Surgery.

OBJECTIVE: In this study, we aimed to investigate the effects of the Ankaferd Blood Stopper (ABS) on nasal bleeding, pain, eating disorders, and sleeping problems in patients undergoing septoplasty. METHODS: The prospective study included 100 patients who underwent septoplasty surgery. Patients were divided into two groups based on the chronological order of hospital admission: Group I was administered the ABS, and Group II was administered a standard Invotec Merocel nasal tampon. In both groups, the intensity of pain experienced by patients postoperatively during tampon use and tampon removal was assessed using the visual analogue scale (VAS). RESULTS: A significant difference was found between the two groups with regard to VAS scores assessed during tampon use. In the ABS group, the VAS scores assessed during tampon use were significantly lower, and the incidence of nasal obstruction, eating disorders, dripping-type bleeding before tampon removal, and sleeping problems was significantly lower in the ABS group than in the Merocel group. CONCLUSIONS: The ABS may be a viable alternative to other nasal packs, as it did not lead to a significant reduction in postoperative patient comfort during tampon use and caused a lower incidence of postoperative pain, eating disorders, sleeping problems, and nasal obstruction than standard Merocel tampons. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

An evaluation of the change in serum SCUBE-1 levels with CPAP treatment in patients with severe obstructive sleep apnea.

OBJECTIVE: Signal peptide CUB-EGF domain-containing protein 1 (SCUBE-1) is a cell surface protein, wherein inflammation causes an increase in serum. The aim of this study was to compare serum SCUBE-1 levels in OSA patients and to investigate the serum SCUBE-1 change with CPAP treatment. METHODS: Blood samples were obtained from 61 severe OSA patients and from 25 control subjects evaluated as simple snorers. The 61 patients with severe OSA were treated with CPAP therapy and were recalled for follow up after 1 year. Evaluation was made after 1 year of CPAP therapy. RESULTS: Serum SCUBE-1 values were significantly higher in patients with severe OSA. The SCUBE-1 values significantly decreased after treatment with CPAP. CONCLUSION: Serum SCUBE-1 values in OSA patients showed a significant reduction in SCUBE-1 levels following 1 year of CPAP treatment.

The role of self-discontentment and impulsivity for youth smoking behavior, nicotine dependence and future smoking intention in a clinical sample of Turkish adolescents.

BACKGROUND: Smoking is one of the most important public health problems among young people. Potential risk factors that may cause vulnerability to smoke in youth should be well known and investigated. The aim of the present study was to evaluate the associations of current smoking behavior and future smoking intention with high-risk personality traits for substance abuse in a clinical sample of Turkish adolescents, and also evaluate nicotine dependence and smoking characteristics with the personality traits in a subsample of regular smokers. METHODS: A cross-sectional study was adopted in which 196 participants took part (aged 14-18 years with a mean of 16.7 years). The assessment consisted of a sociodemographic questionnaire that also questions current smoking behavior and future smoking intention; and additionally, two self-administered instruments including the Substance Use Risk Profile Scale (SURPS) for all participants, and Fagerström Test for Nicotine Dependence (FTND) for only regular smokers. RESULTS: Regular smokers scored higher than never smokers on the lack of self-contentment subscale of SURPS (F(2)=3.30, p=.039). Future smoking intention was found to be associated with nicotine dependence (F(3)=6.67, p=.001). Regular smokers with high levels of nicotine dependence had higher levels of impulsivity and smoked more cigarettes per day than those with low levels of nicotine dependence (t=2.489, p=.017; and t=3.530, p=.001, respectively). The structural equation models (SEM) were created based on these results and the personality theory for substance abuse. The SEM results showed that the first evidence that lack of selfcontentment positively influences regularly smoking behavior and impulsivity positively influences future smoking intention through nicotine dependence. CONCLUSIONS: Lack of self-contentment and impulsivity may mediate the transition from current smoking behavior to future tobacco use disorders in Turkish adolescents. The assessment and intervention of selfdiscontentment and impulsivity can be beneficial in reducing the current smoking behavior in Turkish adolescents.

Relationship Between Preoperative NT-proBNP and Postoperative Adverse Events in Patients with Left Ventricular Assist Device.

BACKGROUND: The aim of this study is to investigate the relationship of preoperative NT-proBNP values with postoperative adverse events in patient left ventricular assist device (LVAD) implantation. METHOD: Forty-six patients (35 males; mean age 49.4 ± 12.9 years) who underwent LVAD implantation between 2016 and 2018 were evaluated in this study. The analysis was made on the relationship between preoperative NT-proBNP and mortality, postoperative right ventricular failure (RVF), postoperative drainage, duration of intubation, and intensive care unit stay, was examined. The optimal NT-proBNP cut-off values for predicting mortality were determined using Receiver Operator Characteristic (ROC) curve analysis and the patients were divided into two groups according to the specified cut-off point. RESULT: Median NT-proBNP was higher in patients who died, had postoperative extracorporeal membrane oxygenation, and early RVF. The median NT-proBNP was 11,103 pg/ml in patients with IABP, and 2943 pg/ml in patients without IABP, and the difference was statistically significant (p = 0.002). The cut-off point for NT-proBNP was found to be 1725.5 pg/ml (Sensitivity:0.929, Specificity:0.688). Accordingly, when the patients were divided into two groups and analyzed, no statistically significant difference was found between preoperative NT-proBNP below or above 1725.5 and postoperative adverse events. There was no statistically significant correlation between preoperative NT-proBNP and postoperative drainage, duration of intubation time, and duration of ICU stay (p > 0.05). CONCLUSION: Routine monitoring of preoperative NT-proBNP and comparison with postoperative values are important in terms of patient selection, the timing of surgery, follow-up of postoperative adverse events, and improving outcomes in VAD patients.

A mixture model with Poisson and zero-truncated Poisson components to analyze road traffic accidents in Turkey.

The analysis of traffic accident data is crucial to address numerous concerns, such as understanding contributing factors in an accident's chain-of-events, identifying hotspots, and informing policy decisions about road safety management. The majority of statistical models employed for analyzing traffic accident data are logically count regression models (commonly Poisson regression) since a count - like the number of accidents - is used as the response. However, features of the observed data frequently do not make the Poisson distribution a tenable assumption. For example, observed data rarely demonstrate an equal mean and variance and often times possess excess zeros. Sometimes, data may have heterogeneous structure consisting of a mixture of populations, rather than a single population. In such data analyses, mixtures-of-Poisson-regression models can be used. In this study, the number of injuries resulting from casualties of traffic accidents registered by the General Directorate of Security (Turkey, 2005-2014) are modeled using a novel mixture distribution with two components: a Poisson and zero-truncated-Poisson distribution. Such a model differs from existing mixture models in literature where the components are either all Poisson distributions or all zero-truncated Poisson distributions. The proposed model is compared with the Poisson regression model via simulation and in the analysis of the traffic data.

Development and Validation of a Culture-Sensitive Generic Health Literacy Scale in Turkish-Speaking Adults.

BACKGROUND: Improving health literacy has become one of the most important public health-related goals at the global level; however, there is no clear consensus on measurement of health literacy. Despite numerous health literacy scales available in Turkish, none of the existing scales was originally developed and validated at a national level. OBJECTIVE: This study aimed to develop and validate a culturally appropriate original health literacy scale (HLS) to be used as a reference for the Turkish-speaking literate adult population in Turkey and abroad. METHODS: Two multidisciplinary workshops with more than 20 experts were conducted and a large item pool was developed. The first and second draft of the scale were pre-tested with 20 and 150 adults, respectively, from different age groups and socioeconomic levels in Ankara. The validity and reliability study of the revised scale (110 items plus 20 self-efficacy statements) was carried out with a household survey of 2,411 adults in 12 randomly selected provinces from 12 Nomenclature of Territorial Units for Statistics Regions in Turkey. Explanatory and confirmatory factor analysis were performed. The fit indices were obtained. The item analysis was applied, and Cronbach's alpha statistics were obtained. KEY RESULTS: The scale was found to be both a valid and a reliable measurement tool to assess health literacy. Cronbach's alpha for two sub-dimensions ("disease prevention and health promotion" and "treatment and access to health services") were 0.79 and 0.91, respectively. Construction validity indices were Root Mean Square Error of Approximation (RMSEA) = 0.043, Goodness of Fit Index (GFI) = 0.96, Normed Fit Index (NFI) = 0.95, and Adjusted Goodness of Fit Index (AGFI) = 0.95. The scale includes "self-efficacy" as an additional dimension (Cronbach's alpha = 0.83, RMSEA = 0.68, GFI = 0.94, NFI = 0.94, and AGFI) = 0.91). CONCLUSION: HLS is a valid and reliable measurement tool to assess health literacy of Turkish-speaking literate adults with a mixed (objective and subjective) assessment approach. [HLRP: Health Literacy Research and Practice. 2022;6(1):e2-e11.] Plain Language Summary: This study aimed to develop and validate a culturally sensitive original health literacy scale to be used as a reference scale for the Turkish-speaking literate adult population in Turkey and abroad. Study findings showed that HLS is both a valid and a reliable measurement tool to assess health literacy of Turkish-speaking literate adults.

Structural equation model of physical activity in Turkish schoolchildren: an application of the integrated behavioural model.

OBJECTIVES: Childhood obesity is increasingly prevalent in the developing world including Turkey. This study examined constructs of the integrated behavioural model associated with physical activity in a sample of schoolchildren in Ankara, Turkey using structural equation modelling. DESIGN: Cross-sectional survey by probability sampling. SETTING: Fifteen schools of different socioeconomic strata in Ankara, Turkey with grade 4 students. PARTICIPANTS: 2066 (969 girls and 1097 boys) grade 4 schoolchildren and their parents selected using a probability-based sampling frame. PRIMARY OUTCOME MEASURES: Three primary outcomes were used: moderate-to-vigorous physical activity, team sport participation, sedentary behaviour. RESULTS: Data were collected from 2066 fourth-grade children from schools of three socioeconomic strata. Missing data were imputed using multiple imputation. To examine the integrated behavioural model, a structural equation model containing latent constructs for physical activity outcome expectancies, self-efficacy, home environment and social norms were fitted with the three outcomes above. Adequate model fit was achieved in the structural equation model (χ2=1821.97, df=872, p<0.001, Comparative Fit Index=0.91, Tucker Lewis Index=0.91, root mean square error of approximation=0.02, standardised root mean square residual=0.04). All scale items were significantly associated with their respective latent constructs (all p<0.001). Several significant pathways between latent constructs and outcomes of interest were observed (p<0.05). Self-efficacy was positively associated with moderate-to-vigorous physical activity (p<0.001) and team sport participation (p<0.001) and negatively associated with sedentary behaviour (p<0.001). Negative outcome expectancies were negatively associated with moderate-to-vigorous physical activity (p<0.01) and sedentary behaviour (p<0.01) while positive outcome expectancies were positively associated with team sport behaviour (p<0.001) and negatively associated with sedentary behaviour (p<0.05). Home support was positively associated with moderate-to-vigorous physical activity (p<0.01) and team sport participation (p<0.05). Finally, physical activity social norms were negatively associated with sedentary behaviour only (p<0.05). CONCLUSIONS: This study supported the extension to Turkish children of the integrated behavioural model in relation to physical activity behaviours. Results illustrate multiple targets for interventions to increase physical activity.

Can we use serum SCUBE 1 levels as a biomarker in obstructive sleep apnea hypopnea syndrome?

OBJECTIVE: To examine the SCUBE1 level, a biomarker in vascular biology that could determine the prognosis of cardiovascular events during OSA treatment. METHODS: In total, 129 patients were included in the study. Thirty were diagnosed with simple snoring and 99 with OSA. RESULTS: In males, significant correlation was determined between SCUBE1 non-REM AHI, hypopnea index, total apnea index, mean SO2, minimum SO2, and < 90% saturation duration. CONCLUSION: Serum SCUBE1 levels increased more in male patients with severe OSA compared to other OSA levels, and high serum SCUBE1 levels were found to be associated with lower oxygen levels in OSA patients. The SCUBE1 biomarker can correlate with severe OSA in males. There was a statistically significant difference between OSA groups in terms of SCUBE1 score for male patients (p = 0.002) but not for females (p = 0.498). It is important that future SCUBE1 studies evaluate males vs. females.

The adaptation of Turkish health literacy scale for literate Syrian adult refugees living in Turkey: a reliability-validity study.

BACKGROUND: Turkey hosts the world's largest refugee population of whom 3.5 million are Syrians and this population has been continuously growing since the year 2011. This situation causes various problems, mainly while receiving health-care services. In planning the migrant health-care services, for the policy makers of host countries, health literacy level of migrants is an important measure. Determination of health literacy level of Syrian refugees in Turkey would be supportive for planning some interventions to increase health-care service utilization, as well as health education and health communication programs. An "original health literacy scale" for 18-60 years of age Turkish literate adults (Hacettepe University Health Literacy Scale-HLS) was developed to be used as a reference scale in 2018. Since it would be useful to compare the health literacy levels of Turkish adults with Syrian adult refugees living in Turkey with an originally developed scale, in this study, it was aimed to adapt the HLS-Short Form for Syrian refugees. METHODS: This methodological study was carried out between the years 2019-2020 in three provinces of Turkey where the majority of Syrians reside. The data was collected by pre-trained, Arabic speaking 12 interviewers and three supervisors via a questionnaire on household basis. At first, the original Scale and questionnaire were translated into Arabic and back translated into the original language. The questionnaire and the Scale were pre-tested among 30 Syrian refugees in Ankara province. A total of 1254 refugees were participated into the main part of the study; 47 health-worker participants were excluded from the validity-reliability analysis. Confirmatory factor analysis (CFA) was performed. Cronbach's alpha and Spearman-Brown coefficients were calculated. RESULTS: Of the participants, 52.9% was male; 26.1% had secondary education level or less; almost half of them had moderate economic level; 27.5% could not speak Turkish. The Cronbach's Alpha was 0.75, Spearman-Brown Coefficient was 0.76; RMSEA = 0.073, CFI = 0.93, TLI = 0.92 and GFI = 0.95 for the Scale. The Cronbach's Alpha was 0.76, Spearman-Brown Coefficient was 0.77; RMSEA = 0.085, CFI = 0.93, TLI = 0.91 and GFI = 0.95 for self-efficacy part. CONCLUSION: In conclusion, the adapted HLS would be a reliable instrument to evaluate the health-literacy level of Syrian refugees living in Turkey and could allow for a comparison of the host country's health literacy level to that of the refugees using the same scale.

Oral health status in children with familial Mediterranean fever.

BACKGROUND: Familial Mediterranean fever (FMF) is the most common hereditary autoinflammatory disease. We aimed to investigate the oral health status and oral hygiene habits in children with FMF. METHODS: In this cross-sectional study, 199 children with FMF, aged between 3-18 years, were included. Demographic findings and oral hygiene habits of children were questioned by face-to-face interview. Oral health status of patients was evaluated using decay-missing-filled index [DMFT (decay-missing-filled teeth), DMFS (decay-missing-filled teeth) for permanent; dmft, dmfs for primary teeth], the International Caries Detection and Assessment System (ICDAS-II) index, PUFA / pufa index [the presence of severely decayed teeth with visible pulpal involvement (P/p), ulceration caused by dislocated tooth fragments (U/u), fistula (F/f) and abscess (A/a)], gingival (GI) and plaque index (PI). In addition to these, occlusion, oral soft and hard tissues were examined. RESULTS: One-hundred-nine (54.8%) of children had at least one decayed permanent tooth and 81.2% of children had at least one decayed primary tooth. The mean DMFT was 1.91±2.45, DMFS was 3.1±4.49, dmft was 3.95±3.54, dmfs was 8.62±8.88, PI was 1.17±0.44, GI was 0.85±0.39. Aphthous mouth ulcer occurred in 19 (9.5%) patients. Recurrent aphthous mouth ulcers were more frequent among patients with one exon-ten and one exon-two mutations than patients with one exon-10 mutation, two exon-ten mutations, or two exon-2 mutations (61.1% vs. 47.9%, 26.1%, 20%, respectively p < 0.001). Tooth decay was more frequent among patients who had attacks in the last six months than those who did not have any attacks during the last six months (97.4% vs. 87.7%, p=0.017). CONCLUSION: Dental caries and periodontal disease, which are public health problems, were seen at a high percentage of children with FMF in our study.

The validity and reliability of the Turkish version of the Body Esteem Scale for Adolescents and Adults (BESAA) for children

Background/aim: Body esteem (BE) is defined as the self-evaluation of one's own body or appearance. The Body Esteem Scale for Adolescents and Adults (BESAA)consists of three subscales: BE-appearance, BE-weight, and BE-attribution. Though initially developed for adolescents and adults, the use of the scale has recently increased in health-related research on children. This study aimed to assess the validity and reliability of the Turkish version of the BESAA for children. Materials and methods: The participants in the study were 4th grade children (aged 9­10 years) in Ankara, Turkey. The validity of the scale was evaluated through exploratory and confirmatory factor analyses. Internal consistency and test-retest reliability were assessed using Cronbach's alpha and Spearman's rho correlation coefficient, respectively. Results: The Turkish version of the BESAA for children includes BE-weight, BE-appearance, and BE-attribution subscales. The scale demonstrated good model fit statistics (chi-square/df = 3.41, P < 0.001) and good internal consistency for BE-weight (α = 0.85), BE-appearance (α = 0.76), and BE-attribution (α = 0.69). According to our findings, test-retest reliability of the three subscales was in the moderate/acceptable range for children (r = 0.57­0.68, P < 0.01). Conclusion: The Turkish version of the BESAA can be used to measure BE in terms of appearance, weight, and attribution in children.

Prevalence of childhood obesity and related parental factors across socioeconomic strata in Ankara, Turkey.

BACKGROUND: Among low- and middle-income nations, the highest prevalence of child overweight and associated metabolic disorders has been found in Middle Eastern and Eastern European countries. Obesity has been on the rise in Turkey and past research has shown regional variations among adults. However, the prevalence of childhood obesity in different socioeconomic groups in the largest metropolitan areas in the country has not been reported. AIMS: This study aimed to investigate the prevalence of child obesity with a population-representative, SES-stratified random sample with objective measures of body mass index (BMI) in the capital city of Turkey. METHODS: Weight status was measured by the WHO growth curve and analyzed by socioeconomic status (SES), sex, and parental factors in a population-representative sample of 2066 parent-child dyads. Chi-square and logistic regression were conducted. RESULTS: Rates of overweight and obesity were 21.2% and 14.6% (35.8% combined) but significantly higher in high (24.5% and 18.9%) vs. low SES (20.1% and 13.8%) (P = 0.02). Boys were at higher risk for obesity than girls, especially in high vs. low SES (Odds Ratio [OR] = 3.0 [95% CI: 1.4-6.5] vs. 1.7 [95% CI: 1.2-2.5]). Having both parents being overweight or obese increased the risk for obesity, particularly in medium and high SES (OR = 5.8 [95% CI: 2.3-14.1]) and 6.3 (95% CI: 1.5-26.2). CONCLUSIONS: Higher maternal education was a risk factor in low-to-medium but not high SES. In Ankara, child overweight and obesity appears to be 1.5 times more prevalent than national estimates. Higher SES may signify greater exposure to an obesogenic environment and greater obesity risk.

Evaluation of being overweight/obese and related sociodemographic factors in 0-5 year age group in Turkey: Turkey Demographic Health Survey 2013 advanced analysis

Background/aim: To determine risk factors of overweightness/obesity in children aged 0-5 years in the Turkish population. Materials and methods: We made advanced analysis using the Turkey Demographic Health Survey (TDHS) 2013 female database, in which data from children aged under five years and their mothers are included. Analyses were performed using weight for height index data. The children were divided into two groups by age as 0­23 months and 24­59 months. Results: The analysis comprised 2196 children aged under 5 years. Several factors were associated with an increase in overweightness/obesity of children aged under 5 years. Overweight/obesity in children aged 0-23 months was associated with several factors such as age (12­23 months) (OR: 2.89 CI: 1.62-5.13), high birth weight (OR: 2.36 CI: 1.26-4.44), maternal obesity (OR: 2.09 CI: 1.33-3.27), and maternal smoking (OR: 2.07, CI: 1.28-3.33). Overweightness/obesity in children aged 24­59 months was associated with several factors such as education level of the mother (OR: 2.27, CI: 1.08-4.75), consanguineous marriage (OR: 2.86, CI: 1.83-4.47), and which region of Turkey the family lives in (OR: 2.79, CI: 1.53-5.08). Conclusion: Our results from the TDHS 2013 showed several risk factors of children overweight/obesity. Determining obesity risk factors, monitoring obese children/adults, and providing a multidisciplinary approach to the treatment and prevention of obesity will be useful for the future.

Regional and total muscle mass, muscle strength and physical performance: The potential use of ultrasound imaging for sarcopenia.

OBJECTIVE: To evaluate the relationship between the regional and total muscle mass, muscle strength and physical performance, and also to investigate the affected muscles, their strength and physical performance with aging. METHODS: A total of 145 healthy subjects were included for the cross-sectional descriptive study. Demographic data were obtained, and body composition was consecutively assessed by anthropometric methods, bioelectrical impedance analysis and ultrasound (muscle thickness, fascicule length and pennation angle). Functional status was assessed using hand grip strength and gait speed measurements. RESULTS: Abdominal and thigh muscles were thinner and triceps muscle was thicker in older subjects when compared with younger ones. Age and grip strength were significant predictors for physical performance. Gait speed, grip strength and regional muscle measurements decreased with age at higher rates (26-28%), skeletal muscle mass index was affected at a lower rate (15%). CONCLUSIONS: Low muscle strength and regional muscle measurements should be used to confirm the diagnosis of sarcopenia.

Perceptions of Obesity Prevention Policies: Socioeconomic Assessment in the Turkish Capital.

PURPOSE: The purpose of this study was to inform public policy opportunities to reduce childhood obesity by identifying parents' perceptions of factors contributing to childhood obesity, attribution of responsibility, and the extent of their support for public prevention policies with attention to socio-economic status. DESIGN AND METHODS: In 2015, 2066 parent-child dyads across socio-economic strata from 43 randomly selected schools in Ankara completed surveys and measurements to examine perceptions, attribution, and prevention policies related to childhood obesity. RESULTS: Parents across the socio-demographic spectrum recognized obesity as a serious problem. Unhealthy food availability was identified as the leading cause of while industry and media were credited with having the greatest responsibility for childhood obesity. There was strong public support for policy strategies targeting schools, marketing, and the built environment, though support tempered as socio-economic status and parental education decreased. CONCLUSIONS: This survey provided insight into parents' knowledge and beliefs surrounding childhood obesity as well as their endorsement of related prevention strategies. Educational messages that address variations in SES to describe the causes of childhood obesity and connect those causes to actionable community prevention strategies may improve community support for enhanced policy actions within and beyond school settings.

Assessing the validity and reliability of family factors on physical activity: A case study in Turkey.

BACKGROUND: Childhood obesity rates have been rising rapidly in developing countries. A better understanding of the risk factors and social context is necessary to inform public health interventions and policies. This paper describes the validation of several measurement scales for use in Turkey, which relate to child and parent perceptions of physical activity (PA) and enablers and barriers of physical activity in the home environment. METHOD: The aim of this study was to assess the validity and reliability of several measurement scales in Turkey using a population sample across three socio-economic strata in the Turkish capital, Ankara. Surveys were conducted in Grade 4 children (mean age = 9.7 years for boys; 9.9 years for girls), and their parents, across 6 randomly selected schools, stratified by SES (n = 641 students, 483 parents). Construct validity of the scales was evaluated through exploratory and confirmatory factor analysis. Internal consistency of scales and test-retest reliability were assessed by Cronbach's alpha and intra-class correlation. RESULTS: The scales as a whole were found to have acceptable-to-good model fit statistics (PA Barriers: RMSEA = 0.076, SRMR = 0.0577, AGFI = 0.901; PA Outcome Expectancies: RMSEA = 0.054, SRMR = 0.0545, AGFI = 0.916, and PA Home Environment: RMSEA = 0.038, SRMR = 0.0233, AGFI = 0.976). The PA Barriers subscales showed good internal consistency and poor to fair test-retest reliability (personal α = 0.79, ICC = 0.29, environmental α = 0.73, ICC = 0.59). The PA Outcome Expectancies subscales showed good internal consistency and test-retest reliability (negative α = 0.77, ICC = 0.56; positive α = 0.74, ICC = 0.49). Only the PA Home Environment subscale on support for PA was validated in the final confirmatory model; it showed moderate internal consistency and test-retest reliability (α = 0.61, ICC = 0.48). DISCUSSION: This study is the first to validate measures of perceptions of physical activity and the physical activity home environment in Turkey. Our results support the originally hypothesized two-factor structures for Physical Activity Barriers and Physical Activity Outcome Expectancies. However, we found the one-factor rather than two-factor structure for Physical Activity Home Environment had the best model fit. This study provides general support for the use of these scales in Turkey in terms of validity, but test-retest reliability warrants further research.

Determinants of Mental Disorders in Syrian Refugees in Turkey Versus Internally Displaced Persons in Syria.

OBJECTIVES: To compare frequencies of some mental health disorders between Syrian refugees living in Turkey and internally displaced persons in Syria, and to identify factors associated with posttraumatic stress disorder and major depressive disorder. METHODS: We carried out a field survey in May 2017 among 540 internally displaced persons in Syria and refugees in Turkey. RESULTS: The study revealed that mental disorders were highly prevalent in both populations. Major depressive disorder was more frequent among refugees in Turkey than among internally displaced persons in Syria; other mental disorders, including posttraumatic stress disorder, were more prevalent in the latter than in the former. Posttraumatic stress disorder was also associated with postmigration factors. Major depressive disorder was more likely among refugees in Turkey. In addition, the likelihood of major depressive disorder was predicted by stopping somewhere else before resettlement in the current location. CONCLUSIONS: The resettlement locus and the context and type of displacement seem to be important determinants of mental health disorders, with postmigration factors being stronger predictors of conflict-related mental health. Internally displaced persons may benefit more from trauma-focused approaches, whereas refugees may derive greater benefit from psychosocial approaches.