Evaluation of the effects of the toilet training process on the children's quality of life.

BACKGROUND: Toilet training is a significant developmental milestone for children. During the process of toilet training, voiding and defecation problems may develop, which have a major adverse impact on the child's quality of life (QoL). The aim of this study was to assess voiding and defecation problems in the process of toilet training and evaluate how these issues influenced the children's QoL. METHODS: The children included in the study were followed up at the Department of Social Pediatrics, Ankara University School of Medicine. Participants were surveyed via a questionnaire that included sociodemographic features, the toilet training process, and the Pediatric Quality of Life Inventory. RESULTS: The study included 177 children and their parents. There was no correlation between the parents' age, sociodemographic features, or the timing of the start of toilet training. Voiding problems were found in 55.6% and defecation problems in 23.6% of the children included in the study. Urinary retention during play and nocturnal enuresis were more frequent in the children toilet trained at 25-36 months of age. The self-reported QoL scores in children with voiding problems and with both voiding and defecation problems were lower than those in children did not have any problems. CONCLUSIONS: Even if a child has been toilet trained, it is essential to investigate daily urination and defecation habits at every follow-up visit and to discuss with families when a physician should be consulted.

The role of social support on the relationships between internet use and sleep problems in adolescents during COVID-19 pandemic: a multicentre study.

BACKGROUND: This study examines the frequency of problematic internet use and sleep problems in adolescents aged 14-18 years during the COVID-19 pandemic and identifies the impact of factors such as sociodemographic characteristics, internet habits, changes in daily life, and perceived social support on these problems. METHODS: This multicentre study was a questionnaire-based online survey study. The questionnaire included the Young Internet Addiction Scale, the Pittsburgh Sleep Quality Index, and the Multidimensional Scale of Perceived Social Support, as well as questions about demographic information, internet habits, and changes in daily life during pandemic. Several multivariate Backward logistic regression models were run to determine the variables that predicted problematic internet use and poor sleep quality. RESULTS: It was determined that the frequency of problematic internet use was 15.5%, and the frequency of poor sleep quality was 47.8%. Poor sleep quality was found 2.5 times higher in problematic internet users. The perceived social support was found insufficient in adolescents with problematic internet use and poor sleep quality. Various factors such as the excessive use of internet and social media, low school success, lack of physical activity, lack of rules for internet use at home, and worsening of relationships with parents were found to be predictive factors for these problems. CONCLUSIONS: Problematic internet use during the pandemic is associated with worsening sleep quality in adolescents. It is important to create special interventions for problematic internet use and sleep problems that develop in adolescents as a result of restrictions during the pandemic.

Preliminary study on bisphenol A levels and possible exposure history of mother and exclusively breastfed infant pairs.

The aims of this study were to determine bisphenol A (BPA) levels in breast milk and urine specimens of healthy mother and exclusively breastfed infant pairs having no known BPA exposure, and also to examine the relationship between BPA levels and possible BPA exposure history. Forty mothers and their 1-2-month-old exclusively breastfeed infant were included in the study. The questionnaires about sociodemographic characteristics and possible BPA exposure history were filled out. Breast milk and urine samples were taken. BPA analyses of these samples were conducted using high-performance liquid chromatography coupled with mass spectrometry. All mother-infant pairs showed detectable BPA concentrations. The geometric means of BPA levels in breast milk, maternal urine, and infant urine were determined as 0.12 µg/L (0.03-0.59), 0.12 µg/L (0.03-0.73), and 0.13 µg/L (0.02-0.44), respectively. Infants whose mothers were consuming yoghurt in plastic containers had relatively higher urinary BPA levels (p = 0.00). Mothers consuming hot beverages in plastic glass showed higher breast milk BPA levels (p = 0.033). There were no statistical associations between BPA levels and the use of plastic materials and tools (p > 0.05).Conclusion: The measurable BPA concentrations in all breast milk specimens of healthy mothers may reflect possible exposure from dietary or non-dietary sources. Exclusively, breastfed healthy infants without any known BPA exposure may be exposed to BPA from their mothers through breastfeeding. What is Known: • Fetuses, neonates and infants are exposed to BPA from their mothers through placental transfer and breastfeeding. • Breast milk is considered a continuous low-level exposure to BPA. What is New: • BPA was detected in 100% of maternal urine, infant urine, and breast milk in healthy mother-infant pairs having no known BPA exposure. • The measurable amount of BPA in breast milk and infant urine may reflect possible BPA exposure of mother-infant pairs.

Evaluation of Childhood Vaccine Refusal and Hesitancy Intentions in Turkey.

OBJECTIVE: To assess the factors affecting parental childhood vaccine refusal and hesitancy (CVRH) intentions in Turkey. METHODS: A total of 33 children's parents who were referred to two different child health care clinics because of CVRH and 99 controls were enrolled into this study from November through December 2017. The socio-demographic characteristics and perceptions of the parents who refused at least one vaccine for their child/children were compared with controls. RESULTS: The monthly household income was significantly lower in CVRH group than control group. Refusal of the heel stick, refusal of hearing test, not using baby car seat, irregular use of vitamin D and iron prophylaxis, using alterative/complementary medicine, distrust in vaccines were the parameters which were found significantly higher in refused vaccine group than in control group. The beliefs "It may be dangerous for children" and "Distrust to the vaccines" were the most determined factors with a ratio of 51.5% in CVRH group. CONCLUSIONS: This is the first study conducted to investigate the social-demographic characteristics and perception of parental CVRH in Turkey. The beliefs "It may be dangerous for the children" and "Distrust the vaccines" were the most determined factors which may affect CVRH. Some child health protective strategies were less undertaken in CVRH group than in controls; including heel stick test, hearing test, using baby car seat and using of Vitamin D and iron prophylaxis. The parents who have CVRH intentions tend to behave irresponsibly in care of their children.

Secular trends in height, weight and body mass index of primary school children in Turkey between 1993 and 2016.

BACKGROUND: The aim of the study was to analyze the secular trends in height, weight and body mass index (BMI) of children in a Turkish primary school in a 23-year time interval. METHODS: The height, weight and BMI of 1099 children between 7 and 15 years old were measured. Data were compared to those of children of the same ages from previous measurements carried out in 1993 (867 children) and in 2003 (1214 children) in the same school. The changes in weight, height and BMI were determined and analyzed statistically. RESULTS: Weight increments between 7.7 and 16.2 kg/23 years and height increments between 1.1 and 8.3 cm/23 years were observed in boys. For girls, weight increments between 6.5 and 13.4 kg/23 years and height increments between 1.3 and 7.2 cm/23 years were indicated. Usually, there were significant height increments between 1993 and 2016 in both genders. However, there were no significant differences in height between 2003 and 2016 for all age groups. Furthermore, there were significant differences in BMI measurements in all age and gender groups between 1993 and 2016. CONCLUSIONS: The secular ascending trend in height seems to stop between 2003 and 2016; however, increments in weight and mean BMI tend to continue in Turkish primary school children and adolescents.

Plasma Amino-Terminal Propeptide of C-Type Natriuretic Peptide Concentration in Normal-Weight and Obese Children.

OBJECTIVE: In studies on the relationship between amino-terminal propeptide of C-type natriuretic peptide (NT-proCNP) concentration and height velocity in children, CNP has been implicated as an emerging new growth marker during childhood. It has been reported that besides its well-studied role in growth, plasma CNP levels are reduced in overweight and/or obese adolescents, suggesting CNP as a potential biomarker in childhood obesity. The primary goal of this study was to test this hypothesis in a Turkish population. METHODS: Consent was taken from 317 children [ages 0-18 (158 girls, 159 boys)] and their parents. All subjects were physically examined; anthropometric measurements were obtained. Body mass index was calculated. During routine blood work, 1 mL extra blood was taken. Plasma NT-proCNP concentration was measured by enzyme-linked immunosorbent assay. RESULTS: Results confirmed the previously described relationship between plasma NT-proCNP concentration and growth velocity. Plasma NT-proCNP concentration showed a negative correlation with age, weight, and height in children. Gender was not a factor that alters the age-dependent plasma NT-proCNP concentration until puberty. CONCLUSION: Unlike previous reports, plasma NT-proCNP concentration of overweight/obese children was not significantly lower than that of children with normal weight in age groups analyzed in a Turkish population. Thus, it is too early to conclude that CNP is a potential biomarker in childhood obesity. Further studies are necessary to address this question.

The relationship between family functioning and the crime types in incarcerated children.

BACKGROUND: We investigated the relationship between the family functioning and crime types in incarcerated children. METHODS: One hundred eighty two incarcerated children aged between 13-18 years who were confined in child-youth prisons and child correctional facilities were enrolled into this descriptive study. Participants completed demographic questions and the McMaster Family Assessment Device (Epstein, Baldwin, & Bishop, 1983) (FAD) with face to face interviews. RESULTS: The crime types were theft, assault (bodily injury), robbery, sexual assault, drug trafficker and murder. The socio-demographic characteristics were compared by using FAD scale, and growing up in a nuclear family had statistically significant better scores for problem solving and communication subscales and the children whose parents had their own house had significantly better problem solving scores When we compared the crime types of children by using problem solving, communication and general functioning subscales of FAD, we found statistical lower scores in assault (bodily injury) group than in theft, sexual assault, murder groups and in drug trafficker group than in murder group, also we found lower scores in drug trafficker group than in theft group for problem solving and general functioning sub-scales, also there were lower scores in bodily injury assault group than in robbery, theft groups and in drug trafficker than in theft group for problem solving subscale. CONCLUSIONS: The communication and problem solving sub-scales of FAD are firstly impaired scales for the incarcerated children. We mention these sub-scales are found with unplanned and less serious crimes and commented those as cry for help of the children.

Determining the persistence of maternally acquired antibodies to hepatitis A and varicella zoster during the first 2 years of life in Turkey.

UNLABELLED: Vaccination should be timed to take into account the potential interference of maternal antibodies. The purpose of this study was to determine the persistence of maternally acquired antibodies to hepatitis A and varicella zoster in a group of healthy infants between 6 and 24 months of age. These infants were divided into four groups according to the age at the time of follow-up visits. The study group consisted of infants who were brought to the 6-month follow-up visit (group 1, n=100), 12-month follow-up visit (group 2, n=99), 18-month follow-up visit (group 3, n=59), and 24-month follow-up visit (group 4, n=59). Hepatitis A, varicella IgG, and IgM antibodies were analyzed qualitatively. Hepatitis A IgG seropositivity was determined as 71 % in group 1, 41.4 % in group 2, 0 % in group 3, and 8.5 % in group 4 (p<0.001). Varicella IgG seropositivity was found to be 5 % in group 1, 4 % in group 2, 4 % in group 3, and 1 % in group 4 (p>0.05). CONCLUSION: We found that maternal hepatitis A antibodies in children disappear between 12 and 18 months, whereas maternal varicella antibodies substantially diminish following the sixth month. Therefore, the vaccination timing should be based on factors such as the interference of maternal antibodies, disease susceptibility period, and immune maturation.

Evaluation of indirect microparticle activity and parameters of thrombin generation test in healthy infants.

INTRODUCTION: Circulating microparticles support thrombin generation. The aim of this study is to determine the indirect microparticle activity and the parameters of thrombin generation in healthy infants. MATERIALS AND METHODS: A total of 85 infants who were brought to follow-up visits were taken into the study. Blood samples were collected. Thrombin generation parameters and indirect microparticle activity were measured. RESULTS: The infants were divided into four groups according to the time of follow-up visits. Mean ages were 1.18 ± 0.19 months in Group 1, 6.15 ± 0.16 months in Group 2, 12.38 ± 0.46 months in Group 3 and 24.53 ± 0.39 months in Group 4, respectively. There was no statistical difference among the age-based groups with respect to the indirect microparticle activity. The lag time and the TTP levels in Group 1 were lower than that found in Group 2. The ETP and peak levels were higher in Group 1 than that of Group 2. The ETP and peak levels in Group 2 were found lower than those found in older children, but the TTP level was found relatively higher. Statistically correlations were found between indirect microparticle activity and all parameters of thrombin generation. CONCLUSIONS: The absence of a difference in terms of age-based microparticle levels may suggest that the features of microparticles in healthy children of this age group are similar. Age-dependent changes in thrombin generation parameters may suggest a regulation mechanism for the thrombin generation system over the first years of life. The results may provide mean values for indirect microparticle activity and thrombin generation in this healthy group.

A comparison between adolescent mothers and adult mothers in terms of maternal and infant outcomes at follow-ups.

OBJECTIVE: To determine the risk factors of adolescent pregnancies and to ascertain the effects of this condition on the maternal and infant outcomes. METHODS: The study was carried out on 100 adolescent mothers less than 20 years of age and on a same number of adult mothers between 22 and 32 years of age and their infants. A socio-demographic attributes questionnaire form, a pregnancy follow-up and birth history form, and a mother and infant follow-up form were used. RESULTS: The mean age of the adolescent mothers was 17.8 ± 0.7 years and that of the adult mothers was 26 ± 0.3 years. Income level of 83% of the families of adolescent mothers and 69% of the families of adult mothers was below the poverty line (p < 0.05). Dropout rate (i.e. rate of those not attending any school) was 36% in the adolescent group and 21% in the adult group. Rate of exclusively breastfeeding during the first 2 months was 40% in adolescents and 62% in adults (p < 0.01). Higher rates of adolescent mothers felt themselves inadequate infant care and with 7% of them experiencing problems in accessing a healthcare institution. CONCLUSIONS: Properly following up adolescent pregnancies during prenatal and postnatal periods may be helpful for preventing the negative impacts on mother and infant health.

The relation between soluble endothelial protein C receptor and factor VIII levels and FVIII/sEPCR index in healthy infants.

OBJECTIVE: Both soluble endothelial protein C receptor (sEPCR) and factor VIII (FVIII) seem to be potential mediators in thrombotic and inflammatory states. The aim of the present study was to determine the relation between plasma sEPCR and FVIII levels in a group of healthy Turkish infants. METHODS: The study population consisted of 50 healthy infants aged 6 months (Group 1, n=23) and 12 months (Group 2, n=27) having no acute or chronic infection and/or disease. sEPCR levels and FVIII levels were measured by ELISA and one stage factor assay method, respectively. RESULTS: The sEPCR levels of the infants aged 6 months were found higher than those of the infants aged 12 months (p<0.001). There was a correlation between sEPCR and FVIII levels of the infants in Group 1 (6-month-old infants) (r=0.678, p<0.001). FVIII/sEPCR index was 0.73±0.3 and 1.0±0.5 in Group 1 and Group 2, respectively (p=0.027). A correlation between infant age and FVIII/sEPCR index was found (r=0.312, p=0.027). CONCLUSION: The FVIII/sEPCR index in healthy infants reflects the physiological condition of this population. The finding showing a positive relationship between sEPCR and FVIII levels suggests a possible interaction between these mediators in healthy infants aged six months.

Soluble endothelial protein C receptor levels in healthy population.

Increased levels of sEPCR lead to dysfunction of EPCR-mediated coagulation. The aim of this present study was to determine plasma sEPCR levels in a group of Turkish healthy population including both adults and children. The study population consisted of 230 healthy individuals (108 children and 122 adults) having no acute or chronic disease. Plasma sEPCR levels were measured with ELISA. Analysis revealed a bimodal distribution in both groups. There was a negative relationship between sEPCR levels and the age of individuals (r = -0.385, P = 0.0001). The sEPCR levels of children were found significantly higher than that of adults (P < 0.001). This study is the first study to determine the relationship of sEPCR levels and terms of age. Higher levels of sEPCR may suggest a regulation mechanism for the protein C anticoagulation system over the first years of life. Further studies should be conducted to evaluate the physiological importance and molecular mechanism of increased sEPCR levels in children.

Establishment of interdisciplinary child protection teams in Turkey 2002-2006: identifying the strongest link can make a difference!

OBJECTIVES: The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS: A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS: Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS: A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS: Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

The influence of maternal smoking on maternal and newborn oxidant and antioxidant status.

BACKGROUND: Maternal smoking has been suggested as a source of oxidant stress in pregnant women and in newborns exposed in utero. The aim of this study was to determine the influence of maternal smoking on oxidant status and antioxidant vitamins of mother-infant pairs. MATERIALS AND METHODS: Socioeconomic and diet characteristics were recorded from 20 smoker and 20 non-smoker pregnant women of 36 weeks' gestation. On the day of delivery, venous blood samples of the women and cord bloods were taken. On postpartum day 7, milk and infant urine samples were collected. Plasma and milk beta-carotene, retinol, alpha-tocopherol and cotinine levels, plasma malondialdehyde levels, and urine cotinine levels were measured. RESULTS: Milk alpha-tocopherol levels of smoking mothers were lower than those of non-smoking mothers. In smokers, there were no correlations between maternal vitamin A intakes and milk levels of retinol, and between maternal plasma levels and milk levels of beta-carotene. CONCLUSIONS: Maternal smoking may lead to decreased milk levels of vitamin E, as a result of making use of this antioxidant in order to limit lipid peroxidation, as well as may lead to a possible limitation on the transfer of lipophilic antioxidants including vitamin A from blood plasma to milk. Further investigations conducted in large populations will be needed to assess the effects of maternal smoking on the oxidant and antioxidant status of breast milk.

A guide for monitoring child development in low- and middle-income countries.

OBJECTIVE: In low- and middle-income countries, methods for clinicians to address difficulties in language, social-emotional, cognitive, behavioral, or neuromotor development during early childhood are lacking. To fill this gap, we designed, in Turkey, the Guide for Monitoring Child Development, which aims to aid clinicians in monitoring and supporting child development and the early detection and management of developmental difficulties. The Guide for Monitoring Child Development monitoring component is a practical, open-ended interview that catalyzes communication between clinicians and caregivers and obtains a portrayal of the child's development. We report on the development and psychometric properties of the Guide for Monitoring Child Development monitoring component for children aged 0 to 24 months. METHODS: We examined the ages of attainment of Guide for Monitoring Child Development milestones and internal consistency in a cross-sectional study of healthy children receiving well-child care (study 1). In 2 clinical samples, we studied the interrater reliability between medical students and a child development specialist administering the guide (study 2), as well as the concurrent validity of the guide administered during a health visit and a comprehensive developmental assessment (study 3). RESULTS: In study 1 (N = 510), item-total scale correlations ranged from 0.28 to 0.91. An age-dependent attainment pattern was seen in all of the milestones. In study 2 (N = 92), interrater reliability between medical-student pairs and between the child development specialist and students was high (kappa scores were 0.83-0.88). In study 3 (N = 79), the sensitivity, specificity, and positive and negative predictive values were 0.88, 0.93, 0.84, and 0.94, respectively. CONCLUSIONS: The Guide for Monitoring Child Development is an innovative method for monitoring child development that is designed specifically for use by health care providers in low- and middle-income countries. Studies in Turkey provide preliminary evidence for its reliability and validity.