Dark side of customs: scalding burns in childhood due to use of traditional teacup and teapot, in Turkey.

The most common type of burn among children is scalding burn. This study aims to reveal child abuse and neglect as a specific etiological factor that specific to our country, traditional teapot- and teacup-related scalding burns. Burn cases that admitted to our Burn Center were investigated, and among these, 72 cases suffering from scalding burns were included in the study. The interview forms issued upon admission of these cases were evaluated in detail. Out of 148 scalding burn cases, 48.6% were related to the use of traditional teapots and teacups. After a detailed assessment, all cases were considered neglect-related burns. As a result of considering the role of traditional teapots and teacups in pediatric injuries in our country, parents and caregivers should be warned about these types of injuries. Also, physicians must determine the possibility of child abuse or neglect in all pediatric burn cases.

The relationship between ochratoxin A and blood pressure in adolescents.

Ochratoxin A (OTA) is a chemical produced by some fungal species, and although its toxic effects have been shown in many animal studies, there are limited studies in humans. We aimed to examine the relationship between OTA and hypertension. 50 newly diagnosed hypertensive patients and 33 healthy individuals aged between 12 and 14 were included in the study. Anthropometric measurements, blood pressure measurements, complete blood count, blood biochemical parameters, urine lead level and urine OTA level were measured. OTA was detected in the urine samples of 90.9% of the control group, 100% of the hypertensive group and 85.7% of the obese+hypertensive group. Median urinary OTA was 32.9 ng/g creatinine for hypertensive group, 32.2 ng/g creatinine for hypertensive+obese group, 18.8 ng/g creatinine for the control group. Multivariate logistic regression analysis revealed a positive association between last quartile of urinary OTA level and being hypertensive [AOR:5.93 (95%CI: 1.27-27.61)] in adolescents without obesity. Hypertensive cases could be evaluated for OTA exposure in further studies.

Changes in maternal anthropometric measurements in the first postpartum month and associated factors.

OBJECTIVE: Maternal anthropometry offers a rapid, inexpensive, and non-invasive method for assessing nutritional status during pregnancy. We aimed to assess the changes in maternal anthropometric measurements in the first month after delivery and to investigate the factors associated with longitudinal changes in maternal postpartum nutritional status. DESIGN: This prospective longitudinal study included 147 mothers who were on the 5th postpartum day applied to outpatient clinics, from January 2018 through January 2020. Each mother completed a structured questionnaire and baseline anthropometric measurements were performed at the postpartum 5th day and re-evaluated at the end of the first month after delivery. PARTICIPANTS: Mother-infant pairs (n = 147). RESULTS: At the end of the first postpartum month, maternal body weight (relative change -5.1%, 95% CI: -5.6%;-4.6%), muscle mass ratio (-1.6%, 95% CI: -2.4%;-0.9%) and body fluid ratio (-2.4%, 95% CI: -3.1%;-1.7%) decreased, whereas fat mass ratio increased (10.3%, 95% CI: 9.0%;11.6%).There was a significant association between infants' feeding type and maternal BMI, weight, muscle mass ratio, body fluid ratio, triceps, and biceps skinfold thickness in mothers (p < .05). We also found a significant relationship between maternal smoke exposure and BMI, maternal weight, fat-mass ratio (p < .05). CONCLUSIONS: There are some important alterations in maternal anthropometric parameters during the postpartum period. This study will help further our understanding of the factors influencing changes in maternal body composition after delivery.

Urinary levels of phthalate esters and heavy metals in adolescents with thyroid colloid cysts.

We aimed to evaluate 14 urinary phthalate metabolites and 4 toxic metals in adolescents having thyroid colloid cyst (TCC) and compare with age and sex-matched others without TCC. Phthalate metabolites were analysed with UPLC-MS/MS and heavy metals with ICP-MS. TCC ratios in tertile subgroups of pollutants were compared with multiple logistic regression analysis after adjusting for age, sex, z-scores for body mass index and urinary creatinine values. Adolescents having the highest tertile of mono (2-ethylhexyl) phthalic acid and mercury had increased odds and those with the highest tertiles of monocarboxy-isononyl phthalate, mono (3-carboxypropyl) phthalate, monoisobutyl phthalate had lower odds for TCC than counterparts. The odds of TCC were lower for those in the second and the third tertiles. No differences in TCC ratios were detected with other pollutants. Given phthalate esters' and toxic metals' specific interactions on TCC, further studies were necessary to assess the influence of chemicals on TCC.

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.

Lead, mercury, and cadmium levels in breast milk and infant hair in the late period of lactation in Ankara, Turkey.

Lead (Pb), mercury (Hg), and cadmium (Cd) have known harmful effects on children's well-being. The object of this study was to measure the levels of heavy metals (Pb, Hg, and Cd) in breast milk and infant hair, connected environmental factors, and the impact on infant growth and development at 8 months. Seventy-four breast milk samples and 46 infant hair samples were analyzed. Cd, Pb, and Hg were detected in 99%, 91%, and 87% of breast milk samples, respectively. Cd levels were higher in the hair of infants in extended families, living in older houses and when there was a maternal history of anemia and postpartum anemia. Hg levels in breast milk were higher in Denver II suspicious/abnormal infants than in Denver II normal infants. Further biomonitoring studies and preventive measures should be conducted to minimize exposure to toxic metals in early childhood period.

Evaluation of problematic screen exposure in pre-schoolers using a unique tool called "seven-in-seven screen exposure questionnaire": cross-sectional study.

BACKGROUND: Screen media exposure has been increasing in the preschool years. Risky aspects of screen exposure have many potential negative effects on children's health. We aimed to evaluate problematic screen exposure in Turkish preschool children by using a unique tool called the "Seven-in-Seven Screen Exposure Questionnaire" and to investigate factors associated with problematic screen exposure. METHODS: A questionnaire form was designed including general descriptive questions in the first part. In the second part, a questionnaire we designed called the "Seven-in-Seven Screen Exposure Questionnaire" was conducted to evaluate problematic screen exposure characteristics. The questionnaire included seven items: daily screen time, viewing with parent(s), setting screen limits, screen exposure during meals and in the hour before bedtime, age of onset of screen exposure, and viewing low-quality content. The total problematic screen exposure score (range 0-13) was generated by summing scores from the seven items. Total scores are classified into two categories: low (< 7) and high (≥ 7). Logistic regression was performed to search for independent parameters associated with problematic screen exposure. RESULTS: One thousand two hundred forty-five mother-child pairs participated in this study. The median age of the children was 3.9 (IQR: 2.9-4.7) years and 51% were males. Overall, 280 children (22.5%) had a problematic screen exposure score of ≥7 (high). The median problematic screen exposure score was 4 (IQR: 3-6). Maternal age of < 30 years; paternal age of ≥30 years; maternal educational level of ≤12 years; the age of 24-48 months; home-based daycare; postponing eating, toileting, or sleeping while using a screen; and using touchscreen devices were found to be associated with an increased risk of having a high problematic screen exposure score. CONCLUSION: Developing national scales to monitor problematic screen use in children would be more effective than monitoring screen time alone. All of the screen use characteristics not recommended in children would be evaluated using problematic screen exposure scales. The "Seven-in-Seven Screen Exposure Questionnaire" may serve as an example for further studies.

Evaluation of blood and tooth element status in asthma cases: a preliminary case-control study.

BACKGROUND: Asthma is a common respiratory disorder; some data were present on the correlation between increased levels of trace elements and the risk of asthma development. It was aimed to evaluate the levels of 13 selected blood and tooth elements (magnesium, phosphorus, calcium, chromium, manganese, iron, copper, zinc, strontium, molybdenum, cadmium, lead, mercury) in a well-controlled asthma group and the control group. METHODS: During the study period, 17 asthma patients and 26 age and gender-matched healthy children donated shed deciduous teeth having neither decay nor filling and enrolled for the study. The element levels in blood and teeth matrixes were analyzed with inductively coupled plasma mass spectrometry. Differences in blood and tooth elements in groups were evaluated with generalized linear models after adjusting confounding factors. RESULTS: After adjusting the child's "z scores of body mass index for age", history of iron deficiency anemia, and status of parental smoking, the generalized linear model revealed significantly lower tooth magnesium levels, lower blood zinc levels, and lower blood zinc/copper ratio in the asthma group than the control group (p = 0.042, p = 0.034, p = 0.002, respectively). Other studied elements for tooth and blood matrixes were similar in groups. CONCLUSION: Our study revealed some differences in tooth and blood element levels in the asthma group. Further studies on zinc and magnesium levels of severe asthma cases are necessary for the interpretation of the results.

Is maternal cigarette or water pipe use associated with stopping breastfeeding? Evidence from the Jordan population and family health surveys 2012 and 2017-18.

BACKGROUND: Maternal smoking is suspected to have negative impacts on breastfeeding, such as decreasing the quantity of breast milk, and reducing vitamin and fat concentrations in the milk in the late lactation period. Cigarette and water pipe tobacco products are widely used in Jordan. We aimed to estimate the association between use of different tobacco products and the rates of current breastfeeding. METHODS: Data from Jordan's Population and Family Health Surveys 2012 and 2017-18 were examined. Last-born, living children, aged < 25 months, from singleton births, ever breastfed, and living with their mother were included. The key outcome variables were the current breastfeeding (during last 24 h) and tobacco usage status [water pipe tobacco (hookah or narghile) and/or cigarette tobacco]. Complex sample multivariate logistic regression analysis was used to evaluate the association of the current breastfeeding with maternal smoking status. RESULTS: Overall, 6726 infants were included in the study. The current breastfeeding rate in infants aged 0-6 months was 87%, compared with 43.9% in infants aged 12-17 months and 19.4% in infants aged 18-24 months. Overall, 4.4% had mothers who smoked cigarettes, 5.4% smoked water pipe, and 1.6% both cigarettes and water pipe. The proportion of breastfed infants in non-smoking mothers was 57.7% and, those in smoke water pipe, cigarette and both tobacco products were 55.4, 44.9, and 51.0% respectively. Univariate analysis revealed that women cigarette smokers had a lower odds ratio (OR) for current breastfeeding (OR 0.60, 95% Confidence Interval [CI] 0.39, 0.92). Multivariate analysis revealed that maternal cigarette smoking was associated with a lower odds ratio for current breastfeeding compared with mothers who smoked neither water pipe nor cigarettes (AOR 0.51, 95% Cl 0.30, 0.87). CONCLUSIONS: These results indicate that maternal smoking is associated with termination of breastfeeding, suggesting that structured training should be organized for healthcare professionals, expectant mothers and the general public about the association between maternal smoking and cessation of lactation.

Blood boron levels and anthropometric measurements in prepubertal children.

This study was conducted to assess the blood boron levels (BBL) in prepubertal children in the West and Central Anatolia regions of Turkey and its relationship with chosen anthropometric measurements. A multistage sampling design that combined multicluster (West Anatolia vs. Central Anatolia regions and rural vs. urban residents) and simple random sampling methods were used for the sample selection. BBL was measured using inductively coupled plasma mass spectrometry. Weight, height, mid-arm circumference, and triceps skinfold thickness were measured. Z-scores for weight-for-age, height-for-age, and body mass index (BMI)-for-age were calculated. Furthermore, arm-muscle area, arm-fat area, and fat percentage were measured. This study enrolled 2126 children, of whom 50.7% were male. The mean age was 8.9 years. The mean concentration of BBL was 15.6 µg/L (interquartile range: 11.7-19.6 µg/L). Children in urban areas had significantly higher BBL than those in rural areas (17.2 ±â€¯5.5 vs. 11.9 ±â€¯4.6 µg/L; p < .001). Children in the West Anatolia region had significantly lower BBL than those in the Central Anatolia region (14.5 ±â€¯5.9 µg/L vs. 17.8 ±â€¯5.0 µg/L; p < .001). BBL was not affected by maternal education, occupation, sex, and anemia. BBL was found to be significantly lower in children with low BMI, low triceps skinfold thickness, low arm fat area, and low-fat percentage. Change in BBL was associated with the region and residence in Turkey. BBL differed between well-nourished and malnourished children. Further studies are needed to evaluate the relationship between anthropometry and BBL.

Parental perception and child's nutritional status.

Childhood obesity is a health hazard increasing worldwide. Preschool period which is under supervision of parents is a critical period to detect overweight and take precautions. We studied the factors affecting parental estimation of their preschool child's weight. Three hundred sixty seven mothers completed questionnaires consisting of child's and parents' anthropometric measurements, parents' assessment of their child's and their own weight status, and general information about their lifestyle. Mothers also chose their wish for current and future body image of their child from child drawings representing percentiles. Child body mass index-for-age z score (BAZ) was related to birth weight and child's appetite. BAZ was not related to child's gender, presence of chronic disease, family pattern, parental age, education or income. 43.1 % of mothers correctly assessed child's BAZ verbally. Maternal verbal estimation was correlated with maternal visual estimation, paternal verbal estimation and child's BAZ. Mothers' wish for future figure of the child was not related to child's BAZ, but showed correlation with mothers' wish for current figure of the child. Mother's correct perception of her child's weight was found to be high, consistent with her spouse and related to child's BAZ.

Initial white blood cell kinetics for assessment of individual response to the conditioning regimen in pediatric hematopoietic stem cell transplantation patients.

We hypothesized that the individual hematological response to chemo/ radiotherapy may be used as a parameter to assess the degree of myeloablation and probability of transplant-related events. This study included 58 pediatric patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT). White blood cell (WBC) ratio (pre-conditioning WBC: day 0 WBC), day 0 WBC count, and WBC nadir day were used as potential indicators of myeloablation. The association between WBC kinetics and clinical result of HSCT was investigated. There was a positive correlation between WBC ratio and the date of engraftment. A positive correlation was noted between day 0 WBC count and engraftment day. There was a negative correlation between WBC nadir day and engraftment day. WBC nadir day was lower in patients with acute graft-versus-host disease (GVHD) than in cases without acute GVHD. Among patients who had fever during the conditioning regimen, the WBC ratio was higher, day 0 WBC count was lower, and WBC nadir day was lower in patients who developed >5 days of fever between day 0 and day +30. The present preliminary study suggests that WBC kinetics may be used as a measure of initial hematological response to the conditioning regimen and perhaps in determining the degree of myeloablation.

Determinants of continued breastfeeding beyond 12 months in Turkey: secondary data analysis of the Demographic and Health Survey.

Continued breastfeeding at year 1 is one of the core indicators for assessing global infant and young child feeding practices. The study aims to determine the frequency of breastfeeding after 12 months (long-term breastfeeding) according to a number of infant and maternal characteristics and to investigate the effects of long-term breastfeeding on the nutritional habits and growth status of children as seen in the national data. The sample included 1666 children aged 12 to 35 months from the 2003 Turkey Demographic and Health Survey. Only 55.9% of children were breastfed beyond 12 months. The rates of long-term breastfeeding were higher in the presence of the following characteristics: high birth order, long preceding birth interval, religious marriage ceremony, usage of traditional contraceptive methods, mothers aged 30-34 years and overweight mothers. Rates were lower for mothers with tobacco exposure and for bottle-fed infants. Long-term breastfeeding did not affect the consumption of plain yogurt, solid foods and semi-solid foods; however, it was associated with a decreased intake of bottled milk and fruit juice. The rates of long-term breastfeeding were similar in the case of undernourished children and of those with normal growth status. Long-term breastfeeding was related to certain maternal and infant characteristics; however, it did not affect the consumption of complementary food. Breastfeeding promotion programs should include targeted interventions for younger, primiparous and smoking mothers.

Changes and determinants in under-five mortality rate in Turkey since 1988.

Child survival is the focus of the fourth Millenium Developmental Goal (MDG4). This paper describes levels, trends, and differentials in Under-Five Mortality Rate (U5MR) and also summarizes state programmes in Turkey between 1988 and 2010. Turkey is among only a few countries that have already surpassed MDG4 and have reduced their under-five mortality rate by more than two-thirds. In 2010, 13 out of every 1,000 children died before their fifth birthday. Low birth weight, high-birth order, short birth intervals, rural residence, low level of maternal education and lowest wealth quintile have affected negatively children's chances of survival. Expanding the scope of free vaccination programmes for children, improving screening and disease prevention schemes aimed at children, encouraging breastfeeding, implementing an emergency obstetric care programme, improving the services provided to newborns (a newborn intensive care programme) have brought about a significant decrease in the rate of infant and under-five mortality. The implementation of state and region specific action plans should be necessary to increase the chance of an access to the Continuum of Care for each mother and infant and to surpass MDG4.

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.

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.