Ayşegül İşler

Immunity against diphtheria among children and adults in Izmir, Turkey.

The aim of this study was to evaluate diphtheria immunity in a sample of the Turkish population having high childhood immunization coverage, including a booster dose of diphtheria toxoid at 12-15 years of age. A total of 599 persons aged 1-70 years were selected with cluster sampling. The information on socio-demographic characteristics, vaccination status and diphtheria history was gathered for each participant. Diphtheria antitoxin levels were measured qualitatively by using micro-enzyme immune assay. Of studied population, 72.3% had fully protective antitoxin levels (≥ 0.1 IU/ml). The rate of protection was 92.5% in the children aged 0-2 years, 93.2% in the primary school children aged 7-9 years, and 86.0% in the adolescents aged 15-19 years. After 20 years of age, diphtheria protection rates showed a significant age-related decrease, reaching minimum in the 30-39 age group, in which 47.3% of these subjects had fully protective antitoxin levels. The diphtheria antitoxin geometric mean titer (GMT) was highest in the 0-2 year age group (1.18 IU/ml). In the adolescents aged 15-19 years, diphtheria antitoxin GMT was 0.71 IU/ml. Then, geometric mean titer decreased with increasing age, and reached the minimum level in the 40-59 years age group (0.18 IU/ml). The protection rate among females was significantly lower than males (67.1% vs. 80.9%). The difference was apparent in the 20-29 and the 30-39 years age group: 80% of the males and 46.2% of the females in the 20-29 years age group, and 60% of males and 44.1% of females in the 30-39 years age group were fully protected against diphtheria (p<0.0001). These results suggest that in Izmir, Turkey, full serological protection against diphtheria is only detectable in <50% of the young adult population, even though childhood immunization coverage is relatively high. Potentially, there is still risk of diphtheria outbreaks among the adults in our country. Therefore, a revaccination of adults with reduced doses of diphtheria toxoid should be considered to sustain diphtheria immunity.

Comparison of temporal artery to mercury and digital temperature measurement in pediatrics.

AIM The aim of the study was to compare the temporal artery thermometer measurements with the mercury and digital axillary thermometer measurements in children. METHODS This study was conducted at the Pediatric Emergency Department of Akdeniz University Hospital over a three-month period in Turkey. The sample for the study comprised 218 children (aged 0-18years). Three different methods were applied to each patient at the same time. After acquiring necessary institutional permission to conduct the study, the informed consent to participate was obtained from parents before the subjects were included in the study. The data were evaluated using general linear models. The differences between the groups were analyzed by Least Significant Difference method. RESULTS The average temperature measured by temporal artery, mercury and digital thermometers were 38.9°C, 38.3°C and 38°C respectively. CONCLUSION Temporal artery thermometer values might be considered as core temperature. Rectal temperature is about 2°F (1°C) higher than an axillary temperature. In our study the difference between the temperature measured values was found to be consistent with the range provided in the literature. Temporal artery thermometers are recommended especially pediatric emergency settings, where an accurate, quick and safe body temperature measurement is of vital importance.

Complementary and alternative approaches used by parents of children with epilepsy on epilepsy management

The aim of this study was to determine the complementary and alternative approaches used by parents of children with epilepsy on epilepsy management. This descriptive study included a total of 304 parents of children with epilepsy aged between 0 and 18years evaluated at the Pediatric Neurology Clinic of Akdeniz University Hospital in Turkey between January and May 2013. Data were collected by using a questionnaire developed by the researchers. It was determined that all the parents use complementary and alternative approaches for their children with epilepsy, and the most common approaches are praying (99.3%); keeping their children away from the effects of smoking (79.8%); feeding their children walnuts (79.6%), butter (59.2%), and bone marrow (58.6%); providing their children with good quality sleep (58.6%); and enabling their children to play games (51%). The approaches commonly applied during seizures include praying (96.2%), comforting their children in their arms and showing affection (55.6%), waiting for seizures to finish at home (45.7%), and laying children on their side (41.1%). Of parents, 98% stated that alternative approaches enable them to control their childs seizures, 100% said that alternative approaches have no adverse effect, and 98.4% stated that they will continue to use these approaches. The childrens approaches to cope with epilepsy included looking after pets (72.7%), listening to music (70.1%), watching television (64.5%), playing games (55.3%), praying (51%), and spending time with friends (48.7%). Most of the approaches used by parents and children with epilepsy for the management of illness are determined to consist of complementary approaches that may contribute to management of epilepsy. Knowing the approaches of parents and children with epilepsy that could adversely affect disease management is important for educating parents and children to avoid these potentially harmful interventions.

Semiologic seizure classification: The effectiveness of a modular education program for health professionals in pediatrics

We tested the effectiveness of a modular education program on Semiologic Seizure Classification (SSC) in helping health professionals in pediatrics correctly recognize seizures in childhood. The study samples included 20 residents, 20 nurses, and 10 EEG technicians working in pediatrics. The study was conducted in two steps. First, a modular education program comprising CD-ROMs including 58 video clips of epileptic seizures designed for the original SSC was developed. Second, each participant took a pretest by viewing the pretest CD-ROM, participated in the modular education program with a CD-ROM, and finally took a posttest with the posttest CD-ROM. The pretest scores were found to be low in each subgroup of the study population: the average scores were 8 for the residents (minimum 4-maximum 10), 2 for the nurses (min 0-max 4), and 2.5 for the EEG technicians (min 0-max 8). After participating in the modular education program, correct recognition of seizures increased in the posttest: the average scores were 15.5 for the residents (min 9-max 20), 15 for the nurses (min 13-max 20), and 13.5 for the EEG technicians (min 3-max 19). The increase in the scores in the subgroups and in all study groups in general was found to be statistically significant (P<0.05). The modular education program developed for SSC was found to be highly effective in teaching health professionals working in general pediatric clinics to correctly recognize seizure types.