Betül Ulukol

Adverse childhood experiences and associations with health-harming behaviours in young adults: surveys in eight eastern European countries

Abstract Objective To evaluate the association between adverse childhood experiences – e.g. abuse, neglect, domestic violence and parental separation, substance use, mental illness or incarceration – and the health of young adults in eight eastern European countries. Methods Between 2010 and 2013, adverse childhood experience surveys were undertaken in Albania, Latvia, Lithuania, Montenegro, Romania, the Russian Federation, The former Yugoslav Republic of Macedonia and Turkey. There were 10 696 respondents – 59.7% female – aged 18–25 years. Multivariate modelling was used to investigate the relationships between adverse childhood experiences and health-harming behaviours in early adulthood including substance use, physical inactivity and attempted suicide. Findings Over half of the respondents reported at least one adverse childhood experience. Having one adverse childhood experience increased the probability of having other adverse childhood experiences. The number of adverse childhood experiences was positively correlated with subsequent reports of health-harming behaviours. Compared with those who reported no adverse experiences, respondents who reported at least four adverse childhood experiences were at significantly increased risk of many health-harming behaviours, with odds ratios varying from 1.68 (95% confidence interval, CI: 1.32–2.15) – for physical inactivity – to 48.53 (95% CI: 31.98–76.65) – for attempted suicide. Modelling indicated that prevention of adverse childhood experiences would substantially reduce the occurrence of many health-harming behaviours within the study population. Conclusion Our results indicate that individuals who do not develop health-harming behaviours are more likely to have experienced safe, nurturing childhoods. Evidence-based programmes to improve parenting and support child development need large-scale deployment in eastern European.

Immunogenicity study of a combined diphtheria, tetanus, acellular pertussis, inactivated poliomyelitis vaccine used to reconstitute a freeze-dried Haemophilus influenzae type b vaccine (DTaP-IPV//PRP-T) administered simultaneously with a hepatitis B vaccine at two, three and four months of life

This study was designed to assess the immunogenicity of a vaccine combining diphtheria and tetanus toxoids, acellular pertussis vaccine, and inactivated poliovirus vaccine reconstituting Haemophilus influenzae type b polysaccharide conjugated to tetanus protein (DTaP-IPV//PRP-T; Pasteur Mérieux Connaught, Lyon, France) administered simultaneously in association with hepatitis B vaccine (RECOMBIVAX (¿trade mark omitted¿) Merck, Sharp & Dohme, West Point, PA, USA) for the primary immunization of infants. The vaccines were administered at two, three and four months of age. One hundred and sixty-two healthy infants, aged 8-10 weeks, were enrolled in the study. Blood samples were taken before the first dose and 4 weeks after the third dose. The infants were observed for 15 minutes after vaccination for any immediate reaction. Adverse events requiring a medical consultation were recorded by the parents in a diary over the 7 days following vaccination. Four weeks after the third immunization, the percentages of infants fulfilling seroconversion criteria were 98.9% for pertussis toxin, 95.9% for filamentous haemagglutinin, 100.0% for tetanus, 100.0% for diphtheria, 99.3% for poliovirus type 1, 100.0% for both poliovirus types 2 and 3, 98.0% for Haemophilus influenzae type b, and 100% for hepatitis B surface antigen. No vaccine-related serious adverse event was reported. The simultaneous administration of DTaP-IPV//PRP-T and hepatitis B vaccines at two, three and four months of age yielded clinically satisfactory immune responses to all antigens compared with historical controls and gave a good safety profile.

Postpartum mood disorders and maternal perceptions of infant patterns in well‐child follow‐up visits

Aims: The aims of this study were to evaluate the associations between postpartum depressive symptoms and maternal perceptions of infant patterns with 1‐year follow‐up examinations, and to assess the impacts of treatment on these perceptions.

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.

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 validity of diagnostic criteria for streptococcal pharyngitis in Integrated Management of Childhood Illness (IMCI) guidelines.

The WHOs Integrated Management of Childhood Illness (IMCI) programme is being implemented in Turkey with an additional section relating to throat problems for our countrys adaptation. The aim of this study is to evaluate the validity of this additional part and suggest new combinations for the diagnosis of streptococcal pharyngitis to improve the guidelines. Throat swabs were obtained from 245 children between 0 and 17 years of age with signs and symptoms of upper respiratory tract infections. Considering the throat culture based diagnosis as the gold standard, the validity of the symptoms alone and in combinations were calculated. The combination in Turkeys IMCI guideline was found to be 36.9 per cent sensitive and 68.3 per cent specific. Sensitivities of combinations including at least two of the following three symptoms, namely sore throat, pharyngeal erythema, and pharyngeal exudates or sore throat, pharyngeal erythema, and fever, were 76.9 and 87.7 per cent, respectively. Specificities of the same combinations were 49.4 and 30.6 per cent. We concluded that new combinations with a higher sensitivity may be considered as a criterion for antibiotic treatment.

Patient Compliance to Psychiatric Interventions and Course of Postpartum Mood Disorders

Objective: Patient compliance to the psychiatric interventions may affect the outcomes of the mothers with postpartum mood disorders. The aim of this study was to assess the course of depressive symptoms of compliant and noncompliant mothers with postpartum mood disorders. Method: One hundred-three mothers were followed with the Edinburgh Postnatal Depression Scale (EPDS) during 12-month follow-up period. Mothers with an EPDS score of 12 or higher were consulted with a psychiatrist. “Noncompliant patient” term was defined in this study for the patients who refused psychiatric consultation or treatment suggestions. Outcomes of the depressive symptoms were followed up according to the EPDS scores. Response rate based EPDS scoring was defined. Results: A total of 35 (34%) mothers received a higher EPDS score;28 (27.2%), who accepted the consultation, were diagnosed with postpartum mood disorder. Twenty-three mothers (10 mothers with major depressive disorder and 13 mothers with adjustment disorder) complied with treatment suggestions, and all of them responded to the treatment. EPDS scores was more likely to decrease in these compliant mothers (p = 0.010). However, of the noncompliant mothers (n=12), only 50% responded to treatment; moreover, the drop out rate was quite high (58.3%). Conclusions: This study reveals that noncompliance to psychiatric interventions may lead to a much less favorable course in depressive symptoms, and to a tendency in drop-outs from visits. Health professionals can give advice to the mothers about postpartum mood disorders and could assist them in getting better outcome.

Child abuse and neglect in Turkey: professional, governmental and non-governmental achievements in improving the national child protection system

Abstract Since ratification of the United Nations Convention on the Rights of the Child in 1995, significant efforts were made in Turkey to improve protection of children from abuse and neglect. The government took steps to amend relevant laws. Several state departments recognized the need for professional in-service training of relevant governmental agency staff. University hospitals established numerous hospital-based multidisciplinary child protection centres. The government established an Interministerial Higher Council, which has been overseeing the foundation of 13 child advocacy centres for a multidisciplinary and interagency response to child sexual abuse. In addition to undertaking research, non-governmental organizations contributed to this process by instituting professional and public education. These ground-breaking developments in the last decade give promise of even further improvement in the national child protection system from investigative, child protective and rehabilitative perspectives.

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.

Serum pro-hepcidin levels in infants with iron deficiency anaemia

Sir, hepcidin is a 25-amino acid peptide that is proposed to be a central mediator of iron metabolism, which acts by limiting intestinal iron absorption and promoting iron retention in reticuloendothelial cells (Leong & Lönnerdal, 2004; Hugman, 2006). The human hepcidin gene encodes a prepropeptide of 84 amino acids, pro-hepcidin (Leong & Lönnerdal, 2004). Serum pro-hepcidin levels were analyzed in healthy adults and newborns, and a variety of adult patients (Kulaksız et al., 2004; Eleftheriadis et al., 2006; Luukkonen & Punnonen, 2006; Tiker et al., 2006). The relatively small number of studies of hepcidin in human anaemia syndromes suggest that this peptide has been thought to play a role in the pathogenesis of human anaemia types, especially anaemia of chronic disease (Means, 2004). In a recently published study (Ulukol et al., 2007), we evaluated the serum concentrations of pro-hepcidin of 90 healthy infants aged 4–12 months (mean age: 6.5 ± 2.6 months). According to erythrocyte indices and serum ferritin levels, 16 infants aged 4–6 months (eight boys and eight girls, mean age: 5.6 ± 1.9 months) diagnosed with iron deficiency anaemia and these infants have been excluded from our previous study. In this present report, we evaluated the serum pro-hepcidin levels of these anaemic infants. These infants were not receiving any iron treatment or prophylaxis at the moment of study. The serum pro-hepcidin levels of these infants were compared with those of 54 healthy nonanaemic infants, who were within the similar age range (4–6 months, mean age: 5.04 ± 0.9 months, 29 boys and 25 girls). Serum pro-hepcidin levels were measured using a commercial enzyme-linked immunosorbent assay (DRG International, Inc., New Jersey, USA). Statistical analysis was performed using the spss 11.5. The Student’s t-test was used to compare the levels of the groups. Table 1 shows laboratory findings of these infants. Serum pro-hepcidin values were in the ranges of 65–420 ng/ml in anaemic infants (179.3 ± 106.9 ng/ml). The pro-hepcidin levels of the anaemic infants were statistically similar with those of the healthy ones. This present report indicated wide physiological variations in serum pro-hepcidin concentrations among the infants aged 4–6 months with iron deficiency anaemia. Previous animal studies show that hepcidin gene expression is downregulated when iron availability is low, and overexpression of hepcidin results in severe iron deficiency in mice (Nicolas et al., 2002a; Mazur et al., 2003). LETTER TO THE EDITOR INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY