Feyza Koc

Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey.

Although Turkey is located in a sunny region, vitamin D deficiency is still a serious health problem in pregnant women and their infants, especially among the low socio-economic status Turkish population. This study was carried out in order to measure serum 25-hydroxyvitamin D3 [25(OH)D] concentrations of the pregnant women in the last trimester and in their neonates at delivery and to determine the factors associated with maternal serum 25(OH)D concentrations. Among the patients visiting the Ege Obstetrics and Gynecology Hospital in the period March to May 2008, 258 healthy pregnant women ≥37 weeks of gestation were included in this study. The information on different characteristics such as the number of pregnancies and births, nutritional status, vitamin and mineral support during gestation, educational status, clothing style and the economic level of the family was collected from women. Blood samples from the mothers and umbilical cord of the newborns were taken to measure 25(OH)D. The mean 25(OH)D concentrations of the mothers and their infants were 11.5 ± 5.4 ng/mL and 11.5 ± 6.8 ng/mL, respectively. We found a strong positive correlation between maternal serum and umbilical cord blood 25(OH)D concentrations (r = 0.651, P < 0.001). The concentration of 25(OH)D was ≤20 ng/mL in 233 mothers (90.3%) and ≤10 ng/mL in 130 mothers (50.4%). Maternal serum 25(OH)D concentrations related strongly to factors such as uncovered dressing style, sufficient consumption of dairy products and multivitamin use during gestation (P < 0.05). About half (52.7%) of these women had a covered dressing style. 25(OH)D concentrations of these covered dressing mothers and their infants were 9.7 ± 5.1 ng/mL and 9.7 ± 5.6 ng/mL, respectively, which were significantly lower compared with those of uncovered mothers and their babies (P < 0.001). This study showed that, despite a sunny environment, vitamin D deficiency and insufficiency are highly prevalent among the mothers and their neonates. This is generally due to the life style and nutritional status of the mothers. These findings suggest that much more effective vitamin D prophylaxis programmes should be implemented for pregnant women as well as for their babies.

Vitamin B12 and folate statuses are associated with diet in pregnant women, but not with anthropometric measurements in term newborns.

Objective: To investigate the frequencies of vitamin B12 and folate deficiencies in pregnant women in low socioeconomic group, the relation between the animal-source foods consumption and maternal vitamin B12-folate statuses, and their impacts on anthropometric measurements of the infants. Methods: A total of 208 pregnant women in the last trimester were included in the study. A questionnaire about socio-demographic status, consumption of meat, egg, milk-dairy products, multivitamin supplementation was used. Vitamin B12 and folate concentrations were studied by chemiluminescence method. The babies of Vitamin B12 deficient mothers were evaluated after birth. Results: The rate of vitamin B12 deficiency was 47.6% and folate deficiency was 17.3% of pregnant women. Animal food consumption was inadequate about half of pregnant women and vitamin B12 levels in these women were significantly low. There were no statistically significant relationships between the birth weight, birth length and head circumference measurements, and maternal vitamin B12 and folate concentrations. Conclusion: The rate of vitamin B12 deficiency in pregnant women in low socioeconomic population is high. Although there were no significant effects of the vitamin B12 and folate deficiencies on birth size, additional studies are required to elucidate the subsequent effects.

Epidemiological study of negative childhood experiences in three provinces of Turkey.

AIM This study aimed to determine the frequencies of negative childhood experiences in the past years and negative childhood experiences throughout life in 11, 13 and 16 year-age group children who attended school in three separate provinces. MATERIAL AND METHODS Approval was obtained from the provincial National Education Directorates and educated investigators applied the ISPCAN child abuse screening tool questionnaire form which measures negative childhood events experienced at home in children. Statistical analysis was performed with chi-square test using SPSS 16.0 program. Approval from the ethics committee was obtained from İzmir Tepecik Education and Research Hospital Chief Physician Office Local Ethics Committee (29/11/2011-29). RESULTS The study was conducted with 7 540 children in İzmir, Denizli and Zonguldak. The frequency of psychological and physical negative childhood experiences and neglect throughout life was found to be 70.5%, 58.3% and 42.6% in the 11, 13 and 16-year age groups, respectively; the frequencies in the last one year was found to be 62.7%, 46.0% and 37.5%, respectively. Psychological negative childhood experiences were found with a higher rate in children who lived in urban areas compared to children who lived in rural areas. Neglect was found with a higher rate in girls and physical negative childhood experiences were found with a higher rate in boys. The frequency of negative childhood experiences increased proportionally with the age of the child independent of the type of experience. CONCLUSION The frequencies of negative childhood experiences for the last one year and for the life-long period were determined using ISPCAN child abuse screening tool in Turkey for the first time in three provinces and in such a large population. The frequency of negative childhood experiences related with child abuse and neglect screened were found to be 42%-70% and it was elucidated that we are confronted with a very significant public health problem and adult health risk in these regions of Turkey.

Missed Cases of Multiple Forms of Child Abuse and Neglect

Child abuse and neglect is a public health problem and usually associated with family dysfunction due to multiple psychosocial, individual, and environmental factors. The diagnosis of child abuse may be difficult and require a high index of suspicion on the part of the practitioners encountering the child and the family. System-related factors may also enable abuse or prevent the early recognition of abuse. Child abuse and neglect that goes undiagnosed may give rise to chronic abuse and increased morbidity-mortality. In this report, we present two siblings who missed early diagnosis and we emphasize the importance of systems issues to allow early recognition of child abuse and neglect.

Staff training makes a difference: improvements in neonatal illicit drug testing and intervention at a tertiary hospital

Abstract Objective: This project explored the impact of staff training on the rates of perinatal maternal and neonatal illicit drug testing. Methods: Controlled, retrospective chart review on 1186 newborn and mother dyads from 2006 (pre-training control group) and on 1861 dyads from 2009 (post-training study group) was completed. Differences between rates of infant and mother drug testing were compared. Results: Increased drug testing rates for the mothers and infants led to increased case finding that tripled both for the mothers (13–3.7%, p < 0.001) and for the infants (0.9–2.9%, p < 0.001). Missed opportunities for newborn testing was reduced by 35 times (20.9–0.6%, p < 0.001). Conclusion: This retrospective study led to an increase in the number of documented drug-exposed newborns. This research emphasizes the importance of and encourages other hospitals to analyze the efficacy of their current protocol and staff training practices in place to ensure the best child protection services.

Perinatal illicit drug screening practices in mother-newborn dyads at a university hospital serving rural/semi-urban communities: translation of research to quality improvement

Objective: To determine staff compliance with the hospital perinatal illicit drug screening-intervention and the prevalence of dyads that are not tested who present with risk factors indicating the need for testing. Methods: This is a retrospective, controlled chart review of mother/newborn dyads presenting to a university hospital for delivery services in 2002 and 2003. Group 1 included all dyads, in which the newborns were tested for illegal drugs after delivery (n = 121). Group 2 included every 25th delivery that did not qualify for Group 1 (n = 107). The documentation rate of demographic characteristics and risk factors were compared. Results: Multiple risk factors were documented in 95.9% of the Group 1 dyads and 32.7% of the Group 2 dyads (p < 0.0001). However, 50 mothers in Group 2 with risk factors, eligible for urine drug testing were not tested. In Group 2, 35.5% of newborns were eligible for drug testing, but were not tested. Twelve infants were not tested when their mothers were tested and two infants were not tested when their mothers tested positive during the study period. Conclusion: The data in the present study revealed the necessity of a staff-training program and the revision of the hospital perinatal illicit drug screening practices- intervention.

470 Adverse childhood experiences study among university students in Turkey

Background There is a salient relationship between exposure to childhood traumatic events and negative health behaviours, and health status. The aim of this study was to identify the prevalence of adverse childhood experiences (ACEs) in a group of university students in Turkey and to evaluate the association of ACEs , with some health consequences including health risk behaviours. Methods This is a descriptive cross-sectional study. 2257 students of 5 universities in Turkey were enrolled into the study between the years 2012–2013. A questionnaire modified from the ACE Questionnaire developed by CDC and Kaiser Permanente was used in the study. The questionnaire includes 53 questions on sociodemographic characteristics, household dysfunction, childhood maltreatment, health risk behaviours, somatic complaints and health status. Results 47.9% of the 2257 respondents were male and 52.1% were female. The mean age of respondents was 20.1 years. The overall prevalence of childhood physical abuse, sexual abuse, emotional abuse, emotional neglect and physical neglect was 21.1%, 7.9%, 9.8%, 8.8% and 5.7% respectively. 5.2% of respondents had divorced or separated parents. The overall prevalence of depression or suicide attempt, problem alcohol use, history of street drug use and involvement in crime or imprisonment in household members was 9.3%, 6.4%, 3.4% and 10.3% respectively. The ACE scores indicate that half of all respondents had a history of at least one ACE. ACE score was positively associated with health risk behaviours. The risk of smoking, harmful alcohol using and drug using increases dependently on the ACE score. Some health problems particularly emotional problems were associated with ACE score of the participants. Conclusions This study suggests that ACE prevalence, health risk behaviours and certain health problems are high in a group of young adults in Turkey. The data from this study does not only provide information about the magnitude of the problem but also evidence that underlines the need to prioritise child maltreatment besides.

A rare cause of recurrent wheezing in children: Bronchogenic cyst

Bronchogenic cysts are benign congenital anomalies caused by aberrant development of the foregut in the embryonic period. These anomalies are located in the posterior part of the carina and constitute about 50% of all mediastinal lesions. In childhood, bronchogenic cysts may be asymptomatic or cause symptoms due to pressure on the respiratory tract. The duration and severity of the symptoms are main determinants for the developments of chronic lung diseases. In this paper, we presented an infant case with bronchogenic cyst admitted to our clinic with recurrent wheezing. Pam Med J 2013;6(3):168-173

Abusive Suffocation Presenting as New-Onset Seizure

Child abuse can often be very difficult to identify. This is especially true in cases of abuse by suffocation. Suffocation often leaves no external physical marks and presents with vague, nonspecific symptoms. Infants who have been suffocated usually present unexplained apnea, cyanosis, or seizure. Moreover, new-onset seizures can be mistaken for an organic seizure disorder. This case report reviews a case of abuse by suffocation, which presented as new-onset status epilepticus. This case illustrates that suffocation can be difficult to diagnose despite the recognition of red flags that should prompt an investigation for abuse.