Figen Sahin

Effectiveness of Inactivated Influenza Vaccine for Prevention of Otitis Media in Children

Objective: The objective of this study was to evaluate the effectiveness of inactivated influenza vaccine in preventing acute otitis media (AOM) and otitis media with effusion (OME) in children aged 6 to 60 months who attend day care. Study Design: This prospective, single-blind study was conducted in 8 day care centers in Ankara, Turkey. One hundred nineteen (61 vaccinated and 58 unvaccinated against influenza) healthy children were examined at study entry and at 6-week intervals for 6 months by the same 2 otorhinolaryngologists who were blinded about the vaccination status of the children. The frequency of AOM and OME is compared between the 2 groups and the effect of influenza season on frequency of episodes was evaluated. Based on national influenza laboratory data, the influenza season was determined to be the period between December 15, 2003, and January 31, 2004. Result: The frequencies of AOM, OME and total otitis media episodes in vaccinated children were 2.3%, 22.8% and 25.2%, respectively, and these frequencies were 5.2%, 31.1% and 36.3% in the unvaccinated group. The difference was statistically significant (P < 0.01). This difference was especially prominent in the influenza season (P < 0.05). Conclusion: Influenza vaccine is effective in reducing AOM and OME episodes in 6- to 60-month-old day care children, especially during influenza season.

Screening for developmental dysplasia of the hip: Results of a 7‐year follow‐up study

Abstract Background : Screening for developmental dysplasia of the hip (DDH) is widely recommended for all infants to prevent disability from late diagnosis of dislocation of the hip. The present study evaluates the results of screening for developmental dislocation of hip in a clinic in Turkey over the course of 7 years.

Diagnostic value of rapid antigen detection test for streptococcal pharyngitis in a pediatric population.

Acute upper respiratory tract infections in children may result in overuse of antibiotics as throat culture cannot be performed in every setting and results cannot be obtained early. A rapid and reliable test might decrease unnecessary antibiotic usage. The purpose of this study was to determine the prevalence of group A beta-hemolytic Streptococcus (GABHS) infections in different pediatric age groups and to assess the diagnostic value of rapid antigen detection test (RADT) for streptococcal pharyngitis. This study was performed in a pediatric outpatient clinic. All children who were admitted with signs and symptoms of acute upper respiratory tract infections were included in the study. Throat culture and RADT were performed and prevalence of GABHS was assessed. Diagnostic value of RADT was determined. This study included 1248 children with a mean age of 6.3+/-3.6 years. There were 655, 518, and 75 children in age groups of 0-6, 7-12 and 13+ years, respectively. The overall prevalence of GABHS was 38.1% (475/1248), as judged by throat culture. The prevalence was highest in the 7-12-year age group (53.9%) and lowest in the 0-6-year age group (25.2%). Considering all patients, RADT gave a sensitivity of 89.7%, specificity of 97.2%. The sensitivity and specificity of RADT were similar in different age groups (p values >0.05). Diagnostic value of RADT is high and can be used safely in populations where streptococcal pharyngitis and its complications such as acute rheumatic fever and acute glomerulonephritis are common.

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.

Nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish infants

OBJECTIVES The aims of this study were to determine nasopharyngeal carriage rates, serotype distribution and antimicrobial resistance patterns of Streptococcus pneumoniae in healthy 0 to 2 year-old infants who live within a rural or urban locale and not attending daycare centers. In order to evaluate the possible impact of pneumococcal conjugate vaccine in this population, coverage of the isolated serotypes by the vaccine was also calculated. METHODS The study was conducted on 564 healthy infants attending 2 different well child clinics, one of which is located in an urban region and the other in a rural region. Specimens were collected with nasopharyngeal swabs. Serotyping was performed with standard antisera. Penicillin susceptibility was determined with E-test. Chi-square tests and logistic regression were used for data analysis. RESULTS The pneumococcal carriage rate was 22.5%. Age (>2 months age) [2.98 (1.41-6.29) p=0.004] and presence of another child within the house who attends school [1.72 (1.13-2.62) p=0.01] increased the carriage rate. The most frequently isolated serotypes were 11 (11.8%), 23 (7.9%), 19F (7.1%), 22 (6.3%), 9 (5.5%), 19 (5.5%) and 23B (5.5%). The total coverage of vaccine and vaccine-related serotypes by 7, 11 and 13 valent pneumococcal conjugate vaccines were 51.2, 59.0 and 59.0%, respectively. Of the isolated pneumococci, 10 (8.5%) were intermediately resistant and 8 (6.8%) were highly resistant to penicillin. CONCLUSION This study provides data about the local carriage rate and serotype distribution of S. pneumoniae strains in Turkish children, which is important in predicting the possible effects of different valent pneumococcal conjugate vaccines in this population.

Factors affecting the timing of teething in healthy Turkish infants: a prospective cohort study

BACKGROUND Teething is a developmental process and occurs over a broad chronological age range. OBJECTIVE The objective of this study was to evaluate the effects of feeding pattern and growth parameters on teething time of healthy infants. METHODS A total of 1200 term newborn infants followed up in Gazi University well-child clinic infants were evaluated, and their growth parameters, feeding patterns, and timing of the eruption of the first tooth were noted. The routine visit times of the clinic were chosen as the cut-off values for teeth eruption for logistic regression analysis for investigating factors that determine the timing of teeth eruption. RESULTS Timing of the eruption of the first tooth ranged from 4 to 13 months. On the sixth month visit, 24.3%, and on the ninth month visit 84.5% of all infants had at least one tooth. Height-adjusted weight and height percentiles being less than 50, being fed by cows milk or by formula in the first year, were independent factors negatively influencing teeth eruption by the sixth month, while all but height-adjusted weight percentiles being less than 50 had negative impact on tooth eruption by the ninth month. CONCLUSION Growth parameters and feeding pattern may be determinants of the timing of teeth eruption in healthy infants.

Toilet training in Turkey: the factors that affect timing and duration in different sociocultural groups.

BACKGROUND The aim of the present study was to determine the patterns of toilet training and the factors that may be related to its timing and duration and the approaches of different sociocultural groups within a developing country. METHODS This cross-sectional survey was performed on 745 children who live in three different sociocultural settlements. The factors that might have affected initiation and completion age and duration of toilet training were assessed with t-test, ANOVA and logistic regression analysis. RESULTS Mean initiation and completion ages were 22.05 +/- 6.73, 28.05 +/- 8.40 months respectively. The families living in rural and semi-urban settlements, mothers educated for less than 5 years, unoccupied mothers, children living in houses which do not have a toilet inside, families who use washable diapers, who use Turkish style toilets and who use punishment methods started training earlier. In the infants whose mothers had an education over 12 years, completion age was later than others and the earliest completion age was seen in families who used punishment method. Mean duration needed to complete toilet training was 6.84 +/- 7.16 months. The duration of training was longer in families living in rural and semi-urban settlements, mothers educated for less than 5 years, unoccupied mothers, children living in houses which do not have a toilet inside, families who use washable diapers and when the initiation was before the child was 18 months old. CONCLUSION Toilet training shows differences among cultures. The age of initiation may be increased as the parents are educated better and a child-orientated approach becomes more popular than the parent-orientated approach.

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.

Preliminary Validation of the Child Abuse Potential Inventory in Turkey

This study aims to provide preliminary findings on the validity of Child Abuse Potential Inventory (CAP Inventory) on Turkish sample of 23 abuser and 47 nonabuser parents. To investigate validity in two groups, Minnesota Multiphasic Personality Inventory (MMPI) Psychopathic Deviate (MMPI-PD) scale is also used along with CAP. The results show that, with the 200.5 cutoff point, which is the average score of the whole Turkish sample, Abuse Scale correctly classified 83% of the participants in the abuse group and 78.8% of the participants in the control group, which gives 21.2% false-positive result. MMPI-PD to all group and Pearson correlation coefficient analysis is found to be significant for both groups. These results show us high reliability and validity of the abuse scale for Turkey.

Seroprevalence of IgG antibodies against Bordetella pertussis in healthy individuals aged 4–24 years in Turkey

The distribution of IgG antibodies to Bordetella pertussis was investigated in serum samples from 550 subjects, aged 4-24 years, to determine the optimal age for booster immunisation. Levels of antibody to B. pertussis antigens were determined using an ELISA that measures a mixture of pertussis toxin, filamentous haemagglutinin and lipopolysaccharide. Geometric mean titres of anti-pertussis antibodies in subjects aged 4-6 years were significantly lower than those in other age groups, which reflects waning immunity following vaccination. High positive titres in older children and adolescents suggested acquired B. pertussis infection, and booster doses at the ages of 7 and 15 years are therefore suggested.