M. Ali Bumin

Prevalence and risk factors of monosymptomatic nocturnal enuresis in Turkish children.

Objectives To determine the prevalence of primary monosymptomatic nocturnal enuresis (PMNE) and assess risk factors that can cause this disease. Methods After the determination of 15 primary schools in the provincial center of Ankara, questionnaires were given to 15,150 students to be answered by their parents. Detailed urologic history was obtained and physical examination applied to the students whose parents answered the questionnaire. After excluding children with polysymptomatic NE, 14060 questionnaires of MNE patients were evaluated. Demographic features with social and medical history of students and their parents, general approach of family to the children, school success of the students and general behavioral attitudes, method of toilet training and the presence of nocturnal enuresis were questioned. Results MNE was determined in 9.0% (n: 1266) of the students and nocturnal enuresis frequency was higher in boys than girls (P<0.05). Univariate analysis revealed gender, method of toilet training, sleep problems, school success, and general approach of the family to children and general behavioral attitudes of the children as significant factors. In logistic regression analysis; age, male gender, toilette training with threatening method, deep sleeper, sleep walking, being introverted and shy, significantly increases the risk of nocturnal enuresis. Conclusions The current study suggests that the methods of toilet training are extremely important to prevent bedwetting and behavioral disorders due to enuresis. Parents should be well-informed about the appropriate toilet training method.

The effectiveness of training for breast cancer and breast self-examination in women aged 40 and over.

Background. Training on breast health is required to increase awareness of early detection of breast cancer, especially in countries with limited resources.Methods. Of the 784 invited women, 462 participated in the study (58.9%). The training included both theoretical and breast self-examination (BSE) training between preeducation and posteducation tests. Following the theoretical presentation, breast examination training was performed using a breast simulator. The competency of the participants on breast examination was assessed by an evaluation guide.Results. All breast cancer symptoms were stated at significantly higher rates compared to those before education (P<.05). The most commonly stated risk factor in both preeducation and posteducation tests was “no breast-feeding,” with ratios of 15.2% and 56.3%, respectively. Early detection modalities for breast cancer were also stated more often in the posteducation test compared to the preeducation (P<.05). In the preeducation test, only 4.3% to 18.7% of the participants women could state most of the BSE steps. After BSE training, 85% to 92% of the participants were competent in BSE steps.Conclusions. Theoretical education on breast cancer and BSE training in low-educated women, even illiterate, is highly effective.

Induced abortion frequency in Ankara, Turkey, before and after the legal regulation of induced abortion.

Objective To determine the effects of the 1983 law that legalized induced abortion on the number and place of abortions, and on the use of family planning (FP) methods before and after abortion, and to determine the demographic characteristics and reproductive health features according to the order of abortion. Method This study included 2455 married, widowed or divorced women presenting at Mother and Child Health-Family Planning Centres in Ankara. A questionnaire was used for data collection. Result Nearly three out of 10 (28.7%) of the women had undergone at least one induced abortion. In the age groups 45–54 and 55–64, 49 and 37.3%, respectively, had had one or more terminations of pregnancy (TOPs). The induced abortion rate increased following the enacting of the law. In the 15–24 and in the 55–64 age group, 55.6 and 89%, respectively, of the women had been aborted by a private physician. Before the index pregnancy, 63.1% were not using contraception compared with 37.3% thereafter. The rate of use of FP increased after the law was passed. Conclusion Although the most common reason for having an abortion was unwanted pregnancy in all age groups and nearly 60.0% of the women aged less than 55 reported that they were not using any FP method at the time of the TOP, the proportion of women having undergone at least one of these procedures increased after the law was passed, indicating that abortion is used as a FP method.

Tetanus immunization in pregnant women. Serum levels of antitetanus antibodies at time of delivery

The objective of this study was to determine the tetanus immunity status of pregnant women at the time of delivery according to tetanus toxoid (TT) vaccination coverage during their most pregnancy. The serum anti-tetanus antibody levels of 493 mothers who had live births at a hospital in Ankara were determined by enzyme-linked immunosorbent assay (ELISA). Protected women were defined as those with serum antibody levels ≥ 0.6 IU/ml. Overall, 69.0% of mothers had protective tetanus antibody titers at the time of delivery. The rates of protection for mothers who had received no vaccination, one TT dose, or two TT doses during pregnancy were 46.4, 93.5, and 95.6%, respectively. Vaccinating every pregnant woman with at least one dose of TT would be an affordable and effective way to protect against neonatal tetanus, and would be a step toward eliminating the deaths that continue to occur due to this preventable disease in Turkey.

Behaviors Toward Methods of Breast Cancer Early Detection in Women Over 40 Years in a Rural Region of Ankara, Turkey

Background. In this study, we aimed to determine behaviors of women over 40 years toward methods of breast cancer early detection in a rural region of Ankara, Turkey. Methods. Of the 1277 women aged over 40 years, 910 (71.3%) participated in the study. Results. Not performing breast self-examination was 3.1 times more frequent in those aged 60 years and older (95% confidence interval [CI], 1.8–5.2), 2.1 times more frequent in those who could only read and write (95% CI, 1.5–2.9), and 2.5 times more frequent in housewives (95% CI, 1.5–4.3). The likelihood of clinical breast exam was 1.8 times less in women aged 60 years old and older compared with younger women. Primary school graduates had a 1.9 times (95% CI, 1.3–2.9) greater chance of not having had a mammography compared with those that been at least primary school graduates. Conclusions. For women to change their behavior and adopt early methods of diagnosing breast cancer, it is necessary to reach priority target groups during the training provided by primary care institutions.