Mujgan Alikasifoglu

Subjective health, symptom load and quality of life of children and adolescents in Europe.

Objectives:To examine cross-cultural differences in the prevalence of school childrens subjective health types and the pattern of socio-demographic and socio-economic differences.Methods:Within the cross-sectional Health Behaviour in Schoolaged Children 2005/2006 Survey 200,000 school children aged 11, 13 and 15 answered a general health item, the Cantrill life satisfaction ladder and a subjective health complaints checklist. ANOVA and multilevel logistic regression models were conducted.Results:Overall, 44% of the respondents reported multiple recurrent health complaints, only poor to fair general health, low life satisfaction or a combination of these. Older adolescents (OR: 1.1–1.6) and girls (OR: 1.2–1.4) reported more health problems, the gender difference increased with age (OR: 1.3–1.6). Low socio-economic status was also associated with health problems (OR: 1.4–2.3). Sizeable cross-national variation in the prevalence of health types and the impact of the above mentioned factors were observed, yet the main pattern of impact could be confirmed cross-culturally.Conclusions:Increasing social and gender role pressure with growing age, as well as restricted access to material resources and psychosocial strains are discussed as potential explanations for the observed health inequalities.

Measuring mental health and well-being of school-children in 15 European countries using the KIDSCREEN-10 index

Objectives:To test the psychometric properties and measurement results of the KIDSCREEN-10 Mental Health Index in school children from 15 European countries.Methods:Within the cross-sectional Health Behaviour in School-aged Children 2005/2006 Survey, 78,000 pupils aged 11, 13, 15 answered the KIDSCREEN and additional measures. Cronbach’s alpha, Rasch partial credit model itemfit and ANOVAs were conducted.Results:Cronbach’s alpha was 0.81, Rasch infit mean square residuals were 0.7–1.3. Mean scores varied 0.8 standard deviation across countries. Older pupils (effect size [ES] = 0.6), girls (ES = 0.2), pupils with low socio-economic status (ES = 0.5) or frequent health complaints (r = 0.5) reported decreased mental health.Conclusions:The KIDSCREEN-10 displayed good psychometric properties. Measured differences between countries, age, gender, SES, and health complaints comply with theoretical considerations.

Influence of Bacillus Calmette-Guèrin vaccination at birth and 2 months old age on the peripheral blood T-cell subpopulations [gamma/delta (γδ) and alpha-beta (αβ) T cell]

The neonatal immune system is immature and may be affected by Bacillus Calmette‐Guèrin (BCG) vaccine. We investigated the influence of BCG given at two different ages on the peripheral blood (PB) T‐cell subpopulations. Forty full term healthy newborns were randomly chosen. Twenty of them were vaccinated with BCG at birth (group I) and the remaining at the age of 2 months (group II). The cell analysis were carried out before (pre‐BCGI and pre‐BCGII), and 2 months after (post‐BCGI and post‐BCGII) the vaccination. The analysis of the gamma/delta and alpha/beta T‐cell receptor (TCR) antigens was done by two‐colour flowcytometer. The purified protein derivative (PPD) response was investigated 2 months after vaccination. The results showed that although T‐cell (TCR+ cell) counts showed no difference in PB before and after vaccination in both study groups, the total lymphocyte and non‐T cell (TCR− cell) populations increased significantly whereas αβT‐cell population significantly decreased after vaccination. On the contrary, γδT‐cell counts in PB increased significantly 2 months after vaccination in group I but not in group II. Total lymphocyte and non‐T cell counts in vaccinated infants at 2 months of age (post‐BCGI) were significantly higher than in unvaccinated infants of the same age whereas αβT‐cell count in vaccinated infants was significantly low. However, total T‐cell and γδT‐cell counts showed no difference. PPD positivity was similar in both study groups (61% in group I, 66% in group II). Neither αβT‐ nor γδT‐cell counts were different in PPD positive and PPD negative infants. Our study shows that BCG causes marked quantitative changes in the PB T‐cell subpopulations in young infants.

The Role of Parental, School, and Peer Factors in Adolescent Bullying Involvement: Results From the Turkish HBSC 2005/2006 Study

The aim of this study was to explore the relationships between involvement in bullying behaviors and school, family, and peer factors. Health Behavior in School Age Children survey questionnaire was used. Of the students surveyed, 20% were both bully and victim, 11% were bully, and 21% were victim. Being male, poor parental support, and poor monitoring by the father were found to be risk factors for being both bully and victim. Poor academic achievement, having peers at different ages, poor quality of friendship, poor communication with parents, and not being isolated by peers were found to be risk factors for being bully. Not liking school, feeling pressured by school work, poor quality of friendship, poor monitoring by the father, close bonding with mother, and poor status of the peer group were found to be risk factors for being victim. These findings highlight the importance that bullying intervention programs should include country-specific and culture-specific influences for success.

Gender Identity and Gender Role in DSD Patients Raised as Females: A Preliminary Outcome Study

Gender identity and gender role are expected to be consistent with gender assignment for optimal DSD management outcome. To our knowledge, our study is the first to attempt evaluation of gender related outcomes in Turkish DSD patients. After receiving institutional ethical board approval and subject (or parent) informed consent, subjects with DSD raised as girls (22 patients 46 XX DSD, 11 patients 46 XY DSD) answered 566 questions of the Minnesota Multiphasic Personality Inventory (MMPI) questionnaire including 60-item Masculinity-Femininity (MF) subscale which was the focus in this study. Controls (n: 50) were females similar to the probands in age, level of education, relationship status, and having a job or not also answered all questions. The answers were evaluated by a trained psychologist (Derya Inceoglu) on MMPI. For statistical purposes, seven findings were obtained from the data related to the MF subscale from the patients and controls. Of these seven findings (S1–S7), two were associated with masculinity (S3–S4) and another two were associated with femininity (S5–S6). In DSD patients, the percentages of masculinity findings were significantly higher when compared to controls (p < 0.001 and p < 0.001 for S3 and S4, respectively). In controls, the percentages of femininity findings were significantly higher when compared to DSD females (p < 0.001 and p < 0.001 for S5 and S6 respectively). There was no significant difference between 46 XX DSD patients and 46 XY DSD patients with respect to the percentage of any of the seven findings. Two patients requested gender change to male; only these two patients had the finding stating that sexual impulses could come to existence as actions (S7). In conclusion efforts to identify modifiable factors with negative impact and thus modifying them, and professional guidance may be important in minimizing the encountered gender related problems in DSD patients.

The Relationship of Disordered Eating Attitudes with Stress Level, Bone Turnover Markers, and Bone Mineral Density in Obese Adolescents

Objective: To investigate the effect of stress caused by disordered eating attitudes on bone health in obese adolescents. Methods: A cross-sectional study comprising 80 obese adolescents was performed from November 2013 to September 2014. Twenty-four-hour urinary free cortisol levels were measured as a biological marker of stress. Bone turnover was evaluated using bone-specific alkaline phosphatase, serum osteocalcin, and urinary N-telopeptide concentrations. Bone mineral density was measured using dual-energy X-ray absorptiometry. The Eating Disorder Examination Questionnaire, Dutch Eating Behavior Questionnaire, Children’s Depression Inventory, and the State-Trait Anxiety Inventory for Children were used to assess eating disorders, depression, and anxiety. Psychiatric examinations were performed for binge eating disorders. Results: In the Pearson’s correlation test, a positive correlation was found between the 24-hour urinary cortisol level and Dutch Eating Behavior Questionnaire total and restrained eating subscale scores (p<0.05 for both). In linear regression analyses, the Dutch Eating Behavior Questionnaire total and restrained eating subscale scores were found to be significant contributors for urinary cortisol level (β=1.008, p=0.035; β=2.296, p=0.014, respectively). The femoral neck areal bone mineral density was found to be significantly higher in subjects who had binge eating disorder compared with those without binge eating disorder (p=0.049). Conclusion: Despite the lack of apparent effects on bone turnover and bone mineral density in our obese adolescents at the time of the study, our results suggest that disordered eating attitudes, and especially restrained eating attitudes, might be a source of stress. Therefore, studies in this area should continue.

Reply to correspondence letter by S. Bertelloni et al. Adolescent medicine in Europe: integration and cooperation are needed

We would like to thank Bertelloni et al. for their comments on our study concerning adolescent health care delivery and training in Europe [1]. Although we propose the integration of an adolescent health care program into primary health care systems, we agree with Bertelloni et al. that secondary care needs to be given in the pediatric departments with a multidisciplinary approach. Besides, as we had stated in our study, adolescent medicine needs to be a certified multidisciplinary subspecialty of pediatrics. Consequently, the training of physicians who will give primary care to adolescents could be organized by pediatricians. Confidentiality, as a main issue in adolescent health care, could be implemented in every European country who undertakes the obligations of United Nations Convention on the rights of the child through appropriate legal changes produced by the pressure of international pediatric communities advocating for children. Meetings, such as that mentioned by Bertelloni et al., may contribute to these efforts. Regarding the training, mentioned societies and chapters certainly provided valuable contributions in continuing medical education for adolescent medicine. However, EuTEACH (http://www.euteach.com/) has proven to be a guide for trainees–teaching professionals with its comprehensive curriculum for adolescent health professionals and was found to be useful by the trainees [2]. We think that adolescent health care delivery and training will be improved with different means and different techniques in each European country. Although we are aware that the same strategies may not be appropriate for all European countries with different health care systems and different economical status, we hope that some considerable changes will be achieved during the coming years. Our study gives the picture of the actual situation in the continental Europe and it will be interesting to see the evolution in 4–5 years.

What more do we need to know for a world without violence

Violence, a universal health issue, presents serious implications for general health and interpersonal relations. Roots of violence appear in early childhood and instances of extreme violence may become apparent in adolescence. Serious antisocial behavior in adolescence is a predictor of violence in later age. Risk factors for violent behavior could be categorized as individual and environmental. Environmental risk factors can be familial, social, and chemical environmental. Maltreatment in childhood is an important predictor of violent behavior in later age. The presence of mental illness is another important predictor of violence. Contemporary television has a visual and auditory power to promote violence with all its elements. Computers are another field where children confront violence. For identification of individuals who have an increased propensity or susceptibility, for violent behavior, research has suggested that polymorphisms related to certain genes might be important. However, we should emphasize that the expression of such behavior would always depend on interactions between various genes, environmental factors, and genetic-environmental interactions. Experiments in rhesus monkeys have shown that optimal early social experiences might overcome the deleterious effects of susceptible alleles. The effective prevention of violence should consist of interventions that aim to reduce the number of risk factors during early childhood, such as home visitation programs and giving individuals the skills and opportunities for engaging in positive behaviors during school years and adolescence, coupled with the identification of new barriers and reassessment of needs.