Publications by authors named "Siddika Songül Yalçın"

30 Publications

  • Page 1 of 1

Bisphenol A Exposure On Exclusively Breastfed Infants In Lactating Women: An Observational Cross-Sectional Study.

J Clin Res Pediatr Endocrinol 2021 Mar 22. Epub 2021 Mar 22.

Hacettepe University Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey.

Objective: Bisphenol A exposure is crucial for lactating women and exclusively breastfed infants. Bisphenol A transfers directly by breastfeeding and may cause adverse health outcomes. We conduct this study to determine maternal human milk bisphenol A level and exclusively breastfed infants' bisphenol A exposure. We investigated the effect of exposure according to participants' nutritional habits.

Methods: We enrolled voluntarily, healthy postnatal, exclusively breastfeeding women (n=80) and collected hindmilk samples. Human milk-free bisphenol A concentration was analyzed using a competitive ELISA method. Free (unconjugated) BPA has been detected in human samples indicating that humans are internally exposed to estrogenically active BPA. Participants' demographic properties, nutritional habits were questioned with an elaborated survey face-to-face by the researcher.

Results: Human milk median free bisphenol A level is 0.63 µg/L. There was no statistically significant association between maternal body mass index, birth type, parity, infant birth week, infant birth weight, and human milk bisphenol A concentration. Nevertheless, we only found a statistically significant association between human milk bisphenol A level and fast-food, carbonated drinks consumption (p=0.022 and p=0.018, respectively). Exclusively breastfed infants' bisphenol A exposure was 0.0099±0.0079 µg/kg bw/day. There was a negative moderate statistically significant correlation between infant bisphenol A exposure and infant current body weight (r= 0.327, p=0.003).

Conclusion: Exclusively breastfed infants bisphenol A exposure was under the tolerable bisphenol A level (4 µg/kg bw/day), and infants' current dietary exposure level was safe.
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http://dx.doi.org/10.4274/jcrpe.galenos.2021.2020.0305DOI Listing
March 2021

Evaluation of injury-related under-five mortality in Turkey between 2014-2017.

Turk J Pediatr 2021 ;63(1):37-47

Department of Public Health, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background: Injury is the most common cause of preventable morbidity and mortality among children. The aim of this study was to determine the epidemiological characteristics and trends of injury-related mortality in children under five and to provide evidence for future preventive strategies.

Methods: Our study was designed as a descriptive cross-sectional study. National under-five mortality data from the Death Notification System database, entered between January 1st, 2014, and December 31th, 2017, was included in the study.

Results: Among all under-five deaths registered in the system, 2,560 injury-related death cases were included in the study. Overall, deaths related to injuries accounted for 4.1% of all deaths in children under five years old. Of all injury deaths, 59.9% of cases were male, 52.7% occurred at home or its close vicinity, and 80.3% were children aged 12-59 months. Injury-related under-five deaths were mainly attributed to traffic injuries (36.5%), falls (12.0%), and suffocation (10.2%). Traffic injuries were the most common cause of injury-related deaths both in infants 0-11 months and children 12-59 months old. The second and third most common causes of injury-related deaths among infants 0-11 months were suffocation and falls, while these were falls and drowning in children aged 12-59 months, respectively. The injury-related under-five mortality rate dropped from 11.3 per hundred thousand in 2014 to 9.1 in 2017. Causes of all unintentional injury-related deaths were associated with season except for other unintentional injuries and exposure to mechanical forces (p < 0.001).

Conclusions: The injury-related mortality rate among children under five years declined from 2014 to 2017, however it is still high. To prevent injuries in children under five, it is important to raise awareness and increase the supervision of children by their caregivers. At the national level, multisectorial cooperation with a holistic approach will be of key importance.
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http://dx.doi.org/10.24953/turkjped.2021.01.005DOI Listing
January 2021

Urinary bisphenol A levels in prepubertal children with exogenous obesity according to presence of metabolic syndrome.

J Pediatr Endocrinol Metab 2021 Apr 24;34(4):495-502. Epub 2021 Feb 24.

Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Objectives: Recent studies have shown a potential link between chronic exposure to Bisphenol A (BPA) and exogenous obesity, the prevalence of which has been increasing dramatically in all age groups and particularly among children in the last decades. In this study, we aimed at comparing BPA exposure levels between controls and otherwise healthy, drug-naive, pre-pubertal children having exogenous obesity with/without metabolic syndrome.

Methods: A total of 63 pre-pubertal children with exogenous obesity whom 27 of them having metabolic syndrome attending Hacettepe University Ihsan Dogramaci Children's Hospital were included in this study. The control group consisted of 34 age- and sex-matched healthy children with no significant underlying medical conditions. Urinary BPA levels were measured using LC-MS/MS (high-performance liquid chromatography coupled with tandem mass spectrometry) methodology.

Results: Urinary BPA levels among obese children were significantly higher than those of the control group (median: 22.9 μg/g-creatinine and 6.9 μg/g-creatinine, respectively; p=0.0001). When adjusted with generalized linear models for age, gender and scores of body mass index, obese children having metabolic syndrome had significantly higher urinary BPA levels than obese children without metabolic syndrome and both obese groups had considerably elevated levels of urinary BPA than the controls (estimated marginal mean ± standard error: 42.3 ± 7.4 μg/g-creatinine, 22.6 ± 3.5 μg/g-creatinine and 12.1 ± 2.5 μg/g-creatinine, respectively, p=0.0001).

Conclusions: This study shows much higher BPA exposure among obese children with metabolic syndrome during the prepubertal period.
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http://dx.doi.org/10.1515/jpem-2020-0371DOI Listing
April 2021

The association between urinary BPA levels and medical equipment among pediatric intensive care patients.

Environ Toxicol Pharmacol 2021 Apr 15;83:103585. Epub 2021 Jan 15.

Hacettepe University, Faculty of Pharmacy, Department of Toxicology, Sıhhiye, Ankara, Turkey.

We aim to evaluate urinary total BPA (tBPA) levels and association with medical devices used on patients in pediatric intensive care units. This cross-sectional descriptive study included 117 critically ill children. Urinary tBPA levels were determined using high-performance liquid chromatography. General estimating equations with repeated measures analyzed the effect of interventions and devices on urinary BPA levels. A total of 292 urine samples taken from 117 child intensive care patients were studied. When age, sex, and body mass index-for age z-scores were controlled, cases having endotracheal intubation showed higher urinary tBPA levels (p = 0.003) and hemodialyzed patients had considerably higher urinary tBPA levels (p = 0.004). When confounding factors were controlled, cases using both multiple iv treatment and more than four medical devices showed higher urinary tBPA levels than their counterparts (p = 0.007 and p = 0.028, respectively). The use of certain medical devices and interventions could increase BPA exposure in pediatric intensive care patients.
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http://dx.doi.org/10.1016/j.etap.2021.103585DOI Listing
April 2021

Influence of season and lactational stage on aflatoxin M1 and ochratoxin A in human milk in a cohort study from southeastern region of Turkey.

Int J Environ Health Res 2020 Dec 14:1-12. Epub 2020 Dec 14.

Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selçuk University , Konya, Turkey.

The aim was to evaluate the changes in aflatoxin M1 (AFM1) and ochratoxin A (OTA) levels in human breast milk (HBM) during the first five postpartum months according to the sampling season in a cohort study from Şanlıurfa. From 78 healthy lactating mothers, HBM was taken at the 5-14 days postpartum (D5-14) and the 6 and 18 weeks postpartum (W6 and W18). Mycotoxin levels were analyzed with competitive ELISA. Generalized Estimating Equations with repeated measures (three-correlation matrix dimension) revealed a significantly higher mean AFM1 level at W6 than that on D5-14. AFM1 and OTA levels in winter and spring were considerably higher than that in summer and autumn. Maternal smoke exposure, body mass index, history of moldy food exposure, birth order, and breastfeeding type did not influence the results. Whilst season had a marked effect on the milk levels of both analytes, lactation stage affected AFM1 more notable than OTA.
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http://dx.doi.org/10.1080/09603123.2020.1860200DOI Listing
December 2020

Element profiles in blood and teeth samples of children with congenital heart diseases in comparison with healthy ones.

J Trace Elem Med Biol 2021 Jan 14;63:126662. Epub 2020 Oct 14.

Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selçuk University, Konya, Turkey.

Background: Some elements were claimed to play a role in the pathogenesis of congenital heart defects (CHD) and influence the general well-being and health of these children.

Objectives: We aimed to assess the levels of some elements simultaneously in the blood and teeth samples of children with cyanotic and acyanotic CHD compared with healthy children.

Methods: A total of 39 children with CHD (11 with cyanotic and 28 with acyanotic CHD) and 42 age- and sex-adjusted controls were enrolled. Levels of 13 elements, including magnesium, phosphorus, calcium, chromium, manganese, iron, copper, zinc, strontium, cadmium, lead, mercury, and molybdenum, were assessed using inductively coupled plasma mass spectrometry.

Results: Children with cyanotic and acyanotic CHD had significantly lower teeth calcium and calcium/phosphorus ratio as compared to the controls after adjusting for confounders. The mean blood iron level was found to be significantly higher in the cyanotic CHD group compared to the other groups. In addition, children with acyanotic CHD had significantly higher teeth copper levels, higher blood molybdenum and lower blood magnesium levels compared to the healthy control group. Blood cadmium and mercury levels were found to be significantly elevated in both the cyanotic and acyanotic CHD groups compared to the healthy control group. There were no differences in toxic metal levels of teeth in cases with CHD.

Conclusion: Monitoring adequate and balanced gestational micronutrient intake might support not only maternal health but also fetal cardiac development and infant well-being. Supplementation of magnesium should be evaluated in patients having CHD.
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http://dx.doi.org/10.1016/j.jtemb.2020.126662DOI Listing
January 2021

Mycotoxin carry-over in breast milk and weight of infant in exclusively-breastfed infants.

Arch Environ Occup Health 2020 Oct 7:1-6. Epub 2020 Oct 7.

Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selçuk University, Konya, Turkey.

The aim was to evaluate the levels of aflatoxin M1 (AFM1), ochratoxin A (OTA), zearalenone (ZEN), deoxynivalenol (DON) in human milk, and to investigate the relation between selected mycotoxin levels in breast milk and infantile growth in exclusively-breastfed infants under four months. Mycotoxin analysis was performed with commercial ELISA kits. Infants were weighed, and z scores of weight-for-age (WAZ) were calculated with WHO standards. The first quartile of the mycotoxin levels was classified in subgroups as low-level, the last quartile as high-level, and between them as middle-level. The subgroups of AFM1, OTA, and DON had similar infants' WAZ. When cases without maternal smoke exposure were selected and WAZ at birth, infant age, and gender were adjusted, higher infant WAZ on admission was detected in high-ZEN subgroup ( = 0.033). Further cohort studies in exclusively-breastfed infants and absence of maternal smoke exposure could clarify the effect of ZEN on infant growth.
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http://dx.doi.org/10.1080/19338244.2020.1828242DOI Listing
October 2020

Incredible pharmaceutical residues in human milk in a cohort study from Şanlıurfa in Turkey.

Environ Toxicol Pharmacol 2020 Nov 19;80:103502. Epub 2020 Sep 19.

Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selçuk University, Konya, Turkey. Electronic address:

Maternal milk is essential for optimum growth and development of an infant. The aim was to examine the presence of pharmaceutical residuals in breastmilk. This cohort study enrolled 90 healthy mother-infant pairs at 5-14 days after delivery and a control examination was performed 4-8 weeks later. Milk samples were taken at both visits. RANDOX Infiniplex kit performed residual analysis. More than half of mothers (54.4 %) had anti-inflammatory drug residues in at least one milk sample: those were 52.2 % for tolfenamic acid and 2.2 % for meloxicam and 1.1 % for metamizole. The most frequent residue group included the beta-lactam antibiotic group, which was detected in 93.3 % of mothers' milk. The second one was the quinolone group (81.1 %). One-third of mothers expressed nitroxynil and one-fifth polymyxin in at least one sample. Almost all mothers had some unexpected drug residues in their milk. Additional studies from other countries can display maternal environmental exposures.
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http://dx.doi.org/10.1016/j.etap.2020.103502DOI Listing
November 2020

Trends and determinants of prelacteal feeding in Turkey: analysis of 2003-2018 demographic and health surveys.

Public Health Nutr 2020 12 5;23(18):3269-3282. Epub 2020 Aug 5.

Institute of Population Studies, Hacettepe University, Ankara, Turkey.

Objective: The aim of the current study is to analyse the trends, determinants of prelacteal feeding (PLF) and its relations with the mode of delivery among infants <24 months over the years 2003-2018.

Design: We pooled data from Turkey Demographic and Health Surveys (TDHS). The key outcome variable was PLF. Factors associated with PLF were analysed by using complex sample multiple logistic regression analysis, separately and merged database.

Setting: TDHS in 2003, 2008, 2013 and 2018.

Participants: Mother-infant dyads (n 4942).

Results: PLF rates fluctuated between 29·3 and 41·4 %. The most common types of PLF were infant formula (61·1 %) followed by sugar/glucose water (24·9 %) and plain water (9·3 %). PLF rate was 1·51 times higher (95 % CI 1·28, 1·78) in cases delivered by caesarean section as compared with those delivered by vaginal route. According to the initiation time of breast-feeding after delivery, the most significant absolute change in PLF rate was observed within 1 h (10·9 % increase). Delayed initiation of breast-feeding was associated with significantly higher odds of PLF compared with the first hour (1 to < 2 h: adjusted OR (AOR) 1·29, 95 % CI 1·04, 1·61; 2-23 h: AOR 1·73, 95 % CI 1·42, 2·11; ≥24 h: AOR 11·37, 95 % CI 8·81, 14·69).

Conclusions: To eliminate suboptimal breast-feeding practices, counselling on breast-feeding and delivery type during antenatal visits, postnatal breast-feeding support and social support should be provided to all mothers and families.
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http://dx.doi.org/10.1017/S1368980020002037DOI Listing
December 2020

Unvaccinated children as community parasites in National Qualitative Study from Turkey.

BMC Public Health 2020 Jul 11;20(1):1087. Epub 2020 Jul 11.

Ankara Health Directorate, Public Health Presidency, Ankara, Turkey.

Background: This national qualitative study explores (1) the experiences, observations, and opinions of health care workers (HCWs) about beliefs, socioeconomic, cultural, and environmental characteristics of parents refusing vaccination and (2) regional differences in the identified risk factors; (3) recommended solutions to improve vaccine acceptance in each of 12 regions in Turkey.

Methods: In total, we carried out 14 individual semi-structured in-depth interviews and 10 focus group discussions with 163 HCWs from 36 provinces. A thematic analysis was performed to explore HCWs' observations about the parents' decisions to reject vaccination and possible solutions for vaccine advocacy.

Results: Within the analyzed data framework, vaccine refusal statements could be defined as vaccine safety, the necessity of vaccines, assumptions of freedom of choice, health workers' vaccine hesitancy, lack of information about national vaccination schedule and components, not trusting the health system, anti-vaccine publications in social media and newspapers, and refugees. Suggestions based on the HCWs suggestions can be summarized as interventions including (1) creating visual cards with scientific data on vaccine content and disease prevention and using them in counseling patients, (2) writing the vaccine components in a way understandable to ordinary people, (3) highlighting the national quality control and production in the vaccine box and labels, (4) conducting interviews with community opinion leaders, (5) training anti-vaccine HCWs with insufficient scientific knowledge and (6) reducing the tax of parents whose children are fully and punctually vaccinated.

Conclusions: The solution to vaccine rejection begins with the right approaches to vaccination during pregnancy. Prepared written and visual information notes should present the information as "vaccination acceptance" rather than "vaccination refusal". Further studies on vaccine refusal rates should be carried out in various regions of the world so that region-specific actions are implemented to decrease the anti-vaxxer movement and to prevent an outbreak of infectious diseases.
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http://dx.doi.org/10.1186/s12889-020-09184-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353754PMC
July 2020

Correction to: Unexpected drug residuals in human milk in Ankara, capital of Turkey.

BMC Pregnancy Childbirth 2020 07 6;20(1):393. Epub 2020 Jul 6.

Unit of Social Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12884-020-03063-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339404PMC
July 2020

Lower strontium in two different body matrices in neurodevelopmental disorders: A preliminary report.

J Trace Elem Med Biol 2020 Dec 16;62:126553. Epub 2020 May 16.

Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selçuk University, Konya, Turkey.

Background: Environmental factors, including elemental homeostasis, have not been studied sufficiently in neurodevelopmental disorders (NDD). This study aims to compare the status of 13 elements in blood and deciduous teeth dentine of children having an autism spectrum disorder or attention deficit hyperactivity disorder with typically developing controls.

Methods: Elements including calcium, phosphorus, magnesium, iron, zinc, copper, chromium, manganese, mercury, lead, cadmium, molybdenum, and strontium in both deciduous teeth and blood were analyzed by inductively coupled plasma mass spectrometry.

Results: Strontium levels in both blood and teeth samples were found to be significantly lower in the NDD group. Additionally, blood cadmium and mercury levels, and copper/zinc ratio were higher in the NDD group.

Conclusions: Our results warrant further investigation in a large series of NDD examining symptom levels and genetic variations associated with elemental homeostasis.
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http://dx.doi.org/10.1016/j.jtemb.2020.126553DOI Listing
December 2020

Mother-child interaction and the development status of children who have been accidentally poisoned.

Turk J Pediatr 2020 ;62(1):61-67

Division of Social Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Positive parent-child interaction, in particular bond between mother and child, is important for the mental and behavioral development of children. The aim of this study was to evaluate both mother-child interactions as well as the developmental status of children admitted to the pediatric emergency department with accidental poisoning using Parenting Interactions with Children: Checklist of Observations Linked to Outcomes tool (PICCOLO) and Denver Developmental Screening Test-II (DDST-II). Children between ages 1 to 5 years who were admitted to the emergency department with accidental poisoning were included in the study alongside a control group selected from healthy volunteers. A ten-minute video recording was obtained both for the case and control groups, while the mother and her child played together in a separate room. The interaction of mother-infant pair was assessed using the PICCOLO tool. The children`s development was examined using the DDST-II. The video recordings of 115 children (n=65 in the case group and n=50 in the control group) were evaluated. A high score of PICCOLO-teaching domain (≥9 points) was associated with a 3.3-fold increase in terms of risk of poisoning [p < 0.05, at 95% confidence interval (CI) of 1.34-8.37]. Multivariable analysis revealed that the PICCOLO-teaching domain was a significant factor. A high proportion of cases had either abnormal or questionable DDST-II scores (p < 0.05). In order to improve the bond between mother and child, drug poisoning prevention training must be meticulously provided to both mothers and children alike. Developmental assessments of these children as a holistic approach also should not be forgotten.
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http://dx.doi.org/10.24953/turkjped.2020.01.009DOI Listing
January 2020

Excessive screen time is associated with maternal rejection behaviours in pre-school children.

J Paediatr Child Health 2020 Jul 20;56(7):1077-1082. Epub 2020 Mar 20.

Department of Pediatrics, Dr. Sami Ulus Child Hospital, Ankara, Turkey.

Aim: Early childhood screen exposure leads to multiple adverse health events and parents have a major influence on their children's screen time. Our aim was to determine the association between maternal acceptance-rejection/control behaviours and excessive screen exposure in pre-school children.

Methods: In this cross-sectional descriptive study, children aged 2-5 years who had daily screen time <1 h (n = 76) and >4 h (n = 62) were enrolled. A structured survey form and Parental Acceptance-Rejection/Control Questionnaire were completed by mothers.

Results: Total rejection scores were found to be lower in those with screen time <1 h than cases with >4 h (82.7 ± 13.2, 89.3 ± 17.2; P = 0.015). In addition, higher hostility, neglect and reverse-affection scores were detected in excessive screen-exposed group (P = 0.033, P = 0.003, P = 0.047, respectively). Multivariate logistic regression analyses revealed that mothers' low acceptance of their children and high neglect score were associated with excessive screen exposure after adjusting possible confounding factors. The undifferentiated rejection and control behaviours of the mothers had no association with excessive screen exposure.

Conclusion: Children with excessive screen time may have a problematic relationship with their mothers. The relationship between parent and child should be examined and corrective actions should be taken.
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http://dx.doi.org/10.1111/jpc.14821DOI Listing
July 2020

Validity Analysis on the Findings of Dehydration in 2 to 24-Month-Old Children With Acute Diarrhea.

Pediatr Emerg Care 2020 Jan 6. Epub 2020 Jan 6.

Hacettepe University Faculty of Medicine, Ihsan Dogramaci Children's Hospital, Department of Pediatrics, Social Pediatrics Unit, Sihhiye, Ankara.

Objective: The most common cause of diarrheal mortality in children is dehydration. In this study, we aimed to assess the validity (sensitivity and specificity) of history and the clinical and laboratory findings in in the diagnosis of dehydration in children younger than 2 years with acute diarrhea.

Methods: One hundred twenty-six 2 to 24-month-old children with acute diarrhea, who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital's Diarrheal Diseases Treatment and Training Unit, were included. The patients were examined on admission for clinical findings of dehydration. Percent weight loss on admission was calculated by using the weight on admission and the weight after the diarrhea resolution and was used as the golden standard for analyzing the validity of clinical and laboratory findings.

Results: Compared with the golden standard, dehydration was overestimated in 13% of the cases and underestimated in 7% when using only the World Health Organization criteria. Dehydrated children had higher diarrheal frequency and longer anuria time. Thirst, weakness, sunken fontanelle, sunken eyes, decreased tears, dry mucous membranes, and dry lip were detected in children with 2% or greater of weight loss. The most valid laboratory findings were low serum pH (<7.30), low bicarbonate (<15 mmol/L), and hyperurisemia (>5.8 mg/dL). In multivariate analysis, physical findings, such as thirst, dry mucous membranes, weakness, sunken eyes, hoarse crying, and low pH, were found to be significant for the diagnosis of dehydration.

Conclusions: In children with acute diarrhea, diarrheal frequency and last urination time should be asked, thirst, dry mucous membranes, weakness, sunken eyes, and hoarse crying should be examined.
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http://dx.doi.org/10.1097/PEC.0000000000001980DOI Listing
January 2020

Unexpected drug residuals in human milk in Ankara, capital of Turkey.

BMC Pregnancy Childbirth 2019 Oct 11;19(1):348. Epub 2019 Oct 11.

Unit of Social Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background: Breast milk is a natural and unique nutrient for optimum growth and development of the newborn. The aim of this study was to investigate the presence of unpredictable drug residues in mothers' milk and the relationship between drug residues and maternal-infant characteristics.

Methods: In a descriptive study, breastfed infants under 3 months of age and their mothers who applied for child health monitoring were enrolled for the study. Information forms were completed for maternal-infant characteristics, breastfeeding problems, crying and sleep characteristics of infants. Maternal and infant anthropometric measurements and maternal milk sample were taken. Edinburgh Postpartum Depression Scale was applied to mothers. RANDOX Infiniplex kit for milk was used for residual analysis.

Results: Overall, 90 volunteer mothers and their breastfed infants were taken into the study and the mean age of the mothers and their infants was 31.5 ± 4.2 years and 57.8 ± 18.1 days, respectively. Anti-inflammatory drug residues in breast milk were detected in 30.0% of mothers and all had tolfenamic acid. Overall, 94.4% had quinolone, 93.3% beta-lactam, 31.1% aminoglycoside and 13.3% polymycin residues. Drugs used during pregnancy or lactation period were not affected by the presence of residues. Edinburgh postpartum depression scores of mothers and crying and sleeping problems of infants were similar in cases with and without drug residues in breast milk. When controlling confounding factors, maternal body mass index alterations were detected to be significantly lower in mothers with anti-inflammatory drug residues in breast milk than in their counterparts (p = 0.017).

Conclusions: Our study suggests that there are unpredictable drug residues in the milk of many mothers. Anti-inflammatory drug exposure might affect maternal weight change during the postpartum period. Further studies are required to evaluate the impact of drug residues on maternal and infant health.
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http://dx.doi.org/10.1186/s12884-019-2506-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6788077PMC
October 2019

Human milk mycotoxin contamination: smoking exposure and breastfeeding problems.

J Matern Fetal Neonatal Med 2021 Jan 8;34(1):31-40. Epub 2019 Mar 8.

Unit of Social Pediatrics, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Mammalian milk may contain pollutants as a result of the maternal exposure. The objective was to determine the presence of selected mycotoxins in human milk and to investigate the effect of maternal characteristics on breastmilk mycotoxin levels and to examine the effect of mycotoxin contamination on lactational problems. Information about maternal characteristics were taken by a questionnaire and breast milk samples were collected. Levels of aflatoxins M1 (AFM1), ochratoxins A (OTA), zearalenone (ZEN), Deoxynivalenol (DON) were determined by the solid-phase direct competitive enzyme immunoassay. Median levels of breast milk AFM1 and OTA was 3.07 pg/mL and 1.38 ng/mL, respectively. ZEN and DON levels were higher than 0.3 ng/mL in 59% and higher than 10 ng/mL in 37.7%. After controlling for confounding factors, mothers who experienced "delayed onset of lactogenesis" had odds 3.33 times more for the highest quartile of ZEN and mothers with cracked nipples had odds 8.36 times more for the highest quartile of DON. Multiple regression analysis revealed that smoking exposure (environmental, maternal smoking versus never) significantly affected being in the highest quartile of OTA. Mycotoxin can pass to breast milk and smoking exposure of the mother may influence this situation. Mycotoxin exposure may lead to lactation problems. Maternal and infant health can be protected by preventing smoking exposure.
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http://dx.doi.org/10.1080/14767058.2019.1586879DOI Listing
January 2021

A possible etiological factor in obesity: element status in blood and tooth of overweight versus normal-weight children.

Int J Environ Health Res 2018 Oct 14:1-13. Epub 2018 Oct 14.

c Department of Food Hygiene and Technology, Faculty of Veterinary Medicine , Selçuk University , Konya , Turkey.

We aimed to assess element status in whole blood and tooth dentin and identify their correlations in overweight or obese children without additional metabolic risk factors. In a case-control study, 40 overweight and 80 normal weight children aged 6-10 years were enrolled. Samples of blood and tooth were collected. While all studied elements were similar in groups in univariate analysis, after adjustment for confounding factors, tooth Mn levels were lower and blood Zn levels were higher in the overweight/obese group (p = 0.049 and p = 0.032, respectively). A significant correlation in blood and tooth dentin levels of Sr and Zn was detected in both groups. In both biological substances, the concentrations of elements did not differ significantly in overweight children without metabolic comorbidities compared to healthy children of normal weight. Presence of low Mn levels in tooth dentin and high Zn levels in blood samples should be explored in further studies.
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http://dx.doi.org/10.1080/09603123.2018.1531115DOI Listing
October 2018

Urinary bisphenol-A levels in children with type 1 diabetes mellitus.

J Pediatr Endocrinol Metab 2018 Aug;31(8):829-836

Hacettepe University, Faculty of Medicine, Department of Pediatrics, Sihhiye, Ankara, Turkey.

Background: Bisphenol-A (BPA) is one of the most abundantly produced chemicals globally. Concerns have been raised about BPA's possible role in the pathogenesis of type 1 diabetes mellitus (T1DM). The main aim of the current study was to evaluate the possible association between BPA exposure and T1DM. The second aim was to investigate children's possible BPA exposure routes in Turkey.

Methods: A total of 100 children aged between 5 and 18 years including 50 children with T1DM and 50 healthy children were included. Urinary BPA levels of all children were measured using high-performance liquid chromatography. Mothers of children enrolled in the study were also requested to complete a survey that included questions on the sociodemographic characteristics, medical history and possible BPA exposure routes of their children.

Results: In the T1DM group, urinary BPA levels were slightly higher compared to the control group, but this difference was not significant (p=0.510). However, there was an inverse relationship between current urinary BPA levels and birth weight. It was found that the use of plastic kettles and the consumption of dairy products in plastic boxes significantly increased the urinary BPA concentrations in all subjects.

Conclusions: Although there was no significant association between urinary BPA levels and T1DM, we found an inverse relationship between current urinary BPA levels and birth weight. This finding might be important for prenatal exposure, and further prospective research must be conducted. Also, the use of plastic kettles, which has not been mentioned much in the literature before, was found to be an important exposure route for BPA.
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http://dx.doi.org/10.1515/jpem-2018-0141DOI Listing
August 2018

Agreement Between Integrated Management of Childhood Illness and Final Diagnosis in Acute Respiratory Tract Infections.

Indian J Pediatr 2018 Dec 19;85(12):1086-1089. Epub 2018 Feb 19.

Department of Pediatric Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey.

Objective: To evaluate the agreement between integrated management of childhood illness (IMCI) and final diagnosis in patients presenting with cough at the second and third level health institutions.

Methods: This cross-sectional study included 373 children aged 2-60 mo who presented with cough at the pediatric emergency and outpatient clinics in the Department of Pediatrics. After clinical examination of children, body temperature, respiratory rate, saturation, presence or absence of the chest indrawing, rales, wheezing and laryngeal stridor were recorded. Cases were categorized according to IMCI algorithm regarding the severity using the color code, such as red (urgent treatment), yellow (treatment in the hospital), or green (treatment at home). Final diagnosis after physical examination, laboratory analysis and chest X-ray was compared with the IMCI algorithm.

Results: Study agreement between IMCI classification and final diagnosis was 74.3% with kappa value 0.55 (moderate agreement). Similar agreement values were detected in both the second and third level health institutions. Health condition and gender did not affect agreement value. Agreement were found to be high in patients <24 mo of age (ĸ = 0.67), presence of fever and cough (ĸ = 0.54), tachypnea (ĸ = 0.93), chest indrawing (ĸ = 1.00) and oxygen saturation of <94%(ĸ = 0.90).

Conclusions: Adding saturation level to the IMCI algorithmic diagnosis may increase agreement between IMCI classification and final diagnosis.
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http://dx.doi.org/10.1007/s12098-018-2637-9DOI Listing
December 2018

Determinants of childhood diarrhea among under-five year old children in Nigeria: A population-based study using the 2013 demographic and health survey data.

Turk J Pediatr 2018 ;60(4):353-360

Institute of Public Health, Hacettepe University, Ankara, Turkey.

Berde AS, Yalçın SS, Özcebe H, Üner S, Karadağ-Caman Ö. Determinants of childhood diarrhea among under-five year old children in Nigeria: A population-based study using the 2013 demographic and health survey data. Turk J Pediatr 2018; 60: 353-360. The study aims to identify socioeconomic, demographic, environmental and child baseline factors associated with Childhood Diarrhea (CD) among under-five year old children in Nigeria. We utilized cross-sectional data from the 2013 Nigerian Demographic and Health Survey (NDHS). The study covered 18,047 mother-baby pairs. The key outcome variable was CD. Chi-square tests and binary logistic regression were used to test for association between CD and related factors. The prevalence of CD was 12.6%. In the multivariate analysis, the following factors were significantly associated with increased risk of CD; younger mother`s age, household size of seven and above, unsafe disposal of child`s last fecal matter and younger child`s age. Also, children living in all geopolitical zones as compared to the South South geopolitical zone had significantly higher risk of CD. Interventions such as information, education and communication programs on hygiene and sanitation aimed at reducing CD in Nigeria should focus more on groups at risk for CD highlighted in our study.
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http://dx.doi.org/10.24953/turkjped.2018.04.001DOI Listing
May 2019

Determinants of pre-lacteal feeding practices in urban and rural Nigeria; a population-based cross-sectional study using the 2013 Nigeria demographic and health survey data.

Afr Health Sci 2017 Sep;17(3):690-699

Institute of Public Health, Hacettepe University, Ankara, Turkey.

Background: Prelacteal feeding (PLF) is a barrier to exclusive breast feeding.

Objective: To determine factors associated with PLF in rural and urban Nigeria.

Methods: We utilized data from the 2013 Nigerian Demographic and Health Survey. Bivariate and multivariate analyses were used to test for association between PLF and related factors.

Results: Prevalence of PLF in urban Nigeria was 49.8%, while in rural Nigeria it was 66.4%. Sugar or glucose water was given more in urban Nigeria (9.7% vs 2.9%), plain water was given more in rural Nigeria (59.9% vs 40.8%). The multivariate analysis revealed that urban and rural Nigeria shared similarities with respect to factors like mother's education, place of delivery, and size of child at birth being significant predictors of PLF. Mode of delivery and type of birth were significant predictors of PLF only in urban Nigeria, whereas, mother's age at birth was a significant predictor of PLF only in rural Nigeria. Zones also showed variations in the odds of PLF according to place of residence.

Conclusion: Interventions aimed at decreasing PLF rate should be through a tailored approach, and should target at risk sub-groups based on place of residence.
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http://dx.doi.org/10.4314/ahs.v17i3.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656220PMC
September 2017

Determinants of Exclusive Breast Feeding in sub-Saharan Africa: A Multilevel Approach.

Paediatr Perinat Epidemiol 2016 09 3;30(5):439-49. Epub 2016 Jun 3.

Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey.

Background: The study aimed to provide an overall picture of the general pattern of exclusive breast feeding (EBF) in sub-Saharan Africa (SSA) by examining maternal sociodemographic, antenatal and postnatal factors associated with EBF in the region, as well as explore countries variations in EBF rates.

Methods: We utilised cross-sectional data from the Demographic Health Surveys in 27 SSA countries. Our study sample included 25 084 infants under 6 months of age. The key outcome variable was EBF in the last 24 h. Due to the hierarchical structure of the data, a multilevel logistic regression model was used to explore factors associated with EBF.

Results: The overall prevalence of EBF in SSA was 36.0%, the prevalence was highest in Rwanda and lowest in Gabon. In the multilevel regression model, factors that were associated with increased likelihood of EBF included secondary and above maternal education, mothers within the ages of 25-34 years, rural residence, richer household wealth quantile, 4+ antenatal care visit, delivering in a health facility, singleton births, female infants, early initiation of breast feeding (EIBF), and younger infants. However, countries with higher gross national income per capita had lower EBF rates.

Conclusions: To achieve a substantial increase in EBF rates in SSA, breast-feeding interventions and policies should target all women but with more emphasis to mothers with younger age, low educational status, urban residence, poor status, multiple births, and male infants. In addition, there is a need to promote antenatal care utilisation, hospital deliveries, and EIBF.
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http://dx.doi.org/10.1111/ppe.12305DOI Listing
September 2016

Determinants of early initiation of breastfeeding in Nigeria: a population-based study using the 2013 demograhic and health survey data.

BMC Pregnancy Childbirth 2016 Feb 6;16:32. Epub 2016 Feb 6.

Department of Social Peadiatrics, Hacettepe University, Ankara, Turkey.

Background: Provision of mother's breast milk to infants within one hour of birth is referred to as Early Initiation of Breast Feeding (EIBF) which is an important strategy to reduce perinatal and infant morbidities and mortality. This study aimed to use recent nationally representative survey data to identify individual, household and community level factors associated with EIBF and to update on previous knowlegde with regards to EIBF in Nigeria.

Methods: We used cross-sectional data from the 2013 Nigerian Demographic and Health Survey (NDHS). Chi-square tests and binary logistic regression were used to test for association between EIBF and individual, household and community level factors.

Result: The proportion of infants who initiated breastfeeding within 1 h of birth was 34.7% (95% Confidence Interval (CI): 33.9-35.6). In the multivariate analysis, mothers who delivered in a health facility were more likely to initiate breastfeeding early as compared to mothers who delivered at home (Adjusted Odds Ratio (AOR) =1.40, 95% CI = 1.22-1.60). The odds of EIBF was three times higher for mothers who had vaginal delivery as compared to mothers who had caesarean section (AOR = 3.08, 95% CI = 2.14-4.46). Other factors that were significantly associated with increased likelihood of EIBF were; multiparity, large sized infant at birth, not working mothers as compared to mothers working in sales and other sectors, wealthier household index and urban residence. Mothers in the South West were less likely to inititiate breastfeeding within 1 h of birth as compared to the North West, however, the following geopolitical zones; North East, North Central, and South South had higher likelihood of EIBF when compared to the North West geopolitical zone.

Conclusion: EIBF in Nigeria is not optimal with just about 34.7% of children initiating breastfeeding within one hour of birth, the results suggest that breastfeeding programmes and policies should give special attention to "rural mothers, working mothers, primiparous mothers, mothers with ceasarean deliveries, home deliveries and poor mothers" and this intervention should cut across geopolitical zones with more emphasis to zones with lower rates of EIBF.
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http://dx.doi.org/10.1186/s12884-016-0818-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4744410PMC
February 2016

Complementary Feeding Practices of Children Aged 12-23 Months in Turkey.

Cent Eur J Public Health 2015 06;23(2):149-54

Maternal Child Health and Family Planning, Republic of Turkey Ministry of Health, Ankara, Turkey.

Aim: This study was conducted to determine the breastfeeding and complementary feeding attitudes and practices of women with children aged 12-23 months in three different regions in Turkey.

Methods: From 12 geographical regions (Nomenclature of Territorial Units for Statistics - NUTS 1), 3 regions were selected depending on the Turkish Demographic Health Survey 2003 (TDHS) results of nutritional status of children. Then, a weighted, multistage, stratified cluster sampling was used. In total, 1,486 children aged 12-23 months and mother pairs were enrolled. Mothers were face-to-face interviewed with trained health workers to collect information on breastfeeding practices, amount and types of complementary foods introduced and potentially related factors and demographic data filled in a questionnaire.

Results: The percentage of ever breastfeeding was 98.7%, no differences were determined among regions for ever breastfeeding (p>0.05). Duration of exclusive breastfeeding was 5.1±2.4 months. The shortest duration of exclusive breastfeeding was found in the good nutritional status region as 4.8±2.4 months (p<0.05). Yogurt, bread, pasta, fruits and vegetables were the foods introduced to the majority of the children. Red meat, poultry and fish were introduced to children in later ages in the low nutritional status region compared to middle and good nutritional status regions. Complementary feeding is introduced earlier than 6 months of age.

Conclusions: Raising awareness on appropriate infant and young child feeding practices should be a priority. Enhancing of mothers knowledge, attitudes and practices on breastfeeding and complementary feeding is needed.
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http://dx.doi.org/10.21101/cejph.a3988DOI Listing
June 2015

Relations of maternal psychopathologies, social-obstetrical factors and mother-infant bonding at 2-month postpartum: a sample of Turkish mothers.

World J Pediatr 2013 Nov 21;9(4):350-5. Epub 2013 Oct 21.

Department of Pediatrics, Fatih University Hospital, Ankara, Turkey.

Background: The mental health of the mother influences early mother-infant relationship. This study aimed to explore the relations between maternal psychopathologies, particularly postpartum depression, social-obstetrical factors and mother-infant bonding.

Methods: One hundred and eighty-nine mother-infant pairs who participated in the longitudinal study entitled "Mother-Infant Care Study" were evaluated at the second month postpartum. The Brief Symptom Inventory (BSI) had been applied to all mothers in the first 3 days postpartum. At the second month postpartum, mothers were assessed with the Edinburgh Postpartum Depression Scale (EPDS), Postpartum Bonding Questionnaire (PBQ), and Mother-Infant Bonding Scale (MIBS).

Results: The mean maternal age was 25.1 (± 5.2) years. The EPDS scores were higher in the mothers who had been supported lifelong by a psychologist due to psychological problems, had a birth interval of ≤ 2 years, and had smoking habits at the second month postpartum. Mothers with a female infant had higher PBQ score than those with a male infant. The EPDS score was correlated positively with the PBQ and MIBS scores. There were positive correlations between the EDS scores and all subscales of PBQ and MIBS scores. Some subscales and indexes of the BSI were correlated with the PBQ, MIBS and EPDS scores.

Conclusion: Identifying postpartum depression and other psychopathologies in mothers is critical for prevention of mother-infant bonding impairment in the early postpartum period.
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http://dx.doi.org/10.1007/s12519-013-0432-2DOI Listing
November 2013

Association between anthropometric measurements and dental caries in Turkish school children.

Cent Eur J Public Health 2011 Sep;19(3):147-51

Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey.

Aim: To evaluate the association between anthropometric measurements and dental caries in school children.

Methods: The study was conducted on 245 primary school children (50.2% boys, 49.8% girls,), aged 5 to 9 years. The prevalence and severity of dental caries was measured using the decayed, missing or filled surfaces (dmfs, DMFS) and teeth (dmft, DMFT) indices.

Results: Mean dmft indices in children for boys and girls were 5.5 +/- 3.92 and 5.0 +/- 3.64, respectively. The prevalence of children with dental caries (dmft > or = 1) was 84.9%. The prevalence of children with body mass index (BMI) <-1SD and > or = +1SD was 15.9% and 22.9%, respectively. Dental caries were found in 89.7% of children with low body weight (including underweight and at risk for underweight) and in 66.1% of overweight-obese children (p<0.05). Similarly, high indices were detected significantly more often in children with low body weight (p<0.05). Height, weight, BMI and percent of fat mass were found to be negatively correlated with dmft indices (r:-0.141, p: 0.028; r:-0.171, p: 0.007; r:-0.139, p: 0.030; r:-0.158, p: 0.013, respectively).

Conclusion: Children with low body weight have a higher risk of developing dental caries than overweight-obese children. For these reasons, the evaluation of nutritional status in children should be implemented in control programs for dental caries both on the community and individual levels.
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http://dx.doi.org/10.21101/cejph.a3648DOI Listing
September 2011

Breastfeeding status and maternal psychopathologies: in a longitudinal study.

Arch Dis Child 2011 Sep 10;96(9):900. Epub 2011 Apr 10.

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http://dx.doi.org/10.1136/adc.2011.214007DOI Listing
September 2011

The factors that affect milk-to-serum ratio for iron during early lactation.

J Pediatr Hematol Oncol 2009 Feb;31(2):85-90

Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

To determine the factors that affect milk iron content at the second week of lactation and whether the supplementation to lactating mother with iron might increase breast milk iron content between 2 weeks and 4 months postpartum. Healthy mothers were enrolled 10 to 20 days postpartum, if their babies were term, normal gestational age, and exclusive breastfed. Maternal blood samples for hemoglobin (Hb), iron, iron binding capacity, serum ferritin, and breast milk samples for iron and zinc were taken and mothers were randomized into iron supplemented and placebo groups. At the end of the fourth month, blood and milk samples were taken again. Forty-seven healthy mothers were included into the study. Milk iron content was lower; however, milk-to-serum iron ratio was higher in cases with low maternal iron reserves than cases with adequate iron reserves. Mothers with low Hb level (<12 g/dL) had higher milk zinc content and lower milk iron/zinc content than mothers with normal Hb value. Iron supplementation to lactating nonanemic mothers did not change milk iron content and the decline in milk iron content and milk-to-serum iron ratio. Milk iron content and milk-to-serum iron ratio of iron could be regulated by active transport in cooperation with maternal iron status.
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http://dx.doi.org/10.1097/MPH.0b013e31819146c2DOI Listing
February 2009

Factors that affect television viewing time in preschool and primary schoolchildren.

Pediatr Int 2002 Dec;44(6):622-7

Institute of Child Health, Department of Social Pediatrics, Faculty of Education, Hacettepe University, Ankara, Turkey.

Background: Excessive viewing of television (TV) has been linked to aggressive behavior, violence and childhood obesity.

Methods: A cross-sectional study was conducted among preschool children and primary schoolchildren in Ankara during March and April 1999 to detect the factors that affect TV viewing time and to evaluate their parents' knowledge, attitudes and practices with regard to TV. The parents were asked to fill out a questionnaire about TV habits of their family, the number and location of TVs in the household and the effect of TV on children. Of 400 questionnaires, 350 answered the questions appropriately for this study. Children were divided into two groups, preschool children and primary schoolchildren. Television viewing time was given daily, as a mean of weekday.

Results: The mean age for becoming a TV viewer was 2.7 +/- 1.6 years. Of all, 62% of children spent >/= 2h/day watching TV and 8.3% of children spent > 4 h. The TV viewing time of child was significantly and positively correlated with that of siblings, mother and father for both groups. Age and sleeping time of the child, age and the education level of mother, presence of TV in the child's room and the starting age watching TV did not affect the viewing time. One-half of parents reported that the TV programs watched included violence, and one-third thought TV depicts child abuse, especially emotional abuse.

Conclusions: It was found that the TV watching habits of parents had an influence on those of their children. Therefore, pediatricians should take 'TV histories' of children and their parents and educate parents how to become good TV viewers.
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http://dx.doi.org/10.1046/j.1442-200x.2002.01648.xDOI Listing
December 2002