Young children's sleep patterns and problems in paediatric primary healthcare settings: a multicentre cross-sectional study from a nationally representative sample

Studies describing paediatric sleep patterns are needed by taking culture into consideration. The aim of this study was to identify parent-reported sleep-wake patterns in young children and explore possible factors influencing sleep problems. The mothers of 2,434 young children enrolled from well-child outpatient clinics in Turkey completed an online survey including sociodemographic variables, Brief Infant Sleep Questionnaire, Edinburgh Postnatal Depression Scale and Generalised Anxiety Disorder scales. Overall, young children in Turkey go to bed late (10:00 p.m.), awaken twice per night for 30 min, and obtain 11.5 h of total sleep, showing no sex-specific differences. Distinct night-time sleep patterns emerged after 18 months of age. Importantly, although currently breastfed healthy children were 3.8-times less likely to sleep through the night, total sleep duration and exclusive breastfeeding duration were higher in children who were not sleeping through the night. Overall, bedsharing was identified in 11.5%, and only room sharing was reported in 52.9%. Parental perception of a child's sleep as problematic was 35.8%. Mothers with higher educational attainment were more likely to perceive their children's sleep as a problem. Maternal depressive and anxious symptoms and a history of excessive infant crying were the determinants predicting the likelihood of both parent-perceived sleep problems and poor sleepers. The present analysis of sleep structure in infancy and toddlerhood provides reference data for well-child visits. These findings highlight the importance of considering maternal anxiety, depression and behaviour management techniques to cope with fussy infants in addressing childhood behavioural sleep problems.

Evaluation of clinical, etiological and antimicrobial resistance profile of pediatric urinary tract infections in a secondary health care centre

Background

Urinary tract infections are common during childhood. The etiologic agents and empirical antibiotics may vary due to age and geographic area.

Objectives

This study was designed to investigate the urinary tract infection pathogens, their antibiotic resistance profile and risk factors in a sample of well-child population.

Materials and Methods

This retrospective study was conducted in the pediatric clinics of a secondary health-care centre in a one-year period. The source of data was hospital and laboratory records. Toilet trained children and adolescents aged between 5–17 years old with positive urine culture were enrolled into the study. Microbiological studies were conducted according to international guidelines.

Results

During the study 3640 urine samples were analyzed and 342(9.4%) had significant growth. Gram negative enterobacteria were the most common infectious agents. Antibiotic susceptibility tests showed low cephalosporine resistance unless ESBL was positive. Multi drug resistance was remarkable. Extended beta lactamase resistance rate was 17%. Previous history of antibiotic use before the present administration was the only significant risk factor for ESBL positivity.

Conclusion

Treating urinary tract infections may become an emerging problem soon. Unless there are risk factors, cephalosporines are good options, but if so nitrofurantoin or carbapanems should be preferred for treatment in this population.

The Story of Post-exposure Rabies Prophylaxis at the Pediatric Emergency Department

Objectives This study aimed to determine the epidemiological and medical features of suspected rabies exposures at a pediatric emergency department in a small city center in middle-northern Turkey.

Methods Data were abstracted from a standard “Rabies Suspected Animal Contact Cases Examination Form.” The following information was recorded: sociodemographic and clinical features of the victim, history of rabies vaccination, date of event, time to hospital administration, animal species and its vaccination history with owner records, type of suspected contact, wound care, tetanus prophylaxis, rabies vaccination, and forensic notifications. Immunoprophylaxis was determined as “appropriate” or “inappropriate” in accordance with the Rabies Field Guideline (2014).

Discussion A total of 306 cases were evaluated at the emergency department of the hospital. The age of the victims ranged between 1.5 and 17 years old, and 61.4% of them were males. Cat scratches were the most common source of suspected rabies exposure. Meanwhile, primary wound care and tetanus immunoprophylaxis were the frequent inappropriate medical applications. Rabies prophylaxis was completed in 76.5% of the cases. However, forensic notifications were missing. In addition, the rate of animal immunization was lower than it should be.

Conclusion Our city is rabies free; however, risky exposures are frequent among children. Lack of knowledge about first aid and animal vaccination is revealed to be a major public health problem. Health care workers should follow current guidelines to provide a holistic approach to the treatment of potential rabies exposures.

Different perspectives of immunizations during pregnancy

Background/aim

Pregnant women and infants are at risk of severe lower respiratory tract infections induced by influenza or pertussis. The uptake of both vaccines is poor in spite of proven benefits and safety. We aimed to determine the knowledge and attitude of pregnant women and their primary healthcare providers towards immunization during pregnancy.

Materials and methods

This cross-sectional and interventional study was conducted in northern Turkey in 2016. It had 3 different groups including 786 pregnant women, 146 primary healthcare staff, and 97 family practitioners. Different questionnaires were filled by each group. The intervention phase of the study consisted of education of the expectant mothers about immunizations during pregnancy.

Results

786 pregnant women aged between 17–44 years were enrolled to the study. Most of the participants had favourable attitude about vaccination, but only 1.1% had influenza immunization, none had Tdap immunization. None of the participants joining the intervention stage were immunized. The healthcare staff and family physicians had knowledge about vaccinations, but had abstention for administration. Postexposure prophylaxis was also provided by referral centres.

Conclusions

Most of the participants either pregnant women or healthcare workers were not vaccinated against pertussis and influenza. Dissemination of maternal immunization must be supported by the team work of healthcare professionals, authorities, universities, professional associations, stake holders, media and patients with current, evidence based knowledge.

Vitamin D Status in a Population of Well Children: Amasya Sample

OBJECTIVE

The aim of this study was to determine the vitamin D status of children living in Amasya, a city in northern Turkey. Vitamin D is an essential hormone for the health of the musculoskeletal system and acts as a modulator for the immune system, a protector of the cardiovascular system and a regulator of metabolic homeostasis.

METHODS

A total of 2551 healthy individuals aged 1 to17 years enrolled in this study. They were divided into 4 groups, according to their ages. Vitamin D status was classified based on the 2015 global consensus statement from the Endocrine Society. The data were collected from the hospital record system, retrospectively, and categorized according to age, gender, and the season in which the blood sample was taken for the measurement of 25 (OH) D levels.

RESULTS

Only 39% of the subjects were found to have sufficient vitamin D levels (>50 nmol/l [i.e., >20 ng/ml]), while the rest had poor vitamin D status. The insufficiency and deficiency problems were greater in females especially in winter and increasing with age.

CONCLUSION

The high frequency of poor vitamin D status in otherwise healthy children indicates a necessity for supplementation and for implementing lifelong strategies that increase and maintain adequate levels of sun exposure.

Influence of long-range Coulomb interaction in velocity map imaging

The standard velocity-map imaging (VMI) analysis relies on the simple approximation that the residual Coulomb field experienced by the photoelectron ejected from a neutral or ion system may be neglected. Under this almost universal approximation, the photoelectrons follow ballistic (parabolic) trajectories in the externally applied electric field, and the recorded image may be considered as a 2D projection of the initial photoelectron velocity distribution. There are, however, several circumstances where this approximation is not justified and the influence of long-range forces must absolutely be taken into account for the interpretation and analysis of the recorded images. The aim of this paper is to illustrate this influence by discussing two different situations involving isolated atoms or molecules where the analysis of experimental images cannot be performed without considering long-range Coulomb interactions. The first situation occurs when slow (meV) photoelectrons are photoionized from a neutral system and strongly interact with the attractive Coulomb potential of the residual ion. The result of this interaction is the formation of a more complex structure in the image, as well as the appearance of an intense glory at the center of the image. The second situation, observed also at low energy, occurs in the photodetachment from a multiply charged anion and it is characterized by the presence of a long-range repulsive potential. Then, while the standard VMI approximation is still valid, the very specific features exhibited by the recorded images can be explained only by taking into consideration tunnel detachment through the repulsive Coulomb barrier.

Effect of Celergen, a marine derivative, on in vitro hepatocarcinogenesis

The aim of this study was to test for a potential anticarcinogenic effect of Celergen, a marine derivative devoid of traceable amounts of inorganic arsenic, on cell proliferation, cell cycle progression and apoptosis in the HepG2 human liver cancer cell line. Celergen significantly inhibited the proliferation of cancer cells in a dose-dependent manner while limiting the cell cycle progression at the G1 phase and significantly inducing apoptosis. Further examination showed that Celergen enhanced expression of the p21(CIPl1WAF1), GADD153 genes and downregulated the c-myc gene. These results suggest that Celergen exerts promising chemopreventive properties to be further investigated.

Effective properties of a sturgeon-based bioactive compound on stress-induced hippocampal degeneration and on in vitro neurogenesis

The aim of this study is to test the activity of a marine bioactive compound containing high-purity caviar-derived DNA, collagen elastin and protein extracts from sturgeon (LD-1227, Caviarlieri, Laboratoires Dom, Switzerland) to exert neuroprotective properties in an experimental setting while also being potential triggers of neurogenesis in a separate in vitro study. Supplementation with high-DHA mixture of LD-1227 was applied for 30 days to stress model rats. Both supplementations significantly mitigated the histological brain damage when analyzing hippocampal subregions and corticosterone level. However, LD-1227 was most significantly efficient in preventing SOD, Catalase and ascorbic acid decrease in brain tissue. Both supplementations stimulated neurogenesis in vitro and neuron markers in particular but og olygodendrocyte markers and glia increased only in LD-1227-enriched medium. Taken together, these data suggest that LD-1227 is able to significantly protect the brain structure redox system to higher degree than DHA. Moreover, from in vitro study it appears that marine bioactive compound, through it wide array of small unsaturated fatty acids, phospholipids and neurotransmitter precursors, is likely to influence neuronal and glial lineage to act differently from a DHA-rich mixture.

Beneficial effect of a sturgeon-based bioactive compound on gene expression of tumor necrosis factor-alpha, matrix metalloproteinases and type-10 collagen in human chondrocytes

In the present study, we examined the effect of a marine bioactive compound containing high-purity caviar-derived DNA, collagen elastin and protein extracts from sturgeon (LD-1227, Caviarlieri, Laboratoires Dom, Switzerland) on IL-1beta-induced activation and production of TNFalpha and MMP-13 in human osteo-arthritis (OA) chondrocytes and intracellular signaling factors. Human chondrocytes were derived from OA cartilage and stimulated with IL-1beta. Gene expression of TNFalpha, MMP-13, MMP-1 and Col10A1 was measured by quantitative RT-PCR. TNFalpha protein in culture medium was determined using cytokine-specific ELISA. Western immunoblotting was used to analyze the MMP-13 production in the culture medium and the activation of NF-kB. DNA binding activity of NF-kB p65 was determined using a highly sensitive and specific ELISA. MMP-13 activity in the culture medium was assayed by gelatine zymography. LD-1227 significantly decreased IL-1beta-stimulated gene expression and production of TNFalpha, MMP-1, MMP-13 and Col10A1 in human chondrocytes. The inhibitory effect of LD-1227 on the IL-1beta-induced expression of these genes was mediated at least in part via suppression of NF-kB p65. These data show that LD-1227 can inhibit IL-1beta-induced proliferation and inflammatory reactions via inhibited activation of the transcription factor NF-kB pathway in human chondrocytes derived from OA patients. These novel pharmacological actions of LD-1227 on IL-1beta-stimulated human OA chondrocytes provide suggestions that this marine biology compound may inhibit cartilage degradation by suppressing IL-1beta-mediated activation and the catabolic response in human chondrocytes.

Electron-phonon scattering in metal clusters

Electron-lattice energy exchanges are investigated in gold and silver nanoparticles with sizes ranging from 30 to 2.2 nm embedded in different environments. Femtosecond pump-probe experiments performed in the low-perturbation regime demonstrate a strong increase of the intrinsic electron-phonon interaction for nanoparticles smaller than 10 nm due to a confinement effect.