A phase 3, multicenter, randomized, double-blind, active-comparator-controlled study to evaluate the safety, tolerability, and immunogenicity of a 4-dose regimen of V114, a 15-valent pneumococcal conjugate vaccine, in healthy infants (PNEU-PED)

BACKGROUND

Pneumococcal disease (PD) remains a major health concern with considerable morbidity and mortality in children. Currently licensed pneumococcal conjugate vaccines (PCVs) confer protection against PD caused by most vaccine serotypes, but non-vaccine serotypes contribute to residual disease. V114 is a 15-valent PCV containing all 13 serotypes in Prevnar 13™ (PCV13) and additional serotypes 22F and 33F. This pivotal phase 3 study compared safety and immunogenicity of V114 and PCV13.

METHODS

1720 healthy infants were randomized 1:1 to receive a 4-dose regimen of V114 or PCV13 concomitantly with other routine pediatric vaccines. Safety was evaluated after each dose as proportion of participants with adverse events (AEs). Serotype-specific anti-pneumococcal immunoglobulin G (IgG) was measured at 1-month post-dose 3 (PD3), pre-dose 4, and 1-month post-dose 4 (PD4). IgG response rates, geometric mean concentrations (GMCs), and opsonophagocytic activity (OPA) were compared between vaccination groups.

RESULTS

The proportion, maximum intensity, and duration of injection-site, systemic, and serious AEs were generally comparable between V114 and PCV13 groups. In comparison to PCV13, V114 met non-inferiority criteria for all 15 serotypes based on IgG response rates at PD3. V114 met non-inferiority criteria by IgG GMCs for all serotypes at PD3 and PD4, except for serotype 6A at PD3. V114-induced antibodies had bactericidal activity as assessed by OPA. Further, V114 met superiority criteria for shared serotype 3 and unique serotypes 22F and 33F compared to PCV13 by serotype-specific IgG GMCs at both PD3 and PD4. Immunogenicity of concomitantly administered routine pediatric vaccines was comparable in V114 and PCV13 groups.

CONCLUSIONS

In healthy infants, V114 displays acceptable safety and tolerability profiles and generates comparable immune responses to PCV13. V114 also met superiority criteria for serotypes 3, 22F, and 33F. These results support use of V114 for prevention of PD as part of routine infant vaccination schedules.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03893448; EudraCT: 2018-004109-21.

Evaluation of Nutritional Status and Factors Related to Malnutrition in Children on CAPD

Objective

The aim of this study was to investigate the nutritional status of children on continuous ambulatory peritoneal dialysis (CAPD) and to relate it to the dose of dialysis and serum levels of inflammatory cytokines and insulin-like growth factor-1 (IGF-1).

Patients

17 CAPD patients (8 girls, 9 boys; mean age 13.1 ± 3.5 years, median 15 years) were included in the study. Anthropometric measurements and serum albumin levels were used in the evaluation of nutritional status. Serum interleukin (IL)-1β, IL-6, tumor necrosis factor α, and IGF-1 levels were determined in all CAPD patients and in a healthy control group. Weekly Kt/V and creatinine clearance (CCr) were measured to determine adequacy of dialysis.

Results

The mean dialysis period was 23.7 ± 15.2 months (median 23 months). Anthropometric measurements and serum albumin level were as follows: height 130.2 ± 15.6 cm, height standard deviation score (HtSDS) -4.2 ± 2.4, body mass index (BMI) 16.3 ± 1.6 kg/m2, body mass index standard deviation score (BMISDS) -0.8 ± 0.9, triceps skinfold thickness (TST) 4.2 ± 1.4 mm, midarm circumference (MAC) 16.21 ± 2.3 cm, upper arm muscle area (AMA) 1799.1 ± 535.7 mm2, upper arm fat area (AFA) 334.5 ± 143 mm2, and serum albumin 3.1 ± 0.7 g/dL. The BMI was above the fifth percentile in all patients; TST and MAC were below the fifth percentile in 14 patients (82.4%) and 10 patients (58.8%) respectively. The AMA was below the fifth percentile in 8 patients; however, the AFA was below the fifth percentile in all patients. Mean serum albumin level was under 3.5 g/dL in 70.5% of the children. We found significant positive correlations between BMI and Kt/V ( r = 0.69, p < 0.01), CCr ( r = 0.64, p < 0.05), and IL-6 ( r = 0.61, p < 0.01). There was an inverse correlation between BMISDS and dialysis period ( r = -0.58, p < 0.05); and between IL-6 and serum albumin ( r = -0.49, p < 0.05). A significant positive correlation between BMISDS and serum IGF-1 level ( r = 0.62, p < 0.01) was noted. We also found a significant positive correlation between serum IGF-1 level and both HtSDS ( r = 0.57, p < 0.05) and TST ( r = 0.52, p < 0.05). Significant positive correlations between AFA and CCr and IGF-1 were also noted (both r = 0.56, p < 0.05).

Conclusion

Although many factors may be responsible for malnutrition and growth retardation, we found that prolonged period of dialysis, inadequate dialysis, and low IGF-1 levels are the most important risk factors in CAPD patients.

Preliminary study on bisphenol A levels and possible exposure history of mother and exclusively breastfed infant pairs

The aims of this study were to determine bisphenol A (BPA) levels in breast milk and urine specimens of healthy mother and exclusively breastfed infant pairs having no known BPA exposure, and also to examine the relationship between BPA levels and possible BPA exposure history. Forty mothers and their 1-2-month-old exclusively breastfeed infant were included in the study. The questionnaires about sociodemographic characteristics and possible BPA exposure history were filled out. Breast milk and urine samples were taken. BPA analyses of these samples were conducted using high-performance liquid chromatography coupled with mass spectrometry. All mother-infant pairs showed detectable BPA concentrations. The geometric means of BPA levels in breast milk, maternal urine, and infant urine were determined as 0.12 μg/L (0.03-0.59), 0.12 μg/L (0.03-0.73), and 0.13 μg/L (0.02-0.44), respectively. Infants whose mothers were consuming yoghurt in plastic containers had relatively higher urinary BPA levels (p = 0.00). Mothers consuming hot beverages in plastic glass showed higher breast milk BPA levels (p = 0.033). There were no statistical associations between BPA levels and the use of plastic materials and tools (p > 0.05).Conclusion: The measurable BPA concentrations in all breast milk specimens of healthy mothers may reflect possible exposure from dietary or non-dietary sources. Exclusively, breastfed healthy infants without any known BPA exposure may be exposed to BPA from their mothers through breastfeeding. What is Known: • Fetuses, neonates and infants are exposed to BPA from their mothers through placental transfer and breastfeeding. • Breast milk is considered a continuous low-level exposure to BPA. What is New: • BPA was detected in 100% of maternal urine, infant urine, and breast milk in healthy mother-infant pairs having no known BPA exposure. • The measurable amount of BPA in breast milk and infant urine may reflect possible BPA exposure of mother-infant pairs.

Determining the persistence of maternally acquired antibodies to hepatitis A and varicella zoster during the first 2 years of life in Turkey

Vaccination should be timed to take into account the potential interference of maternal antibodies. The purpose of this study was to determine the persistence of maternally acquired antibodies to hepatitis A and varicella zoster in a group of healthy infants between 6 and 24 months of age. These infants were divided into four groups according to the age at the time of follow-up visits. The study group consisted of infants who were brought to the 6-month follow-up visit (group 1, n=100), 12-month follow-up visit (group 2, n=99), 18-month follow-up visit (group 3, n=59), and 24-month follow-up visit (group 4, n=59). Hepatitis A, varicella IgG, and IgM antibodies were analyzed qualitatively. Hepatitis A IgG seropositivity was determined as 71 % in group 1, 41.4 % in group 2, 0 % in group 3, and 8.5 % in group 4 (p<0.001). Varicella IgG seropositivity was found to be 5 % in group 1, 4 % in group 2, 4 % in group 3, and 1 % in group 4 (p>0.05).

CONCLUSION

We found that maternal hepatitis A antibodies in children disappear between 12 and 18 months, whereas maternal varicella antibodies substantially diminish following the sixth month. Therefore, the vaccination timing should be based on factors such as the interference of maternal antibodies, disease susceptibility period, and immune maturation.

Child abuse and neglect in Turkey: professional, governmental and non-governmental achievements in improving the national child protection system

Since ratification of the United Nations Convention on the Rights of the Child in 1995, significant efforts were made in Turkey to improve protection of children from abuse and neglect. The government took steps to amend relevant laws. Several state departments recognized the need for professional in-service training of relevant governmental agency staff. University hospitals established numerous hospital-based multidisciplinary child protection centres. The government established an Interministerial Higher Council, which has been overseeing the foundation of 13 child advocacy centres for a multidisciplinary and interagency response to child sexual abuse. In addition to undertaking research, non-governmental organizations contributed to this process by instituting professional and public education. These ground-breaking developments in the last decade give promise of even further improvement in the national child protection system from investigative, child protective and rehabilitative perspectives.

A comparison between adolescent mothers and adult mothers in terms of maternal and infant outcomes at follow-ups

OBJECTIVE

To determine the risk factors of adolescent pregnancies and to ascertain the effects of this condition on the maternal and infant outcomes.

METHODS

The study was carried out on 100 adolescent mothers less than 20 years of age and on a same number of adult mothers between 22 and 32 years of age and their infants. A socio-demographic attributes questionnaire form, a pregnancy follow-up and birth history form, and a mother and infant follow-up form were used.

RESULTS

The mean age of the adolescent mothers was 17.8 ± 0.7 years and that of the adult mothers was 26 ± 0.3 years. Income level of 83% of the families of adolescent mothers and 69% of the families of adult mothers was below the poverty line (p < 0.05). Dropout rate (i.e. rate of those not attending any school) was 36% in the adolescent group and 21% in the adult group. Rate of exclusively breastfeeding during the first 2 months was 40% in adolescents and 62% in adults (p < 0.01). Higher rates of adolescent mothers felt themselves inadequate infant care and with 7% of them experiencing problems in accessing a healthcare institution.

CONCLUSIONS

Properly following up adolescent pregnancies during prenatal and postnatal periods may be helpful for preventing the negative impacts on mother and infant health.

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.

Soluble endothelial protein C receptor levels in healthy population

Increased levels of sEPCR lead to dysfunction of EPCR-mediated coagulation. The aim of this present study was to determine plasma sEPCR levels in a group of Turkish healthy population including both adults and children. The study population consisted of 230 healthy individuals (108 children and 122 adults) having no acute or chronic disease. Plasma sEPCR levels were measured with ELISA. Analysis revealed a bimodal distribution in both groups. There was a negative relationship between sEPCR levels and the age of individuals (r = -0.385, P = 0.0001). The sEPCR levels of children were found significantly higher than that of adults (P < 0.001). This study is the first study to determine the relationship of sEPCR levels and terms of age. Higher levels of sEPCR may suggest a regulation mechanism for the protein C anticoagulation system over the first years of life. Further studies should be conducted to evaluate the physiological importance and molecular mechanism of increased sEPCR levels in children.

Patient compliance to psychiatric interventions and course of postpartum mood disorders

OBJECTIVE

Patient compliance to the psychiatric interventions may affect the outcomes of the mothers with postpartum mood disorders. The aim of this study was to assess the course of depressive symptoms of compliant and noncompliant mothers with postpartum mood disorders.

METHOD

One hundred-three mothers were followed with the Edinburgh Postnatal Depression Scale (EPDS) during 12-month follow-up period. Mothers with an EPDS score of 12 or higher were consulted with a psychiatrist. "Noncompliant patient" term was defined in this study for the patients who refused psychiatric consultation or treatment suggestions. Outcomes of the depressive symptoms were followed up according to the EPDS scores. Response rate based EPDS scoring was defined.

RESULTS

A total of 35 (34%) mothers received a higher EPDS score; 28 (27.2%), who accepted the consultation, were diagnosed with postpartum mood disorder. Twenty-three mothers (10 mothers with major depressive disorder and 13 mothers with adjustment disorder) complied with treatment suggestions, and all of them responded to the treatment. EPDS scores was more likely to decrease in these compliant mothers (p = 0.010). However, of the noncompliant mothers (n = 12), only 50% responded to treatment; moreover, the drop out rate was quite high (58.3%).

CONCLUSIONS

This study reveals that noncompliance to psychiatric interventions may lead to a much less favorable course in depressive symptoms, and to a tendency in drop-outs from visits. Health professionals can give advice to the mothers about postpartum mood disorders and could assist them in getting better outcome.

Postpartum mood disorders and maternal perceptions of infant patterns in well-child follow-up visits

AIMS

The aims of this study were to evaluate the associations between postpartum depressive symptoms and maternal perceptions of infant patterns with 1-year follow-up examinations, and to assess the impacts of treatment on these perceptions.

METHODS

One hundred three mother-infant pairs were evaluated. Data on maternal reports of infant feeding, sleeping and temperament patterns were collected at each well-child visit. The Edinburgh Postpartum Depression Scale was used to assess depressive symptoms. A psychiatrist interviewed the mothers with depressive symptoms, and psychiatric treatments were administered accordingly. The associations between depressive symptoms and maternal perceptions at each visit were analyzed by taking into account the entire follow-up period.

RESULTS

Thirty-five mothers (34%) scored within the clinical range of the EPDS during the follow-up period. Mothers with elevated depressive symptoms were more inclined to report infant cry-fuss, sleeping and temperamental problems through the follow-up. Such complains on infant cry-fuss and temperament problems and maternal sleeping problems improved after treatment in compliant mothers. The dropout rate was high (58.3%) in noncompliant mothers.

CONCLUSION

Postpartum depressive symptoms may lead to negative maternal perceptions of infant patterns. Earlier management of these disorders and maternal compliance to psychiatric suggestions may provide a better care for the mother-infant pairs.

Attitudes of Turkish parents, pediatric residents, and medical students toward child disciplinary practices

OBJECTIVE

The aims of the study were to: determine the attitudes of parents, pediatric residents, and medical students from a Turkish population toward childhood disciplinary methods; ascertain the association of participants' abusive childhood history with their attitudes toward discipline; and assess their attitudes about disciplinary actions, which should be reported as abuse.

METHOD

A cross-sectional survey was conducted in Ankara University School of Medicine, Department of Social Pediatrics. Sixty-five parents, 39 pediatric residents, and 106 medical students completed a questionnaire (Survey of Standards of Discipline). This questionnaire was designed to measure sociodemographic characteristics, attitudes toward childhood disciplinary practices, and abusive childhood experiences. There were 43 different disciplinary acts in this questionnaire. The participants were expected to give responses to these acts in three categories: (a) acceptable as discipline; (b) unacceptable as discipline; and (c) unacceptable as discipline-would report to authorities as child abuse. Based on the responses to this questionnaire, we developed the Severity Scale. Using this scale, physical severity scores, verbal severity scores, and total severity scores were measured for each participant.

RESULTS

None of the participants accepted life-threatening practices as discipline, but some declared certain abusive disciplinary practices as acceptable. Some forceful disciplinary methods were not considered as reportable by participants. All severity scores of both residents and students were found to be higher than those of the parents (for verbal severity scores p=.042). Also, both verbal and physical severity scores of parents with one child were higher than those of parents with two children (for verbal severity scores p=.044). Ninety-one participants (43.3%) indicated that beating was an acceptable form of discipline. Of parents, 66.9% reported abusive childhood history by their own criteria. Of medical students with an abusive childhood experience, 56.5% accepted beating as appropriate (p=.001). Both verbal and physical severity scores were found to be higher in participants with abusive childhood history.

CONCLUSIONS

Abusive childhood history and lack of education regarding appropriate discipline techniques are linked to the acceptance of certain physical discipline practices. Turkey's cultural and traditional norms may be associated with the use of physical punishment, and in some cases, physical abuse. The lack of awareness of abusive discipline methods among physicians constitutes problems for child protection and must be addressed. Thus, educational programs on child disciplinary practices are required to provide an increased awareness of child abuse among health professional trainees and parents in Turkey.

Plasminogen activator inhibitor-1 (PAI-1) gene polymorphism (-675 4G/5G) associated with obesity and vascular risk in children

Atherothrombotic complications in insulin resistance are partly attributed to impaired fibrinolysis caused by increased PAI-1 plasma levels, and 4G/5G promotor polymorphism of the PAI-1 gene may modulate PAI-1 transcription.

OBJECTIVE

To investigate PAI-1-675 4G/5G allele gene polymorphism and its relationship with obesity in children. CHILDREN AND METHOD: The study participants were 133 apparently healthy non-obese children, 24 probable exogenously obese without family history (Group I), 66 probable familial obese (Group II), and 44 obese children who were referred to the pediatric endocrinology department with any complication of obesity (Group III). Group I and Group II obese children were gathered from a school-based epidemiological study.

RESULTS

Incidence of obesity was 19% in a school with high socio-economic status, whereas it was 4% in a school with low socio-economic status. Frequencies of 4G/4G gene polymorphisms were 24.81%, 37.50%, 64.80% and 61.11% in the control group, and groups I, II, and III, respectively. In groups II and III, 4G/4G gene polymorphism, and in non-obese control children 5G/5G gene polymorphism, was common. In obese children in the presence of family history for obesity and metabolic syndrome (odds ratio [OR]: 4.48, 95% confidence interval [CI]: 1.26-15.82), carriage of the 4G allele either in heterozygous or homozygous state increased the risk of vascular disease (OR: 6.10, 95% CI 1.64-22.90). In patients with acanthosis nigricans, high HOMA-IR values, hypertriglyceridemia and elevated atherogenic index, 4G/4G genotype frequency was remarkably higher compared to patients with other features of metabolic syndrome.

CONCLUSION

The increasing prevalence of childhood obesity in high socio-economic status is associated with health risks. In obese children with family history of obesity and cardiovascular disease or type 2 diabetes mellitus and in obese children who had any feature of metabolic syndrome, frequency of 4G/4G genotype was more than the 4G/5G and 5G/5G genotypes in the PAI-1 gene. These patients can be at increased risk for developing vascular disease. Acanthosis nigricans, high HOMA-IR value, hypertriglyceridemia and high atherogenic index can also reflect the high risk of vascular disease in metabolic syndrome.

The secular trends in height and weight of Turkish school children during 1993-2003

BACKGROUND

Secular changes in growth and development can be considered as the changing pattern of somatic development of children in a particular population from one generation to another. Developing countries, which have many changes in socio-economical conditions, reveal various trends in growth. The aims of this study were to analyse growth trends in weight and height of Turkish children from a school in Ankara over the period 1993-2003 with 10-year time interval, and to determine the relation between secular trends.

METHODS

Anthropometric measurements of 1214 children and adolescents (611 boys and 603 girls) aged between 7 and 15 years from Ankara, Turkey, obtained cross sectionally in 2003 were compared with measurements of 867 school children (451 boys and 416 girls) from a previous study which had been obtained in the same primary school in 1993. For 7-15 years of age the increments of weight and height were determined, and analysed statistically.

RESULTS

In 2003 survey boys and girls were taller and heavier than their peers from previous study in all age groups. For all cohorts in boys from 7 to 15 years, weight increments between 2.7 and 6.3 kg/decade and height increments between 1.7 and 5.5 cm/decade were demonstrated. For girls in the same cohorts, weight increments between 2.8 and 6.5 kg/decade and height increments between 1.8 and 5.7 cm/decade were indicated. Both weight and height increments suggest an upward displacement of growth curves in this interval of 10 years.

CONCLUSION

A significant secular increase in weight and height measurements were found in 7-15-year-old boys and girls in Ankara. These secular increases can be explained with improvements in social and health indicators that reflect the overall health status of the population. The secular increases in growth of Turkish school children may reveal updates of growth standards.

The validity of diagnostic criteria for streptococcal pharyngitis in Integrated Management of Childhood Illness (IMCI) guidelines

The WHO's Integrated Management of Childhood Illness (IMCI) programme is being implemented in Turkey with an additional section relating to throat problems for our country's 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 Turkey's 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.

Evaluation of nutritional status and factors related to malnutrition in children on CAPD

OBJECTIVE

The aim of this study was to investigate the nutritional status of children on continuous ambulatory peritoneal dialysis (CAPD) and to relate it to the dose of dialysis and serum levels of inflammatory cytokines and insulin-like growth factor-1 (IGF-1).

PATIENTS

17 CAPD patients (8 girls, 9 boys; mean age 13.1 +/- 3.5 years, median 15 years) were included in the study. Anthropometric measurements and serum albumin levels were used in the evaluation of nutritional status. Serum interleukin (IL)-1beta, IL-6, tumor necrosis factor alpha, and IGF-1 levels were determined in all CAPD patients and in a healthy control group. Weekly Kt/V and creatinine clearance (CCr) were measured to determine adequacy of dialysis.

RESULTS

The mean dialysis period was 23.7 +/- 15.2 months (median 23 months). Anthropometric measurements and serum albumin level were as follows: height 130.2 +/- 15.6 cm, height standard deviation score (HtSDS) -4.2 +/- 2.4, body mass index (BMI) 16.3 +/- 1.6 kg/m2, body mass index standard deviation score (BMISDS) -0.8 +/- 0.9, triceps skinfold thickness (TST) 4.2 +/- 1.4 mm, midarm circumference (MAC) 16.21 +/- 2.3 cm, upper arm muscle area (AMA) 1799.1 +/- 535.7 mm2, upper arm fat area (AFA) 334.5 +/- 143 mm2, and serum albumin 3.1 +/- 0.7 g/dL. The BMI was above the fifth percentile in all patients; TST and MAC were below the fifth percentile in 14 patients (82.4%) and 10 patients (58.8%) respectively. The AMA was below the fifth percentile in 8 patients; however, the AFA was below the fifth percentile in all patients. Mean serum albumin level was under 3.5 g/dL in 70.5% of the children. We found significant positive correlations between BMI and Kt/V (r = 0.69, p < 0.01), CCr (r = 0.64, p < 0.05), and IL-6 (r = 0.61, p < 0.01). There was an inverse correlation between BMISDS and dialysis period (r = -0.58, p < 0.05); and between IL-6 and serum albumin (r = -0.49, p < 0.05). A significant positive correlation between BMISDS and serum IGF-1 level (r = 0.62, p < 0.01) was noted. We also found a significant positive correlation between serum IGF-1 level and both HtSDS (r = 0.57, p < 0.05) and TST (r = 0.52, p < 0.05). Significant positive correlations between AFA and CCr and IGF-1 were also noted (both r = 0.56, p < 0.05).

CONCLUSION

Although many factors may be responsible for malnutrition and growth retardation, we found that prolonged period of dialysis, inadequate dialysis, and low IGF-1 levels are the most important risk factors in CAPD patients.

Attitudes and practices of breastfeeding mothers regarding fasting in Ramadan

OBJECTIVE

To investigate the attitudes and practices of breastfeeding mothers regarding fasting in Ramadan.

DESIGN

Cross-sectional observational survey.

SETTING

Well-child care clinic at Ankara University Medical School and a health station serving an impoverished population in Ankara, Turkey.

PARTICIPANTS

Breastfeeding mothers of infants aged 12 months or younger.

MAIN OUTCOME MEASURES

Fasting during Ramadan.

RESULTS

Of the 164 participating mothers, 61 (37%) were from the health station and 103 (63%) from the university clinic. Most mothers were older than 25 years of age (55%), had more than primary school education (64%), a single child (53%), were living in a nuclear family setting (70%), supplementing breastfeeding (73%) and fasting (52%). Among the 129 mothers of infants aged 6 months or younger, 22% perceived a decrease in their breast milk and 23% an increase in the amount of solid supplements the infant was receiving. Belief that breastfeeding mothers should fast (RR = 6.45, 95% CI: 2.44-17.06), that fasting does not decrease breast milk (RR = 6.24, 95% CI: 1.85-21.05), receiving well-child care at the health station (RR = 3.14, 95% CI: 1.33-7.44), giving supplements (RR = 2.82, 95% CI: 1.09-7.27) and having multiple children (RR = 2.78, 95% CI: 1.23-6.28) were associated with fasting, in a logistic regression model.

CONCLUSIONS

Fasting by breastfeeding mothers of infants is common during Ramadan, and rates are affected by beliefs of mothers on the effects of fasting on breastfeeding. We believe that child health care providers need to be knowledgeable about religious and cultural phenomena, study the effects of Ramadan fasting and form links with Islamic teachings to find religiously and culturally appropriate methods to combat the possible unfavourable effects for infants and children.

Socioeconomically advantaged infants attending a university well-child clinic in Ankara: are they breast-feeding optimally?

This longitudinal observational study aimed to determine the rates of initiation, duration and correlates of breast-feeding by mothers living in a socioeconomically advantaged urban environment in Turkey. Healthy, term infants born at Ankara University Faculty of Medicine Hospital who would be brought to the well-child clinic regularly for at least 12 months were enrolled. Data on feeding practices were obtained at the 1st, 2nd, 3rd, 4th, 5th, 6th, 9th and 12th month well child care visits. Breast-feeding outcome was categorized based on recommendations by the World Health Organization (WHO). The majority of the 295 participating mothers were older than 20 years, high school graduates, and lived in apartment housing, and 54.6% were employed. The rates of breast-feeding were 97.9%, 90.1%, 76.9% and 36.9% at 1, 4, 6 and 12 months, respectively, and rates of exclusive breast-feeding were 89.8%, 59.3% and 2.0% at 1, 4 and 6 months, respectively. At 6 months 69.8% of infants were receiving cow's milk and by 12 months only 23.4% of the infants had been breast-fed according to WHO recommendations. Neither gender; birth weight of infant; age, education, parity, previous breast-feeding experience of mother; nor the status of living as extended versus nuclear family were related to breast-feeding outcome. Mothers who were working (RR: 3.89, 95% CI: 1.42-10.65) and those who had less than 4 months postpartum leave from work (RR: 4.20, 95% CI: 2.16-8.17) were more likely to not breast-feed optimally. The results of this study indicate that even where breast-feeding is normative behavior, it may not be optimally practiced, leading to potentially detrimental nutrition for infants. Promotion of breast-feeding even in advantaged urban populations is needed.

Alternative diagnostic method for streptococcal pharyngitis: Breese scoring system

This study was performed to determine the effectiveness of the Breese scoring system for the diagnosis of streptococcal pharyngitis with respect to different age groups. Two hundred and two children aged three years and younger (Group 1), and 514 children over three years old (Group 2) with complaints of acute pharyngitis were evaluated by Breese scoring and throat-swab cultures. In Group 1, no significant difference was detected in Breese scoring between subjects who had positive and negative culture for group A beta-hemolytic streptococci (GABHS). However, in Group 2 the mean value of the Breese scores was found to be higher in subjects who had positive GABHS. The diagnostic value of Breese scoring was examined for each group. Its sensitivity, and positive and negative predictive values were higher in Group 2 than in Group 1. In conclusion, Breese scoring was determined to be helpful in the diagnosis of streptococcal pharyngitis in children over three years of age.

Immunogenicity study of a combined diphtheria, tetanus, acellular pertussis, inactivated poliomyelitis vaccine used to reconstitute a freeze-dried Haemophilus influenzae type b vaccine (DTaP-IPV//PRP-T) administered simultaneously with a hepatitis B vaccine at two, three and four months of life

This study was designed to assess the immunogenicity of a vaccine combining diphtheria and tetanus toxoids, acellular pertussis vaccine, and inactivated poliovirus vaccine reconstituting Haemophilus influenzae type b polysaccharide conjugated to tetanus protein (DTaP-IPV//PRP-T; Pasteur Mérieux Connaught, Lyon, France) administered simultaneously in association with hepatitis B vaccine (RECOMBIVAX (¿trade mark omitted¿) Merck, Sharp & Dohme, West Point, PA, USA) for the primary immunization of infants. The vaccines were administered at two, three and four months of age. One hundred and sixty-two healthy infants, aged 8-10 weeks, were enrolled in the study. Blood samples were taken before the first dose and 4 weeks after the third dose. The infants were observed for 15 minutes after vaccination for any immediate reaction. Adverse events requiring a medical consultation were recorded by the parents in a diary over the 7 days following vaccination. Four weeks after the third immunization, the percentages of infants fulfilling seroconversion criteria were 98.9% for pertussis toxin, 95.9% for filamentous haemagglutinin, 100.0% for tetanus, 100.0% for diphtheria, 99.3% for poliovirus type 1, 100.0% for both poliovirus types 2 and 3, 98.0% for Haemophilus influenzae type b, and 100% for hepatitis B surface antigen. No vaccine-related serious adverse event was reported. The simultaneous administration of DTaP-IPV//PRP-T and hepatitis B vaccines at two, three and four months of age yielded clinically satisfactory immune responses to all antigens compared with historical controls and gave a good safety profile.

Assessment of the efficacy and safety of paracetamol, ibuprofen and nimesulide in children with upper respiratory tract infections

OBJECTIVE

The aim of this study was to assess and compare the efficacy and tolerability of paracetamol, ibuprofen and nimesulide in children with upper respiratory tract infections (URTIs).

METHODS

Ninety children with acute URTIs and fever were enrolled to the study. The patients were allocated to three groups. The first group was treated with paracetamol 10 mg/kg thrice daily; the second group with ibuprofen 10 mg/kg thrice daily; and the third group received nimesulide 2.5 mg/kg twice daily for 5 days.

RESULTS

The anti-pyretic activity of nimesulide was greater and more rapid than either paracetamol or ibuprofen. The number of patients with normal temperature was significantly greater in the first 2 days for the nimesulide group. The improvement in cough for the paracetamol group was better than the others.

CONCLUSION

The results of this study demonstrated that the anti-pyretic effectiveness of nimesulide is better than paracetamol and ibuprofen in febrile children with URTIs. However, new studies in larger paediatric populations are required to explore the anti-inflammatory effect of nimesulide.