Motherhood experiences of nurses receiving postgraduate education: A phenomenological research study

OBJECTIVE

Trying to juggle multiple roles and responsibilities as a student, nurse, and mother can be challenging due to pressures from overlapping time management. This study was conducted to explore the experiences of graduate students who work as nurses and are mothers.

METHODS

The qualitative phenomenological data for this study were gathered from nurses at a training and research hospital between August and November 2022, utilizing face-to-face interviews. The study cohort comprised twelve nurses aged 28 to 48, all actively engaged in postgraduate education. Data were collected using a descriptive information form and semi-structured interviews. Thematic analysis was executed through inductive coding, facilitated by the Max Qualitative Data Analysis (MAXQDA) Analytics Pro2022 software.

RESULTS

Four central themes were developed: "Experiences During the Breastfeeding Process," "Positive Effects," "Encountered Challenges," and "Expectations."

CONCLUSIONS

The findings underscored that nurses who are mothers and pursuing postgraduate education encounter difficulties throughout their academic pursuits, notably attributed to working conditions and professional cultural values.

Water consumption in 0-6-month-old healthy infants and effective factors: A systematic review

INTRODUCTION

Early introduction of fluids and water affects the duration of breastfeeding, the infant immune system, and possibly causes infants to consume less breast milk, which may, in turn, affect their nutritional and immune status.

OBJECTIVE

This study was carried out to determine water consumption in 0-6-month-old infants and the factors affecting this consumption.

MATERIALS AND METHODS

A literature review was conducted in seven electronic databases (Medline, Web of Science, PubMed, ScienceDirect, Scopus, Cochrane Library, and TÜBITAK) for studies published until April 25, 2022, using the keywords: drinking water, infant, and breastfeeding.

RESULTS

The systematic review included 13 studies. Five studies were crosssectional, three were descriptive and quasi-experimental, and the others were case-control and cohort studies. It was reported in the examined studies that 86.2% of the infants were around 6 weeks old, 44 % of the infants were 1 month old, 77% were 3 months old, 2.5% were 4 months old, and 2.5 to 85% of the infants were around 6 months old when they first consumed water. The prominent reasons for making the infants drink water are the thought that they need it and cultural reasons.

CONCLUSIONS

The exclusive breastfeeding of 0-6-month-old infants is the recommendation of reliable health authorities. Nurses play a key role in implementing this practice. In this systematic review, it was seen that families gave their infants water at varying rates in the 0-6-month period, and the factors affecting this situation were revealed. If nurses determine which factors affect families in terms of the early introduction of fluids, they could be able to plan the necessary education and interventions.

The effects of kangaroo mother care on physiological parameters of premature neonates in neonatal intensive care unit: A systematic review

PURPOSE

The effects of Kangaroo mother care (KMC) on physiological parameters in preterm infants have been reported in the literature by experimental and quasi-experimental studies, and varying findings have been presented. The present study was conducted to determine the effects of KMC on the physiological parameters of premature newborns in the Neonatal Intensive Care Unit.

DESIGN AND METHOD

The review was conducted according to the specified keywords by scanning the EBSCO-host, Cochrane Library, Medline, PubMed, ScienceDirect, Web of Science, and TR index databases using the keywords "kangaroo care AND preterm AND vital signs." The pool mean differences (MDs) were calculated, adopting a 95% confidence interval (CIs) using the Stata 16 software for the meta-analysis [PROSPERO: CRD42021283475].

RESULTS

Eleven studies for systematic review and nine studies for meta-analysis, including 634 participants, were found eligible for inclusion. It was determined that the "temperature" (z = 3.21; p = 0.000) and "oxygen saturation" (z = 2.49; p = 0.000) values created a positive effect in general in the kangaroo care group; however, there was no sufficient evidence to state that it affected the "heart rate" (z = -0.60; p = 0.55) and "respiratory rate" (z = -1.45; p = 0.15) values. In the present study, the duration of KMC application had statistically different effects on temperature and oxygen saturation (SpO₂) (p < 0.05). One-hour or shorter applications of KMC had a higher effect on the temperature and oxygen saturation values (1.83; 1.62, respectively).

CONCLUSION

Our results provided references for clinical implications, and the "temperature" and "oxygen saturation (SpO₂)" values created a positive effect in general in the KMC group. However, there was no sufficient evidence to state that it affected the "heart rate" and "respiratory rate" values. The duration of KMC application had statistically different effects on temperature and oxygen saturation. One-hour or shorter applications of KMC had a higher effect on the temperature and SpO₂ values. Longitudinal, randomized, controlled studies examining the effects of KMC on vital signs in premature newborns with vital parameters outside the normal reference range are recommended.

PRACTICE IMPLICATIONS

The goal of the NICU nurse is to improve the infant's well-being. The application of KMC is a unique care for the nurse in maintaining the newborn's well-being. The vital signs of newborns hospitalized in the NICU with critical problems may be out of normal limits. KMC is an essential developmental care practice that ensures that the neonate's vital signs are kept within normal limits by relaxing the neonate, reducing stress, increasing comfort, and supporting interventions and treatments. KMC application is unique for each mother‑neonate pair. Depending on the tolerance of the mother and infant in terms of duration, it is recommended to perform KMC in the NICU under the supervision of a nurse. Neonatal nurses should support mothers in giving KMC in the NICU since KMC has ameliorative effects on the vital signs of premature neonates.

Impact of COVID-19 pandemic on nurses' burnout and related factors: A rapid systematic review

AIM

This study aimed to investigate the effect of COVID-19 pandemic on nurses' burnout and related factors.

BACKGROUND

Nurses at the frontlines in every field of the health system and composed most of the health service industry closely experience all negative events during the pandemic.

METHODS

This study is a rapid systematic review.

RESULTS

A total of 751 studies were selected, of which 13 studies were compatible with the inclusion criteria. The sample size ranged from 107 to 12.596. The studies determined that nurses' burnout levels were generally moderate level and above during the COVID-19 pandemic. Sociodemographic, occupational, psychological, and COVID-19-related factors affected this burnout.

CONCLUSION

The results of this review may use to make implications that would ease the effect of the pandemic on nurses and develop strategies to protect nurses from burnout in similar possible situations. The protocol information is included here for blind peer review.

PROSPERO REGISTRATION NUMBER (ID)

CRD42021244849.

REGISTRATION AND PROTOCOL

Prior to undertaking the review, we registered the protocol in the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42021244849. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244849. The changes made during the review process were registered in PROSPERO with an update.

Can oral administration of colostrum increase the success of first breastfeeding in premature babies? A study of four cases

Oral administration of colostrum in premature infants has become increasingly common in recent years. Evidence-based studies emphasize that oral administration of colostrum supports immune development in low-birth-weight infants and premature newborns, contributing to the oral microbiota development and reducing the length of stay in hospital. However, its effects on breastfeeding are still not clearly known.This study examines the effect of oral colostrum, which is administered from the first 24 hours of life to the first breast-feeding, on first breast-feeding in very low-birth-weight premature infants who cannot be fed orally. By examining a total of four cases, this study has shown that oral administration of colostrum can be used to increase the success of first breastfeeding. This practice may provide hope for medically vulnerable lowbirth- weight infants,who cannot be fed orally, to benefit more from breast milk. Bangladesh Journal of Medical Science Vol. 21 No. 04 October’22 Page : 912-917

Breastfeeding/Breast Milk Safety in Infants of Mothers with Suspected or Confirmed COVID-19 Infection

The purpose of this systematic review was to determine whether suspected or confirmed COVID-19 infected mothers in the lactation period can breastfeed their infants; and whether suspected or confirmed COVID-19 infected mothers can breastfeed their infants by taking some precautions. The study also aimed to present the measures that can be taken in line with the evidence. The studies conducted after November 2019 and including infants of suspected or confirmed COVID-19 infected mothers were reviewed between 2019 and 2020. A literature review was conducted in five electronic databases (MEDLINE, PubMed, ScienceDirect, Web of Science, and Scopus) to reach original quantitative studies in English. The present authors retrieved 46 of the 1,229 studies included after screening. Three studies were cross-sectional studies, 30 were case studies, and 13 were cohorts. In most of the sources examined, it was concluded that most of the breastfed infants had negative findings for SARS-Cov-2 infection in PCR. In line with the limited data available, it was concluded that most of the breastfed infants had negative findings for SARS-Cov-2 infection in PCR; and breastfeeding mothers should initiate breastfeeding by taking protective measures. Key Words: Breastfeeding, COVID-19, Suspected COVID-19 infected mothers, Confirmed COVID-19 infected mothers.

The Effect of Breastfeeding and an Intensive Breast Milk Nutritional Support Program on Hospitalization Rates for Hyperbilirubinemia in Term Newborns: An Open Randomized Controlled Trial

OBJECTIVE

The aim of this study was to determine the effect of breastfeeding and intensive breast milk nutritional support program (IBNSP) on hospitalization rates for hyperbilirubinemia in normal term newborns.

METHODS

This study's sample consisted of 68 newborn infants (experimental group: 34; control group: 34) born at a university hospital from October 2020 to April 2021. Five steps of breastfeeding and IBNSP were administered to the experimental group for the first 48 h after birth. This program starts at the postpartum first hour and continues until the 48th hour. It includes face-to-face training, practical support on breastfeeding, and one-to-one demonstration and practice methods. The control group received the standard care recommended by the World Health Organization. Both groups' bilirubin levels were measured 24 and 72 h after birth. Participants in both groups were hospitalized for risky (according to bilirubin values) situations. The groups' bilirubin levels and hospitalization rates for hyperbilirubinemia were compared.

RESULTS

There was no statistically significant difference between the experimental (5.19 ± 1.27) and the control (5.83 ± 1.52) groups' bilirubin levels at 24 h after birth, (t = -1.881, p = 0.064); however, the control group infants (12.03 ± 3.67 mg/dl) had higher bilirubin levels than the infants in the experimental group 72 h after birth (9.55 ± 2.82 mg/dl) (t = -3.122, p = 0.003). The experimental group's hospitalization rate for hyperbilirubinemia (n: 1, 2.9%) was lower than the control group's rate (n: 8, 23.5%), and this difference was statistically significant (X2 = 6.275, p = 0.014).

CONCLUSIONS

Breastfeeding and IBNSP effectively prevent hospitalization for hyperbilirubinemia and reduce newborns' bilirubin levels.

Evaluation of cognitive deficits in patients infected with COVID-19

OBJECTIVE

COVID-19 infection can cause impairments in many cognitive areas. The aim of the present study was to evaluate the cognitive functions of patients who had been infected with COVID-19.

PATIENTS AND METHODS

The demographic and infection-related characteristics of patients who had been infected with COVID-19 were determined. Their cranial magnetic resonance imaging (MRI) and electroencephalography (EEG) findings were recorded. The Mini-Mental State Evaluation (MMSE), clock drawing test, forward and backward digit span tests, visual memory test, and Frontal Assessment Battery were applied to the patients. Finger agnosia and ideomotor apraxia were also determined.

RESULTS

The study included 176 patients [100 female (56.8%), 76 male (43.2%), mean age 66.09±13.96 years]. About half of the patients were hospitalized for symptoms of COVID-19 infection (n=82, 46.6%). One third of these patients required intensive care (n=26, 14.8%). While 50 (45.9%) of the 109 patients diagnosed with dementia before infection were hospitalized, 32 (47.8%) of the 67 patients without a diagnosis of dementia required hospitalization (p=0.46). The most common neurological finding during COVID-19 infection was insomnia (n=36, 20.5%). The MMSE and visual memory test scores of the patients who were hospitalized for severe respiratory distress were lower than those whose treatment at home was completed (respectively 17.92±7.69/20.59±7.01, p=0.02; 2.53 ±1.73/3.69±2.80, p=0.01). The patients with moderate to severe cognitive impairment had significantly higher CRP levels at admission than the others (37.52±43.09/20.93±31.74, p=0.01, respectively).

CONCLUSIONS

Cognitive damage in COVID-19 infection may be caused by ACE receptor density in the pial, hippocampal, and amygdala areas. In addition, the reason why people with severe dementia have a milder infection might be explained by the atrophy in these areas.

Effects of antepartum education on worries about labor and mode of delivery

AIM

This study evaluated the effects of antenatal education, which was provided in a pregnancy education class, on pregnant women's concerns about labor and the mode of delivery.

MATERIALS AND METHODS

Primigravid pregnant women (n = 144) were enrolled into the study between May 2017 and November 2018. Pregnant women received standard education on nutrition during pregnancy, exercise, methods of coping with pain, and breastfeeding. The participants completed the "Introductory Information Form" and "Oxford Worries about Labour Scale" to collect data.

RESULTS

A statistically significant difference was found between the participants' pain, distress, uncertainty, and interventions in the pre-education, post-education, and postpartum periods and mean total score on the Oxford scale (p<.05). However, education had no significant effect on the mode of delivery (p>.05).

CONCLUSION

Education provided during pregnancy significantly decreased women's worries about labor, but it did not lead to a significant difference in the modes of delivery.

An investigation of the relationship between mother's personality traits, breastfeeding self-efficacy, and perception of insufficient milk supply

The researchers planned this study as a descriptive-correlational study to determine the relationship between mothers' personality traits, breastfeeding self-efficacy, and perception of insufficient milk supply. This descriptive, cross-sectional, and analytical study involved 429 mothers in Turkey's Sakarya province who applied to a training and research hospital between February-June 2020. It was found that self-control and openness to development affected breastfeeding self-efficacy positively, while neuroticism affected breastfeeding self-efficacy negatively (p < 0.05). Breastfeeding self-efficacy had a significant negative effect on the perception of insufficient milk supply (p < 0.001). Breastfeeding self-efficacy is an important determinant of the amount of milk perceived by mothers.

Designing dress (Sarbebe) for kangaroo care, the effect of kangaroo care provided with this dress on mother and newborn's comfort†

The aims of the researchers were to design the clothes to be worn by the mothers in kangaroo care (KC) and to determine the effect of the KC provided with these clothes on the comfort of the mother and infant. This study was experimentally carried out as a methodological, randomized controlled trial for the designing of clothes for KC. Data were collected using the "Parent and Newborn Information Form", "KC Comfort Scale" and "Newborn Comfort Behavior Scale (Comfort-Neo)". The body temperature, heart rate, oxygen saturation, respiration rate parameters of the newborns were evaluated. The data were transferred to the IBM SPSS Statistics 23 program and evaluated. Our results showed that the KC Comfort Scale total score was 71.1 ± 14.8 in the control group and 84.0 ± 1.5 in the intervention group and "Newborn Comfort Behavior Scale" total scores were found to be 12.47 ± 6.90 in the control group and 8.67 ± 3.46 in the intervention group. It was determined that the KC Comfort Scale (z: -4.785 p: 0.000) in the intervention group were significantly higher compared to the control group (p < 0.05). Pain (z: -4.439 p: 0.000) and distress (z: -4.601 p: 0.000) levels of the control group were found to be significantly higher compared to the intervention group. Sarbebe is recommended to be used in KC practices since it was concluded that maternal comfort and satisfaction was high and the pain and distress scores of the newborn were low after KC provided with Sarbebe.

Scale Development Study: Readiness for Discharge from the Neonatal Intensive Care Unit and Home Care of Premature Infants by Parents

OBJECTIVE

To develop the readiness for hospital discharge scale for mothers and fathers with a premature infant hospitalised in the neonatal intensive care unit and to test the validity and reliability of this scale.

STUDY DESIGN

A cross-sectional study.

PLACE AND DURATION OF STUDY

Sakarya University Education and Research Hospital, Sakarya, Turkey, from February  to June 2020.

METHODOLOGY

This study was conducted with 136 mothers and 133 fathers, who met the inclusion criteria and agreed to participate in the study. After the content validity of the scale was evaluated, the exploratory and confirmatory factor analysis, reliability analysis (Cronbach Alfa) and test-retest reliability were performed.

RESULTS

As a result of the factor analysis, items of the mother form and the father form were reduced to 22 and 20, respectively from the scale with 25 items. The confirmatory factor analysis fit indexes were calculated as χ²/df: 1.666, SRMR: 0.0598 in mothers and χ²/df: 2.110, SRMR: 0.0692 in fathers. The Cronbach's Alpha values were 0.911 for mothers and 0.948 for fathers. The test-retest intraclass correlation coefficient was observed as 0.835 for mothers and 0.942 for fathers.

CONCLUSION

In line with the validity and reliability analyses, it was determined that the mother and father forms of the readiness of the parents of premature infants hospitalised in the NICU for the discharge of infants and home care scale were valid and reliable scales for measuring parents' readiness for discharge. Key Words: Parent, Premature, Neonatal intensive care units, Scale, Development, Reliability and validity.

Being attendant at pediatric clinics can increase bacterial contamination risk on hands?

Objective: The aim of this study was to examine the bacterial growth of the attendants’ hands and to determine the difference between the hospitalized and non-hospitalized attendants’ hands’ bacterial growth. Materials and Methods: In this study, the samples taken from the hands of attendants who were accompanying the hospitalized patients were examined. As a control group attendants who were not hospitalized was chosen. The samples were taken from the attendants’ hands and between the fingers using the swap which was wetted by steril serum physiological. Samples were inoculated to bood agar (BA) and eosine methylene blue agar (EMB) immediately. Inoculated plates were incubated 24-48 hours at 370C and growth was evaluated. Growth was identified using colony morphology, Gram stain, catalase and oxidase reaction. Catalaz positive bacteria were investigated for beta hemolysis, colony morphology on BA, Gram stain and microscopic appearance. Growth characteristics of Gram-negative bacilli on EMB and microscopic appearance were determined. All samples were identified by Vitec II. Results: All participants were women and their average age were 28.93±6.09 (min=18, max=45). It was determined that the rate of bacterial growth was 10% in case group and there was not growth in control group. The difference was statistically insignificant (χ² = 5.263, p = 0.056). Conclusions: In conclusion, the bacterial growth on 10% of participants’ hands in case group is an important and remarkable result. Being at the border of statistical difference between the two groups suggest that similar studies should be conducted with a larger sample group. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.263-267

Childbirth and Postpartum Period Fear and the Related Factors in Pregnancy

OBJECTIVE

This study was carried out to determine the factors affecting pregnant women's anxiety levels during delivery and the postpartum period.

STUDY DESIGN

A descriptive and analytical study.

PLACE AND DURATION OF STUDY

Department of Gynecology and Obstetrics, Polyclinic; and Antenetal Education Class, Sakarya University Education and Research Hospital, Sakarya,Turkey, from October 2018 to January 2019.

METHODOLOGY

Five hundred pregnant women constituted the sample. The data were obtained by using the questionnaire form consisting 25 questions containing the introductory information of pregnant women, prepared by the researchers, and the fear of childbirth and postpartum period scale (FCPPS). Pregnant women's demographic and obstetrical factors and FCPS score were analysed.

RESULTS

A statistically significant difference was determined between pregnant women's employment status (p = 0.003), smoking status (p <0.001), trimester of pregnancy (p <0.001), number of living children (p = 0.015), chronic disease (p <0.001), status of receiving education during pregnancy (p <0.001), status of receiving support during/after delivery (p <0.001), and the FCPPS averages.

CONCLUSION

It was determined that pregnant women's anxieties about delivery and babycare increased, especially in the last trimester.

Examination of the effect of the gender factor on university students’ physical activity level

Objective: Scientific research provide information concerning an insufficient level of physical activity of young people. This study was conducted to determine the levels of physical activity among university students. Materials and Methods: In 2014-2015 academic year, 510 students voluntarily participated in this study. To obtain data, the Personal Information Form and to determine the levels of physical activity. International Physical Activity Questionnaire (IPAQ) were used. Results and Discussion: It is found that the 32.8% of students were not physically active, 49.2% of them had low physical activity level, 18% of students had adequate physical activity level to protect their health. Although it was found that the male students’ physical activity scores, moderately intense activity scores, intense activity scores and walking activity scores significantly higher than girls’ activity scores (p<0.05), there is no significant difference between sitting activity scores (p<0.05). Between students who have Body Mass Index over and under 25 kg/m2, there was no significant difference found between total physical activity, moderately intense activity, intense activity, walking activity and sitting time scores (p<0.05). Conclusion: It was determined that university students have low levels of physical activity and male students have higher physical activity levels than female students. Bangladesh Journal of Medical Science Vol.19(4) 2020 p.625-631

Development of an oral anticoagulant-use attitude scale, and assessment of its validity and reliability

Objectives:

To develop a reliable scale that can measure the attitudes of individuals using oral anticoagulant drugs (OACs).

Methods:

This methodological study was conducted with 296 followed-up individuals using OACs for at least 6 months and visiting the cardiology and neurology clinics of a hospital in Turkey during 2017. A 20-item pool was used to construct the scale and all items were found suitable after content validity analysis and preliminary testing. Construct validity was examined using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA).

Results:

The Kaiser-Meyer-Olkin (KMO) value of the scale (0.79) and results of Bartlett’s test showed that the sample size was suitable for factor analysis (p<0.001). The total Cronbach alpha coefficient of the scale was 0.83. Factor analysis to assess construct-content validity of the scale identified 4 factors (variance, 54%). Using a path diagram in CFA, Chi-square/df ratio values was calculated at 2.807, standardized root mean square residual (SRMR) at 0.093, comparative fit index (CFI) at 0.879, and root mean square error of approximation (RMSEA) at 0.078.

Conclusions:

We found that the OACAs we developed had high reliability and validity.

The Relation of Health-Related Practices of Pregnant Women, Fatigue and Prenatal Attachment

OBJECTIVE

To examine the relation of the health-related practices of expectant mothers during pregnancy and fatigue in mother and prenatal attachment.

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Sakarya Training and Research Hospital, Turkey, between February and April 2016.

METHODOLOGY

The study sample consisted of pregnant women (at least 20-week gestation) aged 18 years or above (n=211) who applied to prenatal care services and agreed to participate in the study. The data were collected through a Personal Information Form, Brief Fatigue Inventory (BFI) and the Prenatal Attachment Inventory (PAI).

RESULTS

The PAI medians of the participants were 55 [42-64], and the BFI medians were 30 [23-42], and a negative, statistically significant relationship was found between BFI and PAI (r= -0.184, p=0.007).

CONCLUSION

Expectant mothers who develop positive health behaviors during pregnancy feel less fatigue and positively affect the prenatal attachment. It is important to evaluate prenatal attachment and identify the mother with low attachment scores.

The determination of infant feeding attitudes among Turkish mothers using the Iowa Infant Feeding Attitude Scale

OBJECTIVE

To assess whether the Iowa Infant Feeding Attitude Scale is a valid and reliable scale for Turkish mothers, and to assess maternal attitudes toward various aspects of infant feeding.

METHODS

This methodological, analytical study was conducted at the obstetrics and gynaecology department of Sakarya Training and Research Hospital, Sakarya, Turkey, from June to August 2015, and comprised mothers of newborn babies. Data was collected using the Turkish version of Iowa Infant Feeding Attitude Scale. SPSS 23 was used for data analysis.

RESULTS

There were 391 participants in the study. Five items of the original Iowa Infant Feeding Attitude Scale were excluded due to the low correlation with the scale integrity (Cronbach's alpha=0.67). The total mean score of the mothers was 48.11±6.57. A statistically significant difference was found between the educational status, having social security, what the mothers having other children fed these children in the first 6 months and family types (p=0.05 each). Significant difference was also found between the mothers only breastfeeding and the mothers feeding with mother's milk and formula (p=0.008).

CONCLUSIONS

The scale was found to be culturally acceptable, reliable and valid scale for Turkish mothers.

Mothers' Attitudes Toward Feeding Twin Babies in the First Six Months of Life: A Sample From Sakarya, Turkey

BACKGROUND

It is stated in the literature that a mother's breast milk is sufficient for more than one baby.

OBJECTIVES

This descriptive study aimed to determine whether twin babies are breastfed during their first six months of life.

MATERIALS AND METHODS

We studied the twin birth cases in a state hospital in Sakarya, Turkey between October 2011 and March 2013. The population of the study consisted of entire mothers who had delivered twins in the maternity ward of the hospital. The sample comprised 30 twins' mothers who agreed to participate in the study via telephone for six months. During these phone calls, they were asked how they preferred to feed their babies. The data were expressed as the mean and percentage.

RESULTS

The average age of the mothers participating in the study was 30.17±5.16 years (min. 19; max. 38). The number of mothers who stated that they had no previous experience of breastfeeding twin babies and had received training to breastfeed multiple babies was 17 (56.7%). Twenty-seven (90%) of the mothers had had caesarean sections, and half of the babies were preterm. Only a few of the babies were fed breast milk for five months. During the following months, the breastfeeding regimen was as follows: 5 babies were breastfed for a month, 5 babies for 2 months, 4 babies for 3 months, 4 babies for 4 months, 2 babies for 5 months, and no babies in the sixth month.

CONCLUSIONS

It was found that the number of twin babies who were only breastfed in the first six months of life was low. According to the literature, a mother's breast milk is sufficient for multiple babies. Mothers expecting twin babies should be informed about the benefits of breastfeeding and be encouraged to breastfeed. They should also receive training on this subject.

Management of Continuous Positive Airway Pressure in the Newborn: Impact of Lecture-based Interactive Workshops on Training for Neonatal Intensive Care Nurses

Objetivos: el objetivo de este estudio fue determinar cómo la formación impartida a través de talleres estructurados relacionados con el manejo de la presión positiva continua en las vías respiratorias en el recién nacido afecta el conocimiento de las enfermeras que trabajan en cuidados intensivos neonatales. Métodos: un grupo de enfermeras asistieron a un taller interactivo basado en una conferencia sobre el manejo de la presión positiva continua en las vías respiratorias en el recién nacido. Las enfermeras en cuestión habían aceptado una invitación para asistir a la presentación antes del evento de capacitación. La información sobre las características diferenciadoras de los participantes se recogió a través de un cuestionario elaborado por los propios investigadores. Una evaluación de los conocimientos de las enfermeras sobre el tema se llevó a cabo a través de un cuestionario de selección múltiple (CSM), el cual fue elaborado por los investigadores en relación con la literatura. El CSM fue enviado por correo a unos expertos en Turquía (siete personas) y unos expertos en el exterior (cinco personas), y sus opiniones fueron tomadas en cuenta. A la luz de sus sugerencias, al CSM se le dio su forma final y el número de preguntas se fijó en 20. El CSM, que consta de 20 preguntas, fue respondido por los participantes antes y después del taller interactivo. A los participantes no se les dijo si la prueba se repitió después del taller de formación. Resultados: treinta y seis enfermeras de la unidad neonatal participaron en el estudio. Cada pregunta en el CSM se consideró como un (1) punto. La puntuación máxima posible en la prueba fue 20. Hubo una mejora significativa en la puntuación de la prueba media después de la conferencia, si se compara con la puntuación preconferencia (media = 19,6, SD = 0,8 vs. media = 13,1, SD = 3.0, P <0,001). Conclusiones: un taller interactivo basado en una conferencia sobre el manejo de la presión positiva continua en las vías respiratorias en el recién nacido ayuda a mejorar el conocimiento de las enfermeras. También ayuda a superar las deficiencias en la formación de enfermeras.

Perceptions of Turkish University Students about the Effects of Water Pipe Smoking on Health

BACKGROUND

The popularity of the water pipe, also referred to as hookah, narghile, shisha or hubble-bubble, has increased tremendously during the past few decades. This study was conducted to determine student water pipe smoking status and perceptions about the effects of water pipe smoking on health in a state university in Ankara.

MATERIALS AND METHODS

This cross-sectional study was conducted between September 2014 and January 2015. The data were collected with a questionnaire and "The Scale of Perception about the Effects of Water Pipe Smoking on Health". The data obtained were evaluated in IBM SPSS (version 20.0) statistical package program in computer. One-way analysis of variance (ANOVA) was used for the analyses by checking homogeneity of variances and Student's t-test. Values of p<0.05 were considered statistically significant.

RESULTS

The total mean score obtained by young people who took part in the study was determined as (X_=65.20±1.25, min=33, max=75). Upon comparison of the total mean scores obtained by young people from the Scale of Perception about the effects of water pipe smoking on health and gender variable, the scores obtained by the females students were higher than those of the male students with a statistically significant difference (t=7.525, p<0.05). A statistically significant difference was observed between the total mean scores obtained by young people with cigarette and water pipe smoking status (for each, t=-3.731, p<0.05; t=-13.987, p<0.05).

CONCLUSIONS

In conclusion, university students have wrong knowledge on the dangers of water pipe smoking. There was a high prevalence of using water pipes among university students. Gender significantly affected the perceptions about the effect of water pipe smoking on health in our sample.

The relationship between maternal attachment, perceived social support and breast-feeding sufficiency

OBJECTIVE

To determine the relationship between maternal attachment, perceived social support and breast-feeding sufficiency.

STUDY DESIGN

Descriptive correlational design.

PLACE AND DURATION OF STUDY

A state hospital and two family health centers in Sakarya, Turkey, between June to December 2011.

METHODOLOGY

The sample was 122 voluntary mothers who had healthy babies of 1 - 2 months old. The data were collected by a Personal Information Form, Maternal Attachment Inventory (MAI), Multidimensional Scale of Perceived Social Support (MSPSS) and Breast-feeding Self-Efficacy Scale-Short Form (BSES-SF). The data collected were analysed by percentage distribution, mean square, independent sample t-test, Mann-Whitney U, Kruskall-Wallis and Pearson correlation.

RESULTS

The mean age of the mothers was 25.01 ± 2.2 years, and 48.4% of them were primary school graduates. BSESSF was 61.02 ± 8.44 (16 - 70), MAI was 99.07 ± 7.19 (56 - 100) and MSPSS was 66.40 ± 13.58 (37 - 84). There was a positive, medium level, significant relationship between the total scores of BSES-SF and MAI (r=0.370, p < 0.001). There was a positive, medium level, significant relationship between the total score of BSES-SF and the score from family subdimension of MSPSS (r=0.255, p < 0.01).There was a positive, medium level, significant relationship between the total score of MAI and the total score of family subdimension of MSPSS (r=0.339, p < 0.001).

CONCLUSION

Successful maternal attachment and familial support positively affected the breast-feeding sufficiency of the mother.

Effects of Nursing Education on Awareness of Risk Factors for Colorectal Cancer

BACKGROUND

The objective of this study is to determine the effect of nursing education on awareness of risk factors for colorectal cancer.

MATERIALS AND METHODS

In this descriptive study, the sample is consisted of 132 volunteer students studying in the 1st and 4th grades of School of Health Nursing Department during the fall semester of 2014-2015. Data were collected via a questionnaire including information on the socio-demographic features of the participants and the correlating risk factors of colorectal cancer, prepared by researchers in view of the literature. The questionnaire was distributed to students and completed during class time. Before presenting the questionnaires to the respondents, informed consent was obtained from each. The data obtained were analyzed with a statistical package (SPSS). At first, a Kolmogorov-Smirnow test was performed on the research data. However, since it was seen that variables did not have a normal distribution, the Wilcoxon Signed Ranks Test was applied. P values of <0.05 were considered statistically significant. Percentages, means and standard deviations were also utilized for evaluation.

RESULTS

Of the total of 132 students participating in this study, 85.6% (n=113) were female, and 14.4% (n=19) were male. The average age was 20.5±2.04. 54.5 % of the students (n=72) were 4th graders and 45.5 % (n=60) were first graders. Total score averages of first graders on risk awareness was X=12 ± 7.24, and fourth graders was X=16.93 ± 7.71. The difference between these two scores were found to be statistically significant (Z= -9,333; p=0.000).

CONCLUSIONS

Nursing education was found out to have a positive influence on the students' awareness of risk factors for colorectal cancer.

Mothers' knowledge and attitudes about HPV vaccination to prevent cervical cancers

BACKGROUND

Cervical cancer which is one of the most preventable cancers is an important public health problem worldwide, and especially in developing countries. The aim of this study was to determine knowledge and attitudes about the HPV vaccination of mothers with 0- to 18-year old children.

MATERIALS AND METHODS

Written approval was taken from the local authorities. The study subjects consisted of 799 mothers who agreed to participate. The data were collected via a "Personal Information Form" which included 30 questions that were prepared by the researchers themselves in line with the literature. The data were collected by face to face interviews with the mothers. Analyses were performed using commercial software.

RESULTS

The mean age of the mothers who participated in the study was 32.0 ± 6.52, and 88.1% reported no information about HPV, and 83.5% no information about HPV vaccination. Only 0.7% of the mothers had daughters who had HPV vaccination, and 44.3% of the mothers who had sons were found out to be indecisive about having HPV vaccination. There was a significant corelation between the educational status of the mothers and their knowledge about HPV vaccination (p<0.05). However, there was no significant correlation in terms of economic conditions (p>0.05).

CONCLUSIONS

This study suggested that mothers had very little information on HPV and HPV vaccination. Knowledge of the disease and its vaccination is an essential factor for the success of the vaccination program. It is of great importance that mothers are trained in this subject by health professionals.

Fallacies about water pipe use in Turkish university students - what might be the consequences?

BACKGROUND

The popularity of the narghile waterpipe, also referred to as hookah, shisha or hubble-bubble has increased tremendously during the past few decades. The aim of this study was to expose perception of narghile among a representative sample of university students in Sakarya University campus.

MATERIALS AND METHODS

Written approval was taken from the local education authority. An anonymous questionnaire which was prepared by the investigators and contained 17 questions was administered. Nine of the questions were related to socio-demographic characteristics and eight were related to the students harm perceptions about waterpipe. A total of 1,320 questionnaries were received and after preliminary evaluation 1,255 (95.7%) were found to be suitable for evaluation. The data was evaluated in SPSS program by using percentages and averages.

RESULTS

The mean ± SD age of the students was 20.8 ± 2.29 years (min 18, max 32). There were 864 (68.8%) females and 391 (31.2%) males. A total of 6.3 % of the students (n=79) believed that waterpipe is not harmful because its smoke does not burn the lungs. Almost one-third (n=318) think that the carcinogenic chemicals are filtered while waterpipe smoke passes from the water; 12.1 % of the students (n=152) checked "true" for the statement of "waterpipe smoke contains no nicotine". It is seen that 14.0 % of the students (n=176) think waterpipe with fruit/ aroma is healthier than plain waterpipe.

CONCLUSIONS

As a result of this study, it is found out that a substantial number of university students have false beliefs on harmful effects of waterpipe smoking.

Comparison of adrenocortical steroidogenesis in women with post-adolescent severe acne and polycystic ovary syndrome

BACKGROUND

Increased adrenocortical production appears to be associated with acne and hirsutism in acne and polycystic ovary syndrome (PCOS). However, the aetiological role of androgens in the pathogenesis of acne per se is far from being clear.

OBJECTIVE

We aimed to evaluate adrenocortical function in women with post-adolescent severe acne in comparison with patients with PCOS and healthy women.

METHODS

The study included 32 women with post-adolescent severe acne, 32 women with PCOS and 32 age and body mass index (BMI)-matched healthy controls (age 17-34 years, BMI: 20.8 ± 1.9 kg/m²). Women with acne did not have hirsutism or ovulatory dysfunction whereas all PCOS patients had androgen excess and ovulatory dysfunction. Measurements included basal testosterone (T), sex hormone-binding globulin (SHBG) and dehydroepiandrosterone sulphate (DHEAS) levels and serum 17-hydroxyprogesterone (17-OHP), androstenedione (A4), DHEA and cortisol levels in response to corticotropin (ACTH) stimulation.

RESULTS

T, free androgen index, DHEAS levels, basal and AUC (area under the curve) values for A4 were significantly higher in PCOS than women with acne and controls (P < 0.05 for all), whereas three groups did not differ for basal or AUC values of DHEA and cortisol. Women with PCOS and those with severe acne had significantly and similarly higher AUC values of 17-OHP compared to controls (P < 0.05).

CONCLUSION

Women with isolated post-adolescent severe acne do not have increased levels of adrenal androgens basally or in response to ACTH. However, these women have similar secretion pattern of 17-OHP with PCOS patients suggesting increased enzymatic activity in this pathway.

Trends in smoking among university students between 2005-2012 in Sakarya, Turkey

Turkey protects its entire population of 75 million people with all the MPOWER measures at the highest level. The aim of this study is to make a comparison of smoking and addiction data obtained from Sakarya University students in 2005-6 and 2012-13. A total of 4,200 (2,500 and 1,700 for each academic year) students at Sakarya University in Sakarya, Turkey, were randomly selected for sampling purposes. The selected participants represented Sakarya University students. Data were collected using a pretested anonymous and confidential, self-completed questionnaire which took 15-20 minutes to complete and Fagerstrom Test for nicotine dependence. Chi-squared, Spearman correlation, and binary logistic regression tests were used to define associations, if any. The level of significance was kept at alpha=0.05. Smoking prevalence dropped by 8.5% (from 26.9% to 18.5%). Male gender, older age, high family smoking index, low self-rated school success, and high peer smoker proportion were common variables that have correlation with smoking status. In the binary logistic regression test the highest contributor to "being a smoker" was found to be the rate of peer smokers. Having all friends smoking puts the student a a 47.5 and 58.0 times higher risk for smoking for males and females, respectively. Our results suggest an admirable diminution of smoking prevalence among Sakarya University students, which can be attributed to MPOWER protection.

Do the pens used by nursing students in clinics cause bacterial contamination?

BACKGROUND

Health professionals and their medical equipment have long been known to act as vectors of infectious diseases. The aim of the present study was to evaluate the role of pens used by nursing students working in clinics in relation to transmission of bacteria.

MATERIALS AND METHODS

The study was conducted in Sakarya University School of Health Sciences in March 2012, with the voluntary participation of 40 third-grade nursing students during their clinical practice. In total, 40 writing items were surveyed.

RESULTS

Twenty-two (55%) of the students were doing their clinical practice at pediatrics department and 18 (45%) were at obstetrics and gynecology department. All the samples consisted of pens and bacterial contamination was observed in 5 (12.5%) of them. The microorganisms identified were: 1 (2.5%) sample was Staphylococcus hominis, 2 (5%) were Staphylococcus epidermidis, 1 (2.5%) was Staphylococcus haemolyticus, and 1 (2.5%) was Staphylococcus warneri.

CONCLUSION

This study highlights the risks of nosocomial infections, especially in pediatric units, if not enough attention is paid to the cleanliness of the pens used in the clinics.

In which regions is breast-feeding safer from the impact of toxic elements from the environment?

Owing to its unique nutritional and immunological characteristics, breast milk is the most important food source for infants. But, children are at greater risk for exposure to environmental toxicants from breast milk. The aim of this study was to evaluate the influence of environmental pollution on essential and toxic element contents of breast milk and determine the risky locations in our population. This study was conducted on women who were breastfeeding (n=90). Milk samples were collected at three locations in Marmara region, Turkey: highly industrialized region highly affected by pollution, urbanized region moderately and rural area that is affected little. Breast milk samples (5 mL) were collected at approximately one month postpartum (mature milk). The concentrations of cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb) and zinc (Zn) in milk samples were compared to the milk samples coming from different locations.Lead, cadmium, nickel, chromium, iron and manganese levels in the breast milk are highest and engrossing especially in rural areas compared to the other regions but cobalt, copper, zinc levels are highest in highly industrial areas. The levels of essential and toxic elements in breast milk can vary in different regions. The levels presented in our study are above some countries' data albeit not at toxic levels. Because of global effects, environmental pollution is not the problem for industrializing regions only. Rural area also may not be safe for breastfeed babies.

Smoking status in parents of children hospitalized with a diagnosis of respiratory system disorders

The purpose of this study was to investigate the relationship between the statuses of hospitalized children with diagnosis of respiratory tract disease with cigarette use in the parents. This descriptive study was conducted in a Gowerment Hospital in the Sakarya city center in Turkey between June 2007 and June 2008. The inclusion criterion was willingness of families with children hospitalized due to diagnosis of respiratory disease to participate in the study. Data were collected from 345 parents using the questionnaire prepared by researchers. In our study parental smoking was observed in 42.3% of fathers, 7.8% mothers and for 20.9% both parents were smoking. It was found that the hospitalization rates were more than two times higher in children diagnosed with pneumonia and bronchitis and three times higher in children hospitalized for asthma whose parents smoke at home compared to those whose parents are non-smokers. Health care professionals who take care of children need to discuss the harmful effects of smoking and the importance of reducing childhood exposure to secondhand smoke; parents should be educated and encouraged not to smoke.

Cerebrovascular reactivity in multiple sclerosis patients

A close relationship between multiple sclerosis (MS) lesions and the cerebral vasculature has long been recognised. Some studies have suggested that vascular endothelial cell activation might be an early event in the evolution of MS, and demyelisation may have an ischemic basis in this condition. Hypoxia caused by breath holding (BH) results in autoregulatory vasodilatation, and an increase in CBF to the cortex. The increased CBF can be evaluated by transcranial Doppler (TCD), and can provide information about the vascular integrity. In this study, we aimed to examine the vascular integrity and assess the vasomotor reactivity of MS patients in response to BH in different activation phases of the disease by means of TCD. We studied 12 patients with clinically diagnosed relapsing remitting (RR) MS, according to the Poser criteria. The initial TCD examination was performed in the first two days of an acute exacerbation of disease and prior to any treatment. The second test was performed just after iv methylprednisolone (IVMP) treatment, and the third examination occurred one month later, when the patient was in the remission phase. A group of 11 healthy subjects was also examined by TCD as control. Blood flow velocities were recorded during 30 seconds of normal breathing and 15 seconds BH. Vasomotor reactivity was calculated as a ratio of difference of cerebral flow velocities during BH. There were no significant vasomotor reactivity differences between the controls (55.7%) and the patients during attacks (46.5%), as well as after treatment (48.3%) and during attack free periods (50.9%). There were also no significant changes amongst the patients groups throughout the study. In this study, in different disease activity stages, we observed non-significant cerebrovascular vasomotor reactivity difference between the RRMS patients and the healthy controls, although it was slightly lower in the MS patients. This observation suggests that cerebrovascular reactivity is normal in different disease activity levels.

Risk factors for urinary incontinence in Turkish women. A cross-sectional study

OBJECTIVE

To explore the association between conventional risk factors and urinary leakage among a random sample of adult Turkish women.

METHODS

Six hundred and fifty patients (mean age 33.2 +/- 10.6 years; range 17-65 years) attending 6 Primary Health Care Centers in the Eastern Marmara Region, Turkey were randomly enrolled in this study, between September 2005 and December 2005. After signing their informed consent, all patients filled in a questionnaire consisting of questions inquiring any kind of urinary leakage, related symptomatology and personal medical history.

RESULTS

One hundred and six women (16.4%) with urinary incontinence (UI) were reported. The most frequent type of incontinence was mixed UI (n=65, 61.3%). The prevalence of stress UI among all incontinent women was 20.8% (n=22) and urge UI 17.9% (n=19). The prevalence was associated with age, body mass index and parity. Number of pregnancies was positively correlated with prevalence of incontinence (r=0.30, p<0.001). Women who had >2 deliveries had a higher risk of UI (odds ratio = 4.04, 95% confidence interval, 2.37 to 6.89, p<0.001).

CONCLUSION

The results of this study supported previous reports revealing that age, body mass index, type of deliveries and number of pregnancies/deliveries are risk factors of UI, and showed that age, body mass index and number of pregnancies should be regarded as independent risk factors.

Tanning youth: knowledge, behaviors and attitudes toward sun protection of high school students in Sakarya, Turkey

The aim of this study was to assess, by means of an in-school questionnaire, the knowledge, attitudes, and behaviors of high-school students in Sakarya, Turkey concerning sun protection and skin cancer. The knowledge and behavior scores of girls were higher than those of boys, whereas boys had better attitude scores.

Spinal extradural metastasis from a medulloblastoma

Medulloblastoma metastasising extraxially is a rare entity. The mechanisms that cause such spread are not fully understood. We present a patient who developed a low thoracic metastasis three years after surgical removal of a posterior fossa medulloblastoma. A spinal metastasis penetrated the dura, thus becoming extradural and from this tumour a completely extradural lumbal metastasis developed. Simultaneous local recurrences of systemic metastases were not noted.

Association of von Recklinghausen's neurofibromatosis and aqueduct stenosis

We present 6 patients with a definite diagnosis of von Recklinghausen's neurofibromatosis. All of them had aqueductal stenosis and hydrocephalus requiring surgical intervention because of clinical signs of increased intracranial pressure confirmed by pressure measurements.

Tension pneumocephalus after transsphenoidal surgery: case report

The authors present a patient who underwent transsphenoidal surgery for a pituitary adenoma and afterward developed late, severe rhinorrhea and tension pneumocephalus. The patient was treated conservatively.