Emel Isıyel

Background: Needle-related procedures such as venipuncture can be distressing for children and may trigger severe fear and behavioral dysregulation, particularly in those with previous traumatic experiences. Trauma-informed care (TIC) is a framework that recognizes the widespread impact of trauma and integrates this knowledge into clinical practice to prevent re-traumatization and support emotional regulation during medical procedures. Methods: This before-and-after study included 135 children aged 4–8 years who had previously shown severe distress during venipuncture, including escape attempts, shouting, or self/other-directed aggressive behaviors. Before venipuncture, children and their families received a TIC-based intervention delivered by a psychological counselor in a dedicated preparation room. Fear, behavioral responses during venipuncture, procedural pain, and heart rate were evaluated before and after the intervention using parent reports, the Children’s Fear Scale, the Wong–Baker FACES Pain Rating Scale, and pulse oximetry. Results: Following the TIC intervention, significant pre–post reduction were observed in distress-related behaviors during venipuncture, including escape attempts, shouting/crying, and self-/other-directed harmful behaviors. The proportion of children rated as experiencing high levels of fear decreased from 96.2% before the intervention to 15.5% after. Among the 85 children with complete heart-rate measurements available, mean heart rate decreased from 113.6 ± 10.1 beats/min to 87.3 ± 8.43 beats/min. Many families reported a more positive venipuncture experience compared with previous procedures. Conclusions: A trauma-informed care intervention delivered before venipuncture is associated with meaningful reductions in behavioral distress, fear, and physiological arousal in children with prior needle-related traumatic experiences. These pre–post associations support the feasibility and potential value of the TIC model, though controlled studies are needed to confirm these findings without confounding clinical effects.

Objective: Social support is a crucial factor that can offer both preventive and protective benefits against mental problems in mothers. This study investigated the associations between social support and depression, anxiety, and stress disorders in Turkish mothers with young children. Materials and Methods: A cross-sectional survey, comprising 27 questions and the “Depression, Anxiety, and Stress Scale (DASS-21),” was administered to mothers with children between the ages of 2–6 years. Results: Among the 542 participating mothers, 56.5% were employed, 62.2% reported receiving social support, and 53.7% of the children attended nursery or kindergarten. The percentage of participants with high depression scores (>9) was 3.9%, high anxiety scores (>7) was 9.6%, and high stress scores (>14) was 4.1%. Overall, the prevalence of abnormal Depression, Anxiety, and Stress Scale-21 (DASS-21) scores was 11.8%. Multivariate logistic regression analysis revealed that housewives had higher odds of having abnormal DASS-21 scores. Additionally, working mothers without social support and those without access to nursery care had significantly higher rates of abnormal DASS-21 scores. Conclusion: The study emphasizes the importance of social support in improving maternal mental health, particularly for working mothers. Providing adequate social support and access to childcare can enhance maternal well-being, reduce stress, and improve self-efficacy in managing caregiving responsibilities. Future research should focus on developing policies and interventions that strengthen social support networks and improve childcare options to address mental health concerns among mothers. Cite this article as: Aydın B, Çelik M, Açoğlu EA, Isıyel E, Yalçın SS. Pathological scores for depression, anxiety, and stress and their association with social support in mothers by employment status. Turk Arch Pediatr. 2025;60(4):384-390.

Amaç: Alt üriner sistem disfonksiyonu geniş spektrumlu bir tanıdır ve Uluslarararası Çocuk İşeme Topluluğuna göre aşırı aktif mesane, işemeyi erteleme, az aktif mesane, seyrek işeme, vajinal reflü, mesane boynu disfonksiyonu ve kıkırdama inkontinansını içerir. Biyofeedback kolay uygulanabilen, girişimsel olmayan ve normal mesane ve barsak fonksiyonlarının sağlanmasında pelvik duvar kaslarını aktive etmek için kullanılan bir tedavi yöntemidir. Bu çalışmada alt üriner sistem disfonksiyonu olan çocuklarda biyofeedback tedavisinin etkinliğinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya alt üriner sistem disfonksiyonu tanısı alan ve standart tedaviye yanıt vermeyen 29 hasta dahil edildi. Bu hastalara 8 hafta süre ile biyofeedback tedavisi uygulandı. Bulgular: Animasyon biofeedback tedavisinden sonra 13 hastada (%44.8) gündüz, iki (%6.8) hastada gece kaçırma şikayetleri düzeldi. Kabızlığı olan 5 hastada tamamen düzelme olmasına rağmen enkoprezisi olan hastalarda düzelme olmadı. Altı hastanın (% 20.7) şikayetlerinde azalma oldu ancak tam düzelme olmadı. Biofeedback tedavisi öncesi 16.19±7.69 olan ortalama işeme bozuklukları semptom skoru, tedavi sonrası 9.52±6.4’e geriledi ve istatistiksel olarak anlamlı bir fark (p<0.001£) saptandı. Sonuç: Çalışmamızdan elde ettiğimiz sonuçlara ve literatür taramalarına göre standart tedaviden fayda görmeyen alt üriner sistem disfonksiyonu olan çocuklarda biyofeedback tedavisi faydalı olabilir.

Article: Side effects of valproic acid: daytime incontinence and nocturnal enuresis - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2021 October;180(10):557-61 - Minerva Medica - Journals

Needle-associated fear and pain in children can lead to poor health consequences and lower uptake rates of medical services. Information and distraction are significant methods in reducing pain and anxiety in children. We aimed to evaluate the effects of giving information and an active distraction method for pediatric venipuncture -related pain and anxiety in 3-8 years old children. Children were randomized into three groups as the control, the informed, the informed and distracted. Fear and pain experience were found to be significantly lower in the informed and distracted group rather than the control and the informed group according to the parents/caregivers. Fear and pain experience were similarly found to be significantly lower in the informed and distracted group than the other groups according to the independent observer. Informing, preparing, coping, distracting methods should be used before, during, and after the invasive procedures to reduce children's pain and anxiety.

Cardiac involvement is an uncommon and life-threatening complication of Behçet`s Disease. We present a 14-year-old boy, admitted to our hospital for recurrent hemoptysis. In his radiologic evaluation, a right ventricular thrombus and pulmonary arterial aneurysm were identified. He was diagnosed with Behçet`s Disease, and then he received prednisone and cyclophosphamide. However, his cardiac thrombus enlargened. After his treatment was replaced with infliximab, the pulmonary aneurysms regressed, and the cardiac thrombus disappeared. In conclusion, infliximab should be considered as a reliable option for vascular Behçet`s Disease resistant to conventional treatment.

Most cases of physical abuse and neglect refer to pediatric emergency clinics, and these patients are diagnosed as only home accidents. Cases that cannot be diagnosed and managed correctly are again exposed to severe trauma and consequently, they may die. The aim of this study is to evaluate the physical abuse and neglect in children younger than three years of age, admitted to the pediatric emergency department with the complaints of trauma, burn, drug poisoning and/or caustic ingestion. This prospective study included 132 patients who were admitted to the pediatric emergency department. Children were classified into three groups as `no abuse`, `suspected abuse` and `abused` after being evaluated with a standard form. Additionally, suspected abuse and abused cases were evaluated once again by `The Team of Child Abuse and Neglect Evaluation, Research and Treatment` in Hacettepe University, İhsan Doğramacı Children's Hospital. The frequency of the suspected abuse or abused cases in all burn, trauma and poisoning cases was found to be 7.5%. It was noticed that 65 of the patients (49.2%) were physically neglected considering the mechanism of occurrence of events. Unplanned pregnancy, absence of prenatal follow-up, high number of siblings, previous physical abuse in the family, absence of witness during the event, and hospitalization were statistically significant differences between no abuse and suspected abuse or abused cases (p < 0.05). Moreover, age group and income were significant risk factors in the logistic regression model for the patients who were thought to be suspected abuse/abused in univariate analyses (age group: Odds ratio (OR) 0.279, 95% confidence interval (CI) 0.085-0.723, p=0.0049; income: OR 2.323, 95% CI 1.052-6.198, p=0.0345). In conclusion, most cases of physical abuse and neglect are referred to the pediatric emergency clinics, and these patients are misdiagnosed as home accidents. The physicians working in the emergency department should be informed and trained in recognizing the cases of abuse and neglect, making the differential diagnosis, identifying the high-risk families and appropriate physical and psychological treatment for the abused and neglected children.

Renal biopsy is an important diagnostic procedure in pediatric nephrology. This study retrospectively investigates the indications, results and complications in a single tertiary children’s hospital in Turkey. We evaluated the native and transplant kidney biopsies in Gazi University Pediatric Nephrology Department between 2001 and 2015. A total of 196 biopsies (144 natives and 52 transplants) were included into the study. The mean age of the patients was respectively 10.8 ± 3.5, 13.9 ± 1.5 years. The main indication for a biopsy was non-nephrotic proteinuria with or without hematuria (n= 35), followed by steroid-resistance nephrotic syndrome (SRNS) (n = 34) and Henoch-Schönlein purpura (HSP)–related proteinuria (n = 20) for native kidneys. We found that focal segmental glomerulosclerosis (FSGS) (11.7%) was the most common histopathologic diagnosis for native kidneys, but acute cellular rejection (7.6%) was the most common histopathologic diagnosis for transplant kidneys. The complication rate in our study was founded 6.6% totally. Different complication rates were found in other studies; however, we think that this difference comes from the inspecting methodology of the complications. Hence, we wanted to share our own experience in the context of other studies in the literature.