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Aims. To evaluate responsibility sharing between parents of children with type 1 diabetes and change in their occupational status one year after the diagnosis. Methods. In this cross-sectional multicenter study, parents of children under the age of 18 with a diagnosis of type 1 diabetes answered a questionnaire assessing diabetes-related responsibility sharing between parents, and occupational changes due to child’s diabetes. Changes in the occupational status with associated factors and distribution of diabetes-related responsibilities between parents were analyzed. Results. Among parents of 882 children (mean (SD) age at diagnosis was 7 (3.8) years, female 52.5%), unemployment increased significantly in mothers (59.0% vs. 67.1%; p0.05) within 1 year after their child’s diagnosis. Working mother’s occupational withdrawal was associated with the child’s age at diagnosis (OR = 0.92, [95% CI 0.86–0.99]; p=0.02) and mother’s education (compared to a university degree or above, high school graduate (OR = 2.93, [95% CI 1.59–5.4]; p more...

Objective: Aim of this study is to examine the psychological resilience of the nursing students in terms of various socio-demographic characteristics.Materials and Methods: The universe of the descriptive study was composed of all the students of the nursing department of a state university located in the Eastern Black Sea Region (337 persons) and no sample selection was chosen (n = 276, response rate: 81.89%).The questionnaire consists of 33 questions and contains the " Resilience Scale for Adults ". This sclar (created by Friborg et al) translated into Turkish and analysed in the terms of "validity and vredibility" by Basım and Çetin. The data collected face to face. The data of the study were collected in 2014 academic year. The descriptive variables are given in number and percentage. Non-parametric tests (Mann Whitneyui and Kruskall Wallis) were performed because of the characteristic of variables.p 0.05) in terms of calculating the point average. The study revealed that the factors of gender, family type, area of residence, grade and selecting nursing education willingly/unwillingly play important role in psychological strength.&nbsp, Amaç: Araştırmanın amacı, hemşirelik öğrencilerinin psikolojik dayanıklılıklarını bazı sosyo demografik özellikler açısından araştırmaktır.Gereç ve Yöntem: Tanımlayıcı tipte olan araştırmanın evrenini Doğu Karadeniz Bölgesinde yer alan bir devlet üniversitesinin hemşirelik bölümü öğrencilerinin tamamı oluşturmuş olup (337 kişi), ayrıca örneklem seçimine gidilmemiştir (n=276 kişi, cevaplılık oranı:%81.89).Anket formu 33 sorudan oluşmakta olup "Yetişkinler için Psikolojik Dayanıklılık Ölçeği"ni de içermektedir. Ölçek Friborg ve arkadaşları tarafından oluşturulmuş, Basım ve Çetin tarafından Türkçe'ye uyarlanıp geçerlilik ve güvenilirlik analizleri yapılmıştır. Çalışmadaki veriler anket formunun yüz yüze görüşme tekniği kullanılması ile yapılmıştır. Araştırmanın verileri 2014 eğitim öğretim yılında toplanmıştır. Tanımlayıcı değişkenler sayı ve yüzde olarak verilmiştir. Değişkenlerin özelliğinden dolayı non-parametrik testler (Mann Whitneu U ve Kruskall Wallis) yapılmıştır. p0.05) görülmüştür. Araştırmada cinsiyet, aile tipi, yaşamın geçtiği yer, bölümü isteyerek/severek seçme ile okunulan sınıfın psikolojik dayanıklılıkta önemli olduğu görülmüştür (p more...

Balıkesir Üniversitesi, Fen Bilimleri Enstitüsü, Biyoloji Ana Bilim Dalı, Tanı koyma aşamasındaki güçlükler ve en etkili sistemik tedavilerin yetersizliği nedeniyle hastaların ancak %5'inde teşhisten sonraki sağ kalım süresi 5 yıl olan pankreas kanseri evrensel olarak ölümcül bir kanser türüdür. Çalışmamızda kanseri durdurmak veya tedavi etmek için kullanılan kemoterapi ajanlarının Panc-1 hücre hattı üzerindeki sitotoksik etkisi belirlenmiştir. Dosetaksel, paklitaksel, okzaliplatin, epirubisin, gemsitabin, irinotekan ve bevasizumab gibi etken maddeli kemoterapi ajanları Panc-1 hücre hattına uygulanarak 24-48-72 saat dilimlerinde hücre canlılığı istatistiksel olarak hesaplanmıştır. Okzaliplatin ve dosetaksel 100-1000 µg/ml'de 72 saat sonunda, irinotekan 72 saat sonunda 1000 µg/ml'de, gemsitabin maksimum 1000 µg/ml'de 24 saat sonunda sitotoksik etki göstermiştir. Paklitaksel 0,1-1-100 ve 1000 µg/ml konsantrasyonlarında hücre canlılığında inhibisyon etkisi belirlenmiştir. Bevasizumab 0,01-0,1-1-10-100-1000 µg/ml dozlarında Panc-1 hücre hattında inhibisyon konsantrasyonu %50 değerinin altına düşmemiştir. Epirubisinin ise 10-100-500 µg/ml'de 72 saat sonunda maksimum düzeyde hücre canlılığını inhibe edici etkisi tespit edilmiştir. Araşidonik asitin prostoglandinlere dönüşmesinde kilit enzim olan siklooksigenaz enzimi pankreas kanserinde hücre apoptozunu engelleyerek kanserli dokunun artmasına neden olmaktadır. Bu amaçla söz konusu kemoterapi ajanlarının koyun pankreası tarafından üretilen siklooksigenaz (COX) enzim aktivitesi üzerine etkisi belirlenmiştir. Dosetaksel artan konsantrasyonlarında COX enzimini inhibe ettiği tespit edilmiştir. Ancak irinotekan, paklitaksel ve epirubisin COX enzimi üzerinde aktivasyon etkisi gösterdiği bulunmuştur. Okzaliplatin kemoterapi ajanının ise COX enzim aktivitesi üzerinde herhangi bir etkisi olmadığı tespit edilmiştir., Stage of diagnosis in patients with difficulties due to lack of effective systemic therapies, pancreatic cancer is one of the leading causes of cancer releated deaths with a 5 years survival being, Bu tez çalışması Balıkesir Üniversitesi Bilimsel Araştırma Projeleri (BAP) Birimi tarafından 2013/0035 nolu proje ile desteklenmiştir. more...

Objective: Hypoglycemia is a common acute complication of type 1 diabetes (T1D), which may cause seizure, loss of consciousness, and temporary motor or sensory impairment. Glucagon administration is an effective way of treating severe hypoglycemia, especially in a free-living setting. Nonetheless, families have difficulties in managing severe hypoglycemia due to their anxiety and challenges with current glucagon administration techniques. The aim of the current study was to explore the associations between parental fear of hypoglycemia (FoH) and their general anxiety level, and in particular, their attitudes towards and thoughts on glucagon administration. Methods: Parents of children with T1D completed questionnaires assessing background and clinical information, FoH, generalized anxiety disorder (GAD) and parental anxiety for glucagon administration (PAGA). Results: sixty-eight parents participated. Positive correlations were found between parental GAD-7 score and both FoH and the number of night-time blood glucose measurements and there was a negative correlation with the child's age. Parents mean self-evaluation score of their competence in glucagon administration was 6 (standard deviation +/- 2.9) on a scale of 0 to 10. Unsurprisingly, this score was negatively correlated with the PAGA scores. There was no significant difference between children using continuous glucose monitoring system and self-monitoring of blood glucose in terms of parental FoH, anxiety and misconceptions about glucagon administration. Conclusion: the results showed that parents of children with T1D had anxiety and fear connected with hypoglycemia and glucagon administration. Structured and practical training should be implemented to increase parents' self-confidence including annual refresher training for home glucagon administration., NA more...

Diabetes care at school has recently appeared on the agenda of international diabetes organizations, the basic principles of which have been newly determined. The aim of this review was to summarize the activities and output of the Diabetes at School Program - a program that has been delivered in Turkey for the last 10 years - and to focus on different aspects of Diabetes Care at School through a national model. Recently, a detailed set of national regulations, including the basic principles proposed by the International Society for Pediatric and Adolescent Diabetes and the experience in Turkey, was prepared and has come into force. The future agenda includes giving priority to socio-economically disadvantaged regions, provision of an Individual Treatment Plan at School for each child with diabetes and ensuring that each school has an action plan for the care of children with diabetes. We believe that if all countries have programs and structured national regulations similar to the Diabetes at School Program, this will enable significant progress in the level of care delivered to children with diabetes., NA more...

It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD., NA more...

Investigating the daily life experiences of patients using Continuous Glucose Monitoring (CGM) can highlight the benefits and barriers in using this system for people with type 1 diabetes (T1D). Semi-structured qualitative interviews were conducted with the caregivers of 10 children aged 6 months. These interviews were analyzed using the content analysis approach and from these interviews, four meta themes emerged: metabolic control, barriers to CGM use, CGM use in daily life, and comparison with fingersticks. Families reported the following as benefits of CGM: pain relief, better hypoglycemia and hyperglycemia management, increased control over diet and social life, reduced worries at school and during the night, and convenience in entrusting the child to the care of others. Cost, concerns related to accuracy and reliability of measurements, insertion, adhesion and removal issues all emerged as barriers to CGM use. The most prominent issue was the economic burden of CGM. Families accept this burden, even though it is challenging, as their experiences in using CGM are positive and they feel that CGM is necessary for T1D management., NA more...

Background: currently, there is a lack of data relating to glycemic parameters and their relationship with C-peptide (CP) and proinsulin (PI) during the partial remission period (PRP) in type 1 diabetes mellitus (T1D). The aim of this study was to evaluate glycemic parameters in children with T1D who are in the PRP using intermittently scanned continuous glucose monitoring systems (isCGMS) and to investigate any relationships between CP and PI levels. Methods: the study included 21 children who were in the PRP and 31 children who were not. A cross-sectional, non-randomized study was performed. Demographic, clinical data were collected and 2 week- isCGMS data were retrieved. Results: the Serum CP showed a positive correlation with time-in-range in the PRP (p:0.03), however PI showed no correlations with glycemic parameters in both periods. The Serum CP and PI levels and the PI:CP ratio were significantly higher in the PRP group than in the non-PRP group. In the non-PRP group, the PI level was below 0.1 pmol/L (which is the detectable limit) in only 2 of the 17 cases as compared with none in the PRP group. Similarly, only 2 of the 17 children in the non-PRP group had CP levels of less than 0.2 nmol / L, although both had detectable PI levels. Overall time-in-range (3. 9-1.0 mmol/L) was significantly high in the PRP group. In contrast, the mean sensor glucose levels, time spent in hyperglycemia, and coefficient of variation levels (32.2vs 40.5%) were significantly lower in the PRP group. Conclusions: although the mean glucose and time in range during the PRP was better than that in the non-PRP group, the glycemic variability during this period was not as low as expected. While the CP levels showed an association with TIR during the PRP, there was no correlation between PI levels and glycemic parameters. Further studies are needed to determine if PI might prove to be a useful parameter in clinical follow-up., NA more...