Person: BORAN, PERRAN
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BORAN
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PERRAN
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Publication Open Access Delivering the thinking healthy programme as a universal group intervention integrated into routine antenatal care: a randomized-controlled pilot study(2023-12-01) BORAN, PERRAN; DÖNMEZ, MELİKE; BARIŞ, HATİCE EZGİ; ALTAŞ, ZEYNEP MEVA; HIDIROĞLU, SEYHAN; SAVE, DİLŞAD; BORAN P., DÖNMEZ M., Barış E., Us M. C., ALTAŞ Z. M., Nisar A., Atif N., Sikander S., HIDIROĞLU S., SAVE D., et al.© 2023, The Author(s).Background: Women with perinatal depression and their children are at increased risk of poor health outcomes. There is a need to implement non-stigmatizing interventions into existing health systems which reduce psychosocial distress during pregnancy and prevent perinatal depression. We adapted the WHO-endorsed Thinking Healthy Programme (THP) to be delivered universally to all women attending routine online pregnancy schools in Istanbul, Turkey. This study aimed to evaluate the feasibility and acceptability of this intervention. Methods: This mixed-methods study incorporated a two-arm pilot randomized controlled trial and qualitative evaluation of the feasibility and acceptability of the adapted THP – Brief Group version (THP-BGV) to a range of stakeholders. We recruited pregnant women at 12-30 weeks’ gestation through pregnancy schools within the University Hospital’s catchment area. Women in the intervention arm received five online sessions of the THP-BGV delivered by antenatal nurses. The intervention employed principles of cognitive behaviour therapy to provide psychoeducation, behaviour activation, problem-solving strategies and group support to participants. In the control arm, women received usual care consisting of routine online educational pregnancy classes aided by the antenatal nurses. The women were assessed for depressive symptoms with the Edinburgh Postnatal Depression Scale at baseline and 4-6 weeks post-intervention and also evaluated for anxiety, perceived social support, partner relationship, level of disability and sleep quality. In-depth interviews were conducted with women and other key stakeholders. Results: Of the 99 consecutive women referred to the pregnancy schools, 91 (91.9%) were eligible and 88 (88.8%) consented to participate in the study and were randomized. Eighty-two (83%) completed the final assessments. Our main findings were that this preventive group intervention was feasible to be integrated into routine antenatal educational classes and it was valued by the women and delivery-agents. While the study was not powered to detect differences between intervention and control conditions, we found small trends towards reduction in anxiety and depressive symptoms favoring the intervention arm. No serious adverse events were reported. Conclusions: Given the paucity of preventive interventions for perinatal depression in low and middle-income countries, a fully powered definitive randomized controlled trial of this feasible and acceptable intervention should be conducted. Trial registration: The study was registered at Clinical Trails.gov (NCT04819711) (Registration Date: 29/03/2021).Publication Open Access Seeing the pandemic through children's eyes: Exploring Turkish children's views on COVID-19 pandemic by focus-group discussions(2023-01-01) BORAN, PERRAN; Senkal E., Kurt O. M., YALÇIN S. S., Koller D., Boran P.BackgroundThe direct and indirect effects of the COVID-19 pandemic on children and youth people are well documented. Little is known about children\"s experiences of the pandemic in their own words. We aimed to explore Turkish children\"s experiences and views about the pandemic, across private and public educational systems. MethodsSix focus group discussions were conducted online with 30 children aged between 7 to 18 years in 2021. Children were enrolled through snowball sampling technique according to developmental age groups. A thematic analysis was conducted. ResultsWe identified five themes: Compliance with public health measures about preventing the spread of COVID-19, changes in daily routines, emotional responses to the pandemic, distance education, and adaptive responses. Overall, children were well informed and receptive to the public health preventive measures with the exception of older children\"s tendency to disregard physical distancing with friends. They reported frustration with those who did not comply with measures and believed that the authorities should strictly enforce public health requirements. Emotional responses comprised fear of family members and themselves being infected, anxiety produced by the uncertainty of the virus, and the loss of social support. There was a perceived disparity between students from public and private schools regarding academic self-competence. Positive aspects of the pandemic included positive interactions with family members and the acquisition of new hobbies. Although most children acknowledged the support of their parents to deal with challenges, children of health workers were particularly isolated in terms of emotional support. ConclusionOur findings offer additional insights and validate previous research on the negative and positive effects of COVID-19 from the child\"s perspective across private and public educational systems. This study contributes to global advocacy efforts aimed at understanding the impact of the pandemic on children.Publication Open Access Young children's sleep patterns and problems in paediatric primary healthcare settings: a multicentre cross-sectional study from a nationally representative sample(2022-12-01) BORAN, PERRAN; BORAN P., Ergin A., Us M. C., DİNLEYİCİ M., VELİPAŞAOĞLU S., YALÇIN S. S., BARUTÇU A., GÖKÇAY E. G., Gur E., camurdan Duyan A., et al.Studies describing paediatric sleep patterns are needed by taking culture into consideration. The aim of this study was to identify parent-reported sleep-wake patterns in young children and explore possible factors influencing sleep problems. The mothers of 2,434 young children enrolled from well-child outpatient clinics in Turkey completed an online survey including sociodemographic variables, Brief Infant Sleep Questionnaire, Edinburgh Postnatal Depression Scale and Generalised Anxiety Disorder scales. Overall, young children in Turkey go to bed late (10:00 p.m.), awaken twice per night for 30 min, and obtain 11.5 h of total sleep, showing no sex-specific differences. Distinct night-time sleep patterns emerged after 18 months of age. Importantly, although currently breastfed healthy children were 3.8-times less likely to sleep through the night, total sleep duration and exclusive breastfeeding duration were higher in children who were not sleeping through the night. Overall, bedsharing was identified in 11.5%, and only room sharing was reported in 52.9%. Parental perception of a child\"s sleep as problematic was 35.8%. Mothers with higher educational attainment were more likely to perceive their children\"s sleep as a problem. Maternal depressive and anxious symptoms and a history of excessive infant crying were the determinants predicting the likelihood of both parent-perceived sleep problems and poor sleepers. The present analysis of sleep structure in infancy and toddlerhood provides reference data for well-child visits. These findings highlight the importance of considering maternal anxiety, depression and behaviour management techniques to cope with fussy infants in addressing childhood behavioural sleep problems.Publication Open Access Rates of emergency room visits and hospitalizations among refugee and resident children in a tertiary hospital in Turkey(2022-08-01) BARIŞ, HATİCE EZGİ; BORAN, PERRAN; BARIŞ H. E., Silahli N. Y., Gul N. A., Qutranji L., Goldhagen J., BORAN P.Evaluation of emergency department (ED) presentation by Syrian refugee children might provide important information about their health care needs. For this purpose, we compared ED presentation of refugee and resident children in a tertiary university hospital in Istanbul, Turkey. Electronic medical records of Syrian refugee children≤18 years old presenting to the ED between January 2013 and July 2019 were retrospectively reviewed and compared with resident children. The study population consisted of 7299 refugees and 690,127 resident children admitted to the ED. High-acuity cases were more frequent in Syrian refugees (2.2% vs 1% p<0.001). One-third of Syrian children were under 12 months of age (31% vs 17%, p<0.001). Syrian children were more commonly hospitalized (7.9% vs 3.1% p<0.001). The median age (and interquartile range – IQR) was lower in hospitalized refugee than in resident children [12 (0–83) months vs 41 (8–111) months, p<0.001]. Rate of intensive care unit hospitalization (13% vs 9.4%, p=0.001) and neonatal hospitalization was higher in Syrians compared to resident children (29% vs 12%, p<0.001). The median NICU stay was longer in refugees [6 (IQR 4–17) days vs 3 (IQR 1–9) days, p<0.001]. Conclusion: Refugee children, as compared to resident children, are more likely to present to the ED with high acuity conditions and at a younger age resulting in higher rates of inpatient admissions. Strategies to increase access to preventive health care services for young refugee children should be explored to decrease ED and hospital services and improve health outcomes.Publication Open Access Evlilik doyumu, maternal depresyon, bağlanma ve erken çocukluk dönemi uyku sorunları: Tanımlayıcı araştırma(2022-06-01) BORAN, PERRAN; BARIŞ, HATİCE EZGİ; Barış H. E., Boran P.Amaç:Evlilik ilişkisi, erken çocukluk dönemi uyku sorunları olan bir çocuğun bakımında özellikle önemli olabilir. Amacımız, annenin evlilikten aldığı doyumun, erken çocukluk dönemi uyku sorunları üzerine etkisini incelemektir.Gereç ve Yöntemler:Çocuk Sağlığı İzlem Polikliniğimizden takipli 3-12 ay arası bebeklerin anneleri, anne ve bebek uykusu ile ilgili soruları içeren Kısa Bebek Uyku Anketi\"nden türetilen sorularla değerlendirildi. Annenin evlilik doyumu, Evlilik Yaşamı Ölçeği (EYÖ) ile; annenin depresif semptomları Edinburgh Doğum Sonrası Depresyon Ölçeği (EDSDÖ) ile; anne-bebek bağlanması ise Doğum Sonrası Bağlanma Ölçeği (DSBÖ) ile değerlendirildi.Bulgular:Yüz dört anne-bebek ikilisinde, bebeklerde uyku sorunu sıklığı %39,4 olarak bildirildi. Uyku sorunu olan ve olmayan bebeklerin annelerinin EYÖ puanları arasında fark saptanmadı. Anne EYÖ puanı ile bebeklerin gece uyanma sayıları negatif korelasyon gösterdi (rs: - 0,27, p=0,005). Babaların %18,3\"ü anne-bebek ikilisinden farklı odada uyumaktaydı. Babanın farklı odada uyuduğu ailelerde, annelerin EYÖ puanı daha düşük saptandı (p=0,008). Evlilik yaşam doyumu daha yüksek olan annelerde, depresif semptom puanlaması düşmekte (p<0,001) ve daha iyi anne-bebek bağlanması gözlenmekteydi (p=0,04). On altı annede EDSDÖ\"ye göre depresyon taraması pozitif saptandı. Bebeklerinde uyku sorunu olan annelerin ortanca EDSDÖ puanı, diğer annelerden yüksek saptanırken (p=0,022); uyku sorunu olan ve olmayan bebeklerin annelerinin DSBÖ puanları arasında anlamlı farklılık izlenmedi.Sonuç:Bebeğin geceleri sık uyanması, annenin evlilik doyumunun azalmasıyla ilişkili iken babanın aynı odada yatması, daha iyi evlilik doyumu ile ilişkili saptanmıştır. Erken bebeklik döneminde uyku sorunları, annenin depresif semptomlarıyla ilişkili bulunmuştur. Klinik uygulamalarda, annenin ruhsal iyilik hâli ve annebebek bağlaması ile ilişkili olduğu gösterilen evlilik doyumuna ve eşler arası yakın ilişkinin sürdürülmesine odaklanmak erken çocukluk dönemi uyku sorunlarının yönetiminin bir parçası olması önerilmektedir.Publication Open Access Adaptation and integration of the thinking healthy programme into pregnancy schools in Istanbul, Turkey(2023-04-12) BORAN, PERRAN; DÖNMEZ, MELİKE; BARIŞ, HATİCE EZGİ; ALTAŞ, ZEYNEP MEVA; HIDIROĞLU, SEYHAN; SAVE, DİLŞAD; BORAN P., DÖNMEZ M., Atif N., Nisar A., Barış E., Us M. C., ALTAŞ Z. M., HIDIROĞLU S., SAVE D., Rahman A.BACKGROUND: Perinatal mental health is a major public health concern. In Turkey, public hospitals operate pregnancy schools which provides an opportunity to integrate an evidence-based Thinking Healthy Programme (THP) for perinatal depression. The aim of this study is to adapt the THP for universal use in the group setting and to understand its acceptability and feasibility for integration into the existing antenatal care programme for both face-to-face and online delivery. METHODS: Following an expert-led adaptation process using the Bernal Framework, field testing was conducted on a group of women and facilitators followed by in-depth interviews (n:8) and group discussions (n = 13). Data were analysed using Thematic Framework Analysis. RESULTS: Minor but significant adaptations were made to the individually delivered THP for use in the universal group pregnancy schools. Initial findings indicate that the THP-group version was acceptable to its target population and could be integrated into the antenatal care plan for delivery during face-to-face and online group classes. CONCLUSION: THP is transferable to the Turkish cultural and healthcare context. The THP-group version has the potential to add value to Turkey\"s existing perinatal healthcare programme.