International Journal of Pediatrics
Volume:9 Issue: 93, Sep 2021

Childhood and adolescence is one of the most sensitive periods of life, and attention to the health of children and adolescents is very important in this period. this study was conducted to determine the prevalence rate of trauma types and its effective factors by systematic review.

This study is a systematic review of published articles in April 2000 to March 2020.The search on trauma and its related factors in people under the age of 18 years old were carried out. We tried to identify all the factors affecting the trauma and design the key words of the paper based on them. Search and data extraction were based on the PRISMA checklist. All the extracted articles were imported into the EndNote X8 software and the studies that were extracted several times were deleted. Then, the data extraction and quality analysis of the articles was done by two researchers separately and the data was reported through a descriptive report and use of systematic review tables.

In the search of 1356 articles, the search was started and after re-examination, 566 articles continued to the next stage. Then 309 articles were excluded from the study and 89 articles entered the next steps. After reviewing the complete file of articles, 43 articles were removed and finally 20 articles were entered into the systematic review stage. In some articles it has been in the form of a clinical examination and in others in the form of self-report and parental questions.

Fetal development is a strong predictor of neonate's survival after birth and poor fetal development is a health risk factor in infancy and adulthood. The frequency of factors that may affect fetal development is different from one society to another; therefore, the present study was conducted to investigate certain prenatal problems and their relationship with neonate's anthropometric indices at birth. The present cross-sectional descriptive-analytical study was conducted using the records registered in Iran’s Integrated Health System (locally known as SIB). They comprised of the records of 616 pregnant mothers who had given birth during 2017-18 in Bushehr city (Iran). The registered details of the mothers and infants were reviewed from the first prenatal visit to the first postpartum visit. A checklist was prepared to cumulate the information in their records. The collected data were analyzed in SPSS-19 through the appropriate statistical tests at a significance level of p <0.05. The mothers' mean age was 30.84±5.30 years. 3.9% of the infants weighed under 2500 g and were, therefore, in LBW group. The frequency of anemia was 16.25% and 22.5% respectively in the first and second trimesters. It was revealed that Gestational age (β=157, p <0.001) and the infant's male gender (β=117, P=0.004) has a direct and significant relationship, and vaginal childbirth an inverse and significant relationship (β=-122, P=0.003) with the infant's head circumference. Gestational age at birth (β=195, P>0.001). The mothers’ body mass Index (BMI) (β=241, P>0.001) in the first prenatal visit was also shown to have a significant relationship with the infant's weight-for-age Z-score. Moreover, GA (β=229, P>0.001) and mother's BMI (β=242, P>0.001) in the first prenatal visit had a significant relationship with the infant's length-for-age Z-score. The infant's anthropometric indices had no significant relationships with perinatal complications such as anemia, controlled diabetes, and urinary tract infections. Prenatal complications such as anemia were prevalent in the study population, and required particular attention. The mother's BMI can predict fetal development and should be the focus of greater attention in prenatal clinics

Given the importance of appropriate use of supplements in children and increasing the effectiveness of the financial resources, this study aimed at investigating the inappropriate use of the supplements. In this cross-sectional study, the data were collected using a researcher made questionnaire. Participants of the study were randomly selected from the cases whose information was available in the integrated health system (SIB). They comprised of 1220 children under two years of age who lived in Qom province. All samples were interviewed in comprehensive health care centers by trained nutritionists obtaining their demographic information including the place of residence, age, income, occupation and educational level, as well as their status of supplements usage. All statistical data were analyzed through SPSS 23. According to the results, it was estimated that 15.15% of financial resources of Iran's health system transformation plan were allocated to the family physician program and 29.11% of its financial resources were wasted. The total waste was   8,615,324,009 Rials (27.87%). Due to the significant percentage of wastage in resources allocated to providing supplements for children under two years of age, it is necessary to design and implement appropriate educational interventions for mothers of under two-year-old children and more precisely monitor the allocation of the resources in this field.

Inconsistent results have been reported about the relationship between low RMR and obesity. The purpose of this study was to investigate the relationship between resting metabolic rate and body composition factors in obese and normal weight gymnastics children.
20 obese and 21 normal-weight boys, aged 8-12 years, participated in this study. In the first session, data regarding the participants’ anthropometrical (weight, height, waist to hip ratio (WHR)) and body composition (body fat percentage (BF%), body fat weight (BFW), and lean body weight (LBW)) measurements were recorded. In the next session, at first, subjects rested for 15 min and then performed a modified Bulk exhausting test. The subjects were connected to the mouthpiece of gas analyzer throughout the rest and exhausting test and VO2max, RER, and RMR were conducted in both groups.
Significant difference was observed for a mean of VO2max, weight, BF%, BFW, LBW, and WHR between the two groups (P=0/001). The mean of RMR per kg body weight was significantly lower in the obese group than in the normal-weight group (P<0/05). There was no significant difference in the RER variable between the two groups (P>0.05). There was a significant linear relationship between RMR with weight, WHR, BFW, LBW, and VO2max in the obese group (P≤0/05).
Based on the results of the present study it can be concluded that the difference between the weight of obese and normal-weight beginner gymnast children is partly due to low RMR; and the lower RMR in obese children might be due to their low cardiorespiratory fitness.

The purpose of this study was to estimate the prevalence of molar incisor Hypomineralisation (MIH) in a group of school children aged 7 to 12 years, in sari.
700 school children (350 males and 350 females) were randomly selected for participation in this descriptive cross-sectional study. The prevalence of MIH was, initially, determined through clinical examination. The participants with MIH were also interviewed, and Related Data was recorded in questionnaires filled by the examiner. The data of study was analyzed using the Chi-square, Fisher’s exact, and Mann-Whitney U tests through SPSS version 17. P-vale less than 0.05 was considered statistically significant.
The prevalence of MIH was 20.2 % (n =142). Prevalence rate calculated in the studied group was 21.1% (males=74) and 19.4% (females=68).There was no significant difference between the two genders in terms of the prevalence and intensity of the MIH (P=0.4).
 
The results revealed that MIH is of moderate prevalence in Sari primary schools, and its prevalence is not significantly associated with gender.
tically significant.
The prevalence of MIH was 20.2 % (n =142). Prevalence rate calculated in the studied group was 21.1% (males=74) and 19.4% (females=68).There was no significant difference between the two genders in terms of the prevalence and intensity of the MIH (P=0.4).
The results revealed that MIH is of moderate prevalence in Sari primary schools, and its prevalence is not significantly associated with gender.

One of the side effects of Methotrexate and 6-Mercaptopurine used in the treatment of patients with Acute Lymphoblastic Leukemia (ALL) is drug hepatitis increasing the level of liver enzymes. The aim of this study was to determine the effectiveness of L-Carnitine in improving liver enzymes in patients treated with methotrexate and 6-Mercaptopurine.
This study was conducted as a single-blind randomized clinical trial (RCT) in the pediatric oncology department of Mohammad Kermanshahi Hospital in Kermanshah. It was performed on 26 patients with ALL treated with methotrexate and 6-mercaptopurine who their liver enzymes were between two to four times normal level. Patients were randomly assigned into two groups including the L-carnitine receiving group and the placebo receiving group. Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels and L-carnitine side effects including headache, vomiting, and diarrhea were assessed Up to 3 month, once every two weeks. To analyze the data, SPSS was used and the significance level was considered at < 0.05.
There were no statistically significant differences between control and intervention groups in terms of side effects of L-carnitine including diarrhea, vomiting and headache (P-value> 0.05). In the first four visits, no statistically significant difference was observed in the level of liver enzymes in the two groups (P-value> 0.05). However, in the fifth and sixth evaluations, a statistically significant difference was seen at the level of liver enzymes between the two groups of intervention and control (P-value <0.05).
Based on the results of this study, it seems that L-carnitine in patients treated with methotrexate and 6-mercaptopurine is effective in improving the level of liver enzymes.

Today Helicobacter pylori is the most common bacterial infection worldwide and is associated with some extra-gastrointestinal diseases such as blood disorders including idiopathic thrombocytopenic purpura (ITP). Therefore, this study was designed and performed to determine the status of Helicobacter pylori infection in children with idiopathic thrombocytopenic purpura referred to Dr. Mohammad Kermanshahi Hospital in 2019. In this cross-sectional study, 68 children with ITP were evaluated for Helicobacter pylori infection using stool antigen test. Information on Helicobacter pylori was collected using a checklist along with data on gender, age, type of ITP (acute / chronic), primary platelet counts, duration of ITP, and history of receiving treatment for H. pylori infection. Data were analyzed by SPSS-20 using descriptive statistics and the Chi-square test. The mean age of all subjects was 6.35 ± 3.44 years with an age range of 1 to 13 years. The mean duration of the disease was 9.73. ± 9.04 months. Among patients, 63.24% (43 patients) were boys. Regarding the type of ITP, the highest percentage was the Acute type of disease (72/06%). Also, based on the analytical results, there was no significant relationship between Helicobacter pylori infection and gender, mean duration of infection and type of ITP (p <0.05). According to the results of this study, half of the ITP patients had Helicobacter pylori infection, but there was no significant relationship between the type of ITP and its duration with Helicobacter pylori infection. Therefore, it is recommended to conduct similar studies with a larger sample size and perform follow-ups to achieve more accurate results

Inguinal hernia repair is one of the most common operations in surgical practice. Herniotomy is the most common choice and standard treatment for inguinal hernia. The purpose of this study was to describe and analyze the data of pediatric patients who had undergone open surgery for inguinal hernia repair.
A retrospective review of 40,000 pediatric patients with inguinal hernia was conducted between 2009 and 2019. The collected data included age, sex, type of hernia, side of hernia, predisposing factors and type of hospitalization. The patients' postoperative follow-up was performed until recovery.
Inguinal hernia was observed in 22125 males (55.31%) and 17847 females (44.61%). We also had 28 cases (0.07%) with testicular feminization. The age of all cases ranged from premature newborn to 16 years old. There were 52.2% right sided hernia, 34.99% left sided hernia and 12.8% bilateral. 59.74% (23898) of the patients had predisposing factors. Most patients were managed as outpatients and about a third of them (9037 cases) needed hospitalization.
In conclusion, although inguinal hernias are usually believed to be much more common in boys, girls also showed a high incidence in this study. Their occurrences among boys are in younger ages as compared to girls. In inguinal hernia repair, we should be careful about family history and predisposing factors, especially chronic constipation.

The aim of study was to investigate the correlation between anthropometrical and physiological characteristics of young elite boys and their performance in crawl and backstroke.
This study was a descriptive research. Subjects of the study consisted of 122 young elite boy swimmers (mean age 12-13 years; height 1.540±8.24m; weight 47.820±6.84kg), who participated in 2018 national championship 2018 in Shiraz and filled the consent forms.
There was a significant negative relationship between foot length (r=-0.400, P=0.028), leg power (length jump) (r=-0.477, P=0.008), static balance (r=-0.380, P=0.038) and dynamic balance (inferior) (r=-0.367, P=0.046) with 100m crawl (n=30) time. Whereas, there was a significant positive relationship between leg action and reaction velocity (r=0.438, P=0.015) with 100m crawl time. Furthermore, a significant negative relationship was found between head circumference (r = -0.507, P=0.019) and 400m crawl (n=21) time. Moreover, leg power (length jump) (r=0.543,P=0.011) was positively correlated with 400m crawl time, while a negative correlation was revealed between trunk circumference at nipple height (r=0.381,P=0.038), trunk circumference at hip (r=-0.523,P=0.003), forearm length (r=-0.412,P=0.024), hand length (r=-0.400,P=0.029), and tight length (r=-0.461, P=0.010) with 100m backstroke (n=30) time. In addition, there was a significant negative relationship between seated height (r=-0.399, P=0.039), hand length (r=-0.400, P=0.039), and tibia length (r=-0.415, P=0.032) with 200m backstroke (n=27) time. Whereas, relationship between trunk circumference at hip (r=0.600, P=0.001), and leg power (high jump) (r=0.408, P=0.035) with 200m backstroke time was significantly positive.
anthropometrical and physiological characteristics were significantly correlated with the performance of young elite boys in crawl and backstroke. It´s recommended that coaches and swimmers pay attention to results of the study at the earliest stages of adolescence for getting more success in reaching the peak of athletic performance

Breath holding spell (BHS) is a sudden, reflexive, non-epileptic phenomenon that is common in infancy and early childhood. The aim of this study was to determine the predictors of breath holding spell (BHS) in children under 5 in Iran.
The study was a case-control study (case, n=55; control, n=55). The cases were selected from children with BHS who had been referred to Mohammad Kermanshahi Hospital of Kermanshah, during 2019. Then, for each case, one control was selected among the children who referred to other wards of this hospital for reasons other than BHS.The data collection tool was a data collection form including demographic, family, obstetric and biochemical characteristics. The biochemical parameters (such as serum calcium, magnesium, albumin, phosphorus and vitamin D levels) were measured by a fully automatic auto-analyzer (Prestige 24i Tokyo-Boeki, Japan). Univariate and multivariate logistic regression models were used to data analysis by STATA 14.
The mean age of children for case and control groups were 22.85 ± 15.34 and 23.29 ± 16.91 months, respectively. The numbers of boys were 32(58.20) and 29(52.70) for case and control groups; respectively. The multivariate logistic regression model showed that the calcium (OR=9.03; 95% CI: 2.51 – 32.48), household size (OR=0.19; 95% CI: 0.04 – 0.90), paternal education (OR=0.48; 95% CI: 0.24 – 0.97), and history of mental illness in family (OR=8.97; 95% CI: 1.15 – 69.72) were, statistically, the most important predictors of BHS in children under 5 years.
Calcium, household size, paternal education and history of mental illness in family were the most important predictors of BHS in children under 5 years; however, studies with larger sample size are required.

Congenital adrenal hyperplasia (CAH) is an autosomal recessive genetic disorder characterized by elevated levels of adrenocorticotropic hormone (ACTH) and overproduction of adrenal sex steroids. It is speculated that the correlation between CAH and testicular adrenal rest tumors (TARTs) is caused through ACTH-triggered progression of aberrant adrenal cells in testes.
Here, we present a case of a nine-year-old boy with bilateral testicular masses referred to Ghaem hospital (Mashhad, Iran), in the summer of 2019. Laboratory studies revealed elevated ACTH and 17-hydroxyprogesterone confirming the diagnosis of CAH. Radiologic assessment showed bilateral multiple heterogeneous masses that had replaced the normal testicular tissue.
Due to the rare nature of TARTs and their manifestations, many of these patients, like ours don’t get prompt detection. It seems crucial for urologists and radiologists to be familiar with this condition as a benign differential diagnosis of bilateral testicular tumors

Cystic fibrosis (CF) as is an inherited disorder that can result in early death. Today, for treating the pulmonary symptoms of CF-related infections and inflammations, antibiotics and anti-inflammatory drugs are widely used. However, this therapeutic approach treats the symptoms without affecting the underlying causes of the disease. Thus, the present article hypothesizes the possible mechanism of action of Flaxseed as a new complementary medication for cystic fibrosis pulmonary disorder.
In this hypothesis, we searched ITM textbooks such as Qanoon fi al-teb, Zakhire-Kharazmshahi, and Exir-Azam. Then, data sources including (Pub Med and Google Scholar) without time restriction from inception up to September 2020 were searched, thoroughly, for the probable mechanisms of action of this herbal medicine on CF.
Flaxseed probably possesses effects for cystic fibrosis, because of the following properties: Flaxseed is rich in alpha-linolenic acid that is the omega-3 fatty acid source in the vegetarian diets, and Flaxseed has anti-inflammatory effect and also contains the flavonoid compounds which affect cystic fibrosis transmembrane conductance regulator; in addition, Flaxseed has phenolic acids (ferulic acid) which affect  Pseudomonas aeruginosa by having anti-Quorum sensing (QS) activities.
Considering the mechanism of action of Flaxseed, the present study hypothesized that it can be used as a complementary medicine in the treatment of cystic fibrosis

VACTERL association is a congenital abnormality involving several organs. The percentage of involvement of different organs in this illness varies and treatment success depends on the intensity of the accompanied anomalies. This study aimed to investigate the prevalence of VACTERL association in neonates Hospitalized in Be'sat Hospital in Hamadan, Iran. This retrospective study was conducted using the descriptive-analytic method and all the neonates who were hospitalized with esophageal atresia and imperforate anus abnormalities in Be'sat Hospital, Hamadan, Iran, from April 2009 to April 2018 were included in the study. Information on the neonates were extracted from the medical records and after being recorded in the checklist, they were analyzed using SPSS v.16 at a 95% confidence level. 127 neonates were included in this study. 42 neonates (33.1%) had esophageal atresia, 78 (61.4%) had imperforate anus, and 7 neonates (5.5%) had both anomalies. 87 of these neonates (68.5%) suffered from congenital heart disease. Atrial septal defect (31%), simultaneous presence of atrial septal defect and patent ductus arteriosus‎ (24%), and patent ductus arteriosus (23%) were the most common congenital heart diseases, respectively. 32 neonates (25.2%) had VACTERL association. Heart, genitourinary, and spinal anomalies were present in 93.2%, 84.3%, and 9.3% of the neonates, respectively. VACTERL association was significantly observed in neonates with imperforate anus (P = 0.001) VACTERL association is common in neonates who suffer from esophageal atresia or imperforate anus. Considering the high prevalence of anomaly of other organs, in addition to complete physical examination, echocardiography, abdominal ultrasound, and radiography of the spine are recommended.

Attention deficit hyperactivity disorder (ADHD) and its possible causes still attract controversy. Genes, pre and perinatal risks, psychosocial factors and environmental toxins have all been considered as potential risk factors. The objective of this study was to evaluate an association between low birth weight (LBW) and attention-deficit hyperactivity disorder (ADHD). This systematic  review  was conducted through medical  database, ISI Web of Knowledge, PubMed, Scopus, Medline, Embase, Google Scholar, and Cochrane for peer-reviewed, cross sectional, cohort studies assessing the correlation between child ADHD with Low birth weight (LBW) from 2005 to 2019 without language restriction. Keywords were selected based on the Mesh terms. From all 126 articles which were totally found, only 19 studies with 15 to 22 scores from STROBE checklist remained in the study for final assessment. Five studies assessed the relationship between VLBW and ADHD, one study the relationship between ELBW and ADHD, and another one between VLBW/ ELBW and ADHD. Significant correlations had been reported between LBW and ADHD in 7 studies, between VLBW and ADHD in 5 studies, and between ELBW and ADHD in 1 study. Nevertheless, some researchers had reported no significant correlation between LBW and ADHD in 5 studies and between VLBW and ADHD in 1 study. Birth weight seems to have a decisive role in the development of attention deficit hyperactivity disorder in children. Specific prevention and management interventions are required to reduce the incidence of ADHD.

Stretching exercises, in static and dynamic states, are used at the beginning of any sport activity in schools. The purpose of this study was to evaluate the effect of the order of static and dynamic stretching on some physical fitness factors in children.
This study was semi-experimental with repeated measures design. 30 participants were selected from female students studying in the fourth grade of elementary school in Miyaneh city, Iran, with cluster sampling. Subjects performed 3 stretching protocols (without stretching, dynamic after static stretching, and static after dynamic stretching) and dependent variables including reaction time, agility, power, speed and flexibility were measured before and after these protocols. In static stretching, stretch was maintained for 15 sec and in dynamic stretching, 5 repetitions of stretch (each repetition 15 sec) in 3 sets, with 10-sec rests between them, were performed. ANOVA with repeated measures and Bonferroni post hoc test were used to compare the effects of the 3 stretching protocols on the dependent variables.
The mean and standard deviations of the subjects’ age in this study was 10.18±0.8 years. Both dynamic after static and static after dynamic stretching had significant effects on reaction time (p=0.001), and flexibility (p=0.008 and p=0.003 respectively), but they didn’t show any significant effect on agility, power and speed (p=1.000). Moreover, the order of stretches had no significant effect on measured factors (p>0.05).
Both stretching protocols improve reaction time and flexibility in children, but do not influence their agility, power and speed. Changing the order of performing of static and dynamic stretching does not make any change in the records of reaction time, agility, power, flexibility and speed.

Characteristically, dishonest learners lack maturity and dedication; and prefer to rationalize their cheating conduct. Therefore, the aim of the present study was to provide a model for explaining the impact of academic motivation on the relationship between basic psychological needs and educational justice with cheating behavior.
Structural equation modeling was the method used in this research. Sample of the study consisted of 400 students selected from all female senior high schools in 4 districts of Tehran, Iran, in the academic year 2017-2018. The sample size was chosen according to Morgan table, using cluster random sampling method. Harter et al.'s Academic Motivation scale (1981), questionnaire of Basic Psychological Needs (2010) educational justice Questionnaire (2010), and Newstead et al.’s cheating Behavior Questionnaire (1996) were used for data collection. Data analysis was performed through SPSS software version 22 and Amos 23(α = 0.05).
Most of the participants were 16-year-old students, studying in the 10th grade. The results showed that the basic psychological needs and educational justice have a significant indirect effect on the cheating behaviors through the educational motivation (β=-0.29; P=0.001) and the mediating role of educational motivation in the relationship between basic psychological needs and Educational justice (β=-0.26; P=0.001) is confirmed by cheating behaviors with 95% confidence (p <0.05. (
The results obtained in this study indicated that educational needs and educational justice have a significant indirect effect on cheating behaviors through educational motivation and the mediating role of educational motivation is supported by cheating behaviors in the relationship between psychological needs and educational justice

The complexity of thalassemia and its treatment process has a significant impact on the quality of life of thalassemia major patients. The aim of this study was to investigate the challenges of improving health-related quality of life in β-thalassemia major patients.
A qualitative content analysis was performed at the thalassemia center in Mashhad, Iran. Semi-structured interviews were performed from January 2019 to May 2020, 25 interviews were performed with 23 participants (15 patients aged ≥18 years, 3 family members and 5 caregivers) who were selected by purposeful sampling.
After analyzing the data, the challenges of improving health-related quality of life in β-thalassemia major patients were categorized into five major themes, including I. living activity, II. opportunity and motivation, III. adaptation, IV. received healthcare, V. psychological and social support.
Age increase among thalassemia patients is associated with increased physical, psychological and social complications and treatment costs that lead to a reduced HRQOL. By increasing age, it is necessary to arrange some programs for their presence in the community and to take particular measures for employment, education and marriage of thalassemia major patients. As life span increases, the treatment of these patients reaches the cost-effectiveness threshold, so policy-making is critical for screening the complications of the disease. Along with providing a perfect treatment environment, the accessibility of appropriate laboratory and equipment for measuring iron deposition should be the priorities for health care system of countries, so that thalassemia patients may experience fewer complications and higher HRQOL in their life.

The present study aimed at assessing the effects of zinc sulfate supplementation on sepsis outcomes in neonates.
This randomized double-blind clinical trial was performed on neonates suffering neonatal sepsis. They were hospitalized in NICU ward at Hajar hospital in Shahrekord, Iran, in 2018. The patients were randomly assigned into two groups receiving a combined therapy of oral zinc sulfate (3mg/kg/day) and antibiotic for ten days (the intervention group, n=30) or routine anti-sepsis antibiotic therapy for the same time (the control group, n=30). The intervention and control groups were matched for baseline variables including gestational age, patients' age, time for beginning the first feeding and baseline anthropometric parameters. Height, weight, head circumference, feeding tolerance time, number of days of oxygenation, number of days hospitalized, NEC, duration of TPN reception, and time at feeding completion in the two groups were compared.
In total, 37 males and 23 females participated in this study, 21.7% of whom were born by natural vaginal delivery and others by cesarean section. There was a significant difference between the intervention and control groups in terms of neonates' weight and height, the rate of receiving TPN, Apgar score and nutrition tolerance. The use of zinc sulfate resulted in a significant increase in body weight and height, requiring less TPN use, and also shorter time to achieve nutritional tolerance (P<0.05).
The use of oral zinc sulfate (3 mg/kg/day divided for 10 days) in neonates suffering from sepsis improves sepsis-related clinical outcomes, leading to improvements in linear growth and nutrition tolerance, along with shortening the time for TPN

Due to the increased effect of environmental factors on the age of menarche and the correlation between the mothers’ and daughters’ age of menarche, we aimed at performing a meta-analysis to compare the mean age of menarche between the mothers and their daughters, examining the correlation between them. This systematic review was conducted to determine the heritability of daughters’ age of menarche. In this systematic review and meta-analysis, a complete search was carried out in PubMed, Scopus, Google Scholar, Web of Science, Science Direct, and CINAHL electronic databases in English with no time limitation. A meta-regression analysis was then performed to evaluate the effect of age and sample size. 13 studies with a total sample size of 9719 for calculating the standardized mean difference and 15 articles with a total sample size of 8840, related to the research objectives, were analyzed in this meta-analysis. The pooled mean of the daughters’ age of menarche was 12.62 yrs. (95% CI: 12.37 – 12.87) and that of the mothers’ age of menarche was 13.58 yrs. (95% CI: 13.31 – 13.81). The standardized mean difference between the mothers’ and daughters’ ages of menarche was -0.72 (CI: -0.99 to -0.44). The results of the meta-analysis revealed that, overall, there is a significant positive correlation between the mothers’ and daughters’ ages of menarche (r=0.27 [CI 95%: 0.17-0.36]). The daughters’ ages of menarche were positively correlated to those of their mothers, but the other environmental factors that may affect this decreasing trend should also be taken into account. Health policy-makers should plan to identify strong predictors, which can be effective in reducing the age of menarche.

One of the most important human abilities in adaptation to professional stressors is resilience, especially in nurses working in burn centers. The present study was conducted to understand how nurses develop intelligent resilience strategies while providing care for burnt children. In this qualitative study, 20 burn nurses working in the burn center of Imam Reza Hospital were selected through purposeful sampling. Semi-structured interviews were conducted. Nurses were asked general and specific questions pertaining to their experiences about stress-coping strategies while providing care for burnt children. Data analysis was carried out using the content analysis method. A total of 198 initial codes were classified into four themes including "intelligent communication", "multifaceted support", "maturity in difficult and high-risk conditions", and "belief in abilities". Via identification of the most important strategies used in this field, effective steps can be taken in reducing the emotional and physical exhaustion of nurses.