International Journal of Pediatrics
Volume:10 Issue: 99, Mar 2022

Worldwide, Smoking is one of the most critical public health issues. On the other hand, different levels of family activity may explain adolescent smoking behaviors. Therefore, this longitudinal study examines the effect of family activities on adolescent Smoking in the United States. 4966 American adolescents aged 12-18 years are used for analysis between 1980 and 2015. Family process criteria (peer influence, control variables, and Smoking) are used to collect data. Kaplan- Meier survival analysis and logistic regression are used to analyze the data.The results showed that women are less likely to smoke than men. The same is true for blacks as compared to whites. Children separated from the family are 20 percent more likely to smoke, and adolescents with high physical activity levels are less likely to smoke before age 16. Moreover, moderate sport levels reduce the risk of smoking by 15%, so people who are more physically active are less likely to smoke during adolescence, but parental education was not related to smoking. Developing standard programs with adequate education and social reinforcement and the efforts of families and communities to engage in sports activities reduced adolescent smoking

The number of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) is increasing significantly. Common treatment options mainly include pharmacotherapies, as well as behavioral and psychosocial treatments applied separately or in combination. Currently, however, there is an increasing trend in the use of complementary and alternative medicines (CAM) in children with ADHD. A significant number of parents of children diagnosed with ADHD prefer to use CAM alone or in combination with current pharmacotherapies for their children's symptoms. Palliative interventions on ADHD patients lead to symptomatic reliefs, which can greatly improve the quality of life among these patients. According to the viewpoints of traditional Persian medicine, there are several nutritional advice and medicinal herbs, recommended for palliating ADHD and improving the patients’ quality of life. In this article we present some recommended medicinal plants for these patients, and the suggested changes in their lifestyle, especially in the dietary programs.

Diabetes mellitus type I (DMT1) is a highlighted endocrine and digestive issue that involves the heart organs; with more effect when lipids profiles are considered. The study aimed to assess the variations in echocardiographic findings due to the changes in lipids profiles among children with DMT1.
This case-control study was performed on 96 DMT1 and 96 healthy children. The DMT1 was confirmed by clinical manifestations and laboratory measures. Both groups underwent conventional echocardiography and HbA1c; diabetic duration and lipids profiles were measured for the children with diabetes. Data was analyzed via SPSS 18.0 and P < 0.05 was considered as the significance level.
It was found that the left MPI was higher in patients (p=0.001) than in healthy controls. Patients with poor control had higher levels of LVMI and left deceleration time (p<0.05) compared to optimal controls. Patients with abnormal CHO had higher ejection fraction, fraction of shortening, Left E/A, LAd/Aod, LAs/Aos, left ejection time and PWD while right deceleration time, Aortic diameter in diastole, aortic diameter in systole, left MPI and left deceleration time had lower levels.  LDL changes affected aorta diameter in diastole, right deceleration time, aorta diameter in systole, left MPI and left deceleration time, fractional shortening, Left E/A, LAd / Aod, LAs/Aos, aortic ejection time and PWD. Patients with an abnormal HDL, had higher left MPI and lower left ejection time.
It was concluded that more conventional echocardiography involvement is observed in DMT1 children who have abnormal lipids profiles as well as abnormal HbA1c and longer diabetes durations.

Presentation of two independent tumors in one case is rare; coincidence of two different bone tumors in a single bone and limb is extremely rare. Here we reported on a male adolescent case with co-existence of NOF and an osteoid osteoma in ipsilateral tibia which was presented with left leg pain and swelling; both tumoral lesions were excised and the patient became symptom free. This case study highlights the importance of careful clinical and radiological investigation for more pathologies in spite of finding a single tumor; and encourages further research on the possible genetic links between these two kinds of tumors.

This study examines the prevalence of upper extremity abnormalities during COVID-19 quarantine. It emphasizes the role of physical activity and screen time in these abnormalities in male adolescents. The relationship between these components and anxiety was also examined.

This descriptive-correlational study was performed on 150 13-15-year-old boys. Upper extremity abnormalities are measured using Image J software and Spinal Mouse. Physical activity, screen time, and anxiety are assessed by the use of standard questionnaires.

Means of age and BMI were 22.86 and 22.48, respectively. The results showed that 70 patients (47%) had forward head posture, 51 patients (34%) had kyphosis, and 11 patients (7%) had lordosis. In addition, the results showed that physical activity and screen time were significantly correlated to forward head and kyphosis (all T>1.96). Also, physical activity, screen time, and upper extremity abnormalities were significantly associated with anxiety (all T>1.96).

The results indicate that upper extremity abnormalities, including forward head and kyphosis, are relatively common in male adolescents during COVID-19 quarantine. Also, physical activity and screen time may impact these abnormalities.

Obesity and its associated comorbidities are growing worldwide, including non-alcoholic fatty liver disease (NAFLD), which is one of the leading causes of chronic liver diseases in both children and adults. The aim of this study was to determine the prevalence of NAFLD among obese children and to investigate the clinical and biochemical predictors associated with NAFLD.

Ninety obese children and adolescents aged 12-18 years were enrolled in this study. All participants underwent anthropometric measurements and biochemical analyses including fasting blood glucose, serum insulin, serum triglycerides (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and liver function tests. Ultrasonography was used to diagnose NAFLD.

The prevalence of NAFLD was 38.9% among obese children, 68.6% of whom met the criteria for metabolic syndrome. Children with NAFLD had significantly higher body mass index, waist circumference, ALT, total cholesterol, LDL-c, TG, fasting insulin, and lower HDL-c levels than those with normal liver ultrasound (P< 0.05). Insulin resistance was significantly more common in the NAFLD group (88.6% vs. 18.2%) (P<001). Logistic regression analysis revealed that BMI and HOMA-IR were independent predictors of NAFLD (P = 0.034 and 0.022, respectively).

More than one-third of obese children have NAFLD, which is closely linked to metabolic syndrome and insulin resistance

Chronic liver disease (CLD) in children is a growing health problem with significant morbidity and mortality. There is a specific susceptibility to electrolyte imbalance in chronic liver disease patients that can deteriorate their condition to hepatic encephalopathy. The aim of this study is to evaluate the electrolyte disturbance in CLD patients with and without hepatic encephalopathy.
This cross-sectional study was conducted in Ghaem Hospital, Mashhad University of Medical Sciences, Iran, during a six-year period. All patients below 14 years of age with chronic liver disease admitted to the pediatric gastroenterology department were included. Demographic data, laboratory tests, clinical manifestations and presence of hepatic encephalopathy were recorded in a checklist for each patient. Data was entered in SPSS software version 20. Qualitative data were analyzed using chi-square, and quantitative data were analyzed using independent t-tests. A P-value <0.05 was considered significant.
Our study on 85 CLD patients showed that the serum sodium level and serum calcium level were significantly lower in patients with hepatic encephalopathy with P-Values of 0.001 and 0.02, respectively. Also, serum urea and bilirubinemia levels were significantly higher in the patients with hepatic encephalopathy with P-Values of 0.03 and 0.001 respectively.
It seems that reducing serum sodium and calcium level can be predictive of hepatic encephalopathy in pediatric patients with chronic liver disease

Chicory has been used in Iranian traditional medicine for the treatment of various liver dysfunctions. This study aimed to investigate the effects of chicory extract consumption by mothers on the frequency of icterus and the serum bilirubin level in neonates.

In this clinical trial, the research population included pregnant women referring to birth preparation classes in an urban area of Iran. Two hundred pregnant women were selected and randomly allocated into two groups of intervention and control. In the intervention group, the mothers were recommended to take Chicory extract (produced by SHAAF Shiraz Company, Iran) from the 36th week of gestation, at 70 cc, three times a day, and to continue the process during the first 2 weeks of lactation. The control group received routine care. Data gathering tools were a demographic questionnaire and a researcher-made checklist for recording the frequency of icterus and the mean level of bilirubin. Data were analyzed using SPSS 18.

The frequency of neonatal icterus in the intervention group was lower than that in the control group, but their difference was not significant (chi-square test, P = 0/11). The difference in the mean bilirubin level was not significant between the two groups on the first day of birth. However, on the third day after birth, the difference was significant and the intervention group had a lower mean of the bilirubin level (Independent T-test, P<0/05).

Based on the results, the consumption of chicory by mothers can be effective in decreasing the bilirubin levels among the neonates

Vaccination of children against hepatitis B virus (HBV) is the most effective strategy to prevent infections in their future life. However, the real response to HBV vaccination in infancy is still unclear. The aim of this study was to evaluate the status of immune response to HBV vaccine among children aged 8 to 18 months in east coast of the Caspian Sea, Bandar-e Turkmen, Golestan, Iran.
In this cross-sectional study, 565 children from Bandar-e Turkmen ranging from 8 to 18 months of age, vaccinated in a routine vaccination program were included. The serum samples were collected from all children and HBsAb titers were measured using ELISA.
Out of 565 children, 12 (2.12%) had anti-HBs titers <10 IU/L (non-responder) while 553 (97.88%) had anti-HBs titers >10 IU/L (responder) (p<0.05). Among these responder children, 92 (16.3%) had anti-HBs titers 10-100 IU/L (poor responder) and 461(81.6%) had anti-HBs titers >100 IU/L (good responder). The negative children were revaccinated (3-doses) and 11 of them became protected against HBV infection (anti-HBs titers >10 IU/L). Only 1 of the included children was non-responder, after routine vaccination and 3 doses revaccination.
The results of this study indicated that the HBV vaccination program in this region of Iran is effective and most of the children showed positive immune responses after three doses of vaccination. Importantly, revaccination of non-protected individuals is recommended

The present study aimed to understand the causative sociodemographic factors to prevent the ever-increasing childhood suicides. The records of the patients presented to the paediatric emergency department of Samsun Training and Research Hospital for attempted suicide between 01 January 2019 and 30 June 30 2021 were investigated in this cross-sectional, descriptive study. SPSS (version 20.0) software package was used for data analyses. A total of 61 children were included in this study. There was no record of mortality. The rate of repeated suicide attempts was 11.4% (n=7). The rate of girls who had attempted suicide (n=53, 86.9%) was higher than that of boys. The mean age of the children was 15.15±2.19 years. The parents of 48% of the cases were married. Hospital admissions most frequently occurred between 6:00 pm and 12:00 am midnight (n=22, 36.1%) and between July and September (n=20, 32.8%). Drug intoxication was the most common form of suicide (n=54, 88.5%), whereas the most frequent reason for attempting suicide was argument with a first-degree relative (n=12, 19.7%). Children with unmarried parents more frequently attempted suicide and were more frequently diagnosed with psychiatric disorders (p=0.031 and p=0.032, respectively). Children diagnosed with psychiatric disorders had a higher rate of previous attempted suicides (p=0.001). It may be valuable to examine problems specific to certain age groups, pay attention to the signs, keep the primary healthcare institutions alert and develop clinical protocols for such cases to prevent suicides.

The purpose of the present study was to investigate the association of autonomy-based teaching style in physical education with intrinsic motivation, social anxiety, and tendency to perform physical activities among primary school children.
The present study used a descriptive-correlational design with 384 children (192 boys; mean age of 10.01 years) from the regular primary schools of Tehran, 2019. Data was collected by the use of standard questionnaires. Pearson correlation test and regression analysis were used to examine the associations between variables and independent t-test was used to analyze gender differences.
The boys had higher scores than the girls in perceived autonomy support, intrinsic motivation, and intention to physically perform activities. However, the girls felt higher social anxiety than boys. The results showed that perceived autonomy support had a positive association with intrinsic motivation (P=0.000), which subsequently was associated with intention to do physical activity in the physical education class (P=0.000). Moreover, the boys reported higher perceived autonomy support (P=0.000), more intrinsic motivation (P=0.000) and intention to do physical activities (P=0.000) than girls, however, girls reported higher levels of social anxiety in physical education class (P=0.000). Finally, social anxiety was inversely associated with intention to do physical activity (P=0.049). 
These findings show that physical education teachers should encourage the perceptions of the students about their control in the physical education class, so that the students experience more autonomy.

Sexual health is individuals’ ability to express their sexual needs within the framework of their society’s values without being afraid of sexually transmitted infections, unwanted pregnancies, violence and discrimination. Given the importance of sexual health in intellectually disabled adolescents, the present study was conducted to explore the sexual health challenges among the intellectually disabled adolescent girls. The present qualitative study was conducted on 48 participants including the parents, teachers, healthcare providers and managers who were selected through purposeful sampling, in Isfahan, Iran. Data was gathered using semi-structured in-depth interviews, focus group discussions and field notes. The collected data was analyzed using conventional content analysis. After data analysis, four sub-categories of “adolescent’s disability in understanding sexual matters and respecting social rules”, “the Comorbidity of psychiatric disorders and intellectual disability”, cultural taboos on sexual issues” and “teachers’ inability to deal with issues related to adolescent’s sexual health” were extracted. These sub-categories together formed the main category of “sexual health challenges''. Based on the results, designing comprehensive programs of sex education for intellectually disabled adolescent girls seems necessary. Also, empowering teachers to teach sexual health to these girls and their parents is of particular importance.  Furthermore, the interaction between the school and parents to maintain the sexual health of intellectually disabled adolescent girls could have an effective role in decreasing the rate of sexual abuse/harassment and their involvement in sexual relationships.

Recent studies show that the prevalence of oral diseases, as one of the non-communicable diseases, is rapidly increasing in Iran and its improvement necessitates an efficient educational program. Thus, the present study aims at investigating the effect of peer education using poster and presentation methods on perceived benefits of oral health based on the Health Belief Model (HBM).
This study is a quasi-experimental study which examines 118 elementary students, categorized into control and experimental groups, in Neyshabur, 2018. The data was collected using a researcher-made questionnaire that examined the participants’ performance as well as the perceived benefits concerning oral health based on HBM before and after the study. In addition, the data was analyzed using SPSS 20 through paired samples t-tests, independent t-tests and Chi Square analysis.
The results show that the perceived benefits mean score for the experimental group increased after the implementation of the treatment (Pretest M=10.83, SD=2.6 & Post Test M=21.69, SD=1.77). Therefore, it could be stated that the peer education approach along with using presentation methods to increase the average score of perceived benefits of the students in oral hygiene is highly effective and statistically significant (P <0.001).
The results revealed that the implementation of active educational methods that are done with the participation and focus of students, can lead to the improvement of oral health indicators in them.

Computer games have often been considered to have a negative impact on children’s sleep. The aim of this study was to determine the effect of distance teaching for mothers on the sleep habits related to computer games among the primary school boys living in Zahedan, Iran, during 2020. The present quasi-experimental study was carried out on the primary school students. 144 male students were randomly selected in two groups of intervention and control. Data collection tools included the Child Sleep Habits and demographic information Questionnaires. If the student was in the intervention group, before the intervention, the researcher held a face-to-face meeting with his mother to complete the questionnaire. Then, I created a group for mothers in Telegram and WhatsApp. The intervention was conducted in 4 weeks, during which the researcher sent the educational texts and videos to the students’ mothers, three times a week. Eight weeks later, the Sleep Habits Questionnaire was completed by the mothers. If the student was assigned to the control group, the demographic information and Sleep Habits Questionnaires were completed by the mothers, as the pre-test. No intervention was made for this group; and the post-test was completed after 8 weeks by the mothers. Data analysis was performed through IBM SPS. The results revealed that the mean and standard deviation of the sleep habits score and its dimensions were not significantly different in the intervention and control groups (P>0.05) before the intervention. However, after the intervention, the sleep habits score and its dimensions showed significant differences between the two groups (P<0.05). Maintaining the physical and mental health of students is an important responsibility of pediatric nurses and parents. It is suggested that teaching sleep habits to mothers should be considered.

Recognizing the predictors of fathers' worry about maternal health, maternity pregnancy, and infant health and personal- familial issues is the first step in counseling them. The present study aimed to determine the predictors of fathers' worry about high-risk pregnancy of their wife. This cross sectional study was conducted on 294 eligible fathers from four health centers and a hospital of Gorgan, Iran. Data collection tools were checklist of demographic and midwifery characteristics, psychological symptoms checklist (SCL-25), mothers' and fathers' worry questionnaire, and a social-familial support scale. Data were analyzed by SPSS and LISREL software 8.8 full version.  According to results of the path analysis, mothers' worry (B= 0.31, p=4.78) among the variables, which were related to fathers' worry from both paths, had the highest positive relationship. The maternal mental health indirectly had the most positive association (B = 0.12, p=3/48) and duration of marriage indirectly had the most negative association with fathers' worry (B = -0.22, p=-3.14). In a direct path, the fathers' mental health was positively related to the fathers' worry (B= 0.3, p=0.000). Mothers' worry, fathers' mental health, duration of marriage, and maternal mental health had the highest association with fathers' worry. The factor was both directly and indirectly related to the mother's worry through association with the maternal mental health. According to findings, on this basis, it is important to pay attention to supportive and counseling programs for fathers.

Due to the applications of the Steam approach in teaching and solving the educational problems in basic sciences such as mathematics and science among children, the importance of Steam teaching for children is now more understood. This issue has led to the design and implementation of the present study with the aim of identifying the components of Steam teaching for children.
The method of the present study was qualitative and analytical and on the basis of the Grounded Theory. The data of the present study was collected in 2020. The sampling method was purposive in which the books and articles related to the Steam-based teaching method were analyzed using Max Kyoda 10 software with three-step coding methods (open, axial and selective).
The results of data analysis showed that the central and recurring category in content analysis of Steam-based teaching is "problem-oriented integration of art with Steam" and means "understanding and applying art in real situations, natural integration of art with the Steam through problem solving. As the main teaching strategy"; and the other extracted coding categories such as causal conditions, contextual conditions, interfering conditions, strategies and outcomes are related to it.
Using the identified components can provide the basis for the development of Steam teaching for children and lead to the creation of desirable operational activities in this area

Thalassemia is one of the most common genetic disorders. Patients with thalassemia and their families face various challenges in their daily lives, which affect their coping strategies. The aim of this study was to evaluate the coping strategies in patients with beta-thalassemia and their parents.

The present systematic review examines the coping strategies applied by the thalassemic patients and their caregivers. We carried out electronic searches using Medline (via PubMed), Web of science, and Scopus to select the related studies without date restriction until Nov, 10, 2021; and completed the findings by hand search. The Mesh-based search terms were Beta thalassemia, Mediterranean anemia, Cooley anemia, coping, and adaptation.

The electronic search process identified 311 papers as candidates for the systematic review. After applying the inclusion and exclusion criteria, 9 articles remained for analysis. The review of the 9 articles showed that the patients with beta-thalassemia use emotion-focused coping strategies in the form of distraction and avoidance coping strategies to deal with their problems. Also, religious coping is the most coping strategy which is used by the parents. Furthermore, there is a positive relation between adaptive coping strategies and quality of life and resilience.

According to the results, patients with beta-thalassemia use maladaptive coping skills (emotion-focused coping strategies). Also the evaluated studies demonstrated that using the adaptive coping strategies improved the quality of life, resilience and psychological health of patients with thalassemia and their caregivers.