Journal of Pediatric Perspectives
Year:2016 | Volume:4 | Issue:5 (29)|Papers Count:18

Background: The Human Development Index (HDI) is a composite statistic of life expectancy, education, and income per capita indicators, which apart from measuring the socio-economic development of countries can predict health outcomes. The current study aimed at determination of the effects of HDI individual components on infant and child mortality. Materials and Methods: At a cross-sectional study, data on infant and child mortality rates and values for HDI individual components were obtained from the World Health Organization (WHO) and the World Bank respectively. The effect of HDI individual components on infant and child mortality were derived from linear regression models. Results: During 1990-2015, infant and child mortality have declined in all countries. Most proportion of child mortality is attributed to death in infants. All HDI individual components significantly inversely were related to infant mortality rate (IMR) and among them expected years of schooling has the strongest effect with regression coefficient of β =-5. 9 (95% CI:-6. 63,-5. 13). Conclusion: The highest IMRs have been observed for EMRO and AFRO regions of the WHO. Policies targeting women health and empowerment can have a tremendous impact on reducing child mortality rates around the world.

Background: Accidents are the first cause of death in children under 5-year, especially in low-and middle-income countries. The aim of this study was to identify the determinants of prevention behavior of domestic accidents in mothers of children fewer than 5 years old based on protection motivation theory )PMT(. Materials and Methods: In this cross-sectional descriptive-analytic study, 190 mothers were randomly selected. The data collection tool was researcher made questionnaire about prevention behaviors of home accidents in children less than five years based on the structures of protection motivation theory. then collected data entered in the software SPSS-22 and were analyzed using descriptive and analytical statistical tests. Results: Mean of perceived response efficacy was in good level and mean of other structures of PMT were in moderate level. There was a significant correlations between the scores of perceived vulnerability (r=. 39, P<0. 05) and perceived severity, between scores of perceived response efficacy and self-efficacy (r=. 47, P<0. 05). In mothers with higher education, score of perceived response efficacy was higher (P<0. 05). Mean of scores of perceived response efficacy and self-efficacy were higher in mothers who take care of their child themselves more than mothers who other people took care of their child (P<0. 05). Conclusion: Mean score of perceived response was in good level and also mean scores of others structures were in moderate level. It seems that PMT can be used as a conceptual frame work for designing educational programs aimed to improve of prevention behaviors of home accidents in mothers with children less than 5 year.

Background: Breast milk is an ideal source of nutrition for growth and development of infants and has unique physiologic and emotional impacts on the health of mothers and infants. However, a few numbers of infants get exclusive breast milk and therefore, it is necessary to identify barriers to breastfeeding. The purpose of the present qualitative research was to explore challenges and barriers to breastfeeding promotion. Materials and Methods: Fourteen nursing mothers, four key family members (grandmothers and husbands) and six personnel who provided breastfeeding counseling services participated in semi-structured individual interviews. Interviews were recorded and transcribed and then analyzed by means of conventional content analysis method. Results: Three main categories "incompetency of breastfeeding services", "mother’ s inadequate breastfeeding self-efficacy" and "family’ s neglect to breast milk" were emerged; that reflected participants’ experiences of barriers to breastfeeding promotion. Conclusion: Participants believed that the healthcare system had the greatest portion in breastfeeding promotion and inadequate performance of baby friendly hospital, failure of prenatal centers in teaching skills to mothers and families, and inadequate support for mother after delivery had caused breastfeeding damage. They also stated that mother’ s breastfeeding self-efficacy and family’ s help and support of breastfeeding had a significant role in breastfeeding promotion. To overcome the barriers to breastfeeding promotion, it is suggested that besides reforming existing plans according to identified barriers in this research, supportive and educational programs should be provided for all individuals involved in breastfeeding including mothers, families and health workers.

Background: The surveillance of adverse events following immunization (AEFI) is essential to improve high standard of vaccine safety, and maintain public trust in immunization programs. This study aimed to determine the AEFI and their related factors in children. Materials and Methods: This cross-sectional study including all children under 7-year of age, in Hamadan Province, the West of Iran, in 2014. All of the AEFI related with Bacille Calmette-Gué rin (BCG), Diphtheria, Pertussis, and Tetanus (DPT), Measles, Mumps, and Rubella (MMR) vaccines were obtained from the documented record-based by Health Centers, in Hamadan province. Results: From a total of 239, 204 doses administered, 284 AEFI were notified (11. 8 per 10, 000 doses). The proportion of AEFI was more frequently reported from Health Houses than Health Centers (60. 2 vs. 37. 0, P<0. 05). The most frequently AEFI reported was lymphadenitis (31. 4%), followed by hyperpyrexia (17%), and severe local reaction (13. 5%). Most frequently AEFI reported were related to vaccination reaction (74. 7%) and programmatic errors (12. 7%). Also, for incidence of lymphadenitis, the overall median time from vaccination to adverse event was 2 days (IQR: 2-15) and the highest median time was 15 days (IQR: 15-571). Conclusion: Our study shown, an increased risk of AEFI in the region and point out that the programmatic error still needs to be considered. Accordingly, the more activities need to be consolidated to reduce the adverse effect. This study assessed the different aspects of AEFI which may help policymakers to improve the immunization programs.

Background: Pregnancy in a woman's life is a unique experience. But due to high risk pregnancy and the need to rest in bed, the women and her family are faced with different challenges and needs. The inability to manage these needs will result in crisis and understanding the needs of pregnant women during bed rest is essential to provide comprehensive health care for them. So this qualitative study was designed and conducted to examine the needs of women with high-risk pregnancy experience during bed rest to improve health in this group. Materials and Methods: This is a qualitative study conducted in 1393 using inductive qualitative content analysis. 32 individual semi-structured interviews were performed with 21 women with high-risk pregnancy and four members of their family (mother of a participant and husbands of three participants) and seven medical staff involved in their healthcare. Collected information was analyzed concurrently with information collecting. Results: Data analysis led to the emersion of the last category of need that was training and consultation. This main category has sub-categories such as: need for consultation on physical problems, psychological problems, marital problems, fear and the stresses caused by bed rest, common problem in pregnancy and childbirth and the need for help for planning various activities during bed rest. Conclusion: Conducting a comprehensive nursing and education services and counseling to women with high-risk pregnancy during bed rest leads to a reduction in their physical and psychosocial problems.

Background: Childhood and adolescence injuries are still frequently occuring in developing countries. This study aims to assess the association of socio-economic status (SES) with injuriesin Iranian children and adolescents. Materials and Methods: This multicentricsurvey was part of a national surveillance program, which was conducted in 2011-2012 amongst 14, 880 students aged6-18 years. Participants were randomly selected from urban and rural areas of 30 provinces in Iran. Socio-economic status (SES) of participants was categorized to “ low” , “ middle” , and “ high” by using principle component analysis method by considering parental job and education as well as family assets. Prevalence, types and places of injuries were based on the questionnaire of the World Health Organization-Global School-based student Health Survey (WHO-GSHS). Multivariate modelwas used for comparison of variables between SES groups. Results: Overall, 13486 out of 14880 invited students (response rate: 90. 6%) participated in this study. Their mean (SD) age was12. 47 (3. 36) years. Boys and urban residents constituted the majority of participants (50. 8% and 75. 6%, respectively). Compared with low SES group, odds of sport injury was higher in students with middle (OR=1. 44; 95%CI: 0. 92-2. 26) and highSES (OR=1. 96; 95%CI: 1. 27-3. 01). Compared to participants withlow SES, odds of home injuries was significantly lower in high SES group (OR=0. 78; 95%CI: 0. 64-0. 95). Conclusion: This study revealedconsiderable differences in injuries of children and adolescents according to their SES, with higher prevalence of home injuries in low SES families and higher prevalence of sport injuries in middle and high SES levels. When implementing injury prevention programs, such differences should be taken into account.

Background: Despite the development of pediatric post-operative pain management and use of analgesic/narcotic drugs, post-operative pain remains as a common problem. Some studies suggested, the most effective approach to controlling immediate post-operative pain may include a combination of drug agents and non-drug methods. The aim of this study was to investigate the effect of music therapy on the acute post-operative pain in Iranian children. Materials and Methods: A quasi-experimental, repeated measure design was used. In this study, 63 children were placed in the music and control groups. In the music group, pain intensity was measured before start intervention (baseline). Then, this group listened to two non-speech music for 20 minutes. Then, pain intensity was measured with numeric rating scale, immediately after intervention, 1 hour, 3 hours and 6 hours after intervention, respectively. Also, in the control group, pain intensity was measured in times similar to music group. Results: The mean of pain intensity did not significantly different between the 2 groups at baseline (P>0. 05). The results of repeated measure ANOVA showed that, trend of pain intensity between 2 groups was significant (P<0. 05), so that pain intensity in the music group had more decrease than control group. Also, mean of used narcotic (Pethidine) in the music group was significant lower than the control group (P<0. 05). Conclusion: The current study showed that music therapy as a non-drug, cheap and easy method, can improve acute post-operative pain in children and also inducing lower use of narcotic in children.

Dear editor-in-chief, According to unevenly epidemiologic studies on health outcomes in Iran, some adverse outcomes such as poisoning especially in children less noticed. We were interested to write some childhood poisoning factsheets to provide easy to understand information on pitfalls and challenges around epidemiologic measures, etiology and prevention in this context. Valid evidences about childhood poisoning in Iran are scare, e. g. we searched the PubMed database with defined keywords including "Child" AND "Poisoning" AND "Iran" in April 2016 that resulted in 47 records. Same search strategy were applied for United States, Australia, Germany and Nigeria, the observed records were 2546, 363, 201 and 75 respectively. A concise review on these limited records, bring for us some fact sheets as follow: In view of epidemiologic measures, burden of childhood poisoning is unknown, a systematic review and meta-analysis on prevalence of types of poisonings in children can provide relevant and reliable evidences that can produce health care and health policy interventions with highest effectiveness. Here, an important point that should be considered in the mind is a holistic search on Iranian database might provide statistics on childhood poisoning prevalence, but due to low specificity and low coverage of databases, this goal seems will not well established. In view of etiology, the pattern of poisonings has changed over the past years, e. g. ingesting oil was the most common cause of poisoning in children during 1986 and 1991. Ingesting drugs, however, has been identified as the cause of most poisonings in 1997 (1). In recently studies, most common types of poisoning were related to narcotics among the narcotics, methadone was the most frequent poisoning agent (2-4). It was obvious information on some type of poisoning such as food poisoning or lead poisoning are lacking. In view of prevention, although the effect of child home environment, storage of poisoning product, parents characteristics and socio-economic status on childhood poisoning has been introduced (5-10), but information about how these risk factors modify the incidence of childhood poisoning are scare in Iran. According to above facts, well designed studies on childhood poisoning can considered as research priorities. Iranian injury registry databases can documented type of poisoning and its risk factors for research proposes.

Background Pulmonary artery banding (PAB) is a technique of palliative surgical therapy used by congenital heart surgeons as a staged approach to operative correction of congenital heart defects. Materials and Methods We report 5-year experiences from January 2011 to January 2016 of Imam Reza Hospital center (a tertiary referral hospital in Mashhad city, North East of Iran) that consist of 50 patients with congenital heart disease with left to right shunt that pulmonary artery banding procedure was performed for them were studied. Results Age of patients (n=50) was 1to 9 months (mean=4. 6 + 1. 3). In this study, the most common disease that need to PAB procedure was Ventricular septal defect (VSD) with twenty-eight patients (56%). Mean of extubation time (hour) was 10. 4 + 0. 8 and mean of hospital stay (day) was 13. 3 + 2. 4 respectively. Conclusion Although the number of pulmonary artery banding palliation surgery was decreased, but in selected group of congenital heart disease, this palliation to reduce over circulation of Pulmonary system, can use successfully with acceptable results and low mortality. We suggest pulmonary artery banding palliative surgery in these selected patients.

Vitamin E (alpha-tocopherol) is a potent and natural antioxidant. Vitamin E is concentrated from soybean oil. The Committee on Fetus and Newborn of the Academy of the American of Pediatrics endorsed 1 to 2 mg/dl as the normal range of serum tocopherol level. Human infants are born with low stores of vitamin E, thus they require an adequate intake of vitamin E soon after birth. The optimum intravenous dose of vitamin E is 2. 8 mg/kg per day (maximum 7 mg/kg per day). Treating very-low-birth-weight infants with 100 mg/kg vitamin E for >1 week results in levels >3. 5 mg/dl and significantly reduces the risks of severe retinopathy, intracranial hemorrhage, hemolytic anemia, chronic lung disease, retrolental fibroplasia and incidence and severity of intraventricular hemorrhage, but increases the risks of sepsis, necrotizing enterocolitis and can cause retinal hemorrhage in very-low-birth-weight infants. Vitamin E supplementation prevents the isolated vitamin E deficiency that causes spinocerebellar symptoms. The major benefits arising from elevated dosages of vitamin E have been the relief of symptoms of vitamin E deficiency in infants with abetalipoproteinamia and chronic cholestasis. Excessive doses of vitamin E may result in side effects and careful monitoring of vitamin E is thus essential. Neonates born to mothers treated with high doses of vitamin E have significantly lower birth weight compared to neonates born to untreated mothers. Vitamin E is not teratogenic. The aim of this study was to review the effects of vitamin E in neonates and young infants.

Background: Metabolic syndrome (MS) is an important risk factor that is associated with vitamin D deficiency, according to recent studies. This study aimed to evaluate the relationship between serum 25-hydroxyvitamin D level and risk of metabolic syndrome in children in Birjand. Materials and Methods: A case-control study on 6 to 18 years old metabolic syndrome patients, this investigation was performed in Birjand University of Medical Sciences, Cardiovascular Research Center. Thirty six children were enrolled in a non-random sampling manner, and the data were analyzed using SPSS-13 using independent t-test and chi square. Results: A total of 36 children entered the study (n=18 per group). The mean serum levels of vitamin D in metabolic and non-metabolic groups was 11. 61± 3. 79 and 14. 09± 6. 41 ng/ml (P>0. 05), respectively. The mean serum levels of vitamin D in the group with normal and abnormal triglyceride levels were 11. 05± 3. 80 and 14. 65± 6. 12 ng/ml, respectively (P<0. 05). Conclusion: The prevalence of vitamin D deficiency and insufficiency among children was high. Also, no association was found between vitamin D deficiency and metabolic syndrom. Controlled longitudinal studies are needed to better define the relationship between vitamin D status and pediatric metabolic syndrome.

Background: Due to little attention to the combined effect of diabetes and pregnancy on mother an infant’ s microelements in literatures. This study aimed to compare newborns growth parameters, Apgar score, the cord blood zinc, magnesium, calcium and phosphor between pregnant women with and without gestational diabetes mellitus. Materials and Methods: This prospective cohort study was conducted in Hamadan city, Iran, during 2013-14. Gestational diabetes considered as exposure and 20 women with gestational diabetes were individually matched with the 20 non-diabetic pregnant women in terms of the variables age, number of pregnancies, and type of delivery were included in this study. The cord blood and mother vein blood samples were taken immediately after delivery. Results: The mean of newborn's head circumference was 34. 85± 0. 9 cm and 33. 90± 0. 97 cm in mothers with gestational diabetes and non-diabetic mothers respectively (P<0. 05). The mean of cord blood calcium was 9. 81± 0. 6 mg/dl in the exposed group and 10. 23± 0. 4 mg/dl in the control group (P<0. 05) and these figures for zinc were 79. 05± 13. 1 mg/dl in the exposed group and 86. 96± 11. 6 mg/dl in the control group (P<0. 05). Conclusion: This prospective cohort study showed the imbalance of some micronutrient in cord blood of mothers with gestational diabetes in comparison to non-diabetic mothers. Therefore in pregnant women with gestational diabetes should be more attention to be paid the concentrations of microelements.

Background Depression and anxiety can have a significant impact on prognosis in diabetic patients. In this study we evaluate how the effect of group learning on anxiety and depression in adolescents with type 1 diabetes at clinics of Ahvaz Jundishapur University of Medical Science. Materials and Methods This study was carried out via a pretest-posttest design on the adolescent 11-21 ages with type I diabetes. 74 patients were randomized in education group (n=37) either to the control group (n=37). Data collection tools included demographic and clinical status questionnaires, and the Beck anxiety and depression inventory. Group training intervention was done for intervention group and three months after study two groups filled questionnaires and inventories. Data analyzed using chi-square test and t-test using SPSS-22 software. Results Findings showed that there was a significant difference between patients mean of depression in intervention group before and after intervention (P <0. 05). Also there was a significant difference between the patients mean of anxiety in intervention group after group training (P<0. 05). Conclusion Results indicated group training of adolescents with type I diabetes caused reducing in depression and anxiety them. So it would be useful considering training programs in pertinent care plan.

Background Acute lung injury (ALI) is defined as PaO2/FiO2 less than 300 with bilateral pulmonary infiltrates, without pressure is the top of the left atrium. Early diagnosis and treatment of pediatric ALI and find new cases is very important. Accurate diagnosis and effective steps to treating these patients is essential in the outcome of ALI. This study was conducted to show the impact of recruitment in the treatment of ALI patients. Materials and Methods This clinical trial study was conducted in Pediatric Educational-Medical center of Tabriz University of Medical Sciences (Tabriz, Iran) and 42 patients with ALI were enrolled. All patients were underwent echocardiography. The patients were divided in 2 groups randomly (intervention and control groups consisted of 21 patients for each group). Patients were followed for 6 months to be evaluated in terms of clinical status and mortality. Results Difference on level of PaO2 in intervention group was-26± 4 in comparison to the control group which was-4± 4 (P<0. 05). Difference on time of dependence on mechanical ventilation in intervention group was 8. 05± 3 in comparison to control group which was 11. 05± 8 (P<0. 05). Mortality rate of intervention group (28%) was lower than the control group (47%)(P<0. 05). Conclusion Implementation of recruitment could play an important role in decreasing of mortality in patients with acute lung injury.

Background The present study was designed and conducted to determine the effect of video game play on pain of venipuncture in 3-6 year-old children. Materials and Methods This randomized controlled trial study was conducted on 80 hospitalized children with pain of venipuncture procedures. Playing a video computer game for children during the venipuncture procedures was the intervention for the interventional group. Also the intensity of pain was measured by behavioral pain scale for children (FLACC scale) during the procedure. This scale was completed for patients without any intervention in the control group during venipuncture procedures. Results Pain intensity mean in the interventional group (2. 65 ± 1. 577) had significant changes in comparison with the control group (7. 95 ± 1. 084) (P<0. 05). 70% of children in the control group experienced severe pain due to venipuncture procedures, but most children in the intervention group (77. 5%) had a little pain. Conclusion According to the results, it seems that video game play intervention has a significant positive effect on the pain of venipuncture procedures in children. Further studies are recommended for the development of this technique in health care centers.

Background Attention deficit hyperactivity disorder (ADHD) is a multi-factorial disorder that has defined by hyperactivity, impulsivity and attention deficits. Various neurotransmitters such as dopamine can play a role in its pathophysiology. The aim of this study was to examine the association of two common single nucleotide polymorphisms in DRD2 gene, Taq I A (T/C) and Taq I B (G/A), with ADHA risk among Iranian-Azeri population. Materials and Methods A study of case– control association was performed with 89 samples with attention deficit hyperactivity disorder and 96 healthy subjects. Peripheral blood samples were used for Genomic DNA extraction by salting-out method. SNP genotyping was carried out by PCR-RFLP technique. The collected data were analyzed through javastant online statistics software, using Chi-square, with a significance level of 0. 05. Results There was not a significant difference in the allele and genotype frequencies between ADHD and Taq1B polymorphism in cases and controls (P>0. 05). In the Taq IA of DRD2 gene, TT homozygous dominants and CC homozygous recessives were more frequent in case group than in control group but significant difference was not observed (P>0. 05). Also, T/C heterozygotes were more frequent among the control group than the case group, and difference was significant (P<0. 05). Conclusion Our data supports lack of association between Taq1A and Taq1B gene polymorphisms and ADHD.

Background A child's hospitalization in intensive care units causes stress and worry in other family members. This study aimed to determine the effect of family presence during pediatric ICU bedside on family general health. Materials and Methods In this clinical trial study, 46 family members of the pediatrics hospitalized in the ICU in Teaching hospital affiliated with the Lorestan University of Medical Sciences in Khorramabad in April to November 2014 were divided into two groups using the stratified block randomization. Family members of the intervention group were present at the bedside of their patients two hours a day for six days, but family members of the control group did not visit their patients during six day. The general health status of the family members in the two groups was evaluated immediately before and after the visit on the first, sixth and twelfth visit, by using the General Health Questionnaire (GHQ). The data was analyzed using the repeated measure tests and independent t-tests. Results Results showed there was a significant difference between the groups in terms of the means of the GHQ scores of the family members before and after the intervention (P<0. 05). Conclusion The presence of family members at pediatrics’ bedside and their cooperation in care can improve their general health.

Background In modern education, physical space is considered as a dynamic factor in students' educational activities. This study was conducted to investigating the impact of lighting educational spaces on learning and academic achievement of elementary students. Materials and Methods At a cross-sectional study (2015-2016), a total of 210 students were selected randomly as sample of study. Cluster sampling was done by appropriate allocation and questionnaires were randomly divided among students. Data collection tools included Hermance’ s achievement motivation questionnaire and researcher-constructed questionnaire (observation checklist to examine the physical parameters of learning environment lighting) and interviews with students. Data of study were analyzed using SPSS-21 software. Results Results of this study showed that lighting educational spaces has a significant impact on learning and academic achievement of elementary school students in Ahvaz, Iran (P<0. 05). Conclusion Since light is most available factor in life, attention to it at schools, best use of it to increase the quality of educational space is a necessary work. Therefore, it is recommended that lightning of class to be provided through natural light (windows, valves, etc) or artificial light (lamps or various kinds of lights) in designing and equipping educational spaces.