Journal of Pediatric Perspectives
Year:2017 | Volume:5 | Issue:5 (41)|Papers Count:20

Ceftazidime is a valuable third-generation bactericidal cephalosporin. Ceftazidime inhibits the biosynthesis of bacterial cell peptidoglycan, causing inhibition of bacterial growth or cell lyses and death. Common nosocomial gram-negative organisms susceptible to ceftazidime include Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, Neisseria, Moraxella catarrhalis, Proteus mirabilis, Proteus vulgaris, and Providencia stuartii. Good activity remains against other gram-negative species including Salmonella, Shigella, and Neisseria species. Ceftazidime is widely distributed in most body tissues and fluids including respiratory secretion, ascitic fluid and cerebrospinal fluid. Ceftazidime is administered parenterally, is completely absorbed after intramuscular injection, and peak drug concentrations generally occur within 3 hours of intramuscular injection. Ceftazidime is not absorbed when taken by mouth. Ceftazidime half-life is 4 to 10 hours at birth, but half this in infants more than a week old. In premature infants, the distribution volume and the clearance of ceftazidime range from 292+44 to 366+130 ml/kg and from 27. 8+5. 8 to 60. 8+8. 3 ml/h/kg, respectively. Ceftazidime binds to plasma proteins at 10% to 17%. No ceftazidime metabolites have been identified and this drug is excreted by renal elimination. The dose of ceftazidime is 25 mg/kg once-daily in the first week of life. Ceftazidime crosses the placenta freely, but there is no evidence of teratogenicity. As empirical ceftazidime monotherapy may not be appropriate for the treatment of neonatal sepsis, the addition of ampicillin, to cover against enterococci and Listeria monocytogenes, seems prudent in these neonatal patients. The aim of this study is to review the effects of ceftazidime in neonates.

Background Unfortunately, gestational diabetes with its demanding health cares and increasing economic costs is globally prevailing. Therefore, preventive measures against this difficulty are highly significant. The aim of the present study was to evaluate the effects of training interventions on behaviors of pregnant women for prevention of gestational diabetes. Materials and Methods This quasi-experimental study was conducted on 91 pregnant women (n=45 in intervention group, n=46 in control group), whom were chosen through multi-stage random sampling, and three training sessions with weekly intervals were offered for the intervention group. The data was collected in two stages including before the intervention and three months after intervention through interview as well as filling in questionnaire forms. The collected data was analyzed through independent sample t-test and paired t-test by considering 0. 05 confidence level using SPSS software (version19. 0). Results The results of present study showed a direct and significant correlation between age and preventive behaviors (r=0. 22, P<0. 05), and also between body mass index (BMI) with perceived susceptibility (r=0. 26, P<0. 05). In addition, the mean scores of all constructs of Health Belief Model in intervention group, three months after intervention, were significantly higher compared with the control group (P<0. 05). Conclusion Due to the fact that the results of the present study suggested the effectiveness of training interventions on enhancing the preventive behaviors against gestational diabetes through Health Belief Model and considering the significance of prevention of this disease, it is suggested to codify essential plans for performing training interventions.

Background Pediatric nephrolithiasis is a condition the prevalence of which varies geographically with multiple etiologies. The aim of this study was to determine possible concomitant anatomic and metabolic disturbances in children with nephrolithiasis and to answer the questions regarding the role of each metabolic and anatomic abnormality. Materials and Methods Between 2007 and 2015, 1, 080 patients referred to our pediatric hospital of Hazrat Masumeh in Qom city, with the diagnosis of nephrolithiasis. Complete history from each eligible patient has taken using a prespecified data extraction form. Then, each child was referred for metabolic and anatomical evaluation using laboratory and imaging tests. Results According to the extracted data, 92% of our patients had at least one concomitant metabolic disorder and 12. 5% had an anatomic abnormality. Recorded metabolic disorders in our series were hypocitraturia (56. 9%), hyperuricosuria (21. 4%), hypercalciuria (19. 3%), hyperoxaluria (14. 7%), phosphaturia (11. 4%), and cystinuria (1. 4%). According to data analysis, 12. 5% of patients had an anatomical abnormality of which the ureteropelvic junction obstruction and vesicoureteral reflux were the most common. Conclusion The current study showed that the most common abnormalities in association with nephrolithiasis were metabolic disturbances, which highlight the importance of further metabolic study, even in patients with anatomical abnormalities.

Background Youth' healthiness depends on their hygiene behaviors. Doing promoting behaviors of healthiness is one of best ways of health protect and control. This study aimed to investigate promoting behaviors of healthiness in two physical activity and nutrition statue domains in high school students. Materials and Methods: The study was descriptive-analytic of cross-sectional type study which was done on 800 students of second level of high school in Sabzevar-Iran, during 2015-2016. Sampling method was as clustered and tool of collecting data was questionnaire include: first part demographic information and second part standard of healthiness promoting behaviors (HPLP). Data were entered into using Stata version 12. 0 after collecting and were analyzed with statistical-descriptive and Chi-square tests. Results: Average of physical activity in boys and girls were 18. 27 ± 5. 38 and 13. 8 ± 6. 3, respectively. There was a significant relationship between rate of students' physical activity with level of parents' education and educational grades of students. Boys had more physical activity compared to girls in terms of gender (P<0. 05). In investigation of nutrition statue item there was no nutritional difference in boys and girls groups (P>0. 05); while, there was significant relationship between favorable nutritional statue and their educational grade levels, educational field and parents' occupation in students (P<0. 05). Conclusion In current study, female students had less physical activity and required programming to improve more physical activities among girls. Parents who had higher educational level, their children had more suitable pattern in terms of physical activity and nutrition statue.

Myasthenia gravis (MG) is an autoimmune disease resulting in destruction of the post-synaptic nicotinic receptors at the neuromuscular junction,Classically,the earliest symptoms of MG are ocular,including ptosis and diplopia,Other less common early symptoms include dysphagia and fatigable chewing,Our case report describes the unusual presentation of MG in a teenager patient and presented for an elective percutaneous endoscopic gastrostomy (PEG),tube placement due to persistent weight loss,The patient underwent the procedure without any complications,At the time of tracheal extubation,she could not maintain spontaneous ventilation,so requiring mechanical ventilation,The patient was transferred from the recovery room to the pediatric intensive care unit (PICU),Subsequent investigations including a bedside electromyography (EMG),led to the diagnosis of MG,The patient was successfully extubated after treatment with intravenous immunoglobulin,oral prednisone 40 mg per day and pyridostigmine 60 mg every 8 hours,

Background Patent ductus arteriosus is an open channel between the aorta and pulmonary artery. The study aimed to evaluate the clinical course of patent ductus arteriosus after discharge and comparing in therapies technique. Materials and Methods This cross-sectional and inferential-descriptive study was performed in the hospitals of city of Zahedan-Iran in the period of one decade from 2005 to 2015. The study populations were all patients with patent ductus arteriosus (PDA) and these patients followed for at least one year after discharge from the hospitals due to the treatment with one of the Video-assisted thoracoscopic surgery (VATS), Amplatzer, surgery and medical techniques. 144 patients were assessed and the results of echocardiographic findings recorded in pre-determined data collection form and analyzed using SPSS version 15. 0. Results No residuals for VATS treatment after hospital discharge, but in the Amplatzer the rate of residual was 13. 3% when the higher rate of 20% was for surgery. The highest rate of residual for PDA closure was 23. 5% in medical treatment. In the treatment methods comparison analysis in respect to the size left atrium-to-aorta (LA / AO) changes from one month to one year observed a significant difference in the methods of VATS, Amplatzer and Surgery in which illustrate the left heart cavities that represent a great relief due to passing time occurred. Conclusion From the study concluded that in the methods of VATS, Amplatzer and surgery a closed PDA needs time to become normal left chambers by changes in LA / AO, but in the medical method, not observed any changes in LA / AO. The results showed any residual due to VATS method after discharge from hospital, but surgery and Amplatzer had very low rates.

Background At present of the limitation of the current case finding strategies and the global urgency to improve tuberculosis (TB) case finding, a renewed interest in active case finding (ACF) has risen. World Health Organization (WHO) calls for research on TB screening among low-income countries because of the limitation of the passive case finding strategies. We aimed to evaluated Active Case Finding strategy for TB among the slums population in North of Iran (Gorgan city) and comprise this procedure to Passive Case Finding. Materials and Methods We conducted a house-to-house survey from April 2016 to July 2016 by trained health volunteers for TB in ten urban slums of Gorgan. Individuals with TB symptoms were identified through targeted screening using a standardized questionnaire and investigated further for TB. Descriptive analyses were performed using Stata-12. Results During study period, of 22, 741 individuals screened for TB, 112 (0. 49%) were identified as TB suspects; 95 suspects were evaluated for TB. TB was diagnosed in four individuals, representing 4. 2% of those evaluated for TB as suspected cases. The incidence rate of tuberculosis was 17. 5 in 100. 000 people in slums population of Gorgan. Of the four detected cases, three individuals had pulmonary TB that among them two cases had new smear-positive TB. Conclusion ACF could supplement current strategies to yield additional TB cases, lead to early diagnosis and better treatment.

Background: Autism as part of the category called Autism spectrum disorder (ASD), is caused by disorders in brain and nervous network and characterized by defect in social behavior, language and cognition. This study aimed to investigate receptive and expressive language performance and the severity of the disorder in 30 children with autism aged 2-8 years who speak in Persian language. Materials and Methods In this cross-sectional study 30 children with autism were selected using random sampling method. The study tools included "The Childhood Autism Rating Scale (CARS)", and "Newsha Developmental Scale (NDS)" for assessing the receptive-expressive language skills. In order to assess the level of language impairment in subjects, the participants were divided into 5 groups with 6 people (considering the speaking ability including sign language and speech), with equal number of boys and girls (3 girls and 3 boys) in each group. All of these children were evaluated by pediatric psychiatry, pediatric neurologist and pediatrician and were assessed according to the criteria for autism based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Eventually, the data were analyzed using descriptive and inferential statistics in SPSS version 16. 0 software. Results The results showed that there was a significant difference between the mean (standard deviation) and scores of receptive – expressive language skills in autistic subjects in each of the groups (P<0. 05). In other words, there is a substantial difference in the mean scores of subscales of Newsha developmental scale with the scores of the subjects. Results also revealed that the processes of language development in subjects improved gradually during the treatment period. Conclusion Altogether, it can be said that the HMTM treatment method (Hojjati Model) which is derived from Iranian traditional medicine and holistic philosophy, can be effective in the treatment of language disorder in children with autism.

Background: Unfortunately just a few numbers of children and adolescents use sufficient amounts of fruit and vegtabless. This study aimed to investigate the Association between social cognitive theory constructs and fruit and vegetables consumption in adolescent girls. Materials and Methods: This is a descriptive analytic study conducted on 308 high school girls (first grade) who were selected by cluster sampling method in Shahrekord, Chaharmahal and Bakhtiari province, Iran. A researcher made questionnaire was used to collect the needed data like demographic variables, substructures of perceived self-efficacy, outcome expectations and outcome evaluation. In order to investigate the fruit and vegetables consumption status, the standard questionnaire of Food Frequency Questionnaire (FFQ) was used. The data were analyzed using SPSS 18. 0 software. Results: The mean scores of outcome expectation, outcome evaluation and perceived self-efficacy were 35. 52± 16. 26, 34. 60± 20. 21 and 32. 55± 19. 81, respectively of the total score of 100. The mean scores of fruit and vegetables consumption and vegetables consumption were reported as 1. 45± 0. 68 and 1. 47± 0. 95, respectively, as well. There was a direct significant correlation between adolescents’ perceived self-efficacy and outcome expectations (P = 0. 034, r = 0. 040). A direct significant correlation was also observed between fruit consumption and both outcome evaluation (P = 0. 033, r = 0. 012), and perceived self-efficacy (P = 0. 051, r =0. 064). Conclusion: Regarding the status of fruit and vegetables consumption and the mean scores of social cognitive theory constructs and relationship between them and also the importance of promoting healthy diet in the critical period of adolescence, it seems necessary to use efficient patterns and theories of health education and promotion has been considered.

Background Breastfeeding is an only reliable nutritional source for infants. Many factors could affect breastfeeding such as delivery type. The aim of this study was to evaluate the relationship of delivery type and breastfeeding successful. Materials and Methods This was a descriptive-analytical study. Subjects of this study were 298 (148 subjects [49. 7%] with cesarean and 150 subject [50. 3%] with vaginal delivery) mothers who were referred to 4 health care centers in Urmia, Iran. The demographic data, type of delivery, breast feeding characteristics were collected by a researcher-made questionnaire. Statistical analysis was carried out using SPSS version 17. 0 software. Results The mean age of mothers was 28. 2 ± 4. 9 years old. Of a total 298 mothers, 148 subjects (49. 7%) had experienced cesarean delivery and 150 subjects (50. 3%) had experienced vaginal delivery. There was no statistically significant difference among mothers who had Vaginal delivery compared to mothers who had Caesarean delivery in terms of the first lactation duration (P = 0. 406), from delivery to first breastfeeding duration (P = 0. 125), mean duration of next breastfeeding (P = 0. 750), mean number of lactation per day (P = 0. 133), and mean number of lactation per night (P = 0. 081), and age of onset of auxiliary nutrition (P = 0. 784). Conclusion In this study there was no relationship between type of delivery and breastfeeding behaviors; while in the vaginal delivery group, the average distance to first lactation was shorter, so, cesarean delivery can be dangerous for mothers, but also can affect the breastfeeding pattern.

Background: The appropriate moment for clamping the umbilical cord is controversial. Immediate cord clamping (ICC) is an item of active management of the third stage of labor (AMTSL). Unclamped umbilical cord may cause inconvenience in preterm neonates because they commonly need some levels of emergent services. Some studies revealed delayed cord clamping (DCC) of preterm neonates results in better health conditions like lower rates of respiratory distress syndrome (RDS), less morbidities in labor room and lower risk of postpartum hemorrhage. The aim of the present study was to determine the effect of delayed umbilical cord clamping on premature neonatal outcomes. Materials and Methods: In this single‑ center randomized control trial study, sixty premature neonates (gestational age ≤ 34 weeks) were randomly assigned to ICC (cord clamped at 5– 10 seconds) or DCC (30– 45 seconds) groups and followed up in neonatal intensive care unit (NICU). Primary outcomes were 1st and 5th minute Apgar score, average of level of hematocrit after birth, intra ventricle hemorrhage and need some levels of resuscitation. Results: Differences in demographic characteristics were not statistically significant. After birth, neonates who had delayed clamping had significantly higher mean hematocrit after at 4-hour of birth (49. 58+5. 15gr/dl vs. 46. 58+5. 40gr/dl in DCC vs. ICC groups, respectively) (P=0. 031). Delayed cord clamping reduced the duration of need to nasal continues positive airway pressure (NCPAP) (86. 7% and 60. 0% in ICC and DCC groups, respectively, P= 0. 039). Attractively, the results showed lower incidence of clinical sepsis in delayed cord clamping neonates (53. 3% vs. 23. 3% in ICC and DCC groups, respectively, P=0. 033). Conclusion: Prematurity complications might decrease by delay umbilical cord clamping which improve the hematocrit, duration of need to NCPAP and incidence of clinical sepsis. Furthermore, DCC may have no negative impact on neonatal resuscitation.

Background Ascending testis (AT) is one of the rare but serious complication that may occurs following inguinal hernia/hydrocele repair. We aimed to review our more than 7 years’ experience and discuss the possible mechanism through which the AT possibly occurs following inguinal hernia/hydrocele repair. Materials and Methods A retrospective analysis of 7, 212 boys who had undergone inguinal hernia/hydrocele repair between March 2009 and April 2016 was conducted. Exclusion criteria were: undescended testis, misdiagnosed AT, and retractile testis. Two types of surgical procedures were performed based on the medical records: (1) transection of the hernia sac and processus vaginalis alone and (2) isolation of the vas deferens and testicular vessels and a global transection of the remaining structures. Subsequently, post-operative incidence of AT was compared across variables extracted from the medical records. Results Sixteen (0. 22%) patients were diagnosed with AT post operatively. AT incidence after inguinal hernia/hydrocele repair was reported in approximately 0. 19% of the entire patient sample (in the 8491 hernia/hydrocele repairs). Comparison of AT incidence with the age at initial operation showed significant increase at the age of one year or less (P =0. 017). In addition, AT incidence was significantly higher in the patients for whom only the sac/processus vaginalis was transected rather than the patients who underwent hernia/hydrocele repair with isolation of the vas deferens and testicular vessels (0. 06% vs. 0. 27%, respectively, P =0. 023). Other subgroup analyses remained non-significant. Conclusion We conclude that transection of the cremaster muscle might decrease the incidence of ascending testis following inguinal hernia/ hydrocele repair.

Background: Tobacco and hookah smoking is a worldwide problem among adolescents. The present study aimed to determine familial and social factors in predicting the tobacco and hookah smoking among high school students in Jahrom, South of Iran. Materials and Methods: This cross-sectional study was conducted for assessing the factors affecting hookah and cigarette smoking among high school students during January to April 2015. The participants were 630 high school students (girls=315 and boys=315). The self-administered questionnaire containing students’ demographics, parent education, family sizes, tobacco using, tobacco using of the family, hookah smoking, and hookah smoking in the family was used. Multiple logistic regression (MLR) models using the Enter method were fitted to assess the factors that increased or decreased the risk of smoking. Results: The risk of cigarette smoking was increased with: cigarette smoking by sister (s) or brother (s) (36. 8 [95% confidence interval (CI) (1. 28-105)]; P=0. 03), hookah smoking by mother (6. 64 [95%CI (1. 28-34. 2)]; P=0. 02), hookah smoking by father (OR: 5. 33 [95%CI: 1. 88-15. 07; P=0. 02 ]), hookah smoking by mother (OR: 29. 53 [95%CI: 10. 26-85. 01, P<0. 001]), hookah smoking by sister (s) or brother (s) (OR: 31. 6 [95%CI: 10. 71-93. 3, P<0. 001]), and not consult with parents (4. 38 [95%CI (1. 48-12. 9)]; P=0. 007), were significantly related to hookah smoking (P<0. 05). Conclusion In current study, the prevalence rate of hookah smoking is notable among both male (3. 8%) and female (1. 6%) sexes. Despite the protective role of family in the substance use studies, in the case of hookah smoking, the family provides an opportunity for adolescence to experience hookah smoking.

Background Social support and school play a pivotal role in the development of oral health-related behaviors among students. This study was conducted to determine the relationship between stages of dental cleaning behavior change based on Trans-theoretical model with school role and social support in Iranian students. Materials and Methods In a cross-sectional study, 525 male and female students were selected through cluster and simple random sampling. Demographic information, data related to trans-theoretical model constructs and social support and school role were collected via self-reports. The obtained data were analyzed using SPSS version 16. 0 software. Results The findings showed that 58% of students (32% boys and 26% girls) used none of the dental cleaning tools. Most of the students (42. 5%) were found to be in the preparation stage of dental cleaning behavior. There was a significantly direct correlation between school role and self-efficiency and perceived benefits (P<0. 05, r=0. 159). Also there was a significantly reverse correlation between school role and perceived barriers (P<0. 05, r=-0. 311, ). No significant correlation was reported between social support and school role during stages of dental cleaning behavior (P>0. 05). Conclusion The results indicated that the majority of students did not use of dental cleaning tools and did not receive sufficient social support in this regard. To perform dental cleaning behavior, student should increase perceived self-efficacy and benefits and decrease perceived barriers. Low performance of dental cleaning behavior among students is indicative of the necessity of performing intervention programs aiming to promote dental cleaning behavior.

Background: Health status is an individual’ s relative level of wellness and illness. Self-Perceived Health (SPH) is a single item considered as a health indicator for national and international survey. The aim of this study was to evaluate the SPH measure and its determinants in a National sample of Iranian children and adolescents. Materials and Methods: This National study was performed as the fourth National survey of a school-based surveillance program entitled the Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN-IV) study. 14, 880 students aged 6-18 years old selected from 30 provinces of Iran by a multistage Cluster and stratified sampling method. Two sets of valid and reliable questionnaires were completed for students and their parents. Results: Overall 13, 846 participated in the present study with 90. 6 % participation. In this study, 80. 5 % of boys and 79. 4% of girls reported good SPH (95% confidence interval (CI), 79. 3-81. 6 versus 78. 1-80. 6, respectively). According to the living area, 79. 5% from urban and 81. 1% from rural area declared good SPH (95% CI, 78. 6-80. 5 versus 79. 2-82. 8, respectively). In the multivariate model, the subjects who had healthy weight compared with excess weight had significantly higher SPH (OR: 1. 36; 95% CI, 1. 17-1. 59). Also, the subjects with high Socio-economic status (SES) had higher odds of SPH (odds ratio [OR], 1. 23; 95% CI, 1. 06-1. 41). Conclusion: Our results showed that SPH can be influenced by both demographic and life style related characteristics among study population. This association was stronger for SPH and academic success, talking with both parents and having normal body image respectively.

Background Urinary reflux is a probable reason of nephrolithiasis among children. This study aimed to assess the relationship between urinary reflux and other reason of stone formation in children. Materials and Methods This cross-sectional study was carried out with 199 children diagnosed with nephrolithiasis using ultrasonography in Hazrate Masumeh Pediatrics Hospital, Qom-Iran. The patients who met the exclusion criteria including: the size of stone less than 2mm, congenital diseases of kidney and cyst or tumor, other disorders with similar ultrasound evidence of kidney stone, the use of ceftriaxone during the last 3 months, and incomplete medical record, were excluded. Variables including baseline characteristics of the samples, the presence of hematuria, pyuria, UTI, size of stone, and the findings of ultrasonography and the Voiding Cystourthrography (VCUG), were collected retrospectively. Data analyzed by SPSS version 19. 0 software. Results A total of 199 children with the mean age was 27. 7 ± 27. 9 months were included in the study. Overall, 83. 9% of the children had normal conditions regarding urinary reflux, with the total urinary reflux rate of 16. 1%. The most prevalent observed clinical manifestation was irritability (45. 2%) followed by fever (45. 2%), and dysuria (19. 6%), respectively. Results showed that UTI increased the risk of urinary reflux in 32. 4% of the children (P=0. 005). The prevalence of UTI in female children was more than male ones (27. 4% vs. 8. 6%, P =0. 001). Conclusion In the present study we concluded that UTI and also pyuria can significantly have decreased the prevalence of VUR. However, based upon our results, there was no significant correlation between urinary stone and VUR.

Background The developmental delays of children, is one of the most important sources of information to detect the developmental delays of children. The aim of this study was to investigate the developmental delays and its relationship with anthropometric indices in Urmia city, Iran. Materials and Methods This is a descriptive analytical study that conducted on 422 children who had 6-12 months old and were selected randomly with cluster sampling from 10 Health Center. Anthropometric indices (weight, height and head circumstance) were collected from recorded files, and development of children was measured using developmental test of Ages and Stages Questionnaires (ASQ). The data were analyzed using SPSS version 18. 0 software. Results The results showed that the prevalence of the developmental delays of children was 18. 8% and the highest and the lowest prevalence was related to the area of communication (7. 1 %), and the area of gross motor (0. 9 %), respectively. The developmental delays of children in boys, was more than girls (P< 0. 05). The mean weight, height and head circumference of children at birth time were 3222. 6± 469 grams, 49. 07± 6. 68 cm and 34. 01± 5. 3 cm, respectively. There was no significant relationship between height and head circumference at birth time and the developmental delays of children (P> 0. 05). Conclusion Considering the significant number of the developmental delays of children and its relationship with birth weight in this study, it is recommended to consider appropriate interventions at pregnancy period for the prevention of low birth weight and the constant programs about the developmental delays.

Pulmonary arteriovenous malformations (PAVM) are abnormal communications between pulmonary arteries and pulmonary veins, and most commonly congenital in nature. Although rare, it is an important consideration in cyanotic patients of unknown cause. We report 3 cases with diffuse PAVM in children with different clinical manifestations and initial diagnosis was made by transthoracic contrast echocardiogram. Transthoracic contrast echocardiography (TTCE) is valuable as initial diagnostic tools for diffuse PAVM. Pulmonary angiography should be reserved for therapeutic purposes for PAVM rather than diagnostic.

Background Menstruation cycle is a normal physiological process that is managed differently according to various social and cultural understandings. The aim of this study was to determine the relationship between attitude and knowledge of female students about menstruation cycle in Urmia city, Iran. Methods and materials In this descriptive cross-sectional study that conducted on 350 female students from second grade of high school girls in the Urmia city who were selected using multistage sampling of urban areas. The data collection instrument was a questionaire including personal and demographic information, knowledge and attitude questions about menstruation cycle that was completed by researcher. The data were analyzed using SPSS version 17. 0 software. Results The mean age of students and mean age of the first menstruation were 15. 96 ± 0. 86 and 12. 29± 1. 04 years old, respectively. The results showed that there was a significant relationship between knowledge and attitude, negative feelings, living with menstruation, openness about menstruation and menstrual symptoms (P<0. 05); this means that by increasing the knowledge, attitudes have increased in the mentioned fields; but there was no statistically significant relationship between knowledge, and positive feelings, acceptance of menarche and acceptance of the menstruation (P>0. 05). Conclusion The menstrual attitude of girl students can be improved by increasing the menstrual knowledge of them with the help of mothers and teachers.

Background Given that school-age students, as active road users, are more vulnerable to injury compared with other pedestrians, a large number of them, following an injury, may either fail to go to school at least for a short time or even suffer from disabilities for the rest of their lives. The aim of this study was to determine safe behavior in road crossing using the theory of planned behavior among middle school students. Materials and Methods The current study was cross-sectional, descriptive-analytical in design. The population included middle school students in Qom, Iran. A multistage sampling procedure was utilized with 364 students participated in the study. A questionnaire about theory of planned behavior underlying safe behavior in road crossing was employed. The collected data were analyzed using SPSS version 20. 0 by independent-samples t-test, Chi-square, and Pearson correlation coefficient. Results In the current study, the mean score of safe behavior in road crossing for female students was significantly higher than in male students (P < 0. 001). In addition, there were significant positive relationships between safe behavior in road crossing and attitude (r = 0. 36, p < 0. 001), perceived behavioral control (r = 0. 24, p < 0. 001), and intention (r = 0. 20, p < 0. 001). In contrast, there was no statistically significant relationship between safe behavior and subjective norms (r =-0. 26, p = 0. 61). Conclusion As regards, safe behavior in road crossing is low among students, and their attitude and ability affected on behavior; therefore, using the theory of planned behavior can be increased safe behavior in road crossing.