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Aims: The purpose of this study was to investigate the effects of Virtual reality training on dynamic balance of children with spastic hemiplegic cerebral palsy (SHCP). Methods: 20 girls with SHCP (mean age = 9.4; SD =1.48) were selected from special schools and divided into the experimental and control groups. Commercially available Kinect dance game (Microsoft Inc., Redmond, WA, U.S.A.) 'Just Dance 3' and Modified star excursion balance test (SEBT) were used for video game based training and dynamic balance tests, respectively. MANCOVA and ANCOVA Tests were performed at p < 0.05 to analyze the data. Results: Based on MANCOVA test results, there was a significant difference between groups at least in one of the dynamic balance variables (anterior, posterolateral, and posteromedial) after controlling for pretest (F (3, 13) = 41.81, p < 0.005). Results of ANCOVA test showed a significant difference between the dynamic balance variables in the anterior (F = 52.80, p = 0.001), posterolateral (F = 117.86, p = 0.001), and posteromedial (F = 23.84, p = 0.001) directions in children with cerebral palsy. Conclusions: This paper proposes that video game based training can successfully guide children with cerebral palsy to improve their balance ability. This virtual system is therefore an interesting tool in the therapies related to the children with cerebral palsy.

This study investigated the use of language learning strategies (LLS) and reasons for learning English among Iranian EFL students who began learning English at different ages. The participants (N = 33, both male and female) were divided into two groups of younger beginners (who began learning English before age 9; N = 16) and older beginners (who began learning English at or after age 12; N = 17). They were invited to complete Oxford's (1990) Strategy Inventory for Language Learning (SILL) questionnaire and to take part in a structured interview. While the students' choices of LLS were identified both through the questionnaire and interviews, their reasons for strategy use and their goals in learning English were determined using the interviews alone. Data analysis indicated that there were differences in LLS categories employed by the groups. Further findings and implications are discussed in the paper.

Oral and dental hygiene plays an important role in the health and well-being of our bodies. Failure to take basic oral and dental hygiene measures not only damages the health of teeth and gums, but can also significantly increase the risk of heart disease, cancer, and diabetes. Entamoeba gingivalis and Trichomonas tenax are reported to be anaerobic parasites found in the human mouth. These parasites are transmitted through saliva, contaminated food containers, drinking water, and/or other utensils. Since the observance of personal hygiene and discipline in taking care of oral and dental health is less in children and this affects their performance in school and their future success, we aimed to evaluate a parasitological and molecular survey of E. gingivalis and T. tenax among children (2 to 15 years) in Lorestan Province, in western Iran. This descriptive cross-sectional survey was conducted from October 2021 to October 2022 on 660 children (aged 2-15 years) referred to health centers of Lorestan Province, Iran. The total prevalence of the parasites was 108 (16.4%) and 117 (17.7%) by microscopy and PCR, respectively. No significant association was reported among age (P=0.716), gender (P=0.289), parental education (P=0.812), tooth brushing (P=0.170), and prevalence of these parasites in children. Conversely, a significant association was reported between settling in rural areas (P=0.002), mouthwash (P=0.001), and the prevalence of these parasites in children. By multivariate test, settling in rural districts (P=0.007) and mouthwash (P<0.001) were considerably associated with the rate of these parasites. We found a significant prevalence of these parasites in children in Lorestan Province, western Iran, indicating that dentists as well as children's parents should pay special attention to oral health strategies in children. [ABSTRACT FROM AUTHOR]

Objective: We aimed to conduct a review to investigate the prevalence of anxiety disorders among Iranian children and adolescents. Method: We systematically reviewed the literature up to June 2014. We searched three Persian databases (Magiran, IranMedex and SID) and three English databases: PubMed, Scopus and PsycINFO. All original studies that investigated the current prevalence of anxiety in a sample of Iranian children and adolescents were entered into the study. All studies conducted on special samples or in special settings were excluded. By searching English databases, we obtained 124 original studies. After removing duplicate papers, 120 articles remained. In the next step, we screened the articles based on their title. In sum, 95 Persian and English articles had relevant titles. After screening based on the abstract and full text, 26 studies remained. After screening based on the full text, all selected studies were qualitatively assessed by two evaluators separately. Result: Twenty five studies were eligible and reported different types of anxiety disorders (i.e., generalized anxiety, separation anxiety, obsessive- compulsive disorder, phobias and panic disorder). The samples varied from 81 to 2996 among studies and their age range was 5 to 18 years. These studies were conducted in different cities of Iran. SCL-90 is a frequently used questionnaire. All anxiety disorders were mostly investigated with the prevalence rates ranging from 6.8% in Saravan to 85% in Bandar Abbas. OCD was the second common study with prevalence rates ranging from 1% in Tabriz to 11.9% in Gorgan . Conclusion: Our findings revealed considerable amount of anxiety disorder among Iranian children and adolescents. Given the fact that anxiety disorder has negative effects on the well-being and function of individuals and can lead to severe problems, this disorder should be considered in mental health programs designed for children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS), a cluster of cardiovascular risk factors, is one of the most common metabolic disorders, which lead to many chronic diseases. The link between childhood MetS and occurrence of atherosclerosis and its sequels in adulthood is well documented. This study aims to systematically review the prevalence of MetS among Iranian children and adolescents. Materials and Methods: An electronic search was conducted on studies published from January 1990 to January 2015. The main international electronic data sources were PubMed and the NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS. For Persian databases, we used domestic databases. We included all available population-based studies and national surveys conducted in the pediatric age group aged 3-21-year-old. Results: In this review, 2138 articles were identified (PubMed: 265; SCOPUS: 368; ISI: 465; Scientific Information Database: 189; IranMedex: 851; Irandoc: 46). After quality assessment, 13 qualified articles were evaluated. The number of total population and points of data were 24,772 and 125, respectively. Regarding the geographical distribution, we found 2 national, 6 provincial, and 5 district level points of data. The prevalence range of MetS among children was 1-22% using different definitions. Reported range of pediatric MetS defined by different criteria was as follows: National Cholesterol Education Program-Adult Treatment Panel III; 3-16%, International Diabetes Federation; 0-8%, American Heart Association; 4-9.5%, The National Health and Nutrition Examination Survey III; 1-18%, de Ferranti; 0-22%. Conclusion: MetS is a common metabolic disorder among Iranian children and adolescents, with increasing trends during the last decades. This finding provides baseline useful information for health policy makers to implement evidence based-health promotion for appropriate controlling of this growing health problem for the pediatric population. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 clinical course, effective therapeutic regimen, and poor prognosis risk factors in pediatric cases are still under investigation and no approved vaccinehas been introduced for them.Methods: This cross-sectional study evaluated different aspect of COVID-19 infection in hospitalized COVID-19 positive children (≺18 years oldwith laboratory confirmed COVID-19 infection, using the national COVID-19 registry for all admitted COVID-19 positive cases from February 19 until November 13,2020, in Iran.Results: We evaluated 6610 hospitalized children. Fifty-four percent (3268) were male and one third of them were infants younger than 1 year. Mortality rate in total hospitalized children was 5.3% and in children with underlying co-morbidities (14.4%) was significantly higher (OR: 3.6 [2.7-4.7]). Chronic kidney disease (OR: 3.42 [1.75-6.67]), Cardiovascular diseases (OR: 3.2 [2.09-5.11]), chronic pulmonary diseases (OR: 3.21 [1.59-6.47]), and diabetes mellitus (OR: 2.5 [1.38-4.55]), resulted in higher mortality rates in hospitalized COVID-19 children. Fever (41%), cough (36%), and dyspnea (27%) were the most frequent symptoms in hospitalized children and dyspnea was associated with near three times higher mortality rate among children with COVID-19 infection (OR: 2.65 [2.13-3.29]).Conclusion: Iran has relatively high COVID-19 mortality in hospitalized children. Pediatricians should consider children presenting with dyspnea, infants≺ 1 year and children with underlying co-morbidities, as high-risk groups for hospitalization, ICU admission, and death. [ABSTRACT FROM AUTHOR]

Background: About 30% of children < 5 years old are estimated to experience vitamin A deficiency worldwide. Globally, vitamin A deficiency can be reduced by five major interventions: supplementation, dietary modification, fortification, promotion of both public health, and breastfeeding. This prospective policy analysis (Prospective policy analysis focuses on the future outcomes of a proposed policy. Adapted from Patton, CV, and Sawicki DS. Basic Methods of Policy Analysis and Planning, Prentice-Hall, Inc. New Jersey,1993). (Patton A, Carl V, and David S. Basic methods of policy analysis and planning, prentice-hall, 3th ed. 2012) aimed to identify evidence-based policy options to minimize prevalence (VAD) among 15-23 months-children in Iran.Methods: Thirty-eight semi-structured face-to-face interviews were held with experts at high, middle, and low managerial levels in Iran's health system, as well as at Schools of Nutrition Sciences and dietetics, using purposive and snowball sampling. All interviews were recorded by a digital voice recorder and then transcribed, codified, and eventually analyzed using a mixed approach (inductive-deductive) by MAXQDA software version 10.Results: Most policies related to VAD reduction in this age group are supplementation, expansion of education, and awareness. Three main factors affecting VAD reduction policies emerged from the analysis: basic factors (governance, infrastructure, and organization), underlying factors (social factors, economy), and immediate factors (services). Due to its cross-sectoral nature, evaluating the results of the implementation of this policy requires strong and coherent inter-sectoral cooperation. The existing primary healthcare network (PHC) is a crucial means for successful implementation of policies to address VAD in Iran.Conclusions: In addition to supplementation and assistance in this age group, other policies should be also planned to reduce VAD in various regions. In addition to the Ministry of Health & Medical Education (MoHME), other actors need to be involved, we advocate, throughout the entire policymaking process of policy-making to reduce VAD in Iran. [ABSTRACT FROM AUTHOR]

Background: Despite the worldwide spread of the coronavirus disease 2019 (COVID-19), the epidemiological and clinical patterns of the COVID-19 infection remain largely unclear, particularly among children. In this study, we explored the epidemiological characteristics, clinical patterns, and laboratory and imaging findings of pediatric patients with COVID-19. Materials and Methods: From March 7 to March 30, 2020, there were a total of 35 patients who had confirmed COVID-19 infection by laboratory virus nucleic acid test (RT-PCR) assay with throat swab samples or typical chest CT manifestation compatible with COVID-19, in addition to a history of close contact with suspected or confirmed SARS‐CoV‐2 in family members. Information recorded included demographic data, medical history, exposure history, underlying comorbidities, symptoms, signs, laboratory findings and radiologic assessments, severity of disease, treatment, and mortality. Results: The median age of the patients was 7.5 years (IQR=4– 11; range=4 months to 15 years). A total of 63% were male. Cough was present in 80% of the patients, followed by fever (77%), nausea or vomiting (29%), diarrhea (26%), shortness of breath (29%), headache (20%), and myalgia (14%). Lymphopenia was present in 43% of the patients, thrombocytopenia in 9%, neutopenia in 8%, and leucopenia in 26%. We reported severe pneumonia in 40% of the hospitalized patients and 18 (51%) had underlying diseases. Of 35 patients, 11 had positive RT-PCR results (31%). The chest CT images of 24 patients (69%) suggested COVID-19, while their RT-PCR assays from throat swab samples were negative. Conclusion: This study demonstrates different clinical findings of pediatrics compared to the previous reports of children. Since a high rate of false negative RT-PCR test was observed, early detection of children with COVID-19 infection by CT is conducive to reasonable management and early treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND Hepatic dysfunction has been associated with poor prognosis in critically ill patients. We aimed to investigate the incidence of early liver dysfunction and its association with probable predictive variables in a group of Iranian patients. METHODS The study was conducted on 149 pediatric patients referred to the pediatric intensive care unit (PICU), Shiraz University of Medical Sciences, Shiraz, Iran between April and October 2016. Serum levels of liver aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin, and international normalized ratio (INR) were recorded in 24, 48, and 96 hours after admission. RESULTS On the first day of admission, direct bilirubin was the least (9.1%) and abnormal alkaline phosphatase level was the most (66.9%) common abnormalities. Abnormal levels of all tests except alkaline phosphatase were predictive of increased rate of mortality. In univariable logistic regression, abnormal aminotransferases (ALT and AST), INR, total bilirubin, and direct bilirubin had significant relationship with patients' mortality after 24, 48, and 96 hours. In multivariable logistic regression only ALT and INR in the first 24 hours had significant relationship with mortality in final model. Although univariate logistic regression revealed a significant relationship between AST and ALT levels with PICU length of stay, no significant relationship was observed between these variables and PICU length of stay (except AST in the first 24 hours) in multivariable analysis. CONCLUSION Increase in liver enzymes may predict mortality and increased PICU length of stay in critically ill children. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the epidemiology and antimicrobial resistance profile of Gram-negative bacteria (GNB) and Gram-positive bacteria (GPB) isolated from clinical specimens in children admitted to Mofid Children's Hospital. Methods: This was a retrospective study of the patients' clinical specimens collected from January 2013 until the end of December 2018. All specimens were evaluated to determine the presence of infection-causing agents using a BACTEC 9120 blood culture. Isolation and identification of bacterial strains were performed using conventional biochemical tests. Antibiotic resistance was determined using Kirby–Bauer disk diffusion and broth microdilution methods. Results were interpreted according to CLSI and EUCAST. Results: A total of 1130 different pathogenic bacteria were detected from 14,690 different clinical specimens and the overall detection rate was 7.7% (1130/14,690). Among bacterial pathogen isolated from clinical specimens, 55% (n=622) were GNB and 45% (n=508) were GPB. The predominant GNB isolates were Pseudomonas aeruginosa, Klebsiella spp., Acinetobacter baumannii, Escherichia coli, Enterobacter spp., Citrobacter spp., respectively. Among GPB, CoNS was the most frequent and Enterococcus spp. was found to have low levels of resistance to linezolid. In GNB, most A. baumannii and P. aeruginosa were ceftriaxone resistant. P. aeruginosa was found to have low levels of resistance to levofloxacin and ciprofloxacin. Conclusions: Our findings revealed that the resistance rate among GNB and GPB associated with different infections in children is very high. These results suggest a constant screening and follow-up programs for the detection of antibiotic resistance, and it also suggests to develop antimicrobial stewardship programs in Tehran, Iran. [ABSTRACT FROM AUTHOR]

Childbearing intentions are primary predictor of childbearing behaviors, particularly in low fertility societies. This study examined the role of relative status of women in childbearing intentions in Iran where fertility has been declining since 1986 and it has been around the replacement level during the last two decades. Data from the 2010 Iran’s Multiple Indicator Demographic and Health Survey (IrMIDHS) were used to estimate the effect of relative status of women on intention to have more children among women with one child and those with two children. The results showed modest effect of relative status of women on future childbearing intentions at both parity one and two controlling for socioeconomic and demographic factors. One implication from this finding is that within low fertility regimes where fertility level is around or below replacement level, the relative status of women is no more as important determinant of childbearing intention as in situations of high fertility regimes. This interpretation is consistent with the fact that most of the studies showing strong effect from relative status of women on childbearing are based on data from the situations where fertility level has been at the pre-transitional level. [ABSTRACT FROM AUTHOR]

Objective: Low iodine intakes are associated with goitre and other iodine-deficiency disorders (IDD) that have affected billions of people worldwide. We aimed to assess total goitre rate (TGR) and urinary iodine concentration (UIC) in schoolchildren between 2007 and 2015, percentage of iodized salt consumption by households, and salt iodine content at production, distribution and household levels in north-west Iran. Design/Setting/Subjects UIC assessed among schoolchildren in nine consecutive years; 240 schoolchildren aged 8-10 years selected by systematic random sampling each year in the West Azerbaijan Province.Results: Median UIC was >100 μg/l in all years. More than 50 % of children had iodine deficiency (UIC≤99 μg/l) in 2010 and 2011, while this rate was approximately 15-35 % in other years. Proportion with UIC below 50 μg/l was <20 % in all years except 2010 and 2011. Excessive UIC (≥300 μg/l) rate was between 5·4 and 27·5 %. TGR decreased from 44 % in 1996 to 7·6 % and 0·4 % in 2001 and 2007, respectively. Regular surveys from 2002 to 2015 showed that 98 % or more of households consumed iodized salt. Iodine level ≥20 ppm was observed in 87·5, 83 and 73 % of salt at production, distribution and household level, respectively (data from national study in 2007). The last national study in 2014 showed that median iodine level in household salt was 27 ppm.Conclusions: Our focused data suggest that the universal salt iodization programme is improving the iodine status of schoolchildren in the West Azerbaijan Province of Iran. Reduction of TGR to less than 5 % in schoolchildren indicates successful elimination of IDD as a major public health problem. [ABSTRACT FROM AUTHOR]

Background: Varicella zoster virus is the etiologic agent of primary varicella (chickenpox) during childhood, and varicella vaccination has not been introduced in Iran. The aim of this study is to estimate cost-effectiveness of one- and two-dose Varicella Vaccination Program in Iran. Methods: A decision-tree model was conducted to evaluate the cost-effectiveness of the Varicella Vaccination Program in a cohort of 12 months children in Iran. Epidemiologic parameters of varicella were extracted from local and international sources, and cost of disease was estimated based on societal prospective in 2015 US$. Incremental cost per disability-adjusted life years (DALY) averted calculated as final outcome. Sensitivity analysis was also performed for lower and upper estimate of incidence, DALY, and vaccine efficacy. Results: Considering the vaccine efficacy of 95%, for the two-dose and 85% for the one-dose vaccination, incremental cost-effectiveness ratio (ICER) per DALYs averted were US$41,531 and US$17,280, respectively. ICER has changed between (US$ 6,177-US$167,047) in lower and upper base estimate of epidemiological burden parameters in sensitivity analysis. Conclusions: Varicella vaccination is not cost-effective in Iran in one-dose and two-dose scenario under the assumptions of this study in base case scenario according to the threshold of incremental cost per DALY averted less than three time of GDP per capita in Iran = US$ 14,292. One-dose vaccination program might be cost-effective in upper scenario of epidemiological burden of varicella in sensitivity analysis. [ABSTRACT FROM AUTHOR]

Background: The most important factors that affect the incidence of vaccine-related complications are the constituent biological components of the vaccine, injection site reactions, age and sex. The aim of this study is to determine the incidence rate of adverse events following immunization with pentavalent vaccine (DTPw-Hep B-Hib (PRP-T) vaccine (pentavac) (adsorbed) is manufactured by Serum Institute of India ltd), which was introduced in Iran in November 2014. It is important to monitor vaccine-related adverse events because of the role of vaccine safety in immunization program success. Methods: This study was a mixed cohort study that included 1119 children less than 1 year of age. In 2015, the children were referred to Hamadan health centers to receive pentavalent vaccine at 2, 4 and 6 months of age. The data were collected from the parents of the children using a questionnaire that was administered either face-to-face or by telephone. The cumulative incidence of side effects and risk ratio was reported with 95% confidence intervals (CI). Chi-squared tests and logistic regressions were used to investigate the association between the variables. Results: The cumulative incidence rate of pentavalent-related adverse events during 48 h following immunization was estimated to be 15.8% for swelling, 10.9% for redness, 44.2% for pain, 12.6% for mild fever, 0.1% for high fever, 20.0% for drowsiness, 15.0% for loss of appetite, 32.9% for irritability, 4.6% for vomiting and 5.5% for persistent crying. There is no evidence for the occurrence of convulsion and encephalopathy among children who receive pentavalent vaccines. Conclusion: Further large studies with long time follow up are required to address rare events include convulsions, encephalopathy or persistent crying. However, Findings urge immunization programs to use pentavalent vaccinations and to continue implementing the current immunization program in children under 1 year of age. [ABSTRACT FROM AUTHOR]

Background: Obesity is a major risk factor for chronic diseases and has a role on high blood pressure, diabetes type II, etc., This review assesses the prevalence of Iranian children obesity and overweight for different age categories and compares the three standard definitions of obesity. Materials and Methods: To retrieve desirable studies concerning childhood anthropometric data from different area of Iran, the MEDLINE, Scopus, and different local databases such as Scientific Information database were used. The studies reported the prevalence of obesity or overweight of children < 6, 6-12, and 12-20 years old, despite differences between definitions of childhood obesity, were included in the study. We combined the reported prevalence of the overweight and obesity with regard to age and gender, and also by the different standard references which are the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) definition, and the International Obesity Task Force (IOTF) references. The analysis was carried out using STATA software. Results: Our review covered 75 articles reported the prevalence of overweight or obesity among children and adolescents for different age groups in Iran. Our meta-regression analysis showed that the prevalence of obesity and overweight did not vary significantly in gender and age categories, but different definitions provide different prevalence of overweight and obesity. Conclusion: The effective factors on obesity and overweight included administration policy and organizational, interpersonal, intrapersonal, and social factors. CDC and WHO references intended in monitoring children's growth and the IOTF cutoffs would rather provide a common set of definitions that researchers and policymakers could use for descriptive and comparative purposes. [ABSTRACT FROM AUTHOR]

Background: Rotavirus diarrhea is one of the most important causes of death among under-five children. Anti-rotavirus vaccination of these children may have a reducing effect on the disease. Objectives: this study is intended to contribute to health policy-makers of the country about the optimal decision and policy development in this area, by performing cost-effectiveness and cost-utility analysis on anti-rotavirus vaccination for under-5 children. Patients and Methods: A cost-effectiveness analysis was performed using a decision tree model to analyze rotavirus vaccination, which was compared with no vaccination with Iran’s ministry of health perspective in a 5-year time horizon. Epidemiological data were collected from published and unpublished sources. Four different assumptions were considered to the extent of the disease episode. To analyze costs, the costs of implementing the vaccination program were calculated with 98% coverage and the cost of USD 7 per dose. Medical and social costs of the disease were evaluated by sampling patients with rotavirus diarrhea, and sensitivity analysis was also performed for different episode rates and vaccine price per dose. Results: For the most optimistic assumption for the episode of illness (10.2 per year), the cost per DALY averted is 12,760 and 7,404 for RotaTeq and Rotarix vaccines, respectively, while assuming the episode of illness is 300%, they will be equal to 2,395 and 354, respectively, which will be highly cost-effective. Number of life-years gained is equal to 3,533 years. Conclusions: Assuming that the illness episodes are 100% and 300% for Rotarix and 300% for Rota Teq, the ratio of cost per DALY averted is highly cost-effective, based on the threshold of the world health organization (< 1 GDP per capita = 4526 USD). The implementation of a national rotavirus vaccination program is suggested. [ABSTRACT FROM AUTHOR]

Background: To investigate the prevalence of antibiotic usage in children aged <5 years with acute respiratory tract illness (ARTI) in Iran. Materials and Methods: Data were collected from a national health survey conducted in 2010 (Iran's Multiple Indicator Demographic and Health Survey). Participants of this cross-sectional study were selected by multistage stratified cluster-random sampling from 31 provinces of Iran. Parents of children with <5 years of age responded to questions about the occurrence of any cough during the previous 2 weeks, referral to private/governmental/other health care systems, and utilization of any oral/injection form of antibiotics. Data were analyzed using SPSS software18. The chi-square test was used to determine antibiotic consumption in various gender and residency groups and also a place of residence with the referral health care system. Results: Of the 9345 children under 5 years who participated in the study, 1506 cases (16.2%) had ARTI during 2 weeks prior to the interview, in whom 1143 (75.9%) were referred to urban or rural health care centers (43.4 vs. 30.4%; P < 0.001). Antibiotics were utilized by 715 (62.6%) of affected children. Injection formulations were used for 150 (13.1%) patients. The frequency of receiving antibiotics was higher in urban than in rural inhabitants (66.0% vs. 57.7%; P < 0.05). Conclusion: The prevalence of total and injection antibiotics usage in children <5 years with ARTI is alarmingly high in Iran. Therefore, interventions to reduce antibiotic use are urgently needed. [ABSTRACT FROM AUTHOR]

Objective: Juvenile systemic lupus erythematosus (JSLE) is a common rheumatologic disorder that involves multi organ systems. Prognosis of lupus in children may be poorer than in adults. In this study, we determine d mortality and morbidity rates in the pediatric SLE in Iran. Methods: In a cross sectional study, we evaluated 120 children with SLE who had registered in our pediatric rheumatology database within 2004-2010. Data including sex, age, remission, age at the time of diagnosis, age at the time of study, various types of organ involvement, mortality and remission were extracted from this database. Findings: From 120 cases, 77% (92 cases) were female s and 23% (28 cases) male s (F:M=3.3). Mean follow up period was 56±32 months and mean age at the time of manifesting disease 10.34±2.9 years. Mortality rate was 10% (12 cases) in our investigation. Musculoskeletal involvement showed significant difference between various age groups (P <0.01), that was more frequent in group of 7 years and older. Frequency of oral ulcer and ophthalmic involvement in boys was significantly higher than in girls (P <0.05). Frequency of cardiovascular involvement (P <0.01) and renal involvement (P <0.01) was significantly higher in the patients who had no remission. There was a significant association between mortality rate and cardiac (P <0.02, OR=4.9), pulmonary (P <0.01, OR=10.167) and liver (P <0.05, OR=1.19) involvement. Conclusion: In our investigation 1-year survival rate was 97% and 5-year survival rate 89%. Liver, cardiac and pulmonary involvements have an association with higher mortality in JSLE patients. [ABSTRACT FROM AUTHOR]

Objective: In developing countries, Helicobacter pylori infection is mainly acquired during childhood and may be a predisposing factor for peptic ulcer or gastric cancer later in life. Noninvasive diagnostic tools are particularly useful in children for screening tests and epidemiological studies. We aimed to determine the prevalence of H. pylori infection among Kurdish children in Sanandaj, West Iran. Methods: We used a Helicobacter Pylori Stool Antigen (HpSA) test to detect H. pylori infection. A questionnaire was used to collect data about age, sex, duration of breastfeeding, and family size. A total of 458 children aged 4 months to 15 years were enrolled in this study. Findings: The mean age of enrolled children was 5.6±5.4 years. Stool samples were positive for H. pylori in 294 (64.2%) children. The prevalence of H. pylori infection increased with age (P<0.001). We found a significant increase in the infection rate as the family size grew (P=0.005). There was no correlation between a positive H. pylori status and gender (P=0.6) or the duration of breastfeeding (P=0.8). Conclusion: It seems that the prevalence of H. pylori infection is very high in children in Sanandaj. It begins at early infancy (before 4th month of age) and cumulatively increases with age. [ABSTRACT FROM AUTHOR]

Objective: To assess the national prevalence of clinical disorders in 6-year-old Iranian children before school entry using a national health assessment survey. Materials and Methods: In a cross-sectional nationwide survey, all Iranian children entering public and private elementary schools were asked to participate in a mandatory national screening program in Iran in 2009 in two levels of screening and diagnostic levels. Results: The study population consisted of 955388 children (48.5% girls and 76.1% urban). Of the whole children, 3.1% of the 6-year-old children had impaired vision. In addition, 1.2, 1.8, 1.4, 10, 10.9, 56.7, 0.7, 0.8 and 0.6% had color blindness, hearing impaired, speech disorder, height to age retardation, body mass index extremes, decayed teeth, having disease with special needs, spinal disorders, and hypertension, respectively. The distribution of these disorders was unequally distributed across provinces. Conclusions: Our results confirmed that the prevalence of clinical disorders among 6-year-old children across Iranian provinces was not similar. The observed burden of these distributions among young children needs a comprehensive national policy with evidence-based province programs to identify the reason for different distribution among provinces. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the reliability, validity and feasibility of the Persian version of the Pediatric Quality of Life inventory (PedsQL™ 4.0TM 4.0) Generic Core Scales in Iranian healthy students ages 7-15 and chronically ill children ages 2-18. Methods: We followed the translation methodology proposed by developer to validate Persian version of PedsQL™ 4.0TM 4.0 Generic Core Scales for children. Six hundred and sixty children and adolescents and their parents were enrolled. Sample of 160 healthy students were chosen by random cluster method between 4 regions of Isfahan education offices and 60 chronically ill children were recruited from St. Alzahra hospital private clinics. The questionnaires were fulfilled by the participants. Results: The Persian version of PedsQL™ 4.0TM 4.0 Generic Core Scales discriminated between healthy and chronically ill children (healthy students mean score was 12.3 better than chronically ill children, P<0.001). Cronbachs' alpha internal consistency values exceeded 0.7 for children self reports and proxy reports of children 5-7 years old and 13-18 years old. Reliability of proxy reports for 2-4 years old was much lower than 0.7. Although, proxy reports for chronically ill children 8-12 years old was more than 0.7, these reports for healthy children with same age group was slightly lower than 0.7. Constructive, criterion face and content validity were acceptable. In addition, the Persian version of PedsQL™ 4.0TM 4.0 Generic Core Scales was feasible and easy to complete. Conclusion: Results showed that Persian version of PedsQL™ 4.0TM 4.0 Generic Core Scales is valid and acceptable for pediatric health researches. It is necessary to alternate scoring for 2-4 years old questionnaire and to find a way to increase reliability for healthy children aged 8-12 years especially, according to Iranian culture. [ABSTRACT FROM AUTHOR]

Objective: To determine persisting antibody levels to hepatitis B virus (HBV) antigen in healthy children, aged 6–9 years, vaccinated at birth. Methods: Blood samples were collected from 374 vaccinated children (178 girls and 196 boys) and 57 unvaccinated children, attending Shiraz Primary School, Shiraz, Iran from September 2002 to April 2003. An HBV surface antibody (anti-HBs) was determined using enzyme-linked immunosorbent assay. Results: The anti-HBs titer was detected in 17% of the 8-year-old children, 7.7% of the 7-year-old children and 46.6% of the 6-year-old children. The decrease was greatest in the 9-year-old children; more than half (54.3%) had a titer of less than 10 IU/ml, indicating a decrease in antibody levels with increasing age/time. Conversely, more than 35% of the 6-year-old children had a titer greater than 150 IU/ml compared with 24, 12 and 7% of children at the age of 7, 8 and 9, respectively, whose antibody titer was less than 150 IU/ml. Conclusion: Antibody titer declined with time. In comparison with other countries, the antibody titer in Iranian children was much lower. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We reviewed records of 35 pediatric liver transplant recipients who were operated at the Shiraz Organ Transplant Center between April 1998 and April 2005 to gather demographic data, primary diagnosis, duration of hospital stay, source of graft, mortality, and surgical (vascular, biliary, fluid collection) and medical (infection, respiratory, neurological, cardiovascular, and gastrointestinal) complications. Among 23 male and 12 female pediatric liver transplant recipients (mean age: 11.8±4.9 years) with a mean hospital stay duration of 23.3±20.3 days, the postoperative complications included biliary leakage (7.20%), biliary stricture (3.10%), biliary obstruction (3.10%), pleural effusion (9.26%), lung collapse (n=1) pulmonary hemorrhage (n=1), and vascular complications of portal and hepatic vasculature (n=10, 28.6%); and infections of the peritoneum, lung, wound site, and urinary tract (n=10; 28.6%). Acute cellular rejection was documented in 6 (17.1%) recipients. Overall, 13 (37.1%) children died. [ABSTRACT FROM AUTHOR]

Background: Lead is a toxic metal that affects almost every organ in the body. Children are more susceptible to lead toxicity because they ingest non-food items (pica), have oral exploratory habits, absorb more substantial amounts of ingested lead compared to adults, and have a developing central nervous system. This study describes venous blood lead concentrations (BLC) in young children living in Birjand, Iran.Methods: A cross-sectional study was performed in 2016 on children 1-7 years of age who were referred to healthcare centers in Birjand City. Demographic information was obtained, and their BLC was tested using atomic absorption spectrometry (AAS).Results: Four hundred children were tested. Their mean age was 52.37 ± 23.77 months; their mean BLC was 2.49 ± 2.64 μg/dL (median 1.85 μg/dL). Thirty-two (8%) children had a BLC > 5 μg/dL. A logistic regression model revealed that per one unit of increase in age, the chance of an elevated BLC decreased by 3% (OR (95%CI): 0.97 (0.96-0.99), p < 0.01). The risks of an elevated BLC was 61% lower in girls compared to boys (OR (95%CI): 0.39 (0.17-0.92), p = 0.03). Further, per one rate of increase in the BMI, the chance of an elevated BLC was higher (OR (95%CI): 1.13 (1.02-1.24), p = 0.01). Children whose fathers were laborers had higher BLC than those with employee fathers (p = 0.01).Conclusion: Of 400 children aged 1-7 years old living in Birjand, Iran, 8% had elevated BLC. BLC correlated with the child 's age, gender, body mass index, and father's occupation. [ABSTRACT FROM AUTHOR]