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Background: Hypertension is considered the most important risk factor for cardiovascular diseases, but its control is poor worldwide. We aimed to assess the availability and affordability of blood pressure-lowering medicines, and the association with use of these medicines and blood pressure control in countries at varying levels of economic development. Methods: We analysed the availability, costs, and affordability of blood pressure-lowering medicines with data recorded from 626 communities in 20 countries participating in the Prospective Urban Rural Epidemiological (PURE) study. Medicines were considered available if they were present in the local pharmacy when surveyed, and affordable if their combined cost was less than 20% of the households' capacity to pay. We related information about availability and affordability to use of these medicines and blood pressure control with multilevel mixed-effects logistic regression models, and compared results for high-income, upper-middle-income, lower-middle-income, and low-income countries. Data for India are presented separately because it has a large generic pharmaceutical industry and a higher availability of medicines than other countries at the same economic level. Findings: The availability of two or more classes of blood pressure-lowering drugs was lower in low-income and middle-income countries (except for India) than in high-income countries. The proportion of communities with four drug classes available was 94% in high-income countries (108 of 115 communities), 76% in India (68 of 90), 71% in upper-middle-income countries (90 of 126), 47% in lower-middle-income countries (107 of 227), and 13% in low-income countries (nine of 68). The proportion of households unable to afford two blood pressure-lowering medicines was 31% in low-income countries (1069 of 3479 households), 9% in middle-income countries (5602 of 65 471), and less than 1% in high-income countries (44 of 10 880). Participants with known hypertension in communities that had all four drug classes available were more likely to use at least one blood pressure-lowering medicine (adjusted odds ratio [OR] 2·23, 95% CI 1·59–3·12); p

BACKGROUND AND OBJECTIVE: Although several investigators have evaluated the effects of the dietary glycemic index on obesity and hypertension among adults, few and controversial evidence reported for adolescents. Furthermore, no studies examined the effect of low glycemic index diet (LGI) on obesity and hypertension in comparison to healthy nutritional recommendation (HNR) based diet. This study was run to compare the effects of low glycemic index (LGI) diet on blood pressure and anthropometric measurements to HNR based diet in adolescent girls.METHODS: Fifty mature adolescent girls aged less than 18 participated in this parallel randomized clinical trial. Those whose body mass index (BMI) was between 85th and 95th percentile of BMI for age table provided by WHO were determined as overweight and those whose BMI was higher than 95th percentile were determined as obese. Randomized allocation assigned subjects to LGI diet or healthy nutritional recommendation (HNR) based diet. Macronutrient distribution was similar between two groups. A menu of allowable foods and a list of HNRs were delivered to LGI and HNR group respectively. Nutritional status during the study was evaluated by four dietary records. Measuring of blood pressure and anthropometric variables were conducted at baseline and after intervention. (IRCT: 201109272839N4)FINDINGS: Finally, the information of 41 subjects was analyzed. Those in LGI group had GI lower than 50 (42.67±.067). Significant reductions were observed in weigh (71.40±2.23 vs. 68.97±2.03 in LGI group and 77.95±3.48 vs. 75.81±3.39 in HNR group p=0.0001 for both) and BMI (27.97±0.55 vs. 26.71±0.48 in LGI group and 28.82±1.01 vs. 27.75±0.97 in HNR group p=0.0001 for both) in both groups. Changes in blood pressure (diastolic blood pressure: -0.25±4.46 in LGI group vs. -0.21±2.72 in HNR group p=0.995 and systolic blood pressure: -1.19±2.52 in LGI group vs. -2.36±2.43 in HNR group p=0.743) and anthropometric variables (weight: -3.24±0.78 in LGI group vs. -2.70±0.60 in HNR group p=0.582, waist circumference: -4.99±1.18 in LGI group vs. -1.07±2.08 in HNR group p=0.221, BMI: -4.35±0.92 in LGI group vs. -3.65±0.58 in HNR group p=0.514) were not different between two groups.CONCLUSION: The result of this study showed that low glycemic index diet has no effects on obesity and hypertension.

Background and Objectives: LMS is a general monitoring method for fitting smooth reference centile curves in medical sciences. They provide the distribution of a measurement as it changes according to some covariates like age or time. This method describes the distribution of changes by three parameters; Mean, Coefficient of variation and Cox-Box power (skewness). Applying maximum penalized likelihood and spline function, the three curves are estimated and fitted and optimum smoothness is expressed by three curves. This study was conducted to provide the percentiles of lipid profile of Iranian children and adolescents by LMS. Methods: Smoothed reference centile curves of four groups of lipids (triglycerides, total-LDL- and HDL-cholesterol) were developed from the data of 4824 Iranian school students, aged 6-18 years, living in six cities (Tabriz, Rasht, Gorgan, Mashad, Yazd and Tehran-Firouzkouh) in Iran. Demographic and laboratory data were taken from the national study of the surveillance and prevention of non-communicable diseases from childhood (CASPIAN Study). After data management, data of 4824 students were included in the statistical analysis, which was conducted by the modified LMS method proposed by Cole. The curves were developed with a degree of freedom of four to ten with some tools such as deviance, Q tests, and detrended Q-Q plot were used for monitoring goodness of fit models. Results: All tools confirmed the model, and the LMS method was used as an appropriate method in smoothing reference centile. This method revealed the distributing features of variables serving as an objective tool to determine their relative importance. Conclusion: This study showed that the triglycerides level is higher and HDL-C level is lower in Iranian children and adolescents than their counterparts in Western countries. Future studies with larger sample size and with higher density at the end points and equal distribution of measurements in changing limits of covariates would hopefully reach more precise findings.

Background: Screening of students´ health problems could lead to timely prevention and control of many health disorders. This study aimed to determine the nationwide prevalence of common disorders through school health screening program in Iran Methods: This cross-sectional national screening program was conducted in 2007-2008 among first- and third-grade- students in primary schools, first- grade-students of middle and high schools of all provinces in Iran.Results: Data were obtained from 3,124,021 (81.9%) students reported from the whole country classified into 33 geographical zones. Of total students studied, 12.48% had weight abnormalities, 4.77% had visual disorders, 3.95 % had head lice, 2.24% had behavioral disorders, and 0.6% had hearing disorders. Among students studied, 0.4%, 0.7%, 0.4% and0.8% had endocrine, psychological, neurological and genitourinary disorders, respectively. In addition, 2.1%, 1.9%, 1.8%, 0.8%0.5%, 0.3% and 0.3% of students had ear, nose & pharynx disorder, anemia ,skin & hair , cardiac ,abdominal, vertebral and lung problems, respectively. In elementary schools;57.6% of first-grade- students with at least one disorder were managed in outpatient settings and 6% of them were hospitalized for more investigation. Among third- grade- students of elementary schools, these values corresponded to 13.2% and 1.1%, respectively. Among first grade students of middle and high schools, this prevalence was 58.5% and 44.6% and 1.2% and 0.3% of students were hospitalized for more investigation.Conclusion: This integrated school screening program revealed a considerably high prevalence of health disorders among school students. These results might help health policy makers to design future health promoting programs.

Introduction: Children’s obesity is strong predictor of obesity in adulthood, which increases the incidence of related diseases such as metabolic syndrome. Fatty liver is an abnormality related to metabolic syndrome with higher prevalence in obese children according to some previous studies. This study investigates the presence of Sonographic Fatty Liver (SFL) in Iranian obese children in comparison with normal and overweight children. Methods: This was a cross-sectional study on 962 randomly selected children between the ages of 6 to 18 years. The subjects were divided into three groups of normal, overweight and obese based on body mass index (BMI). A questionnaire including demographic and anthropometrical characteristics was filled for each case. To detect the presence of SFL, all the subjects underwent assessment with ultrasonography by a radiologist who was not aware of their BMI. The incidence of SFL was determined on the basis of ultrasonographic diagnosis criteria. Results: The prevalence of SFL in obese children was 54.4% that was significantly higher than overweight (10.5%) and normal children (1%). There was no significant difference in prevalence of SFL between sexes. Conclusion: The high rate of detected SFL in obese children in this study suggests that Iranian obese children are at risk of metabolic syndrome. It is therefore necessary to develop some plan to control obesity and its late complications.

"nBackground: The health status of children in the Iran has improved in many areas such as lower rates of infectious diseases and declines in malnutrition. However rapid lifestyle changes might make them prone to chronic diseases in adulthood. Be­cause of the importance of collecting national information about related risk behaviors and risk factors, this national project was conducted for the first time in the Eastern Mediterranean region."nMethods: The baseline survey was conducted among 21111 school students aged 6-18 years, and their parents living in 23 provinces; biochemical tests were obtained from 4811 students."nResults: Underweight and overweight had similar prevalence (13.9% underweight, 13.4% overweight).The most prevalent type of dyslipidemia was low HDL-C and hypertriglyceridemia. In addition to providing national percentiles and reference curves for weight, height and body mass index, this study provided the first reference curves for waist circumference and blood pressure of children, as well as the first national prevalence of pediatric metabolic syndrome in Asia. Unhealthy nutri­tion and low physical activity were associated with most risk factors."nConclusion: Close monitoring of children and adolescents for risk factors and risk behaviors should be considered as a public health priority, thus a national school-based surveillance program is being established in this regard in Iran.

Abstract INTRODUCTION: Chest pain in unstable angina is associated with EKG changes in T-wave and ST-segment, which may help diagnose the disease. Based on certain references EKG changes prolonged for more than 12 hours may be suggestive of non-Q myocardial infarction. This study was conducted to assess the mean duration of EKG changes in patients with unstable angina. methods: This cross-sectional study was conducted on 34 patients in 2001. The subjects were randomly selected among patients hospitalized in the critical care unit of Isfahan Nour Hospital. New ST-segment T-wave changes and ruling out of acute myocardial infarction by enzymatic tests (Total CPK, CPK-MB, LDH) constituted criteria of inclusion in the study. Subjects with Wolf-Parkinson-White syndrome (WFW), salivary diseases, those taking anti-arrhythmic, anti-angina, or digital medications, patients with left bundle branch block, and those who had recently undergone surgery (all of which may cause T-wave and ST-segment changes) were excluded from the study. The patients were followed up for three months after discharges. results: EKG changes persisted for 28.65±7 days. Changes of ST-segment and T-wave lasted for 14.7±24 and 30.1±38 days, respectively. The minimum and maximum durations of EKG changes in patients were 1 day and 90 days, respectively. Eight patients underwent angiography; seven displayed abnormal findings. Statistical analysis did not show a significant relationship between the duration of EKG changes and severity of coronary involvement or incidence of future complications. Discussion: EKG changes in patients with unstable angina who have recently developed these changes may persist for an average duration of one month and may complicate diagnosis. Hence greater importance should be attached to clinical symptoms and further laboratory diagnostic methods should be used.Keywords . Myocardial infarction . ST-segment . T-wave . EKG changes

Background: Screening of students´ health problems could lead to timely prevention and control of many health disorders. This study aimed to determine the nationwide prevalence of common disorders through school health screening program in Iran Methods: This cross-sectional national screening program was conducted in 2007-2008 among first- and third-grade- stu­dents in primary schools, first- grade-students of middle and high schools of all provinces in Iran. Results: Data were obtained from 3,124,021 (81.9%) students reported from the whole country classified into 33 geographi­cal zones. Of total students studied, 12.48% had weight abnormalities, 4.77% had visual disorders, 3.95 % had head lice, 2.24% had behavioral disorders, and 0.6% had hearing disorders. Among students studied, 0.4%, 0.7%, 0.4% and0.8% had endo­crine, psychological, neurological and genitourinary disorders, respectively. In addition, 2.1%, 1.9%, 1.8%, 0.8%0.5%, 0.3% and 0.3% of students had ear, nose & pharynx disorder, anemia ,skin & hair , cardiac ,abdominal, vertebral and lung prob­lems, respectively. In elementary schools, 57.6% of first-grade- students with at least one disorder were managed in outpa­tient settings and 6% of them were hospitalized for more investigation. Among third- grade- students of elementary schools, these values corresponded to 13.2% and 1.1%, respectively. Among first grade students of middle and high schools, this prevalence was 58.5% and 44.6% and 1.2% and 0.3% of students were hospitalized for more investigation. Conclusion: This integrated school screening program revealed a considerably high prevalence of health disorders among school students. These results might help health policy makers to design future health promoting programs.

Background: Screening program in schools are designed to identify children who have early signs of health problems. This study provides information about the findings of national screening program in Iran. Methods: This national program is conducted by the Ministry of Health& Medical Education (MOHME) with collaboration of the Ministry of Education & Training. This program had two major parts including 1) screening of behavioral, hearing and visual disorders, pediculosis and calculating body mass index and 2) physical examination of students, conducted by pri­mary care physicians. All services are offered free of charge. The students' parents are informed about the health status of their children. Results: The screening program conducted in 2007-2008 included 3,124,021 students from 33 cities who were studying in the first- and third- grade- students in elementary schools, first- grade- students in middle and high schools. Of total students stud­ied, 12.48% had weight disorders, i.e. body mass index 95th percentile. 4.77% had visual disorders, 3.95 % had head lice, 2.24% had behavioral disorders, and 0.6% had hearing disorders. Conclusion: In addition to its benefits to the students' health status, the results of this screening program help health policy mak­ers to design interventions for prevention and or early detection and treatment of the most common disorders docu­mented among school students.

Introduction: Diabetes is one of the most common endocrine diseases spreading rapidly in the world. Diabetes complications are classified to acute and chronic. Non-enzymatic glycosylation of all body proteins, such as hemoglobin, albumin is the main cause of pathogenesis in chronic complications of diabetes. As glycosylation reaction of proteins is an oxidative reaction it seems that antioxidants, such as vitamin C, inhibit the reaction and, therefore, chronic complications of diabetes. In the present study inhibitory effects of polyphenolic extracts of Betula pendula, Saliva hydrangea and Crataegus curvisepala, as well as vitamin C, on the extent of glycosylation of albumin, insulin and hemoglobin was investigated. Methods: Polyphenolic extracts of the mentioned plants were prepared in three different concentrations; 3.6, 1.8, and 0.9 mg/ml also vitamin C solutions were prepared in 5 concentrations: 0.5, 5, 10, 50 and 500 µg/ml. Results: The highest extent of glycosylation inhibition of albumin and insulin was due to S.hydrangea by 100% and 97% respectively, and that of hemoglobin was due to a.pendula, by 80%. Vitamin C in its highest concentration inhibit glycosylation of insulin, albumin and hemoglobin by 100%, 93%, and 58% respectively (P < 0.05). Discussion: Based on the findings, it seems that these plants prevent chronic complications of diabetes.

Introduction: In recent years, different studies have considered a possible association between immunologic factors such as anticardiolipin antibody (Ac/a) and the risk of premature myocardial infarction (MI). In the present study, Acla is compared in patient with premature MI and their children with controls. Method: In this case-control study, three paired groups (parent-child) of 25 each, were selected by simple random sampling and their Acla levels measured by ELISA method. A comparison was made between parents who had premature MI ( < 55 years of age) and one of their 12-19 year children as the case group, and the parents with MI > 55 years and one of their children, as well as those with no heart attacks and one of their children as the first and second control groups. Data have been analyzed by SPSS/win using the Chi square test. Result: In this study, the number of positive and or relatively positive titers of Acla was higher in those with premature MI and their children. Also, the percentage of concomitant elevated Acla in parents and their children of the case group was significantly higher than the two control groups (40%vs. 12% and 8% respectively, P < 0.05). Discussion: The findings of this study point to the probable role of Acla as a risk factor in predicting premature MI. More research is recommended in this regard.

Introduction. It has been shown that regular physical activity (at least three days per week and at least 20 minutes per session) has many benefits especially on morphologic and hemodynamic changes of cardiovascular system and on lipid profile. Regarding the increasing trend of atherosclerosis risk factors especially hyperlipidemia and obesity (both modifiable by physical activity) among the children and adolescents of our society, their physical activity was evaluated in this study. Methods. This cross-sectional study has been performed in 1994 and 2001 on 2000 adolescent (1000 each year) arid their parents. Students and their parents were invited to complete their special questionnaire. Data have been collected and analyzed with SPSS 10 using chi-square and t-test. Results. The physical activity level showed no significant improvement during the last 7 years. The rate of regular morning exercise was declining in high schools (4.2% vs. 1.5%, P < 0.05). During these years, some of parents agreed with participation of their children in sport activities out of school hours but their disagreement had significantly increased (4.8% vs. 13.7%, P < 0.05). About 60 percent of students watched television more than 4 hours per day and only 10 percent of parents disagreed about this matter. In general the physical activity of girls was significantly lower than boys (P < 0.05) and regular physical activity in high school students was lower than guidance school students. Discussion. Regarding the physical activity level of adolescents did not show significant improvement in recent years, interventional programs should be performed in schools and in population in order to supply adolescents with facilities for physical activity and to increase the knowledge of adolescents and their families.

Introduction. Coronary artery disease (CAD) is one of the most prevalent disease in human population that has high prevalence and mortality in lsfahan (Iran). As positive family history and changes in serum lipids and lipoproteins are risk factors of these diseases, and also studies have showed the relationship between serum vitamin D and CAD, we studied serum level of lipids, lipoproteins and vitamin D in high risk children compared with control group, and the relation between serum vitamin D and other factors. Methods. This case-control study was done on 44 subjects (25 boys, 19 girls) aged 2-18 years old with positive CAD family history as case group and also 44 persons with negative CAD family history as control group with the same age groups. The subjects were selected by convenience sampling method. Children who consumed antiepilepthic drugs as phenytoin or phenobarbital and those who had positive family histroy for renal stone were excluded for variable vitamin D levels due to drug interaction and genetic susceptibility, respectively. All subjects were invited to Isfahan Cardiovascular Research Center. Using a questionnaire, information on personal characteristics, CVD family history and ... were obtained. A fasting (12-14 hr) blood sample was drawn from each one. Serum APOA1, APO B100 and vitamin Dwere measured by radioimmunoassay and serum lipids by ELAN 2000 autoanalyzer. Statistical analysis was done by SPSS. The level of serum APOA1, APO B100 and vitamin D were compared between two groups by independent t test and the relation of the mentioned apolipoproteins with vitamin D was studied using multiple linear regression. Results. Serum vitamin D was significantly lower in case group (P < 0.045). Among studied factors, only triglyceride was significantly higher in control group (P < 0.0001) and also no significant relaitonship was observed between serum APO A1, APO B100 and vitamin D. Sex comparision in case group showed those mean levels of total and LOL cholesterol, triglyceride and APO B100 in boys are higher than girls are. Instantly in girls, mean ApoA1 and HDL cholesterol are higher than boys are. In addition, in neither case nor control group"s vitamin D showed significat relationship with total, LDL and HDL cholesterol and triglyceride (P > 0.05). Discussion. Generally, as optimum level of vitamin D is regulated by sereval environmental, genetic and metabolic factors, it is necessary to clear the real role of antioxidant vitamin Dfor decreasing CAD occurence especially in Iran.

Introduction: Transferred fats from utroplacental barrier have different concentration about their saturation degree. So, the diet during pregnancy seems to have an important role in determining the serum lipid level of the fetus. This study investigated the influence of modifying the maternal dietary fat on the serum lipids of the cord and one year old infants. Methods: This single blind randomized clinical trail was done on 180 pregnant women who was at 4th month gestational age. All subjects proved to have a fat unmodified diet through a 4-day food record dietary questionnaire. We divided them randomly in two groups. The intervention group was kept on a fat-modified diet including saturated fatty acid < 10 percent, monounsaturated fatty acids: 10-15 percent, polyunsaturated fatty acid up to 10 percent and cholesterol

Introduction It is suggested that parenting intervention programs can play a core component in early child development. Given the limited healthcare resources in developing countries, a group design intervention might be cost-effective. Objectives Our objective was to assess the effect of parenting interventions in a cost-effective setting through group sessions CCD interventions on children’s development and behaviors in a non-Western, low/middle income country. Methods This randomized controlled trial was conducted in a public Pediatrics clinic in Isfahan, Iran. We included 210 pregnant women in their third trimester, and then followed their children for 18 months. The intervention group underwent 5 educational group sessions. The main outcomes were the children’s development and behaviors based on Bayley Scales of Infant and Toddler Development-III (BSCID-III) at 12 months and Children Behavior Checklist (CBCL) at 18-month of age. Results Data of 181 children were analyzed (80 in the intervention group and 101 controls. The adjusted median differences were significantly lower in the intervention group than in controls for attention problems (-3.38; SE=1.59; P=0.035), anxiety problems (-2.28; SE=1.03; P=0.007) and pervasive developmental problems (-5; SE= 1.16; P

Introduction Pregnancy interval may have various impacts on psychiatric and psychologic disorders of the offspring. Objectives This systematic review aimed to assess the relationship of short and long inter-pregnancy intervals (IPIs) with the risk of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Methods We performed a systematic search on electronic databases including Pubmed, Web of Science, Scopus, and Embase. We included observational studies that evaluated the association between IPIs and the risk of ASD and ADHD. Two reviewers independently screened and then extracted data on study characteristics, IPIs/ birth intervals, and outcome measures. The methodological quality of the included studies was evaluated following the Joanna Briggs Institute (JBI) critical appraisal checklist. Results At the final step, 19 out of 161 studies were included in our systematic review. Among them, 16 and 5 studies assessed the association between IPI and the risk of ASD and ADHD, respectively. In 9 studies, findings supported the association between short intervals and an increased risk of ASD. In addition, 7 studies reported significant association between both short and long intervals and an increased risk of ASD. Moreover, 3 studies demonstrated an association between short intervals and ADHD risk, while long birth interval was merely assessed in 2 studies with conflicting results. Conclusions This systematic review strongly confirmed the association of short and long birth intervals with ASD and ADHD. Future studies should investigate the mechanisms underlying these associations and the possible modifiers to decrease the risk of such disorders. Disclosure of Interest None Declared

AbstractBackground and Purpose: Childhood overweight and obesity can be an underlying cause of atherosclerosis. An early stage of atherosclerosis is shown by intimal thickening. The purpose of this study is to evaluate intima-media thickness (IMT) of carotid arteries on 12 to18 years’ old obese children in comparison to control group.Materials and Methods: In a case-control study, height, weight, blood pressure, cholesterol, triglyceride, mean IMT of body and bulb of carotid artery (of both sides) were measured in eighty (40 obese & 40 normal), 12 to18 years old students. Data was analyzed by X2 and student - test in SPSS-15 analytical software at P

Background: Dietary factors have been suggested as potential risk factors for myopia, but research findings on this relationship are inconclusive. The potential predisposing or protective role of macronutrient (carbohydrate, protein, fat) intake in the development of myopia was systematically reviewed, followed by data synthesis by meta-analysis., Methods: A systematic search was conducted in PubMed, Web of Science, Scopus, and Google Scholar up to the end of June 2023 to identify all relevant studies. All observational studies that assessed the relationship between macronutrient intake with myopia, axial length (AL) of eyes and spherical equivalent refractive error (SE) on individuals younger than 18 years old were included., Results: After removing duplicates and screening studies, four studies were included in the systematic review and meta-analysis. Pooled odds ratios regarding the association between myopia development and nutritional intake were 1.01 (95% CI: 0.94, 1.08), 0.97 (95% CI: 0.86, 1.08), and 0.99 (95% CI: 0.83, 1.18) for carbohydrates, proteins, and fats, respectively, indicating no significant associations. Intake of carbohydrates, proteins, and fats was not significantly associated with either SE or AL., Conclusions: Intake of carbohydrates, fats, or proteins did not influence the risk of myopia. The relationship between the intake of other macronutrients and myopia is suggested to be scrutinized in future studies., Registration: The systematic review protocol was registered on PROSPERO (registration number: CRD42024541369)., (© 2024. The Author(s).)

Background: Epidermolysis bullosa (EB) is a collection of rare, inherited disorders that require treatment in specialised centres by multidisciplinary teams knowledgeable about the unique features and challenges of EB manifestations and complications.A major gastrointestinal complication in patients with EB is oesophageal strictures. Effective management of oesophageal strictures can significantly improve patients' quality of life. This study systematically reviews the current literature on treatment options for oesophageal strictures in paediatric patients with EB., Methods: In September 2023, we conducted a systematic search for articles on the treatment of oesophageal stricture in patients with EB. We searched PubMed, Scopus, Embase and Ovid database without language or publication date restrictions. We screened 1042 articles, 15 of them were included in the current review. We extracted the following data from these studies: patient demographics, stricture characteristics, procedural details, clinical outcomes, complications and recurrences., Results: Overall, in the reviewed papers, strictures were located mostly in cervical oesophagus followed by thoracic lesions. Moreover, in most of the cases only a single stricture was reported, but multiple strictures were not uncommon. Stricture treatment approaches included medical management, bougienage, as well as fluoroscopic and endoscopic balloon dilation or a combination of these methods. In most studies, fluoroscopic dilation was used as the primary treatment method in 756 procedures. They commonly used general anaesthesia for the procedure, only one study used sedation. Hospital stays were usually brief, with an average duration of 1 day, and in one study patients were discharged after just 4 hours. Most patients experienced symptom relief, could resume oral intake and gained weight soon after the procedure. However, recurrence rates had large variations from 12% to 83%. Studies reported median recurrence intervals ranging from 7 to 18 months. This review showed that complications such as perforation, fever and odynophagia were relatively uncommon, and were controlled by conservative treatment., Conclusions: Both fluoroscopic and endoscopic balloon dilation are widely used methods for the management of oesophageal strictures in patients with EB. Each technique presents its own set of advantages and potential complications. Although the current evidence is notably limited, practical clinical decision-making may favour the fluoroscopic technique over endoscopic balloon dilation due to a comparatively reduced risk of procedural trauma. To ascertain the most effective approach, high-quality randomised controlled trials are imperative to delineate the superiority of one technique over the other., Competing Interests: Competing interests: None., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Atrazine is a widely used chlorinated triazine herbicide in agricultural settings, which has raised concerns over its potential adverse effects on human health. The extensive application of atrazine has resulted in its pervasive presence in the environment, contaminating soil, groundwater, and surface water. While earlier research suggested that atrazine is unlikely to pose a health concern, recent evidence has indicated the necessity to reassess this point of view. This review aims to assess the recent evidence on atrazine's adverse effects on human health, focusing on (i) Cancer, (ii) Metabolic Diseases, (iii) Reproductive System, (iv) Neural System, and (v) Epigenetic Effects. Strategies to mitigate atrazine contamination and limitations of previous studies are also discussed. We strongly believe that further investigation is necessary to determine the potential detrimental consequences of atrazine in humans, particularly in developing countries, where herbicides are widely used without stringent safety regulations. Therefore, the current review will be beneficial for guiding future research and regulatory measures concerning the use of atrazine., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: This study aims to evaluate the association of beverage consumption with cardiometabolic risk factors and alanine transaminase (ALT) levels in children and adolescents., Materials and Methods: This nationwide study is a part of the fifth survey of a national surveillance program in Iran. Overall, 4200 students, aged 7-18 years, were selected from 30 provinces by multi-stage cluster sampling. In addition to filling in questionnaires, blood sampling and biochemical tests were done. The weekly use of six different beverage types including milk, juice, tea, coffee, soda, and non-alcoholic beer, was documented by interview., Results: The participation rate was 91.5% (n = 3843), and data of 3733 students were complete for the current study. Beverages containing high levels of sugar such as soda and non-alcoholic beer were significantly associated with higher levels of ALT. Model coefficient of regression (SD) was 0.66 (0.31) ( P value: 0.034). Healthy beverages such as milk and fresh juice and also beverages containing high levels of caffeine did not have significant association with ALT levels ( P value = 0.32, P value = 0.60). Healthy beverages had a significant and inverse relationship with triglycerides (TG) ( P value = 0.029), total cholesterol (TC) ( P value = 0.008) and low-density lipoprotein (LDL) ( P value = 0.008) levels., Conclusion: This study showed that consuming sugar-sweetened beverages is significantly associated with higher levels of ALT, whereas healthy beverages are associated with a better cardiometabolic profile meaning that consuming healthy beverages leads to lower TG, TC, and LDL levels. The effects of beverages on children's health should be emphasized in health recommendations., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Advanced Biomedical Research.)

Background: Evidence-based International clinical practice guidelines, universally recommend secondary prevention medications for those with previous cardiovascular disease (CVD). There is limited data on the community use of these medications in the Middle East (ME)., Objectives: This study assesses the use and predictors of evidence based secondary prevention medications in individuals with a history of CVD [coronary heart disease (CHD) or stroke]., Methods: Between 2005 and 2015, we enrolled 11,228 individuals aged between 35-70 years from 52 urban and 35 rural communities from four ME countries, United Arab Emirates (n = 1499), Kingdom of Saudi Arabia (n = 2046), Occupied Palestinian Territory (n = 1668) and Islamic Republic of Iran (n = 6013). With standardized questionnaires, we report estimates of medication use in those with CVD at national level and the independent predictors of their utilization through a multivariable analysis model. Results: Of the total ME cohort, 614 (5.5%) had CVD, of which 115 (1.0%) had stroke, 523 (4.7%) had CHD and 24 (0.2%) had both. The mean age of those with CVD was 56.6 ± 8.8 years and 269 (43.8%) were female. Overall, only 23.5% of those with CVD reported using three or more proven secondary prevention medications, and a substantial proportion (stroke 27.8%, CHD 25.8%) did not take any of these medications. In a fully adjusted analysis, increasing age, female gender, higher education, higher wealth in individual household, residence in a higher income country as well as being obese, hypertensive or diabetic were independent predictors of medication use., Conclusion: The use of secondary prevention medication is low in ME and has not reached the modest recommended WHO target of 50% use of 3 or more medications. Independent factors of higher use were, better socioeconomic status (household wealth, country wealth and education) and better contact and accessibility to health care (increasing age, female gender, obesity, diabetes and hypertension)., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Although most non-acute pain assessment tools are multi-dimensional (behavioral and physiological measures) in their approach, the outputs of such tools are considered unidimensional. This study aimed to explore and determine the behavioral and physiological pain structures of Premature Infant Pain Profile-Revised (PIPP-R) for neonates and its association with parental stress., Methods: This cross-sectional study was conducted in 2022-2023 in Isfahan, Iran. We recruited 400 pre-term infants, i.e. with gestational age (GA) of less than 37weeks who were admitted to the NICU of educational hospitals. PIPP-R and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) were used for data gathering. The latent structures of pain and its association with parental stress were explored using latent variable modeling approach., Results: A two-factor model, i.e. behavioral and physiological pain factors, was extracted, explaining 65% of the total variance. The results of confirmatory factor analysis showed that the identified structures in the exploratory factor analysis could be nearly replicated (CFI = 0.99، TLI = 0.98, RMSEA = 0.001). Behavioral pain structure, independent from gestational age had a significant direct association with parental stress score (β = 0.005, SE = 0.002, p = 0.026)., Conclusions: The PIPP-R assesses both behavioral and physiological pain factors. We also found that behavioral pain factor was associated with parental stress., Impact: These results may provide a potential clue for physicians, nurses, and parents to manage the pain in preterm infant. The PIPP-R scores in preterm infants consist of "Behavioral and Physiological" pain factors. Single dependence on behavioral indicators (such as facial expression) has some limitations. Multidimensional tools may be the optimal method in detecting pain in preterm infants. Parental stress can affect behavioral pain structure in preterm infants. Intensive care nurses play an effective role in reducing the parental stress and pain severity of these preterm infants by including the help of mothers in procedures and providing them with psychological support., (© 2024. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Objectives: To determine the associations between various glucose and lipid-related indicators with elevated alanine aminotransferase (ALT) in pediatric population., Methods: We analyzed the cross-sectional data of 3,771 Iranian children and adolescents aged 7-18 years using the fifth survey of a national school-based surveillance program. The predictive power of 11 different glucose and lipid-related indicators for predicting elevated ALT was examined using receiver operating characteristic (ROC) curve., Results: In the total sample non-HDL-C, non-HDL-C/HDL-C, and TC/HDL-C showed the largest area under the curve (AUC) for elevated ALT detection, with 0.731 (cut-off, 129.5 mg/dL), 0.706, and 0.706, respectively. In girls, non-HDL-C had the highest predictive value (AUC, 0.741, cut-off, 129.5 mg/dL). Among boys, non-HDL-C/HDL-C and TC/HDL-C showed the largest AUC of 0.753 with optimum cut-off values of 2.63 and 3.63, respectively., Conclusions: The findings of this study suggest that non-HDL-C, non-HDL-C/HDL-C, and TC/HDL-C can be predictors of elevated ALT in the pediatric population. These indices can be useful in large population-based studies for predicting children and adolescents at risk of fatty liver., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Thyroid hormones regulate fetal growth and differentiation of several tissues. Maternal dietary patterns may be correlated with changes in the level of neonatal thyroid-stimulating hormone (TSH). We hypothesized that since maternal nutrition affects birth weight and offspring growth, it may also impact endocrine patterns in offspring. This study is aimed at assessing the relationship between maternal dietary phytochemical index (DPI) in the first trimester of pregnancy and neonatal cord blood thyroid hormone levels. Methods: This cross-sectional study is a substudy of a birth cohort. Overall, 216 mothers, aged 16-45 years, were recruited in their first trimester of pregnancy. To calculate DPI, the daily energy percentage of phytochemical-rich foods was divided by the total daily energy intake. At delivery time, TSH and free thyroxine (FT4) levels were measured in cord blood samples using chemiluminescence immunoassay. Results: The mean (standard deviation (SD)) age of mothers was 29.56 (5.50) years, and 47% of newborns were girls. The mean (SD) of DPI in the first, second, third, and fourth quartiles was 25.03 ± 4.67, 33.87 ± 2.18, 40.64 ± 2.10, and 51.17 ± 4.98, respectively. There was not any significant correlation between DPI score with cord serum TSH and FT4 levels in crude and adjusted analysis. Conclusion: No significant relationship between maternal DPI with cord serum TSH and FT4 levels was shown. Limited experience exists about the effect of maternal diet quality indices on neonatal thyroid function, and further studies are needed in this regard., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Vida Hashemi Dehkordi et al.)

Metabolic syndrome (MetS) is becoming prevalent in the pediatric population. The existing pediatric MetS definitions (e.g., the International Diabetes Federation (IDF) definition and the modified National Cholesterol Education Program (NCEP) definition) involve complex cut-offs, precluding fast risk assessment in clinical practice.We proposed a simplified definition for assessing MetS risk in youths aged 6-17 years, and compared its performance with two existing widely used pediatric definitions (the IDF definition, and the NCEP definition) in 10 pediatric populations from 9 countries globally (n = 19,426) using the receiver operating characteristic (ROC) curve analyses. In general, the total MetS prevalence of 6.2% based on the simplified definition was roughly halfway between that of 4.2% and 7.7% estimated from the IDF and NCEP definitions, respectively. The ROC curve analyses showed a good agreement between the simplified definition and two existing definitions: the total area under the curve (95% confidence interval) of the proposed simplified definition for identifying MetS risk achieved 0.91 (0.89-0.92) and 0.79 (0.78-0.81) when using the IDF or NCEP definition as the gold standard, respectively.The proposed simplified definition may be useful for pediatricians to quickly identify MetS risk and cardiometabolic risk factors (CMRFs) clustering in clinical practice, and allow direct comparison of pediatric MetS prevalence across different populations, facilitating consistent pediatric MetS risk monitoring and the development of evidence-based pediatric MetS prevention strategies globally., (© 2024. The Author(s).)

Objectives: We planned to evaluate the association of fetal and maternal thyroid hormones and maternal iodine status with neonates' anthropometric parameters., Methods: In this cross-sectional study, levels of thyrotropin were measured in maternal serum in the first trimester of pregnancy, and thyrotropin (TSH) and free thyroxin (fT4) were measured in cord blood serum samples at birth. Urinary iodine concentration (UIC) levels in random urine samples of mothers were measured in the third trimester of pregnancy. The relationship between UIC and thyroid hormone levels of mothers with neonates' anthropometric birth parameters of neonates was evaluated., Results: One hundred eighty-eight mother-newborn pairs completed the study. Mean (SD) of cord blood TSH (CB-TSH), cord blood-free thyroxin (CB-FT4) values, and maternal TSH (M-TSH) levels were 8.8 (7.3) mIU/L, 1.01 (0.2) ng/dL, and 2.2 (0.9) mIU/L, respectively. After adjusting for confounders, there was a positive significant association between female neonate length and maternal TSH and log log-transformed CB TSH (LN&#95;CB-TSH) (p<0.05). Median UIC (Q1-Q3) was 157 (53-241) μg/L, and there was no association between birth weight, birth length, and head circumferences of neonates and mothers' UIC (p>0.05)., Conclusions: We found a positive correlation between maternal TSH in the first trimester of pregnancy and the birth length of newborns, and a negative correlation was observed between CB-TSH and birth length in girls, but it did not provide conclusive evidence for the relationship between maternal and neonatal thyroid hormone levels and birth weight. There was no association between maternal UIC levels in the third trimester and birth anthropometric parameters., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Aims: The clinical utility of waist-to-height ratio (WHtR) in predicting cardiometabolic risk factors (CMRFs) and subclinical markers of cardiovascular disease remains controversial. We aimed to compare the utility of WHtR with waist circumference (WC) and body mass index (BMI) in identifying children and adolescents (youths) at risk for cardiometabolic outcomes, including clustered CMRFs, high carotid intima-media thickness (cIMT), and arterial stiffness (assessed as high pulse wave velocity, PWV)., Methods: We analyzed data from 34,224 youths (51.0 % boys, aged 6-18 years) with CMRFs, 5004 (49.5 % boys, aged 6-18 years) with cIMT measurement, and 3100 (56.4 % boys, aged 6-17 years) with PWV measurement from 20 pediatric samples across 14 countries., Results: WHtR, WC, and BMI z-scores had similar performance in discriminating youths with ≥3 CMRFs, with the area under the curve (AUC) (95 % confidence interval, CI)) ranging from 0.77 (0.75-0.78) to 0.78 (0.76-0.80) using the modified National Cholesterol Education Program (NCEP) definition, and from 0.77 (0.74-0.79) to 0.77 (0.74-0.80) using the International Diabetes Federation (IDF) definition. Similarly, all three measures showed similar performance in discriminating youths with subclinical vascular outcomes, with AUC (95 % CI) ranging from 0.67 (0.64-0.71) to 0.70 (0.66-0.73) for high cIMT (≥P95 values) and from 0.60 (0.58-0.66) to 0.62 (0.58-0.66) for high PWV (≥P95 values)., Conclusions: Our findings suggest that WHtR, WC, and BMI are equally effective in identifying at-risk youths across diverse pediatric populations worldwide. Given its simplicity and ease of use, WHtR could be a preferable option for quickly screening youths with increased cardiometabolic risk in clinical settings., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Bo Xi reports financial support was provided by National Natural Science Foundation of China. None reports a relationship with None that includes: None has patent None pending to None. None If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: The higher prevalence of hookah tobacco smoking (HTS) has become worrisome in women. Thus, it is essential to identify and measure the perceptions associated with this unhealthy behavior as well as the type of response to risk messages to design the effective programs. This study aimed to psychometric evaluation of a new instrument, named the Extended Parallel Process Model-Hookah Tobacco Smoking Questionnaire (EPPM-HTSQ), for female university students., Material and Methods: This methodological study was conducted in 2019-2020 in central and western Iran. The first version of the instrument was developed with 97 items. Face, Content, and construct validity methods were used to assess the EPPM-HTSQ validity. The data viability for factorability was guided through Kaiser-Meyer-Olkin (KMO) measure of sample adequacy (Values >0.7) and Bartlett's test of Sphericity ( P < 0.05). The Exploratory Factor Analysis (EFA) method with varimax rotation and SPSS software was performed to identify the main factors of the questionnaire and interpretable factors. The internal consistency and external reliability were determined. The test-retest was used for evaluating the stability of tools., Results: During the assessment of the face and content validity 71 items remained in the questionnaire. EFA led to the extraction of nine dimensions: "Focusing on superior rewards," "Response Efficacy," "Perceived physical threat," "Perceived social threat," "Self-efficacy," "Fear control," "Attitude," "Fear," and "Intention" Kaiser-Meyer-Olkin (KMO) test (0.957) and Bartlett's test ( P < 0.001). Cronbach's alpha (0.871-0.951) and ICC (0.985-0.998) were approved for scale dimensions., Conclusion: Important findings of the present study were the development and validation of the EPPM-HTSQ for measuring EPPM variables in relation to HTS; introducing a new variable "focusing on superior rewards"; as well as, the new classification of the concept of "perceived threat." The final version of the EPPM-HTSQ is a valid and reliable tool, but it is suggested to be re-evaluated in other studies with different populations and sample sizes., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Objectives: Exploring clinical information-seeking behaviour (CISB) and its associated factors contributes to its theoretical advancement and offers a valuable framework for addressing physicians' information needs. This study delved into the dimensions, interactions, strategies and determinants of CISB among physicians at the point of care., Design: A grounded theory study was developed based on Strauss and Corbin's approach. Data were collected by semistructured interviews and then analysed through open, axial and selective coding., Setting: The study was conducted at academic centres affiliated with Isfahan University of Medical Sciences., Participants: This investigation involved recruiting 21 specialists and subspecialists from the academic centres., Results: The findings revealed that physicians' CISB encompassed multiple dimensions when addressing clinical inquiries. Seven principal themes emerged from the analysis: 'clinical information needs', 'clinical question characteristics', 'clinical information resources', 'information usability', 'factors influencing information seeking', 'action/interaction encountering clinical questions' and 'consequences of CISB'. The core category identified in this study was 'focused attention'., Conclusions: The theoretical explanation demonstrated that the CISB process was interactive and dynamic. Various stimuli, including causal, contextual and intervening conditions, guide physicians in adopting information-seeking strategies and focusing on resolving clinical challenges. However, insufficient stimuli may hinder physicians' engagement in CISB. Understanding CISB helps managers, policy-makers, clinical librarians and information system designers optimally implement several interventions, such as suitable training methods, reviewing monitoring and evaluating information systems, improving clinical decision support systems, electronic medical records and electronic health records, as well as monitoring and evaluating these systems. Such measures facilitate focused attention on clinical issues and promote CISB among physicians., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The first 1000 days of life are critical for a child's health and development. Impaired growth during this period is linked to increased child morbidity, mortality, and long-term consequences. Undernutrition is the main cause, and addressing it within the first 1000 days of life is vital. Maternal education is consistently identified as a significant predictor of child undernutrition, but its specific impact remains to be determined. This study presents a systematic review and meta-analysis investigating the influence of high versus low maternal education levels on child growth from birth to age two, using population-based cohort studies., Methods: Databases including PubMed, Scopus, EMBASE, Web of Science, ERIC, and Google Scholar were searched from January 1990 to January 2024 using appropriate search terms. We included population-based cohort studies of healthy children aged two years and under and their mothers, categorizing maternal education levels. Child growth and nutritional outcomes were assessed using various indicators. Two reviewers independently conducted data extraction and assessed study quality. The Newcastle Ottawa scale was utilized for quality assessment. Random-effects models were used for meta-analysis, and heterogeneity was assessed using the Cochrane Q and I 2 statistic. Subgroup and sensitivity analyses were performed, and publication bias was evaluated., Findings: The literature search retrieved 14,295 titles, and after full-text screening of 639 reports, 35 studies were included, covering eight outcomes: weight for age z-score (WAZ), height for age z-score (HAZ), BMI for age z-scores (BMIZ), overweight, underweight, stunting, wasting, and rapid weight gain. In middle-income countries, higher maternal education is significantly associated with elevated WAZ (MD 0.398, 95% CI 0.301-0.496) and HAZ (MD 0.388, 95% CI 0.102-0.673) in children. Similarly, in studies with low-educated population, higher maternal education is significantly linked to increased WAZ (MD 0.186, 95% CI 0.078-0.294) and HAZ (0.200, 95% CI 0.036-0.365). However, in high-income and highly educated population, this association is either absent or reversed. In high-income countries, higher maternal education is associated with a non-significant lower BMI-Z (MD -0.028, 95% CI -0.061 to 0.006). Notably, this inverse association is statistically significant in low-educated populations (MD -0.045, 95% CI -0.079 to -0.011) but not in highly educated populations (MD 0.003, 95% CI -0.093 to 0.098)., Interpretation: Maternal education's association with child growth varies based on country income and education levels. Further research is needed to understand this relationship better., Funding: This study was a student thesis supported financially by Tehran University of Medical Sciences (TUMS)., Competing Interests: We declare no competing interests., (© 2024 The Author(s).)

Background: Postpartum depression (PPD) can exert both short-term and long-term effects on a child's health. Offspring born to mothers who suffer from PPD face an elevated susceptibility to encountering psychological disturbances and developmental delays. Moreover, there has been conjecture surrounding a plausible connection between maternal magnesium (Mg) levels and psychiatric manifestations. This study aims to investigate the relationship between maternal Mg levels and PPD and the correlation between PPD and an infant's growth and neurodevelopment at 6 and 12 months., Methods: This longitudinal study is a sub-study derived from the "PERSIAN Birth Cohort Study," encompassing 224 mother-infant pairs randomly enlisted during 2019-2020 in Isfahan. Maternal serum magnesium (Mg) levels were measured at 38 weeks of gestation. PPD was evaluated employing the Edinburgh Postpartum Depression Scale (EPDS) four weeks postpartum. Measurements of birth size were undertaken, adhering to standardized protocols at birth, 6 months, and 12 months. Anthropometric parameters and the Persian version of the validated Ages and Stages Questionnaires (ASQ) were employed to assess infant neurodevelopmental status at 6 and 12 months., Results: Overall, 22.3% of mothers grappled with PPD. The mean (standard deviation) maternal magnesium levels (Mg) were 1.95 ± 0.23 mg/dL. No statistically significant association was detected between maternal serum magnesium (Mg) levels and the incidence of PPD. Correspondingly, no significant association emerged between PPD and indices of growth. However, a noteworthy distinction materialized in the communication scores of offspring born to depressed and non-depressed mothers following adjustments for confounding variables at 12 months (β = 1.81; 95% confidence interval: 0.32-3.30). Furthermore, a substantial regression in communication skills became apparent between 6 and 12 months., Conclusions: This study failed to establish a significant association between maternal serum magnesium (Mg) levels and PPD. Nevertheless, research lends credence to an inverse correlation between maternal depression and subsequent behavioral difficulties in offspring, such as communication skills. Thus, the imperative nature of screening for PPD should be underscored to facilitate its early detection and intervention, thereby enhancing infant well-being., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 International Journal of Preventive Medicine.)

Background: This study presents the first report on research impact assessment (RIA) in non-high-income countries, undertaken as a pilot initiative in 2021. Within it, we aimed to explore the feasibility of employing the 'payback' model for evaluating the impact of health research and enhancing the accountability of universities. We focussed on three key impact domains: 'production of decision support documents and knowledge-based products,' 'implementation of research results,' and 'health and economic impact.', Methods: We adopted a case study approach to assess the impact of 5334 health research projects conducted by researchers from 18 universities from 2018 to 2020. Researchers were required to submit evidence related to at least one of the specified impact domains; six scientific committees verified and scored claimed impacts at the national level., Results: Only 25% of the assessed projects achieved impact in at least one domain, with the production of decision support documents and knowledge products being the most reported impact. Notably, economic impact was verified in only three projects, indicating room for improvement in this area. Technology research exhibited the highest acceptance rate of claimed impact, suggesting a positive correlation between technology-focused projects and impactful outcomes., Conclusions: This study demonstrates the feasibility of employing a case study approach and the 'payback' model to evaluate the impact of health research, even within the constraints of a moderately equipped research infrastructure. These findings underscore the potential of integrating RIA into the governance of health research in Iran and other non-high-income countries, as well as the importance of using RIA to assess the accountability of health research systems, guide the allocation of research funding, and advocate for the advancement of health research. The study sets a precedent for future assessments in similar contexts and contributes to the ongoing global dialogue on the societal impact of health research., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: The high prevalence of sleep problems and their negative consequences on children and parents highlight the need to design early screening instruments to evaluate sleep problems in early childhood. We aimed to determine the validity and reliability of the Brief Infant Sleep Questionnaire (BISQ) among the Iranian population., Methods and Materials: This study included 646 one-year-old infants by random sampling from the PERSIAN birth cohort study. Following the forward-backward translation of the BISQ, its psychometric properties, including construct validity in terms of concurrent and convergent validities as well as reliability, were evaluated., Results: The CVIs and CVR ranged between 0.8 and 1.00 for all items. Therefore, we keep all the items of the original version of the BISQ in the Persian BISQ. Concurrent validity was assessed by comparing items of the Persian BISQ among different maternal views regarding their infant's sleep. All BISQ items were significantly different among the two levels of maternal view about the infant's sleep problem except daytime sleep duration. The convergent validity of the BISQ was evaluated by calculating the correlation between BISQ items and the ISQ (infant sleep questionnaire) total score as a similar tool. ISQ score was adequately correlated with nocturnal sleep latency and the number of waking at night (r s ranged from 0.59 to 0.72). In addition, the associations of mothers' and infants' demographic variables and nutritional and gestational variables with BISQ items were presented to confirm construct validity. Strong correlations were found between the repeated sleep measures for sleep arrangement, sleep position, and sleep situation (kappa ranged from 0.65 to 0.84), nocturnal sleep duration, daytime sleep duration number of wakings at night, night waking duration, nocturnal sleep latency and sleep-onset time (ICC ranged 0.91 to 0.99)., Conclusion: The Persian version of the BISQ is a reliable and valid measure for assessing sleep problems in infants. It would be helpful to be utilized for the early diagnosis of infants' sleep problems., (© 2024. The Author(s).)

Background: The extensive use of various electronic games and communication devices, particularly among children and adolescents, has raised concerns, particularly during the COVID-19 pandemic. This study investigated the link between screen time and internalizing disorders, such as anxiety and depression, among individuals aged ≤18 during the global COVID-19 pandemic., Methods: This systematic review aims to summarize scientific publications from 2019 to early 2022 by searching databases, including the Cochrane Library, PubMed, Web of Science, Scopus, and PsycINFO, to identify suitable studies. In each paper, we searched the following keywords and their synonyms: screen, child, high school, middle school, and psychiatric disorders. The quality of the selected papers was evaluated using a checklist recommended by the National Institutes of Health (NIH) for observational cohort studies., Results: Out of 986 reports identified, we included 12 papers with 14,483 participants. The study revealed a negative correlation between screen time (TV, computer, video games, and mobile phones) and behavioral outcomes. Smartphones were the most frequently used devices, with video games being more prevalent among older participants for education, communication, and entertainment purposes. The prevalence of depression ranged between 10% and 25%. Furthermore, anxiety and depression were identified as predictors of increased screen usage. Some results displayed variation based on the type of screen exposure, the questionnaires used, and the age of the participants., Conclusions: The findings imply an indirect association between increased screen time and depression and anxiety. It is crucial to consider limitations on screen time exposure and parental supervision as measures to prevent certain mental disorders., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 International Journal of Preventive Medicine.)