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Background and Objective: Irrational consumption of blood products leads to unwanted side effects in patients and imposes additional financial burdens on society and patients. This study was done to determine the pattern of consumption of packed red blood cells (PRBC) in hospitalized newborns and children.
Methods: This prospective descriptive-analytic study was conducted on 80 newborn (less than 4 months age) 36 children (more than 4 months to 16 years old) who used PRBC in Sari Bu-Ali Sina hospital, north of Iran. Demographic characteristics of patients and parameters of blood product were recorded and compared with standard guideline.
Results: During the study period, administration of 116 units of PRBC (28.5%) was studied. Totally, in 24 % of cases PRBC consumption did not follow the guideline. PRBC consumption was inappropriately prescribed for patients with hemoglobin higher than 12 g/dL (12%) and for patients with hemoglobin higher than 10 g/dL (12%). Both of the consumption volume to weight ratio (P<0.05) and rate of infusion (P<0.05) were significantly higher in children less than or equal to 4 months, than in children older than 4 months. The most commonly indications were respiratory distress syndrome in neonates (62.1%) and bone marrow suppression (14.7%).
Conclusion: A significant percentage of patients were received PRBC out of guideline recommendations.  It seems, for rational use of PRBC in children and neonates the existing guidelines should be more considered to reduce the cost and side effects.
 

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Background and Objective: The asymmetry index during walking can be used for clinical treatment. This study was done to determine the immediate and long-term effects of foot orthoses on asymmetry of ground reaction forces frequency spectrum in male children with flat foot during walking.
Methods: This clinical trial study was done on fifteen children with flat foot. Subjects were randomly divided into without foot orthoses, immediate and long term usage of foot orthoses groups. The kinematic and kinetic data during three without foot orthoses, immediate and long term use of foot orthoses conditions were recorded by the motion analysis and force platform systems, respectively.
Results: Asymmetry index of medio-lateral frequency spectrum component during walking without foot orthoses, immediate and long term use of orthoses in median frequency and band width were greater than 4 percent. There were not any significant differences in asymmetry index of ground reaction force frequency spectrum components, asymmetry index of essential harmony numbers, asymmetry index of essential harmony total powers, and asymmetry index of fundamental harmony number in vertical, anterior-posterior,  and medio-lateral axes between without foot orthoses, immediate and long term use of foot orthoses conditions. However, asymmetry index of essential harmony total power in medio-lateral axis during immediate use of foot orthoses tend to be reduced than that walking without foot orthoses. However, this difference was not significant.
Conclusion: Despite the high asymmetry index of the ground reaction force frequency spectrum in the medio-lateral component during walking without foot orthoses, immediate and long-term effects of foot orthoses in the median and bandwidth frequency variables, the acute or long term use of foot orthoses did not show any significant effect on improvement of asymmetry index of ground reaction force frequency spectrum components.

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Background and Objective: Childhood behavioral and emotional problems may be continus to puberty, even extend to elderly. This study was carried out to determine the role of family accommodation of child symptoms, parenting style and parental stress in prediction of anxiety disorder in children with 6 - 10 years old in Golestan province, north of Iran.

Methods: In this descriptive-analytic study 300 children with 6-10 years old and their mothers were selected by randomized cluster sampling method during 2017. The questionnaires of family accommodation scale-anxiety (FAS-A, 2013), parent stress index-sort form (PSI-SF, 2000), Bamerind parenting styles questionnaire 1973 and Spence child anxiety scale-parent form (SCAS-P, 1998) were completed by the mothers.

Results: Increasing family accommodation and parenting stress significantly correlated with increasing children anxiety (P<0.05). The authenticated childbearing style by parents significantly correlated with reducing the anxiety in children (P<0.05), but authoritarian parenting and permissive parenting by parents significantly correlated with increasing the anxiety in children (P<0.05). Authenticated childbearing style along with authoritative parenting style, parental stress and family support could predict 49% of children's anxiety (F=97.91, P<0.0001).

Conclusion: Authoritative and authoritarian parenting, parenting stress, family accommodation has an effective role in predicting children's anxiety.

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Background and Objective: Chronic and recurrent abdominal pain affect about 7-20% of children in school age, and it is responsible for 2-4% of children's medical referrals. Helicobacter pylori infection in children can cause gastrointestinal problems in childhood, and the lack of treatment and eradication can lead to serious complications. This study was done to evaluate the prevalence of Helicobacter pylori ELISA stool antigen in children with chronic abdominal pain.

Methods: In this case control study, 33 children with chronic abdominal pain and 30 normal children were evaluated. The stool was tested by ELISA method to evaluate Helicobacter pylori antigen.

Results: 15.2% of chidern in the chronic abdominal pain group were positive for Helicobacter pylori. No positive case was found among control group. This difference between case and control groups was significant (P<0.05).

Conclusion: Considering the high prevalence of Helicobacter pylori antigen in children with chronic abdominal pain, it is suggested that children with chronic abdominal pain without a definite cause screened for Helicobacter pylori infection.

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Background and Objective: Child Sexual Abuse (CSA) is a very serious problem all over the world with widespread and often unrecoverable negative consequences for victim, family and the society. Significant proportion of victims reported abused sexually when they were younger than 7 years. This study was done to evaluate the knowledge and attitude of pre-school girls about sexual abuse prevention in Gorgan during 2016.
Methods: In this descriptive study, 56 pre-school girls with mean age of 76.13±3.87 months (6.34 years), who were chosen through systematic random sampling, among the files of the households with
a pre-school age girl from two health centers in Gorgan, north of Iran during 2016. The Personal Safety Questionnaire- Persian version (PSQ-P) including 12 questions was used to test children’s sexual abuse prevention knowledge and attitude by interview method.
Results: Out of  the 56 children studied, only 9 children (16%) knew all three private parts and of these, only 2 children (3.5%) knew the correct name for all three parts. 80% of children believed that if the perpetrator would ask them to keep touching the private parts as a secret, they should not inform another person. 48% of them did not choose appropriate avoidance responses during inappropriate touching of private parts. 43% of them reported that they do not like their private parts and the appropriate touch of the private parts was not allowed by most children too.
Conclusion: Most pre-school girl children had no proper knowledge and attitude about the sexual abuse prevention, indicating highlights shortcomings in prevention educations at different levels of society.

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Pediatric femoral neck fracture is rare and account for less than 1% of all fractures in childhood. The proximal femur in children is extremely strong, and high-energy forces in 80-90%, following the axial force associated with hip rotation or direct blow are necessary to cause fracture. In this report, the method of femoral neck fracture fixation in eight-year-old girl after car accident is reported. During the operation, we noted a severe femoral neck fracture that was irreparable with the available tools (pin, screw, plate and DHS), which inevitably had to be used by Transosseous method with fiber wire #2, used in proximal humeral fracture fixation. Then, we obtained a fairly satisfactory result with a distal femoral pin inserting it into two-sided spica cast. Although, this kind of fracture is rare, but with a qualified clinical examination, early diagnosis, proper treatment, familiarity with surgical techniques and fixation reduces the complications and this method can be effective in obtaining the desired result.

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Background and Objective: Behavioral disorders among children and adolescents are common and incapacitating which cause many problems for the families and the patient themselves and associated with high prevalence of negative social consequences. This study was done to evaluate the prevalence of psychiatric disorders among children and adolescents in Gorgon, north of Iran (2019).
Methods: This descriptive-analytical study was performed on 1025 children and adolescents aged 6-18 years in Gorgan, north of Iran (2019). Subjects were selected by Multistage Cluster Sampling. Digital version of K-SADS test was studied for 24 types of child and adolescent psychiatric disorders. Sampling was done by trained psychologists, among general population and by referring to the house of people. Psychiatric disorders included mood disorders, behavioral disorders, neurodevelopmental disorders, substance abuse disorders, and elimination disorders.
Results: The prevalence of psychiatric disorders among children and adolescents was 13.2%. This prevalence was 14.3 % and 12.1% in males and females, respectively. According to age groups, The prevalence of psychiatric disorders was common in 6 to 9 years olds with 17.8% which in comparison with other age groups was significant (P<0.05). Eliminatory disorder with 6.1% was the most common illness followed by behavior (6%), tension disorders (4.8%) and neurodevelopmental disorders (3.3%).
Conclusion: The prevalence of psychiatric disorders among children and adolescents in this area is in a median range compared to other domestic and overseas.

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Background and Objective: Anxiety disorders are one of the most common psychiatric disorders in childhood. Some studies have identified the household dimension as an important factor in causing these disorders. However, no convincing results have been achieved. The aim of this study was done to determine the frequency of anxiety disorders among of 8-12 years old children in families with single and multiple children.
Methods: This descriptive-analytical study was performed on 732 children (343 boys and 389 girl) referred to Taleghani hospital (except than psychiatric clinic) and offices of pediatricians in Gorgan, north of Iran during 2017. Subjects were recruited using available sampling method. Demographic questionnaire and Spence Anxiety Scale (SCAS) were completed. Variables including separation anxiety, social anxiety, general anxiety, panic attack, agoraphobia, obsession and compulsion, fear of physical damage were evaluated.
Results: In all anxiety subgroups except general anxiety, mean scores were significantly higher in children with multiple children than single children (P<0.05).
Conclusion: This study showed a high prevalence of anxiety disorders in multi-child families compared to single-child families.

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Background and Objective: Foreign body aspiration is the cause of death in 7% of children under two year’s olds. Children’ molars teeth do not erupt and under devedoled ability to swallow food and generally likely to be distracted, playing or ambulatory while eating. This study was performed to determine the frequency of foreign body aspiration in children under ten years old in north of Iran.
Methods: This descriptive study was done on 50 children (21 boys, 29 girls) less than ten years old with the final detection of foreign body aspiration hospitalized in Taleghani hospital in Gorgan, north of Iran during 2016-17. Demographic characteristics, results of physical examination, radiography and bronchoscopy recorded in the file and the radiology report was collected by a pulmonologist and radiologist.
Results: The common age of foreign body aspiration was between 1-3 years (58%) followed by over 3 years (24%) and under 1 years old (18%). Symptoms of patients with foreign body aspiration were including cough (64%), rhonchi (52%), respiratory distress (32%), wheezing (32%), choking (30%). Common physical examination findings were wheezing (40%), unilateral pulmonary sound (34%), stridor (20%), and rhonchi (6%). The most common findings in Chest X-Rays were unilateral air trapping (48%) in right lung, left mediastan shift (30%), right lung atelectasia (20%), pneumonia (16%). Just in one case (2%) was found the body of radio opac in right lung and in 32% of cases, the graghs were normal. In 70% of patients less 24 hours, in 26% between 1-15 Dayes and in 4% of cases more than 15 Dayes were taken to medical centers. The most common foreign body was nuts (32%) followed by plastic objects (26%), aspiration by sunflower seeds (14%) and beens (10%) and other foreign objects (18%).
Conclusion: The most common clinical signs of foreign body aspiration were cough, wheezing and right lung pneumonia.

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Background and Objective: One of the most important concerns in children is self- medication that may cause in delay the correct diagnosis, and increases morbidity and mortality. This study was performed to determine the frequency of self-medication of parents in children in need of medical care in Gorgan city.
Methods: This descriptive-analytical study was performed on 270 children referred to the pediatric clinic of Taleghani Hospital in Gorgan, northern Iran during 2018-19. Medications were given to the children by their parents arbitrarily without prescriptions by doctors during the recent week were evaluated.
Results: 58.5% and 41.5% of children were males and females, respectively. The average age of children was 5.79 ±4.15 years. Self-medication was the first choice of 60.4% of parents. In the recent week, 48.9% of parents had self-medicated to treat their child's current illness, of which 31.8% reported antipyretic, 17.4% herbal medicines, 11.4% antibiotics and 23.5% other medicines. 91% of parents were unaware of correct dose of drugs and 96.3% did not have any knowledge about possible side effects of drugs, contraindications and precautions. There was a statistically significant association between parent job (self-employment) and self-medication (P<0.05).
Conclusion: 48.9% of parents were performed self-medication on their children. Out of those parents 91% and 96.3% were not aware from the correct drugs dosage and of possible side effects, contraindications and potential risks respectively.

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Background and Objective: Spastic diplegia cerebral palsy is a movement disorder originating from brain injury before, during, or immediately after birth. Exercise plays an important role in motor recovery. This study was performed to determine the effect of high-intensity circuit training on balance and activity daily living in children with cerebral palsy (CP).
Methods: In this clinical trial, 34 children with cerebral palsy were randomly divided into two groups of 17 including occupational therapy (control group) and circuit training group with occupational therapy as interventional group. Berg balance scale and activity scale for kids were used to assess changes in balance and activity of daily living before and after 12 weeks of exercise, respectively. High-intensity circuit training consisting of 3 rounds and each round consisting of 6,
30-second stations and a 30-second break between stations, which were performed three times a week for 12 weeks. Occupational therapy was performed one session per week.
Results: The rate of balance and activities of daily living and its components in the circuit training group with occupational therapy showed a significant improvement compared to control group (P<0.05).
Conclusion: Circuit trainings with occupational therapy can further improve the performance of balance and activity of daily living in children with Spastic diplegia cerebral palsy compared to occupational therapy.

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Background and Objective: Poisoning is one of the most common causes of emergency room visits. Opioids and methadone are the causes of unintentional poisoning, especially in children, who have a high burden of emergency referrals in children's hospitals. This study was performed to evaluate methadone poisoning in the pediatric emergency department in Gorgan, North of Iran.
Methods: This cross-sectional study was performed on the records of patients admitted (85 boys and 70 girls) cases due to methadone poisoning in Taleghani Hospital in Gorgan, North of Iran during 2001-19 .The symptoms of patients and the costs of treatment and care of patients were analyzed.
Results: A total of 258 cases of poisoning were registered, of which 155 (60%) were methadone poisoning. Poisoning occurred for 136 cases (87.8%) with methadone syrup and for 19 cases (12.2%) with methadone tablets. The mean of age and age range was 47.94±36.25 months and 4-156 months, respectively. The mean and standard deviation of the time interval from consumption to the time of admission was 164.84±160.11 minutes and the maximum and minimum time interval were 720 and 15 minutes, respectively. 34 cases (22%) were conscious, 110 cases (71.5%) had impaired level of consciousness, seven cases (4.5%) presented with cardio respiratory arrest and three patients (1.9%) presented with seizures and one child (0.1%) was dead. Moises, bradypnea and apnea were seen in 78 (51.3%), 62 (40%) and 7 (4.5%) children, respectively. Six children had a history of hospitalization due to methadone poisoning, of which 2 were the day before, 3 were the month before, and 1 was 2 years ago. Two children were addicted. The mean±SD of the number of hospitalization days were 2.39±1.57 and the minimum and the maximum were 1 and 9 days. The mean±SD of hospitalization cost was 7642249±5341725 Rials. The average consumption of naloxone was 6.83± 10.41mg and the minimum and the maximum were one and 68 milligrams.
Conclusion: The results of this study showed that meiosis is not observed in half of children with methadone poisoning. Therefore, it is recommended that in the case of children with impaired level of consciousness or seizures without a specific reason; methadone poisoning should be concerned as a differential diagnosis by medical staff and this diagnosis should not be ignored only in the absence of meiosis or respiratory dysfunction.

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Background and Objective: Yersinia is water and foodborne organism that cause human gastroenteritis. This study was done to evaluate the frequency of Yersinia species isolated from children diarrheal samples and chicken meat in Tehran, Iran.
Methods: In this descriptive study 250 sample of diarrhea of children referred to the Children's Medical Center, Tehran, Iran and 250 samples of chicken were collected and examined for Yersinia infection during July 2016 to March 2017. Isolation method was performed based on initial enrichment in phosphate buffer for 3 weeks in refrigerator (cooling in c4 +) and then using KOH as secondary enrichment and culture on CIN agar medium. Biotyping method was used to determine pathogenic strains.
Results: In this study, 5(2%) isolates from pediatric diarrhea samples and 20 isolates (8%) from chicken meat samples were obtained from Yersiniaenterocolitica. Biotyping of human Yersiniaenterocolitica isolates identified 3 cases of biotype 1A, one case of biotype 1B, one case of biotype 2 and from chicken meat isolates, 16 isolates belonged to biotype 1A and 4 isolates belonged to biotype 1B.
Conclusion: Presence of common pathogenic 1B and non-pathogenic 1A biotypes in pediatric diarrhea samples and chicken meat can indicate the cause of diarrhea in children.
 

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Background and Objective: Elimination disorders such as nocturnal enuresis, urinary incontinence during the day, and fecal incontinence are common problems in childhood. This study aimed to evaluate the effectiveness of training mothers with the Adler-Dreikurs approach for reducing anxiety in children with elimination disorders.
Methods: This field trial was done in 2021 on the mothers of 20 children with elimination disorders who had been referred to the Pediatric Gastroenterology Clinic in Gorgan with a pretest, posttest, and follow-up approach. At the physician's discretion, the children's problem had no anatomical origin. Urinary incontinence and fecal incontinence in children were identified only by psychological symptoms and functional elimination disorders. The mothers were divided into an experimental group (n=10) and a control group (n=10). The experimental group received the Adler-Dreikurs training program in 12 sessions of 90 minutes. The research instrument was the Spence Children's Anxiety Scale – Parent (SCAS-P) (2001), which was completed by the mothers in three stages: pretest, posttest, and 2-month follow-up. Sub-components of anxiety including generalized anxiety, social phobia, obsessive-compulsive, specific phobia, and separation anxiety were also measured.
Results: Mean general anxiety scores in the pretest, posttest, and follow-up stages were 69.1±4.04, 45.8±6.1, and 47.8±5.94 in the experimental group and 69±6.58, 67.8±4.89, and 67.6±5.59 in the control group, respectively. There was a significant difference in all subcomponents of child anxiety in the posttest and follow-up stages between the experimental group and the control group (P<0.05). This difference was also present during the follow-up period except for the obsessive-compulsive subcomponent.
Conclusion: Training mothers through the Adler-Dreikurs approach can reduce anxiety in children with elimination disorders.
 

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Background and Objective: A basic factor in the reduction of fertility levels is delayed fertility. This research was carried out in Khorramabad, Lorestan Province, Iran.
Methods: This descriptive-analytical study was conducted on 535 married women aged 15-49 years in Khorramabad. The data were collected face-to-face through a cross-sectional survey in 2020 using a researcher-made questionnaire between September and December 2019. This study used the Kaplan-Meier test to determine the childlessness survival time. A logistic parametric model with the gamma shared frailty distributions was employed to analyze its determinants.
Results: The mean of childlessness survival time was 31.76 months, with a median of 24 months. Women in the age group of 15 to 30 years, women with university education, women who married at the age of less than 25 years, and women with a higher sense of socioeconomic insecurity had a longer childlessness survival time (P<0.05).
Conclusion: Childlessness was evaluated as low in Khorramabad. Only 2% of the women remained childless after 10 years of marriage.

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Background and Objective: Type 1 diabetes is considered one of the most common chronic diseases during childhood. Diagnosis and presence of chronic disease in the child create tension, worry, and problems for parents, particularly for the mother who is responsible for taking care of the child. The present study was conducted to determine the effectiveness of resilience training on the self-esteem of mothers of children with type 1 diabetes.
Methods: This clinical trial was carried out on 60 mothers of children with type 1 diabetes referring to diabetes clinics in the cities of Gonbad-e-Kavus and Gorgan, Golestan province, during 2022-23. Mothers were selected by the convenience sampling method and using a random number table and were assigned to two 30-people control and intervention groups. The resilience training program was implemented for the intervention group in 5-people groups for nine 90-minute sessions during 2 months. The data collection tool consisted of a demographic questionnaire and the Coopersmith Self-Esteem Inventory (SEI) filled out in two pre-test and post-test phases. Scoring of poor, moderate, and strong self-esteem was carried out by obtaining scores of 26 and below, 27-43, and over 44.
Results: The mean and standard deviation of the overall self-esteem (22.73±3.26), social (7.32±0.79), occupational/social (7±1.46), and general self-esteem (44.73±5.03) dimensions had a statistically significant increase in the post-test in mothers of the intervention group compared to those in the control group (P<0.05). The mean and standard deviation of the self-esteem scores of mothers in the intervention group were evaluated as moderate at the onset of the study and strong at the post-test (P<0.05).
Conclusion: Resilience training culminated in increasing the self-esteem of mothers of children with type 1 diabetes.

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Trichotillomania disorder, or hair pulling disorder, is a condition in which patients unconsciously engage in hair-pulling, which reinforces compulsive hair pulling behaviors, culminating in conscious and deliberate hair pulling. Behavioral therapy is a common treatment approach for this disorder. Habit-reversal training (HRT) is a particularly effective treatment method for children with intellectual disabilities who exhibit this disorder. This case report presents the efficacy of HRT in reducing trichotillomania-associated severity and distress. The patient was a 13-year-old girl with intellectual disability who met the diagnostic criteria for trichotillomania according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). She received eight sessions of HRT techniques over one month. The Massachusetts General Hospital Hair Pulling Scale (MGH-HPS) was employed to measure the severity and distress of the hair pulling behavior. Given the patient’s intellectual disability (intelligence quotient [IQ]=65) and limited ability to respond to self-report questions about the nature of self-interests, the parent-report version of the scale was used both during the treatment and the one-month follow-up. The effectiveness of the intervention was evaluated using visual analysis of graphs, percentage of improvement, effect size, and photographs of the eyebrow hair pulling before and after treatment. The results indicated that the HRT significantly reduced both the severity (effect size=1.75) and distress (effect size=1.77) of the trichotillomania disorder, and the patient exhibited a high percentage of improvement. The one-month follow-up demonstrated that the results were maintained.
 

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Background and Objective: Intermittent exotropia is the most common form of exotropia in children. Non-surgical treatments include refractive error correction, occasional patching of the normal eye in young children, prism therapy, and orthoptic exercises. This study aimed to compare the effects of wearing overminus spectacles versus patch therapy in 3- to 8-year-old children with intermittent exotropia.
Methods: This clinical trial was conducted on 30 children (9 boys and 21 girls) with intermittent exotropia aged 3 to 8 years with no previous treatment history referring to the strabismus clinic of Khatam-al-Anbia Hospital in Mashhad. Patients were randomly assigned to two groups: Patch therapy (n=20) and overminus (n=10). In the patch therapy group, the patient’s healthy eye was patched for 2 to 4 hours a day for 6 months. Overminus spectacles were selected based on cycloplegic refraction between 2 and 4 diopters. Astigmatism was fully prescribed. Patient follow-up time was 3 months and then 6 months. Finally, data, including the size of the deviation and the degree of deviation control, were collected and analyzed.
Results: The median spherical error of patients before intervention in the overminus group was +1 diopter in the right eye and +0.75 diopter in the left eye, and in the patch therapy group, +0.75 diopter in both the right and left eyes. Six months after the intervention, the median spherical error in the overminus group was +0.62 diopters in both the right and left eyes, and in the patch therapy group, +0.75 diopters and +0.62 diopters in the right and left eyes, respectively. No significant statistical difference was found between the study groups. The median deviation size of patients in the overminus group before intervention was +25 prism in distance vision and +25 prism in near vision, and 6 months after intervention, it was +22.5 prism in distance vision and +20 prism in near vision. Also, the median deviation size of patients in the patch therapy group before intervention was +25 prism in distance vision and +25 prism in near vision, and 6 months after intervention, it was +25 prism in distance vision and +25 prism in near vision. No significant statistical difference was found between the study groups. The median deviation control based on the Newcastle Scale Score (NSS) of patients before intervention was 3.5 in the overminus group and 4 in the patch therapy group, which was 1.5 in the overminus group and 3 in the patch therapy group 6 months after the intervention. Although there was a greater improvement in control based on the NSS in the overminus group compared to the patch therapy group.
Conclusion: Both overminus and patch therapy are effective in treating patients with intermittent exotropia. In patients using the overminus method, deviation control is higher compared to the patch therapy method.
 

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Background and Objective: School-age children often experience separation anxiety due to being away from their families. A therapeutic approach to address this issue is Theraplay-based play therapy. This study aimed to determine the effectiveness of Theraplay-based play therapy on separation anxiety in elementary school girls.
Methods: This randomized controlled trial involved 60 elementary school girls from Aliabad-e-Katoul County, Iran, divided into two groups of 30: A control group (mean age: 8.69±0.71 years) and an intervention group (mean age: 8.9±0.85 years) in 2023. Hahn et al.’s Separation Anxiety Assessment Scale (SAAS) (parental version, 2003) was administered as a pre-test and post-test to assess separation anxiety. The control group received no intervention. The intervention group participated in ten 45-minute Theraplay-based play therapy sessions with their mothers for 10 days.
Results: The mean total separation anxiety score in the pre-test was 82.2±9.27 in the intervention group and 83.53±8.8 in the control group, showing no statistically significant differences. Similarly, there were no significant differences between the two groups in pre-test scores for separation anxiety dimensions. However, the mean total separation anxiety score in the post-test was 78.36±7.87 in the intervention group and 84.03±9.01 in the control group. This difference was statistically significant (P<0.05). Furthermore, significant differences were observed in all dimensions of separation anxiety (P<0.05) except for the frequency of events in the intervention group before and after the intervention.
Conclusion: The results of this study indicate that the Theraply-based play therapy effectively reduces separation anxiety in elementary school girls.
 

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Background and Objective: Most Iranian provinces, including Golestan Province, have achieved the 2015 Sustainable Development Goals (SDGs) for childhood mortality. However, evidence suggests that mortality rates in some population groups within these regions remain high and concerning. This study aimed to determine the childhood mortality rate in the city of Aqqala in Golestan Province, Iran.
Methods: This descriptive study was conducted on 416 cases (243 males, 172 females, 1 ambiguous genitalia) of mortalities among children aged 0-18 years residing in rural and urban areas of the city of Aqqala from 2017 to 2022. All registered mortalities were extracted from the electronic health record system at Golestan University of Medical Sciences. Incomplete records or those with imprecisely documented causes of mortality were excluded from the study. The causes of childhood mortality were categorized based on the International Classification of Diseases (10^th Revision, 2016). Age divisions were regarded as 0-28 days, 1-12 months, 1-2 years, 2-6 years, 6-12 years, and 12-18 years for neonates, infants, toddlers, preschoolers, school-aged children, and adolescents, respectively.
Results: The overall mortality rate was determined to be 2.15 deaths per 1000 live births, with rates of 23.1 per 1000 live births for male children and 10.3 per 1000 live births for female children. This rate decreased from 22.7 deaths per 1000 live births in 2017 to 12.3 deaths in 2022. The neonatal mortality rate was determined to be 32.8 per 1000 live births, and the infant mortality rate was 5.5 deaths per 1000 live births. The primary causes of mortality, in order of frequency, included certain conditions originating in the perinatal period (28.2%), congenital malformations and chromosomal abnormalities (17.2%), and transport-related accidents (12%).
Conclusion: Despite a declining trend in the overall mortality rate of children under 18 years in the city of Aqqala in Golestan Province, the neonatal mortality rate in this region is alarmingly higher than the Iranian average, necessitating attention and appropriate measures for further evaluation and intervention.