Behavioral and physiological pain structures of PIPP-R and parental stress: structural equation modeling approach.

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 (ß = 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.

Association between anogenital distance as a noninvasive index in the diagnosis and prognosis of reproductive disorder: A systematic review.

Background: There are 2 measures of anogenital distance (AGD) in men and women. AGD has been used as an indicator of fetal androgen dysfunction and an adverse outcome in adulthood. Some studies have shown the association of AGD as a predictor in the diagnosis and prognosis of diseases and disorders. Objective: To systematically summarize the latest evidence for presenting AGD as a new approach for prognosis and early diagnosis of diseases. Materials and Methods: A systematic review of the available literature was performed using Medline via PubMed, Scopus, and ISI Web of Knowledge up to July 2021, using search terms "anogenital distance" OR "anogenital index" OR "ano genital distance" OR "ano genital index". Language restrictions were not imposed. Results: After reviewing the retrieved articles, 47 unique studies were included in this systematic review. Different outcomes, including endometriosis, prostate cancer, polycystic ovary syndrome, pelvic organ prolapse, hypospadias, cryptorchidism, fertility and semen parameters, maternal and birth development, and ovarian and gynecological-related disorders, have been studied in the included evidence. A negative association was observed between AGD and endometriosis and hypospadias and a positive association between AGD and prostate cancer, polycystic ovary syndrome, male fetal gender, and fertility parameters. Conclusion: Using quantitative indicators such as AGD may be a useful clinical tool for the diagnosis of diseases. Although many studies have shown an association between AGD and diseases, some factors, including different measurement methods, different measurement tools, age, and different definitions of AGD, can be involved in the variation of AGD.

Barriers to Providing Spiritual Care from a Nurses' Perspective: A Content Analysis Study.

Background: Spirituality is an important dimension of holistic nursing, and spiritual care is essential to ensure the achievement of optimal care in nursing profession. The aim of this study was to explain the obstacles to providing spiritual care from the perspective of nurses. Materials and Methods: The present qualitative study was conducted between November 2020 and June 2021 with a content analysis approach. Participants included 30 nurses, selected through purposive sampling, working in the general wards and intensive care units of Isfahan University hospitals. Data collection method was semi-structured personal interviews. After recording and transcription word by word, all data were analyzed through qualitative content analysis. MAXQDA 11 was used for data analysis. Results: Research findings included 323 primary codes and two main categories "individual barriers and organizational barriers" and eight subcategories "non-compliance with human resources standards, lack of attention of organizational managers to the importance of holistic care, motivational barriers, training barriers, barriers to interprofessional collaboration, environmental barriers, barriers related to the nurses, and communication barriers." Conclusions: Using the results of the study, policymakers and nursing managers will be able to help facilitate spiritual care, and ultimately, improve the quality of nursing care by improving the infrastructure and removing existing barriers.

Erratum: Author Correction: Association of a body shape index and hip index with cardiometabolic risk factors in children and adolescents: the CASPIAN-V study.

[This corrects the article DOI: 10.1007/s40200-021-00743-0.].

Association of a body shape index and hip index with cardiometabolic risk factors in children and adolescents: the CASPIAN-V study.

OBJECTIVE: This study designed to discover the link between a body shape index (ABSI) and hip index (HI) with cardiometabolic risk factors (CMRFs) in Iranian children and adolescents. SUBJECTS AND METHODS: In a nationwide cross-sectional survey, 4200 students who were 7-18 years old were chosen via a multistage cluster sampling method in 30 provinces of Iran in 2015. Metabolic syndrome (MetS) was defined in line with the Adult Treatment Panel III criteria. ABSI and HI were defined as waist circumference (m)/ [body mass index 2/3 * height (m)1/2] and hip circumference (cm) *(height/ 166 cm)0.310 *(weight / 73 kg)-0.482 respectively. Association between ABSI and HI with CMRFs as categorical and continuous variables were evaluated using multivariable logistic and linear regression analysis respectively. RESULTS: Totally, information of 14,002 students and findings of blood samples of 3483 of them were involved in the current study. In the multivariable logistic regression, an association of HI with high triglyceride (TG) (OR: 0.99, 95 % CI: 0.98-0.99) and ABSI with MetS (OR: 11.41, 2.61-49.88) was statistically significant (P < 0.05). Also, both indices were significantly associated with overweight, generalized, and abdominal obesity. In the multivariable linear regression analysis, increasing HI (per one unit) was associated with body mass index z-score (z-BMI) (ß: -0.01), waist circumference (WC) (ß: 0.15), TG (ß: -0.16), and systolic blood pressure (SBP) (ß: -0.02). Moreover, in the multivariable linear models, ABSI was significantly associated with z-BMI, WC, SBP, and diastolic blood pressure (P < 0.001). CONCLUSIONS: ABSI and HI as novel body shape indices were significantly associated with some CMRFs. Therefore, these indices can be used as some useful anthropometric risk indices for predicting MetS.

A systematic review on the association of month and season of birth with future anthropometric measures.

BACKGROUND: Prenatal factors might have some health impacts later in life. This study aims to systematically review the current literature on the association between season and month of birth with birth weight as well as with weight status in childhood. METHODS: The search process was conducted in electronic databases, including papers published until April 2019 in ISI Web of Science, PubMed, Scopus, and Google Scholar. The following search strategy was used with MeSH terms: ("Seasons"[Mesh]) AND ("Obesity"[Mesh] OR "Pediatric Obesity"[Mesh] OR "Obesity, Abdominal"[Mesh] OR "Overweight"[Mesh] OR "Birth Weight"[Mesh] OR "Body Height"[Mesh]). After the selection process, 50 papers were included in this systematic review. RESULTS: This review showed that individuals who are born in cold season (winter month) have higher body mass index (BMI) and weight in childhood. Birth in March was associated with lower weight and BMI in boys according to most studies. All studies, except one of them, showed that season/month of birth was not associated with birth weight. CONCLUSIONS: This systematic review confirms a relationship between season and month of birth with birth weight and body size in childhood; however, the impact of confounding factors, for example, vitamin D status, should be considered in the underlying pathway of this association. IMPACT: The results provide evidence for the effect of season and month of birth on body size in childhood. Our systematic review suggests that there is no pattern between birth weight and season/month of birth, and the occurrence of low birth weight was more frequent among infants who were born in summer than others. Further research should focus on identifying the impact of confounding factors, for example, vitamin D status in the underlying pathway of this association. There was response to the controversial findings about the effect of environment factors, such as season and month of birth, and future anthropometric indices, such as obesity, weight, height, and birth weight. Obesity is a complex and multifactorial disorder; the findings of the current study would be useful in determining the relationship pathway between the season and the month of birth with other underlying factors for childhood obesity.

Association of Alanine Aminotransferase With Different Metabolic Phenotypes of Obesity in Children and Adolescents: The CASPIAN-V Study.

Aim: To determine the association of alanine aminotransferase with different metabolic phenotypes of obesity in a nationally- representative sample of Iranian children and adolescents. Methods: This national study was conducted in the framework of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease study. Participants consisted of 4,200 subjects aged 7-18 years, who were recruited by multistage random cluster sampling from 30 provinces in Iran. They were categorized to normal weight and obese groups and in each group those with and without MetS components. Results: Overall, 3,843 of participants completed the survey (response rate: 91.5%). Their mean (SD) age was 12.58 (3.15) years; 52.6% were boys, and 72.7% lived in urban areas. Mean of alanine aminotransferase (ALT) in subjects with abdominal obesity and general obesity was 8.81 (95% CI: 7.99-9.62) (IU/L) and 8.87 (95% CI: 7.28-10.46) (IU/L), respectively. According to the adjusted model, one unit increment in ALT increased odds of being metabolically non-healthy obese (MNHO) by 2% compared to metabolically healthy non-obese (MHNO) [adj.OR (95% CI): 1.02 (1.01-1.04)]. Also, subjects in the third and fourth quartiles of serum ALT had significantly greater odds of being MNHO than those in its first quartile [Q3/Q1: adj. OR (95% CI): 3.85 (1.70-8.71); Q4/Q1: Adj. OR (95% CI): 3.63 (1.51-8.73)]. Conclusion: This large population-based study revealed significant associations between metabolic phenotypes of obesity and ALT level.

The Relation between Different Aspects of Quality of Life with Coping Style in Adolescents with Thalassemia in Comparison to a Healthy Group.

Background: Thalassemia as a chronic disease could affect different aspects of a patient's life. On the other hand, when encountering the symptoms of a chronic disease as a stressful factor, the coping strategy of the adolescents and their families could have an important role in the quality of life of these patients. The present study was conducted to determine the relation between different aspects of quality of life with coping styles in the adolescents with thalassemia in comparison to a healthy control group. Materials and Methods: The present study is a case-control research in 2017. Studied samples were 200 adolescents with thalassemia and healthy adolescents. Data gathering tools were demographic characteristics checklist and the coping style and quality of life questionnaire by the World Health Organization. Data were analyzed by SPSS 20 using independent t-test, linear regression and correlation coefficients. Conclusion: Results of Pearson statistical test showed a positive and significant relation between the total mean score of quality of life and its physical, social and mental aspects with emotion-oriented coping style (p<0.01). Also a direct significant relation was observed between the total mean score of quality of life and its social and physical aspects with problem-oriented coping style(p<0.01). Conclusion: According to the results of the present study, educating the adolescents and their families for paying attention to the coping style for stressful factors and preparing these adolescents for passing toward the youth period, which could be challenging for them, are highly recommended.

Relationship Between Parental Communication Patterns and Self-Efficacy in Adolescents with Parental Substance Abuse.

OBJECTIVES: Since an individual's personality and behavior are mainly shaped in the family environment, parental substance abuse and its consequences can lead to confusion and instability in the family environment and reduce child-parent relationship. This study was conducted to investigate the relationship between different aspects of parental communication patterns and self-efficacy in adolescents with parental substance abuse. MATERIALS & METHODS: In this descriptive correlational study, a total of 100 adolescents with parental substance abuse were selected via random sampling. The data collection tools included the parental communication patterns scale and self-efficacy questionnaire. Data were analyzed in SPSS version 20, using linear regression analysis and Pearson's correlation coefficient test. RESULTS: The mean age of the adolescents was 14.5±2.5 years. Pearson's correlation coefficient showed that the adolescents' self-efficacy score was directly correlated with the score of conversation orientation dimension (a parental communication pattern) and inversely correlated with the dimension of conformity orientation (P<0.001). CONCLUSION: Development of educational programs to promote communication skills, positive family interactions, decision-making, and flexibility can change the unhealthy family environment into a healthy and productive one, which promotes self-efficacy beliefs in children.

Association of fruit and vegetable intake with meal skipping in children and adolescents: the CASPIAN-V study.

BACKGROUND: There are few studies on the association of main meal consumption with fruit and vegetable intake. This study aims to assess the relation between skipping main meals and fruit and vegetable intake in children and adolescents. METHODS: This multi-centric cross-sectional study was conducted in 30 provinces of Iran. This study was conducted in the framework of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease study (CASPIAN- V). 14,440 school students aged 7-18 years were assessed. Logistic regression analyses were used to evaluate the association between frequency of fruit and vegetable intake with skipping main meals. RESULTS: Overall, 14,274 students completed the study (99% participation rate). Their mean (SD) age was 12.3 (3.2) (53% were aged 6-12), 50.6% of them were boys, and 71.3% lived in urban area. In multivariate logistic regression model, statistically significant associations were found between skipping main meals and low fruits and vegetables intake. Skipping breakfast was associated with vegetables intake [OR = 1.19(95% CI 1.02-1.38)] and fruits intake [OR = 5.33(95% CI 4.46-6.37)]. Skipping lunch was associated with vegetables intake [OR = 1.61(95% CI 1.29-1.96)] and fruit intake [OR = 9.11(95% CI 6.55-12.67)]. Skipping dinner was associated with vegetables intake [OR = 1.52 (95% CI 1.15-2.01)] and fruits intake [OR = 2.21(95% CI 1.64-2.97)]. CONCLUSIONS: In this study, low frequency of fruit and vegetable intake was associated with skipping main meals. The results highlight the importance of promoting regular meal consumption with increase in the intake of fruit and vegetables among children and adolescents. LEVEL OF EVIDENCE: Level V.

Congenital hypothyroidism in different cities of the Isfahan province: A descriptive retrospective study.

BACKGROUND: Considering the high prevalence rate of congenital hypothyroidism CH in Iran, an epidemiological study in each region would be helpful in understanding the etiology of the disorder and providing preventative strategies in this field. This study aims to determine the prevalence of CH in different cities of the Isfahan province. MATERIALS AND METHODS: This descriptive and retrospective study was conducted among 918 primarily diagnosed CH neonates, who have been identified through the neonatal screening program from 2009 to 2015. At the age of ≥3 years, treatment was discontinued for 4 weeks, and T4 and thyroid-stimulating hormone were measured. Permanent (PCH) or transient (TCH) was determined from the results of the thyroid function tests. RESULTS: From 389,101 screened neonates, 918 were diagnosed with primary CH. The overall prevalence rate of CH was 2.36 in 1000 live birth (ranged 1.58-7.22 in 1000 live birth in different cities). The highest prevalence rate of CH was reported in Ardestan, Khansar, Golpaygan, and Nain cities with prevalence rate of 4.86-7.22 in 1000 live birth and lowest prevalence occurring in Fereydan, Shahreza, Isfahan, and Mobarakeh cities with prevalence rate of 1.58-1.89 in 1000 live birth. In 392 cases which reached to 3 years of age, the rate of TCH was 47.45%. In Chadegan, Natanz, Fereydunshahr, Shahinshahr, Najafabad, Dehaghan, Borkhar, and Mobarakeh, the prevalence of PCH was <50%. CONCLUSION: The current findings indicate that the incidence rate of both PCH and TCH are high in Isfahan province with significant variability in different cities which could be due to the role of different genetic, prenatal, and different environmental factors. These epidemiological data could be used as baseline date to design more etiological studies.

Association of sleep duration with metabolic syndrome and its components in children and adolescents; a propensity score-matched analysis: the CASPIAN-V study.

OBJECTIVE: This study aims to evaluate the association of sleep duration with metabolic syndrome (MetS) and its components in a pediatric population. METHODS: This multi-centric cross-sectional study was conducted in 2015 in 30 provinces of Iran. Participants consisted of 4200 school students aged 7-18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examinations and laboratory tests were performed using standard protocols. The analysis was conducted based on the propensity score matching and conditional logistic regression was used to evaluate the association of short sleep (less than 8 h a day) and the onset of sleep with MetS and its components. Results of conditional logistic regression was reported as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Overall, 3843 of participants completed the survey (response rate: 91.5%). Their mean (SD) age was 12.3 (3.2) years and 50.6% were boys. In the multivariate model, individuals who slept less than 8 h a day had significantly higher odds of MetS (OR 2.05, 95% CI 1.19-3.63) and high blood pressure (BP) (OR 1.46, 95% CI 1.04-2.06). Association between short sleep duration with other MetS components (including abdominal obesity, hypertriglyceridemia, hyperglycemia, and low levels of high-density lipoprotein-cholesterol was not statistically significant (P > 0.05). Moreover, association between the onset of sleep with MetS and its components was not statistically significant (P > 0.05). CONCLUSION: Short sleep duration is associated with increased risk of MetS and high BP in children and adolescents. The clinical impact of current findings should be assessed in future longitudinal studies.

Association between Newborns' Breastfeeding Behaviors in the First Two Hours After Birth and Drugs Used For Their Mothers in Labor.

OBJECTIVE: Use of narcotics to relieve pain in labor affects neurobehavioral and nutritional conditions of newborns after birth. However, there are inadequate data on the effects of drugs currently used in labor. This study was performed to examine the association between newborns' breastfeeding behaviors in the first two hours after birth and drugs used for their mothers in labor in Isfahan, central Iran, from 2014 to 2016. MATERIALS & METHODS: In this descriptive-analytical study, 300 women were selected who had vaginal delivery in the Labor and Gynecology Wards of Al-Zahra and Shahid Beheshti hospitals, Isfahan, Iran from 2014 to 2016. Data were collected by a demographic questionnaire and the Newborn Breastfeeding Behaviors Tool completed by the researcher as she observed the newborns during breastfeeding after birth. The data were analyzed by one-way ANOVA, chi-square test and Kruskal-Wallis test in SPSS 20. RESULTS: There was no significant difference between demographic characteristics of the studied groups (P>0.05). In addition, there was significant difference in breastfeeding behaviors between groups. More clearly, breastfeeding ability was higher in the infants of the women administered with no drug than those of the women in the group (P=0.000). CONCLUSION: Physicians, nurses, and midwives can be informed about the side effects of the drugs used in labor on the newborns' breastfeeding, and improve their breastfeeding outcomes by decreasing the dose of used drug and the duration of the women's treatment with these drugs.

The Effect of Adaptation Training on Controlling Maladaptation Behaviors in Adolescents with Asthma Based on Roy Adaptation Model.

BACKGROUND: Asthma is a common long term inflammatory disease during adolescent. Absence of school education and reduction of mental and social mindedness are among the most common problems found in adolescents with asthma. Therefore, the present study was aimed to examine the effect of Roy adaptation model on controlling maladaptation behaviors in adolescents with asthma. MATERIALS AND METHODS: This study is a semi-experimental research that was conducted with the participation of all adolescents with asthma referred to the Asthma and Allergy Clinic of Shariati Hospital. Random sampling was used for a total of 64 adolescents to have two groups of intervention and control. Data collection was through a questionnaire based on the Roy's Adaptation Model. Over six weeks, adolescents were trained in six two-hour sessions. Data were analyzed by descriptive and analytical statistics consisting of Mann-Whitney, ANOVA, paired t-test and independent t-test. RESULTS: The mean age of adolescents with asthma in the intervention and control groups was 15.8±3.5 and 14.8±3.5 years, respectively. Also, the mean score of maladaptation behaviors in four physiological, self-concept, role-function and interdependence modes had a significant difference in intervention group before and after training (p<0.001), but there was no significant difference in all modes before and after intervention in control group (p>0.05). CONCLUSION: Given the effect of Roy adaptation model on the different aspects of maladaptation behaviors in adolescents with asthma, it is recommended to use this model as a healthcare intervention for controlling maladaptation behaviors in adolescents with other chronic disease.

Prevalence of different metabolic phenotypes of obesity in Iranian children and adolescents: the CASPIAN V study.

BACKGROUND: Pediatric metabolic disorders are a major health problem. The prevalence of child and adolescent metabolic disorders particularly obesity has globally shown a growing pattern. The aims of this study were to estimate the prevalence of different metabolic phenotypes of obesity in children and adolescents. METHODS: This multi-centric cross-sectional study was conducted in 2015 in 30 provinces of Iran. Participants consisted of 4200 school students aged 7-18 years, studied in a national school-based surveillance program (CASPIAN- V) in Iran. Metabolic syndrome (MetS) and obesity was defined according to ATP III and WHO criteria respectively. Subjects were classified into four different metabolic phenotypes of obesity; metabolically healthy nonobese (MHNO), metabolically healthy obese (MHO), metabolically non-healthy non-obese (MNHNO) and metabolically non-healthy obese (MNHO). Moreover students were classified in four different phenotypes of obesity; normal; only abdominal obesity (AO), only generalized obesity (GO) and combined obesity (CO). RESULTS: The prevalence (95% confidence interval) of different metabolic phenotypes of obesity, MHO 10.35 (9.1, 11.8), MNHNO 3.31 (2.6, 4.2) and MNHO 2.19 (1.6, 2.9) was found in boys, while the prevalence of these phenotypes was significantly lower in girls (7.74 (6.6, 9.1), 3.11 (2.4,5.1) and 1.41 (0.9,2.1) respectively). The prevalence of only AO, only GO and CO was 12.17% (11.6, 12.7), 2.51% (2.3,2.8), and 8.86% (8.4,9.3), respectively. Based on gender differences, the prevalence of AO was significantly higher among girls than boys (12.4% of girls vs. 11.9% of boys). CONCLUSIONS: Healthy lifestyle education and program interventions are necessary for children with different metabolic phenotypes of obesity, as there is a high probability that they may suffer from poor health in the future.

Metabolic syndrome and associated factors in Iranian children and adolescents: the CASPIAN-V study.

Introduction: Metabolic syndrome (MetS) is one of the common metabolic disorders seen in children and adolescents. This study aims to assess the rate of the MetS and its associated factors in a nationally-representative sample of Iranian pediatric age groups. Methods: This nationwide cross- sectional study was designed in 2015 in 30 provinces of Iran. Participants consisted of 4,200 school students, aged 7-18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examination and laboratory tests were performed using standard protocols. Blood samples were drawn from 3834 students for biochemical tests. Results: The participation rate for blood sampling was 91.5%. MetS was significantly more prevalent among students in urban than in rural areas (5.7% vs. 4.8%, P value < 0.01). MetS was more prevalent in students with obese parents than in those with non-obese parents (6.4% vs. 4.5%, P value < 0.05). Significant association existed between moderate level of healthy nutritional behaviors and MetS after controlling for potential confounders (odds ratio [OR]: 0.62, 95% CI: 0.40-0.98). Students with high unhealthy nutritional behaviors showed an increased risk of MetS in crude (OR: 1.6, 95% CI: 1.05-2.44) and adjusted model (OR: 1.65, 95% CI: 1.05-2.63). Conclusion: High rate of MetS and associated risk factors was observed in Iranian pediatric age groups, with higher rates among boys. These findings provide useful information for effective preventive strategies based on diet, exercise, and lifestyle modification rather than therapeutic modalities.

Fordyce Happiness Program and Performance for Mothers of Children with Cleft Lip and Palate Referring Healthcare Team in Isfahan University of Medical Sciences in 2015.

OBJECTIVE: The present study was conducted to investigate the effect of happiness program on performance for mothers of children with cleft lip and palate. MATERIALS & METHODS: In this semi experimental study, 64 mothers of children with cleft lip and palate referring healthcare team in Isfahan University of Medical Sciences, Iran were enrolled by simple random sampling in 2015. They were divided to two groups of control and intervention. Then, the program of happiness training was implemented within 10 sessions of two hours each and performance questionnaire were filled out prior two months after the last session. The data were analyzed by paired t-test, independent t-test, chi-square and Mann-Whitney. RESULTS: Mean age of the mothers in intervention and control groups was 33.3±6.3 and 33.5±5.8 yr, respectively. Mean age of the children in intervention and control groups was 6.34±3.37 and .03±3.36 yr, in that order. No significant difference was seen on demographic variables between the two groups. Besides, no significant difference was noticed on mean score of performance domains in the two groups before training. However, after 2 months a significant difference on mean score of performance domains was observed (P<0.000). Intervention group showed significant differences on mean score of performance domains before and after intervention (P<0.000). However, the control group had no significant change. CONCLUSION: Given the effect of happiness, program in promoting mothers performance for children with cleft lip and palate, this program can be used in healthcare centers to empower mothers and enhance performance in taking care of children.