Association of socio-economic status and visual impairment: A population-based study in Iran

Backgrounds: To assess the role of socio-economic inequality in visual impairment (VI) in Varamin district, Iran. Patients and Methods: Using multistage cluster sampling method, 60 clusters (each with 50 subjects) were recruited and underwent clinical eye examinations. Socio-economic status (SES) was identified based on education, occupation, family assets and housing conditions that were measured at the participants’ households using a semi-structured questionnaire and a two-step cluster analysis model. In addition, principal component analysis and the concentration index were used to identify the gap between high and low SES groups. Results: Participants were categorized in high (522, 24.4%), moderate (974, 43.1%) and low (763, 33.7%) socio-economic levels. In these levels, the prevalence of VI was 5.9% (95% CI: 3.3 to 8.6), 10.4% (95% CI: 8.4-12.4), and 12.6% (95% CI: 10.1 to 15.1), respectively. The prevalence of VI in people with low SES was significantly greater than those in high SES level. The proportions of avoidable causes were relatively high in all SES levels (more than 80%) with no significant difference between different levels. Conclusions: There is significant inequality in VI prevalence in Varamin district. Avoidable causes are high in all SES groups. Therefore, community-based modalities and preventive programs with a specific notice to poorer SES groups are recommended to improve eye health in this district. © 2017, Academy of Medical Sciences of I.R. Iran. All rights reserved

Patterns of Uveitis in the Middle East and Europe

Purpose: To compare the patterns of uveitis, emphasizing similarities and discrepancies, in the Middle East and Europe. Methods: Six articles reporting uveitis patterns from the Middle East including a total of 2,693 cases, and seven articles with a sum of 4,379 cases from Europe were analyzed and patterns in each region were defined and compared. Results: In both regions, uveitis was most commonly seen in the fourth decade of life with anterior uveitis being the most common anatomical form. Idiopathic cases accounted for the majority of anterior and intermediate uveitis; toxoplasmosis was the most frequent entity in posterior uveitis while Behcet′s disease and idiopathic forms were the next most common causes in the Middle East and in Europe, respectively. Conclusion: Since patterns of uveitis differ in various geographic regions, discovering these patterns would be helpful for the diagnosis and treatment of this broad category of conditions. This necessitates applying a universal diagnostic classification system to enable accurate comparisons

Fuchs Heterochromic Iridocyclitis-Associated Glaucoma: A Retrospective Comparison of Primary Ahmed Glaucoma Valve implantation and Trabeculectomy with MMC

Purpose: To compare the safety and efficacy of a primary trabeculectomy with mitomycin C (T) and an Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC) related glaucoma, a rare complication of an uncommon form of uveitis. Design: Retrospective comparative case series. Method: Twenty-six patients with uncontrolled FHIC-associated glaucoma received T (n=12) or an AGV (n=14). Primary outcome measures were the surgical success defined as IOP ≤ 21 mmHg and decreased ≥ 20% from the baseline and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and intraocular pressure. Results: The follow-up (mean±SD) was 34.0±17.7 in T and 33.4±18.6 months in AGV (p = 0.837). The cumulative probability of success rate at the final follow-up at three years was 41.7% for T and 85.7% for AGV. There was no significant difference in complications between the two groups (P>0.05). The mean preoperative IOP in T was 23.4±3.3 mmHg and 21.6±5.2 mmHg at the final visit (P= 0.041). In AGV, the preoperative IOP was 24±7.8 and 17.1±2.6 mmHg at the final visit (P= 0.003), respectively. AGV had a significantly lower average IOP at the final follow-up visit compared to T (P= 0.018). The number of glaucoma medications at baseline was 3.3±0.5 in T and 3±0.6 in AGV (P= 0.233). This decreased significantly to 2.4±1.0 and 1.7±0.6 at the final follow-up (P= 0.008 and 0.002, respectively). Patients in AGV needed fewer glaucoma medications (P= 0.041). BCVA was equal in both groups and did not change (p>0.05). Conclusion: Primary AGV had a higher success rate than T in the management of FHIC-associated glaucoma. The risk of cataract formation and progression was significantly higher following T in these patients

Determinants of medication adherence among Iranian patients with type 2 diabetes: An application of health action process approach

Diabetes; Diet; Health profession; Health sciences; Health promotion; Insulin; Determinants, Medication adherence, Type 2 diabetes, Health action process approach, Iran © 2020 To identify determinants of medication adherence among patients with type 2 diabetes based on the health action process approach. This cross-sectional study was conducted among 734 patients with type 2 diabetes attending to south Tehran health centers during June to December 2018. Data were gathered using the Morisky Medication Adherence Scale (MMAS-8-Item) and the health action process approach questionnaire. We used Mann-Whitney, Pearson Chi-Squared, Fisher's Exact and Independent Samples Tests for comparison of adherence medication by demographic characteristics; and linear regression analysis to predict factors related to medication adherence based on HAPA. P-value less than 0.05 considered statistically significant. A total of 232 men and 502 women participated in the study, Mean age was 61.61 ± 9.74. Most participants (82.3) reported low medication adherence (females: 68.4). Medication adherence was significantly associated with gender (p = 0.03). Medication adherence was significantly predicted by intention (β = 0.172, p = 0.0001), task self-efficacy (β = 0.172, p = 0.01), copping planning (β = 0.6, p = 0.0001) and copping self-efficacy (β = -0.244, p = 0.001). The level of adherence to medications among type 2 diabetes patients was low. The behavior intention, task self-efficacy, copping planning and copping self-efficacy were significant determinants contributed to the medication adherence. HAPA inventory includes various factors, especially types of self-efficacy. Thus, utilization of this comprehensive model in interventional studies is suggested. These determinants should be considered in developing interventional programs to improve adherence. © 202

Adjustment formulae to improve the correlation of white-to-white measurement with direct measurement of the ciliary sulcus diameter by ultrasound biomicroscopy

Purpose: This study evaluates the correlation between horizontal white-to-white (WTW) distance using Caliper and Orbscan IIz with the ciliary sulcus diameter measured by high frequency ultrasound biomicroscopy (UBM) and presents an adjustment formula to improve the correlation. Methods: We measured horizontal sulcus-to-sulcus (STS) dimension of 273 right eyes of 273 high myopic patients with 35 MHz UBM and horizontal WTW using Orbscan IIz and Caliper. Mean WTW diameter, differences, and the correlation of measurement methods were evaluated. Results: The mean spherical equivalent was �8.79 ± 4.87 diopters. Mean horizontal STS dimension with UBM was 12.13 ± 0.45 mm (range, 10.81�13.42 mm). Mean WTW diameter in the Caliper method was 11.70 ± 0.40 mm (range, 10.6�12.8 mm) and 11.70 ± 0.40 mm (range, 10.5�13.1 mm) in the Orbscan method. Mean difference of UBM STS and WTW with Caliper was 0.48 ± 0.28 mm (range, �0.19 to 1.37 mm). Mean difference of UBM STS diameter and Orbscan WTW was 0.38 ± 0.31 mm (range, �0.64 to 1.29 mm). The Pearson correlations of WTW diameter measured by Caliper and Orbscan with UBM's STS diameter were 0.778 and 0.773, respectively. This difference diminished after adjustment. The 95 limit of agreement was almost the same in Caliper and Orbscan (�0.07 to 1.03 compared with �0.23 to 0.99). Conclusion: There is a significant difference in measurements between STS diameter using UBM and WTW diameter utilizing Caliper and Orbscan. This difference diminished after our recommended adjustment. © 2017 Iranian Society of Ophthalmolog

Depression, anxiety, and perceived social support among adults with beta- thalassemia major: Cross-sectional study

Background: Considering the high prevalence of depression and anxiety among thalassemia patients and the role of social support in preventing mental disorders, this study aimed to determine prevalence of depression, anxiety, and perceived social support (PSS) among adults with beta-thalassemia major. Methods: This cross-sectional study was performed with 389 adults with beta-thalassemia major. Data were collected via a questionnaire consisting of three parts: demographic and medical information, the Persian version of the hospital anxiety and depression scale, and the Persian version of the Multidimensional Scale of Perceived Social Support. Data were analyzed using IBM SPSS ver. 23.0 (IBM Corp., Armonk, NY, USA) through analytical statistics (independent-samples t-test, one-way analysis of variance, Pearson correlation coefficient, and multilevel linear regression), and the results less than 0.05 were considered to be significant. Results: The mean scores of depression, anxiety, and PSS of patients were 7.42±3.17, 7.47±4.35, and 41.8±8.64, respectively. Of 389 patients, 19.8 had depression and 23.7 had an anxiety disorder. Relationships of depression and anxiety with age, the level of education, job, and family income were statistically significant, as were those of PSS with age, thalassemia center, family income, job, and the level of education. PSS from family, friends, and significant others were the significant predictive factors of depression and anxiety among adult patients with betathalassemia major. Conclusion: Considering the PSS as a factor influencing the reduction in depression and anxiety in thalassemia patients, social support from the social networks (spouse, family members, friends, and healthcare workers) should be integrated with interventions that are designed to improve the mental and physical health of thalassemia patients. © 2018 The Korean Academy of Family Medicine

Depression, anxiety, and perceived social support among adults with beta- thalassemia major: Cross-sectional study

Background: Considering the high prevalence of depression and anxiety among thalassemia patients and the role of social support in preventing mental disorders, this study aimed to determine prevalence of depression, anxiety, and perceived social support (PSS) among adults with beta-thalassemia major. Methods: This cross-sectional study was performed with 389 adults with beta-thalassemia major. Data were collected via a questionnaire consisting of three parts: demographic and medical information, the Persian version of the hospital anxiety and depression scale, and the Persian version of the Multidimensional Scale of Perceived Social Support. Data were analyzed using IBM SPSS ver. 23.0 (IBM Corp., Armonk, NY, USA) through analytical statistics (independent-samples t-test, one-way analysis of variance, Pearson correlation coefficient, and multilevel linear regression), and the results less than 0.05 were considered to be significant. Results: The mean scores of depression, anxiety, and PSS of patients were 7.42±3.17, 7.47±4.35, and 41.8±8.64, respectively. Of 389 patients, 19.8 had depression and 23.7 had an anxiety disorder. Relationships of depression and anxiety with age, the level of education, job, and family income were statistically significant, as were those of PSS with age, thalassemia center, family income, job, and the level of education. PSS from family, friends, and significant others were the significant predictive factors of depression and anxiety among adult patients with betathalassemia major. Conclusion: Considering the PSS as a factor influencing the reduction in depression and anxiety in thalassemia patients, social support from the social networks (spouse, family members, friends, and healthcare workers) should be integrated with interventions that are designed to improve the mental and physical health of thalassemia patients. © 2018 The Korean Academy of Family Medicine

The value of serum B-subunit of human chorionic gonadotropin level in prediction of treatment response to methotrexate in management of ectopic pregnancy; a systematic review and meta-analysis

Background: No consensus has been reached on prognostic value of serum concentration of β (beta) subunit of human chorionic gonadotropin (β-hCG) in treatment response to methotrexate in management of ectopic pregnancy. Therefore, the present study aimed to evaluate this subject through a systematic review and meta-analysis. Materials and Methods: An extensive literature search on online databases was performed. All studies performed on ectopic pregnancy patients treated by methotrexate from all age groups were included. After collecting data, random effect models were used to calculate t he pooled standardized mean difference (SMD) of β-hCG level in treatment success and treatment failure groups. Finally, pooled performance screening characteristics of serum β-hCG level were assessed in different cut offs. Results: Finally, 51 articles were included in meta-analysis. Overall treatment success rate of methotrexate was 84 95% confidence interval (CI): 84-85 percent. A negative association was found between serum β-hCG level and the treatment response before intervention (SMD= -1.10, 95% CI: -1.39 to -0.88). In addition, pooled sensitivity, specificity, and prognostic odds ratio of β-hCG in the 2000 mIU/mL cut off were: 0.75 (0.65-0.82), 0.68 (0.58-0.82), and 6.0 (5.0-8.0), respectively. Conclusion: The present meta-analysis showed that serum β-hCG concentration before treatment could predict success of methotrexate in management of ectopic pregnancy

Determining risk factors for gastric and esophageal cancers between 2009-2015 in East-Azarbayjan, Iran using parametric survival models

Background: Esophageal cancer (EC) and Gastric cancer (GC) have been identified as two of the most common cancers in the northeastern regions of Iran. The increasing rates of these types of cancers requires attention. This study aims to assess the potential risk factors for these two cancers and then determine shared risk factors between them in a population of Iranian patients using parametric survival models. Methods: This retrospective cohort study was conducted using 127 patients with EC and 184 patients with GC in East Azarbaijan, Iran who were diagnosed and registered during the years 2009-2010 in Iran's National Cancer Control Registration Program and were followed for five years. Parametric survival models were used to find the risk factors of the patients. Akaike Information Criteria was used to identify the best parametric model in this study. Interaction analysis was used to determine shared risk factors between EC and GC. Results: The mean (±standard deviation) age of diagnoses for EC and GC were 66.92(±11.95) and 66.5(±11.5) respectively. The survival time ranges of GC patients was (0.07-70.33) and the survival time ranges were from 0.10 to 69.03 months for EC patients. Multivariable Log- logistic model showed that being married (OR=2.25, 95% CI: 1.33 - 3.81) for EC patients and Esophagectomy surgery for EC (OR: 1.62, 95% CI: 1.04 - 2.55) and GC (OR: 1.60, 95% CI: 1.02 - 2.53) had significant effects on survival. Age at the time of diagnosis, job status, and Esophagectomy surgery were statistically comparable regarding their magnitude of effect on survival of two cancers (all Ps > 0.05). Conclusion: Esophagectomy surgery and being married were important risk factors in EC and GC. The log-logistic model was the most appropriate statistical approach to identify significant risk factors on survival of both cancer

Developmental and psychometric properties of a belief-based reproductive health behavior questionnaire for female adolescents

Background: The aim of this study was to develop and evaluate the psychometric properties of a questionnaire for the measurement of reproductive health among female adolescents in Iran. Methods: This cross-sectional study was conducted among 289 female students aged 12-15 yr in Tehran, Iran from 2015-2016. The participants were selected using multi-stage random cluster sampling. In addition, the Belief-Based Reproductive Health Questionnaire (BBRHQ) was designed using the properties of the Theory of Planned Behavior (TPB). Results: Exploratory factor analysis of 104 items identified a six-factor solution. These factors jointly accounted for 67 of the observed variance of outcome variable. The confirmatory factor analysis indicated a good fit to the data. In addition, the Cronbach�s alpha coefficient showed an excellent internal consistency (alpha=0.92). Conclusion: Belief-Based Reproductive Health Questionnaire (BBRHQ) is a valid and reliable instrument for measurement of reproductive health behaviors of adolescents. © 2018, Iranian Journal of Public Health. All rights reserved