Medium-to-high prevalence of screening-detected parkinsonism in the urban area of Tehran, Iran: Data from a community-based door-to-door study

Introduction: Parkinsonism occurs in all ethnic groups worldwide; however, there are wide variations in the prevalence rates reported from different countries, even for neighboring regions. The huge socioeconomic burden of parkinsonism necessitates the need for prevalence studies in each country. So far, there is neither data registry nor prevalence information on parkinsonism in the Iranian population. The aim of our study was to estimate the prevalence rate of probable parkinsonism in a huge urban area in Iran, Tehran using a community-based door-to-door survey. Materials and methods: We used a random multistage sampling of the households within the network of health centers consisting of 374 subunits in all 22 districts throughout the entire urban area of Tehran. Overall, 20,621 individuals answered the baseline checklist and screening questionnaire and data from 19,500 persons aged �30 years were entered in the fnal analysis. Health care professionals used a new six-item screening questionnaire for parkinsonism, which has been previously shown to have a high validity and diagnostic value in the same population. Results: A total of 157 cases were screened for parkinsonism using the validated six-item questionnaire. After age and sex adjustment based on the Tehran population, the prevalence of parkinsonism was calculated as 222.9 per 100,000. Using the World Health Organization�s World Standard Population, the standardized prevalence rate of parkinsonism was 285 per 100,000 (95 confdence interval 240-329). The male:female ratio of probable parkinsonism was calculated as 1.62, and there was a signifcant increase in the screening rate by advancing age. Conclusion: The calculated rates for the prevalence of parkinsonism in our study are closer to reports from some European and Middle Eastern countries, higher than reports from Eastern Asian and African populations, and lower than Australia. The prevalence rate of >200 in 100,000 for parkinsonism in Tehran, Iran could be considered a medium-to-high rate. © 2015 Fereshtehnejad et al

Mortality in Iranian patients with Parkinson's disease: Cumulative impact of cardiovascular comorbidities as one major risk factor

Mortality rate, life expectancy, survival, and the impact of comorbidities on them in people with Parkinson's disease (PD) need to be assessed in settings with different sociodemographic backgrounds. We investigated mortality features in Iranian PD patients focusing on the role of cardiovascular multimorbidity on their survival. Data on mortality and comorbidity profile was gathered in a cohort of 190 individuals with idiopathic PD referred to a Movement Disorders Clinic. Standardized mortality ratio (SMR) compared to the Tehran general population was 3.44 and the life expectancy at birth was 67.4 (95 CI: 59.1-75.8) yr. Patients with at least one cardiovascular comorbidity had a shorter survival time after PD onset (14.0 versus 29.2 yr, p = 0.012). The hazard ratio for death increased 2.8 times (95 CI: 1.5-5.2, p = 0.002) with one additional cardiovascular comorbidity. Among all comorbid conditions, stroke showed the strongest independent effect on mortality in PD patients HR = 13.1 (95% CI: 2.4-71.7), p = 0.003 . Conclusively, life expectancy was slightly lower in Iranian PD patients compared to the general population, while the SMR was high. Cardiometabolic multimorbidity substantially decreased survival in people with PD. Our study highlights the need for assessment, prevention, and treatment of cardiovascular morbidities in parkinsonian patients, given their effect on survival. © 2015 Seyed-Mohammad Fereshtehnejad et al

Relationship between oral health and demographic characteristics in retired elderly people in Iran بررس� ارتباط س�ا٠ت د�ا� با ٠شخصات ج٠ع� تش�اخت� سا�٠�دا� باز�شست�

Objectives The current study aimed to determine the relationship between oral health and demographic characteristics of retired elderly people. Methods & Materials This cross-sectional study was conducted on 158 older adults aged � 60 years. The subjects were selected using random sampling method and personnel codes. All the elderly participants were retired members of the Tehran Municipality Administration. The study data were collected by direct visit to the subjects' place of residence and conducting interviews. The data collection tool was a questionnaire that included 2 sections. The first section consisted of demographic, socioeconomic, and health profiles, while the second section consisted of Geriatric Oral Health Assessment Index (GOHAI). Results We collected data from 158 participants (90 men, 68 women). The mean age of the participants was 68.78 years. The obtained data suggested that 38 (24.05) participants had a poor state of oral health. About 50 of the participants mentioned high dental care costs as a reason for not referring to the dentist. According to the findings of this study, there is a direct relationship between educational level and oral health status in the elderly (P < 0.05). Conclusion Oral and dental health increase the quality of life in the elderly and reduce the high prevalence of dental problems among them. Therefore, designing and implementing practical policies to reduce oral and dental infections in the elderly and promote their health is necessary. © 2019. ا�دا� �د� از ا�� ٠طا�ع�� تع��� ارتباط س�ا٠ت د�ا� با ٠شخصات ج٠ع� تش�اخت� سا�٠�دا� باز�شست� ب�د. ٠�اد � ر�ش �ا ا�� پ���ش ب� ر�ش ت�ص�� �تح���� بر ر�� 158 ��ر سا�٠�د با�ا� 60 سا� تحت پ�شش ساز٠ا� باز�شستگ� ش�ردار� ت�را� ب� ر�ش �٠�� �گ�ر� تصاد�� ا�جا٠شد. داد ��ا ب� ص�رت ٠ست��٠� با ٠صاحب� ٠ست��٠گردآ�ر� شد. ابزار گردآ�ر� داد ��ا شا٠� پرس ش�ا٠� ٠شخصات ج٠ع� تش�اخت� � پرس ش�ا٠� شاخص س�جش س�ا٠ت د�ا� سا�٠�دا� ب�د. �ا�ت� �ا 90 ��ر ) 57 درصد( از پاسخگ��ا� سا�٠�دا� ٠رد � 68 ��ر ) 43 درصد( سا�٠�دا� ز� ب�د�د. ٠�ا�گ�� س� سا�٠�دا� ٠�رد ٠طا�ع� 78 / 68 سا� ب�د. س�ا٠ت د�ا� با س� ) 004 / P=0 (� ج�س ) 034 / P=0 (� � تحص��ات ) 0001 / P=0 ( رابط� ٠ع� �دار داشت. �ضع�ت س�ا٠ت د�ا� � د�دا� سا�٠�دا� ٠رد ب�تر از سا�٠�دا� ز� ب�د. �ت�ج� گ�ر� با ت�ج� ب� ا�٠�ت �را�ا� س�ا٠ت د�ا� � د�دا� در ا�زا�ش ک���ت ز�دگ� سا�٠�دا�� در ��گا٠طراح� ٠داخ�ات برا� ارت�ا� س�ا٠ت د�ا� سا�٠�دا�� ت�ج� ب� ���گ ��ا� ج٠ع� تش�اخت� آ ��ا ضر�ر� ب� �ظر ٠�رسد

Heterogeneous determinants of quality of life in different phenotypes of Parkinson's disease

Objectives Health-related quality of life (HRQoL) is considered a very important outcome indicator in patients with Parkinson's disease (PD). A broad list of motor and non-motor features have been shown to affect HRQoL in PD, however, there is a dearth of information about the complexity of interrelationships between determinants of HRQoL in different PD phenotypes. We aimed to find independent determinates and the best structural model for HRQoL, also to investigate the heterogeneity in HRQoL between PD patients with different phenotypes regarding onset-age, progression rate and dominant symptom. Methods A broad spectrum of demographic, motor and non-motor characteristics were collected in 157 idiopathic PD patients, namely comorbidity profile, nutritional status, UPDRS (total items), psychiatric symptoms (depression, anxiety), fatigue and psychosocial functioning through physical examination, validated questionnaires and scales. Structural equation model (SEM) and multivariate regressions were applied to find determinants of Parkinson's disease summary index (PDSI) and different domains of HRQoL (PDQ-39). Results Female sex, anxiety, depression and UPDRS-part II scores were the significant independent determinants of PDSI. A structural model consisting of global motor, global non-motor and co-morbidity indicator as three main components was able to predict 89 of the variance in HRQoL. In older-onset and slow-progression phenotypes, the motor domain showed smaller contribution on HRQoL and the majority of its effects were mediated through non-motor features. Comorbidity component was a significant determinant of HRQoL only among older-onset and non-tremor-dominant PD patients. Fatigue was not a significant indicator of non-motor component to affect HRQoL in rapid-progression PD. Conclusions Our findings showed outstanding heterogeneities in the pattern and determinants of HRQoL among PD phenotypes. These factors should be considered during the assessments and developing personalized interventions to improve HRQOL in PD patients with different phenotypes or prominent feature. © 2015 Fereshtehnejad et al

Neuropathic Pain Prevalence of Older Adults in an Urban Area of Iran: A Population-Based Study

Background. Pain prevalence would increase as the population grows older, but the exact prevalence rate is not apparent in Iran. Objectives. This study, therefore, set out to reveal the prevalence of pain, especially neuropathic type and explore its associated comorbidities among Iranian older adults in a large urban population-based survey. Methods. 5326 older people, aged � 60 years, were randomly chosen by a multistage, cluster sampling method. The selected people then were interviewed by using the following instruments: a standard questionnaire about pain, questions of interview part of Douleur Neuropathique 4 Questions (DN4) and its comorbidities, GHQ-28, and a sociodemographic checklist. Descriptive statistics and multiple regression analysis were conducted to analyze the gathered data. Results. The average of the participants' age was 68.92 ± 7.02 years. Of 5326 participants, 2529 (47.5) of participants were male. About one-third of this population had chronic pain. Chronic neuropathic pain prevalence was 13.7 and nociceptive in 30. Knee pain (20.6) and feet dysesthesia (7.8) were the most common sites of nociceptive and neuropathic pain, respectively. Results of multiple regression analysis revealed that the major comorbidities of chronic pain were osteoporosis, disability, diabetes mellitus, and stroke. Neuropathic pain experiences were significantly associated with GHQ-28 scores (t=-11.42, P<0.001). Conclusions. In addition to neuropathic pain, other subtypes of pain prevalence and the comorbidities are determined in the community-dwelling elder adults. This study highlights the importance of neuropathic pain and its adverse consequences and can be used to manage this populations' needs in Iran effectively. © 2019 Reza Salman Roghani et al

Comparison of the psychological symptoms and disease-specific quality of life between early- and typical-onset parkinson's disease patients

The impact of Parkinson's disease (PD) on psychological status and quality of life (QoL) may vary depending on age of disease onset. The aim of this study was to compare psychological symptoms and disease-specific QoL between early onset versus the rest of the PD patients. A total number of 140 PD patients with the mean current age of 61.3 (SD=10.4) yr were recruited in this study. PD patients with the onset age of ≤50 yr were defined as "early-onset" (EOPD) group (n=45), while the ones with >50 yr at the time of diagnosis were categorized as the "typical-onset" (TOPD) patients (n=95). Different questionnaires and scales were used for between-group comparisons including PDQ39, HADS (hospital anxiety and depression scale), FSS (fatigue severity scale), MNA (mininutritional assessment), and the UPDRS. Depression score was significantly higher in EOPD group (6.3 (SD=4.5) versus 4.5 (SD=4.2), P=0.02). Among different domains of QoL, emotion score was also significantly higher in the EOPD group (32.3 (SD=21.6) versus 24.4 (SD=22.7), P=0.05). Our findings showed more severe depression and more impaired emotional domain of QoL in early-onset PD patients. Depression and anxiety play an important role to worsen QoL among both EOPD and TOPD patients, while no interaction was observed in the efficacy of these two psychiatric symptoms and the onset age of PD patients. © 2014 Seyed-Mohammad Fereshtehnejad et al

Reliability and validity of the persian version of the fatigue severity scale in idiopathic Parkinson's disease patients

As one of the most frequent symptoms, measurement of fatigue is an issue of interest in Parkinson's disease (PD). The fatigue severity scale (FSS) is one of the recommended questionnaires for this purpose. The aim of our study was to evaluate psychometric properties of the Persian version of the FSS (FSS-Per) to assess fatigue in PD patients. Ninety nondemented idiopathic Parkinson's disease (IPD) patients were consecutively recruited from an outpatient referral movement disorder clinic. In addition to the disease severity scales, the FSS-Per was used for fatigue measurement. The internal consistency coefficient was larger than 0.8 for all of the items with a total Cronbach's alpha of 0.96 (95 CI: 0.95-0.97). The FSS-Per score correlated with the UPDRS score (r = 0.55, P 2) versus those with less severe disease (HY stage � 2) (AUC = 0.81 (95 CI: 0.72-0.90)). The FSS-Per fulfilled a high internal consistency and construct validity to measure the severity of fatigue in Iranian IPD patients. These acceptable psychometric properties were reproducible in subgroups of IPD patients regarding different levels of education, disease severity, sex and age groups. © 2013 Seyed-Mohammad Fereshtehnejad et al

Evolving evidence on a link between the ZMYM3 exceptionally long GA-STR and human cognition

The human X-linked zinc finger MYM-type protein 3 (ZMYM3) contains the longest GA-STR identified across protein-coding gene 5� UTR sequences, at 32-repeats. This exceptionally long GA-STR is located at a complex string of GA-STRs with a human-specific formula across the complex as follows: (GA)8-(GA)4-(GA)6-(GA)32 (ZMYM3-207 ENST00000373998.5). ZMYM3 was previously reported among the top three genes involved in the progression of late-onset Alzheimer�s disease. Here we sequenced the ZMYM3 GA-STR complex in 750 human male subjects, consisting of late-onset neurocognitive disorder (NCD) as a clinical entity (n = 268) and matched controls (n = 482). We detected strict monomorphism of the GA-STR complex, except of the exceptionally long STR, which was architecturally skewed in respect of allele distribution between the NCD cases and controls F (1, 50) = 12.283; p = 0.001. Moreover, extreme alleles of this STR at 17, 20, 42, and 43 repeats were detected in seven NCD patients and not in the control group (Mid-P exact = 0.0003). A number of these alleles overlapped with alleles previously found in schizophrenia and bipolar disorder patients. In conclusion, we propose selective advantage for the exceptional length of the ZMYM3 GA-STR in human, and its link to a spectrum of diseases in which major cognition impairment is a predominant phenotype. © 2020, The Author(s)

Heavy metals in the irrigation water, soils and vegetables in the Philippi horticultural area in the Western Cape Province of South Africa

The aims of this study were to investigate the extent of heavy metal contamination in the Philippi horticultural area in the Western Cape Province, South Africa. Concentrations of Cd, Cr, Cu, Mn, Ni, Pb and Zn were determined in the irrigation water, soils and vegetables in both winter and summer cropping seasons with an ICP-AES and tested against certified standards. Differences were found in heavy metal concentrations between the winter and summer cropping seasons in the irrigation water, soils and vegetables. Certain heavy metals exceeded the maximum permissible concentrations in the irrigation water, soils and vegetables produced in South Africa. These toxic concentrations were predominantly found in the summer cropping season for the soils and in the crops produced in winter. It is thus suggested that further studies are carried out in the Philippi horticultural area to determine the sources of the heavy metals to try and mitigate the inputs thereof and therefore reduce the amount of heavy metals entering the human food chain.ISI & Scopu