Customized clinical practice guidelines for management of adult cataract in Iran

Purpose: To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population. Methods: First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table showed the recommendation itself in clinical question components format along with its level of evidence. The second table contained structured abstracts of supporting articles related to the clinical question with their levels of evidence. The third table included the customized recommendation of the internal group respecting its clinical advantage, cost, and complications. In the fourth table, the internal group their recommendations from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). Finally, customized recommendations were sent one month prior to a consensus session to faculty members of all universities across the country asking for their comments on recommendations. Results: The agreed recommendations were accepted as conclusive while those with no agreement were discussed at the consensus session. Finally, all customized recommendations were codified as 80 recommendations along with their sources and levels of evidence for the Iranian population. Conclusion: Customization of CPGs for management of adult cataract for the Iranian population seems to be useful for standardization of referral, diagnosis and treatment of patients. © 2015 Journal of Ophthalmic and Vision Research | Published by Wolters Kluwer - Medknow

Economic inequality in prevalence of underweight and short stature in children and adolescents: The weight disorders survey of the caspian-IV study

Objective: The aim of this study was to determine the determinants of socio-economic inequality in the prevalence of short stature and underweight in Iranian children and adolescents. Subjects and methods: This cross-sectional nationwide study was conducted on 36,486 participants, aged 6-18 years. This school-based surveillance (CASPIAN-IV) program and its complementary part on weight disorders evaluation was conducted in urban and rural areas of 30 provinces in Iran. In addition to physical examination, a validated questionnaire was completed from students and their parents. Socio-economic status (SES) was determined using principal component analysis, and was classified in quintile scale. Inequality in the prevalence of underweight and short stature was assessed using concentration (C) index and slop index of inequality (SII) by the Oaxaca-Blinder decomposition method. Results: The prevalence (95 CI) of underweight and short stature at national level was 10.89 (10.55, 11.23) and 4.15 (3.94, 4.38), respectively; it had a downtrend from the lowest to highest SES quintile. Furthermore, the value of C for underweight and short stature was negative, i.e. inequality was in favor of high SES groups. Moreover, the prevalence gap of underweight and short stature in the first and fifth quintiles of SES was 6.58 and 5.80, respectively. The highest proportion of this gap was explained by living area. In the multiple logistic model, odds of underweight and short stature were significantly lower in individuals with higher SES. Compared to boys, odds of underweight were decreased in girls, whereas odds of short stature were increased in them. Odds of underweight and short stature were increased in participants from rural areas than in urban areas. With increasing age, the odds of underweight and short stature decreased significantly. Conclusions: The results of this study showed that inequality in the prevalence of short stature and underweight was in favor of high SES groups. Moreover, living area was one of the most important determinants that explained this inequality. Therefore, this issue needs to be considered in health promotion policies. © 2020, Sociedade Brasileira de Endocrinologia e Metabologia. All rights reserved

Association of sleep duration and snack consumption in children and adolescents: The CASPIAN-V study

Objectives: The relationship between sleep deprivation and the risk of overweight and obesity is somewhat known in children and adolescents. This study aimed to investigate the relationship between sleep duration and eating snacks in a national sample of children and adolescents aged 6�18 years old. Methods: This cross-sectional study was carried out on the data of the fifth survey of the national school-based surveillance system entitled the �Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable Disease� (CASPIAN-V) study. Short sleeping duration was defined 10 hr per day for children under 10 years and 9 hr per day for children � 10 years. To assess food habits, the consumption frequency of some food groups including sweets, salty snacks, carbonated beverages, diet soft drinks, soft beer, fresh fruits, dried fruits, fresh juices, vegetables, packed juices, dairy products (milk, yogurt, and cheese), fast foods, tea, sugar along with tea, and coffee was asked using Likert scale (never, rarely, weekly, and daily). Results: In multivariate model, short sleep versus long sleep in students was associated with increased chance of eating salty snacks (OR = 1.49 95% CI: 1.38�1.61; p =.001), soft drinks (OR = 1.12 95% CI: 1.04�1.20; p =.002), fast foods (OR = 1.66 95% CI: 1.54�1.79; p <.001), tea (OR = 1.49 95% CI: 1.39�1.61; p <.001), and tea with sugar (OR = 1.13 95% CI: 1.05�1.22; p <.001). In addition, short sleep in students was associated with a decreased odds of daily intake of soft drinks without sugars (OR = 0.64 95% CI: 0.58�0.70; p <.001), soft beer (OR = 0.92 95% CI: 0.85�0.99; p <.001), fresh fruit (OR = 0.83 95% CI: 0.76�0.90; p <.001), dried fruit (OR = 0.43 95% CI: 0.39�0.46; p <.001), fresh fruit juice (OR = 0.66 95% CI: 0.62�0.72; p <.001), packed juice (OR = 0.91 95% CI: 0.84�0.98; p <.009), milk (OR = 0.51 95% CI: 0.47�0.55; p <.001), yogurt (OR = 0.86 95% CI: 0.79�0.93; p �.001), and coffee (OR = 0.82 95% CI: 0.76�0.89; p �.001). Conclusions: The findings of this study indicate a significant relationship between sleep duration and unhealthy food habits. Therefore, increasing awareness of families in this area may reduce obesity and its complications. © 2020 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc

Socioeconomic inequality in childhood obesity and its determinants: a Blinder�Oaxaca decomposition Desigualdade socioeconômica na obesidade infantil e seus determinantes: decomposição de Oaxaca-Blinder

Objective: Childhood obesity has become a priority health concern worldwide. Socioeconomic status is one of its main determinants. This study aimed to assess the socioeconomic inequality of obesity in children and adolescents at national and provincial levels in Iran. Methods: This multicenter cross-sectional study was conducted in 2011�2012, as part of a national school-based surveillance program performed in 40,000 students, aged 6�18-years, from urban and rural areas of 30 provinces of Iran. Using principle component analysis, the socioeconomic status of participants was categorized to quintiles. Socioeconomic status inequality in excess weight was estimated by calculating the prevalence of excess weight (i.e., overweight, generalized obesity, and abdominal obesity) across the socioeconomic status quintiles, the concentration index, and slope index of inequality. The determinants of this inequality were determined by the Oaxaca Blinder decomposition. Results: Overall, 36,529 students completed the study (response rate: 91.32); 50.79 of whom were boys and 74.23 were urban inhabitants. The mean (standard deviation) age was 12.14 (3.36) years. The prevalence of overweight, generalized obesity, and abdominal obesity was 11.51, 8.35, and 17.87, respectively. The SII for overweight, obesity and abdominal obesity was �0.1, �0.1 and �0.15, respectively. Concentration index for overweight, generalized obesity, and abdominal obesity was positive, which indicate inequality in favor of low socioeconomic status groups. Area of residence, family history of obesity, and age were the most contributing factors to the inequality of obesity prevalence observed between the highest and lowest socioeconomic status groups. Conclusion: This study provides considerable information on the high prevalence of excess weight in families with higher socioeconomic status at national and provincial levels. These findings can be used for international comparisons and for healthcare policies, improving their programming by considering differences at provincial levels. © 2017 Sociedade Brasileira de Pediatri

Socioeconomic inequality in childhood obesity and its determinants: a Blinder�Oaxaca decomposition Desigualdade socioeconômica na obesidade infantil e seus determinantes: decomposição de Oaxaca-Blinder

Objective: Childhood obesity has become a priority health concern worldwide. Socioeconomic status is one of its main determinants. This study aimed to assess the socioeconomic inequality of obesity in children and adolescents at national and provincial levels in Iran. Methods: This multicenter cross-sectional study was conducted in 2011�2012, as part of a national school-based surveillance program performed in 40,000 students, aged 6�18-years, from urban and rural areas of 30 provinces of Iran. Using principle component analysis, the socioeconomic status of participants was categorized to quintiles. Socioeconomic status inequality in excess weight was estimated by calculating the prevalence of excess weight (i.e., overweight, generalized obesity, and abdominal obesity) across the socioeconomic status quintiles, the concentration index, and slope index of inequality. The determinants of this inequality were determined by the Oaxaca Blinder decomposition. Results: Overall, 36,529 students completed the study (response rate: 91.32); 50.79 of whom were boys and 74.23 were urban inhabitants. The mean (standard deviation) age was 12.14 (3.36) years. The prevalence of overweight, generalized obesity, and abdominal obesity was 11.51, 8.35, and 17.87, respectively. The SII for overweight, obesity and abdominal obesity was �0.1, �0.1 and �0.15, respectively. Concentration index for overweight, generalized obesity, and abdominal obesity was positive, which indicate inequality in favor of low socioeconomic status groups. Area of residence, family history of obesity, and age were the most contributing factors to the inequality of obesity prevalence observed between the highest and lowest socioeconomic status groups. Conclusion: This study provides considerable information on the high prevalence of excess weight in families with higher socioeconomic status at national and provincial levels. These findings can be used for international comparisons and for healthcare policies, improving their programming by considering differences at provincial levels. © 2017 Sociedade Brasileira de Pediatri

Association of screen time and physical activity with health-related quality of life in Iranian children and adolescents 11 Medical and Health Sciences 1117 Public Health and Health Services

Background: Health-related quality of life (HRQoL) is a multidimensional concept with significant effects and children and adolescence; while physical activity (PA) and screen time (ST) have been suggested as its probable predictors. Present study aims to investigate the association of PA, ST and their combination, with HRQoL in a nationally-representative sample of Iranian children and adolescents. Methods: As for the estimated sample size, 25,000 students aged 6-18 years were selected via multi-stage cluster sampling from 30 provinces of Iran. Sociodemographic data was obtained by using the questionnaire of the World Health Organization-Global school based student health survey (GSHS). Persian Pediatric Quality of Life inventory (PedsQL) and Physical Activity Questionnaire for the pediatric age group (PAQ-A) were applied for evaluating HRQoL and PA, respectively. PA scores 1-1.9 and 2-5 were respectively considered as low and high PA. The average duration of time spent on watching TV and leisure time computer use were considered as ST behaviors. ST of less than 2 h was considered low. Results: Out of 25,000 invited individuals, 23,043 students (mean age: 12.5) completed the study (response rate: 92.17). In linear regression models, ST duration had significant inverse association with total QoL (β:-0.49, p < 0.05). PA showed positive significant associations with HRQoL total score (β: 1.8, p < 0.05). Joint association of PA and ST revealed the strongest association of "high PA-low ST" category with total HRQoL (β: 2.2, p < 0.05); while "high PA-high ST" showed better total HRQoL score (β: 1.3) compared to "low PA-low ST" subgroup. Conclusion: Both PA and ST are significantly and independently associated with HRQoL in Iranian children and adolescents; while the adverse effect of prolonged ST could be diminished by a high PA. © 2019 The Author(s)

Association of dietary patterns with continuous metabolic syndrome in children and adolescents; A nationwide propensity score-matched analysis: The CASPIAN-V study

Objective: This study aims to determine the association of dietary patterns with metabolic syndrome (MetS) and its components in children and adolescents. Methods: This nationwide study was conducted in 2015 among 4200 students aged 7-18 years, who lived in 30 provinces in Iran. The analysis was conducted based on the propensity score using a matched case-control study design. Three dietary patterns were obtained conducting a principal component analysis with a varimax rotation on 16 dietary groups. Continuous MetS score was computed by standardizing the residuals (z-scores) of MetS components by regressing them according to age and sex. The gold standard diagnosis of MetS was considered based on the International Diabetes Federation criteria. Moreover, for the purpose of data analysis, matched logistics analysis was used. Results: The study participants consisted of 3843 children and adolescents (response rate 91.5) with mean (SD) age of 12.45 (3.04) years. Totally 49.4 of students were girls and 71.4 lived in urban areas. Three dietary patterns were obtained: Healthy, Western, and Sweet. Prevalence of MetS was 5 (boy 5.5 and girl 4.5). Results of multivariate analysis show that students with Sweet dietary patterns were at higher risk for abdominal obesity (OR 1.29; 95 CI 1.01-1.66), elevated blood pressure (OR 1.35; 95 CI 1.01-1.81) and MetS (OR 1.33; 95 CI 1.02-1.74). The two other dietary patterns were not associated with MetS and its components. Conclusion: Sweet dietary pattern increase the risk of MetS and some its components in Iranian children and adolescents. This finding provides valuable information for effective preventive strategies of MetS based on diet rather than medication to maintain healthy lifestyle habits. © 2018 The Author(s)

Evolution of protein-coupled RNA dynamics during hierarchical assembly of ribosomal complexes

Assembly of 30S ribosomes involves the hierarchical addition of ribosomal proteins that progressively stabilize the folded 16S rRNA. Here, we use three-color single molecule FRET to show how combinations of ribosomal proteins uS4, uS17 and bS20 in the 16S 5&apos; domain enable the recruitment of protein bS16, the next protein to join the complex. Analysis of real-time bS16 binding events shows that bS16 binds both native and non-native forms of the rRNA. The native rRNA conformation is increasingly favored after bS16 binds, explaining how bS16 drives later steps of 30S assembly. Chemical footprinting and molecular dynamics simulations show that each ribosomal protein switches the 16S conformation and dampens fluctuations at the interface between rRNA subdomains where bS16 binds. The results suggest that specific protein-induced changes in the rRNA dynamics underlie the hierarchy of 30S assembly and simplify the search for the native ribosome structure

An allosteric role for receptor activity-modifying proteins in defining GPCR pharmacology

G protein-coupled receptors are allosteric proteins that control transmission of external signals to regulate cellular response. Although agonist binding promotes canonical G protein signalling transmitted through conformational changes, G protein-coupled receptors also interact with other proteins. These include other G protein-coupled receptors, other receptors and channels, regulatory proteins and receptor-modifying proteins, notably receptor activity-modifying proteins (RAMPs). RAMPs have at least 11 G protein-coupled receptor partners, including many class B G protein-coupled receptors. Prototypic is the calcitonin receptor, with altered ligand specificity when co-expressed with RAMPs. To gain molecular insight into the consequences of this protein–protein interaction, we combined molecular modelling with mutagenesis of the calcitonin receptor extracellular domain, assessed in ligand binding and functional assays. Although some calcitonin receptor residues are universally important for peptide interactions (calcitonin, amylin and calcitonin gene-related peptide) in calcitonin receptor alone or with receptor activity-modifying protein, others have RAMP-dependent effects, whereby mutations decreased amylin/calcitonin gene-related peptide potency substantially only when RAMP was present. Remarkably, the key residues were completely conserved between calcitonin receptor and AMY receptors, and between subtypes of AMY receptor that have different ligand preferences. Mutations at the interface between calcitonin receptor and RAMP affected ligand pharmacology in a RAMP-dependent manner, suggesting that RAMP may allosterically influence the calcitonin receptor conformation. Supporting this, molecular dynamics simulations suggested that the calcitonin receptor extracellular N-terminal domain is more flexible in the presence of receptor activity-modifying protein 1. Thus, RAMPs may act in an allosteric manner to generate a spectrum of unique calcitonin receptor conformational states, explaining the pharmacological preferences of calcitonin receptor-RAMP complexes. This provides novel insight into our understanding of G protein-coupled receptor-protein interaction that is likely broadly applicable for this receptor class