The minimum basic dataset for diagnoses of cerebrovascular disease: Methodological issue on reliability

Reliability (precision, repeatability, agreement) and validity (accuracy) are two completely different issues which should be assessed using appropriate tests. It is crucial to know that, reporting concordance rate; the selection error rate and the classification error rate are not the most appropriate estimates to assess reliability. Regarding reliability, for qualitative variables, weighted kappa should be used with caution. However, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio positive and negative as well as diagnostic accuracy are estimates that are usually used to evaluate the validity of a test compared to a gold standard

Comment on “Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage”

Comment and Respons

Evaluation of oral hygiene care of under 4 years old children by their mothers based on the Health Belief Model

Objective: Oral health is one of the basic components of preschool children's health. Young children completely depend on their parents, specially their mothers, to have an appropriate oral health. Health belief model shows the relationship between some structures related to personal perceptions, barriers and perceived self-efficiency, and behavior. This study aims to determine the oral health  care status of children under 4 by their mother according to health belief model in Tehran.Methods: In this cross-sectional (descriptive-analytic) study, 200 mothers with children under 4 who visited health care centers under the authority of Shahid Beheshti University of medical Sciences were randomly chosen. A questionnaire which was designed according to health belief  model (HBM) was used to collect data. Collected data was analyzed by SPSS software.Results: It was found that only in 10% of the cases knowledge score was favorable. Participants scored 50.85%, 75.93%, 72.23%, 92.06%, 48.2%, 86.31%, 64.07% in knowledge structures, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self efficiency  and behavior respectively. Knowledge structures (p<0.01, r=0.276), perceived barriers (p<0/01, r=0/314) and perceived self efficiency (p<0.01, r=0.269) showed positive correspondence and significant relationship with the oral and dental health behaviors by their mothers. Structures of health belief model could describe 17.9% of behavior variance. Amongst these structures, perceived barriers had more important role.Conclusion: This study estimated that the behavioral status of oral and dental health care of children under 4 by their mothers is moderate. Therefore planning an educational program using behavioral models and theories, such as health belief model is suggested, so that it can increase knowledge and self-efficiency and reduce perceptive barriers to promote children's oral health

Assessment of Stress in General Dentists in Tehran City

Objectives: This study sought to assess the level of stress in general dentists in the 2nd district of Tehran city in 2014 to find out the stressors and suggest strategies to overcome them.Methods: This descriptive, analytical, cross-sectional study was conducted on 130 general dentists from the 2nd district of Tehran city selected via weighted randomization. Level of stress was assessed using Coudron stress questionnaire. Data were analyzed using SPSS version 20.0 and Spearman’s correlation coefficient, Chi square test and ordinal logistic regression tests. P<0.05 was considered statistically significant.Results: All types of stress (occupational, life health, personal life and personality) were significantly correlated. Normal life health stress (compared to high stress) decreased occupational stress to approximately one third. Level of occupational stress was 2.5 times lower in subjects with normal level of stress in their personal life and 2 times lower in subjects with normal personality stress. Most dentists, irrespective of gender and marital status had high levels of occupational stress. Only 11.27% of those with a work experience of less than 10 years had normal life health stress. Personal life stress was significantly correlated with age, work place, and work experience (P<0.05).Conclusion: Most dentists, irrespective of gender (male: 67.3%, female: 73%) and marital status (married: 66.3%, single: 74.2%) had high levels of occupational stress. The effects of age, gender, marital status, work place and work experience were variable on occupational, life health, personal life and personality stresses and depended on the type of stress assessed

Intra-oral low level laser therapy in chronic maxillary sinusitis: a new and effective recommended technique

Background: Chronic sinusitis is one of the most common chronic diseases involving different age groups. Because the nature and etiology of chronic sinusitis are not completely known, there is not any standard treatment for this disease. It has been suggested that low-level laser can be used in treating chronic sinusitis but there are limited studies about its usage. In this research, intra-oral radiation of low-level laser has been described and implemented for the first time. Suggested hypotheses about the efficacy of this type of radiation (intra-oral) in treating chronic maxillary sinusitis includes this fact that the depth of maxilla’s vestibule is also the floor of maxillary sinus and sinus discharges collect in this area because of gravity effect. Therefore, with considering suitable radiation angle, this area gets the most benefits of laser’s anti-inflammatory effects. Material and Methods: In this study, 20 patients with chronic maxillary sinusitis were included. They were assessed before and after treatment. Treatment plan was performed in 8 sessions every other days using low-level diode laser with 810 nm. Snot-22 questionnaire and rhinomanometry were used for evaluating patients. Changes of signs and symptoms were recorded in questionnaire every session and 6 months after treatment. Friedman and Wilcoxon tests were used for data analyses. In this study, P value < 0.05 was considered statistically significant. Results: All variables and all symptoms of patients were improved using intra-oral low-level laser and this improvement was statistically significant ( P value<0.05). There was also significant decrease in nasal airway resistance and significant increase in air flow ( P value<0.05). Six month after treatment completion, there was no significant difference between the results of completion and the results of 8th treatment session ( P value< 0.05). Conclusions: Using intra-oral low-level laser is a suitable way to treat patients with chronic maxillary sinusitis

Inter-scan reproducibility of coronary calcium measurement using Multi Detector-Row Computed Tomography (MDCT)

Purpose: To assess inter-scan reproducibility of coronary calcium measurements obtained from Multi Detector-Row CT (MDCT) images and to evaluate whether this reproducibility is affected by different measurement protocols, slice thickness, cardiovascular risk factors and/or technical variables. Design: Cross-sectional study with repeated measurements. Materials and methods: The study population comprised 76 healthy women. Coronary calcium was assessed in these women twice in one session using 16-MDCT (Philips Mx 8000 IDT 16). Images were reconstructed with 1.5 mm slice thickness and 3.0 mm slice thickness. The 76 repeated scans were scored. The Agatston score, a volume measurement and a mass measurement were assessed. Reproducibility was determined by estimation of mean, absolute, relative difference, the weighted kappa value for agreement and the Intra-class correlation coefficient (ICCC). Results: Fifty-five participants (72.4%) had a coronary calcification of more than zero in Agatston (1.5 mm slice thickness). The reproducibility of coronary calcium measurements between scans in terms of ranking was excellent with Intra-class correlation coefficients of >0.98, and kappa values above 0.80. The absolute difference in calcium score between scans increased with increasing calcium levels, indicating that measurement error increases with increasing calcium levels. However, no relation was found between the mean difference in scores and calcium levels, indicating that the increase in measurement error is likely to result in random misclassification in calcium score. Reproducibility results were similar for 1.5 mm slices and for 3.0 mm slices, and equal for Agatston, volume and mass measurements. Conclusion: Inter-scan reproducibilility of measurement of coronary calcium using images from MDCT is excellent, irrespective of slice thickness and type of calcium parameter

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2.5 air pollution, 1990-2019 : an analysis of data from the Global Burden of Disease Study 2019

Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2.5 originating from ambient and household air pollution.Methods We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2.5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure-response curve from the extracted relative risk estimates using the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2.5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2.5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals.Findings In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2.5 exposure, with an estimated 3.78 (95% uncertainty interval 2.68-4.83) deaths per 100 000 population and 167 (117-223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13.4% (9.49-17.5) of deaths and 13.6% (9.73-17.9) of DALYs due to type 2 diabetes were contributed by ambient PM2.5, and 6.50% (4.22-9.53) of deaths and 5.92% (3.81-8.64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2.5.Interpretation Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2.5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2.5 air pollution, 1990-2019 : An analysis of data from the Global Burden of Disease Study 2019

Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. Methods We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure–response curve from the extracted relative risk estimates using the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. Findings In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68–4·83) deaths per 100 000 population and 167 (117–223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49–17·5) of deaths and 13·6% (9·73–17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22–9·53) of deaths and 5·92% (3·81–8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2·5. Interpretation Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes