Evidence-based approach to HIV/AIDS policy and research prioritization in the Islamic Republic of Iran

In formulating the second national strategic plan for prevention of HIV/AIDS in the Islamic Republic of Iran a more evidence-based approach was needed. This paper reports on a systematic review of the local evidence about the determinants of HIV/AIDS transmission in 3 categories: poor knowledge and negative attitudes about HIV transmission; injection drug use; and sexual promiscuity. Of 93 reports reviewed, 53 met the inclusion criteria. Information about the prevalence and magnitude of effect for the 3 risk determinants at the national and regional level was scarce. Heterogeneity between studies, even in the same sub-population, was significant. An improved research base and better sharing of information are needed within countries of the Eastern Mediterranean Region

[Assessment of hoffer correction factor for biometry in eyes with phakic intraocular lens implants]

To assess Hoffer correction factor in measurement of axial length [AL] in eyes with phakic IOL implants. In this descriptive historical cohort study, axial length was measured by ultrasound [US] and IOL Master in both phakic and pseudophakic modes in 24 eyes of 14 patients with Artisan intraocular lenses [IOLs] implanted for refractive purposes, Hoffer's suggested formula for correcting ultrasound AL was applied to the data [cor-US] and all four datasets were compared to preoperative ultrasound AL values as standards. The mean difference between preoperative ultrasound measurements and postoperative readings by US [ALpo], IOL Master in phakic mode [AL IOL Mp], IOL Master in pesudophakic mode [AL IOL Mpp] and US corrected with Hoffer factor [ALhc], were 0.01, 0.022, 0.13, and 0.61mm, with mean absolute differences of 0.23, 0.23, 0.26, and 0.25mm, respectively. In these readings, respectively 42.3%, 37.5%, 57.50%, and 46.2% of differences were greater than 0.2 mm, which is considered to be clinically important. Use of the Hoffer correction factor has no clinical application for a more accurate biometry in patients with an Artisan implant. The most reliable method in this type of patients is making an accurate record of their preoperative AL measured with ultrasound or IOL Master

[Exposure to domestic violence in senior secondary school students of Tehran]

Domestic violence has a long history in human life and is the most prevalent form of violence against women. It is a worldwide problem that occurs in all societies with different cultures and socioeconomic groups. As this type of violence occurs generally inside families, children may be more prone to be directly exposed to this type of violence and the aftermaths compared to other types. Exposure to domestic violence has serious and long-lasting effects on emotional and cognitive conditions of children and also on their attitudes towards violence as a method for conflict management. This study has done by the purpose of assessment of frequency and nature of Tehran's secondary school student's exposure to their parent's physical violence against each other. It was a questionnaire survey on senior secondary school population in Tehran, in educational year 2005-06. The sampling method followed a multistage cluster sampling based on the exhaustive list of all senior secondary schools in 19 districts of Tehran and included all high schools, vocational training schools, technical training schools, and mixed vocational-theory [Kaar-Daanesh] schools. The frames were separated for girls and boys. Each district was considered as a stratum and the weight for each stratum in the sample was proportional to the population of the district. There were 1495 students participating in this survey, where the prevalence was estimated to be 22.8% [18.9% - 26.8%] more than half of them had eye-witnessed it [59.8%; 95% CI: 49.6% - 70.0%]. It is twice more prevalent in girls than in boys [31.2% vs. 16.1%]. Recent exposure to this type of violence was much less prevalent [5.7%; 95% CI: 3.6% - 7.8%] in the last month. The main type of violence was hand beating alone [57.1%; 95% CI: 46.8% - 67.3%] and there was mainly fathers who had perpetrated the violent act [54.3% only fathers vs .3.4% only mothers]. The exposure was long lasting and in those with more than one exposure the mean duration was 5.1 years [4.4-5.8]. Exposure to physical violence between parents is a common problem among teenagers in Tehran, a considerable portion of them had eye-witnessed it. It is of a continuous nature starting from childhood and lasting to mid teenages. Based on the results of this study, children are highly exposed to violent behavior between their parents and these events are often continuous. There is an urgent need to explore this possible source of future violence and the short and long term consequences of those exposures. Also, there is a need to conduct more analytical studies on the risk and protective factors for this problem, as well as occurrence of domestic violence per se

[The effect of withdrawal status in predisposing habitual opioid users to traffic accidents: a case-crossover study]

Road traffic injuries are among the most important causes of death and disability in Iran, and the country has one of the highest prevalence of opioid drug use, especially among drivers. The effect of different situations related to opioid use needs great attention. The purpose of this study was to estimate the effect of driving in the withdrawal phase on the occurrence of traffic accidents leading to injury. This is a Case-Crossover study on injured drivers of crashed motor vehicles in Kerman. Drivers having skipped one habitual drug dose within one hour of the driving session were considered as being in withdrawal. We compared the drivers' situation at the time of accident with their regular driving habits. Among 75 drivers who had history of regular use of opium, 15 were in withdrawal phase at the time of accident. The relative rate of occurrence of traffic injuries while driving in these circumstances was 2.67 [95% confidence interval: 1.52 - 4.68]. According to these findings we can conclude that habitual opioid users are at greater risk of traffic accidents while driving in withdrawal status; this risk is more than two-fold relative to not being in withdrawal status

[The degree of unemployment and reasons for not finding appropriate jobs among Iranian physicians]

Unemployment which had been a problem of less educated and unskilled people has become a problem in most of the countries for even the educated and the skilled persons. Unemployment among physicians in Iran has been the subject of discussion during the past so many years, and its severity, causes and ways of combating it has been a focus of discussions in different circles. It is a mail survey conducted on random sample, sized 5482 physicians, from registered physician roster at the Medical Association of Islamic Republic of Iran. The questionnaire included items on employment and unemployment quality and some related factors. The final analysis is based on the 2789 returned questionnaires. Total unemployment has a point prevalence of 9.4% among Iranian physicians [95% CI: 8.3% - 10.5%]. When summed with physicians with qualitative unemployment, this figure reaches 13.7% [95% CI: 12.4% - 14.9%]. Considering quantitative unemployment, the total ratio reaches 25.5%. Half of the unemployed physicians have seeked jobs for more than a year, and they mostly attribute their failure to low income of medical jobs and limited positions for physicians in the governmental sector. Unemployment, in different forms from total to qualitative and quantitative forms affects from one-tenth to one fourth of Iranian physicians. This problem is not limited to Iran, but has been seen in many other countries, especially those that had increased the strength of their medical students in the past. The solution of this problem needs its accurate identification and factors affecting it or related to it. Solving this problem needs finding its accurate fissure and the related factors