Trends in outpatient cataract surgery in the Islamic Republic of Iran, 2006–2010

This study aimed to determine the trends in outpatient cataract surgery and its determinants in the Islamic Republic of Iran between 2006 and 2010. In this cross-sectional study, 106 cataract surgery centres were selected in all provinces by multistage randomized cluster sampling. The number of centres in each province was determined from the number of cataract operations and the number of patient charts examined in each centre was proportionate to the number of cataract operations in that centre. The prevalence of outpatient surgery increased from 46.0% [95% CI, 35.3-56.8] in 2006 to 51.4% [95% CI, 40.2-62.7] in 2010 [P = 0.549]. Patients stayed in hospital for more than one night after 10.5% [95% CI, 6.9-14.1] of operations. Use of phacoemulsification and topical anaesthesia increased the prevalence of outpatient surgery and decreased intraoperative complications. Although outpatient cataract surgery increased by 11.7%, use of methods such as phacoemulsification is not widespread, and more attention should be paid to the barriers to outpatient cataract surgery in the Islamic Republic of Iran

Contributions of public and private sectors to the Iranian cataract surgery output

This study determined trends in the contributions of the public and private sectors to the cataract surgery output in the Islamic Republic of Iran. Data about cataract surgeries performed at surgical centres throughout the nation were extracted from patient charts for a 5-year period from 2006 to 2010. Of the total 516 273 surgeries performed in 2010, more were done in public sector centres [61.7%] than private ones [38.3%]. The total number of surgeries increased by 59.1% between 2006 and 2010. Analysis of the relative contributions of the public and private sectors showed a 41.0% increase in surgeries in public centres and 100.5% in private centres over the 5-year period. Thus the rate of growth of cataract surgery in the private sector was 2.7 times greater than that in the public sector. Despite a smaller contribution to the total number of cataract surgeries, the private sector has experienced a substantial rate of growth

[Distribution of pupil diameter and their related factors in 40-64 years old population of Shahroud]

To determine the mean pupil diameter by the Pentacam in the 40-64 year-old population of Shahroud and its association with some related factors. Three hundred clusters were selected through multistage cluster sampling in the first phase of Shahroud Cohort study of whom 82.2% participated in the study. Refraction, slit lamp examination, and imaging by the Pentacam were performed for all participants. The pupil diameter obtained by the Pentacam was analyzed. Any history of previous ocular surgery and invalid Pentacam data were the criteria for excluding data from further analysis. After implementing the exclusion criteria, the data of 3820 individuals [59.3% female] were analyzed. The mean pupil diameter in this study was 2.74 +/- 0.56 mm [95%CI 2.72-2.76]. The 25%, 50%, 95% and 97.5% percentiles of the pupil diameter in the study population were 2.41, 2.67, 3.60 and 3.85 mm, respectively. In this study, the 95% of the normal range of pupil diameter was 1.63-3.85 mm. In the multiple model, the mean pupil diameter was smaller in men compared to women and decreased significantly with aging [P<0.001]. The mean pupil diameter was significantly larger in myopic versus hyperopic participants [P<0.001]. The pupil diameter was significantly smaller in participants with dark brown irises [P=0.005]. Anisocoria was observed in 9.43% [95%CI 8.43-10.44] of the participants. The pupil diameter in normal individuals by the Pentacam is found to be smaller than other techniques. A cut point of 3.85 mm for the pupil diameter is suggested as the critical criterion for refractive surgery. Moreover, it should be noted that men have a smaller pupil diameter, and that the pupil diameter decreases with aging

[ rate of cataract surgery in Khorasan Razavi, 2006-2010]

To determine the trend of the cataract surgical rate in Khorasan Razavi Province between 2006 and 2010. Five centers were randomly selected from the cataract surgery centers of Khorasan Razavi Province. Using the definition of more than 3000 cataract surgeries per year for a major center, 3 centers were major and 2 were minor. One week of each season was randomly selected for each center and the number of cataract surgeries in that particular week was calculated. A total of 20 weeks for each center were selected. Finally, a percentage of the records, proportionate to the number of surgeries per week, were thoroughly analyzed. The total number of cataract surgeries was estimated 21388, 22750, 23888, 28063, and 30100 from 2007 to 2011, respectively. The cataract surgical rate, considering the population of Khorasan Razavi province, increased linearly from 3782 [95% CI 3732-3833] in 2007 to 5021 [95% CI 4965-5078] in 2011 per 1,000,000 people. In addition, the types of surgeries were intracapsular, extracapsular, phacoemulsification, lensectomy in which were recorded as 0.3%, 15.1%, 84.56%, and 0.1% of the cases, respectively. During the five years of the study, phacoemulsification increased significantly from 74.7% in 2007 to 90.4% in 2011 while the extracapsular method decreased from 14.7% to 9.2% in the same period of time. About 0.87% of the surgeries developed intraoperative complications. This study reported the cataract surgical rate in Khorasan Razavi province exclusively for the first time. The calculated rate was noticeably better than previous reports and was desirable and acceptable according to the WHO standards. However, with regard to the increase in the elderly population of the province, the rate should be even higher to cover all individuals requiring cataract surgery. Therefore, provision of the cataract surgery facilities, especially for the phacoemulsification, and education of this method should receive priority in the health system of this province

Predictors of transition in smoking stages in Iranian adolescents: latent transition analysis

This study determined the prevalence of smoking stages in adolescents, the probability of transition across stages and the personal and environmental predictors of transition. A school-based study was conducted in 2010-11 using a random sample of 5197 students [mean age 15.7 years] in Tabriz city. The students were evaluated twice, 12-months apart. The latent transition analysis model revealed 9 interpretable statuses for the measurement of smoking stages. Prevalence data showed that at the first and second assessments 75.1% and 66.8% of students respectively were in the committer stage, while 4.8% and 7.1% respectively were daily smokers. Over 12 months, 10.1% of the never smokers became experimenters and 1.7% became regular smokers, while 17.0% of experimenters became regular smokers. The analysis also showed factors associated with transitions in cigarette smoking stages. Although the prevalence of smoking was low in our adolescents, the rate of becoming a smoker over 1 year was high

familial aggregation of cigarette smoking in Kish, Iran

Based on WHO reports, smoking is an epidemic in developing countries. One of important issues about this behavior is its distribution pattern in family members. The main purpose of this study was to evaluate if cigarette smoking had a tendency to cluster or aggregate in the families and what the determinants were. Using a multi-stage random cluster sampling approach, a household survey was conducted in Kish Island in 2009. We used the Alternating Logistic Regressions algorithm to model to show the familial aggregation. The odds ratio for the aggregation of cigarette smoking between family members was 1.63 [1.29-2.06] which increased to 1.96 [1.50-2.55] after adjustment for demographic factors. There was no significant correlation between siblings' cigarette smoking nor was between spouses but the pairwise odds ratio for parents offspring was significant. In other words, cigarette smoking in at least one of the parents increased the odds of being a smoker in offspring significantly. The study showed that the smoking behavior aggregated in families significantly. The inter-parent offspring aggregation was the main component of the familial aggregation. Higher education and age-gender interaction were determinants of smoking in the families. The programs for prevention and cessation of this behavior in the community might be more successful if they were designed in a family-based rather than an individual- based approach

Substance abuse in high school students in association with socio-demographic variables in Northwest of Iran

Substance abuse in adolescents and its often tragic consequences, including addiction, is one of the preventable major public health problems. The aims of this paper were to estimate the prevalence of substance abuse and to evaluate its some associated factors in adolescents of Tabriz City [northwest of Iran]. A self-administered questionnaire was completed in 4903 randomly selected students with mean age of 15.7 years old. The aim of the questionnaire was obtaining information on substance abuse, socio-economical information, cigarette smoking behavior, general risk taking behavior, self-esteem, attitude towards smoking and self-injury as well as demographical characteristics. Prevalence of substance abuse was 1.4% [95% CI: 1.1-1.7] which was different statistically significant between boys [2.4%] and girls [0.6%] [P<0.001]. Older age [OR=1.43], not living with parents [OR=2.34], having general risk taking behavior [OR=2.26], higher smoking stage [OR=2.39], lower self-esteem [OR=1.09] and positive attitude toward smoking [OR=1.08] were factors associated with student's ever use of substance. The result has shown low prevalence of substance abuse in Iranian adolescents. Our findings showed some associated factors such as lower self-esteem with adolescent's substance abuse

An investigation on vehicle's fuel consumption and exhaust emissions in different driving conditions

In this paper, vehicle's fuel consumption and exhaust emissions are investigated in different driving conditions based on driving segments clustering. Driving data collection is performed using global positioning systems in real traffic conditions. The driving data is clustered into five groups using k-means clustering technique. Vehicle's fuel consumption and exhaust emissions [i.e. HC, NOx and CO] are investigated in different driving conditions using computer simulations. The relationship between driving features and vehicle's fuel consumption and exhaust emissions is also presented. According to the simulation results, vehicle's fuel consumption decreases as average velocity increases from very congested traffic condition to freeway traffic condition. The most HC is produced is low speeds. The results also demonstrate that high accelerations and decelerations cause high amount of NOx. About the CO emission, a moderate driving in which the velocity and accelerations are not very high or very low, leads to the least amount of CO

Quality of life in the group of patients with chronic eye disease

To assess vision related quality of life and determinants in patients afflicted with chronic eye disease. In this analytical cross-sectional study, consecutive sampling was performed at Noor Eye Hospital between 2008 and 2009. A valid and standard 39-item visual functioning questionnaire [National Eye Institute visual functioning questionnaire, NEI-VFQ 39] was completed. The questionnaire consists of 11 domains related to vision and one domain about general health. The total score range from zero [0] to 100, where a higher score reflects better vision related quality of life. The independent t-test, pearson correlation coefficient as well as simple and multiple linear regression models were employed for statistical analysis. The mean overall score in patient and control groups were 54.5 [95% confidence interval [Cl] 57.3 -71.8] and 96.0 [95% CI: 88.2-103.9], respectively. Patients with cataracts had the highest score [64.6; 95%CI: 57.3 - 71.8] and those with visual acuity of 20/70 or worse showed lowest scores [41.9; 95%CI: 30.7 - 53.1]. Age [P=0.006] and education level [0.001] were associated with quality of life score. Based on our study findings, it could be concluded that low vision patients with a visual acuity of 20/70 or worse hardly received half of the total scores. Diabetic retinopathy, age related macular degeneration, glaucoma, and cataract stand in ascending rank order. The relatively lower scores as compared to results from other countries warrant further research into the causes of such differences

Effect of air pollution on onset of acute coronary syndrome in susceptible subgroups

While long-term exposure to air pollutants is associated with an increase in heart diseases and mortality, little information is available about the short-term effects of air pollution. This case-crossover study assessed the relationship of particulate matter [PM[10]] and carbon monoxide [CO] levels with hospital admission for acute coronary syndrome in Tehran, Islamic Republic of Iran. We interviewed 250 patients with a first episode of acute coronary syndrome and obtained data from hospital records and Tehran Air Quality Control Company. The risk of acute coronary syndrome was significantly associated with elevated concentrations of CO the day before the event [OR 1.18; 95% CI: 1.03-1.34] but not significantly with PM[10] [OR 1.00; 95% CI: 0.99-1.02]. Stratification by age, sex, diabetes, hypertension and smoking status did not affect the results, but women were more susceptible than men to CO levels [OR for women/men 1.68; 95% CI: 1.25-2.26]

[Accuracy of digital panoramic in detection of interproximal caries]

Conventional radiological equipments in our country are going to be converted to digital system using computed radiology [CR] technology. If we know the accuracy of digital panoramic radiography for detection of small defects in tooth, it will be useful in cases with difficulty for taking the intraoral radiographs. The aim of this study was to evaluate sensitivity and specificity of digital panoramic radiography for detection of proximal caries compared with the bitewing radiography. One-hundred patients who had been ordered for taking both bitewing and panoramic radiography were included in this study. Panoramic and then bitewing radiographs were observed by a maxillofacial radiologist and interproximal caries were recorded. Sensitivity and specificity of digital panoramic radiography [CI=95%] was calculated compared with the bitewing radiography as a gold standard. This study showed that the values for sensitivity and specificity were 62.7% [CI 95%=57.7%-67.5%] and 91.0% [CI 95%=89.2%-92.5%], respectively. Sensitivity of digital panoramic is less than bitewing radiography even with processing before printing. Therefore, bitewing radiography is superior for detection of inter proximal caries

[To determine the prognostic factors in esophageal cancer using log-logistic regression model in Iran]

Each year almost 400,000 people are diagnosed with oesophageal cancer worldwide. Wide variation in incidence has been reported both between countries and in different ethnic groups and populations within a country. The area with the highest reported incidence for oesophageal cancer is the so-called Asian 'oesophageal cancer belt', which stretches from eastern Turkey through north-eastern Iran, northern Afghanistan and southern Russia to northern China. In the high risk area of Gonbad in Iran, world age-standardised rates are more than 200 per 100,000 and the male/female ratio is reported as 0.8:1.0.This study aimed to assess the risk factors and demographic factors influencing survival of patients with esophageal cancer in north of Iran using weibull and log-logistic regression models. Demographic and clinical data of 359 patients with confirmed diagnosis of esophageal cancer from Babol Cancer registry utilized for our model. parametric and weibull models were employed to analyze the data. The Akaike information criterion [AIC] was also considered as a criterion to select the best model[s]. All p values as 0.05 were considered as statistically significant. The sample study consisted of 62.7% men and 37.3% women. Estimated survival rates in 1, 3, and 5 years following diagnosis were 23%, 15%, and 13% respectively. According to AIC criterion, the hazard rate of non-monotonic and rejection proportional hazards assumption [p<0.05], log-logistic model was more efficient than weibull model. Family history of having cancer in patients showed a significant difference in both models. It is concluded that early detection of people with a family history of cancer can be effective as an important factor in reducing the risk of death in patients with esophageal cancer

Survival of male breast cancer in Fars, south of Iran

Although breast cancer in men is uncommon, its incidence rates has an increasing trend. Due to its low incidence, there are few studies in this subject and limited information is available. The purpose of this study was to investigate clinicopathological characteristics and survival of male breast cancer [MBC] in Fars Province, south of Iran. The data for this study were obtained from the population based cancer registry of Vice-Chancellor for Health Affairs of Shiraz University of Medical Sciences and Shiraz hospitals between January 1, 1989 and January 1, 2008, including 64 patients with MBC. Demographic, clinical and pathological aspects were investigated. The Kaplan-Meler method was used for the determination of survival rate and Log Rank test for the comparison. The Cox proportional hazards model was used for the multiple analysis. The patients' mean age at the time of diagnosis was 60,3 years [SD=12.7]. The most frequent age group [26.6%] was 51-60 years. The most common symptom [96.8%] was a palpable mass. The majority of patients [44.4%] had a symptom duration of less than or equal to 6 months. 56.3% of the patients had a tumor size of 2-4.9 cm. Forty six percent of the cases had axillary lymph node involvement. The median survival time was 10.0 years [95% confidence interval [CI]: 6.0-14.0]. The 5 year overall survival rate was 66.0% [95% CI=51.08-81.0%]. The median survival time of patients with axillary lymph node involvement was 8.2 years [95% CI=6.7-9.6] and for the cases without involvement was 12.0 years [95% CI=8.4-15.2]. In addition to axillary lymph node involvement, positive family history in contrast to negative family history and left tumors in comparison with right tumors were poorer prognostic factors in univariate analysis respectively [p=0.006, p=0.031]. In multiple analysis, axillary lymph node involvement was an independent predictor of poorer survival [Hazard ratio=1.6, 95% CI=1.1-6.4, p=0.030] and the other variables did not have a significant effect. The mean age of MBC in this series is lower than that in western countries. It is compatible to the mean age of female breast cancer which is approximately one decade less than that in developed countries. The survival rate of MBC is relatively lower than that in western countries. Axillary lymph node involvement is an important prognostic factor in the survival of MBC. Multicenter population based studies with greater number of patients are required for better estimation of different aspects of MBC in Iran

[Residual refractive errors following cataract surgery and its determinants]

To evaluate residual refractive errors after cataract surgery and its determinant factors at Farabi Eye Hospital, Tehran. Simple random sampling was done among cataract surgery scheduled patients over a 4 year period [2003-2006]. Exclusion criteria were uveitis, previous intraocular surgery and ocular trauma. After applying the exclusion criteria, 423 patients were studied. Lens calculation was performed using the SRK-II formula. Unexpected refractive errors were defined as the difference between postoperative refractive errors with target refraction. Mean and percentage of this variable were reported based on 0.5, 1 and 2 D of ametropia. Of 558 studied patients, 78.1% had biometric data before and refractive data after surgery. Mean absolute unpredictable refractive error was 0.84 +/- 0.89 D. Eyes with normal axial length [AL] had the least [0.76 +/- 0.84] and those with long AL had the most unpredictable refractive errors [P<0.001]. 45.9%, 73.9%, and 91.7% of the study cases had refractive errors within 0.5, 1 and 2 D of emmetropia, respectively. Eyes with short AL had positive refraction and those with long AL had negative refraction after surgery. The majority of keratometric astigmatism followed extra-capsular surgery while the least measures were associated with phacoemulsification [P<0.001]. Axial length was one of the important factors influencing residual refractive errors after cataract surgery. Unpredictable refractive errors were more common in eyes with long and short AL than those with normal AL

Association between alzheimer's disease and apolipoprotein E polymorphisms

Alzheimer's disease as a neurodegenerative disorder is the commonest type of dementia. A growing number of genes have been reported as the risk factors, which increase the susceptibility to Alzheimer's disease. Apolipoprotein E [APOE], which its 4 allele has been reported as a risk factor in late onset Alzheimer's disease [AD], is the main cholesterol carrier in the brain. The main goal of this study was to assess the role of APOE genotypes and alleles in AD in Iranian population. This study was performed in Tehran, Iran from 2007 to 2008. Totally, 154 AD cases and 162 control subjects from Iranian population were genotyped for APOE using PCR method. Genotype and alleles frequencies for APOE were calculated and compared between AD case and control subjects by epsilon 2 or Fisher's exact test. Type one error assumed less than 0.05. The frequency of epsilon 2 epsilon 3 genotype was significantly higher in control subjects than AD patients was [13.5% versus 5.2%, P<0.05] and epsilon 3 epsilon 4 genotype frequency was significantly higher in AD cases compared with control subjects. APOE-epsilon 2 allele frequency in cases was lower than that of control subjects but this difference was not significant [4.2% versus 7.7%]. It seems that individuals carrying epsilon 4 allele, develop AD 6.5 times more than non-carriers do [OR=6.566, 95% CI=2.89-14.92]. It has been reported that epsilon 4 allele acts in dose-age-dependent manner but we have shown that the risk of developing AD in male APOE-epsilon 4 allele carriers is higher than that of female epsilon 4 carriers

Does group prenatal care affect satisfaction and prenatal care utilization in Iranian pregnant women?

The need to provide high quality prenatal care services, which take account of women's views and specifically address their need for information, support and communication, has been advocated and group prenatal care, had been suggested as one of the ways to achieve this objective. The purpose of this study was to examine the impact of group versus individual prenatal care on satisfaction and prenatal care use. This was a cluster-randomized controlled trial with the health center as the randomization unit that conducted in 2007. Satisfaction was measured through a standardized questionnaire, and the Kotelchuck Adequacy of Prenatal Care Utilization Index was used to measure prenatal care utilization. We recruited 678 women [group prenatal care, [N=344] and individal prenatal care, [N=334] in the study. Women in group prenatal care model were more satisfied than women in individual prenatal care model in all areas evaluated, including information, communication, co-ordination and quality of care. Group care women were significantly more likely to have adequate prenatal care than individual care women were [OR=1.35 95% CI=1.26-1.44]. Group prenatal care was associated with a significant improvement in client satisfaction and prenatal care utilization. This model of care has implications for the planning and provision of prenatal services within public health system, which is moving toward a better quality health care, and increasing use of services

Metaplot: a novel stata graph for assessing heterogeneity at a glance

Heterogeneity is usually a major concern in meta-analysis. Although there are some statistical approaches for assessing variability across studies, here we present a new approach to heterogeneity using "MetaPlot" that investigate the influence of a single study on the overall heterogeneity. MetaPlot is a two-way [x, y] graph, which can be considered as a complementary graphical approach for testing heterogeneity. This method shows graphically as well as numerically the results of an influence analysis, in which Higgins' I2 statistic with 95% [Confidence interval] CI are computed omitting one study in each turn and then are plotted against reciprocal of standard error [1/SE] or "precision". In this graph, "1/SE" lies on x axis and "I2 results" lies on y axe. Having a first glance at MetaPlot, one can predict to what extent omission of a single study may influence the overall heterogeneity. The precision on x-axis enables us to distinguish the size of each trial. The graph describes I2 statistic with 95% CI graphically as well as numerically in one view for prompt comparison. It is possible to implement MetaPlot for meta-analysis of different types of outcome data and summary measures. This method presents a simple graphical approach to identify an outlier and its effect on overall heterogeneity at a glance. We wish to suggest MetaPlot to Stata experts to prepare its module for the software

Direct estimation of life expectancy in the Islamic Republic of Iran in 2003

We estimated the life expectancy for 2003 for 23 provinces in the Islamic Republic of Iran using population and mortality data from the Ministry of Health and Medical Education. The underreporting of deaths above 4 years was corrected using the Brass Growth Balance method. We assumed that the distributions of population, deaths, and hence life expectancy in the 23 provinces were equal to those for all 28 provinces of the country. Thus we estimated life expectancy at birth to be 71.56 years for the total population [95% uncertainty interval [UI]: 71.52-71.62]; 70.09 [95% UI: 70.02-70.16] years for males, and 73.17 [95% UI: 73.10-73.24] years for females. Our estimates were higher than the model-based estimates of the Statistical Centre of Iran, United Nations agencies and the World Bank, due to differences in the estimation methods used

[Prevalence of amblyopia in school children in Mashhad]

To determine the prevalence of amblyopia and its determinants in students of region 1 in Mashhad, 2006. Using randomized cluster sampling, 2510 students were selected to undergo ophthalmologic examinations. Amblyopia was defined as corrected visual acuity of 8/10 or less in either eye. Of the 2510 selected student, 2150 were examined [85.6% participation rate]. The prevalence of amblyopia was 1.9% [95% confidence interval [CI], 0.94 to 2.9] including 2.1% in female and 1.7% in male subjects [P=0.620]. Amblyopia was detected in right eye in 31.7%, left eye in 41.5% and both eyes in 26.8%. About 66% of amblyopic cases had refractive errors. The prevalence of amblyopia in students of region 1 in Mashhad is comparable to that of other parts of the country. Refractive error is a significant risk factor for occurring amblyopia

[Prevalence of hepatitis B virus [HBV] infection among Iranian prisoners during 2001-2005]

To determine the prevalence of Hepatitis B Virus [HBV] infection, as a blood borne viral infection, among prisoners and its associated factors in Iran. In this cross sectional study, 5317 inmates, who had stayed in prison for at least 3 months, were tested in 7 provinces from 2001 to 2005. The degree of contamination with HBV and its association with age and drug abuse were evaluated. The frequency of contamination with HBV ranged from 1% to 15% in different prisons. Overall frequency was 6.7% [95% CI: 6.1%-7.4%]. The crude and adjusted association between HBV infection and age was studied. While adjusted for prisons. The result showed no significant association between age and HBV infection [P = 0.88] based on Mantel Heanszel test. However, there was a significant association between HBV infection and drug abuse in two out of seven prisons [where the data was available]. The frequency of contamination with HBV infection is relatively high [more than twice] in prisons comparing to the general population [6.7% VS 2.8%]. Planning regular screening, preventive practices such as vaccination against HBV in prisoners as well as easy access to therapeutic facilities are highly recommended