Suicidal ideation and its related factors among older adults: a population-based study in Southwestern Iran.

OBJECTIVES: Suicidal ideation is a major risk factor for suicide and can negatively affect self-care and health behaviors among the older adults. There are limited data on the prevalence and risk factors of suicidal ideation among the older population during the COVID-19 pandemic. The aim of the present study was to examine the prevalence and risk factors of suicidal ideations among Iranian older adults during the COVID-19 pandemic. METHODS: A total of 803 older community adults in Shiraz (Southwestern Iran) were surveyed to determine potential factors influencing suicidal ideation, including demographic factors, physical health status, access to healthcare, current depression status, fear of COVID-19, perceived social support, and social engagement. Data were collected utilizing face-to-face interviews between November and December 2020. Multivariate logistic regression analysis was used to identify independent variables associated with suicidal ideations. RESULTS: Among the 803 participants, 69 reported suicidal ideations (8.6%). Individuals with suicidal ideations were more likely to have greater fear of COVID-19. However, based on the results of multivariate logistic regression analysis, current depression (OR: 2.07, CI 95%: 1.18-3.65), not being married (OR: 1.82, CI 95%: 1.06-3.13), inability to pay for medical bills (OR: 2.16, CI 95%: 1.23-3.79), low perceived social support (OR: 2.03, CI95%: 1.11-3.71), and having limited social network (OR:1.77, CI 95%: 1.02-3.10) appeared to be more powerful influencing factors. CONCLUSION: Suicidal ideation appears to be relatively common among Iranian older adults during the COVID-19 pandemic. A lack of longitudinal data makes it difficult to establish an association between suicidal ideations and the COVID-19 pandemic. Systematic monitoring of suicidal ideation is recommended among high-risk groups, particularly the older population.

Evaluating the Validity and Reliability of the Persian Version of American Orthopedic Foot and Ankle Society Midfoot Scale.

BACKGROUND: The use of a valid and reliable outcome scoring system is crucial for evaluating the result of different treatment interventions. The aims of this study were to translate and culturally adapt the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system into the Persian language and assess its validity and reliability. METHOD: In total, 57 patients with midfoot injuries were enrolled. Forward-backward translation and cultural adaptation methods were used to develop the Persian version of AOFAS midfoot scoring system. Reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's alpha. The discriminant and convergent validities of the scoring system were assessed using the total score of the mental and physical component of SF-36. RESULTS: The mean age of the participants was 46.2 ± 16.3 years. The intra-observer reliability of the totals core of the Persian version of AOFAS midfoot scoring system was 0.96 (confidence interval [CI]: 0.92-0.97) and the inter-observer reliability of the scoring system was 0.90 (CI: 0.86-0.95). The Persian version of AOFAS midfoot scoring system had acceptable convergence with physical component scoring system of SF-36 and its subscales (0.57); moreover, it had acceptable discriminant validity with the mental component of SF-36 and its subscales (0.36). CONCLUSION: The Persian version of AOFAS midfoot is a reliable and valid instrument and could be used by Persian language clinicians and researchers. LEVEL OF CLINICAL EVIDENCE: 3.

The prevalence of refractive error in schoolchildren.

CLINICAL RELEVANCE: Information on the refractive error prevalence in school-aged children will result in delivering the optimal eye health service to this group. BACKGROUND: Understanding the prevalence of refractive error in school-aged children is crucial to reduce the consequences of uncorrected refractive error. This study aims to investigate the prevalence of refractive error among school-aged children in Shiraz, Iran. METHODS: In this cross-sectional population-based study, 2001 schoolchildren aged 6-12 years participated. All participants underwent cycloplegic refraction. Spherical equivalent (SE) of -0.50 dioptre or more was considered as myopia, SE of +2.00 dioptre or more as hyperopia, and astigmatism as cylinder power of 0.75 dioptre or more. The difference of 1.00 dioptre or more between two eyes defined as anisometropia. RESULTS: The prevalence of myopia was 11.6% (95% confidence interval [CI]: 10.2-13.1%), hyperopia 6.7% (95%CI: 5.6-7.9%), and astigmatism 28.9% (95%CI: 26.9-31.0%), out of which 82.1% had with the rule astigmatism. Anisometropia was detected in 4.0% (95%CI: 3.2-5.0%) of children. Astigmatism and anisometropia were significantly higher in boys (p < 0.001, p = 0.03 respectively). The SE decreased significantly with increasing age (p < 0.001) indicating an increase in myopia with age. In addition, the rate of myopic astigmatism increased with age (p < 0.001). Among studied schoolchildren 97.0% could achieve the best-corrected visual acuity of 6/6 and 3.0% could not in the better eye. CONCLUSION: Astigmatism was the most common refractive error among primary school children. The prevalence of myopia was relatively higher than other studies conducted in Iran, and it increased with age. These results may highlight the role of lifestyle changes and increased near work activities on the myopic shift in school-aged children. The findings provide information for screening programmes in school-aged children.

Prevalence of tobacco smoking and its socioeconomic determinants: Tobacco smoking and its determinants.

INTRODUCTION: The epidemic tobacco use is a public health concern worldwide. This study aimed to evaluate the prevalence of tobacco use and its socioeconomic determinants in the city of Shiraz, Iran. METHODS: In total, 5873 adults aged 20 and older were included in this study from the city of Shiraz, Iran, from June to October 2015. The sampling was conducted using the stratified random sampling method. Active cigarette, hookah, and second-hand smokers were labeled as tobacco users in this study. Past smokers and non-smokers were labeled as non-tobacco users. The participants' socioeconomic status (SES) was determined based on their self-reported level of education, occupation, income, and residence. RESULTS: In this study, 35.4% of the participants were tobacco users. The prevalence of active cigarette, active hookah, dual-users, and secondhand smokers was 13.3%, 8.3%, 0.4%, and 13.4%, respectively. The prevalence of tobacco use was highest among individuals with primary education level (40.9%), manual jobs (46.4%), lowest income level (38.1%), and those living in the suburban areas (36.4%). In multivariate analysis, the most socioeconomic factors related to tobacco usage were lack of academic education, manual job, and low-income level. CONCLUSIONS: Tobacco control efforts should be more focused on vulnerable groups of cigarette and hookah users in the southwest of Iran. Moreover, SES and reduction of health-related disparities and inequality should be considered a crucial concern in this regard.

The Prevalence and Causes of Low Vision and Visual Impairment in School-Aged Children: The Shiraz Pediatric Eye Study.

Purpose: To determine the prevalence and causes of visual impairment (VI) in Shiraz schoolchildren aged between 6 and 12 years. Methods: In the present population-based study, stratified random sampling was used to select 2400 schoolchildren aged 6-12 years from all four educational districts of Shiraz, Iran. Using the definitions of the World Health Organization, VI was defined as best-corrected visual acuity (BCVA) ≤0.5 logMAR (20/60) in the better eye, and blindness as BCVA worse than 1.3 logMAR (20/400) in the better eye. The low vision was defined as BCVA equal to or worse than 0.5 logMAR (20/60) in either eye. Data were recorded from a detailed interview and ocular examination of each eligible student. Results: The mean age of the students was 9.1 ± 1.6 years. The prevalence of VI was 3/2001 (0.14%). The cause of VI in all these three patients (100%) was amblyopia due to high refractive errors (high ametropia and astigmatism). Regarding the main refractive errors leading to VI among these three patients, one patient had bilateral high hyperopia (compound hyperopic astigmatism), one of them had bilateral high astigmatism, and the other one had compound myopic astigmatism. According to a visual acuity of less than or equal to 20/60 in at least one eye, 9/2001 (0.4%) of children had low vision. Conclusions: This study revealed a low prevalence of VI in a sample of 6- to 12-year-old school-aged children. Amblyopia in the setting of high ametropia and astigmatism were the most common causes of VI.

Osteoporosis guideline awareness among Iranian nurses: results of a knowledge and attitudes survey.

INTRODUCTION: Osteoporosis is a chronic and progressive disease associated with gradual bone loss and elevated risk of fracture. Role of health care professional especially nurses in lowering burden of osteoporosis via patients and public education is critical. Current study conducted to evaluate knowledge and attitude regarding osteoporosis among the nurses in orthopedic wards and their experience with national clinical osteoporosis guideline. METHODS: A cross-sectional study was conducted from August to December 2016 among all nurses in orthopedic ward of hospitals affiliated to Shiraz University of Medical Sciences. The 23- item self-administered scale consisted of knowledge and attitude questions were used. Moreover, data regarding participation in osteoporosis training courses and awareness of the national osteoporosis clinical guideline were collected as a measure of nurses' experience with guideline. The gathered data were analyzed using SPSS (V. 16), student t-test was used to compare total knowledge and attitude scores between categorical demographic and professional data. Pearson test was used to calculate the correlation between total knowledge and attitude scores and years of practice. A p-value < 0.05 was considered statistically significant. RESULTS: From total of 160 nurses, 143 of them completed the questionnaire (response rate: 89.3%). The total mean ± SD knowledge and attitude scores were 11.60 ± 3.10 and 3.47 ± 0.92 respectively. Six nurses (4.2%) had participated in osteoporosis training courses after graduation, and 39 (27.3%) had been aware of the national osteoporosis clinical guideline. Knowledge and attitude scores among nurses who practice in private hospitals was higher than those practices in the teaching hospitals. These differences were statistically significant based on student t-test. According to Pearson correlation coefficient, there was positive and significant correlation between nurses' knowledge and attitude score (Correlation coefficient: 0.199, p-value = 0.037). CONCLUSION: Our findings reveal that nurses' knowledge and attitude regarding osteoporosis was not satisfactory. Most of them were not aware of national osteoporosis clinical guideline and had not participated in osteoporosis training courses after their graduation. We need more empowered nurses to lowering burden of osteoporosis and its consequences in the future.

Doctor-patient communication skills: a survey on knowledge and practice of Iranian family physicians.

BACKGROUND: Communication skills are fundamental to successful medical practice and can greatly impact patient satisfaction, compliance and outcomes. This study evaluated knowledge and practice of doctor- patient communication among the urban family physicians based on main items of Calgary Cambridge Observation Guides. METHOD: This cross-sectional study was conducted from July to September, 2019, in a 400 randomly selected sample of family physicians of Shiraz, Fars province. The data collection tool was a self-administered, second-part questionnaire developed by the researchers. Participants were asked about their age, gender, practice setting, and years of work experience and if they received any formal training in doctor- patient communication. Data were analyzed using SPSS (Version 16, SPSS Inc., Chicago, IL, USA). A p-value of less than 0.05 was considered statistically significant. RESULTS: The study participants included 204 male and 196 female family physicians with a mean age of 46.7 ± 7.7 years. The mean communication skills knowledge score was 41.5 (SD: ± 2.8) indicating a high level of knowledge. The mean score for practices was 38.7 (SD: ± 3.4), implying a moderate level of practice. Based on Bloom's scale, nearly 80% of family physicians had good knowledge about doctor-patient communication skills, however, 55% of participants reported moderate to poor level of practice in this regard. Results of multivariate regression analysis suggest that higher levels of related knowledge, having higher age or longer work experience, and working in the public sector can predict better practice scores (P < 0.005). CONCLUSION: There is a potential gap between knowledge and self-reported practices toward communication skills among a sample of Iranian family physicians. They have fundamental weakness in the most important evidence-based items of doctor- patient communication. Considering significant role of family physicians in prevention and control of non-communicable diseases (NCDs) as an emerging challenge of our country, the topic of communication skills should be inserted as a top educational priority of family physicians.

Distribution of intraocular pressure in healthy Iranian children: the Shiraz Pediatric Eye Study.

PURPOSE: To describe the mean and normal range of intraocular pressure (IOP) and its associations in healthy Iranian school children using the noncontact tonometer. METHODS: In this cross-sectional study as part of the Shiraz Pediatric Eye Study, a stratified random sampling was performed among elementary school children of Shiraz, Iran. Basic demographics and socioeconomic status of households, past medical history, drug history, and eye health history were collected for each eligible student. Children underwent complete ophthalmic examination. Axial length, corneal curvature, and anterior chamber depth were measured using the IOL-Master 500. RESULTS: Of 2,001 eligible children, 1,901 (95.0%; 3,802 eyes) with a mean age of 9.1 ± 1.6 years (standard deviation; range, 6-12 years) had reliable IOP. The mean spherical equivalent refraction was 0.5 ± 1.3 D for the right eye and 0.6 ± 1.2 D for the left eye. Mean IOP in the right eye was 15.1 ± 2.5 mm Hg (median, 15.0; range, 8.0-27.0 mm Hg); in the left eye, 15.2 ± 2.5 mm Hg (median, 15.0; range, 9.0-28.0 mm Hg). In multiple regression analyses, the mean IOP was significantly lower among asthmatic children compared to normal participants (P = 0.007). The measured IOP was significantly higher in myopic participants than hyperopic patients (P = 0.003). CONCLUSIONS: This study provides a useful normative IOP database using the noncontact tonometer for healthy Iranian school children.

American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Joint Scale: A Cross-Cultural Adaptation and Validation Study in the Persian Language.

We evaluated the reliability and validity of the Persian translation of the American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal joint scale (AOFAS Hallux MTP-IP). The translated AOFAS Hallux MTP-IP scale form was completed for 101 patients with hallux deformities; the subjective questions were answered by the patients, whereas the orthopedic foot and ankle surgeon and his assistant answered the objective questions. The validated Persian version of the 36-Item Short Form Survey Instrument (SF-36) was used for validity assessment. Eighty-five females and 16 males with a mean age of 49 years were enrolled. Hallux valgus and hallux rigidus was the diagnosis in 73 and 28 patients, respectively. Intrarater reliability had a high level of correlation (rho >0.6) for all subscales and total score. Although the correlation between the total score of the AOFAS Hallux MTP-IP scale and role: physical subscale of SF-36 was the highest (rho = 0.47), the total score of AOFAS Hallux MTP-IP scale and the other 7 domains of SF-36 had a correlation ranging between -0.17 and 0.43. Moreover, the correlation between total score of AOFAS-Hallux MTP-IP and SF-36 physical component summary scale was 0.50, which was higher than the correlation between total score of AOFAS and SF-36 mental component summary scale (rho = 0.35). Convergent validity was approved for MTP joint motion (0.59), IP joint motion (0.51), and callus (0.56) items of AOFAS-Hallux MTP-IP. Spearman's rank correlation coefficient between all items of the functional subscale of AOFAS Hallux MTP-IP scale with its own subscales was higher than the coefficient between these items and other subscales, including pain and alignment (discriminate validity). Floor and ceiling effects were calculated as 2% and 1%, respectively. Our findings indicate that the translated Persian version of the AOFAS Hallux MTP-IP scale is a reliable instrument, but its validity is not satisfactory.

Medical Error Reporting: Status Quo and Perceived Barriers in an Orthopedic Center in Iran.

BACKGROUND: Medical error reporting is fundamental for improving patient safety. We surveyed healthcare professionals to evaluate their experience of adverse events witness and reporting, knowledge about adverse events, attitude toward own and colleagues' errors, and perceived barriers in reporting errors. METHODS: This cross-sectional study was conducted on healthcare professionals from May to October 2017 at Chamran hospital, which is the largest referral orthopedic center in southern Iran. The self-administered questionnaire comprised 32 items covering five domains: (1) demographic and professional characteristics, (2) medical error witness and reporting, (3) actual and perceived knowledge regarding type of events and the status of completed training courses, (4) attitude toward reporting one's own and colleagues' errors, and (5) perceived barriers in error reporting. Questionnaire validity and reliability was proven in our previous study. RESULTS: From a total of 210 participants, 164 returned completed questionnaires (response rate = 78.1%); 87 (53%) were physicians and 77 (47%) were nurses. Underreporting was common, particularly among physicians. Out of physicians and nurses, 57.1% and 49.4% had poor knowledge, respectively. Participants reported their own or colleagues' errors alike, but physicians tended to only provide verbal warning to their colleagues (36.8%), and nurses stated they would report the colleagues' errors, if it was serious (32.4%). Fear of blame and punishment and fear of legal ramification were the most important perceived barriers. CONCLUSIONS: Improvements in current medical error registry system, implementing effective educational courses, and modifying the curricula for students seem to be necessary to resolve the problem of underreporting and poor knowledge level.

Visual Impairment Prevalence, Causes, and Role of Healthcare Access: A Systematic Review and Meta-Analysis in Iran.

PURPOSE: Healthcare access is one of the determinants of visual impairment (VI), as a public health problem. The objective of this study was to estimate VI prevalence, related causes, and its correlation with access to physicians in Iran. METHODS: : This systematic review and meta-analysis include observational studies published in Iran. PubMed, Web of Science, Scopus, Google Scholar, and local databases were systematically searched by using the MeSH headings. Data on the provincial distribution of physicians, as an index of access to healthcare, was retrieved. A random-effect meta-analysis was performed to assess. RESULTS: Eight articles were included. The pooled prevalence of blindness, low vision, and VI was 0.80% (95% CI: 0.61-0.99%), 2.92% (95% CI: 2.40-3.44%), and 5.57% (95% CI: 4.71-6.43%). Refractive errors were the most common causes of VI based on PVA with the pooled prevalence of 54.6% (95% CI: 43.4-65.8%). Based on BCVA, we found that the pooled prevalence of cataracts was 37.4% (95% CI: 29.5-45.3%) as the most common cause of VI. The results of metaregression showed that the greater number of general practitioners (GPs) (P value = 0.01) and pharmacists (P value = 0.024) per population were associated with a lower prevalence of blindness. CONCLUSION: Some of the main causes of visual impairment in Iran are preventable. Access to healthcare services may lead to early diagnosis of preventable causes of VI. Further well-designed studies and national surveys should be conducted to provide accurate data from different regions of Iran.

Socioeconomic-related determinants of asthma in the elderly.

INTRODUCTION: As the population ages, the impact of asthma in the elderly is expected to be enhanced over the forthcoming decades. We investigated the prevalence of asthma and its socioeconomic factors in the elderly, Shiraz, Iran. METHODS: In this population-based study, 1527 subjects older than 60 years were selected based on the stratified random sampling method. The data on asthma symptoms, current asthma, physician diagnose asthma, and allergic rhinitis were collected using the translated ECRHS (European Community Respiratory Health Survey) questionnaire. Information on individual socioeconomic status was derived from the participants' self-reported educational level and their occupation, income, and residence. A p-value of less than 0.05 was considered to be statistically significant. RESULTS: The prevalence of asthma, current asthma, physician diagnose asthma, and allergic rhinitis was found to be 8.97, 6.81, 4.78 and, 23.51%, respectively. The most common asthma symptoms were nocturnal chest tightness (15.52%, n = 237/1,527). In univariate analysis, the prevalence of asthma was higher in illiterate patients (12.7%), subjects with the lowest income level (10.6%), and patients living in urban areas (24.1%). Having age more than 80 (OR = 2.01; 95% CI = 1.10-3.65), being a current smoker (OR = 2.76; 95% CI = 1.69-4.51) and living in a suburban area (OR = 3.01; 95% CI = 1.20-7.50) were significant predictive factors for asthma in the regression model. CONCLUSIONS: Asthma and allergic rhinitis in the elderly should be more focus in the southwest of Iran. Moreover, our findings highlighted the effect of socio- economic status, disparities and inequality on community health.

Trends in age at first marriage in women and related factors: A population-based study in southwestern Iran.

Marriage and related processes seem to show individual tendencies but are in fact social phenomena. The aim of this study was to identify, among women, trends in age at first marriage and its related factors. In this cross-sectional study, the target population was women in households in Fars Province, Iran. To identify main effects of variables associated with age at marriage, multiple linear regression modeling was used without interactions. Women's age, women's and their husbands' occupations and educational levels, and place of residence were included in multiple linear regression modeling. A total of 3074 ever-married women were interviewed. A steep upward trend over time in age marriage was observed. The mean age at first marriage was 16.9 ± 3.4 years in women who married during the period from 1954 to 1974, and 21.9 ± 4.1 years among those who married during 2005-2014. Age at first marriage was significantly positively associated with women's and men's educational levels and with husband's employment status as laborers (p = 0.017) and negatively associated with husbands being employees (compared to being unemployed) (p < 0.001). Health providers should focus on increasing public awareness of factors associated with early and with delayed marriage.

Psychometric properties of the Glaucoma Quality of Life-15 questionnaire: Use of explanatory factor analysis.

PURPOSE: The purposes of this study were to validate the Persian translation of the Glaucoma Quality of Life-15 (GQL-15) questionnaire, evaluate its psychometric properties, and identify new composite items and item numbers. METHODS: This cross-sectional study was conducted from August to November 2016, at the Glaucoma Clinic of the Ophthalmology Department at Shiraz University of Medical Sciences, Iran. One hundred ninety patients with glaucoma were enrolled. Habitual-corrected visual acuity (HCVA), intraocular pressure (IOP), slit-lamp biomicroscopy, fundus exam, and mean deviation (MD) of the visual field were recorded in the course of clinical examination by glaucoma professional. Psychometric properties, i.e. test-retest reliability, internal consistency, content validity, and construct validity were evaluated with factor analysis. Based on the Disc Damage Likelihood Scale (DDLS), patients were stratified to mild, moderate, and severe disc damage. The association between the GQL-15 scores and disease severity (mild, moderate and severe) were evaluated by the analysis of variance (ANOVA). RESULTS: Of 190 eligible glaucoma patients, reliable clinical data were available for 140 participants. Mean age [standard deviation (SD)] of the patients was 58.7 (13.3) years. Cronbach's α coefficient ranged from 0.74 to 0.91, and the correlation coefficient for total score was 0.53. The content validity ratio (CVR) was 0.91 based on evaluations in expert panel. Exploratory factor analysis (EFA) based on eigenvalue higher than one identified two factors after varimax rotation for the GQL-15 which explained 66.5% of the total variance. Discriminant validity analysis disclosed statistically significant differences in mean quality of life scores between levels of disease severity. CONCLUSION: The Persian version of the GQL-15 is a reliable and valid questionnaire for use in glaucoma clinics as a complementary tool for evidence-based decision-making.

The Shiraz Pediatric Eye Study; a Population Based Survey of School Age Children: Rationale, Design and Baseline Characteristics.

PURPOSE: To describe the rationale, study design, methodology, and baseline characteristics of the Shiraz Pediatric Eye Study, a population-based survey of schoolchildren in Shiraz, Iran. METHODS: This population-based study included schoolchildren aged 6-12 years from all four educational districts of Shiraz who were recruited in years 2015-2016. Stratified random sampling was used to select 2400 participants from all districts. Data were recorded from a detailed interview and ocular evaluation of each eligible student. The eye examination comprised uncorrected and best corrected visual acuity measurement, refraction, external eye examination (including specific strabismus and lid evaluation tests), slit lamp biomicroscopy, intraocular pressure measurement, the Ishihara color vision test, and stereoacuity. Exophthalmometry, optical biometry, and optical coherence tomography were performed for a randomly selected subset of children. General characteristics and socioeconomic variables were also recorded to assess risk factors. RESULTS: From a total of 2400 selected students, 2001 (83.3%) participated in the study. The mean age of the students was 9.1 ± 1.6 years, and 59.7% were girls. Most children had at least one parent with a diploma or less than diploma (63.5%), and 2.2% had illiterate parents. CONCLUSION: This study is expected to provide accurate estimates of the prevalence of visual impairments and their related determinants in Shiraz. In addition, it will identify children who should be targeted by blindness prevention programs.

Vision-Related Quality of Life in Iranian Patients With Keratoconus: National Eye Institute Vision Function Questionnaire-25.

BACKGROUND: Use of patient-reported outcomes to evaluate the impact of ocular conditions on quality of life (QoL) is rising. Hence, the aims of this study were to determine the impact of keratoconus on QoL, and assess the National Eye Institute of the United States Vision Function Questionnaire (NEI-VFQ) performance in an Iranian population. METHODS: From November 2016 to June 2017, patients with keratoconus definitive diagnosis for more than one year who were being routinely followed at a cornea clinic were recruited. The NEI-VFQ-25 was administered during a face-to-face interview. Ocular examinations comprised best-corrected visual acuity (BCVA) was logged monocularly and binocularly, anterior segment biomicroscopy, refraction, and corneal topography. Keratoconus severity was graded based on steep keratometric (K) reading values. A group of 30 age- and sex-matched subjects with other ocular diseases (except keratoconus) were selected randomly from the cornea clinic. P<0.05 was considered as significant. RESULTS: The mean age of participants was 28.7±7.6 years. The lowest NEI-VFQ subscale scores were related to ocular pain, general vision, mental health, and role difficulty. Almost all NEI-VFQ scores in patients were statistically significant less than mean score of the control group. Composite and all subscales NEI-VFQ scores were lower significantly among patients with higher disease duration (≥5 years). Among clinical data, patients with BCVA ≥0.5 in the better eye had significantly lower NEI-VFQ composite score. Severe keratoconus patients (steep K reading ≥52) had lower NEI-VFQ scores in mental health and dependency subscales (P<0.05). The overall and subscales Cronbach α was above 0.7. CONCLUSION: Iranian patients with keratoconus had physical, emotional, and social impairment in QoL. The NEI-VFQ-25 might be applicable in further studies.

Asthma and its related socioeconomic factors: The Shiraz Adult Respiratory Disease Study 2015.

OBJECTIVE: This study aimed to explore the association between the prevalence of asthma and the socioeconomic factors using data from the Shiraz Adult Respiratory Disease Study, 2015(SARDS). METHODS: The SARDS was conducted from June to October 2015 among adult subjects of the general population of Shiraz, Iran. Current asthma was defined as the presence of at least 1 of the following factors in the preceding 12 months: (1) being awakened by an attack of shortness of breath, coughing, or chest tightness without any identifiable cause; (2) having an asthma attack; (3) currently using medication for asthma; or (4) having wheezing or whistling in the chest not associated with a cold or the flu. Information on individual socioeconomic status was derived from self-reported education level, occupation, income, and residence location. A value of P < .05 was considered statistically significant. RESULTS: A total of 4582 respondents aged 20-60 years were included in the analysis. The overall prevalence of adult asthma was 7.8%. The prevalence of asthma was higher significantly among female and subjects with higher body mass index, allergic rhinitis, smokers, jobless, and individuals who live in suburban areas. In the adjusted logistic regression model, being jobless (odds ratio [OR], 2.256; 95% confidence interval [CI], 1.123-4.535) and living in a suburban area (OR, 1.735; 95% CI, 1.058-2.845) were the most significant socioeconomic predictive factors for adult current asthma. CONCLUSIONS: It can be concluded that lower socioeconomic status is associated with higher adult current asthma prevalence. Target interventions are necessary to reduce disparities in healthcare systems.

American Orthopaedic Foot and Ankle Society ankle-hindfoot scale: A cross-cultural adaptation and validation study from Iran.

BACKGROUND: The use of valid and reliable outcome rating scales is essential for evaluating the result of different treatments and interventions. The purposes of this study were to translate and culturally adapt the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS-AHFS) into Persian languages and evaluate its psychometric properties. METHODS: Forward-backward translation and cultural adaptation method were used to develop Persian version of AOFAS-AHFS. From March to July 2016, one hundred consecutive patients with ankle and hindfoot injuries were included. Internal consistency and reproducibility were evaluated using Cronbach's alpha, Spearman's rank correlation coefficient and Intraclass correlation coefficient (ICC) respectively. Construct validity reported which compare the outcome rating scale measurements with Short Form-36 (SF-36), also convergent and discriminant validity evaluated using Spearman's rank correlation coefficient. RESULTS: Mean age (SD) of the patients was 41.95±13.45years. Cronbach's α coefficient, Spearman's rho and ICC values were 0.71, 0.89 and 0.90 respectively. Total score of AOFAS-AHFS and SF-36 domains has a correlation ranged between 0.17-0.55. Spearman's rank correlation coefficient of 0.4 was exceeded by all items with the exception of stability. The Spearman's rank correlation between each item in functional subscales with its own subscales was higher than the correlation between these items and other subscales. CONCLUSIONS: Persian version of AOFAS-AHFS provides additional reliable and valid instrument which can be used to assess broad range of patients with foot and ankle disorders that speaking in Persian. However, it seems that the original version of AOFAS-AHFS needs some revisions.