The estimation of long and short term survival time and associated factors of HIV patients using mixture cure rate models.

BACKGROUND: HIV is one of the deadliest epidemics and one of the most critical global public health issues. Some are susceptible to die among people living with HIV and some survive longer. The aim of the present study is to use mixture cure models to estimate factors affecting short- and long-term survival of HIV patients. METHODS: The total sample size was 2170 HIV-infected people referred to the disease counseling centers in Kermanshah Province, in the west of Iran, from 1998 to 2019. A Semiparametric PH mixture cure model and a mixture cure frailty model were fitted to the data. Also, a comparison between these two models was performed. RESULTS: Based on the results of the mixture cure frailty model, antiretroviral therapy, tuberculosis infection, history of imprisonment, and mode of HIV transmission influenced short-term survival time (p-value < 0.05). On the other hand, prison history, antiretroviral therapy, mode of HIV transmission, age, marital status, gender, and education were significantly associated with long-term survival (p-value < 0.05). The concordance criteria (K-index) value for the mixture cure frailty model was 0.65 whereas for the semiparametric PH mixture cure model was 0.62. CONCLUSION: This study showed that the frailty mixture cure models is more suitable in the situation where the studied population consisted of two groups, susceptible and non-susceptible to the event of death. The people with a prison history, who received ART treatment, and contracted HIV through injection drug users survive longer. Health professionals should pay more attention to these findings in HIV prevention and treatment.

Investigating factors associated with the number of rehospitalizations among patients with schizophrenia disorder using penalized count regression models.

BACKGROUND: Schizophrenia is a chronic, severe, and debilitating mental disorder always considered one of the recurrent psychiatric diseases. This study aimed to use penalized count regression models to determine factors associated with the number of rehospitalizations of schizophrenia disorder. METHODS: This retrospective cohort study was performed on 413 schizophrenic patients who had been referred to the Sina (Farshchian) Educational and Medical Center in Hamadan, Iran, between March 2011 and March 2019. The penalized count regression models were fitted using R.3.5.2. RESULTS: About 73% of the patients were male. The mean (SD) of age and the number of rehospitalizations were 36.16 (11.18) years and 1.21 (2.18), respectively. According to the results, longer duration of illness (P < 0.001), having a positive family history of psychiatric illness (P = 0.017), having at least three children (P = 0.013), unemployment, disability, and retirement (P = 0.025), residence in other Hamadan province townships (P = 0.003) and having a history of arrest/prison (P = 0.022) were significantly associated with an increase in the number of rehospitalizations. CONCLUSION: To reduce the number of rehospitalizations among schizophrenic patients, it is recommended to provide special medical services for patients who do not have access to specialized medical centers and to create the necessary infrastructure for the employment of patients.

A bayesian approach to model the underlying predictors of early recurrence and postoperative death in patients with colorectal Cancer.

OBJECTIVE: This study aimed at utilizing a Bayesian approach semi-competing risks technique to model the underlying predictors of early recurrence and postoperative Death in patients with colorectal cancer (CRC). METHODS: In this prospective cohort study, 284 patients with colorectal cancer, who underwent surgery, referred to Imam Khomeini clinic in Hamadan from 2001 to 2017. The primary outcomes were the probability of recurrence, the probability of Mortality without recurrence, and the probability of Mortality after recurrence. The patients 'recurrence status was determined from patients' records. The Bayesian survival modeling was carried out by semi-competing risks illness-death models, with accelerated failure time (AFT) approach, in R 4.1 software. The best model was chosen according to the lowest deviance information criterion (DIC) and highest logarithm of the pseudo marginal likelihood (LPML). RESULTS: The log-normal model (DIC = 1633, LPML = -811), was the optimal model. The results showed that gender(Time Ratio = 0.764: 95% Confidence Interval = 0.456-0.855), age at diagnosis (0.764: 0.538-0.935 ), T3 stage (0601: 0.530-0.713), N2 stage (0.714: 0.577-0.935 ), tumor size (0.709: 0.610-0.929), grade of differentiation at poor (0.856: 0.733-0.988), and moderate (0.648: 0.503-0.955) levels, and the number of chemotherapies (1.583: 1.367-1.863) were significantly related to recurrence. Also, age at diagnosis (0.396: 0.313-0.532), metastasis to other sites (0.566: 0.490-0.835), T3 stage (0.363: 0.592 - 0.301), T4 stage (0.434: 0.347-0.545), grade of differentiation at moderate level (0.527: 0.387-0.674), tumor size (0.595: 0.500-0.679), and the number of chemotherapies (1.541: 1.332-2.243) were the significantly predicted the death. Also, age at diagnosis (0.659: 0.559-0.803), and the number of chemotherapies (2.029: 1.792-2.191) were significantly related to mortality after recurrence. CONCLUSION: According to specific results obtained from the optimal Bayesian log-normal model for terminal and non-terminal events, appropriate screening strategies and the earlier detection of CRC leads to substantial improvements in the survival of patients.

Socio-economic disparities in female genital circumcision: finding from a case-control study in Mahabad, Iran.

BACKGROUND: Female genital circumcision (FGC) is still a challenge in reproductive health. This study investigated socioeconomic disparities in FGC in the Kurdish region of Mahabad, Iran. METHODS: A case-control study was conducted in three comprehensive health centers on 130 circumcised girls as the case group and 130 girls without a history of circumcision as the control group, according to the residential area and the religious sect. The participants completed a previously validated demographic and circumcision information questionnaire. A multivariate logistic regression model with a backward method at a 95% confidence level was used to determine the relationship between socioeconomic variables and FGC. RESULTS: Multivariate logistic regression showed that a family history of FGC (AOR 9.90; CI 95%: 5.03-19.50), age ranging between 20 and 30 years (AOR 8.55; CI 95%: 3.09-23.62), primary education (AOR 6.6; CI 95%: 1.34-33.22), and mothers with primary education (AOR 5.75; CI 95%: 1.23-26.76) increased the chance of FGC. CONCLUSION: The present study provided evidence on socioeconomic factors related to FGC in girls. A family history of FGC, age ranging between 20 and 30 years, and girls' and their mothers' education level were strong predictors of FGC. The findings indicate the need to design effective interventions to address these factors to help eradicate FGC.

Epidemiological pattern of trauma patients based on the mechanisms of trauma: trends of a regional trauma center in Midwest of Iran.

INTRODUCTION: Trauma is one of the important issues in public health because it is responsible for 90% of mortality in Low and Middle-Income Countries (LIMCs). The present study aimed to determine the epidemiological pattern of trauma patients in a regional trauma center in the Midwest of Iran from 2014 to 2020. METHODS: This study was a retrospective study that was performed on 29,804 trauma patients admitted to Be'sat Hospital in Hamadan from January 2014 to December 2020. Data was collected using Health Information Management (HIM) Center of the Be'sat Hospital. For investigating the relationship of the characteristics of trauma patients and the mechanisms of trauma, Multiple Multinomial Logistic Regression (MMNLR) model was used. All statistical analyses were performed using the IBM SPSS Statistics version 24. RESULTS: The mean age of all patients was 35.4 (SD = 21.9) years. Most of them were men (71.7%). The most common mechanism of trauma was road traffic accidents (RTAs) (39.6%) followed by falls (30.2%), other (19.7%), violence (6.2%), and burn (4.4%). 1.5% of the trauma patients expired. The results of multiple multinomial logistic regression indicated that significant affected factor on odds referring because of RTAs compared to other mechanism were: season and hospital length of stay (LOS); in falls and violence: age, sex, season, and LOS; and in burn: age, sex, season, evening time, and LOS (p < 0.05). CONCLUSION: Based on the investigation of 29,804 trauma patients, in Iran as a developing country, RTAs and falls were two common mechanisms of trauma. It seems that as a short-term plan, it is possible to focus on road safety, to improve the quality of vehicles, to hold training courses for drivers. Also, as a long-term goal, considering that the elderly population in Iran is increasing, it is necessary to pay attention to fall reduction programs.

The comparison of sexual function in women with or without experience of female genital circumcision: A case-control study in a Kurdish region of Iran.

Studies on the sexual consequences of female genital circumcision are controversial. In this article, we intend to compare the sexual function in women with or without experience of circumcision in the Kurdish region of Mahabad in Iran. In this case-control study 550 women completed the demographic and Female Sexual Function Index (FSFI) questionnaires. Female genital circumcision was associated with reduction of lubrication and sexual satisfaction as well as increasing dyspareunia compared to the uncircumcised women. However, there was no significant difference between two groups regarding to arousal, desire and orgasm of women.

Influential Factors on Survival in Gastric Cancer: A Single-center Study.

Background: Gastric cancer (GC) is one of the conspicuous causes of cancer-related death worldwide. Considering the mounting incidence of this cancer in developing countries such as Iran, determining the influential factors on the survival of involved patients is noteworthy. Hence, we aimed to ascertain the survival rates and the prognostic factors in our GC patients. Materials and Methods: In this retrospective cohort study, data of 314 patients with GC in a referral cancer center in Hamadan province of Iran were studied. The outcome of our study was survival time and the influential factors were gender, age at diagnosis, tumor history, tumor grade, surgery history, radiotherapy history, stage of disease, metastasis history, and lymph node involvement. Kaplan - Meier method and log-rank test were used for the calculation and comparing the survival curves and Cox-proportional hazard model was used for the multivariable analysis of prognostic factors. Results: In a total of 314 GC patients, the median age at the diagnosis was 63 years (range: 21-92) with most patients (74.84%) being males. The median follow-up time was 2.42 years, and the median survival time was 2 years. The multivariable cox analysis of overall survival (OS) indicated that having distant metastasis increased the hazard of death by about 2.5 times (P < 0.0001, heart rates [HR]: 2.53, 95% confidence interval [CI]: [1.71, 3.75]), and receiving surgery as treatment, decreased the hazard of death up to 36% (P = 0.02, HR: 0.64, 95%CI: [0.46-0.89]). The other variables did not have any significant effects on the OS. Conclusion: The results of this study showed that lower survival (greater hazard of death) strongly and significantly associated with having distant metastasis in patients with GC and receiving surgery could significantly decrease the hazard of death in these patients instead.

Generalized linear mixed hidden semi-Markov models in longitudinal settings: A Bayesian approach.

Hidden Markov and semi-Markov models (H(S)MMs) constitute useful tools for modeling observations subject to certain dependency structures. The hidden states render these models very flexible and allow them to capture many different types of latent patterns and dynamics present in the data. This has led to the increased popularity of these models, which have been applied to a variety of problems in various domains and settings, including longitudinal data. In many longitudinal studies, the response variable is categorical or count-type. Generalized linear mixed models (GLMMs) can be used to analyze a wide range of variables, including categorical and count. The present study proposes a model that combines HSMMs with GLMMs, leading to generalized linear mixed hidden semi-Markov models (GLM-HSMMs). These models can account for time-varying unobserved heterogeneity and handle different response types. Parameter estimation is achieved using a Monte Carlo Newton-Raphson (MCNR)-like algorithm. In our proposed model, the distribution of the random effects depends on hidden states. We illustrate the applicability of GLM-HSMMs with an example in the field of occupational health, where the response variable consists of count values. Furthermore, we assess the performance of our MCNR-like algorithm through a simulation study.

Association study of promoter polymorphisms of interferon alpha and beta receptor subunit 1 (IFNAR1) gene and therapeutic response to interferon-beta in patients with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is an autoimmune disease described by inflammatory neuronal losses and resultant failures. The disease could abate by interferon-beta (IFN-ß) therapy in MS patients. However, the drug response productivity is changeable between patients, and the accurate mechanism of action of the IFN-ß is not obvious. The present study aims to investigate the role of interferon alpha and beta receptor subunit 1 (IFNAR1) promoter polymorphisms towards IFN-ß treatment response in MS patients. METHODS: The subjects herein were separated into either responder (n = 57) or non-responder (n = 43) groups according to IFN-ß treatment and Expanded Disability Status Scale score. The Sanger sequencing method was used for genotyping. RESULTS: Among nearly 64 Single Nucleotide Polymorphisms (SNPs), we found a significant association between the rs2850015 polymorphism and the responders and non-responders to IFN-ß treatment in the recessive model of inheritance (P = 0.02). The results also revealed a significant change in the two groups of responders and non-responders to the treatment for rs36158718 as an Insertion/Deletion (INDEL) (P = 0.02). Moreover, bioinformatic analyses predicted a remarkable role for both rs2850015 and rs36158718 related to the changes of binding affinity of transcription factors and alterations in their alleles. CONCLUSION: The present study results suggest that the genetic heterogeneity in the promoter region of IFNAR1 could affect the response to IFN-ß. However, further studies with a larger sample size are needed to further demonstrate this relationship.

Effect of educational intervention on safe traffic behaviors of high school male students in Iran, using the theory of planned behavior: a quasi-experimental study.

BACKGROUND: Behavior change interventions in tackling road traffic injuries are a public health concern. Thus, this interventional research was to survey the effect of safe traffic behaviors among male students in Hamadan, Iran, utilizing theory of planned behavior. METHODS: In this quasi-experimental study, 204 students were randomly selected through multistage sampling from male high school students of Hamadan city, west-central of Iran, and non-randomly allocated to control and intervention groups (102 students in every group). The self-administrate questionnaire was used for data collection in this research. Frequency (percentage) and mean (SD) were used for description. Cronbach alpha coefficient, content validity ratio (CVR) and content validity index (CVI) were used for psychometric evaluation of questionnaire and paired/independent sample t-test was used for data analysis. All statistical analyses were done in SPSS 19 and significant level was considered 0.05. RESULTS: In both groups, more than 50 % of students walked to school. The two study groups were homogeneous in terms of confounding variables (p >  0.05). The validity of the questionnaire was confirmed and the total Cronbach's alpha value was equal to 0.97. There was no significant difference in the score of safe traffic behaviors between the two groups before the intervention (p >  0.05). But after the intervention, the score in the intervention group was significantly increased (p < 0.05). Intragroup comparison also showed that only in the intervention group the score was significantly changed (p < 0.05). CONCLUSION: Theory of planned behavior is a suitable conceptual framework for planning the interventions to increase safe traffic behaviors in students.

Specific causes of recurrence after surgery and mortality in patients with colorectal cancer: A competing risks survival analysis.

BACKGROUND: In situation where there are more than one cause of occurring the outcome such as recurrence after surgery and death, the assumption of classical survival analyses are not satisfied. To cover this issue, this study aimed at utilizing competing risks survival analysis to assess the specific risk factors of local-distance recurrence and mortality in patients with colorectal cancer (CRC) undergoing surgery. MATERIALS AND METHODS: In this retrospective cohort study, 254 patients with CRC undergoing resection surgery were studied. Data of the outcome from the available documents in the hospital were gathered. Furthermore, based on pathological report, the diagnosis of CRC was considered. We model the risk factors on the hazard of recurrence and death using competing risk survival in R3.6.1 software. RESULTS: A total of 114 patients had local or distant recurrence (21 local recurrences, 72 distant recurrences, and 21 local and distant recurrence). Pathological stage (adjusted hazard ratio [AHR] = 4.28 and 5.37 for stage 3 and 4, respectively), tumor site (AHR = 2.45), recurrence (AHR = 3.92) and age (AHR = 3.15 for age >70) was related to hazard of death. Also based on cause-specific hazard model, pathological stage (AHR = 7.62 for stage 4), age (AHR = 1.46 for age >70), T stage (AHR = 1.8 and 2.7 for T3 and T4, respectively), N stage (AHR = 2.59 for N2), and white blood cells (AHR = 1.95) increased the hazard of recurrence in patients with CRC. CONCLUSION: This study showed that older age, higher pathological, rectum tumor site and presence of recurrence were independent risk factors for mortality among CRC patients. Also age, higher T/N stage, higher pathological stage and higher values of WBC were significantly related to higher hazard of local/distance recurrence of patients with CRC.

Factors affecting systolic blood pressure trajectory in low and high activity conditions.

Background: Typically, blood pressure dips during sleep and increases during daytime. The blood pressure trend is affected by the autonomic nervous system. The activity of this system is observable in the low and high activity conditions. The aim of this study was to assess the effect of individual characteristics on systolic blood pressure (SBP) across day-night under low and high activity conditions. Methods: The samples were 34 outpatients who were candidates for evaluation of 24 hours of blood pressure with an ambulatory. They were admitted to the heart clinic of Farshchian hospital, located in Hamadan province in the west of Iran. The hourly SBP during 24 hours was considered as a response variable. To determine the factors effecting SBP in each condition, the hidden semi-Markov model (HSMM), with 2 hidden states of low and high activity, was fitted to the data. Results: Males had lower SBP than females in both states. The effect of age was positive in the low activity state (ß=0.30; p<0.001) and negative in high activity state (ß= -0.21; p=0.001). The positive effect of cigarette smoking on SBP was seen in low activity state (ß=5.02; p=0.029). The overweight and obese patients had higher SBP compared to others in high activity state (ß=11.60; p<0.001 and ß=5.87; p=0.032, respectively). Conclusion: The SBP variability can be displayed by hidden states of low and high activity. Moreover, the effects of studied variables on SBP were different in low and high activity states.

Application of group smoothly clipped absolute deviation method in identifying correlates of psychiatric distress among college students.

BACKGROUND: College students are at an increased risk of psychiatric distress. So, identifying its important correlates using more reliable statistical models, instead of inefficient traditional variable selection methods like stepwise regression, is of great importance. The objective of this study was to investigate correlates of psychiatric distress among college students in Iran; using group smoothly clipped absolute deviation method (SCAD). METHODS: A number of 1259 voluntary college students participated in this cross-sectional study (Jan-May 2016) at Hamadan University of Medical Sciences, Iran. The data were collected using a self-administered questionnaire consisting of demographic information, a behavioral risk factors checklist and the GHQ-28 questionnaire (with a cut-off of 23 to measure psychiatric distress, recommended by the Iranian version of the questionnaire). Penalized logistic regression with a group-SCAD regularization method was used to analyze the data (α = 0.05). RESULTS: The majority of students were aged 18-25 (87.61%), and 60.76% of them were female. About 41% of students had psychiatric distress. Significant correlates of psychiatric distress among college students selected by group-SCAD included the average grade, educational level, being optimistic about future, having a boy/girlfriend, having an emotional breakup, the average daily number of cigarettes, substance abusing during previous month and having suicidal thoughts ever (P < 0.05). CONCLUSIONS: Penalized logistic regression methods such as group-SCAD and group-Adaptive-LASSO should be considered as plausible alternatives to stepwise regression for identifying correlates of a binary response. Several behavioral variables were associated with psychological distress which highlights the necessity of designing multiple factors and behavioral changes in interventional programs.

Relationship Between Parental Stress and their Attitudes Towards Cochlear Implantation Outcomes in Children Referred to Besat Cochlear Implant Center in Hamadan 2018.

PURPOSE: This study aimed to investigate the relationship between parental stress and their attitudes towards post-cochlear implantation outcomes in children referred to Besat cochlear implant center in Hamadan during 2018. DESIGN AND METHODS: In this descriptive cross-sectional study, 100 parents of children with cochlear implantation were selected from Besat cochlear implant center in Hamadan through census method from April to October 2018. The data were collected using a demographic characteristic questionnaire, parental stress scale developed by Berry and Jones, and Parental Attitudes of Various Aspects of Cochlear Implantation. The data were analyzed using SPSS software (version 16) through correlation coefficient, one-way ANOVA, and t-test. P-value <0.05 was considered statistically significant. RESULTS: The results of this study indicated that parental stress negatively correlated with their attitudes towards the outcomes of cochlear implantation (r = -0.420), including the aspects of communication (r = -0.462), educational (r = -0.398), and social skills (r = -0.445), as well as services provided by the health care centers (r = -0.277), and the efficiencies of cochlear implantation center (r = -0.118) (P < 0.05). CONCLUSION: According to the results, parents with more positive attitudes towards the areas of communication, educational, and social skills, as well as services provided by the health care centers, and the efficiencies of cochlear implantation center experienced lower levels of stress. PRACTICE IMPLICATIONS: Nurses can measure the stress and attitudes towards cochlear implantation outcomes in children to accurately assess the needs of the family in order to improve their nursing process and advance the child's rehabilitation program.

The relationship between general health and coping style with perceived stress in primigravida healthy pregnant women: Using the PATH model.

The aim of this study was to analyze relationships among general health, coping style, and perceived stress in healthy primigravida pregnant women. A cross-sectional study was conducted at public health clinics in Hamadan city, Iran between July and December 2015. In total, 380 pregnant women were selected through stratified random sampling. Data were collected using the Revised Prenatal Coping Inventory and General Health Questionnaire. Perceived stress was assessed through an interview comprised of open-ended questions. The final PATH model fit well; general health (ß = 0.02) as well as anxiety and sleep disorders (ß = 0.03) were slightly directly associated with perceived stress, and only planning-preparation was related to perceived stress through general health (ß = 0.09). The findings enhance the knowledge gained from previous perinatal stress research. General health status was directly related to stress, and coping style was indirectly related to stress. Coping styles may mediate the relationship between general health status and perceived stress, suggesting that midwives should attempt to improve the general health of women to reduce stress and its consequences during pregnancy by teaching patients appropriate coping styles. Further studies on the effect of coping style interventions on stress are warranted.

The effect of Valerian on the severity and frequency of hot flashes: A triple-blind randomized clinical trial.

Valerian is one of the most widely used herbal supplements and a phytoestrogenic herb. The aim of this study was to determine the effect of Valerian on the severity and frequency of hot flashes. This triple-blind, randomized, controlled clinical trial was conducted during a three-month period in Hamadan, Iran, in 60 postmenopausal women aged 45-55 years. Participants were randomly assigned to one of two groups- either placebo or Valerian. An oral Valerian 530 mg capsule was given twice per day for two months. An oral placebo 530 mg capsule (starch) was similarly administered. The severity and frequency of hot flashes were determined by the Kupperman index, before the intervention, one month after, and two months after initiation of the intervention. The severity of hot flashes in the Valerian group was significantly lower than that in the placebo group at one (p = .048) and two months (p = .020) after initiation of the intervention. Compared with the placebo group, the mean frequency of hot flashes was significantly reduced two months after initiating the use of Valerian (p = .033). Health-care providers should consider Valerian to be effective for menopausal women with hot flashes.

Comparative Study of Dimensional Accuracy in Three Dental Implant Impression Techniques: Open Tray, Closed Tray with Impression Coping, and Snap Cap.

AIM: Several impression techniques have been proposed to result passive fitness between the prosthesis and osseointe-grated implant. The aim of the study was to compare dimensional accuracy of three impression methods: Open tray, closed tray with impression coping, and closed tray with snap cap. MATERIALS AND METHODS: In this experimental study, a mandibular acrylic model was prepared with a milling machine to place three holes for dental implant analogs (Dio SM) with the dimension of 3.8 × 10 mm into the intended sites (one in midline and two others on the side at a distance of 10 mm) parallel with each other and perpendicular to the plane. Twenty-seven casts were prepared with impression material of polyvinyl siloxane (PVS) and dental stone type IV and divided into three groups. Implant situations were measured by coordinate measuring machine (CMM) and results were analyzed with Kruskal-Wallis and Mann-Whitney test to perform pairwise comparison among the groups. RESULTS: The mean ΔR values for open tray, closed tray with impression coping, and closed tray with snap cap were respectively, 0.070 ± 0.088, 0.173 ± 0.205, and 0.142 ± 0.044. There were statistically significant differences between open tray and closed tray as well as open tray and snap cap methods (p < 0.05), but there was no statistically significant difference between closed tray and snap cap method (p = 0.1). CONCLUSION: Regarding the results, open tray impression technique had the highest dimensional accuracy compared with the other two methods. There were no statically significant differences between closed tray with snap cap and closed tray with impression coping technique. CLINICAL SIGNIFICANCE: Snap cap technique is less time consuming with similar dimensional accuracy in comparison with open tray impression technique.

The burden of pure anisometropic amblyopia: a cross-sectional study on 2800 Iranians.

PURPOSE: To assess the proportion of pure anisometropic amblyopia in a sample Iranian (white) population. METHODS: A total of 2800 consecutive individuals who presented at a referral eye clinic for any reason were examined for the presence of pure anisometropic amblyopia. Anisometropia was reported when a spherical equivalent refraction difference of at least 1.0 D with or without a cylinder refraction difference of at least 1.0 D was present between the two eyes. Amblyopia was defined as the best-corrected visual acuity of 20/30 or worse or a two-line interocular visual acuity difference between eyes that could not be attributed to any structural ocular pathology or visual pathway abnormality. RESULTS: Subjects were 1528 females and 1272 males with a mean age of 30.25 ± 14.93 years (range, 5-65). Amblyopia was diagnosed in 192 cases (6.9%), significantly more frequent among females (7.9 vs. 5.7%, p = 0.02). Pure anisometropic amblyopia was present in 6.1% of the study population, significantly more common in patients with spherical hyperopic anisometropia (37.7%) compared to patients with spherical myopic anisometropia (21.3%), cylindrical myopic anisometropia (4.1%), and cylindrical hyperopic anisometropia (15%) (p < 0.001). CONCLUSIONS: Pure anisometropic amblyopia is a common finding in Caucasians seeking eye care, particularly when anisometropia is of spherical hyperopic subtype.

The Efficacy of Brushing and Flossing Sequence on Control of Plaque and Gingival Inflammation.

PURPOSE: To evaluate the efficacy of brushing and flossing order on control of plaque and gingival inflammation. MATERIALS AND METHODS: This cross-over clinical trial was conducted on 35 students recruited from the dental school at Hamadan University of Medical Sciences. The subjects were asked to use dental floss and then brush for a 2-week period (FB), followed by brushing and then using dental floss for another 2-week period (BF). For a 7-day washout interval between the two phases, the subjects practiced dental hygiene according to their habitual method. The participants received dental prophylaxis at the beginning and plaque control record (PCR), plaque index (PI) and bleeding point index (BPI) were measured at baseline and the end of both phases. The differences of indices between two phases were analysed with the Wilcoxon signed rank test; to assess the influence of sex and sequence on PCR, PI and BPI, analysis of covariance (ANCOVA) was used after adjustment of initial values. RESULTS: The PCR and PI indices in the FB method were significantly lower than with the BF method (P < 0.05). The PI and PCR index differences between the two phases were significant in men but nonsignificant in women. The effect of gender on PI and BPI and the interaction effect of sex and sequence of brushing and flossing on BPI were significant (P < 0.05). CONCLUSIONS: Flossing followed by brushing provides more statistically significant improvements over brushing followed by flossing with respect to plaque control.

Spatial inequalities and non-linear association of continuous variables with mortality risk of liver transplantation in Iran: a retrospective cohort study.

Liver transplantation is the second most common solid organ transplant and the best option for liver failure. Of course, patient survival after transplantation depends on many risk factors. The aim of this study was to investigate the spatial and non-linear effects of continuous risk factors on patient survival after liver transplantation. This retrospective cohort study (n = 3148) used data on liver transplantation in Iran (2004-2019). A generalized additive model with spatial effects and non-linear effects of age and Model for End-Stage Liver Disease (MELD) score variables by penalized spline was used. The majority of patients were male (63.3%), with a mean (SD) age of 42.65 (13.31) and a mean (SD) MELD score of 24.43 (6.72). The 1, 5, and 10-year survival rates were 88.2%, 84.6%, and 82.5% respectively. The non-linear effect showed a steeper slope of the age effect on the hazard of death after the age of 50 (p < 0.05), and the MELD score had a direct but non-linear relationship with the hazard of death (p < 0.05). In the spatial pattern, the provinces with a greater distance from the transplant center had significantly fewer old patients than other provinces. Also, more distant provinces with an older transplant age had higher post-transplant mortality rates. Our study showed that it is better to take age and MELD score into account in postoperative care. The spatial pattern of mortality risk reflects inequalities in access to transplantation and public health services after transplantation.