Cardiovascular risk assessment by FRS and SCORE in Iranian adult population.

BACKGROUND: Handling the growing epidemic of coronary heart disease in developing nations hinges on primary prevention, which logistically requires directing preventive interventions to those at the highest risk. Therefore, implementing cardiovascular risk assessment profiles is crucial to distinguish high risk groups who truly need extensive preventive measures. We aimed to draw a picture of the cardiovascular risk profiles in the Iranian adult population for the first time. METHODS: Demographic, anthropometric, and laboratory data as well as blood pressure and smoking status of 3944 subjects participating in the 2011 national surveillance of risk factors for non-communicable diseases were used to calculate the mean estimated risk of coronary artery disease and the relative frequency of low-, medium- and high-risk subjects based on FRS and SCORE indices in general population as well as different age, sex, and residence subgroups. RESULTS: The average 10-year risk of coronary artery disease (FRS) and 10-year risk of fatal coronary and cerebrovascular accidents (SCORE) in the 25 to 64 year-old population was 13.82 and 0.72 respectively. The relative frequency of the intermediate- and high- risk subjects was 25.8 and 22.6% based on FRS and 9.2 and 1.8% based on SCORE respectively. Average FRS and SCORE were significantly higher among men than women, but were not significantly different among urban and rural residents. CONCLUSIONS: A significant proportion of the Iranian population, based on FRS model, will be at moderate to high risk of coronary events in the next 10 years. Urgent preventive plans are needed at the national level.

Cataract surgical rate in Fars Province: Distribution and trend from 2006 to 2010.

PURPOSE: To determine changes in cataract surgical rate (CSR) in Fars Province from 2006 to 2010 and identify the contributions of public and private sectors. METHODS: This descriptive report is part of the Iranian Cataract Surgery Survey. To determine the provincial CSR, weights of major (>3000 annual surgeries) and minor (≤3000) centers were calculated based on the number of centers chosen for each year and multiplied by their numbers of surgeries. To determine public and private sectors' contributions, the numbers of surgeries in each sector were estimated based on the number of sampled centers. RESULTS: Overall, CSR improved by 25%; the number of CS decreased by 16% in the public sector and increased by 157% in the private sector. In 2006, the public sector contributed to 69% of the CSR, and by 2010, this rate had decreased to 43%. CONCLUSION: The decreasing contribution of the public sector calls for studies to identify causes and remove potential barriers.

Intraoperative Complications of Cataract Surgery in Tehran Province, Iran.

PURPOSE: To determine the prevalence and types of intraoperative complications of cataract surgery and examine potential risk factors. METHODS: Data were obtained from the 2011 Iranian Cataract Surgery Survey in which information about cataract surgeries throughout the nation was collected. In the Province of Tehran, 55 centers and 1 week per season per center were randomly selected for sampling. In each center, the charts of all patients who underwent cataract surgery during the selected weeks (total of 20 weeks per center) were reviewed for data extraction. The prevalence of different types of intraoperative cataract surgery complications were determined, and their relationships with age, sex, surgical method, surgeon, and hospitalization time were examined. RESULTS: The prevalence of intraoperative complications of cataract surgery was 4.15% (95% confidence interval, 0.94 to 7.36). The prevalence of posterior capsular rupture with vitreous loss, posterior capsular rupture without vitreous loss, retrobulbar hemorrhage, suprachoroidal effusion/hemorrhage, intraocular lens drop, and nucleus drop was 2.86, 0.69, 0.06, 0.39, 0.03, and 0.11%, respectively. The prevalence of cataract surgery complications decreased from 6.95% in 2006 to 3.07% in 2010. The results of multiple logistic regression showed that surgery by residents, nonphacoemulsification methods of surgery, and patient age less than 10 years and more than 70 years were the risk factors for complications. CONCLUSIONS: This study evaluated the prevalence of intraoperative complications of cataract surgery for the first time in Tehran Province. The prevalence of complications was high in this study. To achieve the goals of the Vision 2020 Initiative and improve surgical quality, it is necessary to minimize complication rates. Factors to note for decreasing complication rates include type of surgery, surgeon experience, and patient age.

Complications of Cataract Surgery in Iran: Trend from 2006 to 2010.

PURPOSE: To determine intraoperative complications of cataract surgery over the period 2006 to 2010. METHODS: In this cross-sectional study, 106 of 272 cataract surgical centers in Iran were selected through multistage random cluster sampling from all provinces. In each province, the selected number of centers was proportionate to the number of cataract surgeries, and in each center, the selected number of charts was proportionate to the center's number of cataract surgeries, from which we retrieved intraoperative complications. RESULTS: The prevalence of intraoperative complications of cataract surgery was 5.04% (95% confidence interval, CI, 3.53-6.54%) in 2006, which decreased significantly to 3.44% (95% CI 1.84-5.04%) in 2010. The most common complication was posterior capsular rupture/vitreous loss which decreased from 4.29% (95% CI 2.93-5.66%) in 2006 to 2.81% (95% CI 1.3-4.31%) in 2010. The next most common complication was suprachoroidal hemorrhage at 0.56% (95% CI 0.25-0.87%) in 2006 and 0.46% (95% CI 0.3-0.62%) in 2010. The least common complication concerned intraocular lens (IOL)-drop. Complications were seen most with lensectomy, while phacoemulsification caused the least complications. Mean hospitalization time in uncomplicated cases was 0.59 days (95% CI 0.58-0.61 days) and in complicated cases 1.14 days (95% CI 1.07-1.20 days; p < 0.001). CONCLUSION: Complications of cataract surgery in Iran had a decreasing trend during 2006-2010. However, results from 2010 indicate that cataract surgical complications still need to be focused on. Hospitalization was longer for cases with complications, and further reducing this could help decrease costs of cataract surgery.

Cataract Surgical Rate between 2006 and 2010 in Tehran Province.

BACKGROUND: Considering population aging in Iran and the importance of cataract surgery in the old age, this study was performed to show the cataract surgical rate (CSR) between 2006 and 2010 in Tehran Province. METHODS: Eighteen centers were randomly selected from cataract surgery centers in Tehran. In each center, one week in every season was randomly selected and the number of cataract surgeries in the week was calculated. In total, 20 weeks were selected in each center in five years. RESULTS: The CSR increased linearly from 8011 cases per 1,000,000 population in 2006 to 12465 cases per 1,000,000 population in 2010. As for patients below 40 years of age, the percentage of the male patients was more while after the age of 40 years, the percentage of the female patients was more in all age groups. At least 96.2% of the surgeries in each year were performed using the phacoemulsification method. From 2006 to 2010, the percentage of outpatient surgery increased from 48.7% to 72.5%. On the other hand, hospitalization for one night or more had a decreasing trend from 2006 to 2010. CONCLUSION: During 2006-2010, the CSR was acceptable in Tehran in comparison with other studies. However, attention should be paid to the increase in the population of the elderly people. Although more than 95% of the surgeries in the Province of Tehran are performed using the phacoemulsification method, the rate should increase to 100% in the eligible cases.

A Suggested Prototype for Assessing Bone Health.

BACKGROUND: Osteoporosis is becoming a health concern worldwide. Considering the fact that prevention plays an important role in reducing the burden of this silent disease and in view of the limited resources available, many countries have adopted certain programs to fight osteoporosis through shifting their attention towards at-risk individuals. The Iranian Multicenter Osteoporosis Study (IMOS) is one of these programs. The program aims to assess bone health and the prevalence of vitamin D deficiency in different parts of Iran with various altitudes, latitudes and lifestyle habits in a way that the results could be generalized to the country. METHOD: The present article presents the protocol used in the third phase of the study. It was designed based on the experiences gathered in the previous phases to overcome the shortcomings particularly subject loss. The questionnaire applied in this study was developed based on a thorough literature review of the risk factors and secondary causes of osteoporosis and was approved by an expert panel. RESULTS: While the majority of the existing studies aim to study a certain aspect of osteoporosis, the present protocol provides the information needed for policy makers and researchers to study different osteoporosis-related issues. CONCLUSION: The authors believe the protocol, to be implemented with small modifications, can help policymakers in different parts of the world, particularly developing countries, gather accurate information on different aspects of bone health at the national level.

Distribution of cataract surgical rate and its economic inequality in Iran.

PURPOSE: To determine the distribution of the cataract surgical number per million population per year (CSR), the CSR in the population older than 50 years (CSR 50+) in the provinces of Iran, and their economic inequality in 2010. METHODS: As part of the cross-sectional 2011 CSR survey, the provincial CSR and CSR 50+ were calculated as the total number of surgeries in major and minor centers divided by the total population and the population older than 50 years in each province. Economic inequality was determined using the average province income, the average urban and rural household incomes, and the percentage of urban and rural population in each province. RESULTS: Tehran and Ilam provinces had the highest and lowest CSR (12,465 vs. 359), respectively. Fars and Ilam provinces had the highest and lowest CSR 50+ (71,381 vs. 2481), respectively. Low CSR (<3000) was detected in 9 provinces where 2.4 to 735.7% increase is needed to reach the minimum required. High CSR (>5000) was observed in 14 provinces (45.2%) where rates were 0.6 to 59.9% higher than the global target. Cataract surgical rate increased at higher economic quintiles. Differences between the first, second, and fifth (poorest) quintiles were statistically significant. The CSR concentration index was 0.1964 (95% confidence interval, 0.0964 to 0.2964). CONCLUSIONS: In line with the goals of the Vision 2020 initiative to eliminate cataract blindness, more than 70% of geographic areas in Iran have achieved the minimum CSR of 3000 or more. However, a large gap still exists in less than 30% of areas, mainly attributed to the economic status.

Cataract surgical rate in Iran: 2006 to 2010.

PURPOSE: To determine the cataract surgical rate (CSR) between 2006 and 2010 in Iran. METHODS: In this cross-sectional study, sampling was done from surgical centers throughout Iran. Centers throughout all of Iran with more than 3000 surgeries per year were grouped as major centers and the rest were grouped as minor centers. All major centers and a percentage of minor centers were selected from each province. For each center, we determined the number of cataract surgeries in a random week of each season. RESULTS: Of the 237 eligible surgical centers, 124 were selected and 106 were enrolled in the study; 80 were major centers and 26 were minor centers. The number of surgeries has increased from 335,948 in 2006 to 475,526 in 2010. Cataract surgical rate has increased from 4723 (95% confidence interval, 4707 to 4739) per million population in 2006 to 6328 (95% confidence interval, 6309 to 6346) per million population in 2010. In the 50 and older population, CSR was 38,450 per million population in 2010. Average annual number of cataract surgeries per surgeon was 263 in 2006 and 339 in 2010. CONCLUSIONS: Compared with previous studies, the 2006 to 2010 CSR in Iran is on an ascending trend. Also, our numbers are higher than the minimum recommended by the World Health Organization, although lower than that in Western countries. Considering the aging population of the country, the observed rate is not sufficient for all cases of cataract in the future, and there is a need to increase CSR throughout the nation.

Prevalence of vitamin D deficiency among Iranian adolescents.

OBJECTIVE: Despite the high prevalence of vitamin D deficiency in adults worldwide, not many studies have evaluated the condition in adolescents. The present study was therefore conducted to assess the prevalence of vitamin D deficiency in a group of students from Shahroud, Iran. METHODS: The cross-sectional descriptive analytical study was conducted on junior high and high school students of both genders from urban and rural areas of Shahroud, the largest city of Semnan Province in Iran, in winter 2011. The combination of stratified and cluster random sampling methods was applied in the study. A questionnaire on the demographic data, socioeconomic status, lifestyle habits (sun exposure, physical activity, dairy consumption), and drug and personal history was completed for each student. Blood samples were taken to assess vitamin D levels. RESULTS: One thousand forty-seven students from four junior high and six high schools were recruited. From among them, 42.2% were boys and 57.8% were girls. Mean and standard deviation of vitamin D levels in the studied population were 14.7 ± 9.4 ng/mL. Only 7.2% of the boys and 3.8% of the girls had sensible sun exposure. The median of milk consumption was 3 glasses per week, ranging from 0 to 7. CONCLUSION: It could be concluded that vitamin D deficiency is quite prevalent among the Iranian adolescents, and this is mainly because this group follows an unhealthy lifestyle due to osteoporosis.

Trend in cataract surgical rate in iran provinces.

BACKGROUND: The aim of this study was to determine the trend of changes in Cataract Surgical Rate (CSR) in the provinces of Iran during 2006 to 2010 and identify high risk areas. METHODS: This report is part of the national Iranian CSR Study. The percentage change in CSR in 2010 compared to 2006 was conducted in each province, retrospectively. One hundred and ten centers were chosen from all provinces, to determine CSR in each, the weight of major (>3,000 annual surgeries) and minor (3,000 annual surgeries or less) centers was calculated based on the number of selected centers, and multiplied by the number of surgeries in each province. RESULTS: In eight provinces, CSR was decreased by 1-60%. One province (Booshehr) showed no change. Eighteen provinces had 2-79% increase. No 2006 data was available in three provinces. North Khorasan had the most decrease while Kerman had the most increase in CSR. Six of these 8 provinces had CSR>3,000 despite a decrease in 2010, but North Khorasan had CSR<3,000 over the whole 5 year period. In 4 provinces, CSR had a gap from 3,000 despite an ascending trend, and in two, the gap was quite considerable. CONCLUSION: Although CSR has an improving trend in most provinces in Iran, it is decreasing in some provinces, and despite an already low CSR, the exacerbation continues. The growing population of over 50 year olds calls for prompt measures in such provinces. Even in improving provinces, some lag behind the minimum recommended by WHO, and the growth rate of the over 50 population reveals the necessity of immediate planning.