Refractive Errors and Their Associated Factors in Schoolchildren: A Structural Equation Modeling.

PURPOSE: To determine the prevalence of myopia and hyperopia in Shahroud schoolchildren and their risk factors. METHODS: Optometric examinations including the measurement of uncorrected and corrected visual acuity as well as non-cycloplegic and cycloplegic refraction using retinoscopy were done for students. Generalized Structural Equation Modeling (GSEM) was used to determine direct and indirect effects of independent variables on myopia and hyperopia. RESULTS: The data of 5581 students with a mean age of 9.24 ± 1.7 years were used in this study. The prevalence of myopia was 5.0% (95%CI: 4.3-5.7) and the prevalence of hyperopia was 4.8% (95%CI: 4.0 - 5.5) in all schoolchildren. According to the GSEM results, the odds of myopia in rural areas were 0.55 compared to urban areas. A one-unit increase in the ocular AL increased the odds of myopia by 4.91 times. The interaction of sex and age on myopia was significant such that in girls, the odds of myopia increased by 20% for every one-year increase in age while no significant change was seen in boys. A one-unit increase in the ocular AL decreased the odds of hyperopia by 0.49 times. Moreover, the interaction of outdoor activity hours and sex on the prevalence of hyperopia was significant such that increased outdoor activity reduced the odds of hyperopia in girls while no significant correlation was found in boys. CONCLUSION: Myopia and hyperopia had moderate prevalence. Axial Length had the largest direct association on myopia and hyperopia. Age and outdoor activity had weak associations on refractive errors.

Association of Social Determinants of Health and Road Traffic Deaths: A Systematic Review.

OBJECTIVE: This study aims to review systematically the association of social determinants of health (SDH) and road traffic deaths (RTD) within scientific literature. METHODS: A search strategy was designed and run in EMBASE, PubMed via MEDLINE, Scopus, Web of Science, and Cochrane library. Through title, abstract, and full-text screening, all English original papers (except ecological studies) which studied social determinants of health and fatal injuries were included. Papers which studied association between RTD and the education, income, rural settlement, and marital status were evaluated and the related data was extracted from the full-texts. RESULTS: Eleven articles out of 7,897 primary results were selected to be included in the study. Among eight papers studied education, seven confirmed a negative association between years of schooling and RTD. Two out of three articles reported no association between income leveland RTD. Among three papers studied rural settlement, two approved a positive relationship between this determinant and RTD. Both articles studied marital status, confirmed an association between this determinant and RTD. CONCLUSION: A few papers studied association of social determinants of health (SDH) and RTD. There was an inverse relationship between education and RTD. The evidence for such an association between income, rural settlement, and marital state was scarce. Further investigations are recommended through original research.

Effects of reviewing childbirth scenarios on choice of delivery type: a randomized controlled trial.

OBJECTIVE: The incidence of cesarean section (CS) was estimated as about 48% between 2000 and 2012 in Iran. This study was conducted to assess the effects of reviewing written childbirth scenarios on the selection of delivery method. MATERIALS AND METHODS: This randomized controlled trial was conducted in Shohada Women's Hospital in Behshahr, Mazandaran, Iran, from May to December 2015. A total of 223 women at 28 to 32 weeks of gestation were randomly allocated into three groups; the standard care (control), theory of planned behavior (TPB)-based education, and TPB education plus additional support via written childbirth scenarios (scenario). Participants were assessed at baseline (weeks 28-32) and intervention (week 37 of pregnancy) periods. Both intervention groups (TPB and scenario groups) participated in three learning sessions that were based on TPB, whereas the control group received routine care service. RESULTS: The frequencies of normal vaginal delivery (NVD) in the scenario, TPB, and control groups were 73.2%, 58.5%, and 45.7%, respectively (p=0.004). The results showed that the relative risks of CS decision in the scenario and TPB groups in comparison with the control group were both 0.87 and statistically significant (p=0.018 and p=0.013, respectively). The relative risk of choosing CS after the removal of obligatory CS cases in the scenario group compared with the control was 0.85. CONCLUSION: Written childbirth scenarios that contain information on NVD and CS as additional support are effective educational tools for reducing CS rates.

A prospective study of psychomotor performance of driving among two kinds of shift work in Iran.

BACKGROUND AND AIM: Driving after a night shift imposes a risk on health care professionals and other road users. The aim of this study was to measure psychomotor performance of driving of night shift nurses compared to day-shift nurses. METHODS: Forty-seven volunteer female nurses working at Sina hospital in Tehran, Iran, with a call in all departments of hospital, participated in this study (23 night shift and 24 day shift nurses) in 2016. The tests included RT for simple reaction time, ATAVT for perceptual speed, LVT for visual orientation and ZBA for time anticipation. Data collection tools were individual characteristics, 11-item circadian type inventory (CTI), Stanford sleepiness scale (SSS), and Swedish occupational fatigue inventory (SOFI-20) questionnaires. Psychomotor driving performance was assessed using validated computerized traffic psychological battery of Vienna Test System (VTS), before and after the shifts. Data analysis was performed using paired-samples t-test and Linear Regression. RESULTS: The mean age of day and night-shift nurses were 31.4±5.6 and 28.7±3.9 years respectively, no significant difference between two groups. Thirty percent of night shift and 16.7% of day shift nurses reported traffic accidents in the past year. The results revealed that, scores based on viewing times in visual orientation test (p=0.005), and median reaction time score in choice reaction time and reactive stress tolerance test (p=0.045), had a significant association with a 12-hour night shift with a 3-hour nap. CONCLUSIONS: Twelve-hour night shift work impairs choice reaction time and visual orientation in nurses, even though they take a 3- hour nap during the shift. These skills are required for safe driving.

Evaluation of the effect of narrative writing on the stress sources of the parents of preterm neonates admitted to the NICU.

OBJECTIVE: Identification of the nurses' and families' understanding of the stresses in the facilitates nursing interventions and increases parental satisfaction. MATERIAL AND METHODS: The quasiexperimental study with pretest and posttest was administered to a sample size of 70 mothers with preterm neonates hospitalized in the NICUs of two teaching hospitals of Tehran University of Medical during 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods. RESULTS: Evaluation of the differences in the domains of the questionnaire between the 3rd and 10th day of admission using a multivariate analysis showed that narrative writing had significant effects on all three domains (Roys' largest root = 2.141, F = 47.11, p values < 0.001). The results showed that the highest stress reduction was observed in Infant Behavior and Appearance (-11.847) followed by Sights and Sounds of the Unit (-11.352) while the lowest stress reduction was observed in the Parental Role Alterations (-6.149) in the intervention group, while the control mothers experienced a stress increase in all domains. CONCLUSION: According to the findings, narrative writing may be considered an efficient supportive intervention to reduce the maternal stress Infant behavior and appearance in the NICUs. However, more research is needed to justify its implementation.

Detection of prognostic factors in metastatic breast cancer.

BACKGROUND: The aim of this study was to detect prognostic factors in recurrent breast cancer metastasis. MATERIALS AND METHODS: This retrospective cohort study employed data from 996 breast cancer patients of Isfahan Seyed-o-Shohada research center from 1998 to 2010. Stratified Cox proportional hazards model, marginal approach, was used to evaluate the prognostic value of estrogen receptor, progesterone receptor, tumor protein 53, human epidermal growth factor receptor type 2, diagnosis age, nodal ratio, tumor size, antigen Ki67, and cathepsin D. Survival curves were plotted using Kaplan-Meier method and log-rank test was carried out to compare survival in two categories of nodal ratio (≤0.25 vs. >0.25). RESULTS: In simple Cox regression model, age (P = 0.037), nodal ratio (P < 0.0001), and Ki67 (P = 0.032) were associated with hazard of distant metastasis. Multiple analysis showed that patients with greater nodal ratio had significantly higher adjusted hazard of recurrent metastasis (Hazard ratio: 2.756, 95% Confidence interval: 1.017-7.467; P = 0.046). Tumor size was not an independent prognostic factor for recurrent metastasis. Comparing survival curves, there was significant difference between two categories of nodal ratio in the first (P < 0.0001), second (P < 0.0001) and third (P = 0.024) metastasis; survival was higher in-patients with nodal ratio <0.25. CONCLUSION: Our findings indicate that tumor size was insignificant; this raises the question about conventional premise of being a major prognostic factor for distant metastasis. Furthermore, nodal ratio is suggested to clinicians as a prognostic variable in follow-up of breast cancer patients; patients with higher nodal ratio have greater hazard of distant metastasis.

Psychometric properties of the Farsi version of effort-reward imbalance questionnaire: a longitudinal study in employees of a synthetic fibre factory in Iran.

PURPOSE: To assess the reliability and validity of the Farsi version of the effort-reward imbalance questionnaire (F-ERIQ) and to examine the responsiveness of the tool to changes over time. METHODS: A longitudinal study was carried out among 227 male employees of Iran Polyacryl Corporation. The F-ERIQ was developed through a forward-backward translation process that includes three scales of effort, reward and over-commitment (OC). Reliability and internal consistency of the F-ERIQ were assessed by split-half and Cronbach's alpha coefficients. Confirmatory factor analysis, convergent and discriminant validity were conducted to evaluate construct validity. Depressive mood was used as an indicator for exploring criterion validity. The variations in mean scores over time for scales were regarded as measures of the responsiveness to changes. RESULTS: Baseline split-half correlations for effort, reward and OC were 0.53, 0.85 and 0.65, respectively; Cronbach's alpha coefficients improved from 0.61 to 0.70 for effort, 0.85 to 0.88 for reward and 0.67 to 0.72 for OC. All of item-total correlations were higher than 0.23 and item-scales correlations were higher than 0.4. Although Values of Goodness of Fit Index and Adjusted GFI were higher than 0.9 and Root Mean Square Error of Approximation, Root Mean Square Residual and Standardized RMR were lower than 0.05, confirmatory factor analysis only confirmed the construct of the effort and OC. People with higher job stress were at higher risk of depressive mood (at least 3 times more). Overall, the mean score of effort, OC and ERI increase, and the figures decrease for reward among people who experience changes. CONCLUSIONS: These findings provide evidence that the F-ERIQ is a reliable and valid instrument for assessing psychosocial stress at work among Farsi-speaking male employees. We propose that F-ERIQ be further evaluated across a variety of jobs and industries.