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1.
J Adv Med Educ Prof ; 10(3): 145-155, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35910511

RESUMO

Introduction: Mobile learning is one of the innovative teaching techniques that help medical students gain knowledge and skills. One of the factors that expanded the use of this strategy was the COVID-19 pandemic. However, the educational pedagogy of such technology has been neglected. This article aimed to critically review available mobile learning models in medical education to suggest a comprehensive model in the field of mobile learning. Methods: We conducted this critical review based on the five steps of the Carnwell and Daly method. For a comprehensive systematic search from 2000 to April 2021, the following keywords were used: Personal Digital Assistant, m learning, Mobile learning, Ubiquitous learning, U learning, medical students, and medical education. 3176 studies in PubMed, Scopus, ERIC, Magiran, and Web of Science were identified. In total, 8 articles entered the study. Results: Eight models of mobile learning in medical education were identified. The key features of each model were extracted and integrated into the new model for the successful design and implementation of mobile learning. This model includes three main elements of mobile learning: 1-stakeholders, 2-interaction, and 3-technology, which are influenced by external factors including Mobiquette, legitimacy, and awareness. Conclusion: The results of this study are an important contribution to the knowledge collection in mobile learning in medical education. We introduced a comprehensive model of mobile learning including specific characteristics of strategies in the context of medical education.

2.
J Educ Health Promot ; 10: 421, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35071627

RESUMO

The current outbreak of coronavirus disease 2019 (COVID-19) across the world forced universities to suspend learning to limit the spread of the virus. Many medical schools have shifted to online education as an information delivery mechanism where the educator and learner are separated in space and potentially also in time. This systematic review aims to explore and understand the variety of distance learning strategies in medical students in the contexts of COVID-19. A systematic review was conducted in Web of Sciences, PubMed, Educational Resources and Information Center, and Scopus from December 2019 to July 2020. Eight sets of terminology were used, combining "Distance learning" AND "Medical education" AND "Pandemic." Studies were reviewed independently by two reviewers. Data were extracted and quality appraised using QualSyst tools, and synthesized by performing thematic analysis. A total of 473 articles were identified after removing duplicates and 314 records were screened, of which 125 were included in this study. The primary articles were 52 primarily qualitative articles. Five learning strategies consisted of technology-enhanced learning (TEL), simulation-based learning, technology-based clinical education, mobile learning, and blended learning. Tools, methods, and learning resources associated with these five learning strategies were extracted from the articles. Our review highlights that TEL and simulation-based learning were more commonly used than others in distance learning in medical education during the COVID-19 pandemic. These strategies have the potential to improve learners' level of knowledge and performance through making online learning resources such as Massive Open Online Courses, virtual clinical cases, and blended sources accessible.

3.
Ophthalmic Epidemiol ; 27(6): 417-428, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32449414

RESUMO

PURPOSE: To evaluate the effect of a mobile-based screening programme on eye care utilization in Iran. METHOD: In this cluster randomized community trial, a representative sample of residents aged≥50 years from urban and rural areas in four districts in Tehran province were enrolled. The clusters were randomly assigned to one of the three parallel arms; the mHealth arm with digital data collection, vision screening test and retina evaluation using an integrated mobile application, the conventional arm with manual data collection and screening tests using Snellen chart and Fundus photography at the local primary healthcare facility, and the control arm with manual data collection without screening tests. The main outcome measure was eye care utilization which was defined as at least one visit to an optometrist or ophthalmologist. RESULTS: Of 3312 eligible individuals, 2520 (76.1%) participated. In the first 3 months after the screening programme, eye care utilization was higher among those who were referred by the mHealth method (35.6% 95%CI: 31.1-40.4%) compared to those referred by the conventional method (32.7%, 95%CI: 27.5-38.2%) and to those observed in the control arm (4.5%, 95%CI: 3.2-6.0). Eye care utilization improved (OR = 1.5, 95%CI: 1.2-1.9) among the referred people after the screening programme compared to the utilization before this programme; however, this improvement was significantly higher in the mHealth method (OR: 1.7, 95%CI: 1.2-2.4) compared to the conventional method (OR: 1.2, 95%CI: 0.8-1.8). CONCLUSION AND RELEVANCE: The mobile-based screening programme can significantly improve eye care utilization at the community level.


Assuntos
Telemedicina , Seleção Visual , Humanos , Irã (Geográfico) , Programas de Rastreamento , Acuidade Visual
4.
East Mediterr Health J ; 26(3): 304-314, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32281640

RESUMO

BACKGROUND: Hypertension is a major risk factor for cardiovascular diseases and has a high prevalence in the Eastern Mediterranean Region. AIMS: To estimate the prevalence and awareness of hypertension and its associated factors in a central province of the Islamic Republic of Iran. METHODS: This cross-sectional study was conducted among 2320 adults aged 40-80 years in Yazd, Islamic Republic of Iran, in 2010-2011. Multivariable logistic regression analysis was performed to calculate the odds ratios (ORs) for exploring the association between hypertension and associated risk factors. Of eligible subjects, 2098 participated in clinical examinations (response rate: 90.4%). RESULTS: The sex- and age-standardized prevalence of hypertension was 52.8% [95% confidence interval (CI): 49.6-56.1%]. Of 1170 participants with hypertension, 421 were diagnosed for the first time in this survey; therefore, the unawareness proportion was 36.0% (95% CI: 33.2-38.8%). Among known cases (749 of 1170), 68.5% (95% CI: 65.0-71.8%) had uncontrolled blood pressure. Age (OR 70-80 vs. 40-50 years=7.01, 95% CI: 4.01-12.24), obesity (OR=2.78, 95% CI: 2.06-3.75), diabetes (OR=1.46, 95% CI: 1.12-1.89), hyperlipidaemia (OR=1.60, 95% CI: 1.26-2.03) and living in a rural area (OR=1.57, 95% CI: 1.0- 2.45) were significantly associated with hypertension. CONCLUSIONS: Although age is an inevitable risk factor for hypertension, the high unawareness proportion, uncontrolled hypertension and modifiable risk factors such as obesity, hyperlipidaemia and diabetes demand effective preventive and curative strategies.


Assuntos
Hipertensão/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hiperlipidemias/epidemiologia , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Prevalência , Características de Residência , Fatores de Risco , Fatores Sexuais
5.
Ophthalmic Epidemiol ; 27(3): 209-218, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31960781

RESUMO

Purpose: To estimate the prevalence and associated factors of AMD in an Iranian population in 2014.Methods: In this population-based cross-sectional study, a total of 2975 Iranian residents (age: ≥50 years) from the urban and rural areas of Gilan province were included. The prevalence of different grades of AMD was determined using the International Age-Related Maculopathy Epidemiological Study Group grading system.Results: Of 2975 eligible individuals, 2587 (87.0%) subjects participated and 2275 (76.5%) subjects (62.6 ± 8.8 years old) had gradable fundus photographs. Age- and sex-standardized prevalence of early and late AMD based on the 2016 Iran census were 13.2% (95% confidence interval [CI], 10.6-16.2) and 0.7% (95% CI, 0.4-1.3), respectively. In multivariate analysis, each decade increase in age was associated with the adjusted odds of any (adjusted odds ratio [AOR] = 1.31, 95% CI, 1.09-1.56; P = .0031), early (AOR = 1.27, 95% CI, 1.06-1.53; P = .012) and late AMD (AOR = 2.39, 95% CI, 1.08-5.28; P = .031). Hyperopia was identified to be less frequent in late AMD (AOR = 0.20, 95% CI, 0.04-0.80; P = .024). No significant association was found between AMD and sex, smoking, outdoor working, diabetes, hypertension, pseudophakia, hyperlipidemia and myopia.Conclusion: Gilan Eye Study demonstrated the first estimate of age-specific AMD prevalence in Iran being compatible with other WHO regions. With the expected increase in the life expectancy and aging of Iranians, the number of people affected by AMD will be increasing in future. Healthcare policy makers should be advised to provide more efficient eye care services and preventive strategies in this regard.


Assuntos
Técnicas de Diagnóstico Oftalmológico/instrumentação , Degeneração Macular/diagnóstico , Degeneração Macular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Estudos Transversais , Feminino , Fundo de Olho , Humanos , Hiperopia/epidemiologia , Irã (Geográfico)/epidemiologia , Degeneração Macular/classificação , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Inquéritos e Questionários , Acuidade Visual/fisiologia
6.
J Ophthalmic Vis Res ; 14(2): 179-184, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114655

RESUMO

Purpose: To determine the magnitude and causes of blindness and visual impairment (VI) in Kurdistan, using the Rapid Assessment of Avoidable Blindness methodology. Methods: In this population-based cross sectional study, 99 clusters were selected through probability proportional to size sampling. Visual acuity (VA) was measured using a standard tumbling "E" chart. Ophthalmologists examined participants with VA < 6/18 in both eyes. The cause of VI in the better eye or the most treatable cause was considered as the primary cause of VI. Results: A total of 3203 (response rate: 92.4%) individuals aged 50 years and older participated, of whom 1657 (51.7%) were female. The standardized prevalence of blindness, severe visual impairment (SVI), and moderate visual impairment (MVI) based on available correction (presenting VA) were 2.1% (1.5-2.6), 1.7% (1.2-2.2), and 9.6%(8.4-10.8), respectively. The proportion of avoidable causes of blindness, SVI, and MVI were 58.1%, 78.4%, and 83.4%, respectively. The most common cause of blindness and SVI was cataract (27.4% and 60.8% respectively), followed by age-related macular degeneration (25.8% and 13.7%, respectively). The leading causes of MVI were uncorrected refractive errors (RE) (37.2%) and cataract (33.6%). Conclusion: The prevalence of blindness in the study population seems comparable to the region. According to our results, blindness, SVI, and MVI were mostly due to avoidable causes. Cataract and refractive errors are the principal causes of blindness and VI in Kurdistan.

7.
J Ophthalmol ; 2019: 2073679, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30949361

RESUMO

Purpose: To model a community-based telescreening program for diabetic retinopathy (DR) in Iran and to implement a pilot project at the Iranian Diabetes Society (IDS) branch in a Tehran suburb. Methods: In this mixed model study, a web application called the "Iranian Retinopathy Teleophthalmology Screening (IRTOS)" was launched. The educational course for DR screening was established for general practitioners (GPs). Registered patients in IDS branch were recalled for fundus photography; images were transferred to the reading center via IRTOS to be graded by GPs, and patients were informed about the results via mobile messaging. All images were independently reviewed by a retina specialist as the gold standard. Patients who required further assessment were referred to an eye hospital. Results: Overall, 604 subjects with diabetes were screened; of these, 50% required referral. The sensitivity and specificity for diagnosis of any stage of DR by trained GPs were 82.8% and 86.2%, respectively, in comparison to the gold standard. The corresponding values for detecting any stage of diabetic macular edema (DME) were 63.5% and 96.6%, respectively. Conclusions: Telescreening was an effective method for detecting DR in a Tehran suburb. This screening model demonstrated its capacity for promoting diabetic eye care services at the national level. However, the sensitivity for detecting DME needs to be improved by modifying the referral pathway and promoting the skill of GPs.

8.
J Ophthalmic Vis Res ; 14(1): 52-61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30820288

RESUMO

Purpose: To design a screening program for prevention of blindness at the community level in Iran. Methods: In this qualitative study, the components and properties of the screening program were identified using a participatory action research method with focus group meetings (FGMs) with relevant health care providers and authorities. A content analysis approach was used for data analysis. Results: In total, 18 stakeholders including six ophthalmologists with different sub-specialties participated in the five FGMs. The screening program aims to discover vision-threatening eye conditions in people aged 50 years and over. Primary health care workers deliver the program including vision tests and fundus imaging with the support of an ophthalmic technician. Retina specialists perform decision-making. Referral plans are interacted through an automated digital program. The screening environment, feedback, ethics and medical legal issues are other main components of the program. Conclusion: This study presents the initial concepts and components of a screening program for prevention of blindness in the adult population in Iran. The program has the potential to improve eye health at the community level and may potentially be replicated as a model for similar settings elsewhere.

10.
Int J Prev Med ; 8: 49, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28757926

RESUMO

BACKGROUND: Diabetic retinopathy and its consequence, diabetic macular edema, are leading causes of vision loss in diabetics and can develop even in the first years after onset of diabetes. Being asymptomatic in primary phase and having compensatory effect of bilateral vision delay the necessity of eye care utilization. We conducted this study to determine diabetic individuals' level of awareness about the importance of regular eye examinations. METHODS: As part of the cross-sectional, population-based, Yazd Eye Study on people aged 40-80 years, diabetic participants were identified for enrollment in this research. Participants underwent thorough ophthalmic examinations as well as detailed interview. Well-trained interviewers asked participants about their awareness of screening eye examinations and their necessity. Fasting blood sugar, glycated hemoglobin, and complete lipid profile were assessed. All descriptive and analytic tests were done in survey mode. Logistic regression was applied to assess related risk factors. RESULTS: Among 497 diabetic persons out of 2098 participants, 364 respondents (73.4%; 95% confidence interval: 68.6-78.2) were not aware of the necessity of regular eye examinations. Among 133 aware respondents, 21 (16%) respondents had no eye examination over the past year. Educational level significantly correlated with awareness (P = 0.004), and physicians were the most frequent source of awareness (79.7%). CONCLUSIONS: This study showed that a significant proportion of Yazd diabetic population (about 73%) needs to be informed about the necessity of regular eye examinations. The remaining respondents, who had this information, mainly had undergone regular ophthalmologist visits, which imply that educational interventions could improve the situation.

11.
Arch Iran Med ; 20(7): 392-402, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28745901

RESUMO

BACKGROUND: Due to significant achievements in reducing mortality and increasing life expectancy, the issue of disability from diseases and injuries, and their related interventions, has become one of the most important concerns of health-related research. METHODS: Using data obtained from the GBD 2015 study, the present report provides prevalence and years lived with disability (YLDs) of 310 diseases and injuries by sex and age in Iran and neighboring countries over the period 1990-2015. Age-standardized rates of all causes of YLDs are presented for both males and females in 16 countries for 1990 and 2015. We present the percentage of total YLDs for 21 categories of diseases and injuries, the percentage of YLDs for age groups, as well as the ranking of the most prevalent causes and YLDs from the top 50 diseases and injuries in Iran. RESULTS: In 2015, the burden of 310 diseases and injuries among the Iranian population was responsible for 8,357,878 loss of all-age total years, which is equal to 10.58% of total years lived per year. This differs from the neighboring countries, as it ranges from 9.05% in Turkmenistan to 13.36% in Russia. During the past 25 years, a remarkable decrease was observed in all-cause YLD rates in all 16 countries. Meanwhile, in all countries, the age-standardized rate of all causes of YLDs was higher in females than males. CONCLUSION: Based on our findings, one of the remarkable changes in NCDs observed among the studied age groups was increased rate of YLDs from mental disorders, which was replaced by musculoskeletal disorders in older age groups in 2015.


Assuntos
Efeitos Psicossociais da Doença , Avaliação da Deficiência , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Carga Global da Doença , Humanos , Lactente , Recém-Nascido , Irã (Geográfico)/epidemiologia , Expectativa de Vida/tendências , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Mortalidade , Anos de Vida Ajustados por Qualidade de Vida , Distribuição por Sexo , Adulto Jovem
12.
Arch Iran Med ; 20(7): 403-418, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28745902

RESUMO

BACKGROUND: Summary measures of health are essential in making estimates of health status that are comparable across time and place. They can be used for assessing the performance of health systems, informing effective policy making, and monitoring the progress of nations toward achievement of sustainable development goals. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) as main summary measures of health. We assessed the trends of health status in Iran and 15 neighboring countries using these summary measures. METHODS: We used the results of GBD 2015 to present the levels and trends of DALYs, life expectancy (LE), and HALE in Iran and its 15 neighboring countries from 1990 to 2015. For each country, we assessed the ratio of observed levels of DALYs and HALE to those expected based on socio-demographic index (SDI), an indicator composed of measures of total fertility rate, income per capita, and average years of schooling. RESULTS: All-age numbers of DALYs reached over 19 million years in Iran in 2015. The all-age number of DALYs has remained stable during the past two decades in Iran, despite the decreasing trends in all-age and age-standardized rates. The all-cause DALY rates decreased from 47,200 in 1990 to 28,400 per 100,000 in 2015. The share of non-communicable diseases in DALYs increased in Iran (from 42% to 74%) and all of its neighbors between 1990 and 2015; the pattern of change is similar in almost all 16 countries. The DALY rates for NCDs and injuries in Iran were higher than global rates and the average rate in High Middle SDI countries, while those for communicable, maternal, neonatal, and nutritional disorders were much lower in Iran. Among men, cardiovascular diseases ranked first in all countries of the region except for Bahrain. Among women, they ranked first in 13 countries. Life expectancy and HALE show a consistent increase in all countries. Still, there are dissimilarities indicating a generally low LE and HALE in Afghanistan and Pakistan and high expectancy in Qatar, Kuwait, and Saudi Arabia. Iran ranked 11th in terms of LE at birth and 12th in terms of HALE at birth in 1990 which improved to 9th for both metrics in 2015. Turkey and Iran had the highest increase in LE and HALE from 1990 to 2015 while the lowest increase was observed in Armenia, Pakistan, Kuwait, Kazakhstan, Russia, and Iraq. CONCLUSIONS: The levels and trends in causes of DALYs, life expectancy, and HALE generally show similarities between the 16 countries, although differences exist. The differences observed between countries can be attributed to a myriad of determinants, including social, cultural, ethnic, religious, political, economic, and environmental factors as well as the performance of the health system. Investigating the differences between countries can inform more effective health policy and resource allocation. Concerted efforts at national and regional levels are required to tackle the emerging burden of non-communicable diseases and injuries in Iran and its neighbors.


Assuntos
Avaliação da Deficiência , Nível de Saúde , Expectativa de Vida/tendências , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Carga Global da Doença , Humanos , Lactente , Recém-Nascido , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Mortalidade , Anos de Vida Ajustados por Qualidade de Vida , Distribuição por Sexo , Adulto Jovem
13.
Arch Iran Med ; 20(5): 288-294, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28510464

RESUMO

OBJECTIVE: To assess the national health system for management of diabetes mellitus (DM) in Iran, with particular focus on diabetic retinopathy (DR). MATERIALS AND METHODS: In this qualitative study, the national stakeholders related to DR and DM management system were invited to participate. Two researchers performed interview using a semi-structured questionnaire recommended by the World Health Organization titled "Tool for Assessment of Diabetic Retinopathy and DM Management Systems". The questionnaire contains seven different sections, each consisting of closed and open-ended questions, and a final Likert-type score, ranging from 1 indicating the worst to 4 indicating the best status. Inconsistencies were resolved through a collective decision of the research team, followed by a focus group discussion with stakeholders at the Ministry of Health. RESULTS: Fourteen stakeholders out of 15 total invitees were interviewed (response rate: 93.3%). There were national priorities, defined policies, and running programs (score = 3), but the care system should be strengthened in terms of implementation of clinical guidelines, with specific reference to the availability of regular screenings for DR (score = 2). The network of care providers, health information systems, and promotional programs were insufficient (score = 2). The health workforce and technology for DR and DM were acceptable (scores 4 and 3, respectively); however, there were concerns about the appropriate distribution and utilization of resources and out-of-pocket costs paid by patients. CONCLUSION: The existence of national policies, programs, a qualified workforce, and modern technology is promising. Nevertheless, other aspects of the health system need to be improved to ensure access to health and eye care for people with DM and achieve universal health coverage.


Assuntos
Atenção à Saúde/economia , Atenção à Saúde/normas , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/terapia , Retinopatia Diabética/economia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Promoção da Saúde , Humanos , Irã (Geográfico) , Masculino , Pesquisa Qualitativa , Inquéritos e Questionários
14.
J Ophthalmic Vis Res ; 12(2): 141-150, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28540004

RESUMO

PURPOSE: To assess central corneal thickness (CCT) and its associations in an adult Iranian population. METHODS: This was a population-based cross-sectional study of adults aged 40-80 years. Eyes with corneal disorders, previous ocular surgery, or trauma were excluded. All subjects underwent complete ophthalmic examination, general health assessment, laboratory tests, and a detailed interview. CCT was measured with an ultrasonic pachymeter. Intraocular pressure (IOP) was measured with Goldmann applanation tonometry. Except for the report on interocular differences in CCT, only one eye of each subject was used for the rest of statistical analyses. RESULTS: The mean age (±SD) of the 1203 participants, who had CCT measurements and met inclusion criteria, was 51.8 ± 8.5 years. The mean CCT was 544 ± 35, 564 ± 28, and 544 ± 36 µm in the eyes of the normal, ocular hypertension, and glaucoma groups, respectively (P = 0.025). In participants without glaucoma, the mean interocular difference in CCT was 9 ± 12 µm. CCT was not significantly associated with age, sex, or some select systemic factors (body mass index, diabetes, hypertension, and renal failure). While controlling for age and sex, CCT was greater in individuals with higher IOPs (P < 0.001), larger vertical or horizontal cup-to-disc ratios (P = 0.044, and P = 0.025, respectively), and hyperopia (P = 0.009). CONCLUSION: In this adult Iranian population, CCT was significantly associated with IOP, cup-to-disc ratio, and the refractive status of eye. CCT outside the normal range of 475-613 µm or with interocular asymmetry greater than 33 µm (6%) should prompt evaluation for potential ocular disorders.

15.
Ophthalmic Epidemiol ; 24(6): 381-387, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28422552

RESUMO

PURPOSE: To conduct an assessment of avoidable blindness and diabetic retinopathy (DR) in Gilan, 2014. METHODS: A cross-sectional population-based survey was performed on a representative sample of urban and rural individuals aged ≥50 years of the province. Blindness was defined as presenting visual acuity (PVA) <3/60 in the better eye. Moderate visual impairment (MVI) and severe visual impairment (SVI) were defined as 6/60 ≤ PVA <6/18 and 3/60 ≤ PVA <6/60 in the better eye, respectively. Diabetes mellitus (DM) was determined based on random blood sugar (RBS) levels ≥200 mg/dL or a previous diagnosis. We used the Scottish grading system to grade DR. RESULTS: We invited 2975 individuals from 85 clusters. Age- and sex-adjusted prevalence and 95% confidence interval (CI) of blindness, SVI, MVI, and DM in 2587 participants (response rate: 86.9%) were 1.5% (95% CI: 1.1-2.0), 1.5% (95% CI: 0.9-2.0), 11.3% (95% CI: 9.9-12.7) and 21.4% (95% CI: 19.2-23.7), respectively. The leading causes of blindness were cataract (47.1%), age-related macular degeneration (14.7%) and DR (8.8%). Cataract surgery (CS) coverage was 69.3%. The main challenges for CS were cost and unawareness. The outcome of CS was good in 66.9% of operated eyes. Any DR and/or maculopathy were observed in 25.3% (95% CI: 21.0-29.5) of subjects including 12.6% (95% CI: 9.7-15.6) sight-threatening DR. In previously known DM cases, 215 (41.7%) had never undergone an eye examination for DR. CONCLUSION: The proportion of avoidable blindness and DR is considerable in Gilan Province.


Assuntos
Cegueira/epidemiologia , Retinopatia Diabética/epidemiologia , Inquéritos Epidemiológicos , Medição de Risco/métodos , População Rural , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Cegueira/etiologia , Cegueira/prevenção & controle , Estudos Transversais , Retinopatia Diabética/complicações , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
16.
Arch Iran Med ; 20(1): 43-48, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28112531

RESUMO

BACKGROUNDS: To assess the role of socio-economic inequality in visual impairment (VI) in Varamin district, Iran. PATIENTS AND METHODS: Using multistage cluster sampling method, 60 clusters (each with 50 subjects) were recruited and underwent clinical eye examinations. Socio-economic status (SES) was identified based on education, occupation, family assets and housing conditions that were measured at the participants' households using a semi-structured questionnaire and a two-step cluster analysis model. In addition, principal component analysis and the concentration index were used to identify the gap between high and low SES groups. RESULTS: Participants were categorized in high (522, 24.4%), moderate (974, 43.1%) and low (763, 33.7%) socio-economic levels. In these levels, the prevalence of VI was 5.9% (95% CI: 3.3 to 8.6), 10.4% (95% CI: 8.4 to 12.4), and 12.6% (95% CI: 10.1 to 15.1), respectively. The prevalence of VI in people with low SES was significantly greater than those in high SES level. The proportions of avoidable causes were relatively high in all SES levels (more than 80%) with no significant difference between different levels. CONCLUSIONS: There is significant inequality in VI prevalence in Varamin district. Avoidable causes are high in all SES groups. Therefore, community-based modalities and preventive programs with a specific notice to poorer SES groups are recommended to improve eye health in this district.


Assuntos
Classe Social , Transtornos da Visão/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários
17.
Acta Ophthalmol ; 95(2): e144-e151, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27778447

RESUMO

PURPOSE: To determine the distribution of intraocular pressure (IOP), central corneal thickness (CCT) and vertical cup-to-disc ratio (VCDR) in the healthy Iranian population. METHODS: This population-based, epidemiologic study evaluated Iranian aged 40-80 years, residing in Yazd, Iran, in 2010-2011. Eligible subjects were selected by cluster random sampling. Each participant underwent an interview and ophthalmologic examination including slit lamp examination, Goldmann applanation tonometry, binocular optic disc evaluation, stereoscopic fundus photography, ultrasonic pachymetry and visual field testing. RESULTS: Of 2320 eligible individuals, 2098 subjects (response rate of 90.4%) participated in the study. One eye from 1159 subjects (total of 2262 normal eyes) were randomly selected for the purpose of the study. Mean age was 53.1 ± 9.6 years. Mean IOP, CCT and VCDR were 14.2 ± 2.5 mmHg, 543 ± 37 µm and 0.32 ± 0.14, respectively. Multiple regression analysis showed a significant correlation between IOP and age (regression coefficient = 0.02 per year, p = 0.015), CCT (regression coefficient = 0.02 per micron, p < 0.001), Spherical equivalent (regression coefficient = -0.15 per dioptre, p = 0.0.024) and smoking (regression coefficient = 0.89 higher for smokers, p = 0.009); it also showed a significant correlation between CCT with spherical equivalent (regression coefficient = 3.6 per dioptre, p = 0.002) and IOP (regression coefficient = 3.6 per mmHG, p < 0.001). There was no significant correlation with VCDR. CONCLUSIONS: Mean IOP, CCT and VCDR were 14.2 ± 2.5 mmHg, 543 ± 35 µm and 0.32 ± 0.14, respectively, in healthy Iranians that is different from other ethnicities. It seems advisable to pay attention to ethnicity for interpretation of each person's variables.


Assuntos
Córnea/diagnóstico por imagem , Glaucoma/epidemiologia , Pressão Intraocular/fisiologia , Disco Óptico/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Glaucoma/fisiopatologia , Gonioscopia , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco
18.
J Ophthalmic Vis Res ; 11(2): 188-92, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27413500

RESUMO

PURPOSE: To assess quality of life (QOL) in children undergoing strabismus surgery. METHODS: This prospective cohort study included 87 children (including 41 boys, 47.1%) with mean age of 8.7 ± 4.1 years at three academic eye hospitals in Tehran. A modified version of the RAND Health Insurance Study QOL questionnaire was filled based on interviews with parents before and three months after surgery. The questionnaire consisted of 36 Likert scale items ranging in score from 0 to 100, with higher scores representing better function. Relevant items were averaged together and categorized into 11 distinct QOL dimensions. RESULTS: The majority of QOL dimensions improved after strabismus surgery including functional limitation (92.36 ± 16.78 vs. 82.15 ± 20.92, P < 0.01), anxiety (68.61 ± 18.15 vs. 60.28 ± 19.19, P < 0.01), depression (82.31 ± 16.42 vs. 72.36 ± 17.72, P < 0.01), positive well-being (73.33 ± 14.69 vs. 70.56 ± 15.96, 0.048), social relations (79.43 ± 11.52 vs. 68.69 ± 30.98, 0.002), general health perception (76.4 ± 16.48 vs. 67.36 ± 18.9, P < 0.01), resistance/susceptibility (79.72 ± 13.4 vs. 71.02 ± 14.58, P < 0.01), satisfaction with development (73.81 ± 16.07 vs. 70.07 ± 14.98, P = 0.006), and eye alignment concerns (75.44 ± 15.89 vs. 53.14 ± 26.61, P < 0.01). Only self-reported prior health (71.73 ± 15.9 vs. 72.78 ± 15.29, P = 0.33) and parent-child closeness (72.92 ± 15.82 vs. 72.5 ± 17.99, P = 0.73) did not significantly improve. The amount of ocular realignment (more vs. less than 20 prism diopters [PD]) had a direct correlation with improvement in subscales of satisfaction with development (0.019) and eye alignment concerns (0.028). CONCLUSION: Strabismus surgery positively impacts physical and psychosocial function in children. Children with a greater amount of correction experienced more QOL improvement after surgery.

19.
Ophthalmic Epidemiol ; 22(3): 208-13, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26158579

RESUMO

PURPOSE: To determine the prevalence of trachoma and risk factors associated with the disease in rural areas of the Sistan-va-Baluchestan province in Iran from 2012-2013. Population-based prevalence data for trachoma is lacking in this region. METHODS: In this population-based cross-sectional study, 80 clusters were selected using a systematic and probability proportional to size method. All participants underwent clinical eye examinations according to the World Health Organization simplified trachoma grading system. The prevalence of follicular trachoma (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in women aged over 15 years were the most important clinical indicators of trachoma. RESULTS: The study surveyed 8187 individuals and analyzed 7912 participants (96.6%) including 3737 children aged 1-9 years and 4175 females >15 years. The prevalence of TF and TT in the relevant indicator groups were 0.59% (95% confidence interval, CI, 0.36-0.89%) and 0.02% (95% CI 0.00-0.13%), respectively. CONCLUSION: Previously, trachoma prevalence data for this region were lacking. This study confirms that the Sistan-va-Baluchestan region is not endemic for trachoma. This has important implications for national trachoma elimination activities.


Assuntos
População Rural/estatística & dados numéricos , Tracoma/epidemiologia , Triquíase/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
20.
J Ophthalmic Vis Res ; 10(1): 33-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26005550

RESUMO

PURPOSE: To describe prophylactic patterns employed against endophthalmitis after cataract surgery in Iran. METHODS: This cross-sectional study included 486 ophthalmologists filling in a self-administered questionnaire during the 20(th) Annual Congress of the Iranian Society of Ophthalmology in December 2010, Tehran, working in both private and academic medical centers. Prophylactic measures used preoperatively, intraoperatively and postoperatively and self-reported rates of endophthalmitis were assessed as the main outcome measurements. RESULTS: In the preoperative phase, 75.5% of surgeons used povidone-iodine in the conjunctival sac and 71.4% of them did not use antibiotics. The rate of intraoperative prophylaxis was 61.9% either in the form of intracameral antibiotics or subconjunctival injection (mostly cephazolin or gentamicin). Only 7.8% of participants used intracameral cephalosporins. Postoperative antibiotics [mostly chloramphenicol (57%) and ciprofloxacin (28%)] were used by 94.2% of surgeons. On average, ten years of practice were required to observe one case of endophthalmitis. CONCLUSION: The surgeons in present setting used various prophylactic regimens against endophthalmitis after cataract surgery. Setting a local and evidence-based clinical practice guideline seems necessary.

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