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Fatemeh Bakhtari,1 Parvin Sarbakhsh,2 Jalil Daneshvar,1 Devender Bhalla,3,4 Haidar Nadrian5 1Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 2Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 3Pôle Universitaire euclide Intergovernmental UN Treaty 49006/49007, Bangui, Central African Republic; 4Iranian Epilepsy Association, Tehran, Iran; 5Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Haidar Nadrian Department of Health Education and Promotion, Faculty of HealthTabriz University of Medical Sciences, Office No. 317, Attar-e-Neyshabouri St., Tabriz 6617777541, IranEmail haidarnadrian@gmail.comObjective: The objective of this study was to assess depressive symptoms among rural health workers (RHWs) through a multi-factorial socio-ecological framework (SEF) encompassing personal, interpersonal, organizational and community components.Patients and Methods: A random sample of 394 RHWs in all rural areas of East Azerbaijan and fulfilling our other inclusion criteria were recruited. The participants underwent the Short-Form Beck’s Depression Inventory and a validated researcher-constructed SEF questionnaire, including subscales on personal, interpersonal, organizational and community factors associated with depressive symptoms. Internal consistency and factor structure parameters of the SEF were also calculated.Results: A total of 394 RHWs were screened, of whom 170 (43.2%) had mild to major depressive symptoms. Only 6.8% were identified with major depressive symptoms. The SEF-based scale was found to have acceptable content validity (content validity index and ratio were 0.80 and 0.77, respectively) and reliability (Cronbach’s alpha=0.7). In the structural equation modeling, the fit indices showed our model to fit the data well (χ2=14.06, df=14, χ2/df=1.00, CFI=0.967, RMSEA=0.032). The highest direct contribution to depressive symptoms was found from the personal factors component (β=− 2.32). Also, “work load and roles interference” (from organizational level, β=− 0.76) and “family/colleague support” (from community level, β=− 1.28) made significant direct contributions towards depressive symptoms. Besides the SEF components, female gender (β=1.69), family history of mental illness (β=− 1.48), having chronic illnesses (β=− 1.64) and being religious (β=3.43) were the strongest direct contributors to depressive symptoms.Conclusion: Depressive symptoms were common among RHWs, arising from all personal-, interpersonal-, organizational- and community-level factors. Our SEF had adequate internal consistency and factor structure parameters to be applied in the Middle East and North Africa (MENA) region countries, such as Iran, as a theoretical framework to plan for interventional efforts aiming at preventing depressive symptoms among RHWs. The burden of depressive symptoms should be reduced through multi-factorial interventions and rational perspectives.Keywords: depression, rural healthcare, socio-ecological framework, rural health workers

Kurosh Gharagozli,1– 3 Elham Lotfalinezhad,4,5 Fatemeh Amini,5 Vida Saii,1 Devender Bhalla6– 8 1Iran Epilepsy Association, Tehran, Iran; 2Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Brain Mapping Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran; 5Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 6Nepal Interest Group of Epilepsy and Neurology (NiGEN), Kathmandu, Nepal; 7Sudan League of Epilepsy and Neurology (SLeN), Khartoum, Sudan; 8Pôle Universitaire Euclide Intergovernmental UN Treaty 49006/49007, Bangui, Central African RepublicCorrespondence: Devender Bhalla Email bhalla@mail.euclid.intIntroduction: The primary objective of this study was to evaluate fear related to epilepsy and its treatment among those with idiopathic epilepsy. Our secondary objective was to estimate the psychometric properties of a brief Bhalla-Gharagozli Fear in epilepsy Questionnaire (BG-FEQ).Methods: We conducted patient-finding exercise in our study areas through various means to obtain subjects with idiopathic epilepsy. We carefully examined each patient through a detailed case-history examination. Following that, we evaluated fear related to epilepsy by using Bhalla-Gharagozli Fear in Epilepsy Questionnaire (BG-FEQ) across two broad domains: epilepsy and pharmacotherapy.Results: The study obtained 52 subjects (39.0 years; 45.0% males, 70.0% married, 35.0% unqualified, 85.0% active epilepsy, 80.0% generalized seizures) with idiopathic epilepsy. The alpha coefficient was 92.8, with no item-specific coefficient of ≤ 0.91. The alpha coefficient was 0.90 and 0.93 for reporting a “yes” and “no” to the items, respectively. We obtained a two-factor structure of BG-FEQ that provided a cumulative variance of 83.6%. The majority (65.0%) reported at least one fear. The per-patient mean number of the fear element was 2.1 (95% CI 1.1– 3.3), which differed significantly for males and females (1.1, 95% CI 0.4– 2.6 and 3.0, 95% CI 1.4– 4.6, respectively, p=0.03). The most frequent fear was that of addiction and the bad effects of anti-seizure medications (both 45.0%). Upon bootstrap regression after constraining gender, the fear elements were associated with illiteracy, difficulty in understanding epilepsy and sleeping in a prone position. The sample power was 99.0%.Conclusion: There was a significant representation of fear among those with idiopathic epilepsy, especially among the females, particularly the fear of brain tumour, premature death and more frequent/severe seizures over time. At least 65.0% of idiopathic subjects are likely to be affected by at least one fear. The essential mitigating approach should be the education of practitioners towards better identification and therapeutic handling of comorbid constructs, and also for the education of patients and their caregivers towards better awareness and prevention. There is also a need for formal Epilepsy Educators towards better awareness, therapeutic support and prevention of epilepsy.Keywords: idiopathic epilepsy, epidemiology, behavioural, fear, mental health

Haleh Heizomi,1 Zeynab Iraji,2 Rogayeh Vaezi,1 Devender Bhalla,3– 5 Donald E Morisky,6 Haidar Nadrian1,7 1Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 2Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran; 3Pôle Universitaire Euclide, Intergovernmental UN Treaty 49006/49007®, Bangui, Central African Republic; 4Iranian Epilepsy Association®, Tehran, Iran; 5Nepal Interest Group of Epilepsy and Neurology (NiGEN), Kathmandu, Nepal; 6Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA; 7Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IranCorrespondence: Haidar NadrianDepartment of Health Education and Promotion, Faulty of Health, Tabriz University of Medical Sciences, Attar-e-Neyshabouri Street, Tabriz, IranTel +989181734596Email haidarnadrian@gmail.comObjective: We examined the gender-based associations of health literacy (HL) with self-reported medication adherence (MEDA) among patients with primary hypertension (pHTN).Patients and Methods: The subjects were recruited from the general population through all health centers of the Heris county, east Azarbaijan. They were to be adults (30+ years age), with pHTN of any stage, of any gender, and without comorbid illness. All underwent detailed face-to-face interview. We used valid questionnaires for HL and MEDA. Hierarchical regression was done to establish the association between MEDA, socio-demographic variables, and nine HL domains by gender. Other statistical procedures were also done.Results: A total of 300 (48.6% males, mean age: 56.7± 9.3) subjects participated; 43.0% were uneducated, 73.0% had moderate socioeconomic status, 68.0% had poor HL, and 7.0% maintained high adherence. Men were better in reading skills (p=0.002), and accessing (p=0.01) and using (p=0.02) health information, but women were better in health knowledge (p=0.004). The average regression estimate (±standard deviation) between HL and MEDA was 0.37± 0.09, lower among men (0.361± 0.11) than women (0.396± 0.08), p=0.003. Upon hierarchical regression, the association between HL and MEDA was significant for communication and decision-making skills alone among both men (34.5%) and women (40.6%), individually.Conclusion: HL had substantial association with MEDA among those with HTN, for both men and women, particularly the communication and decision-making. With considerations on gender differences, this association should be confirmed through interventional studies to help make HL a formal mitigating strategy for MEDA and other public health goals.Keywords: medication adherence, health literacy, hypertension, gender

The article offers information on the 'Women Legislators: Building Resurgent India' Conference held in New Delhi, India, from March 5-6, 2016. The event featured President of India, Pranab Mukherjee, Vice-President Mohammad Hamid Ansari and Prime Minister Narendra Modi. It discussed the role of women in economic development, power and responsibility of women legislators, and women empowerment.

Inhalation exposure to ozone (O3) is known to induce epithelial and inflammatory changes in the lungs, characterized by neutrophilia and changes in epithelial permeability. Several cell types and their soluble mediators, including interleukin-1 (IL-1) and tumor necrosis factor- (TNF- ), are involved in the evolution of these responses. In this study, we have compared the effects of the combination of anti-IL-1 and anti-TNF- on in vitro and in vivo responses to inhaled O3. Male, Sprague-Dawley rats were exposed, nose-only, to 0.8 ppm O3 for 3 h and the in vitro and in vivo parameters were measured 8-12 h following exposure. The in vitro studies revealed that the adherence of inflammatory cells, primarily macrophages, harvested from the lungs of O3-exposed rats to cultured lung epithelial cells (ARL-14) was significantly greater than the adherence of macrophages from air-exposed controls. Furthermore, this adherence was significantly reduced in antibodytreated cells as compared to cells treated with preimmune rabbit serum. In vivo, elevations were found in the percentage of neutrophils in bronchoalveolar lavage fluid (BALF), 99m transport of Tc-diethylenetriaminepentaacetate (DTPA) across the tracheal epithelium, and concentrations of total protein and albumin in BALF following O3 exposure. However, these effects were not significantly altered by treatment with the anti-IL-1 /anti-TNFcombination. Therefore, it was concluded that O3 affects the early stages of the inflammatory response, particularly with respect to macrophage activation and adherence to epithelial cells, and that this early response may be mediated by IL-1 and/or TNF- . The results also suggest that the in vivo effects of O3 are controlled by complex mechanisms involving factors other than IL-1 and TNF- , even though these cytokines are capable of modifying macrophage function as revealed by the in vitro adherence studies. [ABSTRACT FROM AUTHOR]

Changes in rat tracheal epithelial permeability and polymorphonuclear leukocyte (PMN) populations during a 24-hr time period following a 3-hr exposure to 0.8 ppm ozone (O) were investigated. An increase in permeability to Tc-diethylene-triaminepentaacetate (DTPA) occurred immediately after the exposure, peaked at the 8-hr time point and decreased to control level by 24 hr. For correlation with tracheal permeability, tracheal cross sections were stained with naphthol AS-D chloroacetate and PMNs were scored by their location as well as staining characteristics (positive or negative). The total PMN population remained at the control value at the 0-, 4-, and 8-hr time points, and increased at 12 hr, followed by a rapid decline to below the control value for the remaining time points. There was a shift at the 8-hr time point in the population location, from the vasculature to the interstitium, which returned to control values at 12 hr. The percentage stained PMNs increased significantly at 16 hr while remaining at control values for all other time points. The data reveal that there is a significant increase in tracheal epithelial permeability immediately after the exposure, but the overall increase in the PMN population is preceded by a lag phase. A decrease in the vascular pool of PMNs concomitant with an increase in the interstitial pool of PMNs suggests their migration from blood to the interstitium after ozone exposure. These data indicate that while PMNs may play a role in permeability changes of tracheal epithelium, the initiation is most likely due to other factors. [ABSTRACT FROM PUBLISHER]