BackgroundDiabetic retinopathy (DR) is one of the leading causes of blindness in adults in industrialized countries and the emerging cause of blindness in developing countries. The objective of this study was to describe the prevalence of DR and risk factors associated with it among diabetic patients.MethodsThe analytical cross-sectional survey and eye screenings were carried out among 625 diabetic patients from urban and rural areas of Gegharkunik region. DR was assessed by dilated ophthalmoscopy and defined based on the WHO International Classification of Diseases. The survey instrument, included questions about demographics, disease history, health status, medication use and healthy lifestyle. Descriptive statistics and logistic regression were used to analyze the data.ResultsThe prevalence of DR in the sample was 36.2%. A total of 90.2% of patients with DR had non-proliferative, while 9.8% had proliferative DR. In bivariate analysis, age, diabetes duration, being under insulin treatment, blood glucose level, having non-communicable diseases were significantly associated with DR. In the adjusted analysis being under insulin treatment (OR = 3.24; 95% CI: 1.56–6.75), diabetes duration (OR = 1.23; 95% CI: 1.16–1.31) and age (OR = 1.05; 95% CI: 1.02–1.08) were independently associated with DR.ConclusionEarlier diagnosis of diabetes and DR can help to control some of these factors and prevent further complications and vision loss. Population-based educational programs on diabetes and diabetic retinopathy and continuous medical education on diabetes management can improve diabetes care and self-management and prevent eye complications.

Visual impairment was significantly associated with depression in socially vulnerable older adults in Armenia. Timely eye screenings in similar population groups could lead to early detection of visual impairment and prevention of visual loss and associated mental health problems.

The study found that a positive family history of myopia and environmental factors had independent associations with myopia. The number of near work hours did not play a major role in the development of myopia, but length of time of focused continuous reading did.

The study assessed the level of patient satisfaction at selected primary health-care facilities in Lori and Shirak provinces of Armenia. Self-administered questionnaires were distributed to 684 recent clients at primary health-care facilities. The majority of patients were satisfied with their provider (mean satisfaction score of 1.75 out of maximum 2). Most patients (89.0%) would visit the same provider again, and would recommend the provider to friends (85.6%). Satisfaction with other aspects of care, including waiting time, accessibility of services, confidentiality and cleanliness of the facility, was also high (mean score of 1.70 out of 2). Seventy-eight percent of respondents considered the care they received to be 'excellent' or 'good'. The less educated and those in rural areas were more likely to be satisfied with the provider's quality. Despite the fundamental problems now challenging the Armenian primary health-care sector, patient satisfaction remains high. Given the high level of reported satisfaction, more focused satisfaction research tools and alternative approaches to patient assessments of care are needed to inform quality improvement in the Armenian setting.

IntroductionHealth care in post-war situations, where the system's human and fixed capital are depleted, is challenging. The addition of a frozen conflict situation, where international recognition of boundaries and authorities are lacking, introduces further complexities.Case descriptionNagorno Karabagh (NK) is an ethnically Armenian territory locked within post-Soviet Azerbaijan and one such frozen conflict situation. This article highlights the use of evidence-based practice and community engagement to determine priority areas for health care training in NK. Drawing on the precepts of APEXPH (Assessment Protocol for Excellence in Public Health) and MAPP (Mobilizing for Action through Planning and Partnerships), this first-of-its-kind assessment in NK relied on in-depth interviews and focus group discussions supplemented with expert assessments and field observations. Training options were evaluated against a series of ethical and pragmatic principles.Discussion and EvaluationA unique factor among the ethical and pragmatic considerations when prioritizing among alternatives was NK's ambiguous political status and consequent sponsor constraints. Training priorities differed across the region and by type of provider, but consensus prioritization emerged for first aid, clinical Integrated Management of Childhood Illnesses, and Adult Disease Management. These priorities were then incorporated into the training programs funded by the sponsor.ConclusionsProgramming responsive to both the evidence-base and stakeholder priorities is always desirable and provides a foundation for long-term planning and response. In frozen conflict, low resource settings, such an approach is critical to balancing the community's immediate humanitarian needs with sponsor concerns and constraints.