Trend and projection of non-communicable diseases risk factors in Iran from 2001 to 2030

This study aims to investigate the trends and project the major risk factors of Non-communicable Diseases (NCDs) in Iran. We obtained the trend of prevalence of main risk factors related to NCDs in 30 to 70-year-old-individuals. The data were extracted from WHO STEP wise approach to NCDs risk factor surveillance (STEPS) survey. Also,the previous studies conducted at national and subnational levels from 2001 to 2016 were employed. The prevalence of risk factors was projected by 2030 using Bayesian Model Averaging (BMA) and Spatio-temporal model stratified by sex and province. The percent change for the age-standardized prevalence of smoking in men between 2001 and 2016 was calculated to be - 27.0. Also, the corresponding values for the risk factors of diabetes, hypertension, obesity and overweight, physical inactivity (PI), and mean of salt intake were - 26.1, 29.0, 70.0, 96.8, 116.6, and 7.5, respectively. It is predicted that smoking and these risk factors will undergo a change to show values of - 1.26, 38.7, 43.7, 2.36, and 15.3 by 2030, respectively. The corresponding values in women for the time interval of 2001-2016 were - 27.3, 26.3, 82.8, 1.88, 75.2, and 4.2, respectively. Plus, projections indicate that the 2030 variation values are expected to be - 25.0, 16.7, 37.5, 28.7, 26.7, and 10.9 respectively. This study showed that the prevalence of four risk factors of PI, overweight and obesity, hypertension, and diabetes is increasing in Iran. Therefor, it is necessary to carry out effective interventions to adopt a healthy lifestyle and reduce the risk factors.

Ambient air pollutants and breast cancer stage in Tehran, Iran

This study aimed to examine the impacts of single and multiple air pollutants (AP) on the severity of breast cancer (BC). Data of 1148 diagnosed BC cases (2008-2016) were obtained from the Cancer Research Center and private oncologist offices in Tehran, Iran. Ambient PM10, SO2, NO, NO2, NOX, benzene, toluene, ethylbenzene, m-xylene, p-xylene, o-xylene, and BTEX data were obtained from previously developed land use regression models. Associations between pollutants and stage of BC were assessed by multinomial logistic regression models. An increase of 10 μg/m3 in ethylbenzene, o-xylene, m-xylene, and 10 ppb of NO corresponded to 10.41 (95% CI 1.32-82.41), 4.07 (1.46-11.33), 2.89 (1.08-7.73) and 1.08 (1.00-1.15) increase in the odds of stage I versus non-invasive BC, respectively. Benzene (OR, odds ratio = 1.16, 95% CI 1.01-1.33) and o-xylene (OR = 1.18, 1.02-1.38) were associated with increased odds of incidence of BC stages III & IV versus non-invasive stages. BC stage I and stage III&IV in women living in low SES areas was associated with significantly higher levels of benzene, ethylbenzene, o-xylene, and m-xylene. The highest multiple-air-pollutants quartile was associated with a higher odds of stage I BC (OR = 3.16) in patients under 50 years old. This study provides evidence that exposure to AP is associated with increased BC stage at diagnosis, especially under premenopause age.

The association between ambient air pollution and migraine: a systematic review

Some studies have shown the effect of air pollution on migraine. However, it needs to be confirmed in larger-scale studies, as scientific evidence is scarce regarding the association between air pollution and migraine. Therefore, this systematic review aims to determine whether there are associations between outdoor air pollution and migraine. A literature search was performed in Scopus, Medline (via PubMed), EMBASE, and Web of Science. A manual search for resources and related references was also conducted to complete the search. All observational studies investigating the association between ambient air pollution and migraine, with inclusion criteria, were entered into the review. Fourteen out of 1417 identified articles met the inclusion criteria and entered the study. Among the gaseous air pollutants, there was a correlation between exposure to nitrogen dioxide (NO2) (78.3% of detrimental relationships) and carbon monoxide (CO) (68.0% of detrimental relationships) and migraine, but no apparent correlation has been found for sulfur dioxide (SO2) (21.2% of detrimental relationships) and ozone (O3) (55.2% of detrimental relationships). In the case of particulate air pollutants, particulate matter with a diameter of 10 μm or less (PM10) (76.0% of detrimental relationships) and particulate matter with a diameter of 2.5 μm or less (PM2.5) (61.3% of detrimental relationships) had relationships with migraine. In conclusion, exposure to NO2, CO, PM10, and PM2.5 is associated with migraine headaches, while no conclusive evidence was found to confirm the correlation between O3 and SO2 with migraine. Further studies with precise methodology are recommended in different cities around the world for all pollutants with an emphasis on O3 and SO2.

PERSIAN traffic safety and health cohort: a population-based precrash cohort study

PURPOSE

Despite to high burden of road traffic injuries (RTIs), the RTI epidemiology has received less attention with rare investments on robust population cohorts. The PERSIAN Traffic Safety and Health Cohort (PTSHC) was designed to assess the potential causal relationships between human factors and RTI mortality, injuries, severity of the injury, hospitalised injury, violation of traffic law as well as offer the strongest scientific evidence.

PARTICIPANTS

The precrash cohort study is carried out in four cities of Tabriz, Jolfa, Shabestar and Osku in East Azerbaijan province located in northwest Iran. The participants were people who sampled among the general population. The cluster sampling method was used to enrol the households in this study. The PTSHC encompasses a wide and comprehensive range and types of data. These include not only the common cohort data collections such as medical examination measures, previous medical history, bio assays and behavioural assessments but also includes data obtained using advanced novel technologies, for example, electronic travel monitoring, driving simulation and neuro-psycho-physiologic laboratory assessments specifically developed for traffic health field.

FINDINGS TO DATE

A total of 7200 participants aged 14 years and above were enrolled at baseline, nearly half of them being men. The mean age of participants was 39.2 (SD=19.9) years. The majority of participants (55.4%) belonged to the age group of 30-56 years. Currently, approximately 1 200 000 person-measurements have been collected.

FUTURE PLANS

PSTHC will be used to determine the human-related risk factors by adjusting for the vehicle and land-use-related factors. Therefore, a lot of crashes can be prevented using effective interventions. Although this cohort provides valuable data, it is planned to increase its size to achieve the highest level of evidence with higher generalisability. Also, according to the national agreement this cohort is going to be extended to several geographical regions in second decade.

A Community-Based Safety Reporting System; Development, Implementation, and Evaluation: An Experience of Safe Communities in Iran

Background

Online reporting systems can establish and maintain the community-authority connection for safety promotion initiatives and their sustainability. The aim of this study was to report the development, implementation, and evaluation of an online community safety reporting system in safe communities in Iran.

Methods

In the first place, the life cycle approach and software systems development were used for design and implementation, which included 7 steps. In the following, an online Community Safety Reporting System (CSRS) was developed with two main interfaces, including a web-based and phone application. The software was developed using suitable programming languages for the web and as a mobile application for Android and iOS systems.

Results

During the six months of implementation, we received 80 reports in different safety areas, which were managed by the administrators and provided feedback for reporters. System user-friendliness and easy to use were the main strengths declared by users. The CSRS program is implemented at two levels of usage: public users to report safety issues and city admin functional evaluation of the system through a short interview with users. Moreover, city authorities believed that the system facilitates community participation in decision-making processes. The address of the web page is www.payamiran.ir.

Conclusion

CSRS provides a way for community voices to be heard and facilitates mutual interaction between the community and authorities. CSRS could be used as a community participation tool to ensure safety promotion initiatives sustainability.

Trends and projection of incidence, mortality, and disability-adjusted life years of HIV in the Middle East and North Africa (1990-2030)

Evidence shows a growing trend of the HIV epidemic in the Middle East and North Africa (MENA). We aimed to project the incidence, mortality, and disability-adjusted life years (DALY) in the region from 1990 to 2019 and assess its trend by 2025, and 2030. We extracted the HIV incidence, mortality, and DALY data from the Global Burden of Disease (GBD) and UNAIDS databases. The joinpoint regression model was used to examine changes in HIV trends. The trend changes were estimated by average annual percent change (AAPC). In most countries, an increasing trend was observed in HIV incidence, mortality, and DALY. Specifically, the highest growth in the annual incidence rate was related to Egypt (AAPC = 14.4, GBD) and Iran (AAPC = 9.6, UNAIDS). Notably, Qatar (AAPC = - 5.6, GBD), Bahrain (AAPC = - 3.3, GBD), and Somalia (AAPC = - 4.2, UNAIDS) demonstrated a significant reduction in incidence. Regarding mortality rates, Djibouti (AAPC = 24.2, GBD) and Iran (AAPC = 16.2, UNAIDS) exhibited a significant increasing pattern. Furthermore, the estimated increase in incidence by 2030 was most marked in Djibouti (985%) and Iran (174%). Iran (422%) and Egypt (339%) showed a prominent rise in mortality rates. GBD data showed 16 countries had an increasing pattern in DALY in both genders. According to age and period effects, there was a significant upward trend in incidence, mortality rates, and DALY. Findings highlighted the urgent need for improved prevention and treatment services, including expanding access to HIV testing, promoting safe practices, increasing antiretroviral therapy coverage, and supporting targeted interventions for high-risk populations.

Validity and reliability of short-form travel behavior questionnaire during COVID-19 pandemic (TBQ-Cov19)

INTRODUCTION

Avoiding unnecessary travel and reducing the number of essential travels are among the effective strategies for preventing the spread of COVID-19 during the pandemic. Given that it is impossible to avoid essential travel, health protocols should be observed to prevent disease transmission. The extent to which health protocols are observed during the trip should be accurately assessed by a valid questionnaire. Therefore, this study aims to develop and validate a questionnaire to assess compliance with COVID-19 prevention protocols during travel.

METHODS

In this cross-sectional study, 285 individuals were selected from six provinces using the cluster sampling method in May and June 2021. The Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated using the comments of 12 external experts. The exploratory factor analysis (EFA), with principal component factor in the extraction method and Varimax rotation, were applied to determine construct validity. Cronbach's alpha was employed to assess internal consistency and the Spearman-Brown correlation coefficient was computed for test-retest reliability.

RESULTS

In the content validity phase, the I-CVIs for all items were acceptable, but due to a low CVR value (below 0.56), one question was eliminated. As a result of EFA for construct validity, two factors were extracted that justified 61.8% of the variance. Cronbach's alpha coefficient of the questionnaire, with 10 items, was 0.83. The Spearman-Brown correlation coefficient was 0.911 which confirmed the stability of the questionnaire at an excellent level.

CONCLUSIONS

This questionnaire is a valid tool with good validity and reliability for assessing compliance with health protocols in travel during the COVID-19 pandemic.

Public Perception on the Health Consequences of an Environmental Disaster: The Case of Lake Urmia Drying up

Background: Drying up of lakes is among the most important environmental disasters, which could have a great impact on human health. Since public perception is important in shaping behavior and policy-making, this study was conducted to evaluate the public perception about the health effects of Lake Urmia drying up. Methods: In this cross-sectional study, a questionnaire was prepared and validated in 4 phases, including content validity, construct validity, test-retest reliability, and internal consistency. The online version of the questionnaire was designed in the Google Forms section and shared among public groups to be completed. The printed version of the questionnaire was completed by 2 trained interviewers in 6 villages near Lake Urmia using the convenience sampling method. Data analysis was performed using univariate statistics, including the Mann-Whitney and Kruskal-Wallis tests, and multiple linear regression as multivariate statistics. Results: In total, 475 people completed the online and printed questionnaires, of whom 261 (54.9%) were men. The mean age (SD) of participants was 38.4 years (11.18). The mean (SD) of the overall perceived risk was 3.54 (1.28). For the group of socioeconomic determinants of health, the mean (SD) perceived risk was found to be 3.63 (1.19), while for the group of diseases, it was 3.45. (1.31). In the group of social determinants of health, migration with a mean (SD) of 3.76 (1.24) had the highest perceived risk, followed by income loss (3.63 [1.12]) and job loss (3.49 [1.20]). The highest mean (SD) perceived risk in the group of diseases belonged to lung diseases (3.99 [1.05]), hypertension (3.70 [1.17]), and cancer (3.68 [1.23]), respectively. Conclusion: The general public had a strong notion that the drying up of Lake Urmia posed health risks.

Effect of physician prescribed information on hospital readmission and death after discharge among patients with health failure: A randomized controlled trial

In order to understand if a physician prescribed medical information changes, the number of hospital readmission, and death among the heart failure patients. A 12-month randomized controlled trial was conducted (December 2013-2014). Totally, 120 patients were randomly allocated into two groups of intervention (n = 60) and control (n = 60). Accordingly, the control group was given the routine oral information by the nurse or physician, and the intervention group received the Information Prescription (IP) prescribed by the physician as well as the routine oral information. The data was collected via telephone interviews with the follow-up intervals of 6 and 12 months, and also for 1 year after the discharge. The patients with the median age of (IQR) 69.5 years old (19.8) death upon adjusting a Cox survival model, [RR = 0.67, 95%CI: 0.46-0.97]. Few patients died during 1 year in the intervention group compared to the controls (7 vs 15) [RR = 0.47, 95%CI: 0.20-1.06]. During a period of 6-month follow-up there was not statistically significant on death and readmission between two groups. Physician prescribed information was clinically and statistically effective on the reduction of death and hospital readmission rates among the HF patients in long term follow-up.

Epidemiological pattern of deaths caused by traffic accidents in East Azerbaijan, Iran

Background:

Traffic accidents are one of the main causes of mortality in the world. They are currently estimated to be the ninth leading cause of death across all age-groups globally and are predicted to become the seventh leading cause of death by 2030. Road traffic crashes are a leading cause of death among young people, and the main cause among those aged 15–29 years worldwide. The number of road traffic deaths continues to rise steadily, reaching 1.35 million in 2016, from 1.15 million in 2000. The purpose of the present study is to investigate epidemiologic pattern, and trend of deaths due to accidents in East Azerbaijan province, Iran, from 2012 to 2016, in order to identify its effective determinants to conduct prevention programs.

Methods:

This cross-sectional study was conducted using mortality data of province health center from 2012 to 2016. The data of deaths due to traffic accidents were analyzed using descriptive statistics by means of Microsoft Excel 2013 and SPSS 16.

Results:

A number of 4529 deaths due to traffic accidents occurred during five years of the study period, which were 4.95% of total deaths of all causes, and the third leading cause of mortality. Of all accident deaths, 79.5% were male and 69.7% took place in urban residents. Most accidents occurred in the summer (30.1%), and in August (10.9%). The highest (20.8%) and the lowest (18.2%) deaths occurred in 2016 and 2014, respectively. However, the highest incidence was in 2012 with 26.28 per 100000, and the lowest incidence in 2014 with 23.15 per 100000. The mean age and SD for males and females were 41.15±20.27 and 41.45±23.73 respectively, and the highest percentage of deaths happened in the age-group 20-29 (18.4%), followed by age-group 30-39 (18.3%). One hundred and seventy-eight (3.9%) accident victims were children under five years of age, one of the most important causes of death for this age group.

Conclusions:

Regarding the high incidence of mortality due to accidents, identification and correction of high-risk areas, and strict enforcement of traffic rules are necessary in order to prevent accidents and related deaths.

Keywords:

Epidemiology, Death, Traffic Accidents, East Azerbaijan