Publications by authors named "Ali-Asghar Kolahi"

45 Publications

Burden of tracheal, bronchus and lung cancer and its attributable risk factors in 204 countries and territories, 1990-2019.

J Thorac Oncol 2021 Apr 15. Epub 2021 Apr 15.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Introduction: Understanding trends in the annual incidence, mortality and disability adjusted life years (DALYs) for tracheal, bronchus and lung (TBL) cancers globally is important to enable appropriate targeting of resources for prevention, clinical practice improvement, and research. The aim of this study was to determine the global, regional and national burden of TBL cancer in 204 countries and territories from 1990 to 2019 by age, sex and socio-demographic index (SDI).

Methods: Estimates were produced through various data inputs including: cancer registries (n =5,318), vital registration (n =22,553), vital registration-sample (n =825) and verbal autopsies (n =516). Annual Incidence, mortality, and DALYs were estimated and presented as counts and age-standardised rates per 100,000 population.

Results: There were 2.3 million (95% UI: 2.1 to 2.5) incident cases of TBL cancer, with an age-standardised annual incidence rate of 27.7 (95% UI: 25.3 to 30), which decreased by 2.6% (95% UI: -12.4 to 6.5) between 1990 and 2019. TBL cancer was responsible for 2 million (95% UI: 1.9 to 2.2) deaths globally with an age-standardised death rate of 25.2 (95% UI: 23.2 to 27), a decrease of 7.8% (95% UI: -15.9 to 0.2) between 1990 and 2019. Moreover, TBL accounted for 45.9 million (95% UI: 42.3 to 49.3) DALYs at the global level, with an age-standardised rate of 551.6 (95% UI: 509 to 593.1) DALYs per 100,000 population. The standardised DALY rate declined by 16.2% (95% UI: -24 to -8.2) from 1990 to 2019. Greenland [77.7 (95% UI: 64.4 to 90.6)], Monaco [75.6 (95% UI: 61.4 to 90.8)] and Montenegro [56.7 (95% UI: 46.5 to 68.9)] had the three highest age-standardised annual incidence rates. The aforementioned three countries also had the three highest age-standardised death and DALY rates of TBL cancer. Honduras [68% (95% UI: 14.5 to 137.7)], Cabo Verde [62.2% (95% UI: 24.1 to 101.3)] and Monaco [58.2% (95% UI: 19.2 to 109.7)] showed the largest increase in age-standardised annual incidence rates for TBL cancer during 1990-2019. The largest increases were seen in age-standardised death rates of TBL cancer in Honduras [67.1 % (95% UI: 14.7 to 133.1)], Cabo Verde [64.4 % (95% UI: 25 to 103.4)] and Mozambique [49.9 % (95% UI: 7.9 to 101.3)]. Age-standardised annual incidence and death rates were higher in males than females and increased with population aging. There were non-linear, but generally positive associations between age-standardised DALY rates with corresponding SDI of countries. Globally, smoking (62.4%), ambient particulate matter (15.3%) and high fasting plasma glucose (9.9%) had the top three highest percent of attributable DALYs due to TBL cancer in 2019 for both sexes.

Conclusions: This study showed a decline in burden globally but with some countries showing an increase. These results are crucial to set priorities for prevention and treatment of TBL cancer and would be beneficial for policy makers, government officials, clinicians and researchers.
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http://dx.doi.org/10.1016/j.jtho.2021.03.030DOI Listing
April 2021

Burden of tracheal, bronchus and lung cancer and its attributable risk factors in 204 countries and territories, 1990-2019.

J Thorac Oncol 2021 Apr 15. Epub 2021 Apr 15.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Introduction: Understanding trends in the annual incidence, mortality and disability adjusted life years (DALYs) for tracheal, bronchus and lung (TBL) cancers globally is important to enable appropriate targeting of resources for prevention, clinical practice improvement, and research. The aim of this study was to determine the global, regional and national burden of TBL cancer in 204 countries and territories from 1990 to 2019 by age, sex and socio-demographic index (SDI).

Methods: Estimates were produced through various data inputs including: cancer registries (n =5,318), vital registration (n =22,553), vital registration-sample (n =825) and verbal autopsies (n =516). Annual Incidence, mortality, and DALYs were estimated and presented as counts and age-standardised rates per 100,000 population.

Results: There were 2.3 million (95% UI: 2.1 to 2.5) incident cases of TBL cancer, with an age-standardised annual incidence rate of 27.7 (95% UI: 25.3 to 30), which decreased by 2.6% (95% UI: -12.4 to 6.5) between 1990 and 2019. TBL cancer was responsible for 2 million (95% UI: 1.9 to 2.2) deaths globally with an age-standardised death rate of 25.2 (95% UI: 23.2 to 27), a decrease of 7.8% (95% UI: -15.9 to 0.2) between 1990 and 2019. Moreover, TBL accounted for 45.9 million (95% UI: 42.3 to 49.3) DALYs at the global level, with an age-standardised rate of 551.6 (95% UI: 509 to 593.1) DALYs per 100,000 population. The standardised DALY rate declined by 16.2% (95% UI: -24 to -8.2) from 1990 to 2019. Greenland [77.7 (95% UI: 64.4 to 90.6)], Monaco [75.6 (95% UI: 61.4 to 90.8)] and Montenegro [56.7 (95% UI: 46.5 to 68.9)] had the three highest age-standardised annual incidence rates. The aforementioned three countries also had the three highest age-standardised death and DALY rates of TBL cancer. Honduras [68% (95% UI: 14.5 to 137.7)], Cabo Verde [62.2% (95% UI: 24.1 to 101.3)] and Monaco [58.2% (95% UI: 19.2 to 109.7)] showed the largest increase in age-standardised annual incidence rates for TBL cancer during 1990-2019. The largest increases were seen in age-standardised death rates of TBL cancer in Honduras [67.1 % (95% UI: 14.7 to 133.1)], Cabo Verde [64.4 % (95% UI: 25 to 103.4)] and Mozambique [49.9 % (95% UI: 7.9 to 101.3)]. Age-standardised annual incidence and death rates were higher in males than females and increased with population aging. There were non-linear, but generally positive associations between age-standardised DALY rates with corresponding SDI of countries. Globally, smoking (62.4%), ambient particulate matter (15.3%) and high fasting plasma glucose (9.9%) had the top three highest percent of attributable DALYs due to TBL cancer in 2019 for both sexes.

Conclusions: This study showed a decline in burden globally but with some countries showing an increase. These results are crucial to set priorities for prevention and treatment of TBL cancer and would be beneficial for policy makers, government officials, clinicians and researchers.
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http://dx.doi.org/10.1016/j.jtho.2021.03.030DOI Listing
April 2021

Physical activity levels and related sociodemographic factors among Iranian adults: Results from a population-based national STEPS survey.

Med J Islam Repub Iran 2020 5;34:172. Epub 2021 Jan 5.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Physical inactivity (PA) is one of the leading modifiable risk factors for noncommunicable diseases (NCDs) worldwide. This study aimed to determine PA levels and related sociodemographic factors as risk factors for NCDs among Iranian adults. In this cross sectional study, data were collected from the sixth nationwide STEPS survey in 31 provinces of Iran. A total of 6100 individuals aged 18-64 years were selected by a multistage cluster sampling method, and their PA levels were assessed using the Global Physical Activity Questionnaire (GPAQ). Data were analyzed using descriptive methods and analytical tests, including chi-square, ANOVA, and independent t tests in SPSS version 21 software. The prevalence of vigorous, moderate, and low levels of PA was 36.3% (95%CI:35.1-37.5), 29.2% (95%CI:28-30.3), and 34.5% (95%CI:33.3-35.7) in participants, respectively. The mean ± SD of total MET-min/week was 1842.3±2619.3. Total mean ± SD duration of PA was 98.2 ± 115 min/week (125.8±142.6 and 77.2±84.5 min/week in men and women, respectively). Transport-related PA and severe PA at work had large and small contributions to overall PA, respectively. Urbanization, sex, age, family size, and occupation status were identified as factors associated with PA levels (p<0.001). This study revealed a significant prevalence of low PA among the target population and some sociodemographic characteristics identified as factors associated with PA. Identification of these factors can develop more effective interventions to promote PA.
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http://dx.doi.org/10.47176/mjiri.34.172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004576PMC
January 2021

A systematic literature review of observational studies of the bilateral association between diabetes and migraine.

Diabetes Metab Syndr 2021 Mar 26;15(3):673-678. Epub 2021 Mar 26.

Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Social Determinants of Health Research Center, Department of Community Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address:

Background And Aim: To conduct a systematic literature review and synthesize data from all epidemiological studies investigating the association between diabetes and migraine in adults.

Method And Material: Electronic databases, including Web of Science, PubMed and Scopus in addition to Google Scholar search engine were systematically searched up to Jun 2020 to identify studies reporting the diabetes-migraine association.

Results: A total of 15 studies were selected which were published from 2012 to 2019. Five out of 15 studies assessed the presence of migraine in diabetic subjects, while nine studies assessed the presence of diabetes in migraine subjects. The cohort study reported a hazard ratio for diabetes of 1.06 (95% confidence interval (CI): 0.91-1.24) for women with migraine with aura, 1.01 (95% CI: 0.89-1.16) for women without aura, and 1.13 (95% CI: 0.98-1.3) for women with a migraine history, compared with women with no history of migraine. Due to the high degree of heterogeneity, and the lack of statistical estimates of the association in several of the reviewed studies, meta-analysis of the available data was not possible.

Conclusion: This study is the first review to examine the association between diabetes and migraine. Further longitudinal studies are required to clarify the migraine-diabetes association. There is also a clear need for more studies with larger sample sizes and similar methodologies in order to provide necessary information to conduct a meta-analysis.
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http://dx.doi.org/10.1016/j.dsx.2021.03.018DOI Listing
March 2021

Public Knowledge, Attitudes, and Practices Related to COVID-19 in Iran: Questionnaire Study.

JMIR Public Health Surveill 2021 02 23;7(2):e21415. Epub 2021 Feb 23.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The COVID-19 pandemic is a rapidly growing outbreak, the future course of which is strongly determined by people's adherence to social distancing measures.

Objective: The objective of this study was to determine the knowledge level, attitudes, and practices of the Iranian population in the context of COVID-19.

Methods: A nationwide study was conducted from March 24 to April 3, 2020, whereby data were collected via an online self-administered questionnaire.

Results: Responses from 12,332 participants were analyzed. Participants' mean knowledge score was 23.2 (SD 4.3) out of 30. Most participants recognized the cause of COVID-19, its routes of transmission, its symptoms and signs, predisposing factors, and prevention measures. Social media was the leading source of information. Participants recognized the dangers of the situation and felt responsible for following social distancing protocols, as well as isolating themselves upon symptom presentation. Participants' mean practice score was 20.7 (SD 2.2) out of 24. Nearly none of the respondents went on a trip, and 92% (n=11,342) washed their hands before touching their faces.

Conclusions: Knowledge of COVID-19 among people in Iran was nearly sufficient, their attitudes were mainly positive, and their practices were satisfactory. There is still room for improvement in correcting misinformation and protecting people from deception. Iranians appear to support government actions like social distancing and care for their and others' safety.
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http://dx.doi.org/10.2196/21415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903976PMC
February 2021

Improved dynamics of sharing research findings in the COVID-19 epidemic compared with the SARS and Ebola epidemics.

BMC Public Health 2021 01 9;21(1):105. Epub 2021 Jan 9.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: When a new or re-emergent pathogen, such as SARS-CoV-2, causes a major outbreak, rapid access to pertinent research findings is crucial for planning strategies and decision making. We researched whether the speed of sharing research results in the COVID-19 epidemic was higher than the SARS and Ebola epidemics. We also researched whether there is any difference in the most frequent topics investigated before and after the COVID-19, SARS, and Ebola epidemics started.

Methods: We used PubMed database search tools to determine the time-period it took for the number of articles to rise after the epidemics started and the most frequent topics assigned to the articles.

Results: The main results were, first, the rise in the number of articles occurred 6 weeks after the COVID-19 epidemic started whereas, this rise occurred 4 months after the SARS and 7 months after the Ebola epidemics started. Second, etiology, statistics & numerical data, and epidemiology were the three most frequent topics investigated in the COVID-19 epidemic. However, etiology, microbiology, and genetics in the SARS epidemic, and statistics & numerical data, epidemiology, and prevention & control in the Ebola epidemic were more frequently studied compared with other topics. Third, some topics were studied more frequently after the epidemics started.

Conclusions: The speed of sharing results in the COVID-19 epidemic was much higher than the SARS and Ebola epidemics, and that there is a difference in the most frequent articles' topics investigated in these three epidemics. Due to the value of time in controlling epidemics spread, the study highlights the necessity of defining more solutions for rapidly providing pertinent research findings in fighting against the next public health emergency.
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http://dx.doi.org/10.1186/s12889-020-10116-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794630PMC
January 2021

Current Tobacco Smoking Prevalence Among Iranian Population: A Closer Look at the STEPS Surveys.

Front Public Health 2020 16;8:571062. Epub 2020 Dec 16.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

To determine the current tobacco smoking prevalence among Iranian adults, its geographical distribution in 2011, 2016, and time trend during 2004-2016. We conducted a pooled analysis of the published reports of 2004, 2007, 2008, 2009, and the data of 2011 and 2016 of the STEPwise approach to chronic disease risk-factor surveillance (STEPS) surveys. The prevalence of current tobacco smoking and current daily cigarette smoking in 2016 was 14.1 and 9.7%, respectively. Only 0.2% of participants smoked water-pipe. Current tobacco smoking prevalence remained unchanged during 2004-2016 for both men and women. The prevalence of passive smoking at home or workplace was 27.4%. Current tobacco smoking prevalence and current daily cigarette smoking was significantly lower among women than men. Current tobacco smoking prevalence showed a geographical pattern throughout the country. In both 2011 and 2016, current tobacco smoking prevalence was higher among men who lived in the western provinces, especially the north-west, than those who lived in the eastern and southern provinces. The current tobacco smoking prevalence among Iranian population has not changed significantly during 2004-2016 and does not conform to the international guidelines. Therefore, it remains crucial yet challenging that effective nationwide policies be implemented to reduce the use of tobacco products. One cannot hope for any reductions in smoking prevalence until a cocktail of interventions are built around strong commitment to government policy.
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http://dx.doi.org/10.3389/fpubh.2020.571062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784444PMC
December 2020

Prevalence, Deaths, and Disability-Adjusted Life Years Due to Musculoskeletal Disorders for 195 Countries and Territories 1990-2017.

Arthritis Rheumatol 2021 04 22;73(4):702-714. Epub 2021 Feb 22.

Cabrini Institute and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Objective: To report the levels and trends of prevalence, deaths, and disability-adjusted life years (DALYs) due to musculoskeletal disorders, categorized as low back pain, neck pain, osteoarthritis (OA), rheumatoid arthritis (RA), gout, and other musculoskeletal disorders, across 195 countries and territories from 1990 to 2017 according to age, sex, and Sociodemographic Index (SDI; a composite of sociodemographic factors).

Methods: Data were obtained from the Global Burden of Disease (GBD) Study 2017. The fatal and nonfatal burdens of musculoskeletal disorders were estimated using the Cause of Death Ensemble model and Bayesian meta-regression tool, respectively. Estimates were provided for all musculoskeletal disorders and the corresponding 6 categories at global, regional, and national levels from 1990 to 2017. Counts and age-standardized rates per 100,000 population along with 95% uncertainty intervals (95% UIs) were reported for prevalence, deaths, and DALYs.

Results: Globally, there were ~1.3 billion prevalent cases (95% UI 1.2 billion, 1.4 billion), 121.3 thousand deaths (95% UI 105.6 thousand, 126.2 thousand), and 138.7 million DALYs (95% UI 101.9 million, 182.6 million) due to musculoskeletal disorders in 2017. Age-standardized prevalence, death, and DALY rates per 100,000 population were 16,276.2 (95% UI 15,495.5, 17,145.8), 1.6 (95% UI 1.4, 1.6), and 1,720 (95% UI 1,264.4, 2,259.2), respectively. Age-standardized prevalence (-1.6% [95% UI -2.4, -0.8]) and DALY rates (-3.5% [95% UI -4.7, -2.3]) decreased slightly from 1990. The global point prevalence rate of musculoskeletal disorders in 2017 was higher in women than in men and increased with age up to the oldest age group. Globally, the proportion of prevalent cases according to category of musculoskeletal disorders in 2017 was greatest for low back pain (36.8%), followed by other musculoskeletal disorders (21.5%), OA (19.3%), neck pain (18.4%), gout (2.6%), and RA (1.3%). These proportions did not change appreciably compared with 1990. The burden due to musculoskeletal conditions was higher in developed countries. The countries with the highest age-standardized prevalence rates of musculoskeletal disorders in 2017 were Switzerland (23,346.0 [95% UI 22,392.6, 24,329.8]), Chile (23,007.9 [95% UI 21,746.5, 24,165.8]), and Denmark (22,166.1 [95% UI 20,817.2, 23,542.1]). The greatest increases from 1990 were found in Chile (10.8% [95% UI 6.6, 15.4]), Benin (8.8% [95% UI 6.7, 11.1]), and El Salvador (8.5% [95% UI 5.5, 11.9]).

Conclusion: There is a large burden of musculoskeletal disorders globally, with some notable inter-country variation. Some countries have twice the burden of other countries. Increasing population awareness regarding risk factors, consequences, and evidence-informed treatment strategies for musculoskeletal disorders with a focus on the older female population in developed countries is needed, particularly for low back and neck pain and OA, which contribute a large burden among this cohort.
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http://dx.doi.org/10.1002/art.41571DOI Listing
April 2021

Disparities in cervical cancer screening participation in Iran: a cross-sectional analysis of the 2016 nationwide STEPS survey.

BMC Public Health 2020 Oct 22;20(1):1594. Epub 2020 Oct 22.

Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: One of the most important concerns in every healthcare system is the elimination of disparities in health service utilization and achievement of health equity. This study aimed to investigate the disparities in cervical cancer screening participation in Iran.

Methods: A cross-sectional study was conducted using data from the National Non-Communicable Risk Factors Survey in 2016 (STEPs 2016). Data on cervical cancer screening in addition to demographic and socio-economic factors from 15,975 women aged 18 and above were analyzed. The distribution of surveyed women with regard to cervical cancer screening practice was described. Chi square and logistic regression were used to assess the association of demographic and socio-economic factors with cervical cancer screening participation.

Results: Overall, 52.1% of women aged 30-59 years, had undergone cervical cancer screening at least once in their lifetime. Participation rate in cervical cancer screening programs varied between provinces; ranging from 7.6% in Sistan and Baluchestan to 61.2% in Isfahan. Single marital status, illiteracy, being employed, and having no insurance coverage were associated with lower participation. Age and area of residence were insignificant predictors for participating in cervical cancer screening program. Analysis of the cervical cancer uptake rates across the socio-economic levels revealed that the service is less utilised by high income groups.

Conclusions: Participation in cervical cancer screening program in Iran is not optimal and could be improved. With regard to the distribution of cervical cancer screening practice, social and geographical disparities indicate the need for further research and more comprehensive strategies in order to reduce them.
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http://dx.doi.org/10.1186/s12889-020-09705-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583215PMC
October 2020

Effects of Ginkgo biloba intake on cardiometabolic parameters in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of clinical trials.

Phytother Res 2020 Oct 8. Epub 2020 Oct 8.

Department of Persian Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

Ginkgo biloba (GKB) may have a beneficial effect on cardiometabolic parameters in type 2 diabetes mellitus (T2DM), but the data is inconsistent. Therefore, the current systematic review and meta-analysis of clinical trials was conducted to assess the influence of GKB on cardiometabolic parameters in T2DM. Several online databases such as PubMed, Embase, Scopus, Web of Sciences, Google Scholar and Cochrane Library were systematically searched from inception up to September 2, 2019. Heterogeneity across included studies was assessed using the Cochran's Q statistic and I index. To pool weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs) as summary effect size, we selected fixed or random-effects model according to the result of heterogeneity. Seven studies comprising 768 subjects were included in the present meta-analysis which resulted in a significant effect of GKB on hemoglobin A1c (HbA1c) (WMD = 0.26, 95% CI = [0.02, 0.50], p = .034) and serum HDL-cholesterol levels (WMD = 1.99, 95% CI = [0.19, 3.79], p = .030) with no significant publication bias. GKB can significantly modulate HbA1c and HDL-cholesterol levels. However, due to uncertainties related to the limited number of studies, it is too early to conclude whether GKB has any potential effects on the cardiometabolic factors in patients with T2DM or not.
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http://dx.doi.org/10.1002/ptr.6822DOI Listing
October 2020

Global, regional, and national burden of other musculoskeletal disorders 1990-2017: results from the Global Burden of Disease Study 2017.

Rheumatology (Oxford) 2021 02;60(2):855-865

Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, New South Wales, Australia.

Objectives: To describe the level and trends of point prevalence, deaths and disability-adjusted life years (DALYs) for other musculoskeletal (MSK) disorders, i.e. those not covered by specific estimates generated for RA, OA, low back pain, neck pain and gout, from 1990 to 2017 by age, sex and sociodemographic index.

Methods: Publicly available modelled estimates from the Global Burden of Disease (GBD) 2017 study were extracted and reported as counts and age-standardized rates per 100 000 population for 195 countries and territories between 1990 and 2017.

Results: Globally, the age-standardized point prevalence estimates and deaths rates of other MSK disorders in 2017 were 4151.1 and 1.0 per 100 000. This was an increase of 3.4% and 7.2%, respectively. The age-standardized DALY rate in 2017 was 380.2, an increase of 3.4%. The point prevalence estimate was higher among females and increased with age. This peaked in the 65-69 year age group for both females and males in 2017, followed by a decreasing trend for both sexes. At the national level, the highest age-standardized point prevalence estimates in 2017 were seen in Bangladesh, India and Nepal. The largest increases in age-standardized point prevalence estimates were observed in Romania, Croatia and Armenia.

Conclusion: The burden of other MSK disorders is proven to be substantial and increasing worldwide, with a notable intercountry variation. Data pertaining to specific diseases within this overarching category are required for future GBD MSK estimates. This would enable policymakers to better allocate resources and provide interventions appropriately.
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http://dx.doi.org/10.1093/rheumatology/keaa315DOI Listing
February 2021

The burden of kidney cancer and its attributable risk factors in 195 countries and territories, 1990-2017.

Sci Rep 2020 08 17;10(1):13862. Epub 2020 Aug 17.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Kidney cancer globally accounts for more than 131,000 deaths each year and has been found to place a large economic burden on society. However, there are no recent articles on the burden of kidney cancer across the world. The aim of this study was to present a status report on the incidence, mortality and disability-adjusted life years (DALYs) associated with kidney cancer in 195 countries, from 1990 to 2017. Vital registration and cancer registry data (total of 23,660 site-years) were used to generate the estimates. Mortality was estimated first and the incidence and DALYs were calculated based on the estimated mortality values. All estimates were presented as counts and age-standardised rates per 100,000 population. The estimated rates were calculated by age, sex and according to the Socio-Demographic Index (SDI). In 2017, kidney cancer accounted for 393.0 thousand (95% UI: 371.0-404.6) incident cases, 138.5 thousand (95% UI: 128.7-142.5) deaths and 3.3 million (95% UI: 3.1-3.4) DALYs globally. The global age-standardised rates for the incidence, deaths and DALY were 4.9 (95% UI: 4.7-5.1), 1.7 (95% UI: 1.6-1.8) and 41.1 (95% UI: 38.7-42.5), respectively. Uruguay [15.8 (95% UI: 13.6-19.0)] and Bangladesh [1.5 (95% UI: 1.0-1.8)] had highest and lowest age-standardised incidence rates, respectively. The age-standardised death rates varied substantially from 0.47 (95% UI: 0.34-0.58) in Bangladesh to 5.6 (95% UI: 4.6-6.1) in the Czech Republic. Incidence and mortality rates were higher among males, than females, across all age groups, with the highest rates for both sexes being observed in the 95+ age group. Generally, positive associations were found between each country's age-standardised DALY rate and their corresponding SDI. The considerable burden of kidney cancer was attributable to high body mass index (18.5%) and smoking (16.6%) in both sexes. There are large inter-country differences in the burden of kidney cancer and it is generally higher in countries with a high SDI. The findings from this study provide much needed information for those in each country that are making health-related decisions about priority areas, resource allocation, and the effectiveness of prevention programmes. The results of our study also highlight the need for renewed efforts to reduce exposure to the kidney cancer risk factors and to improve the prevention and the early detection of this disease.
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http://dx.doi.org/10.1038/s41598-020-70840-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431911PMC
August 2020

Prevalence, Incidence, and Years Lived With Disability Due to Gout and Its Attributable Risk Factors for 195 Countries and Territories 1990-2017: A Systematic Analysis of the Global Burden of Disease Study 2017.

Arthritis Rheumatol 2020 11 10;72(11):1916-1927. Epub 2020 Sep 10.

Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia.

Objective: To describe the levels and trends of point prevalence, annual incidence, and years lived with disability (YLD) for gout and its attributable risk factors in 195 countries and territories from 1990 to 2017 according to age, sex, and Sociodemographic Index (SDI; a composite of sociodemographic factors).

Methods: Data were extracted from the Global Burden of Disease (GBD) 2017 study. A comprehensive systematic review of databases and the disease-modeled analysis were performed by the GBD team at the Institute for Health Metrics and Evaluation, in collaboration with researchers and experts worldwide, to provide estimates at global, regional, and national levels during 1990 and 2017. Counts and age-standardized rates per 100,000 population, along with 95% uncertainty intervals (95% UIs), were reported for point prevalence, annual incidence, and YLD.

Results: Globally, there were ~41.2 million (95% UI 36.7 million, 46.1 million) prevalent cases of gout, with 7.4 million incident cases per year (95% UI 6.6 million, 8.5 million) and almost 1.3 million YLD (95% UI 0.87 million, 1.8 million) in 2017. The global age-standardized point prevalence estimates and annual incidence rates in 2017 were 510.6 (95% UI 455.6, 570.3) and 91.8 (95% UI 81.3, 104.1) cases per 100,000 population, respectively, an increase of 7.2% (95% UI 6.4%, 8.1%) and 5.5% (95% UI 4.8%, 6.3%) from 1990. The corresponding age-standardized YLD rate was 15.9 (95% UI 10.7, 21.8) cases per 100,000 persons, a 7.2% increase (95% UI 5.9%, 8.6%) from 1990. In 2017, the global point prevalence estimates for gout were higher in males, and higher prevalence was seen in older age groups and increased with age for both males and females. The burden of gout was generally highest in developed regions and countries. The 3 countries with the highest age-standardized point prevalence estimates of gout in 2017 were New Zealand (1,394.0 cases [95% UI 1,290.1, 1,500.9]), Australia (1,171.4 cases [95% UI 1,038.1, 1,322.9]), and the US (996.0 cases [95% UI 923.1, 1,076.8]). The countries with the highest increases in age-standardized point prevalence estimates of gout from 1990 to 2017 were the US (34.7% [95% UI 27.7%, 43.1%]), Canada (28.5% [95% UI 21.9%, 35.4%]), and Oman (28.0% [95% UI 21.5%, 34.8%]). Globally, high body mass index and impaired kidney function accounted for 32.4% (95% UI 18.7%, 49.2%) and 15.3% (95% UI 13.5%, 17.1%), respectively, of YLD due to gout in the 2017 estimates. The YLD attributable to these risk factors were higher in males.

Conclusion: The burden of gout increased across the world from 1990 to 2017, with variations in point prevalence, annual incidence, and YLD between countries and territories. Besides improving the clinical management of disease, prevention and health promotion in communities to provide basic knowledge of the disease, risk factors, consequences, and effective treatment options (tailoring to high-risk groups such as the middle-aged male population) are crucial to avoid disease onset and hence to decrease the global disease burden.
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http://dx.doi.org/10.1002/art.41404DOI Listing
November 2020

Effects of Diacerein Intake on Cardiometabolic Profiles in Type 2 Diabetics: A Systematic Review and Meta-Analysis of Clinical Trials.

Curr Med Chem 2021 ;28(4):840-852

Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: A systematic review and meta-analysis of clinical trials were undertaken to evaluate the effect of diacerein intake on cardiometabolic profiles in patients with type 2 diabetes mellitus (T2DM).

Methods: Electronic databases such as PubMed, EMBASE, Scopus, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials were searched from inception to 31 July 2019. Statistical heterogeneity was evaluated using Cochran's Q test and I-square (I) statistic. Data were pooled using random-effects models and weighted mean difference (WMD).

Results: From 1,733 citations, seven clinical trials were eligible for inclusion and meta-analysis. A significant reduction in hemoglobin A1c (HbA1c) (WMD -0.73; 95%CI -1.25 to -0.21; P= 0.006; I2= 72.2%) and body mass index (BMI) (WMD -0.55; 95%CI -1.03 to -0.07; P= 0.026; I= 9.5%) was identified. However, no significant effect of diacerein intake was identified on fasting blood sugar (FBS) (WMD -9.00; 95%CI -22.57 to 4.57; P= 0.194; I2= 60.5%), homeostatic model assessment for insulin resistance (HOMA-IR) (WMD 0.39; 95%CI -0.95 to 1.73; P= 0.569; I= 2.2%), body weight (WMD - 0.54; 95%CI -1.10 to 0.02; P= 0.059), triglycerides (WMD -0.56; 95%CI -24.16 to 23.03; P= 0.963; I= 0.0%), total-cholesterol (WMD -0.21; 95%CI -12.19 to 11.78; P= 0.973; I= 0.0%), HDL-cholesterol (WMD -0.96; 95%CI -2.85 to 0.93; P= 0.321; I= 0.0%), and LDL-cholesterol levels (WMD -0.09; 95%CI -8.43 to 8.25; P= 0.983; I= 37.8%).

Conclusion: Diacerein intake may reduce HbA1c and BMI; however, no evidence of the effect was observed for FBS, HOMA-IR, body weight, triglycerides, total cholesterol, HDL-cholesterol or LDLcholesterol.
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http://dx.doi.org/10.2174/0929867327666200728134755DOI Listing
March 2021

A Preliminary Report on the Largest Ongoing Outbreak of Lead Toxicity in Iran.

Sci Rep 2020 07 16;10(1):11797. Epub 2020 Jul 16.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

No countrywide data exists on the patients' characteristics of lead exposure in Iran. We aimed to evaluate the demographic characteristics and blood lead level (BLL) of these patients in the country scale during five consecutive years, including the epidemic outbreak year (2016). Between 2014 and 2018, records of all patients who had referred to two reference laboratories in Tehran, Iran, to check BLL were evaluated. Of 58,642 patients, 48,589 were male. Mean age was 44.9 ± 20.7 years. Males had higher BLLs and were significantly older. Median BLL was 16 µg/dL (0.3 to 263 µg/dL). Median BLL was significantly higher in 45- to 60-year-old patients. The highest median BLL was reported in May 2016 confirming our records about the peak of the epidemic. Although the frequency of high BLL declined after 2016, it never returned to the measures before that. Considering the ongoing high prevalence of increased BLLs after 2016 and similar environmental and occupational exposures as before, lead-contaminated opium still seems to persist in the Iranian opium black market. Substitution of this lead-contaminated opium by Opioid Maintenance Therapy (OMT)-prescribed opium tincture is recommended.
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http://dx.doi.org/10.1038/s41598-020-64859-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367297PMC
July 2020

Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran-a cross-sectional assessment.

Crit Care 2020 07 9;24(1):402. Epub 2020 Jul 9.

The Norwegian CBRNE Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.

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http://dx.doi.org/10.1186/s13054-020-03140-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344025PMC
July 2020

The effect of voglibose on metabolic profiles in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of clinical trials.

Pharmacol Res 2020 09 3;159:104988. Epub 2020 Jun 3.

Social Determinants of Health Research Center, Department of Community Medicine, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address:

Objective: The effect of voglibose on metabolic homeostasis is not well characterized. Therefore, we conducted a systematic review and meta-analysis of clinical trials assessing the effect of voglibose on metabolic profile in patients with type 2 diabetes mellitus (T2DM).

Methods: Systematic searches were conducted in PubMed, Scopus, Embase, Google Scholar, Web of Science and Cochrane Library to identify clinical trials assessing the effects of voglibose supplementation on cardio-metabolic profile from incept up to 29 July 2019. Data was pooled using fixed- or random-effect models and weighted mean difference (WMD) as the effect size.

Results: Eight clinical trials from 1094 reports, were eligible for inclusion. Pooled findings identified significant reductions in hemoglobin A1c (HbA1c) (WMD= -0.27; 95 %CI -0.49 to -0.05; P = 0.01; I = 64.8 %) and an increase in LDL-cholesterol levels (WMD=5.97 mg/dl, 95 % CI 0.88, 11.06, P = 0.02; I = 0.0 %). However, no evidence of effect for voglibose intake on T2DM patients was observed for: fasting blood sugar (FBS) (WMD -7.43 mg/dl; 95 %CI -16.56 to 1.71; P = 0.110; I = 69.3 %), serum insulin (WMD= -0.15 μU/mL; 95 %CI -0.89 to 0.60; P = 0.70; I = 0.0 %), total-cholesterol (WMD=2.82 mg/dl, 95 %CI -2.36 to 8.01, P = 0.70; I = 49.7 %), triglycerides (WMD= -7.07 mg/dl, 95 %CI -21.76 to 7.62, P = 0.34; I = 0.0 %), HDL-cholesterol levels (WMD= -2.10 mg/dl, 95 %CI -4.48 to 0.27, P = 0.08; I = 0.0 %,), body mass index (BMI) (WMD=0.09 kg/m, 95 %CI -0.70 to 0.87; P = 0.87; I = 0.0 %), body weight (WMD= -0.42 kg, 95 %CI -0.84 to 0.00; P = 0.05; I = 0.0 %), and adiponectin levels (WMD = 0.32 μg/mL, 95 %CI -0.74 to 1.38; P = 0.55; I = 0.0 %).

Conclusions: The current meta-analysis identified a decrease in HbA1c and an increase in LDL-cholesterol with administration of voglibose. However, no significant effect was observed on FBS, insulin, bodyweight, BMI, adiponectin, triglycerides, total- and HDL-cholesterol levels.
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http://dx.doi.org/10.1016/j.phrs.2020.104988DOI Listing
September 2020

Global, regional and national burden of osteoarthritis 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017.

Ann Rheum Dis 2020 06 12;79(6):819-828. Epub 2020 May 12.

Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

Objectives: To report the level and trends of prevalence, incidence and years lived with disability (YLDs) for osteoarthritis (OA) in 195 countries and territories from 1990 to 2017 by age, sex and Socio-demographic index (SDI; a composite of sociodemographic factors).

Methods: Publicly available modelled data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 were used. The burden of OA was estimated for 195 countries and territories from 1990 to 2017, through a systematic analysis of prevalence and incidence modelled data using the methods reported in the GBD 2017 Study. All estimates were presented as counts and age-standardised rates per 100 000 population, with uncertainty intervals (UIs).

Results: Globally, the age-standardised point prevalence and annual incidence rate of OA in 2017 were 3754.2 (95% UI 3389.4 to 4187.6) and 181.2 (95% UI 162.6 to 202.4) per 100 000, an increase of 9.3% (95% UI 8% to 10.7%) and 8.2% (95% UI 7.1% to 9.4%) from 1990, respectively. In addition, global age-standardised YLD rate in 2017 was 118.8 (95% UI 59.5 to 236.2), an increase of 9.6% (95% UI 8.3% to 11.1%) from 1990. The global prevalence was higher in women and increased with age, peaking at the >95 age group among women and men in 2017. Generally, a positive association was found between the age-standardised YLD rate and SDI at the regional and national levels. Age-standardised prevalence of OA in 2017 ranged from 2090.3 to 6128.1 cases per 100 000 population. United States (6128.1 (95% UI 5729.3 to 6582.9)), American Samoa (5281 (95% UI 4688 to 5965.9)) and Kuwait (5234.6 (95% UI 4643.2 to 5953.6)) had the three highest levels of age-standardised prevalence. Oman (29.6% (95% UI 24.8% to 34.9%)), Equatorial Guinea (28.6% (95% UI 24.4% to 33.7%)) and the United States 23.2% (95% UI 16.4% to 30.5%)) showed the highest increase in the age-standardised prevalence during 1990-2017.

Conclusions: OA is a major public health challenge. While there is remarkable international variation in the prevalence, incidence and YLDs due to OA, the burden is increasing in most countries. It is expected to continue with increased life expectancy and ageing of the global population. Improving population and policy maker awareness of risk factors, including overweight and injury, and the importance and benefits of management of OA, together with providing health services for an increasing number of people living with OA, are recommended for management of the future burden of this condition.
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http://dx.doi.org/10.1136/annrheumdis-2019-216515DOI Listing
June 2020

COVID-19 pandemic, healthcare providers' contamination and death: an international view.

Crit Care 2020 05 8;24(1):208. Epub 2020 May 8.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, 1546817613, Iran.

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http://dx.doi.org/10.1186/s13054-020-02938-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209975PMC
May 2020

Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017.

BMJ 2020 03 26;368:m791. Epub 2020 Mar 26.

Institute of Bone and Joint Research, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

Objective: To use data from the Global Burden of Disease Study between 1990 and 2017 to report the rates and trends of point prevalence, annual incidence, and years lived with disability for neck pain in the general population of 195 countries.

Design: Systematic analysis.

Data Source: Global Burden of Diseases, Injuries, and Risk Factors Study 2017.

Main Outcome Measures: Numbers and age standardised rates per 100 000 population of neck pain point prevalence, annual incidence, and years lived with disability were compared across regions and countries by age, sex, and sociodemographic index. Estimates were reported with uncertainty intervals.

Results: Globally in 2017 the age standardised rates for point prevalence of neck pain per 100 000 population was 3551.1 (95% uncertainty interval 3139.5 to 3977.9), for incidence of neck pain per 100 000 population was 806.6 (713.7 to 912.5), and for years lived with disability from neck pain per 100 000 population was 352.0 (245.6 to 493.3). These estimates did not change significantly between 1990 and 2017. The global point prevalence of neck pain in 2017 was higher in females compared with males, although this was not significant at the 0.05 level. Prevalence increased with age up to 70-74 years and then decreased. Norway (6151.2 (95% uncertainty interval 5382.3 to 6959.8)), Finland (5750.3 (5058.4 to 6518.3)), and Denmark (5316 (4674 to 6030.1)) had the three highest age standardised point prevalence estimates in 2017. The largest increases in age standardised point prevalence estimates from 1990 to 2017 were in the United Kingdom (14.6% (10.6% to 18.8%)), Sweden (10.4% (6.0% to 15.4%)), and Kuwait (2.6% (2.0% to 3.2%)). In general, positive associations, but with fluctuations, were found between age standardised years lived with disability for neck pain and sociodemographic index at the global level and for all Global Burden of Disease regions, suggesting the burden is higher at higher sociodemographic indices.

Conclusions: Neck pain is a serious public health problem in the general population, with the highest burden in Norway, Finland, and Denmark. Increasing population awareness about risk factors and preventive strategies for neck pain is warranted to reduce the future burden of this condition.
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http://dx.doi.org/10.1136/bmj.m791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249252PMC
March 2020

Substance Use among Poisoned Teenage Patients.

Iran J Public Health 2019 Oct;48(10):1847-1854

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Substance use is a growing problem in many countries especially among teenagers. We aimed to estimate the prevalence and complications of substance use in teenagers referring to a tertiary hospital following intoxication.

Methods: In a cross-sectional study between 2012 and 2013 in Loghman Hakim Hospital, Tehran, Iran, sixteen substances were checked in teenagers referring due to poisoning. They divided into two groups of young (13 to <16 yr; group 1) and old-teenagers (16 to 19 yr; group 2). History of lifetime substance use and drug use within the week prior to admission were recorded.

Results: Mean (range) age of young teenagers was 14.5±0.6 [13, 15] and 17.7±1.1 [16, 19] in old-teenagers with female predominance. Of 264 teenagers, four in group 1 and 27 in group 2 were admitted due to drug overdose. Six and 69 patients in groups 1 and 2 claimed that they had used some kind of substance in the week prior to admission. Twenty (37%) and 106 (50.5%) patients in the young and old-teenager groups were defined as drug users and rates of unreported substance use were 27.8% (15 cases) and 23.8% (50 cases) respectively. Ninety-six substance users (36.4%) had referred due to poisonings other than recreational intoxication (<.001). Screening toxicological lab data showed significant opioid and sedative exposure in old-teenagers.

Conclusion: It seems young adolescents hide their drug abuse more than old teenagers. Using illicit drugs screening tests may help us to provide hidden rate of abuse in teenagers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6908896PMC
October 2019

Global, regional and national burden of rheumatoid arthritis 1990-2017: a systematic analysis of the Global Burden of Disease study 2017.

Ann Rheum Dis 2019 11 11;78(11):1463-1471. Epub 2019 Sep 11.

Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, St Leonards, New South Wales, Australia

Objectives: To provide the level and trends of prevalence, incidence and disability adjusted life years (DALYs) for rheumatoid arthritis (RA) in 195 countries from 1990 to 2017 by age, sex, Socio-demographic Index (SDI; a composite of sociodemographic factors) and Healthcare Access and Quality (an indicator of health system performance) Index.

Methods: Data from the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2017 were used. GBD 2017 modelled the burden of RA for 195 countries from 1990 to 2017, through a systematic analysis of mortality and morbidity data to estimate prevalence, incidence and DALYs. All estimates were presented as counts and age-standardised rates per 100 000 population, with uncertainty intervals (UIs).

Results: Globally, the age-standardised point prevalence and annual incidence rates of RA were 246.6 (95% UI 222.4 to 270.8) and 14.9 (95% UI 13.3 to 16.4) in 2017, which increased by 7.4% (95% UI 5.3 to 9.4) and 8.2% (95% UI 5.9 to 10.5) from 1990, respectively. However, the age-standardised rate of RA DALYs per 100 000 population was 43.3 (95% UI 33.0 to 54.5) in 2017, which was a 3.6% (95% UI -9.7 to 0.3) decrease from the 1990 rate. The age-standardised prevalence and DALY rates increased with age and were higher in females; the rates peaked at 70-74 and 75-79 age groups for females and males, respectively. A non-linear association was found between age-standardised DALY rate and SDI. The global age-standardised DALY rate decreased from 1990 to 2012 but then increased and reached higher than expected levels in the following 5 years to 2017. The UK had the highest age-standardised prevalence rate (471.8 (95% UI 428.9 to 514.9)) and age-standardised incidence rate (27.5 (95% UI 24.7 to 30.0)) in 2017. Canada, Paraguay and Guatemala showed the largest increases in age-standardised prevalence rates (54.7% (95% UI 49.2 to 59.7), 41.8% (95% UI 35.0 to 48.6) and 37.0% (95% UI 30.9 to 43.9), respectively) and age-standardised incidence rates (48.2% (95% UI 41.5 to 55.1), 43.6% (95% UI 36.6 to 50.7) and 36.8% (95% UI 30.4 to 44.3), respectively) between 1990 and 2017.

Conclusions: RA is a major global public health challenge. The age-standardised prevalence and incidence rates are increasing, especially in countries such as Canada, Paraguay and Guatemala. Early identification and treatment of RA is vital especially among females, in order to reduce the ongoing burden of this condition. The quality of health data needs to be improved for better monitoring of disease burden.
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http://dx.doi.org/10.1136/annrheumdis-2019-215920DOI Listing
November 2019

Antenatal care utilisation among Syrian refugees in Tehran: A respondent driven sampling method.

Women Birth 2020 Mar 15;33(2):e117-e121. Epub 2019 Feb 15.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Aim: To assess the antenatal care utilisation among Syrian refugees in Tehran.

Methods: This cross-sectional study was performed in 2016 in Tehran. As the refugees live in the city, we used Respondent Driven Sampling method for finding participants. Data were collected from interviews by a newly graduated Syrian general practitioner.

Findings: In total, 231 women participated in the study. The mean (standard deviation) number of antenatal care visits was 3.73 (1.41) and 131(56.7%) women received at least four visits. The mean (standard deviation) number of antenatal care visits was higher among women with four or more living children compared with those with four or more: 3.47 (1.35); 95% confidence interval 3.28 to 3.66 vs. 2.82 (1.64); 95% confidence interval 2.25 to 3.40, p=0.01. The mean (standard deviation) number of antenatal care visits was higher among women whose spouses had academic degrees compared with those with lower education: 4.13 (1.37); 95% confidence interval 3.86-4.40 vs. 3.28 (1.31); 95% confidence interval 3.05-3.52, p<0.001.

Conclusions: Antenatal care utilisation of Syrian women in Tehran complied with neither national guidelines of Iran nor the recommendations of World Health Organization. However, antenatal care utilisation of Syrian women in Tehran was higher than the main destinations of Syrian refugees. Syrian women kept their own cultural behaviour in terms of antenatal care utilisation.
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http://dx.doi.org/10.1016/j.wombi.2019.02.001DOI Listing
March 2020

Smoking Pattern and Associated Sociodemographic Factors: Findings from a Nationwide STEPS Survey in Iran.

Int J Prev Med 2018 5;9:105. Epub 2018 Dec 5.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Smoking is a modifiable risk factor for noncommunicable diseases with a wide range of harmful health outcomes. Identification of sociodemographic characteristics of smokers can be a guideline to development of effective intervention proportional to target population. This study aimed to determine smoking pattern and its associated sociodemographic factors in Iran.

Methods: This cross-sectional study was conducted based on data from the sixth round of nationwide STEPwise approach to Surveillance (STEPS) survey in the 31 provinces of Iran. A total of 10,834 participants aged ≥15 years were selected through a multistage cluster sampling method. Collecting data was performed via three-step questionnaire (ecological, behavioral risk factors, and physical and biochemical measurements). Data analysis was performed via Epi Info and then SPSS version 21 softwares using descriptive methods and analytical tests.

Results: Of all participants, 9.6% were current cigarette smokers, which was significantly more frequent among men than women (21.5% vs. 1.1%, respectively, < 0.001). Smoking was significantly associated with being self-employed and having under diploma education level ( < 0.05). Of all current cigarette smokers, 8.7% were daily smokers. The mean ± standard deviation of systolic blood pressure and history of cardiovascular symptoms in current smokers were higher than nonsmokers ( = 0.005 and < 0.001, respectively). Coughing for >4 weeks, frequent wheezing, and shortness of breath were significantly more frequent in current smokers than nonsmokers ( < 0.001, < 0.001, and = 0.02, respectively).

Conclusions: Our results draw a picture of sociodemographic distribution of smoking pattern to determine the specific characteristics of the target population affecting cigarette smoking and identified specific demographic strategies for preventive and control action plan.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_488_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298127PMC
December 2018

Public Awareness, Attitudes, and First-Aid Measures on Epilepsy in Tehran.

Iran J Child Neurol 2019 ;13(1):91-106

Objectives: People with epilepsy generally encounter misconceptions and negative attitudes on different aspects of the disease. They are also prone to physical injuries during seizures. Lack of awareness about first-aid measures results in taking inappropriate first-aid measures. We aimed to determine the public awareness, attitudes, and first-aid measures about epilepsy in Tehran.

Materials & Methods: This population-based cross-sectional survey was conducted from Dec 2016 to May 2017 in Tehran, Iran. Random stratified cluster sampling was used. Data were collected through interviews using a questionnaire. The awareness section included general awareness, causes, symptoms, seizure triggers, first-aid measures, and recommended treatments. The Likert scale was used for the attitudes section which included 20 statements. The answers about first-aid measures were categorized as helpful, or harmful.

Results: Overall, 833 adults participated in the survey. The level of total awareness score of 41 (4.9%) participants was very good, 194 (23.3%) good, 255 (30.6%) fair, 210 (25.2%) low, and 133(16.0%) very low. The mean (SD) score about general awareness was 4.6 (3.0), range=0 to 11; causes 5.8 (3.4), range=0 to 13; symptoms of seizures 7.0 (4.0), range=0 to 13; first-aid measures 7.5 (3.4), range=0 to 14. Among all participants, 260 (31.2%), named at least one superstitious cause for epilepsy. Attitudes were generally positive except for marriage and having kids. The level of first-aid measures score of 74(42.5) was very good, 79(45.4) good, and 21(12.1) low.

Conclusion: The awareness of people of Tehran about epilepsy was insufficient, attitudes were generally positive but rather conservative, and first-aid measures at the last witnessed seizure were fairly helpful.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296695PMC
January 2019

Socio-demographic determinants of obesity indexes in Iran: findings from a nationwide STEPS survey.

Health Promot Perspect 2018 7;8(3):187-194. Epub 2018 Jul 7.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Overweight and obesity are considered as non-communicable diseases (NCDs) risk factors with increasing prevalence worldwide. This nationwide study aimed to determine the socio-demographic determinants of obesity indexes in Iran. This cross-sectional study was conducted based on data from the sixth round of nationwide Stepwise approach to surveillance (STEPS) survey in the 31 provinces of Iran in 2011. A total of 9878 people aged ≥20 years were selected using a multi-stage cluster sampling method. Data were collected through three steps questionnaire including ecological, physical and biochemical measurements. We assessed body mass index (BMI), waist circumference(WC) and waist-hip ratio (WHR) as the main indicators of obesity. In this study, the weighted prevalence of overweight and obesity were 34.5% (95% CI:33.6, 35.5) and 21.5% (95% CI: 20.7, 22.3), respectively. The mean ± standard deviation (SD)of BMI among men and women were 25.4±4.4 and 26.9±5.2 kg/m respectively. Older age,living alone, having lower education level, being housewife or retired were associated with overweight and obesity (P<0.05). Urbanization was positively associated with BMI and WC.Being obese or overweight was associated with having a history of type 2 diabetes mellitus (T2DM), hypertension (HTN) and cardiovascular diseases (CVDs). The prevalence of overweight in this study was less than global rate while it was vice versa for obesity prevalence. Some socio-demographic characteristics were identified as determinants of obesity which should be considered for planning preventive and control action plans.
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http://dx.doi.org/10.15171/hpp.2018.25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6064748PMC
July 2018

Pattern of prenatal care utilization in Tehran: A population based longitudinal study.

Women Birth 2018 Jun 28;31(3):e147-e151. Epub 2017 Sep 28.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: To assess the pattern of prenatal care utilization in Tehran in 2015.

Methods: A total of 2005 pregnant women who lived in the catchment area of the study participated. Participants were followed from the sixth week of pregnancy until birth. Data were collected either through interviews or from written medical records.

Findings: More than 95% of mothers completed all eight prenatal care visits. Some 99% of mothers completed at least four visits. The prenatal care utilization was equal among all different socio-economic regions in Tehran. Gynecologists were the main healthcare providers in prenatal care visits. In addition, 75% of mothers went to gynecologists at their office or in hospitals for ordering first-trimester screening tests.

Conclusions: Prenatal care utilization complied with both national guidelines and recommendations of World Health Organization regarding the number of conducted visits. Equal accessibility and availability of prenatal care service despite the socio-economical differences of families is suggestive of equity and social justice in terms of providing health services in both public and private sectors. Among healthcare providers, gynecologists were the main healthcare provider for prenatal care visits.
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http://dx.doi.org/10.1016/j.wombi.2017.09.013DOI Listing
June 2018

Relationship between metabolic syndrome and angiographic severity of coronary artery disease.

ARYA Atheroscler 2016 Sep;12(5):220-225

Internist, Department of Internal Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: There are a few literature data on the correlation between metabolic syndrome (MetS) and coronary disease among Iranian population. This study aimed to find relationship between MetS and severity of coronary artery disease (CAD) in presence of diabetes.

Methods: Total of 192 patients were consecutively enrolled in the study who were admitted to coronary care unit because of acute coronary syndrome (ACS) and then underwent coronary angiography. MetS was defined by Iranian criteria. A coronary atherosclerosis score was used to quantify the extent of atherosclerotic involvement. The relationship between MetS and angiographic CAD severity or clinical presentation was compared between them after adjusting for diabetes.

Results: Individuals with MetS (n = 125) had a higher prevalence of ST-elevation myocardial infarction (71% vs 30%, P < 0.001), multi-vessel disease (50% vs. 34%, P = 0.003), decreased ejection fraction (P = 0.001) and more severe angiographic stenosis based on both modified Gensini (P = 0.081) and syntax (P = 0.008) scores, compared to those without MetS. Syntax score showed statistically significant difference between two groups before (P = 0.021) and after adjustment for diabetes (P = 0.005).

Conclusion: MetS was related to the severity of CAD both clinically and by angiographic scores but diabetes was a challenging factor and may independently increase the severity of CAD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403015PMC
September 2016

Knowledge, attitudes, and practices among mothers of children with epilepsy: A study in a teaching hospital.

Epilepsy Behav 2017 04 10;69:147-152. Epub 2017 Mar 10.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: Knowledge about epilepsy and attitudes towards patients with epilepsy can affect measures taken to manage epilepsy and seizures. Support and understanding of mothers is invaluable in enabling children with epilepsy to develop normal life skills in living with epilepsy. In order to identify the educational needs of mothers of children with epilepsy, their knowledge, attitudes, and practices should be assessed. Therefore, we interviewed a group of mothers of children with epilepsy who were referred to a pediatric neurology clinic in a teaching hospital. The objective of this study was to assess knowledge, attitudes, and practices among mothers of children with epilepsy in order to identify their educational needs.

Methods: In the period of August 2014 to January 2015, mothers whose children were diagnosed with epilepsy for at least six months participated in this cross sectional study, while returning to the neurology clinic of a pediatric hospital for usual follow-up. Data were collected through face-to-face interviews, held by trained female general practitioners. The interviewer used questions from a questionnaire. The knowledge section of the questionnaire included questions regarding prevalence and general knowledge about epilepsy, its etiology, symptoms, and seizure provoking factors. The attitudes section included statements regarding the mother's attitudes towards epilepsy and patients with the disease. The practice section included questions about first-aid measures taken by mothers who had witnessed generalized seizures by the time of interview.

Results: Responses of 206 participants were analyzed. At least 83% of mothers knew that epilepsy is a noncontagious neurological disorder which can be treated by regular drug therapy. In spite of demonstrating good knowledge scores, the majority of mothers felt the need for further training in epilepsy. More than 98% of mothers were against the idea that patients with epilepsy should hide their disease. Though having been referred to physicians, 84% of mothers had provided their children with at least one ineffective treatment, mostly based on superstitions.

Conclusion: Mothers' level of knowledge of epilepsy was good, and their attitudes towards epilepsy were mainly positive. Regarding the right first-aid measures at time of the last seizure, mothers' practices were acceptable. However, there is still room for improvement regarding avoiding the wrong measures. It is suggested that both practice-related issues and other aspects of epilepsy be taken into account in epilepsy-related education programs.
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http://dx.doi.org/10.1016/j.yebeh.2016.10.018DOI Listing
April 2017

Knowledge, attitudes, and practices among mothers of children with epilepsy: A study in a teaching hospital.

Epilepsy Behav 2017 04 10;69:147-152. Epub 2017 Mar 10.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: Knowledge about epilepsy and attitudes towards patients with epilepsy can affect measures taken to manage epilepsy and seizures. Support and understanding of mothers is invaluable in enabling children with epilepsy to develop normal life skills in living with epilepsy. In order to identify the educational needs of mothers of children with epilepsy, their knowledge, attitudes, and practices should be assessed. Therefore, we interviewed a group of mothers of children with epilepsy who were referred to a pediatric neurology clinic in a teaching hospital. The objective of this study was to assess knowledge, attitudes, and practices among mothers of children with epilepsy in order to identify their educational needs.

Methods: In the period of August 2014 to January 2015, mothers whose children were diagnosed with epilepsy for at least six months participated in this cross sectional study, while returning to the neurology clinic of a pediatric hospital for usual follow-up. Data were collected through face-to-face interviews, held by trained female general practitioners. The interviewer used questions from a questionnaire. The knowledge section of the questionnaire included questions regarding prevalence and general knowledge about epilepsy, its etiology, symptoms, and seizure provoking factors. The attitudes section included statements regarding the mother's attitudes towards epilepsy and patients with the disease. The practice section included questions about first-aid measures taken by mothers who had witnessed generalized seizures by the time of interview.

Results: Responses of 206 participants were analyzed. At least 83% of mothers knew that epilepsy is a noncontagious neurological disorder which can be treated by regular drug therapy. In spite of demonstrating good knowledge scores, the majority of mothers felt the need for further training in epilepsy. More than 98% of mothers were against the idea that patients with epilepsy should hide their disease. Though having been referred to physicians, 84% of mothers had provided their children with at least one ineffective treatment, mostly based on superstitions.

Conclusion: Mothers' level of knowledge of epilepsy was good, and their attitudes towards epilepsy were mainly positive. Regarding the right first-aid measures at time of the last seizure, mothers' practices were acceptable. However, there is still room for improvement regarding avoiding the wrong measures. It is suggested that both practice-related issues and other aspects of epilepsy be taken into account in epilepsy-related education programs.
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http://dx.doi.org/10.1016/j.yebeh.2016.10.018DOI Listing
April 2017