Publications by authors named "Ibrahim Abdollahpour"

39 Publications

Joint Waterpipe and Cigarette Smoking as Key Correlate of History of Depression in Iranian Population: A Cross-Sectional Study.

Tob Use Insights 2022 15;15:1179173X221100402. Epub 2022 May 15.

School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

Research on the association between waterpipe smoking and depression is limited. This study aimed to explore the prevalence and adjusted associated correlates of depression among Iranian adult. We analyzed data from 974 participants of a population-based cross-sectional study enrolling 18-50-year-old residents of Tehran, Iran in 2015. Data on lifetime self-reported history of depression, smoking behaviors, socioeconomic status, self-rated health, physical activity, stressful life events as well as a number of relevant confounders was obtained Logistic regression models were employed for estimating adjusted odds ratios (ORs) and their 95% confidence intervals (CI). The mean (SD) age of the study sample was 32.55 (8.58) years. Of 974 recruited adults, 52.36% were female. The lifetime prevalence of depression in the general population was 17.0%. In general, 21.77% and 24.79% of participant reported lifetime history of cigarette and waterpipe smoking, respectively. While only cigarette smoking (OR = 1.94, 95% CI: (1.04-3.61) and only waterpipe smoking (OR = 1.65, 95% CI: (.95-2.86) were significantly associated with depression, joint cigarette and waterpipe smoking (OR= 3.76, 95% CI: (1.99-6.08) was the strongest correlate of depression followed by female gender (OR = 3.28, 95% CI: (2.08-5.15) and poor self-rated health (OR = 2.47, 95% CI: (1.73-3.53). The prevalence of self-reported depression in general population of Tehran is considerably higher than its global mean. We reported joint cigarette and waterpipe smoking as a significant correlate with depression in the general population. Future health promotion interventions should highlight the disadvantages of joint cigarette and waterpipe smoking targeting adults and especially females.
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http://dx.doi.org/10.1177/1179173X221100402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9118885PMC
May 2022

Parental Occupational Exposure and Neurodevelopmental Disorders in Offspring: a Systematic Review and Meta-analysis.

Curr Environ Health Rep 2022 May 6. Epub 2022 May 6.

Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose Of Review: Parental occupational exposures might be associated with neurodevelopmental disorders (NDDs) in offspring. We aimed to conduct a systematic review and meta-analysis to summarize and synthesize the current literature and to estimate the pooled magnitude of the underlying association(s) between parental occupational exposures and subsequent risk of NDDs.

Recent Findings: In the meta-analysis of 20 included studies, significant associations were found between parental occupational exposure to pesticides or solvents and the risk of attention deficit hyperactivity disorder in offspring. Prenatal occupational exposure to pesticides was significantly associated with motor development or cognition disorders in children. Furthermore, some evidence showed that metals might have a role in the development of autism spectrum disorders. Further studies need to identify the level of parental occupational exposures that can be significantly associated with NDDs. Moreover, utilizing standardized outcome and exposure scales is recommended to incorporate paternal, maternal, and parental as well as both prenatal and postnatal exposure in future studies.
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http://dx.doi.org/10.1007/s40572-022-00356-6DOI Listing
May 2022

The value of thoracic computed tomography scan comparing to reverse transcription-polymerase chain reaction for the diagnosis of COVID-19.

J Res Med Sci 2021 29;26:117. Epub 2021 Nov 29.

Applied Physiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Novel coronavirus disease of 2019 (COVID-19) is the current pandemic causing massive morbidity and mortality worldwide. The gold standard diagnostic method in use is reverse transcription-polymerase chain reaction (RT-PCR) which cannot be solely relied upon. Computed tomography (CT) scan is a method currently used for diagnosis of lung disease and can play a substantial role if proved helpful in COVID-19 diagnosis. We conducted this study to evaluate the diagnostic value of CT scan compared to RT-PCR in the diagnosis of COVID-19.

Materials And Methods: We recruited 291 hospitalized patients suspicious of COVID-19 according to typical clinical findings during February-March 2020. The patients underwent CT-scan and RT-PCR procedures on the day of hospital admission. CT scans were reported by two radiologists as typical, indeterminate, negative, and atypical. Statistical indices were calculated twice: once considering "typical" and "indeterminate" categories as positive and the other time counting "typical" results as positive.

Results: The CT reports were classified as typical (64.95%), indeterminate (10.31%), atypical (11%), and negative (13.75%). Considering "typical" and "intermediate" as positive, sensitivity and specificity were 85.3% and 38.8%, respectively, and using the second assumption, the mentioned indices were 75.9% and 50.4%, respectively.

Conclusion: According to our study, CT results do not create enough diagnostic benefit and could result in incorrect confidence if negative. Since widely available, CT integration in the clinical process may be helpful in screening of suspected patients in epidemics. Yet, suspected patients should be isolated till confirmed by (multiple) PCRs.
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http://dx.doi.org/10.4103/jrms.JRMS_1187_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765516PMC
November 2021

Health risk assessment of exposure to chlorpyrifos in pregnant women using deterministic and probabilistic approaches.

PLoS One 2022 20;17(1):e0262127. Epub 2022 Jan 20.

Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.

Since chlorpyrifos (CPF), a major organophosphorus pesticide, is widely used for agricultural and domestic purposes, thus, humans may be exposed to these toxic compounds through multiple sources. In recent years, significant concerns have been raised regarding the deleterious effects of exposure to CPF on human health, especially growing fetus. Therefore, in this study, we aimed to evaluate the health risks of exposure to CPF among pregnant women living in Isfahan province, Iran, using deterministic and probabilistic approaches. The urinary concentration of 3, 5, 6-trichloro-2-pyridinol (TCP), the most common metabolite of CPF, was measured as the biomarker of current exposure to CPF. For this purpose, spot urine samples were taken from 110 pregnant women and the urinary concentrations of TCP were quantified. The estimated daily intake and hazard quotient (HQ) for CPF exposure were measured according to the reference values set by World Health Organization (WHO) and United States Environmental Protection Agency (US EPA) for acute and chronic exposure to CPF. Based on the results, TCP was detected in more than 70% of samples (3.8 ± 2.72 μg/L). The estimated daily intake for some participants was found to be higher than the suggested reference dose by USEPA for chronic exposure to CPF. Furthermore, the HQ>1 was obtained for 20% of the study population in Monte-Carlo analysis using USEPA chronic reference dose, indicating that chronic toxic effects are expected at least for a part of the target population. Based on the findings, proper measures should be taken to reduce the exposure of Iranian pregnant women to CPF and resultant health risks.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0262127PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775211PMC
February 2022

Model Prediction for In-Hospital Mortality in Patients with COVID-19: A Case-Control Study in Isfahan, Iran.

Am J Trop Med Hyg 2021 Feb 16;104(4):1476-1483. Epub 2021 Feb 16.

5Applied Physiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran.

The COVID-19 pandemic has now imposed an enormous global burden as well as a large mortality in a short time period. Although there is no promising treatment, identification of early predictors of in-hospital mortality would be critically important in reducing its worldwide mortality. We aimed to suggest a prediction model for in-hospital mortality of COVID-19. In this case-control study, we recruited 513 confirmed patients with COVID-19 from February 18 to March 26, 2020 from Isfahan COVID-19 registry. Based on extracted laboratory, clinical, and demographic data, we created an in-hospital mortality predictive model using gradient boosting. We also determined the diagnostic performance of the proposed model including sensitivity, specificity, and area under the curve (AUC) as well as their 95% CIs. Of 513 patients, there were 60 (11.7%) in-hospital deaths during the study period. The diagnostic values of the suggested model based on the gradient boosting method with oversampling techniques using all of the original data were specificity of 98.5% (95% CI: 96.8-99.4), sensitivity of 100% (95% CI: 94-100), negative predictive value of 100% (95% CI: 99.2-100), positive predictive value of 89.6% (95% CI: 79.7-95.7), and an AUC of 98.6%. The suggested model may be useful in making decision to patient's hospitalization where the probability of mortality may be more obvious based on the final variable. However, moderate gaps in our knowledge of the predictors of in-hospital mortality suggest further studies aiming at predicting models for in-hospital mortality in patients with COVID-19.
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http://dx.doi.org/10.4269/ajtmh.20-1039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045635PMC
February 2021

Estimating the Marginal Causal Effect and Potential Impact of Waterpipe Smoking on Risk of Multiple Sclerosis Using the Targeted Maximum Likelihood Estimation Method: A Large, Population-Based Incident Case-Control Study.

Am J Epidemiol 2021 07;190(7):1332-1340

There are few if any reports regarding the role of lifetime waterpipe smoking in the etiology of multiple sclerosis (MS). In a population-based incident case-control study conducted in Tehran, Iran, we investigated the association between waterpipe smoking and MS, adjusted for confounders. Cases (n = 547) were patients aged 15-50 years identified from the Iranian Multiple Sclerosis Society between 2013 and 2015. Population-based controls (n = 1,057) were persons aged 15-50 years recruited through random digit telephone dialing. A doubly robust estimation method, the targeted maximum likelihood estimator (TMLE), was used to estimate the marginal risk ratio and odds ratio for the association between waterpipe smoking and MS. The estimated risk ratio and odds ratio were both 1.70 (95% confidence interval: 1.34, 2.17). The population attributable fraction was 21.4% (95% confidence interval: 4.0, 38.8). Subject to the limitations of case-control studies in interpreting associations causally, these results suggest that waterpipe use, or strongly related but undetermined factors, increases the risk of MS. Further epidemiologic studies, including nested case-control studies, are needed to confirm these findings.
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http://dx.doi.org/10.1093/aje/kwab036DOI Listing
July 2021

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Inj Prev 2020 10 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Department of Pharmacy, Adigrat University, Adigrat, Ethiopia.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

The role of dietary antioxidant index and index of nutritional quality in MS onset: finding from an Iranian population-based incident case-control study.

Nutr Neurosci 2022 Feb 27;25(2):379-386. Epub 2020 Apr 27.

Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.

Methods: This was a large population-based case-control study recruiting 547 incident cases and 1057 population controls between August 2013 and February 2015. DAI and INQ were calculated based on the adolescence dietary intake of the participants. Logistic regression was employed for estimating adjusted odds ratios (OR) and their 95% confidence interval in 2018.

Results: Participants with less than median DAI values had two-fold increased risk of MS onset (adjusted OR 2.05, 95% CI: 1.64-2.58,  < 0.001). A significant dose-response pattern for DAI (adjusted OR 1.35, 95% CI: 1.18-1.55, for trend <0.001) was also detected. In the case of INQ, the strongest decreased risk were detected for vitamin D (OR = 0.09) and Zinc (OR = 0.34), followed by vitamin A (OR = 0.49), Calcium (OR = 0.49) and vitamin B6 (OR = 0.51) (All -values < 0.05).

Conclusion: Considering the inherent limitation of case-control designs, an appropriate intake of nutrient antioxidants may have a role in decreasing the likelihood of MS risk. Moreover, those with healthier diet assessed by index of nutritional quality were at decreased risk for MS.
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http://dx.doi.org/10.1080/1028415X.2020.1755792DOI Listing
February 2022

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

Inj Prev 2020 10 24;26(Supp 1):i96-i114. Epub 2020 Apr 24.

Faculty of Health Sciences - Health Management and Policy, American University of Beirut, Beirut, Lebanon.

Background: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
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http://dx.doi.org/10.1136/injuryprev-2019-043494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571366PMC
October 2020

Dietary inflammatory index and risk of multiple sclerosis: Findings from a large population-based incident case-control study.

Clin Nutr 2020 11 6;39(11):3402-3407. Epub 2020 Mar 6.

Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.

Background & Aims: For many decades diet, mainly its "pro-inflammatory" quality has been pondered as a possible risk factor for developing MS. However, the complexity of different dietary composition analysis provided controversial results. Recently a dietary inflammatory index (DII), a population-based score, was developed to objectify the inflammatory characteristics of a specific dietary intake.

Methods: We investigated the potential association between DII (expressed as energy adjusted-DII (E-DII) and non-energy adjusted DII (DII)) assessed from a validated FFQ based on the participants' diet habits during adolescence and the risk for developing MS in a population-based incident case-control study. Multiple logistic regression was used to estimate the adjusted.

Results: We recruited 547 incident MS cases and 1057 general population controls from Tehran, Iran (August 2013-February 2015). A statistically significant higher risk of MS was found in analyses using E-DII scores as a continuous variable with an adjusted odds ratio (AOR) of 1.53 (95% confidence interval (CI): 1.42-1.65, P = 0.001), and as a categorical variable (4th quartile OR 7.01, 95% CI: 4.87-10.1, vs the first quartile), test for trend; OR 1.86 (95% CI: 1.67-2.07), P for trend <0.001. A similar pattern was demonstrated for DII score and risk for MS.

Conclusions: We identified a pro-inflammatory diet characterized by higher E-DII and DII scores during adolescence as a strong risk factor for MS onset. Given the worldwide role of diet in general population health, improving nutritional pattern through educational programs is likely to reduce MS risk.
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http://dx.doi.org/10.1016/j.clnu.2020.02.033DOI Listing
November 2020

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Nature 2019 10 16;574(7778):353-358. Epub 2019 Oct 16.

School of Health Sciences, Madda Walabu University, Bale Goba, Ethiopia.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
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http://dx.doi.org/10.1038/s41586-019-1545-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800389PMC
October 2019

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study.

JAMA Oncol 2019 12;5(12):1749-1768

Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.

Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.

Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).

Conclusions And Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.
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http://dx.doi.org/10.1001/jamaoncol.2019.2996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777271PMC
December 2019

Socioeconomic status as the strongest predictor of self-rated health in Iranian population; a population-based cross-sectional study.

J Psychosom Res 2019 09 8;124:109775. Epub 2019 Jul 8.

School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.

Background: There is little evidence comparing the role of subjective versus objective indicators of socioeconomic status (SES) on individuals' self-rated health (SRH) in Iran.

Objectives: We aimed to investigate underlying predictors of SRH including subjective and objective SES in Tehran, a multi-ethnic city.

Method: This is an analysis of cross-sectional survey data on subjective and objective SES from a population-based case-control study conducted in Tehran, Iran (2015). We used random digit dialing for study sample recruitment. Linear regression models were used for estimating crude and adjusted coefficients (95% confidence intervals). Age, gender, SES as well as cigarette smoking were included as confounders.

Results: 15-50 years old residents of Tehran were recruited in the study (n = 1057). High reported objective and subjective SES was consistently associated with a better SRH. Subjective current SES (p < .001), subjective adolescence SES (p = .018), change in subjective SES (current vs. adolescent) (p = .034) and participants' education years (p < .001). Improvements over time in current SES in comparison to SES rated during adolescence increased the participants' SRH after adjustment for potential confounders (coefficient = 0.170, 95% CI: (0.015, 0.325)). Female participants (coefficient = -0.305, 95% CI: (-0.418, -0.192)) and smokers (high category vs. never smokers) (coefficient = -0.456, 95% CI: (-0.714, -0.197)) reported significantly worse SRH. Increasing age - 0.008 (95% CI: -0.014, -0.002) was associated with decreased SRH.

Conclusion: High subjective and objective SES consistently was the most important predictor of high SRH.
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http://dx.doi.org/10.1016/j.jpsychores.2019.109775DOI Listing
September 2019

Lifetime prevalence and correlates of smoking behavior in Iranian adults' population; a cross-sectional study.

BMC Public Health 2019 Aug 6;19(1):1056. Epub 2019 Aug 6.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Knowledge Utilization Research Center, Tehran University of Medical Science, Tehran, Iran.

Abstact: BACKGROUND: There are few if any reports concerning the joint use of waterpipe, cigarette and exposure to second-hand smoking in Tehran, Iran. Here, we simultaneously investigated the prevalence and predictors of smoking habits in Iranian adults.

Methods: In this population-based cross-sectional study, we recruited 1057 Iranian adults between August 2013 and February 2015, in Tehran, a multi-ethnic city. Participants were selected using random digit dialing. Three separate logistic regression models were applied to estimate the adjusted odds ratios (95% CI).

Results: Exposure to second-hand smoking was the most prevalent smoking type (37, 95% CI: 35-41%) followed by cigarette (23.9% (95% CI: 21-27%)) and water-pipe smoking (20.25% (95% CI: 18-23%)) in adults in Tehran. Almost 3.3 and 4.5% of adults reported three and two types of lifetime smoking behaviors, respectively. Age, sex, history of depression along with lifetime alcohol intake was the important predictors of all three types of smoking. Lifetime alcohol consumption was associated with increased prevalence of all three types of smoking (p for trend < 0.009). Lifetime drug abuse was also associated with increased prevalence of cigarette smoking (OR = 2.04, 95% CI: 1.61-2.59, p < 0.001).

Conclusions: Lifetime prevalence of waterpipe, cigarette and exposure to second-hand smoking is moderately high. Dual smoking behaviors are increasing in Iranian adults. An apparent age-related difference in pattern of waterpipe and cigarette smoking was observed. These findings highlight the need for further educational and preventive programs especially for dual smoking in Iranian young adults. This could provide practical information for evaluating and reforming the tobacco control programs and policies in Iran.
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http://dx.doi.org/10.1186/s12889-019-7358-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685175PMC
August 2019

The role of nutritional factors during adolescence in multiple sclerosis onset: a population-based incident case-control study.

Nutr Neurosci 2021 Jul 31;24(7):500-507. Epub 2019 Jul 31.

Ingrid van der Mei: Menzies Institute for Medical Research, University of Tasmania, Australia.

Objective: The potential role of nutritional factors in multiple sclerosis (MS) etiology is not clearly understood. The authors investigated the association between dietary intake during adolescence with MS.

Design, Setting And Participants: This was a population-based incident case-control study in Iran with 547 incident cases and 1057 general population controls (7/8/2013-17/2/2015). Logistic regression was used to test differences in dietary intake between cases and controls adjusted for confounders.

Results: We found that a higher dietary consumption during adolescence of fresh fish, canned tuna, poultry, cheese, yogurt, butter, fruit, vegetables and a number of dietary supplements were associated with a significantly reduced risk of MS, while red meat, shrimp, and margarine were not associated with MS. Fresh fish had a dose-response association of 0.71 (0.58-0.88) per category increase, and consuming >0.5 serves of canned tuna fish per week had an OR of 0.72 (0.56-0.90); fruit intake had an OR of 0.82 (0.71-0.94) per category increase and cheese consumption an OR of 0.78 (0.67-0.91) per category increase.

Conclusions: We identified that a higher intake of a number of food groups generally viewed as healthy were associated with a reduced risk of MS. A healthier diet during adolescence may be protective of developing MS.
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http://dx.doi.org/10.1080/1028415X.2019.1647689DOI Listing
July 2021

Methodologic and statistical considerations in the propensity score-matched case-control study of effects of antithrombotic therapy on delayed bleeding after gastric endoscopic resection.

Gastrointest Endosc 2019 07;90(1):167

Department of Epidemiology, School of Public Health, Arak University of Medical Sciences, Arak, Iran.

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http://dx.doi.org/10.1016/j.gie.2019.01.018DOI Listing
July 2019

Outcomes of endoscopic submucosal dissection for gastric epithelial neoplasm in chronic kidney disease patients: propensity score-matched case-control analysis, methodological and statistical issues.

Gastric Cancer 2019 07 18;22(4):904-905. Epub 2018 Dec 18.

Department of Epidemiology, School of Public Health, Arak University of Medical Sciences, Arak, Iran.

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http://dx.doi.org/10.1007/s10120-018-00914-8DOI Listing
July 2019

Medical History and Multiple Sclerosis: A Population-Based Incident Case-Control Study.

Neuroepidemiology 2019 26;52(1-2):55-62. Epub 2018 Nov 26.

Professor of Neurology, Jacobs School of Medicine and Biomedical Science, University of Buffalo, Buffalo, New York, USA.

Background: Consistent evidence regarding the potential role of medical history in multiple sclerosis (MS) etiology is lacking.

Objective: The association of medical history variables, that is, head injury and 9 autoimmune diseases with MS onset was investigated.

Methods: This was a population-based incident case-control study in Iran with 547 incident cases and 1,057 general population controls (August 7, 2013 - February 17, 2015). Multiple logistic regression models were used for estimating the adjusted ORs.

Results: Lifetime history of head trauma was not significantly associated with risk of MS after adjustment for well-known confounders (OR 1.24 [0.93-1.66, p = 0.14]). Similarly, there was no statistically significant association between cumulative numbers of head injury and MS (OR 1.02 [0.90-1.15, p = 0.79]). A history of autoimmune disease did not increase the risk of MS (p > 0.1). Similarly, the cumulative number of autoimmune diseases is not significantly associated with the risk of MS (p > 0.70).

Conclusion: Lifetime histories of head trauma as well as 9 investigated autoimmune diseases are not associated with increased risk of MS.
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http://dx.doi.org/10.1159/000494257DOI Listing
December 2019

Stress-full life events and multiple sclerosis: A population-based incident case-control study.

Mult Scler Relat Disord 2018 Nov 22;26:168-172. Epub 2018 Sep 22.

Jacobs School of Medicine and Biomedical Science, University of Buffalo, NY, USA.

Aim: While sizeable evidence regarding the association between stressful-life events and multiple sclerosis (MS) disease activity (clinical and/or radiological) was previously documented, their relation to MS risk is controversial. We aimed to investigate the possible association of stressful-life events and multiple sclerosis risk after adjustment for relevant confounders in an Iranian population.

Method: This was a population-based incident case-control study that recruited 547 MS cases and 1057 healthy controls between August 2013 and February 2015, Tehran. The patients were identified using the Iranian MS Society based on 2010 McDonald criteria. We used standard random digit dialing protocol for control selection. Logistic regression model was applied to estimate the odds ratios (95% CI) adjusted for physical activity, age, gender, tobacco smoking, waterpipe smoking and passive smoking.

Results: While total life events number was not associated with risk of MS, homeless periods OR 3.85 (1.65-8.90), p = 0.002 as well as divorce OR 2.11 (1.24-3.58), p = 0.005 increased the risk of MS. However, marriage OR 0.59 (0.41-0.86), p = 0.006, death of ones' dear OR 0.60 (0.44-0.82), p = 0.002 and joblessness OR 0.61 (0.41-0.91) reduced the risk of MS.

Conclusion: We could not detect a statistically significant role for the total stressful life event during the last 3 years and MS diagnosis. However, there is some evidence confirming the possible role of some individual life events, i.e. divorce and periods of homelessness as potential risk factors for MS and conversely, having married as a protective factor in MS onset.
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http://dx.doi.org/10.1016/j.msard.2018.09.026DOI Listing
November 2018

No association between socioeconomic status and risk of multiple sclerosis: A population-based incident case-control study in a developing country.

Mult Scler Relat Disord 2018 Oct 23;25:292-296. Epub 2018 Aug 23.

Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.

Background: Evidence on the association between socioeconomic status (SES) and multiple sclerosis (MS) is inconsistent. We examined the association of several indicators of SES with MS in an Iranian population.

Methods: We conducted a population-based incident case-control study with 547 incident cases and 1057 general population controls in Iran, 2015. Data was collected using telephone interviews and indicators of SES i.e. parental education, and household SES during adolescence using asset variables. Adjusted odds ratios (AORs) were estimated using multiple logistic regression model.

Results: Parental education levels were not significantly associated with MS development. Household SES during adolescence was insignificantly associated with an increased risk of MS diagnosis (P = 0.575).

Conclusion: We did not identify an association between household SES during adolescence, parental education levels, and a subsequent risk of developing MS in an Iranian population.
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http://dx.doi.org/10.1016/j.msard.2018.08.019DOI Listing
October 2018

Subclinical hypothyroidism is associated with migraine: A case-control study; methodological and statistical issues.

Cephalalgia 2019 01 27;39(1):161. Epub 2018 May 27.

2 Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.

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http://dx.doi.org/10.1177/0333102418779542DOI Listing
January 2019

Estimating the Marginal Causal Effect of Fish Consumption during Adolescence on Multiple Sclerosis: A Population-Based Incident Case-Control Study.

Neuroepidemiology 2018 7;50(3-4):111-118. Epub 2018 May 7.

Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada.

Background: Adolescence is considered as a critical time period in multiple sclerosis (MS) etiology. Nonetheless, there are insufficient reports regarding the potential role of fresh and canned fish consumptions during adolescence in MS etiology. The authors investigated the association between fresh and canned fish consumptions and MS.

Methods: This was a population-based incident case-control study conducted in Tehran. Cases (n = 547) identified from Iranian Multiple Sclerosis Society between August 7, 2013, and November 17, 2015 were included in the study. Population-based controls (n = 1,057) were recruited by random digit telephone dialing without any matching. Inverse-probability-of-treatment weighing (IPTW) using 2 sets of propensity scores and model-based standardization were used to separately estimate the marginal odds ratio between fresh and canned fish consumptions in adolescence and MS.

Results: The marginal OR for fresh fish was 0.72 (95% CI 0.58-0.90; p = 0.005) in both IPTW analyses. Similarly, the marginal OR for canned fish consumption was 0.75 (95% CI 0.60-0.95; p = 0.014).The model-based standardized OR was 0.72 (95% CI 0.58-0.91; p = 0.008) for fresh and 0.73 (95% CI 0.59-0.94; p = 0.006) for canned fish consumption in adolescence.

Discussion: Subject to limitation of case-control studies in interpreting associations causally, this study suggests that both fresh and canned fish consumptions in adolescence can decrease the risk of MS.
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http://dx.doi.org/10.1159/000487640DOI Listing
September 2019

Estimation of the marginal effect of regular drug use on multiple sclerosis in the Iranian population.

PLoS One 2018 24;13(4):e0196244. Epub 2018 Apr 24.

Department of Family Medicine, McGill University, Montréal, Quebec, Canada.

There are only few reports regarding the role of lifetime drug or substance use in multiple sclerosis (MS) etiology. In this study, we investigated the potential effect of drug or substance exposure on the onset of MS diagnosis. We conducted a population-based incident case control study in Tehran. Cases (n = 547) were 15-50 years old persons with MS identified from the Iranian Multiple Sclerosis Society (IMSS) register during August 7, 2013, and November 17, 2015. Population-based controls (n = 1057) were 15-50 years old and were recruited by random digit telephone dialing. Inverse-probability-of-treatment weighing (IPTW) using two sets of propensity scores (PSs) was used to estimate marginal incidence odds ratios (ORs) for MS contrasting pre-specified substance use. The estimated marginal OR was 6.03 (95% confidence interval: 3.54;10.3, using trimmed weights at the 95th percentile of the stabilized weight distribution) in both IPTW analyses comparing lifetime substance use (opioids, cannabis, inhalants, hallucinogens and stimulants) for at least one time monthly during a six-months or longer period vs. no such history of drug use. Subject to limitation of causal claims based on case-control studies, this study suggests that monthly drug or substance use for a period of at least six consecutive months, may increase the risk of MS by factor 3.5 or higher.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0196244PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5916854PMC
July 2018

Lifestyle factors and multiple sclerosis: A population-based incident case-control study.

Mult Scler Relat Disord 2018 May 31;22:128-133. Epub 2018 Mar 31.

Ingrid van der Mei: Menzies Institute for Medical Research, University of Tasmania, Australia.

Objective: Although low sun exposure, low vitamin D, and smoking are established risk factor of multiple sclerosis (MS), there is less evidence on the role of the other lifestyle factors. We examined the association of sun exposure, physical activity, drug abuse, and alcohol intake with MS.

Materials And Methods: This was population-based incident case-control study in Iran with 547 incident cases and 1057 general population controls (7/8/2013-17/2/2015). Logistic regression was used to analyse the data.

Results: Higher sun exposure during adolescence was associated with a reduced risk of MS, both in summer (test for trend p < 0.001) and winter (P < 0.001), while physical activity was not associated with MS (test for trend p = 0.712). Lifetime drug abuse (OR for ever use 2.93 (1.83-4.70)), with a dose-response association (test for trend p < 0.001), and alcohol intake (OR for ever use 1.49 (1.05-2.12)) was significantly associated with an increased risk of MS.

Conclusion: In a middle-eastern setting, we found that sun exposure during adolescence, drug abuse, and alcohol use were all associated with MS. Increasing sun exposure and reducing drug abuse and the use of alcohol through educational programs is likely to reduce the rate of MS.
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http://dx.doi.org/10.1016/j.msard.2018.03.022DOI Listing
May 2018

Developing an adherence in hypertension questionnaire short version: MUAH-16-statistical and methodological issues.

J Clin Hypertens (Greenwich) 2018 04 25;20(4):816. Epub 2018 Mar 25.

Department of Epidemiology, School of Public Health, Arak University of Medical Sciences, Arak, Iran.

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http://dx.doi.org/10.1111/jch.13250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8031266PMC
April 2018

Environmental risk factors in neuromyelitis optica spectrum disorder: a case-control study.

Acta Neurol Belg 2018 Jun 2;118(2):277-287. Epub 2018 Mar 2.

MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.

Neuromyelitis optica spectrum disorder (NMOSD) has unknown risk factors. The aim of this study was to identify the environmental risk factors for NMOSD. A case-control study was conducted in Tehran from 2015 to 2016 among 100 patients with NMOSD. Sex-matched healthy controls (n = 400) were selected through random digit dialing (RDD). Logistic regression was used to estimate unadjusted and adjusted ORs (odds ratio) at 95% confidence intervals (CI) via SPSS. Compared with the control population, in NMOSD patients, the adjusted OR for low dairy consumption per week was (OR = 18.09; 95% CI 6.91, 47.37), following low sea food intake (OR = 13.91; 95% CI 6.13, 31.57) and low fruit and vegetable consumption (OR = 6.23; 95% CI 3.07, 12.62). The lower heavy physical activity (OR: 16.11, 95% CI 7.03, 36.91) among patients had risen the risk of NMOSD. A past history of head trauma was considered a risk for NMOSD (OR: 8.39, 95% CI 4.97, 14.16). The association between NMOSD and intentional abortion only among females (OR: 7.42, 95% CI 2.81, 19.55) was detected. This study indicates significant associations between dietary habits, life style, history of head trauma and intentional abortion in female and the later diagnosis of NMOSD.
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http://dx.doi.org/10.1007/s13760-018-0900-5DOI Listing
June 2018

Uncovering the link between reproductive factors and multiple sclerosis: A case-control study on Iranian females.

Mult Scler Relat Disord 2018 Feb 20;20:164-168. Epub 2018 Mar 20.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Iran. Electronic address:

Background: Increase of MS prevalence in females compared to males, especially in reproductive age, highlights the important role of reproductive factors in MS pathology.

Objectives: We examined the association between females' reproductive age-related factors and MS risk.

Methods: A case-control study including 399 cases and 541 controls was carried out. The adjusted associations between MS risk and reproductive variables including age at menarche, oral contraceptive pills (OCPs) use history, OCP usage duration and age at first use, history of assisted reproductive technologies (ARTs) use, parity history, age at first childbirth and the number of parities, abortion and exclusive breast feeding > 2 months were assessed.

Results: We found protective relationships between MS and older age at menarche (OR = 0.90 {95% CI = 0.82-0.98}), ART use history (OR = 0.45 {95% CI = 0.21-0.99}), older maternal age at first childbirth (OR = 0.94{95% CI = 0.89 - 0.99}) and higher number of parities(OR = 0.61 {95% CI = 0.49 - 0.75), whereas using OCPs was associated with higher risk of developing MS (OR = 1.80 {95% CI = 1.35-2.41}).

Conclusions: Links were noted between a number of reproductive factors and risk of MS.
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http://dx.doi.org/10.1016/j.msard.2018.01.019DOI Listing
February 2018

Parental ethnicity associated with risk for multiple sclerosis: A population-based incident case-control study in Iran.

Mult Scler Relat Disord 2018 Feb 31;20:100-103. Epub 2018 Jan 31.

Institutes of Regional Health Research and of Molecular Medicine, University of Southern Denmark, Denmark.

Background: The epidemiology of multiple sclerosis (MS) includes a consideration of geography and population ethnicity. To determine whether there is any association between ethnicity and risk of MS in a multiethnic, population-based case-control study.

Methods: We conducted a population-based case-control of 547 incident MS cases and 1057 healthy controls between August 2013 and February 2015, Tehran, a multi-ethnic city. The patients were identified and enrolled through the Iranian MS Society. Case status was confirmed by a panel of MS specialists beside of 2010 McDonald criteria. Controls were selected through random digit dialing. A logistic regression model was applied to estimate the odds ratios (95%CI) adjusted for age, sex, tobacco smoking and socioeconomic status.

Results: The risk of MS for Kurd, Turk and Fars ethnicities was apparently smaller compared to one specific ethnic background (Lor); OR 0.36 (0.15-0.86) for Kurd, OR 0.42 (0.24-0.74) for Turk and OR 0.53 (0.31-0.89) for Fars. Heterogeneity in parental ethnicity of common ethnic groups was significantly associated with increased risk of MS OR 1.61 (1.13-2.29). All associations remained after adjustment for relevant confounders.

Conclusions: MS was unequally distributed in the ethnic groups. Moreover, heterogeneity in parental ethnicity seems to be a risk factor for MS.
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http://dx.doi.org/10.1016/j.msard.2018.01.008DOI Listing
February 2018

Positive Aspects of Caregiving and Caregiver Burden: A Study of Caregivers of Patients With Dementia.

J Geriatr Psychiatry Neurol 2018 Jan 29;31(1):34-38. Epub 2017 Nov 29.

3 Department of Epidemiology, School of Public Health, Kermanshah University of Medical Science, Kermanshah, Iran.

Background: Now positive aspect of caregiving (PAC) is well-defined as caregiver gains, satisfaction, meaningful life, and enhanced family relationship. The adjusted association of PAC and caregiver burden is not well acknowledged. This study investigated the association of caregiver burden and PAC adjusting for potential confounders.

Methods: This was a cross-sectional study that recruited 132 caregivers. A linear regression model with PAC was used to estimate the adjusted associations.

Results: The caregiver burden was negatively associated with PAC (mean difference in PAC per a 1-unit increase in caregiver burden = -0.12, 95% confidence interval: -0.18 to -0.056; P < .001). This association remained after adjustment for caregivers' age and marital status as well as patients' dependency level.

Conclusion: The negative significant association of caregiver burden with PAC reinforces the need for interventional and/or educational programs aiming at decreasing the overall imposed burden. This can play an important role in improving caregivers' general health and quality of life.
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http://dx.doi.org/10.1177/0891988717743590DOI Listing
January 2018

Comparing epidemiology and baseline characteristic of multiple sclerosis and neuromyelitis optica: A case-control study.

Mult Scler Relat Disord 2017 Feb 6;12:39-43. Epub 2017 Jan 6.

MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Autoimmune syndromes such as Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO) are chronic, demyelinating diseases of the central nervous system which usually affect young adults. Both environmental risk factors and genetic susceptibility have been proposed to explain the etiology of these diseases. The aim of this study was to compare epidemiology and possible risk factors in MS and NMO in Tehran, Iran.

Method: A population-based incident case-control study was performed in Tehran based on a study conducted on1513 MS patients from Iranian MS Society registry center of Tehran, from 2014 to 2015, and 83 NMO patients diagnosed with NMO in 2015 at Sina hospital, a tertiary care referral center in Tehran. The random digit dialing (RDD) methods were established to select 400 population-based controls. A checklist was designed to cover the epidemiological variables to estimate the possible risk factors for MS and NMO based on a questionnaire designed for multinational case-control studies of environmental risk factors in multiple sclerosis. Structured face to face interviews with cases, and telephone interviews with controls were conducted by trained interviewers to collect data. The multiple logistic regression analysis was done via SPSS package.

Results: The adjusted odds ratio (OR) estimate of MS for females compared to males was (OR =1.47; 95% CI: 1.12, 1.95), and it was (OR=1.54; 95% CI: 1.17, 2.02) for people aged 18-27 years compared to younger ones aged 28-37 years. The adjusted OR estimate of NMO for people aged over 48 years compared to those aged 28-37 years was (OR=3.49; 95% CI: 1.59, 7.64). The point estimates were greater than eight-fold increased risk associated with MS among patients with a positive familial history 8.80 (95% CI: 4.10, 18.90).

Conclusion: The results of this study reveal that the risk of MS is significantly higher in female and younger people in comparison to NMO. Having positive family history of MS can increase the risk of MS substantially. The findings of the study indicated that factors that predict susceptibility to MS, including a positive history of MS in relatives, do not appear to have any association with NMO.
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http://dx.doi.org/10.1016/j.msard.2017.01.004DOI Listing
February 2017
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