Publications by authors named "Noushin Fahimfar"

28 Publications

  • Page 1 of 1

Cardio-metabolic and socio-demographic risk factors associated with dependency in basic and instrumental activities of daily living among older Iranian adults: Bushehr elderly health program.

BMC Geriatr 2021 Mar 9;21(1):172. Epub 2021 Mar 9.

Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Iran's population is aging. Disability is a major public health problem for older adults, not only in Iran but all over the world. The purpose of this study was to investigate the relationship between cardio-metabolic and socio-demographic risk factors and disability in people 60 years and older in Iran.

Methods: The baseline (cross-sectional) data of 2426 samples from the Bushehr Elderly Health (BEH) program was included in the analysis. The participants were selected through multi-stage random sampling in Bushehr, southern Iran. Socio-demographic characteristics, as well as the history of diabetes and other chronic diseases, and smoking were measured using standardized questionnaires. Anthropometric measurements and laboratory tests were performed under standard conditions. Dependency was determined by the questionnaires of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) using Barthel and Lawton scales respectively. Multiple logistic regression was used in the analysis.

Results: Mean (Standard Deviation) of the participants' age was 69.3 (6.4) years (range: 60 and 96 years), and 48.1% of the participants were men. After adjusting for potential confounders, being older, being female (OR (95%CI): 2.3 (1.9-2.9)), having a lower education level, a history of diabetes mellitus (OR: 1.4 (1.2-1.7)) and past smoking (OR: 1.3 (1.0-1.6)), and no physical activity (OR: 1.5 (1.2-1.9)) were significantly associated with dependency in IADL. Also, being older and female (OR: 2.4 (1.9-3.0)), having a lower education level, no physical activity (OR: 2.2 (1.6-2.9)) and daily intake of calories (OR: 0.99 (0.99-0.99)) were associated with dependency in BADL.

Conclusion: Dependency in older adults can be prevented by increasing community literacy, improving physical activity, preventing and controlling diabetes mellitus, avoiding smoking, and reducing daily calorie intake.
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http://dx.doi.org/10.1186/s12877-021-02124-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941716PMC
March 2021

Sex-specific incidence rates and risk factors for fracture: A 16-year follow-up from the Tehran lipid and glucose study.

Bone 2021 May 30;146:115869. Epub 2021 Jan 30.

Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: To examine the population-based incidence of any-fracture and its potential risk factors in a sex-split cohort of the Iranian population.

Materials And Methods: A total of 3477 men and 4085 women with a mean (SD) age of 47.92(13.1) and 45.88(11.47) years, respectively were entered into the study. The age-standardized incidence rates per 100,000 person-years were reported for the whole population and each sex separately. Cox proportional hazard models were used to estimate hazard ratios (HR) for potential risk factors. Only fractures requiring inpatients' care were considered as the outcome. We also defined major osteoporotic fractures (MOF) as the composite of the fractures that occurred in the vertebral, wrist, hip and pelvic sites among population aged ≥50 years.

Results: During the median (IQR) follow-up of 15.9 years, 4.34%men and 3.75% women experienced at least one incident any-fracture. The annual age-standardized incidence rates (95% CI) among men and women were 330.9 (279.6-388.9) and 319.4(268.1-377.3) per 100,000 person-years, respectively; the corresponding values for incidence of MOF was 202.2(142.3-278.6) in men and 342.1(260.4-441.0) per 100,000 person-years for women. In the multivariable model, among the whole population, age groups ≥50 years, central obesity [HR: 95% CI 1.77(1.32-2.39)], current smoking [1.59(1.15-2.20)] and using steroid medications [2.20(1.04-4.67)] significantly increased the risk of incident fracture (all P < 0.05); however the impact of the first two risk factors were more prominent among women (P for interaction ≤0.01). Moreover, being obese was associated with a lower risk of incident first fracture in the total population [HR: 95% CI: 0.61(0.40-0.92)]. Being men [HR: 95% CI: 0.54(0.30-0.99)] and prediabetes status [HR: 95% CI: 0.53(0.30-0.95)] were also associated with lower risk for MOF.

Conclusion: This is the first report of long-term incidence rate of any-fracture and MOF conducted in the metropolitan city of Tehran. Among modifiable risk factors of fracture, in the whole population smoking habit and using steroid medications and particularly for women central obesity should be considered as main risk factors for preventive strategies. Prediabetes status was associated with lower risk of MOF.
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http://dx.doi.org/10.1016/j.bone.2021.115869DOI Listing
May 2021

Comparison of EWGSOP-1and EWGSOP-2 diagnostic criteria on prevalence of and risk factors for sarcopenia among Iranian older people: the Bushehr Elderly Health (BEH) program.

J Diabetes Metab Disord 2020 Dec 29;19(2):727-734. Epub 2020 May 29.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: This study proposed to compare the prevalence and risk factors for sarcopenia by EGWSOP-1 and EWGSOP-2 diagnostic criteria in Iran.

Methods: This cross-sectional study was conducted based on the data collected during the Bushehr Elderly Health (BEH) Program, stage II. Sarcopenia was defined as 3 definitions: EWGSOP-1(with Iranian cut off), EWGSOP-2(with Iranian cut off), EWGSOP-2(with European cut off) definition. We evaluated the age-standardized prevalence of sarcopenia in both genders. Regression analysis was used to show the associations in the adjusted models.

Results: Among 2426 participants, age-standardized prevalence of sarcopenia, and severe sarcopenia by EWGSOP-1 were 19.7%, and 12.9%, in men and 13.6%, and 16.7% in women, respectively. When we used EWGSOP-2 (with Iranian cut-off) criteria, these values were 10.5%, and 12.7% among men and 7.13% and 16.5% in women, respectively. The prevalence sarcopenia and severe sarcopenia by EWGSOP-2 (with European cut-off) were 12.7%, and 13.4% in men and 5.42%, and 13.7% in women, respectively. In both genders, getting older and high-fat mass were positively associated with sarcopenia, and BMI had a significant inverse association in both genders and all defintions.

Conclusions: Results showed that a prevalence of sarcopenia varied largely by using different criteria, in both sexes. EWGSOP2- defined sarcopenia prevalence was lower than that defined using EWGSOP-1 criteria due to different diagnostic factors to detect sarcopenia. Some adverse outcomes should be considered for evaluating sarcopenia to compare the accuracy of EWGSOP-1 and EWGSOP-2.
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http://dx.doi.org/10.1007/s40200-020-00553-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843815PMC
December 2020

Prevalence of osteoporosis among the elderly population of Iran.

Arch Osteoporos 2021 01 21;16(1):16. Epub 2021 Jan 21.

Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

In a large population-based study of Iran, the age-standardized prevalence of osteoporosis was 24.6% in men and 62.7% in women aged ≥ 60 years. Osteoporosis was negatively associated with body mass index in both sexes, and with diabetes in men and hypertriglyceridemia in women.

Purpose: Population aging has made osteoporosis and osteoporotic fractures an important health problem, especially in developing countries. This study aimed to explore the prevalence of osteoporosis and associated factors among the elderly population of the south-west of Iran.

Methods: Baseline data of the second stage of the Bushehr Elderly Health program was used. Spinal, total hip, or femoral neck osteoporosis was described as a BMD that lies 2.5 standard deviations or more, below the average values of a young healthy adult in the lumbar spine, total hip, or femoral neck, respectively. Osteoporosis at either site was defined as total osteoporosis. Age-standardized prevalence of osteoporosis was estimated. We used the modified Poisson regression with a robust variance estimator to identify the factors related to osteoporosis, adjusting for potential confounders.

Results: Overall, 2425 individuals (1166 men) aged over 60 years were included. In all, total osteoporosis was detected in 1006 (41.5%) of the participants. Using the reference value derived from Caucasian women aged 20-29 years, the age-standardized prevalence of total osteoporosis was 24.6 (95% CI: 21.9-27.3) in men, and 62.7 (95% CI: 60.0-65.4) in women. In men, osteoporosis was positively associated with age, smoking, history of fracture, and history of renal/liver diseases and negatively associated with body mass index (BMI) and diabetes. BMI, hypertriglyceridemia, and education were negatively correlated with osteoporosis in women, while years after menopause and history of fracture increased the likelihood of osteoporosis, significantly.

Conclusion: Results support the high prevalence of osteoporosis and osteopenia in the elderly population. Considering the importance of severe complications, especially fractures, comprehensive interventions should be expanded.
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http://dx.doi.org/10.1007/s11657-020-00872-8DOI Listing
January 2021

Protocol for a multicentre, prospective cohort study of clinical, proteomic and genomic patterns associated with osteoporosis to develop a multidimensional fracture assessment tool: the PoCOsteo Study.

BMJ Open 2020 09 30;10(9):e035363. Epub 2020 Sep 30.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)

Introduction: The HORIZON 2020 project PoCOsteo aims (1) to develop a multidimensional fracture risk assessment tool which would take into account all factors known to be related to an individual's fracture risk. The fracture risk model is intended to be developed in two different populations, namely a European and a Middle Eastern one; (2) to develop a medical device, which would measure and/or quantify proteomic as well as genomic factors as present in whole blood samples collected through finger prick; (3) to test the clinical applicability and the validity of prototypes of the to be developed point of care device at both clinical centres.

Methods And Analysis: This article presents the protocol of this prospective cohort that will be carried out independently at two different centres (Division of Endocrinology and Diabetology at the Medical University of Graz (MUG) as a clinic-based cohort, and Endocrinology and Metabolism Research Institute (EMRI) at the Tehran University of Medical Sciences (TUMS) as a population-based cohort). The final aim is to develop a fracture risk assessment model, which would include clinical risk factors, biochemical markers of bone turnover, as well as specific genomic factors. The derivation cohorts will consist of individuals aged 50 years and above. The period of observation for each patient will be 12 months; an extension phase, which would last for another 2 years, is also planned.

Ethics And Dissemination: These studies are conducted in accordance with the World Medical Association Declaration of Helsinki. The Iranian part was approved by the Research Ethics Committee of EMRI, TUMS. The Austrian part was approved by the Ethics Committee of the Medical University of Graz. Based on the gathered information, a multidimensional fracture assessment tool will be designed which will later be added to the PoCOsteo device.
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http://dx.doi.org/10.1136/bmjopen-2019-035363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528352PMC
September 2020

Osteoporosis and cognitive impairment interwoven warning signs: community-based study on older adults-Bushehr Elderly Health (BEH) Program.

Arch Osteoporos 2020 09 10;15(1):140. Epub 2020 Sep 10.

Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Cognitive impairment and osteoporosis are frequently seen to coincide in clinical practice. Osteoporosis was higher in elderly populations with cognitive impairment, especially in postmenopausal women. Thus, prophylaxis for osteoporosis, falls, and fractures should be considered as part of the treatment of patients with cognitive impairment.

Introduction: Cognitive impairment and osteoporosis are two important health concerns among older adults that their possible relationship, concurrent occurrence, and linking mechanism have recently been highlighted. The purpose of this study was to assess the sex-independent association of these two conditions.

Materials And Methods: From among 2331 individuals aged ≥ 60 years selected in Bushehr Elderly Health (BEH) Program, Iran; data of 1508 participants were analyzed. Cognitive status was assessed using Category Fluency Test and Mini-cog assessment instrument. Association between osteopenia-osteoporosis and cognitive impairment were assessed using uni- and multivariable logistic regression models.

Results: Osteoporosis was diagnosed in 598 (39.6%) of the participants (58.3% female and 21.9% male, P < 0.001). From among them, 677 (44.9%) had evidence of cognitive impairment (64.5% female and 31.0% male, P < 0.001). Multivariate logistic regressions showed spinal and total hip osteoporosis was associated with 1.83 (CI 95% 1.13-2.96) and 2.24-fold (CI 95% 1.28-3.89) increase in the risk of cognitive impairment among female subjects, respectively. Ordinal logistic regression, on the other hand, revealed cognitive impairment to be associated with 1.42-fold (CI 95% 1.04-1.92) increase in the risk of spinal osteopenia-osteoporosis, 1.5-fold increase in total hip osteoporosis (CI 95% 1.09-2.05), and 1.48-fold increase in general osteoporosis (CI 95% 1.06-2.0).

Conclusion: Different degrees of bone loss and cognitive impairment may be a risk factor for each other among women but not in men. It is suggested that the screening, adopting preventive measures for the other condition and regular follow-ups, if needed, could be of utmost importance.
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http://dx.doi.org/10.1007/s11657-020-00817-1DOI Listing
September 2020

Contribution of Iran in COVID-19 studies: a bibliometrics analysis.

J Diabetes Metab Disord 2020 Aug 14:1-10. Epub 2020 Aug 14.

Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Iran is fighting heroically against COVID-19. Due to the importance of scientific publications in better dealing with this stubborn virus, this study was conducted aiming at reviewing COVID-19 publications by Iranian scientists.

Methods: We searched for COVID-19 and all its related keywords in the Web of Science (WOS), Scopus and PubMed databases to find documents published by Iranian authors until July 10, 2020. Duplicates documents were excluded, and bibliographic parameters were evaluated. Co-authorship matrix was calculated using Bibexcel, and visualizations were done using VOSviewer.

Results: A total of 849 documents from 3450 Iranian researchers (5.5 authors per document) were retrieved from WOS, PubMed, and Scopus and Iran ranked 12th and 13th in WOS and Scopus in terms of the number of publications. The average citation per document was 2.2 with the h-index of 18. Original articles and letters were the most common formats for Iranian publications. The Journal of Military Medicine has published the highest number of documents. Iranian authors have mostly collaborated with researchers from the United States, Italy, the UK, and Canada, respectively. The co-occurrence network for keywords represented five publication clusters in the collection, and the largest clusters were related to epidemiological studies and public health, followed by clinical studies on COVID-19.

Conclusion: Iranian researchers have had a significant scientific contribution in various areas of the disease. However, the network of studies has not been sufficiently cohesive, and more coherent collaboration between researchers at the national and international levels should be on the agenda of research policymakers in the country.
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http://dx.doi.org/10.1007/s40200-020-00606-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426204PMC
August 2020

Prediction of Cardiovascular Disease Mortality in a Middle Eastern Country: Performance of the Globorisk and Score Functions in Four Population-Based Cohort Studies of Iran.

Int J Health Policy Manag 2020 Jul 15. Epub 2020 Jul 15.

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Considering the importance of cardiovascular disease (CVD) risk prediction for healthcare systems and the limited information available in the Middle East, we evaluated the SCORE and Globorisk models to predict CVD death in a country of this region.

Methods: We included 24 427 participants (11 187 men) aged 40-80 years from four population-based cohorts in Iran. Updating approaches were used to recalibrate the baseline survival and the overall effect of the predictors of the models. We assessed the models' discrimination using C-index and then compared the observed with the predicted risk of death using calibration plots. The sensitivity and specificity of the models were estimated at the risk thresholds of 3%, 5%, 7%, and 10%. An agreement between models was assessed using the intra-class correlation coefficient (ICC). We applied decision analysis to provide perception into the consequences of using the models in general practice; for this reason, the clinical usefulness of the models was assessed using the net benefit (NB) and decision curve analysis. The NB is a sensitivity penalized by a weighted false positive (FP) rate in population level.

Results: After 154 522 person-years of follow-up, 437 cardiovascular deaths (280 men) occurred. The 10-year observed risks were 4.2% (95% CI: 3.7%-4.8%) in men and 2.1% (1.8-2%.5%) in women. The c-index for SCORE function was 0.784 (0.756-0.812) in men and 0.780 (0.744-0.815) in women. Corresponding values for Globorisk were 0.793 (0.766- 0.820) and 0.793 (0.757-0.829). The deviation of the calibration slopes from one reflected a need for recalibration; after which, the predicted-to-observed ratio for both models was 1.02 in men and 0.95 in women. Models showed good agreement (ICC 0.93 in men, and 0.89 in women). Decision curve showed that using both models results in the same clinical usefulness at the risk threshold of 5%, in both men and women; however, at the risk threshold of 10%, Globorisk had better clinical usefulness in women (Difference: 8%, 95% CI: 4%-13%).

Conclusion: Original Globorisk and SCORE models overestimate the CVD risk in Iranian populations resulting in a high number of people who need intervention. Recalibration could adopt these models to precisely predict CVD mortality. Globorisk showed better performance clinically, only among high-risk women.
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http://dx.doi.org/10.34172/ijhpm.2020.103DOI Listing
July 2020

The association of tobacco smoking and bone health in the elderly population of Iran: results from Bushehr elderly health (BEH) program.

J Diabetes Metab Disord 2020 Jun 16;19(1):461-468. Epub 2020 May 16.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, No.10- Jalal -e-ale-ahmad st, chamran hwy, Tehran, Iran.

Purpose: Smoking has been linked with osteoporosis, but further evidence is required, especially concerning the effects of different types of tobacco smoking. We sought to examine the association between smoking and bone health in a large cohort of elderly Iranians.

Methods: The data from 2377 participants aged >60 years of Bushehr Elderly Health (BEH) program were used. Regardless of the type of smoking, participants were initially classified as non-smokers, ex-smokers and current smokers. Current smokers were also categorized based on the smoking type (pure cigarette, pure hookah and both). Dual-energy X-ray absorptiometry was used to evaluate bone density as well as Trabecular Bone Score (TBS). T-score ≤ -2.5 in either of the femoral neck, total hip or spinal sites was applied to determine the osteoporosis. The association of smoking and osteoporosis was assessed using multivariable modified Poisson regression model and reported as adjusted prevalence ratios (APR). The linear regression model was used to assess the association between smoking and TBS, adjusting for potential factors.

Results: A total of 2377 (1225 women) were enrolled [mean age: 69.3 (±6.4) years], among which 1054 (44.3%) participants were nonsmokers. In all, 496 (20.9%) participants were current smokers. Multivariable regression analysis revealed no significant association between smoking (either current or past) and osteoporosis in women. In men, current smoking was negatively associated with osteoporosis (APR: 1.51, 95%CI: 1.16-1.96). Among current users, cigarette smoking was associated with osteoporosis (APR: 1.57, 95%CI: 1.20-2.03); however, we could not detect a significant association between current smoking of hookah and osteoporosis. In men, a significant association was also detected between current cigarette smoking and TBS (coefficient: -0.03, 95%CI: -0.01, -0.04).

Conclusion: Current cigarette smoking is associated with both the quantity and quality of bone mass in elderly men. Although we could not detect a significant association between hookah and osteoporosis in men, considering the prevalence of hookah smoking in the middle eastern countries, further studies are needed to determine the effect of hookah smoking on bone health.
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http://dx.doi.org/10.1007/s40200-020-00532-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270287PMC
June 2020

The landscape of microbiota research in Iran; a bibliometric and network analysis.

J Diabetes Metab Disord 2020 Jun 15;19(1):163-177. Epub 2020 Jan 15.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: To introduce bibliometric features of Iranian documents on microbiota and to provide descriptive information about retrieved documents related to the medical sciences and documents utilizing molecular techniques for microbiota detection.

Methods: This is a descriptive bibliometric study of all Iranian documents on microbiota in any language that were indexed in Scopus before 7 September 2019. We assessed the research performance through statistical analysis of the bibliometric indicators, including number of publications, citations, institutions and journals activities, co-citations and bibliographic couplings, and network analysis of co-authorships, countries' collaborations, terms and keywords.

Results: We extracted 425 relevant documents, 260 of which pertain to the medical sciences. The most focused microbiota modulating interventions and diseases in 33 clinical trials are 'synbiotics' ( = 8) and 'probiotics' (n = 8), and 'Obesity' ( = 3) and 'non-alcoholic fatty liver disease' (n = 3), respectively. During the last decade, Iranian microbiota publications have increasingly grown with a constant upward slope, particularly in the area of medical sciences after 2016. Citation counting reveals that originals and reviews have been cited 4221 times, with an average 10.76 citations and H-index of 34. The most significant performance in publishing Iranian microbiota documents belongs to 'Tehran University of Medical Sciences' as the active institution ( = 89 publications) and the supporting sponsor ( = 19), 'Microbial Pathogenesis' as the productive journal ( = 12), 'Seidavi A' as the most authorships (n = 19), and 'the United States' as the collaborative country ( = 46).

Conclusions: The qualitative and quantitative information of this study will be a practical guidance for future study planning and policy-decision making.
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http://dx.doi.org/10.1007/s40200-020-00488-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270223PMC
June 2020

The external validity and performance of the no-laboratory American Diabetes Association screening tool for identifying undiagnosed type 2 diabetes among the Iranian population.

Prim Care Diabetes 2020 12 7;14(6):672-677. Epub 2020 Jun 7.

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Aims: The aim of this study is to assess the American Diabetes Association (ADA) risk score as a self-assessment screening tool for undiagnosed type 2 diabetes (T2DM) in Iran.

Methods: In a national survey of risk factors for non-communicable diseases, we included 3458 Iranian adults. The discrimination and validity were assessed using the area under the curve (AUC), sensitivity, specificity, Youden's index, positive and negative predictive values (PPV and NPV). The frequency of high-risk Iranian population who need a glucose test and those who need intervention were also estimated.

Results: The AUC was 73.7% and the suggested ADA score of ≥5 yielded a sensitivity of 51.6%, specificity 82.4%, NPV 98.3%, and PPV 7.9%. This threshold results in classifying 18.6% of the Iranians, equals to 8.5 million, as high-risk and 1.5% of the population, about 700,000, would need intervention. However, our study suggested score ≥4 that identified 34% of the population as high-risk and 2% of the population would need intervention.

Conclusion: Our findings support the ADA suggested threshold for identifying high-risk individuals for undiagnosed T2DM; however, a lower threshold is also recommended for higher sensitivity. The ADA screening tool could help the public health system for low-cost screening.
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http://dx.doi.org/10.1016/j.pcd.2020.04.001DOI Listing
December 2020

Prevalence of Osteosarcopenia and Its Association with Cardiovascular Risk Factors in Iranian Older People: Bushehr Elderly Health (BEH) Program.

Calcif Tissue Int 2020 04 17;106(4):364-370. Epub 2019 Dec 17.

Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, No. 10-Jalal-e-ale-ahmad St, Chamran Hwy, P. O. Box, Tehran, 14117-13137, Iran.

Osteosarcopenia is an increasingly recognized geriatric syndrome with a considerable prevalence which increases morbidity and mortality. Although osteosarcopenia is a result of age-related deterioration in muscle and bone, there are many risk factors that provoking osteosarcopenia. These risk factors should be considered by the clinicians to treat osteosarcopenia. We assessed the link between osteosarcopenia and conventional risk factors of cardiovascular diseases. This study was a cross-sectional study that has been conducted within the framework of Bushehr Elderly Health (BEH) program stage II in which participants aged ≥ 60 years were included. Osteopenia/osteoporosis was defined as a t-score ≤  - 1.0 standard deviation below the mean values of a young healthy adult. We defined sarcopenia as reduced skeletal muscle mass plus low muscle strength and/or low physical performance. Osteosarcopenia was considered as the presence of both osteopenia/osteoporosis and sarcopenia. We estimated the age-standardized prevalence of osteosarcopenia for men and women, separately. Using modified Poisson regression analysis, adjusted prevalence ratio (PR) with 95% CI was used to show the measure of associations in the final model. Among 2353 participants, 1205 (51.2%) were women. Age-standardized prevalence of osteosarcopenia was 33.8 (95% CI 31.0-36.5) in men and 33.9 (30.9-36.8) in women. In both sexes, the inverse association was detected with body mass index and having osteosarcopenia (PR 0.84, 95% CI 0.81-0.88 in men and 0.77, 95% CI 0.74-0.80 in women). In both sexes, high-fat mass was positively associated with osteosarcopenia [PR 1.46 (95% CI 1.11-1.92) in men, and 2.25 (95% CI 1.71-2.95) in women]. Physical activity had a significant inverse association in men (PR = 0.64, 95% CI 0.46, 0.88), but not in women. Diabetes was also showed a direct association with osteosarcopenia in men (PR 1.33, 95% CI 1.04-1.69). No associations were detected between the lipid profiles and osteosarcopenia. Results demonstrated a high prevalence of osteosarcopenia in both sexes suggesting a high disease burden in a rapidly aging country. Lifestyle and socioeconomic factors, as well as chronic diseases, were significantly associated with osteosarcopenia.
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http://dx.doi.org/10.1007/s00223-019-00646-6DOI Listing
April 2020

The HIV treatment cascade in people living with HIV in Iran in 2014: Mixed-method study to measure losses and reasons.

Int J STD AIDS 2019 11 27;30(13):1257-1264. Epub 2019 Sep 27.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

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http://dx.doi.org/10.1177/0956462419867573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008700PMC
November 2019

Estimation of HIV incidence and its trend in three key populations in Iran.

PLoS One 2018 29;13(11):e0207681. Epub 2018 Nov 29.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

In Iran, People Who Inject Drugs (PWID), Female Sex Workers (FSW), and prisoners are the main key populations at risk of HIV infection. This study aimed to evaluate the trend of HIV incidence among PWID, FSW and prisoners as an impact measure of HIV harm reduction and prevention efforts in Iran. Data were obtained from the two rounds of national bio-behavioral surveillance surveys among FSW (2010 (n = 872), 2015 (n = 1339)), PWID (2010 (n = 2417), 2014 (n = 2307)), and prisoners (2009 (n = 4536), 2013 (n = 5390)) through facility-based (FSW and PWID surveys) and cluster sampling (prisoner surveys). Time-at-risk was calculated assuming the age at first sex or drug injection as the beginning of the at-risk period and the age at the time of the interview or date when they received a positive HIV test result as the end of this period, adjusted for interval censoring. HIV incidence among PWID in 2014 was 5.39 (95% CI 4.71, 6.16) per 1,000 person-years (PY), significantly lower than in 2009 (17.07, 95% CI 15.34, 19.34). Similarly, HIV incidence was 1.12 (95% CI 0.77, 1.64) per 1,000 PY among FSW in 2015, a significant drop from 2010 (2.38, 95% CI 1.66, 3.40). Also, HIV incidence decreased among prisoners from 1.34 (95% CI: 1.08, 1.67) in 2009 to 0.49 (95% CI: 0.39, 0.61) per 1,000 PY in 2013. Our findings suggest that after an increase in the 2000s, the HIV incidence may have been decreased and stabilized among key populations in Iran.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207681PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6264468PMC
April 2019

Cardiovascular mortality in a Western Asian country: results from the Iran Cohort Consortium.

BMJ Open 2018 07 5;8(7):e020303. Epub 2018 Jul 5.

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

Objectives: Cardiovascular mortality in Western Asia is high and still rising. However, most data documented on risk prediction has been derived from Western countries and few population-based cohort studies have been conducted in this region. The current study aimed to present the process of pooling data and cardiovascular disease (CVD) mortality incidences for four Iranian cohorts.

Methods: From the Iran Cohort Consortium, the Golestan Cohort Study (GCS), Tehran Lipid and Glucose Study, Isfahan Cohort Study (ICS) and the Shahroud Eye Cohort Study (ShECS) were eligible for the current study since they had appropriate data and follow-up visits. Age-standardised CVD mortality rates were estimated for ages 40-80 and 40-65 years. Cox regression was used to compare mortalities among cohorts. Adjusted marginal rates were calculated using Poisson regression.

Results: Overall, 61 291 participants (34 880 women) aged 40-80 years, free of CVD at baseline, were included. During 504 606 person-years of follow-up, 1981 CVD deaths (885 women) occurred. Age-standardised/sex-standardised premature CVD mortality rates were estimated from 133 per 100 000 person-years (95% CI 81 to 184) in ShECS to 366 (95% CI 342 to 389) in the GCS. Compared with urban women, rural women had higher CVD mortality in the GCS but not in the ICS. The GCS population had a higher risk of CVD mortality, compared with the others, adjusted for conventional CVD risk factors.

Conclusions: The incidence of CVD mortality is high with some differences between urban and rural cohorts in Iran as a Western Asian country. Pooling data facilitates the opportunity to globally evaluate risk prediction models.
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http://dx.doi.org/10.1136/bmjopen-2017-020303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042599PMC
July 2018

Knowledge, Attitude, and Practices Regarding HIV and TB Among Homeless People in Tehran, Iran.

Int J Health Policy Manag 2018 06 1;7(6):549-555. Epub 2018 Jun 1.

Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.

Background: Homeless people are at high risk of HIV and tuberculosis (TB) infection due to living in poor sanitary conditions and practicing high-risk behavior. The aim of this study is to assess the knowledge, attitude, and practice (KAP) of homeless people in Tehran regarding TB and HIV.

Methods: Using a convenience sampling, we performed a cross-sectional study on homeless people in Tehran from June to August 2012. Participants aged 18-60 years having at least 10 days of homelessness in the preceding month to the study period were included. All required data were collected through face-to-face interviews conducted using a researcherdesigned questionnaire. Each score in KAP of TB and HIV was separately divided by the maximum score and multiplied by 100 to attain percentage scores. The mean scores were compared using analysis of variance (ANOVA) and student's t test. A Tukey test was used for post hoc analysis and two-by-two comparisons.

Results: In this study, 593 participants consisting of 513 men and 80 women were included. The mean age of the participants was 41.74 ± 0.45 years. Moreover, the total mean score of KAP toward HIV was 79.24 (95% CI: 77.36, 81.12), 57.13 (95% CI: 55.12, 59.14), and 21.14 (95% CI: 18.35, 23.93), respectively. The total mean score of knowledge and practice regarding TB was 62.04 (95% CI: 59.94, 64.14) and 42.57 (95% CI: 40.36, 44.78), respectively.

Conclusion: Although a relatively acceptable knowledge was detected in this high-risk population, practices regarding TB and HIV showed some weaknesses. Developing special programs to improve the healthy behavior of this population is highly recommended.
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http://dx.doi.org/10.15171/ijhpm.2017.129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015517PMC
June 2018

Symptom-Based Versus Laboratory-Based Diagnosis of Five Sexually Transmitted Infections in Female Sex Workers in Iran.

AIDS Behav 2018 Jul;22(Suppl 1):19-25

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Among 1337 Iranian adult female sex workers in 2015, we assessed the diagnostic value of 4 self-reported sexually transmitted infection (STIs) symptoms for detecting laboratory-confirmed gonorrhea, chlamydia, trichomoniasis, human papillomavirus (HPV), and syphilis. While 37.7% reported vaginal discharge (VD), 25.9% reported pain or burning (P/B), 3.0% reported genital ulcers (GU), and 1.4% reported genital warts (GW), the prevalence of laboratory-confirmed syphilis, gonorrhea, chlamydia, trichomoniasis, and HPV was 0.4, 1.3, 6.0, 11.9, and 41.9%, respectively. The sensitivity of VD was 40.3% for detecting tricomoniasis, 37.5% for chlamydia, and 37.5% for gonorrhea. The sensitivity of P/B ranged from 12.5% for gonorrhea to 25.2% for trichomoniasis. The sensitivity of GU and GW was very low for 5 STIs. The sensitivity of all symptoms combined was also lower than 50%. Among asymptomatic participants, 41.2% tested positive for HPV, 11.8% for trichomoniasis, and less than 6.6% for other STIs. Symptom-based case management and surveillance of STIs can lead to misclassification of a large proportion of cases.
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http://dx.doi.org/10.1007/s10461-018-2130-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226376PMC
July 2018

Prevalence of HAV Ab, HEV (IgG), HSV2 IgG, and Syphilis Among Sheltered Homeless Adults in Tehran, 2012.

Int J Health Policy Manag 2018 03 1;7(3):225-230. Epub 2018 Mar 1.

Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.

Background: This study investigated the prevalence for hepatitis A virus (HAV), hepatitis E virus (HEV), herpes simplex virus type 2 (HSV2) and syphilis among homeless in the city of Tehran.

Methods: In this cross-sectional study, 596 homeless were recruited in Tehran. A researcher-designed questionnaire was used to study demographic data. Using enzyme-linked immunoassay, and rapid plasma reagin (RPR) test, we evaluated the seroprevalence of HAV anti-body, HEV IgG, herpes, HSV2 IgG, and syphilis among sheltered homeless in Tehran. The associations between the participant's characteristics and infections were evaluated using logistic regression and chi-square.

Results: A total of 569 homeless, 78 women (13.7%) and 491 men (86.3%) were enrolled into the study from June to August 2012. Their age mean was 42 years and meantime of being homeless was 24 months. Seroprevalence of syphilis, HEV IgG, HSV2 IgG and HAV Ab was 0.55%, 24.37%, 16.48%, and 94.34%, respectively. History of drug abuse was reported in 77.70%; 46.01% of them were using a drug during the study and 26.87% of them had history of intravenous drug abuse. Among people who had intravenous drug abuse, 48.25% had history of syringe sharing.

Conclusion: The prevalence of HAV, HEV and HSV2 were higher than the general population while low prevalence of syphilis was seen among homeless peoples who are at high risk of sexually transmitted infection (STD). Our findings highlighted that significant healthcare needs of sheltered homeless people in Tehran are unmet and much more attention needs to be paid for the health of homeless people.
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http://dx.doi.org/10.15171/ijhpm.2017.74DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890067PMC
March 2018

Predictors of early adulthood hypertension during adolescence: a population-based cohort study.

BMC Public Health 2017 11 28;17(1):915. Epub 2017 Nov 28.

Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Some longitudinal studies have shown that blood pressure tracks from adolescence to adulthood, yet there is limited evidence regarding the predictive factors of adulthood hypertension during adolescence. This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) to investigate the role of some factors in adolescence, measured in the first examination (1999-2001), to predict adulthood hypertension in the 4th examination (2009-2011).

Methods: Overall, 1579 subjects, aged 10-19 years, were used for the analysis of the current study. Mean age (SD) of participants at the baseline was 14.2 (2.5) years and 55% of them were female. A forward stepwise approach (p-value <0.2 for enter and >0.05 for removal) was considered to keep significant covariates among common variables including gender, body mass index, waist circumference, wrist and hip circumferences, fasting blood sugar, triglycerides, high density lipoprotein cholesterol, total cholesterol (TC), systolic (SBP) and diastolic blood pressure (DBP). Variance inflation factor (VIF) showed some multicollinearity for anthropometric variables (VIFs between 3.5 and 10). Multivariable logistic regression revealed that gender, blood pressure, wrist circumference and total cholesterol in adolescents are important predictors for adulthood hypertension.

Results: The risk increased by 4% and 39% per each 10 mmHg and 1 mmol/L increase in SBP/DBP and TC, respectively; additionally, females had a 70% lower risk. Among anthropometric variables, wrist circumference remained in the model, with 50% per centimeter increase in the risk of hypertension.

Conclusions: Wrist circumferences and TC had significant roles in predicting hypertension through adolescence to adulthood.
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http://dx.doi.org/10.1186/s12889-017-4922-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706303PMC
November 2017

Risk of Coronary Heart Events Based on Rose Angina Questionnaire and ECG Besides Diabetes and Other Metabolic Risk Factors: Results of a 10-Year Follow-up in Tehran Lipid and Glucose Study.

Int J Endocrinol Metab 2017 Apr 24;15(2):e42713. Epub 2017 Apr 24.

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: High-risk individuals for CHD could be diagnosed by some non-invasive and low-priced techniques such as Minnesota ECG coding and rose angina questionnaire (RQ).

Objectives: The present study aimed at determining the risk of incident CHD according to ECG and RQ besides diabetes and other metabolic risk factors in our population.

Methods: Participants comprised of 5431 individuals aged ≥ 30 years within the framework of Tehran lipid and glucose study. Based on their status on history of CHD, ECG, and RQ at baseline, all participants were classified to 5 following groups: (1) HistoryRoseECG (the reference group); (2) HistoryRoseECG; (3) HistoryRoseECG; (4) HistoryRoseECG; and (5) History. We used Cox regression model to find the role of ECG and RQ on CHD, independent of other risk factors.

Results: Overall, 562 CHD events were detected during the median of 10.3 years follow-up. CHD incidence rates were 55.9 and 9.09 cases per 1000 person-year for participants with and without history of CHD, respectively. Hazard ratios (HRs) (95% CIs) were 4.11 (3.27 - 5.11) for History + and 2.18 (1.63 - 2.90), 1.92 (1.47 - 2.51), and 2.48 (1.46 - 4.20) for HistoryRoseECG, HistoryRoseECG, and HistoryRoseECG, respectively. RQ and ECG had the same HRs as high as those for hypertension and hypercholesterolemia; however, diabetes showed statistically and clinically more effects on CVD than RQ and ECG.

Conclusions: RQ in general and, ECG especially in asymptomatic patients, were good predictors for CHD events in both Iranian males and females; however, their predictive powers were lower than that of diabetes.
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http://dx.doi.org/10.5812/ijem.42713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556326PMC
April 2017

Remaining Gap in HIV Testing Uptake Among Female Sex Workers in Iran.

AIDS Behav 2017 Aug;21(8):2401-2411

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

We estimated the prevalence of recent HIV testing (i.e., having an HIV test during the last 12 months and knew the results) among 1295 HIV-negative Iranian female sex workers (FSW) in 2015. Overall, 70.4% (95% confidence intervals: 59.6, 79.3) of the participants reported a recent HIV testing. Concerns about their HIV status (83.2%) was reported as the most common reason for HIV testing. Incarceration history, having >5 paying partners, having >1 non-paying partner, receiving harm reduction services, utilizing healthcare services, and knowing an HIV testing site were significantly associated with recent HIV testing. In contrast, outreach participants, having one non-paying sexual partner, and self-reported inconsistent condom use reduced the likelihood of recent HIV testing. HIV testing uptake showed a ~2.5 times increase among FSW since 2010. While these findings are promising and show improvement over a short period, HIV testing programs should be expanded particularly through mobile and outreach efforts.
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http://dx.doi.org/10.1007/s10461-017-1844-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606243PMC
August 2017

Low HIV testing rate and its correlates among men who inject drugs in Iran.

Int J Drug Policy 2016 06 31;32:64-9. Epub 2016 Mar 31.

Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Electronic address:

Background: Iran has a concentrated HIV epidemic among people who inject drugs (PWID). Low HIV testing uptake could contribute to the significant number HIV-infected PWID, who go undiagnosed. This study aims to assess HIV testing uptake and its correlates among PWID in Iran.

Methods: Data were collected through a national cross-sectional bio-behavioral study in 2010. Adult male HIV-negative PWID were included in the current analysis. All estimates were adjusted for the clustering effect of the sampling sites. Multivariable logistic regression was used to examine the correlates of recent HIV testing and adjusted odds ratios (AOR) were reported.

Results: Out of the 2146 eligible PWID for this study, 49.8% reported having ever tested for HIV. However, only 24.9% had tested in the previous year and received their test results. Around 65.2% of PWID knew an HIV testing site. In the multivariable analysis, knowing an HIV testing site (AOR=13.9; P-value<0.001), ≥24 years of age (AOR=3.30; P-value=0.027), and multiple incarcerations (AOR=1.71; P-value<0.001) were positively, and a monthly income of ≥65 US dollar (AOR=0.23; P-value=0.009) was negatively associated with having been tested and received the results.

Conclusion: Despite the availability of free HIV counselling and testing for PWID in Iran, only one-fourth of adult male PWID had been tested for HIV and received their results. Implementing policies and strategies to normalize routine HIV testing among PWID are crucial steps to help curb the epidemic among Iranian PWID.
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http://dx.doi.org/10.1016/j.drugpo.2016.03.009DOI Listing
June 2016

A new approach to test validity and clinical usefulness of the 2013 ACC/AHA guideline on statin therapy: A population-based study.

Int J Cardiol 2015 Apr 5;184:587-594. Epub 2015 Mar 5.

Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The ACC/AHA released a new guideline on the assessment of cardiovascular risk and management of hypercholesterolemia that some controversy exists concerning its usefulness. We examined the clinical usefulness of this guideline in a high incidence population using novel measures.

Methods: First, we validated the new risk equation in a cohort of 2372 men and 2781 women aged 40-75 years. Then, high risk individuals for cardiovascular diseases (CVDs) were identified according to the ACC/AHA guideline at baseline (as a predictor) and CVD outcomes were detected during a 10-year follow-up. Discrimination of the guideline was quantified and the quality of decisions was evaluated by Net Benefit Fraction index considering the harm, for false-positive, and benefit, for true-positive predictions. Finally, net number needed to treat (NNT) for statin was estimated, using test tradeoff index, in diabetic and non-diabetic subjects.

Results: During follow-up, 726 CVD events including 298 hard CVDs occurred. The equation overestimated the risk by 57% in men and 48% in women. Based on the guideline, 73% of men and 44% of women were eligible for statin therapy. The lowest sensitivity was detected for intensive treatment in non-diabetic subgroups (82% in men and 41% in women; corresponding specificity, 52% and 90% respectively). The guideline had a significant net benefit for both moderate and intensive treatment, which resulted in estimated NNTs ranged 5-55; however, net benefit of intensive therapy was uncertain in non-diabetic women.

Conclusions: We objectively showed that the ACC/AHA recommendations could be useful in our population but with some overtreatment in women.
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http://dx.doi.org/10.1016/j.ijcard.2015.03.067DOI Listing
April 2015

Vulnerability of homeless people in Tehran, Iran, to HIV, tuberculosis and viral hepatitis.

PLoS One 2014 4;9(6):e98742. Epub 2014 Jun 4.

Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran; Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Research Centre for Emerging and Reemerging Infectious Diseases (Akanlu), Pasteur Institute of Iran, Kabudar Ahang, Hamadan, Iran.

Background: Homeless people are at risk of contracting communicable infectious diseases, as they indulge in risky behaviours and lifestyle. This study was conducted to determine the prevalence of the aforementioned infections and related risk behaviours among homeless people in Tehran.

Methods: In this study a convenience sample of 593 homeless individuals was studied. The ELISA method was used for the detection of HIV, HCV and HBV. Clinical symptoms, sputum cultures, acid fast bacilli smears, and chest X-rays were used to identify active pulmonary tuberculosis, and the Interferon Gamma Release Assay (IGRA) test was used to identify latent tuberculosis.

Results: The prevalence of HIV, HBV, HCV and latent tuberculosis was 3.4%, 2.6%, 23.3% and 46.7%, respectively. Active pulmonary tuberculosis was found in 7 persons (1.2%). Injection drug use was an independent risk factor for HIV, HCV and HBV infections. Older people had a higher proportion of Mycobacterium tuberculosis infection (OR: 2.6, 95%CI: 1.9, 3.7) and HCV positivity (OR: 1.7, 95% CI: 1.1, 2.5).

Conclusion: Our findings highlighted that much more attention needs to be paid to the health of homeless people.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0098742PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4045893PMC
August 2015

HIV prevalence and related risk behaviours among female sex workers in Iran: results of the national biobehavioural survey, 2010.

Sex Transm Infect 2013 Nov;89 Suppl 3:iii37-40

Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, , Kerman, Iran.

Objectives: To determine the prevalence of HIV and related behavioural risks among Iranian female sex workers (FSW) via the first national biobehavioural surveillance survey.

Methods: In 2010, 1005 FSW were approached and 872 recruited using facility-based sampling from 21 sites in 14 cities in Iran. We collected dried blood samples and conducted face-to-face interviews using a standardised questionnaire. Data were weighted based on the response rate and adjusted for the clustering effect of the sampling site. Adjustment was performed by weighting based on the sampling fraction of each site using a prior estimate of its total size of the FSW population.

Results: The prevalence of HIV infection (95% CI) was 4.5% (2.4 to 8.3) overall, 4.8% (2.2 to 9.8) among those who had reported a history of drug use and 11.2% (5.4 to 21.5) among those who had a history of injection drug use. The frequencies of condom use in the last sexual act with paying clients and non-paying partners were 57.1% and 36.3%, respectively. Any drug use was reported by 73.8% of participants, and among this subgroup, 20.5% had a history of injection drug use.

Conclusions: The prevalence of HIV was considerable among FSW particularly those who had a history of drug injection. A combination of prevention efforts addressing unsafe sex and injection are needed to prevent further transmission of HIV infection.
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http://dx.doi.org/10.1136/sextrans-2013-051028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841765PMC
November 2013

HIV prevalence and risk behaviours among people who inject drugs in Iran: the 2010 National Surveillance Survey.

Sex Transm Infect 2013 Nov 14;89 Suppl 3:iii29-32. Epub 2013 Sep 14.

Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, , Kerman, Iran.

Objectives: To assess the prevalence of HIV and related risk behaviours among people who inject drugs (PWID) in Iran.

Methods: We conducted a national cross-sectional bio-behavioural surveillance survey between March and July 2010, interviewing male PWID from a geographically dispersed sample through a facility-based sampling method.

Results: We recruited 2480, and tested 2290 PWID. The overall prevalence of HIV was 15.2% (95% CI 9.7% to 23.1%). Among those who had injected drugs over the last month, 36.9% had used a non-sterile needle, and 12.6% had practiced shared injection. Over the past 12 months preceding the interview, 30.4% had sold sex for money, drugs, goods or a favour. In the multivariate analysis, the prevalence of HIV had a positive association with age, while having above high school education, and permanent job were protective.

Conclusions: Unsafe injection, and sexual risk behaviours are still frequent and the prevalence of HIV among PWID remains high. Intensified efforts are needed to prevent the further spread of HIV among Iranian PWID and their sexual partners.
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http://dx.doi.org/10.1136/sextrans-2013-051204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841768PMC
November 2013

Risk factors for ischemic stroke; results from 9 years of follow-up in a population based cohort of Iran.

BMC Neurol 2012 Oct 2;12:117. Epub 2012 Oct 2.

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P,O, Box 19395-4763, Tehran, Islamic Republic of Iran.

Background: Data about the risk factors of stroke are sparse in the Middle East populations. We aimed to determine the potential risk factors and their population attributable fraction (PAF) for stroke in an Iranian population.

Methods: A cohort Study consisted of 1089 men and 1289 women, with mean (SD) ages of 61.1(7.6) and 59.0(6.7) years, respectively. Cox regression was implemented to estimate the hazard ratio (HR) of each risk factor for stroke events in a stepwise method. We calculated a multivariate adjusted population attributable fraction (PAF) for any risk factors remained in the model.

Results: During 9.3 years of follow-up, 69 events of stroke occurred with incidence rates of 4.5 (95% CI: 3.3-6.0) and 2.5 (1.7-3.6) in 1000 person-years for men and women respectively. Among potential risk factors, only age ≥ 65 years (HR: 2.03, CI: 1.24-3.31), male gender (HR: 2.00, CI: 1.16-3.43), hypertension (HR: 3.03, CI: 1.76-5.22), diabetes mellitus (HR: 2.18, CI: 1.34-3.56), and chronic kidney disease (CKD) (HR: 2.01, CI: 1.22-3.33), were independently associated with increased risk of stroke events in the total population. A paired homogeneity test showed that the hazard ratio of CKD did not differ from other independent risk factors. The PAFs were 29.7% and 25% for male gender and age ≥ 65 as non-modifiable and 48.6%, 29.1% and 22.0% for hypertension, CKD and diabetes as modifiable risk factors respectively.

Conclusion: Following this population based study of Iranians, we demonstrated that among modifiable risk factors, CKD as well as hypertension and diabetes are the strongest independent predictors of stroke.
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http://dx.doi.org/10.1186/1471-2377-12-117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3517457PMC
October 2012

Does an electrocardiogram add predictive value to the rose angina questionnaire for future coronary heart disease? 10-year follow-up in a Middle East population.

J Epidemiol Community Health 2012 Dec 27;66(12):1104-9. Epub 2012 Apr 27.

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: To evaluate the power of abnormal resting ECG versus Rose Questionnaire angina and its additive value in predicting 10-year coronary heart disease (CHD) risk in an Iranian urban population with high prevalence of CHD.

Methods: There were 5101 subjects ≥30 years (2900 women), free of CHD at baseline; they were categorised in to four groups according to their Rose Angina and ECG status for ischaemia as Rose-/ECG-, Rose+/ECG-, Rose-/ECG+ and Rose+/ECG+. HR of CHD was estimated using Cox regression analysis, given Rose-/ECG- as the reference. The authors used Akaike information criterion, C-index and integrated discrimination improvement indices to evaluate the prognostic value of ECG when would be added to Rose Questionnaire.

Results: During follow-up, 387 CHD events (169 women) were observed. Multivariate analysis showed a HR of 2.59 (95% CI 1.71 to 3.91) and 2.26 (1.48 to 3.44) for Rose+/ECG- group in men and women, respectively. These figures for Rose-/ECG+ were 1.36 (0.90 to 2.05) in men and 2.09 (1.40 to 3.12) in women. There was no any interaction between Rose Questionnaire and gender to predict incident CHD, in age-adjusted analysis. Akaike information criterion, C-index and relative integrated discrimination improvement did not show any difference between models including Rose alone and Rose plus ECG to predict CHD events especially in men.

Conclusions: Rose Questionnaire as a simple screening tool is equally important to predict incident CHD in both genders. Adding abnormal ECG to angina did not culminate in higher risk for future CHD events.
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http://dx.doi.org/10.1136/jech-2011-200242DOI Listing
December 2012