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Background and objectives Clues show that a large number of toxic agents, including carcinogenic, heavy metals, other particles, and high levels of nicotine, are effectively delivered through cigarette and hookah smoking. A pilot study was carried out in Varamin city, Iran in 2016 aimed to determine status of cigarette and hookah smoking in adolescent students using, Global Youth Tobacco Survey (GYTS) questionnaire. Methods It was a cross-sectional study. At the first, of 63 Varamin city schools' using cluster sampling, 48 schools were considered as primary clusters and 4 schools were selected randomly as sample clusters and students with 7, 8 and 9 years of education were studied. The total number of registered students was 1,108 and 1,075 responded to the study questionnaire. The main tool for collecting information used in this study was the GYTS questionnaire developed by the World Health Organization, was completed by subjects. Results Totally, 479 (44.6%) students were boys and 596 (55.4%) were girls. Of 1,075 subjects the number of students at 7, 8 and 9 years education was 369 (34.3%), 362 (33.7%) and 344 (32.0%) respectively. The cigarette and hookah smoking using experience among the population was 9.2% and 25.5 respectively. Regarding the averages of the total score, although students have a relatively good attitude and specially behavioral intention (72% and 88% of the total score respectively), but only 47% of the total knowledge score by boys and 51% by girls, shows the average level of students' awareness related the undesirable effects of smoking. Conclusions Considering that one out of four students experienced cigarette and hookah smoking. Nearly half of the students are exposed to cigarette smoke at home or outdoors. The state of cigarette and hookah smoking in the country is alarming among school students.

The viewpoints of Shahid Beheshti University of Medical Sciences medical experts'' were compared with those of auxiliary health workers regarding health culture related to human papillomavirus vaccination in 2020.In this cross-sectional study, 220 medical experts' (gynecologists, cultural, psychological, infectious, dermatological, and educational) and auxiliary health workers were randomly selected and investigated. The required data were collected using a researcher-made questionnaire modeled on international questionnaires. These questionnaire contained demographic information on the subjects' age and sex as well as health culture was also assessed by measuring the knowledge, attitude, and practice of the subjects.The mean age of the included medical experts' and auxiliary health workers was 38.0 3±8.3 and 35.2±7.5 years old, respectively. There was a significant difference in the knowledge of auxiliary health workers as 55.3 ± 3.8 in comparison with the medical experts' as 51.6 3± 6.3 (p0.002). There was a significant difference on whether changing cultural attitudes about the need for vaccination could be effective on reducing sexually transmitted diseases between the auxiliary health workers and medical experts' (p0.001). There was a significant difference in the knowledge of auxiliary health workers 55.3 ± 3.8 in comparison with the psychology and cultural experts' as 48.5± 6.3, 48.3± 6.8 (p0.001) respectively.Knowledge among the auxiliary health workers was significantly different from that of psychology and cultural experts' in relation to health culture for human papillomavirus vaccination. It was indicated that these experts need to upgrade their health culture knowledge to increase the rate of community participation in human papillomavirus vaccination.

This study aimed to investigate the effect of replacing plant proteins with animal proteins in the dietary approaches to stop hypertension (DASH) diet on cardiometabolic risk factors in obese metabolic syndrome participants.In this double-blind randomized controlled clinical trial, 90 obese patients with metabolic syndrome, aged 30-70 years were randomly allocated into the DASH diet based on plant or animal proteins for 8 weeks. Fasting blood samples were collected to assess the biochemical markers. Also, blood pressure, weight, and waist circumference (WC) were measured at the beginning and end of the trial.The participants in both groups experienced significant reductions in the fasting plasma glucose (FPG), systolic blood pressure (SBP) and diastolic blood pressure (DBP), triglyceride (TG) concentrations, weight and WC. However the reduction in FPG and SBP was higher in the plant-based DASH group, compared to the animal-based DASH group, after adjustment for weight change. No significant changes were found within or between groups with regard to total cholesterol, LDL-C, HDL-C.Substituting plant proteins with animal proteins in the DASH diet improves FPG and SBP in obese individuals with metabolic syndrome, independent of weight change. IRCT registration number: IRCT20090203001640N16.

Background Among candidate genes related to type 2 diabetes (T2DM), one of the strongest genes is Transcription factor 7 like 2 (TCF7L2), regarding the Genome-Wide Association Studies. We aimed to conduct a systematic review of the literature on the modification effect of TCF7L2 on the relation between glycemic parameters and lifestyle factors. Methods A systematic literature search was done for relevant publications using electronic databases, including PubMed, EMBASE, Scopus, and Web of Science, from January 1, 2000, to November 2, 2021. Results Thirty-eight studies (16 observational studies, six meal test trials, and 16 randomized controlled trials (RCTs)) were included. Most observational studies had been conducted on participants with non-diabetes showing that TCF7L2 modified the association between diet (fatty acids and fiber) and insulin resistance. In addition, findings from meal test trials showed that, compared to non-risk-allele carriers, consumption of meals with different percentages of total dietary fat in healthy risk-allele carriers increased glucose concentrations and impaired insulin sensitivity. However, ten RCTs, with intervention periods of less than ten weeks and more than one year, showed that TCF7L2 did not modify glycemic parameters in response to a dietary intervention involving different macronutrients. However, two weight loss dietary RCTs with more than 1-year duration showed that serum glucose and insulin levels decreased and insulin resistance improved in non-risk allele subjects with overweight/obesity. Regarding artichoke extract supplementation (ALE), two RCTs observed that ALE supplementation significantly decreased insulin concentration and improved insulin resistance in the TT genotype of the rs7903146 variant of TCF7L2. In addition, four studies suggested that physical activity levels and smoking status modified the association between TCF7L2 and glycemic parameters. However, three studies observed no effect of TCF7L2 on glycemic parameters in participants with different levels of physical activity and smoking status. Conclusion The modification effects of TCF7L2 on the relation between the lifestyle factors (diet, physical activity, and smoking status) and glycemic parameters were contradictory. PROSPERO registration number CRD42020196327

Objective: In this study, we developed a paradigmatic model focusing on human papillomavirus (HPV) diseases, in order to formulate a theory by investigating pathology in health culture using Grounded Theory, as an inductive and exploratory research method. Materials and methods: It was a qualitative study, and data were collected using in-depth interviews with 20 people (10 men and 10 women) with cultural and religious specialties (clergy). In total, twenty interviews were conducted (mean duration = 45 min) using a semi-structured guide consisting of open-ended questions. All recordings were transcribed verbatim in Persian. All items were extracted based on the participants' responses and related literature. After data collection, the basic theory analysis was performed in terms of the three steps as follows: free coding, axial encryption, the implementation, refinement, and writing the theories in line with selective coding theoretical models. Finally, the paradigm model was determined from the presented models. Results: The paradigm model emerged from professors, clergy, and authorized people, showed that religious taboos about sexually transmitted diseases; lack of wise management, comprehensive supervision, compliance with health standards in the country, proper legislation regarding sexually transmitted diseases as causal factors, awareness, health education in the country, public demand for health, individual dignity, punishment for health detractors, familiarity with individual rights as intervening factors, concern for human lives, health, and belief in fatalism; ethnic differences; irresponsibility; risk perception; high cost of HPV vaccine; immorality in health speech; disregard for people's lives; gender differences as contextual factors; and the consequences is increasing burden of diseases due to sexually transmitted disease such as (HPV). Conclusion: It seems the overall lack of a health-based approach could be a major concern due to the weakness of cultural management in society that requires the involvement and intervention of all policymakers, health planners, authorized people, professors, elites, and clerics to control this major cultural health problem.

Objective The present study was aimed to assess the effect of Resveratrol supplementation, endurance exercise and acute exercise training on oxidative stress and tissue damage markers. Methods Sixty-four male Wistar rats were categorized into four groups including resveratrol group, exercise group, exercise + resveratrol group (n= 16) and control group (n= 16). RES was orally administered to male rats for 28 day at a dose of 10 mg per kg body during exercise. Following the familiarization sessions, rats were acclimated to a calibrated motor driven rodent treadmill for endurance exercise and acute exercise implementation. Changes in oxidative stress and tissue damage markers including 8-hydroxy-2'-deoxyguanosine (8-OhdG), Lactate dehydrogenase (LDH), Creatine Phosphokinase (CPK), protein carbonyl were biochemically measured using commercial ELISA kits based on the manufacturer's instructions. Results The endurance and acute exercise training led to an increase in the levels of CPK and LDH, However, following the endurance and acute exercise training, a reduction in the level of carbonyl and 8-OHdG was observed. RES supplementation did not have any effect on the levels of CPK and LDH; nevertheless, reduced significantly carbonyl, and 8-OHdG levels. Based on this evidence, RES may have protective effects against exercise-induced oxidative stress. Conclusion This study provides further evidence of the antioxidant effects of RES after exercise. However, several factors such as type and duration of exercise, the type of model, the amount of RES supplementation and the time-course consideration can affect the quality of the results. For this reason, further studies in this field are required.

There has been no precise information regarding occupants’ status and their portion in traffic accident. By using traffic police information, epidemiological pattern of road traffic injuries among occupants’ vehicles was analyzed in 2012. It was a cross sectional study. In this study, traffic police registered data in 2012 were used. Subjects were all occupants who had accident record in 2012 (81585: 77841 injured and 3744 death). Before analyzing, various preparatory steps including data control and merging were done after which data were processed. Findings showed that the mean age of the studied population was 28.7 ± 15.11 years. The highest percentage of accident occurred among car and motorcycle occupants respectively. The risk of death among the injured aged 30 - 59 years and 60+ were 1.20 and 2.23 times more than 30 years (as reference) respectively (p < 0.001). Risk of death among the injured in high ways, main roads and rural roads was 2.84 times more than in urban roads (p < 0.001). The risk of death among the injured was 2 times higher in high ways, main roads and rural secondary roads than streets (p < 0.001). Hence car and motorcycle occupants need urgent attention especially in motorways and high ways, main roads and rural secondary.

Objectives This study conducted in 2016 aimed to assess the prevalence and incidence of asthma and chronic obstructive pulmonary disease (COPD) in the Eastern Mediterranean Region (EMR). Material and methods A meta-analysis to evaluate the published research relating to asthma and COPD was conducted using data from 23 EMR Office (EMRO) countries and searching using the web of science, PubMed, SciVerse Scopus, Google scholar, and MEDLINE databases. The keywords entered were all EMRO countries (Afghanistan, Bahrain, Djibouti, Egypt, Islamic republic Iran, Iraq, Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arab, Somalia, Sudan, Syrian Arab Republic, Tunisia, the United Arab Emirates, Yemen republic, and Cyprus) and asthma OR chronic obstructive pulmonary disease (COPD) OR (chronic bronchitis). Our definition of asthma and COPD was according to the World Health Organization (WHO). Results A total of 92 published articles were identified. The pooled prevalence of asthma and COPD was 9.38 (confidence interval [CI]: 9.20-9.55) and 5.39 (CI: 5.17-5.62), respectively. There were no articles about COPD and asthma in Bahrain and Djibouti; no articles about asthma in Jordan and Libyan Arab Jamahiriya; and no articles about COPD in Afghanistan, Iraq, Oman, Palestine, Somalia, Sudan, and Yemen republic. The highest prevalence of asthma was observed in Kuwait, and the highest prevalence of COPD was observed in Pakistan. Conclusion The EMRO countries have inadequate research and data in the areas of asthma and COPD. More efforts and relevant studies must be conducted to understand the countrywide prevalence and real burden of these diseases.

Approximately one-third of Iranian children's deaths are caused by injuries. Of these, 36% result from road traffic injuries (RTIs). Both RTIs and fatalities could be reduced by using child car restraints (CCRs). Despite their demonstrated effectiveness, CCRs are not mandatory in Iran. This study was conducted to assess opportunities and barriers in enacting mandatory CCR laws in that country. Using mixed method research, a phenomenological approach was used to explore the experiences and perspectives of road safety stakeholders in regard to opportunities and threats in enacting mandatory CCR laws in Iran. The themes derived from group discussions were used to first develop a structured questionnaire, which was later distributed to and completed by study participants. The study analysis was conducted using scores and rankings from the responses to these questions. Twenty-eight stakeholders participated in the study. Most were male, aged 36.7 ± 5.6 (range 25-59). In terms of identifying the organization that should establish mandatory CCR laws, the Traffic Police Department achieved the highest score of 90 (range 0-100). The participants also thought that the Traffic Police department is responsible to monitor compliance and conduct follow-up investigations (score = 100). In regard to existing barriers in enacting CCR laws, the lack of positive Publicity by mass media and the lack of related laws received scores of 85 and 70, respectively. Enabling factors and opportunities included 'positive regards or attitude of families towards their child's health,' 'officials' commitment to support such laws' and 'having adequate resources to raise community awareness of the importance of CCR use. These received scores of 83, 69 and 68, respectively. The results suggest that cooperation and collaboration among stakeholders including the Traffic Police, families and local communities are needed to maximize the likelihood of mandating CCR laws.

The aim of this study was to compare the prevalence of subclinical and overt hypothyroidism based on local population-specific reference intervals versus arbitrary cutoffs that are not specific for the population studied or the assay used, during pregnancy in an area of iodine sufficiency. We tested a total of 203 pregnant women in the first trimester of pregnancy, and followed their status in the second and third trimesters. Serum samples from women were assayed for levels of total T4 and T3, FT4I, TSH, TPOAb, and TgAb. Of the 203 women based on our national trimester specific reference ranges of serum TSH and FT4I, 153, 157, and 157 were euthyroid in 3 consecutive trimesters of pregnancy. Accordingly, a total of 23, 12, and 13 had subclinical hypothyroidism in the first, second, and third trimester, respectively. Overt hypothyroidism was detected in 4, 5, and 1 women in the first, second, and third trimesters of pregnancy, respectively. The prevalence of subclinical hypothyroidism was 49, 31, and 34 in each of the trimesters respectively, when TSH>2.5 mIU/l was considered for definition of hypothyroidism in the first trimester, and over 3 mIU/l in the second and third trimesters. Our results showed that using arbitrary cutoff values for TSH instead of population-specific reference intervals may inappropriately increase the rate of subclinical hypothyroidism.

Aims: New road traffic injury (RTI) laws in Iran still neglects the importance of child restraint in automobiles. The objective of this study is to determine the Knowledge, Attitude and Practice (KAP) on the mandatory use of child restraint among parents and nursery instructors. Study Design: An observational KAP study Place and Duration of the Study: City of Tehran capital of Iran, between June 2013 and November 2013. Methodology: An observational KAP study was carried out (using a self-administered questionnaire and a Likert scale) on 403 parents, which children were less than 13 years old and nursery instructors both residing in Tehran by a stratified randomized sampling. Twelve elementary schools and six nurseries were selected randomly. Validity and reliability of questionnaires were determined using the content validity and test re-tests. Subjects were selected randomly and data was collected by trained interviewers, after obtaining consent forms from the subjects. Results: The majority (71%) of parents was female, aged 36.7±5.6 (range: 25-59). Half of the parents did not have any knowledge about child restraint laws and its implementation in the country. The knowledge among subjects about different kinds of child restraints, according to the child’s age and weight, was 22.6%. Only 28% of subjects use child restraints for their children. A significant difference was observed between subjects' use of

BACKGROUND: Road traffic injuries (RTIs) impose significant social and economic burden. Objectives: The objective of this study was to estimate the medical costs and economic production losses caused by RTI in Iran Methods: The major components included in this study were medical costs, lost output, and indirect costs. Cost components and their values in 2011 were obtained using previous experiences and data collected during the study. A general approach that included a consideration of human capital was used to calculate the cost of RTIs. Results: The economic burden of RTIs was estimated to be more than 111,000 billion Iranian rials (IRR) ($4.44 billion USD) in 2011. This cost relates only to the health sector and does not include components such as vehicle damage, lost time in accidents, and the administrative costs of insurance and police services. The estimated cost of RTIs to the health sector was about 2.18% of Iran's total GDP in 2011. Conclusions: The medical costs and economic production losses caused by RTIs in Iran clearly indicate that injuries should be a significant concern for health policymakers and medical planners. Keywords: Road Traffic Injuries; Economic Cost; Medical Costs; Lost Output; Indirect Costs Language: en

To assess the status of road traffic injuries in Iran.The retrospective study was conducted in Iran and comprised all reported traffic accidents from March 2011 to March 2012 that were recorded in the national traffic accident database. The information collected included demographic data specific to road traffic accidents and injuries. The data was summarised and presented using frequencies and percentages.There were a total of 452192 road traffic accidents with 252246 victims in the one-year period. The highest number of accidents, 110348(47%), involved individuals in the 15-30 year age group. Among the gender-identified injured, 206171(78.4%) were male and 56639 (21.6%) were female. Besides, 298750(73.2%) accidents took place between 6am and 6pm. In terms of location, the province of Semnan had the highest rates of injury and death (913 per 100000 and 41per 100000, respectively), while the lowest rate of injury was in Alborz (131 per 100000) and lowest rate of death was in Tehran (5 per 100000). The majority of accidents 301516(66.7%) occurred on inner city roads. Although the total number of victims in inner city roads (180893) was higher than outer the city roads (2.2:1), the number of deaths (8615) on outer roads was higher (3:1).Road traffic injuries placed a heavy burden on the Iranian population, especially on young men. Comprehensive strategies and policies must be implemented for effective prevention of road accidents in Iran.

Iodine deficiency constitutes a public health problem in many countries worldwide. Fetal neurodevelopment is affected by maternal iodine intake. The aim of present study was to assess urinary iodine excretion (UIE) in the 3 trimesters of pregnancy and evaluate its association with newborn thyroid function in Tehran, an area of iodine sufficiency.Based on median urinary iodine in 3 trimesters, 138 pregnant women were divided into 2 groups with UIE150 (group I) and UIE ≥ 150 μg/l (group II). Cord blood samples of their newborns were evaluated for serum concentrations of TSH, T3, T4, free T4 (FT4), and thyroglobolin. Quartiles of UIE were also determined. Correlations between mothers' UIE and newborns' thyroid function in both groups were investigated.Fifty-two pregnant women (38%) had median UIE150 μg/l and 86 had (62%) UIE ≥ 150 μg/l. Median UIE in groups I and II in the 1st, 2nd, and 3rd trimesters were 125 and 212 μg/l, 97 and 213 μg/l, 93 and 227 μg/l, respectively. No significant difference was seen in thyroid function of newborns in the 2 groups. Mean concentrations of T4, T3, FT4, and TSH of newborn did not show significant difference in median UIE of mothers in various quartiles.This study shows that newborns, irrespective of mothers' UIE, in an area with a sustained iodine supplementation program, may not be at risk of alterations in thyroid functions.

This study was conducted to assess the prevalence of metabolic syndrome (MetS) in Tehranian women during menopausal transition. In this cross sectional study 2182 subjects pre-menopausal (pre-M) n = 537 menopausal (M) n = 311 and postmenopausal (post-M) n = 1334 were selected from 15005 participants of the TLGS and assessed for MetS risk factors. All MetS components were evaluated following age adjustment according to the ATPIII criteria. The mean ages of post-M M and pre-M women were 61.0+or-4.3 53.0+or-4.0 and 47.0+or-1.9 years respectively. The prevalence of MetS in subjects was 63% (53% 54% and 69%) in pre-M M and post-M women respectively. HDL-c levels was significantly higher in post-M women in comparison to pre-M women (p < 0.001). TG levels FPG and waist circumference was significantly higher in post-M women in comparison to pre-M women (p < 0.05). The most frequent markers of MetS were low HDL-c and high diastolic blood pressure in post-M women. It is concluded that the frequency of MetS is significantly higher in post-M women as compared to pre-M women; low HDL-c and high diastolic blood pressure is the most frequent feature in comparison to other factors. (authors)

To examine self-reported mobility and limitation in physical functioning among the elderly and associated socio-demographic risk factors.The population-based cross-sectional study was conducted from January 2012 to January 2013 and comprised subjects from five provinces of Iran. The variables were measured using a questionnaire. Self-reported mobility disability and physical functioning disability were defined as having no problems in daily activities and physical tasks. Logistic regression was used to calculate the odds ratio for association of socio-demographic risk factors and outcomes.Of the 1325 subjects, 636(48%) were men. The overall mean age was 69.14±7.37 years. Prevalence of mobility disability and limitation in physical functioning was 401(63%) and 553(87%) in men, and 524(76%) and 641(93%) in women. There was a significant association between mobility disability and family composition and satisfaction with financial situation and housing tenure in both genders (p0.05 each). Physical functioning had a significant relationship with family composition, and satisfaction with financial situations and housing tenure in men and women and population density in men and marital status in women (p0.05 each).The elderly had a high risk of disability. Social factors had more association with mobility disability and limitation in physical functioning and required specific social support.

Background and Aim: To allocate resources at the national level and ensure the safety level of roads with the aim of economic efficiency, cost calculation can help determine the size of the problem and demonstrate the economic benefits resulting from preventing such injuries. This study was carried out to elicit the cost of traffic injuries among Iranian drivers of public vehicles. Materials and Methods: In a cross-sectional study, 410 drivers of public vehicles were randomly selected from all the drivers in city of Tehran, Iran. The research questionnaire was prepared based on the standard for willingness to pay (WTP) method (stated preference (SP), contingent value (CV), and revealed preference (RP) model). Data were collected along with a scenario for vehicle drivers. Inclusion criteria were having at least high school education and being in the age range of 18 to 65 years old. Final analysis of willingness to pay was carried out using Weibull model. Results: Mean WTP was 3,337,130 IRR among drivers of public vehicles. Statistical value of life was estimated 118,222,552,601,648 IRR, for according to 4,694 dead drivers, which was equivalent to 3,940,751,753 $ based on the dollar free market rate of 30,000 IRR (purchase power parity). Injury cost was 108,376,366,437,500 IRR, equivalent to 3,612,545,548 $. In sum, injury and death cases came to 226,606,472,346,449 IRR, equivalent to 7,553,549,078 $. Moreover in 2013, cost of traffic injuries among the drivers of public vehicles constituted 1.25% of gross national income, which was 604,300,000,000$. WTP had a significant relationship with gender, daily payment, more payment for time reduction, more pay to less traffic, and minibus drivers. Conclusion: Cost of traffic injuries among drivers of public vehicles included 1.25% of gross national income, which was noticeable; minibus drivers had less perception of risk reduction than others.

Introduction and aims: Calcium and vitamin D play major roles in calcium homeostasis and skeletal development, especially during pregnancy. This study was conducted to determine changes in calcium, 25 hydroxy [25(OH)] vitamin D3 and other biochemical factors (PTH, osteocalcin, alkaline phosphatase, magnesium, phosphorus) related to calcium homeostasis and bone turnover during pregnancy and compare the values to those of non-pregnant women. Materials and Methods: In a cohort study, 48 pregnant women, in their first trimester of pregnancy (12±2.7 weeks), from 5 prenatal care centers, and 47 non-pregnant women randomly selected from the Tehran Lipid and Glucose Study (TLGS) population were enrolled. These pregnant women were followed in their second (26±1.9 weeks) and third trimesters (37±3.2 weeks) of pregnancy. Samples were drawn from June 2002 to March 2003. Including criteria were healthy women with no background of disease. Women using photo protection and calcium and vitamin D supplementation were excluded. A questionnaire was used to obtain demographic information for both groups. Venous blood samples were taken after 12–14 h of overnight fasting to measure serum calcium, phosphorus, magnesium, alkaline phosphatase, PTH, 25 (OH) vitamin D3 and serum osteocalcin levels. The repeated measures analysis of variance and t-test were used for statistical analysis. Data were matched for age and weight in both the case (in the first trimester) and control groups. Results: Significant differences were found in the mean serum levels of osteocalcin and alkaline phosphatase between the three trimesters of pregnancy (p

Objectives: The menopause is associated with an increased incidence of coronary heart disease (CHD). Assessing CHD risk factors in menopausal women can shed more light on the pathogenesis of accelerated atherosclerosis after the cessation of ovarian function. Design: In this study, 1980 women aged 44-69 years were selected from among 15 005 participants in the Tehran Lipid and Glucose Study (TLGS) and assessed for CHD risk factors. They were classified into three groups: premenopausal women (n = 483), aged between 44 and 50 years, without any history of menstrual irregularities; menopausal women (n = 310), with permanent cessation of menses for at least 12 months and a duration of less than 3 years; and postmenopausal women (n = 1187), with at least a 3-year history of cessation of menses. Demographic information including waist size, height, weight and systolic and diastolic blood pressures was recorded, and body mass index, low-density lipoprotein/high-density lipoprotein ratio (LDL/HDL) and waist/hip r...

Background and Aim: A significant social and economic burden inflicts by road traffic injuries (RTIs). We aimed to use Bayesian model, to present the precise method, and to estimate the cost of RTIs in Iran in 2013. Materials and Methods: In a cross-sectional study on costs resulting from traffic injuries, 846 people per road user were randomly selected and investigated during 3 months (1st September–1st December) in 2013. The research questionnaire was prepared based on the standard for willingness to pay (WTP) method considering perceived risks, especially in Iran. Data were collected along with four scenarios for occupants, pedestrians, vehicle drivers, and motorcyclists. Inclusion criterion was having at least high school education and being in the age range of 18–65 years old; risk perception was an important factor to the study and measured by visual tool. Samples who did not have risk perception were excluded from the study. Main outcome measure was cost estimation of traffic injuries using WTP method. Results: Mean WTP was 2,612,050 internal rate of return (IRR) among these road users. Statistical value of life was estimated according to 20,408 death cases 402,314,106,073,648 IRR, equivalent to 13,410,470,202$ based on the dollar free market rate of 30,000 IRR (purchase power parity). In sum, injury and death cases came to 1,171,450,232,238,648 IRR equivalents to 39,048,341,074$. Moreover, in 2013, costs of traffic accident constituted 6.46% of gross national income, which was 604,300,000,000$. WTP had a significant relationship with age, middle and high income, daily payment to injury reduction, more payment to time reduction, trip mileage, private cars drivers, bus, minibus vehicles, and occupants (P < 0.01). Conclusion: Costs of traffic injuries included noticeable portion of gross national income. If policy-making and resource allocation are made based on the scientific pieces of evidence, an enormous amount of capital can be saved through reducing death and injury rates.

Background Road traffic injuries (RTIs) are the second leading cause of mortality and the first cause of disability adjusted life years (DALYs) in Iran. This study investigated the status of RTIs in Iran. Methods All traffic accident data for the one-year period from March 2011 to March 2012 recorded in the national traffic accident database was investigated. The information included demographic data specific to road traffic accidents (RTAs) and injuries. The data was summarised and presented using the distributions of all components. Results There were a total of 452192 RTAs with 252246 victims in the one-year period. The highest percentage (47%) of these was in the 15–30 year age group. Men constituted 78.4% of those involved in RTAs. Most RTAs (73.2%) took place between 6 am and 6 pm. The province of Semnan had the highest annual incidence rate of RTIs and Alborz had the lowest. The majority of RTAs (66.7%) occurred within the city roads. Although the levels of non-fatal injury were similar within the city roads and outer them, mortality was 3.1 times higher outer the city roads. Conclusions This study confirms that the number of RTIs places a heavy burden on the Iranian population, especially on young men. Comprehensive strategies and policies must be implemented for effective prevention of road accidents in Iran.

Background There are different methods for injury cost calculation. This study is the first ever one using the willingness (WTP) to pay method a middle-income country such as Iran in 2013 to calculate the cost of road traffic injuries (RTIs). Methods In a Cost Analysis Method study on costs resulting from RTIs, 846 people per road user were randomly selected and investigated. The research questionnaire was prepared based on the standard for WTP method; Contingent value (CV), stated preference (SP), revealed preference (RP) model considering perceived risks. The collected data were analysed after their strict control. Final analysis of WTP was carried out using Weibull model and Bayesian method. Results Mean age of the subjects was 33.4 ± 9.9 years old. Mean WTP was 87 $ among these road users. Statistical value of life for one death and one injury cases were estimated 19,713,584,906 IRR and 2,412,582,500 IRR respectively. In sum, 20408 death and 318,802 injury cases amounted to 1,171,450,232,238,648 IRR equivalents to 39,048,341,074 $. Moreover in 2013, costs of RTIs constituted 6.46% of gross national income, which was 604,300,000,000 $. Findings obtained from Weibull model and Bayesian model showed that WTP had a significant relationship with age, gender, education, monthly income. Conclusions Costs of traffic injuries were much higher than the global statistics. If policy making and resource allocation are made based on the scientific pieces of evidence, an enormous amount of capital can be saved through reducing death and injury rates. This method seems to be more precise method to traffic injury cost estimation than human capital method.

To determine risky behaviors leading to unintentional injuries among Tehrani high school students in 2009.This cross-sectional study was carried out berween October and December 2009. Out of 237,300 (185151 governmental, 52149 non governmental) Tehrani high school students in both genders, 727 subjects were selected by multistage randomized sampling. Among 20 education districts, 8 districts were selected and divided by stratified sampling into 3 areas: North, Center, and South. Data were collected by cluster random sampling in each district using the standard questionnaire of the Management Diseases Center of America, which had been validated in Iran. Subjects were healthy students aged 12-18 years. Risky behaviors including fall, burn, poisoning, and road traffic injuries were studied.The mean age of subjects was 16.8+/-1.2, range 12-18 years. Overall, 44% of boys and 38% of girls were exposed to risky behaviors leading to unintentional injuries. Significant differences were observed in driving without licence among boys and in governmental schools (p=0.000). Using a motorcycle was more prevalent in the south of Tehran (p=0.000). Significant differences were observed among boys related to poisoning substance exposure, driving without a licence, motorcycle driving, and non-helmet use during motorcycle driving (p=0.000).Approximately half of the boys and more than one-third of the girls were exposed to risky behaviors leading to unintentional injuries. Prevention of unintentional injuries caused by children's risky behaviors is crucial, particularly among boys and those from deprived areas.

Objectives This study was conducted to assess political mapping in relation to road traffic injuries (RTIs) management and prevention to present a practical model for RTIs. Design A phenomenological qualitative study was developed to identify stakeholders on RTI in Iran in 2008. Setting The designed questions were discussed by systematic discussion with the relevant specialists. After receiving written consent from the main responsible stakeholders, the questionnaire was filled in by trained experts. Themes were determined and content was analysed in each part. Participants Main responsible stakeholders. Main outcome measures By comparing other countries' political mappings which were found in the library and by Internet searching, political mapping of RTI in Iran was suggested. Results Subjects were 26 experts from governmental and nongovernmental organizations. The main proposed leading agencies were traffic police and presidency (13% each). Findings showed that only 31% of our political mapping was formed according to the World Health Organization (WHO). In 94% of cases, the involved organizations had unspecified roles; the reason was poor monitoring for RTI in 39% of organizations. Lack of adequate authority and suitable legislation, appropriate laws and tasks definition were 94% and 18%, respectively. The most essential policy to overcome problems was defined as appropriate legislation (21%), and the most frequent type of support needed was mentioned as adequate budgeting (25%). Conclusion Traffic police can play the leading agency role by government support, with strong leadership, appropriate legislation, defined tasks and adequate budget.

To investigate the relationship between occupation and cardiovascular risk factors in women in Tehran.A cross-sectional study of 566 working women and 561 age-matched housewives selected from among the 15005 Tehran Lipid and Glucose Study (TLGS) participants. All cardiovascular risk factors were assessed.The means of body mass index, waist circumference, waist to hip ratio, systolic and diastolic blood pressures, triglycerides and total cholesterol were significantly higher in housewives as compared to working women (P0.05). Nine percent of working women and 17% of housewives had 4-6 cardiovascular risk factors; 1% of housewives had 7-8 cardiovascular risk factors.An increase in some cardiovascular risk factors was seen in housewives as compared to working women, and the percentage of housewives with 4-6 risk factors was found to be twice that of working women.

This study was conducted to evaluate the relationship between waist-to-hip ratio (WHR) and cardiovascular risk factors in overweight and obese women and to determine a point of WHR above which the chances of having cardiovascular risk factors increased.In this cross-sectional study, 2892 pre- and postmenopausal women aged 20-78 years with body mass index (BMI)or = 25 selected from among 5791 women of the Tehran Lipid and Glucose Study (TLGS) population (n = 15,005), by multistage cluster random sampling method, were included. Anthropometric indices were measured and BMI and WHR were calculated. Blood pressure was evaluated according to standard protocols. Biochemical indices were measured in the fasting state. Subjects were placed into the high-risk categories for cardiovascular disease on the basis of population-defined norms. Women were divided into quartiles based on their WHR: quartile 1:0.78, quartile 2: 0.78-0.83, quartile 3: 0.83-0.88, quartile 4:or = 0.88 for premenopausal women, and quartile 1:0.84, quartile 2: 0.84-0.9, quartile 3: 0.9-0.94 and quartile 4:or = 0.94 for postmenopausal women.A lower proportion of pre- and postmenopausal women with BMIor = 35 were in quartile 1 and a higher proportion in quartile 4. A significant increasing trend was observed for odds ratio of having low HDL-C, high triglyceride, high total-/HDL-cholesterol and high fasting blood sugar (FBS) with increasing WHR. Controlling for BMI and simultaneously adjusting for confounding variables had no effect on this trend. Although no significant increasing trends were seen for having high total cholesterol, LDL-cholesterol, systolic and diastolic blood pressure with quartiles of WHR in both pre- and postmenopausal women, subjects with higher quartiles of WHR still had higher chances for having high total cholesterol. In the case of postmenopausal women having of higher odds for high LDL-cholesterol and high systolic blood pressure in the fourth quartile of WHR should also be added to the high total cholesterol.The results showed that in overweight and obese women, chances of having cardiovascular risk factors increased with WHRor = 0.78 for premenopausal and with WHRor = 0.84 for postmenopausal women.

Objectives: Coronary artery disease is becoming more prevalent in developing countries, particularly in urban areas. This study was conducted to determine the prevalence of cardiovascular risk factors among Tehran urban population. Methods: The prevalence and distribution of high blood pressure, cigarette smoking, dyslipoproteinemia, diabetes mellitus, and obesity was determined in 15005 subjects, aged three years and over, selected by cluster random sampling in Tehran urban district-13 between February 1999 to August 2001. Total energy intake, percent of energy derived from protein, carbohydrate, and fat were assessed in a subsidiary of 1474 persons by means of two 24-hour dietary recalls. Results: In adults, 78% of men and 80% of women presented at least one CVD risk factor. The percentage of adult women with two or more risk factors was significantly greater than the one for men. Prevalence of DM, hypertension, obesity, high TC, low HDL, high TGs, and smoking was 9.8, 20.4, 14.4, 19.3, 32, 5.3, and 22.3%, respectively. In children and adolescents, two or more CVD risk factors were found in 9% of boys and 7% of girls. Prevalence of hypertension, obesity, high TC, low HDL, and high TGs, was 12.7, 5.2, 5.1, 10.2, and 5%, respectively. The mean percentage values of energy intake derived from carbohydrate, protein, and fat were 57.8±6.9, 11.1±1.8, and 30.9±7.2, respectively. Conclusion: The prevalence of cardiovascular risk factors among Tehran urban population is high; particularly of high total cholesterol, low HDL cholesterol levels, and high waist to hip ratio. An effective strategy for life style modification is a cornerstone of a population approach to the cardiovascular risk factors. Moreover, these results will serve as a baseline for assessment of future trends in the risk factors studied.

We aimed to use the willingness to pay (WTP) method to calculate the cost of traffic injuries in Iran in 2013. We conducted a cross-sectional questionnaire-based study of 846 randomly selected road users. WTP data was collected for four scenarios for vehicle occupants, pedestrians, vehicle drivers, and motorcyclists. Final analysis was carried out using Weibull and maximum likelihood method. Mean WTP was 2,612,050 Iranian rials (IRR). Statistical value of life was estimated according to 20,408 fatalities 402,314,106,073,648 IRR (US$13,410,470,202 based on purchasing power parity at (February 27th, 2014). Injury cost was US$25,637,870,872 (based on 318,802 injured people in 2013, multiple daily traffic volume of 311, and multiple daily payment of 31,030 IRR for 250 working days). The total estimated cost of injury and death cases was 39,048,341,074$. Gross national income of Iran was, US$604,300,000,000 in 2013 and the costs of traffic injuries constituted 6·46% of gross national income. WTP was significantly associated with age, gender, monthly income, daily payment, more payment for time reduction, trip mileage, drivers and occupants from road users. The costs of traffic injuries in Iran in 2013 accounted for 6.64% of gross national income, much higher than the global average. Policymaking and resource allocation to reduce traffic-related death and injury rates have the potential to deliver a huge economic benefit.

Introduction The efficacy of provisional driver licensing and mandatory seat belt use legislations on reducing traffic injuries and the intensity of injuries was investigated. Methods Data on traffic crashes and injuries from 1 year before till 2 years after the implementation of provisional driver licensing and mandatory seat belt use legislations were obtained from traffic police. Data of traffic injuries and mortalities from 1 year before till 2 year after the implementation of graduate driver licensing compared in those in early years of their driving experience. To evaluate the efficiency of mandatory seat belt use legislation the intensity of traffic injuries were compared. Results Drivers under 23 years of age consisted 22.8% of total crashes in the prior to the implementation of graduate driver licensing. This proportion reduced to 15.5% and 16.1% in the first and second year after implementation, respectively, in holders of provisional B1 type driver license. This approximately 7% reduction in total accident was statistical significant (p Conclusion It is suggested that both interventions were efficient in reduction of intensity of traffic injuries and provisional driver licensing was efficient in reducing the crude number of traffic injuries.

Objective The role of pupils liaisons education on social discipline promotion and road traffic injury prevention was the main objective of this study. Methods It was a before-after interventional study on 2800 pupils randomly selected from six different districts of Tehran. Data was collected by a questionnaire for children9s performances and other demographic information. Validity and reliability of questionnaire was determined by content validity and test re test. Results Subjects were 2800 pupils 8–15 years (Mean and median of ages: 11 years). Overall, 47.7% of pupils were boys and others girls. In general, 85.9% of parents had positive reaction to point out of their filial, 11% with no reaction and only 3% were protested to filial pointing out. lack of seat belt use 39.1%, speaking with mobile and driving 31.8% and speeding 29.8% as major offences. Recorded offences by traffic police before the intervention was 2789 cases (SD = 2.6). A significant differences with 17.9 percent reduction in offences were observed after intervention (2290 cases, SD = 2.6, p Conclusion Pupils9 liaison program was effective on reduction of driving offences. The most causes of offences were eating or drinking during driving. All affairs which were educated by pupils liaisons were effective on offences reduction except mobile speaking and driving.

Introduction There is 65 deaths per day from road traffic injuries (RTIs). In Iran. Despite some interventions having been implemented, the impacts of these interventions on mortality and morbidity rates have not been evaluated. Objective To ascertain the pattern of RTIs in Iran for the years 2004–2007 and to compare the epidemiological trends of RTIs, before and 2 years after four road safety programs were put into place. Methods A 4-year database from two sources, the traffic police and medico-legal data were employed. The four interventions concurrently/simultaneously put into place in 2005 were as follows: enforcement of laws on the mandatory fastening of seat belts, enforcement of the laws on use of motorcycle helmets, enforcement of general traffic laws and mass media educational campaigns on national radio and television. Results There was a significant decrease in RTIs-related-death and morbidity rates in Iran, after the intervention programs (p Conclusion These findings demonstrate the role of traffic police interventions, initiated simultaneously on a national level, in RTI prevention. They do highlight the importance of the contribution made by law enforcement and mass education campaigns.

Background Road traffic injuries have dramatically increased in previous decade in Iran. According to the literature, rate of road traffic injuries among children & young adults is high. The first step for an accurate planning is situational analysis of knowledge, attitude and practice (KAP) in road traffic injuries. Objective Determining the KAP of road traffic injuries among children (9-14 years)& young adults (15–30 years) in Tehran-Iran. Material and methods A descriptive study was performed among 304 Tehrani children(9–14) and 327 young adults(15–30) years from primary schools to university students who were selected by a proportionate randomised population based sampling method, in 2008. Data was collected by a structured validated & reliable (r = 0.8) questionnaire, after a completed consent from the subjects. Results Mean SD of age in children and young adults were 11.7, 1.6 and 20.74.3, respectively. Overall 50.7% were boys. Among girls (9–14 years), practice scores were higher than boys (p Conclusion These findings revealed the essential need for a comprehensive educational plan on traffic injuries, to enhance knowledge, change attitudes & improvement of practice.

Background and Objective This study investigated the efficacy of mandatory seat belt use legislation on reducing traffic injuries and the intensity of road traffic injuries (RTIs). Materials and Methods Data on RTIs from 1 year before till 2 years after the implementation of mandatory seat belt use legislation were obtained from the police department. After data cleaning and stratification RTIs and moralities from 1 year before till 2 year after the implementation of mandatory seat belt use legislations was compared with those in year prior to the intervention. Results After the implementation of the mandatory seat belt use, traffic mortalities consisted of 13.3% of all RTIs in the year prior to the implementation, while this proportion decreased to 9.9% and 11.5% in the first and second years after the implementation, respectively. The trend of mortality reduction was not consistent for seat belt use, as we observed a slight increase in the proportion of moralities in the second year after the implementation of mandatory seat belt use, though they did not reach the levels for before implementation of those laws. Conclusion Our findings suggested that the mandatory of seat belt use was efficient in reduction of intensity of RTIs and it was also efficient in reducing the crude number of RTIs. However, in the second year after the implantation the efficiency of this intervention reduced.

Summary Objective To assess intertrimester and seasonal variations in urinary iodine concentration (UIC) among pregnant women. Patients and measurements Pregnant Tehranian women, with no history of thyroid ablation or consumption of thyroid-affecting medication were selected consecutively from November 2004 to November 2006. Morning spot urine samples were collected from each participant during the first, second and third trimesters of pregnancy. Of 466 participants, 298 completed the study in all three trimesters of pregnancy. UIC 250 µg/l indicated low, adequate, and high levels, respectively. UIC was measured using a modified Sandell–Kolthoff digestion method. Results The pregnant women were aged 25·0 ± 5·0 (range 16–48) years. Median UIC did not show seasonal fluctuations during pregnancy. However, median (range) UIC was 193 (19–840), 159 (16–640), and 141 (16–400) µg/l in the first, second and third trimesters of pregnancy, respectively (P

Combined oral contraceptive (COC) users were reported to be at high risk for vascular thromboembolism and cardiovascular diseases. This cross-sectional study was aimed at determining the prevalence of cardiovascular risk factors in COC users and non-users in Tehran in 1999. The subjects were 2480 married women aged 15–49 years among the 15 000 participants in the Tehran Lipid and Glucose Study. The method of contraception (COCs, intrauterine devices (IUDs), condoms or coitus interruptus) was determined by questionnaire. Blood pressure, height and weight were measured. A 12–14 h fasting blood sample was taken for the determination of serum glucose, cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Two-hour postprandial plasma glucose, after 75 g oral glucose, was measured. Coitus interruptus, COC, condom and IUD were used in 48, 11, 4 and 5% of the individuals, respectively; 32% used no contraception. Serum cholesterol, triglycerides, HDL and LDL rates were withi...