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Resumo Fundamento: O índice de massa corporal (IMC) é o índice mais usado para categorizar uma pessoa como obesa ou não-obesa, e está sujeito a limitações importantes. Objetivo: Avaliar o efeito direto do IMC nos desfechos cardiovasculares em participantes sem obesidade central. Métodos: Esta análise incluiu 14.983 homens e mulheres com idades entre 45-75 anos do Estudo de Risco de Aterosclerose em Comunidades (ARIC). O IMC foi medido como obesidade geral e a circunferência da cintura (CC), a relação cintura-quadril (RCQ) e circunferência do quadril como obesidade central. A estimativa de máxima verossimilhança direcionada (TMLE, no acrônimo em inglês) foi usada para estimar os efeitos totais (TEs) e os efeitos diretos controlados (CDEs). A proporção de ET que seria eliminada se todos os participantes fossem não obesos em relação à obesidade central foi calculada usando o índice de proporção eliminada (PE). P

Background and aims To elucidate the effect modification of general and central obesity by sex and age on the risk of cardiovascular events. Methods The analysis included 14,983 males and females aged 45–75 years from the Atherosclerosis Risk in Communities study. Obesity was defined with body mass index (BMI), waist-to-hip ratio (WHR) and body shape index (BSI) which categorized the participants as obese and non-obese. Targeted maximum likelihood estimation was used to estimate the risk ratio (RR) with the tmle package in R software. Results After adjustment, the strongest effect of BMI on CHD was in females (RR (95%CI): 1.26 (1.11, 1.42)) and in age>54 (RR (95%CI): 1.16 (1.06, 1.27)) and for HF it was in age>54 (RR (95%CI): 1.18 (1.10, 1.26)) and in females (RR (95%CI): 1.17 (1.08, 1.28)). Regarding central obesity, WHR (RR (95%CI): 1.19 (1.05, 1.34)) had the strongest effects on CHD for males and BSI (RR (95%CI): 1.140 (1.02, 1.26)) for age ≤ 54, and for HF the WHR (RR (95%CI): 1.22 (1.10, 1.36)) and BSI (RR (95%CI): 1.18 (1.07, 1.30)) had the strongest effects for age≤54, respectively. Conclusion Among males and age≤54, WHR index was associated with a higher risk of CHD and HF while BMI was so for females and age>54.

Background Hospital-acquired infections (HAIs) in intensive care units (ICUs) are among the avoidable morbidity and mortality causes. This study aimed at investigating the rate of ICU-acquired infections (ICU-AIs) in Iran. Methods For the purpose of this multi-center study, the rate of ICU-AIs calculated based on the data collected through Iranian nosocomial infections surveillance system and hospital information system. The data expanded based on 12 months of the year (13,632 records in terms of “hospital-ward-month”), and then, the last observation carried forward method was used to replace the missing data. Results The mean (standard deviation) age of 52,276 patients with HAIs in the ICUs was 47.37 (30.78) years. The overall rate of ICU-AIs was 96.61 per 1000 patients and 16.82 per 1000 patient-days in Iran’s hospitals. The three main HAIs in the general ICUs were ventilator-associated events (VAE), urinary tract infection (UTI), and pneumonia events & lower respiratory tract infection (PNEU & LRI) infections. The three main HAIs in the internal and surgical ICUs were VAE, UTI, and bloodstream infections/surgical site infections (BSI/SSI). The most prevalent HAIs were BSI, PNEU & LRI and eye, ear, nose, throat, or mouth (EENT) infections in the neonatal ICU and PNEU & LRI, VAE, and BSI in the PICU. Device, catheter, and ventilator-associated infections accounted for 60.96, 18.56, and 39.83% of ICU-AIs, respectively. The ventilator-associated infection rate was 26.29 per 1000 ventilator-days. Based on the Pabon Lasso model, the lowest rates of ICU-AIs (66.95 per 1000 patients and 15.19 patient-days) observed in zone III, the efficient area. Conclusions HAIs are common in the internal ICU wards. In fact, VAE and ventilator-related infections are more prevalent in Iran. HAIs in the ICUs leads to an increased risk of ICU-related mortality. Therefore, to reduce ICU-AIs, the specific and trained personnel must be responsible for the use of the devices (catheter use and ventilators), avoid over use of catheterization when possible, and remove catheters earlier.

Background Surgical Site Infections (SSIs) are among the leading causes of the postoperative complications. This study aimed at investigating the epidemiologic characteristics of orthopedic SSIs and estimating the under-reporting of registries using the capture-recapture method. Methods This study, which was a registry-based, cross-sectional one, was conducted in six educational hospitals in Tehran during a one-year period, from March, 2017 to March, 2018. The data were collected from two hospital registries (National Nosocomial Infection Surveillance System (NNIS) and Health Information Management database (HIM)). First, all orthopedic SSIs registered in these sources were used to perform capture-recapture (N = 503). Second, 202 samples were randomly selected to assess patients` characteristics. Results Totally, 76.24% of SSIs were detected post-discharge. Staphylococcus aureus (11.38%) was the most frequently detected bacterium in orthopedic SSIs. The median time between the detection of a SSI and the discharge was 17 days. The results of a study done on 503 SSIs showed that the coverage of NNIS and HIM was 59.95 and 65.17%, respectively. After capture-recapture estimation, it was found that about 221 of orthopedic SSIs were not detected by two sources among six hospitals and the real number of SSIs were estimated to be 623 ± 36.58 (95% CI, 552–695) and under-reporting percentage was 63.32%. Conclusion To recognize the trends of SSIs mortality and morbidity in national level, it is significant to have access to a registry with minimum underestimated data. Therefore, according to the weak coverage of NNIS and HIM among Iranian hospitals, a plan for promoting the national Infection Prevention and Control (IPC) programs and providing updated protocols is recommended.

Background: Using dexmedetomidine (Dex) as a sedative agent may benefit the clinical outcomes of post-surgery patients. We reviewed randomized controlled trials (RCTs) to assess whether use of a Dex could improve the outcomes in post-surgery critically ill adults. Methods: We searched Medline, Embase, PubMed, and the Cochrane databases for RCTs comparing Dex with propofol or a placebo in post-operative patients, all included RCTs should be published in English before Jul 2016. Citations meeting inclusion criteria were full screened, and trial available data were abstracted independently and the Cochrane risk of bias tool was used for quality assessment. Results: Sixteen RCTs involving 2568 patients were subjected to this meta-analysis. The use of a Dex sedative regimen was associated with a reduce delirium prevalence [odd ratio (OR):0.33, 95% confidence intervals (CI): 0.24–0.45, I2= 5%, P

Introduction Population-based cancer registry (PBCR) plays a significant role in burden of cancer estimation. Estimating the completeness of cancer registry is one of the criteria to assess the quality of data (results). Also, Capture-recapture is one of the methods used to assess completeness of cancer registry. Objective This study was aimed to estimate the completeness of lung and bronchial cancer registry using three-source capture-recapture method in Khuzestan province. Materials and methods This study was carried out using three-source capture-recapture method and data were obtained from three sources including medical records, death certificates and pathology labs (reports) in Khuzestan. In this study, total new cases of lung and bronchial cancer registered by the three sources in 2011, were enrolled. Among the sources, the common cases were identified and the completeness rate of lung and bronchial cancer registry was calculated by log-linear method using R software, finally. Results Totally, 426 new cases for lung cancer had reported from the three sources in 2011. The completeness index of lung cancer registry was totally estimated 72%, as well as it was independently 40%, 25% and 37.6% for the medical records, pathology reports and death certificates sources, respectively. Conclusion According to the results, after collection and remove repetition of the cases related to lung cancer, it should be added their number registered by the pathology (labs), medical records and death certificates sources by 28%–40%, to estimate actual incidence of lung cancer. Also, the actual incidence of lung cancer cases related to each of medical records, pathology and death certificates was calculated by adding the reported values by 60%, 75% and 63%, respectively.

We determined the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in an affected area in northern Iran in April 2020. Antibodies to SARS-CoV-2 were detected in 528 persons by using rapid tests. Adjusted prevalence of SARS-CoV-2 seropositivity was 22.2% (95% CI 16.4%–28.5%).

Background Hospital-acquired infections (HAIs) are a well-known cause of morbidity and mortality in hospitalized patients. This study aimed at investigating the survival rate in patients with ICU-acquired infections (ICU-AIs) and its related factors in Iran’s hospitals. Methods Data were obtained from the Iranian Nosocomial Infections Surveillance (INIS), which registers all necessary information on the main types of infection from different units of each included hospital. One thousand one hundred thirty-four duplicate cases were removed from the analysis using the variables of name, father’s name, age, hospital code, infection code, and bedridden date. From 2016 to 2019, 32,998 patients diagnosed with ICU-AI from about 547 hospitals. All patients were followed up to February 29, 2020. Results The median age of patients with ICU-AIs was 61 (IQR = 46) years. 45.5, 20.69, 17.63, 12.08, and 4.09% of infections were observed in general, surgical, internal, neonatal and pediatric ICUs, respectively. Acinetobacter (16.52%), E.coli (12.01%), and Klebsiella (9.93%) were the major types of microorganisms. From total, 40.76% of infected patients (13,449 patients) died. The 1, 3, 6-months and overall survival rate was 70, 25.72, 8.21 1.48% in ICU-AI patients, respectively. The overall survival rate was 5.12, 1.34, 0.0, 51.65, and 31.08% for surgical, general, internal, neonatal and pediatric ICU, respectively. Hazard ratio shows a significant relationship between age, hospitalization-infection length, infection type, and microorganism and risk of death in patients with ICU-AI. Conclusions Based on the results, it seems that the nosocomial infections surveillance system should be more intelligent. This intelligence should act differently based on related factors such as the age of patients, hospitalization-infection length, infection type, microorganism and type of ward. In other words, this system should be able to dynamically provide the necessary and timely warnings based on the factors affecting the survival rate of infection due to the identification, intervention and measures to prevent the spread of HAIs based on a risk severity system.

Aims To search for pharmaceutical additives in illicit alcoholic beverages referred to the laboratory of Legal Medicine Organization in Iran in 2017. Methods Hundred beverages were sampled. Ethanol content was determined by gas chromatography with flame ionization detection (GC–FID) and then a liquid-liquid extraction combined with reversed-phase high performance liquid chromatography equipped with a photodiode array detector (PAD) was employed for the qualitative analysis. The analysis was confirmed using gas chromatography coupled with mass spectroscopy (GC/MS). Results In 15% either one or more of the following were detected: tramadol, methadone, diazepam, oxazepam, flurazepam and alprazolam. Tramadol was found with highest frequency. Conclusions The wide availability of addictive pharmaceutical is leading to fortification of alcoholic beverages on some countries. The addition of such depressant additives should be better known because of the potentially fatal consequences of the combination with ethanol, as well as the potential for adverse effects on behavior.

BackgroundRecent studies have shown that antibiotic exposure during infancy is associated with increased body mass in healthy children. This study was performed to investigate the association between early-life antibiotic exposure and risk of childhood obesity.MethodsA systematic review and meta-analysis was performed to comprehensively and quantitatively determine the association between early antibiotic exposure and risk of childhood obesity. Various databases such as PubMed, Embase, Scopus, Web of Science, ProQuest, Cochrane and Google Scholar were searched. A random-effects meta-analysis was performed to pool the statistical estimates. Additionally, a subgroup analysis was performed based on the time of follow-up.ResultsNineteen studies involving at least 671,681 participants were finally included. Antibiotic exposure in early life was significantly associated with risk of childhood weight gain and obesity (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.04–1.06).ConclusionsAntibiotic exposure in early life significantly increases the risk of childhood weight gain and obesity.

This study was conducted to investigate the effect of the prepregnancy BMI on the risk of gestational diabetes mellitus (GDM). Five electronic databases, including PubMed, Scopus, Embase, Web of Science, and Google Scholar, were searched for literature published until 1 January 2018. The two-stage, random effect meta-analysis was performed to compare the dose-response relationship between BMI and GDM. As well as studies with categorized BMI, studies that treat BMI as a continuous variable were analysed. A total of 33 observational studies with an overall sample size of 962 966 women and 42 211 patients with GDM were included in analysis. The pooled estimate of GDM risk in the underweight, overweight, and obese pregnant women was 0.68, 2.01, and 3.98 using the adjusted OR and 0.34, 1.52, and 2.24 using the adjusted RR. The GDM risk increased 4% per unit of increase in BMI with both the crude and adjusted OR/RR models. Also, the risk of GDM increased 19% with the crude model and 14% with the adjusted model. The existence of dose-response relationship between the pre-pregnancy BMI and GDM can strengthen the scientific background for vigorous public health interventions for the control of pre-pregnancy BMI as well as the weight gain during pregnancy.

The authors aim to investigate the GDM and the dose-response association of BMI with it in pregnant women in Kermanshah, Iran. During the 2015-2016 year, the 1010 pregnant women were studied. The restricted cubic spline method was used to evaluate the relationship between BMI and GDM. The risk of GDM was 10.1%. The incidence rate ratio for GDM indicates a non-significant protective effect and, then a significant risk for GDM occurrence along with BMI. BMI can be used as a predictive factor. A healthy diet and recommended levels of physical activity are suggested to prevent overweight and obesity and subsequent GDM.

Background The Metabolic syndrome (MetS), refers to one of the most challenging public health issues across the world. The aim of this study was to explore the clusters of participants on the basis of MetS components and determine its effect on coronary heart disease (CHD). Methods This study used the information from Multi-Ethnic Study of Atherosclerosis (MESA). MESA was performed at 6 US sites and was a population-based cohort study of 6776 adults (3576 females; 3200 males), aged 45 to 84 years. The participants were free of clinical cardiovascular disease at baseline. Latent class analysis (LCA) was conducted to achieve the study's objectives. The outcome variable was CHD during the study period (2000−2012). Results The prevalence of all Mets components (except triglyceride (TG) and fasting blood glucose (FBS)) is more common in females than in males. Three latent classes were recognized: (1) Non-MetS, (2) low risk, and (3) MetS. Notably, MetS latent class included 29.88% and 35.38% in females and males, respectively. After adjustment for covariates (e.g. demographic, biomarker etc.), MetS latent class showed a positive association with CHD events in both genders. Conclusions Results showed that clustering pattern of the MetS components, as well as the association between latent classes and risk of incident CHD events, are different in females and males. Notable percentages of individuals are in the MetS class, which emphasizes the necessity of implementing preventive interventions for this sub-group of the population.

Hospital-acquired infections (HAIs) lead to increased length of hospital stay, inappropriate use of broad-spectrum antibiotics and multiple antibiotic resistance. This study aimed to investigate the rate of HAIs in Iran. In this multi-centre study, the rate of HAIs was calculated based on the data collected through Iranian nosocomial infections surveillance for patients with HAIs, as well as through hospital statistics and information systems on hospital-related variables. Data were analysed using Stata software; in addition, ArcGIS was used for plotting the geographical distribution of HAIs by different provinces. The mean age of the 107 669 patients affected by HAIs was 52 ± 26.71 years. Just over half (51.55%) of the patients were male. The overall rate of HAIs was 26.57 per 1000 patients and 7.41 per 1000 patient-days. The most common HAIs were urinary tract infections (26.83%; 1.99 per 1000 patient-days), ventilator-associated events (20.28%; 1.5 per 1000 patient-days), surgical-site infections (19.73%; 1.45 per 1000 patient-days) and bloodstream infections (13.51%; 1 per 1000 patient-days), respectively. The highest rate of HAIs was observed in intensive care units. Device, catheter and ventilator-associated infections accounted for 38.72%, 18.79% and 16% of all HAIs, respectively. Based on the results, HAIs are common in intensive care units, and urinary tract infections and device-related infections are more prevalent in Iran. To reduce HAIs it is recommended to implement appropriate policies and interventions, train staff about the use of devices, and prepare and update protocols and guidelines for improving the quality of care., Highlights • The overall rate of HAIs was 26.57 per 1000 patients and 7.41 per 1000 patient-days. • Hospital-acquired infections are common in ICU wards, while UTIs and device-related infections are more prevalent in Iran. • Device, catheter and ventilator-associated infections accounted for 38.72, 18.79%, and 16% of all HAIs, respectively.

Background: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a major public health problem in Iran. It imposes heavy costs on governments and affected people. Determining the survival duration of patients and recognizing the related factors can help the disease surveillance system. Objectives: The current study aimed at determining the survival rate and the related factors concerning patients with HIV/AIDS identified in Tehran, Iran. Methods: The study population of the current retrospective cohort consisted of patients with HIV/AIDS covered by the Health Center of Southern Tehran. The data were obtained by referring to the HIV/AIDS care centers and reviewing the patients’ records. Survival rates of the study subjects during 10 years follow-up were calculated. The Cox proportional-hazards model was used to determine the relationship between independent variables and survival of patients with HIV/AIDS. Results: A total of 487 patients were investigated in the current study. Four-hundred thirty-three subjects (88.9%) were male, and 54 (11.1%) female. The mean ± standard deviation of the participants’ age was 44.08 ± 9.00 years. According to univariate analyses, the variables of gender, marital status, education level, occupational status, transmission way, infection with hepatitis C or tuberculosis, and history of antiretroviral treatment were significantly associated with the survival time of patients with AIDS. In the final model, a significant relationship was found between the variables of treatment, coinfection with tuberculosis, occupational status, education level, marital status, and mortality. Conclusions: The current study was one of the few research that examined the survival rate of HIV-infected patients in Iran. Considering the expansion of AIDS epidemic in Iran, it is necessary to take appropriate measures to prevent the spread of the epidemic and decrease the mortality rate of infected patients through early detection and timely treatment of HIV-positive people coinfected with tuberculosis, creation of employment opportunities for patients and addicted individuals, controlling substance abuse, and paying more attention to harm reduction programs in individuals that have unsafe sex as one of the most important high-risk groups to increase their survival time.

Background: Iran is one of the first few countries that was hit hard with the coronavirus disease 2019 (COVID-19) pandemic. We aimed to estimate the total number of COVID-19 related infections, deaths, and hospitalizations in Iran under different physical distancing and isolation scenarios. Methods: We developed a susceptible-exposed-infected/infectious-recovered/removed (SEIR) model, parameterized to the COVID-19 pandemic in Iran. We used the model to quantify the magnitude of the outbreak in Iran and assess the effectiveness of isolation and physical distancing under five different scenarios (A: 0% isolation, through E: 40% isolation of all infected cases). We used Monte-Carlo simulation to calculate the 95% uncertainty intervals (UIs). Results: Under scenario A, we estimated 5 196 000 (UI 1 753 000-10 220 000) infections to happen till mid-June with 966 000 (UI 467 800-1 702 000) hospitalizations and 111 000 (UI 53 400-200 000) deaths. Successful implantation of scenario E would reduce the number of infections by 90% (ie, 550 000) and change the epidemic peak from 66 000 on June 9, to 9400 on March 1, 2020. Scenario E also reduces the hospitalizations by 92% (ie, 74 500), and deaths by 93% (ie, 7800). Conclusion: With no approved vaccination or therapy available, we found physical distancing and isolation that include public awareness and case-finding and isolation of 40% of infected people could reduce the burden of COVID-19 in Iran by 90% by mid-June.

There is no report on the serial interval (SI) of coronavirus disease 2019 (COVID-19) in Iran, the present report aims to estimate the SI and time-varying R of COVID-19 in western Iran. In this study, there were 1477 confirmed, probable and suspected cases of severe acute respiratory syndrome coronavirus 2 for Kermanshah from 22 February to 9 April. The close contacts of the confirmed cases were identified using telephone follow up of patients and their contacts. The SI distribution was used as an alternative. We fitted different models using the clinical onset dates of patients with their close contact (infector-infectee). Also, we applied a 'serial interval from sample' approach as a Bayesian methodology for estimating reproduction number. From 22 February to 29 March, 247 COVID-19 cases were confirmed by RT-PCR. Close contact between 21 patients (21 infector-infectee pairs), including 12 primary cases and 21 secondary cases, was confirmed. The mean and standard deviation of the SI were estimated as 5.71 and 3.89 days. The R varied from 0.79 to 1.88 for a 7-day time-lapse and ranged from 0.92 to 1.64 for a 14-day time-lapse on raw data. Also, the R varied from 0.83 to 1.84 for 7-day time-lapse and from 0.95 to 1.54 for a 14-day time-lapse using moving average data, respectively. It can be concluded that the low reproduction number for COVID-19 in Kermanshah province is an indication of the effectiveness of preventive and interventive programmes such as quarantine and isolation. Consequently, continuing these preventive measures is highly recommended.

The outbreak of COVID‐19 was first reported from China, and on 19 February 2020, the first case was confirmed in Qom, Iran. The basic reproduction number (R0) of infection is variable in different populations and periods. This study aimed to estimate the R0 of COVID‐19 in Qom, Iran, and compare it with that in other countries. For estimation of the serial interval, we used data of the 51 confirmed cases of COVID‐19 and their 318 close contacts in Qom, Iran. The number of confirmed cases daily in the early phase of the outbreak and estimated serial interval were used for R0 estimation. We used the time‐varying method as a method with the least bias to estimate R0 in Qom, Iran, and in China, Italy and South Korea. The serial interval was estimated with a gamma distribution, a mean of 4.55 days and a standard deviation of 3.30 days for the COVID‐19 epidemic based on Qom data. The R0 in this study was estimated to be between 2 and 3 in Qom. Of the four countries studied, the lowest R0 was estimated in South Korea (1.5–2) and the highest in Iran (4–5). Sensitivity analyses demonstrated that R0 is sensitive to the applied mean generation time. To the best of the authors' knowledge, this study is the first to estimate R0 in Qom. To control the epidemic, the reproduction number should be reduced by decreasing the contact rate, decreasing the transmission probability and decreasing the duration of the infectious period.

Aims Fatty Liver Index (FLI) is a surrogate index for diagnosis of Fatty Liver Disease (FLD). We performed a dose-response meta-analysis to investigate the relationship between FLI and diabetes incidence in prospective cohort studies. Methods We conducted a systematic search of articles up to November 2019 in PubMed, SCOPUS, Cochrane library, and Embase. Hazard Ratios (HRs) with corresponding 95% confidence intervals (CIs) of studies were pooled using meta-analysis with DerSimonian and Laird random-effects models to find combined HRs. Dose-response effect of this relationship was also assessed. Results Twenty-seven studies providing 70,918 participants were included in the meta-analysis. Pooled results showed that the highest category of FLI was associated with an increased incidence of diabetes [HR: 2.88, 95% CI: 2.18–3.81; P for heterogeneity: 0.001]. Subgroup analysis based on sex, continent, and the quality of study could not explain the source of heterogeneity. The pooled HR from the random-effects dose-response model indicated a significant association between FLI level and risk of diabetes incidence (Coef = 0.0239, p = 0.001). Conclusion Our dose-response meta-analysis revealed a direct relationship between FLI and HR of diabetes incidence.

Objective Carotenoids (including zeaxanthin and lycopene) and phytosterols reportedly confer beneficial effects on metabolic profile and function, which is of clinical importance. Thus, we sought to review the saffron effects on waist circumstance (WC), fasting plasma glucose (FPG), and HA1C concentrations reported in Randomized Control Trials (RCTs). Method A comprehensive systematic electronic search was performed in PubMed/MEDLINE, Embase, Google Scholar, Cochrane, Web of sciences, and SCOPUS to identify RCTs up to February 2019 without any language restrictions. The pooled weighted mean difference (WMD) calculated with DerSimonian-Laird random. PRISMA guidelines adhered to for this meta-analysis. Result Nine articles with 12 arms containing 595 participants were included in this study. Our study found WC was significantly reduced (WMD: −2.18 cm, 95 % CI: −4.05, −0.32) and FPG (WMD: −6.54 mg/dl, 95 % CI: −10.22, −2.85) following saffron intervention. Subgroup analysis highlighted that FPG levels (WMD: −10.24 mg/dl, 95 % CI: −15.76, −4.72) reduced significantly when intervention duration was longer than twelve weeks. There was no significant effect on HA1C levels (WMD: −0.13 mg/dl, 95 % CI: −0.31, 0.04) following saffron intervention. Conclusion In conclusion, the present study indicates beneficial effects on WC and FPG, following saffron supplementation.

Purpose: To identify and appraise the published studies assessing interventions accounting for reducing fatigue and sleepiness while driving. Methods: This systematic review searched the following electronic databases: Medline, Science direct, Scopus, EMBASE, PsycINFO, Transport Database, Cochrane, BIOSIS, ISI Web of Knowledge, specialist road injuries journals and the Australian Transport and Road Index database. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major injury journals published within the past 15 years. Studies were included if they investigated interventions/exposures accounting for reducing fatigue and sleepiness as the outcome, measured any potential interventions for mitigation of sleepiness and were written in English. Meta-analysis was not attempted because of the heterogeneity of the included studies. Results: Of 63 studies identified, 18 met the inclusion criteria. Based on results of our review, many interventions in the world have been used to reduce drowsiness while driving such as behavioral (talking to passengers, face washing, listening to the radio, no alcohol use, limiting the driving behavior at the time of 12 p.m. â 6 a.m. etc), educational interventions and also changes in the environment (such as rumble strips, chevrons, variable message signs, etc). Meta-analysis on the effect of all these interventions was impossible due to the high heterogeneity in methodology, effect size and interventions reported in the assessed studies. Conclusion: Results of present review showed various interventions in different parts of the world have been used to decrease drowsy driving. Although these interventions can be used in countries with high incidence of road traffic accidents, precise effect of each intervention is still unknown. Further studies are required for comparison of the efficiency of each intervention and localization of each intervention according to the traffic patterns of each country. Keywords: Drowsy driving, Fatigued driving, Intervention, Systematic review

Gestational diabetes mellitus (GDM) is serious health challenges. This study aimed at determining the risk of GDM among pregnant women by pre-pregnancy BMI. Five electronic databases including Medline (PubMed), Scopus, Embase, Web of Science and Google Scholar were searched for literature published form 2015 to January 1, 2021. The pooled estimate risk of GDM among pregnant women was 16.8% (95% CI: 15.3-18.4). The risk of GDM in underweight/normal group and overweight/obese group were 10.7% (95% CI: 9.1-12.4) and 23% (95% CI: 20.2-25.9), respectively. The risk of GDM is high among overweight/obese pregnant women.

Introduction: Biological, environmental, inter- and intrapersonal changes during the antenatal period can result in anxiety and stress in pregnant women. It is pivotal to identify potential stressors and prevent their foetal and maternal consequences. The present study was conducted to validate and examine the factor structure of the Farsi version of the Pregnancy Worries and Stress Questionnaire (PWSQ). Methods: In 2015, 502 Iranian healthy pregnant women, referred to selected hospitals in Tehran for prenatal care at 8-39 weeks of pregnancy, were recruited through a randomized cluster sampling. The PWSQ was translated into Farsi, and its validity and reliability were examined using exploratory factor analysis by SPSS version 21. Results: The content validity of items on the PWSQ was between 0.63-1. The content validity index for relevance, clarity and simplicity were 0.92, 0.98, and 0.98, respectively, with a mean of 0.94. The Kaiser–Meyer– Olkin measure of sampling adequacy was 0.863. Test–retest reliability showed high internal consistency (α=0.89; p

Background The current nationwide study, for the first time, aimed to assess and compare the trend of pre-hypertension and hypertension among urban and rural adolescents in Iran. Methods This study has been conducted in the framework of the National Surveys of Risk Factors for Non-Communicable Diseases. To estimate pre-hypertension and hypertension prevalence among 9715 adolescents, aged 15–19 years, data collected in four repeated cross-sectional surveys (2007–2011) has been used. The prevalence trends of pre-hypertension and hypertension were examined across urban and rural areas of Iran. To calculate the adjusted prevalence ratios (PRs) of pre-hypertension and hypertension over cycles across area of residence and genders, a complex sample survey and multinomial logistic analysis were performed. Results Using the definition of pre-hypertension and hypertension presented by the seventh Joint National Committee (JNC-VII) for adolescents, after adjusting for confounders, the prevalence of pre-hypertension changed in both urban (boys:28.96% to 29.24% and girls:18.33% to 20.06%) and rural (boys 31.58% to 32.05% and girls 22.25% to 24.13%) areas over the study duration. Non-significant rising prevalence of hypertension was also observed in boys and girls of both regions (urban 12.76% to 15.04% and 8.02% to 9.06%; rural 9.95% to 11.79% and 10.35% to 11.60%, for boys and girls respectively). The adjusted prevalence ratios (PRs) of pre-hypertension (2.16; 95% CI 1.68–2.79 and 1.92, 95% CI 1.57–2.34, in urban and rural, respectively) and hypertension (2.40; 95% CI 1.65–3.51 and 1.82, 95% CI 1.36–2.45, in urban and rural, respectively) were higher in boys than girls. Comparing the adjusted PRs of pre-hypertension and hypertension in urban versus rural areas, in both genders, showed higher PRs of pre-hypertension in rural girls (1.33, 95% CI 1.01–1.75). Conclusion The current results showed high constant trends of pre-hypertension and hypertension in Iranian boys and girls, residing in both urban and rural areas.

Overweight and obesity not only are major risk factors for number of chronic diseases, but also a risk factor for pregnancy complications in women. The present study aims to investigate the association between pre-pregnancy BMI and the persistence and duration of BF. The electronic databases including Medline (PubMed), Scopus, Embase, Web of Science and Google Scholar were searched for papers with titles and/or abstracts including one of our keywords and published up to 15 April 2019. For dose-response relationship, the two-stage random-effects meta-analysis was performed using the “dosresmeta” function in R software. Thirty-two studies with the effect of pre-pregnancy BMI on BF initiation, intention and duration were included in the present study. Based on crude and adjusted OR models, the risk of BF cessation increased by 4% (OR = 1.04; 95% CI: 1.02–1.05) with an increase in a unit of BMI. In addition, based on crude and adjusted RR models, the risk of BF cessation increases by 2% and 1% (crude RR = 1.02; 95% CI: 1.01–1.03 and adjusted RR = 1.01; 95% CI: 0.99–1.02) with an increase in one unit of BMI. Based on the result, the health care professionals and other key stakeholders should be aware of the impact excess weight, and that women who are overweight or obese should be encouraged with continued access to guidance, counseling and support, starting from conception, to maximize BF outcomes., Public health; Women's health; Reproductive medicine; Obstetrics and gynecology; Reproductive system; Clinical research; Pre-pregnancy, Body mass index, Breastfeeding, Initiation, Duration.

Background: Murder is one of the public health problems. According to the WHO reports, murder is fourth leading cause of death among young people. The aim of this study was applying joint point regression model to study trend of homicide mortality in Iran, 2006-2016. Study design: A cross-sectional panel (pseudo-panel) study. Methods: Homicide data during 2006 to 2016 were extracted from Iranian legal medicine organization. Trends of homicide incidence were summarized by annual percent change (APC) and average annual percent change (AAPC) using non-linear segmented regression model. Results: Totally, 26918 homicide cases occurred during the period from 2006 to 2016. The highest and lowest frequency was related to the 15-29 yr (46.5%) and 0-4 yr (1.5%) age groups, respectively. The homicide incidence rate of the country in 2016 was 2.81 per 100,000. The four provinces of Sistan & Baluchistan, Khuzestan, Kerman and Ilam had the highest incidence rate in 2016, respectively. During the study period, the incidence rate of homicide in Iran and men have been significantly decreased (APC: -2.8% (95% CI: -3.9, -1.7) and -3.2% (95% CI: - 4.5, -1.8) respectively (PConclusion: The pattern of homicide rate has a downward trend in the country. Moreover, the varying observed trends in some provinces can be due to the variability in mental, geographical, socio-economic and cultural conditions in each region.

Objectives We analyzed dietary patterns using reduced rank regression (RRR), and assessed how well the scores extracted by RRR predicted stroke in comparison to the scores produced by partial least squares and principal component regression models. Methods Dietary data at baseline were used to extract dietary patterns using the 3 methods, along with 4 response variables: body mass index, fibrinogen, interleukin-6, and low-density lipoprotein cholesterol. The analyses were based on 5,468 males and females aged 45-84 years who had no clinical cardiovascular disease, using data from the Multi-Ethnic Study of Atherosclerosis. Results The primary factor derived by RRR was positively associated with stroke incidence in both models. The first model was adjusted for sex and race and the second model was adjusted for the variables in model 1 as well as smoking, physical activity, family and sibling history of stroke, the use of any lipid-lowering medication, the use of any anti-hypertensive medication, hypertension, and history of myocardial infarction (model 1: hazard ratio [HR], 7.49; 95% confidence interval [CI], 1.66 to 33.69; p for trend=0.01; model 2: HR, 6.83; 95% CI, 1.51 to 30.87 for quintile 5 compared with the reference category; p for trend=0.02). Conclusions Based primarily on RRR, we identified that a dietary pattern high in fats and oils, poultry, non-diet soda, processed meat, tomatoes, legumes, chicken, tuna and egg salad, and fried potatoes and low in dark-yellow and cruciferous vegetables may increase the incidence of ischemic stroke.

Background: Cancer is a major public health concern all over the world. The aim of the current study is to demonstrate changing trends of cancer incidence from 2006 to 2009 in Tehran (capital city of Iran) and evaluate the effect of living in different regions according to their median socioeconomic status (SES) on cancer cumulative incidence. Methods: The incident cases were obtained from the population based cancer register of ministry of health and medicine in Iran; we examined the annual percent changes (APCs) and overall trends of total cancer incidence across regions in Tehran. The age and sex standardized incidence rates were computed by the direct method. Poisson regression and negative binominal regression model were used to assess the existence of trends across 4 consecutive years, as well as the effect of living in each region, literacy rate, and employment rate across regions on this trend. All the analyses were done by Stata 12.0 software. Results: The findings of this study showed downward and nonlinear trend during 4 years. The age-standardized incidence rate (ASR) was higher in men compared to women in this period. ASRs for overall 4 years were 114 and 101 per 10,0000 men and women, respectively. Average annual percent change based on ASR and regression model for each sex was the same and around -5% and -6%, respectively. Incidence rate also differed between districts so that north and center districts had higher incidence than southern parts in both sexes. The lowest rate ratio attributed to district 17 and 18 located in south of Tehran and the highest rate ratio attributed to district 6 for each sex compared to the baseline district 16. Results reported the sharp increase of 59% and 37% in district 6 compared to district 16 in men and women, respectively. Better regional social status increased the risk of cancer among women. Also, the results showed a partially significant interaction with higher decrease in annual trend of cancer rate in socially more deprived regions. Conclusions: The results showed downward and nonlinear decreasing trend during 4 years, especially in regions with lower socioeconomic status. Incidence rate also differed between districts so that northern regions had higher incidence than southern regions. Spatio-temporal Analysis of these cancer rates with adjustment for more regional socio-economic characteristics may better explain the disparities in rate of cancer in different districts across time.

Background: In many countries, disease registries are the main source of information necessary for planning and monitoring health-improving programs. In Iran, there is no unified registry system for deaths due to traffic accidents, so organizations that are involved in traffic accidents report different statistics. This study aimed to assess traffic accident mortality rate and completeness of death registries in Northern provinces of Iran from March 21, 2010 to March 20, 2011 using capture-recapture method. Methods: Data of all traffic accident victims including last name, age, sex, and time of death confirmed by traffic police legal forensics organization, and hospitals were used to collect. Then, different log-linear models proposed in the context of capture-recapture method were fitted to predict the number of cases missed by the sources. Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used as goodness of fit indices to identify preferred fitted models. Results: According to the prediction of the most fitted model, the total number of traffic accident deaths was 3857 of which, 727 cases were not documented by any of the responsible organizations. Mortality rate due to traffic accidents was estimated as 53.73 with 95% confidence interval (52.41 - 55.15) per 100000 population of the three provinces. The rates of legal medicine organization, hospitals, and traffic police department were 65.95%, 36.06%, and 16.85%, respectively. Conclusions: Incidence rate of fatal traffic accidents in Northern provinces of Iran is higher in comparison with other provinces. It seems that statistics reported by responsible organizations are underestimated, hence the need for application of methods like the capture-recapture method.

Background: The number of new cancer cases in the elderly is growing because of the aging population. Methods: Cancer data of the elderly (65 years and older) were collected from Iran cancer registry in 2007. Local Moran’s I was used as a measure of spatial analysis to identify the cluster patterns. Results: The overall cancer incidence rates were 862.4 and 474.8 per 100,000 in men and women, respectively. Prostate cancer and breast cancer were the most common types of cancer in men and women, correspondingly. Using the Local Moran’s I tool, we identified more spatial clusters among men than women. Districts 1, 2, 3 and 6 in the north of Tehran were hot spots for prostate cancer and district 16 in the south of Tehran was the cool spot for this type of cancer, and districts 1 and 3 were the hot spots for breast cancer. Conclusions: More cancer hot spots were located in the north of Tehran where districts are more privileged, and more cool spots were located in the south of the city where districts are more underprivileged.

Suicide is a major global public health problem and much burden in the societies. This study aims to calculate the years of life lost (YLL) due to suicide and investigate its trend in Iran. Information on deaths due to suicide in Iran was extracted from Iran Legal Medicine Organization. The years of life lost was calculated in each year according to gender and age-groups. To examine the trend for different years, joinpoint regression was used. The 35,297 deaths due to suicide were recorded in 2006–2015. The total YLL in the 10-year period was 34.52 per 1000 persons in males, 13.61 per 1000 persons in females and 23.35 per 1000 persons in both sexes. Hanging comprised the largest YLL of suicide. The annual percent change of YLL rate was 3.3%. The results revealed that male shows an increasing trend in YLL specifically among youth and adult, while there is no improvement in females. There is a national need to implement an effective health policy intervention in Iran.

Objectives Although the effect of physical activity (PA) on the incidence of atrial fibrillation (AF) has been studied, contradictory results have been reported. Such discrepancies may reflect the different effects of various types of PA upon AF, as well as gender interactions. Therefore, we aimed to evaluate the associations of PA types (total, moderate/vigorous, and intentional), as well as walking pace, with AF risk in men and women. Methods Using the Multi-Ethnic Study of Atherosclerosis Typical Week Physical Activity Survey, 3 PA measures and walking pace were calculated among 6,487 men and women aged 45-84 years. The incidence of AF over approximately 11 years of follow-up was ascertained. The association of each PA measure and walking pace with AF incidence was estimated using multivariable Cox proportional hazard models. An extended Cox model with Heaviside functions (hv) of time was used to estimate the effects of time-varying covariates. Results During 11 years of follow-up (49,557 person-years), 242 new AF cases occurred. The incidence rate of AF was 48.83 per 10,000 person-years. The proportional hazard (PH) assumption for total PA among women was not met; hence, we used the hv to calculate the hazard ratio. Total PA in women in the hv2 analysis was negatively associated with AF in all 3 models, although for hv1 no significant association was observed. The PH assumption for walking pace among men was not met, and none of the hv showed a statistically significant association between walking pace and AF in men. Conclusions These results suggest that PA is inversely associated with AF in women.

Background and Objectives: Road traffic accidents (RTAs) are the second cause of death, the first leading cause of years of life lost due to premature mortality, and the most common source of injury in Iran. According to the World Health Organization estimates, Iran located in the countries that have the highest rates from RTAs. The present study aimed to measure road traffic mortality rates and also to depict a view of the trend for a period of 11 years which started from 2006 to 2016. Materials and Methods: In this cross-sectional study, we collect data on all road traffic deaths in Iran between 2006 and 2016 using records from the Legal Medicine Organization. For doing this research, demographic and epidemiological data of the deceased were extracted using a checklist designed by the forensic experts. Content validity of this form was determined by obtaining comments of professors and scholars in the field. Directly standardized mortality rates were calculated. Finally, the information was analyzed by descriptive statistics. Results: During the 11-year period of this study, 226,514 people in Iran died from RTAs. The age-adjusted mortality rate that caused by road traffic decreased from 41.5/100,000 people in 2006 to 20.4 in 2016 during the study period. There were significant differences in mortality rates between males and females and between outside city and inside city roads. The age-adjusted mortality rate was significantly higher among men than in women. The majority of death has occurred in illiterate young men aged 15–34 years and also in self-employed people. Conclusions: During the 2006–2016, mortality from RTAs decreased from 41.5 to 20.4/100,000 populations. This decreasing trend was observed in both sexes and in outside city and inside city roads. However, this reduction trend in the last years of the study is not suitable. These findings highlighted that training programs and harm reduction approaches for reducing the mortality from traffic accident are still needed.

Background Road traffic injuries (RTIs) are the main causes of death and disability in Iran. However, very few studies about the temporal variations of RTIs have been published to date. Objectives This study was conducted to investigate the temporal pattern of RTIs in Iran in 2012. Materials and Methods All road traffic accidents (RTAs) reported to traffic police during a one-year period (March 21, 2012 through March 21, 2013) were investigated after obtaining permission from the law enforcement force of the Islamic Republic of Iran. Distributions of RTAs were obtained for season, month, week, and hour scales, and for long holidays (more than one day) and the day prior to long holidays (DPLH). The final analysis was carried out using the Poisson regression model to calculate incidence rate ratios for RTIs. All analyses were conducted using STATA 13.1 and Excel software; statistical significance was set at P < 0.05. Results A total of 452,192 RTAs were examined. The estimated rate of all accidents was 219 per 10,000 registered vehicles, or 595 per 100,000 people. About 28% of all RTAs, and more than one third of fatal RTAs, occurred during the summer months. The incidence rate for all traffic accidents on DPLH was 1.20, compared to workdays as a reference category, and it was 1.40 for fatal crashes. The rate of fatal road traffic accidents in outer cities was 3.2 times higher than in inner ones. Conclusions Our findings reveal that there are temporal variations in traffic accidents, and long holidays significantly influence accident rates. Traffic injuries have different patterns on outer/inner city roads, based on weekday and holiday status. Thus, these findings could be used to create effective initiatives aimed at traffic management.

Background Traffic accidents with about 1.24 million deaths and 20 to 50 million cases of injury or disability per year are one of the most important public health challenges around the world. In Iran, traffic accidents, with an annual incidence of 32 cases per 100 thousand people, are considered as the second leading cause of death and the most common cause of injury. Objectives This study aimed to evaluate the epidemiological pattern and mortality rate caused by traffic accidents during year 2012 in the Khuzestan province and its cities. Materials and Methods In this cross-sectional study, all data related to fatal traffic accident referrals to legal medicine center of Khuzestan province during year 2012 were obtained and analyzed. Road traffic accidents mortality rate during this year was calculated for the province and its cities. The data were analyzed using Stata 11 statistical software. Results In 2012, one thousand and twenty deaths related to traffic accidents occurred in Khuzestan province. The incidence of deaths due to accidents in Khuzestan province was 22.5 and the standardized age of incidence was 24.3 per 100 thousand people. Regarding gender, 78.24% of the dead individuals were male and 21.76% were female. The most common final causes of death were head trauma (76.27% cases) and bleeding (12.55% cases). The most deceased people were drivers (42.55%), passengers (34.90%), and pedestrians (21.27%). The highest traffic accidents mortality rate in Khuzestan province was observed in Hoveizeh (55.43 per one hundred thousand), Omidiye (55.30 per one hundred thousand) and Ramhormuz (53.12 per one hundred thousand), and the lowest incidence rates belonged to Lali (5.35 per one hundred thousand) and Shadegan (9.78 per one hundred thousand). Conclusions This study showed that drivers, passengers and pedestrians were the most vulnerable road users. Regarding the fact that most of them were illiterate or had primary education and were self-employed or laborers, it seems essential to develop plans not only to train the road users but also to evaluate the safety of vehicles and roads and post-accident care programs, and consequently, implement special programs fully and strictly in order to reduce traffic fatalities.

Background: The burden of traffic accidents on pedestrians is very high in Iran. Since the pattern of injury is different in urban and suburban accidents, this study was conducted to identify the risk factors associated with pedestrian mortality in urban and suburban traffic accidents in Tehran and Alborz Provinces. Materials and Methods: The data of all traffic accidents related to pedestrians in Tehran and Alborz Provinces were investigated from two databases of traffic police and forensic medicine. The effects of demographic variables (age and gender) and pedestrian position, time, accident location, and vehicle type on the outcome of pedestrian death were investigated. Multiple logistic regression was used to analyze the data. The significance level was considered 65 years compared to 15–24 years (odds ratio [OR]: 2.04, confidence interval [CI]: 1.26–3.3), (OR: 4.8, CI: 2.9–7.9), male gender (OR: 2.26, CI: 1.6–3.1), lighting condition at night compared to day (OR: 1.6, CI: 1.2–2.1), two-way not divided road versus one-way road (OR: 1.6, CI: 1.12–2.3), the status of day after holidays compared to normal days (OR: 1.53, CI: 1.09–2.14), type of vehicle such as heavy or semi-heavy and conventional or pickup versus motorcycles or bicycles (OR: 5.4, CI: 3.1–8.9) and (OR: 1.8, CI: 1.2–2.7) and pedestrian position at crossing the road from an unauthorized route compared to crossing the road from the authorized route (OR: 1.94, CI: 1.4–2.6) were significant on the fatality. Whereas in suburban accidents, there was a statistically significant correlation with pedestrian fatality only in two-way divided road compared to one-way (OR: 0.2, CI: 0.05–0.77). Conclusion: The present study showed that risk factors for pedestrian mortality are different in urban and suburban traffic accidents. It is necessary to take appropriate measures in urban and suburban areas to reduce the severity of injuries in pedestrians.

Objectives While gender differences in physical activity (PA) have been reported, their origin is not well understood. The present study aimed to identify factors contributing to this disparity. Methods This was a population-based cross-sectional study based on the 2011 surveillance of risk factors of non-communicable diseases that was conducted among Iranian adults. Multi-staged sampling was performed to obtain the required study sample. The primary outcome was gender differences in the prevalence of sufficient physical activity (SPA). Total physical activity (TPA) was calculated as metabolic equivalents (MET) per minute during a typical week, as recommended by the World Health Organization. On this basis, achieving 600 MET-min/wk or more was defined as SPA. The nonlinear Blinder-Oaxaca decomposition technique was used to explain the disparity. Results The predicted gap was 19.50%. About one-third of the gap was due to differences in the level of observable covariates. Among them, work status contributed the most (29.61%). A substantial portion of the gap remained unexplained by such differences, of which about 40.41% was related to unobservable variables. The differential effects of standard of living, ethnicity, and smoking status made the largest contribution, accounting for 37.36, 35.47, and 28.50%, respectively. Conclusions Interventions to reduce the gender gap in PA should focus on increasing TPA among housewives and women with chronic diseases, as well as those with a higher standard of living. In addition, it is essential to explore the impact of ethnicity and smoking status on women's TPA in order to promote health.

Introduction Respecting patients’ rights is an essential component in health care. Passing a regulation is not a guarantee for the protection of patients’ rights. This article aimed to assess patients’ awareness of the contents of the Patient’s Bill of Rights in Iran and to determine if they had received a service compatible with their rights charter. Methods This is a descriptive study in 202 hospitalised patients. A questionnaire was used, and associations between variables were examined using Pearson’s correlation test. The significance level was p Results The patients’ ages ranged from 18 to 87 years of age, 33% were male and 79% were married. Patients’ knowledge was lowest regarding the need for consent for the treatment process and was highest regarding the patient’s right to know the expertise of the treatment team. The mean of patients’ knowledge was 77.56%. As for patients’ exercising their rights, the highest score belonged to the patient’s right for attending doctors and treatment team’s confidentiality; the lowest score belonged to the right to receive necessary information about probable complications, other treatment options and participation in the final selection of treatment method. The mean score of patient satisfaction was 8.06 (out of 11). There was no significant relationship with their education level or the number of admissions. Conclusion Health-care professionals can provide care based on patients’ rights, and their knowledge of patients’ rights needs to be evaluated. Educational programmes, leaflets, booklets and posters can be helpful in this regard. In addition, professional organisations and the Ministry of Health need to be more sensitive to this issue.

Background Needle and syringe programs (NSPs) are widely used to reduce harms associated with drug injecting. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach models of NSP on injection risk behaviours. Methods Self-reported data from 455 people who injected drugs (PWID) during 2014 in Kermanshah, Iran, were examined to measure demographic characteristics and risk behaviors. Self-reported and program data were also assessed to identify their main source of injection equipment. Participants were divided into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Coarsened exact matching was used to make the three groups statistically equivalent based on age, place of residence, education and income, and groups were compared regarding the proportion of borrowing or lending of syringes/cookers, reusing syringes and recent HIV testing. Results Overall, 76% of participants reported any NSP service use during the two months prior to interview. Only 23% (95%CI: 17–27) reported outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI: 0.10–0.70), recent syringe reuse (OR: 0.38, 95%CI: 0.23–0.68) and increased recent HIV testing (OR: 2.60, 95%CI: 1.48–4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI: 0.15–0.60), compared to facility-based NSP (OR: 1.25, 95%CI: 0.74–2.17). Conclusion These findings suggest that the outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and increasing the rate of HIV testing. Outreach NSP was even more effective than facility-based in reducing the lending of syringes to others. Scaling up outreach NSP is an effective intervention to further reduce transmission of HIV via needle sharing.

Background and Objectives: Due to the high rate of pedestrian deaths in traffic accidents and given that describing demographic profiles of pedestrian deaths and features of accident locations is an important factor in the prevention, management, and analysis of road traffic accidents, this study aimed at describing the demographic and personal patterns as well as environmental factors affecting the occurrence of road traffic accidents among pedestrians in Iran. Materials and Methods: This cross-sectional study was conducted on all pedestrian deaths caused by traffic accidents referred to the Forensic Medicine Organization in Iran from March 20, 2012, to March 19, 2013. In this study, demographic information as well as the information related to the accidents and other information including trauma location, the final cause of death, date of accident, date of death, time of death, and time of accident were examined. The information received from the Forensic Medicine Organization was first controlled and then analyzed using the Stata 11 software. Results: From a total of 4371 pedestrians died in 2012 due to traffic accidents, 3201 cases (73.2%) were males with a mean age of 48.1 ± 0.46 years, and 1170 cases (23.8%) were females with the mean age of 46.1 ± 0.77 years. In terms of age, education, and marital status, the highest frequencies of pedestrian deaths were, respectively, observed in the age group 65 years old and above (33.4%), the illiterate group (44.5%), and married people (67.9%). The highest and the lowest incidence rates of death were seen in Gilan (11 per 1000 people) and South Khorasan Provinces (2.4 per 100,000), respectively. Conclusions: Pedestrians as the most vulnerable people in traffic accidents comprise a large proportion of deaths and disabilities caused by road traffic accidents. It seems necessary to take some measures including paying special attention to physiological characteristics of the age group above 65 years old, doing close monitoring by the traffic police in October and the rush hours, and providing facilities for pedestrians to cross in busy locations of suburban areas.

Objectives The lower mortality rate of obese patients with heart failure (HF) has been partly attributed to reverse causation bias due to weight loss caused by disease. Using data about weight both before and after HF, this study aimed to adjust for reverse causation and examine the association of obesity both before and after HF with mortality. Methods Using the Atherosclerosis Risk in Communities (ARIC) study, 308 patients with data available from before and after the incidence of HF were included. Pre-morbid and post-morbid obesity were defined based on body mass index measurements at least three months before and after incident HF. The associations of pre-morbid and post-morbid obesity and weight change with survival after HF were evaluated using a Cox proportional hazard model. Results Pre-morbid obesity was associated with higher mortality (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.04 to 2.49) but post-morbid obesity was associated with increased survival (HR, 0.57; 95% CI, 0.37 to 0.88). Adjusting for weight change due to disease as a confounder of the obesity-mortality relationship resulted in the absence of any significant associations between post-morbid obesity and mortality. Conclusions This study demonstrated that controlling for reverse causality by adjusting for the confounder of weight change may remove or reverse the protective effect of obesity on mortality among patients with incident HF.