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Polycyclic aromatic hydrocarbons (PAHs) are one of the most important environmental pollutants. Urinary concentrations of 1-hydropyren metabolites of PAHs have been used as biomarkers of these chemicals' exposure in humans. This cross-sectional study was conducted on 468 healthy Iranian adults over 25 years old and non-smokers in six provinces who were selected based on the clustering method. Fasting urine sampling and body composition and demographic measurements were performed. Urine samples were analyzed by GC-MS. The analysis included descriptive statistics and analytical statistics using multiple linear regression by Python software. 1-Hydroxypyrene was found in 100% of samples, and the mean (Reference Value 95%) concentration of 1-hydroxypyrene was 6.12 (RV 95%: 20) μg/L and 5.95 (21) μg/gcrt. There was a direct relationship between the amount of body composition (body fat, visceral fat), BMI, and age with the urinary concentrations of 1-hydropyren metabolites, and this relationship was significant for BMI with urinary concentrations of 1-hydropyren metabolites (P = 0.045). The amount of 1-hydroxypyrene in healthy Iranian adults has been higher than in similar studies in other countries. These results provide helpful information regarding the exposure of Iranian adults to 1-hydroxypyrene, and these data can be used to supplement the national reference values of human biomonitoring for the interpretation of biomonitoring results. [ABSTRACT FROM AUTHOR]

Due to the increasing water crisis, the reuse of wastewater deserves attention as a method to reduce the pressure of the water crisis, especially in developing countries. The application of health risk assessment models is a way to estimate disease burdens associated with crop irrigation by wastewater effluents. In this study, a quantitative microbial risk assessment (QMRA) with probabilistic Monte-Carlo simulation was used to estimate the annual risk of enteroviruses (EVs) infection and disease burden for consumers of effluent-irrigated raw vegetables in Tehran, the capital of Iran. Wastewater effluent samples were collected over two seasons: summer and winter. EVs were analyzed in three stages, concentration and separation, cell culture, and real-time PCR (RT-PCR). A questionnaire was used to determine the dominant patterns of vegetable washing by consumers. There were 4 vegetable washing steps: wiping away mud (A), rinsing (B), using detergents (C), using disinfectants (D). 5 patterns of washing were examined in the laboratory and the concentration of enteroviruses was measured in every pattern. pattern 1: just wiping away mud (A), pattern 2: wiping away mud and rinsing (AB), pattern 3: wiping away mud by using detergents and rinsing (ABCB), pattern 4: wiping away mud by using disinfectants and rinsing (ABDB), and pattern 5: wiping away mud by using detergents and disinfectants and rinsing (ABCBDB). For washing pattern 1, pattern 2, and pattern 3, the estimated annual infection risk of EVs was estimated to be 5.6 × 10–1, 3.6 × 10–1, 1.7 × 10–1 (risk/per.day), and burden of disease was calculated as 3 × 10–2, 2 × 10–2, and 9 × 10–3 (burden/year), respectively. The results showed that if vegetables are washed according to method 5, the microbial risk will be minimized and the excess prevalence of viral infections will be eliminated. [ABSTRACT FROM AUTHOR]

Cancer is the second leading cause of death in the world and the third leading cause of death in Iran. It has been proven that numerous cancer cases are caused by exposure to environmental pollutants. There is a public health concern regarding an increase in exposure to carcinogens across Iran through different sources (air, food, and water) and a lack of research to address this issue. This study aims to gather data on exposure to heavy metals, polycyclic aromatic hydrocarbons (PAHs), and pesticides and their intake routes during the implementation of a national population health survey. This is a cross-sectional study of environmental pollutants in Iran, with a stratified multi-stage random sampling method, which led to 660 nationally representative samples in 132 clusters in three sequential parts. The first will be questionnaires to obtain demographics, assets, food records, air quality, and food frequency. The second will be physical measurements, including anthropometric and body composition. The third will be lab assessments that measure 26 types of environmental pollutants (7 heavy metals, 16 PAHs, and 3 pesticides) in urine, inhaled air, and consumed food and water of the population under study using ICP-MS and GS-MS devices. The results of this study will inform policymakers and the general population regarding the level of threat and will provide evidence for the development of interventional and observatory plans on the reduction of exposures to these pollutants. It could also be used to develop local standards to control contaminants through the three exposure routes. This study protocol will obtain data needed for policymakers to set surveillance systems for these pollutants at the national and provincial level to address the public concerns regarding the contamination of food, air, and water. [ABSTRACT FROM AUTHOR]

Every year, almost eight million people die from tobacco-related diseases, among which around 1.2 million die from secondhand smoke (SHS) exposure. Generally, it is estimated that SHS constituents generated in the interval between puffs are approximately 3 times more toxic than those produced at the moment of puffing. There is no risk-free level of SHS exposure, and even brief exposure can be harmful to health. The aim of this study was to assess SHS exposure and its trend in the different provinces of Iran from 1990 to 2013. To collect available data on SHS exposure, a systematic review was performed. We searched international and national databases using a combination of Medical Subject Headings (MeSH) and relevant text words in the titles, abstracts, and/or keywords. Also, the data in national surveys were gathered. The frequency of exposure in different provinces as well as age, sex, and rural/urban areas were extracted. Afterwards, modeling was done to estimate SHS exposure from the smoking data. According to our findings, SHS exposure was more prevalent among young people. Moreover, this exposure was greater in rural areas as compared to urban areas. A national study on 13–15-year-old individuals showed the highest exposure occurred outdoors. In addition, a declining trend was observed on SHS exposure over time. It seems that attention to the importance of SHS exposure in researches in Iran dates back to 2001, and gradually, especially in recent years, further studies have been conducted on SHS exposure. [ABSTRACT FROM AUTHOR]

The performance of conventional drinking water treatment plants (WTPs) can be improved using quantitative microbial risk assessment (QMRA). A QMRA study on Cryptosporidium using actual pathogen density was conducted to examine the performance of Jalaliyeh WTP in Tehran, Iran. The infection risk and the burden of disease attributed to the parasite presence in finished water were estimated incorporating physical and chemical log reduction values (LRVs), using stochastic modeling and disinfection profiling. The risk and burden of disease were compared with health-based targets, i.e. one case of infection per 10,000 people or 10−6 DALYs per person per year. The parasite's LRVs were 2.31 and 0.034 log provided by physico-chemical treatment and disinfection processes, respectively. The mean of estimated risk (111 cases per 104 people per year) and the burden of disease (11.7 DALYs per 106 people per year) both exceeded the targets. To control the excess risk, three QMRA-based disinfection scenarios were examined including: (1) employing chlorine dioxide (ClO 2) instead of chlorine (2) ozonation with a concentration of 0.75 mg/L (Ct = 22.5 min mg/L) and (3) UV irradiation with a dose of 10 mJ/cm2. The LRV of parasite may be increased to 3.0, 5.1 and 4.9 log by employing ClO 2 , ozonation and UV irradiation, respectively. The use of ozone or UV as alternative disinfectants, could enhance the disinfection efficacy and provide sufficient additional treatment against the excess risk of parasite. QMRA could make it easier applying appropriate improvement to conventional WTPs in order to increase the system performance in terms of health-based measures. Image 1 • Cryptosporidium actual density monitoring in a conventional water treatment system. • Quantifying risk reduction performance of treatment for Cryptosporidium using QMRA. • Infection risk was ∼0.01/person/year and disease burden was ∼10−5 DALYs/person/year. • Infection risk and disease burden both exceeded the targets for drinking water. • Applying QMRA-based disinfection scenarios using ozone or UV to control excess risk. [ABSTRACT FROM AUTHOR]

Background: Environmental health monitoring and its effects on health are very important in health systems. Relationship between environment and health can be done by simplifying data in understandable indicators for people and policy-makers. The present study presents the general framework for formulating environmental health quality index for Iran. Methods: This study was implemented through expert panel at two levels: indicator domain determination and domain specific variables selection. Domain specific variables were selected based on the Driving force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework from the list of national and international variables. Results: Seven environmental health issues [air quality, drinking water, sewage disposal, food, radiation management and housing and human settlements] were determined, and three variables were selected for air quality, 8 variables for water quality, 5 variables for sanitation, 1 variable for food quality, 3 variables for housing and human settlements, 4 variables for solid waste management and 3 variables for radiation management. Conclusions: Environmental health indicators determination based on the causal effect model leads to a better understanding of the relationship between the environment and health by simplifying data in an understandable format for public and improves prioritization of policy-making in the environmental health. In this study, environmental health indicators for Iran were proposed. [ABSTRACT FROM AUTHOR]

In livestock and poultry, broad-spectrum antibiotics such as tetracyclines and fluoroquinolones are widely used; thus, controlling food productions made from these animals is a necessary task. Meat may contain residues of antibiotics, even in low concentrations, which can cause a selection pressure for antibiotic resistance. Therefore, measurement of amounts of antibiotics in meat is of major importance. A total of 41 beef and 41 chicken meat samples were collected for 1 year. Tetracycline and ciprofloxacin were extracted from samples and tested by an indirect competitive enzyme-linked immunosorbent assay. Overall, 100% of the beef and more than 95% of the chicken meat samples were positive for ciprofloxacin. Only one of the chicken meat samples had concentrations of ciprofloxacin higher than maximum residue limit (MRL). For ciprofloxacin, none of the beef meat samples exceeded the MRL. For tetracycline, 75% of the beef and 58% of the chicken meat samples were positive. All of the samples had concentrations of tetracycline lower than MRL. It was revealed that the chicken meat samples had higher levels of both antibiotics than those of beef samples. The amounts of tested antibiotics were not high in the meat samples, consequently using of beef and chicken meat by consumers in Iran is not resulted in entrance of high amounts of the antibiotics into human body. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate chemical composition of PM10 (particulate matter with aerodynamic diameter ≤ 10 μm) during dust storm and inversion in Tehran and hemolysis effects. Methods: PM10 was sampled in Tehran, Iran, during dust storm and inversion conditions. Water soluble ions (F¯, Cl¯, NO2¯, NO3¯, SO4¯2, Na+, K+, NH4+, Ca+2, Mg+2) and elements (Al, Ba, Cd, Co, Cr, Cu, Fe, Li, Mn, Mo, Ni, Pb, Se, Sn, Sr, V, Zn, Pt, Rh, Pd, As and Si) were analyzed by ion chromatograph (IC) and inductively coupled plasma optical emission spectrometer (ICP-OES), respectively. Hemolysis was examined as in vitro at PM10 concentrations of 50–300 μg/ml. Results: Daily average of PM10 concentrations in dusty and inversion days were 348.40 and 220.54 μg/m3, respectively. Most prevalence ionic components were NO3¯, Cl¯, SO4¯2 and Ca+2 during dust storm and SO4¯2, NO3¯, Cl¯ and NH4+ during inversion. Si, Fe and Al had the maximum values in both conditions. Particles associated with both conditions induced hemolytic responses. PM10 from dusty day showed a higher hemolysis percent (10.24 ± 4.67%) than inversion (9.08 ± 5.47%), but this difference was not significant (p = 0.32). Hemolytic effects were significantly intensified by increased PM concentrations (p < 0.001) in a dose-response manner. Conclusions: As the results, chemical composition of sampled particles from inversion days and dust storm was different from each other. Hemolytic effects of particles during dust storm were more than inversion days. However, this difference was not statistically significant. [ABSTRACT FROM AUTHOR]

The relationship between apparent temperature and cardiovascular disease (CVD) mortality was studied in Rasht, Iran, from 2005 to 2014. The effects of apparent temperature on CVD mortality were investigated using the distributed lag nonlinear model. Data on all types of cardiovascular mortality cases according to the International Classification of Diseases were collected from the only cardiovascular hospital in Rasht, and the meteorological variables were obtained from Rasht Meteorological Center during the period of study. Our findings showed that low temperatures had significant impacts on CVD mortality, and a reverse J-shaped temperature-mortality relationship was found. Moreover, immediate effects of hot temperatures on CVD mortality with the strongest effects on the same day but delayed effects of cold temperature was observed. This study showed that exposure to both hot and cold apparent temperatures was associated with increased cardiovascular mortality in Rasht. [ABSTRACT FROM AUTHOR]

Background: Polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDFs) are highly toxic persistent organic pollutants (POPs), which can cause various health outcomes, such as cancer. As a part of the National and Sub-national Burden of Disease Study (NASBOD), we aimed to estimate dioxins and furans national emissions, identify their main sources, estimate daily intake doses, and assess their trend from 1990-2010 in Iran. Methods: The Toolkit for Identification and Quantification of Releases of Dioxins, Furans and Other Unintentional POPs, which is developed by the United Nations Environment Programme (UNEP 2013), was used to estimate the emissions of PCDD/PCDFs from several sources into the air, water, land, residue, and other products. The daily intake doses were estimated using a linear regression of estimated emissions by UNEP Toolkit and average intake doses in other countries. Finally, the trend of PCDD/PCDFs emissions and daily intake doses were explored from 1990-2010. Results: The total emissions were estimated as 960 g Toxic Equivalents (g TEQ) for 1990 and 1957 g TEQ for 2010 (18.2 and 26.8 g TEQ per million capita, respectively). The estimations suggest that albeit contribution of open burning to PCDD/PCDFs emissions has been declining from 1990 to 2010, it remained the major source of emissions in Iran contributing to about 45.8% out of total emissions in 1990 to 35.7% in 2010. We further found that PCDD/PCDFs are mostly emitted into the ambient air, followed by residue, land, products, and water. The daily intake doses were estimated to be 3.1 and 5.4 pg TEQ/kg bw/day for 1990 and 2010, respectively. We estimated an increasing trend for PCDD/PCDFs emissions and intake doses in Iran from 1990-2010. Conclusions: The high levels of emissions, intake doses, and their increasing trend in Iran may pose a substantial health risk to the Iranian population. Further studies with more rigorous methods are recommended but this should not circumvent taking appropriate policy actions against these pollutants. Currently, Iran has no standard for dioxins and furans. Adaptation of the World Health Organization recommended guidelines might be an appropriate starting point to control dioxins and furans emissions. [ABSTRACT FROM AUTHOR]

Blending of water from different sources into an urban drinking water distribution system can have unintended impacts, such as corrosion and/or release of corrosion by-products from pipe surfaces. Hamedan, a city in west Iran, receives water from four different sources that have different physical and chemical characteristics. The potential for iron release from iron distribution pipes due toin situblending of different sources was investigated in this study. A dedicated software was developed to calculate the corrosion indices of different blends expected in different zones of Hamedan’s water distribution system. The calculated corrosion indices, and iron release were verified and correlated to actual conditions through water sampling conducted in different zones of the city. The Langelier index (LI), Ryznar stability index (RSI or RI), Puckorius scaling index (PSI), and the calcium carbonate precipitation potential were found to be −0.60 ± 0.30, 8.63 ± 0.57, 8.18 ± 0.34, and −10.95 ± 6.9 mg CaCO3/L, respectively. Alkalinity, pH, and carbonate ion were identified as the important parameters that have a role in the control of iron release. Significant linear correlations of LI, RI, and PSI to iron concentration were observed in samples collected from different zones of the distribution system. The spatial correlation between iron concentration and corrosion indices in different zones of the water distribution system was determined using ordinary Kriging interpolation. These indices indicated a wide variation of corrosive potential in different zones of the distribution system. Therefore, these corrosion indices can be used to estimate, monitor, and minimize the potential for iron release from distribution systems. [ABSTRACT FROM AUTHOR]

Potential of wastewater treatment in car industry and groundwater contamination by volatile organic compounds include perchloroethylene (PCE), trichloroethylene (TCE) and dichloromethane (DCM) near car industry was conducted in this study. Samples were collected in September through December 2011 from automobile industry. Head-space Gas chromatography with FID detector is used for analysis. Mean PCE levels in groundwater ranged from 0 to 63.56 μg L with maximum level of 89.1 μg L. Mean TCE from 0 to 76.63 μg L with maximum level of 112 μg L. Due to the data obtained from pre treatment of car staining site and conventional wastewater treatment in car factory, the most of TCE, PCE and DCM removed by pre aeration. Therefor this materials entry from liquid phase to air phase and by precipitation leak out to the groundwater. As a consequence these pollutants have a many negative health effect on the workers by air and groundwater. [ABSTRACT FROM AUTHOR]

Because of the recent frequent observations of major dust storms in southwestern cities in Iran such as Ahvaz, and the importance of the ionic composition of particulate matters regarding their health effects, source apportionment, etc., the present work was conducted aiming at characterizing the ionic composition of total suspended particles (TSP) and particles on the order of ∼10 μm or less (PM) during dust storms in Ahvaz in April-September 2010. TSP and PM samples were collected and their ionic compositions were determined using an ion chromatography. Mean concentrations of TSP and PM were 1,481.5 and 1,072.9 μg/m, respectively. Particle concentrations during the Middle Eastern Dust (MED) days were up to four times higher than those in normal days. Ionic components contributed to only 9.5% and 11.3% of the total mass of TSP and PM, respectively. Crustal ions were most abundant during dust days, while secondary ions were dominant during non-dust days. Ca/Na and Cl/Na ratios can be considered as the indicators for identification of the MED occurrence. It was found that possible chemical forms of NaCl, (NH)SO, KCl, KSO, CaCl, Ca(NO), and CaSO may exist in TSP. Correlation between the anionic and cationic components suggests slight anion and cation deficiencies in TSP and PM samples, though the deficiencies were negligible. [ABSTRACT FROM AUTHOR]

Levels of tributyltin (TBT) and its degradation products, mono (MBT) and dibutyltin (DBT), were monitored in fish commonly consumed in Iran. Samples were purchased from fish markets at seasonal intervals in 2010 along the North coast of Iran. Concentration of MBT, DBT and TBT in the muscle of these fish were in the range of n.d. −1.01 ± 0.84, n.d. −0.33 ± 0.26 and n.d. −4.31 ± 0.95 ngg (wet weight), respectively. Residue levels of butyltins were found lower than the tolerable average residue level of 100 ngg (wet weight). [ABSTRACT FROM AUTHOR]

The aim of this study was estimation of PCDD/PCDFs emissions from various sources in Iran. The results indicated total PCDD/PCDFs emissions in Iran in 2010, was 1,957 g TEQ. Of this amount, about 705.8, 0.5, 463.5, 144.1 and 643.2 g TEQ/year was released to air, water, land, products, and in residues, respectively. Open burning processes and metal production are the major contributors to be known environmental sources of PCDD/PCDFs that contribute to about 70% of total PCDD/PCDFs emissions in Iran. The results showed that total PCDD/PCDFs emissions in Iran per inhabitant were about 26.5 g TEQ/million that is high relatively. [ABSTRACT FROM AUTHOR]

Potential of groundwater contamination by trichloroethylene (TCE) and other volatile organic compounds VOCs near car industry was conducted in this study. TCE, PCE, toluene, xylene, dichloromethane, cyclohexane, n-hexane and n-pentane were detected in all groundwaters. Mean TCE levels in groundwater ranged from 124.37 to 1,035.9 μg L with maximum level of 1,345.7 μg L. Due to the data obtained from conventional wastewater treatment in car factory the TCE removal efficiency was only 24 percent which necessitates the TCE removal by advanced treatment processes before the use of well water. [ABSTRACT FROM AUTHOR]

The waste management practices in primary healthcare centres of Iran were investigated in the present study. A total of 120 primary healthcare centres located across the country were selected using the cluster sampling method and the current situation of healthcare waste management was determined through field investigation. The quantities of solid waste and wastewater generation per outpatient were found to be 60 g outpatient-1 day-1 and 26 L outpatient-1 day-1, respectively. In all of the facilities, sharp objects were separated almost completely, but separation of other types of hazardous healthcare solid waste was only done in 25% of the centres. The separated hazardous solid waste materials were treated by incineration, temporary incineration and open burning methods in 32.5, 8.3 and 42.5% of the healthcare centres, respectively. In 16.7% of the centres the hazardous solid wastes were disposed of without any treatment. These results indicate that the management of waste materials in primary healthcare centres in Iran faced some problems. Staff training and awareness, separation of healthcare solid waste, establishment of the autoclave method for healthcare solid waste treatment and construction of septic tanks and disinfection units in the centres that were without access to a sewer system are the major measures that are suggested for improvement of the waste management practices. [ABSTRACT FROM AUTHOR]

A cross-sectional survey was conducted by random cluster sampling in the city of Tehran. Knowledge of the drivers was assessed with 6 questions about national traffic laws. Attitude was assessed on a 7-item scale of drivers' perceptions. Behavior was observed by a police officer on 13 areas of assessment. Correlations were low among these three scores. Drivers with advanced education had higher scores on behavior. Knowledge, attitude, and behavior of these drivers did not seem associated. [ABSTRACT FROM AUTHOR]

Please note that the corresponding author's correct affiliation is "Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. [ABSTRACT FROM AUTHOR]

Population exposure to environmental contaminants can be precisely observed through human biomonitoring studies. The present study aimed to systematically review all the biomonitoring studies conducted in Iran on some selected carcinogen environmental pollutants. In this systematic review study, 11 carcinogen agents were selected including arsenic, cadmium, chromium, nickel, lindane, benzene, trichloroethylene (TCE), pentachlorophenol (PCP), radon-222, radium-224, − 226, − 228, and tobacco smoke. The Web of Science, PubMed, and Scopus databases were searched for peer-reviewed articles published in English. After several screening steps, data were extracted from the studies. Meta-analyses (a random-effect model using the DerSimonian-Laired method) were performed only for the biomarkers with more than three eligible articles, including cadmium in blood and breast milk, and arsenic in breast milk. Methodological quality of the studies was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. Of the 610 articles found in the database search, 30 studies were eligible for qualitative review, and 13 were included in the meta-analysis (cadmium in blood (n = 3), cadmium in breast milk (n = 6), and arsenic in breast milk (n = 4)). The overall pooled average concentrations (95% CI) of cadmium in blood, cadmium in breast milk, and arsenic in breast milk were 0.11 (95% CI: 0.08, 0.14), 5.38 (95% CI: 3.60, 6.96), and 1.42 (95% CI: 1.02, 1.81) µg/L, respectively. These values were compared with the biomarker concentrations in other countries and health-based guideline values. This study showed that there is a need for comprehensive action plans to reduce the exposure of general population to these environmental contaminants. • 30 study were eligible for qualitative review. • 13 were included in the meta-analysis. • Meta-analysis showed higher levels of As and Cd than in the developed countries. • There is a need for action plans to reduce the exposure of general population. [ABSTRACT FROM AUTHOR]

In line with the commemoration of the scientists who played a significant role in advancing knowledge and providing services to the country, it is imperative to publish their biographies so that their lives and achievements are recorded in the history of the country and serve as an example for future generations. Dr. Bijan Sadrizadeh, a physician and a public health specialist, undertook many valuable activities, particularly in the field of public health in Iran and the world during more than 60 years of great services, including the promotion of public health in the Islamic Republic of Iran, the development of I.R. Iran's international collaborations in the field of public health, and the development of research programs in the field of neglected tropical diseases and the eradication of polio in the world. He served the country in many high-level executive capacities, including three periods as deputy Minister of Health. In addition to several years of full-time employment in the World Health Organization (WHO), Dr. Sadrizadeh also served on the WHO Executive Board and was a member of numerous scientific and advisory committees. In reviewing his life, great determination, devotion, believing in primary health care and universal health coverage and a deep sense of responsibility are visible and can be an inspiration and a model for all. [ABSTRACT FROM AUTHOR]

Air pollution has been identified as one of the most challenging health issues in urban areas worldwide. The aim of this study was to investigate the association between short-term exposure to ambient air pollution and respiratory disease over a long-term period in Shiraz, one of the largest cities in Iran. Methods: hospital admissions due to respiratory diseases (asthma, pneumonia, chronic obstructive pulmonary disease (COPD) and pleural effusion) in residents of Shiraz between March 21, 2009 and March 20, 2015 were included. Demographics for each patient and meta data to include principal meteorological variables (temperature and relative humidity) and five ambient pollutants (CO, O 3 , SO 2 , NO 2 , and PM 10) were also included. Statistical analysis was performed by Poisson regression in single-pollutant generalized linear model with principal component analysis (GLPCA) to analyze the relationship between pollutants and hospital admissions at the 0–9 cumulative lag day period. Pearson correlation test was used to determine the relationship between different pollutants, temperature and humidity. It was found that the highest increase in asthma admission was related to PM 10 (relative risk (RR) = 1.31, 95% CI = 1.17, 1.47). For COPD, the rate of hospital visits significantly increased with the increase in NO 2 concentration (RR = 1.17, 95% CI = 1.09.1.27). In the children's hospital, O 3 (RR = 1.25, 95% CI = 1.06, 1.47) and SO 2 (RR = 1.17, 95% CI = 1.07, 1.28) affected the asthma admissions and all contaminants (highest RR observed was for NO 2 (RR = 1.28 95% CI = 1.18, 1.40) affected pneumonia admissions on cumulative lag days of 0–9. Conclusions: These data confirm an association between ambient air pollutants and hospital admissions due to respiratory disease. Image 1 • The first air pollution and respiratory hospital admission study PCA model in world. • The first air pollution and respiratory duration of hospitalization study PCA model in world. • The study site in particular is regarded as one of the dustiest areas worldwide and thus this study is very important. • Respiratory hospital admissions in Shiraz increased positively with short-term exposure to PM 10 , CO, NO 2, O 3. • PM 10 has the strongest impact. [ABSTRACT FROM AUTHOR]

Dr Malekafzali, an elite biostatistics professor at Tehran University of Medical Sciences, in his more than 50 years of glorious service, has played a crucial role in creation of fundamental evolution in public health, reproductive health and development of applied research in Iran. He has left lasting activities in administrative positions such as health and research deputies, health minister consultant, director of health faculty and director of health research institutes. He published several books and articles on statistics, epidemiology and public health. This article is a review of his worthy and interesting activities in the country's health, research and education. [ABSTRACT FROM AUTHOR]

BACKGROUND: Management and cleaning of large environmental monitored data sets is a specific challenge. In this article, the authors present a novel framework for exploring and cleaning large datasets. As a case study, we applied the method on air quality data of Tehran, Iran from 1996 to 2013. METHODS: The framework consists of data acquisition [here, data of particulate matter with aerodynamic diameter ≤10 µm (PM10)], development of databases, initial descriptive analyses, removing inconsistent data with plausibility range, and detection of missing pattern. Additionally, we developed a novel tool entitled spatiotemporal screening tool (SST), which considers both spatial and temporal nature of data in process of outlier detection. We also evaluated the effect of dust storm in outlier detection phase. RESULTS: The raw mean concentration of PM10 before implementation of algorithms was 88.96 µg/m3 for 1996-2013 in Tehran. After implementing the algorithms, in total, 5.7% of data points were recognized as unacceptable outliers, from which 69% data points were detected by SST and 1% data points were detected via dust storm algorithm. In addition, 29% of unacceptable outlier values were not in the PR. The mean concentration of PM10 after implementation of algorithms was 88.41 µg/m3. However, the standard deviation was significantly decreased from 90.86 µg/m3 to 61.64 µg/m3 after implementation of the algorithms. There was no distinguishable significant pattern according to hour, day, month, and year in missing data. CONCLUSION: We developed a novel framework for cleaning of large environmental monitored data, which can identify hidden patterns. We also presented a complete picture of PM10 from 1996 to 2013 in Tehran. Finally, we propose implementation of our framework on large spatiotemporal databases, especially in developing countries. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study aimed to evaluate and compare the prediction accuracy of two data mining techniques, including decision tree and neural network models in labeling diagnosis to gastrointestinal prescriptions in Iran. METHODS: This study was conducted in three phases: data preparation, training phase, and testing phase. A sample from a database consisting of 23 million pharmacy insurance claim records, from 2004 to 2011 was used, in which a total of 330 prescriptions were assessed and used to train and test the models simultaneously. In the training phase, the selected prescriptions were assessed by both a physician and a pharmacist separately and assigned a diagnosis. To test the performance of each model, a k-fold stratified cross validation was conducted in addition to measuring their sensitivity and specificity. RESULT: Generally, two methods had very similar accuracies. Considering the weighted average of true positive rate (sensitivity) and true negative rate (specificity), the decision tree had slightly higher accuracy in its ability for correct classification (83.3% and 96% versus 80.3% and 95.1%, respectively). However, when the weighted average of ROC area (AUC between each class and all other classes) was measured, the ANN displayed higher accuracies in predicting the diagnosis (93.8% compared with 90.6%). CONCLUSION: According to the result of this study, artificial neural network and decision tree model represent similar accuracy in labeling diagnosis to GI prescription. [ABSTRACT FROM AUTHOR]

BACKGROUND: Iran has witnessed a substantial demographic and health transition, especially during the past 2 decades, which necessitates updated evidence-based policies at national and indeed at subnational scale. The National and Subnational Burden of Diseases, Injuries, and Risk Factors (NASBOD) Study aims to provide the required evidence based on updated data sources available in Iran and novel methods partly adopted from Global Burden of Disease 2010. OBJECTIVE: This paper aims at explaining the motives behind the study, the design, the definitions, the metrics, and the challenges due to limitations in data availability.METHODS: All available published and unpublished data sources will be used for estimating the burden of 291 diseases and 67 risk factors from 1990 to 2013 at national and subnational scale. Published data will be extracted through systematic review. Existing population-based data sources include: registries (death and cancer), Demographic and Health Surveys, National Health Surveys, and other population-based surveys such as Non_Communicable Diseases Surveillance Surveys. Covariates will be extracted from censuses and household expenditure surveys. Hospital records and outpatient data will be actively collected as two distinct projects. Due to lack of data points by year and province, statistical methods will be used to impute the lacking data points based on determined covariates. Two main models will be used for data imputation: Bayesian Autoregressive Multi-level models and Spatio-Temporal regression models. The results from all available models will be used in an Ensemble Model to obtain the final estimates. Five metrics will be used for estimating the burden: prevalence, death, Years of Life Lost due to premature death (YLL), Years of Life Lost due to Disability (YLD), and Disability-Adjusted Life Years Lost (DALY). Burden attributable to risk factors will be estimated through comparative risk assessment based on Population Attributable Fraction (PAF). Uncertainty Intervals (UIs) will be calculated and reported for all aforementioned metrics. RESULTS: We will estimate trends in terms of prevalence, deaths, YLLs, YLDs, and DALYs for Diseases, Injuries, and Risk Factors province from 1990 to 2013. CONCLUSION: Results of the present study will have implications for policy making as they address health gaps in Iranian population and their inequality between provinces. [ABSTRACT FROM AUTHOR]

Background: Development of national evidence-based public health strategies requires a deep understanding of the role of major risk factors (RFs) and the burden of disease (BOD). In this article, we explain the framework for studying the national and sub-national Environmental Burden of Disease (EBD) in Iran as a part of the National and Sub-national Burden of Disease (NASBOD) study. Methods: The distribution of exposures to environmental RFs and their attributable effect size over 1990-2013 will be estimated through comprehensive reviews of either published or unpublished sources. Statistical modeling will be used to impute missing data in the distribution of RFs exposures for each district-year. National and sub-national BOD attributable to these RFs will be estimated in the following metrics: prevalence, death, years of life lost due to premature death (YLL), years of life lost due to disability (YLD), and disability-adjusted life years lost (DALYs).The BOD attributable to the current distribution of exposures will be compared with a counterfactual exposure distribution scenario-here, the theoretical-minimum-risk exposure distribution. Inequalities in the distribution of exposure to RFs will be analyzed and manifested nationwide using geographic information systems. Discussion: The EBD study aims to provide an official report to Iranian Ministry of Health and Medical Education, to publish a series of articles on the exposure trends of the selected environmental RFs, to estimate the BOD attributable to these RFs, and to assess inequalities and its determinants in the distribution of exposure to RFs. Iran's territory is large with diverse population, socioeconomic, and geographic areas. Results of this comparative risk assessment study may pave the way for health policy makers to plan more comprehensive and cost-effective evidence-based strategies. [ABSTRACT FROM AUTHOR]

Prevalence of skin lesions was investigated among 752 participants in eight villages in Kurdistan province in Iran with emphasis on total lifetime intake of arsenic from drinking water (TLIA). The participants were selected from eight villages with different exposure levels using a cluster-sampling technique. TLIA was calculated for each individual taking into account the type of water supply and their mean annual arsenic concentration. The study showed that 49 persons (6.5%) were suffering from hyperkeratosis and 20 persons (2.7%) from hyperpigmentation. The correlation between hyperkeratosis and hyperpigmentation was significant (R =0.325, p <0.01). Using the logistic regression model it was found that the relationship between TLIA and hyperkeratosis (OR=1.14, 95% CI=1.039–1.249), and hyperpigmentation (OR=1.254, 95% CI=1.112–1.416) was also significant. In conclusion, TLIA can be applied as a reliable indicator for the assessment of exposure. [Copyright &y& Elsevier]

Exposure to metal(loid)s can cause adverse health effects. This study evaluated the concentrations of aluminum, arsenic, cadmium, chromium, mercury, nickel, and lead in particulate matter <10 μm (PM 10 ) and in the urine of 100 participants from urban residential areas in Iran. A total of 100 residential buildings (one adult from each household) in six cities across Iran were recruited for this study. The levels of metal(loid)s in PM 10 and the urine of participants were measured using acid digestion followed by inductively coupled plasma mass spectrometry (ICP-MS). The average (±SE) PM 10 concentration in the buildings was 51.7 ± 3.46 μg/m 3 . Aluminum and cadmium had the highest and lowest concentrations among the metal(loid)s, averaging 3.74 ± 1.26 μg/m 3 and 0.01 ± 0.001 μg/m 3 , respectively. In 85 % of the samples, the concentration of metal(loid)s in indoor air exceeded WHO air quality standards. Cadmium and lead had the highest and lowest numbers of indoor air samples exceeding the recommended standards, respectively. A significant correlation was found between the concentration of metal(loid)s in urine samples and indoor PM 10 levels, as well as the wealth index of participants. There was also a significant direct relationship between the concentrations of nickel, arsenic, lead, and mercury in urine and the age of participants. Factors such as building location, type of cooling systems, use of printers at home, and natural ventilation influenced the concentration and types of metal(loid)s in the indoor air., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

The presence of organic and inorganic contaminants in drinking water is a global concern. Nitrate and phenol derivatives are examples of pollutants that could be of anthropogenic origin. They are associated with numerous health risks, underscoring the importance of monitoring their presence in drinking water. This study aimed to measure nitrate and phenol derivatives, including 2,4-Dichlorophenol (2,4-DCP), Pentachlorophenol (PCP), 2,4,5-Trichlorophenol (2,4,5-TCP), 2-Chlorophenol (2-CP), 4-Chlorophenol (4-CP), and phenol, in Tehran's water distribution system (WDS). The pollutants in Tehran's WDS were significantly and positively correlated with precipitation. The Hazard Quotient (HQ) and the Excess Lifetime Cancer Risk (ELCR) of the detected pollutants were estimated. The results showed that the regional mean of nitrate and PCP in Tehran's WDS were 35.58±8.71mg L -1 and 76.14±16.93 ng L -1 lower than the guideline values of 50 mg L -1 and 1000 ng L -1 , respectively. Some districts exhibited nitrate concentration exceeding the allowable limit by a factor of 1.2 to 2.3. Consequently, the nitrate intake in some districts constituted approximately 50% of the reference dose. While PCP as a phenol derivative with more health concerns was identified in Tehran's WDS, the likelihood of its health effects was determined to be negligible.

The burden of disease attributable to exposure to heavy metals via drinking water in Iran (2019) was assessed at the national and regional levels. The non-carcinogenic risk, carcinogenic risk, and attributable burden of disease of heavy metals in drinking water were estimated in terms of hazard quotient (HQ), incremental lifetime cancer risk (ILCR), and disability-adjusted life year (DALY), respectively. The average drinking water concentrations of arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), mercury (Hg), and nickel (Ni) in Iran were determined to be 2.3, 0.4, 12.1, 2.5, 0.7, and 19.7 μg/L, respectively, which were much lower than the standard values. The total average HQs of heavy metals in drinking water in the entire country, rural, and urban communities were 0.48, 0.65 and 0.45, respectively. At the national level, the average ILCRs of heavy metal in the entire country were in the following order: 1.06 × 10 -4 for As, 5.89 × 10 -5 for Cd, 2.05 × 10 -5 for Cr, and 3.76 × 10 -7 for Pb. The cancer cases, deaths, death rate (per 100,000 people), DALYs, and DALY rate (per 100,000 people) attributed to exposure to heavy metals in drinking water at the national level were estimated to be 213 (95% uncertainty interval: 180 to 254), 87 (73-104), 0.11 (0.09-0.13), 4642 (3793-5489), and 5.81 (4.75-6.87), respectively. The contributions of exposure to As, Cd, Cr, and Pb in the attributable burden of disease were 14.7%, 65.7%, 19.3%, and 0.2%, respectively. The regional distribution of the total attributable DALY rate for all heavy metals was as follows: Region 5> Region 4> Region 1> Region 3> Region 2. The investigation and improvement of relatively high exceedance of As levels in drinking water from the standard value, especially in Regions 5 and 3 as well as biomonitoring of heavy metals throughout the country were recommended., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Clostridium difficile is a leading causative agent of hospital-acquired and community-acquired diarrhea in human. This study aims to characterize the predominant C. difficile strains, RT001 and 126, circulating in Iranian hospitals in relation to resistant phenotypes, the antibiotic resistance genes, and their genetic relatedness. A total number of 735 faecal specimens were collected from patients suspected of CDI in Tehran hospitals. Typing and subtyping of the strains were performed using CE-PCR ribotyping and MLVA, respectively, followed by PCR assays for ARGs and indicators of Tns. Minimum inhibitory concentrations (MICs) of five antibiotics were determined by MIC Test Strips. Among 65 strains recovered from CDI patients, RT001 (32.3%) and RT126 (9.2%) were found as the most frequent ribotypes, and 64 MLVA types were identified. Using MLVA, RT001 and RT126 were subtyped into 6 and 4 groups, respectively. The vanA, nim, tetM, gyrA, gyrB genes were detected in 24.6%, 0%, 89.2%, 95.3%, and 92.3% of the strains, respectively. The indicators of Tns including vanHAX, tndX, and int were found in 0%, 3% and 29.2% of the strains, respectively. The most common amino acid (AA) alterations of GyrA and GyrB were related to substitutions of Thr82 → Val and Ser366 → Val, respectively. Resistance rate to metronidazole, vancomycin, tetracycline, ciprofloxacin, and moxifloxacin was 81.5%, 30.7%, 85%, 79%, and 74%, respectively. This study, for the first time revealed the subtypes of circulating RT001 and RT126 in Iran. It is of importance that the majority of the strains belonging to RT001 were multidrug resistant (MDR). This study also pointed to the intra-hospital dissemination of the strains belonging to RT001 and RT126 for short and long periods, respectively, using MLVA. The most important resistance phenotypes observed in this study was vancomycin-resistant phenotypes. Resistance to metronidazole was also high and highlights the need to determine its resistance mechanisms in the future studies.

Acute and chronic exposure to cadmium can cause numerous health effects including poisoning, as well as, bone, liver, and kidney diseases. Cadmium competes with iron absorption in blood and can induce anemia. Cadmium body burden can be measured through urine and blood samples. Urine reflects chronic and blood indicates recent and cumulative exposures to cadmium. Dietary is considered as the main source of exposure to cadmium in non-smoking general population. The study was conducted to determine cadmium level in blood, urine, and in diet of 120 non-smoking adults in Tehran. Dietary components and consumption pattern of participants estimated by a food frequency questionnaire. Next, the correlation investigated between them. Moreover, serum ferritin measured as a marker of iron storage in blood to determine its association with cadmium. The prediction of cadmium fate in the body is determined by toxicokinetic models. This study tried to evaluate one of these models' validity which is developed to predict urinary cadmium from dietary. Afterwards, the predicted urinary compared with the measured urinary cadmium. The correlation coefficient between dietary and blood cadmium equaled 0.66 which was statically significant, but the correlation between dietary and urinary cadmium was minimal and not statically significant (p > 0.05). An inverse and negative correlation was found between serum ferritin and blood cadmium. The mean predicted urinary cadmium calculated by the model was 2.5-fold higher than the measured value in the total population. Results of the present study revealed that blood cadmium reflected mainly acute exposure. There was no correlation between chronic and acute exposures to cadmium. The low serum ferritin level increased cadmium amount in blood. Moreover, the mean predicted urinary cadmium by the model was greater than the measured value. It can because of characteristics of populations and type of dietary exposure. Thus, it is suggested that the model coefficients are determined in each society based on their characteristics.

The continuous discharge of antibiotic pharmaceuticals from incomplete wastewater treatment processes into receiving water bodies has become a matter of both scientific and public concern as antibiotics may exert adverse influences on non-target organisms. In this study, the occurrence of seven most commonly prescribed antibiotics belonging to four therapeutic classes of β-lactams, cephalosporins, macrolides, and fluoroquinolones were investigated in the effluent of two wastewater treatment plants (WWTPs) and two river waters: Firozabad Ditch (receiving effluent) and Kan River (not receiving effluent) in Tehran, Iran. In 2016, average consumption rate of target antibiotics in Tehran province was evaluated based on Anatomical Therapeutic chemical (ATC)/Defined Daily Dose (DDD) system and reported as DDD/1000 inh/day. The highest consumption rate was for amoxicillin (128017.6 mg/1000 inhabitants/day), whereas it remained lower for other compounds (amoxicillin > cefixime > azithromycin > ciprofloxacin > cephalexin > erythromycin > penicillin). Ciprofloxacin (79.62 mg/1000 inh/d) and cephalexin (209.51 mg/inh/d) with highest mass loads were evaluated in the influent of WWTP A and WWTP B, respectively. Ciprofloxacin (24.87 mg/1000 inh/d) and cefixime (90.45 mg/1000 inh/d) were the highest evaluated mass loads in the effluent of Ekbatan wastewater treatment plant (WWTP A) and Tehran Southern wastewater treatment plant (WWTP B), respectively. The calculated risk quotients showed that six out of seven target antibiotics posed a high risk to algae (M. aeruginosa and P. subcapitata) and bacteria (P. putida) in the effluent of WWTPs and the rivers wherein amoxicillin and penicillin posed a higher risk than other antibiotics occurring due to their lowest PNEC., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Air pollution and dust storms are associated with increased cardiovascular hospital admissions. The aim of this study was to investigate the association between short-term exposure to ambient air pollutants and CVD (cardiovascular disease) events in a long-term observational period. The study included the events of cardiovascular diseases (namely coronary artery disease, ischemic heart disease, myocardial infarction, and pneumo thrombo embolism) within the population of Shiraz, from March 21, 2009 to March 20, 2015. Also, each patient's demographics were recorded. Main meteorological variables and five ambient pollutants (CO, O 3 , SO 2 , NO 2 , and PM 10 ) were recorded. Statistical analysis was performed using linear regression (GLM) and a generalized additive model (GAM) estimating Poisson distribution and adjusted for the main risk factors and ambient meteorological variables. A mild prevalence (51.5%) of coronary artery disease (CAD) was registered in 6425 events. In GLM analysis, we observed an association among the pollutants with the coronary artery disease hospital admissions which was in the order of CO, NO 2 , and PM 10 . The highest association of each pollutant with hospital admission was observed as PM 10 at lag 4 (RR = 1.08; 95% CI 1.02, 1.14 and p < 0.05), NO 2 at lag 0 (RR = 1.22; 95% CI 1.00, 1.48), and CO at lag 0 (RR = 1.52 95% CI = (1.16, 1.99)). However, on dusty days, there were significantly higher numbers of referrals of cardiovascular patients (mean = 7.54 ± 4.44 and p = 0.002,) than on non-dusty days. According to these data, dust storms and some types of pollutants in the air are responsible for more admissions to hospitals for cardiovascular problems.

Introduction: The main objective of this study was to design a conceptual framework, according to the policies and priorities of the ministry of health to evaluate provincial public health and primary care performance and to assess their share in the overall health impacts of the community., Methods: We used several tools and techniques, including system thinking, literature review to identify relevant attributes of health system performance framework and interview with the key stakeholders. The PubMed, Scopus, web of science, Google Scholar and two specialized databases of Persian language literature (IranMedex and SID) were searched using main terms and keywords. Following decision-making and collective agreement among the different stakeholders, 51 core indicators were chosen from among 602 obtained indicators in a four stage process, for monitoring and evaluation of Health Deputies., Results: We proposed a conceptual framework by identifying the performance area for Health Deputies between other determinants of health, as well as introducing a chain of results, for performance, consisting of Input, Process, Output and Outcome indicators. We also proposed 5 dimensions for measuring the performance of Health Deputies, consisting of efficiency, effectiveness, equity, access and improvement of health status., Conclusion: The proposed Conceptual Framework illustrates clearly the Health Deputies success in achieving best results and consequences of health in the country. Having the relative commitment of the ministry of health and Health Deputies at the University of Medical Sciences is essential for full implementation of this framework and providing the annual performance report.

Fluoride concentration in groundwater resources that used as the source of drinking water in urban areas of Iran was determined. All of the groundwater wells located in urban areas were monitored in 2008. Fluoride concentration of water samples was measured using SPADNS method. The nationwide mean fluoride concentration in the groundwater resources was found to be 0.47 +/- 0.28 (+/- standard deviation) mg/L. Only in Bushehr Province, the provincial mean fluoride level in the groundwater resources was higher than the WHO guideline value of 1.5 mg/L (1.86 +/- 0.86 mg/L). At nationwide level, the portion of extracted groundwater with fluoride concentration lower than the minimum permissible level of 0.5 mg/L, desirable fluoride range of 0.5-1.5 mg/L and elevated fluoride level was 69.2, 29.3 and 1.4%, respectively. In the areas with low fluoride content drinking water, it is recommended that fluoride is absorbed by use of high fluoride content foods and beverages. The recommendations for the circumstances with excessive fluoride content of drinking water are provision of drinking water from alternative sources and defluoridation of drinking water by point-of-use systems, respectively.