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Background Uncontrolled hyperglycemia is one of the risk factors for cognitive disorders. By this finding, both type 1 and type 2 diabetes may predispose to cognitive impairment in poorly controlled cases. The current large-scale study is aimed at cognitive impairments in diabetic and non-diabetic older adults separately. Methods This is a cross-sectional study from phase 2 of the Bushehr elderly health program (BEHP). Mini-cog and categorical verbal fluency tests (CFTs) were used to assess cognitive function. Patients were classified as non-diabetics, pre-diabetics, or diabetics based on the diagnostic criteria for diabetes mellitus (DM). To compare the means of the two groups, we used the t-test or the Mann-Whitney test. Multivariable logistic regression models were also used to determine the association between pre-diabetes or DM and cognitive impairment. Results Six hundred and ninety-three (45.2%) out of 1533 participants were ascertained to be cognitively impaired. The average hemoglobin A1C was higher in diabetic patients with cognitive impairment compared to those without cognitive impairment. (5.8 ± 1.6% vs. 5.5 ± 1.4%, P = 0.004). Besides, the mean blood glucose levels were found to be more elevated in cognitively impaired cases (108.0 ± 47.4 mg/dL vs. 102.1 ± 0.35 mg/dL, P = 0.002). After adjusting for age, gender, body mass index(BMI), waist circumference, amount of physical activity, and smoking, the multivariable logistic regression model, declared an association between diabetes and cognitive impairment (OR = 1.48, P = 0.003). Older patients, females, widows, and patients with elevated LDL-Cs and blood pressure are also more vulnerable to cognitive impairment. Conclusion In the BEHP, there is a positive association between cognitive impairment and DM, notably in long-term, poorly controlled cases, whereas no association was found among pre-diabetics in our elderly study populations.

BACKGROUND: Mapping the available evidence can be used to inform current diabetes research, identify relevant gaps, and prioritize future research. In this regard, we mapped diabetes research performed in Iran. METHOD: We searched the Scopus and PubMed databases from 01/01/2015 till 01/01/2020 using keywords such as diabetes and Iran. The included articles were classified according to their document types, level of evidence, and subject areas. RESULTS: The majority of the included articles (53%) were related to diabetes types, followed by complications (28%). Most of the documents were original articles (82%), and reviews were 18% of the publications. Systematic reviews constitute only 6% of the total documents. Observational studies were the most common types of study designs (26%), followed by clinical trials (20%). Moreover, topics on control and management of diabetes were the most prevalent subject areas (58%), and fewer studies were on preventive strategies (6%). In diabetes management studies, less attention has been paid to evaluate psychological (10%), educational (9%), and physical activity-related (7%) interventions. There was a shortage of secondary studies related to physical activity, psychology, diagnostic, and screening-related studies. CONCLUSION: To fill diabetes research gaps, more investment in cost-effectiveness interventions, such as preventive strategies and behavioral self-management programs, need. Moreover, we need to pay more attention on applied sciences and real world evidence to bridge translational gaps from bench to bedside. In this regard, further data synthesis can be helpful in evaluating the effectiveness of the available studies and avoiding unnecessary investigations.

Background: Osteoporosis and related fractures are associated with significant morbidity and reduced Health-related Quality of Life (HRQoL). The objective of this study was to measure the HRQoL of osteoporosis patients in Tehran, the capital city of Iran. Method: We surveyed a sample of 478 patients with osteoporosis aged over 50 years with and without osteoporotic fractures. Patients with osteoporotic fractures (hip, vertebral, and forearm) admitted to the educational hospitals affiliated to the Tehran University of Medical Sciences-Iran, during 2017 were randomly selected. Patients without osteoporotic fractures were also randomly selected among patients with a definite diagnosis of osteoporosis who were referred to three outpatient clinics in Tehran during 2017. Data were collected using the EQ-5D-5L questionnaire. Statistical differences between patients with and without a history of fracture were tested with Pearson’s χ2 test, Student's t-test and Mann–Whitney U-test. The association between HRQOL and other variables was evaluated using a multiple linear regression model.Result: The mean ±SD age of the patient was 67.3±11.9 years, and 65% were women. A hundred and seventeen (23%) patients had hip fractures, 56 (11%) patients had vertebral fractures, 127 (25%) patients had forearm fractures and 178 (40%) patients had no fractures. The median (interquartile range) values of HRQOL scores of those with hip, vertebral, and forearm fractures and those with no history of fracture were 0.53 (0.22), 0.60 (0.28), 0.64 (0.26), and 0.64 (0.27), respectively. According to the result of multiple regression model there was a significant relationship between the HRQoL scores and gender, marital status, employment status, presence of any chronic illness in addition to osteoporosis and type of fracture.Conclusion: Osteoporosis and related fractures significantly reduced HRQoL. Due to the significant negative impacts of the osteoporosis on HRQoL and healthcare expenditures, Intervention strategies should be tailored to prevent it and to improve the HRQoL of osteoporosis patients.

The current study aimed at investigating the efficacy of aprepitant-containing triple antiemetic regimen in FLOT (fluorouracil + leucovorin + oxaliplatin + docetaxel) recipients as well as the emetogenic potential of FLOT regimen, through comparison of nausea and vomiting rates in a moderately emetogenic chemotherapy, FLOT, and a highly emetogenic chemotherapy recipients.Patients planned to receive one of FLOT, FOLFOX (fluorouracil + leucovorin + oxaliplatin/moderate-emetic risk), or TAC (docetaxel + doxorubicin + cyclophosphamide/high-emetic risk) regimens were recruited. All patients were treated with the same triple antiemetic regimen containing aprepitant.A total of 165 chemotherapy-naïve patients (52 FLOT recipients) were eligible to enter the study. At the end of day 5, "complete response" (primary efficacy endpoint) was achieved by 84.6%, 63.5%, and 61.5% of the FLOT-receiving patients in acute, delayed, and overall phases, respectively. A significant difference was seen among the odds of FLOT recipients and FOLFOX recipients concerning "complete response" achievement in delayed (p = 0.014) and overall (p = 0.017) phases, "no emesis" in delayed (p = 0.018) and overall (p = 0.010) phases, and also "complete protection" in acute (p = 0.023), delayed (p = 0.009), and overall (p = 0.006) phases; however, the difference between the odds of FLOT recipients and TAC recipients, in relation to achieving these endpoints, was insignificant. FLOT group showed significantly faster time-to-antiemetic regimen failure and time-to-first emetic episode in comparison with the FOLFOX group, which was insignificant in comparison with the TAC group.According to the findings, FLOT has to be considered as a high-emetic-risk regimen; provided that, as recommended by the antiemetic guidelines towards better management of delayed nausea and vomiting induced by highly emetogenic regimens, executing clinical trials concerning the efficacy of continuing dexamethasone on days 2-4 in aprepitant-containing triple antiemetic regimen schedule is required.

PURPOSE: Our study examined whether T2DM and glucocorticoids treatment affect bone quality and quantity that are measured by Bone Mineral Density (BMD) and Trabecular Bone Score (TBS). MATERIALS & METHODS: Participants in this study were 2294 women and men aged over 60 years who participated in stage II of the Bushehr Elderly Health (BEH) program. Patients with T2DM and those who received glucocorticoids were included. BMD was detected using the DXA method and the TBS of L1-L4 was evaluated by TBS iNsight® software. To evaluate the correlation between TBS and BMD levels with diabetes and taking corticosteroids sex-specific multivariable linear regression models were appplied. RESULTS: TBS and BMD were not significantly different in those who had received glucocorticoids versus those who did not.T2DM revealed a significant association with both BMD and TBS in men (beta = 0.12, p

In recent years, a growing interest on the impact of statin intake on bone health has emerged, although the reported results are controversial. The results of this study revealed that BMD at lumbar spine has a significant association with statin intake. However, such association appears to be weaker regarding TBS values compared to BMD. This study was performed with the aim of evaluating associations of statin intake with BMD and TBS using data from 2426 individuals aged ≥ 60 years from the second phase of the Bushehr Elderly Health (BEH) program. We found a positive association between statin and BMD at lumbar spine, whereas association between statin and TBS was detected only in the men in the final model. Introduction In recent years, a growing interest has been established to evaluate the impact of statin intake on bone health, although the reported results are controversial. This study aimed to evaluate the association of statin intake with bone health status according to BMD and TBS. Methods This cross-sectional analysis used data from the elderly Iranian individuals who participated in the Bushehr Elderly Health (BEH) program. Dual x-ray absorptiometry (DXA) device was used to evaluate the BMD at lumbar spine (L1-L4), femoral neck, and total hip, as well as TBS at lumbar spine. Results Among 2426 (1260 women and 1166 men) study participants, 778 were statin users. A positive significant association, irrespective of sex, was observed between statin intake and BMD at L1-L4, even after controlling for potential variables in total population (β = 0.016, p = 0.013). The mean TBS values at L1-L4 were negatively associated with statin intake in total population (β = - 0.009, p = 0.001), while in the full adjusted model, significant positive association between TBS and statin intake was detected only in men (β = 0.013, p = 0.02). Conclusion The results of this study revealed that BMD at lumbar spine has a significant association with statin intake. However, such an association appears to be weaker regarding TBS values compared to BMD.

Objective: Prediction models for cardiovascular disease (CVD) mortality come from high-income countries, comprising laboratory measurements, not suitable for resource-limited countries. This study aims to develop and validate a non-laboratory model to predict CVD mortality in a middle-income setting. Study design and setting: We used data of population aged 40-80 years from three cohort studies: Tehran Lipid and Glucose Study (n = 5160), Isfahan Cohort Study (n = 4350), and Golestan Cohort Study (n = 45,500). Using Cox proportional hazard models, we developed prediction models for men and women, separately. Cross-validation and bootstrapping procedures were applied. The models' discrimination and calibration were assessed by concordance statistic (C-index) and calibration plot, respectively. We calculated the models' sensitivity, specificity and net benefit fraction in a threshold probability of 5%. Results: The 10-year CVD mortality risks were 5.1% (95%CI: 4.8-5.5) in men and 3.1% (95%CI: 2.9%-3.3%) in women. The optimism-corrected performance of the model was c = 0.774 in men and c = 0.798 in women. The models showed good calibration in both sexes, with a predicted-to-observed ratio of 1.07 in men and 1.09 in women. The sensitivity was 0.76 in men and 0.66 in women. The net benefit fraction was higher in men compared to women (0.46 vs. 0.35). Conclusion: A low-cost model can discriminate well between low-and high-risk individuals, and can be used for screening in low-middle income countries. (C)& nbsp;2021 Elsevier Inc. All rights reserved.

Sexual contact is still one of the most important routes of HIV transmission. The aim of this study was identify the factors that underlie the higher prevalence of high-risk sexual behaviors in a s...

The study assessed the HIV treatment cascade of people living with HIV (PLWH) in Iran and the reasons for gaps in HIV services in 2014. We did the cascade analysis using the WHO HIV test–treat–retain cascade analysis tool (2014). To measure the gaps, we checked the records for all PLWH reported to the national HIV surveillance till September 2014 to define how many were alive, linked to HIV care, assessed for CD4 cell count, started antiretroviral therapy (ART), and reported to be alive up to five years after ART. To assess the reasons for gaps in the cascade, we ran desk review, four focus group discussions and 51 in-depth interviews with key informants including PLWH. Spectrum model estimated 75,700 PLWH in Iran, of whom only 22,647 people (%30) were diagnosed. Of those who were diagnosed with HIV, 16,266 people (%72) had enrolled in HIV care. About 13% of all PLWH were retained in HIV care and only 9% (6745 people) had ever been tested for CD4 cell count. Only 8% (6018 people) of all PLWH had received ART by September 2014. We found the biggest gap in the HIV treatment cascade to be HIV diagnosis as only 30% of PLWH have been diagnosed. Innovative strategies to improve HIV testing, particularly those that work best for key populations, are critical to reach the 90–90-90 targets.

Background Osteoporotic fractures impose significant costs on society. The objective of this study was to estimate the direct costs of the hip, vertebral, and forearm fractures in the first year after fracture incidence in Iran. Methods We surveyed a sample of 300 patients aged over 50 years with osteoporotic fractures (hip, vertebral, and forearm) admitted to four hospitals affiliated to Tehran University of Medical Sciences, Iran, during 2017 and were alive six months after the fracture. Inpatient cost data were obtained from the hospital patient records. Using a questionnaire, the data regarding outpatient costs were collected through a phone interview with patients at least six months after the fracture incidence. Direct medical and non-medical costs were estimated from a societal perspective. All costs were converted to the US dollar using the average exchange rate in 2017 (1USD = IRR 34,214) Results The mean ± standard deviation (SD) age of the patient was 69.83 ± 11.25 years, and 68% were female. One hundred and seventeen (39%) patients had hip fractures, 56 (18.67%) patients had vertebral fractures, and 127 (42.33%) ones had forearm fractures. The mean direct cost (medical and non-medical) during the year after hip, vertebral and forearm fractures were estimated at USD5,381, USD2,981, and USD1,209, respectively. Conclusion The direct cost of osteoporotic fracture in Iran is high. Our findings might be useful for the economic evaluation of preventive and treatment interventions for osteoporotic fractures as well as estimating the economic burden of osteoporotic fractures in Iran.

Introduction Pregnancy is associated with changes in bone remodeling and calcium metabolism, which may increase the risk of fragility fracture after menopause. We hypothesized that in postmenopausal women, with history of grand multiparity, the magnitude of trabecular bone deterioration is associated with number of deliveries. Methods 1217 women aged 69.2 ± 6.4 years, from the Bushehr Elderly Health (BEH) program were recruited. The areal bone mineral density (aBMD) of the lumbar spine and femoral neck and trabecular bone score (TBS) of 916 postmenopausal women, with grand multiparity defined as more than 4 deliveries, were compared with those of 301 postmenopausal women with 4 or fewer deliveries. The association of multiparity with aBMDs and TBS were evaluated after adjustment for possible confounders including age, years since menopause, body mass index, and other relevant parameters. Results The aBMD of femoral neck (0.583 ± 0.110 vs. 0.603 ± 0.113 g/cm2), lumbar spine (0.805 ± 0.144 vs. 0.829 ± 0.140 g/cm2) and TBS (1.234 ± 0.086 vs. 1.260 ± 0.089) were significantly lower in women with history of grand multiparity than others. In the multiple regression analysis, after adjusting for confounders, the negative association did persist for lumbar spine aBMD (beta = −0.02, p value = 0.01), and the TBS (beta = −0.01, p value = 0.03), not for femoral neck aBMD. Conclusion We infer that grand multiparity have deleterious effects on the aBMD and the trabecular pattern of the lumbar spine.

Despite the proposed role of the gut microbiota-bone axis, findings on the association between probiotic consumption and bone health are conflicting. This systematic review aimed to assess the effect of probiotic consumption on bone health parameters. A systematic literature search of relevant reports published in PubMed/Medline, Web of Science, SCOPUS, EMBASE, and Google scholar before December 2020 was conducted. All clinical trials or experimental studies, which examined the relationship between probiotic consumption and bone health parameters, were included. No limitation was applied during the search. After screening articles based on inclusion criteria, 44 studies remained. In clinical trials, probiotic consumption affects bone health parameters such as serum calcium levels (3.82; 95% CI: 1.05, 6.59 mmol/l), urinary calcium levels (4.85; 95% CI: 1.16, 8.53 mmol/l), and parathyroid hormone (PTH) levels (−5.53; 95% CI: −9.83, −0.86 ng/l). In most studies, Lactobacillus species such as L. helveticus, L. reuteri, and L. casei were consumed and women aged 50 years or older were assessed. Spinal and total hip bone mineral density (BMD) was not affected significantly by probiotic consumption. In 37 animal experiments, probiotic or symbiotic feeding mostly had effects on bone health parameters. Some strains of Bifidobacterium and Lactobacillus including L. reuteri, L. casei, L. paracasei, L. bulgaricus, and L. acidophilus have indicated beneficial effects on bone health parameters. In conclusion, this systematic review and meta-analysis indicate that probiotic supplementation might improve bone health. Further studies are needed to decide on the best probiotic species and appropriate dosages.

Background: Sarcopenia is characterized by low skeletal muscle mass and function, which is associated with cardiovascular risk factors and may even be related to adverse cardiovascular events and mortality. This study aimed to evaluate whether sarcopenia is related to electrocardiographic (ECG) abnormalities in a large sample of older adults.Methods: We performed a cross-sectional study based on the data collected during the Bushehr Elderly Health (BEH) cohort study. Body composition was measured by dual X-ray absorptiometry (DXA) and muscle strength was measured using a digital dynamometer for each hand of every participant. A person who had low muscle strength, as well as low muscle mass was identified as having sarcopenia. The subjects were classified into three groups according to the Minnesota Code (MC) as major, minor ECG abnormalities and participants with no abnormalities ECG.Results: Of the 2,426 participants, 354 (14.6%) had major ECG abnormalities and 193 (8%) had minor ECG abnormalities. Sarcopenia was associated with an increased risk of major ECG abnormality in all models. After adjustment for confounders of CHD in full model, the OR for major ECG abnormality was 1.47 (95% CI 1.11–1.95) in those with sarcopenia. Low muscle strength and low muscle performance were both with an increased risk of major ECG abnormality in all models. Sarcopenia and low muscle strength increased 28% and 62% risk of any ECG abnormality in the full models [sarcopenia: 1.28(1.01–1.63), low muscle strength: 1.62(1.30–2.03)], respectively.Conclusions: This study showed that sarcopenia and its components are associated with ECG abnormalities in Iranian older people. Although some older adults have higher cardiovascular risk factors, these data showed that further factors such as sarcopenia may be identified as a particular risk factor for future cardiovascular events. Therefore, sarcopenia could be added to the screening of the older population to reduce the risk of cardiovascular events.

The main findings of this study on the self-care behaviors contain “identification of knowledge gaps,” “established networking for seeking information,” “information from trust-to-distrust,” “information-seeking inhibiting factors,” “information-seeking facilitating factors,” and “self-care behaviors based on required knowledge.” Health information–seeking behavior affects self-care and could promote quality of life and life expectancy. This study aimed at assessing health information–seeking and self-care behaviors of women with osteoporosis in Iran. This study was conducted using a content analysis approach. Data were collected through semi-structured interviews with 15 women with osteoporosis aged above 50 years. The participants were selected by purposeful sampling. The data were analyzed by the conventional content analysis method using MAXQdata software version 10. From in-depth descriptions of the participants’ experiences, 246 primary codes were extracted. Subsequently, constant comparison analysis was done and 35 sub-categories and 6 main categories have appeared from the data. Based on the experiences of women with osteoporosis, they received limited information from the health care providers, so they were seeking reliable information sources to meet their information needs. They obtained most of their information from other patients, family members, and network of friends. In the process of seeking information, they face various barriers such as lack of time in the health care team that affect their ability to self-care. The results can guide health policymakers, patient educators, health care providers, information specialists, and patients and their families.

Our purpose was to investigate the co-authorship network of Iranian researchers in the field of osteoporosis. We used 1328 documents retrieved from databases of PubMed, Scopus, and Web of Science in the analysis. The network had 183 authors in 13 clusters, low cohesion, and slow information flow between its members. This study aims to investigate the pattern and characteristics of cooperation between Iranian researchers in the field of osteoporosis through the co-authorship social network analysis. All papers on osteoporosis with at least one Iranian author were retrieved from medical databases of PubMed, Scopus, and Web of Science from 2009 to 2019. After the removal of duplicates, the title and abstract of the papers were reviewed by two independent reviewers, and screening was performed according to the inclusion and exclusion criteria. The data were entered into the BibExecl software, and the different spelling forms in the author names were manually merged. The authors’ co-occurrence matrix was then developed and entered into the UCINET software and the cohesion indexes (density, diameter, and average distance) and centrality indexes (degree, betweenness, closeness, and eigenvector) for the co-authorship network were estimated. The institutions and countries of the authors of the entered papers were also used in the network analysis and their socio-graphs were drawn. We used 1328 documents in the analysis. The co-authorship network was constructed only for authors with at least 5 papers. The network had 183 nodes (authors) in 13 clusters. Its density was 0.063 and its number of components was 2. The large component encompassed 95.6% and the small component 4.4% of authors. The average distance in the main component of the network was 3 and its diameter was 6. Larijani B was ranked first in the network in terms of degree, betweenness, closeness, and eigenvector centrality. In terms of the contribution of organizations in osteoporosis publications, Tehran University of Medical Sciences (with 35.5% of papers published in WoS database), Shahid Beheshti University of Medical Sciences (14.7%), and Shiraz University of Medical Sciences (9.3%) retained in the first to third place, respectively. In papers published on the WoS, most Iranian authors have collaborated with authors from the USA, Belgium, Canada, and the UK respectively. The co-authorship network had low cohesion with slow information flow between its members. The collaboration with young researchers by the network’s active, efficient, and broker authors will lead to the maintenance and development of the network.

Background Iran’s population is aging. Disability is a major public health problem for older adults, not only in Iran but all over the world. The purpose of this study was to investigate the relationship between cardio-metabolic and socio-demographic risk factors and disability in people 60 years and older in Iran. Methods The baseline (cross-sectional) data of 2426 samples from the Bushehr Elderly Health (BEH) program was included in the analysis. The participants were selected through multi-stage random sampling in Bushehr, southern Iran. Socio-demographic characteristics, as well as the history of diabetes and other chronic diseases, and smoking were measured using standardized questionnaires. Anthropometric measurements and laboratory tests were performed under standard conditions. Dependency was determined by the questionnaires of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) using Barthel and Lawton scales respectively. Multiple logistic regression was used in the analysis. Results Mean (Standard Deviation) of the participants’ age was 69.3 (6.4) years (range: 60 and 96 years), and 48.1% of the participants were men. After adjusting for potential confounders, being older, being female (OR (95%CI): 2.3 (1.9–2.9)), having a lower education level, a history of diabetes mellitus (OR: 1.4 (1.2–1.7)) and past smoking (OR: 1.3 (1.0–1.6)), and no physical activity (OR: 1.5 (1.2–1.9)) were significantly associated with dependency in IADL. Also, being older and female (OR: 2.4 (1.9–3.0)), having a lower education level, no physical activity (OR: 2.2 (1.6–2.9)) and daily intake of calories (OR: 0.99 (0.99–0.99)) were associated with dependency in BADL. Conclusion Dependency in older adults can be prevented by increasing community literacy, improving physical activity, preventing and controlling diabetes mellitus, avoiding smoking, and reducing daily calorie intake.

Osteoporotic fractures impose a vast burden on the health system, especially in countries with an old population or an ageing trend such as Iran. This study reviews the articles published by the Endocrinology and Metabolism Research Institute (EMRI) to map and summarize the evidence, identify key themes and highlight research gaps to plan future research. We searched for studies affiliated with EMRI on osteoporotic fracture. Scopus, PubMed, Google Scholar, Scientific Information Database (SID) and Persian databases were used, without restricting time and language. All papers published up to December 2019 were retrieved and merged using Endnote software. Two independent researchers reviewed documents, and non-related papers were removed from the collection. The reference lists of the relevant articles were reviewed to avoid missing any publication. All papers addressing any aspects of fragility fractures were included. Meeting abstracts and letters to the editor were excluded. The visualization of the co-authorship network was illustrated with VOSveiwer program software. The total number of 20 papers, published between 2004 and 2019 were included in our study. “Larijani, B” with 12, “Keshtkar, A”, “Abolhassani, F”, and “Soltani, A” with five papers were the most prolific authors. Six out of 20 (30 %) of the papers were published in the last three years. Among different perspectives of osteoporotic fractures, addressed by EMRI, four main categories of articles were defined including incidence (n = 7), related factors (n = 9), fracture risk assessment (n = 2), and the burden of osteoporotic fractures in Iran (n = 4). There was no updated information about the incidence of osteoporotic fracture and its burden in recent years. Considering the importance of osteoporotic fractures in Iran with an ageing trend, Osteoporosis Research Centers can play an essential role in providing evidence for policymakers. Worldwide, there is a large care gap to assess bone health and start treatments after fragility fractures. Accordingly, following international recommendations, practical interventions are required to fill this gap. EMRI began developing the “Registry of osteoporosis” and also pilot the “Fracture Liaison Services”, as an operative model to address the existing care gap and implement applied research in this science area.

In a large population-based study of Iran, the age-standardized prevalence of osteoporosis was 24.6% in men and 62.7% in women aged ≥ 60 years. Osteoporosis was negatively associated with body mass index in both sexes, and with diabetes in men and hypertriglyceridemia in women. Population aging has made osteoporosis and osteoporotic fractures an important health problem, especially in developing countries. This study aimed to explore the prevalence of osteoporosis and associated factors among the elderly population of the south-west of Iran. Baseline data of the second stage of the Bushehr Elderly Health program was used. Spinal, total hip, or femoral neck osteoporosis was described as a BMD that lies 2.5 standard deviations or more, below the average values of a young healthy adult in the lumbar spine, total hip, or femoral neck, respectively. Osteoporosis at either site was defined as total osteoporosis. Age-standardized prevalence of osteoporosis was estimated. We used the modified Poisson regression with a robust variance estimator to identify the factors related to osteoporosis, adjusting for potential confounders. Overall, 2425 individuals (1166 men) aged over 60 years were included. In all, total osteoporosis was detected in 1006 (41.5%) of the participants. Using the reference value derived from Caucasian women aged 20–29 years, the age-standardized prevalence of total osteoporosis was 24.6 (95% CI: 21.9–27.3) in men, and 62.7 (95% CI: 60.0–65.4) in women. In men, osteoporosis was positively associated with age, smoking, history of fracture, and history of renal/liver diseases and negatively associated with body mass index (BMI) and diabetes. BMI, hypertriglyceridemia, and education were negatively correlated with osteoporosis in women, while years after menopause and history of fracture increased the likelihood of osteoporosis, significantly. Results support the high prevalence of osteoporosis and osteopenia in the elderly population. Considering the importance of severe complications, especially fractures, comprehensive interventions should be expanded.

The main findings of this study on the self-care behaviors contain "identification of knowledge gaps," "established networking for seeking information," "information from trust-to-distrust," "information-seeking inhibiting factors," "information-seeking facilitating factors," and "self-care behaviors based on required knowledge."Health information-seeking behavior affects self-care and could promote quality of life and life expectancy. This study aimed at assessing health information-seeking and self-care behaviors of women with osteoporosis in Iran.This study was conducted using a content analysis approach. Data were collected through semi-structured interviews with 15 women with osteoporosis aged above 50 years. The participants were selected by purposeful sampling. The data were analyzed by the conventional content analysis method using MAXQdata software version 10.From in-depth descriptions of the participants' experiences, 246 primary codes were extracted. Subsequently, constant comparison analysis was done and 35 sub-categories and 6 main categories have appeared from the data.Based on the experiences of women with osteoporosis, they received limited information from the health care providers, so they were seeking reliable information sources to meet their information needs. They obtained most of their information from other patients, family members, and network of friends. In the process of seeking information, they face various barriers such as lack of time in the health care team that affect their ability to self-care.The results can guide health policymakers, patient educators, health care providers, information specialists, and patients and their families.

Our purpose was to investigate the co-authorship network of Iranian researchers in the field of osteoporosis. We used 1328 documents retrieved from databases of PubMed, Scopus, and Web of Science in the analysis. The network had 183 authors in 13 clusters, low cohesion, and slow information flow between its members.This study aims to investigate the pattern and characteristics of cooperation between Iranian researchers in the field of osteoporosis through the co-authorship social network analysis.All papers on osteoporosis with at least one Iranian author were retrieved from medical databases of PubMed, Scopus, and Web of Science from 2009 to 2019. After the removal of duplicates, the title and abstract of the papers were reviewed by two independent reviewers, and screening was performed according to the inclusion and exclusion criteria. The data were entered into the BibExecl software, and the different spelling forms in the author names were manually merged. The authors' co-occurrence matrix was then developed and entered into the UCINET software and the cohesion indexes (density, diameter, and average distance) and centrality indexes (degree, betweenness, closeness, and eigenvector) for the co-authorship network were estimated. The institutions and countries of the authors of the entered papers were also used in the network analysis and their socio-graphs were drawn.We used 1328 documents in the analysis. The co-authorship network was constructed only for authors with at least 5 papers. The network had 183 nodes (authors) in 13 clusters. Its density was 0.063 and its number of components was 2. The large component encompassed 95.6% and the small component 4.4% of authors. The average distance in the main component of the network was 3 and its diameter was 6. Larijani B was ranked first in the network in terms of degree, betweenness, closeness, and eigenvector centrality. In terms of the contribution of organizations in osteoporosis publications, Tehran University of Medical Sciences (with 35.5% of papers published in WoS database), Shahid Beheshti University of Medical Sciences (14.7%), and Shiraz University of Medical Sciences (9.3%) retained in the first to third place, respectively. In papers published on the WoS, most Iranian authors have collaborated with authors from the USA, Belgium, Canada, and the UK respectively.The co-authorship network had low cohesion with slow information flow between its members. The collaboration with young researchers by the network's active, efficient, and broker authors will lead to the maintenance and development of the network.

Background: Iran's population is aging. One of the most common problems in Iranian public health is the high prevalence of cardio-metabolic risk factors. The purpose of this study was to investigate the relationship between cardio-metabolic and demographic risk factors and disability in people 60 years and older in Iran.Methods: Data from the Bushehr Elderly Health (BEH) program was used in the analysis. Demographic characteristics, as well as the history of diabetes and other chronic diseases, and smoking were measured using standardized questionnaires. Anthropometric measurements and laboratory tests were performed under standard conditions. Dependency was determined by the questionnaires of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) using Barthel and Lawton scales respectively. Multiple logistic regression was used in the analysis.Results: Mean (Standard Deviation) of the participants’ age was 69.34 (6.4) years (range: 60 and 96 years), and 48.06% of the participants were men. After adjusting for potential confounders, being older, being female (OR (95%CI): 2.33 (1.89 - 2.86)), having a lower education level, a history of diabetes mellitus (OR: 1.43 (1.17 -1.74)) and past smoking (OR: 1.25 (1.00 - 1.55)), and no physical activity (OR: 1.54 (1.23 - 1.87)) were significantly associated with dependency in IADL. Also, being older and female (OR: 2.38 (1.85 - 3.03)), having a lower education level, no physical activity (OR: 2.17 (1.61 - 2.86)) and low daily intake of calories were associated with dependency in BADL.Conclusion: Age, gender, education level and physical activity are risk factors of the dependency in both of BADL and IADL in the elderly people. Diabetes mellitus and past smoking are risk factors of the dependency in IADL, and low HDL cholesterol and low daily intake of calories are risk factors of the dependency in BADL.

Background Iran is fighting heroically against COVID-19. Due to the importance of scientific publications in better dealing with this stubborn virus, this study was conducted aiming at reviewing COVID-19 publications by Iranian scientists. Methods We searched for COVID-19 and all its related keywords in the Web of Science (WOS), Scopus and PubMed databases to find documents published by Iranian authors until July 10, 2020. Duplicates documents were excluded, and bibliographic parameters were evaluated. Co-authorship matrix was calculated using Bibexcel, and visualizations were done using VOSviewer. Results A total of 849 documents from 3450 Iranian researchers (5.5 authors per document) were retrieved from WOS, PubMed, and Scopus and Iran ranked 12th and 13th in WOS and Scopus in terms of the number of publications. The average citation per document was 2.2 with the h-index of 18. Original articles and letters were the most common formats for Iranian publications. The Journal of Military Medicine has published the highest number of documents. Iranian authors have mostly collaborated with researchers from the United States, Italy, the UK, and Canada, respectively. The co-occurrence network for keywords represented five publication clusters in the collection, and the largest clusters were related to epidemiological studies and public health, followed by clinical studies on COVID-19. Conclusion Iranian researchers have had a significant scientific contribution in various areas of the disease. However, the network of studies has not been sufficiently cohesive, and more coherent collaboration between researchers at the national and international levels should be on the agenda of research policymakers in the country.

Osteoporosis remains a major public health concern, considering its high prevalence along with its association with osteoporotic fractures. It imposes a heavy burden on the society worldwide as the population ages. This paper aims to provide a brief review on Iranian multicenter osteoporosis studies (IMOS) studies and provide some recommendations for improvement. IMOS studies were conducted to investigate the prevalence of osteoporosis and related risk factors. This paper provides a general view on the Iranian multicenter osteoporosis studies (IMOS), conducted during last decades. The results showed a high prevalence of osteoporosis and vitamin D deficiency in the Iranian population. Although the study protocols were mainly similar, some differences were observed in terms of the study population and design. The protocol of IMOS-3 was modified to overcome the setbacks noted in the previous studies; however, it was implemented in two cities with noticeably different socioeconomic and geographical characteristics from five cities where the first phase was conducted, resulting in different lifestyles and habits. Although previous IMOS studies have raised major concerns regarding the high prevalence of osteoporosis and vitamin D deficiency, interpretation should be made with caution given the differences, especially in the surveyed cities. Such discrepancies cause problems in trend analysis, and nationally representative samplings are preferably needed to correctly compare the prevalence of osteoporosis and related risk factors. Considering the aging population and the importance of osteoporosis and its complication, developing a standard surveillance system to obtain valid and nationally representative estimates is recommended.

We investigated the research conducted on osteoporosis at EMRI to provide practical implications and suggestions for the development of future research. We searched osteoporosis and related concepts, as well as various forms of affiliations to EMRI to find published documents indexed in Web of Science, PubMed, and Scopus databases until January 27, 2020. The main purpose and scopes of the studies were classified into seven main study areas. Co-authorship relations were examined using the VOSviewer and keyword analysis was carried out by the ScientoPy. A total 201 papers on the subject of osteoporosis with organizational affiliation to EMRI were found after initial screening and removing duplicates. A time trend analysis of publications showed a growing trend of EMRI’s publication in the field of osteoporosis since 2014. A total of 558 independent authors participated in osteoporosis-related research at EMRI, and the average contribution of authors was 6.72 per papers. The Co-authorship network for authors contributing in at least five publications, showed 4 main clusters of independent authors. The co-occurrence network of keywords included three large and intertwined clusters including the epidemiology of osteoporosis and its resulting fractures and risk factors, bone markers and monitoring the effectiveness of treatment with them, and nutrition and supplements in the field of osteoporosis and fractures. EMRI has significantly contributed in osteoporosis science and related subjects during recent years, especially in public health aspects of osteoporosis and its risk factors and consequences. More attention should be paid to other areas such clinical and basic science studies.

To examine the population-based incidence of any-fracture and its potential risk factors in a sex-split cohort of the Iranian population.A total of 3477 men and 4085 women with a mean (SD) age of 47.92(13.1) and 45.88(11.47) years, respectively were entered into the study. The age-standardized incidence rates per 100,000 person-years were reported for the whole population and each sex separately. Cox proportional hazard models were used to estimate hazard ratios (HR) for potential risk factors. Only fractures requiring inpatients' care were considered as the outcome. We also defined major osteoporotic fractures (MOF) as the composite of the fractures that occurred in the vertebral, wrist, hip and pelvic sites among population aged ≥50 years.During the median (IQR) follow-up of 15.9 years, 4.34%men and 3.75% women experienced at least one incident any-fracture. The annual age-standardized incidence rates (95% CI) among men and women were 330.9 (279.6-388.9) and 319.4(268.1-377.3) per 100,000 person-years, respectively; the corresponding values for incidence of MOF was 202.2(142.3-278.6) in men and 342.1(260.4-441.0) per 100,000 person-years for women. In the multivariable model, among the whole population, age groups ≥50 years, central obesity [HR: 95% CI 1.77(1.32-2.39)], current smoking [1.59(1.15-2.20)] and using steroid medications [2.20(1.04-4.67)] significantly increased the risk of incident fracture (all P 0.05); however the impact of the first two risk factors were more prominent among women (P for interaction ≤0.01). Moreover, being obese was associated with a lower risk of incident first fracture in the total population [HR: 95% CI: 0.61(0.40-0.92)]. Being men [HR: 95% CI: 0.54(0.30-0.99)] and prediabetes status [HR: 95% CI: 0.53(0.30-0.95)] were also associated with lower risk for MOF.This is the first report of long-term incidence rate of any-fracture and MOF conducted in the metropolitan city of Tehran. Among modifiable risk factors of fracture, in the whole population smoking habit and using steroid medications and particularly for women central obesity should be considered as main risk factors for preventive strategies. Prediabetes status was associated with lower risk of MOF.

BACKGROUND: This study proposed to compare the prevalence and risk factors for sarcopenia by EGWSOP-1 and EWGSOP-2 diagnostic criteria in Iran. METHODS: This cross-sectional study was conducted based on the data collected during the Bushehr Elderly Health (BEH) Program, stage II. Sarcopenia was defined as 3 definitions: EWGSOP-1(with Iranian cut off), EWGSOP-2(with Iranian cut off), EWGSOP-2(with European cut off) definition. We evaluated the age-standardized prevalence of sarcopenia in both genders. Regression analysis was used to show the associations in the adjusted models. RESULTS: Among 2426 participants, age-standardized prevalence of sarcopenia, and severe sarcopenia by EWGSOP-1 were 19.7%, and 12.9%, in men and 13.6%, and 16.7% in women, respectively. When we used EWGSOP-2 (with Iranian cut-off) criteria, these values were 10.5%, and 12.7% among men and 7.13% and 16.5% in women, respectively. The prevalence sarcopenia and severe sarcopenia by EWGSOP-2 (with European cut-off) were 12.7%, and 13.4% in men and 5.42%, and 13.7% in women, respectively. In both genders, getting older and high-fat mass were positively associated with sarcopenia, and BMI had a significant inverse association in both genders and all defintions. CONCLUSIONS: Results showed that a prevalence of sarcopenia varied largely by using different criteria, in both sexes. EWGSOP2- defined sarcopenia prevalence was lower than that defined using EWGSOP-1 criteria due to different diagnostic factors to detect sarcopenia. Some adverse outcomes should be considered for evaluating sarcopenia to compare the accuracy of EWGSOP-1 and EWGSOP-2.

PURPOSE: Smoking has been linked with osteoporosis, but further evidence is required, especially concerning the effects of different types of tobacco smoking. We sought to examine the association between smoking and bone health in a large cohort of elderly Iranians. METHODS: The data from 2377 participants aged >60 years of Bushehr Elderly Health (BEH) program were used. Regardless of the type of smoking, participants were initially classified as non-smokers, ex-smokers and current smokers. Current smokers were also categorized based on the smoking type (pure cigarette, pure hookah and both). Dual-energy X-ray absorptiometry was used to evaluate bone density as well as Trabecular Bone Score (TBS). T-score ≤ −2.5 in either of the femoral neck, total hip or spinal sites was applied to determine the osteoporosis. The association of smoking and osteoporosis was assessed using multivariable modified Poisson regression model and reported as adjusted prevalence ratios (APR). The linear regression model was used to assess the association between smoking and TBS, adjusting for potential factors. RESULTS: A total of 2377 (1225 women) were enrolled [mean age: 69.3 (±6.4) years], among which 1054 (44.3%) participants were nonsmokers. In all, 496 (20.9%) participants were current smokers. Multivariable regression analysis revealed no significant association between smoking (either current or past) and osteoporosis in women. In men, current smoking was negatively associated with osteoporosis (APR: 1.51, 95%CI: 1.16–1.96). Among current users, cigarette smoking was associated with osteoporosis (APR: 1.57, 95%CI: 1.20–2.03); however, we could not detect a significant association between current smoking of hookah and osteoporosis. In men, a significant association was also detected between current cigarette smoking and TBS (coefficient: -0.03, 95%CI: −0.01, −0.04). CONCLUSION: Current cigarette smoking is associated with both the quantity and quality of bone mass in elderly men. Although we could not detect a significant association between hookah and osteoporosis in men, considering the prevalence of hookah smoking in the middle eastern countries, further studies are needed to determine the effect of hookah smoking on bone health.

Background Homeless people are at high risk of HIV and tuberculosis (TB) infection due to living in poor sanitary conditions and practicing high-risk behavior. The aim of this study is to assess the knowledge, attitude, and practice (KAP) of homeless people in Tehran regarding TB and HIV. Methods Using a convenience sampling, we performed a cross-sectional study on homeless people in Tehran from June to August 2012. Participants aged 18-60 years having at least 10 days of homelessness in the preceding month to the study period were included. All required data were collected through face-to-face interviews conducted using a researcherdesigned questionnaire. Each score in KAP of TB and HIV was separately divided by the maximum score and multiplied by 100 to attain percentage scores. The mean scores were compared using analysis of variance (ANOVA) and student’s t test. A Tukey test was used for post hoc analysis and two-by-two comparisons. Results In this study, 593 participants consisting of 513 men and 80 women were included. The mean age of the participants was 41.74 ± 0.45 years. Moreover, the total mean score of KAP toward HIV was 79.24 (95% CI: 77.36, 81.12), 57.13 (95% CI: 55.12, 59.14), and 21.14 (95% CI: 18.35, 23.93), respectively. The total mean score of knowledge and practice regarding TB was 62.04 (95% CI: 59.94, 64.14) and 42.57 (95% CI: 40.36, 44.78), respectively. Conclusion Although a relatively acceptable knowledge was detected in this high-risk population, practices regarding TB and HIV showed some weaknesses. Developing special programs to improve the healthy behavior of this population is highly recommended.

OBJECTIVES: To introduce bibliometric features of Iranian documents on microbiota and to provide descriptive information about retrieved documents related to the medical sciences and documents utilizing molecular techniques for microbiota detection. METHODS: This is a descriptive bibliometric study of all Iranian documents on microbiota in any language that were indexed in Scopus before 7 September 2019. We assessed the research performance through statistical analysis of the bibliometric indicators, including number of publications, citations, institutions and journals activities, co-citations and bibliographic couplings, and network analysis of co-authorships, countries’ collaborations, terms and keywords. RESULTS: We extracted 425 relevant documents, 260 of which pertain to the medical sciences. The most focused microbiota modulating interventions and diseases in 33 clinical trials are ‘synbiotics’ (n = 8) and ‘probiotics’ (n = 8), and ‘Obesity’ (n = 3) and ‘non-alcoholic fatty liver disease’ (n = 3), respectively. During the last decade, Iranian microbiota publications have increasingly grown with a constant upward slope, particularly in the area of medical sciences after 2016. Citation counting reveals that originals and reviews have been cited 4221 times, with an average 10.76 citations and H-index of 34. The most significant performance in publishing Iranian microbiota documents belongs to ‘Tehran University of Medical Sciences’ as the active institution (n = 89 publications) and the supporting sponsor (n = 19), ‘Microbial Pathogenesis’ as the productive journal (n = 12), ‘Seidavi A’ as the most authorships (n = 19), and ‘the United States’ as the collaborative country (n = 46). CONCLUSIONS: The qualitative and quantitative information of this study will be a practical guidance for future study planning and policy-decision making. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40200-020-00488-2) contains supplementary material, which is available to authorized users.

Aims The aim of this study is to assess the American Diabetes Association (ADA) risk score as a self-assessment screening tool for undiagnosed type 2 diabetes (T2DM) in Iran. Methods In a national survey of risk factors for non-communicable diseases, we included 3458 Iranian adults. The discrimination and validity were assessed using the area under the curve (AUC), sensitivity, specificity, Youden's index, positive and negative predictive values (PPV and NPV). The frequency of high-risk Iranian population who need a glucose test and those who need intervention were also estimated. Results The AUC was 73.7% and the suggested ADA score of ≥5 yielded a sensitivity of 51.6%, specificity 82.4%, NPV 98.3%, and PPV 7.9%. This threshold results in classifying 18.6% of the Iranians, equals to 8.5 million, as high-risk and 1.5% of the population, about 700,000, would need intervention. However, our study suggested score ≥4 that identified 34% of the population as high-risk and 2% of the population would need intervention. Conclusion Our findings support the ADA suggested threshold for identifying high-risk individuals for undiagnosed T2DM; however, a lower threshold is also recommended for higher sensitivity. The ADA screening tool could help the public health system for low-cost screening.

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

IntroductionThe HORIZON 2020 project PoCOsteo aims (1) to develop a multidimensional fracture risk assessment tool which would take into account all factors known to be related to an individual’s fracture risk. The fracture risk model is intended to be developed in two different populations, namely a European and a Middle Eastern one; (2) to develop a medical device, which would measure and/or quantify proteomic as well as genomic factors as present in whole blood samples collected through finger prick; (3) to test the clinical applicability and the validity of prototypes of the to be developed point of care device at both clinical centres.Methods and analysisThis article presents the protocol of this prospective cohort that will be carried out independently at two different centres (Division of Endocrinology and Diabetology at the Medical University of Graz (MUG) as a clinic-based cohort, and Endocrinology and Metabolism Research Institute (EMRI) at the Tehran University of Medical Sciences (TUMS) as a population-based cohort). The final aim is to develop a fracture risk assessment model, which would include clinical risk factors, biochemical markers of bone turnover, as well as specific genomic factors. The derivation cohorts will consist of individuals aged 50 years and above. The period of observation for each patient will be 12 months; an extension phase, which would last for another 2 years, is also planned.Ethics and disseminationThese studies are conducted in accordance with the World Medical Association Declaration of Helsinki. The Iranian part was approved by the Research Ethics Committee of EMRI, TUMS. The Austrian part was approved by the Ethics Committee of the Medical University of Graz. Based on the gathered information, a multidimensional fracture assessment tool will be designed which will later be added to the PoCOsteo device.

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

We estimated the prevalence of recent HIV testing (i.e., having an HIV test during the last 12 months and knew the results) among 1,295 HIV-negative Iranian female sex workers (FSW) in 2015. Overall, 70.4% (95% confidence intervals: 59.6, 79.3) of the participants reported a recent HIV testing. Concerns about their HIV status (83.2%) was reported as the most common reason for HIV testing. Incarceration history, having >5 paying partners, having >1 non-paying partner, receiving harm reduction services, utilizing healthcare services, and knowing an HIV testing site were significantly associated with recent HIV testing. In contrast, outreach participants, having one non-paying sexual partner, and self-reported inconsistent condom use reduced the likelihood of recent HIV testing. HIV testing uptake showed a ~2.5 times increase among FSW since 2010. While these findings are promising and show improvement over a short period, HIV testing programs should be expanded particularly through mobile and outreach efforts.

Objectives To determine the prevalence of HIV and related behavioural risks among Iranian female sex workers (FSW) via the first national biobehavioural surveillance survey. Methods In 2010, 1005 FSW were approached and 872 recruited using facility-based sampling from 21 sites in 14 cities in Iran. We collected dried blood samples and conducted face-to-face interviews using a standardised questionnaire. Data were weighted based on the response rate and adjusted for the clustering effect of the sampling site. Adjustment was performed by weighting based on the sampling fraction of each site using a prior estimate of its total size of the FSW population. Results The prevalence of HIV infection (95% CI) was 4.5% (2.4 to 8.3) overall, 4.8% (2.2 to 9.8) among those who had reported a history of drug use and 11.2% (5.4 to 21.5) among those who had a history of injection drug use. The frequencies of condom use in the last sexual act with paying clients and non-paying partners were 57.1% and 36.3%, respectively. Any drug use was reported by 73.8% of participants, and among this subgroup, 20.5% had a history of injection drug use. Conclusions The prevalence of HIV was considerable among FSW particularly those who had a history of drug injection. A combination of prevention efforts addressing unsafe sex and injection are needed to prevent further transmission of HIV infection.

Objectives To assess the prevalence of HIV and related risk behaviours among people who inject drugs (PWID) in Iran. Methods We conducted a national cross-sectional bio-behavioural surveillance survey between March and July 2010, interviewing male PWID from a geographically dispersed sample through a facility-based sampling method. Results We recruited 2480, and tested 2290 PWID. The overall prevalence of HIV was 15.2% (95% CI 9.7% to 23.1%). Among those who had injected drugs over the last month, 36.9% had used a non-sterile needle, and 12.6% had practiced shared injection. Over the past 12 months preceding the interview, 30.4% had sold sex for money, drugs, goods or a favour. In the multivariate analysis, the prevalence of HIV had a positive association with age, while having above high school education, and permanent job were protective. Conclusions Unsafe injection, and sexual risk behaviours are still frequent and the prevalence of HIV among PWID remains high. Intensified efforts are needed to prevent the further spread of HIV among Iranian PWID and their sexual partners.

Odds Ratios (95% CIs) of significant variables in adolescence for hypertension events in adulthood, considering BMI as anthropometric variable. Table S2. Odds Ratios (95% CIs) of significant variables in adolescence for hypertension events in adulthood, considering waist circumference as anthropometric variable. Table S3. Odds Ratios (95% CIs) of significant variables in adolescence for hypertension events in adulthood, considering hip circumference as anthropometric variable. (DOCX 16Â kb)

Background High-risk individuals for CHD could be diagnosed by some non-invasive and low-priced techniques such as Minnesota ECG coding and rose angina questionnaire (RQ). Objectives The present study aimed at determining the risk of incident CHD according to ECG and RQ besides diabetes and other metabolic risk factors in our population. Methods Participants comprised of 5431 individuals aged ≥ 30 years within the framework of Tehran lipid and glucose study. Based on their status on history of CHD, ECG, and RQ at baseline, all participants were classified to 5 following groups: (1) History-Rose-ECG- (the reference group); (2) History-Rose+ECG-; (3) History-Rose-ECG+; (4) History-Rose+ECG+; and (5) History+. We used Cox regression model to find the role of ECG and RQ on CHD, independent of other risk factors. Results Overall, 562 CHD events were detected during the median of 10.3 years follow-up. CHD incidence rates were 55.9 and 9.09 cases per 1000 person-year for participants with and without history of CHD, respectively. Hazard ratios (HRs) (95% CIs) were 4.11 (3.27 - 5.11) for History + and 2.18 (1.63 - 2.90), 1.92 (1.47 - 2.51), and 2.48 (1.46 - 4.20) for History-Rose+ECG-, History-Rose-ECG+, and History-Rose+ECG+, respectively. RQ and ECG had the same HRs as high as those for hypertension and hypercholesterolemia; however, diabetes showed statistically and clinically more effects on CVD than RQ and ECG. Conclusions RQ in general and, ECG especially in asymptomatic patients, were good predictors for CHD events in both Iranian males and females; however, their predictive powers were lower than that of diabetes.

Background This study investigated the prevalence for hepatitis A virus (HAV), hepatitis E virus (HEV), herpes simplex virus type 2 (HSV2) and syphilis among homeless in the city of Tehran. Methods In this cross-sectional study, 596 homeless were recruited in Tehran. A researcher-designed questionnaire was used to study demographic data. Using enzyme-linked immunoassay, and rapid plasma reagin (RPR) test, we evaluated the seroprevalence of HAV anti-body, HEV IgG, herpes, HSV2 IgG, and syphilis among sheltered homeless in Tehran. The associations between the participant’s characteristics and infections were evaluated using logistic regression and chi-square. Results A total of 569 homeless, 78 women (13.7%) and 491 men (86.3%) were enrolled into the study from June to August 2012. Their age mean was 42 years and meantime of being homeless was 24 months. Seroprevalence of syphilis, HEV IgG, HSV2 IgG and HAV Ab was 0.55%, 24.37%, 16.48%, and 94.34%, respectively. History of drug abuse was reported in 77.70%; 46.01% of them were using a drug during the study and 26.87% of them had history of intravenous drug abuse. Among people who had intravenous drug abuse, 48.25% had history of syringe sharing. Conclusion The prevalence of HAV, HEV and HSV2 were higher than the general population while low prevalence of syphilis was seen among homeless peoples who are at high risk of sexually transmitted infection (STD). Our findings highlighted that significant healthcare needs of sheltered homeless people in Tehran are unmet and much more attention needs to be paid for the health of homeless people.

Background Some longitudinal studies have shown that blood pressure tracks from adolescence to adulthood, yet there is limited evidence regarding the predictive factors of adulthood hypertension during adolescence. This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) to investigate the role of some factors in adolescence, measured in the first examination (1999–2001), to predict adulthood hypertension in the 4th examination (2009–2011). Methods Overall, 1579 subjects, aged 10–19 years, were used for the analysis of the current study. Mean age (SD) of participants at the baseline was 14.2 (2.5) years and 55% of them were female. A forward stepwise approach (p-value 0.05 for removal) was considered to keep significant covariates among common variables including gender, body mass index, waist circumference, wrist and hip circumferences, fasting blood sugar, triglycerides, high density lipoprotein cholesterol, total cholesterol (TC), systolic (SBP) and diastolic blood pressure (DBP). Variance inflation factor (VIF) showed some multicollinearity for anthropometric variables (VIFs between 3.5 and 10). Multivariable logistic regression revealed that gender, blood pressure, wrist circumference and total cholesterol in adolescents are important predictors for adulthood hypertension. Results The risk increased by 4% and 39% per each 10 mmHg and 1 mmol/L increase in SBP/DBP and TC, respectively; additionally, females had a 70% lower risk. Among anthropometric variables, wrist circumference remained in the model, with 50% per centimeter increase in the risk of hypertension. Conclusions Wrist circumferences and TC had significant roles in predicting hypertension through adolescence to adulthood. Electronic supplementary material The online version of this article (10.1186/s12889-017-4922-3) contains supplementary material, which is available to authorized users.

Background To evaluate the power of abnormal resting ECG versus Rose Questionnaire angina and its additive value in predicting 10-year coronary heart disease (CHD) risk in an Iranian urban population with high prevalence of CHD. Methods There were 5101 subjects ≥30 years (2900 women), free of CHD at baseline; they were categorised in to four groups according to their Rose Angina and ECG status for ischaemia as Rose−/ECG−, Rose+/ECG−, Rose−/ECG+ and Rose+/ECG+. HR of CHD was estimated using Cox regression analysis, given Rose−/ECG− as the reference. The authors used Akaike information criterion, C-index and integrated discrimination improvement indices to evaluate the prognostic value of ECG when would be added to Rose Questionnaire. Results During follow-up, 387 CHD events (169 women) were observed. Multivariate analysis showed a HR of 2.59 (95% CI 1.71 to 3.91) and 2.26 (1.48 to 3.44) for Rose+/ECG− group in men and women, respectively. These figures for Rose−/ECG+ were 1.36 (0.90 to 2.05) in men and 2.09 (1.40 to 3.12) in women. There was no any interaction between Rose Questionnaire and gender to predict incident CHD, in age-adjusted analysis. Akaike information criterion, C-index and relative integrated discrimination improvement did not show any difference between models including Rose alone and Rose plus ECG to predict CHD events especially in men. Conclusions Rose Questionnaire as a simple screening tool is equally important to predict incident CHD in both genders. Adding abnormal ECG to angina did not culminate in higher risk for future CHD events.

ObjectivesCardiovascular mortality in Western Asia is high and still rising. However, most data documented on risk prediction has been derived from Western countries and few population-based cohort studies have been conducted in this region. The current study aimed to present the process of pooling data and cardiovascular disease (CVD) mortality incidences for four Iranian cohorts.MethodsFrom the Iran Cohort Consortium, the Golestan Cohort Study (GCS), Tehran Lipid and Glucose Study, Isfahan Cohort Study (ICS) and the Shahroud Eye Cohort Study (ShECS) were eligible for the current study since they had appropriate data and follow-up visits. Age-standardised CVD mortality rates were estimated for ages 40–80 and 40–65 years. Cox regression was used to compare mortalities among cohorts. Adjusted marginal rates were calculated using Poisson regression.ResultsOverall, 61 291 participants (34 880 women) aged 40–80 years, free of CVD at baseline, were included. During 504 606 person-years of follow-up, 1981 CVD deaths (885 women) occurred. Age-standardised/sex-standardised premature CVD mortality rates were estimated from 133 per 100 000 person-years (95% CI 81 to 184) in ShECS to 366 (95% CI 342 to 389) in the GCS. Compared with urban women, rural women had higher CVD mortality in the GCS but not in the ICS. The GCS population had a higher risk of CVD mortality, compared with the others, adjusted for conventional CVD risk factors.ConclusionsThe incidence of CVD mortality is high with some differences between urban and rural cohorts in Iran as a Western Asian country. Pooling data facilitates the opportunity to globally evaluate risk prediction models.

Background: Despite the high prevalence of diabetes, limited information is available about the impact of impaired glucose regulation on the cardiovascular disease (CVD) risk among Middle East populations. Aims: To determine the risk of CVD in an urban Iranian population according to glucose tolerance status. Material and methods: The study population consisted of 1752 men and 2273 women, aged ≥40 yr, free of CVD at baseline. Incident CVD was ascertained over a median of 7.6 yr of follow-up. Results: A total of 340 CVD events occurred (197 in men and 143 in women). At baseline, there was no difference between newly diagnosed and known diabetes regarding the Prospective Cardiovascular Munster (PROCAM) risk score and prevalence of metabolic syndrome in both genders. Applying the 1997 American Diabetes Association (ADA) criteria, compared with those with normal glucose tolerance, after controlling traditional risk factors, hazard ratios (HR) and 95% confidence intervals (95% CI) for CVD in women with known and newly diagnosed diabetes were 3.30 (2.09–5.21) and 1.93 (1.16–3.21) and the corresponding values for men were 1.90 (1.11–3.25) and 1.69 (1.12–2.54), respectively. Impaired fasting glucose or impaired glucose tolerance was associated with 56% increased risk of CVD in women (HR 1.56, 95% CI 1.00 to 2.45), in the age-adjusted analysis, considering the 2003 ADA criteria. Conclusions: All diabetic subjects, whether newly diagnosed or known cases, should receive intensive primary prevention for CVD regardless of risk factors, in particular females with abnormal glucose regulation.

Iran has a concentrated HIV epidemic among people who inject drugs (PWID). Low HIV testing uptake could contribute to the significant number HIV-infected PWID, who go undiagnosed. This study aims to assess HIV testing uptake and its correlates among PWID in Iran.Data were collected through a national cross-sectional bio-behavioral study in 2010. Adult male HIV-negative PWID were included in the current analysis. All estimates were adjusted for the clustering effect of the sampling sites. Multivariable logistic regression was used to examine the correlates of recent HIV testing and adjusted odds ratios (AOR) were reported.Out of the 2146 eligible PWID for this study, 49.8% reported having ever tested for HIV. However, only 24.9% had tested in the previous year and received their test results. Around 65.2% of PWID knew an HIV testing site. In the multivariable analysis, knowing an HIV testing site (AOR=13.9; P-value0.001), ≥24 years of age (AOR=3.30; P-value=0.027), and multiple incarcerations (AOR=1.71; P-value0.001) were positively, and a monthly income of ≥65 US dollar (AOR=0.23; P-value=0.009) was negatively associated with having been tested and received the results.Despite the availability of free HIV counselling and testing for PWID in Iran, only one-fourth of adult male PWID had been tested for HIV and received their results. Implementing policies and strategies to normalize routine HIV testing among PWID are crucial steps to help curb the epidemic among Iranian PWID.

Background: The ACC/AHA released a newguideline on the assessment of cardiovascular risk andmanagement of hypercholesterolemia that some controversy exists concerning its usefulness. We examined the clinical usefulness of this guideline in a high incidence population using novel measures. Methods: First, we validated the new risk equation in a cohort of 2372 men and 2781 women aged 40-75 years. Then, high risk individuals for cardiovascular diseases (CVDs) were identified according to the ACC/AHA guideline at baseline (as a predictor) and CVD outcomes were detected during a 10-year follow-up. Discrimination of the guidelinewas quantified and the quality of decisions was evaluated by Net Benefit Fraction index considering the harm, for false-positive, and benefit, for true-positive predictions. Finally, net number needed to treat (NNT) for statin was estimated, using test tradeoff index, in diabetic and non-diabetic subjects. Results: During follow-up, 726 CVD events including 298 hard CVDs occurred. The equation overestimated the risk by 57% in men and 48% in women. Based on the guideline, 73% of men and 44% of women were eligible for statin therapy. The lowest sensitivity was detected for intensive treatment in non-diabetic subgroups (82% in men and 41% in women; corresponding specificity, 52% and 90% respectively). The guideline had a significant net benefit for both moderate and intensive treatment, which resulted in estimated NNTs ranged 5-55; however, net benefit of intensive therapy was uncertain in non-diabetic women. Conclusions: We objectively showed that the ACC/AHA recommendations could be useful in our population but with some overtreatment in women. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Background Data about the risk factors of stroke are sparse in the Middle East populations. We aimed to determine the potential risk factors and their population attributable fraction (PAF) for stroke in an Iranian population. Methods A cohort Study consisted of 1089 men and 1289 women, with mean (SD) ages of 61.1(7.6) and 59.0(6.7) years, respectively. Cox regression was implemented to estimate the hazard ratio (HR) of each risk factor for stroke events in a stepwise method. We calculated a multivariate adjusted population attributable fraction (PAF) for any risk factors remained in the model. Results During 9.3 years of follow-up, 69 events of stroke occurred with incidence rates of 4.5 (95% CI: 3.3-6.0) and 2.5 (1.7-3.6) in 1000 person-years for men and women respectively. Among potential risk factors, only age ≥ 65 years (HR: 2.03, CI: 1.24-3.31), male gender (HR: 2.00, CI: 1.16-3.43), hypertension (HR: 3.03, CI: 1.76-5.22), diabetes mellitus (HR: 2.18, CI: 1.34-3.56), and chronic kidney disease (CKD) (HR: 2.01, CI: 1.22-3.33), were independently associated with increased risk of stroke events in the total population. A paired homogeneity test showed that the hazard ratio of CKD did not differ from other independent risk factors. The PAFs were 29.7% and 25% for male gender and age ≥ 65 as non-modifiable and 48.6%, 29.1% and 22.0% for hypertension, CKD and diabetes as modifiable risk factors respectively. Conclusion Following this population based study of Iranians, we demonstrated that among modifiable risk factors, CKD as well as hypertension and diabetes are the strongest independent predictors of stroke.

Introduction Attributable Fraction is the commonest method of describing the proportion of a health outcome attributable to an exposure in an exposed group. It applies to binary variables. Many variables are continuous; changing them to binary variables results in loss of information. Using traditional analyses we compared the importance of cardiovascular disease (CVD) risk factors in a continuous form. Methods A population based cohort study including 1802 men and 2301 women aged ≥40 years in Tehran. We considered modifiable continuous exposures at baseline and CVD events during 8.5 years of follow-up. Using factor analysis we extracted some uncorrelated and standardised factors, each related to a cluster of continuous variables with the same general feature (eg, systolic and diastolic blood pressure as blood pressure factors or body mass index and waist circumference as anthropometric factor); then, a Cox regression including these factors as scores was conducted to estimate the RR of the last quintile to the first for each factor. Finally we compared these similar RRs in the model using the Wald test. Results Anthropometric, blood glucose, blood pressure and cholesterol factors were extracted. The total variance explained by factors was 88.6% in men and 87.3% in women. In men all factors had the nearly the same RRs ranging from 1.7 to 2.2 but in women the RR of cholesterol was significantly higher than the others (3.4 vs 1.7–2.5). Conclusion To prevent CVD, all clusters of risk factors should be considered in control programs. Hypercholesterolaemia maybe more important in women.

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Diabetes and dysglycemia have a high prevalence in Iranian population but the information about their impact on the cardiovascular disease (CVD) risk is scarce in this population. This study aimed to determine the risk of CVD according to glucose tolerance status."n"nMethods: We ascertained cases with incident CVD in a population of 1752 men and 2273 women, 40 years old and over and free of CVD at the beginning of study, during a follow up with a median of 7.6 years. To calculate hazard ratio (HR) for CVD, we controlled traditional risk factors, including age, body mass index, waist, total cholesterol, HDL-cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, education, smoking, hypertension medication, lipid lowering medication and family history of premature CVD and diabetes."n"nResults: Cardiovascular events occurred in 197 men and 143 women. Its incidence density was 11.8 per 1000 person-years (95% confidence interval: 10.6 to 13.1) totally. Multiple adjusted HR in women with known diabetes was 3.88 (95%CI: 2.40 to 6.27) and with newly diagnosed was 2.34 (95%CI: 1.39 to 3.95) and the corresponding values for men were 1.72 (95%CI: 1.00- 2.95) and 1.52 (95%CI: 1.01- 2.31) respectively. Impaired fasting glucose and impaired glucose tolerance increased 56% the risk of CVD in women (HR: 1.56 with 95% CI, 1.00 to 2.45), just in the age adjusted model."n"nConclusion: All diabetic patients should receive primary prevention for CVD intensively, regardless of whether they are newly diagnosed or are known cases; specially, females who have abnormal glucose metabolism.