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

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

Colorectal cancer (CRC) is one of the most common cancers in the world. The aim of this study was to investigate its incidence and risk factors in the Iranian population. A literature search was conducted in PubMed, Web of Science, Scopus, SID, and Magiran from inception until 2019. Studies that reported the incidence rate and risk factors of colorectal cancer were included in this review. Twenty-one articles that reported the incidence rate and 13 that reported the risk factors were included. The incidence rate was different according to the population type, gender, age, and study year in different regions. The main risk factors for colorectal cancer were high consumption of red meat and fried food and low intake of fruits and vegetables, diabetes, a positive family history, and obesity. The incidence of CRC has a marked variation in different parts of Iran, and various risk factors are associated with colorectal cancer. According to incidence rate and various risk factors, precise planning is needed to control colorectal cancer in the future.

Toxocariasis is one of the neglected zoonosis with considerable public health importance around the world. The current study aimed to elucidate the overall prevalence of Toxocara infection in human and definitive hosts and also the contamination of soil and raw vegetables with the ova of these parasites, in Iran, using systematic review and meta-analysis. Six English and Persian databases were explored from 2000 to 2017 using the terms toxocariasis, Toxocara spp., visceral larva migrans, Iran, epidemiology, and prevalence. This meta-analysis conducted using STATA, and for all statistical tests, a p value less than 0.05 was considered significant. The random-effects model was used to the report of the pooled prevalence with a 95% confidence interval (CI). The pooled prevalence of toxocariasis in human was calculated as 11% (95% CI 8–13%). In terms of definitive hosts, the pooled prevalence of Toxocara infection in dogs and cats were calculated as 17% (95% CI 14–20%) and 37% (95% CI 26–48%), respectively. Also, the pooled prevalence of Toxocara spp. eggs in the soil and raw vegetable samples were calculated as 18% (95% CI 13–23%) and 2% (95% CI 1–3%), respectively. The results of current study demonstrate that toxocariasis should be taken more seriously by health authorities. Implementing an appropriate control program is necessary to reduce the incidence of this disease in Iran.

To assess the trend and pattern of depression prevalence among adult population by demographic characteristics and severity of disease from 2005 to 2016.We used six cycles of National Health and Nutrition Examination Survey. The Patient Health Questionnaire (PHQ-9) was used to measure of depression with the total score ranges 0-27. Socio-demographic variables including age, gender, marital status, race, education, and poverty income ratio (PIR) were used. The weighted prevalence was calculated for each cycle. Logistic regression was used for assessing time-trends in the prevalence of depression.A total of 31,191 participants aged20 years were included. The intensity of prevalence trend was different among subgroups of demographic characteristics. Prevalence in females was 1.5-fold more than that in males and increased approximately 2-fold during the study period. The prevalence in "never married" and "other marital status" subgroups was almost 1.5-fold and 2-fold more than that in "married" subgroup, respectively. Prevalence in the never married subgroup increased 2-fold from the first cycle to the latest one. The prevalence of depression was more in the aged60 years, race group other than white, low education and PIR≤1 subgroups. But, the intensity of the increasing trend was more in the subgroups of aged≥60 years, white race and PIR1.the possibility of age-period-cohort (APC) effect that we were unable to assess and control them.In sum, there was an overall increasing trend of depression which was different by demographic characteristics based on subtype of depression.

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

Background Role of leptin is well documented in cardiometabolic diseases. The objective of this study was to investigate if the serum levels of leptin associates with the serum levels of markers related to cardiac and metabolic disorders in adults. Materials and methods One hundred eighty subjects [120 cardiovascular disease (CVD) and 60 healthy controls] were enrolled in the study, to determine the association of the serum leptin (in quartiles) and cardiometabolic diseases [metabolic syndrome (MetS) and CVD] adjusted for other biological and physical examination. MetS was according to the WHO Clinical Criteria for MetS definition and CVD by angiography outcomes. The serum levels of leptin and OX-LDL were measured by ELISA. Results Leptin levels were significantly higher in patients with MetS and those with positive angiography compared with controls. After controlling for potential confounders, a significant association of the leptin levels with cardiometabolic diseases was proven, albeit there was a higher rate of significance between CVD and leptin in comparison with MetS. Additionally, receiver operating characteristic analysis revealed that the serum levels of leptin were a valuable biomarker of the cardiometabolic diseases. Conclusion Our findings demonstrate that serum leptin levels are associated with components of the MetS and with CVD. Serum leptin may be a useful biomarker for CVD.

Colorectal cancer (CRC) is one of the most important cancers, which has various patterns in the world. The aim of this study was to determine the factor associated to survival and looking for screening in Iran. A literature search was conducted using PubMed, Web of Science, Scopus, SID, and Magiran on June 30, 2018. Studies that performed survival analysis and the barrier of screening for colorectal cancer were included in this review. Fifty-three articles for survival and 11 for screening were included and examined. The important factors of survival are the age, cancer stage, tumor grade, ethnicity, marital status, family history of cancer, smoking, metastasis, and obesity. For barrier of screening, the cost, shame, fear of diagnosis the cancer, absence of clinical symptoms, and time limit were determined. Remarkably, knowledge, attitude, and behaviors about CRC screening in Iran are very moderate to poor. According to diversity of survival rates and low tendency to screening, we need to further and deepen studies of barrier and facilitators of screening.

OBJECTIVES: This study was conducted to identify and characterize the barriers and motivations to physical activity (PA) for elderly adults in Iran and other countries.METHODS: We searched 6 databases (PubMed, Embase, Scopus, Web of Science, Magiran, and the Scientific Information Database) from 2000 to the November 2017, using “aged 60 and over,” “physical activity” or “exercise,” and “motivator” and “barrier” as keywords. Two reviewers independently performed the search, screening, and quality assessment of the studies.RESULTS: In total, 34 papers were finally included in the study. The most important barriers, based on the frequency of factors, included physical problems, having no companions, and physical barriers to walking. The motivators included improving one’s physical condition, being social, and suitability of the physical environment.CONCLUSIONS: Important motivators and barriers to PA were more closely related to intrapersonal factors than to the interpersonal and environmental domains. The barriers and motivators to PA in the elderly were not markedly different between Iran and other countries. Therefore, a general strategy could be designed to improve PA in the elderly.

The aim of this study was to evaluate the association between caffeine intake and cognitive function.In this cross sectional study, we used data from the 2013-2014 National Health and Nutritional Examination Surveys (NHANES). Our research subjects were 1440 adults aged ≥60 years. The individual's cognitive functions were evaluated using the Consortium to Establish a Registry for Alzheimer's disease (CERAD) Word List Learning Test, CERAD Word List Recall Test, Animal Fluency test, and Digit Symbol Substitution Test (DSST). Participants were categorized based on the quartiles of caffeine intake. In each dimension of cognitive, we calculated and used median value as cut-off point and assessed the association between each dimension (binary) and caffeine intake using multiple logistic regression analysis in different models.In all of the dimensions, only the highest quartile of caffeine intakes was positively associated with the cognitive function in the crude model and also trend existed (P trend0.05). After adjusting for potential confounders (age, sex, family income, education, marital status, history of disease, sleep disorders, thyroid problems, physical activity, social support, smoking, and some nutrients), the association was marginally significant in CERAD Word List Recall Test (P trend = 0.09), but was not significant in other dimensions of cognitive function. A statistically significant interaction was noted between caffeine intake and gender in relation to the CERAD Word List Recall Test (P = 0.02).Generally, there was a weak positive association between caffeine intake and cognitive performance in older adults that modified by sex. So that, the relation was stronger among male than female.

To understand the genetic architecture and make inferences about transmissible resemblance of systolic and diastolic blood pressure (SBP and DBP) traits in relatives, the polygenic effect of individual alleles in terms of narrow heritability (h2) is usually assessed. The heritability estimates for BP traits are population specific parameters with a wide range in different studies (6–68%), and there is no comprehensive evidence comparing its source(s) of heterogeneity. To fill the gap, this systematic review and meta-analysis study was carried out. Using MeSH terms, 647 records were detected through searching, “Pubmed,” “Ebsco,” “Web of Science,” and “Scopus” databases. From these, 24 relevant full-text articles with 47 comparisons for final quantitative meta-analysis were included in our review over the five continents. The additive genetic effects of both traits showed a widespread distribution (h2SBP: 17–52%, h2DBP:19–41%). Different categories of transmissible resemblance for BP traits were explained by ethnicity; higher heritability was estimated in Europeans and Mexican Americans, while lower heritability was seen in the Middle Eastern, Asians, Africans, Latinos, Hispanics, and American Indians. Low heterogeneity of polygenic effects was seen for both traits in subgroups of the Middle East, Asians, Africans, and Latinos, Hispanics, American Indians. However, there was a substantial heterogeneity of h2 within European and Mexican American studies. Neither pedigree type nor other covariates explained the variance of additive genetic effects of BP traits in different ethnicities.

Remarkable findings from genome wide association studies (GWAS) on blood pressure (BP) traits have made new insights for developing precision medicine towards more effective screening measures. However, generality of GWAS findings in diverse populations is hampered by some technical limitations. There is no comprehensive study to evaluate source(s) of the non-generality of GWAS results on BP traits, so to fill the gap, this systematic review study was carried out. Using MeSH terms, 1545 records were detected through searching in 5 databases and 49 relevant full-text articles were included in our review. Overall, 749 unique variants were reported, of those, majority of variants have been detected in Europeans and were associated to systolic and diastolic blood pressure traits. Frequency of genetic variants with same position was low in European and Non-European populations (n=38). However, more than 200 (>25%) single nucleotide polymorphism were found on same loci or linkage disequilibrium blocks (r2 ≥80%). Investigating for locus position and linkage disequilibrium of infrequent unique variants showed modest to high reproducibility of findings in Europeans that in some extent was generalizable in other populations. Beyond theoretical limitations, our study addressed other possible sources of non-generality of GWAS findings for BP traits in same and different origins.

Background: Coronary Artery Disease (CAD) has long been recognized as a global health issue. Inflammation, Fibrinolysis and Oxidative Stress play an important role in the disruption of plaques leading to CAD. Markers that reflect this pathophysiologic mechanism may have prognostic value. Objective: To estimate the serum concentrations of high-sensitivity C-reactive protein (hs-CRP), sialic acid (SA), vitronectin (VN), plasminogen activator inhibitor-1 (PAI-1), oxidized low density lipoprotein (OX-LDL) and malondialdehyde (MDA) with significant prognostic value in patients with CAD. Methods: The markers included, hs-CRP, SA, VN, PAI-1, OX-LDL and MDA, were compared between 160 angiographically diagnosed CAD patients and 20 age- and sex-matched healthy individuals. The subjects were divided into 4 groups according to angiography results, and association between all risk factors of CAD was studied. Serum levels of SA, VN, PAI-1, and OX-LDL were measured by enzyme-linked immunosorbent assay (ELISA); MDA was measured based on reaction with thiobarbituric acid (TBA); and hs-CRP level was estimated by immunoturbidimetry using a commercial kit. The diagnostic value of these variables was further assessed by ROC curve analysis. Multiple logistic regression was used to evaluate the diagnostic power of the combination. Furthermore, p < 0.05 was considered as significant. Results: Serum levels of hs-CRP, SA, VN, PAI-1, and OX-LDL were significantly higher in patient groups compared to control group (p < 0.001). Using both normal and CAD patients as subjects, ROC analysis was performed. The cutoff for OX-LDL, MDA, PAI-1, VN, hs-CRP and SA was 2.67 (ug/mL), 5.49 (mmol/mL), 67 (ng/mL), 254 (ng/mL), 3.4 (mg/dL), 7/89 (mg/dL), respectively. Eventually, the complete diagnostic efficacy was classified as: SA, hs-CRP, PAI-1, OX-LDL, MDA and VN. Conclusion: Serum levels SA, hs-CRP, VN, PAI-1, OX-LDL and MDA may be predictive of adverse cardiovascular outcomes. Interestingly, these analyses can help as diagnostic and monitoring markers in CAD patients. Resumo Fundamento: A doença arterial coronariana (DAC) tem sido há muito reconhecida como um problema de saúde global. Inflamação, fibrinólise e estresse oxidativo desempenham um papel importante no acometimento das placas, levando à DAC. Os marcadores que refletem esse mecanismo fisiopatológico podem ter valor prognóstico. Objetivo: Estimar as concentrações séricas com valor prognóstico significativo da proteína C-reativa de alta sensibilidade (PCR-as), ácido siálico (AS), vitronectina (VN), inibidor do ativador do plasminogênio-1 (PAI-1), lipoproteína de baixa densidade oxidativa (OX-LDL) e malondialdeído (MDA) em pacientes com DAC. Métodos: Os marcadores inclusos, PCR-as, AS, VN, PAI-1, OX-LDL e MDA, foram comparados entre 160 pacientes com DAC com diagnóstico angiográfico e 20 indivíduos saudáveis pareados por idade e sexo. Os sujeitos foram divididos em 4 grupos de acordo com os resultados da angiografia, e a associação entre todos os fatores de risco da DAC foi estudada. Os níveis séricos de AS, VN, PAI-1 e OX-LDL foram medidos por ensaio imunoenzimático (ELISA); MDA foi medido com base na reação com ácido tiobarbitúrico (TBA); e o nível de PCR-as foi estimado por imunoturbidimetria utilizando um kit comercial. O valor diagnóstico dessas variáveis foi avaliado posteriormente pela análise da curva ROC. Regressão logística múltipla foi utilizada para avaliar o poder diagnóstico da combinação. Além disso, P

Objective Anemia in infants is a common problem, with regular iron supplementation the suggested policy for prevention and control of anemia. The aim of this study was to determine the prevalence and the determining factors of anemia as well as the benefits of regular iron supplementation in 6- to 12-month-old children. Design/setting/subjects In this cross-sectional study, 897 children aged from 6 to 12 months cared for at the Tabas Health Centers, affiliated with Birjand University of Medical Sciences, South Khorasan, Iran, were enrolled in the study. Demographic and anthropometric data as well as the level of hemoglobin were collected through interviews and laboratory tests, respectively. Data analysis was performed using SPSS-22 and stata-13. Chi2, polychromic PCA, and logistic regression were used. The statistical significance level was 0.05. Result The prevalence of anemia, according to the WHO criterion for hemoglobin, was 36.8% (95% CI, 33.6–40.0). Its prevalence showed a decreasing trend as age and duration of iron supplement increased. Each 1-month increase in infant age was associated with a decreased risk of anemia [OR = 0.88 (95% CI, 0.80–0.98)]. Anemia was not significantly different between genders. Individuals in the highest category for parity (≥3) were at a 2.3-fold greater risk of anemia compared with the lowest category [OR = 2.35 (95% CI, 1.43–3.84)]. In contrast, individuals in the highest category for maternal age (>35 years) had a 62% lower risk of anemia compared with the reference category ( Conclusion Implementation of an iron supplementation plan in Iran has decreased anemia among 6- to 12-month-old children.

Background and objectives : The current process of traffic accidents shows that the mortality caused by traffic accidents will be the 5th main reason of mortality by 2030 if no intervention is performed. Interventions similar to the one applied in 1384 by traffic police can have major impact on reducing accident rates. This study aimed to investigate the 5-year process of mortality resulting from traffic accidents in Iran. Material and Methods : This study assessed the statistics of deaths ecologically caused by traffic accidents and related variables affecting it in big cities in Iran including Tehran, Khorasan Ravazi and Fars from 1384 to 1390. Results : The findings showed that during 5 years, a total number of 120070 deaths have occurred in the whole country as a result of traffic accidents which was 1096 deaths lesser than five years before that when the rate of deaths was 121166. The mortality was decreased in all age groups during 2 years after the intervention of the police in 1384 and in the final 3 years of the period, the mortality rate was constant except for 2 age groups (1-17 and 18-24 year old) which showed reduction. Conclusion : The evidence indicates a profound and positive impact of rules and improving culture in 1384. Therefore, establishment of appropriate rules and completion of existing laws by the parliament may are suggested which may lead to the reduction of such rates. ​

Background With increased international travel over the world the need for safe and effective chemoprophylaxis for malaria is as great as ever. The choice of regimen is difficult, as effectiveness should be weighted against potential adverse effects. Although, some studies have reported high prophylactic efficacy of primaquine, there is no comprehensive evidence comparing its prophylactic effectiveness as well as toxicity. To fill the gap, this systematic review and meta-analysis study was carried out. Methods Using MeSH terms, 756 records were detected through searching “Pubmed”, “Embase”,”Web of Science”and “Cochrane” databases. From these,7 relevant full-text articles with 14 comparisons for final quantitative meta-analysis were included in our review. In order to make a comparison between the studies, Risk Ratios(RRs) and their 95% confidence intervals(CIs) were estimated. Results Overall,74% reduction in the incidence of parasitaemia by primaquine versus other prophylactic regimens was estimated(RRoverall = 0.26, CI 95%:0.16–0.41--RRvivax = 0.16, CI 95%:0.07–0.36--RRfalciparum = 0.31, CI 95%:0.18–0.55). The incidence rate ratios for adverse effects showed no statistically significant difference between primaquine and control groups (p > 0.05). Conclusions For persons without G6PD deficiency, who are not pregnant, primaquine is the most effective presently available prophylactic for P. vivax malaria and comparable to such regimens as doxycycline, mefloquine and atovaquone-proguanil for the prevention of P. falciparum malaria.