Prevalence and associated factors of mild cognitive impairment among middle-aged and older adults: Results of the first phase of Ardakan Cohort Study on Aging.

Background and Aims: Data on mild cognitive impairment (MCI) in low- to middle-income countries are still being determined, despite the fact that most future older adults are expected to reside in these regions. This study aimed to investigate the prevalence and associated factors of MCI in Iran. Methods: A cross-sectional study was conducted on 4938 community-dwelling subjects aged 50 years or above in the first wave of the Ardakan Cohort Study on Aging. MCI was evaluated using the Mini-Mental State Examination (MMSE) and the Abbreviated Mental Test Score (AMTS) in literate and illiterate individuals. The relationship between factors associated with the odds of MCI was assessed through logistic regression. Results: The prevalence of MCI among all participants, the literates and illiterates, was 15.8%, 6.3%, and 36.4%, respectively. It was found that failure to accomplish any of the MMSE or AMTS items was significantly related to MCI (p < 0.001). Age ([odds ratio (OR): 1.05; p < 0.001 in the literates], [OR: 1.06; p < 0.001 in the illiterates]), sex (OR: 0.13; p < 0.001 in the illiterates), history of stroke ([OR: 2.86; p = 0.006 in the literates], [OR: 2.04; p = 0.045 in the illiterates]), and depression ([OR: 1.87; p < 0.001 in the literates], [OR: 1.41; p = 0.008 in the illiterates]) were significantly associated with MCI. Conclusion: This study highlights the significant associations between age, education, depression, stroke, and MCI in Iranian participants. These findings emphasize the need for targeted interventions in low-literacy populations, mental health screening, and stroke prevention strategies to mitigate the burden of MCI and enhance cognitive health.

Prevalence, Complications, and Risk Factors of Falls and Fear of Falling Among Older Adults; Based on Ardakan Cohort Study on Aging (ACSA).

Introduction: The objective of this study was to assess the prevalence of falls, fear of falling (FOF), complications arising from falls, and identify possible sociodemographic and health-related factors associated with these outcomes among older adults. Methods: This cross-sectional study was based on the first wave of the Ardakan Cohort Study on Aging (ACSA), which includes participants over 50 years of age residing in Ardakan, Iran. Fall history, number of fall events, FOF, hospitalizations, and fractures in the past 12 months were assessed through a face-to-face interview. Health-related factors were recorded on a self-expressed basis. Associations were assessed using multiple logistic regression. Results: Among the 4,990 participants, fall history in the past 12 months was prevalent in 19.9%, with 10.1% reporting more than two fall events. Women (p < 0.001) and older participants (p< 0.001) had a higher prevalence. In females, 28.8% reported moderate to severe FOF, while 21% experienced disruptions in their daily activities as a result of this fear. The prevalence of fractures following falls was 5.1% in males and 8.6% in females. After adjusting for confounding factors, FOF (OR: 1.59, 95% CI: 1.33-1.91, p<0.001), imbalance (OR: 2.45, 95% CI: 1.68-3.58, p<0.001), urinary incontinence (OR: 1.44, 95% CI: 1.04-1.9, p=0.025), cognitive impairment (OR: 1.21, 95% CI: 1.01-1.46, p=0.049), vertigo or dizziness (OR: 1.39, 95% CI: 1.15-1.68, p<0.001), osteoporosis (OR: 1.24, 95% CI: 1.03-1.50, p=0.023), osteoarthritis (OR: 1.33, 95% CI: 1.13-1.56, p=0.001), depression (OR: 1.30, 95% CI: 1.06-1.60, p=0.010), and Central Nervous System (CNS)-affecting diseases (OR: 1.99, 95% CI: 1.33-2.97, p=0.001) were found to have positive associations with falls. Conclusion: This study showed that about one-fifth of those over 50 in Iran have experienced at least one fall within a year. Self-expressed imbalance, FOF, and urinary incontinence were the most prominent risk factors. Due to resulting in hospitalization and fractures, falls also lead to fear of falling and the associated limitation of activities.

Evaluation of oral health status in the population above 50: evidence from the ardakan cohort study on aging (ACSA).

BACKGROUND: The global population is undergoing rapid aging, and older individuals are more susceptible to various health issues, including oral health problems. Despite the increasing attention given to healthy aging, oral health has often been overlooked in discussions related to health problems. This study aims to assess the oral health status of middle-aged and older adults in Iran. METHODS: This cross-sectional study analyzed data from 4970 men and women aged 50 years and above, who participated in the Ardakan Cohort Study on Aging (ACSA) between 2020 and 2022. Trained personnel administered a questionnaire and conducted oral health examinations to determine the oral health status and oral hygiene behaviors of the participants. RESULTS: The mean value (SD) of the total Decayed, Missing, and Filled Teeth (DMFT) index was 21.3 (10.7). Approximately 46% of all participants were completely edentulous (without natural teeth). Moreover, 58.5% of the total sample wore dentures, and the mean age (SD) when they started using dentures was 48.5 (20.7) years. About 71% of participants with natural teeth reported brushing their teeth at least once a day, while about 63% of denture wearers cleaned their dentures daily. In the sample, 28% of individuals had visited a dentist in the last year. The prevalence of difficulty in biting and chewing food among the participants was 48.2% and 44.6%, respectively. Additionally, nearly 68% of all samples reported experiencing at least one difficulty in daily functioning due to oral/dental conditions. The study identified cutoff points of seven (sensitivity = 56.8 and specificity = 77.5) and 10 (sensitivity = 72.1 and specificity = 71.1) missing teeth, indicating the presence of at least one problem in daily functioning due to oral/dental conditions in middle-aged and older adults, respectively. CONCLUSION: The study reveals a high prevalence of edentulism and denture use among participants aged 50 years and above. The majority of samples reported difficulties in daily functioning due to oral and dental conditions, especially in biting and chewing food. These findings highlight the importance of proactive measures to address oral health issues in middle-aged and older adults, thereby enhancing their overall health and well-being.

The Role of Childhood Circumstances on Social Conditions and Health of Middle-Aged and Older Adults: Ardakan Cohort Study on Aging (ACSA).

Some studies suggest that childhood can affect some later outcomes. This cross-sectional study of the first phase of the Ardakan Cohort Study on Aging (ACSA) on 5,197 individuals examined the effects of childhood socioeconomic and health on aging well. Childhood socioeconomic status (SES) was measured using parents' education and self-expressed family's financial status. Quality of Life (SF-12), Satisfaction with Life Scale (SWLS), WHO well-being scale, and self-reported health questionnaire were used. All data, including childhood experiences, was collected at a single time point. Poor childhood health was associated with lower well-being, life satisfaction, and mental quality of life (OR: .53, p = .032, OR: 0.49, p = .019, and ß: -3.51, p = .008, respectively). The family's financial status during childhood was associated with the mental and physical quality of life, satisfaction, well-being, and health (all p < .05). Fathers and mothers who had some level of education increased the odds of being healthy by 1.20 and 1.49 times, respectively. Childhood circumstances affect older adults' health and social conditions. Policies to improve childhood health and SES should be prioritized.

The Association of Social Support, Depression, and Loneliness with Health-Related Quality of Life in Over 50 Years Adults: Ardakan Cohort Study on Ageing (ACSA).

BACKGROUND AND AIM: Social factors play a crucial role in the quality of life of + 50 adults. This study aimed to investigate the association between social support, depression, and loneliness and the health-related quality of life in + 50 adults of Ardakan. METHODS: This was a cross-sectional study from the first phase of Ardakan Cohort Study on Aging (ACSA) in 2019. Health-Related Quality of Life (HRQoL, SF-16), Duke Social Support Index (DSSI), and Center for Epidemiologic Studies Depression Scale (CES-D10) were used to assess the variables of interest. Multivariable linear regression was used to model the associated factors with the score of the SF-16 tool in two dimensions; physical (PCS) and mental (MCS). FINDINGS: A total of 5197 over 50 years individuals included in this study; The mean age was 62.2 ± 7.3 years old, and 52% were male. The mean score for PCS and MCS subscales was 45.6 (95% CI 45.4 to 45.9) and 49.3 (95% CI 49.0 to 49.5), respectively. Adjusted for other variables, having less feeling level of loneliness, and not having depressive symptoms were related to better PCS and MCS scores. CONCLUSION: The HRQoL for the mental aspect of HRQoL was better than the physical in elder populations. Also, much more focus should be paid to older adults who experience inadequate social support, higher levels of loneliness, and depressive symptoms.

Evaluation of Sleep Quality and Related Factors in Community-Dwelling Adults: Ardakan Cohort Study on Aging (ACSA).

BACKGROUND: Sleep is a necessary physiological process that affects health. The current study aimed to evaluate sleep quality (SQ) and the related factors in Iranian community-dwelling adults. Study Design: A cross-sectional study. Method: Population-based cross-sectional data from the first wave of the Ardakan cohort study on aging (ACSA) were analyzed. The analytical sample consisted of 5197 community-dwelling adults aged≥50. All data were collected by trained staff. Pittsburgh Sleep Quality Index (PSQI) scores were used to measure SQ. Univariable and multivariable logistic regression were used to identify predictors of SQ. RESULTS: The mean age of the participants was 62.22±7.7 years, and 51.8% were female. About threequarters of them (76.36%) were found to have poor SQ (PSQI score≥5). Multivariable logistic regression analysis revealed a relationship between SQ and gender, education, work, and financial level. Furthermore, SQ was found to be associated with self-reported health and physical activity. Regarding comorbidity, SQ had a significant relationship with cardiovascular diseases, musculoskeletal diseases, depression, and anxiety (P<0.05). CONCLUSION: The prevalence of poor SQ was high in these community-dwelling adults in Iran. These findings highlight the importance of intervention programs for sleep hygiene education and screening for middle-aged and older adults.

Efficacy of oseltamivir in the treatment of patients infected with Covid-19.

Objective: The recent unprecedented pandemic caused by Sars-Cov-2 (the new coronavirus 2019), is threatening public health around the world. Although several studies have been performed, there is no identified treatment for Covid-19 patients. Here we assessed the efficacy of oseltamivir in combination therapy, by comparing two different therapeutic regimens in hospitalized patients, in improving outcomes and find better treatment for Covid-19 patients. Methods: This is a single-center retrospective cohort study of 285 confirmed Covid-19 in patients at (XXX). Depending on the date of admission, the patients were divided into two groups; group 1 (oseltamivir group) from February 20, 2020 to March 15, 2020 received Oseltamivir with routine regimen and group 2 (control group) from March 20, 2020 to April 20, 2020 received routine regimen alone that included Azithromycin 500 mg/day and Hydroxychloroquine 200 mg/12 h.Endpoints including duration of hospitalization, requirement to admission to intensive care unit (ICU) and mechanical ventilation, outcome and mortality rate. Results: A total of 285 patients were enrolled in the two months, 120 patients for group 1 and 165 for group 2. The median time from admission to discharge was significantly shorter in the oseltamivir group compared to the control group (4.9 vs 6.6 days, p < 0.001). Additionally, the mortality rate was found to be lower in the oseltamivir group than in the control group (1.7% vs 6,7%, p = 0.06) which was statistically significant by multivariate analysis (p = 0.03). The incidence of admission to the ICU (6.7% vs 11.5%, p = 0.1) and mechanical ventilation (2.5% vs 4.8%, p = 0.3) were also decreased in the oseltamivir group, but was not statistically significant. Conclusions: This study showed that administration of oseltamivir was associated with shorter length of hospital stay and earlier recovery and discharge of hospital, and a lower mortality rate.

Inflammatory cytokines and sarcopenia in Iranian adults-results from SARIR study.

Some studies suggested the effects of inflammatory cytokines in reducing muscle mass and muscle strength and, performance. This study aimed to compare pro-inflammatory cytokines in sarcopenic and non-sarcopenic subjects. 120 men and women were selected out from the cross-sectional study 'sarcopenia and its determinants among Iranian elders' (SARIR). Sarcopenia was defined based on the first 'European Working Group on sarcopenia in older people' (EWGSOP1) guidelines. A fasting blood sample was taken from each participant to measure serum high-sensitivity C-reactive protein (hs-CRP), Interleukin 6 (IL-6), and tumor necrosis factor α (TNFα). A total of 120 participants were included in this study. Mean age was 66.7 ± 7.7 years and mean body mass index (BMI) was 27.3 ± 4.2 kg/m2. Forty participants had the criteria of EWGSOP1 sarcopenia. A statistically significant difference was seen between normal and abnormal groups of muscle strength in hs-CRP (P-value = 0.04). Furthermore, we did not observe any remarkable association between inflammatory biomarkers including IL-6 (OR 1.15; 95% CI 0.31-4.28), TNF-α (OR 0.68; 95% CI 0.17-2.77), and hs-CRP (OR 2.39; 95% CI 0.87-6.55) and the presence of sarcopenia even after controlling for plausible confounders. We found that inflammatory biomarkers level was not associated with odds of sarcopenia. The lack of correlation between inflammatory cytokines and sarcopenia could be due to the participants' age and genetics. Future studies are required to confirm these findings.

Relationship between Socioeconomic Factors and Incidence of Cosmetic Surgery in Tehran, Iran.

BACKGROUND: Cosmetic surgery accompanied with high economic cost is increasing in Iran. It is necessary to be aware about factors affecting cosmetic surgery in order to control its increasing trend. Therefore, we aimed to determine the factors affecting the incidence of cosmetic surgery in Tehran, Iran. METHODS: This survey was conducted on 2002 subjects between the ages of 15 to 60 yr using random digit dialing in Tehran, Iran 2015. Demographic data was collected from all of participants and in the presence of cosmetic surgery, the related cosmetic questions were asked in details. Cosmetic surgery was considered as an event and the incidence rate ratio for variables were estimated. For univariate analysis, Poisson regression was used as well as multi-level Poisson regression was used for multivariate analysis. RESULTS: Totally, 224 participants (11%) undergone cosmetic surgery. There was a significant relationship between the age at surgery of participants with the incidence of cosmetic surgery (P<0.001). Cosmetic surgery in women was 1.9 times greater than in men (P <0.001). Incidence Rate Ratio (IRR) for the average and wealthy economic status in comparison to poor level was estimated (IRR=5.6, CI%95: 3.64,8.63) and (IRR=3.14, CI%95: 1.93,5.11), respectively. In addition, according to multivariate analysis all variables except the level of education and occupation, had significant relationship with the incidence of cosmetic surgery (P<0.001). CONCLUSION: Cosmetic surgery was related to socioeconomic and demographic factors. Given the high economic burden of this unnecessary surgery, it can be effective to emphasize on awareness-raising programs for those are more likely to undergo cosmetic surgery.

Efficacy of phytosomal curcumin among patients with non-alcoholic fatty liver disease.

Scientists proposed that curcumin could be used for treatment of non-alcoholic fatty liver disease (NAFLD). In this article, we aimed to identify the effect of curcumin on NAFLD improvement. Fifty patients with NAFLD, were divided into two groups in this randomized, double-blind, and controlled clinical trial. Patients in the curcumin group received 250 mg/day of phytosomal curcumin, while those in the control group received 250 mg/day of placebo for duration of eight weeks. Anthropometric measurements and fasting blood samples were taken once at the baseline and once at the end of the study. Analysis was performed on 45 patients (curcumin group n = 22, placebo group n = 22). According to between groups analysis, curcumin significantly reduced the carboxymethyl lisine (CML) (148 ± 108 ng/mL vs 197 ± 101 ng/mL, P = 0.04), 8-hydroxy-2' -deoxyguanosine (8-OHdG) (46.9 ± 31.1 ng/mL vs 52.1 ± 43.1 ng/mL P = 0.03), liver enzymes (P < 0.001), weight (P < 0.001), waist circumference (P < 0.001), body fat percent (P < 0.01), and body mass index (BMI) (P < 0.01) in comparison with placebo. However, curcumin supplementation compared to placebo did not reduce soluble receptors for advanced glycation end products (sRAGE), hip circumference, waist/hip, and fat free mass by the end of the study. Our study indicated that phytosamal curcumin might be able to reduce the NAFLD progress by reducing the anthropometric measures, AGEs, and DNA damage. However, we need more studies with longer intervention duration, and larger sample size.

A pilot study of the effect of curcumin on epigenetic changes and DNA damage among patients with non-alcoholic fatty liver disease: A randomized, double-blind, placebo-controlled, clinical trial.

BACKGROUND: The enhancement of oxidative stress in non-alcoholic fatty liver disease (NAFLD) patients may cause mutation in DNA by deamination of cytosine to 5-hydroxyuracil or uracil. This study aimed to discover the effects of curcumin on NAFLD progress, DNA damage caused by oxidative stress, and promoter methylation of mismatch repair enzymes. MATERIAL AND METHODS: in this study, 54 NAFLD patients were randomly devided into two groups, according to a double blind parallel design either phytosomal curcumin (250 mg/day) or placebo for 8 weeks. Fasting blood samples and anthropometric measures were taken twice, once at the baseline and once at the end of the study. Promoter methylation and 8-hydroxy-2' -deoxyguanosine (8-OHdG) concentration as DNA damage mediator were measured by restriction enzymes and enzyme-linked immunosorbent assay, respectively. RESULT: Analysis was performed on 44 patients. According to our between groups analysis, curcumin significantly reduced the methylation in MutL homolog 1 (MLH1) and MutS homolog 2 (MSH2) promoter regions. The within-group comparison revealed that anthropometric variables significantly decreased. However, the result of the between groups comparison indicated no significant changes in the anthropometric variables except for BMI. Liver enzymes and 8-OHdG did not significantly change at the end of the study, neither in curcumin group nor in placebo group. CONCLUSION: Curcumin might be able to reduce the risk of mismatch base pair in DNA among the NAFLD patients. However, it did not change the DNA damage mediator and liver enzymes. For confirming these results, more studies with longer duration, more numbers of examined genes, higher dose of curcumin, and larger sample size are required.

The Relationship Between Positive Perceptions Toward Organizational Politics and the Work-Related Outcomes of Nurses.

BACKGROUND: Organizational politics (OP) exists to varying degrees in all organizations. OP plays an important role in creating synergy between employees and the goals of the organization. PURPOSE: We aimed to investigate the relationship between positive perceptions toward OP and work-related outcomes in nurses, including stress level, burnout level, turnover intention, and job satisfaction. METHODS: This descriptive, analytical study was conducted from April to June 2018 on nurses at Neyshabur University of Medical Sciences Hospitals in Neyshabur, northeastern Iran. The study included 280 nurses working in two teaching hospitals. Five standardized tools were used, including the Perception of Organizational Politics Scale, the Nursing Stress Scale, the Burnout Measure Scale, the Turnover Intention Inventory Scale, and the Minnesota Satisfaction Questionnaire. RESULTS: The results indicate that the participants did not hold positive perceptions toward OP. The mean Perception of Organizational Politics Scale score was 2.63 ± 0.55. Multiple linear regression analyses showed a significant and positive relationship between positive perception toward OP and job satisfaction and a negative relationship between positive perception toward OP and turnover intention, burnout, and job stress. CONCLUSIONS: Nurses who perceive the work environment to be political will experience greater levels of stress, turnover intention, and burnout and lower levels of job satisfaction. Politics is an issue that should be handled by all levels of management. Managers should use supportive, nonpolitical workplace strategies to improve the work-related outcomes of employees.

Urine analysis with dipstick test in asymptomatic 7-year-old children.

INTRODUCTION: The incidence of renal failure in children is increasing worldwide, and most renal diseases do not show clinical symptoms for the patient. Moreover, given the importance of screening for patient identification and prevention planning that result from screening, the present study was performed. METHODS: This cross-sectional study was performed on 292 children aged 7 years who referred to Neyshabur health centers during 2017-2018. In addition, sampling was clustered. The first urine sample was taken in the morning, and the dipstick test was performed. Data were analyzed using SPSS software version 11.5 and Mann-Whitney, Chi-square, and Pearson's tests. RESULTS: Of the 292 children, 142 (48.6%) were male and 150 (51.4%) were female. All the boys had been circumcised. The children were 7-year-old. Urinary tract problems were present in 31 (10.61%) children. Urinary problems were observed in 163 children (55.82%) considering crystalluria. Some children had more than one type of urinary disorder. Pyuria was the most common disorder in 13 (8.7%) of the studied children, and proteinuria was the least common. Nitrite and hemoglobin were not found in the urine of the studied children. There was a statistically significant relationship between gender and white blood cell count (P < 0.001), crystalline oxalate (P = 0.004), and specific gravity (P = 0.009). There was also a statistically significant relationship between urinary-specific gravity and pH (P < 0.001). CONCLUSION: Asymptomatic urinary problems may be identified by screening tests in school-aged children. Therefore, it is necessary to determine the exact cause of the obtained abnormal results and determine whether or not they are related to renal disease in order to reduce the number of people with untreated renal diseases in future.

Do socioeconomic factors affect the prevalence of multiple sclerosis in Iran?

BACKGROUND: A rising trend for incidence of multiple sclerosis (MS) has been observed during the recent years in Iran. Several factors have been investigated as the reason, but socioeconomic determinants have been neglected. The present study aimed to investigate the relationship between Human Development Index (HDI), income and education and MS prevalence in the provinces of Iran. METHODS: The data used in this study were obtained from three sources: (a) National Registry of MS for MS prevalence data from 2006 to 2013, (b) Statistical Centre of Iran for demographic, income, and percentage of educated people data, and (c) some previous studies for HDI data. RESULTS: The findings showed high prevalence of MS in the provinces of Iran. Most patients were residents of provinces with a higher socioeconomic level. Significant relationships were found between the prevalence of MS and HDI, income and educational level (P = .002, P = .006, and P = .001, respectively). CONCLUSION: Socioeconomic determinants in Iran are different from those in many other countries. It seems that Iranian provinces with a higher socioeconomic level have higher prevalence of MS. Further studies in smaller scale are needed to better understand the relationship between socioeconomic determinants and MS prevalence in the provinces of Iran.

Effect of Phytosomal Curcumin on Circulating Levels of Adiponectin and Leptin in Patients with Non-Alcoholic Fatty Liver Disease: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

BACKGROUND AND AIMS: Non-alcoholic fatty liver disease (NAFLD) is associated with insulin resistance and changes in serum adipocytokine levels. The aim of the current study was to evaluate the effect of phytosomal curcumin on serum adiponectin and leptin levels in patients with NAFLD. METHODS: In this randomized double-blind, placebo-controlled trial, 65 eligible patients were randomly allocated into curcumin and placebo recipient groups using a blocked randomized technique. Parameters of weight, height, body mass index (BMI), fasting blood sugar (FBS), lipid profile, aspartate aminotransferase (AST), alanine aminotransferase (ALT), adiponectin, leptin, and the leptin:adiponectin ratio were measured at baseline and eight weeks after intervention. RESULTS: High-density lipoprotein cholesterol (HDL-C) levels increased significantly in the curcumin group compared to the placebo group (p=0.01). Serum adiponectin levels increased significantly (p<0.001) and serum leptin levels decreased significantly (p<0.001) with a decrease in the leptin: adiponectin ratio in the curcumin group compared to the placebo group after 8 weeks of intervention. CONCLUSIONS: Non-alcoholic fatty liver disease was associated with changes in serum adipokines levels. Phytosomal curcumin effectively improved leptin and adiponectin levels. It is possible that curcumin efficacy will increase with long-term use of higher doses of this substance.

Tobacco tax and price in the developed and developing countries in the World.

An ecologic study was conducted on 177 countries which the information of tobacco tax and price and also Human Development Index (HDI) was available in 2014. In this study, the relationship between HDI and four reported indexes by World Health Organization (WHO) was studied. These four indexes included: Tobacco affordability, Taxes as a percent of price of the most sold brand (total tax), Price of a 20 cigarette pack of the most sold brand international dollars at purchasing power parity (Price_ppp) and Price of a 20 cigarette pack of the most sold brand in US$ at official exchange rates (Price_US$). The data of HDI and tobacco were mined from WHO and United Nations Development Programme sites respectively. To study the correlation between HDI and the variables of this study, Pearson correlation coefficient was used and also Linear Regression Analysis was used to study the relationship between HDI and the variables of the study. According to the findings of the linear regression analysis, there was a significant relationship between HDI and total tax (B = 0.81, CI 95%: 0.63-0.99) and tobacco affordability (B = --0.35, CI 95%: --0.42 _ --0.28). There was also a significant relationship between HDI whit price-ppp (B = 9.44, CI 95%: 7.13-11.75) and price-US$ ;(B = 11.97, CI 95%: 9.71-14.23). According to the findings of this study, less developed countries devote less tax on tobacco. Due to the rising trend of the prevalence and also development of non-communicable diseases such as lung cancer in developing countries, policy makers of these countries are required to design stricter policies toward tobacco production and supply as well.

Dataset on the prevalence of tobacco smoking in men and women of selected countries whit difference human development.

This study was conducted to investigate the effect of human development index (HDI) on tobacco smoking prevalence in men and women of countries which their data about tobacco smoking were available for 2015. Pearson's correlation coefficient and linear regression were used to investigate the association between HDI and all types of smoking, particularly cigarette. Daily smoking and current smoking were used as tobacco smoking indices. The information about prevalence of tobacco smoking and HDI was obtained from the World Health Organization (WHO) website and United Nations Development Programme (UNDP), respectively. The results showed that there is no statistically significant relationship between HDI and current tobacco smoking in men (B = -0.45_CI 95%: -29.97, 29.06). However, the same association was significant for women (B = 43.87, CI 95%: 24.97-62.78). The results indicated that women in developed countries are more at risk of health effects attributed to tobacco smoking. Countries should focus on socioeconomic factors to prevent the spread of risk factors for non-communicable diseases.

Diarrhea deaths in children among countries with different levels of the human development index.

The present study investigated the effect of human development index (HDI) on diarrheal deaths per 1000 live births in children under 5 years old in 2015. In addition, the association between HDI, and the use of improved drinking-water sources and sanitation facilities were evaluated in this year. 75 countries that their information was available in Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) conducted by the World Health Organization (WHO) were included in this study. The data required was obtained from WHO and United Nations Development Programme (UNDP) websites. Pearson's correlation coefficient and linear regression were used to evaluate the correlation and association between the variables, respectively. The results showed that there is a significant relationship between HDI and diarrhea-associated deaths per 1000 live births in children during 2015 (B = -354.85, CI95%: -408.91, -300.79). In addition, HDI was associated with the use of improved drinking-water sources (B = 83.93, CI95%: 64.71, 103.15) and improved sanitation facilities (B = 199.90, CI95%: 174.39, 225.42) in 2015. These findings indicate the association between HDI and the measures relevant to diarrheal disease among children. Therefore, in order to achieve to the Millennium Development Goals regarding child health, policymakers should concentrate on environmental and social factors affecting health.