The prevalence of alcohol consumption and its related factors in adolescents: Findings from Global School-based Student Health Survey.

BACKGROUND: Alcohol consumption has become very common among adolescents in recent years and its prevalence varies in different countries. This study aimed to investigate the prevalence of alcohol consumption and related factors in adolescents aged 11 to 16 years. METHODS: This descriptive cross-sectional study was performed on 288385 adolescents (girls, 53.9% of total) aged 11 to 16 years. In the present study, the GSHS data (2003-2018) available to public on the websites of the US Centers for Disease Control and Prevention (CDC) and WHO was used. To investigate the factors affecting alcohol consumption, univariate and multivariate logistics models with 95% confidence limits were used. RESULTS: The overall prevalence of alcohol consumption in adolescents was 25.2%, which was 28.3% and 22.4% in boys and girls, respectively. Among the surveyed countries, the highest prevalence was in Seychelles (57.9%) and the lowest in Tajikistan (0.7). Multivariate analysis showed that the Age for 16 and more than 16 years old (OR = 3.08,95%CI: 2.54-3.74), truancy for more than 10 days (OR = 1.24, 95%CI: 1.08-1.43), loneliness at sometimes of the times (OR = 1.04, 95%CI: 1.01-1.07), insomnia at most of the times (OR = 1.85, 95%CI: 1.70-2.01), daily activity (OR = 1.03, 95%CI: 1.00-1.07), bullied for 1-9 Days in a month (OR = 1.24, 95%CI: 1.09-1.40), cigarette (OR = 4.01, 95%CI: 3.86-4.17), used marijuana for more than 10 days in a month (OR = 5.58, 95%CI: 4.59-7.78), had sex (OR = 2.76, 95%CI: 2.68-2.84), and suicide plan (OR = 1.48, 95%CI: 1.42-1.54) were important factors affecting drinking alcohol. (Table 4). In this study, the sensitivity, specificity, positive predictive value, and negative predictive value were 42.79%, 93.96%, 70.80%, and 82.75. CONCLUSIONS: According to the results of the present study, the prevalence of alcohol consumption among teenagers was high. Therefore, it is suggested that demographic, family, and psychological factors should be taken into consideration in health programs for the prevention and treatment of alcohol consumption in adolescents.

The Relationship between Metformin Consumption and Cancer Risk: An Updated Umbrella Review of Systematic Reviews and Meta-Analyses.

Background: Considering that metformin is widely used in the treatment of diabetes, and its protective role against various malignancies, the strength and validity of the available evidence from related systematic reviews and meta-analysis were evaluated. Methods: Scopus, PubMed, Embase, Cochrane, Web of science databases, and Google Scholar and manual screening of retrieved references were systematically searched from their inception dates to 24 March 2020 by extracting the effect size (Odds ratios (OR) and relative risk (RR) in each study. To present the forest plot of effect of metformin on each cancer, Stata version 14.2 was used. Results: This study included 36 meta-analysis studies and 620 original research studies (26 randomized control trials studies and 594 observational studies (cohort, case-control)) covering 15 different cancers. Overall, metformin medication prevented different cancers, including ovarian cancer (OR = 0.76, 95% CI: 0.62,0.93), cervical cancer (OR = 0.60, 95% CI: 0.43, 0.83), endometrial cancer (OR = 1.05, 95% CI: 0.82,1.35), liver cancer (OR = 0.59, 95% CI: 0.47,0.74), pancreatic cancer (OR = 0.59, 95%CI 0.50,0.69), head and neck cancer (OR = 0.71, 95% CI: 0.61,0.83), stomach cancer (OR = 0.72, 95% CI: 0.26,1.99), colorectal cancer (OR = 0.73, 95% CI: 0.59,0.91), colorectal adenoma cancer (OR = 0.75, 95% CI: 0.65,0.86), colon cancer (OR = 0.79, 95% CI: 0.69,0.91), esophagus cancer (OR = 0.90, 95% CI: 0.83,0.98), lung cancer (OR = 0.92, CI95%:0.85,0.99), breast cancer (OR = 0.93, 95% CI: 0.84,1.02), prostate cancer (OR = 0.94, 95% CI: 0.85-1.04), and bladder cancer (OR = 0.94 95% CI: 0.64,1.38). Conclusions: Treatment with metformin can significantly decrease the chance of all cancers with larger preventive effect on hepatocellular carcinoma and smaller preventive effect on lung and breast cancers.

Tobacco smoking and blood parameters in the kurdish population of Iran.

OBJECTIVE: This study investigates the relationship between smoking and blood parameters in the Iranian Kurdish population. METHOD: The current study was conducted based on the recruitment phase of the Ravansar Non-Communicable Disease (RaNCD) cohort study. RESULTS: Current smokers had higher levels of RBC count, HCT, HGB, MCV, MCH, MCHC, WBC count, and GR%, than in other groups significantly. Passive smokers had higher levels of PLT count and PCT statistically. The increasing exposure time of smoking positively affected WBC count, GR%, PLT count, PCT, and RDW in female passive smokers. In addition, heavy smokers, as well as participants with a higher duration time of smoking, had the same results for significantly lower levels of lymphocyte and monocyte and a higher level of RBC indices. CONCLUSION: According to the present study, along with the current smokers, the intensity of smoking, as well as the duration time of the smoke, could have a positive correlation with blood parameters. Furthermore, passive smokers and specifically secondhand female smokers were more vulnerable to smoke.

Epidemiological Features of Neurological Disorders in North Africa and the Middle East from 1990 to 2019: Results from the Global Burden of Disease Study 2019.

BACKGROUND: The burden of neurological disorders increases with population growth and aging and nearly three-quarters of the global burden of neurological disorders has been reported in low- and middle-income countries. Therefore, this study aimed to report the epidemiological features and the burden of neurological disorders in North Africa and the Middle East (NAME) countries. METHODS: The study population included 21 countries in the NAME region with a population of more than 600 million. The Global Burden of Disease (GBD) 2019 database was used. In GBD 2019, neurological disorders are classified into 7 diseases and injuries. Incidence rates, prevalence rates, death rates, disability adjusted life years (DALYs) rates by age-standardized rate (ASR) per 100000 people were measured. Also, the attributed burden to high body mass index (BMI), high fasting plasma glucose, smoking, and alcohol use were reported. RESULTS: The highest incidence rates of neurological disorders in 2019 were in Iran 11293.27 (95% UI, 10132.62-12499.59) and Egypt 10257.33 (95% UI, 9189.37-11341.16), respectively, and the highest mortality 41.12 (95% UI, 17.68-92.44) and DALYs 1503.0 (95% UI, 853.8-2492.15) rates were in Afghanistan. In NAME region, the incidence and prevalence rate of neurological disorders increased by 0.84% (10006.37 to 10090.79) and 1.36% (33711.72 to 34170.57) respectively, while the mortality and DALYs rate decreased by 2.75% (34.11 to 33.17) and 3.92% (1438.48 to 1382.14) between 1990 and 2019. The highest decrement of the neurological disorders-related DALYs with a 10.10% decrement pertained to Afghanistan (1671.86 to 1503). The highest increment of the neurological disorders-related DALYs with a 1.89% increment pertained to Morocco (1330.69 to 1355.83). The highest attributed DALYs to alcohol use pertained to Turkey 9.8 (95% UI, 4.23-18.05). The highest attributed DALYs to high BMI 112.23 (95% UI, 29.3-285.75) and high fasting plasma glucose 100.36 (95% UI, 18.79-302.85) pertained to Qatar. The highest attributed DALYs to smoking pertained to Lebanon 106.34 (95% UI, 37.65-253.87). Most DALYs were associated with those aged 75 years and more. CONCLUSION: Despite progressive reduction in death due to neurological disorders in the NAME region in recent decades, there was a considerable and increasing number of people affected by different neurological disorders. As populations age, societies will face more challenges regarding prevention, detection, treatment, and rehabilitation.

Ginger as an anticolorectal cancer spice: A systematic review of in vitro to clinical evidence.

Ginger and its derivatives have been shown to be effective in the prevention and treatment of cancer. We undertook a systematic review to answer the question of whether ginger has a role in modifying the biomarkers of cancer in cell culture conditions and on colorectal cancer in randomized clinical trials. We performed a comprehensive search of the literature from Scopus, Embase, Web of Science, PubMed, Cochrane central register of controlled trials, and Cochrane database of systematic reviews. At first, all 12 papers studied the effect of ginger or its derivatives on cell culture conditions. The results of cell culture studies show that ginger has a powerful role in inducing apoptosis. In the second part, five studies of clinical trials were analyzed. By analyzing antitumor markers of clinical trials, ginger increased some anticancer markers but performed poorly in inducing some anticancer markers. This systematic review showed that the consumption of ginger extract has the potential to prevent and treat colorectal cancer but this ability is weak.

Epidemiological features of tuberculosis in the Middle East and North Africa from 1990 to 2019: results from the global burden of disease Study 2019.

Introduction: Tuberculosis (TB) is a preventable and curable disease, although, it still causes more than one million deaths annually. Therefore, the aim of this study was to measure the epidemiological status and the burden of TB in the Middle East and North Africa (MENA) countries. Methods: The study population included 21 countries in the MENA region, covering a population of about 400 million. The Global Burden of Disease (GBD) 2019 database was used. The case definition comprises all forms of TB, containing pulmonary and extra pulmonary TB, which are bacteriologically approved or clinically diagnosed. The prevalence, incidence, death, and the disability-adjusted life years (DALYs) rates per 100,000 people for all national locations by standardized age rates (ASR) were measured. Results: In 2019, Afghanistan had the highest TB-related incidence 85.09 (95% UI, 73.69_98.46), death 21.91 (95% UI, 13.44_29.78), and DALYs rate 695.21 (95% UI, 454.34_939.49). The highest prevalence rates of TB were in Egypt 28935.42 (95% UI, 26125.54_32251.01). The highest TB-related DALYs rate was attributed to alcohol use, high fasting plasma glucose, and smoking were related to Tunisia, Qatar, and Lebanon, respectively. Between 1990 and 2019, TB- related incidence, prevalence, death, and DALYs rate have decreased by 53%, 42.19%, 76.20%, and 75.95% in MENA region, respectively. Conclusion: TB has continued to decrease in prevalence, incidence, death, and DALYs rates in the MENA region, although, nowadays with the COVID-19 pandemic, societies may face more challenges for TB prevention, detection, treatment, and rehabilitation.

Inequality in mammography uptake: results from recruitment phase of first cohort study among Iranian Kurdish population.

BACKGROUND: Breast cancer is the most common malignant disease in women and is the leading cause of cancer deaths among women. Mammography is the best and the most available diagnostic method for breast cancer early detection. The aim of this study was to investigate the prevalence and inequality in the mammography uptake among Kurdish women in the west of Iran. METHODS: This cohort study was conducted using data extracted from the Ravansar Non-communicable Cohort Study among Kurdish women in the west of Iran from 2014 to 2018. The sample included 5289 women aged 35-65 years. The relative and generalized (absolute) concentration index (RC and GC, respectively) was used to quantify and decompose socioeconomic inequalities in mammography uptake. RESULTS: Overall concentration index for mammography was 0.2107, indicating that the mammography uptake concentration was greater in women with a higher socioeconomic status (SES). The predictor variables accounted for 44.6% of the inequality in the mammography uptake. Higher SES, living in urban areas, and age group of 51-55 years old increased the chance of having a mammogram. Available evidence supports the inequality of mammography uptake in favor of women with higher SES. CONCLUSIONS: Cost-free screening services for low SES women, and the development of breast cancer prevention campaigns focusing on disadvantaged women could have an important role in mammography uptake and in the reduction of inequalities.

Socio-Economic Status and Clinical Breast Examination Screening Uptake: Findings from the First Cohort Study among Iranian Kurdish Women.

Clinical Breast Examination (CBE) is utilized as a screening modality in many low income countries without widespread mammography capability. The aim of the current study was to evaluate the impact of socio-economic status (SES) on CBE screening rates in Iranian Kurdish women. A cross-sectional study was conducted in the western region of Iran. A sample of 5,289 Iranian Kurdish women aged 35-65 years old was analyzed. Data were collected from July 2014 to September 2018. The Concentration Index-CI and Concentration Curve were used to estimate the socioeconomic inequalities in CBE rate. The analysis of data was done by STATA software (Version 14). 12.3% of the women had received CBE at least once. CBE rates in the 46-50 age group were higher than in other age groups (OR = 2.06; 95% CI = 1.56-2.71). Women with 6-9 years of education had higher odds ratio of receiving CBE (OR = 1.41; 95% CI = 1.02-1.94). Women living in rural areas were less likely to have received CBE compared to those living in urban areas (OR=0.54; 95% CI = 0.42-0.61). The overall concentration index for receipt of CBE was 0.188. In countries without widespread mammography programs, strategies for the promotion of CBE should focus on the lower SES population.
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The effects of co-administration of probiotics and prebiotics on chronic inflammation, and depression symptoms in patients with coronary artery diseases: a randomized clinical trial.

BACKGROUND: It has been shown that dysbiosis might have a role in developing of chronic inflammation and depression. In this study, we are interested in exploring of anti-inflammatory and anti-depressant effects of Lactobacillus Rhamnosus G (LGG), a probiotic strain, alone or in combination with a prebiotic, Inulin, in patients with coronary artery disease (CAD). METHODS: This randomized, double-blind clinical trial was held on 96 patients with CAD. Patients were randomly allocated into four different groups: LGG [a capsule/day, contained 1.9 × 109 colony-forming unit of Lactobacillus Rhamnosus G], inulin (15 g/day), co-supplemented (LGG and inulin), and placebo. Participants consumed the supplements for two months. Beck Depression Inventory (BDI), MacNew questionnaire and Spielberger state-trait anxiety inventory (STAI-Y) were used to assess depression, quality of life and anxiety, respectively. Serum levels of C-reactive protein (hs-CRP), lipopolysaccharide (LPS), tumor necrosis factor (TNF)-α, and Interleukin (IL)-10 were also measured. RESULTS: Probiotic-Inulin Co-supplementation significantly decreased BDI (-11.52 ± 0+3.20 vs. +2.97 ± 0.39, P = 0.001), STAI-state (-17.63 ± 3.22 vs. -0.60 ± 0.33, P = 0.021), and STAI-trait (-24.31 ± 7.41 vs. -1.45 ± 0.66, P = 0.020) scores, hs-CRP (-1.69 ± 0+66 vs. +0.82 ± 0.39 mg/dL, P = 0.020), LPS (-22.02 ± 5.40 vs. +0.31 ± 0.18 (EU/L), P = 0.047), and TNF-α (-25.05 ± 7.41 vs. +0.79 ± 0.71 (ng/L), P = 0.032) in comparison to placebo. CONCLUSION: Co-supplementation of probiotics and inulin in CAD subjects for eight weeks had beneficial effects on depression, anxiety, and inflammatory biomarkers. Adding inulin to probiotic supplements improved psychological outcomes and inflammatory biomarkers more effectively than two supplements separately.Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20180712040438N4..

Liver Enzymes and Their Association with Some Cardiometabolic Diseases: Evidence from a Large Kurdish Cohort.

OBJECTIVE: According to reports, liver enzymes might play a role in the incidence and development of cardiometabolic diseases such as metabolic syndrome (MetS), hypertension (HTN), and cardiovascular diseases (CVD). We conducted a study to investigate this hypothesis among the Iranian Kurdish population. METHODS: We analyzed data from the baseline phase of the Ravansar noncommunicable disease (RaNCD) cohort. The association between liver enzymes (ALT, AST, ALT/AST ratio, GGT, and ALP) with cardiometabolic disease risk factors was investigated by multiple linear regression. The odds ratio of cardiometabolic diseases in each quartile category of liver enzyme concentration was estimated using multivariable logistic regression. RESULTS: The mean age of participants was 47.3 ± 4.1 years (48.1 years in males and 51.8 years in females). In the adjusted model, all enzymes were positively associated with MetS, HTN, and CVD risk factors except for the ALT/AST ratio with SBP and DBP. In the adjusted model, subjects in the fourth quartile for GGT, ALT/AST ratio, ALT, ALP, and AST had 3.29-, 2.94-, 2.45-, 2.00-, and 1.19-fold increased risk for MetS compared with subjects in the first quartile. Increased levels of GGT and ALP were positively associated with the risk of HTN (ORs = 1.33, 95%CI = 1.03-1.71 for GGT; ORs = 1.32, 95%CI = -1.68 for ALP). An increased GGT level was significantly associated with CVD (ORs = 1.54, 95%CI = 1.03-1.68). Within the normal range quartile, ALT had a significant correlation with the incidence of MetS. CONCLUSION: According to the present study, the levels of liver enzymes could be considered for early diagnosis of MetS, HTN, and CVD.

Pattern of cigarette smoking: intensity, cessation, and age of beginning: evidence from a cohort study in West of Iran.

BACKGROUND: Smoking is a social epidemic and one of the main risk factors for premature deaths and disabilities worldwide. In the present study, we investigated the Pattern of Cigarette Smoking: intensity, cessation, and age of the beginning. METHODS: Data collected from the recruitment phase of Ravansar (a Kurd region in western Iran) Non-Communicable Disease (RaNCD) cohort study was analyzed by using Chi-square test, univariate and multivariate logistic regressions, Poisson regression, and linear regression. RESULTS: Totally 10,035 individuals (47.42% males) participated in the study. Mean age was lower for males (47.45 yr) than for females (48.36 yr). Prevalence of smoking was 20% (36.4% of males and 5.23% of females). Compared to female participants, males showed a 7-fold higher prevalence of smoking and started smoking about 4 years earlier. Being married, having a lower BMI, living in rural areas, and being exposed to secondhand smoke (SHS) were predictors of higher smoking prevalence rates. Furthermore, current exposure to SHS, higher smoking intensity, later smoking initiation, male gender, younger age, lower education, and lower BMI were related to lower likelihood of stopping smoking. Heavy smokers began to smoke about 4 years earlier than casual smokers did. Finally, being divorced/ widow/ widower/ single and childhood exposure to SHS were found to increase the likelihood of becoming a smoker. CONCLUSIONS: Based on present research results, health programs specific to smoking cessation should take socio-demographic factors, smoking history, and current smoking behavior into account.

Prevalence of drug use, alcohol consumption, cigarette smoking and measure of socioeconomic-related inequalities of drug use among Iranian people: findings from a national survey.

BACKGROUND: Drug use can lead to several psychological, medical and social complications. The current study aimed to measure and decomposes socioeconomic-related inequalities in drug use among adults in Iran. METHODS: This was a cross-sectional study The PERSIAN Cohort is the largest and most important cohort among 18 distinct areas of Iran. This study was conducted on 130,570 adults 35 years and older. A structured questionnaire was applied to collect data. The concentration index (C) was used to quantify and decompose socioeconomic inequalities in drug use. RESULTS: The prevalence experience of drug use was 11.9%. The estimated C for drug use was - 0.021. The corresponding value of the C for women and men were - 0.171 and - 0.134, respectively. The negative values of the C suggest that drug use is more concentrated among the population with low socioeconomic status in Iran (p < 0.001). For women, socioeconomic status (SES) (26.37%), province residence (- 22.38%) and age (9.76%) had the most significant contribution to socioeconomic inequality in drug use, respectively. For men, SES (80.04%), smoking (32.04%) and alcohol consumption (- 12.37%) were the main contributors to socioeconomic inequality in drug use. CONCLUSIONS: Our study indicated that drug use prevention programs in Iran should focus on socioeconomically disadvantaged population. Our finding could be useful for health policy maker to design and implement effective preventative programs to protect Iranian population against the drug use.

Association between dyslipidemia and blood lipids concentration with smoking habits in the Kurdish population of Iran.

BACKGROUND: Smoking is the most preventable cause of most chronic diseases such as cardiovascular disease (CVD). Dyslipidemia is also an important risk factor for CVD. Yet, research has provided contradicting findings regarding the association between smoking and blood lipids. This paper examines the relationship between dyslipidemia and smoking based on the results of a cross-sectional sample of a Kurdish population in western Iran. METHODS: This population-based study was derived from the recruitment phase of Ravansar Non-Communicable Disease (RaNCD) cohort study. Logistic regression model adjusted by confounding variables was used to determine the relationship between smoking and blood lipid components. In addition, dose-response relationship between blood lipids and the number of smoked cigarettes was evaluated. RESULTS: For the purpose of this study, 7586 participants were examined. The lifetime prevalence of smoking was 19.9%, and 11.8% were current smokers. The prevalence of dyslipidemia in current smokers (54.9%) was higher than former smokers (43.9%) and in turn former smokers higher than non-smokers (38.0%). Current smokers had greater risk of abnormal HDL cholesterol [OR (95% CI), 2.28(1.98 -2.62)] and triglyceride [OR (95% CI), 1.37(1.15 -1.67)] compared to non-smokers. There was no significant difference in total cholesterol and LDL cholesterol between the two groups. A dose-response relationship was found between the number of cigarettes smoked and HDL-C and TG but no relationship was observed in terms of total cholesterol and LDL-C. CONCLUSIONS: As compared to non-smokers, current smokers and former smokers had abnormal HDL-C and triglyceride and abnormal total cholesterol and triglyceride, respectively. After quitting smoking, heavy smokers showed a more normal HDL-C and total cholesterol levels than the people who tended to smoke a lower number of cigarettes per day.

Socioeconomic - related inequalities in overweight and obesity: findings from the PERSIAN cohort study.

BACKGROUND: Overweight and obesity are major health concerns worldwide, with adverse health consequences during the life span. This study measured socioeconomic inequality in overweight and obesity among Iranian adults. METHODS: Data were extracted from 129,257 Iranian adults (aged 35 years and older) participated in the Prospective Epidemiologic Research Studies in IrAN (PERSIAN) in 14 provinces of Iran in 2014. Socioeconomic-related inequality in overweight and obesity was estimated using the Concentration Index (Cn). The Cn further decomposed to find factors explaining the variability within the Socioeconomic related inequality in overweight and obesity. RESULTS: Of the total number of participants, 1.98, 26.82, 40.76 and 30.43% had underweight, normal weight, overweight and obesity respectively. The age-and sex standardized prevalence of obesity was higher in females than males (39.85% vs 18.79%). People with high socioeconomic status (SES) had a 39 and 15% higher chance of being overweight and obese than low SES people, respectively. The positive value of Cn suggested a higher concentration of overweight (0.081, 95% confidence interval [CI]; 0.074-0.087) and obesity (0.027, 95% CI; 0.021-0.034) among groups with high SES. There was a wide variation in socioeconomic-related inequality in overweight and obesity rate across 14 provinces. The decomposition results suggested that SES factor itself explained 66.77 and 89.07% of the observed socioeconomic inequalities in overweight and obesity among Iranian adults respectively. Following SES, province of residence, physical activity, using hookah and smoking were the major contributors to the concentration of overweight and obesity among the rich. CONCLUSIONS: Overall, we found that overweight and obesity is concentrated among high SES people in the study population. . Accordingly, it seems that intersectional actions should be taken to control and prevent overweight and obesity among higher socioeconomic groups.

Investigating associated factors with glomerular filtration rate: structural equation modeling.

BACKGROUND: Glomerular filtration rate (GFR) is a valid indicator of kidney function. Different factors can affect GFR. The purpose of this study is to assess the direct and indirect effects of GFR-related factors using structural equation modeling. PATIENTS AND METHODS: We analyzed data from the baseline phase of the Ravansar Non-Communicable Disease cohort study. Data on socio-behavioral, nutritional, cardiovascular, and metabolic risk factors were analyzed using a conceptual model in order to test direct and indirect effects of factors related to GFR, separately in male and female, using the structural equation modeling. RESULTS: Of 8927 individuals who participated in this study, 4212 subjects were male (47.20%). The mean and standard deviation of GFR was 76.05 (±14.31) per 1.73 m2. GFR for 0.2, 11.3, 73.0 and 15.5% of people were < 30, 30 - 59, 60 - 90 and >90, respectively. Hypertension and aging in both sexes and atherogenic factor in males directly, and in females, directly and indirectly, had decreasing effects on GFR. Blood urea nitrogen and smoking in male and female, directly or indirectly through other variables, were associated with a lower GFR. In females, diabetes had a direct and indirect decreasing effect on GFR. Obesity in females was directly associated with upper and indirectly associated with lower GFR. CONCLUSION: According to our results, aging, hypertension, diabetes, obesity, high lipid profile, and BUN had a decreasing direct and indirect effect on GFR. Although low GFR might have different reasons, our findings, are in line with other reports and provide more detailed information about important risk factors of low GFR. Public awareness of such factors can improve practice of positive health behaviors.

Prevalence, awareness, treatment, and control of hypertension and their determinants: Results from the first cohort of non-communicable diseases in a Kurdish settlement.

Hypertension is a public health issue in Iran. The study aimed to estimate the prevalence, awareness, treatment, and control of hypertension, and to explore their determinants among 10,040 Kurdish adults from Ravansar Non-Communicable Disease (RaNCD) cohort study in Iran. Univariate, and multivariate analyses were used for statistical analysis. Prevalence of hypertension was 15.7%. Among hypertensive patients, awareness, treatment, and control of hypertension were 80.7%, 73.2%, and 53.3%, respectively. In multivariate analysis, significant associations were found between awareness and female sex, older age, being married rather than being single, literacy, living in rural areas, having family history, and comorbidities, with a higher probability for those who had both diabetes and dyslipidemia. Being married, living in rural areas, being ex-smokers, having less physical activity and individuals who had diabetes and dyslipidemia had higher odds of receiving treatment. Being female had a statistically significant association with the control of hypertension. The Kurdish population had higher awareness, with a greater proportion of treated, and controlled patients compared to populations included in previous studies for the last 20 years in Iran. With the continuing health promotion programs in Iran, it is expected to observe a lower prevalence of hypertension, higher awareness and greater number of treated individuals with controlled hypertension.

Validity of Self-reported Hypertension and Factors Related to Discordance Between Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study in Iran.

OBJECTIVES: Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort. METHODS: The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard. RESULTS: Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency. CONCLUSIONS: The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.

Dietary patterns, nutrition, and risk of breast cancer: a case-control study in the west of Iran.

OBJECTIVES: Unhealthy dietary patterns are the most important changeable risk factors for breast cancer. The aim of this study was to assess the relationship between dietary patterns and the risk of breast cancer among under-50 year women in the west of Iran. METHODS: All women under 50 years old with pathologically confirmed breast cancer between 2013 and 2015 who were referred to oncology clinics in the west of Iran, and 408 under-50 women referred to other outpatient clinics who were without breast or other cancers at the time of the study and 2 years later were selected as the control group. The data were collected using the middle-aged periodical care form of the Iranian Ministry of Health and analyzed using univariate and multivariate logistic regression in Stata. RESULTS: The most powerful risk factor for breast cancer was fried foods; the odds ratio of consuming fried foods more than once a month for breast cancer was 4.5 (95% confidence interval, 2.1 to 9.4). A dose-response model indicated that increasing vegetable and fruit consumption up to 90 servings per month decreased the odds of breast cancer, but consuming more than 90 servings per month increased the risk. CONCLUSIONS: Inadequate consumption of vegetables and consumption of soft drinks, industrially produced juices, fried foods, and sweets were identified as risk factors for breast cancer. In response to these findings, it is necessary to raise awareness and to provide education about healthy diets and the need to change unhealthy dietary patterns.

Hormone Therapy and Factors Affecting Fertility of Women Under 50-Year-Old with Breast Cancer.

BACKGROUND: Although the use of contraceptive hormones is a risk factor for development of breast cancer, level of risk is unknown; thus the current research was conducted to investigate the effect of factors related to fertility and hormone use on risk of breast cancer in women aged under 50 years old in the west of Iran. METHODS: In this case-control study, all incidence cases of breast cancer aged between 25-49 years old (n=212) were selected. Twice as many as the case group, the individuals referred to other outpatient sections of the same hospital at the time of study and up to 2 years after the follow-up not diagnosed with breast or other cancers were selected as a control group. The data were collected using healthy fertility program and middle-aged periodical care forms developed by Iran's Ministry of Health (MOH). RESULTS: After controlling for confounding variables, history of hormonal use for contraception (OR=2.02, 95% CI=1.2-3.3) and hormone therapies (OR=1.9, 95% CI=1.2-3.04) were identified as factors increasing the risk of breast cancer. Dose-response relationships between breast cancer and the use of hormones for contraception and hormone therapy indicated that these factors increased the risk of breast cancer. The risk was found to be higher in women who had been under hormone therapy for more than 120 months. With an increase in the age of the first menstruation, risk of breast cancer increased linearly, but with an increase in the age of the first pregnancy, risk of breast cancer increased exponentially. After 20 years of age, the risk increased with a steeper slope. CONCLUSION: Considering the effect of hormone therapy and fertility factors on breast cancer and changeability of listed risk factors, the researchers suggest planning for sensitizing, increasing the awareness, and educating women and professionals regarding the influence of fertility and hormonal factors including pregnancy at lower ages, minimizing the use of hormones for contraception, and hormone therapy.

Association of Smoking with General and Abdominal Obesity: Evidence from a Cohort Study in West of Iran.

BACKGROUND: This study aimed to examine the association between smoking and obesity among adults in Kermanshah Province, west of Iran. STUDY DESIGN: A cross-sectional study. METHODS: A total of 8822 participants, aged 35-65 yr, form Ravansar Non-communicable Disease (RaNCD) cohort study (2014-2016) were enrolled. Smoking habits were categorized in terms of smoking status (current, former and never smokers) and smoking intensity (light, moderate and heavy). General obesity was defined as body mass index (BMI) ≥30 kg/m2 and abdominal obesity were defined as a waist to hip ratio (WHR) ≥90 for men and ≥85 for women. Multiple logistic regressions were used to examine the association between general and abdominal obesity with smoking status and smoking intensity while controlling for age, sex, years of education and wealth index. RESULTS: Overall, 12% were current smokers, 8.4% former smokers and 79.6% never smokers. The prevalence of light, moderate and heavy smokers among current smokers was 30.8%, 18%, and 51.2%, respectively. The prevalence of general obesity was 27.6%, while the prevalence of abdominal obesity was 82.3%. The probabilities of general and abdominal obesity for current smokers were lower than never smokers by 34% and 36%, respectively. The probability of abdominal obesity for heavy smokers was 31% lower than light smokers. We did not observe significant associations between smoking intensity and general obesity. CONCLUSIONS: Current smokers compared to never smokers were less likely to be obese. The reverse association between smoking and obesity; however, should not be interpreted as a causal relationship.