Familial aggregation of traffic risky behaviours among pedestrians: a cross-sectional study in northwestern Iran.

OBJECTIVE: This study aims to assess the familial aggregation of traffic risky behaviours among pedestrians and describe the sociodemographic profile of pedestrians in northwestern Iran. METHODS: A cross-sectional study was conducted among 933 pedestrians in 2023. Participants were selected using stratified random sampling. Traffic risky behaviour was measured using a validated instrument among heads of households and their first relatives. The generalised estimating equations were computed to estimate the adjusted OR and 95% CI for familial aggregation of traffic risky behaviours. RESULTS: Of the total sample, 52.2% and 27.7% of the participants were male and aged 41-50, respectively. The majority of respondents were categorised in middle socioeconomic class (36.9%). The OR for familial aggregation of traffic risky behaviours was 1.42 (95% CI 1.07 to 1.89), indicating that the presence of traffic risky behaviours in at least one family member increased the likelihood of similar behaviour in other members. Fathers showing violation behaviours were associated by 1.98-fold increase in violation behaviours among their offspring. Similarly, the existence of violation behaviour in one sibling increased the odds of violation behaviour among other siblings (OR 1.99, 95% CI 1.18 to 3.73). CONCLUSIONS: This study revealed the familial aggregation of traffic risky behaviours of pedestrians, with father-offspring and sibling aggregations emerging as prominent components of familial aggregation. The findings suggested that family-based prevention programmes may yield greater effectiveness than individual-based approaches. As such, implementing targeted interventions focusing on family might have a substantial impact on reducing pedestrian traffic risky behaviours.

Development, Validation, and Cross Cultural Adoption of Persian Version of Behavioral Risk Factor Tool.

Background: One of the most crucial objectives of policymakers is to enhance the population's overall health. Establishing a surveillance system is a way to achieve this goal. The Behavioral Risk Factor Surveillance System (BRFSS) is a national system that collects data on the health-related behaviors of the United States residents using the Behavioral Risk Factor Questionnaire (BRFSSQ). This survey is aimed at reducing risk behaviors and their consequences. Regarding the fact that the cultural environment within each country may affect how behaviors are assessed, this study aimed to develop a Persian version, cross-cultural adaptation, and assess the validity and reliability of the PBRFSSQ. Methods: In this cross-sectional study, 250 individuals were enrolled using the stratified sampling method between August 2022 and April 2023. Six steps of translation and test method proposed by Sousa et al was used. Content and face validity were calculated. Also, the Cronbach's alpha and test-retest were computed. Results: Of all participants, 54.5% were male and aged 30 to 65 years old (69%). The Scale Content Validity Index was equal to 0.95. The Intra class Correlation Coefficient (ICC) was computed as 0.86, 0.88, and 0.87 for the core, optional, and total components, respectively. Furthermore, the Cronbach's alpha coefficient of 0.85 was obtained overall. Conclusion: This tool was highly valid and reliable for assessing risky behaviors among the Iranian general population.

Does telehealth affect the adherence to ART among patients with HIV? A systematic review and meta-analysis.

BACKGROUND: Several studies have shown different effects of telehealth interventions on adherence to Antiretroviral therapy (ART) among people living with HIV. This study conducted a meta-analysis of Randomized Controlled Trials (RCTs) to estimate the pooled effect of telehealth interventions on the treatment adherence of HIV patients. METHODS: The researchers conducted literature searches in Scopus, PubMed, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials databases. In addition, open grey was systematically searched until January 2022 for RCTs around the effects of telehealth on adherence to treatment ART among patients with HIV. Each study's methodological quality was assessed using the Cochrane Collaboration tool. Pooled Standard Mean Differences (SMD) and Risk Ratio (RR) with 95% CI were calculated using the random effects model. RESULTS: In total, 12 eligible articles were considered in the present systematic review. A random-effects meta-analysis using 5 RCTs yielded the pooled RR estimate of 1.18 (95% CI: 1.03 to 1.35, p < 0.05); I2 = 0, suggesting the adherence to treatment among patients with HIV who received telehealth intervention was significantly 18% upper than control groups. Moreover, the random effects analysis of SMD showed a positive effect for telehealth with SMR = 0.36 (95% CI: 0.22 to 0.49, p < 0.05); I2 = 91.9%, indicating that telehealth intervention increased ART adherence to the treatment group compared to the control group. CONCLUSION: Telehealth intervention as a new modality of health care service delivery could be a valuable strategy to improve ART adherence among patients with HIV. It can strengthen the capacity of HIV care services. On a large scale, telehealth can be utilized as a supplementary component for ART delivery and retention toward successful adherence to the therapy.

Association between nitrate concentration in drinking water and rate of colorectal cancer: a case study in northwestern Iran.

Nitrate, as a major pollutant of drinking water, is associated with colorectal cancer (CRC) and serves as an environmental health concern, especially in the districts with unregulated agriculture. In this case study in northwestern Iran, we used two databases of nitrate concentration (1999-2013) and age-standardized incidence rate (ASR) for CRC (2002-2012) from 19 counties of East Azerbaijan province. The trend and correlation between nitrate and ASR was investigated. Inverse distance weighted technique was used to spatially interpolate the maps. Expectedly, drinking water nitrate has increased throughout the province (8-20.5 mg/L) as well as the ASR for CRC of men (from 2.07 to 18.05 mg/L) and women (from 1.57 to 10.94 mg/L). While ASR for CRC of men was positively correlated to nitrate (Pearson's r = 0.624, p-value = 0.040), no statistically significant correlation was found between nitrate and ASR for women's CRC (Pearson's r = 0.289, p-value = 0.351). According to our findings, the incidence of CRC was not higher for those residing in the regions with higher nitrate, suggesting that risk factors such as genetic predisposition and diet that were not taken into account could be determinants of this pattern. However, even a small increase in CRC rate due to water nitrate could translate into a large public health concern. The incremental pattern observed in nitrate levels of different counties over the years gives the health policymakers a better perspective of the problem and how the control of water nitrate level as a CRC risk factor might contribute to the prevention of CRC.

Diagnostic accuracy of multitarget stool DNA testing for colorectal cancer screening: A systematic review and meta-analysis.

INTRODUCTION: This study aimed to collect and summarize test data and conduct a meta-analysis, with respect to the Multitarget Stool DNA test sensitivity and specificity, compared to colonoscopy. MATERIAL AND METHODS: All manuscripts were screened for eligibility according to inclusion criteria. Participants were a normal population at an average risk of developing CRC. Intervention was Stool based and DNA panel tests compared with colonoscopy, and outcome was detection of CRC and any pre-cancerous lesions. Inter-study and inconsistency (using the I-squared test) were assessed. RESULTS: Meta-analyses of the Mt-sDNA test showed a combined sensitivity of 89%, 51%, and 76% for the detection of CRC, advanced adenoma (AA), and combined CRC and AA, respectively. The overall specificity was 91%, 89%, and 90% for the detection of CRC, AA, and combined CRC and AA, respectively. CONCLUSION: Mt-sDNA had significantly acceptable diagnostic accuracy for CRC and AA diagnosis, but still has lower sensitivity and specificity than colonoscopy.

Staple Food Fortification with Folic Acid and Iron and Gastrointestinal Cancers: Critical Appraisal of Long-Term National Fortification.

The co-occurrence of wheat flour fortification with folic acid and iron and gastrointestinal cancer incidences were critically assessed in the East Azerbaijan province in Northwest of Iran. In an ecological design, overall gastrointestinal cancer rate ratios and their 95% confidence intervals (95% CI) were calculated as primary outcome before (2004-2006) and after (2007-2015) the introduction of fortification. No consistent changes were observed in esophageal and gastric cancer, but the rate ratios of colorectal cancer increased significantly after fortification in the 35-54 years age group (women: 2.07, 95% CI: 1.79-2.49; men: 1.59, 95% CI: 1.33-1.89) and the 55-74 years age group (women 1.50, 95% CI: 1.27-1.76; men: 2.51, 95% CI: 2.13-2.95). The increased incidence of colorectal cancer was contemporary with long-term fortification; further investigation is required to establish the associations.

Blood transfusions for treating acute chest syndrome in people with sickle cell disease.

BACKGROUND: Sickle cell disease is an inherited autosomal recessive blood condition and is one of the most prevalent genetic blood diseases worldwide. Acute chest syndrome is a frequent complication of sickle cell disease, as well as a major cause of morbidity and the greatest single cause of mortality in children with sickle cell disease. Standard treatment may include intravenous hydration, oxygen as treatment for hypoxia, antibiotics to treat the infectious cause and blood transfusions may be given. This is an update of a Cochrane Review first published in 2010 and updated in 2016. OBJECTIVES: To assess the effectiveness of blood transfusions, simple and exchange, for treating acute chest syndrome by comparing improvement in symptoms and clinical outcomes against standard care. SEARCH METHODS: We searched The Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. Date of the most recent search: 30 May 2019. SELECTION CRITERIA: Randomised controlled trials and quasi-randomised controlled trials comparing either simple or exchange transfusion versus standard care (no transfusion) in people with sickle cell disease suffering from acute chest syndrome. DATA COLLECTION AND ANALYSIS: Both authors independently selected trials and assessed the risk of bias, no data could be extracted. MAIN RESULTS: One trial was eligible for inclusion in the review. While in the multicentre trial 237 people were enrolled (169 SCC, 42 SC, 15 Sß°-thalassaemia, 11Sß+-thalassaemia); the majority were recruited to an observational arm and only ten participants met the inclusion criteria for randomisation. Of these, four were randomised to the transfusion arm and received a single transfusion of 7 to 13 mL/kg packed red blood cells, and six were randomised to standard care. None of the four participants who received packed red blood cells developed acute chest syndrome, while 33% (two participants) developed acute chest syndrome in standard care arm. No data for any pre-defined outcomes were available. AUTHORS' CONCLUSIONS: We found only one very small randomised controlled trial; this is not enough to make any reliable conclusion to support the use of blood transfusion. Whilst there appears to be some indication that chronic blood transfusion may play a roll in reducing the incidence of acute chest syndrome in people with sickle cell disease and albeit offering transfusions may be a widely accepted clinical practice, there is currently no reliable evidence to support or refute the perceived benefits of these as treatment options; very limited information about any of the potential harms associated with these interventions or indeed guidance that can be used to aid clinical decision making. Clinicians should therefore base any treatment decisions on a combination of; their clinical experience, individual circumstances and the unique characteristics and preferences of adequately informed people with sickle cell disease who are suffering with acute chest syndrome. This review highlights the need of further high quality research to provide reliable evidence for the effectiveness of these interventions for the relief of the symptoms of acute chest syndrome in people with sickle cell disease.

Trisomy 13 and 18-Prevalence and mortality-A multi-registry population based analysis.

The aim of the study is to determine the prevalence, outcomes, and survival (among live births [LB]), in pregnancies diagnosed with trisomy 13 (T13) and 18 (T18), by congenital anomaly register and region. Twenty-four population- and hospital-based birth defects surveillance registers from 18 countries, contributed data on T13 and T18 between 1974 and 2014 using a common data-reporting protocol. The mean total birth prevalence (i.e., LB, stillbirths, and elective termination of pregnancy for fetal anomalies [ETOPFA]) in the registers with ETOPFA (n = 15) for T13 was 1.68 (95% CI 1.3-2.06), and for T18 was 4.08 (95% CI 3.01-5.15), per 10,000 births. The prevalence varied among the various registers. The mean prevalence among LB in all registers for T13 was 0.55 (95%CI 0.38-0.72), and for T18 was 1.07 (95% CI 0.77-1.38), per 10,000 births. The median mortality in the first week of life was 48% for T13 and 42% for T18, across all registers, half of which occurred on the first day of life. Across 16 registers with complete 1-year follow-up, mortality in first year of life was 87% for T13 and 88% for T18. This study provides an international perspective on prevalence and mortality of T13 and T18. Overall outcomes and survival among LB were poor with about half of live born infants not surviving first week of life; nevertheless about 10% survived the first year of life. Prevalence and outcomes varied by country and termination policies. The study highlights the variation in screening, data collection, and reporting practices for these conditions.

Analysis of Mortality among Neonates and Children with Spina Bifida: An International Registry-Based Study, 2001-2012.

BACKGROUND: Medical advancements have resulted in better survival and life expectancy among those with spina bifida, but a significantly increased risk of perinatal and postnatal mortality for individuals with spina bifida remains. OBJECTIVES: To examine stillbirth and infant and child mortality among those affected by spina bifida using data from multiple countries. METHODS: We conducted an observational study, using data from 24 population- and hospital-based surveillance registries in 18 countries contributing as members of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Cases of spina bifida that resulted in livebirths or stillbirths from 20 weeks' gestation or elective termination of pregnancy for fetal anomaly (ETOPFA) were included. Among liveborn spina bifida cases, we calculated mortality at different ages as number of deaths among liveborn cases divided by total number of liveborn cases with spina bifida. As a secondary outcome measure, we estimated the prevalence of spina bifida per 10 000 total births. The 95% confidence interval for the prevalence estimate was estimated using the Poisson approximation of binomial distribution. RESULTS: Between years 2001 and 2012, the overall first-week mortality proportion was 6.9% (95% CI 6.3, 7.7) and was lower in programmes operating in countries with policies that allowed ETOPFA compared with their counterparts (5.9% vs. 8.4%). The majority of first-week mortality occurred on the first day of life. In programmes where information on long-term mortality was available through linkage to administrative databases, survival at 5 years of age was 90%-96% in Europe, and 86%-96% in North America. CONCLUSIONS: Our multi-country study showed a high proportion of stillbirth and infant and child deaths among those with spina bifida. Effective folic acid interventions could prevent many cases of spina bifida, thereby preventing associated childhood morbidity and mortality.

Estimation of the preventable proportion of congenital anomalies by selected risk factors in mothers: A case study in Iran.

Background: Worldwide, 1-6 percent of infants have at least one congenital anomaly that can lead to long-term consequences. This may have significant impacts on individuals, families, health-care systems, and societies. The aim of this study was to estimate the Population Attributable Fraction (PAF) of some congenital anomalies by three selected risk factors (obesity, diabetes and smoking) in the northwest of Iran and to estimate the number of preventable defects at birth in the population if we could reduce 50 percent of the exposure rate to these three risk factors at population level. Methods: The regional data on smoking, obesity, and diabetes were entered in Population Estimate of Attributable Fraction of Congenital Conditions Everywhere (PEACE) software developed by International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). It calculates the PAF for congenital anomalies attributed to exposure to those three risk factors. Results: This study showed that main anomalies attributed to "obesity" include Spina Bifida 40.1% (95% CI: 31.7-47.7), Hydrocephaly 26.8 (95% CI: 9.3-42.3) and Anencephaly 17.4 (95% CI: 1.6-31.9). The highest attributable defect to "smoking" was Cleft lip w/out Palate 5.8% (95% CI: 4.3-7.4), whereas for "diabetes" it was Tetralogy of Fallot 33.3 (95% CI: 17.2-49.5). A similar pattern was found when assumed in the model, the impact of 50 percent reduction in the exposure to each of the risk factors on preventable cases of birth defects in the population. Conclusion: Obesity, diabetes, and smoking in women of childbearing age increased the risk of occurrence of congenital anomalies. However, obesity and diabetes had a remarkably greater impact compared to smoking. More studies are needed to investigate the role of passive smoking as a risk factor for the occurrence of birth defects.

Suicidal ideation and its correlates among high school students in Iran: a cross-sectional study.

BACKGROUND: Globally, the second leading cause of death among adolescents is suicide and in middle-income countries adolescents' suicidal ideation is a neglected public health area. The present study was conducted to determine the prevalence and correlates of suicidal ideation among 15-17-year-old high school students in Iran. METHODS: Self-administered, Global School-based Student Health Survey (GSHS) questionnaires were distributed to a representative sample (N =1517) of high-school students aged 15-17 in the city of Tabriz. Multivariate logistic regression was used to assess the association between relevant independent variables (e.g. gender) and the dependent outcome variable (suicidal ideation in the past 12 months). RESULTS: Overall, 62 (4.1%, 95% CI= 3.1, 5.2) of 1,517 students had thoughts of suicide. Three hundred and thirteen (20.6%, 95% CI= 18.6, 22.7) students reported being bullied in the previous 30 days. In addition, 134 (8.8%, 95% CI= 7.5, 10.3) students reported having been sexually abused. Being worried that they could not eat or did not feel hungry (Adjusted Odds Ratio (AOR) = 4.15; 95% Cl [1.71, 10.07]; current cigarette smoking (AOR = 3.00; 95% CI [1.69, 5.30]; thinking about using alcohol or other drugs (AOR = 4.28; 95% CI [2.41, 7.59]; and being sexually abused (AOR = 2.63; 95% CI [1.32, 5.24]) were all factors positively associated with suicidal ideation. CONCLUSION: The prevalence of suicidal ideation was lower in our school students than in earlier studies. Interventions that address the issue of current cigarette smoking, worries, thinking about using alcohol or other drugs and sexual abuse should be given more priority by the public health authorities.

Blood transfusions for treating acute chest syndrome in people with sickle cell disease.

BACKGROUND: Sickle cell disease is an inherited autosomal recessive blood condition and is one of the most prevalent genetic blood diseases worldwide. Acute chest syndrome is a frequent complication of sickle cell disease, as well as a major cause of morbidity and the greatest single cause of mortality in children with sickle cell disease. Standard treatment may include intravenous hydration, oxygen as treatment for hypoxia, antibiotics to treat the infectious cause and blood transfusions may be given. This is an update of a Cochrane review first published in 2010. OBJECTIVES: To assess the effectiveness of blood transfusions, simple and exchange, for treating acute chest syndrome by comparing improvement in symptoms and clinical outcomes against standard care. SEARCH METHODS: We searched The Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings.Date of the most recent search: 25 April 2016. SELECTION CRITERIA: Randomised controlled trials and quasi-randomised controlled trials comparing either simple or exchange transfusion versus standard care (no transfusion) in people with sickle cell disease suffering from acute chest syndrome. DATA COLLECTION AND ANALYSIS: Both authors independently selected trials and assessed the risk of bias, no data could be extracted. MAIN RESULTS: One trial was eligible for inclusion in the review. While in the multicentre trial 237 people were enrolled (169 SCC, 42 SC, 15 Sß°-thalassemia, 11Sß(+)-thalassemia); the majority were recruited to an observational arm and only ten participants met the inclusion criteria for randomisation. Of these, four were randomised to the transfusion arm and received a single transfusion of 7 to 13 ml/kg packed red blood cells, and six were randomised to standard care. None of the four participants who received packed red blood cells developed acute chest syndrome, while 33% (two participants) developed acute chest syndrome in standard care arm. No data for any pre-defined outcomes were available. AUTHORS' CONCLUSIONS: We found only one very small randomised controlled trial; this is not enough to make any reliable conclusion to support the use of blood transfusion. Whilst there appears to be some indication that chronic blood transfusion may play a roll in reducing the incidence of acute chest syndrome in people with sickle cell disease and albeit offering transfusions may be a widely accepted clinical practice, there is currently no reliable evidence to support or refute the perceived benefits of these as treatment options; very limited information about any of the potential harms associated with these interventions or indeed guidance that can be used to aid clinical decision making. Clinicians should therefore base any treatment decisions on a combination of; their clinical experience, individual circumstances and the unique characteristics and preferences of adequately informed people with sickle cell disease who are suffering with acute chest syndrome. This review highlights the need of further high quality research to provide reliable evidence for the effectiveness of these interventions for the relief of the symptoms of acute chest syndrome in people with sickle cell disease.

The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study.

PURPOSE: The purpose of the present study was to determine the correlates of waterpipe (WP) smoking among 15-17-year-old high school students in Iran. METHOD: Data were collected using the Global Youth Tobacco Survey (GYTS), a self-administrated questionnaire distributed to a representative sample of high school students aged 15-17 in the city of Tabriz. Current WP smoking was defined as past 30-day use, and ever WP smoking was defined as at least one or two lifetime puffs. Differences in WP use, knowledge, and attitudes were analyzed using chi-square and Fisher exact tests. Binary logistic regression estimated the association between relevant independent variables (e.g., age) and the dependent variables (current/ever WP smoking). RESULTS: Of 1517 students, 21.6 % (95 % confidence interval [CI] = 19.5, 23.8) were ever WP smokers, and 9.7 % (95 % CI = 8.2, 11.2) were current WP smokers. Of current WP smokers, 40.3 % have stated that they want to stop smoking now. Moreover, 14.1 % of non-WP smokers reported that they might enjoy smoking WP. Of current WP smokers, 49.0 % have smoked at cafés. Additionally, 95.3 % of current WP smokers reported that their age did not prevent them from being served a WP. Studying in high school third grade (adjusted odds ratios (AORs) = 1.70; 95 % CI [1.10, 2.63]), experience of cigarette smoking (AORs = 1.57; 95 % CI [1.12, 2.20]), and being prepared to accept a WP offered by close friends (AORs = 3.31; 95 % CI [2.17, 5.04]) were independently associated with ever WP smoking, and accepting a WP offered by close friends (AORs = 4.36; 95 % CI [2.69, 7.07]) and gender (female) (AORs = 0.45; 95 % CI [0.30, 0.70] were independently associated with current WP smoking. CONCLUSION: Prevalence of current and ever WP smoking is high in Tabriz. There is an urgent need to design interventions in order to increase students' and their parents' awareness regarding the harmfulness of WP, and to establish legal measures to restrict adolescents' access to WPs and tobacco in society.

Increased colorectal cancer incidence in Iran: a systematic review and meta-analysis.

BACKGROUND: Colorectal cancer is the third most common cancer in Iran. The increasing trend of colorectal cancer incidence in Iran and the close relationship with the geographical location are the underlying reasons for this study. DATA SOURCE: Eleven databases, including MEDLINE, EMBASE, SCOPUS, and four other databases, for articles in Persian were searched from April 2014 to October 2014. Additional data were obtained from an online survey of the Central Library of Tabriz Faculty of Medicine. STUDY ELIGIBILITY CRITERIA: In this systematic review and meta-analysis, we included studies reporting different measures of incidence, age-standardized incidence rates, and crude incidence rates. All rates (per 100,000 person-years) were standardized to the world standard population. STUDY APPRAISAL AND SYNTHESIS METHODS: A preliminary review of the title and abstracts of these articles was used to exclude any that were clearly irrelevant. The full text review determined whether the article was relevant to our topic. All the potentially relevant manuscripts were reviewed by two other investigators (S.D., M.G.). A total of 39 studies (10 Persian and 29 English articles) from different provinces and diverse areas of Iran, were analyzed in this study using comprehensive meta-analysis software. For accuracy studies, we used estimated rates for males and females with 95 % confidence intervals. RESULTS: Age-standardized incidence rates were obtained based on the random effects model and were 8.16 (95 % CI: 6.64 to 9.68) and 6.17 (95 % CI: 5.01 to 7.32) for males and females, respectively. The random crude rates were 5.58 (95 % CI: 4.22 to 6.94) for males and 4.01 (95 % CI: 3.06 to 4.97) for females. CONCLUSIONS: Colorectal cancer incidence rates rise due to individual and environmental risk factors as well as improvement in the registry system and increase in access to health services. A more executed organized and structured system for collecting cancer data, in all cities and rural areas of the country, is an essential priority.

Effect of PM2.5 exposure on adhesion molecules and systemic nitric oxide in healthy adults: The role of metals, PAHs, and oxidative potential.

Since there is limited evidence on the impact of PM2.5 content on cardiovascular biomarkers, we conducted a cross-sectional study on 89 healthy adults from October 12 to November 21, 2021. We measured daily PM2.5 in two distinct regions during different time windows: a high-traffic urban area and an industrial suburb. The concentrations of metals, PAHs, and oxidative potential (OP) were determined using ICP-MS, GC-MS, and dithiothreitol (DTT), respectively. Systemic biomarkers, including NO, sICAM-1, sVCAM-1, MDA, and CRP, were quantified in each subject simultaneously. A generalized linear model was used to examine the association between PM2.5 toxicity and each health endpoint. Our findings indicated that daily PM2.5 concentrations exceeded the WHO-recommended level by approximately sevenfold. We found that PM2.5 exposure was associated with adverse cardiovascular outcomes. Moreover, exposure to PM2.5 mass, total PAHs, and certain trace metals (Ni, Fe, V, As, and Pb) resulted in a decline in serum NO levels. At lag 3, exposure to PM2.5 mass resulted in a significant decrease in NO levels [1.32% (95% CI: -2.27, -0.12)] and total PAHs [2.05% (95% CI: -3.93, -0.12)]. In contrast, OP exhibited a mild correlation with NO level increases. Positive associations were observed between PM2.5 and its chemical constituents (PAHs, As, Cu, OP) and adhesion molecules at different lag times. An increase of 0.16 ppb in PAH concentrations at an interquartile range was associated with a 4.74% decline (95% CI, -7.80, -0.55) in the sVCAM-1 level. However, our study did not reveal any significant trend between pollutants and other biomarkers (sICAM-1, MDA, and CRP). Consequently, our findings suggest that different PM2.5 chemical compositions exhibit diverse behavior in biological responses.

Towards Harmonized Adolescent Health Measurement: Assessing Alignment Between Current Recommendations and the Global Action for Measurement of Adolescent Health-Recommended Indicators.

PURPOSE: This study identified alignment of indicators across different initiatives and data collection instruments as a foundation for future harmonization of adolescent health measurement. METHODS: Using the Global Action for Measurement of Adolescent health (GAMA) recommended indicators as the basis for comparison, we conducted a desk review of 14 global-level initiatives, such as the Sustainable Development Goals and the Global Strategy for Women's, Children's and Adolescents' Health, and five multicountry survey programs, such as the Multiple Indicator Cluster Surveys and the Global school-based Student Health Survey. We identified initiative and survey indicators similar to a GAMA indicator, deconstructed indicators into standard elements to facilitate comparison, and assessed alignment to the corresponding GAMA indicator across each of the elements. RESULTS: A total of 144 initiative indicators and 90 survey indicators were identified. Twenty-four initiative indicators (17%) and 14 survey indicators (16%) matched the corresponding GAMA indicators across all elements. Population of interest was the most commonly discrepant element; whereas GAMA indicators mostly refer to ages 10-19, many survey and initiative indicators encompass only part of this age range, for example, 15-19-year-olds as a subset of adults ages 15-49 years. An additional 53 initiative indicators (39%) and 44 survey indicators (49%) matched on all elements except the population of interest. DISCUSSION: The current adolescent measurement landscape is inconsistent, with differing recommendations on what and how to measure. Findings from this study support efforts to promote indicator alignment and harmonization across adolescent health measurement stakeholders at the global, regional, and country levels.

Indicators to Measure Adolescent Health at the Country, Regional, and Global Levels: Results of a Five-Year Selection Process by the Global Action for the Measurement of Adolescent Health.

PURPOSE: To improve adolescent health measurement, the Global Action for the Measurement of Adolescent health (GAMA) Advisory Group was formed in 2018 and published a draft list of 52 indicators across six adolescent health domains in 2022. We describe the process and results of selecting the adolescent health indicators recommended by GAMA (hereafter, "GAMA-recommended indicators"). METHODS: Each indicator in the draft list was assessed using the following inputs: (1) availability of data and stakeholders' perceptions on their relevance, acceptability, and feasibility across selected countries; (2) alignment with current measurement recommendations and practices; and (3) data in global databases. Topic-specific working groups comprised of GAMA experts and representatives of United Nations partner agencies reviewed results and provided preliminary recommendations, which were appraised by all GAMA members and finalized. RESULTS: There are 47 GAMA-recommended indicators (36 core and 11 additional) for adolescent health measurement across six domains: policies, programs, and laws (4 indicators); systems performance and interventions (4); health determinants (7); health behaviors and risks (20); subjective well-being (2); and health outcomes and conditions (10). DISCUSSION: These indicators are the result of a robust and structured five-year process to identify a priority set of indicators with relevance to adolescent health globally. This inclusive and participatory approach incorporated inputs from a broad range of stakeholders, including adolescents and young people themselves. The GAMA-recommended indicators are now ready to be used to measure adolescent health at the country, regional, and global levels.

Gastroschisis prevalence patterns in 27 surveillance programs from 24 countries, International Clearinghouse for Birth Defects Surveillance and Research, 1980-2017.

BACKGROUND: Gastroschisis is a serious birth defect with midgut prolapse into the amniotic cavity. The objectives of this study were to evaluate the prevalence and time trends of gastroschisis among programs in the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), focusing on regional variations and maternal age changes in the population. METHODS: We analyzed data on births from 1980 to 2017 from 27 ICBDSR member programs, representing 24 countries and three regions (Europe+ (includes Iran) , Latin America, North America). Cases were identified using diagnostic codes (i.e., 756.7, 756.71, or Q79.3). We excluded cases of amniotic band syndrome, limb-body wall defect, and ruptured omphalocele. Programs provided annual counts for gastroschisis cases (live births, stillbirths, and legally permitted pregnancy terminations for fetal anomalies) and source population (live births, stillbirths), by maternal age. RESULTS: Overall, gastroschisis occurred in 1 of every 3268 births (3.06 per 10,000 births; 95% confidence intervals [CI]: 3.01, 3.11), with marked regional variation. European+ prevalence was 1.49 (95%CI: 1.44, 1.55), Latin American 3.80 (95%CI: 3.69, 3.92) and North American 4.32 (95%CI: 4.22, 4.42). A statistically significant increasing time trend was observed among six European+ , four Latin American, and four North American programs. Women <20 years of age had the highest prevalence in all programs except the Slovak Republic. CONCLUSIONS: Gastroschisis prevalence increased over time in 61% of participating programs, and the highest increase in prevalence was observed among the youngest women. Additional inquiry will help to assess the impact of the changing maternal age proportions in the birth population on gastroschisis prevalence.

Exploring a Preliminary Set of Indicators to Measure Adolescent Health: Results From a 12-Country Feasibility Study.

PURPOSE: To explore data availability, perceived relevance, acceptability and feasibility of implementing 52 draft indicators for adolescent health measurement in different countries globally. METHODS: A mixed-methods, sequential explanatory study was conducted in 12 countries. An online spreadsheet was used to assess data availability and a stakeholder survey to assess perceived relevance, acceptability, and feasibility of implementing each draft indicator proposed by the Global Action for Measurement of Adolescent health (GAMA). The assessments were discussed in virtual meetings with all countries and in deep dives with three countries. Findings were synthesized using descriptive statistics and qualitative thematic analysis. RESULTS: Data availability varied across the 52 draft GAMA indicators and across countries. Nine countries reported measuring over half of the indicators. Most indicators were rated relevant by stakeholders, while some were considered less acceptable and feasible. The ten lowest-ranking indicators were related to mental health, sexual health and substance use; the highest-ranking indicators centered on broader adolescent health issues, like use of health services. Indicators with higher data availability and alignment with national priorities were generally considered most relevant, acceptable and feasible. Barriers to measurement included legal, ethical and sensitivity issues, challenges with multi-sectoral coordination and data systems flexibility. DISCUSSION: Most of the draft GAMA indicators were deemed relevant and feasible, but contextual priorities and perceived acceptability influenced their implementation in countries. To increase their use for a more comprehensive understanding of adolescent health, better multi-sectoral coordination and tailored capacity building to accommodate the diverse data systems in countries will be required.