Sex differences in high-risk health behaviors among school-going adolescents in Yazd, Iran; a cross-sectional study.

Objective: Adolescents are exposed to a wide range of high-risk health behaviors. This study aimed to investigate the high-risk health behaviors of adolescents in an Iranian adolescent population and gender differences. Method: This cross-sectional descriptive study recruited high school students in Yazd city in center of Iran. Schools were randomly selected. In each school, all selected classes were included. Sampling in each class was census. The study investigated self-reported high-risk health behaviors. Students completed the Global School-based Student Health Survey (GSHS), an anonymous, validated questionnaire. Results: 2420 students participated in this study (52.5% male). The age range was 12-19 years. Daily consumption of ≥1 serving of fruit and vegetables per day was reported by 77.4% and 49.5% of respondents, respectively. Adequate physical activity was reported by only 18.4% of adolescents, and significantly less frequently by girls than boys (p < 0.001). 11.8% were current smokers (M/F ratio: 2.6), and 20.5% (M/F ratio: 1.5) were ever used hookah. The prevalence of ever alcohol and substance abuse was 15.5% and 8.8%, respectively. The prevalence of tobacco and substance use was significantly higher in participants' boys than in girls (p < 0.001). Males were over twice more likely to report frequent fighting in the past 12 months than girls. Overall, girls reported more parental supervision than boys (82.1% vs. 73.4%) and parental monitoring (90.6% vs. 86.8%), while boys reported higher levels of awareness over leisure activities than girls (65.8% vs. 58.4%). Conclusions: High-risk health behaviors are more common in boys than girls. Health policymakers should use these results in prioritizing and designing health interventions to promote youth health. Further studies are recommended to identify the factors influencing the prevalence of these behaviors.

Prevalence of hypertension and related risk factors in central Iran: Results from Yazd Health Study.

BACKGROUND: The prevalence of hypertension (HTN) varies across countries due to differences in its related risk factors. This study aimed to investigate the prevalence of HTN and related risk factors among adults. METHODS: This study was conducted on the data from the recruitment phase of Yazd Health Study. Using multi-stage random cluster sampling, 10000 adults of 20-69 years were selected. Self-reported HTN (diagnosed by a physician) was recorded in a home visit. Blood pressure (BP) was measured using a standard protocol and categorized based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and ýTreatment of High Blood Pressure (JNC-7) classification. T-test was used to examine the gender differences. Qualitative variables were presented as number (frequency). Chi-square test and bivariate logistic regression were carried out to determine the association between risk factors. RESULTS: The response rate was 95% (n = 9975). The prevalence of positive history of HTN was 18.5%. The mean systolic and diastolic BP was 126.5 ± 18.4 and 80.2 ± 12.5 mmHg, respectively. The prevalence of HTN was 36.0% (95%CI: 35.1-36.9). Its prevalence reduced by high-education, physical activity, lower BMI, and lack of history of diabetes mellitus (DM) (P < 0.0001). HTN is less common in smokers (P < 0.0001). Logistic regression analysis showed that HTN was higher among men (OR: 1.83; 95%CI: 1.64-2.03), the elderly (OR: 5.15; 95%CI: 4.20-6.31), low-educated (OR: 1.40; 95%CI: 1.17-1.67), and diabetics (OR: 1.20; 95%CI: 1.05-1.38). The prevalence of HTN was 2 times higher in obeses. HTN did not have a significant relationship with inactivity, smoking, and hypercholesterolemia. CONCLUSION: The prevalence of HTN was high. By identifying modifiable risk factors, health policymakers can prioritize intervention programs. It is necessary to inform younger adult groups how these factors can be managed through a healthy lifestyle and nutritional habits.

Evaluation of chemical and microbial quality of food in northern Iran.

BACKGROUND: Iran is one of the developing countries and foodborne diseases commonly impose problems for public health, the health care system and the economy. Therefore, this study aimed to evaluate the chemical and microbial quality of food in northern Iran. METHODS: This cross-sectional study was conducted in 2019. This study was performed on food samples obtained in a straightforward way while visiting food preparation and distribution centers in Babol. Tests related to different food types were performed by laboratory experts. Data collection with a checklist: date and place of sampling, number of samples, type of food, type of test, compliance of results with standards. Data were analyzed by SPSS22 and descriptive statistics, Chi-square and t-test. RESULTS: 1043 food samples were tested from 5 groups of dairy products, protein, cereals, vegetables and other food groups. The highest number of samples in the cereal group was 767 samples (73.53%). In the cereal group, most samples were breads. The pH of 11.67% of breads and the salt in 21.49% of breads did not match the standard. The blankit (sodium hydrosulfite) on bread dough were negative. Moisture, gluten, ash and pH match with the standards in all flour samples. The results of microbial tests on sweets and ice cream showed that Escherichia coli and Staphylococcus aureus and Salmonella were negative. Enterobacter aerogenes was positive in 8.20% of sweets, mold and yeast were positive in 19.58%. The results of microbial tests on buttermilk and yogurt, grilled meat and chicken sandwiches, vegetables and salads showed that bacteria Escherichia coli and Staphylococcus aureus and all microorganisms were negative. Mold tests were positive in 11.12% of juice samples. CONCLUSIONS: The results showed that the foods and drinks supplied in food and drink preparation and distribution centers in Babol in 2019 were of good chemical and microbial quality. In some food groups the results of microbial and chemical testings were negative, i.e. without contamination. Less than 20% of products in the group of cereals and protein products did not match with the standards, which is a satisfactory result compared to other studies conducted in different cities of Iran. These good results for food quality can be explained bythe constructive performance of food health experts that made good controling, monitoring, and food health and hygiene education.

Prevalence of Allergic Rhinitis and Eczema in Adolescents Living in Yazd City: Part of Global Asthma Network Survey.

Allergic rhinitis and eczema are two common global diseases that can lead to impaired quality of life. Determining the prevalence of these allergic disorders can be useful in planning prevention and treatment. This study aimed to investigate the prevalence and severity of allergic rhinitis and eczema in adolescents living in Yazd city. Using an electronic questionnaire based on the Global Asthma Network (GAN) core questionnaire, 5141 adolescents aged 13-14 years were cross-sectionally surveyed. The prevalence of current symptoms of rhinitis turned out to be 36.3%, proving significantly higher in boys (p=0.009). Moreover, the prevalence of allergic rhinitis and rhinoconjunctivitis in the past year leveled at 12.4% and 10.5%, respectively; however, the former was significantly higher in females (p=0.014). Additionally, severe rhinoconjunctivitis was observed in 0.2% of the participants with no gender preference (p=0.09). Confirmed hay fever by a doctor was reported in 13.2% of adolescents, significantly higher in males (p<0.001). The prevalence of current itchy rash and current eczema was found to be 5.5%, and 2.9%, respectively, with no difference in terms of gender. Severe atopic eczema and eczema confirmed by a doctor were seen in 0.4% and 5% of the participants, no gender preference was identified. Concurrent prevalence of current rhinoconjunctivitis and eczema was detected in 1% of the participants. Despite the increasing trend of allergic diseases in most parts of the world, the prevalence of rhinoconjunctivitis and eczema in adolescents has not increased in Yazd in the last two decades, and this city is located in a low to moderate prevalence area.

Seasonal variations of polycyclic aromatic hydrocarbons in coastal sediments of a marine resource hot spot: the case of pars special economic energy zone, Iran.

Polycyclic aromatic hydrocarbons (PAHs) are an important group of compounds of major environmental concern, which are in the class of persistent organic pollutants. Therefore, the key purpose of this research was to analyze seasonal fluctuations and to determine the probability of polycyclic aromatic hydrocarbons in coastal sediments of the Iranian Marine Resource Center based on the evaluation of 16 US-EPA important PAH compounds. These compounds have been collected from intertidal sediments located in the marine resources of southern Iran in different seasons. These samples of the surficial sediment were collected at the PSEEZ area using a stainless steel grab sampler in four seasons, from depths between 0.5 and 30 m. Surface sediment samples were removed by spoons and carefully placed in an aluminum foil; they were taken to the laboratory on ice and held at 20° C until their study. After extraction, by using a rotary evaporator apparatus, samples were condensed. The assay was added to roughly 2 g of activated copper flasks in the refrigerator for 36 h for desulfurization. Among different seasons, the highest concentration was observed in winter, with a mean of 281.3 ng g-1. According to ecological risk assessment (concentrations of possible effects, low effect range, degree of threshold effects, and median effect range), PAH risks in surface sediments of PSEEZ were lower than the threshold results levels (TEL), possible effects levels (PEL), low range of effects (ERL), and median range of effects (ERM), indicating that a biological effect would rarely occur. The dry weight scale of the concentration of ∑PAHs ranges from 145.7 to 348.42 ng g-1 with a mean quantity of 260.52 ng g-1. Therefore, according to the amount of ∑PAH concentration, the sediments in the PSEEZ area indicated moderate to heavy pollutions. In this way, the sedimentary surface ecosystems of the Persian Gulf were considered as moderately polluted compared with other ecosystems worldwide. Our study highlighted some of the research gaps in PAH contamination studies and the level of PAH contamination. Therefore, this study will provide a scientific background, planning, and policies for PAH pollution control and environmental protection in Iran and similar regions around the world.

Prevalence and Severity of Adolescent Asthma in Yazd, Iran: Based on the 2020 Global Asthma Network (GAN) Survey.

Asthma, as the most common chronic disease in children, encompasses substantial health and socioeconomic burden worldwide. This study aimed to evaluate the prevalence, severity, and management of asthma in adolescents aged 13-14 years. This cross-sectional study, which was part of the Global Asthma Network (GAN) 2020 survey, was conducted in early 2020 in Yazd, Iran. A total of 48 schools in Yazd city were selected by cluster sampling. In this study, 5141 students, including 3069 (59.7%) females and 2072 (40.3%) males participated. Prevalence of ever and current wheezing was 19% and 9% respectively. The former was significantly higher in males than females (p<0.001). About 2% of the participants, which was 22.1% of students with current wheezing, had severe asthma. The prevalence of severe asthma was significantly higher in males (p=0.026). Our results showed that 4.8% of students had confirmed asthma by a doctor, significantly predominant in males (p<0.001). The prevalence of using inhaled medicines in the past 12 months was 3.8%, which was significantly higher in males than females (p<0.001). The prevalence of using short-acting ß-agonists (SABA) and long-acting ß-agonists (LABA) was 2.3% and 1.4% among the students, respectively, with a male predominance (p=0.019). About 1.2% and 0.8% of participants were using inhaled corticosteroids (ICS) and the combination of ICS and LABA, respectively, which was significantly higher in male participants (p<0.001). According to our findings and in comparison to the previous ISAAC study in Yazd, the prevalence of severe asthma has decreased which indicates better management of asthma during the past two decades.

Urban morphology detection and it's linking with land surface temperature: A case study for Tehran Metropolis, Iran.

Expansion of urban areas and alteration of natural land cover exacerbate the local climate change. To find out the effect of land cover changes on the local climate, in this study, the Local Climate Zone (LCZ) concept was utilized to detect urban morphology in Tehran Metropolis. LCZ and Land Surface Temperature (LST) can be identified and classified based on available remote sensing products. Firstly, LCZ maps of Tehran metropolis were extracted using Landsat imagery, and secondly, relationships between LCZ and LST were explored for three years (1990, 2004, and 2018). We found that Tehran urban structure has 13 LCZs based on imagery from Landsat 5 and 14 LCZs based on images for Landsat 7 and 8. Overall accuracy and kappa coefficient were estimated at 62% and 0.60, respectively. Results show that built-up classes including compact high-rise, compact mid-rise, and heavy industrial areas tended to increase the surface temperature, while except for bare land, all other land cover types tended to decrease the surface temperature. The findings also suggest that complementary optical and thermal remote sensing data, such as the combination of OLI with TIRS imageries, were sufficient for supervised LCZ and LST classification in a semi-arid region of Tehran metropolis.

Potential use of grapevine cv Askari for heavy metal phytoremediation purposes at greenhouse scale.

Grapevine varieties possess desirable characteristics for phytoremediation purposes. We investigated the potential of grapevine cv Askari in phytoremediation of heavy metal (HM) pollutions. In total 80 grapevine seedlings were exposed to four levels of HM stress (mild, low, moderate, and severe) in greenhouse condition during two growing years (2018 and 2019). The HM concentrations (Zn, Cu, Cd, Cr, and Pb) were subsequently determined in the soils, roots, and grapevine aboveground parts (AGPs), and then phytoextraction and phytostabilization potential assessment indices, i.e., biological absorption coefficient (BAC), bioconcentration factor (BCF), and translocation factor (TF), were calculated. Results led to ranking of the cumulative concentration order of the HMs, i.e.: soils (3476.6) > AGPs (1418.8) > roots (562.2) mg/kg-DW. The mean concentrations ranking order of studied HMs were in soil: Cu (1184.8) > Pb (865.5) > Cd (803.2) > Cr (623.0) > Zn (277.9) mg/kg-DW; roots, Cu (242.0) > Cd (239.5) > Zn (188.8) > Pb (63.5) > Cr (17.2) mg/kg-DW; and AGP environments, Cu (910.2) > Cd (322.9) > Zn (160.3) > Pb (152.9) > Cr (25.3) mg/kg-DW. Principal component analysis results demonstrated the same distribution pattern for the studied HMs between soil, root, and AGP environments, and the highest correlation coefficients were found for Cu, Zn, and Cd. Based on the obtained results (Cu-BAC (> 1), Zn-BCF (> 1), Zn-TF (< 1), Cu-AGP mean concentrations (> 1000 mg/kg-DW), and Cd-AGP mean concentrations (> 100 mg/kg-DW)), it can be concluded that grapevine cv Askari possesses potentials for phytoremediation purposes of Cu, Zn, and Cd. These results were acquired in a greenhouse environment and under controlled conditions; we suggest that the phytoremediation potential of this grapevine variety be assessed in a contaminated vineyard environment as well.

Ambient air particulate matter (PM10) satellite monitoring and respiratory health effects assessment.

PURPOSE: Air particulate matter with an aerodynamic diameter of 10 µm or less (PM10) is one of the main causes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study explored the relationship between PM10 by remote sensing and AECOPD in Chaharmahal-o-Bakhtiari province from 2014 to2018. METHOD: PM10 concentrations were predicted and validated based on aerosol optical depth (AOD) from 161 images processed by MODIS sensor and ground air quality monitoring station data. Demographic information and spirometric indices of 2038 patients with AECOPD were collected and analyzed from the hospital during the studied periods. SPSS software was used to analyze the relationships between these two categories of information. RESULTS: There was a significant negative relationship between PM10 and FVC, FVC%, FEV1, FEV1%, FEF25-75, FEV1/FVC, PEF, and FEF25FVC indices (p < 0.05). The results showed that over 2014-2018, the annual mean of PM10 concentrations varied from 35 to 52 µg/m3. The result of the regression model showed that the patient's age, body mass index (BMI), and PM10 concentrations were the most affecting variables on the two important spirometric indices i.e., FVC% and FEV1%. The PM10 concentrations and number of AECOPD patients had a similar pattern during the studied period. The women group, age group above 74 years, normal BMI, and non-smoking patients showed the most sensitivity to the PM10 concentrations. CONCLUSIONS: Our findings provide supplementary scientific information on PM10 concentration related to the incidence of AECOPD and as a variable affecting the most important spirometry indicators by providing local decision-makers information needed to set a priority of air pollution control measures as well as health services.

Changes in the prevalence of measures associated with hypertension among Iranian adults according to classification by ACC/AHA guideline 2017.

BACKGROUND: Different definitions have been proposed to categorize hypertension. We aimed to investigate the difference in prevalence of measures associated with hypertension according to the American College of Cardiology/American Heart Association (ACC/AHA) criteria versus Joint National Committee 7 (JNC7) criteria. METHODS: We analyzed the data of 10,000 participants of Yazd Health Study (YaHS) aged 20-69 years. Blood pressure was measured three times with standard protocol defined by ACC/AHA. Prevalence of high blood pressure measure was compared in both definitions and absolute differences reported. RESULTS: The prevalence of high blood pressure in our measurement was 61.0% according to ACC/AHA, and 28.9% according to JNC 7. The prevalence of self-reported hypertension was 18.6%. Age and sex standardized prevalence rates of high blood pressure measure indicates a 2.4-fold increase in the prevalence rate (30.1% absolute difference) by the ACC/AHA guideline. While the prevalence increased in all age groups, the age group of 20-29 showed the highest relative increase by 3.6 times (10.6% vs. 38.1%). High blood pressure measure among people with diabetes increased from 45.8 to 75.3% with the ACC/AHA guideline. Of the people who had no past history of diagnosed hypertension (n = 7887), 55.1 and 22.7% had high blood pressure measure by ACC/AHA and JNC-7 guidelines, respectively. From JNC7 to ACC/AHA, the overall difference in unawareness about HTN increased by 32.4%. CONCLUSION: Prevalence of hypertension associated measures increased over two folds by using the ACC/AHA criteria compared to JNC 7. Also, change in the criteria, reduces awareness of the disease and increases uncontrolled hypertension respectively. More research is needed to determine if the new definitions can affect management of hypertension in societies. Considering local priorities and implication of cost effective may improve implementation of new definitions for hypertension in different countries.

Spatial-seasonal variations and ecological risk of heavy metals in Persian gulf coastal region: case study of Iran.

PURPOSE: This study aimed to perform a systematic review to analyse the seasonal concentration and ecological risk assessment of heavy metals (HMs) in seawater and sediment samples collected from the coastline of Jam city in Bushehr, Iran. METHODS: A total of 96 sediment and seawater samples were collected from 16 sampling stations during the spring, summer, autumn, and winter of 2017. Then, the concentrations of Pb, Ni, Cd, Cr, Cu, Zn, and Fe were determined. Finally, the pollution load index (PLI), ecological risk (Er), and environmental risk (RI) were calculated to assess the HM ecological risk. RESULTS: The results showed that the mean concentrations of HMs were lower than the maximum acceptable concentration by SQG and NOAA. In addition, the PLI assessed a low pollution load level in the region. The ER and RI results also showed that the region was at low risk, and the metal risk was classified as Cd > Cu > Pb > Ni > Zn > Cr. In some samples, the mean concentrations of HM were found to be higher with a statistically significant difference (P˂0.05). The results also showed that sediments were engaging in a moderate Er by Cd. CONCLUSIONS: Generally, the rapid growth of urbanization, as well as industrial and human activities, along this coastline and area has increased the pollutants dumped into the seawater and sediments. Thus, it is necessary to take regular monitoring programs and develop better management strategies to minimize the amount of HMs entering into this coastal area.

Awareness, treatment, and control of hypertension and related factors in adult Iranian population.

BACKGROUND: Hypertension, known as the silent killer, is a major risk factor for cardiovascular disease. Awareness and treatment of hypertension is not appropriate in the world, and this has led to an increase in mortality and morbidity caused by uncontrolled hypertension. This study aims to estimate awareness, treated, and controlled hypertensive and relevant predictors in an adult Iranian population. METHODS: This cross-sectional study was conducted on 10,000 adults aged 20-69 years in Yazd, Iran. They were selected through multi-stage random cluster sampling in 2015-2016. Blood pressure was measured three-time with standard protocol by trained health workers. Those with a positive history of hypertension and using anti-hypertensive drugs, prescribed by a physician, were considered hypertensive. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic BP of ≥90 mmHg. Uncontrolled hypertension was defined in accordance with recommended treatment targets by the Joint National Committee (JNC7). Logistic regression was used to assess the predictors of hypertension awareness, treatment and control. RESULTS: The prevalence of hypertension was 37.3%, and the prevalence of pre-hypertension was 46.4%. 49.7% of People with hypertension were aware of their disease, and 71.5% of them were using antihypertensive drugs prescribed by physicians. Blood pressure was controlled in 38.9% of the treated patients. In the adjusted model, older age, female sex, and history of diabetes mellitus were positively associated with higher awareness. High physical activity, tobacco smoking, and diabetes are the only predictors of treated high blood pressure. Younger age, female sex, and higher education were determinants of controlled hypertension. Having health insurance was significantly correlated with awareness and control of hypertension. CONCLUSION: Hypertension is a public health problem in this population, which is not well controlled. Half of the patients were unaware. Intervention for increased screening coverage is needed. It should plan to raise public awareness about hypertension and improve hypertension control under the supervision of physicians. Implement a family physician program is recommended in the health system.

Agreement between Framingham, IraPEN and non-laboratory WHO-EMR risk score calculators for cardiovascular risk prediction in a large Iranian population.

Introduction: Estimation of the risk of cardiovascular diseases (CVD), may lead to prophylactic therapies. This study aims to compare and evaluate the agreement between CVD prediction of Iran Package of Essential Non-communicable Disease (IraPEN) and Framingham risk score (FRS). Methods: All 40-79 years old participants in the Yazd Health Study who did not have a history of CVD were included. The 10-years risk of CVD was estimated by the laboratory (IraPEN), non-laboratory WHO-EMR B and FRS. The risk was classified into low, moderate and high-risk groups. Cohen's weighted kappa statistics were used to assess agreement between tools. To assess discrepancies McNemar's χ2 test for paired data was used. P values < 0.05 were considered statistically significant. Results: In total, 2103 participant was included and the risk scores were calculated. Of them, 26.5% were stratified as high risk by FRS, compared with 6.1% by IraPEN. A slight agreement (37.9%) was observed (kappa 0.17, P < 0.0001), in other words. This discrepancy between IraPEN vs. FRS was seen in both sexes (P < 0.0001), although in women the agreement ratio was higher (52.1% vs. 21.3%). The discrepancy between FRS and IraPEN in categorizing people at risk of CVD was 55.5%, (P < 0.0001) but this was not significant between IraPEN and non-laboratory WHO-EMR-B (World Health Organization - Eastern Mediterranean Regional-B group countries) score (P < 0.523; discrepancies, 5.8%). Conclusion: Our study shows a slight agreement between various CVD risk scores. Thus, reviewing the IraPEN and using alternative tools for the low-risk group should be considered by decision-makers. It is important to use a more reliable score for nation-wide risk assessment.

Prevalence of modifiable cardiovascular risk factors in Yazd inner-city municipalities.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the world. With effective intervention and control of cardiovascular risk factors, mortality rates may be reduced. The aim of this study was to investigate the prevalence of modifiable risk factors across five municipalities in Yazd city. METHODS: Ten thousand residents of the Yazd greater area aged 20-69 years were selected using cluster random sampling method. Overall, 200 clusters were randomly selected based on the postcodes of residents who lived in the five municipalities of Yazd. Those who lived in Yazd annexed cities and rural areas were excluded. A valid questionnaire was completed and physical examination performed as done (94.9% response rate). Instances of self-reported diabetes mellitus, high blood cholesterol, tobacco smoking, and unhealthy diet were recorded. Blood pressure, height, and weight were measured and physical activity was classified by International Physical Activity Questionnaire (IPAQ). A chi-square test was used to analyze the differences in variables across municipalities. Statistical analyses were performed using SPSS V. 16. RESULTS: We analyzed 8749 participants' data from Yazd city. The prevalence of diabetes mellitus, hypercholesterolemia, and hypertension were 14.1, 16.7 and 18.6%, respectively. One in every four people consumed the recommended five servings of vegetables per day. Fish consumption was less than 5% at least once a week among participants. An unhealthy diet (85.7%); low physical activity (52.2%), hypertension (36.7%) and obesity (26.3%) were the most common cardiovascular risk factors. Only 2.1% of adults had no risk factors for CVD, and almost 75% of people had more than one risk factor. The prevalence of risk factors (excluding hypertension) was significantly different across the municipalities. Residents of region three had the highest prevalence of all risk factors aside from inactivity and unhealthy diet. CONCLUSION: unhealthy dietary habits and inactivity are the most common modifiable risk factors of CVD in Yazd. Spatial variations of cardiovascular risk factors observed. This geographic health inequality requires more attention from policymakers to control CVD risk factors across different municipalities accordingly. Promoting healthy lifestyle is the top priority of health intervention programs. It is recommended to increase access to sport arenas and restrict access to tobacconist in high-risk areas.

Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes in Central Iran: results from Yazd health study.

BACKGROUND: Over the past few decades, the prevalence of Diabetes Mellitus (DM) has risen rapidly in Iran and other low and middle-income countries. We investigated the prevalence of DM, pre-diabetes, undiagnosed and uncontrolled diabetes and its relationship with some associated socioeconomic factors in the Yazd Greater Area in Iran. METHODS: Yazd Health Study is a longitudinal study conducted to determine the prevalence of non-communicable disease and related risk factors. In a two-step cluster sampling, 10,000 adults aged 20-69 years (200 clusters) were selected. In the recruitment phase, DM was considered if the patients had been either diagnosed DM by a physician or had fasting blood glucose ≥ 126 mg/dL. Chi square test was used for categorical variables to evaluate the differences and logistic regression model was applied to determine the predictors of diabetes.. P-value < 0.05 considered statistically significant. RESULTS: Of the 9965 individuals recruited, the crude self-reported prevalence of DM was 14.1% (95% CI: 13.4-14.7). The prevalence was higher in women than men (15.6 vs.12.4%), significantly. The age-standardized prevalence of DM was 8%. The prevalence was 14.9% in Yazd local people and 8.6% in those residents migrated from other provinces (P < 0.0001). We showed a significant association between DM prevalence and age, education, marital status, unemployment, insurance status, and positive family history (P < 0.0001). The prevalence of DM diagnosed by phycisians was 16.1% in participants (age-standardized prevalence: 8.3%). The subset analysis showed that 4.8% of patients were not aware of their disease. The prevalence of pre-diabetes was 25.8%. Of those with diabetes, 58.3% were not adequately controlled, which is not statistically significant with socio-economic status. CONCLUSION: The current study showed a high prevalence of DM in Yazd Greater Area which is closely related to some socio-demographic factors. The high prevalence of pre-diabetes is alarming. Effective strategies for DM prevention should be introduced. The majority of people with diabetes are aware, but half of them are not controlled. The ineffective care plan currently in use, should be reviewed. Patients needs to be encouraged to improve their lifestyle. Active follow-up of patients is recommended to ensure continuity of care.

Urban Heat Island Monitoring and Impacts on Citizen's General Health Status in Isfahan Metropolis: A Remote Sensing and Field Survey Approach.

Urban heat islands (UHIs) are one of the urban management challenges, especially in metropolises, which can affect citizens' health and well-being. This study used a combination of remote sensing techniques with field survey to investigate systematically the effects of UHI on citizens' health in Isfahan metropolis, Iran. For this purpose, the land surface temperature (LST) over a three-year period was monitored by Landsat-8 satellite imagery based on the split window algorithm. Then, the areas where UHI and urban cold island (UCI) phenomena occurred were identified and a general health questionnaire-28 (GHQ-28) was applied to evaluate the health status of 800 citizens in terms of physical health, anxiety and sleep, social function, and depression in UHI and UCI treatments. The average LST during the study period was 45.5 ± 2.3 °C and results showed that the Zayandeh-Rood river and the surrounding greenery had an important role in regulating the ambient temperature and promoting the citizens' health. Citizens living in the suburban areas were more exposed to the UHIs phenomena, and statistical analysis of the GHQ-28 results indicated that they showed severe significant (P < 0.05) responses in terms of non-physical health sub-scales (i.e., anxiety and sleep, social functioning, and depression). Therefore, it can be concluded that not all citizens in the Isfahan metropolis are in the same environmental conditions and city managers and planners should pay more attention to the citizens living in the UHIs. The most important proceedings in this area would be the creation and development of parks and green belts, as well as the allocation of health-medical facilities and citizen education.

Transboundary Basins Need More Attention: Anthropogenic Impacts on Land Cover Changes in Aras River Basin, Monitoring and Prediction.

Changes in land cover (LC) can alter the basin hydrology by affecting the evaporation, infiltration, and surface and subsurface flow processes, and ultimately affect river water quantity and quality. This study aimed to monitor and predict the LC composition of a major, transboundary basin contributing to the Caspian Sea, the Aras River Basin (ARB). To this end, four LC maps of ARB corresponding to the years 1984, 2000, 2010, and 2017 were generated using Landsat satellite imagery from Armenia and the Nakhchivan Autonomous Republic. The LC gains and losses, net changes, exchanges, and the spatial trend of changes over 33 years (1984-2017) were investigated. The most important drivers of these changes and the most accurate LC transformation scenarios were identified, and a land change modeler (LCM) was applied to predict the LC change for the years 2027 and 2037. Validation results showed that LCM, with a Kappa index higher than 81%, is appropriate for predicting LC changes in the study area. The LC changes observed in the past indicate significant anthropogenic impacts on the basin, mainly by constructing new reservoir dams and expanding agriculture and urban areas, which are the major water-consuming sectors. Results show that over the past 33 years, agricultural areas have grown by more than 57% from 1984 to 2017 in the study area. Results also indicate that the given similar anthropogenic activities will keep on continuing in the ARB, and agricultural areas will increase by 2% from 2017 to 2027, and by another 1% from 2027 to 2037. Results of this study can support transboundary decision-making processes to analyze potential adverse impacts following past policies with neighboring countries that share the same water resources.

Ecological and health risks of soil and grape heavy metals in long-term fertilized vineyards (Chaharmahal and Bakhtiari province of Iran).

Heavy metal pollution in food-producing ecosystems resulting from long-term fertilizing and other agricultural practices is causing major concern due to its health risk potential for human and other organisms. This study was designed to investigate heavy metal concentrations (Cu, Zn, Pb, Cr and Cd) and assess their ecological risk using contamination factor (Cf), pollution load index (PLI) and ecological risk index. Health risk assessment (HRA) was also estimated by investigating non-carcinogenic and carcinogenic risks of soil via oral ingestion, dermal contact, inhalation, and health risk of grape consumption. To this aim, 38 fertilized vineyards of the region were investigated during harvesting seasons of 2016 and 2017. The results showed a same ranking order of the metals in the soil and grape that was Zn > Cu > Pb > Cr > Cd. The average concentrations of Zn and Pb in the grape samples were significantly higher than the national permissible limits. According to Cf and PLI indices, Cd had the most ecological risk compared to the other studied metals. The HRA results showed that adults and children are not exposed to non-carcinogenic risk from the studied heavy metals in the vineyard soils. But, it was a tolerable level of carcinogenic health risk only by Cr in some of the vineyards. The PLI had most significant correlation (p < 0.01) with the other studied indices. So, it can be considered as a rapid and applicable index to assess ecological and health risk of heavy metals in the region. To food-chain security and community health, some comprehensive managing plans are necessary to increase farmer's awareness about the standard amount of chemical fertilizers and pesticides. Furthermore, continuous monitoring of heavy metals in soil and grape of the vineyards should be performed.

Prevalence of Depression, Anxiety and Stress among Adult Population: Results of Yazd Health Study.

Objective: The burden of mental disorders continues to grow with significant impacts on health. This study aimed to investigate the prevalence of stress, anxiety, and depression in Yazd adult population and to examine the associated socioeconomic factors. Method : In a 2-step cluster sampling process, 10 000 residents of Yazd Greater Area (200 clusters of 50) were selected during 2014-2015. The short version of Depression, Anxiety and Stress Scale (DASS) Questionnaire was used to assess relevant depression, anxiety, and stress. Data were analyzed by chi-square test. All statistical analyses were done using SPSS version 16.0. P-values less than 0.05 were considered statistically significant. Results: Depression, anxiety, and stress were seen in 29%, 32.2%, and 34.8% of adult residents of Yazd Greater Area, respectively. The symptoms of the disorders were moderate, severe, and very severe in 18.2%, 20.2%, and 23.4% of the population, respectively. Also, a significant difference was found between the symptoms of depression, anxiety, and stress and sex, age group, education, employment, marriage status, and country of birth. Of the total population under study, 3.7% were depressed, 7.7% were anxious, 9.5% had stress alone and 16.4% had symptoms of all the 3 disorders. Frequency of depression among Zoroastrians was more than muslims (42.1% vs 29.7%). Conclusion: Despite achievemments in higher education and economic development of Yazd population over the past 2 decades, the trend of these disorders has alarmingly been increased. Considering the findings, it is necessary to develop evidence-based and appropriate community-based primary and secondary mental health prevention programs.

Prevalence of major depressive disorder in the general population of Iran: A systematic review and meta-analysis.

Background: Major depressive disorder (MDD) is the most common psychological disorder and affects many people worldwide. Surveying the prevalence of mental disorders, especially general disorders, such as major depressive disorder, is highly important for health professionals and policymakers. Due to a wide variation of studies concerning the prevalence of major depressive disorder in Iran, the present study was conducted to integrate such results. Methods: To conduct this study, English (PubMed/Medline, Scopus and Web of Science) and Persian (MHRN, Noormgs, Magiran, Iran-Medex, Irandoc, and SID) databases, from 1990 to 2018, were explored. All articles related to the point prevalence of depressive disorders in the general population of Iran were reviewed. The inclusion criteria of the present study were as follow: cross sectional studies based on general populations; the expression of the point prevalence rate and incidence of major depressive disorder for people over 15 years; and the use of a structured or semi-structured clinical interview for diagnosis of the disorder. Studies that were not original (such as review studies) and those that did not represent general populations were excluded from the study. To analyze the data obtained from this study, the second version of Comprehensive Meta-Analysis (CMA) software was used. The total point prevalence was calculated using the meta-analysis method, and the I2 index was used to measure the heterogeneity of the studies. Results: Of 6734 studies, 30 studies with a total sample size of 37 867 were finally included based on proposed inclusion and exclusion criteria. The sample included 20641 women (55%), and 17 226 (45%) men. In the present meta-analysis study, due to significant heterogeneity (I=97.1%, p=0.001) among studies, the randomized method was used, and the total point prevalence was 4.1% (CI: 3.1% 5.5%). The overall point prevalence of major depressive disorder was 4.8% (CI: 3.6% -5.6%) in women and 2.3% (CI: 1.6% -3.6%)in men, which indicated that the incidence of this disorder was 1.95 times more in women than in men. Conclusion: This meta-analysis study found a considerable prevalence of major depressive disorder among Iranian participants and revealed that the point prevalence of the disease was more than two-fold in women compared to men. Considering these findings and the high burden of this disorder for communities, the need to formulate and implement prevention and treatment programs is highly required.