Overview of oral health status and associated risk factors in maritime settings: An updated systematic review.

OBJECTIVES: The aim of this study is to provide an updated overview of the oral health status and associated risk factors in maritime settings. METHODS: We systematically searched PubMed, Ovid Embase, Web of Science, CINAHL and SCOPUS from January 2010 to April 2023. Two independent reviewers extracted the data. The quality of included studies was assessed using relevant assessment tools. RESULTS: A total of 260 records were found in the initial search; 24 articles met the inclusion criteria. Most studies had descriptive design, and only two randomized controlled trials were found. The main oral health issues noted are oral cancer, dental caries, periodontal diseases, oral mucosal lesions, and dental emergency. Male seafarers have higher risk of oral cancers in the tongue, lips, and oral cavity while oral mucosal lesions are more prevalent among fishermen. CONCLUSIONS: Dental caries and periodontal diseases are prevalent in both seafarers and fishermen. The consumption of tobacco, alcohol, fermentable carbohydrate, and poor oral hygiene are risk factors that affect the oral health status at sea. The occurrence of oral diseases in maritime setting requires more attention of researchers and authorities to develop strategies to tackle these issues. TRIAL REGISTRATION: Systematic review registration number in PROSPERO: CRD42020168692.

Why has the taxing policy on sugar sweetened beverages not reduced their purchase in Iranian households?

Objective: This study aimed at analyzing the effectiveness of the policy of taxing Sugar-Sweetened Beverages (SSBs) on their purchases during the last decade in Iranian households. Methods: The present mixed method study was done in 2017 in four phases: (1) A meta-review of the fiscal policies during the last decade, (2) Collecting existing data on soft drinks' production, price, and household expenditure during the last decade, (3) Conducting 19 semi-structured interviews with key informants, and (4) Facilitating a national meeting to achieve a consensus on the recommendations and future implications. Results: Document reviews showed that based on the Permanent Provisions of National Development Plans of Iran, the Ministry of Health and Medical Education (MOHME) should announce the list of health threatening products to increase taxation for them. The government is allowed to impose taxes on domestically produced and imported SSBs. The average household expenditure on SSBs increased in the rural and urban households of Iran during 2006-2016 in spite of taxation. In the different key informants' opinion, only value-added tax (VAT) was implemented among different fiscal policies, and the other parts, including tax and tolls were debated. Conclusion: The present research findings further proposed some suggestions for increasing the effectiveness of financial policies in reducing the prevalence of NCDs in Iran.

A qualitative study of Covid-19 effects on nutrition associated problems in recovered patients.

BACKGROUND: World is currently challenging with Covid-19 pandemic. Nutritional status is a determinant factor in the treatment process and recovery for patients with Covid-19. Although a limited data is available about the effects of nutrition on this disease. Therefore, the aim of this study was to identify nutritional problems in patients recovering from Covid-19 before, during and after the disease. METHODS: This qualitative descriptive study was carried out based on the specified inclusion criteria through targeted sampling of 45 patients recovered from Covid-19, 2021-2022. In-depth semi-structured individual interviews were used to collect data. Interviews were recorded, transcribed and analyzed using qualitative content analysis method and MAXQDA Software. RESULTS: Based on the participants' description of this stage, it can be reported that most of the individuals who were infected had no specific symptoms. Nutrition-linked problems in the main stage of the disease included troubles in tolerating foods and nutrition (e.g., fatty and solid foods), highly consumed foods in the main stage of the disease (e.g., beverages), individuals' approaches to improve nutritional challenges (e.g., consumption of herbal teas and soft texture foods) and using supplements. The patients stated fewer nutritional problems after recovering from the disease. The most significant change included their desire to eat solid foods such as rice, bread, pasta and fast foods. CONCLUSION: appropriate nutrition with medication can help accelerate the recovery process of the patients, especially hospitalized patients with further severe degrees of the illness.

Economic Sanctions Affecting Household Food and Nutrition Security and Policies to Cope With Them: A Systematic Review.

BACKGROUND: This review was conducted to identify the impact of economic sanctions on household food and nutrition security and policies to cope with them in countries exposed to sanctions. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 2020 were used to identify, select, appraise, and synthesize studies. Electronic databases in addition to Persian ones have been systematically searched for all related documents published until March 2022. Exclusion criteria were: lack of data related to food insecurity in countries subject to sanction and very low quality of the article. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal checklists. The results were presented as qualitative and quantitative syntheses. RESULTS: Of 1428 identified studies, 36 publications remained in the review, which belong to Iran (n=8), Cuba (n=8), Russia (n=7), Iraq (n=7), and Haiti (n=6), respectively. Declining gross domestic product (GDP), devaluation of the national currency, and the quality of food, increase in inflation, unemployment, and consumer prices, infant and under 5 years mortality, energy, and protein deficiency, and the poverty rate were reported as sanction consequences. The most important strategies to improve food security were the humanitarian assistance provided by the international community (Haiti), equity and priority for vulnerable groups mainly by expanding the healthcare system (Cuba), adopting a food ration system in the oil-for-food program, and fixing the price of food baskets (Iraq), import substitution and self-sufficiency (Russia), support domestic production, direct and indirect support and compensation packages for vulnerable households (the approach of resistance economy in Iran). CONCLUSION: Due to the heterogeneity of studies, meta-analysis was not possible. Since inadequate physical and economic food access caused by sanctions affects especially disadvantaged and vulnerable groups, planning to improve food security and providing support packages for these groups seems necessary.

Exploring adults' motives for food choice of sustainable diet components: a qualitative study in Tehran Metropolis.

BACKGROUND: Todays, due to the impact of human food choices on increasing greenhouse gas emissions, water consumption and environmental degradation, there is a new approach about changing the pattern of food production and consumption, including sustainable food and nutrition system related to consumption. This study aimed to explore the components of a sustainable diet among the factors that affect people's food choices. METHODS: This qualitative study was carried out using an in-depth interview with 33 individuals aged 30-64 years old living in different areas of Tehran. Data collection, data analysis and theoretical conceptualization were performed simultaneously. MAXQDA 10 software was used for managing and organizing the data. RESULTS: In this paper, the findings are categorized according to the key components of a sustainable diet in five themes: "Health and Nutrition", "Food and Agriculture Security", "Environment and Ecosystems", "Markets, food trade and production chains", "social, cultural, and policy factors" were categorized. Meanwhile, the components of the "Health and Nutrition" domain had the highest contribution and the components of the two domains "food and agriculture" and "environment and ecosystems" had the lowest role based on the participants' perception in this study. CONCLUSION: Considering to the low importance of the components of a sustainable diet in food choices of the community, promoting the individual awareness of sustainable diet components, clarifying the importance of food choices in creating environmental impacts and leading the national macro policies in the field food and nutrition toward sustainable diet goals are essential.

Developing and Validating Food Choice Determinants Questionnaire: An Instrument for Exploring Food Choice Determinants in Iran.

BACKGROUND: This study was carried out to design and validate a questionnaire to measure the majority of factors influencing food choices among adults in Iran. METHODS: A sequential exploratory mixed-method approach was applied to develop the initial item pool of the Food Choice Determinants Questionnaire (FCDQ) starting with a qualitative study to explore the food choice dimensions and its components. Designing the initial questionnaire using these dimensions and the 36-item Food Choice Questionnaire (FCQ) was then performed. The face, content, and construct validity were also assessed. The construct validity of the questionnaire was assessed using the exploratory factor analysis (EFA). Cronbach's alpha was applied for each main theme to examine the internal consistency. RESULTS: After content and face validity process, a 60-item FCDQ was developed with total items' content validity index (CVI) of 0.69 indicating a reasonable level. The Cronbach's alpha coefficients for each of the six constructs in the scale have shown satisfactory internal consistency. CONCLUSIONS: This instrument is valid and reliable to measure food choice determinants in adults and could be applied to design interventions aiming to better food choice.

Relationship between body mass index, risk of venous thromboembolism and pulmonary embolism: A systematic review and dose-response meta-analysis of cohort studies among four million participants.

BACKGROUND: The relationship between body mass index (BMI) and risk of venous thromboembolism (VTE) and pulmonary embolism (PE) is a controversial issue. This dose-response meta-analysis was performed to investigate the association between BMI and risk of VTE and PE incidence based on cohort studies. METHOD: A comprehensive systematic search was conducted up to August 2019 in MEDLINE/PubMed, SCOPUS, and Cochrane. DerSimonian and Laird random-effects models were run to estimate combined hazard ratios (HRs) with 95% confidence intervals (CIs). Dose-response analysis was also carried out based on BMI values. RESULTS: Eleven articles with 16 arms and 3,910,747 participants were eligible for inclusion in this systematic review and meta-analysis. Pooled results showed a positive association between BMI and risk of VTE in the obese participants compared to participants classified in the normal BMI category (HR: 1.62, 95% CI: 1.29-2.04, I2 = 95%). Furthermore, results showed a significant association between lower BMI (underweight versus normal BMI category) and reduced risk of PE (HR: 0.80, 95% CI: 0.70-0.92, I2 = 9%) and higher risk of PE in obese versus normal BMI participants (HR: 2.24, 95% CI: 1.93-2.60, I2 = 0%). There was a significant linear relationship between BMI and risk of VTE (p < 0.001) and PE (p < 0.001). CONCLUSIONS: This systematic review and dose-response meta-analysis with 3,910,747 participants highlights obesity as a significant risk factor related to the incidence of VTE and PE.

Policy challenges of food advertisements from the viewpoints of Stakeholders: A qualitative study.

This study aims to explore the stakeholders' views and suggestions about the policy challenges of food advertisements. Sixteen semistructured interviews were held with media and the food industry experts. Directed content analysis and constant comparison methods were used to obtained categories until subthemes were extracted, and the results were shared as member checking with the stakeholders. Two categories in two themes and seven subthemes were investigated based on the perspectives of the stakeholders: (a) Creating food advertisements and (b) Regulations and rules of food advertising. Few strict guidelines and rules are governing food advertising in Iran. Some factors influencing the general approach in nutrition policy and particularly the choice of policy options and instruments that can be placed in this area, including economic factors, political leadership, lack of political, and systematic monitoring of food advertising status, will were perceived as powerful constraints in advertising policy. Strong links must be established between all sectors that have a bearing on healthy food (the media, public health community, food industry, and consumers). The research findings seek to offer policy options for both the government and the stakeholders for challenging future policies of food advertising.

Development and implementation of nutrition labelling in Iran: A retrospective policy analysis.

BACKGROUND: Nutrition labelling is a strategy to promote healthy eating and combat non-communicable diseases (NCDs). The present study aimed to provide an analysis of the nutrition labelling policy and its opportunities to improve in Iran. METHODS: Data were collected by 1) reviewing relevant documents and 2) semi-structured interviews with stakeholders through purposive and snowball sampling, continued until data saturation was achieved. A deductive content analysis was used by applying the policy triangulation framework and the Kingdon multiple stream theory. MAXQDA software was used to manage data analysis. RESULTS: Iran, is the first country in the Eastern Mediterranean region which has accomplished to implement nutrition traffic light labelling. The main contextual factors that affected nutrition labelling policy to become a national included health, political commitment, and international factors. Poor involvement of media for public awareness of nutrition traffic labeling, the inconsistency of nutrition traffic light color ranking using food standard guidelines, lack of consistency between nutrition traffic light colors and the healthy/unhealthy nature of some food products and the absence of a comprehensive evaluation plan were among the policy challenges identified. CONCLUSIONS: Strengthening the governance for a healthy food environment is recommended to improve the program. Also, establishing national portion sizes for food labelling, initiating public awareness campaigns, evaluation of the policy effect and public perception of the labels and their application are recommended.

Factors affecting health-promoting lifestyle profile in Iranian male seafarers working on tankers.

BACKGROUND: Seafaring is a risky occupation that is associated with a high incidence of lifestyle-related diseases. The present study was carried out to examine health promotion behaviour and its associated factors in seafarers of the National Iranian Tanker Company. MATERIALS AND METHODS: A cross-sectional study was performed on 200 Iranian male seafarers in 2015. A self-administered socio-demographic and Health Promotion Lifestyle Profile II (HPLP-II) questionnaire was completed. One-way analysis of variance was used to identify significant differences among the various departments. The t-test was utilised to compare the HPLP-II scores according to the demographic variables. Multiple linear regression analysis was performed to assess the association between demographic variables and the overall HPLP-II score, in addition to the six health-promoting lifestyle subscale scores. RESULTS: The mean age of the participants was 35.93 ± 9.51 years. Most of the seafarers were categorised as having a moderate (32%) or good lifestyle (61.5%). The mean lifestyle score was 136.14 ± 19.90, with the subscale spiritual growth showing the highest score (26.16 ± 5.03) and the subscale exercise behaviour showing the lowest score (19.95 ± 4.23). The lowest score for nutrition was found among the seafarers working in the engine department (engine: 20.41 ± 4.50, deck: 23.52 ± 4.97, and galley: 24.83 ± 4.64) (p < 0.05). Working in the engine department was found to have a significant negative effect on the nutrition score (B = -3.57, p < 0.05). Moreover, educational level was found to have a significant positive effect on spiritual growth (B = 2.97, p < 0.05). CONCLUSIONS: The findings suggest that health-related issues in this occupation, especially workers in the engine room, are a matter of concern.

Psycho-Socio-Cultural Determinants of Food Choice: A Qualitative Study on Adults in Social and Cultural Context of Iran.

Objective: Food choice is a process through which people think, feel, and eat food. It does not only influence individuals' health and well-being, families and communities, but also it has an effect on regional, national, and global levels. This qualitative study was conducted to explore perceptions and lived experiences of Tehran adult residents on psychological, social and cultural determinants of food choice. Method: In this qualitative design, we recruited 33 adults aged 30 to 64 years from various districts of Tehran, capital of Iran, and we explored how people make decisions about food choice in practice and shape their perception, attitude, and eating practices. An individual in-depth semi-structured interview guide included major questions with follow-up probes was used to explore participants' current and past eating habits from childhood to adulthood, dietary change at different life courses, and effective psychological state on food selection in different seasons. Results: This study revealed that food choice in the studied adults (30-64 years old) was widely influenced by psychological, social, and cultural determinants, which can be categorized into 5 main themes: cultural context and patterns; social Structure and norms; information resources and media; household and family structure; and nutrition transition. Conclusion: The findings clarified the importance of social and cultural contexts, which influence the food choice of adults in a metropolis like Tehran. Many of these concepts are contextualized from childhood. These findings could serve as guideline to design socio-culturally appropriate strategies and improve dietary behaviors of Iranians.

Concordance between self-reported body mass index with weight perception, self-rated health and appearance satisfaction in people living in Tehran.

BACKGROUND: Obesity is investigated as a health concern due to high prevalence in the world. Nowadays, researchers are looking for an indirect method to measure weight and height. Self-reported Body Mass Index (BMI) is ever more served as an alternative method for direct weight and height measurement. Misreporting is a usual concern in self-reported BMI, thus, this study set explored the association and degree of agreement of self-reported BMI with weight perception, Self-Rated Health (SRH), and appearance satisfaction in people living in Tehran, Iran. METHODS: 722 men and women (268 men and 454 women) aged 30-64 years were selected using Cluster Multi-stage Sampling with the Probability Proportional to Size (PPS) method from each area. The questionnaire included demographic and socioeconomic variables and self-reported weight and height and questions related to weight and health perception, and appearance satisfaction. Independent samples T-test compared the mean of scales and differences in characteristics between BMI categories, analyzed using chi-square test. The Cohen's kappa coefficient examined the association between self-reported BMI and weight perception, SRH, and appearance satisfaction. RESULTS: The mean self-reported weight was 80.79 ± 12.87 in men and 68.33 ± 11.53 in women. The results of the agreement analysis for weight perception were Kappa = 0.38 with p < 0.0001 for women and Kappa = 0.23 with p <0.0001 for men. This measure of agreement, while statistically significant, is fair agreement. SRH and appearance satisfaction were not significantly correlated with self-reported BMI. CONCLUSION: The measurements of height and weight can cause significant imprecisions in calculation of BMI, which is used as a guide for identifying persons at risk of disease. Direct measurement of height and weight should be performed whenever possible for optimal measurements in clinical practice and clinically oriented researches.