Mojgan Padyab

Sustainability of a well-monitored salt iodization program in Iran: Marked reduction in goiter prevalence and eventual normalization of urinary iodine concentrations without alteration in iodine content of salt

Objective: Two yr after legislation of salt iodization of 40 parts per million (ppm) in 1994, goiter was still endemic and urinary iodine concentration (UIC) remained elevated in many provinces of Iran. Goiter prevalence and UIC were compared 2 and 7 yr after sustained consumption of uniformly iodized salt by Iranian households. Methods: Schoolchildren (7–10 yr) of all provinces were randomly selected by cluster sampling from December 2000 to June 2001. Goiter rate, UIC, and household salt iodine values were compared to those in 1996. Factory salt iodine was also compared in 2001 vs 1996. Ultrasonographically determined thyroid volumes of 7–10 yr old children were compared in 2001 vs 1999. Results: In 2001 (no.=33600) vs 1996 (no.=36178), total, grade 1, and grade 2 goiter rates were 13.9 vs 53.8%, 11.0 vs 44.8%, and 2.9 vs 9.0%, respectively (p<0.0001). Weighted total goiter rate was 9.8% in 2001. Median (range) UIC in 2001 (no.=3329) was 165 (18–499) μg/l and in 1996 (no.=2917) was 205 (10–2300) μg/l (p<0.0001). In 2001 vs 1996, mean±SD for iodine salt content was 32.7±10.1 vs 33.0±10.2 ppm (p=0.68) in households and was 33.2±13.4 and 33.8±13.2 ppm (p=0.57) in factories, respectively. Among 7–10 yr old children in 2001 (no.=400) vs 1999 (no.=396), only 7-yr-old children in 2001 (the only group with probably no history of iodine deficiency) showed significant smaller thyroid volumes by ultrasonography compared to those in 1999. Conclusions: After 7 yr of optimized iodized-salt supplementation in Iran, adequate UIC values and marked reduction in goiter rate have been achieved.

Early initiation of antiretroviral therapy results in decreased morbidity and mortality among patients with TB and HIV

IntroductionThe overlapping drug toxicity profiles, drug-drug interactions and complications of management of both HIV and tuberculosis (TB) in patients with advanced HIV have not been fully delineated.MethodsWe conducted a retrospective chart review of the outcomes of tuberculosis treatment among 69 HIV-infected patients with TB, who were hospitalized in Masih Daneshvari Hospital in Tehran, Iran between 2002 and 2006, and who received standard category 1 (CAT-1) regimens. Group I (N = 47) included those treated from 2002 to 2005 with highly active antiretroviral therapy (HAART) initiated after eight weeks of TB treatment for those whose CD4 count was <200 cells/mm3. Group II (N = 22) included TB patients treated from 2005 to 2006, with HAART initiated after two weeks of TB treatment if their CD4 count was <100 cells/mm3 and eight weeks after initiation of TB treatment for those whose CD4 count was between 101 and 200 cells/mm3.ResultsThere were no differences between Groups I and II with regard to: adverse drug reactions [four (8.5%) versus two (9%), p = ns]; IRIS [six (12.7%) versus three (10.7%), p = ns]; and new opportunistic infections [eight (17.0%) versus two (9.1%), p = ns]. Death, however, occurred more frequently in Group I than in Group II [13 (27.7%) versus (4.5%), p = 0.03], where HAART was initiated earlier. Injection of drugs was the most common route of HIV transmission in both groups (72.3% in Group I and 77.3% in Group II).ConclusionThis manuscript shows that in a retrospective review of HIV/TB patients hospitalized in Tehran, improved survival was associated with earlier initiation of antiretroviral therapy in HIV/TB patients with CD4 counts of below 100 cells/mm3.

Is migration to Sweden associated with increased prevalence of risk factors for cardiovascular disease

Bakground The proportion of elderly immigrants in Sweden is increasing. This is an important issue considering that the prevalence of cardiovascular disease (CVD) is a global health problem and that CVD is one of the main causes of morbidity among the elderly. The aim of this study is to analyze whether there is an association between migration status, that is being an elderly Iranian immigrant in Sweden, as compared with being an elderly Iranian in Iran, and the prevalence of risk factors for CVD. Design Population-based cross-sectional study with face-to-face interviews. Participants and setting A total of 176 Iranians in Stockholm and 300 Iranians in Tehran, aged 60-84 years. Methods The prevalence of general obesity, abdominal obesity, hypertension, smoking, and diabetes was determined. Unconditional logistic regression analysis was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes. Results The age-adjusted risk of hypertension and smoking was higher in Iranian women and men in Sweden. OR for hypertension was 1.9 (95% CI: 1.1-3.2) for women and 3.1 (95% CI: 1.5-6.3) for men and OR for smoking was 6.9 (95% CI: 2.2-21.6) for women and 4.7 (95% CI: 2.0-11.0) for men. The higher risk for hypertension and smoking remained significant after accounting for age, socioeconomic status, and marital status. Abdominal obesity was found in nearly 80% of the women in both groups. Conclusion The findings show a strong association between migration status and the prevalence of hypertension and smoking. Major recommendation for public health is increased awareness of CVD risk factors among elderly immigrants.

Prevalence of burnout and associations with psychosocial work environment, physical strain, and stress of conscience among Swedish female and male police personnel

Focus of this study was to investigate prevalence of burnout and relation to psychosocial work environment, physical strain, and stress of conscience amongst female and male police personnel in Sweden. The questionnaire was answered by 856 (55%) patrolling police officers, 437 (56%) women vs. 419 (53%) men. Prevalence and mean values for emotional exhaustion (EE) and depersonalization (DP) was higher in our study compared to other studies including police personnel in Norway and the Netherlands. A multiple logistic regressions showed that for women stress of conscience, high demand, and organizational climate was significant associated with EE, for men it was stress of conscience, decision, and high demand. For DP only stress of conscience contributed statistically significant in our model, respectively, of gender. Further research is needed to develop interventions aiming to reduce levels of burnout among police personnel in Sweden.

Temporal Changes in Anthropometric Parameters and Lipid Profile according to Body Mass Index among an Adult Iranian Urban Population

Aims: To examine changes in anthropometric parameters and lipid profiles over a period of 3.6 years in an Iranian adult population according to body mass index (BMI) groups. Methods: Between 1998 and 2001 (phase 1) and 2002 and 2005 (phase 2), 5,618 nondiabetic Iranian adults aged ≧20 years were examined. Analysis of covariance was used to delineate trends in anthropometric parameters as well as total and low- and high-density lipoprotein cholesterol (TC, LDL-C and HDL-C, respectively) across BMI groups. Results: Although BMI increased in women, this increase was not significant in obese persons. Among the men, however, a significant increase in BMI was observed only in lean persons. Waist circumference (WC) increased across all BMI groups in both sexes. A significant decrease was observed in TC [men: –0.83 mmol/l, 95% confidence interval (CI) –1.27 to –0.40; women: –0.78 mmol/l, CI –0.97 to –0.60] and LDL-C (men: –0.63 mmol/l, CI –1.13 to –0.13; women: –0.51 mmol/l, CI –0.78 to –0.24). A significant decrease in mean HDL-C was observed only among men (–0.09 mmol/l, CI –0.13 to –0.04), with no difference among BMI groups (p = 0.3). There were no significant decreases in TC/HDL-C and LDL-C/HDL-C ratios in men or women. Conclusions: Despite an increase in WC, favorable trends were observed in TC and LDL-C levels. The favorable trend in TC levels was counterbalanced by changes in HDL-C, as reflected by the absence of a significant decrease in TC/HDL-C or LDL-C/HDL-C.

The metabolic syndrome and incident diabetes : Assessment of alternative definitions of the metabolic syndrome in an Iranian urban population

AIMS To compare the ability of definitions of Metabolic Syndrome (MetS) in the prediction of type 2 diabetes. METHODS We examined 4756 subjects in an Iranian population who were non-diabetic at baseline. After 3.6 years, 188 individuals developed diabetes. RESULTS Impaired glucose tolerance (IGT) and MetS definitions predicted type 2 diabetes with odds ratios ranging from 3.7 to 11.9 (all P<0.05) although IGT had the highest area under the receiver operator characteristic (aROC) curve than all the MetS definitions. Reduction of glucose in the National Cholesterol Education Program (NCEP) definition of the MetS increased diabetes prediction, but adding the family history of diabetes did not change aROC curves. The International Diabetes Federation (IDF) definition had the highest sensitivity and false positive rate (72.2 and 35.1%, respectively) and the WHO definition had the lowest ones (54.8 and 9.2%, respectively) for predicting diabetes. The positive predictive values of all definitions were low (8.6-19.7%) but their negative predictive values were around 98%. CONCLUSIONS In Iranian population, the MetS was inferior to IGT for predicting type 2 diabetes. The NCEP definition of the MetS with reduced level of glucose (not including the family history of diabetes) and IDF definition predicted type 2 diabetes at least as well as WHO definition.

Socioeconomic inequalities and body mass index in Västerbotten County, Sweden: a longitudinal study of life course influences over two decades

IntroductionLife course socioeconomic inequalities in heart disease, stroke and all-cause mortality are well studied in Sweden. However, few studies have sought to explain the mechanism for such associations mainly due to lack of longitudinal data with multiple measures of socioeconomic status (SES) across the life course. Given the population health concern about how socioeconomic inequality is related to poorer health, we aim to tackle obesity as one of the prime suspects that could explain the association between SES inequality and cardiovascular disease and consequently premature death. The aim of this study is to test which life course model best describes the association between socioeconomic disadvantage and obesity among 60 year old inhabitants of Västerbotten County in Northern Sweden.MethodsA birth cohort consisting of 3340 individuals born between 1930 and 1932 was studied. Body mass index (BMI) at the age of 60 and information on socioeconomic status at three stages of life (ages 40, 50, and 60 years) was collected. Independent samples t-test was used to compare BMI between advantaged and disadvantaged groups and one-way ANOVA was used to compare BMI among eight SES trajectories. We applied a structured modeling approach to examine three different hypothesized life course SES models (accumulation, critical period, and social mobility) in relation to BMI.ResultsWe found sex differences in the way that late adulthood socioeconomic disadvantage is associated with BMI among inhabitants of Northern Sweden. Our study suggests that social adversity in all stages of late adulthood is a particularly important indicator for addressing the social gradients in BMI among women in Northern Sweden and that unhealthy behaviors in terms of smoking and physical inactivity are insufficient to explain the relationships between social and lifestyle inequalities and BMI.ConclusionIn order for local authorities to develop informed preventive efforts, we suggest further research to identify modifiable risk factors across the life course which could explain this health inequality.

SMOKING PRACTICES AND RISK AWARENESS IN PARENTS REGARDING PASSIVE SMOKE EXPOSURE OF THEIR PRESCHOOL CHILDREN: A CROSS-SECTIONAL STUDY IN TEHRAN

BACKGROUND Young children living with parents who smoke are exposed to unacceptable health hazards. AIM To determine patterns of parental smoking, the level of parental awareness about hazards of secondhand smoke, and the effect of risk awareness on smoking behavior. SETTING Health centers affiliated with two teaching hospitals in Tehran. DESIGN Cross-sectional. MATERIALS AND METHODS Data was collected from parents of preschool children visiting the health centers, through face-to-face interview, during a period of 18 months. STATISTICAL ANALYSIS Data was analyzed by multiple logistic regression, and analysis of variance was done for comparison of means. RESULTS In a total of 647 families, prevalence of parental smoking was 35.7%, (231 families). In 97.8% of smoking families, only the fathers smoked; and in 5 (2.2%) families, both parents were regular smokers. Prevalence of smoking was higher in poor families as compared with families who were well-off (39% vs. 25%; P = 0.025), and also in families with lower educational level. There was no significant difference in risk awareness between smokers and nonsmokers (P > .05). CONCLUSION Low socioeconomic status and low education were identified as risk factors for childrens exposure to secondhand smoke; parental risk awareness had no apparent effect on the smoking behavior. Unlike western societies, fathers were the sole habitual smokers in most families. Since factors that influence smoking behavior vary in different cultures, interventional strategies that aim to protect children from the hazards of tobacco smoke need to target diverse issues in different ethnic backgrounds.

Seasonal variation of neonatal transient hyperthyrotropinemia in Tehran province, 1998-2005.

Seasonal aggregation and the monthly rate of neonatal transient hyperthyrotropinemia (THT) were assessed. From November 1998 to April 2005, neonates of gestational age ≥37 wks, birth weight 2500–4000 g, birth length 45–55 cm, and 1st min Apgar score >3, who had thyrotropin (TSH) ≥20 mU/L in their cord dried-blood specimen, but without congenital hypothyroidism, were enrolled in the study. The recall rate equals the rate of THT occurrence in this study. Of 47,945 neonates, 555 had THT (recall rate: 1.2%). The aggregated seasonal recall rate (recall for further assessment to rule out congenital hypothyroidism) was significantly higher in winter (January, February, and March) than the other seasons (p < .0001). Winter had higher recall rate in each year as compared to other seasons, but the overall rate of recalls decreased in 2001 and 2002. Excluding the first 6 months (due to erratic variations), the remaining 72 months revealed a relatively sinusoidal pattern in monthly recall rates; indeed, there was an initial 11-month high recall rates (1.7%), followed by a 33-month decrease (0.7%), a 19-month increase (1.9%), and a final 9-month decrease (0.8%). The recall rate of each of these time intervals was significantly different from that of the next time interval (p < .0001). The monthly recall rates were best fitted to cubic curve estimation and then autoregressive integrated moving average (ARIMA) (0, 1, 1) models. THT occurs significantly more in winter than in other seasons, and this suggests a possible role for time-varying factor(s) contributing to its seasonal preponderance. (Author correspondence: E-mail: arash_ordookhani@yahoo.com)

Epidemiology of Hypertension Stages in Two Countries in Sub-Sahara Africa: Factors Associated with Hypertension Stages

Studies using the revised hypertension classification are needed to better understand epidemiology of hypertension across full distribution. The sociodemographic, biological, and health behavior characteristics associated with different stages of hypertension in Ghana and South Africa (SA) were studied using global ageing and adult health (SAGE), WAVE 1 dataset. Blood pressure was assessed for a total of 7545 respondents, 2980 from SA and 4565 from Ghana. Hypertension was defined using JNC7 blood pressure classification considering previous diagnosis and treatment. Multivariate multinomial logistic regression analysis using Stata version 12 statistical software was done to identify independent predictors. The weighted prevalence of prehypertension and hypertension in Ghana was 30.7% and 42.4%, respectively, and that of SA was 29.4% and 46%, respectively, showing high burden. After adjusting for the independent variables, only age (OR = 1.32, 95% CI: 1.14–1.53), income (OR = 1.9, 95% CI: 1.04–3.47), and BMI (OR = 1.16, 95% CI: 1.1–1.22) remained independent predictors for stage 1 hypertension in Ghana, while, for SA, age (OR = 2.27, 95% CI: 1.53–3.36), sex (OR = 0.28, 95% CI: 0.08–1), and BMI (OR = 1.15, 95% CI: 1.07–1.25) were found to be independent predictors of stage 1 hypertension. Healthy lifestyle changes and policy measures are needed to promptly address these predictors.