National and subnational mortality effects of metabolic risk factors and smoking in Iran: a comparative risk assessment

<p>Abstract</p> <p>Background</p> <p>Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC), and high body mass index (BMI) on mortality and life expectancy, nationally and subnationally, using representative data and comparable methods.</p> <p>Methods</p> <p>We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease-specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework.</p> <p>Results</p> <p>In 2005, high SBP was responsible for 41,000 (95% uncertainty interval: 38,000, 44,000) deaths in men and 39,000 (36,000, 42,000) deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years (2.6, 3.9) and 4.1 years (3.2, 4.9) in men and women, respectively; the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions.</p> <p>Discussion</p> <p>Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran. Interventions for other metabolic risk factors and smoking can also improve population health.</p

The First Epidemic and New-emerging Human Fascioliasis in Kermanshah (Western Iran) and a Ten-year Follow Up, 1998-2008

Background: Fascioliasis is one of the most common zoonotic diseases in Iran and other parts of the world. Although the largest epidemic of this disease has occurred in northern provinces of Iran (Guilan) during the past two decades and a few cases have also been reported in Tehran and the other provinces, there has been no evidence of its′ occurrence in western provinces of Iran such as Kermanshah before the outbreak which is being reported. Methods: The study was conducted by teamwork of infectious disease specialist, parasitologist, general practitioner, entomologist, and laboratory technician. It is an "epidemic investigation" and a cross sectional descriptive one. Clinical data and para-clinical changes are recorded considering all of the population of a village in Kangavar, one of the suburbs of Kermanshah (western Iran). Results: The mean age was 21.65, (SD=12.44). Fifty three percent were female, and all of them were farmers. Eighty two percent had a history of watercress ingestion in a period of 1-2 months before the admission and 18% consumed other vegetables. The average of eosinophils was 32.35% (SD=26). The patients′ Enzyme Linked Immunosorbent Assay (ELISA) and Counter Current Immuno-electrophoresis (CCIE) serological tests were reported positive by the department of parasitology, Pasteur Institute of Iran. Treatment response to triclabendazole was excellent. A ten-year clinical and laboratory follow-up revealed no evidence of abnormality in treated patients. Conclusions: It was the first case of human fascioliasis in west Iran and was a real epidemic and an emerging infectious disease for this area at that time. The clinical symptoms were less severe compared with other reports. Health education to inhabitants and health care workers can lead to rapid detection of such outbreaks