Socioeconomic inequalities in prevalence, awareness, treatment and control of hypertension: evidence from the PERSIAN cohort study

Background Elevated blood pressure is associated with cardiovascular disease, stroke and chronic kidney disease. In this study, we examined the socioeconomic inequality and its related factors in prevalence, Awareness, Treatment and Control (ATC) of hypertension (HTN) in Iran. Method The study used data from the recruitment phase of The Prospective Epidemiological Research Studies in IrAN (PERSIAN). A sample of 162,842 adults aged > = 35 years was analyzed. HTN was defined according to the Joint National Committee)JNC-7(. socioeconomic inequality was measured using concentration index (Cn) and curve. Results The mean age of participants was 49.38(SD = +/- 9.14) years and 44.74% of the them were men. The prevalence of HTN in the total population was 22.3%(95% CI: 20.6%; 24.1%), and 18.8%(95% CI: 16.8%; 20.9%) and 25.2%(95% CI: 24.2%; 27.7%) in men and women, respectively. The percentage of awareness treatment and control among individuals with HTN were 77.5%(95% CI: 73.3%; 81.8%), 82.2%(95% CI: 70.2%; 81.6%) and 75.9%(95% CI: 70.2%; 81.6%), respectively. The Cn for prevalence of HTN was -0.084. Two factors, age (58.46%) and wealth (32.40%), contributed most to the socioeconomic inequality in the prevalence of HTN. Conclusion The prevalence of HTN was higher among low-SES individuals, who also showed higher levels of awareness. However, treatment and control of HTN were more concentrated among those who had higher levels of SES, indicating that people at a higher risk of adverse event related to HTN (the low SES individuals) are not benefiting from the advantage of treatment and control of HTN. Such a gap between diagnosis (prevalence) and control (treatment and control) of HTN needs to be addressed by public health policymakers

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Assessment of background gamma radiation and determination of excess lifetime cancer risk in Sabzevar City, Iran in 2014

Background: Background gamma radiation levels vary in different locations and depended on many factors such as radiation properties of soil, building materials as well as construction types which human lives on it. People are always exposed to ionizing radiation, which could badly influence their health. The aim of this study was to evaluate the background gamma-ray dose rate and the estimated annual effective dose equivalent and determination of excess lifetime cancer risk in Sabzevar City, Iran. Methods: The aim of this cross-sectional study was to determine the dose rate of background gamma radiation in outdoor an indoor areas, 26 stations were selected using the map of the Sabzevar City. The amount of gamma radiation was measured at 4 months (September to January) in 2014 year. The dosimeter used in this study was a survey meter, that is designed for monitoring radiation of x, gamma and beta rays. Results: The obtained results show that there are significant differences between the indoor and outdoor exposures (P> 0.05). We did not observe significant differences between the time of sampling and sampling locations, (P<0.05). The minimum and maximum values of dose rate were found 66±20 nSvh-1 and 198±28 nSvh-1. The annual effective dose for Sabzevar residents was estimated to be 0.85 mSv and also the amount of excess lifetime cancer risk was estimated 3.39×10-3. Conclusion: According to the results, the excess lifetime cancer risk and the annual effective dose for the Sabzavar City residents due to the background gamma radiation was higher than the global average (0.5 mSv). The epidemiological studies have been proposed to evaluate the risk of chronic diseases associated with natural radiation exposure among residents

Measurement and monitoring of anions, cations and metals in landfill leachate in Iranian metropolises

Leachate generation is a major problem for municipal solid waste (MSW) landfills and causes significant threat to surface and groundwater. Samples were collected from the landfills of Iranian metropolises (Ahwaz, Mashhad, Tehran (before and after treatment plant), Isfahan, Tabriz, Hamedan, Rasht, Sanandaj and Qazvin) based on the standard sampling methods and transferred to the laboratory. Cr, Cd, Hg, Pb, Ni, As, Ca, Mg, Fe, Mn, Na, K, Zn, Al, Ba, Li, Sr, Ti and V were analyzed. The pH values for the ten leachate samples obtained from 4.57 to 8.95. The results showed the amount of some metals in Iranian landfill sites higher than the DOE standards for agricultural irrigation and surface water. Keywords: Selected Iranian metropolises, Landfill leachates, Heavy metal

Survey of water quality in Moradbeik river basis on WQI index by GIS

Background: Survey of pollution and evaluation of water quality in rivers with Oregon Water Quality Index (OWQI) and GIS are effective tools for management of the impact of environmental water resources. The information in calculating the WQI of Moradbeikriver allowed us to take our tests results and make a scientific conclusion about the quality of water. GIS can be a powerful tool for developing solutions for water resources problems for assessing water quality, determining water availability, preventing flooding, understanding the natural environment, and managing water resources on a local or regional scale. Methods: The WQI of Moradbeikriver consists of nine tests: Fecal Coliform (FC), Biochemical Oxygen Demand (BOD5), Nitrates (NO3), Total Phosphate (PO4), pH, temperature, Dissolved Oxygen (DO), turbidity, and Total Solid (TS). Water quality of Moradbeikriver was investigated for 12 months. Concentrations of these nine variables were normalized on a scale from 0 to 100 and translated into statements of water quality (excellent, good, regular, fair, and poor). Also this data were analyzed with WQI index, and then river basis on water quality was zoning by GIS. Results: The average of WQI was 61.62, which corresponded to ‘‘medium’’ quality water at the sampling point 1 (best station) and decreased to around 26.41 (bad quality) at sampling point 6. The association between sampling points and water quality indexes was statistically significant (P<0.05). Conclusion: Based on physical, chemical and biological agent monitoring and also with control of water quality indexes of these points, we observed wastewater and other river pollutants

Evaluation of noise level at intensive care units in selected hospitals of Sanandaj

Background: One of the critical unit in each hospital is intensive care unit (ICU). The United States’ Environmental Protection Agency (EPA) recommends to control the noise level of this unit in order to not exceed 45 decibels (dBA) during the day and 35 dBA at night. In this study, our goal was to evaluate the noise level at adult and neonatal ICUs at some Sanandaj’s hospitals, Iran. Methods: This cross-sectional study was conducted from May 4th to June 4th 2012 in adult and neonatal intensive care units at three major hospitals in Sanandaj (Besat, Tohid and Tamin-Ejtemaei). In order to assess the noise level properly, measurements obtained during the days and nights. At a given day, a unit was selected randomly and measurement of sound levels obtained successively within two-hour periods. The noise levels were measured in decibels using a sound level meter (SLM). This process took four weeks to be completed (one week per unit). In the end of study, the total of 336 records of noise levels were obtained. Descriptive analysis as well as fitting a mixed effect models were used to interpret collected observations. All statistical analysis performed using R developed by R core team. Results: The preliminary analysis of observations showed that mean level of noise varied from 65 to 71 dBA among ICUs under study. Noise levels during the day were slightly higher than that of were observed during the night. Descriptive analysis of observations showed no major differences between the noise levels over the time and between the days/nights. Fitting a mixed-effects model showed significant differences of the noise levels between ICUs (P< 0.001). Conclusion: We found the noise levels were always above the EPA thresholds at all three hospitals both during the day and night. It is recommended to train hospital officials and staffs for keeping noise levels to an acceptable level