Gender Differential in the Association of Body Mass Index and Abdominal Obesity with Prehypertension and Hypertension in Iranian Adults

*Objective:* The aim of this study was to determine the gender differential in the relationship of body mass index (BMI) and abdominal obesity with blood pressure (BP) and prevalence of hypertension (HTN) and prehypertension (Pre-HTN) among the adult population of Iran.

*Design:* A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran.

*Subjects and Measurements:* Weight, height, waist circumference (WC), and systolic and diastolic BP of 45,082 men and 44,322 women aged 15-65 (mean 39.2) were measured. 

*Results:* The prevalence of HTN was 25.2% in men and 24.8% in women; and 50.1% of men and 39.1% of women were pre-hypertensive. WC and BMI were strongly associated with BP in both genders. Multivariate analysis revealed that both WC and BMI had the stronger association with HTN and Pre-HTN in men than women. Compared to men and women with normal weight, the multivariate-adjusted odds ratio (OR) (95% confidence interval) of HTN was 5.75 (5.13, 6.44) for men and 4.29 (3.95, 4.66) for women with BMI ≥ 30. The multivariate OR of prevalence HTN in men with abdominal obesity compared with men without was 3.76 (3.41, 4.22) and in women, 2.92 (2.73, 3.13).

*Conclusion:* These data indicate that both BMI and WC had the stronger association with HTN and Pre-HTN in men than women. 
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HIV prevalence and related risk behaviours among female sex workers in Iran: results of the national biobehavioural survey, 2010

Objectives To determine the prevalence of HIV and related behavioural risks among Iranian female sex workers (FSW) via the first national biobehavioural surveillance survey. Methods In 2010, 1005 FSW were approached and 872 recruited using facility-based sampling from 21 sites in 14 cities in Iran. We collected dried blood samples and conducted face-to-face interviews using a standardised questionnaire. Data were weighted based on the response rate and adjusted for the clustering effect of the sampling site. Adjustment was performed by weighting based on the sampling fraction of each site using a prior estimate of its total size of the FSW population. Results The prevalence of HIV infection (95% CI) was 4.5% (2.4 to 8.3) overall, 4.8% (2.2 to 9.8) among those who had reported a history of drug use and 11.2% (5.4 to 21.5) among those who had a history of injection drug use. The frequencies of condom use in the last sexual act with paying clients and non-paying partners were 57.1% and 36.3%, respectively. Any drug use was reported by 73.8% of participants, and among this subgroup, 20.5% had a history of injection drug use. Conclusions The prevalence of HIV was considerable among FSW particularly those who had a history of drug injection. A combination of prevention efforts addressing unsafe sex and injection are needed to prevent further transmission of HIV infection

Health care-associated infections, including device-associated infections, and antimicrobial resistance in Iran: The national update for 2018

Introduction. Surveillance of health care-associated infections (HAIs) is an essential part of an efficient healthcare system. This study is an update on incidence and mortality rates of HAIs in Iran in 2018. Methods. Almost all hospitals across the country (940 hospitals) entered the data of HAIs and denominators to the Iranian Nosocomial Infections Surveillance (INIS) software. Statistics were derived from INIS. Results. From 9,607,213 hospitalized patients, 127,953 suffered from HAI, 15.65% of whom died. The incidence rate of HAI was calculated as 4.2 per 1000 patient-days. Considering relative frequencies among HAIs, Pneumonia (29.1%) and UTIs (25.6%) were the most common types of infection. Ventilator-associated pneumonia (VAP) was the most frequent device-associated infection (DAI) 25.66 per 1000 ventilator-days, and had the highest mortality rate (43.08%). Incidence density of other DAIs was 5.43 for catheter-associated UTI and 2.86 for catheter-associated BSI per 1000 device-days. Medical ICUs had the highest incidence and percentage of deaths (15.35% and 37.63%, respectively). The most causative organisms were Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumonia. The rate of methicillin-resistance Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria was about 49%, 57%, and 58% respectively. Conclusion. The findings indicate that HAIs in Iran require special attention, and further studies are needed to evaluate them more accurately, identify risk factors and preventive interventions

Needle and syringe sharing practices of injecting drug users participating in an outreach HIV prevention program in Tehran, Iran: A cross-sectional study

HIV infection rates have reached epidemic proportions amongst injecting drug users (IDUs) in Iran. Although a number of community-based interventions have being implemented in the country, there is little information on the risk behaviors of IDU participants in these programs. This cross-sectional report aimed to compare the risk behaviors of injecting drug users with differential exposure rates to an HIV outreach program in Tehran, Iran. Results indicated that shared use of needle/syringe in the past month was significantly lower among IDUs who received estimated ≥ 7 syringes per week than those who did not [adjusted odds ratio (OR) = 14.36, 95% confidence interval (CI) 2.30–89.56]. While the effectiveness of this outreach program needs further evaluation through a longitudinal investigation, our preliminary findings suggest that the outreach program in Tehran may have been beneficial in reducing direct sharing among those who received more than several needles/syringes from the program

Blood pressure percentiles by age and body mass index for adults

Since no comprehensive study has been conducted on blood pressure (BP) percentiles established upon nationally representative sample population of adults, the present study aimed to construct the blood pressure percentiles by age, sex and body mass index (BMI) of the subjects. Analyses were based on data collected in 2011 from 8,425 adults aged 25 to 69 years old. Data on demographic characteristics, anthropometric measurements, and blood pressure was recorded for each subject. Linear Regression analysis was used to assess the adjusted relationship of age-sex-specific standard deviation scores of BMI, height, and weight with blood pressure. Four separate models for systolic blood pressure (SBP) and diastolic blood pressure (DBP) of men and women were constructed for BP percentiles according to age and BMI. Blood pressure increased with the rise in BMI and weight, but showed a negative correlation with height. SBP and DBP rose steadily with increasing age, but the rise in SBP was greater than DBP. Overweight and obese population, seem to fall into the category of hypertensive. The findings of present study show that BP percentiles are steadily increased by age and BMI. In addition, most obese or overweight adults are hypertensive

Distributions of High-Sensitivity C-Reactive Protein, Total Cholesterol-HDL Ratio and 10-Year Cardiovascular Risk: National Population-Based Study

The present study aimed to evaluate the distributions of High-Sensitivity C-reactive protein, TC-HDL ratio and 10-year risk of cardiovascular diseases among Iranian adult population. We conducted a cross-sectional study on a total of 2125 adults aged 25 to 65. Data of the Third National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) was used. Anthropometric indices, blood pressure and biochemical measurements had been obtained. Ten-year risk of cardiovascular events was also calculated using different models. Median (interquartile range) and geometric means (95% CI) of hs-CRP were 5.1(3.9) and 4.1(4.38-4.85), respectively. Mean TC-HDL ratio±(SD) was 5.94±2.84 in men and 5.37±1.97 in women (P<0.001). In spite of risk scores (FRS and SCORE), no significant gender and age-related differences were observed in hs-CRP levels. Exclusion of CRP levels≥10 did not change the results. The proportion of high-risk categories using SCORE and FRS models were 3.6 % and 8.8 %, respectively. In comparison with other published data, greater means and median values of High-Sensitivity C-reactive protein were observed. Higher TC-HDL ratio and cardiovascular risk in men than in women were also demonstrated. The issue of screening for cardiovascular diseases has yet to be addressed due to considerable prevalence of elevated CRP and increased risk of cardiovascular events among various subgroups

Estimating the Annual Risk of Tuberculosis Infection and Disease in Southeast of Iran Using the Bayesian Mixture Method

Background: Tuberculosis is still a public health concern in Iran. The main challenge in monitoring epidemiological status of tuberculosis is to estimate its incidence accurately. Objectives: We used a newly developed approach to estimate the incidence of tuberculosis in Sistan, an endemic area in southeast of Iran in 2012-13. Patients and Methods: This cross-sectional study was conducted on school children aged 6-9 years. We estimated a required sample size of 6350. Study participants were selected using stratified two-stage cluster sampling method and recruited in a tuberculin skin test survey. Indurations were assessed after 72 hours of the injection and their distributions were plotted. Prevalence and annual risk of tuberculosis infection (ARTI) were estimated using the Bayesian mixture model and some traditional methods. The incidence of active disease was calculated using the Markov Chain Monte Carlo technique. Results: We assumed weibull, normal and normal as the best distributions for indurations due to atypical reactions, BCG (Bacillus Calmette–Guérin) reactions and Mycobacterium tuberculosis infection, respectively. The estimated infection prevalence and ARTI were 3.6% (95%CI: 3.1, 4.1) and 0.48%, respectively. These estimates were lower than those obtained from the traditional methods. The incidence of active tuberculosis was estimated as 107 (87-149) per 100000 population with a CDR of 54% (40%-68%). Conclusions: Although the mixture model showed slightly lower estimates than the traditional methods, it seems that this method might generate more accurate results for deep exploration of tuberculosis endemicity. Besides, we found that Sistan is a high endemic area for tuberculosis in Iran with a low case detection rate

Protocol Design for Large–Scale Cross–Sectional Studies of Surveillance of Risk Factors of Non–Communicable Diseases in Iran: STEPs 2016

INTRODUCTION: The rise in non-communicable diseases (NCDs) has gained increasing attention. There is a great need for reliable data to address such problems. Here, we describe the development of a comprehensive set of executive and scientific protocols and instructions of STEPs 2016. METHODS/DESIGN: This is a large-scale cross-sectional study of Surveillance of Risk Factors of NCDs in Iran. Through systematic proportional to size cluster random sampling, 31,050 participants enrolled in three sequential processes, of completing questionnaires; physical measurements, and lab assessment. RESULTS: Out of 429 districts, samples were taken from urban and rural areas of 389 districts. After applying sampling weight to the samples, comparing the distribution of population and samples, compared classification was determined in accordance with the age and sex groups. Out of 31,050 expected participants, 30,541 participant completed questionnaires (52.31% female). For physical measurements and lab assessment, the cases included 30,042 (52.38% female) and 19,778 (54.04% female), respectively. DISCUSSION: There is an urgent need to focus on reviewing trend analyses of NCDs.To the best of our knowledge, the present study is the first comprehensive experience on systematic electronic national survey. The results could be also used for future complementary studies

Third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) in Iran: methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia

<p>Abstract</p> <p>Background</p> <p>The burden of non-communicable diseases is rising globally. This trend seems to be faster in developing countries of the Middle East. In this study, we presented the latest prevalence rates of a number of important non-communicable diseases and their risk factors in the Iranian population.</p> <p>Methods</p> <p>The results of this study are extracted from the third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007), conducted in 2007. A total of 5,287 Iranian citizens, aged 15–64 years, were included in this survey. Interviewer-administered questionnaires were applied to collect the data of participants including the demographics, diet, physical activity, smoking, history of hypertension, and history of diabetes. Anthropometric characteristics were measured and serum biochemistry profiles were determined on venous blood samples. Diabetes (fasting plasma glucose ≥ 126 mg/dl), hypertension (systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or use of anti-hypertensive drugs), dyslipidemia (hypertriglyceridemia: triglycerides ≥ 150 mg/dl, hypercholesterolemia: total cholesterol ≥ 200 mg/dl), obesity (body mass index ≥ 30 kg/m²), and central obesity (waist circumference ≥ 80 cm in females and ≥ 94 cm in males) were identified and the national prevalence rates were estimated.</p> <p>Results</p> <p>The prevalence of diabetes, hypertension, obesity, and central obesity was 8.7% (95%CI = 7.4–10.2%), 26.6% (95%CI = 24.4–28.9%), 22.3% (95%CI = 20.2–24.5%), and 53.6% (95%CI = 50.4–56.8%), respectively. The prevalence of hypertriglyceridemia and hypercholesterolemia was 36.4% (95%CI = 34.1–38.9%) and 42.9% (95%CI = 40.4–45.4%), respectively. All of the mentioned prevalence rates were higher among females (except hypertriglyceridemia) and urban residents.</p> <p>Conclusion</p> <p>We documented a strikingly high prevalence of a number of chronic non-communicable diseases and their risk factors among Iranian adults. Urgent preventive interventions should be implemented to combat the growing public health problems in Iran.</p

Qualitative study of HIV related stigma and discrimination: What women say in Iran

Introduction: HIV-related stigma is a major social problem of people living with HIV. Stigma against these people, especially women, interferes with the prevention, diagnosis and treatment of HIV. This study examined the experiences of HIV infected women who were stigmatized, as well as the strategies used to tackle the issue. Methods: Twenty-five women living with HIV were examined using in-depth, semi-structured interviews. The data obtained was analyzed using content analysis method in MAXQDA10. Results: The finding of this study was classified into four themes: fear, shame, rejection by family or friends and feelings of frustration. The participant strategies adopted to the perceived stigma and discrimination included isolation, nondisclosure, and loss of follow-up. Conclusions: HIV in women has different social interposition. It is necessary to intervene, so as to alleviate the effect of stigma on HIV infected women, in order that they gain the ability to accomplish wellness, increase life span and improve quality of life. Nurses, midwives and other professionals need to be involved to ensure public policy in providing supportive environments, and decrease stigma