Mortality-related factors disparity among Iranian deceased children aged 1-59 months according to the medical activities in emergency units: National mortality surveillance system

Background: To determine disparity in mortality-related factors in 1-59 months children across Iran using hospital records of emergency units. Materials and Methods: After designing and validating a national questionnaire for mortality data collection of children 1-59 months, all 40 medical universities has been asked to fill in the questionnaires and return to the main researcher in the Ministry of Health and Medical Education. Age and sex of deceased children, the type of health center, staying more than 2 h in emergency unit, the reason of prolonged stay in emergency, having emergency (risk) signs, vaccination, need to blood transfusion, need to electroshock and so on have also been collected across the country. There was also a comparison of children based on their BMI. Chi-square test has been applied for nominal and ordinal variables. ANOVA and t-student test have been used for measuring the difference of continuous variables among groups. Results: Mortality in 1-59 months children was unequally distributed across Iran. The average month of entrance to hospital was June, the average day was 16th of month, and the average hour of entrance to hospital was 14:00. The average of month, day and hour for discharge was July, 16, and 14: 00, respectively. The hour of discharge was statistically significant between children with and without risk signs. More than half (54%) of patients had referred to educational hospital emergency units. There were no statistically significant differences between children with and without emergency signs. There were statistically significant differences between children with and without emergency signs in age less than 24 months (0.034), nutrition situation (P = 0.031), recommendation for referring (P = 0.013), access to electroshock facilities (P = 0.026), and having successful cardiopulmonary resuscitation (P = 0.01). Conclusion: This study is one of the first to show the distribution of the disparity of early childhood mortality-related factors within a developing country. Our results suggest that disparity in 1-59 months mortality based on hospital records in emergency units needs more attention by policy-makers. It is advisable to conduct provincially representative surveys to provide recent estimates of hospital access disparities in emergency units and to allow monitoring over time

Reference values for lipid profile in Iranian children and adolescents: The CASPIAN-V study

Background: We aimed to develop the age- A nd sex-specific reference values for lipid profile of Iranian pediatric population. Methods: Fasting lipid profiles of 3843 participants, aged 7 to 18 years, were extracted from a surveillance survey on Iranian children and adolescents living in 30 provinces across the country. Results: The mean (SD) age of participants was 12.3(3.1) years, and 52.3 of them were boys. Significant differences were observed between genders comparing the levels of triglyceride (TG) (P = 0.04), total cholesterol (TC) (P = 0.02), low-density lipoprotein-cholesterol (LDL-C) (P = 0.01), and non-high-density lipoprotein cholesterol (non-HDL-C) (P = 0.03). In both genders, TG levels increased with age in the 75th and higher percentiles. Among boys, TC showed a decreasing trend at all percentiles and all age groups. In girls, TC levels increased with age at all percentiles except for the 75th and 90th percentiles. Among boys, the levels of LDL-C and HDL-C decreased with age in all percentiles. However, LDL-C and HDL-C concentrations increased up to the 50th percentile in girls and then decreased with age. The non-HDL-C level decreased in the 50th and higher percentiles among boys and in the 90th and 95th percentiles among girls. The TG/HDL-C ratio increased with age at all percentiles in boys. In girls, TG/HDL-C ratio increased with age in the 50th and higher percentiles. Conclusions: Based on the observed differences, it seems necessary to determine age- A nd sex-specific cut-off values for lipid parameters of children and adolescents in different populations. © 2020 The Author(s)

Self-rated health and life satisfaction in iranian children and adolescents at the national and provincial level: The CASPIAN-IV study

Background: Self-rated health (SRH) and life satisfaction (LS) are of increasing interest to medical researchers, because of their close relationship with different aspects of health. Objectives: This paper describes the patterns of LS and SRH among Iranian children and adolescents, analyzed by sex and residence area, at the national and provincial levels. Methods: In this nationwide study 14880 students, aged 6-18 years, were selected by multistage random cluster sampling from urban and rural areas of 30 provinces in Iran, as part of the fourth survey of a national surveillance program conducted in 2011-2012. LS and SRH were assessed through a questionnaire following the World Health Organization-Global School-based Student Health Survey (WHO-GSHS) protocols. Results: 13486 out of 14880 invited students completed the study (participation rate: 90.6). Their average age was 12.47 ± 3.36 years. The prevalence of good SRH at national level was 80.13 (95 CI: 79.25, 80.99); the prevalence of LS among Iranian students at the national level was 80.17 (95 CI: 79.18, 81.13). At the provincial level, the highest and the lowest LS scores were 85.42 (80.01, 89.55) and 74.78 (68.74, 79.99), respectively. Likewise, the highest and the lowest prevalence of good SRH was 88.36 (83.99, 91.66) and 74.22 (69.06, 78.78), respectively. Conclusions: Our findings show that, at provincial levels, a complex set of known/unknown influencing factors affect individuals� assessments of their own health quality. Understanding these patterns of SRH and LS could be useful for better health policy and more targeted studies in this field. © 2016, Iranian Red Crescent Medical Journal

Association of some psychosocial factors with anthropometric measures in nationally representative sample of Iranian adolescents: The CASPIAN-III study

Background: During the last two decades, adolescent obesity has increased in western countries. In Iran-as a developing country- the prevalence of obesity is raised among youngsters as well. This study conducted to identify an association of adolescents' loneliness, self-confidence and relationship with others in home and school environment with their weight status. Methods: In this cross-sectional national survey, 5682 students aged 10-18 years from urban and rural districts of 27 provinces of Iran were selected via stratified multi-stage sampling method. Data on psychological problems of students was gathered through a questionnaire. Height, weight, and waist circumferences were measured according to standard protocols. Body mass index (BMI) and waist- to-height ratio was calculated. Results: Boys which did not have best friends, spend time with their friends after school or get acceptance from them, had higher BMI than others. Only girls who did not spend time with their friends had higher BMI (19.48 ± 4.28) vs. (19.09 ± 3.92) and WC (71.04 ± 21.29) vs. (69.15 ± 17.43) than others, P < 0.05. In both sexes, adolescents who had sense of pressure about doing homework or had difficulties in relationship with their parents had higher BMI and WC values. Girls who reported being victim of violent behaviors (being bullied), had lower BMI compared to others. Risk of being overweight and obese, but not abdominal obese was statistically higher in adolescents not having close friends (OR = 1.81, CI: 1.11-2.95). Lack of self-confidence increased only the risk of obesity in teens (OR = 1033, CI: 1.09-1.64). Conclusions: Our findings suggest that strategies for prevention of overweight and obesity in adolescent should be taking into account a deeper knowledge of psychosocial issues due to be able to design more effective programs for treating overweight teens. © 2016 Baygi et al

First report on the validity of a continuous Metabolic Syndrome score as an indicator for Metabolic Syndrome in a national sample of paediatric population - The CASPIAN-III study

Introduction: The aim of this study was to assess the validity of a continuous Metabolic Syndrome score (cMetS) in a nationally representative sample of Iranian children and to identify sex and age-specific optimal cut-off points of cMetS that are associated with MetS. Material and methods: This study was conducted among 3,254 schoolchildren aged 10-18 years. cMetS was derived by aggregating age and sex-standardised residuals of waist circumference (WC), mean arterial pressure (MAP), glucose, high density lipoprotein-cholesterol (HDL-C) and triglycerides (TG). To determine the optimal cut-off points of cMetS for predicting MetS, receiver operator characteristic (ROC) curve analysis was used with an estimation of the variables' sensitivity and specificity. Results: A graded relationship was documented between cMetS and the number of risk factors. Increasing mean values of cMetS with increasing numbers of components were apparent for both genders. The overall optimal cMetS cut-off point for predicting the presence of MetS was 2.93 sensitivity = 92%, specificity = 91%, area of the curve = 0.96 (0.95-0.97). The values for boys and girls were 2.97 and 3.26 respectively in the total study. Conclusion: This nationwide study confirmed the validity of the cMetS score in a population-based sample of Iranian children. cMetS appears to be an appropriate index for investigating the association between potential risk factors and MetS in epidemiological research in Iran

Generalized or abdominal obesity: Which one better identifies cardiometabolic risk factors among children and adolescents? The CASPIAN III study

Objectives: We investigated the association of generalized and abdominal obesity with cardiometabolic risk factors in children and adolescents. Methods: Data were obtained from a surveillance system entitled CASPIAN-III study in school students aged 10-18 years in Iran. Data of subjects with normal body mass index (BMI) or above (BMI≥5th percentile) were analyzed. The associations of obesity with cardiometabolic risk factors were tested using logistic regression models. Results: In the sample of 4641 children and adolescents, overweight/obese children were more likely to have metabolic syndrome and cardiometabolic risk factors compared with their normal weight counterparts. Among these parameters, elevated TG had the strongest association with degree of obesity (overweight: OR1/42.28 95% CI 1.59-3.26; obesity: OR1/45.63 95% CI 4.27,7.43). Combined generalized and abdominal obesity increased the risk of high blood pressure, elevated triglyceride and total cholesterol. Conclusions: Combined type of generalized and abdominal obesity is a predictor of cardiometabolic risk factors. © The Author 2014

Association of sleep duration and snack consumption in children and adolescents: The CASPIAN-V study

Objectives: The relationship between sleep deprivation and the risk of overweight and obesity is somewhat known in children and adolescents. This study aimed to investigate the relationship between sleep duration and eating snacks in a national sample of children and adolescents aged 6�18 years old. Methods: This cross-sectional study was carried out on the data of the fifth survey of the national school-based surveillance system entitled the �Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable Disease� (CASPIAN-V) study. Short sleeping duration was defined 10 hr per day for children under 10 years and 9 hr per day for children � 10 years. To assess food habits, the consumption frequency of some food groups including sweets, salty snacks, carbonated beverages, diet soft drinks, soft beer, fresh fruits, dried fruits, fresh juices, vegetables, packed juices, dairy products (milk, yogurt, and cheese), fast foods, tea, sugar along with tea, and coffee was asked using Likert scale (never, rarely, weekly, and daily). Results: In multivariate model, short sleep versus long sleep in students was associated with increased chance of eating salty snacks (OR = 1.49 95% CI: 1.38�1.61; p =.001), soft drinks (OR = 1.12 95% CI: 1.04�1.20; p =.002), fast foods (OR = 1.66 95% CI: 1.54�1.79; p <.001), tea (OR = 1.49 95% CI: 1.39�1.61; p <.001), and tea with sugar (OR = 1.13 95% CI: 1.05�1.22; p <.001). In addition, short sleep in students was associated with a decreased odds of daily intake of soft drinks without sugars (OR = 0.64 95% CI: 0.58�0.70; p <.001), soft beer (OR = 0.92 95% CI: 0.85�0.99; p <.001), fresh fruit (OR = 0.83 95% CI: 0.76�0.90; p <.001), dried fruit (OR = 0.43 95% CI: 0.39�0.46; p <.001), fresh fruit juice (OR = 0.66 95% CI: 0.62�0.72; p <.001), packed juice (OR = 0.91 95% CI: 0.84�0.98; p <.009), milk (OR = 0.51 95% CI: 0.47�0.55; p <.001), yogurt (OR = 0.86 95% CI: 0.79�0.93; p �.001), and coffee (OR = 0.82 95% CI: 0.76�0.89; p �.001). Conclusions: The findings of this study indicate a significant relationship between sleep duration and unhealthy food habits. Therefore, increasing awareness of families in this area may reduce obesity and its complications. © 2020 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc

Socioeconomic inequality in childhood obesity and its determinants: a Blinder�Oaxaca decomposition Desigualdade socioeconômica na obesidade infantil e seus determinantes: decomposição de Oaxaca-Blinder

Objective: Childhood obesity has become a priority health concern worldwide. Socioeconomic status is one of its main determinants. This study aimed to assess the socioeconomic inequality of obesity in children and adolescents at national and provincial levels in Iran. Methods: This multicenter cross-sectional study was conducted in 2011�2012, as part of a national school-based surveillance program performed in 40,000 students, aged 6�18-years, from urban and rural areas of 30 provinces of Iran. Using principle component analysis, the socioeconomic status of participants was categorized to quintiles. Socioeconomic status inequality in excess weight was estimated by calculating the prevalence of excess weight (i.e., overweight, generalized obesity, and abdominal obesity) across the socioeconomic status quintiles, the concentration index, and slope index of inequality. The determinants of this inequality were determined by the Oaxaca Blinder decomposition. Results: Overall, 36,529 students completed the study (response rate: 91.32); 50.79 of whom were boys and 74.23 were urban inhabitants. The mean (standard deviation) age was 12.14 (3.36) years. The prevalence of overweight, generalized obesity, and abdominal obesity was 11.51, 8.35, and 17.87, respectively. The SII for overweight, obesity and abdominal obesity was �0.1, �0.1 and �0.15, respectively. Concentration index for overweight, generalized obesity, and abdominal obesity was positive, which indicate inequality in favor of low socioeconomic status groups. Area of residence, family history of obesity, and age were the most contributing factors to the inequality of obesity prevalence observed between the highest and lowest socioeconomic status groups. Conclusion: This study provides considerable information on the high prevalence of excess weight in families with higher socioeconomic status at national and provincial levels. These findings can be used for international comparisons and for healthcare policies, improving their programming by considering differences at provincial levels. © 2017 Sociedade Brasileira de Pediatri

Health-related quality of life according to the socioeconomic status of living areas in Iranian children and adolescents: Weight disorders survey

Background: Health-related quality of life (HRQoL) has become a major concern in the field of children�s health research. We assessed HRQoL among Iranian children and adolescents according to the socioeconomic status (SES) of their living region. Methods: Via multistage cluster sampling from rural and urban school students aged 6 to 18 years, this nationwide study was conducted from 2011 to 2012. HRQoL was assessed using the adolescent core version of the Pediatric Quality of Life questionnaire. Through survey data analysis methods, the data were compared according to the SES of the living region, sex, and the living area. Results: Overall, 23043 students participated in the survey (participation rate=92.2). The mean age of the participants was 12.55±3.31 years. Boys accounted for 50.8 of the study population, and 73.4 were from urban areas. At national level, the mean of the HRQoL total score was 81.7 (95 CI: 81.3 to 82.1) with a mean of 83.5 (95 CI: 83.0 to 84.1) for the boys and 79.8 (95 CI: 79.1 to 80.5) for the girls. The highest and the lowest scores, respectively, belonged to social functioning (90.0 95% CI: 89.7 to 90.3) and emotional functioning (78.2 95% CI: 77.7 to 78.7). The highest total HRQoL score belonged to the second highest SES region of the country (mean=83.1; 95% CI: 82.5 to 83.7). The association between total HRQoL and the score of all the subscales and SES in the living area was statistically significant (P<0.001). Conclusion: The results of the present study showed that in the children and adolescents, SES was associated with HRQoL. Accordingly, HRQoL and the related SES differences should be considered one of the priorities in health research and health policy. © 2019, Shiraz University of Medical Sciences. All rights reserved