Different patterns of association between education and wealth with non-fatal myocardial infarction in Tehran, Iran: A population-based case-control study

Background: Myocardial Infarction (MI) is a main cause of death and disability worldwide, which involves a number of genetic, physiopathologic and socio-economic determinants. The aim of this study was to assess the patterns of association between education, wealth and some other risk factors with non-fatal MI in Tehran population. Methods: Data derived from a second round of large cross-sectional study, Urban HEART-2, conducted in Tehran in 2011. Out of 118542 participants, all 249 self-reported incident cases of nonfatal MI were selected as the case group. A number of 996, matched on age and sex, were selected as controls. Principle component analysis (PCA) was used to calculate wealth index and logistic regression model to assess relations between the study variables. Results: Mean (SD) age of participants was 60.25 (12.26) years. A total of 870 (69.9) of the study subjects were men. Education, wealth status, family violence, hypertension and diabetes were observed as independent predictors of non-fatal MI. Overall, as the level of education increased, the odds of non-fatal MI decreased (p<0.001). We observed an almost J-shaped association between wealth status and non-fatal MI. No significant associations were found between marital status, BMI and current smoking with non-fatal MI (p<0.05). Conclusion: We found different patterns of association between education and wealth with nonfatal MI among Tehran adults. Lower risk of non-fatal MI is linked to high educated groups whereas economically moderate group has the lowest risk of non-fatal MI occurrence

Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: Report of ongoing Iranian experience

Introduction: Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. Description of the project: Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. Lesson learned: A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country. © 2004 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved

The role of nitric oxide and prostaglandins in the effects of alcoholic Trigonella foenum-graecum seed extract on aortic reactivity in streptozotocin-diabetic rats

Background and the purpose of the study: Trigonella foenum-graecum (TFG) has demonstrated beneficial effects in both Insulin-dependen and non- Insulin-dependen diabetic animals. This study was conducted to evaluate the effects of the alcoholic seed extract of this plant on aortic reactivity and underlying mechanisms in streptozotocin-diabetic rats. Methods: Male Wistar rats were divided into control, extract-treated control, diabetic, and extract-treated diabetic groups. Diabetes was induced by a single i.p. injection of streptozotocin (STZ; 60 mg/kg). Treatment groups received TFG extract (200 mg/kg; i.p.) every other day for 1 month. Then, contractile responsiveness of thoracic aorta to KCl and noradrenaline (NA) and relaxation to acetylcholine (ACh) and sodium nitroprusside (SNP) was determined. For determination of the involvement of NO and prostaglandins in relaxation response to ACh, rings were incubated 30 min before the experiment with N(�)-nitro-L-arginine methyl ester (L-NAME) and/or indomethacin (INDO). Results: Diabetic state significantly increased maximum contractile responses to KCl and NA (p<0.01-0.005) and reduced maximum relaxation due to ACh (p<0.01) as compared to controls and treatment with TFG extract in diabetic group significantly improved these changes relative to untreated diabetic group (p<0.05). Meanwhile, pretreatment with L-NAME did not produce any significant change between diabetic and extract-treated diabetic groups. On the other hand, there was a significant difference in both of these two groups following pretreatment with INDO (p<0.01). Major conclusion: Intraperitoneal administration of alcoholic seed extract of TFG for one month could improve some functional indices of the vascular system in diabetic state and endothelium-derived prostaglandins are involved in this response

Dental pain and its determinants in an adult population in Tehran, Iran, Urban HEART-2

OBJECTIVE: To assess the prevalence of dental pain in the past year among adults in Tehran-Iran, and its determinants. BASIC RESEARCH DESIGN: Cross-sectional population study. PARTICIPANTS: A sample of 20,322 adults (18-64 years old). METHODS : A questionnaire survey was conducted across the 22 districts using the multi-stage random sampling method. Data were analysed applying the complex samples method. Multiple logistic regression analysis was used to adjust the effects of other variables on the outcome variable as dental pain in the past year. RESULTS : Overall, 19,645 individuals with a mean age of 39.9 (SD=12.5) years responded. Dental pain in the past year was reported by about one sixth (14) of subjects and associated with being widowed/divorced (OR 1.45, 95CI 1.07-1.97, p=0.016), married (OR 1.24, 95CI 1.04-1.47, p=0.016), Azari minority (OR 1.2, 95CI 1.05-1.37, p=0.009) and having dental visit in the past year (OR 2.6, 95CI 2.29-2.95,p�0.001). Older subjects (OR 0.76, 95CI 0.59-0.97, p= 0.029), those with a high economic status (OR 0.84, 95CI 0.72-0.98, p=0.03), good (OR 0.75, 95CI 0.58-0.96, p=0.023) or moderate oral health behaviour (OR 0.79, 95CI 0.62-0.99, p=0.042), and good self-perceived oral health (OR 0.52, 95CI 0.45-0.61, pp�0.001) were less likely to report dental pain. CONCLUSIONS : Dental pain in the past year was associated with being married/widowed, being a minority, and visiting a dentist in the past year. Older subjects and those with a high socio-economic status, good/moderate oral health behaviour, and good self-perceived oral health were less likely to report dental pain

Socio-Economic Status and Prevalence of Self-Reported Osteoporosis in Tehran: Results from a Large Population-Based Cross-Sectional Study (Urban HEART-2)

Osteoporosis is a widespread disease among older peoples. The aim of this study is to estimate the prevalence of self-reported osteoporosis and assessing its association with socio-economic status. A population-based cross-sectional study was conducted in Tehran, Iran in 2011. Participants were 45,990 individuals aged above 20 years from 22 urban districts. Osteoporosis was measured by self-administrative questionnaire. Wealth index was constructed using principal component analysis based on household assets. Chi-square test, chi square test for trend, and crude odds ratio were used to assess associations in univariate analysis. Multiple logistic regression utilized to estimate adjusted associations between self-reported osteoporosis and socio-economic status. The overall estimated prevalence of self-reported osteoporosis was 4 (95 CI 3.88�4.13), 1.19 in men, and 6.84 in women (P < 0.001). The prevalence increased considerably as age increased (P for trend < 0.001). In multivariable analysis, education and wealth status were negative, and smoking was positively associated with the prevalence of self-reported osteoporosis. No association was found between participants� skill levels and Townsend deprivation index with the prevalence of self-reported osteoporosis. The findings of the present study have improved understanding of the association between socioeconomic status and osteoporosis in the Iranian population. It is important to consider socioeconomic status in screening and prevention programs. © 2018 The New York Academy of Medicin

Identifying associated factors with social capital using path analysis: A population-based survey in Tehran, Iran (Urban HEART-2)

Background: Social capital has been defined as norms, networks, and social links that facilitate collective actions. Social capital is related to a number of main social and public health variables. Therefore, the present study aimed to determine the factors associated with social capital among the residents of Tehran, Iran. Methods: In this large cross-sectional population-based study, 31531 residents aged 20 years and above were selected through multi-stage sampling method from 22 districts of Tehran in 2011. The social capital questionnaire, 28-item General Health Questionnaire (GHQ-28), and Short-Form Health Survey (SF-12) were used. Hypothetical causal models were designed to identify the pathways through which different variables influenced the components of social capital. Then, path analysis was conducted for identifying the determinants of social capital. Results: The most influential variables in 'individual trust' were job status (β=0.37, p=0.02), marital status (β=0.32, p=0.01), Physical Component Summary (PCS) (β=0.37, p=0.02), and age (β=0.34, p=0.03). On the other hand, education level (β=0.34, p=0.01), age (β=0.33, p=0.02), marital status (β=0.33, p=0.01), and job status (β=0.32, p=0.01) were effective in 'cohesion and social support'. Additionally, age (β=0.18, p=0.02), PCS (β=0.36, p=0.01), house ownership (β=0.23, p=0.03), and mental health (β=0.26, p=0.01) were influential in 'social trust/collective relations'. Conclusion: Social capital can be improved in communities by planning to improve education and occupation status, paying more attention to strengthening family bonds, and provision of local facilities and neighborhood bonds to reduce migration within the city

Socioeconomic status and prevalence of self-reported diabetes among adults in Tehran: Results from a large population-based cross-sectional study (Urban HEART-2)

Introduction: Diabetes mellitus is an important public health challenge worldwide. The prevalence of type 2 diabetes varies across countries. The aim of this study is to estimate the prevalence of type 2 diabetes and to determine related factors including socioeconomic factors in a large random sample of Tehran population in 2011. Methods: In this cross-sectional study, 91,814 individuals aged over 20 years were selected randomly based on a multistage, cluster sampling. All participants were interviewed by trained personnel using standard questionnaires. Prevalence and Townsend deprivation indexes were calculated. Principal component analysis (PCA) was used to construct wealth index. Logistic regression model was used in multivariate analysis. Results: The estimated prevalence of self-reported diabetes was 4.98 overall, 4.76 in men and 5.19 in women (P < 0.003). In multivariate analysis, age, marital status (married and divorced/widow) and BMI were positively associated with the prevalence of self-reported diabetes. Of the socioeconomic variables, educational level and wealth status were negatively and Townsend Index was positively associated with diabetes. Conclusion: Our study findings highlight low reported prevalence of diabetes among adults in Tehran. Subjects with low socioeconomic status (SES) had a higher prevalence of type 2 diabetes. Weight gain and obesity were the most important risk factors associated with type 2 diabetes. Wealth index and educational level were better socioeconomic indicators for presenting the inequality in diabetes prevalence in relation to Townsend deprivation index. © Italian Society of Endocrinology (SIE) 2015

Response-oriented measuring inequalities in Tehran: Second round of Urban health equity assessment and response tool (Urban HEART-2), concepts and framework

Background: Current evidence consistently confirm inequalities in health status among socioeconomic groups, gender, ethnicity, geographical area and other social determinants of health (SDH), which adversely influence health of the population. SDH refer to a wide range of factors not limited to social component, but also involve economic, cultural, educational, political or environmental problems. Measuring inequalities, improving daily living conditions, and tackling inequitable distribution of resources are highly recommended by international SDH commissioners in recent years to 'close the gaps within a generation'. To measure inequalities in socio-economic determinants and core health indicators in Tehran, the second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2) was conducted in November 2011, within the main framework of WHO Centre for Health Development (Kobe Centre). Method: For 'assessment' part of the project, 65 indicators in six policy domains namely 'physical and infrastructure', 'human and social', 'economic', 'governance', 'health and nutrition', and also 'cultural' domain were targeted either through a population based survey or using routine system. Survey was conducted in a multistage random sampling, disaggregated to 22 districts and 368 neighborhoods of Tehran, where data of almost 35000 households (118000 individuals) were collected. For 'response' part of the project, widespread community based development (CBD) projects were organized in all 368 neighborhoods, which are being undertaken throughout 2013. Conclusion: Following the first round of Urban HEART project in 2008, the second round was conducted to track changes over time, to institutionalize inequality assessment within the local government, to build up community participation in 'assessment' and 'response' parts of the project, and to implement appropriate and evidence-based actions to reduce health inequalities within all neighborhoods of Tehran