Waist circumference, weight, and body mass index of Iranians based on national non-communicable disease risk factors surveillance

Obesity is an important and life-threatening disease, associated with different chronic conditions such as cardiovascular disease, diabetes, and dyslipidemia. We sought to address the paucity of information on the trends of anthropometric indices such as weight, waist circumference, and body mass index in the adult population of Iran. We drew upon data from the First Non-communicable Disease Survey in Iran in 2005. In total, 79,611 participants between 20 and 64 years old were selected via the random multistage cluster sampling. The Lambda Median Scale method was applied to construct normal curves for anthropometric indices. The mean of waist circumference in both genders increased with age and in all the age groups except those between 20 and 24 years old was higher in the women. The mean of body mass index was higher in all the age brackets in the women, but the means of weight and height were higher in the men. The association of theses indices with diabetes, hypertension, and dyslipidemia was stronger in men. The ranges of waist circumference and body mass index in Iranian population are different from those of other countries. The higher body mass index and waist circumference in females and the direct association between obesity and chronic diseases, is advisable that the effects of this phenomenon be fully investigated and due heed be paid to the importance of lifestyle modification

Patients' perspectives on factors that influence diabetes self-care

Although diabetes mellitus is of high concern in Iran, and the level of control is unacceptable, few qualitative studies have been carried out to reflect the experiences of patients on the barriers and motivators to self-care. This study aimed to explore a culturally based experience of Iranian diabetic patients regarding the personal and environmental barriers to and facilitating factors for diabetes self-care. Six focus groups were conducted among type 2 diabetic patients in the Charity Foundation for Special Diseases' diabetes clinic. Purposeful sampling was used. Newly diagnosed patients [less than six months] and all type 1 diabetic patients were excluded. Three focus groups were held on for each sex. A total of 43 patients participated in the study. Framework analysis was used to extract the themes from the data. Data analysis showed five main barriers: physical barriers [such as physical effects of diabetes]; psychological barriers [such as health beliefs]; educational barriers [such as lack of knowledge about diabetes]; social barriers [such as group pressure]; and care system barriers [such as service availability]. Along with the barriers, there were some motivators that the participants mentioned as a stimuli to control their diabetes. They include beliefs about diabetes, perceived responsibility for family, religious beliefs, and the views of significant others. Culturally based interventions are needed to improve diabetes care management in Iran. In addition to personal factors, diabetes health educators should pay attention to the environmental factors when they develop programs

Health state valuation in Iran: an exercise on cardiovascular diseases using visual analogue scale method

Disability Weights [DWs] are main components for computing summary measure of population health [SMPH] and economic studies. They are specific for each community, but there are no previous studies in Iran. In this study, we investigated the feasibility of health state valuation [HSV] in Iranian population. Twelve cardiologists in 3 sessions of expert panels, defined 25 states, related to cardiovascular diseases [3 major and 22 specific diseases]. From January to March 2008, 80 persons in 4 groups including: physicians, patients, patients' families and general publics [each group 20], were interviewed and valuated the states, using visual analogue scale [VAS] method. SPSS[Registered] 15 for window[Registered] [SPSS Corporation, Chicago, Illinois] was used for statistical analysis. Data showed that the defined health states had various severities. All the 4 groups ranked the "3 major-diseases" and "very-mild" and "very-severe" states, similarly. Non-physicians were not able to differentiate among "valvular-diseases" and "pacemakers" properly. The reliability of responses was acceptable. VAS is an appropriate and reliable method for HSV in Iranian population. Non-physicians' opinions can be consider in major cardiac diseases. Valuation of more specific situations must perform by physicians

Prevalence of HIV and hepatitis C virus infections and related behavioral determinants among injecting drug users of drop-in centers in Iran

Drop-in centers [DICs] are set up to reduce the harms of high-risk behaviors in high-risk groups especially in injecting drug users [IDUs]. This study aimed to determine the prevalence of high-risk behaviors in hepatitis C virus [HCV], and human immunodeficiency virus [HIV] in IDUs seeking harm reduction services in DICs in Iran. Fifteen out of 48 centers covered by universities of medical sciences were enrolled through a systematic random sampling method. Information on demography, high-risk behaviors, and HIV and HCV infections of all IDUs [N=1531] were obtained through interview over a one month period. Among 1531 subjects analyzed, 96.1% were male, 47.8% were single, and 35.1% married. The mean age of the participants was 33 +/- 9.0 years and the most prevalent age group was 26-35 years [45%]. The median durations of drug abuse and injection were 12 [ranging 1 to 43] and 5 [ranging to 37] years, respectively. 20.5% [95% CI: 17.94, 23.22] of the participants were HIV positive test cases, while the prevalence of HCV was 43.4% [95% CI: 40.17, 46.62]. The median number of injections was 21 times per week for all injections and zero for injection with shared needles and syringes. 47.4% of the IDUs had sexual contact with someone other than their spouse. The proportions of unprotected homo- and heterosexual contacts among IDUs were 19.4% and 37.4%, respectively. IDUs had a high rate of unsafe sexual contact and injection related behaviors. The high prevalence of HIV and HCV infection among this group implies a high rate of transmission and exposure to the risk of serious diseases. The study showed the necessity of establishing and developing harm reduction support to the majority of IDUs, to reduce transmission and burden of HIV and hepatitis C in Iran

Effectiveness of adolescents' immunization against hepatitis B on burden of the disease in Iran

Hepatitis B is a common problem in many countries. Due to high efficacy, safety and low cost of vaccine, mass immunization has become a favorite strategy to improve population health. In this study, we tried to estimate marginal effectiveness of adolescents' immunization program in Iran. Epidemiologic data about of hepatitis B in Iran was gathered through literature review, expert opinion, existing resources of data and synthesis by modeling of other data. In a state transition model, different stages of disease were simulated in 15 to 100 year old individuals. Comparing the results of burden of hepatitis B with and without immunization revealed an estimate of avoidable burden of disease with intervention. Monte Carlo simulation and sensitivity analyses were done for uncertainty analysis of results. Immunization of around one million 15-year, old males and females prevents 2071 of male and 581 of female premature deaths due to acute hepatitis B, cirrhosis and hepatocellular carcinoma annually. Moreover, it prevents loss of about 52 and 36 percent of YLL [years of life lost] due to hepatitis B complications in males and females respectively. On average, it avoids loss of Disability Adjusted Life Years [DALY] of 0.012 and 0.006 years, according to present value of life. Monte Carlo simulation of populations showed that effectiveness of the intervention is quite significant and about half of males and one third of females with disability, equal to at least one year of full health, will be free. With sensitivity analyses, results were standing in acceptable limit of values in both bivariate and probabilistic calculations. Our study showed that effectiveness of adolescents' immunization against hepatitis B is quite significant. Calculation using basic estimates of cost of intervention program implies that this intervention is possibly very cost effective. For final judgment, results should be combined with cost effectiveness analysis, and compared to other interventions