Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study / 한국역학회지

OBJECTIVES: The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes. METHODS: In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education. RESULTS: The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively. CONCLUSIONS: Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Transition in tobacco use stages and its related factors in a longitudinal study

OBJECTIVES@#Considering the increase in the non-communicable diseases associated with tobacco use in recent decades in Iran, it is necessary to have a general view of the current condition. This study aimed to identify factors associated with tobacco use and to estimate the probability of a 5-year transition in the stages of tobacco use in an adult population.@*METHODS@#In this study, 5190 people in the 40-64-year-old population of Shahroud (North East of Iran) were interviewed in 2009 and 2014 on tobacco smoking. The association of independent variables with tobacco smoking was evaluated using the population-averaged logit model. We calculated smoking transition probabilities from non-smoking to current smoking and past-smoking stages during a 5-year span.@*RESULTS@#The prevalence of current tobacco smoking in 40-69-years age group was 11.1% (95% CI 10.3-12.0), 1% among women (95% CI 0.8-1.3) and 25.6% among men (95% CI 23.7-27.6). During this 5-year period, the probability of transition of a non-smoker to an overall current tobacco smoker was 2.3%. Meanwhile, 18.5% of the overall current tobacco smokers had changed into past smokers. Unemployed (OR = 2), male gender (OR = 53.9), widow/widowers (OR = 5.4), divorces (OR = 3.3), and high economic status (OR = 1.2) are associated to tobacco smoking.@*CONCLUSIONS@#Compared with the other studies, the prevalence of tobacco use in this population is low but transition rate of non-smokers into current smokers or past smokers is high. Conducting interventions on determinants of starting and quitting smoking and education and awareness raising on the risk and harms of smoking seems necessary.

Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study / 한국역학회지

OBJECTIVES: The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes.METHODS: In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education.RESULTS: The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively.CONCLUSIONS: Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study / 한국역학회지

OBJECTIVES@#The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes.@*METHODS@#In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education.@*RESULTS@#The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively.@*CONCLUSIONS@#Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Respiratory tract infections and its preventive measures among hajj pilgrims, 2010: a nested case control study

Respiratory tract infections are very common among the Hajj pilgrims. Some preventive measures including Influenza vaccination, using face mask and salt water gargling have been considered to control these infections and the reports show conflicting results about the effects of each one of these measures. This study is trying to assess the effects of these recommendations on respiratory tract infections. According to nested case-control design, in a cohort consisting of 338 Iranian pilgrims, the outcome examined, was all types of respiratory tract infections other than common colds. With occurrence of any patient in convoy, data collection form was completed for that person. On the same day, two people were randomly selected as control group from among pilgrims who have not affected so far. During Hajj, 32 pilgrims [9.5%] were affected by respiratory tract infections other than common colds. In univariable logistic regression analysis, salt water gargling [OR = 2.4, P = 0.08], existence of other patient in the room [OR = 2.14, P = 0.19], age over 60 years [OR = 1.84, P = 0.15] and the education more than or equal to 3 years [OR = 1.93, P = 0.16] were effective in the respiratory tract infections [P < 0.2]. However, multivariable logistic regression analysis showed that none of the above mentioned factors are significantly associated with these infections. This study showed that measures such as seasonal influenza vaccination, use of face masks and personal prayer carpet have no effect on the incidence of respiratory tract infections. However, washing throat and mouth with salt water can be considered the most effective preventive measures

Cancer incidence and trend analysis in Shahroud, Iran, 2000 - 2010

Cancer is the third leading cause of death in Iran, and its trend is increasing in recent years. National reports state that cancer registries in Shahroud district had 204% coverage in 2008. This study investigated cancer situation in Shahroud with complete details between 2000-2010. Data was obtained from national cancer registry software and analyzed after removing the repeated records. World standard population and direct standardization method was used to calculate Age Standardized incidence Rates [ASRs]. Annual percentage changes calculated using Jointpoint software and Poisson regression model was performed to calculate cancer incidence trends. A total of 2240 cancer cases were identified, 1234 [55.1%] in man and 1006 [44.9%] in woman. The mean age was 61.6 years [Confidence Interval, CI 95%: 60.9- 62.3]. ASRs of total cancers was 95.4 [CI 95%: 89.2-101.6] per 100, 000; this rate was 114.8 [CI 95%: 107.9-121.6] for men and 105.2 [CI 95%: 100.6 -109.8] for women. The average annual increase in ASR was 12.4%, which could not be attributed only to improve reporting. Gastric cancer is the most common cancer in men, and breast cancer is most common in women. Cancer incidence rate has increased significantly in Shahroud in recent years. A portion of this increase can be attributed to increased incidence of cancers, especially cancers of colorectal, gastric, breast, and skin

Important risk factors of mortality among children aged 1-59 months in rural areas of Shahroud, Iran: a community-based nested case-control study

The aim of the study was to evaluate potential risk factors of children mortality between 1-59 months of age. This nested case-control study was conducted among children born from June 1999 to March 2009 in rural areas of Shahroud, located in the central region of Iran using health care visit reports and follow-up data available in household health records. Mortality was significantly associated with breastfeeding duration [OR: 0.87, 95% CI: 0.81-0.93], total health care visits [OR: 0.90, 95% CI: 0.83-0.98] and low birth weight [LBW] [OR: 7.38, 95% CI: 1.37-39.67]. In our study, a longer breastfeeding period and more frequent health care visits were two important protective factors, while LBW was an important risk factor for 1-59 month child mortality. It seems, that complex and multiple factors may be involved in mortality of under 5-year-old children, so combined efforts would be necessary to improve child health indicators

prevalence and determinants of pterygium and pinguecula in an urban population in Shahroud, Iran

While pterygium is considered a common eye disorder, the etiology and pathogenesis is still not known. The aim of this study was to describe the prevalence of pterygium and pinguecula in the over 40 population of Shahroud and assess associated factors. The present study is part of the phase one of the Shahroud Eye Cohort Study conducted in 2009, in which the target population was people between 40 and 64 years of age. Ophthalmic examinations were performed by two ophthalmologists who made the diagnosis of pterygium and pinguecula. We used Chi-square tests, analysis of variance, and multiple logistic regression tests to examine associations. Of the 6311 invitees, 5190 people participated in the study [response rate: 82.2%]. The prevalence of pterygium in at least one eye was 9.4% [95% CI, 8.6-10.3], while 2.9% [95%CI, 2.4-3.3] had bilateral pterygium. The prevalence was significantly higher in men [11.4% vs. 8.0%], and remained relatively constant with age, while the prevalence in women significantly increased with age. The prevalence of pinguecula was 61.0% [95%CI, 59.1-62.9] in at least one eye, and 49.0% [95%CI, 47.1-50.9] in both eyes. The age difference between those with and without pinguecula was significant and the prevalence was significantly higher among men than women [70.6% vs. 53.8%]. The prevalence of pterygium in our study was lower than reported rates in the world but higher than Tehran and was significantly associated with age, gender, working outdoors, and the level of education. The prevalence of unilateral and bilateral pinguecula falls in the mid range and was significantly associated with age, male gender, smoking, working outdoors, and level of education