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Background: Using the WHO STEPwise approach to NCD risk factor surveillance (STEPS), first round of Iran’s STEPS completed in 2005. It has been repeated six times afterward. Here we report the results of 2016 round on the population characteristics and prevalence of diabetes and prediabetes, along with an assessment of the country-level performance on diabetes care in Iran. Methods: Using a proportional-to-size cluster random sampling method, the STEPS 2016 included 18947 subjects aged≥25 years who matched the criteria (non-missing information on diabetes self-report, and biomarkers). For the analyses, survey design methods with weighted samples were employed. Different definitions of diabetes (biomarker-based, self-report, anti-diabetes medication use, or a combination) and prediabetes (different cutpoints of the biomarker) were calculated and presented. Results: An estimated 5171035 persons aged≥25 years or 10.6% (95% CI: 10.0%–11.1%) had diabetes according to the serologic diagnosis of diabetes (FPG≥126 mg/dL) or the use of at least one anti-diabetes medication (1896 out of 18947). Employing the serologic diagnosis of diabetes among those who responded no to the self-reported question, 2.7% (2.5%–3.0%) of the population were not aware of their diabetes compared to 11.5% (10.9%-12.0%) who were diabetics according to the just self-reported question. Defining prediabetes as 100≤FPG9%) was found in 18.4% (16.3%-20.6%) of the patients with self-reported diabetes. Conclusion: Since 2005, the prevalence of diabetes in Iran has been on a gradual increase in both genders with an increasing gap between females and males.

We aimed to estimate the level and trend of plasma cholesterol and raised total cholesterol (TC 200 mg/dl) prevalence at national and subnational level of Iran.Nine national surveys and 27 studies, encompassing 3,505 unique points on over 500,000 adults, aged 25 years with a report of laboratory measurement of TC were found. Age-spatio-temporal model and Gaussian Process Regression were used to estimate mean TC for each sex, 5-year age groups, and 31 provinces from 1990 to 2016.At national level, age-standardized prevalence of TC 200 mg/dL has decreased from 57·2%(53·3-61·1) to 22·4%(20·5-24·3) in women and 53·2%(49·1-57·3) to 18·0%(16·4-19·6) in men. TC distribution presented a condensation between 170-200 mg/dL. At subnational level, decreasing and converging patterns of raised TC prevalence were detected.The decrease in raised TC is likely the result of statin widespread use, food industry improvements, and the expanded primary health care.The online version contains supplementary material available at 10.1007/s40200-022-01052-w.

Background: In developing countries like Iran, the burden of obesity increases through comorbid diseases. We estimated the mean body mass index (BMI) and prevalence of overweight/obesity by components of sex, age, province, and year in Iran from 1990 to 2016. Methods: Through a comprehensive systematic review, all relevant data sources pooled results with individual level national and sub-national population-based studies. Two stages of age-spatio-temporal modeling and Gaussian process regression were used to estimate mean BMI, followed by estimation of obesity and overweight prevalence through the crosswalk modeling. Results: In 2016, the age-standardized mean BMI was 27.9 (27.2–28.7) kg/m² in women and 25.9 (25.2–26.5) kg/m² in men. At the same time, the prevalence rates of overweight and obesity were 71.7% (67.9–75.8), and 36.8% (34.1–39.7) in females, and 57.1% (53.7–60.6), and 18.4% (16.9–20) in men. This shows a considerable increase from 1990 when the figures were respectively 24.4 (23.3–25.5) , 36.6% (32.2–41.5), and 8.2% (95% UI: 6.9–9.7) in women, and 23.5 (22.5–24.5), 30% (26.4–34), and 4.7% (4.0–5.5) in men, with 66% attributed to population growth. Conclusion: Considering the increasing trends of BMI, Sustainable Development Goals (SDGs) seem far out of reach. We need to call for action, aiming for both weight loss strategies and controlling the comorbidities that mediate high BMI risk.

Background Raised blood pressure is a serious risk factor for several non-communicable diseases (NCDs) in Iran. In this study, we aimed to estimate the mean of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and subsequently, the prevalence of hypertension by sex, age, province, and year in Iran. Methods We conducted a systematic review using PubMed, Web of Science, and Scopus databases through December 2017. We also used individual level data from eight national surveys, aggregated data from seven subnational population-based studies, and extracted data reported in 52 published studies. We used a two-stage model including Age-Spatio-Temporal and Gaussian process regression (GPR) to estimate mean systolic and diastolic blood pressure and used a crosswalk model to estimate the prevalence of hypertension by sex, age, province, and year. Results The number of hypertensive adults increased in Iran from 1.8 million (882 thousand in women) in 1990 to 13.6 million (7.2 million in women) in 2016. The national age-standardized prevalence of hypertension increased from 8.7% (7.8-9.7) to 28.8% (27.7-30.0) in women and from 8.0% (7.2-8.9) to 24.2% (23.1-25.3) in men from 1990 to 2016. Mean systolic and diastolic blood pressures show a similar increasing trend. Conclusion During the past 27 years, we observed an increase in the age-standardized prevalence and mean levels of blood pressure. If the current trend in levels of blood pressure and prevalence of hypertension continue in the coming years, Iran will not achieve the sixth target of the Global Action Plan by 2020 and the Sustainable Development Goals (SDGs) by 2030.

Background To achieve Sustainable Development Goal 3.6 in Iran, we need to have a comprehensive understanding of the distribution of risky behaviours regarding road-traffic injuries at national and sub-national levels. Little is known about the road-use vulnerability patterns of road-traffic injuries in Iran. The aim of this study is to describe the prevalence of self-reported human risk factors in road-traffic injuries using the findings from a large-scale cross-sectional study based on the World Health Organization’s stepwise approach to surveillance of non-communicable diseases (STEPs). Methods A cross-sectional survey study in 2016 assessed the road-use pattern and prevalence of risky behaviours of people more than 18 years old. In this study, we planned to recruit 31 050 individuals as a representative sample at national and provincial levels. In practice, 30 541 individuals (3105 clusters) from urban and rural areas of Iran were selected. Basic socio-demographic data, major behavioural risk factors such as seatbelt and helmet non-compliance, drunk driving and occupant in a car with a drunk driver were assessed through baseline interviews gathered through an Android tablet-based questionnaire. Results The overall prevalence of seatbelt and helmet compliance was 75.2% (95% confidence interval: 74.7–75.7) and 13.9% (13.4–14.5), respectively, at the national level. The prevalence of risk-taking behaviours such as drink driving was 0.5% (0.4–0.6) and for being an occupant in a car with a drunk driver was 3.5% (3.2–3.8). At the provincial level, the highest age-standardized prevalence of seatbelt compliance (89.6%) was almost 1.5 times higher than the lowest provincial prevalence (58.5%). In 63% of provinces, the lowest prevalence of seatbelt compliance was observed among people aged 18–24 years old. Conclusions In Iran, existing disease-prevention and health-promotion programmes should be expanded to target vulnerable subgroups that have more prevalent human risk factors for road-traffic injuries. Further research is required to investigate the context-specific proximal human risk factors and vulnerability patterns in Iran.

Background: One billion worldwide population are living in slum areas that mostly accompanied with high rates of poverty, illiteracy, unemployment, unhealthy situation, and inappropriate health-care services. The prediction of enormous growth of slums by 2030, led to a raise to address the “plight of slums” in Sustainable Development Goals (SDGs). To address evidence based health related priorities, we conducted a systematic review to summarizing evidences on health situations of slums population in Iran.Methods: Six electronic databases were systematically searched for published studies without any restriction on age, time and language to assess health situations of slums in Iran by following the PRISMA protocol. All identified articles were screened, quality assessed and data extracted by two authors independently.Results: The finding of this systematic review in addition to overall view categorized in five categories: Health System, Reproductive Health, Infectious Diseases, Non-communicable Diseases and Their Risk Factors, Social Issues besides overall situation of Slums.Conclusions: Community-based participatory interventions with socioeconomic approach on modifiable risk factors; active response of health system; establishment new health care centers in slum areas; augmenting the quality of care; active case finding; and elevating health knowledge, attitude, and practice among slum dwellers is crucial to achieving SDGs.

Non-Communicable Diseases (NCDs) are the largest and fastest growing threat to human health. Iran’s Ministry of Health and Medical Education (MoHME) established the Iranian Non-Communicable Diseases Committee (INCDC) in 2015 to tackle the high burden of NCDs. In line with the WHO’s Global Action Plan, the INCDC developed “The National Action Plan for Prevention and Control of NCDs” and the related risk factors in Iran, 2015–2025”, which was then revised to cover until 2030. In this policy synthesis study, we conducted a content analysis of upstream and other policy documents related to NCDs and relevant risk factors in Iran. We used multiple streams model to illustrate the proactive approach that led to development of the national action plan. While countries are accelerating their efforts to reach SDG 3.4, Iran’s pathway, as a WHO fast track country, will help, we envisage, other countries to scale up their active efforts to move steps forward to tackle the ever- highest burden of NCDs in their own settings.

Background Following global commitments to prevent and control non-communicable diseases, we sought to estimate national and sub-national trends in diabetes mortality in Iran and to assess its association with socioeconomic factors.Methods To assess the correlation between diabetes mortality and socioeconomic factors we used data obtained from the Death Registration System (DRS), the spatio-temporal model and Gaussian Process Regression (GPR) levels and the diabetes mortality trends, which were estimated by sex, age and year at national and sub-national levels from 1990 to 2015.Results Between the years 1990 and 2015, the age-standardized diabetes mortality rate (per 100,000) increased from 3.40 (95% UI: 2.33 to 4.99) to 7.72 (95% UI: 5.51 to 10.78) in males and from 4.66 (95% UI: 3.23 to 6.76) to 10.38 (95% UI: 7.54 to 14.23) in females. In 1990, the difference between the highest age-standardized diabetes mortality rate among males was 3.88 times greater than the lowest (5.97 vs. 1.54) and in 2015 this difference was 3.96 times greater (14.65 vs. 3.70). This provincial difference was higher among females and was 5.13 times greater in 1990 (8.41 vs. 1.64) and 5.04 times greater in 2015 (19.87 vs. 3.94). The rate of diabetes mortality rose with urbanization, yet declined with an increase in wealth and years of schooling as the main socio-economic factors.Conclusion The rising trend of diabetes mortality rate at national level and the sub-national disparities associated with socioeconomic status in Iran warrant the implementation of specific interventions recommended by the ‘25 by 25’ goal.

Background: Dermatologic complications are common in patients with end-stage renal disease and also have a high diversity. Objectives: This meta-analysis reviews prevalence of dermatological manifestations among hemodialysis patients in Iran. Materials and Methods: Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iran-Medex, Irandoc, and Scientific Information Database, as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of dermatological manifestations (until February 2016). Heterogeneity of reported prevalence's between studies was assessed using the Q test; overall prevalence of dermatological manifestations was estimated using random-effect meta-analysis model. Results: We found 1229 records; from them, a total of eight studies comprising 917 hemodialysis patients were included. In all of studies, skin discoloration, pruritus and xerosis have the highest prevalence. According to random-effect meta-analysis model, the pooled prevalence of skin discoloration, pruritus, ecchymosis, xerosis, and half-and-half nail in hemodialysis patients were 48.03 (95 CI: 45.09-51.01), 52.85 (95CI: 49.23-56.47), 19.88 (95 CI: 17.57-22.19), 51.14 (95 CI: 48.25-54.02), and 18.50 (95 CI: 16.0-21.0), respectively. Conclusions: his study shows that the prevalence of dermatological manifestations seems high among the hemodialysis patients in Iran, and skin discoloration, pruritus, and xerosis are more common. © 2018 Wiley Periodicals, Inc.

Raised serum cholesterol is a main risk factor for all-cause and cardiovascular-attributable mortality and morbidity in all nations, particularly in developing countries. Effective policy making in this regard requires detailed data to distinguish disparities and specific patterns. Thus, we aimed to estimate the level and trends of serum cholesterol level and raised total cholesterol prevalence at subnational level from 1990 to 2016 in Iran.We conducted a comprehensive systematic review, through which we detected nine national surveillances, seven large-scale population-based studies, and 88 studies published in databases. We conducted a two-stage model: an Age-Spatio-Temporal model and a Gaussian Process Regression to estimate mean total cholesterol (TC). We used crosswalk to estimate prevalence of raised total cholesterol based on estimated mean, defined as TC higher than 200 mg/dL. All estimations were done in subgroups with sex, age, year, and province combinations.At national level, the number of adults with raised total cholesterol decreased from 10·5 (9·8 – 11·5) million (5·2 million in women) in 1990 to 9·9 (9·0 – 10·6) million (5·4 million in women) in 2016. Age standardized prevalence of raised total cholesterol at national level has decreased from 57·2% (95% CI: 53·3 – 61·1) to 22·4% (20·5 – 24·3) in women and from 53·2% (49·1 – 57·3) to 18·0% (16·4 – 19·6) in men between 1990 and 2016. From 1990 to 2016, age standardized mean TC in both men and women has decreased from 197·3 mg/dL (186·1 – 209·4) to 168·5 (160·7 – 176·7) and from 202·5 mg/dL (191·2 – 214·6) to 174·5 mg/dL (166·6 – 182·8), respectively. In both sexes, population growth had the highest contribution to increase in number of adults with high TC.Decrease in raised TC is likely the result of statin widespread use, food industry improvements, and the expanded primary health care of the country. Provided data at subnational level would help with further evidence-based and population-specific policy making to ensure the continuation of this successful experience, particularly targeting inter-gender and inter-provincial differences. Finally, the increased number of adults with TC slightly below the 200 mg/dL cutoff is threat for the healthcare that should be systematically managed.

Background: Tobacco smoking is one of the most important avoidable causes of mortality from non-communicable diseases (NCDs). This study aimed to report the crude and standardized prevalence of current, ever, and secondhand smoking at national and provincial levels. Methods: This study was performed through an analysis of the results of the STEPs survey 2016, which was conducted as a cross-sectional national study. The samples were selected via multistage cluster sampling and they were representative of general population aged ≥18 years in all provinces of Iran. All the data were analyzed via survey analysis while considering population weights. Age-standardized prevalence was also calculated for the Iranian national population in 2016 and the World Health Organization (WHO) Population 2000-2025. Results: A total of 29963 subjects aged ≥18 years from all provinces of Iran, except for Qom, participated in this study. The age standardized prevalence of current tobacco smoking among adult males and females were 24.4% (95% CI: 23.6%–25.1%) and 3.8% (95% CI: 3.5%–4.1%), respectively. Among the participants, the majority of the current smokers were among those aged 45-54 years (14.5%; 95% CI: 13.6%–15.5%). With increase in age, the prevalence of secondhand smoking decreased to 34.8% (95% CI: 33.3%–36.7%) among people aged 18–24 years and to 22·6% (95% CI: 21.0%–24.3%) among subjects over 70 years. Conclusion: The result of the study can be used to inform policy makers about the status of smoking and help them to design policies for setting rules on and limiting the import of cigarettes and their components to the country.

Background: Since the beginning of the coronavirus disease 2019 (COVID-19) epidemic in Iran, the control and management of the epidemic were headed by the National Headquarter for the Control of COVID-19 Epidemic through setting up different scientific committees, including the COVID-19 National Epidemiology Committee. The present study reviews the missions, structures, achievements, and challenges of the Epidemiology Committee. Study design: A rapid review Methods: All relevant reports, documents, guidelines, published literature, and surveillance data related to the establishment, visions, missions, roles, activities, and outputs of the COVID-19 Epidemiology Committee were critically reviewed in this study. Results: The efforts of the committee’s working groups may have impacted improvements in data registration/usage, provincial data quality at provincial levels, and perception of the epidemic situation in the provinces. The committees have also played role in informing the policies in different stages of the epidemic through routine or problem-based data/evidence analyses, epidemic investigations, and mathematical modeling. Conclusions: The structure and experience gained by the committee can be used in similar situations within and outside the country. To further improve the impacts of our activities, it is essential to have effective interaction, collaboration, and data flow between the committee and a broad range of organizations within and outside the Ministry of Health and Medical Education.

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.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.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.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.

Due to significant achievements in reducing mortality and increasing life expectancy, the issue of disability from diseases and injuries, and their related interventions, has become one of the most important concerns of health-related research.Using data obtained from the GBD 2015 study, the present report provides prevalence and years lived with disability (YLDs) of 310 diseases and injuries by sex and age in Iran and neighboring countries over the period 1990-2015. Age-standardized rates of all causes of YLDs are presented for both males and females in 16 countries for 1990 and 2015. We present the percentage of total YLDs for 21 categories of diseases and injuries, the percentage of YLDs for age groups, as well as the ranking of the most prevalent causes and YLDs from the top 50 diseases and injuries in Iran.In 2015, the burden of 310 diseases and injuries among the Iranian population was responsible for 8,357,878 loss of all-age total years, which is equal to 10.58% of total years lived per year. This differs from the neighboring countries, as it ranges from 9.05% in Turkmenistan to 13.36% in Russia. During the past 25 years, a remarkable decrease was observed in all-cause YLD rates in all 16 countries. Meanwhile, in all countries, the age-standardized rate of all causes of YLDs was higher in females than males.Based on our findings, one of the remarkable changes in NCDs observed among the studied age groups was increased rate of YLDs from mental disorders, which was replaced by musculoskeletal disorders in older age groups in 2015.

BackgroundFrequency of insulin pen use, despite its higher costs, is increasing to substitute the traditional use of insulin vials. This study aims to report insulin pen use frequency and its associated factors among participants of the STEPS survey 2016 in Iran, which was conducted based on the World Health Organization (WHO) STEPS methodology.MethodsIn this cross-sectional study, 19,503 (mean age of 46.03±0.13) out of 30,541 participants of the Iran STEPS survey were included (Inclusion criteria: aged >25 years old and availability of their demographic, clinical, and laboratory results for serum glucose, HbA1c, and lipid profile). Clinical and demographic characteristics, a frequency of use of each diabetes mellitus treatment type, and the association of insulin pen use with health outcomes are reported using descriptive analysis and propensity score modeling.ResultsThere were 1,999(10.85%) individuals diagnosed with diabetes in the population, while 1,160(56.87%) cases were taking antihyperglycemic treatments. In this subset, 240(21.14%) individuals administered insulin with or without using oral agents at the same time. 52.28% of participants who were under insulin therapy used insulin pens. None of the socioeconomic determinants, including gender (p-value = 0.11), type of residential areas (p-value = 0.52), years of schooling (p-value = 0.27), wealth index (p-value = 0.19), marital status (p-value = 0.37), and insurance types (p-value = 0.72) were significantly different among groups using insulin pens and insulin vials. Moreover, in the propensity score modeling, pen usage was not associated with a lower heart attack and ischemic stroke histories, systolic blood pressure, serum lipid profile, blood glucose, or HbA1c levels.ConclusionResults showed that the use of the higher-costing insulin pens compared to traditional vials and syringes is not associated with improved glycemic control and better lipid profile in our sample. Future studies are needed to confirm these findings and to compare other aspects of insulin pen use, including adherence to treatment and cost-effectiveness.

Context Obesity has now become a common health problem worldwide. To gain insight into the epidemiology of the problem in Iran, we systematically reviewed all available studies on the prevalence of overweight and obesity in the Iranian pediatric population. Evidence acquisition We systematically searched PubMed, ISI, SCOPUS, as well as Iranmedex, Irandoc, and Scientific Information Database (SID) databases.All studies on mean and standard deviation or percentile categories of BMI, WC, WHR, or WHtR or prevalence of obesity/overweight in Iranian child and adolescence, were performed from January 1990 to the end of December 2013. Refining processes were conducted by two independent reviewers. Quality assessment and data extraction followed based on validated form. As, these data were heterogeneous, meta-analysis was not performed. Results From 3253 records, through three refining steps, 129 articles were found related to our study. In Iran, national studies are limited and nearly there is no comprehensive study for sub-national trends. Different age and sex groups had large variations in the prevalence of obesity and overweight (from 1% up to 16.1% and from 4.4% up to 42.3% respectively for obesity and overweight). Conclusions Related data are very scattered or limited to some specific subgroups in some living areas. For comparing, aggregating, and imputing the information we need more modern practical statistical methods.

The importance of data quality whether in collection, analysis or presenting stage is a tangible and undeniable scientific fact and the main objects of researches implementation.This paper aims at explaining the main problems of the Iranian scientific papers for providing better data in the field of national and sub-national prevalence, incidence estimates and trends of obesity and overweight.To assess and evaluate papers, we systematically followed an approved standard protocol. Retrieval of studies was performed through Thomson Reuters Web of Science, PubMed, and Scopus, as well as Iranian databases including Irandoc, Scientific Information Database (SID), and IranMedex. Using GBD (Global Burden of Diseases) validated quality assessment forms to assess the quality and availability of data in papers, we considered the following four main domains: a) Quality of studies, b) Quality report of the results, c) Responsiveness of corresponding authors, and d) Diversity in study settings.We retrieved 3,253 records; of these 1,875 were from international and 1378 from national databases. After refining steps, 129 (3.97%) papers remained related to our study domain. More than 51% of relevant papers were excluded because of poor quality of studies. The number of reported total population and points of data were 22,972 and 29 for boys, and 38,985 and 47 for girls, respectively. For all measures, missing values and diversities in studies' setting limited our ability to compare and analyze the results. Moreover, we had some serious problems in contacting the corresponding authors for complementary information necessary (Receptiveness: 17.9%).As the present paper focused on the main problems of Iranian scientific papers and proposed suggestions, the results will have implications for better policy making.

Asthma is a chronic inflammatory airway disease caused or worsened by environmental factors in genetically vulnerable people. The study of national and sub-national burden of asthma aims to provide a quantitative method and valid estimates for the prevalence, incidence, and economic burden of asthma disease in Iran from 1990 to 2013 and this papers explains measures, data sources, methods, and challenges that we will use in the study.In order to conduct this study, we will use all available unpublished data sources, including claim databases and data collected by the food and drug organization (FDO). Moreover, we will devise and run a systematic review of all studies and literature published about asthma epidemiology in Iran, which includes all cross-sectional, cohort and case-control studies with asthma epidemiology focus that are population based. In this study, we will use two statistical models, including spatio-temporal and multilevel autoregressive models to estimate mean and uncertainty intervals for the parameters under study by gender, age, year, and province. All programs will be written in R statistical packages (version 3.0.1).This study helps to obtain information concerning the variation among regions and provinces, and in general among sub-national divisions. Our study can be contribute to better allocation of resources, since it helps policymakers to recognize inequalities between regions and provinces and consequently help them to allocate resources more efficiently.

Non-communicable diseases, as the major public health problem, are caused by different risk factors. The main leading lifestyle risk factors for most diseases burden in Iran are unhealthy diet, physical inactivity, and smoking. The aim of this study is to provide data collection and methodology processes for estimating the trends of exposures to the selected lifestyle risk factors and their attributed burden at national and sub-national levels.Systematic review will be performed through PubMed/MEDLINE, Scopus and ISI/Web of Science as well as Iranian databases such as IranMedex, Irandoc and Scientific Information Database (SID). In addition, hand searching of unpublished data sources will be used to identify relevant population-based studies. The searched studies will be included only if it is reasonably population-based and representative, and exposure data has been reported or could be plausibly obtained from the study. For risk factors with no surveys identified, other sources of potential data will be considered. The target population is healthy Iranian adult population living within Iran from 1990 to 2013. Other data sources include national censuses, national registration systems, and national and sub-national surveys. Spatio-temporal Bayesian hierarchical model and Bayesian multilevel autoregressive model will be used to overcome the problem of data gaps in provinces, and in some age or sex groups or in urban/rural areas. The problem of misaligned areal units will be also addressed in these models.National and sub-national assessment of major lifestyle risk factors such as unhealthy diet, physical inactivity, and smoking is necessary for priority setting and policy making in different regions of Iran.

Non-communicable diseases (NCDs) and their risk factors are a major health threat at the global level, notably for developing countries. The tracking of cardiometabolic risk factors from childhood to adulthood is well documented. Therefore, more attention needs to be directed at primordial and primary prevention of NCDs. Given the high prevalence of NCDs and their risk factors in Iranian population, a study was designed to determine the attributable burden of cardiometabolic risk factors in Iranian pediatric population during past decades.This paper explains the definitions, organization, data sources, methods of data gathering or generating, data analyses, and the trend analysis of the study. A national expert working group addressed unmet needs and offered consultations on the selection of risk factors and the practical definition of disease. In the later stages, during the course of the study, they will supervise the statistical modeling methods, the interpretation of results, and the publication strategy. Also an international expert advisory group will collaborate with the project team.The findings of this study could provide basic information regarding NCD related risk factors, and their burden and trends in children, which is necessary for health policy decisions to reduce the burden of disease and to plan cost-effective preventive strategies.

Non-communicable diseases (NCDs) and their risk factors are the major public health problems. There are some documented trend and point estimations of metabolic risk factors for Iranian population but there are little information about their exposure distribution at sub-national level and no information about their trends and their effects on the population health. The present study protocol is aimed to provide the standard structure definitions, organization, data sources, methods of data gathering or generating, and data on trend analysis of the metabolic risk factors in NASBOD study. We will estimate 1990 to 2013 trends of prevalence, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) and disability-adjusted life years DALYs for MRFs by gender, age group, and province. We will also quantify the uncertainty interval for the estimates of interest.The findings of study could provide practical information regarding metabolic risk factors and their burden for better health policy to reduce the burden of diseases, and to plan cost-effective preventive strategies. The results also could be used for future complementary global, regional, national, and sub national studies.

Background: Reproductive health problems affect youths in all countries. There is an urgent need to enhance youths reproductive health services to provide a healthy life for this group. In this regard, the present study aimed to evaluate the Reproductive Health Peer Education Program based on the opinion of university students. Methods: This interventional study was conducted in Qazvin University of Medical Sciences through the peer education method. The participants of this study were 24 peer educators who received training in a 40 hour peer educator training course. The peer education program was implemented in the university. In order to evaluate this community- based intervention, 329 students were selected through the stratified sampling method and their opinion was assessed. Descriptive statistical methods were used by SPSS software for data analysis. Results: The results of the study revealed that peer education was accepted by 64.7% (n= 213) of the students, according to their opinion. The educational priorities of the students were as follows: pre-marriage counseling (78%, n= 166); STI/AIDS (17%, n= 36); and contraception (5%, n= 11). The peer education program was recognized as the most required reproductive health service in the university by 55.3% (n= 118) of the students. They believed that the most important duties of the peer educators were: education (33.5%, n= 71); counseling (30.4%, n= 65); referring to a counseling center (21.6%, n= 46) and referring to a therapeutic center (14.5%, n= 31). Also, the students stated that confidentiality (53%, n= 113), suitable communication (26%, n= 55) and sufficient knowledge (21%, n= 45) were desired characteristics for the peer educators. Conclusion: According to the students' opinion, peer education could provide suitable reproductive health services and could also be beneficial for reproductive health promotion and might reinforce positive behaviors in youths. Reproductive health peer- counseling is a sensitive process, and it is best to be conducted under the supervision of specialists.

Background: High fasting plasma glucose (FPG) is one of the main leading risk factors of ischemic heart disease (IHD), stroke, and chronic kidney diseases (CKDs). We estimated population attributable fraction (PAF) and attributed death of these fatal outcomes of high FPG at national and subnational levels in 25-64 years old Iranian adult. Methods: We used national and subnational data of the Non-Communicable Disease Surveillance Survey for exposure to risk factors in 2005 and 2011 among Iranian adults of 25-64 years old. For estimating the attributed death, using the death registration system data of Iran, we multiply the cause-specific PAFs by the number of outcome-specific deaths. Results: In Iran, high FPG was responsible for about 31% of attributed total deaths of IHD, stroke, and CKD in 2011. The related attributed deaths had increased from 2005 to 2011. In females, the PAFs for the effect of high FPG on IHD, stroke, and CKD were higher in 2011 than 2005 in all age groups. In males, this increase has occurred in over 45 years old. The highest PAFs of high FPG outcomes mostly related to central provinces of Iran. The central region of Iran had the highest and the southeast of the country had the lowest levels of attributed deaths. Conclusions: Considering the global 25 × 25 targets for noncommunicable disease mortality reduction, high FPG as a leading risk factor of fatal outcomes should be more targeted through the dietary, behavioral, and pharmacological interventions in Iran.

Background The science and technology health plan has defined the outline of health research to the national vision of Iran by 2025. The aim of this study was to focus on the process of needs assessment of health research projects also health research priority setting in Iran. Methods: The project management life cycle has four phases: Initiation, Planning, Execution and Closure. Based on abovementioned points we conducted the study. Results: Focusing on the needs assessment led to systematic implementation of needs assessment of health project in all of the medical sciences universities. Parallel with this achieved strategies health research priority setting was followed through specific process from empowerment to implementation. Conclusion: We should adopt with more systematic progressive methods of health project managements for both our national convenience as well as our international health research programs.

Several systems have been proposed to rank academic institutions worldwide. We aimed to introduce a new method of Health Research System (HRS) evaluation in Iran.In this cross-sectional study, a specific questionnaire has been used to assess stewardship, capacity building, and knowledge production through annual evaluations of HRS in Iran. This article has explored the results of the 5-year evaluation (2003 - 2008) and aims to introduce this method to other developing countries.According to our study, in the stewardship axes, all medical science universities designed strategic plans by 2008 and 70% of the approved projects were based on priorities. In the domain of capacity building, the trend in the number of arranged workshops and held congresses is ascending. In the domain of knowledge production, the number of Iranian biomedical research articles increased from 2996 in 2003 to 8816 in 2008.The proportion of ISI Web of Science/Pub Med indexed articles per academic members also increased from 0.09 to 0.33.We conclude that HRS evaluation in Iran has supported knowledge production and has strengthened evidence-based policy making. The adapted ranking system for evaluation of medical research activities is an effective strategy for HRS promotion.

To study the adolescence opinions' among nutritional habits and beliefs.To conduct a multi disciplinary approach through involving adolescence/youth for finding their mental needs and their suggestion for solving them, we designed a qualitative approach based on grounded theory. For data collection a semi-structured guide questioner designed and 16 focus group discussions were conducted by trained peers with youth aged 10-19 years.According to FGDs results, although majority of participants agreed on the important role of nutrition in health and the effect of nutritional habits on different aspect of health, they used modern and publicized fast foods. On the other hand, most of female and male participants said that different factors influenced the girls and boys diet selection i. e. girls' paid more attention to diet selection and taste and health of foods, whereas boys were careless and gluttony caused more food to be consumed.Adolescents' information (both genders) regarding nutritional problems resulting from improper food habits were not satisfactory. Peer-based health programmes through target groups for capacity building and participation of stakeholders will fulfill the objectives.

To study general practitioners' knowledge regarding smoking and their formal educational training on quitting smoking and associated readiness for providing associated services.This cross sectional study was carried out using an anonymous WHO based questionnaire. According to sample size estimated based on general practitioners' population ratio, review literatures and response rate probability; it was given to the 5140 general practitioners selected by random quota sampling method from a total of 25,600 practitioners all over the country at the time of the study.There were 3804 (74%) males with 16% being smokers and 4.6% having a history of smoking. Thirty percent of the subjects felt that they were ready for smoking cessation counseling, but only 9% had received formal training for it during medical school or post graduate training, while more than 80% perceived such training as necessary. Smoking cessation intervention during physician visits was associated with increased patient satisfaction especially among those who smoked.Formal training for smoking cessation among the study subject was inadequate. They were of the opinion that more courses should be included in medical school as better trained doctors could make good counselors.

Background: The prevalence of obesity continues to rise worldwide with alarming rates in most of the world countries. Our aim was to compare the mortality of fatal disease attributable to excess body mass index (BMI) in Iran in 2005 and 2011. Methods: Using standards implementation comparative risk assessment methodology, we estimated mortality attributable to excess BMI in Iranian adults of 25-65 years old, at the national and sub-national levels for 9 attributable outcomes including; ischemic heart diseases (IHDs), stroke, hypertensive heart diseases, diabetes mellitus (DM), colon cancer, cancer of the body of the uterus, breast cancer, kidney cancer, and pancreatic cancer. Results: In 2011, in adults of 25-65 years old, at the national level, excess BMI was responsible for 39.5% of total deaths that were attributed to 9 BMI paired outcomes. From them, 55.0% were males. The highest mortality was attributed to IHD (55.7%) which was followed by stroke (19.3%), and DM (12.0%). Based on the population attributed fractions estimations of 2011, except for colon cancer, the remaining 6 common outcomes were higher for women than men. Conclusions: Despite the priority of the problem, there is currently no comprehensive program to prevention or control obesity in Iran. The present results show a growing need to comprehensive implications for national and sub-national health policies and interventional programs in Iran.

Background: Constructions in informal settlements not respected any applying rules, regulations of urban planning, and building codes with high population density, are the municipality challenge. We aimed to identify level of buildings seismic vulnerability and population at risk in Tehran’s Farahzad informal settlement in 2017. Methods: In this observational cross-sectional study, residential buildings were assessed for seismic performance of constructions. We screened 160 buildings according to Iranian national guidelines by Rapid Seismic Visual Screening Method as a tool to calculate and determine Level of Retrofitting (LR) scores of buildings. We also interviewed residents of the buildings to collect data regarding socio-demographic data, individual disability status, Disaster Assessment of Readiness and Training (DART) regarding household disaster preparedness, and time occupancy in the buildings. Results: Overall, 160 buildings with 209 households and 957 individuals were surveyed. 97.5% of buildings were formed of heavy construction materials. None of them were categorized as engineered buildings and LR of residential buildings ranged from 82.4% to 163.8% with a mean 117.9%. LR scores of more than 100% were capped as 100%. Vulnerable groups of the sample population include under-five years old (8.7%), 60 yr old and above (6.7%), and 9.1% of households had at least one disabled member. 16.7% of households were living in homes with dense area. The DART score for 94.3% of surveyed households was zero. Conclusion: Disaster managers in Tehran municipality must design and implement a comprehensive risk reduction plan in poor urban areas as vulnerable regions for earthquake hazard.

"nBackground: The purpose of this study was to evaluate the effectiveness of peer education among university students for reproductive health promotion based on researchers' experiences."nMethods: This interventional study was conducted in Qazvin University of Medical Science during 2002 to 2004 through stakeholders' partnership and selection of 24 volunteer students according to their knowledge, interest, com­munication skills. Capacity building was performed through holding an interactive reproductive health coarse contained marital health, illegal abortion, family planning, STI/AIDS, communication and counseling skills. Trained peer educators have introduced to other student and present education and counseling formally and informally. A post interventional study was conducted after 9 months in order to find its effectiveness."nResults: In our experience Stakeholders' partnership in community interventional programs led to the best expected availability of better health through ownership and adopting policies. In present study, the proper determined criteria for selection of peer educators and clear understood expectations of the peer educators' role were very important in health promotional program. Although peer education was acceptable program for university students, more support and supervising for peer groups are needed. The students believed that the power point of peer education and counseling related to same age groups sympathy, confident, well behaved, cheerful, and kind-hearted and peer educators awareness."nConclusion: Universities are appropriate real world for experience a friendly youth program and then disseminate it to other young communities. There seems peer education is effective strategy for reproductive health promotion and reinforce positive behaviors in youth. &nbsp

Objectives: The purpose of this community-based participatory research was to compare different training sources for adolescents′ menstrual health education. Methods: From 15 middle schools in Tehran, through quota random sampling, 1823 female students were selected proportionally and allocated randomly to three groups (parent trained, schools′ health trainers trained, and control). Following a two-year training program, the adolescents′ menstrual health was compared. Results: In the present study, the school health trainers trained group showed a better feeling for menarche, compared to the two other groups (P < 0.001). The need for adolescent health training was emphasized by 82% of the participants; they also believed that the appropriate age for such empowerment courses was about 12 years. In the school health trainers trained group, the offered age was significantly lower than in other groups (P < 0.001). The adolescents trained by the school health trainers had a better practice of habits related to menstrual and hygiene practices, like having a bath during menstruation and the use of sanitary pads or cotton, compared to their counterpart groups (P > 0.05). Conclusion: It is suggested that school-based health training leads to better menstrual health promotion and healthy puberty transition, and school health trainers play a key role in this regard.

Background: The present paper aims to explore the role of Health Research Networks (HRN) in facilitating and expedite achieving the prospects for goals of health research based on the visions of Iran by 2025. Methods: Aiming to the main function of HSR to achieve the targeted conducting of health sciences research; more cooperation and coordination between health science researchers; avoid parallel investigations; and optimum utilization and appropriate distribution of resources, in 2000 the deputy of Research and Technology of Ministry of Health and Medical Education defined and developed a comprehensive HRN. Result: There are currently 27 research networks operating under the supervision of the Deputy of Research and Technology at MOHME. All of the HRN policies are following based on their strategic planning’s which are extracted from national visions of Iran by 2025. Conclusion: Promoting the current position needs a reliable and feasible new strategies. The present article introduces the lessons learned of our experience in virtual web-based health research networking in Endocrinology and Metabolism Research Institute (EMRI).

Background: More than 36 % of the total population of Iran consists of young people aged 15 to 25 yr. Recent studies show that this age group has the highest rate of serious health problems. Youth participatory studies on youth health priority have shown that mental health is one of the most important priorities in youth health. Aim to assessing the mental health needs of youth we conducted a peer group based multidisciplinary study. Methods: To conduct a multi disciplinary approach through involving youth for finding their mental health needs and their suggestion for solving them, we designed a qualitative approach based on grounded theory. To data collection, we used a semi-structured guide questionnaire. Sixteen focus group discussions were conducted by trained peers with youth aged 15-25 years. Result: According to FGDs results, most of youth health needs concern with their interpersonal communica­tions skills particularly with their parents'; they had some problems with their parental expectations meet; life skills; self-expression and problem solving process. They were extremely interested in participatory approach in which they involved in assessment and determination of their health problems also in designing health programs. Conclusion: Success of program shows empowering the community through capacity building and notice to peer group-based interventions to critical enhancing in various aspects of youth health is the most effective method to needs assessment and community mobilization for better health.

Establishment of medical research centers at universities and health-related organizations and annually evaluation of their research activities was one of the strategic policies which followed by governmental organization in last decade in order to strengthening the connections between health research system and health system. The aim of this study is to scrutinize the role of medical research centers in medical science production in Iran. This study is a cross sectional which has been performed based on existing reports on national scientometrics and evaluation results of research performance of medical research centers between years 2001 to 2010. During last decade number of medical research centers increased from 53 in 2001 to 359 in 2010. Simultaneous scientific output of medical research centers has been increased especially articles indexed in ISI (web of science). Proper policy implementation in the field of health research system during last decades led to improving capacity building and growth knowledge production of medical science in recent years in Iran. The process embedding research into the health systems requires planning up until research products improves health outcomes and health equity in country.