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Background Musculoskeletal disorders can reduce quality of life and work capacity. We found better muscle strength can prevent musculoskeletal pain including arthralgia, back, and joint stiffness. This current study was assessed hand grip strength in relation to low back pain and arthralgia in Kurdish men. Methods This cross- sectional study was conducted using data from Ravansar non- communicable diseases (RaNCD) cohort study on 2164 men aged 35–65 years. Hand grip strength (HGS) was measured using a hand-held hydraulic hand grip dynamometer. Low back pain, arthralgia, back and joint stiffness were evaluated by the RaNCD cohort study physician using a standard questionnaire. Results In current study, 21.39 and 24.58% of studied participants had low back pain and arthralgia. Among the participants with low back pain 14.5% had back stiffness and among the participants with arthralgia 12.8% had joint stiffness. The mean of HGS in participants with arthralgia, back and joint stiffness was significantly less than in participants without these disorders (P

BACKGROUND Despite being considered valuable information communication technology (ICT) tools, mobile phones can have some adverse health consequences. OBJECTIVE The present study was conducted to investigate the relationships of mobile phone usage with blood pressure and heart rate in the participants in the first phase of Ravansar Non-Communicable Diseases (RaNCD) cohort study. METHODS The present study used the data collected from the recruitment stage of a population-based investigation, RaNCD cohort study in western part of Iran. The participants with the mobile phone were divided into four equal quantiles using principal component analysis (PCA) to categorize the mean duration of mobile phone usage over the previous 12 months in min/day. RESULTS Among a total of 8801 participants 35-65 in RaNCD cohort, the duration of mobile phone use was 19.5 min/day, as 1515 (17.0%) of the participants in RaNCD cohort study did not use mobile phones. After controlling the confounding variables, the reduction in systolic blood pressure (SBP) was found to be higher than that in diastolic blood pressure (DBP) with an increase in the duration of mobile phone use. In fact, SBP -1.86(-2.83, -0.89) was less than DBP -1.86 (-2.83, -0.89) in the subjects who used their phones for 23.5-330 min/day compared to in those who never used a mobile phone. CONCLUSIONS The results of this study show that exposure to a cellular phone does not terribly effect on SBP, DBP and heart rate. We also found that cell-phone usage was inverse associated with hypertension in women than men; nevertheless, further studies are recommended that be conducted to confirm the significance of this relationship CLINICALTRIAL mobile phone, hypertension, systolic blood pressure, diastolic blood pressure

Background and aims one of the health concerns for any society is to have its own standard of growth. The aim of this study was to provide the age- and sex-specific percentile values of anthropometric measures for adolescents of developing countries. The use of global percentiles in developing countries overestimates underweight and stunting while underestimates overweight and obesity. Methods The data were obtained from the Global School-based Student Health Survey (GSHS). This study was conducted on school students, selected by multistage random cluster sampling from 73 developing countries. A parametric method was used for constructing age-specific reference intervals (normal ranges). Results In general, 210,045 11–18 years-old schoolchildren (14.38 ± 1.39) from 73 developing countries between 2003 and 2014 were included in this study, among which 103,080 (49.08%) were male and 106,965 (50.92%) were female. Calculation of body mass index (BMI) percentile showed that for all BMI percentile curves of both sexes, there was a gradual increase up to the age of around 15 years, and then remain stable (except for 95th percentile). Moreover in all weight percentile curves of boys, except 90th and above, there was a slight rise until the age of 18 years. In 10th height percentile curves and above in boys, there was a sharp increase up to the age of 17, followed by a decline. Similarly, this pattern was found for 50th height percentile and above in girls. Conclusion The use of global percentiles in developing countries overestimates underweight and stunting while underestimates overweight and obesity.

Background Drug use can lead to several psychological, medical and social complications. The current study aimed to measure and decomposes socioeconomic-related inequalities in drug use among adults in Iran. Methods This was a cross-sectional study The PERSIAN Cohort is the largest and most important cohort among 18 distinct areas of Iran. This study was conducted on 130,570 adults 35 years and older. A structured questionnaire was applied to collect data. The concentration index (C) was used to quantify and decompose socioeconomic inequalities in drug use. Results The prevalence experience of drug use was 11.9%. The estimated C for drug use was − 0.021. The corresponding value of the C for women and men were − 0.171 and − 0.134, respectively. The negative values of the C suggest that drug use is more concentrated among the population with low socioeconomic status in Iran (p Conclusions Our study indicated that drug use prevention programs in Iran should focus on socioeconomically disadvantaged population. Our finding could be useful for health policy maker to design and implement effective preventative programs to protect Iranian population against the drug use.

Background Socioeconomic inequality in mental health in Iran is poorly understood. This study aimed to assess socioeconomic inequality in poor mental health among Iranian adults. Methods The study used the baseline data of PERSIAN cohort study including 131,813 participants from 17 geographically distinct areas of Iran. The Erreygers Concentration index (E) was used to quantify the socioeconomic inequalities in poor mental health. Moreover, we decomposed the E to identify factors contributing to the observed socioeconomic inequality in poor mental health in Iran. Results The estimated E for poor mental health was − 0.012 (95% CI: − 0.0144, − 0.0089), indicating slightly higher concentration of mental health problem among socioeconomically disadvantaged adults in Iran. Socioeconomic inequality in poor mental health was mainly explained by gender (19.93%) and age (12.70%). Region, SES itself, and physical activity were other important factors that contributed to the concentration of poor mental health among adults with low socioeconomic status. Conclusion There exists nearly equitable distribution in poor mental health among Iranian adults, but with important variations by gender, SES, and geography. These results suggested that interventional programs in Iran should focus on should focus more on socioeconomically disadvantaged people as a whole, with particular attention to the needs of women and those living in more socially disadvantaged regions.

Background: While evidence has been highlight that obesity may be associated to the increased incidence of Nonalcoholic fatty liver disease (NAFLD), these data have depended on defective measures of obesity such as body mass index (BMI), and usually have not clearly well-known relationship between body composition (including fat within the nonfat mass) with NAFLAD. Methods: In a case control study of people aged 20–75 years, we directly measured body composition (using bioelectrical impedance analysis), height, weight and waist and hip circumferences who referred to radiology clinics in Kermanshah, Iran. Dietary intake was assessed by the food frequency questionnaire (FFQ). Results: Among 231 people examined, 103 cases with NAFLD and 119 as control were established. The risk of NAFLD was positively associated with higher BMI and the components of the body composition. These associations were strengthened after adjusted for potential confounders including gender, age, marital status, education, smoking, alcohol consumption, and physical activity Conclusion: An increasing prevalence of obesity may be associated with the increasing incidence of NAFLD as observed in many populations. We observed an increased risk of NAFLD associated with increased BMI, central adiposity and the fat component of weight, but found no association with nonfat mass.

Background Smoking is the most preventable cause of most chronic diseases such as cardiovascular disease (CVD). Dyslipidemia is also an important risk factor for CVD. Yet, research has provided contradicting findings regarding the association between smoking and blood lipids. This paper examines the relationship between dyslipidemia and smoking based on the results of a cross-sectional sample of a Kurdish population in western Iran. Methods This population-based study was derived from the recruitment phase of Ravansar Non-Communicable Disease (RaNCD) cohort study. Logistic regression model adjusted by confounding variables was used to determine the relationship between smoking and blood lipid components. In addition, dose-response relationship between blood lipids and the number of smoked cigarettes was evaluated. Results For the purpose of this study, 7586 participants were examined. The lifetime prevalence of smoking was 19.9%, and 11.8% were current smokers. The prevalence of dyslipidemia in current smokers (54.9%) was higher than former smokers (43.9%) and in turn former smokers higher than non-smokers (38.0%). Current smokers had greater risk of abnormal HDL cholesterol [OR (95% CI), 2.28(1.98 -2.62)] and triglyceride [OR (95% CI), 1.37(1.15 -1.67)] compared to non-smokers. There was no significant difference in total cholesterol and LDL cholesterol between the two groups. A dose-response relationship was found between the number of cigarettes smoked and HDL-C and TG but no relationship was observed in terms of total cholesterol and LDL-C. Conclusions As compared to non-smokers, current smokers and former smokers had abnormal HDL-C and triglyceride and abnormal total cholesterol and triglyceride, respectively. After quitting smoking, heavy smokers showed a more normal HDL-C and total cholesterol levels than the people who tended to smoke a lower number of cigarettes per day.

Background and aims Chronic inflammation is thought to have a major role in the pathophysiology of depression. Diet has been shown to modulate the inflammatory state, thus emphasizing its potential as a therapeutic role in depression. But, little is known about the relationship between dietary intake and depression. The current study aimed to investigate the relationship between major dietary patterns, a dietary inflammatory index (DII) score, and depression among women. Methods and Materials This cross-sectional study included 4630 women aged 35–65 years using baseline data from the Ravansar Non-Communicable Diseases (RaNCD) cohort study in Western Iran. Diet was evaluated using a validated 125-item food frequency questionnaire (FFQ) to determine DII scores and dietary patterns. Traditional, healthy, and unhealthy dietary patterns were extracted using factor analyses. Results A significant upward trend in the odds of depression was observed across the tertiles s of DII scores (P-trend: 0.019). After the adjustment for possible risk factors, a high adherence to an unhealthy dietary pattern was associated with a higher risk of depression than a low adherence (OR: 1.63; 95% CI: 1.1–2.4). A high adherence to a healthy dietary pattern was associated with the lower odds (OR: 0.61; 95% CI: 0.04–0.92). Among the main food groups, a high intake of eggs and refined grains was associated with a higher risk of depression. Conclusion In women, a refined grain dietary pattern is a risk factor for depression, whereas a healthy dietary pattern is protective. We have also shown that adherence to a pro-inflammatory diet was significantly associated with depression. Adherence to a dietary pattern with high intakes of dairy products, seafood, red meats, nuts, vegetables, fruits, flavor, and vegetable oils and diets with low inflammatory properties were associated with a lower risk of depression in women.

Background Sleep as an essential physiological need plays an important role in the human health. The aim of this study was to examine socioeconomic inequality in sleep duration among Kurdish people in Western of Iran.Methods The study used data of 10058 participants which from Ravansar Non-Communicable Disease (RaNCD) cohort study which recruited a sample of Kurdish adults in Kermanshah, west of Iran. The Slope Index of Inequality (SII) as well as the Relative Index of Inequality (RII) with 95% confidence intervals was calculated to determine socioeconomic inequality in sleep duration.Results There was 0.64 (95% CI: 0.55, 0.74) hour difference in the mean of sleep duration in favor of the rich group. Moreover, the mean of sleep duration in the people with lowest socioeconomic status quintile was 5% lower than those in the highest socioeconomic status quintile (RII= 0.95, 95% CI: 0.93, 0.96). For all analyses, observed inequalities were nearly equal by gender.Conclusion Our results demonstrated an important role for inequality in differential sleep duration in an Iranian Kurdish population. Improving the socioeconomic status of the general population especially people with low socioeconomic status may be useful in tackling the observed sleep issues.

Objectives We sought to determine the main factors related to relapse in patients with substance-related disorders (SRDs) who received methadone maintenance therapy (MMT) using decision tree (DT) analysis. Methods We conducted a cross-sectional study of 4175 patients referred to the 45 MMT centers in Kermanshah province, west of Iran. We included all patients who were under MMT for at least one year. All information was collected through an interview by a psychologist. Descriptive statistics and univariate and multiple regression models were used in statistical analysis. The Gini index was calculated to determine the cut-off point of nodes. We used the Classification and Regression Trees algorithm to create the DT. Results The relapse rate was 76.6% for all participants, with no significant gender differences. The DT resulted in a five-level model of significant factors affecting substance abuse relapse. These included lower cost for buying substances, lower age at first substance use, history of quitting substances without medication, frequency of substances utilization per month, and frequency of methadone therapy. Conclusions Knowing the main factors associated with substance abuse relapse could be important for health care providers to make better decisions for improving the treatment outcomes of SRDs.

Hand grip strength (HGS) can predict physical function in next year when it is positively associated with nutritional and health status. This study aimed to determine the relationship between the healthy eating index (HEI)-2015 and hand grip strength. This cross-sectional study was conducted on data from 4010 participants in the Ravansar non-communicable disease (RaNCD) cohort study. HGS was measured using a hand-held hydraulic hand grip dynamometer. HEI-2015 was calculated using data from the food frequency questionnaire. The mean of total HEI-2015 score was significantly higher in participants with an optimal HGS than in participants with a weak HGS (P = 0.006). Higher adherence to healthy eating was associated with optimal muscle strength (OR 1.26; CI 95% 1.02–1.62). This association was remained after being adjusted for potential confounders (P = 0.01). Among the HEI-2015 components, we only found association between whole fruit, added sugar, and HGS (P = 0.01, 0.019). Our findings indicated that adherence to HEI-2015 could promote muscle strength. Among the HEI-2015 components, higher intake of whole fruit and lower adherence to added sugar had significantly positive effects on HGS. Level V, descriptive cross-sectional study.

Background: Tuberculosis is one of Iran's most significant infectious diseases, which with the advent of new and chronic diseases, is still known as the most threatening disease of human community. The goal of this research was to assess the result of TB treatment in western Iran (province of Kermanshah) and its associated factors during 2005 to 2017. Methods: In this cross-sectional study, all patients who had tuberculosis from 2005 to the end of 2017 were evaluated. Treatment outcomes were categorized into four domains of “treatment completion," “death," “treatment failure," and “recoveries" based on national guidelines, and factors affecting outcome were identified using univariate and multivariate logistic regression. Results: Tuberculosis incidence was 15.21 in males and 14.32 in females per 100,000 individuals. The therapy result was almost uniform during the years investigated. 32.2% had extra pulmonary TB; 58.7% completed treatment; 9.9% died, and 4.1% had treatment failure. After controlling for key factors, the odds of completion of therapy in females were 1.1 (1.0-1.3) times greater than in males, and therapy failure and mortality caused by tuberculosis were also smaller in females than in males 0.6(0.4-0.8) and 0.5(0.3-0.7) respectively). HIV was the greatest variable in the prevalence of tuberculosis with 9.5 (5.8–16.8) times greater chances of death in HIV-positive people than those without HIV. Conclusion: Given the high prevalence of pulmonary tuberculosis and public health concerns, early screening and infection diagnosis, education and protective measures are suggested to prevent tuberculosis patients. Keywords: Epidemiology, Tuberculosis, Tuberculosis treatment results, Iran.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations., A high-resolution, global atlas of mortality of children under five years of age between 2000 and 2017 highlights subnational geographical inequalities in the distribution, rates and absolute counts of child deaths by age.

Hypertension is a public health issue in Iran. The study aimed to estimate the prevalence, awareness, treatment, and control of hypertension, and to explore their determinants among 10,040 Kurdish adults from Ravansar Non-Communicable Disease (RaNCD) cohort study in Iran. Univariate, and multivariate analyses were used for statistical analysis. Prevalence of hypertension was 15.7%. Among hypertensive patients, awareness, treatment, and control of hypertension were 80.7%, 73.2%, and 53.3%, respectively. In multivariate analysis, significant associations were found between awareness and female sex, older age, being married rather than being single, literacy, living in rural areas, having family history, and comorbidities, with a higher probability for those who had both diabetes and dyslipidemia. Being married, living in rural areas, being ex-smokers, having less physical activity and individuals who had diabetes and dyslipidemia had higher odds of receiving treatment. Being female had a statistically significant association with the control of hypertension. The Kurdish population had higher awareness, with a greater proportion of treated, and controlled patients compared to populations included in previous studies for the last 20 years in Iran. With the continuing health promotion programs in Iran, it is expected to observe a lower prevalence of hypertension, higher awareness and greater number of treated individuals with controlled hypertension.

Objective: To estimate (under reporting) UR of SD S (Suicide deaths) and SA S (suicide attempts) in Kermanshah Province which is among provinces with high suicide rate in Iran. Methods: For estimating the size of UR suicide death registers, all cases of SA S and suicide deaths were retrieved from forensic medicine and health centers. Then, using network scale up method, a sample of 500 cases, aged 18 to 65 years, were randomly selected from the general population on the basis of age - sex proportion. To find the 95% confidence interval, bootstrap technique was used. Results: The average coverage of SD S was 58.4%, the lowest and highest coverage rate of SD S were attributed to self-immolation (34.2%) and hanging (80.7%), respectively. The coverage rate of SA S for self-immolation and deliberate self-poisoning were 82.4% and 77.2%, respectively. Size estimation of SA S by NSU method revealed that deliberate self-poisoning with medication (61.7%), poisoning with toxins and chemicals (20.6%), and self-immolation (7.7%) were the most frequent methods of SA S . Conclusion: Given the low coverage of suicide registers, all causes of death, especially deaths classified as accident or deaths with undetermined category, are required to be accurately registered. Investigations of causes of death, correction of wrong codes, as well as interviews with survivors to give them assurance can reduce the rate of suicide denial and result in increased accuracy of death register coverage.

Background Women are the first victims in most of social damages and corruptions. However, due to some social and cultural reasons, the most of the drug addiction studies in Iran target male population. Hence, this study aimed to investigate the pattern of substance abuse and prevalence of HIV and hepatitis risk factors among addicted women. Methods This is a cross-sectional study conducted on women referred to methadone maintenance treatment centers of Western Iran (Kermanshah province). Data were collected through interview by a psychologist who is working full time in the centers. Results A total of 138 addicted women were studied. Among whom, 50 individuals were aged >45 years old (36.2%), 135 individuals (97.8%) had a history of substance abuse in their family, and 66 individuals (40.5%) initiated drug use before age 20. The most common substances were opium and crack with a proportion of 76.8% and 9.4%, respectively. Prevalence of positive HIV and hepatitis B among addicted women were 18.8% (26 persons) and 5.0% (7persons), respectively. Three (2.1%) of addicted women with HIV also had HBV. The most commonly HIV transmission were drug injections (30.7%) and unprotected sex (11.5%). Conclusions Although women do not constitute a significant part of substance abuse, increasing trend of women addiction, on one hand, and high prevalence of risk factors related to HIV or hepatitis in women, on the other hand; show that officials and experts are required to seriously consider prevention and harm reduction programs for women.

Alzheimer's disease (AD) is a progressive neurodegenerative disease leading to a gradual and irreversible loss of memory, linguistic skills, and perception of time and space, thinking, and behavior. Dietary pattern has been presented as a contributor to the incidence of Alzheimer's. This study aimed at reviewing the evidence on the relation between dietary pattern and AD. This systematic search was performed on the articles available in PubMed, Scopus, and Web of Sciences databases until May 2019 using keywords, including (diet, food, dietary pattern, food pattern) and (Alzheimer's disease) among observational studies. After excluding duplicated, and irrelevant studies, 26 studies were eligible for this review study. We categorized the studied dietary patterns into two groups: healthy and unhealthy diet. This study reviewed two case-control, five cross-sectional, and 19 prospective studies. Eight studies assessed unhealthy diet (high-fat diet, high-glycemic diet, sweetened sugary beverage, etc.) and the risk of AD. In addition, the other studies considered the effect of healthy diet such as Mediterranean diet, dietary approaches to stop hypertension (DASH), Mediterranean-DASH intervention for neurodegenerative delay, and seafood-rich diet on AD. This literature review indicated that adherence to a healthy dietary pattern has neuroprotective effects on AD prevention, while unhealthy diet can cause neurodegenerative effects in AD etiology. In conclusion, our findings showed that adherence to healthy diet can decrease oxidative stress and inflammation and accumulation of amyloid-β and consequently can decrease the risk of AD.

Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. The Lancet Publishing Group

Background and Aims: The objectives of the study were (i) cluster analysis of risky behaviors; (ii) determining correlates; and (iii) comparing clusters with regard to the attitude toward mental health help seeking. Methods: The current cross-sectional study is a part of the first phase of the Persian Youth Cohort. From October 2014 to January 2017, 2990 individuals from Ravansar City in western Iran completed structured interviews and national and international standard questionnaires. The obtained data were analyzed using two-stage cluster analysis, multinomial logistic regression analysis, and Chi-square test. Results: This model provided three distinct clusters: (i) low-risk group with mild distress, (ii) high-risk group with high distress, and (iii) violent group with medium distress. Some sociodemographic and lifetime psychiatric disorders were the correlates of unhealthy clusters (P < 0.05). Compared to the reference cluster, a higher number of members in unhealthy clusters were suffering from medium to severe disability. Nevertheless, the participants in these clusters were less inclined to mental health help seeking. Conclusions: More than half of the youth were suffering from suicidal and violent behaviors. Since high-risk participants are less inclined to mental health help seeking, the health policymakers can successfully utilize the results in planning general health programs.

Manual handling of bags which imposes frequent forces and stresses on body parts is a common task that many workers have to perform every day. The present study aimed to assess the postural risk and imposed forces due to manual handling and loading of sugar bags.This study was conducted on male warehouse workers of a sugar manufacturing plant. Rapid upper limb assessment (RULA) was used to assess the risks of awkward postures and computer-aided three-dimensional interactive application to estimate the forces and moments.RULA final scores were estimated to be 7 and 3 before and after the virtual redesign, respectively. Postures B and E obtained the highest compression forces and moments. The compression forces were higher than the action limit (AL) in all postures before the redesign and exceeded the maximum permissible limit (MPL) in posture E. After the redesign, these forces were reduced below the AL and MPL. Moreover, the shearing forces were lower than the AL and MPL in all postures.The main risk factors were heavy weight and poor control of sugar bags. Virtual redesign can diminish bending and twisting postures, and, therefore, some resulting forces and moments.

Purpose In Iran, the most common cause of injuries and the second leading cause of deaths are traffic accidents, and those problems impose a substantial financial burden on the society. This study aims to determine traffic accident mortality trends and their epidemiologic characteristics in the Kermanshah province, west of Iran. Methods In a cross sectional study, road traffic fatality data from 2004 to 2013 were analyzed to determine the epidemiological pattern of traffic accident mortality. Trend assessment was performed to ascertain the decreasing or increasing status. Chi-square and one-way analysis of variance (ANOVA) tests, as well as Poisson regression were used to determine the significance of the data in time. Data were analyzed using Excel and statistical package of SPSS version 19. Results Out of 5110 people that died in traffic accidents, 4024 (78.7%) were males. The state of accidents indicated that 404 (43.8%) female pedestrians died as a result of car crashes, and 1330 (41.4%) males died because of car collisions. 1554 (31.9%) deaths happened to pedestrians and 1556 (32.1%) to vehicle drivers, and the rest belonged to vehicle passengers. Head trauma was the cause of death for as much as 3400 (69.9%) cases. Fatal crashes in which pedestrians were involved mostly occurred between the hours 13:00 to 15:00, while the time for vehicle drivers was between 16:00 to 18:00. 2882 people (59.1%) died before reaching to health care facilities. Traffic crash mortality trend for pedestrians follows a linear pattern with a gentle downward slope, but the trend shows various swings when it comes to vehicle drivers. Conclusion The number of traffic crash deaths from 2004 to 2013 indicates a decreasing trend in two groups of road users: vehicle drivers and car occupants. This can be due to some interventions such as modification of traffic rules and enhancement of police control which has been implemented in recent years. Moreover, more attention should be paid to promote the optimal health care services to save the lives of the injured from traffic accidents.

Aim: Ginger is a natural dietary rhizome with antioxidant, anti-inflammatory, and anticarcinogenic properties. It has many medical beneficial properties such as anti-proliferation and antiapoptotic effects on cancerous esophageal cells. Materials and Methods: Esophageal cancer cells ESO26 were cultured in the presence and absence of ginger extract at various concentrations for 12, 18, and 24h. Then, the viability was determined by 3-(4,5-dimethylthiazol)-2,5-diphenyl tetrazolium bromide (MTT) assay. Western blot analysis of caspase-3 was performed to detect apoptosis. p21, Bax, and Bcl-2 gene expression was measured using quantitative polymerase chain reaction (PCR). Data were analyzed using one-way analysis of variance (ANOVA) followed by Tukey test. Results: The ginger extract increased the cleavage of caspase-3 in cells (P < 0.05). Results of real-time PCR have shown that ginger decreased the expression of Bcl-2 and increased Bax and p21 gene expression (P < 0.05). Conclusions: Results showed that the process of cell proliferation has been stopped. Also, this study indicated that ginger might exert a chemopreventive effect on esophageal cancer through the suppression of proliferation and the growth of tumor cells as well as the induction of apoptosis.

Objectives: The aim of this study is to determine the epidemiology of substance use in terms of age of initiation, duration of use and age of patients when they seek the treatment. Methods: This cross-sectional study was performed on drug-dependent individuals (4176 subjects), who had referred to methadone maintenance treatment (MMT) centers of Kermanshah province, western Iran, during year 2015. The information was gathered by psychologists working in substance use wards, who interviewed clients seeking treatment. Results: Mean age of substance use initiation was 24.1 ± 8.2 year. On average, males and females became dependent on illegal drugs only after 3.6 and 2.5 year since substance use initiation, respectively. The chance of treatment failure for persons over 55 years was 2.5 (95%CI: 1.6 - 3.8) times higher than that for patients aged less than 24 years old. Generally, chance of treatment failure increased by 1.2 (1.1 to 1.3) for every one-year increase since substance use initiation. Conclusions: Given that the age of substance use initiation is very low in Kermanshah and it has a declining trend in Iran, and has a declining trend, increase/decrease in prevalence/age of using illegal drugs is expected unless efforts are made to change status and implement preventive programs.

Background: Injection drug use (IDU) is one of the most dangerous and addictive methods of drug abuse. The current statistics showed that the rate of IDU is increasing, and is higher compared to other methods of drugs abuse. In addition, it is one of the main routes of transmitting infectious diseases, such as human immunodeficiency virus (HIV) and hepatitis in Iran. Objectives: In light of this, the present study aimed at examining the main factors, affecting the tendency for IDU. Patients and Methods: This study was a descriptive study of 823 individuals, having an active file at centers and referred to Kermanshah-based maintenance methadone therapy (MMT) centers, in 2015. Sample collection was performed through multi-stage sampling of all MMT centers. Information gathering was performed with the help of a Psychologist of the ward, in charge of interviewing the referees. The data were analyzed, using multi-variable logistic regression. Results: All the clients were males with an average age of 38.48 ± 11.21 years. Average age of drug abuse initiation was 23.03 ± 7.9 years. After controlling for confounding variables, the individuals, who were a drug addicts for more than 10 years had 3.01 (1.6 to 5.6) times greater tendencies for intravenous drug addiction, compared to those, who were a drug addict for less than five years. In addition, individuals aged more than 35 years had 0.06 (0.01 - 0.22) times less tendencies to IDU drugs, compared to those, who were younger than 19 years old. Although the type of drug that the patient used for the first time, was not affecting the tendency, the risk of intravenous drug addiction in those, who used oral drugs was 1.74 (1.1 to 2.56) times more than those, who developed a drug addiction through nasal drugs. Conclusions: By taking into consideration that drug abuse initiation and the duration of drug use were the main causes of the tendency for IDU, prevention by decreasing the age of the development of drug addiction and decreasing the duration of drug use, could be an effective measure to decrease the rate of IDU in the society.

(1) Cluster analysis of psychiatric disorders and partitioning the youth; (2) determining socio-demographic correlates and parental histories for each one of the clusters; and (3) comparing clusters based on the extent and type of using psychotherapeutic services. The current cross-sectional study is a part of the first phase of PERSIAN Youth Cohort. The sample of the study includes 2991 participants aged 15–34 (27 ± 5.1 years, 55.6% female) from Ravansar district in western Iran. Enrollment and data collection for this phase were performed from October, 2014 to January, 2017. The data were collected through structured interviews, including the Composite International Diagnostic Interview (CIDI; version 2.1), mental health-related Sheehan Disability Scale, and Service Use Questionnaire. The obtained data were analyzed using two-step cluster analysis, multinomial logistic regression, and Chi-square test. Our model proposed three clusters: a clinical cluster with significant mental disability; a healthy cluster with significant disability; and a healthy cluster with mild disability. There is a direct relationship between widow/divorced marital status and psychiatric maternal history with the clinical cluster (P

This study aimed to examine the association between smoking and obesity among adults in Kermanshah Province, west of Iran.A cross-sectional study.A total of 8822 participants, aged 35-65 yr, form Ravansar Non-communicable Disease (RaNCD) cohort study (2014-2016) were enrolled. Smoking habits were categorized in terms of smoking status (current, former and never smokers) and smoking intensity (light, moderate and heavy). General obesity was defined as body mass index (BMI) ≥30 kg/m2 and abdominal obesity were defined as a waist to hip ratio (WHR) ≥90 for men and ≥85 for women. Multiple logistic regressions were used to examine the association between general and abdominal obesity with smoking status and smoking intensity while controlling for age, sex, years of education and wealth index.Overall, 12% were current smokers, 8.4% former smokers and 79.6% never smokers. The prevalence of light, moderate and heavy smokers among current smokers was 30.8%, 18%, and 51.2%, respectively. The prevalence of general obesity was 27.6%, while the prevalence of abdominal obesity was 82.3%. The probabilities of general and abdominal obesity for current smokers were lower than never smokers by 34% and 36%, respectively. The probability of abdominal obesity for heavy smokers was 31% lower than light smokers. We did not observe significant associations between smoking intensity and general obesity.Current smokers compared to never smokers were less likely to be obese. The reverse association between smoking and obesity; however, should not be interpreted as a causal relationship.

Background: The most common suicide attempt (SA) is deliberate self-poisoning (DSP) in Iran. Although the proportion of fatal suicide by DSP is much lower compared to other methods, repeated suicide attempts (RSA) are very high. Objectives: This study aimed at determining the effective factors on RSA among patients referred due to DSP in west of Iran. Methods: All cases attempting DSP, who were referred to the only main poisoning treatment centre in the west of Iran, were assessed during year 2014. They were interviewed by psychologists in order to determine the number of SAs for each person individually, using data linkage. Data was analyzed by zero-truncated poisson regression. Results: During year 2014, of 1790 cases committed with DSP, 64 (3.5%) died because of the severity of poisoning. Among non-fatal DSP attempters, 1069 (61.94%) attempted suicide for the first time and 334 (19.34%) for the second time. In the multivariate model, age was an important predictor of RSA, so that the risk of RSA in 26 to 35 year-old age group was lower than in the 18-year-old age group (IRR 0.3, 95 % CI, 0.2 to 0.4 P = 0.001). Also, SA history was the first risk factor for RSA, so that individuals with SA history had higher RSA than individuals without SA history (IRR 3.1, 95 % CI, 2.8 to 3.3, P = 0.001). After SA history, psychological disorders were the most important risk factor for RSA (IRR 2.7, 95 % CI, 2.1 to 3.6, P = 0.001). Conclusions: Psychological disorders and SA history are the most important factors on RSA. Because of the high prevalence of psychological disorders in SA individuals than the normal population, it is necessary to present psychological and surveillance consultation to suicide attempters to decrease the number of SAs.

Background: Stigma of suicide attempt (SA) results in not asking friends and relatives for help. Others’ awareness of an individual’s SA sometimes can solve his/her problems and reduce rates of SA. This study is intended to examine the degree of SA visibility through deliberate self-poisoning (DSP), which is the most common method of SA in Iran. Methods: In order to study visibility, all individuals who had attempted to suicide by DSP and had been referred to the western Iran poisoning center during April-June, 2016 were entered to the study. A female and a male interviewer experienced in role-plaing were recruited to interview clients, each with clients of their own gender, in order to increase compliance and information accuracy. Multivariate Poisson Regression was used to identify visibility determinants. Results: Among 100 subjects interviewed, 10 denied SA. Regardless of those denying SA, self-poisoning visibility factor (SVF) was 26.6% (21.7-31.5) which decreased to 23.9% (19.7-28.1) after considering those individuals who denied SA. The highest values of SVF were observed in subjects poisoned by toxins, alcohol and illegal drugs, respectively. In the multivariate model, the value of SVF increased with an increase in age (IRR=1.03, 95% CI: 1.02-1.04), having history of SA (IRR=1.18, 95% CI: 1.07-1.30), and being married (IRR=1.70, 95% CI: 1.05-1.29). Conclusions: Lower values of SVF of DSP indicate that individuals committing suicide do not ask others for help and saying their SA intents. The higher the degree of visibility, the lower the rates of committing and repeating SAs. To increase the visibility of SA, therefore, the one way is to prevent and reduce SA repetition.

OBJECTIVES: Unhealthy dietary patterns are the most important changeable risk factors for breast cancer. The aim of this study was to assess the relationship between dietary patterns and the risk of breast cancer among under-50 year women in the west of Iran.METHODS: All women under 50 years old with pathologically confirmed breast cancer between 2013 and 2015 who were referred to oncology clinics in the west of Iran, and 408 under-50 women referred to other outpatient clinics who were without breast or other cancers at the time of the study and 2 years later were selected as the control group. The data were collected using the middle-aged periodical care form of the Iranian Ministry of Health and analyzed using univariate and multivariate logistic regression in Stata.RESULTS: The most powerful risk factor for breast cancer was fried foods; the odds ratio of consuming fried foods more than once a month for breast cancer was 4.5 (95% confidence interval, 2.1 to 9.4). A dose-response model indicated that increasing vegetable and fruit consumption up to 90 servings per month decreased the odds of breast cancer, but consuming more than 90 servings per month increased the risk.CONCLUSIONS: Inadequate consumption of vegetables and consumption of soft drinks, industrially produced juices, fried foods, and sweets were identified as risk factors for breast cancer. In response to these findings, it is necessary to raise awareness and to provide education about healthy diets and the need to change unhealthy dietary patterns.

Background: Self-immolation is one of the most violent methods of suicide, which is spreading in Iran. The highest rate of deaths due to committing suicide and self-immolation in Iran is observed in Kermanshah province. This research was conducted to study the survival rate and the factors that influence survival among the ones who commit self-immolation in Kermanshah province. Methods: In this study, all the cases who did not survive, as well as all the ones who were hospitalized due to self-immolation in Kermanshah province during 2010 and 2011 were examined. The Kaplan-Meier method was used to estimate the survival function, and in order to do the comparisons, Logrank test and Cox Regression were employed using Stata 12 software. Results: The results indicated that during 2010 and 2011, 343 individuals committed self-immolation in Kermanshah Province, while, 288 (84%) were women. Also, it was found that 184 (53%) did not survive, the mean and median of survival time in those who committed suicide deliberately, were 33±2.6 and 11±2 days respectively. Estimation of survival rate using Logrank test indicated that survival rate had a significant relationship with age, mental disorders, drug addiction, and TBSA (Total Body Surface Area), while it did not suggest a statistically significant relationship with gender, marital status and cause of injury. After multivariate analysis using Cox regression, only two variables of age and TBSA could remain in the model and the other variables were excluded from the model. Conclusion: The death toll due to self-immolation is very high and the mean and median of survival time among the people who committed self-immolation is very low. Therefore, it is recommended that remedial action be performed quickly without wasting time.

Introduction Life expectancy at birth (LEB) is closely associated with the degree of economic and social development in developed and developing countries. This study aimed to examine the socioeconomic factors affecting LEB in Iran from 1985 to 2013. Methods Time series analysis was used to examine the effects of key explanatory factors (GDP per capita, number of doctors per 10,000 population, degree of urbanization, food availability, CO2 emission, total fertility rate, inflation rate, and literacy rate) on LEB in Iran from 1985 to 2013. Study data were retrieved from the Central Bank of Iran (CBI), Iranian Statistical Center (ISC), and World Bank. Augmented Dickey Fuller (ADF) and Banergy, Dolado, and Master (BDM) tests, Engle Granger approach, and an ordinary least-square (OLS) model were used to achieve the aim of the study. Data analysis was performed by Stata V.12 software. Results Our findings indicated that GDP per capita (p=0.003), number of doctors per 10,000 population (p=0.036), literacy rate (p=0.0001), and food availability (p=0.0001) have a positive and significant statistically effect on LEB. The relationship between total fertility rate and LEB was negative and significant (p=0.023). In addition, the effect of degree urbanization (p=0.811), CO2 emission (p=0.185), and inflation rate (p=0.579) on LEB were not significant. Conclusion GDP per capita, number of doctors per 10,000 population, food availability, literacy rate, and total fertility were identified as the main factors affecting life expectancy in Iran. The study, however, suggests that life expectancy in Iran could be improved if attention is given to factors that reside outside of the health sector.

BACKGROUND: Self-immolation is one of the most violent methods of suicide in developing countries. The objective of the present study was to investigate the survival rate and factors affecting survival of self-immolation patients. METHODS: All people either died or hospitalized for intentional burns were assessed in Kermanshah province between 2010 and 2013. Required information was gathered from two sources, Kermanshah province legal medicine and burn center of Imam Khomeini Hospital. Survival function was assessed through Cox regression. The data were analyzed with Stata 12 software. RESULTS: Between 2010 and 2013 (three years), 446 people attempted self-immolation, of which 370 were females (83%). In general, 276 people (61.8%) died due to severity of the burns. The median of survival time was 47±5 days. The survival rate after one day, one week, and 21 days after accident was 86%, 52%, and 38%, respectively. Multivariate analysis demonstrated that burn was the most powerful risk factor, sothe risk in those with over 70% burns is 17 times more than those with burns less than 30%. CONCLUSION: Burn percentage is the strongest risk factor, those with high burns percentage should be hospitalized quickly and without waste of time. Language: en

DM type II is one of the most common chronic diseases. The objective of this study is to investigate the prevalence of DM and its association with other age-related diseases in Iran, 2012. In this cross-sectional study, people aged 60 years and over were selected using multistage sampling method. Mini-Nutritional Assessment (MNA), Activity of Daily Living (ADL), and Geriatric Depression Scale (GDS-15 items) questionnaires were used. History of common disorders was taken through self-report, medical records and the results of clinical examinations. A total of 1350 old people were studied. DM type II was found in 297 (22.0%) subjects and 371 (27.5%) of subjects were not aware of their DM status. Hypertension (55.6%), high serum cholesterol (51.8%), malnutrition (40.1%), Alzheimer's disease (16.9%), weight loss within past year (16.1%), weight gain within past year (11.7%), frailty (64.6%), insomnia (50.1%), and vision problems (62.6%) were significantly more common in diabetics. Those who were not aware of their status of DM either were between diabetics and non-diabetics or more similar to non-diabetics. Considering high prevalence of age-related diseases among Iranian elderly people, in particular women and those with DM type II, preventive measures are recommended so as to decrease and control DM type II and its consequent complications.

BACKGROUND: Burns are among the most common injuries affecting a great number of people worldwide annually. In Iran, especially in its western region and in Kermanshah province, burns have a relatively high incidence. The present study was aimed at investigating epidemiological characteristics in Western Iran. METHODS: Within a cross-sectional study, the data on all patients attending the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during 2010-2011 and 2011-2012 (24 months) were collected. Then, age, gender, cause of burns, total body surface area, and time of the occurrence were extracted from the hospital records. The data were analyzed using the SPSS statistical package (Version 19, for Windows). We used chi-squared test when we compared the categorical responses between two or more groups. For comparing means between two groups we used t-test. In addition, trends were investigated using linear regression. RESULTS: Overall 13 248 people were referred to the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during the period of study, including 328 cases of self-immolation. The mean age of the patients was 27±19 years and 29±13 years for unintentional burns and self-immolation respectively. Out of the total number of unintentional cases, 6 519 (50.5%) were men, while the corresponding percentage of men among the self-immolation cases was 16.6% (p less than 0.001). Trends in the number of cases were cyclic, with the highest and lowest number of burns cases being in March and May. Overall, hot liquids and flammable materials were the two most important causes of unintentional burns. However, flammable materials were the main cause of burns among self-immolation cases. During hospital admission, 168 (51%) self-immolation victims and 43 (0.33%) unintentional burn victims died. CONCLUSIONS: While major preventive measures are not adequately used in developing countries, burns and their burden can be significantly reduced by increasing public awareness and by applying simple preventive measures. © 2013 KUMS, All rights reserved. Language: en

The penetration of objects into the orbit can lead to blindness and even to the death of the patient. The penetration of organic objects longer than 7cm into the eye is a rare phenomenon. In this study, we report a case in which a 6-year-old boy fell on a pencil which penetrated the upper side of his right eye orbit. Because of the agitation of the child and the lack of access, it was not possible to perform a brain or orbital computed tomography (CT) scan, but an X-ray showed that the object had gone directly into the retro-orbital space. As the result of a clinical diagnosis, it was possible to ascertain that the globe was severely hypertonic. Throughout this process the child was extremely agitated. After consultation with the neurosurgery service, the patient was rushed to the operation room. After anesthesia and superanasal peritomy, the pencil was removed slowly from the orbit. Neurology and CT scans after surgery didn’t show any ocular or brain symptoms. Once the patient’s general condition had improved sufficiently and his visual acuity had returned to 10/10, he was discharged from the hospital. This case shows that even without specialized tests, such as CT scans, an organ can be saved.

Background Elimination of suicide attempts is impossible, but they can be reduced dramatically by an organized planning. The present study aimed to survey the suicide trends in Fars province (Iran), during 2004-2009 to better understand the prevalence and status of suicide. Methods This survey was a cross-sectional study. The demographic data were collected from the civil status registry between 2004 and 2009. Suicide and suicide attempt data were collected of three sources including the affiliated hospitals of Shiraz University of Medical Sciences, mortality data of Vice Chancellery of Health in Fars province and data from forensic medicine. Then, they were analyzed by Excel and SPSS. Chi-square and regression analyses were used for data analysis. Results During the study, 10671 people attempted suicide, of which 5697 (53%) were women and 4974 (47%) were men. Among them, 1047 people (9.8%) died, of which 363 (34%) were women and 679 (64%) were men. There was a significant relationship between gender and fatal suicide. The mean suicide attempt for both genders was 53 per 100,000 and 49, 57 for men and women, respectively. The trends in the incidence of Suicidal attempts were decreasing. Conclusion Without implementing effective preventive measures, the health care system in Iran will face a further burden of fatal suicides among young people. Therefore; enhancing the primary health care and specialized mental health services for those with unsuccessful suicide attempts can effectively reduce the burden of suicide.

Intentional self-poisoning that is widely used all over the world is one of the most common methods of suicide. This study aim was to determine the rate of attempted intentional self-poisoning and to identify high risk persons in the west of Iran (Kermanshah). A total of 3138 people (1279 M and 1859 F) studied. The average annual rate of suicide in Kermanshah was 153 persons per 100 000 people. The most number of attempted intentional self-poisoning (55.5%) were in the 20-29 year age group. The most popular toxic substances for self-poisoning were drugs (71%) and oil and fuels (15%), respectively. The most number of intentional self-poisoning suicides are attempted by drugs. By considering the high rate of intentional self-poisoning, low age of suicide attempts and also its high mortality rate in Kermanshah, it is necessary to stop the opportunity to buy over-the-counter (OTC) drugs , especially those being most misused. Language: en

The word Greek origin "Plagion" is the root of word plagiarism and in Latin it is "plagiarius", which mean kidnapper, seducer, plunderer and literacy thief. Plagiarism is a serious violation of publishing ethics in academic institutes. This study aimed to examine the conceptual awareness of masters- professors and postgraduate students of Ahvaz Jundishapur University of Medical Sciences (AJUMS) related to plagiarism issues. A self-made questionnaire was used with two different parts included the demographic variables and questions to elicit their conceptual awareness to five more common issues of plagiarism. Participants were 155 Masters-professors and 305 Postgraduate students in AJUMS in South West of Iran. The results show that less than half of the total number of masters-professors and 26.5% of postgraduate students succeeded in giving the right perception of all five common plagiarism forms, so are not familiar enough with plagiarism issue. If we add uncommon types in our list, knowledge level may become less than this rate. The academic institutes have to plan a comprehensive research ethics educational program for increasing understanding and awareness of academicians.

BACKGROUND: Penetrating spinal cord injuries (SCIs) are an uncommon injury and not reported very frequently. SCIs cause sensory, motor and genitourinary system problems or a combination of sensorimotor dysfunctions. These are among the most debilitating kinds of disorders and negatively affect quality of life, not only for the patient, but also for their family members. Therefore, the present study aims to evaluate complete or incomplete SCIs and the course of the injury and the prognosis for SCIs caused by stab wounds. METHODS: This case-series design study was performed on 57 patients attending the emergency department of Taleqani Trauma Center (Kermanshah, Iran) due to SCIs caused by violent encounters involving sharp objects such as a knife, dagger, whittle and Bowie knife between 1999 and 2011. An assessment of sensory and motor functions was performed as part of the neurological examination on admission, and during the treatment, using the Frankel Classification grading system, and the results were recorded. RESULTS: The average age of patients was 27 years (SD= 7.9, Range=17 to 46 years). The results of the study showed a proportion of cervical, thoracic and lumbar injuries of 23 (40%), 24 (42%) and 10 (18%), respectively. There was no case of cerebrospinal fluid leakage (CSF) or infection at the wound site in the subjects. Regarding the extent of the SCI, the combined neurological assessment showed that several patients (43%) had a complete SCI with no sensory and motor functions in the sacral segments and the segments below the site of injury. In 32 patients (57%) incomplete injuries were observed; i.e. they showed only some degrees of sensory-motor functions that were below the neurological level. CONCLUSION: Both complete and incomplete SCIs are of great importance because the prognosis of SCI is directly associated with the location and extent of injury. It should be considered that partial recovery from SCIs is possible in few cases of complete injuries. Therefore, all the patients should be treated carefully and seriously. © 2012 KUMS, All right reserved

BACKGROUND: Work-related injuries are the most important cause of work absence, disability, retirement, mutilation, and even mortality. In Iran a great number of work-related injuries are occurred in construction industry. However, less than 12% of total workers are active in the construction sector. OBJECTIVES: This study aimed to determine the incidence rate of work-related injuries, the type of injuries, and its other determinants among the construction workers of Ilam (Iran). PATIENTS AND METHODS: The participants were the workers and staffs working in the construction activities of Ilam in Western Iran. All the recorded injuries and deaths related to the construction workers of Ilam from 2006-2009 were collected from the Bureau of Labor and Social Affairs and then analyzed by the statistical package of SPSS (version 19, for Windows). RESULTS: During 2006 - 2009 in Ilam, 387workers encountered the building accidents. Their mean age was 34.3 years (SD = 12.4). The average annual incidence of work-related injuries among the workers was 8.2 per 1000 workers. Fracture with 275 cases (71%) was the most common outcome of injuries, and slipping and falling with 77 cases (36%) were the most important events and exposures. The most important factor related to injuries was the lack of surveillance by employers which was also related with the severity of accident-induced injuries (P CONCLUSIONS: Considering the effectiveness of the relevant preventive measures activities such as training the workers as well as using safety tools and more surveillance by employers can decrease the number of work-related injuries among constructive workers. Language: en