OBJECTIVES: The target of the Fourth Millennium Development Goal (MDG-4) is to reduce the rate of under-five mortality by two-thirds between 1990 and 2015. Despite substantial progress towards achieving the target of the MDG-4 in Iran at the national level, differences at the sub-national levels should be taken into consideration. METHODS: The under-five mortality data available from the Deputy of Public Health, Kermanshah University of Medical Sciences, was used in order to perform a time series analysis of the monthly under-five mortality rate (U5MR) from 2005 to 2012 in Kermanshah province in the west of Iran. After primary analysis, a seasonal auto-regressive integrated moving average model was chosen as the best fitting model based on model selection criteria. RESULTS: The model was assessed and proved to be adequate in describing variations in the data. However, the unexpected presence of a stochastic increasing trend and a seasonal component with a periodicity of six months in the fitted model are very likely to be consequences of poor quality of data collection and reporting systems. CONCLUSIONS: The present work is the first attempt at time series modeling of the U5MR in Iran, and reveals that improvement of under-five mortality data collection in health facilities and their corresponding systems is a major challenge to fully achieving the MGD-4 in Iran. Studies similar to the present work can enhance the understanding of the invisible patterns in U5MR, monitor progress towards the MGD-4, and predict the impact of future variations on the U5MR.
Data Collection ; Forecasting* ; Health Facilities ; Humans ; Infant ; Infant Mortality ; Iran* ; Mortality* ; Patient Selection ; Periodicity ; Public Health ; Seasons

PURPOSEIn 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.

METHODSIn 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.

RESULTSOut 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.

CONCLUSIONThe 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.

Accidents, Traffic ; mortality ; statistics & numerical data ; Adolescent ; Adult ; Age Distribution ; Aged ; Automobiles ; statistics & numerical data ; Cause of Death ; Cross-Sectional Studies ; Developing Countries ; Female ; Humans ; Incidence ; Iran ; epidemiology ; Male ; Middle Aged ; Motorcycles ; statistics & numerical data ; Pedestrians ; statistics & numerical data ; Retrospective Studies ; Risk Assessment ; Sex Distribution ; Survival Analysis ; Time Factors ; Young Adult

We aimed to examine associations between muscle strength and obesity and serum lipid profile in Ravansar Non-Communicable Disease (RaNCD) cohort study. This study was conducted on 6,455 subjects aged 35–65 years old from baseline data of RaNCD in Iran. The associations between grip strength and adiposity measurements were explored using linear regression with adjustment for age, height, smoking status, alcohol intake, social class, and prevalent disease. The mean of body mass index (BMI) and muscle strength was 27.2 ± 4.6 kg/m² and 33.3 ± 11.5, respectively. Muscular strength increased with increasing BMI and waist circumference (WC) in both sexes. Multivariate regression analysis revealed a 3.24 (95% confidence interval [CI], 2.29, 4.19) kg difference between BMI in top and bottom in men, and 1.71 (95% CI, 0.98, 2.34) kg/m² in women. After multivariable adjustment, a difference of 2.04 (95% CI, 1.12, 2.97) kg was observed between the top and bottom WC quartiles in men and 1.25 (95% CI, 0.51, 1.98) kg in women. In men, with increase of low-density lipoprotein and cholesterol, the mean muscle strength was significantly increased. Muscle strength may be associated with body composition and lipid profiles. Muscle strength can be an appropriate indicator for predicting some of the problems caused by body composition disorders, which requires further longitudinal studies.
Adiposity ; Body Composition ; Body Mass Index ; Cholesterol ; Cohort Studies ; Female ; Hand Strength ; Humans ; Intra-Abdominal Fat ; Iran ; Linear Models ; Lipoproteins ; Longitudinal Studies ; Male ; Muscle Strength ; Obesity ; Obesity, Abdominal ; Smoke ; Smoking ; Social Class ; Waist Circumference

OBJECTIVES: Obesity is a considerable and growing public health concern worldwide. The present study aimed to quantify socioeconomic inequalities in adult obesity in western Iran. METHODS: A total of 10 086 participants, aged 35-65 years, from the Ravansar Non-communicable Disease Cohort Study (2014-2016) were included in the study to examine socioeconomic inequalities in obesity. We defined obesity as a body mass index ≥30 kg/m2. The concentration index and concentration curve were used to illustrate and measure wealth-related inequality in obesity. Additionally, we decomposed the concentration index to identify factors that explained wealth-related inequality in obesity. RESULTS: Overall, the prevalence of obesity in the total sample was 26.7%. The concentration index of obesity was 0.04; indicating that obesity was more concentrated among the rich (p < 0.001). Decomposition analysis indicated that wealth, place of residence, and marital status were the main contributors to the observed inequality in obesity. CONCLUSIONS: Socioeconomic-related inequalities in obesity among adults warrant more attention. Policies should be designed to reduce both the prevalence of obesity and inequalities in obesity by focusing on those with higher socioeconomic status, urban residents, and married individuals.
Adult* ; Body Mass Index ; Cohort Studies ; Health Equity ; Humans ; Iran* ; Marital Status ; Obesity* ; Prevalence ; Public Health ; Social Class ; Socioeconomic Factors*

A precision instrument is required to assess the nutritional status. This study was conducted on comparison of 3 nutritional questionnaires to determine energy intake (EI) accuracy in adults in Ravansar Non-Communicable Chronic Disease (RaNCD) cohort study. This cross-sectional study was conducted on 118 of participant's RaNCD. EI was evaluated with 3 questionnaires including food frequency questionnaire (FFQ), 24-hours recall (24HR), and food habits questionnaire (FHQ). Resting metabolic rate (RMR) was measured using indirect calorimetry. We used EI/RMR cut off to evaluate EI reporting status. The mean ± standard deviation of age in men and women were 44.1 ± 6.5 and 43.7 ± 5.25 respectively and 50.8% of participants were men. Among 3 EI estimating questionnaires, FFQ was more accurate than 2 other questionnaires (67.8%). We observed that implausible reporters of 24HR were likely overweight (p < 0.005) but we did not observe a significant difference between EI reporting of FFQ and FHQ with participants' body composition. Our finding showed that EI underreporting of 24HR and FHQ were high. Under reporters were seemed to be overweight. Therefore, these results suggested that among 3 nutritional questionnaires the FFQ was an appropriate approach to determine EI in this population due to plausible EI reporting was higher than 2 other nutritional questionnaires (24HR and FHQ).
Adult* ; Body Composition ; Calorimetry, Indirect ; Chronic Disease ; Cohort Studies ; Cross-Sectional Studies ; Energy Intake* ; Female ; Food Habits ; Humans ; Male ; Nutritional Status ; Overweight

OBJECTIVES: Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort. METHODS: The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard. RESULTS: Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency. CONCLUSIONS: The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.
Blood Pressure ; Body Mass Index ; Cohort Studies ; Female ; Humans ; Hypertension ; Incidence ; Internship and Residency ; Iran ; Logistic Models ; Male ; Methods ; Prevalence ; Public Health ; Self Report ; Sensitivity and Specificity ; Smoke ; Smoking ; Social Class

OBJECTIVES: Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort. METHODS: The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard. RESULTS: Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency. CONCLUSIONS The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.