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*

OBJECTIVES: The worldwide incidence of metabolic syndrome (MetS) has increased in recent decades. In this study, we investigated the socioeconomic inequalities associated with MetS and its components in a sample of the Iranian Kurdish population. METHODS: We used data from 3,996 participants, aged 35 years to 70 years, from the baseline phase of the Dehgolan Prospective Cohort Study (February 2018 to March 2019). The concentration index and concentration curve were used to measure inequality and the Blinder-Oaxaca decomposition method was used to examine the contribution of various determinants to the observed socioeconomic inequality in MetS and its components. RESULTS: The prevalence of MetS was 34.44% (95% confidence interval [CI], 32.97 to 35.93). The prevalence of MetS was 26.18% for those in the highest socioeconomic status (SES), compared with 40.51% for participants in the lowest SES. There was a significant negative concentration index for MetS (C=-0.13; 95% CI, -0.16 to -0.09), indicating a concentration of MetS among participants with a lower SES. The most prevalent component was abdominal obesity (59.14%) with a significant negative concentration index (C=-0.21; 95% CI, -0.25 to -0.18). According to decomposition analysis, age, gender, and education were the highest contributing factors to inequality in MetS and its components. CONCLUSIONS This study showed socioeconomic inequality in MetS. People with a low SES were more likely to have MetS. Therefore, policymakers and health managers need to develop appropriate strategies to reduce these inequalities in MetS across age groups, genders, and education levels, especially among women and the elderly.

OBJECTIVES: Rates of attempted deliberate self-poisoning (DSP) are subject to undercounting, underreporting, and denial of the suicide attempt. In this study, we estimated the rate of underreported DSP, which is the most common method of attempted suicide in Iran. METHODS: We estimated the rate and number of unaccounted individuals who attempted DSP in western Iran in 2015 using a truncated count model. In this method, the number of people who attempted DSP but were not referred to any health care centers, n0, was calculated through integrating hospital and forensic data. The crude and age-adjusted rates of attempted DSP were estimated directly using the average population size of the city of Kermanshah and the World Health Organization (WHO) world standard population with and without accounting for underreporting. The Monte Carlo method was used to determine the confidence level. RESULTS: The recorded number of people who attempted DSP was estimated by different methods to be in the range of 46.6 to 53.2% of the actual number of individuals who attempted DSP. The rate of underreported cases was higher among women than men and decreased as age increased. The rate of underreported cases decreased as the potency and intensity of toxic factors increased. The highest underreporting rates of 69.9, 51.2, and 21.5% were observed when oil and detergents (International Classification of Diseases, 10th revision [ICD-10] code: X66), medications (ICD-10 code: X60-X64), and agricultural toxins (ICD-10 codes: X68, X69) were used for poisoning, respectively. Crude rates, with and without accounting for underreporting, were estimated by the mixture method as 167.5 per 100,000 persons and 331.7 per 100,000 persons, respectively, which decreased to 129.8 per 100,000 persons and 253.1 per 100,000 persons after adjusting for age on the basis of the WHO world standard population. CONCLUSIONS: Nearly half of individuals who attempted DSP were not referred to a hospital for treatment or denied the suicide attempt for political or sociocultural reasons. Individuals with no access to counseling services are at a higher risk for repeated suicide attempts and fatal suicides.
Classification ; Counseling ; Delivery of Health Care ; Denial (Psychology) ; Detergents ; Female ; Humans ; Iran* ; Male ; Methods ; Monte Carlo Method ; Poisoning ; Population Density ; Suicide ; Suicide, Attempted ; World Health Organization

OBJECTIVES: Rates of attempted deliberate self-poisoning (DSP) are subject to undercounting, underreporting, and denial of the suicide attempt. In this study, we estimated the rate of underreported DSP, which is the most common method of attempted suicide in Iran.METHODS: We estimated the rate and number of unaccounted individuals who attempted DSP in western Iran in 2015 using a truncated count model. In this method, the number of people who attempted DSP but were not referred to any health care centers, n0, was calculated through integrating hospital and forensic data. The crude and age-adjusted rates of attempted DSP were estimated directly using the average population size of the city of Kermanshah and the World Health Organization (WHO) world standard population with and without accounting for underreporting. The Monte Carlo method was used to determine the confidence level.RESULTS: The recorded number of people who attempted DSP was estimated by different methods to be in the range of 46.6 to 53.2% of the actual number of individuals who attempted DSP. The rate of underreported cases was higher among women than men and decreased as age increased. The rate of underreported cases decreased as the potency and intensity of toxic factors increased. The highest underreporting rates of 69.9, 51.2, and 21.5% were observed when oil and detergents (International Classification of Diseases, 10th revision [ICD-10] code: X66), medications (ICD-10 code: X60-X64), and agricultural toxins (ICD-10 codes: X68, X69) were used for poisoning, respectively. Crude rates, with and without accounting for underreporting, were estimated by the mixture method as 167.5 per 100,000 persons and 331.7 per 100,000 persons, respectively, which decreased to 129.8 per 100,000 persons and 253.1 per 100,000 persons after adjusting for age on the basis of the WHO world standard population.CONCLUSIONS: Nearly half of individuals who attempted DSP were not referred to a hospital for treatment or denied the suicide attempt for political or sociocultural reasons. Individuals with no access to counseling services are at a higher risk for repeated suicide attempts and fatal suicides.
Classification ; Counseling ; Delivery of Health Care ; Denial (Psychology) ; Detergents ; Female ; Humans ; Iran ; Male ; Methods ; Monte Carlo Method ; Poisoning ; Population Density ; Suicide ; Suicide, Attempted ; World Health Organization

Objectives: Socioeconomic inequality in metabolic syndrome (MetS) remains poorly understood in Iran. The present study examined the extent of the socioeconomic inequalities in MetS and quantified the contribution of its determinants to explain the observed inequality, with a focus on middle-aged adults in Iran. Methods: This cross-sectional study used data from the Ravansar Non-Communicable Disease cohort study. A sample of 9975 middle-aged adults aged 35-65 years was analyzed. MetS was assessed based on the International Diabetes Federation definition. Principal component analysis was used to construct socioeconomic status (SES). The Wagstaff normalized concentration index (CIn) was employed to measure the magnitude of socioeconomic inequalities in MetS. Decomposition analysis was performed to identify and calculate the contribution of the MetS inequality determinants. Results: The proportion of MetS in the sample was 41.1%. The CIn of having MetS was 0.043 (95% confidence interval, 0.020 to 0.066), indicating that MetS was more concentrated among individuals with high SES. The main contributors to the observed inequality in MetS were SES (72.0%), residence (rural or urban, 46.9%), and physical activity (31.5%). Conclusions Our findings indicated a pro-poor inequality in MetS among Iranian middle-aged adults. These results highlight the importance of persuading middle-aged adults to be physically active, particularly those in an urban setting. In addition to targeting physically inactive individuals and those with low levels of education, policy interventions aimed at mitigating socioeconomic inequality in MetS should increase the focus on high-SES individuals and the urban population.

Ipsilateral mydriasis (IM) is usually not acute. However, the acute occurrence of unilateral dilated pupil may result in acute ischemic stroke. Herein, we present 3 patients with IM, lateral eye deviation, ptosis, and contralateral hemiparesis due to isolated occlusion of the pre-communicating segment of the posterior cerebral artery with preservation of the posterior communicating artery, which was successfully treated by emergent mechanical thrombectomy. In a 3-month follow-up, all patients were independent without any neurological deficits.

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

The widely accepted option for treating traumatic direct carotid-cavernous fistula (dCCF) has been endovascular treatment using detachable balloons, coils, or embolic agents. Covered stent deployment has been applied by a few operators and has shown promising results. This is a retrospective study on patients with dCCF treated by an endovascular approach using BeGraft, a covered stent. In 4 cases, this device was successfully deployed without any complications. Immediate complete occlusion was achieved in 3 patients (75%) after deployment of the covered stents. One patient required transvenous coiling for occlusion of the remaining endoleak. Follow-up imaging demonstrated 100% fistula occlusion with complete internal carotid artery patency. No early or late complications occurred following treatment. In conclusion, the BeGraft-covered stent could be a promising safe and effective alternative option for the endovascular treatment of dCCF.