alireza moghisi

Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present.

In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey.

By amending the required changes, we could include a total of 27874 individuals in the first step of the survey. This number was 27745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants.

The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.

 Given the importance of appropriate response to prevent and manage Non-Communicable Diseases (NCDs), this study aimed to analyze the state of NCDs services at the level of the PHC system during the COVID-19 pandemic and to determine the main strategies.

 In this qualitative study, first, the circulars and guides in Iran's PHC system from the beginning of the pandemic to the end of September 2020 were retrieved manually and by searching the internal websites of the Ministry of Health. All documents about decision-making or governance and coordination mechanisms for the provision of NCDs services were enrolled and analyzed. In the second phase, the status of service delivery for major NCDs was presented in a model, and finally, SWOT analysis was used to analyze the situation and determine the main strategies. 

 25 out of 199 circulars and guides were eligible and analyzed. In the crisis phase, most risk assessment, screening, and diagnosis services for NCDs have been suspended, and follow-up and care of patients with major NCDs were done by telephone. In the reopening phase, the general strategies and strategies to increase capacity and provide delayed care were adopted, and the PHC model of the provision of essential services for the major NCDs was developed in low-risk, intermediate and high-risk pandemic conditions. Finally, 16 main strategies were determined with the approach of integrating and focusing on essential services, considering vulnerable groups and the use of E-health technologies.

 The results indicate on interruption of NCDs services in the crisis phase while adopting strategies for responding to the pandemic. Revision of the COVID-19 guides with a particular focus on NCDs is recommended.

The COVID-19 pandemic has caused significant disruptions in the provision of non-communicable disease (NCDs) prevention and control services in many countries, and there is a concern that it would lead to long-term complications of the diseases. The aim of this study is to assess the changes in the provisions of selected NCD services before and after the COVID-19 epidemic in Iran’s primary healthcare system.

In this descriptive-analytical retrospective study, the number of eight NCD services provided during the first 10 months of the COVID-19 pandemic from Feb 2020 to Dec 2020 were compared with the same period in the previous year using the data from the Iranian integrated electronic health record system (SIB) and also the association between the number of deaths due to COVID-19 and a sample of NCD services were assessed using cross-correlation analysis. The statistical analysis was performed in Stata Software v.14.

The NCD services have decreased by an average of 18.89% compared to the same period in the previous year; this decline was much more severe at the beginning of the epidemic period (up to 75% in some services) and was greater in physician-provided services than in non-physician services. Also, examining the course of the selected services during this period, a gradual compensation was evident after the initial reduction.

The general trend of the selected services of prevention and control of NCDs in the PHC system of Iran within 10 months after the onset of COVID-19 showed a sharp decline and subsequent gradual compensation. Although the process of compensation in some services may be considered somewhat reassuring, in the case of some essential services, more effort and attention to the implementation of programs or compensatory policies seem necessary.

Covid-19 pandemic has caused significant disruptions in the provision of non-communicable disease prevention and management services in many countries and there is a concern that this disorder will lead to long-term complications of these diseases; This study aimed to quantitatively analyze the status of some prevention and management services of non-communicable diseases in the primary health care system of Iran during the Covid-19 pandemic.

In this study, the routine data of 8 services related to the prevention and management of non-communicable diseases in the integrated electronic health record system (SIB) within 10 months after the outbreak of Covid-19 were compared to the same period last year.

Non-communicable disease prevention and management services have decreased by an average of 18.89% compared to the same period last year; this decrease was much more severe at the beginning of the epidemic period (up to 75% in some services) and more in the services provided by physicians than in the services provided by non-physicians. Also, observation of the course of selected services during this period showed that after the initial reduction of services, a process of gradual compensation is evident.

like other areas involved in the pandemic, the effect of the Covid-19 epidemic on non-communicable disease prevention and management services in the primary health care system of Iran, has been significant and although partial compensation of some services is promising, more attention and effort is needed to revive the other programs.

Evidence shows that COVID-19 pandemic affects non-communicable diseases (NCDs), significantly. This study aimed to analyze the status of prevention and management services of NCDs at the level of primary health care (PHC) system during the COVID-19 pandemic.

In this situation analysis study, first the circulars communicated at the level of PHC system from beginning of the pandemic to the end of September 2020 were manually and electronically retrieved, and those which included a decision or action in terms of governance and coordination mechanisms to provide NCDs in crisis and reopening stages, were analyzed. Then, the plans of major NCDs services in low-risk, intermediate, and high-risk conditions were developed and finalized based on the circulars. Finally, situation analysis was performed using SWOT analysis, and proposed strategies were extracted.

25 out of 199 circulars were analyzed. In the crisis phase, most screening, risk assessment and diagnostic services were suspended, and the follow-ups and care of patients with NCDs were mainly done by telephone. In the reopening phase, general strategies were adopted to increase capacity and to compensate delayed care, and the plan of major NCDs services at the PHC system was developed in the three-pandemic settings. Finally, main strategies were proposed with integration approach and focusing on essential services, considering vulnerable groups and the use of E-health technologies.

The results indicated an interruption in NCDs services during the crisis phase, while adopting strategies to respond to the pandemic. Revision of the COVID-19 guides with a particular focus on NCDs prevention and management services is recommended in national response plan.

Chronic lymphoid leukemia (CLL) is one of the most prevalent types of leukemia, which is responsible for a remarkable mortality rate in the world. This study aimed to investigate the global trend of this cancer from 1990 to 2015 and to determine the relationship between trend of CLL mortality rate and Human Development Index (HDI) throughout the world.

The age-standardized mortality rate data of all countries of the world (per 100,000) were extracted from the GBD database. In addition, the HDI values for the studied countries in different years were obtained from the UNDP database. The statistical analysis was performed using the mixed-effects location-scale model in the SAS software, version 9.4.

The findings of the statistical modeling showed a downward slope for CLL Age Standardized Mortality Rate (ASMR) for total world countries ( ). We also find a significant association between CLL ASMR and HDI. Countries with higher HDI had higher level of CLL ASMR in years 1990 to 2015 with a negative slope. Furthermore, countries with lower HDI had Lower level of CLL ASMR with rather fixed rates in this period.

These findings showed a decreasing trend of global CLL ASMR in the previous decades, although, the fixed trend of CLL ASMR in countries with low HDI is worrisome. The health policymakers should make more efforts to decrease the mortality due to this cancer in these countries.

High-risk driving behaviors are one of the most important and effective factors in the occurrence of traffic accidents. The purpose of this study is to predict driving behavior based on emotional intelligence and perception of driving risk.

The present study is a descriptive in terms of correlation. The statistical population is taxi drivers in Tehran, of which 400 were selected from 5 taxi terminals in 5 different areas of Tehran. Pearson correlation and multiple regression statistical tests were used to analyze the data.

The analysis of the findings of this study indicates that there is an inverse relationship and significance between driving behavior and perception of driving risk (r = -0/34, a= 0/01) and also between driving behavior and emotional intelligence (r = -0/28, a= 0/01). In addition, 16% are able to predict driving behavior due to emotional intelligence and perception of driving risk.

The results of the present study show that high-risk driving behavior can be predicted through emotional intelligence and perception of driving risk. High-risk driving behavior also decreases with increasing emotional intelligence and perception of driving risk. In other words, drivers who commit driving offenses, accidents, and high risk and unsafe driving behaviors and violate traffic rules ,have lower emotional intelligence and risk perception than other drivers.

Physical inactivity (PA) is one of the leading modifiable risk factors for noncommunicable diseases (NCDs) worldwide. This study aimed to determine PA levels and related sociodemographic factors as risk factors for NCDs among Iranian adults.

In this cross sectional study, data were collected from the sixth nationwide STEPS survey in 31 provinces of Iran. A total of 6100 individuals aged 18-64 years were selected by a multistage cluster sampling method, and their PA levels were assessed using the Global Physical Activity Questionnaire (GPAQ).  Data were analyzed using descriptive methods and analytical tests, including chi-square, ANOVA, and independent t tests in SPSS version 21 software.

The prevalence of vigorous, moderate, and low levels of PA was 36.3% (95%CI:35.1-37.5), 29.2% (95%CI:28-30.3), and 34.5% (95%CI:33.3-35.7) in participants, respectively. The mean ± SD of total MET-min/week was 1842.3±2619.3. Total mean ± SD duration of PA was 98.2 ± 115 min/week (125.8±142.6 and 77.2±84.5 min/week in men and women, respectively). Transport-related PA and severe PA at work had large and small contributions to overall PA, respectively. Urbanization, sex, age, family size, and occupation status were identified as factors associated with PA levels (p<0.001).

This study revealed a significant prevalence of low PA among the target population and some sociodemographic characteristics identified as factors associated with PA. Identification of these factors can develop more effective interventions to promote PA.

Comprehensive and accurate data are fundamentally needed for effective management of road traffic injuries (RTIs). Existing sources of RTI reports have a huge underestimation and inaccuracy at some levels. The aim of this study was to develop and validate the registrar-station data collection tool as a part of the Iranian Integrated Road Traffic Injury Registry (IRTIR).

This study was conducted in Tabriz University of Medical Sciences in 2018. A data collection tool was developed to be used by the registrar for inpatient section of IRTIR by information retrieved from the literature review and road traffic experts’ need assessment. The content validity of the preliminary tool was assessed. The feasibility of the tool was tested in two regional referral injury hospitals. Intra- and inter-rater reliability of the tool was evaluated using the individual/absolute intra-class correlation coefficient (ICC) and Kappa. Validity was revisited after 1 year of the pilot study.

The registrar-station data collection tool of IRTIR included 53 items, in five categories. Content validity was approved (modified content validity index was 0.8–1 and content validity ratio was one for all items). ICC was >0.6 for all items, and kappa index ranged between 0.69 and 0.92. The nurse data collection tool of IRTIR was applicable in the pilot phase.

The Registrar-Station data collection tool of IRTIR was confirmed as a valid and reliable tool for inpatient traffic injuries as a part of the Iranian IRTIR

Injuries are still considered as one of the public health problems in Iran and in the world, and their control and prevention are a burden on the health system of many middle and lower income countries. One of the barriers to controlling and preventing injuries in low and middle income countries is the inadequacy or inaccuracy of information. Therefore, there is a need for a relevant national database for these countries. The purpose of this study was to introduce a specialized safety and injury database.

Multilayer architecture has been used in the design of the Iranian Safety and Injury Database (SafeLir). The design of this database is based on several programming languages including SQL, HTML, and Java Script and C #. The performance of this database has been evaluated along with other medical information databases. Ethical considerations are included in the study.

A review of the different sections of the database showed that the SafeLir database has ideal conditions for users and researchers to use in safety and injury research. At present, the beta version of the SafeLir is available on-line, and a variety of documents, including articles from academic journals and congresses, books and dissertations in related fields, can be retrieved from this database. The evaluation of the performance of this SafeLir along with other medical databases also showed that the performance of this database is appropriate and reliable in retrieving relevant information. Even in retrieving national documents, SafeLir's performance was better than other medical databases.

The SafeLir database includes all features expected by researchers and it can be used as a specialized source of safety and injury research.

Overweight and obesity are considered as non-communicable diseases (NCDs)risk factors with increasing prevalence worldwide. This nationwide study aimed to determine the socio-demographic determinants of obesity indexes in Iran.
This cross-sectional study was conducted based on data from the sixth round of nationwide Stepwise approach to surveillance (STEPS) survey in the 31 provinces of Iran in 2011. A total of 9878 people aged ≥20 years were selected using a multi-stage cluster sampling method.
Data were collected through three steps questionnaire including ecological, physical and biochemical measurements. We assessed body mass index (BMI), waist circumference(WC) and waist-hip ratio (WHR) as the main indicators of obesity.
In this study, the weighted prevalence of overweight and obesity were 34.5% (95% CI:33.6, 35.5) and 21.5% (95% CI: 20.7, 22.3), respectively. The mean ± standard deviation (SD)of BMI among men and women were 25.4±4.4 and 26.9±5.2 kg/m2 respectively. Older age,living alone, having lower education level, being housewife or retired were associated with overweight and obesity (P The prevalence of overweight in this study was less than global rate while it was vice versa for obesity prevalence. Some socio-demographic characteristics were identified as determinants of obesity which should be considered for planning preventive and control action plans.

Given the importance of access to information and the need for reliable data, systematic approaches to evaluation of national surveys such as NCD risk factor surveillance system (STEPs) is a priority. Benefiting from partnership of all of stakeholders, present paper provides a practical framework of the strengths and weaknesses of planning and conduction of vast investigation. In addition, it can offer solutions for improving operational and scientific protocols.
The aim to the comprehensive review and analysis of 6 rounds implementations of STEPs, related documents, along with the findings of a qualitative study of the expert opinions were analyzed. The results were presented corresponding to the strengths, weaknesses, and challenges, with proposed approaches.
The results of this study show that in the years of 2004 - 2009 as well as 2011, the same questions have different codes in the questionnaire and in the data files. Based on the results, over the past 6 years, there are more than 240 distinct options in the questions. Accordingly, under 2 main axes of content and implementation, the findings were presented in accordance with the strengths, challenges, and suggested solutions, which includes the areas of questions, anthropometric, biological measurements, and sampling.
Development and standardization of administrative and scientific protocols of STEPs, along with the management of levels of security and availability of data proposed as long-term policies for better conduction and promotion of the study.

There is a little consistency among prenatal care guidelines. An evidence-based guideline can be used to improve the quality of the mother and child health care. This study was designed to compare the consistency of the Iranian integrated maternal health care guideline with evidence-based prenatal care manuals and American guidelines.
In this comparative study, the Iranian guideline recommendations were compared with the content of American prenatal care according to obstetrics and gynecology recommendations of the U.S. preventive services task force and evidence-based prenatal care. The strength of the recommendations was assessed based on evidence-based medicine.
In this study, 71 recommendations were compared in four parts. About 18.3 percent of the recommendations were consistent with all guidelines. Screening for group B streptococcus, performing chorionic villous sampling and amniocentesis for at risk women, and anomaly screening were not mentioned in the Iranian guideline. The Iranian guideline was consistent with the content of U.S. preventive services task force in 38% of the recommendations, American Obstetricians and Gynecologists expert panel guidelines in 75.6% of the recommendations, and with evidence-based care in 66.2% of the recommendations.
Although there was a little consistency among guidelines, the Iranian guideline had a good consistency with the American guidelines and evidence-based care recommendations. Updating clinical tests and the prenatal screening part of the Iranian guideline based on the results of this study may increase the effectiveness of the prenatal care and ultimately improve the mother and child’s health.

A surveillance system helps to detect epidemics and the pattern of the incidence of the problems in the community and is important for evidence based decision making. This study was conducted to determine the feasibility of the Pregnancy Risk Assessment Monitoring System (PRAMS) in Iran. PRAMS feasibility was assessed in a cross-sectional study in the city of Shahriar, located in the west of Tehran in 2013. In this study, 811 women within 2 to 6 months postpartum who had a live or still birth were selected from thyroid screening forms and hospital records through a systematic simple random sampling method. Trained interviewers collected the data via calling mothers from health centers or through home visits. The outcome was tested on the «TELOS» model including technical, economic, legal, operational and schedule feasibility components. Thirty-seven health volunteers collected the data in this study. Many prevalence estimates were comparable with national and Tehran data (technical feasibility). A home based completed questionnaire cost 2. 45 and a phone cost 1. 89 USD (economic feasibility). The project was consistent with legal requirements (legal feasibility). The participation rate was 92. 8% (95%CI: 92. 7-95. 3) for home visits and 90. 9% (95% CI: 87. 3-93. 6) for the phonemethod. Over 80% of different sections of the questionnaire were completed (operational feasibility). All data collection processes took 35 days (schedule feasibility). The adapted PRAMS could be considered feasible in Iran. Its widespread and periodic implementation can provide valuable maternal and child health information in the country.

Three studies were conducted aiming to design specific interventions regarding motorcyclist''s safety using Haddon matrix in 14 cities of Iran. Motorcyclists'' fatality data was extracted in 14 cities (5 safe community practicing and 9 safe community non practicing cities) during 2006-2007. As the next step a cross sectional study on Knowledge, Attitude, Practice (KAP) of motorcyclists about helmet was performed. A range of variables relevant to motorcyclists'' injury and prevention were developed and organized according to the Haddon matrix. The risky behaviors, including over speeding, acrobatic movement, no helmet or not properly wearing helmet were considered. Data were analyzed with chi-square and ANOVA method using STATA software. The highest mortality rate was revealed in Niriz city (NSC) and the least was reported from Arsanjan city (SC) in Fars Province. In Busher province, the highest death rate was detected in the Busher city (SC) and the least was in the Genaveh city (NSC). In Khorasan, the highest death rate was reported from Torbat-e-hydarieh city (NSC) and the lowest was from Bardscan (SC). Male drivers of 19-39 years old were the most affected age groups. The rate of helmet usage in overall was 13% while 97% owned a helmet. Embarrassing of wearing helmet was mentioned by 70% of participants as a reason for not wearing helmet. Participants believed that public education and re-enforcement of mandatory helmet law are two important ways to raise the helmet usage. Constant public education in addition to attention to traffic rules are two important factors to promote helmet wearing rate.