Background: The World Health Organization program on Ending Childhood Obesity (WHO-ECHO) has developed a comprehensive and integrated package of recommendations to address childhood obesity. The present study, entitled IRAN-ECHO, was designed and implemented in the framework of the WHO-ECHO program. Methods: The IRAN-ECHO program is implementing multicomponent interventions by considering life course dimensions. The program has two parts: a population approach and an individual approach. The population approach considers different periods in life, including prenatal, infancy, childhood, and adolescence, as well as family and society. The individual approach targets those children or adolescents with overweight or obesity; this part is conducted as a referral system that is now integrated in the current national health system. As part of the population approach, a quasi-experimental study was conducted in six provinces to compare the status before and after implementing parts of the interventions. By intersectoral collaboration with different organizations, multicomponent interventions are conducted for different age groups. Results: The IRAN-ECHO program is being conducted in six provinces, and will be considered in all provinces in the near future. Its main effects could be assessed in future years. Part of this program that was conducted as a quasi-experimental survey comprised 7149 students and showed that a high percentage of students had acceptable knowledge about adverse health effects of overweight and obesity. However, the knowledge about the low nutritional value of unhealthy snacks such as potato chips, puffs, industrial juices, and carbonated drinks was not appropriate. Many participants had the undesirable attitude of skipping one of the main meals when attempting to lose weight. Conclusions: The IRAN-ECHO program is presenting the feasibility of conducting the WHO-ECHO recommendations in Iran. The scope of potential policy recommendations to decrease childhood obesity is extensive and includes various elements. This program considers multisectoral interventions through population and individual approaches. The multicomponent interventions of this program address the obesogenic environment by considering the life course dimensions. It is expected that, by its life course interventions, it could help in primordial and primary prevention of noncommunicable diseases.

Background: This study compares participants' retention in three phases of smoking cessation interventions, one provided in a health clinic and the subsequent two in community-based settings. Methods: Smoking cessation interventions were conducted in three phases from 2008 to 2015 in two underserved urban communities with low socioeconomic profiles and high rates of smoking (n = 951). Phase I was conducted in a clinic; Phases II and III were conducted in community venues. In Phases II and III, incremental changes were made based on lessons learned from the previous phases. Retention (attending six or more sessions) was the primary predictor of cessation and was analyzed while controlling for associated factors including age, gender, race, employment, education, and nicotine dependence. Results: Retention increased substantially over the three phases, with rates for attending six or more sessions of 13.8%, 51.9%, and 67.9% in Phases I, II, and III, respectively. Retention was significantly higher in community settings than in the clinic setting (adjusted odds ratio [OR] = 6.7; 95% confidence intervals [CI] = 4.6, 9.8). In addition to the intervention in community venues, predictors of retention included age and unemployment. Higher retention was significantly associated with higher quit rates (adjusted OR = 2.4; 95% CI = 1.5, 3.8). Conclusions: Conducting the intervention in community settings using trained peer motivators rather than health-care providers resulted in significantly higher retention and smoking cessation rates. This was due in part to the ability to tailor cessation classes in the community for specific populations and improving the quality of the intervention based on feedback from participants and community partners.

Chronic kidney disease (CKD) is a serious universal problem that is the main risk for several diseases including cardiovascular disease. Dietary factors are important to prevent and control the kidney disease. Some evidence has shown that modifying the amount and the types of dietary protein exert a major effect on renal failure so limiting dietary protein and substituting animal protein with soy protein has suggested. However, there is a lot of controversy about it, especially in human. Thus, this paper will review the clinical trial studies conducted on the effects of soy protein intake on CKD in both animal and human and its effect mechanism.

Consumption of low dietary fermentable carbohydrates, including fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP) has been hypothesized to improve symptoms of irritable bowel syndrome (IBS). This study was done to summarize findings from earlier evidence on the effect of a low FODMAP diet (LFD) on the symptoms of IBS. We searched in ISI Web of Knowledge, PubMed, Scopus, and Google Scholar using the following keywords: “FODMAP” OR “oligosaccharides” OR “disaccharides” OR “Monosaccharaides” in combination with “irritable bowel syndrome” or “IBS” or “Gastrointestinal Disease.” The reference lists of the relevant papers were also examined to avoid missing any publication. No time and language restrictions were applied. The relevant studies were selected through an independent search by two investigators. Overall, 778 relevant articles were found in our initial search. After reviewing title and abstracts, 763 papers were excluded from this review and 15 studies were included. All published studies were interventional studies in which patients with IBS had been recommended or randomized to receive a LFD. Three studies had quasi-experimental design, 9 were parallel randomized clinical trial and 3 studies were of randomized cross-over trials. These studies were conducted between 2009 and 2016. Nine studies were done in Europe, 2 in US, 3 in Australia, and one in Asia. Sample sizes of these studies were varied from 12 to 182. All studies had been conducted on both sexes, with the majority of participants as women (>70%). The age range was between 11 and 74 years in different studies. One study was performed on children, 9 on adults, and 5 others were in young-to-middle age groups. Duration of intervention was varied from 2 days to 16 months (2 studies with <1 week, and others with more than 2 weeks). Eight studies had suggested a significant effect of LFD on the improvement of all IBS symptoms, and 1 study had reported improvement in all symptoms except for constipation. One study had not found a significant difference between LFD and lactobacillus GG on IBS symptoms. Another paper had reported no significant effect of an LFD on IBS compared with the traditional IBS diet. The other paper had reported LFD improved 75% of diarrhea. Adherence to an LFD was not associated with the severity of symptoms. It is concluded that consumption of an LFD might reduce symptoms of IBS; however, further studies are required to shed light on inconsistencies in this field.

Background: Varicella zoster virus is the etiologic agent of primary varicella (chickenpox) during childhood, and varicella vaccination has not been introduced in Iran. The aim of this study is to estimate cost-effectiveness of one- and two-dose Varicella Vaccination Program in Iran. Methods: A decision-tree model was conducted to evaluate the cost-effectiveness of the Varicella Vaccination Program in a cohort of 12 months children in Iran. Epidemiologic parameters of varicella were extracted from local and international sources, and cost of disease was estimated based on societal prospective in 2015 US$. Incremental cost per disability-adjusted life years (DALY) averted calculated as final outcome. Sensitivity analysis was also performed for lower and upper estimate of incidence, DALY, and vaccine efficacy. Results: Considering the vaccine efficacy of 95%, for the two-dose and 85% for the one-dose vaccination, incremental cost-effectiveness ratio (ICER) per DALYs averted were US$41,531 and US$17,280, respectively. ICER has changed between (US$ 6,177–US$167,047) in lower and upper base estimate of epidemiological burden parameters in sensitivity analysis. Conclusions: Varicella vaccination is not cost-effective in Iran in one-dose and two-dose scenario under the assumptions of this study in base case scenario according to the threshold of incremental cost per DALY averted less than three time of GDP per capita in Iran = US$ 14,292. One-dose vaccination program might be cost-effective in upper scenario of epidemiological burden of varicella in sensitivity analysis.

Background: Child-friendly environment project (MAZDAK) is a community-based project for monitoring the development of children in Iran that was implemented as a pilot study in one of the neighborhoods of Tehran (Eyvanak-e Gharb). This study attempted to engage mothers in monitoring of their children's development and assesses the status of children's development by a community-based participatory approach using the ages and stages questionnaires (ASQ). Methods: This study was a community-based participatory research. Two hundred households residing in Eyvanak-e Gharb with children under 5-year-old were selected as a convenient sample and completed the ASQ. Descriptive measures were used to describe the overall status of children, in each domain. Furthermore, we compared the current sample with other populations, using independent t-test. Results: This study engaged mothers, trained volunteers from the community, and some local institutions in screening and monitoring children development and addressing any poor developmental growth. The mean scores of the different domains (communication, gross motor, fine motor, problem solving, and social-personal) in sampled children in MAZDAK project were higher than corresponding mean scores of the children in a project conducted in Tehran in 2006. Conclusions: Involving mothers and community in monitoring children development based on ASQ was an effective strategy to monitor and foster children development.

Background: Development of alloantibodies against the foreign red blood cell (RBC) (alloimmunization) is a well-known complication in thalassemia patients when performing multiple transfusions. The study was conducted to know the prevalence of alloimmunization in thalassemia patients, in the Caspian Sea coastline. Methods: This study is a descriptive, retrospective analysis of transfusion records of 190 patients with β-thalassemia major who received regular transfusions. To detect the type of alloantibodies, two cells panel tests (kits; Iranian Blood Transfusion Organization [IBTO], 3 RBC cells and IBTO, 11 RBC cells) were used. Results: Forty-seven patients were positive for alloantibodies (24.7%). Of them, 18.4% (35 cases) had only one alloantibody, and 6.3% (12 cases) had at least two or more of alloantibodies. The vast majority of alloantibodies were anti-Kell followed by anti-E, and anti-D, respectively. Conclusions: Blood matching for Rh and K antigens in patients with transfusion-dependent thalassemia could reduce the rate of RBC alloinununization.

Background: Tobacco is a most important risk factor for various types of cancer as well as some noncommunicable disease. Around 34.6% of Indian population consume tobacco. The tobacco consumption is higher in some vulnerable population such as drivers, daily wage laborers, and policemen. Tobacco consumption is known to cause oral cancers, and screening for oral cancer in these individuals is known to reduce mortality from cancer. The study was designed to assess the determinants of tobacco use and the prevalence of oral precancerous lesions in cab drivers. Methods: This is a cross-sectional study among cab drivers at prepaid taxi counters in Bengaluru city. A total of 450 cab drivers were enrolled in the study, of which 225 cab drivers were interviewed during morning hours and remaining half at night time using a semi-structured questionnaire. All were screened for oral cancer/precancerous lesions. Results: Nearly 70.88% of cab drivers were consuming tobacco in any form. Long working hours, working at night, and family members consuming tobacco were significant risk factors for tobacco use among cab drivers. Forty-eight drivers were detected to have oral precancerous lesions. Conclusions: It was very evident that long hours of driving and infrequent shifts played a greater role in acquiring the habit. Behavioral counseling and new laws need to be formed to limit the working hours in drivers to have an effective tobacco control.

Background: Chronic noncommunicable diseases (NCDs) could increase the risk of catastrophic health expenditure (CHE). The present study aims to analyze CHE among households with and without chronic NCDs in Hamedan. Methods: In this cross-sectional study, 780 households' patients, who were being discharged from hospitals in Hamedan, were selected using a proportional stratified random sampling method. Required data were collected through interview and observation using World Health Organization standard questionnaire. A household with chronic NCDs is defined as the one with ≥1 chronic disease patient. Both descriptive and analytical statistics, as well as different approaches and thresholds, were used to study CHE among households. Results: The households with chronic disease had higher incidence and intensity of CHE in all approaches and threshold. This result was shown through distributive-sensitive measures. The Regression analysis revealed that lower economic status, lower household size, and high utilization of health care were associated with the CHE incidence and intensity in the households with chronic NCDs in Hamedan. Conclusions: There is a high degree of CHE were caused by chronic NCDs. By thoughtful reconsideration in health-care financing, along with addressing relevant socioeconomic factors, the health system of Iran could cope with financial adversities caused by chronic NCDs.

Background: The evidences on cytotoxic effect of cigarette and waterpipe smoking are very rare and controversial. The aim was to compare the cytotoxic effect of cigarette and waterpipe smoking on human buccal mucosa cells. Methods: The study was case–control. Feulgen-stained samples of exfoliated buccal mucosa cells were evaluated. The cytology slides of 25 cigarette smoker, 25 waterpipe smoker, and 25 individuals in the never smoked were examined. The number of pyknosis, karyorrhexis, and karyolysis in 1000 cells/subject were counted. Exposing to cigarette and waterpipe smoke was considered by the number of pack × years. Results: There were significant differences among the groups in terms of karyolysis and pyknosis while there was no significant difference among the cigarette smokers group and waterpipe smokers group in terms of karyorrhexis (P ≤ 0. 01). The cytotoxicity effect of cigarette smoking was not significantly correlated to time exposure (r = 0.099, P = 0.637). The cytotoxicity effect of waterpipe smoking was significantly correlated to time exposure (r = −370, P = 0.044). Conclusions: The cytotoxic effect of cigarette and waterpipe smoking on buccal mucosa cells was significantly higher than nonsmokers. The effect of cigarette smoking on cellular death was higher than waterpipe. The cytotoxic effect of waterpipe smoking was dose dependent.