Journal of Education and Health Promotion

Abstract BACKGROUND: Dried Urmia Lake in the northwest of Iran is a major regional source of sodium
and toxic metal aerosols which may cause numerous health problems. The aim of this study was to
evaluate iron‑deficiency anemia (IDA) and some related risk factors among women of reproductive
age in the suburb of dried Urmia Lake to provide the information about the problem to the health‑care
providers.
METHODS: This cross‑sectional study was conducted on 278 healthy nonpregnant, nonlactating
women aged 18–45 years, living in the rural area of the Salmas city, closest to the Urmia Lake between
February and June 2017. The study participants were selected using a stratified random sampling
method with proportional allocation from seven villages. A general questionnaire was completed for
each participant to collect sociodemographic information and a 3‑day dietary recall questionnaire
to obtain daily dietary intakes. IDA was defined as a hemoglobin (Hb) level of <12 g/dl and ferritin
concentration of <15 μg/l. Spearman’s correlation coefficient and Fisher’s exact test were applied to
determine sociodemographic factors associated with the serum Hb and ferritin levels.
RESULTS: The prevalence of overall anemia (Hb <12 g/dl) was 7.9%. IDA was determined in 4.3%
and iron deficiency (ID) in 19.1% (serum ferritin <15 μg/l) of the participants. There was a significant
positive correlation between serum Hb concentrations and the mean daily intakes of protein and
iron (P < 0.001). Similarly, a significant positive correlation was observed between serum ferritin
levels and body mass index (P < 0.001). Significant inverse associations were found between Hb
concentrations and the number of pregnancies and children (P < 0.001), as well as the number of
family members (P < 0.05).
CONCLUSIONS: Results indicated a mild prevalence of IDA and a relatively high rate of ID among
studied participants. Educational programs are needed to improve nutritional habits as well as the
use of contraceptives to promote women’s health.

Abstract BACKGROUND AND OBJECTIVE: Data on the factors affecting long‑term mortality following a
stroke in Iran are scarce. The current research aimed at investigating the extent of 2‑year mortality
following a stroke and the factors affecting it in the northwest of Iran.
MATERIALS AND METHODS: This prospective cohort study was conducted in Tabriz, Northwest
of Iran. Patients with computed tomography/magnetic resonance imaging confirmed the first‑ever
stroke were included in this study and followed up to 2 years. Clinical examinations, including the
severity of the stroke using the modified National Institutes of Health Stroke Scale (mNIHSS), were
conducted by a neurologist. The general characteristics, lifestyle factors, and laboratory tests were
also completed. To estimate the survival, Kaplan–Meier analysis was used; and for group comparison,
the log‑rank method was applied. To identify the factors predicting 2‑year mortality, semiparametric
Cox regression analysis was used.
RESULTS: A total of 1036 first‑ever stroke patients were included in the present study. The
mortality rates of stroke in 6‑month, 1‑year, and 2‑years follow‑up periods were 31.6%, 34.5%, and
38%, respectively. The two‑year mortality rate was 33.6% in ischemic and 58.7% in hemorrhagic
stroke (P < 0.001). In the multivariate Cox model, variables age, type of stroke, diabetes, and severity
of the stroke, according to the mNIHSS index, were identified as factors predicting 2‑year mortality
following the stroke.
CONCLUSION: The 2‑year mortality following acute stroke was relatively high compared to that of in
developed countries. Implementation of secondary prevention is recommended to better management
of modifiable predictors of mortality.

Abstract BACKGROUND AND OBJECTIVE: Stroke is the second leading cause of death worldwide and
the number of stroke cases has increased remarkably over the last 20 years. This study aimed at
identifying predictors of with 6‑month mortality of first‑ever stroke patients and the factors contributing
to it in East Azerbaijan province.
MATERIALS AND METHODS: A closed cohort study was carried out from April 2014 to
December 2014. All cases of first‑ever diagnosed stroke were included in the study. Any transient
ischemic attack, silent brain infarctions, and the stroke cases which were neither associated with
trauma, blood disease nor with malignancy were excluded from the study. The variables of this study
include participants’ demographic characteristics, stroke severity National Institutes of Health Stroke
Scale (NIHSS), and stroke risk factors. Patients were followed up within 6 months. To determine the
survival time, the log‑rank method was applied to compare intergroup differences. The tests include
the univariate and multivariate analysis Cox regression. P < 0.05 were considered as statistically
significant.
RESULTS: A total of 576 cases of stroke were included in this study. Average age of ischemic and
hemorrhagic stroke was 70.15 ± 13.0 and 67.79 ± 12.69, respectively. Case‑fatality rate (CFR)
of stroke patients was 49.2 and 21.7% in hemorrhagic and ischemic stroke types, respectively.
Factors contributing to stroke mortality events include the severity of stroke (NIHSS categories
15–19 and ≥20), age over 65, being female, high body mass index and hyperlipidemia. In the
final model, the severity of stroke (with NIHSS 15–19 with hazard ratio (HR) 4.22 (95% confidence
interval [CI] 2.36–7.56) and NIHSS ≥20 with HR 5.34 (95% CI: 2.81–10.12) and age above 65 with
HR 1.61 (95% CI: 1.02–2.51) were the most important predictors of 6‑month mortality.
CONCLUSION: Severity of stroke by NIHSS was the most prominent factor in stroke patients’
mortality. By increasing the follow‑up time, a better evaluation of the predictors of mortality after
stroke can be achieved.

Abstract BACKGROUND AND OBJECTIVE: There is remarkable alteration in hypertension prevalence
and awareness, and their correlates among various geographic locations and ethnic groups. The
aim of this study was to report hypertension prevalence, awareness, and its correlates as well as
hypertension treatment, and control among Azari people aged 35 years and older.
MATERIALS AND METHODS: The pilot phase of the Azar Cohort Study; a state level of a nationwide
PERSIAN cohort study was conducted in Khameneh city between October 2014 and January 2015.
All people 35 years of age and above were invited to take part in this study. A comprehensive range of
different biomarkers, lifestyle, socioeconomic factors, and health‑related factors was collected. Blood
pressure was measured by a trained nurse/midwife. Descriptive statistical methods were used to present
general characteristics of the study population as frequency tables. Separate multiple logistic regression
models were built to assess the predictors of hypertension prevalence.
RESULTS: A total of 1038 people were included in this study. The overall prevalence of hypertension
was 22.9%. Awareness of hypertension was 60.5% and in those with known hypertension, 84% were
using the antihypertensive medications, of those 68.5% had controlled hypertension. After adjustment;
age (odds ratios [OR] adj = 1.12 95% confidence interval [CI]: 1.09–1.15), gender (ORadj = 1.65 95% CI:
1.08–2.51), obesity ORadj = 2.51 (1.40–4.88), waist‑to‑hip ratio (WHR) (ORadj = 1.70 (1.05–2.75), and
comorbidities (ORadj = 2.51 (1.72–3.66) were independent predictors of hypertension.
CONCLUSION: Age, sex, body mass index, WHR, and comorbidities were known as predictors
of hypertension in this study, health promotion strategies including lifestyle modification to reduce
overweight/obesity and secondary prevention programs for early detection of hypertension in high‑risk
groups according to age, gender, and disease profile are recommended.