Background: Identifying risk factors of breast cancer is a key point for preventive strategies to reduce the incidence. The aim of current study was to determine most important risk factors for breast cancer in the Eastern Mediterranean Region (EMR) using a systematic review. Materials and Methods: PubMed, Scopus, Web of Science till August 24, 2012 and the reference lists of all included studies were searched. Analytic studies which had reported odds ratios (OR), relative risk (RR) or required data to calculate them were included. A total of 343 studies were critically appraised and finally 30 studies were meta-analyzed. Heterogeneity between the studies was assessed by I² and Cochran's Q. Egger's test was used to assess publication bias. Results: Twenty five casecontrol studies, one nested case-control and four cohort studies were included. The largest ORs were obtained for history of no live birth (2.25; 95%CI: 1.58-3.18), body mass index (BMI) more than 30 (2.21; 95%CI: 1.71-2.36), age at first pregnancy more than 30 years old (1.52; 95%CI: 1.30-1.77) and meat consumption more than three times per week (1.39; 95%CI: 1.03-1.87). The other important predictors were higher education and smoking as risk factors, physical activity and ovulatory stimulating medication as protective factors. Conclusions: The most important predictors of breast cancer in EMR were history of no live birth, BMI more than 30, age at first pregnancy more than 30 years old, physical inactivity and smoking. Almost all these risk factors are consistent with known risk factors for this cancer in other parts of the world.

Background: According to the World Health Organization, hospitals should assess their internal wards to improve health promotion services using self-assessment tools. To achieve this goal, standards of health promoting hospitals have been developed by the World Health Organization, and measurable elements and indicators have been defined to facilitate the practical application of these standards in planning, implementation, and evaluation of health promotion in hospitals. Moreover, a form has been developed for this self-assessment. Considering linguistic and cultural differences in various countries, standards must be written in equivalent texts and, then, their content and face validity should be examined. Performing this process in a systemic and scientific way can guarantee that the same tools have been used, and thus the results obtained from different hospitals are comparable. Methods: After the preparation phase (considering research aim, obtaining permission from the original designers, and determining the time), the following activities were done: translating the form from its original language to the target language, combining and compiling initial translations to a single translation, reversing the final version of the translation from the target language to the original language, obtaining cognitive information, revising and concluding, and determining the content and face validity of the translated form and final report. After filling in the form, face validity was calculated using impact score formula. Content validity was measured using content validity ratio (CVR) and content validity index (CVI). Results: After calculating the impact score, all 40 items showed a high impact score greater than 1.5, representing the fact that all items are important. The minimum value of CVR for each of the 40 items was estimated to be 0.64; CVI of all items was greater than 0.79. Conclusion: Given the input of the standards of health promoting hospitals affiliated to the World Health Organization in National Accreditation of Iranian hospitals, the form was translated and found to be valid according to content and face validity and is available in Persian to be used in Iranian hospitals (Appendix 1).