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1.  Relationship between Metabolic Syndrome and Its Components with Psychological Distress 
Background. Metabolic syndrome (MetS) and psychological distress are hypothesized to have a bidirectional relationship. According to their high prevalence in most populations, appraisal of this theory would be of great clinical and research interest. Methods. Data were available as part of the Isfahan Healthy Heart Program (IHHP). A total of 9553 men and women aged ≥19 years from three counties in central Iran were selected. Measurements consisted of serologic tests, anthropometrics, and self-reported 12-item general health questionnaire. Logistic regression analysis was used to find the association between MetS, MetS components, and distress level. Results. The mean age of 9553 participants (50% male) was 38.7 ± 15.8 years. After adjusting for demographic factors, MetS (OR = 1.25, 95% CI: 1.01–1.37), central obesity (OR = 1.40, 95% CI: 1.15–1.49), and hypertension (OR = 1.55, 95% CI: 1.42–1.70) were associated with high distress level. However, after adding smoking status and low-density lipoprotein cholesterol to the adjustment factors, hypertension (OR = 1.79, 95% CI: 1.53–1.98) and central obesity (OR = 1.41, 95% CI: 1.17–1.55), but not the MetS, remained significantly associated with distress level. Conclusion. The presence of association between the MetS as well as its key components and high distress level signifies the importance of integrating psychological assessment and intervention in the standard management of MetS patients.
doi:10.1155/2014/203463
PMCID: PMC3941148  PMID: 24672543
2.  The Impacts of Cardiac Rehabilitation Program on Echocardiographic Parameters in Coronary Artery Disease Patients with Left Ventricular Dysfunction 
Introduction. The accurate impact of exercise on coronary artery disease (CAD) patients with left ventricular dysfunction is still debatable. We studied the effects of cardiac rehabilitation (CR) on echocardiography parameters in CAD patients with ventricular dysfunction. Methods. Patients with CAD who had ventricular dysfunction were included into an exercise-based rehabilitation program and received rehabilitation for eight weeks. All subjects underwent echocardiography before and at the end of the rehabilitation program. The echocardiography parameters, including left ventricular ejection fraction (LVEF), LV end-diastolic (LVEDD) and end-systolic diameters (LVESD), and peak exercise capacity measured in metabolic equivalents (METs), were assessed. Results. Seventy patients (mean age = 57.5 ± 10.2 years, 77.1% males) were included into the study. At the end of rehabilitation period, the LVEF increased from 45.14 ± 5.77% to 50.44 ± 8.70% (P < 0.001), and the peak exercise capacity increased from 8.00 ± 2.56 to 10.08 ± 3.00 METs (P < 0.001). There was no significant change in LVEDD (54.63 ± 12.96 to 53.86 ± 8.95 mm, P = 0.529) or in LVESD (38.91 ± 10.83 to 38.09 ± 9.04 mm, P = 0.378) after rehabilitation. Conclusion. Exercise training in postmyocardial infarction patients with ventricular dysfunction could have beneficial effects on cardiac function without adversely affecting LV remodeling or causing serious cardiac complications.
doi:10.1155/2013/201713
PMCID: PMC3891233  PMID: 24459599
3.  Methodology of Isfahan Tobacco Use Prevention Program: First Phase 
Background. Tobacco use continues to be the leading global cause of preventable death. The majority of smokers begin using tobacco products at teen ages. The aims of this study were providing a methodology of Isfahan Tobacco Use Prevention Program and investigating the prevalence of tobacco use and its related factors. Method. It was a cross-sectional study among guidance and high school students in Isfahan province. Initiation, social, psychological (depression and self-efficacy), family, and attitudinal and belief factors and school policy toward smoking (cigarettes and water-pipe) were investigated. Saliva qutinin was given from 5% of participants for determination of accuracy of responses. A self-administered anonymous questionnaire was used for gathering all data. Results. Of all 5500 questionnaires distributed, about 5408 completed questionnaires were returned (with response rate of 98.3%). Of all participants, 2702 (50.0%) were girls and 2706 (50.0%) were boys. Respectively, 4811 (89.0%) and 597 (11.0%) were from urban and rural. Of all participants, 2445 (45.2%) were guidance school and 2962 (54.8%) were high school students. Conclusion. This study will provide a unique opportunity to study prevalence of smoking cigarettes and water-pipe (ghelyan) among guidance and high school students in Isfahan province and determine the role of initiation, social, psychological, family, and attitudinal and belief factors and school policy toward smoking.
doi:10.1155/2013/182170
PMCID: PMC3870653  PMID: 24383007
4.  Developing an appropriate model for self-care of hypertensive patients: first experience from EMRO 
ARYA Atherosclerosis  2013;9(4):232-240.
BACKGROUND
Cardiovascular diseases (CVDs) constitute 53% of deaths above the age of 30; 54% of these deaths are attributed to high blood pressure. Coronary artery disease (CAD) is the main cause of mortality in the world. Hypertension accounts for 13% of mortalities and 6% of morbidities and is one of the main risk factors that cause loss of healthy life years. Blood pressure is not optimally controlled even among those who are aware of their disease. Previous studies showed that apart from pharmacological treatment, lifestyle improvement can also play a significant role in the prevention of high blood pressure CVDs. Self-care among them has been addressed in several previous studies. There are few self-care programs in Iran, but no study has been conducted on blood pressure.
METHODS
In this study the primary model is designed and then revised, and in the pilot study the feasibility of the project was approved and the final model presented.
RESULTS
The current project proposes a model for self-care of hypertensive patients and their families, and is based on education of health care providers and patients in such a way that patients can control their illness.
CONCLUSION
The model can be implemented at a national scale.
PMCID: PMC3746943  PMID: 23970918
Self-Care; Hypertension; Model
5.  Lipid profile in antipsychotic drug users: A comparative study 
ARYA Atherosclerosis  2013;9(3):198-202.
BACKGROUND
Schizophrenic patients who receive antipsychotic drugs may be highly prone to metabolic disorders such as weight gain, dyslipidemia, and insulin resistance. The objective of the present study was to compare the effect of atypical and conventional antipsychotics on lipid profile.
METHODS
128 schizophrenic patients were enrolled into the study. Patients were divided into two groups. One group had received one type of atypical antipsychotic drug, and, the other, one type of conventional antipsychotic drug. They were considered as atypical and conventional groups. Moreover, both groups had not used any other antipsychotic drugs during the past year. Demographic data and food frequency questionnaire were completed by the participants. Serum triglyceride, total cholesterol (TC), high-density lipoprotein and low-density lipoprotein (LDL) cholesterols, and apolipoprotein A and B (Apo B) were tested by blood sample drawing after 12 hours of fasting through the antecubital vein. Student’s t-test was used to compare atypical and conventional groups.
RESULTS
There was no significant difference in age, gender, duration of illness, period of drug consumption, and age at onset of illness in the two groups. Patients in the atypical group used clozapine and risperidone (46.9%) more than olanzapine. In the conventional group 81.3% of patients used phenothiazines. Comparison between lipid profile in the conventional and atypical groups showed a significantly higher mean in TC (P = 0.01), LDL (P = 0.03), and Apo B (P = 0.01) in conventional group than the atypical group.
CONCLUSION
In schizophrenic patients, the level of lipid profile had been increased in both atypical and conventional antipsychotic users, especially conventional users, so the effect of antipsychotic drugs should be investigated periodically.
PMCID: PMC3681276  PMID: 23766777
Atypical Antipsychotic; Conventional Antipsychotic; Lipid Profile
6.  Effects of Pioglitazone on Asymmetric Dimethylarginine and Components of the Metabolic Syndrome in Nondiabetic Patients (EPICAMP Study): A Double-Blind, Randomized Clinical Trial 
PPAR Research  2013;2013:358074.
The present trial aimed to investigate the effects of pioglitazone on the serum level of asymmetric dimethylarginine (ADMA), a marker of endothelial function, and some indices of inflammation and glucose and lipid metabolism in nondiabetic metabolic syndrome patients. 104 eligible participants (57% female; age between 20 and 70) were enrolled in a double-blind placebo-controlled trial and were randomized to receive either pioglitazone (uptitrated to 30 mg/day) or matching placebo for 24 weeks. Participants were clinically examined and a blood sample was obtained at baseline and at the end of the trial. Pioglitazone significantly improved C-reactive protein level irrespective of changes in insulin sensitivity. Compared with the placebo group, alanine and aspartate transaminases were decreased and high-density lipoprotein cholesterol was increased after treatment with pioglitazone. A considerably greater weight gain was also recorded in the intervention group. We failed to observe any significant changes in serum ADMA in either group and between groups with and without adjustment for age, sex, and components of the metabolic syndrome. In a nutshell, pioglitazone seems to have positive effects on lipid profile, liver transaminases, and systemic inflammation. However, its previously demonstrated endothelial function-improving properties do not seem to be mediated by ADMA.
doi:10.1155/2013/358074
PMCID: PMC3654334  PMID: 23710164
7.  Association of apolipoprotein B, apolipoprotein A, and the its ratio with body fat distribution 
Background:
To evaluate the association of apolipoprotein B (apoB), apolipoprotein A (apoA), and apoB/apoA ratio with the body fat indicators in patients with stable angina pectoris (SA).
Materials and Methods:
One hundred and twenty two participants aged 40-60 years old, with a mean age of 52.1 ± 7.2 years and SA, were recruited for the present study. Body weight, height, and waist circumference (WC) were measured, and waist to height ratio (WHtR) was calculated. After 12 hours of fasting, a blood sample was obtained and serum levels of apoB and apoA were measured and the apoB/apoA ratio was calculated. These patients underwent an abdominal computerized tomography scan (CTS) to assess visceral and subcutaneous adipose tissue (VAT, SAT). Linear regressions were computed to assess the relation of apoB, apoA, and their ratio with various measurements of adiposity (VAT, SAT, WC, and WHtR), with adjustment for age, sex, and BMI ≥ 25, WC ≥ 80 in women and WC ≥ 90 in men and WHtR ≥ 0.59.
Results:
From totally 123 patients with SA with a mean age of 52.1 ± 7.2 years, 44.7% male and 55.3% women were entered. Significant positive associations were found between visceral fat area and the apoB/apoA ratio (P = 0.02, β = 0.2), and significant negative correlations were observed between visceral fat area and apoA concentrations (P = 0.04, β = −0.2).
Conclusion:
As abdominal fat accumulation is associated with other risk factors such as apolipoproteins in ischemic patients, then we most focus on control of these factors.
PMCID: PMC3793379  PMID: 24124431
Apolipoprotein A; apolipoprotein B; apolipoprotein B/apolipoprotein A; cardiovascular disease; intra-abdominal fat
8.  Validation of the Revised Stressful Life Event Questionnaire Using a Hybrid Model of Genetic Algorithm and Artificial Neural Networks 
Objectives. Stressors have a serious role in precipitating mental and somatic disorders and are an interesting subject for many clinical and community-based studies. Hence, the proper and accurate measurement of them is very important. We revised the stressful life event (SLE) questionnaire by adding weights to the events in order to measure and determine a cut point. Methods. A total of 4569 adults aged between 18 and 85 years completed the SLE questionnaire and the general health questionnaire-12 (GHQ-12). A hybrid model of genetic algorithm (GA) and artificial neural networks (ANNs) was applied to extract the relation between the stressful life events (evaluated by a 6-point Likert scale) and the GHQ score as a response variable. In this model, GA is used in order to set some parameter of ANN for achieving more accurate results. Results. For each stressful life event, the number is defined as weight. Among all stressful life events, death of parents, spouse, or siblings is the most important and impactful stressor in the studied population. Sensitivity of 83% and specificity of 81% were obtained for the cut point 100. Conclusion. The SLE-revised (SLE-R) questionnaire despite simplicity is a high-performance screening tool for investigating the stress level of life events and its management in both community and primary care settings. The SLE-R questionnaire is user-friendly and easy to be self-administered. This questionnaire allows the individuals to be aware of their own health status.
doi:10.1155/2013/601640
PMCID: PMC3580934  PMID: 23476715
9.  Socioeconomic characteristics and controlled hypertension: Evidence from Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2013;9(1):77-81.
BACKGROUND
Hypertension is a major risk factor for cardiovascular diseases. It affects approximately 18.0% of Iranian adults. This study aimed to estimate age-adjusted prevalence of hypertension and its control among Iranian persons older 19 years of age. It also tried to find and socioeconomic factors associated with hypertension control in Iranian population.
METHODS
In Isfahan Healthy Heart Program (IHHP) subjects were selected by multistage random sampling. The participants completed questionnaires containing demographic information, lifestyle habits, medical history, and consumption of relevant medications, especially antihypertensive agents. Income, marital status, and educational level were considered as socioeconomic factors. Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or taking antihypertensive medications. Controlled hypertension was considered as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg among hypertensive subjects.
RESULTS
The prevalence of hypertension and controlled hypertension was 18.9% and 20.9%, respectively. We found significant relationships between hypertension and marital status, education, and income. At age ≥ 65 years old, odds ratio (OR) was 19.09 [95% confidence interval (CI): 15.01-24.28] for hypertension. Middle family income (OR: 0.71; 95% CI: 0.58-0.87) and education level of 6-12 years (OR: 0.29; 95% CI: 0.25-0.35) were significantly associated with increased risk of hypertension (P = 0.001). Among subjects aging 65 years old or higher, the OR of controlled hypertension was 2.64 (95% CI: 1.61-4.33). Married subjects had a higher OR for controlled hypertension (OR: 2.19; 95% CI: 1.36-3.52). Obesity had no significant relationships with controlled hypertension.
CONCLUSION
The IHHP data showed significant relationships between some socioeconomic factors and controlled hypertension. Therefore, as current control rates for hypertension in Iran are clearly unacceptable, we recommend preventive measures to control hypertension in all social strata of the Iranian population.
PMCID: PMC3653252  PMID: 23696763
Socioeconomic Factor; High Blood Pressure; Control
10.  Social norms of cigarette and hookah smokers in Iranian universities 
ARYA Atherosclerosis  2013;9(1):45-50.
BACKGROUND
First experiences of tobacco use usually occur in adolescence. The recognition of social norms leading to youth smoking is hence necessary. We tried to assess the social norms among Iranian young cigarette and hookah smokers.
METHODS
This cross-sectional study was conducted on 451 girls and 361 boys aging 20-25 years old who entered Isfahan and Kashan Universities (Iran) in 2007. Demographic factors (age, gender, and age at smoking onset) cigarette and hookah smoking status, having a smoking father or smoking friends and four related social norms were recorded. Binary logistic regression analysis was used to separately determine associations between hookah and cigarette smoking and the four social norm variables.
RESULTS
Cigarette and hookah smokers had significant differences with nonsmokers in two social norms: “Perceived smoking by important characters” [odds ratio (OR) = 1.35 in cigarette smokers and 1.58 in hookah smokers; P < 0.001] and “smoking makes gatherings friendly” (OR = 3.62 in cigarette smokers and 6.16 in hookah smokers; P < 0.001). Furthermore, cigarette and hookah smoking were significantly associated with having smoking friends.
CONCLUSION
Highlighting the social norms leading to cigarette and hookah smoking may help policy makers develop comprehensive interventions to prevent smoking among adolescents.
PMCID: PMC3653255  PMID: 23696759
Cigarette; Hookah; Smoking; Social Norm
11.  Parental perceptions of weight status of their children 
ARYA Atherosclerosis  2013;9(1):61-69.
BACKGROUND
Understanding the knowledge, attitudes, and beliefs of parents is important for planning appropriately to control their children’s weight. We aimed to study these variables in parents of normal, underweight, overweight, and obese children.
METHODS
This cross-sectional study targeted the parents of normal, underweight, overweight, and obese children, who were selected using multistage random sampling method. The parents’ knowledge, attitudes, beliefs, and behaviors about the weight status of their children, weight management, obesity, diet, lifestyle, and related psychosocial factors were evaluated using a validated questionnaire. The questionnaire, which had been validated, consisted of 12 demographic, 8 knowledge, 19 attitude and beliefs, and 25 behavior questions. Mean knowledge, attitude and beliefs, and behavior scores were compared across three subgroups of parents. Student’s independent t-test, ANOVA, and Kruskal-Wallis test were used to study the correlation between different demographic and socioeconomic factors, and the studied variables.
RESULTS
90% of parents were aware that obesity is a disease, and 92% knew that eating too much fast food would lead to obesity in children. Only 5% assumed that obese children are healthier than non-obese children. The mean scores of the three subgroups showed no significant difference in knowledge, attitude and beliefs, and behavior. Families with fathers, whose education level was higher than high school diploma, rated their children’s weight status as overweight or obese significantly less than families with fathers, whose education level was high school diploma or lower (8.5% vs. 16.5%, respectively, P = 0.014). Only 12% of parents tried to help their children lose weight at least once, and only 6% arranged sport activities for the family members. In 57% and 41% of families, the child, respectively, decided how much time was enough to watch TV, and how much chocolates and sweets to eat. 46% of children watched TV for more than 2 hours/day, and 49% of children watched TV while eating meals. The mean total score of boys’ parents was significantly lower than that of girls’ parents (P < 0.05). Families with low income, with no medical insurance, or not owning a house thought that the cost of registration in sport activities for children was too high (P < 0.03).
CONCLUSION
Some parents unreasonably rated the weight status of their children as overweight/obese. It is suggested that further studies be carried out to evaluate and improve parents’ knowledge, attitudes, and behaviors regarding their children’s weight.
PMCID: PMC3653261  PMID: 23696761
Children; Obesity; Overweight; Knowledge; Attitude; Belief; Behavior
12.  The effectiveness of stress management intervention in a community-based program: Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2012;7(4):176-183.
BACKGROUND:
This study was designed to assess the effectiveness of stress management training in improving the ability of coping with stress in a large population.
METHODS:
Five cross-sectional studies using multistage cluster random sampling were performed on adults aged ≥ 19 years between 2000 to 2005 in Isfahan and Najafabad (Iran) as intervention cities and Arak, Iran as the control city within the context of Isfahan Healthy Heart Program. Stress management training was adapted according to age and education levels of the target groups. In a 45-minute home interview, demographic data, General Health Questionnaire (GHQ) and stress management questionnaires were collected. Data was analyzed by t-test, linear regression and general linear model.
RESULTS:
Trends of both adaptive and maladaptive coping skills and GHQ scores from baseline to the last survey were statistically significant in both intervention and reference areas (P < 0.001). While adaptive coping skills increased significantly, maladaptive coping skills decreased significantly in the intervention areas. Furthermore, stress levels decreased significantly in the intervention compared to the reference area.
CONCLUSION:
Stress management programs could improve coping strategies at the community level and can be considered in designing behavioral interventions
PMCID: PMC3413087  PMID: 23205052
Stress Management; Community; Intervention; Coping Strategies
13.  Association of Perceived Stress with Stressful Life Events, Lifestyle and Sociodemographic Factors: A Large-Scale Community-Based Study Using Logistic Quantile Regression 
Objective. The present paper aimed at investigating the association between perceived stress and major life events stressors in Iranian general population. Methods. In a cross-sectional large-scale community-based study, 4583 people aged 19 and older, living in Isfahan, Iran, were investigated. Logistic quantile regression was used for modeling perceived stress, measured by GHQ questionnaire, as the bounded outcome (dependent), variable, and as a function of most important stressful life events, as the predictor variables, controlling for major lifestyle and sociodemographic factors. This model provides empirical evidence of the predictors' effects heterogeneity depending on individual location on the distribution of perceived stress. Results. The results showed that among four stressful life events, family conflicts and social problems were more correlated with level of perceived stress. Higher levels of education were negatively associated with perceived stress and its coefficients monotonically decrease beyond the 30th percentile. Also, higher levels of physical activity were associated with perception of low levels of stress. The pattern of gender's coefficient over the majority of quantiles implied that females are more affected by stressors. Also high perceived stress was associated with low or middle levels of income. Conclusions. The results of current research suggested that in a developing society with high prevalence of stress, interventions targeted toward promoting financial and social equalities, social skills training, and healthy lifestyle may have the potential benefits for large parts of the population, most notably female and lower educated people.
doi:10.1155/2012/151865
PMCID: PMC3471433  PMID: 23091560
14.  Determination of normal range of bleeding time in rural and urban residents of Borujerd, Iran: A pilot study 
ARYA Atherosclerosis  2012;8(3):136-142.
BACKGROUND
Bleeding time test is used to assess the function of platelets in human body. The aim of this project was thus to estimate the sample size required to determine the normal range of bleeding time (BT) in Borujerd (a city in Iran). A pilot study was designed to determine the range of normal BT in a small group of normal people. The total sample size for the next study was then calculated according to the results.
METHODS
In order to determine the sample size, a total of 33 volunteers participated in this study. The normal range of BT was determined by Ivy method. Written informed consents were obtained from all participants and their clinical history was recorded. The sampling was performed once for each participant. However, the results were interpreted by two observers. The study protocol was approved by the Ethics Committee of the research center at Lorestan University of Medical Sciences (Iran).
RESULTS
In this study, 33 normal participants (20 women and 13 men) were divided into four age groups of 35-44, 45-54, 55-64 and over 64 years old. Maximum and minimum BTs in men were 209 (in the age group of 35-44 years) and 150 seconds (in the age group of over 64 years), respectively. On the other hand, the corresponding values in women were 194 (in 55-64 year-old subjects) and 145 seconds (in women over 64 years of age). Considering the aforementioned results, the total sample size for the next study was determined to be 580 normal subjects by two-sample t-test power analysis at a power of 0.91816.
CONCLUSION
There was a significant difference between the normal range of BT in participants of Borujerd and previously recorded range in other studies. Moreover, normal BT in men decreased by aging. This study did not show any special order in increasing or decreasing BT in women.
PMCID: PMC3557001  PMID: 23358456
Platelet; Bleeding Time; Ivy Method; Gender
15.  Is there any difference between non-obese male and female in response to cardiac rehabilitation programs? 
Introduction:
Coronary artery disease (CAD) is the leading cause of death and disability all over the world. A sedentary lifestyle and dyslipidemia are known to be the major risk factors, which play an important role in the progression of coronary artery disease. Regarding gender differences, the risk of developing coronary heart disease is recognized as being different between non-obese males and non-obese females. Hence, the aim of this study is to assess the benefits of a comprehensive cardiac rehabilitation program (CRP) on the functional capacity and lipid profiles, such as, total cholesterol, triglycerides, low density lipoprotein cholesterol, and high density lipoprotein cholesterol in non-obese males and non-obese females with coronary artery disease, and comparing these groups.
Materials and Methods:
We evaluated 585 non-obese males and females with coronary artery disease. All the participants completed the cardiac rehabilitation program for two months, which included 24 exercise training sessions, medical evaluation, and consultation. For investigation of the effects of the cardiac rehabilitation program on the functional capacity and lipid profiles, exercise tests were carried out by each patient, and also, their blood samples were taken on entrance and at the end of this period.
Results:
The findings, following 24 sessions in the cardiac rehabilitation program, showed that the functional capacity (P = 0.00) and all lipid profiles had significantly improved in both the groups, except that the high density lipoprotein cholesterol did not show a significant difference in non-obese females. In addition, comparing the two groups did not show any significant differences in lipid profiles, but the changes in functional capacity were significant (P = 0.00) between the two groups, following the cardiac rehabilitation program.
Conclusion:
The CRP, which was performed by the patients under supervision of a physician and an exercise physiologist, plays a key role in improving the functional capacity (FC) and all lipid profiles in non-obese males and females with coronary artery disease, without any attention to gender differences.
PMCID: PMC3687888  PMID: 23798948
Cardiac rehabilitation program; coronary artery disease; gender; risk factor
16.  Gender differences in risk factors of obese patients after cardiac rehabilitation program 
Background:
Obesity is common in patients with cardiovascular disease (CVD) and the vast majority of patients entering into cardiac rehabilitation program (CRP) are obese. Regarding the gender differences, the risk of developing coronary heart disease (CHD) is recognized to be different between obese men and women. So, the purpose of this study was to explore the effect of CRP in functional capacity (FC) and risk factors, such as obesity indexes, lipid profiles, and fasting blood sugar (FBS) in obese men and women with CHD.
Marterials and Methods:
In an observational study between 2000 and 2011, we evaluated a total of 156 obese men and women patients with CHD who were referred to cardiac rehabilitation of Isfahan Cardiovascular Research Institute. Before and after CRP, FC and risk factors were assessed and all the participants completed this period. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes, independent t tests and paired sample t tests were used.
Results:
Data revealed, after CRP, obese women had significant improvement in most evaluated risk factors except total cholesterol (P = 0.05) and FBS (P = 0.09); and obese men had favorable changes in weight (P = 0.00) and body mass index (P = 0.00), FC (P = 0.00) and total cholesterol (P = 0.02); in spite of no significant differences in other lipid profiles. Comparing the 2 groups did not show any significant differences unless high-density lipoprotein cholesterol (P = 0.01) and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P = 0.02) had greater improvement in obese women.
Conclusion:
We concluded that CRP is an important step initiating the process of risk reduction and restoration of FC in obese men and obese women with CHD under attendance and supervision of physician, nurse, and exercise physiologist.
PMCID: PMC3703080  PMID: 23853652
Cardiac rehabilitation program; coronary heart disease; gender; obesity; risk factor
17.  Psychological Status and Quality of Life in relation to the Metabolic Syndrome: Isfahan Cohort Study 
Objective. Current study was designed to investigate the association of metabolic syndrome (MetS) with depression, anxiety, psychological distress, and quality of life (QoL). Design. Two hundred and fifteen contributors with MetS and 253 participants without MetS were randomly selected from 2151 participants of Isfahan Cohort Study who were residents of Isfahan city. Measurements consisted of fasting blood samples, anthropometrics, and self-reported data of 12-item General Health Questionnaire, Hospital Anxiety and Depression Scale, and European Quality of Life-5 Dimension. Binary logistic regression analysis was used to find the association between MetS and four psychological factors. Results. Participants mean age was 56.3 ± 9.8 years. Male/female ratio was 0.86 (217/251). Mean score of depression (P = 0.003), anxiety (P = 0.018), distress (P = 0.047), and QoL (P ≤ 0.001) was significantly higher in MetS group. There were significant increasing relationships between depression (OR 1.10, 95% CI 1.03–1.22), anxiety (OR 1.03, 95% CI 1.05–1.11), and QoL (OR 1.13, 95% CI 1.05–1.23) and MetS when associations were adjusted for other risk factors, but it was not the case for distress (OR 1.03, 95% CI 0.99–1.08). Conclusion. It might be better to consider MetS as a combination of biological and psychological risk factors. Thus, a person with metabolic disease should be recognized as a patient with these factors and be screened for all of them.
doi:10.1155/2012/380902
PMCID: PMC3363984  PMID: 22675350
18.  The effects of an educational program based on PRECEDE model on depression levels in patients with coronary artery bypass grafting 
ARYA Atherosclerosis  2012;8(1):36-42.
BACKGROUND
Depression is among the most important barriers to proper treatment ofcardiac patients. It causes failure in accepting their conditions, decreases their motivation infollowing the therapeutic recommendations, and thus negatively affects their functionality andquality of life. The present study aimed to investigate the effects of an educational programbased on Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis andEvaluation (PRECEDE) model on depression level in coronary artery bypass grafting (CABG)surgery patients.
METHODS
This was a quasi-experimental study in which 54 post-bypass surgery patients ofIsfahan Cardiovascular Research Center were investigated. The patients were randomly dividedinto two groups of intervention and control. The data was collected using two questionnaires.Primarily, the cardiac depression scale was used to measure the degree of depression followedby PRECEDE model-based educational questionnaire to identify the role of the educationalintervention on patients. The PRECEDE model-based intervention composed of 9 educationalsessions per week (60-90 minutes each). The patients were followed up for two months postintervention.
RESULTS
Following the educational intervention, mean scores of predisposing, enabling,and reinforcing factors, and self-helping behaviors significantly increased in the interventiongroup compared to the control group (P < 0.001). In addition, a significant difference in meanscores of depression was observed between the two groups following the educationalintervention (P < 0.001).
CONCLUSION
The findings of the current study confirmed the practicability and effectivenessof the PRECEDE model-based educational programs on preventing or decreasing depressionlevels in CABG patients.
PMCID: PMC3448400  PMID: 23056099
Educational Program; PRECEDE Model; Depression; Coronary Artery Bypass Surgery.
19.  Barriers and facilitators of weight management in overweight and obese people: Qualitative findings of TABASSOM project 
Introduction:
Since weight management is affected by various factors, including social and behavioral ones, this study aimed to explore the peoples’ experience of barriers and facilitators of weight management.
Materials and Methods:
This qualitative content analysis was conducted as the initial step of TABASSOM Study. Participants, who tried to reduce their weight at least once, were selected by purposeful sampling method from aerobic fitness clubs, parks, and public offices in Isfahan in 2010. Data saturation was reached after indepth unstructured interviews with 11 participants. Data analysis was done by conventional content analysis method.
Findings:
The participants have intermittently followed weight loss program. Barriers such as physical problems, lack of motivation, lack of work and family support and lack of time have resulted in their failures and outages. The main facilitator to start or restart after stopping such programs for a while was positive psychologic effect.
Discussion and Conclusion:
Findings showed that many problems could prevent weight loss. It is important to identify obstacles that hinder weight management and regimen programs and to discuss them with people before planning for their weight management.
PMCID: PMC3696212  PMID: 23833613
Obesity; overweight; qualitative study
20.  Stress Level and Smoking Status in Central Iran: Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2011;6(4):144-148.
BACKGROUND
Individuals are faced with numerous stressful life events which can negatively influence mental health. Many individuals use smoking as a means of confronting stress. Given the relatively high prevalence of smoking in central Iran, the present study was conducted to compare stress levels in smokers, non-smokers and those who had quit smoking.
METHODS
This study was conducted as part of Isfahan Cardiovascular Research Program on 9752 individuals in the cities of Isfahan, Arak, and Najafabad in 2008. Sampling was performed using multi-stage cluster randomization method. Data on age, sex, demographic characteristics, and smoking status was collected through interviews. Stress level detected by General Health questionnaire.Logistic regression and chi- squere test was used for data analyzing.
RESULTS
In the present study, 30% of non-smokers, 32.1% ex- smoker and 36.9% of smokers had GHQ of 4 and higher (P=0.01). In regression analysis, the final model which was controlled for age, sex, socioeconomic statues (including place of residence, marital status and education level) showed that the odds ratio of stress in smokers and ex- smoker was significantly higher than in non-smokers (OR=1.66 and OR=1.12, respectively).
CONCLUSION
Since in conducted studies, mental problems and stresses have had an important role in people's smoking, it seems suitable to use the results of this study to present intervention for correct methods of coping with stress towards reducing the prevalence of smoking in the community.
PMCID: PMC3347833  PMID: 22577433
Cigarette; Stress; Community-based Program.
21.  Smoking cessation support in Iran: Availability, sources & predictors 
Background & objectives:
Smoking cessation advice is known as an important factor in motivating smokers to quit smoking. We investigated the extent, sources and predictors of receiving unsolicited advice and seeking active advice for smoking cessation in Iran.
Methods:
A cross-sectional study was performed as a part of Isfahan Healthy Heart Program (IHHP) on 9093 adult individuals (both men and women) in 2004-2005. Demographic characteristics, smoking status, sources and preferences for smoking cessation support were recorded.
Results:
In the studied population, 66.8 and 14.4 per cent had received and asked for cessation support, respectively. Smokers had received advice from family (92.2%), friends (48.9%), physician (27.9%) and other health care providers (16.2%). Smokers had asked for cessation help more frequently from family (64.5%) and friends (42.0%). Women (OR: 0.59, 95% CI: 0.37-0.94) and singles (OR: 0.51, 95% CI: 0.36-0.71) received less advice. Hookah smokers received (OR: 0.23; 95% CI: 0.14-0.38) and asked (OR: 0.21; 95% CI: 0.06-0.68) for cessation help less than cigarette smokers. Receiving advice increased the odds of seeking support (OR: 7.98; 95% CI: 4.37-14.57).
Interpretation & conclusions:
Smokers’ family and friends were more frequent sources for smoking cessation support. Tobacco control programmes can count on smokers’ family and friends as available sources for smoking cessation support in countries where smoking cessation counselling services are less available. However, the role of physicians and health care workers in the smoking cessation counselling needs to be strengthened.
PMCID: PMC3135990  PMID: 21727661
Cigarettes; hookah; Iran; smoking; smoking cessation
22.  Relationship between depression and apolipoproteins A and B: a case–control study 
Clinics  2011;66(1):113-117.
OBJECTIVE:
To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease.
INTRODUCTION:
Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein.
METHODS:
This case–control study included 153 patients with major depressive disorder who fulfilled the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV), and 147 healthy individuals. All participants completed a demographic questionnaire and Hamilton rating scale for depression. Anthropometric characteristics were recorded. Blood samples were taken and total cholesterol, high‐ and low‐density lipoproteins and apolipoproteins A and B were measured. To analyze the data, t‐test, χ2 test, Pearson correlation test and linear regression were applied.
RESULTS:
Depression was a negative predictor of apolipoprotein A (β = −0.328, p<0.01) and positive predictor of apolipoprotein B (β = 0.290, p<0.05). Apolipoprotein A was inversely predicted by total cholesterol (β = −0.269, p<0.05) and positively predicted by high‐density lipoprotein (β = 0.401, p<0.01). Also, low‐density lipoprotein was a predictor of apolipoprotein B (β = 0.340, p<0.01). The severity of depression was correlated with the increment in serum apolipoprotein B levels and the decrement in serum apolipoprotein A level.
CONCLUSION:
In view of the relationship between apolipoproteins A and B and depression, it would seem that screening of these metabolic risk factors besides psychological interventions is necessary in depressed patients.
doi:10.1590/S1807-59322011000100020
PMCID: PMC3044579  PMID: 21437446
Coronary risk factors; Coronary heart disease; Major depression
23.  Positive and negative perfectionism and their relationship with anxiety and depression in Iranian school students 
BACKGROUND:
Although many studies have investigated the relationship between perfectionism, anxiety, and depression among the adults, little is known about the manifestations of perfectionism among schoolage youths. This study has investigated this relationship in an Iranian sample.
METHODS:
Using multistage cluster random sampling, 793 Iranian school students in 2007 were studied. Data of demographic characteristics, children's depression inventory, revised children's manifest anxiety scale, and the positive and negative perfectionism scales were obtained using questionnaires.
RESULTS:
The results indicated that both aspects of perfectionism are associated with depression and anxiety. Negative and positive perfectionism have positive and negative associations, respectively, with depression and anxiety. The interaction of anxiety and depression with perfectionism reveals that depression is in association with lower scores of positive perfectionism, whereas in students with higher scores of negative perfectionism, the anxiety scores are also higher. Moreover, the accompaniment of anxiety with depression is in association with relatively lower levels of negative perfectionism.
CONCLUSIONS:
It was concluded that negative perfectionism is a risk factor for both depression and anxiety, while positive perfectionism is a protective factor. However, the interventions which encourage the positive aspects of perfectionism and decrease its negative aspects may be able to diminish psychopathological subsequence.
PMCID: PMC3063422  PMID: 21448388
Depressions; Anxiety
24.  The Correlation Between Lipid Profile and Stress Levels in Central Iran: Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2010;6(3):102-106.
BACKGROUND
Previous studies suggest that mental status may influence serum lipid levels. This study was conducted on adult population living in rural and urban areas in Central Iran to assess the correlation between stress level and lipid profile disorders.
METHODS
Data was extracted from final evaluation of Isfahan Healthy Heart Program (IHHP) in 2008. Multistage and random cluster methods were used for sampling. The study population consisted of 9752 adults aged ≥19 years living in three districts namely Isfahan, Arak and Najaf Abad. Demographic data, age and sex were recorded. Blood samples were taken to determine the lipid levels including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), low levels of high-density lipoprotein cholesterol (HDL-C) and triglycerides. Stress levels were assessed using the General Health Questionnaire. Logistic regression and chi-square tests were used for statistical analysis.
RESULTS
The odds ratios of high stress in individuals with high levels of TC, LDL-C and low levels of HDL-C compared to normal individuals after adjustment for age and sex were as follows respectively: 1.05 (1.02,1.15), 1.06 (1.02,1.18), 1.06 (1.01,1.17).
CONCLUSION
Intervention activities towards reduction of stress levels at the community level may be useful as part of the strategy for cardiovascular disease prevention.
PMCID: PMC3347824  PMID: 22577424
Cholesterol; Triglycerides; Stress; Adult
25.  The Relationship Between Ankle-Brachial Index and Number of Involved Coronaries in Patients with Stable Angina 
ARYA Atherosclerosis  2010;6(1):6-10.
BACKGROUND
Atherosclerosis is the commonest cause of vascular disease which can involve peripheral and/or cardiac vessels. This study was conducted to evaluate the possible link between Ankle-Brachial Index (ABI) and coronary vessel involvement in patients with stable angina.
METHODS
This cross-sectional study was conducted in 2008 on 120 individuals who were hospitalized in Chamran Heart Center and underwent coronary angiography. A questionnaire was completed to obtain demographic information, history of previous heart disease and smoking. Body height and weight, as blood pressure on hand and foot were measured. The patients underwent angiography and the extent of coronary involvement (> 75%) was determined. After12-14-hour of fasting, blood sugar was obtained to measure total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The Ankle Brachial Pressure Index (ABI) was calculated as the ratio of the blood pressure in the ankles to the blood pressure in the arms. The data were analyzed by SPSS-15 using ANOVA, T-Student test, Spearman's rank correlation coefficient, and discriminant analysis.
RESULTS
Samples were 46 women (38.33%) and 74 men (61.67%) with a mean age of 55.50 ± 10.49. Mean and SD of ABI in men and women was 0.72 ± 0.20 and 0.80 ± 0.19 with no significant difference (P=0.012). The correlation between ABI and extent of coronary involvement was 0.47 (P < 0.0001). The group with lower ABI had the highest levels of coronary involvement (triple vessel, P < 0.05).
CONCLUSION
ABI had a significant relationship with the degree of coronary involvement and a significant predictive value. Therefore ABI seems to be a reliable indicator of high coronary risk.
PMCID: PMC3347808  PMID: 22577406
Ankle to brachial index; Coronary involvement; Stable angina

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