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1.  Brewer's Yeast Improves Glycemic Indices in Type 2 Diabetes Mellitus 
Background:
Brewer's yeast may have beneficial effects on insulin receptors because of itsglucose tolerance factor in diabetic patients. This study was conducted to investigate the effects of brewer's yeast supplementation on glycemic indices in patients with type 2 diabetes mellitus.
Methods:
In a randomized double-blind controlled clinical trial, 84 adults (21 men and 63 women) aged 46.3 ± 6.1 years old with type 2 diabetes mellitus were recruited and divided randomly into two groups: Supplement group receiving brewer's yeast (six 300mg tablets/day, total 1800 mg) and control group receiving placebo (six 300mg tablets/day) for 12 weeks. Body weight, height, body mass index, food consumption (based on 24h food record), fasting blood sugar (FBS), glycosylated hemoglobin, insulin sensitivity, and insulin resistance were measured before and after the intervention. Data analysis was performed using the Statistical Package for Social Sciences (version 18.0).
Results:
The changes in FBS, glycosylated hemoglobin, and insulin sensitivity were significantly different between the two groups during the study (respectively P < 0.001, P < 0.001, P = 0.02 independent sample t-test). There was a significant difference in FBS, glycosylated hemoglobin, and insulin sensitivity at the end of the study between the two groups after removing the effects of baseline values (respectively P = 0.002, P < 0.001, P = 0.02, analysis of covariance). Changes in body mass index, 24h food record, insulin resistance were not significant.
Conclusions:
Dietary supplementation with brewer›s yeast besides the usual treatment of diabetes can ameliorate blood glucose variables in type 2 diabetes mellitus.
PMCID: PMC3843299  PMID: 24319552
Brewer's yeast; HbA1c; type 2 diabetes
2.  Association between Salt Intake and Albuminuria in Normotensive and Hypertensive Individuals 
Background. There is a little published data regarding the association between salt intake and albuminuria as an important alarm for progression of cardiovascular and renal dysfunction. We aimed to assess this relationship to emphasize the major role of restricting salt intake to minimize albuminuria and prevent these life-threatening events. Methods. The study population comprised 820 individuals. Participants were assigned to groups as follows: normal albuminuria, slight albuminuria, and clinical albuminuria. Daily salt intake was assessed on the basis of 24-hour urinary sodium excretion, since urinary sodium excretion largely equals sodium intake. Results. In normotensive participants, the mean level of urine albumin was higher in those who had higher amounts of salt intake with a significantly upward trend (the mean urinary albumin level in low-salt-diet group, in medium-salt-intake group, and in high-salt-intake group was 42.70 ± 36.42, 46.89 ± 38.91, and 53.38 ± 48.23, resp., (P = 0.017)). There was a significant positive correlation between 24-hour urinary sodium secretion and the level of urine albumin (beta = 0.130, P < 0.001). The amount of salt intake was significantly associated with urine albumin concentration (beta = 3.969, SE = 1.671, P = 0.018). Conclusion. High salt intake was shown to be associated with higher level of microalbuminuria even adjusted for potential underlying risk factors.
doi:10.1155/2013/523682
PMCID: PMC3793292  PMID: 24171109
3.  The Effect of Omega-3 Supplements on Antioxidant Capacity in Patients with Type 2 Diabetes 
International Journal of Preventive Medicine  2013;4(Suppl 2):S234-S238.
Background:
Diabetes is one of the most common chronic diseases in which antioxidant capacity changes. Omega-3 fatty acids have extensive biological effects including their advantage on lipoprotein metabolism, platelet function, cytokine production, clotting, fibrinolysis, and inflammatory factors. This study aimed to investigate the effect of omega-3 fatty acid supplements on antioxidant capacity in patients with type 2 diabetes.
Methods:
This clinical trial enrolled 71 women with type 2 diabetes in two case (treated with omega-3 capsules) and control (treated with placebo) groups. In the first stage, participants filled out a demographics questionnaire including age, height, weight, waist circumference, and hip circumference.Their blood sample was taken to evaluate glycosylated hemoglobin and antioxidant capacity. Then the case group received intervention for 8 weeks and weight, waist circumference, and hip circumference were measured and a blood sample was taken again. The data were analyzed using SPSS 18 software.
Results:
The mean difference of antioxidant capacity before and after intervention was significant (P < 0.001). Antioxidant capacity increased in the case group and reduced in the control group.
Conclusions:
With regard to the results of the present study, patients with type 2 diabetes increase their antioxidant capacity, enhance their antioxidant defense system, and probably prevent diabetes complications and related disease progress by taking omega-3 supplements.
PMCID: PMC3678224  PMID: 23776730
Antioxidant capacity; omega-3 supplement; type 2 diabetes
4.  The effects of a comprehensive community trial on cardiometabolic risk factors in adolescents: Isfahan Healthy Heart Program 
ARYA Atherosclerosis  2012;7(4):184-190.
BACKGROUND:
This study aimed to assess the effects of a 6-year-long community-participatory program including school-based interventions on mean values and prevalence of cardiometabolic risk factors among adolescents.
METHODS:
The interventions of this community trial, conducted from 2000 to 2007 in Iran, targeted the whole population (of nearly two millions) living in two cities considered as the intervention area (IA) in comparison with a reference area (RA). Data from surveys conducted before and after interventions was used to compare the differences between the secondary school students of the IA and RA.
RESULTS:
The prevalence of hypercholesterolemia and hypertriglyceridemia declined significantly in girls and boys in the IA (P < 0.01). The prevalence of high LDL-C decreased significantly in the girls in the RA (P = 0.002). Among both sexes in the IA, the prevalence of low HDL-C increased significantly (P < 0.001), whereas it decreased in the girls and boys in the RA (P = 0.04). Although in the IA, the prevalence of overweight and obesity decreased significantly in girls (P = 0.001), it increased in boys (P = 0.001) as well as in the girls of the RA (P = 0.01).
CONCLUSION:
By performing school-based interventions, our study was successful, at least in part, in controlling some cardiometabolic risk factors in adolescents. Such modifications may have long-term impacts on non-communicable diseases prevention in adulthood.
PMCID: PMC3413088  PMID: 23205053
Prevention; Adolescents; Lifestyle; Community Trial; Iran
5.  How does the impact of a community trial on cardio-metabolic risk factors differ in terms of gender and living area? Findings from the Isfahan healthy heart program 
Objective:
To assess the impact of gender and living area on cardiovascular risk factors in the context of a comprehensive lifestyle intervention program.
Design:
Data from independent sample surveys before (2000--2001) and after (2007) a community trial, entitled the Isfahan Healthy Heart Program (IHHP) were used to compare differences in the intervention area (IA) and reference area (RA) by gender and living area.
Setting:
The interventions targeted the population living in Isfahan and Najaf-Abad counties as IA and Arak as RA.
Participants:
Overall, 12 514 individuals who were more than 19 years of age were studied at baseline, and 9570 were studied in postintervention phase.
Interventions:
Multiple activities were conducted in connection with each of the four main strategies of healthy nutrition, increasing physical activity, tobacco control, and coping with stress.
Main Outcomes:
Comparing serum lipids levels, blood pressure, blood glucose and obesity indices changes between IA and RA based on sex and living areas during the study.
Results:
In IA, while the prevalence of hypertension declined in urban and rural females (P < 0.05). In IA, the prevalence of hypercholesterolemia and hypertriglyceridemia decreased in both females and males of urban and rural areas except for hypercholesterolemia in rural males (P < 0.01). In RA, the significant changes include both decrease in the hypercholesterolemia among rural males (P < 0.001) and hypertriglyceridemia in urban females (P < 0.01), while hypertriglyceridemia was significantly increased in rural females (P < 0.01).
Conclusions:
This comprehensive community trial was effective in controlling many risk factors in both sexes in urban and rural areas. These findings also reflect the transitional status of rural population in adopting urban lifestyle behaviors.
PMCID: PMC3687879  PMID: 23798939
Age; cardiovascular risk factor; community health program; health promotion; rural; sex; urban
6.  The Relationship between Weight and CVD Risk Factors in a Sample Population from Central Iran (Based on IHHP) 
ARYA Atherosclerosis  2012;8(2):82-89 .
BACKGROUND
Atherosclerosis is one of the leading causes of mortality all around the world. Obesity is an independent risk factor for atherosclerosis and cardiovascular diseases (CVD). In this respect, we decided to examine the effect of the subgroups of weight on cardiovascular risk factors.
METHODS
This cross-sectional study was done in 2006 using the data obtained by the Iranian Healthy Heart Program (IHHP) and based on classification of obesity by the World Health Organization (WHO). In this study, the samples were tested based on the Framingham risk score, Metabolic Measuring Score (MMS) and classification of obesity. Chi-square and ANOVA were used for statistical analysis.
RESULTS
12514 people with a mean age of 38 participated in this study. 6.8% of women and 14% of men had university degrees (higher than diploma). Obesity was seen in women more than men: 56.4% of women and 40% of men had a Body Mass Index of (BMI) ≥ 25 Kg/m2. 13% of the subjects had FBS > 110 and13.9% of them were using hypertensive drugs. In this study, we found that all risk factors, except HDL cholesterol in men, increased with an increase in weight. This finding is also confirmed by the Framingham flowfigure for men and women.
CONCLUSION
One of every two Americans, of any age and sex, has a Body Mass Index of (BMI) ≥ 25 Kg/m2. Obesity associated CVD and other serious diseases. Many studies have been done in different countries to find the relationship between obesity and CVD risk factors. For example, in the U.S.A and Canada they found that emteropiotic parameters, blood presser and lipids increased by age(of both sexes). Moreover, another study done in China, which is a country in Asia like Iran, shows that BMI has an indirect effect on HDL cholesterol, LDL cholesterol and triglyceride. This data is consistent with the results of the current study. However, In China they found that this relationship in men is stronger than women, but our study reveals the opposite.
PMCID: PMC3463990  PMID: 23056109
Body Mass Index (BMI); Overweight; Cardiovascular Risk Factors; Framingham Risk Score; Metabolic Syndrome
7.  Risk factors of atherosclerosis in male smokers, passive smokers, and hypertensive nonsmokers in central Iran 
ARYA Atherosclerosis  2012;8(2):90-95.
BACKGROUND
Some studies showed that smoking follows an upward trend in Asian countries as compared with other countries. The purpose of this study was to examine the effect of cigarette smoking on cardiovascular diseases and risk factors of atherosclerosis in patients with hypertension.
METHODS
This study was conducted on 6123 men residing in central Iran (Isfahan and Markazi Provinces) that participated in Isfahan Healthy Heart Project (IHHP). Subjects were randomly selected using cluster sampling method. All the subjects were studied in terms of their history of cardiovascular disease, demographic characteristics, smoking, blood pressure, physical examination, pulse rate, respiratory rate, weight, height, waist circumference, and blood measurements including LDL-C, HDL-C, total cholesterol, triglyceride, fasting blood sugar and 2-hour post prandial test.
RESULTS
While 893 subjects suffered from hypertension, 5230 subjects were healthy. The hypertension prevalence was 2.5 times more in urban areas compared to rural areas that showed a significant difference as it increased to 3.5 times smoking factor was considered. The prevalence of risk factors of atherosclerosis and also cardiovascular complications in patients with hypertension were significantly higher than healthy people. Furthermore, they were higher in smokers with hypertension and those exposed to the cigarette smoke than nonsmokers.
CONCLUSION
Smoking and passive smoking had an increasing effect on the prevalence of risk factors of atherosclerosis and consequently the incidence of cardiovascular diseases in patients with hypertension.
PMCID: PMC3463995  PMID: 23056110
Hypertension; Cigarette Smoking; Cardiovascular Disease; Risk Factor
8.  Lipid Profiles and Serum Visfatin Concentrations in Patients with Type II Diabetes in Comparison with Healthy Controls 
Background:
Visfatin is a new adipocytokine which is largely secreted by visceral adipose tissue and its effects in the development of diabetes and inflammatory reactions are similar to insulin. It acts synergistically with insulin in increasing glucose cellular uptake, stimulating glucose transfer to the muscle and adipose tissue, as well as in preventing hepatic glucose production. Its insulin-like effects are mediated through direct connection and activation of insulin receptors without any change or competition with the insulin.
Methods:
This case-control study was conducted among 64 women consisting of 32 diabetic patients, and 32 age-matched healthy controls. The case group consisted of 32 post-menopausal diabetic women, aged 45-65 years. Those patients were eligible who had a history of at least five years of type II diabetes, without any complications of diabetes, and who were treated only by oral glucose-lowering medications. Those individuals with C-reactive protein (CRP) test of 3+ and above were excluded from the study. Results were compared with age- and sex- matched controls.
Results:
Average visfatin level was significantly higher in diabetic patients than in controls (4.3 ± 1.06ng/dl vs. 3.15 ± 0.74ng/dl, respectively< 0.001).
The mean values of anthropometric indexes and lipid profile were not significantly different between diabetic patients and controls
Conclusion:
This study documented an inverse relationship between circulating level of visfatin and fasting blood glucose. This finding may suggest the role of increased visfatin level and increase in synthesis and secretion of the cytokines from adipocytes. These findings may be useful for primary and secondary preventive issues in diabetic and pre-diabetic individuals.
PMCID: PMC3372075  PMID: 22708029
Lipid profile; type II diabetes; visfatin
9.  The effects of omega-3 on blood pressure and the relationship between serum visfatin level and blood pressure in patients with type II diabetes 
ARYA Atherosclerosis  2012;8(1):27-31.
BACKGROUND
Hypertension is a condition normally detected in people with type II diabetes.It eventually leads to cardiovascular diseases in the patient. Visfatin is an adipocytokine which issecreted from adipose tissue and can affect the inflammatory reaction and also serum lipidlevels. Additionally, omega-3 inhibits the accumulation of fat and formation of insulinresistance. The current study tried to investigate the effects of omega-3 on blood pressurecompared to placebo and the relationship between serum visfatin levels and blood pressure.
METHODS
A total number of 71 women with type II diabetes were randomly assigned to2 groups to receive either omega-3 capsules or placebo capsules. In the first step, aquestionnaire consisting age, height, weight, waist and hip circumferences, and systolic anddiastolic blood pressure was filled out for each subject. Blood samples were then collected forlaboratory tests. The next step was to conduct 8 weeks of intervention. All variables, except age,were measured again after the intervention. Hip circumference was considered as the maximumcircumference of the buttocks. Waist circumference was measured by placing a tape horizontallyacross the abdomen at the end of a normal exhalation. Laboratory tests included the assessmentof visfatin, glucose, and glycated hemoglobin (HbA1c) concentrations. Lipid profile, i.e. lowdensity lipoprotein (LDL), high density lipoprotein (HDL), triglyceride (TG), and cholesterol,was also assessed. Using SPSS18, data obtained from the study was analyzed by a variety ofappropriate statistical tests.
RESULTS
There was a significant change in mean differences of systolic and diastolic bloodpressure. Blood pressure showed a significant reduction in the omega-3 group compared to theplacebo group. However, no significant changes were observed in systolic and diastolic bloodpressure before and after the intervention (P > 0.05).
CONCLUSION
Based on the results of this study, a daily consumption of omega-3 is suggestedfor patients with type II diabetes.
PMCID: PMC3448398  PMID: 23056097
Omega 3; Visfatin; Hypertension; Type 2 Diabetes Mellitus.
10.  Does Lipoprotein (a) Level Have a Predictive Value in Restenosis after Coronary Stenting? 
Objectives:
Lipid disorders, lipoproteins, diabetes mellitus, and hypertension are the known risk factors for coronary artery diseases; however, their role is unknown in restenosis after coronary stenting. This study aimed to review the role of these factors, particularly lipoprotein (a) or Lp (a), as a predictive factor for restenosis after coronary stenting with Bare Metal Stent.
Methods:
In this study, coronary artery stenting was performed on 170 patients. Follow-up was done using coronary angiography in 128 patients, 6 months after conducting angioplasty. Clinical and biochemical characteristics of the patients were collected as prospective method and were compared between the patients with and without restenosis.
Results:
Restenosis was seen in 46 patients (35.9%). Fasting blood glucose level (FBG) in patients with restenosis was significantly higher than patients without restenosis (102.3 ± 39 mg/dl vs. 84.5 ± 28.9 [OR: 1.02, 95% CI: 1.00-1.04]). Lp (a) levels (OR: 0.54, 95% CI: 0.26-1.10) and other biochemical markers and clinical variables had no correlation with restenosis.
Conclusions:
Lipoproteins and lipids may not be the underlying cause of restenosis but accurate control of diabetes may improve prognosis after elective coronary stenting.
PMCID: PMC3143529  PMID: 21811658
Stent; Restenosis; Lipoprotein (a); Lipid; Diabetes
11.  The effect of omega-3 on the serum visfatin concentration in patients with type II diabetes 
BACKGROUND:
Visfatin is an adipocytokine which is secreted from adipose tissue and can affect on the diabetes inflammatory reaction and also serum lipids level. On the other hand, Omega-3 can also prevent formation of insulin resistance. In the present study, the effect of Omega-3 on the serum visfatin concentration was evaluated.
METHODS:
71 women with type II diabetes were randomly assigned to the group that took Omega-3 capsules or control group with placebo capsules. In the first step, study subjects filled a questionnaire collecting their age, height, weight, waist circumference, and hip circumference. Also their blood samples were taken for blood tests. In the second step, the intervention was done for 8 weeks and in the third step the aforementioned were collected again. In the blood samples visfatin and lipid profiles (low density lipoprotein [LDL], high density lipoprotein [HDL], triglyceride [TG], and cholesterol), glucose and HbA1c were measured.
RESULTS:
There was no significant difference in serum visfatin level between Omega-3 and placebo groups before the intervention (p = 0.14), while after the intervention, the mean serum visfatin level in the Omega-3 group was significantly higher (p < 0.001). In addition, the mean difference between the serum visfatin level before and after the intervention in both groups was significant (p < 0.001).
CONCLUSIONS:
This study showed an increase in visfatin level following consuming Omega-3 fats but according to controversial issues on insulin-like function of visfatin, the effects of Omega-3 on diabetes should be studied more in further studies.
PMCID: PMC3214353  PMID: 22091264
Fatty Acids; Omega-3; Nicotinamide Phosphoribosyltransferase; Diabetes Mellitus; Type 2
12.  Gender Differences in Obesogenic Behaviour, Socioeconomic and Metabolic Factors in a Population-based Sample of Iranians: The IHHP Study 
This study investigated the gender differences in association of some behavioural and socioeconomic factors with obesity indices in a population-based sample of 12,514 Iranian adults. The mean body mass index (BMI), waist circumference (WC), and the waist-to-hip ratio (WHR) were significantly higher in women than in men. Current and passive smoking had an inverse association with BMI among males whereas current smoking, transportation by a private car, and longer duration of watching television (TV) had a positive association with BMI among females. Current and passive smoking, cycling, and Global Dietary Index (GDI) had an inverse association with WC among males. Higher consumption of fruits and vegetables, current and passive smoking, duration of daily sleep, and GDI had an inverse association with WC among females. Using a private car for transportation had a significant positive association with WHR among both males and females. Living in an urban area, being married, and having a higher education level increased the odds ratio of obesity among both the genders. Non-manual work also increased this risk among males whereas watching TV and current smoking increased this risk among females. Such gender differences should be considered for culturally-appropriate interventional strategies to be implemented at the population level for tackling obesity and associated cardiometabolic risk factors.
PMCID: PMC2995029  PMID: 21261206
Cardiovascular diseases; Cross-sectional studies; Lifestyle; Obesity; Risk factors; Socioeconomic factors; Iran
13.  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
14.  Effect of Hydrogenated, Liquid and Ghee Oils on Serum Lipids Profile 
ARYA Atherosclerosis  2010;6(1):16-22.
BACKGROUND
Trans fatty acids are known as the most harmful type of dietary fats, so this study was done to compare the effects of hydrogenated, liquid and ghee oils on serum lipids profile of healthy adults.
METHODS
This study was a randomized clinical trial conducted on 129 healthy participants aged from 20 to 60 years old who were beneficiaries of Imam-e-Zaman charitable organization. Subjects were randomly divided into 3 groups and each group was treated with a diet containing cooking and frying liquid, ghee, or hydrogenated for 40 days. Fasting serum lipids, including total cholesterol (TC), triglyceride (TG), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), apoprotein A (Apo A), and apoprotein B (Apo B) were measured before and after the study.
RESULTS
TC, TG and Apo B had a significant reduction in the liquid oil group compared to the hydrogenated oil group. In the ghee group TG declined and Apo A increased significantly (P < 0.01). Liquid oil group had a significant reduction in HDL-C, compared to the ghee oil group (P < 0.05).
CONCLUSION
It was concluded that consuming liquid oil along with frying oil caused to reduce all serum lipid levels. However, ghee oil only reduced TG and increased HDL-C levels.
PMCID: PMC3347809  PMID: 22577408
Serum lipids; Apoproteins; Liquid oil; Hydrogenated oil; Ghee; Clinical trial
15.  Association of Socioeconomic Status and Life-style Factors with Coping Strategies in Isfahan Healthy Heart Program, Iran 
Croatian Medical Journal  2009;50(4):380-386.
Aim
To investigate the association between life-style and socioeconomic factors and coping strategies in a community sample in Iran.
Method
As part of a community-based study called Isfahan Healthy Heart Program, we studied 17 593 individuals older than 19 living in the central part of Iran. Demographic and socioeconomic factors (age, sex, occupation status, marital status, and educational level) and lifestyle variables (smoking status, leisure time physical activity, and psychological distress), and coping strategy were recorded. Data were analyzed by Pearson correlation and multiple linear regression.
Results
Not smoking (women β = -11.293, P < 0.001; men β = -3.418, P = 0.007), having leisure time physical activity (women β = 0.017, P = 0.046; men β = 0.005, P = 0.043), and higher educational level (women β = 0.344, P = 0.015; men β = 0.406, P = 0.008) were predictors of adaptive coping strategies, while smoking (women β = 11.849, P < 0.001; men β = 9.336, P < 0.001), high stress level (women β = 1.588, P = 0.000; men β = 1.358, P < 0.001), and lower educational level (women β = -0.443, P = 0.013; men β = -0.427, P = 0.013) were predictors of maladaptive coping strategies in both sexes. Non-manual work was a positive predictor of adaptive (β = 4.983, P < 0.001) and negative predictor of maladaptive (β = -3.355, P = 0.023) coping skills in men.
Conclusion
Coping strategies of the population in central Iran were highly influenced by socioeconomic status and life-style factors. Programs aimed at improving healthy life-styles and increasing the socioeconomic status could increase adaptive coping skills and decrease maladaptive ones and consequently lead to a more healthy society.
doi:10.3325/cmj.2009.50.380
PMCID: PMC2728387  PMID: 19673038
16.  Process evaluation of a community-based program for prevention and control of non-communicable disease in a developing country: The Isfahan Healthy Heart Program, Iran 
BMC Public Health  2009;9:57.
Background
Cardiovascular diseases are the most common cause of mortality in Iran. A six-year, comprehensive, integrated community-based demonstration study entitled Isfahan Healthy Heart Program (IHHP) conducted in Iran, and it started in 2000. Evaluation and monitoring are integrated parts of this quasi-experimental trial, and consists of process, as well as short and long-term impact evaluations. This paper presents the design of the "process evaluation" for IHHP, and the results pertaining to some interventional strategies that were implemented in workplaces
Methods
The process evaluation addresses the internal validity of IHHP by ascertaining the degree to which the program was implemented as intended. The IHHP process evaluation is a triangulated study conducted for all interventions at their respective venues. All interventional activities are monitored to determine why and how some are successful and sustainable, to identify mechanisms as well as barriers and facilitators of implementation.
Results
The results suggest that factory workers and managers are satisfied with the interventions. In the current study, success was mainly shaped by the organizational readiness and timing of the implementation. Integrating most of activities of the project to the existing ongoing activities of public health officers in worksites is suggested to be the most effective means of implementation of the health promoting activities in workplaces.
Conclusion
The results of our experience may help other developing countries to plan for similar interventions.
doi:10.1186/1471-2458-9-57
PMCID: PMC2647538  PMID: 19216762

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