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.
Cardiovascular disorders are an important public health problem worldwide. They are also the leading cause of mortality and morbidity. Therefore, American Heart Association proposed cardiac rehabilitation program as an essential part of care for cardiac patients to improve functional capacity. The aim of this study was to evaluate the effectiveness of cardiac rehabilitation program on functional status and some hemodynamic responses in patients after coronary artery bypass graft (CABG) surgery.
Thirty two patients were selected for this study. All patients underwent cardiac surgery two months before admission. They were allocated to two groups. While the rehabilitation group (n =17, mean age: 62 ± 12 years) completed the cardiac rehabilitation program for two months, the reference group (n = 15, mean age: 58.5 ± 12.5 years) did not have any supervised physical activity during this period. Cardiac rehabilitation program consisted of exercise, nutritional, psychological consultation and risk factor management. At the beginning of the study, functional capacity of patients was evaluated by exercise test, 6-minute walking test and echocardiography. Functional capacity was evaluated for a second time after two months of cardiac rehabilitation. Data were analyzed by SPSS15. For comparing the mean of outcomes, Mann-Whitney test and Wilcoxon signed ranks test were used.
As a result of cardiac rehabilitation, a significant improvement was observed in the distance walked in the rehabilitation group (P < 0.01) compared to the reference group (P = 0.33). It also caused a significant development in hemodynamic responses to exercise such as resting and maximum systolic and diastolic blood pressure, resting and maximum heart rate, ejection fraction and rate pressure product.
Cardiac rehabilitation significantly improves functional capacity and some hemodynamic responses post coronary artery bypass grafting. Therefore, patients need to be referred to rehabilitation units.
Cardiac Rehabilitation Program; Hemodynamic Responses; Coronary Artery Bypass Graft Surgery (CABG)
This study aimed to compare Iranian elderly with the middle-aged population in terms of the prevalence of metabolic syndrome and its components.
This cross-sectional study was conducted using the data from the third phase of the Isfahan Healthy Heart Program. Male and female residents of Isfahan over 19 years of age were selected by multistage cluster random sampling. A questionnaire including demographic characteristics, health status, medical history, medications used, as well as waist circumference, weight, height, and systolic and diastolic blood pressures was completed for all participants. Fasting blood samples were obtained from all subjects and examined for fasting blood sugar and lipid profile. T-test and Mann-Whitney test were used for quantitative data and chi-square test was performed for qualitative data.
The prevalence of metabolic syndrome in individuals aged over 60 years was significantly higher than those under 60 (49.5% vs. 17.5%, respectively; P < 0.001). Metabolic syndrome was also more prevalent among elderly females than in males (59.2% vs. 39.8%, respectively; P < 0.005). Some anthropometric measures such as height, body mass index, abdominal circumference, waist-hip ratio, and waist-to-height ratio were significantly different in men and women below 60 years in comparison with those over 60 years (P < 0.05). Moreover, there were significant differences in most studied parameters between the elderly and non-elderly women (P < 0.001).
This study showed that metabolic syndrome has a relatively high prevalence in Iranian elderly people, especially in elderly women. Therefore, early diagnosis and management of the complication are recommended among this high-risk group to avoid the subsequent complications.
Metabolic Syndrome; Elderly; Iran
This study was designed to assess the effectiveness of stress management training in improving the ability of coping with stress in a large population.
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.
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.
Stress management programs could improve coping strategies at the community level and can be considered in designing behavioral interventions
Stress Management; Community; Intervention; Coping Strategies
Current guidelines recommend cardiac rehabilitation programs (CRP) as a means to improve functional status of patients after coronary revascularization. However, research supporting this recommendation has been limited and positive effects of CRP on diastolic function are controversial. The aim of this study was to examine the effects of an 8-week CRP on left ventricular diastolic function.
This randomized, clinical trial included 29 men with ST elevation myocardial infarction (MI) who had received reperfusion therapy, i.e. coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). They were randomized to a training group (n = 15; mean age: 54.2 ± 9.04 years old) and a control group (n = 14; mean age: 51.71 ± 6.98 years old). Patients in the training group performed an 8-week CRP with an intensity of 60-85% of maximum heart rate. Exercise sessions lasted 60-90 minutes and were held three times a week. At the start and end of the study, all patients performed symptom-limited exercise test based on Naughton treadmill protocol. Pulsed-wave Doppler echocardiography was also used to determine peak velocity of early (E) and late (A) waves, E/A ratios, and the deceleration time of E (DT).
Left ventricular diastolic indices (E, A, E/A ratio, DT) did not change significantly after the CRP. Compared to baseline, patients in the training group had significant improvements in functional capacity (8.30 ± 1.30 vs. 9.7 ± 1.7) and maximum heart rate (118.50 ± 24.48 vs. 126.85 ± 22.75). Moreover, resting heart rate of the training group was significantly better than the control group at the end of the study (75.36 ± 7.94 vs. 79.80 ± 7.67; P < 0.001).
An 8-week CRP in post-MI patients revascularized with PCI or CABG led to improved exercise capacity. However, the CRP failed to enhance diastolic function.
Cardiac Rehabilitation; Diastolic Function; Functional Capacity; Post-Myocardial Patients
Lead contamination can affect many body organs including the heart. This study assessed a number of echocardiographic indices to clarify the effects of lead on cardiac function among battery factory workers who are in constant exposure to lead.
In a cross-sectional study, 142 male battery factory workers who had been exposed to lead for at least 1 year were evaluated. The subjects aged 25-55 years old and were excluded if they had hypertension, diabetes, or cardiovascular diseases. Demographic characteristics, professional profile, lead exposure, history of respiratory diseases, drugs intake, and lifestyle information of the participants were collected. Height, weight and blood pressure measurements were then performed. Blood tests were also ordered to determine blood lead levels. The subjects finally underwent M-mode and Doppler echocardiography. Linear regression analysis was used to establish the effects of lead on the target indices. All statistical analyses were conducted in SPSS18.
The mean age and mean duration of lead exposure of the subjects were 41.78 ± 13.58 and 23.54 ± 14.44 years, respectively. The mean blood lead level was 7.59 ± 2.75 µg/dl. Left ventricular hypertrophy was detected in 12% of the participants. Blood lead levels were not significantly related with echocardiographic indices in the crude model or after adjustments for age alone or for age and other risk factors.
Blood lead levels of our participants were below standard values. In addition, no significant relation was found between left ventricular function indices and blood lead levels. The absence of such relations could have been caused by the exclusion of individuals with hypertension or cardiovascular diseases. Structural modifications in battery factories following legislations in Iran might have been responsible for low blood lead levels among the subjects.
Occupational Exposure; Lead; Left Ventricular Echocardiography
Coronary artery disease (CAD) and myocardial infarction are the most common causes of mortality and morbidity all over the world. Aspirin resistance is an important part of therapeutic failure in patients who experience several atherosclerotic events despite aspirin therapy. Different studies have reported aspirin resistance between 5% and 45% all over the world.
According to different responses to aspirin therapy in countries and lack of adequate studies on aspirin resistance in Iran, this study was designed for evaluation of aspirin resistance in ischemic patients.
Materials and Methods:
Total 170 patients with documented coronary artery stenosis with were enrolled in this cross-sectional prospective study. Two cc urine samples were obtained from all the subjects. Then a questionnaire including questions about major risk factors (hypertension, diabetes, hyperlipidemia, obesity and smoking) was completed for each patient. Thromboxane B2 level in urine was measured two times for each patient by one kit of via ELISA method. Gensini modified was usedfor assessment of severity of coronary arteries involvement. Data were analyzed via SPSS 16. with general linear model (univariate).
75.3% of studied patients were aspirin resistant. There was significant relationship between angiography score and aspirin resistance (P<0.001).Our results also showed that aspirin resistance is more common in studied women than men (P=0.003).Significant correlation was observed between diabetes and aspirin resistance in studied subjects (P=0.023).
Our study showed aspirin resistance in a sample of Iranian ischemic patients is so prevalent which is higher than other studies in another communities and also aspirin resistance is more common in patients with severe CAD.
Aspirin resistance; coronary artery disease; thromboxane B2 level
Lack of heart rate increase proportionate to exercise causes poor prognosis. Moreover, inflammatory factors such as C-reactive protein (CRP) are associated with atherosclerosis. The current study compared these two indices in individuals with and without metabolic syndrome in Isfahan, Iran.
This study was performed on 203 people without and 123 patients with metabolic syndrome who were randomly selected from the participants of the Isfahan Cohort Study. The demographic data, waist circumference, blood pressure, height, and weight of the participants were recorded. Moreover, serum tr`viglyceride (TG), fasting blood sugar (FBS), total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), and high-sensitivity CRP (hs-CRP) levels were measured. Exercise test was carried out according to the Bruce standard protocol and heart rate reserve (HRR) was determined and recorded. The age-adjusted data was analyzed using generalized linear regression and student's t-test in SPSS15.
The mean ages of participants without and with metabolic syndrome were 54.16 ± 8.61 and 54.29 ± 7.6 years, respectively. The corresponding values for mean LDL levels were 116.17 ± 24.04 and 120.12 ± 29.55 mg/dl. TG levels were 140.38 ± 61.65 and 259.99 ± 184.49 mg/dl for subjects without and with the metabolic syndrome, respectively. The mean FBS levels were 81.81 ± 9.90 mg/dl in the participants without the syndrome and 107.13 ± 48.46 mg/dl in those with metabolic syndrome. The mean systolic blood pressure was 116.06 ± 13.69 mmHg in persons without metabolic syndrome and 130.73 ± 15.15 mmHg in patients with the syndrome. The values for mean diastolic levels in the two groups were 76.52 ± 6.69 and 82.84 ± 8.7 mmHg, respectively. While the two groups were not significantly different in terms of HRR (P = 0.27), hs-CRP levels in the metabolic syndrome group was significantly higher than the other group (P = 0.02).
We failed to establish a relationship between HRR and the metabolic syndrome. However, the observed relationship between metabolic syndrome and hs-CRP level, which is an inflammatory factor, indicates elevated levels of hs-CRP in patients with metabolic syndrome.
Metabolic Syndrome; Exercise Test; Heart Rate Reserve; High-Sensitivity C-Reactive Protein
Obesity and sedentary lifestyle are known as important risk factors of coronary artery disease. The prevalence of obesity has increased among both men and women in the world. Therefore, the present study tried to evaluate the effectiveness of a cardiac rehabilitation program on functional capacity and body mass index (BMI) in obese and non-obese women with coronary artery disease.
In an observational study during 2000-11, we evaluated a total of 205 women with coronary artery disease who referred to the cardiac rehabilitation unit of Isfahan Cardiovascular Research Institute, Isfahan, Iran. BMI and functional capacity of each patient were assessed before and after the program. The patients were categorized as obese or non-obese based on their BMI. All participants completed the full course of the program. Data was analyzed by independent t-test and paired t-test in SPSS15.
Our finding showed that an 8-week cardiac rehabilitation program had significant effects on functional capacity in obese and non-obese female patients (P < 0.01 for both). The program also resulted in BMI improvements in both groups (P < 0.01 for both). Comparing the changes in the two groups did not reveal any significant differences in functional capacity. However, the two groups were significantly different in terms of BMI changes.
Cardiac rehabilitation programs are a major step in restoration of functional capacity and improvement of BMI in obese and non-obese women with coronary artery disease.
Cardiac Rehabilitation Program; Coronary Artery Disease; Obesity; Functional Capacity; Body Mass Index
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.
Obesity is strongly associated with coronary heart disease and it is known as an independent risk factor. So, the aim of this study was to investigate the effects of phase II comprehensive cardiac rehabilitation program on obesity indexes, functional capacity, lipid profiles, and fasting blood sugar in obese and non-obese female patients with coronary heart disease and to compare changes in these groups.
Materials and Methods:
Two hundred and five women with coronary heart disease participated in our study. At the beginning of study, body mass index, functional capacity, and lipid profiles and fasting blood sugar were evaluated; then, these patients were divided into two groups, patients who had BMI≥30 were known as obese and who had BMI<30 were known as non-obese patients. All of them completed the period of cardiac rehabilitation program, and 2 months later, all risk factors were examined for the second time in each group. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes, independent t-tests and paired t-tests were used.
Data revealed that unless in weight (P=0.00) and functional capacity (P=0.001), there were no significant differences in obese and non-obese female patients, at baseline. As a result of the cardiac rehabilitation program, both groups had significant improvement in functional capacity (P=0.00), weight reduction (P=0.00), triglyceride (P=0.01 and P=0.02, respectively), low-density lipoprotein cholesterol (P=0.01), and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P=0.00 and P=0.003, respectively). As well, significant improvement was observed in high-density lipoprotein (P=0.01) only in obese female, and non-obese female had significant differences in total cholesterol (P=0.003). However, there were not significant changes in total cholesterol (P=0.05) and fasting blood sugar (P=0.09) in obese female. Also, non-obese females didn’t have favorable differences in high-density lipoprotein cholesterol (P=0.23) and fasting blood sugar (P=0.13). In addition, comparing two groups didn’t show any significant differences in each risk factors except BMI (P=0.03).
Our study revealed that comprehensive cardiac rehabilitation program results in significant improvement in cardiovascular risk factors and functional capacity at all levels of BMI in female with coronary heart disease.
Cardiac heart disease; obesity; risk factor
Deep vein thrombosis (DVT) is a relatively prevalent disease which causes high costs due to the required diagnostic tests, specialized treatments, and hospital admission. In recent decades, implementation of thromboprophylaxis protocols has significantly reduced the incidence of thromboembolism in hospitals. The present study aimed to compare the incidence of venous thromboembolism before and after implementation of the mentioned protocol in hospital with identified risk factors and underlying diseases.
In this case-control group, 385 patients at the risk of DVT, some before and some after implementation of the protocol were studied. Therefore, the level of thromboprophylaxis and the incidence of venous thromboembolism were compared before and after the protocol. Data was entered into SPSS15 and analyzed by chi-square and t tests
Out of 385 patients, 34 patients (8.8%) had venous thromboembolism while 351 (91.2%) were not affected. The incidence of venous thromboembolism was significantly different before and after the implementation of the protocol (17.7% vs. 5.9%; P < 0.001). The incidence of venous thromboembolism in patients not receiving thromboprophylaxis was almost 5 times higher than those who received it (20.7% vs. 5.1%). The frequency distribution of thromboembolism had a significant difference in the two above mentioned groups (P < 0.001).
Thromboprophylaxis protocol reduced venous thromboembolism incidence in patients with underlying diseases which increase the risk of the complication.
Deep vein thrombosis; Thromboprophylaxis
As blood pressure is higher in menopausal women than their peers with similar Body mass index (BMI), and considering hot flashes as one of the most common symptoms of menopause, this study was conducted to examine the 24-hour changes of blood pressure in menopausal women experiencing hot flashes.
This cross-sectional study was performed on 26 menopausal 47-53 year-old women divided into 2 groups of 13. None of them had a history of internal diseases, hypertension, and hormone medications. Their blood pressure and heartbeat were recorded by a blood pressure Holter for 24 hours. The data was analyzed through student t-test and analysis of variance (ANOVA) using SPSS11.5.
Systolic blood pressure of the symptomatic group was significantly higher than the asymptomatic group during waking hours (P < 0.05). However, the heartbeats and systolic blood pressure of the symptomatic group were higher than those in the other group in 24 hours. This difference was not statistically significant (P > 0.05).
Similar to hot flashes, the increase in systolic blood pressure may arise from central sympathetic activity. Peripheral vasoconstriction and increased cardiac output, both caused by baroreflex dysfunction, might also have been responsible for increments in systolic blood pressure. Therefore, prospective studies are required to determine how the growing increase in blood pressure and the prevalence of hypertension differ in both groups.
Women; Menopause; Blood Pressure; Hot Flashes
Today, ischemic heart diseases (IHDs) are the most common diseases worldwide. Angiography is the best way to diagnose IHDs. Angiographic complications however can include death, myocardial infarction, nausea, spasm of the coronary arteries, chest pain, bradyarrhythmia, hypotension, or hypertension. This study aimed to determine the effects of a simultaneous injection of trinitroglycerin (TNG) with contrast agent on the early complications of angiography.
This clinical trial was conducted in Chamran Hospital, Isfahan, Iran in 2005. Before the angiography, the study population were randomly assigned into two groups of intervention (n = 111) and placebo (n = 112). TNG was mixed with contrast material in the intervention group and distilled water was mixed with contrast agent in the placebo group to be used for angiography. Nausea, spasm of the coronary arteries, chest pain, bradyarrhythmia and the mean systolic and diastolic blood pressures were compared during and after the angiography in patients of both groups. The obtained data was analyzed by chi-square and t tests.
The mean age in the intervention and placebo groups were 59.93 ± 9.14 and 59.37 ± 10.12 years, respectively (P > 0.05). The two groups were not significantly different in terms of gender distribution. The frequency of nausea was 4.5% and 6.2% in the intervention and placebo groups, respectively. The corresponding values were 0.9% and 5.4% for coronary artery spasm and 1.8% and 6.3% for chest pain. Bradyarrhythmia occurred in 7.1% of patients in both groups. There were no significant differences in the abovementioned complications. Mean values of the highest and lowest systolic and diastolic blood pressures of the intervention group were significantly different from the placebo group (P = 0.001). Simultaneous injection of TNG and the contrast agent in this study resulted in positive findings (except for changes in blood pressure).
More studies are recommended with different doses of TNG, different times of injection and considering at-risk individuals.
Angiography; Early Complications; Trinitroglycerin
Fibrinolytic therapy is the standard therapeutic method for patients with acute myocardial infarction (AMI). This study endeavored to assess the delay in arrival to the emergency department and door to needle time for thrombolytic therapy.
This study was conducted on 80 patients with AMI whom referred to our clinic from January 2009 to January 2010. We measured time of arrival, needle time and door to needle time for all patients. Moreover, the relations of these times to some variables such as age, gender and the referred shift of emergency department personnel were calculated.
A total of 80 patients, 62 (77.5%) male and 18 (22.5%) female were evaluated for thrombolytic therapy. The arrival time of overnight shifts was 14.59 ± 1.23 minutes shorter than other shifts. The median door to needle time was 46.56 minutes and the mean time of the onset of chest pain to arrival at the emergency department was 19.44 minutes. Seventy-two patients (90%) received fibrinolytic therapy within the first 30 minutes of arrival. The needle time was significantly longer in the night shift (P < 0.05) (between 8 to 14 minutes), while the time of receiving Streptokinase therapy in the other shifts was not meaningfully different. Finally there was a statistically significant difference between the referred shifts and needle time (P < 0.05).
Despite our good results for door to needle time, to improve and attain the gold standard’s limits in administering fibrinolytic therapy, improvement of policies like training the personnel to shorten this time is recommend.
Fibrinolytic Therapy; Door to Needle Time; Acute Myocardial Infarction
In apical surgery, after apicoectomy and retro-preparation of canal, a retrofil material is applied to seal the apical region of the root canal. Mineral trioxide aggregate (MTA) is the gold standard material for this purpose. Changing water/powder ratios of MTA affects its properties. The purpose of this in vitro study was to determine the effect of liquid/powder ratio of retrofil MTA on apical dye leakage, and also compare two packing techniques for MTA.
Materials And Methods
In this in vitro study, 126 intact single-root extracted teeth were instrumented using step-back technique, and obturated with lateral condensation method. The apical 3 mm of roots was resected, and retrograde preparation was performed by an ultrasonic device. Specimens were randomly assigned to 6 groups of 20 each and 6 teeth served as positive and negative controls. All teeth were retrofilled with White ProRoot MTA. Three groups were retrofilled with 0.28, 0.33, and 0.40 water/powder ratios of MTA and packed with plugger; the other three groups were retrofilled with 0.28, 0.33, and 0.40 water/powder ratios and packed with wet-cotton. Linear dye leakage was used to check apical sealing ability, and data were statistically analyzed using Kruskal-Wallis test.
In 0.40 liquid/powder ratio the best applicator for packing MTA was plugger. In 0.28 liquid/powder ratio, moist cotton pellet was the best applicator; in 0.33 liquid/powder ratio, there was no significant difference between the two techniques.
Under the condition of this in vitro study, packing with moist cotton pellet in lower liquid/powder ratios of MTA, as well as packing with a plugger in higher liquid/powder ration decreased apical dye leakage.
Compound proportion; Concentration; Condensation; Dental; Leakage; Mineral trioxide aggregate; Retrofilling
The purpose of this study is to evaluate the possible difference of the impact of Women Healthy Heart Project on lifestyle, as well as physical/biochemical parameters of working women and housewives.
This was a community-based intervention study conducted over 5 years (2002-2007) in the counties of Isfahan and Najafabad (intervention areas) and Arak (control). Pre-study situation analysis of women was followed by 5 years of wide-ranging interventions (educational/environmental) conducted by various organizations using different methodologies. The interventions were aimed at modifying/improving lifestyle by increasing physical activity, encouraging healthy eating, and tobacco use cessation. The organizations involved in performing the interventions included the local radio and television authority, health/treatment centers, the Red Crescent Society, Municipalities, the Relief Committee, the Center for Retirees’ Welfare, and the Literacy Campaign Organization. After 5 years, final phase same as first phase was planed. The subjects studied in all phases‘ the pre- and post-intervention phases consisted of 10586 women aged above 18 years. Demographic data, obesity index, smoking, physical activity and eating habit were assessed before and after the study. Data were analyzed using SPSS-15 using Student's t-test, chi-square test, the general linear model of ANOVA, and logistic regression.
We studied 10586 women (6105 and 4481 women, pre- and post-intervention, respectively). Mean age of working women was 34.14±10.09 and 34.08±9.35 years before and after the study, respectively. Mean age of housewives before and after the study was 40.05±14.61 and 40.36±15.32 years, respectively. Interventions conducted during 5 years improved eating habits and decreased tobacco use in working women and housewives. In every phase of the study, there was a significant age difference between housewives and working women (P<0.001). Hence data were adjusted according to age in each phase. Overall physical activity of housewives and working women increased, but the percentage of passive smokers among housewives remained unchanged. Waist circumference and waist-to-hip ratio changed significantly in housewives following interventions (P<0.001). The parameter which improved significantly in working women was waist circumference (P<0.05). However, after adjusting for age, no significant difference was seen between working women and housewives following interventions.
Community-based interventions, especially those directed at housewives, can lead to significant improvements in lifestyle and cardiovascular risk reduction. It seems that working women require tailored interventions to suit their conditions. Although short-term outcomes may seem insignificant, persistence and continuity of lifestyle changes may lead to reduced prevalence of cardiovascular diseases. Then longer-term studies are warranted.
Women; housewives; working; risk factors; lifestyle modification.
Previous studies reported that the distribution of body fat is an important risk factor for coronary artery diseases (CAD) and abdominal adipose tissue is associated with severe CAD. This study was conducted to evaluate the relationship between body fat distributions, plasma lipids and the severity of CAD in patients with stable angina.
Ninety seven patients who underwent coronary angiography for stable angina were allocated into two groups: patients with mild or sever coronary artery involvement. Lipid profile (total cholesterol, LDL, HDL) and triglyceride (TG) and apolipoprotein A and B, were measured for all of the participants and a demographic data questionnaire was filled by the subjects. Participants underwent abdominal computed tomography (CT-Scan) for measurement of adipose tissues that was classified to visceral and superficial and deep subcutaneous fat tissue compartment.
Patients with severe coronary artery involvement had higher level of apo B (P=0.02). Significant correlation was seen between visceral fat index and TG (P=0.01), HDL-C (P<0.01) in patients with mild coronary involvement and with total cholesterol (P=0.02), LDL-C (P=0.01) and apoB (P<0.01) in patients with severe coronary involvement.No significant relationship was seen among deep cutaneous fat index and lipid profile in both groups.
Our findings showed that visceral adipose tissue is significantly associated with severe CAD and has a significant correlation with lipid profile as well as Apo B.
Visceral Abdominal Adipose Tissue; Superficial Subcutaneous Adipose Tissue; Deep Subcutaneous Adipose Tissue; Coronary Involvement; Lipid Profile.
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.
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.
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).
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.
Cigarette; Stress; Community-based Program.
Using Evidence Based Medicine (EBM) in clinical practice is an important strategy for improving and updating medical services. Therefore, EBM has recently attracted a lot of attention in many medical schools around the world. In this study we tried to evaluate the familiarity of clinical residents who are one of the main clinical decision makers in public hospitals and also the next generation of specialists with EBM and EBM databases.
This was a cross–sectional study in 2010 in which clinical residents of Kerman Medical University (KMU) participated. Residents were asked about the four main EBM databases. The data was collected by a self-administered questionnaire.
The data showed that from the respondents only 26.6% knew about EBM and only 28.7% of the respondents were familiar with “Up to Date”, 22.3% were familiar with “Ovid EBM Reviews”, 6.4% were familiar with “Cochrane” and 5.3% were familiar with “BMJ Clinical Evidence”. The frequencies of those that actually used the databases for clinical decision making and could answer the search questions were even less.
The results showed most of the residents lack sufficient knowledge about EBM and its databases. The reason is probably the inexistence of a systematic and comprehensive curriculum for EBM education during their residency program or undergraduate program. Thus, due to the importance of learning EBM in this group, there is a necessity to plan a comprehensive and proper education schedule for EBM and EBM database use at the beginning or further stages of residency.
Evidence Based Medicine; EBM database; Clinical Residents; Postgraduate Curriculum
About 2-5% of people experience deep-vein thrombosis (DVT) during their lives. Death, disease recurrence, post-thrombotic syndrome, and excessive bleeding due to coagulant medications are among the most important DVT complications. Recent research found a high incidence of DVT recurrence after the first attack. Disease recurrence has a multifactorial pathogenesis and its probability is related with the number and severity of risk factors. The present study aimed to investigate DVT recurrence and the associated risk factors.
This retrospective cross-sectional study evaluated all DVT patients hospitalized in Alzahra Hospital, Isfahan, Iran, during April 2000 to April 2011. The risk factors were obtained from patients' records including smoking, intravenous drug abuse, having a history of surgery in last four weeks, immobility, obesity, history of cardiac disease, and cancer.
A total number of 2550 DVT patients were hospitalized in Alzahra Hospital during the study period. It was only possible to extract the data from 385 patient records. A history of DVT was reported in 48 individuals (12.5%). The comparison between the risk factors in patients with a first time DVT and those experiencing a recurrent DVT revealed significant differences solely in the prevalence of blood disorders and immobility. Applying stepwise regression indicated immobility (OR: 4.57; 95% CI: 1.26-16.57; P < 0.021) and coagulopathy (OR: 0.33; 95% CI: 0.13-0.81; P < 0.016) with DVT recurrence.
Based on our findings, DVT patients are suggested to be mobilized as soon as possible. In addition, they should be advised to increase their activity after discharge.
Deep Vein Thrombosis; Immobility; Risk Factor
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.
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.
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.
Cigarettes; hookah; Iran; smoking; smoking cessation
The current study aims to determine the relation between ankle–brachial index (ABI) and angiographic findings and major cardiovascular risk factors in patients with suspected coronary artery diseases (CAD) in Isfahan.
In this cross-sectional descriptive-analytic research, patients with suspected CAD were studied. Characteristics of studied subjects including demographics, familial history, past medical history and atherosclerotic risk factors such as diabetes mellitus, hypertension, hyperlipidemia and smoking were obtained using a standard questionnaire. ABI was measured in all studied patients. ABI≤0.9 (ABI+) was considered as peripheral vessel disease and ABI>0.9 (ABI-) was considered as normal. Then, all studied patients underwent coronary artery angiography. The results of the questionnaire and angiographic findings were compared in ABI+ and ABI- groups. Data were analyzed by SPSS 15 using ANOVA, t-test, Spearman's rank correlation coefficient, and discriminant analysis.
In this study, 125 patients were investigated. ABI≤0.9 was seen in 25 patients (20%). The prevalence of ABI+ among men and women was 25.9% and 7.5%, respectively (P=0.01). The prevalence of atherosclerotic risk factors was significantly higher in ABI+ patients than in ABI- ones (P<0.05). ABI+ patients had more significant stenosis than ABI- ones. The mean of occlusion was significantly higher in ABI+ patients with left main artery (LMA), right coronary artery (RCA), left anterior descending artery (LAD), diagonal artery 1 (D1) and left circumflex artery (LCX) involvements (P<0.05).
The findings of this research indicated that ABI could be a useful method in assessing both the atherosclerotic risk factors and the degree of coronary involvements in suspected patients. However, in order to make more accurate decisions for using this method in diagnosing and preventing CAD, we should plan further studies in large sample sizes of general population.
Ankle–Brachial Index; Angiography; Atherosclerotic Risk Factors.
To investigate the relation between major depressive disorder and metabolic risk factors of coronary heart disease.
Little evidence is available indicating a relationship between major depressive disorder and metabolic risk factors of coronary heart disease such as lipoprotein and apolipoprotein.
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.
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.
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.
Coronary risk factors; Coronary heart disease; Major depression
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.
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.
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.
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.