Association between acute and chronic life events on acute coronary syndrome: a case-control study.

BACKGROUND AND OBJECTIVES: Some studies have shown that acute and chronic psychological stressors are associated with acute coronary syndromes (ACSs). The aim of the present study was to assess the association between acute and chronic psychological stressors and ACS in an Iranian population. METHOD: In an age-sex frequency-matched, case-control study, 78 hospitalized patients with ACS as the case group were compared with 146 patients with chronic stable angina (CSA) as the control group. Chronic stable angina was confirmed by positive angiographic findings. Acute stressors were examined through a semistructured interview and the acute life event checklist, regarding stressful events during 48 hours before interview. To assess chronic stress, the occurrence of 46 stressful events in a period of 6 months prior to the interview was examined using the stress inventory questionnaire. RESULTS: The average acute stressor counts were 4.80 (SD, 2.87) and 3.97 (SD, 2.2) in ACS and CSA groups, respectively (P = .028). Chronic stressor counts were 9.91 (SD, 5.86) and 6.58 (SD, 3.16) in case and control groups (<.001), respectively. Odds ratios for acute and chronic stressor counts were 1.14 (95% confidence interval [95% CI], 1.02-1.28) and 1.84 (95% CI, 1.10-1.26), respectively; when the associations were adjusted for traditional risk factors, they become 1.12 (95% CI, 0.99-1.27) and 1.20 (95% CI, 1.10-1.30), respectively. CONCLUSION: Acute stress did not contribute significantly in the models including chronic stress. Acute stressful events in the recent 48 hours, independent of traditional risk factors, can have a triggering effect on ACS occurrence. Nevertheless, this happens in the context of high chronic stress. In addition, chronic stress count was moderately associated with ACS even when it was adjusted for traditional risk factors (ALEACE study).

Association of socioeconomic status and life-style factors with coping strategies in Isfahan Healthy Heart Program, Iran.

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 17593 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 beta=-11.293, P<0.001; men beta=-3.418, P=0.007), having leisure time physical activity (women beta=0.017, P=0.046; men beta=0.005, P=0.043), and higher educational level (women beta=0.344, P=0.015; men beta=0.406, P=0.008) were predictors of adaptive coping strategies, while smoking (women beta=11.849, P<0.001; men beta=9.336, P<0.001), high stress level (women beta=1.588, P=0.000; men beta=1.358, P<0.001), and lower educational level (women beta=-0.443, P=0.013; men beta=-0.427, P=0.013) were predictors of maladaptive coping strategies in both sexes. Non-manual work was a positive predictor of adaptive (beta=4.983, P<0.001) and negative predictor of maladaptive (beta=-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.

Comparison of acute ischemic stroke evaluation and the etiologic subtypes between university and nonuniversity hospitals in Isfahan, Iran.

BACKGROUND AND PURPOSE: Performing a proper causative workup for ischemic stroke patients is essential as it guides the direction of primary and secondary preventions. We aim to investigate the etiological evaluation of these patients in university and nonuniversity hospitals. METHOD: We enrolled subjects from the Persian Registry of Cardiovascular Disease-stroke. Stroke patients were categorized base on an etiological-based classification (Trial of Org 10172 in Acute Stroke Treatment or TOAST) into five groups. We also separated patients with ischemic stroke of undetermined etiology due to incomplete standard evaluation from ischemic stroke of undetermined etiology due to negative standard evaluation. The etiological subtypes and diagnostic evaluations were compared between the two hospital groups. RESULT: Ischemic stroke of undetermined etiology was the most common subtype overall (43%). The prevalence of ischemic stroke of undetermined etiology (incomplete standard evaluation) was significantly higher in patients evaluated in nonuniversity hospitals versus university hospital (46.2% vs. 22.3%). Patients with ischemic stroke of undetermined etiology (negative standard evaluation) and large-artery atherosclerosis were significantly more prevalent in university hospitals (10.3% vs. 4.6% and 13.9% vs. 4.4%, respectively). All diagnostic workups were performed more significantly for university hospital patients. Patients with Ischemic stroke of undetermined etiology (negative standard evaluation). Patients were significantly younger (64.91 ± 14.44 vs. 71.42 ± 12.93) and had lower prevalence of risk factors such as hypertension (48.5% vs. 65.4%) and diabetes (19.4% vs. 33.1%) than patients in ischemic stroke of undetermined etiology (incomplete standard evaluation) subgroup. University hospital patients had better clinical outcomes in terms of mortality and degree of disability during one-year follow-up. CONCLUSION: The high clinical burden of ischemic stroke of undetermined etiology especially in nonuniversity hospitals shows the rational for promoting ischemic stroke evaluation and providing specialized stroke centers for these hospitals in a developing country like Iran.

Association of stressful life events and psychological problems profile: Results from a large-scale cross-sectional study among Iranian industrial employees using Bayesian quantile structural equation model.

Objectives: The current study aimed at evaluating the major domains of stressful life events and their association with psychological problems profile in a large sample of Iranian industrial manufacturing employees. Methods: In a cross-sectional study, 3,063 participants were randomly selected from 16,000 employees working in a big industrial company in Isfahan, Iran. Three common psychological problems i.e. depression, anxiety and psychological distress were evaluated using Persian validated version of Hospital Anxiety and Depression Scale (HADS) and 12-item General Health Questionnaire (GHQ-12), respectively. Self-perceived frequency and intensity of stressful life events were measured by stressful life event (SLE) questionnaire. Bayesian quantile structural equation model in R free statistical software (version 3.4) was used for evaluating the association of stressful life events and levels of psychological problems profile. Results: Using factor analysis, two major domains i.e. socioeconomic and personal stressors were derived from 11 life stressors and a unified measure i.e. psychological problem profile was extracted from three common psychological problems. Financial and daily life stressors had the highest and sexual problems showed lowest intensity. Quantile structural equation model revealed that the psychological problems profile scores had stronger association with personal (ß: ranging from 0.45, 1.87) than socioeconomics stressors (ß: ranging from 0.11, 0.27). The association of socioeconomic stressors was fairly uniform across quantiles of psychological problems scores, while personal stressors showed stronger association in higher quantiles, meaning that employees with higher mental health problems more experienced personal stressors. Conclusions: Life stressors particularly personal showed direct association with intensity of psychological problems in manufacturing employees. Life stressors are more perceived by employees with higher intensity of psychological problems. The results of current study can be useful in planning occupational health programs in order to improve psychological health and job productivity.

The influence of dietary patterns and stressful life events on psychological problems in a large sample of Iranian industrial employees: Structural equations modeling approach.

BACKGROUND: Psychological problems affect many employees and their job performance. Although, the association of diet and stress, as modifiable risk factors, with psychological problems have been investigated separately, however their simultaneous impacts have not been studied. The present study aimed at reinvestigating the association of major dietary patterns and stressful life events with intensity of psychological problems in a large sample of Iranian industrial employees. METHODS: In a cross-sectional study, 3063 employees in an industrial unit in Isfahan, Iran were investigated. Psychological problems profile as a latent construct was extracted from three common psychological problems; depression, anxiety and psychological distress. Depression and anxiety were measured by Persian validated version of Hospital Anxiety and Depression Scale (HADS) and psychological distress by the 12 items General Health Questionnaires (GHQ). Major dietary patterns were derived from a validated short form of semi-quantitative Food Frequency Questionnaire (FFQ) using explanatory factor analysis. Stressful life events dimensions were extracted based on factor analysis, from self-perceived frequency and intensity of Stressful Life Events (SLE) questionnaire. Associations of the obtained factors were investigated in a latent structural modeling framework. RESULTS: Three dietary patterns i.e. western, traditional and healthy and two stressors dimensions including personal life and socioeconomics were extracted. Greater adherence to healthy diet was protectively associated with psychological problems profile scores (ß = -0.54; 95% CI: -0.74, -0.34). Adherence to western (ß = 0.23; 95% CI: 0.02, 0.45) and Iranian traditional (ß = 0.48; 95% CI: 0.28, 0.68) dietary patterns were positively associated with higher psychological problems scores in employees. But after adjustment for life stressors only adherence to a healthy diet remained significantly associated with psychological problems profile (ß = -0.43; 95% CI: -0.59, -0.27). Also, personal life stressors (ß = 0.81; 95% CI: 0.63, 0.99) and socioeconomics stressors (ß = 0.12; 95% CI: 0.08, 0.16) had significantly direct association with psychological problems profile scores. LIMITATIONS: Variables assessment by self-reported questionnaires, not affording causality because of cross sectional design, not adjusting the nutrients intake in association analyses, relatively small sample size of women. CONCLUSIONS: Life stressors particularly personal stressors have negative direct association with psychological health of employees. Adherence to a healthy diet can be related to improvement of psychological health in employees. The results can be useful in occupational health planning in order to improve mental health and job productivity.

Perceived factors related to cigarette and waterpipe (ghelyan) initiation and maintenance in university students of Iran.

OBJECTIVES: To investigate the perceived factors leading to cigarette and waterpipe (ghelyan) smoking initiation and maintenance in Iranian university students. METHOD: A cross-sectional study was conducted on 233 students aged 20-25 enrolled in Isfahan University and Kashan University in 2007. Demographic factors as well as cigarette and ghelyan status, and perceived factors related to cigarette or ghelyan smoking initiation and maintenance were recorded. Principal component analysis was carried out to cluster perceived smoking initiation and maintenance factors. RESULT: In a multiple logistic regression model, perceived psychological factors were more significant to cigarette smoking initiation and maintenance than ghelyan smoking among girls (odds ratio, OR = 1.90; P < 0.04) although perceived psychological factors (OR = 2.20; P < 0.001) and social factors (OR = 2.42; P < 0.001) were more significant in cigarette smoking initiation than ghelyan smoking initiation among boys (OR = 2.42; P < 0.001). Moreover, study appears that in boys, perceived entertainment factors could play more significant role in ghelyan smoking initiation compared with cigarette smoking initiation (OR = 0.42; P < 0.001). CONCLUSION: Whereas the factors related to smoking initiation and maintenance are different in both genders and in both tobacco products, identification of cigarette and ghelyan smoking may guide policy makers to develop comprehensive interventions.

Development and validation of the stressful life event questionnaire.

OBJECTIVES: This study evaluates the development of the stressful life event (SLE) questionnaire and tests the validity and reliability of it. METHOD: In total, 3,951 adults aged over 18 years completed the SLE questionnaire. The General Health Questionnaire (GHQ-12) was used to further validate the SLE questionnaire. RESULTS: Eleven domains, including home life, financial problems, social relation, personal conflict, job conflict, educational concerns, job security, loss and separation, sexual life, daily life, and health concerns were obtained by factor analysis. Correlation coefficient was moderately significant among domains of the SLE questionnaire and moderately between the SLE questionnaire and GHQ-12 score, as well. The results of the discriminate validity analysis were promising. In addition, standardized Cronbach'-α was 92%. CONCLUSION: The resultant SLE questionnaire is, therefore, suggested to be potential for the stress measurement in both community and primary care setting.

Effects of 5-year interventions on cardiovascular risk factors of factories and offies employees of isfahan and najafabad: worksite intervention project-isfahan healthy heart program.

BACKGROUND: Effects of 5-year interventions of Worksite Intervention Project from Isfahan Healthy Heart Program on cardiovascular risk factors of factories and offices employees were studied in Isfahan and Najafabad (intervention area) compared to Arak (control area). METHODS: We had especial interventions for nutrition, physical activity and smoking as well as hypertension and obesity screening systems in all offices and factories, and other risk factors screening systems whenever possible. Before and after the interventions, questionnaires containing demographic and other required data were completed for the two populations; height, weight and blood pressure (BP) were measured and a fasting and 2h blood sample was taken for the measurement of blood sugar (BS) and lipid levels. RESULTS: The prevalence of hypercholesterolemia, hypertriglyceridemia and central obesity decreased, but low HDL increased in office staff (P < 0.01). Waist circumference, HDL and total cholesterol mean values decreased, and diastolic BP and fasting and 2h BS increased among the intervention group. In factory workers, the prevalence of hypertriglyceridemia and central obesity decreased, while low HDL prevalence increased in intervention group (P < 0.001). Mean values of waist circumference, HDL and total cholesterol, and triglyceride decreased significantly (P < 0.001), while diastolic BP and fasting BS increased. CONCLUSION: It seems that Worksite Intervention Project has a protective effect on CVD risk factors in factories and offices employees. So, the modifiable project can be used as an applicable tool for health improvement in worksites which creates tangible changes in employees' lifestyle.