Association between ultra-processed foods consumption and micronutrient intake and diet quality in Iranian adults: a multicentric study.

OBJECTIVE: To identify ultra-processed foods (UPF) contribution to daily energy and nutrient intake in Iranians and examine whether UPF intake is associated with nutrient profile and diet quality. DESIGN: In this cross-sectional study, a validated FFQ was used to evaluate usual dietary intake over the preceding year. NOVA system was applied to categorise foods based on their levels of processing. Diet quality was evaluated using the nutrient adequacy ratio (NAR), Nutrient Rich Food Index (NRF) and hybrid nutrient density. SETTING: The LIPOKAP study conducted in five cities of Iran (Isfahan, Birjand, Bandar Abbas, Kermanshah and Shahrekord). PARTICIPANTS: A total of 1994 adults aged ≥18 years were recruited using stratified multistage random cluster sampling method. RESULTS: UPF were responsible for 8·5 % of daily energy intake. In the adjusted model, UPF consumption was inversely associated with carbohydrate, protein, refined and whole grains, fibre, fruit and meat, but was positively linked to energy, total fat, saturated and trans fatty acids and cholesterol. Compared with those in the lowest tertile, individuals in the highest tertile of UPF had smaller NAR for Ca, Mg, Zn, Fe, phosphorus, thiamin, niacin, folate and vitamin C. Both NRF and hybrid nutrient density decreased when the share of daily energy intake from UPF increased. CONCLUSION: The higher consumption of UPF is associated with poorer diet quality and lower nutrient intake. It is recommended that UPF be replaced with minimally processed foods to improve diet quality and nutrient profile.

Effect of Zizyphus jujuba fruits on dyslipidemia in obese adolescents: a triple-masked randomized controlled clinical trial.

OBJECTIVE: This study aimed to assess the effects of Ziziphus jujuba (ZJ) fruit on controlling dyslipidemia in obese adolescents. METHODS: This triple-blind randomized placebo-controlled clinical trial comprised 86 obese adolescents aged 12-18 years with dyslipidemia, i.e. serum low density lipoprotein-cholesterol (LDL-C) or total cholesterol (TC) or triglycerides (TG) equal or more than the age- and gender-specific 95th percentile or high density lipoprotein- cholesterol (HDL-C) less than 5th percentile. They were randomly assigned into two groups of equal number Both groups received similar recommendations for dietary and physical activity habits. The case group received 5 grams of ZJ fruit powder three times a day for one month and controls took the same amount of a placebo powder. Fasting blood sugar, TC, LDL-C, HDL-C and TG were measured at the beginning and at the end of the trial. Data were analyzed using General linear method (multivariate) test. FINDINGS: Overall, 70 participants (51% boys, mean age of 14 +/- 2) completed the trial. The two groups studied did not differ in terms of age, gender, weight and body mass index (BMI). After the trial, serum TC decreased significantly (19 +/- 37 mg/dl in controls vs. 170 +/- 29 mg/dl in cases, P = 0.007) reduction. The corresponding figure was also significant for LDL-C (114 +/- 38 mg/dl vs. 104 +/- 22 mg/dl, respectively, P = 0.004). The changes in BMI and other lipids were not significant. CONCLUSION: This study suggest that ZJ's fruits is generally well tolerated and may have potential favorable effects on serum lipid profile. While healthy lifestyle is the mainstay of controlling childhood obesity, this nutraceutical may be considered as a complementary treatment. Key words: Zizyphus, dyslipidemia, adolescence, obesity.

Dietary inflammatory index in relation to severe coronary artery disease in Iranian adults.

Background: Limited findings are available on the relationship between dietary inflammation index (DII) and severe coronary artery disease (CAD). Considering the high prevalence of CAD and its complications, we examined the relationship between DII and CAD. Methods: This cross-sectional study was conducted on 275 adults who underwent elective angiography. Severe coronary artery disease was measured by the gensini scoring system. DII was measured by a valid semi-quantitative 168-item food frequency questionnaire (FFQ). Blood samples were collected after 12 h of fasting to measure serum lipid profile and quantitative C-reactive protein (q-CRP) levels. Binary logistic regression was used to calculate the odds (OR) and 95% confidence interval (CI). Results: People in the last tertile of the DII had a higher chance of suffering from severe coronary artery disease (OR: 3.71; 95% CI: 1.97-6.98), hypercholesterolemia (OR: 2.73; 95% CI: 5.03-1.48), reduced HDL-cholesterol levels (OR: 3.77; 95% CI: 9.34-1.52), and hypertension (OR: 1.93; 95% CI: 3.49-1.06) compared to people in the first tertile. After adjusting for confounding factors, the relationship remained significant. A direct and significant relationship was observed between the DII and increased q-CRP levels, which disappeared after adjusting for confounding factors in the adjusted model (OR: 2.02; 95% CI: 0.86-4.73). Conclusion: This cross-sectional study showed a direct and linear relationship between following an anti-inflammatory diet and decreasing the chance of severe CAD. Therefore, it seems necessary to implement community-based educational programs to promote healthy nutrition in order to prevent CADs.

Genetic variation in salt taste receptors impact salt intake and blood pressure.

So far, few studies have examined the effect of salt taste receptors genetic variation on dietary intake in the Iranian population. We aimed to evaluate associations between single nucleotide polymorphisms (SNPs) in salt taste receptors' genes with dietary salt intake and blood pressure. A cross-sectional study was carried out among 116 randomly selected healthy adults aged ≥ 18 in Isfahan, Iran. Participants underwent sodium intake determination by 24-h urine collection, as well as dietary assessment by semi-quantitative food frequency questionnaire and blood pressure measurement. Whole blood was collected to extract DNA and genotype of SNP rs239345 in SCNN1B and rs224534, rs4790151 and rs8065080 in TRPV1 gene. Sodium consumption and diastolic blood pressure were significantly higher in carriers of the A-allele in rs239345 compared to subjects with the TT genotype (4808.4 ± 824.4 mg/day vs. 4043.5 ± 989.3 mg/day; P = 0.004) and 83.6 ± 8.5 mmHg vs. 77.3 ± 7.3 mmHg; P = 0.011), respectively. The level of sodium intake was lower in the TT genotype of TRPV1 (rs224534) than the CC genotype (3767.0 ± 713.7 mg/day vs. 4633.3 ± 793.5 mg/day; P = 0.012). We could not find any association between genotypes of all SNPs with systolic blood pressure as well as genotypes of rs224534, rs4790151 and rs8065080 with diastolic blood pressure. Genetic variations can relate with salt intake and consequently may associate with hypertension and finally cardiovascular disease risk in the Iranian population.

Trends in the burden and determinants of hypertensive heart disease in the Eastern Mediterranean region, 1990-2019: an analysis of the Global Burden of Disease Study 2019.

Background: Hypertensive heart disease (HHD), one of the end-organ damage consequences of hypertension, is an important public health issue worldwide. Data on the HHD burden in the Eastern Mediterranean region (EMR) are scarce. We aimed to investigate the burden of HHD in the EMR, its member countries, and globally from 1990 to 2019. Methods: We used 2019 Global Burden of Disease (GBD) data to report the HHD age-standardised prevalence, disability adjusted life years (DALYs), years of life lost (YLLs), and mortality, as well as HHD risk factors attribution percent with their 95% uncertainty interval (UI). Global data are reported alongside EMR data, and its 22 respective countries. We compared the burden of HHD by socio-demographic index (SDI), sex, age groups, and countries. Findings: The age-standardised prevalence rate (per 100,000 population) of HHD was higher in the EMR (281.7; 95% UI: 204.5-383.4) in 2019, compared with the global prevalence (233.8; 95% UI: 170.5-312.9). The EMR age-standardised DALYs (per 100,000 population) for HHD in 2019 was 561.9 (361.0-704.1), compared with 268.2 (204.6-298.1) at the global level. There was an increase in HHD prevalence, reduction in mortality, and DALYs between 1990 and 2019 (4.01%, -7.6%, and -6.5%, respectively) in EMR. Among EMR countries, the highest versus lowest rates of age-standardised prevalence, mortality, and DALYs in 2019 [estimate (95% UI)] were in Jordan [561.62 (417.9-747.6)] versus Saudi Arabia [94.9 (69.5-129.0)]; Afghanistan [74.5 (23.7-112.3)] versus Saudi Arabia [4.3 (3.3-5.9)]; and Afghanistan [1374.1 (467.2-2020.7)] versus Qatar [87.11 (64.40-114.29)], respectively. Interpretation: HHD remains a significant problem in the EMR, with a higher burden than global levels. Serious efforts toward high-quality management and prevention are strongly recommended. Based on this study, our recommendation for the EMR is to adopt effective preventive strategies. For example, promoting healthy dietary patterns and prompt screening for undiagnosed HTN in public places, promoting regular blood pressure measurements at home, and creating community awareness about early detection of HTN. Funding: None.

The relationship between ultra processed food consumption and premature coronary artery disease: Iran premature coronary artery disease study (IPAD).

Background: Ultra-processed foods (UPF) consumption may affect the risk of PCAD through affecting cardio metabolic risk factors. This study aimed to evaluate the association between UPFs consumption and premature coronary artery disease (PCAD). Methods: A case-control study was conducted on 2,354 Iranian adults (≥ 19 years). Dietary intake was assessed using a validated 110-item food frequency questionnaire (FFQ) and foods were classified based on the NOVA system, which groups all foods according to the nature, extent and purposes of the industrial processes they undergo. PCAD was defined as having an stenosis of at least single coronary artery equal and above 75% or left main coronary of equal or more than 50% in women less than 70 and men less than 60 years, determined by angiography. The odds of PCAD across the tertiles of UPFs consumption were assessed by binary logistic regression. Results: After adjustment for potential confounders, participants in the top tertile of UPFs were twice as likely to have PCAD compared with those in the bottom tertile (OR: 2.52; 95% CI: 1.97-3.23). Moreover, those in the highest tertile of the UPFs consumption had more than two times higher risk for having severe PCAD than those in the first tertile (OR: 2.64; 95% CI: 2.16-3.22). In addition, there was a significant upward trend in PCAD risk and PCAD severity as tertiles increased (P-trend < 0.001 for all models). Conclusion: Higher consumption of UPFs was related to increased risk of PCAD and higher chance of having severe PCAD in Iranian adults. Although, future cohort studies are needed to confirm the results of this study, these findings indicated the necessity of reducing UPFs intake.

The modifiable noncommunicable risk factors among an Iranian population.

Noncommunicable diseases (NCDs) are a major cause of morbidity and mortality in developing countries. Risk factors, such as hypertension, dyslipidemia, obesity and smoking play an important role in the high prevalence of NCDs. In this study we assessed the type and prevalence of NCD risk factors among an Iranian adult population. We conducted a cross sectional study of 500 men and 500 women, aged 15-65 years, selected by multi-stage random cluster sampling from urban areas of Isfahan, the second largest city in Iran. The prevalences of 8 risk factors were determined in this study: sedentary lifestyle (47.2%), overweight and obestity (body mass index > or = 25 kg/m2) (60.8%), hypertension (elevated systolic and/or diastolic blood pressure) (22%), low high density lipoprotein level (27.6%), high total cholesterol level (16.9%), high triglyceride level (22.1%) and high fasting blood sugar (7.6%). Sedentary life and overweight/obesity were common at all ages, especially among women. Given the high prevalence of NCD risk factors in the studied population, there is an urgent need for age-appropriate interventions to result in lifestyle changes to decrease the prevalence of NCD risk factors.

Effect of different dosages of nitroglycerin infusion on arterial blood gas tensions in patients undergoing on- pump coronary artery bypass graft surgery.

BACKGROUND: On-pump coronary artery bypass graft (CABG) surgery impairs gas exchange in the early postoperative period. The main object on this study was evaluation of changes in arterial blood gas values in patients underwent on pump CABG surgery receiving different dose of intravenous nitroglycerin (NTG). MATERIALS AND METHODS: sixty-seven consecutive patients undergoing elective on-pump CABG randomly enrolled into three groups receiving NTG 50 µg/min (Group N1, n =67), 100 µg/min (Group N2, n = 67), and 150 µg/min (Group N3, n = 67). Arterial blood gas (ABG) tensions were evaluated just before induction of anesthesia, during anesthesia, at the end of warming up period, and 6 h after admission to the intensive care unit. RESULTS: Pao2 and PH had the highest value during surgery in Group N1, Group N2, and Group N3. No significant difference was noted in mean values of Pao2 and PH during surgery between three groups (P > 0.05). There was no significant difference in HCO3 values in different time intervals among three groups (P > 0.05). CONCLUSION: our results showed that infusing three different dosage of NTG (50, 100, and 150 µg/min) had no significant effect on ABG tensions in patients underwent on-pump CABG surgery.

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.

The relationship between cardiological parameters and PCR in patients with coronavirus infection: A cross-sectional study.

Cardiovascular injuries induced by SARS CoV-2 have been reported repeatedly in various studies. Therefore, it is necessary to understand cardiac complications at a low cost, quickly. This study aimed to determine the relationship between cardiological parameters and polymerase chain reaction (PCR) in patients with coronavirus infection. : Patients who were admitted to the emergency department due to the ongoing pandemic, all patients with similar symptoms to coronavirus disease 2019 infection were initially admitted to the respiratory emergency room and underwent subsequent evaluations to confirm or rule out SARS-COV2 infection symptoms were assessed for eligibility. Patient were categorized into 2 groups 1. Positive PCR and negative PCR groups. Binary logistic regression was performed to assess the effect of several factors on the likelihood of developing positive troponin, reduced ejection fraction (EF), and Positive brain natriuretic peptide (BNP). Among 195 patients included, 115 (58.9%) had positive PCR. Patient in the positive PCR and negative PCR were 58.04 ±â€…18.03 and 59.19 ±â€…15.38 years of age, respectively. Patients in the "positive PCR" were significantly less likely to have chronic kidney disease (6.69% vs 17.5%, P value: .022), consume calcium channel blockers (6.69% vs 18.75%, P value:0.012). At the univariable level, positive PCR was significantly associated with fewer odds for positive BNP (OR:0.46, P = .019); nevertheless, the association was no longer significant after adjusting for confounders (adjusted OR:0.56, P = .158). Unadjusted positive PCR results were not found to have a significant association with positive troponin or reduced EF. Likewise, multivariable regression revealed no association between positive PCR and positive troponin (aOR:1.28, P = .529) and reduced EF (aOR:0.65, P = .369). PCR positivity did not result in positive troponin and BNP and did not appear to decrease EF. In other words, serial troponin and BNP checks and initial echocardiography in coronavirus disease 2019 respiratory emergencies do not make significant differences in diagnostic and therapeutic management and inpatient outcomes of patients with positive or negative PCR and are not specific findings. Evidence suggests some coronavirus-induced cardiac complications will be manifested in the long term.

Gender differences in the prevalence of hypertension in a representative sample of Iranian population: the Isfahan Healthy Heart Program.

BACKGROUND: Management and control of hypertension is an important potential health challenge that may result in considerable cardiovascular adverse events especially for women. In this population-based survey, we sought to determine the epidemiology of hypertension among women compared with men in a community sample of Iranians in the 2008s. METHODS: Data were originated from the Isfahan healthy heart program (IHHP) that was designed and launched in 2000 in order to assess the efficacy of lifestyle interventions such as determining the cumulative prevalence of hypertension in a representative sample of Iranian women and to compare it to men. Blood pressure was measured in 12514 individuals (6123 men and 6391 women aged > or = 19 years) selected through multistage random cluster sampling in each sex and age groups. Baseline data were also collected using a special questionnaire and interviews by expert and trained nurses for this survey. RESULTS: It was revealed a significant increasing trend in the prevalence of hypertension in both urban and rural population in the two genders (p for trend <0.001). The prevalence of hypertension in women was estimated from 4.4 % in subjects aged < 30 years to 39.1% in the elderly aged > or = 60 years in urban population. Moreover, hypertension was also estimated from 8.6% in individuals aged < 30 years to 32.0% in the elderly aged > or = 60 years in rural population. Both systolic and diastolic blood pressures were frequently higher in women than in men aged 50-60 years. Women more than men are aware of their blood pressure changes and hypertension is more controlled and under pharmacological treatment in women. CONCLUSION: Our study supports the pivotal role of women-specific control and management of hypertension and emphasizes the global education programs about the importance of hypertension control and monitoring and also lifestyle modification for reducing the risk of hypertension in Iranian women. (www.actabiomedica.it).

The incidence of myopericarditis in patients with COVID-19.

Introduction: SARS-COV-2 can affect different organ systems, including the cardiovascular system with wide spectrum of clinical presentations including the thrombotic complications, acute cardiovascular injury and myopericarditis. There is limited study regarding COVID-19 and myopericarditis. The aim of this study was to evaluate myopericarditis in patients with definite diagnosis of COVID-19. Methods: In this observational study we analyzed the admitted patients with definite diagnosis of COVID-19 based on positive RT-PCR test. Laboratory data, and ECG changes on days 1-3-5 were analyzed for sign of pericarditis and also QT interval prolongation. Echocardiography was performed on days 2-4 and repeated as necessary, and one month after discharge for possible late presentation of symptom. Any patient with pleuritic chest pain, and pericardial effusion and some rise in cardiac troponin were considered as myopericarditis. Results: A total of 404 patients (18-90 years old, median = 63, 273 males and 131 females) with definite diagnosis of COVID-19 were enrolled in the study. Five patients developed in-hospital pleuritic chest pain with mild left ventricular dysfunction and mild pericardial effusion and diagnosed as myopericarditis, none of them proceed to cardiac tamponade. We found no case of late myopericarditis. Conclusion: Myopericarditis, pericardial effusion and cardiac tamponade are rare complication of COVID-19 with prevalence about 1.2 %, but should be considered as a possible cause of hemodynamic deterioration.

The impact of a 6-year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: experiences from the Isfahan healthy heart program.

OBJECTIVES: We aimed to evaluate the changes over time in the prevalence, awareness, treatment, and control rate of hypertension in intervention and reference areas of a comprehensive community trial with reference area. METHODS: Data from independent sample surveys before and after implementation of the program (2001 vs.2007) were used to compare differences in the intervention and references areas over time. Hypertension was defined as blood pressure ≥140/90 mmHg in non-diabetic patients and ≥130/80 mmHg in diabetic individuals and or taking antihypertensive medications. Interventional activities included educational strategies at population level as well as for hypertensive patients, their families and health professionals. RESULTS: The study population of the baseline survey included 6175 (48.7% males) in the interventional area and 6339 (51.3% male) in the reference area. The corresponding figures in the post-intervention phase was 4717 (49.3% male) in the interventional area and 4853 (50.7% male) individuals in the reference area. The prevalence of hypertension had a non-significant decrease from 20.5%to 19.6%, in the interventional area whereas in the reference area, it increased from 17.4% to 19.6% (P = 0.003). If we consider Bp ≥ 140/90 in diabetic and non-diabetic patients as hypertension definition, the prevalence of hypertension in the interventional areas had a non-significant decrease from 18.9% in 2001 to 17.8% in 2007, whereas in the reference area, it had a significant rise from 15.7% to 17.9% (P = 0.002) respectively. Awareness, treatment and control rates of hypertension had better improvement in urban and rural part of the interventional area compared to reference area. The awareness, treatment, and control rates of hypertension increased significantly in the age groups of more than 40 years, as well as in all groups of body mass index in interventional areas without significant change in the reference area. Mean systolic blood pressure of study population in the interventional area decreased from 116.13 ±19.37 to 112.92 ± 18.27 mmHg (P < 0.001) without significant change in reference area. CONCLUSIONS: This comprehensive and integrated program of interventions was effective in tackling with the prevalence of hypertension, and may improve the awareness, treatment and control rates of this disorder in a developing country setting.

Obesity and cardiometabolic risk factors in a representative population of Iranian adolescents and adults in comparison to a Western population: the Isfahan Healthy Heart Programme.

OBJECTIVE: The aim of the present study was to develop reference data for the Iranian population for anthropometric values and cardiometabolic data in comparison with those in Americans, as representative of a Western population. DESIGN: The present cross-sectional survey, conducted as part of the baseline survey of a community-based interventional study (the Isfahan Healthy Heart Programme), used a two-stage clustering design and was conducted in 12 600 randomly selected adults (> or =19 years of age) and 2000 adolescents (aged 11-18 years) living in three cities in the central part of Iran. For comparison with a Western population, comparable data for Americans were derived from the data sets of the Second and Third National Health and Nutrition Examination Surveys (NHANES II and NHANES III). RESULTS: Iranian women had significantly higher mean BMI, waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) than Iranian men and American women; but the mean BMI of Iranian men was lower than that of American men. The mean serum TAG level of Iranian men was significantly higher than that of Iranian women, whereas the mean serum total cholesterol (TC), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels were significantly higher in Iranian women than in men. The Iranian population had lower mean TC, LDL-C and TAG levels than the Americans, but such difference was not documented for HDL-C. Iranian adolescents had significantly lower mean BMI and higher mean TAG than did American adolescents. CONCLUSIONS: Our findings provide serious evidence for health professionals and policy makers about the very high prevalence of generalized and abdominal obesity in Iran. Controlling this emerging health problem, notably in women, should become a national priority in Iran and necessitates comprehensive public health programmes.

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.

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.

Stroke in Isfahan, Iran: hospital admission and 28-day case fatality rate.

BACKGROUND: In Isfahan, a city in the middle of Iran, a community intervention trial has been started for cardiovascular disease prevention and control via reducing its risk factors and improvement of relevant healthy behavior. A surveillance system was needed to monitor vascular diseases, especially stroke, during and following this community intervention program. METHODS: A prospective study on hospitalized stroke patients was done in Isfahan, Iran, from 2000 to 2003. All hospitalized stroke events were recorded via a system adopted from the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) project, yet ignoring the MONICA age limitation. The age-adjusted hospital admission rate was calculated. Patients and/or their families were followed and asked regarding the patients' survival status. RESULTS: The age-adjusted hospital admission rate in Isfahan was increasing from 2000 to 2003 (rising from 84.16 to 103.23/100,000). The 28-day case fatality rates were nearly the same during these years and were about 32%. Ischemic stroke events made up the majority of cases (about 70%), and intracerebral hemorrhage events had the second highest prevalence (25%). CONCLUSIONS: This study showed that the stroke hospital admission rate might be increasing in Isfahan. A community-based stroke incidence study is needed to elucidate stroke epidemiology in Isfahan, Iran, as a Middle East country.

Diabetes and associated cardiovascular risk factors in Iran: the Isfahan Healthy Heart Programme.

INTRODUCTION: Diabetes mellitus (DM) is one of the major health problems worldwide. The aim of this study was to detect the prevalence of DM and its associated risk factors in Iran. MATERIALS AND METHODS: This cross-sectional study was performed in 3 cities in the central part of Iran on participants over the age of 19 years. Sampling was conducted by multi-stage randomised cluster method. Initially, a questionnaire consisting of demographic information, drug intake and smoking status was filled out. Later, a physical examination was performed, including the measurement of systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI) and waist-to-hip ratio (WHR). Fasting blood sample was drawn and analysed for sugar, total cholesterol (TC), triglyceride (TG) and 2-hour postprandial glucose. A fasting blood sugar (FBS) of >126 mg/dL or a 2-hour plasma glucose of over 200 mg/dL was considered an indication of diabetes. The impaired glucose tolerance test (IGTT) was defined with 2-hour plasma glucose of 140 to 200 mg/dL and FBS <126 mg/dL. The collected data were analysed with Student's t-test, chi-square test and multiple logistic regression analysis. RESULTS: This study was performed on 12,514 subjects (48.9% males and 51.1% females). The total prevalence of DM was 6.7% and 5.3% in urban and rural areas and 5.4% and 7.1% in males and females, respectively. The mean blood glucose rose with age in both sexes, and blood glucose was higher in females and in urban areas. IGTT, known and new DM heightens as age increased and more than half of the diabetes cases in all age groups were newly diagnosed. The mean blood pressure, age, BMI, waist circumference and serum lipids were higher in people with DM and IGTT especially in females. Obesity, a family history of DM, high blood pressure, high WHR and ageing were associated with a higher probability of DM, but sex had no effect on this probability. DISCUSSION AND CONCLUSION: Considering the high prevalence of DM in the central regions of Iran, providing vast educational programme to prevent this disease is essential and screening FBS tests, especially for obese subjects and those with a family history of DM, should be taken into account.

Paternal or maternal history of hypertension is more important in increasing the risk of hypertension inoffspring?

BACKGROUND: Along with tripartiteclose relationship of socioeconomic level, smoking, and prevalence of hypertension, the present study aimed to assess the relationship between socioeconomic status (SES) and hypertension based on habitual smoking in Iranian population. METHODS: The present study analyzed the individuals subsample consisted of 9623 subjects, out of all people resident in Isfahan province in Iran of the wave of the Isfahan Heart Health Project (IHHP) in three cities in Iran: Isfahan, Najafabad and Arak. Systolic and diastolic blood pressures were measured in supine position using an automated blood pressure monitor. Smokers were defined as persons who were smoked prior to the survey and never smokers were defined as a person who had never smoked. RESULTS: Those individuals who experienced cigarette smoking, SES class was significantly lower in hypertensive patients compared with normotensive subject so 7.8% of hypertensive patients and 92.2% of normotensive ones classified in SES class IV (p<0.001). Univariate analysis showed hypertension was related to lower SES class when compared with normotension status in both smoker and nonsmoker groups (p<0.001). In stepwise logistic regression models adjusting sex, age, global dietary index and leisure time physical activity, hypertension could be predicted by lower SES in nonsmoker group, while this predictive role for SES could not be reveal in smoker group. CONCLUSION: The significant SES-smoking association may determinate in the increasing blood pressure even adjusted for other covariates such as demographics as well as dietary behaviors and leisure time physical activity.

Investigating the root causes of duplicate publication in research articles.

Duplicate publication is the republication of an article in which a lot of important parts overlap with the published copy. This issue is nearly at the top of the list of subjects, which medical journal editors discuss. this study was conducted with the purpose of investigating the publication patterns and determining it's root causes in research articles in the Isfahan University of Medical Science and to find a solution to prevent it. In a cross sectional study, All the discovered cases of duplicate publication, which were referred to the ethics committee of the Isfahan University of Medical Science during 2005-2008 were selected to be investigated through a descriptive method. After confirmation about the case of a duplicate publication, the requisite investigation was conducted through interviews and review of the correspondence and documentaries, and then, a radical line was charted. After investigating the cases and classifying the radical causes and incidents, categorization and definition of duplicate publication are presented. Eight out of nine republished articles belonged to the first category of Baily's index (copy publication) and one was in the third category (minimum publishable unit: Salami slicing). The results of the present article indicate that, the scientific community of the country is not yet familiar with the professional principles of scientific and research affairs. According to the results of this investigation, it is recommended to take official action against duplicate publication cases, violation of copyright, and also to have strict instructions against this unethical practice.