The association between dietary insulin index and load with mental health.

BACKGROUND: Depression, anxiety, and stress are common mental problems. The aim of this cross-sectional study was to investigate the association between two indexes that measure postprandial insulin response to different food, dietary insulin index (DII) and insulin load (DIL), with psychological disorders. METHOD: Participants (n = 10,000) aged 20-69 were randomly selected from 200 clusters in Yazd from the recruitment phase of the Yazd Health Study. The dietary intake of participants was collected by a reliable and validated food frequency questionnaire (FFQ) consisting of 178 food items. DII and DIL were calculated from the FFQ data using previously published reference values. To assess psychological disorders an Iranian validated short version of a self-reported questionnaire (Depression Anxiety Stress Scales 21 [DASS21]) was used. RESULTS: No significant association was observed between DIL and DII with odds of depression or anxiety using crude or adjusted models. However, individuals in the highest quartiles of DIL had the lowest odds of stress (OR: 0.69; 95% CI 0.48-1.01, P-trend = 0.047). This association remained significant after adjustment for potential confounders in model II including marital status, smoking, education, job status, salt intake, and multi-vitamin supplement use (OR: 0.38; 95% CI 0.16-0.91, P-trend = 0.039) and the third and final model which is further adjusted for BMI (OR: 0.39; 95% CI 0.16-0.91, P-trend = 0.041). CONCLUSION: Overall, consumption of foods with higher DII as well as DIL were associated with lower stress scores; however, no significant relationship was observed between DII or DIL with respective depression or anxiety scores.

Incidence of cancers in Kuzestan province of iran: trend from 2004 to 2008.

BACKGROUND: Cancer is an increasing cause of mortality and morbidity worldwide. Incidences of common cancers has been growing in different provinces of Iran in recent years but trends in Khuzestan which shares a border with Iraq and is located in south west of Iran have not been investigated. This study aimed to assess secular changes in incidences of common cancers in Khuzestan province from 2004 to 2008. MATERIALS AND METHODS: Data were collected from Khuzestan cancer registry which is a branch of Iranian Ministry of Health Cancer Registry (http://ircancer.ir) for the period 2004-2008. Data were presented as incidence rates by site, sex, age, using the crude rate and age-standardized rate (ASR) per 105 persons. A direct method of standardization was applied according to the WHO guideline and data analysis was performed using the SPSS package. RESULTS: During the 2004-2008 period, 14,893 new cases of cancer were registered in Khuzestan cancer registry. The age- standardized incidence rate of all cancers was 153.7 per 105 in males and 156.4 per 105 in females. The incidence was increased over the period of five years. The most incident cancers among males were skin cancer (ASR =18.7/105), stomach cancer (ASR13.8/105), lung cancer (ASR12.9/105), leukemia (ASR=12.6/105) and prostate cancer (ASR=12.4/105). In females, the most incident cancers were breast cancer (ASR=41/105), skin cancer (ASR=16.4/105), colorectal cancer (ASR=10.0/105), leukemia (ASR=8.1/105) and lung cancer (ASR=6.9/105). CONCLUSIONS: Incidences of various cancers are rising in Khuzestan. It is necessary to develop and implement comprehensive cancer control programs in this region which could be monitored and evaluated by the future trend data from cancer registry.

A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness.

BACKGROUND: The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers. METHOD: We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease. RESULTS: Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes. CONCLUSIONS: In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case.