Occupational categories and cardiovascular diseases incidences: a cohort study in Iranian population.

INTRODUCTION: In spite of traditional cardiovascular risk factor, the different occupations can play an important role in cardiovascular disease (CVDs) incidence. We aimed to assess the correlation between the occupational classes, based on the International Standard Classification of Occupation (ISCO), and CVDs in Iran as a developing country. METHODS: We followed the 2440 men, aged 35-65 years and without history of CVDs over fourteen years; 2001 to 2015 during the Isfahan Cohort Study. ISCO was used to classify occupations into 10 categories. Incidence rates of ischemic heart diseases and stroke were recorded. Socioeconomic demographic data including marital state, income and place of living and metabolic risk factors were also recorded. RESULTS: The mean age was 46.97 ± 8.31 years old. 272 cardiovascular events (CVEs) were recorded that unstable angina was the highest recorded with 49% prevalence and the fatal stroke had the lowest outbreak (1%). The unemployed/jobless group and elementary occupations (9th ISCO category) had higher and lower relative frequency in CVEs respectively. There was non-significant decrease in CVEs in all of categories except of 4th (clerical support workers) and 10th (armed forces) groups in comparison to unemployed/jobless subjects (P > 0.05). After considering of the group 7 as a reference group (most absolute CVEs frequency), in fully adjustment analysis group 4 had significant risk for CVEs (P = 0.04). CONCLUSIONS: This study indicates that working as clerical support workers (4th ISCO category) is associated with higher significant risk for IHD and stroke incidence in comparison to craft and related trades workers (7th group of ISCO).

Breakfast consumption in relation to lowered risk of psychological disorders among Iranian adults.

OBJECTIVES: This study aims to find whether breakfast consumption is associated with human mental health. STUDY DESIGN: This cross-sectional study was conducted to investigate the association between breakfast consumption and psychological disorders, including depression and anxiety, among Iranian adults. METHODS: This cross-sectional study was conducted on 4378 general public adults in Isfahan, Iran. Breakfast consumption was assessed using a validated detailed dietary habits' questionnaire. Depression and anxiety were screened using an Iranian validated Hospital Anxiety and Depression Scale questionnaire. Psychological distress was examined by means of Iranian validated version of General Health Questionnaire (GHQ-12 items). Depression, anxiety, and psychological distress were defined based on standard criteria. RESULTS: Overall, 13.95% (n = 611) of study participants had anxiety, 28.62% (n = 1253) were depressive, and 23.18% (n = 1015) had psychological distress. After controlling for potential confounding variables, participants with every day breakfast consumption had lower odds for depression (odds ratio [OR]: 0.49, 95% confidence interval [95% CI]: 0.36-0.66) compared with those with the least frequent intake of breakfast, even after further adjustment for body mass index [BMI] (OR: 0.47, 95% CI: 0.34-0.63). Frequent breakfast consumption was inversely associated with anxiety before (OR: 0.53, 95% CI: 0.37-0.76, P < 0.001) and after controlling for BMI (OR: 0.52, 95% CI: 0.36-0.75, P < 0.001). The same findings were obtained for psychological distress (OR: 0.46, 95% CI: 0.33-0.62, P < 0.001). CONCLUSION: We found an inverse association between breakfast consumption and depression, anxiety, and psychological distress among Iranian adults. Further prospective studies are needed to confirm these findings.

Longitudinal association of metabolic syndrome and dietary patterns: A 13-year prospective population-based cohort study.

BACKGROUND AND AIMS: Diet is a potential factor contributing to the development of the Metabolic Syndrome (MetS). This longitudinal study with repeated measurements of dietary intake was thus conducted to examine the longitudinal association between major dietary patterns and risk of MetS. METHODS AND RESULTS: The study was conducted within the framework of the Isfahan Cohort Study (ICS), in which 1387 participants were followed from 2001 to 2013. Validated food frequency questionnaire, anthropometric measurements, blood pressure, fasting serum lipids and blood sugars were evaluated in three phases of the study. Mixed effect Logistic and Cumulative Logit regressions were applied to evaluate the longitudinal associations between dietary patterns change and MetS and number of MetS components. Three dietary patterns were identified: Healthy, Iranian and Western dietary patterns. After adjustment for potential confounders, the higher scores of Healthy diet were inversely associated with the risk of MetS and number of MetS components (OR: 0.50, 95% CI: 0.36-0.70, OR: 0.52, 95% CI: 0.39-0.70, respectively). The greater adherence to the Iranian diet was positively associated with the risk of MetS and number of MetS components (OR: 1.28, 95% CI: 1.01-1.65, OR: 1.45, 95% CI: 1.16-1.81, respectively). The Western dietary pattern did not show any significant associations. CONCLUSION: Adherence to a Healthy diet was associated with lower risk of MetS even in a developing country setting. However, the Iranian diet was positively associated with the risk of MetS. These results may guide the development of improved preventive nutrition interventions in this adult population.

The relationship between tooth loss and psychological factors.

OBJECTIVES: Limited evidence is available regarding mutual interactions between psychological factors and tooth loss. This study aimed to investigate the association between these two issues. METHOD: In this 2011 cross-sectional study we obtained data from 4,585 adults who had completed information in 20 counties across Isfahan province, Iran, regarding tooth loss and psychological factors (depression, anxiety and stress level). To analyse the data ANOVA and multiple ordinal regression were applied. RESULTS: After adjusting socio demographic factors, the association between depression (OR 1.23; 95% CI = 1.01,1.49), anxiety (OR 1.19; 95% CI = 1.03,1.38), and high stress level (OR 95% CI = 1.19; 1.01,1.39) remained significant. CONCLUSION: We confirm the interaction between psychological factors and tooth loss, but recommend further studies on a national Iranian population.

Citalopram for pediatric functional abdominal pain: a randomized, placebo-controlled trial.

BACKGROUND: Antidepressants are effective in adults with pain-related functional gastrointestinal disorders. We investigated the effectiveness of citalopram in the treatment of childhood functional abdominal pain (FAP). METHODS: Children with FAP, based on the Rome III criteria (n = 115, aged 6-18 years), were randomized to receive either citalopram 20 mg/day or placebo for 4 weeks. Treatment response was defined as ≥ 2 point reduction in the 6-point Faces pain rating scale or 'no pain'. Depression, anxiety, somatization, and physician-rated global severity and improvement were also evaluated. Patients were followed up for 8 weeks after medication period. KEY RESULTS: Eighty-six patients completed the medication (43 in each group). Response rate in the citalopram and placebo groups based on per-protocol (intention-to-treat) analysis was 55.8% (40.6%) and 39.5% (30.3%) at week 4 (p = 0.097 [0.169]) and 72.0% (52.5%) and 53.4% (41.0%) at week 12 (p = 0.059 [0.148]), respectively. In per-protocol analysis, more reduction was observed in pain (F = 3.84, p = 0.024) and global severity scores (F = 4.12, p = 0.021) in the citalopram group compared with the placebo group over the study period. Such differences were not present in the intention-to-treat analysis. No difference was found between the two groups regarding change in depression, anxiety, or somatization score over the study. CONCLUSIONS & INFERENCES: Overall, we found a trend toward the effectiveness of citalopram in the treatment of children with FAP. Trials with longer treatment duration in larger samples of patients are required in this regard.

Topiramate add-on treatment in schizophrenia: a randomised, double-blind, placebo-controlled clinical trial.

Glutamate antagonists such as topiramate have been proposed based on the glutamate hypothesis of schizophrenia because its properties encourage its exploration and possible development as a medication for the treatment of schizophrenia. A randomised, double-blind, placebo-controlled clinical trial was performed on 18- to 45-year-old patients with schizophrenia. Baseline information including vital signs, height, weight, smoking status, demographic characteristics, (past) psychiatric history, medication history and medication-related adverse effects were collected. Patients were randomly assigned to a topiramate or placebo group. Efficacy of medication was measured by administering Positive and Negative Syndrome Scale (PANSS), and tolerability of treatment was recorded on day 0 (baseline), day 28 and day 56. PANSS values (95% confidence interval) at baseline, day 28 and day 56 in the topiramate group were 96.87 (85.37-108.37), 85.68 (74.67-96.70) and 76.87 (66.06-87.69), respectively; compared with 101.87 (90.37-113.37), 100.31 (89.29-111.32) and 100.56 (89.74-111.37) in the placebo group. General linear model for repeated measures analysis showed that topiramate has lowered PANSS values significantly compared with the placebo group. Similar significant decline patterns were found in all three subscales (negative, positive and psychopathology sign). Clinical response (more than 20% reduction in PANSS) was significantly higher in topiramate-treated subjects than controls (50% vs 12.5%). Topiramate can be an effective medication in controlling schizophrenic symptoms, considering its effect on negative symptoms and controlling antipsychotic-associated weight gain.

Evaluation of the Quit and Win contest for smoking cessation in the Islamic Republic of Iran.

Quit and Win is an international biannual smoking cessation contest. Although more than 70 countries participate, few are from the Eastern Mediterranean Region. This study evaluated 4 Quit and Win campaigns in Isfahan province, Islamic Republic of Iran, from 1998 to 2004, documenting participation rates, self-reported 1-month and 1-year abstinence rates and related factors. Participation rates among smokers ranged from 0.7%-2.4% of the smokers in Isfahan. One-month quit rates varied from 41.8% in 1998 to 92.8% in 2004. At 1-year follow-up, self-reported quit rates varied from 22.5% in 1998 to 91.2% in 2004. This model was found to be feasible and successful in our community, and can be implemented in other low- and middle-income countries.

Cardiovascular risk factors in Iranian adults according to educational levels: Isfahan healthy heart program.

There is abundant evidence that the socioeconomic status (SES) is inversely associated with CVD risk factors. The objective of this study is to describe the distribution of CVD risk factors according to educational level in Iranian adults. A cross-sectional survey was performed on subjects over the age of 19 in three cities. Demographic data, as well as information on educational level and smoking habits was obtained and then height, weight and blood pressure measurement and blood sampling were arranged. Data was analyzed by the Mantel-Haenszel, Kendalls T correlation and multivariate analysis test. Of 9587 subjects, 48% were men and 52% were women, with mean ages of 39.0+/-15.3 and 38.8+/-14.5 years, respectively. All CVD risk factors showed an inverse relationship with educational level in all subjects, except for smoking and low HDL-C in women. High TC and LDL-C and low HDL-C were inversely related to educational level (P<0.05); however, this relationship was not significant with Mantel-Haenszel test in men. The association between CVD risk factors and educational level in women was stronger than in men. The differences found between CVD risk factors with educational level are important and should be considered in programs designed to increase level of education in order to lower CVD risk factors.

Blood pressure and associated cardiovascular risk factors in Iran: Isfahan Healthy Heart Programme.

This study was done to estimate the prevalence of high blood pressure (BP) in treated and non-treated subjects with respect to age and gender and its association with other cardiovascular risk factors in Iran. This cross sectional study was performed in three cities of Iran on participants over 19 years at 2002. First a questionnaire consisting of demographic details, drug intake and smoking status was filled. Then physical examination including systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI) and waist to hip circumference (WHC) was performed. Fasting blood sample was drawn for sugar (FBS), total cholesterol (TC) and triglyceride (TG) and a 2-hour postprandial glucose was also measured. In this study performed on 12494 subjects, 48% were males and 52% females. The mean age of men and women was 38.99+/-15.30 and 38.80+/-14.54 years respectively. The prevalence of high BP in men and women was 15.6% and 18.8% respectively. The prevalence of high BP was higher in women than in men, except in the younger age classes. Overall 26.7% of hypertensive men and 47.7% of hypertensive women were on anti-hypertensive pharmacological treatment. Among the treated patients, BP was under control in 6.4% of the men and 13.8% of the women. In 86.5% of men with high BP and 89.3% of women with high BP, at least one other cardiovascular risk factor was present and its prevalence increased with age in both genders. BMI >25 (especially abdominal obesity) was the most frequent associated risk factor (41.9% in male, 59% in female). Except for smoking, the prevalence of each cardiovascular risk factor increased with the severity of hypertension, except in young women. The prevalence of high BP- even in treated subjects- is high in Iran. Many subjects with high BP have at least one other associated cardiovascular risk factor. These data emphasize the necessity of implementing community-based interventions.