Predictors of multimorbidity among the Kurdish population living in the Northwest of Iran.

BACKGROUND: There is limited information about the predictors of multimorbidity (MM) among ethnic minority older adults in Iran. This study aimed to examine the impact of sociodemographic and lifestyle factors on the prevalence of MM, among older Kurdish people living in the Northwest of Iran. METHODS: The current study was conducted in Bukan city located in West Azarbaijan province in the Northwest of Iran. The data for this study was based on the enrolment phase of a longitudinal study on ageing among the Kurdish population aged 50-94 yearswhich was designed according to the elderly component of the PERSIAN Cohort in Iran. Stratified random sampling was used to select people aged 50 + from eight health centres in Bukan from Oct 2017 to Dec 2018. Those who accepted the invitation and completed the baseline questionnaire were included in this study (N = 1493; Response rate 75%). A range of different factors,including sociodemographic and lifestyle factors as well as self-reported chronic conditions, was obtained by trained interviewers. MM was defined as "coexistence of two or more chronic conditions in the same person". We included a list of 36 diseases/conditions in this analysis. Descriptive analysis and logistic regression were performed to compare the prevalence of MM according to different factors. RESULTS: Over a third of the participants (36.6%) had ≥2chronic conditionsand 15.7% had≥3 chronic conditions. Hypertension, diabetes, musculoskeletal conditions, fatty liver, and heart diseases were common chronic conditions. In a fully adjusted logistic regression model, older age (ORadj = 1.92, 95% CI: 1.48-2.48), being female (ORadj = 1.49, 95%CI: 1.14-1.94), living without aspouse (ORadj = 1.81, 95%CI: 1.34-2.44), and inadequate consumption of fruit and vegetables (ORadj = 1.33, 95%CI: 1.06-1.67) were associated with the higher prevalence of MM. CONCLUSION: This study found that the prevalence of MM is relatively high among older Kurdishadults. Sociodemographic differences in the prevalence of MM might be of interest tothe health care system,and the prevalence of common chronic conditions in this study may highlight the need forlifestyle modifications in this community.

A cross-sectional study on adaptability and pertinence of the "Health Promoting Hospitals" (HPH) initiative in Iran: health professionals' perspectives.

BACKGROUND: Despite the expansion of the HPH approach and its application in several countries of the world, the conception is still not ascertained in Iran. The main purpose of this study was to investigate the Iranian health professionals' ideas on applicability of the HPH standards in day-to-day practices of the Iranian hospitals. STUDY DESIGN: A cross-sectional study. METHODS: The study respondents were 354 physicians, nurses and general managers working in the ten educational hospitals affiliated to the Tabriz University of Medical Sciences in Tabriz the capital city of the East Azarbaijan province, North West of Iran. A validated self-assessment tool was used for data collection about adaptability of the HPH standards i.e. management policy, patient assessment, patient information, healthy workplace promotion and inter-sectional cooperation from September to November 2016. RESULTS: The mean adaptability score of the HPH standards (60.0, SD: 13.0, range: 0- 136) represents ambivalent sentiment of the Iranian health professionals. The inter-sectoral cooperation and patient information standards were suggested to be the most and lest adaptable elements respectively. Only 32% of the study respondents endorsed the HPH standards' overall appositeness in the studied hospitals. Mean adaptability score of the HPH standards was significantly different between male and female health professionals, specialized and general hospitals, small oppose to the medium and large hospitals and those without prior knowledge and the knowledgeable respondents about the HPH standards (P< 0.05). CONCLUSIONS: This study gave an overall snapshot regarding the applicability of the HPH strategy in typical Iranian education hospitals through a wide range of health professionals' point of views. Understanding the limitations that constrain generalizability of the findings, the study results reflected a part of the gaps existing for application of the HPH strategy in the Iranian hospitals and challenges that might impede its successful conduct.

Appropriate cutoff values of anthropometric variables to predict cardiovascular outcomes: 7.6 years follow-up in an Iranian population.

OBJECTIVE: To determine cutoff points of anthropometric variables for predicting incident cardiovascular disease (CVD) in Iranian adults. DESIGN: It is a population-based longitudinal study. SUBJECTS: A total of 1614 men and 2006 women, aged > or =40 years, free of CVD at baseline were included in the study. MEASUREMENTS: Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and cardiovascular risks were assessed. Incident CVD was ascertained over a median of 7.6 years follow-up. The adjusted hazard ratios (HRs) for CVD were calculated for 1 s.d. change in all obesity variables using Cox proportional hazards regression analysis. Receiver operator characteristic (ROC) curve analysis was used as the method of defining the points of the maximum sum of sensitivity and specificity (MAXss) of each variable as a predictor of CVD. RESULTS: We found 333 CVD events during follow-up. The risk-factor-adjusted HRs were significant for all anthropometric variables in males and WHR in females and were 1.19, 1.24, 1.21 and 1.24 for BMI, WC, WHR and WHtR in males and 1.27 for WHR in females, respectively (all P<0.05). ROC analysis showed the highest area under curve (AUC) for WHR, WHtR and WC, followed by BMI in males and both genders aged< or =60 years. In females, WHR and WHtR had the highest AUC, followed by WC and BMI. Among those >60 years old, all the anthropometric variables showed same CVD predicting power. The cutoff values (MAXss) for CVD prediction in males and females were BMIs 26.95 and 29.19 kg m(-2),WCs 94.5 and 94.5 cm, WHRs 0.95 and 0.90, and WHtR 0.55 and 0.62, respectively. CONCLUSION: There was no difference between central obesity variables in predicting CVD in males, whereas in females WHR and WHtR were more appropriate. The cutoff values of anthropometric variables were higher in the Iranian than in other Asian populations.

Psychometric properties of the Persian Health Care Climate Questionnaire (HCCQ-P): assessment of type 2 diabetes care supportiveness in Iran.

Background: Health-care systems play a key role in responding to the growing problems of patients with type 2 diabetes by supporting their autonomy in providing routine care. The Health Care Climate Questionnaire (HCCQ) was designed to assess patients' perceived degree of autonomy support within the care practice settings. The main purpose of this study was to translate and evaluate psychometric properties of the Persian version of the HCCQ (HCCQ-P) to be applied among Iranian and other Persian-speaking patients with type 2 diabetes. Method: Translation/back-translation procedures were carried out to prepare a preliminary draft of the HCCQ-P that was subsequently sent for face and content validity appraisal by a group of 15 health education/promotion and nursing specialists. Minor revisions were performed based on the feedback, and the content validity ratio (=0.91) and content validity index (=0.95) were within the acceptable range. The structural validity of the scale was assessed by exploratory and confirmatory factor analysis. Results: The exploratory and confirmatory factor analysis outputs (root mean square error of approximation=0.079, comparative fit index=0.976, Tucker Lewis index=0.967, standardized root mean square residual=0.022) demonstrated the proper performance and fitness statistics of the translated HCCQ in a one-dimensional model similar to the original scale. The internal consistency and reliability scores endorsed the validity of the translated measure (α=0.945, intraclass correlation coefficient=0.999, P=0.000). Conclusion: In this study, the translated HCCQ-P scale showed robust internal validity for its application in the assessment of health-care settings' supportiveness in care provision to Persian-speaking patients with type 2 diabetes. Future cross-cultural and multidisciplinary studies are recommended to investigate the applicability of the scale in different patients/cultural groups and health-care settings.

The effects of vitamin D3 supplementation on some metabolic and inflammatory markers in diabetic nephropathy patients with marginal status of vitamin D: A randomized double blind placebo controlled clinical trial.

AIMS: Diabetic nephropathy is known to be an independent risk factor in the progression of renal and cardiovascular disorders. Due to the association between vitamin D deficiency and diabetic nephropathy, vitamin D deficiency in the diabetic nephropathy population, this study conducted to examine the effects of Vitamin D3 on metabolic and inflammatory parameters in patients with diabetic nephropathy. METHODS: This eight-week, randomized, double-blind, placebo-controlled trial was carried out on 50 diabetic nephropathy patients with marginal status of vitamin D. Participants were randomly assigned to two groups: control and intervention. Participants received a vitamin D3 (50000 IU) supplement weekly on a specific day. Fasting blood samples were collected from all patients at their entry to the study, and eight weeks after intervention. RESULTS: Analyses showed significance differences in physical activity between the intervention and placebo groups (P = 0.018). There were no significant differences between the percentage changes of HbA1c, insulin and, inflammatory parameters such as TNF-α and IL-6 (P > 0.05), while the percentage change of FBS was significantly higher in the placebo group compared to the treatment one (P < 0.0001). Lower levels of FBS (P < 0.0001), insulin (P < 0.069), HOMA-IR (P < 0.001), TNF-α (P< 0.002) and IL-6 (P < 0.037) were found after supplementation in treatment group. However, the phosphorous and protein percentage change in urine were lower (P = 0.07) and higher (P = 0.003) between groups. CONCLUSIONS: It was found that vitamin D supplementation can be regarded as an effective way to prevent the progression of diabetic nephropathy by reducing levels of proteinuria, and inflammatory markers such as TNF-α and IL-6.