Iranian children with overweight and obesity: an internet-based interventional study.

BACKGROUND: Obesity or overweight in children is an excessive accumulation of adipose tissue that can potentially regress health indicators and increase the likelihood of various diseases. OBJECTIVES: This model was implemented to improve the nutritional status and lifestyle behavior of children aged 6-12 years with overweight/obesity. METHODS: A quasi-experimental design with 90 participants in each control and intervention group with a multistage cluster random sampling method after reviewing the literature, and their screening by experts were adopted. RESULTS: After 6 months there were significant differences in Body Mass Index and weight for age percentile values of children allocated in control and intervention groups after controlling for beginning values (p = 0.024, Partial eta2 = 0.028, 0.044, Partial eta2 = 0.023), respectively. Although there was an increased rate in BMI and weight for age percentile in both groups this increase in the control group after the 6th month significantly was more than that in the intervention group after the 6th months. A considerable difference in BMI of girls after the intervention was observed in the experimental group (p = 0.006, Partial eta2 = 0.092). However, our results showed that there was no significant difference in BMI of boys in the intervention and control groups before and 6 months after the intervention (p = 0.507). CONCLUSIONS: We conclude that though the weight increase rate was lower in the experimental group, the implemented model alone was not enough. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20200717048124N1 at 05/08/2020, retrospectively registered.

E-Learning Model in Chronic Kidney Disease Management: a Controlled Clinical Trial.

INTRODUCTION: Chronic kidney disease (CKD) is a challenging health problem. The present study examined impact of self-care education through e-learning on improving kidney function among individuals with CKD. MATERIALS AND METHODS: The studied population consisted of CKD patients receiving care at 10 centers for treating noncommunicable diseases in Tehran. Three centers were randomly selected and 39 patients with a glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2, minimum education of grade 9, minimum of 2 years of referrals, and computer literacy of the individual or a first-degree relative were included in the study, while 92 patients were assigned into the control group. Changes in GFR were compared after 6 months following an e-learning program for the patients in the intervention group. RESULTS: The mean change in GFR was 7.5 ± 8.9 mL/min/1.73 m2 for the intervention group after the e-learning intervention, while this was -2.3 ± 8.5 mL/min/1.73 m2. The two groups were also significantly different in terms of age, marital status, education level, mean arterial pressure, and serum high-density lipoprotein level, and therefore, multivariable comparison of GFR was made incorporating these factor into the analysis and showed a significant improvement of GFR in the intervention group. CONCLUSIONS: According to the results of this study, effects of the e-learning educational intervention on improvement in kidney function and CKD treatment were established.

Prevalence and determinants of chronic kidney disease in northeast of Iran: Results of the Golestan cohort study.

BACKGROUND: The burden of chronic kidney disease (CKD) is increasing globally in particular in fast emerging economies such as Iran. Population-based studies on prevalence of CKD in Iran are scarce. The objective of the current study was to explore the prevalence and determinants of CKD in the setting of Golestan Cohort Study (GCS), the largest prospective cohort in the Middle East. METHODS: In this observational study, 11,409 participants enrolled in the second phase of GCS were included. Sex, age, literacy, residence, anthropometric measurements, smoking, opium use, self-reported history of cardiovascular diseases (heart disease and/or stroke), hypertension, diabetes, and lipid profile were the predictors of interest. The outcomes of interest were eGFR and CKD defined as eGFR< 60 ml/min/1.73m2. RESULTS: Mean (SD) of GFR was 70.0 ± 14.7 ml/min/1.73m2 among all participants, 68.2 ± 14.2 among women, and 72.0 ± 15.0 among men. Prevalence of CKD was 23.7% (26.6% in women, 20.6% in men). The prevalence of CKD stages 3a, 3b, 4, and 5 were 20.0%, 3.3%, 0.4% and 0.1%, respectively. Female sex, older age, urban residence, history of CVD, hypertension or diabetes, larger body mass and surrogates of body fat and opium use were all associated with CKD. Opium had a significant positive association with CKD in adjusted model. All anthropometric measurements had positive linear association with CKD. Being literate had inverse association. Sex had significant interaction with anthropometric indices, with higher odds ratios among men compared with women. A significantly high association was observed between the rate of change in waist circumference and systolic blood pressure with risk of CKD. CONCLUSION: One in four people in this cohort had low eGFR. Obesity and overweight, diabetes, hypertension, and dyslipidemia are major risk factors for CKD. Halting the increase in waist circumference and blood pressure may be as important as reducing the current levels.

A multilevel model for services provided to patients with chronic kidney disease.

Chronic kidney disease (CKD) is a general health problem with high rates of mortality and morbidity. The increasing prevalence of CKD has led to the recognition of the fact that it needs special care. One approach to CKD management is to present a model of care for the disease. A model of care for CKD was developed by drawing on the literature, including guidelines for CKD care, and by using previous experiences in providing care for patients with diabetes mellitus and CKD. The model focuses on training, identification of patients, care, follow-up, and evaluation of patients. In this study, two levels were defined for providing care to patients with CKD. The first level involves care provided by family physicians, while the second level was defined as community health services for CKD. Establishment of at least 1 CKD community health service at each capital city of any province seems to be an effective factor in improving services provided to patients with CKD.

Chronic kidney disease management program in Shahreza, Iran.

INTRODUCTION: Chronic kidney disease (CKD) is a public health problem that needs an integrated program to be detected, monitored, and controlled. This study reports the results of a CKD program designed and implemented in Shahreza, Iran. MATERIALS AND METHODS: After initial evaluation of CKD in Shahreza, a CKD management program was developed in the Ministry of Health and the pilot project was started in February 2011 in Shahreza rural areas. The patients at risk, including those with diabetes mellitus and hypertension, were tested with serum creatinine and urine albumin-creatinine ratio. The CKD management program included training, screening, monitoring, and controlling of weight, hypertension, diabetes mellitus, lipids, and vitamin D. RESULTS: This pilot program was organized in the rural population aged over 30 years who were suffering from hypertension, diabetes mellitus, or both, and resulted in the discovery of cases in various stages of CKD. The prevalence of CKD in this high-risk group was 21.5%. Persistent albuminuria and a glomerular filtration rate less than 60 mL/min/1.73 m(2) were 13% and 11%, respectively. The rate of CKD stages 1, 2, 3a, 3b, 4, and 5 were 2.75%, 6.82%, 10.08%, 0.92%, 0.31%, and 0.17% respectively. After 1 year of the program implemented, incidence rate of CKD was 24% and improvement rate was 21%. In diabetic patients, the mean of hemoglobin A1c decreased from 8.5 ± 1.9% to 7.5% ± 1.8%. CONCLUSIONS: Integration of CKD programs in primary health care is possible and results in improvement in management of CKD patients.

Distribution of albuminuria and low glomerular filtration rate in a rural area, Shahreza, Iran.

INTRODUCTION: Chronic kidney disease (CKD) is becoming a major public health problem worldwide. A remarkable part of health budget is designated annually to control end-stage renal disease in most countries. The aim of this study was to screen for CKD among the general population of the rural area of Shahreza, in the central region of Iran. MATERIALS AND METHODS: In a study of rural area around Shahreza, Iran, in 2009, a total of 1400 participants aged over 30 years old were selected by systematic randomized sampling. Glomerular filtration rate (GFR) was used as an index of kidney function and albuminuria, as an index of kidney damage. The simplified Modification of Diet in Renal Disease Study equation was used for estimation of GFR. RESULTS: A GFR less than 60 mL/min/m2 was found in 4.7% of the study population (1.8% in men and 6.1% in women). Microalbuminuria and macroalbuminuria were present in 16.2% of the participants (15% of men and 16.8% of women). Pyuria and hematuria rates were 12.3% and 12.6%. The prevalence of a GFR less than 60 mL/min/1.73 m2 was significantly increasing by age groups in both genders. CONCLUSIONS: Considering its high prevalence, CKD needs measures to identify the disease sooner and requires an active national screening program to identify patients in earlier stages. It seems reasonable to integrate such programs in the primary healthcare system.