Exposure to occupational air pollution and vascular endothelial dysfunction in workers of the steel industry in Iran.

Air pollution is recognized as a risk factor for cardiovascular diseases; however, the precise underlying mechanisms remain unclear. This study investigated the impact of occupational air pollution exposure on endothelial function in workers within the steel industry. Specifically, we examined male employees in the coke-making division of the Isfahan Steel Company in Iran, as well as those in administrative roles with no known history of cardiovascular risk. Data on age, body mass index, duration of employment, blood pressure, fasting blood sugar, and lipid profile were collected. To assess endothelial function, flow-mediated dilation (FMD) was measured. The baseline brachial artery diameter was greater (mean difference [95% CI] = 0.068 mm [0.008 to 0.128]), while the FMD was lower (mean difference [95% CI] = -0.908 % [-1.740 to -0.075]) in the coke-making group than in the control group. After controlling for potential confounding variables, it was observed that working in the coke-making sector of the industry was associated with lower FMD (F = 3.954, p = .049). These findings indicated that occupational air pollution exposure among workers in the steel industry is linked to impaired endothelium-dependent vasodilation.

Ambient carbon monoxide and cardiovascular-related hospital admissions: A time-series analysis.

Background and aims: Although several studies have investigated the association between air pollutants and cardiovascular diseases (CVDs) in recent years, a lack of evidence exists regarding carbon monoxide (CO) exposure, especially in the Eastern Mediterranean's polluted regions. In this study, we aimed to evaluate the short-term effect of CO exposure on daily CVD hospital admissions in Isfahan, a major city in Iran. Methods: Data were extracted from the CAPACITY study on daily CVD hospital admissions in Isfahan from March 2010 to March 2012. The 24-h mean CO concentrations were obtained from four local monitoring stations. In a time-series framework, the association between CO and daily hospitalizations for total and cause-specific CVDs in adults (ischemic heart disease (IHD), heart failure (HF), and cerebrovascular disease) was conducted using Poisson's (or negative binomial) regression, after adjusting for holidays, temperature, dew point, and wind speed, considering different lags and mean lags of CO. The robustness of the results was examined via two- and multiple-pollutant models. Stratified analysis was also conducted for age groups (18-64 and ≥65 years), sex, and seasons (cold and warm). Results: The current study incorporated a total of 24,335 hospitalized patients, (51.6%) male with a mean age of 61.9 ± 16.4 years. The mean CO concentration was 4.5 ± 2.3 mg/m³. For a 1 mg/m3 increase in CO, we found a significant association with the number of CVD hospitalizations. The largest adjusted percent change in HF cases was seen in lag0, 4.61% (2.23, 7.05), while that for total CVDs, IHD, and cerebrovascular diseases occurred in mean lag2-5, 2.31% (1.42, 3.22), 2.23% (1.04, 3.43), and 5.70% (3.59, 7.85), respectively. Results were found to be robust in two- and multiple-pollutant models. Although the associations changed for sex, age groups, and seasons, they remained significant for IHD and total CVD, except for the warm season, and for HF, except for the younger age group and cold seasons. Additionally, the exposure-response relationship curve of the CO concentrations with total and cause-specific CVD admissions showed non-linear relationships for IHD and total CVDs. Conclusions: Our results showed that exposure to CO contributed to an increase in the number of CVD hospitalizations. The associations were not independent of age groups, season, and sex.

Effects of sulfur dioxide and particulate matter pollution on hospital admissions for hypertensive cardiovascular disease: A time series analysis.

Background and aims: Air pollution is a major environmental risk factor and the leading cause of disease burden with detrimental effects on cardiovascular systems. Cardiovascular diseases are predisposed by various risk factors, including hypertension, as the most important modifiable risk factor. However, there is a lack of sufficient data concerning the impact of air pollution on hypertension. We sought to study the associations of short-term exposure to Sulfur dioxide (SO2) and particulate matter (PM10) with the number of daily hospital admissions of hypertensive cardiovascular diseases (HCD). Methods: All hospitalized patients between March 2010 to March 2012 were recruited with the final diagnosis of HCD based on the International Classification of Diseases 10 (codes: I10-I15) from 15 hospitals in Isfahan, one of the most polluted cities in Iran. The 24-hour average concentrations of pollutants were obtained from 4 monitoring stations. In addition to single- and two-pollutant models, we used Negative Binomial and Poisson models with covariates of holidays, dew point, temperature, wind speed, and extracted latent factors of other pollutants controlling for multi-collinearity to examine the risk for hospital admissions for HCD affected by SO2 and PM10 exposures in the multi-pollutant model. Results: A total of 3132 hospitalized patients (63% female) with a mean (standard deviation) age of 64.96 (13.81) were incorporated in the study. The mean concentrations of SO2 and PM10 were 37.64 µg/m3 and 139.08 µg/m3, respectively. Our findings showed that a significantly increased risk of HCD-induced hospital admission was detected for a 10 µg/m3 increase in the 6-day and 3-day moving average of SO2 and PM10 concentrations in the multi-pollutant model with a percent change of 2.11% (95% confidence interval: 0.61 to 3.63%) and 1.19% (0.33 to 2.05%), respectively. This finding was robust in all models and did not vary by gender (for SO2 and PM10) and season (for SO2). However, people aged 35-64 and 18-34 years were vulnerable to SO2 and PM10 exposure-triggered HCD risk, respectively. Conclusions: This study supports the hypothesis of the association between short-term exposure to ambient SO2 and PM10 and the number of hospital admissions due to HCD.

Morning Exercise at School and Sedentary Activities are Important Determinants for Hypertension in Adolescents.

BACKGROUND: This study was performed to determine the association of Pre-hypertension/hypertension (pre-HTN/HTN) with leisure-time activities and morning exercise at school in a sample of Iranian adolescents. METHODS: This secondary study has done using data of 1992 adolescents participated in of Isfahan Healthy Heart Program. The outcome variable was having/not having pre-hypertension/hypertension (pre-HTN/HTN). The students with Blood pressure (BP) between 90th to 95th percentiles were considered as positive pre-HTN and students with BP >95th percentile were considered as positive HTN. Students with pre-HTN or HTN were considered as positive pre-HTN/HTN. The asked leisure-time activities were categorized in three group including first (ping-pong, basketball, and volleyball), second (football, walking, and bicycling) and sedentary activities (watching TV, studying, and computer gaming), using factor analysis. RESULTS: The prevalence of pre-HTN and HTN was 16.1% and 6.7%, respectively. Based on multiple logistic regression pre-HTN/HTN was associated just with sedentary activities and morning exercise at school. Odds Ratio (95% confidence interval) for sedentary activities and morning exercise at school was 1.51 (1.13-2.01) and 0.63 (0.44-0.89), respectively. CONCLUSION: We observed adolescents who engaged in morning exercise at school had lower prevalence of HTN while those who spent more times on sedentary activities were in higher risk for HTN. We suggest to permanent holding of morning exercise and educational programs on healthy lifestyle skills for adolescents by schools.

The effect of educational and encouraging interventions on anthropometric characteristics and perilipin-1 levels: TABASSOM Study.

BACKGROUND: Perilipin protein located in lipid droplets is involved in formation and storage of lipid in adipocytes; thus, it is considered as one of the obesity biomarkers. This study was performed to examine the effect of educational and encouragement interventions and lifestyle modifications on anthropometric characteristics and perilipin-1 level. METHODS: This quasi-experimental study was conducted on subsample of TABASSOM Study. Participants were 42 overweight and obese children and adolescents aged 6-18 years old and 80 overweight and obese adults aged 19-65 years old. Anthropometric characteristics including weight, height, waist circumference (WC), body fat percentage (BFP), and perilipin-1 level were measured at the first and the end of study (after one year). RESULTS: After intervention, the mean of perilipin-1 decreased significantly in total children and adolescents (before vs. after: 26.79 ± 13.17 vs. 22.57 ± 8.03; P = 0.006) and girls (27.75 ± 10.51 vs. 22.00 ± 8.15; P = 0.001), but decreasing was not significant in boys. In adults, perilipin-1 levels were significantly reduced in total subjects (before vs. after: 16.19 ± 13.42 vs. 15.34 ± 11.25; P = 0.029) and men (18.02 ± 15.78 vs. 15.44 ± 10.61; P = 0.003). There was no significant difference in mean of body mass index (BMI), WC, and BFP in both groups after 12 months. CONCLUSION: Educational and encouraging interventions and lifestyle modifications could lead to decreasing perilipin-1 level in adults, children, and adolescents.

The effectiveness of mindfulness-based intervention on perceived stress and perception of disease in patients with acute coronary syndrome.

CONTEXT: One of the most important issues in patients with coronary artery disease is their mental health indices such as perceived stress and perception of disease. AIMS: The aim of this study was to evaluate the effectiveness of mindfulness-based intervention on the perceived stress and disease perception of patients with acute coronary syndrome. MATERIALS AND METHODS: This is a clinical trial, two-group, and three-stage study on 76 patients with acute coronary syndrome who were randomly divided into intervention and control groups. Nine weekly sessions of mindfulness-based training program were administered to the intervention group. The control group received routine services during this period. Data collection was done before, immediately, and 1 month after the intervention, using the Perceived Stress Scale and the Illness Perception Questionnaire. Data were analyzed using descriptive and inferential statistics. RESULTS: There was no significant difference between the mean scores of perceived stress and illness perception before intervention. After the intervention and 1 month after it, the mean score of perceived stress in the intervention group was statistically significantly lower than the control group (P < 0.001), and the perception of disease in the intervention group was statistically significantly higher than that of the control group (P < 0.001). CONCLUSIONS: It is worthwhile to suggest the mindfulness-based training program to reduce the perceived stress and correct the perception of disease for patients with acute coronary syndrome.

The burden of cardiovascular and respiratory diseases attributed to ambient sulfur dioxide over 26 years.

INTRODUCTION: Developing countries, particularly those with a rapid development, are experiencing increasing pollution by sulfur dioxide (SO2). Despite the considerable SO2 exposure effect on health, there is little evidence regarding this fact in Iran, as one of the largest oil and gas producing countries in the world. The present study, therefore, was designed to investigate the burden of cardiovascular and respiratory diseases attributed to the SO2 exposure in Iran, over a 26-year period. MATERIALS AND METHODS: All measured SO2 levels were collected from 92 air quality monitoring stations (AQMSs) in 29 cities, during 1996-2013. Since the study years were from 1990 to 2015, and also due to missing data at existing stations, the spatiotemporal model was used to estimate the exposure to this gas during this period. To calculate the burden of cardiovascular and respiratory diseases, the population attributable fraction (PAF) value was calculated, and the SO2-attributed mortality and years of life lost (YLL) were determined per province, and in the whole country. RESULTS: The results of this study showed that the SO2 concentration was increased from 22.00 ppb (7.69-67.28) in 1990 to 27.81 ppb (9.88-82.27), in 2015. The lowest annual value of 11.53 ppb (4.68-32.06) and the highest value of 45.11 ppb (16.58-1226) were estimated at 2004 and 1997, respectively. There was a sinusoidal trend in the gas concentration changes. The highest occurrence of SO2-attributed deaths due to cardiovascular and respiratory diseases were 0.080 (0.024-0.168) and 0.076 (0.026-0.165), and the lowest levels were 0.017 (0.004-0.044) and 0.047 (0.017-0.124), respectively. CONCLUSIONS: According to the results in our country, the SO2 trend was sinusoidal during 26 years, with a recurrent rise occurring after each declining period. It is recommended to design the sustainable national method policies and programs with the continuous evaluation and modification for the reduction of fossil fuel consumption and further implementation in the use of clean energy.

Association between ambient fine particulate matter with blood pressure levels among Iranian individuals admitted for cardiac and respiratory diseases: Data from CAPACITY study.

BACKGROUND: The relation between air pollution and cardiovascular diseases (CVDs) risk factors, especially blood pressure (BP) levels, has been less frequently assessed. The aim of this study was evaluating the association between air pollutants of less than 2.5 µm [particulate matter (PM2.5)] and BP indices among individuals admitted with CVDs and pulmonary diseases. METHODS: This cross-sectional study was in context of air pollution associated with hospitalization and mortality of CVDs and respiratory diseases (CAPACITY) study. Data of 792 Iranian patients referring to two hospitals in Isfahan, Iran, for cardiovascular or respiratory problems from March 2011 to March 2012 were used for analysis. BP indices including systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were obtained from patients' medical forms and mean PM2.5 concentrations during 24 hours prior to admission of each patient were obtained from Isfahan Department of Environment (DOE). RESULTS: Mean ± standard deviation (SD) of participants' age were 62.5 ± 15.9 years. All BP indices on admission were significantly higher in women compared with men. Adjustment of all potential confounders including age, sex, temperature, wind speed, and dew point revealed that increasing one quartile in PM2.5 concentrations had been associated with 1.98 mmHg raising in SBP at the time of admission [95% confidence interval (CI) = 0.41-3.54, P = 0.010]. Women with cardiac diseases had higher all BP indices with increased PM2.5 concentration [SBP: ß: 4.30, 95% CI = 0.90-7.70, P = 0.010; DBP: ß: 1.89, 95% CI = 0.09-3.69, P = 0.040; MAP: ß: 3.09, 95% CI = 0.68-5.51, P= 0.010, respectively). CONCLUSION: Our findings suggest that increasing PM2.5 concentration has been positively associated with raising SBP in total population and all BP indices among women with cardiac problems at admission time. Several comprehensive studies are required for confirming these relations.

Correlation between air pollution and hospitalization due to myocardial infarction.

BACKGROUND: Air pollution is associated with increased risk of cardiovascular disease (CVD). This study aims to evaluate the correlation between air pollutants and hospitalization due to myocardial infarction (MI) as part of "correlation of air pollution with hospitalization and mortality of CVDs and respiratory diseases (CAPACITY) study". METHODS: This case-crossover study analyzed the data of 319 patients who were admitted with diagnosis of ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) in three main hospitals of Isfahan, Iran. The data of airborne pollutants including particulate matter < 10 µm (PM10), particulate matter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) as well as climatic indices (temperature, wind speed, and humidity) at 24 hours, 48 hours, and one week before admission were extracted from CAPACITY study. The conditional logistic regression method was used to evaluate the correlation between air pollutants and MI hospitalization. RESULTS: 319 patients with mean age of 63.15 ± 28.14 years, including 238 men (74.6%), and 207 patients with STEMI (64.8%) were recruited. The risk of hospitalization significantly increased in patients with STEMI and 10-unit increment in PM2.5 at 48 hours before admission [odds ratio (OR) = 3.70, 95% confidence interval (CI): 1.69-7.69]. Although, majority of air pollutants had positive association with hospitalization in patients with NSTEMI, they were not statistically significant. CONCLUSION: This study showed significant association between elevated PM2.5 at 48 hours before admission and hospitalization of patients with STEMI. This finding can warn policymakers to design better care services for patients at risk of acute MI during the times of increased air pollution.

National and sub-national exposure to ambient fine particulate matter (PM2.5) and its attributable burden of disease in Iran from 1990 to 2016.

Ambient particulate matter is a public health concern. We aimed (1) to estimate national and provincial long-term exposure of Iranians to ambient particulate matter (PM) < 2.5 µm (PM2.5) from 1990 to 2016, and (2) to estimate the national and provincial burden of disease attributable to PM2.5 in Iran. We used all available ground measurements of PM < 10 µm (PM10) (used to estimate PM2.5) from 91 monitoring stations. We estimated the annual mean exposure to PM2.5 for all Iranian population from 1990 to 2016 through a multi-stage modeling process. By applying comparative risk assessment methodology and using life table for years of life lost (YLL), we estimated the mortality and YLL attributable to PM2.5 for five outcomes. The predicted provincial annual mean PM2.5 concentrations range was between 21.7 µg/m3 (UI: 19.03-24.9) and 35.4 µg/m3 (UI: 31.4-39.4) from 1990 to 2016. We estimated in 2016, about 41,000 deaths (95% uncertainty interval [UI] 35634, 47014) and about 3,000,000 YLL (95% UI: 2632101, 3389342) attributable to the long-term exposure to PM2.5 in Iran. Ischemic heart disease was the leading cause of mortality by 31,363 deaths (95% UI: 27520, 35258), followed by stroke (7012 (5999, 8062) deaths), lower respiratory infection (1210 (912, 1519) deaths), chronic obstructive pulmonary disease (1019 (715, 1328) deaths), and lung cancer (668 (489, 848) deaths). In 2016, about 43% of all PM2.5 related mortality in Iran was, respectively, in the following provinces: Tehran (12.6%), Isfahan (9.3%), Khorasan Razavi (8.0%), Fars (6.5%), and Khozestan (6.4%). In summary, we found that the majority of Iranians were exposed to the levels of ambient particulate matter exceeding the WHO guidelines from 1990 to 2016. Further, we found that there was an increasing trend of total mortality attributed to PM2.5 in Iran from 1990 to 2016 where the slope was higher in western provinces.

Association between ambient air pollution and hospitalization caused by atrial fibrillation.

BACKGROUND: Many studies have shown the worst effects of air pollution on cardiovascular diseases (CVDs). Present study focused on the relationship between atrial fibrillation (AF), as one of the common arrhythmias, and air pollutants in Isfahan, Iran, an industrial city in the Middle East. METHODS: A case-crossover design was used to explore the associations between air pollution and AF hospitalized patients with ventricular response (VR) > 90 beats per minute (bpm) (fast response) and those with VR ≤ 90 bpm. All patients' records were extracted from their hospital files. Air pollutants data including particulate matter less than 10 µ (PM10), PM2.5, carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) were obtained from the Correlation of Air Pollution with Hospitalization and Mortality of Cardiovascular and Respiratory Diseases (CAPACITY) study. Conditional logistic regression test was used to measure the relationship between pollutants and hospitalization due to AF. RESULTS: Records of 369 patients, including 173 men (46.9%) who were hospitalized for AF during the study period and had complete data were extracted. Although a positive but not statistically significant relationship was shown between 10-unit increases in all pollutants (except PM10) and the hospitalization due to AF in patients with rapid VR (RVR), the only significant relationship was observed in case of NO2 [odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.0-2.1, P = 0.031]. CONCLUSION: This study showed positive significant relationships between NO2 and the hospitalization due to AF in patients with RVR. NO2 is a greenhouse gas whose levels are expected to increase due to global environmental changes. Therefore, relevant strategies should be adopted to decrease its levels, especially in industrial cities like Isfahan.

Are dietary patterns differently associated with differentiated levels of mental health problems? Results from a large cross-sectional study among Iranian manufacturing employees.

OBJECTIVES: The present study aimed to classify participants based on mental health problems profile and to evaluate its relationship with dietary patterns among Iranian manufacturing employees. DESIGN: Observational study with a cross-sectional design. SETTING: This study was conducted in Esfahan Steel Company, one of the biggest Iranian industrial manufacturing companies. PARTICIPANTS: Complete data on 2942 manufacturing employees, with a mean (SD) age of 36.68 (7.31) years, were analysed. OUTCOME MEASURES: Hospital Anxiety and Depression Scale(HADA) and General Health Questionnaire (GHQ-12) were used to evaluate anxiety and depression and psychological distress, respectively. RESULTS: Three major dietary patterns, namely 'western', 'healthy' and 'traditional', were extracted using factor analysis. A two-class, one-factor structure was identified from study participants in terms of mental health problems profile based on the factor mixture model. Two identified classes were labelled as 'low mental health problems' (2683 manufacturing employees, 91.2%) and 'high mental health problems' (259 individuals, 8.8%). After adjusting for the impact of potential confounders, manufacturing employees in the highest tertile of healthy dietary pattern had lower odds of being in the high mental health problems profile class (OR=0.67, 95% CI 0.49 to 0.92). In contrast, greater adherence to Western and traditional dietary patterns was associated with increased odds of being in the high mental health problems class (OR=1.66, 95% CI: 1.18 to 2.35 and OR=1.52, 95% CI :1.10 to 2.11, respectively). CONCLUSIONS: Our study provided informative pathways on the association of dietary patterns and mental health among manufacturing employees. The findings can be used by workplace health promotion policymakers in improving mental health in such study population. Interventional and prospective studies that investigate the effects of change in dietary patterns on the mental health of manufacturing employees are suggested.

The association between particulate matter 2.5 and hospitalization and mortality rates of heart failure: The CAPACITY study.

BACKGROUND: Considering the high concentrations of pollutants in large cities of Iran and the high prevalence of heart failure (HF) among Iranians, especially with increasing life expectancy, this study investigated the relationship between airborne contaminants with a diameter < 2.5 µm or particulate matter 2.5 (PM2.5) and hospitalization and mortality in patients with HF in Isfahan, Iran, during 2011. METHODS: This ecological study was carried out on a part of data from the CAPACITY study. A total of 275 patients with HF were randomly selected from 840 subjects with International Statistical Classification of Diseases, 10th Revision (ICD-10) diagnosis code I50 in the CAPACITY study. Patients' records were evaluated and their clinical characteristics, disease history, and laboratory and echocardiographic findings were extracted. Air pollution and climatic data were extracted from the CAPACITY study. Poisson regression was used in crude and adjusted models to evaluate the association between PM2.5 and study outcomes. All analyses were performed using crude models and models adjusted for temperature, dew point, and wind speed. RESULTS: 54.9% (n = 151) were men with mean age of 70.4 ± 13.7 years. While most patients (85.8%) were discharged after recovery, 14.2% of the patients died in the hospital. Blood glucose, heart rate, and ejection fraction (EF) were significantly higher on unhealthy days than normal days. Regression analysis revealed no significant relationships between hospitalization and mortality rates and PM2.5 concentrations on healthy days, unhealthy days for sensitive people, and unhealthy days. CONCLUSION: The model used in our study revealed no significant relationships between PM2.5 concentrations and hospital admission on healthy days, unhealthy days for sensitive people, and unhealthy days.

Air pollution and cardiovascular and respiratory disease: Rationale and methodology of CAPACITY study.

BACKGROUND: Considering the high level of air pollution and its impact on health, we aimed to study the correlation of air pollution with hospitalization and mortality of cardiovascular (CVD) and respiratory diseases (ResD) (CAPACITY) to determine the effects of air pollutants on CVD and ResD hospitalizations and deaths in Isfahan, Iran. METHODS: Hourly levels of air pollutants including particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3), information of CVD and ResD admissions and death certificate were obtained respectively from Department of Environment (DOE), Iran, hospitals and cemetery. Time series and case-crossover model were used to find the impact of air pollutants. This paper only summarizes the descriptive findings of the CAPACITY study. RESULTS: The total number of hospitalized patients were 23781 in 2010 and 22485 in 2011. The most frequent cause of hospitalization and death was ischemic heart diseases in both years. While the mean annual levels of O3, CO, and PM10 were lower in 2011 than in 2010, NO2 and SO2 levels higher in 2011. In both years, PM10 was similarly increased during last month of fall, late spring and early summer. In 2011, the PM2.5 and PM10 monthly trend of change were similar. CONCLUSION: The CAPACITY study is one of the few large-scale studies that evaluated the effects of air pollutants on a variety of CVD and ResD in a large city of Iran. This study can provide many findings that could clarify the effects of these pollutants on the incidence and burden of both disease groups.

Comparison of health-related quality of life after percutaneous coronary intervention and coronary artery bypass surgery.

BACKGROUND: Health-related quality of life (HRQOL) evaluation is an important measure of the impact of the disease. As more people with coronary heart disease (CHD) live longer, doctors and researchers want to know how they manage in day to day life. It looked like adults with CHD had a decrease QOL. The aim of this study was to comparison of HRQOL of patients who underwent percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) and to assess its main determinants in the whole sample of coronary artery disease (CAD) patients. METHODS: The study was carried out to estimate HRQOL of 109 patients who underwent invasive coronary revascularization [PCI (n = 75) and CABG (n = 34)]. We applied HRQOL after 6 months and 2 years in both groups and scores were compared. The HRQOL data were obtained using MacNew Heart Disease questionnaire with dimensions emotional, physical and social that estimated. Data entry and analysis were performed by SPSS. RESULTS: A total MacNew scale in CABG and PCI group in 6 months after treatment were 45.32 ± 13.75 and 53.52 ± 15.63, respectively (P = 0.010). After 2 years HRQOL mean changed to 51.176 ± 14.80 and 49.55 ± 16.22, respectively, in CABG and PCI group (P = 0.428). Our results in within-group analysis showed total MacNew scale and its subscales were changed significantly after 2 years in CABG and PCI group's scores were detected. We found in the whole sample of CAD patients those who had a higher level of income and education and were not either overweight or obese experienced better HRQOL. CONCLUSION: Our results showed that patients who underwent PCI experienced significantly higher HRQOL in 6 months after revascularization but over 24 months follow-up no difference was observed between the two groups.

Policy makers' viewpoints on implementation of the World Health Organization Framework Convention on Tobacco Control in Iran: A qualitative investigation of program facilitators.

BACKGROUND: The epidemic of smoking is a great concern of health systems. Moreover, the number of smokers is increasing worldwide and this has led to an escalating trend of morbidity, mortality, and burden of smoking-related diseases. Therefore, monitoring the implementation of tobacco control laws in different countries is of extreme importance. This study aimed to describe policy makers' experiences and perceptions of the facilitating factors of the implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in Iran. METHODS: This was a qualitative research in which data were collected through individual interviews. The participants included policy makers who were members of the national assembly for tobacco control. In this study, 13 unstructured interviews of about 45 to 60 minutes duration were conducted in an extrapolative manner. The qualitative content analysis method was applied until extrapolation of basic themes was complete. RESULTS: As a result of the analysis, the themes of performance through training, through research, through intersectoral collaboration, and through setting priorities emerged. The emerged themes connote some critical points that have key roles in promoting the effective implementation of the WHO FCTC. Furthermore, the main role of the health sector becomes predominant. CONCLUSION: The study findings suggested the managed and coordinated work as one of the main facilitating factors of the implementation of the WHO FCTC at a national level.

The impact of health-related quality of life on the incidence of ischaemic heart disease and stroke; a cohort study in an Iranian population.

OBJECTIVE: The aim of study was to evaluate the impact of health-related quality of life (QoL) on the occurrence of ischaemic heart disease (IHD) and stroke using a validated questionnaire. METHODS: We followed the 3,283 subjects, aged ≥ 35 years and without history of cardiovascular events (CVE) over four years from 2007 to 2011 from the Isfahan cohort study. The World Health Organization QoL questionnaire (WHOQOL-BREF), which contains four separate domains, was used to assess QoL. Incidence rates of IHD and stroke were recorded during follow-up. Socioeconomic demographic data including marital state, educational level, occupation, income and place of living and metabolic risk factors such as diabetes mellitus (DM), hypertension (HTN), dyslipidaemia, body mass index and smoking were also recorded. RESULTS: More IHD (42%) and stroke (57%) patients were illiterate; while the educational status was significantly different only in the IHD group (P = 0.000). Differences in income and occupation were notable in patients with stroke and IHD, respectively, compared to subjects without them (P < 0.050). DM and HTN were significantly higher in IHD and stroke patients in comparison with subjects without CVE (P = 0.000). Two-way multivariate analyses of covariance test after age, educational status and metabolic risk factors adjustment showed that subjects with stroke had a significantly higher score in all QoL domains in comparison with individuals without stroke (P < 0.050). There was no significant association between QoL domains and IHD incidence (P > 0.050). CONCLUSION: This study indicates that there is no association between QoL and IHD incidence although there was a significant relationship between higher QoL and incidence of stroke.

The cumulative incidence of conventional risk factors of cardiovascular disease and their population attributable risk in an Iranian population: The Isfahan Cohort Study.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of death in Iran. The present study evaluated the 7-year incidence of CVD risk factors among the participants of Isfahan cohort study (ICS). MATERIALS AND METHODS: ICS was a longitudinal study on adults over 35 years of age from the urban and rural areas in three counties in central Iran. Data on clinical examination and blood measurements were collected in 2001. Subjects were followed and similar data were collected in 2007. Cumulative incidence was calculated through dividing new cases of each risk factor by the population free of that risk factor at baseline. Incidence proportion was determined for major CVD risk factors including hypertension (HTN), hypercholesterolemia (HC), hypertriglyceridemia (HTg), obesity, diabetes mellitus (DM), metabolic syndrome (MetS), and smoking. RESULTS: A total number of 6323 adults free of CVDs were recruited. After 7 years of follow-up, 3283 individuals were re-evaluated in 2007. The participants' age was 49.2 ± 10.3 years in 2001 (mean ± SD). The 7-year cumulative incidence of HTN, HC, HTg, overweight, obesity, DM, MetS, and smoking was 22.8%, 37.4%, 28.0%, 26.3%, 7.4%, 9.5%, 23.9%, and 5.9% in men and 22.2%, 55.4%, 33.5%, 35.0%, 18.8%, 11.3%, 36.1%, and 0.7% in women, respectively. Among those with overweight or obesity, 14.7% of men and 7.9% of women decreased their weight up to the normal level. CONCLUSIONS: The present study revealed a high incidence of CVD risk factors especially dyslipidemia, obesity, MetS and HTN. Therefore, the application of life-style modification interventions seems necessary.

A framework for exploration and cleaning of environmental data--Tehran air quality data experience.

BACKGROUND: Management and cleaning of large environmental monitored data sets is a specific challenge. In this article, the authors present a novel framework for exploring and cleaning large datasets. As a case study, we applied the method on air quality data of Tehran, Iran from 1996 to 2013.  METHODS: The framework consists of data acquisition [here, data of particulate matter with aerodynamic diameter ≤10 µm (PM10)], development of databases, initial descriptive analyses, removing inconsistent data with plausibility range, and detection of missing pattern. Additionally, we developed a novel tool entitled spatiotemporal screening tool (SST), which considers both spatial and temporal nature of data in process of outlier detection. We also evaluated the effect of dust storm in outlier detection phase. RESULTS: The raw mean concentration of PM10 before implementation of algorithms was 88.96 µg/m3 for 1996-2013 in Tehran. After implementing the algorithms, in total, 5.7% of data points were recognized as unacceptable outliers, from which 69% data points were detected by SST and 1% data points were detected via dust storm algorithm. In addition, 29% of unacceptable outlier values were not in the PR.  The mean concentration of PM10 after implementation of algorithms was 88.41 µg/m3. However, the standard deviation was significantly decreased from 90.86 µg/m3 to 61.64 µg/m3 after implementation of the algorithms. There was no distinguishable significant pattern according to hour, day, month, and year in missing data. CONCLUSION: We developed a novel framework for cleaning of large environmental monitored data, which can identify hidden patterns. We also presented a complete picture of PM10 from 1996 to 2013 in Tehran. Finally, we propose implementation of our framework on large spatiotemporal databases, especially in developing countries.

The relation between occupational exposure to lead and blood pressure among employed normotensive men.

BACKGROUND: Lead is a pollutant with numerous adverse effects on health. Since it can affect blood pressure, peripheral blood vessels, and the heart, the present study aimed to evaluate the relation between occupational exposure to lead and blood pressure. MATERIALS AND METHODS: This cross-sectional study included male individuals working in battery firms in Isfahan. A questionnaire covering demographic characteristics and the history of different diseases and occupational exposure to lead was completed. Each participant's blood pressure was also measured and recorded. After obtaining blood samples and determining lead levels, mean and frequency analyses were performed. In addition, Pearson's correlation test and linear regression were used to assess the relation between blood lead levels (BLLs) and systolic and diastolic blood pressure. All analyses were performed in SPSS.19. RESULTS: The mean age of the 182 studied workers was 42.85 ± 13.65 years. They had worked in battery firms for a mean period of 23.67 ± 14.72 years. Moreover, the mean value of BLLs among the participants was 7.92 ± 3.44 µg/dL. Correlation between BLL and systolic and diastolic blood pressure was not significant. The effects of lead on systolic and diastolic blood pressure after stepwise regression were B = -0.327 [confidence interval (CI) 95%: -0.877 to 0.223] and B = -0.094 (CI 95%: -0.495 to 0.307), respectively. CONCLUSION: This study revealed that BLLs in battery firm workers to be normal. Additionally, BLLs were not significantly related with either systolic or diastolic blood pressure which might have been the result of normal BLLs.