Modeling Survival in Patients With Brain Stroke in the Presence of Competing Risks / 예방의학회지

Objectives@#After heart disease, brain stroke (BS) is the second most common cause of death worldwide, underscoring the importance of understanding preventable and treatable risk factors for the outcomes of BS. This study aimed to model the survival of patients with BS in the presence of competing risks. @*Methods@#This longitudinal study was conducted on 332 patients with a definitive diagnosis of BS. Demographic characteristics and risk factors were collected by a validated checklist. Patients’ mortality status was investigated by telephone follow-up to identify deaths that may be have been caused by stroke or other factors (heart disease, diabetes, high cholesterol, etc.). Data were analyzed by the Lunn-McNeil approach at alpha=0.1. @*Results@#Older age at diagnosis (59-68 years: adjusted hazard ratio [aHR], 2.19; 90% confidence interval [CI], 1.38 to 3.48; 69-75 years: aHR, 5.04; 90% CI, 3.25 to 7.80; ≥76 years: aHR, 5.30; 90% CI, 3.40 to 8.44), having heart disease (aHR, 1.65; 90% CI, 1.23 to 2.23), oral contraceptive pill use (women only) (aHR, 0.44; 90% CI, 0.24 to 0.78) and ischemic stroke (aHR, 0.52; 90% CI, 0.36 to 0.74) were directly related to death from BS. Older age at diagnosis (59-68 years: aHR, 21.42; 90% CI, 3.52 to 130.39; 75-69 years: aHR, 16.48; 90% CI, 2.75 to 98.69; ≥76 years: aHR, 26.03; 90% CI, 4.06 to 166.93) and rural residence (aHR, 2.30; 90% CI, 1.15 to 4.60) were directly related to death from other causes. Significant risk factors were found for both causes of death. @*Conclusions@#BS-specific and non-BS-specific mortality had different risk factors. These findings could be utilized to prescribe optimal and specific treatment.

Developing a questionnaire to assess Iranian nurses’ knowledge of and attitude to Middle East respiratory syndrome

Background: With the emergence of Middle East respiratory syndrome (MERS), health care preparedness has received increasing attention, which requires valid tools to assess the knowledge and attitude of health workers, such as nurses, with regard to this disease.Aims: This study aimed to develop and evaluate a knowledge and attitudes questionnaire on MERS coronavirus for Ira-nian nurses. Methods: A questionnaire was developed based on international and national guidelines and a literature review. Ten nurses were recruited to assess face validity and 11 experts reviewed the instrument to determine the content validity ratio and index. Exploratory factor analysis was then done with a random sample of 155 nurses in Tabriz city, Islamic Republic of Iran. Results: Following determination of face and content validity, 78 items (61 knowledge and 17 attitude) were retained in the final version of the questionnaire. The knowledge scale had an average content validity index of 0.80 and the attitude scale a value of 0.91. In the exploratory factor analysis, five dimensions with eigenvalues > 1 and loading level ≥ 0.4 were extracted for the knowledge scale (46 items) and two for the attitude scale (16 items). The Kuder–Richardson 21 coefficient and intraclass correlation coefficient for the knowledge scale were 0.94 and 0.91 respectively. In the attitude scale, the Cronbach alpha coefficient and intraclass correlation coefficients were 0.82 and 0.89 respectively. Conclusions: The scale developed in this study is reliable and stable and a suitable instrument for evaluating the knowl-edge and attitude of nurses about MERS-CoV.

Contexte : Avec l'émergence du Syndrome respiratoire du Moyen-Orient (MERS), une attention croissante a été accordée à la préparation en matière de soins de santé, nécessitant des outils valables pour évaluer les connaissances et les attitudes vis-à-vis de cette maladie chez les agents de santé, tels que les personnels infirmiers. Objectifs : La présente étude visait à mettre au point et à évaluer un questionnaire sur les connaissances et attitudes vis-à-vis du coronavirus du Syndrome respiratoire du Moyen-Orient (MERS-CoV) à l’attention des personnels infirmiers iraniens. Méthodes : Un questionnaire a été préparé sur la base des directives internationales et nationales et d’une revue de la littérature. Dix membres du personnel infirmier ont été recrutés pour évaluer la validité apparente et 11 experts ont examiné l'instrument pour déterminer le ratio et l'indice de validité du contenu. Une analyse factorielle exploratoire a ensuite été réalisée sur un échantillon aléatoire de 155 personnels infirmiers dans la ville de Tabriz, en République islamique d'Iran. Résultats : Après avoir déterminé la validité apparente et du contenu, 78 items (61 pour les connaissances et 17 pour les attitudes) ont été retenus dans la version finale du questionnaire. L'échelle des connaissances avait un indice de validité du contenu moyen de 0,80 et l'échelle d’attitudes une valeur de 0,91. À l'analyse factorielle exploratoire, cinq dimensions ayant des valeurs propres supérieures à 1 et un coefficient de saturation supérieur ou égal à 0,4 ont été extraites pour l'échelle des connaissances (46 items) et deux pour l'échelle d'attitudes (16 items). Le coefficient de Kuder-Richardson formule 21 et le coefficient de corrélation intra-classe pour l'échelle des connaissances étaient respectivement de 0,94 et 0,91. Dans l'échelle d'attitudes, le coefficient alpha de Cronbach et le coefficient de corrélation intra-classe étaient respectivement de 0,82 et 0,89. Conclusions : L'échelle mise au point dans cette étude est fiable et stable. Elle constitue également un instrument approprié pour évaluer les connaissances et les attitudes des personnels infirmiers au sujet du MERS-CoV.

Oleoylethanolamide increases the expression of PPAR-Α and reduces appetite and body weight in obese people: A clinical trial.

Obesity is a crucial public health problem worldwide and is considered as the main cause of many chronic diseases. The present study evaluated the effects of Oleoylethanolamide (OEA) supplementation on proximal proliferator-activated receptor-α (PPAR-α) gene expression, appetite sensations, and anthropometric measurements in obese people. This randomized, double-blind, placebo-controlled clinical trial was carried out on 60 healthy obese people in Tabriz, Iran, in 2016. The eligible subjects were divided into an intervention group (who received two 125 mg OEA capsules daily) and a placebo group (who received the same amount of starches) and treated for 60 days. Anthropometric measurements and body composition were assessed in a fasting state at baseline and at the end of the study. The visual analogue scales (VAS) were used to assess appetite sensations. Quantitative real-time PCR analysis targeting the 16S rRNA gene of PPAR-α was done. Analysis was done on 56 participants who continued intervention until the end of the study. A significant increase in PPAR-α gene expression was observed in the intervention group (p < 0.001). Weight, body mass index, waist circumference, and fat percent decreased significantly at the end of the study in the intervention group (all p < 0.01). Hunger, the desire to eat, and cravings for sweet foods decreased significantly and fullness increased significantly by the end of study in the intervention group at the end of study (all p < 0.01). The fullness item increased significantly by the end of study in the intervention group (p < 0.001). Use of OEA as a complementary approach could be effective in suppressing appetite and modulating energy balance in obese people.

Erratum: Associations between Dietary Allium Vegetables and Risk of Breast Cancer: A Hospital-Based Matched Case-Control Study / 한국유방암학회지

This article was initially published on the Journal of Breast Cancer with a misspelled author name and affiliation of the seventh author.

TCF7L2-rs7903146 polymorphism modulates the effect of artichoke leaf extract supplementation on insulin resistance in metabolic syndrome: a randomized, double-blind, placebo-controlled trial / 中西医结合学报

<p><b>BACKGROUND</b>Transcription factor 7-like 2 (TCF7L2)-rs7903146 polymorphism is associated with increased risk of type 2 diabetes. The response of insulin and insulin resistance to artichoke leaf extract (ALE) may be affected by TCF7L2-rs7903146 polymorphism.</p><p><b>OBJECTIVE</b>This study examined the effects of ALE supplementation on metabolic parameters of the TCF7L2-rs7903146 polymorphism in patients with metabolic syndrome (MetS).</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>This double-blind clinical trial was conducted on 80 patients with MetS in Sina Clinic, Khoy, Iran. The patients were randomized into ALE or placebo groups to receive either ALE (1800 mg/d as four tablets) or matching placebo for 12 weeks.</p><p><b>MAIN OUTCOME MEASURES</b>Anthropometric indices, blood pressure, glucose and lipid profile levels were measured before and after the study. Moreover, patients were genotyped for TCF7L2 polymorphism.</p><p><b>RESULTS</b>ALE supplementation decreased insulin level and the homeostasis model assessment of insulin resistance (HOMA-IR) in patients with the TT genotype of TCF7L2-rs7903146 polymorphism (P < 0.05). There was no significant interaction between blood pressure, glucose and lipid profile response to ALE supplementation.</p><p><b>CONCLUSION</b>The responses of insulin and HOMA-IR to ALE supplementation have shown an interaction with single-nucleotide polymorphism rs7903146 in TCF7L2.</p><p><b>TRIAL REGISTRATION</b>Iranian Registry of Clinical Trial IRCT201409033320N9.</p>

Prediction of incidence and bio-psycho-socio-cultural risk factors of post-partum depression immediately after birth in an Iranian population.

INTRODUCTION: Post-partum depression (PPD) is the most prevalent mental problem associated with childbirth. The purpose of the present study was to determine the incidence of early PPD and possible relevant risk factors among women attending primary health centers in Mazandaran province, Iran for the first time. MATERIAL AND METHODS: A longitudinal cohort study was conducted among 2279 eligible women during weeks 32-42 of pregnancy to determine bio-psycho-socio-cultural risk factors of depression at 2 weeks post-partum using the Iranian version of the Edinburgh Postnatal Depression Scale (EPDS). Univariate and hierarchical multiple logistic regression models were used for data analysis. RESULTS: Among 1,739 mothers whose EPDS scores were ≤ 12 during weeks 32-42 of gestation and at the follow-up study, the cumulative incidence rate of depression was 6.9% (120/1,739) at 2 weeks post-partum. In the multivariate model the factor that predicted depression symptomatology at 2 weeks post-partum was having psychiatric distress in pregnancy based on the General Health Questionnaire (GHQ) (OR = 1.06, (95% CI: 1.04-1.09), p = 0.001). The risk of PPD also lower in those with sufficient parenting skills (OR = 0.78 (95% CI: 0.69-0.88), p = 0.001), increased marital satisfaction (OR = 0.94 (95% CI: 0.9-0.99), p = 0.03), increased frequency of practicing rituals (OR = 0.94 (95% CI: 0.89-0.99), p = 0.004) and in those whose husbands had better education (OR = 0.03 (95% CI: 0.88-0.99), p = 0.04). CONCLUSIONS: The findings indicated that a combination of demographic, sociological, psychological and cultural risk factors can make mothers vulnerable to PPD.

Associations between Dietary Allium Vegetables and Risk of Breast Cancer: A Hospital-Based Matched Case-Control Study / 한국유방암학회지

PURPOSE: The protective effect of Allium vegetables against carcinogenesis has been reported in experimental studies particularly focusing on the gut. Therefore, we conducted a hospital-based matched case-control study to explore the association between dietary Allium consumption and risk of breast cancer among Iranian women in northwest Iran. METHODS: A validated, quantitative, food frequency questionnaire was completed in 285 women (aged 25–65 years old) newly diagnosed with histopathologically confirmed breast cancer (grade II, III or clinical stage II, III) in Tabriz, northwest Iran, and the completed questionnaires were included in an age- and regional-matched hospital based-control study. The odds ratios (ORs) and 95% confidence intervals (95% CI) were estimated using conditional logistic regression models. RESULTS: Multivariate analysis showed that there was a negative association between the consumption of raw onion and risk of breast cancer after adjustment for covariates (OR, 0.63; 95% CI, 0.40–1.00); however, this association was insignificant. On the other hand, there was a positive association between consumption of cooked onion and risk of breast cancer, after adjustment for covariates (OR, 1.54; 95% CI, 1.02–2.32). However, reduced risk of breast cancer was associated with higher consumption of garlic and leek with adjusted ORs of 0.41 (95% CI, 0.20–0.83) and 0.28 (95% CI, 0.15–0.51), respectively. CONCLUSION: Our findings suggest that high consumption of certain Allium vegetables, in particular garlic and leek, may reduce the risk of breast cancer, while high consumption of cooked onion may be associated with an increased risk of breast cancer.

Effects of vitamin D supplementation on metabolic indices and hs-CRP levels in gestational diabetes mellitus patients: a randomized, double-blinded, placebo-controlled clinical trial

BACKGROUND/OBJECTIVES: Vitamin D plays an important role in the etiology of gestational diabetes mellitus (GDM). This study evaluated the effect of vitamin D supplementation on metabolic indices and hs-C-reactive protein (CRP) levels in GDM patients. SUBJECTS/METHODS: The study was a randomized, placebo-controlled, double-blinded clinical trial. Seventy-six pregnant women with GDM and gestational age between 24-28 weeks were assigned to receive four oral treatments consisting of 50,000 IU of vitamin D3 (n = 38) or placebo (n = 38) once every 2 weeks for 2 months. Fasting blood glucose (FG), insulin, HbA1c, 25-hydroxyvitamin D, lipid profile, hs-CRP, and homeostasis model assessment-insulin resistance (HOMA-IR) were measured before and after treatment. Independent and paired t-tests were used to determine intra- and intergroup differences, respectively. ANCOVA was used to assess the effects of vitamin D supplementation on biochemical parameters. RESULTS: Compared with the placebo group, in the vitamin D group, the serum level of 25-hydroxyvitamin D increased (19.15 vs. -0.40 ng/ml; P < 0.01) and that of FG (-4.72 vs. 5.27 mg/dl; P = 0.01) as well as HbA1c (-0.18% vs. 0.17%; P = 0.02) decreased. Improvements in the lipid profiles were observed in the vitamin D group, but without statistical significance. Significant increases in concentrations of hs-CRP, FG, HbA1c, total cholesterol, and LDL cholesterol were observed in the placebo group. No significant change in fasting insulin and HOMA-IR was observed in either group. CONCLUSIONS: In GDM patients, vitamin D supplementation improved FG and HbA1c but had no significant effects on lipid profile or hs-CRP.

Effects of vitamin D supplementation on metabolic indices and hs-CRP levels in gestational diabetes mellitus patients: a randomized, double-blinded, placebo-controlled clinical trial

BACKGROUND/OBJECTIVES: Vitamin D plays an important role in the etiology of gestational diabetes mellitus (GDM). This study evaluated the effect of vitamin D supplementation on metabolic indices and hs-C-reactive protein (CRP) levels in GDM patients. SUBJECTS/METHODS: The study was a randomized, placebo-controlled, double-blinded clinical trial. Seventy-six pregnant women with GDM and gestational age between 24-28 weeks were assigned to receive four oral treatments consisting of 50,000 IU of vitamin D3 (n = 38) or placebo (n = 38) once every 2 weeks for 2 months. Fasting blood glucose (FG), insulin, HbA1c, 25-hydroxyvitamin D, lipid profile, hs-CRP, and homeostasis model assessment-insulin resistance (HOMA-IR) were measured before and after treatment. Independent and paired t-tests were used to determine intra- and intergroup differences, respectively. ANCOVA was used to assess the effects of vitamin D supplementation on biochemical parameters. RESULTS: Compared with the placebo group, in the vitamin D group, the serum level of 25-hydroxyvitamin D increased (19.15 vs. -0.40 ng/ml; P < 0.01) and that of FG (-4.72 vs. 5.27 mg/dl; P = 0.01) as well as HbA1c (-0.18% vs. 0.17%; P = 0.02) decreased. Improvements in the lipid profiles were observed in the vitamin D group, but without statistical significance. Significant increases in concentrations of hs-CRP, FG, HbA1c, total cholesterol, and LDL cholesterol were observed in the placebo group. No significant change in fasting insulin and HOMA-IR was observed in either group. CONCLUSIONS: In GDM patients, vitamin D supplementation improved FG and HbA1c but had no significant effects on lipid profile or hs-CRP.

Effects of phylloquinone supplementation on lipid profile in women with rheumatoid arthritis: a double blind placebo controlled study

BACKGROUND/OBJECTIVES: Rheumatoid arthritis (RA) is associated with an excess mortality from cardiovascular disease which is likely attributed to an atherogenic lipid profile. Among nutritional factors vitamin K has been recently focused as a pivotal nutrient in improvement of lipid related markers. Thus, this study was designed to determine the effects of vitamin K on lipid profile in this disease. SUBJECTS/METHODS: Fifty eight patients with definitive RA were participated in the present double blind placebo controlled study. They were randomly allocated into two groups to receive vitamin K1 as phylloquinone [10 mg/day] (n = 30) or placebo pills (n = 28), for eight weeks. In order to control the effects of probable confounders dietary intakes, anthropometric measurements including weight and height, clinical status using disease activity score-28 (DAS-28), physical activity and anxiety status were evaluated at baseline. Moreover, serum levels of lipid related markers including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were measured at baseline and at the end of intervention. RESULTS: There were no significant differences between the two groups regarding any of the baseline characteristics. After adjusting for some relevant confounders, in comparison between two groups, we observed no significant changes in lipid related markers at the end of intervention. Also, there was no significant difference between before and after intervention values within groups (P > 0.05). CONCLUSIONS: Function of vitamin K1 in lipid profile modification remains still controversial. This study showed that vitamin K1 has no effect on lipid profile in women with rheumatoid arthritis. Further studies with a longer follow-up are required to determine the effects of vitamin K on atherogenic lipid profile.

Effects of phylloquinone supplementation on lipid profile in women with rheumatoid arthritis: a double blind placebo controlled study

BACKGROUND/OBJECTIVES: Rheumatoid arthritis (RA) is associated with an excess mortality from cardiovascular disease which is likely attributed to an atherogenic lipid profile. Among nutritional factors vitamin K has been recently focused as a pivotal nutrient in improvement of lipid related markers. Thus, this study was designed to determine the effects of vitamin K on lipid profile in this disease. SUBJECTS/METHODS: Fifty eight patients with definitive RA were participated in the present double blind placebo controlled study. They were randomly allocated into two groups to receive vitamin K1 as phylloquinone [10 mg/day] (n = 30) or placebo pills (n = 28), for eight weeks. In order to control the effects of probable confounders dietary intakes, anthropometric measurements including weight and height, clinical status using disease activity score-28 (DAS-28), physical activity and anxiety status were evaluated at baseline. Moreover, serum levels of lipid related markers including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were measured at baseline and at the end of intervention. RESULTS: There were no significant differences between the two groups regarding any of the baseline characteristics. After adjusting for some relevant confounders, in comparison between two groups, we observed no significant changes in lipid related markers at the end of intervention. Also, there was no significant difference between before and after intervention values within groups (P > 0.05). CONCLUSIONS: Function of vitamin K1 in lipid profile modification remains still controversial. This study showed that vitamin K1 has no effect on lipid profile in women with rheumatoid arthritis. Further studies with a longer follow-up are required to determine the effects of vitamin K on atherogenic lipid profile.

Enhancing the Effects of Low Dose Doxorubicin Treatment by the Radiation in T47D and SKBR3 Breast Cancer Cells / 한국유방암학회지

PURPOSE: Breast cancer is the most common malignancy of women worldwide. Radiotherapy consists of a vital element in the treatment of breast cancer but relative side effects and different radioactive responses are limiting factors for a successful treatment. Doxorubicin has been used to treat cancers for over 30 years and is considered as the most effective drug in the treatment of breast cancer. There are also many chronic side effects that limit the amount of doxorubicin that can be administered. The combined radio-drug treatment, with low doses, can be an approach for reducing side effects from single modality treatments instead of suitable cure rates. METHODS: We have studied the effect of 1, 1.5, and 2 Gy doses of 9 MV X-rays along with 1 microM doxorubicin on inducing cell death, apoptosis and also p53 and PTEN gene expression in T47D and SKBR3 breast cancer cells. RESULTS: Doxorubicin treatment resulted in upregulation of radiation-induced levels of p53 and downregulation of PTEN at 1 and 1.5 Gy in T47D breast cancer cells, as well as downregulation of p53 mRNA level of expression and upregulation of PTEN mRNA level of expression in SKBR3 breast cancer cell line. In addition, doxorubicin in combination with radiation decreased the viability of breast cancer cell lines in the both cell lines. CONCLUSION: Low doses of doxorubicin, with least cell toxicity, may be an effective treatment for breast cancer when used in conjunction with ionizing radiation.