The Effect of Nutrition Consultation on Dietary Diversity Score of Cardiac Patients Referred to Cardiac Rehabilitation Research Center Isfahan Cardiovascular Research Institute during 2008-2013

BACKGROUND

Dietary diversity score (DDS) measurement was used to assessment of diet quality in different disease like cardiovascular disease. One way to improve the cardiovascular patient's ability is cardiac rehabilitation program that include exercise training, nutrition consultation and psychological treatment. No study was designed to compare the DDS before and after dietary consultation among cardiac rehabilitation patients, so this study was designed to examine this purpose.

METHODS

Subjects were participated in the 2-month cardiac rehabilitation program. All patients that completed the cardiac rehabilitation program and 2 dietary records (before and after nutritional counseling in cardiac rehabilitation program) enrolled in study. Kant et al method was used for scoring dietary diversity. Data were analyzed using the statistical package for social sciences (SPSS version 20). Wilcoxon test were used to compare DDS score for each subgroup and pair sample T test was used to compare total DDS after and before nutrition counseling. P < 0.05 was considered as statistically significant.

RESULTS

The differences between DDS of grain, fruit, vegetable and meat before and after nutrition counseling were not significant (P = 0.635, P = 0.423, P = 0.826, P = 0.207 respectively), but differences of DDS for dairy and total DDS before and after nutrition counseling were significant (P = 0, P = 0.001).

CONCLUSIONS

Dietary diversity was increased after nutrition counseling among patients with cardiac disease.

Cognitive rehabilitation in patients with nonamnestic mild cognitive impairment

Background:

The nonamnesic type of mild cognitive impairment (na-MCI) is predementia state with subtle decline incognitive domains except memory. Although cognitive rehabilitation (CR) has been investigated in amnesic type of MCI, we could not find any trial that rehabilitated na-MCI exclusively. We studied the effectiveness of CR on na-MCI.

Materials and Methods:

This study was a blinded, randomized clinical trial. Individuals with age of 60 years or more, complete self-directedness and diagnosis of na-MCI, based on Neuropsychiatry Unit Cognitive assessment tool, were selected. The 51 patients were randomly assigned into three groups: CR, lifestyle (LS) modification, and the control group (CG). Neuropsychological tests for executive functioning were assessed at the baseline, after the interventions, and 6 months later.

Results:

The mean score of the “design fluency” test increased significantly in CR, compared to LS and CG (P = 0.007). In “five-point” test, mean score increased significantly in CR (P = 0.03). There was higher mean score of Behavioral Rating Inventory of Executive Function for adults in CR (P = 0.01).

Conclusion:

Consideration of the MCI subtypes allows us to target specific cognitive domains, such as information processing, for better CR outcome. CR may result in better performance of executive functioning of daily living.

Cost-effectiveness of surgical excision versus Mohs micrographic surgery for nonmelanoma skin cancer: A retrospective cohort study

BACKGROUND

Nonmelanoma skin cancer rates are increasing worldwide. Mohs micrographic surgery and surgical excision (SE) are the two treatment methods for this type of cancer. The current paper aims at determining and comparing the cost-effectiveness of SE and Mohs micrographic surgery.

MATERIALS AND METHODS

The current study has a retrospective cohort design. A number of 630 patients suffering from nonmelanoma skin cancer who at some point of time during the years 2007-2014 referred to the Al-Zahra or Seyed Al-Shohada Hospitals in Isfahan. Patients were followed up for 4 years, and then the incremental cost-effectiveness ratio (ICER) of the two methods was calculated.

RESULTS

The average (minimum-maximum) cost of the SE and Mohs surgery methods in Iran was obtained as 18,550,170 (2335,800-260,898,262) and 12,236,890 (6488,340-41,161,700) Iranian Rial, respectively. Recurrence percentage was also reported as 7.9% and 8.7% for SE and Mohs micrographic surgery, respectively (P > 0.05). The ICER of SE in comparison with Mohs surgery was calculated as 7891,600 Iranian Rials per recurrence avoided.

CONCLUSION

Mohs surgery is less expensive than SE, it seems like Mohs surgery is more affordable, however further studies in different populations of the country are needed.

Effect of add-on valproate on craving in methamphetamine depended patients: A randomized trial

Background:

Methamphetamine dependence lead to the compulsive use, loss of control, and social and occupational dysfunctions. This study aimed to compare the effect of valproate in reducing the craving in methamphetamine dependents.

Materials and Methods:

This is a randomized, double-blind, controlled clinical trial on 40 men of 18–40 years old referred to Noor Hospital during December 2012–September 2013 in Isfahan, Iran. The subjects participated in matrix program and randomly were divided into two groups of valproate and placebo. A 4-months program of intervention with valproate or placebo was arranged for each group. The rate of craving to methamphetamine and positive methamphetamine urine tests were evaluated in both groups every 2 weeks using cocaine craving questionnaire-brief (CCQ-Brief) and urine test. After the 4 months (active treatment with valproate and placebo), the drug was tapered and discontinued within 10 days, and patients were introduced to self-help groups and monitored regularly on a weekly basis over another 3 months. Collected data were analyzed with SPSS 20 using analysis of covariance repeated measure, Chi-square, and t-test.

Results:

CCQ score of the intervention group was significantly less than the placebo group (P < 0.001), except on weeks 1, 3, and 28. The ratio of a positive urine test for methamphetamine in the intervention group was significantly lower than the control group in all screenings except weeks 3 and 28.

Conclusion:

Adding valproate to matrix program in the treatment of methamphetamine dependence showed significant effect on the reduction of the craving to methamphetamine.

Effect of Garlic and Lemon Juice Mixture on Lipid Profile and Some Cardiovascular Risk Factors in People 30-60 Years Old with Moderate Hyperlipidaemia: A Randomized Clinical Trial

BACKGROUND

This study was performed to effects of garlic and lemon juice mixture on lipid profile and some cardiovascular risk factors in people 30-60 years old with moderate hyperlipidemia.

METHODS

In a parallel-designed randomized controlled clinical trial, a total of 112 hyperlipidemic patients 30-60 years, were recruited from Isfahan Cardiovascular Research Center. People were selected and randomly divided into four groups. Control blood samples were taken and height, weight, and blood pressure were recorded. (1) Received 20 g of garlic daily, plus 1 tablespoon lemon juice, (2) received 20 g garlic daily, (3) received 1 tablespoon of lemon juice daily, and (4) did not receive garlic or lemon juice. A study technician was done the random allocations using a random numbers table. All participants presented 3 days of dietary records and 3 days of physical activity records during 8 weeks. Blood samples were obtained at study baseline and after 8 weeks of intervention.

RESULTS

Results showed a significant decrease in total cholesterol (changes from baseline: 40.8 ± 6.1, P < 0.001), low-density lipoprotein-cholesterol (29.8 ± 2.6, P < 0.001), and fibrinogen (111.4 ± 16.1, P < 0.001) in the Group 1, in comparison with other groups. A greater reduction in systolic and diastolic blood pressure was observed in Group 1 compared with the Groups 3 and 4 (37 ± 10, P = 0.01) (24 ± 1, P = 0.02); respectively. Furthermore, a great reduction in body mass index was observed in the mixed group compared with the lemon juice and control groups (1.6 ± 0.1, P = 0.04).

CONCLUSIONS

Administration of garlic plus lemon juice resulted in an improvement in lipid levels, fibrinogen and blood pressure of patients with hyperlipidemia.

Isolation and characterization of Clostridium difficile in farm animals from slaughterhouse to retail stage in Isfahan, Iran

To determine the prevalence of Clostridium difficile in farm animals from slaughterhouse through to retail stage, a total of 750 samples of feces, posteviscerated and washed carcass were collected from cattle, camels, goats, and sheep in Isfahan, Iran. The overall prevalence of C. difficile in feces, posteviscerated and washed carcass were 20 (13.3%), 23 (15.3%), and 11 (7.3%), respectively; while C. difficile was isolated from 79 (26.3%) retail samples. Twenty-nine (3.8%) isolates were toxigenic, with most toxigenic isolates (n = 17, 5.6%) identified from the retail stage. All toxigenic isolates harbored tcdA and tcdB; however, all were negative for cdtB. The 29 isolates were classified into 21 different ribotypes. This study revealed evidence of existence of toxigenic C. difficile in farm animal feces and meat in Iran.

Validity, reliability and factor analysis of Persian version of schizophrenia quality of life scale

CONTEXT

Exact measurement of quality of life (QOL) in schizophrenia patients for evaluation of the patient's deterioration and also to assess the efficacy of therapeutic Interventions has become a daily task, which requires accurate assessment tools.

AIMS

This study was aimed to assess the psychometric properties of a Persian version of schizophrenia QOL scale (SQLS) as a common transcultural instrument.

SETTINGS AND DESIGN

One hundred and fifty schizophrenia patients who referred to Psychiatric Clinic in Noor Hospital (Isfahan, Iran) have been selected using simple sampling method.

SUBJECTS AND METHODS

Aside with SQLS, short form-36 general health (SF-36) and World Health Organization QOL-brief-26 (WHOQOL-BREF-26). Questionnaires were completed by the cases for determination of correlation coefficients.

STATISTICAL ANALYSIS USED

The data were analyzed using descriptive statistics, factor analysis, Cronbach's coefficient alpha, Pearson correlation coefficient by Statistical Package for Social Sciences software, version 18 (SPSS-18).

RESULTS

Total reliability of the questionnaire was reported by using Cronbach's coefficient alpha 0.84, reliability of individual relationships subscales was 0.91, signs 0/87, symptoms 0/72 and motivation/energy 0/61. Correlation coefficients of SF-36 with a total scale of SQLS and correlation coefficient of WHOQOL-BREF-26 with a total scale of SQLS were acceptable. Exploratory factor analysis using varimax rotation identified four principle components (interpersonal relationship, symptoms, signs, motivation, and energy), which will determine QOL at 52.7% variance.

CONCLUSIONS

Persian version of the SQLS can be used as a simple, reliable and valid tool in Iranian population.

The relationship between different diet quality indices and severity of airflow obstruction among COPD patients

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide. Smoking is the number one cause of COPD; however, genetic, environmental and dietary factors contribute to the etiology of this disease. In this study, we assessed the association between three diet quality indices -the Healthy Eating Index-2005 (HEI-2005), the Healthy Eating Index-2010 (HEI-2010), and Mediterranean Diet Score (MED)- and the severity of disease in COPD patients.

METHODS

This cross-sectional study was performed at Rasul-e-Akram Hospital in Tehran on 121 COPD patients with the mean age of (SD) of 66.1(10.9) years. A pulmonary specialist diagnosed all participants based on a spirometry test. They were categorized into four groups (1, 2, 3, 4 stages of disease). Three diet quality indices, spirometry test and determination of disease severity were performed for all the participants. ANCOVA and Kruskal-Wallis test were used to assess the relationship between dietary quality indices and severity of the disease. The relationship between HEI-2010, HEI-2005, MED score, their components and lung function was assessed using a multiple linear regression analysis. All analyses were done using SPSS 18.

RESULTS

Reduction of the Healthy Eating Index-2010 and MED score were observed along with the increase in disease severity, but they were not significant. The relationship between the three diet quality indices and lung function showed a significant association between MED score and Forced expiratory volume in one second (FEV1), The Forced Vital Capacity (FVC) (β=2.9, 95% CI (1.1, 4.8), p=0.002), (β=2.8, 95% CI (0.9, 4.8), p=0.007), respectively.

CONCLUSION

Mediterranean dietary pattern and obtaining a better score on HEI-2010 diet were associated with a better lung function test.

The incidence of congenital hypothyroidism and its determinants from 2012 to 2014 in Shadegan, Iran: a case-control study

OBJECTIVES:

Congenital hypothyroidism (CH) is one of the major causes of preventable mental retardation in infants. The aim of this study was to determine the incidence of CH in Shadegan, Khuzestan Province, Iran from 2012 to 2014 and to identify the risk factors associated with CH.

METHODS:

A total of 203 cases were confirmed from 2012 to 2014 in Shadegan, with 66, 86, and 51 patients reported in 2012, 2013, and 2014, respectively. A total of 3,900, 3,991, and 4,050 live births occurred in 2012, 2013, and 2014, respectively. The controls (n=657) were selected using a random number table, and a case-control study was carried out to determine the risk factors for neonatal CH, including demographic, environmental, and medical factors.

RESULTS:

The incidence of CH was 17.0 per 1,000 live births in 2012, 21.5 per 1,000 live births in 2013, and 12.6 per 1,000 live births in 2014. This study showed that the likelihood of CH in children born to parents with a history of consanguineous marriage was 2.41 times greater than in children born to parents with no such history (odds ratio, 2.41; 95% confidence interval [CI], 1.65 to 3.53). This study also found that CH was 3.4 times more likely (95% CI, 2.29 to 5.20) in infants born in urban settings than in infants born in rural areas.

CONCLUSIONS:

The incidence of CH in Shadegan from 2012 to 2014 was approximately 17 times greater than the expected incidence in Iran. CH was associated with a history of consanguineous marriage and urbanization.

Burden of ischemic heart diseases in Iran, 1990-2010: Findings from the Global Burden of Disease study 2010

Background:

Cardiovascular diseases are viewed worldwide as one of the main causes of death. This study aims to report the burden of ischemic heart diseases (IHDs) in Iran by using data of the global burden of disease (GBD) study, 1990-2010.

Materials and Methods:

The GBD study 2010 was a systematic effort to provide comprehensive data to calculate disability-adjusted life years (DALYs) for diseases and injuries in the world. Years of life lost (YLLs) due to premature mortality were computed on the basis of cause-of-death estimates, using Cause of Death Ensemble model (CODEm). Years lived with disability (YLDs) were assessed by the multiplication of prevalence, the disability weight for a sequel, and the duration of symptoms. A systematic review of published and unpublished data was performed to evaluate the distribution of diseases, and consequently prevalence estimates were calculated with a Bayesian meta-regression method (DisMod-MR). Data from population-based surveys were used for producing disability weights. Uncertainty from all inputs into the calculations of DALYs was disseminated by Monte Carlo simulation techniques.

Results:

The age-standardized IHDs DALY specified rate decreased 31.25% over 20 years from 1990 to 2010 [from 4720 (95% uncertainty interval (UI): 4,341-5,099) to 3,245 (95% UI: 2,810-3,529) person-years per 100,000]. The decrease were 38.14% among women and 26.87% among men. The age-standardized IHDs death specefied rate decreased by 21.17% [from 222) 95% UI: 207-243 (to 175 (95% UI:152-190) person-years per 100,000] in both the sexes. The age-standardized YLL and YLD rates decreased 32.05% and 4.28%, respectively, in the above period.

Conclusion:

Despite decreasing age-standardized IHD of mortality, YLL, YLD, and DALY rates from 1990 to 2010, population growth and aging increased the global burden of IHD. YLL has decreased more than IHD deaths and YLD since 1990 but IHD mortality remains the greatest contributor to disease burden.

Factors Affecting Mortality and Treatment Completion of Tuberculosis Patients in Isfahan Province from 2006 to 2011

Background:

Regarding cases of infectious diseases tuberculosis (TB) is the most important cause of death and according to the DALY criteria, this disease has the seventh position in global disease ranking. In this study, we aim to determine the risk factors, which have a significant effect on the treatment completion and mortality of TB patients.

Methods:

This study is a retrospective cohort study. The sample is made up of registered TB patients in the Isfahan Province from 2006 to 2011. Information of the patients was collected from their files in health centers in the Isfahan Province. Variables such as age, sex, weight, nationality, residence, type of TB, imprisonment, human immunodeficiency virus, TB case were measured. Descriptive statistics (including frequency, percentage, mean and standard deviation) and statistical analysis (including Cox proportional hazard model) were used.

Results:

The result showed that imprisonment (hazard ratio [HR] = 4.76, P = 0.019), age (HR = 4.44, P = 0.001) and the TB case (HR = 2.73, P = 0.037) of pulmonary TB had significant impacts on mortality of the patients, also in the case of treatment completion, the TB case (HR = 0.34, P < 0.001) proved to have a significant impact on completion of the treatment. Type of extra-pulmonary TB in extra-pulmonary TB patients also had an effect on treatment completion.

Conclusions:

We can conclude that factors such as age, imprisonment, TB case and type of extra-pulmonary TB are effective on the treatment completion and mortality of the patients. It may be useful for policy makers to make more control of high-risk patients.

Antibacterial effect of calcium hydroxide combined with chlorhexidine on Enterococcus faecalis: a systematic review and meta-analysis

Objective

Enterococcus faecalis (E. faecalis) is the most frequently isolated strain in failed endodontic therapy cases since it is resistant to calcium hydroxide (CH). Whether a combination of CH and chlorhexidine (CHX) is more effective than CH alone against E. faecalis is a matter of controversy. Thus, the aim of this study was to conduct a systematic review and meta-analysis of the literature.

Material and Methods

A comprehensive search in PubMed, EMbase, EBSCOhost, The Cochrane Library, SciELO, and BBO databases, Clinical trials registers, Open Grey, and conference proceedings from the earliest available date to February 1, 2013 was carried out and the relevant articles were identified by two independent reviewers. Backward and forward search was performed and then inclusion and exclusion criteria were applied. The included studies were divided into "comparisons" according to the depth of sampling and dressing period of each medicament. Meta-analysis was performed using Stata software 10.0. The level of significance was set at 0.05.

Results

Eighty-five studies were retrieved from databases and backward/forward searches. Fortyfive studies were considered as relevant (5 in vivo, 18 in vitro, 18 ex vivo, and 4 review articles). Nine studies were included for meta-analysis. Inter-observer agreement (Cohen kappa) was 0.93. The included studies were divided into 21 comparisons for meta-analysis. Chi-square test showed the comparisons were heterogeneous (p<0.001). Random effect model demonstrated no significant difference between CH/CHX mixture and CH alone in their effect on E. faecalis (p=0.115).

Conclusions

According to the evidence available now, mixing CH with CHX does not significantly increase the antimicrobial activity of CH against E. faecalis. It appears that mixing CH with CHX does not improve its ex vivo antibacterial property as an intracanal medicament against E. faecalis. Further in vivo studies are necessary to confirm and correlate the findings of this study with the clinical outcomes.

The decrease in NKG2D+ Natural Killer cells in peripheral blood of patients with metastatic colorectal cancer

BACKGROUND

Natural killer (NK) cells play important roles in the immune defense against tumors such as colorectal cancer. In humans, NKG2D is an activating immune receptor constitutively expressed in most cytotoxic lymphocytes including NK and CD8+ T cells. In this study, the expression of NKG2D molecule was investigated in peripheral blood NK cells from colorectal cancer patients and compared with healthy subjects.

METHODS

We studied 21 non-metastatic (low-grade), 17 non-metastatic (high-grade), 16 metastatic colorectal cancer patients, and 24 healthy controls. Peripheral blood samples were obtained to isolate peripheral blood mononuclear cells (PBMCs) and the percentage of peripheral blood NKG2D+CD3-CD56+ NK cells was analyzed by flow cytometry. The expression of NKG2D at mRNA level was also measured by real-time PCR in both, patients and control subjects.

RESULTS

The results showed a significant reduction in the percentage of NKG2D+NK cells as well as NKG2D mRNA expression in peripheral blood of metastatic colon cancer patients.

CONCLUSION

This result suggests that decreased expression of activating NKG2D receptor in metastatic colorectal cancer might compromise NK cell function and allow tumor to evade immunity (Tab. 3, Fig. 4, Ref. 33).

A study conducted on the demographic factors of victims of violence in support and administrative departments of hospital in 2013

BACKGROUND

Violence is now regarded as a serious problem and its complication causes heavy costs on the healthcare systems. The present study aimed to investigate the correlation between some demographic characteristics and confrontation with violence. Since there is no study on the prevalence of violence among the support and administration staff of hospitals in Iran, this study was conducted to investigate violence in these departments.

MATERIALS AND METHODS

This descriptive-analytical and correlation survey was carried out by census among the support and administrative staff interacting with patients and their companions in Al-Zahra University Hospital of Isfahan in 2013. Research tool was a researcher-made questionnaire including five domains: Personal information, workplace information, verbal violence, physical violence, and other violent acts. Its validity was evaluated by experts reviewing it and its reliability by test-retest (r =0.9). Finally, data were analyzed using descriptive statistical indicators and statistical tests such as Chi-square for sex, marital status, and work department and Mann-Whitney U test for age, level of education, work experience, and violence types by the statistical software SPSS version 20.

RESULTS

According to the results obtained, 81% of subjects had been abused at least once and the most reported violence was related to verbal violence (78.4%). There was significant correlation between sex and violence and men were the main victims of violence, but there was no relation between marital status, age, and violence. Work experience was correlated to physical violence and other violent acts conversely. There was also an inverse correlation between physical violence and education; also, security staff faced more violence than others.

CONCLUSION

As high prevalence of violence was found especially among the security staff and personnel with less education and work experience, it is suggested to take actions such as educating about patient accompaniment and visiting condition, holding training workshops on confronting with violence and appropriate communication with patients and families, using experienced and patient staff to interact with clients.

Effect of Vitamin D supplementation on symptoms and C-reactive protein in migraine patients

BACKGROUND

Migarine is the most common headache around the world including Iran. In recent years, Vitamin D deficiency has been shown to a global health problem. A few studies have been determined inverse association between serum levels of Vitamin D with a headache. So, in this study, we investigated the effect of Vitamin D supplementation on symptoms and C-reactive protein (CRP) among patients with migraine.

MATERIALS AND METHODS

This study was randomized, double-blind, and controlled-placebo clinical trial. Sixty-five migraine patients aged 10-61 years were included for analysis. Vitamin D was administrated for 10 weeks with 50,000 IU dosage of Vitamin D per week. Multivariate analysis of covariate and univariate analysis of covariate were done to determine the effects of Vitamin D supplementation on symptoms, including severity, duration, frequency of headache, and the headache diary result (HDR).

RESULTS

Mean headache frequency and HDR had significant difference among two groups (5.9 ± 7.0 vs. 7.0 ± 6.0, P = 0.06 and 85.0 ± 134.2 vs. 132.1 ± 147.1, P = 0.04). But, a mean difference of headache frequency was marginally significant (P = 0.06). These values were lower among the intervention group compared to placebo group. The association was not observed between CRP with migraine disease.

CONCLUSION

In this study, we shown Vitamin D supplementation may be useful in decreasing frequency of headache attacks and HDR among patients with migraine.

Measuring Equity in Access to Pharmaceutical Services Using Concentration Curve; Model Development

This paper has two objectives. First, it establishes a model for scoring the access to pharmaceutical services. Second, it develops a model for measuring socioeconomic indicators independent of the time and place of study. These two measures are used for measuring equity in access to pharmaceutical services using concentration curve. We prepared an open-ended questionnaire and distributed it to academic experts to get their ideas to form access indicators and assign score to each indicator based on the pharmaceutical system. An extensive literature review was undertaken for the selection of indicators in order to determine the socioeconomic status (SES) of individuals. Experts' opinions were also considered for scoring these indicators. These indicators were weighted by the Stepwise Adoption of Weights and were used to develop a model for measuring SES independent of the time and place of study. Nine factors were introduced for assessing the access to pharmaceutical services, based on pharmaceutical systems in middle-income countries. Five indicators were selected for determining the SES of individuals. A model for income classification based on poverty line was established. Likewise, a model for scoring home status based on national minimum wage was introduced. In summary, five important findings emerged from this study. These findings may assist researchers in measuring equity in access to pharmaceutical services and also could help them to apply a model for determining SES independent of the time and place of study. These also could provide a good opportunity for researchers to compare the results of various studies in a reasonable way; particularly in middle-income countries.

Evaluation of routine postoperative chest roentgenogram for determination of the correct position of permanent central venous catheters tip

BACKGROUND

Proper placement of central venous catheter (CVC) tip could reduce early and late catheter-related complications. Although the live fluoroscopy is standard of care for placement of the catheter, it is not available in many centers. Therefore, the present study evaluated the sensitivity and specificity of bedside chest X-ray (CXR) for proper positioning of the catheter tip.

MATERIALS AND METHODS

A total of 82 adult patients undergoing elective placement of tunneled CVC were enrolled in this study during 2010-2012. The catheter tip position was evaluated by postoperative bedside chest radiographs as well as trans-thoracic echocardiogram as definite diagnostic tool. The catheter position was considered correct if the tip was positioned in the right atrium both in CXR or echocardiography. Finally, CXRs interpreted by expert radiologist. Thus findings were compared by echocardiography. Sensitivity, specificity, accuracy, positive, and negative predictive values were calculated. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, IL), and P < 0.05 considered as significant.

RESULTS

The patients were 57.37 ± 18.91 years of age, weighed 65.79 ± 15.58 kg and were 166.36 ± 9.91 cm tall. Sensitivity and specificity of CXR for proper catheter tip position were 74.3% and 58.3%, respectively. Positive and negative predictive values were 91.2% and 28%. In addition accuracy, positive likelihood ratio, and negative likelihood ratio were 71.9%, 1.78, and 2.27 respectively.

CONCLUSION

Bedside CXR alone does not reliably predict malpositioning after CVC placement.

The Effect of Fabric Type of Common Iranian Working Clothes on the Induced Cardiac and Physiological Strain Under Heat Stress

The present study compared the effect of fabric type of working clothes on heat strain responses in different levels of physical workload and under different kinds of weather conditions. Four kinds of working clothing fabric that are greatly popular in Iranian industry were assessed on 18 healthy male at 2 environments: hot and humid (dry temperature [DBt]: 35°C and relative humidity [RH]: 70%) and hot and dry (DBt: 40°C and RH: 40%). The physiological responses such as heart rate and core body temperature were reported. It was found that there were no significant differences between different types of clothing fabric on cardiac and physiological parameters. It can be recommended that 100% cotton clothing ensemble during low-workload activities and 30.2% cotton-69.8% polyester clothing ensemble during moderate-workload activities is used for Iranian workers to maintain the cardiac and physiological strains as low as possible.

The Effects of Consumption of Bread Fortified With Soy Bean Flour on Metabolic Profile in Type 2 Diabetic Women: A Cross-over Randomized Controlled Clinical Trial

BACKGROUND

Diabetes mellitus is one of the most common chronic diseases in the world and has become a major threat for global health. Recent studies reported that the soy has beneficial effects in diabetic mellitus patients. The aim of this study was to assess the effects of soybean flour fortified bread consumption on metabolic profile in type 2 diabetic women.

METHODS

This randomized, cross-over, controlled clinical trial was carried out in 30 type 2 diabetic women. At first, a 2-week run-in period was applied. Then, participants were randomly assigned to either intervention or control groups. Participants in the intervention group were asked to replace 120 g of soybean flour fortified bread with the same amount of their usual bread intake or other cereal products for 6 weeks. After a 4 weeks washout period, participants were crossed over for another 6 weeks.

RESULTS

Mean (±standard deviation) age and body mass index of subjects was 45.7 ± 3.8 years and 29.5 ± 3.9 kg/m(2), respectively. The results of our study showed no significant effects of soybean flour fortified bread on metabolic profile. We found a reduction in serum triglycerides (change difference: -3.7, P = 0.82), serum low-density lipoprotein-cholesterol (change difference: -11.2, P = 0.50), insulin (change difference: -3.6, P = 0.7), and homeostatic model assessment of insulin resistance (change differences: -0.57, P = 0.45) after 6 weeks but these changes were not statistically significant. No significant effects of soybean flour fortified bread on serum concentrations of fasting blood sugar, glycated hemoglobin, high-density lipoproteins and total cholesterol levels were found.

CONCLUSIONS

Six weeks consumption of soybean flour fortified bread among diabetic patients had no significant effects on metabolic profile.

Effect of needs-assessment-based psychoeducation for families of patients with schizophrenia on quality of life of patients and their families: A controlled study

INTRODUCTION

Family psychoeducation is one of the most routine interventions in a schizophrenic patients' management. We evaluated the effects of a needs-assessment-based educational program in comparison with the current program on global function and quality of life (QOL) of the patients and their families.

MATERIALS AND METHODS

In this controlled study, 60 schizophrenia patients and their families were allocated for a needs-assessment-based psychoeducation (treatment) and current education (control) programs. The family members of both the groups participated in 10 sessions of education, within about six months. The patients' global function and QOL were assessed with the global assessment of function (GAF) and the Schizophrenia Quality of Life Scales (SQLS), respectively. The families' QOL was assessed with the World Health Organization's (WHO) Quality of Life-BREF (WHOQOL-BREF). Assessments were done at the beginning and then every six months, for a total of 18 months.

RESULTS

Forty-two cases completed the study. Global function was improved with the treatment (P = 0.002), but not in the control group (P = 0.601). The patients' quality of life in the treatment group showed significant improvement on the psychosocial (P < 0.01) and symptoms/side effects subscale scores (P < 0.01), but not on the energy subscale score (P > 0.1). There was no significant change in the family's quality of life in both groups.

CONCLUSIONS

The family psychoeducational needs assessment may lead to more improvement in schizophrenic patients' global function and quality of life, but has no significant effect on their families' quality of life. It is recommended that the psychiatric care centers develop their psychoeducation profiles based on the needs-assessment program.

Effects of needs-assessment-based psycho-education of schizophrenic patients' families on the severity of symptoms and relapse rate of patients

BACKGROUND

Family psycho-education is one of the most effective interventions for preventing relapse in patients with schizophrenia. We evaluated the efficacy of a needs-assessment-based educational program in comparison with a current program (textbook based) in the treatment of schizophrenia.

MATERIALS AND METHODS

Patients with schizophrenia and their families (N = 60) were allocated to needs-assessment-based education (treatment) and textbook-based (control) programs; both included 10 sessions of education within about 6 months. Symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS) prior to intervention and every 3 months for a total of 18 months. A 25% decrease or increase in total PANSS score was considered as response or relapse, respectively.

RESULTS

Forty-two cases completed the study. The total PANSS score was significantly decreased in both groups with more reduction in the treatment group. Positive and negative scale scores were reduced in the treatment group, but not significantly in the control group. Response rate was higher in the treatment group and relapse rate was lower (15% vs. 27.2%, P = 0.279). In logistic regression analysis, needs-assessment-based psycho-education was associated with more treatment response.

CONCLUSIONS

Needs-assessment-based psycho-education is more effective than textbook-based education for treating schizophrenia. We recommend psychiatric care centers to conduct needs-assessment and develop their own program for family psycho-education.

Is there any association of personality traits with vascular endothelial function or systemic inflammation?

Background:

Evidences showed association of some personality traits with increased risk of cardiovascular diseases, but mediated mechanisms are not entirely described. In this study, we investigated the association of different personality traits with systemic inflammation and endothelial function as probable mediators.

Methods:

This cross-sectional study was conducted in 2011 on 40-60 years old employees of an industrial company located in Isfahan city (central Iran). Participants were selected through simple random sampling. Personality types were evaluated using the neuroticism-extroversion-openness personality inventory and systemic inflammatory status was determined with high sensitive C-reactive protein (hs-CRP) level. To evaluate endothelial function flow mediated dilation (FMD) were measured. The obtained data were analyzed with univariate correlation and multiple linear regression tests.

Results:

A total of 254 cases with mean age of 51.4 ± 6.1 years were evaluated. There was no significant relationship between hs-CRP level and FMD with the personality traits in univariate analysis. In multivariate analysis, no association was found between the scores of personality traits and FMD with controlling the factors such as age, body mass index dyslipidemia, hypertension and diabetes. Only there was an inverse association between conscientiousness score and hs-CRP (β = −0.241, P = 0.013).

Conclusions:

In our population who were the employees of an industrial company, no relationship was found between specific personality trait and endothelial dysfunction. However, we found that the personality trait of responsibility (conscientiousness) is negatively associated with inflammation. Further multi-center studies and also cohort studies are recommended in this regard.