Socioeconomic status and mortality after acute myocardial infarction: a study from Iran

Oral Health Literacy and Its Determinants in Young Couples

Objectives: Oral health literacy (OHL) is an interplay of cultural, social and individual factors and plays an effective role in public health promotion. This study aimed to assess OHL and its socioeconomic and demographic determinants among young couples. Materials and Methods: This analytical cross-sectional study was conducted on 828 adults between 15 to 35 years in 2018 in Zanjan city. Data regarding their OHL were collected by using a 17-item Oral Health Literacy-Adult Questionnaire (OHL-AQ) that was filled out by a combination of self-report and interview. OHL was categorized as adequate, marginal, and inadequate. The effects of age and gender as demographic variables, and floor area per person as a proxy of financial status on OHL were also assessed. Data were analyzed using the linear and multinomial logistic regression models. Results: The mean OHL score was 7.86±3.83 out of 17 in equal number of males and females. Only 21% of the couples had adequate OHL. The socioeconomic, but not demographic variables had significant correlations with the qualitative and quantitative variables of OHL even after controlling for the effect of confounders. A correlation was particularly found between inadequate OHL and years of education [odds ratio:6.00; 95% CI: 3.86-9.28); P<0.001]. Conclusion: Socioeconomic factors had independent correlations with inadequate OHL. Participants with higher levels of education, those living in urban areas, and individuals with better financial status had higher levels of OHL and lower odds of inadequate OHL.

Myocardial Infarction in Iran: Epidemiology, Management, and Prognosis

Background

Cardiovascular diseases, specifically acute myocardial infarction (AMI), are the leading cause of death worldwide. In this review, we explain the characteristics of AMI in Iran.

Methods

We searched PubMed, Google, and Google Scholar for articles containing myocardial infarction, STEMI, and MI+ Iran in English and Persian words.

Results

The age-standardized incidence rate of MI was 73.3 per 100 000. The mean±SD age of patients was 61.20±13.40 years. In-hospital mortality of patients with AMI in the IMIR was 12.1%. Concerning AMI complications reported in the IMIR, 5.8% of patients experienced ventricular tachycardia, and 2.5% experienced ventricular fibrillation. The 1-year mortality rate in the IPACE2 study was 4.3%.

Conclusion

Only a few national studies are available in Iran regarding patients with AMI. A federal surveillance program continuously monitoring and tracking coronary events is essential to improve the general population's health.

Association of socioeconomic status with cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis

Aim

Cardiovascular disease (CVD) remains one of the leading causes of mortality worldwide, and several studies have indicated the association between socioeconomic status (SES) with CVD and cardiovascular risk factors (CVRFs). It is necessary to elucidate the association of SES and CVRFs with CVD.

Subject and methods

We searched PubMed, Embase, Web of Science, and the Cochrane Library for publications, using "socioeconomic status," "cardiovascular disease," and corresponding synonyms to obtain literature. The quality of studies was evaluated using the National Institutes of Health Quality Assessment Tool (NIH-QAT). All analyses were performed using Stata V.12.0.

Results

There were 31 eligible studies included in this meta-analysis. All studies presented a low risk of bias via NIH-QAT assessment. As for CVD incidence/mortality, pooled hazard ratios (HR) of low and middle vs. high income were [HR = 1.22 (1.17-1.28); HR = 1.12 (1.09-1.16)] and [HR = 1.37 (1.21-1.56); HR = 1.19 (1.06-1.34)]. The HR of education were [HR = 1.44 (1.28-1.63); HR = 1.2 (1.11-1.3)] and [HR = 1.5 (1.22-1.83); HR = 1.13 (1.05-1.22)]. The HR of deprivation were [HR = 1.28 (1.16-1.41); HR = 1.07 (1.03-1.11)] and [HR = 1.19 (1.11-1.29); HR = 1.1 (1.02-1.17)]. SES was negatively correlated with CVD outcomes. A subgroup analysis of gender and national income level also yielded a negative correlation, and additional details were also obtained.

Conclusions

SES is inversely correlated with CVD outcomes and the prevalence of CVRFs. As for CVD incidence, women may be more sensitive to income and education. In terms of CVD mortality, men may be more sensitive to income and education, and people from low- and middle-income countries are sensitive to income and education.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01825-4.

Probiotic effects on sexual function in women with polycystic ovary syndrome: a double blinded randomized controlled trial

Background

Considering the presence of sexual dysfunction in patients with polycystic ovary syndrome, our aim was to provide scientific evidence studying effect of oral probiotic on sexual function in patients with PCOS treated with letrozole in an Iranian population.

Methods

This study was a double blind randomized clinical trial. Eligible women were allocated to Lactofem plus letrozole (n = 20) or letrozole (n = 20). Folic acid was prescribed to all participants in two groups during the study. In group A, Lactofem capsule was administered daily for the first month. In the second month, letrozole (2.5 mg daily from the third day of the menstrual cycle for 5 days) plus Lactofem capsule same as previous month were prescribed. In group B, letrozole administered 2.5 days from the third day of the menstrual cycle for 5 days in the second month. All questionnaires were completed by patients after the intervention (two months after the start of treatment). The Female Sexual Function Index (FSFI) and Body Image Concern Inventory (BICI) were used to assess sexual function and body satisfaction, respectively.

Results

There is statistically significant increase in chemical pregnancy rate (10% vs. 0%; p = 0.05) and clinical pregnancy (10% vs. 0%; p = 0.05) in Probiotic plus letrozole group compared to letrozole group after intervention. Based on our results, there was a statistically significant difference in each domain and sum score of sexual function of before and after the intervention between group (P < 0.05). Our findings have been shown, after eight weeks, the probiotic plus letrozole group had a significant improvement in the FSFI domains and sum score compared to letrozole alone group. Moreover, there are a significant improvement in mean (IQR) of body image score in probiotic group [30 (4.99) vs. 40 (4.36); P < 0.01].

Conclusion

The results of the current study suggests that eight weeks of administration of probiotic may improve chemical and clinical pregnancy rate, sexual function and body satisfaction in women with PCOS.

Oral health literacy and socio-demographics as determinants of oral health status and preventive behavior measures in participants of a pre-marriage counseling program

This analytical cross-sectional study aimed to assess the correlation of oral health literacy (OHL) and oral health status and behavior in participants of a pre-marriage counseling program. Also, it aimed to determine the target population's OHL needs to design necessary interventions. A total of 828 couples with a mean age of 24.22 years participating in a pre-marriage counseling program were evaluated. Data were collected using the oral health literacy-adult questionnaire (OHL-AQ). Clinical oral examinations were performed to measure the gingival index (GI), plaque index (PI), and DMFT. The mean OHL score of the couples was 7.86±3.83 out of 17; while, the mean DMFT score was 6.30±5.73. After controlling for the confounders, OHL had a significant correlation with the frequency of dental visits, and smoking status, and inverse correlation with the number of decayed teeth and missing teeth, and PI, and GI (p<0.05). The current results highlight the necessity of OHL interventions to fill the existing gaps. This is an unmet need of the couples, and such interventions are required to promote their own oral health as well as the oral health of their future children.

The effect of cardiac rehabilitation program on functional capacity and waist to hip ratio in patients with coronary artery disease: A clinical trial

AIMS

This study aimed to determine the impact of cardiac rehabilitation programs on functional capacity and waist to hip ratio in coronary artery disease (CAD) patients.

METHODS

In this clinical trial study 70 CAD patients were selected using purposive sampling and based on inclusion criteria. The intervention consisted of a 12-week training and exercise program included walking sessions at home at least three times a week. The 6-min walk test (6MWT) was conducted to measure the functional capacity and waist to hip ratio (WHR), as the anthropometric index, in both groups before and after the intervention. Data were analyzed in SPSS 21 using independent t test, paired t test, and Chi-square test.

RESULTS

The mean distance traveled in the 6MWT was 297.30 m and 283.55 in intervention and control groups respectively before the intervention. After the intervention, this distance was 509.03 and 389.91 m in intervention and control groups respectively, suggesting a significant difference between the two groups (p < .001). The mean WHR was 0.8648 and 0.8403 in intervention and in control respectively before the intervention. After the intervention, this value became 0.7985 and 0.8555 in intervention and control groups respectively and showed significant difference (p < .001).

CONCLUSIONS

The cardiac rehabilitation program improved the ability of patients in the 6MWT and enhanced their functional capacity and reduced the mean WHR, which in turn evinces the improvement of the anthropometric index and mitigation of risk factors in CAD patients. So, healthcare providers can deploy such rehabilitation programs to empower patients, alleviate disease complications, and reduce individual and social costs of cardiovascular diseases.

Effects of Boiled Dill Seed on Anxiety During Labor: A Randomized Clinical Trial

OBJECTIVE

To evaluate the effect of boiled dill seed (Anethum graveolens) on anxiety during childbirth compared with oxytocin.

METHODS

This study was a randomized clinical trial with 100 pregnant women who were assigned to the oxytocin (50 cases) and the boiled dill seed (50 cases) group by a table of random number. In the boiled dill seed group, 10 g of dill seed was boiled in 100 mL for 10 min and was given to women after filtration once orally at the beginning of active phase. In the oxytocin group, 10 IU of oxytocin in 1000 mL of Ringer solution was prescribed according to the clinical routine. The State-Trait Anxiety Inventory (STAI) in both groups before (at the beginning of the active phase) and after (6 h after the delivery) was completed. Meanwhile, pain intensity and duration of labor, dilatation and effacement scores, Apgar score of newborns, and FHR were measured and evaluated.

RESULTS

No statistically significant differences were shown in obvious anxiety scores between the two groups at baseline (P0.05). After the delivery, in the boiled dill seed group, the number of women with severe [0 vs. 8.0% (4/50)] and almost severe [0 vs. 14.0% (7/50)] trait and almost severe [0 vs. 14.0% (7/50)] state anxiety was lower than those in the control group (P=0.050, P=0.041, respectively). Moreover, labor was shorter in the 1st (P 0.01), 2nd (P=0.78) and 3rd (P=0.10) stages in the boiled dill seed group compared to the control group CONCLUSIONS: Dill seed could be used as an effective treatment to reduce anxiety during labor. Dill seed can be effective in reducing the length of labor. Due to lack of maternal and fetal complications, the boiled dill seed could also be used to reduce cesarean section rates in women who are fearful and anxious of delivery. (RCT Code: IRCT201607177065N2).

Association of oral health behavior and the use of dental services with oral health literacy among adults in Tehran, Iran

Objective:

To assess the association of oral health behavior (OHB) and the use of dental services with oral health literacy (OHL) among Iranian adults.

Methods:

This was a cross-sectional population study of a random sample of 1031 adults aged 18–65 in Tehran, Iran. We collected data on tooth brushing frequency, the consumption of sugary snacks and beverages, and time since last dental visit. To measure OHL, we used a validated OHL adults’ questionnaire (OHL-AQ). In addition to descriptive analysis, we used multiple logistic regression models to assess the association of OHB and the most recent dental visit with OHL while controlling for socioeconomic and demographic factors.

Results:

The participants’ mean age was 36.3 (standard deviation 12.9), and 51% were women. Of the participants, 81.3% reported brushing their teeth daily (≥1/day), 37.6% consumed sugary snacks or beverages between meals less than once daily (<1/day), and 36.8% used dental services within the past 6 months. In the adjusted models, high OHL scores significantly correlated with daily (≥1/day) tooth brushing (odds ratio [OR] = 1.97, 95% confidence interval [CI]: 1.30–2.98), the consumption of sugary snacks or beverages (<1/day between meals) (OR = 1.56, 95% CI: 1.13–2.15) and the recent use of dental services (≤6 months) (OR = 1.59, 95% CI: 1.15–2.21), respectively.

Conclusions:

OHL relates significantly to improved OHB and the use of dental services. Oral health promotion programs should, therefore, take into account improvements in adults’ OHL, particularly in countries with developing health-care services.

Dietary intake and lifestyle behaviour in different phenotypes of polycystic ovarian syndrome: a case-control study

BACKGROUND

The present study aimed to compare dietary intake and lifestyle behaviour in women with polycystic ovarian syndrome (PCOS) and healthy women.

METHODS

One hundred and sixty healthy women (partner with male infertility) were recruited to a control group; 168 women with PCOS (diagnosed on ultrasound) were recruited to a case study group for this cross-sectional comparative study. The case group was classified into three phenotypes based on the presence or absence of menstrual disorder (M), hyperandrogenism (HA) and polycystic ovary according to sonography (PCO): HA+PCO (n = 53), PCO+M (n = 57) and M+HA+PCO (n = 66). Dietary intake and lifestyle behaviour were measured using a food frequency questionnaire and a lifestyle questionnaire.

RESULTS

The mean energy (P < 0.001) and fat (P < 0.001) intakes were greater in PCOS groups compared to the control group. The average energy and fat intakes were greater in HA+M+PCO group after age and body mass index (BMI) adjustment compared to the other phenotypes (P < 0.001). In comparison with the control group, lifestyle scores were lower in the PCOS group in the fields of physical activity, weight and nutrition control after age and BMI adjustment (P < 0.001). The average score of lifestyle in the fields of physical activity, weight and nutrition control, and psychological health was lower in the phenotype HA+M+PCO compared to the other phenotypes (P < 0.001).

CONCLUSIONS

A limited energy and fat intake is strongly recommended in Iranian women with PCOS, especially for phenotype HA+M+PCO. Consultation with respect to improvement of psychological health and the importance of weight and nutrition control, as well as appropriate physical activity, is advocated, especially in patients with phenotype HA+M+PCO.

Measurement components of socioeconomic status in health-related studies in Iran

OBJECTIVE

The socioeconomic status (SES) is as a symbol of social determinants of health which has a dominant influence on population health. The purpose of this study was collecting, weighing, and determining the most relevant SES measurement items in Iran.

RESULTS

The SES health studies conducted in Iran was searched from 2007 to 2017. First, the SES items were categorized. Then, each item was weighed based on its reliability and generalizability. Finally, the necessity of items was determined, weighed, and ranked. This is the two-round Delphi technique. After weighing 57 SES items, 37 items were selected with ≥ 1 weight and classified in 7 categories. According to the Delphi evaluation, 15 items were identified ≥ 3.5 for measuring SES of Iranian households: household size, head of household education, head of household job, household monthly income, type of school that children attend, house ownership, local value of residence, number of rooms in the house, house area, personal computer/laptop, smart cell phone, 3D TV, dishwasher, microwave, and car ownership. The SES items for the present society are categorized in 7 domains. The items collected in this study have the most comprehension of all studies related to income, life facilities, and assets.

Oral health of 6-7 year-old children according to the Caries Assessment Spectrum and Treatment (CAST) index

Background

The index of Caries Assessment Spectrum and Treatment (CAST) reveals a range of caries development from a non-cavitated status to advanced lesions. The aim of the present study was to explore the oral health status of 6- to 7-year-old children based on the CAST index in relation to oral health knowledge and background determinants.

Methods

A multi-stage cluster random sampling method was applied and after ethical clearance, clinical examination was performed (Kappa = 0.89). The status of caries and oral hygiene was recorded according to the CAST index and OHI-Simplified (OHI-S) index, respectively. A self-administered questionnaire was used to collect the data of parental knowledge of oral health. SPSS version 22.0 was used for data analysis and p-value less than 0.05 were considered significant.

Results

Seven hundred and thirty-nine children and their parents in 24 schools participated in this study (88%), of whom 48.6% were boys and the rest were girls. In permanent molars, a healthy status (code 0–2) was observed in 89.3–93.7% of the teeth. In primary molar teeth, dentinal lesions ranged from 25.3 to 31.2%, the prevalence of pulp involvement was between 2.9 and 10.5%, and less than 1% had abscess/fistula. Serious morbidity (codes 6 and 7) were more common in the first primary molars than the second ones. Multi-variable logistic regression analysis indicated that children with a low level of father’s education were 2.45 times more likely to have a CAST score of 3 and higher (95% CI 1.35–4.46, p = 0.003) compared to children whose fathers had academic education. For each one-unit increment of OHI_S, the likelihood of a CAST score 3 and higher in primary dentition increased by 1.77 times (OR = 1.77; 95% CI 1.08–2.93, p = 0.02).

Conclusion

The consequences of dental caries including abscess and fistula were more prevalent in the first and second primary teeth. There was a significant correlation between a CAST score of 3 and higher with father’s education (as an indicator of social rank) and oral hygiene status. The CAST index is a useful and practical index in epidemiological surveys.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0709-x) contains supplementary material, which is available to authorized users.

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Background

There is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy).

Methods

A retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years).

Results

Mortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47–0.94; OR age > 75 years 0.72, 95% CI:0.54–0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58–0.93).

Conclusions

Among patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75 years. Our findings suggest that the educational component should not be underestimated in order to improve short-term outcomes, which are considered as performance measures at the hospital level. Hospital managers might consider strategies that are sensitive to patients with low SES, such as providing post-hospitalization support to less-educated patients and promoting a healthier lifestyle, to improve both health equity and performance outcomes.

Evaluation of the Impact of a Mass Media Campaign on Periodontal Knowledge among Iranian Adults: A Three-Month Follow-Up

Objectives

This study aimed to evaluate the impact of a national media campaign to promote oral health and periodontal knowledge among adults after a three-month follow-up.

Methods

We conducted a population-based study of adults aged 18 to 50 years using a stratified multi-stage sampling method in Tehran, Iran in 2011. The campaign included an animation clip about periodontal health and disease telecast on national TV for ten consecutive days. We used an instrument to assess the effect of the campaign at baseline, immediately after the campaign and after a three-month follow-up. A total of 543 participants responded at baseline and immediately after the intervention, and 294 were interviewed at the three-month follow-up assessment (response rate: 54.1%). We assessed each participant’s periodontal knowledge score, calculated as a sum of correct answers, and the change in their score following the campaign. We then used a five-item questionnaire to evaluate the participants’ opinion of the success of the campaign. We used descriptive statistics and generalised estimating equations (GEE) analysis to conduct the statistical analysis.

Results

The mean score for knowledge improvement from baseline to immediate post-intervention evaluation was higher among those who saw the campaign (0.61) than among those who did not (0.29); the corresponding figures from immediate evaluation to three-month follow-up were -0.17 and 0.15, respectively. Adjusting for baseline values, the GEE analysis demonstrated that improvement in the mean score of post-campaign knowledge associated significantly with age, education and seeing the campaign. Significant interaction between the time since seeing the campaign and whether the participant saw it (p < 0.001) revealed that the mean difference in the knowledge score between the groups who did and did not see the campaign was 0.4 at the immediate evaluation and -0.04 at the three-month follow-up. The participants received the campaign well in terms of being appealing (91.4%), worth bearing in mind (83.4%) and containing valuable information (80.3%).

Conclusions

Our findings indicate that a population-based media campaign promoting oral health and periodontal knowledge among adults had a positive short-term impact, although the effect seemed to plateau after three months.

The Nurse-Led Telephone Follow-Up on Medication and Dietary Adherence among Patients after Myocardial Infarction: A Randomized Controlled Clinical Trial

BACKGROUND

Adherence to dietary and medication regimen plays an important role in successful treatment and reduces the negative complications and severity of the disease. Therefore, the present study aimed to investigate the effect of nurse-led telephone follow-up on the level of adherence to dietary and medication regimen among patients after Myocardial Infarction (MI).

METHODS

This non-blinded randomized controlled clinical trial was conducted on 100 elderly patients with MI who had referred to the cardiovascular clinics in Shiraz. Participants were selected and randomly assigned to intervention and control groups using balanced block randomization method. The intervention group received a nurse-led telephone follow-up. The data were collected using a demographic questionnaire, Morisky's 8-item medication adherence questionnaire, and dietary adherence questionnaire before and three months after the intervention. Data analysis was done by the SPSS statistical software (version 21), using paired t-test for intra-group and Chi-square and t-test for between groups comparisons. Significance level was set at<0.05.

RESULTS

The results of Chi-square test showed no statistically significant difference between the intervention and control groups with respect to their adherence to dietary and medication regimen before the intervention (P>0.05). However, a statistically significant difference was found between the two groups in this regard after the intervention (P<0.05). The mean differences of dietary and medication adherence scores between pre- and post-tests were significantly different between the two groups. Independent t-test showed these differences (P=0.001).

CONCLUSION

The results of the present study confirmed the positive effects of nurse-led telephone follow-up as a method of tele-nursing on improvement of adherence to dietary and medication regimen in the patients with MI.

TRIAL REGISTRATION NUMBER

IRCT201409148505N8.

Predictors of Delay in Seeking Health Care among Myocardial Infarction Patients, Minia District, Egypt

Objectives. To determine the barriers that hinder early seeking of medical care among Minia's myocardial infarction patients. Methods. The study was based on individual interviews with 207 men and women with a first confirmed myocardial infarction (MI), admitted to the coronary care units of hospitals in Minia city in the period from April 1 to August 30, 2014. Data was collected via structured questionnaire and patient medical charts. The delay was evaluated by assisting patients to triangulate time of symptom onset and time of professional health care by placing both times in context of daily activities that participants could easily remember. Results. The median (25th, 75th percentiles) delay time was 4 (2, 10) h. Only 32.8% of patients arrived within 2 hours of symptoms onset. Variables that significantly predicted prehospital delay time were patient's misinterpretation of nature of pain with OR 8.98 (95% CI) (3.97-20.32), illiteracy 7.98 (2.77-22.95), age (>65) 5.07 (1.57-16.29), and pain resistance behavior 4.61 (2.04-10.41). Conclusions. Interventions to decrease prehospital delay must focus on improving public awareness of acute myocardial infarction symptoms and increasing their knowledge on early treatment benefits.

Relationship between risk factors and in-hospital mortality due to myocardial infarction by educational level: a national prospective study in Iran

Introduction

Since no hospital-based, nationwide study has been yet conducted on the association between risk factors and in-hospital mortality due to myocardial infarction (MI) by educational level in Iran, the present study was conducted to investigate relationship between risk factors and in-hospital mortality due to MI by educational level.

Methods

In this nationwide hospital-based, prospective analysis, follow-up duration was from definite diagnosis of MI to death. The cohort of the patients was defined in view of the date at diagnosis, hospitalization and the date at discharge (recovery or in-hospital death due to MI). 20750 patients hospitalized for newly diagnosed MI between April, 2012 and March, 2013 comprised sample size. Totally, 2511 deaths due to MI were obtained. The data on education level (four-level) were collected based on years of schooling. To determine in-hospital mortality rate and the associated factors with mortality, seven statistical models were developed using Cox proportional hazards models.

Results

Of the studied patients, 9611 (6.1%) had no education. in-hospital mortality rate was 8.36 (95% CI: 7.81-8.9) in women and 6.12 (95% CI: 5.83-6.43) in men per 100 person-years. This rate was 5.56 in under 65-year-old patients and 8.37 in over 65-year-old patients. This rate in the patients with no, primary, high school, and academic education was respectively 8.11, 6.11, 4.85 and 5.81 per 100 person-years. Being woman, chest pain prior to arriving in hospital, lack of thrombolytic therapy, right bundle branch block, ventricular tachycardia, smoking and ST-segment elevation myocardial infarction were significantly associated with increased hazard ratio (HR) of death. The adjusted HR of mortality was 1.27 (95% CI: 1.06-1.52), 0.93 (95% CI: 0.77-1.13), 0.72 (95% CI: 0.57-0.91) and 0.82 (95% CI: 0.66-1.01) in the patients with respectively illiterate, primary, secondary and high school education compared to academic education.

Conclusion

A disparity was noted in post-MI mortality incidence in different educational levels in Iran. HR of death was higher in illiterate patients than in the patients with academic education. Identifying disparities per educational level could contribute to detecting the individuals at high risk, health promotion and care improvement by relevant planning and interventions in clinics and communities.

Assessment of periodontal knowledge following a mass media oral health promotion campaign: a population-based study

Background

Oral health promotion can be achieved through education using various approaches including mass media health education campaigns. Mass media campaigns might increase oral health knowledge and perhaps could lead to desired behaviour changes and prevention of oral diseases. The aim of this study was to assess the effect of a national television campaign on knowledge of periodontal health among Iranian adults.

Methods

We conducted a population-based survey among adults aged 18–50 using a stratified multistage sampling method in the 22 districts of Tehran, Iran, in 2011. All participants were interviewed at two points in time: baseline (before launching the campaign) and follow-up assessment (after the campaign was finished) by using a validated instrument. The campaign included an animation clip about periodontal health and disease that was telecasted for ten days from several national TV channels. The instrument included items related to aetiology and sign of gum disease. Periodontal knowledge score and its change were calculated for each participant and were evaluated using statistical analyses in order to examine the effect of the campaign.

Results

In all 791 individuals (mean age: 32.6 years) were interviewed at baseline. Of these, 543 individuals were followed one month after the campaign. However, only 163 out of 543 reported that they had seen the campaign. Thus, comparison was made between those who had seen the campaign and who did not. The knowledge scores improved significantly among those who saw the campaign compared to those who did not (the mean knowledge score improvement 0.61 ± 0.96 versus 0.29 ± 0.8 respectively, p < 0.001). The results obtained from multiple logistic regression analysis indicated that improvement in periodontal knowledge was significantly associated with exposure to the campaign (OR = 2.20, 95% CI = 1.37-3.54), female gender (OR = 1.59, 95% CI = 1.05-2.43), being in age group 25–34 (OR = 1.76, 95% CI = 1.00-3.08), having higher education (high school: OR = 2.34, 95% CI = 1.23-4.43; university: OR = 3.33, 95% CI = 1.66-6.64), and baseline knowledge (OR = 0.25, 95% CI = 0.17-0.36).

Conclusion

The study demonstrated a significant impact of the mass media campaign on Iranian adults’ knowledge regarding periodontal health and disease.

Long-term survival among older patients with myocardial infarction differs by educational level: results from the MONICA/KORA myocardial infarction registry

Background

Socioeconomic disparities in survival after acute myocardial infarction (AMI) have been found in many countries. However, population-based results from Germany are lacking so far. Thus, the objective of this study was to examine the association between educational status and long-term mortality in a population-based sample of people with AMI.

Methods

The sample consisted of 2,575 men and 844 women, aged 28–74 years, hospitalized with a first-time AMI between 1 January 2000 and 31 December 2008, recruited from a population-based AMI registry. Patients were followed up until December 2011. Data on education, risk factors and co-morbidities were collected by individual interviews; data on clinical characteristics and AMI treatment by chart review. Cox proportional hazards models were used to assess the relationship between educational status and long-term mortality.

Results

During follow-up, 19.1% of the patients with poor education died compared with 13.1% with higher education. After adjustment for covariates, no effect of education on mortality was found for the total sample and for patients aged below 65 years. In older people, however, low education level was significantly associated with increased mortality (hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.05–1.98, p = 0.023). Stratified analyses showed that women older than 64 years with poor education were significantly more likely to die than women in the same age group with higher education (HR 1.57, 95% CI 1.02–2.41, p = 0.039).

Conclusions

Elderly, poorly educated patients with AMI, and particularly women, have poorer long-term survival than their better educated peers. Further research is required to illuminate the reasons for this finding.

Association Study of rs3184504 C>T Polymorphism in Patients With Coronary Artery Disease

Cardiovascular disease has become the main factor of death and birth defects in the world and also in Iran. New clinical studies have shown that early diagnosis of patients with coronary artery disease (CAD) can contribute to effective prevention or therapeutic structures, which reduce mortality or the next chance of cardiovascular events, and increase the quality of life. Most studies on CAD disease and its genetic risk factors so far, have been done excluding the Iranian population. PubMed was used to search for all relevant studies published on or before 2013 and rs3184504 was selected for association study for CAD. A total of 200 subjects with 100 cases and 100 controls were ultimately included in the analysis. Blood samples were collected and after DNA extraction the DNA analysis was performed by TaqMan Probe Real Time PCR to evaluate the association between candidate variant with the disease and some blood biochemical factors. Our study demonstrated that there was not a direct association between rs3184504 C>T variant with risk of CAD in Iranian population, whereas, there is a significant association between this variant with increased blood LDL and diastolic blood pressure. Further molecular analysis and other disease association studies are necessary in the Iranian population.

Sexual Functioning among Married Iranian Women with Polycystic Ovary Syndrome

BACKGROUND

This study aimed to assess sexual functioning among women with polycystic ovary syndrome (PCOS) in Iran.

MATERIALS AND METHODS

A cross-sectional study was conducted to ascertain factors re- lated to sexual functioning in 300 PCOS patients attending to the private practice centers in Kashan, Isfahan Province, Iran, from May to October 2012. The Female Sexual Function Index (FSFI) was used to measure sexual functioning. Moreover, the socio-demo-graphic details and clinical information of PCOS including obesity, hirsutism, acne, mestrual cycle disturbances, infertility and endocrine profile were recorded for each patient.

RESULTS

Overall the prevalence of female sexual dysfunction (FSD) was 16.6%. In particular patients indicated poorer sexual functioning for the desire (48.3%) and the arousal (44.7%) subscales. Multiple logistic regression analysis suggested patients with lower educational level (OR: 2.94; 95% CI: 1.46-5.92) and irregular menstrual status (OR: 4.61; 95% CI: 1.93-11) were more likely to report sexual dysfunction.

CONCLUSION

The findings suggest that desire and arousal were the most prevalent sexual disorders reported in this patient population. In addition, findings suggested that women with limited or no formal education and a history of menstrual irregularities were the most likely to report female sexual dysfunction. Further investigations are needed to examine female sexual functioning among women with PCOS, to educate their health care providers, and to develop therapeutic interventions.

Body image satisfaction and self-esteem status among the patients with polycystic ovary syndrome

BACKGROUND

Most previous research has focused on polycystic ovary syndrome (PCOS) characteristics and their association with psychological disorders, such as anxiety and depression.

OBJECTIVE

In the present study, our aim was to study whether PCOS characteristics are associated with several aspects of psychological well-being namely self-esteem and body satisfaction.

MATERIALS AND METHODS

This was a cross-sectional study of 300 women with PCOS that was carried out in Kashan, Iran. Main outcome measures were the Body Image Concern Inventory (BICI) and the Rosenberg's Self-Esteem Scale and clinical information of PCOS. Major clinical PCOS features including obesity (BMI), excessive body hair (hirsutism score), acne, menstrual cycle disturbances and infertility.

RESULTS

The findings of regression analysis indicated that infertile women had lower levels of self-esteem (=-0.11, p=0.049) and poorer body satisfaction (=0.121, p=0.036) compared with PCOS women without infertility. Furthermore, hirsute women experienced poorer self-esteem than women without hirsutism (=-0.124, p=0.032). Women with menstrual irregularities had higher body dissatisfaction (=0.159, p=0.005). Moreover, women with higher body mass index scores had poorer body satisfaction (=0.151, p=0.009) but were not associated with self-esteem.

CONCLUSION

The emotional well-being of the patients presenting with the syndrome needs to be recognized more fully, particularly in relation to the low self-esteem, poor body image, and struggles with weight, menstrual irregularities, hirsutism and infertility. The results of this study raise implications for clinical practice and suggest that a multidisciplinary approach to the management of women with PCOS. This article extracted from Ph.D. thesis. (Fatemeh Bazarganipour).

Iranian version of modified polycystic ovary syndrome health-related quality of Life questionnaire: Discriminant and convergent validity

BACKGROUND

A preliminary report indicated that the Iranian version of modified polycystic ovary syndrome health-related quality of life questionnaire (MPCOSQ) is a valid measure of health-related quality of life (HRQOL) in PCOS patients. Accordingly, the Iranian version of MPCOSQ was subjected to further psychometric analyses among a different sample of patients with PCOS.

OBJECTIVE

To examine discriminant and convergent validity of the Iranian version of MPCOSQ.

MATERIALS AND METHODS

This was a cross sectional study of 200 women with PCOS that was carried out in two private gynecology clinics in Kashan, Iran. Discriminant validity was assessed using the known groups comparison. Convergent validity was evaluated by assessing the correlation between similar content on the MPCOSQ and the SF-36.

RESULTS

The mean scores for the MPCOSQ showed that women rated lowest on the infertility and menstrual subscales indicating worst health in these dimensions. The results from the SF-36 questionnaire indicated that emotional and vitality domains were the areas of poorest health. Known groups comparison showed that the MPCOSQ differentiated well between sub-groups of women who differed in PCOS specific symptoms, lending support to its discriminant validity. Convergent validity was assessed and as expected a good positive correlation was found between related subscales of the two instruments.

CONCLUSION

The MPCOSQ has now been extensively tested in Iran and can be considered for using as an outcome measure in future outcome studies in this population. This study extracted from Ph.D. thesis. (Fatemeh Bazarganipour).

Psychological investigation in patients with polycystic ovary syndrome

Background

The aim of the present study was to estimate the prevalence of mood disorders and examine a range of predictors for psychological well-being among Iranian women with polycystic ovary syndrome (PCOS).

Methods

A cross-sectional study was undertaken to ascertain the factors related to psychological distress in PCOS patients in Kashan, Iran. Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS). In addition we assessed quality of life using the Short Form Health Survey (SF-36). Socio-demographic details and clinical information of PCOS including obesity (body mass index), excessive body hair (hirsutism score), acne, menstrual cycle disturbances, infertility and endocrine profile also were recorded for each patient.

Results

In all 300 women with PCOS were entered into the study. Of these 32% (n =96) showed elevated HADS anxiety while depression was high in 5% (n =15). Quality of life was significantly impaired in women with anxiety (P <0.05), and depression (P <0.001) and in particular, in women with coexistence anxiety and depression (P <0.001) compared with unaffected participants. Compared with the non-depressed PCOS patients, the depressed women had significantly higher menstrual irregularities (P = 0.008). Moreover, we found significant difference in FAI level between the depressed and non depressed (p = 0.05), the anxious and non anxious patients (p < 0.001) compare to non affected PCOS women.

Conclusions

The high prevalence of depression and anxiety in this population suggests that initial evaluation of all women with PCOS should also include assessment of mental health disorders. The clinician should further pay attention to background of their patients especially in view of the factors influencing psychological well-being.

Effect of continuous care model on lifestyle of patients with myocardial infarction

BACKGROUND

Myocardial infarction (MI) is a life threatening disease that influences the physical, psychological and social dimensions of the individual. Improper lifestyle is one of the causes of this disease. The use of nursing models could be one of the important and fundamental steps in changing the risk factors associated with MI. This study was carried out to evaluate the effect of continuous care model on the lifestyle of patients with MI.

METHODS

This randomized clinical trial was carried out on 70 patients with MI in coronary care units of hospitals affiliated to Shiraz University of Medical Sciences. Enrolled patients were randomly assigned to intervention or control groups using a randomization list (random permutated blocks with length 4). The continuous care model was used for 35 patients in the intervention group for a period of 3 months and in the control group, the usual cares were applied for 35 patients. Data were collected through lifestyle questionnaire before the intervention and 3 months after. The data were analyzed using chi-square, independent t-test and paired t-test.

RESULTS

Patients in the intervention group showed significant improvements in lifestyle (125.6 ± 15.4 vs. 180.1 ± 19.9). Moreover, the lifestyle score of intervention group was significantly better than that of the control group (117.9 ± 22.0 vs. 180.1 ± 19.9; P < 0.001) after three months.

CONCLUSION

Applying a continuous care model had positive effects on the lifestyle of patients with Myocardial Infarction. In order to reduce the risk factors and improve the lifestyle of patients with MI, nurses could use this model to create an effective change.

Determinants of oral health: does oral health literacy matter?

Objective. To evaluate oral health literacy, independent of other oral health determinants, as a risk indicator for self-reported oral health. Methods. A cross-sectional population-based survey conducted in Tehran, Iran. Multiple logistic regression analysis served to estimate the predictive effect of oral health literacy on self-reported oral health status (good versus poor) controlling for socioeconomic and demographic factors and tooth-brushing behavior. Results. In all, among 1031 participants (mean age 36.3 (SD 12.9); 51% female), women reported brushing their teeth more frequently (P < 0.001) and scored higher for oral health literacy (mean 10.9 versus 10.2, P < 0.001). In the adjusted model, high age (OR = 1.01, 95% CI 1.003–1.034), low education (OR = 1.88, 95% CI 1.23–2.87), small living area in square meters per person (OR = 1.85, 95% CI 1.003–3.423), poor tooth brushing behavior (OR = 3.35, 95% CI 2.02–5.57), and low oral health literacy scores (OR = 1.58, 95% CI 1.02–2.45) were significant risk indicators for poor self-reported oral health. Conclusions. Low oral health literacy level, independent of education and other socioeconomic determinants, was a predictor for poor self-reported oral health and should be considered a vital determinant of oral health in countries with developing health care systems.

The role of microRNAs in cardiovascular disease

Cardiovascular disease has become the main factor of death and birth defects in the world. There are some therapeutic structures and drugs for curative and palliative therapy of the disease, but to the aim of accessing reliable therapy or to postpone onset of disease, especially for individuals with heritable coronary artery disease in their pedigree Genetic engineering technologies are making advances in the field by identifying oligonucleotides with higher potencies which can be easily targeted against almost any gene, particularly interfering RNA (RNAi). Recently, the focus of RNAi approaches has encompassed the use of synthetic sequences to mimic or silence endogenous microRNAs (miRNAs) that are abruptly dysregulated following cardiovascular diseases. In this review, we summarize the role of miRNAs in heart development and vascular system as two main factors of birth defects and adult morbidity and mortality and miRNAS as new therapeutic agents.

Immediate results and six-month outcomes after percutaneous coronary intervention in a referral heart center in Isfahan, Iran

BACKGROUND

There is a lack of data in our society on the outcomes, complications, and prognostic factors in patients with coronary artery disease who underwent percutaneous coronary intervention (PCI). We evaluated the success rate, early and late outcomes, and prognostic factors in a referral university center in Isfahan, IRAN.

METHODS

This prospective cohort study was conducted in Chamran University Hospital in Isfahan (IRAN) from March 2010 to February 2011. Patients consequently were included if they have the indication for emergent or elective PCI. Outcomes included procedural success, complications, and major adverse cardiovascular events (MACE) during hospitalization and 6 months follow-up.

RESULTS

A total of 282 patients (74.1% females) with mean age of 57.0±3.2 years were studied. Most of the patients (89.7%) underwent elective PCI. Angiographic and procedure success rates were 95.7% and 94.6%, respectively. In-hospital MACE included two cases of death (0.7%) and one MI (0.3%); 2/29 (6.9%) of the emergent PCI and 1/253 (0.4%) of the elective PCI cases. MACE during follow-up included three cases of death (1.0%) and two MI (0.7%); 2/252 (0.8%) of the elective PCI and 1/28 (3.5%) of the emergent PCI cases. The overall MACE was calculated as 8 cases (2.8%) which included 5/29 (17.2%) of the emergent and 3/253 (1.1%) of the elective cases; P<0.001. In multivariate analysis, none of the factors including gender, age, emergency of the procedure, lesion type, number of stenotic vessels, or stent type were associated with total MACE (P>0.05).

CONCLUSION

PCI is performed with an acceptable success rate in our center in Isfahan and mortality and complications are within the range reported by other highly specialized centers in IRAN. Further studies with larger sample size are needed to find predictive factors.

Cytochrome P450 2C19 Polymorphism in Iranian Patients with Coronary Artery Disease

BACKGROUND

The polymorphisms of cytochrome P450 2C19 (CYP2C19) gene are major prognostic factors for the response to clopidogrel therapy in patients with coronary artery diseases (CAD). The CYP2C19*2 is the most important allele responsible for resistance to clopidogrel therapy. This study examined CYP2C19 gene polymorphism (CYP2C19*1 and *2) in Iranian patients.

METHODS

This cross-sectional study was performed on 43 Iranian patients with CAD who underwent percutaneous coronary intervention (PCI) and received drug-eluted stents (DES). CYP2C19 polymorphisms were assessed using real time PCR and frequency of CYP2C19*1 and CYP2C19*2 were determined, and then homo- or heterozygous state of genes was detected by Melt Curve Analysis method.

RESULTS

Forty three patients (mean age = 58.8 ± 10.0 years, 79.1% male) participated in this study. CYP2C19*1/CYP2C19*1 genotype was observed in 31 (72.1%) of participates, CYP2C19*1/CYP2C19*2 genotype in 10 (23.3%), and CYP2C19*2/CYP2C19*2 genotype in 2 patients (4.7%). The frequency of CYP2C19*2 allele in the sample was 27.9%.

CONCLUSION

This study demonstrated a high prevalence of CYP2C19*2 gene polymorphism in Iranian patients. Further studies with larger samples or longitudinal are required to determine the effects of this polymorphism on the prognosis of CAD patients in our population.