Adjusting for reverse causation to estimate the effect of obesity on mortality after incident heart failure in the Atherosclerosis Risk in Communities (ARIC) study / 한국역학회지

OBJECTIVES: The lower mortality rate of obese patients with heart failure (HF) has been partly attributed to reverse causation bias due to weight loss caused by disease. Using data about weight both before and after HF, this study aimed to adjust for reverse causation and examine the association of obesity both before and after HF with mortality. METHODS: Using the Atherosclerosis Risk in Communities (ARIC) study, 308 patients with data available from before and after the incidence of HF were included. Pre-morbid and post-morbid obesity were defined based on body mass index measurements at least three months before and after incident HF. The associations of pre-morbid and post-morbid obesity and weight change with survival after HF were evaluated using a Cox proportional hazard model. RESULTS: Pre-morbid obesity was associated with higher mortality (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.04 to 2.49) but post-morbid obesity was associated with increased survival (HR, 0.57; 95% CI, 0.37 to 0.88). Adjusting for weight change due to disease as a confounder of the obesity-mortality relationship resulted in the absence of any significant associations between post-morbid obesity and mortality. CONCLUSIONS: This study demonstrated that controlling for reverse causality by adjusting for the confounder of weight change may remove or reverse the protective effect of obesity on mortality among patients with incident HF.

effect of life skills training in group and behavior change on affective health of people addicted to methamphetamine crystal

Although various medical and psychological interventions have been used to treat addiction, addiction particularly methamphetamine addiction as a social, health and medical issues is still jeopardizing the human community. This study is aimed at determining the impact of teaching life skills and changing behavior on the emotional well-being of the individuals addicted to crystal methamphetamine. This study was carried out using before-after plan with participation of 28 crystal methamphetamine addicts. In addition to receiving medical treatment, the intervention group patients obtained necessary trainings required for developing life skill and changing behavior during 15 sessions, whilst the control group received only the routine pharmacotherapy treatments and primary interventions. Then pretest and posttest scores of the two groups were compared. The mean score on emotional well-being by the intervention group is lower than that in control group after treatment [10.71<18.78] which was statistically significant. The history of dependence on methamphetamine, age, education, the times of quits, and the marital status had no impact on the extent of the influence of teaching life skills and behavior changes on the individuals' emotional well-being. Notwithstanding that addiction could influence various aspects of mental and emotional health of dependent people, teaching life skills and behavioral changes may lead to enhancement in their emotional well-being. Hence it is necessary to encourage these individuals to participate in group sessions of changing behavior and teaching life skills

Zinc status in Cardiovascular patients in the north of Islamic Republic of Iran

Studies have demonstrated that zinc plays an important role in development of cardiovascular diseases in Western populations. But there is little data for other racial groups. This study was aimed to investigate the association between serum zinc and coronary artery disease [CAD] in Iranian subjects.This study was conducted on 81 subjects, which referred to Heshmat Hospital of Guilan province, Iran, for routine coronary angiography from June to August 2011. Subjects were assigned into 2 groups; 41 CAD patients. case and 40 healthy subjects in control group. Data about smoking habit,physical activity, dietary intake and anthropometric indices were collected by questionnaire. Serum zinc was measured by atomic spectroscopy. The serum zinc concentrations were significantly lower in case group than control [p<0.05]. The mean serum zinc concentration in the case and control group was 73.50 +/- 1.61microg/dl and 78.47 +/- 1.66 micro g/dl, respectively. subjects that lives in rural area had 7.11-fold higher CAD risk in compare to subjects lives in urban after adjustment for confounder factors, they also had lower zinc concentration than urban [p<0.05]. in our study With increasing in serum zinc concentration CAD risk decrease 0.94-fold.Zinc concentration had significant correlation with age [r= -0.23 p<0.05], weight [r=0.26 p<0.05] and Place for living [r=- 0.22 p= 0.04].There were no significant correlation between the dietary intake, Waist circumference ,smoking and serum zinc concentration in our study. Serum zinc concentration was significantly lower in the north of Islamic Republic of Iran patients with abnormal versus those with a normal angiogram. It seems Serum zinc concentration correlate with some risk factors for coronary artery disease

relationship between vaginal bleeding in the first and second trimester of pregnancy and preterm labor

Vaginal bleeding is a common complication during pregnancy, which is observed in about 1/4 of pregnancies and in half of cases can lead to abortion. If vaginal bleeding happens during pregnancy some adverse pregnancy outcomes, including perinatal mortality and morbidity, low birth weight and preterm delivery will be increased. The aim of this study was to determine the relationship between vaginal bleeding and its characteristics in the first and second trimester of pregnancy and preterm labor. This is a case-control study conducted on 440 pregnant women referred to Al-Zahra Hospital in Rasht, Iran. Data were collected by a form. The form included demographic characteristics and confounding factors, the occurrence of bleeding during pregnancy and its features. Data were analyzed by T test, chi square and logistic regression in SPSS 16. Findings showed that vaginal bleeding was associated with 3 times increased risk of preterm delivery [OR: 3, 1.84-4.89]. Also, findings showed that bleeding characteristics including bleeding time, frequency, severity and intensity was significantly associated with preterm labor. According to significant association between vaginal bleeding and preterm delivery, it seems that performing some interventions to prevent preterm labor could be appropriate.

Respiratory findings in dental laboratory technicians in Rasht [north of Iran]

There are several occupations that can expose people to some air pollutants. Dental technicians are exposed to inorganic dust and chemical vapors when making dental prosthesis that can put them at risk for respiratory problems. This study was performed to assess respiratory dysfunction in a group of dental technicians. This was a cross-sectional study designed to ascertain the prevalence of respiratory disorders in dental laboratory technicians in Rasht, a city located in north of Iran. A Structured questionnaire was adapted according to the European Community Respiratory Health Survey questionnaire and used to elicit information regarding sociodemographic characteristics and medical status of the study participants. The ventilation status, protective measures and direct exposure to materials in the laboratories were directly observed by the observers and subjects underwent respiratory tests and chest x-ray. The mean age of dental technicians was 31.31 yrs [range 18-56 years] and 83% were males with a mean dental work experience of 9.04 years. In 54.8% of cases, the work environment did not have air conditioning system. The most common signs and symptoms were cough [38.1%] and wheezing [16.7%]. There was a significant correlation between smoking and respiratory signs. Restrictive airway pattern and air trapping were two prevalent findings which were observed in 85.7% and 33.3% of the subjects. Cigarette smoking had a negative effect on FEV1, FEF[25%-75%], and TLC causing a significant reduction in all three parameters [p<0.05]. The most prevalent finding was interstitial opacity which was observed in 10 individuals [23.8%]. This finding was not significantly associated with age, gender, cigarette smoking, or daily work hours. However, there was a significant statistical association between work experience and interstitial opacity. The prevalence of respiratory dysfunction and chest x-ray findings were high as in several similar studies. In order to reduce the hazards of respiratory disorders in risky occupations and provide dental workers with technical preventive measures, a more comprehensive study should be conducted throughout the country and further evaluations through biopsy and CT-scan need to be performed in suspicious cases when necessary

Simple formulas for screening abnormal blood pressure in children and adolescents

Childhood hypertension has been extensively focused on in the past decades because of its increasing incidence, which is related to physicians' awareness and the increasing number of obese children. Age, gender, and body size are the main determinants of blood pressure in children. The revised childhood blood pressure tables of the National High Blood Pressure Education Program are a prerequisite for classification of childhood hypertension. Although these tables provide a reasonable basis, they are intricate and height percentile is needed for final diagnosis. Many attempts have been done to decrease such complexity. We present new formulas that are concise and memorable, and will help physicians to screen prehypertensive and hypertensive pediatric patients

Vaginal sonography and hysteroscopy; comparison in infertility patients

Hysteroscopy is a valuable diagnostic and therapeutic modality in the management of infertility. To evaluate the consistency of hysteroscopy based on a histopathological report from endometrial specimens for intrauterine disorders. This is a cross-sectional study. The study included 115 infertile patients. All were admitted for investigation of infertile women before assisted reproduction in Mehr infertility institute between 2006 and 2007 hysteroscopy, and histological evaluation of endometrial biopsy performed.We compared the efficacy of hysteroscopy in the diagnosis of benign intrauterine pathology in infertile women in whom the diagnosis was confirmed by histological studies. The women had a complete evaluation with preoperative hysteroscopy, and histological analysis of uterine cavity specimens. Sensitivity and specificity, predictive were calculated for hysteroscopy considering the histological study as 100%. Sensitivity and specificity of sonography in diagnosing the polyp were stated 81% and 64% respectively. Sensitivity and specificity of hysteroscopy showed of polyps revealed 85% and 84% respectively. The results indicated that sensitivity and specificity of sonography in diagnosing the myoma were 25% and 98% respectively. Sensitivity and specificity of hysteroscopy in diagnosing the myoma were expressed 50% and 93% respectively. Hysteroscopy is a safe and rapid direct visualisation of the uterine cavity. We believe it should be replaced by the diagnostic hysteroscopy as a first line infertility investigation