[Concept of the quality of the educational services in cardiac rehabilitation]

Achieving quality educational services is one of the current health system challenges; and nurses have a great role in this regard. Although quality educational services are a complex concept; so it is important to clarifying and exploring the related components. The study aimed to describe the components underlies to quality educational service in a cardiac rehabilitation program qualitatively and introduce some of the related problems. This is a qualitative study using qualitative content analysis method.Study population consisted of health practitioners working at health and research centers affiliated to Isfahan University of Medical Sciences, cardiac patients including inpatient and out patient service users and their assistants [family members]. Data were gathered through conducting unstructured interviews with a purposive sample of 25[consisted of 3 physicians, 6 nurses, 1 dietarian, 13 patients and 2 patient assistant]. The study was begun at 1386 and data analysis was completed at 1388. The rigor of the study was achieved applying Guba and Lincoln directions. The concept of quality educational services in cardiac rehabilitation is described using four underlying concepts namely fittingness, comprehensiveness, authenticity and orderliness that are the elements of quality educational services in the cardiac rehabilitation program. Based on the findings, paying attention to audiences' special needs and capabilities are important determinants in providing quality educational services in the cardiac rehabilitation program. Hereby the audiences could receive the trustful and responsive services. We suggest organizing the education and information giving routs. It would result in service comprehensiveness that could save the service taking opportunities. The existed problems were inadequate fittingness, poor coordination in the services and poor referral system that were resulted in poor response to some of the audiences needs. [Quality educational services] is a context based concept. Considering the cardiac rehabilitation, it was emphasized on providing need based services fitted to users' capabilities, attending to various bio-psycho-social aspects at both person and family levels and serving the services through predefined and coordinated pathways. It is necessary to nurses as one of the key members of cardiac rehabilitation team that consider such emerged elements in service management and direct care delivery to the cardiac patients and their families. Future researches on emerged concepts are worthy to suggest

Socioeconomic disparities and smoking habits in metabolic syndrome: evidence from Isfahan healthy heart program

The metabolic syndrome [Mets] consists of major clustering of cardiovascular disease [CVD] risk factors. This study determines the association of socioeconomic determinants and smoking behavior in a population-based sample of Iranians with Mets. This cross-sectional survey comprised 12600 randomly selected men and women aged >/= 19 years living in three counties in central part of Iran. They participated in the baseline survey of a community-based program for CVD prevention entitled" Isfahan Healthy Heart Program" in 2000-2001. Subjects with Mets were selected based on NCEP- ATPIII criteria. Demographic data, medical history, lifestyle, smoking habits, physical examination, blood pressure, obesity indices and serum lipids were determined. The mean age of subjects with Mets was significantly higher. The mean age of smokers in both groups was higher than non-smokers but with lower WC and WHR. Marital status, age and residency were not significantly different in smokers with Mets and non-smokers with Mets. Smoking was more common in the middle educational group in the income category of Quartile 1-3. Mets was significantly related to age, sex and education. Middle-aged and elderly smokers were at approximately 4-5 times higher risk among Mets subjects. Low education decreased the risk of Mets by 0.48; similarly in non-smokers, 6-12 years of education decreased the risk of Mets by 0.72. More educated persons had a better awareness and behavior related to their health and role of smoking. In the lower social strata of the Iranian population, more efforts are needed against smoking habits

Awareness, treatment and control of hypertension, dyslipidaemia and diabetes mellitus in an Iranian population: the IHHP study

We used data from the baseline survey from the Isfahan Healthy Heart Programme to determine the prevalence of hypertension, dyslipidaemia and diabetes among a representative samples of 12 514 adults living in 3 cities in the Islamic Republic of Iran. The prevalence of hypertension, dyslipidaemia and diabetes was 17.3%, 66.3% and 5.6% respectively. Awareness, treatment and control of hypertension were 40.3%, 35.3%, and 9.1% respectively. The rates for dyslipidaemia were 14.4%, 7.1% and 6.5% respectively, and 54.6% of diabetics were aware of their disease and 46.2% were under treatment

Prognostic value of infection and inflammation markers for late cardiac events in an Iranian sample

We evaluated the serum levels of IgG antibodies to Helicobacter pylori, Chlamydia pneumonia and cytomegalovirus and the level of the inflammatory markers C-reactive protein and fibrinogen in 57 patients with acute coronary syndrome, 65 with unstable angina, 60 with stable angina and 44 healthy controls, and whether these markers were associated with cardiac instability 6 months after admission. There was a significant increased risk of late coronary events [cardiac death or readmission with acute coronary events] associated with seropositivity to C. pneumoniae [adjusted odds ratio 2.12; 95% confidence interval: 1.16-4.08]. Other parameters were not significantly associated with late cardiac events after adjustment for age, sex, diabetes mellitus, hypertension, hyperlipidaemia and smoking behaviour

Evaluation of the Quit and Win contest for smoking cessation in the Islamic Republic of Iran

Quit and Win is an international biannual smoking cessation contest. Although more than 70 countries participate, few are from the Eastern Mediterranean Region. This study evaluated 4 Quit and Win campaigns in Isfahan province, Islamic Republic of Iran, from 1998 to 2004, documenting participation rates, self-reported 1-month and 1-year abstinence rates and related factors. Participation rates among smokers ranged from 0.7%-2.4% of the smokers in Isfahan. One-month quit rates varied from 41.8% in 1998 to 92.8% in 2004. At 1-year follow-up, self-reported quit rates varied from 22.5% in 1998 to 91.2% in 2004. This model was found to be feasible and successful in our community, and can be implemented in other low-and middle-income countries

Pharmacological treatment, lifestyle modification and awareness in coronary artery and cerebrovascular disease patients

Cardiovascular diseases [CVD] and cerebrovascular diseases [CeVD] are a large and growing problem in low- and middle-income populations. Secondary prevention which can reduce the risk of recurrent CVD includes changes in lifestyle, pharmacological interventions and revascularization procedures. The aim of the first phase of this project was to perform situation analysis and identify gaps in secondary prevention of major cardiovascular diseases. This study estimated the physicians' awareness and the patients' knowledge and behavior towards CVD and CeVD complications. It also assessed the efficacy of methods for decreasing recurrent events. A sample of consecutive patients was selected from the outpatient units of the health care facilities selected for the study. Stratified random sampling of primary and secondary private and public health care facilities in cities and villages was performed to select 449 eligible cases. We selected 257 men and 192 women. The inclusion criteria were as follows: Age above 21 years, established diagnosis of cardiovascular and/or cerebrovascular disease defined as any of the following alone or in combination with others: previous myocardial infarction, stable/unstable angina, percutaneous transluminal coronary angioplasty [PTCA], coronary artery bypass graft [CABG], stroke, transient ischemic attack [TIA] or carotid arterectomy. The patients were included if their first event had occurred more than a month, but no earlier than three years ago. The prevalence of high systolic and diastolic blood pressure was 40.1% and 26.9% respectively in MI patients, and 70.1% and 51.2% respectively in CeVD patients. In most of the patients fasting blood sugar and total cholesterol were within the normal range. Among MI patients, 93.9%, 68.5% and 48.2% were already taking aspirin, beta-blockers and statins respectively. Among CeVD patients, 79.9%, 61.1% and 23.2% were taking aspirin, beta-blockers and statins, respectively. Blood pressure had been managed in 94.9% and 93.7% of MI and CeVD patients, respectively. Among MI patients, 85.8% and 83.2% had correct behavior towards blood sugar and cholesterol control and 68% had adequate knowledge of the risk of recurrent events. Secondary prevention of vascular disease should be regarded as a key component of public health strategies to reduce the rising burden of CVD and CeVD in Iran

relationship between serum vitamin D level, coronary artery diseases and the associated risk factors in female carpet weavers

Regarding some evidences, the mortality of coronary artery diseases may be related to vitamin D [VD] deficiency. This kind of deficiency is more common among female carpet weavers. To determine the relationship between serum vitamin D level, coronary artery diseases [CAD] and the associated risk factors in female carpet weavers. This case-control study was conducted on 460 postmenopausal carpet-weavers and noncarpet- weavers in the villages of Isfahan with similar socio-economic conditions. The participants initially underwent the clinical examinations and electrocardiography and if necessary, ecocardiography and exercise tests. Blood pressure, blood lipids and both serum and dietary vitamin D were measured and a questionnaire was completed for every participant. The presence of CAD was determined based on the Rose questionnaire and/or Minnesota electrocardiography coding system. The frequency of CAD and the mean values of other factors were insignificant between two groups [p>0.05]. There was no statistical association between the serum vitamin D level and some of the CAD risk factors among carpet and non-carpet weavers and persons with or without CAD [p>0.05]. There was only a direct relationship between abdominal obesity and serum vitamin D level [OR=0.69, p= 0.03]. Regarding our data, no relationship was found between CAD and serum vitamin D. However, more investigations including the determination of serum and dietary calcium, serum phosphorus and PTH are needed. Also a research, analyzing the vitamin D receptor [VDR] gene polymorphisms is proposed

mean duration of electrocardiographic changes in unstable angina

According to some references, the duration of these changes for more than 12 hours after pain relief in unstable angina may be indicative of non-Q-Wave myocardial infarction [MI]. To obtain the mean duration of ECG changes in patients with unstable angina. The present work was a cross-sectional study in which 34 patients, who were admitted to the coronary care unit [CCU] for unstable angina, were investigated. The selection of subjects was based on the presence of ST-segment and T-wave changes in ECG of patients with anginal pain but without MI, confirmed by laboratory measurements of enzymes such as LDH, CPK-MB and total CPK. The patients with other causes of ST-segment and T-wave changes [WPW syndrome, salivary diseases, using anti-arrhythmic and anti-angina drugs, left bundle branch block, digital administration and currently experienced surgery] were excluded from the study. The subjects were followed up for 3 months after discharge. The mean duration of ECG changes in study group was 28.65 +/- 7 days. The mean duration of ST-segment and T-wave changes were 14.7 +/- 24 days and 30.1 +/- 38 days, respectively. The minimum duration of ECG changes was one day and the maximum was 90 days. The results showed that in hospitalized patients with unstable angina, the ECG changes can be prolonged for an average of one month which must be considered for further diagnostic and treatment decisions