Relationship between Depression and Constipation: Results from a Large Cross-sectional Study in Adults / 대한소화기학회지

Background/Aims@#Accumulating evidence based on a few studies suggests a relationship between depression and functional constipation. This study examined whether depression is associated with a higher risk of functional constipation and whether it is gender specific. @*Methods@#This cross-sectional study was carried out on 3,362 adults aged 18-55 years. In this study, functional gastrointestinal symptoms were determined using an Iranian reliable and valid version of the modified Rome III questionnaire. The Iranian validated version of the hospital anxiety and depression scale was used to evaluate the psychological health. Scores of eight or more on the depression subscale in the questionnaire were considered the presence of depression. Simple and multiple binary logistic regression were used for data analysis. @*Results@#The mean±SD age of participants was 36.29±7.87 years, and 58.5% were female. The prevalence of depression and constipation in the study sample was 28.6% and 23.9%, respectively. In the full adjusted model, in the total sample, depressed people showed a significantly higher risk of constipation; adjusted OR (AOR), 1.69 (95% CI, 1.37-2.09). Although a significant association was observed between depression and constipation in both genders, the association was stronger in men than women (AOR, 2.28; 95% CI, 1.50, 3.63 vs. AOR, 1.55; 95% CI, 1.21, 1.99). @*Conclusions@#These study findings showed that depressed people are at a significantly higher risk of being affected by constipation. The current study findings justify the importance of mental health evaluations in all patients with functional gastrointestinal disorders, particularly among constipated individuals.

Determinants of depression in non-cardiac chest pain patients: a cross sectional study

Background@#Non-cardiac chest pain (NCCP) is a common patient complaint imposing great costs on the healthcare system. It is associated with psychological factors such as depression. The aim of the present study is determining depression predictors in NCCP patients. @*Methods@#The participants of this cross-sectional study were 361 NCCP patients. Patients filled out questionnaires concerning their sociodemographic, lifestyle, and clinical factors (severity of pain, type D personality, somatization, cardiac anxiety, fear of body sensations, and depression). @*Results@#Based on multiple ordinal logistic regression, lack of physical activity (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.09-2.87), sleep quality (OR, 2.98; 95% CI, 1.15-7.69), being a smoker (OR, 1.33; 95% CI, 2.41-4.03), present pain intensity (OR, 1.08; 95% CI, 1.05-1.11), type D personality (OR, 2.43; 95% CI, 1.47- 4.03), and somatization (OR, 1.22; 95% CI, 1.15-1.3) were significant predictors of depression in NCCP patients. Additionally, multiple linear regression showed that being unmarried (β = 1.51, P = 0.008), lack of physical activity (β = 1.22, P = 0.015), sleep quality (β = 2.26, P = 0.022), present pain intensity (β = 0.07, P = 0.045), type D personality (β = 1.87, P < 0.001), somatization (β = 0.45, P < 0.001), and fear of bodily sensation (β = 0.04, P = 0.032) increased significantly depression scores in NCCP patients. @*Conclusions@#Physicians should consider the predictors of depression in NCCP patients which can lead to receiving effective psychological consultations and reducing the costs and ineffectual referrals to medical centers.

Determinants of depression in non-cardiac chest pain patients: a cross sectional study

Background@#Non-cardiac chest pain (NCCP) is a common patient complaint imposing great costs on the healthcare system. It is associated with psychological factors such as depression. The aim of the present study is determining depression predictors in NCCP patients. @*Methods@#The participants of this cross-sectional study were 361 NCCP patients. Patients filled out questionnaires concerning their sociodemographic, lifestyle, and clinical factors (severity of pain, type D personality, somatization, cardiac anxiety, fear of body sensations, and depression). @*Results@#Based on multiple ordinal logistic regression, lack of physical activity (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.09-2.87), sleep quality (OR, 2.98; 95% CI, 1.15-7.69), being a smoker (OR, 1.33; 95% CI, 2.41-4.03), present pain intensity (OR, 1.08; 95% CI, 1.05-1.11), type D personality (OR, 2.43; 95% CI, 1.47- 4.03), and somatization (OR, 1.22; 95% CI, 1.15-1.3) were significant predictors of depression in NCCP patients. Additionally, multiple linear regression showed that being unmarried (β = 1.51, P = 0.008), lack of physical activity (β = 1.22, P = 0.015), sleep quality (β = 2.26, P = 0.022), present pain intensity (β = 0.07, P = 0.045), type D personality (β = 1.87, P < 0.001), somatization (β = 0.45, P < 0.001), and fear of bodily sensation (β = 0.04, P = 0.032) increased significantly depression scores in NCCP patients. @*Conclusions@#Physicians should consider the predictors of depression in NCCP patients which can lead to receiving effective psychological consultations and reducing the costs and ineffectual referrals to medical centers.

Factors associated with smoking contemplation and maintenance among Iranian adolescents

Background: Evidence is scarce on which factors contribute to cigarette and waterpipe contemplation and no previous study has examined the factors associated with waterpipe maintenance.

Aims: This study aimed to determine the factors associated with cigarette and waterpipe smoking contemplation and maintenance among Iranian adolescents.

Methods: Factors including depression, risky behaviour, family conflict, attitude to smoking acceptability and self-efficacy were examined using a questionnaire for 5500 adolescents at the smoking contemplation or maintenance stage.

Results: Students with depression had nearly double the chance [95% confidence interval [CI]: 1.41–2.72] of cigarette smoking contemplation. Risk takers had odds of 2.13 [95% CI: 1.51–2.94] and 1.49 [1.22–1.85] of cigarette and waterpipe [hookah] smoking contemplation, respectively. Those facing family conflict had odds of 1.87 [95% CI: 1.38–2.53] and 1.53 for cigarette and waterpipe smoking contemplation, respectively. The contemplation odds for students with more positive attitude to smoking acceptability were 2.12 [95% CI: 1.51–2.97] and 1.72 for cigarette and waterpipe smoking, respectively. Higher self-efficacy was associated with lower cigarette and waterpipe smoking contemplation. Risky behaviour was related to smoking maintenance. A more positive attitude to smoking acceptability was related to higher waterpipe maintenance [odds ratio = 1.57 95% CI: 1.03–2.40].

Conclusions: Depression, attitude to smoking acceptability and risky behaviour are factors associated with smoking contemplation and maintenance.

Smoking motivators are different among cigarette and waterpipe smokers: the results of ITUPP

The present study explores different drivers of cigarette and water pipe smoking among middle and high school students in Isfahan province. A questionnaire-based cross-sectional study was conducted. Trained staff collected questionnaires and saliva samples for response accuracy evaluation. Prevalence by demographic, parental and educational factors was calculated. Logistic regression was applied to compare behavior drivers of those who purely smoked cigarettes or a waterpipe. Waterpipe smokers were considered as the reference category. This study reported ORs along 95% confidence intervals; 5408 questionnaires were returned. The sample age was 15.37 +/- 01.70 on average. The self-reported prevalence of cigarette and waterpipe experimentation was 11.60% [n = 624] and 20.70% [n = 1,109], respectively; and 5.08% [n = 311], 11.06% [n = 619] for smokers, and 13.30% [n = 711] for the whole sample. Psychological factors were the most important driver for cigarette smoking; bad event happening with odds of 2.38 [95% CI: 1.29-4.39]; angriness 2.58 times [95% CI: 1.51-4.43]; and distress by 2.49 times [95% CI: 1.42-4.40]. Habitual situations were strong predictors of cigarette smoking, but not a predictor of waterpipe smoking, such as smoking after a meal [OR = 3.11, 95% CI: 1.67-5.77]; and smoking after waking up [OR = 2.56, 95% CI: 1.42-4.40]. Comprehensive and multifaceted preventive programs must tailor identified factors and increase family's awareness

Synbiotic containing Bacillus coagulans and fructo-oligosaccharides for functional abdominal pain in children

We evaluated the effectiveness of a synbiotic in the treatment of childhood functional abdominal pain [FAP]. Probiotics are effective in the treatment of functional gastrointestinal disorders in adult patients, but there is lack of information in children. Children with FAP, based on the Rome III criteria [n= 115, aged 6-18 years], were randomized to receive either synbiotic [Bacillus coagulans, Unique IS-2, 150 million spore plus FOS, 100 mg] twice daily or placebo for four weeks. Treatment response was defined as >/= 2-point reduction in the 6-point self-rated pain scale or "no pain". Physician-rated global severity and improvement were also evaluated. Patients were followed for a total of 12 weeks. Eighty-eight patients completed the trial [45 with synbiotic]. Response rate was higher with synbiotic than placebo after medication [60% vs. 39.5%, P = 0.044], but was not different between the two groups at week 12 [64.4% vs. 53.4%, P = 0.204]. Difference between the two groups regarding the physician-rated global severity over the study period was not statistically significant [z = -1.87, P = 0.062]. There was no significant difference between the two groups in physician-rated global improvement [week 4, P = 0.437; week 12, P = 0.111]. Receiving synbiotic [OR 2.608, 95% CI: 1.01-6.68] and baseline pain score [OR 2.21, 95% CI: 1.19-4.10] were predictors of treatment response after medication. The synbiotic containing Bacillus coagulans and FOS seems to be effective in the treatment of childhood FAP. Further trials are recommended in this regard

Indicators developed to evaluate the international framework convention on tobacco control in Iran; a grounded theory study

This study aimed to develop indicators for evaluating the implementation of The Framework Convention on Tobacco Control [FCTC] in Iran. We used the "grounded theory" framework. Totally, 265 policy-makers, stakeholders, and community members were recruited by purposeful sampling in 2008. After analyzing the gathered data, 251 indicators, including 82 indicators as "applied indicators", were derived from second-level codes for three groups. A suitable evaluation questionnaire can be designed based on the extracted indicators for policy makers, stakeholders, and the community to follow the implementation of the FCTC in Iran

Cheese consumption in relation to cardiovascular risk factors among Iranian adults- IHHP Study

BACKGROUND/OBJECTIVE: It is expected that dairy products such as cheeses, which are the main source of cholesterol and saturated fat, may lead to the development or increase the risk of cardiovascular and metabolic diseases; however, the results of different studies are inconsistent. This study was conducted to assess the association between cheese consumption and cardiovascular risk factors in an Iranian adult population. SUBJECTS/METHODS: Information from the Isfahan Healthy Heart Program (IHHP) was used for this cross-sectional study with a total of 1,752 participants (782 men and 970 women). Weight, height, waist and hip circumference measurement, as well as fasting blood samples were gathered and biochemical assessments were done. To evaluate the dietary intakes of participants a validated food frequency questionnaire, consists of 49 items, was completed by expert technicians. Consumption of cheese was classified as less than 7 times per week and 7-14 times per week. RESULTS: Higher consumption of cheese was associated with higher C-Reactive Protein (CRP), apolipoprotein A and high density lipoprotein cholesterol (HDL-C) level but not with fasting blood sugar (FBS), total cholesterol, low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and apolipoprotein B. Higher consumption of cheese was positively associated with consumption of liquid and solid oil, grain, pulses, fruit, vegetable, meat and dairy, and negatively associated with Global Dietary Index. After control for other potential confounders the association between cheese intake and metabolic syndrome (OR: 0.81; 96%CI: 0.71-0.94), low HDL-C level (OR: 0.87; 96%CI: 0.79-0.96) and dyslipidemia (OR: 0.88; 96%CI: 0.79-0.98) became negatively significant. CONCLUSION: This study found an inverse association between the frequency of cheese intake and cardiovascular risk factors; however, further prospective studies are required to confirm the present results and to illustrate its mechanisms.

association between stress levels and food consumption among Iranian population

Background: stress has been considered as a highly common disorder that has a complicated relation with dietary intake and has been linked with both increased and decreased dietary intake

Objective: this study was conducted to assess the association between food consumption and stress levels in an Iranian adult population

Methods: in this cross-sectional study, data from the third phase of Isfahan Healthy Heart Program [IHHP] that was conducted for cardiovascular diseases prevention and health promotion were used. Nine thousand five hundred forty-nine adults aged = 18 years participated in the study. Dietary habits were assessed by a 49- item Food Frequency Questionnaire [FFQ]. Stress levels were assessed by General Health Questionnaire-12 [GHQ-12]. The participants were separated on the basis of their stress levels into two groups as the low- and high- stress groups

Results: individuals in the low- stress group were significantly younger and tended to have higher physical activity and education level, lower LDL cholesterol, and were less likely to be current smokers. Dietary intake of unsaturated oils, grains, fruits, vegetables, meat, and dairy products was significantly higher in the low- stress group whereas dietary intake of saturated oils was significantly lower; moreover, Global Dietary Index [GDI] was lower in the low- stress group. We found a significant positive association between stress level, GDI [OR: 1.24; 95% CI: 1.14 – 1.35], and saturated oils [OR: 1.17; 95% CI: 1.08 – 1.28] and inverse association between stress level and intake of unsaturated oils [OR: 0.84 ; 95% CI: 0.77 – 0.91], fruits and vegetables [OR: 0.83; 95% CI: 0.76 – 0.90], meat [OR:0.88; 95% CI:0.82 – 0.97],and dairy products [OR: 0.88 ; 95% CI: 0.81 – 0.96] after adjustments based on sex, age, smoking, and physical activity

Conclusion: our results showed a significant positive association between dietary intake and stress. We must have a special attention to dietary intake in stress management program of high- stress individuals, and in dietary recommendations, psychologic aspects should be considered. However, prospective longitudinal studies are needed to assess the causal relationship between stress and dietary factors

Abdominal fat distribution and serum lipids in patients with and without coronary heart disease

Objective: to investigate the association between obesity indices, abdominal fat distribution, and lipid profile in patients with stable angina [SA]

Methods: body weight, height, waist circumference [WC], body mass index [BMI], and waist /height ratio [WHtR] of 123 patients with SA who underwent coronary angiography were measured. Fasting blood samples were taken to measure the levels of fasting blood sugar [FBS], total cholesterol [TC], low- and high-density lipoprotein cholesterol [LDL-C, HDL-C], apolipoproteins A and B [apo A and apo B], and triglycerides [TG]. According to angiography reports, the participants were divided into patients with or without coronary heart disease [CHD]. All patients underwent an abdominal computerized tomography [CT] scan to measure the visceral, superficial, and deep subcutaneous fat

Results: the mean ages of the patients with CHD [n = 73] and without CHD [n = 50] were 50.5 +/- 7.6 and 53.7 +/- 7.6 years, respectively [P = 0.03]. The patients with CHD had significantly higher levels of TC, TG, and superficial subcutaneous fat, while the patients without CHD had higher levels of apo A [P = 0.05]. Multivariate analyses showed a significant association of visceral fat with TC, LDL-C, TG, and apo B, in the patients without CHD, while significant inverse associations were found between WC and HDL-C, WHtR, and apo A as well as visceral fat and LDL-C in the patients with CHD

Conclusions: among anthropometrics and imaging indices of obesity, WC and WHtR have shown better association between central obesity with dyslipidemia in the patients with CHD, while CT-measured visceral adipose tissue area was the best correlate of dyslipidemia in the patients without CHD

Opium decreases the age at myocardial infarction and sudden cardiac death: a long-and short-term outcome evaluation

Background: opium dependence is a recognized individual and public health threat, but little is known about its association with acute myocardial infarction [AMI] or sudden cardiac death [SCD]

Methods: in a cross-sectional study followed by a one-year matched longitudinal cohort, all 569 men hospitalized with AMI in all Cardiac Care Units [CCU] of Isfahan, Iran, were recruited in a six-month period. In addition, 123 out-of-hospital deaths were included that were diagnosed as SCD at the same duration. Among those discharged alive, 126 opium dependents were matched with 126 nondependents [mostly nonusers] according to age and smoking status, and were followed for one year. Opium dependence was measured using the ICD10 criteria and Severity of Dependence Scale [SDS] questionnaire. The method was validated by morphine blood levels. Biochemical measurements, blood pressure, blood cell counts, anthropometrics, and ejection fraction were measured at baseline and repeated at the end of follow-up

Results: there were 118 [17.1%] patients with an average of 17.4 +/- 10.4 years of abuse who met the criteria for opium dependency. Opium dependence decreased the age at event by 3.6 [95% CI: 1.2 – 6.0] years and was independent of smoking [P = 0.003]. In terms of cardiovascular risk factors such as ejection fraction, in addition to post-AMI mortality and morbidity, no significant associations were noted at baseline or after one year of follow-up. The odds ratio of sustained smoking after AMI was 1.92 [95% CI: 1.04 – 3.52] in opium dependents [P = 0.033]

Conclusion: despite public opinion, opium did not improve cardiovascular risk factors, or post-AMI mortality and morbidity. Conversely, there were irrefutable findings regarding the detrimental effects of opium dependence

Barriers and facilitators of weight management in overweight and obese people: qualitative findings of tabassom project

Since weight management is affected by various factors, including social and behavioral ones, this study aimed to explore the peoples' experience of barriers and facilitators of weight management. This qualitative content analysis was conducted as the initial step of TABASSOM Study. Participants, who tried to reduce their weight at least once, were selected by purposeful sampling method from aerobic fitness clubs, parks, and public offices in Isfahan in 2010. Data saturation was reached after indepth unstructured interviews with 11 participants. Data analysis was done by conventional content analysis method. The participants have intermittently followed weight loss program. Barriers such as physical problems, lack of motivation, lack of work and family support and lack of time have resulted in their failures and outages. The main facilitator to start or restart after stopping such programs for a while was positive psychologic effect. Findings showed that many problems could prevent weight loss. It is important to identify obstacles that hinder weight management and regimen programs and to discuss them with people before planning for their weight management.

Gender differences in risk factors of obese patients after cardiac rehabilitation program

Obesity is common in patients with cardiovascular disease [CVD] and the vast majority of patients entering into cardiac rehabilitation program [CRP] are obese. Regarding the gender differences, the risk of developing coronary heart disease [CHD] is recognized to be different between obese men and women. So, the purpose of this study was to explore the effect of CRP in functional capacity [FC] and risk factors, such as obesity indexes, lipid profiles, and fasting blood sugar [FBS] in obese men and women with CHD. In an observational study between 2000 and 2011, we evaluated a total of 156 obese men and women patients with CHD who were referred to cardiac rehabilitation of Isfahan Cardiovascular Research Institute. Before and after CRP, FC and risk factors were assessed and all the participants completed this period. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes, independent t tests and paired sample t tests were used. Data revealed, after CRP, obese women had significant improvement in most evaluated risk factors except total cholesterol [P = 0.05] and FBS [P = 0.09]; and obese men had favorable changes in weight [P = 0.00] and body mass index [P = 0.00], FC [P = 0.00] and total cholesterol [P = 0.02]; in spite of no significant differences in other lipid profiles. Comparing the 2 groups did not show any significant differences unless high-density lipoprotein cholesterol [P = 0.01] and low-density lipoprotein cholesterol/ high-density lipoprotein cholesterol ratio [P = 0.02] had greater improvement in obese women. We concluded that CRP is an important step initiating the process of risk reduction and restoration of FC in obese men and obese women with CHD under attendance and supervision of physician, nurse, and exercise physiologist.

relationship between hematologic variables and metabolic syndrome

The relation between hematologic variables and insulin resistance has been reported previously; however, there is still debate about the correlation between hematologic variables and the metabolic syndrome [MetS]. This study aimed to evaluate the relationship between MetS and white blood cells [WBC] and red blood cells [RBC]. This cross-sectional study recruited 11974 participants over 19 years old who participated in the Isfahan Healthy Heart Program [IHHP] in Najafabad and Arak, Isfahan. Participants were selected using multi-stage random sampling. A questionnaire about demographic variables, including age, sex, and past medical history, was filled for each participant by a trained nurse, and the participants' blood pressure, height, weight, waist circumference, and other anthropometric variables were recorded by physicians using standard methods. After 12 hours fasting, laboratory parameters, including RBC, WBC, hemoglobin [Hb], and hematocrit, [Hct] together with such biochemical variables as glucose, triglyceride [TG], and HDL-cholesterol were measured. MetS was defined according to the ATP-III criteria. The data were entered in SPSS-11 and analyzed using the t-test and correlation analysis. From the 11974 participants, 6132 [51%] were female. Mean age was 35.6 +/- 3.8 years in the females and 35.9 +/- 32 years in the males. In general, 23.1% of the subjects had MetS: 35% in the females and 10.6% in the males [p<0.05]. WBC and RBC were higher in the subjects with Mets. Regarding the correlation between the hematologic variables and the MetS components, the most significant correlations were seen between TG and WBC [r: 0.195, p<0.001] and HDL-C and RBC [r: -0.245, p<0.001]. According to our findings, high counts of RBC and WBC were observed in those with MetS. The predictive use of these parameters needs further longitudinal

Diabetes and associated cardiovascular risk factors in Iran: the Isfahan Healthy Heart Programme

<p><b>INTRODUCTION</b>Diabetes mellitus (DM) is one of the major health problems worldwide. The aim of this study was to detect the prevalence of DM and its associated risk factors in Iran.</p><p><b>MATERIALS AND METHODS</b>This cross-sectional study was performed in 3 cities in the central part of Iran on participants over the age of 19 years. Sampling was conducted by multi-stage randomised cluster method. Initially, a questionnaire consisting of demographic information, drug intake and smoking status was filled out. Later, a physical examination was performed, including the measurement of systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI) and waist-to-hip ratio (WHR). Fasting blood sample was drawn and analysed for sugar, total cholesterol (TC), triglyceride (TG) and 2-hour postprandial glucose. A fasting blood sugar (FBS) of >126 mg/dL or a 2-hour plasma glucose of over 200 mg/dL was considered an indication of diabetes. The impaired glucose tolerance test (IGTT) was defined with 2-hour plasma glucose of 140 to 200 mg/dL and FBS <126 mg/dL. The collected data were analysed with Student's t-test, chi-square test and multiple logistic regression analysis.</p><p><b>RESULTS</b>This study was performed on 12,514 subjects (48.9% males and 51.1% females). The total prevalence of DM was 6.7% and 5.3% in urban and rural areas and 5.4% and 7.1% in males and females, respectively. The mean blood glucose rose with age in both sexes, and blood glucose was higher in females and in urban areas. IGTT, known and new DM heightens as age increased and more than half of the diabetes cases in all age groups were newly diagnosed. The mean blood pressure, age, BMI, waist circumference and serum lipids were higher in people with DM and IGTT especially in females. Obesity, a family history of DM, high blood pressure, high WHR and ageing were associated with a higher probability of DM, but sex had no effect on this probability.</p><p><b>DISCUSSION AND CONCLUSION</b>Considering the high prevalence of DM in the central regions of Iran, providing vast educational programme to prevent this disease is essential and screening FBS tests, especially for obese subjects and those with a family history of DM, should be taken into account.</p>