[Association between healthy lifestyle score and upper gastrointestinal disorders in Iranian adults]

Background and Objective: Although lifestyle-related factors have separately been examined in relation to functional gastrointestinal disorders [FGIDs], there is no epidemiologic data on the combined association of lifestyle factors with these conditions. We aimed to examine how combinations of several lifestyle factors were associated with functional dyspepsia [FD], its symptoms and gastro-esophageal reflux disease [GERD] in a large group of Iranian adults

Methods: This descriptive -analytic study was conducted on 3363 Iranian adults [19-70 yr], whom were working in 50 health centers across Isfahan province in Iran during 2012. We used easy non-random sampling to select participants. The "healthy lifestyle score" for each participant was calculated by summing up the binary score given for five lifestyle factors, including dietary habits, dietary intakes, psychological distress, smoking and physical activity. A dish-based 106-item semi-quantitative validated food frequency questionnaire, General Practice Physical Activity Questionnaire, General Health Questionnaire and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. A validated Persian version of ROME III questionnaire was used, to assess functional gastrointestinal disorders

Results: The prevalence of FD and GERD among study participants was 14.5 and 23.6%, respectively. After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle had 79 and 74% lower odds of FD [95% CI: 0.05-0.92, OR: 0.21, P=0.03] and GERD [95% CI: 0.09-0.69, OR: 0.26, P=0.01], respectively, compared with those with the lowest score. They were also less likely to have early satiation [95% CI: 0.11-0.73, OR: 0.28, P=0.001], postprandial fullness [95% CI: 0.09-0.50, OR: 0.22, P<0.001] and epigastric pain [95% CI: 0.21-0.92, OR: 0.44, P=0.03]. In addition to the combined healthy lifestyle score, low levels of psychological distress, a healthy diet, healthy dietary habits and non-smoking were separately associated with FGIDs [P<0.05]

Conclusion: This study showed that adherence to a healthy lifestyle was associated with lower odds of GERD, FD and its symptoms in this group of Iranian adults. Individual lifestyle-related factors were also associated with these conditions

[Relation between pattern of nutrient intake and obesity in Isfahanian Adults: SEPAHAN study]

Background and Objective: The growing evidence suggest on the association between dietary patterns and obesity. This study was done to determine the relation between pattern of nutrient intake and obesity in Isfahanian adults

Methods: In this descriptive - analytical study, dietary data were collected using a semi-quantitative food frequency questionnaire in 8,691 subjects aged 18-55 years. Complete data of 6,724 and 5,203 adults were available for general and abdominal obesity, respectively. Daily intakes of 38 nutrients and bioactive compounds were calculated for each participant. Factor analysis was applied to derive major nutrient patterns

Results: Three major nutrient patterns were identified: 1] pattern high in fatty acids, cholesterol, vitamin B12, vitamin E, zinc, choline, protein, pyridoxine, phosphorus, and pantothenic acid; 2] high in thiamine, betaine, starch, folate, iron, selenium, niacin, calcium, and manganese; and 3] high in glucose, fructose, sucrose, vitamin C, potassium, dietary fiber, copper and vitamin K. Men in the highest quintile of the second pattern were less likely to be generally obese in the fully adjusted model [95% CI: 0.20-0.76, OR: 0.39, P<0.05]. After adjustment for potential confounders, a significant positive association was observed between the third pattern and general obesity among men [95% CI: 1.04-3.04, OR: 1.77, P<0.05], but it was not in women [95% CI: 0.74-1.88, OR: 1.18, P>0.05]

Conclusion: Nutrient patterns were significantly associated with general, but not abdominal obesity in the male Iranians participating in SEPAHAN study

effects of cognitive - behavior therapy and drug therapy on quality of life and symptoms of patients with irritable bowel syndrome

Psychological treatment and the efficacy of drug therapy are considered to be useful in quality of life and symptoms of patients with irritable bowel syndrome. The aim of this study was to examine the effects of cognitive-behavior therapy associated with drug therapy in comparison to drug therapy alone on the quality of life and symptoms of IBS patients with diarrhea predominance. This study was a randomized clinical trial on 64 IBS patients. The patients were selected according to Rome-Hi criteria, and were divided into the two groups. Bowel Symptoms Severity and Frequency Scale [BSS-FS] and Quality Of Life [QOL-IBS] were used for evaluation of patients' symptoms. The first group underwent cognitive-behavior therapy with medication therapy, and the second group only received medication. Data were analyzed using analysis of multiple covariances [MANCOVA]. The two groups showed significant difference in the QOL-IBS in post treatment and follow-up stages [P<0/05]. There were significant differences in the severity and frequency of IBS symptoms between the two groups after the study period [P < 0.05]. However, no significant difference was observed at follow-up stage between the two groups [P > 0.05]. Cognitive-behavior therapy associated with drug therapy can be useful in IBS patients with diarrhea predominance. However, stopping this treatment may lead to recurrence of the symptoms

Talents for future: report of the second national medical science Olympiad in Islamic Republic of Iran

This report describes a unique experience of Second National Medical Science Olympiad that was held in August 2010 in Shiraz, Islamic Republic of Iran. The history of medical science Olympiad in Iran and the development, process and domains in the Olympiad and the way for future will be discussed

Effects of relaxation and citalopram on severity and frequency of the symptoms of irritable bowel syndrome with diarrhea predominance

Irritable bowel syndrome [IBS] is the most prevalent functional bowel disorder which is characterized by chronic abdominal pain and altered bowel habit in the absence of any organic disease. This study examined the effects of "relaxation and citalopram" in comparison to "citatopram" alone on alleviating the symptoms of IBS patients with diarrhea predominance. This study was a randomized clinical trial which included 64 IBS patients. The patients were selected according to Rome-Ill criteria, and were divided into two groups. Bowel Symptoms Severity and Frequency Scale [BSS-FS] was used for evaluation of the patients' symptoms. Data was analyzed using analysis of covariance [ANCOVA]. There were significant differences in the severity and frequency of IBS symptoms between two groups after the study period regarding BSS-FS [P<0.05]. However, no significant difference was observed at follow-up stage between two groups [P > 0.05]. Relaxation in addition to citalopram in IBS patients with diarrhea predominance can decrease the severity and frequency of symptoms. However, stopping this treatment may lead to recurrence of the symptoms

Effect of relaxation with drug therapy on the psychological symptoms in patients with irritable bowel syndrome-diarrhea dominant [IBS-D]

Irritable bowel syndrome is the most prevalent functional bowel disorder which is characterized by chronic abdominal pain and altered bowel habit in the absence of organic disease. Psychological factors are of the major factors involved in this disease. The aim of this study was comparison of the effect of relaxation with and without drug therapy on the psychological symptoms in patients with irritable bowel syndrome-diarrhea predominant [IBS-D]. This clinical- trial study was performed on 32 IBS-diarrhea dominant patients. Patients were randomly divided into two groups. One group was treated by using relaxation technique without drug therapy and another group was treated by using relaxation technique combined with drug therapy. Diagnostic characters of Rome-II and III were used for diagnosing the IBS-D patients and SCL-90 test was used for evaluating the psychological symptoms. The study was performed in three steps, pretest, post test and 4 months after last intervention [follow up group]. Data were analyzed using analysis of covariance [ANCOVA] method. The average age of the patients in this study was 37 +/- 15.43 years. Our study demonstrated that there was a significant reduction in psychological symptoms scores in post test and follow up groups compared to the pre test group. This reduction was higher in patients receiving relaxation combined to drug therapy compared to the drug therapy group [P<0.05]. Based on the results of this study, Combination of relaxation and drug therapy is effective for reducing the psychological symptoms in irritable bowel syndrome patients

[Study on validity of farsi version of irritable bowel syndrome quality of life questionnaire [IBS-QOL-34]]

This study aimed to evaluate psychometric characteristics [diagnostic validity and reliability] of quality of life questionnaire in irritable bowel syndrome [IBS-QOL] which is a popular inter-cultural measure. According to ROME II criteria 126 patients were included by the caring physician in Alzahra and Noor hospital clinics in Isfahan, Iran. Results: Eight scales of the questionnaire and total quality of life measure showed good internal reliability [Cronbach alpha=0.93 for the whole questionnaire, 0.88 for dysphoria, 0.67 for activities interference, 0.72 for body image, 0.57 for health worry, 0.57 for food abstinence, 0.71 for social reaction, 0.76 for sexual worry, 0.62 for interpersonal relations]. The validity was measured against another quality of life questionnaire [IBS-QOL-36] and a significant correlation was found [r=0.61. p<0.01]. To evaluate diagnostic accuracy 40 patients were compared with 40 healthy subjects. Except for body image scale other parts of questionnaire and the global quality of life were significantly different between these two groups [p<0.05]. Generally, Farsi version of IBS-QOL questionnaire was found to be a valid and reliable mean to study patients with irritable bowel syndrome

effects of clinical rounds on patients in internal wards of hospitals affiliated to Isfahan University of medical sciences: the viewpoints of clinical care team

Clinical rounds as one of the clinical teaching methods, may cause adverse effects on patients and the medical team is able to report such problems. The purpose of this study was to determine the effects of clinical rounds on patients from medical teams' points of view. This descriptive cross-sectional study was conducted on 150 members of clinical care team including clerkship and internship students and nurses who were selected through convenient sampling method in educational hospitals affiliated to Isfahan Medical University. A questionnaire containing demo-graphic features, items asking the medical team's viewpoint about the method of running medical rounds, the list of events experienced by the patient, and medical team opinions regarding the patients' feelings toward the manner of clinical round was distributed as self-administered. The data was analyzed by SPSS software using frequency distribution, mean and standard deviation, and the comparisons were made by ANOVA. The medical team believed that patients had the most satisfaction from performing procedures by interns and residents, precision and follow up in therapeutic affairs, general outcome of hospitalization, and the duration of visits. Their least satisfaction was about the number of examiners, the duration of patient's encounter with the main physician, explanation about the disease and taking the patient's opinion into account in decision making. Based on the medical team's opinion, the current method of clinical rounds may cause dissatis-faction in patients and result in undesirable consequences. Revision and reforming the current situation of rounds can lead to the improvement of this process

effect of communication skill training on clinical skill of internal medicine and infectious disease residents of Isfahan University of Medical Sciences

Clinical competence has four essential components: knowledge, physical exam, problem solving and communication skill. The communication skill isn't an optional extra in medical training but it is a core clinical skill. This stud is performed in order to determine whether communication skill training for Internal Medicine and Infectious Disease residents improves their clinical competence. This study was performed in 2004-2005 in Isfahan University of Medical Sciences. Thirteen internal Medicine and Infectious Disease residents were involved in this study. We had 8 residents in group one and 5 residents in group two. Group one first participated in communication skill workshop and then their clinical skill was evaluated with objective structured clinical examination [OSCE1]. Group two's clinical skill was first evaluated with OSCE1 and then after participating in communication skill workshop again their clinical skill was evaluated by OSCE 2. The scores of group one in OSCE1 after participation in communication skill workshop were compared to group two in OSCE1 before the workshop. The scores of group two before the communication skill workshop [OSCE1] and after the workshop [OSCE2] were compared Also the scores of group one after the workshop [OSCE1] and group two after the workshop [OSCE2] were compared. Group one after the communication skill workshop had significantly higher scores in clinical skill compared to group two before the workshop. Group two had significantly higher clinical skill scores after the communication skill workshop compared to the clinical skill scores of the same group before the workshop. Communication skill workshop significantly improved the clinical skill of Internal medicine and Infectious disease residents

Seroprevalence of hepatitis B in Nahavand, Islamic Republic of Iran

We determined the seroprevalence of hepatitis B in Nahavand in a sample of 1824 subjects > 5 years in 2002. Face- to- face interviews were conducted and blood samples taken. The association between risk factor and hepatitis B was assessed using logistic regression. The prevalence of HbsAg positive cases was 2.3%, and HBcAb and HBsAb were isolated in 7.8% and 11.6% of the participants respectively; 11.9% were positive for both HBcAb and HBsAb. History of surgery and imprisonment were the major risk factors for infection with odds ratios of 2.14 [95% CI: 1.22- 3.05] and 3.57 [95% CI: 1.68- 5.4] respectively

Silent ischemia in type I diabetic patients: a study of EKG changes

Ischemic Heart Diseases [IHD] is the major cause of mortality and morbidity worldwide. Diabetes Mellitus [DM] is known as one of the main risk factors of IHD. Silent ischemia is seen in diabetic patients more that in others. Identification of these cases is of great value in clinical practice. In this study, ECG changes and their relationship with clinical symptoms of ischemia were evaluated in diabetes type II patients. In a cross-sectional study at Isfahan Endocrinology and Metabolism Research Center on diabetes type II patients [2004], 500 consecutive records out of nearly 5000 active records were selected via a simple sampling method. 12-lead resting ECG was taken from all patients. Minnesota codes were used to study ECG changes. Patients with electrocardiograms suggestive of ischemia or MI but no chest pain were considered as having silent ischemia. A total of 500 subjects [44.4% men and 55.6% women] were studied. EKG changes favoring MI, probable MI, and ischemia were seen in 2%, 12.4%, and 13.6% of patients. Silent ischemia had a prevalence of 85.6%. Of this number, 6.3% had suffered definitive MI based on EKG changes. Silent ischemia is very common in diabetic patients. Alertness to silent ischemia, especially in the elderly can greatly contribute to early detection of CVD and adoption of timely therapeutic measures in these patients. However, as this study was merely based on resting-state EKG changes, the findings may be questionable. Hence, further studies using more accurate ischemia detection methods are warranted

An economic analysis of premarriage prevention of hepatitis B transmission in Iran

To assess the economic aspects of HBV [hepatitis B virus] transmission prevention for premarriage individuals in a country with cultural backgrounds like Iran and intermediate endemicity of HBV infection.A cost-effectiveness analysis model was used from the health care system and society perspectives. The effectiveness was defined as the number of chronic HBV infections averted owing to one of the following strategies: 1] HBsAg screening to find those would-be couples one of whom is HBsAg positive and putting seronegative subjects on a protection protocol comprising HBV vaccination, single dose HBIG and condom protection. 2] HBsAg screening as above, in addition to performing HBcAb screening in the HBsAg negative spouses of the HBsAg positive persons and giving the protocol only to HBcAb negative ones. Sensitivity and threshold analyses were conducted. The cost of each chronic infection averted was 202$ and 197$ for the strategies 1 and 2, respectively. Sensitivity analysis showed that strategy 2 was always slightly cheaper than strategy 1. The discounted threshold value for the lifetime costs of chronic liver disease, above which the model was cost saving was 2818$ in strategy 1 and 2747$ in strategy 2.Though premarriage prevention of HBV transmission in the countries with cultural backgrounds similar to Iran seems cost saving, further studies determining precise costs of HBV infection in Iran can lead to a better analysis