[Using lms method in smoothing reference centile curves for lipid profile of iranian children and adolescents: a caspian study]

LMS is a general monitoring method for fitting smooth reference centile curves in medical sciences. They provide the distribution of a measurement as it changes according to some covariates like age or time. This method describes the distribution of changes by three parameters; Mean, Coefficient of variation and Cox-Box power [skewness]. Applying maximum penalized likelihood and spline function, the three curves are estimated and fitted and optimum smoothness is expressed by three curves. This study was conducted to provide the percentiles of lipid profile of Iranian children and adolescents by LMS. Smoothed reference centile curves of four groups of lipids [triglycerides, total-LDL- and HDL-cholesterol] were developed from the data of 4824 Iranian school students, aged 6-18 years, living in six cities [Tabriz, Rasht, Gorgan, Mashad, Yazd and Tehran-Firouzkouh] in Iran. Demographic and laboratory data were taken from the national study of the surveillance and prevention of non-communicable diseases from childhood [CASPIAN Study]. After data management, data of 4824 students were included in the statistical analysis, which was conducted by the modified LMS method proposed by Cole. The curves were developed with a degree of freedom of four to ten with some tools such as deviance, Q tests, and detrended Q-Q plot were used for monitoring goodness of fit models. All tools confirmed the model, and the LMS method was used as an appropriate method in smoothing reference centile. This method revealed the distributing features of variables serving as an objective tool to determine their relative importance. This study showed that the triglycerides level is higher and HDL-C level is lower in Iranian children and adolescents than their counterparts in Western countries. Future studies with larger sample size and with higher density at the end points and equal distribution of measurements in changing limits of covariates would hopefully reach more precise findings

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

nationwide survey of prevalence of pediculosis in children and adolescents in Iran

Since 2005, pediculosis is one of the obligatory reportable diseases from community to the Center of Disease Control. This study is the first nationwide survey on the prevalence of pediculosis and some associated risk factors in Iranian children and adolescents. National data of the Ministry of Health and Medical Education were gathered in 2005 through school screening programs and obligatory reports from the country health centers. 12,359,448 Iranian children and adolescents were screened in 2005. Overall, 213,450 students, consisting of 198,947 girls and 14,320 boys were reported have pediculosis. The prevalence of pediculosis was 581 per 100,000 population that varied from 1/100 000 to 8,303/100,000. In general, the highest prevalence of pediculosis was documented in south-eastern cities. The prevalence of pediculosis was significantly higher in girls than in boys [93% vs. 7%, respectively, p<0.0001]. In both genders, the highest prevalence of pediculosis was documented in the 6-10- year age group. Of those infected, 62% lived in rural areas, and 32% of those infected with pediculosis had a previous history of this infection. Most [99.37%] infected individuals had head lice, the rest had body and public pediculosis. The prevalence of pediculosis is low in Iranian children and adolescents, but this infestation is still a health problem in some south-eastern cities with warm climate and low to middle socioeconomic status

[Comparison of dietary and physical activity patterns among obese children and adolescents with or without metabolic syndrome]

Considering the appearance of chronic diseases in adulthood and the emergence of their underlying causes such as metabolic syndrome since early years of life, recognition of effective factors and taking interventional measures will lead to a more short term and long term beneficial effects. The aim of this study was to compare the dietary and physical activity patterns among obese children and adolescents with or without metabolic syndrome. This case-control study was conducted in 2007 in Isfahan. 825 overweight or obese children and adolescents [body mass index equal to or greater than 85th percentile] aged between 6-17 years were assigned into two groups: with or without metabolic syndrome and the dietary and physical activity patterns of the groups were compared with each other. Data were introduced into SPSS software and analyzed by means of Chi-Square, regression and t-tests. Comparison of the mean frequency of food consumption and physical activities in both groups indicated that increased consumption of meat, egg, dairy products, nuts, vegetables and fruits had a significant relationship with decreased incidence of metabolic syndrome. The physical activity level of those with metabolic syndrome was lower than that of those without this syndrome. However this difference was not significant. Considering the increasing incidence of obesity and metabolic syndrome in children and adolescents, and its relation with the dietary habits and physical activity established from early life, it is necessary to pay more attention to the lifestyle of children and adolescents in order to prevent emergence of chronic diseases in the future

Nationwide report on the findings of integrated school health screening program in Iran

Screening of students' health problems could lead to timely prevention and control of many health disorders. This study aimed to determine the nationwide prevalence of common disorders through school health screening program in Iran. This cross-sectional national screening program was conducted in 2007-2008 among first-and third-grade-students in primary schools, first-grade-students of middle and high schools of all provinces in Iran. Data were obtained from 3,124,021 [81.9%] students reported from the whole country classified into 33 geographical zones. Of total students studied, 12.48% had weight abnormalities, 4.77% had visual disorders, 3.95% had head lice, 2.24% had behavioral disorders, and 0.6% had hearing disorders. Among students studied, 0.4%, 0.7%, 0.4% and0.8% had endocrine, psychological, neurological and genitourinary disorders, respectively. In addition, 2.1%, 1.9%, 1.8%, 0.8%0.5%, 0.3% and 0.3% of students had ear, nose and pharynx disorder, anemia, skin and hair, cardiac, abdominal, vertebral and lung problems, respectively. In elementary schools, 57.6% of first-grade-students with at least one disorder were managed in outpatient settings and 6% of them were hospitalized for more investigation. Among third-grade-students of elementary schools, these values corresponded to 13.2% and 1.1%, respectively. Among first grade students of middle and high schools, this prevalence was 58.5% and 44.6% and 1.2% and 0.3% of students were hospitalized for more investigation. This integrated school screening program revealed a considerably high prevalence of health disorders among school students. These results might help health policy makers to design future health promoting programs

[Predicting risk factors of cardiovascular disease according to anthropometric measures in children and adolescents]

Regarding the higher risk of abdominal obesity versus generalized obesity, nowadays the combined measurement of body mass index [BMI] and waist circumference [WC] is used for prediction of obesity health hazards among adults however; such information is limited among children and adolescents. In this study, the individualized and combined influence of BMI and WC on risk factors of cardiovascular disease [CVD] in overweight children and adolescents was assessed. This study included 3432 overweight/obese children and adolescents referred to the Pediatric Preventive Cardiology Department [Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences] in whom six CVD risk factors were measured and registered. At the first step of analysis, BMI and WC were considered as continuous variables in predicting CVD risk factors. At the second step, the participants were initially categorized into overweight and obese, and later, the risk factors in each group were compared among those with WC lower and or higher than 75th percentile. When the BMI and WC in a regression model for predicting CVD risk factors were used, the increase in variance was found to have insignificant difference compared to those obtained for BMI and WC, individually. When the aforementioned categories were applied, WC was shown to be more informative about risk factors than that of BMI alone. The findings of present study emphasize on the role of abdominal obesity in increasing the risk of chronic diseases, notably CVD in children and adolescents hence, similar to adults, measurement of WC as well as BMI should be routinely considered among children and adolescents

[Prevalence of sonographic fatty liver in overweight and obese children; a cross sectional study in Isfahan]

Children's obesity is strong predictor ob obesity in adulthood, which increases the incidence of related diseases such as metabolic syndrome. Fatty liver is an abnormality related to metabolic syndrome with higher prevalence in obese children according to some previous studies. This study investigates the presence of Sonographic Fatty Liver [SFL] in Iranian obese children in comparison with normal and overweight children. This was a cross-sectional study on 962 randomly selected children between the ages of 6 to 18 years. The subjects were divided into three groups of normal, overweight and obese based on body mass index [BMI]. A questionnaire including demographic and anthropometrical characteristics was filled for each case. To detect the presence of SFL, all the subjects underwent assessment with ultarsonography by a radiologist who was not aware of their BMI. The incidence of SFL was determined on the basis of ultrasonographic diagnosis criteria. The prevalence of SFL in obese children was 54.4% that was significantly higher than overweight [10.5%] and normal children [1%]. There was no significant difference in prevalence of SFL between sexes. The high rate of detected SFL in obese children in this study suggests that Iranian obese children are at risk of metabolic syndrome. It is therefore necessary to develop some plan to control obesity and its late complications

Rationale, methods and first results of the Iranian national programme for prevention of chronic diseases from childhood: caspian study

The CASPIAN Study aims to implement a school-based surveillance system for prevention of noncommunicable diseases from childhood in the Islamic Republic of Iran. The baseline survey was conducted from November 2003 to May 2004 in 23 provinces among 21 111 school students aged 6-18 years and their parents. The data collected included: birth weight and current anthropometric measurements; dietary and exercise habits; family history of chronic diseases; and knowledge about prevention. Fasting blood sugar and lipid profile were assessed in a subsample of 4811 students

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

[Comparison between carotid IMT of obese adolescents with normal group]

Childhood overweight and obesity can be an underlying cause of atherosclerosis. An early stage of atherosclerosis is shown by intimal thickening. The purpose of this study is to evaluate intima-media thickness [IMT] of carotid arteries on 12 to18 years' old obese children in comparison to control group. In a case-control study, height, weight, blood pressure, cholesterol, triglyceride, mean IMT of body and bulb of carotid artery [of both sides] were measured in eighty [40 obese and 40 normal], 12 to18 years old students. Data was analyzed by X[2] and student - test in SPSS-15 analytical software at P<0.05. The mean age in obese and control groups were 13.9 +/- 1.7 and 14.4 +/- 1.9 years respectively [P=0.192] .The mean weight, cholesterol and triglyceride in the obese group was 72.05 kg, 175.9 mg/dl and 154.9mg/dl. In control group, 47.9 kg, 146.9 mg/dl and 90.05 mg/dl respectively [P<0.000]. The mean carotid artery IMT in obese and control groups were 0.4806, 0.4167 [P<0.00] and the mean IMT of bulb were 0.4885, 0.4362 [P<0.00] respectively. Increase in IMT of body and bulb of carotid artery, were shown in obese adolescences and these increases of thickness were associated with high blood levels of cholesterol and triglyceride

Cardiovascular disease risk factors, metabolic syndrome and obesity in an Iranian population

As part of the Isfahan Healthy Heart Program, we evaluated the prevalence of cardiovascular disease risk factors in Iranians with generalized and abdominal obesity. We carried out a crosssectional study on 3694 participants aged >/= 19 years. Overall, 36.6% of men and 35.9% of women were overweight; 11.2% of men and 28.1% of women were obese. Mean body mass index [BMI], waist circumference [WC] and waist/hip ratio [WHR] increased with age up to 65 years. Total serum cholesterol, triglycerides and 2-hour post-load plasma glucose increased with BMI, WC and WHR in both sexes. Prevalence of metabolic syndrome was 19.8% in females with normal BMI, 48.1% in overweight females and 63.2% in obese females. In males, corresponding values were 3.7%, 18.0% and 40.1%

Clustering of coronary artery disease risk factors in patients with type 2 diabetes and impaired glucose tolerance

A cross-sectional study in Isfahan city, Islamic Republic of Iran, compared the frequency of coronary artery disease risk factors in known and newly diagnosed diabetic patients and individuals with impaired glucose tolerance [IGT] with normal individuals. The prevalence of known cases of diabetes, new cases of diabetes and cases with IGT in the general population sample of 3940 were 4.3%, 1.1%, and 6.2% respectively. The frequency of dyslipidaemia was significantly different comparing diabetics and normal individuals. There was a significantly higher prevalence of risk factors [i.e. increased body mass index or waist circumference accompanied by dyslipidaemia] in the female population. The study highlights the importance of defining strategies for prevention and early diagnosis of diabetes in the community

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

Parental consanguinity among parents of neonates with congenital hypothyroidism in Isfahan

We determined the prevalence of congenital hypothyroidism and the rate of consanguinity among parents of hypothyroid neonates among 93 381 neonates born in 17 hospitals in Isfahan from May 2002 to April 2005. Serum thyroxine [T4] and thyroid stimulating hormone [TSH] levels were measured on the 3rd-7th day of birth and neonates with abnormal levels were recalled and the levels reassessed. Those with TSH

Physical activity in iranian students CASPIAN study

Sedentary behavior in childhood is one of the strongest risk factors for many chronic diseases and somatic conditions in adulthood, including cardiovascular disease, hypertension, obesity, and osteoporosis. This study was an investigation to design a surveillance system for non-communicable diseases. The present national survey was performed as a multi-centric cross-sectional study for the baseline survey of a project entitled: "Childhood and Adolescence Surveillance and PreventIon of Adult Non- communicable Diseases-CASPIAN Study. The study was supported by the World Health Organization and performed by the Ministry of Health, the Ministry of Education, with collaboration of 23 universities of Medical Sciences. One of the items studied was the physical activity. Physical activity data is evaluated by metabolic equivalent [METs] accelerometers. 21111 school pupils aged 6 to 18 years consisting of 10858 girls [51.4%] and 10253 boys [48.6%] have been studied. 5.2% of them were obese and 9.4% overweight. The mean times of moderate and vigorous physical activity were 4.7 and 0.8 hours everyday. Boys were more active than girls [p<0.05] and primary school students were more active than high school students [p<0.05]. Watching television, using the computer, or playing video games were the most common sedentary activity in students. Physical activity in our subjects was in acceptable level. Boys tend to be more active than girls, and there is a decrease in activity over the adolescent years

Assessment of anxiety in 12-18 years old overweight and obese students in Isfahan

Childhood obesity has become a health hazard in different communities. In addition to organic disorders, it can also lead to some psychological disturbances such as anxiety. To compare the mean anxiety score between overweight and obese adolescents with controls, and to assess the correlation between the anxiety of adolescents with their school performance and the jobs of their parents. This case-control study was performed in 2003 among 266 students aged between 12-18. They were selected by multi-stage random sampling from among guiding-and high schools of Isfahan. Ninety three overweight and obese students [body mass index or BMI>85th age and gender specific percentile] were considered as the case group and 176 students with a BMI<85th percentile as controls. Two questionnaires, validated in a pilot study on 50 students, were completed by each subject. Data were analyzed by SPSS 11 software using the t-Student Chi-Square, ANOVA and Pearson correlation at p<0.05. The mean anxiety score and the school performance were not significantly different between two groups. A significant correlation was found between the parents' jobs and the mean anxiety score and school performance of their children. The students whose parents were an employee or teacher had a lower anxiety score and a better school performance. In spite of higher anxiety score in obese adolescents found in western countries, the present study was not indicative of any significant difference between two groups which is supposed to be mainly associated with a public opinion in which many people in our society yet believe that the obesity is an indicator of health. Larger longitudinal studies are recommended

impact of breast feeding in prevention of obesity in children

Some factors in the infancy can lead to a deleterious effect on childhood obesity. Finding of such factors can help in the primary prevention of this disorder in children which is related to obesity in adulthood. To compare the birth weight, frequency and the duration of breast feeding during infancy in obese children and controls. This case-control study was performed in 2003 among 140 children aged between 2-12 years with obesity [BMI> 95[th] age and gender-specific percentile] and an equal number of age and gender-matched controls from among the neighbors of the cases. Birth weight was recorded from the nursery card or the growth chart on the vaccination card. The frequency and duration of breast feeding were recorded according to mothers' responses. Data were analyzed by SPSS 11 using the student t and chi square tests at P<0.05. The mean birth weight was not significantly different between case and controls. The frequency and duration of breast feeding was significantly lower in cases than the controls. The frequency and duration of breast feeding in obese children were significantly lower than controls. This emphasizes the importance of breast feeding to help the primary prevention of obesity and many non-communicable diseases later in life

prevalence of cardiovascular risk factors among women of central parts of Iran: Isfahan healthy heart programme

Among the leading causes of mortality in women is the cardiovascular disease [CVD] and the control of CVD risk factors prevents CVD and the associated mortality. To determine the prevalence of CVD risk factors in women of central part of Iran. This descriptive cross sectional study was performed on 6391 women in three cities located in central parts of Iran [Isfahan, Najaf-Abad and Arak]. The subjects were 20 years old or above. Demographic data and blood samples for glucose and lipid measurements were collected. Determination of blood pressure for three consecutive periods and also weight and height were performed for each subject. Hypertriglyceridemia, smoking and overweight were more prevalent in urban areas while hypertension, high LDL-C and hypercholesterolemia more prevalent in rural parts. Hypercholesterolemia, high LDL-C and diabetes increased with aging. Based on our results, the prevalence of risk factors was high among the study group. More education and also recommendations on changing of women lifestyle are suggested

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

Trends in blood pressure level, prevalence of hypertension and its care in Isfahan

This study evaluated the trend of HTN in population of isfahan who are above 18 years. Current study measured the trend of HTN, the mean systolic and diastolic blood pressure, the rate of patients awareness, treatment and control of HTN. This study consists of 4 cross sectional surveys which have been performed in 1991, 1993, 1997 and 2000. All 4 surveys measured the trend of HTN, the rate of awareness, treatment and control of HTN in patients. All studies were cross- sectional. The health supplier went to patients home and invited them to refer to HTN clinic of Isfahan Cardiovascular Research Center. When data were collected,, they given to computer and analyzed using SPSS by t-test. The trend of HTN has decreased since 1999 to 2000 [31.8% in 1991 and 17.5% in 2000] but this trend hasn't significantly decreased in population, also the trend of HTN between sexes had no significant differences [P>0.05]. The mean systolic and diastolic BP of both male and female hypertensive patients have been significantly decreased since 1991 to 2000. Percentile patients' awareness, treatment of HTN, and control of HTN have increased from 46%, 23% and 2.8% to 50%, 33.9% and 12% since 1991 to 2000 respectively. Women controlled their hypertension better than men [16.5% in women and 6.5% in men]. Considering decreasing of HTN, and the mean systolic and diastolic BP, it is essential to design and implement proper community-based intervention for primary and secondary prevention of HTN. The decreasing trend of HTN, mean systolic and diastolic BP and the increasing trend of patients' awareness of treatment, and control of HTN, are helpful to develop this process by these mechanisms. Considering the trend of HTN among patients above 60 years it is essential to implement more effective methods to control their HTN