Environmental determinants of cardiovascular diseases risk factors: a qualitative directed content analysis.

BACKGROUND: Cardiovascular diseases (CVDs) are the number one cause of death in the world. In most analyses of health problems, environment plays a significant and modifiable role in causing the problem either directly or indirectly through behavior. OBJECTIVES: This study aims to understand the patients and healthcare providers' experiences about the environmental determinants of CVD risk factors based on the Precede Model. PATIENTS AND METHODS: This qualitative study conducted over six months in 2012 at Diabetes Units of Health Centers associated with Alborz University of Medical Sciences and Health Services which is located in Karaj, Iran. The data were collected based on individual semi-structured interviews with 50 patients and 12 healthcare providers. Data analysis was performed simultaneous with data collection using the content analysis directed method. RESULTS: Lack of behaviors like stress control, healthy eating and physical activity were the roots of the risk factors for CVD. The environmental factor is one of the barriers for conducting these behaviors. The environmental barriers included of structural environment including "availability and accessibility of health resources", "new skills", and "law and policies" which are located in enabling category and social environment including "social support", "motivation to comply" and "consequences of behavior" which are located in reinforcing category. The most barriers to performing health behaviors were often structural. CONCLUSIONS: The environmental factors were barriers for doing healthy behaviors. These factors need to be considered to design health promotion interventions. Policymakers should not only focus on patients' education but also should provide specific facilities to enhance economic, social and cultural status.

Effect of low glycemic load diet with and without wheat bran on glucose control in gestational diabetes mellitus: A randomized trial.

BACKGROUND: A low-glycemic index diet is effective in blood glucose control of diabetic subjects, reduces insulin requirement in women with gestation diabetes mellitus (GDM) and improves pregnancy outcomes when used from beginning of the second trimester. However there are limited reports to examine the effect of low glycemic load (LGL) diet and fiber on blood glucose control and insulin requirement of women with GDM. Therefore, the aim of this study was to examine the effect of low glycemic load diet with and without fiber on reducing the number of women with GDM requiring insulin. MATERIALS AND METHODS: All GDM women (n = 31) were randomly allocated to consume either a LGL diet with Fiber or LGL diet. RESULTS: We found that 7 (38.9%) of 18 women with GDM in Fiber group and 10 (76.9%) in "Without Fiber" group required insulin treatment. CONCLUSION: The LGL diet with added fiber for women with GDM dramatically reduced the number needing for insulin treatment.

A comparison of health-related quality of life among normal-weight, overweight and obese adults in Qazvin metabolic diseases study (QMDS), Iran.

BACKGROUND: Obesity is a public health problem that has raised concern worldwide. Numerous epidemiological studies have been showed the relationship between obesity, abdominal fatness and risk of a wide range of illnesses (i.e. diabetes). Obese people experience health-related quality-of-life (HRQL) impairments. The purpose of this study was to evaluate the effect of BMI on Quality of Life, among Normal-Weight, Overweight and Obese adults in Qazvin, Iran. METHODS: This Cross-Sectional study was conducted on 1103 subjects (aged 20-78 years old) from September 2010 to April 2011 in Qazvin, Iran. The study subjects were selected by multistage cluster random sampling method from residents of mindoodar district of Qazvin. Obesity was defined based on Body Mass Index and SF-36 questionnaire was used as measurement instrument for quality of life. Data were analyzed by Chi-square test, ANOVA and MANOVA. RESULTS: A total of 527 men and 576 women were entered the study. Mean BMI was 25.97 ±4.5 Kg/m2. The scores of 6 domains were significantly different between 3 groups of BMI. The differences of physical component summary (PCS) and mental component summary (MCS) scores were also significant between normal weight, overweight and obese subjects (p<0.001 and p<0.025, respectively). CONCLUSION: This study underlines the importance of HRQL in overweight and obese individuals. These results suggest that more attention to the obesity and overweight is needed in Iranian population.

Effect of low-glycemic load diet on changes in cardiovascular risk factors in poorly controlled diabetic patients.

BACKGROUND: One dietary strategy aimed at improving both diabetes control and control of cardiovascular risk factors is the use of low glycemic index diets. These diets have been reported to be beneficial in controlling diabetes, and also increase high density lipoprotein cholesterol (HDL-C), lower serum triglyceride, and reduce glycated protein. AIM: Therefore, we aimed to investigate the effect of a low glycemic index-low glycemic load (GL = 67-77) diet on lipids and blood glucose of poorly controlled diabetic patients. MATERIALS AND METHODS: In an intervention study, 100 poorly controlled diabetic patients (age 52.8 ± 4.5 years) who were taking insulin or on oral medication underwent administration of low GL diet (GL = 67-77; energy = 1800-2200 kcal, total fat = 36%, fat derived from olive oil and nuts 15%, carbohydrate = 41%, protein = 22%) for 10 weeks. Patients were recommended to follow their regular lifestyle. Total cholesterol, low density lipoprotein (LDL), HDL, triglyceride, glycated hemoglobin (HbA1c), weight, and body mass index (BMI) were measured before and 10 weeks after the intervention. RESULTS: Before intervention, initial blood cholesterol and triglyceride concentrations were 205.9 ± 21.6 and 181.5 ± 22.2, respectively, and were reduced to 182.6 ± 18.2 and 161.6 ± 16.7, respectively, after 10 weeks intervention (P < 0.001). LDL reduced and HDL increased significantly. The HbA1c percentage reduced by 12% (from 8.85 ± 0.22% to 7.81 ± 0.27%) (P < 0.001), and also their weight significantly reduced from 74.0 ± 5 kg to 70.7 ± 4.6 kg (P < 0.001). CONCLUSION: This study demonstrated that low GL diet having lower carbohydrate amount and higher fat content is an appropriate strategy in blood lipid and glucose response control of poorly controlled diabetic patients.

Knowledge, attitude and practice towards standard isolation precautions among Iranian medical students.

OBJECTIVE: Health care workers especially medical students are at risk of being exposed to blood-borne pathogens. Therefore, the aim of this study was to determine the knowledge, attitude and practice of medical students towards standard isolation precautions (SIP). METHODS: A standardized questionnaire was completed by 148 medical students from April to July of year 2009 to seek their knowledge, attitude and practice towards standard isolation precautions in a clinical setting at Qazvin University of Medical Sciences, Iran. RESULTS: The mean score of knowledge, attitude and practice towards standard isolation precautions were 6.8±2.1 (maximum 10), 16.6±4.2 (maximum 20), and 18.05 ± 4.5 (maximum 30) respectively. Significant differences were observed between practice of female and male (P < 0.008) and also knowledge of year 6 and year 7 students (P <0.021). DISCUSSION: Education on infection control based on standard isolation precaution must be stressed and barriers of appropriate practice must be removed.

Perception of the medical students on their future career in Qazvin University of Medical Sciences.

INTRODUCTION: Young physicians have many recruitment barriers in Iran. Therefore, for planning purpose, assessment of the attitudes of medical intern students towards their future career is important. METHODS: This cross-sectional study assessed the view points of 300 medical students through a self administered questionnaire. Data were analyzed using SPSS software with P value < 0.05. RESULTS: Two hundred and forty students (80%) of the students had responded to the questionnaire. Among them, 67.5% were female with mean age of 21.7±2.4. The main factors for deciding to study in medicine were their interest (64.1%), family pressure (13.5%) and social prestige of medical career (9.8%). The mean score of attitudes was 2.3±0.6. In total, 24.5% of students demonstrated not having interest in studying medicine. The most important cause of their interest change was long duration of education (24.4%) and cost of studying in medicine (13.8%). In total, 88.6% of students had negative viewpoint towards their medical career in future. CONCLUSION: In general, the attitude of medical students toward their future career was negative.

Nutritional status assessment of Minodar residence in Qazvin city, Iran: vitamin D deficiency in sunshine country, a public health issue.

INTRODUCTION: Nutrition has main effect on health or disease and results of nutrition assessment can be used in health planning of communities. Therefore we aimed to conduct the nutrition assessment especially vitamin D statue of an urban region in Qazvin city. METHODS: In a cross sectional study in year 2011, subjects who were randomly selected from residents of aged ≥ 20 years old in Minodar, an urban region of Qazvin city participated in this study. A 3-days food diary questionnaire was used to collect food consumption data and weight and height of subjects were measured. The food intake was analysis using "Nutrition 4, Diet analysis, Module version 3.5.2". RESULTS: The participants included 930 subjects (434 M and 496 F) having Mean BMI = 26 ± 4.4 kg/m2 and 60% of subjects were either overweight or obese. Daily energy intake of 50% of subjects was more than 2500 (13.6% from proteins, 55.6% from carbohydrate and 30.5% from fat sources). The daily cholesterol intake among 50-75% of population was more than daily recommended of 300 mg. The mean iron and zinc intakes were 17±5.6 and 12±4.5 mg/day and the intakes were highest in aged group of 20-29, while reduced in older groups. Vitamin A deficiency was observed in studied population and 75% of them were receiving less than daily recommended allowance of 800 µg/day, 25% of total studied population was receiving less than 400 µg/day. Vitamin D ingestion among 90-95% of participants was less than minimum daily recommended amount of 10 µg/day and calcium intake in 50-75% of studied population was less than recommended daily allowance of 800 mg/day. High amount of florid and caffeine ingestion from black tea was observed among population and 75% of population had florid intake of 10000 mµ/day. CONCLUSION: In general, majority of the population of region had higher amount intake of fat, cholesterol, low intake of calcium and vitamin D.

Urinary total protein as the predictor of albuminuria in diabetic patients.

BACKGROUND: In order to detect nephropathy, measurement of total (24 hrs) urinary albumin or albumin/creatinin ratio in random urine samples is being recommended. But methods of albumin measurement are not available in all laboratories and also cost about 6 times more than that of urinary total protein measurement. OBJECTIVES: This Study was performed to determine appropriate cut off point in 24 hours urine total protein to diagnose micro- and macroalbuminuria in patients with diabetes mellitus. PATIENTS AND METHODS: In this study, 204 patients with diabetes mellitus type I and II were selected. In collected 24 hours urine from patients, protein and albumin were measured by using Pyrogallol and Immunoturbidimetry methods, respectively. RESULTS: Normoalbuminuri (albumin < 30 mg/24 hrs urine), microalbuminuri (albumin = 30-300 mg/24 hrs urine), and macroalbuminuri (albumin > 300 mg/24 hrs urine) were detected in 130, 51, and 23 patients, respectively. In 24 hrs urine collections, amounts of protein and albumin were compared to calculate cut off point of exerted protein for nephropathy diagnosis. cut off point of 73 mg/day for urinary total protein had appropriate sensitivity (94.5 %, CI = 91.4 % -97.6 %) and specificity (77.9 %, CI = 72.8 % -82.9 %) for microalbuminuria, while cut off point of 514 mg/day (sensitivity 95.7 %; specificity 98.9 %) was detected for diagnosis macroalbuminuria. Urine protein exertion of 150 mg/day that is currently considered as a normal value in most laboratory kits had a sensitivity of 73.1 % by which 30 % of microalbuminuric cases remained undiagnosed. CONCLUSIONS: Urinary total protein cut-off points of 73 mg/day and 514 mg/day were diagnostic for micro- and macroalbuminuria, respectively.

Effect of low and high glycaemic index drink on sleep pattern in children.

OBJECTIVES: To evaluate the effect of high and low glycaemic index drinks on children's sleep pattern. METHODS: Eight children underwent 3 nights of full polysomnography study, one familiarization and two test nights consecutively. On the test nights, 1 hour before bedtime, the children had a milk drink of either low or high GI in a random order. The glycaemic loads (GL) were 7.4 and 52.8 for low and high GI drink respectively. RESULTS: The mean of total arousal index in the first half of night after the high GI was greater than that of low GI drink. (12.9 +/- 4.6 vs. 9.9 +/- 2.2, P = 0.03). NREM arousal index in the first half of night after the high GI was also higher than that of low GI drink. (12.7 +/- 4.8 vs. 9.6 +/- 2.3, P = 0.05). Other sleep parameters did not show any significant difference in low GI and high GI diets. CONCLUSION: NREM and total arousal indices were higher in those who consumed high GI drinks compared with low GI, one hour before sleep. It seems that the high quantity consumption of carbohydrates close to the bedtime is accompanied by frequent arousals and may affect the sleep quality.

Effect of an integrated case-based nutrition curriculum on medical education at Qazvin University of Medical Sciences, Iran.

INTRODUCTION: Nutrition education is identified as an important part of medical education by organizations. Qazvin University of Medical Sciences, school of medicine (QUMS SOM), has a required basic nutrition course of 36 hr in second year of medical school, but education experts reports show that the course does not provide required therapeutic skills for graduate student. METHOD: We decided to organize an 8-hr diet therapy work shop in order to develop a patient experience clinical based case study teaching to enhance clinical skills at QUMS SOM. RESULTS: Students' perception score about adequacy of nutrition instruction increased from 20% (at baseline) to 70% (after intervention). The mean nutrition knowledge score of total students in clinical nutrition were different between before and one month after integration (8.3±2.5, 13.4±3.2, P < 0.001). And two groups of participants including staggers and interns had similar nutritional knowledge score at pre-test (7.9±2.6 and 8.9±2.3 respectively). CONCLUSION: Implemented nutrition curriculum at QUMS was appropriate method to enhance student's perception about nutrition integration and to increase and translate the knowledge to clinical practice.

Effect of low glycemic load diet on glycated hemoglobin (HbA1c) in poorly-controlled diabetes patients.

Different carbohydrate diets have been administrated to diabetic patients to evaluate the glycemic response, while Poor-controlled diabetes is increasing world wide. To investigate the role of an alternative carbohydrate diet on glycemic control, we explored the effect of a low glycemic load (Low GL)-high fat diet on glycemic response and also glycated hemoglobin (HbA1c) of poor-controlled diabetes patients. Hundred poorly-controlled diabetes patients, HbA1c > 8, age 52.8 ± 4.5 y, were administrated a low GL diet , GL = 67 (Energy 1800 kcal; total fat 36%; fat derived from olive oil and nuts 15%; carbohydrate 42%; protein 22%) for 10 weeks. Patients did their routine life style program during intervention. Fasting blood glucose and HbA1c before and after intervention with significant reduction were: 169 ± 17, 141 ± 12; 8.85% (73 mmol/mol) ± 0.22%, and 7.81% (62 mmol/mol) ± 0.27%; respectively (P < 0.001). Mean fasting blood glucose reduced by 28.1 ± 12.5 and HbA1c by 1.1% (11 mmol/mol) ± 0.3% (P=0.001). There was positive moderate correlation between HbA1c concentration before intervention and FBS reduction after intervention (P < 0.001, at 0.01 level, R =0.52), and strong positive correlation between FBS before intervention and FBS reduction (P < 0.001, at 0.01 level, R = 0.70). This study demonstrated that our alternative low glycemic load diet can be effective in glycemic control.

Acute effects of the very low carbohydrate diet on sleep indices.

OBJECTIVE: We compared the effect of short-term consumption of a very low carbohydrate (VLC) diet over 48 h to a control mixed diet on sleep indices in healthy, non-obese men. DESIGN: This study employed a repeated-measure design where subjects were given isocaloric (2400 kcal) diets and matching evening test meals (4 h before usual bed-time), which were either mixed low-fat, high carbohydrate (15.5%, 12.5% and 72% of energy from protein, fat and carbohydrate, respectively) or VLC (38%, 61% and < 1% of energy from protein, fat and carbohydrate, respectively). Polysomnographic testing was performed on the familiarization and control night, 4 h after the first VLC test meal (acute phase) and 48 h (ketosis phase) following commencement of the VLC diet. SUBJECTS: Fourteen healthy, non-obese men (aged 18-35 years; body mass index 23.4 +/- 1.9 kg/m(2)) who were good sleepers took part in the study. MEASUREMENT: Objective sleep was recorded using a computerized sleep system. Urine ketone level was monitored with reagent strips before the evening test meals and at bed-time on the control night, during the VLC acute and ketosis phases. Blood glucose level was measured with a glucometer before the evening test meal until 120 min following the meal. Hunger and fullness were assessed immediately after the meal until bed-time with Likert scales. RESULTS: The proportion of rapid-eye movement (REM) sleep to total sleep time was significantly reduced at the VLC acute and VLC ketosis when compared to the control night (P = 0.006; n = 11 and P = 0.05; n = 14, respectively). The percentage of slow wave sleep (SWS) significantly increased for both the VLC acute (17.7 +/- 6.7) and ketosis (17.8 +/- 6.1) phases compared to control (13.9 +/- 6.3), P = 0.02 for both phases. CONCLUSIONS: In healthy, good sleepers, the VLC diet over the short-term promotes increases in the percentage of SWS (deep sleep stage 4) and a reduction in the percentage of REM sleep ('dreaming' sleep) compared to the control mixed diet. The sleep changes may be linked to the metabolism of the fat content of the VLC diet.

High-glycemic-index carbohydrate meals shorten sleep onset.

BACKGROUND: Dietary carbohydrate intake has been shown to increase the plasma concentration of tryptophan, a precursor of serotonin and sleep-inducing agent. OBJECTIVE: To investigate the role of carbohydrate in sleep induction, we explored the effect of glycemic index (GI) and meal time on sleep in healthy volunteers. DESIGN: We compared the effect of high- and low-GI carbohydrate-based meals ingested 4 h before bedtime on sleep quality. We also evaluated the effect of the timing of high-GI meals (4 h compared with 1 h) on sleep quality. Twelve healthy men (aged 18-35 y) were administered standard, isocaloric (3212 kJ; 8% of energy as protein, 1.6% of energy as fat, and 90.4% of energy as carbohydrate) meals of either Mahatma (low GI = 50) or Jasmine (high GI = 109) rice 4 h before their usual bedtime. On another occasion, the high-GI meal was given 1 h before bedtime. The participants underwent a familiarization night followed by 3 test nights in random order 1 wk apart. RESULTS: A significant (P = 0.009) reduction in the mean (+/-SD) sleep onset latency (SOL) was observed with a high-GI (9.0 +/- 6.2 min) compared with a low-GI (17.5 +/- 6.2 min) meal consumed 4 h before bedtime. The high-GI meal given 4 h before bedtime showed a significantly shortened SOL compared with the same meal given 1 h before bedtime (9.0 +/- 6.2 min compared with 14.6 +/- 9.9 min; P = 0.01). No effects on other sleep variables were observed. CONCLUSIONS: We showed that a carbohydrate-based high-GI meal resulted in a significant shortening of SOL in healthy sleepers compared with a low-GI meal and was most effective when consumed 4 h before bedtime. The relevance of these findings to persons with sleep disturbance should be determined in future trials.