On the estimation of survival time and contributory risk factors in the elderly participants in the Tehran lipid and glucose study. A 10-year follow-up

ABSTRACT       In the increasing population of the elderly in Iran, so far no prospective health studies have been undertaken.  This study was conducted to identify the risk factors of survival time of the elderly of ages above 60 years. Material and Methods: Individuals above 60 years old were recruited in the primary phase of the Tehran Lipid and Glucose Study (TLGS) during 1998-2001. They were followed up for 10 years and their vital status were registered (1998-2008).  Age and sex mortality rates for age groups (60-69, 70-79, 80+) were calculated and by using Cox proportional hazard model the hazard rates were estimated. Results: Out of 929 males, 154 (17%) and out of 869 women 85(10%) died during the follow-up years. Cox model showed that diabetes on an average reduces 4.4 years and 2.5 years and smoking reduces 5 and 6.6 years of males' and females' survival time, respectively. BMI>33Kg/m2 and dis-lipoproteinemia reduce 4.5 years and 4 years of women's life span.  Tehranian native men on an average live 3 years shorter than other male residents. In addition, hypertension and history of MI, stroke or sudden death of father, brother or son reduce 3.3 years and 4.1 years of men's life time. Conclusion: The elderly population is in need of a healthy ageing to be gained from prevention and intervention. Identification of life time reducing risk factors of elderly helps the policymakers to develop some protocols to increase the life span of the population.

Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II

<p>Abstract</p> <p>Background</p> <p>The Tehran Lipid and Glucose Study (TLGS) is a long term integrated community-based program for prevention of non-communicable disorders (NCD) by development of a healthy lifestyle and reduction of NCD risk factors. The study begun in 1999, is ongoing, to be continued for at least 20 years. A primary survey was done to collect baseline data in 15005 individuals, over 3 years of age, selected from cohorts of three medical heath centers. A questionnaire for past medical history and data was completed during interviews; blood pressure, pulse rate, and anthropometrical measurements and a limited physical examination were performed and lipid profiles, fasting blood sugar and 2-hours-postload-glucose challenge were measured. A DNA bank was also collected. For those subjects aged over 30 years, Rose questionnaire was completed and an electrocardiogram was taken. Data collected were directly stored in computers as database software- computer assisted system. The aim of this study is to evaluate the feasibility and effectiveness of lifestyle modification in preventing or postponing the development of NCD risk factors and outcomes in the TLGS population.</p> <p>Design and methods</p> <p>In phase II of the TLGS, lifestyle interventions were implemented in 5630 people and 9375 individuals served as controls. Primary, secondary and tertiary interventions were designed based on specific target groups including schoolchildren, housewives, and high-risk persons. Officials of various sectors such as health, education, municipality, police, media, traders and community leaders were actively engaged as decision makers and collaborators. Interventional strategies were based on lifestyle modifications in diet, smoking and physical activity through face-to-face education, leaflets & brochures, school program alterations, training volunteers as health team and treating patients with NCD risk factors. Collection of demographic, clinical and laboratory data will be repeated every 3 years to assess the effects of different interventions in the intervention group as compared to control group.</p> <p>Conclusion</p> <p>This controlled community intervention will test the possibility of preventing or delaying the onset of non-communicable risk factors and disorders in a population in nutrition transition.</p> <p>Trial registration</p> <p>ISRCTN52588395</p

The knowledge of pediatric intensive care unit staffs regarding Pulse Oximetery

Background &amp;amp; Aim: Pulse Oximeter monitoring technology has become so common in intensive health care settings over the last decade that blood oxygen level is now considered as the fifth vital sign. However, it seems that medical and nursing staffs are not specially educated to operate with the devices. The aim of the study was to investigate the knowledge of medical assistants (residents), nurses and anesthesia technicians of pediatric intensive care units regarding Pulse Oximetery. Methods &amp;amp; Materials: This is a cross-sectional study. The study population consisted of all nurses, first year to third year medical assistants, and anesthesia technicians who working in intensive care units in Pediatric Center. A questionnaire was used for data gathering that had three sections: the first section as demographic data (occupational condition, record of service in pediatric unit, having the experience of using Pulse Oximetery, having enough knowledge about Pulse Oximetery, and its educational program type); the second section (eighteen short answer questions) in order to determine the participants knowledge about Pulse Oximetery and the third section (four imaginary clinical scenarios) evaluating the participants interpretation on Pulse Oximetery reports and its changes in patients. The collected data were analyzed through descriptive and inferential statistics (Fisher exact test) by SPSS v.15 and EPI6 computer softwares. Results: The analyses showed that 77.4% of the participants did not pass any educational course regarding Pulse Oximetery, also 67.9% of them correctly identified what Pulse Oximeter measures, and 47.2% of the subjects correctly identified how a Pulse Oximeter works, and 13.2% identified its normal range, but only 26.4% had a correct understanding of the Oxhemoglobin dissociation curve and explained it completely true. It was found that the majority of the participants were wrong in their answers about Pulse Oximeter monitoring. They made mistakes in interpretation of the imaginary clinical scenarios. Conclusion: The results of the study showed that the majority of pediatric intensive care unit staffs have little knowledge regarding Pulse Oximeter monitoring, then with attention to the vast usage of the technology the necessity of formal educational programs in colleges and retraining courses during employment about the device for health care providers is apparent. &amp;nbsp

Leisure time physical activity and its determinants among adults in Tehran: Tehran lipid and glucose study

Objectives: The aim of this study was to assess leisure time physical activity and its determinants among adults in Tehran. Methods: This cross-sectional study comprised adults (n = 7285), aged 20 years and older. The subjects were participants of the Tehran Lipid and Glucose Study between 2002 and 2004. Information on the number of days spent on different activities during a week and the time devoted to each activity on a typical day was recorded. In addition, each activity, weighted by its relative intensity, was referred to as a metabolic equivalent. Results: The prevalence of inactivity was 69.8% (95% CI: 68.7-70.8) in the whole population and 30.2% (95% CI: 27.2-33.1%) of men and 30.3% (95% CI: 27.7-32.8%) of women were considered as active. Leisure time physical activity less than 30 min/week was scored in 1590 (50.6%) men and 1803 (43.5%) women. The most frequent leisure time physical activity performed by men (96.1%) and women (95.2%) was walking. A negative association was observed in men between leisure time physical activity and increased work hours, older age, more cigarette smoking and higher body mass index (69.8% were overweight and 75.3% were obese; P < 0.05). Leisure time physical activity was more likely to be associated with high educational levels in men. In addition, there was a statistically significant relationship between physical inactivity and occupation in both men and women. Conclusions: The prevalence of physical inactivity among adults in Tehran was high. Leisure time physical inactivity was more likely to be associated with older age, more cigarette smoking, more working hours, and higher body mass index. Public health efforts are needed to improve people′s participation in physical activities in Iran

The association between transition from metabolically healthy obesity to metabolic syndrome, and incidence of cardiovascular disease: Tehran lipid and glucose study.

Considering that the data available on the cardiovascular (CV) risk of metabolically healthy obesity phenotype, and the effect of transition to an unhealthy status are inconsistent, the aim of this study was to investigate the possible role of transition to unhealthy status among metabolically healthy overweight/obese (MHO) subjects on CVD incidence over a median follow-up of 15.9 years. In this large population-based cohort, 6758 participants (41.6% men) aged ≥ 20 years, were enrolled. Participants were divided into 4 groups based on their obesity phenotypes and follow-up results, including persistent metabolically healthy normal weight (MHNW), persistent MHO, transitional MHO and metabolically unhealthy overweight/obese (MUO). Metabolic health was defined as not having metabolic syndrome based on the Joint Interim Statement (JIS) criteria. Multivariable adjusted hazard ratios (HRs) were calculated for cardiovascular events. During follow-up, rate of CVD Incidence per 1000 person-years were 12 and 7 in males and females, respectively. Multivariable adjusted HRs (CI 95%) of CVD incidence among males and females were 1.37 (.78-2.41) and .85 (.34-2.15) in persistent MHO group, 1.55 (1.02-2.37) and .93 (.41-2.12) in transitional MHO group and 2.64 (1.89-3.70) and 2.65 (1.24-5.68) in MUO group. Our findings showed that CVD risk did not increase in the persistent MHO phenotype over a 15.9-year follow-up in both sexes. However, transition from MHO to MUO status during follow-up increased the CVD risk just in male individuals. Further studies are needed to provide conclusive evidence in favor of benign nature of transitional MHO phenotype in females

Waist circumference has heterogeneous impact on development of diabetes in different populations : Longitudinal comparative study between Australia and Iran

Aims : Comparing waist circumference (WC) role in diabetes risk prediction and diagnosis of metabolic syndrome (MS) in different populations.Methods : Population-based samples from Australia (n = 9026) and Iran (n = 8259) were studied in 2000 and followed for 4 years. Follow-up attendance was 58% and mean age was 51 vs. 47. Pearson correlations calculated between WC and other MS components. ROC for the role of WC in the prediction of incident diabetes was used.Results : Prevalences of MS (48% vs. 28%), an increased WC (58.5% vs. 54.5%), low HDL-C (35% vs. 11.2%), high triglyceride (52.2% vs. 29.6%) were significantly higher in Iran. Fasting glucose &ge;5.6 mmol/L was higher in Australia (26% vs. 23%). Hypertension was no different (38%). Pearson correlations between WC and other MS components were stronger in Australians: FPG (0.32 vs. 0.2), HDL (0.47 vs. 0.16), TG (0.38 vs. 0.30) and SBP (0.38 vs. 0.36). Among women, area under ROC curve for WC as a predictor for diabetes was significantly higher for Australians (0.76 vs. 0.68, p &lt; 0.001) with no difference among men (0.69 vs. 0.71, p = 0.4).Conclusion : WC was more strongly related to other components of MS in Australia. Association between WC and MS or incident diabetes varies between ethnicities.<br /

Cohort profile update: Tehran cardiometabolic genetic study

The Tehran cardiometabolic genetic study (TCGS) is a large population-based cohort study that conducts periodic follow-ups. TCGS has created a comprehensive database comprising 20,367 participants born between 1911 and 2015 selected from four main ongoing studies in a family-based longitudinal framework. The study's primary goal is to identify the potential targets for prevention and intervention for non-communicable diseases that may develop in mid-life and late life. TCGS cohort focuses on cardiovascular, endocrine, metabolic abnormalities, cancers, and some inherited diseases. Since 2017, the TCGS cohort has augmented by encoding all health-related complications, including hospitalization outcomes and self-reports according to ICD11 coding, and verifying consanguineous marriage using genetic markers. This research provides an update on the rationale and design of the study, summarizes its findings, and outlines the objectives for precision medicine