Gender Differential in the Association of Body Mass Index and Abdominal Obesity with Prehypertension and Hypertension in Iranian Adults

*Objective:* The aim of this study was to determine the gender differential in the relationship of body mass index (BMI) and abdominal obesity with blood pressure (BP) and prevalence of hypertension (HTN) and prehypertension (Pre-HTN) among the adult population of Iran.

*Design:* A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran.

*Subjects and Measurements:* Weight, height, waist circumference (WC), and systolic and diastolic BP of 45,082 men and 44,322 women aged 15-65 (mean 39.2) were measured. 

*Results:* The prevalence of HTN was 25.2% in men and 24.8% in women; and 50.1% of men and 39.1% of women were pre-hypertensive. WC and BMI were strongly associated with BP in both genders. Multivariate analysis revealed that both WC and BMI had the stronger association with HTN and Pre-HTN in men than women. Compared to men and women with normal weight, the multivariate-adjusted odds ratio (OR) (95% confidence interval) of HTN was 5.75 (5.13, 6.44) for men and 4.29 (3.95, 4.66) for women with BMI ≥ 30. The multivariate OR of prevalence HTN in men with abdominal obesity compared with men without was 3.76 (3.41, 4.22) and in women, 2.92 (2.73, 3.13).

*Conclusion:* These data indicate that both BMI and WC had the stronger association with HTN and Pre-HTN in men than women. 
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Vehicle Routing and Scheduling Problem for a multi-period, multi-perishable product system with time window: A Case study

[EN] The well-known Vehicle Routing Problem (VRP) is to find proper sequence of routes in order to minimize transportation costs. In this paper, a mixed-integer programming model is presented for a food distributer company and the model outputs are to determine the optimal routes and amount of pickup and delivery. In the objective function, the costs of transportation, holding, tardiness and earliness are considered simultaneously. The proposed model with respect to real conditions is multi-period and has two different time periods: one for dispatching vehicles to customers and suppliers and the other for receiving customers’ orders. Time window and split pickup and delivery are considered for perishable products. The proposed model is nonlinear and will be linearized using exact techniques. At the end, model is solved using GAMS and the sensitivity analysis is performed. The results indicate that the trend of changes in holding and transportation costs in compared to tardiness and earliness costs are closed together and are not so sensitive to demand changes.Rashidi Komijan, A.; Delavari, D. (2017). Vehicle Routing and Scheduling Problem for a multi-period, multi-perishable product system with time window: A Case study. International Journal of Production Management and Engineering. 5(2):45-53. doi:10.4995/ijpme.2017.5960SWORD455352DENG, A., MAO, C., & ZHOU, Y. (2009). Optimizing Research of an Improved Simulated Annealing Algorithm to Soft Time Windows Vehicle Routing Problem with Pick-up and Delivery. Systems Engineering - Theory & Practice, 29(5), 186-192. doi:10.1016/s1874-8651(10)60049-xAndersson, H., Hoff, A., Christiansen, M., Hasle, G., & Løkketangen, A. (2010). Industrial aspects and literature survey: Combined inventory management and routing. Computers & Operations Research, 37(9), 1515-1536. doi:10.1016/j.cor.2009.11.009Baldacci, R., Mingozzi, A., & Roberti, R. (2012). Recent exact algorithms for solving the vehicle routing problem under capacity and time window constraints. European Journal of Operational Research, 218(1), 1-6. doi:10.1016/j.ejor.2011.07.037Belfiore, P., & Yoshizaki, H. T. Y. (2013). Heuristic methods for the fleet size and mix vehicle routing problem with time windows and split deliveries. Computers & Industrial Engineering, 64(2), 589-601. doi:10.1016/j.cie.2012.11.007Cacchiani, V., Hemmelmayr, V.C., Tricoire, F., (2012). A set-covering based heuristic algorithm for the periodic vehicle routing problem. Discrete Applied Mathematics, 163(1), 53-64. https://doi.org/10.1016/j.dam.2012.08.032Cattaruzza, D., Absi, N., Feillet, D., & Vidal, T. (2014). A memetic algorithm for the Multi Trip Vehicle Routing Problem. European Journal of Operational Research, 236(3), 833-848. doi:10.1016/j.ejor.2013.06.012Çetinkaya, C., Karaoglan, I., & Gökçen, H. (2013). Two-stage vehicle routing problem with arc time windows: A mixed integer programming formulation and a heuristic approach. European Journal of Operational Research, 230(3), 539-550. doi:10.1016/j.ejor.2013.05.001Eksioglu, B., Vural, A. V., & Reisman, A. (2009). The vehicle routing problem: A taxonomic review. Computers & Industrial Engineering, 57(4), 1472-1483. doi:10.1016/j.cie.2009.05.009Hasani-Goodarzi, A., & Tavakkoli-Moghaddam, R. (2012). Capacitated Vehicle Routing Problem for Multi-Product Cross- Docking with Split Deliveries and Pickups. Procedia - Social and Behavioral Sciences, 62, 1360-1365. doi:10.1016/j.sbspro.2012.09.232Rahimi-Vahed, A., Gabriel Crainic, T., Gendreau, M., & Rei, W. (2015). Fleet-sizing for multi-depot and periodic vehicle routing problems using a modular heuristic algorithm. Computers & Operations Research, 53, 9-23. doi:10.1016/j.cor.2014.07.004Shahin Moghadam, S., Fatemi Ghomi, S. M. T., & Karimi, B. (2014). Vehicle routing scheduling problem with cross docking and split deliveries. Computers & Chemical Engineering, 69, 98-107. doi:10.1016/j.compchemeng.2014.06.015Silva, M. M., Subramanian, A., & Ochi, L. S. (2015). An iterated local search heuristic for the split delivery vehicle routing problem. Computers & Operations Research, 53, 234-249. doi:10.1016/j.cor.2014.08.005Taş, D., Jabali, O., & Van Woensel, T. (2014). A Vehicle Routing Problem with Flexible Time Windows. Computers & Operations Research, 52, 39-54. doi:10.1016/j.cor.2014.07.005Yu, B., & Yang, Z. Z. (2011). An ant colony optimization model: The period vehicle routing problem with time windows. Transportation Research Part E: Logistics and Transportation Review, 47(2), 166-181. doi:10.1016/j.tre.2010.09.010Zhang, S., Lee, C. K. M., Choy, K. L., Ho, W., & Ip, W. H. (2014). Design and development of a hybrid artificial bee colony algorithm for the environmental vehicle routing problem. Transportation Research Part D: Transport and Environment, 31, 85-99. doi:10.1016/j.trd.2014.05.01

Beyond CAPM: an innovative factor model to optimize the risk and return trade-off

Different models have tried to improve the Capital Asset Pricing Model findings, on the basis that different factors can affect asset return. This paper examines a series of explanatory factors, broader than those explained by traditional theory, to see whether they are able to more accurately explain the returns. Should the previous point be confirmed, we must consider that the risk of an asset depends on multiple factors, rather than the few that are usually identified in the literature. Even though more than 300,000 factors are examined in this paper, the results show that in recent years just 87 factors are able to fully explain the returns of 4,500 companies in the 15 European countries examined. Our analysis also shows that business and macroeconomic, rather than financial factors, are those that heavily bear on asset returns; and that factors that affect asset return, either only positively or only negatively, do not exist. However, the same factor can affect some companies positively and others negatively. Thus, since not all firms are always sensitive to the same factors, there is the possibility to further decrease risk in proportion to return, through a factor-based risk optimisation process

Beneficial effect of high energy intake at lunch rather than dinner on weight loss in healthy obese women in a weight-loss program: a randomized clinical trial

ABSTRACT Background: The association between the time of nutrient intake and health has been described in a few studies. To our knowledge, no study has evaluated the relation between high energy intakes at lunch compared with at dinner on weight loss in overweight and obese subjects. Objective: We compared the effect of high energy intake at lunch with that at dinner on weight loss and cardiometabolic risk factors in women during a weight-loss program. Design: Overweight and obese women [n = 80; body mass index (BMI; in kg/m2): 27–35; age: 18–45 y] were asked to eat either a main meal at lunch (LM) or a main meal at dinner (DM) for 12 wk while in a weight-loss program. Results: A total of 80 participants were randomly assigned to one of 2 intervention groups. Sixty-nine subjects (86%) completed the trial (34 subjects in the DM group, and 35 subjects in the LM group). Baseline variables were not significantly different between groups. A significant reduction in anthropometric measurements and significant improvements in cardiometabolic risk characteristics were observed over 12 wk in both groups. Compared with the DM group, the LM group had greater mean 6 SD reductions in weight (LM: 25.85 6 1.96 kg; DM: 24.35 6 1.98 kg; P = 0.003), BMI (LM: 2.276 0.76; DM: 1.68 6 0.76; P = 0.003), homeostasis model assessment of insulin resistance (LM: 20.66 6 0.33; DM: 20.46 6 0.24; P = 0.001), and fasting insulin (LM: 22.01 6 1.10 mIU/mL; DM: 21.16 6 0.72 mIU/mL; P , 0.001) after 12 wk. However, there were no significant differences for fasting plasma glucose and lipid profiles within both groups after 12 wk. Conclusions: The consumption of higher energy intake at lunch compared with at dinner may result in favorable changes in weight loss in overweight and obese women after a weight-loss program of 12 wk. The consumption may also offer clinical benefits to improve insulin resistance. This trial was registered at clinicaltrials.gov as NCT02399280. Am J Clin Nutr doi: 10.3945/ajcn.116.134163

Effect of a long bout versus short bouts of walking on weight loss during a weight loss diet: a randomized trial

Objective: To evaluate the effect of different daily physical activity (PA) frequencies while maintaining the same daily volume of PA on weight loss, carbohydrate and lipid metabolism, in women with overweight/obesity throughout a 24- week intervention.Methods: 65 women [BMI = 27- 35 kg/m²; age= 18-40 y] who had a sedentary lifestyle were randomly allocated to include either a longer-bout of PA (LBP), 50 min/d moderate-intensity PA, or two shorter-bouts of PA (SBP), two 25 min/d moderate intensity PA, 6 d/week during their weight loss plan. Anthropometric and blood measurements were taken at baseline and 24 weeks.Results: Compared with the LBP group, the SBP group had a greater decrease in weight (SBP: -8.08 ± 2.20 kg; LBP: -6.39 ± 2.28 kg; P = 0.019), BMI (SBP: -3.11 ± 0.87 kg/m²; LBP: -2.47 ± 0.86 kg/m², P=0.027) and waist circumference (SBP: -8.78 ± 2.62 cm; LBP: -5.76 ± 2.03 cm; P = 0.026). No significant differences were seen in carbohydrate and lipid metabolism characteristics after the 24 weeks.Conclusion: PA undertaken in 2 shorter-bouts per day could be more effective for weight loss than when undertaken in a daily long-bout in adult women on a 24 wk weight loss program

Multimorbidity as an important issue among women: results of gender difference investigation in a large population-based cross-sectional study in West Asia

Objectives: To investigate the impact of gender on multimorbidity in northern Iran. Design: A cross-sectional analysis of the Golestan cohort data. Setting: Golestan Province, Iran. Study population: 49 946 residents (age 40–75 years) of Golestan Province, Iran. Main outcome measures: Researchers collected data related to multimorbidity, defined as co-existence of two or more chronic diseases in an individual, at the beginning of a representative cohort study which recruited its participants from 2004 to 2008. The researchers utilised simple and multiple Poisson regression models with robust variances to examine the simultaneous effects of multiple factors. Results: Women had a 25.0% prevalence of multimorbidity, whereas men had a 13.4% prevalence (p<0.001). Women of all age-groups had a higher prevalence of multimorbidity. Of note, multimorbidity began at a lower age (40–49 years) in women (17.3%) compared with men (8.6%) of the same age (p<0.001). This study identified significant interactions between gender as well as socioeconomic status, ethnicity, physical activity, marital status, education level and smoking (p<0.01). Conclusion: Prevention and control of multimorbidity requires health promotion programmes to increase public awareness about the modifiable risk factors, particularly among women

How to develop clinical reasoning in medical students and interns based on illness script theory : An experimental study

Acknowledgments Authors would like to acknowledge Iran University of Medical Sciences for providing financial support. Extend thanks to medical students and interns for their participation in the study. Funding The present study was financially supported by Iran University of Medical Sciences, for partial fulfillment of Ph.D. dissertation, (Grant No: 6784). The funding organization did not play any roles in the study design, collection, analysis, and interpretation of data, or in writing the manuscript.Peer reviewedPublisher PD

Multimorbidity as an important issue among women: results of gender difference investigation in a large population-based cross-sectional study in West Asia

Objectives: To investigate the impact of gender on multimorbidity in northern Iran. Design: A cross-sectional analysis of the Golestan cohort data. Setting: Golestan Province, Iran. Study population: 49 946 residents (age 40–75 years) of Golestan Province, Iran. Main outcome measures: Researchers collected data related to multimorbidity, defined as co-existence of two or more chronic diseases in an individual, at the beginning of a representative cohort study which recruited its participants from 2004 to 2008. The researchers utilised simple and multiple Poisson regression models with robust variances to examine the simultaneous effects of multiple factors. Results: Women had a 25.0% prevalence of multimorbidity, whereas men had a 13.4% prevalence (p<0.001). Women of all age-groups had a higher prevalence of multimorbidity. Of note, multimorbidity began at a lower age (40–49 years) in women (17.3%) compared with men (8.6%) of the same age (p<0.001). This study identified significant interactions between gender as well as socioeconomic status, ethnicity, physical activity, marital status, education level and smoking (p<0.01). Conclusion: Prevention and control of multimorbidity requires health promotion programmes to increase public awareness about the modifiable risk factors, particularly among women

Clinicoepidemiological Features of 82 Cases of Bullous Pemphigoid in Tehran, Iran

Bullous Pemphigoid is a chronic immunobullous disease, characterized by subepidermal bulla on the skin and mucosa. The purpose of the present study was to investigate the clinicoepidemiological features of bullous pemphigoid in Iranian patients. In this retrospective descriptive study, we reviewed 82 bullous pemphigoid patients within 2014-2016. The mean age of the patients was 67.13 years (range between 25 and 97) including 32(39.1%) males and 50(60.9%) females. Mucosal involvement was positive in 33(40.2%) of the patients, and oral mucosa was most commonly involved. Head and neck area were involved in 43 (52.4%) of the patients. Clinical and epidemiological characteristics of bullous pemphigoid are different in different regions of the world

The global, regional, and national burden of colorectal cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background Data about the global, regional, and country-specific variations in the levels and trends of colorectal cancer are required to understand the impact of this disease and the trends in its burden to help policy makers allocate resources. Here we provide a status report on the incidence, mortality, and disability caused by colorectal cancer in 195 countries and territories between 1990 and 2017. Methods Vital registration, sample vital registration, verbal autopsy, and cancer registry data were used to generate incidence, death, and disability-adjusted life-year (DALY) estimates of colorectal cancer at the global, regional, and national levels. We also determined the association between development levels and colorectal cancer age-standardised DALY rates, and calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. All of the estimates are reported as counts and age-standardised rates per 100 000 person-years, with some estimates also presented by sex and 5-year age groups. Findings In 2017, there were 1·8 million (95% UI 1·8–1·9) incident cases of colorectal cancer globally, with an agestandardised incidence rate of 23·2 (22·7–23·7) per 100 000 person-years that increased by 9·5% (4·5–13·5) between 1990 and 2017. Globally, colorectal cancer accounted for 896 000 (876 300–915 700) deaths in 2017, with an agestandardised death rate of 11·5 (11·3–11·8) per 100 000 person-years, which decreased between 1990 and 2017 (–13·5% [–18·4 to –10·0]). Colorectal cancer was also responsible for 19·0 million (18·5–19·5) DALYs globally in 2017, with an age-standardised rate of 235·7 (229·7–242·0) DALYs per 100 000 person-years, which decreased between 1990 and 2017 (–14·5% [–20·4 to –10·3]). Slovakia, the Netherlands, and New Zealand had the highest age-standardised incidence rates in 2017. Greenland, Hungary, and Slovakia had the highest age-standardised death rates in 2017. Numbers of incident cases and deaths were higher among males than females up to the ages of 80–84 years, with the highest rates observed in the oldest age group (≥95 years) for both sexes in 2017. There was a non-linear association between the Socio-demographic Index and the Healthcare Access and Quality Index and age-standardised DALY rates. In 2017, the three largest contributors to DALYs at the global level, for both sexes, were diet low in calcium (20·5% [12·9–28·9]), alcohol use (15·2% [12·1–18·3]), and diet low in milk (14·3% [5·1–24·8]). Interpretation There is substantial global variation in the burden of colorectal cancer. Although the overall colorectal cancer age-standardised death rate has been decreasing at the global level, the increasing age-standardised incidence rate in most countries poses a major public health challenge across the world. The results of this study could be useful for policy makers to carry out cost-effective interventions and to reduce exposure to modifiable risk factors, particularly in countries with high incidence or increasing burde