Use and Evaluation of a Register for a Well Population in Studies on Cardiovascular Disease and Diabetes in the West of Scotland

Cardio-respiratory diseases and cancer are the most important causes of mortality and morbidity in west central Scotland. From 1972 to 1976, more than 16,000 men and women were recruited to a well-population study (Renfrew and Paisley as part of Midspan) of cardiorespiratory diseases and risk factors including 10,541 men and women aged 45-64 whose baseline casual blood glucose was measured. This population was "flagged" with the National Health Service Central Registry (NHSCR) and has been followed up for mortality. By 1986, sufficient deaths had occurred to allow an opportunity for epidemiological research. This study therefore 1) examined the quality of data available from the Midspan survey, 2) explored its use in answering a number of epidemiological questions, and 3) evaluated the potential for further follow-up studies

The prevalence of suicide ideation and factors associated among students of Isfahan University of Medical Sciences, 2013-2014

زمینه و هدف: خودکشی جوانان، یکی از تأسف برانگیزترین رخدادها است. افکار خودکشی به عنوان افکار خود گزارش­دهی درباره­ی خودکشی، در دامنه­ای از یک میل مبهم با نفوذ برای مردن تا نقشه­ی کامل خودکشی تعریف می­شود. یکی از مهمترین روش های پیشگیری از خودکشی، شناسایی افرادی است که دارای افکار خودکشی هستند. هدف این مطالعه تعیین شیوع افکار خودکشی و عوامل مرتبط با آن در دانشجویان دانشگاه علوم پزشکی اصفهان در سال 94-93 می باشد. روش بررسی: در این مطالعه مقطعی، 1000 دانشجوی رشته های مختلف دانشگاه علوم پزشکی اصفهان به روش تصادفی– طبقه بندی در سال تحصیلی94-93 انتخاب شدند. با استفاده از پرسشنامه Inter-cultural وSF36 شیوع افکار خودکشی و عوامل مرتبط با آن تعیین و داده‌ها با استفاده از آزمون های آماری کای دو، t مستقل و رگرسیون لجستیک تحلیل شد. یافته‌ها: در دانشجویان شیوع مادام العمر، یک ساله و لحظه ای افکار خودکشی به ترتیب 7/29 ، 15 و 2/6 بود. بین سن، جنس، وضعیت تأهل، محل سکونت، میزان اعتقادات مذهبی، سلامت عمومی، گرایش نسبت به پدیده خودکشی، توجیه پذیری افکار خودکشی و داشتن افکار خودکشی، ارتباط معنی داری مشاهده گردید (05/0>P). افکار خودکشی در مردان بیش از زنان و در دانشجویان متأهل بیشتر از دانشجویان مجرد بود و با افزایش اعتقادات مذهبی کاهش می یافت. نتیجه گیری: این مطالعه نشان داد افکار خودکشی در بین دانشجویان از شیوع بالایی برخوردار است. باتوجه به این که فکر خودکشی می تواند زمینه ساز اقدام به خودکشی باشد، بنابراین می توان با ارائه خدمات بهینه بهداشت روانی و غربالگری منظم و دوره ای دانشجویان از نظر افکار خودکشی و اختلالات روانی گام های مؤثری را در راستای پیشگیری از این معضل اجتماعی در بین دانشجویان برداشت

Zapadalność na zespół metaboliczny i czynniki ryzyka tego zespołu u chorych na cukrzycę typu 2 pacjentów poradni diabetologicznej w Isfahanie w Iranie

Introduction: At present, little data exists about the incidence of, and the risk factors associated with, metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (T2DM). The aims of this present study were to assess the incidence and risk factors of MetS in people with T2DM using routinely collected data from a clinical information system at Isfahan Endocrine and Metabolism Research Centre, Iran. Material and methods: During the mean (SD) follow-up period of 11.7 (4.8) years, 3,047 patients with T2DM who were free of MetS at baseline were examined to determine the incidence and predictors of progression to MetS. The mean (SD) age of participants was 50.4 (11.0) years, with a mean (SD) duration of diabetes of 6.3 (6.2) years at initial registration. A modified National Cholesterol Education Programme- Adult Treatment Panel III definition (with body mass index [BMI] instead of waist circumference) was used for the MetS. Results: The prevalence of MetS was 63.2% (95% CI: 62.3, 64.1). The incidence of MetS was 28.5 (95% CI: 26.8, 30.2) (25.9 men and 30.9 women) per 1,000 patient-years based on 35,677 patient-years of follow-up. Multivariate analysis revealed that higher body mass index (BMI) and education, lower HbA1c and treatment with oral agent or insulin were associated with MetS. Conclusions: These are the first estimates of the incidence and risk factors of MetS in patients with T2DM in Iran. These findings show that the natural course of MetS is dynamic. The clinical management of patients with T2DM will contribute significantly to MetS prevention. (Pol J Endocrinol 2012; 63 (5): 372-380)Wstęp: Obecnie dostępnych jest niewiele danych dotyczących zapadalności na zespół metaboliczny (MetS) i związanych z nim czynników ryzyka u chorych na cukrzycę typu 2 (T2DM). Niniejsze badanie przeprowadzono w celu oceny zapadalności na MetS i występowania czynników ryzyka tego zespołu u chorych na cukrzycę typu 2 na podstawie rutynowych danych gromadzonych w systemie informacji klinicznej w Isfahan Endocrine and Metabolism Research Centre w Iranie. Materiał i metody: W ciągu okresu obserwacji, trwającego średnio (SD) 11,7 (4,8) roku, przebadano 3047 chorych na T2DM, u których wyjściowo nie stwierdzono cech MetS, w celu określenia zapadalności i czynników predykcyjnych progresji do MetS. Średnia wieku (SD) uczestników wynosiła 50,4 (11,0) roku, a średni czas trwania (SD) cukrzycy w momencie pierwszej rejestracji danych - 6,3 (6,2) roku. Rozpoznanie MetS ustalano na podstawie zmodyfikowanej definicji National Cholesterol Education Programme - Adult Treatment Panel III (w której uwzględniono wskaźnik masy ciała [BMI] zamiast obwodu talii). Wyniki: Częstość występowania MetS w badanej populacji wynosiła 63,2% (95% CI: 62,3-64,1). Wskaźnik zapadalności na MetS wynosił 28,5 (95% CI: 26,8-30,2) (25,9 dla mężczyzn i 30,9 dla kobiet) na 1000 pacjentolat, co wyliczono na podstawie obserwacji obejmującej 35 677 pacjentolat. W analizie wieloczynnikowej wykazano, że wyższe wartości BMI, wyższy poziom wykształcenia, niższe HbA1c i leczenie doustnymi lekami hipoglikemizującymi oraz insuliną wiązały się z MetS. Wnioski: W niniejszej pracy po raz pierwszy oszacowano zapadalność na MetS i określono czynniki ryzyka rozwoju tego zespołu u pacjentów z T2DM w Iranie. Uzyskanie rezultaty wskazują, że naturalny przebieg MetS jest procesem dynamicznym. Odpowiednie leczenie chorych na T2DM może mieć istotne znaczenie w zapobieganiu MetS. (Endokrynol Pol 2012; 63 (5): 372-380

Comparison of systolic and diastolic blood pressure with pulse pressure and mean arterial pressure for prediction of type 2 diabetes: The Isfahan Diabetes Prevention Study

Wstęp: Celem badania było porównanie wartości prognostycznej skurczowego i rozkurczowego ciśnienia tętniczego (BP), ciśnienia tętna (PP), cząstkowego ciśnienia tętna (PPF) i średniego ciśnienia tętniczego (MAP) w odniesieniu do rozwoju cukrzycy typu 2 u krewnych pierwszego stopnia pacjentów chorujących na tę chorobę. Materiał i metody: W latach 2003–2005 włączono do badania 701 niechorujących na cukrzycę krewnych pierwszego stopnia osób chorych na cukrzyce typu 2 w wieku 20–70 lat i obserwowano ich do 2008 roku pod kątem rozwoju cukrzycy typu 2. Na początku badania i w ciągu okresu obserwacji u uczestników wykonywano standardowy 2-godzinny test doustnego obciążenia 75 g glukozy. Oceniano wartość pola pod krzywą ROC dla PP, MAP, PPF, skurczowego i rozkurczowego BP w prognozowaniu rozwoju cukrzycy typu 2. Wyniki: W okresie obserwacji cukrzyca rozwinęła się u 72 uczestników badania (10,3%). Zapadalność na cukrzycę typu 2 wynosiła 3,4 na 100 osobolat u mężczyzn i 4,9 u kobiet. Skurczowe i rozkurczowe BP oraz MAP wiązały się z cukrzycą, lecz nie stwierdzono takiego związku w przypadku PP i PPF. Odnotowano podobne zależności między skurczowym i rozkurczowym BP oraz MAP a zapadalnością na cukrzycę. Pola powierzchni pod krzywymi ROC wynosiły 0,582 dla skurczowego BP, 0,589 dla rozkurczowego BP, 0,589 dla MAP, 0,520 dla PP i 0,468 dla PPF. Wnioski: Powyższe dane wskazują, że skurczowe i rozkurczowe BP były równie silnie jak MAP związane z rozwojem cukrzycy. Podwyższone BP może być pomocne w identyfikowaniu krewnych pierwszego stopnia chorych na cukrzycę typu 2 obciążonych wysokim ryzykiem zachorowania na cukrzycę, dlatego należy u nich monitorować ciśnienie tętnicze. (Endokrynol Pol 2011; 62 (4): 324–330)Background: The aim of this study was to compare the ability of the systolic and diastolic blood pressure (BP), pulse pressure (PP), fraction PP (PPF) and mean arterial pressure (MAP) to predict progression to diabetes in non-diabetic first-degree relatives (FDRs) of patients with type 2 diabetes. Material and methods: A total of 701 non-diabetic FDRs aged 20-70 in 2003 to 2005 were followed through to 2008 for the occurrence of type 2 diabetes mellitus. At baseline and through follow-ups, participants underwent a standard 75 g 2-h oral glucose tolerance test. Prediction of progression to type 2 diabetes was assessed using area under the receiver-operating characteristic (ROC) curves based upon measurement of PP, MAP, PPF, systolic and diastolic BP. Results: Diabetes developed in 72 participants (10.3%) during the follow-up period. The incidence of type 2 diabetes was 3.4 per 100 person years in men and 4.9 in women. Systolic and diastolic BP and MAP were related to diabetes, but PP and PPF were not. Systolic and diastolic BP and MAP have similar associations with incident diabetes. Areas under the ROC curves were 0.582 for systolic, 0.589 for diastolic, 0.589 for MAP, 0.520 for PP, and 0.468 for PPF. Conclusion: These results indicate that systolic and diastolic BP are as strong as MAP in predicting progression to diabetes. Increased BP may help identify FDRs of patients with type 2 diabetes at high risk for diabetes who are candidates for BP control. (Pol J Endocrinol 2011; 62 (4): 324–330

Incidence of Metabolic Syndrome and Its Risk Factors among Type 2 Diabetes Clinic Attenders in Isfahan, Iran

Aim. At present, little data exist about incidence and the risk factors associated with metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (T2DM). The objectives of present study were to assess the incidence and risk factors of MetS in people with T2DM. Methods. During the mean (SD) follow-up period of 11.7 (4.8) years, 3,047 patients with T2DM and free of MetS at baseline have been examined to determine incidence and predictors of progression to MetS. A modified the National Cholesterol Education Program—Adult Treatment Panel III definition with body mass index (BMI) instead of waist circumference was used for the MetS. Results. The prevalence of MetS was 63.2% (95% CI: 62.3, 64.1). The incidence of MetS was 28.5 (95% CI: 26.8, 30.2) (25.9 men and 30.9 women) per 1,000 patient-years based on 35,677 patient-years of follow-up. Multivariate analysis revealed that higher BMI and education, lower HbA1c and treatment with oral agent or insulin were associated with MetS. Conclusion. These are the first estimate of incidence and risk factors of MetS in patients with T2DM in Iran. These findings showed that the natural course of MetS is dynamic. The clinical management of patients with T2DM will contribute significantly to MetS prevention

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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Effects of Adjunct Low-Dose Vitamin D on Relapsing-Remitting Multiple Sclerosis Progression: Preliminary Findings of a Randomized Placebo-Controlled Trial

The aim of this preliminary study was to evaluate the effect of low-dose oral vitamin D in combination with current disease-modifying therapy on the prevention of progression of relapsing-remitting multiple sclerosis (RRMS). A phase II double-blind placebo-controlled randomized clinical trial conducted between October 2007 and October 2008 included 50 patients with confirmed RRMS aged 25 to 57 years and normal serum 25-hydroxyvitamin D. They were randomly allocated to receive 12 months of treatment with either escalating calcitriol doses up to 0.5 μg/day or placebo combined with disease-modifying therapy. Response to treatment was assessed at eight-week intervals. In both groups, the mean relapse rate decreased significantly (P < 0.001). In the 25 patients treated with placebo, the mean (SD) Expanded Disability Status Scale (EDSS) increased from 1.70 (1.21) at baseline to 1.94 (1.41) at the end of study period (P < 0.01). Average EDSS and relapse rate at the end of trial did not differ between groups. Adding low-dose vitamin D to routine disease-modifying therapy had no significant effect on the EDSS score or relapse rate. A larger phase III multicenter study of vitamin D in RRMS is warranted to more assess the efficacy of this intervention

Relationship between Weight, Body Mass Index, and Bone Mineral Density in Men Referred for Dual-Energy X-Ray Absorptiometry Scan in Isfahan, Iran

Objective. Although several studies have investigated the association between body mass index (BMI) and bone mineral density (BMD), the results are inconsistent. The aim of this study was to further investigate the relation between BMI, weight and BMD in an Iranian men population. Methods. A total of 230 men 50-79 years old were examined. All men underwent a standard BMD scans of hip (total hip, femoral neck, trochanter, and femoral shaft) and lumbar vertebrae (L2-L4) using a Dual-Energy X-ray Absorptiometry (DXA) scan and examination of body size. Participants were categorised in two BMI group: normal weight <25.0 kg/m2 and overweight and obese, BMI ≥ 25 kg/m2. Results. Compared to men with BMI ≥ 25, the age-adjusted odds ratio of osteopenia was 2.2 (95% CI 0.85, 5.93) and for osteoporosis was 4.4 (1.51, 12.87) for men with BMI < 25. It was noted that BMI and weight was associated with a high BMD, compatible with a diagnosis of osteoporosis. Conclusions. These data indicate that both BMI and weight are associated with BMD of hip and vertebrae and overweight and obesity decreased the risk for osteoporosis. The results of this study highlight the need for osteoporosis prevention strategies in elderly men as well as postmenopausal women

Hypertension in Non-Type 2 Diabetes in Isfahan, Iran: Incidence and Risk Factors

Objective. To estimate the incidence of and risk factors for the development of hypertension (HTN) in people with T1D using routinely collected data. Method. The mean 16-year incidence of HTN was measured among 1,167 (557 men and 610 women) nonhypertensive patients with T1D from Isfahan Endocrine and Metabolism Research Center outpatient clinics, Iran. HTN was defined as a systolic blood pressure (BP) of 140 mm Hg or higher and/or a diastolic BP 90 mm Hg or higher and/or use of antihypertensive medications. The mean (standard deviation [SD]) age of participants was 20.6 years (10.5 years) with a mean (SD) duration of diabetes of 3.6 years (4.8 years) at registration. Results. The prevalence of HTN at baseline was 9.7% (95% CI: 8.2, 11.5). Among the 1,167 patients free of HTN at registration who attended the clinic at least twice in the period 1992–2016, the incidence of HTN was 9.6 (8.0 women and 11.3 men) per 1000 person-years based on 18,870 person-years of follow-up. Multivariate analyses showed that male gender, older age, higher triglyceride, and higher systolic BP were significantly and independently associated with the development of HTN in this population. Conclusion. These findings will help the identification of those patients with T1D at particular risk of HTN and strongly support the case for vigorous control of BP in patients with T1D

Effects of Chewing Different Flavored Gums on Salivary Flow Rate and pH

Chewing gum increases salivary flow rate (SFR) and pH, but differences in preferences of gum flavor may influence SFR and pH. The aim of this paper was to assess the effect of five different flavors of sucrose-free chewing gum on the salivary flow rate and pH in healthy dental students in Isfahan, Iran. Fifteen (7 men and 8 women) healthy dental student volunteers collected unstimulated saliva and then chewed one of five flavored gums for 6 min. The whole saliva was collected and assessed for 6 consecutive days. After unstimulated saliva was collected, stimulated saliva was collected at interval of 0-1, 1–3, and 3–6 minutes after the start of different flavored chewing gums. The SFR and salivary pH were measured. The SFR increased in all five flavored gums at 1, 3, and 6 minutes after start of chewing gums (P < 0.001). The flow rate of all products reached peak in the 1st minute of stimulation, except spearmint-flavored gums which reached peak in the 6th minute. In the 1st minute, the strawberry-flavored gums showed the highest SFR. During 1–3 minutes, strawberry- and apple-flavored gums showed higher SFR, respectively. Only the spearmint- and cinnamon-flavored gum significantly increased salivary pH. Gum flavored can affect the SFR and pH and special flavors can be advised for different individuals according to their oral conditions