Accountability to all four Dimensions of Health

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نامه به سردبیر

سردبیر محترم یکی از ابعاد مهم چهارگانه سلامت، سلامت معنوی است که بر اهتمام به ارتقای آن توسط سازمان جهانی بهداشت تأکید شده است. از آنجا که سلامت معنوی سبب بهبود شاخص‌های ابعاد دیگر سلامت جسمی، روانی، اجتماعی می‌گردد، توجه به این بعد سلامت بیشتر در دوره بزرگسالی و در بیماران مبتلا به بیماری‌های صعب‌العلاج صورت می‌گیرد. حال آنکه رشد و تکامل معنویت باید از سنین کودکی در نظر قرار گیرد. رشد معنویت در هر انسانی دارای یک روند دینامیک و پویا است که در طی یک دوران رخ می‌دهد. در طی این روند، انسان به طور فزاینده‌ای به معنی، اهداف و ارزش‌های زندگی پی می‌برد. (فولتون و همکاران[i]، 1995 م.) رشد معنویت در کودک بسیار پیچیده است و تحت تأثیر عوامل متعددی نظیر خانواده، رسانه‌ها، افراد مسؤول جامعه و ارزش‌های فرهنگی است. امروزه تأثیر رسانه‌ها به ویژه صدا و سیما، اینترنت و فیلم‌های سینمایی انکارناپذیر است و تضاد و دوگانگی ناشی از تأثیر این عوامل، همانند رشد کودک در یک خانواده مذهبی که در معرض مستمر رسانه‌ هالیوودی است، بسیار پرتعارض می‌باشد. (لانهام[ii]، 2005 م.) تجربه‌های معنوی و دینی می‌تواند اثرات قوی در زندگی کودکان داشته باشد؛ رشد اخلاقی آن‌ها را تحت تأثیر قرار دهد، ارتباطات اجتماعی آن‌ها را تقویت کند و راه ارتباط با خویشتن و رفتارهایشان را تنظیم نماید. (بارنس و همکاران[iii]، 2000 م.) کودکانی که در خانواده‌های غیر معنوی/ مذهبی پرورش می‌یابند، بیشتر با سؤالاتی درباره خداوند و ذات لایزال الهی مواجه می‌شوند و پاسخ این سؤالات و رموز معنویت را در جامعه جستجو می‌کنند (فولتون، و همکاران[iv]، 1995 م.) و چه بسا به معنویت‌های کاذب دست می‌یابند. از این رو کتب و مقالات مندرج در حوزه سلامت معنوی مرور و مطالب مربوط به مراحل مختلف رشد معنوی در کودکان و نوجوانان مورد تحلیل قرار گرفت. ... پی‌نوشت‌ها [i]. Fulton RB. & Moore CM. [ii]. Lanham, MD. [iii]. Barnes LL. & Plotnikoff GA. & Fox K. & Pendleton S. [iv]. Fulton RB. & Moore CM

Predictive performances of lipid accumulation product vs. adiposity measures for cardiovascular diseases and all-cause mortality, 8.6-year follow-up: Tehran lipid and glucose study

<p>Abstract</p> <p>Background</p> <p>The body mass index (BMI) is the most commonly used marker for evaluating obesity related risks, however, central obesity measures have been proposed to be more informative. Lipid accumulation product (LAP) is an alternative continuous index of lipid accumulation. We sought in this study to assess if LAP can outperform BMI, waist-to-height-ratio (WHtR), or waist-to-hip-ratio (WHpR) in predicting incident cardiovascular disease (CVD) or all-cause mortality.</p> <p>Results</p> <p>Among participants of Tehran Lipid and Glucose Study, 6,751 participants (2,964 men), aged ≥ 30 years, were followed for a median of 8.6 years. We observed 274 deaths (men: 168) and 447 CVD events (men: 257). Levels of common CVD risk factors significantly increased across LAP quartiles. Mortality rates did not differ by LAP quartiles. Among participants free of CVD at baseline [6331 (2,741 men)], CVD incident rates per 1000 person increased in a stepwise fashion with increasing LAP quartile values in both men (from 6.9 to 17.0) and women (from 1.3 to 13.0), (Ps < 0.001).</p> <p>Among women, a 1-SD increment in log-LAP conferred a 41% increased risk for CVD (HR 1.41, 95% CIs 1.02-1.96). Among men, however, LAP was not observed to be independently associated with increased risk of CVD; except in a sub-group of men assigned to the lifestyle modification interventions, where, LAP predicted CVD risk.</p> <p>After adjustment with CVD risk factors LAP turned to be inversely associated with risk of all-cause mortality (HR, men 0.74, 95% CIs 0.61-0.90; women, 0.94 95% CIs 0.74-1.20).</p> <p>Among women, magnitude of increased risk of CVD due to LAP was not different from those of anthropometric measures. Among men, however, WHpR was observed to be more strongly associated with increased risk of CVD than was LAP.</p> <p>Among neither men nor women were the predictive performances (discrimination, calibration, goodness-of-fit) of the LAP better than those of different anthropometric measures were.</p> <p>Conclusions</p> <p>If LAP is to be used for predicting CVD, it might not be superior to WHtR or WHpR.</p

Diabetes prediction, lipid accumulation product, and adiposity measures; 6-year follow-up: Tehran lipid and glucose study

<p>Abstract</p> <p>Background</p> <p>The body mass index (BMI) is the most commonly used marker for evaluating obesity related risks, however, central obesity measures have been proposed to be more informative. Lipid accumulation product (LAP) is an alternative continuous index of lipid accumulation, which is computed from waist circumference (WC, cm) and triglycerides (TGs, mmol/l): (WC-65) ×TG (men) and (WC-58) ×TG (women). We sought in this study to assess if LAP can outperform BMI, waist-to-height-ratio (WHtR), or waist-to-hip-ratio (WHpR) in identifying prevalent and predicting incident diabetes.</p> <p>Results</p> <p>The cross-sectional analyses were performed on a sample included 3,682 men and 4,989 women who were not pregnant, aged ≥ 20 years. According to the age (≥ 50 and <50 years) - and sex-specific analyses, odds ratios (ORs) of LAP for prevalent diabetes were higher than those of BMI, WHpR, or WHtR among women, after adjustment for mean arterial pressure and family history of diabetes. The OR of LAP in old men was lower than those of other adiposity measures; in young men, however, LAP was superior to BMI but identical to WHpR and WHtR in identifying prevalent diabetes. Except in young men, LAP showed highest area under the receiver operating characteristic curves (AROC) for prevalent diabetes (P for trend ≤ 0.005).</p> <p>For longitudinal analyses, a total of 5,018 non-diabetic subjects were followed for ~6 years. The ORs of BMI, WHpR, and WHtR were the same as those of LAP in both sexes and across age groups; except in young men where LAP was superior to the BMI. AROCs of LAP were relatively the same as anthropometric adiposity measures.</p> <p>Conclusions</p> <p>LAP was a strong predictor of diabetes and in young individuals had better predictability than did BMI; it was, however, similar to WHpR and WHtR in prediction of incident diabetes.</p

Predictive performance of the visceral adiposity index for a visceral adiposity-related risk: Type 2 Diabetes

<p>Abstract</p> <p>Background</p> <p>Visceral adiposity index (VAI) has recently been developed based on waist circumference, body mass index (BMI), triglycerides (TGs), and high-density lipoprotein cholesterol (HDL-C). We examined predictive performances for incident diabetes of the VAI per se and as compared to the metabolic syndrome (MetS) and waist-to-height-ratio (WHtR).</p> <p>Methods</p> <p>Participants free of diabetes at baseline with at least one follow-up examination (5,964) were included for the current study. Weibull regression models were developed for interval-censored survival data. Absolute and relative integrated discriminatory improvement index (IDI) and cut-point-based and cut-point-free net reclassification improvement index (NRI) were used as measures of predictive ability for incident diabetes added by VAI, as compared to the MetS and WHtR.</p> <p>Results</p> <p>The annual incidence rate of diabetes was 0.85 per 1000 person. Mean VAI was 3.06 (95%CIs 2.99-3.13). Diabetes risk factors levels increased in stepwise fashion across VAI quintiles. Risk gradient between the highest and lowest quintile of VAI was 4.5 (95%CIs 3.0-6.9). VAI significantly improved predictive ability of the MetS. The relative IDI and cut-point free NRI for predictive ability added to MetS by VAI were 30.3% (95%CIs 18.8-41.8%) and 30.7% (95%CIs 20.8-40.7%), respectively. WHtR, outperformed VAI with cut-point-free NRI of 24.6% (95%CIs 14.1-35.2%).</p> <p>Conclusions</p> <p>In conclusion, although VAI could be a prognostic tool for incident diabetes events, gathering information on its components (WC, BMI, TGs, and HDL-C) is unlikely to improve the prediction ability beyond what could be achieved by the simply assessable and commonly available information on WHtR.</p

The prevalence of idiopathic hirsutism and polycystic ovary syndrome in the Tehran Lipid and Glucose Study

<p>Abstract</p> <p>Background</p> <p>There is no clear and contemporaneous method for screening of idiopathic hirsutism (IH) and polycystic ovary syndrome (PCOS) at the community level and current estimates regarding their prevalence are limited. We aimed to ascertain the prevalence of IH and PCOS in a randomly selected sample of reproductive aged female participants of the Tehran Lipid and Glucose Study (TLGS).</p> <p>Methods</p> <p>One thousand and two women, aged 18-45 years, were randomly selected from among reproductive aged women who participated in the TLGS. Those women with either hirsutism or menstrual dysfunction were assessed for biochemical hyperandrogenemia; whereas those participants with hirsutism per se were further assessed for subclinical menstrual dysfunction. PCOS were diagnosed using the National Institute of Health (NIH) criteria. IH was defined as hirsutism without clinical or sub clinical menstrual dysfunction or biochemical hyperandrogenemia (BH).</p> <p>Results</p> <p>The mean ± SD of age of study population was 29.2 ± 8.7 years. Estimated prevalences of idiopathic hirsutism and pure menstrual dysfunction were 13.0% (95% CI: 10.9%-15.1%) and 1.5%(95% CI: 1.1%-1.9%), respectively. The prevalence of PCOS was 8.5% (95% CI: 6.8% - 10.2%); more than one third of these cases would possibly have remained undiagnosed or misdiagnosed, had we not assessed them for subclinical menstrual dysfunction or biochemical hyperandrogenemia.</p> <p>Conclusions</p> <p>These data from a large representative and non selected population of women confirm the concept that IH and PCOS are the two most common gynecological endocrinopathies among reproductive aged women. The estimated prevalence of these conditions is highly influenced by their screening methods at the community level.</p

Prognostic significance of the Complex "Visceral Adiposity Index" vs. simple anthropometric measures: Tehran lipid and glucose study

<p>Abstract</p> <p>Background</p> <p>Visceral adiposity index (VAI) has recently been suggested to be used as a surrogate of visceral adiposity. We examined if VAI could improve predictive performances for CVD of the Framingham's general CVD algorithm (a multivariate model incorporating established CVD risk factors). We compared the predictive abilities of the VAI with those of simple anthropometric measures i.e. BMI, waist-to-height ratio (WHtR) or waist-to-hip ratio (WHpR).</p> <p>Design and methods</p> <p>In a nine-year population-based follow-up, 6 407 (2 778 men) participants, free of CVD at baseline, aged ≥ 30 years were eligible for the current analysis. The risk of CVD was estimated by incorporating VAI, BMI, WHpR, and WHtR, one at a time, into multivariate accelerated failure time models.</p> <p>Results</p> <p>We documented 534 CVD events with the annual incidence rate (95%CIs) being 7.3 (6.4-8.3) among women and 13.0 (11.7-14.6) among men. Risk of future CVD increased with increasing levels of VAI among both men and women. VAI was associated with multivariate-adjusted increased risk of incident CVD among women. However, the magnitude of risk conferred by VAI was not significantly higher than those conferred by BMI, WHpR, or WHtR. Among men, after adjustment for established CVD risk factors, VAI was no longer associated with increased risk of CVD. VAI failed to add to the predictive ability of the Framingham general CVD algorithm.</p> <p>Conclusions</p> <p>Using VAI instead of simple anthropometric measures may lead to loss of much information needed for predicting incident CVD.</p

Is There any Association between Age at Menarche and Risk of Metabolic Syndrome? The Tehran Lipid & Glucose Study

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