Iranian Journal of

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Introduction: The height measurements in the elderly are associated with several problems. In this study we used a model to predict of the Iranian people aged height from age, shin length and forearm length. Methods: A total 165 aged people ≥60 years were randomly selected based on medical record number of about 800 eligible older people who lived in Kahrizak Charity Foundation. Standing height, shin length and forearm length were measured. Data from 99 participants were used to creat a predicting multivariate linear regression model for estimation of standing height of older men and women. The data of the rest 66 participants were used for models testing. Result: The following equations were created: Men height = 78.928+ (1.430× shin length) + (0.817×forearm length)-(0.176×age) The height of women = 71.694+ (1.414×shin length) + (1.084× forearm length)-(0.277× age) R2 were calculated as 0.63 for men and 0.52 for women. Error of estimation was +0.44 cm and it was - 0.16cm and +1.09cm for men and women respectively. Estimated heights were not significantly different from standing statures. Conclusion: height was predictable from shin length and for forearm lengths and also age with a relatively small error in the estimation among Iranian older people. The error of model is more in women than men.

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Increasing of the aging population in most of the developed countries should be more attention to the health issues of this aged group. In Iran, the ageing program has been launched and some institutes or organizations have been in charge of this program. The coordination of health policies and activities in elderly care programs and ageing networks could be helped to improve of elderly life span. This paper discusses the performance of different organizations and or other relevant entities regarding an ageing program in Iran and also comparing those activities to the other developed countries.

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Background: Falling is one of the health problems among aged population. Elderly living in institutions are at greater risk of falling than those dwellings in the community, due to their health status and environmental conditions. This study was designed and conducted aimed to address the factors affecting falls in Kahrizak Charity Foundation (KCF). Methods: This is a prospective longitudinal study, which 194 of residents of KCF were participating in it with inclusion criteria were selected by Random Cluster sampling. They were enrolled after signing an informed consent. At baseline the data of demographic, lifestyle, past medical history and visual ability were collected by interviewing. The anthropometric measurements were performed as well. Cognitive status data were collected using abbreviated mental test (AMT) questionnaire and mini mental state examination (MMSE), balance status was assessed using the Tinetti mobility test (TMT) and its balance and gait sub- scores, depression was detected using the geriatric depression scale-15 (GDS-15). The participants were monitored for the falls occurrence its complications by daily call with caregivers and filling out the special forms for the recording of the falls occurrence by the head nurse. Data were analyzed using univariate and multivariable Cox-regression models. Results: The mean age of the participants was76.02 (8.82) years and the mean follow-up days was 754.40±189.26 days. 44 cases of falls were recorded during follow-up (over two years). The fall rate was 22.7 subjects per 100 participants per year. History of stroke, Parkinson's disease, visual loss, taking antidepressants, TMT score and TMT balance sub-score after adjustment (for age, sex, body mass index and survival time) were associated with falls. Conclusion: The falls among nursing home elderly residents were associated with a history of chronic diseases such as stroke and Parkinson's diseases, visual acuity, use of antidepressants and the TMT and its balance sub score.

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Background: Because of various health problems, the risk of the death in the elderly is higher than adults. The purpose of this study was to investigate the causes of the death, and comparing the cause of death that recorded on the death certificates and those were extracted from the medical records review. Methods: Variables included the demographic characteristics (age and sex), time of death and the cause of death were recorded in the death certifies and those were extracted from the medical records. Results: The mean of death age was 83.8 (8.50) years and in women and men were 84.2 and 81.5 years, respectively, (P < 0.01).The most prevalent cause of death was sudden cardiac death based on both death certificates recorded and review of medical records were 42.5% and 25.9% respectively. Sudden cardiac death in both methods was higher in women than men. Using the kappa, the highest degree of correspondence about the cause of death between two method was about gastrointestinal bleeding (K = 0.76) and then the cancers (K = 0.71) and respiratory infections (K =0.67). Total Kappa of two methods for causes of mortality was 0.50. The most cases of death were reported during 12:00 – 13:59 and 8:00 – 9:59am, time period (16.2 % and 14.1% respectively). Conclusion: the causes of deaths, which are recorded in the elderly nursing homes, do not have enough accuracy. Due to the high incidence of sudden cardiac death in elderly in nursing homes, resuscitation facilities and teams may be helping to reduce these types of death.

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Background: One of the common problems of the elderly, which increase of its prevalence with aging is the dementia and the cognitive impairment. We can help the involved patients to have a better quality of life with early diagnosis of the cognitive impairment. The aim of this study was an assessment of the validity and reliability of the Persian version of the abbreviated mental test (AMT) among the older people in a nursing home setting. Methods: 176 eligible elderly people aged ≥ 60 years living in KahrizakCharity Foundation (KCF), were selected randomly based on medical record number. Demographic information and past medical history of the participants were collected. Geriatric depression scale 15 (GDS-15), global deterioration scale (GDS) forms and also the Persian version of the abbreviated mental test (AMT) were administered. The participants were assigned to two groups the normal and impaired cognitive groups, based on DSM-IV diagnostic criteria. The GDS cut-points were used for assessment of validity, sensitivity and specificity of the Persian version of AMT. Results: The mean age of the participants was 77.30 (7.94) years. The Persian version of AMT had good discriminated validity in diagnosis of normal and impaired cognitive participants (7.35 ± 2.33 and 5.99 ± 2.29, P < 0.01 respectively) and at cut-point AMT< 8,(based on GDS cut-point) it had a sensitivity and specificity 92.15 % and 81.50% respectively. The sensitivity and specificity based on theism IVcriteriawere 64.9% and 64.0% at cut-off point equal to 7, respectively. The internal consistency of the Persian version of AMT was acceptable (Cronbach’salpha coefficient =0. 76). As well as the external reliability (intra-rater) of this instrument was good inter-class correlation coefficient (ICC) = 0.89) Conclusion: The Persian version of the AMT has appropriate validity and reliability in Iranian older people.

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Background: The purpose of this study was the investigation effect of gender on plasma glucose, insulin and insulin resistance index in response to acute endurance activity and subsequent recovery periods in healthy individuals.

Methods: Eight females and seven males 20-30 years old (females 22.37±1.50 and men 23.42±1.27 years old, female weight 55.50±8.14 men and 79.85±15.16 kg, women height 160.12 ± 4.18 men and 179.71±6.57 cm) voluntarily participated in this study. Subjects performed two control activities during two consecutive weeks. The implementation of the sessions was randomly determined for each subject. Exercise program consisted of 45 min acute endurance at 75% of maximum heart rate on the treadmill and subsequently the subject was in a sitting position for one clock recovery. Four blood samples (6 ml) before and immediately after exercise, as well as 1 and 24 hours after the activity was collected. Two-way analysis of variance for data analysis was used.

Results: Regardless of gender, effects of activity and recovery on plasma insulin and insulin resistance index was significant (p <0.05) but not significant for glucose. Also when the data were corrected by changes in plasma volume, similar results were observed for insulin. Although changes of all factors (glucose, insulin, and insulin resistance) in response to activity session of acute exercise endurance was higher in men than in woman, gender has not significant effect on factors.

Conclusion: acute endurance activity and recovery induce change in insulin resistance index but these changes were not related to gender.

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Background: Diabetes is the most common metabolic disorder. Progression of diabetes complications mostly due to lack of blood sugar control. The purpose of this study was to test a hypothesized model of individual and social factors affecting blood sugar control.

Methods: Present study is a cross-sectional study and patients were selected using sex stratified random sampling. Path analysis was conducted to investigate effects variables of the diabetes knowledge, patient and doctor relationship, self care, the number of education years, household income and duration of diabetes on HbA1c. The following goodness-of-model fit were used: χ2, RMSEA, CFI and SRMR test-statistics.

Results: The estimated model demonstrated good model fit, (χ² = 5, p=0.4), (RMSEA=0.006), (CFI =0.99) and (SRMR=0.022). Total effect and total indirect effect of age on HbA1c were significant. Age through duration of diabetes had significant indirect effect on HbA1c. Total effect of duration of diabetes on HbA1c was significant. With increasing duration of diabetes HbA1c also had increased. Total effect of waist-to-hip ratio on HbA1c was significant. Waist-to-hip ratio had significant direct effect on HbA1c.

Conclusion: In the current study the effect of individual factors such as age, waist-to-hip ratio, depression and duration of diabetes on glycemic control were detected. According to the capabilities used in this method can providing results of this study with patients and local policy makers in order to improve the care of patients with diabetes

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Background: Older people are vulnerable in terms of health status. The elderly`s Khuzestan due to the very warm weather of this region are more at risk for health problems. This study is a report on the health status of the elderly in Khuzestan province in 2012.
Methods: This is a Cross-sectional study, with multi-level proportional cluster Random sampling among people aged ≤ 60 years of Khuzestan province. Nutritional status was assessed by Mini Nutritional Assessment (MNA), depressed mood screening was conducted with Geriatric Depression Scale-15 questionnaire, activities of daily living was evaluated using KATZ ADL and Lawton Instrumental ADL tools.
Results: In this study, 387 people participated. The prevalence of hypertension, diabetes mellitus, depressed mood, and anxiety in the participants, were 38.8%, 28.6%, 34.9 and 38.7, respectively. Hearing loss reported in 33.9% and vision impairment was in 62.2% of the participants. Memory impaired founded in 14.9% of the participants.  4.3% of the elderly suffered from malnutrition and 48.3% were at risk of malnutrition. Dysfunction in ADL were existed in 13.9% and 30.3% of the participants had some degrees of dysfunction in IADL.
Poly pharmacy (consumed more than 3 medications) was observed in 36.5% of older adults in this province. The most common health services need was medical services at home and then transport services.
Conclusion: Although the health status of the elderly in Khuzestan province  generally was not worse than the average of Iran, it needs that a special pay attention in some areas, such as hypertension, diabetes, nutritional status and lack of independence in activities of daily living in this age group.
 

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Background: Improved in health condition, reduced fertility rates, and increased life expectancy has increased number and proportion of elderly population. This study was reported the health status of older population in North Khorasan province.
Methods: This is a cross-sectional study that enrolled 99 subjects (40 men and 59 women) ≥ 60 years by a multi-levels proportionate cluster random sampling method.
Required information was gathered by means of a demographic questionnaire. Mini Nutritional Assessment (MNA), Geriatric Depression Scale-15 (GDS-15), Katz's basic activity of daily living, and Lawton's instrumental activity of daily living were administered. Measurements of anthropometric and blood pressure were performed based on standard methods
Results: The prevalence of diabetes and hypertension in elderly, were 17.7% and 57.6%, respectively. Depressed mood was observed in 36.4% of the participants 36.4% of the participants and 18.2 percent of them reported that their health condition was bad. In addition, 73.5% of the elderly had complained about any bodily pain. As well as, 22.6% of the participants used opium at least once during the last year.
Conclusion: It seems that the health status of the elderly in North Khorasan province is not suitable in many indicators, such as hypertension, malnutrition, drug abuse and complaints of pain and their health status was worse than the national average of Iran. A special attention requires to the health status of elderly in this province .

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Background: Although several tools for evaluating and screening of cognitive status have been introduced, most of them are not applicable in Iranian elderly population because of cultural differences and high illiteracy rate. This study is report of "Brief Cognitive Assessment Tool"(BCAT) was developed as a cognitive status-evaluating test and reported psychometric characteristics.
Methods: the BCAT tool includes memory assessment using three words recall test with a rating similar to Mini-Cog and the functional status including "ability to dress", "ability to use the phone," " ability to manage own medications", among both two sexes and financial management capabilities in men and ability to prepare food in women. Functional rating is different in educated and non-educated people. Diagnosis of dementia is considered, when memory impairment is accompanied by the dysfunction. Eighty-six residents of a nursing home (41 men and 45 women) among who had inclusion and no had exclusion criteria also consent to participate were randomly enrolled. Concurrent validity was shown as correlation coefficient between the BCAT categorization and score of mini meAntal state examination (MMSE). Criterion validity, sensitivity and specificity of BCAT were evaluated based on global deterioration scale (GDS). Reliability of two raters results within two weeks was indicated by Kappa coefficient.
Results: The sensitivity and specificity and accuracy rate of the BCAT based the GDS was 88.6%, 82.6%, and 84.9%, respectively. The correlation between the MMSE score and results of the BCAT classifying was significant. The Kappa coefficient between the results of two raters was 81.1%.
Conclusion: It seems that the BCAT has good psychometric properties to recognize cognitive impairment among Iranian older adults.

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Background: Elderly people need more receiving health services. Planning to provide services at regional and national levels requires information about the health status of the elderly. This study was performed to assess the health status of East Azarbaijan province.
Methods: In this cross-sectional study, 436 subjects were enrolled (180 men and 258 women) aged ≥ 60 years using multi-level proportioned cluster Random sampling from 19 cities of the province.
Data was collected by a demographic questionnaire , measuring  anthropometric characteristics, and blood pressure and  using "Mini  Nutritional Assessment" ,”Geriatric Depression Scale-15 ", “Katz’s Activity of daily living”,  and "Lawton’s Instrumental activities of daily living”.
Results: The mean age of the participants was 69.31 years.  The self-reported prevalence of diabetes was 34.2%. The prevalence of hypertension in the elderly was 52.5%. The most common complaint of the participants was pain (60.9%). Totally, 46.9% had a difficulty in walking, 44.3% visually impaired, and 26.4% suffered from hearing impairment. Moreover, 44.8% of sleep disorders was found. Also 26% of the participants had depressed mood.
Conclusion: Elderly residents of East Azerbaijan province, has probably a better health status than the average Iranian elderly. However, there is a high prevalence of hypertension and diabetes among older adults of this province that need to more pay attention.

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Background: Alborz Province is one of the provinces that accepted immigrants. Immigration has a profound effect on physical and mental health in elderly. This study was performed to assess the health status of Alborz province older population.
Methods: In this cross-sectional study, 235 subjects were enrolled (113 men and 122 women) aged ≥ 60 years using multi-level proportionated cluster random sampling that selected from 19 cities of this province. Data was collected by a demographic questionnaire, measuring anthropometric characteristics, and blood pressure and using "Mini Nutritional Assessment", ”Geriatric Depression Scale-15 ", “Katz’s Activity of daily living”, and "Lawton’s Instrumental activities of daily living”. Data was analyzed with spss21.
Results: The mean age of the participants was 68(6.00) years.  The prevalence of anxiety and depression among the participants was as 51.5% and 34%, respectively. At risk or malnutrition was observed in 27% of the participants and 54.5% had suffered dental problems and 49.8% also had problem in walking.
Conclusion: Overall, the health status of elderly people in the Alborz, perhaps slightly better than the national average, but the high prevalence of metabolic disorders also the high prevalence of depression and anxiety require serious intervention by policy makers to promote the health in elderly.

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Background: There are many research have been done so far about the effect of exercise training on diabetic type 2 related risk factors. But in this regard there is no study performed in Iran. So, the aim of the present study was to investigate the effect of endurance exercise training on some diabetic type 2 dependent variables in the form of systematic review and meta-analysis of studies that were performed in Iran.
Methods: In this research PubMed, Embase, Cochran, Scopus, ISI, Google Scholar, Science direct, Sid and Magiran databases were searched for Persian sources. Data analysis were done using STATA software version 12.0.
Results: Generally, 242 articles were founded in primary search, which 24 articles were included in this research. Finally research were evaluated 592 Iranian's peoples which 294 peoples as a control group (96 male and 198 women) and 298 peoples as a training group (97 male and 201 women).The results indicate that there were significant association between endurance exercise and blood glucose levels (P=0.0001,-1.016,-0.656;95%CI), insulin (P=0.0001,-1.042,-0.682;95%CI), insulin resistance (P=0.0001;-0.563,-0.217;95%CI).
Conclusion: Generally, this systematic review and meta-analysis study was demonstrated endurance exercise could be related with decrease diabetes type 2 related risk factors. So, it is recommended that sport and medicine experts use endurance exercise as a non- pharmacological intervention for treatment of diabetes type 2 patients.
 

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of obesity and inactive physical activity, and glucose modulation is of great importance in these individuals. Thyme was studied on type 2 diabetic rats by streptozotocin and high fat diet.
Methods: Male Wistar rats weighing 110±10 g were used in this study. The rats were randomly divided into four groups of Thymus + Exercise, Thymus, Exercise and Control groups. The extract was taken 200 g daily through a gavage syringe. Exercise included: Running on a treadmill at a speed of at least 20 m / min and a maximum of 38 m / min for 60 minutes daily, 5 days a week, for 8 weeks. Serum malondialdehyde (MDA), glutathione peroxidase (GTX), superoxide dismutase (SOD), catalase (CAT) were measured by ELISA method.
Results: Serum MDA and CAT levels were significantly higher in the control group (p = 0.002). The results also showed that there was no significant difference between SOD and GPX levels in different research groups (p = 0.790).
Conclusion: Intermittent exercise (HIIT) and thyme extract can improve oxidative and antioxidant balance in diabetic rats.

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Background: The aim of this study was to evaluate the effect of eight weeks of endurance training and Empagliflozin consumption on inflammatory markers and their relationship with heart structure and function of diabetic male Rats.
Methods: 40 male Wistar rats were randomly divided into five groups: healthy control, diabetic control, diabetic + empagliflozin, diabetic + endurance training and diabetic + endurance training + empagliflozin. The groups were anesthetized and their cardiac function and TNF-α and TGF-β indices were evaluated by one-way ANOVA and Pearson correlation tests after performing the training protocol and receiving medication.
Results: There were significant differences in left ventricular end systolic thickness (P = 0.011), left ventricular end systolic volume (P = 0.008), TNF-α (P = 0.014) and TGF-β (P = 0.001) was observed between the research groups. Also, there was a significant negative relationship between TGF-β with body weight, heart fiber shortening percentage and injection fraction and a significant positive relationship with glucose levels, left ventricular end systolic thickness and left ventricular end systolic volume. In addition, a significant negative correlation was observed between TGF-β and the injection fraction (P≤0.05).
Conclusion: Aerobic exercise seems to improve the inflammatory status, structure and function of diabetic heart tissue beyond the dual effect of Empagliflozin.

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Background: Type 2 diabetes is the most common metabolic disease, a chronic and progressive disorder that causes permanent complications and increased cardiovascular, cerebrovascular, peripheral vascular disease, nephropathy, retinopathy, neuropathy, diabetic foot, amputation and death in patients.The aim of the present study was to examine the predictor role of negative repeating thoughts, emotion regulation strategies and self-care in remedial acceptance and adherence of patients with type 2 diabetes.
Methods: The method of the present study was descriptive, correlation type, and the population was from all the patients with type 2 diabetes who were members of Diabetes Association in Chahar-Mahal-o Bakhtiyari. Among this group, using the convenience sampling method, and on the basis of Morganʼs table, 300 patients with type 2 diabetes were recruitment. Using MackEuy and othersʼ negative repeating thoughts questionnaire (2014), Mans & Malouf emotion regulation­ strategies questionnaire (2009), Toobert & Glasgow self-care questionnaire (2000) & Modanloo acceptance and treatment follow-up questionnaire (2014), the experiment group was investigated. The data were analyzed by SPSS software.
Results: Our findings have shown that negative repeating thoughts, emotion regulation strategies and self-care predict the remedial acceptance and adherence of patients with type 2 diabetes significantly.
Conclusion: With pay attention to identify of the predictor role of negative repeating thoughts, emotion regulation strategies and self-care in remedial acceptance and adherence of patients with type 2 diabetes, and high prevalence of this disease too, it seems that psychological intermediations, with pay attention to role of mentioned variables to decrease of psychological problems and increase of adherence in them, pay attention to role of negative repeating thoughts too, compatible and incompatible strategies of emotion regulation and adhere to self-care could be taken as prevention of deterioration type 2 diabetes and better controlling.

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Background: The health assistant and treatment assistant in the Ministry of Health and Medicine are in charge of educating people with diabetes and empowering them to achieve self-management of diabetes. The present study was conducted with the aim of determining the status of education and support for diabetes self-management in comprehensive health service centers and diabetes clinics in Isfahan province.
Methods: The diabetes education units of 20 comprehensive health service centers and 11 diabetes clinics in Isfahan province formed the sample size. The data collection tool was a checklist with 107 items, which was completed by observing and reviewing 170 paper/electronic files of patients with diabetes.
Results: In more than two-thirds of the files of diabetes centers/clinics, initial assessment were neither performed nor recorded. Educational needs assessment was recorded in 5% of the files and educational planning was not recorded in nearly 100% of them. In more than a third of the files (36.5%), diet education was recorded once when the case was filed. In 3.4% of files, educational effectiveness evaluation was recorded and in three quarters of files (75.78%), continuous support for self-management was not recorded.
Conclusion: There is a significant gap between the status of education and support for diabetes self-management and the process and outcome standards of DSMES in the educational units covered by the provincial health and treatment department. This gap seriously and negatively affects the results of this approach.

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Background: Clinical studies have demonstrated that diabetes, as a metabolic disorder, can significantly impact the quality of life of individuals affected by the condition. Physical activity has been identified as a potentially effective therapeutic intervention for managing diabetes in these individuals. This study examined the correlation between serum levels of GLP-1 and the hormones thyroxine, TSH, insulin, glucose, HbA1c, VO2peak, as well as various anthropometric indicators after eight weeks of calisthenics exercises.
Methods: This semi-experimental study involved 14 sedentary children with type 1 diabetes, averaging 12.42±1.28 years, selected through non-random sampling. The participants performed calisthenics exercises for eight weeks (three sessions per week). Physiological assessments and blood samples were collected 48 hours before and after the training period. The relationship was analyzed using Pearson's correlation test, and intra-group changes were assessed using paired t-tests.
Results: The findings demonstrated a positive and significant correlation between GLP-1 and insulin both before (r=0.703, p=0.005) and after the exercise intervention (r=0.668, p=0.009). Additionally, an inverse and significant correlation was observed between GLP-1 and waist circumference (WC) levels before (r=0.633, p=0.019) and after exercise (r=0.575, p=0.043), as well as between GLP-1 and body fat percentage after exercise (r=0.676, p=0.007). In terms of intra-group changes, the results indicated a significant increase in GLP-1, insulin, and VO2peak, along with a significant decrease in WC.

Conclusion: The findings of this study show that engaging in calisthenics exercises can be effective in reducing the negative effects of type 1 diabetes and increasing the health of diabetic children.