Iranian Journal of

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Background: Diabetes type 2 is one of the most prevalent reasons of Hyperglycemia. Different areas experience varying degrees of epidemic intensity. Diabetes is one of the most important causes of death and disability in most countries and imposes heavy financial burdens on people and governments. Although much research has been conducted on its prevention and treatment. It has been recognized as a hereditary disease, the genes causing it or its mode of inheritance are not yet known. Because of the significant role they play in metabolism of glucose, several genes have suggested, but the main cause of the disease has not yet been identified. Our objective is to investigate the epidemic aspects of the hereditary diabetes in people aged 20 years and over.
Methods: A cross sectional study was conducted on 14687 subjects, in the urban setting of east Tehran between 1379 and 1380. Of 407 families, 180 agreed to and completed related questionnaires and underwent the necessary tests 180 diabetic families, with at least one member suffering from diabetes type 2, were studied closely in order to clarify the degree of spread and family background. Analysis was performed using Chi Square and t-test.
Results: Of 1612 subjects, 497 had diabetes, including 802 women and 792 men (p<0. 001). Most of the diabetics (approx. 79%) were between the ages of 41-70 years old with the highest (55.3%) and lowest (6.2%) rates in the age groups of 51-60 and 20-30 years respectively. Diabetes was more prevalent among siblings with 53% in comparison to the prevalence among offsprings-44%. The prevalence of Diabetes type 2 in first-degree relatives was more frequent between sister and brother (52.7%), followed by that between father and daughter (36%). Conclusion: It is recommended that the related authorities implement strategies, including screening of families, with a view to identify those at risk and reduce related complications.

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Background: Type 2 diabetes is a hereditary disease but the inheritance and responsible genes have not been clearly clarified yet. According to the most studies, diabetes is one of the most common causes of mortality and morbidity in populations. Diabetes occurs in 30% of first degree family members of diabetic patients, But most people are not aware of their disease.
Methods: We studied first degree relatives of type 2 diabetes and screened them for diabetes, IFG and IGT.174 families(1556 people) of Tabriz residents were studied, among them 1232 persons grater than 30 years were alive and FBS and OGTT were done in this group .
Results: According to this study, 1232 persons were alive and 324 persons had died and DM was found in 343 (27.9%) and 82 (25.3%) of them respectively. We found 179 (14.5%) persons with IFG and 89 (7.2%) with IGT.The percent of diabetes in offspring and siblings were 32.9% and 22.1% respectively. The majority of patients had 41 – 50 years old. Risk of diabetes among offspring who had diabetes in both parents was more than the ones who had diabetic father or mother. In this study, women with diabetes were more than men (32.4% vs. 22.2% respectively). The prevalence of Diabetes type 2 in first-degree relatives was more frequent between sister and brother (41.95%), followed by that between father and son (10.9%).
Conclusion: Prevalence of diabetes in most populations is 8 – 10 %. If diabetes occurs in someone, risk of development of diabetes will increase to 30% in their family members. Therefore, screening must be done in all family members of diabetic patients to recognize the problem and to prevent from diabetes complication.

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Background: Family satisfaction in subpopulations referred to the endocrine clinic including diabetic and non diabetic patients and their spouses are compared in the present study. This study also assesses the correlation between family satisfaction and variables such as age, sex, educational level, economic status, type of diabetes, duration of the disease, type of therapy and dosage of drugs. A comparison of the frequency of sexual dysfunction between diabetics and non-diabetic pairs was also done.
Methods: In this case- control study, 400 subjects were selected as simplified non-randomized method from outpatients referred to the Shahre Kord endocrine clinic in 2002. We assigned samples to group I (diabetic patients, n=100), group II (diabetic patients spouses, n=100), group III (non-diabetic patients, n=100) and group IV (non-diabetic patients spouses, n=100). Groups I and II were similar in sex, socioeconomic status and educational level. GRIMS family relationship questionnaire was used to evaluate family satisfaction.
Results: Family satisfaction for diabetics in comparison with non-diabetics (P=0.05), diabetics in comparison with their spouses (P=0.003), and non-diabetics in comparison with their spouses (p=0.002) were significantly less. There was no significant difference between family satisfaction in diabetic and non-diabetic patients spouses (p>0.05). Relative frequency of sexual dysfunction was 76% and 29% and relative frequency of decreased libido was 32% an 12%, in diabetic and non- diabetic couples, respectively. Family satisfaction was less in patients with diabetes type I and whom using higher dosage of drugs.
Conclusion: This study emphasized on the attention to the family as a part of approach to the diabetic patients. According to our results, it is recommended to focus the most attention in this field to the patients with type I diabetes and who consume more amounts of drugs.

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Background: Diabetes mellitus is the most common human metabolic disease. Chronic hyperglycemia and carbohydrate metabolism disorder accompany with plasma lipid and lipoprotein disorder. Cardiovascular disease is one of the macro vascular complications of diabetes type 2 which leads to high morbidity and mortality. Dyslipidemia is one of the major risk factors of cardiovascular diseases in diabetic patients. High TG and low HDL-C levels are the most prevalent type of dyslipidemia. Low levels of HDL-c considered as a risk factor for cardiovascular diseases. Methods: In this study 40 type 2 diabetic patients (13 male - 27 female) were included. Lovastatin and Gemfibrozil were recommended separately for 2 months and HDL-C were measured at the baseline and after taking drugs. In all patients BS, TG and TC at the baseline before and after these drugs were normal and so were not any change in their diet. Laboratorial findings gathered and analyzed. The relationship between increase level of HDL and decrease of TC with taking Lovastatin and Gemfibrozil were studied. Results: The averages of TC and HDL-C before taking drug as linear were 36.5mg/dl and 174.56 mg/dl and after taking Lovastatin as linear were 43.3 mg/dl and 150.44 mg/dl. The average of TC and HDL-C after taking Gemfibrozil were 43.33mg/dl and 146.36mg/dl. 18.54 % increase in HDL-C and 13.82% decrease in TC were seen with Lovastatin and 18.54% increase in HDL-C and 16.05% decrease in TC were found with Gemfibrozil. Conclusion: In this study no difference was observed between the effect of Lovastatin and Gemfibrozil in increase of HDL-C (P=0.449). Also there was no difference between the effect of Lovastatin and Gemfibrozil in decrease of TC (P=0.992). The increase of HDL-C after taking Lovastatin had relation with sex and HDL-C increased in females (P=0.006) Also the increase of HDL-C after taking Gemfibrozil had relation with sex and females had more affected (P=0.035).

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Background: Diabetes is a chronic disease which requires patient participation in treatment process. The outcome of the treatment depends on the patient health belief and the cognition about illness. The aim of this study was to clarify the effect of educational intervention focusing on Health Belief Model in health beliefs and awareness of diabetic patients.
Methods: As a clinical trial 64 diabetic patients were selected from 4 hospitals in Tehran in 2006. Patients randomly assigned to two equal number groups, as case and control groups. After determine of education needs using the health belief model, education program were performed in intervention group. Data from each patient was collected by using questionnaire, at the initial visit and two month after education. Parametric and nonparametric tests were used for statistical analysis.
Results: Independent t test didn’t show a significant difference between two groups in the HBM's domains before the educational program (p>0.05). After education the same test indicated a significant difference between two groups (p<0.05), except in perceived barriers and perceived benefits domains (p>0.05). In the intervention group awareness from 11 to 15(p<0.0001), perceived susceptibility from 27 to 30 (p<0.05), perceived severity from 20 to 25 (p<0.0001), self efficacy from 19 to 22 (p<0.0001) and self care behaviors from 95 to 117 (p<0.0001) increased.
Conclusion: Educational intervention focusing on changing health beliefs and increasing awareness may be effective in promoting self care behaviors in diabetic patients.

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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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Introduction: Mental disorders are common in the elderly.The purpose of this study was to assess the general health status and its related factors among people ≥ 65 years in different districts of Tehran. Methods: This study has used data of the participants ≥ 65 years old in urban health equity and response tool (Urban-HEART) study. Finally the data of 1313 elderly were considered for this study. Variables included demographic characteristics (gender, age, education level, family size, marital status and employment status) and mental health using the Persian GHQ -28 questionnaire (domains: somatic, depression, insomnia and anxiety) and quality of life using the SF12. Results: The mean age of participants was 73.68 (5.91) (women=627 and men=686). GHQ-28 median of scores the participants were 24.00 (22.00)[20.00 (27.00) in women and 19.00 (19.00) in men (P<0.01)].Based on GHQ-28 cut-point 23, 50.2%of the participants had mental health problems, [61.2% women and 40.1% men (P<0.01)].The residents of third municipality districts had the best mental health (26.3% of men and 38.5% of women had mental health problems) and the aged of 20th municipality district had the worst health status (65.7% of males and 84.2% of women had mental health problems).In multivariable logistic regression model, for each year of increment age, 2.9% chance of mental health problems increased (P<0.01). With increasing level of education, mental health status was improved (P trend < 0.01). The relationship between family size and mental health was not significant (P =0.06). Conclusion: Mental health status of the elderly in Tehran was worse than the many other countries. The elderly lived in 20th municipal district, had the worst and the dwellers in the 3th district had the best mental health status.

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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 aging of the population is a great challenge of the public health in this century. The health promotion of the elderly people requires a comprehensive and accurate understanding of their health status.
Methods: This cross-sectional study has assessed the health status of 191 old people ≥ 60 in Sistan and Balouchestan province that selected by a multi-level cluster random sampling. General health data was collected using SF-36 questionnaire, nutrition status was assessed using Mini Nutritional Assessment (MNA), depression status was detected by the geriatric depression scale-15 (GDS-15), functional status was assessed using the activity daily living (ADL) and instrumental activity daily living (IADL) questionnaires, as well as, the information about demographic, history of diseases, vaccination, participation in social activities, and the utilization of elderly care services were evaluated by an approved questionnaire. History of hypertension was asked from the participants. Moreover the blood pressures of them were twice measured.
Results: The mean age of the participants was 69.81 (8.32) years. The health status was reported excellent and bad by 4.2% and 9.4% of the participants, respectively. The prevalence of fall in recent year, memory disorder, hearing and visual impairment, and malnutrition were 35.3%, 15.6%, 30.3%, 56.6%, and 8.9%, respectively. The prevalence of dependency in "activity of daily living" and "instrumental activity of daily living" were 25.8% and 58.2%, respectively.
Conclusion: It seems that the prevalence of malnutrition, impaired ADL and IADL, and memory impairment in the older population of Sistan and Baluchestan are above the national and global averages.