Iranian Journal of

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Background: The precise mechanisms of vascular diseases in insulin dependent diabetes mellitus (IDDM) are not clearly understood. There are evidences of alteration in mechanisms involved in regulating vascular tone including increased ACE activity in some tissues. To investigate the effect of insulin treatment on these changes this study was performed.
Methods: Three groups of 8 male Sprauge Dawely rats including control (C) and two diabetic groups (D, IT) were used in this study. Diabetes was induced by injection of 60 mg/kg STZ ip. After induction of diabetes IT group were treated with insulin (10 units/kg/day s.c.) for four weeks. The control group and the untreated diabetic group were treated with the same amount of Saline and for the same time. ACE activity was determined by HPLC method.
Results: 4 weeks after induction of diabetes, SBP and ACE activity in serum, lung, heart and aorta increased in D group compared to control rats. Insulin treatment reversed these changes to normal values in IT group.
Conclusion: It is concluded that increased ACE activity could contribute to the development of diabetic vasculopathy and ACE reducing activity of insulin may be partially involved in decrease of cardiovascular complications in diabetes.

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Background: Due to homeostatic and regulatory potentials of nitric oxide (NO) in vascular physiology, regulatory systems that determine NO bio-synthesis and bioavailability have been the subject of extensive research in molecular medicine. In the field of vascular system pathophysiology, endothelial nitric oxide synthase (eNOS) which is the major producer and regulator of NO in vascular tissues has received the most attention. Impairment of NO bioavailability (NO quenching) is a common feature in poorly controlled diabetics due to increased catabolism and decreased production of NO. Such impairment in severe forms could end to vasodilation breakdown in peripheral tissues (mainly in skeletal muscles) and defective regional blood flow, that in turn disturb insulin-dependent glucose uptake ensuing insulin resistance state.
Methods: The phenotypic impact of an eNOS gene polymorphism at position 786*C/T (that its functionality has been revealed already) on genetic propensity to diabetic retinopathy is evaluated in a British-Caucasian population with type 1 diabetes (T1DM).
Results: In contrast to genotypes, there was a significant difference in distribution of allele frequencies between T1DM patients (n= 249) and healthy controls (n= 104) (p= 0/036), that may imply eNOS and/or NO involvement in development of T1DM. Most notably a significant difference also was evident in allele frequency between retinopaths (n= 134) and healthy controls (p= 0/02). No significant difference was detected when the genotype/allele frequencies were compared between retinopaths (n= 134) and non-retinopaths diabetics (n= 115) (p=NS).
Conclusion: Our data is compatible with previous studies which demonstrated that allele C of eNOS 786*C/T polymorphism is associated with increased HbA1c levels. By emphasizing the phenotypic and prognostic value of the abovementioned polymorphism, our data calls for further investigations to find out whether this polymorphism can be employed as a genetic marker in clinical medicine to recognize high-risk diabetics at the time of diabetes onset/diagnosis.

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Background: To determine the importance of type 2 Diabetes mellitus as a risk factor for osteoporosis in postmenopausal women, this study was designed in endocrine clinic of zanjan in 2003.
Methods: As a case-control study, 40 diabetic and 40 healthy menopause women have been recruited. These two groups were matched in terms of their age, length of their menopausal period and body mass index. Serum Calcium, Phosphorus, Alkaline phosphatase and Estradiol were measured in all the cases and bone densities in three sites (Femoral neck, lumbar spine and forearm) were evaluated with DXA. All data were analyzed using T-test, analysis of variance, chi-square and multiple regression tests.
Results: The frequency of osteoporosis and osteopenia in diabetic women were not significantly different from non diabetics. The mean bone density in femoral neck was higher in diabetic group (P= 0.013). In both groups there was a significant relationship between bone density and length of menopause (P<0.01) .The relationship between BMI and Bone density was significant only in femoral neck (P<0.01) in both groups. In diabetic women, the higher HbA1c accompanied with the lower bone density in lumbar spine.
Conclusion: Although the level of HbA1c as a marker of blood glucose control, has a relationship with lumbar spine density in diabetics, Diabetes type 2 is not a risk factor for osteoporosis, So screening, diagnosis and management of osteoporosis in diabetes type 2, Should be done independently and according to other risk factors.

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Background: Overweight is one of the most worldwide health problems particularly in industrial and developed communities. Obese subjects are at high risk for developing various disorders such as diabetes and especially cardiovascular diseases. It has been well established that life style modification plays an important role in reducing these complications, particularly weight reduction and caloric restriction (CR) as a non- pharmacological approach. In the present study the possible effects of caloric restriction on Nitric Oxide production and blood pressures in rat were investigated.
Methods: Four groups of rats were selected as control(C), caloric restriction (CR), diabetic (D), and caloric restriction diabetic (CRD). Control animals fed freely with standard pellet but caloric restricted animals fed an every other day diet for 4 weeks. The systolic blood pressure (SBP) was measured in all groups using the tail-cuff method under the light general anesthesia induced by ether. Nitric oxide (NO x) concentrations were determined in serum using a colorimetric non- enzymatic NO assay kit .
Results: In CR experimental groups (CR&CRD) SBP was significantly decreased as compared to control: (P<0.001) and diabetic (P<0.01) rats , while the serum NO x was significantly increased (P<0.01) in both groups as compared to control and diabetic rats.
Conclusion: On the basis of obtained results, it could be concluded that caloric restriction may reduce blood pressure and increase nitric oxide in diabetic and non-diabetic rats. Increase nitric oxide is the likely mechanism for decreasing blood pressure .

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Background: Cardiovascular disease including hypertension are complications of long-standing diabetes. A few Studies had shown the positive effects of L-carnitine on hypertension. In this study, the possible effects of L-carnitne on nitric oxide (NO) levels and angiotensin-converting enzyme (ACE) activity in serum as well as systolic blood pressure (SBP) in diabetic and normal rats were studied.

Methods: In this study forty rats were used in four groups including non-treated control (C), L-carnitne treated control (CT), diabetic (D) and L-carnitne treated diabetic (DT). Diabetes was induced in rats by injection of stereptozotosin. Both of C & D groups had a free access to food and water and CT & DT groups were received daily dose of L-carnation in drinking water. At the end of 12 weeks SBP, serum NO and ACE activity were measured.

Results: Systolic blood pressure was significantly decreased in DT group compared to D group. Serum ACE activity was also significantly decreased in DT group compared to D group and the serum NO levels were significantly increased in DT & CT groups compared to D & C groups respectively.

Conclusion: Finally it could be concluded that L-carnitine may reduce SBP in diabetic rats via elevation of serum NO levels and reduction of serum ACE activity.

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Objective: Health of old people is one of the critical issues in many societies that needs to accurate health policy making and adjust planning in health issues of elderly. The present study designed to compare the efficacy of the two traditional and electronic training methods in nutritional issues in order to life style modification in old people to develop of healthy elderly. Methods: This survey was a quasi-experimental method via applying the Pre-test and Post-test among 65+ years old people in a retirement association of Sari province, Mazandaran state. By simple random sampling method, 60 old people were selected, and then trained in two separated classes to 15 persons as women and men (30 persons) via film technique. The other method was a traditional which applied in the two separated classes of 15 persons as women and men (30 persons) by book technique. The questionnaire applied to measure of nutritional knowledge made up by the health center. Data were described by using SPSS software in accordance to descriptive statistics indexes (mean and standard deviation), and inferential statistics indexes (independent T and dependent T) were used in order to generalize results. Findings: The mean score of increasing knowledge in training group by film was 18/57 and the mean score in training group by book was 16/90 (T =5/299, df= 58). To satisfaction evaluating, the mean score in training group by film was 59 and the mean score in training group by book was 35/73 (T =1/96, df=58). Conclusion: Based on results training of old people by electronic method as a film is more effective than traditional method to increasing of nutritional knowledge in elderly. On the other hand, they had more satisfaction to life style modification by using film method in comparison with traditional method as book reading technique. Also, the training cost of the elderly via educational film is lower than training by book. So, should be suggested to consider in training by film rather than book as an efficient and effective method to improve of elderly health.

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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: Aspects of social and economic development in ICT has led to new applications of these technologies. Using the portal geriatrics’ is an access point to a wide range of resources and information in the content for geriatric medicine specialists, physicians and other health care workers, elderly and their families. It provides integrated information on the sources and applications of heterogeneous. The National Portal of Geriatric Medicine is the best solution to resolve this problem.This study compares the experience of few developed countries and offer the geriatrics’ portal. Methods: This paper is based on valid studies, library and internet searches in databases like as science directly, Springer, Proquest, and advanced search in Google to review the literature on the geriatrics portal in selected the countries. Findings: Developing a portal is a strategy to support the development and maintenance of all the desirable features of the portal and user needs’ analysis. It could also, characterize the structure and integrated system of geriatric care. It makes the integrity to fulfill of the main condition portal services and the content that offer to the elderly.

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Objective: The present study describes assessing physical health status of old people in different age groups in Tehran metropolitan area. The outcomes of this study could help to health policy makers to develop of better health policy in gerontology field by determine of priorities of care in different age groups of old people and effect of socio-economic components on elder’s’ physical health. Method: This was a cross sectional study in 2010. The participants were (N=402) aged 60 years old and over which have underrepresented from Shahid Beheshti university. The survey methods were via face- to-face interviews, and just in a few cases as telephone interviews. The instrument to data collection included demographic questionnaire, SF-36 short form and ADL tools. Data analyzed by Stata and SPSS Ver.15 through t-test, one-way ANOVA. Regression models applied as well. Findings: Based on the results 45% of elderly were in (60-69) years old, 36.5% were in (70-79) years old, and 18.5% were 80+ years old. The median age was 71.5±8.9 years. Regarding ADL, 18.2% of elderly were dependent 22.3% were semi dependent, and 59.5% of participants were independent to do activity of daily living. Regarding physical functioning, 29.6% of elderly had severe limitation 32.6% had moderate limitation, and 37.8% had no limitation in their physical function. Components of age, sex, marital status, education, job, income, insurance, housing, and living with whom had significant association with physical health status in old people. Although based on regression model and considering in effect of conflict variables, age and sex had more effect to predict of activity of daily living in old people. Age, sex, to be alone, and financial problems were the most predictors on physical function in aged people. Conclusion: The important components that effect on physical health of elderly related to fragile elderly from aspect of socio economic factors. Based on the results of this study aged elderly and old women were more disable to do Activity of Daily Living (ADL). Regarding physical function age, sex, living with whom, and financial dependency were significant components in relation with physical function. In other words, older people, women, elderly who did not live with their spouse, and elderly who were dependent in financial aspect to others had more difficulty in physical function.

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Introduction: Studying of physical and mental health of older adults is important for health care services to elderly. With increasing ageing population and chronic diseases among older people, the expenditure of ageing services will increase. Thus, it is necessary to clear a cut point chronological age for starting ageing career. The aim of this paper is to understand health differences between two cohorts (60-64 and 65-69) of older adults. Methods: This study is cross-sectional and descriptive-analytical study. Data collected by structured questionnaire. The study population was 60 -64 and 65-69 cohort groups of older adults who living in rural and urban areas of Tehran in 2011. The sample size was estimated 400 people those were chosen using cluster sampling. Findings: The findings of study showed significantly differences between two groups of older adults, 60-64 and 65-69, in terms of physical health that measured using activity of daily living(ADL) and limitation of physical function. In contrast, there were no significant differences between two age groups in psychological wellbeing and mental illness. Based on results, complementary health services can start from 65 years old and providing counseling services according to women and men differences.

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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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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: One of the important indicators of diabetes treatment and control is enhancement of quality of life in patients with diabetes. Therefore, in recent years, quality of life in these patients regarded by therapists and researchers and increased studies in this field. The aim of this study was collection and integration of these studies results to investigate the effect size of sport and psychological interventions on quality of life in patients with type 2 diabetes by meta-analysis method. Methods: For this purpose, 25 acceptable studies (15 psychological interventions, 10 sport interventions) in terms of methodology (hypothesis, research method, statistic population, volume of sample, sampling method, instrument measure & statistic analysis method) selected, and meta-analysis performed on them. Research instrument was checklist of meta-analysis. Results: The study findings showed that the rate of effect size of psychological interventions on quality of life in patients with type 2 diabetes was d=0.95 (p<0.00001) and the effect size of sport interventions on quality of life in this patients was d=2.2(p<0.00001). According to Cohen’s chart both effect sizes of sport and psychological interventions were high. Conclusion: psychological and sport interventions can be effective on improvement of quality of life in patient with 2 diabetes.

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Background: Diabetes Mellitus (DM) is one the most common chronic disease, with many complications including renal failure, blindness and non traumatic amputation. Prevention of complications is possible through monitoring and control of blood glucose levels. Considering how easy home blood glucose monitoring is, we decided to evaluate the performance of two available glucometers for detection of blood glucose compared with standard laboratory methods. Methods: In this study, 369 patients with diabetes who admitted to the Shahid Beheshti hospital laboratory in 2013 selected by simple way. After fasting blood glucose testing at the laboratory by lancet devices for ONCALL and GLUCOCARD Glucometers, capillary blood was taken, and glucose measurements were performed by a special strips. Finally, we compared of capillary blood glucose levels of 369 patients as determined by test strips (Glucometers) with venous blood glucose levels measurements by the enzymatic method (the standard laboratory kit), and the results was evaluated by statistical tests such as the mean ± standard deviation, and Pearson correlation. Results: The mean blood glucose measurements reported using the Glucocard glucometer, the ONCALL glucometer and the standard laboratory method were 127.0±51.6mg/dl, 117.9±42.1 mg/dL and 118.09±51.9 mg/dL. Results obtained using the ONCALL Glucometer had no differences with the standard method levels)p=0.901(, but obtained results from GLUCOCARD Glucometers had differences with the standard method levels(p≤0.001). Conclusion: Diversity glucometer devices used in various parts of the country highlight the need for similar studies. We recommend use the ONCALL Glucometer with standard principles for glucose monitoring routine.

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Background: Reducing in mortality rate due to improved health status in recent years has led to an increased number of elderly people in the world. Therefore, this study aimed to determine the structure of the home care plane in developed countries to provide practical implementations for Iran. This paper is based on valid studies, library and internet searches in databases like science directly, Springer, Proquest, and advanced search in Google to review the literature on the home care programs in developed countries. Results: Documents showed that developed countries have established the aimed, needs, priorities programming of the elderly home care plan. Those groups of countries have designed the home care services to care of older people in their homes respect to maintained of their function and ability as independent individuals. Conclusion: The investigations have been shown that community-based services and home care programs that is not considered as a medical service component, could be eliminated the support needs, and helped the elderly people to live independently and continue their life with quality. Considering the significant role of home services in the prevention of hospital readmission in elderly and to maintain of independency rate and also increasing the quality of life in elderly people, is a necessary issue in Iran that makes to improve on the quality of life in Iranian seniors

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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: Metabolic syndrome is a cluster of disorders which altogether increase the risk of cardiovascular disease and type 2 Diabetes. We evaluated the effect of consumption of Omega-3 Fatty Acids on different components of this syndrome. Methods: This was a double blind placebo controlled clinical trial on 199 elderly residents of Kahrizak charity foundation in Tehran. Participants were divided into two groups of intervention and control, consisting of 100 and 99 persons, respectively. The intervention group was given the Omega-3 Fatty Acid capsules contain 180 mg EPA and 120 mg DHA once daily. The control group was given placebo once per day. The duration of the study was 6 months in the beginning and after 6 months of the study, blood pressure, waist circumference and Serum levels of ESR, hs-CRP, APO B, APO A1 and Insulin were measured. Results: The study was completed in 89 and 87 participants in the intervention and control groups, respectively. The mean age of intervention and control groups were 74.13 ± 9.96 and 75.17 ± 8.70 years, respectively. Consumption of Omega-3 Fatty Acids could decrease diastolic blood pressure (P = 0.001) and serum Triglyceride levels (P = 0.01) significantly compared to control group. No change was observed in other measured parameters. Conclusion: Consumption of Omega-3 Fatty Acids with dosage used in this study could probably improve symptoms of Metabolic syndrome in the elderly.

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Background: Health staffs have different attitudes and beliefs toward elders that have effect on their behaviors in health service delivery to elders. This study was done for determination of Golestan province health centers general practitioners (GPs) attitude toward elders. Methods: In this cross sectional study, 152 general practitioners of Golestan province health centers were selected via random sampling. The Kogan's Attitudes toward Older People Scale (KAOPS) questionnaire was used as data gathering tools. Data analysis was done in SPSS 16 software using Pearson correlation coefficient, paired t-test, t-tests and one way ANOVA test. Results: Mean (standard deviation) of participants age was 34.73 (6.26) years. Mean (standard deviation) of total score of attitude toward elder scale was 115.48 (10.22) (score range in scale 34-204). 54.2 percent of GPs have lower score than mean. Negative attitude mean score were higher than positive attitude mean score which was statistically significant (P= 0.0001). Conclusion: According to our finding, only half of GPs had favorite attitude toward elder. Whereas negative attitudes were higher than positive attitude toward elder, designing some programs for change in attitude of heath care staffs is necessary.

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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.