Iranian Journal of

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Background: Dyslipidemia accounts as a major risk factor for cardiovascular diseases. The aim of this survey was to determine the prevalence of dyslipidemia among relatives of patients with premature coronary artery disease (PCAD).
Methods: As a cross-sectional study 232 first degree relatives of patients with PCAD were recruited. A questionnaire was filled out by all of the participants all of them undergone physical examination and blood sampling. Lipid profile was categorized according to the NCEP: ATPIII criteria.
Results: Total Cholesterol>200 in 29.7%, LDL>160 in 10.3%, HDL<40 in 12.9%, TG>200 in 32.8%, ApoB100>130 in 14.2%, Apo A1<90 in 1.7% and LP(a)>30 in 47% of participants were seen. Serum levels of TG were significantly higher in men than women levels of HDL and ApoA1 were lower in men than women. The Prevalence of dyslipidemia among relatives was 59.6%.
Conclusion: In view of high prevalence of Dyslipidemia among relatives of PACD patients, active interventions in order to primary prevention of cardiovascular diseases via exact screening is recommended.

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Background: Assessing the trend of ischemic heart diseases and the process of acute coronary care is one of the most important tools in monitoring the programs dedicated to control of ischemic diseases. The current project was developed to assess the feasibility of using routine data registered in clinical records for coronary event registration according to the standards of WHO/MONICA project.
Methods: Hospital records of 320 cases with primary diagnosis of acute coronary syndrome (80 cases from each quarter, July 2003-4) were evaluated according to sufficiency of data. Data were evaluated according to “internal consistency”, “change in the proportion of missing data in the time periods” and “the proportion of insufficient data”.
Results: Available data of hospital records were not sufficient to determine the diagnosis in 0.7% of cases In addition, they were resulted in a probable diagnosis in 11.2% of coronary events. Median percents of missing data regarding the prescribed drugs before event was more than 10% in both fatal and non-fatal coronary events (score 1 of 4). Median percents of missing data regarding the ECGs, cardiac enzymes and cardiac resuscitation was lower than 5% in non-fatal coronary events and lower than 2% in fatal cases (scores 2 and 3 of 4 relatively).
Conclusion: The quality of available registered data in the evaluated clinical records was comparable with many reporting units of MONICA project. Using the available clinical records seems to be effective and feasible for systematic registration of cardiac events.

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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 Diseases are becoming increasingly prevalent due to urbanization and industrialization of our country. Therefore Screening of the Cardiovascular Risk Factors is one of the most important health system priorities. The aim of this study was to evaluate a screening method implementing family history for cardiovascular risk factors.
Methods: We chose 10 Junior-high schools in the 6th district of Tehran using simple random sampling. Then a questionnaire asking about family history of cardiovascular disease in the first degree relatives (including grand parents) was distributed between them and was completed – with contribution of parents. Then high-risk and low-risk families were invited separately to Dr Shariati Hospital for further evaluation. SPSS software version 10 using student T-test, Chi-Square and descriptive tests were applied for data analysis
Results: Approximately 40% of families had positive family history (high risk). From this group, 72% participated for follow-up. From the low-risk group, only 34% participated. Total cholesterol and LDL-C levels were significantly higher in high risk (HR) group. FBS was also significantly higher in fathers and children of the HR group (P<0.05). High TC, LDL-C and FBS levels were more prevalent among the HR families (P<0.05). No significant differences were observed in age, BMI, BP, TG and HDL-C between the 2 groups.
Conclusion: Families with a history of cardiovascular disease participated in greater numbers in the screening process and the prevalence of risk factors in this group was significantly higher. The findings confirm the usability of family history in screening programs.

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The behavior of tissue fragments in permissive jells is like liquid drops. Under appropriate conditions this phenomenon could be used to print tissues of prescribed shape. Application of the principles of rapid prototyping to tissue engineering or robotic biofabrication is a novel technology that holds promising future in producing suitable human organs in large scale. An introductory discussion of the new interdisciplinary technology of bioprinting is presented in this article.

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Background: Fortification of corn with folic acid has beneficial effects on hyperhomocysteinemia and heart disease. Folate fortification was contributed to an increase in average folate status and a reduction in serum homocysteine concentration.

Methods: In this randomized clinical trial 17 men and women aged 61±5 years old with hyperhomocysteinemia with mean homocysteine concentration of 15/32±6/13 µmol/L were recruited. Subjects received fortified bread which contained 100µg folic acid daily for 8 weeks. Three-day food record, food frequency questionnaire and BMI (Body Mass Index) data at baseline and week 8 were completed. Plasma homocysteine and serum folate at baseline and week 8 were measured. All dietary and statistical analyses were undertaken using Nutritionist III and SPSS release 15.0 software with paired t-test.

Results: Mean plasma homocysteine concentration decreased significantly in hyperhomocysteinemic subjects after daily consumption of folate fortified bread for 8 weeks (P<0.001).After 8 weeks serum folate concentration increased %26 (P=0.06). Mean BMI, energy and other components of dietary intake did not change significantly. Dietary vitamin C decreased significantly (P<0.001).

Conclusion: Daily consumption of folic acid fortified bread, with 100 µg folic acid, in hyperhomocysteinemic subjects for 8 weeks led to significant decrease in plasma homocysteine and an increase in serum folate.

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High plasma homocysteine is identified as an important risk factor for cardiovascular disease. Epidemiological studies have shown that increased plasma homocysteine is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease. Homocysteine may have an effect on atherosclerosis by damaging the inner lining of arteries and promoting blood clots .Folic acid and other B group vitamins help break down homocysteine in the body and folate fortification of foods reduces the average homocysteine level in the population. Low blood levels of folate are also linked with a higher risk of fatal coronary heart disease and stroke. Homocysteine levels are strongly influenced via diet, as well as via genetic factors. Many common genetic disorders and problems (such as vitamin deficiency) adversely affect the metabolism of homocysteine. Common causes of a high homocysteine level include dietary deficiency of folate and B group vitamins, hypothyroidism, kidney disease, psoriasis, and some medicines. Clinical trials to date have not provided consistent evidence that lowering homocysteine levels reduce strokes, heart attacks and other cardiovascular events notwithstanding it is recommended to lower a high homocysteine level because it is a risk factor for heart disease. Homocysteine abnormalities also contribute to birth defects and dementia and folic acid supplementation in the pre-conceptual period is effective in preventing recurrent and primary neural tube defects.

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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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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: 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: 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: 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: 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.