Iranian Journal of

---

Background & Objectives: The youth group is more prone to HIV infection. Education is a cornerstone to prevention. This study was conducted to compare the efficacy of peer education and traditional lectureship and distribution of pamphlet on high school students.
Methods: 1500 female high school students, third graders, were selected based on stratified random sampling studying in 21 high schools in Kermanshah. In each high school, 73 third grades were selected as the sample of the study. We designed a questionnaire as an assessment tool for interventions. Peer education was done by 502 students, and AIDS awareness pamphlet was distributed on 500 students, and the rest of students were attended a one-day workshop which was ran by a female physician in their high school.
Results: The mean average age was 16.78 (SD= ± 0.7) years. The mean scores of pretest and post-test in each groups were statistically significant different (P=0.0001). Mean score of difference in workshop by female physician was greater than peer education group, 10.7 and 8.8, respectively. The group whome received their knowledge about AIDS by pamphlet obtained the least mean score than other groups and this was statistically significant (P=0.0001).
Conclusions: The findings of this study indicate that educating students by general practitioners is more effective way to increase students’ knowledge about prevention of AIDS.

---

Background & Objectives: Triglyceride/HDL-cholesterol ratio (TG/HDL-C) has been shown as an indicator for metabolic syndrome (MetS). This study aimed to detect the role of this ratio to predict coronary heart disease (CHD) outcome in an Iranian men population with high prevalence of MetS.
Methods: 1824 men ≥ 40 years old, free of clinical cardiovascular disease at baseline, were included in the study from February 1999 to August 2001. Serum level of total cholesterol (TC), HDL-C, TG, and risk factors of CHD including age, systolic blood pressure, diastolic blood pressure, body mass index, diabetes, smoking and family history of cardiovascular diseases were measured at initial phase of study.
Results: During a median follow up of 6.5 years until March 2007, a total of 163 new CHD events occurred. According to a Cox proportional hazard modeling, after adjustment for TC and other risk factors, men in the top quartile of TG/HDL-C relative to first quartile had a significant hazard ratio (HR) of 1.85 (95% CI, 1.07-3.17). Combined HR for TC and TG/HDL-C (men in the top quartiles of both TC and TG/HDL-C relative to first quartiles) after adjustment for other risk factors was 6.13 (95% CI, 2.37-15.86).
Conclusions: The evaluation of both TG/HDL-C ratio and TC should be considered for CHD risk prediction in Iranian male population.

---

Background & Objectives: The city of Jask in south east of Iran has been considered an endemic focus of leishmaniasis. PCR-based techniques can detect lower parasite burdens, reducing the number of false negatives and improving the quantification of Leishmania parasites in the sand fly. The aim of this epidemiological study was to detect vector(s) by PCR techniques in the city of Jask located in Hormozgan province.
Methods: Sand flies were captured using CDC miniature light traps and sticky papers during 2007-2008 and identified by their morphology. DNA extraction performed by Proteinase K and Phenol/Chloroform/Isoamyl Alcohol methods. Leishmania kinetoplast minicircle DNA was amplified by two Nested-PCR techniques using species-specific primers (LINR4-LIN17-LIN19) and (CSB1XR-CSB2XF-LiR-13Z).These primers could differentiate among Leishmania species of Iran.
Results: A total of 8123 sand flies were collected. The fauna was identified as eight species (3 Phlebotomus and 5 Sergentomyia). Phlebotomus papatasi, P. salehi and Sergentomyia theodori were the three most dominant species (59.91%, 17.21% and 7.32% respectively). 60, 50 and 40 parous unfed female specimens of P. papatasi, P. salehi and S. theodori were investigated for Leishmania DNA infection. Leishmania major DNA was detected in 3 (5%) specimens of P. papatasi and 2 (4%) specimens of P. salehi. Anthropophilic index of these two species were 29.6 & 18 percent, respectively.
Conclusion: This study was the first molecular study for detection of cutaneous eishmaniasis vectors in Hormozgan province in Iran. According to the findings of the present study P. papatasi and P. salehi are probable vectors of cutaneous leishmaniasis in this focus.

---

Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: There is little known about the relation between metabolic syndrome and fiber intake are available in Iran. We evaluated the relation between total, and various types and sources of dietary fiber and the prevalence of the metabolic syndrome.
Methods: In this cross sectional study, 2457 adults, aged 19-84 years were studied. Total dietary fiber intake and its types and sources were assessed using a validated semi quantitative food-frequency questionnaire. Blood pressure, Anthropometric, and biochemical measurements were assessed. The metabolic syndrome was defined according to definition by Iranian National Committee of Obesity.
Results: In the multivariate-adjusted odds ratio, intakes of total (OR: 0.53 95% CI: 0.39-0.74), both soluble
(OR: 0.60 95% CI: 0.43-0.84) and insoluble dietary fiber (OR: 0.51 95% CI: 0.35-0.72), fruit fiber
(OR: 0.51 95% CI: 0.37-0.72), legume fiber (OR: 0.73 95% CI: 0.53-0.99) and cereal fiber
(OR: 0.74 95% CI: 0.57-0.97) were inversely associated with the metabolic syndrome. There was not significant association between using vegetable and nut fiber and prevalence of metabolic syndrome.
Conclusion: Total dietary fiber, both soluble and insoluble fibers, and especially fruit and legumes fibers, reduce the metabolic syndrome among adults in Tehran.

---

Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Cardiovascular disease is the first cause of death and third place in disease burden in Iran. This study estimates population attributable fraction (PAF) of cardiovascular risk factors in Tehran population. PAF is one of the important parameters of measuring population affect of risk factors and evaluating potential impact of preventive strategies in community level.
Methods: In this study 5868 participants above 30 years old of Tehran lipid and glucose study (TLGS) were employed and 501 CVD events detected during 10 years follow-up. Direct estimate of adjusted PAFs using logistic regression which is one of less biased exist methods of PAF calculation were applied.
Results: Highest modifiable cardiovascular risk factor PAFs, in sequence, was smoking (14.16%), hypertension (11.73%), diabetes (7.32%), hypercholesterolemia (6.85%) and central obesity (5.91%) for men, and hypertension (19.25%), diabetes (18.82%), central obesity(9.88%) and hypercholesterolemia (7.95%), for women. Also PAF of hazardous age and premature family history of CVD, as most important nonmodifiable CVD risk factors, were 36.09%, 16.61% and 3.95%, 7.56% for men and women respectively.
Conclusion: According to the difference of risk factors PAFs ranking in men and women, it is suitable that CVD preventive interventions to be prioritized by sex separately. In this regard, besides special attention to control tobacco use in men, hypertension and diabetes in both sexes and high cholesterol in men and central obesity in women respectively, should be given in priority of preventive strategies.

---

Background & Objectives: Studying several linked markers provides more information on locating disease genes locus by using genetic association analysis.  The aims of this study were to introduce Multimarker Family Base Association Tests (FBAT-MM) and its Linear Combination (FBAT-LC) in multimarker genetic association analysis and to examine the association of selected microsatellites with HDL-C in an Iranian population.
Methods: One hundred twenty five (125) families having at least one member with metabolic syndrome and at least two members with low HDL-C were selected from participants of the Tehran Lipid and Glucose Study (TLGS). Multimarker genetic association of HDL-C level with some microsatellites in the chromosomes 8, 11, 12, and 16 were examined using FBAT-MM and FBAT-LC methods.
Results: The families consisted of 563 individuals (269 males and 294 females). FBAT-MM showed significant genetic association only between HDL-C and three microsatellites in Chromosome 11 (P<0.05). The microsatellite D11S1304 was found as the significant factor for multimarker genetic association.
Conclusion: FBAT-MM and FBAT-LC did not show shortcomings such as excessive conservatism and low power which are, usually, observed in other multimarker methods.  Finding microsatellites associated with HDL-C level can provide background for further researches on the role of predisposing genes in metabolic syndrome.

Normal

---

Background & Objectives: Although the population of elderly is increasing in Iran, few studies carried out on this group. The aim of this study was to identify life expectancy and contributory risk factors for the Tehranian elderly of ages above 60 years.
Methods: Individuals above 60 years old whom were recruited in the primary phase of the Tehran Lipid and Glucose Study (TLGS) during 1998-2001 were followed up for 12 years and their vital status were registered (1998-2011). Age and sex mortality rates for age groups (60-69, 70-79, 80+) were calculated and by using Cox proportional hazard model the mean of survival time and hazard rates with respect to risk factors were estimated.
Results: Life expectancy for females and males after crossing 60 years of age reaches to 81 and 80 years, respectively without any statistically significant differences between these two groups. Cox model showed that diabetes, BMI>33Kg/m2 and non ischmecic heart disease reduced survival time in women significantly. While diabetes, smoking, hypertension, ischemic heart disease, history of MI, stroke or sudden death of father, brother or son, lack of physical activity and antihypertensive medications are among the hazardous risk factors for men.
 Conclusion: Among the variables studied, only three (ABC) of them were found as risk factors of women's life, while for men seven risk factors were identified. It seems that more studies are needed to determine the risk factors for women.

---

Background & Objectives: We studied the risk of Chronic Kidney Disease (CKD), Metabolic Syndrome (MetS), and their interaction on the incidence of Coronary Heart Disease (CHD).
Methods: A population of 6568 participants (43.4% male) with a mean age of 48.4 years for males and 46.7 years for females and a median follow-up of 10.1 years was investigated. They were divided into 4 groups at baseline: CKD-/MetS-, CKD+/MetS-, CKD-/MetS+, CKD+/MetS+. Hazard Ratios (HRs) were calculated for each group and were compared to the first group using multivariate Cox regression analysis adjusted for age, education, smoking, total cholesterol, and the family history of cardiovascular diseases.
 Results: Men with CKD (without MetS) showed an HR of 1.74 (CI 95%: 1.16-2.60) for CHD events. The measured value was 2.34 (1.77-3.08) for men with MetS (without CKD). The respective results were in women 1.18 (0.64-2.19) and 2.59 (1.73-3.88). CKD and MetS had a significant negative interaction with CHD events (HR=0.40, 0.24-0.66). The interaction was not significant in women (P value=0.48).
Conclusion: The results of this study indicated that CKD without MetS was a risk factor for coronary heart disease in men but not in women.

---

Background & Objectives: The case-cohort study is one of the youngest designs in epidemiology and some methodological aspects of it are still in debate. This study aimed at comparing the estimated hazard ratio, standard error, and interaction hazard ratio between the case-cohort and cohort studies for assessing the relationship between diabetes and cardiovascular diseases.

Methods: A total of 1701 men and 2253 women aged between 40 and 75 years were considered as the main cohort. Subcohort sampling was performed using simple random sampling with a sampling fraction of 0.3%. The hazard ratio of the cohort study was calculated using Cox regression model and the 3 methods of Prentice, Self-Prentice, and Barlow were used for calculating the hazard ratio of the case-cohort study. The mentioned regression models were used to assess the interactions.

Results: The results of the two studies were similar in populations with higher incidence (cohort of men) and lower incidence (the cohort of women) when frequency percent of exposure variable was greater than 10%. When the sample size of the initial cohort was less than 1250 subjects, discrepancies were observed between the results of the two studies. In addition, the standard error of the case-cohort study was higher than the cohort study. The results of both studies were similar in assessing the considered interactions.

Conclusion: The results are similar when the initial cohort sample sizes are sufficient. Meanwhile, unlike the percentage of exposure frequency, the outcome incidence has a negligible impact on the discrepancy between the results while the effect of the relative frequency of the exposure levels on the results discrepancy is noticeable.

---

Background & Objectives: Some studies on chronic diseases have indicated that obesity may result in a paradoxically longer survival. The present study was aimed to investigate the effect of Chronic Kidney Diseases (CKD) and Metabolic Syndrome (MetS) on the incidence of Coronary Heart Disease (CHD).

Methods: In order to record time to CHD events, a sample of 6,507 individuals (mean age 47.4 years, 43.4% males) was followed for nearly 10 years. Participants were also categorized into four groups according to presence/absence of CKD and MetS. Then, using a Multivariate Cox Regression, the Hazard Ratio (HR) of each group was estimated relative to individuals free of both CKD and MetS separately for obese (BMI&ge27.1 Kg/m2) and non-obese persons (BMI<27.1 Kg/m2).

Results: HR for non-obese patients with CKD but not MetS was obtained 2.06 (95%CI: 1.28-3.31) in men and 2.56 (1.04-6.31) in women. However, these associations were not significant for obese patients. Furthermore, among non-obese men and women with MetS alone, HR was estimated 2.52 (1.71-3.73) and 4.68 (2.20-9.95), respectively. For obese patients, these values were 1.70 (1.05-2.78) and 1.90 (1.16-3.13), respectively.

Conclusion: The results reflect that among those who had MetS alone, the risk of CHD incidence was twice higher in non-obese individuals compared to obese patients.

---

Background & Objectives: Considering the importance of CVD risk factors in diabetic and non-diabetic populations and the high prevalence of diabetes and cardiovascular risk factors, we studied the trend of anthropometric indexes, blood pressure, smoking and lipids in diabetic and non-diabetic populations.

Methods: The data of Tehran Lipid and Glucose Study was used in this investigation. The study population comprised 1045 diabetic and 5136 non-diabetic subjects. To investigate the secular longitudinal trends, the Generalized Estimation Equation method was employed. All statistical models were adjusted for age to eliminate the potential confounding effect of age. The interaction between the diabetes status and each phase of the study was checked in a separate model in GEE.

Results: Over a decade, the serum levels of TC, TGs, LDL-C and non HDL-C decreased although about 60% of the diabetic population did not reach the therapeutic goals of non-HDL-C and LDL-C levels until 2011. Control of hypertension was more successful in females, but about 60% of both males and females with diabetes were still hypertensive at the end of follow-up period. Smoking increased during the follow-up.

Conclusion: This study showed that among CVD risk factors, healthcare professionals paid more attention to hypercholesterolemia neglecting other risk factors including hypertension and central obesity.

---

Background and Objectives: The Covid-19 prevalence can threaten self-care behaviors and disease control in people with type 2 diabetes (T2D) through increasing anxiety and stress levels and limited access to medical services. This study was conducted to investigate the association of the Covid-19 pandemic with self-care behaviors in patients with T2D.
 
Methods: The present study was conducted on 318 adults with T2D who participated in the Tehran Lipid and Glucose Study (TLGS) between 1397 and 1399 and completed the summary of diabetes self-care activities (SDSCA) questionnaire. Data on self-care activities during the Covid-19 pandemic were collected 3-4 months after the announcement of the epidemic in the country via telephone calls. For data analysis, a multiple linear regression model and paired t-test were used.
 
Results: The mean total scores of self-care behaviors were 49.7±14.8 and 56.1±13.1 before and after the Covid-19 pandemic, respectively (P<0.001). After the Covid-19 pandemic, women's total self-care score increased with an increase in the diabetes duration (β= 0.31, P= 0.020) after adjusting for the aforementioned related conditions. This score showed a significant decrease in women with a high school education compared to those with higher education (β= -6.57, P= 0.024). Moreover, the diet and foot care subscales in both sexes and the blood glucose testing score in women were significantly higher after versus before the pandemic.
 
Conclusion: Following the Covid-19 pandemic, self-care behaviors, especially those related to diet, foot care, and blood glucose testing, improved in the short term

---

Background and Objectives: The aim of this study was to investigate the epidemiological characteristics of patients with Covid-19 in Hamadan Province.
 
Materials and Methods: In this descriptive cross-sectional study, demographic and epidemiological data of all people who presented to hospitals in Hamadan Province from February 2019 to December 2020 were extracted using two checklists. Data were then analyzed using the Stata software.
 
Results: In this study, 9674 covid-19 positive patients were examined. According to results, 49.11% of the cases occurred in the elderly over 60 years. The rate of involvement was higher in females than males (51.57% vs. 48.43%). Moreover, 72.05% of the definitive patients lived in the city and 0.76% reported traveling to areas with a high prevalence of the disease two weeks before the onset of symptoms. The highest incidence of this disease per one hundred thousand population was in Malayer, Hamedan and Nahavand counties and the highest fetality was in Razan and Dargazin, Tuyserkan and Asadabad counties, respectively. The data of suspected, probable, and definite outpatients with Covid-19 presenting to medical centers were not evaluated in this study.
 
Conclusion: Due to the high death rate in the elderly, males, those with underlying diseases, and people living in rural areas, it is necessary to design and apply precautionary measures in these groups. Attention should be paid to these high-risk groups in the shortest possible time to reduce the burden of this disease on individuals as well as the health care system.

---

---