Ali Soroush

Sociodemographic Predictors in Failure to Complete Outpatient Cardiac Rehabilitation

Objective To investigate the role of sociodemographic factors in failure to complete outpatient cardiac rehabilitation (CR). Methods This was a retrospective study that used information obtained from the database of the cardiac rehabilitation department of a cardiac hospital in Iran. Data from 1,050 CR patients treated at the hospital between January 2001 and January 2013 was analyzed using binary logistic regression analysis. Results Only 49% of the patients completed the CR program. After adjustment for baseline variables, it was found that the following were significantly associated with failure to complete the CR program: illiteracy (p<0.001), old age (p<0.001), being an employee or retired (p<0.05), having a low capacity for exercise (p<0.001), depression (p<0.001), low anxiety (p<0.001), and not currently being a smoker (p<0.001). Conclusion Paying more attention to older patients with low literacy levels and limited exercise capacity, who are employed or retired, and who are not current smokers, and taking therapeutic measures to control psychological complications such as depression, may be effective in ensuring that patients complete outpatient cardiac rehabilitation.

“ASUKI Step” pedometer intervention in university staff: rationale and design

BackgroundWe describe the study design and methods used in a 9-month pedometer-based worksite intervention called “ASUKI Step” conducted at the Karolinska Institutet (KI) in Stockholm, Sweden and Arizona State University (ASU) in the greater Phoenix area, Arizona.Methods/design“ASUKI Step” was based on the theory of social support and a quasi-experimental design was used for evaluation. Participants included 2,118 faculty, staff, and graduate students from ASU (n = 712) and KI (n = 1,406) who participated in teams of 3–4 persons. The intervention required participants to accumulate 10,000 steps each day for six months, with a 3-month follow-up period. Steps were recorded onto a study-specific website. Participants completed a website-delivered questionnaire four times to identify socio-demographic, health, psychosocial and environmental correlates of study participation. One person from each team at each university location was randomly selected to complete physical fitness testing to determine their anthropometric and cardiovascular health and to wear an accelerometer for one week. Study aims were: 1) to have a minimum of 400 employee participants from each university site reach a level of 10, 000 steps per day on at least 100 days (3.5 months) during the trial period; 2) to have 70% of the employee participants from each university site maintain two or fewer inactive days per week, defined as a level of less than 3,000 steps per day; 3) to describe the socio-demographic, psychosocial, environmental and health-related determinants of success in the intervention; and 4) to evaluate the effects of a pedometer-based walking intervention in a university setting on changes in self-perceived health and stress level, sleep patterns, anthropometric measures and fitness.Incentives were given for compliance to the study protocol that included weekly raffles for participation prizes and a grand finale trip to Arizona or Sweden for teams with most days over 10,000 steps.Discussion“ASUKI Step” is designed to increase the number of days employees walk 10,000 steps and to reduce the number of days employees spend being inactive. The study also evaluates the intra- and interpersonal determinants for success in the intervention and in a sub-sample of the study, changes in physical fitness and body composition during the study.Trial registrationCurrent Controlled Trials NCT01537939

The Role of Oral Contraceptive Pills on Increased Risk of Breast Cancer in Iranian Populations: A Meta-analysis.

Background Cancer is one of the main public health issues in the world. Breast cancer is one of the most common types of cancer among women. It is also the second cause of mortality in women. The association between the use of oral contraceptive pills and breast cancer is controversial and a main issue in public health. Some findings have shown that taking these pills does not have a significant effect in increasing the risk of breast cancer, while others have confirmed the carcinogenic effect of these products. These contradictory findings necessitated this meta-analysis, through of all correlated studies in Iran. Methods All published studies were considered from June 2000 until June 2015, using reliable Latin databases like PubMed, Google Scholar, Google search, Scopus, and Science Direct, and Persian database like SID, Irandoc, IranMedex, and Magiran. Finally, 26 papers were selected: 24 studies were case control while two were population based studies. A total of 26 papers with 46,260 participants were assessed since 2001. Results Overall estimate of OR for the effect of oral contraceptive pills on breast cancer is 1.521 (CI = 1.25–1.85), which shows that the intervention group had more chance (52%) compared to the control group (P = 0.001). Using these pills increased the risk of breast cancer up to 1.52 times. Conclusions Because of directly increasing levels of estrogen and the role of estrogen in gaining weight indirectly, oral contraceptive pills can stimulate the occurrence of breast cancer. More studies should be conducted for controlling the period of pill use.

Surveying the effects of exercise program on sleep quality of the male elderly

Background Old age is a stage of life featured with many physiological and mental changes. The Iranian population is aging, and one of the problems that the elderly are faced with is sleep disorders. The present study is an attempt to examine the effectiveness of an exercise program on the sleep quality of the elderly. Methods A semi-experimental study was carried out on the elderly males referred to the Shahid Yari Elderly Center, Kermanshah, Iran. The sample group comprised of 46 participants: 23 in the experimental group and 23 in the control group. The study was carried out for a period of 2 months and follow-up was conducted every week. To improve the quality of sleep of the participants, a four-stage exercise program was implemented and the collected data were analyzed by SPSS version 20. Results The results of a Mann–Whitney test showed that the quality of sleep of the majority in the experimental group improved compared with that of the control group (P<0.05). In addition, a Wilcoxon test showed improvement of the Petersburg’s sleep quality index based on subelements and the results of a total score of sleep in the experimental group after the intervention. Conclusion The study showed effectiveness of scheduled exercising on the quality of sleep of the elderly. It is recommended, therefore, to add an exercise program to the daily program of the elderly.

The Incidence and Mortality of Liver Cancer and its Relationship with Development in Asia

Cancer in 2013 was among the main leading causes of illness and death worldwide with an annual incidence of 14.9 million new cases and 8.2 million deaths caused. More than 60 percent occurs in Africa, Asia and Central and South America (Fitzmaurice et al., 2015). It is expected that the number of new cancer cases increases 70 percent in next two decades (Pakzad et al., 2015b). Liver cancer is among the most common cancers in the world (Wei et al., 2014) so that this cancer is the fifth most common cancer in men (Hall and Wild, 2003) and the ninth most common cancer in women worldwide. This cancer is the second most common cause of cancer death worldwide in 2012 (Pakzad et al., 2015b). Liver cancer mortality is rapidly increasing since 1970. Due to this point that more than 85 percent of liver cancer new cases occur in developing countries which do not have proper

U.S. Cohort Differences in Body Composition Outcomes of a 6-Month Pedometer-Based Physical Activity Intervention: The ASUKI Step Study

Background: Regular physical activity (PA) enhances health and is an important factor in disease prevention and longevity. The 2008 U.S. Physical Activity Guidelines recommends that all healthy adults attain at least 150 minutes per week of moderate intensity aerobic PA (e.g., brisk walking) to maintain and promote PA. Objectives: This study determined the effects of a 6-month pedometer-based worksite walking intervention with participants focusing on a goal of achieving 10,000 steps per day, on body composition in adults with a wide range of body mass index (BMI) values and compares the changes with outcomes of similar studies. Materials and Methods: The design was a single group, quasi-experimental study. All participants received a pedometer and were asked to register the daily number of steps. Men and women (n = 142; age = 41 ± 11.5 years; BMI = 27.2 ± 7.25 kg.m-2) received body composition measures at 1, 3, and 6 months. A multilevel growth modeling approach was used to explore change over time and to predict change by steps, age, gender, and fat category categorized as normal and overweight/obese. Results: Significant individual differences in linear slopes and change over time were observed for waist circumference (WC) (-3.0 cm) only in unconditional model (t = -0.67, P = 0.02). Conclusions: A 3.0 cm loss in WC shows that a 10,000 step per day walking program has the potential to influence changes in body composition measures that are correlated with adverse health outcomes. While significant changes did occur there are some limitations. The analysis did not consider the data regarding completing of 10,000 steps per day and other potential factors that could influence the results. Compliance to the walking dose and initial physical activity and body composition levels are important to consider when studying body composition changes in such programs.

Which Factors Unexpectedly Increase Depressive Symptom Severity in Patients at the End of a Cardiac Rehabilitation Program

Objective To investigate predictors of depressive symptom aggravation at the end of a cardiac rehabilitation (CR) program. Methods The design of the study was retrospective. The administrative data were obtained from the database of the CR department of a heart hospital in Iran. The demographic and clinical information of 615 CR patients between January 2000 and January 2010 was analyzed using binary logistic regression analysis. Results The results showed that 10.7% of the patients completed the CR program with aggravated depressive symptoms. After adjustment for gender, age, and pre-intervention depression score, lower education level (p<0.05) and smoking (p<0.01) were significant predictors of increased depressive symptoms at the end of the program. Our model variables could explain 6% to 13% of the dependent variable variance. Conclusion The results suggest that targeting patients who are less literate or who smoke could allow for taking the required measures to prevent or control depression at the end of a CR program. It is suggested that future studies consider other variables.

Trajectories and predictors of steps in a worksite intervention : ASUKI-step

Objectives: We evaluated the trajectory of steps over time, success in walking 10,000 steps/day for 100 days, and socio-demographic predictors of success in a pedometer-based intervention (ASUKI-St ...

A new delivery model to increase adherence to methadone maintenance treatment

Dear Editor, Today, a large number of Iranian addicts are treated in methadone maintenance treatment (MMT) centers (1). According to the current procedure, each patient has treatment record in only one clinic. So, each patient is able to get prescribed medications and other medical services of the center. Receiving drugs and center-based services has always faced serious challenges such as access (2). For example, some patients with mobility jobs, people with movement restrictions and physical conditions, and patients living in rural and remote areas are unable to refer to get the medication according to a regular timetable (3). The mentioned issues are a serious challenge for persistence and adherence to MMT. Under such circumstances, a significant proportion of patients abandoned treatment plan and they lost the ancillary services, including medical visits, psychological interventions, and physical and emotional support from a social worker. Ultimately, this situation led to an increased the risk of relapse and resume high risk behaviors related to substance abuse (4). Social damage and financial losses of the countrys health system are only some of the negative consequences of this situation. Based on these considerations, presentation of the strategies and constructive recommendations in support of the related organizations is a necessity. Despite the several offers raised, it seems that the abolition of the system receiving drugs from the origin center and the use of digital identification systems can be useful and practical (5). In the form of drug delivery system, patients can receive their daily dosages in any of the center across the country. This project is done in such a manner that each patient first enrolls in an MMT center and fills out a medical record form. Then, the doctor will determine the types of medication and drug dose based on the patients’ medication history. In the first three months of treatment (i.e. until the stabilization of the dose), visits or appointments will be face to face. After the period and stabilized drug dose, the patient who receives medication is no longer confined to the origin center. This means that each patient is issued an entity identifier such as a smart card for medication. By issuing the smart card, the patient can receive quota set medication use in any part of the country. Definitely to prevent abuse of patients, it is recommended that the patients identity be verified through the finger, eye, or facial recognition digital sensors (5). Meanwhile, bringing up an instruction can be useful based on a mandatory visit to the center of origin for medical examination and psychological services at least once a month. So far, few studies have been conducted to review and confirm the delivery format of pharmaceutical services (6, 7). However, previous studies show that the facial assessment via computer evaluation and photo anthropometric variations in facial features are standard references for personal identification in the field of health and forensic (8, 9). Thus, our offer could possibly be effective in increasing adherence to treatment and reducing problems caused by the access to origin MMT center. As a result, we recommend using this pilot model for at least a one-year period. Then, if the benefit of this model is in practice, this proposal could be implemented permanently.

Subjective correlates of stress management in outpatient cardiac rehabilitation: the predictive role of perceived heart risk factors

Introduction: The causal attributions and perceived risk factors can affect patients’ health behaviors. Therefore, the present study aimed to assess (i) the effect of an outpatient cardiac rehabilitation (CR) program on perceived heart risk factors (PHRFs) and on psychological stress, and (ii) the role of changes of PHRFs at pre-post CR in predicting changes in psychological stress. Methods: In this longitudinal study, 110 CR patients were assessed from June to November 2016 in a hospital in Iran. Perceived heart risk factors and perceived stress were investigated using the PHRFs scale and the Depression, Anxiety, Stress Scale-21, respectively. PHRFs and DASS-21 Stress scale scores were compared before and after 26 sessions of exercise-based CR through paired sample t-tests. In addition, we investigated the effect of PHRF’s change scores on DASS-21 Stress scale scores using linear regression analysis. Results: Results showed that CR has a little impact in improving the patients’ perception of heart risk factors, However, CR is significantly effective in reducing stress (P < 0.05). Regression analysis evidenced that improvements in patients’ perception of risk factors can significantly predict a reduction in psychological stress (P = 0.030). The model explained 11.2% of the variance in the results. Conclusion: PHRFs appear to be significant predictive components of CR’s stress reduction. Practitioners should focus on patients’ perception of risk factors to facilitate stress management in CR program.