فهرست مطالب

Research in Medical Sciences - Volume:16 Issue: 4, Apr 2011

Journal of Research in Medical Sciences
Volume:16 Issue: 4, Apr 2011

  • 134 صفحه،
  • تاریخ انتشار: 1390/03/17
  • تعداد عناوین: 20
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  • Fereshteh Ashtari, Mohammad Reza Savoj Pages 457-462
    Background
    Methotrexate، a toxic antimetabolite that limits cellular reproduction by acting as an antagonist to folic acid، has been used to control autoimmune disease with different results. The aim of this study was to evaluate the effectiveness of low dose methotrexate in the relapsing-remitting multiple sclerosis (RRMS).
    Methods
    Eighty patients with definite RRMS age 15 to 55 years were randomly allocated to receive a 12-months treatment course of either oral methotrexate (7. 5 mg/week) or intramuscular interferon β-1α (30 µg/week). Response to treatment was assessed at 12-months after start of therapy.
    Results
    The results of the study demonstrated significant reduction in relapse rate in both groups (p < 0. 01(. In 40 patients treated by methotrexate، the mean value (SD) of relapse rate decreased from 1. 75 (0. 74) to 0. 97 (0. 83) (p < 0. 01). Correspondingly، the mean value (SD) of relapse rate decreased from 1. 52 (0. 59) to 0. 57 (0. 78) (p < 0. 01). Decrease of relapse rate in interferon β-1α group was more than the other group (p = 0. 06).
    Conclusions
    This study suggests that although treatment with methotrexate may significantly reduce relapse rate and slow progression of disease in patients with RRMS، but its efficacy is less than interferon β-1α and it may be better used as add-on therapy.
  • Abdolamir Atapour, Hojatollah Raji Asadabadi, Shirin Karimi, Akram Eslami, Ali Akbar Beigi Pages 463-468
    Background
    This study was performed to compare the outcomes of open surgical procedure and percutaneously peritoneal dialysis catheter (PDC) insertion by using laparoscopic needle.
    Methods
    This randomized clinical trial study was conducted in the Department of Nephrology of Alzahra in Isfahan, Iran during 2009 and 2010. 64 uremic patients were randomized by random allocation software into two study groups. Thirty four catheters were inserted percutaneously (P group) and 30 catheters were placed surgically (S group). Information were collected included demographic data, body mass index, cause of renal disease, duration of operation, and time of hospital stay. Outcomes were considered as mechanical and infectious complications.
    Results
    There were no significant differences in age, gender, the mean of body mass index, positive history hemodialysis, diabetes mellitus, hypertension, ischemic heart disease, and time of hospital stay. Hemopenitoneom was more frequent in S group than P group (13.3% versus 3.2%; p < 0.0001). There were no significant difference between two groups in early peritonitis, early leakage, hernia, hollow viscous perforation, catheter obstruction, and malpositioning and the time of peritoneal dialysis onset. Outflow failure and the exit site infection was more frequent in S group than P group (p < 0.0001). Mean of the operative time was longer in S group than P group (27.70 ± 2.79 minutes versus 10.48 ± 1.91 minutes; p < 0.001).
    Conclusions
    Percutaneous catheter insertion in comparison to surgical method had the fewer rate of complication and less time consuming.
  • Khadijeh Rahmani, Abolghasem Djazayeri, Mohsen Ibrahimhabibi, Homa Heidari, Ahmadreza Dorostimotlagh, Maryam Pourshahriyari, Leila Azadbakht Pages 469-476
    Background
    School feeding programs are important interventions for improving the nutritional status. This study was conducted to evaluate the effects of milk supplementation on physical and mental function as well as school performance.
    Methods
    This case-control population based intervention was conducted on 469 students from 4 schools in a medium socio-economic status region in Tehran, Iran. The schools were chosen by Iranian ministry of education and training but they were allocated in case and control randomly (Two girls’ schools and two boys’ schools). All the students in the first to third classes in intervention schools were consumed daily milk. Sterilized and homogenized milk was distributed daily during three months (250 ml for each student). Anthropometric measurements were done according to the standard methods. For evaluating the mental function, two psychological tests including the Raven’s Coloured Progressive Matrices (CPM) and Wechsler Intelligence Scale for children test (verbal, non-verbal, total Intelligent Quatient) were used to evaluate the students. School performance was assessed by grade-point averages of each student.
    Results
    The weight of children was significantly different between control and intervention groups at the end of study among girls (23.0 ± 3.8 vs. 23.8 ± 4.3 kg; p < 0.05). There was no significant difference between the mean of height and mid-arm circumference between control and intervention group at the end of trial (p > 0.05) in total participants; however, the mid-arm circumference was different among girls. Psychological tests scores were significantly different between control and intervention groups (p < 0.05) at the end of trial among boys. The grade-point average was significantly different at the end of trial between intervention and control groups among girls (p < 0.05).
    Conclusions
    School feeding programs focus on milk supplementation had beneficial effects on the physical function and school performances, specifically among girls in Iran.
  • Mahmoud Saeidi, Omid Aghadavoudi, Mohsen Mirmohammad Sadeghi, Mojtaba Mansouri Pages 477-483
    Background
    Postsurgical pain usually results in some complications in the patients. This study has tried to investigate the effects of parasternal single injection of bupivacaine on postoperative pulmonary and pain consequences in patients after open heart surgery.
    Methods
    In a prospective double blind clinical study, 100 consenting patients undergoing elective open heart surgery were randomized into two groups. In case group, bupivacaine was injected at both sides of sternum, immediately before sternal closure. In the control group, no intervention was performed. Then, the patients were investigated regarding intubation period, length of ICU stay, ABG parameters, morphine requirement, and their severity of postoperative pain using a visual analogue scale (VAS) device.
    Results
    No differences were found between the two groups regarding to age, sex, pump time, operation time, and body mass index and preoperative cardiac ejection fraction. Mean intubation length in case group was much shorter than control group. Mean PaO2 in case group was lower in different checking times in postoperative period. The patients in the case group needed less morphine compared to those in the control group during the 24-hour observation period in the ICU. Finally, mean VAS scores of pain in case group were significantly lower than those in control group at 6, 12, and 24 hours postoperatively.
    Conclusions
    Patients'' pain relief by parasternal single injection of bupivacaine in early postoperative period can facilitate earlier ventilator weaning and tracheal extubation after open heart surgery as well as achieving lower pain scores and narcotic requirements.
  • Elham Hakki Kazazi, Mehrdad Sheikhvatan, Mehran Mahmoodian, Mahmood Sheikh Fathollahi, Hakimeh Sadeghian Pages 484-489
    Background
    The location of acute myocardial infarction (MI) is an important prognostic factor for risk stratification of patients with first ST-segment elevation MI (STEMI). The main goal of this study was to compare the severity and extension of coronary involvement in these two types of MI.
    Methods
    This study reviewed angiographic reports of 579 patients with a first anterior wall STEMI and 690 with a first inferior STEMI that were referred to Tehran Heart Center between March 2004 and September 2007. The number of coronary vessels involvement and the presence of left main lesion were determined based on angiography reports. The Gensini score was also calculated for each patient from the coronary arteriogram.
    Results
    Incidence of left main lesion was similar between the two groups. Although coronary arteries involvement according to Gensini score was more severe in anterior wall MI group compared with inferior wall MI group, the number of involved coronary arteries was significantly higher in the inferior MI patients. Recommendation of coronary artery bypass grafting, percutaneous coronary intervention (PCI) or medical treatment were the same for both groups; however, patients with anterior MI were treated more with primary PCI.
    Conclusions
    According to our angiography database, despite anterior wall MI is associated with more severity of coronary artery disease; inferior wall MI is more extent with regard to the number of involved coronary vessels. Location of MI can predict the severity and extension of infarction.
  • Hossein Hajianfar, Mohammad Javad Hosseinzadeh, Ahmad Bahonar, Kazem Mohammad, Golam Reza Askari, Mohammad Hassan Entezari, Ali Keshavarz, Nazli Ansari Pages 490-495
    Background
    Visfatin is an adipocytokine which is secreted from adipose tissue and can effect on the diabetes inflammatory reaction and also serum lipids level. On the other hand, Omega-3 can also prevent form insulin resistance. In the present study, the effect of Omega-3 on the serum Visfatin concentration was compared with placebo.
    Methods
    A total of 71 women with type II diabetes were randomly assigned to the group that took Omega-3 capsules or control group with placebo capsules. In the first step, the study subjects filled in a questionnaire including age, height, weight, waist circumference, hip circumference. In addition, their blood samples were taken for the blood tests. In the second step, the intervention was done for 8 weeks and in the third step the aforementioned were collected again. Hip circumference was measured from the middle and the largest part of it. Waist circumference was also measured from the cord at the end of a normal exhalation. In the blood samples visfatin and lipid profiles (LDL: low density lipoprotein, HDL: high density lipoprotein, TG: triglyceride and cholesterol), glucose and HbA1c were measured.
    Results
    There was no significant difference in serum visfatin level between Omega-3 and placebo groups before the intervention (p = 0.14), while after the intervention, the mean serum visfatin level in the Omega-3 group was significantly (p < 0.001) higher. In addition, the mean difference before and after the serum visfatin level showed a significant difference in both groups (p < 0.001).
    Conclusions
    This study showed an increase in visfatin level following consuming omega-3 fats but according to controversial issues on insulin-like function of visfatin, the effects of Omega-3 on diabetes should be studied more in further studies.
  • Sayed Nassereddin Mostafavi, Behrooz Ataei, Zari Nokhodian, Majid Yaran, Anahita Babak Pages 496-501
    Background
    Toxoplasmosis is a worldwide infection. Most studies on toxoplasmosis are in women in child bearing ages. We conducted an epidemiological survey on the population of the Isfahan Province to identify characteristics of the individuals associated with seropositivity.
    Methods
    In a cross sectional study, 599 serum samples were randomly collected for seroepidemiology of Hepatitis A and E, and were also used for titration of IgG anti-toxoplasma gondii antibody by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Data were analyzed using SPSS software15. Chi square and Fisher exact tests were employed to examine antibody status in different age, gender, education and residency groups.
    Results
    The overall prevalence was 41.4% (248/599). There was a statistical significant association between seroprevalence with age, education and gender (p < 0.05) but not with residency state. The peak age for acquisition of the infection in females was 20-29 and in males 20-39 years old.
    Conclusions
    Results of current study showed a moderate prevalence of toxoplasma gondii infection. However higher seroconversion rate in active social and reproductive ages, females and low educated individuals necessitate active preventive programs in these high risk groups.
  • Mohsen Mirmohammad Sadeghi, Mojgan Gharipour, Peiman Nilforoush, Hamid Shamsolkotabi, Hamid Mirmohammad Sadeghi, Amjad Kiani, Pouya Mirmohammad Sadeghi, Niloufar Farahmand Pages 502-508
    Background
    There is limited data about the influence of timing of cardiac surgery in relation to diagnostic angiography and/or the impact of the amount of contrast media used during angiography on the occurance of acute renal failure (ARF). Therefore, in the present study the effect of the time interval between diagnostic angiography and cardiac surgery and also the amount of contrast media used during the diagnostic procedure on the incidence of ARF after cardiac surgery was investigated.
    Methods
    Data of 1177 patients who underwent different types of cardiac surgeries after cardiac catheterization were prospectively examined. The influence of time interval between cardiac catheterization and surgery as well as the amount of contrast agent on postoperative ARF were assessed using multivariable logistic regression.
    Results
    The patients who progressed to ARF were more likely to have received a higher dose of contrast agent compared to the mean dose. However, the time interval between cardiac surgery and last catheterization was not significantly different between the patients with and without ARF (p = 0.05). Overall, postoperative peak creatinine was highest on day 0, then decreased and remained significantly unchanged after this period. Overall prevalence of acute renal failure during follow-up period had a changeable trend and had the highest rates in days 1 (53.57%) and 6 (52.17%) after surgery. Combined coronary bypass and valve surgery were the strongest predictor of postoperative ARF (OR = 4.976, CI = 1.613-15.355 and p = 0.002), followed by intra-aortic balloon pump insertion (OR = 6.890, CI = 1.482-32.032 and p = 0.009) and usage of higher doses of contrast media agent (OR = 1.446, CI = 1.033-2.025 and p = 0.031).
    Conclusions
    Minimizing the amount of contrast agent has a potential role in reducing the incidence of postoperative ARF in patients undergoing cardiac surgery, but delaying cardiac surgery after exposure to these agents might not have this protective effect.
  • Hashemi, Akbar Hassanzadeh, Mojtaba Abtahi, Navid Omidifar, Hanif Okhovat Pages 509-515
    Background
    Antimicrobials treatment of Otitis media (OM) reduces some complications, but some of chronic complications, and specially otitis media with effusion (OME), seem to increase. Theoretically the usage of nasal corticosteroid sprays may prevent this problem by reducing the local inflammation around the eustachian tube. So, this study aimed to evaluate the role of nasal corticosteroid spray as an adjuvant for the treatment of OME.
    Methods
    In a randomized, prospective clinical trial, 2 groups of 46 subjects who had OME were recruited. A questionnaire containing patients'' characters, history, complaints, otologic examinations and the report of tympanometries was filled for all before and after treatment. We administered a period of amoxicillin and a decongestant for both group and nasal beclomethasone spray only for case group.
    Results
    Thirty five of cases (76.1%) and 22 (47.8%) of controls had an improvement in their symptoms or the quality of hearing (p = 0.005). Partial remission was the most common finding in 52.2% of the patients in the case group but for control group there was no change (p = 0.024). The higher improvement in the tympanic retraction in the case group was significant (p < 0.05). A significant better tympanometric result has showed in the treatment of left ear in the patients of the case group (p = 0.038) but not for right ear (p = 0.136).
    Conclusions
    We concluded that the administration of nasal beclomethasone spray as an adjuvant for the treatment of OME not only improved the results treatment but also increased the resolution of symptoms and the patients'' quality of hearing.
  • Bijan Rezakhaniha, Nahid Arianpour, Soheila Siroosbakht Pages 516-523
    Background
    Nocturia may be due to urological and non-urological diseases; some of the possible underlying non-urological diseases may be life-threatening. We investigated the efficacy and safety of lowest dose of oral desmopressin in treatment of nocturia in elderly men.
    Methods
    60 old men referring to urology clinic of Imam Reza hospital in Tehran, Iran during 2008-2009 for treatment of nocturia were included in a double-blind placebo-controlled study. They complained of about 2 voids per night. Patients were randomly divided into 2 study groups (30 patients in each group). Care was taken to match the patients of the 2 groups by age and clinical criteria. Patients belonging to group A received placebo and patients of group B received 0.1 mg desmopressin at bed time for 8 weeks. They were assessed after 4 and 8 weeks of treatment. The means were compared using paired sample t and chi square tests for time of nocturia before and after treatments and also between the two groups. ANOVA test was used to evaluate statistical differences between outcomes of the two groups.
    Results
    Mean number of nocturia before and after receiving desmopressin were 2.6 and 1.6 respectively (p < 0.001). Mean number of nocturia before and after receiving placebo were 2.5 and 2.3 respectively with no significant difference (p = 0.344). After 4 weeks of treatment with desmopressin, 17 (56.7%) had less than 2 voids, 5 patients (16.7%) had 2 voids, and 8 (26.7%) had more than 2 voids per night (p < 0.05). After 8 weeks, patients were evaluated and it was noticed that in group B, 4 patients (13.3%) had 2 voids, 24 (80%) had less than 2 voids, and 2 (6.7%) had more than 2 voids per night (p = 0.004).
    Conclusions
    Oral administration of desmopressin is an effective and well-tolerated treatment for nocturia in elderly men.
  • Mohammad Ali Attari, Sayyed Ahmad Mirhosseini, Azim Honarmand, Mohammad Reza Safavi Pages 524-529
    Background
    Stability is often described to be static (quiet standing) and dynamic (maintaining a stable position while undertake a prescribed movement). Many researchers have used only static tests to evaluate the stability of normal and handicapped subjects. However, it is important to evaluate the stability of subjects while undertaking various tasks (dynamic stability). It is not currently clear whether static balance can predict dynamic balance or not. Therefore, the aim of this research was to investigate the relationship between static and dynamic stability tests parameters.
    Methods
    The current clinical trial study was carried out in the Bioengineering Unit of Strathclyde University during 2008 and 2009. The normal subjects with no history of musculoskeletal disorders from staff and students of the Unit were selected in this study. Twenty-five normal subjects were recruited to participate in this research project. They were asked to stand on a force plate in quiet standing and while undertaking various hand tasks. The functional stability of the subjects was measured while transverse and vertical reaching tasks were undertaken. The correlation between various parameters of stability in quiet standing and functional hand tasks was evaluated using Pearson correlation.
    Results
    There was no significant correlation between static and dynamic stability parameters. The Pearson correlation coefficients for all parameters regarding the static and dynamic tests were less than 0.46.
    Conclusions
    As there is no correlation between stability parameters in quiet standing and while performing various hand tasks, it is not practical to discuss ability of the subjects to control their balance while undertaking various hand tasks based on static balance ability.
  • Mohammad Taghi Karimi, Stephan Solomonidis Pages 530-535
    Stability is often described to be static (quiet standing) and dynamic (maintaining a stable position while undertake a prescribed movement). Many researchers have used static and dynamic tests without reporting the relationship between them. Unfortunately, it is not currently clear weather or not static balance is reflective of dynamic balance or not. So the main aim of this research was to find the association between the stability in quiet standing and while the subjects undertaking various hand tasks. 25 normal subjects were recruited to participate in this research project. They were asked to stand on a force plate in quiet standing and while undertaking various hand tasks. The functional stability of the subjects was measured by transverse and vertical reaching tasks. The correlation between various parameters of stability in quiet standing and functional hand tasks was evaluated by use of Pearson correlation. The results of this research project showed that there was no significant correlation between static and dynamic stability. As there is no correlation between stability parameters in quiet standing and while performing various hand tasks, it is not practical to discuss ability of the subjects to control their balance while undertaking various hand tasks based on static balance ability.
  • Ali Momeni, Mohammad Rajaei Pages 536-540
    Background
    Hepatitis B is the most important cause of cirrhosis in developing countries. Hemodialysis patients are susceptible to infection due to repeated contact with dialysis machines and blood products. The aim of this study was to compare the efficacy of intradermal low dose with intramuscular high dose hepatitis B vaccination in hemodialysis patients.
    Methods
    In a cross-sectional study on 24 hemodialysis patients that not responded to conventional method of vaccination in this center (double dose in 0, 1 and 6 months) and have antibody titer less than 10 mu/ml were enrolled to intramuscular or intradermal group, randomly. In intradermal (ID) group 10 µg (0.5 ml) recombinant vaccine, every 2 weeks to 6 months and in intramuscular (IM) group 40 µg (2 ml) at 0, 1, 2, and 6 months were prescribed and antibody titer were checked after 1 and 3 months of the end of vaccination.
    Results
    Mean HBS antibody titer in patients was 4.4 ± 3.1 mu/ml at the beginning of study (minimum: 1.1 mu/ml and maximum: 9.2 mu/ml) and after 1 month and 3 months, mean HBS antibody were 190.4 ± 59 and 223.3 ± 83.9, respectively (p < 0.001). After one month, in intradermal and intramuscular groups, mean HBS antibody was 198.8 ± 75.6 mu/ml and 181.2 ± 61.8 mu/ml, respectively (p = 0.5) and after 3 months it was 230 ± 76 mu/ml and 216.2 ± 94.3 mu/ml, respectively (p = 0.83).
    Conclusions
    Antibody titer was high (> 50 mu/ml) in two groups after 1 and 3 months of vaccination and no significant difference was found between the 2 groups. Therefore, two methods of vaccination (high dose IM and low dose SC) are equally effective and the selection of vaccination method is based on health policy.
  • Saeed Karimi, Shirin Alsadat Hadian Zarkesh Moghadam Pages 541-552
    Background
    Health equity audit، as an alternative solution، is a process by which local partners systematically review inequalities in the patients` health، their access to appropriate services and health system outputs. Then، necessary activities needed in order to have more equitable services are agreed on and these concurrences become the executive scheme and action initiates. Therefore، it is pivotal for health care organizations to pay special attention to this important topic. The objective of the current study was to review the health equity audit model in different countries to gather viewpoints of various involved groups in health sector، particularly health experts، and to offer a practical and appropriate model for health equity audit in Iran.
    Methods
    This study adopted applied research approach in two phases. In the first step، this study conducted theoretical health equity audit models in the texts; the experiences of other countries were studied and the most appropriate model for Iranian health system was selected. In the second step، this study employed the Delphi technique. According to the Delphi technique the questionnaire applied in order to gather data and then، the final model was extracted.
    Results
    Agreeable topics، performing agencies، 6 equity audit stages، and equity indicators under 3 main parts with 16 sub-sections were elaborated and viewpoints of Iranian experts in the above fields were gathered and presented as the proposed health equity audit model for Iran.
    Conclusions
    This study reviewed the model of health equity audit for UK and provided a comparative model for health system of Iran with respect to the opinions of academic experts.
  • Hammad Ali Qazi Pages 553-558
    The childhood obesity has been a growing concern over the last decade all over the world. Built environmental characteristics such as parks and playgrounds serves as a reference point for physical activity in children. The equality issues related to ethnicity, Social Economic Status (SES), gender and social support have been related with both physical activity and presence and quality of parks and playgrounds. However, only limited studies have these issues in children. The current paper is a general enumerative review that would discusses the above issues with respect to obesity in all age groups, giving particular emphasis to childhood obesity. The importance of this review is to further explore the importance and highlight the findings related to these issues, so that future original studies could be planned keeping these associations in mind.
  • Alireza Moayyeri, Akbar Soltani, Hamideh Moosapour, Mohsin Raza Pages 559-564
    Physicians all through the world visit patients under time limitations. The most important troubled clinical skill under «time constraint» is the diagnostic approach. In this situation, clinicians need some diagnostic approaches to reduce both diagnostic time and errors. It seems that highly experienced physicians utilize some special tactics in this regard. Evidence-based medicine (EBM) as a relatively new paradigm for clinical practice stresses on using research evidences in diagnostic evaluations. The authors aimed to evaluate experts'' strategies and assess what EBM can add to these tactics. They reviewed diagnostic strategies of some veteran internists in their busy outpatient clinics and proposed an evidence-based diagnostic model engaging clinical experience and research evidence. It appears that every clinician utilizes a set of «key pointer» questions for decision-making. In addition to use of evidence-based resources for making differential diagnosis and estimating utility of various diseases, clinicians should use «key pointers» with significant likelihood ratios and from independent systems to reduce time and errors of history taking. Clinical trainees can improve their practice by constructing their own set of pointers from valid research evidences. Using this diagnostic model, EBM can help physicians to struggle against their «time constraint».
  • Mohammad Reza Akhoondinasab, Mahmoud Omranifard Pages 565-567
    Liposarcoma are one of the common soft tissue sarcomas of adulthood which are remarkable because of their frequently large size. We report a case with an extremely large well-differentiated retroperitoneal liposarcoma that weighted 32 kilograms. The patient had relapse about one year later and two recurrent tumors were successfully excised.
  • Mitra Niafar, Shahram Dabiri, Farshid Bozorgi, Farid Niafar, Nasrin Gholami Pages 568-573
    Medullary thyroid carcinoma accounts for 4% of thyroid carcinoma and originates from parafollicular cells, secreting calcitonin and carcinoembryonic antigen (CEA). Conventional radiographic modalities such as Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), and Ultrasonography (U/S), are used for detecting recurrences following total thyroidectomy. However, metastatic disease frequently escapes detection by the above modalities, even when its presence is suggested by persistently elevated serum calcitonin levels. In this paper, we report a case of medullary thyroid carcinoma in a 40 year-old woman who had whole body octreotide scintigraphy to evaluate and detect the origin of calcitonin and CEA secretion.
  • Ali Dastranj Tabrizi, Amir Vahedi, Hiedar Ali Esmaily Pages 574-579
    Endometrial polyps are common pathologic findings in gynecologic pathology practice. Although malignant changes in these lesions are uncommon, numerous studies confirmed this association especially with endometrial serous and clear cell carcinoma. Two cases of malignant endometrial polyps in association with presumed precursor lesion in one of them are presented.
  • Shervin Assari Pages 580-582
    •I read the paper by Abbaszadeh et al with great curiosity because of my interest in any study with a health behavior as the “outcome”.1 In the setting of myocardial infarction (MI), this controlled study documents a decrease in barriers and an increase in knowledge and perceived benefits of controlling diet and physical activity following the use of video-CD (VCD). Using a conceptual model based on the Health Belief Model (HBM), they measured outcomes at baseline and 45 days after. The advantages of the study include applying theory-based intervention, controlled design, randomization, and attempts to increase the validity of the questionnaire. Generally, such reports in a new special clinical setting are welcomed. However, I have a few points of criticism, related to the methodology, statistical analysis, and presentation of results. After talking about my critical points, I will discuss health behaviors, HBM, and some of the current challenges in the field. Lastly, as the study has used media for health education, I discuss the possibility of tailoring within media based health education.•From a methodological point of view, first of all, although groups are comparable by the means of socio-demographic confounders and baseline outcomes, severity of disease could still act as an unmeasured confounder. Profile of MI risk factors and duration of ischemic heart disease are not compared at baseline. My second concern refers to the report on the detail of the intervention. We need more detailed information about the content and the length of the video. A content analysis by means of motivational or fear arousal approach is necessary. As the authors mentioned, patients were allowed to watch the VCD more than once. Unfortunately, the number of times the video is seen is not a variable in this study. If we are unaware of the dose of our intervention, this could challenge the applicability of the findings.•I also have a concern about the implemented statistical approach. The authors have reported between-group, but not within-group comparisons, and the efficacy of training is based on non-significant and significant differences in pre- and post-intervention outcomes, respectively. The P values for within-group changes in outcomes are missing.•A common problem with prospective studies is failure to report loss to follow-up. Thus, we do not know how many patients left the study, and why. CONSORT is a useful reporting guideline. We also do not receive information about the missing data. However, I acknowledge the word limit, as the paper was published as a “short communication”.•My final concern is about the exact meaning of perceived severity and susceptibility in patients who have experienced MI. Is it about recurrence of MI, or its consequences? This is not a problem for barriers, knowledge, and perceived benefit. The study would also be more informative if it had measured the “behavior” itself, and if it assessed the possible inter-associations between HBM constructs in this special setting. •The general term of health behavior covers a wide range of behaviors- from unprotected intercourse of a sex worker, to non-adherence to medication by a patient, or one’s decision to use health care. Janz and Becker categorized these behaviors under the following three headings respectively: 1) preventive health behaviors, 2) sick-role behaviors, and 3) health care use.2•Many health behavior theories have concepts in common. HBM, developed by Becker, has roots in Value Expectancy Theory,3 and is a basis for the Trans-Theorithical Model.4 According to the HBM, people will perform a given behavior if they themselves see that it will provide benefits according to their perception of their situation and needs. The Trans-Theorithical Model asserts that people’s behavior is a result of their decision balance, an ongoing challenge between their pros and cons surrounding certain behaviors.•Although the HBM is not the only model frequently used to explain health behavior, it is the most applied one. On April 2011, a simple search in Pubmed for HBM resulted in about 3,800 papers, which is considerably higher than any other behavior theory, including the Social Cognitive Theory, Theory of Planned Behavior, or the Trans-Theoretical Model. This is partly because the HBM was one of the first theories in the field, developed in1950s.5-7 This is also because the HBM has proven to be applicable to behaviors in different settings, from public health,8 to internal medicine,9 and surgery.10•But why is HBM not optimal when our aim is to predict, not to explain a behavior and why is it not as useful as some other models in some instances?11 Based on the literature, HBM constructs explain only a trivial amount of variance of the behaviors- about 10-20%. For the answer, we should look for some confounders. Literature shows that risk perception is influenced by affect,12 memory,13 and previous experience with that behavior.14 Kahneman and Tversky explained how cognitive biases affect decision making,15,16 and we know decision-making is the back bone of HBM.17 Interestingly, such biases seem to exist in different settings, from preventive behaviors18 to health care use.19•Based on the results, the authors are not only inviting health educators to use HBM based interventions, they also suggest media for that purpose. To improve health behaviors, media is an inexpensive modality which can target a high number of people. Media also provides the option of tailoring health education.20,21 Tailoring refers to any method of individualization of communications based on who the target audience is. There is evidence that a tailored approach creates a higher impact from the communication.22,23 The authors might find the works done by the University of Michigan''s Health Media Research Laboratory,24 especially their e-Health interventions25 interesting.•This study asks the general question of whether a theory based health intervention works or not. Many reviews have answered “yes” to this question. However, the as-yet un-answered questions are how, and in whom they work best? The “how” asks for the pathway or mechanism- or the most effective ingredient of the intervention, and “whom” asks for the people who most benefit from it. These questions come from the mediation and moderation concepts, respectively.23,26,27 •l hope the authors have found some useful points in my letter. They have already published health behavior studies using HBM in other settings.28-30 The scientific community has learned about HBM theory from Prof. Becker, who lived, taught, and passed away in Ann Arbor.31 Now, several years later, I am writing this letter from his city, about his theory, from his department. God bless him.