International Journal of Preventive Medicine
Volume:3 Issue: 8, Aug 2012

Every day the cardiologist faces the complex clinical decisionmaking challenges. Each cardiac disease can be treated in multiple ways according to multiple interrelated factors dependent on patient characteristics, severity, and progression of disease, and patient and physician preference. There are different standard models for predicting risk factors such as models based on the logistic regression model, Cox regression model, dynamic logistic regression model, and simulation models such as Markov model and microsimulation model. The main aim of the paper is to compare different models of predicting the progress of a coronary artery disease, in order to help cardiologists to make a good decision, and also answer the above-mentioned questions. The microsimulation model should provide cardiologists, researchers, and medical students a user-friendly software package, which can be used as an intelligent interventional simulator. There are five main common models for predicting of outcomes, including models based on the logistic regression model (for short-term outcomes), Cox regression model (for intermediate-term outcomes), dynamic logistic regression model, and simulation models such as Markov and microsimulation models (for long-term outcomes). Given the complex medical decisions cardiologists face in everyday practice, the multiple interrelated factors that play a role in choosing the optimal treatment, and the continuously accumulating new evidence on determinants of outcome and treatment options for CAD, the cardiologist may potentially benefit from a clinical decision support system that accounts for all these considerations and allows for evidence-based objective selection of the optimal treatment for the patient that is sitting in his/her office.

Type 2 diabetes is the most common metabolic disorder worldwide. Traditional herbs and spices can be used to control blood glucose concentrations. The objective of this study was to evaluate the effects of the daily intake of three grams cinnamon over eight weeks on glycemic status, lipid profiles and body composition in type 2 diabetic patients. A double blind, randomized, placebo controlled clinical trial was conducted on 44 patients with type 2 diabetes. Participants were randomly assigned to take either a three g/ day cinnamon supplement (n=22) or a placebo (n=22) for eight weeks. Weight, height, body fat mass and systolic and diastolic blood pressure were measured at baseline and after intervention. The fasting blood glucose, insulin, HbA1c, total cholesterol, LDL C, HDL C, Apo lipoprotein A I and B were measured at baseline and endpoint. From 44 subjects participated in this study 37 completed the study. There were no significant differences in baseline characteristics, dietary intake and physical activity between groups. In the treatment group, the levels of fasting blood glucose, HbA1c, triglyceride, weight, BMI and body fat mass decreased significantly compared to baseline, but not in placebo group. No significant differences were observed in glycemic status indicators, lipid profile and anthropometric indicators between the groups at the end of intervention. These data suggest that cinnamon may have a moderate effect in improving glycemic status indicators.

Diagnosis of dengue infection is easily and best accomplished by demonstration of specific IgM antibodies in blood. We analyzed retrospectively the dengue IgM seropositivity available for samples obtained over a period of 5 years (2006– 2010) from patients with suspected dengue fever (DF)-like illness to investigate whether there was an overall increase in the dengue IgM prevalence over this period. Blood samples were collected from patients with DF-like febrile illnesses attending the Pediatric, Medicine, and Fever clinics of a Government hospital, Delhi. A total of 8138 individuals (suspected dengue cases) obtained over 5 years were tested for dengue specific IgM antibodies. Year wise, month wise, and age wise data on geographic distribution and clinical manifestations were analyzed. Of the 8138 samples, 1600 (19.66%) were positive for dengue specific IgM. The year 2006 had the highest number of reported cases, 761 (46.23%). In our study, the age group most commonly affected of all 5 years was 11–20 years. Out of the total 1600 cases admitted to the hospital between 2006 and 2010, 279 (58.9%) had DF, 178 (37.6%) had dengue hemorrhagic fever, and 16 (3.38%) had dengue shock syndrome. We found a high burden of dengue in young children and late adolescents in both rural and urban communities at a magnitude greater than previously described. Interpretation and We observed an increase in the dengue positive cases every alternate year, thereby indicating a possible role of herd immunity in northern India. We did not find a steady increase in the number of cases over 5 years. We found an increase in the number of positive cases in children and young adolescents.

“Caregiver Burden” is actually an expression addressing the adverse consequences of the care provided to the patients’ with dementia. Review of the previous studies reveals a higher rate of depression and anxiety among the caregivers as compared to the general population. This study has been designed to evaluate the caregiver burden and then the factors influencing it among caregivers of patients with dementia in Iran. In this cross‑sectional study, 153 patients and their caregivers registered in the Iranian Association of Alzheimer were included. Data collection scales were Iranian Version of Caregiver Burden, Global Deterioration scale and Barthel index. Multiple linear regression model was applied to determine the factors influencing the caregiver burden. Out of the 153 patients, 90 were male. The mean age calculated for the patients and the caregivers was 77.1 and 53, respectively. The mean of caregiver burden was 55.2. Three variables, gender (P<0.01), education of the patient (P<0.005 for illiterate patients), and the patient’s dependence on the caregiver for his/her daily tasks (P<0.000)) were correlated with a high level of burden on the caregiver. The recommended model explains 0.664% of the variance of the outcome variable. Presence of either moderate or higher levels of burden (58‑116) in more than 50% of the caregivers of these patients’ highlights the need for more attention from health policy makers in Iran. Promoting the level of caregivers’ quality of life along with enabling the patients in performing their daily tasks in order to reduce the imposed burden on caregivers’ is recommended.

A cluster of risk factors for cardiovascular diseases and type 2 diabetes mellitus, which occur together more often than by chance alone, have been known as the metabolic syndrome. Various definitions have been proposed by different organizations over the past decade. This study was designed to evaluate a new definition of the metabolic syndrome for the prediction of diabetes mellitus among the Iranian population. This study was conducted in an urban population, aged 20 to 74 years, from Yazd, a city in the center of Iran. The study is a part of the phase I of Yazd Healthy Heart Program, that is, a community‑based intervention study for the prevention of cardiovascular disease. The significance level has been defined as P<0.05. Prevalence of the metabolic syndrome by the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria was 21.3 ±. 017%, and by International Diabetes Federation (IDF) criteria it was 30.16 ±. 02%. The multivariate analysis showed that the most important relevant factors of diabetes mellitus were: Increased age and metabolic syndrome by both definitions of NCEP and IDF criteria, and also, the most important relevant factors of stable angina were: Increased age, male sex, and metabolic syndrome by only IDF definitions, but the NCEP definition of the metabolic syndrome cannot predict diabetes mellitus independent of age and sex. This study showed that increased age and metabolic syndrome are the most important relevant factors for diabetes mellitus, especially by using the IDF criteria for definition of the metabolic syndrome.

Supplementation with β-alanine has been proposed to improve performance in some exercises such as cycling and running. Also, it has been demonstrated that great deals of proton ions are produced in the skeletal muscles during exercise that result in acidosis, whereas β-alanine may reduce this effect. Therefore, the aim of this study is to assess the effects of alanine supplementation on VO2 max, time to exhaustion and lactate concentrations in male physical education students. Thirty-nine male physical education students volunteered for this study. Participants were supplemented orally for 6 week with either β-alanine (5*400 mg/d) or placebo (5*400 mg dextrose/d), randomly. VO2 max and time to exhaustion (TTE) with a continuous graded exercise test (GXT) on an electronically braked cycle ergometer; and serum lactate and glucose concentrations were measured before and after supplementation. Supplementation with β-alanine showed a significant increase in VO2 max (P<0.05) and a significant decrease in TTE and lactate concentrations (P<0.05). A significant elevation in lactate concentrations and a non significant increase in TTE were observed in placebo group. Plasma glucose concentrations did not change significantly in two groups after intervention. It can be concluded that β-alanine supplementation can reduce lactate concentrations during exercise and thus can improve exercise performance in endurance athletes.

High prevalence of low back pain is one of the most common problems among nurses. The aim of this study was to evaluate the relation of the intensity of low back discomfort to two low back pain contributor factors (Ergonomics risk factors and psychosocial factors). This cross-sectional survey was conducted on 120 emergency unit nurses in Esfahan. Job content, ergonomics hazards and nordic questionnaire were used in that order for daily assessment of Psychosocial and Ergonomics factors and the intensity of low back discomfort. Nurses were questioned during a 5-week period, at the end of each shift work. The final results were analyzed with SPSS software18/PASW by using Spearman, Mann-Whitney and Kolmogorov-Smirnove test. There was a significant relationship between work demand, job content, social support and intensity of low back discomfort (P value <0.05). But, there was not any link between intensity of low back discomfort and job control. Also, there was significant relationship between intensity of low back discomfort and ergonomics risk factors. This study showed an indirect relationship between the intensity of low back discomfort and social support. This study also confirmed a direct relationship between the intensity of low back discomfort and work demand, job content, ergonomics factors (Awkward Postures (rotating and bending), manual patient handling and repetitiveness, standing continuously more than 30 min). So, to decrease work related low back discomfort, psychosocial factors should be attended in addition to ergonomics factors.

To determine the factors responsible for patient delay and treatment delay in newly diagnosed sputum smear-positive pulmonary tuberculosis (TB) patients. Study subjects (N = 150) were randomly selected from municipal health centers in Mumbai, India. Duration of symptoms, treatment, and reason for delay were assessed using interviews and medical records. We defined patient delay as presentation to a health care provider (HCP) >20 days of the onset of TB-related symptoms and treatment delay as therapy initiated more than 14 days after the first consultation (for TB-related symptoms) with an HCP. Of the 150 subjects, 29% had patient delays and 81% had treatment delays. In multivariable analysis, patient delay was significantly associated with the self-perception that initial symptoms were due to TB [odds ratio (OR) = 3.8, 95% confidence interval (CI) = 1.1–12.6] and perceived inability to pay for care (OR = 2.9, 95% CI = 1.2–7.1). Treatment delay was significantly associated with consulting a non-allopathic provider (OR = 12.3, 95% CI = 1.4–105) and consulting >3 providers (OR = 5.0, 95% CI = 1.4–17.4). Patient interval was half the treatment interval (median days: 15 vs. 31). Women were slightly more likely to experience patient and treatment delays than men. For two-thirds of the patients, another TB patient was a source of TB-related knowledge, while health education material (16%) and television (10%) played a smaller role. Treatment delay, primarily due to diagnosis delay, was a greater problem than patient delay. Expanding public public and public–private partnerships and regular training sessions for HCPs might decrease treatment delay. Media coverage and cured TB patients as peer advocates may help to reinforce TB-related health education messages.

Intraosseous ganglia are benign cysts that usually can be seen in lower extremity; especially around ankle.These cysts have fewer incidences in upper extremity, mainly around the wrist. They are extremely rare in olecranon. These lesions are often asymptomatic. Patient was a 75-year-old man who had trauma many years ago. When he came to our clinic, he complained of severe pain around his elbow that he could not do ordinary activity. He had local tenderness in elbow and 30 degree limitation in extension. In radiography, lytic, multiloculated lesion existed in region of olecranon. After excisional biopsy was done, cavity was cleaned completely with curette and was filled with autogenous bone. At 10-year follow-up, the patient was completely asymptomatic. Control radiograph showed cavity filled completely by bone; there was no evidence of relapse.

Cervical cancer is the most common gynecological cancer in Iran. The single most effective tool in reducing death due to cervical cancer is the use of pap smear as a screening tool. Therefore, the aim of this study was to determine the effectiveness of education based on Health Belief Model about giving pap smear in women. This quasi-experimental study was performed on 70 women who referred to two health center in Kouhdasht (Lorestan- Iran). The samples were randomly divided in two groups (35 in intervention group and 35 in control group). The data were collected by a validated and reliable questionnaire. Interventions were run based on Health Belief Model during three sessions only for intervention group. Each educational session was for 45–60 min. The independent t-test and paired t-test were used to analyze data. A two-tailed P value lower than 0.05 was considered statistically significant. According to results, the mean scores of knowledge were significantly different between two groups after intervention (P < 0.001). The mean scores of the model variables (perceived susceptibility and severity, perceived benefits, and barriers) had no significant difference in the two groups before intervention, but after intervention had significant difference between the two groups (P < 0.001). Designing and executing health education programs based on health belief model can promote the practice of women regarding to pap smear tests.