مجله علوم پزشکی رازی
سال بیست و یکم شماره 9 (پیاپی 126، آذر 1393)

Introduction of leptin، a product of the obese gene، recently has led to numerous experiments to better understand body weight and composition function. Based on these findings، leptin is proposed to be an important factor in energy balance and metabolism to influence body weight. In addition، investigators have reported contradictory findings about the influence of physical exercise under various experimental conditions on leptin secretion regulation from adipose tissue stores. Thus، this review has been focused on the conflicts in the literature and the acute effect of various physical exercises on leptin and leptin’s response to acute exercise and trainings. In this review، the studies that examined the influence of a variety exercise on leptin and the complications in the literature are summarized then the implication with physical exercise and training are discussed. The effect of physical exercise and training on leptin concentrations is currently controversial. Several researchers revealed that exercise may result in reductions depending on the duration and calorie expenditure whereas others have reported no change in concentrations. This review appears that involving in physical exercise longer than 60 minutes with a significant caloric agitation (>800 kcals) is necessary for acute exercise to result in a significant reduction in leptin concentrations in non-athletes.

Growing in health care costs lead to increasing concern about the economic impact of health costs on the family facing the disease. The aim of this study was to investigate factors affecting the probability of catastrophic expenditures exposure among households in Tehran. The main goal of research was understanding the factors affecting the probability of catastrophic expenditures exposure among households in Tehran using Econometrics Logit model. The study considered all the areas of the Tehran city. The data were gathered with Urban Health Equity Assessment and Response Tool (Urban HEART) has been used in the research. In the year 2011 about 11 percent of people in Tehran have been faced to catastrophic health costs. The results of Econometrics models show that households with the number of members under 5 years or over 65 years, unemployed or less educated head, or households with a chronic patient and without insurance supports are more likely to face with catastrophic health care costs. This study showed that catastrophic health care costs of the various groups and households had significant difference, of course, clearly, with the performance of the health system transformation project, changes have taken place in this important indicator and factors affecting it, that requires a separate study and research

Health indicators are being used in health planning and management. The aim of this survey was to find effects of family physician program on health indicators in Qazvin province. This study was a descriptive cross sectional study. Data were gathered using a check list adopted from Zige Hayati of Village Health House. A total of 864 Zige Hayati from 108 villages between 2004 and 2010 were studied. Data were analyzed by SPSS 11.5. Results showed that family physician program improved some indices include of under 5-year population percentage, the percentage of women between 49-15 years old, crude birth rate, TL, vasectomy and IUD, vaccine and also the percentage of stillbirths and LBW. At the same time the indicators of maternal deaths, deaths less than one month and one year, the percentage of births attended by trained person has had a decline. According to this finding, family physician program improved health indicator. Because of limitations of cross sectional study, other studies are suggested for more accurate evaluation by eliminating confounding variables

Given the prevalence of sleep disorders among patients with heart disease and importance of recognizing determinants of it, the purpose of this study was to determine the status of sleep self-efficacy and perceived social support in patients with poor sleep quality after coronary bypass surgery in 2013.

This is a cross-sectional study. First, 100 patients whit poor sleep quality referred to the cardiac rehabilitation clinic of Tehran Heart Center were selected through simple sampling method and completed questionnaires of sleep self-efficacy and interpersonal support evaluation list–short form. Data were analyzed by the SPSS and one way-ANOVA, independent samples t test and Pearson correlation coefficient.

The results indicated that sleep self-efficacy of patients for performing various sleep health promoting behaviors was low. For example, only 37% of patients were confident to themselves ability for turning out negative thoughts after lying in bed. Some 34% of them were confident that not allow a poor night's sleep interfere with daily activities. About 27% of them stated that awake after a poor night's sleep without feeling upset about it. The result also showed that acquired tangible assets support domain of patients was low. Other domains of social support were satisfactory. There was a significant relation between perceived social support and sleep self-efficacy (p=0.004, r= 0. 28).

In developing interventions for increasing sleep quality of patients may be increase their sleep self-efficacy to performing sleep health promoting behaviors.

Lack of attention to standardized guidelines has caused tragic outcome in patients with atrial fibrillation and ultimately increase of financial burden imposed on the community structure of the economic system. Therefore, the present study was aimed to assess the exposure of patients with atrial fibrillation.

A total of 506 patients with atrial fibrillation were evaluated. After setting the gold standard (America Heart Association protocol) and data collection, kappa (κ) coefficient was calculated for inter-rater reliability of the measures taken by physicians with the gold standard.

The most common procedure was the use of digoxin in controlling the rate prescribed. Kappa coefficient obtained in this area with 0.12 (95% CI: 0.096-0.14), which was in poor condition means that the measures provided by physicians was far from the gold standard (p<0.0001). The kappa coefficient of anticoagulation therapy was also equal to 0.07 (95% CI: 0.001-0.14). Hence, the consistency of adopted procedure by physicians with the gold standard anticoagulation was low (p=0.023).

This study showed that a large percentage of physicians are not aware of the standards of care, and are using the old method. This may cause serious consequences and increased disease burden on patients and the healthcare system of the country.

Skin cancer is the third prevalent cause of mortality and morbidity and the second widespread cancer based on organ involvement in Yazd province. This study aimed to assess the effects of educational intervention on promoting skin cancer preventive behaviors of female students based on of some PRECEDE Model constructs.

Semi- experimental interventional study with 75 sample size in each group performing random sampling from Yazd universities was implemented. Validity and reliability of researcher made scales were approved. Questionnaires filled by participants and data were analyzed. Based on problem and weakness of preventive skin cancer and its predisposing factors adoption analysis was distinguished and educational intervention planned and performed. Educational strategy was compromised face to face and group discussion. After three months follow up, data using descriptive and inferential statistics were analyzed. Significance level was set less than 0.05.

Before intervention, predisposing factors was in the moderate level (%56.6) [Knowledge in moderate (%51.6), attitude relatively good (%66.1)] and preventive behavior adoption was poor (%48). Knowledge with attitude and practice, also attitude with practice had direct significant correlation. Knowledge and attitude as predisposing factor accounted for 25.1% of the variation of skin cancer preventive behavior changes with the attitude as the strongest predictor.

Based on more attitude power in predicting skin cancer preventing behavior, more attention to attitude changes in order to prevent skin cancer epidemic is suggested. It seems that The PRECEDE model is the effective model in planning interventional programs to promote skin cancer preventive behaviors

Considering roles of social-psychological risk factors, behavior and unhealthy life etiology and pathogenesis of cardiovascular diseases, this study explores vital exhaustion and type D personality in patients with heart disease, acute myocardial infarction and heart failure with normal individuals. In the is causal-comparative study, 100 patients diagnosed with cardiovascular disease (50 patients with heart failure and 50 with acute myocardial infarction) and 50 healthy individuals matched with the patient groups were selected. The study instruments were Vital exhaustion Maastricht questionnaire and Denollet type D personality form. Multivariate analysis of variance was used for data analysis. The findings showed that among heart patients and normal subjects in terms of type D personality and its components (social inhibition and negative affect) there were significant differences in vital exhaustion. But no difference was observed between patients with acute myocardial infarction and heart failure. Since vital exhaustion and type D personality are from important risk factors for patients with heart disease, the results of this study have important implications in the field of education and health interventions to improve the quality of life of patients with cardiovascular diseases.

Long-term chronic diseases such as AIDS, cancer and heart disease affect patients’ attitude, always create crises in individuals’ life. The main purpose of this study was to compare the situation resiliency and depression in cardiac patients with healthy People. During a descriptive of causal–comparative study and using convenience sampling 106 cardiac patients (58 women and 48 men) were selected from Motahari Hospital in Jahrom city in 2013. Also 102 healthy volunteers (52 females and 50 males) based on demographic variables matched with the patient groups were selected. Beck Depression Inventory and Resiliency Scale and Connor Davison were administered to participants. Data based on level of 95% were analyzed using SPSS v.16. Independent t-test revealed a significant increase in depression scores and significant reduction in resiliency between people with heart disease and normal samples (p<0.001). In addition, analysis of variances revealed that women are better than men at resiliency (p<0.003). The education level was positively associated with resiliency in coping with the diseases (p<0.011). resiliency plays mediating role in heart disease outset, and its low levels are as a risk factor for people with cardiovascular disease.

Pregnancy could be a challenge for physicians managing women with rheumatic diseases. Many of these diseases affect women of child-bearing age. Awareness of safe drugs, pregnancy effects on disease, and the effect of pregnancy are vitally important. For better results a group consisted of a gynecologist and internal physician should work together to these women. In general, active inflammation from rheumatic diseases immunosuppressant medications pose threat to health of both mother and fetus. In recent years availability of biologic therapies for treating resistant rheumatic diseases has created a great challenge concerning their safety during pregnancy and breastfeeding. During this study, we reviewed treatment of the most common rheumatic diseases including Rheumatoid Arthritis, Systemic Lupus Erythematous and Antiphospholipid syndrome. Prior, during and after pregnancy, the most relevant issues regarding medications will be discussed.