Publications (22)28.26 Total impact
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Dataset: published AIM
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Article: Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country:the isfahan healthy heart program.
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ABSTRACT: This study evaluated the outcome of a comprehensive, community-based healthy lifestyle program on cardiometabolic risk factors. The Isfahan Healthy Heart Program (IHHP) was a comprehensive action-oriented, multi-component intervention with a quasi-experimental design and reference area. IHHP targeted the population-at-large (n = 2,180,000) in three districts in central Iran. Data from independent sample surveys before (2000 - 2001) and after (2007) this program were used to compare differences in the intervention area and reference area over time after controlling for age, education level and income. The samples in 2000 - 2001 and 2007 included 6175 and 4719 participants in intervention area, and 6339 and 4853 in reference area, respectively. Multiple interventional activities were performed based on the four main strategies of healthy nutrition, increased physical activity, tobacco control and coping with stress. The prevalence of abdominal obesity, hypertension, hypercholesterolemia, hypertriglyceridemia and high LDL-C decreased significantly in the intervention area versus the reference area in both sexes. However the reduction in overweight and obesity was significant only in females (P < 0.05 for all). There were no significant changes in the prevalence of diabetes mellitus. In the intervention area, the prevalence of hypercholesterolemia decreased from 23.5% to 12.5% among females without any changes in females in the reference area (p < 0.0001). In males, hypercholesterolemia decreased significantly in both intervention area (18.5% to 9.6%) and reference area (14.4% to 9.8%; p = 0.005). Mean triglyceride levels had a significant decrease in the intervention area and a non-significant decrease in the reference area (p < 0.0001). A comprehensive healthy lifestyle program comprising preventive and promotional activities that considers both population and high risk approaches can be effective in controlling cardiometabolic risk factors in a middle-income country.Archives of Iranian medicine 01/2013; 16(1):4-11. · 0.97 Impact Factor -
Article: Lipid Profiles and Serum Visfatin Concentrations in Patients with Type II Diabetes in Comparison with Healthy Controls.
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ABSTRACT: Visfatin is a new adipocytokine which is largely secreted by visceral adipose tissue and its effects in the development of diabetes and inflammatory reactions are similar to insulin. It acts synergistically with insulin in increasing glucose cellular uptake, stimulating glucose transfer to the muscle and adipose tissue, as well as in preventing hepatic glucose production. Its insulin-like effects are mediated through direct connection and activation of insulin receptors without any change or competition with the insulin. This case-control study was conducted among 64 women consisting of 32 diabetic patients, and 32 age-matched healthy controls. The case group consisted of 32 post-menopausal diabetic women, aged 45-65 years. Those patients were eligible who had a history of at least five years of type II diabetes, without any complications of diabetes, and who were treated only by oral glucose-lowering medications. Those individuals with C-reactive protein (CRP) test of 3+ and above were excluded from the study. Results were compared with age- and sex- matched controls. Average visfatin level was significantly higher in diabetic patients than in controls (4.3 ± 1.06ng/dl vs. 3.15 ± 0.74ng/dl, respectively< 0.001). The mean values of anthropometric indexes and lipid profile were not significantly different between diabetic patients and controls This study documented an inverse relationship between circulating level of visfatin and fasting blood glucose. This finding may suggest the role of increased visfatin level and increase in synthesis and secretion of the cytokines from adipocytes. These findings may be useful for primary and secondary preventive issues in diabetic and pre-diabetic individuals.International journal of preventive medicine 05/2012; 3(5):326-31. -
Article: Sex differences in the impact of a community-based program for non-communicable disease prevention: The Isfahan Healthy Heart Program (IHHP)
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ABSTRACT: AimsTo study the feasibility and impact of a comprehensive, integrated, community-based program directed towards reducing modifiable risk factors for cardiovascular disease. In this study, we reported the differences in the impacts of IHHP on physical activity, smoking and nutritional behaviors of a study population based on sex. Subjects and methodsUsing multi-stage cluster sampling on people aged ≥19years of both intervention and reference areas, 12,514 individuals in 2001, 5,891 in 2002, 4,793 in 2003 and 6,097 in 2004 as well as a sample of 3,011 participants from the intervention area in 2005 were enrolled. Women made up 50.8 percent of participants, with similar proportions from 2001 to 2005 and comparable distribution between intervention and reference areas. Eight distinct component interventional projects were designed separately for both sexes to improve modifiable risk factors in the intervention area. The WHO STEPwise risk factor surveillance questionnaires were used to conduct the annual cross-sectional surveys for behavioral changes. Estimates of intervention effect ratio were conducted based on annual changes in the behavioral modifiable risk factors for both men and women. ResultsIntervention activities positively affected the total and leisure-time physical activities in men, but not women. Dietary choice of both sexes showed modest degrees of improvement. Smoking status of men improved in the study period (except 2004), while the effect on women was not significant. ConclusionsFurther interventions to improve physical activity in women should be regarded as a health priority in Iran. Sex differences should be considered in implementing any health promotion activity.Journal of Public Health 04/2012; 17(4):257-263. · 2.06 Impact Factor -
Article: The effects of omega-3 on blood pressure and the relationship between serum visfatin level and blood pressure in patients with type II diabetes.
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ABSTRACT: Hypertension is a condition normally detected in people with type II diabetes.It eventually leads to cardiovascular diseases in the patient. Visfatin is an adipocytokine which issecreted from adipose tissue and can affect the inflammatory reaction and also serum lipidlevels. Additionally, omega-3 inhibits the accumulation of fat and formation of insulinresistance. The current study tried to investigate the effects of omega-3 on blood pressurecompared to placebo and the relationship between serum visfatin levels and blood pressure. A total number of 71 women with type II diabetes were randomly assigned to2 groups to receive either omega-3 capsules or placebo capsules. In the first step, aquestionnaire consisting age, height, weight, waist and hip circumferences, and systolic anddiastolic blood pressure was filled out for each subject. Blood samples were then collected forlaboratory tests. The next step was to conduct 8 weeks of intervention. All variables, except age,were measured again after the intervention. Hip circumference was considered as the maximumcircumference of the buttocks. Waist circumference was measured by placing a tape horizontallyacross the abdomen at the end of a normal exhalation. Laboratory tests included the assessmentof visfatin, glucose, and glycated hemoglobin (HbA1c) concentrations. Lipid profile, i.e. lowdensity lipoprotein (LDL), high density lipoprotein (HDL), triglyceride (TG), and cholesterol,was also assessed. Using SPSS18, data obtained from the study was analyzed by a variety ofappropriate statistical tests. There was a significant change in mean differences of systolic and diastolic bloodpressure. Blood pressure showed a significant reduction in the omega-3 group compared to theplacebo group. However, no significant changes were observed in systolic and diastolic bloodpressure before and after the intervention (P > 0.05). Based on the results of this study, a daily consumption of omega-3 is suggestedfor patients with type II diabetes.ARYA atherosclerosis. 01/2012; 8(1):27-31. -
Article: Risk factors of atherosclerosis in male smokers, passive smokers, and hypertensive nonsmokers in central Iran.
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ABSTRACT: Some studies showed that smoking follows an upward trend in Asian countries as compared with other countries. The purpose of this study was to examine the effect of cigarette smoking on cardiovascular diseases and risk factors of atherosclerosis in patients with hypertension. This study was conducted on 6123 men residing in central Iran (Isfahan and Markazi Provinces) that participated in Isfahan Healthy Heart Project (IHHP). Subjects were randomly selected using cluster sampling method. All the subjects were studied in terms of their history of cardiovascular disease, demographic characteristics, smoking, blood pressure, physical examination, pulse rate, respiratory rate, weight, height, waist circumference, and blood measurements including LDL-C, HDL-C, total cholesterol, triglyceride, fasting blood sugar and 2-hour post prandial test. While 893 subjects suffered from hypertension, 5230 subjects were healthy. The hypertension prevalence was 2.5 times more in urban areas compared to rural areas that showed a significant difference as it increased to 3.5 times smoking factor was considered. The prevalence of risk factors of atherosclerosis and also cardiovascular complications in patients with hypertension were significantly higher than healthy people. Furthermore, they were higher in smokers with hypertension and those exposed to the cigarette smoke than nonsmokers. Smoking and passive smoking had an increasing effect on the prevalence of risk factors of atherosclerosis and consequently the incidence of cardiovascular diseases in patients with hypertension.ARYA atherosclerosis. 01/2012; 8(2):90-5. -
Article: The Relationship between Weight and CVD Risk Factors in a Sample Population from Central Iran (Based on IHHP).
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ABSTRACT: Atherosclerosis is one of the leading causes of mortality all around the world. Obesity is an independent risk factor for atherosclerosis and cardiovascular diseases (CVD). In this respect, we decided to examine the effect of the subgroups of weight on cardiovascular risk factors. This cross-sectional study was done in 2006 using the data obtained by the Iranian Healthy Heart Program (IHHP) and based on classification of obesity by the World Health Organization (WHO). In this study, the samples were tested based on the Framingham risk score, Metabolic Measuring Score (MMS) and classification of obesity. Chi-square and ANOVA were used for statistical analysis. 12514 people with a mean age of 38 participated in this study. 6.8% of women and 14% of men had university degrees (higher than diploma). Obesity was seen in women more than men: 56.4% of women and 40% of men had a Body Mass Index of (BMI) ≥ 25 Kg/m2. 13% of the subjects had FBS > 110 and13.9% of them were using hypertensive drugs. In this study, we found that all risk factors, except HDL cholesterol in men, increased with an increase in weight. This finding is also confirmed by the Framingham flowfigure for men and women. One of every two Americans, of any age and sex, has a Body Mass Index of (BMI) ≥ 25 Kg/m2. Obesity associated CVD and other serious diseases. Many studies have been done in different countries to find the relationship between obesity and CVD risk factors. For example, in the U.S.A and Canada they found that emteropiotic parameters, blood presser and lipids increased by age(of both sexes). Moreover, another study done in China, which is a country in Asia like Iran, shows that BMI has an indirect effect on HDL cholesterol, LDL cholesterol and triglyceride. This data is consistent with the results of the current study. However, In China they found that this relationship in men is stronger than women, but our study reveals the opposite.ARYA atherosclerosis. 01/2012; 8(2):82-9. -
Article: The effects of a comprehensive community trial on cardiometabolic risk factors in adolescents: Isfahan Healthy Heart Program.
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ABSTRACT: BACKGROUND: This study aimed to assess the effects of a 6-year-long community-participatory program including school-based interventions on mean values and prevalence of cardiometabolic risk factors among adolescents. METHODS: The interventions of this community trial, conducted from 2000 to 2007 in Iran, targeted the whole population (of nearly two millions) living in two cities considered as the intervention area (IA) in comparison with a reference area (RA). Data from surveys conducted before and after interventions was used to compare the differences between the secondary school students of the IA and RA. RESULTS: The prevalence of hypercholesterolemia and hypertriglyceridemia declined significantly in girls and boys in the IA (P < 0.01). The prevalence of high LDL-C decreased significantly in the girls in the RA (P = 0.002). Among both sexes in the IA, the prevalence of low HDL-C increased significantly (P < 0.001), whereas it decreased in the girls and boys in the RA (P = 0.04). Although in the IA, the prevalence of overweight and obesity decreased significantly in girls (P = 0.001), it increased in boys (P = 0.001) as well as in the girls of the RA (P = 0.01). CONCLUSION: By performing school-based interventions, our study was successful, at least in part, in controlling some cardiometabolic risk factors in adolescents. Such modifications may have long-term impacts on non-communicable diseases prevention in adulthood.ARYA atherosclerosis. 01/2012; 7(4):184-190. -
Article: Does lipoprotein (a) level have a predictive value in restenosis after coronary stenting?
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ABSTRACT: Lipid disorders, lipoproteins, diabetes mellitus, and hypertension are the known risk factors for coronary artery diseases; however, their role is unknown in restenosis after coronary stenting. This study aimed to review the role of these factors, particularly lipoprotein (a) or Lp (a), as a predictive factor for restenosis after coronary stenting with Bare Metal Stent. In this study, coronary artery stenting was performed on 170 patients. Follow-up was done using coronary angiography in 128 patients, 6 months after conducting angioplasty. Clinical and biochemical characteristics of the patients were collected as prospective method and were compared between the patients with and without restenosis. Restenosis was seen in 46 patients (35.9%). Fasting blood glucose level (FBG) in patients with restenosis was significantly higher than patients without restenosis (102.3 ± 39 mg/dl vs. 84.5 ± 28.9 [OR: 1.02, 95% CI: 1.00-1.04]). Lp (a) levels (OR: 0.54, 95% CI: 0.26-1.10) and other biochemical markers and clinical variables had no correlation with restenosis. Lipoproteins and lipids may not be the underlying cause of restenosis but accurate control of diabetes may improve prognosis after elective coronary stenting.International journal of preventive medicine 07/2011; 2(3):158-63. -
Article: The effect of omega-3 on the serum visfatin concentration in patients with type II diabetes.
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ABSTRACT: Visfatin is an adipocytokine which is secreted from adipose tissue and can affect on the diabetes inflammatory reaction and also serum lipids level. On the other hand, Omega-3 can also prevent formation of insulin resistance. In the present study, the effect of Omega-3 on the serum visfatin concentration was evaluated. 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, study subjects filled a questionnaire collecting their age, height, weight, waist circumference, and hip circumference. Also their blood samples were taken for blood tests. In the second step, the intervention was done for 8 weeks and in the third step the aforementioned were collected again. In the blood samples visfatin and lipid profiles (low density lipoprotein [LDL], high density lipoprotein [HDL], triglyceride [TG], and cholesterol), glucose and HbA1c were measured. 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 higher (p < 0.001). In addition, the mean difference between the serum visfatin level before and after the intervention in both groups was significant (p < 0.001). 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.Journal of research in medical sciences 04/2011; 16(4):490-5. · 0.46 Impact Factor -
Article: Gender differences in obesogenic behaviour, socioeconomic and metabolic factors in a population-based sample of Iranians: the IHHP study.
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ABSTRACT: This study investigated the gender differences in association of some behavioural and socioeconomic factors with obesity indices in a population-based sample of 12,514 Iranian adults. The mean body mass index (BMI), waist circumference (WC), and the waist-to-hip ratio (WHR) were significantly higher in women than in men. Current and passive smoking had an inverse association with BMI among males whereas current smoking, transportation by a private car, and longer duration of watching television (TV) had a positive association with BMI among females. Current and passive smoking, cycling, and Global Dietary Index (GDI) had an inverse association with WC among males. Higher consumption of fruits and vegetables, current and passive smoking, duration of daily sleep, and GDI had an inverse association with WC among females. Using a private car for transportation had a significant positive association with WHR among both males and females. Living in an urban area, being married, and having a higher education level increased the odds ratio of obesity among both the genders. Non-manual work also increased this risk among males whereas watching TV and current smoking increased this risk among females. Such gender differences should be considered for culturally-appropriate interventional strategies to be implemented at the population level for tackling obesity and associated cardiometabolic risk factors.Journal of Health Population and Nutrition 12/2010; 28(6):602-9. · 0.95 Impact Factor -
Article: Association of socioeconomic profiles with cardiovascular risk factors in Iran: the Isfahan Healthy Heart Program.
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ABSTRACT: To determine the relationship between socioeconomic status (SES) and cardiovascular disease (CVD) risk factors. A representative sample of adult populations living in three cities in Iran was studied. The demographic and subjective data were collected by questionnaires prepared and validated for this study; physical examination and laboratory tests were conducted under standard protocols. Three components of SES including education, occupation, and income were determined. The univariate ANOVA was used for statistical analysis. The population studied (99.3% response rate) comprised 12,514 subjects (51% females, mean age 38.4 ± 14.3 years). While higher education was a protective factor against smoking in men OR = 0.8 (95% CI = 0.7-0.8), it increased the risk of smoking in women OR = 1.2 (95% CI = 1.02-1.5). The other risk factors increased with education especially in men. Higher income level increased the OR of CVD risk factors. Occupation had an inverse association with the aforementioned risk factors. The employed individuals had higher serum lipid level and body mass index than unemployed individual. In line with previous studies, we found an association between SES and CVD risk factors. Education level was the strongest associated factor.International Journal of Public Health 02/2010; 56(1):37-44. · 2.54 Impact Factor -
Article: ANTHROPOMETRIC INDICES IN ASSOCIATION WITH CARDIOMETABOLIC RISK FACTORS: FINDINGS OF THE ISFAHAN HEALTHY HEART PROGRAM
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ABSTRACT: BACKGROUND: Obesity is increasing worldwide, but the debate about the most valid index as-sociated with its health hazards remains unresolved. This study aimed to compare four main an-thropometric indices by gender, to determine the best index in predicting cardiometabolic risk factors and to find their cutoff values in the population studied.ARYA Atherosclerosis Journal. 01/2010; 5. -
Article: The correlation between lipid profile and stress levels in central iran: isfahan healthy heart program.
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ABSTRACT: Previous studies suggest that mental status may influence serum lipid levels. This study was conducted on adult population living in rural and urban areas in Central Iran to assess the correlation between stress level and lipid profile disorders. Data was extracted from final evaluation of Isfahan Healthy Heart Program (IHHP) in 2008. Multistage and random cluster methods were used for sampling. The study population consisted of 9752 adults aged ≥19 years living in three districts namely Isfahan, Arak and Najaf Abad. Demographic data, age and sex were recorded. Blood samples were taken to determine the lipid levels including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), low levels of high-density lipoprotein cholesterol (HDL-C) and triglycerides. Stress levels were assessed using the General Health Questionnaire. Logistic regression and chi-square tests were used for statistical analysis. The odds ratios of high stress in individuals with high levels of TC, LDL-C and low levels of HDL-C compared to normal individuals after adjustment for age and sex were as follows respectively: 1.05 (1.02,1.15), 1.06 (1.02,1.18), 1.06 (1.01,1.17). Intervention activities towards reduction of stress levels at the community level may be useful as part of the strategy for cardiovascular disease prevention.ARYA atherosclerosis. 01/2010; 6(3):102-6. -
Article: Perceived factors related to cigarette and waterpipe (ghelyan) initiation and maintenance in university students of Iran.
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ABSTRACT: To investigate the perceived factors leading to cigarette and waterpipe (ghelyan) smoking initiation and maintenance in Iranian university students. A cross-sectional study was conducted on 233 students aged 20-25 enrolled in Isfahan University and Kashan University in 2007. Demographic factors as well as cigarette and ghelyan status, and perceived factors related to cigarette or ghelyan smoking initiation and maintenance were recorded. Principal component analysis was carried out to cluster perceived smoking initiation and maintenance factors. In a multiple logistic regression model, perceived psychological factors were more significant to cigarette smoking initiation and maintenance than ghelyan smoking among girls (odds ratio, OR = 1.90; P < 0.04) although perceived psychological factors (OR = 2.20; P < 0.001) and social factors (OR = 2.42; P < 0.001) were more significant in cigarette smoking initiation than ghelyan smoking initiation among boys (OR = 2.42; P < 0.001). Moreover, study appears that in boys, perceived entertainment factors could play more significant role in ghelyan smoking initiation compared with cigarette smoking initiation (OR = 0.42; P < 0.001). Whereas the factors related to smoking initiation and maintenance are different in both genders and in both tobacco products, identification of cigarette and ghelyan smoking may guide policy makers to develop comprehensive interventions.International Journal of Public Health 12/2009; 56(2):175-80. · 2.54 Impact Factor -
Article: Short-term results of a community-based program on promoting healthy lifestyle for prevention and control of chronic diseases in a developing country setting: Isfahan Healthy Heart Program.
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ABSTRACT: The objective of the study is to investigate the effect of a comprehensive community trial on behavioral modification after 2 years of intervention. The interventions of this 6-year, comprehensive community-based study target the whole population, of nearly 2 180 000, living in 2 cities in Iran and are compared with another Iranian city considered as reference. Educational, environmental, and legislative interventions are being conducted at the population level. From the baseline to the second year of evaluation of this study, the consumption of hydrogenated fat decreased significantly in the intervention community, but it remained nearly constant in the reference area. Meanwhile, the consumption of liquid oil increased in the intervention community, whereas it decreased in the reference area. The prevalence of current smoking and attempt to smoke decreased, respectively, in men and youths living in the intervention area but increased or remained constant in the reference area; however, no favorable change was seen for smoking among women. Leisure time physical activity increased in women and declined in men of both communities; the slopes of these changes were greater in the intervention area. Although the consumption of salty/fat snacks slightly decreased in the school students of the intervention area, it had a sharp increase in the reference area. This program succeeded in improving some aspects of lifestyle in its different target groups. The authors suggest that the synergy of activities intensified the dose of interventions and led to this improvement.Asia-Pacific Journal of Public Health 10/2009; 23(4):518-33. · 1.06 Impact Factor -
Article: Association of socioeconomic status and life-style factors with coping strategies in Isfahan Healthy Heart Program, Iran.
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ABSTRACT: To investigate the association between life-style and socioeconomic factors and coping strategies in a community sample in Iran. As part of a community-based study called Isfahan Healthy Heart Program, we studied 17593 individuals older than 19 living in the central part of Iran. Demographic and socioeconomic factors (age, sex, occupation status, marital status, and educational level) and lifestyle variables (smoking status, leisure time physical activity, and psychological distress), and coping strategy were recorded. Data were analyzed by Pearson correlation and multiple linear regression. Not smoking (women beta=-11.293, P<0.001; men beta=-3.418, P=0.007), having leisure time physical activity (women beta=0.017, P=0.046; men beta=0.005, P=0.043), and higher educational level (women beta=0.344, P=0.015; men beta=0.406, P=0.008) were predictors of adaptive coping strategies, while smoking (women beta=11.849, P<0.001; men beta=9.336, P<0.001), high stress level (women beta=1.588, P=0.000; men beta=1.358, P<0.001), and lower educational level (women beta=-0.443, P=0.013; men beta=-0.427, P=0.013) were predictors of maladaptive coping strategies in both sexes. Non-manual work was a positive predictor of adaptive (beta=4.983, P<0.001) and negative predictor of maladaptive (beta=-3.355, P=0.023) coping skills in men. Coping strategies of the population in central Iran were highly influenced by socioeconomic status and life-style factors. Programs aimed at improving healthy life-styles and increasing the socioeconomic status could increase adaptive coping skills and decrease maladaptive ones and consequently lead to a more healthy society.Croatian Medical Journal 09/2009; 50(4):380-6. · 1.80 Impact Factor -
Article: Obesity and cardiometabolic risk factors in a representative population of Iranian adolescents and adults in comparison to a Western population: the Isfahan Healthy Heart Programme.
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ABSTRACT: The aim of the present study was to develop reference data for the Iranian population for anthropometric values and cardiometabolic data in comparison with those in Americans, as representative of a Western population. The present cross-sectional survey, conducted as part of the baseline survey of a community-based interventional study (the Isfahan Healthy Heart Programme), used a two-stage clustering design and was conducted in 12 600 randomly selected adults (> or =19 years of age) and 2000 adolescents (aged 11-18 years) living in three cities in the central part of Iran. For comparison with a Western population, comparable data for Americans were derived from the data sets of the Second and Third National Health and Nutrition Examination Surveys (NHANES II and NHANES III). Iranian women had significantly higher mean BMI, waist circumference (WC), hip circumference (HC) and waist:hip ratio (WHR) than Iranian men and American women; but the mean BMI of Iranian men was lower than that of American men. The mean serum TAG level of Iranian men was significantly higher than that of Iranian women, whereas the mean serum total cholesterol (TC), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels were significantly higher in Iranian women than in men. The Iranian population had lower mean TC, LDL-C and TAG levels than the Americans, but such difference was not documented for HDL-C. Iranian adolescents had significantly lower mean BMI and higher mean TAG than did American adolescents. Our findings provide serious evidence for health professionals and policy makers about the very high prevalence of generalized and abdominal obesity in Iran. Controlling this emerging health problem, notably in women, should become a national priority in Iran and necessitates comprehensive public health programmes.Public Health Nutrition 08/2009; 13(3):314-23. · 2.17 Impact Factor -
Article: Process evaluation of a community-based program for prevention and control of non-communicable disease in a developing country: The Isfahan Healthy Heart Program, Iran.
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ABSTRACT: Cardiovascular diseases are the most common cause of mortality in Iran. A six-year, comprehensive, integrated community-based demonstration study entitled Isfahan Healthy Heart Program (IHHP) conducted in Iran, and it started in 2000. Evaluation and monitoring are integrated parts of this quasi-experimental trial, and consists of process, as well as short and long-term impact evaluations. This paper presents the design of the "process evaluation" for IHHP, and the results pertaining to some interventional strategies that were implemented in workplaces The process evaluation addresses the internal validity of IHHP by ascertaining the degree to which the program was implemented as intended. The IHHP process evaluation is a triangulated study conducted for all interventions at their respective venues. All interventional activities are monitored to determine why and how some are successful and sustainable, to identify mechanisms as well as barriers and facilitators of implementation. The results suggest that factory workers and managers are satisfied with the interventions. In the current study, success was mainly shaped by the organizational readiness and timing of the implementation. Integrating most of activities of the project to the existing ongoing activities of public health officers in worksites is suggested to be the most effective means of implementation of the health promoting activities in workplaces. The results of our experience may help other developing countries to plan for similar interventions.BMC Public Health 03/2009; 9:57. · 2.00 Impact Factor -
Article: Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran.
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ABSTRACT: To assess the effects of a comprehensive, integrated community-based lifestyle intervention on diet, physical activity and smoking in two Iranian communities. Within the framework of the Isfahan Healthy Heart Program, a community trial was conducted in two intervention counties (Isfahan and Najaf-Abad) and a control area (Arak). Lifestyle interventions targeted the urban and rural populations in the intervention counties but were not implemented in Arak. In each community, a random sample of adults was selected yearly by multi-stage cluster sampling. Food consumption, physical exercise and smoking behaviours were quantified and scored as 1 (low-risk) or 0 (other) at baseline (year 2000) and annually for 4 years in the intervention areas and for 3 years in the control area. The scores for all behaviours were then added to derive an overall lifestyle score. After 4 years, changes from baseline in mean dietary score differed significantly between the intervention and control areas (+2.1 points versus -1.2 points, respectively; P < 0.01), as did the change in the percentage of individuals following a healthy diet (+14.9% versus -2.0%, respectively; P < 0.001). Daily smoking had decreased by 0.9% in the intervention areas and by 2.6% in the control area at the end of the third year, but the difference was not significant. Analysis by gender revealed a significant decreasing trend in smoking among men (P < 0.05) but not among women. Energy expenditure for total daily physical activities showed a decreasing trend in all areas, but the mean drop from baseline was significantly smaller in the intervention areas than in the control area (-68 metabolic equivalent task (MET) minutes per week versus -114 MET minutes per week, respectively; P < 0.05). Leisure time devoted to physical activities showed an increasing trend in all areas. A significantly different change from baseline was found between the intervention areas and the control area in mean lifestyle score, even after controlling for age, sex and baseline values. The results suggest that community-based lifestyle intervention programmes can be effective in a developing country setting.Bulletin of the World Health Organisation 01/2009; 87(1):39-50. · 4.64 Impact Factor
Top co-authors
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Institutions
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2011
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Isfahan Cardiovascular Research Institute
Eşfahān, Ostan-e Esfahan, Iran
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2009
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Isfahan University of Medical Sciences
Eşfahān, Ostan-e Esfahan, Iran
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