Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design,methods and initial experience

The Isfahan Healthy Heart Programme (IHHP) is a five to six year comprehensive integrated community-based programme for cardiovascular diseases (CVD) prevention and control via reducing CVD risk factors and improvement of cardiovascular healthy behaviour in a target population. IHHP started late in 1999 and will be finished in 2005-2006. A primary survey was done to collect baseline data from interventional (Isfahan and Najaf-Abad) and reference (Arak) communities. In a two-stage sampling method, we randomly selected 5 to 10 percent of households from randomly selected clusters. Then individuals aged > or = 19 years were selected for the survey. This way, data from 12,600 individuals (6300 in interventional counties and 6300 in the reference county) was collected and stratified according to living area (urban vs. rural) and different age and sex groups. The samples underwent a 30-minute interview to complete validated questionnaires containing questions on demography, socioeconomic status, smoking behaviour, physical activity, nutritional habits and other behaviour regarding CVD. Blood pressure and body mass index (BMI) measurements were done and fasting blood samples were taken for two hours post load plasma glucose (2 hpp), serum (total, HDL and LDL) cholesterol and triglyceride levels. A twelve-lead electrocardiogram was recorded in all persons above 35 years of age. Community-wide surveillance of deaths, hospital discharges, myocardial infarction and stroke registry was carried out in the intervention and control areas. Four to five years of interventions based on different categories such as mass media, community partnerships, health system involvement and policy and legislation have started in the intervention area while Arak will be followed without intervention. Considering the results of the baseline surveys, (assessments needed, the objectives, existing resources and the possibility of national implementation) the interventions were planned. They were set based on specific target groups like school children, women, work-site, health personnel, high-risk persons, and community leaders were actively engaged as decision makers. A series of teams was arranged for planning and implementation of the intervention strategies. Monitoring will be done on small samples to assess the effect of different interventions in the intervention area. While four periodic surveys will be conducted on independent samples to assess health behaviours related to CVD risk factors in the intervention and reference areas, the original pre-intervention subjects aged more than 35 years will be followed in both areas to assess the individual effect of interventions and outcomes like sudden death, fatal and nonfatal MI and stroke. The whole baseline survey will be repeated on the original and an independent sample in both communities at the end of the study.     

Investigation of Helicobacter pylori infection in beta-thalassaemia major patients with recurrent abdominal pain

BACKGROUND: Recurrent abdominal pain (RAP) affects many children, especially those affected by beta-thalassaemia major. The role of Helicobacter pylori is still unclear in children with RAP. OBJECTIVES: The aim of the present study was the comparison of beta-thalassaemia major patients and normal controls with RAP in H. pylori infection. The factors influencing H. pylori prevalence were also investigated. METHODS: A series of 50 beta-thalassaemia major cases (30 female, 20 male; aged 6-25 years) and 50 age-matched and sex-matched controls, both presenting with RAP, were recruited during a period of 18 months. The study participants were obtained through a multistage random sampling method among those that met Apley's criteria. All the patients and controls had undergone diagnostic oesophagogastroduodenoscopy with biopsy. H. pylori infection was confirmed by two histopathological examinations on an endoscopy sample and a rapid urease test. RESULTS: H. pylori infection in thalassaemic patients was more common than in controls [34/50 (68%) versus 30/50 (60%)], but this higher frequency was not statistically significant. A clear relationship was found between the prevalence of H. pylori and age, duration of transfusion/chelation programmes, pain duration and splenectomy. In contrast, H. pylori did not correlate with abdominal pain characteristics, blood group, serum ferritin level and pathology of the upper gastrointestinal tract. The most frequent endoscopy abnormality was gastritis (72%). Nausea and heartburn were the leading associated symptoms. CONCLUSION: The high prevalence of H. pylori infection suggests that H. pylori should be remembered as a probable cause of RAP in beta-thalassaemia major patients.     

Prevalence of fasciolosis and dicrocoeliosis in slaughtered sheep and goats in Amol Abattoir,Mazandaran, northern Iran

Objective

The liver flukes, Fasciola spp. and Dicrocoelium dendriticum, infect ruminants and other mammalian extensively and cause major diseases of livestock that produce considerable economic losses.

Methods

A survey of 2391 sheep and goats slaughtered at an abattoir in Amol region, northern Iran was used to determine the prevalence of the liver flukes infection based on season, sex and specie of the animals.

Results

The results revealed that the prevalence rate of Fasciola spp. and Dicrocoelium dendriticum was 6.6% and 4.3% respectively. Dicrocoeliosis was more dominant in female animals (7.1%) whereas there was no sex-related difference in the prevalence of Fasciola spp. in male and female animals. Furthermore, Fasciolosis was significantly more prevalent than dicrocoeliosis in both sheep and goats. The Seasonal prevalence of Fasciola spp. was highest (P<0.005) during spring (8.3%) followed in order by autumn (8.1%), winter (5.9%) and summer (4.0%) but Dicrocoeliosis did not follow any seasonal pattern.

Conclusions

According to this study, it can be concluded that Amol is regarded as an endemic region for Fasciola spp and D. dandriticum infection. Moreover, Fasciola spp. is the most widespread liver fluke found in sheep and goats which is more dominant in sheep than goats.     

Elevated hippocampal resting-state connectivity underlies deficient neurocognitive function in aging

The brain is not idle during rest. Functional MRI (fMRI) studies have identified several resting-state networks, including the default mode network (DMN), which contains a set of cortical regions that interact with a hippocampus (HC) subsystem. Age-related alterations in the functional architecture of the DMN and HC may influence memory functions and possibly constitute a sensitive biomarker of forthcoming memory deficits. However, the exact form of DMN–HC alterations in aging and concomitant memory deficits is largely unknown. Here, using both task and resting data from 339 participants (25–80 y old), we have demonstrated age-related decrements in resting-state functional connectivity across most parts of the DMN, except for the HC network for which age-related elevation of connectivity between left and right HC was found along with attenuated HC–cortical connectivity. Elevated HC connectivity at rest, which was partly accounted for by age-related decline in white matter integrity of the fornix, was associated with lower cross-sectional episodic memory performance and declining longitudinal memory performance over 20 y. Additionally, elevated HC connectivity at rest was associated with reduced HC neural recruitment and HC–cortical connectivity during active memory encoding, which suggests that strong HC connectivity restricts the degree to which the HC interacts with other brain regions during active memory processing revealed by task fMRI. Collectively, our findings suggest a model in which age-related disruption in cortico–hippocampal functional connectivity leads to a more functionally isolated HC at rest, which translates into aberrant hippocampal decoupling and deficits during mnemonic processing.The brain is not idle at rest (1). Rather, intrinsic neuronal signaling, which manifests as spontaneous fluctuations in the blood oxygen level-dependent (BOLD) functional MRI (fMRI) signal, is ubiquitous in the human brain and consumes a substantial portion of the brain’s energy (2). Coherent spontaneous activity has been revealed in a hierarchy of networks that span large-scale functional circuits in the brain (3–6). These resting-state networks (RSNs) show moderate-to-high test–retest reliability (7) and replicability (8), and some have been found in the monkey (9) and infant (10) brain. In the adult human brain, RSNs include sensory motor, visual, attention, and mnemonic networks, as well as the default mode network (DMN). There is evidence that the DMN entails interacting subsystems and hubs that are implicated in episodic memory (11–13). One major hub encompasses the posterior cingulate cortex and the retrosplenial cortex. Other hubs include the lateral parietal cortex and the medial prefrontal cortex. In addition, a hippocampus (HC) subsystem is distinct from, yet interrelated with, the major cortical DMN hubs (12, 14).The functional architecture of the DMN and other RSNs is affected by different conditions, such as Alzheimer’s disease (AD), Parkinson’s disease, and head injury, suggesting that measurements of the brain’s intrinsic activity may be a sensitive biomarker and a putative diagnostic tool (for a review, see ref. 15). Alterations of the DMN have also been shown in age-comparative studies (16, 17), but the patterns of alterations are not homogeneous across different DMN components (18). Reduced functional connectivity among major cortical DMN nodes has been reported in aging (16, 17) and also in AD (19) and for asymptomatic APOE e4 carriers at increased risk of developing AD (20). Reduced cortical DMN connectivity has been linked to age-impaired performance on episodic memory (EM) tasks (21, 22). For instance, Wang and colleagues (21) showed that functional connectivity between cortical and HC hubs promoted performance on an EM task and was substantially weaker among low-performing elderly. This and other findings suggest that reductions in the DMN may be a basis for age-related EM impairment. However, elevated connectivity has been observed for the HC in individuals at genetic risk for AD (23, 24) and for elderly with memory complaints (25). Furthermore, a trend toward elevated functional connectivity for the medial temporal lobe (MTL) subsystem was observed in healthy older adults (26). Critically, higher subcortical RSN connectivity was found to correlate negatively with EM performance in an aging sample (27). Moreover, a recent combined fMRI/EEG study observed age increases in HC EEG beta power during rest (28).Thus, the association of aging with components of the DMN is complex, and it has been argued that age-related increases in functional connectivity need further examination (18). Such increases could reflect a multitude of processes, including age-related degenerative effects on the brain’s gray and white matter (18). Additionally, increases in HC functional connectivity may reflect alterations in proteolytic processes, such as amyloid deposition (29). Amyloid deposition is most prominent in posterior cortical regions of the DMN (29). It has been argued that there is a topological relationship between high neural activity over a lifetime within the DMN and amyloid deposition (30). Increased amyloid β protein burden within the posterior cortical DMN may cause cortico–hippocampal functional connectivity disruption (31), leading to a more functionally isolated HC network, which translates into aberrant hippocampal decoupling (30, 32, 33). Correspondingly, a recent model hypothesized that progressively less inhibitory cortical input would cause HC hyperactivity in aging (34).Elevated HC resting-state connectivity might thus be a sign of brain dysfunction, but the evidence remains inconclusive. Here, using data from a population-based sample covering the adult age span (n = 339, 25–80 y old), we tested the hypothesis that aging differentially affects distinct DMN components. A data-driven approach, independent component analysis (ICA), was used to identify DMN subsystems (4). We expected to observe age-related decreases in the connectivity of the cortical DMN. We also examined age-related alterations of HC RSN connectivity, and tested whether such alterations were related to HC volume and white matter integrity. We predicted that if increased HC connectivity was found, it would be accompanied by age-related decreases in internetwork connectivity of the HC RSN with cortical DMN regions. To constrain interpretations of age-related alterations, the DMN components were related to cognitive performance. Elevated HC RSN should negatively correlate with level and longitudinal change in EM performance. Such negative correlations could reflect an inability to flexibly recruit the HC and functionally associated areas during EM task performance due to aberrant hippocampal decoupling (23, 24). We tested this prediction by relating the HC RSN, within-person, to HC recruitment during an EM fMRI task (35, 36).