Background: Depression is one of the most important consequences of cardiovascular diseases (CVDs), and to control and treat it, it is necessary to identify its direct and indirect triggers and underlying factors. Therefore, the current study aims to evaluate and investigate the mediator role of aggression in the relationship between marital stress and depression. Methods: The sample of current cross-sectional study includes 212 patients with coronary artery disease (CAD) in Iran evaluated from Jan to Jun 2017. The required data were gathered using Beck’s Depression Inventory (BDI) questionnaire, Buss and Perry’s Aggression Questionnaire (BPAQ), and Hudson’s Marital Satisfaction Index (HMSI). The data were analysed using Pearson’s correlation coefficient and structural equation modeling (SEM) using SPSS20 and AMOS software. Results: The mean age of participants (68.4% male) was 58.5 ± 8.9. The results show that there is a significant positive relationship between all the variables (P < 0.05). The results of the model show that marital stress cannot directly predict depression (P = 0.586). However, through aggression, marital stress can significantly predict 18% of the variance of depression (P < 0.001). Conclusions: Not directly, but indirectly through aggression, marital stress can significantly predict increased depression among patients with CAD. The physiological and psychological pathways of the findings can be discussed.

Background: The present study was conducted to determine the differential profile of social anxiety disorder (SAD) and avoidant personality disorder (APD) based on dimensional diagnosis in criterion B of the DSM-5 Alternative Model for Personality Disorders (DSM-5-AMPD) in a college sample. Methods: Samples of this cross-sectional study included 320 (23.08 ± 2.66 years; 57% female) college students in western Iran during February 2015 to December 2017. Liebowitz-social anxiety scale, PID-5, SCID-II, SCID-II-SQ and diagnostic interview for SAD were the tools. The data were analysed using Pearson correlation and multiple linear regression analysis. Results: Forty-three and 38 participants met criteria for SAD alone and APD, respectively. Five main domains of PID-5 could explain 29% and 54% of the variance of SAD and APD, respectively. Facets of negative affect, detachment, antagonism, disinhibition, and psychoticism could explain 25% versus 43%, 26% versus 54%, 7% versus 27%, 21% versus 41%, 13% versus 30% of the variance of SAD and APD, respectively. Conclusion: SAD and APD probably refer to two distinct mental states having prominent anxiety, emotional instability, and interpersonal pattern of avoidance and detachment of challenge. SAD is a simple form of mental disturbances with anxiety in its core features; although, APD is possibly referring to more complicated psychopathology.

BACKGROUND: Health care services effort to provide alternative cardiac rehabilitation (CR) models to serve patients according to their preferences and needs. So, the present study aimed to assess and compare the effects of hospital-based and hybrid CR programs on chest pain intensity and discomfort in cardiac surgery patients. METHODS: In this prospective study, 110 cardiac surgery patients were invited to the CR department of a hospital in the western part of Iran between March and July 2016. Patients were divided into two groups: hospital-based and hybrid CR. The hospital-based program included 26 sessions, and the hybrid program included 10 training sessions and exercise. The Brief Pain Inventory and Pain Discomfort Scale were used as research instrument, and data were analyzed using the paired t-test and ANCOVA. RESULTS: The results indicated that both hospital-based and hybrid CR are effective in reducing the chest pain intensity and discomfort of cardiac surgery patients (P < 0.05). In addition, the comparison of scores before and after treatment using ANCOVA shows that no significant differences were observed between the two programs (P > 0.05). CONCLUSIONS: Traditional hospital-based CR delivery is still the first choice for treatment in developing countries. However, hybrid CR is as effective as a hospital-based program in reducing pain components and it includes only 38% of the total cost in comparison to hospital-based delivery. So, we recommend using hybrid CR according with the recommendations of American Heart Association about using CR for the management of angina symptoms.
American Heart Association ; Cardiovascular Diseases ; Chest Pain* ; Cost-Benefit Analysis ; Delivery of Health Care ; Developing Countries ; Home Care Services ; Humans ; Iran ; Prospective Studies ; Rehabilitation* ; Thoracic Surgery ; Thorax*

No abstract available.
Chest Pain* ; Humans ; Thorax*

BACKGROUND: Cancer is one of the main public health issues in the world. Breast cancer is one of the most common types of cancer among women. It is also the second cause of mortality in women. The association between the use of oral contraceptive pills and breast cancer is controversial and a main issue in public health. Some findings have shown that taking these pills does not have a significant effect in increasing the risk of breast cancer, while others have confirmed the carcinogenic effect of these products. These contradictory findings necessitated this meta-analysis, through of all correlated studies in Iran. METHODS: All published studies were considered from June 2000 until June 2015, using reliable Latin databases like PubMed, Google Scholar, Google search, Scopus, and Science Direct, and Persian database like SID, Irandoc, IranMedex, and Magiran. Finally, 26 papers were selected: 24 studies were case control while two were population based studies. A total of 26 papers with 46,260 participants were assessed since 2001. RESULTS: Overall estimate of OR for the effect of oral contraceptive pills on breast cancer is 1.521 (CI = 1.25–1.85), which shows that the intervention group had more chance (52%) compared to the control group (P = 0.001). Using these pills increased the risk of breast cancer up to 1.52 times. CONCLUSIONS: Because of directly increasing levels of estrogen and the role of estrogen in gaining weight indirectly, oral contraceptive pills can stimulate the occurrence of breast cancer. More studies should be conducted for controlling the period of pill use.
Breast Neoplasms* ; Breast* ; Case-Control Studies ; Estrogens ; Female ; Humans ; Iran ; Mortality ; Public Health ; Sudden Infant Death

BACKGROUND: Patients suffering from non-cardiac chest pain (NCCP) can interpret their chest pain wrongly despite having received a correct diagnosis. The objective of this study was to compare the efficacy of the relaxation method with metaphor therapy for reducing irrational beliefs and pain severity in patients with NCCP. METHODS: Using a randomized controlled trial, 33 participants were randomly divided into a relaxation training group (n= 13), a metaphor therapy group (n = 10), and a control group (n = 10), and were studied for 4 weeks. The two tools used in this research were the Brief Pain Inventory (BPI) index for determining the degree of pain and the short version of the Jones Irrational Belief Test. Metaphor therapy and a relaxation technique based on Ost's treatment were used as the interventions. The collected data were analyzed with a multivariate analysis of covariance (MANCOVA), a Chi-square test, and the Bonferroni procedure of post-hoc analysis. RESULTS: The relaxation training method was significantly more effective than both metaphor therapy and the lack of treatment in reducing the patients' beliefs of hopelessness in the face of changes and emotional irresponsibility, as well as the pain severity. Metaphor therapy was not effective on any of these factors. In fact, the results did not support the effectiveness of metaphor therapy. CONCLUSIONS: Regarding the effectiveness of the relaxation method as compared with metaphor therapy and the lack of treatment in the control group, this study suggests that relaxation should be paid greater attention as a method for improving the status of patients. In addition, more studies are needed to determine the effectiveness of metaphor therapy in this area.
Chest Pain* ; Diagnosis ; Humans ; Metaphor* ; Multivariate Analysis ; Relaxation*

BACKGROUND: Despite providing insufficient medical evidence of the existence of a real cardiac condition, patients with non-coronary chest pain still interpret their pain incorrectly. The present study, therefore, sought to compare the irrational beliefs in non-coronary patients with mild chest pain against those with severe chest pain. METHODS: A cross-sectional design was used. The statistical population comprised non-coronary patients who presented to the Heart Emergency Center of Kermanshah city, Iran. Using a matching method, 96 participants were selected and studied in two groups of 48. The instruments used were the Comorbidity Index, Brief Pain Index, and the Jones Irrational Beliefs Test (short-form). The multivariate analysis of variance, chi-square test, and t-test were used for data analysis. RESULTS: Controlling for the effects of age and comorbid conditions, the severity of three types of irrational beliefs, including emotional irresponsibility (P<0.001), hopelessness changes (P<0.001), and problem avoiding (P=0.002) was higher among patients with severe chest pain (according to effect level). However, in terms of demand for approval, no difference was seen between the two groups (P=0.180). CONCLUSION: Non-coronary patients with severe chest pain showed a greater number of irrational beliefs in comparison to patients with mild pain. Irrational beliefs are common mental occurrences in patients with non-coronary chest pain, and they should be attended to by health professionals, especially in severe non-coronary chest pain. Further investigation to determine the association between irrational beliefs and non-coronary chest pain is necessary.
Chest Pain* ; Comorbidity ; Emergencies ; Health Occupations ; Heart ; Humans ; Iran ; Multivariate Analysis ; Statistics as Topic

BACKGROUND: Given the importance of test anxiety among gifted students, the present study was conducted to assess the intervening role of alexithymia in the relationship between test anxiety and attachment styles. METHODS: By means of simple random sampling, 300 participants were selected out of all the students at two high schools in Khorramabad, which are affiliated with the Iranian National Organization for Development of Exceptional Talents (SAMPAD). Test anxiety, alexithymia, and attachment style questionnaires were used for data collection. Pearson correlation and path analysis tests were used to analyze the data. RESULTS: The results showed a positive relationship between test anxiety and avoidant and anxious attachment styles. Alexithymia and test anxiety were also positively related. Moreover, the results indicated that 12% of changes in test anxiety were explained by avoidant and anxious attachment styles as well as alexithymia. The relationship between the avoidant attachment style and test anxiety was 0.06 through alexithymia. However, no significant relationship between anxious attachment and test anxiety through alexithymia was found. CONCLUSION: The avoidant attachment style leads to test anxiety when the level of alexithymia increases in an individual.
Affective Symptoms* ; Anxiety* ; Aptitude ; Data Collection ; Humans

OBJECTIVE: To investigate predictors of depressive symptom aggravation at the end of a cardiac rehabilitation (CR) program. METHODS: The design of the study was retrospective. The administrative data were obtained from the database of the CR department of a heart hospital in Iran. The demographic and clinical information of 615 CR patients between January 2000 and January 2010 was analyzed using binary logistic regression analysis. RESULTS: The results showed that 10.7% of the patients completed the CR program with aggravated depressive symptoms. After adjustment for gender, age, and pre-intervention depression score, lower education level (p<0.05) and smoking (p<0.01) were significant predictors of increased depressive symptoms at the end of the program. Our model variables could explain 6% to 13% of the dependent variable variance. CONCLUSION: The results suggest that targeting patients who are less literate or who smoke could allow for taking the required measures to prevent or control depression at the end of a CR program. It is suggested that future studies consider other variables.
Demography ; Depression* ; Education ; Heart ; Heart Diseases ; Humans ; Iran ; Logistic Models ; Rehabilitation* ; Retrospective Studies ; Smoke ; Smoking

OBJECTIVE: To investigate the role of sociodemographic factors in failure to complete outpatient cardiac rehabilitation (CR). METHODS: This was a retrospective study that used information obtained from the database of the cardiac rehabilitation department of a cardiac hospital in Iran. Data from 1,050 CR patients treated at the hospital between January 2001 and January 2013 was analyzed using binary logistic regression analysis. RESULTS: Only 49% of the patients completed the CR program. After adjustment for baseline variables, it was found that the following were significantly associated with failure to complete the CR program: illiteracy (p<0.001), old age (p<0.001), being an employee or retired (p<0.05), having a low capacity for exercise (p<0.001), depression (p<0.001), low anxiety (p<0.001), and not currently being a smoker (p<0.001). CONCLUSION: Paying more attention to older patients with low literacy levels and limited exercise capacity, who are employed or retired, and who are not current smokers, and taking therapeutic measures to control psychological complications such as depression, may be effective in ensuring that patients complete outpatient cardiac rehabilitation.
Anxiety ; Demography ; Depression ; Literacy ; Heart Diseases ; Humans ; Iran ; Logistic Models ; Outpatients* ; Patient Dropouts ; Rehabilitation* ; Retrospective Studies ; Sociology