ObjectivesThis study aimed to translate, cross-culturally adapt and psychometrically validate a Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P) and to identify the main barriers in an Iranian setting.SettingAfshar cardiac rehabilitation (CR) centre, affiliated with the Yazd University of Medical Sciences, in the centre of Iran.DesignThis was a multimethod study, culminating in a cross-sectional survey.ParticipantsInpatient CR graduates who did not attend their initial outpatient CR appointment.MethodThe 21-item CRBS was translated and cross-culturally adapted in accordance with best practices; an expert panel considered the items and previous non-attending patients were interviewed via phone to refine the scale. Next, structural validity was assessed; participants were invited to complete the CRBS on the phone between March 2017 and February 2018. Using exploratory factor analysis (EFA) with principal component analysis extraction and oblique rotation. Second, confirmatory factor analysis (CFA) was used to verify the results; several goodness-of-fit indices were considered. The internal consistency and 3-week test–retest reliability of the scale (5% subsample) were evaluated using Cronbach’s α and intraclass correlation (ICC), respectively.ResultsFace, content and cross-cultural validity were established by the experts and patients (n=50). One thousand and one hundred (40.7%) of the 2700 patients completed the CRBS-P. Structural validity was established by EFA (Bartlett’s test p<0.001; =0.759) and confirmed by the CFA; a four-factor solution with 18 items accounting for 61.256% of variance had the best fit (χ2/df=3.206, root mean square error of approximation=0.061 and Comparative Fit Index=0.959). The internal consistency and test–retest reliability (n=42) of the scale were acceptable (ICC=0.743 95% CI (0.502 to 0.868); overall α=0.797). The top barriers were not knowing about CR, cost and lack of encouragement from physicians.ConclusionThe four-factor, 18-item CRBS-P had good psychometric properties, and hence can be reliably and validly used to measure CR barriers in Iran and other Persian-speaking populations.

Background: Pulp stones are calcified masses formed in the primary and permanent dentitions. The ischemic cardiovascular disorders (CVD) can be the first health problem of the world. It seems that there is a relationship between pulp stones and cardiovascular diseases to determine the diagnostic value of panoramic dental radiographs as non-invasive test for the early detection of CVD. Methods and Materials: The subjects of the study came from patients presenting to Dental Radiology Department of Dental School in Yazd who aged 30-64 years, had 8 natural teeth. They were referred to the Cardiovascular Center of Afshar Hospital in Yazd for cardiovascular evaluation. To set the cutoff point, the ratio of teeth with pulp stones to the total number of teeth for each person was calculated and also ABI for diagnosing IHD via ROC curve was used. Results: Only 3.8% of patients without pulp stone were affected by ischemic heart disease (IHD). About Sixty seven percent (67.3%) of individuals had at least one tooth with pulp stone. In individuals without IHD, 5% of the teeth showed pulp stone while this rate was 45% (9 times) in CVD patients. The number of patients for whom the ratio of teeth with pulp stone to total number of teeth was 0.2 or more, was 138.7 times greater than the other. Conclusion: The dentists, who order panoramic radiographs for the treatment of patients, exactly study those teeth for the presence of pulp stones. The ratio of teeth with pulp stone to total teeth equal 0.2 or more was a good tool for early detection of CVD.

Background: Cardiac specialists are arguably the most influential providers in ensuring patients access cardiac rehabilitation (CR). Physician barriers to referral have been scantly investigated outside of high-income settings, and not qualitatively. Aim: This study investigated cardiac specialists’ perceptions of barriers and facilitators to patient CR participation in a low-resource setting, with a focus on referral. Methods: In this qualitative study, focus groups were conducted with conventional content analysis. Thirteen of 14 eligible cardiac specialists working in Yazd, Iran, participated in 1 or both focus groups (n = 9 and n = 10, respectively). The recording of the first focus group was transcribed into a word file verbatim, and the accuracy of the content of all field notes and the transcripts was approved by the research team, which was then analyzed inductively. Following a similar process, saturation was achieved with the second focus group. Results: Four themes emerged: “physician factors,” “center factors,” “patient factors,” and “cultural factors.” Regarding “physician factors,” most participants mentioned shortage of time. Regarding “center factors,” most participants mentioned poor physician-patient-center coordination. In “patient factors,” the subcategories that arose were socioeconomic challenges and clinical condition of the patients. “Cultural factors” related to lack of belief in behavioral/preventive medicine. Conclusions: Barriers to CR referral and participation were multilevel, as in high-resource settings. However, relative recency of the introduction of CR in these settings seemed to cause great lack of awareness. Cultural beliefs may differ, and communication from CR programs to referring providers was a particular challenge in this setting.