دانشگاه علوم پزشکی ایران
Iran University of Medical Sciences

Introduction of Amol Cohort Study (AmoCS) Introduction of Amol Cohort Study: AmoCS

 | Post date: 2017/10/22 | 

Amol Cohort Study (AmolCS) is a population-based cohort study that was started in September 2008 in Amol, a densely populated city of northern Iran.

 
 

Amol (Persian: آمل‎‎ – [ɒˈmol]About this sound pronunciation (help·info); also Romanized as Āmol and Amul)[3] is a city in and the administrative center of Amol CountyMazandaran ProvinceIran. At the 2006 census, the population of the city was 197,470, in 55,183 families.[4]

Amol is located on the Haraz river bank. It is less than 20 kilometres (12 mi) south of the Caspian sea and less than 10 kilometres (6.2 mi) north of the Alborz mountains. It is 180 kilometres (110 mi) from Tehran, and 60 kilometres (37 mi) west of the provincial capital, Sari.[3] Amol is a historic city, with its foundation dating back to the Amard.
 



The city of Amol is one of the largest cities in northern Iran; it has a population of approximately 300,000 which includes the rural inhabitants of surrounding villages. This area has a homogeneous population with a well-developed public health service. The Gastro-Intestinal and Liver Disease Research Center (GILDRC) has conducted a multidisciplinary cohort study of the general population of Amol and its surrounding areas since 2008. 

There are 2 phases of this cohort study including phase I of 6140 subjects, age 10 to 90 years, participated in the main cohort study and the next phase (II) consist of almost 5000 paticipants. In the second phase we collected 5312 (3020 men and 2292 women) subjects aged 18–74 years among individuals aged 10–90 years. 

 
The sampling frame was obtained from local health centers, where all citizens have a health record files. The city population was divided into 16 strata based on gender and age groups in 10 ­year intervals. The subjects were randomly selected from each stratum.

All participants gave informed consent for the study, approved by the Ethics Committee of Iran University of Medical Sciences. 

Primary healthcare centers were used to collect the data on the population where 25of them serving the rural population and 16 serving the urban population.

AmolCS is a population based study of asymptomatic adults residing in urban and rural areas of Amol city. Sample selection is based on multistage sampling in health centers between 2008 – 2014. According to the Iranian health policy, every person in urban and rural areas in entitled to primary health care services provided at health centers located throughout the country. In this study, these centers were defined as "strata" and samples were collected from each health center. By a multiplestage sampling method, we selected all Health Centers and samples were collected from each health Center based on its population. In each household two samples (one male and one female) selected randomly. A total of 6143 subjects were involved in this study.


The research team scheduled a face-to-face interview with all eligible participants. If a subject refused or was unable to participate or was absent at the three consecutive pre-arranged appointments of study, another person from the same cluster who matched for sex and age was selected. The inclusion criteria were, first: being a permanent resident of this region, second: desire for participation in the study and third: age over 10 years old.

 

At the outset of the study, the procedure was described to the participants; consequently a questionnaire including demographic, anthropometric, drug and clinical histories was completed for each individual under the direction and assistance of a trained health care professional (behvarz). A behvarz is a nursing assistant who has basic health care knowledge. In the next step, all participants were referred to the Haraz Research Center, a branch of the Gastro-Intestinal and Liver Disease Research Center (GILDRC) for complimentary clinical and paraclinical evaluations.

All participants underwent abdominal ultra sonography (Esaote My lab 50) by an experienced radiologist. Ultrasound was set for multi frequency at a wavelength between 2.7 to 5 (greater wavelength for obese subjects and less for non-obese subjects). The liver and gall bladder were examined by a convex probe. A 30-ml blood sample (after a 14-hour fasting period) was taken from each participant for evaluation of triglyceride levels, cholesterol levels, blood urea, nitrogen, creatinine and insulin levels. All blood exams were performed at Haraz Research Center.

According to the AHA (American Heart Association) the normal blood pressure (BP) was defined as systolic BP= 90 to 120 and diastolic BP= 60-80 mmHG. Non alcoholic fatty liver diseases (NAFLD) was defined as the presence of steatosis in uktrasonography in the lack of significant alcohol consumption.Obesity was also defined as body mass index (BMI) >= 30. The study was approved by the board of ethics of the GILDRC and written consent was obtained from each participant.

A summary of Amol's activities:


   The first phase of COHORT Started on December 9, 2009 and ended on October 31, 2009. The number of participants in this phase was 6140.
Information collected from participants in this phase includes: demographic information (age, sex, marital status, place of residence, ethnicity level telephone,), economic status, nutrition, history of chronic disease, mental health status, history of drug use, History of smoking and alcohol, risk factors associated with blood-borne diseases and fluids. 

Blood tests performed in this phase include: FBS,TG,CHL,HD,LDL,Insulin,ALT,AST,ALKP,GGT,HBSAg,HBSAb,HBCAb, HBSAb,HCVAb.  Also, a few Serum and buffy coat samples from most participants were stored at -70 ° C                                                                      
Ultrasound was also performed to determine the fatty liver, gallstones and hepatic masses.

The second phase of COHORT Started on April   13, 2015 and ended on December 3, 2017. The number 5234 people from the first stage participated in the second phase, and about 160 people died, 46 immigrated and 700 people avoided participation.

Blood tests performed in this phase include:
CBC,FBS,TG,CHL,HD,LDL,Insulin,ALT,AST,ALKP,GGT,BUN,Cr, GGT,HbA1C,MicroAlb,AntiTTG,T3,T4,TSH,Ca,vitD Level.
As in the previous step, ultrasound was performed to determine the fatty liver, gallstones and hepatic masses and an electrocardiogram was also used to examine the participants' heart condition.

Clinic of Counseling and Liver Diseases: 


Since 2008, the Clinic has begun to admit and treat hepatitis’s and gradually began to cover other patients with liver disease. For each patient, an interview was conducted and his information was documented, and then training on nutrition, medicine, treatment and Psychological counseling is provided in case of mental illness.
Currently, there are 548 patients with hepatitis B and 192 patients with hepatitis C and 242 patients with inflammatory bowel disease including Crohn's disease, ulcerative colitis and 37 patients with autoimmune hepatitis and 22 PSC and PBC patients. , 73 patients with other liver diseases such as: Achalasia, Budd Chiari syndrome, caroli syndrome, hemochromatosis, Sarcoidosis, Types of Liver Cirrhosis, NASH and NAFLD. 


Every day, from Saturday to Thursday, patients can receive healthcare by calling or by going to the clinic.

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