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Additional file 1: Supplementary 1. The data on the symptomology derived from standard T-scores of all SCL-90 and PDQ-4 subscales.

Supplemental material, sj-pdf-2-imr-10.1177_03000605211070766 for Comprehensive meta-analysis of associations between temperament and character traits in Cloninger���s psychobiological theory and mental disorders by Saeid Komasi, Farzin Rezaei, Azad Hemmati, Khaled Rahmani, Federico Amianto and Jouko Miettunen in Journal of International Medical Research

Supplemental material, sj-pdf-1-imr-10.1177_03000605211070766 for Comprehensive meta-analysis of associations between temperament and character traits in Cloninger���s psychobiological theory and mental disorders by Saeid Komasi, Farzin Rezaei, Azad Hemmati, Khaled Rahmani, Federico Amianto and Jouko Miettunen in Journal of International Medical Research

Dear Editor, Perceived heart risk factors including psychological and non-psychological factors (components of behavioral, biological, environmental, and physiological) are as part of the mental representation of illnesses that arise from patients' health knowledge and independently can predict their health behavior (1-2). Causal beliefs and perceived risk factors are associated not only with patient's health and adjustment but also the impact on their adherence to treatment recommendations (3). Patients' cognition has a significant impact on disease course and progression during all stages of illness experience including understanding signs, looking for a reason to link the disease to it, and considering a change in an individual’s behavior (3), so it is suggested that patients with perceived psychological risk factors and who experienced more anxiety and depression be compared to other patients in the stage of secondary prevention (2, 3). Angina and suffering caused by it are other clinical representations of heart disease that almost a third of these patients complain of it even after successful revascularization and express inability to control it (4). It seems that pain intensity and discomfort, as important aspects of angina, were not affected only by cardiac event or procedure and nonphysical factors also play a role in its experience. Thus, since identifying factors associated with angina in the secondary prevention can be effective in improving the quality of life and returning patients to normal life, it seems that there is a need to conduct further studies with regard to the relationship between perceived risk factors and clinical representation of angina in heart patients. Based on these considerations, a study was conducted to compare the chest pain severity and discomfort in heart patients with and without perceived psychological risk factors. From May to July 2015, 219 cardiac patients (23- 79 years with the mean [SD] = 58.5±9.4) after cardiac surgery were invited to participate in the study in Imam Ali Hospital of Kermanshah City (Western part of Iran). After obtaining a written informed consent to participate in the study, demographic data and medical histories of the patients were evaluated and recorded by an expert cardiologist. Then, a brief pain inventory (5), pain discomfort scale of Jensen et al. (6), and open single-item related to perceived heart risk factors (2, 4), as appropriately validated scales were provided for the patients by a clinical psychologist. Descriptive statistics and independent t-test were used to compare the differences between the two groups in terms of pain intensity and discomfort. All statistical analysis was performed using SPSS 20 software. According to descriptive data, 63% of patients were males, 89.4% married, 34.7% housekeepers, 32.2% self-employed, 8.2% employees, and 21.9% retires. In terms of level of education, 70.3% were below high school level 18.3% high school graduate and 11.4% with a college degree. In addition, the results show that 118 and 110 people respectively are with the perceived non-psychological and psychological risk factors. The means (SD) of pain intensity respectively were 3.751.94 and 4.321.86 for the patients with perceived non-psychological and psychological risk factors. Also, the means (SD) of pain discomfort respectively were 9.486.52 and 12.307.58 for patients with the perceived non-psychological and psychological risk factors. In relation to the main analysis, the independent t-test results show that there is a significant difference between the two groups in term of pain intensity (P=0.030) and discomfort (P=0.004) and the patients with perceived psychological risk factors indicate more pain severity and discomfort compared with the patients with perceived non-psychological risk factors. Our results showed that the severity of pain and pain discomfort are more in patients with perceived psychological risk factors compared with those patients with perceived non-psychological risk factors. In this regard, the results of the two studies showed that the patients with perceived psychological risk factors experience more anxiety and depression compared to others (2, 3). Since the patient's perception of illness directly linked to actual risk factors of disease (1), and considering the relationship between chest pain and psychological symptoms, it seems that the identification of patients perceived risk factors can play an important role in screening patients suffering from angina. Therefore, there is the possibility that we can quickly recognize and control the psychological symptoms (3) and discomfort or pain through changing the patients’ perception of disease risk factors in the stage of secondary prevention.

Dear Editor, Today, a large number of Iranian addicts are treated in methadone maintenance treatment (MMT) centers (1). According to the current procedure, each patient has treatment record in only one clinic. So, each patient is able to get prescribed medications and other medical services of the center. Receiving drugs and center-based services has always faced serious challenges such as access (2). For example, some patients with mobility jobs, people with movement restrictions and physical conditions, and patients living in rural and remote areas are unable to refer to get the medication according to a regular timetable (3). The mentioned issues are a serious challenge for persistence and adherence to MMT. Under such circumstances, a significant proportion of patients abandoned treatment plan and they lost the ancillary services, including medical visits, psychological interventions, and physical and emotional support from a social worker. Ultimately, this situation led to an increased the risk of relapse and resume high risk behaviors related to substance abuse (4). Social damage and financial losses of the country's health system are only some of the negative consequences of this situation. Based on these considerations, presentation of the strategies and constructive recommendations in support of the related organizations is a necessity. Despite the several offers raised, it seems that the abolition of the system receiving drugs from the origin center and the use of digital identification systems can be useful and practical (5). In the form of drug delivery system, patients can receive their daily dosages in any of the center across the country. This project is done in such a manner that each patient first enrolls in an MMT center and fills out a medical record form. Then, the doctor will determine the types of medication and drug dose based on the patients’ medication history. In the first three months of treatment (i.e. until the stabilization of the dose), visits or appointments will be face to face. After the period and stabilized drug dose, the patient who receives medication is no longer confined to the origin center. This means that each patient is issued an entity identifier such as a smart card for medication. By issuing the smart card, the patient can receive quota set medication use in any part of the country. Definitely to prevent abuse of patients, it is recommended that the patient's identity be verified through the finger, eye, or facial recognition digital sensors (5). Meanwhile, bringing up an instruction can be useful based on a mandatory visit to the center of origin for medical examination and psychological services at least once a month. So far, few studies have been conducted to review and confirm the delivery format of pharmaceutical services (6, 7). However, previous studies show that the facial assessment via computer evaluation and photo anthropometric variations in facial features are standard references for personal identification in the field of health and forensic (8, 9). Thus, our offer could possibly be effective in increasing adherence to treatment and reducing problems caused by the access to origin MMT center. As a result, we recommend using this pilot model for at least a one-year period. Then, if the benefit of this model is in practice, this proposal could be implemented permanently.

Introduction: The causal attributions and perceived risk factors can affect patients’ health behaviors. Therefore, the present study aimed to assess (i) the effect of an outpatient cardiac rehabilitation (CR) program on perceived heart risk factors (PHRFs) and on psychological stress, and (ii) the role of changes of PHRFs at pre-post CR in predicting changes in psychological stress. Methods: In this longitudinal study, 110 CR patients were assessed from June to November 2016 in a hospital in Iran. Perceived heart risk factors and perceived stress were investigated using the PHRFs scale and the Depression, Anxiety, Stress Scale-21, respectively. PHRFs and DASS-21 Stress scale scores were compared before and after 26 sessions of exercise-based CR through paired sample t-tests. In addition, we investigated the effect of PHRF’s change scores on DASS-21 Stress scale scores using linear regression analysis. Results: Results showed that CR has a little impact in improving the patients’ perception of heart risk factors, However, CR is significantly effective in reducing stress (P < 0.05). Regression analysis evidenced that improvements in patients’ perception of risk factors can significantly predict a reduction in psychological stress (P = 0.030). The model explained 11.2% of the variance in the results. Conclusion: PHRFs appear to be significant predictive components of CR’s stress reduction. Practitioners should focus on patients’ perception of risk factors to facilitate stress management in CR program.