Showing papers in "Archives of Iranian Medicine in 2014"

Evaluating Causes of Death and Morbidity in Iran, Global Burden of Diseases, Injuries, and Risk Factors Study 2010

Abstract: BACKGROUND: we aimed to recap and highlight the major results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 by mortality and morbidity to clarify the current health priorities and challenges in Iran. METHODS: We estimated Iran's mortality and burden of 289 diseases with 67 risk factors and 1160 sequelae, which were used to clinically present each disease and its disability or cause of death. We produced several measures to report health loss and status: all-cause mortality, cause-specific mortality, years of life lost due to death (YLL), healthy years of life lost due to disability (YLD), disability-adjusted life years (DALYs), life expectancy, and healthy life expectancy, for three time periods: 1990, 2005, and 2010. RESULTS: We found out that life expectancy at birth was 71.6 years in men and 77.8 years in women. Almost 350 thousand deaths occurred in both sexes and all age groups in 2010. In both males and females and all age groups, ischemic heart disease was the main cause of death, claiming about 90 thousand lives. The main contributors to DALYs were: ischemic heart disease (9.1%), low back pain (9.0%), road injuries (7.3%), and unipolar depressive disorders (6.3%). The main causes of death under 5 years of age included: congenital anomalies (22.4%), preterm birth complications (18.3%), and other neonatal disorders (13.5%). The main causes of death among 15 - 49 year olds in both sexes included: injuries (23.6%) and ischemic heart disease (12.7%) The highest rates of YLDs were observed among 70+ year olds for both sexes (27,365 per 100,000), mainly due to low back pain, osteoarthritis, diabetes, falls, and major depressive disorder. The main risk factors to which deaths were attributable among children under 5 years included: suboptimal breast feeding, ambient PM pollution, tobacco smoking, and underweight. The most important risk factors among 15 to 49 year olds were: dietary risks, high blood pressure, high body mass index, physical inactivity, smoking, and ambient PM pollution. The pattern was similar among 50+ year olds. CONCLUSION: Although non-communicable diseases had the greatest burden in 2010, the challenge of communicable and maternal diseases for health system is not over yet. Diet and physiological risk factors appear to be the most important targets for public health policy in Iran. Moreover, Iranians would greatly benefit from effective strategies to prevent injury and musculoskeletal disorders and expand mental care. Persistent improvement is possible by strengthening the health information system to monitor the population health and evaluate current programs. Language: en

Acute adult and adolescent poisoning in Tehran, Iran; the epidemiologic trend between 2006 and 2011

Abstract: BACKGROUND: The aim of this study was to determine the frequency of each poisoning and its related death in our center as a sample of Tehran in six consecutive years (2006 to 2011). METHODS: All poisoned children and adults referring to Loghman-Hakim hospital poison center and hospitalized in the study period were enrolled and evaluated. RESULTS: In 108,265 patients, the most common causes of poisoning were anti-epileptics and sedative-hypnotics (22.3%). The most common causes of death were pesticides (24.84%) and narcotics (24.75%). In drugs of abuse, opium was more prevalent in the early period of the study but was replaced by methadone later. CONCLUSION: It seems that national policies for drug control and prevention of suicide have not been efficient enough. We expect to see Iran in the first 50 countries with regard to suicide and to maintain the first place in narcotic abuse if enough attention is not provided. Language: en

Health transition in Iran toward chronic diseases based on results of Global Burden of Disease 2010.

Abstract: Background: Drawing on the results of the country-level Global Burden of Diseases, Injuries, and Risk Factors 2010 Study, we attempted to investigate the drivers of change in the healthcare system in terms of mortality and morbidity due to diseases, injuries, and risk factors for the two decades from 1990 to 2010. Methods: :HGHFRPSRVHGWUHQGVLQPRUWDOLW\��FDXVHRIGHDWK��\HDUVRIOLI

Application of spatio-temporal model to estimate burden of diseases, injuries and risk factors in Iran 1990 - 2013.

Abstract: BACKGROUND: Identifying the burden of disease and its inequality between geographical regions is an important issue to study health priorities. Estimating burden of diseases using statistical models is inevitable especially in the context of rare data availability. To this purpose, the spatio-temporal model can provide a statistically sound approach for explaining the response variable observed over a region and various times. However, there are some methodological challenges in analysis of these complex data. Our primary objective is to provide some remedies to overcome these challenges. METHOD: Data from nationally representative surveys and systematic reviews have been gathered across contiguous areal units over a period of more than 20 years (1990 - 2013). Generally, observations of areal units are spatially and temporally correlated in such a way that observations closer in space and time tend to be more correlated than observations farther away. It is critical to determine the correlation structure in space-time process which has been observed over a set of irregular regions. Moreover, these data sets are subject to high percentage of missing, including misaligned areal units, areas with small sample size, and may have nonlinear trends over space and time. Furthermore, the Gaussian assumption might be overly restrictive to represent the data. In this setting, the traditional statistical techniques are not appropriate and more flexible and comprehensive methodology is required. Particularly, we focus on approaches that allow extending spatio-temporal models proposed previously in the literature.Since statistical models include both continuous and categorical outcomes, we assume a latent variable framework for describing the underlying structure in mixed outcomes and use a conditionally autoregressive (CAR) prior for the random effects. In addition, we will employ misalignment modeling to combine incompatible areal units between data sources and/or over the years to obtain a unified clear picture of population health status over this period. In order to take parameter uncertainties into account, we pursue a Bayesian sampling-based inference. Hence, a hierarchical Bayes approach is constructed to model the data. The hierarchical structure enables us to "borrow information" from neighboring areal units to improve estimates for areas with missing values and small number of observations. For their general applicability and ease of implementation, the MCMC methods are the most adapted tool to perform Bayesian inference. CONCLUSION: This study aims to combine different available data sources and produce precise and reliable evidences for Iranian burden of diseases and risk factors and their disparities among geographical regions over time. Providing appropriate statistical methods and models for analyzing the data is undoubtedly crucial to circumvent the problems and obtain satisfactory estimates of model parameters and reach accurate assessment. Language: en

Reliability and validity of Persian version of perceived stress scale (PSS-10) in adults with asthma.

Abstract: BACKGROUND: Asthma is a major public health problem in the world, and recent findings suggest that stress influences asthma and asthma morbidity. The 10-item Perceived Stress Scale (PSS-10) is one of the most frequently used instruments to measure psychological stress. This study was conducted to evaluate the psychometric properties of the Persian versions of the PSS-10 in adults with asthma. METHODS: In this descriptive cross-sectional study as a methodological research, 106 asthmatic patients referring to several clinics in Sanandaj (western Iran) were selected through convenience sampling. The PSS-10 and the 21-item Depression anxiety and stress scale (DASS-21) were administrated to all patients. Cronbach’s alpha was used to evaluate reliability of PSS-10, and confirmatory factor analysis (CFA) and convergent validity were used to evaluate its validity. RESULTS: The results of confirmatory factor analysis indicated that a two-factor structure of PSS-10 provided a good fit to data. The Cronbach’s alpha coefficients for negative factor, positive factor and total score (PSS-10) were 0.86, 0.83, and 0.90, respectively. The PSS-10 was positively correlated with the DASS-21 and its subscales, indicating an acceptable convergent validity. Female asthmatic patients scored higher on PSS-10 in comparison with male asthmatic patients. CONCLUSION: The Persian version of PSS-10 is a valid and reliable instrument to measure perceived stress in adults with asthma.

NASBOD 2013: design, definitions, and metrics.

Abstract: BACKGROUND: Iran has witnessed a substantial demographic and health transition, especially during the past 2 decades, which necessitates updated evidence-based policies at national and indeed at subnational scale. The National and Subnational Burden of Diseases, Injuries, and Risk Factors (NASBOD) Study aims to provide the required evidence based on updated data sources available in Iran and novel methods partly adopted from Global Burden of Disease 2010. OBJECTIVE: This paper aims at explaining the motives behind the study, the design, the definitions, the metrics, and the challenges due to limitations in data availability. METHODS: All available published and unpublished data sources will be used for estimating the burden of 291 diseases and 67 risk factors from 1990 to 2013 at national and subnational scale. Published data will be extracted through systematic review. Existing population-based data sources include: registries (death and cancer), Demographic and Health Surveys, National Health Surveys, and other population-based surveys such as Non_Communicable Diseases Surveillance Surveys. Covariates will be extracted from censuses and household expenditure surveys. Hospital records and outpatient data will be actively collected as two distinct projects. Due to lack of data points by year and province, statistical methods will be used to impute the lacking data points based on determined covariates. Two main models will be used for data imputation: Bayesian Autoregressive Multi-level models and Spatio-Temporal regression models. The results from all available models will be used in an Ensemble Model to obtain the final estimates. Five metrics will be used for estimating the burden: prevalence, death, Years of Life Lost due to premature death (YLL), Years of Life Lost due to Disability (YLD), and Disability-Adjusted Life Years Lost (DALY). Burden attributable to risk factors will be estimated through comparative risk assessment based on Population Attributable Fraction (PAF). Uncertainty Intervals (UIs) will be calculated and reported for all aforementioned metrics. RESULTS: We will estimate trends in terms of prevalence, deaths, YLLs, YLDs, and DALYs for Diseases, Injuries, and Risk Factors province from 1990 to 2013. CONCLUSION: Results of the present study will have implications for policy making as they address health gaps in Iranian population and their inequality between provinces. Language: en

Factors associated with sexual dysfunction; a population based study in Iranian reproductive age women.

Abstract: Background: Sexual function results from complex interactions of neurovascular and endocrine factors. The prevalence of sexual dys- function varies in different countries. This study aimed to determine the prevalence of sexual dysfunction and the related factors among reproductive age women in Iran. Methods: A community-based cross-sectional descriptive study was carried out on 784 married women living in urban areas of 4 prov- LQFHVRI�,UDQ��3DUWLFLSDQWVZHUHUHFUXLWHGXVLQJDVWUDWLoHG��P XOWLVWDJHSUREDELOLW\�FOXVWHUVDPSOLQJPHWKRG��)HPDOHVH(XDOIX QFWLRQZDV� DVVHVVHGXVLQJWKH�)HPDOHVH(XDOIXQFWLRQLQGH(�TXHVWLRQQDLUH�� 'DWDZDVDQDO\)HGXVLQJ�6SHDUPDQDQGORJLVWLFUHJUHVVLRQWHVWV� � Results: The results demonstrated 27.3% prevalence of sexual dysfunction including 0.8% severe, 20.3% moderate, and 6.3% mild sex- ual dysfunction. Among women with sexual dysfunction, the frequency of desire, arousal, lubrication, and orgasmic disorders were 35.6%,

Levels and trends of child and adult mortality rates in the islamic republic of iran, 1990-2013; protocol of the nasbod study

Abstract: Background: Calculation of burden of diseases and risk factors is crucial to set priorities in the health care systems. Nevertheless, the reliable measurement of mortality rates is the main barrier to reach this goal. Unfortunately, in many developing countries the vital registra- tion system (VRS) is either defective or does not exist at all. Consequently, alternative methods have been developed to measure mortality. This study is a subcomponent of NASBOD project, which is currently conducting in Iran. In this study, we aim to calculate incompleteness of the Death Registration System (DRS) and then to estimate levels and trends of child and adult mortality using reliable methods. Methods:�,QRUGHUWRHVWLPDWHPRUWDOLW\�UDWHV��oUVW��ZHLGHQWLI\�DOOSR VVLEOHGDWDVRXUFHV��7KHQ��ZHFDOFXODWHLQFRPSOHWHQHVVRIFKLOG DGXOWPRUDOLW\�VHSDUDWHO\��)RULQFRPSOHWHQHVVRIFKLOGPRUWDOLW \��ZHDQDO\)HVXPPDU\�ELUWKKLVWRU\�GDWDXVLQJPDWHUQDODJHFRK RUWDQGPD - ternal age period methods. Then, we combine these two methods using LOESS regression. However, these estimates are not plausible for some provinces. We use additional information of covariates such as wealth index and years of schooling to make predictions for these provinces using spatio-temporal model. We generate yearly estimates of mortality using Gaussian process regression that covers both sampling and non-sampling errors within uncertainty intervals. By comparing the resulted estimates with mortality rates from DRS, we FDOFXODWHFKLOGPRUWDOLW\�LQFRPSOHWHQHVV��)RULQFRPSOHWHQHVVRIDGXOWPRUWDOLW\��*HQHUDOL)HG�*URZWK�%DODQFH��6\QWKHWLF�((WLQFW �*HQHUDWLRQ� and a hybrid of two mentioned methods are used. Afterwards, we combine incompleteness of three methods using GPR, and apply it to correct and adjust the number of deaths. Conclusion: In this study, we develop a conceptual framework to overcome the existing challenges for accurate measuring of mortality rates. The resulting estimates can be used to inform policy-makers about past, current and future mortality rates as a major indicator of health status of a population.

Population health and burden of disease profile of Iran among 20 countries in the region: from Afghanistan to Qatar and Lebanon.

Abstract: BACKGROUND: Population health and disease profiles are diverse across Iran's neighboring countries. Borrowing the results of the country-level Global Burden of Diseases, Injuries, and Risk Factors 2010 Study (GBD 2010), we aim to compare Iran with 19 countries in terms of an important set of population health and disease metrics. These countries include those neighboring Iran and a few other countries from the Middle East and North Africa (MENA) region. METHODS: We show the pattern of health transition across the comparator countries from 1990 through 2010. We use classic GBD metrics measured for the year 2010 to indicate the rank of Iran among these nations. The metrics include disability-adjusted life years (DALYs), years of life lost as a result of premature death (YLLs), years of life lost due to disability (YLDs), health-adjusted life expectancy (HALE), and age-standardized death rate (ASD). RESULTS: Considerable and uniform transition from communicable, maternal, neonatal, and nutritional (CMMN) conditions to non-communicable diseases (NCDs) was seen between 1990 and 2010. On average, ischemic heart disease, lower respiratory infections, and road injuries were the three principal causes of YLLs, while low back pain and major depressive disorders were the top causes of YLDs in these countries. Iran ranked 13th in HALE and 12th in ASD. The function of Iran's health care, measured by DALYs, was somewhat in the middle of the HALE spectrum for the comparator countries. This intermediate position becomes rather highlighted when Afghanistan, as outlier, is taken out of the comparison. CONCLUSION: Effective policies to reduce NCDs need to be formulated and implemented through an integrated health care system. Our comparison shows that Iran can learn from the experience of a number of these countries to devise and execute the required strategies. Language: en

Bayesian autoregressive multilevel modeling of burden of diseases, injuries and risk factors in Iran 1990 - 2013

Abstract: BACKGROUND: Statistical modeling and developing new methods for estimating burden of diseases, injuries and risk factors is a fundamental concern in studying the country health situation for better health management and policy making. Bayesian autoregressive multilevel model is a strong method for this kind of study though in complex situations it has its own challenges. Our study aims to describe the way of modeling space and time data through an autoregressive multilevel model and address challenges in complex situation. METHOD: We will obtain data from different published and unpublished secondary data sources including population-based health surveys (e. g. NHS, DHS, STEP) at national and provincial levels and we also assess epidemiological studies via systematic review for each disease, injuries and risk factor over the period of 1990-2013. These data generally have a multilevel hierarchy and also time correlation. However, statistical analysis of diseases, injuries and risk factors data is primarily facing the problem of information scarcity. Data are generally too scarce to ensure reliable estimates in many practical problems. Also, there may be nonlinear changes over time, different kind of uncertainties in data and incompatible geographical data. We describe Bayesian autoregressive multilevel modeling approach that provides a natural solution to these problems through its ability to sensibly combine information from several sources of data and available prior information. In this hierarchy model levels of each hierarchy borrow information from each other and also lower levels borrow information from higher levels. We will fit the model using Markov Chain Monte Carlo (MCMC) methods because of its capabilities and benefits in complex cases. DISCUSSION: Our analyses will include different existing sources of data in Iran for 24 years through a rational and reasonable model to estimate burden of diseases, injuries and risk factors for Iran at national, regional and provincial levels while considering several kinds of uncertainties. Comprehensive and realistic estimates are always an issue of request that will be obtained through a suitable statistical modeling considering all dimensions and then can be used for making better decision in real situations. Language: en

Application of Gaussian Process Regression (GPR) in estimating under-five mortality levels and trends in Iran 1990 - 2013, study protocol.

Abstract: BACKGROUND: Searching for the latest methods of estimating mortality rates is a major concern for researchers who are working in burden of diseases. Child mortality is an important indicator for assessing population health care services in a country. The National and Sub-national Burden of Diseases, Injuries, and Risk Factors (NASBOD) is conducted in Iran with comparative methods and definitions of Global Burden of Disease (GBD) 2010 to estimate major population health measures including child mortality rate. The need to have accurate and valid estimation of under-5 mortality rate led to apply more powerful and reliable methods. METHOD: The available datasets consist of under-five mortality rates from different sources including death registration systems and summary birth history (SBH) questions from censuses and Demographic Health Survey. These datasets are gathered at national and sub-national levels. We have five time series of under-five mortality rates from SBH method that each one contains 25-year time period. We also calculated Child mortality rates from death registration for 5 years. The main challenge is how to combine and integrate these different time series and how to produce unified estimates of child mortality rates during the course of study. By synthesizing the result of other models, Gaussian Process Regression (GPR) is used as the final stage for generating yearly child mortality rates in this study. GPR is a Bayesian technique that uses data information and defines several hierarchical prior parameters for model. In corporation of GPR and MCMC methods, predicted rates are updated using data and defined parameters in model. This method, also captures both sampling and non-sampling errors and provides uncertainty intervals. The existence of uncertainty for predicting mortality rate is one of the considerable advantages of GPR that distinguish it from other alternative methods. DISCUSSION: Estimating accurate and reliable child mortality rates at national and sub-national levels is one of the important parts of NASBOD project in Iran. Gaussian Process Regression with its special features improves achievement of this goal. GPR is a serious competitor for other supervised mortality predictive methods. This article aims to explain the application and preferences of GPR method in estimating child mortality rate. Language: en

Situation analysis of the national comprehensive cancer control program (2013) in the i. r. of iran, assessment and recommendations based on the iaea impact mission

Abstract: Introduction Iran was engaged in the Program of Action for Cancer Therapy (PACT) in 2012, and delegates from the International Atomic Energy Agency (IAEA), and the World Health Organization (WHO) evaluated the National Cancer Control Program (NCCP) status (the imPACT mission), based on which they provided recommendations for improvements of NCCP in the I.R. of Iran. We reported the results of this situational analysis and discussed the recommendations and their implication in the promotion of NCCP in the I.R. of Iran. Methods International delegates visited the I.R. of Iran and evaluated different aspects and capacities of NCCP in Iran. In addition, a Farsi version of the WHO/IAEA self-assessment tool was completed by local experts and stakeholders, including experts from different departments of the Ministry of Health and Medical Education (MOHME) and representatives from the National Cancer Research Network (NCRN). Following these evaluations, the PACT office provided recommendations for improving the NCCP in Iran. Almost all the recommendations were endorsed by MOHME. Results The PACT program provided 31 recommendations for improvement of NCCP in Iran in six categories, including planning, cancer registration and information, prevention, early detection, diagnosis and treatment, and palliative care. The most important recommendation was to establish a strong, multi-sectoral NCCP committee and develop an updated national cancer control program. Conclusion The imPACT mission report provided a comprehensive view about the NCCP status in Iran. An appropriate response to these recommendations and filing the observed gaps will improve the NCCP status in the I.R. of Iran.

Opium as a Risk Factor for Upper Gastrointestinal Cancers: A Population-based Case-Control Study in Iran

Abstract: Background: Gastrointestinal cancers, including esophageal, gastric, liver and pancreatic are relatively common in Iran. Furthermore, consumption of opium and its derivatives (OD OR = 18.7; 95 % CI: 5.5 - 63.3). This dose-response relationship was also strong even in patients with gastric cancers (OR: 9.2; 95 % CI: 2.5 - 33.7). Conclusion: The results of this study showed that opium consumption can be a strong risk factor for UGI cancers in Iran.

Factors affecting professional delay in diagnosis and treatment of oral cancer in Iran.

Abstract: Background: Oral cancer is the most common malignant tumor among head and neck cancers. Delay in diagnosis affects the treatment and prognosis of oral cancer. We measured the professional delay in the diagnosis and its attributes in the Cancer Institute of Iran, the largest referral center for oral cancer patients in the country. Methods: We interviewed oral cancer patients to measure the delay and used case-control approach to study association of various prognostic factors with professional delay and tumor stage. Result: Out of 206 patients, 71.4% were diagnosed at the advanced stage. The median of the patient, professional and total delays were 45, 86 and 140 day, respectively. In the univariate model, prescription of medicines like analgesics (OR = 5.3, 95% CI 2.2–12.9) and history of dental procedure (OR=6.8, 95% CI 1.7–26.9) were associated with higher risk of delay compared to patient who were biopsied from the beginning. History of loose teeth increased the risk of delay 4 times (OR = 4.0, 95% CI 1.6–9.8). Patients with primary education had 70% lower risk of delay compared to the illiterate patients (OR = 0.3, 95% CI 0.1–0.7) and the risk was lower among patients who had diploma (OR = 0.04, 95% CI 0–0.7) and college education (OR = 0.1, 95% CI 0–0.4). The delayed patients were diagnosed in more advanced stage compared to the patients without delay (OR = 2.1, 95% CI 1.0–4.4). Conclusion: Development of a national guideline for follow-up of oral lesions, training and awareness of health care professionals about oral cancer diagnosis may decrease the delay and improve the oral cancer outcome in Iran.

Prevalence and risk factors of cholelithiasis in Amol city, northern Iran: a population based study.

Abstract: BACKGROUND: Cholelithiasis is one of the most prevalent gastrointestinal disorders requiring hospitalization. While different factors influence gallstone formation in patients, these factors are not the same in different societies or in different geographical locations. AIM: To evaluate the epidemiology and risk factors associated with gallstone formation in a large population group, the present survey was conducted in northern Iran. METHODS: In 6143 asymptomatic subjects, the incidence of gallstone formation as well as risk factors were evaluated through a structured questionnaire, physical examination and ultrasonography study. Sample selection was based on stratified cluster systemic randomization. RESULTS: Of these enrolled subjects 3507 (57.1%) were male and 2636 (42.9%) were female with a mean age of 42.71 ± 17.1 years. The prevalence of gallstones was 0.80%. On multivariate analysis, the risk of gallstone disease is correlated to rural locale, diastolic hypertension, age, and TG levels. However, systolic hypertension, glucose serum levels and obesity were also significantly associated with the presence of gallstones. CONCLUSION: The present study proposes that the rate of gallstone disease in northern Iran is lower than previous studies have reported, and that most of the risk factors can be prevented by changes in lifestyle and diet.

Therapeutic Effects, Tolerability and Safety of a Multi-Strain Probiotic in Iranian Adults With Irritable Bowel Syndrome and Bloating

Abstract: BACKGROUND: Irritable bowel syndrome (IBS) is a common disorder in Iran with challenging treatment. Although trials have suggested that probiotics alleviate the complaints of patients with minimal side effects, they have not been investigated in Iranian adults. METHODS: In a randomized double-blind study, 108 eligible IBS patients (Rome III Criteria) aged 20 – 70 years who referred consecutively to a clinical center in Tehran with abdominal bloating from 2010 to 2012 received a combination probiotics or placebo twice daily for 4 weeks. The objective was to evaluate the efficacy and safety of a multi-strain probiotics combination. One week prior to and throughout the treatment, the participants recorded their abdominal symptoms on a daily basis, using visual analogue scale and reported satisfactory relief of general symptoms at the end of each week. Adverse events were evaluated by self-reporting and physical examination. Continuous variables were analyzed by independent t-test and chi-square was used for binomials. RESULTS: The baseline characteristics were balanced (60% female, mean age 36.7 ± 11.5). A total of 97 (51 intervention, 46 control) completed the treatment. Intention to treat analysis was done on 108 allocated subjects. 85% of the probiotic group reported satisfactory relief of general symptoms compared with 47% in the control group (P < 0.01). A reduction in abdominal bloating and pain with probiotic was superior to placebo [-13.0 vs. -3.7 (P < 0.01), -8.2 vs. -2.1 (P = 0.02), respectively]. No severe adverse drug reaction was seen in either group. CONCLUSIONS: A 4-week period of treatment with the combination probiotics twice daily was safe, well tolerated, and effective in our patients. Further investigation is recommended for other subgroups of IBS. Trial Registration: IRCT.ir IRCT2012071010230N1

White rice consumption is a risk factor for metabolic syndrome in Tehrani adults: a prospective approach in Tehran Lipid and Glucose Study.

Abstract: Background: Consumption of white rice has been proposed as a dietary risk factor for development of metabolic disorders and type 2 diabetes, especially in populations who consume white rice as a staple food. In this study, we investigated the association between con- VXPSWLRQRIZKLWHULFHDQGWKHRFFXUUHQFHRIPHWDEROLFV\QGURPHLQ�7HKUDQLDGXOWVDIWHU���\HDUVRIIROORZXS��

Development of Gastric Cancer and Its Prevention

Abstract: Gastric cancer is a heterogeneous disorder; genetic factors, H. pylori infection and various environmental factors contribute to its development. Advanced atrophic corpus-predominant gastritis provides the histological base for its genesis. Low socio-economic status and poor hygienic conditions, smoking habits, heavy alcohol consumption, high salt and low intake of vegetables and fruits are important external factors for the occurrence of gastric cancer. For its prevention, the eradication of H. pylori infection at an early age is mandatory for subjects at high risk or those living in areas with high prevalence of gastric cancer. Given that an increased serum level of Pepsinogen II is a good biomarker for the presence of gastritis, it seems reasonable to screen all infected subjects at risk of gastric cancer with increased serum pepsinogen II at an early age (at around 30 years) to eradicate H. pylori. An endoscopy should be performed for subjects at an older age (40 years and older), when increased serum pepsinogen II level is associated with decreased serum pepsinogen I and pepsinogen I to II ratio.

Stigma and its determinants among male drug dependents receiving methadone maintenance treatment.

Abstract: Background: The stigma attached to substance use is considered as a barrier to treatment, resulting in continued dependence and harmful consequences for the health of drug abusers and society. Methods: In the current study, stigma and its relation with patient characteristics and secrecy was examined in people who were in treatment of drug dependency. Participants were 144 patients from two referral methadone treatment centers who completed a survey containing questionnaires about stigma, secrecy and other measures of drug use. Results: Patients reported high levels of self-stigma and moderate levels of stigma-related rejection and perceived stigma as well as commonly using secrecy, as a way of coping. More experiencing of self -stigma was associated with unemployment, positive history of IV drug use, incarceration and heroin consumption, compared to opium use. IV drug users and unemployed persons also reported more contacts with stigma-related rejection. No association was found between stigma and previous history of treatment for substance abuse. Conclusion: Findings indicate stigma in individuals who are in the treatment for substance dependence and highlight the need for more studies to clarify all aspects of drug use stigma.

Changes in frequency of HBV, HCV, HIV and syphilis infections among blood donors in Tehran province 2005 - 2011.

Abstract: BACKGROUND: Evaluating trends in blood donors’ infectious diseases is essential for monitoring the safe supply of blood, donor screening effectiveness, and the occurrence of infections in the blood donor population which consequently gives an idea of the epidemiology of these diseases in the community. The aim of the present study was to assess the prevalence of hepatitis B, hepatitis C, HIV and syphilis by carrying out confirmatory tests in Tehran’s blood transfusion center between 2005 and 2011. METHODS: This was a retrospective study conducted at Tehran’s Blood Transfusion Center (TBTC) from 2005 to 2011. All donor serum samples were screened for HBV, HCV, HIV and syphilis using third generation ELISA kits and RPR test. Initial reactive samples were tested in duplicate. Confirmatory tests were performed on all repeatedly reactive donations. For statistical analysis, T- test, ANOVA and Chi-square test were carried out on SPSS software and 95% confidential intervals (95% CI) were used. RESULTS: Over a period of six years (March 2005 to March 2011), a total of 2,026,628 donations were collected. Out of the total blood donors, 10,476 were positive for HBV, HCV, HIV and syphilis. The overall frequency of HBS Ag, anti-HCV, HIV Ag/Ab and syphilis antibodies were 388,112, 5.4 and 10.5 per 100,000 donations, respectively. The prevalence of HBV among blood donors showed a downward trend over the period of six years. The trend of HCV fluctuated during the period under study, peaking in 2007. The trend of HIV infection frequency had increasing patterns in 2011. The trend of syphilis infection frequency was increasing in 2008 and decreasing after that. CONCLUSION: Declining trend in prevalence of blood-borne infections indicates the effectiveness of screening methods and selection of appropriate donors. Higher prevalence of blood-borne infections in males, low educated, married, first-time donors and donors who referred to the mobile centers requires a different planning in these groups.

Attitude of cancer patients toward diagnosis disclosure and their preference for clinical decision-making: a national survey.

Abstract: Objectives: There is still contradictory evidence on disclosure preferences regarding cancer diagnosis. The aim of this study was to evaluate the preference of cancer patients for knowing the truth about their disease, as well as the factors that might have an impact on these preferences. Method: This study was conducted in 11 cancer centers in Iran. A questionnaire was used to collect data, and all patients above 15 years of age who were willing to participate were included in the study. The patients were asked if they were aware of the malignant nature of their disease, and if they came to know about their disease at the time of initial diagnosis, or later. The patients were then asked about the

Family physician program in Iran: considerations for adapting the policy in urban settings.

Abstract: Nationwide implementation of Family Physician (FP) program started in 2005 and targeted almost 25,000,000 citizens residing in rural areas and cities with less than 20,000 populations in Iran. Despite its blatant initiation that resulted in some modest achievements, the future of FP looks unclear in Iran. Thus far, no longitudinal evaluation of the implementation and impact of FP program has been conducted. However, meager evidence highlights the facilitating role of an existing and strong Primary Health Care (PHC) network in the implementation of FP in rural areas in Iran. A longstanding challenge, however, as emphasized by most stakeholders, remains to be the expansion of FP program into urban settings, where the PHC is undeveloped and fragile as well as the powerful private sector is resistant. Using an adapted conceptual framework of institutions, ideas, and interests, this policy perspective aims to shed light on main difficulties of FP implementation in urban areas of Iran. We analyze FP policy in the context of ongoing interactions and conflicts among institutions (the structures and rules that shape policies), interests (the groups and individuals influencing policy), and ideas (discourses around policies). Our argument will, we envisage, help plan for more appropriate implementation of FP in cities in Iran, and hopefully beyond.

Health system responsiveness for care of patients with heart failure: evidence form a university hospital

Abstract: Background Responsiveness refers to non-clinical aspects of the health system and responds to this question that whether health system is responsive to rightful expectations of people. The present study was conducted to determine the health system responsiveness about chronic heart failure patients in one of the main heart centers in Tehran during 2012 - 2013. Methods In this cross-sectional study 300 patients have completed a valid questionnaire that designed by World Health Organization (WHO) for measurement of responsiveness. Analysis of data was based on analysis WHO multi-country study that was designed to evaluate responsiveness in health care systems. Results In outpatient services, worst performance was related to choice and prompt attention domains (35.8% and 35.1%). Autonomy (31.5%) has the worst performance of inpatient services. Both in outpatient and inpatient services "confidentiality of information" has the best performance (87.8% and 85.6%). Responsiveness of the health system in inpatient services has the worst performance comparing to outpatient services (57.2% versus 66.5%). Most important domains from patient's view were prompt attention and dignity (47% and 23%). Conclusion More attention to patient's rights, giving them opportunity to choose health care services (choice), providing fast access to emergency care (prompt attention) and considering autonomy are most important aspects of health responsiveness. From patient's view "prompt attention" was reported as the most important aspect of responsiveness.

Serum lipids and lipoproteins in patients with psoriasis.

Abstract: Background: 3VRULDVLVLVDFRPPRQFKURQLFDQGUHFXUUHQWLQ?DPPDWRU\�VNLQGL VRUGHUcharacterized by hyperproliferation of keratino- F\WHVDQGLQoOWUDWLRQRI�7�FHOOV��PRQRF\WHVPDFURSKDJHVDQGQHXUPDODQGHSLGHUPDOOD\HUVRIthe skin. The prevalence of cardiovascular disorders in these patients is remarkably higher compared to normal individuals, which seems to be associated with the hyperlipidemia. This study was designed and FRQGXFWHGWRLQYHVWLJDWHWKHVHUXPOLSLGSURoOHLQSVRULDWLFSD WLHQWVand its association with the severity of disease.

National and sub-national prevalence, trend, and burden of cardiometabolic risk factors in Iranian children and adolescents, 1990 - 2013

Abstract: Background: Non-communicable diseases (NCDs) and their risk factors are a major health threat at the global level, notably for devel- oping countries. The tracking of cardiometabolic risk factors from childhood to adulthood is well documented. Therefore, more attention needs to be directed at primordial and primary prevention of NCDs. Given the high prevalence of NCDs and their risk factors in Iranian population, a study was designed to determine the attributable burden of cardiometabolic risk factors in Iranian pediatric population during past decades. Methods:�7KLVSDSHUH(SODLQVWKHGHoQLWLRQV��RUJDQL)DWLRQ��GDWDVRXUFHV ��PHWKRGVRIGDWDJDWKHULQJRUJHQHUDWLQJ��GDWDDQDO\VHV��DQG� the trend analysis of the study. A national expert working group addressed unmet needs and offered consultations on the selection of risk IDFWRUVDQGWKHSUDFWLFDOGHoQLWLRQRIGLVHDVH��,QWKHODWHUVW DJHV��GXULQJWKHFRXUVHRIWKHVWXG\��WKH\�ZLOOVXSHUYLVHWKHV WDWLVWLFDOPRGHO - ing methods, the interpretation of results, and the publication strategy. Also an international expert advisory group will collaborate with the project team. Conclusion:�7KH�oQGLQJVRIWKLVVWXG\�FRXOGSURYLGHEDVLFLQIRUPDWLRQUHJD UGLQJ�1&'�UHODWHGULVNIDFWRUV��DQGWKHLUEXUGHQDQGWUHQGV�

National and sub-national environmental burden of disease in Iran from 1990 to 2013-study profile.

Abstract: BACKGROUND: Development of national evidence-based public health strategies requires a deep understanding of the role of major risk factors (RFs) and the burden of disease (BOD). In this article, we explain the framework for studying the national and sub-national Environmental Burden of Disease (EBD) in Iran as a part of the National and Sub-national Burden of Disease (NASBOD) study. METHODS: The distribution of exposures to environmental RFs and their attributable effect size over 1990-2013 will be estimated through comprehensive reviews of either published or unpublished sources. Statistical modeling will be used to impute missing data in the distribution of RFs exposures for each district-year. National and sub-national BOD attributable to these RFs will be estimated in the following metrics: Prevalance, death, years of life lost due to premature death(YLL), years of life lost due to disability (YLD), and disability -adjusted life years last(DALYS). The BOD attributable to the current distribution of exposures will be compared with a counterfactual exposure distribution scenario–here, the theoretical-minimum-risk exposure distribution. Inequalities in the distribution of exposure to RFs will be analyzed and manifested nationwide using geographic information systems. DISCUSSION: The EBD study aims to provide an official report to Iranian Ministry of Health and Medical Education, to publish a series of articles on the exposure trends of the selected environmental RFs, to estimate the BOD attributable to these RFs, and to assess inequalities and its determinants in the distribution of exposure to RFs. Iran’s territory is large with diverse population, socioeconomic, and geographic areas. Results of this comparative risk assessment study may pave the way for health policy makers to plan more comprehensive and cost-effective evidence-based strategies.

National and sub-national burden of breast cancer in Iran; 1990-2013.

Abstract: BACKGROUND: Estimating the burden of diseases, injuries and major risk factors is necessary for adopting appropriate health policies in every country, and this paper aims to explain the study protocol of national and sub-national burden of breast cancer in Iran from 1990 to 2013. METHODS: We will perform a systematic review of the confirmed databases and literature to gather data on breast cancer epidemiology in Iran. The definitions, data sources, organizing the team, methods of data gathering and data generating will be explained in this paper. The methodology of estimating the trend of prevalence, years of life lost due to premature death (YLLs), years of life lost due to disability (YLDs) and disability-adjusted life years lost (DALYs) of breast cancer by age groups, provinces and probable inequalities will be explained. We will tackle possible data problems due to the lack of data points on provinces and years and also geographical misalignment by using two advanced statistical methods, namely Bayesian autoregressive multilevel and Spatio-temporal models. Trend estimation will be reported using these two models together with uncertainty intervals. CONCLUSION: This study provides a comprehensive assessment of breast cancer and its specific pattern in Iran. The results will help policy makers to know the trend of prevalence, the distribution, and the inequalities of breast cancer in Iran to allocate resources in a better way.

Systematic review: endocrine abnormalities in patients with liver cirrhosis.

Abstract: Background: Cirrhosis is the end stage of many different forms of acute and chronic liver damages. Interactions between liver and endo- FULQHV\VWHPLVVLJQLoFDQW��EHFDXVHOLYHULVWKHPDLQRUJDQRI� PHWDEROLVPDQGFDWDEROLVPRIPDQ\�SURWHLQV�� Aim: In this study, current literature about endocrine abnormalities among patients with liver cirrhosis was reviewed. Methods:�$�3XE0HGVHDUFKZDVSHUIRUPHGRQ�(QJOLVKOLWHUDWXUHIURP�-DQXD U\������RQZDUGWR�oQGKXPDQVWXGLHVUHSRUWLQJHQGRFULQH� dysfunction in liver cirrhosis. Relevant articles were included and reviewed by two expert reviewers. Data were summarized ant tabulated in separate categories for each endocrine involvement. Results: Among 944 studies, 36 articles were eligible for review. Growth hormone resistance and low Insulin like growth factor-1 are prevalent in patients with liver cirrhosis with negative impact on prognosis. Thyroid dysfunction is mostly seen in the form of sick euthyroid V\QGURPH��2VWHRSRURVLVLVDOVRSUHYDOHQWLQFLUUKRVLVEXWWKHH (DFWPHFKDQLVPLVQRWFOHDU��$GUHQDOLQVXIoFLHQF\�LVDSUHYDOHQ WFOLQLFDOIHD - ture both in compensated and critically ill patients with cirrhosis with negative impact on patients' outcomes. Conclusion: Disorders of endocrine system is prevalent in cirrhosis. These patients should be checked and treated for these disorders to achieve a stable clinical situation and prepare for liver transplantation.

Body Composition Reference Percentiles of Healthy Iranian Children and Adolescents in southern Iran

Abstract: Background: The prevalence of childhood obesity has risen greatly worldwide. However, assessment of obesity among children and adolescents is further complicated by the changes occurring in the body composition during the growth. The aim of this study is to create JHQGHUVSHFLoFSHUFHQWLOHFXUYHVIRUWRWDOERG\�IDWSHUFHQWDJH�

Meningioma protein-protein interaction network.

Abstract: BACKGROUND: Meningioma is one of the most common central nervous system tumors derived from meningothelial (arachnoid cap) cells. This paper identiied the network-based Protein-Protein Interactions (PPI) for meningioma compared to healthy controls. METHODS: Gene expression data, including 384 gene or protein names, were extracted from a number of previous investigations. Out of these 384 proteins, 176 were found to be exclusively expressed in meningiomas and 208 proteins were down-regulated. The networks of related differentially expressed genes were explored using cytoscape and the PPI analysis methods such as MCODE and ClueGO. RESULTS: Analysis introduced a number of hub proteins and 27 clusters (protein complex) with distinctive seed genes. Identiied ClueGO Pathways based on subnetworks mined by MCODE was composed of positive regulation in RBC homeostasis, dysregulation of transport from ER to Golgi, disruption regulation of cell cycle and antigen processing and presentation of exogenous peptide antigen and neutraliza- tion of exogenous dsRNA. Combination of over-expression of TCEA1, UBE2E1, XRCC5, IFIT1, IFIT-3, MCM2, and MCM7 and under- expression of CDC25A, SEC31A, and CDK6 can serve as a diagnostic biomarker panel for meningiomas. CONCLUSION: These proposed network-based biomarkers for the meningioma patterns may be helpful in diagnosis, prognosis and treat- ment processes, although biomarker validation is necessary.