Spatial Inequalities in the Incidence of Colorectal Cancer and Associated Factors in the Neighborhoods of Tehran, Iran: Bayesian Spatial Models / 예방의학회지

OBJECTIVES: The aim of this study was to determine the factors associated with the spatial distribution of the incidence of colorectal cancer (CRC) in the neighborhoods of Tehran, Iran using Bayesian spatial models. METHODS: This ecological study was implemented in Tehran on the neighborhood level. Socioeconomic variables, risk factors, and health costs were extracted from the Equity Assessment Study conducted in Tehran. The data on CRC incidence were extracted from the Iranian population-based cancer registry. The Besag-York-Mollié (BYM) model was used to identify factors associated with the spatial distribution of CRC incidence. The software programs OpenBUGS version 3.2.3, ArcGIS 10.3, and GeoDa were used for the analysis. RESULTS: The Moran index was statistically significant for all the variables studied (p < 0.05). The BYM model showed that having a women head of household (median standardized incidence ratio [SIR], 1.63; 95% confidence interval [CI], 1.06 to 2.53), living in a rental house (median SIR, 0.82; 95% CI, 0.71 to 0.96), not consuming milk daily (median SIR, 0.71; 95% CI, 0.55 to 0.94) and having greater household health expenditures (median SIR, 1.34; 95% CI, 1.06 to 1.68) were associated with a statistically significant elevation in the SIR of CRC. The median (interquartile range) and mean (standard deviation) values of the SIR of CRC, with the inclusion of all the variables studied in the model, were 0.57 (1.01) and 1.05 (1.31), respectively. CONCLUSIONS: Inequality was found in the spatial distribution of CRC incidence in Tehran on the neighborhood level. Paying attention to this inequality and the factors associated with it may be useful for resource allocation and developing preventive strategies in atrisk areas.

Spatial Inequalities in the Incidence of Colorectal Cancer and Associated Factors in the Neighborhoods of Tehran, Iran: Bayesian Spatial Models / 예방의학회지

OBJECTIVES@#The aim of this study was to determine the factors associated with the spatial distribution of the incidence of colorectal cancer (CRC) in the neighborhoods of Tehran, Iran using Bayesian spatial models.@*METHODS@#This ecological study was implemented in Tehran on the neighborhood level. Socioeconomic variables, risk factors, and health costs were extracted from the Equity Assessment Study conducted in Tehran. The data on CRC incidence were extracted from the Iranian population-based cancer registry. The Besag-York-Mollié (BYM) model was used to identify factors associated with the spatial distribution of CRC incidence. The software programs OpenBUGS version 3.2.3, ArcGIS 10.3, and GeoDa were used for the analysis.@*RESULTS@#The Moran index was statistically significant for all the variables studied (p < 0.05). The BYM model showed that having a women head of household (median standardized incidence ratio [SIR], 1.63; 95% confidence interval [CI], 1.06 to 2.53), living in a rental house (median SIR, 0.82; 95% CI, 0.71 to 0.96), not consuming milk daily (median SIR, 0.71; 95% CI, 0.55 to 0.94) and having greater household health expenditures (median SIR, 1.34; 95% CI, 1.06 to 1.68) were associated with a statistically significant elevation in the SIR of CRC. The median (interquartile range) and mean (standard deviation) values of the SIR of CRC, with the inclusion of all the variables studied in the model, were 0.57 (1.01) and 1.05 (1.31), respectively.@*CONCLUSIONS@#Inequality was found in the spatial distribution of CRC incidence in Tehran on the neighborhood level. Paying attention to this inequality and the factors associated with it may be useful for resource allocation and developing preventive strategies in atrisk areas.

Study protocol for promoting physical activity among women based on the MAPP process

Background: The participation of all stakeholders is necessary when a community-based intervention is designed. For running a practical intervention, it is necessary to have a framework to design the programme while considering all stages of planning, implementation and evaluation.

Aims: To describe a study protocol based on the MAPP process [Mobilizing for Action through Planning and Partnerships] for promoting physical activity [PA].

Methods: This protocol is implemented in 6 distinct phases. The goal of the first and second phase is to organize the programme and increase participation, and to determine the vision of the programme, respectively. The third phase provides a comprehensive picture of a community. The fourth and fifth phases identify strategies for the programme. The sixth phase is about the action cycle.

Conclusion: The framework considers all factors on PA improvement and, consequently, results in a culture-based programme for women

Return to work after trauma: A survival analysis / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To evaluate the return to work (RTW) rate, time and predictors among trauma patients using survival analysis.</p><p><b>METHODS</b>This cohort study was conducted with a three-month follow-up on 300 trauma patients hospitalized in Shahid Beheshti Hospital, Kashan, Iran in 2014. The data were collected through conducting interviews and referring to patients' medical records during their hospital stay and follow-up information at one & three months after discharge from hospital. Final analysis was conducted on the data retrieved from 273 patients. Data were analyzed by chi-square test, Mann-Whitney U test and survival analysis method.</p><p><b>RESULTS</b>The rate of RTW at the end of the first and the third follow-up months was respectively 21.6% and 61.2%. Survival analysis showed that the RTW time (Time between admission to first return to work) was significantly longer among patients with illiteracy, drug abuse, hospitalization history in the intensive care unit, low socioeconomic status, non-insurance coverage, longer hospital stay, multiple and severe injuries as well as severe disability.</p><p><b>CONCLUSION</b>Our findings indicated that trauma has profound effects on the rate and time of RTW. Besides disability, many personal and clinical factors can affect the outcome of RTW.</p>

Trends in gastrointestinal cancer incidence in Iran, 2001-2010: a joinpoint analysis / 한국역학회지

OBJECTIVES: The main purpose of this study was to evaluate changes in the time trends of stomach, colorectal, and esophageal cancer during the past decade in Iran. METHODS: Cancer incidence data for the years 2001 to 2010 were obtained from the cancer registration of the Ministry of Health. All incidence rates were directly age-standardized to the world standard population. In order to identified significant changes in time trends, we performed a joinpoint analysis. The annual percent change (APC) for each segment of the trends was then calculated. RESULTS: The incidence of stomach cancer increased from 4.18 and 2.41 per 100,000 population in men and women, respectively, in 2001 to 17.06 (APC, 16.7%) and 8.85 (APC, 16.2%) per 100,000 population in 2010 for men and women, respectively. The corresponding values for colorectal cancer were 2.12 and 2.00 per 100,000 population for men and women, respectively, in 2001 and 11.28 (APC, 20.0%) and 10.33 (APC, 20.0%) per 100,000 in 2010. For esophageal cancer, the corresponding increase was from 3.25 and 2.10 per 100,000 population in 2001 to 5.57 (APC, 12.0%) and 5.62 (APC, 11.2%) per 100,000 population among men and women, respectively. The incidence increased most rapidly for stomach cancer in men and women aged 80 years and older (APC, 23.7% for men; APC, 18.6% for women), for colorectal cancer in men aged 60 to 69 years (APC, 24.2%) and in women aged 50 to 59 years (APC, 25.1%), and for esophageal cancer in men and women aged 80 years and older (APC, 17.5% for men; APC,15.3% for women) over the period of the study. CONCLUSIONS: The incidence of gastrointestinal cancer significantly increased during the past decade. Therefore, monitoring the trends of cancer incidence can assist efforts for cancer prevention and control.

Predictors of Colorectal Cancer Survival in Golestan, Iran: A Population-based Study / 한국역학회지

OBJECTIVES: We aimed to investigate factors associated with colorectal cancer survival in Golestan, Iran. METHODS: We used a population based cancer registry to recruit study subjects. All patients registered since 2004 were contacted and data were collected using structured questionnaires and trained interviewers. All the existing evidences to determine the stage of the cancer were also collected. The time from first diagnosis to death was compared in patients according to their stage of cancer using the Kaplan-Meir method. A Cox proportional hazard model was built to examine their survival experience by taking into account other covariates. RESULTS: Out of a total of 345 subjects, 227 were traced. Median age of the subjects was 54 and more than 42% were under 50 years old. We found 132 deaths among these patients, 5 of which were non-colorectal related deaths. The median survival time for the entire cohort was 3.56 years. A borderline significant difference in survival experience was detected for ethnicity (log rank test, p=0.053). Using Cox proportional hazard modeling, only cancer stage remained significantly associated with time of death in the final model. CONCLUSIONS: Colorectal cancer occurs at a younger age among people living in Golestan province. A very young age at presentation and what appears to be a high proportion of patients presenting with late stage in this area suggest this population might benefit substantially from early diagnoses by introducing age adapted screening programs.

Socioeconomic status and incidence of traffic accidents in metropolitan Tehran: a population based study

Population based estimates of traffic accidents [TAs] are not readily available for developing countries. This study examined the contribution of socioeconomic status [SES] to the risk of TA among Iranian adult s. A total of 64,200people aged>/=18years were identified from 2008 Urban Health Equity Assessment and Response Tool [Urban HEART] survey. 22,128 households were interviewed to estimate the overall annual incidence, severity and socioeconomic determinants of TAs for males and females in Iranian capital over the preceding year. Wealth index and house value index were constructed for economic measurement. Weighted estimates were computed adjusting for complex survey design. Logistic regression models were used to examine individual and SES measures as potential determinants of TAs in adults. The overall incidence of traffic accident was 17.3[95% CI 16.0, 18.7] per 1000 per year. TA rate in men and women was 22.6[95% CI 20.6, 24.8] and 11.8[95% CI 10.4, 13.2], respectively. The overall TA mortality rate was 26.6[95% CI 13.4, 39.8] per 100,000 person years, which was almost three times higher in men than that for women [40.4 vs. 12.1 per 100,000person years]. Lower economic level was associated with increased incidence and mortality of TA. Association between SES and incidence, and severity and mortality of TA were identified. TAs occur more in lower socioeconomic layers of the society. This should be taken seriously into consideration by policy makers, so that preventive programs aimed at behavioral modifications in the society are promoted to decrease the health and economic burden imposed by TAs

Do clinical and demographic features of patients with upper-gastrointestinal cancer affect their health-related quality of life?

Oesophagogastric [OG] cancer as a globally common and deadly malignancy, which is widely spread in Northeast Iran, has an extensive impact on health-related quality of life [HRQL]. Demographic and histopathologic changes have been apparent in oesophagogastric cancer, therefore. HRQL could be used, as an outcome, to assess and determine the efficacy and impact of cancer care. A consecutive sample of upper-gastrointestinal cancer patients admitted to the main oncology/ radiotherapy departments in the North-East of Iran were recruited into the study. All participants completed the European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 and QLQ-OG25questionnaires in a face to face interview. Of the total 275 patients participated in the study, 54% had oesophageal, 34% stomach and 12% OG junction cancers. About 73.1% had TNM [tumour, node, metastasis] staging; of which 69% were in stage III and IV. The most common type of cancer in oesophagus was Squamous Cell Carcinoma [SCC] [95.3%] in lower third, Adenocarcinoma in stomach [97.8%] and in the OG junction [93.8%]. Patients with stomach or OG junction tended more to present in higher stages [P < 0.001]. Unlike QLQ-C30, the EORTC QLQ-OG25 was able to differ patients significantly in anxiety scale [P = 0.01], body image, chocking and weight loss [P < 0.05]. Those who had self care ability had better quality of life scores [P < 0.001] in more scales and items. SCC is predominant type of upper GI cancer in Khorasan provinces similar to the high risk area in Northern Iran. The specific health-related quality of life tool [EORTC QLQ-OG25] was able to distinguish most of the symptoms in patients with upper GI cancer

Inequalities in cancer distribution in Tehran; a disaggregated estimation of 2007 incidence by 22ÿdistricts

Cancer is the third cause of death in Iran, with an increasing incidence projected for the next decade. This study aimed to provide a disaggregated viewpoint on cancer incidence in all 22 districts of Tehran, using the Geographic Information System [GIS]. Identifying clusters of cancers may assist in recognizing the cause of the disease, visualizing patterns of cancer distribution, the potential disparities, and help in the provision of early detection programs and equitable, curative, and palliative services. According to the 2007 - 2008 Cancer Registry Data published by the Ministry of Health, there were 7948 new cancer cases diagnosed in Tehran. Data were collected from all pathology centers and hospitals, either public or private facilities, in Tehran. These were classified into 31 main categories according to the expert panels and available resources. The population of the districts and neighborhoods were obtained from the Iran Statistical Center and the Municipally of Tehran, respectively. Home addresses and phones were extracted from the database and imported to GIS. The Age-Standardized Rate [ASR] was calculated using both the new world standard population [2000 - 2025] and the Iran population. Overall, the cancer incidence rate and ASR were 101.8 and 94.775 per 100,000 people, respectively. The maximum cancer incidence rates in both sexes were in districts 6, 3, 1, and 2, whereas, the maximum ASRs were in districts 6, 1, 2, and 3. District 6 accommodated the highest ASRs in both the sexes. Common cancers were breast, skin, colorectal, stomach, and prostate. The ASR in men and women were 129.954 and 114.546 per 100,000 population. This report provides an appropriate guide to estimate the cancer distribution within the districts of Tehran. Higher ASR in districts 6, 1, 2, and 3, warrant further research, to obtain robust population-based incidence data and also to investigate the background predisposing factors in the specified districts

Demographic and prognostic factors of 455 patients with acute leukemia admitted to two referral hospitals in Tehran-Iran during ten years [2001-2011]

Global death toll of Acute Leukemia [AL], as a heterogeneous group of hematopoietic malignancies, is rather high, i.e. almost 74% of 300,000 new cases die every year. This reflects a poor prognosis of this malignancy in most parts of the world, where contemporary and rather complex remedies are not available. There are a few well documented reports about the epidemiologic features of AL at national level in Iran. This retrospective study demonstrates demographic and laboratory features of Acute Myeloid Leukemia [AML] and Acute Lymphoblastic Leukemia [ALL] patients admitted to the main referral oncology hospitals in the ex-Iran University of Medical Sciences in Tehran [Firoozgar and Rasoul-Akram hospitals] during the last decade [2001-2011]. Medical records of all patients admitted to the both hospitals diagnosed with AML and ALL were reviewed during the study period for demographic, biological and clinical characteristics at diagnosis. Four-hundred fifty five patients were diagnosed with AML and ALL, who admitted to the both hospitals during ten years, of whom 59.6% [271 patients] were male. Fifty five percent of patients had AML and 44.6% had ALL, both significantly dominated in men [p<0.001]. AML patients died more significantly [p<0.05] and the most deaths occurred in older patients [p<0.001]. Initial WBC count was significantly related to death [p= 0.001], where the least death [13%] occurred in the group with initial WBC between 5-10x103/microL and most of deceased had an initial WBC more than 10x103/microL. Logistic regression showed that age, fever and WBC were significant prognostic factors. Demographic characteristics of AL patients were almost the same as other global reports. Most deaths occurred in older patients, those who had fever, and patients with higher WBC count at first admission, which warrants more investigations accurately and also improvements in hospital records

Mental health status of individuals fifteen years and older in Tehran-Iran [2009]

This survey was implemented as a part of the Urban Health Equity Assessment and Response Tool [Urban HEART Project] in Tehran, Iran. Since an accurate programming in order to provide mental health services in the province of Tehran requires basic and essential information, the present study was carried out to determine the mental health status of a population sample aged 15 years and over in the mentioned city. The present research was a descriptive cross-sectional study. The statistical population comprised all individuals residing in the 22 areas of Tehran Municipality. Regular random cluster sampling was used in order to choose the subjects from among the households in the mentioned areas. In total, 19370 subjects [7705 male and 11665 female] completed the 28-item version of the General Health Questionnaire for the assessment of mental health. Data were collected and analyzed by trained personnel of Tehran municipality health centers. The results of this survey indicated that 34.2% of the population in the age group 15 years and above suffer from mental disorders [37.9% of women and 28.6% of men]. Women's relative risk of developing mental disorders was 1.3 times higher than that of men. The risk of mental disorders increased with age; and divorced or widowed people were 1.5 times more likely to develop mental disorders compared with single and married individuals. Housewives and unemployed men had the highest risk of developing mental disorders. The highest rates of positive responses to questions on the GHQ-28 were related to malaise and being bad-tempered, anxiety and apprehension, inability to allocate time to tasks, insomnia and hopelessness. Anxiety and somatization were more common than social dysfunction and depression. It is estimated that about 2 million individuals in Tehran require mental health care. Also, insufficient number of psychiatrists and psychiatric beds, indicates that there is a need to provide appropriate staff and facilities to make mental health care available in large cities such as Tehran. The provision of life skills workshops for general population is also suggested, in order to enable individuals to cope with stressful situations in urban areas

[Distribution of cancer incidence in districts and neighbourhoods of a number of Tehran districts in 1386]

The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking and various environmental factors. A variety of cancers data in special geographic areas can help define medical programs for treatment and screening of high-risk groups. Since cancer types has not been reported within districts and neighbourhoods of Tehran city so far, this study could be considered as the first in this respect, which defines cancer epidemiology in the catchment area, and on the other hand, paves the provision of equitable services patient who need these facilities. This is the cross sectional study that shows cancer distribution patern. Incident cases from Tehran residents covered by the Iran University of Medical Sciences were obtained, which included almost 55% of the total cancer incidence in Tehran in 2007. Districts covered by the university were located in west and southwest of Tehran including districts 2,5,6,9,18,21, and 22 cases of other districts refered to Iran university that identified incidence cancer but results must interpreted with caution since those resident districts have not been covered population data were obtained from the previous census in 2006. Age and sex standard rate were calculated based on Iranian standard population. Cancers distribution maps were developed using available adresses, indicating districts and neighbourhoods in GIS. Common cancers diffrence within covered districts was tested by Fisher exact test. Cancer incidence in specified districts of Tehran was 72.822 in 100000 population, where district 6 had the highest incidence [ASR=90.552] followed by district 2 [ASR=71.503] and the least incidence was in district 18 [ASR=34.991]. This diffrence was significant within districts by Fisher exact test. The highest ASRs in women was 87.517 in districts 6 and 2 [71.621] and in male respectivly 94.683 and 70.919. Highest incidence within neighbourhoods were Abasabad, Qaemmaqam and Gand in males and Ddaneshgah, Arjantin and Shiraz in females. High cancers ASR consisted of breast [9.018], colorectal [4.94], prostate [4.174], stomach [3.711] and skin [3.522]. More cancer aggregation, which was observed in districts 2 and 6 within the university catchment area and districts 1 and 3 out of this territory, warrants more researches to investigate what factors in the specified districts and neighbourhoods has led to this condition

BRCA1 protein expression level and CD44[+] phenotype in breast cancer patients

CD44[+]/CD24[-/low] breast cancer cells have tumour-initiating properties with stem cell-like features. Breast cancer gene 1 [BRCA1] is a tumour suppressor gene that plays a crucial role in DNA repair and maintenance of chromosome stability. The clinicopathological features of breast cancer in BRCA1 mutation carriers suggest that BRCA1 may function as a stem-cell regulator. In the present experimental study we examined the expression and localization of the BRCA1 protein and investigated the prognostic value as well as its relationship with the putative cancer stem cell [CSC] marker [CD44] in 156 tumour samples from a well-characterized series of unselected breast carcinomas using immunohistochemistry. Statistical analysis of the data was performed using SPSS software version 16 [Chicago, IL, USA]. In breast tumours, the loss of nuclear expression was detected in 23 cases [15%], whereas cytoplasmic expression of BRCA1 was observed in 133 breast carcinomas [85%]. Altered BRCA1 expression was significantly associated with high grade and poor prognosis breast tumours [p=0.006]. We further established an inverse significant correlation between BRCA1 expression levels and CD44[+] cancer cell phenotype [p=0.02] Loss of BRCA1 expression is a marker of tumour aggressiveness and correlates with CD44[+] tumour cell phenotype. Taken together, the present study supports the idea that the loss of BRCA1 results in persistent errors in DNA replication in breast stem cells and provides targets for additional carcinogenic events