ABSTRACT
The Gastro-Esophageal Malignancies in Northern Iran [GEMINI] research project is an example of recent progress in health research in Iran. The original aim of this project was to identify etiologic factors and prevention measures for upper gastrointestinal cancers in Northern provinces of Iran, but its achievements have gone much beyond this initial goal. GEMINI consists of several projects including cancer registries, pilot studies, case-control studies, and the Golestan Cohort Study. GEMINI has been conducted through extensive collaborations between the Digestive Disease Research Center of Tehran University of Medical Sciences with other domestic and international health organizations. The achievements of GEMINI include producing new knowledge, introducing new research methods, developing and expanding health research and health care infrastructures, investing in human resources, and increasing the awareness and knowledge of policy makers and officials at all levels about the importance of chronic diseases in Iran's health priorities. The success of GEMINI reveals the feasibility of large-scale health research studies in developing countries and serves as a successful model not only for health research in Iran, but also for similar research studies in other developing nations
Subject(s)
Humans , Chronic Disease , Research , Research Design , Gastroenterology , Delivery of Health Care , Community Health Planning , Health PromotionABSTRACT
Many clinical trials and natural history studies on nonalcoholic fatty liver disease [NAFLD] and nonalcoholic steatohepatitis [NASH] rely heavily on liver histology to define their endpoints. There are many indications that the liver is not uniformly involved in NAFLD thus sampling error is a major concern. This study aims to evaluate the uniformity of various histologic features in livers affected with NAFLD. Samples from a forensic autopsy series were studied and subjects with NAFLD identified. We took specimens from three different parts of each liver and recorded the degrees of steatosis, hepatocyte ballooning, lobular inflammation, portal inflammation, and fibrosis. A NASH activity index [NAI] which is the sum of scores of histologic features was also calculated. The agreement between the 3 samples from each liver was studied. There were 945 autopsies performed; 896 were suitable for histologic evaluation and 283 had NAFLD. Of these, 146 livers were available to our study from which 438 samples were taken. Fibrosis [intra-class correlation [ICC] = 0.87], lobular inflammation [kappa = 0.83], and portal inflammation [kappa = 0.83] were fairly uniformly distributed in the damaged liver. Steatosis was less uniform [kappa = 0.64], and hepatocyte ballooning was least uniformly distributed [kappa = 0.57]. The ICC for NAI was 0.86, which indicated good agreement. The individual histologic features of NAFLD and NASH are not uniformly distributed in the liver. Hepatocyte ballooning is especially non-uniform. Such non-uniformity should be taken into account when interpreting results of studies that rely on paired biopsies. A summary score such as NAI is less affected by sampling error
Subject(s)
Humans , Male , Female , Selection Bias , Autopsy , Biopsy , Liver/pathologyABSTRACT
Short term randomized trials have shown the effectiveness of a fixed dose combination therapy [known as Polypill] on reducing blood pressure and serum cholesterol but the impact of Polypill on cardiovascular disease risk or mortality has not yet been directly investigated. Previous studies combined the effects of each component assuming a multiplicative joint risk assumption that may have led to overestimating the combined effects. We conducted an updated meta-analysis of randomized trials of anti-hypertensives, statins and aspirin. We used the estimated effect sizes applying a more conservative assumption to estimate the number of ischemic heart disease [lHD] and stroke deaths that could have been averted by Polypill in Iranians aged 55 years or older in 2006. We searched Medline and reviewed previous meta-analyses to select randomized trials on Angiotensin Converting Enzyme- inhibitors, thiazides, aspirin, and statins. We used a random-effects model to pool relative risks for each component and estimated the joint relative risks using multiplicative and additive assumptions for 4 combinations of Polypill components. We used age- and cause-specific mortality, separately by gender, and estimated the number of preventable deaths from IHD and stroke. Under the additive joint RR assumption, the standard Polypill formulation was estimated to prevent 28500 [95% Cl: 21700, 34100] IHD deaths and 12700 [95% Cl: 8800, 15900] stroke deaths. Removing aspirin from the combination decreased preventable IHD deaths by 15% under the additive assumption [5600 deaths] and by 21% under the multiplicative assumption [6800 deaths] and reduced preventable stroke deaths under both additive and multiplicative assumptions by 3% [300 deaths]. There was no significant difference between Polypill combinations with anti-hypertensive agents in full-dose or half-dose. Polypill can prevent a large number of IHID and stroke deaths in Iran. The cost-effectiveness, feasibility, and acceptability of this prevention strategy remain to be investigated