RESUMO
Objective[s]: radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right-sided cancer
Methods: to minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease [based on Framingham risk scoring] were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy [CRT] to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy [in 2 Gy daily fractions] over a 5-week course. The same dose-adjusted chemotherapy regimen [including anthracyclines, cyclophosphamide and taxol] was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion
Results: a total of 71 patients with a mean age of 45.3 +/- 7.2 years [35 patients with leftsided breast cancer [exposed] and 36 patients with right-sided cancer [controls]] were enrolled. Dose-volume histogram [DVH] [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls [P=0.02, Odds ratio=1.46]. In semiquantitative segmental analysis, only apical [28.6% versus 8.3%, P=0.03] and anterolateral [17.1% versus 2.8%, P=0.049] walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score [SSS] of>3 was observed in twelve cases [34.3%], while in five of the controls [13.9%],[Odds ratio=1.3]. There was no significant difference between the groups regarding left ventricular ejection fraction
Conclusion: the risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the left hemi thorax is not low. It is reasonable to minimize the volume of the heart being in the field of radiation employing didactic radiation planning techniques. Also it is advisable to screen these patients with MPI-SPECT, even if they are clinically asymptomatic, as early diagnosis and treatment of silent ischemia may change the outcome
RESUMO
Early detection through screening is the best method to reduce death due to breast cancer. It has been shown, having knowledge and generating positive attitudes, influences the decision of women to participate in the screening programs. The aim of this study was to identify the factors associated with breast cancer screening [BCS] and with an intention to have screening among women in Tehran, Iran. A cross-sectional study was carried out from January to July 2011, among women who had attended to primary health-care centers in West Tehran using multi-stage sampling method. We invited 1,240 women sequentially to complete a self-administered survey questionnaire at the beginning of their visit; and 1,012 [82%] completed the survey. The questionnaire included, items drawn from the Preventive Health Model that assess socio-demographic background and perceptions about BCS. Multiple logistic regression analysis was performed to identify factors associated with screening and intention to do screening in the future. The mean age of subjects was 38.2 years. Women who perceived more screening efficacy [odd ratio [OR] =1.63; confidence interval [CI] 95%: 1.12-2.37] and fewer performance barriers [OR = 0.82; CI 95%: 0.68-0.97] were more likely to perform clinical breast exam in the future. The women who reported higher clinical breast exam self-efficacy [OR = 1.82; CI 95%: 1.39 2.37], mammography self-efficacy [OR = 1.31; CI 95%: 1.04-1.65], screening efficacy [OR = 1.53; CI 95%: 1.18 1.97], and family influence [OR = 1.27; CI 95%: 1.05-1.54], and those who reported fewer screening performance barriers [OR = 0.56; CI 95%: 0.48-0.67] were more likely to decide for carried out mammography in the future. Most respondents indicated that they intended to do clinical breast exam and mammography in the future [75.8% and 72.1% respectively]. About 65% of women reported they would do both. We found that women's intention to do BCS was very high and a comprehensive national program is needed to guide their intention. Among different demographic factors, the impact of education level on doing BCS was significant
RESUMO
The main aim of this study was to assess the prevalence of depression and general anxiety of the prisoners of war [POW] children. The study was also designed to compare the prevalence of depression and general anxiety amongst the POW's children and normal adults, 20 years after the Iraq-Iran war. An analytic cross-sectional study carried out in June 2009 in Yazd [the centre of Yazd province in Iran]. The target and sampled population were the children of the Iranian POW who lived in Yazd. One hundred and twenty six POW's children, who were born before 1990 [date of father's freedom] were assessed. The duration of father's captivation was between 29-119 months. Ninety-five subjects accepted to participate. General anxiety and major depression were assessed by Persian version of Hamilton Scale for anxiety and Beck depression Inventory. This study was a combination of the psychological interview and questionnaire. Ninety five of normal adult group were also paired matched and assessed. Among 126 POW's children who fulfilled the inclusion criteria, the responsive rate was 75.3% [95 participants].The mean age of participants was 28.3 [SD: 5.34].The father's captivation duration were 29-119 months [mean: 79.2, SD: 21.6]. The prevalence of depression and general anxiety amongst the POW's children were 48.4% and 79%. The prevalence of depression and general anxiety among the paired group were 21.1% and 63.2%.The differences between two groups were significant [p =0.000]. In this study we have demonstrated the prevalence of major depression and general anxiety in POW's children and a normal adult sample. The differences of major depression and general anxiety among the two groups were significant