Challenges of determining the relative contribution of determinants of health on population health: a Canadian perspective.

This article investigates the source of frequently cited data regarding the relative contribution of determinants of health to population health in Canada. It critically discusses the imperative for such national or regional data in policymaking, and the challenges and limitations of this approach.

Economic sanctions threaten population health: the case of Iran.

OBJECTIVE: The aim of the study is to review evidence of the negative consequences of international economic sanctions on population health in Iran and pathways via which the sanctions affect health. STUDY DESIGN: This is a narrative review. METHODS: Data from the World Bank and the Central Bank of Iran were gathered to clarify economic consequences of sanctions. Moreover, the literature was reviewed for published data on health consequences of economic sanctions in Iran and economic crisis in other parts of the world. Finally, some mechanisms via which economic sanctions could affect health were reviewed. RESULTS: Iran experienced 11.8% reduction in gross domestic production growth in 2012 compared with 2011, besides 40% inflation and 200% depreciation of Iranian currency. Ultimately, it resulted in increased living costs and unemployment. One year after termination of sanctions, Iran's gross domestic production growth increased by 14.1% in 2016. Data revealed that mental health has been affected during sanctions. Moreover, access to essential and lifesaving medication has been compromised, similar to other countries during economic recession. CONCLUSION: Economic sanctions have had negative consequences on population health in Iran by impairing social determinants of health and access to medication and care. These sanctions widen economic inequality and health gap.

Current and Future Challenges of Radiation Oncology in Iran: A Report from the Iranian Society of Clinical Oncology.

AIMS: Growth of the cancer incidence rate in Iran has been very high in recent years. Therefore, the Iranian health care system should be prepared for the treatment of a huge number of patients in the foreseeable future. One of the most important treatment options for cancer is radiation. However, there is no comprehensive information on infrastructure for radiation oncology in this country. MATERIALS AND METHODS: In 2015, a questionnaire was designed by the Iranian Society of Clinical Oncology (ISCO) and all radiation oncology centres in the country were visited to determine four important components of radiation oncology services, including facilities, equipment, personnel and patients. RESULTS: In 2015, 94 radiotherapy centres were identified in Iran. Sixty-one centres were fully operational, six centres were commissioning, 26 centres were under construction and one was inactive. Among the fully operational radiotherapy centres, 54 offered three-dimensional conformal radiotherapy and two-dimensional radiotherapy, eight offered brachytherapy, two intensity-modulated radiotherapy, two intraoperative radiotherapy, ostereotactic radiosurgery, two hyperthermia and 59 chemotherapy. Moreover, the survey identified 110 linear accelerators, 25 cobalt-60, one gamma knife, 21 remote brachytherapy afterloaders and six orthovoltage units. Treatment planning equipment included 15 graphy simulators, 19 dedicated computed tomography simulators, 22 multileaf collimator and 12 electronic portal imaging devices. Moreover, in 2015, 243 clinical oncologists participated in the treatment of 42 350 cancer patients in need of radiotherapy, which is about one radiation oncologist for 175 patients. During 2010-2015, number of cobalt-60 reduced 70%, from 25 units to 8 units. CONCLUSIONS: There is a significant gap between Iran's available facilities for radiation therapy and international standards. Moreover, during international economic sanctions against Iran this gap widened.

Which is access suitable for a solitary upper pole renal stone? A possible novel criterion.

AIM: The aim of the present study was to discover a new criterion for choosing subcostal or supracostal upper pole renal access before performing PCNL in upper pole renal stone cases. METHODS: Between April 2006 and July 2009 we performed 35 subcostal upper poles PCNL in solitary upper pole stone cases. The inclusion criteria were stone size >1.5 cm or stone size <1.5 cm and resistant to extracorporeal shockwave lithotripsy. The exclusion criteria were renal anomalies, uretero-pelvic junction obstruction, multiple stone (associated pelvic or a lower pole stone) and any contraindication for surgery. We determined access length as the new criterion (the distance between the point of needle entrance and lower border of stone on the skin) and access success, in all patients. Then we analyzed the relationship between these two main variables and used roc curve to find a reliable cut point of access length. RESULTS: The mean of access length was 9.72 cm (range: 6-14) and access was successful in 29 (82.8%) patients. Between measured variables, access length was the only variable that related to access success (P=0.04); furthermore, two reliable cut points (8 cm and 12 cm) for predicting access success. If access length was <8 cm or 8-12 cm or >12 cm, the access success was 100%, 83% and 50%, respectively. CONCLUSION: Access length can be used as a criterion for choosing subcostal upper pole renal PCNL and predicting its success, in the case of solitary upper pole renal stones 12 cm can serve as a critical valve for a decision.

Efficacy and morbidity following PCNL in patients with renal anomalies: the outcome from a randomized study comparing different imaging modalities for assessment.

AIM: The aim of this paper was to assess outcome of totally tubeless percutaneous nephrolithotomy (TPCNL) performing with and without preoperative computed tomography (CT) scan, in anomalous kidneys. METHODS: A total of 50 patients with renal anomaly were randomly divided into two groups. Exclusion criteria was stone size >3.5 cm. Twenty six had malrotation, 21 had horseshoe kidney and 3 had ectopic pelvic kidneys. For 25 patients, TPCNL was performed with preoperative CT scan and in the remnant only intravenous urography and renal ultrasonography were done, preoperatively. The incidence of complications and outcomes were compared between two groups in a 1 month period. RESULTS: In the group with preoperative CT scan, the mean (SD) stone size was 2.9 (0.75) vs. 2.7 (0.95) cm2. Between the two groups, there were not statistical differences in the mean (SD) analgesic requirement, hemoglobin drop, operation time, hospital stay, and return to normal activity. They were 7.5 (1.7) vs. 6.1 (1.9) mg of morphine, 1.20 (0.36) vs. 1.52 (0.27) mg/dl, 64 (13.2) vs. 59 (13.3) minutes, 1.9 (0.4) vs. 1.7 (0.45) and 12.4(2.9) vs. 10 (3.5) days, respectively. Only 2 patients required blood transfusion and one patient had postoperative pneumothorax in the group with CT while in the other group, three patients required postoperative transfusion and one showed postoperative fever. A successful outcome at the first attempt was 88% in group with CT vs. 80% in the other group. CONCLUSION: It seems that TPCNL could be done with safety in renal anomalies by omitting preoperative CT scan.

Evaluation of Epstein-Barr virus load in saliva before and after renal transplantation.

INTRODUCTION: Posttransplant lymphoproliferative disorders (PTLD) arising in solid organ transplant patients show a strong correlation with Epstein-Barr virus (EBV) infection. The aim of our study was to evaluate the frequency of EBV DNA levels before and after transplantation among saliva samples of Iranian kidney transplant patients. MATERIALS AND METHODS: In 40 kidney transplant recipients and their healthy donors, we evaluated the EBV DNA levels in saliva samples by quantitative polymerase chain reaction method using samples obtained 1 hour before transplantation surgery. In addition, 3 months after transplantation we evaluated EBV DNA levels in recipients for comparison with preoperative levels. Exclusion criteria included hepatitis B, hepatitis C, and human T-cell leukemia virus infections before transplantation as well as HIV-positive patients under highly active antiretroviral therapy, graft rejection requiring dialysis and active viral infection of oral cavity. RESULTS: Before renal transplantation, there was no significant difference in saliva EBV DNA levels between kidney donor and recipient patients (P=.8). The levels increased significantly to 67.6% in the recipient group after transplantation (P=.01). CONCLUSION: We observed that EBV was more frequently present in the oral mucosa after renal transplantation. Thus, we can follow these patients for EBV infection using saliva examinations as a simple screening method.