Emergence and Spread of SARS-CoV-2 Variants of Concern in Canada: a Retrospective Analysis from Clinical and Wastewater Data

The spread of SARS-CoV-2 has been studied at unprecedented levels worldwide. In jurisdictions where molecular analysis was performed on large scales, the emergence and competition of numerous SARS-CoV-2 lineages has been observed in near real-time. Lineage identification, traditionally performed from clinical samples, can also be determined by sampling wastewater from sewersheds serving populations of interest. Of particular interest are variants of concern (VOCs), SARS-CoV-2 lineages that are associated with increased transmissibility and/or severity. Here, we consider clinical and wastewater data sources to retrospectively assess the emergence and spread of different VOCs in Canada. We show that, overall, wastewater-based VOC identification provides similar in-sights to the surveillance based on clinical samples. Based on clinical data, we observed a synchrony in VOC introduction as well as similar emergence speeds across most Canadian provinces despite the large geographical size of the country and differences in provincial public health measures. In particular, it took approximately four months for VOC Alpha and Delta to contribute to half of the incidence, whereas VOC Omicron achieved the same contribution in less than one month. By quantifying the timing and rapidity of SARS-CoV-2 VOCs invasion in Canada, this study provides important benchmarks to support preparedness for future VOCs, and to some extent, for future pandemics caused by other pathogens.

Prevalence and Burden of Refractive Errors at National and Sub-national Levels in Iran.

PURPOSE: To estimate the prevalence, burden of refractive errors and their associated trend from 1990 to 2018 and geographic inequalities in Iran. METHODS: Data regarding the epidemiology of refractive errors was extracted from three different sources: systematic review of published literature, data from visual school screening programs, and data from Iran's national health survey (NHS). The pool of all available data on refractive errors as well as demographic, location, and socioeconomic status covariates were fitted in spatio-temporal and Gaussian process regression models to predict the prevalence of refractive errors from the years 1990 to 2018 in 31 provinces grouped by age and sex in order to calculate years lived with disability (YLDs). RESULTS: In 2018, the age-adjusted prevalence of refractive errors was 16.32% (95% uncertainty interval [UI]: 12.44-21.48%) in both sexes, 17.98% (95% UI: 13.74-23.61%) in women, and 14.66% (95% UI: 11.14-19.36%) in men. The prevalence of refractive errors reveals that it increases with age. Refractive errors contributed to 441.41 and 348.38 YLDs in men and women, respectively. The age-standardized prevalence growth was 31.30% in females and 24.32% in males from the years 1990 to 2018. Significant geographical heterogeneity was observed. The age-standardized YLDs rates of refractive errors represent an increasing trend of 28.9% increase from 1990 to 2018. CONCLUSION: Over 28 years, the prevalence of refractive errors increased significantly. Women tend to have higher rates of prevalence. The prevalence increased in older ages. Border provinces had the lowest prevalence. Age-standardized YLDs rates of refractive errors increased by about 30%.

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.

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.

Factors Affecting Health Care Utilization in Tehran.

INTRODUCTION: Successful health system planning and management is dependent on well informed decisions, so having complete knowledge about medical services' utilization is essential for resource allocation and health plans. The main goal of this study is identification of factors effecting inpatient and outpatient services utilization in public and private sectors. METHODS: This study encompasses all regions of Tehran in 2011 and uses Urban HEART questionnaires. This population-based survey included 34700 households with 118000 individuals in Tehran. For determining the most important factors affected on health services consumption, logit model was applied. RESULTS: Regarding to the finding, the most important factors affected on utilization were age, income level and deciles, job status, household dimension and insurance coverage. The main point was the negative relationship between health care utilization and education but it had a positive relationship with private health care utilization. Moreover suffering from chronic disease was the most important variable in health care utilization. CONCLUSIONS: According to the mentioned results and the fact that access has effect on health services utilization, policy makers should try to eliminate financial access barriers of households and individuals. This may be done with identification of households with more than 65 or smaller than 5 years old, people in low income deciles or with chronic illness. According to age effect on health services usage and aging population of Iran, results of this study show more importance of attention to aged population needs in future years.

Psychometric analysis of a Persian version of the European Organization for Research and Treatment of Cancer OG25 Quality of Life Questionnaire in oesophagogastric cancer patients.

BACKGROUND: Health-related quality of life (HRQL) is a fundamental outcome in oncology patients and quality of life (QOL) assessment requires clinically relevant questionnaires. The purpose of this study was translation and definition of measurement properties and the clinical validity of Quality of Life Questionnaire (QLQ) -OG25 module in Persian patients with oesophagus, oesophagogastric junction (OGJ) or gastric cancers. MATERIALS AND METHODS: The translation procedure followed European Organization for Research and Treatment of Cancer (EORTC) guidelines. Both EORTC QLQ-OG25 and a core questionnaire (EORTC QLQ-C30) were administered to patients with oesophagus (150), OG junction (93) and gastric (32) cancer undergoing multi-modal treatments. Convergent and discriminant validity, Cronbach's alpha coefficient and known-groups comparisons were used to examine reliability and validity. RESULTS: In all, 275 patients (mean age 62 years) completed both questionnaires. Compliance rate was high and the questionnaire module was well accepted. We found good reliability for multi-item subscales of QLQ-OG25 (Cronbach's alpha coefficients 0.76-0.89). About 73% had TNM staging and scales distinguished between clinically distinct groups of patients. However, patients in palliative group experienced compromised functional status and worse treatment-associated symptoms than those in the potentially curative group. Test-retest scores were consistent. Multi-trait scaling analysis demonstrated good convergent and discriminant validity. CONCLUSIONS: Overall, the Persian version of QLQ-OG25 demonstrated psychometric and clinical validity that supports its application as a supplement to the original tool (EORTC QLQ-C30) when assessing HRQL in patients with upper-gastrointestinal (GI) cancer both in curative and palliative phases.

Psychometric properties of the Persian version of satisfaction with care EORTC-in-patsat32 questionnaire among Iranian cancer patients.

BACKGROUND: Cancers impose an increasing burden on health of the populations and individuals, but little is known about cancer patient satisfaction with care. The aim of this study was to assess the psychometric properties of the Persian version of European Organisation for Research and Treatment of Cancer (EORTC) In-Patsat32, as a recently developed questionnaire to assess cancer patient satisfaction with care and information provided during hospital admission. MATERIALS AND METHODS: Complying with EORTC protocols, the Persian version of Inpatsat32 was translated and piloted in a small group of patients, then applied to 380 cancer patients admitted to different oncology wards in Tehran. Validity (convergent, discriminant, and divergent) and reliability of the tool was assessed through using multitrait analysis, factor analysis, intraclass correlations, Chronbach's alpha and test-retest (on a sample of 70 patients). RESULTS: Good acceptance and high sensitivity of the questionnaire with low floor and ceiling effects were recognized, indicating power of the instrument to detect differences between groups with heterogeneous levels of satisfaction. Multitrait scaling analyses supported the convergent validity of the majority of scales (correlation coefficient >0.4) and favorable discriminant validity (item own scale correlation >0.8). There was no correlation between In-patsat32 scales and the EORTC-C30, which measures different concepts, confirming divergent validity of the tool. Internal consistency for all domains was high (α>0.70) except for the hospital access score and the test-retest reliability was excellent (r=0.86-0.96). There was a weak responsiveness to change except for nurses technical skills. Principle component analysis confirmed five domains with much improved internal consistency (α>0.9). CONCLUSIONS: The Persian version of the EORTC-in-patsat32 module is a reliable and valid instrument to measure cancer patient satisfaction with care received during their hospitalization period and can be utilized in clinical cancer research.

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.