The metabolism of clofibrate in man

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Healthcare utilization in patients with esophageal cancer in a high risk area in northeast of Iran

Introduction: Golestan, a province located north of Persian Gulf in northeastern part of Iran is a well known area for high risk of esophageal cancer (EC) in the world. There is no information about healthcare utilization in populations residing in the area. This study was conducted to assess utilization of healthcare and its associated factors among esophageal cancer patients in this region as well as to address ethical implication of this utilization. Methods: All new cases of EC in Golestan province during year of 2007 were recruited. Seven diagnostic and five therapeutic services were used to assess diagnostic utilization index (DUI), and therapeutic utilization index (TUI), respectively. Multivariate regression analysis was used to assess the relationship between variables and DUI or TUI. P-value of less than 0.05 was considered as statistically significant. Results: Tow hundred twenty three, patients were enrolled with mean (Standard Deviation) age of 64.3 (12.5) years with 57.8% male. We observed that occupation (P<0.01), ethnicity (P<0.01) and sex (P=0.03) were strongly associated with DUI. Insurance coverage (P<0.01), place of residency (P<0.01), and occupation (P=0.01) were associated with TUI. Conclusion: We concluded that several factors contribute to disparity in healthcare utilization in the studied population

Chronic pain: the importance of a sex and gender-based approach to treatment

Twenty-eight million women in the United States suffer from chronic pain. 70% of patients seeking treatment for chronic pain are women, and are found to return to pain clinics thirty-two times more frequently than men. These findings indicate that women experience insuficient pain relief following intervention. Given that 80% of pain research has been conducted on men, most knowledge of pain pathways in women are extrapolations, shedding light on the ineficiencies of current treatment algorithms, and the importance of a sex and gender-based approach to chronic pain. The biochemistry and physiology of the pain pathway, as well as the pharmacokinetics and pharmacodynamics of medications used to remedy pain responses, are signifcantly different between men and women. Low-estradiol states result in a reduction in both mu-opioid receptor recruitment and basal activation, leading to significant hyperalgesia and sensitivity to chronic pain in women as compared to men. Further compounding the dichotomy between the chronic pain response is the response to analgesics. Women have lower levels of glucuronidation, higher volumes of distribution, and lower clearance of commonly administered analgesics as compared to men. Psychosocial factors such as gender roles, expectations surrounding pain, and coping strategies also determine how pain is perceived and ultimately influence how pain is treated. These findings are just beginning to shed light on the ways in which women and men respond differently in vivo to pain. However, the decision to treat women and men as separate entities with respect to pain management should not be a binary one. While patients should be treated as individuals, pre-menopausal, post-menopausal and transgender women, should all be met with an approach that takes into account the sex and gender differences that exist. Pain management physicians should take heed of these complex differences and utilize a sex and gender-based approach while managing patients.https://jdc.jefferson.edu/sexandgenderhealth/1025/thumbnail.jp

The trend of seat belt use among drivers in the north of Iran, 2007-2010: An epidemiologic study

Backgrounds and Objectives: Using seat belt has a considerable role in reducing human damage. The aim of this study was to compare trend of seat belt use rate during 4 years, from 2007 to 2010, in Golestan province (northern Iran). Materials and Methods: This was a population-based cross-sectional study that enrolled 3999 subjects aged 15-65 years during four years (2007 = 1000 cases, 2008 = 1000 cases, 2009 = 999 cases and 2010= 1000 cases) using stratified cluster sampling. Interviewers recorded the data using a multidimensional questionnaire including anthropometric indexes. Using seat belt in the case of sitting in the front seat of car (as a driver or passenger) of all samples was asked. SPSS 16.0 software was used for statistical data analysis. Results: The rate of seat belt use in the years 2007, 2008, 2009 and 2010 were 71%, 69.8%, 74.5 and 86.4%, respectively. Seat belt use during the four years increased up to 15.4%. Statistical differences among four years was significant (P<0.01). The increasing seat belt use rate was 19% and 14.9% in urban and rural areas, respectively. The seat belt use rate was higher in subjects with =35 years old people in proportion to 35= years old people (17.85% versus 14.3%). During the latest year of study, using seat belt was about 14.8% higher in men comparing with women (P<0.05). Conclusion: Using seat belt increased up to 3.9% per year and the trend in the rural areas was lower than in the urban areas. Seat belt used in men more than women. Using seat belt and its growing trend, will help in reducing mortality caused by accidents in Iran. © IDOSI Publications, 2012

Five-year trend in hydrogenated vegetable oil consumption among Northern Iranian families

Background: The main aim of this study was to assess the trends in hydrogenated vegetable oil (HVO) consumption and some related factors among northern Iranian families from 2006 to 2010. Methods: A cross-sectional, population-based study was conducted with 6497 subjects, 15 to 65 years old, who were chosen by multistage cluster random sampling. The subjects were randomly chosen by 325 clusters with an equal size (n = 20 subjects). A multidimensional questionnaire including so-ciodemographic questions and type of cooking oil used were administered by interviewers. Results: The percentages of the sample reporting HVO consumption across the 5 years are as follows: 2006,85.2%; 2007, 79.7%; 2008, 75.9%; 2009, 59.3%; and 2010, 55.7%. Consumption decreased 29.5% during the 5 years of study and an average of 5.9% per year (P < .05). The estimated odds ratio of HVO consumption in rural areas verus urban areas was 2.59 (95% confidence interval [CI], 2.31-2.90); for poor compared with good economic level the odds ratio was 3.99 (95% CI, 3.13-5.10 for; for the uneducated versus college-educated sample it was 5.75 (95% CI, 4.10-8.17); and the odds ratio was 3.34(95% CI, 2.51-4.45) for Sisstani compared with Fars-native ethnic group. Conclusion: HVO consumption decreased during the 5-year study (2006 to 2010), but HVO is still used extensively in northern Iran. Preventive early intervention strategies are needed to target uneducated and poor families, with an emphasis on the Sisstanish ethnic group, to increase awareness about the negative consequences of HVO consumption

Cancer incidence in Golestan province: Report of an ongoing population-based cancer registry in Iran between 2004 and 2008

Background: Golestan Province, at the western end of the Asian esophageal cancer (EC) belt in northeastern Iran, was reported to have one of the highest worldwide rates of EC in the 1970s. We have previously shown a declining incidence of EC in Golestan during the last decades. This study reports additional new results from the Golestan Population-based Cancer Registry (GPCR). Methods: The GPCR collected data from newly diagnosed (incident) cancer cases from all 68 public and private diagnostic and therapeutic centers in Golestan Province. CanReg-4 software was used for data entry and analysis based on the guidelines of the International Agency for Research on Cancer (IARC). Age-standardized incidence rates (ASR) of cancers were calculated using the 2000 world standard population. Results: From 2004 through 2008, 9007 new cancer cases were reported to the GPCR. The mean (SD) age was 55.5 (18.6) years, and 54 were diagnosed in men. The ASRs of all cancers were 175.3 and 141.1 per 100,000 person-years for males and females, respectively. Cancers of the stomach (ASR:30.7), esophagus (24.3), and lung (15.4) were the most common cancers in males. In females, breast cancer (ASR:26.9) was followed by malignancies of the esophagus (19.1) and stomach (12.4). The diagnosis of cancer was based on histopatho- logical reports in 71 and on death certificate only in 9 ofcases. Conclusions: The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase

Influence of education in the prevalence of obesity in Iranian northern adults

Background: The main aim of this study was to evaluate whether prevalence of obesity in educational levels is different and some related factors in Iranian northern adults. Materials and methods: This was a cross-sectional descriptive study based on population and 2452 cases (1224 men and 1228 women) aged 15e65 years were chosen by cluster and stratify sampling. Subjects were randomly chosen from 125 clusters and each cluster included 20 cases. Interviewers recorded the data using a multidimensional questionnaire including socio-demographic indexes. Results: As a whole, the prevalence of obesity was seen in 24% of subjects (15.5% in male and 32.5% in female) and significantly was seen in 3.1% and 14.1% of uneducated people more than in 1e9 year schooling and in high school or college-educated people, respectively (P = 0.001). The risk of obesity was 2.294 (P = 0.001) in uneducated compared to high school or college-educated people, 1.668 (P = 0.001) in urban area compared to rural area, 2.619 (P = 0.001) in 40e65 year people compared to 15e40 year people, and 1.534 (P = 0.003) in good economic compared to poor economic groups. After adjusted for location area, gender, age, and economic stats, the risk of obesity was 2.044 (P = 0.001) in uneducated people compared to high school or college-educated subjects. Conclusion: The obesity as a health problem in Iranian northern adults supported in this study and it was negatively associated with educational levels. Public health programs that aim to reduce obesity should primarily focus on the illiterate and low-educated people. Copyright © 2013, SciBioIMed.Org, Published by Reed Elsevier India Pvt. Ltd. All rights reserved

Differences in the prevalence of obesity among Fars-native, Turkman, and Sisstanish ethnic groups in Iranian northern adults in 2010

Objectives: The aim of this study was to evaluate the differences of obesity rate among three ethnic groups in northern adults in IR Iran in 2010. Methods: The present cross-sectional, analytical study was conducted on 2994 cases of the same age and sex in three ethnic proportions (Fars-native=1625, Turkman=977, and Sisstani=392). The subjects aged between 15 and 65 years old and were selected by multistage cluster sampling techniques including 150 clusters each containing 20 subjects in urban and rural areas in 11 districts in Golestan province (northern IR Iran). Obesity was defined after WHO classification by BMI (Body Mass Index) equal or over 30 kg/ m2. SPSS 16.0 software was used for statistical analysis and P value<0.05 was considered as statistically significant. Results: Mean±SD of BMI in Fars-native, Turkman, and Sisstanish ethnic groups was 26.72±5.56, 26.18±5.34, and 24.59±6.72 kg/m2, respectively. Averagely, obesity was common in 22.8% of the subjects and was significantly higher among the females compared to males (32.3% vs13.3%) (P=0.001). Also, its prevalence was estimated as 25%, 22.6%, and 14% in Fars-native, Turkman, and Sisstanish ethnic groups, respectively. Statistical differences were significant among the three ethnic groups (P=0.001). The risk of obesity was 2.041 [95% CI, 1.502-2.722] in Fars-native and 1.781 [95% CI, 1.298-2.472] in Turkman groups compared to Sisstanish ethnic group. Conclusions: Over one out of five adults in northern IR Iran suffer from obesity and an alarming rate was shown among the women. Among the three ethnic groups, the highest and the lowest rates were seen in Fars-native and Sisstanish ethnic groups, respectively. Variation of obesity among the three ethnic groups should be studied in future studies