Developing national framework of monitoring and evaluation of non-communicable diseases control and prevention: an experience from Iran

Background: Islamic Republic of Iran, as a country has undergone dramatic and rapid demographical and economic transition leading to increase mortality and morbidity of Non-Communicable Diseases (NCDs). Furthermore, the prevalence of risk factors of NCDs is at alarming range for the population. In response to this challenge, a number of different high level policies have been developed dealing with NCDs, directly or indirectly. However, the fragmentation of policies makes monitoring of NCDs control difficult. Therefore, the aim of the present study was to develop a comprehensive framework for monitoring and evaluating of NCDs control and prevention.  Methods: A qualitative approach with content analysis method was conducted. Components of NCDs monitoring and evaluation framework were extracted and adaptation of components based on requirements of Iran’s health system was made.    Results: Based on the proposed framework, the three main components of NCDs surveillance are as follows; 1) monitoring outcomes (morbidity and mortality); 2) monitoring risk factors; and 3) assessing health care system response, which includes national capacity to prevent NCDs.  Conclusion: The developed framework is a political tool to strengthen activities to control and prevention of NCD and making more effective inter-sectorial collaboration

Risk of second primary cancer among breast cancer patients: A systematic review and meta-analysis

ObjectivesThe aim of this study was to estimate the extra risk of second primary cancer among breast cancer patients.Methods and materialsThis is a systematic review. A comprehensive search of literature was performed in PubMed, Web of Science, Cochrane library, and Scopus. The search included all published studies up to October 2022. This systematic review included studies published in the English language that reported the risk of second primary non-breast cancer [i.e., standardized incidence ratio (SIR)] among breast cancer patients older than 15 years. After evaluating the methodological quality of the selected studies, SIRs were pooled with consideration of heterogeneity among studies. The estimates were pooled by age and time since the diagnosis of primary breast cancer for both sexes (male and female). Age was categorized based on before 50 years and after 50 years, and time was categorized as duration of less than and more than 10 years, respectively.ResultsFrom 2,484 articles, 30 articles were eligible for inclusion in the systematic review and meta-analysis. The studies varied in terms of population, number of cases, study design, setting, and year of implementation of the research. The estimated SIR for men and women was 1.28 (95% CI: 1.18, 1.38) and 1.27 (95% CI: 1.15, 1.39), respectively. Women diagnosed with breast cancer before menopause [SIR: 1.52 (95% CI: 1.34, 1.71) vs. 1.21 (95% CI: 1.08, 1.34)] as well as women after 10 years since their breast cancer diagnosis [1.33 (95% CI: 1.22, 1.431) vs. 1.24 (95% CI: 1.10, 1.37)] were at a higher risk of developing second primary cancer. Among men, while there were no differences in risk based on age, with the increase of time, the risk of second primary cancer was reduced [SIR: 1.22 (95% CI: 1.12, 1.33) vs. 1.00 (95% CI: 0.79, 1.22)].ConclusionThere is an extra risk of second primary cancer among breast cancer patients. The extra risk should be considered for further screening and preventive measures among this population.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336062, identifier (CRD42022336062)

Evaluation of patient safety culture in medical students

Introducción: la seguridad del paciente es la prevenciónde la prevención y la mejora de resultados desfavorableso daños resultantes del proceso de atención médica. Hoy,reducir y erradicar estos errores y ampliar la seguridad dela atención se ha convertido en una prioridad mundial.El objetivo principal del presente estudio es investigar laspercepciones de los médicos internos de diferentes hospitalesde la Universidad de Ciencias Médicas Shahid Beheshtisobre el tema de la cultura de seguridad del paciente.Materiales y métodos: se seleccionaron 90 estudiantesde diferentes barrios. El cuestionario de cultura de seguridaddel paciente AHRQ se usó para recopilar los datos. Culturade seguridad del paciente en pasantes se estudió en 7campos utilizando esta herramienta confiable y sostenible.pregunta de puntuación relacionada con cualquier elementode 5 grados (1 a 5) usando Likert hecho. Las opciones incluyentotalmente en desacuerdo, en desacuerdo, neutral,de acuerdo y totalmente de acuerdo. Usando pruebas noparamétricas, se evaluó la relación de respuesta a cada ítemy se analizó la importancia de la diferencia de las razones.Resultados: Los resultados generales mostraron que lapuntuación de los rendimientos medios de la unidad detrabajo (p = 0.00), los errores de replicación (p = 0.00) yel hospital (p = 0.03) fueron significativamente más altosy las puntuaciones del grado de concesiones de seguridaddel paciente (p = 0.00) son significativamente más bajasque el promedio también en los campos de supervisión(p = 0.058) y las comunicaciones (p = 0.1) las medias nomostraron diferencias significativas con respecto al promedio.Se observó el grado de seguridad del paciente entérminos de diferencia estadísticamente significativa entrelas puntuaciones de hombres y mujeres (p = 0.00) y elhospital (p = 0.01), mientras que en otras áreas hay diferenciassignificativas entre los grupos.Conclusión: Los resultados de este estudio mostraronque, en general, en el campo de la cultura de seguridaddel paciente, es necesario adoptar una actitud integral, esla falta de una gestión integral y una reducción eficientede la seguridad del paciente en el hospital, seguido deun aumento de las lesiones a los pacientes y los sectoresde salud

Evaluation of patient safety culture in medical students

Introducción: la seguridad del paciente es la prevenciónde la prevención y la mejora de resultados desfavorableso daños resultantes del proceso de atención médica. Hoy,reducir y erradicar estos errores y ampliar la seguridad dela atención se ha convertido en una prioridad mundial.El objetivo principal del presente estudio es investigar laspercepciones de los médicos internos de diferentes hospitalesde la Universidad de Ciencias Médicas Shahid Beheshtisobre el tema de la cultura de seguridad del paciente.Materiales y métodos: se seleccionaron 90 estudiantesde diferentes barrios. El cuestionario de cultura de seguridaddel paciente AHRQ se usó para recopilar los datos. Culturade seguridad del paciente en pasantes se estudió en 7campos utilizando esta herramienta confiable y sostenible.pregunta de puntuación relacionada con cualquier elementode 5 grados (1 a 5) usando Likert hecho. Las opciones incluyentotalmente en desacuerdo, en desacuerdo, neutral,de acuerdo y totalmente de acuerdo. Usando pruebas noparamétricas, se evaluó la relación de respuesta a cada ítemy se analizó la importancia de la diferencia de las razones.Resultados: Los resultados generales mostraron que lapuntuación de los rendimientos medios de la unidad detrabajo (p = 0.00), los errores de replicación (p = 0.00) yel hospital (p = 0.03) fueron significativamente más altosy las puntuaciones del grado de concesiones de seguridaddel paciente (p = 0.00) son significativamente más bajasque el promedio también en los campos de supervisión(p = 0.058) y las comunicaciones (p = 0.1) las medias nomostraron diferencias significativas con respecto al promedio.Se observó el grado de seguridad del paciente entérminos de diferencia estadísticamente significativa entrelas puntuaciones de hombres y mujeres (p = 0.00) y elhospital (p = 0.01), mientras que en otras áreas hay diferenciassignificativas entre los grupos.Conclusión: Los resultados de este estudio mostraronque, en general, en el campo de la cultura de seguridaddel paciente, es necesario adoptar una actitud integral, esla falta de una gestión integral y una reducción eficientede la seguridad del paciente en el hospital, seguido deun aumento de las lesiones a los pacientes y los sectoresde salud

Assessment of the fitness of Cox and parametric regression models of survival distribution for Iranian breast cancer patients' data

Factors affecting the time of survival after breast cancer (BC) diagnosis remain unknown. However, some of the prognostic factors have been identified. The aim of this study was to investigate the effects of biologic and socioeconomic factors on long-term survival of BC patients. This was a descriptive chart review and survey of all women with a confirmed diagnosis of BC registered in Shohada-e-Tajrish Cancer Research Center database from March 2004 to March 2015. The checklist of study consisted of biologic, demographic, reproductive, genetic, medical, and therapeutic information of patients. The minimum time of follow-up was 3 years and the maximum was 10 years. We then evaluated possible associations of these variables with BC survival using Cox and parametric regression models of survival analysis. The study population was 1276 BC patients. Their mean survival was 23 (range 1–120) months. Between the parametric models, Weibull regression model demonstrated the lowest Akaike information criterion and thus the best fit, and tumor size, number of lymph nodes, BC stage, educational level, and high-fat diet were significant in this model. Based on our findings, educational level, consumption of fat, and characteristics of tumor at the time of diagnosis (disease stage, tumor size, number of involved lymph nodes) are the most important prognostic factors affecting long-term survival of BC patients. We suggest that future studies assess the efficacy of possible interventions for these factors

Determinants of survival of common childhood cancers in Iran

Background: Cancer is the second most common cause of morbidity and mortality in children. This study aimed to epidemiologically and demographically assess common cancers in children in Iran. Materials and Methods: This cohort study was conducted on children registered in Mahak Hospital and Rehabilitation Complex (which is a non-governmental organizations (NGO)-related hospital for only malignant diseases). A total of 2232 questionnaires were filled out for cancer patients between 2007 and 2016. The factors including age, gender, race, family history, type of treatment, and type of cancer were entered into Cox regression model to examine their effect on mortality of children diagnosed with cancer. Results: The Cox regression model showed that age, race, type of cancer, family history of cancer, and type of treatment had a significant effect on mortality of children diagnosed with cancer (P < 0.05). The hazard ratio (HR) of mortality in 10–15 years old was higher than that of 1–5 years old (P = 0.03, HR = 1.3). The HR of mortality in patients with brain tumor (P < 0.01, HR = 2.24), sarcoma (P < 0.01, HR = 2.32), and neuroblastoma (P < 0.01, HR = 2.56) was twice the value in patients with leukemia. The HR of mortality in patients who had a family history of cancer was higher than that of patients without it (P < 0.01, HR = 1.33). Patients who had undergone chemotherapy along with surgery and radiotherapy (P = 0.02, HR = 0.68) and patients who received chemotherapy along with surgery (P = 0.01, HR = 0.67) had a lower HR of mortality compared to the chemotherapy group. Conclusion: Young age, multidisciplinary approach, and absence of family history were associated with lower hazard of death in children diagnosed with cancer; brain tumor, leukemia, and sarcoma had higher hazard of mortality compared to leukemia. Children with a family history of cancer should be under regular follow-up. Treatment should be multidisciplinary and comprehensive