Trend of cigarette smoking in Iranian adult population from 2000 to 2011 based on four national surveys

Background: Tobacco smoking has been a major health concern for many years. People's awareness of the potential health hazards and government policies might change its pattern and prevalence of use. In order to monitor its conversion, determining the overall pattern of tobacco use and trend analyses would be crucial, which were aimed in the present study. Methods: Patterns of smoking in four national surveys conducted in years 2000, 2005, 2007, and 2011 with 33300, 89337, 5287, and 8837 participants, respectively, were assessed. Current status of cigarette, pipe and water-pipe smoking, the number of cigarettes used per day, and the age of smoking initiation were major parameters. After weighting based on province, residential area, gender, and age group, trend analysis was done through complex samples general linear model using IBM SPSS Statistics for Windows, Version 20.0. The values in the first survey (2000) were considered as reference points and categories. Results: While current cigarette smoking prevalence has been decreased (13.5% in 2000 to 11.3% in 2011) P<0.001, the average of pack-years increased. There was no significant decline in the mean age of initiation. It is also true for the prevalence of pipe and water-pipe smoking, which showed no noticeable difference compared to 2000. Conclusion: According to our findings it seems that health policy makers should focus more on designing programs targeting water-pipe consumption and also pay attention to the trends among subgroups for tailoring policies and scheme implementation

Distributions of High-Sensitivity C-Reactive Protein, Total Cholesterol-HDL Ratio and 10-Year Cardiovascular Risk: National Population-Based Study

The present study aimed to evaluate the distributions of High-Sensitivity C-reactive protein, TC-HDL ratio and 10-year risk of cardiovascular diseases among Iranian adult population. We conducted a cross-sectional study on a total of 2125 adults aged 25 to 65. Data of the Third National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) was used. Anthropometric indices, blood pressure and biochemical measurements had been obtained. Ten-year risk of cardiovascular events was also calculated using different models. Median (interquartile range) and geometric means (95% CI) of hs-CRP were 5.1(3.9) and 4.1(4.38-4.85), respectively. Mean TC-HDL ratio±(SD) was 5.94±2.84 in men and 5.37±1.97 in women (P<0.001). In spite of risk scores (FRS and SCORE), no significant gender and age-related differences were observed in hs-CRP levels. Exclusion of CRP levels≥10 did not change the results. The proportion of high-risk categories using SCORE and FRS models were 3.6 % and 8.8 %, respectively. In comparison with other published data, greater means and median values of High-Sensitivity C-reactive protein were observed. Higher TC-HDL ratio and cardiovascular risk in men than in women were also demonstrated. The issue of screening for cardiovascular diseases has yet to be addressed due to considerable prevalence of elevated CRP and increased risk of cardiovascular events among various subgroups

The clinical application of ctDNA to predict response to neoadjuvant chemoradiotherapy in patients with locally-advanced rectal cancer

Abstract Colorectal cancer is a major cause of cancer-related deaths worldwide. A third of colorectal cancers reside in the rectum. Many patients with rectal cancer present in the locally-advanced stage which needs multi-modality therapy usually starting with neoadjuvant chemo-radiotherapy followed by surgery and adjuvant systemic chemotherapy. Total neoadjuvant therapy, defined as the preoperative administration of both neoadjuvant chemoradiotherapy and systemic chemotherapy is also an evolving treatment that can be delivered if indications for preoperative chemotherapy exist. Identifying biomarkers to predict response to neoadjuvant therapy, can improve patient selection for a non-surgical, active surveillance approach. Circulating tumor DNA (ctDNA) can be detected in about 75% of patients with locally-advanced rectal cancer (LARC) at the baseline and in about 15–20% of patients in the post-neoadjuvant, or postoperative setting. ctDNA clearance rate after delivering neoadjuvant chemoradiotherapy, or integrating baseline ctDNA with other conventional markers of clinical response can be a promising marker to select and monitor patients on the “watch and wait” approach. In this article, we aimed to integrate the recent findings and provide a unique insight into the utilization of preoperative ctDNA to predict clinical response in patients with LARC. We also sought to highlight the potential areas for future research in this field. Further studies with a larger number of participants from diverse populations and settings are needed to increase external validity of such investigations and determine the role of ctDNA in guiding clinical decisions and management of patients with LARC

Necessity of Pelvic Lymph Node Irradiation in Patients with Recurrent Prostate Cancer after Radical Prostatectomy in the PSMA PET/CT Era: A Narrative Review

The main prostate cancer (PCa) treatments include surgery or radiotherapy (with or without ADT). However, none of the suggested treatments eliminates the risk of lymph node metastases. Conventional imaging methods, including MRI and CT scanning, are not sensitive enough for the diagnosis of lymph node metastases; however, the novel imaging method, PSMA PET/CT scanning, has provided valuable information about the pelvic LN involvement in patients with recurrent PCa (RPCa) after radical prostatectomy. The high sensitivity and negative predictive value enable accurate N staging in PCa patients. In this narrative review, we summarize the evidence on the treatment and extent of radiation in prostate-only or whole-pelvis radiation in patients with positive and negative LN involvement on PSMA PET/CT scans

Can We Create A Reliable and Valid Short Form of Champion Health Belief Model Questionnaire?

Background: We aimed to create a shortened form of the Champion Health Belief Model instrument which is a widely used questionnaire about breast cancer screening behaviors with acceptable validity and reliability. Methods: The Persian version of the Champion Health Belief Model (CHBM) instrument consists of 57 items in 8 concepts. The subjects of the study were 40 female faculty members and 34 nurses of Tehran University of Medical Sciences in 2014. Based on the results, the most influential questions in each concept were chosen and then analyzed for internal consistency and the mean scores of the concepts were compared to the original questionnaire. Next, the original form was delivered to a different population. The mean scores of each concept were compared between original and short forms. At last, the same second population was asked to fill in the shortened form in a two-week interval and a test re-test comparison was done. Results: In the first step, out of 57 items in the original questionnaire, 28 items were selected based on their influence on the mean score of each concept. In 40 female faculty members who were all above 40, all of the Cronbach’s alphas for all subscales were above 0.6 (ranging from 0.624 to 0.830) in the shortened form questionnaire; although they were lower than the original form. There were no significant differences between short and original questionnaires in terms of mean subscale scores. In the second step, in the second population including 34 female nurses aged over forty years in a university medical center, there was again no significant statistical difference between the 28-item and 57-item instruments. In the third step, two weeks later, the completed shortened questionnaire among 20 subjects of the same population of the nurses showed similar results, indicating the reliability of the newly design shortened form of the questionnaire. Conclusions: The shortened 28-item form of the CHBM instrument seems to be both valid and reliable, and less time-consuming. Its results can be comparable to other studies that used the standard form

Prevalence of Behavioral Inhibition among Preschool Aged Children in Tehran, Iran

One of the identified risk factors for anxiety disorders in adolescence and adulthood is inhibited behaviors in childhood. The present study sought to examine the relationship between behavioral inhibition with some of the internal (personal) and external (family environment) factors in a sample of preschool children in kindergartens. In a cross sectional study in 2009, data was collected trough a structured questionnaire completed by parents and teachers in day-care centers. A total of 1403 children were assessed. Analysis was performed through complex sample analysis. The results showed that 7.4% (CI95%= 6.1%-9.1%) of children according to parents' and 8.1% (CI95%= 6%- 10.7%) according to teachers' evaluation classified as behaviorally inhibited. The higher levels of behavioral inhibition were shown by girls, first children, single parent families and older children. Birth year before 2004, birth rank, living in a single parent family and maternal level of education were independent predictors for behavioral inhibition in logistic regression modeling. There is relatively high prevalence of inhibited behaviors among Iranian children. Further examination of diagnosed children with behavioral inhibition by experienced psychiatrists is needed. Also establishing consultation centers for behaviorally inhibited children and instructing their parents and teachers are recommended

Long-term survival rates of patients with nasopharyngeal carcinoma treated by radiochemotherapy: a retrospective cohort study

Abstract Background Nasopharyngeal cancer (NPC) is showing an increasing incidence in Iran. Radiation is the main treatment of this cancer. Use of new techniques such as intensity-modulated radiotherapy (IMRT) is on the rise. Here, we aimed to evaluate the oncological outcomes of NPC patients treated with three-dimensional conformal radiotherapy (3DCRT) for a more reliable comparison with IMRT in the future. Results We reviewed the medical records of 106 patients with NPC treated by definitive radiotherapy from 2007 to 2016. Patients were treated with 70 Gy in 2-Gy fractions. Twenty-one patients died during the follow-up period. Twenty-nine patients suffered from locoregional or distant recurrences. Of these, 6 recurred after 2 years of treatment completion. The 2-year and 5-year overall survival rates were 81% and 76%, respectively. The 2-year and 5-year progression-free survival rates were 72% and 63%, respectively. The 5-year locoregional recurrence and distant metastasis-free survival rates were 68% and 69%, respectively. Conclusion Due to high survival rates of NPC and the importance of receiving planned total dose of RT, the treatment-related toxicity and quality of life are critical considerations both for patients during active treatment and for survivors

Adjuvant high-dose-rate brachytherapy in the management of oral cavity cancers: 5 years of experience in Iran

Purpose : Brachytherapy is a cost-effective method for the management of oral cavity cancers in low to middle income countries. We aimed to evaluate the clinical outcomes of high-dose-rate interstitial brachytherapy (HDR-IBT) in patients with oral cavity cancer. Material and methods: From 2009 to 2013, 78 patients (49 combined external beam radiotherapy [EBRT] plus IBT and 29 IBT monotherapy) with oral cavity cancers had been treated in our center. Slightly more than half the patients were male, and the median age was 54 years. The treatment was planned based on the Paris system. The main outcomes were disease-free and overall survival. Results : The median follow-up duration was 36.5 months (range, 1.17-54.23). The actuarial four-year overall and disease-free survival rates were 83% and 65%, respectively. The local and locoregional control was achieved among 89.74% and 87.17% of patients, respectively. None of the factors including tumor size, node status, gender, and radiation modality (IBT alone vs. IBT + EBRT) had a significant statistical correlation to the local control rate. All the patients tolerated the planned treatment in the IBT alone group. Late complications included a case of trismus and three cases of catheter insertion site fibrosis. Conclusions : HDR-IBT as a monotherapy or in combination with EBRT is an appropriate option for the management of oral cavity squamous cell carcinomas, and supports the improvement in treatment outcomes and toxicity profiles in adjuvant settings