Trends of Colorectal Cancer Incidence, Prevalence and Mortality in Worldwide From 1990 to 2017.

Background: Colorectal cancer is a major health problem both in developing and developed countries. This cancer is among the top three commonly diagnosed cancers in males and females. In this context, assessing the Incidence, Prevalence and Mortality Rate trend of this cancer is of great importance. Methods: We used the data from the GBD 2017 study to assess the global trend of 3 important indicators of colorectal cancer burden and to examine the relationship between trends of these indicators with Human Development Index (HDI). We used the multivariate mixed effects modeling framework with time and HDI as the covariates. Results: Trend analysis of colorectal cancer burden indicators showed a rather steady trend for mortality rate, while it revealed increasing slopes for both the incidence and prevalence rates. In addition, our findings showed a direct relationship between prevalence and incidence rates of this cancer and HDI level and indirect association between mortality rate and level of HDI. Conclusion: There were significant changes in indicators of colorectal cancer during the study period. The inverse relationship between mortality due to this cancer and socio-economic status of the countries indicated an urgent need for screening the patients and promoting the level of care in countries with lower levels of HDI.

A Trend Study of Preterm Infant Mortality Rate in Developed and Developing Countries over 1990 to 2017.

BACKGROUND: Preterm birth is the most important in children under 5 yr mortality. In this study, we used the Global Burden of Disease Data (GBD) to evaluate the trend of preterm infant mortality rate for all countries from 1990 to 2017 and to assess the effect of development factors on this trend. METHODS: The preterm infant mortality rate data from 196 countries of the world, from 1990 to 2017, were extracted from the GBD database. To study the trend of preterm infant mortality rate, a mixed-effects log-linear regression model was fitted separately for each IHME super-region. In the next step of data analysis, the development factor was included in the model to determine its effect on this trend for all countries under study. RESULTS: The average rate mortality rate has declined about 2% per year throughout the world over the mentioned period. The highest and lowest decreasing trends were observed in high-income countries (about 4.0%) and Sub-Saharan Africa (about 1.0%), respectively. Including the effect of development factor in the mentioned model revealed that in 1990, the rate of preterm infant mortality in developed countries was 2.2 times of this rate in developing countries and this rate ratio has increased to 2.69 in year 2017. CONCLUSION: Although the preterm infant mortality rate were decreasing in all super regions, there is a remarkable gap in this rate between developing and developed countries yet. Therefore, preventative strategies are needed to reduce preterm birth and its burden, especially in the developing world.

Trends in premature mortality in the Islamic Republic of Iran: probability of dying between ages 30 and 70 years.

BACKGROUND: The burden of noncommunicable diseases (NCDs) is a major challenge facing the whole world. Around 15 million premature deaths due to NCDs occur in people aged 30-70 years annually. AIMS: Mortality data based on death registration systems and population data were used to estimate proposed mortality statistics in the Islamic Republic of Iran. METHODS: Various criteria and methods were used to assess the quality of mortality data. The probability of dying among those aged 30-70 years for all causes and for NCDs was calculated using the life table method. RESULTS: The mortality rate in the population aged 30-69 years was 343.12 (per 100 000 persons) in 2006 and decreased to 240.62 in 2016 in both sexes. The probability of dying due to NCDs was 21.36% in 2006 and declined to 14.95% in 2016 for both sexes. CONCLUSIONS: The number of premature deaths due to NCDs have decreased over the last decade. We predict that this reduction will continue and the country will meet the targets of the WHO NCD action plan by 2025 and also the targets of the Sustainable Development Goals for reducing premature deaths by 2030. However, the morbidity and burden of NCDs are still public health concerns in the country. Due to advancements in health care technologies and also the aging population, these concerns will impose greater costs on the health system. Hence, prevention programmes for NCDs should be an urgent priority for Iranian health policy.

Expression of transforming growth factor-beta and interferon gamma biomarkers after whole body gamma irradiation.

CONTEXT: There are plenty of evidence that suggest that the potential high doses of radiation result in severe health effects to exposed individuals, although there is no consensus about the health impact of low dose of ionizing radiation (IR). AIMS: This study aimed to discuss the effect a range of IR doses on the changes of gene expression and serum protein levels of two immune factors transforming growth factor-ß (TGF-ß) and interferon gamma (IFN-γ) in rats. Findings from this study can be useful to develop a suitable biomarker for biological dosimetry applications. SUBJECTS AND METHODS: After 24 h of irradiation of rats with the doses of 1000, 500, 100, 50, and 20 mGy, the gene expression of TGF-ß and IFN-γ in lymphocytes was assessed using quantitative polymerase chain reaction. Besides, the protein level of these two factors in blood plasma was determined by enzyme-linked immunosorbent assay (ELISA) kits. STATISTICAL ANALYSIS USED: One-way analysis of variance Tukey-Kramer Multiple Comparisons Test was used. P <0.05 was considered statistically significant. RESULTS: Significant increases in the expression levels of TGF-ß and IFN-γ genes were observed by increasing the dose from 100 to 500 mGy and then 1000 mGy compared to the control (P < 0.05). The ELISA tests showed significant differences in the serum level of TGF-ß cytokine in the dose of 1000 mGy, while the serum level of IFN-γ cytokine showed significant differences in doses of 20 mGy and 1000 mGy compared to the control (P < 0.05). CONCLUSIONS: The results of this study showed the changes in the expression of TGF-ß and IFN-γ genes after irradiation more than 100 mGy in lymphocytes compared to the control group; the changes in the serum levels of these cytokines only occurred in the specific doses compared to the control group.

The District Health Information System (DHIS2): A literature review and meta-synthesis of its strengths and operational challenges based on the experiences of 11 countries.

BACKGROUND: Health information systems offer many potential benefits for healthcare, including financial benefits and for improving the quality of patient care. The purpose of District Health Information Systems (DHIS) is to document data that are routinely collected in all public health facilities in a country using the system. OBJECTIVE: The aim of this study was to examine the strengths and operational challenges of DHIS2, with a goal to enable decision makers in different counties to more accurately evaluate the outcomes of introducing DHIS2 into their particular country. METHOD: A review of the literature combined with the method of meta-synthesis was used to source information and interpret results relating to the strengths and operational challenges of DHIS2. Databases (Embase, PubMed, Scopus and Google Scholar) were searched for documents related to strengths and operational challenges of DHIS2, with no time limit up to 8 April 2017. The review and evaluation of selected studies was conducted in three stages: title, abstract and full text. Each of the selected studies was reviewed carefully and key concepts extracted. These key concepts were divided into two categories of strengths and operational challenges of DHIS2. Then, each category was grouped based on conceptual similarity to achieve the main themes and sub-themes. Content analysis was used to analyse extracted data. RESULTS: Of 766 identified citations, 20 studies from 11 countries were included and analysed in this study. Identified strengths in the DHIS were represented in seven themes (with 21 categories): technical features of software, proper management of data, application flexibility, networking and increasing the satisfaction of stakeholders, development of data management, increasing access to information and economic benefits. Operational challenges were identified and captured in 11 themes (with 18 categories): funds; appropriate communication infrastructure; the need for the existence of appropriate data; political, cultural, social and structural infrastructure; manpower; senior managers; training; using academic potentials; definition and standardising the deployment processes; neglect to application of criteria and clinical guidelines in the use of system; data security; stakeholder communications challenges and the necessity to establish a pilot system. CONCLUSION: This study highlighted specific strengths in the technical and functional aspects of DHIS2 and also drew attention to particular challenges and concerns. These results provide a sound evidence base for decision makers and policymakers to enable them to make more accurate decisions about whether or not to use the DHIS2 in the health system of their country.

Association of tumor necrosis factor-α -308 G/A gene polymorphism with coronary artery diseases: An evidence-based study.

BACKGROUND: Coronary artery disease (CAD) is the leading cause of death worldwide and remains a major health problem, providing the rationale for identification of molecular markers for detection of individuals at high risk of developing CAD. Tumor necrosis factor-α (TNF-α) plays a crucial role in the pathogenesis of CAD. We have therefore explored the association of TNF-α 308 (G/A) gene polymorphism in 903 individuals with/without CAD. METHODS: TNF-α 308 gene polymorphism was analyzed in 903 subjects of whom 222 were healthy controls. Among the 681 patients who were investigated angiographically, 468 had ≧50% stenosis and 213 patients had <50% stenosis. Biochemical profiles (eg, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting blood glucose, and CRP) were evaluated. Associations between TNF-α genotypes with biochemical and anthropometric characteristics were determined. RESULTS: The frequencies of TNF-α-AA or AG genotypes were significantly lower in patients classified as CAD patients with ≥ or <50% obstruction in at least one coronary artery, compared to the control group. We observed that CAD patients with ≥50% stenosis and with AA genotype were associated with higher risk of CAD with OR of 3.56 (95%CI: 1.02-12.41; P=.046) using multivariate analysis. Moreover, we found that TNF-α-308-AA genotype was associated with blood pressure and CRP level in CAD patients, compared to the wild type-genotype. CONCLUSION: Our data showed an association of TNF-α-308G/A polymorphism with CAD patients with ≥50% obstruction, supporting the need for further investigations on the role of TNF-α-308G/A polymorphism with hypertension.

Trend forecasting of main groups of causes-of-death in Iran using the Lee-Carter model.

Background: Authoritative information and description of the causes of mortality trends is one of the most basic principles of evaluation of the health sector in all countries. Therefore, this study aims to predict the trend in main groups of causes of death in the Islamic Republic of Iran. Methods: The study population comprised all deaths recorded in the system of registration and classification of causes of death of Ministry of Health and Medical Education during the years 2006 to 2015. The information was collected via death certificate, burial permit, and information forms. In order to forecast the trends of causes-of-death, Lee Carter model was employed in a demographic package 18.1 of R software version 3.3.1. Results: Based on the results, the crude death rate in the total population has reduced from 435.86 in 2006 to 405.01 per 100000 population in 2035. It is anticipated that endocrine, nutritional and metabolic diseases with the rate of 197.71 per 100000 population will be responsible for the highest causes of death in the year 2035 and from 2021 onwards, the mental and behavioral disorders will be responsible for the lowest rate of mortality. Conclusion: Non-communicable diseases have a major role in the deaths of Iranian population; therefore, to reduce the impact of non-communicable diseases on individuals and society, a holistic approach is needed which requires all sectors to cooperate.

Cross-Cultural Adaptation of Persian Version of Scale of Oral Health Outcomes for 5-Year-Old Children.

OBJECTIVES: Indicators of oral health-related quality of life (OHRQoL) in children are widely adopted to evaluate the effects of oral problems. Recently, the scale of oral health outcomes for 5-year-old children (SOHO-5) was developed based on the children's self-reports. This study aimed to evaluate the validity and reliability of the Persian version of the questionnaire in a sample of Iranian children. MATERIALS AND METHODS: This cross-sectional study was conducted on 160 children from four areas of Isfahan selected via non-random purposive sampling. After forward-backward translation of the questionnaire, content and face validity evaluation, a pilot test was carried out. Children forms were completed by interview, while parents forms were self-administered. Test-retest reliability was evaluated in 30 subjects. Construct validity, internal consistency and descriptive quality of life score were assessed with SPSS 18. The child-parent agreement was measured with correlation test and paired t-test (α=0.05). RESULTS: The mean (±standard deviation) quality of life scores in children and parents were 2.3±3 and 1.3±1.9, respectively. The most prevalent impacts were difficulty sleeping and eating. The Cronbach's alpha coefficients were 0.82 and 0.67 for the child and parent versions, respectively. Significant correlation of the scores with the oral health rating, pain history and perceived need for treatment confirmed its construct validity (r: 0.4-0.6, P<0.05). The hypothesis of the agreement was not supported (P>0.05). CONCLUSIONS: Based on the findings, the Persian version of SOHO-5 has acceptable reliability and validity for use in the pediatric population of Iran while there were some conflicts by parents.

Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015.

BACKGROUND: Child mortality as one of the key Millennium Development Goals (MDG 4-to reduce child mortality by two-thirds from 1990 to 2015), is included in the Sustainable Development Goals (SDG 3, target 2-to reduce child mortality to fewer than 25 deaths per 1000 livebirths for all countries by 2030), and is a key indicator of the health system in every country. In this study, we aimed to estimate the level and trend of child mortality from 1990 to 2015 in Iran, to assess the progress of the country and its provinces toward these goals. METHODS: We used three different data sources: three censuses, a Demographic and Health Survey (DHS), and 5-year data from the death registration system. We used the summary birth history data from four data sources (the three censuses and DHS) and used maternal age cohort and maternal age period methods to estimate the trends in child mortality rates, combining the estimates of these two indirect methods using Loess regression. We also used the complete birth history method to estimate child mortality rate directly from DHS data. Finally, to synthesise different trends into a single trend and calculate uncertainty intervals (UI), we used Gaussian process regression. FINDINGS: Under-5 mortality rates (deaths per 1000 livebirths) at the national level in Iran in 1990, 2000, 2010, and 2015 were 63·6 (95% UI 63·1-64·0), 38·8 (38·5-39·2), 24·9 (24·3-25·4), and 19·4 (18·6-20·2), respectively. Between 1990 and 2015, the median annual reduction and total overall reduction in these rates were 4·9% and 70%, respectively. At the provincial level, the difference between the highest and lowest child mortality rates in 1990, 2000, and 2015 were 65·6, 40·4, and 38·1 per 1000 livebirths, respectively. Based on the MDG 4 goal, five provinces had not decreased child mortality by two-thirds by 2015. Furthermore, six provinces had not reached SDG 3 (target 2). INTERPRETATION: Iran and most of its provinces achieved MDG 4 and SDG 3 (target 2) goals by 2015. However, at the subnational level in some provinces, there is substantial inequity. Local policy makers should use effective strategies to accelerate the reduction of child mortality for these provinces by 2030. Possible recommendations for such strategies include enhancing the level of education and health literacy among women, tackling sex discrimination, and improving incomes for families. FUNDING: Iran Ministry of Health and Education.

Disturbance of zinc and glucose homeostasis by methyl tert-butyl ether (MTBE); evidence for type 2 diabetes.

1. The prevalence of diabetes and the other metabolic disorders has noticeably increased worldwide. A causal link between increasing risk of type 2 diabetes and exposure to environmental pollutants has been reported. 2. We hypothesized that exposure to methyl tert-butyl ether (MTBE), an oxygenate additive to gasoline would hinder zinc and glucose homeostasis in rats. 3. Male Sprague-Dawley rats received MTBE in drinking water for 90 days. At the end of the treatment, pancreas and blood samples were collected for biochemical and molecular examinations. Expression of four candidate genes, including Insulin1, Insulin2, MT1A, SLC30A8 by Real-Time Quantitative PCR (Q-PCR) as well as biochemical parameters, including fasting blood glucose (FBS), triglycerides (TG), cholesterol (CHO), low-density lipoprotein (LDL), high-density lipoprotein (HDL), copper (Cu2+) and calcium (Ca2+) levels as well as High-sensitive C-reactive protein were assessed as endpoints. 4. This study suggested that MTBE exposure can be associated with disruption in zinc homeostasis and glucose tolerance.

Association of tumor necrosis factor-α promoter G-308A gene polymorphism with increased triglyceride level of subjects with metabolic syndrome.

BACKGROUND: The G-308A single nucleotide polymorphism (SNP) in the promoter of tumor necrosis factor-alpha (TNF-α) gene has previously been reported to be associated with cardiovascular risk. However the potential association of this polymorphism with metabolic syndrome (MetS) is unclear. The aim of the current study was to explore the association of this TNF-α gene polymorphism with MetS in an Iranian population. METHODS/PATIENTS: Two hundred and twenty two subjects were recruited and anthropometric and biochemical parameters were determined. Genotyping was performed using the amplification refractory mutation system polymerase chain reaction. The association of the genetic-polymorphism with MetS was evaluated by univariate and multivariate analyses. RESULTS: MetS subjects had a significantly (P<0.05) higher level of fasted serum triglycerides, body-mass-index, waist-circumference, blood pressure and fasting-blood-glucose, and lower level of high-density lipoprotein cholesterol. The possession of AA or GA genotype of the TNF-α gene was not associated with MetS in our population. However the AA genotype of TNF-α was related to an increased level of triglyceride in MetS patients, compared to the control group. CONCLUSION: TNF-α G-308A polymorphism is unlikely to play an important role in the development of MetS in our population.

Developing a household survey tool for health equity: A practical guide in Islamic Republic of Iran.

BACKGROUND: An obvious gradient in health outcomes has been implicated in many evidences relating to social and economic factors. Proper data are requested to convince policy-makers calling for intersectoral action for health. Recently, I.R. of Iran has come up with 52 health equity indicators to monitor health equity through the country. Conducting regular surveys on 14 out of 52 national health equity indicators is needed to provide a basis for the health inequality analysis through the country. We aimed to introduce a survey tool and its related protocols on health equity indicators. METHODS: This study was conducted through addressing the literature and expertise of health and demographic surveys at the national and international levels. Also, we conducted technical and consultative committee meetings, a final consensus workshop and a pilot study to finalize the survey tool. RESULTS: We defined the study design, sampling method, reliable questionnaires and instructions, data collection and supervision procedure. We also defined the data analysis protocol on health equity indicators, generated from non-routine data. CONCLUSION: A valid and reliable tool, which could be employed at the national and sub-national levels, was designed to measure health equity in Iran. Policy-makers can use this survey tool to generate useful information and evidence to design appropriate required intervention and reduce health inequality across the country.