Long-term outcomes of real world 'watch and wait' data for rectal cancer after neoadjuvant chemoradiotherapy.

AIM: A 'watch and wait' (W&W) strategy after neoadjuvant long-course chemoradiotherapy (NACRT) remains controversial. Whilst encouraging short-term data exist, the strategy will be judged on long-term data. We present long-term, real-world UK data from a single National Health Service trust. METHODS: An analysis was performed of a prospectively maintained W&W database over 9 years between 2010 and 2018. Outcome measures include incidence and time to regrowth and overall and disease-free survival. RESULTS: We diagnosed 563 rectal cancers in 9 years. In all, 283 patients underwent rectal resection (50.3%). NACRT was used in 155 patients for margin-threatened tumours on staging MRI. Forty-nine patients (31.6%) experienced either a 'near complete' or a complete clinical response (cCR) at their 10 weeks post-NACRT assessment (MRI and endoscopy). The median age was 69 years (range 44-83), and the male to female ratio was 32:17. The median follow-up was 38 months (range 12-96). The median tumour distance from the anal verge was 7 cm (1-15 cm). Twenty-two patients had a cCR on initial assessment and 27 patients had a 'near' cCR. Of those 27 who experienced a 'near' cCR, 17 (63%) progressed to cCR on repeat assessment and 10 (37%) did not. Of these 10 patients, seven underwent standard surgical resection and three were unfit for surgery. R0 for the seven with delayed resection was 100%. Of 39 patients (22 cCR and 17 'near' cCR who progressed to cCR) (25.2% of those receiving NACRT), six patients experienced local regrowth (15.4%). The median time to local regrowth was 29 months (15-60 months). One of these six patients underwent salvage abdominoperineal resection, one was advised to have contact radiotherapy and four opted against surgery and also had contact radiotherapy. The overall survival was 100% at 2 years and 90% at 5 years. Disease-free survival was 90.47% at 2 years and 74.8% at 5 years. CONCLUSION: A W&W treatment strategy was employed safely in this patient cohort with acceptable rates of local regrowth and survival.

Self-reported versus proxy reported quality of life for breast cancer patients in the Islamic Republic of Iran.

Since quality of life (QoL) is subjective, self-reported QoL is the main source of assessment; however, in some situations the patient cannot evaluate his/her own status. In this cross-sectional study, 148 patients with breast cancer referred to the Cancer Institute of the Islamic Republic of Iran and their caregivers were selected through the consecutive sampling method. Five oncologists from this centre also evaluated the QoL of these patients. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was completed by these 3 groups and the results compared. The patient-caregiver intra-class correlation coefficient (ICC) for all 15 QLQ.C30 domains was moderate to good (ICC = 0.41-0.76). Agreements between QoL scores of patients and those of oncologists were moderate to good, except in the 4 domains. In the patient-caregiver comparison there was 55% exact agreement, and for the patient-physician comparison agreement was 45%. The findings can be used in the patients' decision-making process and care planning when patients with breast cancer are unable to self-report the QoL.

Rainbow-trapping by adiabatic tuning of intragroove plasmon coupling.

Trapping broadband electromagnetic radiation over a subwavelength grating, provides new opportunities for hyperspectral light-matter interaction on a nanometer scale. Previous efforts have shown rainbow-trapping is possible on functionally graded structures. Here, we propose groove width as a new gradient parameter for designing rainbow-trapping gratings and define the range of its validity. We articulate the correlation between the width of narrow grooves and the overlap or the coupling of the evanescent surface plasmon fields within the grooves. In the suitable range (≲150 nm), this width parameter becomes as important as other known parameters such as groove depth and materials composition, but tailoring groove widths is remarkably more feasible in practice. Using groove width as a design parameter, we investigate rainbow-trapping gratings and derive an analytical formula by treating each nano-groove as a plasmonic waveguide resonator. These results closely agree with numerical simulations.

Does religious coping and spirituality have a moderating role on depression and anxiety in patients with spinal cord injury? A study from Iran.

OBJECTIVES: We evaluate the level of anxiety and depression among patients with spinal cord injury (SCI) in relation with their religious coping and spiritual health. SETTING: Brain and Spinal Cord Injury Repair Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. METHODS: A sample of patients with SCI participated in this cross-sectional study. They completed a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale, the Brief Religious Coping Questionnaire and the Spiritual Well-being Scale. Then, the association between anxiety, depression and independent variables was examined. RESULTS: In all, 213 patients with SCI were studied. Of these, 64 (30%) have had anxiety and 32 (15%) have had depression. Multiple logistic regression analyses revealed that gender (odds ratio (OR) for female=3.34, 95% confidence interval (CI)=1.31-8.51, P=0.011), employment (OR for unemployed=5.71, 95% CI=1.17-27.78, P=0.031), negative religious coping (OR=1.15, 95% CI=1.04-1.28, P=0.006) and existential spiritual well-being (OR=0.93, 95% CI=0.89-0.97, P=0.003) were significant contributing factors to anxiety (Table 3), whereas negative religious coping (OR=1.21, 95% CI=1.06-1.37, P=0.004) and existential spiritual well-being (OR=0.90, 95% CI=0.84-0.96, P=0.001) were significant contributing factors to depression. CONCLUSION: The findings indicated that depression and anxiety are two psychologically important side effects after SCI. The findings also indicated that religion and spiritual well-being have a moderating role on occurrence of depression and anxiety.

Diagnostic values of different definitions of metabolic syndrome to detect poor health status in Iranian adults without diabetes.

AIMS: This study aimed to compare the diagnostic impact of four definitions of the metabolic syndrome for detection of poor health status in adults without diabetes living in Tehran. METHODS: A representative sample of 950 individuals (64% women), aged ≥ 20 years, participants of the Tehran Lipid and Glucose Study in 2005-2007, were recruited for the study. Health status was assessed using the Iranian version of the 36-item Short Form Health Survey. We assessed the detectability of poor health status by definitions of the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation, the American Heart Association/National Heart, Lung, and the Blood Institute and the Joint Interim Statement. RESULTS: Compared with other definitions, the Joint Interim Statement identified more participants (46.9%) having the metabolic syndrome. Using the National Cholesterol Education Program Adult Treatment Panel III, the International Diabetes Federation and the Joint Interim Statement, the metabolic syndrome was significantly related to poor physical health status, even after adjustment for confounding variables, in women, but not in men. None of the four definitions of the metabolic syndrome was related to the mental health status in either gender. The receiver operating characteristic curves showed no significant difference in the discriminative power of the metabolic syndrome definitions in detecting poor health status in either gender. However, women showed a higher area under the curve for all definitions, in comparison with men. CONCLUSION: There was no difference in the four different definitions of the metabolic syndrome in detecting poor health status among Iranian adults.

Severity of symptoms, physical functioning and satisfaction in patients with lumbar spinal stenosis: a validation study of the Iranian version of the Swiss Spinal Stenosis Score.

AIM: A common cause of low back pain is lumbar spinal stenosis (LSS). The Swiss Spinal Stenosis Score (SSS) is a well-known questionnaire that measures the severity of symptoms, physical functioning and patient's satisfaction in lumbar spinal stenosis. This study aimed to translate and validate the SSS in Iran. METHODS: A prospective clinical validation study was performed. Forward-backward procedure was applied to translate the original questionnaires into Persian. A sample of patients with lumbar spinal stenosis completed the questionnaire twice: at pre- and postoperative (6 months follow-up) assessments. To test reliability the internal consistency was assessed by the Cronbach's alpha coefficient. Validity was evaluated using the known groups comparison. In addition the Oswestry Disability Index was used to perform convergent validity. RESULTS: In all 121 patients were entered into the study. The mean age of patients was 62.3 (SD=10.2) years. The Cronbach's alpha coefficient for the SSS was 0.88. Validity was performed by known groups analysis and showed satisfactory results. The instrument discriminated well between the subgroups of patients who differed in age, severity of lumbar spinal stenosis, and the Self-Paced Walking Test (SPWT). The change in the Oswestry Disability Index strongly correlated with the change in patients' scores on the SSS; lending support to its good convergent validity (r=0.82; P<0.001). CONCLUSION: The Iranian version of Swiss Spinal Stenosis Score performed well and the findings suggest that it is a valid measure of symptoms, physical functioning and satisfaction among patients with lumbar spinal stenosis.

Seat-belt use among drivers and front passengers: an observational study from the Islamic Republic of Iran.

Although seat-belts are the most effective means of preventing severe injuries and deaths from road accidents, drivers and passengers in many developing countries neglect to wear them. This study aimed to measure the rate of use of seat-belts and factors affecting their use in Tehran, Islamic Republic of Iran. In direct observations of 7718 vehicles at randomly selected sites in Tehran, 77.9% of drivers and 43.7% of front passenger had seat-belts fastened. More women used seat-belts than did men while driving but fewer as front-seat passengers. Rates of seat-belt wearing among both drivers and front passengers of vans and pick-up vehicles was low. In a separate interview study of 666 citizens, 62.4% stated that they always wore seat-belts while driving. The most frequently reported reasons for using seat-belts were avoiding fines, fear of injuries and respecting the law. To improve seat-belt use, it is recommended that law enforcement accompanied by public education should be a priority.

Users of withdrawal method in the Islamic Republic of Iran: are they intending to use oral contraceptives? Applying the theory of planned behaviour.

Many couples in the Islamic Republic of Iran rely on coital withdrawal for contraception. The purpose of this cross-sectional study was to use the theory of planned behaviour to explore factors that influence withdrawal users' intent to switch to oral contraception (OC). Participants were 336 sexually active, married women, who were current users of withdrawal and were recruited from 5 public family planning clinics in Tehran. A questionnair included measures of the theory of planned behaviour: attitude (behavioural beliefs, outcome evaluations), subjective norms (normative beliefs, motivation to comply), perceived behaviour control, past behaviour and behavioural intention. Linear regression analyses showed that past behaviour, perceived behaviour control, attitude and subjective norms accounted for the highest percentage of total variance observed for intention to use OC (36%). Beliefs-based family planning education and counsellingshould to be designed for users of the withdrawal method.

Influence of sociodemographic features and general health on social capital: findings from a large population-based survey in Tehran, Iran (Urban-HEART).

OBJECTIVES: Social capital is associated with a number of sociodemographic characteristics and health outcomes. This study aimed to assess the components of social capital, and determine its association with different demographic features and general health in Tehran. STUDY DESIGN: A large population-based cross-sectional survey was conducted using the Urban Health Equity Assessment and Response Tool (Urban-HEART). METHOD: A comprehensive questionnaire containing 13 sections, including a specific tool to measure social capital, was administered to 22,300 randomly selected clustered sample households within all 22 districts in Tehran between June and September 2008. The social capital questionnaire consists of two main components - structural and cognitive - which measure collective activities, voluntary help, social cohesion, social network, reciprocity and trust. The first question of Short Form-12 was used to evaluate self-rated health. Descriptive statistics, contingency tables, independent sample t-test, analysis of variance, post-hoc test (least squares difference) and multiple linear regression were used to detect differences. A P-value <0.01 was considered to indicate significance. RESULTS: The social capital questionnaire and health-related quality-of-life tool were completed by 21,704 individuals (response rate 97%) in all 22 districts of Tehran. All social capital components apart from participation varied by age group and gender (P < 0.01). An improvement was seen in several social capital components with increased level of education (P < 0.01). All social capital elements apart from volunteering were associated with marital status (P < 0.01). Family size, family assets and length of residence in neighbourhood were considered to be determinants of social capital (P < 0.01), and respondents with better health showed higher levels of social capital (P < 0.0001). CONCLUSION: Various individual and household characteristics influence social capital. General health and social capital are mutually and independently correlated with other determinants, so improvements in either may lead to higher levels of social capital and well-being.

The psychometric properties of an Iranian translation of the Work Ability Index (WAI) questionnaire.

BACKGROUND: This study was carried out to evaluate the psychometric properties of an Iranian translation of the Work Ability Index (WAI) questionnaire. METHODS: In this methodological study, nurses and healthcare workers aged 40 years and older who worked in educational hospitals in Ahvaz (236 workers) in 2010, completed the questionnaire and 60 of the workers filled out the WAI questionnaire for the second time to ensure test-retest reliability. Forward-backward method was applied to translate the questionnaire from English into Persian. The psychometric properties of the Iranian translation of the WAI were assessed using the fallowing tests: Internal consistency (to test reliability), test-retest analysis, exploratory factor analysis (construct validity), discriminate validity by comparing the mean WAI score in two groups of the employees that had different levels of sick leave, criterion validity by determining the correlation between the Persian version of short form health survey (SF-36) and WAI score. RESULTS: Cronbach's alpha coefficient was estimated to be 0.79 and it was concluded that the internal consistency was high enough. The intraclass correlation coefficient was recognized to be 0.92. Factor analysis indicated three factors in the structure of the work ability including self-perceived work ability (24.5% of the variance), mental resources (22.23% of the variance), and presence of disease and health related limitation (18.55% of the variance). Statistical tests showed that this questionnaire was capable of discriminating two groups of employees who had different levels of sick leave. Criterion validity analysis showed that this instrument and all dimensions of the Iranian version of SF-36 were correlated significantly. Item correlation corrective for overlap showed the items tests had a good correlation except for one. CONCLUSION: The finding of the study showed that the Iranian version of the WAI is a reliable and valid measure of work ability and can be used both in research and practical activities.

Quality of life of Iranian beta-thalassaemia major patients living on the southern coast of the Caspian Sea.

In the present study, the aim was to explore the quality of life of thalassaemia major (TM) patients according to age, sex, school performance, severity and complications of the disease. A cross-sectional descriptive study was conducted. Quality of life was evaluated by 4 questionnaires; demographic characteristics, the short form 36 health survey (SF-36), Persian version of symptoms checklist-90-revised (SCL-90-R) and life satisfaction index (LSI). 687 (41.08%) of the eligible patients with TM completed the questionnaires. With the SF-36 questionnaire, 329 (47.9%) participants had an excellent level of physical functioning. With the SCL-90-R questionnaire, 446 (64.9%) participants had a global severity index of > 0.7, considered psychiatric patients, 141 (20.5%) patients had GSI between 0.4 and 0.7, considered suspected psychiatric patients and 100 (14.6%) participants had GSI of < 0.4, considered non-psychiatric patients. The mean score of LSI questionnaire was 20.50 (SD 5.95), range 2-37. Beta-TM patients are at risk of psychiatric symptoms and need appropriate psychiatric counselling.

Twenty years of breast cancer in Iran: downstaging without a formal screening program.

BACKGROUND: breast cancer (BC) is the most common malignancy among Iranian women. Although the relative incidence of BC is low, the cause-specific mortality is much higher than developed countries. The present study surveyed the overall trend of BC in Tehran. PATIENTS AND METHODS: all breast pathologic records were studied in five major hospitals in Tehran during three phases (1: 1985-1995; 2: 1996-2000; and 3: 2001-2005). Malignant cases were classified according to the tumor-node-metastasis classification. Data were compared across the study. RESULTS: Of 9050 medical records from male and female patients with 'breast disease', 2946 females with BC were included. A significant increase in the diagnosis of palpable early BCs (stage II increased, stage III decreased) was observed between phases 1 and 2. A relative increases in stages 0 and I were noted between phases 3 and 2. Nevertheless, 76.8% of cases were T2 or higher and 65.3% had positive lymph nodes in the last phase. The proportion of patients with stage IIIb was increased in phase 3, despite the reduction in phase 2. CONCLUSIONS: despite the relative improvement in the status of BC patients, the vast majority are diagnosed in advanced stages. Specific screening measures should be implemented in Iran.

Knowledge, attitudes and practices towards HIV/AIDS among Iranian prisoners in Mazandaran province in the south-coast area of the Caspian Sea.

HIV infection in the Islamic Republic of Iran is concentrated primarily among intravenous drug users. This study investigated the knowledge, attitudes and practices towards HIV/AIDS prevention of a random sample of prisoners in 5 prisons in Mazandaran province. Of 1760 individuals aged 18-65 years old completing the questionnaire, the mean age was 30.1 (SD 8.1) years (range 18 to 59 years); 95.8% were male. Respondents had an average to fairly good knowledge about HIV/AIDS, with the percentages answering correctly ranging from 11.9% to 85.9%. However many had the misconception that "HIV/AIDS does not influence Iran" and "I will not be infected with HIV/AIDS under any conditions" and 63.6% agreed that lack of religious and moral commitment could spread AIDS infection. HIV/AIDS prevention efforts are needed for prisoners in Mazandaran province.

Preoperative chemoradiotherapy for rectal cancer: a comparison between intravenous 5-fluorouracil and oral capecitabine.

INTRODUCTION: Capecitabine provides an attractive alternative to intravenous (IV) 5-flourouracil (5-FU) in chemoradiation regimes for rectal cancer by avoiding the need for intravenous access and inpatient stay. We aimed to compare retrospectively the efficacy of concurrent capecitabine with IV 5-FU in preoperative pelvic chemoradiation schedules for rectal cancer in our centre. METHOD: Patients treated from January 2005 to June 2007 were included. Information was collected on patient characteristics; treatment details; pathological response to treatment; recurrence and survival. All statistical analyses were performed using SPSS V17. RESULTS: All patients had pelvic radiation. Ninety-nine patients were treated with capecitabine and 97 with 5-FU. The two groups were well matched for age, sex and TNM stage. There were significantly more PS (performance status) 0 patients in the capecitabine group (51%vs 30%) (P = 0.001). Of the 99 patients in the capecitabine group, 91 (92%) were able to undergo surgery with 84 (93%) achieving R0 resection. In the 5-FU group, these proportions were 87 (90%) and 70 (80%). The difference in the rate of R0 resection was statistically significant (P = 0.024). The APR rate was 35% in the capecitabine group compared with 47% in the 5-FU group (P = 0.06). There was no significant difference in pathological complete response (pCR) rates between capecitabine (14%) and 5-FU(12%). A higher pCR rate (30%) was observed in patients who underwent a brachytherapy boost (P = 0.051). There were three local recurrences in the whole patient group, (capecitabine 1; 5-FU 2). Thirty-five patients had distant metastases, 14 in the capecitabine and 21 in the 5-FU group. There was no significant difference in the risk of recurrence between the two groups. Six patients in each group had grade 3 toxicity with diarrhoea being more common with capecitabine. CONCLUSIONS: Preoperative chemoradiotherapy with capecitabine for rectal cancer is efficacious and comparable to 5-FU (IV). It is more convenient, is well tolerated and avoids the need for inpatient admission.

Anxiety, depression and health-related quality of life in those injured by landmines, Ilam, Islamic Republic of Iran.

We assessed depression, anxiety and health-related quality of life (HRQOL) in 137 cases of landmine injury in Ilam province, using the Hospital Anxiety & Depression Scale (HADS) and the Short Form Health Survey (SF36) questionnaires. We also compared their scores with an uninjured control group (n = 360). Most of the injured were male (93.4%) and illiterate (54.7%) with some irreversible sequelae (86.9%). Overall, 69.3% of the injured participants scored high for both anxiety and depression. The level of anxiety and depression was significantly higher in older cases, those not completely recovered compared with recovered cases and those with amputation compared with those without amputation. The injured also had significantly lower mean scores in all HRQOL components than the control group. Landmine injured should be monitored for early identification and treatment of depression and anxiety.

Metal-matrix nanocomposites under compressive loading: Towards an understanding of how twinning formation can enhance their plastic deformation.

Recently, Cu-Ag nanocomposites (NCs) have been extensively used as medical implants and surgical instruments due to their antibacterial properties. Consequently, mechanical behavior analysis of these NCs is of crucial importance with emphasis on their plastic deformation mechanisms. From the materials science perspective, dislocations slip at the room temperature and high strain rates conditions is hindered. However, copper and silver, as two metals with low stacking fault energy are prone to twin formation. Since microstructural changes in these nanostructured composites occur at the atomic scale, molecular dynamics (MD) simulation is undoubtedly a great tool to use. Accordingly, in the present research, first, the deformation mechanism of perfect copper-silver NCs under uniaxial compression is deeply analyzed employing MD. This is followed by inspection of the voids effect on their plastic deformation process. The results show that twinning is the dominant mechanism governing their deformation under uniaxial compressive loading conditions. It is revealed that twins are created by the conversion of internal stacking faults to their external counterparts. Also, investigation of the microstructural evolution demonstrates that the presence of voids within NC samples provides new sites for nucleation of Shockley dislocations in addition to the interface zone. Finally, to address the effect of interfacial coherency on the results, copper-based NCs infused with gold and nickel nanoparticles are also thoroughly examined.

Protein corona impact on nanoparticle-cell interactions: toward an energy-based model of endocytosis.

Upon incubation of nanoparticles in biological fluids, a new layer called the protein corona is formed on their surface affecting the interactions between nanoparticles and targeted cells during the endocytosis process. In the present study, a mathematical model based on the diffusion of membrane mobile receptors is proposed. Opposing the endocytosis proceeding, membrane bending and tension energies are named as resistant energy. Also, the binding energy and free-energy associated with the configurational entropy are collectively termed promoter energy. Utilizing this model, endocytosis of gold nanoparticle (GNP) is simulated to explore the biological media effect. The results reveal that there exists a nanoparticle size of 60 nm at which, the endocytosis time is at a minimum. It has been illustrated that, although for sufficiently small particles of diameter 30nm, membrane tension has a negligible contribution (<10%) in the resistant energy, it noticeably increases the endocytosis processing time for large particles. Therefore, we report several parametric studies to provide a better insight into the effects of biological media on the ingestion of nanoparticles. Through a detailed analysis of the engulfment of the nanoparticles, it is shown that the nanoparticle radius corresponding to the quickest possible ingestion time is affected in the presence of corona. Moreover, it is found that the formation of this layer does not only affect the endocytosis time but also can lead to incomplete engulfment by decreasing the ligand density on the nanoparticle surface. Use of the proposed model can play a significant role in advancing the design of nanoparticles in targeted drug delivery applications.

An MD-based systematic study on the mechanical characteristics of a novel hybrid CNT/graphene drug carrier.

This paper is aimed to assess the mechanical properties of a hybrid graphene-carbon nanotube carrier embedded with doxorubicin (DOX). Utilizing molecular dynamics simulation, the results reveal that by increasing the temperature from 309 to 313 K, the elastic modulus of the GS/CNT/DOX carrier decreases from 0.8 to 0.74 TPa. Also, it is shown that the presence of chitosan molecules enhances the mechanical characteristics of the proposed nanocarrier. Taking the chirality of the graphene sheet into account, the results indicate that by increasing the size of the graphene sheet, the failure stress is slightly increased for the armchair type. However, this value decreases as the size of the zigzag sample increases. Additionally, the influence of aspect ratio on the elastic modulus, fracture stress, and fracture strain of these systems is systematically examined. It has been shown that the failure stress may change significantly with increasing this parameter, especially for carrier systems having zigzag carbon nanostructures. Moreover considering various voids content in the CNT structure, the weakening effect of defects is systematically explored. Also, the dependence of the mechanical features of the proposed hybrid carrier on the presence of DOX molecules is studied via MD simulations. Finally, we have investigated the role of CNT physical characteristics including its size and chirality on the results. Graphical abstract.

Quality of life in patients with oral cancer treated by different reconstruction methods as measured by the EORTC QLQ-H&N43.

This was a prospective clinical study and the purpose was to assess the quality of life (QoL) as the primary endpoint for patients given prospective treatment for cancer of the oral cavity that required reconstruction using various reconstruction methods in Azerbaijan. All patients who were operated on during the year 2017 to 2018 were entered into the study. Quality of life was assessed six months postoperatively using the European Organization for Research and Cancer Treatment Core Cancer Quality of Life (EORTC QLQ-C30) and the Head and Neck Specific Quality of Life (QLQ-H&NN43) questionnaires. A total of 96 patients completed the questionnaires. There were 36 patients who did not receive a flap, 31 patients received a local flap, and 29 patients had distant-regional flaps. QoL assessed by the EORTC QLQ-C30, and the QLQ-H&N43 was lower in patients who received a local flap. In general, the results showed that the reconstruction with a distant-regional flap compared with no flap and local flap leads to improved quality of life of patients with oral cancer.

Monitoring outcomes in children with acquired brain injury (ABI): a Persian validation study of Child and Family Follow-up Survey (CFFS).

AIM: To translate and validate the Child and Family Follow--up Survey (CFFS) in Iran. METHODS: 49 cases with Acquired Brain Injury (ABI), and 30 healthy children were included and the CFFS was completed. The Pediatric Quality of Life Inventory (PedsQL) also was completed. The internal consistency, test-retest reliability, known groups comparison and criterion validity were assessed. RESULTS: The mean age of participants was 10.9 years. Cronbach's alpha coefficients were Child and Adolescent Scale of Participation (CASP) (0.91), Child and Adolescent Factors Inventory (CAFI) (0.90) and Child and Adolescent Scale of Environment (CASE) (0.89). Reliability, validity and correlation of CASP and CAFI showed satisfactory results. Significant correlations among the three CFFS subscale scores were observed. These scores were also significantly correlated with the total scores of the PedsQL. CONCLUSION: The findings suggest that CFFS is a valid measure to monitor long--term outcomes of children and young adolescents with ABI.