Assessment of hydrogeochemical characteristics and quality of groundwater resources in relation to risk of gastric cancer: comparative analysis of high- and low-risk areas in Iran.

The chemical quality of groundwater supplies in two high-risk area (HRA) and low-risk area (LRA) for gastric cancer in Iran was assessed through hydrogeochemical analysis and water quality indices. For this aim, Piper and Schoeller diagrams and water quality index (WQI) were applied. In addition, exposure to nitrate via drinking water and its corresponding risk were also assessed using Monte Carlo simulation technique. Data on physicochemical properties of groundwater resources were obtained from Iran Water Resources Management Company. Sampling and analysis of tap water for nitrate concentration were conducted in two cities of Shiraz (as a representative of LRA) and Ardabil (as a representative of HRA). According to Piper diagrams, the dominant hydrogeochemical facies of groundwater supplies in HRA and LRA were Na-HCO3 (43.75%) and Ca-HCO3 (41.77%), respectively. The predominant cations in groundwater resources of HRA were found to be Na+ (68.06%) and Ca2+ (31.94%). For LRA, the typical cations were in decreasing trend: Ca2+ (39.64%) > Mg2+ (18.35%) > Na+ (17.26%). For two areas, HCO3-, SO42- and Cl- were, respectively, the most frequent anions. Two-sample Wilcoxon test showed that there were statistically significant difference between two areas in terms of anions and cations concentrations (p value < 0.05). The mean of total hardness (Ca2+ + Mg2+) concentration of water supplies in LRA (528.1 mg/L) was higher than HRA (263.1 mg/L), whereas the mean of Na+ concentration was found to be lower in LRA (90.6 mg/L) compared with HRA (108.1 mg/L). The sum of nitrate intake and its risk in LRA was higher than HRA. WQI results showed that drinking water quality in HRA and LRA ranged from excellent to poor and most water resources were of a good quality class. Further studies are suggested to investigate the role of drinking water in the etiology of gastric cancer in Iran.

Monitoring and exposure assessment of nitrate intake via fruits and vegetables in high and low risk areas for gastric cancer.

BACKGROUND: Gastric cancer (GC) is the first leading cause of cancer-related deaths in Iran. GC is a multifactorial disease and is caused by the interaction of genetic and environmental factors. The aim of this study was to assess the exposure and risk of nitrate intake through fruits and vegetables (F&V) in high-risk area (HRA) and low-risk area (LRA) of GC in Iran. METHODS: Twenty nine species of F&V were examined for nitrate by reverse-phase HPLC (RP-HPLC) method. Food frequency questionnaire (FFQ) data of 2000 adults participating in Persian cohort were applied to determine consumption patterns of F&V in those areas. A point-estimate daily intake was applied to compare two areas in terms of nitrate intake. Monte-Carlo simulation technique was applied to estimate chronic daily intake (CDI) of nitrate. RESULTS: The results showed that point-estimate daily intake of nitrate for subjects participated in the study was 2.02 ± 1.02 mg kg-1 day-1 in HRA and 1.98 ± 1.05 mg kg-1 day-1 in LRA. 6.53% of the participants in the HRA, and 5.9% of the participants in the LRA had an unacceptable point-estimate daily intake compared with an acceptable limit of 3.7 mg kg-1 day-1 established by FAO/WHO. CDI of nitrate in HRA was 1.94 ± 0.95 mg kg-1 day-1 and in the LRA was 1.93 ± 1.06 mg kg-1 day-1. CONCLUSION: The results showed that there is no difference between HRA and LRA in terms of nitrate intake through F&V.

Building cancer registries in a lower resource setting: The 10-year experience of Golestan, Northern Iran.

INTRODUCTION: The Golestan population-based cancer registry (GPCR) was established in Golestan province, Northern Iran, within the Asian belt with predominance of upper-gastrointestinal cancers. We aimed to present the experiences of the registry in a resource-limited setting over the 10 years since its inception (2004-2013). METHODS: The GPCR was established as a research project to enable sustainable funding. A clear plan was developed for use of the GPCR data. New primary cancers were registered based on international standards, indices of data quality were routinely assessed and age-standardized incidence rates (ASR) per 100,000 person-years calculated using IARC's CanReg-5 software. RESULTS: Overall, 19807 new cancer cases were registered during the study period, an average of 1981 cases per annum, with overall ASR of 175.0 and 142.4 in males and females, respectively. The GPCR data suggested gastrointestinal and breast cancers as the most common malignancies in Golestan province. We observed increasing incidence rates of breast and colorectal cancers but declining trends of esophageal cancer. Overall, indices of data quality were within acceptable ranges. CONCLUSIONS: The GPCR data have been included in IARC's Cancer Incidence in Five Continents series, were used in 21 research projects, and published as 30 research papers. The key ingredients for the successful establishment and maintenance of the GPCR included sustainable sources of funding, a clear action plan for the use of data as well as stakeholder cooperation across all areas of the registration. The GPCR may be considered as a model for planning population-based cancer registries in lesser-resourced settings.

Multimorbidity as an important issue among women: results of a gender difference investigation in a large population-based cross-sectional study in West Asia.

OBJECTIVES: To investigate the impact of gender on multimorbidity in northern Iran. DESIGN: A cross-sectional analysis of the Golestan cohort data. SETTING: Golestan Province, Iran. STUDY POPULATION: 49 946 residents (age 40-75 years) of Golestan Province, Iran. MAIN OUTCOME MEASURES: Researchers collected data related to multimorbidity, defined as co-existence of two or more chronic diseases in an individual, at the beginning of a representative cohort study which recruited its participants from 2004 to 2008. The researchers utilised simple and multiple Poisson regression models with robust variances to examine the simultaneous effects of multiple factors. RESULTS: Women had a 25.0% prevalence of multimorbidity, whereas men had a 13.4% prevalence (p<0.001). Women of all age-groups had a higher prevalence of multimorbidity. Of note, multimorbidity began at a lower age (40-49 years) in women (17.3%) compared with men (8.6%) of the same age (p<0.001). This study identified significant interactions between gender as well as socioeconomic status, ethnicity, physical activity, marital status, education level and smoking (p<0.01). CONCLUSION: Prevention and control of multimorbidity requires health promotion programmes to increase public awareness about the modifiable risk factors, particularly among women.

The gastro-esophageal malignancies in Northern Iran research project: impact on the health research and health care systems in Iran.

BACKGROUND: The Gastro-Esophageal Malignancies in Northern Iran (GEMINI) research project is an example of recent progress in health research in Iran. The original aim of this project was to identify etiologic factors and prevention measures for upper gastrointestinal cancers in Northern provinces of Iran, but its achievements have gone much beyond this initial goal. METHODS: GEMINI consists of several projects including cancer registries, pilot studies, case-control studies, and the Golestan Cohort Study. GEMINI has been conducted through extensive collaborations between the Digestive Disease Research Center of Tehran University of Medical Sciences with other domestic and international health organizations. The achievements of GEMINI include producing new knowledge, introducing new research methods, developing and expanding health research and health care infrastructures, investing in human resources, and increasing the awareness and knowledge of policy makers and officials at all levels about the importance of chronic diseases in Iran's health priorities. CONCLUSION: The success of GEMINI reveals the feasibility of large-scale health research studies in developing countries and serves as a successful model not only for health research in Iran, but also for similar research studies in other developing nations.