Population-based cancer survival in the Golestan province in the northeastern part of Iran 2007-2012.

OBJECTIVE: We studied 5-year relative survival (RS) for 14 leading cancer sites in the population-based cancer registry (PBCR) of Golestan province in the northeastern part of Iran. METHODOLOGY: We followed patients diagnosed in 2007-2012 through data linkage with different databases, including the national causes of death registry and vital statistics office. We also followed the remaining patients through active contact. We used relative survival (RS) analysis to estimate 5-year age-standardized net survival for each cancer site. Multiple Imputation (MI) method was performed to obtain vital status for loss to follow-up (LTFU) cases. RESULTS: We followed 6910 cancer patients from Golestan PBCR. However, 2162 patients were loss to follow-up. We found a higher RS in women (29.5%, 95% CI, 27.5, 31.7) than men (21.0%, 95% CI, 19.5, 22.5). The highest RS was observed for breast cancer in women (RS=49.8%, 95% CI, 42.2, 56.9) and colon cancer in men (RS=37.9%, 95% CI, 31.2, 44.6). Pancreatic cancer had the lowest RS both in men (RS= 8.7%, 95% CI, 4.1, 13.5) and women (RS= 7.9%, 95% CI, 5.0, 10.8) CONCLUSION: Although the 5-year cancer survival rates were relatively low in the Golestan province, there were distinct variations by cancer site. Further studies are required to evaluate the survival trends in Golestan province over time and compare them with the rates in the neighboring provinces and other countries in the region.

Systematic review of priority setting studies in health research in the Islamic Republic of Iran.

BACKGROUND: Several research priority-setting studies have been conducted in different countries, including the Islamic Republic of Iran. AIMS: We conducted a systematic review and evaluated the quality of the priority-setting reports about health research in the Islamic Republic of Iran. METHODS: English and Farsi databases were searched from January to July 2016 to extract reports (up to December 2015) about priority setting in health research in the Islamic Republic of Iran. We constructed a checklist to extract data from the identified studies. Articles were studied in detail and content analysis was carried out. Relevant items were scored and analysed using Microsoft Excel. RESULTS: We identified 36 articles. Eight articles involved all the main stakeholders. About half the articles used valid criteria for ranking. Transparency was fulfilled in 13 articles. Upstream rules and regulations were ignored in 26 articles. An implementation plan was considered in 9 articles and context analysis was demonstrated in only 3. CONCLUSIONS: Developing standard packages for priority setting, training of researchers and improving the capacity of organizations may improve the quality of priority-setting studies in the future.

Priority-setting in health research in Iran: a qualitative study on barriers and facilitators.

BACKGROUND: Priority-setting is a complicated and time-consuming process; however, if appropriately conducted, it could efficiently divert resources to the most important studies. A considerable body of evidence indicates that priority-setting measures in health research taken so far in Iran have not satisfied decision-makers, policy-makers, funders, communities, or even researchers. This study was designed to explore the flaws of these measures and their deciding factors. METHODS: We conducted semi-structured interviews with 23 key participants and used a thematic data-analysis approach to analyse verbatim transcripts and documents. Our interviewees, who were skilful at conducting health research and worked as managers at different levels of the health system, were selected using a purposeful sampling. We asked about their experiences of priority-setting in health and relevant challenges and asked for recommendations. These semi-structured interviews were taped, transcribed and analysed in terms of content and themes using the MAXQDA10 qualitative data-analysis software. RESULTS: With regard to priority-setting facilitators and barriers, four themes were extracted, namely managerial factors, structural factors, motivational factors, and process factors. Managers' commitment, consideration of intellectual property, compliance with superordinate rules, and provision of a definition of reliable criteria were among the facilitators. The rapid turnover of managers, inefficiency of criteria for faculty promotion, and disregard of appeal mechanisms were examples of the barriers. CONCLUSION: It is important to consider appropriate regulations and motivations to provide research priorities and divert scarce resources to them. In addition, it is necessary to improve the knowledge and skills of researchers and research administration offices on priority-setting methods, thereby enhancing priority-oriented research projects.

Esophageal Cancer in Golestan Province, Iran: A Review of Genetic Susceptibility and Environmental Risk Factors.

Esophageal squamous cell carcinoma (ESCC) is an aggressive tumor that is typically diagnosed only when the tumor has gained remarkable size, extended to peripheral tissues, and led to dysphagia. Five-year survival of advanced cancer is still very poor (19%), even with improved surgical techniques and adjuvant chemoradiation therapy. Therefore, early detection and prevention are the most important strategies to reduce the burden of ESCC. Our review will focus on the studies conducted in Golestan province, an area with a high prevalence of ESCC in northern Iran. We review three aspects of the research literature on ESCC: epidemiological features, environmental factors (including substance abuse, environmental contaminants, dietary factors, and human papillomavirus [HPV]), and molecular factors (including oncogenes, tumor suppressor genes, cell cycle regulatory proteins, and other relevant biomarkers). Epidemiological and experimental data suggest that some chemicals and lifestyle factors, including polycyclic aromatic hydrocarbons (PAHs), cigarette smoking, opium use, and hot tea drinking are associated with the development of ESCC in Golestan. HPV infects the esophageal epithelium, but so far, no firm evidence of its involvement in esophageal carcinogenesis has been provided. Some of these factors, notably hot tea drinking, may render the esophageal mucosa more susceptible to injury by other carcinogens. There are few studies at molecular level on ESCC in Golestan. Increasing awareness about the known risk factors of ESCC could potentially reduce the burden of ESCC in the region. Further studies on risk factors, identifying high risk populations, and early detection are needed.

Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique.

BACKGROUND: Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. OBJECTIVES: The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). MATERIALS AND METHODS: We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. RESULTS: Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. CONCLUSION: As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system such as ABC technique, hospitals would be able to generate robust evidences for financial management of their overhead, intermediate and final ACs.

Quality of Life for Elderly Residents in Nursing Homes.

BACKGROUND AND OBJECTIVES: More than 8% of Iran's populations are elderly. The greatest challenge in this generation is improvement of health and QoL.The main goal of this study was QoL for elderly residents in nursing homes over 65 years in Golestan Province - Iran. METHODS: This research was an analytical cross study. The population society includes the elderly over 65 years in Golestan Province - Iran. The sample size was calculated based on the correlation of 193 elderly men and women. Therefore, if the correlation is 2.0 or greater is statistically significant at 80% and 0.95 confidence. The needed data collected from two questionnaires Consumer product Safety Commission (CPSC) to assess the QOL of nursing homes and the SF-36 for health QOL the elderly indicators through interviews and observation. The reliability of the CPSC questionnaire was estimated using Cronbach's alpha with a coefficient of 0.838. The SF-36 questionnaire was validated with Cronbach's alpha with a coefficient of 0.95. To analyze data, ANOVA one-way test was used that after investigating homogenization of variances with Levin statistic, if homogenization reported P is rejected, the independent T-test was used to interpret it. RESULTS: Among QOL dimensions only General Health (GH) status showed a significant association with supporting organizations covering status (P = 0.01). The relationship between QOL with marital status in both genders was observed that the General Health (GH) (P = 0.001), Physical Functioning (PF) P = (0.007) Mobility Restricts (MR) P = (0.002), Emotional Problems (EP) (P = 0.001), vitality (V) (P = 0.001), Mental Health (MH) (P = 0.001) were significantly related. CONCLUSIONS: There was a significant relationship between the Physical Functioning (PF) mean and the mean of other QOL indicators in two groups of male and female (P = 0.007), also the safety of nursing homes just related respectively with residence variable (P = 0.01) and their employment (P = 0.031).

Heart Surgery Waiting Time: Assessing the Effectiveness of an Action.

BACKGROUND: Waiting time is an index assessing patient satisfaction, managerial effectiveness and horizontal equity in providing health care. Although heart surgery centers establishment is attractive for politicians. They are always faced with the question of to what extent they solve patient's problems. OBJECTIVES: The objective of this study was to evaluate factors influencing waiting time in patients of heart surgery centers, and to make recommendations for health-care policy-makers for reducing waiting time and increasing the quality of services from this perspective. PATIENTS AND METHODS: This cross-sectional study was performed in 2013. After searching articles on PubMed, Elsevier, Google Scholar, Ovid, Magiran, IranMedex, and SID, a list of several criteria, which relate to waiting time, was provided. Afterwards, the data on waiting time were collected by a researcher-structured checklist from 156 hospitalized patients. The data were analyzed by SPSS 16. The Kolmogorov Smirnov and Shapiro tests were used for determination of normality. Due to the non-normal distribution, non-parametric tests, such as Kruskal-Wallis and Mann-Whitney were chosen for reporting significance. Parametric tests also used reporting medians. RESULTS: Among the studied variables, just economic status had a significant relation with waiting time (P = 0.37). Fifty percent of participants had diabetes, whereas this estimate was 43.58% for high blood pressure. As the cause of delay, 28.2% of patients reported financial problems, 18.6% personal problem and 13.5% a delay in providing equipment by the hospital. CONCLUSIONS: It seems the studied hospital should review its waiting time arrangements and detach them, as far as possible, from subjective and personal (specialists) decisions. On the other hand, ministries of health and insurance companies should consider more financial support. It is also recommend that hospitals should arrange preoperational psychiatric consultation for increasing patients' emotionally readiness.

Evaluation of Quality of Life and Safety of Seniors in Golestan Province, Iran.

This study evaluated the criteria for quality of life (QoL) using standardized short-form health survey with only 36 questions (SF-36; Version 2.0) and Consumer Product Safety Commission (CPSC) questionnaires to study the relationship between QoL and living conditions of seniors in Golestan province in Iran. This was an analytical cross-sectional study with descriptive and analytical parts. The population was individuals above 65 years of age in Golestan province in Iran. The sample size was calculated based on the correlation coefficient; a correlation of .2 or greater was considered statistically significant at 80% for the power of the test at the 95% confidence level. The data on QoL of seniors were collected by interview and observation using the CPSC questionnaire for nursing homes and the SF-36 for QoL health indicators. The reliability of the CPSC questionnaire was estimated using Cronbach's alpha with a coefficient of .838. The SF-36 questionnaire was validated with Cronbach's alpha with a coefficient of .95. Chi-square and logistic regression were used to interpret the probability of abnormal QoL between levels of independent predictors. The percentage of seniors in overall poor health as a binary outcome was 43.5, and the percentage of unsafe conditions was 49.8.

Characteristics of high-risk sexual behaviors for human immunodeficiency virus infection among Iranian drug abusers.

OBJECTIVES: This study was conducted to estimate the prevalence and the associated factors of high-risk sexual behaviors among drug abusers referred to a methadone clinic in Gorgan, the capital of Golestan province in the northeast of Iran, to help health care decision makers on designing interventional programs. METHODS: In this cross-sectional study, 400 drug abusers referred to our methadone clinic were evaluated for high-risk sexual behavior. A logistic regression model was fitted for the association between independent variables and high-risk sexual behavior. RESULTS: Approximately a quarter of patients (25.5%) had high-risk sexual behavior among which 47% had not used a condom in their last sexual contact. Drug abusers who had poor economic status had a lower chance of high-risk sexual behavior than those with good economic status (adjusted odds ratio [AOR] = 0.35, 95% confidence interval [CI] = 0.13-0.96). Also, 1-year increase in age reduced the chance by 6% (AOR = 0.94, 95% CI = 0.91-0.98). Heroin abusers, compared with opium abusers, had a duplicated chance of having high-risk sex (AOR = 2.11, 95% CI = 1.12-3.96). CONCLUSION: According to this study, high-risk sexual behavior in the drug abusers referred to methadone clinic was associated with younger age, good economic status, and heroin addiction. Hence, in interventional planning, more attention should be paid to young drug abusers, patients with good economic status, and heroin addicts as well.