Familial aggregation of traffic risky behaviours among pedestrians: a cross-sectional study in northwestern Iran.

OBJECTIVE: This study aims to assess the familial aggregation of traffic risky behaviours among pedestrians and describe the sociodemographic profile of pedestrians in northwestern Iran. METHODS: A cross-sectional study was conducted among 933 pedestrians in 2023. Participants were selected using stratified random sampling. Traffic risky behaviour was measured using a validated instrument among heads of households and their first relatives. The generalised estimating equations were computed to estimate the adjusted OR and 95% CI for familial aggregation of traffic risky behaviours. RESULTS: Of the total sample, 52.2% and 27.7% of the participants were male and aged 41-50, respectively. The majority of respondents were categorised in middle socioeconomic class (36.9%). The OR for familial aggregation of traffic risky behaviours was 1.42 (95% CI 1.07 to 1.89), indicating that the presence of traffic risky behaviours in at least one family member increased the likelihood of similar behaviour in other members. Fathers showing violation behaviours were associated by 1.98-fold increase in violation behaviours among their offspring. Similarly, the existence of violation behaviour in one sibling increased the odds of violation behaviour among other siblings (OR 1.99, 95% CI 1.18 to 3.73). CONCLUSIONS: This study revealed the familial aggregation of traffic risky behaviours of pedestrians, with father-offspring and sibling aggregations emerging as prominent components of familial aggregation. The findings suggested that family-based prevention programmes may yield greater effectiveness than individual-based approaches. As such, implementing targeted interventions focusing on family might have a substantial impact on reducing pedestrian traffic risky behaviours.

Towards Harmonized Adolescent Health Measurement: Assessing Alignment Between Current Recommendations and the Global Action for Measurement of Adolescent Health-Recommended Indicators.

PURPOSE: This study identified alignment of indicators across different initiatives and data collection instruments as a foundation for future harmonization of adolescent health measurement. METHODS: Using the Global Action for Measurement of Adolescent health (GAMA) recommended indicators as the basis for comparison, we conducted a desk review of 14 global-level initiatives, such as the Sustainable Development Goals and the Global Strategy for Women's, Children's and Adolescents' Health, and five multicountry survey programs, such as the Multiple Indicator Cluster Surveys and the Global school-based Student Health Survey. We identified initiative and survey indicators similar to a GAMA indicator, deconstructed indicators into standard elements to facilitate comparison, and assessed alignment to the corresponding GAMA indicator across each of the elements. RESULTS: A total of 144 initiative indicators and 90 survey indicators were identified. Twenty-four initiative indicators (17%) and 14 survey indicators (16%) matched the corresponding GAMA indicators across all elements. Population of interest was the most commonly discrepant element; whereas GAMA indicators mostly refer to ages 10-19, many survey and initiative indicators encompass only part of this age range, for example, 15-19-year-olds as a subset of adults ages 15-49 years. An additional 53 initiative indicators (39%) and 44 survey indicators (49%) matched on all elements except the population of interest. DISCUSSION: The current adolescent measurement landscape is inconsistent, with differing recommendations on what and how to measure. Findings from this study support efforts to promote indicator alignment and harmonization across adolescent health measurement stakeholders at the global, regional, and country levels.

Indicators to Measure Adolescent Health at the Country, Regional, and Global Levels: Results of a Five-Year Selection Process by the Global Action for the Measurement of Adolescent Health.

PURPOSE: To improve adolescent health measurement, the Global Action for the Measurement of Adolescent health (GAMA) Advisory Group was formed in 2018 and published a draft list of 52 indicators across six adolescent health domains in 2022. We describe the process and results of selecting the adolescent health indicators recommended by GAMA (hereafter, "GAMA-recommended indicators"). METHODS: Each indicator in the draft list was assessed using the following inputs: (1) availability of data and stakeholders' perceptions on their relevance, acceptability, and feasibility across selected countries; (2) alignment with current measurement recommendations and practices; and (3) data in global databases. Topic-specific working groups comprised of GAMA experts and representatives of United Nations partner agencies reviewed results and provided preliminary recommendations, which were appraised by all GAMA members and finalized. RESULTS: There are 47 GAMA-recommended indicators (36 core and 11 additional) for adolescent health measurement across six domains: policies, programs, and laws (4 indicators); systems performance and interventions (4); health determinants (7); health behaviors and risks (20); subjective well-being (2); and health outcomes and conditions (10). DISCUSSION: These indicators are the result of a robust and structured five-year process to identify a priority set of indicators with relevance to adolescent health globally. This inclusive and participatory approach incorporated inputs from a broad range of stakeholders, including adolescents and young people themselves. The GAMA-recommended indicators are now ready to be used to measure adolescent health at the country, regional, and global levels.

Exploring a Preliminary Set of Indicators to Measure Adolescent Health: Results From a 12-Country Feasibility Study.

PURPOSE: To explore data availability, perceived relevance, acceptability and feasibility of implementing 52 draft indicators for adolescent health measurement in different countries globally. METHODS: A mixed-methods, sequential explanatory study was conducted in 12 countries. An online spreadsheet was used to assess data availability and a stakeholder survey to assess perceived relevance, acceptability, and feasibility of implementing each draft indicator proposed by the Global Action for Measurement of Adolescent health (GAMA). The assessments were discussed in virtual meetings with all countries and in deep dives with three countries. Findings were synthesized using descriptive statistics and qualitative thematic analysis. RESULTS: Data availability varied across the 52 draft GAMA indicators and across countries. Nine countries reported measuring over half of the indicators. Most indicators were rated relevant by stakeholders, while some were considered less acceptable and feasible. The ten lowest-ranking indicators were related to mental health, sexual health and substance use; the highest-ranking indicators centered on broader adolescent health issues, like use of health services. Indicators with higher data availability and alignment with national priorities were generally considered most relevant, acceptable and feasible. Barriers to measurement included legal, ethical and sensitivity issues, challenges with multi-sectoral coordination and data systems flexibility. DISCUSSION: Most of the draft GAMA indicators were deemed relevant and feasible, but contextual priorities and perceived acceptability influenced their implementation in countries. To increase their use for a more comprehensive understanding of adolescent health, better multi-sectoral coordination and tailored capacity building to accommodate the diverse data systems in countries will be required.

Development, Validation, and Cross Cultural Adoption of Persian Version of Behavioral Risk Factor Tool.

Background: One of the most crucial objectives of policymakers is to enhance the population's overall health. Establishing a surveillance system is a way to achieve this goal. The Behavioral Risk Factor Surveillance System (BRFSS) is a national system that collects data on the health-related behaviors of the United States residents using the Behavioral Risk Factor Questionnaire (BRFSSQ). This survey is aimed at reducing risk behaviors and their consequences. Regarding the fact that the cultural environment within each country may affect how behaviors are assessed, this study aimed to develop a Persian version, cross-cultural adaptation, and assess the validity and reliability of the PBRFSSQ. Methods: In this cross-sectional study, 250 individuals were enrolled using the stratified sampling method between August 2022 and April 2023. Six steps of translation and test method proposed by Sousa et al was used. Content and face validity were calculated. Also, the Cronbach's alpha and test-retest were computed. Results: Of all participants, 54.5% were male and aged 30 to 65 years old (69%). The Scale Content Validity Index was equal to 0.95. The Intra class Correlation Coefficient (ICC) was computed as 0.86, 0.88, and 0.87 for the core, optional, and total components, respectively. Furthermore, the Cronbach's alpha coefficient of 0.85 was obtained overall. Conclusion: This tool was highly valid and reliable for assessing risky behaviors among the Iranian general population.

Effect of PM2.5 exposure on adhesion molecules and systemic nitric oxide in healthy adults: The role of metals, PAHs, and oxidative potential.

Since there is limited evidence on the impact of PM2.5 content on cardiovascular biomarkers, we conducted a cross-sectional study on 89 healthy adults from October 12 to November 21, 2021. We measured daily PM2.5 in two distinct regions during different time windows: a high-traffic urban area and an industrial suburb. The concentrations of metals, PAHs, and oxidative potential (OP) were determined using ICP-MS, GC-MS, and dithiothreitol (DTT), respectively. Systemic biomarkers, including NO, sICAM-1, sVCAM-1, MDA, and CRP, were quantified in each subject simultaneously. A generalized linear model was used to examine the association between PM2.5 toxicity and each health endpoint. Our findings indicated that daily PM2.5 concentrations exceeded the WHO-recommended level by approximately sevenfold. We found that PM2.5 exposure was associated with adverse cardiovascular outcomes. Moreover, exposure to PM2.5 mass, total PAHs, and certain trace metals (Ni, Fe, V, As, and Pb) resulted in a decline in serum NO levels. At lag 3, exposure to PM2.5 mass resulted in a significant decrease in NO levels [1.32% (95% CI: -2.27, -0.12)] and total PAHs [2.05% (95% CI: -3.93, -0.12)]. In contrast, OP exhibited a mild correlation with NO level increases. Positive associations were observed between PM2.5 and its chemical constituents (PAHs, As, Cu, OP) and adhesion molecules at different lag times. An increase of 0.16 ppb in PAH concentrations at an interquartile range was associated with a 4.74% decline (95% CI, -7.80, -0.55) in the sVCAM-1 level. However, our study did not reveal any significant trend between pollutants and other biomarkers (sICAM-1, MDA, and CRP). Consequently, our findings suggest that different PM2.5 chemical compositions exhibit diverse behavior in biological responses.

Gastroschisis prevalence patterns in 27 surveillance programs from 24 countries, International Clearinghouse for Birth Defects Surveillance and Research, 1980-2017.

BACKGROUND: Gastroschisis is a serious birth defect with midgut prolapse into the amniotic cavity. The objectives of this study were to evaluate the prevalence and time trends of gastroschisis among programs in the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), focusing on regional variations and maternal age changes in the population. METHODS: We analyzed data on births from 1980 to 2017 from 27 ICBDSR member programs, representing 24 countries and three regions (Europe+ (includes Iran) , Latin America, North America). Cases were identified using diagnostic codes (i.e., 756.7, 756.71, or Q79.3). We excluded cases of amniotic band syndrome, limb-body wall defect, and ruptured omphalocele. Programs provided annual counts for gastroschisis cases (live births, stillbirths, and legally permitted pregnancy terminations for fetal anomalies) and source population (live births, stillbirths), by maternal age. RESULTS: Overall, gastroschisis occurred in 1 of every 3268 births (3.06 per 10,000 births; 95% confidence intervals [CI]: 3.01, 3.11), with marked regional variation. European+ prevalence was 1.49 (95%CI: 1.44, 1.55), Latin American 3.80 (95%CI: 3.69, 3.92) and North American 4.32 (95%CI: 4.22, 4.42). A statistically significant increasing time trend was observed among six European+ , four Latin American, and four North American programs. Women <20 years of age had the highest prevalence in all programs except the Slovak Republic. CONCLUSIONS: Gastroschisis prevalence increased over time in 61% of participating programs, and the highest increase in prevalence was observed among the youngest women. Additional inquiry will help to assess the impact of the changing maternal age proportions in the birth population on gastroschisis prevalence.

A multi-program analysis of cleft lip with cleft palate prevalence and mortality using data from 22 International Clearinghouse for Birth Defects Surveillance and Research programs, 1974-2014.

BACKGROUND: Cleft lip with cleft palate (CLP) is a congenital condition that affects both the oral cavity and the lips. This study estimated the prevalence and mortality of CLP using surveillance data collected from birth defect registries around the world. METHODS: Data from 22 population- and hospital-based surveillance programs affiliated with the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) in 18 countries on live births (LB), stillbirths (SB), and elective terminations of pregnancy for fetal anomaly (ETOPFA) for CLP from 1974 to 2014 were analyzed. Prevalence and survival (survival for LB only) estimates were calculated for total and subclassifications of CLP and by pregnancy outcome. RESULTS: The pooled prevalence of total CLP cases was 6.4 CLP per 10,000 births. The prevalence of CLP and all of the pregnancy outcomes varied across programs. Higher ETOPFA rates were recorded in most European programs compared to programs in other continents. In programs reporting low ETOPFA rates or where there was no ascertainment of ETOPFA, the rate of CLP among LB and SB was higher compared to those where ETOPFA rates were ascertained. Overall survival for total CLP was 91%. For isolated CLP, the survival was 97.7%. CLP associated with multiple congenital anomalies had an overall survival of 77.1%, and for CLP associated with genetic/chromosomal syndromes, overall survival was 40.9%. CONCLUSIONS: Total CLP prevalence reported in this study is lower than estimates from prior studies, with variation by pregnancy outcomes between programs. Survival was lower when CLP was associated with other congenital anomalies or syndromes compared to isolated CLP.

Does telehealth affect the adherence to ART among patients with HIV? A systematic review and meta-analysis.

BACKGROUND: Several studies have shown different effects of telehealth interventions on adherence to Antiretroviral therapy (ART) among people living with HIV. This study conducted a meta-analysis of Randomized Controlled Trials (RCTs) to estimate the pooled effect of telehealth interventions on the treatment adherence of HIV patients. METHODS: The researchers conducted literature searches in Scopus, PubMed, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials databases. In addition, open grey was systematically searched until January 2022 for RCTs around the effects of telehealth on adherence to treatment ART among patients with HIV. Each study's methodological quality was assessed using the Cochrane Collaboration tool. Pooled Standard Mean Differences (SMD) and Risk Ratio (RR) with 95% CI were calculated using the random effects model. RESULTS: In total, 12 eligible articles were considered in the present systematic review. A random-effects meta-analysis using 5 RCTs yielded the pooled RR estimate of 1.18 (95% CI: 1.03 to 1.35, p < 0.05); I2 = 0, suggesting the adherence to treatment among patients with HIV who received telehealth intervention was significantly 18% upper than control groups. Moreover, the random effects analysis of SMD showed a positive effect for telehealth with SMR = 0.36 (95% CI: 0.22 to 0.49, p < 0.05); I2 = 91.9%, indicating that telehealth intervention increased ART adherence to the treatment group compared to the control group. CONCLUSION: Telehealth intervention as a new modality of health care service delivery could be a valuable strategy to improve ART adherence among patients with HIV. It can strengthen the capacity of HIV care services. On a large scale, telehealth can be utilized as a supplementary component for ART delivery and retention toward successful adherence to the therapy.

Sex-specific association of exposure to air pollutants and Nrf2 gene expression and inflammatory biomarkers in exhaled breath of healthy adolescents.

Studies investigating the nuclear factor erythroid 2-related factor 2 (Nrf2) expression levels in the respiratory system of healthy subjects are scarce. Moreover, separate studies on the health-related outcomes of air pollution for each sex are limited. The current panel study investigated sex-specific Nrf2 expression levels and related oxidative stress and inflammatory responses among healthy adolescents exposed to PM2.5, PM10, O3, and PM2.5-bounded metals in a high traffic region. Forty-nine healthy nonsmoking subjects participated in the study for five consecutive months (Nov. 2019 to Feb. 2020). Each subject was asked to provide 1 mL of exhaled breath condensate (EBC). Data were analyzed using linear mixed-effects models. The results showed that PM10, PM2.5, O3, and PM2.5-bounded metals were negatively linked to Nrf2 expression level in EBC of females with -58.3% (95% CI: 79.5, -15.4), -32.1% (95% CI: -50.3, -7.1), -76.2% (95% CI: -92.6, -23.9), and -1.9 (95% CI: -3.4, -0.4), respectively. While our results presented no significant association between the studied pollutants and Nrf2 gene expression in males, significant associations were observed between the pollutants and total nitric oxide (NOx), interleukins 6 (IL-6), and tumor necrosis factor-alpha (TNF-α) in the EBC of females. In the case of males, only EBC cytokines showed a significant association with air pollutants. Overall, this study suggests that exposure to ambient air pollutants may affect the respiratory system with biologically different mechanisms in males and females. PM2.5 concentration had a positive correlation with exhaled TNF-α and IL6 values in females while positive correlation with TNF-α and negative correlation with IL6 values in males. O3 had a negative correlation with TNF-α in males.

Prevalence and mortality among children with anorectal malformation: A multi-country analysis.

PURPOSE: We examined the total prevalence, trends in prevalence, and age-specific mortality among individuals with anorectal malformation (ARM) METHODS: We conducted a retrospective cohort study using data from 24 population- and hospital-based birth defects surveillance programs affiliated with the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) from 18 countries and for births from 1974 to 2014. We estimated pooled and program-specific total prevalence per 10,000 total births. Poisson regression was used to assess time trends in prevalence from 2001 to 2012 when most programs contributed data. We calculated selected age-specific proportions of deaths, stratified by case status RESULTS: The pooled total prevalence of ARM was 3.26 per 10,000 total births (95% Confidence Interval = 3.19, 3.32) for birth years 1974-2014. About 60% of cases were multiple or syndromic. Prevalence of multiple, syndromic, and stillborn cases decreased from 2001 to 2012. The first week mortality proportion was 12.5%, 3.2%, 28.3%, and 18.2% among all, isolated, multiple, and syndromic cases, respectively CONCLUSIONS: ARM is relatively rare, with multiple and syndromic cases showing decreasing prevalence during the study period. Mortality is a concern during the first week of life, and especially among multiple and syndromic cases. Our descriptive epidemiological findings increase our understanding of geographic variation in the prevalence of ARM and can be used to plan needed clinical services. Exploring factors influencing prevalence and mortality among individuals with ARM could inform future studies.

Diagnostic accuracy of multitarget stool DNA testing for colorectal cancer screening: A systematic review and meta-analysis / Precisión diagnóstica de las pruebas de DNA en heces con objetivos múltiples para la detección del cáncer colorrectal: una revisión sistemática y un metaanálisis

Introduction: This study aimed to collect and summarize test data and conduct a meta-analysis, with respect to the Multitarget Stool DNA test sensitivity and specificity, compared to colonoscopy. Material and methods: All manuscripts were screened for eligibility according to inclusion criteria. Participants were a normal population at an average risk of developing CRC. Intervention was Stool based and DNA panel tests compared with colonoscopy, and outcome was detection of CRC and any pre-cancerous lesions. Inter-study and inconsistency (using the I-squared test) were assessed. Results: Meta-analyses of the Mt-sDNA test showed a combined sensitivity of 89%, 51%, and 76% for the detection of CRC, advanced adenoma (AA), and combined CRC and AA, respectively. The overall specificity was 91%, 89%, and 90% for the detection of CRC, AA, and combined CRC and AA, respectively. Conclusion: Mt-sDNA had significantly acceptable diagnostic accuracy for CRC and AA diagnosis, but still has lower sensitivity and specificity than colonoscopy.(AU)

Introducción: Este estudio tuvo como objetivo recopilar y resumir los datos de las pruebas y realizar un metaanálisis con respecto a la sensibilidad y especificidad de la prueba de DNA en heces multiobjetivo, en comparación con la colonoscopia. Material y métodos: Todos los manuscritos fueron examinados para determinar su elegibilidad de acuerdo con los criterios de inclusión. Los participantes eran una población normal con un riesgo promedio de desarrollar CRC. La intervención se basó en heces y pruebas de panel de DNA en comparación con la colonoscopia, y el resultado fue la detección de CRC y cualquier lesión precancerosa. Se evaluaron la inconsistencia entre estudios y la inconsistencia (mediante la prueba de I cuadrado). Resultados: Los metaanálisis de la prueba Mt-sDNA mostraron una sensibilidad combinada del 89%, 51% y 76% para la detección de CRC, adenoma avanzado (AA) y CRC y AA combinados, respectivamente. La especificidad general fue del 91%, 89% y 90% para la detección de CRC, AA y CRC y AA combinados, respectivamente. Conclusión: Mt-sDNA tuvo una precisión diagnóstica significativamente aceptable para el diagnóstico de CRC y AA, pero aún tiene una sensibilidad y especificidad más bajas que la colonoscopia.(AU)

Assessment of Neuropsychiatric Indicators in Children and Adolescents With Primary Brain Tumors and Other Brain Space-Occupying Lesions Before and After Surgery.

Objectives: Cognitive abilities might be impaired due to brain lesions in children and adolescents. This study aimed to investigate neuropsychiatric indicators in children and adolescents with primary brain tumors and other brain space-occupying lesions (SOLs) before and after the surgical procedure. Materials & Methods: The current pre-post study was conducted on 81 patients with brain SOLs aged under 18 years hospitalized in the Neurosurgery Ward of Imam Reza university hospital, Tabriz, Iran, within 20 December 2016 to 20 December 2017. The patients with metastatic brain tumors were excluded. Before and after the surgical procedure, Digit Span forward and backward task (to assess working memory), Stroop Task and Trail Making Task A and B (to assess attention), and Rey-Osterrieth Complex Figure Test (ROCF) (to assess visuospatial memory) were carried out. Then, the scores of the tests were compared to standard values and postsurgical scores. Results: The most prevalent type of brain SOLs was medulloblastoma, and the most prevalent region of involvement was the posterior fossa. The scores of all tests after the surgery were significantly improved, compared to those before the surgery (P<0.05). In the assessment of Digit Span forward and backward task scores, there was no significant difference between the scores of patients before the surgery and standard values (P>0.05). Regarding the scores of various stages of the ROCF, the scores of the immediate recall stage were significantly low (P<0.05). Regarding Trail Making Task A and B and Stroop Task before the surgery, only Trail Making Task A and B scores were significantly increased (P<0.05). The scores of Trail Making Task A were significantly higher in patients with medulloblastoma and anatomically in left temporal tumors, which indicated greater damage to the attention field (P<0.05). In addition, in cerebellar tumors, the scores of the immediate recall stage of the ROCF were significantly lower than in other brain tumors or SOLs (P<0.05). Conclusion: The visuospatial memory and attention of preoperative assessments were significantly impaired, compared to those of the healthy population (P<0.05). Working memory, visuospatial memory, and attention showed improvement, compared to those before the surgery. Deficits in the attention domain were greater in medulloblastoma.

The Impact of Neutrophil-Lymphocyte Ratio in Febrile Seizures: A Systematic Review and Meta-Analysis.

This meta-analysis was conducted to determine the relationship between neutrophil to lymphocyte ratio (NLR) and febrile seizure (FS). Our study was registered with the PROSPERO (ID: CRD42021259944). Web of Science, Embase, PubMed, Scopus, and ProQuest Central were searched, and finally, 17 studies were included. Standardized mean difference (SMD) was reported with a 95% confidence interval (CI) for the NLR levels. Compared with the febrile control group, the FS patients' NLR levels were significantly higher (SMD = 0.49; 95%CI = 0.26 to 0.72, P < 0.001). Furthermore, we conducted a comparison of NLR levels between febrile controls against simple and complex FS cases separately and found that NLR levels of children with either simple or complex FS were higher compared with those of febrile controls (SMD = 0.42, 95%CI = 0.14 to 0.69, P = 0.003 and SMD = 0.90, 95%CI = 0.71 to 1.09, P < 0.001, respectively). Also, in comparison with the NLR levels of the simple FS group, the complex FS patients' NLR levels were significantly higher (SMD = 0.59, 95%CI = 0.34 to 0.85, P < 0.001). Our study indicated that NLR could be recommended as an inexpensive diagnostic biomarker for FS. In addition, it can be useful when distinguishing between simple FS and complex FS.

Priority Indicators for Adolescent Health Measurement - Recommendations From the Global Action for Measurement of Adolescent Health (GAMA) Advisory Group.

PURPOSE: This article describes the selection of priority indicators for adolescent (10-19 years) health measurement proposed by the Global Action for Measurement of Adolescent health advisory group and partners, building on previous work identifying 33 core measurement areas and mapping 413 indicators across these areas. METHODS: The indicator selection process considered inputs from a broad range of stakeholders through a structured four-step approach: (1) definition of selection criteria and indicator scoring; (2) development of a draft list of indicators with metadata; (3) collection of public feedback through a survey; and (4) review of the feedback and finalization of the indicator list. As a part of the process, measurement gaps were also identified. RESULTS: Fifty-two priority indicators were identified, including 36 core indicators considered to be most important for measuring the health of all adolescents, one alternative indicator for settings where measuring the core indicator is not feasible, and 15 additional indicators for settings where further detail on a topic would add value. Of these indicators, 17 (33%) measure health behaviors and risks, 16 (31%) health outcomes and conditions, eight (15%) health determinants, five (10%) systems performance and interventions, four (8%) policies, programmes, laws, and two (4%) subjective well-being. DISCUSSION: A consensus list of priority indicators with metadata covering the most important health issues for adolescents was developed with structured inputs from a broad range of stakeholders. This list will now be pilot tested to assess the feasibility of indicator data collection to inform global, regional, national, and sub-national monitoring.

Identifying the main barriers for participation in a population-based colorectal cancer screening programme in East Azerbaijan, Iran.

Background: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of death worldwide. However, CRC is considered as one of the most preventable cancers by which the mortality rates reduce about 60% through implementing the screening programmes. The present study aimed to evaluate the main barriers of CRC screening in a defined population. Method: Healthy individuals from all regions of the state were invited to participate in different healthcare centres. They were assessed by a provided online risk assessment tool, which was completed for all recruited subjects, and has been developed to assess the CRC risk based on personal and family history of adenoma, CRC, and other high-risk diseases. Research team staff assessed all individuals by this tool and then eligible people according to their lifetime risk of CRC were included in the study. There was not any age restriction in this study. Colonoscopy and three stool-based tests including faecal occult blood test, faecal immunochemical test and stool DNA tests were performed. Results: Overall, 725 cases including 425 (58.6%) males and 300 (41.4%) females participated in the study. Lack of knowledge and attitude about screening programmes was the most common barrier, especially among women (68% for women versus 58% for men) and those from rural areas (88% in rural versus 55% in urban areas). Fear of colonoscopy and procedure complications and pain (48%), discomfort and anxiety from inserting a tube into the bowel (65% among females versus 43% among males) were reported commonly. Embarrassment and dignity were other complaints, especially in women (62% in females versus 35% in males). Conclusion: Increasing knowledge and attitude about the aims and benefits of screening programmes, acceptable and convenient communication of health systems with the general population are considered to be the key elements in the success and implementation of any screening programme.

Analysis of early neonatal case fatality rate among newborns with congenital hydrocephalus, a 2000-2014 multi-country registry-based study.

BACKGROUND: Congenital hydrocephalus (CH) comprises a heterogeneous group of birth anomalies with a wide-ranging prevalence across geographic regions and registry type. The aim of the present study was to analyze the early neonatal case fatality rate (CFR) and total birth prevalence of newborns diagnosed with CH. METHODS: Data were provided by 25 registries from four continents participating in the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) on births ascertained between 2000 and 2014. Two CH rates were calculated using a Poisson distribution: early neonatal CFR (death within 7 days) per 100 liveborn CH cases (CFR) and total birth prevalence rate (BPR) per 10,000 births (including live births and stillbirths) (BPR). Heterogeneity between registries was calculated using a meta-analysis approach with random effects. Temporal trends in CFR and BPR within registries were evaluated through Poisson regression modeling. RESULTS: A total of 13,112 CH cases among 19,293,280 total births were analyzed. The early neonatal CFR was 5.9 per 100 liveborn cases, 95% confidence interval (CI): 5.4-6.8. The CFR among syndromic cases was 2.7 times (95% CI: 2.2-3.3) higher than among non-syndromic cases (10.4% [95% CI: 9.3-11.7] and 4.4% [95% CI: 3.7-5.2], respectively). The total BPR was 6.8 per 10,000 births (95% CI: 6.7-6.9). Stratified by elective termination of pregnancy for fetal anomalies (ETOPFA), region and system, higher CFR were observed alongside higher BPR rates. The early neonatal CFR and total BPR did not show temporal variation, with the exception of a CFR decrease in one registry. CONCLUSIONS: Findings of early neonatal CFR and total BPR were highly heterogeneous among registries participating in ICBDSR. Most registries with higher CFR also had higher BPR. Differences were attributable to type of registry (hospital-based vs. population-based), ETOPFA (allowed yes or no) and geographical regions. These findings contribute to the understanding of regional differences of CH occurrence and early neonatal deaths.

Cross-cultural validation of stool Based Colorectal cancer screening methods in the North West of Iran.

Background: Globally, colorectal cancer (CRC) is the third most common cancer and the second leading cause of death from cancer. Incidence and mortality from CRCboth can be reduced and prevented using screening and early detection programs. The current study aimed to assess the feasibility of the colorectal cancer screening program in Northwest of Iran. Methods: The study designed as a cross-cultural analytic study, to evaluate the diagnostic accuracy of stool-based tests compared with colonoscopy, during 2016-2020. All individuals first were assessed with our CRC risk assessment tool, then eligible volunteers entered the study. Colonoscopy was performed on all participants, also stool-based tests including traditional guaiac, high-sensitivity guaiac-based, fecal immunochemical test (FIT), and multitarget stool DNA (Mt-sDNA) panel tests were performed. Results: Mt-sDNA test panel had a sensitivity of 77.8% (95% CI: 40-97.2)for detecting colorectal cancer with a specificity of 91.2% (95% CI:85.4-95.2). The FIT test alone had a lower sensitivity (66.7%; 95% CI:29.9-92.5) and almost the same specificity of 93.9% (95% CI: 88.7-97.2) for cancer detection. Mt-sDNA test had better diagnostic accuracy than the FIT (AUC = 0.85 vs 0.80), and is a more useful screening test. Positive and negative predictive values for cancer detection for both Mt-sDNA and FIT tests were almost the same results, however Mt-sDNA test had better NPV results than the FIT test alone. Conclusion: Our results showed that both Mt-sDNA panel and the FIT test had acceptable cut-off points for cancer detection, however, Mt-sDNA test had better diagnostic accuracy.