hossein molavi vardanjani

 Drug data has been used to estimate the prevalence of chronic diseases. Disease registries and annual surveys are lacking, especially in less-developed regions. At the same time, insurance drug data and self-reports of medications are easily accessible and inexpensive. We aim to investigate the similarity of prevalence estimation between self-report data of some chronic diseases and drug data in a less developed setting in southwestern Iran.

 Baseline data from the Pars Cohort Study (PCS) was re-analyzed. The use of disease-related drugs were compared against self-report of each disease (hypertension [HTN], diabetes mellitus [DM], heart disease, stroke, chronic obstructive pulmonary disease [COPD], sleep disorder, anxiety, depression, gastroesophageal reflux disease [GERD], irritable bowel syndrome [IBS], and functional constipation [FC]). We used sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the Jaccard similarity index.

 The top five similarities were observed in DM (54%), HTN (53%), heart disease (32%), COPD (30%), and GERD (15%). The similarity between drug use and self-report was found to be low in IBS (2%), stroke (5%), depression (9%), sleep disorders (10%), and anxiety disorders (11%).

 Self-reports of diseases and the drug data show a different picture of most diseases’ prevalence in our setting. It seems that drug data alone cannot estimate the prevalence of diseases in settings similar to ours. We recommend using drug data in combination with self-report data for epidemiological investigation in the less-developed setting.

Rituximab (RTX) is approved for treating CD20-positive B-cell malignancies, including non-Hodgkin lymphoma, when used alongside chemotherapy. It has the potential to interact with and alter the host immune system, putting patients at a heightened risk of infection. Therefore, the use of RTX necessitates a meticulous assessment of infectious risks based on the latest evidence.

We conducted a prospective investigation into infectious complications and mortality among children undergoing RTX treatment over the observation period of the study.

In this observational cohort study, we included 61 pediatric patients treated with RTX for malignancy and immune thrombocytopenic purpura (ITP), as well as 122 cancer patients who had never received RTX (the unexposed group). These patients were prospectively monitored for febrile neutropenia (FN), bloodstream infection (BSI), invasive fungal infection (IFI), and mortality. All infectious complications were documented starting from the initial dose of RTX and continuing for at least six months following the last dose. Logistic regression and Cox regression analyses, with consideration for the proportional hazards assumption, were utilized to evaluate the impact of covariates on mortality and infection-related outcomes.

Infectious complications were observed in 52.5% of children treated with RTX. These complications were notably more prevalent in children with malignancy compared to those with chronic ITP (89.5% versus 10.5%, respectively). RTX was found to be associated with an increased likelihood of mortality in children with malignancy (OR [95% CI]: 1.54 [0.41, 5.69]). According to Cox regression analysis, RTX was linked to a higher risk of IFIs, death, FN events, and BSIs over a 36-month observation period (4.33 [1.21, 15.52], 3.26 [1.008, 10.59], 1.68 [0.83, 3.41], and 1.59 [0.27, 9.17], respectively). The total dose of RTX administered was also associated with adverse patient outcomes, with the odds of infectious events and death increasing in the second, third, and fourth quartiles of the total RTX dose administered. Furthermore, the estimated one-year and two-year survival rates for cancer patients treated with RTX were 77% and 58%, respectively.

RTX treatment, when used concurrently with immunosuppressive chemotherapy for hematologic malignancies in children, showed additive and dose-dependent effects on clinical outcomes.

Intimate partner violence (IPV) is a significant public health issue, especially in developing countries. This study aimed to provide a systematic review and meta-analysis of IPV among married Iranian women.

In this systematic review and meta-analysis, following PRISMA guidelines, eight electronic databases were searched for quantitative articles, with the target population of married Iranian women. Articles from 2010 to 2020 were extracted and assessed with an 8-scored checklist for risk of bias. Different types of IPV include mental, physical, and sexual types. Heterogeneity was assessed with I2 and Q tests. Random effect model was used for meta-analysis. Factors such as income, education, employment, mean age, urbanization, and human development index (HDI) were assessed within homogenous groups.

Thirty-four studies (19,445 participants) were included. The mean age of women was 33.4 years. The overall prevalence of past-year IPV was estimated at 62.6% (CI: 53.6-71.5). Mental, physical, and sexual violence were estimated at 59% (CI: 53.7- 64.4), 30.8% (CI: 26.2-35.4), and 29% (CI: 22.4-35.5), respectively. The results revealed that a negative correlation existed between the occurrence of violence and higher education, higher HDI indices for regions, and employment.

The findings of this study indicate that IPV exists in high proportions in Iran. Improving the economic situation, increasing education, and raising public awareness through social media are the preventive factors.

 Methanol-poisoning can be a challenging cause of mortality. Identifying the epidemiological, clinical, and para-clinical determinants of outcome in methanol-poisoning patients could be a step forward to its management.

 In this hospital-based cohort study, 123 methanol-poisoning patients were included. Data on background variables, details of methanol consumption, and laboratory assessments were recorded for each patient. Patients underwent brain CT scans without contrast. We evaluated the association of all gathered clinical and para-clinical data with patients’ outcome and length of hospital stay (LOS). Independent association of potential determinants of death, and LOS were modeled applying multivariable logistic, and Ordinary Least Square regressions, respectively. Odds ratio (OR), and regression coefficient (RC), and their 95% confidence intervals (CIs) were estimated.

 Most of the study population were male (n=107/123). The mean age of the participants was 30.3±9.1 years. Ninety patients (73.2%) were reported as being conscious on admission, and 34.3% of patients were identified with at least one abnormality in their CT scan. Level of consciousness (LOC) (OR: 42.2; 95% CI: 2.35-756.50), and blood pH (OR: 0.37; 95% CI: 0.22-0.65) were associated with death. Supratentorial edema (RC: 17.55; 95% CI: 16.95-18.16) were associated with LOS.

 Besides LOC, patients with any abnormality in their brain CT scan on admission were found to be at higher risk of death, and patients with supratentorial edema were at risk of longer LOS. Brain CT-scan on admission should be considered as a part of the routine procedure during the management of methanol-poisoning.

Healthcare workers (HCWs) directly or indirectly involved in the coronavirus disease 2019 (COVID-19) treatment process may experience severe mental consequences of the pandemic. Hence, this study aimed to evaluate the mental health status of HCWs in hospitals affiliated with Shiraz University of Medical Sciences, Iran.

This cross-sectional study was performed on 503 HCWs from five hospitals in Shiraz, including one COVID-19 front-line hospital, two COVID-19 second-line hospitals, and two without COVID-19 wards. Then, to assess the levels of anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD) among HCWs, the Persian versions of the Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), and Global Psychotrauma Screen (GPS) questionnaires were placed, respectively.

The mean age of participants was 33.94±8.26 years, and 252 (50.1%) were females. Anxiety, depression, insomnia, and moderate to high levels of PTSD were observed in 40.4%, 37.8%, 24.5%, and 71% of participants, respectively. A history of mental disorders was associated with all four outcomes (P<0.05). Females gender and living with elderly and/or children were correlated with anxiety and PTSD (P<0.05). Working at COVID-19 front- and second-line hospitals were similarly linked to higher insomnia and PTSD levels (P<0.05). Also, working in COVID-19 wards or non-clinical settings was associated with anxiety and depression (P<0.05).

Most of the HCWs in this study may experience mental difficulties. Some factors may increase their risk of experiencing these difficulties. Hence, in the crisis era, mental health monitoring and identification of groups with predisposing factors are required to provide appropriate care as quickly as feasible.

 Although polypharmacy is considered a major predictor of irrational use of drugs, little is known about polypharmacy in developing regions. We aimed to indicate the prevalence and correlates of polypharmacy and to determine the medication profile at the population level in southern Iran.

 In this cross-sectional study, we analyzed data from participants of the Pars Cohort Study (PCS) (aged above 40 years, N=9269). Polypharmacy was defined as using five or more medications concurrently. A Poisson multivariable model was applied to estimate the adjusted prevalence ratios (APRs) of various risk factors. The Anatomical Therapeutic Chemical (ATC) classification system was used for classifying medications.

 Prevalence of polypharmacy was 10.4%, (95% CI: 9.75; 11.08) and it was higher among females (15.0%), older adults (age≥65 years) (16.0%), and individuals with more than two chronic conditions (31%). Being female, educated, married, and not having a low socio-economic class were independently associated with a higher likelihood of polypharmacy. The most prevalent medications among female participants were sex hormones and modulators of the genital system (58.4%), drugs for acid-related disorders (14.6%), and anti-anemic preparations (13.6%,). On the other hand, males were using acid-related disorders (14.6%), anti-inflammatory and anti-rheumatic products (7.8%), and beta-blocking agents (6.3%).

 The prevalence of polypharmacy in our sample was relatively low, especially among males. Cardiovascular drugs, acid suppressants, hormonal contraceptives, and anti-anemic preparations are drug classes with the highest contribution to polypharmacy.

Medical students are exposed to high risk mental health disorders. Owing to the higher probability of exposure to the mentioned risk factors among dorm-resident students and senior students, the present study was conducted to explore mental health disorder and its relationship with higher academic year and dorm residence, amongthe medical students of Shiraz University of Medical Sciences. This cross-sectional study was conducted among 270 medical students in 2019. A multi-stage random sampling was applied. A standardized self-administered questionnaire, which comprised of demographic variables and General Health Questionnaire-28, was used. The mean age of the participants was 22.52±2.26 years. About 166 individuals (61.5%, CI 95%: 55.69, 67.30) showed symptoms of mental health disorders, and anxiety was the most common mental disorder with a prevalence of 16.7% in medical students. There were significant relationships between mental health and higher age (P=0.001), clinical phase students (P<0.001), single students (P=0.044), dorm residence (P<0.001), and those in poor economic condition (P=0.047). The chance of developing mental health disorders in dormitory students and in clinical phase students was 2.48 (CI 95%: 1.36, 4.53) and 2.97 (CI 95%: 2.12, 4.15) times higher than in non-dormitory and basic phase students, respectively. Due to the higher prevalence of mental health disorders among medical students compared to the general population, interventions should be done at the university level to promote the students’ mental health, especially clinical and dormitory students. In addition, policymakers should design and implement a comprehensive student mental health care program nationally.

Despite the evidence for validity of body image pictogram (BIP) to discriminate overweight, obese, and normal individuals, there is little evidence on the probable effect of socio-demographic variables on its validity. To investigate the effects of socioeconomic status (SES), age, ethnicity, and educational level on the validity of BIP to discriminate normal weight, overweight, and obese people.

We used the Pars Cohort Study (PCS) data. Stunkard’s BIP score was used as test measure. Participants were classified as normal (body mass index [BMI]<25), overweight (BMI=25 to 29.9), and obese (BMI≥29.9) based on their BMI (kg/m2 ). Area under curve (AUC) and its 95% CI were estimated and compared. Optimal cutoff points and their sensitivity, specificity, and likelihood ratio were reported.

A total of 9232 participants with a female/male ratio of 1.03 were included. The prevalence of overweight and obesity was 37.4% and 18.2%, respectively. Regardless of socio-demographic levels, the optimal cut-points to discriminate normal BMI from overweight, and overweight from obese participants were BIP score of four and five, respectively. Estimated AUC correlated with ethnicity (P<0.001) for both genders, and with SES for females (P<0.05).

Although BIP may be a valid measure to categorize the general adult population into normal, overweight and obese, its validity depends on SES and ethnicity. BIP may be available as a proxy measure for BMI categories in socio-demographically homogeneous populations but not in heterogeneous populations.

 Chronic obstructive pulmonary disease (COPD) is a common disease that causes 6% of deaths, 90% of which occur in low- and middle-income countries. Improving these patients' quality of life (QOL) is one of the primary treatment goals. The St. George's Respiratory Questionnaire (SGRQ) is used to measure the health status of patients with respiratory problems. This research aimed to assess the health status of patients with COPD after validating the Persian version of this questionnaire.

 The study was performed from Feb to Oct 2016 in Shiraz, Iran. First, the Persian version of the questionnaire was validated using a back-translation technique by two translators, supervised by two researchers, and finally approved by two pulmonologists. The test-retest method was used to investigate the questionnaire's reliability. The questionnaire was used to assess the health status of 158 COPD patients with FEV1/FVC ratio≤ 0.7 or FEV1<80%, without exacerbation, cardiac disease, or recent hospitalization.

 The reliabilities of the first part (questions 1-7) and second part (questions 8-14) of the questionnaire was 0.64 and 0.90, respectively. The current health was good, fair, poor, and very poor in 7.6%, 22.2%, 44.9%, 22.8%, and 2.5% of the patients, respectively. The mean± standard deviation (SD) scores calculated for symptoms, activity, and impact were 54.216±23.725, 41.477±24.996, and 37.482±26.390, and the total score was 133.176±69.284.

 The Persian version of the SGRQ-C was valid and reliable. The patients with COPD at our center had a good health status.

Oral health conditions are a group of complications that are partially associated with breast cancer (BC) treatments. However, evidence on the sociodemographic risk factors of oral health conditions among BC patients is scarce. This study aimed to investigate the relationship between the socioeconomic status (SES) and dental health in a population of Iranian female BC patients in 2020. A cross-sectional study was conducted in Kerman, Iran. Indices of decayed, extracted, and filled teeth were measured based on clinical examination by a general dentist. Data were collected through structured face-to-face interviews, review of the patients’ medical records, and clinical examination for six months. Data were analyzed by applying univariate and multivariable generalized negative binomial regression (GNBReg). Data were analyzed using the Stata. Data from 1760 BC patients were collected, 1707 of whom were included in the analysis. The mean age of the participants was 46.3 ± 9.8 years. The mean of the total decayed, missing, and filled teeth, and the number of decayed teeth (DT), missing teeth (MT), and filled teeth (FT) were 12.8 ± 5.8, 3.5 ± 3.1, 4.6 ± 5.2, and 4.6 ± 4.4 teeth, respectively. Regarding SES, the number of participants with high, high-middle, low-middle, and low SES were 421, 432, 395 and 459, respectively. According to univariate analysis, there was no significant difference between different SES in mean DMFT (decayed, missing, and filled teeth), while SES was significantly associated with DT, MT and FT among the study participants. Female BC patients in Iran have lower levels of dental health regardless of their SES. As those from different socioeconomic classes are seeking different and mostly inadequate or unsuitable dental healthcare services, tailored interventional programs are needed to address the dental healthcare needs of patients in each socioeconomic class.

This study aimed to investigate the protective role of deferoxamine (DFO) in the prevention of doxorubicin (DOX)-induced hepatic fibrosis in children.

In this prospective randomized controlled trial, 61 treatment-naïve children (2-18 years) with different types of cancer who referred to a tertiary teaching hospital in the South of Iran were enrolled. They were randomly assigned to 3 groups; group 1 (control, n=21), group 2 (DFO 10 times DOX dose, n=20), group 3 (DFO 50mg/kg, n=20). DFO was administered as an 8-hour continuous intravenous infusion during and after DOX infusion in each chemotherapy cycle. Non-invasive serum markers of liver fibrosis, including AST-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4) score and Fibro Test were measured in each individual. Besides, hepatic Fibro Scan was used after the last course of chemotherapy to estimate the fibrosis degree.

Alanine aminotransferase was mildly increased after treatment compared to before treatment. The treatment with DFO 10 times DOX dose was associated with a significant decline in post-treatment APRI (adjusted odds ratio 0.17; 95% confidence interval 0.03- 0.84. P-value=0.015). The METAVIR fibro scores were in the F0-F1 zone in all participants, and the results were comparable in study groups. No adverse drug effects were reported in the treatment groups.

DOX may not lead to severe liver fibrosis if the maximum cumulative dose allowed is not exceeded. DFO at the dose of 10 times of DOX dose may have a potential protective role against liver fibrosis. More studies with longer follow-up are needed to further assess this issue.

 Cancer family history (CFH) could be an effective non-invasive preventive tool for cancer screening. There are limited data on the prevalence of CFH.

 We aimed to estimate a robust population-based prevalence of CFH in southeastern Iran.

 This study is a population-based survey. Participants were recruited in a multistage proportional-to-size cluster sampling design. A validated interview form was used, including a pedigree table and a cancer detail table. A positive CFH was defined as a verbal self-report of cancer diagnosis in at least 1 relative. The CFH prevalence was estimated according to age, gender, residential area, relatives’ closeness, and cancer type. Estimated prevalence values were corrected for the sensitivity of self-reported CFH in a Monte Carlo-based sensitivity analysis.

 A total of 2057 interviews with a male-female ratio of 1: 14 were analyzed. The overall prevalence (95% uncertainty level (UL)) of CFH in at least 1 relative (first or second-degree relatives (FDR/SDR)) was 37.06 (27.50, 47.05). The prevalence (95% UL) of CFH in at least 1 female and male FDR was 12.54 (8.62, 17.25) and 11.07 (7.22, 15.34), respectively. The prevalence (95% UL) of a positive history of lung, breast, and colorectal cancers in at least 1 FDR was 2.05 (1.36, 2.90), 1.36 (0.79, 2.08), and 1.23 (0.63, 2.02), respectively.

 The prevalence of positive CFH in FDRs is less than that of developed countries and exceeds 11.8% in the general population of southeastern Iran. CFH taken by general practitioners in routine visits is recommended as a screening tool in this population.

Due to the rapid advancement of medical knowledge, promotion in research is necessary to have the best clinical practice. Research Self‑efficacy (RSE) is the researcher’s confidence in their ability to conduct a specific study. The Evidence‑Based Practice (EBP) represents how to improve the quality of care and treatment of patients. RSE and EBP are the cornerstones of successful research and then efficacious medical practice.This study aims to evaluate RSE and acceptance of EBP and their correlation among medical students.

This is a cross‑sectional study designed on 600 clinical students at the medical school of Shiraz, using a census method in 2020. Students were invited to fill out the standardized Phillips and Russell’s questionnaires about RSE (4 domains, 33 questions) and Rubin and Parrish’s questionnaire of EBP (10 questions). The gathered data were analyzed through the SPSS at α = 0.05 using descriptive statistics, t‑test, Chi‑square, and multiple linear regressions.

There was a positive correlation between EBP and RSE score (P < 0.05). The results of linear regression test showed that all variables had a significant effect on our response variables and their effect were significant (P < 0.05). The highest mean score in RSE was shown in the subscale of writing skills (52.54). The lowest score was observed in the subscale of quantitative (student’s subjective assessment of their ability to work with statistically related data and formulas) as well as computer skills (35.61).

Students who participated in a research project, workshop, or Master of Public Health program got a higher RSE and EBP. Due to the positive correlation between RSE and EBP, we conclude that trained physicians who can research independently and use research evidence can find the best treatment approach for patients. These finding support the importance of integrating research education in medical curriculum to increase RSE and finally improvement of EBP among medical students.

Abdominal obesity is associated with increased risk of myocardial infarction and death events. Thus, obtaining data on the status of abdominal obesity is important in risk factor assessment and prevention of non-communicable diseases. This study aimed to evaluate the validity of using pictograms to classify abdominal obesity indices (waist circumference [WC], waist-hip ratio [WHR], and waist-height ratio [WHtR]) into normal and at-risk categories and determine the effects of demographic characteristics on this validity.

This cross-sectional study used data from Pars Cohort Study (PCS). Participants chose the most similar pictogram scores to their body size at 15, 30 years, and current age. Optimal normal/at-risk cut-off values for pictograms were calculated using sensitivity/specificity plots. Receiver operating characteristic curves were used to evaluate the validity of pictograms. Validity measures were analyzed across different subgroups of demographic characteristics.

A total of 9263 participants (46% males) were included in the study. The estimated area under the curves were 84% for WC, 77% for WHR, and 89% for WHtR in males, and 84% for WC, 73% for WHR, and 90% for WHtR in females. Optimal pictogram cutoffs to classify central obesity for WC, WHR, and WHtR were 4, 4, and 5 in males and 4, 4, and 6 in females, respectively. The majority of demographic characteristics were not associated with the validity of pictograms.

Using pictograms to determine normal and at-risk categories of abdominal obesity indices is valid among adult population with a wide range of demographic characteristics. However, the results need to be interpreted with caution in those with a positive history of weight fluctuation.

Coronavirus disease 2019 (COVID-19) is a life-threatening disease that has spread globally and received international concern. Iran is one of the countries severely affected by this pandemic, implementing social lockdown and restrictive strategies. According to Persian medicine, restrictions like quarantine have psychological and social consequences.

This study aimed to investigate the relationship between sleep quality and anger behaviors in Iran and compare it with Persian medicine viewpoints.

In this cross-sectional study, 739 participants were interviewed in April 2020 in Shiraz, Iran. The questionnaire included the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Anger Inventory (MAI), and items on demographics, temperament, and the quarantine situation social factors. All participants completed the questionnaires willingly and were ensured of data confidentiality.

We found that 58.3% of the participants had low sleep quality. Females showed higher scores on anger and its related aspects (P < 0.05). In addition, people with lower education and income levels revealed higher anger scores (P < 0.05). Moreover, the mean scores of anger and its related factors were higher in participants with low sleep quality, higher sleep latency, daytime dysfunction, and experience of using sleep medications (P < 0.05). Also, after adjustment for demographics and other social factors, the mean scores of anger and all of its aspects were higher in those with a sleep disorder, use of sleep medications, and daytime dysfunction (P < 0.05).

In conclusion, our findings illustrated that various factors, including low sleep quality, are associated with anger in individuals with the experience of home quarantine during the COVID-19 outbreak. The outcome is compatible with Persian medicine evidence.

 Self-report of the use of complementary and integrated medicine by patients with Multiple Sclerosis (MS) can minimize the risk of possible side effects and drug interactions. This study aimed to survey the self-reported use of complementary and integrated medicine by patients with MS in Iran.

 This is an analytical cross-sectional study conducted in spring 2020 on 577 patients with MS who were selected from the Fars MS Disease Registry using a simple random sampling method. Data were collected using a standardized questionnaire and interview, and analyzed in SPSS v. 12 software.

 There was a significant difference between the self-reported use of complementary and integrated medicine and patients’ gender, marital status, employment status, level of education and the complications of the disease (P≤0.05). Overall, 97% of participants had used at least one of the complementary and integrated medicine items, however, only two-thirds of them declared their use to the physician. The most common used complementary and integrated medicine items were herbal medicines and dietary supplements.

 Most of MS patients in Shiraz use complementary and integrated medicine. The declaration of the use of these treatments by MS patients may play a role in strengthening the physician-patient relationship as well as strengthening evidence-based policy and better management of MS.

Public health policies and programs should be adapted to the level of public trust in the healthcare system, as an indicator of the public support level. Accordingly, the data about public trust level in the healthcare system is considered as a critical requirement for managing public health crises. This study aimed to rapidly assess the public trust in the healthcare system during the COVID-19 epidemic in Iran, as well as to evaluate the effect of socioeconomic status (SES) on this trust.

This cross-sectional and web-based study which was conducted in Iran during the COVID-19 epidemic included adults aged 18-60 years. A probability proportional to size multistage random sampling was applied and performed in 15 provinces of the country. Data on the main sources of information about COVID-19, trust in healthcare system, fear level of COVID-19, and demographics were collected via an electronic questionnaire. Multiple linear regression was applied, and adjusted regression coefficients and 95% confidence intervals (CIs) were estimated.

A total of 5250 adults (response rate: 76%) were included in the study. The mean of reported trust scores was 50.3 ± 22.8, and that of fear scores was 72.0 ± 17.8. The highest (65%) and lowest (28%) levels of trust were observed among participants from the lowest and highest SES, respectively. Gender (male) (P = 0.006), higher levels of education (P < 0.001), higher socio-economic status (P < 0.001), and higher fear scores (P < 0.001) were independently correlated with the lower level of ⦰ trust in healthcare system.

It was found that the public trust in Iran’s healthcare system was not high enough at the time of the COVID-19 epidemic in the country, especially among higher social class population.

We examined and estimated the trend of breast cancer incidence in Kerman, the largest province in Iran.

Having compiling the data of new cases from three sources (cancer registry, pathology, radiotherapy) in this longitudinal study, the number of untouched cases was estimated using log-linear model. We estimated the annual age-standardized rate (ASR) per 100,000 women in 2001-2015. We utilized joint point regression method to estimate the trend of breast cancer incidence during the examined years.

The ASR of breast cancer increased from 25 in 2001-2005 to 37 in 2011- 2015, showing that the annual average percentage increased by 5.9% (95% Confidence Interval: 3.5, 8.4, p <0.001). Moreover, during this period, the completeness of the cancer registry increased from 16% in the first five years to 70% in the last five years.

Our findings revealed that the coverage of the cancer registry increased significantly. It seems that part of the increasing trend of the reported cancer incidence was attributed to the enhancement of the cancer registry scheme, but our findings suggested that the real incidence of breast cancer had a growing trend.

Polypharmacy can negatively affect the life of type 2 diabetes (T2DM) patients. There is little evidence on the associated factors of, and patterns of polypharmacy among T2DM patients in developing regions. The aim of this study is to determine the population-based prevalence of polypharmacy, its associated factors, and pattern in southern Iran.

We used baseline data from the Pars Cohort Study (PCS). Age-standardized prevalence of polypharmacy and its 95% confidence interval (CI) were estimated. Association of polypharmacy with demographic and socio-economic factors, anthropometric measures, serum biomarkers, physical activity, cigarette and tobacco smoking, and multimorbidity was assessed by applying multivariable Poisson modeling. Prevalence ratio (PR) and its CI were estimated. The Anatomical Therapeutic Chemical (ATC) classification system was used for drug classification.

Totally, 874 previously diagnosed T2DM patients with a mean age of 56.3±9.2 participated in the study. The estimated agestandardized prevalence for men and women was 17.2% (CI: 12.0–22.0) and 34.1% (CI: 33.2–39.4), respectively. The prevalence of hypertension, hyperlipidemia and cardiovascular disorders among the study population was 39%, 58% and 20%, respectively. Having more than four comorbidities (PR, 3.90; CI, 2.39–6.34), central obesity (PR, 2.66; CI, 1.03–6.84), and female gender (PR, 1.49; CI, 1.14–1.97) were associated with polypharmacy. Also, 56.0% of patients and 23.0% of elder patients (>59 years old) reported using anti-diabetic agents.

Polypharmacy was low among T2DM patients. More than 75% of the elder population were not on anti-diabetic medications. Polypharmacy was higher among patients with multiple comorbidities, central obesity, lower physical activity, lower socio-economic status, younger age at diagnosis, and longer duration of T2DM.

Previous studies have shown that breast cancer (BC) risk perception could be a motivation for screening behaviors. This study was conducted to compare the level of BC risk perception of women aged between 30-40 and 41-60 years, and to determine the factors affecting screening behaviors and examine the association between BC risk perception and BC screening behaviors.

This cross-sectional study was performed using a Rutherford instrument for BC risk perception on 754 women aged 30 to 60 years with no history of BC in 2018. The questionnaire included demographic information, risk factors of BC, screening practice, and risk perception of BC. The association between screening behaviors with women’s BC risk perception and some other variables were assessed utilizing pathway analysis method with the Structural equation modeling (SEM), which summarized the results by odds ratio index.

The mean score of BC risk perception was 28.9±24.3, which was 31.2±24.4 in women aged 30 to 40 and 25.9±23.9 in women aged 41 to 60 years (P value = 0.003). The association between mammography with risk perception was (OR:1 [95%CI: 0.9, 1]). According to this study, the most important variables affecting mammography were increased clinical examination (OR: 34.6 [95%CI: 16.3, 73.7]), age (OR: 8.8 [95%CI: 4.9,16]), family history of breast cancer (OR: 4 [95%CI: 1.3, 12.9]), and higher education level ([OR: 1.4[95%CI: 1.1,1.9]).

The results of our study indicated that younger women had higher BC risk perception. BC risk perception was not found to have any direct effects on mammography. This survey revealed that physicians had an important role in encouraging women to perform mammography.

Poor oral health is common in the world, especially in low-income and developing countries. We evaluated oral health status and its association with sociodemographic and economic variables in one of the largest cohort studies in Iran.

This cross-sectional study was conducted using data from the Pars Cohort Study which is conducted in a rural area in southern Iran. A total of 9264 individuals were enrolled in the initial registry. Data on sociodemographic and clinical characteristics were collected. Oral assessment was completed by trained physicians. Generalized negative binomial regression modeling was applied.

Overall, data from 9264 participants entered the final analysis. The participants’ mean age was 52.6 ± 9.7 years. In total, 8975 participants (96.8%) had at least one tooth loss and 1790 participants (19.3%) were edentulous. Female gender (incidence rate ratio [IRR]: 1.05, 95% CI: 1.02, 1.08) (IRR: 1.12, 95% CI: 1.07, 1.16), opium consumption (IRR: 1.17, 95% CI: 1.12, 1.22) (IRR: 1.23, 95% CI: 1.16 1.30), lower socioeconomic status (SES) (IRR: 1.07, 95% CI: 1.03, 1.10) (IRR: 1.10, 95% CI: 1.06, 1.15) and being illiterate (IRR: 1.23, 95% CI: 1.20, 1.26) (IRR: 1.36, 95% CI: 1.32, 1.41) were associated with higher decayed, missing and filled teeth (DMFT) and more tooth loss.

Oral health was poor in our study sample, especially among older individuals, people with lower SES, illiterate participants, smokers and opiate consumers, which shows the need for improvement in oral health care.

Celiac disease is a common disorder but there are few studies comparing the clinical features of the disease in adults, adolescents and children.

Demographic and clinical characteristics of all patients with celiac disease referred to the Celiac Clinic were evaluated and compared in different age groups.

Of 3416 participants, 473 patients were included. 302 (63.8%) were women and 171 (36.2%) were men. Overall, 325 (68.7%) and 411 (86.9%) patients had gastrointestinal (GI) and non-GI manifestations, respectively. The most common symptom in adults was psychiatric problems (66.5%), while abdominal discomfort was the most common symptom in adolescents (45.2%) and children (53.8%). According to age groups, GI manifestations were seen in 79 (66.4%), 119 (59.8%), and 127 (81.9%) children, adolescents, and adults, respectively. Adults had significantly more GI manifestations than the other groups (PR 1.167; 95% CI: 1.094- 1.244; p < 0.001). Non-GI manifestations were seen in 90 (75.6%), 174 (87.4%), and 147 (94.8%) children, adolescents, and adults, respectively. Adults had significantly more non-GI manifestations than the other groups (PR 1.112; 95% CI: 1.060-1.168; p < 0.001).

Our study showed that there were significant differences in the clinical features of celiac disease between the different age groups. Considering these results may help plan for future studies.

Retinoblastoma (RB) is the most common intraocular malignancy in childhood. The aim of this study was to investigate the epidemiological features and survival rates of patients with RB in southwestern Iran.

This retrospective study was conducted on patients with RB referred to the only referral center of southwestern Iran from 2010 to 2018. Demographic characteristics at first symptom presentation, the time interval between the symptom presenting and the treatment, educational level, socioeconomic status, type of ocular symptoms, extra-ocular involvement, types of treatments, outcomes and follow-up, the treatment interval until death and the survival rate of the patient, and pathology reports were recorded and analyzed.

This study included 46 new patients with RB (25 boys and 21 girls) including 65.2% unilateral, 26.1% bilateral, and 8.7% trilateral involvements. The mean age at first symptom presentation was 18.98±16.16 months. The mean delay time was 2.48 (Interquartile range: 5.16) for boys and 3.02 (Interquartile range: 5.37) for girls (P = 0.265); death rate was significantly different for boys and girls (12.0 % versus 430%; P = 0.039). E-nucleation was done in 95.3% of cases. In 29% of patients the tumor was well-differentiated, and about 64.5% of the cases were pathologically graded at pathological tumor stages 3 or 4. At the time of the study, 54.3% of the patients were alive.  The mean survival time was 44.0 months.

Almost all cases were diagnosed in the advanced stages of the disease in Southwestern Iran. The disease is not preventable but early diagnosis improves the prognosis so we recommend that an eye examination at birth and designing and implementing prevention programs through parenting and child care personnel be performed in order to pay attention to early symptoms of the condition and in the absence of symptoms, screening should be done every six months.