maryam khayamzadeh

The introduction of health culture promotion in Ministry of Education is to know the components and elements and the nature of the education and training system and its culture, and this is achieved through the strategic management of health culture in education. In this manuscript, the role of education in health culture promotion is discussed.

This is a review study which was performed by searching keywords in national and international databases and summarizing the obtained contents.

In the new approach to health, culture and health are two categories intertwined, and all cultural elements in education are tied to the health of students, schools and society. In this approach, the school as a small and influential society, affects the lifestyle and health literacy of the students, considering all the physical and social aspect. The process of managing and promoting health culture includes two main components of organizational culture and individual student behavior. These two components must be in systemic interaction. The individual behavior of the student should be based on the organizational culture of the school. Health promotion schools include a systemic and comprehensive approach that integrates all aspects of health in the educational environment. Their goal is to promote health culture among students considering physical, social and environmental factors, by improving knowledge and awareness.

The approach of health promoting schools shows a paradigm shift towards an integrated and system-based model that requires re-evaluation of the processes of planning, implementation and evaluation of activities and programs of Education Ministry to effectively strengthen the health culture.

Academic faculty members play the most influential role in realizing the goals and ideals of higher education and community health. In the contemporary period, the cultural and educational role of professors, in the most crucial mission of higher education, has not received the required and necessary attention, and neglecting it has resulted in irreparable damages and adverse consequences. This study attempted to identify the prominent cultural roles of professors in relation to students (with an emphasis on higher health education), while explaining the necessity and importance, and effective solutions were examined and proposed. The present study was conducted using a descriptive-analytical method and a focus group discussion. Selected views of expert professors and data from authentic local scientific articles and related topics in upstream documents were utilized. The findings of the study were classified into five main themes and forty categories. “Cultural goals and ideals”; “general mission of professors for the cultural education of all students” and “special mission of professors of higher health education”; “authentic methods”; and “requirements for cultural education of students” were identified and recommended under the eight selected topics in each axis in order of priority. University Professors play a central role in the cultural and ideological education of students. It is appropriate to develop this responsibility in an objective manner and with suitable scientific methods and observe its excellence and realization in the education system.

The integration of medical education in healthcare system with the law establishing the Ministry of Health and Medical Education in 1985 is one of the important issues in the history of medical developments in Iran. The purpose of this study is to discover and analyze the consequences of this law and the establishment of the ministry.

In this qualitative study, 13 policymakers, legislators, and medical education researchers in Iran were selected to participate through semi-structured interviews. The data obtained were analyzed using conventional content analysis method.

Despite the problems of the integration, this system had positive achievements during about 4 decades. The three main categories built in the research are: human resource development, growth and promotion of the quality of services, and promotion of medical knowledge.

The formation of the Ministry of Health and Medical Education under the law in 1985 had positive achievements for the ministry and the social system. Moreover, paying attention to the weaknesses and challenges of the Integration is one of the important necessities for correcting the mentioned obstacles and limitations.

Breast cancer develops due to the combination of external and internal risk factors. Also, the role of viruses is considerable in developing breast cancer.

This study compared the frequency of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) and the level of IgM and IgG antibodies against HSV between cancer patients and healthy individuals.

Sixty women with breast cancer and 60 healthy women (40 with fibroadenoma and 20 in good health) were selected. Breast tissue and serum samples were taken from all the subjects to evaluate the HSV-1 and HSV-2 genome frequency using real-time PCR. Also, serum levels of IgM HSV and IgG HSV antibodies were assessed using the ELISA technique.

The HSV-1 genome was detected in six cancer specimens and in two fibroadenoma specimens (P = 0.143, OR: 3.22, CI95%: 0.623 - 16.66). Three cancer cases and one fibroadenoma case were positive for HSV-2 (P = 0.309, OR: 3.105, CI95%: 0.314 - 30.73). HSV IgM antibody was positive in three subjects in the control group and six in the case group (P = 0.298, OR: 2.11, CI95%: 0.503 - 8.87). Although the higher mean levels of antibodies were found in the case group (4.01 ± 5.91 U/mL) compared to the control group (2.95 ± 3.51 U/mL), there was no statistically significant difference between them (P = 0.179). The serum of all samples was positive for the HSV IgG antibody, and there was a statistically significant difference in its mean levels between the case (91.22 ± 13.58 U/mL) and control (81.58 ± 17.02 U/mL) groups (P = 0.008).

The present study showed that HSV-1 and HSV-2 were not directly related to breast tissue carcinogenesis and may act as co-factors.

Triple negative breast cancer (TNBC) accounts for about 10% to 20% of breast cancers, does not respond to endocrine treatment, and is more aggressive. Two chemotherapy methods suggested include neoadjuvant chemotherapy (NAC), performed before surgery, and adjuvant chemotherapy (AC), performed after surgery. In order to determine whether the choice of chemotherapy method has any impact on patients’ outcome, the present study aimed to compare the overall survival (OS) and disease-free survival (DFS) of TNBC patients with a 10-year follow-up.  

The present study aimed to investigate the effect of neoadjuvant versus adjuvant chemotherapy on the final outcome of patients with TNBC. Women with TNBC stages II and III who referred to the Cancer Research Center of Shahid Beheshti University of Medical Sciences during 2000 and 2020 were included (N = 237) and visited or called by phone to obtain their consent and complete their information. The participants were categorized into 2 groups according to the treatment protocol they received; one group received NAC (N = 85) and the other group received AC (N = 188); patients’ age, tumor’s grade and stage, lymphovascular invasion (LVI), DFS, and OS were compared between the 2 treatment types. For the statistical analysis, the statistical software IBM SPSS Statistics for Windows, Version 24.0. (IBM Corp) was used. All tests were 2-sided and P values < 0.050 were considered statistically significant.  

The frequency of pathologies, LVI, and type of surgery was not different between the groups (p = 0.543, p = 0.352, p = 0.935), while the frequency of age categories and tumor grade was significantly different between the groups (p = 0.003, p = 0.001). Ten-year OS and DFS were not different between the groups (p = 0.771, p = 0.506). The Multivariate Cox analysis results showed clinical stage, pathologic grade, age >70, and LVI as significant predictors of death.   

These results showed that the choice of chemotherapy method, performed before or after surgery, does not influence the 10-year OS and DFS of TNBC patients.

Gastric cancer has been one of the major causes of death in the past decades. It is the fifth most prevalent cancer and the third leading cause of neoplasm death worldwide. Thus, to know more about this health problem, assessing the burden of this cancer and its association with socioeconomic status of countries is of great importance. In this study, we aimed to evaluate the mean trend of gastric cancer mortality-to-incidence ratio (GCMIR) in different super regions defined by the Institute for Health Metrics and Evaluation (IHME) and investigate the relationship between GCMIR and Human Development Index (HDI) in the period 2000-2016.

We used the data from the Global Burden of Disease (GBD) 2016 study to calculate GCMIR for 185 world countries in the period 2000–2016. We also extracted the HDI data for each year under study from the Updates of the UNDP website. To attain the analytic aims, marginal modeling and generalized estimating equations (GEE) were utilized.

Sub-Saharan Africa was the only super region with a positive slope of GCMIR, and high-income countries had the greatest decreasing slope of GCMIR during the study period. Moreover, there was a negative association between GCMIR and HDI in these years.

Our findings revealed that gastric cancer could be thought not only as a biological disease but also as a social event that will be more controllable with the improvement of economic status and other social determinants of health.

Smoking is a major public health challenge. In addition, it cause economic damage due to lost productivity and increased health care costs. In this article, challenges and suggestions for controlling this health and social problem are presented.

National and international referrences were used to prepare this article.

The World Health Organization led the development of the Framework Convention on Tobacco Control, the first global health treaty to strengthen efforts in order to reduce using tobacco among signatory members. The organization introduced the MPOWER package, which contain six evidence-based control measures to help countries implement tobacco control policies,. Worldwide, reducing smoking can be achieved by doubling the adjusted inflation prices or tripling the indirect tobacco tax. Other interventions recommended by the World Health Organization (WHO) Framework Convention on Tobacco Control and the MPOWER six-point initiative can also help reduce tobacco consumption. The world has changed dramatically since the last reported of WHO on the global tobacco epidemic in 2019.

Several items can help tobacco controling program such as increase tobacco tax, supply and access to smoking cessation treatments, increase health warnings in tobacco packaging, increase the accuracy of tobacco epidemiological data and reduce exposure to second-hand smoke.

 The role of carcinogenic viruses in developing breast cancer has not yet been identified. Many studies have examined the association between breast cancer and human cytomegalovirus (HCMV), but conflicting results have been reported.

 The aim of this study was to evaluate the levels of IgM & IgG antibodies against HCMV by identifying the viral genome in the breast tissue of women with breast cancer.

 A total of 60 patients with breast cancer and 60 healthy individuals (40 cases with fibroadenoma and 20 healthy samples) were selected. Serum levels of IgM & IgG antibodies against HCMV were measured by ELISA, and after DNA extraction from the breast tissue, the presence of the cytomegaloviruses (CMV) genome was assessed by Real-Time PCR.

 Real-time PCR results showed that 20 samples of breast cancer tissue and 5 samples of fibroadenoma were positive for CMV genome (P = 0.001, OR: 5.50, CI 95%: 1.90 - 15.89). All samples had CMV-IgG antibody in their serum, but their mean serum level was higher in the cancer group (48.27 ± 15.99 U/mL) than the control group (40.11 ± 18.01 U/mL) (P = 0.004). However, CMV-IgM anti-viral antibody was positive in 5 cases with cancer and 3 cases in the control group. The mean serum concentration of this antibody was higher in the cancer group (6.60 ± 6.75 U/mL) than the control group (4.92 ± 3.03 U/mL) (P = 0.099).

 Increased serum levels of anti-CMV antibodies in patients with cancer, as well as the presence of viral genomes in some cases, indicate the carcinogenesis effect of the virus.

The COVID-19 pandemic is now the most important and the most urgent challenge in most countries of the world. Although rapid and massive vaccination in most countries have enlightened the path of control of this pandemic but even in these countries the high replication capacity of the new variants of this virus and reduced sensitivity in compliance to preventive measures may lead to infections and death. Control of this pandemic depends not only on rapid and massive vaccination but also on cooperation of governmental and non-governmental sectors, as well as community engagement. There is a continuous need for dynamic approaches in improving the policies, programs and interventions to control the pandemic.

In this study, a mixed method including focus group discussion and experts panels and review of scientific references as well as the best practices at global and national levels were used to find the bottle necks for improvement in the control of this pandemic .

Strengthening the headquarters for the COVID-19 pandemic at national, provincial and county level with decentralization of power and multisectoral approach, improvement of communication and community engagement, monitoring and facilitation of quarantine, strengthening the role of the Ministry of Health, reform of clinical pathways and rapid expansion of programs for universal health coverage decentralization, enhancing rapid access to vaccination, updating the guidelines, reforming disease control centers, continuous epidemiological studies and intelligent use of traditional medicine were found to be the most important foci to be improved. Reopening of schools and educational institutes should be a dynamic process with consideration of not only the health of the attendees but also their social and mental needs.

Although rapid and massive vaccination arethe mainstays to control this pandemic, other interventions are needed to improve the control policies, programs and interventions in a dynamic manner.

Breast cancer (BC) is surging as a public health issue in Iran and engagement in positive health behaviors improves the odds of survival and reduces the risk of concomitant comorbidities in BC survivors.

The primary purpose of this study was to investigate the impact of socioeconomic inequalities on leisure-time physical activity (LTPA) and fruit and vegetable (F & V) consumption among Iranian BC survivors. Another objective of this study was to examine the role of psychosocial factors, such as stress, self-efficacy, and social support as mediators between socioeconomic status (SES) and these health behaviors. Few studies have investigated social disparities in the health behaviors of cancer survivors. Likewise, the mediating role of psychosocial factors in the SES-health behavior gradient has rarely been explored in the cancer context. Psychosocial factors might have positive implications for socioeconomically disadvantaged survivors.

Cross-sectional data were obtained from 196 patients with BC by a telephone-administrated questionnaire. The Behavioral Risk Factor Surveillance System (BRFSS) 2013 was partially employed to measure exercise and F & V consumption. Cross-sectional analyses (correlation and logistic regression) were conducted to assess the relationship between SES, psychosocial factors, and health behaviors (P < 0.05).

Regarding LTPA and F & V consumption, more than half of the survivors complied with the recommended levels, consecutively. Both education and family income exhibited a positive association with LTPA and F & V consumption. Furthermore, self-efficacy and social support showed a positive relationship with LTPA and F & V consumption.

The SES impacted health behaviors directly and via intermediary psychosocial factors. The results can inform future studies and interventions; psychosocial factors could buffer the effects of social inequalities on health behaviors. A key policy priority should, therefore, be planning and implementing psychosocial empowerment interventions to promote exercise and a healthy diet among impoverished cancer survivors.

Induced demand refers to performing care or unnecessary services to patients or clients of the health system by applying power and ordering the specialists of the system. Induced demand arises as a result of various economic and structural factors, health market factors, and the behavior of service recipients and vendors. In our country, induced demand is one of the challenges of the health system; it increases the costs of the health sector and reduces its efficiency. One of the main challenges in the health system is the lack of causes of problems such as induced demand and its underlying factors. Explaining and analyzing this phenomenon can provide a clear perspective for decision-making. According to general health policies, prevention of induced demand for medicine and medical equipment and supplies is the responsibility of the Ministry of Health and Medical Education, but practical activities have not been done yet. Despite the need for national applied research, we found a few credible databases about this phenomenon and there were limited researches that do not answer the questions and challenges in basic decisions. The aim of this study was to explain the strategies to reduce induced demand in the country's health services.

This study was done by searching credible scientific and international references with the keyword "induced demand" and reviewing the available upstream documents, collected information on the definitions of induced demand and its effective causes, induced demand methods in medical services, challenges and how to control it. An expert panel was held with 23 specialist and national experts. Findings were collected and completed and analyzed qualitatively.

According to the findings, induced demand is a complex and multifactorial phenomenon that impairs the efficiency and allocation of national resources. In addition to upsetting the balance of supply and demand in the health market, it imposes additional costs on the patient and wastes time. This phenomenon sometimes leads to treatment and misdiagnosis and medical complications for health system client. Structural (causes related to organizational structure and service delivery, service recipients, and causes arising from insurance organizations) and social causes underlie the macro causes affecting induced demand.

Induced demand is the result of the interaction of individual, social and organizational factors that have social, health, and economic consequences for the community and can be prevented by using multiple strategies to prevent induced demand in health services.

 Sarcomas are a wide group of tumors with a mesenchymal origin, accounting for 1% of all adult malignancies.

 This study examined the incidence rates and distribution patterns of morphological subtypes and primary sites of soft tissue and bone sarcomas in a 6-years period in the total population of Iran.

 The data was retrieved from the Iranian National Cancer Registry (INCR). A total of 14630 patients were identified with either bone or soft tissue sarcoma during 2009 - 2014. The morphological and topographical classifications were based on the ICD-O-3 and World Health Organization (WHO) guidelines. The crude and age-standardized incidence rates (ASIR) were calculated.

 The combined crude incidence was calculated 3.2/100,000, and for STS and BS was 2.7 and 0.5 per 100,000 individuals, respectively, increasing with the age. Among the patients, 16.47 and 83.53% of cases had BS and STS, respectively with male predilection. The ASIR calculated 2.8 and 2.6 for STS and 0.51 and 0.37 for BS in males and females, respectively. Sarcoma, osteosarcoma, leiomyosarcoma, liposarcoma, and spindle cell sarcoma were the most common morphologies. The connective tissue of the lower limb, long bone of the lower limb, skin, and uterus were the most frequent primary tumor sites. The majority of tumors were of unknown/undifferentiated grade (grade 9), then grade 3, 1, 2, 4, and score 0 had the highest frequencies, respectively. The highest ASIR of sarcoma was detected in Khuzestan, Kohgiloyeh and Boyer-Ahmad, Isfahan, Tehran, Fars, and Khorasan Razavi provinces. Analysis of the incidence trends showed a slight increase over the study period.

 These findings can help better diagnose and management of sarcoma patients throughout Iran.

Covid-19 has spread rapidly in the world and has affected the health and other aspects of human being life. The virus which causes this disease has various effects on mental health, and different segments of society such as patients, health care providers and general population. In this article, the effects of this virus on mental health and related risk factors are discussed.

For compiling this review, national and international articles from credible referrences have been used.

Symptoms such as anxiety, depression, post-traumatic stress disorder, psychological distress and stress were reported in the general population and patiets with COVID-19. Factors such as staying at home, social distancing, closing educational centers, mass lockdown, worry about being infected and transmission to others are the risk factors of these diseases.

COVID-19 has a dual effect on human mental health, one of the complications of this disease is psychological complications and on the other hand, patients with mental illness are prone to COVID-19.Considering the numerous and sometimes dangerous effects of Covid 19 on mental health, reducing the dangerous effects of these complications is one of the priorities of the health system. In order to properly manage the effects of Covid 19 on the mental health of the community, urgent call for more attention given to public mental health and policies and also cooperation of the policy makers, scientific experts and the community members to assist people through this challenging time are necessory.

Covid 19 has spread rapidly in the world. In dealing with this event, in addition to preventive and therapeutic interventions, psycho-spiritual approachis needed. Islamic spiritual health is intended to be guidance in daily life including the current pandemic.

Islamic references specially the holy Quran were searched for key word affection.

According to the Islamic references, there are two systems in the world, creation system and legislation system. Divine creative permission means that God allows something to happen. But the divine legislative permission is related to the divine commands. God knows all the details of world events. One of the important issues to be considered in all kinds of disasters, including the current Covid crisis, is the issue of the various circumstances surrounding an event. From the perspective of the Quran, the types of disasters which occur for human can be divided into six main categories. Self-induced disaster, troubles caused by oppressors, disaster for punishment, disaster for examination, troubles of the saints, troubles of duties.Based on Islamic beliefs there shouldbe active and rational planning and action along with promoting the relation with almighty God to increase the resilience.

There is urgent need to promote spirituality literacy in the community Based on Islamic beliefs rational planning and action along with religious instructions and praying are mandatory impositions.

One of the most important alterations in breast cancer treatment is the change of view in axillary lymph node management. At the moment, sentinel lymph node biopsy (SLNB) is the standard care in axillary lymph node management. However, in patients with clinically positive lymph nodes or in patients, who have no willingness to receive radioactive drugs, axillary lymph node dissection (ALND) must be done. To the best of our knowledge, there is no overall survival (OS) benefit in ALND, especially at the early stage of breast cancer, during which this procedure is not justified.

Herein, we have reported the results of 27 years of experiments in limited axillary lymph node dissection (LALND) in comparison to ALND as well as the relationship among the number of removed lymph nodes, OS, and disease-free survival (DFS) at the early stage of breast cancer.

OS and DFS for 588 cases, who were at the early stage of breast cancer and treated by LALND between 1984 and 2019, were compared with 1026 patients, who were treated by ALND during the same interval in this study. Notably, SLNB cases were excluded.

The results revealed no significant difference among the groups in terms of DFS (P = 0.268, 0.123, and 0.333). Also, there was no difference in terms of OS between the LALND group (1 - 4 nodes, 5 - 6 nodes, and 7 - 8 nodes) and ALND group (≥ 9 nodes) in patients without lymph node involvement (AHR less than 2). However, in the patients with axillary lymph node metastasis (N1, N2), similar results were obtained. Correspondingly, in this group, the best results were observed in those patients, whose 7 - 8 lymph nodes were removed.

Regarding the results of the current study; it can be concluded that performing the LALND in the defined anatomic range and removing 7 - 8 lymph nodes instead of removing 10 lymph nodes are not inferior when it is not possible to do SLNB (there is no access to it) and/or being a contraindication to do it for evaluating the status of axillary lymph nodes in the patients at the early stage of breast cancer.

Bladder cancer is the fourth most common cancer in men and the most common cancer in women, comprising 8% of all males and 3% of female tumors. The present study aimed to estimate the five-year survival rates of bladder cancer in Iran.

Information on3,337 registered cases of bladder cancer was obtained from the Office of National Cancer Registry in the Ministry of Health and Medical Education (MOH & ME). A telephone survey was conducted to gather additional information, such as survival status, demographic, and clinical profile. Kaplan–Meier estimates of five-year survival rates were calculated according to the age of diagnosis, gender, pathological type, and provincial pole. Results and

Overall five-year survival rate was 77%. According to the pathologic type, five-year survival rates were 81%, 66%, 81%, 42%, 77%, and 82% in low-grade urothelial carcinoma, high-grade urothelial carcinoma, adenocarcinoma, undifferentiated carcinomas, Squamous Cell Carcinomas (SCCs), and other tumors, respectively. Additionally, those tumors  were 93%, 88%, 81%, 64%, and 44% among patients whose average ages at diagnosis were < 50, 50–59, 60–59, 70–79, and > 80 years old, respectively. Our study revealed that age and histological type were the major prognostic factors for survival in patients with bladder cancer. Therefore, given the histologic features of the tumor and patients with advanced age, a continuous screening would be highly warranted.

Prostate Cancer is recognized as the second cause of death due to cancers among men worldwide.Due to the lack of local evidence on the survival rate of patients with prostate cancer, this study aimed to esti-mate the 5-year survival rate of patients afflicted with this condition in Iran.

This studymade use of information on 9,772 prostate cancer cases who were registered in the National Cancer Registryduring 2010-15. A telephone survey, with a response rate of 35%, was conducted to gather additional informa-tion such as death status, demographic characteristics, and clinical profile. Kaplan-Meier estimates was used toestimate five-year survival rates.

The overall five-year survival rate of prostate cancer was 82% (95% CI:80-83%). Significantly higher five-year survival rates were observed among retired patients (rate: 94%,95%CI:92-96), patients receiving a combination of radiotherapy and surgery (rate: 92%,95%CI: 89-94), and patients re-siding in rural areas (rate: 92%, 95%CI: 90-93).

We found that various factors such as occupation,area of residence, and the type of medication, may influence on survival rate of prostate cancer. Careful evalua-tion and understanding of effective factors are required to adopt proper health policies and treatment options.Due to the importance of etiologic and epidemiological data, inclusion of such data into the national registrysystem for Prostate Cancer is strongly recommended

Risk communication (RC) and community engagement are perquisite for management of epidemics. Triumph of RC depends on adjustment of message and considering the characteristics of the sender and the audience according to the context and situation.

This article has been prepared using scientific and relevant articles and guidelines.

For effective RC , the essential steps include public participation; planning; credibility ; deference of other sources of communication ; financing & ethical considerations. For success in RC one should consider community culture, people's beliefs and their understanding of the event . The people’s right to be  worried in epidemics should be recognized by the authorities and participatory strategies rather than compulsive one should be prioritized.

In the pandemic of COVID-19, series of successful and nonsuccessful experiences happened. The of review of these experiences may help the policy makers in their future efforts .

Quality of life in patients with cancer is an important issue. It affects different aspects of the patients’ life. Supportive group therapy helps the majority of women with breast cancer to treat their disease and decrease the recurrence of the disease. Group poetry therapy, as a safe method, can be used to increase the quality of life of patients.

We designed this study to evaluate the effect of poetry therapy on the quality of life of patients with cancer.

A total of 91 participants were divided into the poetry therapy group (n = 31) and the control group (n = 60). Six sessions of weekly poetry therapy were held. Miller Hope scale, Quality-of-Life Questionnaire Core 30 (QLQ-C30), and Quality of Life Questionnaires-Breast 23 (QLQ-BR23) were fulfilled by patients before, 1 week, and 2 and 6 months after the intervention.

Poetry therapy increased hope based on Miller Hope scale 1 week, 8 weeks, and 6 months after the intervention (P = 0.001). The improvement of the functional item of QLQ-BR23 and QLQ-C30 was significant in poetry therapy in comparison with the control group at the end of the study (P = 0.001). The change of side effect items does not differ over the course of the study (P > 0.05).

Group poetry therapy can be a good psychotherapy way to increase the quality of life of patients with breast cancer.

Survival time is one of the indicators used for evaluation of the quality of care in different types of malignancies, including breast cancer. The present study aimed to estimate the survival rate of breast cancer and its related factors among Iranian patients.

Overall, 3148 cases of breast cancer who referred to the Cancer Research Center in Shahid Beheshti University of Medical Sciences, Tehran, Iran during 1994-2017 participated in this longitudinal study. Survival estimates were calculated using the Kaplan-Meier method and the Bayesian generalized Birnbaum–Saunders model with cure rate from geometric distribution. Clinical, pathological, and biological variables as potential prognostic factors were entered in univariate and multivariate analyses. In order to identify the significant prognostic factors, 95% highest posterior density (HPD) intervals were used.

The overall 1, 5, 10, 15, 20 and 25-year survival rate were 95%, 75%, 60%, 47%, 46% and 46%, respectively. A significant relation was observed between survival time and the variables such as age, size of tumor, number of lymph nodes, stage, histological grade, estrogen receptor, progesterone receptor, and lymphovascular invasion.

The findings of this study might help the health managers to plan long-term programs considering regional determinants, public education, and screening for early detection of breast cancer cases which can eventually influence the overall survival rate of these patients.

Bladder cancer is the ninth common cause of cancers in both sexes worldwide. Nevertheless, little is known about the descriptive and analytic epidemiology of bladder cancer in Iran. The present study aimed to describe the nationwide distribution of death due to bladder cancer in Iran.

This cross-sectional study used data of bladder cancer cases who were registered in the national cancer-registry system by the Ministry of Health and Medical Education during 2001-2007. Age-standardized mortality rates due to bladder cancer were presented according to nine geographic poles across the country.

The overall mortality rate of bladder cancer (per 100,000 population) was 2.26 in men and 1.36 in women; while the rates were constantly higher for men across all age groups. The highest and lowest age-standardized mortality rates in provinces (per 100,000 population) belonged to Mazandaran (6.126) and Tehran (1.112), respectively.

Death from bladder cancer seems to increase by age in Iran, mainly among men. This association might be partially due to increased life expectancy, altered high-risk lifestyle behaviors and/or improvement in cancer registration system. Information on the distribution of mortality due to bladder cancer could be useful for local prevention strategies, where specific profile of communities and patients is taken into account

 Nowadays, one criterion to assess the impact of various treatments in cancer patients is the quality of life (QOL), which represents the patients’ physical and psychosocial manner. It is already proved that BCc1 nanomedicine enjoys therapeutic behavior in cancer treatment of in vitro, animal, and human studies.

 In the present study, we aimed at investigating the QOL in gastric cancer patients according to the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) questionnaire after treating them with BCc1 nanomedicine synthesized based on nanochelating technology.

 A randomized, double-blind, and multicenter study was conducted to investigate the QLQ-STO30 of 60 metastatic (8 weeks after treatment) and 60 non-metastatic (20 weeks after treatment) gastric cancer patients in two separate groups named BCc1 nanomedicine and placebo.

 In the metastatic patients, the mean difference of overall QLQ-STO30 showed a 2.8-score improvement in BCc1 nanomedicine (P < 0.05) and a 5.2-score decline in placebo (P < 0.05); in non-metastatic patients, it showed a 2.3-score improvement in BCc1 nanomedicine (P > 0.05) and a 3-score decline in placebo (P > 0.05).

 The results of the study showed that BCc1 nanomedicine improves a number of indices in metastatic and non-metastatic gastric cancer patients, such as functional domains, symptom scales, and global QOL included in EORTC QLQ-STO30 questionnaire.

Cancer is the first cause of death followed by ischemic heart disease (IHD) and stroke, worldwide, with increasing 19.5% years of life lost (YLL) due to cancer from 2007 to 2017. The cancer burden is steadily increased with decreasing 4.4% death rate from 2007 - 2017. The incidence rate of cancer is twice to 3 times higher in developed countries with low mortality due to care regarding developing countries. Here, we report the 10 years’ incidence and mortality of malignancies in Iran with different patterns compared to the other parts of the world. Data of national cancer registry system from 2005 to 2014 were analyzed in order to find out the trend of age standardized incidence rate (ASIR)/age standardized mortality rate (ASMR)/ mortality to incidence ratio (MIR) in both sexes in Iranian population. Growing trend in ASIR for both sexes in all of the cancers were seen. ASMR decreased from 2005 to 2014 in both sexes with higher rate in males. MIR decreased by half in 2014 compared to 2005 regarding the increase of cancer in Iran. In Iran, the incidence of cancer is increasing due to aging people and death is decreasing due to the good care of patient. So, it is a good sample of developing country, which is comparable with the developed ones.

The goal of the pharmaceutical system in all countries centers around increasing patient access to affordable drugs. The ideological basis of the Islamic republic of Iran emphasizes justice and self-sufficiency. This was one of the main vectors of activity in the health system including the pharmaceutical system. At the 40th anniversary of this important event the résumé of activities and challenges in this field including success and failures are summarized.

The related data were gathered through searching electronic databases in both Farsi and English. The published articles as well as the reports from Ministry of Health and Medical Education were used.

In the early years after the Islamic revolution there was a trend towards self-sufficiency; most of the pharmaceutical industries were nationalized and imports were restricted while generic production was encouraged. Over time more private factories were launched; generic production was transformed to generic brand and brand production. This transformation was criticized recently with more emphasis on generic production again. Currently over 100 drug manufacturing companies, 200 drug importing companies, 70 drug distribution companies and over 11,000 drugstores are active in the nation. The quantitative share of domestic production was more than 97%. The total cost of drugs in Iran was about 4 Billion US dollars in recent years corresponding to the annual per capita drug usage of about $ 57 which is lower than the world average. The highest export figures of drugs from Iran has been around 200 million US dollars. Many products are manufactured domestically at a lower price than the world market. Drug subsidies have also kept prices artificially low for some imported items. Establishment of the Food and Drug Organization was one of the most important developments in the country's pharmaceutical field that could underpin transparency and efficiency in drug policy making.

The pharmaceutical system in Iran has transformed from a system mainly based on drug importation to a system with self-sufficiency and autonomy. But there are still many challenges in equitable drug access especially for more sophisticated drugs.

Cancer is the second most common cause of morbidity and mortality in children. Tis study aimed to epidemiologically and demographically assess common cancers in children in Iran.

Tis cohort study was conducted on children registered in Mahak Hospital and Rehabilitation Complex (which is a non-governmental organizations (NGO)-related hospital for only malignant diseases). A total of 2232 questionnaires were flled out for cancer patients between 2007 and 2016. Te factors including age, gender, race, family history, type of treatment, and type of cancer were entered into Cox regression model to examine their e?ect on mortality of children diagnosed with cancer.

Te Cox regression model showed that age, race, type of cancer, family history of cancer, and type of treatment had a signifcant e?ect on mortality of children diagnosed with cancer (P < 0.05). Te hazard ratio (HR) of mortality in 10–15 years old was higher than that of 1–5 years old (P = 0.03, HR = 1.3). Te HR of mortality in patients with brain tumor (P < 0.01, HR = 2.24), sarcoma (P < 0.01, HR = 2.32), and neuroblastoma (P < 0.01, HR = 2.56) was twice the value in patients with leukemia. Te HR of mortality in patients who had a family history of cancer was higher than that of patients without it (P < 0.01, HR = 1.33). Patients who had undergone chemotherapy along with surgery and radiotherapy (P = 0.02, HR = 0.68) and patients who received chemotherapy along with surgery (P = 0.01, HR = 0.67) had a lower HR of mortality compared to the chemotherapy group.

Young age, multidisciplinary approach, and absence of family history were associated with lower hazard of death in children diagnosed with cancer; brain tumor, leukemia, and sarcoma had higher hazard of mortality compared to leukemia. Children with a family history of cancer should be under regular follow-up. Treatment
should be multidisciplinary and comprehensive.