Unveiling an Association between Waterpipe Smoking and Bladder Cancer Risk: A Multicenter Case-Control Study in Iran

BACKGROUND

Limited data exist for the association between bladder cancers and waterpipe smoking, an emerging global public health concern.

METHODS

We used the IROPICAN database in Iran and used multivariable logistic regression, adjusting for cigarette smoking, opium use, and other confounding factors. In addition, we studied the association between exclusive waterpipe smoking and bladder cancer.

RESULTS

We analyzed 717 cases and 3,477 controls and a subset of 215 patients and 2,145 controls who did not use opium or cigarettes. Although the OR adjusted for opium, cigarettes, and other tobacco products was 0.92 [95% confidence interval (CI), 0.69-1.20], we observed a statistically significant elevated risk in exclusive waterpipe smokers (OR = 1.78; 95% CI, 1.16-2.72) compared with non-users of opium or any tobacco. Associations were strongest for smoking more than two heads/day (OR = 2.25; 95% CI, 1.21-4.18) and for initiating waterpipe smoking at an age less than 20 (OR = 2.73; 95% CI, 1.11-6.72). The OR for urothelial bladder cancer was higher in ex-smokers (OR = 2.35; 95% CI, 1.24-4.42) than in current smokers (OR = 1.52; 95% CI, 0.72-3.15). All observed associations were consistently higher for urothelial histology.

CONCLUSIONS

Waterpipe smoking may be associated with an increased risk of bladder cancer, notably among individuals who are not exposed to cigarette smoking and opium.

IMPACT

The study provides compelling evidence that waterpipe smoking is a confirmed human carcinogen, demanding action from policymakers. See related In the Spotlight, p. 461.

Determinants of multimorbidity in older adults in Iran: a cross-sectional study using latent class analysis on the Bushehr Elderly Health (BEH) program

BACKGROUND AND OBJECTIVES

Multimorbidity, defined as the presence of two or more long-term health conditions in an individual, is one of the most significant challenges facing health systems worldwide. This study aimed to identify determinants of classes of multimorbidity among older adults in Iran.

RESEARCH DESIGN AND METHODS

In a cross-sectional sample of older adults (aged ≥ 60 years) from the second stage of the Bushehr Elderly Health (BEH) program in southern Iran, latent class analysis (LCA) was used to identify patterns of multimorbidity. Multinomial logistic regression was conducted to investigate factors associated with each multimorbidity class, including age, gender, education, household income, physical activity, smoking status, and polypharmacy.

RESULTS

In 2,426 study participants (mean age 69 years, 52% female), the overall prevalence of multimorbidity was 80.2%. Among those with multimorbidity, 3 latent classes were identified. These comprised: class 1, individuals with a low burden of multisystem disease (56.9%); class 2, individuals with predominantly cardiovascular-metabolic disorders (25.8%) and class 3, individuals with predominantly cognitive and metabolic disorders (17.1%). Compared with men, women were more likely to belong to class 2 (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52-2.54) and class 3 (OR 4.52, 95% CI 3.22-6.35). Polypharmacy was associated with membership class 2 (OR 3.52, 95% CI: 2.65-4.68) and class 3 (OR 1.84, 95% CI 1.28-2.63). Smoking was associated with membership in class 3 (OR 1.44, 95% CI 1.01-2.08). Individuals with higher education levels (59%) and higher levels of physical activity (39%) were less likely to belong to class 3 (OR 0.41; 95% CI: 0.28-0.62) and to class 2 (OR 0.61; 95% CI: 0.38-0.97), respectively. Those at older age were less likely to belong to class 2 (OR 0.95).

DISCUSSION AND IMPLICATIONS

A large proportion of older adults in Iran have multimorbidity. Female sex, polypharmacy, sedentary lifestyle, and poor education levels were associated with cardiovascular-metabolic multimorbidity and cognitive and metabolic multimorbidity. A greater understanding of the determinants of multimorbidity may lead to strategies to prevent its development.

The association between continuous metabolic syndrome score and its components with electrocardiographic abnormalities in community-dwelling older adults: the Bushehr elderly health (BEH) program

BACKGROUND

Metabolic syndrome (MetS) known as a risk factor for cardiovascular diseases (CVDs) has developed into a major source of health issue, especially for the elderly. In the present study, we investigated the association between continuous MetS (cMetS) score and its components with electrocardiographic (ECG) abnormalities in the community-dwelling older adults.

METHODS

This cross-sectional study is derived from the second phase of BEH cohort study which is conducted on individuals aged over 60 years old. Standard 12-lead ECGs were recorded and coded by qualified physicians and continuous values of metabolic syndrome risk scores (cMetS) were measured. Data regarding socio-demographic, medical history, and lifestyle variables were collected by trained interviewers. The multinomial regression analysis was used to investigate the relationship between cMetS and its components with ECG abnormalities in the included participants.

RESULTS

2426 individuals (mean age ± standard deviation: 69.30 ± 6.33 years) were included in the final analysis. Overall, 22.5% of the participants showed ECG abnormalities. Among these, 8.0% (n = 139) of participants had minor and 14.6% (n = 354) had major ECG abnormalities. In the final models, cMetS (OR = 1.04), mean arterial pressure (MAP((OR = 1.01), and higher fasting blood glucose (FBG) (OR = 1.01) increased the risk of ECG abnormalities (p < 0.05). Also, cMetS (OR = 1.05) and MAP (OR = 1.02) were associated with an increased risk of major ECG abnormalities (p < 0.05).

CONCLUSION

MetS and MAP were significantly associated with ECG abnormalities. The results of the present study suggest that ECG screening in the older population with MetS could potentially help to detect those at the higher risk of CVDs.

Determinants of waterpipe smoking in Iranian adults: results from the IROPICAN study

Introduction

Waterpipe smoking has become increasingly popular in Western countries, particularly among young individuals. This study aims to identify the factors influencing waterpipe smoking by focusing on consumption patterns.

Methods

We utilized data from a multicenter case-control study (IROPICAN) conducted in Iran. Multivariate logistic regression estimated the adjusted odds ratio and 95% confidence intervals as a measure of association between waterpipe smoking and different factors.

Results

Among 3,477 subjects were included, 11.8% were waterpipe smokers. Most of <50 years old smokers were occasional (80%), while daily smokers were often >50 years (85%). Around 59% of occasional users started it before 30 years old. Low education, low SES, alcohol consumption, cigarette smoking, secondhand smoke exposure, and opium use were associated with waterpipe smoking. Stratified analysis by frequency pattern showed an association between occasional smoking with age 0.97 (0.96-0.98), university degree 0.36 (0.17-0.76), urban dwellers 1.40 (1.06-1.86) and between high SES and daily smoking 0.34 (0.17-0.69).

Conclusion

Our results offer valuable information to policymakers for developing waterpipe smoking control measures. The occasional waterpipe smoking results may be generalized to the younger people in Western countries.

Opium use and risk of colorectal cancer: a multi-center case-referent study in Iran

BACKGROUND

Opium use has been associated with an increased risk of cancers of the lung, oesophagus, and pancreas, and it was recently classified by the International Agency for Cancer Research as carcinogenic to humans. It is not clear whether opium also increases the risk of colorectal cancer (CRC). The aim of our study was to assess the association between various metrics of opium use and the risk of CRC.

METHODS

This case-referent study from seven provinces in Iran comprised 848 CRC cases and 3215 referents. Data on opium use (duration, amount, frequency) and potential confounders were collected by trained interviewers. Multivariable unconditional logistic regression models were used to measure odds ratios (OR) adjusted for age, gender, province, marital status, family history of CRC-linked cancers, consumption of red meat, fruits and vegetables, body shape, occupational physical activity, and socioeconomic status.

RESULTS

Regular opium consumption was not associated with the risk of CRC (OR 0.9, 95% confidence interval, CI: 0.7, 1.2) compared to subjects who never used opium. However, frequent opium use more than twice a day was associated with an increased risk of CRC compared to non-users of opium (OR: 2.0, 95% CI: 1.1, 3.8; p for quadratic trend 0.008).

CONCLUSION

There seems to be no overall association between opium use and CRC, but the risk of CRC might be increased among persons who use opium many times a day.

Clinical Breast Cancer Registry of IR. Iran (CBCR-IR): Study Protocol and First Results

BACKGROUND

Breast cancer (BC), as a significant global health problem, is the most common cancer in women. Despite the importance of clinical cancer registries in improving the quality of cancer care and cancer research, there are few reports on them from low- and middle-income countries. We established a multicenter clinical breast cancer registry in Iran (CBCR-IR) to collect data on BC cases, the pattern of care, and the quality-of-care indicators in different hospitals across the country.

METHODS

We established a clinical cancer registry in 12 provinces of Iran. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During this registry, we studied the clinical characteristics and outcomes of patients with cancer who were admitted from 2014 onwards.

RESULTS

We registered 13086 BC cases (7874 eligible cases) between 1.1.2014 and 1.1.2022. Core needle biopsy from the tumor (61.25%) and diagnostic mammography (68.78%) were the two most commonly used diagnostic methods. Stage distribution was 2.03% carcinoma in situ, 12% stage I, 44.65% stage II, 21.32% stage III, and 4.61% stage IV; stage information was missing in 1532 patients (19.46%). Surgery (95.01%) and chemotherapy (79.65%) were the most common treatments for all patients.

CONCLUSION

The information provided by this registry can be used to evaluate and improve the quality of care for BC patients. It will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran.

The association of body composition and fat distribution with dysmobility syndrome in community-dwelling older adults: Bushehr Elderly Health (BEH) program

BACKGROUND AND OBJECTIVE

Dysmobility Syndrome (DS) is characterized as an accumulation of clinical risk factors for functional disability, such as osteoporosis, sarcopenia, and obesity. Neurological disorders that affect the motor and sensory systems can also contribute to the condition, resulting in gait and muscle strength disturbances, as well as a history of falls and fractures. The study aimed to determine the association between fat distribution in different body areas and the odds of older adults developing DS, as there is still uncertainty about the accumulation of fat in which area is most closely linked to the condition.

METHODS

This cross-sectional study was conducted according to the data from the second phase of the Bushehr Elderly Health Cohort (BEH). Dysmobility Syndrome was defined based on the co-occurrence of at least three outcomes of its criteria. Body composition was measured using dual-energy X-ray absorptiometry (DXA) and anthropometric studies. For evaluating the relationship, multivariate logistic regression and adjusted univariate linear regression were used.

RESULTS

Of 2,359 who were recruited in the study, 1,277 participants (54.13%) had DS. According to the final logistic regression model in the limb region, FM and FM to FFM ratios were significantly associated with DS [OR (95%CI) = 1.04 (1.02 to 1.05), and 3.42 (1.95 to 5.99), respectively]. Also, In the trunk region, the FM and FM to FFM ratio were significantly related to the odds of DS, although this relationship was weaker than in the limbs region [OR (95%CI) = 1.02 (1.00 to 1.03), and 2.45 (1.36 to 4.39), respectively].

CONCLUSION

Our findings indicate that a higher regional and whole-body amount of fat mass rather than fat-free mass is closely linked to an increased risk of DS, particularly in the elderly population. Notably, higher fat mass in the limbs (especially in the legs) is associated with greater odds of DS, while a higher android-to-gynoid fat mass ratio is associated with lower DS risk. Screening fat mass distribution in older individuals can be a valuable strategy for promptly diagnosing DS, implementing interventions to prevent disabilities, and improving their quality of life.

Association between depression and blood pressure in community-dwelling older adults: focus on Bushehr elderly health (BEH) program

INTRODUCTION

Depression and increased blood pressure are significant burdens in elderly care. This study was conducted to discover the association between hypertension (HTN) and depression based on data obtained from the Bushehr Elderly Health (BEH) program in a large population of Iranian elderly in Bushehr, southern Iran.

METHODS

This study was carried out based on data obtained from the Bushehr Elderly Health (BEH) program in a large population of Iranian elderly in Bushehr, a southern city in Iran. 2419 old adults were included in the study through multi-stage random sampling. Depression was assessed using Patient Health Questionnaire-9 (PHQ-9), and blood pressure was measured using a standard mercury sphygmomanometer. Statistical analysis was conducted via chai-square, analysis of variance (ANOVA), and univariate and multivariate linear regression tests.

RESULTS

The mean age of participants was 69.95 ± 6.95 years. The prevalence of depression was 23.8%. Diastolic blood pressure (DBP) decreased with increasing PHQ score (B=-0.001; 95%CI: -0.00 to -0.00, P-value = 0.011). In the final model adjusted for confounding variables, no significant association was found between depression score and DBP (B=-0.00; 95%CI: -0.00 to 0.00, P = 0.13). Conversely, in the final model, which included the confounding variable, SBP was significantly associated with depression. It was deduced that a variable acted as a negative confounder in this association; in a way that with increased depression score, SBP significantly decreased (B=-0.00; 95% CI: -0.00 to -0.00, P = 0.04).

CONCLUSION

Depression and its related medications could be significantly associated with controlled SBP. Health practitioners in primary health care centers must monitor the elderly inflicted with HTN for early symptoms of depression to help maintain blood pressure levels using medicinal and non-medicinal interventions.

Association of age-related declined renal function and osteoporosis based on trabecular bone score in Bushehr Elderly Health (BEH) program

PURPOSE

Osteoporosis is a systemic disease characterized by decreased bone strength and an increased risk of fracture in old age. Age and pathologic renal failure are independent risk factors for osteoporosis. However, it is not determined whether age-related decreased renal function, in the context of senescence, can be considered as an independent risk factor for osteoporosis. Therefore, this study was conducted to evaluate the effect of senescence-induced renal failure on bone quality and trabecular bone score.

METHODS

This study used a cross-sectional design and was carried out based on data collected during the Bushehr Elderly Health (BEH) program, Phase II. A total of 2,125 elderly participants aged over 60 years old entered the study after meeting the inclusion criteria and providing informed consent. They underwent examinations for weight, height, abdominal and hip circumference, as well as blood pressure measurement. All participants also underwent DXA to assess bone mass density (BMD). Trabecular bone score (TBS) was calculated using the DXA apparatus software output. Univariate and adjusted multivariate linear regression analyses were used to evaluate the associations.

RESULTS

In the univariate linear regression analysis, there was a direct correlation between age-related renal failure and TBS (β = 0.038, p < 0.0001), neck of femur BMD (β = 0.047, p < 0.0001), and lumbar BMD (β = 0.055, p < 0.0001). However, after adjusting for BMI, age, sex, smoking, and physical activity, no significant association was observed for these variables.

CONCLUSION

It is hypothesized that age-related renal failure cannot be considered as an independent risk factor for osteoporosis in elderly individuals aged over 60 years old.

Relationship Between Neck Circumference and Risk Factors of Metabolic Syndrome in a Bushehr Elderly Health Study

Metabolic syndrome includes a set of metabolic disorders such as obesity, high blood pressure, hypertriglyceridemia, lipid disorders, and glucose intolerance. In this cross-sectional (descriptive-analytical) study, 2,426 people were selected from the 60 years old and above population of Bushehr for a second-phase investigation of the relationship between neck circumference (NC) and cardiometabolic risk factors in the elderly people. The data (mean and standard deviation) were analyzed using STATA MP Version 15 software. The results of the study showed that the average age of all elderly participants in the study was 69.34 ± 6.39 years. The mean and standard deviation of the NC index in men, women, and all participants were 39.31 ± 2.89, 34.86 ± 2.84, and 37.00 ± 3.62, respectively. The mean and standard deviation of most laboratory indicators (triglyceride [TG], total cholesterol [TC], low-density lipoprotein [LDL], high-density lipoprotein [HDL]) were significantly higher in women, and there was no significant difference in fasting blood glucose (FBG) between men and women. NC index in the total population was significantly associated with all risk factors of metabolic syndrome (body mass index, systolic blood pressure, diastolic blood pressure) and laboratory indicators (FBG, TG, TC, LDLC, and HDL). The present study shows that the NC index can be a good predictor for the diagnosis of metabolic syndrome and visceral adipose tissue in the elderly.

Dietary Choline and Betaine Intake and Risk of Colorectal Cancer in an Iranian Population

BACKGROUND

Colorectal cancer (CRC) is increasing in low- and middle-income countries, likely due to changing lifestyle habits, including diet. We aimed to investigate the relationship between dietary betaine, choline, and choline-containing compounds and CRC risk.

METHODS

We analyzed data from a case-control study, including 865 CRC cases and 3206 controls from Iran. Detailed information was collected by trained interviewers using validated questionnaires. The intake of free choline, phosphocholine (Pcho), glycerophosphocholine (GPC), phosphatidylcholine (PtdCho), and sphingomyelin (SM), as well as of betaine was estimated from food frequency questionnaires and categorized into quartiles. The odds ratios (OR) and 95% confidence intervals (CI) of CRC for choline and betaine quartiles were calculated using multivariate logistic regression by adjusting for potential confounders.

RESULTS

We observed excess risk of CRC in the highest versus lowest intake of total choline (OR = 1.23, 95% CI 1.13, 1.33), GPC (OR = 1.13, 95% CI 1.00, 1.27), and SM (OR = 1.14, 95% CI 1.01, 1.28). The intake of betaine exerted an inverse association with CRC risk (OR = 0.91, 95% CI 0.83, 0.99). There was no association between free choline, Pcho, PtdCho, and CRC. Analyses stratified by gender showed an elevated OR of CRC in men for SM intake OR = 1.20, 95% CI 1.03, 1.40) and a significantly decreased CRC risk in women for betaine intake (OR = 0.84, 95% CI 0.73, 0.97).

CONCLUSION

Dietary modifications leading to an increase in betaine sources and managing the use of animal products as references for SM or other choline types might contribute to decreasing the risk of CRC.

Opium use and risk of lung cancer: A multicenter case-control study in Iran

Opium use was recently classified as a human carcinogen for lung cancer by the International Agency for Research on Cancer. We conducted a large, multicenter case-control study evaluating the association between opium use and the risk of lung cancer. We recruited 627 cases and 3477 controls from May 2017 to July 2020. We used unconditional logistic regression analyses to estimate the odds ratios (OR) and 95% confidence intervals (CI) and measured the association between opium use and the risk of lung cancer. The ORs were adjusted for the residential place, age, gender, socioeconomic status, cigarettes, and water pipe smoking. We found a 3.6-fold risk of lung cancer for regular opium users compared to never users (95% CI: 2.9, 4.6). There was a strong dose-response association between a cumulative count of opium use and lung cancer risk. The OR for regular opium use was higher for small cell carcinoma than in other histology (8.3, 95% CI: 4.8, 14.4). The OR of developing lung cancer among opium users was higher in females (7.4, 95% CI: 3.8, 14.5) than in males (3.3, 95% CI: 2.6, 4.2). The OR for users of both opium and tobacco was 13.4 (95% CI: 10.2, 17.7) compared to nonusers of anything. The risk of developing lung cancer is higher in regular opium users, and these results strengthen the conclusions on the carcinogenicity of opium. The association is stronger for small cell carcinoma cases than in other histology.

Opium Use and the Risk of Liver Cancer: A Case-Control Study

Limited evidence is available to acknowledge the association between opium use and liver cancer. In a case-control study, we recruited 117 cases of primary liver cancer (PLC) and 234 age and sex-matched neighborhood controls from 2016 to 2018. We calculated odds ratios (OR) for opium use and 95% confidence intervals (95% CI), using conditional logistic regressions. Compared with non-users the adjusted OR (AOR, 95% CI) for opium use was 6.5 (95% CI, 2.87-13.44). Compared with people who had no history of use, a strong dose-response effect of opium use was observed by amount of use (AOR, 10.70; 95% CI, 3.92-28.70). Cumulative use of opium also indicated that using over 30 gr-year could increase the PLC risk dramatically (AOR, 11.0; 95% CI, 3.83-31.58). Those who used opium for more than 21 years were highly at risk of PLC (AOR, 11.66; 95% CI, 4.43-30.67). The observed associations were significant even among never tobacco smokers (including cigarette and water-pipe smoking).

PREVENTION RELEVANCE

The results of this study indicate that opium use dramatically increased the risk of liver cancer. Because opioids are increasing for medical and non-medical use globally; accordingly, severe health consequences such as liver cancer have to be investigated widely.

Applications of different machine learning approaches in prediction of breast cancer diagnosis delay

Background

The increasing rate of breast cancer (BC) incidence and mortality in Iran has turned this disease into a challenge. A delay in diagnosis leads to more advanced stages of BC and a lower chance of survival, which makes this cancer even more fatal.

Objectives

The present study was aimed at identifying the predicting factors for delayed BC diagnosis in women in Iran.

Methods

In this study, four machine learning methods, including extreme gradient boosting (XGBoost), random forest (RF), neural networks (NNs), and logistic regression (LR), were applied to analyze the data of 630 women with confirmed BC. Also, different statistical methods, including chi-square, p-value, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC), were utilized in different steps of the survey.

Results

Thirty percent of patients had a delayed BC diagnosis. Of all the patients with delayed diagnoses, 88.5% were married, 72.1% had an urban residency, and 84.8% had health insurance. The top three important factors in the RF model were urban residency (12.04), breast disease history (11.58), and other comorbidities (10.72). In the XGBoost, urban residency (17.54), having other comorbidities (17.14), and age at first childbirth (>30) (13.13) were the top factors; in the LR model, having other comorbidities (49.41), older age at first childbirth (82.57), and being nulliparous (44.19) were the top factors. Finally, in the NN, it was found that being married (50.05), having a marriage age above 30 (18.03), and having other breast disease history (15.83) were the main predicting factors for a delayed BC diagnosis.

Conclusion

Machine learning techniques suggest that women with an urban residency who got married or had their first child at an age older than 30 and those without children are at a higher risk of diagnosis delay. It is necessary to educate them about BC risk factors, symptoms, and self-breast examination to shorten the delay in diagnosis.

Lung cancer risk in relation to jobs held in a nationwide case-control study in Iran

BACKGROUND

Globally, lung cancer is the most frequent occupational cancer, but the risk associated with the occupations or occupational environment in Iran is not clear. We aimed to assess occupations with the risk of lung cancer.

METHODS

We used the IROPICAN nationwide case-control study data including 658 incident lung cancer cases and 3477 controls. We assessed the risk of lung cancer in relation to ever working in major groups of International Standard Classification of Occupations, high-risk occupations for lung cancer and duration of employment and lung cancer subtype among construction workers and farmers while controlling for cigarette smoking and opium consumption. We used unconditional regression logistic models to estimate ORs for the association between increased lung cancer risk and occupations.

RESULTS

We observed elevated ORs for lung cancer in male construction workers (OR=1.4; 95% CI: 1.0 to 1.8), petroleum industry workers (OR=3.2; 95% CI: 1.1 to 9.8), female farmers (OR=2.6; 95% CI: 1.3 to 5.3) and female bakers (OR=5.5; 95% CI: 1.0 to 29.8). A positive trend by the duration of employment was observed for male construction workers (p< 0.001). Increased risk of squamous cell carcinoma was observed in male construction workers (OR=1.9; 95% CI: 1.2 to 3.0) and female farmers (OR=4.3; 95% CI: 1.1 to 17.2), who also experienced an increased risk of adenocarcinoma (OR=3.8; 95% CI: 1.4 to 9.9).

DISCUSSION

Although we observed associations between some occupations and lung cancer consistent with the literature, further studies with larger samples focusing on exposures are needed to better understand the occupational lung cancer burden in Iran.

Using machine learning in prediction of ICU admission, mortality, and length of stay in the early stage of admission of COVID-19 patients

The recent COVID-19 pandemic has affected health systems across the world. Especially, Intensive Care Units (ICUs) have played a pivotal role in the treatment of critically-ill patients. At the same time however, the increasing number of admissions due to the vast prevalence of the virus have caused several problems for ICU wards such as overburdening of staff and shortages of medical resources. These issues might have affected the quality of healthcare services provided directly impacting a patient's survival. The objective of this research is to leverage Machine Learning (ML) on hospital data in order to support hospital managers and practitioners with the treatment of COVID-19 patients. This is accomplished by providing more detailed inference about a patient's likelihood of ICU admission, mortality and in case of hospitalization the length of stay (LOS). In this pursuit, the outcome variables are in three separate models predicted by five different ML algorithms: eXtreme Gradient Boosting (XGB), K-Nearest Neighbor (KNN), Random Forest (RF), bagged-CART (b-CART), and LogitBoost (LB). With the exception of KNN, the studied models show good predictive capabilities when evaluating relevant accuracy scores, such as area under the curve. By implementing an ensemble stacking approach (either a Neural Net or a General Linear Model) on top of the aforementioned ML algorithms the performance is further boosted. Ultimately, for the prediction of admission to the ICU, the ensemble stacking via a Neural Net achieved the best result with an accuracy of over 95%. For mortality at the ICU, the vanilla XGB performed slightly better (1% difference with the meta-model). To predict large length of stays both ensemble stacking approaches yield comparable results. Besides it direct implications for managing COVID-19 patients, the approach presented serves as an example how data can be employed in future pandemics or crises.

Human Papillomavirus and Risk of Head and Neck Squamous Cell Carcinoma in Iran

Human papillomavirus (HPV) causes a subset of head and neck squamous cell carcinoma (HNSCC). Knowledge of determinants of α-, β-, and γ-HPVs types in the oral cavity is required for a better understanding of HNSCC development. Oral rinse samples of 498 HNSCC cases and 242 controls from the IROPICAN study-a large multicenter case-control study in Iran-were screened for 21 α-HPV, 46 β-HPVs, and 52 γ-HPVs using bead-based HPV genotyping assays. α-HPVs were detected only in 1.2% of the patients and 2.9% of the controls from which HPV16 was the most prevalent type among participants. β-HPVs were detected in 43.8% of the patients and 38.6% of the controls where the lip and oral cavity (45.5%) had the highest positivity. Values for γ-HPV prevalence in patients and controls were 26.1% and 24.7%, respectively. The highest percentage of γ-HPV positivity was found in the larynx (30.4%). Concerning the β genus, HPV23 and HPV38 were the most prevalent types among the patients and controls, respectively. For the γ genus, SD2 in cases and HPV134 in controls were the most prevalent types. Overall, detection of α-HPVs (aOR, 0.40; 95% CI = 0.1 to 1.2; P = 0.11), β-HPVs (aOR, 1.9; 95% CI = 0.9 to 1.6; P = 0.29), and γ-HPVs infections (aOR, 1.04; 95% CI = 0.7 to 1.5; P = 0.83) was not associated with the HNSCC development. Our data did not suggest an HPV-related etiology for HNSCC pathogenesis. Nonetheless, this study provides novel insights into the diversity of β-, and γ-HPVs in different HNSCC anatomical subsites. IMPORTANCE Infection with human papillomavirus (HPV) is responsible for a subset of neck squamous cell carcinoma (HNSCC), but knowledge of the prevalence of and risk factors for oral HPV infection, especially cutaneous types in Iran, remains unknown. In a large retrospective study, the authors used a sensitive assay for the detection of α-, β-, and γ-HPVs in oral rinse samples of HNSCC and matched controls. They find that the α-HPV contribution to HNSCC in Iran is lower than global prevalence. High-risk α-HPVs or cutaneous β- and γ-HPVs were not associated with the HNSCC development. Besides, this study provides novel insights into the diversity of β- and γ-HPVs in different HNSCC anatomical subsites.

Consumption of Yoghurt and Other Dairy Products and Risk of Colorectal Cancer in Iran: The IROPICAN Study

Background: There is evidence of an inverse association between yoghurt intake and risk of colorectal cancer (CRC). We aimed at investigating the association between the intake of yoghurt and other dairy foods consumed in Iran and CRC risk. Methods: Our analysis included 4070 subjects within the IROPICAN (Iran Study of Opium and Cancer) study. Detailed information was collected by the use of validated questionnaires. We estimated adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between the intake of total dairy products, and, separately, of yoghurt, milk, cheese, kashk, dough, cream, ice cream, and other milk products, and CRC using unconditional logistic regression analyses. The intake was categorized in tertiles. Results: Overall, we analyzed 865 cases and 3205 controls. Total dairy products intake was not associated with CRC. The OR for one tertile increase (OR_T) in yoghurt intake was 0.97 (95% CI 0.87–1.08) for CRC and 0.66 (95% CI 0.52–0.84) for proximal colon cancer. Cream intake was associated with CRC (OR_T3 = 1.33, 95% CI 1.08–1.64), colon (OR_T3 = 1.37, 95% CI 1.03–1.81), and proximal cancer (OR_T3 = 1.29, 95% CI 1.04–1.61). The OR of distal colon cancer for ice cream intake was 0.59 (95% CI 0.43–0.82). Other dairy products were not associated with CRC risk.

Opium use and risk of bladder cancer: a multi-centre case-referent study in Iran

BACKGROUND

Bladder cancer (BC) is the 10th most common type of cancer worldwide and the fourth most common type of cancer in Iran. Opium use is considered as one of the risk factors for BC. We aim to assess the association between various parameters of opium use, which in Iran is mainly ingested or smoked in various forms, and the risk of BC.

METHOD

In this multi-centre case-referent study in Iran, 717 BC cases and 3477 referents were recruited to the study from May 2017 until July 2020. Detailed histories of opium use (duration, amount, frequency) and potential confounders were collected by trained interviewers. Multivariable unconditional logistic regression models were used to measure adjusted odds ratio (OR) and 95% confidence intervals (CI). The ORs were adjusted for age, gender, place of residence and pack-years of cigarette smoking.

RESULTS

Regular opium consumption was associated with an increased risk of BC (OR 3.5, 95% CI: 2.8, 4.3) compared with subjects who never used opium. Compared with continuous users, the risk decreased to one-third for those who stopped opium more than 10 years ago. The adjusted OR for those who used both crude opium (teriak) and opium juice was 7.4 (95% CI: 4.1, 13.3). There was a joint effect of opium and tobacco (OR for users of both opium and tobacco 7.7, 95% CI: 6.0, 9.7).

CONCLUSIONS

Regular opium use is associated with an approximately 4-fold risk for BC. The OR decreases along with the increasing time since stopping opium use.

Association between platelet, white blood cell count, platelet to white blood cell ratio and sarcopenia in community-dwelling older adults: focus on Bushehr Elderly Health (BEH) program

BACKGROUND

Sarcopenia is a progressive age-related skeletal muscle disorder associated with harmful impacts on health. The present study aimed to investigate the relation between sarcopenia, platelet (PLT), white blood cell (WBC), and PLT to WBC ratio (PWR) due to the importance of early sarcopenia diagnosis.

METHODS

This cross-sectional study was conducted based on the second stage of the Bushehr Elderly Health (BEH) Program. Sarcopenia was defined based on the revised edition of the European Working Group on Sarcopenia in Older People (EWGSOP2) in accordance with the Iranian cut-off point. Univariate and adjusted multivariate logistic regression and linear regression were used to evaluate the associations.

RESULTS

The prevalence of sarcopenia among participants was 35.73%. PLT count and PWR were statistically higher in severe sarcopenic participants, while no differences were seen in WBC. In crude analysis, sarcopenia was not associated with quartiles of PLT, WBC, and PWR, while after adjusting for age, marital status, and sex, the association was seen in the fourth quartile of PLT and PWR [OR (95%CI) = 1.40 (1.08 to 1.81), p-value = 0.009 for PLT; OR (95%CI) =1.55 (1.20 to 2.00), p-value =0.001 for PWR]. This association remained significant in the fully adjusted model [OR (95%CI) =1.82 (1.20 to 2.78), p-value =0.005 for PLT; OR (95%CI) =1.57 (1.03 to 2.40), p-value =0.035 for PWR]. Among sarcopenia parameters, PLT count was more likely to be associated with handgrip strength and muscle mass. After stratifying the participants by gender, sarcopenia parameters were no longer statistically significant in men.

CONCLUSION

This study showed that PLT and PWR were associated with sarcopenia after considering confounding factors, while this association was not seen in WBC. Moreover, results showed that gender had an important impact on sarcopenia parameters.

The association between moral distress and mental health among nurses working at selected hospitals in Iran during the COVID-19 pandemic

BACKGROUND

In the event of an epidemic outbreak, the mental health of medical staff, including nurses who serve on the frontlines of hospitals, can be affected; thus, the identification of factors affecting nurses' mental health is of importance.

OBJECTIVE

This study aimed to examine the association between moral distress and the mental health of nurses working at four selected hospitals in Iran during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

A cross-sectional questionnaire survey was conducted on 296 nurses working at the selected hospitals in Bushehr and Shiraz (south of Iran) at the time of the COVID-19 outbreak. The collected data were analyzed via logistic regression analysis.

RESULTS

The mean scores for nurses' moral distress were low (54.31±24.84). The results of this study indicated more symptoms of mental issues among nurses (73.60%). Moreover, a significant association was observed between mental health and moral distress. Among the examined demographic variables, only gender had a significant association with mental health (p-value = 0.014).

CONCLUSION

The results of this study indicated that an increase in moral distress would lead to a significant increase in mental health issues of the examined nurses. Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of mental health, as well as providing adequate emotional and family support for nurses. Considering the intensifying role of gender in this association, timely interventions are necessary to reduce the negative effects of workplace pressure/stress on female nurses.

Induced genetic and chemical changes in medicinally important plant Catharanthus roseus (L.) G. Don: cold plasma and phytohormones

BACKGROUND

Catharanthus roseus (L.) G. Donis a medicinal plant species belonging to the Apocynaceae family, which produces vinblastine and vincristine along with 100 other monoterpenoid indole alkaloids. The process of biosynthesis of C. roseus alkaloids is complex, in which many genes, enzymes, and regulators are involved. Induced mutations may be considered as a potential source for producing a higher amount of vinblastine and vincristine in this plant species. Therefore, the objective of the present study was to examine the effects of different treatments utilized on the induced genetic changes in C. roseus plants and enzyme activities.

METHODS AND RESULTS

Spermine, jasmonic acid, methyjasmonate, putrescine, and cold plasma treatments were used for seed treatments. Different molecular markers, namely inter simple sequence repeat, inter retrotransposon amplified polymorphism, and retrotransposon microsatellite amplified polymorphism were employed to reveal the induced genetic changes. Antioxidant enzyme activities were also studied. The treated plants showed genetic variability and a significant increase in antioxidant enzyme activity compared to the control plants. The putrescine treatment resulted in the highest level of activity in superoxidase. A significant positive correlation occurred between the molecular markers data and antioxidant enzyme activities in treated plants.

CONCLUSION

Our data revealed that the different phytohormones and cold plasma treatments could induce both genetic and chemical content changes in C. roseus plants.

Prevalence of vitamin D deficiency and its associated risk factors among rural population of the northern part of the Persian Gulf

BACKGROUND

Accumulating evidence indicates that vitamin D deficiency has been increased globally over the last two decades. However, the majority of these studies are concerned with cities and there is scant information regarding the prevalence of vitamin D in rural areas. The main aim of this study was to investigate the prevalence of vitamin D deficiency and its associated risk factors among the rural population in Bushehr province which shares the longest border with the Persian Gulf.

METHODS

The rural inhabitants of more than 25 years old from three mountainous, plain, and seashore areas of Bushehr province were selected through a stratified multi-cluster random sampling method. After obtaining the participants' demographic and anthropometric data and their past medical history, serum 25-hydroxyvitamin D [25(OH)D] was measured using ELISA.

RESULTS

A total of 1806 (means ±SD, 46± 14years old) rural subjects (35 % males and 65 % females) participated in this study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 28 %, 50 %, and 22 %, respectively. The deficiency of vitamin D in women was higher than in men (OR=1.27, 95 % CI: 1.05 to 1.54, P=0.04). There was a positive significant correlation between age and serum vitamin D levels. Men with vitamin D deficiency had higher BMI (P=0.008); this association was not observed among women (P=0.7). There was no significant difference between the food item's consumption frequencies, and vitamin D status (P>0.05). The mountainous, and plain areas had the highest and lowest vitamin D levels, respectively.

CONCLUSIONS

Although, Bushehr province is located in a sunny part of Iran, the prevalence of vitamin D deficiency was high among its rural population. The shift of their lifestyle patterns and rapid industrialization in these rural areas may be responsible. Therefore, the enrichment of dietary sources with vitamin D and the use of vitamin D supplements are recommended to tackle the high prevalence of vitamin D deficiency in the rural population of the northern part of the Persian Gulf.

Opium use as an independent risk factor for pancreatic cancer: A case-control study

BACKGROUND

Pancreatic cancer (PC) is ranked as the seventh leading cause of cancer deaths worldwide. The current study was conducted to explore the correlation between the use of opium and its derivatives (opium) and PC in Iran.

METHODS

In this case-control study which was conducted in Kerman province, south east part of Iran; 176 patients with PC, and 352 healthy individuals as the control group were matched in terms of age, sex, and place of residence. A structured questionnaire including questions of opium usage, alcohol usage, cigarette smoking, and diet was used to collect the data. The relation between the use of opium and PC was adjusted for tobacco smoking, education, daily intake of fruit, vegetables, red meat, and hydrogenated fats and analyzed using the conditional logistic regression.

RESULTS

There was a positive relationship between the opium use and the increased risk of PC (Adjusted Odds Ratio (AOR) = 4.33, 95 % CI: 2.09-8.95), which was even stronger than its association with cigarette smoking (AOR = 1.67, 95 % CI: 0.86-3.24), although their difference was not statistically significant. A significant dose-response relation was detected between the use of opium; as the relation was stronger in heavy users (AOR low users = 4.93, 95 % CI: 1.79-13.54 and AOR heavy users = 5.10, 95 % CI: 2.10-12.35). Moreover, PC was higher among participants starting the use of opium at a younger age than those who started opium at an older age (AOR = 8.03, 95 % CI: 3.19-20.23).

CONCLUSION

This study demonstrated that opium use is associated with a high and strong risk of PC as an independent risk factor. Further studies should be done to reduce the use of opium in Iran and other world countries.

Geographic distribution and time trends of water-pipe use among Iranian youth and teenage students: A meta-analysis and systematic review

Water-pipe tobacco smoking is harmful to health, yet its rate of prevalence remains uncertain. Recent evidence has shown that the prevalence of water-pipe smoking among students is higher than in the general population. In this study, a systematic review of related literature on water-pipe use was conducted, and for this purpose, 76 articles were examined in the study. In this vein, geographic distribution and time trends of water-pipe consumption in Iran were considered. The results of this study showed that lifetime, last-year, and last-month prevalence of water-pipe smoking use among Iranian students were 28.78 (25.07-32.49), 20.84 (16.01-25.66), and 16.36 (11.86-20.85), respectively. The results also showed a wide variation by the region and sex in Iran. This study has shown the importance of addressing public prevention and alerting programs in schools and universities.

Correction: Sensitivity of self-reported opioid use in case-control studies: Healthy individuals versus hospitalized patients

[This corrects the article DOI: 10.1371/journal.pone.0183017.].

Association between anemia, physical performance and cognitive function in Iranian elderly people: evidence from Bushehr Elderly Health (BEH) program

Background and objectives

The present study aimed to investigate the relation between anemia and hemoglobin (Hgb) concentration, physical performance, and cognitive function in a large sample of Iranian elderly population.

Methods

Data were collected from Bushehr elderly health (BEH) program. A total of 3000 persons aged ≥60 years were selected through multistage random sampling. Hemoglobin values lower than 12 and 13 g/dL were considered as anemia for women and men, respectively. The cognitive function was measured using the Mini-cog test and Category fluency test (CFT), and the physical function was measured using handgrip strength (muscle strength), Relative handgrip strength (RHGS), and 4.57-m usual gait speed. Univariate and adjusted multivariate logistic regression and linear regression with Stata MP (version 15) were run, and a p-value of < 0.05 was used as statistically significant for all analyses.

Results

Among participants, 7.43% were anemic, and 115 (51.57%) simultaneously had anemia and cognitive disorder. There were significant associations between red blood cell count (RBC), hemoglobin (Hgb), platelet count (PLT), and hematocrit percentage (HCT) with cognitive impairment. Additionally, Hgb concentration was significantly associated with all physical measures (Mean handgrip, Relative handgrip, and usual gait speed) and late recall (mini-cog) among the whole participants. This association remained statistically significant after considering multi-cofounders. In contrast, after stratifying the participants by gender, the association between Hgb concentration and usual gait speed was decreased in both men and women; moreover, Hgb association with cognitive measures (category fluency test and late recall) was no longer significant (all p-values > 0.05).

Conclusion

There was a cross-sectional and significant association between anemia and functional variables (e.g., Relative and mean handgrip) in Iranian elderly population, whereas Semantic memory, Late recall, and walking were more affected by gender.

Opium use reporting error in case-control studies: neighborhood controls versus hospital visitor controls

Background: There are relatively scant data to determine whether hospital visitors could serve as a proper source of controls in case-control studies of illicit drug use. The aim of this study was to evaluate using neighborhood versus hospital visitor controls in reporting opium use. Methods: We used data from 2 independent case-control studies of cancer in Iran. In the first study, controls were selected from neighborhoods of the patients. For the second one, controls were selected from among hospital visitors. In the latter study, hospital visitors were companions of the patients or others visiting the hospital for reasons other than disease treatment. We used stata (version 12; Stata Corp( for all analyses and with a significance level of 0.05. Results: Data from 616 of neighborhood controls and 414 of hospital visitor controls were analyzed. Opium point prevalence among men was significantly higher in hospital visitors than neighborhood controls (43.3% vs 32.2%; P = 0.047), while the prevalence of cigarette smoking was very similar in both control groups (46.3% vs 47.2%; P =.847). Using a logistic regression analysis, in an unadjusted analysis, neighborhood controls were less likely to report opium use in both genders, with (unadjusted OR = 0.77; 95% CI: 0.59,1). After adjusting for potential confounders, the differences of opium use between the 2 control groups became more pronounced (Adjusted OR = 0.26; 95% CI: 0.10, 0.69). Conclusion: Because of the similarity of reporting cigarette smoking among neighborhood controls but substantially lower reporting of opium use among them, we concluded that neighborhood controls underreport opium use-a sensitive question- and that using neighborhood control biases the findings in case-control studies. Hospital visitor controls may be more appropriate than neighborhood controls for case-control studies of illicit drugs.

Environmental fate of cigarette butts and their toxicity in aquatic organisms: A comprehensive systematic review

Cigarette butts (CBs) are the most frequently littered pieces of environmental wastes which are released both directly and indirectly into the environment and finally may reach aquatic environments and contaminate aquatic biomes. However, to date, there is no comprehensive review on the extent and magnitude of the potential effects of CBs on aquatic organisms. Hence, a systematic review of published studies was conducted in this paper to survey the fate of CBs in the aquatic environments and also the impacts of exposure to CBs on survival, growth, and reproduction of aquatic organisms. The gathered data showed that the leachates of CBs in the aquatic environment could extremely be toxic for various organisms and increasing the exposure time, increases the mortality rate. In addition, smoked filtered CBs with tobacco remnants have higher mortality rate compared to unsmoked filtered butts (USFs) for Hymenochirus curtipes, Clarias gariepinus, tidepool snails, Atherinops affinis and Pimephales promelas. The fate of CBs in the aquatic environments is affected by various factors, and prior to sinking they are floated for a long time (long distance). Hence, CBs and their associated toxic chemicals might be ingested by diverse aquatic organisms. However, further studies are necessary to understand the exact toxicity of CBs on different freshwater and marine organisms and also their fate in the aquatic media. The results of this review showed the essentiality of regulations to prevent the release of chemical and toxic compounds into the aquatic environments.

Perceived discrimination and subjective well-being among Middle Eastern migrants in Australia: The moderating role of perceived social support

BACKGROUND

Middle Eastern (ME) migrants are vulnerable to developing mental health problems due to pre-migration and post-migration traumas and stresses. The evidence on the subjective well-being of ME migrants and its contributing factors is limited and inconclusive.

OBJECTIVES

The aim of this study is to examine the moderating role of perceived social support in the association between perceived discrimination and subjective well-being, after controlling for socio-demographic factors.

METHOD(S)

This cross-sectional survey study was conducted in Queensland, Australia. A total of 382 first-generation young adult ME migrants, aged between 20 to 39 years, completed a self-administered questionnaire. To analyse data, a series of three hierarchical multiple regression (HMR) analyses were conducted, one for each of the subjective well-being components (i.e., positive affect, negative affect, and satisfaction with life). The interaction between perceived social support and perceived discrimination for the prediction of subjective well-being components was further explored using simple slope analysis.

RESULTS

Gender was found to be a significant predictor of positive and negative affect. Education was found to predict satisfaction with life, but not positive and negative affect. Married migrants were found to have significantly higher life satisfaction, positive affect and lower negative affect. Perceived social support had a moderating role in the association between perceived discrimination and subjective well-being.

CONCLUSION

Considering the buffering role of perceived social support against the adverse effects of perceived discrimination on subjective well-being, organizations and individuals working with ME migrants should acknowledge the significance of social support and improve their capacity to deliver effective and appropriate social support services to migrants experiencing discrimination.

Opium use and the risk of head and neck squamous cell carcinoma

Scant evidence exists to support the association of opium use with head and neck cancer, limited to the larynx and oral cavity. In a multicenter case-control study-Iran Opium and Cancer study, we recruited 633 cases of head and neck squamous cell carcinoma (HNSCC) (254 lip and oral cavity, 54 pharynx, 327 larynx and 28 other subsites within the head and neck) and 3065 frequency-matched controls from April 2016 to April 2019. Odds ratios (ORs) for opium use and 95% confidence intervals (95% CIs) were obtained using mixed-effects logistic regression because of heterogeneity among centers. The adjusted OR (95% CI) for regular opium use was 3.76 (2.96-4.79) for all HNSCC combined. Strong dose-response effects were observed by frequency or amount of use, and duration of use. Regular opium uses significantly increased the risk of HNSCC of the pharynx, larynx and other subsites within the head and neck with OR (95% CI) of 2.90 (1.40-6.02), 6.55 (4.69-9.13) and 5.95 (2.41-14.71), respectively. The observed associations were significant even among never tobacco smokers (including cigarette and water-pipe smoking). Moreover, by the multiplicative interaction scale, the effect of opium use could be varied by cigarette smoking on HNSCC, 8.16 (6.20-10.74). For the first time, the current study showed opium users have an increased risk of several anatomic subsites of HNSCC.

The Iranian Study of Opium and Cancer (IROPICAN): Rationale, Design, and Initial Findings

BACKGROUND

The International Agency for Research on Cancer (IARC) recently classified opium use as a Group 1 carcinogen. However, much remains to be studied on the relation between opium and cancer. We designed the Iranian Opium and Cancer (IROPICAN) study to further investigate the association of opium use and cancers of the head and neck, bladder, lung, and colon and rectum. In this paper, we describe the rationale, design, and some initial results of the IROPICAN Study.

METHODS

The IROPICAN is a multi-center case-control study conducted in 10 provinces of Iran. The cases were all histologically confirmed and the controls were selected from hospital visitors who were free of cancer, were not family members or friends of the cancer patients, and were visiting the hospital for reasons other than their own ailment. The questionnaires included detailed questions on opium use (including age at initiation, duration, frequency, typical amount, and route), and potential confounders, such as tobacco use (e.g., cigarettes, nass and water-pipe), and dietary factors. Biological samples, including blood and saliva, were also collected.

RESULTS

The validation and pilot phases showed reasonably good validity, with sensitivities of 70% and 69% for the cases and controls, respectively, in reporting opium use. The results also showed excellent reliability, with intra-class correlation coefficients of 0.96 for ever opium use and 0.88 (95% CI: 0.80, 0.92) for regular opium use. In the main phase, we recruited 3299 cancer cases (99% response rate) and 3477 hospital visitor controls (89% response rate). The proportion of ever-use of opium was 40% among cases and 18% among controls.

CONCLUSION

The IROPICAN study will serve as a major resource in studies addressing the effect of opium on risk of cancers of the head and neck, bladder, lung, and colon and rectum.

Is opium use associated with an increased risk of lung cancer? A case-control study

Background

In recent years, lung cancer (LC) incidence has increased in Iran. The use of opium and its derivatives (O&D) has increased as well. This study aimed to investigate the association between the use of O&D and LC incidence.

Methods

In this case-control study conducted in Kerman, Iran; 140 patients with lung cancer and 280 healthy controls matched by age, sex, and place of residence were included. Data, including O&D use, cigarette smoking, alcohol use, and diet, were collected using a structured questionnaire. The relation between the use of O&D and LC was evaluated using conditional logistic regression adjusted for tobacco smoking, education, daily intake of fruit, vegetables, red meat, and hydrogenated fats.

Results

Opium ever-use was associated with an increased risk of LC (Adjusted Odds Ratio (AOR) =5.95, 95% CI: 1.87–18.92). Participants were divided into low and high use groups based on the median of opium use in the control group. A significant dose-response relation was observed between the amount of daily O&D use and LC; and the relation was stronger in high users (AOR _{low users} = 3.81% CI: 1.13–12.77 and OR _{high users} = 9.36, 95% CI: 2.05–42.72). Also, LC was higher among participants starting the use of O&D at younger ages (≤ 41 years old vs never users AOR = 8.64, 95% CI: 1.90–39.18) compared to those who started at an older age (> 41 years old vs never users, AOR = 4.71, 95% CI: 1.38–16.08). The association between opium, and lung cancer among non-smokers was OR: 6.50 (95% CI: 2.89 to 14.64).

Conclusion

The results of this study show that opium use is probably a dose related risk factor for lung cancer.

The prevalence of asthma in adult population of southwestern Iran and its association with chronic rhinosinusitis: a GA2LEN study

Background

Asthma is recognized as a major public health concern in the world. The aim of this investigation was to evaluate the prevalence of asthma by using the Global Allergy and Asthma Network of Excellence (GA²LEN) questionnaire and examine its association with chronic rhinosinusitis, in the province of Bushehr, Southwestern of Iran.

Methods

In a cross-sectional, population-based study, a total of 5420 invited individuals, aged 15–65, were selected through a multi-stage, stratified, cluster random sampling and from which 5201 completed the GA²LEN questionnaire (response rate = 95.9%). The prevalence of asthma, current, and physician-diagnosed asthma were analyzed by using sex and age groups and the association of asthma and chronic rhinosinusitis (CRS) was investigated using a multiple logistic regression model.

Results

Based on the information from the GA²LEN questionnaire, the overall prevalence of asthma in the population under study was 10.0% (95% CI 9.2–10.8). Moreover, the prevalence of current asthma was 8.9% (95% CI 8.1–9.7). Further, the prevalence of current early, late-onset and physician-diagnosed asthma within the asthma group was 51.1% (95% CI 46.5–55.7), 48.9% (95% CI 44.3–53.5) and 3.9% (95% CI 2.1–2.5), respectively. Additionally, CRS was more frequent among the participants with asthma [(57.3%, OR = 2.3; 95% CI 2.1–2.5)], and there was a significant association between CRS and current, early and late-onset of asthma (P < 0.001; OR = 4.4, 3.2 and 6, respectively).

Conclusion

This large population study conducted in the southwestern part of Iran suggests that the prevalence of asthma is high. Moreover, the result of this study showed a strong association of asthma with CRS; also after adjusting for sex, age, educational level, and smoking.

National Study of Opium and Cancer in Iran (IROPICAN): Study Protocol and Results of the Pilot Phase

Background: Several epidemiologic studies have reported that opium consumption is associated with higher risk of cancer and may indeed cause cancer. However, most of these studies were not primarily designed to study the effect of opium on cancer. Therefore, control selection and data collections methods were not optimized for this purpose. Aim: We designed a large multicenter case-control study to specifically investigate the association between opium use and risk of 4 cancer types (i.e., lung, bladder, head and neck and colorectal cancers). We will recruit 800 cases and 800 controls for each cancer in this project. Methods: So far we have collected 70% of the cases and controls. We report here the study protocol and results of the pilot phase. Results: During the pilot phase, we determined that hospital visitors are the most appropriate type of controls; 185 cases and 176 controls were enrolled. Controls are matched to cases for sex, age and place of residence. Collection of data using a comprehensive questionnaire, focused on measuring use of opium and its derivatives, was feasible. Underreporting of opium was estimated to be 30% among controls. Collection of other data, including data tobacco and alcohol use, and nutritional data using a food frequency questionnaire, was feasible. Biologic samples including blood and saliva sample were collected from cancer cases and controls. Results of the pilot phase and validation study were used to optimize the full study protocol and questionnaires. Conclusion: The pilot phase of the study showed that the study is feasible, the best method of control selection is from hospital visitors, and both questionnaire and biologic samples can be collected. In addition of the results from pilot phase, preliminary results from the main phase of this study will be presented.

Number of HIV-infected cases in Iran: True or just an iceberg

Background:

The number of HIV cases in Iran is increasing. Knowledge of the changing epidemiology of HIV is fundamental for service planning and prevention activities. This study aims to estimate the number of HIV-infected cases by the capture and recapture method for size estimation.

Materials and Methods:

From 2002 to 2009, we used three different centers – hospitals, the Voluntary Counseling and Testing (VCT) center, and a central prison in Fars Province for data retrieval. The overlaps between these centers were investigated to determine the true estimate of HIV cases. Finally, interactions were analyzed by a linear logarithm model with STATA version 9 software.

Results:

We observed 5167 HIV cases. The number of males was ten times more than that of females. The most frequent age range was between 15 and 44 years. The majority of cases (n = 3347) were retrieved from the VCT center. The least number of infected persons were located in the prison and hospitals. The estimated number of cases in Fars Province was 14,925 from 2002 to 2009. The best model consisted of three sources.

Conclusion:

Covering the system of medicine deputy for registering the number of infected cases with HIV is poor in Iran. Improvements in making arrangements for enhancing the quality of data related to HIV-infected cases are essential for solving this problem and must be on the agenda for medical policymaking.

Completeness of cancer registry data in a small Iranian province: A capture–recapture approach

Background and Objective:

The incidence of cancer is rising in Iran, and hence it is important to assess the accuracy of the Iranian cancer registry dataset. In this study, the completeness of the cancer registry in the Kohgiluyeh and Boyer-Ahmad (K&B) province is evaluated.

Method:

The data of registered cases of cancer of people who were living in the K&B province at the time of diagnosis were obtained from the provincial cancer registry offices in K&B, Fars and all other neighbouring provinces. A capture–recapture method along with log-linear statistical modelling were used for analysis.

Results:

The results indicated that of 2029 known cases of cancer, only 1400 (31%) were registered by the K&B cancer registry office. Age-adjusted incidence rates for all common types of cancer rose from 307.0 per 100,000 (95% confidence interval (CI); 293.8, 320.3, based on observed cases) to 376.4 per 100,000 (95% CI; 361.7, 391.1, based on expected number of cases estimated by capture–recapture analysis) ( p < 0.01). The completeness of cancer registry data varied significantly for different types of cancer.

Conclusion:

Results suggest that the provincial cancer dataset, which is a part of the national cancer registry programme, is neither complete nor representative. A major improvement in case finding, registry procedures and effective data sharing by provincial cancer registry offices is needed in order to provide valid data for epidemiology of cancer in Iran.

Effects of Dexamphetamine and Music on Reversal Learning

Background:

Reversal learning has proven to be a valuable task in assessing the inhibitory process that is central to executive control. Psycho-stimulants and music are prevalent factors that influence cognition.

Objectives:

The present study aimed at investigating the influences of dexamphetamine and music on inhibitory control.

Materials and Methods:

This experimental study was conducted between May and June 2014 in the laboratory animal center of Shiraz University of Medical Sciences, Shiraz, Iran. Thirty mice were divided to five groups including a control group, a witness group, and three experimental groups. Food availability was restricted in order to maintain the subjects at 85% of their free-feeding body weight for behavioral testing. After discrimination learning, animals received four injections of 2 mg/kg dexamphetamine at two-hour intervals. The music group was exposed to music half an hour before reversal learning.

Results:

According to the results of the repeated measure analysis of variance (ANOVA), music increased errors (mean difference: -2.40, 95% CI: -3.59 to -1.22), yet dexamphetamine had no significant effect on reversal learning. Due to various advantages, we transited to the mixed model that showed increasing (Beta: 2.2 95% CI: 0.26 to 4.13) and borderline (Beta: 1.8 95% CI: -0.13 to 3.73) effects on the number of errors for dexamphetamine and music group, respectively.

Conclusions:

Drug-treated subjects were impaired in their ability to modulate behavior, based upon changing information about stimulus-reward associations, possibly due to the inability to inhibit their response. These effects may have relevance to some mental disorders such as drug-abuse, schizophrenia, and obsessive-compulsive disorder.

The Evaluation of Curative Effect of Acupuncture

The present study attempts to critically evaluate previously published research articles on the efficiency of acupuncture in the treatment of diseases. First, 35 systematic reviews or meta-analysis were found in the Cochrane database. Second, 54 related articles were selected by searching important scientific databases. Based on the results obtained regarding the efficacy of acupuncture for the treatment of various diseases, the articles were divided into 3 groups. The first group of articles confirmed the efficacy of treatment by acupuncture. In the second group of articles, the therapeutic effect of acupuncture was shown; however, further research is required to verify the results. In the third group of articles there is no evidence regarding the therapeutic effect of acupuncture till now. There is an urgent need to design and conduct double-blinded randomized clinical trials with high-quality methodologies. This provides a more careful evaluation of acupuncture efficiency in relation to the treatment of a vast array of diseases, based on scientific evidence.

Completeness and underestimation of cancer mortality rate in Iran: a report from Fars Province in southern Iran

BACKGROUND

The incidence and mortality rates of cancer are increasing worldwide, particularly in the developing countries. Valid data are needed for measuring the cancer burden and making appropriate decisions toward cancer control. We evaluated the completeness of death registry with regard to cancer death in Fars Province, I. R. of Iran.

METHODS

We used data from three sources in Fars Province, including the national death registry (source 1), the follow-up data from the pathology-based cancer registry (source 2) and hospital based records (source 3) during 2004 - 2006. We used the capture-recapture method and estimated underestimation and the true age standardized mortality rate (ASMR) for cancer. We used log-linear (LL) modeling for statistical analysis.

RESULTS

We observed 1941, 480, and 355 cancer deaths in sources 1, 2 and 3, respectively. After data linkage, we estimated that mortality registry had about 40% underestimation for cancer death. After adjustment for this underestimation rate, the ASMR of cancer in the Fars Province for all cancer types increased from 44.8 per 100,000 (95% CI: 42.8 - 46.7) to 76.3 per 100,000 (95% CI: 73.3 - 78.9), accounting for 3309 (95% CI: 3151 - 3293) cancer deaths annually.

CONCLUSION

The mortality rate of cancer is considerably higher than the rates reported by the routine registry in Iran. Improvement in the validity and completeness of the mortality registry is needed to estimate the true mortality rate caused by cancer in Iran.