Cancer Visibility among Iranian Familial Networks: To What Extent Can We Rely on Family History Reports?

Unawareness of breast cancer family history among African women

Introduction

comprehensive cancer risk assessment services are lacking in most sub-Saharan African countries and the use of accurate family history (FH) information could serve as a cheap strategy for risk evaluation. The aim of this study is to determine the proportion of women unaware of family history of cancer among female relatives and associated socio-demographic characteristics.

Methods

using case-control data on breast cancer among 4294 women in Nigeria, Uganda and Cameroon, we investigated the proportion of women unaware of family history of cancer among their female relatives. The association between participants' response to their awareness of female relatives' cancer history and socio-demographic characteristics was analysed according to case-control status, family side and distance of relation. Results: the proportion of women unaware if any relative had cancer was 33%, and was significantly higher among controls (43.2%) compared to 23.9% among cases (p<0.001) (Adjusted Odds Ratio (OR) = 2.51, 95% CI = 2.14 - 2.95). Age, education and marital status remained significantly associated with being unaware of FH among controls on multiple regression.

Conclusion

about a third of women interviewed did not know about cancer history in at least one of their female relatives. Efforts aimed at improving cancer awareness in sub-Saharan Africa (SSA) are needed. Our findings could be useful for future studies of cancer risk assessment in SSA.

Estimating the Size of Hidden Groups

NSU studies have been applied in different countries. For example, this technique has been used in the United States to estimate the number of women who had been raped in the last year.

Minor Head Trauma and its Short-term Outcomes Among Elderly Patients: a Prospective Epidemiological Study in North of Iran

Introduction

Traumatic brain injury (TBI) is of the most challenging public health problems.

Aim

The aim of this study was to investigate the epidemiology of mild TBI, frequency of clinically important head injuries identifiable on computed tomography (CT) scans and also short-time outcomes of mild TBI in elderly population in north of Iran.

Patients and Methods

A prospective epidemiological study was conducted at the Emergency department of Imam Khomeini general hospital, Mazandaran, Iran. Inclusion criteria were age older than 60, Glasgow coma scale (GCS) score of 13-15, and a single head trauma. Data were collected by retrospective chart review, interview with patients or their caregivers and contact with them after a week from time of discharge or transferring to another wards.

Results

Response rate was estimated at 67.8% (n: 122/180). Mean age of patients was 65.54±6.42 years. 82% of patients were younger than 70. Mean time from head trauma to hospital admission was 270 minutes. In majority of patients, mechanism of trauma was fall (28%) and then interpersonal violence (25%). 6.6% (95% CI: 2.87 to 12.5%) of patients suffered from important radiologically head injuries and 2.5% (95% CI: 0.5-7.00) were readmitted to hospital within a week.

Conclusion

Time to admission for minor TBI in elderly patients was too long and could be of clinical concern. Considering the lower prevalence of important radiologically head injury among elderly population, using any clinical guideline for indication of CT scan may be more cost-effective than routine use of CT scan. Although short term outcomes of minor TBI were less threatening and not lethal but these patients need follow-up.

Methodological considerations in using the Network Scale Up (NSU) for the estimation of risky behaviors of particular age-gender groups: An example in the case of intentional abortion

Background

Network Scale Up (NSU) is a promising tool for size estimation of sensitive issues. In this study we investigated the important methodological considerations to employ this method for estimating behaviors, such as abortion, which happens in a particular age-gender group.

Methods

We recruited 1250 males and 1250 females aged 18 to 50. Abortion rate was calculated through direct question and NSU methodology. The NSU was applied on three sub-samples (male, female and aggregate). Integrating replies to 25 reference groups, we estimated the network size (C) of respondents and its age-gender structure. To calculate the part of network that is subject to abortion, we compared two approaches: proportional and data based. The Visibility Factor (VF) was calculated through 222 females who had abortion. Direct estimate was considered as gold standard.

Results

Using C’s derived from proportional method, the Relative Bias (RB) in the male and female samples was 33% and 84%. Applying the data-based C’s, the RB in the gender-specific and aggregate samples was 5% and 2%.

Conclusion

The proportional method overestimates the prevalence. The data-based method to calculate the C is superior. The determination of the age-sex distribution of the network and the specific VF is essential.

Stigma and Related Factors in Iranian People with Cancer

Introduction: Stigma is one of the psychosocial and intercultural issues that can be found in chronic diseases, including cancer. Stigma may reduce communication due to social isolation, feeling shame and others’ judgment, and these factors make far from professional services and poor health outcomes in individuals with cancer. Assessment of stigma can help determine and recognize the overall levels of stigma in the community and identify situations that need intervention. Objective: The aim of this study was to determine stigma and related factors in individuals with cancer in Iran. Methods: This descriptive cross-sectional study was conducted on 142 patients with cancer selected via convenience sampling method in two hospitals affiliated to Shahid Beheshti Medical University. A demographic as well as clinical record form and “A questionnaire for measuring attitudes toward cancer (cancer stigma) ‑ Patients version” by Cho et al., (2013) were used for data collection. Data were analyzed using descriptive statistics and regression analysis. Results: More than one quarter of participants (26.1%) had negative attitudes toward cancer and high stigma score>= 2.5. More than half of the participants (57.5%) agreed that their job performance would be reduced even after treatment. 54.5% of the patients considered it difficult to regain health after being diagnosed. There was a significant correlation between the stigma score and the level of education (p= 0.033, OR=0.78). Conclusion: The results showed that stigma in dimensions of impossibility of recovery and stereotypical aspects of cancer were more common. These findings can lead to interventions and educational efforts on cancer coherence which may help in treatment, rehabilitation and return to normal life.

A review of methods to estimate the visibility factor for bias correction in network scale-up studies

Network scale-up is an indirect size estimation method, in which participants are questioned on sensitive behaviors of their social network members. Therefore, the visibility of the behavior affects the replies and estimates. Many attempts to estimate visibility have been made. The aims of this study were to review the main methods used to address visibility and to provide a summary of reported visibility factors (VFs) across populations. We systematically searched relevant databases and Google. In total, 15 studies and reports that calculated VFs were found. VF calculation studies have been applied in 9 countries, mostly in East Asia and Eastern Europe. The methods applied were expert opinion, comparison of NSU with another method, the game of contacts, social respect, and the coming-out rate. The VF has been calculated for heavy drug users, people who inject drugs (PWID), female sex workers (FSWs) and their clients, male who have sex with male (MSM), alcohol and methamphetamine users, and those who have experienced extra-/pre-marital sex and abortion. The VF varied from 1.4% in Japan to 52.0% in China for MSM; from 34.0% in Ukraine to 111.0% in China for FSWs; and from 12.0% among Iranian students to 57.0% in Ukraine for PWID. Our review revealed that VF estimates were heterogeneous, and were not available for most settings, in particular the Middle East and North Africa region, except Iran. More concrete methodologies to estimate the VF are required.

Estimating the visibility rate of abortion: a case study of Kerman, Iran

OBJECTIVES

Abortion is a sensitive issue; many cultures disapprove of it, which leads to under-reporting. This study sought to estimate the rate of abortion visibility in the city of Kerman, Iran-that is, the percentage of acquaintances who knew about a particular abortion. For estimating the visibility rate, it is crucial to use the network scale-up method, which is a new, indirect method of estimating sensitive behaviours more accurately.

MATERIALS AND METHODS

This cross-sectional study was conducted in Kerman, Iran using various methods to ensure the cooperation of clinicians and women. A total of 222 women who had had an abortion within the previous year (74 elective, 74 medical and 74 spontaneous abortions) were recruited. Participants were asked how many of their acquaintances were aware of their abortion. Abortion visibility was estimated by abortion type. 95% CIs were calculated by a bootstrap procedure. A zero-inflated negative binomial regression analysis was conducted to assess the variables related to visibility.

RESULTS

The visibility (95% CI) of elective, medical and spontaneous abortion was 8% (6% to 10%), 60% (54% to 66%) and 50% (43% to 57%), respectively. Women and consanguineal family were more likely to be aware of the abortion than men and affinal family. Non-family members had a low probability of knowing about the abortion, except in elective cases. Abortion type, marital status, sex of the acquaintance and closeness of the relationship were the most important determinants of abortion visibility in the final multifactorial model.

CONCLUSIONS

This study shows the visibility rate to be low, but it does differ among social network members and by the type of abortion in question. This difference might be explained through social and cultural norms as well as stigma surrounding abortion. The low visibility rate might explain the low estimates of abortion rates found in other studies.

The Burden of Care: Mothers' Experiences of Children with Congenital Heart Disease

BACKGROUND

Mothers play a key role in caring for their sick children. Their experiences of care were influenced by culture, rules, and the system of health and care services. There are few studies on maternal care of children with congenital heart disease. Also, each of them has studied a particular aspect of care. The present research aimed to understand care experiences of mothers of children with congenital heart disease.

METHODS

A conventional content analysis was used to obtain rich data. The goal of content analysis is "to provide knowledge and deeper understanding of the phenomenon under the study". The study was conducted in Kerman, Iran in 2014, on mothers of children with CHD. The purposive sampling technique was used to select the participants. Participants were 14 mothers of children with CHD and one father and one nurse of open heart surgery unit, from two hospitals affiliated with Kerman University of Medical Sciences. Eighteen semi-structured interviews were constructed. Data were analyzed using conventional content analysis. MAXQDA 2007 software (VERBI GmbH, Berlin, Germany) was used to classify and manage the coding. Constant comparative method was done for data analysis. The reliability and validity of the findings, including the credibility, confirm ability, dependability, and transferability, were assessed.

RESULTS

According to the content analysis, the main theme was the catastrophic burden of child care on mothers that included three categories: 1) the tension resulting from the disease, 2) involvement with internal thoughts, and 3) difficulties of care process.

CONCLUSION

The results of this study may help health care professionals to provide supportive and educational packages to the patients, mothers and Family members until improving the management of patient's care.