Evaluation of parametric models by the prediction error in colorectal cancer survival analysis

The aim of this study is to determine the factors influencing predicted survival time for patients with colorectal cancer [CRC] using parametric models and select the best model by predicting error's technique. Survival models are statistical techniques to estimate or predict the overall time up to specific events. Prediction is important in medical science and the accuracy of prediction is determined by a measurement, generally based on loss functions, called prediction error. A total of 600 colorectal cancer patients who admitted to the Cancer Registry Center of Gastroenterology and Liver Disease Research Center, Taleghani Hospital, Tehran, were followed at least for 5 years and have completed selected information for this study. Body Mass Index [BMI], Sex, family history of CRC, tumor site, stage of disease and histology of tumor included in the analysis. The survival time was compared by the Log-rank test and multivariate analysis was carried out using parametric models including Log normal, Weibull and Log logistic regression. For selecting the best model, the prediction error by apparent loss was used. Log rank test showed a better survival for females, BMI more than 25, patients with early stage at diagnosis and patients with colon tumor site. Prediction error by apparent loss was estimated and indicated that Weibull model was the best one for multivariate analysis. BMI and Stage were independent prognostic factors, according to Weibull model. In this study, according to prediction error Weibull regression showed a better fit. Prediction error would be a criterion to select the best model with the ability to make predictions of prognostic factors in survival analysis

impact of training on women's capabilities in modifying their obesity- related dietary behaviors: applying family-centered empowerment model

Dietary behaviors affect obesity; therefore, it seems necessary to conduct inter-ventions to modify behavioral patterns leading to weight-gain in the family. Our goal was to de-termine the impact of training on women's capabilities in modifying their obesity-related dietary behaviors in Urmia, West Azerbaijan Province, Iran: applying family-centered empowerment model. A quasi-experimental study with Pretest-Posttest design was conducted on 90 over-weight/obese women in 2012 in two Health Centers of Urmia. Convenience sampling was done and the participants were randomly assigned to two 'test' and 'control' groups. Data collection was done by completing the demographic data questionnaire, the empowerment tool and dietary behavior checklist. The intervention was conducted in the form of 6 educational classes held for the 'test' group. After two months, posttest was performed by completing the forms once again. Data were analyzed with descriptive tests, t-tests, Chi2 and Fisher's test. The dietary behavior scores of the intervention group had risen from 7.4 +/- 2.11 to 9.95 +/- 2.41 [P<0.001], and the good dietary behaviors had risen from 21.4% to 61.9% [P=0.002]. The 'good' capability level of this group had risen from 23.8% to 97.61% [P<0.001], and their mean capability score had risen from 54.61 +/- 7.34 to 70.26 +/- 6.04 [P<0.001]. However, the changes were not significant in the control group. The educational intervention performed whit applying family-centered empowerment model in this study was proven effective in women. Hence it is advised to consider it in behavior changing interventions to promote the health of the family and community.

Changes in daily activities of cancer patients after diagnosis: how do canadian and Iranian patients perceive the change?

Being diagnosed with cancer has major impacts on a patient's life. This study was conducted to explore how specific daily activities of patients change as a result of cancer diagnosis or its treatment and how these patients feel about such changes. This was a cross-sectional descriptive study. Cancer patients referred to our clinics and by completing a questionnaire, they reported their daily activities and how they changed after diagnosis. A total of 201 patients in Canada and 167 patients in Iran completed the questionnaire. The research setting was the outpatient cancer clinics of the Jewish General Hospital in Montreal, Canada [February to April 2008] and Imam Reza Hospital and Ghaem Hospital in Mashhad, Iran [March to August 2008]. More than 40 percent of the patients reported changes after the diagnosis in at least 8 out of 22 daily activities listed in the questionnaire. While a negative perception towards the changes was more common, some patients also perceived some changes as positive. More than half of the participants [56.9%] who were employed at the time of diagnosis experienced changes in the amount or type of their paid work after being diagnosed with cancer. The impact of a cancer diagnosis and treatment on a patient's daily activities is drastic. There is a need to provide support and interventions to help patients maintain daily activities they need and/or like. Further studies are needed to better understand the nature of such interventions

[Application of random effect model for determining factors affecting FTT in less than 2 years children in east of Tehran]

Failure To Thrive [FTT] is the delay or suspension in child growth; not dealing with this disorder may lead to more serious consequences like increased death rate, appearance of other relevant diseases, reduced learning, and mental, emotional, or physical disabilities. Given the serious symptoms of failure to thrive in children's future, this paper tries to identify and investigate factors affected in FTT. The study population included children below 2 years old visiting the Health Center of East Tehran from which 1660 infants using two-stage cluster sampling method were selected according to the input criteria [not suffering from any particular disease at birth, and having regular visit to health centers]. After gathering data from the first two years of the infants' lives, factors associated with FTT using SAS software and Random Effect Regression Model were analyzed. Mean age [ +/- SD] of mothers at birth time was 27.3 +/- 5.46 years and 46% [764] of the mothers had an education lower than high school diploma but there was no significant relationship between mothers' education and FTT [p = 0.290]. Mean weight [ +/- SD] of children at birth was 3202 +/- 463.03 g and 5.1% [85] of them were born with underweight [2500g] and 68.1% [1130] of the children were affected by FTT at least in one period. Factors associated with diarrhea, infection, teething, nourishment, weaning, and other diseases had significant role in causing FTT [p < 0.05], out of which the cause of diarrhea was the most likely factor. In addition, the model's random section became significant [p < 0.05]. Given the abundance and graveness of the symptoms of this disorder in child's future and the high likelihood of occurrence of this disorder among infants below 2 years, a strong need is felt to deal with this impairment. Given the significance of the random effect, the known causes alone are not enough for prediction of FTT among infants and genetic and environmental factors play a role in occurrence of FTT as well

[Effect of apple consumption on lipid profile and oxidative stress indices among hyperlipidemic men]

This study was conducted to evaluate the effect of apple consumption on lipid profile and oxidative stress indices among hyperlipidemic men. We performed an experimental study on 46 hyperlipidemic men [Total Cholesterol [TC]=200-240 mg/dl, Triglyceride[TG]=150-350mg/dl] aged 30-50 years who were randomly divided into two [apple and control] groups. The apple group [23 subjects] received 300 gr of whole apple per day [Golden delicious] for 8 weeks. Control group [23 subjects] had the regular dietary pattern for the same period of time. Blood samples were collected at baseline and after intervention [after 8 weeks] and analyzed for serum TG, TC, LDL-C, HDL-C and plasma oxidative stress indices of Malondialdehyde [MDA] and Total Antioxidant Capacity [TAC] level. Before study, education level and family size were compared in both the groups. Before and after intervention, physical activity and dietary intake were compared between the two groups. Both total polyphenol and total fiber in the consumed apples were measured. Total polyphenol and total fiber were 485 mg/kg fresh apple and 4.03 gr/100 gr fresh apple, respectively. Chi square and t-tests with SPSS V.16 were used for data analysis. After 8 weeks, mean different TG concentrations increased significantly in apple group as compared to control group; however, no significant differences were observed in regards to TC, LDL-C, HDL-C, MDA and TAC level between the two groups. Consumption of Golden delicious apple may increase serum TG concentration in hyperlipidemic men. However, we need more studies to study the effect of Golden delicious apple on serum TC, LDL-C, HDL-C concentrations and plasma MDA and TAC indices

[Disease-free survival of breast cancer patients and identification of related factors]

Breast cancer is the most common cancer among women especially in eastern Mediterean region. Disease-free survival is common to evaluate the treatment of cancers. Several factors have been determined as prognostic factors for disease-free survival in studies. In this cross-sectional study, during 2005-2007, 153 women with breast cancer were treated in Fayazbakhsh hospital, Tehran. These patients had no metastasis at the time of diagnosis. Patients underwent MRM or BCS surgery. All patients followed until 2011 April. Metastases were diagnosed with x-ray, Biochemical methods, ultrasound with oncologist confirmation. A Cox's regression with time to first event variable was used to determine the prognostic factors. Kaplan-Myer method was used to estimate the survival function. All statistical methods ran in R software version 2.10. Out of 133 patients, 25[18.8%] died and 108[81.2%] were alive. Out of alive patients, 99[74.4%] without metastasis and 9 patients[6.8%] experienced a metastasis. Using Kaplan-Myer estimation showed that disease-free survival was 64 months, and five years rate of disease-free was 72 percent. Increasing in disease-free survival was associated with low grade of tumor, low number of involved lymph nodes, ER negative and HER2 negative. Odds ratio of metastasis or death for HER2 positive was 2.46 times of HER2 negative. Patients with grade 3 had risk of metastasis 1.69-fold of grade2. The result of this study showed that HER2, ER, Grade and number of involved lymph nodes were prognostic factors. Age, size of tumor and PR were not identified as prognostic factors

[Comparing three adjuvant chemotherapy regimes after modified radical mastectomy in breast cancer patients using log-logistic model]

Chemotherapy after surgery is one of the adjuvant therapy components in breast cancer patients. In the current study, Taxane-based and Anthracycline-based regimes were compared to Cyclophosphamide, Methotrexate and 5-Fluorouracil [CMF] chemotherapy after modified radical mastectomy [MRM] surgery in terms of disease-free survival [DFS]. Sixty-two patients with confirmed breast cancer that underwent MRM surgery at no metastasis stage [M0] enrolled. These patients were received one of the three types of adjuvant chemotherapies that mentioned above and the relapse/metastasis in 8-year follow-up was recorded. In addition, some paraclinical and demographical factors were recorded and the efficacy of the different chemotherapy regimes was compared using log-logistic survival model. The mean age [SD] of patients was 49 [1.31]. More than 40% of patients had tumors with grade 3. The median time of follow-up was 20.0 months and the rate of 5-year DFS was 48%. Survival analysis indicated that type of chemotherapy [OR [Taxane/CMF] =3.676; OR [Anthracycline/CMF]=3.185], histological grade [OR=2.528], tumor size [OR=5.598] and number of lymph nodes [OR=1.112] affect the DFS. The results of the current study indicated that the efficacy of Taxane-based and Anthracycline-based is more than CMF. This study also showed that early detection of tumor was an important factor for a successful treatment in terms of DFS, and so, it declares the roll of screening and public education

Performance assessment of Hasheminejad hospital in 2007 according to the The Baldrige Criteria for Performance Excellence

The Baldrige Criteria for Performance Excellence provide a systems perspective for understanding performance management. They reflect management practices against which an organization can measure itself. The Criteria have been accepted internationally as the model for performance excellence. This descriptive cross-sectional study was performed at Hasheminejad hospital, a training hospital of Iran University of Medical Science And Health Services, in Tehran. Members of the study team interviewed the Hospital administrator and senior managers according to the standard global Malcolm Baldrige questionnaire and documented the data. 7 criteria were used for performance assessment. This hospital got 426 points from a maximum of 1000 [42.6%]. Of 426 point, 46 [37% of maximum point] was for leadership criteria, 38 [44%] for strategic planning, 41 [50%] for focus on patients and other costumers, 40 [44%] for criteria of data assessment, analysis and management, 43 [51%] for focus on personnel, 33 [39%] for process management and 185 [41%] for function of organization. Baldrige model can be used as comprehensive model for assessing the performance of training hospitals. By using this model, managers can find strengths and weaknesses of organizations and then use this model for performance improvement